I85PREP
⌘ K
ABU Urology study materials
ABU Urology study resources

ABU Urology practice questions

One question at a time. Build your ABU Urology understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Urologic Oncology

What is the most common histologic type of prostate cancer?

  1. Urothelial carcinoma
  2. Squamous cell carcinoma
  3. Small cell carcinoma
  4. Adenocarcinoma Correct answer.

Explanation

Prostate cancer is an adenocarcinoma in more than 95% of cases. It arises from glandular epithelium, whereas urothelial, squamous, and small cell carcinomas are uncommon variants.

Question 2Urologic Oncology

Which renal cell carcinoma subtype is the most common?

  1. Papillary renal cell carcinoma
  2. Clear cell renal cell carcinoma Correct answer.
  3. Chromophobe renal cell carcinoma
  4. Collecting duct carcinoma

Explanation

Clear cell renal cell carcinoma accounts for about 70-75% of renal cell carcinomas. It is characterized by inactivation of the von Hippel-Lindau gene and abundant clear cytoplasm.

Question 3Urologic Oncology

Which histologic type accounts for most bladder cancers in the United States?

  1. Urothelial carcinoma Correct answer.
  2. Small cell carcinoma
  3. Adenocarcinoma
  4. Squamous cell carcinoma

Explanation

Urothelial carcinoma is the predominant histologic type of bladder cancer in the United States and Europe. Squamous cell carcinoma is more common in regions with schistosomiasis.

Question 4Urologic Oncology

Which serum marker may be elevated in pure seminoma?

  1. Carcinoembryonic antigen
  2. CA 19-9
  3. Beta-hCG Correct answer.
  4. Alpha-fetoprotein

Explanation

Pure seminoma may produce beta-hCG when syncytiotrophoblastic cells are present, but alpha-fetoprotein is not elevated in pure seminoma. An elevated AFP suggests a nonseminomatous component.

Question 5Urologic Oncology

What is the most common histologic type of penile cancer?

  1. Adenocarcinoma
  2. Melanoma
  3. Squamous cell carcinoma Correct answer.
  4. Basal cell carcinoma

Explanation

More than 95% of penile cancers are squamous cell carcinomas. They usually arise from the glans or prepuce and are associated with phimosis and HPV.

Question 6Urologic Oncology

Which paraneoplastic syndrome results from erythropoietin production by renal cell carcinoma?

  1. Polycythemia Correct answer.
  2. Hypercalcemia
  3. Hypoglycemia
  4. Thrombocytosis

Explanation

Renal cell carcinoma can secrete erythropoietin, causing secondary polycythemia. Hypercalcemia also occurs in RCC but is usually due to parathyroid hormone-related peptide, not erythropoietin.

Question 7Urologic Oncology

Which hereditary syndrome is associated with an increased risk of upper tract urothelial carcinoma?

  1. Von Hippel-Lindau disease
  2. Lynch syndrome Correct answer.
  3. Birt-Hogg-Dubé syndrome
  4. Tuberous sclerosis

Explanation

Lynch syndrome, caused by mismatch repair gene mutations, increases the risk of upper tract urothelial carcinoma and colorectal cancer. VHL, tuberous sclerosis, and Birt-Hogg-Dubé predispose mainly to renal tumors.

Question 8Urologic Oncology

In prostate cancer grading, what does Gleason pattern 5 represent?

  1. Well differentiated
  2. Poorly differentiated Correct answer.
  3. Benign glands
  4. Moderately differentiated

Explanation

Gleason pattern 5 denotes poorly differentiated glands or single cells, the highest grade in the Gleason system. It worsens prognosis when present.

Question 9Urologic Oncology

A 62-year-old man has a PSA of 8.0 ng/mL and a normal digital rectal examination. Which procedure establishes the diagnosis?

  1. Cystoscopy
  2. Transrectal ultrasound-guided prostate biopsy Correct answer.
  3. Radical prostatectomy
  4. Bone scintigraphy

Explanation

An elevated PSA with a normal digital rectal examination still requires tissue diagnosis, usually by transrectal ultrasound-guided biopsy. Imaging and staging tests do not establish the diagnosis.

Question 10Urologic Oncology

A 70-year-old man has high-grade Ta bladder cancer after complete transurethral resection. Which adjuvant therapy is most appropriate?

  1. Intravesical gemcitabine alone
  2. Systemic cisplatin-based chemotherapy
  3. Intravesical BCG induction plus maintenance Correct answer.
  4. Single immediate postoperative mitomycin C

Explanation

High-grade Ta is high-risk non-muscle-invasive bladder cancer, and intravesical BCG induction with maintenance reduces recurrence and progression. A single perioperative mitomycin dose is reserved for lower-risk disease.

Question 11Urologic Oncology

A 25-year-old man has a painless solid testicular mass. What is the next best step?

  1. Radical inguinal orchiectomy Correct answer.
  2. Scrotal orchiectomy
  3. Retroperitoneal lymph node dissection
  4. Transscrotal needle biopsy

Explanation

A solid testicular mass is presumed malignant, and radical inguinal orchiectomy provides diagnosis and local control. Transscrotal biopsy is avoided because it can seed the scrotum and alter lymphatic drainage.

Question 12Urologic Oncology

A 55-year-old man has a 4-cm enhancing renal mass and a normal contralateral kidney. Which treatment is preferred?

  1. Partial nephrectomy Correct answer.
  2. Active surveillance
  3. Percutaneous radiofrequency ablation
  4. Radical nephrectomy

Explanation

For a 4-cm localized renal mass, partial nephrectomy is preferred when technically feasible because it preserves renal function with similar oncologic outcomes. Radical nephrectomy is reserved for larger or centrally invasive tumors.

Question 13Urologic Oncology

A man has newly diagnosed prostate cancer with a PSA of 25 ng/mL and Gleason score 8. Which staging study is most appropriate?

  1. No staging imaging
  2. Chest radiograph alone
  3. Bone scan and CT or MRI Correct answer.
  4. FDG-PET

Explanation

High-risk prostate cancer, indicated by PSA 25 and Gleason 8, warrants staging with bone scan and cross-sectional imaging of the pelvis and abdomen. These tests detect bone and nodal metastases.

Question 14Urologic Oncology

A patient has gross hematuria, and CT shows a filling defect in the renal pelvis. What is the next best diagnostic step?

  1. Radical nephroureterectomy
  2. Renal ultrasonography
  3. Repeat CT in six months
  4. Ureteroscopy with biopsy Correct answer.

Explanation

A renal pelvis filling defect suspicious for upper tract urothelial carcinoma should be evaluated by ureteroscopy with biopsy and selective cytology. This confirms histology and helps plan nephroureterectomy.

Question 15Urologic Oncology

A young man has a testicular mass, markedly elevated beta-hCG, and normal alpha-fetoprotein. Which histology is most likely?

  1. Yolk sac tumor
  2. Choriocarcinoma Correct answer.
  3. Teratoma
  4. Pure seminoma

Explanation

Choriocarcinoma characteristically produces very high beta-hCG levels and may cause gynecomastia or hyperthyroidism. Pure seminoma usually has only modest hCG elevation, and yolk sac tumors elevate AFP.

Question 16Urologic Oncology

Which PSA threshold defines biochemical recurrence after radical prostatectomy?

  1. 0.2 ng/mL Correct answer.
  2. 2.0 ng/mL
  3. 10 ng/mL
  4. 4.0 ng/mL

Explanation

After radical prostatectomy, biochemical recurrence is defined as a confirmed PSA of 0.2 ng/mL or higher. The 2.0, 4.0, and 10 ng/mL thresholds are used in other contexts, such as radiation therapy or screening.

Question 17Urologic Oncology

A 60-year-old man has muscle-invasive bladder cancer staged T2N0M0. Which treatment improves overall survival?

  1. Transurethral resection alone
  2. Neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy Correct answer.
  3. BCG maintenance therapy
  4. Radical cystectomy alone

Explanation

Muscle-invasive bladder cancer is treated with neoadjuvant cisplatin-based combination chemotherapy followed by radical cystectomy. This approach improves overall survival compared with cystectomy alone.

Question 18Urologic Oncology

A patient has a testicular tumor with seminoma histology but an alpha-fetoprotein level of 500 ng/mL. How should this be managed?

  1. Treat as pure seminoma with radiation
  2. Treat as a nonseminomatous germ cell tumor Correct answer.
  3. Repeat AFP and observe
  4. Perform retroperitoneal lymph node dissection alone

Explanation

Pure seminoma does not produce alpha-fetoprotein. Any elevation of AFP indicates a nonseminomatous component, so the patient should be managed as having a nonseminomatous germ cell tumor.

Question 19Urologic Oncology

A 55-year-old woman has a 3-cm renal mass containing macroscopic fat on CT. What is the most likely diagnosis?

  1. Papillary renal cell carcinoma
  2. Angiomyolipoma Correct answer.
  3. Oncocytoma
  4. Clear cell renal cell carcinoma

Explanation

Macroscopic fat within a renal mass is characteristic of angiomyolipoma, a benign tumor. Clear cell and papillary carcinomas rarely contain fat, and oncocytoma does not.

Question 20Urologic Oncology

A man with penile squamous cell carcinoma has persistent palpable inguinal lymph nodes after antibiotic treatment. What is the next best step?

  1. Immediate bilateral inguinal lymph node dissection
  2. Observation for six months
  3. Radiation therapy to both groins
  4. Fine-needle aspiration Correct answer.

Explanation

Persistent palpable inguinal nodes in penile cancer after antibiotic treatment require tissue confirmation, usually by fine-needle aspiration. Inguinal lymph node dissection is then performed if metastasis is confirmed.

Question 21Urologic Oncology

What is the most common adrenal incidentaloma?

  1. Benign cortical adenoma Correct answer.
  2. Pheochromocytoma
  3. Adrenocortical carcinoma
  4. Metastatic carcinoma

Explanation

Benign cortical adenoma is the most common adrenal incidentaloma. Hormonal evaluation and imaging characteristics guide further management.

Question 22Urologic Oncology

Which factor most strongly increases the risk of urothelial carcinoma of the bladder?

  1. High dietary calcium
  2. Alcohol consumption
  3. Cigarette smoking Correct answer.
  4. Vigorous exercise

Explanation

Cigarette smoking is the strongest modifiable risk factor for urothelial carcinoma of the bladder. Alcohol, dietary calcium, and exercise are not established strong risk factors.

Question 23Urologic Oncology

Which renal cell carcinoma subtype is most strongly associated with von Hippel-Lindau disease?

  1. Clear cell renal cell carcinoma Correct answer.
  2. Chromophobe renal cell carcinoma
  3. Papillary renal cell carcinoma
  4. Collecting duct carcinoma

Explanation

Von Hippel-Lindau disease is associated with clear cell renal cell carcinoma due to VHL gene inactivation. Papillary, chromophobe, and collecting duct carcinomas are not the typical VHL-associated subtype.

Question 24Urologic Oncology

A 65-year-old man has Gleason 3+3=6 prostate cancer in one of 12 cores, a PSA of 4.2 ng/mL, and no palpable disease. Which management is most appropriate?

  1. Immediate radical prostatectomy
  2. External beam radiation therapy
  3. Androgen deprivation therapy
  4. Active surveillance Correct answer.

Explanation

Low-risk prostate cancer, defined by Gleason 6, low PSA, and low volume, is managed with active surveillance to avoid overtreatment. Radical prostatectomy and radiation are options if progression occurs.

Question 25Urologic Oncology

After radical inguinal orchiectomy for stage I pure seminoma, which is an accepted management option?

  1. Pelvic radiation alone
  2. Active surveillance Correct answer.
  3. Routine retroperitoneal lymph node dissection
  4. Cisplatin-based combination chemotherapy

Explanation

After orchiectomy for stage I pure seminoma, active surveillance is an accepted standard because cure rates are high and salvage therapy is effective. Adjuvant carboplatin or radiation may be offered in selected cases, but routine retroperitoneal lymph node dissection is not used for seminoma.

Question 26Endourology and Stone Disease

A 45-year-old man has sudden left flank pain and hematuria without fever. Renal function is normal. Which test is preferred to confirm a suspected ureteral stone?

  1. Noncontrast CT abdomen/pelvis Correct answer.
  2. Retrograde urethrography with voiding phase
  3. Intravenous pyelography with delayed films
  4. Radionuclide renal scan with diuretic

Explanation

Noncontrast CT of the abdomen and pelvis is the first-line imaging test for suspected renal colic because it detects stones, obstruction, and alternative diagnoses. Intravenous contrast is not needed and adds risk.

Question 27Endourology and Stone Disease

In industrialized countries, which stone composition is most common?

  1. Calcium oxalate Correct answer.
  2. Cystine
  3. Uric acid
  4. Struvite

Explanation

Calcium oxalate stones account for roughly 70-80% of urinary calculi. Uric acid, struvite, and cystine stones are much less common.

Question 28Endourology and Stone Disease

Which urine pH range is targeted for dissolution of a uric acid stone?

  1. 6.5 to 7.0 Correct answer.
  2. 7.5 to 8.0
  3. 5.5 to 6.0
  4. 5.0 to 5.5

Explanation

Uric acid solubility rises sharply above pH 6.5, so alkalinization to 6.5-7.0 dissolves stones. Higher pH risks calcium phosphate precipitation.

Question 29Endourology and Stone Disease

Recurrent struvite stones are most strongly associated with infection by which organism?

  1. Staphylococcus saprophyticus
  2. Escherichia coli
  3. Enterococcus faecalis
  4. Proteus mirabilis Correct answer.

Explanation

Proteus mirabilis is urease-producing and splits urea to ammonia, alkalinizing urine and favoring struvite. E. coli, S. saprophyticus, and enterococci are not classic urease producers.

Question 30Endourology and Stone Disease

A 30-year-old woman has a 5-mm distal ureteral stone, controlled pain, no fever, and normal renal function. What is the most appropriate initial management?

  1. Immediate percutaneous nephrolithotomy with stone clearance
  2. Long-term indwelling nephrostomy tube drainage
  3. Observation plus medical expulsive therapy Correct answer.
  4. Urgent open ureterolithotomy through a flank incision

Explanation

Small distal ureteral stones often pass spontaneously, and alpha-blocker medical expulsive therapy can be offered when pain is controlled and there is no infection or renal impairment. Immediate surgery or long-term drainage is reserved for complications or failure of conservative care.

Question 31Endourology and Stone Disease

Which finding on noncontrast CT most strongly indicates that an obstructing stone requires urgent decompression?

  1. Mild perinephric stranding
  2. Gas within the collecting system Correct answer.
  3. Stone size of 4 mm
  4. A stone at the ureterovesical junction

Explanation

Gas in the collecting system suggests gas-forming infection or pyonephrosis, and an obstructed infected system needs urgent drainage. Small stones, mild stranding, and UVJ location alone do not mandate decompression.

Question 32Endourology and Stone Disease

Which stone type is typically radiolucent on plain abdominal radiography?

  1. Calcium oxalate monohydrate
  2. Struvite
  3. Cystine
  4. Uric acid Correct answer.

Explanation

Uric acid stones lack sufficient calcium to be seen on plain radiographs and are best detected by CT. Calcium oxalate, struvite, and cystine stones are usually radiopaque, though cystine may be faint.

Question 33Endourology and Stone Disease

Which dietary measure most reliably reduces recurrence of calcium stones?

  1. High fluid intake (2.5 L urine/day) Correct answer.
  2. Low fluid intake to reduce urine volume
  3. High sodium intake from processed foods
  4. High animal protein intake at every meal

Explanation

Increasing fluid intake to achieve at least 2.5 L of urine daily lowers stone recurrence by reducing urine supersaturation. High sodium, high animal protein, and low fluid intake all promote calcium stones.

Question 34Endourology and Stone Disease

A 32-year-old pregnant woman at 20 weeks has a 7-mm obstructing ureteral stone and fever. What is the most appropriate initial step?

  1. Stent or percutaneous nephrostomy drainage Correct answer.
  2. Shock wave lithotripsy with fetal shielding
  3. Definitive ureteroscopic stone extraction without drainage
  4. Oral potassium citrate dissolution therapy

Explanation

An infected obstruction during pregnancy is an emergency requiring decompression with a ureteral stent or nephrostomy and antibiotics. Definitive stone treatment is usually deferred until after delivery.

Question 35Endourology and Stone Disease

Which statement best describes the role of a ureteral access sheath during flexible ureteroscopy?

  1. Replaces the need for laser lithotripsy
  2. Prevents all ureteral strictures after ureteroscopy
  3. Eliminates the need for any postoperative ureteral stent
  4. Lowers pressure and permits repeat passes Correct answer.

Explanation

A ureteral access sheath facilitates repeated passage of the ureteroscope, improves irrigation outflow, and helps limit intrarenal pressure. It does not remove the need for stenting or lithotripsy and does not prevent all strictures.

Question 36Endourology and Stone Disease

A 58-year-old man has a 2.5-cm partial staghorn calculus in a normal renal unit. Which treatment is most appropriate?

  1. Medical expulsive therapy
  2. Observation with annual imaging
  3. Shock wave lithotripsy monotherapy
  4. Percutaneous nephrolithotomy Correct answer.

Explanation

PCNL is first-line for staghorn or large renal stones because it achieves high stone-free rates in a single procedure. Observation, MET, and SWL monotherapy are inadequate for a stone of this size.

Question 37Endourology and Stone Disease

Which patient is the best candidate for medical expulsive therapy with an alpha-1 blocker?

  1. 12-mm proximal stone in a stable patient
  2. 7-mm distal stone with controlled pain Correct answer.
  3. 3-mm stone in a solitary kidney
  4. Obstructing stone with sepsis

Explanation

MET is most reasonable for distal ureteral stones of about 5-10 mm when pain is controlled and there is no infection or renal compromise. Large proximal stones, solitary-kidney obstruction, and sepsis require prompt intervention.

Question 38Endourology and Stone Disease

A 45-year-old woman has recurrent calcium oxalate stones. Her 24-hour urine shows hypercalciuria with normal serum calcium and PTH. Which initial medication is most appropriate?

  1. Potassium citrate for hypocitraturia
  2. Hydrochlorothiazide Correct answer.
  3. Penicillamine for cystinuria
  4. Allopurinol for hyperuricosuria

Explanation

Thiazide diuretics reduce urinary calcium excretion and are used for hypercalciuric calcium stone formers. Allopurinol targets hyperuricosuria, citrate targets hypocitraturia, and penicillamine is for cystinuria.

Question 39Endourology and Stone Disease

Which holmium laser setting is most appropriate for dusting a 6-mm renal stone?

  1. High energy and low frequency
  2. Low energy and low frequency
  3. Low energy and high frequency Correct answer.
  4. High energy and high frequency

Explanation

Dusting uses low pulse energy with high frequency to produce fine fragments that pass more readily. Higher energy with lower frequency favors fragmentation of larger stones.

Question 40Endourology and Stone Disease

A 70-year-old man develops fever and flank pain 48 hours after PCNL. CT shows a perinephric collection and an obstructed collecting system. What is the next best step?

  1. Drainage plus broad-spectrum antibiotics Correct answer.
  2. Shock wave lithotripsy of residual fragments
  3. Immediate repeat PCNL through the same tract
  4. Discharge with oral antibiotics and outpatient follow-up

Explanation

Post-PCNL infection with an obstructed system or abscess requires urgent drainage and broad-spectrum antibiotics. Repeat PCNL or SWL is inappropriate during acute infection.

Question 41Endourology and Stone Disease

Which stone is most resistant to shock wave lithotripsy?

  1. Uric acid
  2. Calcium oxalate dihydrate stones
  3. Brushite (calcium phosphate) Correct answer.
  4. Struvite

Explanation

Brushite stones are hard and poorly fragmented by SWL, often requiring PCNL or ureteroscopy. Uric acid stones are relatively soft and fragment easily.

Question 42Endourology and Stone Disease

A 28-year-old man has a cystine stone. Which regimen is most appropriate for stone prevention?

  1. High fluid intake plus urine pH >7.0 Correct answer.
  2. Urine acidification with cranberry juice
  3. Dietary calcium restriction alone
  4. Thiazide diuretic monotherapy

Explanation

Cystine solubility increases with high urine volume and alkaline pH, so patients need high fluid intake and alkalinization to pH 7.0-7.5. Calcium restriction, acidification, and thiazides alone do not address cystinuria.

Question 43Endourology and Stone Disease

A 62-year-old woman has a 1.5-cm lower-pole renal stone and a 4-mm infundibulum. Which factor most limits shock wave lithotripsy success?

  1. Narrow dependent lower-pole calyx Correct answer.
  2. Patient age over 60 years at treatment
  3. Stone composition of pure uric acid
  4. History of well-controlled hypertension

Explanation

Lower-pole stones with a narrow infundibulum have poor fragment clearance after SWL, reducing success. Uric acid composition is favorable for fragmentation, and age or hypertension is not the primary limiting factor.

Question 44Endourology and Stone Disease

A patient with a 10-mm proximal ureteral stone and severe colic has creatinine rising from 1.0 to 2.2 mg/dL. What is the most appropriate management?

  1. Observation with repeat creatinine in 2 weeks
  2. Medical expulsive therapy alone
  3. Oral alkalinization therapy
  4. Urgent decompression, then stone treatment Correct answer.

Explanation

An obstructing stone with acute kidney injury requires urgent decompression by stent or nephrostomy, followed by definitive stone treatment. Observation or MET alone risks further renal loss.

Question 45Endourology and Stone Disease

During flexible ureteroscopy, irrigation inflow is high and outflow is poor. Which complication is most likely?

  1. Stone migration into the proximal ureter
  2. Ureteral stricture requiring long-term stenting
  3. Renal fornix rupture with fluid extravasation Correct answer.
  4. Ureteral avulsion at the ureterovesical junction

Explanation

Poor outflow during ureteroscopy raises intrarenal pressure, which can rupture a fornix and cause fluid extravasation or absorption. Ureteral avulsion is a mechanical injury, and stricture is a late healing complication.

Question 46Endourology and Stone Disease

A 35-year-old woman has a 2-cm renal pelvic stone and a history of recurrent urinary tract infections. Which treatment approach is most appropriate?

  1. Medical expulsive therapy
  2. Observation
  3. Percutaneous nephrolithotomy Correct answer.
  4. Extracorporeal shock wave lithotripsy

Explanation

PCNL is the preferred treatment for a 2-cm renal pelvic stone, especially with recurrent infection. Stones of this size do not pass with MET, and SWL has lower clearance rates.

Question 47Endourology and Stone Disease

Which maneuver best reduces the risk of ureteral injury during ureteroscopic access?

  1. Forcing the ureteroscope past a resistance
  2. Using the largest available ureteroscope
  3. Omitting fluoroscopy during access
  4. Safety guidewire and gentle dilation Correct answer.

Explanation

A safety guidewire, gentle hydrodilation, and appropriate instrument size reduce ureteral trauma during access. Forcing the scope or using an oversized instrument increases injury risk.

Question 48Endourology and Stone Disease

A 40-year-old woman has recurrent calcium oxalate stones after Roux-en-Y gastric bypass. Which metabolic abnormality is most likely?

  1. Hypocitraturia
  2. Hyperoxaluria Correct answer.
  3. Hyperuricosuria
  4. Hypercalciuria

Explanation

After malabsorptive bypass, unabsorbed fatty acids bind calcium, leaving colonic oxalate free to be absorbed and causing enteric hyperoxaluria. This raises urinary oxalate and calcium oxalate stone risk.

Question 49Endourology and Stone Disease

A patient has a 3-mm asymptomatic calyceal stone. What is the most appropriate management?

  1. Percutaneous nephrolithotomy
  2. Ureteroscopy with laser lithotripsy
  3. Shock wave lithotripsy
  4. Observation with periodic follow-up Correct answer.

Explanation

Small asymptomatic calyceal stones can be observed because many remain stable and intervention carries risk. Active treatment is reserved for growth, symptoms, obstruction, or infection.

Question 50Endourology and Stone Disease

A 60-year-old man is scheduled for flexible ureteroscopy for a 1-cm renal stone. Which preoperative finding most strongly warrants delaying surgery?

  1. Positive urine culture with fever Correct answer.
  2. Urine pH of 6.0 on dipstick
  3. Microscopic hematuria on urinalysis
  4. Trace proteinuria on dipstick testing

Explanation

Active urinary infection with fever should be treated before ureteroscopy because instrumentation can precipitate sepsis. Proteinuria, hematuria, and a pH of 6.0 are not contraindications.