NMS Q&A Family Medicine

SECTION VIIUrology and Nephrologyin Primary Carechapter 17Problems of the Urinary TractExamination questions: Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 A 60-year-old multifarous, 10-year postmenopausalwoman complains of loss of urine while coughingand laughing, increasing over the past several monthsto the point that she has taken to stop and cross herlegs to avoid loss of urine at those times. Pelvic examinationshows a first degree urethrocele and involuntarypassage of urine when she bears down. Each ofthe following is acceptable conservative therapyexcept for which one?(A) Intermittent catheterization(B) Urecholine(C) Imipramine(D) Metoclopramide(E) Pseudoephedrine2 A 35-year-old woman enters your office with complaintsof fever, malaise, and vague abdominal discomfort.She denies gastrointestinal symptoms, cough,coryza, and pain in specific areas. A urinalysis revealspositive dip tests for leukocyte esterase, nitrite, andoccult blood and a white blood cell (WBC) count of10 to 15 WBCs/high-power fields. She has never hada urinary tract infection (UTI) in the past. Beforeexamining her, you know with 98% certainty that thepatient has which of the following diagnoses?(A) Cystitis(B) Ureterolithiasis(C) Bladder cancer(D) Pyelonephritis(E) Trigonitis3 Which of the following is the organism most likely tobe grown and isolated in pyelonephritis?(A) Escherichia coli(B) Staphylococcus saprophyticus(C) Proteus organisms(D) Klebsiella organisms(E) Enterococci4 In a new case of pyelonephritis in an adult, diagnosedon the basis of clinical, historical, and physical evidence,which of the following should be carried outnext?(A) Intravenous urogram(B) Culture and sensitivity of the urine(C) Initiation of a course of a fluoroquinoloneantibiotic107