FNP GU and mens health

A male child has a swelling in the upper thigh below the inguinal ligament with cramping and abdominal pain. What is in the NP's differential diagnosis? -Testicular torsion -Femoral hernia -Varicocele -Hydrocele

-Femoral hernia

Which of the following drugs is classified as a 5-alpha reductase inhibitor? -Terazosin (Hytrin) -Tamsulosin (Flomax) -Finasteride (Procar) -Sildenafil (Viagra)

-Finasteride (Procar), it lowers serum testosterone and decreases the size of the prostate

The single most important risk for developing UTI in women is? -Constipation -Infrequent voiding -Drinking caffeinated beverages -Frequent sexual activity

-Frequent sexual activity

A patient presents with hematuria, RBC casts, and proteinuria. What is a likely explanation? -Acute tubular necrosis -Chronic renal insufficiency -Glomerular disease -Prerenal disease

-Glomerular disease

A patient with urinary burning, frequent, and urgency is found to have positive leukocytes and negative nitrites. A likely explanation is that the patient? -Has a kidney stone -Could be pregnant -Has an STD -Is taking an antibiotic

-Has an STD

An early indication that a young patient has renal artery stenosis is? -Decreased urine production -Increased blood pressure -Decreased glomerular filtration rate (GFR) -Coarctation of the aorta

-Increased blood pressure

A 50 y/o male patient reports that he has a sensation of scrotal heaviness. He reports that the sensation is worse at the end of the day. He denies pain. What is the likely etiology of these symptoms? -Strangulated hernia -Inguinal hernia -Epididymitis -Hydrocele

-Inguinal hernia

Hesselbach's triangle forms the landmark for? -Inguinal hernia -Femoral hernia -Abdominal hernia -Umbilical hernia

-Inguinal hernia

All of the following are considered risk factors for urinary tract infections in women except? -Diabetes mellitus -Diaphragms and spermicide use -Pregnancy -Intrauterine device

-Intrauterine device

What is the recommendation for screening a 40 y/o caucasian male? -Digital rectal exam -PSA -Digital rectal exam and PSA -He should be screened starting at age 50 years

-Digital rectal exam

A 73 y/o patient is thought to have BPH. Which tests would be a part of the initial workup? -Digital rectal exam (DRE) only -Digital rectal exam, urinalysis, PSA -PSA only -PSA,DRE,BUN,Cr

-Digital rectal exam, urinalysis, PSA

Which of the following increases the prostate-specific antigen (PSA) insignificantly? -Digital rectal exam -Ejaculation -Prostatitis -Prostate biopsy

-Digital rectal exam. Leads to transient increase of 0.26-0.4ng/ml for 48-72 hours after

A 25 y/o patient with subacute bacterial epididymitis should be treated initially with? -An oral quinolone -Doxycycline -Anti-inflammatories and analgesics -Ice and scrotal support

-Doxycycline, because the most likely organism is Chlamydia

A patient who is found to be pregnant has asymptomatic bacteriuria. What is the likely pathogen? -Klebsiella -E. coli -Stap saprophyticus -No pathogen

-E. coli. she should be treated with an antibiotic because she is at high risk to develop pyelonephritis. Nitrofurantoin is safe for pregnancy and has good coverage for most UTI pathogens including E.coli

The most common pathogen associated with pyelonephritis is? -E.coli -H.influenzae -Streptococcus sp. -Staphylococcus sp.

-E.coli

Which of the following lab tests is a sensitive test for evaluating renal function? -Electrolyte panel -Estimated glomerular filtration rate (eGFR) -Creatinine -Blood urea nitrogen (BUN)

-Estimated glomerular filtration rate (eGFR)

The NP is evaluating patients who are at high risk for complications due to urinary tract infections. Which of the following patients does not belong in this category? -A 38 y/o diabetic patient with an A1C of 7.5%. -A woman with rheumatoid arthritis who is being treated with methotrexate and low dose steroids. -A pregnant woman -A 21 y/o woman who has a history of irritable bowel syndrome.

-A 21 y/o woman who has a history of irritable bowel syndrome.

The way that 5-alpha-reductase inhibitors work is that they produce? -Dilation of the detrusor muscles -A decrease in the size of the prostate -Increase blood flow to the prostate -Inhibition of the prostate tissue synthesis

-A decrease in the size of the prostate

A patient with testicular torsion will have? -A positive cremasteric reflex on the affected side. -A negative cremasteric reflex on the affected side -Positive cremasteric reflex bilaterally -Negative cremasteric reflex bilaterally

-A negative cremasteric reflex on the affected side

A 22 y/o male patient has symptoms of burning with urination. Which assessment below is least important at this time? -Body temperature -Full genital exam and rectal exam -Abdominal exam -Assessment of CVA tenderness

-Abdominal exam

A 30 y/o male who is sexually active presents with pain with bowel movements. He is negative when checked for hemorrhoids but has a tender prostate gland. What should be suspected? -Acute bacterial prostatitis -Prostate cancer -BPH -Gonorrhea

-Acute bacterial prostatitis

A 35 y/o sexually active man presents with a 1-week history of fever and pain over the left scrotum. It is accompanied by frequency and dysuria. The scrotum is edematous and tender to the touch. He denies flank pain, nausea, and vomiting. He reports that the pain is lessened when he uses scrotal support briefs. The urinalysis shows 2+ blood and a large number of leukocytes. What is the most likely diagnosis? -Acute urinary tract infection -Acute pyelonephritis -Acute orchitis -Acute epididymitis

-Acute epididymitis

All of the following clinical signs and symptoms are seen early in testicular torsion except? -Nausea and vomiting -Absence of the cremasteric reflex -Affected testicle is elevated compared with the normal testicle -Affected testicle is swollen and feels cold to the touch

-Affected testicle is swollen and feels cold to the touch

What class of medication can be used to treat benign prostatic hyperplasia and provide immediate relief? -Alpha-1 blocker -5-alpha reductase inhibitors -Diuretics -Analgesics

-Alpha-1 blocker

A 40 y/o male has been diagnosed with acute bacterial prostatitis. His PSA (prostate-specific antigen) is elevated on the diagnosis. How soon should his PSA be rechecked? -About one week -1-2 weeks -2-4 weeks -At least 6 weeks

-At least 6 weeks

A patient with urolithiasis is more likely to? -Have frequent urinary tract infections -Be of male gender -Have chills and fever -Demonstrate RBC casts

-Be of male gender

A 65 y/o patient has a firm, non-tender, symmetrically enlarged prostate gland on examination. His PSA is 3.9ng/ml. This probably indicates? -Prostate cancer -Benign prostatic hypertrophy (BPH) -Prostate infection -A perfectly normal prostate gland

-Benign prostatic hypertrophy (BPH)

A 26 y/o female presents with flank pain that waxes and wanes. Her urine specimen indicates the presence of? -Blood -Nitrites -Leukocytes -Calcium

-Blood. These symptoms describe a patient who has a kidney stone, urolithiasis. The cause of the pain is usually movement of the stone and blood is always expected in the urine of these patients

A patient has been diagnosed with pyelonephritis. He probably will have? -CVA tenderness -A positive Murphys sign -Back pain -Pain which waxes and wanes

-CVA tenderness

According to the centers for disease control and prevention, which of the following is the recommended treatment for uncomplicated gonorrheal urethritis infection in an adult man? -Ceftriaxone (Rocephin) 250mg IM plus azithromycin 1g orally. -Valacyclovir (Valtrex) 500mg PO BID x 10 days. -Ceftriaxone (Rocephin) 250mg IM plus doxycycline 100mg orally BID for 14 days. -One dose of oral fluconazole (Diflucan) 150mg.

-Ceftriaxone (Rocephin) 250mg IM plus azithromycin 1g orally.

Which of the following is the most common cause of nongonococcal urethritis? -Escherchia coli -Chlamydia trachomatis -Neisseria gonorrhoeae -Mycoplasma gentialium

-Chlamydia trachomatis

A 76 y/o male presents with irritation after voiding. If sexually transmitted diseases and urinary tract infections are ruled out, what is another etiology? -Acute bacterial prostatitis -Chronic prostatitis -Epididymitis -Asymptomatic bacteriuria

-Chronic prostatitis

An elderly patient with urinary frequency is found to have a UTI. What drug could produce arrhythmias in her? -Doxycycline -Amoxicillin -Ciprofloxacin -Macrodantin

-Ciprofloxacin. it is quinolone and has the potential to produce a prolongation of the QT interval

A 70 y/o male patient with a long history of hypertension is diagnosed with advanced chronic renal insufficiency. Lab reports would indicate? -Clear urine and elevated serum creatinine -Dark urine and elevated BUN/creatinine -Proteinuria that is worsening -Anemia, leukopenia, and thrombocytopenia

-Clear urine and elevated serum creatinine

A female patient who is 45 y/o states that she is having urinary frequency. She describes episodes of "having to go right now" and not being able to wait. Her urinalysis is normal. What is part of the differential? -Diabetes -Lupus -Stress incontinence -Asymptomatic bacteriuria

-Diabetes, related to the polyuria

A patient who has a radical prostatectomy 6 months ago comes to the nurse practitioner clinic. He complains of urinary incontinence since his surgery. This: -Is a common complication -Usually accompanies erectile dysfunction -Indicates a probably urinary tract infection -Will resolve in about 6 months

-Is a common complication

A patient has been taking saw palmetto. Why is this used? -It improves clotting of the blood -It improves urine flow -It decreases environmental allergies -It decreases the risk of colon cancer

-It improves urine flow

An elderly male patient is taking finasteride, a 5-alpha-reductase inhibitor. What effect might this have on PSA level? -It will increase -It will decrease -There is no predictable change -There will be no change

-It will decrease

An older female patient c/o episodes of incontinence when she laughs or sneezes. What would be the first line to treat her symptoms? -Kegel exercises -Prescribe an anticholinergic -Avoid caffeine and alcohol -Minimize fluids at nighttime

-Kegel exercises

The incidence of pyelonephritis is? -More common in children -Less common than UTI -Always associated with UTI -More likely in elderly males

-Less common than UTI

An older adult who lives at home develops a urinary tract infection. Which medication should be avoided if the patient has arrhythmias? -Trimethoprim -Trimethoprim-sulfamethoxazole -Levofloxacin -Macrodantin

-Levofloxacin

When a prostate gland is infected with bacteria or an STD. How long is the patient usually treated with antibiotics? -About 5 days -7-10 days -14 days -Longer than 14 days

-Longer than 14 days

A pregnant patient with urinary frequency is found to have a UTI. What drug is safest to treat this? -Doxycycline -Amoxicillin -Ciprofloxacin -Macrodantin

-Macrodantin

Which of the following actions is contraindicated in patients with acute prostatitis? -Massaging the infected prostate -Serial urine samples -Rectal exams -Palpation of the epididymis

-Massaging the infected prostate

A patient with dysuria has a urine specimen that reveals <10,000 bacteria and numerous trichomonads. How should this patient be managed? -Increased fluids and a urinary tract analgesic -Ciprofloxacin for 3 days -Metronidazole for 7 days -Ciprofloxacin and metronidazole

-Metronidazole for 7 days

A physically independent 75 y/o is living in an assisted living facility. She walks one mile daily on most days. She is beginning to have some memory issues but is otherwise healthy and takes only her "hormone". She is found to have asymptomatic bacteriuria. How should she be managed? -Repeat the urinalysis in 7 days -Treat her today with a one-day dose of an antibiotic -Monitor her for symptoms of a urinary tract infection -Repeat the urinalysis in 4 weeks

-Monitor her for symptoms of a urinary tract infection

Orchitis is caused by which of the following? -Mumps virus -Measles virus -Chlamydia trachomatis -Chronic urinary tract infections that are not treated properly

-Mumps virus

Which of the following medication classes should be avoided in men with benign prostatic hypertrophy (BPH)? -Alpha-blockers -Fluoroquinolones -Nasal decongestants -Beta-blockers

-Nasal decongestants

A pregnant patient is found to have positive leukocytes and positive nitrates in her urine. What medications should be given? -Doxycycline -Trimethoprim-sulfamethoxazole -Ciprofloxacin -Nitrofurantoin

-Nitrofurantoin

A localized tumor in the prostate gland is likely to produce? -Hematuria -Pelvic or low back pain -Frequent daytime voiding -No symptoms

-No symptoms

What symptom listed below may be seen in a male with BPH? -Dysuria -Nocturia -Low back pain -Pain with bearing down

-Nocturia. hesitency, urgency, post void dribbling and frequency are classic symptoms

A 21 y/o woman complains to you of a 1-week episode of dysuria, frequency, and a strong odor to her urine. This is her second episode of the year. The previous urinary tract infection occurred 3 months ago. What is the most appropriate follow-up for this patient? -Order a urinalysis and urine for C&S, and treat the patient with antibiotics. -Order a urine C&S and hold treatment until you get the results back from the lab. -Treat the patient with a 7-day course of antibiotics and order a urine C&S now and after she completes her antibiotics.

-Order a urinalysis and urine for C&S, and treat the patient with antibiotics.

An 84 y/o female recently started a medication to help with overactive bladder symptoms. Since taking the medication, she developed dry mouth and worsening constipation. She is most likely taking? -Oxybutynin (Ditropan) -Tamsulosin (Flomax) -Mirabegron (Mybetriq) -Finasteride (Procar)

-Oxybutynin (Ditropan)

Which of the following is associated with the highest incidence of erectile dysfunction? -Lamotrigine (Lamicatal) -Clonazepam (Klonopin) -Paroxetine (Paxil) -Doxepin (Sinequan)

-Paroxetine (Paxil)

An NP is teaching a 54 y/o woman with stress urinary incontinence about kegel exercises. The patient is instructed to tighten her pelvic floor muscles for a count of 10 and then to relax them for a count of 10. The NP instructs the patient that kegel exercises should be done consistently every day at what frequency? -Perform 30 exercises each time in the morning and evening. -Perform 20 exercises each time two times a day -Perform 15 exercises each time three to four times a day -Perform 10 exercises each time three times a day

-Perform 10 exercises each time three times a day

A patient has a UTI. What findings on a urine dipstick best describe a typical UTI? -Positive leukocytes -Positive nitrates -Positive leukocytes, positive nitrites -Positive nitrites and hematuria

-Positive leukocytes, positive nitrites

A quinolone used to treat a urinary tract infection would be contraindicated in a? -Pregnant patient -19 y/o female -Patient with hypertension -Patient with pyelonephritis

-Pregnant patient

Which of the following increases the risk of cryptorchidism? -Family history of hearing problems -Premature birth -Maternal iron deficiency anemia -Constipation

-Premature birth

A 75 y/o patient has a history of benign prostatic hyperplasia (BPH). Which of the following clinical findings is expected during the prostatic exam of this patient? -Prostate feels rubbery and uniformly enlarged -Prostate feels boggy and warm -Prostate feels hard and indurated -Presence of tender nodules on the lateral edge of the gland

-Prostate feels rubbery and uniformly enlarged

A healthy 32 y/o female has a fever, left flank pain, and nausea. What is the most likely diagnosis? -Urinary tract infection -Renal stone -Cholecystitis -Pyelonephritis

-Pyelonephritis

A patient presents with CVA tenderness, fever of 101 and she is anorexic. What is her likely diagnosis? -Diverticulosis -Renal stones -Pyelonephritis -Urinary tract infection

-Pyelonephritis. CVA tenderness and fever are typical of this diagnosis

A sexually active male patient presents with epididymitis. What finding is likely? -Abnormal urinalysis -Dysuria -Recent history of heavy physical exercise -Scrotal edema

-Recent history of heavy physical exercise

An adolecent has suspected varicocele. He has dull scrotal pain that is relieved by? -Standing -Recumbancy -Having a bowel movement -Elevation of the testicle

-Recumbancy

A 28 y/o male nurse tells the employee health nurse practitioner that he was treated for a urinary tract infection twice the previous year. The patient denies fever, flank pain, or urethral discharge during the visit. Which of the following is the best follow-up for this patient? -Refer the patient to the urologist -Prescribe the patient ofloxacin (Floxin) for 2 weeks instead of 1 week. -Advise the patient that he needs to void every 2 hours when awake. -Refer the patient to the local emergency department, because he has a very high risk of sepsis.

-Refer the patient to the urologist. UTI's are very rare in healthy young men

A 6-month-old male has a palpable cystic mass in his scrotum. His mother states that sometimes the size of his scrotum seems larger than today during the exam. How should this be managed? -Referral to urology as soon as possible -Referral to urology if this has not resolved in 6 months -Scrotal ultrasound should be ordered -Order a urine specimen to rule out infection

-Referral to urology if this has not resolved in 6 months

Your 35 y/o patient is being worked up for microscopic hematuria. All of the following are differential diagnoses of microscopic hematuria except? -Kidney stones -Bladder cancer -Acute pyelonephritis -Renal artery stenosis

-Renal artery stenosis

The following statements about benign prostatic hypertrophy are correct except? -It occurs in up to 50% of men older than 50 years of age. -Dribbling and nocturia are common patient complaints. -Saw palmetto is always effective in reducing symptoms -The PSA value is usually slightly elevated

-Saw palmetto is always effective in reducing symploms

Testicular torsion can produce? -Penile erythema -Scrotal edema -Scrotal erythema -Penile edema

-Scrotal edema

A male patient has epididymitis. His most likely complaint will be? -Burning with urination -Testicular pain -Scrotal pain -Penile discharge

-Scrotal pain

A common presentation of an inguinal hernia is? -Scrotal pain with a scrotal mass -A scrotal mass only -Scrotal pain and penile discharge -Abdominal pain and scrotal erythema

-Scrotal pain with a scrotal mass

Which of the following drugs is most likely to cause sexual dysfunction in males? -Selective serotonin reuptake inhibitors (SSRIs) -Angiotensin-converting enzyme (ACE) inhibitors -Amphetamines -Atypical antidepressants

-Selective serotonin reuptake inhibitors (SSRIs)

A 22 y/o male who is otherwise healthy complains of scrotal pain. His pain has developed over the past 4 days. He is diagnosed with epididymitis. What is the most likely risk factor? -Age -Sexual activity -Underlying hydrocele -Urinary tract infection

-Sexual activity

Acute prostatitis can present with all the following signs and symptoms except? -Fever and chills -Tenderness of the scrum on the affected side. -Perineal pain. -Slow onset of symptoms.

-Slow onset of symptoms.

A patient reports that her urine has a light green hue. She feels well otherwise. The most reason for this is? -Something she has eaten or drunk -An infection in the urinary tract -A stone in the upper urinary tract -A psychiatric illness

-Something she has eaten or drunk

A 68 y/o woman c/o leaking a small amount of urine whenever she sneezes, laughs, and or strains. The problem has been present for many months. The patient denies dysuria, frequency, and nocturia. The urine dipstick test is negative for white blood cells. red blood cells. ketones, and urobilinogen. What is the name of the condition? -Urge incontinence -Overflow incontinence -Urinary incontinence -Stress incontinence

-Stress incontinence

The cremasteric reflex is elicited by? -Asking the patient to open his or her mouth and touching the back of the pharynx -Hitting the biceps tendon briskly with a reflex hammer and watching the lower arm for movement. -Hitting the patellar tendon briskly with a reflex hammer and watching the lower leg for movement. -Stroking the inner thigh of a male patient and watching the testicle on the ipsilateral side rise up toward the body.

-Stroking the inner thigh of a male patient and watching the testicle on the ipsilateral side rise up toward the body.

Spermatogenesis occurs at the? -Vas deferens -Seminal vesicles -Testes -Epididymis

-Testes

A 35 y/o male patient reports the acute onset of scrotal pain after a 10-mile run. He has nausea and an asymmetric high-riding testis on the right side. His urine is within normal limits. What should be suspected? -Sports hernia -Epididymis -Testicular torsion -Prostatitis

-Testicular torsion

A 10 y/o boy complains of sudden onset of scrotal pain upon awakening that morning. He is also complaining of severe nausea and vomiting. During the physical exam, the NP finds a tender, warm, and swollen left scrotum. The cremasteric reflex is negative and the urine dipstick is negative for leukocytes, nitrites, and blood. The most likely diagnosis is? -Acute epididymitis -Severe salmonella infection -Testicular torsion -Acute orchitis What type of follow-up should this patient receive? -Refer him to a urologist within 48 hours. -Refer him to the emergency department as soon as possible. -Presecribe ibuprofen (Advil) 600mg QID for pain. -Order a testicular ultrasound for further evaluation.

-Testicular torsion -Refer him to the emergency department as soon as possible.

Which of the following clinical findings can mimic a case of testicular torsion but is not considered an emergent condition? -The "blue dot" sign -One swollen testicle with yellow-colored penile discharge -Acute onset of dysuria and frequency -A varicocele

-The "blue dot" sign

A 72 y/o male patient is found to have early renal insufficiency. The NP knows this because? -The serum creatinine is slightly elevated -There is protein in the urine -The blood pressure is elevated -The patient has evidence of anemia

-The serum creatinine is slightly elevated

The following PSA levels have been observed in a patient. What conclusion can be made following these annual readings? Year 1: 3.2ng/ml Year 2: 3.8ng/ml Year3: 4.2ng/ml -They are all within normal range -None are within normal range -There is a steady increase that is worrisome -There is a steady increase but not worrisome

-There is a steady increase that is worrisome. PSA less than 4 is normal, but a PSA velocity increse over .35ng/ml per year is associated with high risk of death from prostate cancer. This patient needs a biopsy from a urologist

How long should a female patient with an uncomplicated UTI be treated with an oral antibiotic like trimethoprim-sulfamethoxazole? -One day -Three days -Seven days -Ten days

-Three days

Noninfectious epididymitis is common in? -Soccer players -Truck drivers -Marathon runners -men who wear briefs

-Truck drivers

A female has a urine specimen that is positive for leukocytes and nitrates. There is blood in the specimen. An appropriate diagnosis is? -UTI -Asymptomatic bacteriuria -UTI with hematuria -UTI or chlamydia

-UTI with hematuria

A 14 y/o patient has an acute, painless groin swelling. What tool would yield the most information to identify the etiology of the swelling? -Abdominal radiographs -Ultrasound of the abdomen -Ultrasound of the scrotum -MRI of the scrotum

-Ultrasound of the scrotum

An older adult has begun to use over-the-counter diphenhydramine to help him go to sleep. What serious side effects can occur in older adults with this medication? -Urinary retention -Kidney stones -Prostatitis -Renal artery stenosis

-Urinary retention r/t potent anti-cholenergic effects

A 24 y/o female patient has been diagnosed with an uncomplicated UTI. Which assessment below is least important at this time? -Body temperature -Abdominal exam -Assessment of CVA tenderness -Vaginal exam

-Vaginal exam

A 17 y/o boy reports feeling something on his left scrotum. On palpation, soft and movable blood vessels that feel like a "bag of worms" are noted underneath the scrotal skin. The testicle is not swollen or reddened. the most likely diagnosis is? -Chronic orchitis -Chronic epidiymitis -Testicular torsion -Varicocele

-Varicocele

A Digital rectal exam may be performed on a male patient to assess his prostate gland. The position that is NOT acceptable for prostate assessment is? -While the patient is leaning over an exam table with arms folded over his abdomen. -Side-lying position with legs flexed toward the abdomen. -Supine with legs in stirrups -While kneeling

-While kneeling

A 44 y/o female patient is diagnosed with a urinary tract infection. Which bacteria count collected via "midstream, clean-catch" supports a diagnosis of UTI? -less than 10,000 bacteria -less than 25,000 bacteria -less than 50,000 bacteria -less than 100,000 bacteria

-less than 100,000 bacteria

Kegel exercises may be helpful for patients with what type of incontinence? -stress -urge-mixed -overflow

-stress

Balanitis is caused by: A) Staphyloccocus aureus B) Streptococcus pyogenes C) Candida albicans D) Trichomonads

C) Candida albicans

There is a higher risk of balanitis in which of the following conditions? A) Renal insufficiency B) Diabetes mellitus C) Graves' disease D) Asthma

B) Diabetes mellitus

The mother of an 11 y/o with sickle cell anemia calls on the phone because her son woke up with a painful penile erection that will not go away. The NP's most appropriate intervention is? -Insert a foley and measure the child's intake and output for the next 24 hours. -Insert a foley and obtain a specimen for urinalysis and urine C&S. -Recommend an increase in the child's fluid intake. -Recommend immediate referral to the emergency department.

Recommend immediate referral to the emergency department.

All of the following are true statements about sexuality in the older adult except? -Erectile dysfunction is very common -It may take longer to become aroused -The elderly are no longer interested in sexuality -Dyspareunia is a common symptom of atrophic vaginitis

The elderly are no longer interested in sexuality