NURS 5432 Module 4: Men's Health
Exam – 300 Questions with Answers &
Rationales
This comprehensive examination covers essential men's health topics including benign
prostatic hyperplasia (BPH), erectile dysfunction (ED), prostate cancer screening,
testicular disorders, male infertility, hypogonadism, sexually transmitted infections, male
obesity, and andropause. Questions are aligned with current American Urological
Association (AUA), U.S. Preventive Services Task Force (USPSTF), and NICE guidelines.
Section 1: Benign Prostatic Hyperplasia (Questions 1–50)
1. Which medication is the most appropriate initial therapy for a 62-year-old man with
moderate-to-severe lower urinary tract symptoms (LUTS) and a prostate volume of 35 cc
on transrectal ultrasound?
A) Finasteride 5 mg daily
B) Tamsulosin 0.4 mg daily
C) Dutasteride 0.5 mg daily
D) Solifenacin 5 mg daily
✅ Correct Answer: B (Tamsulosin 0.4 mg daily)
Rationale: For initial moderate-to-severe LUTS, an alpha-blocker is first-line therapy due
to its rapid onset of action (days). 5-ARIs should be added only when there is
demonstrable prostatic enlargement (typically >30-40 cc). Antimuscarinics are reserved
for predominant storage symptoms or in combination with alpha-blockers.
2. The AUA recommends that 5-alpha-reductase inhibitor (5-ARI) + alpha-blocker
combination therapy be offered ONLY to patients with which set of clinical findings?
A) Prostate volume ≤30 ml and PSA <1.5 ng/mL
B) PSA <1.0 ng/mL and mild LUTS (IPSS <8)
C) Prostate volume >30 ml, PSA >1.5 ng/mL, or palpable prostatic enlargement on DRE
D) Age >80 years with any LUTS and post-void residual >200 ml
,✅ Correct Answer: C
*Rationale: AUA guidelines specify that 5-ARI in combination with an alpha-blocker
should be offered only to patients with LUTS associated with demonstrable prostatic
enlargement as judged by a prostate volume on imaging >30 cc, a PSA >1.5 ng/mL, or
palpable enlargement on DRE.*
3. A 68-year-old man with BPH has been taking finasteride 5 mg daily for 6 months with
minimal symptom improvement. His most recent PSA level is 1.2 ng/mL (down from 2.4
ng/mL at baseline). How should the provider interpret this PSA change?
A) The decrease indicates a poor response to finasteride
B) The PSA should be multiplied by 2 to estimate the pre-treatment level
C) The PSA decrease is an adverse effect requiring discontinuation
D) PSA monitoring is no longer necessary once a 5-ARI is started
✅ Correct Answer: B
Rationale: 5-ARIs reduce serum PSA by approximately 50% within 6-12 months. Any PSA
value measured during therapy must be multiplied by 2 to reflect the true value for
prostate cancer risk assessment. The decrease does not indicate a poor treatment
response.
4. Which of the following is the most bothersome side effect of tamsulosin that requires
patient counseling before initiating therapy?
A) Weight gain and hyperglycemia
B) Retrograde ejaculation and dizziness/orthostatic hypotension
C) Severe constipation and dry mouth
D) Gynecomastia and decreased libido
✅ Correct Answer: B
Rationale: The alpha-blocker tamsulosin is associated with a risk of retrograde ejaculation
(abnormal ejaculation) and orthostatic hypotension/dizziness due to smooth muscle
relaxation in the vas deferens and blood vessels.
5. A 66-year-old man with BPH has already tried an alpha-blocker and a 5-ARI without
relief. His prostate volume is 85 cc. In addition to a TURP, which of the following is an
evidence-based procedural option?
, A) Transurethral needle ablation (TUNA)
B) Prostatic urethral lift (PUL, e.g., UroLift)
C) High-intensity focused ultrasound (HIFU)
D) Microwave thermotherapy (TUMT)
✅ Correct Answer: B
*Rationale: The prostatic urethral lift (PUL) is a minimally invasive option for LUTS/BPH,
especially in patients with obstructive median lobes or prostates <100 cc. TUNA and
TUMT are older technologies with less durable outcomes and are not preferred.*
6. A patient with LUTS has an International Prostate Symptom Score (IPSS) of 22
(severe). What is the appropriate next step before initiating medical therapy?
A) Immediate referral for TURP
B) Digital rectal examination (DRE) and urinalysis
C) Prostate biopsy without further testing
D) Cystoscopy to confirm bladder outlet obstruction
✅ Correct Answer: B
Rationale: Before initiating medical therapy for LUTS, the standard evaluation includes a
DRE to assess prostate size and contour (nodules) and a urinalysis to rule out infection or
hematuria. PSA may also be considered with informed consent.
7. A benign prostatic enlargement (BPE) patient with bothersome storage symptoms
(frequency and urgency) continues to have them despite alpha-blocker treatment. Which
medication may be added?
A) Dutasteride
B) Solifenacin
C) Tadalafil 5 mg daily
D) Phenazopyridine
✅ Correct Answer: B
Rationale: If storage symptoms persist after using an alpha-blocker, an anticholinergic
(like solifenacin) can be added to address overactive bladder symptoms. This
combination requires monitoring of post-void residual (>150 ml is a contraindication).
Exam – 300 Questions with Answers &
Rationales
This comprehensive examination covers essential men's health topics including benign
prostatic hyperplasia (BPH), erectile dysfunction (ED), prostate cancer screening,
testicular disorders, male infertility, hypogonadism, sexually transmitted infections, male
obesity, and andropause. Questions are aligned with current American Urological
Association (AUA), U.S. Preventive Services Task Force (USPSTF), and NICE guidelines.
Section 1: Benign Prostatic Hyperplasia (Questions 1–50)
1. Which medication is the most appropriate initial therapy for a 62-year-old man with
moderate-to-severe lower urinary tract symptoms (LUTS) and a prostate volume of 35 cc
on transrectal ultrasound?
A) Finasteride 5 mg daily
B) Tamsulosin 0.4 mg daily
C) Dutasteride 0.5 mg daily
D) Solifenacin 5 mg daily
✅ Correct Answer: B (Tamsulosin 0.4 mg daily)
Rationale: For initial moderate-to-severe LUTS, an alpha-blocker is first-line therapy due
to its rapid onset of action (days). 5-ARIs should be added only when there is
demonstrable prostatic enlargement (typically >30-40 cc). Antimuscarinics are reserved
for predominant storage symptoms or in combination with alpha-blockers.
2. The AUA recommends that 5-alpha-reductase inhibitor (5-ARI) + alpha-blocker
combination therapy be offered ONLY to patients with which set of clinical findings?
A) Prostate volume ≤30 ml and PSA <1.5 ng/mL
B) PSA <1.0 ng/mL and mild LUTS (IPSS <8)
C) Prostate volume >30 ml, PSA >1.5 ng/mL, or palpable prostatic enlargement on DRE
D) Age >80 years with any LUTS and post-void residual >200 ml
,✅ Correct Answer: C
*Rationale: AUA guidelines specify that 5-ARI in combination with an alpha-blocker
should be offered only to patients with LUTS associated with demonstrable prostatic
enlargement as judged by a prostate volume on imaging >30 cc, a PSA >1.5 ng/mL, or
palpable enlargement on DRE.*
3. A 68-year-old man with BPH has been taking finasteride 5 mg daily for 6 months with
minimal symptom improvement. His most recent PSA level is 1.2 ng/mL (down from 2.4
ng/mL at baseline). How should the provider interpret this PSA change?
A) The decrease indicates a poor response to finasteride
B) The PSA should be multiplied by 2 to estimate the pre-treatment level
C) The PSA decrease is an adverse effect requiring discontinuation
D) PSA monitoring is no longer necessary once a 5-ARI is started
✅ Correct Answer: B
Rationale: 5-ARIs reduce serum PSA by approximately 50% within 6-12 months. Any PSA
value measured during therapy must be multiplied by 2 to reflect the true value for
prostate cancer risk assessment. The decrease does not indicate a poor treatment
response.
4. Which of the following is the most bothersome side effect of tamsulosin that requires
patient counseling before initiating therapy?
A) Weight gain and hyperglycemia
B) Retrograde ejaculation and dizziness/orthostatic hypotension
C) Severe constipation and dry mouth
D) Gynecomastia and decreased libido
✅ Correct Answer: B
Rationale: The alpha-blocker tamsulosin is associated with a risk of retrograde ejaculation
(abnormal ejaculation) and orthostatic hypotension/dizziness due to smooth muscle
relaxation in the vas deferens and blood vessels.
5. A 66-year-old man with BPH has already tried an alpha-blocker and a 5-ARI without
relief. His prostate volume is 85 cc. In addition to a TURP, which of the following is an
evidence-based procedural option?
, A) Transurethral needle ablation (TUNA)
B) Prostatic urethral lift (PUL, e.g., UroLift)
C) High-intensity focused ultrasound (HIFU)
D) Microwave thermotherapy (TUMT)
✅ Correct Answer: B
*Rationale: The prostatic urethral lift (PUL) is a minimally invasive option for LUTS/BPH,
especially in patients with obstructive median lobes or prostates <100 cc. TUNA and
TUMT are older technologies with less durable outcomes and are not preferred.*
6. A patient with LUTS has an International Prostate Symptom Score (IPSS) of 22
(severe). What is the appropriate next step before initiating medical therapy?
A) Immediate referral for TURP
B) Digital rectal examination (DRE) and urinalysis
C) Prostate biopsy without further testing
D) Cystoscopy to confirm bladder outlet obstruction
✅ Correct Answer: B
Rationale: Before initiating medical therapy for LUTS, the standard evaluation includes a
DRE to assess prostate size and contour (nodules) and a urinalysis to rule out infection or
hematuria. PSA may also be considered with informed consent.
7. A benign prostatic enlargement (BPE) patient with bothersome storage symptoms
(frequency and urgency) continues to have them despite alpha-blocker treatment. Which
medication may be added?
A) Dutasteride
B) Solifenacin
C) Tadalafil 5 mg daily
D) Phenazopyridine
✅ Correct Answer: B
Rationale: If storage symptoms persist after using an alpha-blocker, an anticholinergic
(like solifenacin) can be added to address overactive bladder symptoms. This
combination requires monitoring of post-void residual (>150 ml is a contraindication).
