Renal & Bladder Trauma

1) The kidney is well protected against trauma by:

A. Heavy lumbar muscles
B. Vertebral bodies
C. Ribs, and the viscera anteriorly
D. All of the above

2) Regarding hematuria in renal trauma which is

correct:
A. It correlate with the degree of injury
B. Renal injuries can occur without haematuria
C. Sensitive and specific

3) The gold standard for diagnosing stable patients

with renal
trauma is:
A. KUB x ray
B. IVP
C. MRI
D. Contrast CT KUB
D

4) Conservative management can be applied in:

A. Grade III renal injuries with hemodybamic
instability
B. Grade IV renal injuries with hemodybamic
stability
C. Suspected renal pedicle avulsion
D. Ureteropelvic junction disruption.
B

5) In renal exploration due to renal trauma , in

case of major
renovascular injuries, you should do:
A. angioembolisation
B. speedy nephrectomy
C. renorrhaphy
D. vascular stent insertion

6) The standard modality in diagnosing bladder

injuries is :
A. ascending cystogram
B. US
C. IVP
D. MRI

7) Surgical exploration is indicated in bladder

injuries in the
following conditions except:
A. Extraperitoneal bladder rupture with Bladder
neck
involvement
B. Intraperitoneal bladder Injuries with
hemodynamic
stability
C. Extraperitoneal bladder rupture with Bone
fragments in
the bladder wall
D. Bladder contusion

8) Contusion or bruising of the renal parenchyma

is considered
as …………. renal trauma
A. Grade 1
B. Grade 2
C. Grade 3
D. Grade 4

9) Grade 2 renal trauma in a surgically stable

patient is best
managed :
A. Conservatively
B. Exploration
C. Nephrectomy
D. Renal repair

10) Indication of nephrectomy in renal trauma

includes :
A. Grade 1or 2 renal traumas in a stable patient
B. Grade 3 renal trauma in a stable patient
C. Extensive renal, vascular injuries beyond repair
D. Grade 2 renal trauma

11) Intraperitoneal bladder Injuries should be

managed :
A. Conservatively
B. By catheter insertion
C. Surgical exploration
D. medical treatment

12) Which of the following is an absolute indication

for exploration in renal trauma:
A. renal pedicle avlusion
B. hemodynmically stability
C. non expanding hematoma
D. non pulsatile hematoma

13) Renal trauma grade 1 in stable patient is

managed by:
A. Conservatively
B. Exploration
C. Nephrectomy
D. Renal repair

14) In case of non-expanding hematoma of kidney

in stable patient, the best management is:
A. Conservatively
B. Exploration
C. Nephrectomy
D. Renal repair

15) In case of renal trauma grade 1, surgical

unstable, the best mangment is:
A. Conservatively
B. Exploration
C. Nephrectomy
D. Medical treatment

B
16) Iatrogenic cause of renal trauma:
A. PCNL
B. Ureteroscopy
C. ESWL
D. All of the above

17) Renal trauma cause parenchymal laceration of

the renal cortex <1 cm is:
A. grade 1
B. grade 2
C. grade 3
D. grade 4

18) In bladder trauma with extraperitoneal bladder

wall lacerations <2 cm, it is ........
A. grade 1
B. grade 2
C. grade 3
D. grade 4

B
19) Finding may be found during examination after
renal trauma:
A. Outlet or Inlet of the projectile at loin
B. Ectopic kidney
C. Necroturia
D. Hematochezia

A
20) Hematurea is an indicator for severe renal
injury in cases of renal trauma
A. Yes
B. No

21) Regarding urethral rupture:

A. Can be due to urethral catheterization
B. More common in women
C. Pelvic fracture causes rupture of anterior
urethra
D. Catheterization is the 1st line of management

(A)

22) Injury of the ureter is least likely to occur

during one of the following operations:
A. Abdomino-perineal resection of rectal cancer
B. Small intestinal resection
C. Total hysterectomy
D. Left hemicolectomy

B
23) Majority of renal trauma can be managed
conservatively:
A. Yes
B. No

24) Complications of rupture kidney include:

A. Shock.
B. Renal failure if solitary kidney.
C. A-V fistula.
D. Pseudohydronephrosis.
E. All of the above.

(E)

25) Renal injury:

A. Is usually common due to the strong rib cage
and strong back muscles.
B. Penetrating injury is more common than blunt
injury.
C. Absence of haematuria doesn't rule out renal
injury.
D. IVP is the investigation of choice for staging of
injury.
E. Staging usually depends on surgical exploratory
laparotomy.

(C)

26) About rupture urethra:

A. Common in prostatic urethra.
B. Causes bleeding per rectum.
C. Fracture of pubic ram causes rupture
membranous urethra.
D. The 1st step of treatment is usually urethral
catheterization.
(C)

27) Bladder injuries:

A. May be intraperitoneal or extraperitoneal.
B. Associated with fracture pelvis.
C. Ascending cystourethrography with
extravasation of dye outside the bladder.
D. All of the above.
E. None of the above.
(D)

28) Arrangement of the structures in the renal

sinus from anterior to posterior are:
A. Renal pelvis, renal vein & renal artery
B. Renal vein, renal pelvis & renal artery
C. Renal vein, renal artery & renal pelvis
D. Renal artery, renal vein & renal pelvis

29) In intraperitoneal rupture of the bladder, it is

untrue that it:
A. Occurs only when the bladder is overdistended.
B. May be due to external trauma or intravesical
instrumentation.
C. Is particularly common in females.
D. May cause peritonitis with shifting dullness.
E. Requires immediate laparotomy.

(C)

30) The incorrect statement about extraperitoneal

rupture of the bladder is that it:
A. Ts almost always a complication of fracture
pelvis.
B Causes extravasation in the perivesical space
and anterior abdominal wall.
C. Causes suprapubic pain with an intense desire
to micturate.
D. Produces a rapidly increasing tender swelling
above the pubis.
E. Can be differentiated from intrapelvic rupture of
the urethra by catheterization.

31) In extra pelvic rupture of the urethra, the

following statements are true EXCEPT that it:
A. Usually affects the bulbous portion
B. Causes bleeding from the meatus.
C. Results in retention of urine.
D. Produces no external signs.
E. May be partial or complete.

(D)

32) The following statements about intrapelvic

rupture of the urethra are correct EXCEPT that it:
A. Always involves the membranous urethra
B. May be a complication of pelvic fractures
C. Is usually associated with rupture of the
puboprostatic ligaments
D. Causes urethral bleeding with inability to
micturate.
E. Produces no rectal signs.

(E)

33) Following a fall, a young male felt sharp pain in

the perineum with bleeding from the meatus and
inability to pass urine. Examination revealed a
distended bladder and a perineal haematoma. The
diagnosis proved to be:
A. Intrapelvic rupture of urethra.
B. Extra pelvic rupture of urethra
C. Perineal haematoma.
D. Intraperitoneal rupture of bladder.
E. Extraperitoneal rupture of bladder.

(B)

34) The best method to diagnose renal trauma in a

shocked patient who is not allergic to IV contrast
is:
A. Plain UT
B. IVU
C. Ultrasonography
D. DMSA scan

(C)

35) A 28-year-old male fell from the bicycle chair

on the bicycle bar. On examination there was a
perineal hematoma and a few drops of blood was
present on the anterior meatus. The best
management is:
A. Ask the patient to void
B. Insert a silicone urethral catheter
C. Perform a micturating urethrogram
D. Suprapubic cystostomy may be required

(D)

36) A 31-year-old male was brought by an

ambulance following a road traffic accident
complaining of right loin pain. A Foley catheter
revealed reddish urine, and the vital signs
remained stable. CT abdomen with contrast
revealed renal parenchymal laceration with No
urinary extravasation. No other abnormalities were
present. The best management would be:
A. Nephrectomy
b. Hospitalization with bed rest
C. Laparotomy and suture of lacerations.
D. Angiographic embolization.
(B)

37) A patient came to you following trauma to the

perineum by a stick. On examination there was
blood coming out of the anterior meatus. The best
management is:
A. Ask the patient to try to void
B. Suprapubic cystostomy
C. Pass a Foley's catheter.
D. Tobramycin (An aminoglycoside)

(A)

38) Which of the following is/are true of blunt renal

trauma?
A. Blunt renal trauma and penetrating renal
injuries are managed similarly
B. Blunt renal trauma with urinary extravasation
always requires surgical exploration.
C. Blunt renal trauma must be evaluated by
contrast studies using either IVP or CT
D. Blunt renal trauma requires exploration only
when the patient exhibits hemodynamic instability
E.Any kidney fractured by blunt renal trauma must
be explored.

(D)

39) A 32-year-old male came to the ER with

fracture pelvis, he complains of desire to
micturate. On examination, there was suprapubic
dullness and a few drops of blood were present at
the external meatus. Ultrasound revealed a full
bladder. The first thing to do:
A. Pass a urinary catheter
B. Endoscopic visual urethrotomy
C. Suprapubic cystostomy
D. Surgical exploration to fix the fracture

(C)

40) A 40-year-old male was admitted to hospital in

severe shock after a road traffic accident.
Abdominal examination revealed tenderness and
rigidity in the left loin and haematuria. He should
be suspected to have sustained:
A. Rupture of the spleen.
B. Rupture of the left kidney.
C. Retroperitoneal haematoma.
D. Extraperitoneal rupture of the bladder.
E. Intrapelvic rupture of the urethra..

(B)