Renal/ Urology

Question 1

Which receptors are responsible for the increase in prostatic smooth muscle tone seen in BPH?

Answer 1

Alpha 1 adrenergic receptors

Question 2

What are the ‘storage’ symptoms patients can experience in BPH?

Answer 2

Frequency, Urgency, Nocturia, Incontinence

Question 3

What are the ‘voiding’ symptoms patients can experience in BPH?

Answer 3

Weak stream, terminal dribbling, dysuria, (painful/ difficulty urinating), straining

Question 4

Name some alpha blocker medications for BPH

Answer 4

Doxazosin, Terazosin, Tamsulosin, Silodosin

Question 5

What about 5-alpha reductase inhibitors for BPH?

Answer 5

Example is finasteride, which is a 5-alpha reductase inhibitor which reduces serum dihydroxytestosterone (DHT)

Question 6

What is meant by the term ‘obstructive uropathy’?

Answer 6

Obstructive uropathy is another way of saying ‘urinary tract obstruction’

Question 7

When kidney function is affected (indicated by reduced creatinine clearance) in the context of obstructive uropathy, what is it called?

Answer 7

Obstructive Nephropathy

Question 8

What is meant by the term ‘urinary tract infection/ UTI’ and what is the most common type?

Answer 8

A UTI is an infection of the kidneys, bladder or urethra. Infectious cystitis is the most common type of UTI, which is caused by a bacterial infection of the bladder.

Question 9

What is the most common type of renal cell carcinoma?

Answer 9

Clear renal cell carcinoma (80%)

Question 10

In patients who are symptomatic for renal cell carcinoma, what is the classic triad of symptoms ?

Answer 10

Flank pain, haematuria (microscopic/gross), palpable abdominal mass

Question 11

What is the management for renal cell carcinoma (RCC) in both metastatic and non-metastatic disease?

Answer 11

In non-metastatic RCC the first line management is surgical resection.
In metastatic RCC the first line management is targeted small molecule therapy (drugs ending in -nibs).

Question 12

What is the most common type of bladder cancer?

Answer 12

90% of bladder cancers are urothelial carcinoma (previously known as transitional cell carcinoma).

Question 13

What scoring system is used for prostate cancer and how does it work?

Answer 13

Gleason scoring system.
Score of 1-5 in the most cancerous area from the biopsy.
Score of 1-5 in another area from the biopsy.
Add the two numbers together to get a score of 2-10.

Question 14

What is the most common site for prostate cancer to metastasise to?

Answer 14

Bone

Question 15

What is the most common type of testicular cancer?

Answer 15

90% come from germ cell tumours

Question 16

Epididymitis is Prehn’s sign positive, what does this mean?

Answer 16

Prehn’s sign positive means that lifting of the scrotum eases pain

Question 17

What condition is orchitis often associated with/ caused by?

Answer 17

Mumps virus (so patients often have a headache, fever, parotid swelling).

Question 18

What does the term intravaginal vs extravaginal mean in relation to testicular torsion? And is testicular torsion Prehn’s sign positive or negative?

Answer 18

Intravaginal or extravaginal depending on whether the spermatic cord rotates inside of or as well as the tunica vaginalis. Testicular torsion is Prehn’s sign negative.

Question 19

What is a hydrocele and what are the general features?

Answer 19

A hydrocele is accumulation of serous fluid in the cavity of the tunica vaginalis, without communication to the abdominal cavity. Transillumination is positive. Anechoic on ultrasound.

Question 20

What is a spermatocele and what are the features?

Answer 20

Spermatocele = cyst of the epididymis, which arise from the epididymal duct and contain sperm. Prevalence of 10-30%. Often small and have positive transillumination. Anechoic on ultrasound.

Question 21

What is a varicocele and what are the features of one?

Answer 21

When one of the veins in the pampiniform plexus (in the spermatic cord) becomes dilated and larger than normal (varicose). Increased venous reflux of warm blood from the core increases the temperature in the testis, leading to atrophy which threatens fertility. Exacerbated in Valsalva manoeuvre. Backflow can be seen in scrotal Doppler ultrasound. It is usually left sided (increased resistance to flow on the left side- drains into the left renal vein). Classic bag of worm’s appearance.

Question 22

What is a haematocele?

Answer 22

Collections of blood in the scrotal sac, but outside of the testis. A risk factor for this is trauma and varicocele.

Question 23

What is a epididymal cyst?

Answer 23

A well circumscribed serous fluid filled cyst in the epididymis. Remind yourself of how this is different to a spermatocele

Question 24

What is the definition of chronic kidney disease (CKD)?

Answer 24

Abnormal kidney structure or function present for >3 months duration. Either of the following for >3 months duration: proteinuria and/ or haematuria, or; GFR <60ml/min/1.73m2

Question 25

What are renal/ urinary stones usually made up of?

Answer 25

Calcium oxalate