GU Flashcards
The daughter of an elderly confused patient reports that her parent is having urinary
incontinence several times each day. What will the provider do initially?
a. Obtain a urine sample for urinalysis (UA) and possible culture
b. Order serum creatinine and blood urea nitrogen tests
c. Perform a bladder scan to determine distention and retention
d. Tell the daughter that this is expected given her mother’s age and confusion
ANS: A
When incontinence occurs, UA is performed initially to exclude hematuria, pyuria, glucosuria,
or proteinuria and possible infection. Serum creatinine and BUN may be performed if renal disease is suspected. Bladder scans may be performed if the UA is normal to evaluate
physiologic causes. It is not correct to offer reassurance without ruling out other causes.
The provider is evaluating a patient for potential causes of urinary incontinence and performs
a postvoid residual (PVR) test which yields 30 mL of urine. What is the interpretation of this
result?
a. The patient may have overflow incontinence.
b. The patient probably has a urinary tract infection (UTI).
c. This is a normal result.
d. This represents incomplete emptying.
ANS: C
A PVR less than 50 mL is considered normal and this result does not indicate any
abnormality.
The provider is counseling a patient who has stress incontinence about ways to minimize
accidents. What will the provider suggest initially?
a. Increasing fluid intake to dilute the urine
b. Referral to a physical therapist
c. Taking pseudoephedrine daily
d. Voiding every 2 hours during the day
ANS: D
Timed voiding is useful to help minimize stress incontinence and is used initially. Increasing
fluid intake will increase symptoms. PT referral may be done if other measures fail to help
with exercises to strengthen the pelvic floor muscles. Pseudoephedrine is useful, but not an
initial therapy
An older male patient reports urinary frequency, back pain, and nocturia. A dipstick urinalysis
reveals hematuria. What will the provider do next to evaluate this condition?
a. Order a PSA and perform a digital rectal exam (DRE)
b. Refer for a biopsy
c. Refer the patient to a urologist
d. Schedule a transurethral ultrasound (TRUS)
ANS: A
Patients with symptoms of potential prostate cancer should be screened with PSA and DRE.
Referral to a urologist is the next step even with normal findings, since PSA is occasionally
normal. The urologist may order TRUS or biopsy.
An older male patient has a screening prostate-specific antigen (PSA) which is 12 ng/mL. What does this value indicate? a. A normal result b. Benign prostatic hypertrophy c. Early prostate cancer d. Prostate cancer
ANS: D
A PSA greater than 10 ng/mL suggests prostate cancer. A level between 4 and 10 ng/mL may
be early prostate cancer or a benign condition. A level less than 4 ng/mL is normal.
A patient is diagnosed with prostate cancer and diagnostic testing reveals disease that has
gone past the prostatic capsule without evidence of metastasis. The patient does not wish to
undergo treatment. What will the provider tell this patient?
a. Chemotherapy is indicated to provide cure for this cancer.
b. Monitoring prostate-specific antigen (PSA) with regular digital rectal examination
(DRE) is an acceptable option.
c. Palliative radiation therapy is necessary to improve quality of life.
d. This level of disease requires intervention with hormonal therapy.
ANS: B
This patient has stage T2 prostate cancer which may be managed with watchful waiting which
includes PSA and DRE evaluation. Chemotherapy, palliative radiation therapy, and hormonal
therapy are not required.
A male patient reports nocturia and daytime urinary frequency and urgency without changes
in the force of the urine stream. What is the likely cause of this?
a. Bladder outlet obstruction
b. Lower urinary tract symptoms (LUTS)
c. Prostate cancer
d. Urinary tract infection (UTI)
ANS: B
Lower urinary tract symptoms (LUTS) result from irritative changes in the lower tract.
Bladder outlet obstruction causes hesitancy, decreased caliber and force of the urine stream,
and postvoid dribbling. Diagnosis of prostate cancer and UTI require further testing and are
less likely causes.
A 70-year-old male reports urinary hesitancy, postvoid dribbling, and a diminished urine
stream. A digital rectal exam (DRE) reveals an enlarged prostate gland that feels rubbery and
smooth. Which tests will the primary care provider order based on these findings?
a. Bladder scan for postvoid residual
b. Prostate-specific antigen (PSA) and bladder imaging
c. Urinalysis and serum creatinine
d. Urine culture and CBC with differential
ANS: C
The DRE reveals a prostate gland consistent with benign prostatic hyperplasia (BPH). The
primary provider should order a urinalysis and creatinine to evaluate possible infection and
renal function. A bladder scan is ordered at the discretion of the urologist. The prostate exam
isn’t consistent with prostate cancer, so PSA and bladder imaging are not necessary.
Symptoms of prostatitis would indicate a need for evaluation of possible infection.
A patient has been taking terazosin daily at bedtime to treat benign prostatic hyperplasia
(BPH) and reports persistent daytime dizziness. What will the provider do?
a. Prescribe finasteride instead of terazosin
b. Recommend taking the medication in the morning
c. Suggest using herbal preparations
d. Switch the prescription to doxazosin
ANS: A
Patients who cannot tolerate the side effect of alpha-adrenergic antagonists, the provider may
initiate therapy with a 5a-reductase inhibitor such as finasteride. Terazosin should be given at
bedtime to minimize these adverse effects. Herbal preparations have not been proven to be
safe or effective. Doxazosin is in the same drug class as terazosin.
A pregnant woman at 30 weeks gestation presents with proteinuria. What will the provider do
next?
a. Evaluate her blood pressure and discuss with OB/GYN
b. Monitor serum glucose for gestational diabetes
c. Perform a 24-hour urine collection
d. Reassure her that this normal at this stage of pregnancy
ANS: A
Proteinuria after 24 weeks gestation is usually a sign of preeclampsia, so her blood pressure
should be evaluated and discussed with the OB/GYN. Serum glucose evaluation for
gestational diabetes is performed as part of routine screening but is not related to the finding
of proteinuria. A 24-hour urine collection is not indicated.
An older male patient reports gross hematuria but denies flank pain and fever. What will the provider do to manage this patient? a. Monitor blood pressure closely b. Obtain a urine culture c. Perform a 24-hour urine collection d. Refer for cystoscopy and imaging
ANS: D
Gross hematuria in older men denotes a significant risk of malignant disease, so cystoscopy
and imaging are indicated. Proteinuria is concerning for hypertension. The patient does not
have flank pain or fever, so the likelihood of infection is lower. A 24-hour urine collection is
not indicated.
A female patient reports hematuria and a urine dipstick and culture indicate a urinary tract
infection. After treatment for the urinary tract infection (UTI), what testing is indicated for
this patient?
a. 24-hour urine collection to evaluate for glomerulonephritis
b. Bladder scan
c. Repeat urinalysis
d. Voiding cystourethrogram
ANS: C
After treatment has been completed, repeated urinalysis is necessary to ensure that the
hematuria has resolved. Failure to follow hematuria to resolution may result in failure to
diagnose a serious condition.
Which is a prerenal cause of acute kidney injury (AKI)?
a. Hemorrhagic shock
b. Hydronephrosis
c. Hypertension
d. Renal calculi
ANS: A
Hemorrhagic shock interferes with perfusion of the kidney, which is a prerenal cause of AKI.
Hydronephrosis and renal calculi are postrenal causes leading to obstruction to renal pelvis,
ureters, bladder, or urethra. Hypertension is an intrinsic cause.
A primary care provider sees a new patient who reports having a diagnosis of chronic kidney
disease for several years. The patient is taking one medication for hypertension which has
been prescribed since the diagnosis was made. The provider orders laboratory tests to evaluate
the status of this patient. Which laboratory finding indicates a need to refer the patient to a
nephrologist?
a. Albumin/creatinine ratio (ACR) of 325 mg/g
b. Blood pressure of 145/85 mm Hg
c. Glomerular filtration rate (eGFR) of 35
d. Urine red blood cell (RBC) count of 15/hpf
ANS: A
An albumin/creatinine ratio greater than 300 mg/g warrants referral. A specialist is necessary
for persistent hypertension refractory to treatment with four or more agents, a GFR of less
than 30, and urine RBC greater than 20/hpf.
Which tests should be monitored regularly to monitor for complications of chronic renal disease (CRD)? (Select all that apply.) a. Liver enzymes b. Parathyroid hormone levels c. Serum glucose d. Serum lipids e. Vitamin D levels
ANS: B, D, E
CKD can cause hyperparathyroidism, hyperlipidemia, and alterations in vitamin D, calcium,
and phosphorus metabolism, so these should be monitored. Liver function and serum glucose
are not affected by CKD
