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  • Question 1 - A 30-year-old man undergoes an orchidectomy for a testicular lump. Post-surgery, the histology...

    Correct

    • A 30-year-old man undergoes an orchidectomy for a testicular lump. Post-surgery, the histology report reveals the presence of cartilage and columnar epithelial cells. What is the probable diagnosis?

      Your Answer: Teratoma

      Explanation:

      Types of Testicular Tumours: Teratoma, Seminoma, Hamartoma, Epididymal Cyst, and Choriocarcinoma

      Testicular tumours can be classified into different types based on their histological features and clinical presentation. Here are five types of testicular tumours:

      Teratoma: This type of germ cell tumour can be pure or part of a mixed germ cell tumour. It is commonly seen in very young patients and presents with a painless testicular mass. Teratomas are composed of tissues arising from all three germ cell layers and can contain any type of tissue. Radical orchidectomy is the mode of treatment.

      Seminoma: Seminoma is a type of germ cell tumour that presents with a painless testicular lump. It is treated with orchidectomy and has a uniform yellow cut surface. Histologically, it is composed of a uniform population of large cells arranged in nests.

      Hamartoma: A hamartoma is a benign tumour-like proliferation composed of a mixture of cells normal for the tissue from which it arises. Within the normal testicular tissue, there is no cartilage.

      Epididymal Cyst: An epididymal cyst is a fluid-filled sac arising usually superoposterior to the testis. It transilluminates on examination and is lined by a single layer of cuboidal to columnar epithelium, with or without Ciliary.

      Choriocarcinoma: Choriocarcinomas are malignant germ cell tumours composed of syncytiotrophoblast, cytotrophoblast, and intermediate trophoblast cells. They are rare and associated with raised serum beta-human chorionic gonadotrophin levels. These tumours are usually haemorrhagic masses and often have metastasis at presentation.

      In conclusion, understanding the different types of testicular tumours and their clinical presentation is crucial for their early detection and appropriate management.

    • This question is part of the following fields:

      • Urology
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  • Question 2 - A 42-year-old man comes to the Emergency Department complaining of intense left flank...

    Correct

    • A 42-year-old man comes to the Emergency Department complaining of intense left flank pain that extends to his groin. A urinalysis reveals the presence of blood in his urine. Based on these symptoms, you suspect that he may have a kidney stone. An ultrasound scan of the kidneys, ureters, and bladder (KUB) confirms the presence of a likely stone in his left ureter. What imaging technique is best suited for visualizing a renal stone in the ureter?

      Your Answer: Non-contrast computed tomography (CT) KUB

      Explanation:

      Imaging Tests for Urological Conditions

      Non-contrast computed tomography (CT) KUB is recommended by the European Urology Association as a follow-up to initial ultrasound assessment for diagnosing stones, with a 99% identification rate. Micturating cystourethrogram is commonly used in children to diagnose vesicoureteral reflux. Magnetic resonance imaging (MRI) KUB is not beneficial for renal stone patients due to its high cost. Plain radiography KUB may be useful in monitoring patients with a radio-opaque calculus. Intravenous urography (IVU) is less superior to non-contrast CT scan due to the need for contrast medium injection and increased radiation dosage to the patient.

    • This question is part of the following fields:

      • Urology
      31.7
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  • Question 3 - A 30-year-old woman presents to the Emergency Department with acute abdominal pain which...

    Correct

    • A 30-year-old woman presents to the Emergency Department with acute abdominal pain which started about six hours ago. She claims the pain is in the lower abdomen and has been worsening gradually. She has not been able to pass urine since before the pain started.
      Upon examination, vital signs are stable and suprapubic tenderness is present. There is no rebound tenderness, and the examining doctor does not find any signs of peritonitis. In addition, the doctor finds a large solid abdominal mass in the right lower quadrant. The patient said this mass had been there for a few years and has made it difficult to get pregnant. The patient also claims that she has heavy periods. She is due to have an operation for it in two months. A serum pregnancy test is negative.
      Which of the following is the most likely diagnosis requiring immediate treatment and admission?

      Your Answer: Acute urinary retention

      Explanation:

      Possible Diagnoses for a Patient with Acute Urinary Retention and an Abdominal Mass

      During this admission, the patient presents with symptoms consistent with acute urinary retention, including sudden onset of symptoms and suprapubic tenderness. The presence of an abdominal mass suggests a possible gynecological cause, such as a uterine fibroid. However, it is important to note that if cancer is suspected, the patient would be referred for investigation under the 2-week cancer protocol, but the acute admission is required for urinary retention and catheterization.

      Other possible diagnoses, such as ovarian cyst, appendicitis, and caecal tumor, are less likely based on the patient’s symptoms and presentation. While a uterine fibroid may be a contributing factor to the urinary retention, it is not the primary reason for the admission. Overall, a thorough evaluation is necessary to determine the underlying cause of the patient’s symptoms and provide appropriate treatment.

    • This question is part of the following fields:

      • Urology
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  • Question 4 - Lila is a 38-year-old woman who presents to you with heavy menstrual bleeding...

    Correct

    • Lila is a 38-year-old woman who presents to you with heavy menstrual bleeding that has been progressively worsening over the past year. She also complains of severe period pain that typically starts a few days before each menstrual cycle. Her menstrual cycles are regular, occurring every 28 days. Lila states she has not been sexually active for the past year and is not taking any regular medications. She has two children, both born via vaginal delivery without any complications. Upon abdominal examination, no abnormalities are noted, and a speculum examination reveals a normal cervix. You decide to order a full blood count. What is the most appropriate next step?

      Your Answer: Request a transvaginal ultrasound

      Explanation:

      If a patient presents with menorrhagia along with pelvic pain, abnormal exam findings, or intermenstrual or postcoital bleeding, it is recommended to conduct a transvaginal ultrasound. According to the NICE guidelines, a transvaginal ultrasound should be preferred over a transabdominal ultrasound or MRI for women with significant dysmenorrhoea or a bulky, tender uterus on examination that suggests adenomyosis.

      In the case of Lila, who is experiencing new menorrhagia and significant dysmenorrhoea, a transvaginal ultrasound is necessary. If a transvaginal ultrasound is not possible, a transabdominal ultrasound or MRI can be considered, but the limitations of these techniques should be explained.

      For women without identified pathology, fibroids less than 3 cm in diameter, or suspected or diagnosed adenomyosis, the first-line treatment recommended by the guideline is a levonorgestrel intrauterine system (LNG-IUS). While this may be an appropriate treatment for Lila, the initial next step should be to arrange for a transvaginal ultrasound to investigate further. At this stage, there are no red flags in Lila’s history or examination that warrant an urgent referral to gynaecology.

      Managing Heavy Menstrual Bleeding

      Heavy menstrual bleeding, also known as menorrhagia, is a condition where a woman experiences excessive blood loss during her menstrual cycle. While it was previously defined as total blood loss of over 80 ml per cycle, the management of menorrhagia now depends on the woman’s perception of what is excessive. In the past, hysterectomy was a common treatment for heavy periods, but the approach has changed significantly since the 1990s.

      To manage menorrhagia, a full blood count should be performed in all women. If symptoms suggest a structural or histological abnormality, a routine transvaginal ultrasound scan should be arranged. For women who do not require contraception, mefenamic acid or tranexamic acid can be used. If there is no improvement, other drugs can be tried while awaiting referral.

      For women who require contraception, options include the intrauterine system (Mirena), combined oral contraceptive pill, and long-acting progestogens. Norethisterone can also be used as a short-term option to rapidly stop heavy menstrual bleeding.

    • This question is part of the following fields:

      • Urology
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  • Question 5 - A 50-year-old postal worker presents with a two-day history of increasing right-sided flank...

    Correct

    • A 50-year-old postal worker presents with a two-day history of increasing right-sided flank pain that extends to the groin. The patient also reports experiencing frank haematuria. The patient has had a similar episode before and was previously diagnosed with a kidney stone. An ultrasound scan confirms the presence of a renal calculi on the right side. What is the most probable underlying cause?

      Your Answer: Hyperparathyroidism

      Explanation:

      Understanding Risk Factors for Renal Stones

      Renal stones are a common medical condition that can cause significant discomfort and pain. Understanding the risk factors associated with renal stones can help in their prevention and management. Hyperparathyroidism is a known cause of renal stones, and patients presenting with urinary stones should have their calcium, phosphate, and urate levels measured to exclude common medical risk factors. A low sodium diet is recommended as high sodium intake can lead to hypercalcemia and stone formation. Bisoprolol use may cause renal impairment but is less likely to be associated with recurrent renal calculi. Contrary to popular belief, vitamin D excess rather than deficiency is associated with the formation of kidney stones. Finally, gout, rather than osteoarthritis, is a risk factor for renal stones due to the excess uric acid that can be deposited in the kidneys. By understanding these risk factors, patients and healthcare providers can work together to prevent and manage renal stones.

    • This question is part of the following fields:

      • Urology
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  • Question 6 - A 78-year-old man visits his doctor with a complaint of urinary leakage. He...

    Correct

    • A 78-year-old man visits his doctor with a complaint of urinary leakage. He reports that over the past 2 years, he has been experiencing difficulty reaching the toilet on time. He now leaks urine before he can make it to the bathroom, particularly when at rest.

      During the examination, the doctor finds that the man's abdomen is soft and non-tender, and there is no palpable bladder. A urine dipstick test shows no nitrites or leukocytes.

      The man expresses no interest in surgical intervention. What is the most appropriate course of action for managing his likely diagnosis?

      Your Answer: Bladder retraining

      Explanation:

      Bladder retraining is the appropriate solution for this woman’s overactive bladder, which is characterized by a sudden urge to urinate followed by uncontrollable leakage. Stress urinary incontinence can be ruled out as the cause since the leakage occurs at rest and not during coughing or sneezing. Bladder retraining involves gradually increasing the time between voids and should be attempted for six weeks before considering medication. Duloxetine, which increases the contraction of the urethral striated muscles, is not suitable for urge urinary incontinence. Mirabegron, a beta-3 agonist, may be used as an alternative to antimuscarinics in frail elderly patients, but bladder retraining should be attempted first. Oxybutynin, an anti-muscarinic, is not recommended for frail elderly women due to the risk of cholinergic burden and resulting confusion and delirium.

      Understanding Urinary Incontinence: Causes, Classification, and Management

      Urinary incontinence (UI) is a common condition that affects around 4-5% of the population, with elderly females being more susceptible. Several risk factors contribute to UI, including advancing age, previous pregnancy and childbirth, high body mass index, hysterectomy, and family history. UI can be classified into different types, such as overactive bladder (OAB)/urge incontinence, stress incontinence, mixed incontinence, overflow incontinence, and functional incontinence.

      Initial investigation of UI involves completing bladder diaries for at least three days, vaginal examination, urine dipstick and culture, and urodynamic studies. Management of UI depends on the predominant type of incontinence. For urge incontinence, bladder retraining and bladder stabilizing drugs such as antimuscarinics are recommended. For stress incontinence, pelvic floor muscle training and surgical procedures such as retropubic mid-urethral tape procedures may be offered. Duloxetine, a combined noradrenaline and serotonin reuptake inhibitor, may also be used as an alternative to surgery.

      In summary, understanding the causes, classification, and management of UI is crucial in providing appropriate care for patients. Early diagnosis and intervention can significantly improve the quality of life for those affected by this condition.

    • This question is part of the following fields:

      • Urology
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  • Question 7 - A 53-year-old woman presents with left loin pain and haematuria. Upon examination, she...

    Incorrect

    • A 53-year-old woman presents with left loin pain and haematuria. Upon examination, she displays tenderness in her left loin. A CT-KUB is conducted, revealing the presence of a renal tract calculus in her left kidney. Where is the most frequent location for this condition?

      Your Answer: Mid-ureter

      Correct Answer: Vesicoureteric junction (VUJ)

      Explanation:

      The Most Common Sites for Urinary Calculi: Understanding the Locations and Symptoms

      Urinary calculi, commonly known as kidney stones, can occur in various locations within the renal tract. The three most common sites are the pelvi-ureteric junction (PUJ), within the ureter at the pelvic brim, and the vesicoureteric junction (VUJ), with the latter being the most frequent location. Stones obstructing the PUJ present with mild to severe deep flank pain without radiation to the groin, irritative voiding symptoms, suprapubic pain, urinary frequency/urgency, dysuria, and stranguria. On the other hand, stones within the ureter cause abrupt, severe colicky pain in the flank and ipsilateral lower abdomen, radiation to the testicles or vulvar area, and intense nausea with or without vomiting. While the renal pelvis and mid-ureter are also possible sites for urinary calculi, they are less common. Stones passed into the bladder are mostly asymptomatic but can rarely cause positional urinary retention. Understanding the locations and symptoms of urinary calculi can aid in prompt diagnosis and management.

    • This question is part of the following fields:

      • Urology
      41.9
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  • Question 8 - A 30-year-old man presents with left scrotal discomfort and a feeling of tightness....

    Correct

    • A 30-year-old man presents with left scrotal discomfort and a feeling of tightness. Upon examination, there is mild swelling of the left scrotum with varices resembling a bag of worms in the overlying skin that appears dark red. Scrotal ultrasound confirms the presence of a varicocele on the left side. Which structure is most likely dilated in this patient?

      Your Answer: Pampiniform plexus

      Explanation:

      Anatomy of the Male Reproductive System

      The male reproductive system is a complex network of organs and structures that work together to produce and transport sperm. Here are some key components of this system:

      Pampiniform Plexus: This network of veins runs along the spermatic cord and drains blood from the scrotum. When these veins become dilated, it can result in a condition called varicocele, which may cause a bag of worms sensation in the scrotum.

      Ductus Deferens: This tube-like structure is part of the spermatic cord and carries sperm and seminal fluid from the testis to the ejaculatory duct.

      Processus Vaginalis: This structure can sometimes be present in the groin area and may communicate with the peritoneum. When it does, it can lead to a condition called hydrocele, where fluid accumulates in the scrotum.

      Testicular Artery: This artery originates from the abdominal aorta and supplies blood to the testis. It is not involved in the formation of varicocele.

      Genital Branch of the Genitofemoral Nerve: This nerve provides sensation to the skin in the upper anterior part of the scrotum and innervates the cremaster muscle. It is not involved in the formation of varicocele.

      Understanding the anatomy of the male reproductive system can help in identifying and treating various conditions that may affect it.

    • This question is part of the following fields:

      • Urology
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  • Question 9 - A 58-year-old man presents to his Emergency Department complaining of blood in his...

    Correct

    • A 58-year-old man presents to his Emergency Department complaining of blood in his urine. He reports that this has been happening over the past three days. He denies any pain or fever.
      Physical examination revealed bilateral wheezes but is otherwise unremarkable. He does not have any problem passing urine. He has always lived in the UK and has not travelled anywhere outside the country recently. The patient is retired but used to work in a textile factory where he was responsible for working in the dye plants producing different coloured fabric. He has a past medical history of chronic obstructive pulmonary disease (COPD) and hypertension. He takes losartan for his hypertension and a budesonide and formoterol combination inhaler for his COPD. The man is an ex-smoker with a 30 pack-year smoking history.
      What is the most likely diagnosis in this patient?

      Your Answer: Bladder cancer

      Explanation:

      Differential Diagnosis for Painless Haematuria: Bladder Cancer vs. Other Possibilities

      When a patient presents with painless haematuria, bladder cancer should be highly suspected until proven otherwise. While other conditions, such as urinary tract infections, can cause haematuria, a strong history of smoking and exposure to chemical dyes increase the likelihood of bladder cancer.

      Prostate cancer is unlikely to present with haematuria and is more likely to be associated with lower urinary tract symptoms. Benign prostatic hyperplasia would present with signs of lower urinary tract obstruction, which this patient does not have. Nephrolithiasis can cause haematuria, but the absence of pain makes it less likely. Renal cancer may also present with haematuria, but it is more likely to be associated with loin or abdominal pain, weight loss, anaemia, and fatigue.

      In summary, when a patient presents with painless haematuria and a history of smoking and exposure to chemical dyes, bladder cancer should be the primary concern. Other possibilities should be considered, but they are less likely based on the absence of additional symptoms.

    • This question is part of the following fields:

      • Urology
      51.6
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  • Question 10 - A 65-year-old patient is referred to the Outpatient Clinic with raised prostate-specific antigen...

    Correct

    • A 65-year-old patient is referred to the Outpatient Clinic with raised prostate-specific antigen (PSA), but a normal prostate on physical examination. He is later diagnosed with prostate cancer on biopsy.
      What is the most common area of the prostate where this disease develops?

      Your Answer: The peripheral zone

      Explanation:

      Anatomy of the Prostate Gland and its Relation to Prostate Cancer

      The prostate gland is a small, walnut-shaped gland located in the male reproductive system. It is divided into several zones, each with its own unique characteristics and potential for developing prostate cancer.

      The peripheral zone is the most common site for developing prostate carcinomas. It extends around the gland from the apex to the base and is located posterolaterally.

      The central zone surrounds the ejaculatory duct apparatus and makes up the majority of the prostatic base.

      The transition zone constitutes two small lobules that abut the prostatic urethra and is where benign prostatic hyperplasia (BPH) tends to originate. Carcinomas that originate in the transition zone have been suggested to be of lower malignant potential compared to those in the peripheral zone.

      The anterior fibromuscular stroma is the most anterior portion of the gland and is formed by muscle cells intermingled with dense connective tissue. The chance of malignancy occurring in this area is low, but asymmetrical hypertrophy of the anterior fibromuscular stroma can mimic the presence of prostate cancer.

      The posterior capsule is made of connective tissue and is usually not the primary origin of prostate cancer. The cancer usually arises in the peripheral zone and may then extend through the capsule as it progresses.

      Understanding the anatomy of the prostate gland and its relation to prostate cancer can aid in early detection and treatment. Regular prostate exams and screenings are important for maintaining prostate health.

    • This question is part of the following fields:

      • Urology
      14.6
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  • Question 11 - A 35-year-old man presents to the Emergency Department (ED) in extreme pain. He...

    Correct

    • A 35-year-old man presents to the Emergency Department (ED) in extreme pain. He reports one day of pain in his right loin spreading round into the groin. The pain comes in waves and he says it is the worst pain he has ever experienced. The ED doctor suspects a diagnosis of renal colic.
      What investigation finding would be the most consistent with this diagnosis?

      Your Answer: Microscopic haematuria

      Explanation:

      Interpreting Urine and Blood Tests for Renal Colic

      Renal colic is a common condition that can cause severe pain in the back and abdomen. When evaluating a patient with suspected renal colic, several tests may be ordered to help diagnose the condition and determine the appropriate treatment. Here are some key points to keep in mind when interpreting urine and blood tests for renal colic:

      – Microscopic haematuria with normal nitrites and leukocytes is a common finding in patients with renal colic and/or stones. This suggests that there is blood in the urine, but no signs of infection.
      – Positive leukocytes or nitrites on a urine dipstick would be suggestive of a urinary tract infection and would not be consistent with a diagnosis of renal stones.
      – A raised serum creatinine can occur with severe renal stones where there is urethral obstruction and subsequent hydronephrosis. This would be a urological emergency and the patient would likely require urgent stenting to allow passage of urine.
      – A raised serum white cell count would be more consistent with an infection as the cause of the patient’s pain, making this a less appropriate answer.

      In summary, when evaluating a patient with suspected renal colic, it is important to consider the results of urine and blood tests in conjunction with other clinical findings to make an accurate diagnosis and determine the appropriate treatment.

    • This question is part of the following fields:

      • Urology
      27
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  • Question 12 - A 25-year-old man presents to the Emergency Department with a 4-hour history of...

    Correct

    • A 25-year-old man presents to the Emergency Department with a 4-hour history of sudden-onset pain in his left scrotum that makes walking difficult. On examination, his left testicle is firm and diffusely tender.
      What is the most urgent management option?

      Your Answer: Scrotal exploration

      Explanation:

      Diagnosis and Treatment of Testicular Torsion

      Testicular torsion is a medical emergency that requires immediate attention. One of the main differential diagnoses to consider in a patient with scrotal pain is testicular torsion. If there is a high suspicion of torsion, emergency exploration surgery should not be delayed by investigations.

      During scrotal exploration, the affected testicle is inspected for viability. If viable, detorsion and orchidopexy are performed. However, if the testicle is non-viable, it must be removed. The salvage rate for detorsion within 6 hours of symptom onset is >95%, but this drops to <10% after 24 hours. While antibiotics and analgesia are appropriate for epididymo-orchitis, ruling out testicular torsion is the priority. Urinalysis may be helpful in borderline cases, but an abnormal result does not exclude testicular torsion. Doppler ultrasound scan of the testes may also be useful, but if there is a high suspicion of torsion, scrotal exploration must not be delayed by investigations.

    • This question is part of the following fields:

      • Urology
      27.7
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  • Question 13 - A 75-year-old man presents to the clinic for the second time this year...

    Incorrect

    • A 75-year-old man presents to the clinic for the second time this year with fever, dysuria, dribbling of urine. Previous admissions were for urinary tract infections. He has a history of hypertension and previous myocardial infarction for which he takes ramipril and rosuvastatin. On examination, he is pyrexial (38.5 °C) and has a pulse of 105/min and his blood pressure (BP) is 142/84 mm Hg. His cardiovascular and respiratory examination is normal. There is suprapubic tenderness with dullness, on percussion, indicating a distended bladder. Per rectal examination reveals a smoothly enlarged prostate.
      What is the best next investigation to determine the cause of this patient’s urinary retention?

      Your Answer: Magnetic resonance imaging (MRI) abdomen

      Correct Answer: Ultrasound pelvis with post-void bladder volume

      Explanation:

      Diagnostic Tests for Benign Prostatic Hyperplasia

      Benign prostatic hyperplasia is a common condition in older men that can cause urinary symptoms. To diagnose this condition, several diagnostic tests can be used. One of the most common tests is an ultrasound pelvis with post-void bladder volume, which can estimate the degree of bladder obstruction.

      However, other tests such as CT abdomen and MRI abdomen are not useful for diagnosing benign prostatic hyperplasia. CT abdomen is more useful for diagnosing malignancies of the pelvic-ureteric system, while MRI abdomen is more sensitive for diagnosing lymph-node metastasis in prostate cancer.

      Micturating cystourethrogram is also not useful for diagnosing prostatic hypertrophy, as it is used to diagnose fistula, vesicoureteric reflux, and urethral stricture. Similarly, serum alpha-fetoprotein has no role in cancer of the prostate, as it is a tumour marker in hepatocellular carcinoma, non-seminomatous germ-cell tumours, and yolk-sac tumours.

      In conclusion, an ultrasound pelvis with post-void bladder volume is the most useful diagnostic test for benign prostatic hyperplasia.

    • This question is part of the following fields:

      • Urology
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  • Question 14 - A 35-year-old healthy man presents because he and his wife have been repeatedly...

    Correct

    • A 35-year-old healthy man presents because he and his wife have been repeatedly unsuccessful in achieving pregnancy, even after three years of actively attempting to conceive. They are not using any method of contraception. The wife has been tested and determined to be fertile. The husband’s past medical history is significant for being treated for repeated upper respiratory tract infections and ear infections, as well as him stating ‘they told me my organs are all reversed’. He also complains of a decreased sense of smell. His prostate is not enlarged on examination. His blood test results are within normal limits.
      Which of the following is the most likely cause of the patient’s infertility?

      Your Answer: Lack of dynein arms in microtubules of Ciliary

      Explanation:

      Possible Causes of Infertility in a Young Man

      Infertility in a young man can have various causes. One possible cause is Kartagener’s syndrome, a rare autosomal recessive genetic disorder that affects the action of Ciliary lining the respiratory tract and flagella of sperm cells. This syndrome can lead to recurrent respiratory infections and poor sperm motility. Another possible cause is cryptorchidism, the absence of one or both testes from the scrotum, which can reduce fertility even after surgery. Age-related hormonal changes or atherosclerosis can also affect fertility, but these are less likely in a young, healthy man with normal blood tests. Cystic fibrosis, a genetic disorder that affects the lungs and digestive system, can also cause infertility, but it is usually detected early in life and has additional symptoms such as poor weight gain and diarrhea.

    • This question is part of the following fields:

      • Urology
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  • Question 15 - A 55-year-old man has been experiencing pain with urination for the past week....

    Correct

    • A 55-year-old man has been experiencing pain with urination for the past week. His temperature is 37.5 °C. On digital rectal examination, his prostate is slightly enlarged and mildly tender to palpation. Laboratory studies show his white blood cell count to be 13 000 mL. Urine culture grows > 100 000 Escherichia coli organisms. His serum prostate-specific antigen (PSA) is 6 ng/ml (normal < 5ng/ml). He receives antibiotic therapy and his clinical condition initially improves. However, his symptoms recur six times over the next 12 months.
      What is the most likely diagnosis for this patient?

      Your Answer: Chronic bacterial prostatitis

      Explanation:

      Understanding Prostate Conditions: Differentiating Chronic Bacterial Prostatitis, Nodular Prostatic Hyperplasia, Prostatic Adenocarcinoma, Prostatodynia, and Urothelial Carcinoma of the Urethra

      Prostate conditions can cause various symptoms and complications, making it crucial to differentiate between them for proper diagnosis and treatment. Chronic bacterial prostatitis, for instance, is characterized by recurrent bacteriuria and UTIs, often caused by E. coli. Nodular prostatic hyperplasia, on the other hand, can lead to an enlarged prostate and recurrent UTIs due to obstruction. Prostatic adenocarcinoma, which is usually non-tender, can cause a palpable nodule and significantly elevated PSA levels. Prostatodynia, meanwhile, presents with prostatitis-like symptoms but without inflammation or positive urine cultures. Lastly, urothelial carcinoma of the urethra is rare but may cause haematuria and UTI predisposition. Understanding these conditions and their distinguishing features can aid in prompt and accurate diagnosis and management.

    • This question is part of the following fields:

      • Urology
      36
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  • Question 16 - A 40-year-old man presents with blood in his ejaculate. He reports no lower...

    Incorrect

    • A 40-year-old man presents with blood in his ejaculate. He reports no lower urinary tract symptoms and no abdominal pain and is generally healthy. He has been in a long-term monogamous relationship and denies any history of trauma. Examination of his scrotum and penis is unremarkable, and his prostate is normal and non-tender upon digital rectal examination. Urinalysis results are within normal limits, and there is no family history of cancer.
      What is the most appropriate next step, in addition to obtaining a urine sample for microscopy, culture, and sensitivities?

      Your Answer: Refer urgently to Urology

      Correct Answer: Reassure him that this symptom is not a sign of anything serious but ask him to return if he has >3 episodes or the problem persists for over a month

      Explanation:

      Haematospermia, or blood in semen, is usually not a cause for concern in men under 40 years old. The most common causes are trauma, urinary tract infection (especially prostatitis), and sexually transmitted infection. However, it is important to rule out cancer through appropriate physical examination. If the symptom persists for over a month or there are more than three episodes, referral is recommended, especially for men over 40 years old. While reassurance is appropriate, patients should be encouraged to seek medical attention if the problem persists. Antibiotics may be prescribed if a urinary tract infection is suspected, but this is unlikely in cases with normal urinalysis. Urgent referral is necessary for men with signs and symptoms suggestive of prostate or urological malignancies, or if the underlying cause of haematospermia may be cysts or calculi of the prostate or seminal vesicles.

    • This question is part of the following fields:

      • Urology
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  • Question 17 - A 14-year-old boy comes to the Emergency Department with severe scrotal pain that...

    Incorrect

    • A 14-year-old boy comes to the Emergency Department with severe scrotal pain that has been ongoing for the past 3 hours. During the examination, he is visibly distressed and his scrotum appears red and tender. He cries out in agony when you try to touch or lift his left testicle. The right testicle appears normal. What test should you perform next?

      Your Answer: Ultrasound

      Correct Answer: None of the above

      Explanation:

      Testicular Torsion: Symptoms, Causes, and Diagnosis

      Testicular torsion is a medical emergency that requires immediate surgical intervention. It is characterized by excruciating pain and tenderness in one testicle, which worsens when the testicle is raised. This condition typically affects young teenagers and is caused by an anatomical variant that allows the spermatic cord to wind around itself and cut off blood flow to the testicle. If left untreated for more than 4-6 hours, testicular necrosis can occur.

      While orchitis and epididymitis can also cause testicular pain, they are much milder and can be differentiated from testicular torsion by the response to raising the testicle. MRI and X-ray are not helpful in diagnosing this condition, and ultrasound should not delay surgical intervention. Routine blood tests, such as CRP and WCC, may be performed, but surgery should not be delayed while awaiting results.

      In summary, testicular torsion is a serious condition that requires prompt diagnosis and surgical intervention to prevent testicular necrosis.

    • This question is part of the following fields:

      • Urology
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  • Question 18 - A 35-year-old man presents with a right inguinal mass. Upon examination, the left...

    Incorrect

    • A 35-year-old man presents with a right inguinal mass. Upon examination, the left testis is found to be normal in size and position, but the right testis cannot be palpated in the scrotum. An ultrasound confirms that the inguinal mass is a cryptorchid testis.
      What is the best course of action for addressing this patient's testicular anomaly?

      Your Answer: Put it into the scrotum surgically (orchidopexy)

      Correct Answer: Remove it (orchidectomy)

      Explanation:

      Options for Managing Cryptorchidism

      Cryptorchidism, or undescended testis, is a condition where one or both testes fail to descend into the scrotum. Here are some options for managing this condition:

      1. Orchidectomy: This involves removing the undescended testis, which eliminates the risk of developing seminoma. If the patient is 30 years old or older, the undescended testis is unlikely to be capable of spermatogenesis, so removal should not affect fertility.

      2. Bilateral orchidectomy: This involves removing both testes, but it is not necessary if only one testis is undescended. The opposite testis is not affected by the undescended testis and should be left intact.

      3. Orchidopexy: This is a surgical procedure to place the undescended testis in the scrotum. It is most effective when done before the age of 2, but it does not reduce the risk of developing testicular cancer.

      4. Testosterone therapy: This is not necessary for patients with cryptorchidism, as the Leydig cells in the testicular interstitium continue to produce testosterone.

      5. Chromosome analysis: This is indicated if there is a suspicion of a chromosomal defect, such as testicular feminisation or Klinefelter syndrome.

      In summary, the management of cryptorchidism depends on the individual case and should be discussed with a healthcare provider.

    • This question is part of the following fields:

      • Urology
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  • Question 19 - A 54-year-old man visits his GP clinic, reporting discomfort in his scrotum. During...

    Incorrect

    • A 54-year-old man visits his GP clinic, reporting discomfort in his scrotum. During the examination, the doctor notices an abnormality on the right side of the scrotum that feels like a bag of worms. The patient mentions that this has only been present for the past two months and there is no change in the examination when he lies down. What is the recommended next step?

      Your Answer: Reassure

      Correct Answer: Ultrasound of the kidneys, ureters and bladder

      Explanation:

      Medical Imaging Recommendations for Suspected Left Renal Malignancy

      Introduction:
      When a patient presents with a left-sided varicocele, it is important to consider the possibility of an underlying left renal malignancy. In this scenario, we will discuss the appropriate medical imaging recommendations for this suspected condition.

      Ultrasound of the Kidneys, Ureters, and Bladder:
      A varicocele is a dilation of the pampiniform plexus of the spermatic cord, which is dependent on the spermatic vein. In some cases, a left-sided varicocele can be associated with a left renal malignancy. This occurs when a large left renal tumor compresses or invades the left renal vein, causing an obstruction to venous return and resulting in a varicocele. Therefore, an ultrasound of the kidneys is recommended to assess for any potential malignancy.

      Ultrasound of the Liver:
      In this scenario, an ultrasound of the kidneys would be more useful than an ultrasound of the liver, as renal malignancy is suspected.

      Ultrasound of the Left Groin:
      Signs and symptoms of an inguinal hernia include a bulge in the area on either side of the pubic bone, which becomes more obvious when the patient is upright, especially when coughing or straining. However, there are no signs of hernias on clinical examination in this case.

      Magnetic Resonance Imaging (MRI) of the Whole Spine:
      MRI of the whole spine is recommended in cases of potential cord compression. However, this is not clinically suspected in this scenario.

      Reassure:
      If a left-sided varicocele does not drain when lying supine, it should be referred for ultrasound to rule out underlying malignancy. The new onset of the varicocele makes this more likely and therefore should be further investigated.

    • This question is part of the following fields:

      • Urology
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  • Question 20 - A 28-year-old man and his 26-year-old wife visit their GP for a follow-up...

    Incorrect

    • A 28-year-old man and his 26-year-old wife visit their GP for a follow-up appointment regarding their difficulty in conceiving. The couple has been trying to conceive for the past year without success. The wife has a regular menstrual cycle and no previous gynaecological issues. An ovulation test measuring her progesterone level showed normal ovulation. The GP advises the couple that the husband needs to undergo tests to determine if there is any cause on his side contributing to the infertility. Both the man and the woman have no history of sexually transmitted infections. The man has been smoking one to two cigarettes a day since he was 16 years old. What is the best next investigation for this patient?

      Your Answer: Testosterone level

      Correct Answer: Semen analysis

      Explanation:

      Investigations for Male Infertility: Semen Analysis, Testicular Biopsy, Hormone and Genetic Testing

      When a couple experiences fertility problems, a semen analysis is typically the first investigation for the man. This test measures semen volume, pH, sperm concentration, total sperm number, total motility, vitality, and sperm morphology, using World Health Organization reference values for interpretation. If the semen analysis reveals azoospermia (no sperm present), a testicular biopsy may be performed to collect spermatozoa for in-vitro fertilization treatment.

      If the semen analysis does not explain the infertility, follicle-stimulating hormone and testosterone levels may be measured, but these are not first-line investigations. Genetic testing may also be considered to identify genetic abnormalities, such as Klinefelter syndrome, which can cause male infertility. Overall, a combination of these investigations can help diagnose and treat male infertility.

    • This question is part of the following fields:

      • Urology
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  • Question 21 - A 58-year-old man with long-standing multiple sclerosis (MS) is admitted due to increasing...

    Incorrect

    • A 58-year-old man with long-standing multiple sclerosis (MS) is admitted due to increasing problems with his care in the community. He is bed-bound with a spastic paraparesis. He is noted to have a permanent 14-gauge urinary catheter in situ and has a history of recurrent urinary tract infections. The family informs the nursing staff that this has not been changed for some time. Your senior colleague wishes for the catheter to be replaced due to recurrent UTIs.
      Which one of the following statements is the most accurate?

      Your Answer: A male chaperone is required

      Correct Answer: A single dose of prophylactic gentamicin is advisable

      Explanation:

      Best Practices for Permanent Indwelling Urinary Catheters

      Introduction:
      Permanent indwelling urinary catheters are commonly used in patients with urinary retention or incontinence. However, they can pose a risk of infection and other complications. Therefore, it is important to follow best practices when placing and maintaining these catheters.

      Prophylactic Gentamicin:
      When replacing a permanent catheter, it is recommended to administer a single dose of prophylactic gentamicin to prevent infection.

      Regular Replacement:
      It is essential to have measures in place for regular routine replacement of permanent catheters. This is because they are a foreign body and can be a portal of entry for infection. Urinary sepsis in these patients can be devastating and fatal.

      Same-Sized Catheter:
      When replacing a catheter, it is not necessary to change the size unless there are symptoms of catheter bypass. Increasing the size can cause pain and trauma.

      Local Anaesthetic Gel:
      Even if a patient has paraparesis, local anaesthetic gel must be used during catheter insertion to prevent pain.

      Chaperone:
      It is good practice to offer a chaperone during any intimate examination/procedure. The patient may accept or decline a chaperone. If a chaperone is required, they do not have to be a man as long as there is consent from the patient.

      Regular Replacement Schedule:
      Long-term catheters require changing every 12 weeks due to the design of the catheter and the risk of infection. This can be done in the community by district nurses.

      Best Practices for Permanent Indwelling Urinary Catheters

    • This question is part of the following fields:

      • Urology
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  • Question 22 - You are asked to review a middle-aged man, following an admission for lower...

    Correct

    • You are asked to review a middle-aged man, following an admission for lower abdominal pain. The patient has a distended abdomen and has not passed urine for eight hours. He is very uncomfortable and has a large palpable bladder extending above the pubic symphysis. A digital rectal examination is performed, which reveals an enlarged, smooth prostate. Urinalysis is unremarkable, and he remains systemically well. He describes increasing difficulty with voiding and poor stream over the past six months, but no other symptoms.
      What is the most likely underlying cause for his urinary retention?

      Your Answer: Benign prostatic hypertrophy (BPH)

      Explanation:

      Causes of Urinary Retention in Men

      Urinary retention, the inability to empty the bladder completely, can have various underlying causes. In men, some common conditions that can lead to urinary retention are benign prostatic hypertrophy (BPH), renal calculi, prostate carcinoma, urinary tract infection, and bladder cancer.

      BPH is a non-cancerous enlargement of the prostate gland that often occurs with aging. It can compress the urethra and obstruct the flow of urine, causing symptoms such as difficulty starting urination, weak stream, dribbling, and frequent urination. Immediate treatment for acute urinary retention due to BPH may involve inserting a urinary catheter to relieve the pressure and drain the bladder.

      Renal calculi, or kidney stones, can cause urinary retention if they get stuck in the ureter or bladder neck. The pain from passing a stone can be severe and radiate from the back to the groin. Blood in the urine may also be present.

      Prostate carcinoma, or prostate cancer, can also cause urinary retention if the tumour grows large enough to block the urethra. However, this is not a common presentation of prostate cancer, which usually manifests with other symptoms such as urinary frequency, urgency, nocturia, pain, or blood in the semen.

      Urinary tract infection (UTI) can result from incomplete voiding due to BPH or other causes. UTI can cause symptoms such as burning, urgency, frequency, cloudy or foul-smelling urine, and fever. However, not all cases of urinary retention are associated with UTI.

      Bladder cancer is a rare cause of urinary retention, but it can occur if the tumour obstructs the bladder outlet. Bladder cancer may also cause painless hematuria, urinary urgency, or pelvic discomfort.

      In summary, urinary retention in men can have multiple etiologies, and the diagnosis depends on the patient’s history, physical examination, and additional tests such as imaging, urinalysis, or prostate-specific antigen (PSA) testing. Prompt evaluation and management of urinary retention are essential to prevent complications such as urinary tract infection, bladder damage, or renal impairment.

    • This question is part of the following fields:

      • Urology
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  • Question 23 - A 30-year-old man presents with a left-sided, painless testicular lump. He has a...

    Correct

    • A 30-year-old man presents with a left-sided, painless testicular lump. He has a history of orchidopexy for an undescended testicle.
      On examination, there is a firm lump lying in the body of the left testicle. His body mass index is 27. There are a few left-sided inguinal lymph nodes palpable. You suspect testicular cancer.
      Which of the following findings on history and examination makes this provisional diagnosis more likely?

      Your Answer: History of orchidopexy for an undescended testicle

      Explanation:

      Understanding the Risk Factors and Symptoms of Testicular Cancer

      Testicular cancer is a serious condition that can have life-altering consequences if not detected and treated early. One of the main risk factors for this type of cancer is a history of undescended testes, which increases the risk significantly. Additionally, men with a high body mass index may have a lower risk of developing testicular cancer.

      It’s important to note that the presence or absence of tenderness in the testicles does not necessarily indicate the presence of cancer. However, any man who notices a lump or mass in the body of the testicle should seek urgent medical attention to rule out the possibility of cancer.

      In terms of metastasis, testicular cancer commonly spreads to the para-aortic lymph nodes rather than the inguinal nodes. By understanding these risk factors and symptoms, men can take proactive steps to protect their health and detect any potential issues early on.

      Understanding the Risk Factors and Symptoms of Testicular Cancer

    • This question is part of the following fields:

      • Urology
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  • Question 24 - A 19-year-old man comes to the clinic complaining of a painful swelling in...

    Correct

    • A 19-year-old man comes to the clinic complaining of a painful swelling in the area of his glans penis that has been present for 6 hours. Upon examination, the glans penis is red, oedematous, and extremely tender. The foreskin is pulled back, but there is no evidence of scrotal or penile necrosis or redness.

      What is the best course of action for treatment?

      Your Answer: Soak the foreskin and glans penis in a hypertonic solution and attempt to manually replace the foreskin by using gentle, but sustained, distal traction

      Explanation:

      Management of Penile Conditions: Differentiating Paraphimosis and Balanitis

      Penile conditions such as paraphimosis and balanitis require prompt and appropriate management. Paraphimosis occurs when the foreskin is retracted but cannot be replaced, leading to swelling of the glans penis. This is a urological emergency that requires immediate intervention. Treatment involves attempting to manually reduce the foreskin, aided by a hypertonic solution to draw out fluid from the swollen area. Referral to Urology is necessary if reduction is not successful.

      Balanitis, on the other hand, is inflammation of the foreskin usually caused by dermatitis or infection with Candida, Gardnerella, or staphylococcal organisms. Symptoms include tenderness and erythema of the glans penis, itching, penile discharge, difficulty with retraction of the foreskin, and difficulty urinating or controlling urine stream. Treatment involves prescribing a 7-day course of hydrocortisone and clotrimazole cream or flucloxacillin if caused by Staphylococcus aureus.

      It is important to differentiate between these two conditions and provide appropriate management to prevent complications.

    • This question is part of the following fields:

      • Urology
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  • Question 25 - A 25-year-old man who has received a transplant of the left kidney is...

    Incorrect

    • A 25-year-old man who has received a transplant of the left kidney is exhibiting symptoms that suggest hyperacute rejection of the transplant. What is the probable time frame for this type of rejection to occur?

      Your Answer: 48 hours post transplantation

      Correct Answer: Within minutes of transplantation

      Explanation:

      Understanding the Types and Timing of Transplant Rejection

      Transplant rejection can occur in different types and at different times after transplantation. Hyperacute rejection is the earliest and occurs within minutes of transplantation due to pre-existing donor-specific antibodies. This reaction is complement-mediated and irreversible, requiring prompt removal of the transplanted tissue. Acute rejection can occur up to 3 months after transplantation and is cell-mediated, involving the activation of phagocytes and cytotoxic T lymphocytes. Rejection that occurs in the first few days after transplantation is known as accelerated acute rejection. Chronic rejection, which is controversial, involves antibody-mediated vascular damage and can occur months to years after transplantation. Blood group matching can minimize hyperacute rejection, while monitoring and immunosuppressive therapy can help prevent and treat other types of rejection.

    • This question is part of the following fields:

      • Urology
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  • Question 26 - A 32-year-old obese man presents to Accident and Emergency with a 2-day history...

    Incorrect

    • A 32-year-old obese man presents to Accident and Emergency with a 2-day history of nausea, frank haematuria and sharp, persistent left-sided flank pain, radiating from the loin to the groin. On examination, he has left renal angle tenderness.
      Urine dip shows:
      frank haematuria
      blood 2+
      protein 2+.
      He has a history of hypertension, appendicitis 10 years ago and gout. You order a non-contrast computerised tomography (CT) for the kidney–ureter–bladder (KUB), which shows a 2.2 cm calculus in the proximal left (LT) ureter.
      Which of the following is the definitive treatment for this patient’s stone?

      Your Answer: Admission and treatment with diclofenac, antiemetic, and rehydration therapy

      Correct Answer: Percutaneous ureterolithotomy

      Explanation:

      Treatment Options for Large Kidney Stones

      Large kidney stones, typically those over 2 cm in diameter, require surgical intervention as they are unlikely to pass spontaneously. Here are some treatment options for such stones:

      1. Percutaneous Ureterolithotomy/Nephrolithotomy: This procedure involves using a nephroscope to remove or break down the stone into smaller pieces before removal. It is highly effective for stones between 21 and 30 mm in diameter and is indicated for staghorn calculi, cystine stones, or when ESWL is not suitable.

      2. Extracorporeal Shock Wave Lithotripsy (ESWL): This option uses ultrasound shock waves to break up stones into smaller fragments, which can be passed spontaneously in the urine. It is appropriate for stones up to 2 cm in diameter that fail to pass spontaneously.

      3. Medical Expulsive Therapy: In some cases, calcium channel blockers or a blockers may be used to help pass the stone. A corticosteroid may also be added. However, this option is not suitable for stones causing severe symptoms.

      It is important to note that admission and treatment with diclofenac, antiemetic, and rehydration therapy is only the initial management for an acute presentation and that sending the patient home with paracetamol and advice to drink water is only appropriate for small stones. Open surgery is rarely used and is reserved for complicated cases.

    • This question is part of the following fields:

      • Urology
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  • Question 27 - A 68-year-old man tells his general practitioner that, for the past two months,...

    Incorrect

    • A 68-year-old man tells his general practitioner that, for the past two months, he has been passing urine more often than usual and getting up at night to urinate. Given the man’s age, you suspect he might have symptoms related to an enlarged prostate.
      Which of the following should be done first to confirm the first impression?

      Your Answer: Rectal examination of the prostate

      Correct Answer: Full urological history

      Explanation:

      Assessing Prostate Enlargement: Diagnostic Tests and Treatment Options

      To determine the presence and severity of prostate enlargement, a full urological history should be taken, with attention paid to obstructive and irritation symptoms. If enlargement is suspected, a blood test for prostate-specific antigen (PSA) should be done before rectal examination, as the latter can increase PSA levels. Tamsulosin may be prescribed as a first-line drug for mild cases, but a thorough history should be obtained before starting pharmacological treatment. Abdominal examination is not typically necessary for initial diagnosis.

    • This question is part of the following fields:

      • Urology
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  • Question 28 - A 4-year-old boy undergoes a biopsy for a painless testicular tumour. Microscopy reveals...

    Incorrect

    • A 4-year-old boy undergoes a biopsy for a painless testicular tumour. Microscopy reveals tissue that resembles glomeruli. What is the most probable diagnosis?

      Your Answer: Embryonal carcinoma

      Correct Answer: Yolk cell tumour

      Explanation:

      Types of Testicular Tumours and Their Characteristics

      Testicular tumours can be classified into different types based on their characteristics. The following are some of the common types of testicular tumours and their distinguishing features:

      1. Yolk Sac Tumour: This is the most common type of testicular tumour in children under the age of 4. It is a mucinous tumour that contains Schiller-Duval bodies, which resemble primitive glomeruli. Alpha fetoprotein is secreted by these tumours.

      2. Embryonal Carcinoma: This type of tumour typically occurs in the third decade of life. On microscopy, glands or papules are seen.

      3. Leydig Cell Tumour: This is a benign tumour that can cause precocious puberty or gynaecomastia. Reinke crystals are noted on histology.

      4. Seminoma: Seminoma is the most common testicular tumour, usually occurring between the ages of 15 and 35. Its features include large cells with a fluid-filled cytoplasm that stain CD117 positive.

      5. Choriocarcinoma: This tumour secretes β-human chorionic gonadotropin (β-HCG). Due to the similarity between thyroid-stimulating hormone and β-HCG, symptoms of hyperthyroidism may develop. Histology of these tumours shows cells that resemble cytotrophoblasts or syncytiotrophoblastic tissue.

      In conclusion, understanding the different types of testicular tumours and their characteristics can aid in their diagnosis and treatment.

    • This question is part of the following fields:

      • Urology
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  • Question 29 - A 22-year-old man discovered a painless enlargement of his left testicle during his...

    Correct

    • A 22-year-old man discovered a painless enlargement of his left testicle during his shower. He is sexually active, but he reports no recent sexual encounters. What would be the most suitable serological test to assist in diagnosing his condition?

      Your Answer: Alpha-fetoprotein (aFP)

      Explanation:

      Tumor Markers: Common Biomarkers for Cancer Diagnosis

      Tumor markers are substances produced by cancer cells or normal cells in response to cancer. These biomarkers can be used to aid in the diagnosis and management of cancer. Here are some common tumor markers and their associated cancers:

      – Alpha-fetoprotein (aFP): Elevated levels of aFP may indicate non-seminomatous germ cell tumors of the testis, but biopsy is necessary for definitive diagnosis.
      – Calcitonin: Produced by medullary carcinomas of the thyroid, calcitonin opposes the action of parathyroid hormone.
      – Parathyroid-related peptide (PTHrP): Produced in squamous cell carcinoma of the lung, PTHrP can cause a paraneoplastic syndrome.
      – Carcinoembryonic antigen (CEA): Elevated in cancers of the stomach, lung, pancreas, and colon, and sometimes in yolk sac tumors.
      – CA-125: Elevated in ovarian cancer, but can also be elevated in benign conditions such as endometriosis, uterine fibroids, and ovarian cysts.

      While tumor markers can provide clues to the diagnosis of cancer, biopsy is necessary for definitive diagnosis. It is important to note that elevated levels of these biomarkers do not always indicate cancer and can be caused by other conditions. Consultation with a healthcare provider is necessary for proper interpretation of tumor marker results.

    • This question is part of the following fields:

      • Urology
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  • Question 30 - A 54-year-old man visits the GP clinic with concerns about his inability to...

    Correct

    • A 54-year-old man visits the GP clinic with concerns about his inability to sustain an erection during sexual activity. He has no known medical conditions and reports no stress or relationship issues. Upon examination, he exhibits bilateral toe proprioception loss. Cardiovascular and respiratory evaluations are normal. There are no notable findings on physical examination, including genital examination. What is the initial investigation that should be conducted for this patient?

      Your Answer: Fasting blood sugar

      Explanation:

      Investigations for Erectile Dysfunction: Understanding the Role of Different Tests

      Erectile dysfunction (ED) is a common condition that can have a significant impact on a man’s quality of life. It is also considered an independent risk factor for cardiovascular disease and can be a presenting symptom of diabetes mellitus. Therefore, it is important to conduct appropriate investigations to identify any underlying causes of ED. Here, we will discuss the role of different tests in the evaluation of ED.

      Fasting Blood Sugar Test

      As mentioned earlier, diabetes mellitus is a common cause of ED. Therefore, it is recommended that all patients with ED undergo a fasting blood sugar test to rule out diabetes.

      Ultrasound of Testes

      Testicular pathology does not lead to ED. Therefore, an ultrasound of the testes is not indicated unless there are specific indications for it.

      Prostate-Specific Antigen (PSA) Test

      ED is not a presentation of prostate cancer. However, treatment of prostate cancer, such as radical prostatectomy, can lead to ED. Therefore, a PSA test is not indicated for the evaluation of ED.

      Semen Analysis

      Semen analysis is performed when couples present with infertility. It does not have a role in the evaluation of ED unless there are specific indications for it.

      Serum Hormone Levels

      Serum oestrogen and progesterone levels are hormones that are found abundantly in women. They are assayed, along with LH and FSH levels, to pursue the cause of hypogonadism when it is suspected. However, in the case of ED, hypogonadism must be ruled out with serum testosterone level.

      In conclusion, appropriate investigations are necessary to identify any underlying causes of ED. A fasting blood sugar test and serum testosterone level are the most important tests to perform in the evaluation of ED.

    • This question is part of the following fields:

      • Urology
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