Urology

Question 1

BPH

Answer 1

Frequency: Needing to urinate more often.
Urgency: A sudden, strong urge to urinate.
Nocturia: Waking up frequently at night to urinate.
Hesitancy: Difficulty starting urination or a weak urine stream.
Other potential symptoms include incomplete bladder emptying, straining during urination, and dribbling at the end of urination. If left untreated, BPH can lead to complications like urinary retention or recurrent urinary tract infections (UTIs).

Example sentence: The patient presented with symptoms of BPH, including nocturia and hesitancy.

Question 2

UTI

Answer 2

Lower UTI: Dysuria (painful or burning sensation during urination).
Frequent urination with small amounts of urine.
Urgency (strong need to urinate).
Suprapubic discomfort or pressure.
Cloudy or strong-smelling urine.
Hematuria (blood in the urine).
Upper UTI (Pyelonephritis): Fever, chills.
Flank or back pain.
Nausea, vomiting.
Severe cases can lead to sepsis if untreated.

Example sentence: The patient was diagnosed with an upper UTI (Pyelonephritis) after presenting with fever and back pain.

Question 3

kidney stones

Answer 3

Severe pain (renal colic): This is the hallmark symptom. The pain typically starts suddenly in the side or back, radiating to the lower abdomen and groin. It can be excruciating and comes in waves as the stone moves.
Hematuria (blood in urine): Urine may appear pink, red, or brown.
Nausea and vomiting: Often accompany the pain.
Frequent urination or urgency: If the stone moves down into the bladder.
Painful urination: When the stone is close to the bladder.
Fever and chills: If an infection is present (this is an emergency situation).

Example sentence: The patient presented with severe pain and hematuria, which were indicative of kidney stones.

Question 4

Adult PKD

Answer 4

autosomal dominant
large multicystic kidneys, liver Cysts, berry aneurysm
clinical Features: hematuria, flank pain, UTI, renal stones, hypertension
typical outcome: Chronic renal failure starting 40-60 years

Example sentence: The patient with Adult PKD exhibited clinical features of hematuria and hypertension.

Question 5

Child PKD

Answer 5

autosomal recessive
enlarged, cystic kidneys at birth
hepatic fibrosis
typically death in infancy or childhood

Example sentence: The infant was diagnosed with Child PKD, which has a poor prognosis.

Question 6

lumps in groin

Answer 6

Differential diagnosis
Inguinal hernia, femoral hernia, enlarged lymph nodes, saphena varix,
hydrocele of the cord (or of the canal of Nück in women), vaginal hydrocele, undescended testis, lipoma of the cord, femoral aneurysm, psoas abscess.

Example sentence: The physician considered various differential diagnoses for the lumps in the patient’s groin.

Question 7

Hernia

Answer 7

A hernia (usually) has a cough impulse (i.e. it expands on coughing) and
(usually) reduces with direct pressure or on lying down unless, uncommonly, it is incarcerated (i.e. the contents of the hernia are fixed in the
hernia sac by their size and by adhesions).
Since inguinal and femoral hernias arise from within the abdomen and descend into the
groin, it is not possible to get above them. For lumps that arise from within the scrotum, the superior edge can be palpated (i.e. it is possible to get above them).

Example sentence: The hernia displayed a cough impulse and reduced with direct pressure.

Question 8

Inguinal hernia

Answer 8

Inguinal: the hernia reduces through the abdominal wall at a point
above and medial to the pubic tubercle. An indirect inguinal hernia often
descends into the scrotum; a direct inguinal hernia rarely does.

Example sentence: The surgeon identified an indirect inguinal hernia that descended into the scrotum.

Question 9

Femoral hernia

Answer 9

Femoral: the hernia reduces through the abdominal wall at a point below
and lateral to the pubic tubercle.

Example sentence: The patient presented with symptoms of a femoral hernia, which was diagnosed based on the location of reduction.

Question 10

Enlarged inguinal lymph nodes

Answer 10

A firm, non-compressible, nodular lump in the groin. Look for pathology in
the skin of the scrotum and penis, the perianal area and anus, and the skin
and superficial tissues of the thigh and leg.

Example sentence: The physician palpated an enlarged inguinal lymph node in the patient’s groin.

Question 11

Saphena varix

Answer 11

A dilatation of the proximal end of the saphenous vein. Can be confused
with an inguinal or femoral hernia because it has an expansile cough impulse
(i.e. expands on coughing) and disappears on lying down. It is easily com-
pressible and has a fluid thrill when the distal saphenous vein is percussed.

Example sentence: The patient presented with symptoms of saphena varix, which was initially confused with a hernia.

Question 12

Hydrocele ofthe cord (or of the canal of Nück in women)

Answer 12

A hydrocele is an abnormal quantity of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis, the double layer of the peritoneum surrounding the testis and which was the processus vaginalis in
the fetus. Normally, the processus vaginalis becomes obliterated along its
entire length, apart from where it surrounds the testis where a potential
space remains between the parietal and visceral layers. If the central part of the processus vaginalis remains patent, fluid secreted by the trapped peritoneum accumulates and forms a hydrocele of the cord (the equivalent is known as the canal of Nück). Ahydrocele of the cord may therefore be present in the groin.

Example sentence: The physician diagnosed the patient with a hydrocele of the cord based on the accumulation of peritoneal fluid.

Question 13

Undescended testis

Answer 13

May be on the correct anatomical path but may have failed to reach the
scrotum (incompletely descended testis) or may have descended away from the normal anatomical path (ectopic testis). The lump is smooth, oval, tender to palpation, and non-compressible, and there is no testis in
the scrotum.
## Footnote

No example sentence provided.

Question 14

What is a hydrocele of the cord?

Answer 14

Fluid secreted by the ‘trapped’ peritoneum accumulates and forms a hydrocele of the cord.

Equivalent in females is known as the canal of Nück.

Question 15

What are the characteristics of an undescended testis?

Answer 15

Smooth, oval, tender to palpation, and non-compressible lump in the groin.

May be incompletely descended or ectopic.

Question 16

What is a femoral aneurysm?

Answer 16

An expansile aneurysm located just below the inguinal ligament.

Usually confused with a femoral hernia.

Question 17

What is the presentation of psoas abscess?

Answer 17

A soft, fluctuant, compressible mass in the femoral triangle.

Occurs in unwell patients with fever.

Question 18

What is a hydrocele?

Answer 18

An abnormal quantity of peritoneal fluid between the layers of the tunica vaginalis.

May be primary or secondary.

Question 19

What is an epididymal cyst?

Answer 19

A cyst derived from the collecting tubules of the epididymis.

Also known as a spermatocele if containing spermatozoa.

Question 20

What are the characteristics of a testicular tumor?

Answer 20

Firm or hard lump with a smooth or irregular surface.

May mimic acute epididymo-orchitis.

Question 21

What is a varicocele?

Answer 21

Dilatation of the pampiniform plexus, essentially varicose veins of the testis and spermatic cord.

Common in men, may cause a dragging sensation.

Question 22

What is a varicocele?

Answer 22

Dilatation of the pampiniform plexus—the collection of veins surrounding the testis and extending up into the spermatic cord (essentially varicose veins of the testis and spermatic cord). Small, symptomless varicoceles occur in 720% of normal men and are commoner on the left side. They may cause a dragging sensation or an ache in the scrotum. Said to feel like a ‘bag of worms’. The varicocele disappears when the patient lies down.

Example: cannot get above it.

Question 23

What is a sebaceous cyst?

Answer 23

Common in scrotal skin. They are fixed to the skin and have a smooth surface.

No additional information.

Question 24

What is epididymo-orchitis?

Answer 24

Infection of the epididymis (principally) with TB, which has spread from the blood or urinary tract. The absence of pain and tenderness is noticeable. The epididymis is hard and has an irregular surface. The spermatic cord is thickened, and the vas deferens also feels hard and irregular (a ‘string of beads’).

No additional information.

Question 25

What is gumma of the testis?

Answer 25

Rare; syphilis of the testis resulting in a round, hard, insensitive mass involving the testis (a so-called billiard ball); difficult to distinguish from a tumour.

Example: cannot feel testicle separately

Question 26

What is carcinoma of scrotal skin?

Answer 26

Appears as an ulcer on the scrotal skin, often with a purulent or bloody discharge.

No additional information.

Question 27

What is orchitis?

Answer 27

In the absence of involvement of the epididymitis, due to a viral infection, e.g. mumps. Often occurs with enlargement of the salivary glands.

Example: cannot feel testicle separately

Question 28

What is testicular torsion?

Answer 28

The testis and epididymis are usually fixed to their surrounding tissues. Testicular torsion can occur and normally results in severe scrotal pain, which is a surgical emergency. Torsion produces an initial venous infarction followed by arterial occlusion. If the twist is not reversed within 4-6 hours gangrene will occur. Fertility may be affected by an episode of torsion.

Example: cannot feel testicle separately