Urology 3

oelomar's version from 2016-02-27 14:51


Question Answer
From which part of the nephron does renal cell carcinoma arise?The epithelium of the proximal convoluted tubule.
What is the average age of presentation for renal cell carcinoma?55
What are the clinical features of renal cell carcinoma?Can be asymptomatic. Presents with a triad of flank pain, mass, and haematuria. Varicocele (an abnormal enlargement of the pampiniform venous plexus in the scrotum) is seen in men. Endocrine effects include the secretion of erythropoietin thereby leading to polycythaemia, and renin secretion leading to hypertension (found in 30%). Anaemia can also be present due to the under-production of erythropoietin.
How is renal cell carcinoma diagnosed?Ultrasonography is used to demonstrate the solid lesion. CT scanning is used to identify the renal lesion and involvement of the renal vein or inferior vena cava. MRI is better for tumour staging.
How is renal cell carcinoma treated?Nephrectomy is performed. Medroxyprogesterone acetate is of some value in controlling metastatic disease.
Renal cell carcinoma is the least common type of renal malignancy. True or False?False. It is the most common type and is responsible for approximately 90-95% of cases.
What is Wilms’ tumour?Also known as nephroblastoma, Wilms’ tumour is a cancer of the kidneys that typically occur in children in the first 3 years of life. It is unilateral in over 95% of cases.
What does Wilms’ tumour present with?Huge, palpable flank mass, abdominal pain, haematuria (20% of cases).
What is the 5-year survival rate in patients with Wilms’ tumour?90%. Wilms’ tumour is highly responsive to treatment.


Question Answer
What is transitional cell carcinoma? What does it affect?A type of cancer that typically occurs in the urinary system. The calyces, renal pelvis, ureters, bladder (most common) and urethra are lined by transitional cell epithelium. It is the most common type of bladder cancer and cancer of the ureter, and urethra. It is the second most common type of kidney cancer.
What do transitional cell carcinomas present with?It depends on the location and extent of the cancer. Painless haematuria is the most common presenting symptom. Transitional cell carcinomas in the kidney and ureter may also give rise to flank pain, particularly if urinary tract obstruction is present.
How are pelvic and ureteric tumours treated?These are treated by nephroureterectomy. Radiotherapy and chemotherapy appear to be of little or no value. Subsequently, cystoscopy should be regularly carried out, since about half the patients will develop bladder tumours.
How are superficial bladder tumours treated?Transurethral resection for bladder tumour (TURBT).
How are invasive bladder tumours treated?Radical cystectomy (removal of the entire bladder, nearby lymph nodes, part of the urethra, and nearby organs that may contain cancer cells) in patients under 70 years and radical radiotherapy in those over 70 years with salvage cystectomy (surgical removal of the urinary bladder) for recurrences.
What is the 5-year survival rate for patients with transitional cell carcinoma?The prognosis ranges from a 5-year survival rate of 80–90% for lesions not involving bladder muscle to 5% for those presenting with metastases.
What is schistosomiasis and what is its association with bladder cancer and snails?Also known as snail fever, this is a disease caused by parasitic worms of the Schistosoma type. Schistosomiasis infection can lead to squamous cell carcinoma of the bladder. The parasite can be found in lakes with fresh water snails.


Question Answer
BPH is more common in Asians. True or False?False.
What are the clinical features of BPH?Voiding symptoms: weak or intermittent urinary flow, straining, hesitancy, terminal dribbling and incomplete emptying. Storage symptoms: urgency, frequency, urgency incontinence and nocturia. Post-micturition: dribbling. Complications include UTI, retention, obstructive uropathy.
What does the prostate feel like on examination in an individual with BPH?On examination, the prostate is uniformly enlarged with a rubbery texture. If the prostate is hard or has irregular lesions, suspect cancer.
What is finasteride and how does it work?Finasteride is a 5α-reductase inhibitor. 5α-reductase is the enzyme that converts testosterone to dihydrotestosterone (DHT). DHT is the ultimate mediator of prostatic growth as it causes cell growth and inhibits apoptosis. Finasteride slows the conversion of testosterone into DHT, thus slowing down the growth of the stromal and epithelial prostate cells. It also promotes apoptosis.
What are the drawbacks of finasteride/dutasteride?Slow acting, erectile dysfunction, gynaecomastia, reduced libido, PSA reduced too much.
What is tamsulosin and how does it work?Tamsulosin is an α1-adrenergic receptor antagonist. Contraction of prostatic smooth muscle is mediated by α1-adrenergic receptors. Tamsulosin bocks the receptor and causes prostatic smooth muscle relaxation, thereby reducing urethral occlusion. Tamsulosin may also encourage apoptosis.
What are the drawbacks of tamsulosin/alfuzosin/doxazosin?Dizziness, drowsiness, headaches, little or no sperm on ejaculation.
When treating BPH, why are anti-androgens and α1 blockers taken together?The anti-androgens are better but are slow-acting, whereas α1 blockers are quick-acting.
What is TURP, how does it work, and what is its major drawback?Transurethral resection of the prostate. It is used to treat BPH. A device called the resectoscope is used which is a thin metal tube consisting of a light, a camera and a loop wire. The resectoscope is inserted into the urethra and guided to the site of the prostate. An electric current is used to heat the loop of wire, and the heated wire is used to cut away the section of the prostate that is causing the symptoms. After the procedure, a catheter is used to pump saline water into the bladder and flush away pieces of prostate that have been removed.
Histologically, prostatic carcinoma is what type of tumour?Adenocarcinoma.
What are the normal levels of PSA?0-4ng/ml.
In prostate cancer, there are more cells than in BPH. Therefore, in prostate cancer, the level of PSA in the blood is greater than that in BPH. True or false?True.
What is endorectal coil MRI?A type of medical imaging in which MRI is used in conjunction with a coil placed into the rectum in order to obtain high quality images of the area surrounding the rectum. Endorectal coil MRI is useful for determining the extent of spread and local invasion of cancers of the prostate, rectum, and anus.
What is the Gleason Grading System?A grading system used to help evaluate the prognosis of men with prostate cancer using samples from a prostate biopsy. The higher the score (out of 10), the worse the prognosis. 8-10=aggressive. 5-7=intermediate. 2-4=indolent.
What can raise PSA levels?BPH, prostate cancer, prostatitis, ejaculation (48 hours), vigorous exercise (48 hours).


Question Answer
Around 20% of men with prostate cancer have normal PSA levels. True or false?True.
What is Type IV RTA and what are the features?A type of RTA which is not actually a tubular disorder at all, nor has any clinical syndrome similar to the other types of RTA. The disorder is with the adrenal glands, and is a result of hypoaldosteronism either due to a deficiency of aldosterone or due to a resistance of its effects (pseudohypoaldosteronism). The cardinal features are mild acidosis and hyPERkalaemia.
How is Type IV RTA treated?Fludrocortisone (a mineralocorticoid), sodium bicarbonate, diuretics, or ion exchange resins to remove potassium, or a combination of these.
What is Type III RTA and what are the features?A very rare condition that represents a combination of type I and type II RTA. It is observed as the result of inherited carbonic anhydrase II deficiency. It is characterised by osteopetrosis, cerebral calcification, and mental retardation.
What is Type II RTA and what are the features?Also known as proximal RTA, this is observed as the result of failed sodium bicarbonate reabsorption from the urine by the proximal tubular cells. The cardinal features are acidosis and hypokalaemia.
How is Type II RTA treated?Sodium bicarbonate.
What is Type 1 RTA and what are the features?Also known as distal RTA, this is due to a failure of H+ secretion in the distal tube. It consists of severe acidosis, hypokalaemia, low urinary citrate, and hypercalciuria; which can result in osteomalacia, renal stone formation, and recurrent UTIs.
60% of total body weight is water. True or false?True.
2/3 of the water in the body is intracellular. True or false?True. 1/3 is extracellular.
¼ of the extracellular fluid in the body is plasma volume and the other ¾ is interstitial volume. True or false?True.