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FEBU practice questions

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Question 1Urology (European Board Examinations in Urology - Written Examination)

A 24-year-old man presents with a painless, firm left testicular mass. Scrotal ultrasound shows an intratesticular hypoechoic lesion. Serum alpha-fetoprotein is markedly elevated. Which histological diagnosis is most consistent with this marker profile?

  1. Non-seminomatous germ cell tumour Correct answer.
  2. Pure seminoma
  3. Sertoli cell tumour
  4. Leydig cell tumour

Explanation

Alpha-fetoprotein is never produced by pure seminoma; its elevation indicates a non-seminomatous component such as yolk sac or embryonal carcinoma. Pure seminoma may raise hCG but not AFP. Sex cord-stromal tumours do not typically secrete AFP.

Question 2Urology (European Board Examinations in Urology - Written Examination)

Which serum marker is the most reliable for monitoring disease burden in a patient with a pure seminoma?

  1. Placental alkaline phosphatase
  2. Lactate dehydrogenase
  3. Beta-hCG Correct answer.
  4. Alpha-fetoprotein

Explanation

Beta-hCG is elevated in roughly 15-20% of pure seminomas and correlates with tumour burden and response to treatment. AFP is never raised in pure seminoma, and LDH is too non-specific to be a reliable monitoring marker.

Question 3Urology (European Board Examinations in Urology - Written Examination)

A 62-year-old man has an elevated PSA of 8 ng/mL and a normal digital rectal examination. According to contemporary risk stratification, which parameter is essential before deciding on prostate biopsy?

  1. Serum testosterone level
  2. Multiparametric MRI of the prostate Correct answer.
  3. Bone scan
  4. Renal function tests

Explanation

Multiparametric MRI before biopsy improves detection of clinically significant cancer and can guide targeted sampling, and it is now recommended in the diagnostic pathway for elevated PSA. Bone scan and testosterone measurement are not part of initial biopsy decision-making in a man with normal DRE.

Question 4Urology (European Board Examinations in Urology - Written Examination)

Which finding on urinalysis most strongly suggests an upper urinary tract source rather than a bladder source of haematuria?

  1. Alkaline urine pH
  2. Isolated microscopic haematuria
  3. Presence of squamous epithelial cells
  4. Red cell casts Correct answer.

Explanation

Red cell casts form within renal tubules and therefore indicate a glomerular or renal parenchymal origin of bleeding. Squamous cells reflect contamination, and alkaline pH or isolated microscopic haematuria do not localise the source.

Question 5Urology (European Board Examinations in Urology - Written Examination)

A 70-year-old man presents with acute urinary retention, a tender bladder and a post-void residual of 900 mL. Which is the most appropriate immediate management?

  1. Immediate suprapubic catheterisation
  2. Urethral catheterisation with controlled decompression Correct answer.
  3. Clean intermittent self-catheterisation teaching
  4. Oral alpha-blocker and review in one week

Explanation

Acute painful retention with a distended bladder is managed by urethral catheterisation, with gradual decompression to reduce the risk of decompression haematuria. Suprapubic catheterisation is reserved for failed urethral access or specific indications.

Question 6Urology (European Board Examinations in Urology - Written Examination)

Which organism is the most common cause of uncomplicated community-acquired urinary tract infection in women?

  1. Klebsiella pneumoniae
  2. Escherichia coli Correct answer.
  3. Proteus mirabilis
  4. Staphylococcus saprophyticus

Explanation

Escherichia coli accounts for the majority (roughly 75-90%) of uncomplicated community-acquired UTIs. Staphylococcus saprophyticus is a notable cause in young sexually active women but is far less frequent overall.

Question 7Urology (European Board Examinations in Urology - Written Examination)

A 30-year-old woman has a 6 mm distal ureteric stone with mild hydronephrosis, controlled pain and no fever. What is the most appropriate initial management?

  1. Observation with analgesia and medical expulsive therapy Correct answer.
  2. Emergency ureteroscopy
  3. Open ureterolithotomy
  4. Percutaneous nephrostomy

Explanation

Small distal ureteric stones under 10 mm have a high chance of spontaneous passage, so observation with analgesia is appropriate when pain is controlled and there is no infection or obstruction-related renal impairment. Alpha-blockers can be offered as medical expulsive therapy.

Question 8Urology (European Board Examinations in Urology - Written Examination)

Which type of urinary stone is radiolucent on a plain abdominal radiograph?

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

Explanation

Uric acid stones are radiolucent on plain radiography because they lack sufficient calcium density. Calcium oxalate, struvite and cystine stones are all radiopaque to varying degrees.

Question 9Urology (European Board Examinations in Urology - Written Examination)

A 55-year-old man has bothersome LUTS with an IPSS of 20 and a prostate volume of 60 mL. Which medication class provides the greatest likelihood of symptom improvement in this setting?

  1. 5-alpha reductase inhibitor Correct answer.
  2. Antimuscarinic agent
  3. Phosphodiesterase-5 inhibitor
  4. Alpha-1 receptor antagonist

Explanation

In men with enlarged prostates above 40 mL, 5-alpha reductase inhibitors reduce prostate volume and provide durable symptom improvement, and they also lower the risk of retention and surgery. Alpha-blockers act faster but do not alter prostate size or long-term outcomes.

Question 10Urology (European Board Examinations in Urology - Written Examination)

A 68-year-old man has a PSA of 15 ng/mL, Gleason 4+3=7 on biopsy and a negative bone scan. Which is the most appropriate staging investigation to assess for nodal disease before radical treatment?

  1. Serum acid phosphatase
  2. Intravenous urography
  3. PSMA PET-CT Correct answer.
  4. Repeat transrectal biopsy

Explanation

PSMA PET-CT has superior sensitivity and specificity for nodal and distant metastases compared with conventional imaging in intermediate- and high-risk prostate cancer. It directly informs whether local or systemic treatment is appropriate.

Question 11Urology (European Board Examinations in Urology - Written Examination)

Which finding on renal ultrasound in a 3-year-old boy with a palpable left flank mass is most typical of a Wilms tumour?

  1. A solid intrarenal mass displacing normal parenchyma Correct answer.
  2. Diffuse bilateral renal enlargement
  3. A completely cystic lesion with septations
  4. A dilated renal pelvis with cortical thinning

Explanation

Wilms tumour typically appears as a solid intrarenal mass that distorts and displaces normal renal parenchyma. Cystic lesions, hydronephrosis and bilateral enlargement point to other diagnoses such as cystic nephroma, pelviureteric obstruction or polycystic disease.

Question 12Urology (European Board Examinations in Urology - Written Examination)

A 25-year-old man has a 6 mm proximal ureteric stone with obstruction and a raised creatinine. Which management is most appropriate?

  1. Observation with analgesia and repeat imaging in 4 weeks
  2. Urgent decompression with ureteric stent or nephrostomy Correct answer.
  3. Oral potassium citrate and review in 6 weeks
  4. Extracorporeal shockwave lithotripsy as an emergency

Explanation

An obstructing stone with rising creatinine indicates obstructive nephropathy or an infected obstructed system, which requires urgent decompression by stent or nephrostomy. Definitive stone treatment follows once renal function and infection are controlled.

Question 13Urology (European Board Examinations in Urology - Written Examination)

A 45-year-old woman has recurrent cystitis with three episodes in six months. Which preventive measure has the best evidence for reducing recurrence in this setting?

  1. Low-dose nightly antibiotic prophylaxis or post-coital prophylaxis Correct answer.
  2. Routine daily cranberry juice as sole prophylaxis
  3. Prophylactic oral ciprofloxacin taken continuously for one year
  4. Long-term intravesical antibiotic instillation

Explanation

In recurrent uncomplicated cystitis, low-dose continuous or post-coital antibiotic prophylaxis reduces recurrence and is supported by randomised evidence. Cranberry products have modest and inconsistent evidence, and prolonged fluoroquinolone use carries significant collateral damage.

Question 14Urology (European Board Examinations in Urology - Written Examination)

A 60-year-old man has a 2 cm lower pole renal mass and a solitary kidney. Which treatment best preserves renal function while offering oncological control?

  1. Partial nephrectomy or nephron-sparing ablation Correct answer.
  2. Radical nephrectomy
  3. Systemic targeted therapy
  4. Active surveillance alone

Explanation

Nephron-sparing surgery or ablation preserves renal function and is preferred for small renal masses, and is particularly important in a solitary kidney. Radical nephrectomy risks dialysis dependence in this setting.

Question 15Urology (European Board Examinations in Urology - Written Examination)

A 30-year-old man sustains a straddle injury with blood at the meatus and inability to void. Which is the most appropriate next step?

  1. Attempt urethral catheterisation
  2. Cystoscopy
  3. Retrograde urethrography Correct answer.
  4. Immediate suprapubic catheterisation

Explanation

Blood at the meatus after blunt perineal trauma raises suspicion of urethral injury, and retrograde urethrography is the diagnostic investigation before any instrumentation. Blind catheterisation risks converting a partial to a complete injury.

Question 16Urology (European Board Examinations in Urology - Written Examination)

A 70-year-old woman has stage 2 pelvic organ prolapse and symptomatic stress incontinence. Which finding on urodynamics would most influence the choice of a midurethral sling?

  1. Reduced bladder capacity
  2. Poor compliance
  3. Intrinsic sphincter deficiency with low leak point pressure Correct answer.
  4. Detrusor overactivity

Explanation

Intrinsic sphincter deficiency with low leak point pressure predicts a higher failure rate with a standard midurethral sling and may favour a bulking agent or a compression sling. Detrusor overactivity and poor compliance affect urgency and storage management rather than sling selection.

Question 17Urology (European Board Examinations in Urology - Written Examination)

Which is the most appropriate initial management for a 4-year-old boy with a unilateral undescended testis palpable in the inguinal canal?

  1. Observation until puberty
  2. Immediate orchiectomy
  3. Orchidopexy within the first year of life Correct answer.
  4. Hormonal therapy with hCG

Explanation

Orchidopexy is recommended within the first 12-18 months of life to reduce the risk of impaired spermatogenesis and malignancy and to allow surveillance. Hormonal therapy and delayed observation are not recommended as primary management.

Question 18Urology (European Board Examinations in Urology - Written Examination)

A 65-year-old man has a 3 cm distal ureteric stricture after radiotherapy and recurrent stone disease. Which reconstructive option is most appropriate?

  1. Ileal ureter substitution Correct answer.
  2. Nephrostomy for life
  3. Balloon dilatation alone
  4. Long-term ureteric stent changes

Explanation

Long ureteric defects or radiation-induced strictures that are not amenable to primary repair are best managed with ileal ureter substitution, which provides durable drainage. Repeated stenting and balloon dilatation have high failure rates in irradiated tissue.

Question 19Urology (European Board Examinations in Urology - Written Examination)

A 72-year-old man with a 90 mL prostate and refractory retention is offered surgery. Which minimally invasive option preserves ejaculation while relieving obstruction?

  1. Holmium laser enucleation of the prostate
  2. Prostatic urethral lift Correct answer.
  3. Transurethral resection of the prostate
  4. Open prostatectomy

Explanation

The prostatic urethral lift mechanically retracts lateral lobes and preserves ejaculatory function, though it is less effective for very large glands. TURP, HoLEP and open prostatectomy all carry a substantial risk of retrograde ejaculation.

Question 20Urology (European Board Examinations in Urology - Written Examination)

A 28-year-old man has a painless 3 cm left varicocele and a normal semen analysis. Which management is most appropriate?

  1. Embolisation of the left renal vein
  2. Scrotal exploration
  3. Immediate varicocelectomy
  4. Observation with clinical review Correct answer.

Explanation

An asymptomatic varicocele with normal semen parameters can be observed, since treatment is indicated for infertility, pain or testicular atrophy. Surgery is not indicated purely on the basis of a palpable varicocele.

Question 21Urology (European Board Examinations in Urology - Written Examination)

A 35-year-old man presents with a 12-hour history of a painful, swollen testis with an absent cremasteric reflex. Doppler ultrasound shows reduced flow. Which is the most appropriate next step?

  1. Antibiotics for epididymitis
  2. Repeat ultrasound in 24 hours
  3. Scrotal support and analgesia
  4. Urgent surgical exploration Correct answer.

Explanation

Testicular torsion is a surgical emergency, and immediate exploration with detorsion and fixation is required to salvage the testis. Delay for antibiotics or repeat imaging risks testicular loss.

Question 22Urology (European Board Examinations in Urology - Written Examination)

Which finding on a DMSA scan indicates a renal scar in a child with vesicoureteric reflux?

  1. Increased cortical uptake
  2. Focal cortical defect with reduced uptake Correct answer.
  3. Delayed drainage of tracer from the pelvis
  4. Differential function of 55% in the affected kidney

Explanation

DMSA scanning detects cortical scarring as focal areas of reduced tracer uptake. Differential function within normal limits and delayed drainage are not markers of scarring.

Question 23Urology (European Board Examinations in Urology - Written Examination)

A 50-year-old man has a 1 cm proximal ureteric stone and a 2 cm renal pelvic stone. Which single definitive treatment addresses both stones?

  1. Medical expulsive therapy
  2. Percutaneous nephrolithotomy Correct answer.
  3. Shockwave lithotripsy to the renal stone only
  4. Ureteroscopy to the ureteric stone only

Explanation

Percutaneous nephrolithotomy can clear a large renal pelvic stone and, via antegrade access, address a proximal ureteric stone in one procedure. The other options treat only one stone or are unlikely to clear the renal burden.

Question 24Urology (European Board Examinations in Urology - Written Examination)

A 60-year-old man has a 4 cm renal mass with a level II thrombus extending into the renal vein. Which management is most appropriate?

  1. Active surveillance
  2. Radical nephrectomy with thrombectomy Correct answer.
  3. Partial nephrectomy
  4. Systemic immunotherapy alone

Explanation

A renal vein thrombus without caval involvement can be managed by radical nephrectomy with venous thrombectomy, which offers the best chance of cure. Partial nephrectomy is unsuitable for a 4 cm tumour with venous extension.

Question 25Urology (European Board Examinations in Urology - Written Examination)

A 68-year-old man has a high-risk prostate cancer with a PSA of 40 ng/mL and Gleason 5+4=9. Which is the most appropriate treatment intent?

  1. Active surveillance
  2. Radical prostatectomy alone
  3. Focal therapy
  4. Radiotherapy combined with androgen deprivation therapy Correct answer.

Explanation

High-risk localised prostate cancer is best treated with radiotherapy combined with long-course androgen deprivation, which improves survival compared with radiotherapy alone. Surgery alone or focal therapy is inadequate for this risk group.

Question 26Urology (European Board Examinations in Urology - Written Examination)

A 24-year-old man is evaluated for infertility. Semen analysis on two occasions shows a volume of 0.4 mL, absent fructose, and acid pH. Which diagnosis best fits these findings?

  1. Congenital bilateral absence of the vas deferens Correct answer.
  2. Ejaculatory duct obstruction
  3. Klinefelter syndrome
  4. Idiopathic oligospermia

Explanation

Low-volume, acidic, fructose-negative ejaculate indicates absence of seminal vesicle contribution, characteristic of congenital bilateral absence of the vas deferens, usually linked to CFTR mutations. The testes are typically of normal size with epididymal remnants palpable. Genetic counselling and CFTR testing are indicated before any assisted reproduction.

Question 27Urology (European Board Examinations in Urology - Written Examination)

Which mechanism best explains the development of a hydrocele in an infant?

  1. Thrombosis of the pampiniform plexus
  2. Failure of closure of the processus vaginalis Correct answer.
  3. Deficiency of the cremasteric reflex arc
  4. Obstruction of the deep inguinal lymphatics

Explanation

A congenital hydrocele results from incomplete obliteration of the processus vaginalis, allowing peritoneal fluid to surround the testis. A communicating hydrocele varies in size with crying or straining. Most idiopathic infant hydroceles resolve spontaneously within the first two years.

Question 28Urology (European Board Examinations in Urology - Written Examination)

A 40-year-old woman has a 1.5 cm proximal ureteric stone with mild obstruction and a creatinine of 340 µmol/L. She has no fever and pain is controlled. What is the most appropriate next step?

  1. Observation with analgesia and repeat creatinine in 48 hours
  2. Oral potassium citrate dissolution therapy
  3. Emergency ureteric stenting or nephrostomy drainage Correct answer.
  4. Extracorporeal shockwave lithotripsy in the same session

Explanation

Obstructive uropathy with significantly impaired renal function requires urgent decompression, usually by retrograde stent or percutaneous nephrostomy, before definitive stone treatment. Decompression protects renal function and allows recovery before ureteroscopy. Dissolution and lithotripsy are elective and inappropriate in the acute obstructive setting.

Question 29Urology (European Board Examinations in Urology - Written Examination)

Which feature on CT urography is most suggestive of upper tract urothelial carcinoma rather than a renal stone?

  1. A hyperdense calculus measuring 800 Hounsfield units
  2. A cortical cyst with water attenuation
  3. A filling defect within the collecting system with delayed enhancement Correct answer.
  4. A wedge-shaped area of reduced perfusion

Explanation

Upper tract urothelial carcinoma typically appears as an enhancing soft-tissue filling defect within the pelvicalyceal system or ureter, often with delayed enhancement. Stones are hyperdense on unenhanced imaging and do not enhance. Cysts and perfusion defects suggest other renal pathology.

Question 30Urology (European Board Examinations in Urology - Written Examination)

A 62-year-old man has a 3 cm anterior urethral stricture following traumatic catheterisation. Which treatment offers the best long-term durability?

  1. Optical urethrotomy
  2. Two-stage meatotomy
  3. Buccal mucosa graft urethroplasty Correct answer.
  4. Intermittent self-dilatation

Explanation

For long or recurrent anterior urethral strictures, substitution urethroplasty using buccal mucosa offers the highest long-term success rates. Endoscopic urethrotomy has high recurrence rates for strictures longer than 1–2 cm. Self-dilatation is palliative, and meatotomy is reserved for meatal stenosis.

Question 31Urology (European Board Examinations in Urology - Written Examination)

Which finding on urodynamics is most consistent with detrusor underactivity?

  1. Low detrusor pressure with poor flow and incomplete emptying Correct answer.
  2. High detrusor pressure with low flow in a male patient
  3. Reduced maximum urethral closure pressure at rest
  4. Detrusor overactivity during filling

Explanation

Detrusor underactivity is characterised by a weak or poorly sustained detrusor contraction, producing low voiding pressure, poor flow, and elevated post-void residual. It is distinct from bladder outlet obstruction, which shows high pressure with low flow. Overactivity and low closure pressure describe different conditions.

Question 32Urology (European Board Examinations in Urology - Written Examination)

A 55-year-old woman has bothersome urgency and frequency with urodynamically proven detrusor overactivity that has failed bladder training and tolterodine. What is the next appropriate step?

  1. Intravesical botulinum toxin A injection Correct answer.
  2. Long-term indwelling catheterisation
  3. Sacral neuromodulation as first-line therapy
  4. Immediate augmentation cystoplasty

Explanation

After failed behavioural therapy and antimuscarinic treatment, intravesical onabotulinumtoxinA is a recognised third-line therapy for refractory idiopathic detrusor overactivity. It reduces urgency and frequency with a low risk of urinary retention. Sacral neuromodulation is an alternative third-line option, not first-line.

Question 33Urology (European Board Examinations in Urology - Written Examination)

Which organism is most commonly responsible for acute prostatitis in men over 35 years?

  1. Staphylococcus saprophyticus
  2. Escherichia coli Correct answer.
  3. Neisseria gonorrhoeae
  4. Mycobacterium tuberculosis

Explanation

Gram-negative Enterobacteriaceae, predominantly Escherichia coli, cause most acute bacterial prostatitis in older men. Sexually transmitted organisms are more relevant in younger men. Tuberculous prostatitis is rare and associated with systemic disease.

Question 34Urology (European Board Examinations in Urology - Written Examination)

A 30-year-old man has a painless, hard testicular mass. Tumour markers show a markedly elevated alpha-fetoprotein with normal beta-hCG. Which histological type is most likely?

  1. Non-seminomatous germ cell tumour Correct answer.
  2. Sertoli cell tumour
  3. Leydig cell tumour
  4. Pure seminoma

Explanation

Marked alpha-fetoprotein elevation strongly suggests a non-seminomatous germ cell tumour, such as yolk sac or embryonal elements. Pure seminomas do not produce alpha-fetoprotein. Sex cord-stromal tumours usually do not raise these markers.

Question 35Urology (European Board Examinations in Urology - Written Examination)

Which investigation is the standard for detecting bone metastases in newly diagnosed high-risk prostate cancer?

  1. Ultrasound of the pelvis
  2. Plain pelvic radiograph
  3. Technetium-99m bone scintigraphy Correct answer.
  4. Serum alkaline phosphatase alone

Explanation

Radionuclide bone scintigraphy remains widely used to detect skeletal metastases in high-risk prostate cancer, though PSMA PET is increasingly used where available. Plain films and alkaline phosphatase lack sensitivity. Pelvic ultrasound does not assess bone.

Question 36Urology (European Board Examinations in Urology - Written Examination)

A 70-year-old man presents with painless gross haematuria. Which initial investigation is most appropriate to evaluate the upper urinary tracts?

  1. Renal angiography
  2. Scrotal ultrasound
  3. Retrograde urethrography
  4. CT urography Correct answer.

Explanation

CT urography is the imaging standard for painless haematuria, evaluating both the upper tracts and bladder for stones, tumours, and other causes. It is combined with cystoscopy in the haematuria pathway. Angiography, urethrography, and scrotal ultrasound address different questions.

Question 37Urology (European Board Examinations in Urology - Written Examination)

A 68-year-old woman has stage III apical vaginal prolapse and is medically unfit for surgery. Which conservative option is most appropriate?

  1. Anterior colporrhaphy
  2. Sacral colpopexy
  3. Pelvic floor muscle training alone
  4. A ring pessary with oestrogen replacement Correct answer.

Explanation

For women who are unfit for surgery or prefer conservative management, a vaginal pessary provides effective support, and topical oestrogen improves tissue quality and pessary tolerance. Pelvic floor training alone is insufficient for advanced prolapse. Surgical options are unsuitable in an unfit patient.

Question 38Urology (European Board Examinations in Urology - Written Examination)

Which nerve-sparing structure, when injured during radical prostatectomy, is most responsible for erectile dysfunction?

  1. Obturator nerve
  2. Genitofemoral nerve
  3. Pudendal nerve in Alcock's canal
  4. Cavernous nerves running posterolateral to the prostate Correct answer.

Explanation

The cavernous nerves run in the neurovascular bundles posterolateral to the prostate and are at risk during radical prostatectomy, causing erectile dysfunction when injured. The obturator, pudendal, and genitofemoral nerves serve other functions. Preservation of the neurovascular bundles is central to nerve-sparing techniques.

Question 39Urology (European Board Examinations in Urology - Written Examination)

A 45-year-old man has a 2 cm renal mass with a normal contralateral kidney. Which treatment is most appropriate for a T1a tumour?

  1. Systemic tyrosine kinase inhibitor therapy
  2. Partial nephrectomy Correct answer.
  3. Active surveillance for ten years
  4. Radical nephrectomy

Explanation

For a T1a renal mass, partial nephrectomy is the standard of care where technically feasible, preserving renal function while achieving oncological control. Radical nephrectomy is reserved for larger or centrally located tumours. Systemic therapy is for metastatic disease.

Question 40Urology (European Board Examinations in Urology - Written Examination)

Which feature on renal ultrasound most reliably distinguishes a simple cyst from a complex cystic renal mass?

  1. Anechoic internal contents
  2. Posterior acoustic enhancement
  3. Smooth thin wall
  4. Presence of septations or solid nodular components Correct answer.

Explanation

The Bosniak classification uses septations, nodularity, and enhancement to grade cystic renal masses; septations and solid components raise concern for malignancy. Anechoic contents, posterior enhancement, and a thin smooth wall are features of simple benign cysts.

Question 41Urology (European Board Examinations in Urology - Written Examination)

A 28-year-old woman has stress urinary incontinence confirmed on urodynamics with normal detrusor function. Which initial management is most appropriate?

  1. Immediate mid-urethral sling insertion
  2. Oral antimuscarinic therapy
  3. Supervised pelvic floor muscle training for at least three months Correct answer.
  4. Intermittent self-catheterisation

Explanation

Supervised pelvic floor muscle training is first-line for stress urinary incontinence and should be tried for at least three months before surgical options. Mid-urethral sling surgery is reserved for failure of conservative therapy. Antimuscarinics treat urgency, not stress leakage.

Question 42Urology (European Board Examinations in Urology - Written Examination)

A 35-year-old man has acute epididymitis with a tender swollen epididymis. Which organism should be covered in a sexually active man under 35?

  1. Candida albicans
  2. Pseudomonas aeruginosa
  3. Chlamydia trachomatis Correct answer.
  4. Escherichia coli

Explanation

In sexually active men under 35, Chlamydia trachomatis and Neisseria gonorrhoeae are the commonest causes of acute epididymitis, so empirical therapy should cover these organisms. Enteric organisms are more relevant in older men or after instrumentation.

Question 43Urology (European Board Examinations in Urology - Written Examination)

A 60-year-old man has a 4 cm renal tumour with a level II thrombus extending into the renal vein. Which management is most appropriate?

  1. Partial nephrectomy alone
  2. Active surveillance
  3. Systemic immunotherapy alone
  4. Radical nephrectomy with thrombectomy Correct answer.

Explanation

Renal cell carcinoma with a level II venous thrombus confined to the renal vein is managed by radical nephrectomy with thrombectomy, often requiring vascular control. Partial nephrectomy cannot address the thrombus. Systemic therapy is reserved for metastatic disease.

Question 44Urology (European Board Examinations in Urology - Written Examination)

A 40-year-old woman has recurrent calcium oxalate stones and a 24-hour urine showing hypercalciuria. Which dietary measure is most appropriate?

  1. Severe dietary calcium restriction
  2. High animal protein intake
  3. Adequate fluid intake and normal dietary calcium Correct answer.
  4. High sodium intake

Explanation

High fluid intake reduces stone recurrence, and normal dietary calcium binds oxalate in the gut, reducing absorption. Severe calcium restriction increases oxalate absorption and stone risk. High protein and sodium increase calcium excretion.

Question 45Urology (European Board Examinations in Urology - Written Examination)

Which type of urinary diversion carries the highest risk of hyperchloraemic metabolic acidosis?

  1. Ileal conduit
  2. Orthotopic neobladder
  3. Ureterosigmoidostomy Correct answer.
  4. Continent cutaneous reservoir

Explanation

Ureterosigmoidostomy exposes urine to the colonic mucosa, which reabsorbs chloride and ammonium, causing hyperchloraemic metabolic acidosis. Ileal conduits and reservoirs can also cause acidosis but to a lesser degree. Regular electrolyte monitoring is required for all diversions.

Question 46Urology (European Board Examinations in Urology - Written Examination)

Which finding is most characteristic of a complete spinal cord injury above T6 causing neurogenic bladder?

  1. Normal detrusor function with stress incontinence
  2. Acontractile detrusor with absent reflexes
  3. Isolated urethral stricture
  4. Detrusor overactivity with detrusor-sphincter dyssynergia Correct answer.

Explanation

Suprasacral spinal cord lesions above T6 typically produce a neurogenic overactive detrusor with detrusor-sphincter dyssynergia, risking high storage pressures and upper tract damage. Acontractile bladders are more typical of lower motor neuron lesions. Urodynamic assessment guides management.

Question 47Urology (European Board Examinations in Urology - Written Examination)

A 65-year-old man has a PSA of 8 ng/mL and a suspicious digital rectal examination. Which is the most appropriate next investigation?

  1. Repeat PSA in one year
  2. Immediate radical prostatectomy
  3. Bone scan alone
  4. Transrectal ultrasound-guided prostate biopsy Correct answer.

Explanation

An elevated PSA with a suspicious digital rectal examination warrants prostate biopsy to establish the diagnosis. Repeat PSA alone delays diagnosis. Radical prostatectomy requires histological confirmation, and bone scan is a staging test, not diagnostic.

Question 48Urology (European Board Examinations in Urology - Written Examination)

Which antibiotic is contraindicated in a patient with a known deficiency of glucose-6-phosphate dehydrogenase?

  1. Trimethoprim
  2. Amoxicillin
  3. Cefalexin
  4. Nitrofurantoin Correct answer.

Explanation

Nitrofurantoin can precipitate haemolysis in patients with glucose-6-phosphate dehydrogenase deficiency and should be avoided. Trimethoprim, amoxicillin, and cefalexin are not associated with this risk. Nitrofurantoin is otherwise a first-line agent for uncomplicated cystitis.

Question 49Urology (European Board Examinations in Urology - Written Examination)

A 3-year-old boy has a unilateral non-palpable undescended testis. Which initial investigation is most appropriate?

  1. Serum testosterone measurement
  2. Examination under anaesthesia with laparoscopy if needed Correct answer.
  3. Scrotal ultrasound
  4. MRI of the pelvis

Explanation

For a non-palpable testis, examination under anaesthesia with laparoscopy allows localisation of an intra-abdominal testis and planning of orchidopexy. Ultrasound is unreliable for locating non-palpable testes. Hormonal tests and MRI do not guide surgical management.

Question 50Urology (European Board Examinations in Urology - Written Examination)

A 24-year-old man presents with sudden-onset severe left testicular pain of 4 hours' duration, nausea and a high-riding testis with an absent cremasteric reflex. Which is the most appropriate immediate management?

  1. Empirical antibiotics for epididymo-orchitis
  2. Urgent scrotal exploration Correct answer.
  3. Urine culture and analgesia with review in 24 hours
  4. Doppler ultrasound of the scrotum before any intervention

Explanation

Testicular torsion is a surgical emergency, and salvage rates fall sharply after 6 hours of ischaemia. Clinical suspicion is sufficient to justify immediate scrotal exploration with bilateral orchidopexy, and imaging must never delay surgery when the diagnosis is likely.