Urology Flashcards
Which plays the main role in the development of testicular tumor?
A) injury
B) testicular torsion
C) retentio testis (cryptorchidism)
D) genetic predisposition
C) retentio testis (cryptorchidism)
EXPLANATION
The only proven risk factor in the development of testicular cancer is cryptorchism. (In this case, the testicular cancer is 10 to 20 times more common). The role of injury, testicular torsion, genetic predisposition has not been proven.
In which typical disease complains the patient pain when touching his scrotum?
A) testicular tumor
B) epididymitis
C) hydrocele
D) varicocele
B) epididymitis
EXPLANATION
In the case of epididymitis, the patient’s epididymides and testicles are enlarged, and feels painful to touch. In case of testicular cancer, a painless nodule or the painless enlargement of the testis can be detected. Varicocele can cause dragging-like or aching pain within the scrotum, enlarged veins are palpable or to be seen, and does not feel painful when touched. The hydrocele is a transparent, painless, and fluctuating fluid can be detected.
The most specific palpation sign of prostate cancer is:
A) enlarged, pasta like
B) cartilage hard
C) enlarged, painful
D) enlarged, painless
B) cartilage hard
EXPLANATION
A typical palpation found in prostate cancer is a insensitive hard noudule, or a an insensitive, stony uneven surfaced prostate. Acute prostatitis is associated with high fever, a highly sensitive, enlarged prostate. In the case of BPH, we can palpate a glandular or muscular, painless, enlarged prostate,
Why do we not see pus cells in the urine which was proved to be pus positive with KOH test?
A) the urine is alkaline
B) besides the pus cells, there are also bacterial cells too
C) the urine is acidic
D) there are crystals in the urine
A) the urine is alkaline
EXPLANATION
In strongly alkaline urine, cellular elements fall apart, so no white blood cells can be seen under a microscope.
What is specific for the female urine?
A) it has higher pH level
B) it contains a lot of epithelial cells
C) it contains always some red blood cells
D) it contains always some pus cells
B) It contains a lot of epithelial cells
EXPLANATION
Epithelial cells are often detected in female urine. These are mostly derived from the vagina.
The normal serum creatinine level is:
A) 60-120 micromol/liter
B) 6-12 micromol/ liter
C) 6-120 microgram/ liter
D) 60-120 milligram / liter
A) 60-120 micromol/liter
EXPLANATION
The normal creatinine level is 60-120 μmol / l.
The following diagnoses are synonyms. The only exception is:
A) hypernephroma
B) Grawitz- tumor
C) renal cell carcinoma
D) renal adenoma
D) renal adenoma
EXPLANATION
The renal adenoma is a benign, epithelial tumor, while hypernephroma, Grawitz tumor and renal cell carcinoma are synonyms for malignant kidney cancer.
The testicular torsion:
A) is always on both sides
B) children most likely wake up because of scrotal pain
C) immediately causes a high fever
D) is more common on the right side
B) children most likely wake up because of scrotal pain
EXPLANATION
The testicular torsion mostly occurs in young boys. It usually starts with a suddenly appearing, very severe testicular pain radiating towards the same side flank. High fever can only be caused if the testicles are already necrotized. It appears with the same frequency on both sides.
It is typical for renal colic, except:
A) kidney sensitivity
B) nausea, vomiting
C) pain in the labias or in the testicles
D) sensitivity at the McBurney’s point
D) sensitivity at the McBurney’s point
EXPLANATION
Typical renal colic is associated with intense pain, which spreads into the testicles of the same side or in the labias and often comes with nausea and vomiting. The pressure sensitivity experienced at the McBurney point is typical for acute appendicitis.
The conversion of testosterone into dihydrotestosterone is done by:
A) 5α-reductase
B) 7-β-citosterine
C) aromatase
D) acid phosphatase
A) 5α-reductase
EXPLANATION
In the development of BPH an important role is played by the dihydrotestosterone converted from testosterone by the 5-α reductase.
Which of the following factors plays a certain role in the epidemiology of prostate cancer?
A) age
B) genetic factors
C) hormone levels
D) most likely all three
D) most likely all three
EXPLANATION
Although there are no clear pathogenic factors in the epidemiology of prostate cancer, it is likely that age (older age), genetic factors (more commonly occurring in the family) and hormonal factors (androgen-dependent) are likely to be involved in the development of the disease.
The following factor has an important role in the etiology of urothelial cancer:
A) smoking
B) alcohol
C) bensidin
D) bensin
A) smoking
EXPLANATION
Smoking plays a role in the development of urothelial carcinomas. Other factors, such as certain polycyclic hydrocarbons also increase the risk of bladder cancer, but the relationship is not as clearly demonstrated as with smoking.
Charrière =
A) 0,5 mm
B) 3 mm
C) 1 mm
D) 0,33 mm
D) 0,33 mm
EXPLANATION
Charrière (Ch) is the outer diameter of the catheters; 1 Ch = 0.33 mm.
The main symptom of stress incontinence is:
A) urination urgency
B) incontinence during nights
C) low abdominal pain
D) incontinence after increased abdominal pressure
E) burning in the vagina
D) incontinence after increased abdominal pressure
EXPLANATION
In stress incontinence the patietnt complaints of involuntary urine leakage when the intravesical pressure associated with the elevated abdominal pressure exceeds the maximal urethral pressure without the contraction of the detrusor muscle.
Urodynamic examination is recommended:
A) in case of hematuria
B) in case of pyuria and fever
C) imperative urinary stimuli and involuntary discharge of urine from the bladder when coughing
D) in case of abnormal bleeding
C) imperative urinary stimuli and involuntary discharge of urine from the bladder when coughing
EXPLANATION
The combined occurrence of imperative urinary stimuli and physical exertion leads to mixed incontinence, which indicates urodynamic examination. In case of haematuria ultrasound and cystoscopy is the recommended diagnostic method. Gynecological examination is indicated if abnormal bleeding occures. In case pyuria, urine sediment controll, or if necessary bacteriological urine test is indicated.
When feeling a painless node in the testis the next step should be:
A) observation, making up a next consultation
B) send him to urology
C) antibiotics and control
D) investigation because of potential chronic prostatitis
B) send him to urology
EXPLANATION
The painless palpable nodule in the testicles is suspected of tumor, so urological examination is recommended.
Dysuria can be a symptom of:
1) bladder stone
2) prostate cancer
3) acute prostatitis
4) phimosis
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
EXPLANATION
Dysuria may be caused by urethral compression of the BPH, prostate cancer obstructing the pars prostatica, inflammation and enlargement of prostate. And so does the punctually narrowed form of phimosis too, where the patient urinates under the foreskin, around glans.
Cause of pollakisuria:
1) Ormond’s disease
2) urine retention in the bladder
3) stress incontinence
4) urethritis
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
C) the 2nd and 4th answers are correct
EXPLANATION
Urine remaining after urination forms a constant urge to urinate. In case of urethritis infected urine causes irritative symptoms such as pollakisuria.
Cause of urinary total retention:
1) bladder tumor
2) prostatitis acuta
3) bladder stone
4) bladder paralysis
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
E) all of the answers are correct
EXPLANATION
The bladder tumor located around the internal orifice can block the orifice or infiltrate the back tract of urethra. Bladder stones embedded in the orifice or in the back track of urethra may also cause complete retention. During acute prostatitis, the inflamed, enlarged prostate may compress the prostatic urethra completely. In case of bladder paralysis, the detrusor muscle does not work, so it can not empty the urine.
Inflammations with fever:
1) acute pyelonephritis
2) acute prostatitis
3) acute epididymitis
4) acute cystitis
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
A) the 1st, 2nd and 3rd answers are correct
EXPLANATION
Only urological organs having parenchyma can cause fever, so acute cystitis does not.
What tests can detect prostate cancer?
1) PSA
2) DRE (digital rectal examination)
3) biopsy
4) abdominal CT
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
A) the 1st, 2nd and 3rd answers are correct
EXPLANATION
PSA (prostate-specific antigen) is prostate and non-prostatic cancer specific. Its normal level is 0 to 4 ng / ml, it is uncertain at 4-10 ng / ml, it is more likely tumor if it is more than 10 ng / ml. With the RDE examination the cartilage- hard nodule raises the suspicion of malignant prostate disease, but a certain diagnosis can only be established based on histology. In advanced case abdominal CT only shows the larger lymph nodes, but for the finer structure TRUS (transrectal ultrasound) is needed, but it is not as specific as RDV and PSA together. So the first step is therefore a rectal examination and after palpating a suspecious finding PSA level should be measured. (2 days intermission should be between the blood test and the RDE, because palpation affects the PSA level). Prostate biopsy is always mandatory in case of suspected prostate cancer.
Cystography is indicated in:
1) bladder fistula
2) detecting or excluding bladder trauma
3) examine bladder diverticulum
4) diagnosing cystitis
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
A) the 1st, 2nd and 3rd answers are correct
EXPLANATION
Contrast agent exit can be seen during cystography in bladder injury or in cases of fistulas. Bladder diverticulum is represented by increased contrast agent uptake during cystography. In the diagnosis of cystitis, anamnesis and urine sediment controll (pyuria) is mostly sufficient, and if necessary (mostly in specific types) cystoscopy can be performed.
Ultrasound
1) is better than intravenous urography to detect kidney tumors
2) is better than intravenous urography to detect urothelial tumor
3) is better than CT to detect prostate diseases
4) in the urological ultrasound examinations the 15000-20000 Mhz frequency is used
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
B) the 1st and 3rd answers are correct
EXPLANATION
Intravenous urography shows the urinary system, which is more informative than US in urothelial tumors. To detect changes in parenchyma (kidney tumor), US is much better. TRUS is considerably cheaper than CT but provides less information about the prostate. Urological transducers have a frequency of 3 to 7 MHz.
In the andrological examination the following hormone levels are measured:
1) testosterone
2) FSH
3) LH
4) Parathormone
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
A) the 1st, 2nd and 3rd answers are correct
EXPLANATION
Testosterone is the male sex hormone, LH is its trophormon, and FSH stimulates spermatogenesis (they are measured in case of hypogonadism). We are measuring parathormone in potential hyperthyroidism.
The testicular ultrasound examination is good to detect:
1) infertility
2) testicular tumor
3) azoospermia
4) orchidoepididymitis
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
ANSWER
C) the 2nd and 4th answers are correct
EXPLANATION
Infertility and azoospermia is a complex andrological diagnosis, which is based on physical examination; US alone is not enough. It is absolutely necessary to perform a microscopic examination of the ejaculate. Other procedures like microbiological, diagnostic, surgical, radiological, biochemical, genetic, endocrinological, examinations are necessary in order to find the cause. In case of orchiepididymitis, an inhomogeneous echotexture can be found in the testicles. In a testicular tumor an inhomogenous echotexture can be observed in part or in the whole testicle.
The chloride level can be high :
1) in kidney failure
2) after ureterosigmoideostomy
3) because of increased intake of sodium hydrogencarbonate from soda pops
4) in hyperchloremic metabolic acidosis
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
C) the 2nd and 4th answers are correct
EXPLANATION
Ureterosigmoideostomy is followed by hyperchloraemic acidosis (see URO-71). Laboratory abnormalities in renal failure: hyponatremia, hypochloremia, hypocalcemia, hyperkalemia, hypermagnesemia, acidosis.
To prevent superficial bladder tumors bladder installation can be performed with:
1) BCG
2) Bleomycin
3) Mitomycin C
4) Vincristin
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
B) the 1st and 3rd answers are correct
EXPLANATION
Bleomycin and Vincristin are suitable for systemic chemotherapy. For the instillation treatment of superficial bladder tumors only Mitomycin C, BCG, Adriamycin and Epirubicin can be used.
Continent urinary diversions are:
1) ureterocutaneostomy
2) orthotopic ileal bladder
3) cutaneous uretero-ileostomy (Bricker bladder)
4) Sigma rectum pouch (Mainz pouch II)
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct
C) the 2nd and 4th answers are correct
EXPLANATION
In an ureterocutaneostomy the urethra is terminating on the abdominal wall. In the Bricker bladder, ureter is implanted in a short ileum segment, the other end of the intestinal tract is determined to the abdominal wall. These two methods are not continental urinary tract creating methods, because the urine is constantly flowing away, patients should wear urostomy bags. Orthotopic bladder formation is a bladder replacement from an isolated intestinal tract, in which case the bladder is sewn with the original urethra. The Mainz II. pouch is actually a low pressure, continental urine reservoir, in which case the ureter is implanted into the detubularized intestinal segment of the sigma.