APEA 3P Exam Prep-
Nephrology/GU Questions with
Correct Answers and Explanations
A 79-year-old female patient with urinary frequency is found to have a UTI. What
medication could produce arrhythmias in her?
Doxycycline
Amoxicillin
Ciprofloxacin
Macrodantin
Ciprofloxacin is a quinolone antibiotic. All quinolones have the potential to produce
prolongation of the QT interval. It should be prescribed with caution in older adults.
Mrs. Jackson complains of urinary incontinence when she laughs or sneezes. What
should be used first line to treat her symptoms?
Kegel exercises
Prescribe oxybutynin
Avoid caffeine and alcohol
Minimize fluids at nighttime
This patient has stress incontinence. The first-line approach with these patients is to
attempt to strengthen the pelvic floor muscles. Appropriate performance of Kegel
exercises is key. Prescribing an anticholinergic might worsen incontinence because it
will cause urinary retention. Avoiding caffeine and alcohol is especially helpful for
people with urge incontinence, but could have a minimal benefit for this patient.
However, this does not address the underlying problem, weak pelvic muscles.
Minimizing fluids at nighttime will help if nocturia is a problem.
A 76-year-old male presents with urethral irritation after voiding. If sexually
transmitted diseases and urinary tract infection are ruled out, what is another
etiology?
Acute bacterial prostatitis
, Chronic prostatitis
Epididymitis
Asymptomatic bacteriuria
Chronic prostatitis can produce these symptoms. Sometimes this is accompanied by
perineal pain, but the patient may have a normal prostate exam. Acute bacterial
prostatitis patients will present with fever, chills. Examination of the prostate gland
reveals a tender, boggy prostate gland. Epididymitis can produce scrotal pain, not
dysuria or irritation with voiding. Asymptomatic bacteriuria is asymptomatic. These
patients don’t know they have this because they have no symptoms.
A healthy 32-year-old female has left flank pain and nausea. What is the most likely
diagnosis?
Urinary tract infection
Renal stone
Cholecystitis
Pyelonephritis
The most common presentation of acute uncomplicated pyelonephritis includes
fever, flank pain, and nausea and vomiting. Sometimes patients present with
symptoms of pelvic inflammatory disease (PID). In this presentation, abdominal pain
is common too. Fever is so strongly correlated with acute pyelonephritis that it is
unusual not to have fever. Renal stone patients may have this presentation, but
fever is usually NOT present. It is unlikely that cholecystitis would present with left-
sided flank pain. The gall bladder is on the right side of the body.
The incidence of pyelonephritis is:
least common in young adults.
less common than urinary tract infections.
always associated with urinary tract infections.
more likely in elderly males.
The incidence of pyelonephritis in the US is much less common than urinary tract
infections (UTIs). It is less likely in males, but is most common in females aged 15-
29 years; and even more common during pregnancy. Factors associated with
pyelonephritis are frequent sexual intercourse, UTI within the last year, presence of
diabetes, and presence of stress incontinence within the previous 30 days.
Nephrology/GU Questions with
Correct Answers and Explanations
A 79-year-old female patient with urinary frequency is found to have a UTI. What
medication could produce arrhythmias in her?
Doxycycline
Amoxicillin
Ciprofloxacin
Macrodantin
Ciprofloxacin is a quinolone antibiotic. All quinolones have the potential to produce
prolongation of the QT interval. It should be prescribed with caution in older adults.
Mrs. Jackson complains of urinary incontinence when she laughs or sneezes. What
should be used first line to treat her symptoms?
Kegel exercises
Prescribe oxybutynin
Avoid caffeine and alcohol
Minimize fluids at nighttime
This patient has stress incontinence. The first-line approach with these patients is to
attempt to strengthen the pelvic floor muscles. Appropriate performance of Kegel
exercises is key. Prescribing an anticholinergic might worsen incontinence because it
will cause urinary retention. Avoiding caffeine and alcohol is especially helpful for
people with urge incontinence, but could have a minimal benefit for this patient.
However, this does not address the underlying problem, weak pelvic muscles.
Minimizing fluids at nighttime will help if nocturia is a problem.
A 76-year-old male presents with urethral irritation after voiding. If sexually
transmitted diseases and urinary tract infection are ruled out, what is another
etiology?
Acute bacterial prostatitis
, Chronic prostatitis
Epididymitis
Asymptomatic bacteriuria
Chronic prostatitis can produce these symptoms. Sometimes this is accompanied by
perineal pain, but the patient may have a normal prostate exam. Acute bacterial
prostatitis patients will present with fever, chills. Examination of the prostate gland
reveals a tender, boggy prostate gland. Epididymitis can produce scrotal pain, not
dysuria or irritation with voiding. Asymptomatic bacteriuria is asymptomatic. These
patients don’t know they have this because they have no symptoms.
A healthy 32-year-old female has left flank pain and nausea. What is the most likely
diagnosis?
Urinary tract infection
Renal stone
Cholecystitis
Pyelonephritis
The most common presentation of acute uncomplicated pyelonephritis includes
fever, flank pain, and nausea and vomiting. Sometimes patients present with
symptoms of pelvic inflammatory disease (PID). In this presentation, abdominal pain
is common too. Fever is so strongly correlated with acute pyelonephritis that it is
unusual not to have fever. Renal stone patients may have this presentation, but
fever is usually NOT present. It is unlikely that cholecystitis would present with left-
sided flank pain. The gall bladder is on the right side of the body.
The incidence of pyelonephritis is:
least common in young adults.
less common than urinary tract infections.
always associated with urinary tract infections.
more likely in elderly males.
The incidence of pyelonephritis in the US is much less common than urinary tract
infections (UTIs). It is less likely in males, but is most common in females aged 15-
29 years; and even more common during pregnancy. Factors associated with
pyelonephritis are frequent sexual intercourse, UTI within the last year, presence of
diabetes, and presence of stress incontinence within the previous 30 days.
