GU GYN

Question 1

What are the most common causes of dysuria in men and women?

Answer 1

In women: cystitis, urethritis, vaginitis. In men: prostatitis, urethritis.

Question 2

How does the presentation of dysuria in a patient with urethritis differ from a patient with cystitis?

Answer 2

Urethritis often presents with burning during urination and urethral discharge, while cystitis presents with urinary urgency, frequency, and suprapubic discomfort.

Question 3

A sexually active female presents with dysuria but has no bacteria on urinalysis. What is the next step in evaluation?

Answer 3

Consider testing for sexually transmitted infections (STIs) such as chlamydia and gonorrhea, which can cause urethritis.

Question 4

What is the most common cause of bacterial cystitis?

Answer 4

Escherichia coli.

Question 5

How is cystitis differentiated from pyelonephritis?

Answer 5

Cystitis presents with urinary urgency, frequency, and dysuria, while pyelonephritis includes systemic symptoms like fever, flank pain, and nausea/vomiting.

Question 6

What are the treatment options for uncomplicated cystitis in women?

Answer 6

Nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin.

Question 7

What are the hallmark signs of pyelonephritis?

Answer 7

Fever, chills, flank pain, costovertebral angle (CVA) tenderness, and nausea/vomiting.

Question 8

What is the most appropriate initial imaging study for a patient with pyelonephritis and suspected obstruction?

Answer 8

Renal ultrasound or non-contrast CT abdomen/pelvis to assess for hydronephrosis or stones.

Question 9

A patient with pyelonephritis is not improving after 48 hours of IV antibiotics. What is the next step?

Answer 9

Consider a repeat urine culture and imaging to rule out abscess or obstruction.

Question 10

What are the key differences between acute and chronic bacterial prostatitis?

Answer 10

Acute prostatitis presents with fever, dysuria, and perineal pain, while chronic prostatitis causes recurrent UTIs and pelvic discomfort without systemic symptoms.

Question 11

How is bacterial prostatitis treated?

Answer 11

Fluoroquinolones (ciprofloxacin) or trimethoprim-sulfamethoxazole for 4-6 weeks.

Question 12

Why should vigorous prostate massage be avoided in acute bacterial prostatitis?

Answer 12

It can lead to bacteremia and sepsis.

Question 13

What are the most common causes of epididymitis in men <35 and >35 years old?

Answer 13

<35: Chlamydia trachomatis and Neisseria gonorrhoeae. >35: E. coli and other gram-negative bacteria.

Question 14

What physical exam finding differentiates epididymitis from testicular torsion?

Answer 14

Epididymitis has a positive Prehn’s sign (pain relief with scrotal elevation), whereas torsion does not.

Question 15

How is epididymitis treated?

Answer 15

STI-related: Ceftriaxone + doxycycline. Non-STI: Fluoroquinolones (levofloxacin).

Question 16

What is the most common viral cause of orchitis?

Answer 16

Mumps virus.

Question 17

A patient presents with unilateral testicular pain and swelling following a viral prodrome. What is the likely diagnosis?

Answer 17

Viral orchitis.

Question 18

How is orchitis managed?

Answer 18

Supportive care with NSAIDs, scrotal elevation, and ice packs. If bacterial, treat based on suspected pathogens.

Question 19

What are the recommended first-line treatments for chlamydia and gonorrhea?

Answer 19

Chlamydia: Doxycycline for 7 days. Gonorrhea: Ceftriaxone IM + doxycycline (to also cover chlamydia).

Question 20

How is primary syphilis diagnosed?

Answer 20

Positive darkfield microscopy or serologic testing (RPR/VDRL followed by treponemal test).

Question 21

A patient presents with a painless genital ulcer. What is the most likely diagnosis?

Answer 21

Primary syphilis.

Question 22

What are the two most common causes of acute scrotal pain?

Answer 22

Testicular torsion and epididymitis.

Question 23

A patient presents with severe testicular pain of sudden onset. What is the first imaging test of choice?

Answer 23

Doppler ultrasound of the scrotum.

Question 24

Why is testicular torsion a urologic emergency?

Answer 24

Prolonged ischemia (>6 hours) can lead to testicular necrosis.

Question 25

What is the most common cause of a painless testicular mass?

Answer 25

Testicular cancer.

Question 26

How is a hydrocele differentiated from a varicocele?

Answer 26

Hydroceles transilluminate; varicoceles feel like a “bag of worms” and do not.

Question 27

A firm, painless testicular mass is found on exam. What is the next step?

Answer 27

Scrotal ultrasound and serum tumor markers (AFP, beta-hCG, LDH).

Question 28

What is the most common type of kidney stone?

Answer 28

Calcium oxalate.

Question 29

What are the characteristic symptoms of nephrolithiasis?

Answer 29

Colicky flank pain radiating to the groin, hematuria, nausea/vomiting.

Question 30

What imaging modality is preferred for diagnosing nephrolithiasis?

Answer 30

Non-contrast CT abdomen/pelvis.

Question 31

What are the three most common causes of vaginitis?

Answer 31

Bacterial vaginosis, candidiasis, trichomoniasis.

Question 32

What is the characteristic discharge for bacterial vaginosis?

Answer 32

Thin, grayish-white, fishy-smelling discharge.

Question 33

What is the first-line treatment for trichomoniasis?

Answer 33

Metronidazole 2g oral single dose.

Question 34

What are the diagnostic criteria for PID?

Answer 34

Lower abdominal pain, cervical motion tenderness, adnexal tenderness, and fever.

Question 35

What are potential complications of untreated PID?

Answer 35

Infertility, ectopic pregnancy, chronic pelvic pain.

Question 36

What is the recommended outpatient treatment for PID?

Answer 36

Ceftriaxone IM + doxycycline for 14 days.

Question 37

What are the differences between primary and secondary dysmenorrhea?

Answer 37

Primary: No pelvic pathology, due to prostaglandin release. Secondary: Due to endometriosis, fibroids, or adenomyosis.

Question 38

What is the first-line treatment for primary dysmenorrhea?

Answer 38

NSAIDs and hormonal contraception.

Question 39

What is the most common cause of abnormal uterine bleeding in reproductive-age women?

Answer 39

Anovulation (polycystic ovary syndrome, perimenopause).

Question 40

What is the most common location for ectopic pregnancy?

Answer 40

Fallopian tube.

Question 41

What is the most common benign breast tumor in young women?

Answer 41

Fibroadenoma.

Question 42

What are the red flag signs of breast cancer?

Answer 42

Painless lump, nipple retraction, peau d’orange skin changes.

Question 43

What is testicular torsion?

Answer 43

Testicular torsion occurs when the spermatic cord twists, cutting off blood supply to the testicle, leading to ischemia and potential testicular necrosis.

Question 44

What is the most common age group affected by testicular torsion?

Answer 44

Adolescents between 12-18 years old, but it can occur at any age.

Question 45

What is the classic presentation of testicular torsion?

Answer 45

Sudden, severe unilateral testicular pain with nausea, vomiting, and a high-riding, swollen testicle.

Question 46

How does testicular torsion differ from epididymitis on physical exam?

Answer 46

Testicular torsion has negative Prehn’s sign (lifting the scrotum does not relieve pain) and an absent cremasteric reflex. Epididymitis has positive Prehn’s sign and a normal cremasteric reflex.

Question 47

What is the significance of the absent cremasteric reflex in testicular torsion?

Answer 47

It indicates loss of the normal reflexive contraction of the cremaster muscle, a hallmark sign of testicular torsion.

Question 48

What is the most reliable imaging test for diagnosing testicular torsion?

Answer 48

Doppler ultrasound of the scrotum, which shows absent or decreased blood flow to the affected testicle.

Question 49

Why is immediate surgical intervention necessary for testicular torsion?

Answer 49

Prolonged torsion (>6 hours) can lead to testicular infarction and permanent loss of function.

Question 50

What is the treatment for testicular torsion?

Answer 50

Immediate surgical detorsion and orchiopexy (fixation of both testicles to prevent recurrence).

Question 51

If surgery is not immediately available, what bedside maneuver can be attempted for testicular torsion?

Answer 51

Manual detorsion, rotating the affected testicle outward (like “opening a book”), but surgery is still required.

Question 52

What is the prognosis of testicular torsion if treated within 6 hours?

Answer 52

Nearly 100% testicular salvage rate if detorsed within 6 hours; after 12 hours, the salvage rate drops significantly.

Question 53

What are possible complications if testicular torsion is not treated in time?

Answer 53

Testicular infarction, atrophy, loss of fertility, and potential psychological effects.