Urology

What is the lowest number of colony forming units seen on urine culture that indicate a positive result?

10 ^ 5 / mL

A 28-year-old woman comes to the clinic with UTI symptoms for the first time in several years. She is sexually active in a monogamous relationship with her husband. She has no drug allergies. Assuming there are no resistance issues, which treatment regimen would be appropriate first-line therapy? a. Nitrofurantoin (Macrobid) 100 mg bid x 5 days b. Ceftriaxone (Cefazolin) 2 g q 24 hours x 3 days c. Amoxicillin 500 mg bid x 5 days d. Ciprofloxacin (Cipro) 500 mg bid x 3 days

A

A 50-year-old obese male who struggles from time to time with gout presents to the clinic having recently passed a kidney stone. He was not able to retrieve the stone for analysis. Based on the most likely make-up of his stone, which recommendation would be most appropriate for him? a. Avoid alcohol intake b. Increase dietary vitamin C c. Increase dietary fruits and vegetables d. Acidify urine

A

AE is a 30-year-old male who has had several stones over the past five years. Of the following contributing risk factors for stone production, listed in the article, which is considered modifiable? a. Fluid intake b. History of bowel surgery c. Chronic kidney disease d. Congenital abnormalities

A

A 50-year-old man presents with a complaint of gradual onset of pain and swelling in his left testicle, and fever. On physical examination he has a positive Prehn's sign. What is the most likely pathogen in this patient? a. E. coli b. Chlamydia c. Klebsiella d. Staphylococcus

A - E. Coli. This is Epididymitis

A 26-year-old man comes to the clinic for evaluation of a mass in his left hemiscrotum. He first noticed it several years ago and it has not changed in that time. On physical examination, a 4 cm mass can be felt superior and posterior to the testicle. The mass is soft, not tender to palpation, and distinct from the testicle. The testicle is non-tender and there are no nodules. Which of the following is the most appropriate treatment choice? A. No further work up or treatment B. Aspirate the mass with an 18 gauge needle C. Refer to urology for urgent evaluation D. Further evaluation is recommended if fertility is a concern

A - This is a spermatocele and no treatment is usually needed

A 22-year-old woman has been sexually active for three years, and now has a new boyfriend. She has a past history of two UTI's, always associated with sexual intercourse. Her past infections have resolved quickly with a short course of nitrofurantoin. She was treated for another UTI 10 days ago, but this time symptoms did not resolve. Which finding would trigger a more extensive work-up? a. Vaginal discharge b. Supra-pubic pain c. Hematuria d. Urgency

A - Vaginal Discharge

What is the most common composition of renal calculi?

Calicum

A 32 year old man presents to the urgent care with a concern of scrotal tenderness that began 3 days ago that has now worsened. PE reveals a temp of 100.7F, positive tenderness in the posterolateral aspect of the right testis, and swelling There is no spermatic cord tenderness with palpation and no transillumination present. What is the most likely diagnosis? A: Epididymitis B: Epididymo/orchititis C: Hydrocele D: Orchitis E: Testicular torsion

A: Epididymitis

A 32 year old man presents with a complaint of urinary frequency and suprapubic pain. He states he has been feeling poorly for the past 4 days with intermittent fever, chills, and persistent malaise. He denies feeling this way before. Physical exam is significant for a temp of 101 F. Genital exam is normal except for the finding of a tender, enlarged prostate on digital rectal exam. What is the most likely diagnosis? A: Acute bacterial prostatitis B: Benign prostatic hypertrophy C: Chronic Bacterial prostatitis D: Gonorrhea E: Prostatic abscess

A: Acute bacterial prostatitis

What is the initial treatment of choice for an adult patient diagnosed with phimosis? A: Broad-spectrum antibiotics B: Circumcision C: Dorsal Slit D: Immediate retraction of the foreskin E: Oral anti-fungal

A: Broad-spectrum antibiotics

Which of the following PE finding is found with hydrocele? A: Cystic scrotal mass B: Fever C: Enlargement with valsalva D: Painful testis E: Solid mass on upper pole of testis

A: Cystic scrotal mass

A 38 year old man presents with an abrupt onset of myalgia, low back pain, and perineal pain. The patient also reports urinary symptoms of frequency, urgency and dysuria. A urinalysis reveals 3+ WBCs, and urine culture confirms the presence of gram-negative bacteria. What is the initial therapeutic approach for this patient? A: Fluroquinolone for 4 weeks B: Fluroquinolone and alpha-blocker for 8 weeks C: Hospitalization with IV cephlasporin D: Nonsteroidal anti-inflammatory drugs and hot sitz baths for 48 hours E: Penicillin IM injection immediately

A: Fluroquinolone for 4 weeks

A 68 yr old male presents for concerns with inability to maintain erection. He uses Nitroglycerin as needed for unstable angina prescribed by his cardiologist in addition to his anti-hypertensive medications. His serum testosterone level is within normal limits. Which of the following initial treatments for ED is appropriate for this patient? A: Intraurethral alprostadil (MUSE) B: Penile Prosthesis C: Tadalafil (Cialis) D: Testosterone Gel (Androgel) E: Yohimbine (Yohimbe)

A: Intraurethral alprostadil (MUSE)

Which of the following history findings is seen in patients with ED and is linked to its mechanism of endothelial dysfunction? A: difficulty maintaining erection B: Dyspareunia C: Loss of libido D: Pain with erection E: Previous Pelvic surgery

A: difficulty maintaining erection

Which of the following urinary findings will be observed in a patient with noninflammatory non-bacterial prostatitis? A: negative urine culture with positive culture of expressed secretions B: Negative urine culture with negative culture of expressed secretions C: negative urine culture with elevated erythrocytes on microscopic D: Positive urine culture with positive culture of expressed secretions E: Positive urine culture with negative culture of expressed secretions

A: negative urine culture with positive culture of expressed secretions

A 33 year-old man presents concerned about an enlarged right scrotum he has had for about three years. The patient reports he has had no pain, fever, nausea or vomiting. On physical examination the right scrotum is twice the size of the left, cystic in nature and relatively soft to palpation. Scrotal contents cannot be distinguished with palpation. Which of the following would be the most appropriate next step in evaluating this patient? A. No further work up is indicated B. Scrotal ultrasound C. Semen analysis D. Aspirate with an 18 gage needle

B

A woman is 30 weeks pregnant and just completed treatment for her first UTI. She was asymptomatic and the culture was done because of a positive screening UA at her OB appointment. What follow up is indicated after treatment? a. No follow up for UTI if she is asymptomatic b. Repeat urine culture and do periodic UA's until delivery c. She should remain on prophylactic antibiotics until delivery d. No further work up, she should not have been treated for asymptomatic bacteriuria

B

An 18-year-old man is awakened in the middle of the night with severe left testicular pain and swelling. He has no fever, but complains of nausea. On further evaluation, which would you expect to see in this patient? A. Tender indurated left epididymis B. A high-riding, swollen, malrotated left testicle C. Improvement of symptoms with scrotal elevation and ice D. Fever, malaise, weight loss

B

BR is a 45-year-old male with a history of passing kidney stones. He has had right flank pain for about one week and went to the emergency department because of pain. A CT shows a 5 mm distal ureteral stone with obstruction. He decides to give it some more time to pass on its own. You recommend increasing fluid intake, prescribe an appropriate analgesic and a medication from which class of drugs that is known to facilitate stone passage? a. Beta blockers b. Alpha blockers c. Corticosteroids d. Benzodiazepine

B

Which of the following findings would be of most concern if found while examining a 26 year old healthy male patient? A: A left testis sitting higher than the right B: A non-tender mass on the testis C: A tender epididymis D: An enlarged, fluid - filled scrotum E: Dilated veins within the spermatic cord

B

A 24 year-old man presents to your clinic concerned about fertility. He and his wife have been trying to get pregnant for about one year. On self-examination he has felt a subtle swelling of his left hemiscrotum. On physical examination, his scrotum looks normal however, on palpation there is fullness and what feels like vasculature in the proximal left hemiscrotum. How would you describe this mass? A. A cystic lesion associated with the epididymis B. A grade II lesion C. A cystic lesion surrounding the testicle D. A grade III lesion

B - Grade 2 lesion of a Varicocele

A 52-year-old man presents to your clinic complaining that, "my right testicle is huge." He first noticed testicular swelling in the right testicle after a scrotal injury two years ago. The patient states that it has not changed size over the past year, but is large and gets in his way. On physical exam, the mass engulfs the right testicle. What further finding on physical exam would help make the diagnosis? A. The right testicle is normal in size, non-tender, with no nodules B. Mass transillumination C. The mass is tender to palpation D. Negative Prehn's sign

B - Mass Transillumination. This is a hydrocele

Which of the following lab is expected in a patient with prostatic enlargement causing obstruction? A: Decreased PSA B: Elevated serum creatinine C: Hematuria D: Leukocytosis E: Pyuria

B: Elevated serum creatinine

Upon genital examination of a newborn male, the urethral meatus is found located proximal to the tip of the glans of the ventral aspect of the penis. This finding is defined as which of the following conditions? A: Epispadias B: Hypospadias C: Phimosis D: Urethral Stricture E: Urethrorectal fistula

B: Hypospadias

A 60-year-old male presents with frequency and urgency to urinate. He gets up three or four times nightly to void. He has not had routine screening for prostate cancer. Physical exam reveals a moderately enlarged prostate. Diagnosis?

BPH

A 50-year-old woman comes to her gynecologist for an annual examination. Her routine lab work includes a PAP smear, CBC, BMP, HCG, a lipid profile and a urine dip-stick. She is healthy, runs three miles a day, takes no medications, and has no complaints at this visit. All labs were negative, except for the urine dip-stick that was positive for leukocytes and nitrites. How should this positive finding be managed? a. Send the urine for culture and sensitivity and treat only if bacteria grows out b. Treat empirically, no need to send for culture c. Don't treat and reconsider practice of screening UA's d. Initiate further work up for evaluation of asymptomatic bacteriuria

C

A 65-year-old man comes to the Urgent Care clinic complaining of urgency, frequency, and dysuria. He has noticed slowing of his urine flow over the past year and reports having some difficulty emptying his bladder. A urine dip-stick shows evidence of bacteria in the urine. What would be the best approach in managing his condition? a. Treat empirically with an antibiotic b. Only treat if nitrites are positive on a dip stick c. Treat empirically with an antibiotic and send urine for culture d. Start an antibiotic and order a CBC and BMP

C

Kidney stone formation in children is on the rise. Which of the following is stated in the article as a reason for the increase? a. Bottled water b. Soda consumption c. Obesity d. Computer games

C

A 72 year old man presents to the office with a chief complaint of a 3 month history of nocturia. He states he is upset by the dribbling he experiences after voiding, has been getting up 3x per night to urinate, andn sometimes he finds himself straining to void. What is the most reasonable initial therapeutic approach for this patient? A: Finasteride (Proscar) B: Fluid restriction before sleeping C: Tamsulosin (Flomax) D: Transurethral resection of the prostate E: Watchful waiting

C - Tamsulosin (Flomax)

A 30-year-old woman comes to the clinic with dysuria and frequency, but she denies supra-pubic pain or hematuria. She recalls a similar episode two years ago and was treated for a UTI; symptoms resolved. She is otherwise healthy, married, and has two children. What would be the best next step in managing her condition? a. Order a urine dipstick in clinic, treat if positive b. Order a CBC to evaluate for pyelonephritis c. Start her on an antibiotic d. Send urine for a culture and sensitivity before initiating treatment

C - You don't necessarily need to do a UA

Which of the following conditions would be best evaluated using urodynamic testing? A: Bladder Tumor B: Interstitial Cystitis C: Neurogenic Bladder D: Recurrent Cystitis E: Urethral stricture

C: Neurogenic Bladder

Which type of incontinence would a male patient most likely experience secondary to uncontrolled BPH? A: Neuropathic incontinence B: Nocturnal incontinence C: Overflow incontinence D: Stress incontinence E: Urge incontinence

C: Overflow incontinence

A 65 yr old female presents with complaint of urine leakage for the past 12 months. She states that she only notices leaking after sneezing or coughing, not with feelings of urgency. Urinalysis is normal. Which of the following treatments is appropriate at the initial stage of her treatment? A: Anticholinergic agent B: Intravesicular botulinum toxin A (Botox) C: Pelvic floor muscle training D: Surgical repair

C: Pelvic floor muscle training

A 65 yr old woman presents with a complaint of blood in her urine intermittently for the last month. She denies fever, chills, flank pain, dysuria, or frequency. Social history is positive for a 45 pack year history but she reports stopping smoking last year. What is the most likely cause of her hematuria? A: Acute cystitis B: Acute pyelonephritis C: Bladder Cancer D: Renal Calculus E: Urethral prolapse

C: Bladder Cancer

Which is the following is the most likely presenting symptom of bladder cancer? A: Dysuria B: Foul-Smelling Urine C: Hematuria D: Oliguria E: Urinary Frequency

C: Hematuria

On pelvic CT, a patient is found to have incidental bilateral hydronephrosis. Which of the following urinary symptoms would point to a urethral stricture as the cause of his findings? A: Dysuria B: Frequency C: Hesitancy D: Nocturia E: Urgency

C: Hesitancy

A 57 yr old female presents with complaints of increasing urinary urgency and pelvic pain. These symptoms have gradually worsened over the past 6 months to the point the patient gets up at night to void several times a night. The pain always improves after voiding. The patient is postmenopausal and denies any history of other urinary tract infections or leaking urine. On examination, there is no suprapubic pain with palpation and UA is negative. For which of the following disorders is this patient most at risk? A: Bladder Cancer B: Endometriosis C: Interstitial cystitis D: Overflow incontinence E: Urinary tract infection

C: Interstitial cystitis

Which of the following antibiotics is best for urinary tract infection due to Pseudomonas species?

Ciprofloxacin (Cipro)

A 34-year-old woman comes to the clinic with urinary urgency, frequency, dysuria and hematuria. She has had several infections over the past year, so you decide to send her urine for culture and sensitivity testing. While you are awaiting the results, you start her on an antibiotic. Which bacteria would be most important to cover initially? a. Staphylococcus saprophyticus b. Klebsiella c. Proteus mirabilis d. Escherichia coli

D - E. Coli

A 52 yr old male presents with concerns about problems with erections. After a full workup, he is diagnosed with organic ED. Which of the following modifications will decrease risk of progressive disease? A: Low carb diet B: Start SSRI C: Increase alcohol consumption D: Stop smoking E: Use lower extremities compression stockings

D: Stop smoking

A 23 year-old man presents to your clinic with "a bunch of stuff in my ball sac on the left". During physical exam, a mass is palpated in the left scrotum. With the patient supine on the exam table, his scrotum is raised and the palpable mass resolves. When he stands up again, the mass recurs. Which of the following is the most likely diagnosis? A. Epididymitis B. Testicular tumor C. Hydrocele D. Varicocele

D

A patient has a history of multiple episodes of renal calculi secondary to hypercalcemia. On lab analysis, levels of PTH are found to be consistently low. Which of the following is the most likely explanation for these lab findings? A: Dietary calcium excess B: Hyperthyroidism C: Malignancy D: Primary hyperparathyroidism E: Vitamin D intox

D

A 37 year old woman returns for re-eval after being treated for a urinary tract infection 5 days prior with oral antibiotics. She reports her symptoms have not gotten better and have even gotten worse with a new onset of fever and flank pain. Which of the following tests is an appropriate next step in her eval? A: Renal US B: Serum Creatinine C: Straight cath sample for dipstick UA D: Urine culture and sensitivity E: Urine cytology

D: Urine culture and sensitivity

A 28-year-old female presents with complaint of acute onset left flank pain, gross hematuria, and vomiting. She is pregnant, at 30 weeks. When producing a urine specimen in the office, she passes a 5 mm stone. If it were sent to a lab for analysis, what would be the most likely make-up of the stone? a. Struvite b. Uric acid c. Calcium oxalate d. Calcium phosphate

D: Calcium phosphate most common stone type in pregos.... Calcium oxalate is most common stone type in non-pregos

Which of the following findings on digital rectal exam is most concerning for cancer of the prostate? A: Bright red blood B: Decreased sphincter tone C: Enlargement D: Nodularity E: Pain

D: Nodularity

A 16 year old girl presents to the ED with a 1 day history of severe right flank pain with associated vomiting. She denies any fever, urgency, or dysuria. her PMH is unremarkable. PE revelas guarding and rebound on the right lower abdomen, along with severe right CVA tenderness. Which of the following radiological studies is indicated for this patient? A: Flat plate abdominal series B: Intravenous pyelogram (IVP) C: KUB D: Non-con spiral CT pelvis E: Urine cytology

D: Non-con spiral CT pelvis

A 72 yr old female presents with complaints of urine leakage for the past 4 months. She states that she leaks urine when she feels the urge to urinate and cannot stop it from occurring. Urinalysis is normal. In addition to bladder training, which of the following medications is first-line treatment for her symptoms? A: Darifenacin (Enablex) B: Finasteride (Proscar) C: Botox D: Oxybutin (Ditropan) E: Tamsulosin (Flomax)

D: Oxybutin (Ditropan)

Which of the following is an indication for circumcision? A: Balanoposthitis B: Cancer prevention C: Hypospadias D: Paraphimosis E: Peyronie Disease

D: Paraphimosis

Which of the following is an obstructive voiding symptom associated with BPH? A: Frequency B: Incontinence C: Nocturia D: Post Void Dripping E: Urgency

D: Post Void Dripping

A 34 year old female at 32 weeks gestation presents for an obstetric check. She denies urinary symptoms other than frequency, which she has had for the past 6 months and attributes to her pregnancy. Her urine dipstick, today and at her last visit were positive for leukocyte esterase. Urine culture proved bacteria count at > 10 ^ 5 CFU/mL. She was treated with an appropriate antibiotic for 7 days. Which of the following is best for the management of the patient at this point in her care? A: Extend antibiotic for 14 days total treatment B: perform cystoscopy C: Perform IV pyelogram (IVP) D: Repeat urine culture after treatment E: Refer to urology

D: Repeat urine culture after treatment

• 64 year old female • Just finished complete urologic evaluation for hematuria, everything is completely normal • Follow-up at 12 months shows microscopic hematuria again What is the next step??

Do a UA the following year and if that is clear of RBCs then get one more UA the next year. You need annual UAs for 2 years (both being clear of blood) following hematuria

• 60 year old male • Smokes one pack every other day • Significant voiding complaints—slow stream, hesitancy starting stream, starts and stops flow • UA: 3 RBCs on one microscopic exam What is the next step??

Do a full work up. This is a classic case of a patient who has bladder cancer until proven otherwise.

• 55 year old female • UA: 3+ blood, otherwise completely normal dip (protein negative) • Completely asymptomatic, blood found on routine annual PE • Vital signs all WNL • Quit smoking 10 years ago • Exercises regularly, runs 2-3 miles 3x/week Whats wrong with this picture?

Do not get a random screening UA. If the microscopic UA shows blood then do a work up!

Which anatomical portion of the prostate becomes hyperplastic in the process of benign prostatic hyperplasia? A: Anterior fibromuscular area B: Central zone C: Peripheral zone D: prostatic capsule E: transition zone

E

A 75 yr old women, G4P4, presents to establish care. Appearing healthy, denies any addition problems. When specifically asked she admits to having urinary incontinence for 'a couple of years' and now describes symptoms that have recently worsened. The patient experiences the need to void almost hourly and she now uses 4-5 adult incontinence pads per day to manage the urine she leaks. She denies leaking urine with coughing or sneezing. What is the most likely diagnosis? A: Acute Cystitis B: Interstitial cystitis C: Rectal prolapse D: Stress incontinence E: urge incontinence

E - Urge incontinence Treatment - Medication Oxybutin

A 32 year old female presents with fever, chills, and flank pain for 24 hours. She developed dysuria and urinary frequency 3 days prior and states that both have worsened. Which of the following findings most specifically confirms the likely diagnosis? A: 3+ red blood cells B: 3+ white blood cells C: Epithelial cells D: Hyaline casts E: White blood cell casts

E - White blood cell casts - these are pathognomonic for Pyelonephritis

A 56 year old male presents to the ED with complaints of a painful erection for the past 3 hours in the absence of sexual activity. His PMH is significant for sickle cell anemia. Based on this history, which of the following is the most likely diagnosis? A: Balanitis B: Paraphimosis C: Penile Fracture D: Peyronie Disease E: Priapism

E: Priapism

A 6 - month old boy is brought to the office by his mother for a follow up check for his right undescended testicle that has been absent since birth. This examination is consistent with previous examinations, revealing an empty right hemiscrotum. Even with surgical treatment, which of the following conditions is the patient at a higher risk of developing in later years? A: Epididymitis B: Hypospadias C: Orchitis D: Retrograde ejaculation E: Testicular Torsion

E: Testicular Torsion

What is the most common cause of recurrent urinary tract infections in a 4 yr old girl? A: Bladder diverticulum B: Congenitally shortened urethra C: Renal calculus D: Resistant organism E: Vesicoureteral reflux

E: Vesicoureteral reflux

A 69 yr old presents for his annual physical. When reviewing his urinary ROS he only complains of diminished force of the urinary stream and denies frequency, nocturia, or dysuria. He states that this symptom does not bother him. His prostate specific antigen (PSA) is 1.6 ng/mL. He scores a 6 on the AUA symptom score. Which of the following treatment options is appropriate for this patient? A: Finasteride (Proscar) B: Oxybutin (Ditropan) C: Tamsulosin (Flomax) D: TURP E: Watchful waiting

E: Watchful waiting

What is the most common pathogen associated with acute cystitis in female patients?

Escherichia Coli

A 28 yr old female presents with her fourth episode of culture confirmed cystitis in the past 6 months. Each episode clears completely with antibiotic treatment. She is currently trying to conceive with her partner and a has a sulfa allergy. Which regimen would be most appropriate for this patient as prophylaxis?

Nitrofurantoin (Macrobid) 50 mg daily

Which of the following conditions is defined as the inability to reduce the foreskin of the penis once it has been retracted? A: Hypospadias B: Paraphimosis C: Phimosis D: Urethral Meatal Stricture

Paraphimosis

• 24 year old female •UA dip + Blood • No risk factors • 1-2 red blood cells on a single microscopic UA • Father had bladder tumor removed five years ago What is the next step?

The microscopic UA is not significant because it only shows 1-2 RBCs.. you need 3+ to be significant

A 20 year old college football player presents with a chief complaint of a dull ache in his scrotum after prolonged standing on the sideline. It seems to get worse with vigorous activity and is relieved by lying down. Dilated veins in the left scrotum are observed on inspection, and both testicles are palpable without masses. What is the most likely diagnosis?

Varicocele

M asters and Johnson Four-Phase Model:

• Phase 1:Excitement • Phase 2: Plateau • Phase 3: Orgasm • Phase 4: Resolution