Genitourinary
Final Test Review
(Questions & Solutions)
2025
1
,1. A 72-year-old man presents with progressive urinary hesitancy,
nocturia (3×/night), and a postvoid residual of 180 mL on bladder scan.
Digital rectal exam reveals a smooth, enlarged prostate. First‐line medical
therapy?
A) Finasteride
B) Tamsulosin
C) Oxybutynin
D) Desmopressin
ANS: B
Rationale: α₁-blockers (e.g., tamsulosin) rapidly reduce smooth muscle
tone in the prostate and bladder neck to improve symptoms.
2. A 68-year-old man on tamsulosin for BPH complains of dizziness upon
standing and ejaculatory dysfunction. Which adjustment is most
appropriate?
A) Switch to finasteride
B) Add oxybutynin
C) Increase tamsulosin dose
D) Start sildenafil
ANS: A
Rationale: Finasteride (5-α reductase inhibitor) reduces prostate size over
months and avoids α₁-blocker side effects like hypotension and sexual
dysfunction.
3. A 65-year-old with BPH has a peak flow rate of 6 mL/s (normal >15). He
has severe LUTS refractory to medical therapy. Best next step?
A) Transurethral resection of the prostate (TURP)
B) Cystoscopy only
C) Continue alpha‐blocker therapy
D) Intermittent catheterization
ANS: A
Rationale: TURP is the gold‐standard surgical intervention for refractory
2
, BPH with significant flow obstruction.
4. A 70-year-old with BPH develops acute urinary retention. He is started
on Foley catheter and IV fluids. Next step to avoid recurrence?
A) Schedule outpatient TURP
B) Switch to finasteride immediately
C) Start desmopressin
D) Advise routine catheter changes only
ANS: A
Rationale: Acute retention in BPH often requires surgical decompression
(e.g., TURP) to prevent recurrent retention.
II. Bladder Disorders (5 questions)
5. A 55-year-old woman with frequency, urgency, and urge incontinence;
bladder diary shows 12 voids/day, small volumes. First‐line
management?
A) Bladder training and pelvic floor exercises
B) Timed voiding only
C) Start duloxetine
D) Intravesical botulinum toxin
ANS: A
Rationale: Behavioral therapies (bladder training, Kegels) are first‐line for
overactive bladder.
6. A 68-year-old male has painless gross hematuria for two weeks. He is a
former smoker. Next diagnostic step?
A) Cystoscopy
B) Urine dipstick alone
C) 24-hour urine collection
D) KUB X-ray
ANS: A
Rationale: Painless hematuria in a smoker mandates cystoscopic
evaluation to exclude bladder cancer.
3
Final Test Review
(Questions & Solutions)
2025
1
,1. A 72-year-old man presents with progressive urinary hesitancy,
nocturia (3×/night), and a postvoid residual of 180 mL on bladder scan.
Digital rectal exam reveals a smooth, enlarged prostate. First‐line medical
therapy?
A) Finasteride
B) Tamsulosin
C) Oxybutynin
D) Desmopressin
ANS: B
Rationale: α₁-blockers (e.g., tamsulosin) rapidly reduce smooth muscle
tone in the prostate and bladder neck to improve symptoms.
2. A 68-year-old man on tamsulosin for BPH complains of dizziness upon
standing and ejaculatory dysfunction. Which adjustment is most
appropriate?
A) Switch to finasteride
B) Add oxybutynin
C) Increase tamsulosin dose
D) Start sildenafil
ANS: A
Rationale: Finasteride (5-α reductase inhibitor) reduces prostate size over
months and avoids α₁-blocker side effects like hypotension and sexual
dysfunction.
3. A 65-year-old with BPH has a peak flow rate of 6 mL/s (normal >15). He
has severe LUTS refractory to medical therapy. Best next step?
A) Transurethral resection of the prostate (TURP)
B) Cystoscopy only
C) Continue alpha‐blocker therapy
D) Intermittent catheterization
ANS: A
Rationale: TURP is the gold‐standard surgical intervention for refractory
2
, BPH with significant flow obstruction.
4. A 70-year-old with BPH develops acute urinary retention. He is started
on Foley catheter and IV fluids. Next step to avoid recurrence?
A) Schedule outpatient TURP
B) Switch to finasteride immediately
C) Start desmopressin
D) Advise routine catheter changes only
ANS: A
Rationale: Acute retention in BPH often requires surgical decompression
(e.g., TURP) to prevent recurrent retention.
II. Bladder Disorders (5 questions)
5. A 55-year-old woman with frequency, urgency, and urge incontinence;
bladder diary shows 12 voids/day, small volumes. First‐line
management?
A) Bladder training and pelvic floor exercises
B) Timed voiding only
C) Start duloxetine
D) Intravesical botulinum toxin
ANS: A
Rationale: Behavioral therapies (bladder training, Kegels) are first‐line for
overactive bladder.
6. A 68-year-old male has painless gross hematuria for two weeks. He is a
former smoker. Next diagnostic step?
A) Cystoscopy
B) Urine dipstick alone
C) 24-hour urine collection
D) KUB X-ray
ANS: A
Rationale: Painless hematuria in a smoker mandates cystoscopic
evaluation to exclude bladder cancer.
3
