GU

Question 1

A 45-year-old man with a history of benign prostatic hyperplasia (BPH) presents with worsening urinary symptoms, including nocturia and weak stream. What is the most appropriate initial pharmacological treatment?

Answer 1

Alpha-blockers

Alpha-blockers are effective in managing the symptoms of BPH by improving urinary flow and reducing discomfort associated with urinary obstruction.

Question 2

A 50-year-old man presents for a routine check-up and expresses concerns about prostate health. What is the most appropriate screening recommendation for prostate cancer?

Answer 2

Prostate-specific antigen (PSA) test every year starting at age 50

PSA testing is used as a screening tool to detect prostate cancer early, before symptoms develop. Prostate cancer is one of the most common cancers in men, and early detection can improve treatment outcomes.

Question 3

A male adult patient presents to the clinic with sudden onset of painful hematuria. The most likely diagnosis is:

Answer 3

Sexually transmitted infection

Question 4

A 25-year-old woman presents with a urinary tract infection (UTI) confirmed by urinalysis. She has no allergies. What is the most appropriate first-line antibiotic treatment?

Answer 4

Nitrofurantoin

Overall, Nitrofurantoin is a preferred choice for treating uncomplicated UTIs, especially in otherwise healthy individuals where local resistance patterns support its efficacy.

Question 5

Your patient has presented with flank pain, CVA tenderness, frequency. Which diagnostic finding would be useful to differentiate between cystitis and pyelonephritis?

Answer 5

UA with presence of WBC casts

UA with WBC casts suggests pyelonephritis. UA with RBC suggests glomerulonephritis.

Presence of hematuria is non-specific and a UC positive for proteus is not specific to either, as both cystitis and pyelonephritis could have proteus as the bacterial agent.

Question 6

Causes of acute AKI

Answer 6

• Aminoglycosides
• contrast agents
• nonsteroidal anti-inflammatory drugs (NSAIDs),
• angiotensin-converting enzyme (ACE) inhibitors
• protease inhibitors

Question 7

S/S Acute Pyleonephritis

Answer 7

• high fever
• chills
• nausea/vomiting
• dysuria
• frequent urination
• unilateral flank pain(described as a deep ache)
• nausea (with/without vomiting)-
• may have a recent history of urinary tract infection (UTI)

Question 8

Bladder CA S/S

Answer 8

• painless hematuria
• May have irritative voiding symptoms (dysuria, frequent urination, nocturia) that are not related to a UTI.

Patients who have advanced disease with metastases may complain of lower abdominal or pelvic pain, perineal pain, low-back pain, or bone pain.

Question 9

Rhabdomyolysis s/s

Answer 9

• acute onset of muscle pain (not related to physical exertion)
• muscle weakness
• dark urine (myoglobinuria)

Question 10

Oliguria is defined as…

Answer 10

Urinary output of <400 to 500 mL/day (adults)

Question 11

Serum Creatinine

Answer 11

product of creatine metabolism in skeletal muscle; also is derived from dietary meat intake.

Males is 0.7 to 1.3 mg/dL
Females is 0.6 to 1.1 mg/dL

Question 12

Creatinine Clearance (24-hour Urine)

Answer 12

Used to evaluate patients with proteinuria, albuminuria, and microalbuminuria.

Question 13

eGFR

Answer 13

Normal is >90 mL/min

<60 mL/min for at least 3 months indicates CKD

Question 14

Blood Urea Nitrogen

Answer 14

Measure of the kidneys’ ability to excrete urea (waste product of protein metabolism).

Elevated levels with decreased blood flow to the kidneys or damage to the kidneys.

Question 15

Bun-to-creatinine Ratio

Answer 15

A decrease in the blood flow of the kidneys will increase the BUN:Cr ratio.

Used to evaluate dehydration, hypovolemia, and acute kidney failure.

A rise in BUN:Cr ratio is suggestive of decreased kidney perfusion (prerenal disease).

Question 16

UA

Answer 16

Neutrophils - associated with bacteria
Leukocytosis - associated with cystitis
Protein - suggests kidney damage is present
Nitrates - Increase due to breakdown of urea into nitrite by bacteria - indicative of UTI
WBC casts - seen with infections
RBC casts - indicate glomerulonephritis
pH - kidney stones and infections

Question 17

WBC casts with proteinuria and hematuria are associated with what condition?

Answer 17

Pyelonephritis

Question 18

Stages of CKD

Answer 18

Stage 1 ≥ 90 mL/min Kidney damage with normal or high kidney function

Stage 2 60 to 89 mL/min Mild loss of kidney function

Stage 3a 45 to 59 mL/min Mild-to-moderate loss of kidney function

Stage 3b 30 to 44 mL/min Moderate-to-severe loss of kidney function

Stage 4 15 to 29 mL/min Severe loss of kidney function

Stage 5 < 15 mL/min Kidney failure

Question 19

Prerenal AKI

Answer 19

Usually due to hypoperfusion of the kidneys.

• hypovolemia
• HF, edema, MI
• ACE, ARB, NSAIDS

Question 20

Intrarenal AKI

Answer 20

Caused by damage to the tissues of the kidney or renal tubule, involving pathology of the vessels, glomeruli, or tubules-interstitial

• Acute tubular necrosis
• Nephrotoxins
• Glomerular disease
• Thrombosis in renal artery/vein

Question 21

Postrenal AKI

Answer 21

Usually due to the obstruction of the flow of urine in the renal tubular system to the urethra.

• Bladder obstruction
• Urethral/renal obstruction
• neurogenic bladder

Question 22

Complicated pyelonephritis presents in patient with…

Answer 22

• underlying renal disease
• male sex, kidney stone
• anatomic urinary tract abnormality
• immunosuppression

Should be referred to ED

Question 23

Treatment for pyelonephritis

Answer 23

Oral fluoroquinolone (levofloxacin, ciprofloxacin)

Question 24

gold-standard test for measuring protein excretion of the kidneys

Answer 24

24 hour urine collection

Question 25

Indication for antibiotics in asymptomatic bacteruria

Answer 25

• pregnancy
• patients undergoing urologic intervention
• Renal transplant recipients

Question 26

Diagnosing UTI

Answer 26

> 100,000 CFU/mL of one organism

Question 27

What test is used to diagnose kidney stones?

Answer 27

CT