PANCE Blueprint Genitourinary (6%)

PANCE Blueprint Genitourinary (6%)

PANCE Blueprint Genitourinary (6%)

Follow along with the NCCPA™ PANCE and PANRE Genitourinary Content Blueprint

  • 37 PANCE and PANRE Genitourinary Content Blueprint Lessons (FREE)
  • 72 Question Comprehensive Genitourinary Exam (available to smartypance members)
  • Genitourinary Pearls Flashcards (available to smartypance members)
  • Genitourinary Pearls high yield summary tables (FREE)
  • ReelDX™ integrated video content (available to smartypance members)


  1. Genitourinary System Flashcards (Members Only)

  2. Genitourinary 72 Question Comprehensive Exam (Members Only)

    1. Enlargement of transitional zone - In men with BPH, avoid use of anticholinergic and antihistamines
      • PSA is often elevated - considered normal < 4
      • PSA > 4 think BPH, prostate CA and prostatitis
      • Symptomatic: Alpha blocker (Tamsulosin)
      • Decrease prostate size: 5 alpha reductase inhibitors (Finasteride)
      • Definitive: TURP
    2. If still non-palpable at 6 mo well-child exam, refer to urology/surgery for evaluation and possible orchiopexy
      • ↑ Risk in premature infants 30%
      • If not repaired risks infertility and malignancy
      • Treatment: Orchiopexy by age 1
    3. The most common vascular cause is atherosclerosis. Consider psychological cause.
      • Nocturnal penile tumescence used to evaluate sleep erections
      • Phosphodiesterase 5 inhibitors Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra)
      • Do not use with nitrates may cause hypotension
    4. Hydrocele: On physical exam mass will transilluminate Varicocele: Dilation of the pampiniform plexus
      • Bag of worms in scrotum (made worse when patient is upright and improves when patient is supine)
      • More common on left
    5. Stress: urine leakage due to abrupt increases in intra-abdominal pressure (eg, with coughing, sneezing, laughing, bending, or lifting)
      • Treatment: strengthen pelvic floor or surgery
      Urge: results from an overactive detrusor muscle. Increased frequency. Vaginal delivery.
      • Treatment: Oxybutynin
      Overflow: Cannot empty bladder, just leaks. High PVR
      • Treatment: Self catheterization
      Functional: mobility issue Mixed: (combo of stress and urge) most common.
    6. Flank pain radiating to groin, hematuriaCVA tenderness.
      • Lithotripsy: Stones > 1 cm unlikely to pass. Lithotripsy is indicated in patients with stones > 6 mm in size or intractable pain.
      • Hydration:  Stones < 5 mm likely to pass.
      • Calcium oxalate (80%): Most common, excess oxalate, hyperparathyroidism, radiopaque.
      • Struvite (10%): Associated with UTI with Klebsiella and Proteus species, radiopaque.
      • Uric Acid (7%): Excess meat/alcohol, gout, radiolucent.
      • Cystine (1%): Rare genetic, radiolucent.
    7. Paraphimosis: Inability to return foreskin to normal position causes tourniquet effect, is a medical emergency
      • Entrapment of the foreskin behind glans
      • More acute than phimosis
      Phimosis: Inability to retract the foreskin, usually resolves by age 5, betamethasone topically, if no improvement circumcision
      • Unable to retract foreskin
      • More chronic than paraphimosis
    8. Asymmetric high riding testicle bell clapper deformity”, negative prehn's sign (lifting of testicle will not relieve pain). Teenage males.
      • Very tender to palpation. Cremaster reflex absent.
      • Blue dot sign: Tender nodule 2 to 3 mm in diameter on the upper pole of the testicle.
      • Diagnosis: Radionuclide study and ultrasound
      • Surgical emergency: Repair both testes within 4-6 hours
    1. Infection of the bladder and is characterized by dysuria without urethral discharge. E. coli (most common)
      • Treat with Nitrofurantoin (not over age 65), Bactrim, Fosfomycin
      • Ciprofloxacin- reserved for complicated cases
      • Postcoital UTI: single-dose TMP-SMX or cephalexin may reduce frequency of UTI in sexually active women
      Lower UTI in pregnancy
      • Nitrofurantoin (Macrobid): 100 mg PO BID × 7 days
      • Cephalexin (Keflex): 500 mg PO BID × 7 days
    2. Epididymitis is characterized by dysuria, unilateral scrotal pain and swelling.
      • + Prehn's sign: relief with elevation is a classic sign
      • men < 35 chlamydia and gonorrhea: Doxycycline 100mg PO BID for 10 days + Ceftriaxone 250 mg IM × 1
      • men > 35 E.coli: Treat with Levofloxacin x 10 days
    3. Unilateral swollen testicle with erythema and shininess of the overlying skin. Orchitis is rarely seen without epididymitis unless patient has mumps.
      • 25 % are associated with MUMPS
      • Over 35: E. coli, Levofloxacin
      • Under 35:  Gonorrhea and chlamydia, Ceftriaxone + doxycycline/azithromycin
    4. Sudden onset of fever, chills, and low back pain combined with urinary frequency, urgency and dysuria.
      • Men < 35: Chlamydia and Gonorrhea - ceftriaxone and azithromycin (or Doxycycline)
      • E coli in men > 35 -  treat with fluoroquinolones or bactrim x 1 month
      • Chronic prostatitis  - treat with fluoroquinolones or bactrim x 6-12 weeks
      • If you suspect acute prostatitis do not massage the prostate this can lead to sepsis
    5. Irritative voiding + Fever + flank Pain + nausea and vomiting + CVA tenderness
      • Organism: E. coli
      • Urinalysis: Bacteria and WBC casts
      • Outpatient: ciprofloxacin/levofloxacin +/- ceftriaxone IM
      • Inpatient: Ciprofloxacin/levofloxacin or imipenem for more severe disease
    6. In urethritis, the main symptoms are dysuria and, primarily in men, urethral discharge.
      • Diagnosis: nucleic acid amplification test (NAAT)
      • N. gonorrhoeae (gram negative diplococci) and C. trachomatis
        • Ceftriaxone 250 mg intramuscular in a single dose for treatment of gonococcal infection PLUS Azithromycin (1 gram in a single oral dose) for possible additional activity against N. gonorrhoeae and for treatment of potential chlamydia coinfection.
        • Doxycycline (100 mg orally twice daily for seven days) is an alternate option for a second agent to administer with ceftriaxone.
    1. Bladder cancer (Lecture)

      Painless hematuria in a smoker, transitional cell carcinoma is the most common type.
    2. Most common area: Peripheral zone. Digital Rectal Exam: hard, irregular, nodular prostate Tumor marker: PSA. (also elevated in BPH)
      • PSA is considered normal < 4
      • PSA > 4 think BPH, prostate CA and prostatitis
      Recommended age to start annual prostate screening:
      • White male average risk: 50 years old
      • Black male + Family History or + BRCA mutations: 40 years old
    3. Classic triad of flank pain + hematuria + painless abdominal/renal mass
      • Renal clear cell carcinoma is the most common type (80%)
      • Transitional cell is the second most common type (20%)
      • Smoking is the most significant risk factor
    4. Presents as a firm, painless, non tender testicular mass
      • Seminoma is the most common type (60%)
      • Risk factors include history of cryptorchidism
      • Diagnostic studies: Initial-Ultrasound. Tumor markers: AFP, βHCG
    1. Acute tubular necrosis (ATN)
      • Etiology: Kidney ischemia or toxins
      • Urinalysis: Muddy brown casts. Renal tubular epithelial cells + High Urine Osmolality
      • FENa > 2%
      Interstitial nephritis
      • Etiology: Immune-mediated response
        • Drugs: PCN, sulfa, NSAIDs, phenytoin etc.
        • Immunologic and infectious disease: strep, SLE, CMV, Sjogren's, Sarcoidosis
      • Urinalysis: WBC casts and eosinophils
      • Etiology: IGA Nephropathy (Berger disease), postinfectious, membranoproliferative
      • Urinalysis: Oliguria, hematuria and RBC casts
    2. CKD is a progression of ongoing loss of kidney function (GFR) defined as < 60 mL/min/1.73 m² or presence of kidney damage (proteinuria, glomerulonephritis or structural damage from polycystic kidney disease) for > 3 months.
      • Measurement of GFR is the gold standard - The Cockcroft - Gault formula (requires age, body weight, and serum creatinine) or Modification of Diet in Renal Disease equation
      • Etiology: Diabetes, hypertension, glomerulonephritis
      • Findings: Fatigue, pruritus, Kussmaul respirations, asterixis (flapping tremor), muscle wasting, broad waxy casts
    3. Immune-mediated glomerular inflammation results in glomerular damage which results in urinary protein and RBC loss
      • Proteinuria, HTN, azotemia, oliguria (<400 ml urine/day), hematuria (RBC casts) hallmark, edema is not as much as nephrotic syndrome
      • Urinalysis: proteinuria < 3.5 grams per day, hematuria, RBC casts
      • Biopsy: hypercellular, immune complex deposition
      Etiologies of acute glomerulonephritis:
      • IgA Nephropathy (Berger disease): most common cause of acute glomerulonephritis worldwide - often affects young males within days  (24-48 hours) after URI or GI infection.
      • Postinfectious - Group A strep: 10-14 days after infection - diagnosed with ASO titers and low serum complement.
      • Membranoproliferative glomerulonephritis: due to SLE, viral hepatitis.
      • Rapidly progressive glomerulonephritis - crescent formation on biopsy due to fibrin and plasma protein deposition.
        • Goodpasture's syndrome: (+) anti-GBM antibodies, dx linear IgG deposits, treat with high dose steroids, plasmapheresis + cyclophosphamide.
        • Vasculitis: lack of immune deposits (+) ANCA antibodies.
    4. Urine outflow obstruction causes renal distention
      • Treat underlying cause
    5. Glomerular damage results in increased urinary protein loss
      • Proteinuria, hypoalbuminemia, edema, hyperlipidemia, edema is predominant feature, transudative pleural effusion
      • Urinalysis: proteinuria > 3.5 grams on 24-hour urinefatty casts, oval fat bodies
      • Biopsy: hypo-cellular minimal change disease loss of podocytes on microscopy
      The most common primary causes are:
      • Membranous nephropathy: most common in non-diabetic adults associated with malignancies.
      • Minimal change disease: 80% of nephrotic syndrome in kids. Responds to corticosteroids.
      • Focal segmental glomerulosclerosis:  obese patients, heroin, and HIV black males.
      The most common secondary causes are:
      • Lupus: both nephritic and nephrotic.
      • Diabetes: common cause of nephrotic syndrome and subsequent renal failure.
      • Preeclampsia
    6. Narrowing of one or both of the renal arteries, most often caused by atherosclerosis or fibromuscular dysplasia.
      • Renal Arteriography is Gold Standard for diagnosis
      • May hear a renal artery bruit on auscultation
      • Percutaneous transluminal angioplasty (PTA) plus stent placement or with surgical bypass of the stenotic segment
    1. Hyponatremia / Hypervolemia: serum sodium of < 135 mmol/L
      • Presentation: Muscle cramps and seizures
        • Hypervolemic hyponatremia – CHF, nephrotic syndrome, renal failure, cirrhosis
        • Euvolemic hyponatremia – SIADH (Picmonic), steroids, hypothyroid
        • Hypovolemic hyponatremia – sodium loss (renal, non-renal)
      • Serum Na should be corrected slowly—by ≤ 10 mEq/L over 24 h to avoid osmotic demyelination syndrome
    2. Hypernatremia / Hypovolemiaserum sodium of > 145 mmol/L
      • Etiology: Diarrhea, burns, diuretics, hyperglycemia, diabetes insipidus, deficit of thirst
      • Rapid overcorrection causes cerebral edema and pontine herniation
      • Diabetes insipidus - Low urine sodium (but high serum sodium) and polyuria usually indicate diabetes insipidus
  3. Average values "24/7 40/40"
    • 24 (HCO3, base) / 7.40 (pH) / 40 (CO2, acid)
    Respiratory Acidosis:
    • pH < 7.35, pCO2 > 45, HCO3 > 26
    • Lungs fail to excrete CO2 (Breathing too slow (holding onto CO2), pulmonary disease, neuromuscular disease, drug-induced hypoventilation - opiates, barbiturates)
    Respiratory Alkalosis:
    • pH > 7.45, pCO2 < 35, HCO3 < 22
    • Excessive elimination of CO2 (Breathing too fast (blowing of CO2), pulmonary embolism, fever, hyperthyroid, anxiety, salicylate intoxication, septicemia )
    Metabolic Acidosis
    • pH <7.35, pCO2 < 35, HCO3 < 22
    • Need to calculate anion gap: Anion Gap = Na – (Cl + HCO3-) = 10-16
    • Increased ion gap (>16): Addition of hydrogen ions (lactic acidosis (think metformin), diabetic ketoacidosis, aspirin overdose)
      •  MUDPILES:
        • Methanol
        • Uremia
        • Diabetic Ketoacidosis
        • Paraldehyde
        • Infection
        • Lactic Acidosis
        • Ethylene Glycol
        • Salicylates
    • Low anion gap (<16): Loss of bicarbonate (diarrhea, pancreatic or biliary drainage, renal tubular acidosis)
    Metabolic Alkalosis:
    • pH > 7.45, pCO2 > 45, HCO3 > 26
    • Loss of hydrogen (vomiting), bulimia, overdose of antacids, addition of bicarbonate (hyperalimentation therapy)


The Daily PANCE and PANRE

Get 60 days of PANCE and PANRE Multiple Choice Board Review Questions delivered daily to your inbox. It's 100% FREE and 100% Awesome!

You have Successfully Subscribed!