Urology 2024 Leaked Variants.docx

**[MCQs:]** **[Paper 1:]** **1. What are the first and second most common zones from where prostate cancer arise?** a\) central then transitional b\) peripheral then transitional c\) peripheral then central d\) transitional then central e\) central then peripheral **2. Enuresis nocturnal can...

**[MCQs:]** **[Paper 1:]** **1. What are the first and second most common zones from where prostate cancer arise?** a\) central then transitional b\) peripheral then transitional c\) peripheral then central d\) transitional then central e\) central then peripheral **2. Enuresis nocturnal can have:** a\) normal up to 5-6 years of age b\) in neurological diseases (spina bifida etc.) c\) emotional liability d\) congenital diseases of the excretory system e\) carcinoma of the prostate **3. Treatment of urinary incontinence:** a\) Kegel exercises **4. The most important risk factor for prostate cancer is:** a\) race b\) age c\) high BMI d\) genetic predisposition e\) concomitant benign prostate hyperplasia **5. The most common type according to the chemical composition of stone is:** a\) calcium phosphate b\) calcium oxalate c\) urinary acid d\) magnesium ammonium phosphate e\) cystine **6. TUR syndrome is due to:** a\) hyponatremia b\) hypernatremia c\) hypervolemia d\) hypocalcemia e\) hyperkalemia **7. The normal frequency of urination for an adult in 1 day is:** a\) 4-6 b\) 6-8 c\) 6-9 d\) 5-8 e\) 5-9 **8. A recurrent urinary tract infection is defined as:** a\) twice in 6 months or 3 times in 1 year b\) recurrence of uroinfection in a period of 2 weeks with the same pathogen c\) urinary tract infection more than 4 weeks after a previous infection with another d\) each successive episode of uroinfection e\) untreated infection **9. From which part of the epididymis does the vas deferens being?** a\) body b\) head c\) tail d\) rete testis e\) vas aberration **10. A potentially malignant cyst graded as Bosniak III grade is:** a\) 0% b\) 10% c\) 25% d\) 50% e\) 90% **11. Define oligozoospermia:** a\) less than 15 million sperm per ml b\) less than 40 million sperm for ejaculate c\) less than 20 million sperm per ml d\) less than 60 million sperm per ml e\) less than 60 million sperm for ejaculate **12. What is the last stage in the embryonic development in the urinary system:** a\) pronephros b\) metanephros c\) mesonephros **[Open questions:]** 1. **List the penile anomalies** 2. **Risk factors of bladder carcinoma** **[Case 1: ]** A 44-year old woman presents with a 3-year history of worsening urinary incontinence. She wears 3 pads daily. What is the definition of urinary incontinence? **What are the subtypes of urinary incontinence? How can we diagnose this patient?** **What can give as treatment?** **[Case 2:]** A 40-year old man presents with a dysuria, E.coli as a causative agent, gas within kidney parenchyma and a history of diabetes mellitus. The diagnosis is made by CT. **What are the types of pyelonephritis?** **What is seen in each stage in terms of clinical presentation? What is your diagnosis?** **[Paper 2:]** **1. Papillary bladder carcinoma - WHO CLASSIFICATION** **2. PRECANCEROUS LESIONS FOR PENILE CANCER** **6. Prenatal ultrasound for which congenital anomalies** **7. Obesity and hypertension for which cancer** **8. Cryptorchidism is RF for what - testicular torsion, inguinal hernia, testicular cancer etc** **9. Kidney trauma - etc** ⁠ ⁠it's relatively common compared to all injuries ⁠ ⁠Main causes of is iatrogenic ⁠ ⁠Urethral gold standard diagnosis **10. Nephrostomy** **11. Urolithiasis inhibitors factors** **12. Most common metastasis for prostate/liver** **13. Which marker is used for non-seminoma test cancer?** **14. What classification is classified for 1cm perforation in kidney? Roman numeral I-V** **[Open questions:]** 1. **Kidney trauma treatment and principles** - Conservative: bed rest, monitoring of vital signs, Abs, analgesics, NSAIDs - Surgical: evacuation of haematoma, renal parenchyma suture, partial nephrectomy, renal vessel suture or plastic reconstruction 2. **⁠Alpha blockers - selective and non-selective and mechanism of action** - They act on the prostate and bladder neck through alpha receptors, causing smooth muscle relaxation and stream enhancement - Non-selective Doxazosin, Terazosin (headache, orthostatic HT) - Selective Tamsulosin, Alfuzosin (retrograde ejaculation, orthostatic HT) **[Case 1: ]** *You are called to see a 10-year old boy, acute right scrotal pain, nausea & vomiting, hemodynamically stable, mildly erythematous swollen right scrotum, pain. When the patient allows examination, you are able to get above the swelling but when examining the testis the patient cries. The testis is mildly swollen & lying in a horizontal position.* **What is the most likely diagnosis?** **What test would you carry out to confirm this diagnosis?** **What is the pathological basis of this disorder?** **What might happen next to this boy if he is not treated?** **[Case 2:]** A patient with penile swelling, painful, haemorrhagic mucous suffusion. **What is the most likely diagnosis?** **What could be differential diagnosis?** **What is the cause and risk factors?** **What would be the treatment?** **[Paper 3:]** **1. Which cancer has the best prognosis (ans = seminoma)** **2. Bladder carcinoma diagnosis** **5. Through prenatal US examination can detect the following anomalies:** a\) renal agenesis b\) double ureter c\) bifurcated ureter d\) bladder agenesis e\) hypospadias **6. Complete fusion of the parenchyma of both kidneys is defined as:** a\) dystopic kidney b\) horseshoe kidney c\) breaded kidney d\) cystic degeneration of the kidney e\) nephroptosis **7. What are the three characteristics of prune-belly syndrome:** a\) partial or complete absence of abdominal muscles b\) bilateral cryptorchidism c\) malformation of the urinary tract d\) testicular torsion e\) varicocele **8. Stauffer syndrome in renal cell carcinoma is characterised by:** a\) increased blood pressure b\) erythrocytosis c\) liver dysfunction **9. What are the inhibitors of stone formation:** a\) citrate b\) magnesium c\) pyrophosphate d\) low urine volume e\) vitamin D **10. Urinary catheters are lubricated prior to insertion to limit which of the following:** a\) risk of infection b\) bladder spasms c\) trauma to urethra d\) encrustations e\) all of the above **11. What other abnormalities of the excretory system occur in Wilms tumor?** a\) bladder exstrophy b\) cryptorchidism c\) horseshoe kidney d\) renal hyperplasia e\) megaureters **12. In patients with anuria (acute renal failure), the most dangerous is change in:** a\) potassium b\) calcium c\) phosphates d\) chlorides e\) creatinine **13. A risk factor for non-ischemic priapism is:** a\) haematological disease b\) injury to the perineum and penis c\) 5-PDE inhibitors d\) alpha-blockers e\) antipsychotics **14. Which hormones during intrauterine development play a role in forming the fetus in:** a\) dihydrotestosterone b\) testosterone c\) mullerian-inhibiting substance d\) 5-alpha reductase e\) all of the above **[Open questions:]** 1. **Boaris plastic** - For lesions \>2cm in the middle 3^rd^ of the ureter = bladder wall flap (Boari) 2. **Klinefelter hormone levels** - Elevated LH and FS, decreased testosterone 3. **Subvesical obstruction** - Due to bladder neck sclerosis, posterior urethral valves (membranous formation) 4. **How does prostate cancer spread** - Lymphatic: pelvic lymph nodes - Hematogenous: flat bones of pelvis and vertebra 5. **Treatment for erectile dysfunction, tests to use** - Step 1 (pharmacotherapy) = 5-phosphodiesterase inhibitors (Sildenafil) - Step 2 (intraurethral administration) of alprostadil (prostaglandin E2) - Step 3 (penile prostheses) **[Case 1:]** Erectile dysfunction **[Case 2:]** Prostate carcinoma **[Case 2:]** Acute kidney injury  **[Paper 4:]** **[Open questions:]** 1. **Tumor markers for cancer** - PSA, PCA-3, alpha-feta protein, h-bcg, LDH 2. **What causes ureteral injury and what's the diagnosis** - Blunt trauma: fall, road accident, blow to perineum, fracture of penis - Penetrating trauma: gunshot and stab wounds, animal bites, amputation of penis 3. **Renal cell carcinoma** - adenocarcinoma of renal cortex originating from proximal convoluted tubules 4. **Cystitis (collection of sterile urine), acute and chronic cystitis treatment** - Cleaning with antiseptic solution e.g. iodasept - Acute cystitis Tx = trimethoprim/sulfamethoxazole, nitrofurantoin, fosfomycin - Chronic cystitis Tx = alkalisation of urine, immunoprophylaxis (uro-vaxom caps) **[Case 1:]** Woman with uti what microorganisms cause it, what antibiotics to use, what to advise the patient to do in the future, how to take the sample of urine? **[Case 2:]** Man with previous history of kidney stones, haematuria and enlarged lymph nodes. Diagnosis, differential diagnosis, other methods of investigation and treatment? **[Case 3:]** Bilateral \_\_\_\_\_ 2 years ago last 6 months pain in lumbar region. No urine for 2 days , absent on ultrasound. What is diagnosis and mechanism? **[Paper 5:]** **1. Which conditions are included in acute scrotum:** a\) acute epididymitis b\) varicocele c\) fournier's gangrene d\) testicular torsion e\) priapism **2. Normal values for the specific gravity of morning urine:** a\) 1.001-1.010 b\) 1.005-1.015 c\) 1.015-1.025 d\) 1.020-1.030 e\) 1.001-1.030 **3. Bladder biopsy is usually performed:** a\) transrectally under ultrasound control b\) transperineal under ultrasound control c\) through a cystoscope d\) through suprapubic access e\) not performed due to risk of bladder perforation **4. Which of the congenital disorders usually doesn't need treatment:** a\) cryptorchidism b\) horseshoe kidney c\) retractable testis d\) ectopic testis e\) penoscrotal hypospadias **5. Medications that indirectly form stones are:** a\) indinavir b\) triamterene c\) corticosteroids d\) drugs with e\) vitamin D **14. ?** a\) unilateral is combined with many congenital anomalies and has a p... b\) bilateral after birth is an incompatible condition c\) termination of pregnancy is recommended in case of unilateral agenesis... prenatally... d\) termination of pregnancy is recommended in case of bilateral agenesis... prenatally... e\) it is combined with a horseshoe-shaped kidney **15. Cowper's glands:** a\) they are located in the transition zone of the prostate near the neck... b\) they are part of the seminal vesicles c\) they are located in the urogenital diaphragm d\) can be examined with bidigital palpation e\) produce more than 50% of the volume of ejaculate **16. In young men, the most common causes of inflammatory diseases of the...** a\) proteus b\) pseudomonas c\) C. trachomatous d\) N. gonorrhoeae e\) E.coli **17. Which of the following are risk factors for cryptorchidism?** a\) premature birth b\) low birth weight c\) varicocele d\) horseshoe kidney e\) epispadias **18. Ectopic ureter is:** a\) ureteral osteum is outside the trigone of the bladder b\) the ureter passes behind a blood vessel -- vena cava or iliac vein c\) the ureter is double d\) the ureter is bifurcated e\) the ureter is dilated and atonic **19. Up to what age is enuresis considered a physiological condition:** a\) 1 year b\) 2 years c\) 3 years d\) 4 years e\) 5 years **22. Which of the following are zones of the prostate?** b\) peripheral c\) transitional d\) central e\) fibro-muscular **23. Which embryonic structure is the final stage in the development of the kidney:** a\) pronephros b\) internephros c\) mesonephros d\) alantois e\) metanephros **24. Which of the following are forms of homolateral dystopia:** a\) abdominal b\) pelvis c\) iliac d\) lumbar e\) thoracic **25. As recurrent uroinfection is defined as:** a\) infection within 2 weeks with the same pathogen b\) urinary tract infection more than 4 weeks after a previous infection c\) infection twice in 6 months or four times in 1 year d\) infection twice in 6 months or three times in 1 year e\) treatment-resistant infection with positive cultures immediately **26. Non-selective alpha-blockers are:** a\) Tamsulosin b\) Silodosin c\) Doxazosin d\) Terzosin e\) Alfuzosin **27. Which of the following are risk factors for renal cell carcinoma:** a\) aniline dyes b\) obesity c\) hypertension d\) race e\) HPV **28. Which stone has the highest density (most X-ray positive):** a\) calcium phosphate b\) calcium oxalate c\) magnesium ammonium phosphate d\) worth it e\) cysteine **[Open questions:]** 1. **Antegrade pyelography -- description, technique and indications** 2. **Treatment of erectile dysfunction** **[Case 1:]** Urinary incontinence -- types of incontinence, treatment **[Case 2:]** A patient after a car accident has pain in the pelvis. Objectively, a haematoma around the scrotum and blood staining around the external opening of the urethra were found. The patient reported inability to urinate. Imagine study... **What imaging is the following study?** **What is expected to be found on a digital rectal exam?** **What is the management and what are the expected complications?** **[Extras from Paper 5??]** **1. What will a patient with BPH reveal during a digital rectal exam:** a\) hard and painful nodule b\) hard and painless corn c\) fluctuation and softening of the lobe d\) dense elastic and homogenous consistency e\) indurative process presence of nodules **2. The appendix of the testicle is located:** a\) in the upper pole of the testicle b\) in the lower pole of the testicle c\) in the sheaths of the testis around the upper pole d\) in the sheaths of the testis around the lower pole e\) between the body of the testis and the tail of the epididymis **3. Finasteride and dutasteride are:** a\) alpha blockers b\) alpha mimetics c\) 5-alpha reductase inhibitors d\) 5-PDE inhibitors e\) antimuscarinic medications **4. Testosterone is secreted by the:** a\) plexus pampiniformis b\) Leydig cells c\) Sertoli cells d\) epididymis e\) the prostate **5. Gynecomastia in urological patients can be observed:** a\) carcinoma of the prostate b\) testicular carcinoma c\) carcinoma of the kidney d\) kidney failure e\) treatment with 5-alpha reductase inhibitors