MALE GENITOURINARY(GU) PRACTICE QUESTIONS AND ANSWERES 100% CORRECT

Which of the following is inconsistent with the description of benign prostatic hyperplasia (BPH)? A. obliterated median sulcus B. size larger than 2.5 cm × 3 cm C. sensation of incomplete emptying D. boggy gland -ANS D When prescribing antihypertensive therapy for a man with BPH and hypertension, the NP considers that: A. loop diuretics are the treatment of choice. B. an alpha1 antagonist should not be used as a solo or first-line therapeutic agent. C. angiotensin receptor antagonist use is contraindicated. D. beta-adrenergic antagonist use often enhances urinary flow. -ANS B When assessing a 78-year-old man with suspected BPH, the NP considers that: A. prostate size does not correlate well with severity of symptoms. B. BPH affects less than 50% of men of this age. C. he is at increased risk for prostate cancer. D. limiting fluids is a helpful method of relieving severe symptoms. -ANS A Which of the following medications can contribute to the development of acute urinary retention in an older man with BPH? A. amitriptyline B. loratadine C. enalapril D. lorazepam -ANS A A 78-year-old man presents with a 3-day history of new-onset fatigue and difficulty with bladder emptying. Examination reveals a distended bladder but is otherwise unremarkable. Blood urea nitrogen level is 88 mg/dL (31.4 mmol/L); creatinine level is 2.8 mg/dL (247.5 µmol/L). The most likely diagnosis is: A. prerenal azotemia. B. acute glomerulonephritis. C. tubular necrosis. D. postrenal azotemia. -ANS D Surgical intervention in BPH should be considered with all of the following except: A. recurrent urinary tract infection. B. bladder stones. C. persistent obstruction despite medical therapy. D. acute tubular necrosis. -ANS D Finasteride (Proscar, Propecia) and dutasteride (Avodart) are helpful in the treatment of BPH because of their effect on: A. bladder contractility. B. prostate size. C. activity at select bladder receptor sites. D. bladder pressure. -ANS B Tamsulosin (Flomax) is helpful in the treatment of BPH because of its effect on: A. bladder contractility. B. prostate size. C. activity at select bladder receptor sites. D. bladder pressure. -ANS C Concerning BPH, which of the following statements is true? A. Digital rectal examination is accurate in diagnosing the condition. B. The use of a validated patient symptom tool is an important part of diagnosing the condition. C. Prostate size directly correlates with symptoms and bladder emptying. D. Bladder distention is usually present in early disease. -ANS B Concerning herbal and nutritional therapies for BPH treatment, which of the following statements is false? A. The mechanism of action of the most effective and best studied products is similar to prescription medications for this condition. B. These therapies are currently considered emerging therapy by the American Urological Association. C. Major areas of concern with use of these therapies include issues of product purity and quality control. D. These therapies are safest and most effective when used with prescription medications. -ANS D You examine a 32-year-old man with chancroid and anticipate finding: A. a verruciform lesion. B. a painful ulcer. C. a painless, crater-like lesion. D. a plaquelike lesion. -ANS B All of the following are typical findings for a patient with chancroid except: A. multiple lesions. B. spontaneous rupture of affected nodes. C. blood-tinged penile discharge. D. dense, matted lymphadenopathy on the ipsilateral side of the lesion. -ANS C The causative organism of chancroid is: A. Ureaplasma species. B. Chlamydia trachomatis. C. Mycoplasma hominis. D. Haemophilus ducreyi. -ANS D Treatment options for chancroid include all of the following except: A. azithromycin. B. ciprofloxacin. C. ceftriaxone. D. amoxicillin. -ANS D When ordering laboratory tests to confirm chancroid, the NP considers that: A. concomitant infection with herpes simplex is often found. B. a disease-specific serum test is available. C. a white blood cell count with differential is indicated. D. dark-field examination is needed. -ANS A The most common causative organism of lymphogranuloma venereum is: A. Ureaplasma genitalium. B. C. trachomatis types 1 to 3. C. Neisseria gonorrhoeae. D. H. ducreyi. -ANS B Symptoms of lymphogranuloma venereum typically occur how long after contact with an infected host? A. 5-7 days B. 1-4 weeks C. 4-6 weeks D. 2-3 months -ANS B Physical examination findings in lymphogranuloma venereum include: A. verruciform lesions. B. lesions that fuse and create multiple draining sinuses. C. a painless crater. D. plaquelike lesions. -ANS B Treatment options for lymphogranuloma venereum include: A. tetracycline. B. penicillin. C. ceftriaxone. D. dapsone. -ANS A The presentation of acute epididymitis in an otherwise-well 22-year-old man includes A. the presence of a positive Prehn sign. B. low back pain. C. absent cremasteric reflex. D. diffuse abdominal pain. -ANS A The most likely causative pathogens in a 26-year-old man with acute epididymitis include: A. Escherichia coli. B. Enterobacteriaceae. C. C. trachomatis. D. Pseudomonas species. -ANS C A likely causative pathogens in a 25-year-old man with acute epididymitis who has sex with other men is: A. Escherichia coli. B. Mycoplasma spp. C. Chlamydia trachomatis. D. Acinetobacter baumannii. -ANS A Which of the following is part of a reasonable treatment option for a 30-year-old man with acute epididymitis who presents without gastrointestinal upset and will be treated as an outpatient? A doxycycline B. amoxicillin C. metronidazole D. clindamycin -ANS A Appropriate treatment of acute epididymitis for a 32-year-old man who has sex with other men is: A. ceftriaxone. B. azithromycin. C. levofloxacin. D. TMP-SMX. -ANS C Neisseria gonorrhoeae are best described as: A. gram-positive cocci. B. gram-positive rods. C. gram-negative diplococci. D. gram-negative bacilli. -ANS C The preferred treatment for uncomplicated gonococcal proctitis is: A. ceftriaxone 125 mg IM as a single dose plus a single dose of azithromycin 1 g po. B. oral erythromycin 500 mg bid for 7 days. C. oral norfloxacin 400 mg bid with metronidazole 500 mg bid for 3 days D. azithromycin 1 g po as a single dose plus single dose of injectable doxycycline 100 mg -ANS A Which of the following is recommended by the Centers for Disease Control and Prevention as single-dose therapy for uncomplicated urethritis caused by N. gonorrhoeae when an oral product is the most appropriate option? A. cefixime B. metronidazole C. azithromycin D. amoxicillin -ANS A You see a 42-year-old man with uncomplicated urogenital gonorrhea. His medical records indicate a severe allergic reaction to penicillin that includes difficulty breathing and diffuse urticaria. You recommend treatment with: A. cefixime. B. levofloxacin. C. azithromycin. D. tigecycline. -ANS C In gonococcal infection, which of the following statements is true? A. Risk of transmission from an infected woman to a male sexual partner is about 20% to 30% with a single coital act. B. Most men have symptomatic infection. C. The incubation period is about 2 to 3 weeks. D. The organism rarely produces beta-lactamase. -ANS A Risk factors for acute bacterial prostatitis include all of the following except: A. having unprotected sex. B. use of a urinary catheter. C. prior bladder infection. D. age 70 years. -ANS D The most common causative organisms of acute bacterial prostatitis in men 35 years are: A. E. coli and K. pneumoniae. B. N. gonorrhoeae and C. trachomatis. C. Pseudomonas and Acinetobacter species. D. enterococci. -ANS B When choosing an antimicrobial agent for the treatment of chronic bacterial prostatitis, the NP considers that: A. gram-positive organisms are the most likely cause of infection. B. cephalosporins are the first-line choice of therapy. C. choosing an antibiotic with gram-negative coverage is critical. D. length of antimicrobial therapy is typically 5 days. -ANS C All of the following are likely to be reported by patients with acute bacterial prostatitis except: A. perineal pain. B. irritative voiding symptoms. C. penile discharge. D. fever. -ANS C During acute bacterial prostatitis, the digital rectal examination usually reveals a gland described as: A. boggy. B. smooth. C. irregular. D. cystic. -ANS A A 30-year-old man with prostatitis presents with a fever of 102.3ºF (39.1ºC). What would be the expected CBC findings from this patient? A. WBC = 15,000/mm3; neutrophils = 4000/mm3 B. WBC = 18,000/mm3; neutrophils = 11,500/mm3 C. WBC = 7200/mm3; neutrophils = 3200/mm3 D. WBC = 4000/mm3; neutrophils=1200/mm3 -ANS B Appropriate antimicrobial treatment for a 25-year-old man with acute bacterial prostatitis is: A. oral azithromycin. B. IM ceftriaxone followed by oral doxycycline. C. oral ofloxacin. D. oral amoxicillin-clavulanate. -ANS B Appropriate antimicrobial treatment for a 65-year-old man with acute bacterial prostatitis is: A. erythromycin. B. cefepime. C. TMP-SMX. D. ciprofloxacin. -ANS D Symptoms in chronic bacterial prostatitis often include: A. fever. B. gastrointestinal upset. C. low back pain. D. penile discharge. -ANS C The most common causative organisms in chronic bacterial prostatitis include: A. gram-negative rods. B. gram-positive cocci. C. gram-negative cocci. D. gram-positive coccobacilli. -ANS A Which of the following is the best choice of therapy in chronic bacterial prostatitis? A. oral trimethoprim-sulfamethoxazole for 2 weeks B. parenteral ampicillin for 4 weeks C. oral ciprofloxacin for 4 weeks D. injectable gentamicin for 2 weeks -ANS C The best diagnostic test to identify the offending organism in acute bacterial prostatitis is: A. a urine cultures. B. a urethral culture. C. antibody testing. D. a urine Gram stain. -ANS A You perform a digital rectal examination (DRE) on a 72-year-old man and find a lesion suspicious for prostate cancer. The findings are described as: A. a rubbery, enlarged prostatic lobe. B. an area of prostatic induration. C. an indurated gland. D. prostatic tenderness. -ANS B Which part of the prostate is readily palpable during a DRE? A. anterior lobe B. median lobe C. lateral lobes D. posterior lobe -ANS D A 54-year-old white man with no obvious risk for prostate cancer opted to undergo PSA screening and DRE testing. The DRE findings are normal and his PSA is 3.7 ng/mL. You recommend: A. repeating the PSA test immediately. B. repeat screening in 1 year. C. repeat screening in 2 years. D. repeat screening in 5 years. -ANS B Risk factors for prostate cancer include all of the following except: A. African ancestry. B. history of genital trauma. C. family history of prostate cancer. D. high-fat diet. -ANS B The average American man has an approximately ____% lifetime risk of prostate cancer and an approximately ____% likelihood of clinical disease. A. 15, 5 B. 25, 8 C. 40, 10 D. 60, 15 -ANS C All of the following can cause an elevated PSA level except: A. prostate infection. B. cystoscopy. C. BPH. D. prostatectomy. -ANS D According to recent epidemiologic studies, prostate cancer is the number ___ cause of cancer death in men residing within the United States? A. 1 B. 2 C. 3 D. 4 -ANS B A 24-year-old man presents with sudden onset of left-sided scrotal pain. He reports having intermittent unilateral testicular pain in the past but not as severe this current episode. Confirmation of testicular torsion would include all of the following findings except: A. unilateral loss of the cremasteric reflex. B. the affected testicle held higher in the scrotum. C. testicular swelling. D. relief of pain with scrotal elevation. -ANS D In assessing a man with testicular torsion, the NP is most likely to note: A. elevated PSA level. B. white blood cells reported in urinalysis. C. left testicle most often affected. D. increased testicular blood flow by color-flow Doppler ultrasound. -ANS C Anticipated organ survival exceeds 85% with testicular decompression within how many hours of torsion? A. 1 B. 6 C. 16 D. 24 -ANS B To prevent a recurrence of testicular torsion, which of the following is recommended? A. use of a scrotal support B. avoidance of testicular trauma C. orchiopexy D. limiting the number of sexual partners -ANS C A 23-year-old man has a nontender "bag of worms" mass within the left scrotum that disappears when he is in the supine position. He is diagnosed with a varicocele. What is a risk factor that may have contributed to this condition? A. younger age B. current cigarette smoker C. multiple sexual partners D. none of the above -ANS D Which of the following is a common finding in a man with varicocele? A. lower sperm count with increased number of abnormal forms B. increased rate of testicular cancer C. recurrent scrotal pain D. BPH -ANS A Treatment options for varicocele repair include all of the following except: A. open surgery. B. laparoscopic surgery. C. treatment with a thrombolytic agent. D. percutaneous embolization. -ANS C How long after contact does the onset of clinical manifestations of syphilis typically occur? A. less than 1 week B. 1 to 3 weeks C. 2 to 4 weeks D. 4 to 6 weeks -ANS C Which of the following is not representative of the presentation of primary syphilis? A. a painless ulcer B. localized lymphadenopathy C. flulike symptoms D. a spontaneously healing lesion -ANS C Which of the following is representative of the presentation of secondary syphilis? A. generalized rash B. chancre C. pupillary alterations D. aortic regurgitation -ANS A Which of the following is found in tertiary syphilis? A. arthralgia B. lymphadenopathy C. maculopapular lesions involving the palms and soles D. gumma -ANS D Syphilis is most contagious at which of the following times? A. before onset of signs and symptoms B. during the primary stage C. during the secondary stage D. during the tertiary stage -ANS C First-line treatment options for primary syphilis include: A. penicillin. B. ciprofloxacin. C. erythromycin. D. ceftriaxone. -ANS A Sequelae of genital human papillomavirus (HPV) infection in a man can include: A. anorectal carcinoma. B. low sperm count. C. paraphimosis. D. Reiter syndrome. -ANS A Which of the following best describes the lesions associated with condyloma acuminatum? A. verruciform B. plaquelike C. vesicular D. bullous -ANS A Treatment options for patients with condyloma acuminatum include all of the following except: A. imiquimod. B. podofilox. C. topical acyclovir. D. cryotherapy. -ANS C Which HPV types are most likely to cause anorectal carcinoma? A. 1 and 3 B. 6 and 11 C. 16 and 18 D. 72 and 81 -ANS C Which HPV types are most likely to cause condyloma acuminatum? A. 1, 2, and 3 B. 6 and 11 C. 16 and 19 D. 22 and 24 -ANS B Routine anal Pap tests can be considered for all of the following patient populations except: A. men with HIV. B. men who has sex with men (MSM). C. women with a history of anogenital HPV infection. D. all males under age 25 years. -ANS D What approximately what percentage of sexually active adults has serological evidence of human herpesvirus 2 (HHV-2 or herpes simplex type 2)? A. 5 B. 15 C. 25 D. 40 -ANS B All of the following are likely reported in a man with an initial episode of genital HSV-2 (HHV-2) infection except A. painful ulcer.