GoodJob Chris Urology

A 65-year-old man presents with lower urinary tract symptoms. Digital rectal exam reveals a firm, nodular prostate. What is the most appropriate initial investigation? A. PSA (Prostate-Specific Antigen) B. Transrectal ultrasound C. Cystoscopy D. MRI of the pelvis

A. PSA (Prostate-Specific Antigen) — PSA is the first-line investigation when prostate cancer is suspected based on DRE findings.

Which of the following is the most common type of renal stone? A. Struvite B. Uric acid C. Cystine D. Calcium oxalate

D. Calcium oxalate — Calcium oxalate stones account for ~80% of all renal stones.

Which urological condition is most likely to cause a painless testicular mass in a 25-year-old male? A. Epididymitis B. Testicular torsion C. Testicular cancer D. Hydrocele

C. Testicular cancer — Painless testicular mass in a young male is testicular cancer until proven otherwise.

What is the most appropriate management of acute testicular torsion in a 16-year-old boy? A. Antibiotics B. Manual detorsion and observation C. Emergent surgical exploration D. Ultrasound and delayed surgery

C. Emergent surgical exploration — Testicular torsion is a surgical emergency; time to detorsion determines viability.

Which of the following is the most common organism causing uncomplicated urinary tract infections in women? A. Proteus mirabilis B. Enterococcus faecalis C. Staphylococcus saprophyticus D. Escherichia coli

D. Escherichia coli — E. coli causes ~80–85% of uncomplicated UTIs in women.

What is the first-line treatment for benign prostatic hyperplasia (BPH)? A. Alpha-blockers B. Finasteride C. TURP D. Watchful waiting

A. Alpha-blockers — Alpha-blockers (e.g., tamsulosin) provide rapid symptom relief and are first-line for BPH.

What is the most common congenital anomaly of the urinary tract? A. Posterior urethral valves B. Vesicoureteral reflux C. Ureteropelvic junction obstruction D. Horseshoe kidney

B. Vesicoureteral reflux — VUR is the most common congenital urinary tract anomaly.

Which of the following is a known risk factor for bladder cancer? A. Diabetes mellitus B. Cigarette smoking C. Alcohol consumption D. Hypertension

B. Cigarette smoking — Smoking is the #1 risk factor for bladder cancer, responsible for ~50% of cases.

In Peyronie's disease, which structure is most commonly affected? A. Epididymis B. Urethra C. Tunica albuginea D. Corpus spongiosum

C. Tunica albuginea — Peyronie's disease involves fibrotic plaque formation in the tunica albuginea of the penis.

Which of the following tumor markers is most commonly elevated in non-seminomatous testicular germ cell tumors? A. PSA B. AFP C. CEA D. CA-125

B. AFP (Alpha-fetoprotein) — AFP is elevated in non-seminomatous GCTs (e.g., yolk sac tumor, embryonal carcinoma).

Which imaging modality is most sensitive for detecting renal stones? A. X-ray KUB B. Ultrasound C. CT without contrast D. MRI

C. CT without contrast — Non-contrast CT (NCCT) has ~98% sensitivity for renal stones and is the gold standard.

Which of the following is a clinical feature of nephrotic syndrome? A. Hematuria B. Oliguria C. Proteinuria >3.5 g/day D. Hypertension only

C. Proteinuria >3.5 g/day — Nephrotic syndrome is defined by massive proteinuria (>3.5 g/day), hypoalbuminemia, and edema.

What is the most common cause of acute scrotal pain in adolescents? A. Epididymitis B. Testicular torsion C. Varicocele D. Hydrocele

B. Testicular torsion — Testicular torsion is the most common cause of acute scrotal pain in adolescents.

A 60-year-old man has gross hematuria. What is the most important initial investigation? A. PSA test B. Cystoscopy C. IVU (intravenous urogram) D. Ultrasound

B. Cystoscopy — Cystoscopy is the most important investigation for gross hematuria to rule out bladder cancer.

What is the most common histologic type of prostate cancer? A. Squamous cell carcinoma B. Urothelial carcinoma C. Adenocarcinoma D. Small cell carcinoma

C. Adenocarcinoma — Over 95% of prostate cancers are adenocarcinomas arising from prostatic acini.

In a renal transplant patient, which immunosuppressive drug is associated with gum hypertrophy? A. Tacrolimus B. Mycophenolate mofetil C. Prednisolone D. Cyclosporine

D. Cyclosporine — Cyclosporine (calcineurin inhibitor) is classically associated with gingival hyperplasia.

A ureteric stone is most likely to get lodged at which location? A. Renal pelvis B. Ureteropelvic junction C. Mid-ureter D. Ureterovesical junction

D. Ureterovesical junction — The UVJ is the narrowest part of the ureter and the most common site of stone impaction.

Which test is used to assess bladder function and compliance? A. Intravenous pyelogram B. Urodynamic study C. CT urography D. Renal biopsy

B. Urodynamic study — Urodynamics measures bladder pressure, volume, and flow to assess function and compliance.

What is the classic triad of renal cell carcinoma? A. Fever, hematuria, proteinuria B. Hematuria, flank pain, abdominal mass C. Dysuria, urgency, frequency D. Hypertension, edema, proteinuria

B. Hematuria, flank pain, abdominal mass — This classic triad occurs in ~10% of RCC patients and indicates advanced disease.

Which of the following is associated with painless hematuria in a smoker? A. Nephrolithiasis B. Interstitial cystitis C. Bladder cancer D. Pyelonephritis

C. Bladder cancer — Painless hematuria in a smoker is bladder cancer until proven otherwise.

What is the most common cause of scrotal swelling in newborns? A. Hydrocele B. Hernia C. Torsion D. Varicocele

A. Hydrocele — Communicating hydrocele is the most common cause of scrotal swelling in newborns due to patent processus vaginalis.

Which organism is most associated with struvite stones? A. E. coli B. Klebsiella pneumoniae C. Proteus mirabilis D. Enterococcus faecalis

C. Proteus mirabilis — Proteus mirabilis is a urease-producing organism that alkalinizes urine and forms struvite (infection) stones.

What is the first-line treatment for uncomplicated UTI in women? A. Ciprofloxacin B. Nitrofurantoin C. Ceftriaxone D. Gentamicin

B. Nitrofurantoin — Nitrofurantoin (or trimethoprim-sulfamethoxazole) is first-line for uncomplicated UTI.

A varicocele is more commonly found on which side? A. Right B. Left C. Bilateral D. Equally on both sides

B. Left — Left-sided varicocele is more common because the left testicular vein drains at a right angle into the left renal vein.

What is the treatment of choice for high-grade non-muscle invasive bladder cancer? A. Oral chemotherapy B. Cystectomy C. Intravesical BCG D. Observation

C. Intravesical BCG — BCG immunotherapy is the standard treatment after TURBT for high-grade non-muscle invasive bladder cancer.

What is the most appropriate next step in a child with posterior urethral valves? A. Renal transplant B. Immediate circumcision C. Voiding cystourethrogram (VCUG) D. Cystoscopy and ablation

D. Cystoscopy and ablation — After initial stabilization and VCUG diagnosis, cystoscopic valve ablation is the definitive treatment.

Which tumor marker is specific for seminoma? A. AFP B. hCG C. LDH D. None – no specific marker

D. None – no specific marker — Seminomas may mildly elevate LDH or hCG, but AFP is NOT elevated; there is no truly specific marker.

What is the most common site of metastasis in prostate cancer? A. Brain B. Lungs C. Bones D. Liver

C. Bones — Prostate cancer preferentially metastasizes to bone (osteoblastic lesions), especially the lumbar spine and pelvis.

Which grade in Gleason scoring indicates poorly differentiated tumor? A. Grade 1 B. Grade 2 C. Grade 3 D. Grade 5

D. Grade 5 — Gleason grade 5 represents the most poorly differentiated, anaplastic pattern with no glandular formation.

A man has a painless, transilluminating scrotal swelling. Likely diagnosis? A. Epididymal cyst B. Hydrocele C. Varicocele D. Testicular tumor

B. Hydrocele — A scrotal swelling that transilluminates (light passes through) is consistent with a fluid-filled hydrocele.

The gold standard investigation for vesicoureteral reflux is: A. IVU B. CT urogram C. Voiding cystourethrogram D. MRI urogram

C. Voiding cystourethrogram (VCUG) — VCUG is the gold standard for diagnosing and grading vesicoureteral reflux.

Which condition shows a 'bag of worms' appearance on physical exam? A. Hydrocele B. Testicular torsion C. Epididymitis D. Varicocele

D. Varicocele — Dilated, tortuous veins of the pampiniform plexus in a varicocele feel like a bag of worms.

Priapism is most commonly associated with: A. Leukemia B. Diabetes C. Sickle cell disease D. Hypertension

C. Sickle cell disease — Sickle cell disease causes vaso-occlusion in penile vasculature, leading to ischemic priapism.

The most common type of testicular cancer is: A. Sertoli cell tumor B. Seminoma C. Embryonal carcinoma D. Teratoma

B. Seminoma — Seminoma is the most common testicular germ cell tumor, typically in men aged 25–45.

A 5-year-old boy has enuresis. What is the most likely cause? A. Neurological deficit B. Vesicoureteral reflux C. Delayed bladder maturation D. Diabetes insipidus

C. Delayed bladder maturation — Primary nocturnal enuresis in children is most commonly due to delayed maturation of bladder control.

Which antibiotic is best avoided in pyelonephritis due to poor tissue penetration? A. Ciprofloxacin B. Trimethoprim-sulfamethoxazole C. Nitrofurantoin D. Ceftriaxone

C. Nitrofurantoin — Nitrofurantoin achieves urine but NOT adequate renal tissue concentrations, making it unsuitable for pyelonephritis.

The normal bladder capacity in adults is approximately: A. 100–150 mL B. 150–250 mL C. 300–500 mL D. 600–800 mL

C. 300–500 mL — Normal adult functional bladder capacity is 300–500 mL; first urge to void occurs around 150–200 mL.

What is the most common cause of obstructive uropathy in elderly men? A. Prostate cancer B. BPH C. Urethral stricture D. Bladder stones

B. BPH — Benign prostatic hyperplasia is the most common cause of bladder outlet obstruction and obstructive uropathy in elderly men.

Bell-clapper deformity predisposes to which condition? A. Epididymitis B. Torsion of appendix testis C. Testicular torsion D. Hydrocele

C. Testicular torsion — Bell-clapper deformity (high attachment of tunica vaginalis) allows the testis to rotate freely, predisposing to torsion.

Which of the following increases risk for penile cancer? A. Circumcision in infancy B. Poor hygiene C. Smoking cessation D. Regular condom use

B. Poor hygiene — Poor hygiene (associated with phimosis and smegma accumulation) is a known risk factor for penile cancer.