PANCE Blueprint Genitourinary (5%)

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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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?