Urology

·      Voiding Dysfunction 

1.    Urinary Retention.

???) In chronic retention of urine, one statement is not true:

It is usually painless

The bladder is atonic and may distend up to the umbilicus

It may present with uremia

It should be revealed by rapid decompression

Benign hyperplasia of the prostate is a common cause

Answer: 4* It should be revealed by rapid decompression

2.    Benign Prostatic Hyperplasia (BPH).

???) The most common cause of acute retention of urine in men is:

Chronic prostatitis

Benign hyperplasia of prostate

Carcinoma of prostate

Urethral stricture

Prostatic abscess

Answer: 2* Benign hyperplasia of prostate

???) The following are indications for prostatectomy, except:

Severe prostatitis

Enlarged prostate felt by PR digital examination

Recurrent acute retention of urine

Chronic retention of urine

Development of urinary complications as infection, hemorrhage and stones

Answer: 2* Enlarged prostate felt by PR digital examination

***) Which of the following is not a possible complication of senile hypertrophy of the prostate:

Hematuria

Hydronephrosis

Recurrent urinary tract infection

Renal failure

Renal cell carcinoma

Answer: 5* Renal cell carcinoma

·      Stone Disease  

1.    Renal Stones.

???) The most accurate method of detecting renal calculi is:

Unenhanced spiral CT

Enhanced spiral CT

Ultrasonography

Excretory urogram

KUB film (kidneys, ureters, bladder).

Answer: 1* Unenhanced spiral CT

???) The best treatment of a 4mm lower ureteric stone is a 30 years old healthy male is:

Immediate surgical removal

Immediate endoscopic removal

Immediate extracorporal shock with lithotripsy

Diuretic drugs

Plenty of fluids and pain killer

Answer: 5* Plenty of fluids and pain killer

2.    Uric Acid Stones.

???) Which of the following urinary calculi is radiolucent:

Calcium oxalate

Uric acid

Cystine stone

Mixed stone

Triple phosphate stone

Answer: 2* Uric acid

3.    Cystine Stones.

???) One of the following is a radio-lucent urinary stone:

Cholesterol

Cystine

Urate

Oxalate

Phosphate

Answer: 2* Cystine

???) As regarding cystine stones all of the following are true, except:

They are primary uncommon urinary stones

They are inherited stones

They are radio-opaque

Can be treated conservatively

They develop in alkaline urine

Answer: 3* They are radio-opaque

·      Urological Neoplasms  

1.    Malignant Renal Neoplasms.

***) The most common clinical picture of renal cell carcinoma is:

Pyrexia

Hematuria

Mass in the flank

Left sided varicocele

Flank pain

Answer: 2* Hematuria

2.    Prostatic Carcinoma.

???) Concerning prostatic carcinoma, all of the following statements are correct, except:

Many cases remain symptom free for long time

Signs and symptoms are similar to benign prostatic hyperplasia

Blood stream spread is mainly to the bone

Bone metastases are osteolytic

Stilbestrol is useful in management

Answer: 4* Bone metastases are osteolytic

3.    Testicular Tumors.

???) The following tumors are benign, except:

Leiomyoma

Chondroma

Seminoma

Meningioma

Dermoid cyst

Answer: 3* Seminoma

???) A 35 years old male presented with bilateral gynecomastia and RL. testicular tumor. The most likely pathological diagnosis is:

Lymphoma

Seminoma

Teratocarcinoma

Choriocarcinoma

Metastatic carcinoma

Answer: 2* Seminoma

???) Serum alpha-fetoprotein is raised in one of the following tumors

Malignant teratoma of the testis

Carcinoma of the prostate

Malignant lymphoma

Carcinoma of the breast

Carcinoma of the sigmoid colon

Answer: 1* Malignant teratoma of the testis

·      Scrotal Mass 

1.    Varicocele.

???) Chronic scrotal pain is most often due to:

Testicular trauma

Cryptorchidism

Testicular torsion

Varicocele

Orchitis

Answer: 4* Varicoceles

2.    Hydrocele.

???) A 2 years old child with oblong cystic swelling in the inguinal canal that moves downward pull of the testis has:

Indirect inguinal hernia

Direct inguinal hernia

Encysted hydrocele

Vagial hydrocele

Femoral hernia

Answer: 3* Encysted hydrocele

???) A smooth oval cystic swelling associated with the spermatic cord that moves downwards with gentle traction upon the testis is:

Irreducible indirect inguinal hernia

Varicocele

Encysted hydrocele

Communicated hydrocele

Vaginal hydrocele

Answer: 3* Encysted hydrocele

3.    Testicular Torsion.

???) Concerning torsion testicles all of the following are true, except:

The condition is rare in normal fully descended testicles

The highest incidence is between 10 and 25 years of age

The condition stimulates strangulated inguinal hernia or epididimoorchitis

Acute straining during defecation or lifting heavy weight is an axciting cause

Treatment consists of exploration of the affected side only

Answer: 5* Treatment consists of exploration of the affected side only

???) In cases of torsion testicles all are true, except:

Orchidopexy of the affected side only

Undescended testis is more liable for torsion

Orchidopexy of both testis must be done

It affects young age males

Clinically it simulates acute epididymoorchitis

Answer: 1* Orchidopexy of the affected side only

???) Concerning torsion testicle all of the following are true, except:

The highest incidence is between 40 and 50 years of age

Although acute straining is a predisposing factor some cases occur during sleep

Clinically it simulates epididimo-orchitis or strangulated inguinal hernia

The condition develops more commonly in the incompletely descended testicles

After dealing surgically with the affected side exploration and fixation of the opposite side should be done

Answer: 1* The highest incidence is between 40 and 50 years of age

???) Which of the following simulates clinically torsion of the testicle:

Encysted hydrocele

Communicated hydrocele

Varicocele

Acute epididymo-orchitis

Indirect inguinal hernia

Answer: 4* Acute epididymo-orchitis

???) The commonest cause of acute scrotal pain in a 12 years old child with no fever and normal urine analysis is:

Epididimitis

Orchitis

Varicocele

Torsion of testicle

Hydrocele

Answer: 4* Torsion of testicle

·      Trauma  

1.    Renal Trauma.

???) As regarding renal injury, all of the following are true, except:

It may follow direct blow or fall upon the loin

It may be an isolated injury or associated with injury of other intra-abdominal organs

Swelling of the flank and hematuria are important manifestations

The magnitude of the injury is variable

Nephrectomy is the ideal method of treatment whatever the degree of injury

Answer: 5* Nephrectomy is the ideal method of treatment whatever the degree of injury

???) As regard to kidney injuries all of the following are true, except:

Direct blows or fall upon the loin are common causes of such injuries

Although hematuria is a cardinal sign it may not make its appearance until some hours after the accident

Associated injury of other abdominal viscera may occur

IVU should be done

In all cases direct exploration of the kidney should be done to preserve the kidney

Answer: 5* In all cases direct exploration of the kidney should be done to preserve the kidney

2.    Urethral Injuries.

???) Ureteral injuries are least common as a result of:

Radical hysterectomy

Penetrating or blunt trauma

Abdominoperineal resection

Anterior resection of the sigmoid

Radiation therapy of carcinoma of the cervix

Answer: 2* Penetrating or blunt trauma

???) Concerning rupture of the bulbous urethra all of the following are true, except:

Falling astride a projecting object is the usual cause of injury

After the accident the condition is highly suspected by triad of urethra hemorrhage, perineal hematoma and retention of urine

If the patient is allowed to pass urine extravasation of urine usually occurs subcutaneously

The usual treatment is immediate urethral catheterization applied in the emergency room and left for one week

A course of antibiotics is given and continued until complete healing of the urethra

Answer: 4* The usual treatment is immediate urethral catheterization applied in the emergency room and left for one week

·      Pediatric Urology 

1.    Nephroblastoma (Wilms' Tumor).

???) Concerning nephroblastoma (Wilm's tumor), all the following are true, except:

Arising from embryonic nephrogenic tissue, so it is a mixed tumor

Originally it is situated in one pole of the kidney, and bilateral cases occasionally are seen

The most common presentation is a progressively enlarging abdominal mass noticed by the parents

Progressive deterioration of general health, anemia and pyrexia are common manifestations

The tumor spreads mainly by lymph to the para-aortic lymph nodes

Answer: 5* The tumor spreads mainly by lymph to the para-aortic lymph nodes

2.    Cryptorchidism (Ectopic Testes).

???) Undescended testicle is commonly associated with:

Direct inguinal hernia

Hypospadia

Indirect inguinal hernia

Paraphimosis

Femoral hernia

Answer: 3* Indirect inguinal hernia

???) Concerning undescended testicle, all of the following are true, except:

The testis may be incompletely descended or in an ectopic site

The condition may be unilateral or bilateral

In neglected bilateral cases sterility usually occurs

The affected testis is more liable to trauma, torsion and malignancy

In unilateral cases surgical treatment has to be done just after puberty

Answer: 5* In unilateral cases surgical treatment has to be done just after puberty

???) Regarding undescended testicle all of the following are true, except:

It is usually associated with a hernial sac

It is more liable for torsion than the normally descended testicle

Neglected bilateral cases are associated with decreased spermatogenesis

Orchiopexy does not reduce the risk of malignant degeneration

Surgical correction should be done around the age of puberty

Answer: 5* Surgical correction should be done around the age of puberty