PANCE Blueprint Genitourinary (5%)

PANRE & PANRE-LA Genitourinary Practice Exam

Question 1
A 45-year-old man presents to the clinic with a 6-month history of pelvic pain, discomfort in the perineal region, urinary urgency, and occasional erectile dysfunction. He reports no fever or history of urinary tract infections. His symptoms have caused significant distress and have impacted his quality of life. Digital rectal examination reveals a mildly tender prostate without nodules. Urinalysis and urine culture are unremarkable. Which of the following is the most appropriate initial management for this patient?
A
Immediate surgical intervention
Hint:
Immediate surgical intervention is not indicated for CP/CPPS without evidence of obstructive pathology or failure of conservative management.
B
Empirical intravenous antibiotics
Hint:
Empirical intravenous antibiotics are not recommended as initial treatment for CP/CPPS in the absence of bacterial infection, as evidenced by negative urine culture.
C
Alpha-blockers and anti-inflammatory medications
D
Chronic opioid therapy
Hint:
Chronic opioid therapy is not recommended for managing chronic prostatitis due to the risk of addiction and lack of efficacy in long-term management of chronic pain conditions.
E
Intramuscular testosterone injections
Hint:
Intramuscular testosterone injections are not a treatment for CP/CPPS. There is no evidence to support the use of testosterone for this condition, and it could potentially exacerbate certain prostate conditions.
Question 1 Explanation: 
Alpha-blockers and anti-inflammatory medications are often used as initial management for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) to alleviate urinary symptoms and discomfort. Alpha-blockers can help relax muscle fibers in the prostate and bladder neck, improving urine flow and reducing symptoms. Anti-inflammatory medications can help manage pain and inflammation. This combination addresses the symptomatic relief in the absence of a bacterial infection, as indicated by normal urinalysis and urine culture.
Question 2
A 4-year-old boy is brought in for a well-child visit. His mother is concerned because she cannot retract his foreskin. The child has no voiding difficulties or signs of infection. Examination reveals a non-retractable foreskin with a pinpoint opening. Which of the following is the most appropriate recommendation?
A
Circumcision
Hint:
Circumcision is rarely necessary in cases of uncomplicated physiological phimosis and would be overly invasive.
B
Daily forceful foreskin retraction
Hint:
This is harmful! Forcible retraction can lead to scarring, pain, and worsened phimosis.
C
Observation and reassurance
D
Prescription of topical corticosteroids
Hint:
Topical steroids can help with some cases of pathologic phimosis but are generally unnecessary in a young child with an otherwise normal exam.
E
Referral for emergent dorsal slit incision
Hint:
Surgical intervention is reserved for severe cases of phimosis that lead to ballooning of the foreskin, urinary troubles, or recurrent infections. It's not indicated in this scenario.
Question 2 Explanation: 
Physiological phimosis, where the foreskin is non-retractable, is normal in young children. The majority of cases resolve with time. Observation and gentle hygiene are recommended with no forceful retraction attempts.
Question 3
A 28-year-old man presents for evaluation of infertility. He and his partner have been trying to conceive for over a year. Physical examination reveals a soft, "bag of worms" consistency above the left testicle that increases in size with the Valsalva maneuver. Semen analysis shows oligospermia (low sperm count). Which of the following is the most appropriate next step in management?
A
Observation and repeat semen analysis
Hint:
While helpful to track changes, in a couple already struggling with infertility for a year, proactive management would be preferred.
B
Prescription of clomiphene citrate
Hint:
Clomiphene citrate targets female infertility by stimulating ovulation and would not address the male factor infertility associated with a varicocele.
C
Reassurance and lifestyle advice
Hint:
Lifestyle changes can be beneficial but wouldn't directly address the impact of a varicocele on sperm parameters.
D
Referral for varicocele repair
E
Scrotal support
Hint:
This might provide mild relief from discomfort associated with larger varicoceles but wouldn't rectify the underlying fertility issue.
Question 3 Explanation: 
Varicoceles can contribute to male infertility by impairing sperm production. In a patient with a diagnosed varicocele, abnormal semen parameters, and an infertility issue, varicocele repair is often recommended to improve fertility chances.
Question 4
A 24-year-old sexually active woman presents with two days of dysuria, urinary frequency, and a mucopurulent vaginal discharge. Urinalysis reveals leukocyte esterase, but no nitrites. Urine culture is pending. Which of the following is the most likely diagnosis?
A
Bacterial vaginosis
Hint:
Typically has thin, grey, malodorous discharge; microscopy would show "clue cells," not inflammatory findings on urinalysis.
B
Chlamydia trachomatis infection
C
Gonococcal urethritis
Hint:
Can have mucopurulent discharge, but classically is more purulent. Gonorrhea frequently co-exists with Chlamydia, requiring treatment for both.
D
Trichomoniasis
Hint:
Often presents with yellow-green, frothy discharge and vulvovaginal irritation. Microscopy with motile trichomonads is diagnostic.
E
Urinary tract infection (UTI)
Hint:
Typical UTIs usually cause positive nitrites on urinalysis in addition to leukocyte esterase.
Question 4 Explanation: 
This patient's presentation aligns with cervicitis, often caused by Chlamydia trachomatis. Key features are:
  • Mucopurulent discharge
  • Dysuria, frequently accompanying cervicitis due to associated urethritis
  • Positive leukocyte esterase without nitrites (classic UTI features might be absent)
Question 5
A 35-year-old man with no significant past medical history comes to your clinic for a routine health maintenance visit. He has no complaints but is concerned about testicular cancer, as a friend was recently diagnosed. He inquires about screening for testicular cancer. According to current guidelines, which of the following is the most appropriate recommendation for testicular cancer screening in this asymptomatic patient?
A
Annual ultrasound of the testicles
Hint:
Annual ultrasound of the testicles is not recommended for routine screening of testicular cancer in asymptomatic men due to the lack of evidence that it improves outcomes.
B
Routine serum tumor marker tests (AFP, hCG, LDH)
Hint:
Routine serum tumor marker tests (AFP, hCG, LDH) are not recommended for screening in asymptomatic men at average risk because there is no evidence that they reduce mortality from testicular cancer.
C
Monthly self-examination of the testicles
Hint:
Monthly self-examination of the testicles has been suggested in the past, but current guidelines do not universally recommend it for all men due to the lack of evidence that it reduces testicular cancer mortality. However, men should be aware of the normal feel of their testicles so they can report any changes to their physician.
D
Routine testicular examination by a healthcare provider
Hint:
Routine testicular examination by a healthcare provider is not recommended for asymptomatic men at average risk for the same reasons as above; there is no proven benefit in reducing mortality from testicular cancer.
E
No screening recommended for asymptomatic men at average risk
Question 5 Explanation: 
There is no evidence that screening asymptomatic men at average risk for testicular cancer with ultrasound, serum tumor markers, or clinical examination reduces mortality from testicular cancer. Men should be informed about the signs and symptoms of testicular cancer, but routine screening is not recommended.
  • The USPSTF reaffirms its recommendation against screening adolescent or adult males for testicular cancer by clinician examination or patient self-examination.
  • The American Academy of Family Physicians recommends against routine screening for testicular cancer in asymptomatic adolescent and adult males.
  • The American Academy of Pediatrics does not include screening for testicular cancer in its recommendations for preventive health care.
  • Finally, the American Cancer Society does not recommend testicular self-examination.
Question 6
A 35-year-old man with no significant past medical history comes to your clinic for a routine health maintenance visit. He has no complaints but is concerned about testicular cancer, as a friend was recently diagnosed. He inquires about screening for testicular cancer. According to current guidelines, which of the following is the most appropriate recommendation for testicular cancer screening in this asymptomatic patient?
A
Annual ultrasound of the testicles
Hint:
Annual ultrasound of the testicles is not recommended for routine screening of testicular cancer in asymptomatic men due to the lack of evidence that it improves outcomes.
B
Routine serum tumor marker tests (AFP, hCG, LDH)
Hint:
Routine serum tumor marker tests (AFP, hCG, LDH) are not recommended for screening in asymptomatic men at average risk because there is no evidence that they reduce mortality from testicular cancer.
C
Monthly self-examination of the testicles
Hint:
Monthly self-examination of the testicles has been suggested in the past, but current guidelines do not universally recommend it for all men due to the lack of evidence that it reduces testicular cancer mortality. However, men should be aware of the normal feel of their testicles so they can report any changes to their physician.
D
Routine testicular examination by a healthcare provider
Hint:
Routine testicular examination by a healthcare provider is not recommended for asymptomatic men at average risk for the same reasons as above; there is no proven benefit in reducing mortality from testicular cancer.
E
No screening recommended for asymptomatic men at average risk
Question 6 Explanation: 
There is no evidence that screening asymptomatic men at average risk for testicular cancer with ultrasound, serum tumor markers, or clinical examination reduces mortality from testicular cancer. Men should be informed about the signs and symptoms of testicular cancer, but routine screening is not recommended.
  • The USPSTF reaffirms its recommendation against screening adolescent or adult males for testicular cancer by clinician examination or patient self-examination.
  • The American Academy of Family Physicians recommends against routine screening for testicular cancer in asymptomatic adolescent and adult males.
  • The American Academy of Pediatrics does not include screening for testicular cancer in its recommendations for preventive health care.
  • Finally, the American Cancer Society does not recommend testicular self-examination.
Question 7
A 45-year-old man presents to the emergency department with acute onset of severe left flank pain that radiates to the groin, accompanied by nausea and vomiting. He describes the pain as intermittent and colicky in nature. His past medical history is significant for recurrent urinary tract infections and hyperuricemia. On physical examination, he is afebrile, and his blood pressure is 130/85 mmHg. Abdominal examination reveals tenderness in the left flank region without rebound or guarding. Urinalysis shows hematuria and crystalluria. No leukocytosis is noted on complete blood count. Which of the following is the most likely composition of the patient's renal stone?
A
Calcium oxalate
Hint:
While calcium oxalate stones are the most common type of kidney stones, this patient's specific history of hyperuricemia makes uric acid stones more likely. Calcium oxalate stones are typically associated with conditions that lead to hypercalciuria and oxalate excretion.
B
Struvite
Hint:
Struvite stones are associated with urinary tract infections caused by urease-producing bacteria. Although the patient has a history of UTIs, the presence of hyperuricemia and crystalluria without leukocytosis or infection at presentation makes uric acid stones more likely.
C
Cystine
Hint:
Cystine stones are rare and occur in patients with a genetic disorder called cystinuria, which leads to excessive excretion of cystine in the urine. There is no indication that this patient has cystinuria.
D
Calcium phosphate
Hint:
Calcium phosphate stones are often associated with conditions that lead to high urinary pH levels, such as renal tubular acidosis. The patient's presentation and history are more suggestive of uric acid stones due to hyperuricemia.
E
Uric acid
Question 7 Explanation: 
Given the patient's history of hyperuricemia and the presence of crystalluria with hematuria, a uric acid stone is the most likely composition of the renal stone. Uric acid stones are more likely to form in patients with conditions that lead to decreased urine pH and increased concentrations of uric acid in the urine, such as gout or diseases associated with high cell turnover rates. The patient's recurrent urinary tract infections could also contribute to an environment conducive to stone formation, but in the context of hyperuricemia, uric acid stones are more probable.
Question 8
A 62-year-old woman presents with complaints of urinary urgency, frequency, and occasional urge incontinence for the past several months. She voids at least eight times during the day and twice at night. Initial workup including urinalysis and urine culture were negative. Which of the following is the most appropriate next step in management?
A
Cystoscopy
Hint:
Cystoscopy can help rule out bladder pathologies, but it's not always necessary as an initial step in uncomplicated OAB cases.
B
Initiation of immediate-release oxybutynin
Hint:
While anticholinergic medications like oxybutynin can be helpful for OAB, it's preferable to start with conservative behavioral therapies due to potential side effects of medications
C
Post-void residual assessment
Hint:
It's useful to check for incomplete bladder emptying but might not be the immediate next step after a negative initial workup, especially if incontinence is the primary symptom.
D
Pelvic floor muscle training
E
Trial of sacral nerve stimulation
Hint:
This third-line therapy is reserved for refractory OAB that hasn't responded to conservative management and medications.
Question 8 Explanation: 
Behavioral therapies like pelvic floor muscle training (sometimes with biofeedback) are considered first-line management for overactive bladder. They help strengthen the pelvic floor, improving bladder control.
Question 9
A 60-year-old man with no significant past medical history or family history of prostate cancer comes to your clinic for a routine health maintenance visit. He is asymptomatic and inquires about prostate cancer screening. He has read about PSA testing but is concerned about the potential harms. Based on the USPSTF guidelines, which of the following is the most appropriate recommendation for prostate cancer screening in this patient?
A
Measure PSA annually as screening is indicated starting at age 50
Hint:
The screening age is 55 according to USPSTF guidelines
B
Advise against PSA-based screening due to his age.
Hint:
The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older, not for those aged 55 to 69 years.
C
Discuss the potential benefits and harms of PSA-based screening to help him make an informed decision.
D
Only perform PSA-based screening if he has urinary symptoms suggestive of prostate cancer.
Hint:
This is not in line with the guidelines, which suggest that the decision to screen should not solely be based on the presence of urinary symptoms but rather on a discussion of the benefits and harms of screening.
E
Reassure the patient that with his low-risk profile, no screening is recommended.
Hint:
This is not in line with current guidelines
Question 9 Explanation: 
According to USPSTF guidelines, the decision to undergo PSA screening for prostate cancer in men aged 55-69 should be an individual one, with the opportunity to discuss benefits and harms with their clinician. In men ≥70 years old, evidence does not support screening.
Question 10
A 22-year-old sexually active male presents with acute onset of unilateral testicular pain, swelling, and erythema. He reports dysuria and a recent high fever. Examination shows an exquisitely tender, enlarged testicle. Scrotal ultrasound reveals increased testicular blood flow. Which of the following is the most appropriate management?
A
Azithromycin and bed rest
Hint:
While azithromycin treats chlamydia, it wouldn't adequately cover possible gonorrhea co-infection.
B
Doxycycline and ceftriaxone
C
Incision and drainage
Hint:
This is reserved for suspected testicular abscess, which isn't supported by the initial presentation and imaging.
D
Prednisone taper
Hint:
Prednisone can be used for idiopathic orchitis, but this presentation strongly suggests an infectious cause.
E
Supportive care with NSAIDs and scrotal elevation
Hint:
These provide symptomatic relief but are insufficient without antibiotics to address the underlying infection.
Question 10 Explanation: 
This patient demonstrates signs of orchitis, likely caused by sexually transmitted infections (STIs) such as chlamydia and gonorrhea. Doxycycline and ceftriaxone provide comprehensive coverage against these common pathogens.
Question 11
A 32-year-old woman presents with a 1-year history of pelvic pain, urinary urgency, and frequency, particularly during the night. She reports that her symptoms worsen with the consumption of certain foods and beverages. She has had multiple negative urine cultures over the past year. Cystoscopy shows glomerulations after hydrodistention. Which of the following is the most likely diagnosis?
A
Chronic bacterial cystitis
Hint:
Typically presents with positive urine cultures, which are absent in this case.
B
Endometriosis
Hint:
Can cause pelvic pain and sometimes bladder symptoms, but her pain pattern strongly aligns with IC.
C
Interstitial cystitis
D
Overactive bladder
Hint:
Overactive bladder (OAB) shares some symptoms with IC (urgency, frequency, nocturia), but OAB doesn't generally have the same bladder-filling pain characteristic of IC.
E
Urethral stricture
Hint:
Can cause voiding dysfunction but typically wouldn't manifest with the bladder-filling pain pattern seen in IC.
Question 11 Explanation: 
This patient's presentation strongly suggests interstitial cystitis (IC). Her chronic pelvic pain, urinary urgency, and frequency (especially worsened by specific foods), combined with an absence of infection and the cystoscopic finding of glomerulations, make IC the most likely diagnosis.
Question 12
A 30-year-old man presents to the emergency department with fever, chills, lower back pain, and painful urination for the past two days. He also reports difficulty starting urination and a feeling of not being able to completely empty his bladder. Digital rectal examination reveals a tender, swollen, and warm prostate. Which of the following is the most appropriate initial treatment?
A
Alpha-blockers
Hint:
Alpha-blockers are used to relieve urinary symptoms in benign prostatic hyperplasia, not as initial treatment for acute prostatitis.
B
Immediate surgical intervention
Hint:
Immediate surgical intervention is not indicated in acute prostatitis unless there's abscess formation requiring drainage.
C
Intravenous antibiotics
D
Nonsteroidal anti-inflammatory drugs (NSAIDs) alone
Hint:
NSAIDs can be used for symptomatic relief but are not sufficient as monotherapy for acute bacterial prostatitis.
E
Watchful waiting
Question 12 Explanation: 
Intravenous antibiotics are the cornerstone of treatment for acute bacterial prostatitis, especially in severe cases presenting with systemic symptoms like fever and chills. Broad-spectrum antibiotics covering common uropathogens, including Gram-negative bacteria, should be initiated promptly after obtaining cultures.
Question 13
A 68-year-old woman presents with complaints of sudden urine leakage when she coughs, sneezes, or exercises. She notices that her undergarments get damp throughout the day. There's no associated bladder pain or fever. Which of the following is the most likely type of urinary incontinence?
A
Functional incontinence
Hint:
This results from physical or cognitive impairments that prevent a person from timely toileting, not associated with involuntary leakage during straining.
B
Overflow incontinence
Hint:
It presents with urinary frequency, dribbling, and incomplete bladder emptying. There's usually underlying bladder outlet obstruction or dysfunctional emptying mechanism.
C
Stress incontinence
D
Transient incontinence
Hint:
This has an acute onset due to temporary causes like infections, medications, or restricted mobility, not with daily leaking triggered by activity.
E
Urge incontinence
Hint:
The hallmark is a sudden, overwhelming urge to urinate often linked to overactive bladder, typically causing much larger void volumes than described.
Question 13 Explanation: 
This patient demonstrates classic signs of stress urinary incontinence (SUI). This occurs due to weakness of pelvic floor muscles and urethral sphincter , leading to leakage with sudden increases in intra-abdominal pressure (coughing, physical activity).
Question 14
A 25-year-old sexually active man presents with acute onset of unilateral scrotal pain, swelling, and erythema. He is febrile and has dysuria. Physical examination reveals exquisite tenderness along the epididymis. The cremasteric reflex is present. Urinalysis demonstrates positive leukocyte esterase and numerous white blood cells. Which of the following is the most appropriate management?
A
Azithromycin alone
Hint:
While azithromycin treats chlamydia, it wouldn't adequately cover potential gonorrhea co-infection.
B
Ceftriaxone monotherapy
Hint:
Ceftriaxone treats gonorrhea but may not be sufficient for chlamydial co-infection.
C
Ceftriaxone and doxycycline
D
Ciprofloxacin
Hint:
Ciprofloxacin wouldn't be ideal due to rising resistance patterns in Neisseria gonorrhoeae.
E
Ibuprofen and scrotal elevation
Hint:
These offer supportive care but don't address the underlying infectious cause, requiring antibiotic treatment.
Question 14 Explanation: 
Empirical antibiotic therapy targeting Chlamydia trachomatis and Neisseria gonorrhoeae is the most appropriate initial management for epididymitis in a sexually active young man, as these are the most common causative organisms in this age group. Antibiotics should be started promptly to reduce the risk of complications, with adjustment based on culture results if necessary.
Question 15
A 65-year-old man with a history of heavy smoking presents with painless hematuria for the past two weeks. Urinalysis is positive for blood, and he has no signs of infection. Which of the following is the most appropriate next step in the diagnostic workup of this patient?
A
Abdominal CT scan with contrast
Hint:
While CT can detect bladder masses, it may miss smaller lesions and doesn't allow for direct biopsy.
B
Bladder biopsy with cystoscopy
C
Initiation of intravesical BCG therapy
Hint:
BCG (Bacillus Calmette-Guérin) is a form of immunotherapy used for some bladder cancers, but its initiation would be premature without a confirmed diagnosis and staging.
D
Urine cytology
Hint:
Cytology, examining urine for abnormal cells, can be helpful in bladder cancer detection, but cystoscopy with biopsy is still required for definitive diagnosis.
E
Voiding cystourethrogram (VCUG)
Hint:
A voiding cystourethrogram evaluates bladder function and anatomy, but it isn't the best tool for primary tumor diagnosis.
Question 15 Explanation: 
Cystoscopy with biopsy is the gold standard for diagnosing bladder cancer and characterizing tumor appearance. It directly visualizes bladder lesions and allows for targeted tissue sampling.
Question 16
A 75-year-old uncircumcised man presents to the emergency department with progressively worsening penile pain and swelling. Examination reveals the foreskin retracted behind the glans penis, forming a constricting band with associated edema and discoloration. Which of the following is the most appropriate immediate management?
A
Application of ice packs
Hint:
While ice can help temporarily with swelling, it won't resolve the underlying constriction and might delay essential reduction.
B
Dorsal slit procedure
Hint:
This is a surgical technique to relieve foreskin constriction but could be avoided if timely manual reduction is successful.
C
Hyaluronidase injection to reduce edema
Hint:
Hyaluronidase can sometimes be used to facilitate foreskin reduction but might not be readily available and can delay more definitive therapy.
D
Manual reduction of the foreskin
E
Urgent circumcision
Hint:
Circumcision might be the definitive management if there are recurrent paraphimosis episodes or if non-surgical measures fail. However, emergency circumcision has a much higher rate of complications.
Question 16 Explanation: 
Paraphimosis is a urological emergency. Manual reduction is the immediate priority to restore blood flow and prevent potential tissue necrosis. If attempts at manual reduction fail, additional interventions may be necessary.
Question 17
A 24-year-old woman presents to the clinic with a 2-day history of dysuria, increased urinary frequency, and suprapubic pain. She denies any vaginal discharge or recent sexual activity. Her temperature is 37.2°C (99°F), and physical examination is unremarkable except for mild suprapubic tenderness. Urinalysis shows pyuria and bacteriuria. Which of the following is the most appropriate initial treatment?
A
Intravenous antibiotics
Hint:
Intravenous antibiotics are reserved for severe cases or pyelonephritis, not uncomplicated cystitis.
B
Oral fluoroquinolones
Hint:
Oral fluoroquinolones may be used for complicated cases or when first-line agents are contraindicated due to their broader spectrum and risk of resistance.
C
Oral nitrofurantoin
D
Immediate cystoscopy
Hint:
Immediate cystoscopy is not indicated in uncomplicated cystitis and is reserved for cases with suspected anatomical abnormalities or non-resolving symptoms.
E
High-dose oral corticosteroids
Hint:
High-dose oral corticosteroids are not used in the treatment of bacterial cystitis and can potentially worsen the infection.
Question 17 Explanation: 
Oral nitrofurantoin for 5 days is recommended as first-line treatment for uncomplicated bacterial cystitis in women. It is effective against common causative organisms and has a low risk of inducing antibiotic resistance.
Question 18
A 68-year-old man presents with increasing bothersome lower urinary tract symptoms. He reports nocturia, urinary hesitancy, weak stream, and post-void dribbling. His International Prostate Symptom Score (IPSS) is 22 (moderate severity). Digital rectal exam reveals a smooth, enlarged prostate without nodules. Prostate-specific antigen (PSA) is 2.8 ng/mL. Which of the following is the most appropriate initial management for this patient?
A
Finasteride
Hint:
Finasteride, a 5-alpha reductase inhibitor, can also be used to treat BPH. It acts by slowly shrinking the prostate, but effects can take months to become noticeable.
B
Immediate catheterization
Hint:
This would be reserved for acute urinary retention, which is not clearly depicted in this scenario.
C
Prostate biopsy
Hint:
While elevated PSA can raise concern for prostate cancer, a biopsy isn't indicated at this initial juncture; BPH likely explains the symptoms and moderately elevated PSA.
D
Saw palmetto
Hint:
This herbal supplement lacks established efficacy and isn't considered a standard treatment for BPH.
E
Tamsulosin
Question 18 Explanation: 
Tamsulosin, an alpha-blocker, is a first-line medication for BPH. It relaxes smooth muscle in the prostate and bladder neck, improving urinary flow and reducing bothersome symptoms.
Question 19
A 60-year-old man presents with slowly enlarging, painless scrotal swelling. Examination reveals a non-tender, fluid-filled mass that transilluminates. The testis cannot be clearly palpated separately. Scrotal ultrasound confirms a hydrocele. Which of the following is the most appropriate management?
A
Immediate surgical referral
Hint:
urgery is reserved for symptomatic hydroceles, those causing significant discomfort, or when there's suspicion of an underlying testicular pathology.
B
Needle aspiration
Hint:
Aspiration offers temporary relief but has a high recurrence rate and risks infection. It's generally not recommended as a primary treatment.
C
Scrotal support
Hint:
Scrotal support might alleviate mild discomfort but won't resolve the underlying hydrocele.
D
Observation with reassurance
E
Trial of tamsulosin
Hint:
Tamsulosin treats urinary symptoms related to benign prostatic hyperplasia and plays no role in hydrocele management.
Question 19 Explanation: 
Most hydroceles in adults are asymptomatic and benign. Initial management usually involves observation and reassurance, particularly in older patients and if the hydrocele isn't bothersome.
Question 20
A 16-year-old boy presents to the emergency department with sudden onset of severe left scrotal pain that started 6 hours ago after a soccer game. He also reports nausea and denies any trauma to the groin area. On physical examination, the left testicle is elevated and lies horizontally. The scrotum is erythematous and swollen. There is marked tenderness on palpation of the left testicle. Which of the following physical exam findings is most indicative of testicular torsion in this patient?
A
Absent cremasteric reflex and a low-lying testicle
Hint:
While the cremasteric reflex is absent, the testicle usually becomes high-riding, not low-lying.
B
Absent cremasteric reflex and a horizontally oriented testicle
C
Intact cremasteric reflex and diffuse scrotal edema
Hint:
Intact cremasteric reflex makes torsion less likely. Diffuse edema points more towards inflammatory processes.
D
Positive Prehn's sign (relief of pain with testicular elevation)
Hint:
Prehn's sign is suggestive of epididymitis, not torsion. Torsion generally worsens with elevation.
E
Tender, indurated epididymis
Hint:
Epididymal tenderness points towards epididymitis/orchitis, where inflammation would be centered on the epididymis, not the entire testicle.
Question 20 Explanation: 
Testicular torsion presents with:
  • Absent cremasteric reflex: Normally, stroking the inner thigh leads to testicle elevation, but this reflex is lost in torsion.
  • High-riding & abnormal orientation: The twisted spermatic cord shortens, and the affected testicle may have a transverse ("horizontal") lie.
There are 20 questions to complete.
List
Return
Shaded items are complete.
12345
678910
1112131415
1617181920
Return

2024 PANRE & PANRE-LA Genitourinary System Content Blueprint (Prev Lesson)
(Next Lesson) Genitourinary System With Joe Gilboy PA-C (Video Lecture)
Back to PANCE Blueprint Genitourinary (5%)

NCCPA™ CONTENT BLUEPRINT