Genitourinary Conditions Management

Question 1

Nephrolithiasis - Management (4/7/3)

Answer 1

conservative 1) leave to pass naturally (<5mm) 2) hydration 3) weight loss 4) low dietary sodium, calcium medical 1) analgesia (NSAIDs, aspirin —> diclofenac) 2) antiemetic 3) antibiotics (if infected) 4) αB (e.g. tamulosin) (>5mm) 5) thiazide diuretic (calcium recurrence) 6) sodium bicarbonate (uric acid recurrence) 7) cysteine chelator (cysteine recurrence) surgery 1) extracorpeal shockwave lithotripsy (>10mm or refractory) 2) uretoscopy + YAG laser lithotripsy (>10mm or refractory) 3) percutaneous nephrolithotomy (>15mm or complex)

Question 2

Acute Kidney Injury - Management (0/7/2)

Answer 2

medical 1) treat underlying cause 2) stop nephrotoxic drugs (NSAID, ACEi, gentamicin) 3) loop diuretic (hypervolaemia) 4) IV fluids (hypovolaemia) 5) vassopressor (e.g. catecholamines) (hypotensive) 6) calcium gluconate or insulin (hyperkalaemia) 7) sodium bicarbonate (metabolic acidosis) surgery 1) urinary catheter (obstruction) 2) renal replacement therapy (esp. haemofiltration) (refractory)

Question 3

Chronic Kidney Disease - Management (4/2/1)

Answer 3

conservative 1) glucose control 2) smoking cessation 3) weight loss 4) renal replacement therapy education medical 1) treat underlying cause 2) stop nephrotoxic drugs (e.g. NSAIDs, gentamicin) surgery 1) renal replacement therapy (peritoneal dialysis, haemodialysis, haemodiafiltration, haemofiltration, kidney transplant)

Question 4

Chronic Kidney Disease - Management (Complications) (10)

Answer 4

hypertension 1) ACEi or ARB (or CCB) 2) βB or thiazide diuretic (adjunct) cardiovascular disease 3) aspirin 4) statin anaemia 5) EPO stimulating agent 6) ferrous sulphate secondary hyperparathyroidism 7) phosphate binder 8) ergocalciferol metabolic acidosis 9) sodium bicarbonate oedema 10) loop diuretic (e.g. furosemide)

Question 5

Kidney Cancer - Management (Renal Cell Carcinoma) (0/4/2)

Answer 5

medical 1) local ablation (radiofrequency or cryo-) (non-surgical candidate) 2) chemotherapy (IL-2, TNF-α) (stage 3-4) 3) angiogenesis inhibitor (e.g. sunitinib) (refractory stage 3-4) 4) mTOR inhibitor (e.g. temsirolmus) (refractory stage 3-4) surgery 1) radical nephrectomy* (unilateral) 2) partial nephrectomy (bilateral)

Question 6

Bladder Cancer - Management (3/2)

Answer 6

medical 1) post-op chemotherapy (T1-T3) 2) radiotherapy (T2-T3) (non-surgical candidate) 3) palliative chemotherapy + radiotherapy (T4) surgery 1) transurethral resection (T1) 2) radical cystectomy* (T2-T3)

Question 7

Testicular Cancer - Management (2/2/1)

Answer 7

conservative 1) sperm storage 2) regular self-examination medical 1) chemotherapy (metastasis above diaphragm) 2) radiotherapy (metastasis below diaphragm) surgery 1) radical orchidectomy*

Question 8

Prostate Cancer - Management (1/3/1)

Answer 8

conservative 1) surveillance (>70 years old + low risk) medical 1) androgen deprivation therapy (LHRH agonists, androgen receptor blockers) (delays progression) 2) bisphosphonates (bone metastasis—>hypercalcaemia) 3) radiotherapy (external beam or brachytherapy) (>70 years old or non-surgical candidate) surgery 1) radical prostatectomy* (<70 years old)

Question 9

Benign Prostatic Hyperplasia - Management (3/2/2)

Answer 9

conservative 1) avoid coffee, alcohol 2) relax when voiding 3) void twice in a row medical 1) α1B (e.g. tamulosin) (voiding symptoms) 2) 5α reductase inhibitor (e.g. finasteride) surgery 1) transurethral incision of prostate (TIRP) 2) transurethral resection of prostate* (TURP)

Question 10

Pyelonephritis - Management (3/3/0)

Answer 10

conservative 1) rest 2) cranberry juice 3) rehydration medical 1) analgesia 2) PO antibiotics (ciprofloxacillin or co-amoxiclav) 3) IV antibiotics (gentamicin or co-amoxiclav)

Question 11

Cystitis - Management (3/3/0)

Answer 11

conservative 1) rest 2) cranberry juice 3) rehydration medical 1) analgesia 2) PO antibiotics (trimethoprim or cefalexin) 3) IV antibiotics (ciprofloxacin or co-amoxiclav) (severe)

Question 12

Prostatitis - Management (0/2/0)

Answer 12

medical 1) analgesia (NSAID) 2) PO antibiotics (ciprofloxacin)

Question 13

Urethritis - Management (3/3/0)

Answer 13

conservative 1) patient education 2) partner notification 3) contact tracking medical 1) analgesia 2) PO azithromycin (chlamydia) 3) PO azithromycin + IM ceftriaxone (gonorrhoea)

Question 14

Erectile Dysfunction - Management (2/5/1)

Answer 14

conservative 1) psychosexual therapy 2) risk factor modification medical 1) Viagra 2) treat underlying cause (1st) 3) phosphodiesterase-5-inhibitors (2nd) 4) intracarvenous prostaglandin injections (3rd) 5) vacuum erection device (4th) surgery 1) penile prosthesis (5th)