Questions- GU
A 72-year-old man is transported via ambulance to the emergency department with severe chest pain and shortness of breath. Electrocardiogram (ECG) reveals ST-segment elevation in leads II, III, and aVF. While in the emergency department, he loses consciousness and is found to be in ventricular fibrillation. Resuscitation is successful, and a pulse is restored within 3 minutes. He is taken to the cardiac catheterization laboratory, where he undergoes two-vessel stenting. Two days later, his creatinine has increased from a baseline of 1.1 to 2.2 mg/dL. The next day, the creatinine is 3.9 mg/dL. Fractional excretion of sodium is ordered. You would expect this to be
>1
Mr. Smith is a 65 year-old man who recently had his prostate-specific antigen (PSA) level drawn in your family practice. Last year his PSA level was 2.0 ng/ml and this year it is 3.5 ng/ml. He asks you if he should be concerned about his current PSA level. Which of the following statements is true?
A. Mr. Smith is at an increased risk for having prostate cancer because his PSA velocity is greater than 0.75 ng/ml/year.
A 56 year old male presents to your clinic complaining of erectile dysfunction. Given the most likely cause of this disorder, which of the following is the most pertinent question to ask this patient?
Are you currently being treated for high blood pressure or heart disease? While there are many causes for erectile dysfunction, cardiovascular disease and ED share many of the same risk factors, and sometimes ED can herald cardiovascular disease. Incidence of ED in patients with diabetes mellitus is also high. Given this fact, this question is the most pertinent to ask your patient.
A 65-year-old female presents to clinic for her annual pap smear. She is in good health but has mild hyperlipidemia, which is controlled with diet. She had a hysterectomy more than 10 years ago for dysfunctional uterine bleeding. How often should she have a pap smear?
According to the new 2010 ACOG guidelines, women who have no high-grade lesions or cervical cancer history, and are over 65, may discontinue cervical cancer screening due to the decrease risk and slow progression if disease does occur.
MCC of postrenal azotemia in men?
BPH
Respiratory acidosis is common in which of the following diseases?
COPD
DX test for Wilm's tumor
CT
what is used to stage Wilm's tumor?
CT
A 42 year old male presents to your emergency department complaining of sudden onset left flank pain. He is also complaining of some nausea and a few episodes of vomiting. He states that the pain radiates down to his left testicular area. What is the best diagnostic study to order at this time?
CT scan with out contrast
A 49 year old male presents for a one month follow-up to an initial reading of microscopic hematuria. He had come to your office to have a complete physical before beginning a new job. Routine urinalysis with microscopy at that time revealed microscopic hematuria. The patient denied dysuria, fevers, and flank pain. The findings of today's urinalysis with microscopy are unchanged. Which of the following is the next step in the evaluation of this patient's hematuria?
CT urography Asymptomatic microhematuria can be a finding associated with bladder cancer (urothelial cancer most common), and therefore a thorough evaluation is warranted in high risk groups. Those individuals at high risk include; smoking history, chemical or dye exposure, history of gross hematuria, history of urologic disorders or disease, age > 40 years, history of recurrent UTI despite adequate antibiotic use, presence of irritative voiding symptoms. This complete workup begins with imaging of the upper tract by CT urography to rule out stones, tumors, etc. It may then continue to cystoscopy with biopsy.
common causes of metabolic acidosis?
Common causes of Metabolic acidosis are DKA, Lactic acidosis, and aspirin overdose. Patients who have metabolic acidosis present with low pH and low bicarbonate
A 63 year old male presents to the clinic complaining of urinary changes. He states that he has a difficult time emptying his bladder and that he notices that he leaks urine throughout the day. He also states that the force of his stream has gradually grown weaker. Which of the following is the best screening method for this patient's suspected diagnosis?
DRE- best screening method BPH
Which of the following U.S. Preventive Services Task Force (USPSTF) recommendations for prostate cancer is correct?
DREs are not recommended and PSA screening is recommended based upon patient risk, but only after discussing the benefits and risks with the patient and the patient expressing the desire to have the examination performed.
What is the most common causitive pathogen in simple cystitis?
E. coli
Which of the following statements about anemia associated with CKD is TRUE?
It is due to the inability of the kidney to transform erythropoietin into its physiologically active form.
correct equation for calc of anion gap?
Na - (HCO3 + Cl)
What is the first line therapy in a patient with secondary erectile dysfunction?
Sildenafil
You are evaluating a 77-year-old male with stage 3 chronic kidney disease (CKD). He denies any complaints today. His renal function has been stable over the past 6 months. However, you note that his Hgb has decreased from 10 g/dl to 8.5g /dl despite erythropoietin injections. Hemoccult stool times 3 is negative. What should you do next?
Order iron profile with ferritin
Which of the following is the most sensitive screening test for prostate cancer?
PSA
7.52, CO2 23, CO3- 28
Respiratory Alkalosis with metabolic compensation
True or False: The cremasteric reflex may be absent in the affected testicle that is torsed
TRUE
Which of the following best describes the mechanism of action of angiotensin-converting enzyme (ACE) inhibitors in controlling blood pressure and preventing or slowing kidney damage?
They result in dilation of the efferent arteriole, reducing glomerular pressure.
initial lab in painless hematuria?
U/A
3 y/o child with smooth, firm mass on left abdomen. no irregular behavior
Wilm's tumor
When initially screening for CKD, which of the following would be ordered?
blood pressure measurement, serum creatinine level, spot urine protein measuremen
A 7-year-old male is suspected to have a Wilms' tumor (nephroblastoma). What is the most common symptom at presentation?
abdominal mass
A 60 year old male presents to the clinic complaining of low back pain, painful urination, increased frequency, and also states that it hurts with sex and especially during ejaculation. Which of the following therapies represents the best choice for this patient?
acute bacterial prostatitis MCC: GN rods; Fluorquinolones is the drug of choice
What is the best test to determine acid-base status in an ill patient?
arterial blood gas
commonly used abx in UTI?
bactrim, cipro, nitrofuratoin, cephlaxin
You are evaluating a urinalysis on a 44-year-old female due to complaints of recurrent urinary tract infections (UTIs). Which of the following microscopic findings would be most suggestive of chronic kidney disease?
broad waxy casts
A 24 week pregnant female presents to your clinic with fevers and bilateral flank pain. She also complains of burning with urination. On microscopic examination of the urine, white blood cell casts are found. Which of the following is the treatment of choice for this patient's condition?
ceftriaxone
A 22 year old male presents complaining of severe pain when urinating and abnormal penile discharge. Gram stain reveals intracellular gram negative diplococci. Which of the following pharmacologic therapies is most appropriate at this time?
ceftriaxone and doxycyline
A patient present to your office complaining of chronic problems with keeping her sodium levels within normal range. A chemistry panel is ordered and reveals a sodium level of 125. What is the worrisome complication associated with correcting chronic hyponatremia too quickly?
central pontine myelinolysis
Which of the following is considered a painless penile lesion?
chancre- painless lesion in syphilis
A 34 year old male comes into your clinic complaining of testicular pain and heaviness in the left hemiscrotum. He tells you that the pain radiates up to his left flank. The patient has a positive Prehn's sign on physical exam. Which of the following is the most common organism implicated in this condition?
chlamydia trachomatis 2nd MC: gonorrhea
Which of the following risk factors is responsible for approximately one-half of cases of urothelial cancer in both men and women?
cigarette smoking
A 41 year old patient has had low grade fevers for the past week. He also complains of burning with urination, and increased frequency and urgency. Digital rectal exam reveals a tender prostate. Which of the following is the recommended therapy for this patient?
cipro x 14 days
A 48 year old male presents to your clinic complaining of left testicular pain for the last 36 hours. He states that the pain is worse with standing and better when he lies down. He denies any history of sexual activity. Physical exam reveals a tender left testicle with pain radiating up toward his groin. The patient exhibits a positive Prehn's sign and a large amount of white blood cells are visualized on urine microscopy. The drug of choice for this patient's condition is which of the following?
ciprofloxacin
Which of the following is a cause of hyperkalemi?
crush injuries, succinycholine administration, renal failure
MCC cystitis?
e. coli
Which of the following represents the best test for assessing kidney function?
estimated GFR
Which of the following pharmacologic agents used in the treatment of benign prostatic hypertrophy affects the levels of prostate specific antigen?
finasteride
Which of the following medications is indicated in the treatment of a patient with benign prostatic hypertrophy and low blood pressure?
finasteride don't use terazosin--> alpha block--> can cause severe hypoTN
Which of the following EKG findings most commonly found in a patient who has hypokalemia?
flattening of T waves
A patient presents to the clinic for evaluation of hematuria. After initial microscopy is performed, he is shown to also have red blood cell casts. This most likely indicates which of the following conditions?
glomerulonephritis
An 8 year old boy presents to the clinic following a recent illness that consisted of cough, runny nose, congestion and earaches. His mother tells you that this morning his urine was a dark color and she thought it looked like blood. Physical exam reveals mild hypertension. Urinalysis is positive for hematuria and proteinuria. What is this child's most likely diagnosis?
glomerulonephritits
What UA finding is typical of glomerulonephritis?
hematuria
What is the chief symptom associated with bladder cancer?
hematuria
What is the classic triad of renal cell carcinoma?
hematuria, mass, flank pain
MC electrolyte abnormality in hosptilized patient?
hypoNa
What cause struvite stones?
including Proteus and Pseudomonas while being caused less commonly by Klebsiella
The most common type of hernia in the United States is which of the following?
indirect hernia
increased frequency of urination, pelvic pain that is better with urination, hx of depression
intersitital cystitis
A 28 year old female comes into the clinic for evaluation of chronic pelvic pain. She states that she has a history of anxiety and depression, but is concerned about the increased frequency of urination that she has been experiencing over the last few months. She also complains of pelvic pain and tells you that nothing seems to aggravate this, but she does feel relief when she urinates. Urinalysis reveals squamous epithelial cells, and trace blood. Which of the following is the most likely diagnosis?
interstitial cystitis
A 43 year old female G4P4 presents to the clinic complaining of wetting herself. She is very concerned as this has led to some very embarrassing moments. A further history reveals this usually happens when she coughs or sneezes. The initial treatment of choice for this patient is which of the following?
kegel exercises other: regular toilet trips, limited fluid consumption, losing weight if needed and smoking cessatio
Which of the following is a cause of acute urinary retention?
large urethral stone, DM neuropathy, anticholinergic meds
pH 7.25, HCO2 16--> what is acid base d/o?
metabolic acidosis
7.46 pH and HCO3- 28
metabolic alkalosis
The most common cause of nephrotic syndrome in children is
minimal change disease
MCC of viral orchitis?
mumps
A 32 week pregnant female presents to her OB/GYN for routine follow up. The patient has been doing great the entire pregnancy and denies any physical symptoms. Her urinalysis reveals negative nitrites and negative leukocyte esterase with 1+ bacteriuria. What is the next best step in management of this patient?
nitrofurantion
A 22 year old female who is 12 weeks pregnant comes into your clinic complaining of burning with urination and increased frequency over the last few days. Physical exam reveals suprapubic tenderness and urinalysis reveals positive nitrites and positive leukocyte esterase. Which of the following represents the best pharmacological intervention at this time?
nitrofurantoin
What is the imaging modality of choice in suspected nephrolithiasis?
non-contrast CT
Which of the following are common adverse effects associated with aminoglycosides?
ototoxicity and nephrotoxicity
A 17 year old uncircumcised male presents to the your clinic complaining of penile pain and nausea. He states that this has never happened before but he is unable to put the foreskin back. Upon physical examination you discover the foreskin in a trapped in a retracted position. Which of the following is the most likely diagnosis?
paraphimosis
Which of hte following EKG findings is consistent with pt who has hyperK?
peaked T waves
A 33 year old male presents complaining of painful erections. He describes his erections to be abnormally curved over the last few years and states that it is getting worse. Physical exam reveals nontender subcutaneous plaques along the dorsal aspect of the penis, which of the following is the most likely diagnosis?
peyrione's disease
Which of the following is the best pharmacologic therapy for a patient with a sustained erection of greater than four hours?
phenylephrine
MCC of acute renal failure?
pre-renal azotemia
What UA finding is typical of nephrotic syndrome?
proteinuria
earliest sign of chronic renal failure?
proteinuria
A 31 year old female presents with a chief complaint of back pain and painful urination. She also states she has been going to the bathroom much more frequently than usual. Her vital signs are normal except for a low grade fever, and physical exam reveal costovertebral angle tenderness to palpation on the left side. Which of the following is the most likely diagnosis?
pyelonephritis
Which condition is suggested by urethritis, arthritis, and conjunctivitis?
reactive arthritis
An 23 year old female presents to your office for routine follow-up on an elevated blood pressure reading taken one week prior. She has no significant past medical history besides an appendectomy at age 14. On physical exam today, the patient again has an elevated blood pressure. Although there may be many causes of hypertension, which of the following is the most common cause of secondary hypertension?
renal artery stenosis
If you suspect a patient is in acute renal failure, which of the following is the best initial radiographic diagnostic study?
renal u/s
Which of the following is the primary acid-base disturbance you would expect in a patient who is having an acute severe anxiety attack?
resp alkalosis
A 22 year old male complains of a lump in his left testicle, he states he noticed it a few months ago but now thinks it is getting larger. It is non-tender and does not transilluminate. The patient denies any urinary symptoms. Which of the following is the next best test to order in the management of this patient?
scrotal u/s
What is the definitive diagnostic test for a patient with suspected testicular torsion?
scrotal u/s
The most common causes of intrinsic AKI are
sepsis, ischemia, and nephrotoxins, both endogenous and exogenous
All of the following are part of the initial work-up of acute renal failure EXCEPT:
serum BUN/Cr, UA, serum electrolytes
A 71 year old male with chronic chest pain and current nitrate therapy should avoid which of the following medications?
sildenafil
A patient present to your office complaining of earaches, and low grade fevers, she also states that she has chronic problems with keeping her sodium levels within normal range. Physical exam reveals a normal oxygen saturation and no respiratory distress. A blood chemistry panel is ordered and reveals a sodium level of 125, what is the next step in management of this patient?
slow drip IV saline-
The organism responsible for most cases of peritonitis in patients on peritoneal dialysis is
staph
Which of the following types of incontinence is most commonly diagnosed among women?
stress
Which of the following types of renal calculi is associated with an infectious cause?
struvite
PE of testicular torsion?
testicular tenderness, transverse lie of testicle, scrotal swelling, ipsilateral loss of cremasteric reflex, high riding testes
A 34 y/o male comes into your clinic comlaining of testicular pain and heaviness in left hemiscrotum. He tells you the pain radiates up his left flank. He has positive hx of cryptorchidism. On exam he feels less pain with elevation of the scrotum. DX?
testicular torsion
An 80 year old male with history of benign prostatic hypertrophy presents to the emergency room with bladder distention and oliguria. He denies any chest pain or shortness of breath but has been febrile for two days. Physical exam reveals abdominal tenderness, mostly in the suprapubic region. What is the next best step in the evaluation and management of this patient?
urethral catheter
Which of the following is the most common cause of dysuria in an adult male?
urethritis
Your patient returns to your office for a follow up for non-insulin-dependent diabetes mellitus (NIDDM). Her HgA1c in the office is 6.4%. She is concerned about developing kidney disease from her diabetes and requests that you test her for this. What initial screening test should you order that would provide clues to potential diabetic nephropathy allowing for treatment to slow the disease progression?
urine microablumin
bag of worms
varicocele
A 2 month old male present to your clinic for routine check up and immunizations. His mother states that the child has been doing very well despite an undescended left testicle in the inguinal canal. Which of the following is the most appropriate patient education at this time?
watch and wait until 6 mo's of age
What demographics are most commonly associated with testicular torsion?
young males through twenties