Renal/Genitourinary

Question 1

A 65-year-old man with insulin-dependent diabetes, hypertension, chronic kidney disease, and cirrhosis presents to the office for a routine physical exam. He reports tingling around his mouth and occasional muscle cramping that has gotten progressively worse over the past few months. He has a positive contraction of the right facial muscle when you tap the skin over the right facial nerve, anterior to the external right ear. Lab studies show his albumin level is low at 2.5 g/dL. Which of the following electrolyte imbalances would he most likely have in addition to hypoalbuminemia?

A) Hypocalcemia
B) Hypokalemia
C) Hyponatremia
D) Hypophosphatemia

Answer 1

Hypocalcemia

Hypoalbuminemia is the most common cause of hypocalcemia and can be caused by cirrhosis, nephrosis, malnutrition, burns, chronic illness, and sepsis.

Question 2

What electrolyte imbalance is associated with peaked T waves on ECG?

Answer 2

Hyperkalemia

Question 3

A 60-year-old man presents to his urologist with concerns of difficulty voiding, urinary retention, and weak urinary stream. Digital rectal examination is significant for an irregular, firm prostate gland. His prostate-specific antigen level is 42 ng/mL. Which of the following grading systems is used for the most likely diagnosis?

A) Gleason
B) Nottingham
C) Ranson
D) Scarff-Bloom-Richardson

Answer 3

Gleason

The Gleason grading system is a five grade system that classifies the architectural pattern of malignant cells. A score of 1–5 is assigned to the largest and second largest areas of malignant cells for a total Gleason score of 2–10. A higher score correlates with a larger tumor volume, a more advanced pathologic stage, and a worse prognosis. Treatment for prostate cancer depends on the Gleason score, life expectancy, and PSA level.

Question 4

What zone of the prostate does prostate cancer most commonly arises from?

Answer 4

The peripheral zone

Question 5

What is the most important risk factor associated with prostate cancer?

How is prostate cancer diagnosed after screening?

Answer 5

Advancing age

Core-needle Biopsy

Question 6

What are the common side effects associated with alpha-adrenergic receptor blockers?

Answer 6

• Orthostatic hypotension
• Dizziness
• Vertigo
• Peripheral edema

Question 7

For BPH with recurrent urinary tract infections despite medical treatment what is the next step in management?

Answer 7

Surgery - transurethral resection of the prostate (TURP)

TURP is the gold standard treatment for BPH