Pestana Urology

Question 1

A young boy presents with sudden, severe testicular pain? What will be found on PE (4)? Will the cord be tender? Tests? Treatment?

Answer 1

Testicular torsion. Tender, swollen, high riding, horizontal lie. No. NO TIME FOR TESTS, IT’S AN EMERGENCY! Surgical intervention.

Question 2

A teenage man presents with sudden severe testicular pain. He is febrile and has experienced pyuria? Will the cord be tender? Tests? Treatment?

Answer 2

Acute epididymitis. Yes. Sonogram (to rule out testicular torsion). IV antibiotics.

Question 3

A Urology patient who has been sent home to attempt to spontaneously pass a ureteral stone develops chills, flank pain, and a severe fever? Treatment?

Answer 3

Obstruction and Infection of the urinary tract. IV antibiotics and ureteral stent/percutaneous nephrostomy (decompress the urinary tract).

Question 4

A 30 year old woman presents with increased urinary frequency, dysuria, and cloudy malodorous urine? Treatment?

Answer 4

UTI (cystitis). Empiric antibiotics?

Question 5

What are two major complications of an intravenous pyelogram (IVP)? What has replaced this test in a urologic workup?

Answer 5

Allergic reaction to dye, contraindicated in patients with renal failure (Creatinine>2). CT and sonogram.

Question 6

A patient presents with chills, fever, nausea, vomiting, and flank pain. Tests? Treatment?

Answer 6

Pyelonephritis. Urinalysis and cultures, CT and sonogram. IV antibiotics.

Question 7

An older man presents with chills, fever, dysuria, lower back pain, and an extremely tender prostate on DRE? Treatment? Complications?

Answer 7

Acute bacterial prostatitis. IV antibiotics. Don’t do any more DRE - could lead to sepsis!

Question 8

A newborn baby boy is unable to urinate during the first day of life. He has normal meatal width? Tests? Treatment?

Answer 8

Posterior urethral valves. Voiding cystourethrogram. Endoscopic regurgitation or resection.

Question 9

On PE of a newborn baby, you note the urethral opening on the ventral side of the penis? Complications? Treatment?

Answer 9

Hypospadias. No circumcision! Plastic reconstruction.

Question 10

Children who present with UTI symptoms should be assessed via what test?

Answer 10

CT scans.

Question 11

A child presents with dysuria, increased urinary frequency, perineal pain, flank pain, fever and chills. Tests? Treatment?

Answer 11

Vesicoureteral reflux. CT scan, voiding cystourethrogram, urinalysis and cultures. IV antibiotics (empiric, then culture-guided choice).

Question 12

A young girl complains of her vagina being wet with urine all of the time. She does not void at inappropriate times and has normal urge to void? Tests? Treatment?

Answer 12

Low implantation of ureter. PE or IVP. Corrective surgery.

Question 13

A teenager presents with colicky flank pain after his first night drinking in college?

Answer 13

Ureteropelvic junction obstruction (UPJ)

Question 14

When any patient presents with hematuria, what must you do?

Answer 14

Workup for Cancer - CT scan and cystoscopy (for bladder).

Question 15

A 60 year old man presents with flank pain, flank mass, and hematuria? What physiologic changes are often noted in this condition (3)? Tests? Treatment?

Answer 15

Renal Cell Carcinoma. Hypercalcemia, erythrocytosis, and elevated liver enzymes. CT scan. Surgery.

Question 16

Which cancer has the highest correlation with smoking?

Answer 16

Bladder cancer.

Question 17

A 70 year old man is found to have a rock hard discrete nodule on DRE and a PSA of 10? Tests? Treatment?

Answer 17

Prostate cancer. Sonogram guided Transrectal needle biopsy and CT. Surgery or radiation.

Question 18

Medical treatment for widespread bone metastases from prostate cancer?

Answer 18

Flutamide (anti-androgen)

Question 19

A 25 year old presents with a painless testicular mass? Which serum markers are upregulated with this condition? Tests? Treatment?

Answer 19

Testicular cancer. Biopsy with radical orchiectomy. Alpha fetoprotein and B-human chorionic gonadotropin (B-HCG). Radiation and Chemotherapy (platinum based, ie. cisplatin)

Question 20

A man with PMH of benign prostatic hypertrophy (BPH) who has recently been taking antihistamines for a bad cold, develops an inability to void and a distended palpable bladder? Medical and Mechanical Treatments?

Answer 20

Acute urinary retention. Indwelling catheter for three days. Alpha blockers or 5-alpha reductase inhibitors (for largest bladders).

Question 21

How is postoperative urinary retention managed?

Answer 21

Indwelling catheter until retention resolves.

Question 22

A middle aged woman with many children leaks a small amount of urine when she laughs, sneezes, or bears down. They deny incontinence at night? Cause? Treatments?

Answer 22

Stress incontinence. Weakened pelvic floor with prolapsed bladder neck. Pelvic floor exercises or surgical repair (severe cases).

Question 23

A patient presents with colicky flank pain that radiates to the inner thigh and genitals? Is intervention always necessary? Treatment? Contraindications? Prevention?

Answer 23

Passage of ureteral stones. No, small stones pass spontaneously (<3cm have 70% chance). Ertracorporeal shock wave lithotripsy (ESWL). Pregnant women, bleeding diathesis, stones that are several centimeters. Drink lots of water.

Question 24

Most common cause of pneumaturia? Tests? Treatment?

Answer 24

Fistula between bladder and sigmoid colon from diverticulitis. CT scan and sigmoidoscopy (rule out cancer, second most common cause). Surgical therapy.

Question 25

Psychogenic impotence - Nocturnal Erections? Onset? Treatment?

Answer 25

Does not interfere with nocturnal erections. Sudden (often partner or situation specific). Psychotherapy.

Question 26

Organic impotence. Sudden vs Chronic causes? Nocturnal erections? Treatment?

Answer 26

Sudden - trauma, pelvic surgery, prostate cancer surgery, Chronic - diabetes, arteriosclerosis. No nocturnal erections. Sildenafil, surgery (for arterial injury), or suction devices/implants.

Question 27

A 6 month old presents with a cystic scrotal mass. There are no other complications? Treatment?

Answer 27

Hydrocele. Normally resolves within 12 months.