Deck 11: Genitourinary System

Question 1

A 33-year-old female patient visits the clinic multiple times over the last year complaining of dysuria, frequency, urgency, suprapubic pain, and dyspareunia. Her physical examination, including a pelvic examination, is normal. Urinalysis and urine culture is repeatedly negative. Her IV pyelogram is also normal. The clinician should recognize that this presentation is consistent with symptoms of:

A) Asymptomatic bacteriuria
B) Upper urinary tract infection
C) Interstitial cystitis
D) Polycystic kidneys

Answer 1

Interstitial cystitis

Question 2

On a physical examination for employment, a 45-year-old male shows no significant findings and takes no medications. Past medical history and surgery are unremarkable. On urinalysis, hematuria is present. The urinalysis is repeated on another day and still reveals microscopic hematuria. It is important to recognize that painless hematuria can be diagnostic of:

A) Urinary tract infection
B) Bladder cancer
C) Nephrolithiasis
D) Pyelonephritis

Answer 2

Bladder cancer

Question 3

Calculation of prostate specific antigen (PSA) velocity provides a more specific measure of prostate cancer risk. An increased risk of prostate cancer is indicated when the PSA rises more than:

A) 0.125 ng/mL per year
B) 0.25 ng/mL per year
C) 0.5 ng/ml per year
D) 0.75 ng/mL per year

Answer 3

0.75 ng/mL per year

Question 4

A 77-year-old male patient with a history of benign prostatic hyperplasia treated with finasteride has routine laboratory revealing a prostate specific antigen (PSA) of 7.5 ng/mL. Which of the following must be considered in interpreting this finding?

A) Finasteride is associated with a 50% decrease in prostate cancer risk
B) Finasteride is associated with a 50% increase in prostate cancer risk
C) Finasteride is associated with a 50% decrease in PSA
D) Finasteride is associated with a 50% increase in PSA

Question 5

A 27-year-old male comes in to the clinic for symptoms of dysuria and urinary frequency, as well as urgency and perineal pain. Transrectal palpation of the prostate reveals a very tender, boggy, swollen prostate. The clinician should recognize these as signs of:

A) Prostatitis
B) Prostate cancer
C) Urethritis
D) Benign prostatic hyperplasia

Question 6

A 43-year-old male patient complains of right-sided abdominal and pain in the back in the right costovertebral angle region, fever, chills, dysuria, and nausea. On physical examination, there is a 102°F fever, tachycardia, and right costovertebral angle tenderness to percussion. The most likely condition is:

A) Lower urinary tract infection
B) Pyelonephritis
C) Nephrolithiasis
D) Hydronephrosis

Question 7

A 65-year-old male patient complains of frequency, urgency, hesitancy, and weak urine stream. Physical examination is unremarkable, except digital rectal exam reveals an enlarged, firm, nontender prostate gland. Urine culture reveals 100 bacteria CFU/mL. The clinician should suspect:

A) Lower urinary tract infection due to benign prostatic hyperplasia
B) Bacteriuria due to prostatitis
C) Obstructive uropathy due to prostate cancer
D) Upper urinary tract infection due to benign prostatic hyperplasia

Question 8

Which of the following disorders can cause urinary incontinence?

A) Cystocele
B) Overactive bladder
C) Uterine prolapse
D) All of the above

Question 9

A major reason for the atrophic changes that occur in the pelvic floor muscles of the elderly woman is:

A) Diminished levels of estrogen
B) Increased levels of testosterone
C) Autonomic neuropathy
D) Decreased glycogen in the vagina

Question 10

An IV pyelogram should not be performed if serum creatinine is:

A) Less than 1.5
B) Greater than 1.0
C) Greater than 1.6
D) Less than 1.0

Question 11

The most common complication of an untreated urinary obstruction due to a ureteral calculus is:

A) Hydronephrosis
B) Renal artery stenosis
C) Ureteral rupture
D) Kidney mass

Question 12

Your 55-year-old male patient presents to the emergency department with complaints of sudden development of severe right-sided, colicky lower abdominal pain. He cannot sit still on the examining table. The patient has previously been in good health. On physical examination, there are no signs of peritoneal inflammation. A urine sample reveals hematuria and crystalluria. Which is the next diagnostic test that should be done immediately?

A) Ultrasound of the abdomen
B) Abdominal x-ray
C) Digital rectal exam
D) Spiral computed tomography scan

Question 13

Your 77-year-old patient complains of frequent urination, hesitation in getting the stream started, and nocturnal frequency of urination that is bothersome. On digital rectal exam there is an enlarged, firm, nontender, smooth prostate. The clinician should recognize these as symptoms of:

A) Prostatitis
B) Prostate cancer
C) Urethritis
D) Benign prostatic hyperplasia

Question 14

When conducting an initial evaluation of incontinence, which of the following is not indicated?

A) Postvoid residual volume
B) IV pyelogram
C) Urinalysis
D) Blood, urea, nitrogen (BUN) and creatinine

Question 15

An 18-year-old female patient presents with repeated urinary tract infections. She has no risk factors in her history, and her physical examination is unremarkable. She also has a normal pelvic examination. Which of the following should be obtained if anatomical abnormalities are suspected?

A) IV pyelogram
B) Ultrasound of the kidneys
C) Cystoscopy
D) Transvaginal ultrasound of the bladder

Question 16

When performing a dipstick test on a patient's urine sample, a positive leukocyte esterase and nitrite is indicative of:

A) Microscopic hematuria
B) Urinary tract infection
C) Calculi in the urine
D) Possible bladder tumor

Question 17

A 15-year-old female patient presents with complaints of constant thirst, urination up to 20 times a day, and recent unintentional weight loss of 10 pounds over the last month. It is important for the clinician to recognize these symptoms as those of:

A) Renal cancer
B) Diabetes insipidus
C) Diabetes mellitus
D) Interstitial cystitis

Question 18

On digital rectal exam, you note that a 45-year-old patient has a firm, smooth, nontender but asymmetrically shaped prostate. The patient has no symptoms and a normal urinalysis. The patient's prostate specific antigen is within normal limits for the patient's age. The clinician should:

A) Refer the patient for transrectal ultrasound-guided prostate biopsy
B) Obtain an abdominal x-ray of kidneys, ureter, and bladder
C) Recognize this as a normal finding that requires periodic follow-up
D) Obtain urine culture and sensitivity for prostatitis

Question 19

Your 24-year-old female patient complains of dysuria, as well as frequency and urgency of urination that develops the day after she uses her diaphragm. Urine culture reveals a bacterial count of 100 CFU/mL. These signs and symptoms indicate:

A) Upper urinary tract infection
B) Lower urinary tract infection
C) Normal bacteriuria
D) Urethritis

Question 20

Your 66-year-old patient complains of frequency of urination and hesitancy of the urine stream. On digital rectal exam there is a hard, nodular, enlarged, nontender prostate. The clinician should recognize these as symptoms of:

A) Prostatitis
B) Prostate cancer
C) Urethritis
D) Benign prostatic hyperplasia