ROSH REVIEW Genitourinary UPDATED ACTUAL Questions and CORRECT
Answers
1. Which of the follow- Correct Answer ( C )
ing is the most com- Explanation:
mon solid renal tu- Nephroblastoma, or Wilms tumor, is the most common solid renal tumor of
mor of childhood? childhood. It accounts for approximately 5% of all childhood cancers and
in 5% of those cases the cancer occurs bilaterally. There is a sporadic form
Adenocarcinoma that arises from two postzygotic mutations and a familial form that arises
Leiomyoma after one pre-zygotic mutation and one postzygotic mutation. Signs and
Nephroblastoma symptoms range from the discovery of an asymptomatic abdominal mass
Renal lipoma to abdominal pain, anorexia, abdominal distention, vomiting, and hema-
turia. Urinalysis will demonstrate hematuria and a complete blood count
(CBC) may show anemia. Diagnosis can be made by obtaining abdominal
ultrasound or CT scans of the abdomen, although chest X-ray is used to
evaluate for metastatic lung disease. Treatment includes surgical resection
of the kidney and is usually accomplished through a radical nephrectomy
through a transabdominal incision. Chemotherapy and radiation therapy are
also used as adjuncts to surgical resection. If the histology of the tumor is
favorable, the prognosis is good with a 4-year-survival rate around 90%.
2. One Step Further Answer: The third year of life.
Question: What is
the peak age for
presentation with a
Wilms tumor?
3. A previously Correct Answer ( B )
healthy, asympto- Explanation:
matic 21-year-old
,Sexually transmitted infections (STIs)
are a serious public health problem in
, woman presents the United States and worldwide. Sequelae of untreated STIs include infer-
to your office tility, cervical cancer, infections, and transmission to uninfected individuals.
with questions about Many patients with STIs are asymptomatic, and assessment of risk factors is
screening for sexual- an important aspect of determining who and when to screen. STI counseling
ly transmitted infec- and an assessment of risk factors begins with a thorough sexual history
tions. She is sexually including questions about new partners, frequency of condom use, history
active and would like of multiple sexual partners, intercourse with trauma, and types of sexual
to know what screen- exposures. Risk factors for STIs include new and multiple sexual partners,
ing tests she should age younger than 25 years, previous STIs, illegal drug use, incarceration
have done. Which of at a correctional facility or juvenile detention facility, intercourse with sex
the following is the workers, and meeting sexual partners on the internet. The United States
next best step in Preventive Services Task Force (USPSTF) recommends annual screening for
management? Neisseria gonorrheae and Chlamydia trachomatis infection in sexually active
women under the age of 25 years.
Annual testing for
human papillo-
mavirus
Annual testing for
Neisseria gonor-
rheae and Chlamy-
dia trachomatis
One time screening
for hepatitis B
One time screening
for herpes simplex
virus
4. A 67-year-old man Correct Answer ( B )
presents to his pri- Explanation:
mary care provider The man in this case has anemia of chronic disease and should be man-
with dyspnea and aged with darbepoetin. Anemia in chronic kidney disease (CKD) is primarily
fatigue. He has a due to decreased production of erythropoietin by the diseased kidney.
, past medical his- Almost all of patients with glomerular filtration rate less than 30 mL/min
tory of hyperten- have some degree of anemia. Erythropoietin is produced by the kidney
sion, diabetes mel- in response to decreased blood oxygen levels. Erythropoietin stimulates
litus, and stage 3 red blood cell production by the bone marrow. Anemia in CKD should be
chronic kidney dis- differentiated from iron deficiency anemia. In anemia of CKD, total iron
ease. A CBC shows binding capacity is usually normal to decreased; mean corpuscular volume
a hemoglobin of 9 and mean corpuscular hemoglobin are slightly decreased. Serum ferritin
g/dL, hematocrit of levels are usually increased. The anemia in CKD is usually normocytic and
28%, total iron-bind- normochromic, in contrast to iron deficiency anemia which is a microcytic
ing capacity of 220 and hypochromic anemia. Symptoms of CKD anemia include fatigue, dysp-
mcg/dL, mean cor- nea, depression, palpitations, and reduced exercise capacity. Recombinant
puscular volume of human erythropoietin and other erythropoiesis-stimulating agents are the
80 fL, mean cor- standard of care for anemia in CKD. Treatment is usually recommended
puscular hemoglo- when hemoglobin (Hgb) levels fall below 10 g/dL. The goal of treatment
bin concentration of should be to maintain Hgb levels between 10.5 and 11.5 g/dL. Hgb levels
31 g/dL, and ferritin greater than 13 g/dL are associated with increased morbidity and mortality.
of 310 ng/dL. A pe- Epoetin alpha and darbepoetin are two erythropoiesis-stimulating agents
ripheral blood smear commonly used. Both drugs have a black box warning for increased risk of
shows normocytic, thromboembolism, myocardial infarction, and stroke when used to target
normochromic red Hgb levels > 11 g/dL. Because CKD alone is an independent risk factor
blood cells with few for development of cardiovascular disease, risks versus benefits should be
reticulocytes. Which weighed before initiated an erythropoiesis-stimulating agents. Patients with
of the following is CKD require close prevention and management of cardiovascular disease.
the most appropri-
ate management? At this point, this man does not require a red blood cell transfusion (D). A red
blood cell transfusion threshold of 7 to 8 g/dL is generally accepted in he-
Cyanocobalamin modynamically stable patients except those with acute coronary syndrome.
Darbepoetin
Ferrous gluconate
and darbepoetin
Red blood cell trans-
fusion
Answers
1. Which of the follow- Correct Answer ( C )
ing is the most com- Explanation:
mon solid renal tu- Nephroblastoma, or Wilms tumor, is the most common solid renal tumor of
mor of childhood? childhood. It accounts for approximately 5% of all childhood cancers and
in 5% of those cases the cancer occurs bilaterally. There is a sporadic form
Adenocarcinoma that arises from two postzygotic mutations and a familial form that arises
Leiomyoma after one pre-zygotic mutation and one postzygotic mutation. Signs and
Nephroblastoma symptoms range from the discovery of an asymptomatic abdominal mass
Renal lipoma to abdominal pain, anorexia, abdominal distention, vomiting, and hema-
turia. Urinalysis will demonstrate hematuria and a complete blood count
(CBC) may show anemia. Diagnosis can be made by obtaining abdominal
ultrasound or CT scans of the abdomen, although chest X-ray is used to
evaluate for metastatic lung disease. Treatment includes surgical resection
of the kidney and is usually accomplished through a radical nephrectomy
through a transabdominal incision. Chemotherapy and radiation therapy are
also used as adjuncts to surgical resection. If the histology of the tumor is
favorable, the prognosis is good with a 4-year-survival rate around 90%.
2. One Step Further Answer: The third year of life.
Question: What is
the peak age for
presentation with a
Wilms tumor?
3. A previously Correct Answer ( B )
healthy, asympto- Explanation:
matic 21-year-old
,Sexually transmitted infections (STIs)
are a serious public health problem in
, woman presents the United States and worldwide. Sequelae of untreated STIs include infer-
to your office tility, cervical cancer, infections, and transmission to uninfected individuals.
with questions about Many patients with STIs are asymptomatic, and assessment of risk factors is
screening for sexual- an important aspect of determining who and when to screen. STI counseling
ly transmitted infec- and an assessment of risk factors begins with a thorough sexual history
tions. She is sexually including questions about new partners, frequency of condom use, history
active and would like of multiple sexual partners, intercourse with trauma, and types of sexual
to know what screen- exposures. Risk factors for STIs include new and multiple sexual partners,
ing tests she should age younger than 25 years, previous STIs, illegal drug use, incarceration
have done. Which of at a correctional facility or juvenile detention facility, intercourse with sex
the following is the workers, and meeting sexual partners on the internet. The United States
next best step in Preventive Services Task Force (USPSTF) recommends annual screening for
management? Neisseria gonorrheae and Chlamydia trachomatis infection in sexually active
women under the age of 25 years.
Annual testing for
human papillo-
mavirus
Annual testing for
Neisseria gonor-
rheae and Chlamy-
dia trachomatis
One time screening
for hepatitis B
One time screening
for herpes simplex
virus
4. A 67-year-old man Correct Answer ( B )
presents to his pri- Explanation:
mary care provider The man in this case has anemia of chronic disease and should be man-
with dyspnea and aged with darbepoetin. Anemia in chronic kidney disease (CKD) is primarily
fatigue. He has a due to decreased production of erythropoietin by the diseased kidney.
, past medical his- Almost all of patients with glomerular filtration rate less than 30 mL/min
tory of hyperten- have some degree of anemia. Erythropoietin is produced by the kidney
sion, diabetes mel- in response to decreased blood oxygen levels. Erythropoietin stimulates
litus, and stage 3 red blood cell production by the bone marrow. Anemia in CKD should be
chronic kidney dis- differentiated from iron deficiency anemia. In anemia of CKD, total iron
ease. A CBC shows binding capacity is usually normal to decreased; mean corpuscular volume
a hemoglobin of 9 and mean corpuscular hemoglobin are slightly decreased. Serum ferritin
g/dL, hematocrit of levels are usually increased. The anemia in CKD is usually normocytic and
28%, total iron-bind- normochromic, in contrast to iron deficiency anemia which is a microcytic
ing capacity of 220 and hypochromic anemia. Symptoms of CKD anemia include fatigue, dysp-
mcg/dL, mean cor- nea, depression, palpitations, and reduced exercise capacity. Recombinant
puscular volume of human erythropoietin and other erythropoiesis-stimulating agents are the
80 fL, mean cor- standard of care for anemia in CKD. Treatment is usually recommended
puscular hemoglo- when hemoglobin (Hgb) levels fall below 10 g/dL. The goal of treatment
bin concentration of should be to maintain Hgb levels between 10.5 and 11.5 g/dL. Hgb levels
31 g/dL, and ferritin greater than 13 g/dL are associated with increased morbidity and mortality.
of 310 ng/dL. A pe- Epoetin alpha and darbepoetin are two erythropoiesis-stimulating agents
ripheral blood smear commonly used. Both drugs have a black box warning for increased risk of
shows normocytic, thromboembolism, myocardial infarction, and stroke when used to target
normochromic red Hgb levels > 11 g/dL. Because CKD alone is an independent risk factor
blood cells with few for development of cardiovascular disease, risks versus benefits should be
reticulocytes. Which weighed before initiated an erythropoiesis-stimulating agents. Patients with
of the following is CKD require close prevention and management of cardiovascular disease.
the most appropri-
ate management? At this point, this man does not require a red blood cell transfusion (D). A red
blood cell transfusion threshold of 7 to 8 g/dL is generally accepted in he-
Cyanocobalamin modynamically stable patients except those with acute coronary syndrome.
Darbepoetin
Ferrous gluconate
and darbepoetin
Red blood cell trans-
fusion
