Urology

Question 1

First line treatment for BPH

Answer 1

Alpha blockers when mod-severe symptoms

SOR A

Question 2

When to use 5-alpha reductase inhibitors

Answer 2

bothersome, mod-severe symptoms and documented enlarged prostate when alpha blocker monotherapy not effective

SOR A

Question 3

In addition to alpha blockers and 5 alpha reductase inhibitors (Level A). What is a medication whose off label use helps BPH (level B)?

Answer 3

Cialis - mechanism unknown

don’t use with alpha blockers

Question 4

Empiric antibiotics for Acute bacterial prostatitis (3 choices)
- what are you trying to cover

Answer 4

• cover gram negative enterics. Cover for GC/CHL if sexually active
• Ceftriaxone + Doxy. Ciprofloxacin. Bactrim
• duration 10-14 days

Question 5

Which labs most accurately predict hypogonadism

Answer 5

AM labs:

• low testosterone
• high FSH
• high LH

Question 6

What is the diagnostic sequence for primary hypogonadism

Answer 6

1. Testosterone level –> low
2. repeat free testosterone. Add FSH, LH
3. Low T, high FSH, high LH = primary hypogonadism = pituitary is working, the testes are not

Question 7

What is the diagnostic sequence for secondary hypogonadism

Answer 7

1. Testosterone level –> low
2. repeat free testosterone. Add FSH, LH
3. Low T, low FSH, low LH = secondary hypogonadism = regulatory problem, so look at the pituitary
4. prolactin, MRI, TSH, T4

Question 8

What are concerning side effects of treating with testosterone

Answer 8

increased risk of prostate cancer and breast cancer
worsening BPH
blood clots
sleep apnea

Question 9

Which populations benefit most from PDE type 5 inhibitors in treatment of ED?

Answer 9

DM, spinal cord injury, antidepressant side effects

SOR A

Question 10

Who should be screened with PSA?

Answer 10

AAFP does not recommend routine PSA based screening.
For men ages 55-69 who are considering periodic prostate cancer screening –> shared decision making
SOR C

Don’t screen older than 70
SOR D

Question 11

What lifestyle changes should people with kidney stones make if they have calcium oxalate stones?

Answer 11

• don’t change dietary sodium
• increase fluid intake to at least 2 L per day

SOR B

Question 12

Which initial image should I get if I suspect kidney stones?

Answer 12

• pregnant, gallbladder dz, or gyn cause suspected –> US
• Hx or radio-opaque stones –> X ray
• Everyone else –> US if not obese, otherwise non contrast CT

Question 13

How do I manage Kidney stones that are < 4 mm?

Answer 13

98% pass on their own in 1-2 weeks
analgesia
alpha blockers unlikely to benefit
repeat KUB in 1-2 weeks
Urology if not passed in 2-4 weeks

Question 14

How do I manage kidney stones 5-10 mm?

Answer 14

53% pass on their own
analgesia
alpha blockers unlikely to benefit
repeat KUB in 1-2 weeks
Intervene if: persisting colic, failure of stone progression, evidence of obstruction

Question 15

What size kidney stone warrants immediate urology referral?

Answer 15

10 mm

SOR C

Question 16

Who needs to have their kidney stone analyzed?

Answer 16

Recurrent stone formers

Question 17

Diagnostic evaluation of hematospermia

Answer 17

Exclude infection with UA
rule out prostatitis
Imaging in persistent symptoms
- 1st transrectal ultrasonography
- 2nd MRI

Question 18

What are the top 3 reasons for hematuria?

Answer 18

infection, stones, malignancy

Question 19

If unable to diagnose reason for hematuria based on UA with micro and history, what should be done next?
What is the next question I need to ask myself?

Answer 19

Is this glomerular or not?

• Glomerular (proteinuria, renal disease) –> nephro
• Not –> 1. CT urography 2. Cytology 3. Cystoscopy

Question 20

How do you diagnose chronic bacterial prostatitis?

Answer 20

Hx - recurrent acute sxs with asymptomatic intervals. lasts > 3 months
UA - WBCs pre and post prostatic massage
C & S - neg on pre and + on post prostatic massage

Question 21

Treatment for chronic bacterial prostatitis

Answer 21

1st line: Bactrim (level C)

2nd line Quinolones

Question 22

How do you treat Acute infectious epididymitis?

Answer 22

prepubertal - post infectious or anatomic –> refer all to GU for anatomic eval
If < 35 treat for GC/CHL
If > 35 treat for enteric UTI pathogen

SOR A

Question 23

What are “kidney stone labs” that you should get in recurrent stone formers? - there are 9

Answer 23

CBC
UA
Urine C and S
BMP
CA
PO4
vitamin D
Stone analysis
Urate

Question 24

What further testing do you need in Kidney stone formers in these following scenarios?

• hypercalcemia
• abnormal albumin
• hyperoxaluria
• sarcoidosis

Answer 24

• hypercalcemia –> PTH
• abnormal albumin –> ionized calcium
• hyperoxaluria –> oxalate levels
• sarcoidosis –> ACE level and calcitriol

Question 25

Workup for scrotal pain

Answer 25

• CRP > 24 –> suspect epididymitis/orchitis
• scrotal ultrasonography
  ALL SOR C recommendations

Question 26

What is Prehn’s sign in testicular pain

Answer 26

elevation relieves pain in epididymitis and not torsion

*this is not a reliable test

Question 27

Differential of testicular pain - 5 causes

Answer 27

Testicular torsion
Torsion of appendix testes
Epididymitis
Trauma
Orchitis
(there are other causes but these are the main ones)

Question 28

Differential of testicular swelling

Answer 28

hydrocele
caricocele
spermatocele
tumor