Urology MCQs

Urology (Y2)

Question 1: A 65-year-old male patient is admitted to the hospital with symptoms of dehydration and altered mental status. Laboratory tests are conducted to evaluate his renal function. The physician is particularly concerned about the possibility of acute kidney injury (AKI) and looks for specific biomarkers that indicate renal impairment.

Which of the following is used as a marker to detect acute kidney injury?

  1. 26 µmol/L of albumin
  2. 26 µmol/L of creatinine 
  3. 30 µmol/L of albumin
  4. 30 µmol/L of creatinine
  5. 30 µmol/L of inulin

Question 2: A 72-year-old patient with a history of chronic respiratory disease is admitted to the hospital with acute kidney injury (AKI) secondary to volume overload. The nephrology team discusses various renal replacement therapy options with the patient, considering the impact of each option on her respiratory condition.

Which of the following temporary renal replacement therapies is the least suitable for patients with respiratory problems?

  1. Haemodialysis
  2. Hemofiltration
  3. Hemodiafiltration
  4. Peritoneal dialysis
  5. Kidney transplant

Question 3: Which of the following cancers has the highest incidence rates in males aged 30-34?

  1. Prostate cancer
  2. Testicular cancer 
  3. Bladder cancer
  4. Renal cancer
  5. BPH

Question 4:  A 65-year-old man undergoes routine screening for prostate cancer, including a prostate-specific antigen (PSA) test and digital rectal examination (DRE). Upon further evaluation, a biopsy confirms the presence of prostate cancer. The oncologist discusses the staging of his cancer and notes that most cases are diagnosed at a specific stage due to the prevalence of screening practices.

At what stage are most prostate cancers diagnosed at?

  1. T1
  2. T1a/b
  3. T1c 
  4. T2
  5. T3/T4

Question 5: Which of the following does not offer sympathetic innervation to the kidneys?

  1. Coeliac ganglion & plexus
  2. Aorticorenal ganglion
  3. Least splanchnic nerve
  4. First lumbar splanchnic nerve
  5. Greater splanchnic nerve

Question 6: Which of the following are NOT, non-germ cell tumours that may lead to the development of testicular cancer?

  1. Stromal tumours
  2. Spermatic cord tumours
  3. Lymphoid & haematopoietic tumours
  4. Teratomas
  5. Secondary tumours

Question 7: A 58-year-old patient with end-stage kidney disease is scheduled to begin dialysis treatment. The nephrologist discusses the composition of the dialysate solution that will be used during the procedure to effectively remove waste products and maintain electrolyte balance.

Which of the following contains the correct composition of a dialysate given to a patient with end-stage kidney disease?

  1. High Na+
  2. High K+
  3. High HCO3–
  4. High H+
  5. High O2

Question 8: A 45-year-old woman presents to her primary care physician with recurrent urinary tract infections (UTIs). She has previously been treated with first-line antibiotics but is now experiencing persistent symptoms. After reviewing her treatment history and current guidelines, the physician considers the appropriate third-line treatment option.

What is the 3rd line treatment of UTIs in the UK?

  1. Ceftriaxone 
  2. Ciprofloxacin
  3. Amphotericin
  4. Pevmicillinam
  5. Trimethoprim

Question 9:  An 80-year-old man presents to the emergency department with complaints of increased urinary frequency and urgency. The physician evaluates the patient for a urinary tract infection (UTI) and considers common clinical signs and symptoms, taking into account the typical presentation in elderly individuals.

Which of the following is not a clinical sign for diagnosing UTIs in elderly patients (>65 yrs)?

  1. Dysuria
  2. Haematuria
  3. Frequency/urgency
  4. Temperature decreased by 1.5º 
  5. Suprapubic pain

Question 10: A 42-year-old woman presents to the emergency department with severe flank pain that radiates to her lower abdomen. After performing a physical examination and obtaining a history, the physician suspects a possible ureteric stone. The physician explains to the patient that pain from the ureters can be referred to certain areas of the back and abdomen due to the specific nerve supply.

Which of the following is the correct referred region of pain of the ureters?

  1. T10-T11
  2. T0-L1
  3. T11-L2
  4. T11-L1
  5. T10-L2

Question 11: Which of the following is not likely to cause fluid accumulation in pouches of the broad ligament in a female (vesicouterine pouch & rectouterine pouch)?

  1. Rupture of ileum
  2. Rupture of the colon
  3. Ectopic pregnancy
  4. Appendicitis
  5. Pelvic inflammatory disease

Question 12: A 60-year-old male with a history of hypertension and diabetes presents for a follow-up appointment to manage his chronic kidney disease (CKD). The physician discusses the potential complications and consequences of his condition. As part of the discussion, they review various metabolic changes that can occur in CKD patients.

Which of the following is not a direct consequence of chronic kidney disease?

  1. Azotaemia (excess nitrogenous compounds in blood)
  2. Hyperkalaemia
  3. Hyperphosphatemia
  4. Hypercalcaemia
  5. Anaemia

Question 13: Which of the following MUST be measured in addition to eGFR in order to diagnose CKD?

  1. Creatinine
  2. Albumin
  3. Urine output
  4. PTH blood test
  5. Calcitriol concentration

Question 14: A 55-year-old patient with chronic kidney disease has a blood test to assess her kidney function. The lab report includes an estimated glomerular filtration rate (eGFR), which the physician explains is calculated using specific patient factors to assess kidney function accurately. The patient asks which factors are typically included in the eGFR calculation.

Which of the following is not used to calculate eGFR?

  1. Age
  2. Gender
  3. Race
  4. Creatinine concentration
  5. Weight (or muscle mass)

Question 15: A 68-year-old man presents to his urologist with painless haematuria. After initial investigations, the doctor discusses possible risk factors for bladder cancer, as the patient is concerned about lifestyle and environmental factors that could contribute to the disease.

Which of the following is not a predisposing factor for bladder cancer?

  1. Smoking
  2. Obesity
  3. Radiation/iatrogenic
  4. Occupation
  5. Chronic inflammation

Question 16: Which of the following is the second most common cause of bladder cancer in the UK?

  1. Squamous cell carcinoma
  2. Adenocarcinomas
  3. Transitional cell carcinomas
  4. Small cell lung cancer
  5. Non-invasive papillary carcinoma

Question 17: A 70-year-old patient with a history of hypertension presents to the emergency department with decreased urine output, and the physician suspects acute kidney injury (AKI). During the examination, the physician assesses fluid status to determine if fluid resuscitation is appropriate.

In which of the following scenarios should you start fluid resuscitation in a patient with suspected AKI?

  1. Pitting oedema
  2. High jugular venous measurement
  3. Tall T waves on an ECG
  4. Decreased urine output
  5. Pulmonary oedema

Question 18: A 26-year-old woman presents to her healthcare provider with concerns about unusual vaginal discharge and discomfort during intercourse. The clinician discusses the symptoms associated with sexually transmitted infections (STIs) and asks her about any other symptoms she may be experiencing.

Which of the following symptoms is not a common symptom of STIs in females?

  1. Dysuria
  2. Dyspareunia
  3. Change in discharge
  4. Intermenstrual bleeding 
  5. Fluid accumulation in pelvic pouches

Question 19: A 55-year-old woman who recently received a kidney transplant presents for her routine follow-up appointment at the transplant clinic. The healthcare team discusses the importance of monitoring for viral infections, given her immunocompromised state post-transplant. The doctor explains the specific viruses that pose a heightened risk and the potential complications associated with these infections.

Immunocompromised renal transplant patients are at an increased risk of which of the following viruses & what are the consequences of being infected with this virus?

  1. HEP B causing hepatocellular carcinoma
  2. HPV causing liver cirrhosis
  3. BK causing bladder cancer
  4. BK causing prostate cancer
  5. HEP C causing hepatocellular carcinoma

Question 20: A 30-year-old man presents to the clinic with a painful ulcer on his genital area. Upon examination, the clinician identifies a chancre, which is typically associated with certain sexually transmitted infections (STIs). The healthcare provider decides to perform a swab of the chancre for laboratory analysis to determine the causative agent.

Which of the following STDs is diagnosed via swabbing a chancre?

  1. Mycoplasma genitalium
  2. Treponeme Pallidum
  3. Neisseria Gonorrhoea
  4. Chlamydia trichomatis
  5. Non-specific urethritis

Question 21: A 32-year-old woman presents to her OB-GYN after experiencing two miscarriages in the past year. She’s concerned and wants to understand what factors might be contributing to her pregnancy losses. Her medical history reveals that she has mild hyperthyroidism but no other known health issues.

Which of the following conditions is least likely to be associated with recurrent miscarriages in this patient?

  1. Thrombophilia
  2. Antiphospholipid Syndrome
  3. Cervical weakness
  4. Hyperthyroidism
  5. Chromosomal abnormalities

Question 22: Which of the following correctly highlights the difference between a complete & a partial molar pregnancy?

  1. Complete = Sperm fertilises an empty egg which duplicates. Partial = 2 sperm fertilise a haploid egg
  2. Complete = maternal genes are the only genes present. Partial = both maternal & paternal genes are involved
  3. Complete = triploid chromosomes. Partial = diploid chromosomes
  4. Complete = foetal features are present on ultrasound scan. Partial = no foetal features visible on ultrasound scan
  5. Both have reduced levels of ß-hCG compared to normal pregnancies

Question 23: A 28-year-old woman presents to the emergency department with abnormal vaginal bleeding and severe nausea. Transvaginal ultrasound confirms a diagnosis of a complete hydatidiform mole.

What is the first line treatment for molar pregnancies?

  1. Hysterectomy
  2. Chemotherapy
  3. Radiotherapy
  4. Unilateral salpingo-oophorectomy
  5. Surgical curette

Question 24: A 32-year-old pregnant woman at 30 weeks of gestation presents for a routine ultrasound. The ultrasound reveals an abnormal placentation with suspicion of an invasive placenta potentially extending beyond the uterine wall. The radiologist notes that the placenta may have penetrated into the bladder.

Which of the following placental abnormalities correctly refers to an invasive placenta that may have penetrated into the bladder?

  1. Placenta praevia
  2. Placenta accreta
  3. Placenta percreta
  4. Placenta increta
  5. Velamentous placenta

Question 25: A 45-year-old woman presents to her gynaecologist with persistent abdominal pain and bloating. After further investigation, imaging studies reveal an ovarian mass. A biopsy of the mass shows the presence of urothelial tissue.

Which of the following types of ovarian cancer is characterised by containing urothelial tissue?

  1. Serous adenocarcinoma
  2. Brenner adenocarcinoma
  3. Mucinous adenocarcinoma
  4. Endometroid adenocarcinoma
  5. Clear cell adenocarcinoma

Question 26: A 50-year-old woman presents to the oncology clinic for follow-up after being diagnosed with a gynaecological cancer. During the consultation, the oncologist discusses the different types of gynaecological cancers and their prognoses. The patient is particularly concerned about which type has the most favourable outcome.

Which of these gynaecological cancers has the best prognosis?

  1. Squamous epithelial ovarian cancers
  2. Germ cell cancers
  3. Stromal cancers e.g., granulosa cell
  4. Endometrial cancer type 1 
  5. Endometrial cancer type 2

Question 27: A 60-year-old woman visits her primary care physician for a routine health check-up. During the visit, they discuss her medical history and any potential risk factors for various health conditions, including endometrial cancer. The physician provides information about various risk factors associated with the disease and asks her to consider which factors might apply to her.

Which of the following is not a risk factor associated with type I endometrial cancer?

  1. Obesity
  2. PCOS
  3. Lynch Syndrome
  4. Smoking
  5. Diabetes 

Question 28: A 35-year-old woman of African descent presents to her gynaecologist with complaints of heavy menstrual bleeding and pelvic pain. After a thorough examination and imaging, the doctor diagnoses her with a benign uterine condition. During the consultation, the physician explains that this condition is characterised by smooth muscle tumours, which are more prevalent in women of African ethnicities.

Which of the following benign uterine conditions is being described?

  1. Endometriosis
  2. PCOS
  3. Uterine fibroids
  4. Polyps
  5. Adenomyosis

Question 29: A 28-year-old woman presents to her primary care physician with concerns about irregular menstrual cycles, excessive hair growth, and difficulty losing weight. The physician suspects polycystic ovary syndrome (PCOS) and orders a series of hormonal tests to evaluate her condition. During the follow-up visit, the physician explains the hormonal imbalances commonly associated with PCOS.

Which of the following hormonal imbalances does not occur in PCOS?

  1. Hyperinsulinemia
  2. Hyperandrogenism
  3. High oestrogen levels
  4. Low SHBP (Sex Hormone Binding Protein)
  5. High FSH levels 

Question 30: A 24-year-old woman presents to her gynaecologist with symptoms of irregular menstrual cycles and hot flashes. After a thorough evaluation, the physician suspects premature ovarian insufficiency (POI) and discusses various conditions that may be associated with this diagnosis. The patient is curious about different genetic and autoimmune disorders that can impact ovarian function.

Which of the following is not associated with premature ovarian insufficiency?

  1. Turner’s Syndrome
  2. Klinefelter’s Syndrome
  3. Galactosaemia
  4. Fragile-X Syndrome
  5. Autoimmune disorders e.g. Myasthenia Gravis

Question 31: A paediatric endocrinologist evaluates a newborn baby diagnosed with Congenital Adrenal Hyperplasia (CAH). The parents have questions about the implications of this condition on their child’s development and health. The doctor explains the various symptoms and risks associated with CAH.

Which of the following does not usually occur if a baby has been diagnosed with Congenital Adrenal Hyperplasia?

  1. Child will experience rapid growth & exhibit gigantism
  2. Girl will experience scant menstruation or amenorrhea
  3. Boys will have a higher risk of prostatic enlargement or prostatic cancers
  4. Both may experience lethargy, vomiting, diarrhoea, dehydration, hyperkalaemia
  5. Both will have reduced mineralocorticoids, glucocorticoids & hyponatraemia

Question 32: A 16-year-old girl presents to her gynaecologist with concerns about primary amenorrhea and abdominal pain. After a thorough examination and imaging studies, the physician evaluates the possible congenital conditions that could explain her symptoms. The doctor explains that some congenital anomalies can affect menstruation differently.

In which of the following congenital conditions would a girl still have her menstrual cycles?

  1. Imperforate hymen
  2. Transverse vaginal septum
  3. Vertical vaginal septum
  4. Mayer-Rokitansky-Kuster-Hauser Syndrome
  5. Cervical agenesis

Question 33: Which of the following is characterised as storage symptoms of the lower urinary tract?

  1. Hesitancy
  2. Dribbling
  3. Straining
  4. Nocturia
  5. Incomplete emptying

Question 34: Which of the following antibiotics used to treat a UTI is ineffective in patients with renal failure (<45)?

  1. Nitrofurantoin
  2. Trimethoprim
  3. Pevmicillinam
  4. Ceftriaxone
  5. Ciprofloxacin

Question 35: What is the primary treatment for testicular cancer?

A) Chemotherapy
B) Radiation therapy
C) Watchful waiting
D) Orchidectomy through inguinal incision
E) Radical retroperitoneal lymph node dissection

Question 36: Which of the following is NOT part of the TNM staging system for renal cell carcinoma?

A) Fuhrman grade
B) Lymph node involvement
C) Metastasis
D) Tumour size
E) Invasion of nearby tissues

Question 37: Which of the following is a symptom of Zoon balanitis (plasma cell balanitis)?

A) Painful urination
B) Red-orange patch on the glans
C) Urethral discharge
D) Foul-smelling discharge from the foreskin
E) Testicular swelling

Question 38: Which of the following is a common complication of untreated paraphimosis?

A) Testicular cancer
B) Infertility
C) Ischemia of the glans penis
D) Prostate cancer
E) Urinary incontinence

Question 39: Which of the following is the most common presenting symptom of bladder cancer?

A) Haematuria
B) Painful urination (dysuria)
C) Increased urinary frequency
D) Urinary incontinence
E) All of the above

Question 40: Which of the following is the most common type of prostate cancer?

A) Adenocarcinoma
B) Transitional cell carcinoma
C) Sarcoma
D) Small cell carcinoma
E) Neuroendocrine carcinoma

Question 41: What role does hyalinosis play in glomerulosclerosis?

A) It is the process of normal tissue repair after injury.
B) It refers to the accumulation of plasma proteins in the glomeruli due to endothelial damage.
C) It indicates the presence of cancer cells in the glomeruli.
D) It is the inflammatory response to bacterial infection in the kidneys.
E) It describes the degeneration of nerve tissues in the kidneys.

Question 42: What is the primary mechanism by which SGLT2 inhibitors help preserve kidney function in diabetic nephropathy?

A) They reduce blood glucose levels only.
B) They increase insulin secretion from the pancreas
C) They cause vasodilation of renal arteries.
D) They directly repair damaged kidney tissues.
E) They decrease the reabsorption of sodium and glucose, leading to osmotic diuresis.

Question 43: Which of the following statements about collecting duct carcinoma (CDC) is true?

A) CDC is the most common type of renal cell carcinoma.
B) CDC primarily affects younger patients and has a favourable prognosis.
C) CDC arises from the renal cortex and is highly aggressive.
D) CDC originates in the medullary collecting ducts and is associated with poor prognosis.
E) CDC responds well to chemotherapy.

Question 44: Which of the following describes cryptorchidism?

A) The failure of one or both testicles to descend into the scrotum
B) Swelling of the testicles due to infection
C) Twisting of the spermatic cord leading to testicular ischemia
D) Fluid collection around the testicle
E) Inflammation of the epididymis

Question 45: Which grading system is used to assess the aggressiveness of renal cell carcinoma?

A) Marsden Grading
B) Fuhrman Grading
C) Gleason Score
D) TNM Staging
E) Robson Classification

Question 46: Which of the following is a medical emergency in patients with acute kidney injury (AKI)?

A) Refractory hyperkalaemia
B) Mild proteinuria
C) Hypocalcaemia
D) Low-grade fever
E) Peripheral oedema

Question 47: What is the definition of CKD (Chronic Kidney Disease)?

A) Rapid decline in kidney function over days
B) sudden onset of haematuria 
C) Presence of kidney stones
D) Temporary increase in creatinine levels due to dehydration
E) Persistent reduction in eGFR (<60) for at least 3 months

Question 48: Which of the following is the most common cause of death in patients with chronic kidney disease (CKD)?

A) Infection
B) Electrolyte imbalances
C) cardiovascular disease
D) Renal cell carcinoma
E) Pulmonary embolism

Question 49: A patient presents with acute testicular pain and swelling. A “bell clapper” deformity is suspected. Which of the following conditions does this term describe?

A) Varicocele
B) Hydrocele
C) Testicular torsion
D) Epididymo-orchitis
E) Cryptorchidism

Question 50: Which of the following is a major consequence of chronic kidney disease?

A) Hypercalcemia
B) Renal anaemia
C) Pulmonary embolism
D) Hyperkalaemia
E) Hypertensive retinopathy

Question 51: Which of the following statements best describes Continuous Ambulatory Peritoneal Dialysis (CAPD)?

A) It is performed automatically while the patient sleeps
B) It uses a machine to filter the blood directly
C) It allows for dialysis without a machine, multiple times a day
D) It relies solely on diffusion for waste removal
E) It requires hospitalization for each dialysis session

Question 52: What is culdocentesis primarily used to diagnose?

A) Ovarian cancer
B) Renal cyst rupture
C) Testicular torsion
D) Ectopic pregnancy
E) Prostate cancer

Question 53: A 45-year-old male presents with flank pain, haematuria, and a history of multiple renal cysts. His blood pressure is elevated, and a family history reveals that his father also had kidney disease that progressed to kidney failure in his 50s. Ultrasound reveals multiple large bilateral renal cysts. Which of the following is the most likely diagnosis?

A) Simple renal cyst
B) Autosomal Recessive Polycystic Kidney Disease (ARPKD)
C) Autosomal Dominant Polycystic Kidney Disease (ADPKD)
D) Acute Pyelonephritis
E) Nephrolithiasis

Question 54: A 32-year-old woman presents with a complaint of malodorous vaginal discharge, which is described as thin and grey in colour. She denies any itching, burning, or pain. Which of the following options is the most likely diagnosis?

A) Candida vulvovaginitis
B) Bacterial vaginosis
C) Trichomoniasis
D) Chlamydia cervicitis
E) Gonorrhoea

Question 55: Which of the following is a complication of pelvic inflammatory disease (PID) that involves inflammation around the liver, causing upper right quadrant pain?

A) Epididymo-orchitis
B) Cervical agenesis
C) Hematometra
D) Fitz-Hugh-Curtis syndrome
E) Bacterial vaginosis

Question 56: Which of the following is the first-line treatment for an uncomplicated UTI?

A) Amoxicillin-clavulanate for 10-14 days

B) Nitrofurantoin for 5 days

C) Ciprofloxacin for 10 days

D) Trimethoprim-sulfamethoxazole for 14 days

E) Ceftriaxone as a single intravenous dose

Question 57: Which of the following patients would be classified as having a complicated UTI?

A) A 25 year old healthy female with no prior UTI history presenting with dysuria.

B) A 28 year old female experiencing mild dysuria after recent antibiotic treatment for a skin infection.

C) A 22 year old female with urinary urgency and no other health conditions.

D) A 35 year old female on oral contraceptives with mild urinary symptoms.

E) A 30 year old male with an indwelling catheter and symptoms of urinary tract infection.

Question 58: Which of the following is the most common type of kidney stone?

A) Calcium oxalate stones
B) Uric acid stones
C) Struvite stones
D) Cystine stones
E) Magnesium Ammonium Phosphate stones

Question 59: Which congenital renal anomaly is characterized by a fusion of the lower poles of the kidneys?

A) Crossed renal ectopia
B) Unilateral renal agenesis
C) Horseshoe kidney
D) Bilateral renal agenesis
E) Simple renal cysts

Question 60: Which condition is associated with oligohydramnios and characteristic facial features known as Potter facies?

A) Bilateral renal agenesis
B) Crossed renal ectopia
C) Horseshoe kidney
D) Renal dysplasia
E) Complex renal cysts

Question 61: In an infant with a suspected inguinal hernia, what clinical finding would most likely suggest an inguino-scrotal hernia rather than a simple inguinal hernia?

A) A visible bulge in the groin that disappears when lying down

B) A bulge only in the inguinal canal area

C) A bulge that extends into the scrotum

D) Tenderness upon palpation in the groin area only

E) Pain in the umbilical region without any visible bulge

Question 62: Meyer-Rokitansky-Kuster-Hauser (MRKH) syndrome is best characterised by which of the following?

A) Congenital absence of the uterus and upper two-thirds of the vagina
B) Presence of a unicornuate uterus with normal ovaries
C) Obstructed uterine outflow due to transverse vaginal septum
D) Congenital adrenal hyperplasia leading to ambiguous genitalia
E) Complete fusion of Müllerian ducts resulting in a bicornuate uterus

Question 63: A patient presents with a longitudinal vaginal septum. What is a potential presentation associated with this condition?

A) Absence of a menstrual cycle (amenorrhea)
B) Normal menstruation but potential difficulty with tampon insertion
C) Retention of menstrual blood in the uterus, causing cyclical abdominal pain
D) A single normal vaginal canal with no noticeable symptoms
E) Infertility due to complete vaginal obstruction

Question 64: Nutcracker Syndrome is a condition characterized by compression of the left renal vein. Which of the following best explains why Nutcracker Syndrome occurs predominantly on the left side and its associated symptoms?

A) Compression of the right renal artery between the aorta and the superior mesenteric artery (SMA), leading to venous congestion.
B) The left renal vein crosses between the abdominal aorta and the superior mesenteric artery (SMA), leading to compression and increased venous pressure.
C) The left kidney has a shorter renal vein compared to the right, leading to susceptibility to compression by nearby structures.
D) The right renal vein drains into the inferior vena cava at an acute angle, making it more prone to compression by abdominal organs.
E) Nutcracker Syndrome arises solely from congenital malformations of the renal vessels, causing severe compression of both renal veins.

Question 65: You are seeing a 62-year-old patient with Stage 3 CKD (eGFR 45 mL/min/1.73 m²) due to long-standing type 2 diabetes. The patient has hypertension controlled with an ACE inhibitor and is also on a non-steroidal anti-inflammatory drug (NSAID) for chronic back pain. Recent laboratory results show worsening kidney function (eGFR decreased to 38 mL/min/1.73 m²) and mild proteinuria.

What is the most appropriate initial step in the management of this patient’s CKD?

A) Continue current medications but increase water intake to improve kidney perfusion.
B) Stop the ACE inhibitor to prevent further decline in kidney function.
C) Discontinue the NSAID and provide alternative pain management strategies.
D) Initiate high-protein dietary supplementation to support kidney function.
E) Refer for dialysis due to the progression of kidney disease.

Question 66: A 45-year-old male presents to the emergency department with a two-day history of severe vomiting and diarrhea. On examination, a heart rate of 110 bpm, and blood pressure of 88/60 mmHg. Laboratory results show an elevated serum creatinine of 2.5 mg/dL (baseline 1.0 mg/dL) and blood urea nitrogen (BUN) of 45 mg/dL. The patient reports significantly decreased urine output over the past 24 hours and is not on any nephrotoxic medications.

What is the most likely diagnosis explaining this patient’s Acute Kidney Injury (AKI)?

A) Prerenal AKI due to volume depletion.
B) Intrinsic AKI due to acute tubular necrosis (ATN) from ischemia.
C) Postrenal AKI due to urinary tract obstruction.
D) Intrinsic AKI due to acute interstitial nephritis (AIN) from a drug reaction.
E) Prerenal AKI caused by hepatorenal syndrome.

Question 67: Which of the following statements best differentiates hemodialysis, hemofiltration, and peritoneal dialysis in the treatment of acute and chronic kidney conditions?

A) Hemofiltration is preferred over hemodialysis for rapid removal of water-soluble toxins due to its superior diffusion capacity.
B) Hemodialysis primarily relies on convection to clear solutes, while hemofiltration uses diffusion as its main method of solute clearance.
C) Peritoneal dialysis is a continuous process that often allows for greater patient mobility and independence compared to intermittent hemodialysis.
D) Hemofiltration is often chosen over hemodialysis for patients with chronic kidney disease requiring outpatient therapy.
E) Hemodialysis cannot be used to treat acute kidney injury in critically ill patients due to its rapid fluid shifts and associated risks.

Question 68: Which of the following correctly describes the main site of semen production and where semen is typically deposited into the urethra during ejaculation?

A) Semen is primarily produced in the epididymis and is deposited directly into the spongy (penile) urethra.
B) The seminal vesicles contribute the largest volume of semen, which is deposited into the prostatic urethra via the ejaculatory ducts.
C) The majority of semen is produced in the testes and is deposited into the prostatic urethra through the ductus deferens.
D) The prostate gland is responsible for the majority of semen production and deposits it directly into the membranous urethra.
E) Semen is formed mainly in the bulbourethral glands and is deposited into the urethra during arousal but not ejaculation.

Question 69: Which of the following types of bladder cancer is most commonly associated with mutations in the P21 RAS gene, leading to the activation of the MAPK signaling pathway?

A) low grade/ non invasive transitional cell carcinoma

B) Squamous cell carcinoma.
C) Adenocarcinoma.
D) Small cell carcinoma.
E) high grade invasive transitional cell carcinoma

Question 70: A 68-year-old man is newly diagnosed with prostate cancer. His PSA level is 25 ng/mL, and imaging shows evidence of extracapsular extension with no lymph node involvement or distant metastasis. According to the TNM staging system, what is the clinical stage of this prostate cancer?

A) T1c N2 M0
B) T2 N1 M1
C) T3a N0 M0
D) T3b N1 M0
E) T4 N3 M0

Question 71:

A 30-year-old man presents with a painless swelling in his left scrotum, which he first noticed several months ago. On examination, the swelling is soft, fluctuant, and transilluminates with light. It does not reduce lying down and is not associated with tenderness, fever, or a change in the overlying skin. The swelling does not change in size with straining or standing, and no bowel sounds are heard over it.

What is the most likely diagnosis?

A) Varicocele
B) Epididymo-orchitis
C) Inguinoscrotal hernia of the gut
D) Hydrocele
E) Spermatocele

Question 72: A 28-year-old woman who is 16 weeks pregnant presents to her obstetrician with dysuria, frequency, and mild suprapubic discomfort for the past three days. She denies fever, flank pain, or systemic symptoms. Urinalysis confirms the presence of leukocytes and nitrites, suggesting a urinary tract infection. Her medical history is unremarkable, and this is her first episode of a UTI during pregnancy.

What is the most appropriate antibiotic treatment for this patient?

A) Ciprofloxacin for 3 days
B) Nitrofurantoin for 5-7 days
C) Trimethoprim-sulfamethoxazole (TMP-SMX) for 3 days
D) Doxycycline for 5 days
E) Amoxicillin-clavulanate for 3 days

Question 73: A 45-year-old man presents to the emergency department with severe, colicky left flank pain radiating to the groin, consistent with renal colic. Imaging reveals a 5  mm non-obstructive stone in the proximal left ureter with no signs of hydronephrosis. He is afebrile with normal renal function and no signs of infection.

What is the most appropriate initial treatment option for this patient’s renal stone?

A) Immediate extracorporeal shock wave lithotripsy (ESWL)
B) Ureteral stenting to relieve obstruction
C) Percutaneous nephrolithotomy (PCNL)
D) Conservative management with hydration, analgesia, and medical expulsive therapy
E) Open surgical removal of the stone

Question 74: A 35-year-old man presents with a history of intermittent flank pain, hematuria, and high blood pressure. Family history reveals that his father had kidney disease and underwent dialysis. Imaging studies reveal bilaterally enlarged kidneys with numerous cysts of varying sizes. What is the most likely diagnosis?

A) Renal cell carcinoma (RCC)
B) Autosomal recessive polycystic kidney disease (ARPKD)
C) Autosomal dominant polycystic kidney disease (ADPKD)
D) Multicystic dysplastic kidney disease
E) Simple renal cyst

Question 75: A 28-year-old sexually active man presents with a triad of symptoms including urethritis, conjunctivitis, and arthritis predominantly affecting the knees and ankles. He reports dysuria and has a history of a recent unprotected sexual encounter. Laboratory tests show no evidence of gonococcal infection, and urine PCR testing is pending. What is the most likely diagnosis for his symptoms?

A) Gonococcal urethritis with septic arthritis
B) Human papillomavirus (HPV) infection
C) Chlamydia trachomatis infection causing sexually acquired reactive arthritis (SARA)
D) Syphilis with secondary systemic symptoms
E) Herpes simplex virus (HSV) infection

Question 76: A 62-year-old woman presents with a three-month history of urinary urgency, frequency, and waking several times at night to void. She also reports occasional episodes of urine leakage when she cannot reach the bathroom in time but denies leakage with coughing, sneezing, or heavy lifting. There is no hematuria, pain, or fever. A urine dipstick test is negative for leukocytes, nitrites, and blood. What is the most likely diagnosis?

A) Stress urinary incontinence (SUI)
B) Overactive bladder (OAB)
C) Bladder cancer
D) Renal stone
E) Urinary tract infection (UTI)

Question 77: A newborn male is diagnosed with a congenital abnormality of the penis. On examination, the urethral opening is located on the dorsal side of the shaft, and there is a broad, flat appearance to the penis. What is the most likely diagnosis?

A) Hypospadias
B) Epispadias
C) Paraphimosis
D) Testicular torsion
E) Phimosis

Question 78: A 3-year-old girl is referred to the paediatric endocrinology clinic due to ambiguous genitalia, including an enlarged clitoris, fused labia, and a deepening voice. Her birth weight was normal, but she has a history of rapid growth and early pubic hair development. Laboratory tests reveal low cortisol and aldosterone levels with elevated 17-hydroxyprogesterone (17-OHP). What is the most likely diagnosis, and which enzyme is primarily affected?

A) Congenital adrenal hyperplasia causing a 21-hydroxylase deficiency, leading to a block in cortisol and aldosterone synthesis
B) 11β-hydroxylase deficiency, leading to excess mineralocorticoids and androgens
C) 3β-hydroxysteroid dehydrogenase deficiency, leading to impaired steroidogenesis and ambiguous genitalia
D) congenital adrenal hyperplasia causing 17α-hydroxylase deficiency, resulting in low cortisol, sex steroids, and high aldosterone
E) 17,20-lyase deficiency, leading to impaired androgen synthesis and ambiguous genitalia

Question 79: A 24-year-old woman presents with irregular menstrual cycles, hirsutism, and acne. She also reports difficulty conceiving for the past 6 months. On examination, she has mild obesity with a BMI of 30, and coarse hair on her upper lip and chin. An ultrasound reveals enlarged ovaries with multiple peripheral cysts. Hormonal testing shows elevated testosterone and LH/FSH ratio of 2.5:1. Which of the following is the most likely underlying pathophysiological mechanism contributing to her condition?

A) Increased secretion of prolactin leading to hyperandrogenism
B) Insulin resistance and hyperinsulinemia leading to elevated ovarian androgen production
C) Hypothalamic dysfunction resulting in altered GnRH pulse frequency
D) Ovarian resistance to FSH, causing an imbalance in follicle maturation
E) Decreased cortisol clearance resulting in elevated adrenal androgen levels

Question 80: A 50-year-old woman presents with a 6-month history of irregular periods, hot flashes, and night sweats. She reports sleep disturbances and mood swings. Her last menstrual period was 8 weeks ago. On examination, her blood pressure is normal, and her BMI is 26. Which of the following hormonal changes would you most likely expect to find in her blood work, considering she is in the perimenopausal period?

A) Elevated estradiol, decreased FSH, and normal progesterone
B) Elevated luteinizing hormone (LH), elevated estradiol, and low progesterone
C) Elevated follicle-stimulating hormone (FSH), decreased estradiol, and low progesterone
D) Decreased LH, decreased estradiol, and high progesterone
E) Decreased estradiol, elevated FSH, and low LH

Question 81: A 32-year-old woman presents with a history of severe dysmenorrhea, deep pelvic pain during intercourse, and infertility for the past 2 years. On pelvic examination, there is tenderness in the posterior fornix. Ultrasound findings are non-specific, but MRI reveals small, scattered endometrial-like tissue outside the uterus. Which of the following conditions is most likely to explain her symptoms, and how does it differ from the other potential diagnoses?

A) Endometrial hyperplasia, characterized by abnormal proliferation of the endometrial lining
B) Leiomyomas, characterized by smooth muscle tumors within the uterus
C) Endometriosis, characterized by ectopic endometrial tissue outside the uterus
D) Endometrial polyps, characterized by localized growth of endometrial tissue within the uterine cavity
E) Adenomyosis, characterized by endometrial tissue invading the myometrium

Question 82: A 29-year-old woman undergoes a Pap smear and is found to have cervical intraepithelial neoplasia (CIN) grade 2. The pathologist notes that the dysplastic changes in the cervical epithelium begin in the basal layer of the epithelium and progress upwards. Which of the following explanations best explains why these changes occur from the basal cells to the top cells in CIN?

A) The basal layer is where the stem cells of the epithelium reside, making it the primary site for initial oncogenic mutations
B) The apical layer of the epithelium is more exposed to carcinogens, so mutations tend to start from the top and progress downward
C) The basal cells are the most differentiated and thus have the highest potential for undergoing genetic changes leading to CIN
D) The immune system targets the basal cells first, leading to a gradual accumulation of mutations as the cells migrate upward
E) The basal layer is closest to the blood supply, making it more susceptible to the initial effects of HPV infection and subsequent transformation

Question 83: A 30-year-old woman presents with irregular bleeding and an abnormally high serum beta-hCG level following a miscarriage at 9 weeks of gestation. Ultrasound reveals a heterogeneous mass in the uterus. After suction curettage, her beta-hCG level remains elevated. Which of the following best differentiates gestational trophoblastic disease (GTD) from gestational trophoblastic neoplasia (GTN) in this patient?

A) GTD typically involves the formation of a hydatidiform mole, whereas GTN involves malignancy that has the potential for invasion and metastasis and a constantly high beta- HCG levels even after removal of miscarriage
B) GTD is characterized by a persistently low beta-hCG level after miscarriage, whereas GTN typically shows a dramatic rise in beta-hCG levels
C) In GTD, the uterus usually appears normal on ultrasound, whereas in GTN, the ultrasound shows a characteristic “snowstorm” pattern
D) GTD is associated with irregular bleeding but no symptoms of metastasis, whereas GTN is typically confined to the uterus without risk of distant spread
E) GTD is associated with a high risk of invasive disease and distant metastasis, whereas GTN is a self-limiting condition that resolves spontaneously without treatment