MSN 621 final number 2- Questions and Answers|
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A 55-year-old man with chronic kidney disease undergoing hemodialysis presents to the office
with complaints of erectile dysfunction. The patient states that his symptoms started three
weeks ago. He also reports that he does not have nocturnal erections. Which of the following is
the most likely treatment option for the patient's current complaint? Sildenafil
A 65-year-old male presents to a clinic with complaints of difficulty in urination and hematuria
for the past several weeks. He also has a history of weight loss and fatigue. On the digital rectal
exam (DRE), the prostate is enlarged, nodular, and rock hard. His prostate-specific antigen (PSA)
is 40 ng/ml. A magnetic resonance imaging (MRI) scan of the pelvis was advised. Which of the
following MRI finding is an indication of a stage III disease? Extracapsular extension
A 65-year-old male presents to a clinic with complaints of lumbar pain and difficulty with
urination. Detailed medical history revealed that he had lost 22 kgs of weight over a period of
six months. He also reports that he often feels fatigued. On physical examination, his back is
non-tender, and there is no abnormal finding on the neurologic exam. The rectal exam reveals
an enlarged, nodular hard prostate with obliteration of the slit and immobile rectal mucosa in
the region corresponding to the prostate. His prostate-specific antigen (PSA) is 38 ng/mL.
Magnetic resonance imaging and prostate biopsy show a clinically advanced disease and a
Gleason score of 4 + 4 = 8. He was started on oral hormonal agents but did not show any
response. The blood workup for AR-V7 was positive. What does the presence of AR-V7
(androgen receptor splice variant-7 messenger RNA) in this patient mean? Resistance to
both enzalutamide and abiraterone acetate
A 65-year-old male presents to a clinic with complaints of increased urinary frequency,
hesitancy, and incontinence associated with a weak stream. Detailed medical history revealed
that he also had a few episodes of hematuria over the past several weeks. On abdominal
examination, the abdomen was soft and non-tender. On digital rectal exam (DRE), there was a
large prostate nodule with immobile overlying mucosa. Lab reports showed hemoglobin of 14
g/dL, hematocrit 39.2%, white blood cell count 9,200/mm3 with a normal differential count,
platelets 230,000/mm3, blood urea nitrogen 11 mg/dL, and creatinine level 1.1 mg/dL. His liver
,function tests (LFT) were all within a normal range. His prostate-specific antigen (PSA) was 40
ng/mL. Ultrasound pelvis showed a hypoechoic lesion in the peripheral zone of the prostate. An
ultrasound-guided biopsy reveals 8/8 positive specimens with a Gleason score of 8. A bone scan
was perf Radiation and androgen ablation
A 65-year-old male presents to a clinic with complaints of nocturia, urgency, and hesitancy for
the past two months. He denies any history of hematuria, suprapubic pain, or dysuria. On a
digital rectal examination, there is a small palpable nodule in the area corresponding to the
prostate. Suprapubic ultrasound shows a prostate volume of 45 ml. Magnetic resonance
imaging reveals a PIRADS 3 lesion. A biopsy of the lesion demonstrates predominantly poorly-
formed, fused, or cribriform glands with a lesser component of well-formed glands. What is the
Gleason grade group of the lesion? Group 3
A 65-year-old male presents with a weak urinary stream, weight loss, and fatigue. He denies any
history of hematuria, suprapubic pain, or dysuria. A rectal exam is done, which reveals a 2 cm
hard nodule on the prostate. His prostate-specific antigen (PSA) is 16 ng/mL. A biopsy of the
nodule was taken. What histological feature is most likely to be seen on microscopy?
Increased cellular atypia with loss of glandular architecture and lack of a basal cell layer
A 65-year-old male presents to a clinic with complaints of difficulty in maintaining the urinary
stream, hesitancy, and nocturia associated with urgency. Detailed medical history revealed that
he also had a few episodes of hematuria over the past several weeks. On abdominal
examination, the abdomen was soft and non-tender. The findings of the digital rectal exam
(DRE) are unremarkable. His prostate-specific antigen (PSA) is 16 ng/mL. Suprapubic ultrasound
reveals a prostate volume of 30 ml. An ultrasound-guided biopsy shows 3+3 positive specimens
with a Gleason score of 6. A bone scan was performed, which did not reveal any skeletal lesions.
What is the current recommendation regarding the next best step in the management of this
patient? Counsel him regarding the active surveillance of the disease
A 74-year-old man with recently diagnosed low-risk prostate cancer presents to the clinic for
evaluation. He is on "active surveillance." Which of the following is most appropriate to be
included in the patient's further management? Periodic prostate-specific antigen (PSA)
testing and an additional biopsy 12-18 months after diagnosis
,A 77-year-old male with metastatic prostatic cancer is taking high doses of oral opioids for pain
control. Currently, he complains of persistent, intolerable sedation. Which of the following is the
best pharmacological strategy for treating the opioid-related sedation in this patient? Trial of
dose reduction or an alternate opioid medication
A 60-year-old male with advanced prostate cancer requires increased morphine dosage for pain
control. The healthcare provider notes that the patient is alert and responsive but has
intermittent brief jerky movements of his arms and legs. Which of the following is the most
likely explanation for these findings? Morphine induced myoclonuys
A 55-year-old man presents to the clinic with complaints of increased urinary frequency at
night, difficulty initiating urine, feeling incomplete bladder emptying, and terminal dribbling.
These symptoms have been present for the last year but have worsened over few months. He
has no associated fever, weight loss, blood in the urine, or burning on urination. However, he
has been treated twice for urinary tract infections in the past year. He has a history of type 2
diabetes and takes metformin. His most recent HbA1c was 7.8% one month back. He is sexually
active with his wife only. A digital rectal examination (DRE) reveals a smooth, soft enlarged
prostate. His prostate-specific antigen is measured to be 11 ng/mL (reference range: 1.0-1.5
ng/mL). A transrectal punch biopsy of the prostate is performed, and the histopathology is
shown in the figure. Which of the following is the most likely diagnosis? Adenocarcinoma
A 65-year-old male is diagnosed with the most common cancer given his age and gender.
Metastasis to which of the following is most commonly associated with this patient's condition?
Bone
A 65-year-old patient has end-stage uterine cancer. Which of the following organisms is most
likely to be the cause of a urinary tract infection in this patient? Pseudomonas aeruginosa
A decrease in the forced expiratory volume in one second (FEV1) to forced vital capacity (FVC)
ratio is most likely to be seen in a patient with which of the following? Asthma
, A middle-aged male presents to the emergency department with an exacerbation of his chronic
obstructive pulmonary disease (COPD). He has been coughing and been moderately short of
breath for the past 2 days. He says that his inhalers do work, but he ran out of supplies. He
complains of general malaise. After examining him, you decide to start him on antibiotics.
However, you first decide to send the sputum for gram stain and culture. According to the 2015
Global Initiative for Chronic Obstructive Lung Disease report, which of the following organisms
is most likely to be involved in COPD exacerbation? Moraxella catarrhalis
A 65-year-old male is evaluated for worsening shortness of breath and a productive cough for 6
months. He is a current smoker with a 30-pack-year smoking history. His other medical history
includes hypertension and chronic kidney disease. On examination, his blood pressure is 145/95
mmHg, pulse 88/min, and oxygen saturation of 92% on room air. He does not have accessory
muscle use. On lung auscultation, there is decreased air movement and prolonged expiration.
There are no wheezes detected. No S3 or S4 auscultated. There is no jugular vein distention. He
has no lower extremity edema and denies chest pain or calf tenderness. Chest x-ray reveals
bilateral hyperinflated lung fields. Which of the following is the next best step in the diagnosis of
this patient's condition? Spirometry
A 65-year-old male patient presents to the hospital with the complaint of increasing shortness
of breath. His condition has been progressively worsening over the past six months. He is a
smoker and a bird keeper. He has one son and one daughter with asthma. On examination,
there is a wheeze and coarse end-inspiratory crackles in the chest. A chest radiograph reveals
diffuse non-specific changes consistent with lung disease. What investigation is most likely to
yield the diagnosis in this case? Spirometry with reversibility
A 65-year-old male patient presents to the clinic with complaints of a dry cough and wheezing,
particularly at night. He has had asthma. Six months ago, his symptoms were well-controlled on
inhaled fomoterol and low dose budesonide twice a day and occasional use of an albuterol
inhaler as required. However, now he is more short of breath with morning dipping of his peak
flow readings. On examination, he is mildly dyspneic but able to complete sentences. On
auscultation, there are wheezes scattered in his chest. His peak expiratory flow rate is 70% of
predicted. What is the most appropriate next step in the management of this patient?
Inhaled budesonide dose
Latest Update 100% Verified
A 55-year-old man with chronic kidney disease undergoing hemodialysis presents to the office
with complaints of erectile dysfunction. The patient states that his symptoms started three
weeks ago. He also reports that he does not have nocturnal erections. Which of the following is
the most likely treatment option for the patient's current complaint? Sildenafil
A 65-year-old male presents to a clinic with complaints of difficulty in urination and hematuria
for the past several weeks. He also has a history of weight loss and fatigue. On the digital rectal
exam (DRE), the prostate is enlarged, nodular, and rock hard. His prostate-specific antigen (PSA)
is 40 ng/ml. A magnetic resonance imaging (MRI) scan of the pelvis was advised. Which of the
following MRI finding is an indication of a stage III disease? Extracapsular extension
A 65-year-old male presents to a clinic with complaints of lumbar pain and difficulty with
urination. Detailed medical history revealed that he had lost 22 kgs of weight over a period of
six months. He also reports that he often feels fatigued. On physical examination, his back is
non-tender, and there is no abnormal finding on the neurologic exam. The rectal exam reveals
an enlarged, nodular hard prostate with obliteration of the slit and immobile rectal mucosa in
the region corresponding to the prostate. His prostate-specific antigen (PSA) is 38 ng/mL.
Magnetic resonance imaging and prostate biopsy show a clinically advanced disease and a
Gleason score of 4 + 4 = 8. He was started on oral hormonal agents but did not show any
response. The blood workup for AR-V7 was positive. What does the presence of AR-V7
(androgen receptor splice variant-7 messenger RNA) in this patient mean? Resistance to
both enzalutamide and abiraterone acetate
A 65-year-old male presents to a clinic with complaints of increased urinary frequency,
hesitancy, and incontinence associated with a weak stream. Detailed medical history revealed
that he also had a few episodes of hematuria over the past several weeks. On abdominal
examination, the abdomen was soft and non-tender. On digital rectal exam (DRE), there was a
large prostate nodule with immobile overlying mucosa. Lab reports showed hemoglobin of 14
g/dL, hematocrit 39.2%, white blood cell count 9,200/mm3 with a normal differential count,
platelets 230,000/mm3, blood urea nitrogen 11 mg/dL, and creatinine level 1.1 mg/dL. His liver
,function tests (LFT) were all within a normal range. His prostate-specific antigen (PSA) was 40
ng/mL. Ultrasound pelvis showed a hypoechoic lesion in the peripheral zone of the prostate. An
ultrasound-guided biopsy reveals 8/8 positive specimens with a Gleason score of 8. A bone scan
was perf Radiation and androgen ablation
A 65-year-old male presents to a clinic with complaints of nocturia, urgency, and hesitancy for
the past two months. He denies any history of hematuria, suprapubic pain, or dysuria. On a
digital rectal examination, there is a small palpable nodule in the area corresponding to the
prostate. Suprapubic ultrasound shows a prostate volume of 45 ml. Magnetic resonance
imaging reveals a PIRADS 3 lesion. A biopsy of the lesion demonstrates predominantly poorly-
formed, fused, or cribriform glands with a lesser component of well-formed glands. What is the
Gleason grade group of the lesion? Group 3
A 65-year-old male presents with a weak urinary stream, weight loss, and fatigue. He denies any
history of hematuria, suprapubic pain, or dysuria. A rectal exam is done, which reveals a 2 cm
hard nodule on the prostate. His prostate-specific antigen (PSA) is 16 ng/mL. A biopsy of the
nodule was taken. What histological feature is most likely to be seen on microscopy?
Increased cellular atypia with loss of glandular architecture and lack of a basal cell layer
A 65-year-old male presents to a clinic with complaints of difficulty in maintaining the urinary
stream, hesitancy, and nocturia associated with urgency. Detailed medical history revealed that
he also had a few episodes of hematuria over the past several weeks. On abdominal
examination, the abdomen was soft and non-tender. The findings of the digital rectal exam
(DRE) are unremarkable. His prostate-specific antigen (PSA) is 16 ng/mL. Suprapubic ultrasound
reveals a prostate volume of 30 ml. An ultrasound-guided biopsy shows 3+3 positive specimens
with a Gleason score of 6. A bone scan was performed, which did not reveal any skeletal lesions.
What is the current recommendation regarding the next best step in the management of this
patient? Counsel him regarding the active surveillance of the disease
A 74-year-old man with recently diagnosed low-risk prostate cancer presents to the clinic for
evaluation. He is on "active surveillance." Which of the following is most appropriate to be
included in the patient's further management? Periodic prostate-specific antigen (PSA)
testing and an additional biopsy 12-18 months after diagnosis
,A 77-year-old male with metastatic prostatic cancer is taking high doses of oral opioids for pain
control. Currently, he complains of persistent, intolerable sedation. Which of the following is the
best pharmacological strategy for treating the opioid-related sedation in this patient? Trial of
dose reduction or an alternate opioid medication
A 60-year-old male with advanced prostate cancer requires increased morphine dosage for pain
control. The healthcare provider notes that the patient is alert and responsive but has
intermittent brief jerky movements of his arms and legs. Which of the following is the most
likely explanation for these findings? Morphine induced myoclonuys
A 55-year-old man presents to the clinic with complaints of increased urinary frequency at
night, difficulty initiating urine, feeling incomplete bladder emptying, and terminal dribbling.
These symptoms have been present for the last year but have worsened over few months. He
has no associated fever, weight loss, blood in the urine, or burning on urination. However, he
has been treated twice for urinary tract infections in the past year. He has a history of type 2
diabetes and takes metformin. His most recent HbA1c was 7.8% one month back. He is sexually
active with his wife only. A digital rectal examination (DRE) reveals a smooth, soft enlarged
prostate. His prostate-specific antigen is measured to be 11 ng/mL (reference range: 1.0-1.5
ng/mL). A transrectal punch biopsy of the prostate is performed, and the histopathology is
shown in the figure. Which of the following is the most likely diagnosis? Adenocarcinoma
A 65-year-old male is diagnosed with the most common cancer given his age and gender.
Metastasis to which of the following is most commonly associated with this patient's condition?
Bone
A 65-year-old patient has end-stage uterine cancer. Which of the following organisms is most
likely to be the cause of a urinary tract infection in this patient? Pseudomonas aeruginosa
A decrease in the forced expiratory volume in one second (FEV1) to forced vital capacity (FVC)
ratio is most likely to be seen in a patient with which of the following? Asthma
, A middle-aged male presents to the emergency department with an exacerbation of his chronic
obstructive pulmonary disease (COPD). He has been coughing and been moderately short of
breath for the past 2 days. He says that his inhalers do work, but he ran out of supplies. He
complains of general malaise. After examining him, you decide to start him on antibiotics.
However, you first decide to send the sputum for gram stain and culture. According to the 2015
Global Initiative for Chronic Obstructive Lung Disease report, which of the following organisms
is most likely to be involved in COPD exacerbation? Moraxella catarrhalis
A 65-year-old male is evaluated for worsening shortness of breath and a productive cough for 6
months. He is a current smoker with a 30-pack-year smoking history. His other medical history
includes hypertension and chronic kidney disease. On examination, his blood pressure is 145/95
mmHg, pulse 88/min, and oxygen saturation of 92% on room air. He does not have accessory
muscle use. On lung auscultation, there is decreased air movement and prolonged expiration.
There are no wheezes detected. No S3 or S4 auscultated. There is no jugular vein distention. He
has no lower extremity edema and denies chest pain or calf tenderness. Chest x-ray reveals
bilateral hyperinflated lung fields. Which of the following is the next best step in the diagnosis of
this patient's condition? Spirometry
A 65-year-old male patient presents to the hospital with the complaint of increasing shortness
of breath. His condition has been progressively worsening over the past six months. He is a
smoker and a bird keeper. He has one son and one daughter with asthma. On examination,
there is a wheeze and coarse end-inspiratory crackles in the chest. A chest radiograph reveals
diffuse non-specific changes consistent with lung disease. What investigation is most likely to
yield the diagnosis in this case? Spirometry with reversibility
A 65-year-old male patient presents to the clinic with complaints of a dry cough and wheezing,
particularly at night. He has had asthma. Six months ago, his symptoms were well-controlled on
inhaled fomoterol and low dose budesonide twice a day and occasional use of an albuterol
inhaler as required. However, now he is more short of breath with morning dipping of his peak
flow readings. On examination, he is mildly dyspneic but able to complete sentences. On
auscultation, there are wheezes scattered in his chest. His peak expiratory flow rate is 70% of
predicted. What is the most appropriate next step in the management of this patient?
Inhaled budesonide dose
