CME Flashcards
1
Q
Which statement is correct about scrotal masses
a. Most painful masses are due to malignant neoplasms.
b. Spermatocele and epididymal cysts must be treated
immediately so that reproductive function is preserved.
c. Testicular cancer is characterized by a painful scrotal lump.
d. Scrotal pain associated with a mass requires emergent
management.
A
D
2
Q
Which of the following is an accurate characteristic of
testicular torsion?
a. Pain results from ischemia of the testicular artery due to
rotation of the testicle along its vertical axis.
b. Testicular torsion predominantly occurs in males up to
age 25 years.
c. An intact cremasteric refl ex is expected in patients with
testicular torsion, who will have an abnormal Phren sign.
d. A testis that is palpated to be in a low-lying position is a
signifi cant indication of torsion.
A
A
3
Q
- Which statement is correct about epididymitis?
a. In men younger than age 35 years, the most common cause
of epididymitis is urinary tract infection.
b. The most common cause is bacterial infection.
c. A patient who participates in prolonged bicycle or motorcycle
riding or strenuous physical activity has no increased risk for
developing epididymitis.
d. The pain is bilateral and will present suddenly over 2 to 4 hours.
A
B
4
Q
- Which of the following describes the correct use of
ultrasound in the evaluation of scrotal pain?
a. Torsion of the testicular appendix is diagnosed by a blue dot
sign on color fl ow Doppler.
b. Ultrasonography showing reduced blood fl ow is characteristic
for epididymitis.
c. Ultrasound has 94% sensitivity and 96% specifi city for
diagnosing testicular torsion.
d. A hydrocele will not transilluminate on ultrasound, so
ultrasound is not useful for evaluating this condition.
A
C
5
Q
- Which of the following is a characteristic unique to a
testicular neoplasm?
a. On imaging, it will appear as a hyperechoic mass with
irregular borders.
b. Tumor markers such as AFP, hCG, and lactate dehydrogenase
will be elevated.
c. An ultrasound of the mass will show an area of black next to
an area of gray.
d. A Valsalva maneuver will accentuate the veins that are dilated
due to the tumor blocking venous fl ow.
A
B
6
Q
- Which patient history factor has been linked to
prostate cancer?
a. history of smoking
b. history of prostatitis
c. history of benign prostatic hyperplasia
d. none of the above have been linked
A
D
7
Q
2. Which prostate gland finding on DRE is the most suspicious for prostate cancer? a. enlargement b. homogeneity c. fi rmness d. induration
A
D
8
Q
- What is the first-line diagnostic imaging test recom-
mended for the initial evaluation of clinically suspected prostate cancer?
a. radionuclide bone scan
b. abdominal ultrasound
c. transrectal ultrasound
d. abdominal CT scan
A
C
9
Q
- Which is a significant adverse outcome associated with
prostate cancer treatment with androgen deprivation
therapy?
a. cardiovascular disease
b. osteonecrosis
c. hematuria
d. bowel dysfunction
A
A
10
Q
- Which statement is correct about prostate cancer?
a. Prostate cancer is the most commonly diagnosed cancer
in men.
b. The USPSTF recommends that asymptomatic men over
age 50 years receive PSA screening.
c. Treatment of localized prostate cancer requires radical
prostatectomy.
d. Clinicians are overdiagnosing and aggressively treating
clinically insignifi cant disease.
A
D
11
Q
- What is the most common cause of hyponatremia in
older adults?
a. cirrhosis c. hypothyroidism
b. nephrotic syndrome d. SIADH
A
D
12
Q
- What type of hyponatremia occurs when patients have
excess free water relative to serum sodium levels?
a. hypertonic hyponatremia
b. isotonic hyponatremia
c. hypotonic hyponatremia
d. pseudohyponatremia
A
C
13
Q
- A 68-year-old woman is taking metoprolol, fluoxetine,
lorazepam, and aspirin. Which medication is most likely
to cause hyponatremia?
a. lorazepam
b. metoprolol
c. fl uoxetine
d. aspirin
A
C
14
Q
- An 88-year-old woman presents with signs and symptoms
of acute hyponatremia. She is at an increased risk of
permanent neurologic damage, coma, or death if her
serum sodium levels fall below what level?
a. 140 mEq/L c. 130 mEq/L
b. 135 mEq/L d. 125 mEq/L
A
D
15
Q
- A 72-year-old man has been seen every 3 months
for the past 2 years in the family practice clinic for
mildly low serum sodium levels. He denies symptoms
of nausea, vomiting, headache, fatigue, mental status
changes, weakness, or seizures. What is the first-line
treatment for asymptomatic patients with chronic
hyponatremia?
a. oral salt tablets
b. fl uid restriction
c. 3% hypertonic saline
d. loop diuretics
A
B
16
Q
- A 78-year-old woman presents to the ED with sudden
onset of severe headache, vomiting, and confusion and
is found to have a severely low serum sodium level. She
was discharged from the same ED 36 hours ago for viral
gastroenteritis and her serum sodium was within normal
limits at that time. If her acute hyponatremia is corrected
too rapidly, the patient is at risk for what condition?
a. osmotic demyelination syndrome
b. falls
c. osteoporosis
d. gout
A
A
17
Q
- Which statement is correct about ESRD in the
United States?
a. More than 25% of Americans will develop stage 3 to 5 kidney
disease during their lifetimes.
b. The diagnosis of ESRD accounted for 8.1% of the 2011
Medicare budget, costing $49.3 billion.
c. Diabetes and anemia are the two most common causes of
CKD in the United States.
d. The leading causes of ESRD are autoimmune disease and
recurrent urinary tract infections.
A
B
18
Q
- According to the National Kidney Foundation’s KDOQI
guidelines, what is the minimal amount of time that
a patient meet diagnostic criteria, such as persistent
reduction in eGFR or albuminuria, before the diagnosis
of CKD is established?
a. 1 month
b. 2 months
c. 3 months
d. 6 months
A
C
19
Q
- Which statement is correct about laboratory tests and
CKD?
a. Use the eGFR rather than the serum creatinine level to detect
and monitor CKD.
b. The serum creatinine level is suffi cient to monitor CKD over
time.
c. eGFR levels rise as humans age.
d. If a patient switches from an animal protein diet to a
vegetarian diet, providers should expect to see no change
in the serum creatinine.
A
A
20
Q
- Which is the preferred method of screening for
albuminuria?
a. urine dipstick testing for the presence of protein
b. spot urine sample for the albumin/creatinine ratio
c. 24-hour urine collection
d. serum albumin testing
A
B
21
Q
- Which are the most effective steps for managing CKD?
a. Initiating aggressive weight loss efforts and reducing BP to
the lowest tolerable level.
b. Initiating smoking cessation, mild weight loss, and concurrent
loop and thiazide diuretic therapy.
c. Using beta-blockers to reduce proteinuria and vascular injury.
d. Initiating an ACE inhibitor or ARB as initial or add-on therapy.
A
D
22
Q
- Which statement is correct about the pathophysiology
of BPH?
a. Cigarette smoking is a proven cause of BPH.
b. DHT is the androgen thought to be the main mediator
of prostatic hyperplasia.
c. Cytokines convert testosterone to DHT, which induces
epithelial growth factors.
d. Rising estrogen levels in aging men defi nitively cause BPH.
A
B
23
Q
2. Which of the following is a storage symptom caused by BPH? a. urinary incontinence b. dribbling c. straining to void d. decreased urinary fl ow
A
A
24
Q
- What is the most reliable way to diagnose BPH?
a. Obtain a PSA level to determine if it is elevated.
b. Discover palpable nodularity on digital rectal examination.
c. The patient has low scores on symptom screening scales.
d. BPH is a diagnosis of exclusion; therefore, no tests are
specifi c for its diagnosis.
A
D
25
4. Which statement is correct about treating BPH with
medication?
a. Regardless of the choice of medication, patients must
be followed every 2 to 4 weeks to evaluate for adverse
reactions.
b. Silodosin and tamsulosin are nonselective alpha-1A
receptors.
c. 5-alpha-reductase inhibitors can be used as monotherapy
or adjunct therapy.
d. Anticholinergics have very few adverse reactions and should
be used in older men with BPH.
C
26
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5. According to the article, what is the gold standard for
treating BPH?
a. saw palmetto
b. urethral stent placement
c. TURP
d. HoLEP
```
C
