APEA Urology

APEA Urology

Question:

In men, painful urination without frequency or urgency suggests:

 

cystitis.  Incorrecturethritis.  Correctconstipation.acute prostatitis.

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Explanation:

In men, painful urination without frequency or urgency suggests urethritis. Cystitis presents with frequency and urgency. Constipation usually does not present with urinary tract symptoms. Acute prostatitis presents with frequency, urgency, and dysuria. APEA Urology.

Question:

A 65-year-old woman complains that when she feels the urge to urinate, she has to go immediately or else she urinates “on herself”. She has become homebound because she wants to stay close to the bathroom. This condition is termed:

 

functional incontinence.overflow incontinence.urge incontinence.  Correctstress incontinence.

 

Explanation:

In urge incontinence, (overactive bladder), urgency is followed by immediate involuntary leakage due to uncontrolled detrusor contractions that overcome urethral resistance. Following an urge to void, there is an involuntary loss of urine since the patient cannot get to the toilet quickly enough. Overflow incontinence is associated with a neurological or anatomical obstruction from pelvic organs or the prostate which limits bladder emptying and causes an overdistended bladder. Stress incontinence is commonly seen in women and arises from decreased intraurethral pressure. This condition is generally noted when a patient coughs, sneezes, or laughs APEA Urology. Functional incontinence usually arises from cognitive impairment, musculoskeletal problems, or immobility.

Question:

Symptoms of proctitis may include all of the following except:

 

left-sided abdominal pain.rectal pain.suprapubic pain.  Correcttenesmus.

 

Explanation:

Proctitis is inflammation of the lining of the rectum leading to rectal pain, bleeding, and a continuous sensation to defecate (tenesmus). Additional symptoms may also include left-sided abdominal pain, diarrhea, pain with bowel movements, and a feeling of fullness in the rectum. Suprapubic pain is not generally associated with proctitis.

Question:

A 40 year old male complains of right flank pain. His temperature is 102° F. These symptoms may be characteristic of:

 

renal calculi.acute pyelonephritis.  Correcturethritis.prostatitis.

 

Explanation:

Kidney pain in the flank area and groin that is accompanied by fever and chills is consistent with acute pyelonephritis. Renal or ureteral colic usually presents with a sudden onset of pain in the flank area, abdomen, or groin. Chills and fever do not generally accompany urinary calculi. In men, painful urination without frequency or urgency suggests urethritis. Acute prostatitis presents with frequency, urgency, and dysuria. APEA Urology.

Question:

A useful mnemonic for elucidating causes of incontinence in the older adult is:

 

STOOL.DIAPERS.  CorrectDRIP.URINE.

 

Explanation:

For elucidating causes of incontinence, two mnemonics may be helpful: DIAPERS, (Delirium, Infection, Atrophic urethritis/vaginitis, Pharmaceuticals, Excess urine output from conditions like hyperglycemia or heart failure, Restricted mobility, and Stool impaction) and DDRRIIPP (Delirium, Drug side effects, Retention of feces, Restricted mobility, Infection of urine, Inflammation, Polyuria, and Psychogenic).

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You are answering Subject Specific Questions.

Subject: Urology

 

 

Question:

Which condition usually coexists with epididymitis?

 

Varicocele of the spermatic cordSpermatocele of the epididymis  IncorrectTorsion of the spermatic cordChlamydia infection  Correct

 

Explanation:

An acutely inflamed epididymis is tender and swollen and may be difficult to distinguish from the testicle. Additionally, the scrotum may be reddened and the vas deferens inflamed. It occurs most commonly in adults who are affected with Chlamydia. Coexisting urinary tract infection or prostatitis supports the diagnosis. Varicocele refers to varicose veins of the spermatic cord, usually found on the left. It feels like a soft “bag of worms” on palpation of the scrotum. A painless, movable cystic mass just above the testicle suggests a spermatocele or an epididymal cyst. Both transilluminate. Torsion, or twisting, of the testicle on its spermatic cord produces an acutely painful, tender, and swollen organ that is retracted upward in the scrotum APEA Urology. The scrotum becomes red and edematous. There is no associated urinary infection in a patient who has testicular torsion.

Question:

Which of the following substances is found in the urine of a child suspected of having post streptococcal glomerulonephritis?

 

Blood and protein  CorrectBacteria and ketonesGlucose and white blood cellsCasts and mucous threads

 

Explanation:

With post streptococcal (strep) glomerulonephritis, a child may have a history of a recent strep infection (pharyngitis or impetigo). Proteinuria is secondary to altered glomerular structure and functioning. Gross hematuria causes the urine to be tea-colored. Bacteria, white blood cells and mucus can be seen with urinary tract infections. Glucose and ketones present in the urine may be associated with diabetes.

Question:

A whitish sebaceous secretion that collects between the glans penis and foreskin or in the vulva is known as:

 

candida.smegma.  Correctleukorrhea.leukocoria.  Incorrect

 

Explanation:

A whitish sebaceous secretion that collects between the glans penis and foreskin or in the vulva is known as smegma. Candida can occur as a result of a yeast infection and in the vaginal area. It appears as a white substance usually causing vaginal itching. Leukorrhea refers to a thick whitish or yellowish vaginal discharge commonly seen during pregnancy. Leukocoria is an abnormal white reflection from the retina of the eye and its presence could indicate retinoblastoma or a congenital cataract. APEA Urology.

Question:

A 40 -year-old male states that he felt “something” above his left testis. On examination, a painless cyst is noted above the left testicle. Transillumination is positive. This is consistent with a:

 

varicocele of the spermatic cord.  Incorrectspermatocele of the epididymis.  Correcttorsion of the spermatic cord.prostatitis.

 

Explanation:

A painless, movable cystic mass just above the testicle suggests a spermatocele or an epididymal cyst. Both transilluminate and are difficult to distinguish clinically. An acutely inflamed epididymis is tender and swollen and may be difficult to distinguish from the testicle. Additionally, the scrotum may be reddened and the vas deferens inflamed. Coexisting urinary tract infection, or prostatitis, supports the diagnosis. Varicocele refers to varicose veins of the spermatic cord, usually found on the left. It feels like a soft “bag of worms” upon palpation of the scrotum. Torsion, or twisting, of the testicle on its spermatic cord produces an acutely painful, tender, and swollen organ that is retracted upward in the scrotum. The scrotum becomes red and edematous. There is no associated urinary infection.

Question:

Undescended testicle(s) in a young male is termed:

 

testicular torsion.epispadias.hydrocele.cryptorchidism.  Correct

 

Explanation:

The term cryptorchidism is used to denote undescended testicles. Epispadias is present when the urethral orifice is located on the dorsal surface of the glans or shaft of the penis. A hydrocele denotes fluid in the scrotal sac. Testicular torsion occurs when the spermatic cord (from which the testicle is suspended) twists, reducing the testicle’s blood supply resulting in ischemia of that testicle. This is a medical emergency APEA Urology.

Question:

When examining the scrotum in a young male child, test the cremasteric reflex by:

 

scratching the medial aspect of the thigh.  Correcthaving the child lie down and palpate the femoral pulse.gently pulling the penis downward.  Incorrectpalpating the area above the symphysis pubis.

 

Explanation:

To elicit the cremasteric reflex, examine the child when he is relaxed and have him sit crossed legged on the table. Palpate the scrotum. The child can also blow into a balloon, this would cause an increase in intra-abdominal pressure and stimulate the reflex. The cremasteric reflex can be tested by scratching the inside of the child’s thigh. Pulling the penis downward, palpating the femoral pulse or the area above the symphysis pubis do not elicit this reflex.

Question:

Which one of the following patient positions would be least beneficial to examine the genitals of a young female child?

 

Have the child sit on her parent’s lap with the parent holding the child’s knees apartHave the child lie supine in the frog-leg positionHave the child sit crossed legged on the examination table  CorrectPosition the child in the knee-chest position APEA Urology.

 

Explanation:

To properly visualize the genitals of a young female child, she can be positioned on the parent’s lap with the knees apart, supine in a frog-leg position, or in the knee-chest position. Having her sit crossed-legged would not expose the genitals. This position is useful when examining the male child and eliciting the cremasteric reflex.

Question:

A 50-year-old male describes difficulty emptying his bladder. On exam, a distended bladder is noted following urination. This finding may be associated with:

 

functional incontinence.  Incorrectoverflow incontinence.  Correcturge incontinence.stress incontinence.

 

Explanation:

Overflow incontinence is associated with a neurological or anatomical obstruction from pelvic organs or the prostate which limits bladder emptying and causes a distended bladder. Stress incontinence is commonly seen in women and arises from decreased intraurethral pressure. This condition is noted when a patient coughs, sneezes, or laughs. In urge incontinence, urgency is followed by immediate involuntary leakage due to uncontrolled detrusor contractions that overcome urethral resistance. Following an urge to void, there is an involuntary loss of urine. Functional incontinence usually arises from cognitive impairment, musculoskeletal problems, or immobility APEA Urology.

Question:

One cause of proctitis could be related to:

 

gastritis.frequent anal intercourse.  Correctcirrhosis.pancreatitis.

 

Explanation:

Proctitis is inflammation of the lining of the rectum leading to rectal pain, bleeding, and a continuous sensation to defecate. Causes may include: inflammatory bowel disease, sexually transmitted infections, radiation therapy, and frequent anal intercourse.

Question:

Which one of the following symptoms would be least indicative of acute glomerulonephritis?

 

HematuriaPolyuria  CorrectProteinuriaHypertension

 

Explanation:

Symptoms of acute glomerulonephritis include hematuria. This is a universal finding, even if it is microscopic. Gross hematuria is reported in 30% of pediatric patients, often manifesting as smoky, coffee, or cola-colored urine. Oliguria is seem. Hypertension proteinuria edema (peripheral or periorbital) is reported in approximately 85% of pediatric patients. Edema may be mild (involving only the face) to severe, bordering on a nephrotic appearance. Headache may occur secondary to hypertension. Confusion may occur secondary to malignant hypertension in as many as 5% of patients. Shortness of breath or dyspnea on exertion may occur secondary to heart failure or pulmonary edema. It is usually uncommon, particularly in children. Possible flank pain secondary to stretching of the renal capsule may occur APEA Urology.

Question:

In renal adaptation of the newborn, which one of the following statements is correct?

 

The kidneys have an inability to concentrate urine and adapt to fluid and electrolyte stress.  CorrectIn the nephrons of the kidneys long tubules enhance the effectiveness of tubular reabsorption.The kidneys are fully capable of concentrating urine and maintaining fluid and electrolyte balance.The kidneys have the ability to increase the production of antidiuretic hormone (ADH) effectively.

 

Explanation:

In the neonate the kidneys are structurally complete but physiologically immature. The glomeruli have an inability to filter and concentrate urine, therefore glucose and amino acids escape and there is decreased ability to remove uric acid crystals which give the reddish appearance to the urine. There is an inability to adapt to fluid and electrolyte stress leading to loss of bicarbonate and poor reabsorption. This puts the neonate at increased risk of metabolic acidosis. The tubules are short/narrow which causes a problem with reabsorption. The nephrons function well within a month. ADH inhibits diuresis and the immature kidney causes an increased risk for dehydration.

Question:

A 33 year old male presents for examination because of a scrotal complaint. The exam reveals the presence of 2 testicles and palpable tissue resembling a “bag of worms” over the left testicle. When in the supine position with the scrotum elevated, the “bag of worms” disappears. This condition is suggestive of a:

 

varicocele of the spermatic cord.  Correctspermatocele of the epididymis.torsion of the spermatic cord.prostatitis.

 

Explanation:

Varicocele refers to varicose veins of the spermatic cord, usually found on the left. It feels like a soft “bag of worms” upon palpation of the scrotum. An acutely inflamed epididymis is tender and swollen and may be difficult to distinguish from the testicle. The scrotum may be reddened and the vas deferens inflamed. Epididymitis occurs usually in adults, who are infected with Chlamydia. Coexisting urinary tract infection or prostatitis support the diagnosis. A painless, movable cystic mass just above the testicle suggests a spermatocele or an epididymal cyst. Both transilluminate. Torsion, or twisting, of the testicle on its spermatic cord produces an acutely painful, tender, and swollen organ that is retracted upward in the scrotum. The scrotum becomes red and edematous. There is no associated urinary infection. APEA Urology.

Question:

Benign prostatic hypertrophy begins in the:

 

second decade of life.third decade of life.  Correctfourth decade of life.fifth decade of life.  Incorrect

 

Explanation:

In men, proliferation of prostate epithelial and stromal tissue, termed benign prostatic hyperplasia (BPH), begins in the third decade, and symptoms occur in only about half of men with enlargement. Hyperplasia continues to increase prostate volume until the seventh decade, then appears to plateau. These changes are androgen dependent APEA Urology.