Male GU

Question 1

When prescribing antihypertensive therapy for a man with BPH and hypertension, the nurse practitioner (NP) considers that:
A. loop diuretics are the treatment of choice.
B. an alpha1-antagonist should not be used as a solo or first-line therapeutic agent.
C. angiotensin receptor antagonist use is contraindicated.
D. beta-adrenergic antagonist use often enhances urinary flow.

Answer 1

B

Question 2

Which of the following is inconsistent with the description of benign prostatic hyperplasia (BPH)?
A. obliterated median sulcus
B. size larger than 2.5 cm × 3 cm
C. sensation of incomplete emptying
D. boggy gland

Answer 2

D

On rectal examination, the prostate usually is enlarged, has a rubbery consistency, and in many cases has lost the median sulcus or furrow.

Question 3

3. When assessing a 78-year-old man with suspected BPH, the NP considers that:
   A. prostate size does not correlate well with severity of symptoms.
   B. BPH affects less than 50% of men of this age.
   C. he is at increased risk for prostate cancer.
   D. limiting fluids is a helpful method of relieving severe symptoms.

Answer 3

A

Question 4

4. Which of the following medications can contribute to the development of acute urinary retention in an older man with BPH?
A. amitriptyline
B. loratadine
C. enalapril
D. lorazepam

Answer 4

A

Question 5

5. A 78-year-old man presents with a 3-day history of new-onset fatigue and difficulty with bladder emptying. Examination reveals a distended bladder but is otherwise unremarkable. Blood urea nitrogen level is 88 mg/dL (31.4 mmol/L); creatinine level is 2.8 mg/dL (247.5 μmol/L). The most likely diagnosis is:
A. prerenal azotemia.
B. acute glomerulonephritis.
C. tubular necrosis.
D. postrenal azotemia.

Answer 5

D

Question 6

6. Surgical intervention in BPH should be considered with all of the following except:
   A. recurrent urinary tract infection.
   B. bladder stones.
   C. persistent obstruction despite medical therapy.
   D. acute tubular necrosis.

Answer 6

D

Question 7

7. Finasteride (Proscar®, Propecia®) and dutasteride (Avodart®) are helpful in the treatment of BPH because of their effect on:
   A. bladder contractility.
   B. prostate size.
   C. activity at select bladder receptor sites.
   D. bladder pressure.

Answer 7

B

Question 8

8. Tamsulosin (Flomax®) is helpful in the treatment of BPH because of its effect on:
   A. bladder contractility.
   B. prostate size.
   C. activity at select bladder receptor sites.
   D. bladder pressure.

Answer 8

C

Question 9

9. Concerning BPH, which of the following statements is true?
   A. Digital rectal examination is accurate in diagnosing the condition.
   B. The use of a validated patient symptom tool is an important part of diagnosing the condition.
   C. Prostate size directly correlates with symptoms and bladder emptying.
   D. Bladder distention is usually present in early disease.

Answer 9

B

Question 10

10. Concerning herbal and nutritional therapies for BPH treatment, which of the following statements is false?
    A. The mechanism of action of the most effective and best studied products is similar to prescription medications for this condition.
    B. These therapies are currently considered emerging therapies by the American Urological Association.
    C. Major areas of concern with use of these therapies include issues of product purity and quality control.
    D. These therapies are safest and most effective when used with prescription medications.

Answer 10

D

Question 11

11. You examine a 32-year-old man with chancroid and anticipate finding:
A. a verruciform lesion.
B. a painful ulcer.
C. a painless, crater-like lesion.
D. a plaque-like lesion.

Answer 11

B

Question 12

12. All of the following are typical findings for a patient with chancroid except:
    A. multiple lesions.
    B. spontaneous rupture of affected nodes.
    C. blood-tinged penile discharge.
    D. dense, matted lymphadenopathy on the ipsilateral side of the lesion.

Answer 12

C

Question 13

13. The causative organism of chancroid is:
A. Ureaplasma species.
B. Chlamydia trachomatis.
C. Mycoplasma hominis.
D. Haemophilus ducreyi.

Answer 13

D

Question 14

14. Treatment options for chancroid include all of the following except:
A. azithromycin.
B. ciprofloxacin.
C. ceftriaxone.
D. amoxicillin.

Answer 14

D

Question 15

15. When ordering laboratory tests to confirm chancroid, the NP considers that:
    A. concomitant infection with herpes simplex is often found.
    B. a disease-specific serum test is available.
    C. a white blood cell count with differential is indicated.
    D. dark-field examination is needed.

Answer 15

A

Question 16

16. The most common causative organism of lymphogranuloma venereum is:
A. Ureaplasma genitalium.
B. C. trachomatis types L1 to L3.
C. Neisseria gonorrhoeae.
D. H. ducreyi.

Answer 16

B

Question 17

17. Symptoms of lymphogranuloma venereum typically occur how long after contact with an infected host?
A. 5–7 days
B. 1–4 weeks
C. 4–6 weeks
D. 2–3 months

Answer 17

B

Question 18

18. Physical examination findings in lymphogranuloma venereum include:
    A. verruciform lesions.
    B. lesions that fuse and create multiple draining sinuses.
    C. a painless crater.
    D. plaque-like lesions.

Answer 18

B

Question 19

19. Treatment options for lymphogranuloma venereum include:
A. doxycycline.
B. penicillin.
C. ceftriaxone.
D. dapsone.

Answer 19

A

Question 20

20. The presentation of acute epididymitis in an otherwise-well 22-year-old man includes:
    A. the presence of a positive Prehn sign.
    B. low back pain.
    C. absent cremasteric reflex.
    D. diffuse abdominal pain.

Answer 20

A

Positive Prehn’s sign indicates there is pain relief with lifting the affected testicle, which points towards epididymitis.

Question 21

21. The most likely causative pathogens in a 26-year-old man with acute epididymitis include:
A. Escherichia coli.
B. Enterobacteriaceae.
C. C. trachomatis.
D. Pseudomonas species.

Answer 21

C

Question 22

22. A likely causative pathogen in a 37-year-old man with acute epididymitis who has sex with men is:
    A. Escherichia coli.
    B. Mycoplasma spp.
    C. Chlamydia trachomatis.
    D. Acinetobacter baumannii.
23. Which of the following is a reasonable treatment option for a 30-year-old man with acute epididymitis who presents without gastrointestinal upset and will be treated as an outpatient?
    A. PO doxycycline with IM ceftriaxone
    B. PO amoxicillin/clavulanate
    C. PO metronidazole with PO linezolid
    D. PO clindamycin with PO cefixime
24. Appropriate treatment of acute epididymitis for a 32-year-old man who has sex with men is:
    A. IM ceftriaxone.
    B. PO azithromycin.
    C. PO levofloxacin.
    D. IV trimethoprim-sulfamethoxazole (TMP-SMX).

Answer 22

A

Question 23

23. Which of the following is a reasonable treatment option for a 30-year-old man with acute epididymitis who presents without gastrointestinal upset and will be treated as an outpatient?
A. PO doxycycline with IM ceftriaxone
B. PO amoxicillin/clavulanate
C. PO metronidazole with PO linezolid
D. PO clindamycin with PO cefixime

Answer 23

A

Question 24

24. Appropriate treatment of acute epididymitis for a 32-year-old man who has sex with men is:
    A. IM ceftriaxone.
    B. PO azithromycin.
    C. PO levofloxacin.
    D. IV trimethoprim-sulfamethoxazole (TMP-SMX).

Answer 24

C

Question 25

25 to 30. Indicate whether each finding would be present in acute epididymitis. (Answer yes or no.)
____ 25. irritative voiding symptoms
____ 26. penile discharge
____ 27. ulcerative lesion
____ 28. scrotal swelling
____ 29. boggy prostate
____ 30. epididymoorchitis in later stages of disease

Answer 25

25. Yes
26. Yes
27. No
28. Yes
29. No
30. Yes

Question 26

31. Neisseria gonorrhoeae are best described as:
A. gram-positive cocci.
B. gram-positive rods.
C. gram-negative diplococci.
D. gram-negative bacilli.

Answer 26

C

Question 27

32. The preferred treatment for uncomplicated gonococcal proctitis is:
    A. ceftriaxone 250 mg IM as a single dose plus a single dose of azithromycin 1 g PO.
    B. oral erythromycin 500 mg BID for 7 days.
    C. oral norfloxacin 400 mg BID with metronidazole 500 mg BID for 3 days
    D. azithromycin 1 g PO as a single dose plus single dose of injectable doxycycline 100 mg.

Answer 27

A

Question 28

33. Which of the following is recommended by the Centers for Disease Control and Prevention (CDC) as single-dose therapy for uncomplicated urethritis caused by N. gonorrhoeae when an oral product is the most appropriate option?
A. cefixime
B. metronidazole
C. TMP-SMX
D. amoxicillin

Answer 28

A

Question 29

34. You see a 42-year-old man with uncomplicated urogenital gonorrhea. His medical records indicate a severe allergic reaction to penicillin that includes difficulty breathing and diffuse urticaria. You recommend treatment with:
    A. oral cefixime.
    B. parenteral levofloxacin.
    C. oral zithromycin plus oral gemifloxacin.
    D. parenteral tigecycline plus oral metronidazole.

Answer 29

C

Question 30

35. In gonococcal infection, which of the following statements is true?
    A. Risk of transmission from an infected woman to a male sexual partner is about 20% to 30% with a single coital act.
    B. Most men have symptomatic infection.
    C. The incubation period is about 2 to 3 weeks.
    D. The organism rarely produces beta-lactamase.

Answer 30

A

Question 31

36 to 39. Indicate whether each finding normally would be present in gonorrheal urethritis in an otherwise well 28-year-old man. (Answer yes or no.)
\_\_\_\_ 36. dysuria
\_\_\_\_ 37. milky penile discharge
\_\_\_\_ 38. scrotal swelling
\_\_\_\_ 39. fever

Answer 31

36. Yes
37. Yes
38. No
39. No

Question 32

40. Risk factors for acute bacterial prostatitis include all of the following except:
A. having unprotected sex.
B. use of a urinary catheter.
C. prior bladder infection.
D. age >70 years.

Answer 32

D

Question 33

41. The most common causative organisms of acute bacterial prostatitis in men <35 years are:
    A. E. coli and Klebsiella pneumoniae.
    B. N. gonorrhoeae and C. trachomatis.
    C. Pseudomonas and Acinetobacter species.
    D. enterococci.

Answer 33

C

Question 34

42. When choosing an antimicrobial agent for the treatment of chronic bacterial prostatitis, the NP considers that:
    A. gram-positive organisms are the most likely cause of infection.
    B. cephalosporins are the first-line choice of therapy.
    C. choosing an antibiotic with gram-negative coverage is critical.
    D. length of antimicrobial therapy is typically 5 days.

Answer 34

B

Question 35

43. All of the following are likely to be reported by patients with acute bacterial prostatitis except:
A. perineal pain.
B. irritative voiding symptoms.
C. penile discharge.
D. fever.

Answer 35

C

Question 36

44. During acute bacterial prostatitis, the digital rectal examination usually reveals a gland described as:
A. boggy.
B. smooth.
C. irregular.
D. cystic.

Answer 36

A

Question 37

45. A 30-year-old man with prostatitis presents with a fever of 102.3°F (39.1°C). What would be the expected CBC findings from this patient?
    A. WBC = 15,000/mm3; neutrophils = 4000/mm3
    B. WBC = 18,000/mm3; neutrophils = 11,500/mm3
    C. WBC = 7200/mm3; neutrophils = 3200/mm3
    D. WBC = 4000/mm3; neutrophils = 1200/mm3

Answer 37

B