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A 63-year-old man is seen in the clinic with a chief complaint of nocturia.
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Multiple Choice

Identify the choice that best completes the statement or answers the question.


____     1.            A 63-year-old man is seen in the clinic with a chief complaint of nocturia. Which of the following should be included in the differential diagnosis?

a.            Psychogenic nocturia     c.             Irritative posterior urethral lesion

b.            Urethral polyp   d.            Benign prostatic hypertrophy



____     2.            A 76-year-old man is seen in the office for complaints of urinary incontinence. The clinician should explore which of these causes of incontinence in men?

a.            Urethral polyps c.             Anticholinergic medication

b.            Urinary tract infection    d.            All of the above



____     3.            A 14-year-old male is seen with complaints of severe testicular pain. The clinician suspects testicular torsion. Which of the following is the appropriate action?

a.            Immediate referral to a urologist

b.            Obtain a computed tomography (CT) scan

c.             Instruct the patient to elevate scrotum

d.            Prescribe ibuprofen



____     4.            An 82-year-old man is seen in the primary care office with complaints of dribbling urine and difficulty starting his stream. Which of the following should be included in the list of differential diagnoses?

a.            Benign prostatic hyperplasia (BPH)          c.             Prostate cancer

b.            Parkinson’s disease        d.            All of the above



____     5.            Which of the following would be an appropriate treatment for a patient with mild benign prostatic hyperplasia (BPH)?

a.            Refer to urologist for surgery

b.            Prescribe a trial of tamsulosin

c.             Recommend cranberry supplements

d.            Reevaluate symptoms in 1 to 3 months



____     6.            A 30-year-old man is seen with a chief complaint of loss of libido. Which of the following laboratory tests would help establish a diagnosis?

a.            Testosterone level

b.            Prostate-specific antigen (PSA)

c.             Nocturnal penile tumescence and rigidity

d.            Prolactin level



____     7.            Which of the following should be considered in a patient presenting with erectile dysfunction?

a.            Diabetes mellitus             c.             Atherosclerosis

b.            Hypertension    d.            All of the above



____     8.            A 35-year-old man presents with complaints of painful erections, and he notices his penis is crooked when erect. What is the most likely diagnosis?

a.            Peyronie’s disease          c.             Scarring of the cavernosa

b.            Damage to the pudendal artery                d.            All of the above



____     9.            The patient with benign prostatic hyperplasia (BPH) is seen for follow-up. He has been taking finasteride (Proscar) for 6 months. The clinician should assess this patient for which of these side effects of the medication?

a.            Erectile dysfunction        c.             Hypotension

b.            Glaucoma            d.            Headache



____     10.          The clinician should prescribe an antibiotic that covers which of these organisms for a patient with acute prostatitis?

a.            Gram-positive cocci        c.             Gram-positive bacillus

b.            Gram-negative cocci       d.            Gram-negative bacillus



____     11.          The 56-year-old man with chronic prostatitis should be treated with trimethoprim 80 mg-sulfamethoxazole 400 mg (TMP-SMX, Bactrim) for how long?

a.            3 to 7 days           c.             3 to 6 weeks

b.            14 to 21 days      d.            6 to 12 weeks



____     12.          A 46-year-old man presents with urinary hesitancy and low back pain. He has no history of urinary tract infection (UTI). Digital rectal examination (DRE) reveals a normal prostate, and a diagnosis of prostatodynia is made. Which is the appropriate treatment?

a.            Terazosin 2 mg PO once a day    c.             Saw palmetto 320 mg per day

b.            Ice pack to scrotal area  d.            All of the above



____     13.          A 23-year-old sexually active man is seen in the clinic with unilateral painful testicular swelling and is diagnosed with epididymitis. In order to prescribe the correct drug, the clinician understands that which of these is the most common causative organism?

a.            Escherichia coli  c.             Chlamydia trachomatis

b.            Staphylococcus aureus  d.            Pseudomonas aeruginosa



____     14.          Which test is used to confirm a diagnosis of epididymitis?

a.            Urinalysis

b.            Gram stain of urethral discharge

c.             Complete blood cell (CBC) count with differential

d.            Ultrasound of scrotum



____     15.          Treatment for epididymitis includes which of the following?

a.            Warm sitz baths                c.             Masturbation

b.            Scrotal elevation              d.            All of the above



____     16.          Which of the following data are indicative of testicular torsion?

a.            Absent cremasteric reflex            c.             Testicle very low in the scrotum

b.            Pain relieved on testicular elevation        d.            Swollen scrotum with “red dot sign”



____     17.          A 60-year-old man presents with an enlarged scrotum. The clinician uses a penlight to transilluminate the scrotum. In a patient with a hydrocele, what would the clinician expect to find?

a.            The scrotum will be dark.

b.            The scrotum will appear light pink or yellow.

c.             The scrotum will appear milky white.

d.            The internal structures will be clearly visible.



____     18.          During a digital rectal exam (DRE) on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious?

a.            An enlarged rubbery gland          c.             A tender gland

b.            A hard irregular gland     d.            A boggy gland



____     19.          A 78-year-old man is diagnosed with C2 prostate cancer, and he asks the clinician what that means. In order to answer the patient, the clinician must have which of these understandings of the Jewett rating system?

a.            The cancer involves the seminal vesicles.

b.            There is metastatic disease to regional lymph nodes.

c.             The cancer is confined to the capsule.

d.            There is metastasis to distant organs.



____     20.          A 58-year-old patient has been receiving leuprolide as treatment for prostate cancer. The clinician should instruct the patient about which of these side effects of the medication?

a.            Risk of osteoporosis       c.             May have impotence

b.            May have hot flushes    d.            All of the above



____     21.          A 22-year-old male is seen in the clinic because he found a hard lump in his testicle when performing testicular self-examination (TSE). Which of the following should be included in the list of differential diagnoses?

a.            Testicular cancer              c.             Varicocele

b.            Inguinal hernia  d.            All of the above



____     22.          What is the treatment of choice for a patient diagnosed with testicular cancer?

a.            Radical orchidectomy     c.             Radiation implants

b.            Lumpectomy     d.            All of the above



____     23.          A patient with testicular cancer is being followed after completing treatment 1 year ago. He has been symptom-free with no evidence of disease. How often should he have a computed tomography (CT) scan?

a.            Every month      c.             Every 6 to 12 months

b.            Every 3 to 4 months        d.            Every year




Indicate whether the statement is true or false.


____     24.          Patients treated for Neisseria gonorrhoeae should also be treated for Chlamydia trachomatis.


____     25.          Hepatitis A is considered a sexually transmitted infection by the Centers for Disease Control and Prevention (CDC).

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A 63-year-old man is seen in the clinic with a chief complaint of nocturia.
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