Genitourinary Conditions Investigations

Question 1

Nephrolithiasis - Investigations (3/2)

Answer 1

initial 1) kidney, ureter, bladder x-ray (KUBXR) (80%) 2) urine dipstick (blood) 3) UnE (cause) consider 1) non-contrast CT kidney, ureter, bladder* (NCC-KUB) (99%) (18 months radiation dose) 2) abdominal ultrasound (rare acutely)

Question 2

Acute Kidney Injury - Investigations (6/0)

Answer 2

initial 1) UnE (high urea, creatinine, K+, metabolic acidosis) 2) LFT (hepatorenal syndrome) 3) blood/urine MSnC (infection) 4) urine dipstick (blood+proteins—>glomerular, leucocytes+nitrates—>infection) 5) kidney ultrasound (CKD—>small kidneys, obstruction) 6) ECG (hyperkalaemia)

Question 3

Chronic Kidney Disease - Investigations (8/1)

Answer 3

1) U&E (high urea, creatinine, K+, metabolic acidosis) 2) serum Ca2+ (low) 3) serum PO43-(high) 4) serum PTH (high) 5) FBC (normocytic anaemia) 6) urine dipstick (haematuria, proteinuria) 7) eGFR (<60ml/min/1.73m2) 8) kidney ultrasound (small) consider 1) kidney biopsy (underlying cause)

Question 4

Kidney Cancer - Investigations (Renal Cell Carcinoma) (6/1)

Answer 4

initial 1) FBC (anaemia or polycythaemia) 2) LFT (abnormal) 3) high CRP + ESR 4) urine dipstick (haematuria, proteinuria) 5) kidney ultrasound (exclude simple cysts) 6) abdomen, pelvis enhanced contrast CT* consider 1) kidney biopsy (confirmation)

Question 5

Bladder Cancer - Investigations (Transitional Cell Carcinoma) (1/3)

Answer 5

initial 1) urine dipstick (haematuria) consider 1) cystoscopy + tissue biopsy* 2) urine cytology 3) CT/MRI urogram (stage)

Question 6

Testicular Cancer - Investigations (3/2)

Answer 6

initial 1) testicle colour Doppler ultrasound 2) serum α-fetoprotein (positive) 3) serum β-human chorionic gonadotrophin (positive) consider 1) testicular biopsy (confirmation) 2) abdomen, pelvis CT (staging)

Question 7

Prostate Cancer - Investigations (1/2)

Answer 7

initial 1) serum PSA (>4μg/L, 16μg/L if metastatic) consider 1) transrectal ultrasound guided prostate biopsy* 2) abdomen, pelvis MRI (staging

Question 8

Benign Prostatic Hyperplasia - Investigations (3/3)

Answer 8

initial 1) serum PSA (high) 2) urine dipstick (pyruria) 3) International Prostate Symptoms Score (7Qs, 0-35) consider 1) abdomen, pelvis ultrasound (mass, stone, hydronephrosis) 2) transrectal ultrasound (mass, stone, hydronephrosis) 3) cystoscopy (mass, stone, stricture)

Question 9

Pyelonephritis - Investigations (4/0)

Answer 9

initial 1) urine dipstick (nitrites, leucocytes, proteins) 2) midstream urine MS+C* (>10^5 colony forming units) 3) FBC (leucocytosis) 4) high CRP + ESR

Question 10

Cystitis - Investigations (4/0)

Answer 10

initial 1) urine dipstick (nitrites, leucocytes, proteins) 2) mid-stream urine MS+C* (>10^5 colony forming units) 3) FBC (leucocytosis) 4) high CRP + ESR

Question 11

Prostatitis - Investigations (5/2)

Answer 11

initial 1) serum PSA (high) 2) urine dipstick (nitrites, leucocytes, proteins) 3) mid-stream urine MS+C* (>10^5 colony forming units) 4) FBC (leucocytosis) 5) high CRP + ESR consider 1) STI screening 2) transurethral ultrasound

Question 12

Urethritis - Investigations (3/0)

Answer 12

initial 1) nucleic acid amplification test (swab - female, first void volume - male) 2) urethral discharge MS+C (PMN leucocytes) 3) urine dipstick (exclude UTI)

Question 13

Erectile Dysfunction - Investigations (5/2)

Answer 13

initial 1) Internal Index of Erectile Dysfunction questionnaire 2) fasting blood glucose (>11mM) 3) fasting lipid profile 4) BP 5) HR consider 1) 9:00am testosterone (low - hypogonadism) 2) PRL/FSH/TSH (if testosterone low)