ROSH REVIEW Genitourinary Exam | Questions & Answers (100 %Score) Latest
Updated 2024/2025 Comprehensive Questions A+ Graded Answers | With Expert Solutions
Which of the following is the most common solid renal tumor of childhood?
Adenocarcinoma
Leiomyoma
Nephroblastoma
Renal lipoma - Correct Answer ( C )
Explanation:
Nephroblastoma, or Wilms tumor, is the most common solid renal tumor of 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 that arises from two postzygotic
mutations and a familial form that arises after one pre-zygotic mutation and one
postzygotic mutation. Signs and symptoms range from the discovery of an
asymptomatic abdominal mass to abdominal pain, anorexia, abdominal distention,
vomiting, and hematuria. 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%.
One Step Further
Question: What is the peak age for presentation with a Wilms tumor? - Answer: The
third year of life.
A previously healthy, asymptomatic 21-year-old woman presents to your office with
questions about screening for sexually transmitted infections. She is sexually active and
would like to know what screening tests she should have done. Which of the following is
the next best step in management?
Annual testing for human papillomavirus
Annual testing for Neisseria gonorrheae and Chlamydia trachomatis
One time screening for hepatitis B
One time screening for herpes simplex virus - Correct Answer ( B )
Explanation:
Sexually transmitted infections (STIs) are a serious public health problem in the United
States and worldwide. Sequelae of untreated STIs include infertility, cervical cancer,
infections, and transmission to uninfected individuals. Many patients with STIs are
asymptomatic, and assessment of risk factors is an important aspect of determining
who and when to screen. STI counseling and an assessment of risk factors begins with
a thorough sexual history including questions about new partners, frequency of condom
,use, history of multiple sexual partners, intercourse with trauma, and types of sexual
exposures. Risk factors for STIs include new and multiple sexual partners, age younger
than 25 years, previous STIs, illegal drug use, incarceration at a correctional facility or
juvenile detention facility, intercourse with sex workers, and meeting sexual partners on
the internet. The United States Preventive Services Task Force (USPSTF) recommends
annual screening for Neisseria gonorrheae and Chlamydia trachomatis infection in
sexually active women under the age of 25 years.
A 67-year-old man presents to his primary care provider with dyspnea and fatigue. He
has a past medical history of hypertension, diabetes mellitus, and stage 3 chronic
kidney disease. A CBC shows a hemoglobin of 9 g/dL, hematocrit of 28%, total iron-
binding capacity of 220 mcg/dL, mean corpuscular volume of 80 fL, mean corpuscular
hemoglobin concentration of 31 g/dL, and ferritin of 310 ng/dL. A peripheral blood
smear shows normocytic, normochromic red blood cells with few reticulocytes. Which of
the following is the most appropriate management?
Cyanocobalamin
Darbepoetin
Ferrous gluconate and darbepoetin
Red blood cell transfusion - Correct Answer ( B )
Explanation:
The man in this case has anemia of chronic disease and should be managed with
darbepoetin. Anemia in chronic kidney disease (CKD) is primarily due to decreased
production of erythropoietin by the diseased kidney. Almost all of patients with
glomerular filtration rate less than 30 mL/min have some degree of anemia.
Erythropoietin is produced by the kidney in response to decreased blood oxygen levels.
Erythropoietin stimulates red blood cell production by the bone marrow. Anemia in CKD
should be differentiated from iron deficiency anemia. In anemia of CKD, total iron
binding capacity is usually normal to decreased; mean corpuscular volume and mean
corpuscular hemoglobin are slightly decreased. Serum ferritin levels are usually
increased. The anemia in CKD is usually normocytic and normochromic, in contrast to
iron deficiency anemia which is a microcytic and hypochromic anemia. Symptoms of
CKD anemia include fatigue, dyspnea, depression, palpitations, and reduced exercise
capacity. Recombinant human erythropoietin and other erythropoiesis-stimulating
agents are the standard of care for anemia in CKD. Treatment is usually recommended
when hemoglobin (Hgb) levels fall below 10 g/dL. The goal of treatment should be to
maintain Hgb levels between 10.5 and 11.5 g/dL. Hgb levels greater than 13 g/dL are
associated with increased morbidity and mortality. Epoetin alpha and darbepoetin are
two erythropoiesis-stimulating agents commonly used. Both drugs have a black box
warning for increased risk of thromboembolism, myocardial infarction, and stroke when
used to target Hgb levels > 11 g/dL. Because CKD alone is an independent risk factor
for development of cardiovascular disease, risks versus benefits should be weighed
before initiated an erythropoiesis-stimulating agents. Patients with CKD require
One Step Further
,Question: What is the most common complication of chronic kidney disease? - Answer:
Hypertension.
A 23-year-old man presents with burning and itching of the penis. On physical
examination, the patient is uncircumcised. There is erythema and inflammation of the
distal foreskin and superficial layer of the glans. With retraction of the foreskin there is
scant white discharge. What is the appropriate treatment?
Ceftriaxone IM
Clotrimazole cream
Doxycycline
Mupirocin ointment - Correct Answer ( B )
Explanation:
This patient has balanoposthitis, inflammation of the glans penis (balanitis) as well as
the distal foreskin (posthitis). There are multiple causes of balanoposthitis. In younger
patients, local irritation from bubble baths is a common cause as well as from soaps and
detergents. These cases are treated with topical steroids like hydrocortisone. The
etiology may also be infectious with candida as the most common organism. With
Candidal infections, a whitish discharge with some eroded plaques may be present.
This patient's presentation is suggestive of a Candida infection which is treated with
topical antifungal agents such as clotrimazole. Other infectious organisms include
anaerobic organisms (treated with topical metronidazole) as well as streptococcal
infections. It is uncommon for sexually transmitted infections to cause balanoposthitis.
By far the most common contributing factor is poor hygiene.
One Step Further
Question: What is the name of the inability to retract foreskin? - Answer: Phimosis.
A 68-year-old woman with no significant medical history presents to the clinic with her
daughter for cognitive changes. The daughter says that her mother gets "lost" in
conversations, and that she would "sleep all day" if permitted. Further questioning
reveals a recent history of constipation, as well as passing two kidney stones within the
past 12 months. Which of the following electrolyte imbalances is most consistent with
these symptoms?
Hypercalcemia
Hyperkalemia
Hypocalcemia
Hypokalemia - Correct Answer ( A )
Explanation:
Hypercalcemia is associated with cognitive changes, malaise and fatigue, constipation,
and renal calculi. Other symptoms may include polyuria, polydipsia, and bone pain. This
can be remembered by the phrase "stones, bones, abdominal groans, psychic moans,
and fatigued overtones." Hypercalcemia has many possible etiologies, though primary
hyperparathyroidism remains the most common. Others include hypercalcemia of
malignancy, multiple myeloma, sarcoidosis, prolonged immobilization, or excessive
, intake of calcium/vitamin D supplements. The most accurate measurement of serum
calcium is the ionized calcium concentration and should be ordered whenever the total
serum calcium abnormal. Until the primary cause is identified, hypercalcemia is initially
managed with fluids and forced calciuresis. Intravenous saline is needed in severe
cases. Intravenous bisphosphonates may be used in hypercalcemia that is due to
hyperparathyroidism or a malignancy. Calcitonin can be given to manage
hypercalcemia while the bisphosphonates reach therapeutic levels. Unmanaged
hypercalcemia may lead to serious complications including neuromuscular
manifestations such as weakness or paresthesia, or cardiac arrhythmias secondary to
QT interval shortening or heart block.
One Step Further
Question: Which serum component, if low, may cause a spuriously low total serum
calcium reading? - Answer: Albumin concentrations lower than 4 g/dL will reduce the
total serum calcium level
A 32-year-old woman presents six hours after ingesting 40 tablets of regular-strength
(325 mg) aspirin in a suicide attempt. She is lethargic with a heart rate of 106
beats/minute, blood pressure of 142/84 mm Hg, respiratory rate of 30 breaths/minute,
and a temperature 38.5 0C. What abnormality would be expected on her arterial blood
gas?
Mixed respiratory acidosis with a metabolic alkalosis
Mixed respiratory alkalosis with a metabolic acidosis
Pure metabolic acidosis
Pure respiratory alkalosis - Correct Answer ( B )
Explanation:
Aspirin toxicity results in a complex acid-base disturbance. Salicylates stimulate the
respiratory center resulting in tachypnea, with a subsequent decrease in pCO2 and
respiratory alkalosis. Cell metabolism is also interrupted, leading to the production of
lactic acid and ketoacids and an elevated anion gap metabolic acidosis. The mixed
respiratory alkalosis with the elevated anion gap metabolic acidosis can result in a near-
normal pH. In the late stages of toxicity, as the patient becomes progressively more
fatigued with associated electrolyte abnormalities and dehydration, a respiratory
acidosis can occur which signals impending cardiovascular collapse.
One Step Further
Question: Is the ototoxicity commonly seen in salicylate toxicity permanent? - Answer:
No. The tinnitus, seen at salicylates levels > 20 mg/dL, is reversible.
A 67-year-old man presents to your office six months after prostatectomy for follow up
on his previously diagnosed prostate cancer. Labwork reveals an elevated serum
prostate specific antigen. After discussing options with the patient, a decision is made to
use pharmacologic treatment. Which of the following is the most appropriate initial
agent?
