Free Urology mock test

Urology sample questions with answers

10 more original exam-style Urology questions, worked in full. They are not real or recalled exam questions, and none of them is in the mock above or on the bank page, so sit the mock first if you have not.

1. Question 1 · Paediatric Urology

   A 6-year-old girl of consanguineous parents has recurrent bilateral calcium oxalate monohydrate stones, dense medullary nephrocalcinosis, markedly elevated urinary oxalate and glycolate, and an eGFR that has fallen to 25 mL/min/1.73 m2. Which statement about her condition is correct?

   1. APrimary hyperoxaluria type 1 results from deficient hepatic alanine-glyoxylate aminotransferase; some patients respond to pyridoxine, and combined or sequential liver-kidney transplantation is the definitive treatment once renal failure supervenes
   2. BIsolated kidney transplantation alone is curative because the enzyme defect resides in the kidney
   3. CThe condition is caused by excessive dietary oxalate and is fully controlled by dietary restriction
   4. DDistal renal tubular acidosis is the diagnosis, confirmed by a urine pH persistently below 5.3
   Show answer and explanation

   Correct answer: A. Primary hyperoxaluria type 1 results from deficient hepatic alanine-glyoxylate aminotransferase; some patients respond to pyridoxine, and combined or sequential liver-kidney transplantation is the definitive treatment once renal failure supervenes

   Primary hyperoxaluria type 1 is a peroxisomal hepatic enzyme deficiency of alanine-glyoxylate aminotransferase causing massive endogenous oxalate production, with raised urinary glycolate; a minority of AGXT genotypes respond to pyridoxine, and because the defect is hepatic, isolated kidney transplantation fails as the new graft is rapidly destroyed by oxalate, so liver-kidney transplantation is definitive (with RNA-interference therapy such as lumasiran now available). Dietary oxalate restriction is inadequate for a synthetic overproduction disorder. Distal RTA causes an inappropriately high urine pH above 5.5 in the face of acidosis, not a low pH.

   Reference: KDIGO and OxalEurope consensus statements on primary hyperoxaluria; EAU Guidelines on Urolithiasis, 2024

2. Question 2 · Infections and Inflammatory Conditions of the Genitourinary Tract

   A 63-year-old diabetic man has CT-proven emphysematous pyelonephritis with gas extending into the perinephric space. Which combination of features is most strongly associated with failure of percutaneous drainage and the need for nephrectomy?

   1. AIsolated fever above 39 C and leucocytosis
   2. BThrombocytopenia, acute kidney injury, shock and altered consciousness
   3. CGas confined to the parenchyma with a serum creatinine of 90 micromol/L
   4. DPositive urine culture for Escherichia coli
   Show answer and explanation

   Correct answer: B. Thrombocytopenia, acute kidney injury, shock and altered consciousness

   Published series identify thrombocytopenia, acute renal failure, shock and disturbed consciousness as independent predictors of poor outcome with conservative or percutaneous management, and patients with two or more of these features have markedly higher mortality unless nephrectomy is performed. Fever, leucocytosis and a positive culture are universal in this condition and carry no discriminatory value. Gas limited to the parenchyma with preserved renal function corresponds to lower-class disease that usually responds to drainage.

   Reference: Huang JJ, Tseng CC, Archives of Internal Medicine, 2000; Campbell-Walsh-Wein Urology, 12th edition

3. Question 3 · Andrology, Male Infertility and Sexual Medicine

   A 29-year-old man with symptomatic hypogonadotropic hypogonadism wishes to father a child within the next year. Which treatment strategy is most appropriate?

   1. ATransdermal testosterone gel with monitoring of semen parameters
   2. BLong-acting testosterone undecanoate injections every 12 weeks
   3. CHuman chorionic gonadotropin, with FSH added if sperm do not appear
   4. DSubcutaneous testosterone pellets implanted every 4 months
   Show answer and explanation

   Correct answer: C. Human chorionic gonadotropin, with FSH added if sperm do not appear

   Exogenous testosterone in any formulation suppresses pituitary LH and FSH, reduces intratesticular testosterone and causes marked impairment of spermatogenesis, so it should be avoided in men actively seeking fertility. Gonadotropin therapy with hCG, which stimulates Leydig cells and restores intratesticular testosterone, and the addition of FSH where sperm do not appear, both treats symptoms and induces spermatogenesis in secondary hypogonadism. Gels, injections and pellets all share the same fertility-suppressing mechanism and are therefore equally unsuitable here.

   Reference: AUA Guideline on Testosterone Deficiency (2018, amended 2024); EAU Guidelines on Sexual and Reproductive Health, 2024

4. Question 4 · Genitourinary Trauma and Reconstructive Urology

   A 44-year-old man has near-total destruction of the right ureter from the pelvic brim to the bladder following pelvic radiotherapy and multiple failed endoscopic procedures. His serum creatinine is 105 micromol/L, hepatic function is normal and urodynamics show a compliant bladder. Which reconstruction is most appropriate?

   1. ABoari flap ureteroneocystostomy
   2. BPsoas hitch alone
   3. CIleal ureteric substitution
   4. DPermanent nephrostomy only
   Show answer and explanation

   Correct answer: C. Ileal ureteric substitution

   When the defect is too long for bladder-based reconstruction, an ileal segment can replace the entire ureter provided renal function is adequate (classically creatinine below about 180 micromol/L) and the bladder is compliant, since impaired renal function risks severe hyperchloraemic metabolic acidosis. A Boari flap typically bridges only up to about 10-15 cm and a psoas hitch less than that, and a permanent nephrostomy is a palliative measure rather than a reconstruction in a fit patient.

   Reference: Campbell-Walsh-Wein Urology, 12th edition (2021); EAU Guidelines on Urological Trauma, 2024

5. Question 5 · Basic Sciences and Basics of Urologic Surgery

   A 70-year-old man with moderate bothersome lower urinary tract symptoms is listed for elective transurethral resection of the prostate. Eight weeks ago he received a drug-eluting coronary stent for an acute coronary syndrome and is on aspirin and ticagrelor. What is the most appropriate management?

   1. AProceed now, stopping both antiplatelet agents 7 days beforehand
   2. BProceed now on aspirin alone, stopping ticagrelor 5 days beforehand
   3. CPostpone the elective operation until the recommended minimum duration of dual antiplatelet therapy after the stent is complete, continuing both agents meanwhile and discussing timing with cardiology
   4. DBridge with a glycoprotein IIb/IIIa inhibitor and operate next week
   Show answer and explanation

   Correct answer: C. Postpone the elective operation until the recommended minimum duration of dual antiplatelet therapy after the stent is complete, continuing both agents meanwhile and discussing timing with cardiology

   Elective, non-time-critical surgery should be deferred during the early high-risk window after drug-eluting stent implantation for an acute coronary syndrome, because interrupting dual antiplatelet therapy carries a substantial risk of stent thrombosis, myocardial infarction and death; his symptoms are bothersome but not an absolute indication for surgery. Stopping either or both agents at this stage, or bridging with intravenous antiplatelet agents outside a specialist protocol, exposes him to avoidable cardiac risk.

   Reference: ESC/EACTS Guidelines on Acute Coronary Syndromes and antiplatelet therapy (2023); EAU Guidelines, perioperative management of antithrombotic therapy (2024)

6. Question 6 · Kidney and Adrenal Tumours

   A 63-year-old man presents with a 10 cm right renal mass, multiple bilateral pulmonary metastases, liver metastases, anaemia, corrected calcium of 2.9 mmol/L and ECOG performance status 2. He has no haematuria or intractable pain. What is the most appropriate initial management?

   1. AStart systemic therapy first; upfront cytoreductive nephrectomy is not indicated in poor-risk disease
   2. BPerform upfront cytoreductive radical nephrectomy, then start systemic therapy
   3. CPerform bilateral pulmonary metastasectomy before addressing the primary tumour
   4. DOffer palliative renal artery embolisation as definitive treatment of the primary
   Show answer and explanation

   Correct answer: A. Start systemic therapy first; upfront cytoreductive nephrectomy is not indicated in poor-risk disease

   The CARMENA trial showed that sunitinib alone was non-inferior to nephrectomy followed by sunitinib in intermediate- and poor-risk metastatic RCC, so upfront cytoreductive nephrectomy is no longer routine and is reserved for good-performance-status patients with low metastatic burden or for palliation of severe local symptoms. This patient has multiple IMDC risk factors and ECOG 2, so systemic therapy comes first; metastasectomy is inappropriate for widespread bilateral disease, and embolisation is a symptom-directed palliative measure, not definitive treatment.

   Reference: Mejean et al., CARMENA trial, New England Journal of Medicine (2018); EAU Guidelines on Renal Cell Carcinoma (2024)

7. Question 7 · Urolithiasis and Obstructive Uropathy

   A 39-year-old man with a horseshoe kidney has a 2.5 cm stone in the right renal pelvis with a high, medially placed pelvis and a long, dependent lower pole infundibulum. Renal function is normal. Which treatment is most likely to render him stone free?

   1. AShockwave lithotripsy, since the isthmus offers a good acoustic window
   2. BPercutaneous nephrolithotomy, typically through an upper pole calyceal access
   3. COpen pyelolithotomy with division of the isthmus
   4. DObservation with potassium citrate
   Show answer and explanation

   Correct answer: B. Percutaneous nephrolithotomy, typically through an upper pole calyceal access

   In a horseshoe kidney the high anterior pelvis and malrotation produce poor dependent drainage, so shockwave lithotripsy is limited by failure of fragment clearance despite adequate fragmentation; percutaneous nephrolithotomy, usually via an upper pole posterior calyx (which is relatively superficial and posteriorly directed in these kidneys), gives the highest stone-free rates. Open surgery with isthmus division is obsolete for stone clearance, and a 2.5 cm stone will not dissolve with citrate unless it is pure uric acid.

   Reference: EAU Guidelines on Urolithiasis, 2024; Campbell-Walsh-Wein Urology, 12th edition, 2021

8. Question 8 · Prostate: Benign Prostatic Hyperplasia and Prostate Cancer

   An 82-year-old man with severe cardiopulmonary disease, a 150 mL prostate and a long-term catheter is considered unfit for general or spinal anaesthesia. A multidisciplinary discussion proposes prostatic artery embolisation. Which statement about this option is most accurate?

   1. AIt removes prostatic tissue for histological examination, so a separate biopsy is unnecessary
   2. BIt produces flow-rate improvements superior to TURP in randomised comparisons
   3. CIt is contraindicated in prostates larger than 80 mL
   4. DIt is performed under local anaesthesia via arterial access, but carries a risk of non-target embolisation causing bladder, rectal or penile ischaemia
   Show answer and explanation

   Correct answer: D. It is performed under local anaesthesia via arterial access, but carries a risk of non-target embolisation causing bladder, rectal or penile ischaemia

   Prostatic artery embolisation is an angiographic, catheter-based procedure done under local anaesthesia and sedation, which makes it attractive in men unfit for anaesthesia, but atherosclerotic and anomalous pelvic vasculature creates a genuine risk of non-target embolisation with bladder wall, rectal or glans ischaemia. Randomised comparisons show TURP gives superior objective flow and residual improvements, with PAE offering less morbidity but lower durability. Large glands are in fact among the better candidates, and because no tissue is retrieved, prostate cancer must still be excluded separately when clinically indicated.

   Reference: EAU Guidelines on Non-Neurogenic Male LUTS (2024); AUA Guideline on Management of BPH/LUTS (amended 2023)

9. Question 9 · Patient Safety, Professionalism, Ethics, Communication and Evidence-Based Urology

   A 30-year-old man with severe intellectual disability who has never had capacity requires an elective flexible ureteroscopy for a symptomatic renal stone. His parents attend with him in a GCC hospital. What is the most appropriate consent process?

   1. AAsk the patient to sign the consent form himself since he is an adult
   2. BProceed without any documented consent because the patient can never give it
   3. CObtain consent from the legally recognised guardian or next of kin as defined by local health authority regulation, involve the patient to the extent he is able, and document the best-interests discussion
   4. DRely on the emergency two-doctor provision, as this bypasses the need for guardian involvement
   Show answer and explanation

   Correct answer: C. Obtain consent from the legally recognised guardian or next of kin as defined by local health authority regulation, involve the patient to the extent he is able, and document the best-interests discussion

   For an adult who permanently lacks capacity, GCC health authority regulations require written consent from the legally authorised guardian or next of kin, supported by a documented best-interests assessment and, wherever possible, assent from the patient at his own level of understanding. A signature from a person who cannot understand the information is not valid consent, and proceeding with no documentation is unlawful. The emergency provision applies only where treatment cannot be deferred, which is not the case for an elective procedure.

   Reference: SCFHS Professionalism and Ethics Handbook for Residents; DHA Health Regulation Sector, Consent Policy for Health Facilities; UAE Federal Law No. 4 of 2016 on Medical Liability

10. Question 10 · Neurourology, Voiding Dysfunction, Incontinence and Female Urology

    A 52-year-old woman with uncomplicated, clinically demonstrable pure stress urinary incontinence has failed six months of pelvic floor training. She has no urgency, no prior pelvic surgery or radiotherapy, no prolapse beyond the hymen, a post-void residual of 20 mL and a negative urinalysis. She wishes to proceed with surgery. What is the most appropriate next step?

    1. APerform multichannel urodynamics first, as it is mandatory before any anti-incontinence surgery
    2. BCounsel and proceed with anti-incontinence surgery without routine preoperative urodynamics
    3. CPerform cystoscopy and retrograde urethrography before offering surgery
    4. DTrial duloxetine for 12 months before any surgical option is discussed
    Show answer and explanation

    Correct answer: B. Counsel and proceed with anti-incontinence surgery without routine preoperative urodynamics

    Randomised evidence (the VALUE and VUSIS trials) showed that in women with uncomplicated, demonstrable stress urinary incontinence, preoperative urodynamics does not change outcomes, so guidelines advise it is not routinely required and is reserved for complicated cases such as mixed symptoms, prior failed surgery, significant prolapse or voiding dysfunction. Routine cystoscopy and urethrography are likewise not indicated in an uncomplicated case. Duloxetine is not licensed everywhere, is poorly tolerated and is not a mandatory prerequisite to surgery.

    Reference: Nager CW et al., VALUE trial, NEJM (2012); AUA/SUFU Surgical Treatment of Female Stress Urinary Incontinence Guideline (2023); EAU Guidelines on Urinary Incontinence (2024)