Urology Incorrect Passmed Qs

Question 1

Management of a congenital hydrocele in a newborn?

Answer 1

Reassure and surgical repair if does not resolve in 1-2 years- to avoid complications such as an incarcerated hernia.

Communicating hydroceles are common in newborn males (clinically apparent in 5-10%) and usually resolve within the first few months of life

Question 2

Tamsulosin
Class?
Side effects? 4

Answer 2

alpha-1 antagonists e.g. tamsulosin, alfuzosin

Side effects:
dizziness, postural hypotension, dry mouth, depression

Question 3

What on a CTKUB would indicate recent stone passage?

Answer 3

Periureteric fat stranding and no ureteric calculus present.

Question 4

Management of renal stone obstruction + signs of sepsis and why?

(lots of info but don’t need it all to get full marks- just the jist)

Answer 4

Urgent renal decompression and IV antibiotics- decompression is usually via percutaenous nephrostomy under interentional radiology.

• The patient will have an infected pyuria proximal to the obstruction due to the stagnation of urine which is whats causing the systemic symptoms.Urine output can be relatively normal bc the other kidney will compensate.

Question 5

Different renal stones and their management:

1. What size of stone means expectant management?
2. Stones with a total volume of < 2cm and no fever/ hydronephrosis
3. Large left sided staghorn calculus that measures 2.3cm
4. 0.7cm in diameter, fever and associated hydronephrosis
5. Stone <2cm + pregnant

Answer 5

1. < 0.5cm/ 5mm
   2.Extra corporeal shock wave lithotripsy
2. Percutaneous nephrolithotomy (lithotripsy from the inside)
3. Urgent decompression- Percutaneous nephrostomy + IV abx
4. uteroscopy

Question 6

Hydronephrosis

Investigations:
1. First-line-
2. To look at position/ extent-
3. Allows treatment…
4. If suspect stone….

Management remove obstruction!
1. Acute upper urinary tract obstruction….
2. Chronic upper urinary tract obstruction….

Answer 6

1.
2. IVU- intravenous urogram
3. Antegrade or retrograde pyelography (Xray)
4. CTKUB non-contrast

1. Acute- nephrostomy tube
2. Chronic- ureteric stent or a pyeloplasty

Question 7

Which type of stones do these medications decrease the risk of and how?

Allopurinol-
Cholestyramine
Oral bicarbonate
Pyridoxine
Thiazides diuretics

Answer 7

Allopurinol- xanthine oxidase inhibitor therefore dec. uric acid stones

Cholestyramine- reduces urinary oxalate secretion and can decrease oxalate stones

Oral bicarbonate- increase the alkalization of the urine and decrease uric acid stones

Pyridoxine- may reduce oxalate stones by reducing urinary oxalate secretion.

Thiazides diuretics- increase distal tubular calcium resorption and therefore decrease calcium in the urine and stone formation

Question 8

Renal Cancer: Which type?

1. STEM- textiles/ platic/ rubber industry job?
2. Common renal tumour in kids
3. Associated with tuberous sclerosis
4. In children but, Most common extracranial tumour of childhood. More on the adrenal gland than the kidney itself. Usually calcified.
5. Most common

Answer 8

1. Renal transitional cell carcinoma
2. Wilm’s tumour- Nephroblastoma. occupy the adrenal and apex of the kidney
3. Angiomyolipoma- It is a benign lesion.
4. Neuroblastoma
5. Renal cell carcinoma