Urology

Question 1

There is severe testicular pain of sudden
onset, but no fever, pyuria, or history of recent mumps. The testis is swollen, exquisitely
tender, “high riding,” and with a “horizontal lie.” The cord is not tender

Answer 1

Testicular torsion

Question 2

Mx of Testicular torsion

Answer 2

After the testis is untwisted, an orchiopexy is done to prevent recurrence; simulataneous contralateral orchiopexy is also indicated

Question 3

_______can be confused with testicular torsion. It is seen in young men old enough to be sexually active, and it also starts with severe testicular pain of sudden onset

Answer 3

Acute epididymitis

Question 4

PE OF Acute epididymitis

Answer 4

There is fever and pyuria, and although the testis is swollen and very tender, is in the normal
position. The cord is also very tender

Question 5

A typical scenario is a patient who is being allowed to pass a ureteral stone spontaneously, and who suddenly develops chills, fever spike (104–105°F), and flank pain

Answer 5

obstruction and infection of the urinary tract

Question 6

_________ is the most common reason a newborn boy doesn’t urinate during day 1 of life (also look for meatal stenosis).

Answer 6

Posterior urethral valve

Question 7

Dx and Tx of posterior urethral valve

Answer 7

Voiding cystourethrogram is the diagnostic test, and endoscopic fulguration or resection will get rid of them

Question 8

The urethral opening is on the ventral side of

the penis, somewhere between the tip and the base of the shaft

Answer 8

Hypospadias

Question 9

What should not be done in pt with Hypospadias

Answer 9

Circumcision should never be done on such a child, inasmuch as the skin of the prepuce will be needed for the plastic reconstruction that will eventually be done

Question 10

UTI in children should always lead to a urologic workup. The cause may be _______, or some other congenital anomaly

Answer 10

vesicoureteral reflux

Question 11

_________ and infection produce burning on urination, frequency, low abdominal and perineal pain, flank pain, and fever and chills in a child.

Answer 11

Vesicoureteral reflux

Question 12

The patient feels normally the need to void, and voids normally at appropriate intervals (urine deposited into the bladder by the normal ureter); but is also wet with urine all the time (urine that drips into the vagina

Answer 12

Low implantation of a ureter

Question 13

The anomaly at the UPJ allows normal urinary output to flow without difficulty, but if a large diuresis occurs, the narrow area cannot handle it

Answer 13

Ureteropelvic junction (UPJ) obstruction

Question 14

________in its full-blown picture produces hematuria, flank pain, and a flank mass. It can also produce hypercalcemia, erythrocytosis, and elevated liver enzymes

Answer 14

Renal cell carcinoma

Question 15

MX of Renal cell carcinoma

Answer 15

Surgery is
the only effective therapy and may include partial nephrectomy, radical nephrectomy, or even
inferior vena cava resection.

Question 16

\_\_\_\_\_\_\_ has a very close correlation
with smoking (even more so than cancer of the lung), and usually presents with hematuria.

Answer 16

Cancer of the bladder (transitional cell cancer in most cases)

Question 17

Mx of Cancer of the bladder

Answer 17

Both surgery and intravesical BCG have therapeutic

roles, and a very high rate of local recurrence makes life-long close follow-up a necessity

Question 18

Prostate CA

Surveillance frequently stops at age ____ beyond which survival is not affected by treatment.

Answer 18

75,

Question 19

Widespread bone metastases respond for a few years to
1
2
3

Answer 19

androgen ablation, surgical (orchiectomy)
or medical (luteinizing hormone-releasing hormone agonists, or antiandrogens like flutamide).

Question 20

________ affects young men, in whom it presents as a painless testicular mass

Answer 20

Testicular cancer

Question 21

Most testicular cancers are exquisitely ________ and _______ offering many options for successful treatment in advanced, metastatic disease.

Answer 21

radiosensitive and chemosensitive (platinum-based chemotherapy),

Question 22

Triggers of urinary retention

Answer 22

It is often precipitated during a cold, by the use of antihistamines
and nasal drops, and abundant fluid intake

Question 23

Initial Tx of urinary retention

Answer 23

First line of long-term therapy is alpha-blockers. 5-alpha-reductase inhibitors are used for very large glands (>40 g).

Question 24

The patient may not feel the need to void because of post-op pain, medications, etc., but will report that every few minutes there is involuntary release of small amounts of urine.

Answer 24

Postoperative urinary retention

Question 25

They leak small amounts of urine whenever intra-abdominal pressure suddenly increases.

This includes sneezing, laughing, getting out of a chair, or lifting a heavy object

Answer 25

Stress incontinence

Question 26

PE of pts with Stress incontinence

Answer 26

weak pelvic floor, with the prolapsed bladder neck outside of the “high-pressure” abdominal area.

Question 27

Small stones (≤3 mm) at the ureterovesical junction have a \_\_\_\_\_\_ chance of passing spontaneously. Such cases can be handled with analgesics, plenty of fluids, and watchful
waiting

Answer 27

70%

Question 28

On the other hand, a 7-mm stone at the UPJ only has a _____probability of passing. Intervention will be required

Answer 28

5%

Question 29

MC MX of stone

Answer 29

extracorporeal shock-wave lithotripsy (ESWL).

Question 30

ESWL cannot be used in

Answer 30

(pregnant women, bleeding diathesis, stones that are several centimeters large).

Question 31

________is almost always caused by fistulization between the bladder and the GI tract, most commonly the sigmoid colon, and most commonly from diverticulitis (second possibility is cancer of the sigmoid, and cancer of the bladder is a very distant third

Answer 31

Pneumaturia

Question 32

______ has sudden onset, is partner- or situation-specific, does not interfere with nocturnal erections (which can be tested with a roll of postage stamps), and can be effectively treated with psychotherapy only if it is done promptly.

Answer 32

Psychogenic impotence

Question 33

First line medical Tx for impotence

Answer 33

Sildenafil, tadalafil, and vardenafil have become first choice therapy in many cases,

Question 34

Sx Tx for impotence

Answer 34

vascular surgery (well-suited for those
with arterial injury), suction devices (can be used on almost everybody), and prosthetic
implants