001 Evaluation of the Urologic Patient - History and Physical Examination

Question 1

IPSS Score:
__: mild symptoms
__: moderate symptoms
__ severe symptoms

Answer 1

IPSS Score:
0 to 7: mild symptoms
8 to 19: moderate symptoms
20 to 35: severe symptoms

Question 2

Renal pain radiates from the flank anteriorly to the respective lower quadrant and may be referred to the __, __, or __. The pain is __ (fluctuates). It may be associated with gastrointestinal symptoms due to reflex stimulation of the __.

Answer 2

Renal pain radiates from the flank anteriorly to the respective lower quadrant and may be referred to the TESTIS, LABIUM, or MEDIAL ASPECT OF THE THIGH. The pain is COLICKY (fluctuates). It may be associated with gastrointestinal symptoms due to reflex stimulation of the CELIAC GANGLION.

Question 3

Patients with slowly progressive urinary obstruction with bladder distention often have/have no pain, despite residual volumes in excess of a liter.

Answer 3

Patients with slowly progressive urinary obstruction with bladder distention often HAVE NO pain, despite residual volumes in excess of a liter.

Question 4

Pain of prostatic origin is well/poorly localized.

Answer 4

Pain of prostatic origin is POORLY localized.

Question 5

Scrotal pain may be primary or referred. Pain referred to the testicle originates in the __, __, or __.

Answer 5

Scrotal pain may be primary or referred. Pain referred to the testicle originates in the RETROPERITONEUM, URETER, or KIDNEY.

Question 6

__, particularly in adults, should be regarded as a symptom of malignancy until proven otherwise.

Answer 6

HEMATURIA, particularly in adults, should be regarded as a symptom of malignancy until proven otherwise.

Question 7

Adults normally arise no more than __ a night to void. Urine production increases at night (recumbent position) in older patients and those with cardiac disease, particularly CHF.

Answer 7

Adults normally arise no more than TWICE a night to void. Urine production increases at night (recumbent position) in older patients and those with cardiac disease, particularly CHF.

Question 8

__: urine escapes into the bulbar urethra and then leaks at the end of micturition. This may be alleviated by perineal pressure following voiding.

Answer 8

POSTVOID DRIBBLING: urine escapes into the bulbar urethra and then leaks at the end of micturition. This may be alleviated by perineal pressure following voiding.

Question 9

Those who present with microscopic hematuria and irritative voiding symptoms should be suspected of having __ until proven otherwise.

Answer 9

Those who present with microscopic hematuria and irritative voiding symptoms should be suspected of having CARCINOMA IN SITU OF THE BLADDER until proven otherwise.

Question 10

Continuous incontinence is most commonly due to __, __, or __.

Answer 10

Continuous incontinence is most commonly due to ECTOPIC URETER, URINARY TRACT FISTULA, or TOTALLY INCOMPETENT SPHINCTER.

Question 11

__ almost always resolves spontaneously and is rarely associated with any significant urologic pathology.

Answer 11

HEMATOSPERMIA almost always resolves spontaneously and is rarely associated with any significant urologic pathology.

Question 12

When urinary obstruction is associated with __ and __, it should be regarded as a urologic emergency.

Answer 12

When urinary obstruction is associated with FEVER and CHILLS, it should be regarded as a urologic emergency.

Question 13

It is always worthwhile to obtain the __ in patients who are to be operated on.

Answer 13

It is always worthwhile to obtain the PREVIOUS OPERATIVE REPORT in patients who are to be operated on.

Question 14

If the patient is uncircumcised, the foreskin must be __ for inspection of the glans.

Answer 14

If the patient is uncircumcised, the foreskin must be RETRACTED for inspection of the glans.

Question 15

The testes are normally __ in length and __ in width.

Answer 15

The testes are normally 6CM in length and 4CM in width.

Question 16

If one obtains a stool guaiac test (hemoccult) as a screen for colon cancer, two subsequent stool specimens must be obtained for an adequate test. If the hemoccult is positive, the patient should be on a __ for 3 days before collection of three specimens.

Answer 16

If one obtains a stool guaiac test (hemoccult) as a screen for colon cancer, two subsequent stool specimens must be obtained for an adequate test. If the hemoccult is positive, the patient should be on a RED MEAT-FREE DIET for 3 days before collection of three specimens.

Question 17

A male urologist should always perform a female pelvic examination with a __.

Answer 17

A male urologist should always perform a female pelvic examination with a FEMALE NURSE IN ATTENDANCE.

Question 18

The __ tests the integrity of this spinal cord reflex involving S2 to S4.

Answer 18

The BULBOCAVERNOUS REFLEX tests the integrity of this spinal cord reflex involving S2 to S4.

Question 19

A positive dipstick for blood in the urine indicates hematuria, hemoglobinuria, or myoglobinuria. Hematuria is distinguished from hemoglobinuria and myoglobinuria by __ (more than three red blood cells per high-power field is abnormal).

Answer 19

A positive dipstick for blood in the urine indicates hematuria, hemoglobinuria, or myoglobinuria. Hematuria is distinguished from hemoglobinuria and myoglobinuria by MICROSCOPIC EXAMINATION OF THE CENTRIFUGED URINE AND IDENTIFICATION OF RED BLOOD CELLS (more than three red blood cells per high-power field is abnormal).

Question 20

Hematuria of nephrologic origin is frequently associated with __ and __.

Answer 20

Hematuria of nephrologic origin is frequently associated with PROTEINURIA and DYSMORPHIC ERYTHROCYTES.

Question 21

Anticoagulation at normal therapeutic levels does/does not predispose patients to hematuria.

Answer 21

Anticoagulation at normal therapeutic levels DOES NOT predispose patients to hematuria.

Question 22

The most accurate method to diagnose urinary tract infection is by microscopic examination of the urine and identifying __ and __. This is confirmed by __.

Answer 22

The most accurate method to diagnose urinary tract infection is by microscopic examination of the urine and identifying PYURIA and BACTERIA. This is confirmed by URINE CULTURE.

Question 23

The __ is the focus of the visit and is the reason the patient seeks consultation. It should be the lead sentence in the history and physical.

Answer 23

The CHIEF COMPLAINT is the focus of the visit and is the reason the patient seeks consultation. It should be the lead sentence in the history and physical.

Question 24

A family history should always include questions about __, __, and __.

Answer 24

A family history should always include questions about RENAL AND PROSTATE CANCER, RENAL CYSTS, and STONE DISEASE.

Question 25

__ occurs most commonly in patients with sickle cell disease but can also occur in those with advanced malignancy, coagulation disorders, or pulmonary disease, as well as in many patients without an obvious cause.

Answer 25

PRIAPISM occurs most commonly in patients with sickle cell disease but can also occur in those with advanced malignancy, coagulation disorders, or pulmonary disease, as well as in many patients without an obvious cause.

Question 26

On urine dipstick, false-negative results for glucose and bilirubin may be seen in the presence of __ in the urine.

Answer 26

On urine dipstick, false-negative results for glucose and bilirubin may be seen in the presence of ELEVATED ASCORBIC ACID CONCENTRATIONS in the urine.

Question 27

Glomerular proteinuria is the most common type of proteinuria and results from increased glomerular capillary permeability to protein, especially albumin. Glomerular proteinuria occurs in any of the primary glomerular diseases such as __ or in __.

Answer 27

Glomerular proteinuria is the most common type of proteinuria and results from increased glomerular capillary permeability to protein, especially albumin. Glomerular proteinuria occurs in any of the primary glomerular diseases such as IGA NEPHROPATHY or in GLOMERULOPATHY ASSOCIATED WITH SYSTEMIC ILLNESS SUCH AS DIABETES MELLITUS.

Question 28

Five bacteria per high-power field in a spun specimen reflect colony counts of about __.

Answer 28

Five bacteria per high-power field in a spun specimen reflect colony counts of about 100,000/mL.

Question 29

An important example of nonspecific lower urinary tract symptoms that may occur secondary to a variety of neurologic conditions is __ resulting from neurologic disease such as cerebrovascular accident, diabetes mellitus, and Parkinson disease.

Answer 29

An important example of nonspecific lower urinary tract symptoms that may occur secondary to a variety of neurologic conditions is IRRITATIVE SYMPTOMS resulting from neurologic disease such as cerebrovascular accident, diabetes mellitus, and Parkinson disease.

Question 30

The renal threshold for glucose corresponds to a serum glucose level of about __; above this level, glucose will be detected in the level in the urine.

Answer 30

The renal threshold for glucose corresponds to a serum glucose level of about 180mg/dL; above this level, glucose will be detected in the level in the urine.