Urology 2

Question 1

MC type of bladder CA

Answer 1

urothelial (transitional cell) carcinoma

Question 2

risks bladder CA

Answer 2

smoking MC
caucasion
cyclophosphamide
dyes, leather, rubber

Question 3

sx bladder CA

Answer 3

hematuria MC, painless, present throughout micturition

may have dysuria, urgency, frequency

Question 4

dx bladder CA

Answer 4

UA w microscopy and cultures to rule out benign causes

workup for bladder CA - cystoscopy, renal function testing, upper urinary tract imaging (CT urography)

cystoscopy w biopsy - standard for dx and staging; can be curative

Question 5

tx bladder CA

Answer 5

localized - transurethral resection of bladder tumor (electrocautery)

muscle invasive - radical cystectomy w urinary diversion

metastatic - platinum based chemo

Question 6

benign prostatic hyperplasia

Answer 6

hyperplasia of periurethral or transitional one –> prostatic obstruction or bladder outlet obstruction

Question 7

sx BPH

Answer 7

irritative sx - urinary frequency, urgency, nocturia, incontinence

obstructive - hesitancy, weak, slow, splitting, intermittent stream force, incomplete emptying

Question 8

PE BPH

Answer 8

DRE - uniformly enlarged, smooth, firm, contender, rubbery prostate

Question 9

dx BPH

Answer 9

no eval if no significant sx or not impacting health

UA - look for hematuria

PVR if retention

urine cytology if concerned for CA

Question 10

tx BPH

Answer 10

observation if asx - mild; lifestyle - avoid fluids prior to bed, decreased consumption of diuretics (alcohol, caffeine), double void to empty bladder completely

alpha 1 blockers - best initial for rapid relief; do not change size of prostate; tamsulosin
- PDE 5 if both BPH and ED

5 alpha reductase inhibitors - reduces size of pastorate over 6-12 months (finasteride or dutasteride)

transurethral resection of prostate - can cause sexual dysfunction or incontinence

Question 11

MC type of prostate CA

Answer 11

adenocarcinoma - 95%

Question 12

risks prostate CA

Answer 12

increasing age > 40 (strongest)
genetics
black race

Question 13

sx prostate CA

Answer 13

most asx
back or bone pain - METs
urinary frequency, urgency, retention, decreased stream

Question 14

PE prostate CA

Answer 14

DRE - hard, indurated, nodular, enlarged, asymmetrical prostate

Question 15

dx prostate CA

Answer 15

PSA - > 4 ng/mL
Transrectal US guided needle biopsy - most accurate

bone scan if PSA > 10

Gleason grading system determines aggressiveness

Question 16

tx prostate CA

Answer 16

observation
external beam radiation
radical prostatectomy –> can cause incontinence and ED

hormonal therapy - androgen deprivation therapy - GnRH agonist (Leuprolide, Goserelin) or GnRH antagonist (Degarelix, Relugolix)

Question 17

4 types of kidney stones

Answer 17

calcium - calcium oxalate MC
uric acid
struvite - composed of magnesium ammonium phosphate; stag horn calcite - usually due to proteus
cystine - rare; usually due to congenital defect

Question 18

sx nephrolithiasis

Answer 18

renal colic - sudden, constant upper lateral back or flank pain

or

painless gross hematuria without pain (less common)

may have groin pain

Question 19

PE nephrolithiasis

Answer 19

CVA tenderness
usually afebrile

Question 20

dx nephrolithiasis

Answer 20

UA - initial - microscopic or gross hematuria; nitrites if infectious; acidic urine pH < 5; may have alkaline urine ph > 7.2 if struvite stones

non contrast CT abdomen and pelvis - test of choice

KUB radiographs - only calcium and struvite stones are radiopaque - visible on radiographs

Question 21

tx nephrolithiasis

Answer 21

stones < 5 mm diameter - IV or oral fluids and analgesics - NSAIDs, ketorolac, ibuprofen

stones > 5 - < 10 mm diameter - alpha blockers - tamsulosin, extracorporeal shock wave lithotripsy, ureteroscopy with or without stent - provides immediate relief

percutaneous nephrolithotomy most invasive and used for large stones > 10 mm or struvite or other methods fail

Question 22

what is the narrowest point of urinary tract

Answer 22

ureterovesiscular junction

Question 23

dietary factors associated w lower risk for nephrolithasis

Answer 23

calcium
potassium
phytake intake

increased fluid

Question 24

causes of erectile dysfunction ED

Answer 24

vascular - MC - atherosclerosis, dm, psychogenic, prolactinoma

meds - BB, thiazides, spironolactone, CCB, SSRI, TCA

Question 25

differentiate psychological vs systemic cause ED

Answer 25

abrupt onset - psychological

Question 26

tx ED

Answer 26

PDE5 inhibitors - sildenafil, Tadalafil

not used w nitrates or patients w CVD

Question 27

hydronephrosis

Answer 27

urinary tract obstruction –> dilation of collecting system in one or both kidneys

characterized by obstruction of passage of urine

Question 28

RF hydronephrosis

Answer 28

kidney stones
tumors
BPH
prostate CA

Question 29

sx hydronephrosis

Answer 29

MC asx
change in urine output
HTN
hematuria
rarely pain

Question 30

dx hydronephrosis

Answer 30

UA - often benign; may show hematuria
US - initial imaging - dilation of collecting system in one or both kidneys

CT scan - if flank pain or suspected nephrolithiasis

Question 31

tx hydronephrosis

Answer 31

removal of obstruction

Question 32

Polycystic kidney disease (PKD)

Answer 32

autosomal dominant disorder due to mutations in either PKD1 (85-90%) or PKD2

progressive disorder characterized by formation and enlargement of kidney cysts and cysts in other organs (liver MC, spleen, pancreas)

Question 33

where do cysts form in PDK

Answer 33

kidney
liver (MC other site)
spleen
pancreas

Question 34

what stimulates the formation of cysts in PKD

Answer 34

vasopressin/ADH

Question 35

sx PKD

Answer 35

abdominal and flank pain
hematuria
cerebral berry aneurysms –> subarachnoid hemorrhage
MVP
colonic diverticula (diverticulosis)

Question 36

PE PKD

Answer 36

palpable flank mass or large palpable kidney
HTN

Question 37

dx PKD

Answer 37

UA - hematuria, decreased urine concentrating ability, proteinuria

Renal US - most widely used - can also be used to screen family

CT or MRI more sensitive than US

genetic testing after dx

Question 38

tx PKD

Answer 38

simple cyst - observation, ACEI, ARBs

multiple - supportive, infcrease fluids which decreases vasopressin, HTN control

Tolvaptan is a vasopressin 2 receptor antagonist that has most benefit on eGFR decline in high risk patients