Urology

Question 1

Non-cystic manifestations associated with adult polycystic kidney disease?

Answer 1

-MITRAL valve prolapse
-intracranial berry aneurysms
-colonic diverticula
-renal cell carcinoma

Question 2

How might urethral trauma present?

Answer 2

Scrotal haematoma / perineal bruising
Blood at external urethral meats
High riding prostate on rectal exam OR absence of palpable prostate on exam

(If suspected, refer urgently to urology)

Question 3

Risk factors for CKD?

Answer 3

Black/Asian ethnicity
HTN
Cardiovascular disease
Smoking
Chronic NSAID use
Proteinurea
Urinary outflow obstruction

Question 4

Which of these UTI abx can discolour urine?
Nitrofurantoin
Trimethoprim

Answer 4

Nitrofurantoin - turns urine brown ‘Nasty’

Question 5

Sterile pyuria means?
Most common cause in UK?

Answer 5

Presence of leukocytes in urine without infection
Partially or recently treated UTI

Question 6

Foods to be avoided when preventing renal stones?

Answer 6

Chocolate!
Tea
Nuts
Strawberries
Rhubarb
Spinach
Beans
Beetroot

Question 7

UTI abx choice in pregnancy?

Answer 7

Nitrofurantoin
(Avoid trimethoprim in pregnancy. Teratogenic risk in 1st trimester)

Question 8

Deteriorating renal function after CT with contrast - cause?

Answer 8

Acute tubular necrosis

Question 9

What is Berger’s disease (IgA nephropathy) and how does it present?

Answer 9

Most common type of glomerulonephritis in ADULTS worldwide
Visible haematuria 24-48 hours after URTI

Question 10

What is Wegener’s granulomatosis (granulomatosis with polyangiitis/GPA)?

Answer 10

Systemic vasculitis - affects small and medium vessels.
Classic triad: upper, and lower respiratory tract involvement and glomerulonephritis
Often also involves cutaneous, ocular, musculoskeletal and peripheral nervous system

Question 11

Most appropriate action for a pt with a ?blocked catheter post-TURP?

Answer 11

Bladder washout

Question 12

Which staph organism causes UTIs in young fit adults, particularly young, sexually active women?

Answer 12

Staph saprophyticus
‘Phyt = fit young people!’)

Question 13

Older patient with urinary incontinence, dementia and abnormal gait. Dx?

Answer 13

Normal pressure hydrocephalus! This is the classic triad of symptoms

Question 14

Pt with gastric carcinoma - vague back pains, raised ESR/CRP. Ct shows BL hydronephrosis with drawing together of ureters in midline and peri-aortic mass. Dx?

Answer 14

Retro peritoneal fibrosis

Question 15

Complications of phimosis?

Answer 15

Inability to clean under foreskin is associated with;
-stones in preputial sac
-cancer of penis

Question 16

2 types of phimosis and how they are treated?

Answer 16

1 physiological (without scarring/primary) - conservative

2. Pathological (secondary/ due to scarring) - circumcision. Short course of corticosteroids can benefit mild scarring

Question 17

Blood gas for pt with chronic renal failure should show what?

Answer 17

Metabolic acidosis with respiratory compensation

Question 18

How does exercise affect serum potassium levels?

Answer 18

Causes hypERkalaemia

Question 19

Insulin injections cause what to serum potassium?

Answer 19

HypOkalaemia (why fluids with K are given with insulin infusions)

Question 20

Most likely organism to have caused acute epididymo-orchitis in:
-man under 35?
-men over 35

Answer 20

Under 35: STI ie chlamydia or gonorrhoea

Over 35: non-STI is E Coli, Pseudomonas

Question 21

Medical treatment for BPH?

Answer 21

A-1 Adrenergic receptor antagonists ie tamsulosin

5a-reductase inhibitors ie finasteride

Question 22

Surgical options for BPH?

Answer 22

Transurethral microwave thermotherapy (TUMT)
Transurethral needle ablation (TUNA)
Transurethral resection of prostate (TURP)

Question 23

What is Alport syndrome?
How does it present?

Answer 23

X-linked/autosomal recessive rare gene defect for type IV collagen in basement membranes
Sensorineural deafness, pyelonephritis, haematuria, renal failure

Question 24

In men >60, what is the commonest cause of painless, visible haematuria?

Answer 24

Transitional cell carcinoma of the bladder

Question 25

30 y/o woman with longstanding stress incontinence and pelvic pain. Bimanual reveals pain on palpitation of urethra, bladder neck and locator ani. Dx?

Answer 25

Interstitial cystitis (bladder pain syndrome)

Question 26

Nephrogenic diabetes insipidus.
Blood results show?
Causes?
Tx?

Answer 26

Low urine osmolality
Hugh serum osmolality/sodium

HypOkalaemia, hypercalcaemia, CKD, lithium

Desmopressin
Thiazide diuretics
NSAIDs
Sodium restriction

Question 27

55 y/o, hx of RA, presents either HTN and oedema. BL renal masses, urinalysis reveals proteinuria and renal biopsy fluoresces bright green under polarised light after Congo red staining. Dx?

Answer 27

Renal amyloidosis

Question 28

Mean age of Wilson’s tumour presentation?
How does it present?

Answer 28

3.5 years
Abdo pain, abdominal mass, HTN, fever (caused by tumour necrosis), haematuria, anaemia

Question 29

First line tx for pyelonephritis?

Answer 29

CEFALEXIN for 7-10 days

Question 30

Triad of HUS? (haemolytic uraemic syndrome?)

Answer 30

Acute renal failure
Microangiopathic haemolytic anaemia
Thrombocytopenia

Question 31

What is HUS caused by?

Answer 31

Mostly INFECTION- E Coli

Question 32

How does HUS present?

Answer 32

Profuse diarrhoea that turns bloody 1-3 days later
Fever, abdominal pain, vomiting

Question 33

Most common type of prostate cancer?

Answer 33

Adenocarcinomas

Question 34

Grading system for prostate cancer?

Answer 34

Gleason score

Question 35

How to differentiate testicular tumour from haematoma?

Answer 35

Haematoma are usually painful and scrotum likely to be swollen

Note: testicular tumours are the most common malignancy in young men !

Question 36

What type of cancer can the BCG vaccine be used in the treatment for?

Answer 36

Bladder cancer!

Question 37

Which cause of testicular swelling will transilluminate?

Answer 37

Hydrocele