Urology

Question 1

T/F: Fever and pyuria are seen in testicular torsion.

Answer 1

False! But it is seen in epididymitis

Question 2

T/F: Unlike in testicular torsion, the cord is tender in epididymitis

Answer 2

True

Question 3

How is epididymitis treated?

Answer 3

Antibiotics; possibly a sonogram to rule out testicular torsion

Question 4

Patient allowed to pass a stone spontaneously suddenly develops chills, fever spike to 104/105, and flank pain:
Next step?

Answer 4

Ureteral obstruction!
Treat with IV antibiotics and immediate decompresion of the urinary tract (with ureteral stent or percutaneous nephrostomy)

Question 5

IVP is contraindicated with patients who have Cr of

Answer 5

> 2

Question 6

Only __________ can look at hte bladder mucosa in detail and aid in detecting early bladder cancers

Answer 6

cystography

Question 7

What imaging modality is used to look for dilation of ureters or kidneys?

Answer 7

ultrasound

Question 8

What imaging modality is good for looking at renal tumors?

Answer 8

CT

Question 9

Old man with chills, fever, dysuria, urinary frequency, diffuse low back pain, and an exquisitely tender prostate on rectal exam:

Answer 9

acute bacterial prostatitis. Treat with IV abx and don’t repeat any more rectal exams (could lead to septic shock)

Question 10

What is the most common reason a newborn boy is not urinating during his first day of life? How do you assess?

Answer 10

Posterior urethral valves (meatal stenosis should also be looked for)
Catheterization should be done, as well as voiding cystourethrogram for diagnosis and endoscopic fulguration (electrical dissection) or resection will get rid of them

Question 11

Why should circumcision not be performed on a child with hypospadias?

Answer 11

Precupice will be needed for plastic reconstruction that will eventually be done

Question 12

T/F: UTI in children should always lead to urologic work up

Answer 12

True.. (?); VUR may be reason or another congenital anomaly

Question 13

T/F: IF vesicoureteral reflex is found following IVP and voiding cystogram, child should be kept on IV abx until they “grow out of the problem”

Answer 13

True

Question 14

Little girl who voids normally at appropriate intervals but is also wet with urine all the time:

Answer 14

Low implantation of a ureter (other ureter deposits urine into bladder normally). Physical exam may reveal, or IVP may be needed. Corrective surgery is needed

Question 15

Adolescent who goes on beer-drinking binge for first time in life and has colicky flank pain:

Answer 15

ureteropelvic junction obstruction (anomaly at UPJ allows normal urinary output to flow without difficulty, but a large diuresis cannot be accomodated)

Question 16

What is the workup of hematuria?

Answer 16

CT (kidney cancer) and cystoscopy (bladder cancer)

Question 17

What are the 3 cardinal signs of renal cell carcinoma?

Answer 17

1) Flank pain
2) Hematuria
3) Flank mass

Question 18

What are lab abnormalities caused by renal cell carcinoma?

Answer 18

Hypercalcemia, erythrocytosis, and elevated liver enzymes

Question 19

What does renal cell carcinoma look like on CT?

Answer 19

Solid homogenous mass (may be growing into IVC or renal vein)

Question 20

T/F: Transitional cell cancer of the bladder has a stronger association with smoking than lung cancer.

Answer 20

True

Question 21

T/F: Lifelong follow-up is a necessity for bladder cancer.

Answer 21

True, though surgery and intravesical chemo (BCG) have therapeutic roles, bladder cancer has a high rate of local recurrence

Question 22

WIdespread bone metastases from prostatic cancer respond to what?

Answer 22

Androgen ablation, either surgical (orchiectomy) or medical (LH releasing-hormone agonists, like leuprolide, or anti-androgens like flutamide (note: anti-androgens may be given in the beginning with LHRH agonists to prevent flare))

Question 23

Even with all of its contingencies, what is considered a normal PSA?

Answer 23

4 mg/dL or below

Question 24

Because benign testicular tumors are virtually nonexistent, the presence of a testicular mass will always require a radical orchiectomy by the _________ route.

Answer 24

Inguinal

Question 25

Why is urinary retention in men with BPH often precipitated during a cold?

Answer 25

1) use of antihistamines and nasal drops

2) abundant fluid intake

Question 26

What are choices for long-term therapy for BPH?

Answer 26

1) alpha blockers
2) 5-Alpha-reductase inhibitors (finasteride) are used for very large glands (over 40g). FInasteride is also used for androgenic hair loss

Question 27

This drug prevents conversion of testosterone into the more potent DHT.

Answer 27

finasteride (or other 5-alpha reductase inhibitors)

Question 28

Kidney stones greater than ______ require intervention since they do not likely pass spontaneously.

Answer 28

5mm

Question 29

In which patients can ESWL (extracorporeal shock-wave lithotripsy) not be performed?

Answer 29

Pregnant women
Bleeding diathesis
stones that are several cm large

Question 30

Pneumaturia is almost always caused by

Answer 30

fistulization between the bladder and the GI tract, most commonly the sigmoid colon

Question 31

Fistulization between the bladder and the GI tract (most commonly the sigmoid colon) is most commonly caused by

Answer 31

diverticulitis

second possibility is cancer of the sigmoid and cancer of the bladder is a “very distant third”

Question 32

What is the workup of pneumaturia?

Answer 32

1) CT to look for inflammatory diverticular mass
2) sigmoidoscopy to rule out cancer
surgical therapy is required

Question 33

Characterize psychogenic impotence. What is the treatment?

Answer 33

Sudden onset, is partner- or situation-specific, does not interfere with nocturanl erections, and is effectively treated with only psychotherapy if done promptly

Question 34

T/F: Organic impotence can also be sudden-onset.

Answer 34

True! If it is caused by trauma (such as after pelvic surgery, because of nerve damage, or after trauma to the perineum, which involves arterial disruption)

Question 35

Organic impotence because of chronic diseases (like ________) has very gradual onset, going from erections not lasting long enough, to being of poor quality, to not happening at all.

Answer 35

diabetes, arteriosclerosis

Question 36

What are the different therapeutic options for incontinence?

Answer 36

1) sildenafil, tadalafil, vardenafil (cGMP PDE5 inhibitors)
2) vascular surgery (for those with arterial injury)
3) suction devices (everybody)
* *not really 4) prosthetic implants (irreversible and fraught with complications)