Mixed

Question 1

Treatment of OAB (overactive bladder syndrome)/urge incontinence

Answer 1

1. anticholinergics (antimuscarinics, e.g. solifenacin, tolterodine, oxybutynin)
2. beta-3 agonists (e.g. mirabegron)

Question 2

How do anticholinergics work?

Answer 2

competitive antagonist of acetylcholine at postganglionic muscarinic receptors.

Question 3

How do beta-3-agonists work?

Answer 3

Beta-3 agonists directly bind receptors on the detrusor, resulting in relaxation of bladder smooth muscle.

Question 4

Distinguishing feature of inguinal hernia

Answer 4

Disappears when patient lies down, may be tender

Question 5

Distinguishing feature of testicular tumour

Answer 5

Solid on ultrasound, non tender

Question 6

Distinguishing feature of testicular torsion

Answer 6

Sudden onset of testicular pain, high-lying

Question 7

What is testicular torsion?

Answer 7

A torsion is a twist in the spermatic cord which shortens the cord and so raises the testicle to a higher position. This soons cuts off the blood supply, so that the testicle rapidly becomes very painful. It is an emergency, and has to be referred immediately as the testis starts to show necrosis in only a few hours.

Question 8

Which tumour marker is only produced by teratoma?

Answer 8

AFP

Question 9

Alpha feto protein (AFP)

Answer 9

1. Can be found in up to 25% of teratomas (non-seminoma germ cell tumour)
2. AFP is primarily produced by yolk sac (endodermal sinus) components and to a lesser extent by embryonal carcinomas and teratomas.
3. Pure choriocarcinoma and pure seminoma do not produce AFP.

Question 10

Human chorionic gonadotrophin (hCG)

Answer 10

Germ cell tumours (GCTs, i.e. seminoma and teratoma) produce

Question 11

LDH

Answer 11

Low specificity tumour marker

useful as an indicator of tumour burden and treatment response

Very high LDH levels suggest bulky disease, and rising levels indicate recurrence.

Question 12

The patient is diagnosed with a seminoma. How would you further manage the patient?

Answer 12

Seminomas are radiosensitive, and radiotherapy is the main treatment regime for them.

Question 13

The patient is diagnosed with a teratoma. How would you further manage the patient?

Answer 13

Teratomas are not radiosensitive. Stage I disease, confined to the testicle, is treated by orchidectomy and surveillance.

Chemotherapy (generally using “BEP”, i.e. Bleomycin, Etopiside, Cisplatin, usually using four courses at three-weekly intervals) is given to Stage I patients who relapse, or patients with metastatic disease at presentation.

Question 14

What is Cryptorchidism?

Answer 14

congenital undescended testis.