Review questions Exam 3

Question 1

Anna, a 32 yo R presents to the ED complaining of fever, chills, severe pain in her lower back. She mentions he has been feeling the urge to urinate more frequently and when she does, it burns. She also notes that her urine appears cloudy and foul smelling. + costovertebral tenderness
What is the most likely diagnosis based on her symptoms?

Answer 1

acute pyelo

Question 2

Anna, a 32 yo R presents to the ED complaining of fever, chills, severe pain in her lower back. She mentions he has been feeling the urge to urinate more frequently and when she does, it burns. She also notes that her urine appears cloudy and foul smelling. + costovertebral tenderness
Which lab test is most critical in confirming the dx?

Answer 2

urine culture

Question 3

Anna, a 32 yo R presents to the ED complaining of fever, chills, severe pain in her lower back. She mentions he has been feeling the urge to urinate more frequently and when she does, it burns. She also notes that her urine appears cloudy and foul smelling. + costovertebral tenderness
what is the typical causitive agen for anna’s condition?

Answer 3

E. coli

Question 4

Anna, a 32 yo R presents to the ED complaining of fever, chills, severe pain in her lower back. She mentions he has been feeling the urge to urinate more frequently and when she does, it burns. She also notes that her urine appears cloudy and foul smelling. + costovertebral tenderness
What sx distinguishes pyelo from UTI?

Answer 4

flank pain

Question 5

Anna, a 32 yo R presents to the ED complaining of fever, chills, severe pain in her lower back. She mentions he has been feeling the urge to urinate more frequently and when she does, it burns. She also notes that her urine appears cloudy and foul smelling. + costovertebral tenderness
Additional sx is most concerning for pyleo?

Answer 5

high fever-> systemic sx

Question 6

Anna, a 32 yo R presents to the ED complaining of fever, chills, severe pain in her lower back. She mentions he has been feeling the urge to urinate more frequently and when she does, it burns. She also notes that her urine appears cloudy and foul smelling. + costovertebral tenderness
If sx include nausea/ vomiting than what medication should be provided?

Answer 6

antiemetics

Question 7

Anna, a 32 yo R presents to the ED complaining of fever, chills, severe pain in her lower back. She mentions he has been feeling the urge to urinate more frequently and when she does, it burns. She also notes that her urine appears cloudy and foul smelling. + costovertebral tenderness
In managing when should a follow-up urine culture be performed?

Answer 7

1 week after completing abx (to assure infection is cleared)

Question 8

Anna, a 32 yo R presents to the ED complaining of fever, chills, severe pain in her lower back. She mentions he has been feeling the urge to urinate more frequently and when she does, it burns. She also notes that her urine appears cloudy and foul smelling. + costovertebral tenderness
What preventative measure is most effective in reducing the reoccurance of pyleo in women?

Answer 8

1. increase fluid intake
2. increased risk of bacteria during sex, so urinate after

Question 9

Which diagnostic test would best eval the extent of John’s BPH?
a. PSA test - not quantifying
b. UA-nosxofUTI
c. US of the prostate

Answer 9

C. US of the prostate

Question 10

What is the common non surgical tx option for BPH?
a. Alpha blockers
b. Turp (surgery
c. Chemotherapy (not cancer)
d. Prostatectomy (surgery)

Answer 10

a. alpha blockers

Question 11

Which sx if a direct result of the enlarged prostate in BPH?
a. Nocturia
b. Hematuria
c. Painful ejaculation
d. Weight loss

Answer 11

a. nocturia (cannot empty the bladder) (very common sx)

Question 12

What complication is John at risk for if his BPH is not treated?
a. Kidney failure
b. Bladder stones
c. Prostate cancer
d. UTI (no bacteria in the bladder, bacteria migrates from outside, “through urethra”/catheter)

Answer 12

b. Bladder stones (chronic urinary retention, stagnant urine → stones form)

Question 13

The use of catheter increases the risk of UTI by?

Answer 13

15-30 %

Question 14

Which lifestyle modifications can help manage BPH symptoms?
a. Limiting fluid intake in the evening (patho is difficulty urinating)
b. Consuming more caffeine → increases urination
c. decreasing physical activity
d. increasing alcohol consumption-> increasing urination

Answer 14

a. limiting fluid intake in the evening

Question 15

What is the role of the PSA test in the management of BPH?
a. to diagnose BPH
b. to monitor the progression of BPH
c. to exlude prostate cancer
d. to determine the size of the prostate

Answer 15

a. to monitor the progression of BPH

Question 16

What surgical tx is considered a standard procedure for severe BPH?
a. laser therapy
b. TURP
c. prostatectomy
d. cath

Answer 16

B. TURP

Question 17

11. How does BPH primarily cause urinary sx?
    a. By causing UTI
    b. By causing obstructing the flow of urine
    c. By decreasing the bladder capacity

Answer 17

B. by causing obstrucing flow of urine

Question 18

12. Which med class is commonly prescribed to reduce the side of the prostate?
    a. 5-alpha reductase inhibitors (only alpha 1 receptors on
    b. BB
    c. CCB
    d. ACEi

Answer 18

a. 5-alpha reductase inhibitors

Question 19

1. In a 50 y/o M with complaint of painless hematuria, absent of voiding sx and a normal GU examination, what
   should you suspect?
   a. Bladder neoplasm (always suspect with hematuria)
   b. UTI (voiding issue)
   c. Urethritis (PainFUL)
   d. Testicular torsion (painFUL)
   e. Epididymitis (PainFUL)

Answer 19

a. bladder neoplasm

Question 20

How do you confirm the diagnosis of neoplasm?

Answer 20

Biopsy

Question 21

3. Which scrotal mass will transilluminate?
   a. Varicocele (bag of worms)
   b. Hydrocele
   c. Testicular tumor
   d. Torsion of the testicle

Answer 21

B. hydrocele

Question 22

45 y/o african american M presents to the office with CC of back pain. Examination of the back is normal. Digital
rectal exam is performed and shows some areas of prostatic indurations and intact rectal sphincter. The patient denies any urological sx, smoking or drug abuse. What is the most likely diagnosis?
a. Bladder cancer
b. BPH (nocturia, voiding, dribbling, urinary sx)
c. Prostate cancer
d. Hemorrhoids
e. Chronic prostatitis

Answer 22

C. prostate cancer( highest metastasis of cancer is to bone, otherwise usually asymptomatic, won’t
cause urinary sx, “silent killer”)

Question 23

Prostatic indurations are noted on a routine examination of an asymptomatic 57 y/o male. A PSA and Urinalysis
are done several days later. The PSA is 12 ng/mL and the urinalysis is normal. A repeat PSA done 2 weeks later is 10 ng/mL. You refer this patient to the urologist to r/o a GU disorder. What will be the urologist’s first step?
Normal valve PSA: 50-59 y/o <3.5 ng/mL
a. Scrotal US (no CC region)
b. Pelvic CT scan (won’t change the tx plan, why expose to radiation) (BPH would also have some urinary sx) (seems like high sus
c. Transrectal US guided biopsy (indurations, age, given PSA levels, points you to bx)
d. Bone scan of the lumbar spine (not necessarily next step)
e. Cystoscopy

Answer 23

C. Transrectal US guided biobsy

aggravating factors: cycling, caffeine, alcohol

Question 24

What is the most common histological type of bladder cancer?
a. Adenocarcinoma
b. Squamous cell
c. Small cell (found in the lungs)
d. Transitional cell (cells in bladder are transitional)
e. Large cell (found in the lungs)

Answer 24

D. Transitional cells

Question 25

What grading system is used to elevate the histology of a prostate biopsy specimen a. Ranson score b. Gleason score c. Osler Score

Answer 25

B. Gleason score

Question 26

In what area of the prostate do most malignancies develop? a. Transitional zone b. Periurethral zone c. Peripheral zone d. Central zone

Answer 26

c. Peripheral zone (70%)

Question 27

25 y/o M presents to the clinic complaining of pain in his scrotum this morning. He woke up with a dull ache and now it “hurts” back”. On examination, you find a very tender right testicle, especially posteriorly. The testicles hang equally, appear symmetrical, not enlarged and are equal in size. The patient has a + Prehn’s sign (sign of epididymitis or torsion). What is the most appropriate next step in the management of this patient? a. Immediate referral for surgical exploration b. Scrotal support, an abx directed as E. Coli and pain meds c. Transilluminate the scrotum d. Order a color doppler scrotal US (check the blood flow, check for necrosis, assess for torsion)

Answer 27

d. Order a color doppler scrotal US (check the blood flow, check for necrosis, assess for torsion) | MCC of epididymitis –> STI (gonorrhea)

Question 28

What is the most common pathogen associated with acute cystitis in females?

Answer 28

E. Coli

Question 29

On routine urinalysis, a 50 y/o M is noted to have microscopic hematuria. He is asymptomatic and cannot recall if he ever had hematuria previously. After taking a history, you decide to further evaluate this factor. Which factor increases the likelihood that there is a serious underlying abnormality? a. Acetaminophen use for chronic low back pain (unlikely) b. Cig smoking (bad things happen to people who smoke) c. High number of WBC in the urine d. Urge for incontinence e. Recent vigorous exercise

Answer 29

b. Cig smoking (bad things happen to people who smoke)

Question 30

Inability to retract the forekin from the glans peneis due to inflammation of infection is often an indication for circumcision. Which is the most likely diagnosis? a. Phimosis b. Paraphimosis c. Balanitis d. Urethral meatus sphincter

Answer 30

a. Phimosis

Question 31

Which of the follwoign would be most concern if found while examining a 26 y.o M patient with no other complaints? a. Tender testicle (epididymitis, not severe) b. Enlarged fluid filled scrootun (Hydrocele, no severe) c. Nontender mass in the testes (nontender, nonmobile mass, probably cancer, ALWAYS look out) d. Mass that feels like a “bag of worms” (varicocleae, no severe)

Answer 31

c. Nontender mass in the testes (nontender, nonmobile mass, probably cancer, ALWAYS look out)

Question 32

Which of the following classes of drugs have been used to treat BPH

Answer 32

alpha adrenergic blockers

Question 33

58 y/o M presents, complaining of urgency, frequency and dysuria. He is found to have a temp of 101F, no flank pain and urinalysis positive for nitrates, 5-10 WBCs and leukocyte esterase. Which of the following is an appropriate tx length for his UTI? Normal values Temp: 98.6 Nitrate: negative Leukocytes: <4 cells/HPF Leukocyte esterase: negative - Seems like it is a complicated case, due to sx and age and results a. 3 days b. 7 days c. 10 days d. 14 days (male w/ UTI and fever = complex UTI, assessing risk vs benefit, concern of systemic infection)

Answer 33

D. 14

Question 34

Which of the following examinations/tests would be most helpful in screening the differential diagnosis for an enlarged prostate? a. Digital rectal exam (DRE) (alone not definitive for enlarged prostate) b. Prostate specific antigen (PSA) (standard screening test, would show it is enlarged) c. Bone scan of the lumbar spine d. Urethrocystoscopy

Answer 34

b. Prostate specific antigen (PSA) (standard screening test, would show it is enlarged)

Question 35

Which of the following tests would definitievle rule out testicular torsion a. CT of the testicle b. Plain radiograph of the testicle c. Doppler US (assess for the blood flow) d. Examination alone e. Urinalysis and culture

Answer 35

c. Doppler US (assess for the blood flow)

Question 36

Which of the following conditions would have a + Prehn’s sign? a. Epididymitis b. Testicular torsion c. Acute prostatitis d. Chronic prostatitis e. Paraphimosis

Answer 36

a. Epididymitis Prehn’s sign: lift up a friend and makes them feel better - Won't work on torsion, instead exacerbation

Question 37

You diagnose benign prostatic hyperplasia (BPH) on an elderly gentleman. Which of the following medications prevents the conversion of testosterone to dihydrotestosterone to decrease the size of the prostate? a. Finasteride (does not affect the risk of prostate cancer) b. Terazosin c. Prazosin d. Oxybutynin

Answer 37

a. Finasteride (does not affect the risk of prostate cancer)

Question 38

64 yo M presents to your office concerned about right testicular swelling that worsened testercay. He denies any pain or any dysfunction with sexual activity. On exam, his right scrotum is enlarged and the testicle cannot be easily palpated. There is no tenderness. The left testicle is normal. You can transilluminate the right scrotum. What is the most likely diagnosis? a. Hydrocele b. Spermatocele c. Epididymitis d. Varicocele

Answer 38

a. Hydrocele

Question 39

Which of the following patients is most likely to have bladder cancer? a. 50 y/o F with painless hematuria and hx of smoking b. 40 y/o F with her first episode of acute dysuria, frequency

Answer 39

a. 50 y/o F with painless hematuria and hx of smoking

Question 40

Which finding is most specific in distinguishing pyelonephritis from cystitis a. CVA tenderness (tenderness can be in either) b. Fever and chills c. Leukocytosis d. White cell casts (comes from the kidneys- so most specific)

Answer 40

d. White cell casts (comes from the kidneys- so most specific)

Question 41

10 y/p M with no hx of trauma presents to the ED with a 14 hr hx of a painful scrotum. Elevation of the scrotum does not relieve pain. He also complains of N/V. Examination reveals an enlarged, tender, erythematous scrotum that does not transilluminate. The testicle is in a transverse (horzontil) position. The cremasteric reflex is absent on the sde of the swelling.. What is the mostly likely diagnosis? a. Epididymitis b. Varicocele c. Testicular torsion

Answer 41

c. Testicular torsion Lack of pain with elevation or transverse positioning also signs of testicular torsion

Question 42

14 y/o M complains opf gradually worsening scrotal pain and swelling and dysuria. On examination, the scrotum is edematous and erythematous. There is exquisite tenderness

Answer 42

epididymitis

Question 43

13 y/o M complains of heaviness in his scrotim and some vague pain that worsens with exertion pald

Answer 43

Varicocele

Question 44

22 y/o F presents with dull constant flank pain, fever, bacteriuria, pyuria, what is the most likely diagnosis? a. Cystitis b. Nephrolithiasis c. Pyelonephritis d. Pelvic inflammatory disease e. Cervicitis

Answer 44

c. Pyelonephritis

Question 45

For which group is screening for asymptomatic bacteriuria recommended? a. All patients b. Male patients c. Female patients d. Sexually active female patients e. Pregnant patients (+ elderly)

Answer 45

e. Pregnant patients (+ elderly)

Question 46

21 y/o M who recently recovered from the mumps presents to the ED complaining of testicular tenderness, on exam. What is the most likely diagnosis?

Answer 46

a. Orchitis

Question 47

Which of the following tumors is associated with elevation in both alpha fetoprotein (AFP) and beta human chorionic gonadotropin (B- HCG)? a. Embryonal carcinoma b. Endodermal sinus tumor c. Seminoma d. Teratoma e. Choriocarcinoma

Answer 47

a. Embryonal carcinoma

Question 48

What is the most common site of obstruction in nephrolithiasis? a. Pelvic brim b. Renal brim c. Ureteropelvic junction d. Ureterovesical junction

Answer 48

d. ureterovesicular junction

Question 49

What is the best treatment for stress incontinence? a. Kegel exercises b. Adult diapers and pads c. Anticholinergic medications d. Prostagesterone

Answer 49

a. kegel excercises