Urology

Question 0

Testicular torsion – age? Notable findings in Vitals/labs?

Physical exam findings?

When/what surgery?

Answer 0

Young adolescence

No fever, pyuria,

#Swollen testes, extremely tender
#high riding with horizontal lie
#no cord tenderness

Immediate; untwisting and orchiopexy

Question 1

Dire urologic emergencies?

Answer 1

#Testicular torsion
#Combination of obstruction and infection

Question 2

Condition that can be confused with testicular torsion? (Why?)

Important vitals/labs?
Physical exam findings?

Surgery when?

Answer 2

Acute epididymitis (Also testicular pain of sudden onset)

#Fever
#Pyuria

#Swollen and very tender
#Normal position (not in horizontal line)
#Tender cord

Do sonogram to rule out testicular torsion. Then antibiotics, no surgery

Question 3

Why is combination of obstruction and infection of the urinary tract a dire emergency? Typical scenario? When/what surgery?

Answer 3

Can destroy the kidney in a few hours, and caused deaths from sepsis

Patient spontaneously passing ureteral stones suddenly develops chills, spikes fever, and flank pain

#IV antibiotics
#Decompression of the urinary tract (by simplest/quickest means – stent or percutaneous nephrostomy)

Question 4

Patient presents with urinary frequency, painful urination, and small volumes of cloudy and malodorous urine – diagnosis? Typical patient? Management?

Answer 4

UTI (cystitis)

#Empiric antimicrobial therapy
#If in child or man, urinary cultures and urologic workup to determine cause

Question 5

Patient with suspected urologic tumor – test?

Patient with suspected attraction – test?

Patient with suspected early bladder cancer – Test?

Answer 5

CT

Sonogram

Cystoscopy

Question 6

Intravenous pyelogram gives good views of? Provides information on?

Limitations?

Answer 6

Kidney, collecting system, ureter, some Bladder

Function of renal parenchyma, yours, bladder reflux

Contraindicated in patients with creatinine over 2; patients allergic to dye

Question 7

Patient presents with chills, high fever, nausea and vomiting, flank pain – suspected diagnosis? Management?

Answer 7

Pyelonephritis

#Cultures and appropriate antibiotics
#Urologic workup (IVP or sonogram)

Question 8

Older man presents with chills, fever, dysuria, low back pain, urinary frequency – suspected diagnosis? Physical exam findings? Management?

Answer 8

Acute bacterial prostatitis

Exquisitely tender prostate

#IV antibiotics
#No more rectal exams (could lead to septic shock)

Question 9

Newborn does not urinate the first day of life – differential? Diagnostic test? Management?

Answer 9

1. posterior urethral valves (most common)
2. Meatal stenosis

Voiding cystourethrogram

#Catheterization
#if posterior urethral valves, Endoscopic fulguration or resection

Question 10

Newborn presents with hypospadias – procedure that should not be done?

Answer 10

Circumcision (skin will be needed for reconstruction)

Question 11

Children who present with these urologic problems should always get a urologic workup?

Answer 11

#Hematuria (undiagnosed congenital abnormality)
#UTI – look for vesicoureteral reflux

Question 12

Child presents with burning on urination, frequency, flank pain, and fever – suspected diagnosis? Management?

Answer 12

Vesicoureteral reflux

#Empiric antibiotics
#Antibiotics based on culture
#IVP and voiding cystogram for reflux
#If found, long-term antibiotics

Question 13

Low implantation of a ureter in boys versus girls?

Answer 13

Asymptomatic in boys

In girls, feel need to void, and voids normally at appropriate intervals, but is also wet with urine all the time (urine drips into vagina from low implantation)

#Physical exam to find abnormal ureteral opening
#IVP if cannot be found
#Corrective surgery

Question 14

Patient who goes on beer-drinking binge for first time in life, and develops colicky flank pain – suspected diagnosis? Mechanism?

Answer 14

Ureteropelvic junction obstruction – Normal urinary output flows without difficulty, but large diuresis cannot easily pass through narrow area

Question 15

Most common presentation for urologic tumors?

When does a patient with this sign not need a work up rule out cancer?

Answer 15

Hematuria (Kidney, ureter, bladder cancer)

After significant trauma

Question 16

Work up for hematuria?

Answer 16

#CT scan
#Cystoscopy – only way to rule out bladder cancer

Question 17

Renal cell carcinoma – presenting symptoms? Lab findings? Best imaging? Only effective therapy?

Answer 17

Hematuria, flank pain, flank mass

#Hypercalcemia
#Erythrocytosis
#Elevated liver enzymes

CT scan showing heterogenic solid tumor

Surgery