Urology Exams

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Urology Exams

مشاركةبواسطة دكتور كمال سيد » الخميس فبراير 07, 2019 8:14 pm

Viva Practice for the FRCS(Urol) and Postgraduate Urology Examinations

URO E-learning » Multiple-choice questions

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Re: Urology Exams

مشاركةبواسطة دكتور كمال سيد » الخميس فبراير 07, 2019 8:17 pm


1. The most ominous sign or symptom of urinary system disease is :
A. Urinary frequency.
B. Pyuria.
C. Pneumaturia.
D. Dysuria.
E. Hematuria.

Answer E :
While urinary frequency (voiding more than three to five times daily) or dysuria (painful voiding) may be asign of malignant disease, they are more commonly associated with nonmalignant inflammatory disease, neurologic disease,or calculous disease of the urinary tract.
Pyuria (pus in the urine) is most commonly associated with infection and not malignancy.
Pneumaturia (air or gas in the urine) indicates a fistula between bowel and the urinary tract or infection by fermination in diabetic urine
Hematuria (blood in the urine) is most worrisome. While this may be produced by infection or by calculous disease, it is most commonly associated with malignant disease in the absence of associated signs or symptoms such as pyuria, frequency, and dysuria.
Thus, of the ones mentioned, hematuria is the most ominous single sign or symptom.

2. A patient with acute urinary tract infection (UTI) usually presents with :
A. Chills and fever.
B. Flank pain.
C. Nausea and vomiting.
5fiveTo 10 white blood cells per high-power field (hpf) in the uncentrifuged urine specimen.
E. Painful urination.

Answer E :
Cystitis or infection of the bladder is the most common UTI.
Lower UTI, or cystitis, is an infection in the bladder.
Painful urination and frequency are the most common presenting complaints.
Hematuria may occur, but is associated with painful urination and frequency.
Flank pain, fever, chills, nausea, and vomiting usually occur only when the infection involves the kidney.
An acute UTI is identified in unspun urine only when there are more than 10 leukocytes per hpf in the unspun urine.
The normal urine may have as many as 10 WBC/per hpf without being infected.

3. Renal adenocarcinomas:
A. Are of transitional cell origin.
B. Usually are associated with anemia.
C. Are difficult to diagnose.
D. Are extremely radiosensitive.
E. Frequently are signaled by gross hematuria.

Answer: E
Renal adenocarcinomas arise from the renal tubular cells and not from the transitional cells that line the collecting system of the kidney.
Although one fifth of all patients with renal cancer may present with anemia, the most common presenting symptom is hematuria, either gross or microscopic.
Ultrasonography may confirm that a renal lesion is either cystic or solid but computed tomography (CT) is probably the most accurate imaging study for diagnosing the disease.
Renal adenocarcinoma is little sensitive to current chemotherapeutic agents.
Radiotherapy plays almost no role in the management of the primary tumor.
Operation is the treatment of choice when the disease is confined to the kidney itself or when it has extended just outside the renal capsule.
An operation has little effect once the disease is extended to adjacent structures or to regional lymph nodes.

4. 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

Answer: C
Ureteral obstruction produces loss of renal function when there is only one renal unit and the ureter is obstructed or when obstruction is bilateral.
Ureteral obstruction often is best identified by either intravenous pyelography(IVP) or retrograde pyelography, which allows one to identify the specific site of obstruction.
Calculous disease is the mostcommon cause of ureteral obstruction.
Ureteral obstruction is not a surgical emergency that requires open surgical intervention, but it may be relieved by retrograde or antegrade passage of a double-J stent to bypass the obstruction, permitting orderly nonemergent identification of the cause of obstruction and selection of a treatment process.

5. 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 produced by shortening of the urethra.

Answer: E
Stress urinary incontinence is seen principally in older females and is produced by pelvic floor relaxation with shortening of urethral length.
The symptom of stress urinary incontinence is urinary leakage produced by an increase in intra-abdominal pressure, as with straining to lift or to laugh.
Urgency and frequency are symptoms of urge incontinence,not stress incontinence.
Stress incontinence classically is not seen either in males or in young females who have good pelvicfloor support.



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Re: Urology Exams

مشاركةبواسطة دكتور كمال سيد » الخميس فبراير 07, 2019 8:22 pm

6. 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.

Answer: D
Blunt renal trauma should be explored.
Only those who have gross hematuria need undergo contrast studies.
Microscopic hematuria is no longer an indication for contrast evaluation.
Patients who have blunt renal trauma need to undergo exploration only if they are hemodynamically unstable.
Conservative management in the absence of hemodynamic instability is the current trend.
All penetrating injuries should undergo exploration.

7. 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.

Answer: D
Carcinoma of the bladder is primarily of transitional cell origin, arising from the transitional epithelium that lines the bladder. It may be confused with an acute UTI by producing urgency, frequency, and hematuria.
Bladder carcinoma may be treated conservatively using intravesical agents if the tumor is intraepithelial in origin and does not invade through the basement membrane.
Neither radiation nor chemotherapy is the treatment of choice for disease that invades the muscle of the bladder.
Partial cystectomy may be chosen only when the disease is focal and there are no mucosal changes in other parts of the bladder.

8. The major blood supply to the testes comes through the:
A. Hypogastric arteries.
B. Pudendal arteries.
C. External spermatic arteries.
D. Internal spermatic arteries.

Answer: D
Testes arise from portions of the wolffian bodies on the genital ridge close to the kidneys; therefore, the major blood vessels from the testes arises from the aorta just below the renal arteries and are termed the # internal spermatic arteries.
Secondary blood supply to the testes comes from the # artery of the vas deferens, and a small branch from the epigastric artery termed the # external spermatic artery forms during descent of the testes from the abdomen to the scrotum.
The surgical importance of this phenomenon is that operations involving the region of the renal arteries may sacrifice the internal spermatic artery.
If the two other arteries are intact, the testes will survive; however, if the patient has had avasectomy and the artery of the vas has been sacrificed, there is a possibility of testicular atrophy, since the testicle will have to be totally dependent on the arterial supply derived from the small external spermatic artery.

9. 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.

Answer: A
Patients who have undergone operations for benign prostatic hyperplasia or hypertrophy have had only the inner portion of the prostate removed, which consists of the periurethral glandular structures that give rise to hyperplasia and hypertrophy.
The posterior segment of the prostate, which is compressed by the anterior (inner) portion, comprises thesurgical capsule and is left behind. The posterior portion of the prostate gland is the most frequent site of origin of prostate cancer. There is no difference in the incidence of carcinoma of the prostate in patients with benign prostatic hypertrophyand those without benign prostatic hypertrophy or those who have and have not undergone operation for prostatic hypertrophy.
Since prostate carcinoma can develop at any time in a patient's life, routine examinations and prostate-specific antigen assay are the most efficient methods of detecting this disease.

10. The male contribution to a couple's infertility is approximately:
A. 10%.
B. 25%.
C. 50%.
D. 75%.

Answer: C
In the United States of America it has been estimated that approximately 15% of couples have difficulty with conception.
Adequate evaluation of the marital unit for infertility demands assessment of the male partner since infertile status may be attributed to the male as much as 50% of the time.
A full evaluation of the male partner is important to avoid extended fruitless evaluation and management of the female partner when the male is infertile


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Re: Urology Exams

مشاركةبواسطة دكتور كمال سيد » الخميس فبراير 07, 2019 8:27 pm


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Re: Urology Exams

مشاركةبواسطة دكتور كمال سيد » الخميس فبراير 07, 2019 8:38 pm



1. The most severe complications of intracavernosal injections are:

Α. inflammation of the corpora cavernosa

Β. haematoma

C. priapism

D. urethral injury

Ε. penile oedema

2. Intracavernosal injections are more effective, when used in men with:

Α. Diabetes Mellitus

Β. fibrosis of the corpora cavernosa

C. mild vasculopathy

D. hypertension

Ε. neurogenic disorder

3. The action mechanism of prostagladin:

Α. is indirect, blocking α-adrenergic receptors

Β. is direct, inducing relaxation of smooth muscle fibers

(C. inhibits PDE5 (phosphodiesterase type

D. has central effect

Ε. none of the above

4. To treat priapism after the use of intracavernosal injections, the first step is:

Α. intracavernosal administration of a sympathomimetic agent

Β. bloodletting

C. cold packs

D. invasive manipulation

5. The most common adverse event of intracavernosal injections is:

Α. priapism

Β. haematoma

C. oedema

D. drop of blood pressure

Ε. pain

F. allergic reaction

6. : PDE5 inhibitors act by

Α. reducing cGMP degradation

Β. reducing NO composition

C. reducing cGMP intracellular levels

D. increasing free calcium levels

7. A 50-year old hypertensive patient reports that he has tried a PDE5i without result. The next step would be:

Α. replacement with another PDE5i

Β. intracavernosal injections

C. full history taking concerning the route of drug administration and its dosage

D. immediate discontinuation of the anti-hypertensive regimen

8. : The 3 available PDE5 inhibitors

Α. have similar efficacy

Β. have similar pharmacokinetic features

C. have been approved for daily use

D. differ only with regard to the maximum recommended dose

9. : PDE5 inhibitors

Α. should be provided with caution to patients taking nitrates

Β. can be administered independently from food intake

C. must be provided to the maximul tolerated dose before characterizing a patient as "non-responsive" to PDEi

D. is contra-indicated when the patient receives alfuzosin at the same time

10. A 45-year old diabetic patient responding initially to sildenafil for about 3 years, reports that his erection is no
: longer sufficient enough to achieve sexual intercourse. The next step is to

Α. increase the dose on demand up to 200mg

Β. test serum testosterone level

C. check diabetes control

(D. test serum testosterone level, control diabetes and re-administrate sildenafil (100mg

11. What do shock waves cause to corpora cavernosa?

Α. Activation of NO

Β. Activation of Cgmp

C. Proliferation of smooth muscle fibers

D. Neovascularisation of the corpora cavernosa

Ε. None of the above

12. : Shock wave therapy is used in......

Α. Renolithiasis

Β. Chololithiasis

C. Peyronie's disease

D. Myocardial ischaemia

Ε. all the above

13. In a patient who does not respond to PDE5 inhibitors, what do we expect from fhe shock-wave therapy?

Α. Functional restoration

Β. Improvement, but also need for supplementary use of PDE5i for functional erection

C. There is not rellay any clinically significant improvement

D. All the above are equally possible to occur

14. In a patient with moderate insufficiency of the corpora cavernosa, what do we expect from the shock-wave therapy?

Α. Functional restoration

Β. Improvement, but also need for permanent use of PDE5i for functional erection

C. No clinically significant improvement

D. All the above are equally possible to occur


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Re: Urology Exams

مشاركةبواسطة دكتور كمال سيد » الخميس فبراير 07, 2019 8:44 pm


15. A 67-year old hypertensive patient with erectile dysfunction for 5 years, was prescribed with sildenafil 100mg. The patient took tablets at 10 different instances always with empty stomach and at least 1 hour before sexual contact. 5 out of 10 times, his erection was satisfactory with regard to rigidity and duration. Two (2) times his erection was sufficient for penetration, without though satisfactory duration. The other 3 times there was penile tumescence but this was not enough for penetration. This patient is considered:

Α. to respond to sildenafil treatment

Β. not to respond to sildenafil treatment

16. According to a prospective, placebo-controlled, crossover clinical study, the add-on therapy with intracavernosal PGE-1 every 2 weeks in patients with partial response even to the maximum sildenafil dose significantly improves IIEF‐EF score by:

Α. 15%

Β. 65%

C. 25%

D. 30%

17. Choose the correct answer.

Α. Intrapenile injections are highly effective and result in patients' high satisfaction.

Β. Intrapenile injections may achieve high satisfaction but may also lead to withdrawal.

C. Priapism occurs in 20% of patients using intrapenile injections.

D. Fibrosis of the corpora cavernosa occurs more often when there is also papaverine in the mixture.

18. Choose the correct answer.

Α. The infection rate in intrapenile prostheses is 20%.

Β. Prosthesis with antiobiotic prophylaxis is absolutely indicated in diabetic patients.

C. The antibiotic prophylaxis does not prevent the formation of biofilm upon the prosthesis.

19. Choose the correct answer

Α. The prosthesis provides the highest satisfaction rate for the sexual partner.

Β. The prosthesis has a reintervention rate >30% within the first 5 years.

C. Penile prosthesis is contra-indicated in diabetic patients.

20. Which of the following is required in order to have erection achieved?

Α. Sexual arousal

Β. Communication between brain nerves and penile nerves

C. Relaxation of blood vessels supplying the penis

D. All the above

21. All medications mentioned below may cause erectile dysfunction, apart from:

Α. antihypertensives

Β. antifungals

C. tranquillizers

D. anithistamines

22. Which hormonal factor is not required in order to assess erectile dysfunction?


Β. Prolactin


D. Τestosterone

23. Pharmaceutical agents for the treatment of erectile dysfunction act by inhibiting the PDE5 action, which is responsible for:

Α. testosterone degradation

Β. degradation of cyclic-GMP in the penis

C.degradation of NO in the penis

D. None of the above

24. A 50-year hypertensive man visits the Urologist due to erectile dysfunction. He tried a PDE5 inhibitor with no result. The next step should be:

Α. to use another PDE5 inhibitor

Β. to switch to intracavernosal injections

C. to check thoroughly the drug administration route and dosage

D. to discontinue immediately the antihypertensive regimen

25. Which of the factors below contribute to the emergence of erectile dysfunction?

Α. Depression and unemployment

Β. Hypertension and heart diseases

C. Diabetes

D. All the above

26. Which of the conditions below may be related to normal erectile function?

A. Mild arterial insufficiency with normal venous closure mechanism

Β. Severe arterial insufficiency with normal venous closure mechanism

C Normal arterial blow with insufficient venous closure mechanism

D. All the above

27. Which of the below factors play a role in normal erection?

Α. Haemodynamics of the corpora cavernosa

Β. Biomechanical properties of tissues

C. Geometry of the penis

D. All the above

28. Why does the relaxation of a few cavernosous muscle fibres induce erection?

Α. Because the two corpora cavernosa communicate with each other

Β. Because there are gap junctions among smooth muscle fibers

C. Because the drug diffuses

D. None of the above

29. What pO2 values of the penis are required to achieve erection?

Α. <20mmHg

Β. 40-50mmHg

C. 60-70mmHg

D. >80mmHg



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Re: Urology Exams

مشاركةبواسطة دكتور كمال سيد » الخميس فبراير 07, 2019 8:49 pm

urology MCQs & ANSWERES

Correct answers


9 C

17 D

25 D

2 Ε

10 D

18 Β

26 Α

3 Β

11 D

19 Α


4 Β

12 Ε

20 D

28 Β

5 Ε

13 Β

21 Β

29 D

6 Α

14 D

22 Α

7 C

15 Α

23 Β

8 Α

16 Β



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Re: Urology Exams

مشاركةبواسطة دكتور كمال سيد » الخميس فبراير 07, 2019 8:52 pm


Bladder Cancer
1. In 100 male patients visiting the Outpatient Clinic with LUTS and OAB:

Α. 1% are likely to develop bladder cancer

Β. 60% are likely to develop benign prostatic obstruction (BPO)

C.22% are likely to develop benign prostatic obstruction (BPO)

D. A & B are correct

E. A & C are correct

2. How many patients with bladder cancer undergoing secondary re-staging transurethral resection (re-TUR), will be substaged after the re-TUR?

Α. 5%

Β. 13%

C. 25%

D. 40%

3. Which of the following factors plays the least role for survival in muscle-invasive bladder cancer?

Α. Age

Β. Lymphnode metastases

C. The pathoanatomical stage of the disease

D. The ratio infiltrated : removed lymphnodes

4. The best time period for assessing mortality and complications after radical cystectomy is:

Α. 30 days after radical cystectomy

Β. 60 days after radical cystectomy

C. 90 days after radical cystectomy

D. throughout the patient's hospital stay

5. Which of the following complications occurs more often following cystectomy?

Α. Haemorrhage

Β. Urinary tract infection (UTI)

C. Paralytic ileus

D. Surgical wound dehiscence

6. Which of the following is not an exclusion criterion from a bladder-preservation protocol, in a patient with muscle-invasive cancer?

Α. Age>75

Β. Hydronephrosis

C. Multifocal disease

D. CIS (carcinoma in situ)

7. Candidates for partial cystecomy after preoperative chemotherapy ARE NOT the patients with:

Α. CIS (carcinoma in situ)

Β. good bladder capacity

C. solitary tumor

D. full response to chemotherapy

8. Which of the following statements about preoperative chemotherapy in bladder cancer is true?

Α. Response is the most important prognostic factor.

Β. Preoperative chemotherapy is more effective than adjuvant chemotherapy.

C. Preoperative chemotherapy can be used in patients with lymphnode or visceral disease.

D. Preoperative chemotherapy should be used in all patients.

9. Tri-modality therapy for bladder preservation includes:

Α. Radiotherapy - Chemotherapy - Cystectomy

Β. Chemotherapy – TUR – Radiotherapy

Γ. TUR – Radiotherapy – Chemotherapy

Δ. Chemotherapy - Cystectomy - Radiotherapy

10. Following Tri-modality therapy, the bladder is preserved by:

Α. 20%

Β. 50%

Γ. 5%

Δ. 80%

11. Restaging TUR (re-TUR) is recommended:

Α. when no muscle layer has been obtained

Β. when there is no residual tumor

C. in every T1G3 patient

D. in all the above cases

12. A secondary re-staging TUR inT1G3:

Α. reduces the relapse rate

Β. improves response to the adjuvant intravesical BCG therapy

C. Α & Β

D. has no benefit

13.The most effective adjuvant intravesical BCG therapy in patients with T1G3 tumor ........

Α. starts on the 3rd postoperative day, with only one single 12-week continuous infusion therapeutic cycle

Β. consists of only one single 6-week continuous infusion therapeutic cycle

C. consists of one single 6-week infusion therapeutic cycle, followed by a maintenance scheme of one infusion/time during the follow-up period

D.consists of an initial 6-week infusion therapeutic cycle, followed by a maintenance scheme of three weekly infusions/time during follow-up

14. When can immediate cystectomy be recommended In T1G3 patients?

Α. In every case of such a tumor

Β. When there are 3 major risk factors

C. When the tumor is localized on the dome of the bladder

D. Never



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Re: Urology Exams

مشاركةبواسطة دكتور كمال سيد » الخميس فبراير 07, 2019 8:56 pm


15. The use of photodynamic diagnosis in muscle-invasive bladder cancer reduces:

Α. the progression rate of the disease

Β. the relapse rate ≥20%

C. the relapse rate < 10%

D. none of the above

16. How many EORTC risk factors are needed in order to classify patients with non-muscle invasive (Ta, T1) bladder tumor as low-moderate-high risk for relapse or progression of the disease?

Α. 4

Β. 5

C. 6

D. 7

17. Which of the following statements is FALSE?

Α. Immediate postoperative intravesical infusion of cytotoxic agents benefits all patients.

Β. Mitomycin‐C causes fewer complications than Farmorubicin when infused immediately postoperatively.

C. The small extraperitoneal bladder rupture is not a contraindication for intravesical infusion after 24 hours.

D. Α & C

Ε. All the above

18. Which of the following statements is FALSE?

Α. A second BCG cycle in a Τ1G3 tumor does not offer any benefit.

Β. A third BCG cycle in a Τ1G3 tumor is more effective than the second cycle.

C. A second BCG cycle in a Τ1G3 tumor is a good alternative option to cystectomy at relapse Τα/cis

D. A second BCG cycle in a Τ1G3 tumor is a good alternative option to cystectomy at relapse Τ1G3.

19. Which of the following statements is FALSE?

Conservative treatment for a Τ1G3 tumor is a bad idea:

Α. in a patient with the first Τ1G3 relapse within 3-6 months

Β. in a patient with residual tumor Τ1 at re‐TUR

C. in a young patient with a tumor >3cm in size

D. in all the above cases

20. Which of the following statements is TRUE?

Α. Τ1G3 tumors are rare.

Β. Τ1G3 tumors have a relapse rate of up to 80%.

C. Τ1G3 tumors have a relapse rate of 0%.

D. Τ1G3 tumors have a mortality rate of 0%.

21. Which of the below play/s a role in bladder tumor staging?

Α. The technique of transurethral resection with muscular layer in the specimen

Β. The presence of pericystic fat in the specimen

C. Cauterization of the base of the tumor

D. All the above

22. Re-staging TURB (re –TURB):

A. is performed 1 week after the first transurethral resection.

Β. does not offer more diagnostic information.

C. reduces relapse rate.

D. is always performed in combination with intravesical administration of Gemcitabine.

23. The first laparoscopic cystectomy was performed in:

Α. 1991

Β. 1992

C. 2000

D. 2001

24. Which of the following is TRUE with regard to the value of intravesical infusion of cytotoxic agents immediately after the transurethral resection (TUR) of a non-invasive tumor ?

A. It reduces the relative relapse risk by 40%.

B. It is beneficial both in solitary and multiple tumors.

C. The greatest benefit occurs when the infusion takes place within 24 hours after TUR.

D. There are no differences between drugs, with regard to efficacy.

E. All the above

25. Which of the following answers is FALSE?

The use of stapling devices in cystectomy seems to:

A. significantly reduce blood loss in the hands of experienced surgeons

B. significantly reduce the duration of cystectomy in the hands of experienced surgeons

C. significantly help non-experienced Urologists by limiting blood loss during cystectomy

D. helps non-experienced Urologists by reducing the time needed for bladder removal

26. How likely is it for a Τ1G3 bladder tumor that has relapsed within the first trimester after intravesical BCG infusions to invade the muscular wall?

A. < 10%

B. 20%

C. 30-50%

D. >80%

27. The best treatment for bladder adenocarcinoma is:

A. Radiotherapy

B. Cystectomy

C. Chemotherapy

D. TUR + intravesical BCG infusions



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Re: Urology Exams

مشاركةبواسطة دكتور كمال سيد » الخميس فبراير 07, 2019 8:58 pm


Correct answers

1 Ε

9 C

17 D

25 Β

2 Β

10 Β

18 C

26 D

3 Α

11 D

19 D

27 Β

4 C

12 C

20 Β


13 D

21 Α

6 Α

14 Β

22 C

7 Α

15 Β

23 Β

16 C

24 Ε




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