Urology

Question 1

Sudden severe testicular pain
Swollen, tender, high riding testis
Cord not tender
Dx tx?

Answer 1

Testicular torsion
No tests
Emergency surgery and orchiopexy

Question 2

Sudden severe testicular pain
Fever, pyuria, cord is tender
Testis in normal position
Dx tx?

Answer 2

Acute epididymitis
Sonogram to r/o torsion
Antibiotics

Question 3

Flank pain, fever spikes, chills
Known ureteral stone
Tx?

Answer 3

Combination obstruction, infection

Immediate decompression by ureteral stent or percutaneous nephrostomy

Question 4

Urinary frequency, dysuria, cloudy urine

Dx Tx?

Answer 4

Urinary tract infection
Empiric antibiotics
If pyelo or UTI man or child, urine cultures and r/o obstruction

Question 5

Dx test for renal tumor
obstruction/dilation
bladder tumor

Answer 5

renal tumor- CT
obstruction/dilation- sonogram
bladder tumor- cystoscopy

Question 6

Flank pain, chills, high fever, nausea and vomiting

Dx Tx

Answer 6

Pyelonephritis
IVP or sonogram, urine cultures
IV antibiotics

Question 7

Contraindications to intravenous pyelogram

Answer 7

Allergy to contrast dye

Creatinine >2

Question 8

Older male
dysuria, chills, fever, urinary frequency, diffuse low back pain, tender prostate on exam
Dx Tx

Answer 8

Acute bacterial prostatitis
No more rectal exams! Can cause septic shock
IV antibiotics

Question 9

Newborn male
No urination day 1 after birth
Dx Tx

Answer 9

Posterior urethral valves
Voiding cystourethrogram
Catheterization, endoscopic fulguration

Question 10

Urethral opening on ventral side of penis

What should not be done

Answer 10

Hypospadias

Dont circumcise- need prepuce for reconstruction

Question 11

Child
dysuria, frequency, low abdominal and perineal pain, flank pain, fever, chills
Dx Tx

Answer 11

Vesicoureteral reflux
IVP and voiding cystogram
Long term antibiotics

Question 12

Little girl
Wet with urine all the time despite voiding normally
Dx Tx

Answer 12

Low implantation of ureter
IVP
Corrective surgery

Question 13

Adolescent

Colicky flank pain after first beer-drinking binge

Answer 13

Ureteropelvic junction obstruction

narrow area cannot handle large diuresis

Question 14

Most common presentation of cancer in kidney, ureter or bladder

Answer 14

Hematuria

Question 15

Workup of hematuria

Answer 15

CT scan, cystoscopy

Question 16

Hematuria, flank pain, flank mass
Hypercalcemia, erythrocytosis, elevated liver enzymes
Dx Tx

Answer 16

Renal cell carcinoma
CT scan
Surgery

Question 17

Hematuria in a smoker
Irritative voiding symptoms
Dx Tx

Answer 17

Bladder cancer
CT, cystoscopy
Surgery, intravesical BCG, lifelong follow up

Question 18

Diagnosis, treatment of prostate cancer

Answer 18

Transrectal needle biopsy

Surgery, radiation, goserelin, flutamide

Question 19

Painless testicular mass

Dx Tx

Answer 19

Testicular cancer
Serum AFP, HCG levels, radical orchiectomy and biopsy
Radiation, chemotherapy (platinum based) successful for metastatic disease

Question 20

Etiology of acute urinary retention in males

Tx

Answer 20

BPH, episode precipitated by antihistamines and fluid intake during a cold
3 day foley catheter, alpha blocker, TURP rarely done

Question 21

Post-op patient with incontinent bladder
Bladder is distended
Tx

Answer 21

Postoperative urinary retention (overflow)

Indwelling catheter

Question 22

Leakage of urine with increase abdominal pressure
Seen in multiparous women
No incontinence at night
Tx

Answer 22

Stress incontinence

Pelvic floor exercises or surgical repair

Question 23

Colicky flank pain radiates to inner thigh
Nausea, vomiting
Dx Tx

Answer 23

Ureteral stone
CT scan
< 3mm give analgesics, fluids, wait for passage
Larger stones need extracorporeal shock-wave lithotripsy (ESWL), basket extraction, sonic probes, lasers or open removal

Question 24

Contraindications to ESWL

Answer 24

Pregnancy
bleeding diathesis
>2cm stones

Question 25

Etiology of pneumaturia

Dx tx?

Answer 25

Fistulization between bladder and colon, often secondary to diverticulitis
CT scan, sigmoidoscopy r/o cancer
Surgical repair