Exam 3 - GU packrat Flashcards
Which of the following in examination of urinary sediment indicates contamination? A. Granular casts B. Leukocyte casts C. Squamous epithelial cells D. Transitional epithelial cells
(c) C. The urinalysis should be repeated if squamous epithelial cells are found in the specimen as this indicates contamination.
A 62 year-old male presents with hematuria associated with flank pain. Review of a recent abdominal CT scan revealed the presence of 5 cm solid mass in the right kidney. Chest x-ray and bone scan are unremarkable. Which of the following is the most appropriate intervention? A. Chemotherapy B. Radiation therapy C. Radical nephrectomy D. Cell-based tumor vaccine
(c) C. Presence of a solid renal mass is renal cell cancer until proven otherwise which is also supported by the symptoms of hematuria and flank pain. Since there is no evidence of metastasis, localized renal cell cancer is treated by radical nephrectomy.
A 53 year-old male presents with complaints of frequency, urgency and dysuria associated with fever andchills. He also notes some discomfort in his back. Physical examination reveals a febrile patient with minimal suprapubic tenderness and moderate costovertebral angle tenderness. The remainder of the exam is unremarkable. Which of the following is the most likely diagnosis? A. Acute cystitis B. Acute prostatitis C. Acute epididymitis D. Acute pyelonephritis
(c) D. Acute pyelonephritis is supported by the irritative voiding symptoms associated with fever, flank pain and CVA tenderness.
A 28 year-old G1P0 in her third trimester presents complaining of dysuria, frequency and urgency for the past 2 days. She denies any back pain or fever. Physical examination is essentially unremarkable except for some mild suprapubic tenderness. Urinalysis reveals bacteriuria and pyuria. Which of the following is the most appropriate therapy?
A. Cephalexin (Keflex)
B. Doxycycline (Doryx)
C. Ciprofloxacin (Cipro)
D. Trimethoprim/sulfamethoxazole (Bactrim)
(c) A. First generation cephalosporins, such as cephalexin, are one of the antibiotics of choice to treat a pregnant female with acute cystitis.
(h) B. Tetracyclines, such as doxycycline, are contraindicated in pregnancy due to fetal tooth and bone development.
(h) C. Fluoroquinolones, such as ciprofloxacin, are contraindicated in pregnancy due to teratogenic effects.
(u) D. Sulfa drugs, such as trimethoprim/sulfamethoxazole, may be used in the first two trimesters to treat cystitis in pregnant females; however its use is contraindicated in the third trimester due to potential problems with neonatal hyperbilirubinemia.
A patient presents with acute onset of scrotal pain. Which of the following is consistent with a diagnosis of testicular torsion? A. Prehn's sign B. High-riding testicle C. Transilluminating mass D. Blue dot sign
(c) B. High-riding testicle is noted in testicular torsion due to shortening and twisting of the spermatic cord.
A 42 year-old male presents complaining of a sudden onset of a severe intermittent pain originating in the flank and radiating into the right testicle. He also complains of nausea and vomiting. On examination the patient is afebrile, but restless. Examination of the abdomen reveals tenderness to palpation along the right flank with no rebound or direct testicular tenderness. Urinalysis reveals a pH of 5.4 and microscopic hematuria, but is otherwise unremarkable. Which of the following is the most likely diagnosis? A. Bladder cancer B. Nephrolithiasis C. Acute appendicitis D. Acute epididymitis
(c) B. A sudden onset of severe colicky flank pain associated with nausea and vomiting as well as the absence of rebound or direct testicular tenderness makes nephrolithiasis the most likely diagnosis. This is further supported by the presence of hematuria on the urinalysis.
Which of the following is the most consistent physical examination finding associated with a hydrocele?
A. Tender and swollen testicle
B. Palpable painless mass on the testicle
C. Nontender scrotal mass that transilluminates
D. Inability to get exam finger above scrotal mass
(c) C. A hydrocele is a fluid-filled mass that is nontender to palpation. Diagnosis is readily made by transillumination, however evaluation is still warranted as 10% of testicular tumors may have an associated hydrocele.
An inpatient currently is receiving IV antibiotic treatment for acute pyelonephritis. Which of the following is an acceptable criterion for switching from IV to oral antibiotic therapy?
A. After 48-72 hours of IV therapy
B. If the patient is failing to respond
C. Until urine cultures become negative
D. 24 hours after patient becomes afebrile
(c) D. IV antibiotic treatment is continued for 24 hours after a patient becomes afebrile. Oral antibiotics are then started to complete a 7-day course of therapy.
When performing a rectal examination, prostatic massage is contraindicated in A. acute bacterial prostatitis. B. chronic bacterial prostatitis. C. nonbacterial prostatitis. D. prostatodynia.
(c) A. Vigorous manipulation of the prostate during rectal examination may result in septicemia. This is contraindicated in the presence of fever, irritative voiding symptoms, and perineal/sacral pain.
A patient with prostate cancer has a nonpalpable, focal lesion, and the patient is reluctant to have surgery at this time. Which of the following would best monitor disease progression?
A. Periodic rectal exams
B. Transrectal ultrasonography
C. Measurements of serum acid phosphatase
D. Measurements of prostate-specific antigen
(c) D. PSA measurement correlates well with volume and stage of disease and is the recommended examination for monitoring disease progression.
Which of the following increases the risk of developing testicular cancer? A. Low socioeconomic status B. History of cryptorchidism C. Multiple episodes of epididymitis D. Being of African-American ethnicity
(c) B. The major predisposing risk factor is cryptorchidism unrepaired until after age two.
When the diagnosis of gonococcal urethritis is confirmed, which of the following is the treatment of choice?
A. Ceftriaxone (Rocephin)
B. Amoxicillin (Amoxil)
C. Penicillin G benzathine (Bicillin LA)
D. Doxycycline (Vibramycin)
(c) A. Ceftriaxone is recommended therapy for gonococcal urethritis.
Which of the following can be used to treat chronic bacterial prostatitis? A. Penicillin B. Cephalexin (Keflex) C. Nitrofurantoin (Macrobid) D. Levofloxacin (Levaquin)
(c) D. Chronic bacterial prostatitis (Type II prostatitis) can be difficult to treat and requires the use of fluoroquinolones or trimethoprim-sulfamethoxazole, both of which penetrate the prostate.
Which of the following is most frequently associated with bladder cancer? A. Hematuria B. Dysuria C. Urgency D. Frequency
(c) A. Significant persistent hematuria >3 RBC/HPF on three urinalyses, a single urinalysis with >100 RBC, or gross hematuria, identifies significant renal or urologic lesions. Bladder cancer usually presents with painless hematuria.
A 35 year-old pregnant patient presents with fever, chills, and left-sided flank pain. On physical examination left-sided CVA tenderness is noted. Urinalysis reveals numerous white blood cells and white blood cell casts. Which of the following is the most appropriate treatment?
A. Oral ciprofloxacin (Cipro)
B. Oral trimethoprim-sulfamethoxazole (Bactrim)
C. IV gentamicin (Garamycin)
D. IV ceftriaxone (Rocephin)
(c) D. IV cephalosporins are first line treatment of pyelonephritis in a pregnant patient, followed by oral step-down therapy.
The most definitive treatment for primary enuresis is
A. oxybutynin chloride (Ditropan).
B. imipramine (Tofranil).
C. trimethoprim-sulfamethoxazole (Bactrim).
D. desmopressin (DDAVP).
(c) D. Intranasal desmopressin is effective in 50% of patients treated and is the treatment of choice.
A male patient complains of chronic dysuria, frequency, and urgency with associated perineal pain. The most likely diagnosis is A. cystitis. B. gonococcal urethritis. C. epididymitis. D. prostatitis.
(c) D. Some patients are asymptomatic, but low back or perineal pain, fever, chills, and irritative urinary symptoms
are common in prostatitis.
A 40 year-old female G5P5 complains of small quantities of urine leaking when she coughs, sneezes, or laughs. Her genitourinary examination is unremarkable and her urinalysis is normal. At this time, which of the following is the most appropriate management plan?
A. Refer for a cystoscopy.
B. Recommend Kegel exercises.
C. Refer for surgical correction.
D. Recommend hormone replacement therapy.
(c) B. Strengthening the pelvic muscles by Kegel exercises and emptying the bladder frequently may resolve the problem.
Which of the following diagnostic findings in the urinary sediment is specific for a diagnosis of chronic renal failure? A. Hematuria B. Proteinuria C. Broad waxy casts D. Hyaline casts
(c) C. Broad waxy casts in urinary sediment are a specific finding in chronic renal failure.
Which of the following is the most likely physical examination finding in a patient with Peyronie’s disease?
A. inflammation of the glans of the penis
B. foreskin that cannot be retracted
C. chancre on the shaft of the penis
D. fibrous band on lateral portion of the penis
(c) D. Peyronie disease typically presents with fibrotic areas under the penile skin along with a history of penile curvature during erection.
A male patient presents with hematuria. Upon further questioning the patient states that the hematuria occurs at the end of his urinary stream. Which of the following is the most likely source of blood? A. renal pelvis B. bladder neck C. anterior urethra D. ureter
(c) B. Terminal hematuria, blood at the end of the urinary stream, suggests a bladder neck or prostatic urethral source.
A 20 year-old male presents with a hard mass on the testicle. There has been no previous infection or trauma to the area. Which of the following is the initial diagnostic evaluation to pursue?
A. serum alpha fetoprotein levels
B. serum human chorionic gonadotropin hormone
C. CT scan of the pelvis
D. ultrasound of the testicles
(c) D. An ultrasound of the testes will enable the clinician to discriminate between testicular tumors and epididymitis, orchitis, hematomas, hydroceles, and infiltrative diseases of the testes.
A 34 year-old male presents with symptoms of painful urethral discharge. History reveals recent (7 days ago) intercourse with a new partner. A Gram stain is negative for intracellular diplococci. Assuming no allergies, which of the following is the antibiotic of choice? A. doxycycline B. penicillin G C. ciprofloxacin (Cipro) D. cephalexin (Keflex)
(c) A. Tetracyclines, such as doxycycline, are drugs of first choice for Chlamydia.
The most effective preventive strategy to prevent recurrence of renal lithiasis is which of the following?
A. increase in hydration
B. early treatment of urinary tract infection
C. limitation of calcium intake
D. use of probenecid
(c) A. Keeping the urine dilute is the most effective strategy to prevent crystal accumulation in the urine and the development of urinary stones.
A urinalysis performed during a routine physical examination on a 43 year-old male reveals 1-2 hyaline casts/HPF. The remainder of the UA is normal. Based upon these results, the physician assistant should
A. collect a urine for culture and sensitivity.
B. do nothing, since these casts are considered normal.
C. refer the patient to a nephrologist.
D. schedule the patient for a CT scan.
c) B. Hyaline casts are not indicative of renal disease. They can be found following strenuous exercise and with concentrated urine or during a febrile illness.
Which of the following is the most common composition of kidney stones? A. calcium oxalate B. uric acid C. struvite D. calcium phosphate
(c) A. Approximately three fourths of all kidney stones are comprised of calcium oxalate.
When treating a patient with BPH who complains of increased frequency, urgency, decreased force of stream and hesitancy with an alpha-adrenergic blocking agent, the patient should be warned of what possible side effect? A. hypertensive crisis B. postural hypotension C. development of prostate cancer D. development of testicular cancer
(c) B. This class of medications can cause postural hypotension as a result of the decrease in peripheral vascular resistance and lower arterial blood pressure by causing relaxation of the arterial and venous smooth muscle.
A 7 year-old boy wets the bed nearly every night. Which of the following is the best pharmaceutical agent to use in treating this patient? A. desmopressin (DDAVP) B. paroxetine (Paxil) C. lorazepam (Ativan) D. hyoscyamine (Levsin)
(c) A. Desmopressin, while not curative, will relieve symptoms.
Which of the following is the treatment of choice for a nursing home patient who has asymptomatic bacteriuria with no history of diabetes or structural abnormalities of the genitourinary tract?
A. ciprofloxacin (Cipro)
B. sulfamethoxazole-trimethoprim (Bactrim) C. cephalexin (Keflex)
D. no treatment is needed
(c) D. Asymptomatic bacteriuria is commonly seen in the geriatric population and no treatment is needed as long as the patient is not diabetic or has no structural abnormalities of the genitourinary tract.
