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AMC MCQ - Key points > Urology > Flashcards

Urology Flashcards

1
Q

Describe the symptoms of renal colic (kidney stones).

A

Severe colicky flank pain radiating to scrotum, labia, and groin, accompanied by nausea, vomiting, and possibly hematuria.

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2
Q

What is the best imaging modality for investigating kidney stones?

A

CT scan.

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3
Q

Define the most common type of renal stones.

A

Calcium oxalate.

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4
Q

How should kidney stones be treated based on their size?

A

<5mm: conservative treatment with good hydration; 5mm-2.5cm: ESWL; >2.5cm: surgery.

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5
Q

Do you need to reduce calcium levels in the diet for calcium oxalate stones?

A

No.

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6
Q

Describe the definitive treatment for ureteric stones.

A

First-line treatment is ureteroscopic laser lithotripsy for stones at any level.

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7
Q

What is the most common absolute indication for surgery in renal stones?

A

Obstruction and infection.

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8
Q

Define the second most common cause of painless hematuria in adults.

A

Kidney cancer.

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9
Q

How should incidentally discovered renal masses be managed in older patients?

A

Active surveillance, followed by CT imaging and total nephrectomy if needed.

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10
Q

When can laparoscopic partial nephrectomy be considered for renal masses?

A

Not specified in the provided content.

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11
Q

Describe a small tumour in one kidney less than 4cm.

A

Renal cell carcinoma.

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12
Q

What is the recommended treatment for metastasis in kidney cancer?

A

Total nephrectomy followed by immunotherapy.

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13
Q

How is kidney injury diagnosed in a trauma patient presenting with hematuria and flank pain?

A

Investigation of choice: CT with contrast.

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14
Q

What is the first step in diagnosing urethral rupture in a trauma patient with blood at the urethral meatus?

A

Perform retrograde urethrography.

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15
Q

Define the diagnosis for a patient presenting with HTN, hematuria, and bilateral flank mass.

A

Polycystic kidney disease (PKD).

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16
Q

What is the initial investigation for suspected PKD?

A

Ultrasound.

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17
Q

How is acute bacterial prostatitis diagnosed in a patient with fever, chills, and urinary urgency?

A

Best investigation: mid-stream urine collection.

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18
Q

What is the primary treatment for acute bacterial prostatitis?

A

Antibiotics.

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19
Q

Describe the first symptom of benign prostatic hyperplasia (BPH).

A

Nocturia.

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20
Q

What is the most important investigation for BPH?

A

Ultrasound.

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21
Q

How is BPH typically managed medically?

A

Alpha blockers.

5-alpha reductase inhibitors

5-ARIs inhibit the conversion of testosterone to dihydrotestosterone (DHT) to reduce prostate growth and prostate volume. The most common 5-ARIs prescribed on the Australian Pharmaceutical Benefits Scheme (PBS) are dutasteride and finasteride.

Combination therapy
Since 2016, tamsulosin plus dutasteride has been available to GPs to prescribe as a combined formulation without specialist approval.

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22
Q

What is the surgical treatment for severe cases of BPH?

A

Transurethral resection of the prostate (TURP) surgery.

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23
Q

What is the most common complication of TURP surgery?

A

Bleeding.

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24
Q

What is the most serious complication of TURP surgery?

A

TURP syndrome (water intoxication and hyponatremia).

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25
Q

What are the initial steps in evaluating an enlarged prostate with suspected cancer?

A

1st step: PSA test, 2nd step: TRUS with biopsy.

The more common diagnostic findings are a tender, boggy prostate on DRE together with a sudden rise in PSA
that returns to normal levels after appropriate treatment. Remember to undertake the PSA test before undertaking the DRE as a vigorous prostate examination can alter the PSA result! Always consider prostatitis in men presenting with vague, deep seated pelvic pain. you will never find it if you don’t consider it.racgp

26
Q

What is the management approach for an elderly patient with prostate cancer who is not a candidate for surgery?

A

Watchful waiting.

27
Q

Describe the treatment options for prostate cancer based on its extent.

A

Focal: Radical prostatectomy; Local metastases: TBD.

28
Q

What is the first step when a patient asks for screening of prostate cancer?

A

Counseling that it is not recommended.

29
Q

What is the next step if a patient persists on screening for prostate cancer despite counseling against it?

A

Perform only PSA test, DRE not recommended anymore.

30
Q

Describe the diagnosis of an older male with back pain, mild anemia, and high calcium level.

A

Diagnosis: Multiple myeloma.

31
Q

Describe the diagnosis of bone metastases in a patient with normal calcium levels.

A

Diagnosis: Prostate cancer with bone metastases.

32
Q

What is the diagnosis when a patient feels dragging pain at the upper pole of the testis and a bag of worms is felt while palpating the pampiniform plexus of veins?

A

Diagnosis: Varicocele.

33
Q

What is the most important investigation for varicocele?

A

Semen analysis.

34
Q

What is the diagnosis for a young patient with a long-standing history of varicocele that empties on scrotum elevation?

A

Diagnosis: Primary varicocele.

35
Q

What is the confirmatory investigation for primary varicocele?

A

Ultrasound.

36
Q

What is the diagnosis for an older patient with a short-standing history of varicocele that does not empty on scrotum elevation?

A

Diagnosis: Secondary varicocele.

37
Q

What is the investigation of choice for secondary varicocele?

A

CT scan.

38
Q

What is the first investigation for an infant with scrotal swelling?

A

Transillumination test (positive).

39
Q

What is the investigation of choice for hydrocele?

A

Ultrasound.

40
Q

What is the treatment for hydrocele?

A

Observation (no treatment before the first year).

Pre-referral management
Provide reassurance most congenital hydroceles resolve by 2 years old, without intervention.

When to refer
Refer to the General Surgery Department if:

the hydrocele is still present after 2 years of age.
it is congenital or an acquired hydrocele
is causing pain or enlarging. Racgp

41
Q

Describe the condition of a child with painless edema affecting the penis and scrotum.

A

Idiopathic edema.

42
Q

Describe the diagnosis for a patient with fever, pain, swelling, and redness of the scrotum.

A

Diagnosis: Epididymo-orchitis.

43
Q

What is the most common organism causing epididymo-orchitis overall?

A

E. coli, Chlamydia in patients under 35 years.

44
Q

What are the initial investigations for epididymo-orchitis?

A

Urinalysis and culture.

45
Q

What is the next step after finding a painless swelling in a young adult that transilluminates positively and can be visualized on ultrasound as a cystic dilation?

A

Ultrasound; Diagnosis: Epididymal cyst.

46
Q

What is the first step in the management of a tumor marker in young patients to exclude cancer?

A

Very, very important.

47
Q

What is the second step in the management of a tumor marker in young patients after the initial evaluation?

A

Review after 3-6 months.

48
Q

Describe the approach for surgery mentioned in the content. Testicular

A

Trans-scrotal approach.

49
Q

What is a potential risk for a patient with transverse testis according to the content?

A

Testicular torsion.

For a patient with transverse testis, a potential risk is testicular torsion. Transverse testis refers to the abnormal positioning of the testis in a horizontal rather than a vertical orientation within the scrotum, which can increase the likelihood of the testis twisting around the spermatic cord. This can lead to testicular torsion, a medical emergency that cuts off blood supply to the testis and can cause permanent damage if not promptly treated.

  • Testicular Torsion: Increased risk due to abnormal testicular positioning.
  • Emergency: Requires immediate medical attention to restore blood flow and prevent damage.

For further details, refer to the RACGP guidelines on male reproductive system conditions and specific literature on testicular abnormalities.

50
Q

What urgent treatment is recommended for testicular torsion within a specific timeframe as per the content?

A

Urgent surgery in less than 6 hours without investigations.

For testicular torsion, urgent treatment involves immediate surgical exploration. The procedure includes detorsion and fixation of both testes (orchidopexy). This intervention is crucial and should be performed within 6 hours of symptom onset to maximize the chances of salvaging the testis. Even if more than 6 hours have passed, surgery should not be delayed as there can still be a possibility of saving the testis up to 48 hours post-torsion. Manual detorsion may be attempted if surgery cannot be arranged promptly, but surgery is still required afterwards.

For more details, you can refer to the RACGP guidelines here.

51
Q

Define the recommended treatment for a seminoma according to the content.

A

Radiation and surgery.

The recommended treatment for seminoma, according to the RACGP guidelines, varies based on the stage of the cancer:

  1. Stage I Seminoma: The primary treatment is surgery to remove the affected testicle (radical inguinal orchiectomy). Post-surgery options include careful observation (surveillance), radiation therapy to the para-aortic lymph nodes, or chemotherapy with carboplatin.
  2. Stage IIA Seminoma: After surgery, options include radiation to the retroperitoneal lymph nodes or chemotherapy with either 4 cycles of EP (etoposide and cisplatin) or 3 cycles of BEP (bleomycin, etoposide, and cisplatin).
  3. Stage IIB Seminoma: Treatment typically involves chemotherapy, usually with 4 cycles of EP or 3 cycles of BEP. Radiation might be an alternative if lymph nodes aren’t significantly enlarged.
  4. Stage IIC Seminoma: Chemotherapy is the primary treatment, with options including 4 cycles of EP, 3-4 cycles of BEP, or 4 cycles of VIP (etoposide, ifosfamide, and cisplatin).

For more detailed guidelines, you can refer to resources such as the American Cancer Society and other relevant oncological guidelines oai_citation:1,Treatment Options for Testicular Cancer, by Type and Stage | American Cancer Society.

52
Q

How should undescended testis in an infant be managed based on the content?

A

Surgery before 12 months to reduce the risk of malignancy.

Undescended testis (UDT) is a condition where one or both testes have not moved into the scrotum before birth. It is one of the most common pediatric surgical conditions. The RACGP guidelines outline the following management steps:

  1. Initial Examination and Diagnosis:
    • At birth, all male infants should be examined to check the position of the testes.
    • Re-examine at 3 months to determine if spontaneous descent has occurred. About half of the undescended testes at birth will descend by 12 weeks.
  2. Referral:
    • If the testis remains undescended at 3 months, refer to a pediatric surgeon for evaluation.
    • Bilateral undescended testes or associated genital abnormalities (e.g., hypospadias) require urgent referral to investigate potential disorders of sexual differentiation.
  3. Surgical Intervention (Orchidopexy):
    • Timing: Surgery is typically recommended between 6 and 12 months of age. This timing aims to preserve fertility and reduce the risk of testicular cancer.
    • Procedure: Orchidopexy involves moving the undescended testis into the scrotum and securing it. For impalpable testes, examination under anesthesia and diagnostic laparoscopy may be necessary.
    • Follow-Up: After surgery, follow-up is important to monitor the position of the testis and ensure normal development.
  4. Additional Considerations:
    • Imaging: Routine ultrasonography is not recommended before referral, as it has limited utility in locating an undescended testis.
    • Hormonal Therapy: Not recommended due to limited efficacy and potential side effects.
  5. Monitoring for Complications:
    • Parents should be informed about potential issues such as subfertility and the increased risk of testicular cancer, particularly for intra-abdominal testes.
    • Regular monitoring and annual check-ups are advised to assess for any signs of testicular ascent or other complications.

These steps ensure early detection, timely referral, and appropriate surgical intervention, minimizing long-term risks associated with undescended testis oai_citation:1,RACGP - Undescended testes oai_citation:2,RACGP - Undescended testes: Diagnosis and timely treatment in Australia (1995–2014).

53
Q

What is the most important investigation for a patient with confirmed testicular cancer according to the content?

A

Abdominal CT to assess para-aortic lymph nodes.

54
Q

Describe the most common association with undescended testis as mentioned in the content.

A

Inguinal hernia.

55
Q

What is the first tumor marker to look for in testicular cancer according to the content?

A

Alpha-fetoprotein.

56
Q

How should metastatic testicular cancer be treated according to the content?

A

Chemotherapy and surgery.

57
Q

What is the recommended investigation for bladder cancer as per the content?

A

Cystoscopy and biopsy.

58
Q

Describe the sequence of steps recommended in the content for evaluating painless hematuria.

A

Urine analysis and culture first, followed by a CT scan if normal.

59
Q

What is the investigation of choice for kidney stones according to the content?

A

CT scan.

60
Q

How should kidney stones in a patient with polycystic kidney disease be investigated based on the content?

A

Ultrasound.

61
Q

What condition should be considered in an immigrant from Sudan or Somalia presenting with painful hematuria according to the content?

A

Bilharziasis.

62
Q

What is the second most common cause of painless hematuria according to the content?

A

Cancer of the kidney.

AMC MCQ - Key points (49 decks)

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