Q 1: A 65-year-old man with a history of BPH has recurrent gross

hematuria. The patient is clinically stable, with no transfusion

requirement, no clots in urine, and no difficulty with bladder

emptying. A hematuria evaluation with CT urogram, cystoscopy,

and urine cytology is otherwise unremarkable. The best next step in

management is:

a. five-alpha reductase inhibitor.

b. alpha-blocker therapy.

c. prostatic artery embolization (PAE).

d. channel TURP.

e. trial of antibiotic therapy

Ans: a. Five-alpha reductase inhibitor. Treatment with five-alpha

reductase inhibitors has been associated with decreased VEGF

expression, prostate microvessel density, and prostatic blood

flow

Q2: Symptomatic physiologic hydronephrosis of pregnancy should be

primarily managed by:

a. percutaneous nephrostomy.

b. conservative measures.

c. antibiotic prophylaxis.

d. ureteral stent.

e. Alpha-blocker therapy.

ANS: b. Conservative measures. In general, ureteral stent insertion in

symptomatic gestational hydronephrosis does not generally add

benefit over conservative treatment and should be reserved for

complicated cases or additional pathologic obstructions.

Q3: The bladder trigone develops from which of the following

structures?

a. Mesonephric ducts
b. Müllerian ducts

c. Urogenital sinus

d. Metanephric mesenchyme

ANS: c. Urogenital sinus

[1:59 pm, 28/05/2021] Dr Bilal: Which of the following is a contraindication to

transureteroureterostomy for repair of significant lower ureter

injury?

a. History of urolithiasis

b. History of ureteral trauma

c. Morbid obesity

d. Neurogenic bladder

e. Thoracic spine fracture

Q4: a. History of urolithiasis. TUU is contraindicated in patients with a

history of kidney stones because a distal ureteral obstructing stone

can put then put both kidneys at risk.

ANS: What is the best treatment for a short, mid ureter ureteral contusion

caused by a high-velocity bullet?

a. Observation

b. Ureteral stent placement

c. Transureteroureterostomy

d. Excision and ureteroureterostomy

e. Oversew the contusion with healthy ureteral tissue

ANS: d. Excision and ureteroureterostomy. High-velocity gunshot

wounds to the ureter result in blast injury and thus often heal with

stricture or break down from ureteral necrosis.

Q6:Renal tubular acidosis may be associated with nephrolithiasis due

to:

a. hypercalciuria and hypocitraturia.

b. hyperoxaluria and hypercalcemia.

c. hyperuricosuria.

d. hypocitraturia with normal urine magnesium.

e. hypercitraturia and hypercalciuria.

ANS: a. Hypercalciuria and hypocitraturia. Hypocitraturia, commonly

seen in patients with dRTA, promotes the formation of

nephrolithiasis due to reduced inhibitory action of urinary citrate.

In addition, hypercalciuria will occur due to mobilization of

calcium from bone and impaired renal tubular absorption of

calcium, both as a result of chronic acidosis.

Q7: Which of the following is the most difficult stone composition to

fragment with SWL?

a. Calcium oxalate dihydrate

b. Calcium oxalate monohydrate

c. Struvite

d. Hydroxyapatite

e. Uric acid

ANS: b. Calcium oxalate monohydrate. Cystine and brushite are the

stones most resistant to SWL, followed by calcium oxalate

monohydrate. Next, in descending order, are hydroxyapatite,

struvite, calcium oxalate dihydrate, and uric acid stones.

Q8: A 42-year-old woman presents with a hypoenhancing renal mass

that is resected and determined to be a metanephric adenoma. A

paraneoplastic syndrome identified in this disease is:

a. hyperaldosteronism.

b. hyperparathyroidism.

c. Cushing syndrome.

d. polycythemia.

e. syndrome of inappropriate antidiuretic hormone secretion

(SIADH).
ANS: d. Polycythemia. Polycythemia (d) has been identified in

metanephric adenoma due to tumor production of erythropoietin,

IL-6, IL8, G-CSF, and GM-CSF. The remainder (a, b, c, e) of

choices describe paraneoplastic syndromes not associated with

metanephric adenoma.

Q9: A 35-year-old woman in her third trimester is brought to the

emergency department unresponsive with hypotension, anemia,

and is found to have a retroperitoneal hemorrhage. The most likely

cause is:

a. angiomyolipoma.

b. clear cell renal cell carcinoma.

c. metanephric adenoma.

d. oncocytoma.

e. trauma

ANS: a. Angiomyolipoma. The most common cause of Wunderlich

syndrome is from an angiomyolipoma (a). An additional clue to

this presentation is the patient’s pregnancy, where hormonal

changes can result in growth of the lesion

Q10: Which of the following is an absolute contraindication to

laparoscopic radical nephrectomy?

a. Tumor size greater than 14 cm

b. Age older than 80 years

c. Uncorrected coagulopathy

d. Renal vein thrombus

e. Multiple prior abdominal surgeries

ANS: c. Uncorrected coagulopathy. Uncorrected coagulopathy is an

absolute contraindication to laparoscopic renal surgery, as are

untreated infection and hypovolemic shock. Laparoscopic partial

nephrectomy has been reported as a feasible and safe approach in

the management of select large renal masses, elderly patients, renal

vein thrombosis, and multiple prior abdominal surgeries

Q11: Conditions that decrease urine specific gravity include all of the

following EXCEPT:

a. increased fluid intake.

b. use of diuretics.

c. decreased renal concentrating ability.

d. dehydration.

e. diabetes insipidus

ANS: d. Dehydration. Conditions that decrease specific gravity include

(1) increased fluid intake, (2) diuretics, (3) decreased renal