Which region of the prostate is most responsible for symptoms of benign prostate hyperplasia?
What is the mainstay of therapy for stage D prostate cancer?
Androgen ablation therapy
What disorder must be considered in patients who have irritative bladder symptoms, such as frequency, hesitancy, dysuria, and irritability, in the absence of urinary tract infection?
Which of the following substances composes most renal stones?
Which of the following is characterized by leakage of urine that occurs while coughing?
Which of the following is a serum marker for seminoma?
Which of the following medications is contraindicated in patients who take sildenafil?
Which of the following treatments is the best management for obstructive pyelonephritis secondary to an obstructing urethral stone?
Intravenous antibiotics and emergency stent placement
Which of the following substances compose infection stones?
Magnesium ammonium phosphate
Which of the following produces fructose?
An adult patient presents with blunt renal trauma and gross hematuria and is hemodynamically stable. Which of the following is immediately required?
Computed tomography scan
Which of the following statements is characteristic of testicular torsion?
It is commonly associated with loss of the ipsilateral cremasteric reflex
A 54-year-old man comes to the urgent care clinic with the acute onset of back pain. His vital signs are stable. He has point tenderness over the spinous process of T11. Rectal examination shows normal tone, brown, guaiac-negative stool, and a large nodule. There is a 3/5 strength on the left and 5/5 strength on the right to dorsiflexion of the great toes. An MRI of the spine shows multiple lesions consistent with metastatic disease in the spine, and a compression deformity of T11 with spinal cord impingement. The patient is felt to have metastatic prostate cancer. An MRI of the prostate can be done in patients for preoperative staging. It has a sensitivity of 38% for spread of disease beyond the capsule of the prostate, but a specificity of 97%. Based on this data, which of the following is true concerning an MRI of the prostate?
It would be a poor screening test to pick up disease in this patient
A 25-year-old man is admitted to the hospital for chemotherapy treatment of metastatic seminoma. He presented three weeks ago with painless testicular mass and underwent orchiectomy, yielding a diagnosis of seminoma. A CT scan of the abdomen confirmed metastatic disease to the retroperitoneal lymph nodes. His temperature is 37.1o C (98.8oF). He is well appearing, heart is regular without murmurs, lungs are clear, and abdomen is benign. Some postsurgical changes are present on inspection of the genitals. Laboratory studies show a leukocyte count of 6500/L, hematocrit of 45%, platelets of 359,000/L blood urea nitrogen 12 mg/dL, and creatinine of 0.6 mg/dL. Soon after his admission chemotherapy orders are finished, he states that he has changed his mind with regard to therapy and says that he now “has found God and feels that God alone will cure his disease". What’s the most appropriate management at this time?
Discuss his religious beliefs and point out the benefits chemotherapy will offer him
A 33-year-old construction worker was walking along a steel beam when he fell, straddling the beam. There was no loss of consciousness. He was brought to the emergency department complaining of pain to his testes and perineum. On physical exam, his vital signs are stable, his abdomen is soft, and his bladder is palpable almost halfway to the umbilicus. There is no evidence of flank or back ecchymosis. Genital examination reveals gross blood at the urethral meatus. There is a butterfly pattern of ecchymosis over the scrotum and perineum, his testicles are palpable and mildly tender. The prostate is normal in location, size and consistency. He complains of the urge to urinate but only a few drops of fresh blood appear at the meatus. What is the next best step in management?
Order a retrograde urethrogram
A 65-year-old African American man comes to the clinic complaining of urinary hesitancy. He has been treated for benign prostatic hyperplasia with tamsulosin for the past two months. The patient states that for the past two days his urinary stream has become progressively weaker until the day of presentation when all he can do is “dribble a few drops” of urine. He feels the constant urge to urinate and admits to episodes of incontinence when he was unable to get to the bathroom in time. He is not leaking urine when he coughs or sneezes. He denies any dysuria, hematuria, fever, chills, or previously similar episodes. Physical examination reveals an uncomfortable male with normal bowel sounds. In the lower abdomen there is a palpable mass, dull to percussion, extending from the suprapubic area superiorly to the level of the umbilicus. The mass is nontender, smooth, slightly mobile, and firm. Significant laboratory data include a serum BUN of 43 mg/dL and a creatinine of 2.6 mg/dL. Prostate specific antigen is 11.4 ng/dL, He is unable to provide a urine sample. What is the most appropriate next step in management?
Place a Foley catheter
A 64-year-old man comes to the office complaining of “red urine.” For the past 11 years, he has been treated for diabetes and hypertension, and he has never mentioned blood in his urine before. There is no pain associated with the blood, and it occurs about once a week and persists through the entire urinary stream. The first episode was about six weeks ago, but he did not seek treatment because the bleeding stopped on its own. However, it has now persisted on a weekly basis and he is concerned. He denies fevers, back or abdominal pain, weight loss, history of urinary tract infection, or renal stones. Physical examination reveals no changes since his health maintenance examination eight months prior. Urinalysis shows 12 to 14 red blood cells, 0 to 1 white blood cells, negative nitrite, and negative leukocyte esterase. Urine culture shows no growth. Complete blood count and biochemical profile are normal. Prostate specific antigen is 1.1 ng/mL. A cystoscopy reveals a raised papillary frond, 1 cm in size, over the trigone. It is consistent with transitional cell carcinoma of the bladder. What is the most appropriate next step in management?
Resect the lesion through the cystoscope
A 90-year-old man comes to the clinic for follow up appointment. He has a history of chronic obstructive pulmonary disease and hypertension. He feels well and denies fever, weight loss, or any other problems. A complete physical examination performed during his last visit one month ago. At that time, a prostate nodule was discovered on a digital rectal examination. He was referred to a urologist. A transrectal biopsy of the prostate was performed two weeks ago and reveals a Gleason grade 7 carcinoma. What is the most appropriate next step in the management of this patient?
Order a bone scan
A just completed study sponsored by the National Institutes of Health examined differences in rates of survival for men ages 65 to 75 who were diagnosed with prostate cancer. For all cases, the cancer was first identified based on PSA readings and then confirmed by biopsy. The study shows 10-year survival rates for patients receiving standard radiation treatment, targeted radiation pellets, and surgical intervention. Based on the data derived from this study, life expectancy for patients diagnosed with prostate cancer who elect surgical intervention is best estimated as which of the following:
A 60-year-old man is diagnosed with prostate cancer and elects therapy with radiation pellets. After his initial treatment he seems pleased at the process, but asks whether he "will be alive in 10 years to see my daughter graduate from college?" Based on the available graph, what is the most appropriate response?
“It is possible but less than a 50/50 chance.”
A previously healthy 12-year-old boy is brought to the emergency department by his mother because of a 4-hour history of acute right testicular pain. The patient denies a history of trauma and he has never experienced this type of dull, achy visceral pain before. He has tried some nonsteroidal anti-inflammatory drugs that his mother gave him with marginal relief. A urinalysis is negative. His temperature is normal. His right testicle is tender to palpation and larger as compared to the other side. There is probable blue dot sign with normal lie to the testicle. The cremasteric reflex is not observed. What is the most appropriate next step?
Prepare the patient for immediate surgery for exploration
A previously healthy 43-year-old man comes to the office complaining of a 1-week history of left scrotal swelling. He initially noticed it shortly after moving furniture. He denies any nausea, vomiting, change in bowel habits, abdominal pain, or urinary tract symptoms. On examination, he has an enlarged left hemi-scrotum with a reducible mass that is clearly distinct from the testicle. With the mass reduced, the patient performs the Valsalva maneuver and a protrusion at the external inguinal ring is noted. Also, the testicles appear normal in size and consistency when the mass is reduced. Which of the following statements is correct regarding this patient’s condition?
This mass may become strangulated
A 30-year-old healthy man comes to the employee health clinic complaining of a constant dull, achy feeling in his left testicle. It started two weeks ago. He denies any trauma, dysuria, fever or chills, unprotected sexual activity, or prior similar episodes. On physical examination, the right testicle is normal in location, size, and consistency. The left testicle is enlarged, hard, irregular, and nontender to palpation. There is no trans-illumination of light through this scrotal mass. Serum beta hCG and AFP levels are elevated. At this time, which of the following statements is most correct about this condition?
Radical orchiectomy is the first line of treatment