Pance Genitourinary - Final Test Review (Qns & Ans) - 2025, Exams of Nursing

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Genitourinary

Final Test Review

(Questions & Solutions)

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

7. A 40-year-old with recurrent UTIs and flank pain is diagnosed with interstitial cystitis. Which finding supports the diagnosis? A) Hunner’s ulcers on cystoscopy B) Positive urine culture C) Elevated PSA D) Proteinuria >1 g/day ANS: A Rationale: Hunner’s lesions on cystoscopy are characteristic of interstitial cystitis/painful bladder syndrome.
8. A 75-year-old with chronic urinary retention and recurrent UTIs has a palpable bladder above the pubis. Diagnosis? A) Neurogenic bladder B) Overactive bladder C) Stress incontinence D) Interstitial cystitis ANS: A Rationale: Chronic retention with overflow and recurrent infections suggests neurogenic bladder dysfunction.
9. A postpartum 28-year-old woman experiences leakage on exertion and cough. Urodynamics show urethral hypermobility. Best treatment? A) Midurethral sling B) Estrogen cream only C) Anticholinergics D) Beta-3 agonist ANS: A Rationale: Stress incontinence from urethral hypermobility is best treated surgically with a midurethral sling. III. Congenital/Acquired Abnormalities (4 questions)
10. A 2-year-old boy has a palpable mass in the anterior scrotum that transluminates. Diagnosis? A) Hydrocele

B) Varicocele C) Indirect inguinal hernia D) Testicular torsion ANS: A Rationale: A hydrocele transilluminates and is common in infants due to patent processus vaginalis.

11. A newborn male with absent right testis in scrotum and inguinal canal. Next step? A) Orchiopexy by 6 months B) Watchful waiting until age 1 C) Hormonal therapy only D) Manual manipulation ANS: B Rationale: Most undescended testes descend by 6 months; orchiopexy recommended between 6–12 months.
12. A 45-year-old woman has bladder prolapse (“cystocele”) and vaginal bulge. Best intervention? A) Pessary placement B) Midurethral sling C) Anticholinergic therapy D) Intravesical therapy ANS: A Rationale: Vaginal pessary is a non‐surgical option to support a cystocele and relieve symptoms.
13. A 30-year-old presents with ureteropelvic junction obstruction on ultrasound, recurrent UTIs, and hydronephrosis. Definitive management? A) Pyeloplasty B) Chronic antibiotics only C) Nephrectomy D) Percutaneous nephrostomy as sole therapy ANS: A Rationale: Surgical repair (pyeloplasty) corrects UPJ obstruction and

scrotal skin. Urgent management? A) Surgical debridement for Fournier’s gangrene B) Oral antibiotics only C) Warm soaks D) Hyperbaric oxygen only ANS: A Rationale: Fournier’s gangrene is surgical emergency with broad‐ spectrum antibiotics and debridement.

18. A child with UTI recurs repeatedly. VCUG reveals grade III VUR. Next step? A) Surgical reimplantation of ureter B) Long-term prophylactic antibiotics C) No intervention if asymptomatic D) Timed voiding only ANS: B Rationale: Grade I–III VUR is initially managed with prophylactic antibiotics; surgery for higher grades or failure. V. Neoplasms (4 questions)
19. A 65-year-old smoker presents with painless gross hematuria. Cystoscopy shows a papillary bladder tumor. Next management? A) Transurethral resection of bladder tumor (TURBT) B) Radical cystectomy immediately C) Oral chemotherapy only D) Intravenous antibiotics ANS: A Rationale: Initial diagnosis and treatment of superficial bladder cancer is TURBT, followed by risk‐adapted therapy.
20. A 55-year-old with PSA 12 ng/mL and abnormal DRE. Biopsy shows Gleason 8 adenocarcinoma. Next step? A) Radical prostatectomy or radiation B) Repeat PSA in 6 months only

C) Finasteride D) Watchful waiting ANS: A Rationale: High‐grade prostate cancer (Gleason ≥8) warrants definitive treatment (surgery or radiation).

21. A 12-year-old boy has flank mass, hematuria, and hypertension. CT shows Wilms tumor. Initial therapy? A) Nephrectomy followed by chemotherapy B) Radiation only C) Observation D) High-dose steroids ANS: A Rationale: Wilms tumor is managed with surgery and adjuvant chemotherapy (and sometimes radiation).
22. A patient with renal cell carcinoma is found to have an ipsilateral varicocele. Pathophysiology? A) Tumor invasion of left renal vein B) IVC thrombus on right side C) Testicular torsion D) Spermatic cord infection ANS: A Rationale: RCC can invade the left renal vein, causing backflow and left‐ sided varicocele. VI. Nephrolithiasis/Urolithiasis (5 questions)
23. A 35-year-old with acute flank pain and hematuria; CT shows 5 mm ureteral stone. Best management? A) NSAIDs and hydration B) Lithotripsy C) Ureteral stent only D) Immediate surgery ANS: A

C) Struvite D) Uric acid ANS: A Rationale: Indinavir can precipitate in urine causing protease inhibitor– related stones. VII. Penile Disorders (4 questions)

28. A 55-year-old diabetic presents with painful erection >4 hours after Viagra use. Next step? A) Intracavernosal phenylephrine injection B) Observation C) Ice packs only D) Oral beta-blockers ANS: A Rationale: Ischemic priapism requires intracavernosal α-agonist to restore detumescence and prevent fibrosis.
29. A 60-year-old with tunica albuginea plaque causing dorsal penile curvature and painful erections. Diagnosis? A) Peyronie’s disease B) Phimosis C) Paraphimosis D) Balanitis ANS: A Rationale: Peyronie’s is characterized by fibrous plaques causing curvature and pain.
30. A 2-year-old uncircumcised boy has a nonretractable foreskin and ballooning with urination. Diagnosis? A) Physiologic phimosis B) Paraphimosis C) Balanoposthitis D) Urethral stricture ANS: A

Rationale: Physiologic phimosis in young boys is normal; prepuce often becomes retractable by school age.

31. A 50-year-old man with penile lesion biopsy shows invasive squamous cell carcinoma. Risk factor? A) Poor hygiene and HPV infection B) Syphilis C) Balanitis xerotica D) Paraphimosis ANS: A Rationale: Penile SCC is associated with HPV types 16/18 and poor hygiene in uncircumcised men. VIII. Testicular Disorders (4 questions)
32. A 17-year-old with sudden severe testicular pain, absent cremasteric reflex, and high-riding testis. Next step? A) Urgent Doppler ultrasound and surgical detorsion B) NSAIDs and rest C) Orchiectomy only D) Antibiotics ANS: A Rationale: Testicular torsion requires immediate ultrasound and emergent surgery within 6 hours to save the testis.
33. A 30-year-old with painless testicular mass on exam and elevated AFP and β-hCG. Diagnosis? A) Nonseminomatous germ cell tumor B) Seminoma C) Leydig cell tumor D) Epididymal cyst ANS: A Rationale: Elevated AFP and hCG suggest nonseminomatous testicular cancer.

A) Sitz baths and topical estrogen B) Vaginal dilators C) Surgical resection D) Oral antibiotics ANS: A Rationale: Urethral prolapse in prepubertal girls responds to conservative estrogen cream and hygiene.

38. A 40-year-old with recurrent urethritis and greenish discharge. NAAT positive for C. trachomatis. Treatment? A) Azithromycin 1 g PO × B) Doxycycline ×3 days C) Ceftriaxone only D) Metronidazole ANS: A Rationale: Single‐dose azithromycin is first‐line for chlamydial urethritis.
39. A 70-year-old man with radiation therapy history presents with dysuria and urethral narrowing on cystoscopy requiring dilation. Likely cause? A) Radiation-induced urethral stricture B) Lichen sclerosis C) BPH D) Urethral carcinoma ANS: A Rationale: Radiation fibrosis can cause both bladder and urethral strictures.
40. A 25-year-old presents with recurrent UTIs and a complaint of a “pocket” along the urethra. Imaging confirms a 2 cm urethral diverticulum. Best management? A) Surgical excision B) Broad‐spectrum antibiotics C) Observation D) Dilation

ANS: A

Rationale: Symptomatic urethral diverticula require surgical excision to prevent infection and stone formation.

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Benign Prostatic Hyperplasia (BPH) A 65-year-old man presents with hesitancy, weak stream, and frequent nighttime urination. Which finding on digital rectal examination (DRE) most strongly supports benign prostatic hyperplasia? a) Nodular, asymmetrical prostate b) Symmetrically enlarged, smooth, firm prostate c) Hard, irregular prostate d) Tender, boggy prostate ANS: b) Symmetrically enlarged, smooth, firm prostate Rationale: BPH typically presents as a smooth, firm, symmetrically enlarged prostate on DRE. Nodularity or asymmetry raises concern for prostate cancer. Which first-line pharmacologic treatment targets smooth muscle tone in BPH and provides rapid symptom relief? a) 5-alpha reductase inhibitors b) Anticholinergics c) Alpha-1 adrenergic antagonists d) PDE-5 inhibitors ANS: c) Alpha-1 adrenergic antagonists Rationale: Alpha-blockers relax prostatic smooth muscle, improving urine flow within days to weeks. A patient with BPH develops new acute urinary retention. Which is the preferred immediate management? a) Begin oral finasteride b) Catheterize bladder c) Urgent transurethral resection of the prostate (TURP) d) Increase fluid intake

a) Schistosomiasis infection b) Chronic cyclophosphamide use c) Cigarette smoking d) Chronic indwelling catheter ANS: c) Cigarette smoking Rationale: Smoking is the strongest and most common risk factor in the US. A postmenopausal woman has urinary incontinence worsened by coughing and sneezing. What is the underlying pathophysiology? a) Detrusor overactivity b) Urethral sphincter weakness c) Bladder outlet obstruction d) Reflex neurogenic bladder ANS: b) Urethral sphincter weakness Rationale: Stress incontinence results from insufficient urethral sphincter tone. Congenital and Acquired Abnormalities A newborn male has a urethral opening on the ventral surface of the penis. What is this condition? a) Epispadias b) Hypospadias c) Phimosis d) Paraphimosis ANS: b) Hypospadias Rationale: Hypospadias denotes an abnormally ventral meatus. In a patient with horseshoe kidney, there is increased risk for which complication? a) Renal cell carcinoma b) Ureteropelvic junction obstruction c) Wilms tumor d) Hydronephrosis ANS: d) Hydronephrosis

Rationale: Horseshoe kidney can predispose to obstruction, leading to hydronephrosis. A teenage boy is diagnosed with cryptorchidism. Which is the greatest risk if uncorrected? a) Urinary tract infection b) Testicular torsion c) Testicular cancer d) Testicular microlithiasis ANS: c) Testicular cancer Rationale: Cryptorchidism greatly increases future risk of testicular malignancy. A 3-year-old boy has a non-retractile foreskin with ballooning during urination, but no pain. Next step? a) Immediate circumcision b) Trial of topical corticosteroids c) Reassure, normal finding in young boys d) Attempt forceful retraction ANS: c) Reassure, normal finding in young boys Rationale: Physiologic phimosis is normal and resolves with age. Infectious Disorders A 24-year-old sexually active male has dysuria and purulent urethral discharge. Gram stain: gram-negative diplococci in PMNs. Diagnosis? a) Chlamydia trachomatis urethritis b) N. gonorrhoeae urethritis c) E. coli cystitis d) Mycoplasma genitalium infection ANS: b) N. gonorrhoeae urethritis Rationale: Gram-negative intracellular diplococci indicate gonococcus. A 60-year-old diabetic man has fever, perineal pain, dysuria, and boggy, tender prostate on exam. What is most appropriate empiric therapy? a) Oral doxycycline

Rationale: Prostate cancer commonly spreads to bone and causes osteoblastic lesions. A 25-year-old man presents with a painless, firm testicular mass. Which tumor marker would be most supportive of seminoma? a) Alpha-fetoprotein (AFP) b) Beta-human chorionic gonadotropin (β-hCG) c) PSA d) CA- 125 ANS: b) Beta-human chorionic gonadotropin (β-hCG) Rationale: Seminomas may elevate β-hCG (but not AFP). A 65-year-old man has painless gross hematuria. What is the next step in diagnosis? a) Repeat urinalysis in one month b) Immediate cystoscopy c) Empiric antibiotics d) Renal biopsy ANS: b) Immediate cystoscopy Rationale: Painless hematuria is concerning for malignancy; cystoscopy is essential. A renal mass is found incidentally on CT. Which imaging feature suggests renal cell carcinoma rather than a benign cyst? a) Smooth, thin wall with water attenuation b) Enhances with contrast c) Non-enhancing, homogeneous d) Located in renal pelvis ANS: b) Enhances with contrast Rationale: RCCs enhance with contrast; simple cysts do not. Nephrolithiasis/Urolithiasis A 34-year-old man has sudden severe flank pain radiating to the groin, hematuria, and vomiting. What is the most sensitive initial imaging for nephrolithiasis?

a) KUB (X-ray) b) Renal ultrasound c) Non-contrast helical CT d) MRI abdomen ANS: c) Non-contrast helical CT Rationale: CT is the most sensitive and specific for stones. Which stone type is most strongly associated with chronic urinary tract infections with urease-producing bacteria? a) Uric acid b) Cystine c) Calcium oxalate d) Struvite ANS: d) Struvite Rationale: Struvite stones form in alkaline urine due to urease-splitting organisms. A patient with recurrent calcium stones has hypercalciuria and hypocitraturia. Which is an appropriate dietary recommendation? a) Increase dietary calcium b) Increase animal protein c) Restrict fruit and vegetables d) Restrict sodium ANS: d) Restrict sodium Rationale: High sodium increases calcium excretion; restriction helps prevent stones. A 54-year-old man with a 3-mm distal ureteral stone is stable and pain is controlled. What is the best next step? a) Percutaneous nephrolithotomy b) Surgical ureterolithotomy c) Observation with increased fluids d) Begin chronic allopurinol ANS: c) Observation with increased fluids Rationale: Most stones <5mm pass spontaneously; fluids and pain control