Genitourinary 2010

1. Integumentary integrity, determines the condition of the skin. When evaluating the
condition of the skin of a patient that is totally dependent on others . What would the
therapist be looking for ?
a) Activities, positioning , and postures that produce or relieve trauma to the
skin.
b) Diet.
c) Appetite.
d) Sleeping.

Rationale: Examination findings for integumentary integrity, include activities,

positioning , and postures that produce or relieve trauma to the skin, assistive ,
adaptive, orthotic, protective, supportive, or prosthetic devices and equipment that
may produce or relieve trauma to the skin.

2. You have a patient diagnosed with placenta previa. What is the best physical therapy
intervention?
a) partial sit ups
b) abdominal exercises
c) pelvic floor exercises
d) proper breathing exercises and abdominal exercises

Rationale: Placenta previa is a condition in which the placenta does not elevate
from its original low position and assumes a position that is below the fetus and
attached to the lower half of the uterus. It may cover the mouth of the uterus. This is
a leading cause of vaginal bleeding and a serious condition that increases morbidity
and mortality of both the fetus and mother. Abdominal exercises can worsen this
condition. Pelvic floor and breathing exercises are important and should be
continued. Genitourinary: Application

3. Your patient is two weeks post transurethral resection of the prostate (TURP) without
complications. Which exercises will best help the patient?
a) abdominal strengthening
b) trunk stabilization
c) Kegel exercises
d) Hip exercises

Rationale: Kegel exercises strengthen the pelvic floor muscles and are appropriate
in males following prostate procedures. The other choices to be performed properly
would require some abdominal or trunk contraction which could exacerbate urinary
incontinence problems. Genitourinary

4. Your patient developed lateral separation or split of the rectus abdominis after
delivery. What is the best intervention?
a) full sit-ups
b) bilateral straight leg raising
c) pelvic floor exercises
d) splinting of the abdominal musculature
 Rationale: Diastasis recti abdominis is a condition in which there is a lateral
separation or split of the rectus abdominis. It is important to teach protection
(splinting) of the abdominal musculature. Patients should be instructed to avoid full
sit-ups or bilateral straight leg raising. Pelvic floor exercises are done but are not
remediation for diastasis recti. Genitourinary: Intervention

5. After the first trimester, women should avoid exercise in which position since this
position is associated with decreased cardiac output?
a) prone
b) supine
c) right-sidelying
d) left sidelying

Rationale: According to the American College of Sports Medicine, women can

continue to exercise regularly (3 times a week) at mild to moderate intensities
throughout pregnancy if no additional risk factors are present. After the first trimester,
women should avoid exercise in the supine position since this position is associated
with decreased cardiac output. Prolonged standing with no motion should also be
avoided. Non-weightbearing exercise (swimming) is an appropriate alternative to
walking or jogging, depending on the patient's skill and interests. Genito : App

6. A physical therapist treats a patient referred to physical therapy with incontinence.

The patient describes her difficulty beginning after the birth of her son. After completing
an examination the therapist concludes that the patient has extremely weak pelvic floor
muscles. When instructing the patient in pelvic floor muscle strengthening program, the
Most appropriate position to initiate treatment is.
a) Side lying.
b) Sitting.
c) Standing.
d) Supine.

Rationale: Patients with very weak pelvic floor muscles should initiate exercises in a
horizontal plane in order to avoid gravity exerting a down ward force on the pelvic
floor. Although side lying would be an acceptable position it is more awkward than
the supine position for most patients. Patients should move to more challenging
positions as their strength increases.

7. A physical therapist instructs a patient with a Foley catheter in ambulation activities.

During ambulation the therapist should position the collection bag:
a) Above the level of the patients bladder.
b) Below the patient’s bladder.
c) Above the patient’s heart.
d) Below the patient’s heart.

Rationale: Rationale the effect of gravity necessitates the collection bag below the
level of the patient’s bladder.

8. A patient complains of fatigue. The patient has a history of diabetes. Upon

examination, the patient has elevated blood pressure, abnormal heart and lung sounds.
Tests reveal chronic renal failure. What are other symptoms of chronic renal failure ?
a) Generalized itching.
 b) Increase in weight.
c) Diarrhea.
d) Insomnia.

Rationale: Chronic renal failure results in an accumulation of fluid and waste

products in the body, leading to a build up of nitrogen waste products in the blood
( azotemia ) and general ill health. Most body systems are affected by chronic renal
failure.

9. The genitourinary system consists of all the reproductive organs and the urinary
system. Which of the following belongs to the renal system?
a) Ureters.
b) Intestines.
c) Stomach.
d) Bowel.

Rationale: The ureters are part of the renal system , also include is the kidneys,
urinary bladder, urethra. The genital system is a complex system comprised of the
male and female gonads, and associated ducts, external genitalia, and associated
hormones that all function to reproduce the species.

10. Your patient in the ICU was diagnosed with functional incontinence. All of the
following may cause this problem except:
a) Impaired cognition
b) Circulatory disruptions
c) Environmental barriers
d) Impaired Physical Functioning

Rationale: Answer: 2. Circulatory disruptions Reason The possible reasons for

Functional incontinence are Impaired cognition, Circulatory disruptions and
Environmental barriers.

11. A patient with history of renal failure is being monitored for the possible
complications. Name a possible complication from chronic renal failure.
a) Congestive heart failure.
b) Increased functioning of white blood cells.
c) Low blood pressure.
d) Increase in immune response.

Rationale: There is no cure for chronic renal failure. Untreated, it usually progresses
to end stage renal disease. Lifelong treatment may control the symptoms of chronic
renal failure. One of the possible complications of the disease is congestive heart
failure. Renal pathology usually occurs secondary to diabetes mellitus or
hypertension, but can also occur from poison, trauma, and genetics

12. A physical therapist treats a 54- year- old male rehabilitating from a tibial plateau
fracture. While completing his resistive exercise the patient indicates that lifting weights
often causes him to void small amounts of urine. What would the therapist consider the
most appropriate action ?
a) Refer to a support group.
b) Instruct the patient in pelvic floor muscle exercises.
 c) Discontinue resistive exercises as part of the established plan of care.
d) Educate the patient about incontinence.

Rationale: Incontinence refers to an inability to control the release of urine faeces or

gas education may include basic information related to incontinence as well as a
referral to the patients primary care provider. A vast majority of patient’s with
incontinence can be successfully treated with non evasive techniques such as pelvic
floor exercises. However with out more definitive medical information this action
would be premature.

13. Mrs Bond presents with frequency of urine. She complains of feeling very tired. The
physician diagnosed her to have kidney disease. Which diagnostic test can the physician
use to confirm his diagnosis?
a) Blood and urine tests.
b) X-ray.
c) CT scan.
d) Ultrasound.

Rationale: Because a person can have kidney disease without any symptoms, a
doctor may first detect the condition through routine blood and urine tests. The
national kidney foundation recommends three single test to screen for kidney
disease: a blood pressure measurement, a spot check for protein or albumin in the
urine, and a calculation of glomerular filtration rate ( GFR ) based on a serum
creatinine measurement . Measuring urea nitrogen provides additional information.

14. The kidneys are bean shaped organs, each about the size of a fist. They are located
near the middle of the back, just below the rib cage , one on each side of the spine. The
kidneys are sophisticated reprocessing machines. How many quarts of blood are filtered
through the kidneys daily ?
a) 100 quarts
b) 200 quarts
c) 300 quarts
d) 350 quarts

Rationale: Every day , a person’s kidneys process about 200 quarts of blood to sift
out about 2 quarts of waste products and extra water. The wastes and extra water
become urine, which flow to the bladder through tubes called ureters.

15. Mrs. Long is a 49-year old patient currently on the wait list for a kidney transplant.
She comes in today for intermittent hemodialysis The patient is all swollen. She
complains of feeling exhausted. How long does it take to remove water and waste
products through intermittent hemodialysis ?
a) 1-2 hours
b) 2-4 hours
c) 5-6 hours
d) 6-7 hours

Rationale: The major difference between intermittent and continuous therapies is

the speed at which water and wastes are removed. Intermittent hemodialysis
removes large amounts of water and wastes in a short period of time ( usually over
 2-4 hours ), whereas , continuous renal replacement therapies remove water and
wastes at a slow and steady rate. While intermittent dialysis allows chronic renal
failure patients to limit the amount of time that they are connected to a machine., the
rapid removal of water and wastes during intermittent treatments may be poorly
tolerated by hemodynamically unstable patients.

16. The kidney is an important contributor to homeostasis. These essential functions

include acid- based balance, regulation of electrolyte concentrations, control of blood
volume, and regulation of blood pressure. Which organ system regulates homeostasis ?
a) Renal system.
b) Cardiovascular system.
c) The nervous system.
d) Endocrine system.

Rationale: In most cases the disruption of homeostasis is mild and temporary , and
the responses of body cells quickly restore balance in the internal environment.

17. The ER physician suspected Andrew to have genitourinary problems. Which among
the following complaints are related to the genitourinary system?
a) Abdominal pain
b) Decreased appetite
c) Headaches
d) Multiple wounds

Rationale: Abdominal pain ( duration and location )type of pain, burning, dull,
knifelike, cramping, nausea and vomiting, hernia and incontinence are symptoms
that are related to the genitourinary system.

18. The physician performs a pelvic exam on a patient. Examination reveals that the
bladder is bulging into the vaginal space. The physician diagnosed the patient to have
stress incontinence. Which diagnostic test would be most appropriate?
a) Cystoscopy.
b) Blood tests.
c) MRI.
d) X-ray.

Rationale: Stress incontinence is an involuntary loss of urine that occurs during

physical activity, such as coughing, sneezing, laughing, or exercise.

19. Jill is diagnosed with stress incontinence. What are the risk factors associated with
this condition?
a) Multiple pregnancies.
b) Lack of exercise.
c) Medications.
d) Sedentary lifestyle.

Rationale: Stress incontinence is often seen in women who have had multiple
pregnancies and vaginal childbirths , and whose bladder, urethra, or rectal wall stick
out in to the vagina ( pelvic prolapse).
20. A male patient diagnosed with renal failure is seen by physician. He was prescribed
with peritoneal dialysis. Where is this procedure usually performed?
a) Home.
b) Hospital.
c) Ambulatory surgery.
d) Outpatient clinic.

Rationale: With peritoneal dialysis ( PD ), you have some choices in treating

advanced kidney failure. Since the 1980’s, when PD first became a practical and
widespread treatment for kidney failure, much has been learned about how to make
PD more effective and minimize side effects. Since you don’t have to schedule
dialysis sessions at a centre, PD gives you more control. You can give yourself
treatments at home.

21. Sally turner complains to her physician that she has pain in voiding. She explains
that her urine has been cloudy and smelly. The physician tests her urine and diagnosed
her with “ UTI “. What is the best treatment for this condition?
a) Antibiotics.
b) Kegel's exercise.
c) Drink plenty of water and cranberry juice.
d) Surgery.

Rationale: Antibiotics is the best course of action. Plenty of fluids at least 2 liters per
day is also recommended.

22. You went for a urinalysis. Assuming that you healthy and free of disease, what will
you find on your urine report?
a) Urine is virtually sterile
b) White Blood Cells
c) Red Blood Cells
d) Staphylococcus

Rationale: Healthy urine should be virtually sterile. Any bacteria are a sign of an
infection and not something you would normally see. This is one reason urine tests
are so important as any germs present will point to an infection somewhere in the
body.

23. A male patient diagnosed with polycystic kidney disease, has fully developed
autonomic dominant PKD, the weight of his kidney would be :
a) 10-20 pounds
b) 20-30 pounds
c) 25-30 pounds
d) 30-35 pounds

Rationale: In fully developed autosomal dominant PKD , a cyst filled kidney can
weigh 20-30pounds. High blood pressure is common and develops in most patients
by age 20 or 30.

24. A patient complains that she feels a lump when she goes to the bathroom to pass
urine. On examination, the physician finds a cystocele. What is it?
a) Bladder drooping in to the vagina.
 b) Prolapse uterus.
c) Prolapse bladder.
d) Fibroid.

Rationale: A cystocele occurs when the wall between a women’s bladder and her
vagina weakens and allows the bladder to droop in to the vagina. This condition may
cause discomfort and problems with emptying the bladder.

25. Mrs W, 43 years old, presents with colorless urine. What should you tell her?
a) You need to drink more vitamins.
b) You need to exercise more often.
c) You are drinking too much fluid.
d) You are having a urinary tract infection.

Rationale: Healthy urine should be straw colored. Anything darker means more fluid
should be drunk. Clear urine, usually in larger quantities than usual, is often a sign of
drinking too much, especially of diuretics such as caffeine or alcohol.

26. Mr. S presents to the clinic with erectile dysfunction. The patient has a history of
diabetes. What is the percentage of men with diabetes who suffers with impotence ?
a) 25-45%
b) 25-50%
c) 25-60%
d) 25-85%

Rationale: Erectile dysfunction also known as impotence , is estimated to range

from 25-85% in men with diabetes, which makes this population three times more
likely than the general population.

27. Julie is recovering from a radical mastectomy. What surgical procedure is involved
when this operation is performed ?
a) Axillary lymph nodes are removed.
b) Pectoral muscles are removed.
c) Axillary lymph nodes and some skin are removed.
d) The entire breast is removed.

Rationale: A radical mastectomy involves, having the entire breast , pectoral

muscles, axillary lymph nodes, and some skin removed usually secondary to breast

28. Mandy is pregnant and advised to keep up her exercise at a moderate rate. What
percent of the maximal heart rate for 30 minutes per session is advocated?
a) 15-25%
b) 25-30%
c) 30 -50%
d) 50 -60 %

Rationale: Guidelines permit women to remain at 50 -60 % of their maximal heart

rate for approximately thirty minutes per session

29. Mandy is her 1st trimester of pregnancy. What are the exercise activities that she
must avoid ?
 a) High level balance activities.
b) Swimming.
c) Running.
d) Working out in the gym.

Rationale: Exercise activities to avoid include, high level balance activities, skiing,
water skiing, scuba diving, horse back riding, contact sports, skating, strenuous
lifting.

30. Sheila is 3 months pregnant seen by the physician. She is worried that she is gaining
a lot of weight. How much weight would one normally expect to gain for a full term
pregnancy ?
a) 15-20 pounds
b) 25 -30 pounds
c) 28 - 30 pounds
d) 25-35 pounds

Rationale: Physiological changes during pregnancy , include eight gain 25- 35

pounds.

31. Male 47 years old is diagnosed with chronic kidney failure. He undergoes dialysis
two times per week. What happens when you have chronic kidney failure?
a) Harmful wastes build up in your body.
b) Kidney stones start to form.
c) Peritonitis develops.
d) Urinary tract infections develops.

Rationale: Healthy kidneys clean your blood by removing excess fluid, minerals, and
wastes. They also make hormones that keep your bones strong and your blood
healthy. When your kidneys fail, harmful wastes build up in your body, your blood
pressure may rise, and your body may retain excess fluid. and not make enough red
bloods cells.

32. In the womb, the amniotic fluid is mainly made up of the baby's urine.
a) False
b) True

Rationale: Although the initial fluid is secreted by the mother at around two weeks
after conception, made from mainly water with some nutrients, it doesn't take long for
this to be recycled by the foetus. Then the majority of the fluid is composed of the
baby's urine.

33. Chronic renal failure and ESRD affect more than 2 out of 1,000 people in the United
states. Along with high blood pressure, what other disease predisposes the person to
develop chronic renal failure?
a) Cholecystitis.
b) Diabetes.
c) Pancreatitis.
d) Gall stones.
 Rationale: Chronic renal failure and ESRD affect more than 2 out of 1,000 people in
the United states. Diabetes and high blood pressure are the two most common
causes for most cases.

34. Many compounds are dissolved in normal healthy urine. Which one will you NOT
find?
a) vitamin C
b) Glucose
c) Various minerals
d) Ammonia

Rationale: Glucose in the urine is not found if the urine is healthy, and if is found is
usually a sign of diabetes. Many other traces of substances are present in urine as
the body also excretes excess nutrients such as vitamin C and various minerals.
Although ammonia is also associated with urine it forms on decomposition of urea
after it has left the body and is not part of it when fresh.

35. Urinating on a jellyfish sting can treat the poison.

a) False
b) True

Rationale: It has no benefit and may actually make the wound even worse.

36. The adrenal gland , (also known as the suprarenal glands ) are star shaped
endocrine glands that sit on top of the kidneys. Name an artery that supplies blood to the
adrenal gland ?
a) The superior suprarenal artery is provided by the inferior phrenic.
b) The left common carotid artery.
c) Right common carotid artery.
d) Left inferior thyroid artery.

Rationale: Although variations of the blood supply to the adrenal glands ( and
indeed the kidneys themselves ) are common, there are usually three arteries that
supply each adrenal gland , they include the superior artery is provide by the inferior
phrenic, the middle suprarenal artery is provided by the abdominal aorta, the inferior
suprarenal artery is provided by the renal artery.

37. Mr G has hypertension and diabetes. How do the kidneys affect blood pressure?
a) Kidneys excrete sodium chloride to maintain normal sodium balance.
b) Kidneys secrete a variety of hormones including erythropoietin, urodilation,
rennin and calcitriol.
c) Kidneys regulate the acid base balance of the blood (Ph ) by excretion or
conservation of ions such as H+ ions or HCO3’ ions.
d) Kidneys filtering capacity , and volume of filtrate per minute by the kidneys.

Rationale: Regulation of the blood pressure is maintained by the kidneys ability to

excrete enough sodium chloride to maintain normal sodium balance, extrecellular
fluid volume, and blood volume.

38. A male patient with chronic kidney failure is scheduled for therapy. He tells you that
he undergoes dialysis on a regular basis. What is the frequency of this procedure?
 a) 1 hour per week / 4-6 hours
b) 2 hours per week / 4-6 hours
c) 3 times per week / 3-5 hours
d) 4 times per week / 4-6 hours

Rationale: A patient requires this process on average three times per week and
each visit requires three - five hours to complete treatment.

39. Your patient is undergoing dialysis. What are the common side effects of dialysis that
you should look for?
a) Headaches.
b) Anemia.
c) Nausea.
d) Hypotension.

Rationale: Side effects that may be associated with dialysis include anemia, renal
osteodystrophy, pruritus ( itching ), sleep disorders, ( restless legs ) , and dialysis
-related amyloidosis.

40. Your patient was diagnosed with “oliguria”. What does this term refer to when
associated with the kidneys ?
a) Inadequate urine output in a 24 hour period less than 400ml.
b) Inadequate urine output in a 24 hour period; less than 100ml.
c) Large volume of urine excreted at one time.
d) No out put of urine.

Rationale: Inadequate output of urine in a 24 hour period less than 400 mls which
indicates acute renal failure, diabetes mellitus.

41. A post partum patient was scheduled for therapy. She complains of malaise and low
abdominal pain. You perform your assessment and you noted that he patient has high
fever and rapid heartbeat. What would you suspect?
a) polycystic kidneys
b) urinary tract infection
c) post partum endometritis
d) internal hemorrhage

Rationale: Post partum endometritis is an infection that develops within the lining of
the uterus after delivery. The likelihood that it will occur depends on several factors.
For example : 1-3% of women who have a vaginal delivery develop post partum
endometritis, 5-15% of women who have a scheduled cesarean before the onset of
labor or rupture membranes develop endometritis, as many as 35% of women who
have cesarean delivery after an extended period of labor and ruptured membranes
develop endometritis: and the frequency of infection in indigent patients may be
almost double the figures cited above.

42. These are crystalline structure formed from normal components of urine (calcium,
magnesium ammonium phosphate, uric acid, cystine).
a) Renal cystic disease
b) Renal calculi
c) Urine
 d) Ureter

Rationale: Answer: 2. Renal calculi Reason Renal calculi (kidney stones) are
crystalline structure formed from normal components of urine (calcium, magnesium
ammonium phosphate, uric acid, cystine).

43. The seminiferous tubules are part of the genito-urinary system. What are they?
a) The bulging of the anterior wall of the rectum into the vagina secondary to
weakening of the pelvic floor supporting structures.
b) Coiled tubes found within each lobe of the testes where spematogenesis
takes place.
c) A non cancerous enlargement of the prostrate gland that is progressive.
d) Urinary stones that develop in the kidneys.

Rationale: Coiled tubes found within each lobe of the testes where spermatogenesis
takes place.

44. A patient presents with a painless lump in his testis. He was diagnosed to have a
malignant tumor. What is the age that is most common for men to get this tumor?
a) 20-40
b) 25-35
c) 30-40
d) 35-45

Rationale: Testicular cancer is a “germ cell cancer “ as the cells which become
cancerous are those involved with making sperm. It is uncommon , bit is the most
common cancer in men aged 20-40.

45. What structures inside the penis are responsible for an erection?
a) A series of small bones that push out of the pelvic cavity and into the penis
during arousal.
b) Columns of erectile tissue that fill with blood.
c) Small balloon-like glands that fill with air.

Rationale: The erectile tissue of the penis – on the upper side (is the corpora
cavernosa) which looks like two rods running the length of penis – on the lower side
is the corpus spongiosum, which ends in the glans penis. During sexual arousal, the
nerves that supply the penis direct the small arteries, which supply the corpora
cavernosa and corpus spongiosum, to open and fill this sponge like tissue with
blood, causing the erection. Veins permit only the bare minimum of blood to return to
the heart, just enough to maintain circulation.

46. Your patient was diagnosed with penile cancer. He tells you that his doctor told him
that he is in stage 3 for his cancer. What are tissues affected?
a) To tissues near the penis and may have spread to lymph nodes in the groin or
pelvis.
b) Anywhere in or near the penis and to one or more lymph nodes deep in the
pelvis or groin.
c) Connective tissue just under the skin of the penis and to one lymph node in the
groin.
 d) Connective tissue or erectile tissue of the penis and to more than one
lymph node on one or both sides of the groin.

Rationale: In stage 3 cancer has spread to connective tissue or erectile tissue of the
penis and to more than one lymph node on or both sides of the groin, the urethra or
prostate and may have spread to one or more lymph nodes on one or both sides of
the groin.

47. What is the name of the tube that carries both sperm and urine out of the penis?
a) Urethra
b) Ureter
c) Epididymis
d) Fallopian tube

Rationale: The urethra is the tube that runs the length of the penis. It is attached to
the bladder, to allow the passage of urine. The vas deferens is a structure of the
male body that transports sperm to the urethra during ejaculation.

48. Brenda, 34 years old, is suffering with endometriosis. Acute endometrial

inflammations is caused by the bacterial infection ( strep, staph ) usually after delivery.
What are the causes of “chronic endometritis” ?
a) Tuberculosis.
b) Cystitis.
c) Flu.
d) Polyps.

Rationale: The causes of chronic endometritis are: bleeding, pain, infertility pelvic
inflammatory disease, retained products of conception, IUD, tuberculosis, non-
specific--possibly due to Chlamydia, histopathology--plasma cells/ spindle stroma/
desynchronise glands and stroma

49. Peter, 46 years old, is suffering from glomerulonenephritis, an inflammation of the

kidneys that involves the glomeruli. What can cause this problem?
a) Proteinuria.
b) An allergic reaction to toxins.
c) Liguria.
d) Hypoalbuminemia.

Rationale: An inflammation of the kidney that involves the glomeruli. One of the
most common causes is an allergic reaction to the toxins, produced by the
streptococcal bacteria.

50. These are paired, bean-shaped organs located outside of the peritoneal cavity.
a) Heart
b) Kidneys
c) Livers
d) Lungs

Rationale: Answer: 2. Kidneys Reason Kidneys are paired, bean-shaped organs

located outside of the peritoneal cavity in the posterior upper abdomen on each side
of the vertebral column.