Review questions Exam 3 Flashcards
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?
acute pyelo
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?
urine culture
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?
E. coli
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?
flank pain
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?
high fever-> systemic sx
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?
antiemetics
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?
1 week after completing abx (to assure infection is cleared)
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?
- increase fluid intake
- increased risk of bacteria during sex, so urinate after
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
C. US of the prostate
What is the common non surgical tx option for BPH?
a. Alpha blockers
b. Turp (surgery
c. Chemotherapy (not cancer)
d. Prostatectomy (surgery)
a. alpha blockers
Which sx if a direct result of the enlarged prostate in BPH?
a. Nocturia
b. Hematuria
c. Painful ejaculation
d. Weight loss
a. nocturia (cannot empty the bladder) (very common sx)
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)
b. Bladder stones (chronic urinary retention, stagnant urine → stones form)
The use of catheter increases the risk of UTI by?
15-30 %
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
a. limiting fluid intake in the evening
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
a. to monitor the progression of BPH
What surgical tx is considered a standard procedure for severe BPH?
a. laser therapy
b. TURP
c. prostatectomy
d. cath
B. TURP
- 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
B. by causing obstrucing flow of urine
- 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
a. 5-alpha reductase inhibitors
- 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)
a. bladder neoplasm
How do you confirm the diagnosis of neoplasm?
Biopsy
- Which scrotal mass will transilluminate?
a. Varicocele (bag of worms)
b. Hydrocele
c. Testicular tumor
d. Torsion of the testicle
B. hydrocele
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
C. prostate cancer( highest metastasis of cancer is to bone, otherwise usually asymptomatic, won’t
cause urinary sx, “silent killer”)
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
C. Transrectal US guided biobsy
aggravating factors: cycling, caffeine, alcohol
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)
D. Transitional cells
What grading system is used to elevate the histology of a prostate biopsy specimen
a. Ranson score
b. Gleason score
c. Osler Score
B. Gleason score
In what area of the prostate do most malignancies develop?
a. Transitional zone
b. Periurethral zone
c. Peripheral zone
d. Central zone
c. Peripheral zone (70%)
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)
d. Order a color doppler scrotal US (check the blood flow, check for necrosis, assess for torsion)
MCC of epididymitis –> STI (gonorrhea)
What is the most common pathogen associated with acute cystitis in females?
E. Coli
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
b. Cig smoking (bad things happen to people who smoke)
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
a. Phimosis
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)
c. Nontender mass in the testes (nontender, nonmobile mass, probably cancer, ALWAYS look out)
Which of the following classes of drugs have been used to treat BPH
alpha adrenergic blockers
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)
D. 14
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
b. Prostate specific antigen (PSA) (standard screening test, would show it is enlarged)
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
c. Doppler US (assess for the blood flow)
Which of the following conditions would have a + Prehn’s sign?
a. Epididymitis
b. Testicular torsion
c. Acute prostatitis
d. Chronic prostatitis
e. Paraphimosis
a. Epididymitis
Prehn’s sign: lift up a friend and makes them feel better - Won’t work on torsion, instead exacerbation
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
a. Finasteride (does not affect the risk of prostate cancer)
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
a. Hydrocele
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
a. 50 y/o F with painless hematuria and hx of smoking
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)
d. White cell casts (comes from the kidneys- so most specific)
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
c. Testicular torsion
Lack of pain with elevation or transverse positioning also signs of testicular torsion
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
epididymitis
13 y/o M complains of heaviness in his scrotim and some vague pain that worsens with exertion pald
Varicocele
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
c. Pyelonephritis
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)
e. Pregnant patients (+ elderly)
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?
a. Orchitis
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
a. Embryonal carcinoma
What is the most common site of obstruction in nephrolithiasis?
a. Pelvic brim
b. Renal brim
c. Ureteropelvic junction
d. Ureterovesical junction
d. ureterovesicular junction
What is the best treatment for stress incontinence?
a. Kegel exercises
b. Adult diapers and pads
c. Anticholinergic medications
d. Prostagesterone
a. kegel excercises
