I85PREP
⌘ K
Iran Specialty Board - Urology study materials
Iran Specialty Board - Urology study resources

Iran Specialty Board - Urology practice questions

One question at a time. Build your Iran Specialty Board - 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 1Basic Sciences Relevant to Urology (anatomy, physiology, embryology, pharmacology, microbiology, immunology)

During a radical prostatectomy, the surgeon must control the arterial supply of the prostate. The inferior vesical artery, which provides the principal prostatic blood supply, most commonly arises from which vessel?

  1. Obturator artery
  2. Middle rectal artery
  3. Superior vesical artery Correct answer.
  4. Internal pudendal artery

Explanation

The inferior vesical artery usually branches from the superior vesical artery (a branch of the anterior division of the internal iliac), though it may arise directly from the internal iliac. It descends to supply the bladder base, prostate and seminal vesicles. The prostatic branch is often called the prostatic artery and is the main target during embolization or careful pedicle control.

Question 2Basic Sciences Relevant to Urology (anatomy, physiology, embryology, pharmacology, microbiology, immunology)

A 24-year-old man has a unilateral undescended testis that was non-palpable in the scrotum at birth. Which embryologic mechanism most directly explains failure of the testis to reach the scrotum?

  1. Impaired descent along the gubernaculum-guided path Correct answer.
  2. Failure of mesonephric duct development
  3. Incomplete fusion of the urogenital folds
  4. Failure of regression of the paramesonephric duct

Explanation

Testicular descent depends on the gubernaculum anchoring the gonad and guiding it from the abdomen through the inguinal canal into the scrotum, aided by androgen and calcitonin gene-related peptide signaling. Cryptorchidism reflects disruption of this descent process, whether from androgen deficiency, mechanical tethering or gubernacular abnormality. Fusion defects of the urogenital folds cause hypospadias, not maldescent.

Question 3Basic Sciences Relevant to Urology (anatomy, physiology, embryology, pharmacology, microbiology, immunology)

A patient with a spinal cord injury above T6 develops severe hypertension, bradycardia, headache and sweating during bladder catheterization. Which physiologic mechanism best explains this autonomic dysreflexia?

  1. Primary failure of the adrenal medulla
  2. Loss of vagal parasympathetic tone to the heart
  3. Denervation hypersensitivity of bladder detrusor muscarinic receptors
  4. Uninhibited sympathetic outflow triggered by visceral distension below the lesion Correct answer.

Explanation

After spinal shock resolves, visceral stimuli such as bladder distension trigger a massive sympathetic discharge below the cord lesion, causing vasoconstriction and hypertension. The brainstem attempts to compensate with vagal bradycardia, but descending inhibitory signals cannot pass the lesion. This produces the classic hypertension with reflex bradycardia of autonomic dysreflexia.

Question 4Basic Sciences Relevant to Urology (anatomy, physiology, embryology, pharmacology, microbiology, immunology)

A 30-year-old woman has recurrent urinary tract infections. Imaging shows a duplicated collecting system with the upper pole moiety inserting ectopically. Which embryologic abnormality best explains this configuration?

  1. Premature division of the ureteric bud from the mesonephric duct Correct answer.
  2. Failure of the urogenital sinus to develop
  3. Abnormal regression of the mesonephric duct
  4. Delayed canalization of the cloaca

Explanation

An abnormally early origin of a second ureteric bud from the mesonephric duct leads to duplication, and the resulting upper-pole ureter tends to insert ectopically and obstruct (Weigert-Meyer rule). The lower-pole ureter inserts more medially and is prone to vesicoureteral reflux. This explains the typical upper-pole hydronephrosis and ectopic insertion.

Question 5Basic Sciences Relevant to Urology (anatomy, physiology, embryology, pharmacology, microbiology, immunology)

A 55-year-old man with benign prostatic hyperplasia is started on tamsulosin. Which pharmacologic property best explains its efficacy in relieving lower urinary tract symptoms?

  1. Muscarinic M3 receptor antagonism reducing detrusor contractility
  2. 5-alpha reductase inhibition shrinking glandular volume
  3. Beta-3 adrenergic agonism increasing bladder capacity
  4. Selective alpha-1A adrenergic antagonism reducing prostatic smooth muscle tone Correct answer.

Explanation

Tamsulosin is a selective alpha-1A adrenergic antagonist; alpha-1A receptors predominate in prostatic stroma and bladder neck, so blockade reduces smooth muscle tone and dynamic obstruction. Symptom relief occurs within days but does not shrink the gland. This selectivity also limits orthostatic hypotension compared with nonselective agents.

Question 6Basic Sciences Relevant to Urology (anatomy, physiology, embryology, pharmacology, microbiology, immunology)

A 68-year-old man with a ureteral stone develops fever and hypotension. Blood cultures grow a lactose-fermenting gram-negative rod. Which virulence factor most directly promotes ascending infection from the gut to the urinary tract?

  1. Streptolysin O pore formation
  2. Endospore formation enabling survival in urine
  3. Coagulase-mediated fibrin clot formation
  4. P fimbriae binding globoseries glycosphingolipids on uroepithelium Correct answer.

Explanation

Uropathogenic Escherichia coli, the commonest cause of obstructive pyelonephritis, uses P fimbriae (pyelonephritis-associated pili) to adhere to galactose-containing receptors on uroepithelial cells. Adhesion resists washout and permits ascending colonization. Coagulase and streptolysin O belong to gram-positive organisms, and E coli does not form spores.

Question 7Basic Sciences Relevant to Urology (anatomy, physiology, embryology, pharmacology, microbiology, immunology)

During a vasectomy, the surgeon identifies the vas deferens in the scrotum. Which embryologic structure gives rise to the vas deferens?

  1. Urogenital sinus
  2. Mesonephric duct Correct answer.
  3. Genital tubercle
  4. Paramesonephric duct

Explanation

The mesonephric (Wolffian) duct, under testosterone influence, forms the epididymis, vas deferens, seminal vesicle and ejaculatory duct. The paramesonephric duct forms female internal genitalia and the appendix testis in males. The urogenital sinus and genital tubercle contribute to the urethra and external genitalia.

Question 8Basic Sciences Relevant to Urology (anatomy, physiology, embryology, pharmacology, microbiology, immunology)

A patient with chronic kidney disease has a serum potassium of 6.8 mmol/L and peaked T waves. Intravenous calcium gluconate is given. What is the primary rationale for this therapy?

  1. It stabilizes cardiac myocyte membranes against arrhythmia Correct answer.
  2. It directly binds potassium in the gut to prevent absorption
  3. It shifts potassium intracellularly via sodium-potassium ATPase stimulation
  4. It removes potassium from the body by enhancing renal excretion

Explanation

Calcium raises the cardiac membrane threshold potential, antagonizing the arrhythmogenic effect of hyperkalemia without lowering serum potassium. It is a temporizing measure that protects the heart while potassium-lowering therapies (insulin-glucose, beta agonists, dialysis) are arranged. It does not shift or remove potassium.

Question 9Basic Sciences Relevant to Urology (anatomy, physiology, embryology, pharmacology, microbiology, immunology)

A 45-year-old man has an elevated serum creatinine and a renal ultrasound shows a large simple cyst. Which statement about simple renal cysts is most accurate?

  1. They arise from obstructed collecting ducts and are lined by simple cuboidal epithelium Correct answer.
  2. They are lined by urothelium and communicate with the collecting system
  3. They contain septations and nodular enhancement on CT
  4. They are premalignant and require partial nephrectomy

Explanation

Simple cysts are common, benign, and thought to arise from obstructed tubules or collecting ducts; they are lined by a single layer of cuboidal epithelium and do not communicate with the collecting system. Bosniak I cysts have thin walls without septation or enhancement. They are generally asymptomatic and require no intervention.

Question 10Basic Sciences Relevant to Urology (anatomy, physiology, embryology, pharmacology, microbiology, immunology)

A 62-year-old man with localized prostate cancer undergoes radical prostatectomy. Which anatomic landmark separates the prostate from the rectum and is most important to preserve during dissection?

  1. Denonvilliers fascia Correct answer.
  2. Scarpa fascia
  3. Colles fascia
  4. Buck fascia

Explanation

Denonvilliers fascia (the rectovesical septum) lies between the prostate and seminal vesicles anteriorly and the rectum posteriorly. It is the key plane during posterior dissection and protects the rectum from injury. The other named fasciae belong to the perineum, penis and abdominal wall.

Question 11Basic Sciences Relevant to Urology (anatomy, physiology, embryology, pharmacology, microbiology, immunology)

A 28-year-old woman has recurrent calcium oxalate stones. Which dietary modification most effectively reduces urinary oxalate excretion?

  1. Restricting dietary calcium to less than 400 mg daily
  2. Increasing dietary sodium to improve hydration
  3. Supplementing vitamin C at high doses
  4. Increasing dietary calcium intake with meals Correct answer.

Explanation

Adequate dietary calcium taken with meals binds intestinal oxalate, reducing its absorption and urinary excretion. Restricting calcium paradoxically increases oxalate absorption and stone risk. High sodium increases calciuria, and high-dose vitamin C is metabolized to oxalate.

Question 12Basic Sciences Relevant to Urology (anatomy, physiology, embryology, pharmacology, microbiology, immunology)

A patient undergoing cystoscopy receives intravesical lidocaine. Which pharmacologic principle best explains the need for a higher concentration to anesthetize the bladder mucosa than the skin?

  1. Bladder mucosa is more vascular and rapidly clears the drug
  2. Bladder mucosa is thick and keratinized, impeding diffusion
  3. Lidocaine is a weak base and is less ionized at bladder pH Correct answer.
  4. Local anesthetics require systemic absorption for effect

Explanation

Lidocaine is a weak base; its uncharged form penetrates membranes, and the fraction present as uncharged depends on pH. In acidic urine or solutions, more drug is ionized and less crosses the urothelium. Adequate dwell time and buffering improve anesthesia.

Question 13Basic Sciences Relevant to Urology (anatomy, physiology, embryology, pharmacology, microbiology, immunology)

A 35-year-old woman has a positive urine pregnancy test and right lower quadrant pain. Which embryologic origin does the structure most likely involved share with the uterus?

  1. Paramesonephric duct Correct answer.
  2. Genital tubercle
  3. Mesonephric duct
  4. Urogenital sinus

Explanation

The fallopian tube and uterus both derive from the paramesonephric (Mullerian) ducts, which fuse and canalize. An ectopic pregnancy typically implants in the fallopian tube. The mesonephric duct forms male internal genitalia, while the urogenital sinus and genital tubercle form the bladder and external genitalia.

Question 14Basic Sciences Relevant to Urology (anatomy, physiology, embryology, pharmacology, microbiology, immunology)

A patient has nephrotic-range proteinuria. Which change in glomerular physiology most directly produces proteinuria?

  1. Elevated bladder pressure causing vesicoureteral reflux
  2. Increased tubular secretion of protein
  3. Reduced renal plasma flow from afferent arteriolar constriction
  4. Increased filtration of negatively charged albumin due to loss of podocyte charge barrier Correct answer.

Explanation

The glomerular filtration barrier normally restricts albumin through size and negative charge selectivity; podocyte foot processes and their negatively charged glycocalyx are key. Loss of this charge barrier permits albumin to pass into the filtrate. Hemodynamic changes alone do not cause nephrotic-range proteinuria.

Question 15Basic Sciences Relevant to Urology (anatomy, physiology, embryology, pharmacology, microbiology, immunology)

A 70-year-old man is started on finasteride for benign prostatic hyperplasia. Which laboratory parameter will predictably change as a result of therapy?

  1. Serum creatinine doubles
  2. Serum prostate-specific antigen is approximately halved Correct answer.
  3. Serum testosterone falls below castrate levels
  4. Urinary pH becomes alkaline

Explanation

Finasteride inhibits 5-alpha reductase type 2, lowering dihydrotestosterone and shrinking glandular volume; prostate-specific antigen falls by about 50% over months. Clinicians must double the measured PSA when screening for cancer in treated men. Testosterone is not reduced to castrate levels.

Question 16Basic Sciences Relevant to Urology (anatomy, physiology, embryology, pharmacology, microbiology, immunology)

A 40-year-old man develops a urethral stricture after trauma. Which portion of the male urethra is most commonly injured in a straddle injury?

  1. Membranous urethra
  2. Prostatic urethra
  3. Penile urethra
  4. Bulbar urethra Correct answer.

Explanation

A straddle injury compresses the bulbar urethra against the inferior pubic rami, causing extravasation of urine into the superficial perineal space. The membranous urethra is more typically injured in pelvic fracture. The prostatic urethra is protected within the pelvis.

Question 17Basic Sciences Relevant to Urology (anatomy, physiology, embryology, pharmacology, microbiology, immunology)

A patient with recurrent urinary tract infection is found to have a urea-splitting organism. Which organism is most likely responsible, and what stone composition results?

  1. Proteus mirabilis causing struvite stones Correct answer.
  2. Klebsiella pneumoniae causing cystine stones
  3. Staphylococcus saprophyticus causing uric acid stones
  4. Escherichia coli causing calcium oxalate stones

Explanation

Urease-producing organisms such as Proteus mirabilis hydrolyze urea to ammonia, alkalinizing urine and precipitating magnesium ammonium phosphate (struvite) and carbonate apatite. These form staghorn calculi and require complete stone removal. E coli does not typically split urea.

Question 18Basic Sciences Relevant to Urology (anatomy, physiology, embryology, pharmacology, microbiology, immunology)

During a renal transplant, the donor kidney is placed in the iliac fossa. Which vascular anastomosis is most commonly performed for venous drainage?

  1. Donor renal vein to inferior vena cava
  2. Donor renal vein to internal iliac vein
  3. Donor renal vein to external iliac vein Correct answer.
  4. Donor renal vein to superior mesenteric vein

Explanation

The donor renal vein is typically anastomosed end-to-side to the external iliac vein, while the renal artery is anastomosed to the external or internal iliac artery. The ureter is reimplanted into the bladder with a tunneled technique. This extraperitoneal placement allows easy access and short vessels.

Question 19Basic Sciences Relevant to Urology (anatomy, physiology, embryology, pharmacology, microbiology, immunology)

A 25-year-old man has azoospermia and absent vasa deferentia bilaterally with normal testicular volume. Which genetic defect best explains this presentation?

  1. Y chromosome microdeletion of AZFc
  2. Klinefelter syndrome with 47,XXY karyotype
  3. CFTR mutation causing congenital bilateral absence of the vas deferens Correct answer.
  4. 5-alpha reductase deficiency

Explanation

Congenital bilateral absence of the vas deferens is strongly associated with CFTR mutations, often in men without overt cystic fibrosis. The Wolffian duct derivatives are affected, producing obstructive azoospermia with preserved spermatogenesis. Klinefelter syndrome and AZF deletions cause non-obstructive azoospermia with small testes.

Question 20Basic Sciences Relevant to Urology (anatomy, physiology, embryology, pharmacology, microbiology, immunology)

A patient with a solitary kidney undergoes partial nephrectomy. Which physiologic compensatory change is expected in the remaining nephrons?

  1. Decreased single-nephron glomerular filtration rate
  2. Reduced renin secretion from the macula densa
  3. Loss of tubular reabsorptive capacity
  4. Increased single-nephron filtration and hypertrophy Correct answer.

Explanation

After loss of renal mass, remaining nephrons undergo compensatory hyperfiltration and hypertrophy, increasing single-nephron glomerular filtration rate to maintain total clearance. This adaptation is mediated by vasodilation of the afferent arteriole and increased intraglomerular pressure. Long term, hyperfiltration may contribute to progressive sclerosis.

Question 21Urologic Evaluation and Diagnostic Imaging (history, physical examination, urinalysis, urodynamics, radiology, endoscopy)

A 24-year-old man presents with sudden severe left flank pain radiating to the groin. Non-contrast CT of the abdomen and pelvis is performed. Which finding most directly confirms a ureteral stone as the cause of obstruction?

  1. A calcific density within the ureteral lumen with proximal hydroureteronephrosis Correct answer.
  2. A filling defect in the bladder with a thickened bladder wall
  3. Uniform thickening of the renal pelvis with perinephric stranding
  4. A calcific density within the renal parenchyma without dilatation of the collecting system

Explanation

Non-contrast CT is the imaging study of choice for suspected acute ureteral colic because it detects nearly all stones regardless of composition and shows the secondary signs of obstruction. A stone within the ureteral lumen accompanied by dilatation of the ureter and collecting system proximal to it establishes both the stone and its obstructive effect.

Question 22Urologic Evaluation and Diagnostic Imaging (history, physical examination, urinalysis, urodynamics, radiology, endoscopy)

Which urinalysis finding is most characteristic of acute bacterial cystitis in a symptomatic woman?

  1. Broad granular casts with 24-hour protein excretion above 3 g
  2. Positive leukocyte esterase and nitrite with pyuria Correct answer.
  3. Dysmorphic red cells with red cell casts
  4. Sterile pyuria with eosinophil predominance

Explanation

Enteric gram-negative organisms reduce dietary nitrate to nitrite, so a positive nitrite test is fairly specific for bacterial urinary tract infection, and leukocyte esterase reflects pyuria. Together with pyuria on microscopy they support the diagnosis of acute bacterial cystitis.

Question 23Urologic Evaluation and Diagnostic Imaging (history, physical examination, urinalysis, urodynamics, radiology, endoscopy)

During a filling cystometrogram a patient reports a strong desire to void at 120 mL with a detrusor pressure rise of 45 cm H2O. What is the most appropriate interpretation?

  1. Genuine stress incontinence demonstrated on filling
  2. Detrusor overactivity with reduced functional capacity Correct answer.
  3. Impaired detrusor contractility during the voiding phase
  4. Normal bladder compliance with a normal first sensation

Explanation

An involuntary detrusor contraction during the filling phase, here producing a large pressure rise at a low volume, defines detrusor overactivity and explains the early strong desire to void. Reduced cystometric capacity accompanies the overactive detrusor.

Question 24Urologic Evaluation and Diagnostic Imaging (history, physical examination, urinalysis, urodynamics, radiology, endoscopy)

A 68-year-old man has an IPSS of 22, a post-void residual of 250 mL, and a peak flow of 6 mL/s. Which urodynamic finding would best identify detrusor underactivity as the cause of his voiding symptoms?

  1. Low detrusor pressure with low flow during voiding Correct answer.
  2. Reduced bladder compliance during filling
  3. Detrusor overactivity during the filling phase
  4. High detrusor pressure with low flow during voiding

Explanation

Detrusor underactivity is defined by a contraction of reduced strength or duration producing low pressure and a low flow rate, often with incomplete emptying. High pressure with low flow instead indicates bladder outlet obstruction.

Question 25Urologic Evaluation and Diagnostic Imaging (history, physical examination, urinalysis, urodynamics, radiology, endoscopy)

Which physical examination finding best supports a diagnosis of acute bacterial prostatitis rather than acute epididymitis?

  1. A painless, hard nodule in the peripheral zone of the prostate
  2. A reducible inguinal swelling that transmits a cough impulse
  3. A warm, boggy, exquisitely tender prostate on rectal examination Correct answer.
  4. A tender, swollen epididymis with a normal prostate on rectal examination

Explanation

Acute bacterial prostatitis produces a swollen, warm, and markedly tender prostate on digital rectal examination, and prostatic massage should be avoided because of the risk of bacteremia. Epididymal tenderness localizes inflammation to the scrotal contents.

Question 26Urologic Evaluation and Diagnostic Imaging (history, physical examination, urinalysis, urodynamics, radiology, endoscopy)

A 30-year-old woman has a history of recurrent urinary tract infections and a duplicated collecting system on ultrasound. Which imaging study best demonstrates an ectopic ureterocele and its relationship to the bladder neck?

  1. Intravenous urography with delayed films
  2. Diuretic renography
  3. Voiding cystourethrography Correct answer.
  4. Magnetic resonance urography

Explanation

Voiding cystourethrography opacifies the bladder and urethra under fluoroscopy and clearly shows an intravesical or ectopic ureterocele as a filling defect, including its position relative to the bladder neck. It also detects vesicoureteral reflux, which frequently coexists with duplication anomalies.

Question 27Urologic Evaluation and Diagnostic Imaging (history, physical examination, urinalysis, urodynamics, radiology, endoscopy)

Which statement about the measurement of post-void residual urine is most accurate?

  1. Residual volume should be measured immediately after voiding during the same visit
  2. A single elevated value reliably confirms bladder outlet obstruction
  3. Residual volume is unrelated to the risk of urinary retention
  4. Bladder ultrasound estimation avoids catheterization and correlates well with catheter drainage Correct answer.

Explanation

Bladder ultrasound provides a noninvasive estimate of post-void residual that correlates closely with catheterized volumes and avoids the risk of introducing infection. It is a standard part of the evaluation of lower urinary tract symptoms.

Question 28Urologic Evaluation and Diagnostic Imaging (history, physical examination, urinalysis, urodynamics, radiology, endoscopy)

A 55-year-old man has painless gross hematuria. Which initial imaging strategy is most appropriate for evaluating the upper urinary tract?

  1. Plain abdominal radiograph alone
  2. Multiphasic CT urography Correct answer.
  3. Scrotal ultrasound
  4. Retrograde urethrography

Explanation

CT urography combines unenhanced, nephrographic, and excretory phases to detect urothelial tumors, stones, and upper tract obstruction, and it is the preferred imaging test for painless gross hematuria in adults. It is paired with cystoscopy to complete the evaluation.

Question 29Urologic Evaluation and Diagnostic Imaging (history, physical examination, urinalysis, urodynamics, radiology, endoscopy)

During rigid cystoscopy a bladder tumor is seen on the lateral wall. Which maneuver most improves visualization of the bladder neck and anterior wall?

  1. Lowering the irrigant volume and pressing suprapubically Correct answer.
  2. Overdistending the bladder with irrigation
  3. Tilting the patient into steep Trendelenburg
  4. Rotating the cystoscope sheath and using the obturator

Explanation

Partial emptying of the bladder allows the anterior wall and bladder neck to fall toward the lens, and suprapubic pressure further brings these areas into view. Overdistension paradoxically moves the anterior wall away from the cystoscope.

Question 30Urologic Evaluation and Diagnostic Imaging (history, physical examination, urinalysis, urodynamics, radiology, endoscopy)

A patient with a spinal cord injury has a serum creatinine of 0.7 mg/dL but a measured 24-hour creatinine clearance of 45 mL/min. What best explains this discrepancy?

  1. Creatinine clearance systematically underestimates glomerular filtration rate
  2. Creatinine secretion is increased by the injured kidney
  3. The creatinine assay overestimates the true serum concentration
  4. Reduced muscle mass lowers serum creatinine despite impaired filtration Correct answer.

Explanation

Serum creatinine depends on muscle mass as well as glomerular filtration, so patients with spinal cord injury and muscle wasting may have a near-normal creatinine despite substantially reduced clearance. Creatinine-based estimates therefore overestimate renal function in this population.

Question 31Urologic Evaluation and Diagnostic Imaging (history, physical examination, urinalysis, urodynamics, radiology, endoscopy)

Which finding on a plain abdominal radiograph is most suggestive of a staghorn calculus?

  1. A large branching radiopacity conforming to the renal pelvis and calyces Correct answer.
  2. Multiple small radiolucencies scattered through the renal outline
  3. A smooth rounded opacity in the renal pelvis that changes position with posture
  4. A radiopaque density overlying the sacrum with a phlebolith ring

Explanation

A staghorn calculus is a large branched stone that fills the renal pelvis and extends into the calyces, producing a characteristic branching radiopacity on plain film. Most staghorn stones are struvite or otherwise radiopaque.

Question 32Urologic Evaluation and Diagnostic Imaging (history, physical examination, urinalysis, urodynamics, radiology, endoscopy)

A 62-year-old woman with stress urinary incontinence undergoes urodynamic testing before surgery. Which finding would most strongly argue against a simple midurethral sling?

  1. Post-void residual of 20 mL
  2. Urethral hypermobility demonstrated on the cotton swab test
  3. Valsalva leak point pressure of 45 cm H2O
  4. Detrusor overactivity with leakage before the Valsalva maneuver Correct answer.

Explanation

Leakage during filling before any increase in abdominal pressure indicates detrusor overactivity rather than stress incontinence, and surgery directed at the outlet may worsen urgency or fail to control symptoms. This finding should prompt reconsideration of the diagnosis and treatment plan.

Question 33Urologic Evaluation and Diagnostic Imaging (history, physical examination, urinalysis, urodynamics, radiology, endoscopy)

A 40-year-old man is being evaluated for infertility. Which semen analysis parameter, according to World Health Organization reference limits, represents the lower reference limit for total sperm number per ejaculate?

  1. 15 million
  2. 39 million Correct answer.
  3. 58 million
  4. 10 million

Explanation

The WHO lower reference limit for total sperm number per ejaculate is 39 million, with a sperm concentration lower limit of 15 million per mL. Total number, not concentration, is the parameter asked about here.

Question 34Urologic Evaluation and Diagnostic Imaging (history, physical examination, urinalysis, urodynamics, radiology, endoscopy)

A 35-year-old woman reports urine leakage during coughing but also has frequency and urgency. Which initial test most usefully distinguishes stress from urge incontinence at the bedside?

  1. Serum creatinine measurement
  2. A validated symptom questionnaire combined with a voiding diary Correct answer.
  3. Renal ultrasound with post-void residual
  4. Urethral pressure profilometry

Explanation

A structured questionnaire and a bladder diary of fluid intake, voided volumes, and leakage episodes help characterize the pattern of incontinence and are appropriate first-line, noninvasive assessments. They guide the need for urodynamics.

Question 35Urologic Evaluation and Diagnostic Imaging (history, physical examination, urinalysis, urodynamics, radiology, endoscopy)

A patient reports severe flank pain during intravenous contrast administration for CT urography, and the study is aborted. Which premedication strategy is most appropriate before a repeat contrast study in a patient with a prior moderate reaction?

  1. No premedication is needed because reactions are not reproducible
  2. Prophylactic epinephrine administered intramuscularly before contrast
  3. A corticosteroid regimen begun 13 hours, 7 hours, and 1 hour before contrast Correct answer.
  4. A single dose of oral antihistamine given after contrast administration

Explanation

For patients with prior moderate contrast reactions, a corticosteroid premedication regimen beginning about 13 hours before contrast, with doses at 7 and 1 hours, reduces the risk of recurrent reactions. Antihistamines may be added but do not replace steroids.

Question 36Urologic Evaluation and Diagnostic Imaging (history, physical examination, urinalysis, urodynamics, radiology, endoscopy)

A 70-year-old man with a history of transitional cell carcinoma has a 1-cm filling defect in the renal pelvis on the excretory phase of CT urography. What is the most appropriate next step in evaluation?

  1. Repeat CT urography in 6 months
  2. Percutaneous nephrostomy placement
  3. Ureteroscopy with biopsy of the lesion Correct answer.
  4. Renal artery angiography

Explanation

A filling defect in the upper tract in a patient with prior urothelial carcinoma is suspicious for upper tract urothelial carcinoma, and direct endoscopic visualization with biopsy provides tissue diagnosis and allows treatment planning. Cytology and selective washings may be complementary.

Question 37Urologic Oncology (kidney, bladder, prostate, testis, penile, adrenal tumors)

A 62-year-old man has a 3.5 cm solid enhancing left renal mass with a normal contralateral kidney and normal renal function. Which management is most appropriate?

  1. Partial nephrectomy Correct answer.
  2. Active surveillance with repeat imaging in 6 months
  3. Percutaneous radiofrequency ablation as first-line therapy
  4. Radical nephrectomy with adrenalectomy

Explanation

For a T1a renal mass with a normal opposite kidney, nephron-sparing surgery is the standard of care because it preserves renal function with oncologic outcomes equivalent to radical nephrectomy. Radical nephrectomy is reserved for tumors not amenable to partial resection or with advanced local features.

Question 38Urologic Oncology (kidney, bladder, prostate, testis, penile, adrenal tumors)

Which histologic subtype accounts for the majority of sporadic renal cell carcinomas?

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

Explanation

Clear cell renal cell carcinoma represents roughly 70-75% of sporadic RCCs and is characterized by inactivation of the VHL gene on chromosome 3p. Papillary and chromophobe subtypes are less common, and collecting duct carcinoma is rare and aggressive.

Question 39Urologic Oncology (kidney, bladder, prostate, testis, penile, adrenal tumors)

A patient with a 6 cm renal mass invading the renal vein but not beyond the diaphragm is classified as which T stage?

  1. T3b
  2. T3a Correct answer.
  3. T2a
  4. T2b

Explanation

Tumor extending into the renal vein or its segmental branches, or into perirenal fat, is T3a. Extension into the vena cava below the diaphragm is T3b, and above the diaphragm or into the vena cava wall is T3c.

Question 40Urologic Oncology (kidney, bladder, prostate, testis, penile, adrenal tumors)

Which paraneoplastic finding is most classically associated with renal cell carcinoma?

  1. Hypoglycemia
  2. Cushing syndrome
  3. Polycythemia Correct answer.
  4. Hypercalcemia

Explanation

Erythropoietin production by clear cell renal cell carcinoma causes secondary polycythemia, a classic paraneoplastic manifestation. Hypercalcemia can occur via PTHrP but is less specific, and hypoglycemia is rare.

Question 41Urologic Oncology (kidney, bladder, prostate, testis, penile, adrenal tumors)

A 55-year-old man presents with painless gross hematuria. Which initial evaluation is most appropriate for suspected bladder cancer?

  1. Urine culture and empiric antibiotics
  2. CT urography alone
  3. Renal ultrasound alone
  4. Cystoscopy with urine cytology Correct answer.

Explanation

Cystoscopy combined with urine cytology is the standard initial evaluation for suspected bladder cancer because cystoscopy directly visualizes the bladder mucosa and cytology provides a complementary assessment of high-grade disease. Imaging alone cannot exclude urothelial malignancy.

Question 42Urologic Oncology (kidney, bladder, prostate, testis, penile, adrenal tumors)

Which bladder cancer histology is most common in regions endemic for Schistosoma haematobium?

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

Explanation

Chronic schistosomal infection induces squamous metaplasia and inflammation, leading to squamous cell carcinoma as the predominant bladder malignancy in endemic areas such as Egypt. In non-endemic regions, urothelial carcinoma predominates.

Question 43Urologic Oncology (kidney, bladder, prostate, testis, penile, adrenal tumors)

A patient with muscle-invasive bladder cancer (T2N0M0) is a good surgical candidate. What is the recommended definitive treatment?

  1. Intravesical BCG
  2. Transurethral resection alone
  3. Partial cystectomy
  4. Radical cystectomy with urinary diversion Correct answer.

Explanation

Radical cystectomy with pelvic lymphadenectomy and urinary diversion is the standard of care for muscle-invasive bladder cancer in surgical candidates. Neoadjuvant cisplatin-based chemotherapy is often added. Transurethral resection alone is inadequate for muscle invasion.

Question 44Urologic Oncology (kidney, bladder, prostate, testis, penile, adrenal tumors)

Which agent is standard intravesical therapy for high-risk non-muscle-invasive bladder cancer to reduce recurrence and progression?

  1. Bacillus Calmette-Guérin Correct answer.
  2. Mitomycin C
  3. Doxorubicin
  4. Gemcitabine

Explanation

Intravesical BCG is the standard adjuvant therapy for high-risk non-muscle-invasive bladder cancer because it reduces both recurrence and progression. Mitomycin C is used mainly for low-risk disease or as perioperative single instillation.

Question 45Urologic Oncology (kidney, bladder, prostate, testis, penile, adrenal tumors)

A 68-year-old man has a PSA of 12 ng/mL and a hard nodule on digital rectal examination. Which next step is most appropriate?

  1. Empiric antibiotics then repeat PSA
  2. Repeat PSA in 6 months
  3. MRI without biopsy
  4. Prostate biopsy Correct answer.

Explanation

An elevated PSA combined with a suspicious digital rectal examination warrants prostate biopsy to establish a tissue diagnosis. Imaging may be used to guide biopsy, but it does not replace histologic confirmation.

Question 46Urologic Oncology (kidney, bladder, prostate, testis, penile, adrenal tumors)

Which Gleason pattern combination corresponds to Gleason score 3+4=7?

  1. Primary pattern 3, secondary pattern 4 Correct answer.
  2. Primary pattern 4, secondary pattern 5
  3. Primary pattern 3, secondary pattern 3
  4. Primary pattern 4, secondary pattern 3

Explanation

Gleason score is the sum of the most prevalent and second most prevalent patterns. A score of 7 from 3+4 indicates predominantly pattern 3 with a secondary pattern 4, whereas 4+3 indicates the reverse.

Question 47Urologic Oncology (kidney, bladder, prostate, testis, penile, adrenal tumors)

A man with localized prostate cancer has a PSA of 8 ng/mL, Gleason 3+4, and clinical stage T2a. Which risk category applies?

  1. Very high risk
  2. Intermediate risk Correct answer.
  3. High risk
  4. Low risk

Explanation

Intermediate-risk prostate cancer includes PSA 10-20 ng/mL, Gleason 7, or clinical stage T2b-T2c. This patient has Gleason 7 disease, placing him in the intermediate-risk group.

Question 48Urologic Oncology (kidney, bladder, prostate, testis, penile, adrenal tumors)

Which treatment is most appropriate for a 72-year-old man with metastatic hormone-sensitive prostate cancer?

  1. Radical prostatectomy
  2. Brachytherapy alone
  3. Androgen deprivation therapy plus a novel hormonal agent Correct answer.
  4. Active surveillance

Explanation

For metastatic hormone-sensitive prostate cancer, combining androgen deprivation therapy with a novel hormonal agent such as abiraterone or enzalutamide improves overall survival. Local therapies alone are inadequate for metastatic disease.

Question 49Urologic Oncology (kidney, bladder, prostate, testis, penile, adrenal tumors)

A 30-year-old man has a painless testicular mass. Which tumor marker is most useful for a pure seminoma?

  1. Carcinoembryonic antigen
  2. Alpha-fetoprotein
  3. Lactate dehydrogenase
  4. Beta-human chorionic gonadotropin Correct answer.

Explanation

Beta-hCG is elevated in a minority of pure seminomas, whereas AFP is never elevated in pure seminoma and its elevation indicates nonseminomatous elements. LDH is a nonspecific marker of tumor burden.

Question 50Urologic Oncology (kidney, bladder, prostate, testis, penile, adrenal tumors)

Which is the standard initial surgical approach for a suspicious testicular mass?

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

Explanation

Radical inguinal orchiectomy with early control of the spermatic cord is the standard because it provides definitive diagnosis and treatment while avoiding scrotal violation that could alter lymphatic drainage. Transscrotal approaches are avoided for malignant suspicion.