The scientific council of urology UROLOGY ASSESMENT EXAM. —UROLITHIASIS Assessment Exam for 3-5th year staged students... The Scientific council of urology ‘Answer only 25 questions. Time allowed: one hour '26-6-2019} ANSWER SHEET 1-d 6-c 11-a 16-b 21-c 2-c 7-d 12-b 17-c 22-b |3-b 8-d 13-a 18-b 23-c | 4-c¢ 9-a 14-d 19-b 24-0 5-e 10-b 15-c 20-b 25-dThe scientific council of urology UROLOGY ASSESMENT EXAM. —_UROLITHIASIS 3. Citrate inhibits calcium oxalate stone formation by: a. Binding urinary inhibitors. b. Lowering urine magnesium levels. ¢. Increasing urinary saturation of sodium urate. 4. Complexing calcium. e. Lowering urine PH. One of the most interesting observations in recent years is the obvious role of Randall’s plaques. What is the chemical composition of such precipitates? A. Calcium hydrogen phosphate. B. Calcium oxalate. C. Apatite, D. Uric acid. E. Oxalate. Fifty yrs. glaucoma patient on acetazolamide may develop stones composed of: a. Calcium oxalate. b. Calcium phosphate. c. Struvite. d. Cystine. e Urieaci A.32-year-old man with inflammatory bowel disease has passed two calcium oxalate stones, Twenty-four hour urine collection reveals elevated oxalate. The next stey a. Restrict oxalate, b. Restrict sodium. c. Calcium. 4. e, Thiazides. Potassium citrate.The scientific council of urology UROLOGY ASSESMENT EXAM. UROLITHIASIS 5. The Uric acid stone formers should obtain their dietary protein intake from vegetables and: a. soy. b. eggs. ©. fish. d. chicken, e. dairy products. The best predictor of post-percutaneous nephrolithotomy (PNL) wrosepsis Preoperative bladder urine culture. Intraoperative bladder urine culture. Stone culture Preoperative blood culture. Intraoperative blood culture. eaoge . What is the preferred treatment for a known brushite stone former harboring a lower pole renal calculus 25 mm in diameter? SWL. SWL with ureteral stenting. Flexible ureteroscopy with holmium laser lithotripsy. PNL. Laparoscopic pyelolithotomy. eaege Sixty years old patients on clopodogril that cannot be stopped , what is the preferred treatment option for his a symptomatic 1.5 em renal ealculus? SWL. SWL after administration of fresh-frozen plasma. Indwelling ureteral stent. Flexible ureteroscopy. PNL. geese The management of uretric coli never includes: Aggressive hydration, Desmopressin. Rofecoxib. Urinary decompression. alpha blockers. saogeThe scientific council of urology UROLOGY ASSESMENT EXAM. —_UROLITHIASIS. 10. EMQ: for the followings clinical senarios: ‘A. Renal stones < 1 cm. B. Non-lower pole stones between 1 and 2 em. C. Lower pole 1-2 em or stones > 2 em. Best ti 1. PNL. 2, SWL or ureterorenoscopic extraction, 3. SWL or PNL. 4 5, ted wi |. Tamsulusin. Partial lower pole nephrectomy. Answer A,EB,3:C,5. A2: B,3: C1. A,3: BI: CS. AA:B,1: C2. A2: Ba: C1 11, What are the preferred initial power settings for holmium laser lithotripsy of ureteral stones? 0.6J,6Hz 0.6 J, 10 Hz 1.0, 10Hz 123, 10Hz 1.0J, 15 Hz eaoge 12, Factors shown to increase the risk of blood transfusions during PCNL procedure are: Patient positioning, arterial hypertension, surgeon experience. b. Renal pelvis damage, surgeon experience, multiple punctures. ¢. Preoperative infection, arterial hypertension, multiple punctures, 4. Surgeon experience, patient positioning, preoperative infection. e. Anesthetic experience, Aneasthetic drugs,chest infectiThe scientific council of urology UROLOGY ASSESMENT EXAM. —_ UROLITHIASIS 13. During PCNL : The optimal point of entry to manage 2 cm pelvie stone secondary to PUJ obstruction is? Posterior upper pole calyx. Posterior lower pole calyx. Anterior upper pole calyx. Anterior lower pole calyx. Renal pelvis. 14, Ifa retroperitoneal injury to the colon is diagnosed after PNL, what is the preferred management? a. Surgical exploration and repair. b. Diverting colostomy with later definitive repair c. Leaving the nephrostomy tube in for 2 weeks to allow the tract tomature. d._ Insertion of a double-J stent and withdrawal of the nephrostomy tube into the 15. Proper management of a stone trapped in a basket, after colon, Immediate removal of the nephrostomy tube. removal there was uretric avulsion with ureter all in continuity and no safety guidewire in place, is: a. b c. d. e Immediate surgical exploration and primary repair. Cystoscopy to place a guidewire and ureteral stent. Placement of a percutaneous nephrostomy drain. Immediate ureteral reimplantation. Immediateileal ureter. 16, EMQ: For the following stone types ; In descending order, the most r A. Calcium oxalate monohydrate B. Brushite. C. Cystine. D. Uric acid stones. E. struvite. istant stones for SWL are? BCDAE. CBAED, ABCDE, EDCAB. DECBA. peesThe scientific council of urology UROLOGY ASSESMENT EXAM. —_UROLITHIASIS 17, Regarding urolithiasis in pregnancy: The metabolic changes in pregnancy increase the rate of new stone occurrence. Low voltage SWL is safe in early pregnancy. Pregnancy induces a state of absorptive hypercalciuria and mild hyperuricosuria. Encrustationof stents during pregnancy is less than in non-pregnant women due to increased excretion of urinary inhibitors such as citrate and magnesium, as well as increased urinary output. €. Fifly percent to 80% of pregnant patients will spontaneously pass the JJ stent. pegs 18, All of the following regarding primary bladder calculi in children are true, except: The peak incidence is between the ages of 2 and 4 years. Patients usually present with multiple calculi. The incidence is much higher in males than females. Formation is associated with low-phosphate diets. Formation is generally not associated with urinary tract infection, 19. Which continent diversion has the highest risk of stone formation? Mainz pouch. Kock pouch. Orthotopic hei Indiana pouch. Cecal reservoir. -Kock pouch. eapge 20. The two most frequent complications of PCNL are: a, Pleura lesion, transfusion. b. Mild bleeding, postoperative fever. c. Septicemia, mild bleeding. d e. Transfusion, colonic injury. Hypo natreamia, renal impairment. 21. The ideal puncture of PCNL would be: a. A percutaneous tract that leads straight from the skin to the lower calyx. b. A percutaneous tract that leads straight from the skin to the pelvis. cc. A percutaneous tract that leads straight from the skin through a papilla and the target calyx into the renal pelvis d, Transcostal tract. e. A retroperitoneal tract.The scientific council of urology UROLOGY ASSESMENT EXAM. —_UROLITHIAS(S 2. 23. Regarding the technique of RIRS all are true, except: a. Stones in lower pole calyces can be treated in situ or moved, with flexible graspers or a basket into renal pelvis. b. A head-down patient position with the ipsilateral flank elevated may help when access into the lower pole is difficult. ¢. The goal of lithotripsy is to reduce the stone to fine dust and to small fragments 2 mm or less in diameter. 4. Complication rates are low, with fever and UTI being the most commonly. e. Single session success rates are reported to be in the 70% to 80% range. Which of the following is false regarding the design & instrumentation of RIRS: Endoscopes contain two-way, logical tip deflection of 270° Have shaft diameters less than 8.5 French (Fr). FLexible ureteroscopes have a single 4 Fr working channel. For flexible ureteroscopic access, the Teflon-jacketed nitinol-based zebra wire is commonly employed by many urologists. €. 1.3-t02.4-Fr nitinol baskets and 200- or 365-m laser fibers, is desirable to maximize concurrent irrigation flow eee 24, Fifty years old man with loin pain and LUTS, what is the best treatment?The scientific council of urology UROLOGY ASSESMENT EXAM. — UROLITHIASIS Vesicolithotomy. Uretroneocystostomy. Uretroscopy and laser lithotripsy. Insicision of the uretric orifice, milking the stone done to the bladder and litholopaxy. €. Tamsulusin and dissolving agents 25- A patient elects SWL for treatment of a symptomatic, partially obstructing radiopaque 7 mm proximal ureteral calculus. The next step is: A. Push back of the stone into the renal pelvis prior to SWL. B. Placement of a stent alongside the stone prior to SWL. C. Placement of a nephrostomy tube prior to SWL. D. In-situ SWL treatment. E. Placement of a ureteral catheter to the level of the stone. The Scientific council of urology FeedBack TSientific base A.Hard B.Medium _C..Weak @Contents_ | “A.Covering of B.Some ~ O.NOT. \ She urology 33. $e 1 topic 2sea a 3- Difficulty A.Very Hard 8. Hard C..easy Any other comments: GOOD LUCK