Urology Final Exam 2020-2021

Urology Final Exam 2020-2021:

Duration: 60 minutes
60 questions (17 SCQs Dr. Mohammad MOUSSA, 11 SCQs Dr. Walid ALAME, 10
SCQs Dr. Mohammad AJROUCH, 10 SCQs Dr. Antoine NOUJEIM, 12 SCQs Dr.
Nehme RAAD)
IT’S IMPORTANT TO STUDY THE SESSION FOR THE EXAM, ESPECIALLY DR.
AJROUCH.
ALL DR. MOUSSA’S QUESTIONS ARE FROM THE RED INFORMATION IN THE SLIDES.
Note: The questions are written in the same order as that in the exam  not all the
questions of the same Dr. are discrete, rather some of them are found within the
questions of other Dr.

Choose the correct answer:

1. The following is true about vesicoureteral reflux:
a. It is a retrograde urine flow
b. Is asymptomatic or associated with severe nephropathy
c. Caused by inadequate length of the intravesical submucosal tunnel of
the ureter
d. All are true

2. The gold standard technique for the diagnosis of VUR is:

a. CT Scan
b. Ultra Sonography
c. Cystography
d. Renal Scintigraphy

3. What is true about Hypospadias:

a. Is a ventral opening
b. Leads to chordee
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 c. Has a glandular groove and a dorsal hood of foreskin
d. All are true

4. Choose the wrong about epispadias:

a. Is a dorsal opening
b. Has a short stubby phallus
c. Is not associated with bladder exstrophy
d. Sometimes associated with urinary incontinence

5. Posterior urethral valve can be treated by:

a. Cystoscopic valve ablation
b. Urinary diversion by a Foley catheter or suprapubic catheter
c. Incision of the bladder neck
d. All of the above

6. UPJ stenosis: which is incorrect

a. Ureteral hypoplasia
b. Aperistalsis
c. Entrapment of ureter by crossing vessel
d. All are correct

7. UPJ surgery is indicated in:

a. Less than 40% split function of the affected kidney on diuretic urogram
b. Recurrent UTI
c. Renal parenchymal atrophy
d. Horseshoe kidney

8. Angiomyolipoma:
a. Most frequent benign renal tumor
b. Asymptomatic
c. Can cause spontaneous retroperitoneal hemorrhage
d. Surgery is the only treatment

9. RCC, all are true except:

a. Clear cell carcinoma represents 70% of them
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 b. Renal medullary is the least aggressive
c. Triad of hematuria, abdominal mass and flank pain is uncommon (6-
10%)
d. It is associated with renal end stage disease in 4%

10. Adrenal cancers, all are true except:

a. 0.05-0.2% of cancers with female preponderance
b. Related to several hereditary syndromes
c. Radiotherapy is used for metastasis
d. Treatment is only total excision

11. Bladder cancer risk factors include:

a. Smoking
b. Aryl amine exposure
c. Chemotherapy
d. Pelvic radiation therapy
e. All of the above

12. Bladder cancer:

a. 5% squamous cell carcinoma
b. 90% transitional cell carcinoma
c. 0.5%-2% adenocarcinoma
d. Carcinogenesis could has 40 year latency period
e. All of the above

13. Which is true concerning urinary cytology?

a. High sensitivity in low grade tumor
b. Low sensitivity in high grade tumor
c. Used in follow up with cystoscopy of high risk disease
d. Negative urinary cytology excludes tumor

14. Treatment of bladder cancer:

a. TRU-BT to obtain pathology
b. The absence of detrusor muscle is associated with a significantly higher
risk of residual disease
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 c. BCG is immunotherapy
d. Cystectomy us the gold standard in case of localized invasive bladder
cancer
e. All of the above

15. Which is wrong about renal incontinence?

a. Stress urinary incontinence is due to loss of support from pelvic floor
musculature and connective tissue
b. Stress urinary incontinence is due to urethral sphincter weakness
c. Urge incontinence is due to detrusor overactivity
d. Childbirth is not a risk factor of urinary incontinence

16. Chronic pelvic pain syndrome (false statement):

a. Prevalence 25% - 30%
b. Most common urological disorder in men < 50 years old
c. It is due to a psychogenic problems with neurological, immune and
endocrinological disturbances
d. Type III can be inflammatory and non-inflammatory

17. Bladder stones:

a. Mainly in developing countries
b. Higher prevalence in males than females
c. Due to urinary stasis
d. 10% uric acid

18. Treatment of bladder stones include all the following except:

a. Open surgery is the gold standard
b. Medical therapy by dilution of stones by giving oral alkalinization drugs
c. Surgical removal by endoscopic procedures can be done
d. Cystolitholapaxy or laser stone fragmentation

19. Regarding the testicular torsion, all of the following are false except:
a. Usually occurs before puberty
b. It is a medical emergency
c. The cremasteric reflex is present
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 d. Doppler is not a must to do before surgery
20. Renal colic, all are false except:
a. Subacute
b. Bed rest can relieve the patient
c. CT scan is the choice for diagnosis
d. We can overhydrate during acute episodes

21. Non seminomatous GCTs (false):

a. Yolk sac tumor is most common in children
b. Teratoma is resistant to chemotherapy
c. They are chemosensitive
d. Atrophy is not risk factor of testicular cancer

22. About testicular cancer:

a. Most common solid tumor of men age 15 to 34 years old
b. Painless hard mass or swelling of the testicle
c. ……….
d. ……….

23. Fournier gangrene (choose the false):

a. Life threatening condition
b. Involves the lower abdomen
c. Caused by both aerobic and anaerobic bacteria
d. Crepitation occurs in a late finding

24. In case of a blunt trauma to the kidney, which is not true:

a. look for grade 5 injury
b. Imaging is not necessary in case of gross hematuria
c. ……….
d. ……….

25. About blunt trauma injury to the bladder (choose the correct answer):
a. It's often associated with other non-urologic injuries
b. Intraperitoneal injury occurs with pelvic fracture
c. It's associated with 80-94% of pelvic fractures
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 d. ……….
26. Concerning trauma to the testicles, which of the following is NOT true:
a. The testes are protected by cremasteric reflex
b. Blunt trauma causes eggplant deformity
c. Conservative management leads to necrosis
d. 75% is blunt trauma

27. Penile fracture:

a. From outside to inside: skin  dartos fascia  Buck fascia  tunica
vaginalis
b. Disruption of the tunica albuginea
c. Delayed surgical repair results in lower incidence of long-term penile
curvature
d. Dartos fascia rupture  Eggplant deformity

28. About penile amputation, all of the following are TRUE except:
a. It is usually the result of genital self-mutilation
b. 50% of patients performing genital self-mutilation are psychotic
c. The surgery achieves very good results
d. a and c are correct
e. a, b, and c are correct

29. Question about urethral injury

30. Concerning spermatogenesis:

a. Meiosis occurs in the epididymis
b. Mitosis occurs in the epididymis
c. It takes 72 days
d. ……….

31. Choose the correct answer :

a. Oligospermia: increase in number of sperm cells in the ejaculate
b. Azoospermia: no sperm cells in the ejaculate
c. Asthenospermia: increase in sperm motility
d. Teratospermia: low sperm count
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32. Most common cause of UTI:
a. Klebsiella
b. Proteus
c. Escherichia coli
d. Enterococcus
e. Pseudomonas aeruginosa

33. Pyuria without bacteriuria, think about:

a. Tuberculosis
b. Stones
c. Cancer
d. All of the above

34. Most common route of urinary tract infection:

a. Ascending route
b. Hematogenous route
c. Lymphatic route
d. Direct extension

35. About semen:

a. Seminal vesicle produces 60% of seminal fluid
b. prostate produces 4% of seminal fluid
c. ……….
d. ……….

36. When are we sure that a female has cystitis?

a. Ecoli > 1,000 CFU/ml
b. Ecoli > 10,000 CFU/ml
c. Ecoli > 50,000 CFU/ml
d. ……….
e. Ecoli > 100,000 CFU/ml

37. All factors suggest complicated UTI except one:

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 a. Elderly patient
b. 29 years old female
c. Male gender
d. Pregnancy

38. All statements about Gonococcal Urethritis are true except one:
a. It is sexually transmitted disease
b. Neisseria Gonorrhea a diplococus Gram negative is the pathogen
responsible
c. Whitish urethral discharge
d. Direct exam of Urethral swap can diagnosis 95% of cases

39. All statements about Non Gonococcal Urethritis are true except one:
a. Usually found in association with gonorrhea
b. Chlamydia Trachomatis most commonly found
c. Water like urethral discharge
d. Direct exam of Urethral swap can find chlamydia in 95%

40. Cryptorchidism: which statement is NOT TRUE:

a. Hormone therapy: Not used routinely
b. Orchidopexy: treatment of choice
c. Surgery should take place after Puberty
d. Laparoscopic surgery is indicated for non-palpable Testis

41. Testicular Torsion: which statement is NOT TRUE:

a. Abrupt onset of scrotal pain
b. Edematous, tender scrotum
c. Elevation of testis relieves pain (Prehn's Sign)
d. Cremasteric reflex is absent

42. Which from the following symptoms is NOT considered an irritative urinary
symptom?
a. Urinary frequency
b. Urgency
c. Intermittence
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 d. Urge incontinence
43. What does the T3b staging in the TNM classification of prostate cancer
mean?
a. Extension to the rectum
b. Extension to the seminal vesicles
c. A tumor extending to both prostatic lobes
d. Macroscopic extension beyond the prostate capsule

44. At which PSA value (minimum required value) the risk of BPH progression
increases?
a. 0.5 ng/ml
b. 1.5 ng/ml
c. 2.5 ng/ml
d. 4 ng/ml

45. A 65 years old man presented to your clinic for general check-up. He was
brought on a wheel chair due to a recent stroke 3 months ago. He was
found to have multiple comorbidities with a low ejection faction and
dyspnea at rest. A digital rectal examination was non-suspicious for
prostate cancer. What is your recommendation about screening for
prostate cancer in this patient?
a. A PSA should be done now and then yearly
b. The total PSA should be done without the free PSA
c. If the total PSA is 4.3 ng/ml, do a transrectal prostate biopsy
d. A PSA is not recommended

46. Distal rectal exam usually evaluates which of the following prostatic zone?
a. Peripheral zone
b. Central zone
c. Periurethral zone
d. Median lobe

47. About PSA dosage:

a. It is a tumor marker secreted by muscle cells of the prostate
b. It increases of about 0.3 ng/ml for each gram of prostatic tissue
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 c. It must done yearly for men till the age of 90
d. A PSA between 4 and 10 ng/ml is considered to be normal

48. Choose the correct answer about the treatment of benign prostatic
hyperplasia using alpha blockers:
a. Alpha blockers acts at the level of striated muscle cells of the bladder
neck and the prostatic urethra
b. Alpha blockers acts at the level of glandular component of the prostate
c. Symptoms relieve is late after the treatment with alpha blockers
d. They are indicated if the patient has bothersome urinary symptoms with
a small prostate

49. About calcium stones:

a. 50% of blood calcium is filtered: among those, 95% are reabsorbed and
2% are excreted
b. 30% of urinary stones are calcium stones
c. They could be associated with a crohn disease in case of calcium
phosphate stones
d. We can distinguish between renal and absorptive hypercalciuria by
measuring PTH level

50. Renal colic:

a. Is caused by a chronic obstruction of the ureter
b. Is considered a medical emergency in case of associated fever
c. Is associated with gastrointestinal symptoms such as vomiting and
diarrhea
d. Is always associated with macroscopic hematuria

51. Which of the following pathologies is NOT associated with calcium oxalate
stone?
a. Inflammatory bowel disease
b. Chronic urinary tract infection
c. Jejunoileal bypass
d. Hyperparathyroidism

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52. What should a patient presenting for erectile dysfunction be evaluated for?
a. Macroscopic hematuria
b. Premature ejaculation
c. Cardiac problems
d. Prostate cancer

53. Which of the following treatment rely on a sexual stimulation to improve

erection?
a. Oral phosphodiesterase inhibitors
b. Intracavernous prostaglandin E
c. Vacuum device
d. Penile prosthesis

54. What are the characteristics of a PSYCHOGENIC erectile dysfunction?

a. Gradual onset, varying course, situational and absent morning erections
b. Gradual onset, constant course, global and present morning erections
c. Acute onset, constant course, situational and absent morning erections
d. Acute onset, varying course, situational and present morning erections

55. What defines Peyronie's disease?

a. It is a segmental fibrosis of the tunica albuginea.
b. Its first phase is asymptomatic, with progressive curvature of the penis.
c. Its second phase is painful due to the inflammatory process.
d. It has a spontaneous regression of the curvature in most of the cases.

56. Which exam is the most important in case of a penile cancer?

a. Physical exam
b. Penile Ultrasound
c. Inguinal and penile CT scan
d. Penile MRI

57. Following a motor vehicle accident, a neurologic lesion at which level is able
to cause an autonomic dysreflexia?
a. Cerebral hematoma
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 b. Spinal cord lesion at T2
c. Spinal cord lesion at L2
d. Spinal cord lesion at S2

58. An ischemic stroke will most likely cause which dysfunctional voiding?
a. Detrusor hyporeflexia
b. Detrusor overactivity with no sphincter dyssynergia
c. Detrusor overactivity with external sphincter dyssynergia
d. Detrusor overactivity with external and internal sphincter dyssynergia

59. A 34 years old man presented to the emergency department following a car
accident for spinal cord injury at the level of L1. Three months after the
accident, he started to develop lower limbs spasticity with urinary
incontinence. Which condition should be suspected during this phase?
a. Detrusor hyporeflexia
b. Detrusor overactivity with no sphincter dyssynergia
c. Detrusor overactivity with external sphincter dyssynergia
d. Detrusor overactivity with external and internal sphincter dyssynergia

60. Testicular cancer associated with high HCG:

a. Choriocarcinoma
b. Embryonal carcinoma
c. Yolk sac tumor
d. Teratoma

Good luck

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