Urology

Question 1
The von Hippel-Lindau (VHL) gene mutation is MOST commonly found in:
1. Type 1 papillary renal cell carcinoma
2. Type 2 papillary renal cell carcinoma
3. Sporadic non-inherited clear cell renal cell carcinoma
4. Chromophobe renal cell carcinoma

Answer 1
The correct answer is 3. Sporadic non-inherited clear cell renal cell carcinoma.

Question 2
Three years after placement of an artificial urinary sphincter (AUS) post prostatectomy and adjuvant radiotherapy,
a 67-year-old man presents with urosepsis, a large scrotal abscess, and urethral cuff erosion. The cuff is removed,
the urethra repaired, and a catheter is left in place for 3 weeks. Repeat evaluation 6 months later includes a
normal urethroscopy, and a 3 pad per day bothersome stress urinary incontinence. What is the MOST appropriate
management?
1. Cunningham clamp
2. Male sling
3. Bladder neck injection with bulking agent
4. Transcorporeal placement of a new AUS.

Answer 2
The correct answer is 4. Transcorporeal placement of a new AUS/

Question 3
What is the mechanism of action of trimethoprim?
1. Inhibition of dihydropteroate synthetase
2. Competitive inhibition of dihydrofolate reductase
3. Inhibition of cell wall synthesis
4. Disruption of protein synthesis

Answer 3
The correct answer is 2. Competitive inhibition of dihydrofolate reductase.
 Urology

Question 4
The acute phase (i.e. the first 1-2 hours) of unilateral ureteral obstruction is initially characterized by:
1. Increased renal blood flow
2. Increased glomerular filtration rate (GFR)
3. Increased afferent arteriole resistance
4. Increased tubuloglomerular feedback

Answer 4
The correct answer is 1. Increased renal blood flow.

Question 5
During laparoscopic left adrenalectomy for a 3-cm adrenal mass, troublesome bleeding is encountered during
dissection along the medial margin of the gland. What is the MOST likely source of bleeding?
1. Lumbar vein
2. Inferior vena cava
3. Inferior phrenic vein
4. Splenic vein

Answer 5
The correct answer is 3. Inferior phrenic vein.