Urology Flashcards

Question 1

Q

URO - 1
One of the aetiologies listed below predisposes to testicular tumors:
A) testicular trauma
B) testicular torsion
C) undescended testes
D) BRCA2 mutation

Answer

A

ANSWER
C) undescended testes

EXPLANATION
In the aetiology of testicular tumors the only evidence-based risk factor is an undescended testis (in this case testicular tumors are 10-20 times more likely to occur). Trauma, torsion, genetic factors are not evidence-based predisposing factors.

Question 2

Q

URO - 2
Mark the pathology which usually leads to scrotal pain on palpation:
A) testicular tumor
B) epididymitis
C) hydrocele
D) varicocele

Answer

A

ANSWER
B) epididymitis

EXPLANATION
In case of epididymitis, the epididymis and the testicle are enlarged, and are painful to touch. In case of a testicular tumor, a non-tender nodule can be palpated, or the entire testicle could be non-tender, but enlarged. Varicocele causes a pulling-like pain, the distended veins can be palpated as a „bag of worms”, the testicles themselves are not painful to touch. A hydrocele can be transilluminated, it is not painful, a fluctuating fluid can be palpated within the scrotu

Question 3

Q

URO - 3
Prostate cancer is palpated as:
A) enlarged, consistency similar to smooth muscle
B) hard
C) tender, enlarged
D) non-tender, enlarged

Answer

A

ANSWER
B) hard

EXPLANATION
Prostate cancer: hard, non-tender nodule in the prostate, or firm, irregular surface, of a non-tender prostate. Acute prostatitis presents with fever, extremely tender and enlarged prostate. BPH presents as nodular, glandular or muscle-like alteration of the enlarged prostate.

Question 4

Q

URO - 4
Characteristic finding of female spontaneous urine:
A) higher pH
B) contains many epithelial cells
C) always contains a few red blood cells
D) always contains some pus

Answer

A

ANSWER
B) contains many epithelial cells

EXPLANATION
In the female urine epithelial cells are often present, originating from the vagina

Question 5

Q

URO - 5
Testicular torsion:
A) always bilateral
B) presents with sudden pain, which usually wakes the patient from his sleep
C) present with high fever immediately
D) more frequent on the right side

Answer

A

ANSWER
B) presents with sudden pain, which usually wakes the patient from his sleep

EXPLANATION
Usually, young men are predisposed to testicular torsion, which presents at night and the patient is awoken by a sudden, very intense scrotal pain radiating inguinally. It causes high fever only if it begins necrotizing. It presents equally commonly on either side.

Question 6

Q

URO - 6
Typical for renal colic, except:
A) flank tenderness
B) nausea, vomiting
C) labial or scrotal pain
D) tenderness on palpation of McBurney’s point

Answer

A

ANSWER
D) tenderness on palpation of McBurney’s point

EXPLANATION
Typical signs of renal colic include intense flank pain, which radiates to the labia or scrotum of the same side and is often accompanied by nausea or vomiting. Tenderness of the McBurney’s point is characteristic in appendicitis.

Question 7

Q

URO - 7
The conversion of testosterone to dihydrotestosterone is catalysed by the following enzyme which is also targeted as part of BPH treatment:
A) 5-α-reductase
B) 7-β-cytosterine
C) aromatase
D) acidic phosphatase

Answer

A

ANSWER
A) 5-α-reductase
EXPLANATION
In the aetiology of BPH 5-α-reductase plays crucial role in converting testosterone to dihydrotestosterone within the prostate.

Question 8

Q

URO - 8
In the aetiology of prostate cancer the following plays a role:
A) age
B) genetic factors
C) hormonal factors
D) all of the above

Answer

A

ANSWER
D) all of the above

EXPLANATION
Although in the aetiology of prostate cancer causal factors have not been determined, but older age, genetic- (positive family history) and hormonal factors (androgen-dependency) all contribute to the development of prostate cancer.

Question 9

Q

URO - 9
The main risk factor for urothelial cancer is:
A) smoking
B) alcohol
C) benzidine
D) petrol

Answer

A

ANSWER
A) smoking

EXPLANATION
Smoking certainly plays a role as a risk factor for urothelial carcinoma. Other factors e.g. certain polycyclic chemicals also increase the risk of bladder tumors, but the connection is not as obvious as with smoking.

Question 10

Q

URO - 10
The main symptom of stress urinary incontinence:
A) frequent urinary urge
B) nocturnal urinary dribbling
C) involuntary voiding following psychological stress
D) urinary dribbling following an increase in abdominal pressure (e.g. during exercise, coughing, sneezing etc.)
E) vaginal burning

Answer

A

ANSWER
D) urinary dribbling following an increase in abdominal pressure (e.g. during exercise, coughing, sneezing etc.)

EXPLANATION
In case of stress urinary incontinence, the increased abdominal pressure leads to increased intravesical pressure without the contraction of the detrusor muscle, which exceeds the urinary tract’s pressure

Question 11

Q

URO - 11
Tasks following the palpation of a nodule in the testis:
A) observation, then a control check-up
B) send the patient to a urologist
C) antibiotics, then control check-up
D) do a diagnostic work-up for chronic prostatitis

Answer

A

ANSWER
B) send the patient to a urologist

EXPLANATION
The palpation of a nodule within a testicle is suspicious of a testicular tumor, which requires further examination by a urologist.

Question 12

Q

URO - 12
Difficulty of voiding can be caused by:
1) prostate enlargement due to benign prostatic hyperplasia (BPH)
2) prostate cancer
3) acute prostatitis
4) phimosis
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
E) All of the answers are correct

EXPLANATION
Dysuria can be caused by BPH compressing the posterior wall of the urethra, prostate cancer, causing obstruction of the prostatic urethra, inflamed, enlarged prostate and extreme narrowing of the foreskin. In the latter case the patient first voids under the foreskin surrounding the glans.

Question 13

Q

URO - 13
The cause of complete urinary retention can be:
1) bladder tumor
2) acute prostatitis
3) urethral narrowing
4) hypo- or acontractility of the detrusor
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
E) All of the answers are correct

EXPLANATION
Bladder tumors near the internal urethral orifice can obstruct outflow as valves or can infiltrate the posterior urethra. Urethral narrowing can also compromise flow and can lead to complete obstruction. In case of acute prostatitis, the inflamed, enlarged prostate can completely compress the prostatic urethra. In case of hypo- or acontractile detrusor function, the contractile function of the detrusor decreases, or is insufficient, thus the urine cannot be emptied. The underlying cause can be myogenic or neurogenic.

Question 14

Q

URO - 14
Inflammations accompanied by fever:
1) acute pyelonephritis
2) acute prostatitis
3) acute epididymitis
4) acute cystitis
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
A) Answers 1, 2 and 3 are correct

EXPLANATION
Only parenchymal organs’ inflammations are accompanied by fever, thus NOT cystitis.

Question 15

Q

URO - 15
In the primary diagnosis of prostate cancer includes:
1) PSA
2) DRE (digital rectal examination)
3) prostate biopsy
4) abdominal ultrasound
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
A) Answers 1, 2 and 3 are correct

EXPLANATION
PSA (prostate-specific antigen) is prostate-specific, but not prostate cancer. Its normal range is 0-4 ng/ml, a grey zone is between 4-10 ng/ml, above 10 ng/ml a tumor is likely. Digital rectal examination (DRE) raises the suspicion of prostate cancer if an uneven surface or firm nodules are palpated, but only histology can confirm it. Therefore, for screening PSA and DRE are mandatory. (If DRE is performed first, at least 2 days should pass to have PSA tested as even palpation can increase PSA.) If prostate cancer is suspected based on either PSA or DRE, prostate biopsy is mandatory. The abdominal ultrasound has no use in the diagnosis of prostate cancer.

Question 16

Q

URO - 16
Which hormons are essential to measure as part of andrological examinations?
1) testosterone
2) FSH
3) LH
4) parathyroid hormone
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
A) Answers 1, 2 and 3 are correct

EXPLANATION
Testosterone is the male sex hormone; LH is its trophic hormone and FSH enhances spermatogenesis (their levels are measured if hypogonadism is suspected). Parathyroid hormone is measured if hyperthyroidism is suspected.

Question 17

Q

URO - 17
Ultrasonography of the testes can be used for the diagnosis of:
1) infertility
2) testicular tumor
3) azoospermia
4) orchidoepididymitis
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
C) Answers 2 and 4 are correct

EXPLANATION
Infertility and azoospermia are complex andrological diagnoses, ultrasonography is insufficient on its own for the diagnoses. Semen analysis and the exploration of the underlying cause (via microbiological, diagnostic, surgical, radiological, biochemical genetic and endocrine tests) are inevitable. In case of orchidoepididymitis, the testicle is non-homogeneous, and in case a testicular tumor non-homogeneous region(s) or an entire non-homogeneous testicle can be observed.

Question 18

Q

URO - 18
In case of non-muscle invasive bladder tumors recurrence can be prevented via bladder instillation of the following chemicals:
1) BCG
2) Bleomycin
3) Mitomycin C
4) Vincristin
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
B) Answers 1 and 3 are correct

EXPLANATION
Bleomycin and Vincristin are used as systemic chemotherapeutic agents. Mitomycin C and BCG are used as intravesical agents in case of non-muscle invasive bladder tumors.

Question 19

Q

URO - 19
Continent urine diversions include:
1) ureterocutaneostomy
2) bilateral percutaneous nephrostomy
3) ureteroileocutaneostomy (Bricker ileal conduit)
4) orthotopic bladder
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
D) Only answer 4 is correct

EXPLANATION
Ureterocutaneostomy involves the anastomosis of ureters to the abdominal skin. Bilateral percutaneous nephrostomy involves urine diversion from both kidneys via puncturing the kidneys under ultrasound imaging and inserting percutaneous drains (catheters). The creation of a Bricker ileal conduit involves the anastomosis of the ureters into a short segment of the ileum, and the other end of the gut is anastomosed to the abdominal wall. The above three are non-continent diversions, thus urine outflow is continuous, patients wear stoma bags or urine collection bags. Creation of an orthotopic bladder involves the isolation of a section of a small intestine, which is connected to the original urethral stump, and both of the ureters are connected to the neobladder. Therefore, the route of the urine is as follows: upper urinary tract-orthotopic bladder-urethra. Emptying of the bladder can be voluntarily controlled via the outer sphincter of the urethra.

Question 20

Q

URO - 20
Can be used to treat muscle-invasive bladder tumors as a part of curative or palliative management:
1) Mitomycin, Epirubicin
2) radical cystectomy
3) local chemotherapy
4) resection of the bladder wall
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
C) Answers 2 and 4 are correct

EXPLANATION
Local chemotherapy can only be used in the treatment of non-muscle invasive bladder tumors to prevent recurrence. Patients with muscle-invasive bladder tumors can be cured via radical cystectomy, bladder wall resection (baldder dome) and TUR, on their own, or combined with radio- or chemotherapy (adjuvant, neoadjuvant therapy). For palliation, TUR can be performed, or chemo-, or radiation therapy can be administered, though in certain cases cystectomy may also be performed.

Question 21

Q

URO - 21
Pyelonephritis in pregnancy:
1) usually left-sided
2) its treatment is the termination of the pregnancy
3) frequent in the first trimester
4) presents in pregnant women as fever and renal pelvis dilation visualised under ultrasonography
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
D) Only answer 4 is correct

EXPLANATION
Pyelonephritis in pregnancy usually occurs during the second half of the pregnancy, affects the right side more frequently and if despite antibiotics and anti-inflammatory medications the fever or the pain don’t subside, a double J stent or nephrostomy should resolve the dilation and alleviate the symptoms.

Question 22

Q

URO - 22
Choose the procedure that is not transurethral:
1) internal urethrotomy
2) ESWL (Extracorporeal Shock Wave Lithotripsy)
3) inserting ureteral catheter with cystoscopy
4) epicystostomy
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
C) Answers 2 and 4 are correct

EXPLANATION
Internal urethrotomy is an endoscopic (transurethral) incision of the urethral stenoses with optic control. A ureteral catheter inserted using a special ureterocystoscope, also through the urethra. ESWL: Extracorporal shock wave lithotripsy does not need an endoscopic intervention. Epicystostomy is defined as percutaneous bladder punction.

Question 23

Q

URO - 23
Which factors have negative effect on erectile function?
1) diabetes
2) high uric acid levels
3) beta blockers utilized in hypertension
4) antidiabetics
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
B) Answers 1 and 3 are correct

EXPLANATION
Diabetes mellitus causes impotency via vascular and neurogenic mechanisms. Beta-blockers may lead to erectile dysfunction due to reduced arterial inflow.

Question 24

Q

URO - 24
Acute kidney failure laboratory values are:
1) hyperkalemia
2) increased serum creatinine levels
3) acidosis
4) decreased eGFR
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
E) All of the answers are correct

EXPLANATION
the characteristic of labor changes of acute kidney failure: increased serum creatinine, potassium and carbamide levels, decreased GFR and acidosis.

Question 25

Q

URO - 25
Which are the markers of testicular tumor?
1) PSA (Prostate-Specific Antigen)
2) β-hCG
3) testosterone
4) AFP (Alpha-fetoprotein)
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
C) Answers 2 and 4 are correct

EXPLANATION
The serum levels of β-hCG increase mainly in choriocarcinoma and AFP is higher in nonseminoma type testicular tumors. PSA is a tumor marker used in prostate cancer. Testosterone levels are utilized for the differential diagnosis of the subtypes of hypogonadism.

Question 26

Q

URO - 26
Which of the following drugs are used to improve urinary incontinence in females?
1) Doxycycline
2) Anticholinergics
3) Alpha-receptor blockers
4) Beta-3-adrenoreceptor agonists
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
C) Answers 2 and 4 are correct

EXPLANATION
Anticholinergics block the effect of acetylcholine on the presynaptic nerve terminals, thus the whole nerve transmission is inhibited. This decreases the tone of the detrusor muscle and involuntary contractions. Therefore, it increases bladder capacity and decreases its excitability. They are recommended for the treatment of urge incontinence. Doxycycline is an antibiotic, hence it has no effect on urinary incontinence. The alpha-adrenoreceptor blockers relax the smooth elements of bladder neck to increase the urine outflow, hence they worsen urinary incontinence. Beta-3-adrenoreceptor agonists relax detrusor muscle to improve bladder continence issues, thus we utilize them in the treatment of urge incontinence.

Question 27

Q

URO - 27
Cause(s) of erectile dysfunction:
1) antihypertensive drugs
2) induratio penis plastica
3) smoking
4) alcoholism
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
E) All of the answers are correct

EXPLANATION
Antihypertensive drugs can cause erectile dysfunction through reduced arterial inflow. In plastic penile induration, the penile curvature may reach such a high level, that it leads to erectile dysfunction. The smoking doubles the risk of ED. Chronic alcoholism can also lead to erectile dysfunction.

Question 28

Q

URO - 28
Which of the following can be used to differentiate kidney cysts from tumors?
1) ultrasound
2) IVP (Intravenous pyelography)
3) CT
4) retrograde pyelography
5) MRI
A) 1st, 3rd and 5th answers are correct
B) 1st, 4th and 5th answers are correct
C) 2nd, 3rd and 4th answers are correct
D) 2nd, 4th and 5th answers are correct
E) All 5 answers are correct

Answer

A

ANSWER
A) 1st, 3rd and 5th answers are correct

EXPLANATION
US and CT can differentiate the solid surface from the fluid-containing cystic mass based on their echogenicity and density. Furthermore, CT and MR can differentiate based on morphological characteristics and contrast enhancement patterns. Retrograde pyelography and excretory urography only display the volume, and differential diagnosis is not feasible.

Question 29

Q

URO - 29
Symptoms of acute pyelonephritis:
1) kidney pain related to movement
2) affected kidney is sensitive to balloting
3) fever
4) pyuria
5) macroscopic haematuria
A) 1st, 3rd and 5th answers are correct
B) 1st, 4th and 5th answers are correct
C) 2nd, 3rd and 4th answers are correct
D) 2nd, 4th and 5th answers are correct
E) All 5 answers are correct

Answer

A

ANSWER
C) 2nd, 3rd and 4th answers are correct

EXPLANATION
Acute pyelonephritis usually develops due to the infection of the lower urinary tract. Characteristic symptoms are high fever with chills, pain due to the enlarged kidneys stretching the kidney capsules and pyuria (except the blocked kidney) refers to urinary infection. Macroscopic hematuria is not characteristic. Kidney pain related to movement refers to orthopedic conditions.

Question 30

Q

URO - 30
Cause of pain associated with posture or movement can be:
1) rheumatic disease
2) vesicoureteral reflux (VUR)
3) kidney stone is stuck in the ureter
4) nephroptosis
5) spinal disc herniation
A) 1st, 3rd and 5th answers are correct
B) 1st, 4th and 5th answers are correct
C) 2nd, 3rd and 4th answers are correct
D) 2nd, 4th and 5th answers are correct
E) All 5 answers are correct

Answer

A

ANSWER
B) 1st, 4th and 5th answers are correct

EXPLANATION
Body movement related pain is mainly caused by conditions affecting the musculoskeletal system, e.g. rheumatoid arthritis or disc herniation. Renal ptosis can cause pain observed during standing (due to renal occlusion) and laying down relieves the pain. Kidney stones stucked in the urinary tract can cause continuous colic pain. Vesicoureteral reflux causes renal pain during urination.

Question 31

Q

URO - 31
Causes of macroscopic hematuria can be:
1) renal adenocarcinoma
2) glomerulonephritis
3) vesicoureteral reflux (VUR)
4) acute cystitis
5) bladder tumor
A) 1st, 3rd and 5th answers are correct
B) 1st, 4th and 5th answers are correct
C) 2nd, 3rd and 4th answers are correct
D) 2nd, 4th and 5th answers are correct
E) All 5 answers are correct

Answer

A

ANSWER
B) 1st, 4th and 5th answers are correct

EXPLANATION
The most common symptom of bladder tumor is macroscopic, painless, so-called “silent” hematuria, often with clots. Renal tumors may also cause macroscopic bleeding when they break into the lumen of the urinary tract. In one type of acute cystitis, namely in hemorrhagic cystitis, macroscopic hematuria can be observed in addition to pyuria. Glomerulonephritis cause microhematuria. VUR does not lead to haematuria.

Question 32

Q

URO-32-35
Pair the andrological abnormalities with the letter signed statements! One disease can be assigned to more statements!
A) erectile dysfunction
B) infertility
C) male menopause
D) retrograde ejaculation
URO - 32 - It can be caused by varicocele
URO - 33 - It appears as a frequent complication after TUR (transurethral resection) surgery.
URO - 34 - It can be caused by beta-blockers.
URO - 35 - One way of the treatment can be a vacuum constriction device

Answer

A

ANSWER
URO - 32 - It can be caused by varicocele - B)

The extended venous plexus increases the temperature of the testis impairing spermatogenesis (normally requires temperature below the body temperature. Following TURP the bladder neck is opened up. During ejaculation, the sperm launched towards the bladder (it travels towards lower resistance into the posterior urethra that is a shorter distance than towards the normal ejaculation route). These patients do not detect any ejaculation through their urethra during orgasm. Beta-blockers decreases arterial inflow resulting in erectile dysfunction. Drug treatment resistant erectile dysfunction can be further approached with vacuum therapy.

URO - 33 - It appears as a frequent complication after TUR (transurethral resection) surgery. - D)

The extended venous plexus increases the temperature of the testis impairing spermatogenesis (normally requires temperature below the body temperature. Following TURP the bladder neck is opened up. During ejaculation, the sperm launched towards the bladder (it travels towards lower resistance into the posterior urethra that is a shorter distance than towards the normal ejaculation route). These patients do not detect any ejaculation through their urethra during orgasm. Beta-blockers decreases arterial inflow resulting in erectile dysfunction. Drug treatment resistant erectile dysfunction can be further approached with vacuum therapy.

URO - 34 - It can be caused by beta-blockers. - A)

The extended venous plexus increases the temperature of the testis impairing spermatogenesis (normally requires temperature below the body temperature. Following TURP the bladder neck is opened up. During ejaculation, the sperm launched towards the bladder (it travels towards lower resistance into the posterior urethra that is a shorter distance than towards the normal ejaculation route). These patients do not detect any ejaculation through their urethra during orgasm. Beta-blockers decreases arterial inflow resulting in erectile dysfunction. Drug treatment resistant erectile dysfunction can be further approached with vacuum therapy.

URO - 35 - One way of the treatment can be a vacuum constriction device - A)

The extended venous plexus increases the temperature of the testis impairing spermatogenesis (normally requires temperature below the body temperature. Following TURP the bladder neck is opened up. During ejaculation, the sperm launched towards the bladder (it travels towards lower resistance into the posterior urethra that is a shorter distance than towards the normal ejaculation route). These patients do not detect any ejaculation through their urethra during orgasm. Beta-blockers decreases arterial inflow resulting in erectile dysfunction. Drug treatment resistant erectile dysfunction can be further approached with vacuum therapy.

Question 33

Q

URO-36-40
Pair the the kidney stone(s) to the typical description! (One kidney stone type can be assigned to more statements!)
A) uric acid stone
B) cystine stone
C) calcium oxalate stone
D) struvite stone
URO - 36 - High, alkaline pH levels increase the risk of developing this type of kidney stone.
URO - 37 - Called as negative stone as well
URO - 38 - Good solubility when treated with drugs.
URO - 39 - To prevent the recurrence, D-Penicillamin or Thiola can be used.
URO - 40 - If presented, reduced meat diet is recommended

Answer

A

ANSWER
URO - 36 - High, alkaline pH levels increase the risk of developing this type of kidney stone. - D)

Infected (struvite) kidney stone develops in alcalic urine. Uric acid stones cannot be detected on abdominal or pelvical X-ray (they are negative stones) and can be dissolved with alkalifying the urine. We apply D-Penicillamine or Thiola for cystine stones.

URO - 37 - Called as negative stone as well - A)

Infected (struvite) kidney stone develops in alcalic urine. Uric acid stones cannot be detected on abdominal or pelvical X-ray (they are negative stones) and can be dissolved with alkalifying the urine. We apply D-Penicillamine or Thiola for cystine stones.

URO - 38 - Good solubility when treated with drugs. - A)

Infected (struvite) kidney stone develops in alcalic urine. Uric acid stones cannot be detected on abdominal or pelvical X-ray (they are negative stones) and can be dissolved with alkalifying the urine. We apply D-Penicillamine or Thiola for cystine stones.

URO - 39 - To prevent the recurrence, D-Penicillamin or Thiola can be used. - B)

Infected (struvite) kidney stone develops in alcalic urine. Uric acid stones cannot be detected on abdominal or pelvical X-ray (they are negative stones) and can be dissolved with alkalifying the urine. We apply D-Penicillamine or Thiola for cystine stones.

URO - 40 - If presented, reduced meat diet is recommended - A)

Infected (struvite) kidney stone develops in alcalic urine. Uric acid stones cannot be detected on abdominal or pelvical X-ray (they are negative stones) and can be dissolved with alkalifying the urine. We apply D-Penicillamine or Thiola for cystine stones.

Question 34

Q

URO-41-46
Pair the diagnostic procedure name(s) to the relevant description! One procedure can be matched to multiple description!
A) URS (ureterorenoscopy)
B) PCNL (Percutaneous Nephrolithotomy)
C) ESWL (Extracorporeal Shock Wave Lithotripsy)
D) all of them
E) none of them
URO - 41 - Non-endoscopic procedure
URO - 42 - Used in urinary stone treatment
URO - 43 - Used in BPH treatment
URO - 44 - The procedure is performed through the skin
URO - 45 - It can be a diagnostic procedure too.
URO - 46 - The procedure is only performed in intubation narcosis

Answer

A

ANSWER
URO - 41 - Non-endoscopic procedure - C)

Explantion: URS is an endoscopic procedure through the ureter, which may be suitable for the removal of upper urinary tract stones, but also for histological sampling (diagnostic procedure) in case of suspected ureteral or pyelic tumor. PCNL means percutaneous endoscopic kidney stone removal. ESWL is an intervention suitable for crushing urinary tract stones (ureteral stones, kidney stones), which is performed outside the body with excited shock waves, and it is not an endoscopic intervention.

URO - 42 - Used in urinary stone treatment - D)

Explantion: URS is an endoscopic procedure through the ureter, which may be suitable for the removal of upper urinary tract stones, but also for histological sampling (diagnostic procedure) in case of suspected ureteral or pyelic tumor. PCNL means percutaneous endoscopic kidney stone removal. ESWL is an intervention suitable for crushing urinary tract stones (ureteral stones, kidney stones), which is performed outside the body with excited shock waves, and it is not an endoscopic intervention.

URO - 43 - Used in BPH treatment - E)

Explantion: URS is an endoscopic procedure through the ureter, which may be suitable for the removal of upper urinary tract stones, but also for histological sampling (diagnostic procedure) in case of suspected ureteral or pyelic tumor. PCNL means percutaneous endoscopic kidney stone removal. ESWL is an intervention suitable for crushing urinary tract stones (ureteral stones, kidney stones), which is performed outside the body with excited shock waves, and it is not an endoscopic intervention.

URO - 44 - The procedure is performed through the skin - B)

Explantion: URS is an endoscopic procedure through the ureter, which may be suitable for the removal of upper urinary tract stones, but also for histological sampling (diagnostic procedure) in case of suspected ureteral or pyelic tumor. PCNL means percutaneous endoscopic kidney stone removal. ESWL is an intervention suitable for crushing urinary tract stones (ureteral stones, kidney stones), which is performed outside the body with excited shock waves, and it is not an endoscopic intervention.

URO - 45 - It can be a diagnostic procedure too. - A)

Explantion: URS is an endoscopic procedure through the ureter, which may be suitable for the removal of upper urinary tract stones, but also for histological sampling (diagnostic procedure) in case of suspected ureteral or pyelic tumor. PCNL means percutaneous endoscopic kidney stone removal. ESWL is an intervention suitable for crushing urinary tract stones (ureteral stones, kidney stones), which is performed outside the body with excited shock waves, and it is not an endoscopic intervention.

URO - 46 - The procedure is only performed in intubation narcosis - E)

Explantion: URS is an endoscopic procedure through the ureter, which may be suitable for the removal of upper urinary tract stones, but also for histological sampling (diagnostic procedure) in case of suspected ureteral or pyelic tumor. PCNL means percutaneous endoscopic kidney stone removal. ESWL is an intervention suitable for crushing urinary tract stones (ureteral stones, kidney stones), which is performed outside the body with excited shock waves, and it is not an endoscopic intervention.

Question 35

Q

URO - 47
In case of acute renal colic the first choice of medications should be narcotic pain medication, therefore this patients should be directed to the nearest Urology Department immediately.
A) both the statement and the explanation are true and a causal relationship exists between them
B) both the statement and the explanation are true but there is no causal relationship between them
C) the statement is true, but the explanation is false
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer

A

ANSWER
E) both the statement and the explanation are false

EXPLANATION
Renal colic without fever, vomiting or unbearable pain can be treated at home with NSAID, tamsulosin and antispasmodics (eg No-Spa). If any of the three factors are present the patient should be hospitalised. In the hospital urinary diversion is present and stronger painkillers are available. However, in order to avoid masking the symptoms of any other acute abdominal complaints on the spot, narcotic analgesics are prohibited.

Question 36

Q

URO - 48
Cystoscopy should be performed 3 months after the TUR surgery of non muscle invasive bladder tumor because this is the best way to detect the possible recurrence.
A) both the statement and the explanation are true and a causal relationship exists between them
B) both the statement and the explanation are true but there is no causal relationship between them
C) the statement is true, but the explanation is false
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer

A

ANSWER
A) both the statement and the explanation are true and a causal relationship exists between them

EXPLANATION
Early detection of reoccuring bladder cancer is very important. The best way to diagnose the reoccuring tumor is to perform cystoscopy. It is suggeted to perform cystoscopy every three months in the first year after surgery and every 6 months afterwards.

Question 37

Q

URO - 49
After the TUR surgery of superficial bladder cancer local BCG intravesical installation should be performed, because this is the only drug for this procedure.
A) both the statement and the explanation are true and a causal relationship exists between them
B) both the statement and the explanation are true but there is no causal relationship between them
C) the statement is true, but the explanation is false
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer

A

ANSWER
E) both the statement and the explanation are false

EXPLANATION
In the case of superficial, non muscle invasive bladder tumors, the rate of recurrences are quite high. To prevent high recurrences it is suggested to perform intravesical instillation of chemotherapy. For high grade cancer it is suggested to use BCG and delay the instillationin a few weeks after the surgery. For low grade cancer it is suggested to use immediate instillation using epirubicin or mitomycin.

Question 38

Q

URO - 50
If urinary diversion is done by using small bowels than constant bacteruria will be present, so patients will have hyperchloremic acidosis.
A) both the statement and the explanation are true and a causal relationship exists between them
B) both the statement and the explanation are true but there is no causal relationship between them
C) the statement is true, but the explanation is false
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer

A

ANSWER
D) the statement is false, but the explanation itself is true

EXPLANATION
In case of small bowel bladder replacement - if secondary superficial infection has not occurred - urine is not bacteriuretic. After bladder replacement with intestinal segregation, hyperchloraemic acidosis is always present. This is due to the fact that chloride and ammonium ion are reabsorbed from the bowels and as a result protons that are removed from the ammonium ion in the liver, will lower the pH level in the blood (shifting in the acidic direction).

Question 39

Q

URO - 51
While performing radical prostatectomy in case of intermediate risk prostate cancer a lymphadenectomy is also performed because with nerve sparing surgery the postoperative erectile disfunction is less likely.
A) both the statement and the explanation are true and a causal relationship exists between them
B) both the statement and the explanation are true but there is no causal relationship between them
C) the statement is true, but the explanation is false
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer

A

ANSWER
B) both the statement and the explanation are true but there is no causal relationship between them

EXPLANATION
In case of intermediate and high risk prostate cancer lymphadenectomy is mandatory. In case of low risk disease lymphadenectomy is not neccessary. The neuro-vascular bundle is located on the lateral side of the prostate. Nerve sparing surgery usually results better erectile function. Lymphadenectomy doesn’t effect the nerve sparing technique.

Question 40

Q

URO - 52
First diagnostic procedure:Case: A 65-year-old man comes to the hospital with a complaint of frequent urination. He also has pain in the lower back and in his legs. There is no blood in the urine. Urination is not painful, but there is a decrease urin flow.
A) DRE (digital rectal examination)
B) PSA (prostate specific antigen)
C) Transrectal ultrasound (TRUS)
D) prostate biopsy

Answer

A

ANSWER
A) DRE (digital rectal examination)

EXPLANATION
When examining male patients with urinary complaints, the first test to be performed is the urinalysis and then the physical examination (which includes digital rectal examination). This examination is quite simple and cheap, and always mandatory in such cases.

Question 41

Q

URO - 53
The patient’s PSA level is 20 ng/ml. DRE shows a large, not sensitive prostate with hard, uneven surface. What is the most likely diagnosis?
Case: A 65-year-old man comes to the hospital with a complaint of frequent urination. He also has pain in the lower back and in his legs. There is no blood in the urine. Urination is not painful, but there is a decrease urin flow.
A) Suspicion of prostate cancer
B) BPH (Benign prostatic hyperplasia)
C) chronic prostatitis
D) acute prostatitis

Answer

A

ANSWER
A) Suspicion of prostate cancer

EXPLANATION
The hard, uneven prostate, the inhomogeneous prostate structure detected with elevated PSA level suggests the presence of prostate cancer. BPH: palpation found: glandular or muscle like prostate. Although the PSA may have elevated but is below 10ng/ml. Chronic prostatitis: sensitive, stuffed founds in the prostate, PSA may be moderately elevated. Acute prostatitis: patient has high fever, a very sensitive prostate, with softened palpation and enlarged prostate.

Question 42

Q

URO - 54
What is TRUE regarding the statements below.
Case: A 65-year-old man comes to the hospital with a complaint of frequent urination. He also has pain in the lower back and in his legs. There is no blood in the urine. Urination is not painful, but there is a decrease urin flow.
1) Perform prostate biopsy, if posible perform prostate MRI beforhand (not mandatory).
2) The presence of prostate cancer is very likely, therefore radical prostatectomy should be performed.
3) The only role of transrectal ultrasound during biopsy is to target the prostate.
4) In case prostate biopsy proves that there is cancer present and the patient is in good shape and staging examination shows no distant metastasis then curative treatment (radical prostatectomy or irradiation) is suggested.
5) In case prostate biopsy is not performed than only hormonal therapy is given.
A) 1st, 2nd and 3rd answers are correct
B) 1st, 3rd and 4th answers are correct
C) 1st, 4th and 5th answers are correct
D) 1st, 3rd and 5th answers are correct
E) 2nd, 3rd, and 4th answers are correct

Answer

A

ANSWER
B) 1st, 3rd and 4th answers are correct

EXPLANATION
Treatment for prostate cancer can only be started if histopathological diagnosis was made, threrfore prostate biopsy is mandatoryt to start any treatment. Curative tretment (radical prostatectomy or irradiation) should be performed in case the patient is free from metastasises, fit for surgery, his life expectancy exceeds 10 years, and he is not older than 75 years old.

Question 43

Q

URO - 55
Which answer is not an option to treat urge urinary incontinence/overactive bladder?
A) botulinum toxin injection into the detrusor muscle
B) anticholinergic therapy
C) intravesical epirubicin instillation
D) beta 3 adrenoreceptor agonist
E) sacral neuromodulation

Answer

A

ANSWER
C) intravesical epirubicin instillation

EXPLANATION
The first line treatment for urge urinary incontinence/overactive bladder is medical therapy (anticholinergic and beta 3 adrenoreceptor agonist). Second line treatment consist of botulinum toxin injection into the detrusor muscle or sacral neuromodulation. Intravesical epirubicin instillation is used to prevent the reoccurance of non-muscle invasive bladder cancer.

Question 44

Q

URO - 56
The possible side effects of the anticholinergic treatment used for urge urinary incontinence are the following:
1) dry mouth
2) obstipation
3) problems with eye movement coordination
4) urinary retention
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
E) All of the answers are correct

EXPLANATION
Anticholinergic medication decreases bowel movement, detrusor contractility and saliva excretion. It also influences eye movement. Therefore it causes parasympathetic symptoms such as obstipation, dry mouth, urinary retention, eye movement cordination problems.

Question 45

Q

URO-57-61
Pair the given urinary stone with the correct statement. (one stone to each statement!)
A) small, resting kidney stone
B) staghorn kidney stone
C) 5-10 mm large, 600 HU density
D) 4 mm large stone in the mid-ureter
E) intravesical stone
URO - 57 - irritative urinary symptoms
URO - 58 - mostly symptom free
URO - 59 - causes renal colic, but likely to spontaneously pass
URO - 60 - ideal stone for ESWL therapy
URO - 61 - Percutaneous nephrolithotomy (multiple surgeries if required)

Answer

A

ANSWER
URO - 57 - irritative urinary symptoms - E)

Small, resting stones in the kidney usually doesn’t cause obstruction in the urinary tract, therefore these are usually asymptomatic. In case a stone gets in the ureter it can cause obstruction and renal colic. Stones smaller than 5mm have a 90% chance to pass on it’s own spontaneously. Large staghorn stones are treated with percutaneous nephrolithotomy, in some cases multiple surgeries are required. Stones in the pyelon that aren’t too large (smaller than 20mm) and aren’t too dense (less than 1000HU) can be treated by ESWL therapy. Bladder stones can irritate the bladder mucose therefore causing frequent urges to urinate.

URO - 58 - mostly symptom free - A)

Small, resting stones in the kidney usually doesn’t cause obstruction in the urinary tract, therefore these are usually asymptomatic. In case a stone gets in the ureter it can cause obstruction and renal colic. Stones smaller than 5mm have a 90% chance to pass on it’s own spontaneously. Large staghorn stones are treated with percutaneous nephrolithotomy, in some cases multiple surgeries are required. Stones in the pyelon that aren’t too large (smaller than 20mm) and aren’t too dense (less than 1000HU) can be treated by ESWL therapy. Bladder stones can irritate the bladder mucose therefore causing frequent urges to urinate.

URO - 59 - causes renal colic, but likely to spontaneously pass - D)

Small, resting stones in the kidney usually doesn’t cause obstruction in the urinary tract, therefore these are usually asymptomatic. In case a stone gets in the ureter it can cause obstruction and renal colic. Stones smaller than 5mm have a 90% chance to pass on it’s own spontaneously. Large staghorn stones are treated with percutaneous nephrolithotomy, in some cases multiple surgeries are required. Stones in the pyelon that aren’t too large (smaller than 20mm) and aren’t too dense (less than 1000HU) can be treated by ESWL therapy. Bladder stones can irritate the bladder mucose therefore causing frequent urges to urinate.

URO - 60 - ideal stone for ESWL therapy - C)

Small, resting stones in the kidney usually doesn’t cause obstruction in the urinary tract, therefore these are usually asymptomatic. In case a stone gets in the ureter it can cause obstruction and renal colic. Stones smaller than 5mm have a 90% chance to pass on it’s own spontaneously. Large staghorn stones are treated with percutaneous nephrolithotomy, in some cases multiple surgeries are required. Stones in the pyelon that aren’t too large (smaller than 20mm) and aren’t too dense (less than 1000HU) can be treated by ESWL therapy. Bladder stones can irritate the bladder mucose therefore causing frequent urges to urinate.

URO - 61 - Percutaneous nephrolithotomy (multiple surgeries if required) - B)

Small, resting stones in the kidney usually doesn’t cause obstruction in the urinary tract, therefore these are usually asymptomatic. In case a stone gets in the ureter it can cause obstruction and renal colic. Stones smaller than 5mm have a 90% chance to pass on it’s own spontaneously. Large staghorn stones are treated with percutaneous nephrolithotomy, in some cases multiple surgeries are required. Stones in the pyelon that aren’t too large (smaller than 20mm) and aren’t too dense (less than 1000HU) can be treated by ESWL therapy. Bladder stones can irritate the bladder mucose therefore causing frequent urges to urinate.

Question 46

Q

URO - 62
What is the most likely diagnosis? One correct answer.
Case: 60 years old male patient with the following symptoms: narrow and interrupted urine stream, nycturia. He did not have fever or blood in his urine.
A) urethral sctricture
B) prostatitis
C) BPH
D) urethral injury

Answer

A

ANSWER
C) BPH

EXPLANATION
The most common cause of such symptoms in such age is prostate enlargement caused by prostate hyperplasia.

Question 47

Q

URO - 63
After noting the patients history and symptoms which examinations should be performed?
Case: 60 years old male patient with the following symptoms: narrow and interrupted urine stream, nycturia. He did not have fever or blood in his urine.
1) urine test
2) cystoscopy
3) detection of residual urine after urination with ultrasound
4) detection of residual urine after urination with bladder catheter
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
B) Answers 1 and 3 are correct

EXPLANATION
Urine test is neccessary to rule out infection with such symptoms. It is important to rule out complete urinary retention with abdominal ultrasound for patients who have difficulty of urinating.

Question 48

Q

URO - 64
A patient had a digital rectal examination which showed aproximately 50ml, large prostate with a normal palpation. PSA was 2,3 ng/ml. These two suggested that the patient didn’t have prostate cancer. Uroflowmetry showed decreased urin flow, and bladder ultrasound revealed 100ml residual urine. The patient did not have UTI, but complains of erectile dysfunction. What kind of first line therapies should not be suggested in this case?
Case: 60 years old male patient with the following symptoms: narrow and interrupted urine stream, nycturia. He did not have fever or blood in his urine.
A) alpha blocker
B) 5 alpha reductase inhibitor
C) alpha blocker+5 alpha reductase inhibitor
D) LHRH analogues
E) phosphodiesterase 5 inhibitors

Answer

A

ANSWER
D) LHRH analogues

EXPLANATION
Alpha blockers can be used as first line treatment in BPH. This medication blocks the receptors at the bladder neck and in the prostate and thus causes muscle relaxation therefore alows better urine flow. 5 alpha reductase inhibitor blocks testosterone-dihydrotestosterone conversion and thus reduces prostate size. Phosphodiesterase 5 inhibitors also induce muscle relaxation in the prostate and the urethra and improve the erectile function. LHRH analogues are used in prostate cancer treatment.

Question 49

Q

URO-65-69
Please connect the given urine deviation technique with the correct situation. (each urine deviation matches one siuation)
A) urinary bladder catheter for long term urine deviation
B) suprapubic catheter (epicystostomy) for long term urine deviation
C) one time transurethral urine catheterisation
D) intermitting, transurethral self catheterization
E) wide (20 Ch), three way, irrigation catheter insertion
URO - 65 - Acute prostatitis and complete retention
URO - 66 - Urinary retention developed due to BPH
URO - 67 - Urinary retention developed due to spinal anesthesia following surgery for inguinal hernia in a young male patient
URO - 68 - Blood and clots in urine, resulting bladder tamponade
URO - 69 - Definitive bladder dysfunction developed due to neurogenic causes, akontractile detrusor function

Answer

A

ANSWER
URO - 65 - Acute prostatitis and complete retention - B)

In the case of urinary retention or significant urine retention caused by BPH, we most commonly use a transurethral balloon catheter. Continuous urinary drainage is not necessary when urinary retention is expected to be only temporary (e.g., after spinal anesthesia); in such cases, a single catheterization is sufficient. In cases of urinary retention caused by acute prostatitis, epicystostomy is the solution; transurethral catheterization is not recommended due to the increased risk of epididymitis. Intermittent self-catheterization is recommended if the urinary retention is due to neurological causes, because it can reduce continous urinary tract infection unlike a permanent transurethral balloon catheter. In cases of clotting hematuria and urinary retention, use a catheter that is relatively thick (minimum 18-20 Ch), capable of clearing clots, and continuous physiological saline irrigation can be performed through the third lumen of the catheter to prevent clot formation, thus catheter blockage.

URO - 66 - Urinary retention developed due to BPH - A)

In the case of urinary retention or significant urine retention caused by BPH, we most commonly use a transurethral balloon catheter. Continuous urinary drainage is not necessary when urinary retention is expected to be only temporary (e.g., after spinal anesthesia); in such cases, a single catheterization is sufficient. In cases of urinary retention caused by acute prostatitis, epicystostomy is the solution; transurethral catheterization is not recommended due to the increased risk of epididymitis. Intermittent self-catheterization is recommended if the urinary retention is due to neurological causes, because it can reduce continous urinary tract infection unlike a permanent transurethral balloon catheter. In cases of clotting hematuria and urinary retention, use a catheter that is relatively thick (minimum 18-20 Ch), capable of clearing clots, and continuous physiological saline irrigation can be performed through the third lumen of the catheter to prevent clot formation, thus catheter blockage.

URO - 67 - Urinary retention developed due to spinal anesthesia following surgery for inguinal hernia in a young male patient - C)

In the case of urinary retention or significant urine retention caused by BPH, we most commonly use a transurethral balloon catheter. Continuous urinary drainage is not necessary when urinary retention is expected to be only temporary (e.g., after spinal anesthesia); in such cases, a single catheterization is sufficient. In cases of urinary retention caused by acute prostatitis, epicystostomy is the solution; transurethral catheterization is not recommended due to the increased risk of epididymitis. Intermittent self-catheterization is recommended if the urinary retention is due to neurological causes, because it can reduce continous urinary tract infection unlike a permanent transurethral balloon catheter. In cases of clotting hematuria and urinary retention, use a catheter that is relatively thick (minimum 18-20 Ch), capable of clearing clots, and continuous physiological saline irrigation can be performed through the third lumen of the catheter to prevent clot formation, thus catheter blockage.

URO - 68 - Blood and clots in urine, resulting bladder tamponade - E)

In the case of urinary retention or significant urine retention caused by BPH, we most commonly use a transurethral balloon catheter. Continuous urinary drainage is not necessary when urinary retention is expected to be only temporary (e.g., after spinal anesthesia); in such cases, a single catheterization is sufficient. In cases of urinary retention caused by acute prostatitis, epicystostomy is the solution; transurethral catheterization is not recommended due to the increased risk of epididymitis. Intermittent self-catheterization is recommended if the urinary retention is due to neurological causes, because it can reduce continous urinary tract infection unlike a permanent transurethral balloon catheter. In cases of clotting hematuria and urinary retention, use a catheter that is relatively thick (minimum 18-20 Ch), capable of clearing clots, and continuous physiological saline irrigation can be performed through the third lumen of the catheter to prevent clot formation, thus catheter blockage.

URO - 69 - Definitive bladder dysfunction developed due to neurogenic causes, akontractile detrusor function - D)

In the case of urinary retention or significant urine retention caused by BPH, we most commonly use a transurethral balloon catheter. Continuous urinary drainage is not necessary when urinary retention is expected to be only temporary (e.g., after spinal anesthesia); in such cases, a single catheterization is sufficient. In cases of urinary retention caused by acute prostatitis, epicystostomy is the solution; transurethral catheterization is not recommended due to the increased risk of epididymitis. Intermittent self-catheterization is recommended if the urinary retention is due to neurological causes, because it can reduce continous urinary tract infection unlike a permanent transurethral balloon catheter. In cases of clotting hematuria and urinary retention, use a catheter that is relatively thick (minimum 18-20 Ch), capable of clearing clots, and continuous physiological saline irrigation can be performed through the third lumen of the catheter to prevent clot formation, thus catheter blockage.

Question 50

Q

URO - 70
Surgical treatment methods suitable for BPH:
1) TURP (Transurethral Resection of the Prostate)
2) Open adenomectomy
3) Laser prostate enucleation
4) Radical prostatectomy
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
A) Answers 1, 2 and 3 are correct

EXPLANATION
The surgical solution for BPH depends on the size of the prostate. For volumes up to 70-80 ml, TURP is recommended, while for volumes above this, open adenomectomy or laser prostate enucleation may be suggested. Radical prostatectomy is performed not for BPH but for prostate cancer.

Question 51

Q

URO - 71
Characteristic feature of uroflowmetry curve for BPH:
A) Normal
B) Flat, plateau-like flow
C) Decreased maximum and average flow rate with a prolonged flow
D) Voiding volume less than 50 ml

Answer

A

ANSWER
C) Decreased maximum and average flow rate with a prolonged flow

EXPLANATION
The normal uroflowmetry curve is bell-shaped, while flat, plateau-like flow is typical for urethral stricture, not for BPH. The uroflowmetry of BPH is prolonged, but not plateau-like.

Question 52

Q

URO - 72
Characteristic of TUR syndrome, except:
A) Hyperkalemia
B) Intravascular hemolysis
C) Occurs during TURP
D) Renal function cannot deteriorate

Answer

A

ANSWER
D) Renal function cannot deteriorate

EXPLANATION
TUR syndrome typically develops during transurethral resection of the prostate (TURP) when a significant amount of hypotonic irrigation fluid enters the circulation during the surgery. This fluid can cause hemolysis, leading to hyperkalemia and potentially kidney failure

Question 53

Q

URO - 73
What is the most likely cause of fever?
Case: A 35-year-old female patient presents with right-sided flank pain and fever of 39 degrees Celsius. CT imaging revealed a 12 mm stone in the right ureter with dilated renal pelvis and swollen kidney parenchyma.
A) Urocystitis
B) Complicated acute pyelonephritis due to upper urinary tract obstruction
C) Rupture of the renal pelvis
D) Nephrotic syndrome
E) Renal tuberculosis

Answer

A

ANSWER
B) Complicated acute pyelonephritis due to upper urinary tract obstruction

EXPLANATION
Upper urinary tract dilation developed due to ureteral stone and got infected, as confirmed by the fever and swelling of the parenchyma. The patient developed complicated pyelonephritis.

Question 54

Q

URO - 74
What treatment option(s) is/are suitable?
Case: A 35-year-old female patient presents with right-sided flank pain and fever of 39 degrees Celsius. CT imaging revealed a 12 mm stone in the right ureter with dilated renal pelvis and swollen kidney parenchyma.
1) Broad-spectrum antibiotic therapy
2) Percutaneous nephrostomy
3) Double-J catheter
4) Extracorporeal shock wave lithotripsy (ESWL)
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
A) Answers 1, 2 and 3 are correct

EXPLANATION
In complicated pyelonephritis accompanied by fever, systemic broad-spectrum antibiotic therapy is necessary to treat bacteremia. In the presence of a large ureteral stone, spontaneous stone passage and resolution of the dilatation cannot be expected. Placement of a double-J catheter or nephrostomy tube is necessary for drainage of purulent fluid accumulation in the renal pelvis. Shock wave lithotripsy is contraindicated in a purulent environment.

Question 55

Q

URO - 75
In which case of complication might kidney removal be necessary?
Case: A 35-year-old female patient presents with right-sided flank pain and fever of 39 degrees Celsius. CT imaging revealed a 12 mm stone in the right ureter with dilated renal pelvis and swollen kidney parenchyma.
A) Concomitant localized peritonitis
B) Polyarthritis
C) Rupture of renal pelvis
D) Pyelonephritis with apostematous complications leading to urosepsis
E) Bladder rupture

Answer

A

ANSWER
D) Pyelonephritis with apostematous complications leading to urosepsis

EXPLANATION
Despite antibiotic therapy and upper urinary tract diversion, persistent symptoms may indicate the formation of a renal abscess. One form of this is apostematous inflammation involving numerous small abscess formations affecting the renal parenchyma. In such cases, if other treatments fail, kidney removal may be unavoidable.

Question 56

Q

URO - 76
What disease(s) most commonly present with symptom called silent hematuria?
Case: A 65-year-old male patient with macroscopic hematuria presents at the urology outpatient clinic. He does not complain of urinary retention or painful urination. He does not mention any abdominal discomfort.
1) Acute prostatitis
2) Benign prostatic hyperplasia
3) Upper urinary tract cancer
4) Bladder cancer
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
D) Only answer 4 is correct

EXPLANATION
Silent, painless hematuria most commonly indicates bladder cancer. Upper urinary tract cancer may also present with silent hematuria, but in these patients, renal colic may occur, as well as passing of worm or thread-like clots. Painless bleeding may also occur from the dilated veins of enlarged prostate (benign prostatic hyperplasia -BPH), but patients with BPH typically report dysuric symptoms. Hematuria can also occur in acute prostatitis, but it is typically accompanied by pain, urinary difficulty, and fever.

Question 57

Q

URO - 77
Which conditions can increase the risk of developing hematuria?
Case: A 65-year-old male patient with macroscopic hematuria presents at the urology outpatient clinic. He does not complain of urinary retention or painful urination. He does not mention any abdominal discomfort.
1) Diabetes mellitus
2) Chronic liver disease
3) Hypertension
4) Anticoagulant therapy
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
C) Answers 2 and 4 are correct

EXPLANATION
Chronic liver disease can lead to a decreased level of factors necessary for hemostasis, resulting in an increased tendency for bleeding. The same risk applies to anticoagulant therapies widely used for various indications, including inhibition of platelet aggregation or the use of low molecular weight heparins.

Question 58

Q

URO - 78
Which tests can help to determine the origin of hematuria?
Case: A 65-year-old male patient with macroscopic hematuria presents at the urology outpatient clinic. He does not complain of urinary retention or painful urination. He does not mention any abdominal discomfort.
1) Cystoscopy
2) Urine dipstick test
3) CT urography
4) Urodynamic testing
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct

Answer

A

ANSWER
B) Answers 1 and 3 are correct

EXPLANATION
Cystoscopy can confirm bleeding originating from prostate and bladder abnormalities, while detecting bleeding from the ureters can suggest upper urinary tract origins and their lateralization. Contrast-enhanced CT with a delayed phase can confirm the origin of bleeding throughout the entire urinary system. Urine sediment analysis is a nonspecific test that can confirm hematuria but does not provide information about its origin. Urodynamic testing provides information about bladder function but is not used in the diagnosis of bloody urine.

Question 59

Q

URO - 79
Which tests need to be performed?
Case: 50-year-old male. After a day of drinking alcohol, he experiences blunt abdominal trauma. He was brought to the emergency department by ambulance. He is conscious and oriented. Vital signs: Blood pressure: 140/80 mmHg, Pulse: 80/min. On physical examination, he complains of diffuse abdominal pain, with the point of maximum tenderness located above the symphysis pubis. He hasn’t urinated for hours.
A) Chest X-ray
B) Abdominal and pelvic CT with contrast agent
C) Abdominal X-ray
D) Bowel transit study

Answer

A

ANSWER
B) Abdominal and pelvic CT with contrast agent

EXPLANATION
Blunt abdominal trauma with a full bladder predisposes to bladder rupture. It can be diagnosed by abdominal and pelvic CT with contrast agent. Attention should be drawn to the history, physical examination, and the absence of urination.

Question 60

Q

URO - 80
In the contrast-enhanced abdominal and pelvic CT scan, what should we ask from the radiologist? If they can confirm the presence of ………….:
Case: 50-year-old male. After a day of drinking alcohol, he experiences blunt abdominal trauma. He was brought to the emergency department by ambulance. He is conscious and oriented. Vital signs: Blood pressure: 140/80 mmHg, Pulse: 80/min. On physical examination, he complains of diffuse abdominal pain, with the point of maximum tenderness located above the symphysis pubis. He hasn’t urinated for hours.
A) Gastric rupture
B) Bladder rupture
C) Rib fracture
D) Spinal injury

Answer

A

ANSWER
B) Bladder rupture

EXPLANATION
Leakage of contrast material from the bladder confirms suspicion of bladder injury.

Question 61

Q

URO - 81
In case of intraperitoneal bladder injury, the treatment is:
Case: 50-year-old male. After a day of drinking alcohol, he experiences blunt abdominal trauma. He was brought to the emergency department by ambulance. He is conscious and oriented. Vital signs: Blood pressure: 140/80 mmHg, Pulse: 80/min. On physical examination, he complains of diffuse abdominal pain, with the point of maximum tenderness located above the symphysis pubis. He hasn’t urinated for hours.
A) Transurethral balloon catheter
B) Epicystostomy
C) Bilateral percutaneous nephrostomy
D) Surgical exploration, bladder suturing and revision of the intestinal tract

Answer

A

ANSWER
D) Surgical exploration, bladder suturing and revision of the intestinal tract

EXPLANATION
In the case of intraperitoneal bladder injury, surgical intervention is necessary to remove the urine from the peritoneum, check the integrity of the intestines, and suture the bladder injury to prevent the development of severe peritonitis in the absence of these measures. Infraperitoneal bladder lesions can heal with the placement of a permanent urinary catheter, without the need for surgical exploration.

Question 62

Q

URO - 82
What is the most likely diagnosis?
Case: A non-pregnant woman presents to the emergency department with fever and lower back pain. Previously, she experienced the symptoms of lower urinary tract infection. Her lower back is tender to percussion, and urine dipstick test shows hematuria and pyuria.
A) Upper urinary tract cancer
B) Acute pyelonephritis
C) Pyelo-ureteral reflux
D) Acute cystitis

Answer

A

ANSWER
B) Acute pyelonephritis

EXPLANATION
Fever and pyuria indicate inflammation of the urinary parenchymal organs. Hematuria (but not hemato-pyuria) is mainly indicative of renal pelvis tumor, while kidney pain typically associated with pyelo-ureteral reflux is due to increased hydrostatic pressure in the bladder (e.g., during urination or bladder filling). Cystitis is not accompanied by fever.

Question 63

Q

URO - 83
What tests would you preform first?Case: A non-pregnant woman presents to the emergency department with fever and lower back pain. Previously, she experienced the symptoms of lower urinary tract infection. Her lower back is tender to percussion, and urine dipstick test shows hematuria and pyuria.
1) Laboratory tests (complete blood count, CRP, kidney function)
2) Urine culture
3) Ultrasound
4) CT
A) All answers are correct
B) Answers 1 and 3 are correct
C) Answers 1, 2 and 3 are correct
D) Answers 1, 3 and 4 are correct
E) Answers 1, 2 and 4 are correct

Answer

A

ANSWER
C) Answers 1, 2 and 3 are correct

EXPLANATION
Laboratory tests, especially parameters indicating inflammation, are essential. They not only help assess the severity of the condition but also facilitate monitoring. Urine culture can assist in selecting targeted antibiotic therapy, particularly if empirical treatment fails. Ultrasound is the first step in evaluating the condition of the kidneys, allowing detection of urinary tract dilatation or abscesses. A CT scan of the abdomen and pelvis is not immediately recommended (not in the first line) but may be necessary if the cause is unclear or if the condition does not improve.

Question 64

Q

URO - 84
What treatment would you choose?Case: A non-pregnant woman presents to the emergency department with fever and lower back pain. Previously, she experienced the symptoms of lower urinary tract infection. Her lower back is tender to percussion, and urine dipstick test shows hematuria and pyuria.
1) Antibiotics, hydration, antipyretics, bed rest
2) Antibiotics
3) Change of antibiotic if renal asbcess is confirmed
4) Urinary diversion in case of renal pelvic dilatation
A) Answers 2 and 4 are correct
B) Answers 1 and 3 are correct
C) Answers 1 and 4 are correct
D) Answers 2, 3 and 4 are correct
E) Answers 1, 3 and 4 are correct

Answer

A

ANSWER
C) Answers 1 and 4 are correct

EXPLANATION
Bacterial origin requires administration of antibiotics, with antipyretics needed for fever, which also have analgesic effects. Bed rest is advisable for most patients who are unwell. In the case of pyelectasia, diversion of the infected urine is essential to prevent progression. In the case of a renal abscess, invasive methods such as drainage of the abscess, surgical exploration, or even nephrectomy may be necessary.

Answer 65

A

ANSWER
D) Nitrofuranotin

EXPLANATION
Nitrofurantoin is used in the treatment of lower urinary tract infections but is not used in cases of acute pyelonephritis

Answer 66

A

ANSWER
D) Fluoroquinolone

EXPLANATION
Uncomplicated acute cystitis often resolves without the need for antibiotic therapy, alongside supportive treatment. If antibiotics are used, nitrofurantoin or fosfomycin are recommended due to their good resistance profiles and low side effects. Fluoroquinolones are not recommended as first-line treatment for lower urinary tract infections due to their decreased use caused by common side effects and high resistance rates. Symptomatic treatment with nonsteroidal anti-inflammatory drugs or bactericidal agents (such as D-mannose) alone is often sufficient.

Answer 67

A

ANSWER
E) broad-spectrum antibiotics, non-steroidal anti-inflammatory drugs, and epicystostomy in case of urinary retention

EXPLANATION
Acute prostatitis is a severe infectious disease requiring broad-spectrum antibiotic treatment. Massage of the prostate (previously used in the treatment of chronic prostatitis) to allow inflammatory secretions to enter the circulation is prohibited. In urinary retention, urethral catheter to prevent secretion is contraindicated, insertion of epicystostomy (suprapubic catheter) is an option. Local cooling of the prostate (Arzberger’s treatment) and non-steroidal anti-inflammatory drugs can complement antibiotic treatment but are not suitable for the treatment of prostatitis alone. The inflammatory process may cause a false-positive rise in PSA level and is not useful for therapeutic decisions in acute prostatitis.

Answer 68

A

ANSWER
B) Answers 2, 3, 4 are correct

EXPLANATION
Acute epididymitis, like all bacterial infections, requires antibiotic treatment. To relieve symptoms, icing of the sensitive area (scrotum) and NSAIDs are recommended to speed healing. Removal of the epididymis (epididymectomy) is only an option in cases of abscess formation. Urinary diversion can be used in acute prostatitis and in cases complicated by urinary retention, in which a suprapubic catheter is inserted.

Answer 69

A

ANSWER
D) Answers 2 and 3 are correct

EXPLANATION
For urinary tract inflammation during pregnancy, penicillin derivatives are the first-line antibiotic treatment of choice. Fluoroquinolones are not recommended in pregnancy. Because of the risk of preterm delivery and fetal retardation, asymptomatic bacteriuria should be treated. Pyelectasia alone does not require intervention, but if it is accompanied by acute pyelonephritis that does not improve on antibiotic treatment, urinary diversion (double J catheter or percutaneous nephrostomy) is recommended.

Answer 70

A

ANSWER
D) all of the above

EXPLANATION
Needle biopsy can cause bleeding. Transrectal prostate biopsy can cause infection and prostatitis. Temporary swelling of the prostate after biopsy may cause difficulty in urination.

Answer 71

A

ANSWER
C) pelvic MRI scan, chest CT scan, bone isotope

EXPLANATION
Locoregional propagation can be excluded by pelvic MRI scan and typical distant metastases by bone isotope and chest CT scan.

Answer 72

A

ANSWER
A) radical prostatectomy, radiotherapy

EXPLANATION
Possible curative treatment options for localized prostate cancer are radical prostatectomy and radiotherapy.

Answer 73

A

ANSWER
B) urethral stricture, incontinence, erectile dysfunction

EXPLANATION
the typical complications after radical prostatectomy are stricture of the urethral anastomosis, incontinence due to weakness of the external sphincter and erectile dysfunction due to nerve damage.

Answer 74

A

ANSWER
A) PSA, chest and abdomen CT scan, bone scan, PSMA PET-CT scan

EXPLANATION
PSA, chest CT scan and bone biopsy are standard methods for prostate cancer follow-up, PSMA PET-CT scan may be used in uncertain cases.

Answer 75

A

ANSWER
A) Answers 1, 2 and 3 are correct

EXPLANATION
For metastatic prostate cancer chemotherapy (docetaxel, cabazitaxel), androgen receptor pathway inhibitors (enzalutamide, apalutamide, abiraterone acetate), and for bone metastases alpha radiation radium isotope therapy can be offered. Radical prostatectomy is a treatment option for organ confined tumors.

Answer 76

A

ANSWER
B) Kidney biopsy and exploratory biopsy of the femur

EXPLANATION
If the diagnosis of renal tumor is confirmed by the imaging tests, sampling from the kidney and the femur is not necessary.

Answer 77

A

ANSWER
D) The above answers A-B-C in that order

EXPLANATION
If the patient has a solitary metastasis and life expectancy is more than one year: radical surgery should be applied. Radical surgery of the primary tumor should be done before the treatment of metastasis.

Answer 78

A

ANSWER
C) Irradiation of lung metastases

EXPLANATION
The above-mentioned medications can be expected to prolong survival and improve quality of life. Irradiation may be effective in relieving the symptoms of bone metastases but it is ineffective for lung metastases.

Answer 79

A

ANSWER
E) palpable inguinal lymph nodes

EXPLANATION
A large renal tumor may be palpable and painful. It can also cause varicocele through occlusion of the renal vein and vena cava. If the tumor reaches the renal pelvis, it might lead to haematury. Renal tumors do not metastasize to the inguinal region.

Answer 80

A

ANSWER
B) intravenous urography

EXPLANATION
In the investigation of renal tumors, in addition to the examination of the extent of the primary tumor, the screening of distant metastases is essential for treatment planning. Intravenous urography does not provide useful information on either the primary tumor or metastases.

Answer 81

A

ANSWER
A) Answers 1, 2 and 3 are correct

EXPLANATION
The treatment of kidney cancer is primarily surgical, radical nephrectomy or kidney-sparing excision of the tumor. In some cases (e.g. high surgical risk, multiple tumors, etc.) minimally invasive destructive techniques may be considered, and in the elderly, close follow-up for small tumors should be considered, as the risk of surgery may exceed the risk of tumor. Renal tumors are not radiosensitive and cannot be treated with classical chemotherapeutic drugs, only immunotherapy or biological therapy can be applied.

Answer 82

A

ANSWER
B) Inguinal lymph nodes

EXPLANATION
the lymphatic drainage of the penis is directed towards the lumbar lymph nodes, so this region is the primary site of metastasis.

Answer 83

A

ANSWER
C) Answers 2 and 4 are correct

EXPLANATION
Precancerous conditions can be classified into low- and high-risk groups according to the frequency of developing to penile cancer. Bowen’s disease and Lichen sclerosus belong to the high-risk group. Condyloma acuminatum and balanitis do not belong to the group of precancerous conditions.

Answer 84

A

ANSWER
B) Blood in urine

EXPLANATION
The most common symptom of bladder cancer is asymptomatic haematuria. Microscopic haematuria is when microscopic examination of the urine confirms blood in the urine, or macroscopic is when the color of blood is visible to the patient. Fever and pain are less common symptoms, occurring when there is secondary inflammation, upper urinary tract obstruction or a large tumor. Weight loss is a late symptom of the tumor.

Answer 85

A

ANSWER
B) Answers 1 and 3 are correct

EXPLANATION
To reduce recurrence, instillation of local chemotherapy within 6 hours after transurethral surgery is recommended for all endoscopically non-muscle-invasive looking tumors if there is no suspicion of bladder perforation or bleeding risk. If the patient has not received early local chemotherapy, intravesical chemotherapy is recommended once a week for 6 weeks after surgery. Chemotherapy should not be given before surgery. There is no proven benefit of local chemotherapy after partial resection or muscle infiltration.

Answer 86

A

ANSWER
A) Answers 1, 2 and 3 are correct

EXPLANATION
Ultrasonography of the pelvis and bladder ultrasonography play a major role in the diagnosis of bladder cancer. Urine cytology can be used to detect high-grade tumors and is important in the follow-up of these tumors and thus in the early detection of their recurrence. Tumor markers are not currently (2024) in routine clinical practice and cannot replace the diagnostic steps listed above.

Answer 87

A

ANSWER
C) Surgical (if possible microsurgical) sperm extraction can be performed, with a background of cryopreservation. After a successful intervention intracytoplasmic sperm injection (ICSI) can be performed.

EXPLANATION
Non-obstructive azoospermia is a secretory dysfunction, a disorder of spermatogenesis. Approximately 50% of these patients have focal spermatogenesis. Finding these foci (testicular ducts) and isolating sperm from them can lead to pregnancy via ICSI. The intervention must be performed with cryopreservation background.

Answer 88

A

ANSWER
B) Cardiology consultation

EXPLANATION
The risk factors of erectile dysfunction show significant similarities with the risk factors of cardiovascular diseases. Men between the ages of 40 and 50 with erectile dysfunction are 50 times more likely to have cardiovascular events within 10 years. The frequency between 50 and 60 years is 6.5 times more, above 60 years the difference is less. For this reason in the international guidelines the cardiology consultation is included at the level of the physical examination in the flowchart for the investigation of erectile dysfunction.

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