Practice Genitourinary System Questions on the Physician Assistant Exam
Although the genitourinary system can be complex, it’s actually pretty easy to get a handle on what you need to know for the Physician Assistant Exam (PANCE). Instead of trying to memorize thousands of facts, aim to understand basic principles and recognize key words or phrases in the test questions. The practice questions here give you a sense of what to expect of PANCE GU questions.
Example PANCE Questions
You’re evaluating a 32-year-old man who was found on the ground after a drug overdose. It’s not known how long he was there, but from the history, you suspect it may have been several hours. On admission, his creatinine level is 4.5 mg/dL. Urinalysis is strongly positive for blood, but the microscopic evaluation reveals only 0–2 RBC/HPF. Which of the following is the likely cause of hematuria and acute renal failure in this patient?
(A) Wegener’s granulomatosis
(B) Acute glomerulonephritis
(D) Acute interstitial nephritis
(E) Minimal change disease
You’re seeing a 65-year-old man in the primary care office who presents with worsening lower extremity edema. He has a history of Type 2 diabetes. On physical exam, he has a blood pressure of 150/86 mm Hg. His albumin/creatinine ratio is 160. His creatinine is 1.2 mg/dL. Which of the following medications would you prescribe for treating this patient?
(A) Lisinopril (Zestril)
(B) Diltiazem (Cardizem)
(C) Amlodipine (Norvasc)
(D) Hydrochlorothiazide (Microzide)
(E) Terazosin (Hytrin)
You’re seeing a patient who will be undergoing a cardiac catheterization in the next 24 hours. He has Stage III chronic kidney disease (CKD) with a creatinine level of 1.5 mg/dL. Which of the following interventions should be instituted at this time?
(A) Encourage the patient to drink plenty of fluids the night before the procedure.
(B) Administer a dose of furosemide prior to the procedure.
(C) Order intravenous normal saline and oral N-acetylcysteine (Mucomyst).
(D) Rehydrate with an oral bicarbonate-based solution.
(E) Administer a dose of hydrochlorothiazide before the procedure.
Which one of the following statements concerning post-streptococcal glomerulonephritis is true?
(A) The mainstay of treatment requires the use of steroids like prednisone.
(B) It is characterized by normal complement levels.
(C) The glomerulonephritis occurs two to four days after the development of pharyngitis.
(D) It is characterized by low complement levels that persist for months after diagnosis.
(E) It is a self-limiting condition.
You’re treating a 62-year-old man for benign prostatic hyperplasia (BPH). He has an American Urological Association (AUA) symptom score of 7, denoting mild BPH symptoms. He also has hypertension, so you elect to start terazosin (Hytrin). What would you advise this patient concerning potential side effects of this medication?
(A) There are no side effects he needs to be aware of.
(B) He should get up slowly and notify you if he has lightheadedness or dizziness.
(C) He should call you if his blood pressure increases.
(D) He needs blood work to monitor potassium levels.
(E) He needs to watch for edema and constipation.
You are in the ICU and are asked to interpret the following arterial blood gas (ABG) findings:
HCO333 (assuming a normal level of 24–26)
What is the acid-base disorder demonstrated in this patient?
(A) Respiratory acidosis
(B) Respiratory alkalosis
(C) Metabolic acidosis
(D) Metabolic alkalosis
(E) Normal acid-base equation
Example PANCE Answers and Explanations
Use this answer key to score the practice genitourinary system questions. The answer explanations offer insight into why the correct answer is better than the other choices.
1. C. The history fits the clinical picture of rhabomyolysis and muscle damage causing the acute kidney failure. Wegener’s granulomatosis, Choice (A), is an example of a vasculitis that affects the sinuses, lungs, and kidneys. You’d expect to see red blood cells in the urinary sediment. With acute glomerulonephritis, Choice (B), you’d expect to see red blood cells and/or red blood cell casts in the urine. Acute interstitial nephritis, Choice (D), usually causes white blood cells, urine eosinophils, and/or white cell casts in the urine. Minimal changes disease, Choice (E), is a cause of nephrotic syndrome in adults and wouldn’t cause hematuria.
2. A. Lisinopril is an example of an ACE inhibitor, which is the first line of treatment for proteinuria. The man in this question has diabetic retinopathy and neuropathy. He also has an elevated blood pressure and microalbuminuria, on the basis of his albumin/creatinine ratio. Concerning Choice (E), terazosin (Hytrin) would be a good choice if benign prostatic hyperplasia were present; however it’s not the best choice for diabetic nephropathy.
3. C. The only proven therapy for the prevention of contrast-induced nephropathy is the administration of isotonic saline at least 12 hours prior to the intended procedure. N-acetylcysteine (Mucomyst) is an antioxidant that’s also used to prevent contrast-induced nephropathy. Choice (A) is wrong because drinking plenty of fluids isn’t as effective as intravenous hydration in preventing contrast-induced nephropathy. Giving a diuretic like furosemide (Lasix), Choice (B), would be counterproductive and could actually worsen kidney function. Oral-based solutions, whether they contain bicarbonate or not, haven’t been proven to be of any benefit, so Choice (D) is wrong. You wouldn’t want to give hydrochlorothiazide (HCTZ), Choice (E), prior to a contrast dye procedure. It would worsen kidney function.
4. E. Post-streptococcal glomerulonephritis occurs in young children, usually a few weeks after a pharyngitis. It’s characterized by a low complement level C3 that usually stays low for 6 weeks and then normalizes. This condition is self-limiting and doesn’t require steroid or other immunosuppressive treatment. Antistreptolysin titers (ASO) are elevated early in the condition, and anti-DNase B titers rise later on.
5. B. The patient is on terazosin (Hytrin), which is an alpha blocker. A main side effect of alpha blockers is postural hypotension, so the patient needs to get up slowly and notify you if he experiences any lightheadedness or dizziness. You may need to adjust the dose or discontinue the medication if the symptoms are severe.
Alpha blockers serve double duty: They’re used to treat both benign prostatic hyperplasia and hypertension. This medication won’t increase blood pressure, Choice (C), nor is this medication a diuretic or ACE inhibitor, which can affect potassium levels, Choice (D). Edema and constipation, Choice (E), are common side effects of calcium channel blockers, not alpha blockers.
6. D. This patient has metabolic alkalosis. To understand this question, you need to understand the patterns of acid-base disorders. First, the pH is > 7.4, so you’re dealing with an alkalosis. The next step is to figure out whether you’re dealing with a metabolic alkalosis or a respiratory alkalosis. The bicarbonate level here is elevated, and an elevated bicarbonate level plus and elevated pH points to a metabolic alkalosis. So what about the elevated pCO2? This is the respiratory compensation for the metabolic alkalosis. Remember, the pH tells you the primary process that’s going on.