Urogenital

Question 1

What are non-malignant scrotal diseases?

Answer 1

Epididymal cyst, hydrocele, varicocele, adenomatoid tumour

Question 2

What are the causes of urinary tract obstruction?

Answer 2

Urinary stones, urothelial tumours, extrinsic compression by abdominal masses, prostatic hyperplasia, urinary tract malformations, strictures

Question 3

How does obstruction of the urinary tract present?

Answer 3

Pain, impaired renal function, recurrent UTIs
Upper tract obstruction - loin pain radiating to groin
Lower tract obstruction - urinary retention, severe suprapubic pain, urinary frequency, poor stream, terminal dribbling

Question 4

How is obstruction of the urinary tract diagnosed?

Answer 4

US: hydronephrosis (swelling of the kidney due to a build-up of urine)
CT scan: level of obstruction

Question 5

How is obstruction of the urinary tract managed?

Answer 5

Upper - nephrostomy or ureteric stent

Lower - urethral or suprapubic catheter

Question 6

What causes haematuria?

Answer 6

Malignancy, calculi, IgA nephropathy, polycystic kidney disease

Question 7

What is benign prostatic hyperplasia?

Answer 7

Enlargement of the prostate gland due to an increase in cell number

Question 8

How does benign prostatic hyperplasia present?

Answer 8

LUTS - frequency, urgency, nocturia, hesitancy, poor flow, terminal dribbling

Question 9

What are differential diagnoses of benign prostatic hyperplasia?

Answer 9

Overactive bladder, prostatitis, prostate cancer, UTI

Question 10

How are benign prostatic hyperplasias diagnosed?

Answer 10

Ultrasound, PSA test, biopsy

Question 11

How are benign prostatic hyperplasias managed?

Answer 11

Lifestyle - avoid caffeine, alcohol to reduce urgency. Void twice in a row to aid emptying
Drugs - alpha blockers 1st line
Surgery - transurethral resection/incision of prostate, prostatectomy

Question 12

What are the complications of benign prostatic hyperplasia?

Answer 12

Urinary retention, recurrent UTIs, bladder stones, obstructive nephropathy

Question 13

How do renal carcinomas present?

Answer 13

Painless haematuria, loin pain, abdominal mass, anorexia, malaise, weight loss

Question 14

How are renal carcinomas managed?

Answer 14

Radical nephrectomy, radio frequency ablation is an option for patients unfit or willing to undergo surgery

Question 15

What is a Wilm’s tumour?

Answer 15

Nephroblastoma - a malignant childhood renal neoplasm. Present with abdominal mass and haematuria

Question 16

How do bladder carcinomas present?

Answer 16

Painless haematuria, LUTS, recurrent UTIs, voiding irritability

Question 17

How are bladder carcinomas managed?

Answer 17

Depends on the stage
T1 - diathermy via transurethral resection
T2-3 - radical cystectomy
T4 - palliate chemo/radiotherapy

Question 18

How do prostate cancers present?

Answer 18

Majority asymptomatic, LUTS may be present

Question 19

How are prostate cancers diagnosed?

Answer 19

Needle biopsy performed after a raised serum PSA level is found
DRE - hard, irregular prostate

Question 20

How are prostate cancers managed?

Answer 20

Prostatectomy, radiotherapy, analgesia, treat hypercalcaemia

Question 21

What is a seminoma?

Answer 21

Germ cell tumour of the testicle

Question 22

What is a teratoma?

Answer 22

Non-germ cell tumour of the testicle

Question 23

How do testicular tumours present?

Answer 23

Painless testis lump, secondary hydrocele, dyspnoea, abdominal mass

Question 24

How are testicular tumours managed?

Answer 24

Radical orchidectomy, seminomas are radiosensitive, use chemotherapy for teratomas

Question 25

How are GU tract tumours generally diagnosed?

Answer 25

CT of abdomen and pelvis CXR, biopsies Urine cytology

Question 26

What is urolithiasis?

Answer 26

Urinary tract calculi - the formation of stony concretions in the bladder or urinary tract

Question 27

What can urinary tract calculi be formed from?

Answer 27

Calcium, phosphate, oxalate, urate

Question 28

What are the causes of urinary calculi?

Answer 28

Anatomical factors e.g. obstruction Urinary factors e.g. calcium, oxalate, urine, cystine Calcium stones associated with hypercalciuria, uric acid stones with hyperuricaemia

Question 29

How does urolithiasis present?

Answer 29

Triad: fever, vomiting, flank pain. | Nausea, urinary frequency/ urgency, Haematuria, tachycardia

Question 30

Where would pain be felt if urinary calculi caused obstruction of the kidney?

Answer 30

Loin

Question 31

What are the 3 most common sites of urinary tract calculi?

Answer 31

Pelviureteric junction, pelvic brim, vesicoureteric junction

Question 32

What are the risk factors for calculi?

Answer 32

High protein/ high salt intake Male, white Obesity, dehydration, medications e.g. antacids

Question 33

Where would pain be felt if urinary calculi caused obstruction of the bladder or urethra?

Answer 33

Pelvic pain

Question 34

How is urolithiasis diagnosed?

Answer 34

CT - helps exclude differentials Urine dipstick - positive for blood 24hr urine sample for stone biochemistry - calcium, phosphate, oxalate, urate US - hydronephrosis

Question 35

How is urolithiasis managed?

Answer 35

Acute - NSAIDs, antiemetics, IV fluids | Surgical - nephrostomy, ureteric stent, endoscopic treatment, extracorporeal shock waves

Question 36

Which clinical syndromes are caused by lower urinary tract infections?

Answer 36

Cystitis, prostatitis, epididymitis, urethritis

Question 37

Which clinical syndromes are caused by upper urinary tract infections?

Answer 37

Pyelonephritis

Question 38

What is the main organism that causes UTIs?

Answer 38

Escherichia coli

Question 39

How are UTIs diagnosed?

Answer 39

Urinalysis - leucocytes/ nitrates Microscopy Microbiological culture is gold standard - midstream urine specimen

Question 40

How are UTIs managed?

Answer 40

Treat with antibiotics

Question 41

What is prostatitis?

Answer 41

Inflammation of the prostate gland

Question 42

How does prostatitis present?

Answer 42

Pain, fever, malaise, nausea, urinary symptoms

Question 43

What is cystitis?

Answer 43

Inflammation of the bladder caused by an infection (usually E.coli)

Question 44

How does cystitis present?

Answer 44

Frequency, dysuria, urgency, suprapubic pain, polyuria, haematuria

Question 45

What is pyelonephritis?

Answer 45

Infection of the renal parenchyma and soft tissues of renal pelvis/ upper ureter

Question 46

How does pyelonephritis present?

Answer 46

Classic triad of loin pain, fever, pyuria | Associated cystitis symptoms

Question 47

How is pyelonephritis managed?

Answer 47

Fluid replacement, broad spectrum IV antibiotics, drain obstructed kidney, analgesia

Question 48

What is urethritis?

Answer 48

Sexually transmitted inflammation of the urethra

Question 49

What can causes urethritis?

Answer 49

Gonorrhoea, chlamydia

Question 50

How is urethritis managed?

Answer 50

Gonorrhoea - ceftriaxone Chlamydia - doxycycline Bacteria - oflaxacin

Question 51

What is epididymo-orchitis?

Answer 51

Sexually transmitted inflammation of the epididymis +/- testes

Question 52

What causes epididymo-orchitis?

Answer 52

Chlamydia, E.coli, mumps, gonorrhoea

Question 53

What are the features of epididymo-orchitis?

Answer 53

Swelling, dysuria, sweats, UTI symptoms, urethral discharge. | Warn of possible infertility

Question 54

How is epididymo-orchitis managed?

Answer 54

Doxycycline, analgesia, scrotal support, sexual abstinence

Question 55

What are the male symptoms of STIs?

Answer 55

Urethral discharge, dysuria, genital skin problems, testicular pain/ swelling, peri-anal or anal symptoms

Question 56

What are the female symptoms of STIs?

Answer 56

Unusual vaginal discharge, vulval skin problems, abdominal pain, unusual vaginal bleeding