Urology pathology

Question 1

How does testicular torsion typically present?

• Sudden pain in the scrotum and an absent cremasteric reflex
• swelling of scrotum and fever
• A painless testicular mass that cannot be transilluminated
• ‘bag of worms’ appearance of scrotum

Answer 1

esticular torsion is usually seen in adolescents and presents as sudden pain in the scrotum. On physical examination, the cremasteric reflex may be absent. It is caused by the twisting of the spermatic cord containing the pampiniform plexus, vas deferens and testicular artery. The blood supply is impaired leading to congestion and necrosis of the testicle. It is a surgical emergenc

Question 2

What is the best description for the area of the prostate that the carcinoma usually affects?

• posterior and peripheral region
• anterior and peripheral region
• preiurethral region
• entire anterior region

Answer 2

prostatic cancer typically arises from the posterior lobe and on the periphery. This is why it is often asymptomatic as it does not compress the urethra producing no urinary symptoms at an early stage. The prostate is located anterior to the rectum. Thus, on digital rectal exam (DRE), a mass can be felt as the posterior and peripheral region is affected.

Question 3

What is priapism?

• inability to void the bladder
• Abnormal curvature of the penis
• Painful erection lasting > 4 hours
• Cyst due to a dilated testicular duct

Answer 3

Priapism is a prolonged and painful erection of the penis. Sickle cell disease, trauma and medications for erectile dysfunction (e.g. sildenafil) are all potential causes of this condition. It requires prompt treatment to prevent ischaemia. Treatment options include phenylephrine injection, surgical decompression and corporal aspiration.

Question 4

Which of the following is a common cause of right axis deviation?

• ventricular septal defect
• atrial septal defect
• right ventricular hypertrophy
• left ventricular hypertrophy

Answer 4

In right ventricular hypertrophy, the increased muscle mass of the right ventricle causes an increased signal on the ECG. As a result, the axis of the heart is shifted to the right with lead III becoming more positive and lead I and II becoming less positive.

Question 5

Which artery is most likely to be affected in the context of ST elevation being present in leads V3 and V4?

• all of the above
• left anterior descending artery
• left circumflex artery
• right coronary artery

Answer 5

eads V3 and V4 represent the anterior portion of the heart. ST elevation in these leads would be suggestive of anterior myocardial infarction. The anterior portion of the heart is supplied primarily by the left anterior descending artery.

Question 6

What is the most common cause of left axis deviation?

• defects of the conduction system
• right ventricular hypertrophy
• left ventricular hypertrophy
• atrial septal defects

Answer 6

Left axis deviation is rarely the result of left ventricular hypertrophy and more often due to defects in the conduction system of the heart.

Question 7

An ECG reveals an absence of P-waves and an irregular rhythm. Which of the following is the most likely diagnosis?

• atrial fibrillation
• 2nd degree heart block
• 1st degree heart block
• ventricular tachycardia

Answer 7

In atrial fibrillation, the atria no longer conduct electricity from the sinoatrial node in an orderly fashion. As a result, P-waves are lost. As a result of disordered atrial activity, only occasional waves of depolarisation pass through to the atrioventricular node and cause ventricular activation. This causes the typical irregular rhythm.