Disorders of the Genitourinary System

Disorders of the Genitourinary System Related

Review Disorders of the Genitourinary System related questions and content

A 60-year-old woman is undergoing a pelvic examination. During the examination, the nurse finds a mass in the pelvic region that is hard, irregular, and fixed. The nurse's most appropriate course of action would be to:

  • A. Monitor the mass and perform routine follow-up.
  • B. Refer the patient to a gynecologist for further evaluation.
  • C. Obtain a biopsy of the mass to assess for malignancy.
  • D. Perform a pelvic ultrasound to assess the mass.
Correct Answer: B

Rationale: The correct answer is B: Refer the patient to a gynecologist for further evaluation. Given the characteristics of the mass (hard, irregular, fixed), it raises concerns for possible malignancy. Referring the patient to a gynecologist allows for a specialist to conduct a thorough evaluation, which may include additional imaging studies and biopsies to determine the nature of the mass. Monitoring the mass (choice A) without further evaluation may delay potential diagnosis and treatment. Obtaining a biopsy (choice C) without proper evaluation by a specialist may not be appropriate at this stage. Performing a pelvic ultrasound (choice D) can provide additional information but may not be sufficient for a definitive diagnosis of malignancy.

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Spironolactone can be usefully combined with the following diuretics except: *

  • A. Amiloride
  • B. Chlorthalidone
  • C. Furosemide
  • D. Hydrochlorothiazide
Correct Answer: D

Rationale: Spironolactone is a potassium-sparing diuretic, so combining it with another potassium-sparing diuretic like amiloride can lead to hyperkalemia. Chlorthalidone, a thiazide-like diuretic, can be synergistic with spironolactone. Furosemide, a loop diuretic, can counteract the potassium-sparing effects of spironolactone. Hydrochlorothiazide, a thiazide diuretic, can also lead to hypokalemia when combined with spironolactone. Therefore, the correct answer is D, as combining spironolactone with hydrochlorothiazide may increase the risk of potassium imbalance.

A 70 year old man requires treatment with an alpha-blocker for overflow incontinence due to enlarged prostate. Which of the following alpha blocking drugs is most appropriate drug to prescribe that will not affect his blood pressure significantly?

  • A. Prazosin
  • B. Phentolamine
  • C. Tamsulosin
  • D. Terazosin
Correct Answer: C

Rationale: The correct answer is C: Tamsulosin. It is the most appropriate alpha-blocker for the elderly man with enlarged prostate and overflow incontinence because of its selective action on alpha-1A receptors in the prostate, leading to relaxation of smooth muscle without significantly affecting blood pressure.

Rationale:
1. Prazosin (Choice A) and Terazosin (Choice D) are non-selective alpha-blockers that can cause significant blood pressure lowering due to their action on alpha-1 receptors in blood vessels, which may not be suitable for this patient.
2. Phentolamine (Choice B) is also a non-selective alpha-blocker that can lead to significant blood pressure reduction, making it unsuitable for this patient.
3. Tamsulosin (Choice C) is a selective alpha-1A blocker, primarily acting on the prostate, with minimal impact on blood pressure, making it the most appropriate choice for this patient.

The drug of choice for treatment and secondary prophylaxis against * cryptococcal meningitis among AIDS patients is:

  • A. Amphotericin B
  • B. Flucytosine
  • C. Fluconazole
  • D. Ketoconazole
Correct Answer: C

Rationale: The correct answer is C: Fluconazole. Fluconazole is the drug of choice for treating and preventing *cryptococcal meningitis in AIDS patients due to its excellent CNS penetration and efficacy. It is preferred over Amphotericin B due to its better safety profile and tolerability. Flucytosine is not used as monotherapy and is often combined with other antifungals. Ketoconazole is not recommended for cryptococcal meningitis due to poor CNS penetration.

What indicates to the nurse that a patient with oliguria has prerenal oliguria?

  • A. Urine testing reveals a low specific gravity.
  • B. Causative factor is malignant hypertension.
  • C. Urine testing reveals a high sodium concentration.
  • D. Reversal of oliguria occurs with fluid replacement.
Correct Answer: A

Rationale: The correct answer is A because prerenal oliguria is typically characterized by a low specific gravity in urine testing. This indicates that the kidneys are conserving water due to decreased blood flow or volume. Choices B and C are incorrect as they do not specifically relate to prerenal oliguria. Choice D is also incorrect as reversal of oliguria with fluid replacement is not specific to prerenal oliguria and can occur in other types of renal failure.

Which of the following diuretics is the most potent and cause hypotension * due to hypovolemia from excessive diuresis?

  • A. Acetazolamide
  • B. Furosemide
  • C. Spironolactone
  • D. Hydrocholorpthiazide
Correct Answer: B

Rationale: Step 1: Furosemide is a loop diuretic, known for its high potency in inhibiting the reabsorption of sodium and chloride in the loop of Henle.
Step 2: This leads to significant diuresis, causing hypovolemia and subsequent hypotension.
Step 3: Acetazolamide is a carbonic anhydrase inhibitor diuretic, not as potent as loop diuretics.
Step 4: Spironolactone is a potassium-sparing diuretic, less likely to cause hypotension due to its mechanism of action.
Step 5: Hydrochlorothiazide is a thiazide diuretic, less potent than loop diuretics like furosemide in causing hypovolemia and hypotension.

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