Uro Mcq
A/E of zoladex
Hot flashes (flushing), dizziness, headache, increased sweating, decreased sexual interest/ability, trouble sleeping, nausea, change in breast size.
Absolute indication for TRUS of prostate in BPH
Biopsy
Painless ulcer on the glans - cause
Syphilis Chlamydia Granuloma
DTPA scan
Tells you the difference in function between the two kidneys Radionuclide test Diethylenetriamine Pentaacetic Acid
Management of priapism - high flow
Watch and wait, they usually resolve on their own. If they don't, Pudendal arteriogram and embolization or surgical ligation should follow.
Treatment of acute epididymorchitis < 35 yo
ceftriaxone 200mg IM stat doxycycline 100mg PO 10days
DM Surface Area
checks the renal SHAPE
A 42-year-old diabetic man presents with history of curvature of his penis for 1 year and is unable to have successful intercourse with his partner. What is the most probable diagnosis?
Peyronie's disease
Cacuss of struvite stones
Proteus Klebsiella Pseudomonas
What are the relative Indications for TURP in BPH
failure of medical therapy recurrent cystitis bladder calculi persistent prostatic bleeding
Suprapubic pain, cigarette smoking. What is the likely diagnosis?
genitourinary Malignancy - probs TCC of the bladdeer
Patient is found to have a cyst on ultrasound after routine check-up, what would prompt you to investigate further
solitary kidney multiple cysts other symptoms like haematuria if it looks like the one with worms in it Can't remember it.
. Which of the following UTIs is a common risk factor for squamous cell carcinoma of the bladder? A Staphylococcus aureus B Schistosomiasis C Escherichia coli D Proteus mirabilis E All of the above
Schistosomiasis
Management after first-line (a1 receptor antagonists) failed in chronic obstruction due to BPH. surgery. PDE5, 2 more
surgery
What are the absolute Indications for TURP in BPH
urinary retention (intractable) renal insufficiency (caused by BPO-benign prostatic obstruction)
Patient with an iodine allergy. What imaging studies can you do?
non contrast CT KUB X-ray KUB,
Treatment of acute epididymorchitis > 35 yo
ofloxacin 300mg PO b/d 10days
With the foreskin: A Pathological phimosis is more common than physiological phimosis B It is always retractile at birth C BXO does not usually occur until after the age of 5 years D Removal has no role in the prevention of infection E Must be removed under general anaesthetic
BXO does not usually occur until after the age of 5 years. It is well documented that the foreskin is adherent to the glans at birth with the majority becoming retractile by the age of 5 years. In babies, circumcision is performed under local anaesthetic.
Young male with cysteine kidney stone, what is most true they are softer stones family history plays a role can be dissolved with medical management Cystine stones are caused by a rare, inherited disorder called "cystinuria."
Cysteine stones are caused by a rare inherited disorder called cystinuria. It mentions both family history and it is rare. Therefore it is the most likely answer. They are not softer stones, they in fact often require ECSWL.
Features of TB infection on the urogenital system
Cystitis that doesn't respond to antibiotics Haematuria Flank pain due to ureteric stricture 🡪 hydronephrosis Renal failure (if bilateral) Constituinal symtoms uncommon 3 x early morning samples for acid fast bacilli On urethrogram - Parenchymal calcifications, moth eaten calyces, cavities in renal parenchyma Strictures
Best investigation for vesicovaginal fistula
Cystoscopy ??
A 64-year-old woman presents with a 1 week history of visible haematuria, dysuria and bothersome lower urinary tract symptoms (LUTS). What is the most likely diagnosis?
Dysuria is a classic symptom of urinary tract infections which also commonly cause LUTS. However, any episode of visible haematuria in a woman of this age warrants thorough investigation for an underlying cause, after treating the acute infection (e.g. bladder outlet obstruction) with chronic urinary retention or diabetes mellitus.
What is the most likely urological dysfunction following a CVA?
Detruser overactivity
Which of the following factors increases the risk of infection? A A urinary pH of 6.0 B Lactobacilli colonisation of external genitalia C Antegrade urinary flow in urethra D Spinal cord injuries E All of the above
E
Organism of simple cystitis of the bladder
E coli
Causative organism in simple cystitis
E coli, P mirabilis, K pneumoniae
Which of the following is NOT a feature of hypospadias? A Ventral chordee B Hooded foreskin C Dorsally placed meatus D Proximal meatus
Dorsally placed meatus (seen inepispadias)
Cystinuria - Microscopy
Hexagonalcystals
Which of the following pathologies can cause prerenal failure? A Advanced prostate cancer B Contrast-induced nephropathy C Diabetic nephropathy D Hypovolaemic shock due to haemorrhage E Bladder cancer
Hypovolaemic shock due to haemorrhage
What is the pharmacological management of prostate cancer? Options: testosterone, LH agonist, LH antagonist, something else)
LH antagonists and agonists Zoladex is a GnRH agonist, which stands for gonadotropin-releasing hormone agonist. It's the commonly used drug for prostate cancer in SA.
MAG3
MAG=MAKE. Therefore checks kidneys ability to make urine(renal function)
Inhibitors of stones
Magnesium and citrate
Which isn't a Feature of hypospadias Proximal meatus Meatus fibrosis Ventral curve of the penis Dorsal hood of the dore skin
Meatus fibrosis
What is the best management in a 28 (I think) year old man who presents with a solid, painless testicular mass?
Orchidectomy by inguinal incision. Not scrotal incision as that can cause seeding
DTPA
P is for Perfusion and PHiltration
A man presents with a hard, enlarging lump in his left testicle. Examination suggests possible testicular cancer. Which lymph nodes does testicular cancer spread to first?
Para-aortic
Which of the following factors increases the risk of infection? A A urinary pH of 6.0 B Lactobacilli colonisation of external genitalia C Antegrade urinary flow in urethra D Spinal cord injuries E All of the above
Spinal cord injuries
ndescended testes: A Are most commonly bilateral B Are associated with a patent processus vaginalis C Need immediate correction D Should be diagnosed by ultrasound E Should be diagnosed by CT scan
Are associated with a patent processus vaginalis
Cystinuria - Treatment
Urine alkalisation potassium citrate and acetazolamide dietary salt and animal protein restriction Thiol containing compounds Penicillamine Tiopronin
Drug class of oxybutinin
antocholonergic/antimuscarinic
Adverse Effects of Oxybutinin
dry mouth blurred vision dry eyes nose Skin stomach pain Constipation Diarrhea nausea heartburn
Male with recent UTI treated with antibiotics, what is the cause of epididymo-orchitis in him?
e.coli or c. trachomatis depending on sexual history.
Patient presents with fever, tachycardia, increased BP, hydronephrosis and pain radiating to the groin - management
infection causing retention or obstruction First need to relieve pressure catheterise and then urine MC and S likely a complicated UTI aminoglycosides, fluoroquinolone, cephalosporine, co-amoxiclav
Before inflation of a balloon catheter, what should one make sure
make sure that it sits comfortably at the hilt
Treatment of a stricture, 1 cm and patient has never had other procedure done
optical urethrotomy visual internal urethotomy if <2cm (endoscopically cut the stricture, rate of recurrence 30-80%) >2cm needs reconstruction with buccal mucos
Scan to see the difference between pelvis and uretopelvix junction
retrograde pyelogram
Second most common cause of vesicourinary infection in children
H influenza and pseudomonas
Organisms splitting urea are
Proteus Pseudomonas Klebsiella Staphylococcus Mycoplasma
Surgical options for strictures-
1Direct Vision Internal Urethrotomy, 2Dilatation, 3Open surgery with stricture removal reconnection and reconstruction, 4 use of grafts: Urethroplasty(buccal and penile)
A silicone catheter can stay in situ for: A 1 month B 14 days C 7 days D 3 months E 6 months
3 months
What situation would you do resection of BPH
>85g = open surgery 50-80g = transurethral resection of the prostate Recurrent ahematuria Prev prostate surgery Cardiac disease bc the meds cannot be used
Which of the following is NOT a sign of a urethral injury? A Blood at the urethral meatus B Perineal bruising/haematoma C High riding prostate D Haematuria E Haemodynamic instability
Haemodynamic instability
Management of priapism - low flow
Aspiration of the corpus cavernosum, Phenylephrine injection, IV and analgesia. Surgery: Distal shunting or radio distal/proximal shunt
Cystinuria - Genetics
Autosomal recessive
During evaluation a patient is found to have detrusor-sphincter dysynergia (DSD). This finding suggests that the neurological lesion lies:
Between the pons and sacral spinal cord DSD is a sign of a supra-sacral lesion, which is caused by a lesion between the pons and L5 spinal segment. This leads to bladder overactivity and sphincter spasticity, which can cause abnormally high bladder pressures.
The name of the snail in schistosomiasis
Bulinus africanus -Planorbidae Planorbidae Intermediate host
What imaging studies to not do when pt allergic to iodine
CT KUB X ray kub
Cystinuria - Colour of stones
Compact,yellow Waxy
4mm stone - uti symptoms. Treat with antibiotics and wait for stone to pass DJ stent ESWL
DJ stent
Which of the following is NOT a baseline investigation for ED?
ECG
A 62-year-old woman presents to the GP with intermittent loin to groin pain and visible haematuria. She had also recently been admitted to hospital with acute pancreatitis. What is the likely cause?
Excess parathyroid hormone results in increased release of calcium from the bone matrix, increased calcium reabsorption by the kidney and increased renal production of 1,25-dihydroxyvitamin D3 (calcitriol), which increases intestinal absorption of calcium. Primary hyperaparthyroidisim is common in postmenopausal women. Excessive renal calcium excretion causes renal calculi and hypercalcaemia can cause several symptoms including muscle weakness, polyuria, polydipsia, dehydration, hypertension, anorexia; nausea and vomiting; constipation; acute pancreatitis.
Immediately following a T4 spinal cord injury, the bladder is most likely to behave in which of the following ways?
Fill at low pressure, no detrusor contractions, unable to empty The patient will be in a state of 'spinal shock'. The patient will have no visceral or somatic reflexes. Over the next few weeks to months these will return. The bladder initially therefore fills, usually at low pressure, but cannot mount a contraction in order to empty. The patient usually requires some form of catheterisation (either intermittent or indwelling) in the initial period following a spinal injury. The behaviour of the bladder following the return of reflexes depends on the level of spinal cord injury.
Urodynamic studies- why are they performed?
For suspected urinary incontinence
Fournier's gangrene is uniquely associated with which of these signs?
Gas formation between tissue planes Urine cultures are normally negative
Patient with features of kidney stone, most appropriate investigation:
Gold standard imaging is CT without contrast.
Which of the following is TRUE in erectile dysfunction (ED)? A There is no role of checking serum glucose and lipid profile in ED investigations B PDE-5 inhibitors can be given safely with nitrate medications C If a man experiences nocturnal penile erection, but cannot achieve erection for intercourse, he is likely to have psychogenic ED D Afferent information travels from penile ischiocavernosus and bulbocavernosus muscles to Onuf's nucleus (S2-4) E The dorsal penile and pudendal nerves carry the efferent fibres to the spinal cord at S2-4 level
If a man experiences nocturnal penile erection, but cannot achieve erection for intercourse, he is likely to have psychogenic ED
Which of the following can distinguish a penile fracture from superficial dorsal vein rupture?
Immediate detumescence Superficial dorsal vein rupture is a rare condition which can mimic penile fracture. Both conditions present with a grossly swollen and bruised penis, often following sexual intercourse. Penile fracture is typically accompanied by a snapping or popping sound and immediate detumescence whereas dorsal vein rupture is not.
Immediate detumescence Superficial dorsal vein rupture is a rare condition which can mimic penile fracture. Both conditions present with a grossly swollen and bruised penis, often following sexual intercourse. Penile fracture is typically accompanied by a snapping or popping sound and immediate detumescence whereas dorsal vein rupture is not.
Improved serum testosterone Hormonal function will not usually be altered by surgical exploration. Reduction in anti-sperm antibodies is a theoretical benefit that can have an impact on future fertility. Scrotal haematomas can be dramatic, and can subsequently become infected. Large haematomas can compromise testicular viability.
Treatment for suspected testicular cancer (scrotal biopsy, transscrotal removal, repeated exams, orchidectomy, there may have been a different one. Can't remember this question too well).
Orchidectomy
79-year-old man presents with a 3-month history of a slowly enlarging red lump on his glans penis. He has no voiding difficulty and is not circumcised. His foreskin is fully retractile and otherwise normal. What is the most likely diagnosis?
Penile squamous cell carcinoma The most common cancer to affect the penis is squamous cell carcinoma. Risk factors include not being circumcised, manual labour (presumed through the chronic irritation of dirt from a labourer's hands). Sexually transmitted viral infection also pre-disposes, similarly to cervical cancer. Penile adenocarcinoma is rare. Penile melanoma is rare as it is commonly related to sun exposure and usually presents with a pigmented lesion. BXO usually presents with a phimosis and is a pre-malignant condition which usually warrants circumcision.
Patient has a background history of gout. Now presenting with right flank pain. What is the most appropriate investigation to determine if the patient likely has uric acid stones?
Person said Urine pH but I think urine microscopy or uric acid levels in the pee or blood
A 64-year-old man presents with a 2-month history of painless visible haematuria, hypertension, weight loss, pyrexia and anaemia. What is the most likely diagnosis?
Renal cancer Haematuria has many causes; however, the symptoms described are those of paraneoplastic syndrome, seen in up to 30% of renal cancer cases.
A 79-year-old man presents with a 3-year history of voiding LUTS (poor stream, incomplete emptying, hesitancy) and a 3-month history of hip and lower back pain which is worse at night. His adjusted serum calcium is 2.9 mmol/L (reference range 2.25-2.5 mmol/L). What is the most likely diagnosis?
Prostate cancer Metastatic prostate cancer is the most likely diagnosis in this scenario. Renal cancer can also metastasise to bone but not typically to the hip. A digital rectal examination, prostate-specific antigen (PSA) and bone scan should be performed to confirm the diagnosis of prostate cancer. However, a prostate biopsy would not routinely be required in this man. A peripheral nervous system examination is important to exclude spinal cord compression from bony metastases and a post void residual bladder scan (ward or clinic based bedside ultrasound machine) will also exclude chronic retention secondary to bladder outlet obstruction.
What bacteria can produce struvite stones
Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas species and Staphylococcus aureus
A patient presents with metastatic renal cell carcinoma. Which of the following is most likely to be part of the management: chemo, radiation, cryotherapy, immunotherapy?
RCC is chemo and radioresistant so therefore treat with cryotherapy??? Someone said - Radiation is most likely to be part of management, followed by immunotherapy and cryotherapy.
120gram prostate and 10x10x8cm bladder stone, management?
Radical prostatectomy open uro
Haematuria is a known side effect of which tuberculosis medication?
Rifampicin inhibits bacterial DNA-dependent RNA synthesis by inhibiting bacterial DNA-dependent RNA polymerase. Side effects of treatments for tuberculosis can be remembered via the following: Ethambutol - Eyes are affected; optic neuritis. Rifampicin - Red/Orange Metabolites. Pyrazinimide - HePatotoxicity, joint pain. Isoniazid - also known as isonicotinylhydrazine (or INH) - Peripheral Neuropathy, Hepatitis, three letters INH - SLE (systemic lupus erythematosus) like symptoms.
Which of the following is TRUE about the treatment of ED? A The PDE-5i are initiators of erection and usually do not require sexual stimulation B Alprostadil has lower success rate up to 30% in the treatment of ED C Fibrosis is not a complication of intracavernous injection treatment D PDE-5i are not the first line of treatment E Sildenafil and vardenafil have been associated with visual abnormalities
Sildenafil and vardenafil have been associated with visual abnormalities
. Which of the following is NOT an indication for renal imaging? A Visible haematuria B Systolic blood pressure >90 mmHg since the injury and non-visible haematuria C Rapid deceleration injury D Suspected renal trauma in a child E Penetrating trauma
Systolic blood pressure >90 mmHg since the injury and non-visible haematuria
Infective cause of haematuria
TB Bilharzia cystitis, pyelonephritis, interstitial nephritis, post-infective glomerulonephritis (post URTI), urethritis, prostatitis.
Which of the following is TRUE in ED? A The cavernous artery is the branch of inferior vesical artery B Tadalafil is effective after 30 minutes after administration and its efficacy is maintained for up to 36 hours and is affected by food C If oral therapy fails surgical implantation of a penile prosthesis is the treatment of choice D ED is not associated with hyperprolactinaemia E Chronic diseases are included in reversible causes of ED
Tadalafil is effective after 30 minutes after administration and its efficacy is maintained for up to 36 hours and is affected by food
Which of the following drugs does NOT cause renal failure? A Gentamicin B Lithium C Tamsulosin D Amphotericin B E ACE inhibitor
Tamsulosin
Which of these features least describes the symptoms and signs of autonomic dysreflexia? A Hypertension B Bradycardia C Profuse sweating (above the level of injury) D Flushed appearance (above the level of injury) E A lesion at the level of T4
The correct answer is A. In autonomic dysreflexia there is sympathetic overactivity. This leads to hypertension, pounding headache, bradycardia, sweating and flushing, and can occur in supra-sacral lesions above the level of T6.
most common testicular ca in Adults
The most common type of testis cancer in ADULTS is a germ cell tumor. There are two main types of GCT: seminoma nonseminomatous germ cell tumors (NSGCT). Both seminoma and NSGCT occur at about the same rate, and men can have seminoma, NSGCT or a combination of both.
Which of the following is NOT a cause of ED? A Tricyclic antidepressants B Parkinson's disease C 5-alpha reductase inhibitors D Trimethoprim E Radical prostatectomy
Trimethoprim
What is required for diagnosis of infection stones
Urea splitting bacteria High PH Ammonia presence
A 70-year-old man with no past medical history suffers a cerebrovascular accident (CVA). He experiences symptoms of hesitancy, poor flow, incomplete bladder emptying, urgency and frequency. What would be the ideal next step?
Urodynamic evaluation Overall, the patient describes symptoms of bladder outflow obstruction which would indicate most likely prostatic obstruction. However, before embarking on a definitive procedure one must eliminate any evidence of detrusor overactivity that may be causing his symptoms, as if this is present any outlet surgery can worsen the patient's symptoms.
A 71-year-old man presents with a 6-month history of visible haematuria and bothersome LUTS. He denies dysuria. He is a heavy smoker (80 year pack history). What is the most likely diagnosis?
Urothelial bladder cancer There are many possible explanations for his symptoms. However, from this list, bladder (urothelial) cancer is the most likely cause of his symptoms. Bladder cancer must be excluded in any patient with this history. Adenocarcinoma is less common and typically results from a congenital remnant of the urachus. Benign prostatic enlargement causing bladder outlet obstruction (BOO) and incomplete bladder emptying with or without ensuing recurrent urinary tract infections is another possible explanation.
What are the tumour markers in testicular cancer? Non-cellular: B-HCG, AFP Cellular: LDH and GGT What scan would you use to identify the difference between the Pelvic and Uteropelvic junction? The gold-standard for a stone is a non-contrast CT KUB. During surgery, a retrograde pyelogram can be used.
a | macroscopic caseating lesions on the kidney surface; b | macroscopic caseating lesions in renal parenchyma('moth-eaten' due to papillary necrosis) AKA putty kidney. c | microscopically: granuloma with central caseous necrosis and giant cells; d | End-stage renal tuberculosis. Gross pathological specimen of the kidney, depicting extensive destruction of renal tissue and lobar caseation. e | Contrast-enhanced CT image: infundibular stenosis resulting in a non-opacified dilated upper calyx. f | Distal Ureteric strictures and small capacity bladder.
A 22-year-old medical student has recently returned from his elective in Africa and is complaining of fever, abdominal pain and blood in the urine. What is the likely causative organism?
chistosomiasis also known as bilharzia is a type of infection caused by parasites that live in fresh water, such as rivers or lakes. Parasite eggs can be released into the water from infected humans in urine or stool. These can survive in water for up to 7 days. Once the eggs hatch, the larvae that is released attaches into tissue of freshwater snails if present. It matures into cercaria and then, after 4-6 weeks, leaves the snail and if it comes into contact with human skin, burrows in and then develops into schistosomules. These are able to move around the body through the blood vessels, eventually reaching the organs of the abdomen. About 4-6 weeks after infection, the schistosome is mature, the males and females mate, and the female worm starts to lay eggs. Some of these eggs remain in organs close to the adult worms where an immune reaction occurs, some remain in the body and move through the blood to other organs, and some pass out in urine and faeces, allowing the life cycle to begin again. Direct infection from human to human does not occur. Adult worms can remain active for 5 years or more, and there may have been cases where worms have lived in a human host for up to 30 years. The female worm will continue to lay eggs throughout her lifespan. Schistosomiais is prevalent in tropical and sub-tropical areas, especially in poor communities without access to safe drinking water and adequate sanitation. Symptoms include fever, headache, fatigue, arthralgia, abdominal pain, cystitis and haematuria. If the central nervous system is infected, seizures, urinary incontinence and peripheral neuropathy can occur. Treatment is normally with a single dose of praziquantel.
Renal cell carcinoma- what wouldn't be a symptom/ caused by RCC?
classic triad of occurs in less than 15% of patients palpable mass Haematuria flank pain 10%-40% of patients with this disease will develop a paraneoplastic syndrome.
Anterior wall vagina prolapse 4cm past hymen on standing. Which is false. Examine on standing another one could only be cytocoele could be cytocoele, uterus or enterocoele.
could only be cytocoele
Struvite stones are formed by
urinary tract infection with urease producing bacteria that splits urea to ammonium increases urine pH to neutral or alkaline values.