Urology-Final exam

1. pyelonephritis is the most likely diagnosis in a patient

with:
a) chills, fever, and flank pain
b) bacteria and pyuria
c) focal scar in renal cortex.
d) delayed renal function.

2. The most reliable urine specimen is obtained by:

a) urethral catheterization.
b) catheter aspiration.
c) midstream voiding.
d) suprapubic aspiration.

3. Indications for ureteroscopy include all of the following EXCEPT:

a) obstructing ureteral calculus.
b) filling defect of the renal pelvis.
c) 1.5-cm midureteral stricture.
d) ureteropelvic junction obstruction with a large crossing vessel
present.

4. A 75-year-old woman being investigated for recurrent urinary tract infections

(Proteus on culture) has a staghorn calculus on CT. What is the most likely stone
composition?
a) Cysteine
b) Uric acid
c) Struvite
d) Calcium oxalate
e) Hydrogen

5. According to American Urological Association guidelines, the

proper initial assessment of a 50-year-old patient with asymptomatic microhematuria
includes:
a) blood pressure measurement, serum creatinine level, cystoscopy, and computed
tomographic (CT) urogram
b) no evaluation unless microhematuria is persistent/recurrent
or hematuria is visible.
c) urine cytology, blue-light cystoscopy, and any upper tract
imaging.
d) urine cytology and renal/bladder ultrasound.

6. What is the arterial supply of the prostate?

a) Superior vesical artery
b) Obturator artery
c) Inferior vesical artery
d) Inferior epigastric artery
e) External iliac artery

7. Which of the following anterior pituitary hormones directly

influences testicular function?
a) Estradiol and adrenocorticotropic hormone (ACTH)
b) Follicle-stimulating hormone (FSH) and estradiol
c) Luteinizing hormone (LH) and FSH
d) Testosterone and LH

8. Which of the following veins are responsible for varicoceles?

a) The hypogastric veins
b) The deferential veins
c) The internal iliac veins
d) The internal spermatic veins

9. Which of the following structures is NOT in the retroperitoneum?

a) Kidney
b) Second portion of the duodenum
c) Ascending colon
d) Transverse colon

10. What statement best describes the lymphatic drainage of the

right testis?
a) Superficial then deep right inguinal nodes
b) Left para-aortic with some drainage to the interaortocaval nodes
c) Only to the interaortocaval nodes
d) Interaortocaval nodes primarily with some drainage to the
right paracaval nodes and a small but appreciable amount
of drainage to the left para-aortic nodes

11. Which of the following Germinal Cell Tumors subtypes is most likely to spread
hematogenously?
a) Choriocarcinoma
b) Embryonal carcinoma
c) Immature teratoma
d) Teratoma with malignant transformation

12. What is epispadias?

a) Opening of urethra on the ventral surface of the penis
b) Opening of urethra on dorsal surface of the penis
c) Inflammation of the testicle
d) Benign warty growth on genital skin

13. The treatment modality associated with the greatest stone-free rates and the
least morbidity for patients with distal ureteral stones of any size is:
a) PNL.
b) SWL.
c) ureteroscopy.
d) laparoscopic ureterolithotomy.

14. Which of the following is an indication for transurethral resection of the

prostate (TURP)?
a) High pressure chronic retention
b) First-line treatment for poor flow and incomplete emptying
c) Recurrent blocked catheters
d) prostate size more than 80 g
e) Urgency and frequency

15. Vesical calculus disease is usually associated with what condition ?

a) Foreign bodies
b) Urinary tract infections
c) Catheterization
d) Bladder outlet obstruction

16. The investigation of choice to define function in an obstructed kidney is

a) Intravenous urography (IVU)
b) Ultrasound
c) CT urography
d) DMSA
e) MAG3
17. Carcinoma of the bladder:
a) Is primarily of squamous cell origin.
b) Is preferentially treated by radiation.
c) May be treated conservatively by use of intravesical agents even if it invades
the bladder muscle.
d) May mimic an acute UTI with irritability and hematuria.
e) Is preferentially treated by partial cystectomy.

18. The most common histologic bladder cancer cell type is:
a) squamous.
b) adeno.
c) transitional.
d) small cell.

19. Where does benign prostatic hyperplasia (BPH) originate?

a) transition zone.
b) peripheral zone.
c) periurethral glands.
d) transition zone and periurethral zone.

20. Serum prostate-specific antigen (PSA) levels are specific for the presence of
prostate:
a) disease.
b) cancer.
c) inflammation.
d) none of the choices

21. Which adrenoreceptor subtype mediates prostatic smooth muscle contraction?

a) alpha1
b) Beta 2
c) alpha2
d) Beta 1

22. the most suitable investigation/ management of A 25-year-old man presents with
slowing of his urinary flow and terminal urethral dribbling. He has a past history
of a treated sexually transmitted disease.
a) cystoscopy
b) ultrasound of kidneys and bladder residual
c) video urodynamics
d) MAG3 scan
e) urethrogram

23. Which of the following is an absolute contra-indication for performing

endoscopic procedures in the upper urinary tract?
a) Active urinary tract infection
b) Prostatic hypertrophy
c) Pregnancy
d) Anticoagulant therapy

24. Which of the below is important in bladder tumor staging?

a) TUR with muscular layer in the specimen
b) The presence of pericystic fat in the specimen
c) Cauterization of the base of the tumor
d) TUR with bladder neck biopsy.

25. Strong predictors of acute urinary retention (AUR) include:

a) A raised urea
b) A raised International Prostate Symptom Score (IPSS)
c) A 20 g prostate
d) Qmax >15 mL/s
e) Age <50 years

26. The most suitable investigation/ management of A 40-year-old woman who has had
two previous colposuspensions for urinary incontinence now complains of mixed urge
and stress leakage
a) cystoscopy
b) ultrasound of kidneys and bladder residual
c) urodynamic study
d) MAG3 scan
e) urethrogram

27. The most suitable investigation/ management of An 80-year-old man presents to

the urology clinic with poor flow, frequency and nocturia. He is noted to have an
elevated creatinine
a) cystoscopy
b) ultrasound of kidneys and bladder residual
c) video urodynamics
d) MAG3 scan
e) urethrogram

28. The most suitable investigation/ management A 75-year-old woman presents with
recent onset of severe urinary urgency and bladder pain. Urinary dipstick shows no
nitrates, protein 1+ and RBCS MANY.
a) cystoscopy
b) ultrasound of kidneys and bladder residual
c) video urodynamics
d) MAG3 scan
e) urethrogram

29. Which of the following is not assessed on the IPSS questionaire?

a) Incomplete emptying
b) Frequency
c) Quality of life
d) Incontinence
e) Straining

30. The most likely cause for bladder outlet obstruction in A 35-year-old man
complains of difficulty passing urine. He has a history of multiple hospital
admissions as a child for recurrent urine infections. mcug showed bilateral vesico-
ureteric reflux and high post void residue.
a) urethral stricture
b) prostate cancer
c) benign prostatic hypertrophy
d) bladder stones
e) bladder tumor

31. The most likely cause for bladder outlet obstruction in An 84-year-old man
complains of difficulty passing urine, nocturia, hesitancy and terminal dribbling.
His PSA is normal for his age
a) urethral stricture
b) prostate cancer
c) benign prostatic hypertrophy
d) bladder stones
e) blood clot

32. The most likely cause for bladder outlet obstruction in A 63-year-old man 1
week post-TURP underwent a successful trial without catheter 2 days ago and was
discharged. He reattends in severe discomfort, being no longer able to pass urine.
a) urethral stricture
b) prostate cancer
c) benign prostatic hypertrophy
d) bladder stones
e) blood clot

33. Ureteral obstruction:

a) Is associated with hematuria.
b) Is associated with deterioration of renal function and rising blood urea
nitrogen (BUN) and creatinine values.
c) Is commonly caused by a urinary tract calculus.
d) Usually requires open surgical relief of the obstruction.
e) Is usually associated with infection behind the obstruction.

34. Patients who have undergone operations for benign prostatic hypertrophy or
hyperplasia:
a) Require routine rectal examinations to detect the development of carcinoma of
the prostate.
b) Do not need routine prostate examinations.
c) Have a lesser incidence of carcinoma of the prostate.
d) Have a greater incidence of carcinoma of the prostate.

35. Grade of VUR with a slightly tortuous ureter, with moderate dilatation of
pelvis and blunting of calyces
a) Grade 1
b) Grade II
c) Grade III
d) Grade IV
e) Grade V

36. Which of the following statement(s) IS FALSE concerning the detection and
diagnosis of prostatic cancer?
a) An elevation of prostate specific antigen (PSA) above 100 is highly sensitive
and specific for prostatic carcinoma
b) American blacks have an increased risk of prostatic carcinoma
c) Autopsy series would suggest that 10% of men in their 50�s will have small
latent prostatic cancers
d) Transrectal prostatic biopsy is indicated for a palpable 1 cm prostate nodule
e) Serum prostatic acid phosphatase remains the most useful tumor marker for
prostatic carcinoma

37. A 65-year-old male is diagnosed as having prostatic cancer based on transrectal

biopsy of a 1 cm palpable nodule. Which of the following statement(s) is false
concerning his management?
a) If the tumor is confined within the prostatic capsule (stage A or B), radical
prostatectomy is an appropriate option
b) If positive lymph nodes are detected on laparoscopic pelvic lymph node
dissection (stage Dl), radical prostatectomy is indicated
c) Radical prostatectomy is invariably associated with impotence
d) External beam radiation is an appropriate treatment if the tumor is confined to
the prostate
e) There is currently no role for orchiectomy in the management of prostatic cancer

38. A 28-year-old white male presents with asymptomatic testicular enlargement.

Which of the following statement(s) is TRUE concerning his diagnosis and
management?
a) Tumor markers, b-fetoprotein (AFP) and human chorionic gonadotropin (HCG) will
both be of value
b) Orchiectomy should be performed via scrotal approach
c) The diagnosis of seminoma should be followed by postoperative radiation therapy
d) With current adjuvant chemotherapy regimens, retroperitoneal lymphadenectomy is
indicted in most of cases

39. The most likely cause of A 52-year-old man presents with a testicular swelling
that has increased in size gradually over a period of years. On examination the
swelling transilluminates and the testis cannot be felt separate from the swelling.
a) varicocoele
b) hydrocoele
c) testicular cancer
d) acute epididymo-orchitis
e) testicular torsion

40. The most likely cause of A 40-year-old man complains of severe pain and
swelling over the last 48 hours in his right scrotum. Testis and epididymis are
very tender. He reports that he has had unprotected intercourse recently.
a) varicocoele
b) hydrocoele
c) testicular cancer
d) acute epididymo-orchitis
e) testicular torsion

41. The most likely cause of A 20-year-old man with a history of undescended testes
presents with a hard painless testicular lump.
a) varicocoele
b) hydrocoele
c) testicular cancer
d) acute epididymo-orchitis
e) acute epididymo-orchitis

42. The most likely cause of A 19-year-old boy wakes at night crying from severe
pain in the testis associated with vomiting.
a) varicocoele
b) hydrocoele
c) testicular cancer
d) acute epididymo-orchitis
e) testicular torsion

43. Stress urinary incontinence:

a) Is principally a disease of young females.
b) Occurs only in males.
c) Is associated with urinary frequency and urgency.
d) May be corrected by surgically increasing the volume of the bladder.
e) Is a disease of aging , obesity and multiparty

44. A 74-year-old man with urinary frequency and urgency has benign prostatic
hypertrophy. He refuses operative intervention but agrees to a trial of finasteride
therapy. During the trial, synthesis of which of the following substances is most
likely to be inhibited?
a) Androstenedione
b) Dihydrotestosterone
c) Estradiol
d) Estrone
e) Testosterone

45. The most common cause of groin pain

a) Renal calculus
b) Pyelonephritis
c) Ureteric calculus
d) Renal cell carcinoma
e) Prostatism

46. Treatment of bacterial prostatitis

a) Cystoscopy
b) Ciprofloxacin and azithromycin orally once
c) Trimethoprim/sulfamethoxazole for one week
d) Renal ultrasound
e) Ciprofloxacin for 4 to 6 weeks

47. The appropriate surgical treatment for suspected carcinoma of the testis is:
a) Transscrotal percutaneous biopsy.
b) Transscrotal open biopsy.
c) Repeated examinations.
d) trans inguinal radical orchiectomy .

48. von hippel-lindau syndrome is associated with

a) Bladder cancer
b) Prostate cancer
c) Renal tumors
d) Testicular tumors

49. Ureteric buds arise from

a) Mesoderm
b) Ectoderm
c) Endoderm
d) Mullerian duct
e) Mesonephric duct

50. Submucosal tunnel to ureter diameter ratio appropriate to prevent VUR is

a) 1-2
b) 1-3
c) 1-4
d) 1-5

----------Key----------

1. (a)
2. (d)
3. (d)
4. (c)
5. (a)
6. (c)
7. (c)
8. (d)
9. (d)
10. (d)
11. (a)
12. (b)
13. (c)
14. (a)
15. (d)
16. (e)
17. (d)
18. (c)
19. (d)
20. (d)
21. (a)
22. (e)
23. (a)
24. (a)
25. (b)
26. (c)
27. (b)
28. (a)
29. (a)
30. (a)
31. (c)
32. (e)
33. (c)
34. (a)
35. (d)
36. (e)
37. (b)
38. (a)
39. (b)
40. (d)
41. (c)
42. (e)
43. (e)
44. (b)
45. (e)
46. (e)
47. (d)
48. (c)
49. (e)
50. (d)