CME

Question 1

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.

Answer 1

D

Question 2

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.

Answer 2

A

Question 3

8. 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.

Answer 3

B

Question 4

9. 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.

Answer 4

C

Question 5

10. 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.

Answer 5

B

Question 6

1. 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

Answer 6

D

Question 7

2. Which prostate gland finding on DRE is the most
suspicious for prostate cancer?
a. enlargement
b. homogeneity
c. fi rmness
d. induration

Answer 7

D

Question 8

3. 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

Answer 8

C

Question 9

4. 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

Answer 9

A

Question 10

5. 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.

Answer 10

D

Question 11

7. What is the most common cause of hyponatremia in
   older adults?
   a. cirrhosis c. hypothyroidism
   b. nephrotic syndrome d. SIADH

Answer 11

D

Question 12

8. 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

Answer 12

C

Question 13

9. 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

Answer 13

C

Question 14

10. 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

Answer 14

D

Question 15

11. 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

Answer 15

B

Question 16

12. 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

Answer 16

A

Question 17

6. 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.

Answer 17

B

Question 18

7. 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

Answer 18

C

Question 19

8. 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.

Answer 19

A

Question 20

9. 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

Answer 20

B

Question 21

10. 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.

Answer 21

D

Question 22

1. 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.

Answer 22

B

Question 23

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

Answer 23

A

Question 24

3. 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.

Answer 24

D

Question 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.

Answer 25

C

Question 26

5. According to the article, what is the gold standard for
treating BPH?
a. saw palmetto
b. urethral stent placement
c. TURP
d. HoLEP

Answer 26

C