Genitourinary

Question 1

What are 5α-reductase inhibitors used for? Give an example of a 5α-reductase inhibitors.

Answer 1

BPH;

Finasteride (5mg/d po)

Question 2

Alpha blockers are used to treat BPH. Give four examples of this type of drug

Answer 2

Tamsulosin, alfuzosin, doxazosin, terazosin

Question 3

What is nephrotic syndrome?

Answer 3

Nephrotic syndrome is defined by the presence of proteinuria, oedema, hyperlipidaemia, and hypoalbuminaemia.

(It has serious complications and must be on the differential diagnosis for any patient presenting with new-onset oedema).

Question 4

What effect do the following have on micturition:

a) The sympathetic system
b) The parasympathetic system

Answer 4

• The sympathetic NS relaxes the detrusor muscle of the bladder (urinary retention)
• The parasympathetic NS causes contraction of detrusor (i.e. stimulates micturition)

Question 5

Which drugs commonly cause urinary retention?

Answer 5

Any drugs with antimuscarinic effects:

• TCAs: Amitriptyline, Imipramine
• Antihistamines: Cetirizine, Chlorpheniramine
• Drugs used to treat urinary incontinence e.g. Tolterodine and Oxybutynin

Question 6

Which electrolyte disturbances can cause nephrogenic diabetes insipidus?

Answer 6

Hypokalemia and Hypercalcemia

Question 7

What scrotal lump does this presentation describe:
History - A painless swelling in the scrotum.
Onset gradual or sudden.
Examination -A scrotal swelling which you can get above. The testis cannot be palpated separate to the swelling. The lump transilluminates.

Answer 7

Hydrocele

Question 8

Name a congenital cause of a hydrocele

Answer 8

Patent processus vaginalis (PPV)

Question 9

What type of testicular tumours is alpha-fetoprotein raised in?

Answer 9

Nonseminomatous germ cell tumors e.g. teratoma

Question 10

What is orchidopexy?

Answer 10

Surgery to move an undescended testicle into the scrotum and permanently fix it there. Orchidopexy also describes the surgery used to resolve testicular torsion.

Question 11

Which pathogens are most likely to cause epididymo-orchitis in patients:

a) > 35 years?
b) <35 years?

Answer 11

In men > 35 years of age, urinary tract pathogens such as Escherichia coli are most likely.

Younger men, sexually active: chlamydia trachomatis and N. gonorrhoeae

Question 12

What is a scrotal swelling which you CANNOT get above indicative of?

Answer 12

An INDIRECT inguinal hernia