Urology

Question 1

Upper urinary tract obstruction (i.e. in the ureters) presents with

Answer 1

Loin to groin or flank pain on the affected side (due to stretching and irritation of ureter and kidney)

Reduced or no urine output

Non-specific systemic symptoms, such as vomiting

Impaired renal function on blood tests (i.e. raised creatinine)

Question 2

Lower urinary tract obstruction (i.e. in the bladder or urethra) presents with

Answer 2

Difficulty or inability to pass urine (e.g., poor flow, difficulty initiating urination or terminal dribbling)

Urinary retention, with an increasingly full bladder

Impaired renal function on blood tests (i.e. raised creatinine)

Question 3

Idiopathic hydronephrosis

Answer 3

Narrowing at the pelviureteric junction (PUJ) – the site where the renal pelvis becomes the ureter. This narrowing may be congenital or develop later.

Question 4

When does a post-void bladder scan indicate need for a catheter?

Answer 4

More than 500mls remaining

Question 5

Tamsulosin side effects

Answer 5

Orthostatic hypotension and dizziness on standing

Question 6

Medical options for BPH

Answer 6

Alpha-blockers (e.g., tamsulosin) relax smooth muscle, with rapid improvement in symptoms

5-alpha reductase inhibitors (e.g., finasteride) gradually reduce the size of the prostate

Question 7

Features that make a sexually transmitted organism more likely in epididymo-orchitis

Answer 7

Age under 35
Increased number of sexual partners in the last 12 months
Discharge from the urethra

Question 8

Antibiotic regimen for E.Coli caused epididymo-orchitis

Answer 8

Ofloxacin for 14 days
Levofloxacin for 10 days
Co-amoxiclav for 10 days (where quinolones are contraindicated)

Question 9

Antibiotic regimen for STI epididymo-orchitis

Answer 9

Intramuscular ceftriaxone (single dose)
Doxycycline
Ofloxacin

Question 10

Side effects of Quinolone antibiotics such as ofloxacin, levofloxacin and ciprofloxacin

Answer 10

Tendon damage and tendon rupture, notably in the Achilles tendon
Lower seizure threshold (caution in patients with epilepsy)

Question 11

Gleeson grading system

Answer 11

Based on the histology from the prostate biopsies. It is specific to prostate cancer

The greater the Gleason score, the more poorly differentiated the tumour is (the cells have mutated further from normal prostate tissue) and the worse the prognosis is. The tissue samples are graded 1 (closest to normal) to 5 (most abnormal).

The Gleason score will be made up of two numbers added together for the total score (for example, 3 + 4 = 7): The first number is the grade of the most prevalent pattern in the biopsy The second number is the grade of the second most prevalent pattern in the biopsy

A Gleason score of:

6 is considered low risk
7 is intermediate risk (3 + 4 is lower risk than 4 + 3)
8 or above is deemed to be high risk

Question 12

Signs of testicular torsion

Answer 12

Firm swollen testicle
Elevated (retracted) testicle
Absent cremasteric reflex
Abnormal testicular lie (often horizontal)
Rotation, so that epididymis is not in normal posterior position

Question 13

Examination findings with a hydrocele are

Answer 13

The testicle is palpable within the hydrocele

Soft, fluctuant and may be large

Irreducible and has no bowel sounds (distinguishing it from a hernia)

Transilluminated by shining torch through the skin, into the fluid (the testicle floats within the fluid)

Question 14

What causes a Varicocele?

Answer 14

Result of increased resistance in the testicular vein. Incompetent valves in the testicular vein allow blood to flow back from the testicular vein into the pampiniform plexus.

Question 15

Examination findings of varicocele

Answer 15

A scrotal mass that feels like a “bag of worms”
More prominent on standing
Disappears when lying down
Asymmetry in testicular size if the varicocele has affected the growth of the testicle

Question 16

Varicoceles that do not disappear when lying down raise concerns about…

Answer 16

Retroperitoneal tumours obstructing the drainage of the renal vein. These warrant an urgent referral to urology for further investigation.

Question 17

Common cause of non cancerous testicular lump

Answer 17

Epididymal Cyst

Question 18

UTI: an appropriate initial antibiotic in the community would be

Answer 18

Trimethoprim (often associated with high rates of bacterial resistance)
Nitrofurantoin (avoided in patients with an eGFR <45)

Question 19

Paraneoplastic syndromes of RCC

Answer 19

Polycythaemia – due to secretion of unregulated erythropoietin
Hypercalcaemia – due to secretion of a hormone that mimics the action of parathyroid hormone
Hypertension – due to various factors, including increased renin secretion, polycythaemia and physical compression
Stauffer’s syndrome – abnormal liver function tests (raised ALT, AST, ALP and bilirubin) without liver metastasis

Question 20

Unusual infections can occur secondary to immunosuppressant medication, such as

Answer 20

Pneumocystis jiroveci pneumonia (PCP/PJP)
Cytomegalovirus (CMV)
Tuberculosis (TB)

Question 21

All men with ED should have

Answer 21

Testosterone level checked

Question 22

Most common RF for RCC

Answer 22

Smoking

Question 23

RF for testicular cancer

Answer 23

Undescended testes, a positive family history of testicular cancer, infertility, Klinefelter’s syndrome, and mumps orchitis.

Question 24

Tamsulosin MOA

Answer 24

a-1 antagonist

Question 25

Most common cause of ED

Answer 25

By far the most common cause of organic ED is vasculogenic causes. This includes cardiovascular disease (CVD), hypertension, hyperlipidaemia, diabetes mellitus, smoking, and major pelvic surgery.

Same RF as heart disease

Question 26

Ongoing loin pain, haematuria, pyrexia of unknown origin →

Answer 26

?renal cell cancer

Question 27

First line investigation for suspected prostate cancer

Answer 27

Multiparametric MRI has replaced TRUS biopsy as the first-line investigation in suspected prostate cancer

Question 28

RCC is a

Answer 28

Adenocarcinoma

Question 29

Survival rate of seminomas vs teratomas

Answer 29

5 year survival for seminomas is around 95% if Stage I
5 year survival for teratomas is around 85% if Stage I

Question 30

Adult patients with a hydrocele require

Answer 30

An ultrasound to exclude underlying causes such as a tumour

Question 31

Which hernias do females get?

Answer 31

Femoral

Question 32

Side effect of GnRH agonist for prostate cancer

Answer 32

GnRH agonists may cause ‘tumour flare’ when started, resulting in bone pain, bladder obstruction and other symptoms

GnRH agonists which aim to suppress testosterone production by overstimulation of the hormone cascade.

Question 33

Investigations for suspected epididymo-orchitis by age

Answer 33

Sexually active younger adults: NAAT for STIs

Older adults with a low-risk sexual history: MSSU

Question 34

A 1 litre bag of Hartmann’s solution contains

Answer 34

1 litre of water
131 mmol sodium
111 mmol chloride
5 mmol potassium
2 mmol calcium
29 mmol lactate (helps to buffer the solution – reducing the risk of acidosis)

Question 35

When would one use colloid fluids - example?

Answer 35

Human albumin solution, may be used in patients with decompensated liver disease.

Albumin is an important component of plasma and increases the plasma volume. It increases the oncotic pressure of the plasma, drawing in and retaining fluid.