Urology Flashcards
URO - 1
One of the aetiologies listed below predisposes to testicular tumors:
A) testicular trauma
B) testicular torsion
C) undescended testes
D) BRCA2 mutation
ANSWER
C) undescended testes
EXPLANATION
In the aetiology of testicular tumors the only evidence-based risk factor is an undescended testis (in this case testicular tumors are 10-20 times more likely to occur). Trauma, torsion, genetic factors are not evidence-based predisposing factors.
URO - 2
Mark the pathology which usually leads to scrotal pain on palpation:
A) testicular tumor
B) epididymitis
C) hydrocele
D) varicocele
ANSWER
B) epididymitis
EXPLANATION
In case of epididymitis, the epididymis and the testicle are enlarged, and are painful to touch. In case of a testicular tumor, a non-tender nodule can be palpated, or the entire testicle could be non-tender, but enlarged. Varicocele causes a pulling-like pain, the distended veins can be palpated as a „bag of worms”, the testicles themselves are not painful to touch. A hydrocele can be transilluminated, it is not painful, a fluctuating fluid can be palpated within the scrotu
URO - 3
Prostate cancer is palpated as:
A) enlarged, consistency similar to smooth muscle
B) hard
C) tender, enlarged
D) non-tender, enlarged
ANSWER
B) hard
EXPLANATION
Prostate cancer: hard, non-tender nodule in the prostate, or firm, irregular surface, of a non-tender prostate. Acute prostatitis presents with fever, extremely tender and enlarged prostate. BPH presents as nodular, glandular or muscle-like alteration of the enlarged prostate.
URO - 4
Characteristic finding of female spontaneous urine:
A) higher pH
B) contains many epithelial cells
C) always contains a few red blood cells
D) always contains some pus
ANSWER
B) contains many epithelial cells
EXPLANATION
In the female urine epithelial cells are often present, originating from the vagina
URO - 5
Testicular torsion:
A) always bilateral
B) presents with sudden pain, which usually wakes the patient from his sleep
C) present with high fever immediately
D) more frequent on the right side
ANSWER
B) presents with sudden pain, which usually wakes the patient from his sleep
EXPLANATION
Usually, young men are predisposed to testicular torsion, which presents at night and the patient is awoken by a sudden, very intense scrotal pain radiating inguinally. It causes high fever only if it begins necrotizing. It presents equally commonly on either side.
URO - 6
Typical for renal colic, except:
A) flank tenderness
B) nausea, vomiting
C) labial or scrotal pain
D) tenderness on palpation of McBurney’s point
ANSWER
D) tenderness on palpation of McBurney’s point
EXPLANATION
Typical signs of renal colic include intense flank pain, which radiates to the labia or scrotum of the same side and is often accompanied by nausea or vomiting. Tenderness of the McBurney’s point is characteristic in appendicitis.
URO - 7
The conversion of testosterone to dihydrotestosterone is catalysed by the following enzyme which is also targeted as part of BPH treatment:
A) 5-α-reductase
B) 7-β-cytosterine
C) aromatase
D) acidic phosphatase
ANSWER
A) 5-α-reductase
EXPLANATION
In the aetiology of BPH 5-α-reductase plays crucial role in converting testosterone to dihydrotestosterone within the prostate.
URO - 8
In the aetiology of prostate cancer the following plays a role:
A) age
B) genetic factors
C) hormonal factors
D) all of the above
ANSWER
D) all of the above
EXPLANATION
Although in the aetiology of prostate cancer causal factors have not been determined, but older age, genetic- (positive family history) and hormonal factors (androgen-dependency) all contribute to the development of prostate cancer.
URO - 9
The main risk factor for urothelial cancer is:
A) smoking
B) alcohol
C) benzidine
D) petrol
ANSWER
A) smoking
EXPLANATION
Smoking certainly plays a role as a risk factor for urothelial carcinoma. Other factors e.g. certain polycyclic chemicals also increase the risk of bladder tumors, but the connection is not as obvious as with smoking.
URO - 10
The main symptom of stress urinary incontinence:
A) frequent urinary urge
B) nocturnal urinary dribbling
C) involuntary voiding following psychological stress
D) urinary dribbling following an increase in abdominal pressure (e.g. during exercise, coughing, sneezing etc.)
E) vaginal burning
ANSWER
D) urinary dribbling following an increase in abdominal pressure (e.g. during exercise, coughing, sneezing etc.)
EXPLANATION
In case of stress urinary incontinence, the increased abdominal pressure leads to increased intravesical pressure without the contraction of the detrusor muscle, which exceeds the urinary tract’s pressure
URO - 11
Tasks following the palpation of a nodule in the testis:
A) observation, then a control check-up
B) send the patient to a urologist
C) antibiotics, then control check-up
D) do a diagnostic work-up for chronic prostatitis
ANSWER
B) send the patient to a urologist
EXPLANATION
The palpation of a nodule within a testicle is suspicious of a testicular tumor, which requires further examination by a urologist.
URO - 12
Difficulty of voiding can be caused by:
1) prostate enlargement due to benign prostatic hyperplasia (BPH)
2) prostate cancer
3) acute prostatitis
4) phimosis
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
E) All of the answers are correct
EXPLANATION
Dysuria can be caused by BPH compressing the posterior wall of the urethra, prostate cancer, causing obstruction of the prostatic urethra, inflamed, enlarged prostate and extreme narrowing of the foreskin. In the latter case the patient first voids under the foreskin surrounding the glans.
URO - 13
The cause of complete urinary retention can be:
1) bladder tumor
2) acute prostatitis
3) urethral narrowing
4) hypo- or acontractility of the detrusor
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
E) All of the answers are correct
EXPLANATION
Bladder tumors near the internal urethral orifice can obstruct outflow as valves or can infiltrate the posterior urethra. Urethral narrowing can also compromise flow and can lead to complete obstruction. In case of acute prostatitis, the inflamed, enlarged prostate can completely compress the prostatic urethra. In case of hypo- or acontractile detrusor function, the contractile function of the detrusor decreases, or is insufficient, thus the urine cannot be emptied. The underlying cause can be myogenic or neurogenic.
URO - 14
Inflammations accompanied by fever:
1) acute pyelonephritis
2) acute prostatitis
3) acute epididymitis
4) acute cystitis
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
A) Answers 1, 2 and 3 are correct
EXPLANATION
Only parenchymal organs’ inflammations are accompanied by fever, thus NOT cystitis.
URO - 15
In the primary diagnosis of prostate cancer includes:
1) PSA
2) DRE (digital rectal examination)
3) prostate biopsy
4) abdominal ultrasound
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
A) Answers 1, 2 and 3 are correct
EXPLANATION
PSA (prostate-specific antigen) is prostate-specific, but not prostate cancer. Its normal range is 0-4 ng/ml, a grey zone is between 4-10 ng/ml, above 10 ng/ml a tumor is likely. Digital rectal examination (DRE) raises the suspicion of prostate cancer if an uneven surface or firm nodules are palpated, but only histology can confirm it. Therefore, for screening PSA and DRE are mandatory. (If DRE is performed first, at least 2 days should pass to have PSA tested as even palpation can increase PSA.) If prostate cancer is suspected based on either PSA or DRE, prostate biopsy is mandatory. The abdominal ultrasound has no use in the diagnosis of prostate cancer.
URO - 16
Which hormons are essential to measure as part of andrological examinations?
1) testosterone
2) FSH
3) LH
4) parathyroid hormone
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
A) Answers 1, 2 and 3 are correct
EXPLANATION
Testosterone is the male sex hormone; LH is its trophic hormone and FSH enhances spermatogenesis (their levels are measured if hypogonadism is suspected). Parathyroid hormone is measured if hyperthyroidism is suspected.
URO - 17
Ultrasonography of the testes can be used for the diagnosis of:
1) infertility
2) testicular tumor
3) azoospermia
4) orchidoepididymitis
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
C) Answers 2 and 4 are correct
EXPLANATION
Infertility and azoospermia are complex andrological diagnoses, ultrasonography is insufficient on its own for the diagnoses. Semen analysis and the exploration of the underlying cause (via microbiological, diagnostic, surgical, radiological, biochemical genetic and endocrine tests) are inevitable. In case of orchidoepididymitis, the testicle is non-homogeneous, and in case a testicular tumor non-homogeneous region(s) or an entire non-homogeneous testicle can be observed.
URO - 18
In case of non-muscle invasive bladder tumors recurrence can be prevented via bladder instillation of the following chemicals:
1) BCG
2) Bleomycin
3) Mitomycin C
4) Vincristin
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
B) Answers 1 and 3 are correct
EXPLANATION
Bleomycin and Vincristin are used as systemic chemotherapeutic agents. Mitomycin C and BCG are used as intravesical agents in case of non-muscle invasive bladder tumors.
URO - 19
Continent urine diversions include:
1) ureterocutaneostomy
2) bilateral percutaneous nephrostomy
3) ureteroileocutaneostomy (Bricker ileal conduit)
4) orthotopic bladder
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
D) Only answer 4 is correct
EXPLANATION
Ureterocutaneostomy involves the anastomosis of ureters to the abdominal skin. Bilateral percutaneous nephrostomy involves urine diversion from both kidneys via puncturing the kidneys under ultrasound imaging and inserting percutaneous drains (catheters). The creation of a Bricker ileal conduit involves the anastomosis of the ureters into a short segment of the ileum, and the other end of the gut is anastomosed to the abdominal wall. The above three are non-continent diversions, thus urine outflow is continuous, patients wear stoma bags or urine collection bags. Creation of an orthotopic bladder involves the isolation of a section of a small intestine, which is connected to the original urethral stump, and both of the ureters are connected to the neobladder. Therefore, the route of the urine is as follows: upper urinary tract-orthotopic bladder-urethra. Emptying of the bladder can be voluntarily controlled via the outer sphincter of the urethra.
URO - 20
Can be used to treat muscle-invasive bladder tumors as a part of curative or palliative management:
1) Mitomycin, Epirubicin
2) radical cystectomy
3) local chemotherapy
4) resection of the bladder wall
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
C) Answers 2 and 4 are correct
EXPLANATION
Local chemotherapy can only be used in the treatment of non-muscle invasive bladder tumors to prevent recurrence. Patients with muscle-invasive bladder tumors can be cured via radical cystectomy, bladder wall resection (baldder dome) and TUR, on their own, or combined with radio- or chemotherapy (adjuvant, neoadjuvant therapy). For palliation, TUR can be performed, or chemo-, or radiation therapy can be administered, though in certain cases cystectomy may also be performed.
URO - 21
Pyelonephritis in pregnancy:
1) usually left-sided
2) its treatment is the termination of the pregnancy
3) frequent in the first trimester
4) presents in pregnant women as fever and renal pelvis dilation visualised under ultrasonography
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
D) Only answer 4 is correct
EXPLANATION
Pyelonephritis in pregnancy usually occurs during the second half of the pregnancy, affects the right side more frequently and if despite antibiotics and anti-inflammatory medications the fever or the pain don’t subside, a double J stent or nephrostomy should resolve the dilation and alleviate the symptoms.
URO - 22
Choose the procedure that is not transurethral:
1) internal urethrotomy
2) ESWL (Extracorporeal Shock Wave Lithotripsy)
3) inserting ureteral catheter with cystoscopy
4) epicystostomy
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
C) Answers 2 and 4 are correct
EXPLANATION
Internal urethrotomy is an endoscopic (transurethral) incision of the urethral stenoses with optic control. A ureteral catheter inserted using a special ureterocystoscope, also through the urethra. ESWL: Extracorporal shock wave lithotripsy does not need an endoscopic intervention. Epicystostomy is defined as percutaneous bladder punction.
URO - 23
Which factors have negative effect on erectile function?
1) diabetes
2) high uric acid levels
3) beta blockers utilized in hypertension
4) antidiabetics
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
B) Answers 1 and 3 are correct
EXPLANATION
Diabetes mellitus causes impotency via vascular and neurogenic mechanisms. Beta-blockers may lead to erectile dysfunction due to reduced arterial inflow.
URO - 24
Acute kidney failure laboratory values are:
1) hyperkalemia
2) increased serum creatinine levels
3) acidosis
4) decreased eGFR
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
E) All of the answers are correct
EXPLANATION
the characteristic of labor changes of acute kidney failure: increased serum creatinine, potassium and carbamide levels, decreased GFR and acidosis.