Lithiasis/Infections

Question 1

During a ureteroscopy for a stone of 1 cm in the mid-portion of the ureter on the right side a perforation is identified of the ureter wall and fragments of the stone are outside the ureter. Which is the best treatment?

A. Placemente of a JJ catheter
B. Insertion of a nephrostomy tube
C. Immediate open procedure to remove the fragments outside the ureter and closure of ureteral defect
D. Placement of a transurethral catheter and starting antibiotic therapy for 1 week followed by ureteroscopy after 1 week for inspection of the ureter

Answer 1

A. Placemente of a JJ catheter

Question 2

What is the treatment of choice for a 4 cm staghorn calculus?

A. ESWL-monotherapy
B. Anatrophic nephrolithotomy
C. Retrograde intrarenal surgery
D. Percutaneous nephrolithotripsy

Answer 2

D. Percutaneous nephrolithotripsy

Question 3

Candiduria is a common complication of:

A. Diabetes mellitus
B. Renal tuberculosis
C. Glomerulonephritis
D. Interstitial nephritis

Answer 3

A. Diabetes mellitus

Question 4

What is correct regarding stents in the upper urinary tract?

A. There are always problems with full metal stents because of the end in the bladder
B. Full metal stents can best be used for ureteral strictures
C. Moste ureteric stents are composed of polymeric materials
D. Metal stents can be treated for encrustration with endourological techniques using laser

Answer 4

C. Moste ureteric stents are composed of polymeric materials

Question 5

What is the most frequent complication following PCNL?

A. Pain
B. Fever
C. Urinary leakage
D. Ureteric obstruction

Answer 5

B. Fever

Question 6

Please indicate which is not an absolute contraindication for whock wave lithotripsy (SWL) of ureteral calculi:

A. Pregnancy
B. Distal ureteric obstruction
C. Active infection
D. Atrial fibrillation

Answer 6

D. Atrial fibrillation

Question 7

What level of uropathogens’ colony count is considered to be indicative of clinically relevant bacteriuria in acute uncomplicated pyelonephritis in premenonpausal, non-pregnant women?

A. ≥104cfu/mL
B. ≥103cfu/mL
C. ≥106cfu/mL
D. ≥108cfu/mL

Answer 7

A. ≥104cfu/mL

Question 8

Ureteral JJ-stenting before shock wave lithotripsy in management of renal calculi reduces the risk of:

A. Steinstrasse formation
B. Infectious complications
C. Haemorrhage
D. Renal colic

Answer 8

D. Renal colic

Question 9

In stone-forming patients, a high recurrence of disease occurs in slightly more than:

A. 2% of patients
B. 10% of patients
C. 25% of patients
D. 50% of patients

Answer 9

B. 10% of patients

Question 10

What is an indication for active stone treatment?

A. Small cystine stone
B. Growth of the stone
C. Small stone (<4mm) in the upper pole
D. Stone in a calyceal diverticulum without symptoms

Answer 10

B. Growth of the stone

Question 11

What is correct regarding stone-free rates, when comparing URS and SWL for ureteral stones?

A. There is no difference beween URS and SWL
B. Stone-free rates are higher when using SWL
C. Stone-free rates are higher when URS is performed
D. URS and SWL cannot be compared because they are different treatment modalities

Answer 11

C. Stone-free rates are higher when URS is performed

Question 12

Please complete the statement. Routine DJ stenting in SWL treatment of 1 cm stones in the proximal ureter:

A. Is not recommended
B. Will result in a higher stone-free rate
C. Reduces the formation of steinstrasse
D. Is recommended because of the lower complication rate

Answer 12

A. Is not recommended

Question 13

What is the best treatment for a 3 cm renal pelvis kidney stone?

A. Ureteroscopy
B. Laparoscopy
C. Shock Wave Lithotripsy
D. Percutaneous Nephrolithotomy

Answer 13

D. Percutaneous Nephrolithotomy

Question 14

A 64-year-old diabetic man with a long-term urethral catheter presents with painful swelling of perineum and scrotum. He has small, necrotic areas of the skin with surrounding erythema and oedema. What is the initial step in the management of this patient in addition to antibiotics?

A. Change of urethral catheter
B. Surgical debridement should be performed
C. A suprapubic catheter should be inserted
D. A colostomy should be performed

Answer 14

B. Surgical debridement should be performed

Question 15

Cystine calculi:

A. Are radiopaque
B. Can be fragmented easily
C. May be caused by urinary infection
D. Require a high fluid intake and alkalinization

Answer 15

D. Require a high fluid intake and alkalinization

Question 16

A young patient with acute leukemia under treatment with cytotoxic drugs presents with severe abdominal pain of sudden onset. The most likely diagnosis is:

A. Peptic ulcer
B. Acute appendicitis
C. Oxalate stone colic
D. Uric acid stone colic

Answer 16

D. Uric acid stone colic

Question 17

Which technique of stone fragmentation within the ureter has been associated with the highest incidence of ureteral injury?

A. Ultrasonic lithotripsy
B. Pneumatic lithotripsy
C. Electrohydraulic lithotripsy
D. Laser lithotrpsy

Answer 17

C. Electrohydraulic lithotripsy

Question 18

Two weeks following a percutaneous stone removal for a pelvic stone of 4 cm in the left kidney a 35-year-old woman presents with recurrent gross macroscopic hematuria. Which is the most likely diagnosis?

A. Bladder tumour
B. Arterio-venous fistula
C. Urinary tract infection
D. Remnant stone in the left kidney

Answer 18

B. Arterio-venous fistula

Question 19

The management of cystine stone includes:

A. Urinary pH maintained over 6.0
B. Maintenance of acid urinary pH
C. Fluid intake so that 24-hour urine volume exceeds 3 L
D. Administration of Allopurinol 100-300 mg/d

Answer 19

C. Fluid intake so that 24-hour urine volume exceeds 3 L

Question 20

Recommended first-line treatment for steinstrasse with large stone fragments is:

A. Conservative treatment
B. Ureteroscopy
C. Medical expulsion therapy
D. SWL + stent

Answer 20

B. Ureteroscopy

Question 21

Acute uncomplicated cystitis is most often found in:

A. Children
B. Young men
C. Elderly patients
D. Premenopausal women

Answer 21

D. Premenopausal women

Question 22

Which antibiotic is most suitable to treat chronic prostatitis?

A. Amoxicillin
B. Ciprofloxacin
C. Nitrofurantoin
D. Amoxicillin and clavulanic acid

Answer 22

B. Ciprofloxacin

Question 23

In shock wave lithotripsy the stone-free rate is higher when frequency is:

A. 60-90 shock waves/min
B. 90-120 shock waves/min
C. 120-150 shock waves/min
D. 150-180 shock waves/min

Answer 23

A. 60-90 shock waves/min

Question 24

What is the first-line imaging in a patient with suspicion of urosepsis?

A. KUB
B. MRI
C. CT scan
D. Ultrasonography

Answer 24

D. Ultrasonography

Question 25

What is the advantage of stenting before shock wave lithotripsy (SWL) for larger stones?

A. Higher stone-free rate
B. Lower rate of auxiliary procedures
C. Lower rate of steinstrasse
D. Higher rate of stone fragmentation

Answer 25

C. Lower rate of steinstrasse

Question 26

A struvite stone consists of:

A. Calcium oxalate dihydrate
B. Magnesium ammonium phosphate
C. Calcium carbonate
D. Uric acid

Answer 26

B. Magnesium ammonium phosphate

Question 27

A 66-year-old healthy woman has an asymtomatic bacteriuria with a positive urine culture for Escherichia coli (>100,000 colony-forming units(cfu) per mL), sensitive to all tested anti-microbial agents.
How would you proceed?

A. Treat with ciprofloxacin
B. Treat with Nitrofurantoin
C. Treat with Trimethoprim/Sulfamethoxazol
D. No antibiotic treatment needed

Answer 27

D. No antibiotic treatment needed

Question 28

How long does Chronic Bacterial Prostatitis treatment with Fluoroqinolones last?

A. 1 week
B. 2 weeks
C. 4 weeks
D. 8 weeks

Answer 28

C. 4weeks

Question 29

How long does Chronic Bacterial Prostatitis treatment with Fluoroqinolones last?

A. 1 week
B. 2 weeks
C. 4 weeks
D. 8 weeks

Answer 29

C. 4 weeks