Urology from AMK teach - 21/05/2022

Question 1

67yr old women several episodes of seeing blood in ruine, vague ache in flank left side. mass in kidney. blood in urine, normal bladder. ct scan mass on kidney.

given most likely diagnosis what factor has contributed to this diagnosis

Answer 1

smoking - renal cell carcinoma - adenocarcinoma, silent cancer only picked up imaging , haematuria and vague loin pain with secondary problems like weight loss

dye factory workers - aromatic amines and schistosomiasis - bladder cancer

asbestos - mesothelioma - what does this present on lungs

alcohol - head and neck, HCC cancer

Question 2

bladder cancer if found what should happen

Answer 2

2ww - 45 yr with unexplained haemutria , either without UTI or persisting after treatment for UTI

Question 3

renal cancer appears like what in the lungs

Answer 3

renal cell carcinoma
CT for staging
investigations - USS,CT and IVU

nephrectomy - 1st line

Question 4

4yr old oy painless abdomen mass , large firm and smooth mass in right flank

Answer 4

wilms tumour

Question 5

PKD sx

Answer 5

pain, HTN , irregular kidneys and adults

Question 6

are umbilical hernias present from birth

Answer 6

yes

Question 7

nephroblastoma, wilms tumour common cancer under 5
metanephric blasternal cells
sx

Answer 7

painless enlarged mass, abdo pain, haemautria, lethargy, fever, weight loss, HTN

need a biopsy to diagnose but also USS abdomen and CT for staging

mangemtn includes nephrectomy with either chemo or radio

Question 8

46yr lady fluctuating loin to groin pain, similar to previous episodes, stones in kidneys, penicillin allergy, most appropriate analgesia considering severity of her pain

Answer 8

intramuscular diclofenac

in renal colic avoid opiates

tamulosin - ading spontaneous

Question 9

renal colic Is pain associated with renal stones. stuck in PUJ, plea trim and VUJ , risk factors include diet, dehydration, medications, caucasian , horseshoe kidney
causes what

Answer 9

inadequate drainage- hydronephrosis, diverticulum of bladder
excess of stones
lack oh inhibitors of stone formation like magnesium
abnormal constituents - infection of foreign body, vit a deficiency

Question 10

renal colic sx and mx

Answer 10

intermittent severe loin to groin pain , N+V hameturia reduced urien output and symptoms of sepsis

MSU , FBC< renal , CRP, AXR , UD

non contrast CT KUB

NSAID and fluids and antiemetics and tamsulosin ( to make stone pass)

less than 5mm watch and wait
over 10mm surgical intervention

Question 11

dark red blood, painless, HTN and dyes

Answer 11

transitional cell carcinoma

clear cells - renal cancer
SCC - flat mucosal lesions associated with schistosomiasis

Question 12

RF for bladder cancer

Answer 12

smoking, chemical exposure, schistosomiasis, male, long term cathertisation

Question 13

sx bladder cancer

Answer 13

painless haematuria, renal colic, urianry retention, dysuria, freeuncey, urgency, fever, weight loss, night sweats

IX- cystoscopy and biopsy

Question 14

non muscle invasive for bladder cancer

Answer 14

Tis, Ta, T1

muscle invasive is T2-4

management is TURBT - trans urethral resection of bladder tumour- for what when what stage ????????
, intravesical chemo, intravesical BCG , radical cystectomy, chemo and radio

Question 15

87yr man, hernia surgery der régional spinal anaesthesia. most likely post op complication of this patient

Answer 15

UR, headache, hypertension, meningitis or epidural haematoma

Urinary retention

Question 16

define UR

Answer 16

bladder volume of over 150ml after attempted voiding

caused by BPH , UTI, tumour, medications , post-op

dull achy abdo pain radiated to penile tip , difficult to pass , maybe blood
suprapubic tenderness

Question 17

Ix UR

Answer 17

MSU - bladder scan not diagnostic

Question 18

Mx

Answer 18

urianry catheter

tamulosin

Question 19

UTI treatment

Answer 19

nitrofurantoin for 7 days

antibiotics for U~TI

3day for simple women
5-10 days for immunosupressed women or abnormal anatomy
7 days for men , pregnant women or catheter related

nitrofurantoin avoid if eGFR is under 45 - cefalexin if pregnant

Question 20

3month h of increased frequency, nocturia( night) , limited intake and no benefit. no family history, no masses, normal tone, enlarged prostate. most likely

Answer 20

BPH

overactive bladder - frequent, uriante posible icnotnence and nocturia

prostates, fever suprapubic and low back pain, clanged on DRE

prostate Ca - abnormal DRE - nodules

Question 21

tamulosin - alpha blocker and finasteride and TURP used in

Answer 21

BPH

Question 22

65 yr old wants screening for prostate cancer - prostate hard and asymmetrical and large on left , PSA high referred on 2ww and has transracial ultrasound guided biopsy what scoring symptoms will be used to evaluate diagnosis

Answer 22

Gleason grading system

glasgow score - acute pancreatic

Question 23

prostate cancers are adenocarcinoma in peripheral zone

PSA raised in

Answer 23

prostate cancer
BPH 
prostatis 
UTI 
vigrourosu exercise - cycling 
recent ejaculation

Question 24

Gleason grading

Answer 24

6 low risk
7 intermediate e
8 or above high risk

staging TMN

Question 25

37 man 2 week history of pelvic pain and dysuria, pain perineum and lower back,pain flares when opens bowls, run down and achy , no URTI , no PMH , no meds , abdomen is tender, nom assess, enlarged tender prostate . systemically well and has low grade fever, has leukocytes and nitrite an blood wha treatment fro likely diagnosis

Answer 25

prostitis

ciproflaxacin for 2 weeks - ofloxacin is alternative but requires 2 week course
chronic prostitis - trimethoprim for 4 weeks

Question 26

acute bacterial prostitis

Answer 26

acute infection and rapid onset of sx , under 3 months, need to investigate fro STI
mx include laxatives,PO abx , ( IV if septic ) , analgesia

most common cause I e-coli

Question 27

testis
30ry sexually aactive man, scortla pain, and discharge and malaise. inflammation , prehns sign is positive, palpable cord like trajectory

Answer 27

chlamydia trachoamtis

over 35 eocli can cause epididymis orchitis

Question 28

parotid swelling

Answer 28

mumps

Question 29

prehns sign

Answer 29

lift testicle releives pain in epididymis orchitis

Question 30

Mx of epididymo orchitis

Answer 30

IV abx , high risk sti refer to GUM, low risk STI - ofloxacin 14 days

Question 31

17yr old girl presents to her general practitioner with primary amenorrhea. small pbuic hair under arms , normal breast, bilateral groin swelling

Answer 31

complete androgen insensitivity syndrome XY - phenotypical female due to testosterone resistance , internally have testes

ansonia - kallmans syndrome

patients with complete androgen insensitivity syndrome do not have ovaries

Question 32

testicualr cancer markers

Answer 32

AFPteratoma
beta HCG fro LDH
scrotal USS

Question 33

whirlpool sign

Answer 33

testicular torsion