Renal Surgery and Gyn and Obs

28th batch

25. Regarding bladder outflow obstruction due to benign prostatic hyperplasia (BPH)?

A. BPH start in the peripheral zone

B. BPH lead to prostatic malignancy over longer period.

C. Acute urinary retention is an indication for surgery

D. Finasteride can reduce the size of prostate

E. Anejaculation is caused by Tamsulosin.

31. Regarding renal calculi?

A. Struvite stones have the highest incidence

B. Absence of micro haematuria can exclude the diagnosis of renal calculi

C. CECT best test for Renal calculi

D. X-ray is sensitive in diagnosis of acute calculi

E. X-ray can exclude diagnosis of Renal calculi

59. A 60-year-old man with known hypertensive on ACEI present to the medical casualty
ward with weakness. He is on statin for hypercholesteremia, carvedilol and
spironolactone for chronic heart failure and insulin for DM. His BP is 130/80 mmHg. What
is the main cause for his hyperkalaemia?

Serum creatinine 1.4mg/dl (0.8-1.2)

Serum potassium 7.2 mmol/l (2.5-5.5) Blood glucose 250 mg/dl (<180)

Creatinine phosphokinase 300 U/L (30-308)

A. Drug induced action on renin angiotensin system

B. Statin induced rhabdomyolysis

C. Worsening heart failure

D. Worsening renal failure

E. Uncontrolled diabetes mellitus

ANSWERS

25. FFTTT

A. BPH starts in transition zone.

B. does not lead to cancer

C. Indicationsforsurgery-ModeratetosevereIPSS,Acuteurinaryretention,RecurrentUTI,

Obstructive uropathy, Recurrent Haematuria.

D. Finasteride is a 5alpha reductase inhibitor and reduce formation of dihydrotestosterone

and reduce prostate size

E. Tamsulosin is alpha blocker, can cause anejaculation.

31. FFFTF

• Best first line investigation is NCCT

• Xray is not sensitive or specific in the acute stage is used in follow up. • Xray cannot detect
renal stones <2mm

• Haematuria will present in less than 70% after 3 days from event

• Commonest stone is calcium oxalate

59. Answer A

B-serum creatinine phosphokinase level is high. but it is near to upper range limit.

C-BP is normal.so it cannot be due to worsening of HF

D-serum creatinine level is high. But again, it is near to upper range limit.
E-patient with diabetes have diminished capacity to excrete potassium into urine due to
renal damage but serum creatinine level is near to high range li

27th batch

39) Symptoms of urinary disturbances associated with storage include

A. Hesitancy

B. Increase frequency

C. Nocturia

D. Poor urinary flow

E. –

59) A 50-year-old patient met with a road traffic accident and a pelvic injury was
suspected. Genital examination revealed blood at the urethral meatus. What is the most
appropriate next step of management?

A) Antibiotic and analgesics

B) CT Abdomen

C) Cystourethrogram

D) Urethral catheterization

E) Suprapubic puncture

60) What is the most sensitive investigation to diagnose a ureteric stone in a 40-year-old
man?

A) X-ray KUB

B) Ultrasound KUB

C) Non-contrast CT KUB

D) Intravenous Urogram
E) Urinalysis

67) A 34-year-old woman attended the clinic with increased urinary frequency and
urgency. She has occasional involuntary urinary leakage too. She is not on any medication
and not undergone a pelvic surgery. What is the appropriate step in the management?

A) Reduce fluid intake

B) Pelvic muscle physiotherapy

C) Start anticholinergic drugs

D) Do urodynamic testing

E) Collect samples for UFR and urine culture

ANSWERS

39. F TT FT

Lower urinary tract symptoms (LUTS) is a term used to describe an array of symptoms
affecting the control and quality of micturition in the lower urinary tract.

* In older men, LUTS are commonly caused by benign prostatic enlargement (BPE), which is
most commonly due to the histological diagnosis of benign prostatic hyperplasia (BPH)

* In females, LUTS are most commonly presents in those over 40 years old and commonly
associated with a lower urinary tract infection

LUTS can be broadly categorised* into storage symptoms and voiding symptoms

B. True- Goodpasture syndrome gives rise to type 1 RPGN which is induced by anti-GBM
antibodies C. True- MPGN may present as both nephrotic and nephritic syndromes

D. True- Nodular glomerular sclerosis; Kimmelstein-Wilson nodules is a feature of diabetic

nephropathy

E. False- IgA nephropathy can result in both RPGN and FSGS. It presents commonly as
nephritic syndrome.

* Storage symptoms occur when the bladder should otherwise be storing urine, symptoms
being urgency, frequency, nocturia, and urgency incontinence.
* Voiding symptoms occur usually due to bladder outlet obstruction making it more difficult
to pass urine, therefore symptoms being hesitancy, intermittency, straining, terminal
dribbling and incomplete emptying.

59. Answer E

Following RTA , pelvic fracture should be suspected. And it could cause rupture of the
membranous urethra.

The clinical features are,

1. urinary retention

2. blood at the urethral meats

3. high riding prostate on digital rectal examination

4. Typically marked bruising of the pubic area, scrotum and penis

If the diagnosis is suspected,, a urethrogram with water soluble contrast media is

confirmatory. For that, a suprapubic catheter should be inserted asap using the Seldinger
technique.

In a patient with pelvic fracture without blood at the urethral meatus who has not yet
passed urine. single gentle attempt at catheterization is permissible.

Following blow to the perineum( by fall astride injury) commonly by cycling accidents, loose
manhole covers and gymnasium accidents astride the beam could cause rupture of the
bulbar urethra.

Signs:-perineal bruising, haematoma, bleeding from urethral meatus, retention of urine

Mx: treated with appropriate analgesia and antibiotics

If bladder is full, urine drained by suprapubic catheterization

60. Answer C

Non-contrast CT (CT KUB) is the gold standard for imaging ureteric stones, with the vast
majority (99%) being radio dense. Stones >1 mm in size are visualized, with the specificity of
helical CT as high as 100%

( resource - https://radiopaedia.org/articles/ureteric-calculi )
67. Answer C

Clinical features suggestive of OAB. Drug treatment continues to have an important role in
the management of women with OAB. Other treatment options include conservative
management with lifestyle interventions, modification of fluid intake, and physiotherapy
including bladder retraining. Surgery remains the last resort in the treatment and is usually
reserved for intractable detrusor overactivity,

26th batch

40) Regarding pain in the urinary tract,

A) Pain due to chronic prostatitis can be felt in the perineum.

B) Pain arising from a ureter due to an impacted calculus is usually colicky in nature.

C) Pain due to staghorn calculus felt over supra pubic area.

D) Pain due to irritation of trigon of bladder can present in tip of the penis.

E) Renal pain which occurs in loin is probably due to stretching of capsule of kidney.

68) 58-year-old women complain leakage of urine with cough and sneezing. There is no
urgency/urge incontinence. Examination reveal grade 1 cystocele with no significance
uterine prolapse. Which of the following intervention is most suitable to improve her
urinary symptoms?

A) Avoiding intake of carbonated drinks

B) Carry out pelvic floor exercises

C) Long term antibiotic Rx for recurrent UTI

D) Start on anticholinergic

E) Surgical correction of cystocele

70) A 35-year-old woman with a diagnosis of acute pyelonephritis is on intravenous

cefotaxime. Her fever continued despite treatment. An ultrasound scan of kidney, ureters
and bladder (KUB), was done on the 6th day of treatment. It showed grossly dilated right
ureter and pelvis secondary to a renal calculus obstructing the right ureter. Which of the
following is the next step in management?

A) Arrange CT scan KUB.

B) Continue the same antibiotic for 2 more weeks.

C) Drainage of infected urine proximal to the obstruction.

D) Increase the fluid intake.

E) Surgical removal of the stone.

ANSWERS

40.

A) T

B) T

C) ??

D) T

E) T

68. B

70. C

25th Batch

31) Which of the following is/are true or false regarding overactive bladder ?
a) Bladder contacts during the fill8ing phase.
b) It causes high residual volume
c) It causes urinary stress incontinence.
d) It is treated with tolterodine.
e) Vaginal tape procedures are preferred to medical management.

33) Which of the following is/are true or false regarding vesico-ureteric reflux (VUR) ?
a) It is associated with posterior urethral valves.
b) It is best diagnosed by intravenous urogram.
c) Mid dilation of ureter is seen in grade 1 VUR.
d) Scarring of the kidney is due to intra renal reflux.
e) Surgery is the treatment of choice for grade 3 VUR.

34) Which of the following is/are recognized complications of ureteric calculi ?

a) Deterioration of renal function.
b) Pyonephrosis.
c) Rupture of the ureter.
d) Transitional cell carcinoma.
e) Ureteric stricture.

38) Regarding radiological investigations of the urinary tract,

a) Abdominal ultrasound examination differentiate a renal tumour from a cyst
b) Intravenous urogram (IVU) is performed using water soluble contrast medium.
c) Radiolucent ureteric calculi are readialy detected in non-contrast CT-KUB.
d) Technetium 99m-DTPA is the test of choice in detecting renal scarring.
e) Vesico-ureteric reflux is best diagnosed by micturating cystourethrogram (MCUG).

SBA

64) A 65-year-old male presents with suprapubic pain and inability to pass urine over the
last 12 hours. On examination the urinary bladder is palpable. Urethral catheterization
was attempted and failed.
What is the next step in management?
a) Cystoscopy
b) Suprapubic catheterization
c) Ultrasound scan KUBP ( kidney ureter bladder prostate)
d) Uroflowmetry
e) X ray KUB ( Kidney ureter bladder)

68) A 40-year-old patient after blunt trauma to left loin complains of haematuria.
What is the best step in management?
a) Contrast CT abdomen
b) Cysto-urethroscopy
c) Intravenous urogam
d) Ultrasound scan of the abdomen
e) Urgent explorative laparotomy

69) A 35-year-old male presented with severe loin to groin pain in his left side and it was
associated with vomiting. He was diagnosed to have ureteric colic.
What is the best radiological investigation that would provide the most detailed
information?
a) CT KUB (kidney ureter bladder)
b) Cysto-urethrogram
c) Intravenous urogram
d) Ultrasound scan abdomen
e) X ray KUB

70) A 70-year-old man presented to the surgical casualty unit with aching pain in both
loins. Previous intravenous pyelogram (IVP) and ultrasound scan of abdomen showed
bilateral hydronephrosis and hydroureter.
What is the most likely cause?
a) Advanced rectal carcinoma
b) Bilateral pelvi-ureteric junction obstruction due to calculi
c) Malignant bladder tumour
d) Prostatic enlargement
e) Tight phymosis

ANSWERS

31.
aT
bF
cF
dT
eF
33.
a T • Grade I - Reflux into nondilated ureter
• Grade II - Reflux into renal pelvis and calyces without dilation
• Grade III - Reflux with mild to moderate dilation and minimal blunting of fornices
• Grade IV - Reflux with moderate ureteral tortuosity and dilation of pelvis and
calyces
• Grade V - Reflux with gross dilation of ureter, pelvis, and calyces, loss of papillary
impressions, and ureteral tortuosity
(medscape)
MCUG - gold standard imaging modality
Surgery inducations - Persistent gross VUR ( grade 1V-V) or Persistent moderate VUR
(grade 111) with recurrent infections after discontinuation of prophylaxis
(Paed UTI - Handout)
bF
cF
d T *****
eF

34.
aT
bT
cT
dF
eT

38.
aT
bT
cT
dF
eT

SBA

64 B ; suprapubic catheterization should be done 1st , because patients electrolyte and acid
base
balance is already deteriorated. After making that normal investigations should be done

68 A ; CT shows a comprehensive picture which helps to determine the further management

69 A ; CT shows the most detailed picture

70 D ; Prostatic enlargement is common in elderly males, which obstruct urethra.

24th Batch

26. Urge incontinence

a. In elderly males is caused by bladder outflow obstruction

b. Can be caused by bladder calculi
c. Is a symptom of acute bacterial cystitis
d. Is made worse by consuming foods and drinks containing caffeine
e. Is treated with oxy-butynin

38. T/F regarding trauma to urethra

a. Intravenous urethrogram (IVU) shows anatomy of the injury
b. Pelvic fractures are associated with posterior urethral injury
c. Presence of blood in urethra is an indication for urgent catheterization
d. Rectal examination exclude urethral injury
e. Urethral repair should be done in acute stage

40. Urinary tract calculi

a. Composed of Calcium oxalate have a characteristic staghorn shape
b. Composed of pure uric acid are radio luscent
c. In the bladder causes terminal hematuria
d. In the pelvis, are treated with lithotripsy
e. Results in colicky pain which radiates from loin to groin

SBA

43. A 23 year old was admitted to surgical casualty ward following a blunt trauma to left
side of lower chest. His blood pressure was 90/60mmHg and pulse rate was 120 bpm.
X ray showed left lower rib fracture. US abdomen showed moderate amount of free
fluid with a large hematoma of the spleen. What is the most appropriate management
within the next 6 hours?
a. Fluid resuscitation and splenectomy
b. Laparoscopic splenectomy
c. Splenic artery embolization
d. Urgent laparotomy and splenectomy
e. Vaccination and splenectomy

ANSWERS
26 a. F

b. T

c. T

d. T

e. T

38 a. F

b. T

c. F

d. F

e. F
40 a. F

b. T

c. T

d. T

e. T

SBA

(43) A

23rd Batch

26. Following are known cause of frequent macturtion associated with urgency
A. Lower UTI
B. Fecal impaction in rectum
C. Lower lumbar spinal cord injury
D. Destruso instability
E. Pudendal nerve injury following birth trauma

28. Urinary outflow tract obstruction cause

A. Urethral stricture
B. Benign prostatic hyperplasia
C. Divertieulum of bladder
D. Phimosis
E. Feces impact in rectum

30. T/F regarding urethral injury

A. Urethral injuries are coming occur due to blunt abdominal traumol.

B. Ureters are repair with absorbable materials
C. It present with late strictures
D. It is associated with gynecological surgeries
E. Uss gives a good anatomical picture of the injury

SBA

60. A 3-months-old baby boy has repeated vomiting. Ultra sound scan of the abdomen
shows bilateral gross hydronephrosis.
Which clinical feature best suggests posterior urethral valve as the likely aetiology?
A. Bilateral loin masses
B. Associated hypospadias
C. Generalised oedema
D. Hypertension
E. Palpable bladder

61. A 55-year-old woman presented with involuntary passage of urine while coughing.
Clinical examination confirmed the above findings. Rest of the clinical examination was
normal.
What is the first step in the management?
A. Applying tension free vaginal tape
B. Bladder drilling
C. Burch colposuspension
D. Pelvic floor exercises
E. Oxybutynin

69. A 50 year old patient had a road traffic accident. Blood was visible at the urethral
meatus. X-ray showed a pelvic fracture.
What is the most appropriate immediate next step?
A. Urethral catheterization
B. Suprapubic puncture
C. Antibiotics and analgesics
D. Computed tomography (CT) scan of abdomen
E. Cystourethrogram

ANSWERS

26.
A)T
B)T
C)F
D)T
E)T

28.

A)T

B)T

C)F diverticulum caused by bladderoutflow obstruction

D)F

E)F urinary incontinenece

30.

A)F

B)T

C)T

D)T

E)F

SBA

61.D

69.B