GU

Question 1

Required workup for painless hematuria in an adult over 35

Answer 1

Assessment for bladder cancer w/ CT urogram and cystoscopy

Question 2

Medication linked to hemorrhagic cystitis and bladder cancer

Answer 2

Cyclophosphamide

Question 3

What can be used to prevent cyclophosphamide bladder toxicity?

Answer 3

Mesna (concentrates in bladder and forms conjugate with the toxic metabolite of cyclophosphamide, acrolein)

Question 4

Diagnostic test for kidney stones

Answer 4

Non-contrast CT or ultrasound

Question 5

Radiolucent kidney stone associated with needle-shaped crystals in the urine

Answer 5

Uric acid stones

Question 6

Kidney stones linked to fat malabsorption

Answer 6

Calcium oxalate (unabsorbed fat chelates calcium in the gut, freeing oxalate to be absorbed)

Question 7

Kidney stones seen in primary hyperparathyroidism and renal tubular acidosis

Answer 7

Calcium phosphate

Question 8

Kidney stones seen with acidic urine

Answer 8

Uric acid stones

Question 9

Kidney stones seen with increased cell turnover

Answer 9

Uric acid stones

Question 10

Treatment of uric acid stones

Answer 10

Hydration, low-purine diet, and alkalinization of the urine with oral potassium citrate. (Can add allopurinol if this regimen fails)

Question 11

Kidney stones seen patient with genetic defect in amino acid transporters

Answer 11

Cystine stones

Question 12

Radioopaque kidney stones with hexagonal crystals in the urine

Answer 12

Cystine stones

Question 13

Kidney stones associated with alkaline urine due to urease-producing bacteria

Answer 13

Struvite stones

Question 14

Organism associated with struvite stones

Answer 14

Proteus (could be other urease-producing bacteria)

Question 15

Management of kidney stones by size

Answer 15

<1 cm: may pass, give analgesia and hydration.

Larger will require surgery

Question 16

Treatment for uncomplicated acute cystitis

Answer 16

Nitrofurantoin, TMP-SMX, or fosfomycin
(Quinolones only if all 3 of these cannot be used in uncomplicated acute cystitis - but these are primary for complicated acute cystitis)

Question 17

Treatment for complicated acute cystitis

Answer 17

Fluoroquinolones are mainstay (sometimes broader-spectrum, like amp/gent, in more severe cases)

Question 18

What makes acute cystitis “complicated?”

Answer 18

Patient factors:
1. Diabetes
2. Pregnancy
3. Immunosuppression
4. Renal failure
5. Urinary tract obstruction
Situational factors:
6. Indwelling catheter
7. Urinary procedure
8. Hospital acquired

Question 19

UTI with alkaline urine

Answer 19

Urease-producing bacteria, most commonly Proteus mirabillis (can lead to recurrent UTIs and struvite stones)

(Klebsiella is a less common urease-producing bacterial cause of UTI)

Question 20

When does pyelonephritis need imaging?

Answer 20

1. Symptoms persist after 48-72 hours of appropriate treatment
2. History of kidney stones
3. Unusual findings (gross hematuria, suspicion for obstruction)

Question 21

What is complicated pyelonephritis?

Answer 21

Pyelonephritis with any of:

1. Corticomedullary abscess
2. Perinephric abscess
3. Emphysematous pyelonephritis
4. Papillary necrosis

Question 22

Urinary incontinence with coughing and sneezing

Answer 22

Stress incontinence (due to pelvic floor instability)

Question 23

Urinary incontinence with sudden, frequent need to empty bladder

Answer 23

Urge incontinence

Question 24

Urinary incontinence with constant dribbling and incomplete emptying

Answer 24

Overflow incontinence

Question 25

General treatment for all types of urinary incontinence

Answer 25

Lifestyle modifications and pelvic floor exercises

Question 26

Treatment for stress incontinence

Answer 26

Pessaries, then pelvic floor surgery

Question 27

Treatment for urge incontinence

Answer 27

Bladder training and lifestyle modification first, then oxybutynin or other antimuscarinics

Question 28

Treatment for overflow incontinence

Answer 28

Bathanechol (cholinergic agonist) or periodic self-catheterization

Question 29

Potentially reversible causes of urinary incontinence in the elderly

Answer 29

``` DIAPPERS: Delirium Infection (e.g. UTI) Atrophic urethritis/vaginitis Pharmaceuticals (alpha blockers, diuretics) Psychologic (depression) Excessive urine output (e.g. DM, CHF) Restricted mobility (e.g. post-surgery) Stool impaction ```

Question 30

First treatment for BPH

Answer 30

Alpha1-blockers (e.g. tamsulosin, doxazosin, terazosin) (5-alpha reductase inhibitors (e.g. finasteride, dutasteride) are either adjuvants or second-line if alpha1-blockers not tolerated)

Question 31

Treatment for chronic prostatitis

Answer 31

Antibiotics, alpha-blockers, 5-alpha reductase inhibitors

Question 32

Erectile dysfunction with loss of bulbocavernosus reflex

Answer 32

Neurogenic erectile dysfunction | Bulbocavernosus reflex: squeeze glans or tug on catheter, anal sphincter should contract

Question 33

Types of causes or organic erectile dysfunction

Answer 33

1. Vascular (most common) 2. Neurogenic 3. Medication-induced 4. Endocrine (e.g. hypogonadism)

Question 34

Medications that can lead to erectile dysfunction

Answer 34

1. Antihypertensives (especially beta blockers and thiazides) 2. SSRIs 3. Anti-androgenic medications (e.g. spironolactone)

Question 35

Most common cause of priaprism, especially in an adolescent

Answer 35

Sickle cell disease

Question 36

Medications that can lead to priaprism

Answer 36

1. Trazadone (atypical antidepressant with some alpha-block) 2. Valproate 3. Alpha1-blokers for BPH 4. Anticoagulants 5. Cocaine

Question 37

First step in diagnosis of possible testicular cancer based on suggestive exam? Next step?

Answer 37

First: Ultrasound Second, if high likelihood of cancer from imaging: orchiectomy (FNA and biopsy are CI due to risk of seeding lymphatics and blood with cancer cells)

Question 38

Hormone(s) produced by Leydig cell testicular tumor

Answer 38

Testosterone and estrogen

Question 39

Hormone(s) produced by choriocarcinoma testicular tumor

Answer 39

beta-HCG

Question 40

Hormone(s) produced by endodermal sinus testicular tumor a.k.a. yolk sac tumor

Answer 40

AFP

Question 41

Hormone(s) produced by seminoma testicular tumor

Answer 41

Usually none

Question 42

UTI symptoms with perineal pain and fever and chills in a man. Diagnosis? Key test? Treatment?

Answer 42

Diagnosis: Acute bacterial prostatitis Test: Urine culture to direct antibiotics Treatment: 4-6 weeks of antibiotics