00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Secs)
  • Question 1 - 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: C-reactive protein (CRP) and white cell count (WCC) as inflammatory markers

      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
      23
      Seconds
  • Question 2 - 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
      15.2
      Seconds
  • Question 3 - 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
      15.6
      Seconds
  • Question 4 - 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
      29.4
      Seconds
  • Question 5 - A 28-year-old man and his 26-year-old wife visit their GP for a follow-up...

    Correct

    • 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: 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
      18.2
      Seconds
  • Question 6 - A 28-year-old man comes to the Emergency Department complaining of pain in his...

    Correct

    • A 28-year-old man comes to the Emergency Department complaining of pain in his left testicle that has been gradually increasing over the past 72 hours. He appears to be in discomfort but is able to walk. Upon examination, his left testicle is tender to firm palpation. His vital signs are normal, and there is no redness or swelling. His abdominal examination is unremarkable. He reports dysuria and has recently started a new sexual relationship.

      What is the most suitable course of action?

      Your Answer: Treat with ceftriaxone 500 mg intramuscular (im) plus doxycycline 100 mg twice daily for 10–14 days

      Explanation:

      Treatment Options for Epididymo-orchitis: Choosing the Right Antibiotics

      Epididymo-orchitis is a condition that causes inflammation of the epididymis and testicles. It is most commonly caused by sexually transmitted infections such as Chlamydia trachomatis or Neisseria gonorrhoeae. When treating this condition, it is important to choose the right antibiotics based on the suspected causative organism.

      In the case of a sexually transmitted infection, ceftriaxone 500 mg intramuscular (im) plus doxycycline 100 mg twice daily for 10–14 days is the recommended treatment. However, if an enteric organism is suspected, ciprofloxacin may be preferred.

      It is important to note that pain relief alone is not sufficient and empirical treatment with antibiotics is advised. Additionally, immediate involvement of a urologist is necessary to rule out testicular torsion.

      While hospital admission and intravenous antibiotics may be necessary in severe cases, stable patients with epididymo-orchitis do not require this level of intervention. By choosing the appropriate antibiotics and involving a urologist when necessary, patients can receive effective treatment for this condition.

    • This question is part of the following fields:

      • Urology
      48.9
      Seconds
  • Question 7 - A male toddler, on physical examination at the age of 2, is noticed...

    Correct

    • A male toddler, on physical examination at the age of 2, is noticed to have an abnormal opening of the urethra on to the ventral surface of the penis.
      Which of the following is the most likely diagnosis?

      Your Answer: Hypospadias

      Explanation:

      Common Congenital Penile Deformities and Conditions

      Hypospadias, Cryptorchidism, Exstrophy, Epispadias, and Phimosis are all congenital penile deformities and conditions that affect newborn boys. Hypospadias is the most common, occurring in about 1 in every 150-300 boys. It is characterized by an abnormal opening of the urethral meatus on the ventral surface of the penis, ventral curvature of the penis, and a hooded foreskin. Cryptorchidism, on the other hand, is the failure of the testes to descend into the scrotal sac and is seen in 3% of all full-term newborn boys. Exstrophy is a rare condition where the bladder protrudes through a defect in the lower abdominal wall. Epispadias is defined as an abnormal opening of the urethra on the dorsal aspect of the penis, while Phimosis is a condition where the foreskin cannot be fully retracted over the glans of the penis. These conditions may have genetic components and can lead to complications such as infection, urinary tract obstruction, and other associated conditions.

    • This question is part of the following fields:

      • Urology
      7.1
      Seconds
  • Question 8 - You have organized a semen analysis for a 37-year-old man who has been...

    Correct

    • You have organized a semen analysis for a 37-year-old man who has been experiencing difficulty in conceiving with his partner for the past year. The results are as follows:

      - Semen volume 1.8 ml (1.5ml or more)
      - pH 7.4 (7.2 or more)
      - Sperm concentration 12 million per ml (15 million per ml or more)
      - Total sperm number 21 million (39 million or more)
      - Total motility 40% progressively motile (32% or more)
      - Vitality 68% live spermatozoa (58% or more)
      - Normal forms 5% (4% or more)

      His partner is also undergoing investigations, and you plan on referring him to fertility services. What steps should be taken based on these semen analysis results?

      Your Answer: Repeat test in 3 months

      Explanation:

      If a semen sample shows abnormal results, it is recommended to schedule a repeat test after 3 months to allow for the completion of the spermatozoa formation cycle. Immediate retesting should only be considered if there is a severe deficiency in spermatozoa, such as azoospermia or a sperm concentration of less than 5 million per ml. In this case, the man has mild oligozoospermia/oligospermia and a confirmatory test should be arranged after 3 months.

      Understanding Semen Analysis

      Semen analysis is a test that measures the quality and quantity of semen in a man’s ejaculate. To ensure accurate results, it is recommended that the sample be collected after a minimum of 3 days and a maximum of 5 days of abstinence. It is also important to deliver the sample to the lab within 1 hour of collection.

      The normal semen results include a volume of more than 1.5 ml, a pH level of more than 7.2, a sperm concentration of more than 15 million per ml, morphology of more than 4% normal forms, motility of more than 32% progressive motility, and vitality of more than 58% live spermatozoa. However, it is important to note that different reference ranges may exist, and these values are based on the NICE 2013 guidelines.

      Overall, semen analysis is an important tool in assessing male fertility and can provide valuable information for couples trying to conceive.

    • This question is part of the following fields:

      • Urology
      65.1
      Seconds
  • Question 9 - 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
      23
      Seconds
  • Question 10 - A 25-year-old man who has received a transplant of the left kidney is...

    Correct

    • 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: 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
      13
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Urology (8/10) 80%
Passmed