Quiz 3
A 67 Caucasian male presents to the clinic because he noticed blood in his urine for the
last 5 months. He describes it as intermittent and painless. When it is present, it usually
appears bloody throughout the voiding process, especially towards the end. He has a
30 pack-year smoking history. He denies fever, unintentional weight loss, and changes
in bowel movements. Physical exam including a digital rectal exam (DRE) come back
normal. A urinalysis shows > 100 RBCs per high power field (HPF). Because of your
high suspicion for cancer, you refer. A cystourethroscopy and biopsy of the bladder is
done. Results show that it is in fact bladder cancer, and it has invaded through the
epithelium but not into the muscle. What stage is this?
A. Ta
B. T1
C. T2
D. T3 correct answers B
A 62 year old Caucasian male with a 40 pack year history presented to your clinic for a
colon cancer screening 3 weeks ago when he stated that was his first time at a doctor's
office in years and that he came because his wife made him. He denied any symptoms,
however his wife said she was worried because he had been "dropping weight like
crazy". At the last exam, a digital rectal exam (DRE) was performed and the prostate
was found to be indurated. Along with a DRE, a prostate specific antigen (PSA) was
measured at 6.0 ng/mL. He returned to the office last week for a follow-up PSA that was
measured at 6.1 ng/mL. Based on the indurated prostate and his PSA levels, the patient
reported days later for his transrectal ultrasound with prostate biopsy. The completed
pathology report was sent to your office today and it states that the primary
differentiation pattern seen on biopsy was that the specimen had irregular masses
correct answers C
A 3 year old male presents to the clinic with a palpable mass on the lower left portion of
his abdomen and mild, painless hematuria. His parents state that they first noticed the
mass around 6 months ago but only decided to come to the clinic after their son began
passing what appeared to be blood with his urine. They also state that their son has
been having poor feeding lately and has appeared to be losing weight along with his
other symptoms. Based on this patient's age and his urological symptoms, you conclude
that this patients most likely diagnosis is which of the following?
A. Wilm's Tumor
B. Hydronephrosis
C. Transitional Cell Carcinoma
D. Prostate Cancer correct answers A
A 2-year-old Caucasian male presents to your pediatric clinic with abnormal urination.
His mother states ever since he started toilet training, he is unable to urinate properly.
,She claims his urine stream is deflected upward and he is unable to direct the stream
into the toilet. He has no other symptoms associated with this condition. Upon physical
exam, you note he is circumcised and there is scarring on the ventral aspect of the
meatus on the glans penis . The rest of the exam was unremarkable. Based on the
symptoms and physical exam, what is the most likely diagnosis for this patient?
A. Urethral Stricture
B. Meatal Stenosis
C. Hypospadias
D. Epispadias correct answers B
A 42 year-old Caucasian male patient with HIV presents to the ER with dysuria x 7 days
and severe right lower back pain and nausea x 1 day. He tells you he took an over-the-
counter medication which didn't help much and turned his urine a weird color. His vitals
today are: BP 118/78, HR 92bpm, O2 98% on room air, T 39 degrees Celsius. Upon
physical exam, the patient has tenderness at the right costovertebral angle, but the
remainder of the exam is unremarkable. You order a urinalysis which has white blood
cell casts and is cloudy in appearance, CBC which results with WBC count
>22,000/mm3, and urine culture which results as >100,000 CFU/mL. You suspect
pyelonephritis and order a CT scan to rule out other sources, and it is consistent with
pyelonephritis. Based on his history, physical exam, and CT findings, you diagnose him
with pyelonephritis. What is the treatment of choice for this patient?
A. oral ciprofloxacin x correct answers B
A 60 year-old African American male walks into the clinic complaining of a lesion on his
penis that has been present for 2 months. He said he was given penicillin for it
previously, but it didn't get better. He also stated that there is some bleeding and denies
any pain associated with the lesion. Upon examination you also notice that there is also
some balanitis. He has a 40 pack year history and is a diabetic controlled on Metformin.
A sexual transmitted disease (STD) panel was ran that all came back negative. What is
the next best step for this patient?
A. Prescribe him more penicillin
B. Watch and wait for the lesion to resolve
C. Perform a biopsy of the tissue
D. Immediately send him for radiation therapy correct answers C
A 69-year-old Caucasian male by the name of Donald Trump presents to the ED
complaining of "blood in his pee for awhile now". Mr. Trumps states that the blood in his
urine is typically at the end of the urinary stream, comes and goes and does not cause
him any pain. He reported coming to the ER solely because his wife Melania Trump
insisted he come. Associated symptoms include urinary frequency. He denies
abdominal pain, bone, flank or pelvic pain, anorexia, pallor, lower extremity edema,
rectal fullness or weight loss. PMHx includes chronic cystitis, and leukemia at the age of
50, treated with cyclophosphamide. SHx includes a 30-pack-year smoking history.
Suspecting bladder cancer, cytology was performed which detected non-muscle
invasive disease of the bladder, staged at Tis (i.e. carcinoma in situ, high-grade
, dysplasia, confined to the epithelium). What is the best treatment choice for non-muscle
invasive disease correct answers A
A 4-year-old male presents to your primary care clinic with his parents. His mother
complains that he has had abdominal pain and swelling for the past 8 weeks that will
not go away. She is very persistent that this is more than just a mild tummy ache, as
she reports that her son has seemed more tired lately, has a reduced appetite, and has
had a low-grade fever intermittently for 2 weeks. Birth history includes a spontaneous
vaginal delivery with no complications, and he has no known medical conditions. Vital
signs are as follows: T 100.4F, P 105 bpm, BP 122/80, RR 22, Ht 41 in, Wt 40 lbs. On
physical exam, you palpate a firm, smooth mass in the right upper quadrant that does
not cross the midline. What is the most appropriate initial diagnostic study for your
suspected diagnosis?
A. CT abdomen and pelvis with contrast
B. Chest X-ray
C. Abdominal ultrasound with doppler
D. Renal biopsy correct answers C
A 45-year-old Caucasion male smoker presents to your office with a complaint of
urinary frequency and increased pain with urination. He informs you that he has been
waking up more frequently during the night to urinate. He states that his diet consists of
eating spicy foods, drinking sodas and coffee. He denies fever, changes in bowel
movements, rashes, ulcers, penile discharge and hematuria. His vital signs are as
follows: BP: 118/75mmHg, HR: 80 bpm, RR: 18, T: 98.6F. Physical exam was
unremarkable. Lab results results are as follows: WBC 4500 uL, Na 145 mEq/L, Cl 105
mEq/L, serum creatinine 0.9 mg/dL, BUN 12 mg/dL, urine microscopy is negative for
bacteria. UA was negative for nitrite and leukoesterase. Urine cultures were <50,000
CFU/ml of staphylococcus epidermidis. Cystoscopy with biopsy was ordered to rule out
cancer. The biopsy results stated, "no malignant cells identified." The cystoscopy report
findings sta correct answers A
A 29 year old male was referred to your GU clinic with painless, solid testicular swelling.
He said that his wife had found the mass and urged him to come in. He denies nausea,
vomiting, coughing, bone pain, or back pain. His past medical history is significant for
cryptorchidism, but is otherwise healthy. You decide to run labs and find elevated alpha-
fetoprotein (AFP), elevated lactate dehydrogenase (LDH), and an elevated beta subunit
of human chorionic gonadotropin (beta-hCG). Scrotal ultrasound revealed a
hyperechoic mass of the patient's right testicle. You diagnose the patient with testicular
cancer. You stage the cancer and find that it is confined only to the testicle. Which stage
of testicular cancer does this patient have?
A. Stage 0
B. Stage 1
C. Stage 2
D. Stage 3 correct answers B
