Urology/renal

Question 1

hydrocele vs epidermal cyst?

Answer 1

epidermal cyst - separate from the body of the testicle + found posterior to the testicle
do NOT transilluminate

hydrocele - in tunica vaginalis - soft, non-tender swelling of the hemi-scrotum. Usually anterior to and below the testicle. Can get above it unlike a hernia
transilluminates

Question 2

What cancer is a varicocele associated with?

Answer 2

RCC

Question 3

How long can it take finasteride to work?

Answer 3

5 alpha-reductase inhibitors
Reduce testosterone conversion –> reduce prostate size
take up to 6m to work

Question 4

What bloods results would you see with rhabdomyolysis?

Answer 4

Hyper K, PO4, uric acid, CK
Hypo Ca

Question 5

What medical mx can be given for renal stones (not pain relief)?

Answer 5

Alpha-adrenergic blockers eg tamsulosin can help facilitate stone passage. They work by relaxing the smooth muscle in the walls of the ureter, thereby allowing the stone to pass more easily, used if 5-10mm size

Question 6

most common causitive agent in <20 yrs for epeidiy-morchitis vs >35?

Answer 6

chlamydia <20
e.coli >35

Question 7

How do you diagnose post-strep glomerulonephritis?

Answer 7

Anti-streptolysin O titres

Question 8

How is stress incontinence mx?

Answer 8

Lifestyle - wt loss, no caffeine, no excess fluids
pelvic floor exercises
surgery
duloxetine/ SNRI

Question 9

What diet do u follow in renal failure

Answer 9

Patients with renal failure are advised to adopt a diet which has low stuff so kidney filters less
Low protein
Low phosphate
Low sodium
Low potassium

Question 10

Different stages of CKD?

Answer 10

stage 1 - egfr >90 + markers of kidney damage (proteinuria or raised cr/ urea)

stage 2 - ecgfr 60-90 + markers of kidney damage

stage 3a- eGFR 45-59 with or without kidney damage

stage 3b- eGFR 30-44

Question 11

Overflow incontinence vs urge vs overactive bladder vs stress?

Answer 11

over flow incontinence LUTS + bladder palpable- can be caused by prostate, foecal impaction or nerve damage (treat underlying cause and cathterise)

Urge incontinence would be preceded by a sudden need to urinate.

An overactive bladder syndrome is a form of urge incontinence caused by an overactive bladder, it too would be associated with incontinence, polyuria and nocturia. Detrusor overactivity is the cause. (treat with bladder trining, antimuscarinics etc)

Stress incontinence would be likely associated with raised intraabdominal pressure, such as a sneeze or a cough. (pelvic floor training, then try duloxetine/ srgery)

Question 12

What is schistosoma infection linked to?

Answer 12

developing squamous cell carcinoma of the bladder.

Question 13

How do the results for urine osmalility and sodium look for pre-renal vs renal AKI?

Answer 13

pre-renal ie poor perfusion of kidney –> Kidneys act to concentrate urine and retain sodium - urine osmolality high, urine sodium low

Renal ie acute tubular necrosis / nephritis —> Kidneys can no longer concentrate urine or retain sodium - urine osmolality low, urine sodium high

Question 14

In a patient with recurrent renal stones due to hypercalcuira how may risk be reduced?

Answer 14

thiazide diuretics

Question 15

Mx of epidimyo-orchitis?

Answer 15

If unknown organism: ceftriaxone 500mg intramuscularly single dose, plus oral doxycycline 100mg twice daily for 10-14 days if younger man where STI more likely cause

cipro used if older man

Question 16

What is the surgical mx of testicular torison in presence of a bell clapper deformiity?

Answer 16

should involve fixation of both testes to prevent torsion of the other testes

Question 17

Mx of hydrocele?

Answer 17

Adult patients with a hydrocele require an ultrasound to exclude underlying causes such as a tumour

Question 18

Summarise renal artery stenosis - pathophysiology, ix and mx

Answer 18

Renal artery is narrowed due to atherosclerosis/ connective tissue issue (eg takayasus arteritis in young asian women)–> lower BP in kidney arterioles —> release of renin and kidney atrophues —> high BP in body

Will present with raised BP, potential CKD, CT will show one kidney smaller than other, best imaging is digital subtration angiography

mx may be conservative, may need ballooon angioplasty

Question 19

Post strep glomerulonephritis Vs iga nephropathy

Answer 19

Post strep:
-1-2 week post URTI
-protreinuria and haematuria
- low complement levels

IGa A aka Berger’s disease:
-1-2 days post URTI
-young males
-haematuria only
-associsted with HSP, alcohol and coeliac

Question 20

|Presentation of renal vein thrombosis?

Answer 20

loin pain, haematuria, declined renal function, on USS that kidney is enlarged
secondary to nephrotic syndrome

Question 21

What do the presence of red cell casts in urine indicate?

Answer 21

glomerulonephritis

Question 22

gold standard ix for urinary reflux?

Answer 22

micturating cystogram

Question 23

What is the most appropriate 1st line abx for pyelonephritis (if no cultures back)?

Answer 23

cefalexin 500mg BD for 7-10 days

Question 24

mx of overactive bladder?

Answer 24

1st line - bladder training
2nd line - oxybutynin, solifenacin, tolteridine, trospium
3rd line - botulinum toxin A, sacral nerve stimulation, augmentation cystoplasty, urinary diversion

Question 25

phimosis vs paraphimosis?

Answer 25

Phimosis - foreskin is tight and can’t be fully retracted, painless, difficulty urinating, may bulge during urinating.
Can be caused by scarring to foreskin, infection, forcing foreskin before its ready to retract
treat with steroid cream, if over 10 circumcision

paraphimosis - foreskin is retracted and can’t be returned to its original position, painful, swollen, may be colour change
can be caused by phimosis, infection, not replacing foreskin after retration
treat with circumcision and abx if needed