Genitourinary 1: The Audio PANCE and PANRE Board Review Podcast Topic Specific Review Episode 35

Welcome to episode 35 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I continue to cover topic specific PANCE and PANRE review from the Academy course content following the NCCPA™ content blueprint.

This week we will be covering 10 topic specific Genitourinary board review questions.

GU accounts for 6% of your PANCE/PANRE board exam.

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full genitourinary board review includes over 72 GU specific questions and is available to all members of the PANCE and PANRE Academy.

You can download and listen to past FREE episodes here, on iTunes or Stitcher Radio.
You can listen to the latest episode, take an interactive quiz and download your results below.

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Genitourinary PANCE and PANRE Podcast Quiz

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Question 1

A 65 year-old patient presents with hypertension and peripheral edema. Urinalysis reveals pale urine, with a specific gravity of 1.002, 2+ protein, trace glucose, and is negative for red blood cells and leukocytes. Serum electrolytes include BUN of 58 mg/dl and creatinine of 4.5 mg/dl. These are unchanged from previous results obtained 3 months and 6 months ago. Of the following, what other laboratory abnormalities would you expect?

A	Hypercalcemia Hint: Patients with chronic renal failure typically present with hypocalcemia, hyperphosphatemia, and metabolic acidosis.
B	Metabolic alkalosis Hint: See A for explanation
C	Hypophosphatemia Hint: See A for explanation
D	Anemia

Question 1 Explanation:

Anemia of chronic disease is associated with chronic renal failure

Question 2

A 65 year-old male with a 60 pack-year smoking history presents with painless hematuria for two days. He also complains of frequency and dysuria. He denies a history of recent upper respiratory tract infection. Which of the following is the most likely diagnosis?

A	Bladder cancer
B	Wegener's granulomatosis Hint: Wegener's granulomatosis disease involves the kidneys and the lungs. Renal signs include hematuria, red blood cells casts, and proteinuria.
C	IgA nephropathy Hint: IgA nephropathy typically presents after an upper respiratory tract infection and presents with hematuria and proteinuria.
D	Benign prostatic hypertrophy Hint: BPH presents with voiding symptoms such as hesitancy, straining, weak stream and postvoid dribbling.

Question 2 Explanation:

Bladder cancer is associated with smoking and presents with painless hematuria.

Question 3

A patient on acetazolamide for glaucoma complains of increasing shortness of breath. The patient denies cough, chest pain, or fever. Physical examination is unremarkable except for an increased respiratory rate of 30/minute. Labs include Na 132 mEq/L, K 5.6 mEq/L, Cl 120 mEq/L, and CO2 10 mEq/L. Arterial blood gas results are pH 7.18, pO2 98 mmHg, pCO2 22 mmHg, and HCO3 8 mEq/L. Based upon these results, what is the diagnosis?

A	Metabolic alkalosis Hint: See B for explanation
B	Metabolic acidosis
C	Respiratory alkalosis Hint: See B for explanation
D	Respiratory acidosis Hint: See B for explanation

Question 3 Explanation:

Acetazolamide inhibits carbonic anhydrase, which inhibits bicarbonate ion regeneration, with resulting normal anion-gap, hyperchloremic acidosis. Respiratory compensatory mechanisms lead to hyperventilation.

Question 4

Which of the following is the most appropriate intervention for a stage I testicular seminoma?

A	Watchful waiting Hint: Surveillance is an option in stage I disease of a nonseminoma testicular tumor.
B	Chemotherapy initially Hint: Patients with stage IIC and stage III are treated with chemotherapy
C	Orchiectomy and radiation
D	Orchiectomy and chemotherapy Hint: Chemotherapy is used for later stage tumors (II/III) and followed by surgery in stage III tumors.

Question 4 Explanation:

Inguinal orchiectomy followed by retroperitoneal radiation therapy cures about 98% of patients with stage I seminoma.

Question 5

A patient with prostate cancer has a nonpalpable, focal lesion, and the patient is reluctant to have surgery at this time. Which of the following would best monitor disease progression?

A	Periodic rectal exams Hint: Many prostate carcinomas are contained within the gland, making it difficult to assess progression with a digital examination alone.
B	Transrectal ultrasonography Hint: Ultrasonography is used largely for staging disease, not monitoring disease progression.
C	Measurements of serum acid phosphatase Hint: Serum acid phosphatase is more predictive of metastatic disease than PSA measurement, but its use has largely been replaced by PSA.
D	Measurements of prostate-specific antigen

Question 5 Explanation:

PSA measurement correlates well with volume and stage of disease and is the recommended examination for monitoring disease progression.

Question 6

When the diagnosis of gonococcal urethritis is confirmed, which of the following is the treatment of choice?

A	Ceftriaxone (Rocephin)
B	Amoxicillin (Amoxil) Hint: Effective single-dose regimens for uncomplicated gonococcal urethritis include cefixime or one of the fluoroquinolones, but NOT amoxicillin due to penicillin-resistant strains of gonorrhea.
C	Penicillin G benzathine (Bicillin LA) Hint: Penicillin G benzathine is the treatment of choice for primary syphilis.
D	Doxycycline (Vibramycin) Hint: Doxycycline is the treatment of choice for Chlamydia urethritis, not gonococcal urethritis.

Question 6 Explanation:

Ceftriaxone is recommended therapy for gonococcal urethritis.

Question 7

A patient presents with edema, which is most noticeable in the hands and face. Laboratory findings include proteinuria, hypoalbuminemia, and hyperlipidemia. The most likely diagnosis is

A	congestive heart failure Hint: Dependent edema is the most typical finding with CHF. Laboratory findings do not generally include proteinuria or hypoalbuminemia.
B	end-stage liver disease Hint: Symptoms of end-stage liver disease usually include increased abdominal girth indicating ascites. Hypoalbuminemia can occur as a result of malnutrition or concurrently with nephrotic syndrome.
C	nephrotic syndrome
D	malnutrition Hint: Malnutrition is marked by physical wasting, not edema. Hypoalbuminemia may be seen, but hyperlipidemia is not typical.

Question 7 Explanation:

Proteinuria, hyperlipidemia, and hypoalbuminemia are consistent with nephrotic syndrome.

Question 8

Which of the following is most frequently associated with bladder cancer?

A	Hematuria
B	Dysuria Hint: Dysuria, urgency, and frequency are associated with irritative voiding symptoms associated with cystitis.
C	Urgency Hint: See B for explanatioon
D	Frequency Hint: See B for explanatioon

Question 8 Explanation:

Significant persistent hematuria >3 RBC/HPF on three urinalysis, a single urinalysis with >100 RBC, or gross hematuria, identifies significant renal or urologic lesions. Bladder cancer usually presents with painless hematuria.

Question 9

A 35 year-old pregnant patient presents with fever, chills, and left-sided flank pain. On physical examination left-sided CVA tenderness is noted. Urinalysis reveals numerous white blood cells and white blood cell casts. Which of the following is the most appropriate treatment?

A	Oral ciprofloxacin (Cipro) Hint: See B for explanation
B	Oral trimethoprim-sulfamethoxazole (Bactrim) Hint: The fluoroquinolones and trimethoprim-sulfamethoxazole are contraindicated in pregnancy.
C	IV gentamicin (Garamycin) Hint: Gentamicin is not indicated as first line therapy in the treatment of pyelonephritis in a pregnant patient.
D	IV ceftriaxone (Rocephin)

Question 9 Explanation:

IV cephalosporins are first line treatment of pyelonephritis in a pregnant patient, followed by oral step-down therapy.

Question 10

The most definitive treatment for primary enuresis is

A	oxybutynin chloride (Ditropan) Hint: Oxybutynin chloride is used for bladder spasms. It cannot be used for children under 5 years of age and is not indicated in primary enuresis.
B	imipramine (Tofranil) Hint: Imipramine is an older form of treatment that is moderately effective, but many patients relapse when therapy is stopped. This is no longer considered the treatment of choice.
C	trimethoprim-sulfamethoxazole (Bactrim) Hint: TMP-SMX is indicated for urinary tract infections that may cause secondary enuresis, but it is not used in primary enuresis.
D	desmopressin (DDAVP)

Question 10 Explanation:

Intranasal desmopressin is effective in 50% of patients treated and is the treatment of choice.

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