Evaluation of the Urologic Patient : History and Physical Examination

Question 1

What is the purpose of a thorough history and physical examination in patient evaluation?
A) To develop rapport with the patient
B) To obtain information salient to treatment
C) To gather information pertinent to the cause of a disease
D) All of the above

Answer 1

D) All of the above

Question 2

When should laboratory and radiologic examinations be performed?
A) Based on the patient’s age
B) Based on the physician’s preference
C) Based on the findings of history and physical examination
D) Based on the patient’s insurance coverage

Answer 2

C) Based on the findings of history and physical examination

Question 3

What is the danger of relying too heavily on previously obtained labs and images?
A) The urologist may miss important information from the patient
B) The urologist may order unnecessary tests
C) The urologist may make incorrect diagnoses
D) All of the above

Answer 3

A) The urologist may miss important information from the patient

Question 4

What can a thorough physical examination uncover that may be missed by relying solely on medical records and images?
A) Incidentalomas
B) Aberrant labs
C) Chart lore
D) Penile tumor

Answer 4

D) Penile tumor

Question 5

How can the physician optimize the patient encounter environment?
A) By making the environment warm and comforting
B) By reviewing the patient’s vitals and prior records before entering the room
C) By avoiding any barriers, especially a computer
D) All of the above

Answer 5

D) All of the above

Question 6

Why is it important to assess the patient’s level of comprehension during the encounter?
A) To ensure that the physician is using the correct medical terminology
B) To determine if the patient is capable of making their own medical decisions
C) To determine if the patient is capable of comprehending complex matters
D) None of the above

Answer 6

C) To determine if the patient is capable of comprehending complex matters

Question 7

What is the benefit of having a family member or friend present during the patient encounter?
A) To focus the patient on the physician’s discussion
B) To obtain the information necessary to make a diagnosis
C) To relay information to the patient at a time when the shock of the unfortunate news has passed
D) None of the above

Answer 7

C) To relay information to the patient at a time when the shock of the unfortunate news has passed

Question 8

What are the components of a complete medical history for urologic patients?
A) Chief complaint, history of present illness (HPI), past medical and surgical history, history of allergic reactions, social and family history, and a review of systems
B) Blood pressure, heart rate, respiratory rate, and temperature
C) Name, address, and date of birth
D) Current medications and dosages

Answer 8

A) Chief complaint, history of present illness (HPI), past medical and surgical history, history of allergic reactions, social and family history, and a review of systems

Question 9

What is the definition of chief complaint in urologic patients?
A) The reason why the patient is seeking urologic care
B) The patient’s social and family history
C) The patient’s medical and surgical history
D) The patient’s current medications and dosages

Answer 9

A) The reason why the patient is seeking urologic care

Question 10

What should be the urologist’s focus when a patient presents with a chief complaint?
A) To target the chief complaint to allay the patient’s immediate concerns
B) To identify other urologic issues
C) To refer the patient to another physician
D) To conduct laboratory and radiologic examinations

Answer 10

A) To target the chief complaint to allay the patient’s immediate concerns

Question 11

What is the risk of not addressing the chief complaint in urologic patients?
A) The patient may not follow up with the recommended treatment
B) The patient may develop additional urologic issues
C) The patient may seek care from another provider
D) The patient may experience ineffective care

Answer 11

D) The patient may experience ineffective care

Question 12

What is the first step in the urologist’s approach to a patient with a chief complaint?
A) Conducting laboratory and radiologic examinations
B) Developing a rapport with the patient
C) Thinking of a differential diagnosis
D) Identifying the patient’s medical and surgical history

Answer 12

C) Thinking of a differential diagnosis

Question 13

How does the history of present illness (HPI) aid in the urologist’s approach to a patient with a chief complaint?
A) By identifying the patient’s current medications and dosages
B) By narrowing the differential diagnosis
C) By identifying the patient’s social and family history
D) By identifying other urologic issues

Answer 13

B) By narrowing the differential diagnosis

Question 14

When obtaining the history of present illness, what information should the urologist aim to obtain?
A) The patient’s social history
B) The patient’s past medical and surgical history
C) The nature, timing, severity, and factors that may exacerbate or relieve the chief complaint
D) The patient’s family history

Answer 14

C

Question 15

When a patient reports pain as their chief complaint, what should the urologist do to help pinpoint the cause of the pain?
A) Assess the onset and duration of the pain
B) Characterize the location and nature of the pain
C) Ascertain if the pain episode has occurred previously
D) All of the above

Answer 15

D

Question 16

Which type of pain is caused by obstruction or inflammation within the parenchyma of a GU organ?
A) Parenchymal pain
B) Obstructive pain
C) Referred pain
D) Tenderness

Answer 16

A

Question 17

What is the difference between pain and tenderness?
A) Pain is the sensation felt by the patient, while tenderness is pain with palpation.
B) Pain and tenderness are the same thing.
C) Pain with palpation is due to inflammation, while pain is due to obstruction.
D) Tenderness is the sensation felt by the patient, while pain is pain with palpation.

Answer 17

A

Question 18

How can an understanding of nervous system anatomy facilitate the comprehension of associated signs or symptoms seen with GU pain?
A) Irritation of the kidneys can result in paroxysmal nausea and vomiting.
B) Irritation of the ureter may result in referred pain to the ipsilateral testicle in men or labium in women.
C) Pain of an acute nature is due to a clear cause.
D) A and B

Answer 18

D

Question 19

What should the urologist do if a patient reports pain with no identifiable urologic cause?
A) Prescribe narcotic pain medication.
B) Refer the patient to their primary care physician and/or pain management specialists.
C) Wait for the pain to subside on its own.
D) Order imaging to identify the cause of the pain.

Answer 19

B

Question 20

What are some signs of narcotic-seeking behavior and narcotic abuse?
A) Requesting specific narcotics by brand name
B) Coming from unusual locations
C) Exhibiting inconsistent behavior
D) All of the above

Answer 20

D

Question 21

What is the best way for a physician to assess the location of a patient’s pain during the HPI?
A) Ask the patient to describe the location of the pain
B) Ask the patient to point to the site of maximal pain with one finger
C) Perform a physical examination of the area where the patient reports pain
D) Use imaging studies to identify the source of the pain

Answer 21

B) Ask the patient to point to the site of maximal pain with one finger

Question 22

Which type of pain is typified by a patient with intermittent pain for which the patient is always moving to seek a position of comfort?
A) Obstructive pain
B) Parenchymal pain
C) Referred pain
D) Neuropathic pain

Answer 22

A) Obstructive pain

Question 23

Which nervous system structure is responsible for the visceral innervation of the foregut and the kidneys?
A) The celiac plexus
B) The thoracic ganglia
C) The lumbar plexus
D) The sacral plexus

Answer 23

A) The celiac plexus

Question 24

What is the typical location of renal pain?
a. Just medial to the vertebral spine
b. At the level of the 9th rib
c. Just lateral to the vertebral spine and inferior to the 12th rib
d. In the upper abdomen

Answer 24

c. Just lateral to the vertebral spine and inferior to the 12th rib.

Question 25

Which of the following can cause colicky-type pain in the renal collecting system?
a. Inflammation of the renal parenchyma
b. Intraperitoneal pathology
c. Obstruction of the renal collecting system
d. Gastrointestinal pathology

Answer 25

c. Obstruction of the renal collecting system.

Question 26

How does renal pain typically differ from intraperitoneal pain?
a. Renal pain is located in the upper abdomen
b. Renal pain is related to food ingestion
c. Renal pain causes peritoneal signs on abdominal exam
d. Renal pain does not cause ipsilateral shoulder pain

Answer 26

d. Renal pain does not cause ipsilateral shoulder pain.

Question 27

What is the typical cause of ureteral pain?
A. Infection of the ureter
B. Ureteral hyperperistalsis
C. Gastrointestinal issues
D. Musculoskeletal issues

Answer 27

B. Ureteral pain is typically due to ureteral obstruction, which results in acute distention of the ureter and hyperperistalsis, causing ureteral spasm and irritation of type A and C nerve fibers in the ureteral wall.

Question 28

Where is the location of ureteral pain?
A. Ipsilateral scrotum
B. Abdominal midline
C. Contralateral costovertebral angle
D. Ipsilateral lower quadrant

Answer 28

D. Ureteral pain is typically located in the ipsilateral lower quadrant, and the point of ureteral obstruction may cause referred pain to the ipsilateral scrotum or penis.

Question 29

What is a possible cause of suprapubic pain?
a) Inflammation of the kidneys
b) Inflammation of the ureters
c) Inflammation of the bladder
d) Inflammation of the prostate

Answer 29

Answer: c) Inflammation of the bladder

Question 30

In what condition is suprapubic pain worst when the bladder is distended?
a) Cystitis
b) Pyelonephritis
c) Urethritis
d) Interstitial nephritis

Answer 30

a) Cystitis

Question 31

What is strangury?
a) Pain in the testicles
b) Pain in the urethra
c) Pain in the suprapubic region
d) Sharp and stabbing pain at the end of urination

Answer 31

d) Sharp and stabbing pain at the end of urination (presumably resulting from final contraction of the inflamed detrusor)

Question 32

What is prostatic pain?
a) Pain located deep within the pelvis
b) Pain in the costovertebral angle
c) Pain located in the ipsilateral lower quadrant
d) Pain that radiates down to the ipsilateral scrotum

Answer 32

a) Pain located deep within the pelvis

Question 33

What are the irritative voiding symptoms associated with prostatitis?
a) Urinary frequency, urgency, and dysuria
b) Colicky-type pain
c) Shoulder pain
d) Exquisite tenderness to any abdominal motion

Answer 33

a) Urinary frequency, urgency, and dysuria

Question 34

Which of the following conditions can cause penile pain in a flaccid penis?
a. Paraphimosis
b. Peyronie disease
c. Cancer
d. Cystitis

Answer 34

d. Cystitis or prostatitis can cause referred pain to the flaccid penis.

Question 35

Which of the following conditions can cause penile pain in a rigid penis?
a. Paraphimosis
b. Peyronie disease
c. Cancer
d. Priapism

Answer 35

d. Priapism can cause penile pain in a rigid penis.

Question 36

What is the cause of pain in the scrotum due to epididymitis and orchitis?
a) Inflamed pustule from an ingrown hair
b) Torsion of the testicle
c) Acute vascular congestion
d) Varicoceles

Answer 36

c

Question 37

What is the characteristic feature of torsion of the testicle?
a) Relief of pain by maneuvers that elevate or support the testis
b) Acute vascular congestion and pain
c) Accumulated vascular congestion
d) Dull ache towards the end of the day

Answer 37

b

Question 38

What are some risk factors for detecting cancer in patients with hematuria?
a) Exposure to alkylating chemotherapy, analgesic abuse history, and chronic foreign objects in the urinary tract
b) Presence of irritative voiding symptoms and smoking history
c) Industrial chemical exposure history and history of nephrologic pathology
d) All of the above

Answer 38

d) All of the above.

Question 39

What are some causes of obstructive LUTS (oLUTS)?
a) Overactive bladder, cystitis, prostatitis, bladder stones, or bladder cancer
b) Benign prostatic hyperplasia (BPH), urethral stricture disease, and detrusor-external sphincter dyssynergia
c) Dysfunctional voiding, severe phimosis, and severe meatal stenosis
d) All of the above

Answer 39

b) Benign prostatic hyperplasia (BPH), obstructive prostate cancer, urethral stricture disease, dysfunctional voiding, detrusor-external sphincter dyssynergia, severe phimosis, and severe meatal stenosis.

Question 40

What is the purpose of a bladder diary?
a) To assess the severity of urinary incontinence
b) To measure the volume of urine produced by the kidneys
c) To determine if the urinary frequency may be due to incomplete bladder emptying, overactive bladder, or polyuria
d) To diagnose bladder stones or bladder cance

Answer 40

c) To determine if the urinary frequency may be due to incomplete bladder emptying, overactive bladder, or polyuria.

Question 41

What is continuous incontinence?
A) Involuntary passage of urine due to urinary urgency
B) Loss of urine with any activity that increases intra-abdominal pressure
C) Constant wetness in the perineum independent of urge to urinate or maneuvers associated with increased intra-abdominal pressure
D) Loss of urine due to limited mobility

Answer 41

C

Question 42

What is overflow incontinence?
A) Involuntary passage of urine due to urinary urgency
B) Loss of urine with Valsalva maneuvers
C) Involuntary passage of urine when the urinary volume within the bladder approaches and exceeds bladder capacity
D) Urinary incontinence due to limited mobility

Answer 42

C

Question 43

What is functional incontinence?
A) Involuntary passage of urine due to urinary urgency
B) Loss of urine with any activity that increases intra-abdominal pressure
C) Involuntary passage of urine when the urinary volume within the bladder approaches and exceeds bladder capacity
D) Urinary incontinence due to limited mobility or limited access to a toilet or urinal

Answer 43

D

Question 44

What percentage of children still experience enuresis up to 5 years of age?
a) 5%
b) 10%
c) 15%
d) 20%

Answer 44

c) 15%.

Question 45

What is the incidence of ED in men over the age of 40?
A. Less than 10%
B. About 25%
C. About 50%
D. More than 75%

Answer 45

C

Question 46

What is a validated questionnaire often used to quantify and monitor erectile function?
A. The International Index of Erectile Function (IIEF)
B. The International Index of Bladder Function (IIBF)
C. The International Index of Bowel Function (IIBF)
D. The International Index of Sexual Function (IISF)

Answer 46

A

Question 47

What are some symptoms of hypogonadism?
A. Decreased strength and weight loss
B. Change in sleep patterns and weight gain
C. Increased strength and infertility
D. Increased appetite and emotional stability

Answer 47

B. Change in sleep patterns and weight gain

Question 48

What is the best tool to quantify and monitor a patient’s sexual desire?
A. Blood test
B. Physical examination
C. Clinical questionnaire
D. Imaging studies

Answer 48

C. Clinical questionnaire

Question 49

Which of the following is a validated questionnaire to aid in the evaluation for hypogonadism?
A. International Index of Erectile Function (IIEF)
B. Androgen Deficiency in Aging Questionnaire (ADAM)
C. International Prostate Symptom Score (IPSS)
D. Sexual Health Inventory for Men (SHIM)

Answer 49

B. Androgen Deficiency in Aging Questionnaire (ADAM)

Question 50

According to the International Society of Sexual Medicine Guidelines, what is the definition of premature ejaculation?
a) Less than 2 minutes (if lifelong) or 3 minutes (if acquired)
b) Less than 1 minute (if lifelong) or 3 minutes (if acquired)
c) Less than 5 minutes (if lifelong) or 7 minutes (if acquired)
d) Less than 3 minutes (if lifelong) or 5 minutes (if acquired)

Answer 50

b) Less than 1 minute (if lifelong) or 3 minutes (if acquired) and must be associated with inability to delay ejaculation and with negative personal consequence.

Question 51

What is the median intravaginal ejaculatory latency time (IELT) according to a study published in 2005?
a) 1-2 minutes
b) 3-5 minutes
c) 5-7 minutes
d) 7-12 minutes

Answer 51

c) 5-7 minutes

Question 52

What is the recommended treatment for patients with true premature ejaculation?
a) Penile prosthesis
b) Sexual counseling or vaginal quieting
c) Oral antibiotics
d) Testosterone replacement therapy

Answer 52

b) Sexual counseling or vaginal quieting.

Question 53

What condition can result in anejaculation in patients with advanced cases?
a) Hypogonadism
b) Diabetes
c) Androgen deficiency
d) Retroperitoneal surgery

Answer 53

b) Diabetes

Question 54

What can cause anorgasmia in men?
a) Medications used to treat hypertension
b) Excessive alcohol consumption
c) Pudendal nerve dysfunction
d) All of the above

Answer 54

d) All of the above

Question 55

What is the most common cause of hematospermia?
a. Prostate cancer
b. Testicular cancer
c. Seminal vesicle inflammation
d. Bladder cancer

Answer 55

c. Seminal vesicle inflammation

Question 56

When should a urologist consider further evaluation for hematospermia?
a. When blood is present in the ejaculate after a long duration of sexual abstinence
b. When blood is present in the ejaculate for a few days
c. When blood is present in the ejaculate for several weeks
d. When blood is present in the ejaculate for a few months

Answer 56

c. When blood is present in the ejaculate for several weeks.

Question 57

Which of the following conditions should be screened for in patients with pneumaturia?
a) Crohn disease
b) Enteritis
c) History of recent intra-abdominal surgery or radiation
d) All of the above

Answer 57

d) All of the above

Question 58

Are rigors always associated with fevers?
A) Yes, always.
B) No, they can occur independently.
C) It depends on the severity and site of infection.
D) It depends on whether the fevers are subjective or objective.

Answer 58

B

Question 59

Which of the following is a concern when an elderly patient reports fevers and chills?
A) Bacteremia
B) Crohn disease
C) Cystitis
D) Enteritis

Answer 59

A

Question 60

What are constitutional symptoms?
A) Symptoms related to the constitution of a country
B) Symptoms related to the urinary tract
C) Symptoms related to the digestive system
D) Symptoms that include fevers, chills, night sweats, anorexia, weight loss, fatigue, or lethargy

Answer 60

D

Question 61

Why is it important for a urologist to obtain an accurate medical history from patients?
a. It helps determine the patient’s compliance with medications
b. It helps determine the severity of the patient’s medical illness
c. It helps determine the patient’s risk of developing urologic conditions
d. Both a and b

Answer 61

d

Question 62

What can be misleading when assessing a patient’s medical history based on their medication list?
a. The patient may not be compliant with all their medications
b. Several medications may be administered for different reasons
c. The patient may not remember all the medications they are taking
d. Both a and b

Answer 62

d

Question 63

What is an example of an undiagnosed medical condition that can adversely affect a patient or subsequent urologic treatment?
a. Hyperthyroidism
b. Osteoporosis
c. Obstructive sleep apnea
d. Asthma

Answer 63

c

Question 64

What is the Eastern Cooperative Oncology Group score used for?
a) To assess functional ability of patients for surgery
b) To classify patients based on their ability to perform physical activity and self-care
c) To assess the risk for coronary artery disease
d) To quantify and monitor erectile function

Answer 64

b) To classify patients based on their ability to perform physical activity and self-care

Question 65

According to Levitt et al., what is the significance of assessing activities of daily living (ADLs) in patients undergoing percutaneous nephrolithotomy?
a) It helps in quantifying and monitoring erectile function
b) It helps in assessing the risk for obstructive sleep apnea
c) It is an independent predictor of complications better than other scores
d) It is helpful in diagnosing urinary tract infections

Answer 65

c) It is an independent predictor of complications better than other scores

Question 66

ECOG

Answer 66

Question 67

Which class of drugs is associated with decreased libido?
a) Antihypertensives
b) Psychotropic drugs
c) Chemotherapeutic agents
d) Drugs with abuse potential

Answer 67

a) Antihypertensives

Question 68

Which drug is associated with erectile dysfunction?
a) Hydrochlorothiazide
b) Diazepam
c) Nifedipine
d) Baclofen

Answer 68

a) Hydrochlorothiazide

Question 69

Which class of drugs is associated with ejaculatory dysfunction?
a) Antihypertensives
b) Psychotropic drugs
c) Chemotherapeutic agents
d) Smooth muscle relaxants

Answer 69

a) α-Adrenergic antagonists

Question 70

Which drug is associated with priapism?
a) Hydrochlorothiazide
b) Prazosin
c) Valproic acid
d) Phenylephrine

Answer 70

b) Prazosin

Question 71

Which class of drugs is associated with urinary retention or obstructive voiding symptoms?
a) Antihistamines
b) Anticholinergic agents or musculotropic relaxants
c) α-Adrenergic agonists
d) Calcium channel blockers

Answer 71

b) Anticholinergic agents or musculotropic relaxants

Question 72

Which class of drugs is associated with acute renal failure?
a) Antimicrobials
b) Nonsteroidal anti-inflammatory drugs
c) Antipsychotics
d) Smooth muscle relaxants

Answer 72

a) Antimicrobials

Question 73

Which drug is associated with gynecomastia?
a) Hydrochlorothiazide
b) Verapamil
c) Cisplatin
d) Diphenhydramine

Answer 73

b) Verapamil

Question 74

Which drug is associated with ejaculatory dysfunction?
a) Hydrochlorothiazide
b) Propranolol
c) Trazodone
d) Hydralazine

Answer 74

d) Tamsulosin

Question 75

Which drug is associated with priapism?
a) Phenothiazines
b) Diphenhydramine
c) Nifedipine
d) Baclofen

Answer 75

a) Phenothiazines

Question 76

Which class of drugs is associated with gynecomastia?
a) Psychotropic drugs
b) Antihypertensives
c) Cardiac drugs
d) Gastrointestinal drugs

Answer 76

b) Antihypertensives

Question 77

Common drug side effects

Answer 77

Question 78

Why is understanding a patient’s occupation important for a urologist?
a) It helps the urologist assess the patient’s mental health
b) It provides the urologist with greater insight into the patient’s world-view and socioeconomic status
c) It helps the urologist evaluate the patient’s physical abilities
d) It helps the urologist identify allergies and intolerances

Answer 78

b) It provides the urologist with greater insight into the patient’s world-view and socioeconomic status. Understanding the patient’s current or prior occupations provides the urologist with greater insight into the patient’s world-view and socioeconomic status, as well as possible industrial exposure to possible carcinogenic agents.

Question 79

Which diseases have a well-defined genetic component with a clear mode of transmission?
a) Prostate cancer and urolithiasis
b) Renal tubular acidosis and cystinuria
c) Adult polycystic kidney disease, tuberous sclerosis, and von Hippel-Lindau disease
d) Bladder cancer and testicular cancer

Answer 79

c) Adult polycystic kidney disease, tuberous sclerosis, and von Hippel-Lindau disease. Many diseases with urologic manifestations have a clear genetic component, and their mode of transmission is well defined. Examples include adult polycystic kidney disease, tuberous sclerosis, von Hippel-Lindau disease, renal tubular acidosis, and cystinuria.

Question 80

What is the purpose of a review of systems in a medical evaluation?
a) To determine the patient’s socioeconomic status
b) To evaluate the patient’s physical abilities
c) To identify important issues that may not be related to the chief complaint
d) To determine the patient’s genetic predisposition to diseases

Answer 80

c) To identify important issues that may not be related to the chief complaint. A review of systems is a comprehensive system-based checklist to determine if there are any other complaints or ailments that the patient may have. This may be a valuable opportunity to identify important issues that may not be related to the chief complaint.

Question 81

What are the vital signs that should be measured during a physical examination?
a) Temperature, weight, respiratory rate, blood sugar
b) Temperature, heart rate, blood pressure, respiratory rate
c) Blood pressure, weight, heart rate, blood sugar

Answer 81

b) Temperature, heart rate, blood pressure, respiratory rate.

Explanation: Vital signs are objective measurements that provide information about a patient’s basic bodily functions. The vital signs include temperature, heart rate, blood pressure, respiratory rate, and pain rating.

Question 82

What is the sixth vital sign?
a) Blood sugar
b) Respiratory rate
c) Distress level

Answer 82

c) Distress level.

Explanation: Some have advocated for a rapid screening tool used to assess distress in patients and measures set in place to provide such patients with prompt attention from social worker, mental health professional, or pastoral care. Such a tool can be considered a sixth vital sign and can help decrease the anxiety and distress within an already stressful waiting room.

Question 83

What is the first mode of physical examination?
a. Inspection
b. Auscultation
c. Percussion
d. Palpation

Answer 83

a. Inspection is the first mode of physical examination and can be applied to the entire patient at the onset of the encounter. It involves observing the patient for any general appearance and making preliminary assessments of frailty and nutritional status.

Question 84

What is frailty?
a. Excess vulnerability to stressors with reduced ability to maintain or regain homeostasis after a destabilizing event
b. Inability to walk due to weakness or injury
c. Unhealthy or inadequate diet resulting in malnutrition
d. Emotional or psychological distress resulting from a traumatic event

Answer 84

: a. Frailty has been defined as excess vulnerability to stressors with a reduced ability to maintain or regain homeostasis after a destabilizing event. It can be assessed through simple tools such as gait speed, the get-up-and-go test, grip strength, and calf circumference.

Question 85

What can be obtained from the general physical examination?
a. Clues regarding the patient’s level of pain or emotional distress
b. Information about the patient’s socioeconomic status and appropriateness in dress
c. Quality of the patient’s dentition or moist mucous membranes
d. All of the above

Answer 85

d. All of the above can be obtained from the general physical examination, which involves making general observations of the patient’s appearance, nutritional status, and mobility, as well as assessing for any stigmata or clues of underlying disease. The quality of the patient’s dentition or moist mucous membranes can also be a sign of health and hydration.

Question 86

What is the purpose of bimanual examination or renal ballottement?
a. To palpate for the kidney with the examining hand through the anterior abdominal wall
b. To assess the sensation of the skin for pain, temperature, and light touch
c. To evaluate the presence of a bruit in the renal artery
d. To percuss the kidneys to elicit the positive sign

Answer 86

a. To palpate for the kidney with the examining hand through the anterior abdominal wall.

Explanation: Bimanual examination, or renal ballottement, is a physical examination technique used to palpate for the kidney with the examining hand through the anterior abdominal wall, while the non-examining hand is placed posteriorly at the costophrenic angle. This technique can help to identify the size, shape, and position of the kidney, and any areas of tenderness or masses.

Question 87

Kidney exam

Answer 87

Question 88

What is the standard of care for examination of patients with large bladder tumors postresection?

A) Bimanual examination
B) Percussion examination
C) Auscultation examination
D) Palpation examination

Answer 88

A) Bimanual examination.

Explanation: A bimanual examination is the standard of care for examination of patients with large bladder tumors postresection. It can aid in assessing the mobility of the bladder and is helpful in predicting pT3 disease. Percussion and palpation can also aid in palpation of the bladder, but bimanual examination is the preferred method. Auscultation examination is not typically used in bladder examination.

Question 89

Female bimanual

Answer 89

Question 90

Male bimanual

Answer 90

Question 91

What should be done during a physical examination of the penis?
a) Inspect for hair distribution and lesions on the skin
b) Palpate the urethra for location and absence of stenosis
c) Both A and B
d) None of the above

Answer 91

Answer: c) Both A and B

Explanation: During a physical examination of the penis, the phallus should be inspected for hair distribution, lesions on the skin, and the presence or absence of a foreskin. The urethra should be inspected for location and absence of stenosis and presence of urethral discharge. The foreskin, if present, should be retracted to ensure that there are no penile tumors; most penile tumors involve the prepuce or the glans penis.

Question 92

Which of the following infectious processes is more common in the scrotum and should be assessed during examination?
a) Hepatitis C
b) Tuberculosis
c) Tinea cruris
d) Malaria

Answer 92

Answer: c) Tinea cruris. The scrotal skin should be assessed for infectious processes such as tinea cruris, cellulitis, and pustules, which are more common.

Question 93

What is tinea cruris?

Answer 93

Tinea cruris, also known as jock itch, is a common fungal skin infection that affects the groin and inner thighs. It is more common in men than in women and typically presents as a red, itchy rash with well-defined edges. It can be caused by various types of fungi, including Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum. Treatment usually involves antifungal creams or ointments, and keeping the affected area clean and dry can help prevent its recurrence.

Question 94

What is the typical size of the testicles?
a) 3 cm in length and 2 cm in width
b) 6 cm in length and 4 cm in width
c) 8 cm in length and 6 cm in width
d) 10 cm in length and 8 cm in width

Answer 94

b) 6 cm in length and 4 cm in width. Testicles have a typical size of 6 cm in length and 4 cm in width, with variation seen among different races.

Question 95

Which of the following is not a cause of a small testicle?
a) Prior infarct
b) Surgery
c) Hypogonadism
d) Infection

Answer 95

d) Infection. A testicle that is small can be suggestive of prior infarct, surgery, hypogonadism, or endocrinopathy such as Klinefelter disease, but not infection.

Question 96

Which of the following is almost always benign?
a) Masses in the testes
b) Epididymal masses
c) Masses in the spermatic cord
d) Hydrocele

Answer 96

b) Epididymal masses. Epididymal masses, which obliterate the distinct ridge of tissue posterior to the testis, are almost always benign.

Question 97

How can a hernia be assessed in children?
a) By assessing for the absence of a cremasteric reflex
b) By performing Valsalva maneuver and palpating for a bulge that descends against the finger
c) By assessing for the “silk glove” sign
d) By transillumination

Answer 97

c) By assessing for the “silk glove” sign. In children, the presence of a hernia can be appreciated by assessing for the “silk glove” sign, where the potential space within the hernia sac allows for the hernia sac to roll over itself, resembling the sensation of rolling over the finger of a silk glove.

Question 98

Inguinal hernia exam

Answer 98

Question 99

What is the purpose of a digital rectal examination (DRE)?
a. To assess bladder size
b. To detect external genitalia abnormalities
c. To evaluate for internal Mullerian structures in females
d. To assess prostate size, detect or provoke prostatitis, and screen for prostate cancer

Answer 99

d. To assess prostate size, detect or provoke prostatitis, and screen for prostate cancer. The DRE is a common method used to assess the prostate gland and is performed to screen for prostate cancer or to assess prostate size and possible inflammation in men who may have prostatitis.

Question 100

What is the recommended age range for prostate cancer screening according to current AUA guidelines?
a. Men over 30 years old
b. Men over 40 years old
c. Men over 50 years old
d. Men over 60 years old

Answer 100

Answer: c. Men over 50 years old. According to current AUA guidelines, prostate cancer screening should be offered in men of average risk from the age of 55 to 69 at an interval of every 2 years.

Question 101

How should a patient be positioned for a DRE?
a. Standing with feet together
b. Lying on their back with legs bent
c. Standing with feet shoulder width apart and bent nearly 90 degrees at the waist
d. Lying on their stomach with legs bent

Answer 101

c. Standing with feet shoulder width apart and bent nearly 90 degrees at the waist. The patient should be standing with feet shoulder width apart and bent nearly 90 degrees at the waist, with their hand or elbows supported on a table. Alternatively, the patient may be in a lateral decubitus position, flexed at the hips and knees, on the examining table.

Question 102

What is the purpose of a female pelvic exam by a urologist?
a. To screen for sexually transmitted infections
b. To evaluate for pelvic organ prolapse, urinary incontinence, and anterior vaginal masses
c. To assess ovarian function
d. To evaluate for endometrial cancer

Answer 102

Answer: b. To evaluate for pelvic organ prolapse, urinary incontinence, dyspareunia, blood per urethra or vagina, and anterior vaginal masses.

Explanation: The female pelvic exam by a urologist is performed to assess for pelvic organ prolapse, urinary incontinence, dyspareunia, blood per urethra or vagina, and anterior vaginal masses.

Question 103

What should be evaluated during the visual inspection of the external genitalia and introitus in a female pelvic exam?
a. Erosions, ulcers, and discharge
b. Size of the uterus
c. Urinary incontinence
d. Erectile function

Answer 103

a. Erosions, ulcers, and discharge.

Explanation: The visual inspection of the external genitalia and introitus should evaluate for atrophic changes, erosions, ulcers, discharge, or genital warts.

Question 104

How is a bimanual examination performed in a female pelvic exam?
a. Two fingers of the dominant hand are placed into the vaginal vault and the nondominant hand is placed over the patient’s shoulder
b. Two fingers of the dominant hand are placed into the vaginal vault and the nondominant hand is placed over the lower abdomen
c. One finger of the dominant hand is placed into the vaginal vault and the nondominant hand is placed over the patient’s shoulder
d. One finger of the dominant hand is placed into the vaginal vault and the nondominant hand is placed over the lower abdomen

Answer 104

b. Two fingers of the dominant hand are placed into the vaginal vault and the nondominant hand is placed over the lower abdomen.

Explanation: Bimanual examination should be performed by placing two of the examiner’s fingers of the dominant hand into the vaginal vault (one finger if the introitus is small) and placing the nondominant hand over the lower abdomen and palpating for pelvic mass or tenderness.

Question 105

What does a sensory dermatome map help with in a neurologic examination?
a. Evaluate the integrity of the bulbocavernosal reflex
b. Localize the location of a neurologic deficit
c. Assess for a lesion in the thoracic nerves
d. Evaluate for signs of Parkinson’s disease

Answer 105

Answer: b. Localize the location of a neurologic deficit. A sensory dermatome map helps identify the location of a neurologic deficit based on sensory deficits in different areas of the body.

Question 106

What does the bulbocavernosal reflex test?
a. Sensory deficits of the genitalia and perianal area
b. Integrity of the spinal cord–mediated reflex arc involving S2-S4
c. Reflexes in the lower extremities
d. Motor function in the upper extremities

Answer 106

b. Integrity of the spinal cord–mediated reflex arc involving S2-S4. The bulbocavernosal reflex tests the integrity of the spinal cord–mediated reflex arc involving S2-S4 by checking if there is an immediate contraction of the anal sphincter muscles upon squeezing the glans penis or clitoris.

Question 107

How is the bulbocavernosal reflex elicited in patients with an indwelling Foley catheter?
a. Squeezing the glans penis or clitoris
b. Tugging on the Foley catheter
c. Tapping on the patella
d. Running a tongue depressor along the sole of the foot

Answer 107

b. Tugging on the Foley catheter. In patients with an indwelling Foley catheter, tugging on the catheter can elicit the bulbocavernosal reflex instead of squeezing the glans penis or clitoris.

Question 108

Sensory Dermatomes

Answer 108

Question 109

What is pseudodementia in elderly patients?

A) A type of dementia that is caused by age-related brain changes
B) A form of depression that can mimic symptoms of dementia
C) A type of delirium caused by medication side effects
D) A neurological disorder that causes cognitive impairment

Answer 109

B) A form of depression that can mimic symptoms of dementia.

Explanation: Pseudodementia is a term used to describe a condition in which a person has symptoms that mimic those of dementia but are actually caused by depression or another emotional or psychological problem. In elderly patients, it is important to assess for pseudodementia because this condition can be treated effectively with appropriate psychiatric interventions.

Question 110

What is the difference between sex and gender?

A. Sex refers to a person’s perceived internal self, whereas gender is assigned from birth based on chromosomes or gonads.
B. Sex and gender are the same thing.
C. Sex refers to a person’s physical characteristics, whereas gender refers to their social roles and behaviors.
D. Sex refers to a person’s chromosomal or gonadal sex, which is assigned from birth, whereas gender is a person’s perceived internal self.

Answer 110

D is the correct answer. Sex refers to a person’s chromosomal or gonadal sex, which is assigned from birth, whereas gender is a person’s perceived internal self.

Question 111

Why is having a broad differential diagnosis important in urology?
A. It helps in providing quicker diagnosis
B. It prevents the need for laboratory and radiographic evaluations
C. It enables the practitioner to consider multiple possible diagnoses
D. It is not important in urology

Answer 111

C. It enables the practitioner to consider multiple possible diagnoses. Explanation: A broad differential diagnosis helps in considering multiple diagnoses and prevents premature closure on a single diagnosis.