Urology

Question 1

What are the symptoms of epididymitis?

Answer 1

Acute epididymal pain/swelling, erythema, urethral discharge; TTP epididymis/vas.

Question 2

What conditions should be ruled out in epididymitis?

Answer 2

Torsion (emergency), trauma, varicocele, tumor.

Question 3

What is the etiology of epididymitis in patients under 35?

Answer 3

Chlamydia/Gonorrhea.

Question 4

What is the etiology of epididymitis in patients over 35?

Answer 4

E. coli/G-negative bacteria.

Question 5

What tests are used for diagnosing epididymitis?

Answer 5

Urethral swab/urine NAAT; tips: no void 2 h, milk urethra, swab 3–4 cm.

Question 6

What is the treatment for epididymitis in patients over 35?

Answer 6

> 35: ofloxacin 300 mg BID x10 d / ciprofloxacin 500 mg BID x10 d / levofloxacin 500 mg OD x10 d.

Question 7

What is the treatment for epididymitis in patients under 35?

Answer 7

<35: cefixime 800 mg PO x1 + doxy 100 mg BID x10 d (or) ceftriaxone 250 mg IM x1 + azithro 1 g PO x1/doxy.

Question 8

What are the etiologies of erectile dysfunction?

Answer 8

Vascular, neuro, medications (SSRIs, β-blockers, antiandrogens, barbiturates, H₂ blockers), substances, post-TURP, endocrine (DM).

Question 9

What history and physical exam elements are important for erectile dysfunction?

Answer 9

Nocturnal tumescence, erection attainment/maintenance, self-stimulation; neuro/vascular exam, orthostatics, DRE.

Question 10

What labs are recommended for erectile dysfunction?

Answer 10

CBC, lipids, FBG/HbA1c, TSH, prolactin, free testosterone, LH/FSH.

Question 11

What is the treatment for erectile dysfunction?

Answer 11

PDE-5 inhibitors (sildenafil 50–100 mg PRN; tadalafil longer) — avoid with nitrates; alprostadil/vacuum; prosthesis; T replacement if hypogonadal; psych; exercise/weight loss; PE: SSRI/clomipramine.

Question 12

What are the lower urinary tract symptoms (LUTS) of BPH?

Answer 12

Frequency, nocturia, hesitancy, urgency, weak stream.

Question 13

What are the differential diagnoses for BPH?

Answer 13

Stricture, bladder neck contracture, prostate/bladder CA, stones, UTI/prostatitis, neurogenic bladder.

Question 14

What is included in the work-up for BPH?

Answer 14

DRE, UA (hematuria → work-up), PSA, PVR, uroflow, cytology; consider U/S, TRUS/biopsy.

Question 15

What are the treatment options for BPH?

Answer 15

α-1 blockers (terazosin; SE: orthostasis, dizziness, congestion), 5-ARI (finasteride; SE: ↓libido/ED).

Question 16

What are the risk factors for testicular cancer?

Answer 16

Cryptorchidism (#1), family history, Caucasian, atrophy; age 15–34.

Question 17

What tumor markers are associated with testicular cancer?

Answer 17

AFP, β-hCG, LDH.

Question 18

What is the treatment for testicular cancer?

Answer 18

Orchidectomy, then risk-adapted RT/chemo (platinum).

Question 19

What labs are used for staging/monitoring prostate cancer?

Answer 19

ALP, Ca/PO₄, CBC, lytes, PSA.

Question 20

What is the recommendation for PSA/DRE screening in asymptomatic men over 50?

Answer 20

No routine PSA/DRE; use in abnormal DRE, LUTS eval, or post-treatment follow-up.

Question 21

What is the treatment for stage IV prostate cancer?

Answer 21

Bilateral orchiectomy or LHRH agonist/antagonist ± antiandrogen.

Question 22

What are the risks associated with radical prostatectomy/radiation therapy?

Answer 22

Incontinence, stricture, bowel injury, ED, anesthesia risks.

Question 23

What medications can worsen urinary incontinence (UI)?

Answer 23

Diuretics, anticholinergics (TCA).

Question 24

What types of urinary incontinence are related to BPH?

Answer 24

Overflow, urge.

Question 25

What antihypertensive is helpful for urinary incontinence?

Answer 25

α-1 blocker.

Question 26

What is the follow-up recommendation for microscopic hematuria?

Answer 26

UA & BP yearly → q2y.

Question 27

What should be excluded if microscopic hematuria is detected?

Answer 27

Transient causes (menses, exercise, sex, instrumentation, DRE) → repeat; culture for UTI; if negative, serum Cr + renal U/S.

Question 28

What are the risk factors for bladder cancer?

Answer 28

Age >40, smoking, gross hematuria, prior urologic disease, chemical/dye exposure, phenacetin/cyclophosphamide/HIV treatment, HIV/SLE/vasculitis/schisto, pelvic RT.

Question 29

What are the components of a semen analysis for male infertility?

Answer 29

Volume, count, motility, progression, morphology.

Question 30

What are some causes of male infertility?

Answer 30

Cryptorchidism, varicocele, hypogonadism; drugs (opioids, antiandrogens, ketoconazole, spironolactone, H₂ blockers, psych meds), radiation; epididymal dysfunction (colchicine), CF; ejaculatory disorders.

Question 31

What are the differential diagnoses for a painful testicle?

Answer 31

Torsion, epididymitis, trauma, hernia, HSP, mumps, Fournier’s.

Question 32

What is the emergency treatment for testicular torsion?

Answer 32

Detorsion within 4–6 hours; U/S if time permits.

Question 33

What are the complications of undescended testes?

Answer 33

Cancer (≈1/80 uni; 1/50 bilat), infertility, torsion, indirect hernia.

Question 34

What is the treatment for undescended testes?

Answer 34

Orchidopexy before 1 year (orchidectomy if late to lower CA risk).

Question 35

What are the causes of urinary retention?

Answer 35

DM neuropathy, BPH, cognitive/neurologic disease, medications (amitriptyline, opioids, baclofen, testosterone), pelvic organ prolapse, masses, infections, postpartum.

Question 36

What are the types of urinary incontinence?

Answer 36

Stress, urge, overflow, mixed, functional.

Question 37

What interventions are recommended for stress urinary incontinence?

Answer 37

Kegels; topical estrogen/TCA; sling (TVT); behavior.

Question 38

What is the classic triad of renal cell carcinoma?

Answer 38

Hematuria, flank pain, palpable mass (late).

Question 39

What are the paraneoplastic syndromes associated with renal cell carcinoma?

Answer 39

Cushing’s, SIADH, hypercalcemia, hypoglycemia, carcinoid, polycythemia, neuro syndromes, dermato, Trousseau; endocrine (HTN/erythrocytosis), hepatic dysfunction.

Question 40

What is the treatment for renal cell carcinoma?

Answer 40

Surgery; RT for palliation; immunotherapy for metastasis.

Question 41

What are the symptoms of nephrolithiasis?

Answer 41

Severe flank pain, N/V, frequency/urgency, hematuria, CVA TTP.

Question 42

What is the best imaging for nephrolithiasis?

Answer 42

Non-contrast CT abdomen/pelvis.

Question 43

What is the management for nephrolithiasis?

Answer 43

NSAIDs, fluids, opioids PRN; if not passed by 4 weeks, refer.