Urology Prometric exam questions

The Urology exam in every GCC country

From each regulator's own exam pages; anything a regulator does not publish says so. Assessment mode also depends on your licence title, so confirm your route on your eligibility notice.

12 worked Urology practice questions

Original exam-style questions from the bank, spread across the blueprint domains. They are not real or recalled exam questions. Try each one, then open the answer for the rationale and reference. None of them appear in the free mock exam, so reading them will not spoil it.

1. Question 1 · Urolithiasis and Obstructive Uropathy

   A 25-year-old woman has a 4 mm stone in the proximal ureter with mild hydronephrosis, controlled pain and normal renal function. She asks whether tamsulosin will help her pass it. Which statement best reflects current evidence?

   1. AAlpha-blockers roughly double the passage rate for stones of this size and site
   2. BAlpha-blockers are contraindicated in women because of orthostatic hypotension
   3. CThe benefit of alpha-blockers is small or absent for small proximal stones, which have a high spontaneous passage rate anyway
   4. DAlpha-blockers should be continued for at least six months to maximise clearance
   Show answer and explanation

   Correct answer: C. The benefit of alpha-blockers is small or absent for small proximal stones, which have a high spontaneous passage rate anyway

   Meta-analyses show that the expulsive benefit of alpha-blockers is concentrated in larger, distal ureteric stones, where alpha-1D receptor density is highest; for small (under 5 mm) and proximal stones, the spontaneous passage rate is already high and the incremental benefit is small or not demonstrable. Alpha-blockers are used off-label but safely in women, and prolonged courses beyond about four to six weeks are not indicated because a stone that has not passed by then warrants intervention.

   Reference: EAU Guidelines on Urolithiasis, 2024; AUA/Endourological Society Guideline on Surgical Management of Stones, 2016 (amended 2024)

2. Question 2 · Prostate: Benign Prostatic Hyperplasia and Prostate Cancer

   A 70-year-old man with metastatic castration-resistant prostate cancer has progressed on abiraterone and docetaxel. Germline and somatic testing reveal a pathogenic BRCA2 mutation. Which targeted treatment is most appropriate to consider next?

   1. ASwitching to bicalutamide monotherapy
   2. BAn EGFR tyrosine kinase inhibitor
   3. CHigh-dose ketoconazole
   4. DA PARP inhibitor such as olaparib
   Show answer and explanation

   Correct answer: D. A PARP inhibitor such as olaparib

   Tumours with defects in homologous recombination repair genes, particularly BRCA2, are sensitive to PARP inhibition through synthetic lethality, and olaparib improved radiographic progression-free and overall survival in men with such alterations progressing after an androgen receptor pathway inhibitor. This is why guidelines recommend germline and somatic testing in metastatic disease. EGFR inhibitors have no established role in prostate cancer. Ketoconazole is an obsolete, weakly active option, and bicalutamide monotherapy is ineffective in castration-resistant disease already progressing on more potent androgen receptor pathway inhibition.

   Reference: PROfound trial, N Engl J Med 2020; EAU Guidelines on Prostate Cancer (2024)

3. Question 3 · Patient Safety, Professionalism, Ethics, Communication and Evidence-Based Urology

   A senior resident asks you to counter-sign twelve robot-assisted radical prostatectomy entries in his operative logbook, admitting that he only observed the cases, because he needs the numbers for a consultant licensing application. What is the most appropriate response?

   1. ASign the entries, since observation contributes to surgical learning
   2. BSign them but add a private note in your own records that he was an observer
   3. CDecline politely and take no further action, as it is a personal matter between him and the licensing authority
   4. DDecline, explain that certifying cases he did not perform is falsification of a licensing document, and escalate through the training programme director if he persists or has done this elsewhere
   Show answer and explanation

   Correct answer: D. Decline, explain that certifying cases he did not perform is falsification of a licensing document, and escalate through the training programme director if he persists or has done this elsewhere

   Counter-signing cases the trainee did not perform is a probity breach and a fraudulent representation to a licensing authority, which could result in an inadequately trained surgeon being credentialed for major oncological surgery, so refusal is mandatory. A private caveat does not undo a false public certification. Because the risk extends beyond your own relationship with the trainee to future patients and to other supervisors, the concern must be escalated through the programme or clinical director rather than left as a private matter.

   Reference: GMC Good Medical Practice (2024), honesty and probity; SCFHS Professionalism and Ethics Handbook for Residents; DHA Manual for Licensing Healthcare Professionals

4. Question 4 · Neurourology, Voiding Dysfunction, Incontinence and Female Urology

   A 52-year-old woman undergoes transvaginal excision of a urethral diverticulum containing a solid, enhancing nodule seen on preoperative MRI. Which statement about malignancy arising within a female urethral diverticulum is correct?

   1. AAdenocarcinoma is the most frequently reported histological type
   2. BSquamous cell carcinoma accounts for the overwhelming majority of cases
   3. CMalignancy within a diverticulum is exclusively metastatic and never primary
   4. DSmall cell carcinoma is the commonest type and is always managed with primary radiotherapy alone
   Show answer and explanation

   Correct answer: A. Adenocarcinoma is the most frequently reported histological type

   Carcinoma arising within a female urethral diverticulum is rare, but adenocarcinoma is the most frequently reported histology, in contrast to primary urethral carcinoma overall where urothelial and squamous histologies predominate. Squamous cell carcinoma occurs but is not the dominant type in diverticular malignancy, and these are genuine primary tumours rather than metastases. Small cell carcinoma of the urethra is exceedingly rare and would not be managed by radiotherapy alone.

   Reference: EAU Guidelines on Primary Urethral Carcinoma (2024); Campbell-Walsh-Wein Urology, 12th ed. (2021)

5. Question 5 · Bladder Cancer, Urothelial, Testicular and Penile Malignancy

   A 28-year-old man with a metastatic non-seminomatous germ cell tumour has completed BEP chemotherapy. Markers have normalised, but CT shows a residual retroperitoneal mass of 2.5 cm. What is the most appropriate management?

   1. AObservation with repeat CT in 3 months
   2. BPost-chemotherapy retroperitoneal lymph node dissection
   3. CTwo further cycles of BEP
   4. DRetroperitoneal radiotherapy to the residual mass
   Show answer and explanation

   Correct answer: B. Post-chemotherapy retroperitoneal lymph node dissection

   In non-seminoma, any residual mass of 1 cm or larger after chemotherapy with normalised markers should be resected, because approximately 40% contain teratoma and around 10% viable germ cell tumour, neither of which is reliably eradicated by further chemotherapy and both of which carry risks of growth or malignant transformation. Observation risks growing teratoma syndrome and late relapse. Additional chemotherapy is not indicated when markers have normalised, and radiotherapy is ineffective against teratoma.

   Reference: EAU Guidelines on Testicular Cancer (2024); NCCN Guidelines for Testicular Cancer (2024)

6. Question 6 · Renal Failure, Renovascular Disease and Transplantation

   A transplant recipient is converted from tacrolimus to sirolimus because of calcineurin-inhibitor toxicity, three weeks after transplantation. Which complication is most characteristically associated with early mTOR inhibitor use in this setting?

   1. AImpaired wound healing and lymphocele formation
   2. BGingival hyperplasia and hirsutism
   3. CHaemorrhagic cystitis
   4. DMarked hypertrichosis with hyperkalaemic renal tubular acidosis
   Show answer and explanation

   Correct answer: A. Impaired wound healing and lymphocele formation

   mTOR inhibitors such as sirolimus impair fibroblast proliferation and lymphatic healing, so early use is linked to wound dehiscence, lymphocele and delayed graft-ureter healing, and conversion is generally deferred until the wound has healed. Gingival hyperplasia and hirsutism are classic ciclosporin effects, and hyperkalaemic tubular acidosis is seen with calcineurin inhibitors generally. Haemorrhagic cystitis in transplantation is typically associated with BK or adenovirus infection, or with cyclophosphamide, rather than with sirolimus.

   Reference: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients (2009); EAU Guidelines on Renal Transplantation (2024)

7. Question 7 · Urologic Imaging, Endoscopy, Instrumentation and Urodynamics

   A staging PSMA PET-CT in a man with newly diagnosed high-risk prostate cancer reports symmetrical, mild tracer uptake in small structures adjacent to the coeliac axis, with no corresponding abnormality on the CT component. What is the most likely explanation?

   1. AEarly retroperitoneal nodal metastasis requiring extended lymphadenectomy
   2. BPhysiological uptake in the coeliac ganglia, a well-recognised pitfall
   3. CTracer extravasation at the injection site with systemic redistribution
   4. DPaget disease of the adjacent vertebral bodies
   Show answer and explanation

   Correct answer: B. Physiological uptake in the coeliac ganglia, a well-recognised pitfall

   The coeliac and other sympathetic ganglia physiologically express PSMA and are a classic false-positive pitfall, typically appearing as symmetrical, mild, linear or band-like uptake without a CT correlate. True nodal metastases are usually asymmetrical and correspond to a discrete node on CT. Injection-site extravasation produces uptake at the limb of injection, and Paget disease affects bone, not soft tissue adjacent to the coeliac axis, and would show characteristic CT changes.

   Reference: Fendler WP et al., PSMA PET/CT Procedure Guidelines, EANM/SNMMI, 2023; EAU Guidelines on Prostate Cancer, 2024

8. Question 8 · Paediatric Urology

   A 4-year-old girl with bilateral grade IV vesicoureteric reflux has been on continuous antibiotic prophylaxis for 18 months. She has had two further febrile breakthrough urinary tract infections in the last six months, and a repeat DMSA scan now shows new cortical scarring in the left kidney. Bladder and bowel function have been optimised. What is the most appropriate management?

   1. AOpen or minimally invasive ureteric reimplantation
   2. BChange to a different prophylactic antibiotic and continue observation
   3. CStop prophylaxis and manage each infection as it arises
   4. DSingle endoscopic subureteric bulking-agent injection as definitive therapy
   Show answer and explanation

   Correct answer: A. Open or minimally invasive ureteric reimplantation

   Breakthrough febrile infections with new renal scarring in high-grade reflux, despite optimised bladder-bowel function and adequate prophylaxis, is a recognised indication for surgical correction, and ureteric reimplantation offers the highest and most durable success rate (over 95%) for grade IV-V disease. Simply changing the antibiotic or stopping prophylaxis leaves the kidneys exposed to further scarring. Endoscopic injection has substantially lower success rates in high-grade reflux and is a poorer choice once scarring is progressing.

   Reference: EAU/ESPU Guidelines on Paediatric Urology, 2024; AUA Guideline on the Management of Primary Vesicoureteral Reflux in Children (amended)

9. Question 9 · Infections and Inflammatory Conditions of the Genitourinary Tract

   Which set of laboratory variables makes up the LRINEC score used to support the diagnosis of necrotising soft tissue infection?

   1. AC-reactive protein, lactate, troponin, sodium, magnesium and phosphate
   2. BProcalcitonin, lactate, albumin, platelets, INR and bilirubin
   3. CErythrocyte sedimentation rate, ferritin, D-dimer, potassium, urea and calcium
   4. DC-reactive protein, total white cell count, haemoglobin, sodium, creatinine and glucose
   Show answer and explanation

   Correct answer: D. C-reactive protein, total white cell count, haemoglobin, sodium, creatinine and glucose

   The Laboratory Risk Indicator for Necrotising Fasciitis comprises CRP, total white cell count, haemoglobin, serum sodium, creatinine and glucose, with a score of 6 or more raising suspicion and 8 or more indicating high risk. The other combinations describe general sepsis or organ-failure markers that are not part of the instrument. Importantly, the score is an adjunct only, and a low score never overrides a clinical diagnosis or delays surgical exploration.

   Reference: Wong CH et al., Critical Care Medicine, 2004 (LRINEC score); IDSA Skin and Soft Tissue Infection Guidelines, 2014

10. Question 10 · Andrology, Male Infertility and Sexual Medicine

    Six weeks after inflatable penile prosthesis insertion, a man presents with scrotal pain, erythema and fixation of the pump to the skin, but no systemic sepsis and no erosion of any component. He wishes to retain a functioning device. Which management option is most appropriate?

    1. ALong-term oral antibiotics with retention of the implant and no surgery
    2. BRemoval of the pump alone, leaving the cylinders and reservoir in situ
    3. CExplantation with immediate salvage: removal of all components, extensive antiseptic irrigation and implantation of a new device at the same sitting
    4. DExplantation of all components and no further implant surgery at any time
    Show answer and explanation

    Correct answer: C. Explantation with immediate salvage: removal of all components, extensive antiseptic irrigation and implantation of a new device at the same sitting

    In a clinically stable patient without systemic sepsis, extensive tissue necrosis or component erosion, the Mulcahy salvage protocol of removing all components, irrigating the spaces with a sequence of antiseptic solutions and implanting a new prosthesis in the same operation succeeds in the great majority of cases and avoids the corporal fibrosis and penile shortening that follow delayed reimplantation. Antibiotics alone cannot eradicate biofilm on a prosthetic surface. Partial removal leaves infected foreign material behind, and simple explantation with no reimplantation is reserved for septic patients, erosion or severe necrosis, and even then delayed reimplantation may later be offered.

    Reference: AUA Guideline on Erectile Dysfunction (2018, amended 2019); Campbell-Walsh-Wein Urology, 12th edition, 2021

11. Question 11 · Genitourinary Trauma and Reconstructive Urology

    A 26-year-old man has blunt scrotal trauma. Ultrasound shows an intact tunica albuginea and normal testicular echotexture, but a large tense haematocele measuring about three times the size of the contralateral testis, with worsening pain. What is the most appropriate management?

    1. AScrotal exploration with evacuation of the haematocele
    2. BContinued conservative management with elevation and analgesia
    3. CRepeat ultrasound in one week
    4. DAntibiotics and needle aspiration in clinic
    Show answer and explanation

    Correct answer: A. Scrotal exploration with evacuation of the haematocele

    A large haematocele - conventionally more than about three times the size of the contralateral testis - should be explored and evacuated even when the tunica appears intact, because conservative management is associated with prolonged pain, infection, pressure atrophy and a high rate of delayed orchidectomy. Repeat imaging or needle aspiration does not decompress an organised clot and risks infection.

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

12. Question 12 · Bladder Cancer, Urothelial, Testicular and Penile Malignancy

    A 64-year-old man completed adequate BCG (a full induction course plus at least two of three maintenance instillations). At 6 months he has persistent high-grade Ta disease on biopsy. He is fit for major surgery. Which term best describes his disease status and what is the standard recommendation?

    1. ABCG-intolerant disease; switch to intravesical mitomycin C
    2. BBCG-unresponsive disease; radical cystectomy is the standard recommendation
    3. CBCG-refractory but responsive disease; repeat a full induction BCG course
    4. DBCG-relapsing disease; observe with 3-monthly cystoscopy alone
    Show answer and explanation

    Correct answer: B. BCG-unresponsive disease; radical cystectomy is the standard recommendation

    Persistent or recurrent high-grade disease within 6 months (or CIS within 12 months) after adequate BCG defines BCG-unresponsive disease, for which radical cystectomy remains the standard of care in a surgically fit patient because further BCG is unlikely to work and progression risk is high. BCG-intolerance denotes inability to complete therapy because of toxicity, not treatment failure. Repeating BCG in unresponsive disease has poor response rates, and pure observation abandons a curable patient. Bladder-sparing alternatives (for example pembrolizumab, nadofaragene firadenovec or nogapendekin alfa plus BCG) are options for those who refuse or are unfit for cystectomy.

    Reference: AUA/SUO NMIBC Guideline (amended 2024); EAU Guidelines on NMIBC (2024); FDA labelling for BCG-unresponsive NMIBC agents

Urology reference books and guidelines

Every question in this bank names the textbook or guideline its answer rests on. These are the sources our Urology questions cite most often - the reading list to revise from alongside the bank.

Where your regulator publishes a reading list, use the editions it names. Exam questions are not taken from any one book.