NSG 6020 H&P Practice Q's – GU Questions With Complete
Solutions
A *75-year-old* retired construction worker comes to your
clinic, complaining of bright red blood in the toilet for the last
several months. He has no pain with defecation but has
occasional constipation. He states he eats a healthy diet with
fruits and vegetables and walks 2 miles a day. *He has had a 10-
pound weight loss over the last 3 months*. He denies fever or
night sweats. His medical history includes high blood pressure,
coronary artery disease, and arthritis. He has also had an
appendectomy. He smoked for 40 years, two packs a day, but
quit 15 years ago. He used to drink alcohol but doesn't now. His
father died in his 60s of a heart attack and his mother had breast
cancer in her 70s. On examination he appears his stated age and
sits comfortably on the examining table. His blood pressure is
150/85 and his pulse is 88. He is afebrile. His cardiac, lung, and
abdominal examinations are normal. Visualization of t Correct
Answers Anorectal cancer
A 15-year-old high school football player is brought to your
office by his mother. He is complaining of severe testicular pain
since exactly 8:00 this morning. He denies any sexual activity
and states that he hurts so bad he can't even urinate. He is
nauseated and is throwing up. He denies any recent illness or
fever. His past medical history is unremarkable. He denies any
tobacco, alcohol, or drug use. His parents are both in good
health. On examination you see a young teenager lying on the
bed with an emesis basin. He is very uncomfortable and keeps
shifting his position. His blood pressure is 150/100, his pulse is
110, and his respirations are 24. On visualization of the penis he
,is circumcised and there are no lesions and no discharge from
the meatus. His scrotal skin is tense and red. Palpation of the left
testicle causes severe pain and the patient begins to cry. His
prostate examination is unremarkable. His cr Correct Answers
Torsion of the spermatic cord
A 16-year-old high school junior is brought to your clinic by his
father. The teenager was taught in his health class at school to
do monthly testicular self-examinations. Yesterday when he felt
his left testicle it was enlarged and tender. He isn't sure if he has
had burning with urination and he says he has never had sexual
intercourse. He has had a sore throat, cough, and runny nose for
the last 3 days. His past medical history is significant for a
tonsillectomy as a small child. His father has high blood
pressure and his mother is healthy. On examination you see a
teenager in no acute distress. His temperature is 100.8 and his
blood pressure and pulse are unremarkable. On visualization of
his penis, he is uncircumcised and has no lesions or discharge.
His scrotum is red and tense on the left and normal appearing on
the right. Palpating his left testicle reveals a mildly sore swollen
testicle. The right testicle i Correct Answers Acute orchitis
Acute orchitis causes an inflamed, tender testicle. The scrotum
will be red and tense. Orchitis is usually unilateral and often
associated with viral infections such as mumps.
A 17-year-old high school student is brought in to your
emergency room in a comatose state. His friends have
accompanied him and tell you that they have been shooting up
heroin tonight and they think their friend may have had too
much. The patient is unconscious and cannot protect his airway,
, so he is intubated. His heart rate is 60 and he is breathing
through the ventilator. He is not posturing and he does not
respond to a sternal rub. Preparing to finish the neurologic
examination, you get a penlight.
What size pupils do you expect to see in this comatose patient?
Correct Answers Pinpoint pupils
Narcotics and cholinergics cause very small (1 mm) pupils.
A 20-year-old part-time college student comes to your clinic,
complaining of growths on his penile shaft. They have been
there for about 6 weeks and haven't gone away. In fact, he thinks
there may be more now. He denies any pain with intercourse or
urination. He has had three former partners and has been with
his current girlfriend for 6 months. He says that because she is
on the pill they don't use condoms. He denies any fever, weight
loss, or night sweats. He is engaged to be married and has no
children. On visualization of his penis you see several moist
papules along all sides of his penile shaft and even two on the
corona. He has been circumcised. On palpation of his inguinal
region there is no inguinal lymphadenopathy.
Which abnormality of the penis does this patient most likely
have? Correct Answers Condylomata acuminata
A 21-year-old engineering student comes to your office,
complaining of leg and back pain and of tripping when he walks.
He states this started 3 months ago with back and buttock pain
but has since progressed to feeling weak in his left leg. He
denies any bowel or bladder symptoms. He can think of no
specific traumatic incidences but he was a defensive lineman in
high school and junior college. His past medical history is
Solutions
A *75-year-old* retired construction worker comes to your
clinic, complaining of bright red blood in the toilet for the last
several months. He has no pain with defecation but has
occasional constipation. He states he eats a healthy diet with
fruits and vegetables and walks 2 miles a day. *He has had a 10-
pound weight loss over the last 3 months*. He denies fever or
night sweats. His medical history includes high blood pressure,
coronary artery disease, and arthritis. He has also had an
appendectomy. He smoked for 40 years, two packs a day, but
quit 15 years ago. He used to drink alcohol but doesn't now. His
father died in his 60s of a heart attack and his mother had breast
cancer in her 70s. On examination he appears his stated age and
sits comfortably on the examining table. His blood pressure is
150/85 and his pulse is 88. He is afebrile. His cardiac, lung, and
abdominal examinations are normal. Visualization of t Correct
Answers Anorectal cancer
A 15-year-old high school football player is brought to your
office by his mother. He is complaining of severe testicular pain
since exactly 8:00 this morning. He denies any sexual activity
and states that he hurts so bad he can't even urinate. He is
nauseated and is throwing up. He denies any recent illness or
fever. His past medical history is unremarkable. He denies any
tobacco, alcohol, or drug use. His parents are both in good
health. On examination you see a young teenager lying on the
bed with an emesis basin. He is very uncomfortable and keeps
shifting his position. His blood pressure is 150/100, his pulse is
110, and his respirations are 24. On visualization of the penis he
,is circumcised and there are no lesions and no discharge from
the meatus. His scrotal skin is tense and red. Palpation of the left
testicle causes severe pain and the patient begins to cry. His
prostate examination is unremarkable. His cr Correct Answers
Torsion of the spermatic cord
A 16-year-old high school junior is brought to your clinic by his
father. The teenager was taught in his health class at school to
do monthly testicular self-examinations. Yesterday when he felt
his left testicle it was enlarged and tender. He isn't sure if he has
had burning with urination and he says he has never had sexual
intercourse. He has had a sore throat, cough, and runny nose for
the last 3 days. His past medical history is significant for a
tonsillectomy as a small child. His father has high blood
pressure and his mother is healthy. On examination you see a
teenager in no acute distress. His temperature is 100.8 and his
blood pressure and pulse are unremarkable. On visualization of
his penis, he is uncircumcised and has no lesions or discharge.
His scrotum is red and tense on the left and normal appearing on
the right. Palpating his left testicle reveals a mildly sore swollen
testicle. The right testicle i Correct Answers Acute orchitis
Acute orchitis causes an inflamed, tender testicle. The scrotum
will be red and tense. Orchitis is usually unilateral and often
associated with viral infections such as mumps.
A 17-year-old high school student is brought in to your
emergency room in a comatose state. His friends have
accompanied him and tell you that they have been shooting up
heroin tonight and they think their friend may have had too
much. The patient is unconscious and cannot protect his airway,
, so he is intubated. His heart rate is 60 and he is breathing
through the ventilator. He is not posturing and he does not
respond to a sternal rub. Preparing to finish the neurologic
examination, you get a penlight.
What size pupils do you expect to see in this comatose patient?
Correct Answers Pinpoint pupils
Narcotics and cholinergics cause very small (1 mm) pupils.
A 20-year-old part-time college student comes to your clinic,
complaining of growths on his penile shaft. They have been
there for about 6 weeks and haven't gone away. In fact, he thinks
there may be more now. He denies any pain with intercourse or
urination. He has had three former partners and has been with
his current girlfriend for 6 months. He says that because she is
on the pill they don't use condoms. He denies any fever, weight
loss, or night sweats. He is engaged to be married and has no
children. On visualization of his penis you see several moist
papules along all sides of his penile shaft and even two on the
corona. He has been circumcised. On palpation of his inguinal
region there is no inguinal lymphadenopathy.
Which abnormality of the penis does this patient most likely
have? Correct Answers Condylomata acuminata
A 21-year-old engineering student comes to your office,
complaining of leg and back pain and of tripping when he walks.
He states this started 3 months ago with back and buttock pain
but has since progressed to feeling weak in his left leg. He
denies any bowel or bladder symptoms. He can think of no
specific traumatic incidences but he was a defensive lineman in
high school and junior college. His past medical history is
