Urology

Question 1

In which part of the prostate do adenocarcinomas tend to arise in?

Answer 1

Peripheral prostate

Question 2

What medication may offer benefit for 1 -2 years for patients with metastatic prostate cancer?

Answer 2

LHRH agonist e.g. goserelin

Question 3

Name some risk factors associated with bladder cancer

Answer 3

Smoking; aromatic amines (rubber); chronic cystitis; schistosomiasis

Question 4

What investigation is diagnostic of bladder cancer?

Answer 4

Cystoscopy and biopsy

Question 5

What stage would you give to a bladder cancer tumour confined to the lamina propria?

Answer 5

T1

Question 6

What does it mean if a bladder cancer tumour is classed as T2?
What would be felt at EUA?

Answer 6

T2 = Superficial muscle is involved

A rubbery thickening would be felt

Question 7

What does it mean if a bladder cancer tumour is classed as T3?
What would be felt at EUA?

Answer 7

T3 = Deep muscle involved

A mobile mass would be felt

Question 8

What does it mean if a bladder cancer tumour is classed as T4?
What would be felt at EUA?

Answer 8

T4 = Invasion beyond bladder

Fixed mass would be felt

Question 9

What our the treatments for bladder cancers staged Tis/ Ta/ T1?

Answer 9

Diathermy via e.g. TURBT

Chemo/intravesical BCG as maintenance

Question 10

What our the treatments for bladder cancers staged T2-3?

Answer 10

Radical cystectomy. Neoadjuvant chemo.

Question 11

What our the treatments for bladder cancers staged T4?

Answer 11

Palliative chemo/radiotherapy

Question 12

What type of cancer is haemodialysis RF for?

Answer 12

Renal cell carcinoma

Question 13

List 4 ways that renal cell carcinoma can present and why

Answer 13

• Increased BP due to renin secretion
• Polycythaemia from EPO secretion
• Bone mets (check ALP)
• Cannon ball mets on CXR

Question 14

What treatments are renal cell carcinoma resistant to?

Answer 14

Radiotherapy and chemotherapy

Question 15

What are the 4 stages of testicular cancer?

Answer 15

1) No mets
2) Infradiaphragmatic node involvement
3) Supradiaphragmatic node involvement
4) Lung involvement

Question 16

Which nodes do testicular cancer initially spread via?

Answer 16

Para-aortic lymph nodes

Question 17

Name 2 useful tumour markers for testicular cancer

Answer 17

AFP and hCG

Question 18

Give details of the surgery used in testicular cancer

Answer 18

Radical orchidectomy: inguinal incision, occlude spermatic cord before mobilisation to decrease intra-operative spread.

Question 19

Which type of testicular tumour is v radiosensitive?

Answer 19

Seminomas!

Question 20

What is a hydrocele?

Answer 20

An abnormal quantity of peritoneal fluid between parietal and visceral layers of tunica vaginalis

Question 21

What is balantis?

Answer 21

Inflammation of foreskin & glans.

Question 22

Name 2 risk factors for balantis

Answer 22

Diabetes and children with tight foreskins

Question 23

What are the treatment options for balantis?

Answer 23

Abx (linked with strep + staph), circumcision

Question 24

What is phimosis?

Answer 24

Foreskin occludes the meatus.

Question 25

What is paraphimosis?

Answer 25

When tight foreskin is retracted and becomes irreplaceable –> prevents venous return –> oedema and ischaemia of glans.

Question 26

How does phimosis present in young boys? What should be attempted?

Answer 26

Recurrent balantis and ballooning. Try retraction.

Question 27

How does phimosis present in adults?

Answer 27

Painful sex, infection, ulcers

Question 28

When does paraphimosis typically occur?

Answer 28

After catheterisation

Question 29

What are the treatments for paraphimosis?

Answer 29

• Ask patient to squeeze glans
• 50% Glucose-soaked swabs
• May need dorsal slit

Question 30

If the prostate is described as “boggy” on DRE, what is the likely diagnosis?

Answer 30

Prostatitis

Question 31

What is the gold standard way to image stones?

Answer 31

Non-contrast CT

Question 32

What is the best imaging modality for hydronephrosis?

Answer 32

USS

Question 33

How do thiazide diuretics prevent the development of calcium kidney stones?

Answer 33

They decrease calcium excretion (less to urine to form stones)

Question 34

What treatment options are available for stones over 5mm or where the pain is not resolving?

Answer 34

• Medical expulsion therapy (nifedipine or an alpha blocker - e.g. Tamsulosin)
• Extracorpeal lithotripsy
• Percutaneous nephrolithotomy (keyhole surgery)

Question 35

What part of the prostate is affected in BPH?

Answer 35

Inner (transitional) zone

Question 36

What 2 drugs can be given to a patient with BPH as they await surgery?

Answer 36

• a-blockers e.g. Tamsulosin: decrease muscle tone

- 5a-reductase inhibitors (e.g. finasteride): decreases testosterone being converted to dihydrotestosterone

Question 37

What advice must you give to men taking finasteride?

Answer 37

Wear condoms as finasteride is excreted in semen

Question 38

Simply, how do PDE 5 inhibitors work biochemically?

Answer 38

They increase cGMP

Question 39

Name 3 things that uroflowmetry measures

Answer 39

Voided volume, max. flow rate, time taken to void

Question 40

What is the treatment for lower UTIs in women?

Answer 40

Trimethoprim of nitrofurantoin

Question 41

What is the treatment for non-pregnant women with upper UTIs?

Answer 41

Urine culture

E.g. IV Co-amoxiclav, then oral when afebrile (complete a 7 day course)

Question 42

What is the treatment for UTIs in men?

Answer 42

2 week course of a quinolone e.g. levofloxacin