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10-14-2008, 01:42 AM #1
Urology MCQs/EMQs
1 Which of the following was not defined as clinical progression in the MTOPS study?
A Recurrent haematuria
B Renal failure
C Increase of 4 points in the AUA symptom score
D Urinary incontinence
E Recurrent urinary tract infection
2 In the PLESS study what is the effect of finasteride on acute urinary retention versus placebo?
A Incomplete emptying
B Frequency
C Quality of life
D Incontinence
E Straining
4 What proportion of patients with a flow rate of more than 15mls/sec are obstructed?
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A 25%
B 30%
C 35%
D 65%
E 40%
5 What is the bladder outlet obstruction index for a man with a voided volume of 310mls, a Qmax of
13mls/sec and a pdet at Qmax of 90cmH20?
A 76
B 72
C 74
D 64
E 82
6 In the development of BPH which of the following is not a growth stimulating factor?
A KGF
B TGFb
C IGF
D EGF
E bFGF
7 What is the risk of retention in a 70-79 year old with moderate lower urinary tract symptoms?
8 Regarding the natural history of BPH, what is the average decline in peak urinary flow rate?
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A 0.1mls/sec/year
B 0.2mls/sec/year
C 0.3mls/sec/year
D 0.4mls/sec/year
E 0.5mls/sec/year
A 70%
B 65%
C 60%
D 55%
E 50%
10 What proportion of men aged 50-59 with BPH have clinical symptoms?
A 15%
B 20%
C 25%
D 30%
E 35%
A Gland size
B Symptom severity
C PSA
D Age
E High post-void residual
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A 36%
B 30%
C 20%
D 16%
E 6%
14 What are the arteries seen after middle lobe resection during a TURP?
A Capsular arteries
B Badenoch's arteries
C Floch's arteries
D Branches of the internal pudendal artery
E Branches of the superior vesical artery
A Mesoderm
B Ectoderm
C Endoderm
D Mullerian duct
E Mesonephric duct
16 Which alpha-blocker has the strongest association with floppy iris syndrome?
A Alfuzosin
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B Indoramin
C Prazosin
D Tamsulosin
E Doxasosin
A 50%
B 60%
C 70%
D 80%
E 90%
A alpha1-a
B alpha1-b
C alpha2
D alpha1
E alpha1-L
19 What is the risk reduction for clinical progression with combination treatment in the MTOPS study?
A 66%
B 44%
C 39%
D 34%
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E 28%
20 What is the change in symptom score in the placebo arm of the PLESS study?
A 3.3 increase
B 1.3 decrease
C 1.0 decrease
D 1.3 increase
E 3.3 decrease
Answers
[HIDE]1A
Clinical progression was defined in the MTOPS study as
2C
99(7%) patients in placebo group compared to 42(3%) in finasteride group suffered acute urinary
retention– Risk reduction of 57%
6B Transforming growth factor beta ihibits epithelial cell proliferation, the other growth factors
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stimulate cell division and differentiation
7E This data comes from the Olmstead County Study (required reading) which showed that men aged
70-79 with moderate/severe symptoms had a retention risk of 34.7 /1000 person years
8B You are required to be aware of the natural history of BPH and the Olmstead study showed an
average decline of 0.2mls/sec/year in patients with BPH
9A This figure comes from Barry et al J Urol 1984 which is a useful paper
10C Garraway et al Lancet 1991 found that 25% of men with a TRUSS volume of >20mls had an IPSS
of >11
12E The national prostatectomy audit quotes a rate of 31% however it appears the risk is much lower.
Wasson's TURP vs watchful waiting study found no difference in the rates of ED between the 2 groups
and Marberger's BJU 1999 meta-analysis indicated a rate of 6.5%
13A The inferior vesical artery supplies the prostate-as it approaches the gland it divides into urethral
and capsular branches
14B The arteries seen at 5 and 7 o clock after middle lobe resection are urethral branches of the
inferior vesical artery known as Badenoch's arteries. The smaller arteries seen at 2 and 10 clock are
known as Floch's arteries
15A Transition zone arises from mesoderm, peripheral zone arises from endoderm and central zone
appears to be embryologically distinct possibly mullerian in origin
16D Although described as a class effect, the incidence of floppy iris syndrome with tamsulosin is
approx 85%-90%
17E The dual 5ARI reduces serum DHT levels by 90%, the reduction achieved by finasteride is less but
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this does not appear to translate into an increased clinical effect
18A The alpha1-a subtype predominates in human stroma and therefore mediates prostatic smooth
muscle contraction
19A The risk reduction for clinical progression is 66% with combination, 39% with doxazosin and 34%
with finasteride
20B Patients in the placebo arm noticed a 1.3 point improvement/decrease in their symptom score
versus a 3.3 improvement on finasteride. The fact that symptoms improved on placebo is useful to
remember in discussions about treatment in the viva
[/HIDE]
10-14-2008, 01:43 AM #2
Uti
1 What was Kass’s proposed criteria for urinary tract infection?
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E > 105 bacteria/ml
3 Which of the following types of adhesion molecules is associated with pyelonephritis in the general
population?
4 36 year old man has symptoms of prostatitis, his 4 glass localisation test reveals WBC’s in VB3.
What is the type of prostatitis?
A Type IV
B Type IIIa
C Type IIIb
D Type II
E Type I
5 What is the first 10mls of urine collected after prostatic massage known as?
A EPS
B VB3
C VB2
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D Midstream urine
E VB1
6 Which of the following is not one of the defining factors of the systemic inflammatory response
syndrome (SIRS)
A Temperature >38 o C
B Respiratory rate >20 breaths/minute
C White cell count > 15000cells/mm3
D Pulse > 90 beats/minute
E PaCO2 < 4.3kPa
A 40%
B 50%
C 65%
D 75%
E 85%
A Tendon damage
B Rash
C Worsening hyperkalaemia in patients with renal failure
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D Folate deficiency
E Stevens-Johnson syndrome
A E-coli
B Chlamydia trachomatis
C N. gonorrhoeae
D Mycobacterium TB
E Amlodipine
Answers
4 B Type IIIa inflammatory chronic pelvic pain syndrome, according to the NIH classification
5 The first 10mls of urine collected after prostatic massage is known as VB3. The 4 glass Stamey
localisation test includes VB1-1st 10mls of urine, VB2-MSU, VB3-1st 10mls after prostatic massage
and EPS-expressed prostatic secretions
8B E-coli is responsible for 50% of hospital-acquired UTI’s and 85% of community-acquired UTI’s
10-14-2008, 01:44 AM #3
Uti
Concerning antibiotics
A trimethoprim
B gentamicin
C amoxicillin
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D nitrofurantoin
E ciprofloxacin
F cefotaxime
G augmentin
H cefuroxime
A Sporocysts
B Proceroid
C Schistosomule
D Cercaria
E Coracidia
F Pleroceroid
G Miracidia
A Malacoplakia
B HIV
C Xanthogranulomatous pyelonephritis
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D TB
E Emphysematous pyelonephritis
F Acute pyelonephritis
G Pyonephrosis
H Perinephric abscess
Classification of uropathogens
A Gram-positive cocci
B Trematode
C Gram-negative cocci
D Tapeworm
E Nematode
F Gram-positive anaerobic bacilli
G Gram-negative aerobic bacilli
H Gram-negative anaerobic bacilli
16 Echinococcus granulosus
17 Mycobacterium tuberculosis
18 Lactobacillus acidophilus
19 Enterococcus faecalis
20 Pseudomonas
Answers
[HIDE]1 E Ciprofloxacin acts on the alpha subunit of DNA gyrase to cause DNA unwinding
2A
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3A
4 H cefuroxime is a 2nd generation cephalosporin, cefotaxime is a 3rd generation cephalosporin
5 B gentamicin blocks protein synthesis by binding to the 30S subunit of ribosomal RNA
6G
7C
8C
9D
10 G
Miracidia eggs enter fresh water, swell and release miracidia larvae. These enter fresh water snails to
produce sporocysts. Each sporocyst releases 200-400 cercaria which are infected minature worms
with a forked tail. The cercariae penetrate unbroken skin and become shistosomules after shedding
their tales. They travel to the liver to mature. Mature adults then couple and migrate to vesical veins.
Here they lay eggs which penetrate the bladder and enter the urine.
11A
12C XGP is usually (but not always) associated with underlying calculi
13C XGP can also be caused by E-coli but Proteus is more common
14E The high glucose levels in diabetics provide an ideal environment for fermentation by
enterobacteria with the production of CO2. XGP can also occur in diabetics
15A Macrophages are unable to completely lyse bacteria which are phagocytosed in malacoplakia
16D
17I
18F
19A
20G[/HIDE]
#4
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10-14-2008, 01:46 AM #4
A 532 nm
B 2140 nm
C 980 nm
D 1650nm
E 1860 nm
A DNA repair
B Re-oxygenation
C Re-accumulation
D Re-assortment
E Re-population
A Gray
B Sievert
C Rad
D Roentgen
E becquerels
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4 Which of the following detects protein on dipstik urinalysis?
A Peroxidase
B Red azo dye
C Indoxyl
D Tetrabromophenol blue dye
E Diazonium salt
5 What is the approximate mortality rate associated with non-ionic contrast media?
A 1/200,000
B 1/100,000
C 1/50,000
D 1/25,000
E 1/10,000
6 Which of the following types of diuretic renogram curve refers to a system which is dilated without
obstruction?
A Type IV
B Type IIIa
C Type IIIb
D Type II
E Type I
A 10 mg per 10 ml
B 1 mg per ml
C 10 mg per ml
D 0.1mg per ml
E 1mg per 100ml
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8 What frequency of transducer is used during transrectal ultrasound?
A 3.5 MHz
B 4.5 MHz
C 5.5 MHz
D 6.5 MHz
E 7.5 MHz
A Circumference in mm
B Circumference multiplied by 3 in mm
C Diameter in mm
D Circumference in cm
E Diameter multiplied by 3 in mm
11 What stage of chronic kidney disease has a patient with an estimated GFR of 26ml/min/1.73m2?
A Stage 4
B Stage 1
C Stage 3
D Stage 5
E Stage 2
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12 What is the 1 year graft survival following living-donor kidney transplantation?
A 95%
B 90%
C 80%
D 70%
E 65%
A Renal
B Lung
C Lymphoproliferative
D Skin
E Cervical
A Mycophenolate mofetil
B Cyclosporine A
C Tacrolimus
D Azathioprine
E Sirolimus
A 1.0
B 2.5
C 3.0
D 4.7
E 10
16 Which of the following best describes the thin descending limb of the loop of Henle?
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A Impermeable to water
B Permeable to water and less permeable to sodium, chloride and urea
C Impermeable to water, highly permeable to sodium and chloride and slightly permeable to urea
D Permeable to water, sodium, chloride and urea
E Impermeable to water and urea with sodium and chloride actively reabsorbed
A +300
B +40
C0
D -50
E -1000
A Phase IV
B Phase III
C Phase II
D Phase I
E Phase 0
A Peroxidase
B Red azo dye
C The production of indoxyl and oxidation of a diazonium salt
D Tetrabromophenol blue dye
E Double oxidation reaction
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A 50-80 mg/day
B 80-150 mg/day
C 150-200 mg/day
D 200-230 mg/day
E 230-250 mg/day
Answers
[HIDE]1B
2C
The "four R's" which determine radiosensitivity are repair, re-oxygenation, re-assortment and re-
population
3A
In SI units, the activity of a radioactive source is measured in becquerels (symbol Bq). The absorbed
dose of ionizing radiation is measured in grays (symbol Gy) where one gray is equal to one joule of
energy being imparted to one kilogram of matter (the rad is the previously used unit). The dose
equivalent, which is a measure of the effects of radiation on living organisms, is measured in sieverts
(symbol Sv)
4D
5A
6B
Type IV Delayed double peak pattern (Homsey)
Type IIIa Dilated without obstruction
Type IIIb Equivocal
Type II Obstructed
Type I Normal
7D 1 in 10,000 or 1mg per 10ml adrenaline solution is often used during cardiace arrest in prepared
syringes. A 1 in 1000 or 1mg per ml adrenaline solution is often used IM for anaphylactic reactions.
UrologyUK comment: Although this seems like a fairly non-urological question there are a significant
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number of everyday clinical MCQ's and EMQ's in the exam.
9E
The French guage is equal to the diameter of the tube multiplied by 3 in mm, not as is often thought
the circumference in mm. However, remember that the circumference is diameter multiplied by Pi
(3.14) so it is nearly correct!!
10B
Stents paralyse peristalsis and therefore do not aid stone passage. They increase intrarenal
pressures. Pearle, M; J Urol 1998 demonstrated that there was no difference in recovery between
patients treated with nephrostomy vs JJ stent. JJ stents are less effective at relieving obstruction
from extrinsic compression.
11A
12B
1 year graft survival for living donor nephrectomy is 95% with HLA-identical siblings, 90% for 1-
haplotype-identical related donor and 80% for cadaveric kidneys
13D
The approximate distribution of new cancers is renal 5%, lung 5%, lymphoproliferative 11%, skin 40%
and cervical 4%
14C
Tacrolimus is nephrotoxic and in approximately 20% of patients causes diabetes
15D
16B
The thin descending limb is best described by B, the thin ascending limb is best described by C and
the thick ascending limb best described by E
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17D
Substance Hounsfield Unit
Air -1000
Fat -50
Water 0
Soft tissue (eg muscle) +40
Calculus +100 to +400
Bone +1000
18D
Phase IV - Post-launch safety surveillance
Phase III - Randomised control trial
Phase II - Assesses how well the drug works as well as continued safety
Phase I - Assesses safety
Phase 0 - First human trial - does it behave in humans as expected
19C
Leucocyte esterase catalyses the production of indoxyl which oxidises a diazonium salt leading to a
colour change
10-14-2008, 01:48 AM #5
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Embryology
A 2 weeks
B 32 days
C 7 weeks
D 42 days
E 36 weeks
F 5 weeks
G 9 weeks
H 3 months
I 21 days
J 6 weeks
K 4 weeks
1 Nephrogenesis complete
2 Pronephros arises from intermediate mesoderm
3 Testosterone production from the Leydig cells commences
4 Ureteric buds arise from the mesonephric ducts
5 Paramesonephric ducts appear
6 Sertoli cells begin to produce anti-Mullerian hormone
7 Formation of the prostate commences
A 10%
B 17%
C 20%
D 80%
E 30%
F 33%
G 45%
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H 1%
A 21 hydroxylase deficiency
B Autosomal dominant
C 50%
D Over-virilised female
E Autosomal recessive
F 17-OH progesterone
G Mixed gonadal dysgenesis
H True hermaphrodite
I 95%
J 11B-hydroxylase
K 85%
Vesicoureteric reflux
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A 10%
B 50%
C 3:1
D Grade 3
E 30%
F 60%
G 5:1
H 2:1
I Grade 2
K Grade 4
Answers
8C, 9E
10B This figure comes from Dhillon HK. Great Ormond Street Experience BJU 1998
11H
12F Which is why patients should be followed up into adolescence
13E
14K It is responsible for 85% of intersex disorders overall and 95% of cases of female
pseudohermaphroditism/over-virilised female
15C
16F, 17A, 18E 21 hydroxylase deficiency is inherited in an autosomal recessive fashion and is the most
common cause of CAH. It catalyses the conversion of 17-OH progesterone to 11-deoxycortisol, its
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absence therefore results in an increase in 17-OH progesterone levels
19G Mixed gonadal dysgenesis is a spectrum of gonadal and genital abnormalities associated with
absence of the 1 of the pair of sex chromosomes
10-14-2008, 01:48 AM #6
A VHL syndrome
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B Birt-Hogg-Dube
C Short arm of chromosome 7
D Hereditary renal cell carcinoma syndrome
E Hypoxia-inducible factor
F X-linked
G Short arm of chromosome 3
H Hereditary leiomyomatosis and renal cell cancer syndrome (HLRCC)
I Fumarate hydratase
J Hereditary papillary renal carcinoma syndrome(HPRC)
K VEGF
Pathology
A Adenocarcinoma
B Squamous cell carcinoma
C Papillary carcinoma
D Carcinoma in situ
E Sarcoma
F Oncocytoma
G Conventional
H Chromophobe
I Transitional cell carcinoma
I Medullary cell
J Angiomyolipoma
Immunotherapy/Chemotherapy
A Thiotepa
B Sorafenib
C Mitomycin
D Intravesical Bacille-Calmette-Guerin
E Sunitinib
F Doxorubicin
G Temsirolimus
H Methotrexate
I Taxanes
Answers
[HIDE]1H
2A
3G
4B
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5J
6E The VHL gene product destabilises HIF-1a and HIF-2a which in turn prevent overexpression of
VEGF
14I Taxanes are spindle-tubule inhibitors and interfere with the mitotic spindle
15C Mitomycin is an antibiotic chemotherapeutic agent which is a cross-linking agent and inhibits DNA
synthesis
16D The mechanism of action of intravesical BCG is unclear but it appears to be an immune stimulant,
activating dendritic cells and upregulating cytokines in the bladder wall
17I As taxanes interfere with mitosis they are active in the M-phase
18B This was demonstrated by the Target Study NEJM 2007
19H Antimetabolites include methotrexate and gemcitibine
20E This was demonstrated by Motzer's phase III trial in NEJM 2007[/HIDE]
03-08-2009, 01:44 AM #7
thank you
07-11-2009, 05:01 PM #8
me too
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Reply With Quote
07-11-2009, 05:07 PM #9
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to see the answers u have to click the thanks button below the post...
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