Urology

Question 1

What are the risk factors for prostate cancer?

Answer 1

Age, Fhx, african-american, BRCA gene, hereditary breast/ovarian cancer syndrome and lynch syndrome

Question 2

What confunders can influence a PSA level?

Answer 2

Ejaculation <48hr, strenuous exercise, UTI/prostatitis, recent biopsy.

Question 3

What is empirical therapy for acute prostatitis?

Answer 3

Trimethoprim 300mg OD for 2 weeks. 2nd line: cephalexin 500mg q6h for 2 weeks.

Question 4

How do you test for and treat chronic prostatitis?

Answer 4

Elevated leukocyte count pre and post prostatic massage, only treat if culture positive. Ciprofloxacin 500mg BD 4 weeks

2nd line: norflox 400mg BD or trimethoprim 300mg OD for 4 weeks.

Question 5

What are the risk factors for malignancy in the setting of haematuria?

Answer 5

Age >50, smoking, gross haematuria, prev pelvic radiotherapy, occupational exposures, recurrent UTI

Question 6

What is intravesical BCG used for and what are its side effects?

Answer 6

Immunotherapy to reduce recurrence and invasion into muscle. Acute: frequency, dysuria, low grade fever. Late: sepsis, rash (BCG-osis)

Question 7

What are empirical cystitis treatment options?

Answer 7

Trimethoprim 300mg D for 3 days. 2nd line: nitro 100mg q6h for 3 days.

Alternative: cefalexin 500mg BD for 5 days. Don’t change therapy if improving symptoms.

Question 8

What features necessitate treating a UTI in a RACF resident?

Answer 8

Acute dysuria OR fever/confusion WITH NEW urgency/frequency/haematuria/pelvic pain/flank pain/incointence OR catheter + fever/confusion/flank pain/rigors.

Take cultures and stop treatment if negative.

Question 9

Klinefelter syndrome - karyotype, features, test and treatment.

Answer 9

XXY, small testes/taller height/reduced hair/breasts/osteoporosis, 2 morning fasting testosterone levels, testosterone replacement.

Question 10

What are the causes of haematospermia? What are the red flags?

Answer 10

UTI/STI, prostatitis, abstinence or prolonged sex, anticoagulation, TB. Age >40, persistent, constitutional symptoms, prostate cancer RF.

Question 10

What are the requirements for effective semen analysis?

Answer 10

Abstinence 2-3d prior, analysis within 1 hour and keep at room temperature. If mild derangement, repeat in 1-3mo. If severe, repeat in 2-4 weeks.

Consider FSH, testosterone level then LH and prolactin.

Question 11

When is PSA used in screening? How is an elevated result managed?

Answer 11

2 yearly from age 50-69 (earlier if high risk). If >3, repeat in 6 weeks. If repeat is >5.5 refer. If repeat >3 and free to total ratio < 25% , refer.

Question 12

What are 8 categories of risk factors for erectile dysfunction?

Answer 12

Age, CV disease, endocrine, neurological, medications, prostate cancer treatment, penile disorders, drugs/alcohol.

Question 13

What are some examples of conditions which increase someones risk with intercourse? What are 2 alternatives to PDE5 inhibtors for ED?

Answer 13

Severe AS, HOCM, ICD in situ, poorly controlled AF. Vacuum erection device, intracavernosal injection.

Question 14

What medication can be used for priapism? What meds can be used for premature ejaculation?

Answer 14

Pseudoephedrine 120mg stat. Emla cream 10-20min prior, dapoxetine 1-3hr prior, paroxetine 20mg daily.

Question 15

What are causes of male infertility - pretesticular (3), testicular (3), post testicular (2)

Answer 15

Pre: prolactinoma, kallmman syndrome (hypogonadism), drugs. T: infection, chemo/radio/surgery, klinefelter. Post: ejaculatory or sexual dysfunction.

Question 16

How is asymptomatic bacteruira managed in pregnancy and why? What abx are used for UTI in pregnancy?

Answer 16

Risks of pyelo + low birth weight. Confirm on 2nd culture, treat and check for cure in 2 weeks. Nitro 1st line, keflex 2nd. Trimethoprim ok in late pregnancy. If Group B strep, may need intrapartum prophylaxis.

Question 17

What are 4 voiding and 4 storage symptoms? What are the likely and red flag diagnoses?

Answer 17

Hesitancy, intermittency, straining, dribbling. BPH, risk prostate ca. Nocturia, urge, incontinence, frequency. Overactive bladder, risk bladder ca.

Question 18

What are 6 differentials of BPH? What tests are indicated?

Answer 18

UTI, cancer, urethral stricture, meatal stricture/phimosis, constipation, overactive bladder. MCS, UEC, consider PSA and urine cytology and U/S.

Question 19

What medications treat voiding symptoms in males? What are their side effects?

Answer 19

Alpha blockers (tamsulosin or prazosin). Dizziness, nasal congestion, anejaculation, postural hypotension. Take 4-6 weeks. 5a reductase blockers - finasteride, dutasteride - reduce libido, gynaecomastia, erectile dysfunction.

Question 20

What are the risks of a TURP

Answer 20

Retrograde ejaculation, reduced fertility, erectile dysfunction 10%, urinary incontinence, urethral strictures.

Question 21

What scrotal conditions cause diffuse pain vs local pain? What are 4 painless swellings?

Answer 21

D: torsion, epididymo-orchitis, fournier’s gangrene. L: torsion of appendix, epididymitis. Painless: hydrocoele, epidiymal cyst, varicocoele, cancer.

Question 22

What are 3 risk factors for testicular cancer? What blood test are indicated? What are 2 future considerations when treating?

Answer 22

Cryptoorchidism, HIV, down syndrome. bHCG and aFP elevated. Sperm banking, increased CVD risk in future.

Question 23

What are 5 indications for urology input for renal colic? What are 3 tests used in long term ix of renal colic?

Answer 23

Sepsis, stone >7mm, single kidney or CKD, significant AKI, complete obstruction. Calcium level, uric acid level, PTH.

Question 24

What are 6 lifestyle factors to reduce risk of renal colic?

Answer 24

Healthy BMI, hydration for clear urine, low sodium (reduces calcium in urine), low oxalate diet, low animal protein diet, reduce sugar sweetened beverages.

Question 25

What are 3 risks of a vasectomy? 2 points of aftercare.

Answer 25

Infection, bleeding, failure (1 in 2000). No sex for 1 week, need 3mo or 20 ejaculations after and confirm w spermanalysis.

Question 26

What are 6 differentials of nocturia?

Answer 26

OSA, CKD, CCF, urological cancer, BPH, overactive bladder syndrome.

Question 27

How are paraphimosis and priapism managed?

Answer 27

Oral analgesia, firm compression bandage 15-20min. Cold shower, gentle job, pseudoephedrine, consult urology - corporal aspiration.

Question 28

How is acute epididymitis treated in young men vs old men?

Answer 28

STI related - ceftriaxone 500mg STAT + doxy 14d OR azith 1g now and in 1 week. UTI: trimethoprim 300mg 2 weeks or keflex.