Genitourinary EXAM MASTER Questions and Answers 100% Pass!!

Genitourinary EXAM MASTER Questions and Answers 100% Pass!! ase A 62-year-old woman is being treated for chronic congestive heart failure. She has been put on hydrochlorothiazide therapy. Her serum electrolyte levels are being monitored and show a persistent hypokalemia. Question The addition of what to her therapeutic regimen would be most appropriate? -Answer- Correct answer: Amiloride Explanation Amiloride is a potassium-sparing diuretic. Its diuretic effect is not very potent; therefore, it is good to use in combination with other diuretics. Acetazolamide is a carbonic anhydrase inhibitor. It causes a mild diuresis, a marked elevation of urinary pH, and a significant loss of potassium. Furosemide is a loop diuretic. It has a rapid onset of action and is a potent diuretic. However, it also causes potassium depletion and would only worsen the hypokalemia. Indapamide is a thiazide analog with a long duration of action. If anything, it would exacerbate the hypokalemia. Mannitol is an osmotic diuretic and would not be recommended in this patient. Furthermore, it would not have a potassium-sparing effect. Case A 42-year-old man presents with lower extremity swelling. His past medical history and review of symptoms is otherwise negative. The patient looks comfortable, with vitals showing the following: BP 142/91 mm Hg, HR 90 beats/min, RR 16 breaths/min, T 98°F, height 5'9'', and weight 158 lb. His examination is only remarkable for 2+ pitting edema in the lower extremities. The patient is counseled on a low-salt diet. The abnormal laboratory values are as follows: Lab Result Urinalysis 3+ protein, coarse granular casts, 2 - 5 WBCs, 0 - 2 RBCs Serum albumin 2.1 gm/dL Serum creatinine 2.0 mg/dL Serum BUN 18 mg/dL Hemoglobin 12.1 gm/dL Question What should be the next step in the management of this patient? -Answer-Correct answer: Order a 24-hour urine to quantitate urine protein Explanation The clinical picture is most consistent with nephrotic syndrome. This syndrome is characterized by proteinuria in excess of 3.5 grams a day per 1.73 m3 body surface area. Other symptoms commonly seen include edema, hypoalbuminemia, and hyperlipidemia. Patients may also exhibit anemia. Usually there is not an active urine sediment. The correct diagnostic test to confirm nephrotic syndrome is a 24-hour urine to quantitate the protein loss. If the diagnosis is confirmed, a renal biopsy may be considered to aid in determining the cause of nephrotic syndrome. However, because it is an invasive test, it should not be performed until the diagnosis is established. The patient has no symptoms of a urinary tract infection and only a small number of WBCs in her urinalysis, so a urine culture and empiric treatment would not be indicated. Since the patient does not have hematuria or pain, a kidney stone is unlikely; therefore, an intravenous pyelogram would not be indicated. Case A 54-year-old man presents with a lump in his scrotum recently. After answering many questions about possible symptoms and undergoing a thorough genitourinary examination, the patient is told that he most likely has a hydrocele. Question What findings most closely support this diagnosis? -Answer-orrect answer: Non-tender, fluid-filled lesion that transilluminates Explanation The correct answer is a non-tender, fluid-filled lesion that transilluminates. A hydrocele is a collection of fluid within the tunica vaginalis. It is non-tender, usually develops slowly over time, and will transilluminate when a light is held up to the scrotal wall. Patients can experience fluctuating size of the hydrocele, swelling of the scrotum or inguinal canal, heavy sensation within the scrotum, and do not typically experience any pain. Solid mass within the testicle that does not transilluminate is not the correct answer. Solid masses that are actually in the testicle itself are malignancies until proven otherwise. Patients may have a reactive hydrocele in addition to the malignancy, but hydroceles do not actually present as solid masses. In addition, hydroceles will transilluminate, whereas testicular malignancies will not transilluminate on examination. Painful swollen retracted testis that does not transilluminate is not the correct answer. This more closely describes testicular torsion as opposed to a hydrocele. Testicular torsion is painful, whereas hydroceles are not painful. Testicular torsion can also cause one testicle to retract and will not transilluminate upon examination. Testicular torsion is a urologic emergency, whereas hydroceles are often not even treated. Non-tender mass with the consistency of a "bag of worms" without transillumination is not the correct answer, as this description is more closely associated with a varicocele. Both hydroceles and varicoceles are non-tender, but hydroceles will transilluminate and varicoceles will not. Since a varicocele is a venous varicosity without the spermatic vein, it is often described as having the consistency of a "bag of worms" on examination. It will also decreas Case Ico-delete Highlights A 41-year-old woman has been hospitalized for over a week. Her laboratory results reflect an electrolyte abnormality and her EKG demonstrates peaked T waves as well as a widening of the QRS complex. Question These EKG abnormalities are characteristic of what condition? -Answer-Correct answer: Hyperkalemia Explanation Hyperkalemia refers to an elevated potassium level. Hyperkalemia can result in peaked T waves on EKG. The T wave is a reflection of ventricular repolarization. There can be widening of the QRS complex as well. The QRS complex is seen when the ventricle depolarizes. Hypercalcemia refers to an elevated calcium level. A shortened QT interval is seen with hypercalcemia. The time from the beginning of the QRS complex to the ending of the T wave is the QT interval. Hypothermia can cause a slower rhythm. Osborne waves can be present. There can be an elevation of the ST segment. The time from the end of the QRS complex to the beginning of the T wave is the ST segment. Hyponatremia refers to a depressed sodium level. Hyponatremia is not associated with EKG changes. Hyperglycemia refers to an elevated blood glucose level. Hyperglycemia is not associated with EKG changes. Case Ico-delete Highlights A 27-year-old woman presents with a change in her urine color; the change occurred a few days ago and has persisted. Her vital signs are: blood pressure 145/90 mmHg, pulse 82 bpm, respirations 16/min, and temperature 98.6°F. On physical examination, you note lower extremity edema. Urinalysis: Appearance: Pink and Cloudy Glucose: Negative Bilirubin: Negative Ketones: Negative Spec. Gravity: 1.035 Blood: 2+ pH: 6.5 Protein: Trace Urobilinogen: Normal Nitrite: Negative Leuk. Esterase: Negative Microscopic Examination: RBCs: 10 - 20 cells/hpf WBCs: 0 - 2 cells/hpf Question What is the initial diagnosis? -Answer-Correct answer: Nephritic syndrome Explanation The clinical picture is suggestive of nephritic syndrome. Nephritic syndrome is classified as a glomerular disease; clinical findings include edema, hypertension, and hematuria. Clinical findings for nephrotic syndrome include large urine protein, peripheral edema, and low serum albumin. Large urinary protein is not present in this patient. Clinical findings in cystitis include the patient being afebrile, irritative voiding symptoms, and positive urine cultures. On urinalysis, leukocyte esterase is usually present with positive or negative nitrites; it has a cloudy appearance and may have a noxious smell. Microscopic exam may reveal WBCs and bacteria. These symptoms are not present in this patient. Findings with pyelonephritis include fever, flank pain, and symptoms similar to cystitis. These findings are not present in this patient