Urology Basics Practice Questions

Question 1

A 97-year-old man visits the urology clinic 5 days after experiencing urinary retention at an emergency department visit. The patient has a history of hypertension, type II diabetes mellitus, stroke, dyslipidemia, a past myocardial infarction, and severe osteoarthritis in his right hip. He is not compliant with his medications and his multiple comorbidities are poorly managed. In the hospital, the patient’s urinary retention was treated with Foley catheterization. At clinic, the patient’s serum-specific prostate-specific antigen (PSA) is 6.0 ng/mL (normal is < 4 ng/mL). Digital rectal examination (DRE) demonstrates a nontender prostate with several rock hard nodules. The patient's Foley is removed and he is able to urinate on his own. Which is the most appropriate next step in management?

Accepted Answer

Transrectal prostate biopsy

Answer

Repeat PSA test

Answer

CT abdomen and pelvis

Answer

Cystourethroscopy

Answer

Reassurance

Question 2

A previously healthy 22-year-old man presents to the university clinic with increasing scrotal pain and swelling over the past 5 days. He also has dysuria and urinary frequency. He has never felt this type of pain before. The young man considers himself generally healthy and takes no medications. He is sexually active with one partner and uses condoms inconsistently. At the clinic, his temperature is 36.7℃ (98.1℉), the blood pressure is 115/70 mm Hg, the pulse is 84/min, and the respirations are 14/min. On examination, he has swelling and tenderness of the right scrotum, especially over the posterior aspect of the right testicle. The Prehn sign is positive. The remainder of the physical exam is unremarkable. Doppler sonography shows increased blood flow to the testis. Which of the following is the most appropriate next step in management?

Accepted Answer

IV ceftriaxone and oral doxycycline

Answer

Oral metronidazole for patient and sexual partner

Answer

Radical orchiectomy

Answer

Surgical exploration

Answer

Manual detorsion guided by Doppler sonography

Question 3

A 75-year-old woman presents to the physician with a complaint of a frequent need to void at nighttime, which has been disrupting her sleep. She notes embarrassingly that she is often unable to reach the bathroom in time, and experiences urinary leakage throughout the night as well as during the day. The patient undergoes urodynamic testing and a urinalysis is obtained which is normal. She is instructed by the physician to perform behavioral training to improve her bladder control. Which of the following is the most likely diagnosis contributing to this patient’s symptoms?

Accepted Answer

Urge incontinence

Answer

Urinary tract infection

Answer

Stress incontinence

Answer

Overflow incontinence

Answer

Total incontinence

Question 4

A 75-year-old male presents to the emergency room complaining of severe lower abdominal pain and an inability to urinate. He reports that he last urinated approximately nine hours ago. When asked to urinate, only a few drops dribble from the tip of his penis. Further questioning reveals that the patient has experienced progressively worsening difficulty with urinating over the past two years. He has lived alone for five years since his wife passed away. He has not seen a doctor in that time. His temperature is 98.8°F (37.1°C), blood pressure is 145/90 mmHg, pulse is 115/min, and respirations are 22/min. He appears to be in severe pain. Physical examination reveals a distended bladder and significant tenderness to palpation over the inferior aspect of his abdomen. Which of the following sets of lab values would most likely be found in a urinalysis of this patient?

Accepted Answer

Urine osmolality 300 mOsmol/kg H2O, Urine Na+ 45 mEq/L, FENa 5%, no casts

Answer

Urine osmolality 550 mOsmol/kg H2O, Urine Na+ 15 mEq/L, FENa 0.9%, red blood cell casts

Answer

Urine osmolality 400 mOsmol/kg H2O, Urine Na+ 25 mEq/L, FENa 1.5%, no casts

Answer

Urine osmolality 200 mOsmol/kg H2O, Urine Na+ 35 mEq/L, FENa 3%, muddy brown casts

Answer

Urine osmolality 600 mOsmol/kg H2O, Urine Na+ 15 mEq/L, FENa 0.8%, hyaline casts

Question 5

A 37-year-old woman presents to the Emergency Department after 8 hours of left sided flank pain that radiates to her groin and pelvic pain while urinating. Her medical history is relevant for multiple episodes of urinary tract infections, some requiring hospitalization, and intravenous antibiotics. In the hospital, her blood pressure is 125/83 mm Hg, pulse of 88/min, a respiratory rate of 28/min, and a body temperature of 36.5°C (97.7°F). On physical examination, she has left costovertebral tenderness and lower abdominal pain. Laboratory studies include a negative pregnancy test, mild azotemia, and a urinary dipstick that is positive for blood. Which of the following initial tests would be most useful in the diagnosis of this case?

Accepted Answer

Renal ultrasonography

Answer

Urine osmolality

Answer

Fractional excretion of sodium (FeNa+)

Answer

Contrast abdominal computed tomography

Answer

Blood urea nitrogen (BUN): serum creatinine (SCr) ratio

Question 6

A 47-year-old man is brought to the emergency department 1 hour after injuring his genital area when he fell astride his backyard fence. He was trimming a tree from the fence when he lost his balance. His vital signs are within normal limits. Examination shows blood at the urethral meatus, perineal ecchymoses, and a scrotal hematoma. An x-ray of the pelvis shows swelling of the soft tissue but no other abnormalities. Which part of the urinary tract is most likely damaged in this patient?

Accepted Answer

Bulbous urethra

Answer

Penile urethra

Answer

Anterior bladder wall

Answer

Prostatic urethra

Answer

Membranous urethra

Question 7

A 22-year-old man is brought to the emergency department because of progressive left-sided scrotal pain for 4 hours. He describes the pain as throbbing in nature and 6 out of 10 in intensity. He has vomited once on the way to the hospital. He has had pain during urination for the past 4 days. He has been sexually active with 2 female partners over the past year and uses condoms inconsistently. His father was diagnosed with testicular cancer at the age of 51 years. He appears anxious. His temperature is 36.9°C (98.42°F), pulse is 94/min, and blood pressure is 124/78 mm Hg. Cardiopulmonary examination shows no abnormalities. The abdomen is soft and nontender. Examination shows a tender, swollen left testicle and an erythematous left hemiscrotum. Urine dipstick shows leukocyte esterase; urinalysis shows WBCs. Which of the following is the most appropriate next step in management?

Accepted Answer

Scrotal ultrasonography

Answer

CT scan of the abdomen and pelvis

Answer

Surgical exploration

Answer

Measurement of serum mumps IgG titer

Answer

Measurement of serum α-fetoprotein level

Question 8

A 59-year-old man comes to the physician because of a 3-month history of frequent urination. He has to urinate every 1–2 hours during the day and wakes up at least 2–3 times at night to urinate. He also reports that over the last 2 months, he has difficulty initiating micturition and the urinary stream is weak, with prolonged terminal dribbling. His pulse is 72/min, and blood pressure is 158/105 mm Hg. Rectal exam shows a smooth, symmetrically enlarged prostate without any tenderness or irregularities. Prostate-specific antigen is within the reference range and urinalysis shows no abnormalities. A postvoid ultrasound shows a residual bladder volume of 110 mL. Which of the following is the most appropriate next step in management?

Accepted Answer

Terazosin therapy

Answer

Transurethral resection of the prostate

Answer

Bladder catheterization

Answer

Finasteride therapy

Answer

Cystoscopy

Question 9

A 67-year-old man presents to his primary care physician complaining of frequent urination overnight. He states that for several years he has had trouble maintaining his urine stream along with the need for frequent urination, but the nighttime urination has only recently started. The patient also states that he has had 2 urinary tract infections in the last year, which he had never had previously. On exam, his temperature is 98.8°F (37.1°C), blood pressure is 124/68 mmHg, pulse is 58/min, and respirations are 13/min. On digital rectal exam, the prostate is enlarged but feels symmetric and smooth. Which of the following is a possible consequence of this condition?

Accepted Answer

Increased serum creatinine

Answer

Malignant transformation

Answer

Increased serum AFP

Answer

Increased serum hCG

Answer

Increased serum ALP

Question 10

A 33-year-old man is brought to the emergency department 20 minutes after losing control over his bicycle and colliding with a parked car. The handlebar of the bicycle hit his lower abdomen. On arrival, he is alert and oriented. His pulse is 90/min, respirations are 17/min and blood pressure is 110/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. The pupils are equal and reactive to light. There are multiple bruises over his chest and lower extremities. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The abdomen is soft and nontender. There is no pelvic instability. Rectal examination is unremarkable. A complete blood count, prothrombin time, and serum concentrations of glucose, creatinine, and electrolytes are within the reference range. Urine dipstick is mildly positive for blood. Microscopic examination of the urine shows 20 RBCs/hpf. Which of the following is the most appropriate next step in management?

Accepted Answer

CT scan of the abdomen and pelvis

Answer

Intravenous pyelography

Answer

Laparotomy

Answer

Observation and follow-up

Answer

Suprapubic catheterization

Urology Basics

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Bladder cancer surgical management

Cystoscopy and urethroscopy

Kidney stone management

Male infertility surgical procedures

Nephrectomy indications

Paraphimosis and phimosis

Prostate surgery basics

Renal cell carcinoma surgery

Testicular torsion emergency management

Urethral injury management

Urinary diversion procedures

Urinary retention management

Urological trauma management

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