Palestinian Medical Council

Urology Board Examination

November 2005

:The lumbodorsal fascia is contiguous with -1

a- The transversalis fascia
b- The aponeurosis of the transversus muscle
c- The external oblique fascia
d- The rectus sheath

:The dorsal lumbotomy incision to expose the kidney -2

a- Requires incision of the latissmus dorsi muscle
b- Requires excision of the 12th rib
c- Requires incision of quadratus lumborum muscle
d- Slits the lumbodorsal fascia without incising muscle

:The renal artery branch from the aorta at the level of -3

a- First lumbar vertebral body
b- Third lumbar vertebral body
c- Second lumbar vertebral body
d- 12th thoracic vertebral body

:Testicular arteries most commoly originate from -4

a- The renal arteries
b- The common iliac arteries
c- Abdominal aorta above the superior mesenteric artery
d- Abdominal aorta below the renal arteries

:The primary lymph node drainage site for the right testis -5
a- Superficial right inguinal lymph nodes
b- Deep right inguinal lymph nodes
c- Interaortocaval lymph nodes
d- Right common iliac lymph nodes

:The posterior surface of the tail of the pancreas is associated with -6

a- Splenic artery
b- Splenic vein
c- Left adrenal gland
d- All of the above
:Arterial supply to the bladder includes -7
a- Superior vesical artery
b- Inferior vesical artery
c- Obturator artery
d- All of the above

:Benign prostatic hyperplasia may arise from -8

a- Periurethral glands
b- Central prostatic zone
c- The transition zone
d- a and c

:Lymphatic drainage from the prostate flows to -9

a- External and common iliac nodes
b- Internal iliac and obturator nodes
c- Common iliac nodes
d- Para-aortic nodes

: Which of the following statements is not true -10

a- Catecholamines are secreted as a response to sympathetic stimulation
b- The zona glomerulosa produces aldosterone in response to angiotensin
c- The zona reticularis produces androgens in response to LH
d- The zona fasciculata produces glucocorticoids in response to ACTH

:All of the following are secreted by the adrenal gland except -11
a- Angiotensin
b- Aldosterone
c- Catecholamins
d- Glucocorticoids

:The 5 alfa-Reductase enzyme . -12

a. Converts testosterone to dehydrotestosterone
b. Converts 40% of the testosterone to DHT
c. Exists as 5 isoforms each fncoded by separate gene
d. Presents predominantly in the human prostate

:Calcium reabsorption is stimulated by all the following except -13

a. Hypocalcemia
b. Metabolic alkalosis
c. Hypermagnesemia
d. Phosphate loading
:Renin is secreted by .14
.a. The medular adrenal zone
.b. Juxtaglomerular renal zone
.c. Renal cortex
d. Convulated tubules

:The primary site of renin degredation is -15

a. Liver
b. Kidney
c. Lung
d. Spleen

:The most accurate method of detecting urinary calculi is -16

a- Unenhanced spiral CT
b- Enhanced spiral CT
c- Ultrasonography
d- IVU

:The posterior urethra is best visualized by -17

a- Static cystogram
b- Retrograde urethrogram
c- Voiding cystourethrogram
d- Expression cystourethrogram

:Solid renal mass has a CT density of -18

a- Less than 20 HU enhancement
b- Equal to or mor than 20 HU
c- Equal to or less than 10 HU
d- Less than 40 HU

:The agent of choice for renal cortical imaging is -19

a- DMSA
b- DTPA
c- MAG3
d- Galium scan

:Upper tract deterioration occur when intravesical pressure is -20

a. 15 cm H2O
b. 25 cm H2O
c. > 40 cm H2O
d. > 60 cm H2O
:Nephrectomy as a treatment option for renal artery stenosis -21
a- Is indicated for hypertension with poorly functioning kidney
b- Is indicated hypertension with bilateral renal artery stenosis
c- Is indicated in cases of ischemic nephropathy
d- Rarely provides long-term therapeutic benefit

:Medical management for patients with renal artery stenosis -22

a- Rarely succeeds in controlling hypertension
b- Presents the best chance for maintaining renal function
c- Is generally prefrred for children
d- Is appropriate therapy for older patients with hypertension

Urodynamic study of a 5 year old male child with voiding -23

dysfunction showed a voiding intravesical presure of 42cm/H2O with
simultaneous UPP of 70cm/H2O without involuntary contractions, the
:most apropriate diagnosis is
a. Spastic neurogenic bladder
b. Unstable urinary bladder
c. Detrusitor Sphincter dyssenergia
d. Mixed type neurogenic bladder

:Closure urethral presure in patient with external sphincteric damage -24

a. Between 12-15cm/H2O
b. Closed to zero
c. Above 60
d. The same with intravesical presure

The most appropriate method to evaluate the urinary tract in patient -25
:with microhematuria and thoracic gunshot injury is
a- One shot IVP
b- Abdominal ultrasound
c- Clinical observation
d- Immediate CT

During laparatomy due to gunshot injury, a large perinephric -26

hematoma was discovered, intraoperative IVP showed contrast
:extravasation, the first surgical step is
a- Immediate nephrectomy
b- Immediate nephrorrhaphy
c- Isolation of the renal pedicle
d- Opening of Gerota's fascia

The best option for the repair of mid-ureteral transection after stab -27
:wound is
a- Transuretero-ureterostomy
b- Uretero-ureterostomy
c- Ureteral stent
d- Psoas hitch reimplant

A 72-year-old woman is operated for vaginal hysterectomy, in the -28

recovery room, she was anuric for 6 hours despite I.V fluids, BP is 90/50.
estimated blood loss during surgery was 2000cc. The explanation of this
:condition is
a. Acute tubular necrosis
b. Bilateral ureteral obstruction
c. Hypovolemic shock
d. Prerenal azotemia

A large ureteral perforation was observed during ureteroscopic -29

:lithotripsy, the immediate management is
a- Open ureteral repair
b- Insertion of internal stent
c- Placement of nephrostomy
d- Observation

:Which of the following is true about bladder injuries -30

a- They are present in 6-10% of patients with pelvic fracture
b- Abdominal pain and tenderness are pathognomonic
c- Gross hematuria is common
d- 50% are associated with urethral injury

In a blunt trauma patient with pelvic fracture, the best method to -31
:evaluate urethral injury is
a- Retrograde urethrography
b- Antegrade urethrography
c- Flexible cystoscopy
d- CT with intravesical contrast

Three months after urethral injury, a 2cm urethral stricture was -32
:developed, which of the following is true about surgical repair
a- Good result can be achieved with one stage urethroplasty
b- Two-stage repair is required
c- The patient will be incontinent after any surgical repair
d- Use of UroLume endoprosthesis is the best method

:The blood in a hematocele is contained in -33

a- The tunica albuginea
b- The tunica vaginalis
c- Colles fascia
d- Scarpa's fascia

The primry goal when evaluating a patient with genital gunshot -34
:wounds is to determine the presence or abcence of
a- Major associated injury
b- Associated urethral injury
c- Rectal injury
d- Testicular disruption

:Sarcoidosis is associated with hypercalciuria because of -35

a- Absorptive hypercalciuria
b- Renal hypercalciuria
c- Renal tubular acidosis
d- Resorbtive hypercalciuria

:Which of the following influences uric acid stones formation -36

a- Urinary Ph
b- Urinary concentration of uric acid
c- Uric acid excretion
d- All of the above

:The hereditary characteristic of primary hypercalciuria is -37

a- Autosomal dominant
b- Autosomal recessive
c- Sex-linked recessive
d- Non of the above

A 56 year old diabetic female presents with anuria, fever and -38
vomiting, U/S reveals single Rt hydronephrotic kidney with mid-ureter
:stone, her serum creatinin was 5, the first step to treat this patient is
a- Placement of ureteric catheter
b- Urgent ureterolithotomy
c- IV fluids and antibiotics
d- Percutaneous nephrostomy
:The stone free rate of 1cm renal stone treated by ESWL is -39
a- 88%
b- 74%
c- 63%
d- Less than 50%

:Absolut contraindication for ESWL includs all the following except -40
a- Coagulopathy
b- Pregnancy
c- Previous pyelolithotomy
d- UPJ obstruction

:PCNL is preferred to ESWL when -41

a. An upper calyx stone is present
b. Stone of 3 cm or more
c. UPJ stone
d. Upper ureteral stone

According to EAU guidelines in the management of ureteral stone in -42

:pregnancy
a. ESWL and PCNL relatively are contraindicated
b. PCNL could be performed in the third trimester
c. Ureteroscopy can be used by an expert endoscopist
d. Ureterolithoyomy is indicated in all cases

:The treatment of choice for distal ureteral obstructing stone is . -43

a. D.J stent
b. Ureteroscopic lithotripsy
c. ESWL
d. Ureterolithotomy

The most accurate imaging modality to demonstrate a thrombus in -44

:the inferior vena cava associated with renal carcinoma is
a- Abdominal ultrasound
b- Angiography
c- CT
d- MRI
The response rate to interleukin-2 monotherapy in metastatic renal -45
:cell carcinoma is
% a- 5
% b- 10
% c- 18
% d- 25

A 48 year old woman with history of seizure disorder presents with -46
gross hematuria, CT shows a huge left perinephric hematoma associated
:with 8 cm renal angiomyolipoma, the best immediate management is
a- Selective embolization
b- Nephrectomy
c- Observation
d- Partial nephrectomy and evacuation of hematoma

Which environmental factor is most generally accepted as a risk -47

:factor for renal cell carcinoma
a- Radiation therapy
b- Nonsteroidal anti-inflamatories
c- Tobacco use
d- High-fat diet

:What is the most common form of renal sarcoma -48

a- Liposarcoma
b- Rabdomyosarcoma
c- Angiosarcoma
d- Leiomyosarcoma

:The location of the gene involved in Wilms tumor is on -49

a. Chromosome 7
b. Chromosome 2
c. Chromosome 11
d. Chromosome 10

:The most common benign tumor associated with hypertension is -50

a. Angipmyolipoma
.b. Pheochromocytoma
.c. Oncocytoma
d. Complicated cyst

The major disadvantage of partial nephrectomy compared with -51

:radical nephrectomy for localized carcinoma is the increased risk of
a- Tumor recurrence in the remnant kidney
b- Postoperative distant metastasis
c- Perioperative hemorrhage
d- Recurrence in peripheral lymph nodes

One of the followig is considered as a premalignant or subsequent of -52

:bladder cancer
a- Overactive atypia
b- Inverted papilloma
c- Malacoplakia
d- Nephrogenic adenoma

Upon the WHO classification, low grade urothelial carcinoma is the -53
: same as
a- Urothelial papiloma
b- Grade 1 TCC
c- Grade 2 TCC
d- Grade 3 TCC

:Which of the following is true regarding urachal carcinoma -54

a- It is usually transitional cell carcinoma
b- It is best treated by partial cystectomy
c- It responds well to radiotherapy
d- It is usually adenocarcinoma

Which of the following statements is true regarding bladder cancer -55

:metastases
a- They rarely develop before muscularis propria invasion occurs
b- They involve primarily perivesical nodes
c- They involve primarily the liver
d- They never appearin bone

When a transurethral resection of bladder tumor demonstrates high -56

:grade T1 disease
a- The finding is often an overstaging error
b- Detrusor perforation occurs more frequently
c- Another TUR is appropriate in the absence of muscularis propria
d- Urine cytology will generally demonstrate atypia

:Immediate intravesical chemotherapy after TUR is associated with -57

a- Decreases in tumor recurrence during an intermediate follow up
b- A decrease in the progression rate of high grade tumor
c- Pancytopenia of short duration
d- A decrease of occurence of carcinoma in situ

Intravesical BCG is indicated in the treatment of all the following -58

:conditions except
.a. Bladder carcinoma in situ
.b. Multiple superficial bladder tumors
.c. To prevent tumor recurrence
.d. Muscles invassive transitional carcinoma

Antimycobacterial therapy is necessary during BCG treatment if a -59

:patient demonstrates which of the following symptoms
a- Any temperature higher than 38.5
b- Dysuria with microscopic hematuria
c- Arthralgia and hedache
d- Temperature higher than 38.5 more than 48 hours

Which of the following statements is true regarding radical -60

:cystectomy
a- It results in disease-free survival rates that decline with increasing
stage of disease
b- It is best for patients with local nodal disease
c- It produces overall survival rates more than bladder sparing protocols
% d- It results in bowel obstruction in more than 20

Which of the following statements is true regarding adjuvant -61

:chemotherapy after radical cystectomy
a- It improves disease specific outcome in patients with T2 disease
b- It is most appropriate for patients with less than T2 disease
c- It is better tolerated than neoadjuvant chemotherapy
d- none of the above

The most characteristic clinicopathological feature in nonbilharzial -62

:squamous cell carcinoma is
a. Usually multiple bladder tumors
b. High recurrence rate
c. Most tumors are superficial
d. Low incidence of distant metastasis

:The treatment of choice for ureteric carcinoma is -63

.a. Radiotherapy
.b. Segmental resection with end to end anastomosis
.c. Trans-ureteroscopic resection of the tumor
.d. Nephroureterectomy with bladder cuff resection

When high grade PIN is found by prostatic biopsy, the probability to -64
:find carcinoma in subsequent biopsies is
% a- 5
% b- 10
% c- 30
% d- 50

:The most useful first-line test for diagnosis of prostate cancer is -65
a- Digital rectal examination
b- PSA assay
c- Transrectal ultrasound
d- Combination of DRE and PSA

What percentage of stage T1 cancers are located in the transition -66

zone
% a- 5
% b- 15
% c- 20
% d- 30

:Which of the following statements regarding PSA is true . -67

a. It is a glycoprotein that coagulates the ejaculate
b. PSA level is proportional to the volume of the cancer
c. It is not organ specific
d. It is not increased in acute prostatitis

A68 year old man presents with obstructive symptoms, PR reveals a -68
stony Rt lobe, PSA was 182, biopsy by guided U/S confirmed a Gleason
:4+5 carcinoma, the best treatment for this patient is
a. Brachioterapy
b. External beam radiation
c. Maximal androgen blockage
d. Radical prostatectomy

Which of the following statements concerning early hormonal -69

:therapy is true
a- It should be routinely applied to men with a rising PSA value
b- It has not been shown tobe advantageous in men with rising PSA
c- It is not useful in conjunction with radiotherapy of T3 disease
d- It is the treatment of choice in noncurable cases

:Antiandrogens may be useful as monotherapy for what reason -70

a- They produce castration levels of testicular and adrenal androgens
b- They have been shown to be equally effective as castration
c- They have more favorable profile of side effects during long-term
therapy
d- They preserve potency

LHRH agonist depots have become standard treatment of advanced -71

:prostete cancer because of
a- They avoid the mutilating effect of castration
b- They are easy to apply
c- They were shown to be superior to castration
d- They have more favorable profile of side effects than castration

All the following statements about retroperitoneal fibrosis are true -72
:except
a. Leads to hydronephrosis and varying
degrees of renal failure
b. Arterial obstruction is frequently seen
c. Medial deviation of the ureter
.d. Gastrointestinal symptoms are common

:The most common cause of retroperitoneal fibrosis is -73

a- Idiopathic
b- Methysergide
c- Aortic aneurysma repair
d- Lymphoma
Elevated alpha phetoprotein levels can be found in all of the -74
:following except
a. Embryonal cell carcinoma
b. Teratocarcinoma
c. Pure seminoma
d. Yolk sac

Which of the following regarding testicular carcinoma in situ is -75

:correct
a. The lesion is usually palpable
b. Increased incidence with age
c. A certain incidence can be made by ultrasound
d. It is most frequent among patients with gonadal dysgenesia

A young adult man presents with a Rt testicular mass after having -76
bilateral orchidopexy as a child. After Rt orchidectomy and Lt testicular
biopsy he was found to have Rt embryonal carcinoma with vascular
invasion and Lt intratubular neoplasia. CTS was normal. The appropriate
:management of this patient is
a- Lt orchidectomy and 2 cycles of BEP chemotherapy
b- 4 cycles of chemotherapy
c- Lt radical orchidectomy and survival protocol
d- Modified Rt side retroperitoneal lymphadenectomy

A young adult man presents with a 5 cm left testicular tumor, -77

elevated AFP (180ng/ml), pathology study after radical orchidectomy
revealed an anaplastic seminoma with vascular invasion. AFP was normal
3 weeks after the orchidectomy. Further management of this patient
:should include which of the following
a- Adjuvant cisplatin-based chemotherapy
b- Retroperitoneal external beam radiotherapy
c- Bilateral retroperitoneal lymphadenectomy with adjuvant radiation
d- Bilateral retroperitoneal llmphadenectomy

Management options for clinical stage 1 seminoma after radical -78

:inguinal orchidectomy include all the following except
a- Survillance protocol
b- Adjuvant radiotherapy
c- Retroperitoneal lymphadenectomy
d- 2 cycles of chemotherapy
In spinal cord injury, the bladder drainage technique with the lowest -79
:complication is
a- Clean intermittent catherization
b- Suprapubic catheter
c- Indwelling urethral catheter
d- Condom Catheter

The most common bacterial cause of xantogranulomatous -80

:pyelonephritis is
a- E. Coli
b- Pseudomonas
c- Proteous mirabilis
d- Staphylococcus

Nytrofurantoin prophylaxis is effective because of the concentration -81

;of the drug in
a- Urine
b- Bladder
c- Serum
d- Vagina

:The drug thought to be safe in any phase of pregnancy is -82

a- Nitrofurantoin
b- Sulfonamide
c- Penicillin
d- Quinolones

Which of the following statements is true regarding . -83

:xantogranulomatous pyelonephritis
a. Incision and drainage is usually curative
b. The diagnosis can be made by CT scan
c. It is precancerous lesion
d. About one third of patients present with negative culture

:The greatest obstacle in the treatment of perinephric abscess is the -84

a. Inability to obtain positive cultures
b. Presence of comorbid diseases in many patients
c. Delay in diagnosis due to nonspecific symptoms
d. Poor cure rate with percutaneous drainage
The high mortality rate associated with perinephric abscess is -85
:primarily attributed to
a- Bacterial hemolysis
b- Diabetes mellitus
c- Delay in diagnosis
d- Inappropriate antimicrobial therapy

The most common etiologic organism in emphysematous -86

:pyelonephritis is
a. Pseudomonas mirabilis
b. E. coli
c. Klebsiella
d. Proteus

The most common cause of unresolved bacteriuria during -87

:antimicrobial therapy is
a- Development of bacterial resistance
b- Rapid reinfection
c- Presence of azotemia
d- Initial bacterial resistance

:The most reliable early clinical indicator of septicemia is -88

a- Chills
b- Fever
c- Hyperventilation
d- Change in mental status

All the following features of urinary tuberculosis can be seen on IVP -89
:except
a- Vesicoureteral reflux
b- Infundibular stenosis
c- Ureteral stricture
d- Renal calcifications

:All the following are complications of urinary tuberculosis except -90

.a. Multiple ureteric strictures
.b. Perinephric abscess
.c. Ureteric malignancy
.d. Renal stones
In which of the following organs does tuberculosis results from direct -91
hematogenous spread

a. Testis
b. Bladder
c. Epididymis
d. Kidney

The syndrome of interstitial cystitis is defined by all the following -92

:except
a. Characteristic histological findings
b. Sterile urine
c. Negative cytology
d. Characteristic cystoscopic findings

There is a direct relationship between AIDS and all of the following -93
:malignancies except
a. Kaposi sarcoma
b. Testicular cancer
c. B. cell lymphoma
d. Non-Hodgkins lymphoma

:Bacterial prostatitis is usually caused by -94

a. Hematogenous infection
b. Lymphatic infection
c. Gram positive organisms
d. A single gram negative pathogen

:Chronic bacterial prostatitis is best diagnosed by -95

a. Histological examination
b. History and physical examination
c. Segmented urine and prostatic fluid cultures
.d. Cystoscopy

In the absence of neurlogic disease uninhibited contractions are . -96

:referred to as
a. Detrusor instability
b. Detrusor hyperreflexia
c. Involuntary bladder contraction
.d. Detrusor-sphincter dyssynergia
After an acute toxic event such as a febrile illness how long would -97
:you expect sperm count to be depressed
a- 1 week
b- 3 weeks
c- 3 months
d- 6 months

Hormonal evaluation of an infertile man with sperm count of 5 mil/ml -98

:should include assaays of testosterone and
a- Prolactine
b- FSH
c- FSH and LH
d- LH

:Patients with cystic fibrosis have infertility caused by -99

a- Immotile sperm
b- Vasal obstruction
c- Absence of the vas
d- Hypogonadism

:Fructose is secreted by -100

a- Prostate
b- Seminal vesicles
c- Testis
d- Epididymis

:All the following are a cause of azoospermia except -101

.a. Varicocele
.b. Primary testicular failure
.c. Sertoli cell syndrome only
.d. Klinefelter syndrome

;Tte association of impotence with peyronie disease -102

a. Occure in 15% of patients and is psychogenic
b. It is a result of veno-occlusive dysfunction
c. It is a result of concomitant vascular disease
d. It is best evaluated by pharmacocavernosometry

:In priapism, tissue ischemia begins after -103

a. 2 hours
b. 4 hours
c. 6 hours
d. 10 hours

:Treatment of priapism more than 36 hours requires -104

a. Aspiration of blood
b. Aspiration and irrigation with saline
c. Injection of an alpha agonist
d. Shunting procedure

:All the following can be a cause of priapism except -105

a. Peripheral vascular disease
.b. Acute leukemia
.c. Intracavernous injections of vasoactive drugs
.d. Hemodialysis

It is advisable in a man with BPH and slightly elevated creatinine -106

:level to perform
a- TUR-P
b- TRUS
c- Renal U/S
d- Urodynamic study

:The absolute indication for TUR-P is -107

a- Severe obstructive symptoms
b- 300 cc PVR
c- Single episode of urinary retention
d- Gross hematuria secondary to BPH

Which of the following statements regarding to transurethral -108

:prostate incision is true
a- It is appropriate for large prostate
b- It has no complications
c- It causes retrograde ejaculation in 37% of cases
d- It commonly results in TUR syndrom

:Which of the following is a potential side effect of alpha-blockers -109

a. Hypertension
b. Orthostatic hypotension
c. Runing nose
.d. Tension hedacke
Which alpha 1 receptor subtype mediates prostate smooth muscle -110
:tension
a- alpha 1a
b- alpha 1b
c- alpha 1c
d- alpha 1d

Which of the following regarding the evaluation of patients with -111

:BPH is false
a. Uroflowmetry is a useful measurement of urinary stream
b. Urinary tract infection should be ruled out
c. PSA test should be done
d. Cystoscopy is mandatory for all patients with BPH

:The 5 alfa-Reductase enzyme -112

a. Converts testosterone to dehydrotestosterone
b. Converts 40% of the testosterone to DHT
c. Exists as 5 isoforms each fncoded by separate gene
d. Presents predominantly in the human prostate

Which of the following statements concerning post obstructive -113

:diuresis is false
a. It is rare and occurs after release of bilateral ureteral obstruction or
solitary obstructed kidney
b. Duresis results from impaired sodium reabsorption, impaired urine
.concentrating ability, and solute duresis due to retained urea
c. Parenteral fluid replacement therapy with N/S at 100% of urine
output is required
d. Usually, postobstructive diuresis is mild, self-limiting and
physiologic with excretion of retained sodium and water

All the following are used in the conservative treatment of stress -114
:incontinence Except
a. Physiotherapy/Biofeedback
b. Vaginal electrostimulation
c. Anticholenergic agents
d. Tricyclic psychomotor drugs
A 72 year old man known to have BPH and D.M, presents with -115
:urinary incontinence, most appropriate cause on his condition is
a- Diadetic neuropathic bladder
b- Over-flow incontinence
c- Secondary urinary infection
d- Associated bladder tumor

A 32 year old female presents with total urinary incontinence since 3 -116
months after traumatic delevary. What is the modality of choice to
:evaluate her in order to diagnose the cause of incontinence
a- Pelvic CT
b- Urodynamic study
c- Cystoscopy
d- Cystourethrography

When should an infant with ambigous genitalia undergo testing for -117
:congenital adrenal hyperplasia
a- At the first well-child visit
b- Befor discharge from the newborn nursery
c- At 6 weeks of age
d- At 12 weeks of age

:Renal scaring in the presence of reflux likely involves -118

a- High intravesical pressure with sterile urine
b- Infection
c- High grade reflux
d- All of the above

:MAG 3 Duretic scan is most indicated in the diagnosis of -119

a. Vesico-ureteral reflux
b. Uretero-pelvic junction stenosis
c. Neonatal bladder outlet obstruction
d. Ectopic ureter

:The diagnostic method of choice for nonpalpable testicle is -120

a. Abdominal CT
b. MRI
c. Diagnostic laparascopy
d. Surgical exploration