Urology state

URO - 1
Which plays the main role in the development of testicular tumor?
A) injury
B) testicular torsion
C) retentio testis (cryptorchidism)
D) genetic predisposition

URO - 1
Which plays the main role in the development of testicular tumor?
A) injury
B) testicular torsion
C) retentio testis (cryptorchidism)
D) genetic predisposition

ANSWER
C) retentio testis (cryptorchidism)
EXPLANATION
The only proven risk factor in the development of testicular cancer is cryptorchism. (In this case, the testicular cancer is 10 to 20 times more common). The role of injury, testicular torsion, genetic predisposition has not been proven.

URO - 2
In which typical disease complains the patient pain when touching his scrotum?
A) testicular tumor
B) epididymitis
C) hydrocele
D) varicocele

ANSWER
B) epididymitis
EXPLANATION
In the case of epididymitis, the patient's epididymides and testicles are enlarged, and feels painful to touch. In case of testicular cancer, a painless nodule or the painless enlargement of the testis can be detected. Varicocele can cause dragging-like or aching pain within the scrotum, enlarged veins are palpable or to be seen, and does not feel painful when touched. The hydrocele is a transparent, painless, and fluctuating fluid can be detected.

URO - 3
The most specific palpation sign of prostate cancer is:
A) enlarged, pasta like
B) cartilage hard
C) enlarged, painful
D) enlarged, painless

ANSWER
B) cartilage hard
EXPLANATION
A typical palpation found in prostate cancer is a insensitive hard noudule, or a an insensitive, stony uneven surfaced prostate. Acute prostatitis is associated with high fever, a highly sensitive, enlarged prostate. In the case of BPH, we can palpate a glandular or muscular, painless, enlarged prostate,

URO - 4
Why do we not see pus cells in the urine which was proved to be pus positive with KOH test?
A) the urine is alkaline
B) besides the pus cells, there are also bacterial cells too
C) the urine is acidic
D) there are crystals in the urine

ANSWER
A) the urine is alkaline
EXPLANATION
In strongly alkaline urine, cellular elements fall apart, so no white blood cells can be seen under a microscope.

URO - 5
What is specific for the female urine
A) it has higher pH level
B) it contains a lot of epithelial cells
C) it contains always some red blood cells
D) it contains always some pus cells

ANSWER
B) it contains a lot of epithelial cells
EXPLANATION
Epithelial cells are often detected in female urine. These are mostly derived from the vagina.

URO - 6
The normal serum creatinine level is:
A) 60-120 micromol/liter
B) 6-12 micromol/ liter
C) 6-120 microgramm/ liter
D) 60-120 milligram / liter

ANSWER
A) 60-120 micromol/liter
EXPLANATION
The normal creatinine level is 60-120 μmol / l.

URO - 7
The following diagnoses are synonyms. The only exception is:
A) hypernephroma
B) Grawitz- tumor
C) renal cell carcinoma
D) renal adenoma

ANSWER
D) renal adenoma
EXPLANATION
The renal adenoma is a benign, epithelial tumor, while hypernephroma, Grawitz tumor and renal cell carcinoma are synonyms for malignant kidney cancer.

URO - 10
The testicular torsion:
A) is always on both sides
B) children most likely wake up because of scrotal pain
C) immediately causes a high fever
D) is more common on the right side

ANSWER
B) children most likely wake up because of scrotal pain
EXPLANATION
The testicular torsion mostly occurs in young boys. It usually starts with a suddenly appearing, very severe testicular pain radiating towards the same side flank. High fever can only be caused if the testicles are already necrotized. It appears with the same frequency on both sides.

URO - 11
It is typical for renal colic, except:
A) kidney sensitivity
B) nausea, vomiting
C) pain in the labias or in the testicles
D) sensitivity at the McBurney's point

ANSWER
D) sensitivity at the McBurney's point
EXPLANATION
Typical renal colic is associated with intense pain, which spreads into the testicles of the same side or in the labias and often comes with nausea and vomiting. The pressure sensitivity experienced at the McBurney point is typical for acute appendicitis.

URO - 12
The conversion of testosterone into dihydrotestosterone is done by:
A) 5α-reductase
B) 7-β-citosterine
C) aromatase
D) acid phosphatase

ANSWER
A) 5α-reductase
EXPLANATION
In the developement of BPH an important role is played by the dihydrotestosterone converted from testosterone by the 5-α reductase.

URO - 13
Which of the following factors plays a certain role in the epidemiology of prostate cancer?
A) age
B) genetic factors
C) hormone levels
D) most likely all three

ANSWER
D) most likely all three
EXPLANATION
Although there are no clear pathogenic factors in the epidemiology of prostate cancer, it is likely that age (older age), genetic factors (more commonly occurring in the family) and hormonal factors (androgen-dependent) are likely to be involved in the development of the disease.

URO - 14
The following factor has an important role in the etiology of urothelial cancer:
A) smoking
B) alcohol
C) bensidin
D) bensin

ANSWER
A) smoking
EXPLANATION
Smoking plays a role in the development of urothelial carcinomas. Other factors, such as certain polycyclic hydrocarbons also increase the risk of bladder cancer, but the relationship is not as clearly demonstrated as with smoking.

URO - 15
Charrière =
A) 0,5 mm
B) 3 mm
C) 1 mm
D) 0,33 mm

ANSWER
D) 0,33 mm
EXPLANATION
Charrière (Ch) is the outer diameter of the catheters; 1 Ch = 0.33 mm.

URO - 16
The main symptom of stress incontinence is:
A) urination urgency
B) incontinence during nights
C) low abdominal pain
D) incontinence after increased abdominal pressure
E) burning in the vagina

ANSWER
D) incontinence after increased abdominal pressure
EXPLANATION
In stress incontinence the patietnt complaints of involuntary urine leakage when the intravesical pressure associated with the elevated abdominal pressure exceeds the maximal urethral pressure without the contraction of the detrusor muscle.

URO - 17
Urodynamic examination is recommended:
A) in case of hematuria
B) in case of pyuria and fever
C) imperative urinary stimuli and involuntary discharge of urine from the bladder when coughing
D) in case of abnormal bleeding

ANSWER
C) imperative urinary stimuli and involuntary discharge of urine from the bladder when coughing
EXPLANATION
The combined occurrence of imperative urinary stimuli and physical exertion leads to mixed incontinence, which indicates urodynamic examination. In case of haematuria ultrasound and cystoscopy is the recommended diagnostic method. Gynecological examination is indicated if abnormal bleeding occures. In case pyuria, urine sediment controll, or if necessary bacteriological urine test is indicated.

URO - 18
When feeling a painless node in the testis the next step should be:
A) observation, making up a next consultation
B) send him to urology
C) antibiotics and control
D) investigation because of potential chronic prostatitis

ANSWER
B) send him to urology
EXPLANATION
The painless palpable nodule in the testicles is suspected of tumor, so urological examination is recommended.

URO - 19
Dysuria can be a symptom of:
1) bladder stone
2) prostate cancer
3) acute prostatitis
4) phimosis
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
E) all of the answers are correct
EXPLANATION
Dysuria may be caused by urethral compression of the BPH, prostate cancer obstructing the pars prostatica, inflammation and enlargement of prostate. And so does the punctually narrowed form of phimosis too, where the patient urinates under the foreskin, around glans.

URO - 20
Cause of pollakisuria:
1) Ormond's disease
2) urine retention in the bladder
3) stress incontinence
4) urethritis
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
C) the 2nd and 4th answers are correct
EXPLANATION
Urine remaining after urination forms a constant urge to urinate. In case of urethritis infected urine causes irritative symptoms such as pollakisuria.

URO - 21
Cause of urinary total retention:
1) bladder tumor
2) prostatitis acuta
3) bladder stone
4) bladder paralysis
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
E) all of the answers are correct
EXPLANATION
The bladder tumor located around the internal orifice can block the orifice or infiltrate the back tract of urethra. Bladder stones embedded in the orifice or in the back track of urethra may also cause complete retention. During acute prostatitis, the inflamed, enlarged prostate may compress the prostatic urethra completely. In case of bladder paralysis, the detrusor muscle does not work, so it can not empty the urine.

URO - 22
Inflammations with fever:
1) acute pyelonephritis
2) acute prostatitis
3) acute epididymitis
4) acute cystitis
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
A) the 1st, 2nd and 3rd answers are correct
EXPLANATION
Only urological organs having parenchyma can cause fever, so acute cystitis does not.

URO - 23
What tests can detect prostate cancer?
1) PSA
2) DRE (digital rectal examination)
3) biopsy
4) abdominal CT
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
A) the 1st, 2nd and 3rd answers are correct
EXPLANATION
PSA (prostate-specific antigen) is prostate and non-prostatic cancer specific. Its normal level is 0 to 4 ng / ml, it is uncertain at 4-10 ng / ml, it is more likely tumor if it is more than 10 ng / ml. With the RDE examination the cartilage- hard nodule raises the suspicion of malignant prostate disease, but a certain diagnosis can only be established based on histology. In advanced case abdominal CT only shows the larger lymph nodes, but for the finer structure TRUS (transrectal ultrasound) is needed, but it is not as specific as RDV and PSA together. So the first step is therefore a rectal examination and after palpating a suspecious finding PSA level should be measured. (2 days intermission should be between the blood test and the RDE, because palpation affects the PSA level). Prostate biopsy is always mandatory in case of suspected prostate cancer.

URO - 24
Cystography is indicated in:
1) bladder fistula
2) detecting or excluding bladder trauma
3) examine bladder diverticulum
4) diagnosing cystitis
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
A) the 1st, 2nd and 3rd answers are correct
EXPLANATION
Contrast agent exit can be seen during cystography in bladder injury or in cases of fistulas. Bladder diverticulum is represented by increased contrast agent uptake during cystography. In the diagnosis of cystitis, anamnesis and urine sediment controll (pyuria) is mostly sufficient, and if necessary (mostly in specific types) cystoscopy can be performed.

URO - 25
Ultrasound
1) is better than intravenous urography to detect kidney tumors
2) is better than intravenous urography to detect urothelial tumor
3) is better than CT to detect prostate diseases
4) in the urological ultrasound examinations the 15000-20000 Mhz frequency is used
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
B) the 1st and 3rd answers are correct
EXPLANATION
Intravenous urography shows the urinary system, which is more informative than US in urothelial tumors. To detect changes in parenchyma (kidney tumor), US is much better. TRUS is considerably cheaper than CT but provides less information about the prostate. Urological transducers have a frequency of 3 to 7 MHz.

URO - 26
In the andrological examination the following hormone levels are measured:
1) testosterone
2) FSH
3) LH
4) Parathormone
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
A) the 1st, 2nd and 3rd answers are correct
EXPLANATION
Testosterone is the male sex hormone, LH is its trophormon, and FSH stimulates spermatogenesis (they are measured in case of hypogonadism). We are measuring parathormone in potential hyperthyroidism.

URO - 27
The testicular ultrasound examination is good to detect:
1) infertility
2) testicular tumor
3) azoospermia
4) orchidoepididymitis
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
C) the 2nd and 4th answers are correct
EXPLANATION
Infertility and azoospermia is a complex andrological diagnosis, which is based on physical examination; US alone is not enough. It is absolutely necessary to perform a microscopic examination of the ejaculate. Other procedures like microbiological, diagnostic, surgical, radiological, biochemical, genetic, endocrinological, examinations are necessary in order to find the cause. In case of orchiepididymitis, an inhomogeneous echotexture can be found in the testicles. In a testicular tumor an inhomogenous echotexture can be observed in part or in the whole testicle.

URO - 28
The chloride level can be high :
1) in kidney failure
2) after ureterosigmoideostomy
3) because of increased intake of sodium hydrogencarbonate from soda pops
4) in hyperchloremic metabolic acidosis
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
C) the 2nd and 4th answers are correct
EXPLANATION
Ureterosigmoideostomy is followed by hyperchloraemic acidosis (see URO-71). Laboratory abnormalities in renal failure: hyponatremia, hypochloremia, hypocalcemia, hyperkalemia, hypermagnesemia, acidosis.

URO - 29
To prevent superficial bladder tumors bladder installation can be performed with:
1) BCG
2) Bleomycin
3) Mitomycin C
4) Vincristin
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
B) the 1st and 3rd answers are correct
EXPLANATION
Bleomycin and Vincristin are suitable for systemic chemotherapy. For the instillation treatment of superficial bladder tumors only Mitomycin C, BCG, Adriamycin and Epirubicin can be used.

URO - 30
Continent urinary diversions are:
1) ureterocutaneostomy
2) orthotopic ileal bladder
3) cutaneous uretero-ileostomy (Bricker bladder)
4) Sigma rectum pouch (Mainz pouch II)
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
C) the 2nd and 4th answers are correct
EXPLANATION
In an ureterocutaneostomy the urethra is terminating on the abdominal wall. In the Bricker bladder, ureter is implanted in a short ileum segment, the other end of the intestinal tract is determined to the abdominal wall. These two methods are not continental urinary tract creating methods, because the urine is constantly flowing away, patients should wear urostomy bags. Orthotopic bladder formation is a bladder replacement from an isolated intestinal tract, in which case the bladder is sewn with the original urethra. The Mainz II. pouch is actually a low pressure, continental urine reservoir, in which case the ureter is implanted into the detubularized intestinal segment of the sigma.

URO - 31
Invasive bladder tumor treatment options:
1) Mitomycin, Epirubicin
2) radical cystectomy
3) local chemotherapy
4) resection of bladder wall
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
C) the 2nd and 4th answers are correct
EXPLANATION
Local chemotherapy is only suitable for the prevention of tumor recurrences after surgical treatment of superficial bladder tumors. The treatment of invasive bladder tumors involves radical cystectomy, bladder wall resection and TUR, possibly with radiotherapy or chemotherapy (adjuvant, neoadjuvant therapy). For palliative use, TUR, radiation or chemotherapy is most commonly used, although in some cases cystectomy can be performed.

URO - 32
Pyelonephritis gravidarum:
1) is mostly on the left side
2) therapy = pregnancy interruption
3) frequent in the first trimester
4) hydronephrosis can be detected with ultrasound
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
D) only the 4th answer is correct
EXPLANATION
Pregnancy pyelonephritis usually occurs in the second half of pregnancy, affects the right side more often. With the double J catheter or nephrostomy placed for the time of pregnancy, the urine can be led away, and the patient becomes asymptomatic.

URO - 33
Not a transurethral procedure:
1) internal urethrotomy
2) ESWL (Extracorporeal Shock Wave Lithotripsy)
3) inserting urethral catheter with cystoscopy
4) epicystostomy
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
C) the 2nd and 4th answers are correct
EXPLANATION
Internal uretrotomy is the incision of the urethral stenoses with the optic control. An ureteral catheter inserted using a special ureterocystoscope, also through the urethra. ESWL: see question n.o.: URO-61. Epicystostomy means percutaneous bladder punction.

URO - 34
Which factors have negative effect on potency?
1) diabetes
2) hyperthyroidism
3) beta blockers used in hypertension
4) antidiabetics
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
B) the 1st and 3rd answers are correct
EXPLANATION
Diabetes mellitus causes in a vascular and in a neurogenic way damage to potency. Βeta-blockers may lead to erectile dysfunction due to reduced arterial flow.

URO - 35
Acute kidney failure laboratory values:
1) hyperkalemia
2) hypermagnesemia
3) acidosis
4) hyponatremia
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
E) all of the answers are correct
EXPLANATION
See question n.o: URO-28.

URO - 36
Cause of acute anuria:
1) fungal infections
2) methyl alcohol
3) ethylene glycol
4) sodium hydroxide
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
A) the 1st, 2nd and 3rd answers are correct
EXPLANATION
Ethylene glycol (antifreeze liquid), certain mushroom poisoning and methyl alcohol may cause acute renal anuria based on nephrotoxicity.

URO - 37
Which are the testicular tumor markers?
1) PSA (Prostate-Specific Antigen)
2) β-hCG
3) testosterone
4) AFP (Alpha-fetoprotein)
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
C) the 2nd and 4th answers are correct
EXPLANATION
Serum level of β-hCG increase mainly in choriocarcinoma and AFP is higher in nonseminoma type testicular tumors. PSA is a tumor marker used in prostate cancer. Testosterone levels are determined for the differential diagnosis of different types of hypogonadism.

URO - 39
Which of the following drugs are used to improve incontinence in females?
1) Doxycycline
2) Ditropan (oxybutynin)
3) Minipress (prazosin)
4) Ephedrine
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
C) the 2nd and 4th answers are correct
EXPLANATION
Ditropan is an anticholinergic drug, which causes smooth muscle relaxation. It is used in "urge" type incontinence. Ephedrine is an α- and β-adrenoreceptor-excitatory, enhances the tone of the internal sphincter of the bladder. The drug that can be given in stress incontinence. Doxycyclin is an antibiotic. The Minipress α1 adrenoreceptor blocker, which leads to relaxation of smooth muscle elements on the vesicles, and thus increases urine flow.

URO - 40
Cause(s) of erectile dysfunction:
1) antihypertensive drugs
2) induratio penis plastica
3) prostatovesiculitis
4) alcoholism
A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

ANSWER
E) all of the answers are correct
EXPLANATION
Antihypertensive drugs can cause erectile dysfunction through reduced arterial inflow. In plastic penile induration, the penile curvature may reach such a high level, that it leads to erectile dysfunction. Prostatovesiculitis usually causes premature ejaculation. Chronic alcoholism can also lead to erectile dysfunction.

URO - 41
Which of the following can be used to separate kidney cyst from tumor?
1) ultrasound
2) IVP (Intravenous pyelogram)
3) CT
4) retrograde pyelography
5) angiography
A) the 1st, 3rd and 5th answers are correct
B) the 1st, 4th and 5th answers are correct
C) the 2nd, 3rd and 4th answers are correct
D) the 2nd, 4th and 5th answers are correct

ANSWER
A) the 1st, 3rd and 5th answers are correct
EXPLANATION
US and CT can separate the solid surface from the fluid-containing cystic formula according to their echogenicity and density. Angiography shows abnormal vascular strucure in the tumor, but in the cyst is not to be seen. Retrograde pyelography and excretory urography only shows the volumen, but no differential diagnosis can be made.

URO - 43
Symptoms of acute pyelonephritis:
1) Both side kidney pain
2) kidney sensitivity to touch
3) fever
4) pyuria
5) macroscopic haematuria
A) the 1st, 3rd and 5th answers are correct
B) the 1st, 4th and 5th answers are correct
C) the 2nd, 3rd and 4th answers are correct
D) the 2nd, 4th and 5th answers are correct

ANSWER
C) the 2nd, 3rd and 4th answers are correct
EXPLANATION
Acute pyelonephritis usually develops due to the the onset infections targeting the lower section of the urinary tract. Typical symptomes are high fever with chills, the enlarged kidneys stretch the kidney capsules and this causes pain. Pyuria (excluding the blocked kidney) refers to urinary infection. Macroscopic haematuria is not characteristic. Bilateral kidney pain refers to a locomotor disorder or an internal medicine related kidney disease.

URO - 44
Cause of pain associated with posture or movement can be:
1) rheumatic disease
2) vesicoureteral reflux (VUR)
3) kidney stone stuck in the ureter
4) nephroptosis
5) spinal disc herniation
A) the 1st, 3rd and 5th answers are correct
B) the 1st, 4th and 5th answers are correct
C) the 2nd, 3rd and 4th answers are correct
D) the 2nd, 4th and 5th answers are correct

ANSWER
B) the 1st, 4th and 5th answers are correct
EXPLANATION
Body movement related pain is mainly caused by diseases affecting the parts of the musculoskeletal system, for example rheumatoid arthritis, disc herniation. Renal ptosis can cause a pain observed when standing (because of renal occlusion) . Laying down relieves the pain. Kidney stones stuck in the urinary tract can cause continuous colic. Vesicoureteral reflux causes renal pain while urination.

URO - 45
Cause of macroscopic haematuria can be:
1) renal adenocarcinoma
2) acute pyelonephritis
3) vesicoureteral reflux
4) acute cystitis
5) bladder tumor
A) the 1st, 3rd and 5th answers are correct
B) the 1st, 4th and 5th answers are correct
C) the 2nd, 3rd and 4th answers are correct
D) the 2nd, 4th and 5th answers are correct

ANSWER
B) the 1st, 4th and 5th answers are correct
EXPLANATION
The most common symptom of bladder tumor is macroscopic, clumsy, painless, so-called "silent" haematuria. Renal tumors may also cause macroscopic bleeding when they break into the cavity. In one form of acute cystitis namely in haemorrhagic cystitis in addition to pyuria, macroscopic haematuria can be observed.

URO-46-50
Pair the lab marker with the most relevant number marked clinical status!
A) PSA
B) AFP
C) β-hCG
D) alkaline phosphatase
E) all of them
F) none of them
URO - 46 - Elevated level can be a predictive sign of bone metastases in prostate cancer.
URO - 47 - After the TUR surgery of bladder cancer it should be frequently checked.
URO - 48 - The normal level could be higher than 6,5 ng/ml after the age of 80.
URO - 49 - Elevated level can be found in the early stage prostate cancer too.
URO - 50 - In the case of seminoma extending through the tunica albuginea elevated level can be found.

ANSWER
URO - 46 - Elevated level can be a predictive sign of bone metastases in prostate cancer. - D)
URO - 47 - After the TUR surgery of bladder cancer it should be frequently checked. - F)
URO - 48 - The normal level could be higher than 6,5 ng/ml after the age of 80. - A)
URO - 49 - Elevated level can be found in the early stage prostate cancer too. - A)
URO - 50 - In the case of seminoma extending through the tunica albuginea elevated level can be found. - F)

URO-51-54
Pair the andrological abnormalities with the letter signed clinical references!
A) erectile dysfunction
B) infertility
C) male menopause
D) retrograde ejaculation
URO - 51 - It can caused by varicocele
URO - 52 - It appears as a frequent complication after TUR (transurethral resection) surgery.
URO - 53 - It can caused by beta blockers.
URO - 54 - One way of the treatment can be a vacuum constriction device

ANSWER
URO - 51 - It can caused by varicocele - B)
URO - 52 - It appears as a frequent complication after TUR (transurethral resection) surgery. - D)
URO - 53 - It can caused by beta blockers. - A)
URO - 54 - One way of the treatment can be a vacuum constriction device - A)

URO-55-60
Pair the the kidney stone(s) to the typical description!
A) uric acid stone
B) cystine kidney stone
C) calcium oxalate kidney stone
D) struvite kidney stone
URO - 56 - A high, alkaline pH level increases the risk of developing these type of kidney stones.
URO - 57 - the so called negative stone
URO - 58 - Good solubility when treated with drugs.
URO - 59 - To prevent the recurrence D-Penicillamin or Thiola can be used.
URO - 60 - In case of presence, reduced meat diet is recommended

ANSWER
URO - 56 - A high, alkaline pH level increases the risk of developing these type of kidney stones. - D)
URO - 57 - the so called negative stone - A)
URO - 58 - Good solubility when treated with drugs. - A)
URO - 59 - To prevent the recurrence D-Penicillamin or Thiola can be used. - B)
URO - 60 - In case of presence, reduced meat diet is recommended - A)

URO-61-66
Pair the diagnostic procedure name(s) to the relevant description!
A) URS (ureterorenoscopy)
B) PCNL (Percutaneous Nephrolithotomy)
C) ESWL (Extracorporeal Shock Wave Lithotripsy)
D) all of them
E) none of them
URO - 61 - non-endoscopic procedure
URO - 62 - used in kidney stone treatment
URO - 63 - Used in BPH treatment
URO - 64 - The procedure is performed through the skin
URO - 65 - It can be a diagnostic procedure too.
URO - 66 - The procedure is only performed in intubation narcosis

ANSWER
URO - 61 - non-endoscopic procedure - C)
URO - 62 - used in kidney stone treatment - D)
URO - 63 - Used in BPH treatment - E)
URO - 64 - The procedure is performed through the skin - B)
URO - 65 - It can be a diagnostic procedure too. - A)
URO - 66 - The procedure is only performed in intubation narcosis - E)

URO - 68
In case of acute renal colic the first choice should be narcotic pain medication, so patients having renal colic should be directed to urology department immediately.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

ANSWER
E) both the statement and the explanation are false
EXPLANATION
Renal colic with fever, chills and without vomiting can be treated in the patients home with iv. or im. analgesics and antispasmodics (eg Algopyrin, No-Spa). However, in the case of no response of medication, an institute referral is required. Here, with the assured diagnosis, we can add stronger painkillers. However, in order to avoid masking the symptoms of any other acute abdominal complaints on the spot, narcotic analgesics are prohibited.

URO - 69
3 months after the TUR surgery of bladder tumor cystoscopy should be performed because this is the best way to detect the possible recurrence.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

ANSWER
A) both the statement and the explanation are true and a causal relationship exists between them;
EXPLANATION
See n.o: URO-47.

URO - 70
After the TUR surgery of superficial bladder tumors local BCG bladder installation should be performed, because this is the only drug for this procedure.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

ANSWER
C) the statement is true, but the explanation is false;
EXPLANATION
In the case of superficial bladder tumors, the recurrences are very common, as prevention immunomodulatory agents can be locally used such as BCG, Interferon or Interleukin instillation.

URO - 71
If the urine flows through the small intestine constant bacteruria will be detected, so patients will have hyperchloremic acidosis.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

ANSWER
D) the statement is false, but the explanation itself is true
EXPLANATION
In the case of small bowel bladder replacement - if secondary superficial infection has not occurred - urine is not bacteriuretic. After bladder replacement with intestinal segregation, hyperchloraemic acidosis is always present. This is due to the fact that chloride and ammonium ion are absorbed from the intestine and due to the protons that are removed from the ammonium ion in the liver, the pH level of the blood is shifted in the acidic direction.

URO - 73
Before radical prostatectomy (PSA under 10 ng/ml) regional lymph node dissection should be performed, because the result influences the possibly occurring adjuvant therapy.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

ANSWER
A) both the statement and the explanation are true and a causal relationship exists between them;
EXPLANATION
Radical prostatectomy means the „en bloc" removal of the prostate and the seminal vesicles. This surgery is indicated only at an early stage (prostate-restricted tumor), so it can not be performed in lymph node positivity. The lymph nodes are removed before surgery or laparoscopically in the first part of the operation and if the frozen section is positive, prostate removal can not be performed.

URO - 74
Renal colic is a relative contraindication to IVP, because no filtration appears in the kidneys during the colic period.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

ANSWER
A) both the statement and the explanation are true and a causal relationship exists between them;
EXPLANATION
During renal colic, the affected kidneys are obstructed, so a reduced degree of contrast agent will be visible. Thus, the IVP test performed at that time will not be valuable.

URO - 77
First diagnostic procedure:
A 65-year-old man comes to the clinic with a complaint of frequent urination. He also complains about low back and leg pain. There is no blood in the urine, urination is not painful, comes in weak yellow stream.
A) DRE (digital rectal examination)
B) PSA (prostate specific antigen)
C) Transrectal ultrasound (TRUS)
D) prostate biopsy

ANSWER
A) DRE (digital rectal examination)
EXPLANATION
When examining male patients with urinary complaints, the first test to be performed is the urinalysis and then the rectal digital examination, which is the simplest and the cheapest and is always mandatory.

URO - 78
By performing the TRUS procedure an increased, non homogenic prostate is found. The capsule is ruptured. The PSA level is 20 ng/ml. The DRE shows a large, not sensitive prostate with hard, uneven surface. What is the most likely diagnosis?
A 65-year-old man comes to the clinic with a complaint of frequent urination. He also complains about low back and leg pain. There is no blood in the urine, urination is not painful, comes in weak yellow stream.
A) PCA (prostate cancer)
B) BPH (Benign prostatic hyperplasia)
C) chronic prostatitis
D) acute prostatitis

ANSWER
A) PCA (prostate cancer)
EXPLANATION
The hard, uneven prostate, the inhomogeneous prostate structure detected with elevated PSA level and with TRUS, and the broken capsule, refer to prostate cancer. BPH: palpation found: glandular or muscle like prostate. US test: the capsule is intact although the PSA may have elevated but is below 10 ng / ml. Prostatitis chronica: sensitive, stuffed founds in the prostate, US may exhibit inhomogeneity, possibly echodense masses in the prostate, PSA may be moderately elevated. Acute prostatitis: patient has high fever, a very sensitive, dough-sensitive, enlarged prostate.

URO - 80
As a result of the diagnostic steps a prostate cancer of stage T3cN1M1 is found, the treatment can be:
A 65-year-old man comes to the clinic with a complaint of frequent urination. He also complains about low back and leg pain. There is no blood in the urine, urination is not painful, comes in weak yellow stream.
1) radical prostatectomy
2) bilateral orchiectomy
3) hormone therapy with LHRH agonists
4) Anti-androgen therapy
5) estrogen hormone therapy
A) the 1st, 2nd and 3rd answers are correct
B) the 1st, 3rd and 4th answers are correct
C) the 1st, 4th and 5th answers are correct
D) the 1st, 3rd and 5th answers are correct
E) the 2nd, 3rd and 4th answers are correct

ANSWER
E) the 2nd, 3rd and 4th answers are correct
EXPLANATION
A T3c, N1, M1 stage prostate cancer is a late metastatic carcinoma, so only palliative treatment is possible. This is a method of suspending androgenic activity, which can be achieved by surgical or pharmacological castration (reduction of androgenic hormone levels), antiandrogens (receptor inhibition). Radical prostatectomy can only be performed in early stage prostate cancer, as it is already late.