Urology - Final 2023 Flashcards
Which risk factor is related to recurrent UTI in young and pre-menopausal women?
a. Urinary incontinence
b. Sexual intercourse
c. Increased post-vouid urine
d. Cystocele
Answer: B. Sexual intercourse.
This is correct because having sexual intercourse is a risk factor for UTI in young and pre-menopausal women, according to the Centers for Disease Control and Prevention (CDC). This is due to the fact that having sex can introduce bacteria from the genitalia into the urinary tract, which can lead to infection. Urinary incontinence, increased post-void urine and cystocele are not risk factors for UTI in this population.
According to the AAST renal injury grading scale, a cortical laceration >1cm without urinary extravasation is classified as:
a. Grade I
b. Grade 2
c. Grade 3
d. Grade 4
Answer: C. Grade 3
According to the American Association for the Surgery of Trauma (AAST) Organ Injury Scale for kidney injuries, a cortical laceration >1cm without urinary extravasation is classified as Grade 3. This is supported by the AAST documents available on their website which reveals that a Grade 3 includes hematuria without urinary extravasation but with cortical laceration >1 cm.
Incorrect Answers
A. Grade 1 - Grade 1 includes lacerations <1 cm, which does not apply in this case.
B. Grade 2 - A Grade 2 includes either a laceration >1 cm without urinary extravasation or a laceration <1 cm with urinary extravasation, which does not apply in this case.
D. Grade 4 - Grade 4 includes injuries resulting in total or nearly total organ loss, which is significantly more severe than the stated in the question.
Active surveillance in prostate cancer:
a. Is a palliative intended treatment option
b. Can be applied to patients with all tumour stages
c. Is not applied by pre-defined schedules
d. Aims to minimise treatment-related toxicity without compromising survival
Answer: d. Aims to minimise treatment-related toxicity without compromising survival.
This is correct, as active surveillance has been established as an approach for men with low risk prostate cancer, intended to reduce overtreatment and treatment-related toxicity. According to the American Cancer Society, Active Surveillance is a strategy used to monitor the growth of prostate cancer rather than treat it with surgery or radiation. It involves regular check-ups and tests to ensure that the cancer does not become more aggressive, with treatment being recommended if appropriate. Adopting active surveillance can thus help to minimise the risks of over treatment, including decrease the likelihood of experiencing treatment-related toxicity.
A 58-year-old male patient was referred to the urologist due to gross hematuria. Bladder cancer was considered among the possible diagnoses. During the clinical interview, the urologist asked about a potential exposition to bladder cancer risk factors. Apart from tobacco exposure, what is the most common risk factor for urothelial bladder cancer?
a. Occupational exposure to aromatic amines or polyciclic aromatic and chlorinated hydrocarbons
b. Exposure to trihalomethanes or arsenic in drinking water
c. Exposure to cyclophosphamide
d. Metabolic factors (high BMI, high BP, diabetes)
Answer: a. Occupational exposure to aromatic amines or polyciclic aromatic and chlorinated hydrocarbons
Explanation: According to the American Cancer Society, the most common risk factor for urothelial bladder cancer is long-term exposure to certain occupational/industrial chemicals. These include “aromatic amines and polycyclic aromatic hydrocarbons (found in industries such as rubber, leather, and dye manufacturing), or exposure to chlorinated hydrocarbons (found in the manufacturing of pesticides).” These risk factors are much more common than exposure to trihalomethanes, arsenic in drinking water, or cyclophosphamide, making answer a the most correct choice. In addition, metabolic factors such as a high BMI, high blood pressure, and diabetes are not considered direct risk factors for urothelial bladder cancer.
A 65-year-old man is admitted to the emergency department with acute left-sided colicky flank pain. Suspicion of acute renal colic is raised. There are no clinical signs of sepsis. What is the best first option for pain management in this patient?
C. Diclofenac??
The best first option for pain management would be the use of nonsteroidal anti-inflammatory drugs (NSAIDs) combined with spasmolytics, such as peppermint oil or Buscopan.
Which of the following comments/attitudes should be followed as a treatment of urinary treat stones?
- High fluid intake
- Restriction of animal protein intake
- Restriction of oral calcium intake
- Restriction of salt intake
- Physical exercise
a. 1, 2, 3, 4
b. 1, 3, 4, 5
c. 1, 2, 4, 5
d. 2, 3, 4, 5
Answer: c. 1, 2, 4, 5
High fluid intake, restriction of animal protein intake, restriction of salt intake, and physical exercise are all treatments that should be followed for urinary tract stones. Restriction of oral calcium intake is not recommended as a treatment for urinary tract stones. According to the American Urological Association, “high fluid intake and restriction of animal protein, salt and calcium intake have been broadly proposed to reduce the risk of stone formation. Regular physical exercise may also be beneficial.” Therefore, the correct answer is c. 1, 2, 4, 5.
Struvite stone consist of:
a. Calcium oxalate dihydrate
b. Magnesium ammonium phosphate
c. Calcium carbonate
d. Uric acid
Answer: B. Magnesium ammonium phosphate.
Struvite stones, also known as infection stones or magnesium ammonium phosphate stones, are composed of magnesium ammonium phosphate and are the result of a urinary tract infection (UTI). Struvite stones are made up of the minerals magnesium, ammonium, and phosphate, and are formed when an infection in the urinary tract leads to an alkaline pH in the urine. External sources:
https://www.urologycarealliance.com/conditions-and-treatments/struvite-stones/
https://medlineplus.gov/ency/article/000532.htm
Cytology of voided urine is useful in the detection of which tumour:
a. Low-grade bladder tumour
b. Renal cell carcinoma
c. Grade 3 bladder tumour
d. T4a prostate tumour
Answer: C. Grade 3 bladder tumour.
Cytology of voided urine is an important diagnostic tool for detecting high-grade bladder tumours, such as grade 3 bladder tumours. High-grade bladder tumours have a higher likelihood of spreading to other parts of the body, so detecting them early is crucial for effective treatment and improved prognosis. Cytology of voided urine can also be used for monitoring the progression of bladder cancer after treatment, as well as for detecting recurrences.
A young patient with acute leukemia under treatment with cytotoxic drugs
presents with severe abdominal pain of sudden onset. The most likely diagnosis is:
a. Pentic ulcer
b. Acute appendicitis
c. Oxalate stone colic
d. Uric acid stone colic
Answer d: Uric acid stone colic. Leukemia treatment can lead to an increased risk of formation of kidney stones, with uric acid stones being the most common type. Uric acid stones can cause severe abdominal pain, and can be a potential side effect of cytotoxic drug treatment for leukemia. External sources:
-https://www.ncbi.nlm.nih.gov/pubmed/10966281
-http://www.oncologynurseadvisor.com/clinton-rucker-md-uric-acid-stones-in-the-pediatric-patient/article/351557/
What operation is associated with the highest risk of venous thromboembolism:
a. Radical prostatectomy
b. Radical cystectomy
c. Partial nephrectomy
d. Percutaneous nephrolithotomy
Answer: B. Radical cystectomy.
According to a study published in the journal PLOS ONE, radical cystectomy, a major surgery to remove the bladder due to bladder cancer, is the surgery associated with the highest risk of venous thromboembolism, a life-threatening blood clot that forms in veins and can travel to the lungs. The other options – radical prostatectomy, partial nephrectomy, and percutaneous nephrolithotomy – also involve surgery and thus are associated with a risk of venous thromboembolism, but radical cystectomy is associated with the highest risk.
What is preferred diagnostic modality for suspected renal injury in stable patents?
a. Contrast-enhanced CT b.
b. Ultrasonography
c. Angiography
d. Plain X-ray
Answer: a. Contrast-enhanced CT.
Contrast-enhanced CT is currently the preferred diagnostic modality for suspected renal injury in stable patents due to its sensitivity, specificity, and accuracy. It is imperative that any suspected renal injury be evaluated to provide early diagnosis and appropriate treatment. A contrast-enhanced CT scan is the most effective examination for this purpose, as it provides detailed images of the affected area, including any injuries or abnormalities, and can diagnose a variety of medical conditions. Additionally, a contrast-enhanced CT scan can also be used to monitor the progress of any treatment. Ultrasonography, angiography, and plain X-ray can also help diagnose renal injury, but contrast-enhanced CT provides more detailed images and is considered the most accurate option.
Priapism is defined as a persistent penile erection that continues for more than:
a. 2 hours
b. 4 hours
c. 6 hours
d.10 hours
Answer: B. 4 hours
Explanation: According to the American Urological Association (AUA), “Priapism is defined as a persistent penile erection that continues for more than 4 hours without sexual stimulation or stimulation that is insufficient to induce detumescence” (Source: https://www.auanet.org/education/guidelines/priapism.cfm). Therefore, Answer B is correct.
The most common early complication after nephron sparing surgery is:
a. Urinary fistula
b. Acute renal failure
c. Renal vein thrombosis
d. Post-operative bleeding
Answer: D. Post-operative bleeding.
Post-operative bleeding is a common early complication after nephron sparing surgery. This type of surgery involves removing a portion of the kidney, and bleeding from the surgical site can occur in the early post-operative period. Bleeding can increase the risk of infection, as well as lead to a longer hospital stay and a slower recovery time. In some cases, it may also require additional surgical intervention to control the bleeding.
Although urinary fistula and other complications such as acute renal failure and renal vein thrombosis can also occur after nephron sparing surgery, post-operative bleeding is the most common early complication. It is important for patients to be aware of the potential risks and complications associated with any surgical procedure, and to closely monitor their symptoms and seek medical attention if they develop any concerning symptoms.
What is the most common cause of ureteric trauma?
a. Stab wounds
b. Iatrogenic trauma
c. Motor vehicle accident
d. Rapid deceleration injuries
b. Iatrogenic trauma.
Ureteric trauma refers to damage to the ureter, which is the tube that carries urine from the kidney to the bladder. The most common cause of ureteric trauma is iatrogenic trauma, which refers to injury that is caused by medical intervention or treatment. This can occur during surgical procedures, such as gynecological surgeries or urologic surgeries, where the ureter may be accidentally damaged during the procedure.
