Genitourinary

Question 1

What behavioral modification can be used for BPH?

Answer 1

1. Decrease night time fluids

2. Decrease alcohol

3. Decrease caffeine

Question 2

What is first line treatment for BPH?

Answer 2

Alpha blockers. If these are ineffective, the patient may try 5-alpha-reductase inhibitors.

Question 3

At what age should orciopexy be done for cryptorchidism?

Answer 3

The testicles usually have descended by 3 months. If they haven’t by 6 months, surgery is indicated.

Question 4

Is hydrocele worrisome when seen in infants?

Answer 4

No, this is quite common. Most will self resolve by two years of age. If they haven’t by two, then surgery can be done to correct.

Question 5

16 year old patient comes in complaining of left testicular pain and heaviness. Palpation over the left testicle feels like a bag of worms. What is the most likely diagnosis?

Answer 5

This is classic for a varicocele. Most are left sided. If a right sided varicocele is noted, this should prompt a workup for vena cava obstruction.

Question 6

What is first line treatment for stress incontinence?

Answer 6

Psuedoephedrine and/or imipramine.

Question 7

Majority of stones will be composed of what?

Answer 7

Calcium oxylate make up about 80% of renal stones.

Question 8

How are struvite renal stones formed?

Answer 8

These are formed after repeated urinary tract infections from urea splitting bacteria - Proteus.

Question 9

What is the test of choice for the diagnosis of nephrolithiasis?

Answer 9

A non-contrast helical CT is the test of choice in adults. Children and pregnant women should have an ultrasound done first to avoid radiation.

Question 10

What size stones will usually pass on their own?

Answer 10

Most stones

Question 11

What are the two medical expulsive therapies shown to help with stone passage?

Answer 11

1. Alpha blockers

2. Nifedipine

Question 12

Why do thiazide diuretics prevent recurrence of calcium oxylate stones?

Answer 12

Thiazide diuretics decrease urinary calcium excretion preventing stone formation. Loop diuretics will increase calcium excretion - don’t get confused!

Question 13

A 14 year old patient is coming in with left sided testicular pain. Physical exam shows edema and erythema. An abscent cremasteric reflex is noted on the left testicle. What is the next step in management?

Answer 13

The next best step is surgery. This patient is presenting with classic signs of testicular torsion. Also, look for a negative prehn sign.

Question 14

What is the most specific marker for UTI on dipstick?

Answer 14

Nitritres on dip stick are most specific for UTI.

Question 15

A 22 week gestation female is complaining of dysuria, increased urinary frequency, and fever. Symptoms began 2 days ago. How should this patient be managed?

Answer 15

This patient should be hospitalized. A urinary tract infection with fever is pyelonephritis. Fever means systemic infection. All patients who are pregnant with pyelonephritis require hospitalization.

Question 16

What is the most common etiology of epididymitis?

Answer 16

1. Patients >35 = E-coli

2. Patients

Question 17

Most bladder cancers are what type of cancer?

Answer 17

Most are urothelial aka transitional cell carcinoma.

Question 18

What is the workup required of a 45 year old patient with persistent painless hematuria?

Answer 18

Painless hematuria in a patient over 40 is bladder cancer until proven otherwise. These patients require cytoscopy, urine cytology, and a CT of the abdomen/pelvis.

Question 19

When should you screen for prostate cancer?

Answer 19

Only when you and the patient have had a discussion of the risks and benefits and the patient agrees to testing. Prostate cancer should not be universally screened for!

Question 20

The classic triad of palpable abdominal mass, hematuria, and flank pain indicates what disease?

Answer 20

This is classic for renal cell carcinoma.

Question 21

What is the average age for testicular cancer?

Answer 21

Most will be diagnosed from 15-35 years of age.

Question 22

What is the most common renal malignancy in children? How do they present?

Answer 22

This is a Wilms tumor. Patients are usually

Question 23

What is the most common cause of acute kidney injury?

Answer 23

Dehydration is by far the most common cause. This will lead to prerenal azotemia (acute kidney injury). Simply hydrate these patients.

Question 24

A BUN:Cr ratio of 2:1 indicates what type of AKI?

Answer 24

Classic for pre-renal failure.

Question 25

A 50 year old patient was told to drink a lot of water before having an ultrasound to evaluate his enlarged prostate. The patient returned to the office 2 hours later stating he is unable to urinate; he states he is having worsening abdominal pain since ultrasound was done. What is the next step?

Answer 25

This patient is suffering from obstruction of the urinary tract secondary to an enlarged prostate. This patient should have a catheter placed before he starts to develop post-renal failure.

Question 26

A patient is with chronic kidney disease is being started on lisinopril. What is the risk and how do we prevent this complication?

Answer 26

The major risk in these patients are worsening GFR and hyperkalemia. The treatment of choice for chronic kideny disease is an ACE inhibitor, but precautions should be taken. A baseline creatinine should be drawn. Three days after the medication is given, the patient should have a creatinine and potassium drawn. Hyperkalemia or an increase of creatinine of 30% is indication to remove the ACE inhibitor.

Question 27

How soon after strep infection will a patient present with glomerulonephritis?

Answer 27

Patients usually present 1-3 weeks post infection.

Question 28

Minimal change disease is associated with what malignancy?

Answer 28

Non-hodgkin lymphoma

Question 29

What is the definition for nephoritic syndrome?

Answer 29

This will require a urinary protein excretion of 3.5 grams per day. This can be a result of any of the glomerulonephropathies.

Question 30

What is the most common cause of death for patients with polycystic kidney disease?

Answer 30

These patients will most commonly die from a cardiac cause.

Question 31

A 30 year old female is presenting to the cardiologist for resistant hypertension. On physical exam she is noted to have a soft non tender abdomen with an accompanying abdominal bruit. What is the most likely diagnosis?

Answer 31

Renal artery stenosis. These patients will also have a dramatic increase in their creatinine after an ACE or ARB is given. The etiology in female patients

Question 32

What test can be used to differentiate nephrogenic vs central diabetes insipidus?

Answer 32

This can be done with the administration of DDAVP aka ADH


1. Nephrogenic DI - no change in symptoms. Have the hormone, but receptors are insensi- tive; problem with the kidney.
2. Central DI - patients will urinate less and their urine will be more concentrated. They were missing the hormone, and you replaced it artificially; problem with posterior pituitary.

Question 33

What is the risk of correcting hyponatremia to rapidly?

Answer 33

Central pontine myelinolysis aka osmotic demyelization. The only indication to rapidly correct is if the patient is presenting with severe symptoms (not severely low labs) such as seizure or coma. Treat your patient not the labs.

Question 34

How are patients with mild SIADH treated?

Answer 34

Simply fluid restrict these patients. Giving normal saline will make things worse.

Question 35

What type of acid/base disorder will be caused from vomiting? How about diarrhea?

Answer 35

1. Vomiting - metabolic alkalosis


2. Diarrhea - non anion gap acidosis