UROP

Üroloji
1. A 29-year-old female with Multiple Sclerosis presents first time to urology with urgency incontinence. Her PVR is 25 ml and her upper urinary tract is normal. Her urine analysis is normal and urine culture is sterile. Her uroflowmetry is normal but her cystometry reveals terminal detrusor overactivity incontinence at 300 ml bladder volume.What is the most appropriate treatment?
A) Limit fluid intake
B) Oral antimuscarinic treatment *
C) Alpha blocker treatment
D) Mid-urethral synthetic sling surgery; TOT or TVT
E) Sacral neuromodulation

2. Which of the following needs to be excluded for the diagnosis of overactive bladder syndrome?
A) Painful urination *
B) Nocturia
C) Frequent urination
D) Urgency
E) Urgency incontinence

3. Which of the following lasers is currently the most often used ONE in ureteroscopic fragmentation of ureteral stones?
A) Tulium laser
B) Holmium YAG laser *
C) KTP laser
D) Neodymium YAG laser
E) Erbium YAG laser

4. A 30-year-old woman presents with urinary incontinence (UI) that occurs only with a strong cough. She is obese, has 1 child and smokes 1 pack for day. Which option should be avoided in the first line management of her stress UI?
A) Mid-urethral synthetic slings (TOT or TVT) *
B) To treat conditions leading to coughing
C) To lose weight
D) To perform pelvic floor exercises
E) To stop smoking

5. A young healthy body-builder is consulting you to receive exogenous testosterone to increase his muscle size. He has to be informed about which of the following consequences?
A) His spermatogenetic activity will improve without any difference in testicular size
B) His spermatogenetic activity will be impaired and his testicles will shrink in size *
C) His spermatogenetic activity will improve and his testicles will increase in size
D) His spermatogenetic activity will be impaired but his testicles will increase in size
E) His spermatogenetic activity will stay the same but his testicles will shrink in size

6. In 1998, Nobel Prize in Physiology or Medicine was awarded to scientists Ferid Murad, Robert F. Furchgott and Louis J. Ignarro for their research on the regulation of smooth muscle tone in humans that involves various organs or systems.Which of the following is the mainstay of the oral treatment for erectile dysfunction based on this discovery?
A) The role of L-arginine-nitric oxide-cGMP pathway in the regulation of smooth muscle tone. *
B) The role of cyclooxygenase (COX) and lipoxygenase (LOX) products (i.e. prostaglandins and leukotrienes) in the regulation of smooth muscle tone
C) The role of Rho-kinase pathway in the regulation of smooth muscle tone.
D) The role of K-channels in the regulation of smooth muscle tone
E) The role of “transient receptor potential cation channel subfamily” (vanilloid receptors) in the regulation of smooth muscle tone

7. A 24-year-old otherwise healthy single man presents with 2 recent sperm analyses indicating normal ejaculate volume, sperm concentration of 10-12x106/mL, 3% normal morphology according to Kruger and 30% progressive motility. His physical examination and scrotal doppler ultrasound examination reveal a left sided high-grade testicular varicocele.Which of the following is the most appropriate management?
A) Sperm cryopreservation
B) To check the FSH and prolactin levels
C) Obtain a third sperm analysis
D) Follow up the patient until he wants to conceive children
E) Left microscopic varicocelectomy *

8. A 33-year-old male patient referred to Urology department due to right renal colic. He previously passed many stones spontaneously. (Stone analysis revealed calcium oxalate monohydrate).  Urinanalysis showed 23 RBC no WBC and serum creatinine level was 0.83 mg/dL. His noncontrast spiral CT shown below reveals a 6 mm upper ureteric stone. He was advised medical expulsive therapy and a control visit one week later if he does not develop new symptoms. What is the most important determinant of spontaneous stone passage in this patient?


A) Age of the patient
B) Body mass index of the patient
C) Previous history of passing stones
D) Stone size *
E) Stone localization

9. A 72-year-old male patient is referred to you for incidentally detected left renal stone.  He has known gouty diathesis.  Urinalysis revealed pH: 5 and 35 erythrocyte/HPF. Serum creatinine, uric acid and calcium levels were 0.97 mg/dL, 10.4 mg/dL and 9.3 mg/dL, respectively. Ultrasound showed a 9 mm left renal pelvic stone, with no hydronephrosis. KUB and IVP are shown below. A non-contrast CT measured the stone density as 400 HU.What is the optimal treatment alternative for this patient?

A) Open pyelolithotomy
B) Percutaneous nephrolithotomy (PNL)
C) Retrograde intrarenal surgery (RIRS)
D) Extracorporeal shock wave lithotripsy (SWL)
E) Oral chemolysis + Medical expulsive therapy   *



10. A 12-year-old girl presents with bilateral Grade 2 hydronephrosis and urinary incontinence despite antimuscarinic management and regular clean intermittent catheterization (CIC). Her serum creatinine is 1 mg/dl. Her VCUG reveals bilateral grade 3 VUR and a low capacity bladder with severe trabeculation. Her urodynamic study reveals severely hypocompliant bladder. Which of the following is the treatment of choice?
A) Increase the dose of oral antimuscarinic treatment
B) Increase the frequency of CIC
C) Bilateral ureteroneocystostomy to treat VUR
D) Intradetrusor Botulinum neurotoxin injection
E) Bladder augmentation surgery *

11. What is the external diameter of a 24 Fr urethral catheter?
(Catheters in Urology)
(Distinguish different types of urethral catheters)
(Learning)
(Dr. Yakup Kordan)

A) 10 mm
B) 5 mm
C) 8 mm *
D) 12 mm
E) 30 mm

12. Which of the following is not an invasive urodynamic test?
A) Cystometry
B) Pressure flow study
C) Urethral pressure profile
D) Video-urodynamic study
E) Uroflowmetry + anal sphincter EMG with superficial electrodes *





13. Which of the following is the most common presentation of male sexual dysfunction?
A) Loss of libido
B) Erectile dysfunction
C) Difficulty in reaching orgasm
D) Premature ejaculation *
E) Painful intercourse

14. Which of the following patients is the  best suitable one for ileal neobladder following radical cystectomy for muscle invasive bladder cancer?
A) quadriplegic patients
B) cancer at the bladder dome *
C) cancer in prostatic urethra
D) patients over the age of 80
E) patients with creatinine level > 2 mg/dL

15. After multiple failed attempts  to insert an urethral catheter to relieve urethral obstruction what is the next best step?
A) Attempt to insert a stiffer urethral catheter
B) Placement of percutaneous cystostomy *
C) Placement of bilateral nephrostomy
D) Perineal urethrostomy
E) Ballon dilation of the obstructed urethral segnent under flouroscopy






16. Which of the following renal diseases has the highest probability of recurrence in the transplanted  kidney?
A) Chronic glomerulonephritis
B) IgA nephropathy
C) Autosomal dominant polycystic kidney
D) Focal segmental glomerulosclerosis *
E) Multicystic kidney disease

17. ER department is calling you to consult a patient, who had a ESWL  session for right renal pelvis stone four days ago.  He has right flank pain, vomiting, dysuria and high fever (38.7 C°).  Physical examination reveals right costavertebral angle tenderness (+).  Urinalysis is normal but serum creatinine level is 1.4 mg/dL. His WBC count and CRP are 14.300 K/uL and 127 mg/L, respectively.  Ultrasound shows multiple stones in lower pole and renal pelvis of the right kidney and also moderate hydronephrosis. His left kidney is normal. Your colleague has sent you the KUB via WhatsApp, which you can see below.What should be your next step?




A) Urine and blood cultures, antipyretic and prophylactic antibiotics and follow up the patient with serial CBC in ER
B) Urine and blood cultures, antipyretic and prophylactic antibiotic. Thereafter, advising to visit you tomorrow morning.
C) Urine and blood cultures, antipyretic and empiric antibiotics. Immediate hospitalization and percutaneous drainage. *
D) Urine and blood cultures, antipyretic and prophylactic antibiotics. Emergency ureterorenoscopy to remove all of the stone fragments.
E) Urine and blood cultures, evaluation of serum INR, antipyretic and prophylactic antibiotics. Hospitalization and performing second session SWL.

18.  An absolute contraindication for Extracorporeal Shock Wave Lithotripsy (SWL) is;
A) Hypertension
B) Diabetes Mellitus
C) Pregnancy *
D) Uncontrolled urinary tract infection
E) History of myocardial infarction

19. What is the most common histological type of testicular tumor in adults elder than 50 years of age?
A) Seminoma
B) Choriocarcinoma
C) Primary testicular lymphoma *
D) Embryonal carcinoma
E) Yolc sac tumor




20. Meyer-Weigert rule establishes the embryological basis of which of the following genitourinary anomalies?
(VUR, voiding dysfunction and UTI)
(Recognize the diagnostic tools for the diagnosis of VUR)
(Learning)
(Tarık Esen, Ilmay Bilge, Tufan Tarcan)

A) Bladder extrophy
B) Epispadias
C) Duplicated urinary collecting system *
D) Ectopic kidney
E) Prune-Belly syndrome

21. Which of the following symptom scores is designed to assess lower urinary tract symptoms associated with benign prostatic enlargement?
A) International prostate symptom score (IPSS) *
B) Overactive bladder (OAB) questionnaire V8
C) SEAPI Quality of Life questionnaire
D) King’s Health Questionnaire
E) International Consultation on Incontinence Questionnaire (ICI-q)

22. Which of the following is the greatest risk factor in a patient with testis cancer for the development of a metachronous germ cell tumor  in the contralateral testis?
A) Testicular trauma
B) Orchitis
C) Decreased fertility
D) Testicular microlithiasis *
E) Vasectomy




23. As a consequence of the CO2 pneumoperitoneum used during minimally invasive (laparoscopic/robot assisted) prostatectomy, the anesthesia team must be aware of the potential for:
Prostate cancer
Describe the treatment options of localized and locally advanced prostate cancer.
Learning
Tarık Esen, Tufan Tarcan
A) Bleeding and hypotension
B) Hypoxia and acidosis
C) Tachycardia and hypertension
D) Bradycardia and hypotension
E) Hypercarbia and oliguria *

24. A 25-year-old otherwise healthy single man presents with erectile dysfunction that he had never before but started recently to experience in his new relationship. He reports that can initiate a normal erection which resolves copmpletely as he starts intercourse without ejaculation. His nocturnal penile tumescence is normal and he has no erectile problems during masturbation. His physical examination is unrevealing.What should be the next step in the management of this patient?
A) Penile Doppler ultrasound
B) Intracavernosal papaverine test
C) Hormonal evaluation
D) Start immediately oral PDE5 inhibitor
E) Consultation with a sexual therapist *

25. Which of the following causes of sexually transmitted diseases play a role in the etiology of Buschke-Lowenstein tumors?
A) Treponema pallidum
B) Haemophilus ducreyi
C) Herpes simplex
D) Human papilloma virus *
E) Klebsiella granulomatis

26. A 25-year-old otherwise healthy man presents with urethral purulent discharge and dysuria that started two weeks after an unprotected sexual intercourse. His past medical history is unrevealing. His physical examination is otherwise normal.Which of the following antibiotic regimen would you initiate empirically after having obtained relevant cultures?
A) Ciprofloxacin 500 mg orally twice per day for seven days + single dose of ceftriaxone 250 mg IM injection
B) Ciprofloxacin 500 mg orally twice per day for fourteen days
C) Doxycycline 100 mg orally twice per day for seven days + single dose of ceftriaxone 250 mg IM injection *
D) Amikocin 0.5 gr twice daily IM for 7 days  + azithromycin 1 g orally in a single dose
E) Azithromycin 1 g orally in a single dose + doxycycline 100 mg orally twice per day for seven days

27. A 70-year-old diabetic male patient presents with inability to empty his bladder and urinary incontinence associated with effort.  He has a benign prostatic enlargement of 40 g and mildly dilated kidneys and large bladder capacity on ultrasound. His pressure-flow study is non-obstructive and he appears to have 1000 ml residual urine. His serum creatinine is 1.7 mg/dl.What is the most appropriate treatment?
A) Alpha blocker treatment
B) Clean intermittent catheterization *
C) Transurethral resection of the prostate
D) Sacral neuromodulation
E) Combined treatment with alpha blockers + 5 alpha reductase inhibitors

28. A 45-year-old male patient with Balkan endemic nephropathy which is a risk factor for the development for upper tract urothelial cancer presents with painless macrohematuria.Which of the following diagnostic tools is the most appropriate one for this patient?
(Urothelial cancer)
Describe the diagnostic and staging methods of urothelial tumors
(Core)
Dr. Derya Balbay, Dr. Tarık Esen

A) PSA
B) Noncontrast spiral abdominal CT
C) CT Urography *
D) Cystoscopy
E) Pelvic MR

29. Which non-radioactive pharmaceutical is often administered to distinguish an obstructed dilated collection system from a nonobstructed dilated collection system during dynamic renal scintigraphy?
A) Dobutamine
B) Furosemide *
C) Propranolol
D) Captopril
E) Adenosine

30. What is the most common cause of stress type urinary incontinence after radical prostatectomy?
(The incontinent patient (Neurogenic voiding dysfunction-Female urology)
Recognize how post-prostatectomy incontinence develops and should be evaluated/managed.
(Learning)
Dr. Tufan Tarcan


A) Sphincteric deficiency *
B) Loss of bladder capacity
C) Failure to reconstruct the bladder neck
D) Injury to the neurovascular bundles
E) Detrusor overactivity

31. Which of the following is an emptying phase LUTS?
(Differential diagnosis of lower urinary tract symptoms)
Distinguish emptying phase and storage phase lower urinary tract symptoms
(Core)
Dr. Tarık Esen, Dr. Tufan Tarcan


A) Frequency
B) Urgency
C) Nocturia
D) Urge incontinence
E) Post-void dribbling *





32. Which of the following statements regarding benign prostatic hyperplasia (BPH) is true?
A) The fibrostromal proliferation of BPH occurs mainly in the outer portion of the gland.
B) Assuming a voided volume greater than 150ml, a peak urine flow rate of 15ml/s or higher is good evidence of outflow obstruction.
C) Suprapubic transvesical prostatectomy for BPH aims enucleation of the whole gland and eliminates the risk of future prostate cancer.
D) Indications for surgery include recurrent urinary retentions and recurrent urinary tract infections. *
E) BPH is a risk factor for the development of prostate cancer.

33. Which of the following should always be avoided in the presence of hypospadias? (Bedside/Outpatient: History taking and examination in Urology)
(Distinguish the physical appearance of the penis in hypospadias vs. Epispadias)
(Learning)
(Dr. Tarık Esen, Dr. Murat Can Kiremit)
A) Circumcision *
B) Ruling out intersex abnormalities in proximal hypospadias
C) Surgical correction of hypospadias in early childhood.
D) Urinary ultrasound examination
E) Counselling of the parents

34. A 19-year-old man is involved in a motorcycle accident in which he sustains a closed fracture of his right femur and a pelvic fracture. In addition to the obvious deformity in his leg, physical examination is remarkable for the presence of a scrotal hematoma and blood at the external urethral meatus. There is no blood in the rectal exam, but the prostate cannot be felt. The patient states that he feels the need to void, but can not urinate.Which of the following is the most appropriate next step in diagnosis?
A) CT scan of the pelvis
B) Scrotal sonogram
C) IV pyelogram (IYP)
D) Retrograde cystogram via Foley catheter
E) Retrograde urethrogram *



35. Which of the following is considered a malpractice in the treatment of non-muscle-invasive bladder tumors?
A) Complete transurethral resection
B) Intravesical BCG within the first 6 hours of TUR-BT *
C) Early cystectomy
D) Maintenance intravesical chemotherapy
E) Maintenance intravesical BCG

36. Lamina propria is spared from invasion in which of the following stages of upper tract urothelial carcinoma?
A) Tis *
B) T1a
C) T1b
D) T2a
E) T2b

37. Which of the following is a typical clinical feature of dysplastic multicyctic kidney disease?
A) Unilaterality *
B) Concomittant aneurysms in the brain
C) Most commonly seen cystic disease of the kidney
D) Autosomal dominant penetrance
E) Autosomal recessive penetrance






38. Which of the following is the most accurate diagnostic modality for bladder tumors?
A) 18-FDG PET CT
B) Chromosomal abnormalities
C) 3 Tesla MRI
D) Urinary NMP-22 (Nuclear Matrix Protein) levels
E) Conventional cystoscopy *

39. A 55-year-old man is diagnosed with benign prostatic hyperplasia. The patient rejects pharmacologic treatment and decides to undergo transurethral resection of the prostate (TURP).Which of the following is the most common complication of this procedure?
A) Bladder neck contracture
B) Impotence
C) Incontinence
D) Retrograde ejaculation *
E) Urethral stricture

40. A previously healthy 60-year-old man is referred for urologic evaluation of macroscopic hematuria. Urinary cytology is positive for malignant cells, and cystoscopic examination reveals an exophytic multifocal tumor. TUR of the tumor demonstrates papillary fronds lined by cells similar to transitional epithelium but showing nuclear atypia, mitoses, and necrosis.Which of the following is the most important risk factor for the development of this type of tumor?
A) Aniline dyes
B) Smoking *
C) Recurrent cystitis
D) Schistosomiasis
E) Cyclophosphamide


41. A 30-year-old man presents with painful, rigid erection of 4 hrs duration not associated with sexual desire. You examine the patient, perform a cavernosal blood aspiration send the sample for blood-gas analysis. The ph is 7.30. What is the most probable diagnosis and which anamnestic clue in patient’s history helps you to establish it?
(Case discussion: Urological emergencies and trauma)
(Describe the most common causes and management options of ischemic priapism) (Distinguish the clinical differences between ischemic and non-ischemic priapism)
(Learning)
(Tarık Esen, Tufan Tarcan, Yakup Kordan)

A) High flow priapism-Idiopathic thrombocytopenic purpura
B) Peyronie s disease-Iron deficiency anemia
C) Low flow priapism-Sickle cell anemia *
D) Cavernitis-Hemophilia
E) Low flow priapism-Acute myeloblastic leukemia

42. A 35-year-old man comes to the physician because of persistent dull perineal pain and dysuria for 6 months. The patient denies urinary tract infections or urethral discharge. His temperature is 36.5 C°. On digital rectal examination, the prostate is slightly tender and boggy but not enlarged or indurated. Urinalysis is normal. Stamey localization test with expressed prostatic secretions shows the following:
Initial urine portion                              2-3 WBC
Mid-urine portion                                2-3 WBC
Expressed prostatic secretion        25-30 WBC
Terminal urine portion                     10-15 WBC
Cultures of prostatic secretion and urine are negative for bacteria. Which of the following is the most likely diagnosis?
A) Acute cystitis
B) Acute prostatitis
C) Chronic bacterial prostatitis
D) Chronic nonbacterial prostatitis *
E) Prostatodynia



43. For which of the following renal cell cancer subtypes, uropathologists tend not to give a Fuhrman Grading?
A) Clear Cell
B) Papillary Type I
C) Oncocytoma
D) Chromophobe *
E) Papillary Type II

44. You are planning to do an open kidney surgery through an intercostal lumbotomy. What is the deepest layer of muscle you have to transect to reach retroperitoneum?
A) M.rectus abdominis
B) M.obliquus internus
C) M.transversus *
D) M.sacrospinosus
E) M.serratus

45. Which of the following is the most common presenting symptom in Wilms’ tumor?
A) Abdominal mass *
B) Abdominal pain
C) Nausea
D) Vomiting
E) Hypertension






46. Which ureteral segment has the weakest muscular backup and is therefore more prone to avulsion during rigid ureteroscopic interventions?
A) Mid-ureter
B) Distal ureter
C) Ureterovesical junction
D) The segment crossing over the iliac vessels
E) Ureteropelvic junction *

47. Which of the following is true regarding renal masses?
A) Juxtaglomerular tumors are malignant and prone to metastasize early in the course of the disease
B) Oncocytomas are benign tumors and never metastasize *
C) Angiomyolipomas are the most frequent pathology associated with von Hippel-Lindau syndrome
D) Acquired cystic diseases of the kidneys are the most frequent pathology associated with tuberous sclerosis
E) Renal adenomas can easily be differentiated from malignant tumors with MR imaging

48. Ga68 PSMA PET CT is a novel scintigraphic technique to detect the metastatic involvement in patients with high risk prostate cancer. Which of the following biopsy results in a patient with a normal DRE constitutes the ideal indication for this investigation?
A) Unifocal Gleason 3+3 disease with a PSA of 4.5 ng / mL
B) Multifocal Gleason 3+4 disease with a PSA of 5.9 ng / mL
C) Multifocal Gleason 4+4 disease with a PSA of 15.6 ng / mL *
D) Unifocal Gleason 3+4 with a PSA of 12 ng / mL
E) Multifocal Gleason 3+3 with a PSA of 10 ng / mL




49. Which of the following clinical presentations may be related to paraneoplastic syndromes in renal cell cancer?
A) Hypotension
B) Gynecomastia
C) Hepatic dysfunction *
D) Hypokalemia
E) Hypocalcemia

50. A 65-year-old man comes to the physician for a check-up. Which of the following screening methods would allow the highest detection rate for early stage prostatic carcinoma?
A) Cytologic examination of prostatic secretion and PSA. If suspicious biopsy
B) Digital rectal examination alone. If suspicious Multiparametric MRI (MP-MRI)
C) Serum PSA determination alone. If suspicious biopsy
D) Serum PSA and digital rectal examination. If suspicious MP-MRI *
E) Transrectal ultrasonography. If suspicious biopsy

51. A 2-year-old girl is brought to the emergency department with fever, chills, poor appetite, and vomiting. On examination, she is irritable and diaphoretic. Her temperature is 39.2C° (102.5 F), blood pressure is 70/48 mm Hg, pulse is 108/min, and respirations are 17/min. She is tender at the left costovertebral angle.Initial laboratory tests show the following:Leukocyte count        16,300/mm3Hemoglobin                12.5 g/dLPlatelet count             245,000/mm3Blood urea nitrogen   6 mg/dLCreatinine                   0.5 mg/dLUrinalysis is positive for leukocyte esterase and nitrite, with 150 WBC/HPF. After IV antibiotic administration and stabilization, what is the most appropriate diagnostic study in outpatient conditions?
A) CT of the abdomen and pelvis
B) IV pyelography
C) Plain abdominal radiography
D) Radionuclide imaging of the kidneys
E) Voiding cystourethrography *

52. A 10-year-old boy presents to the E.R. with testicular pain of 4 hours duration. The pain was acute onset and woke the patient from sleep. He vomited twice before reaching the E.R. On physical examination he is noted to have a high riding, indurated, and markedly tender left testis. Pain is not diminished by elevation. Urinalysis is unremarkable. Which of the following statements regarding the patient’s diagnosis and treatment is true?
(Case discussion: Urological emergencies and trauma)
(Distinguish the clinical, biochemical and radiological features of spermatic cord torsion) (Recognize the rationale behind timely surgical intervention in spermatic cord torsion
(Learning)
(Tarık Esen, Tufan Tarcan, Yakup Kordan)

A) This is most probably an incarcerated hernia and emergency operation is needed.
B) This is most probably a superinfected hydrocele and needle aspiration is needed.
C) This is acutely thrombosed adolescent varicocele and conservative treatment is needed.
D) This is most probably a testicular torsion and emergency surgery is needed. *
E) This is most probably an episode of acute epididymitis and antibiotics will suffice.

53. Which of the following represents the best candidate for active surveillance in a patient with prostate cancer but normal DRE following a 12 cores biopsy?
(Prostate cancer)
(Understand the concept and (dis)advantages of active surveillance in (very) low risk prostate cancer)
(Learning)
(Tarık Esen, Tufan Tarcan)


A) PSA 5, Gleason 3+3,   2 cores *
B) PSA 14,Gleason 3+4,   4 cores
C) PSA 4, Gleason 4+3,    2 cores
D) PSA 8, Gleason 3+3,    8 cores
E) PSA 10,Gleason 4+4,   one single core

54. Activation of which adrenergic receptor type plays an important role during the storage phase of bladder function due to its muscle relaxant effect on detrusor?
A) Alpha 1a
B) Alpha 2
C) Alpha 1d
D) Beta 1
E) Beta 3 *



55. A 37-year-old non-smoker woman presents with gross hematuria ,urgency and frequency. She reports chronic low-grade fever weight loss for over 1 year. Urinalysis also shows pyuria, but urinary cultures are negative for bacteria. CT-Urography reveals diminished contrast excretion and cavitary lesions in the right kidney. What is the next best diagnostic step?
A) Urine cytology
B) Urine NMP 22
C) Immediate cystoscopy
D) PCR of urine for Tuberculosis *
E) Urine morphology

56. A 62-year-old academician complains of extremely weakened flow, long voiding time, frequency and incomplete emptying for the last 6 months. He had no LUTS prior to that. He had undergone a bilateral knee replacement surgery 8 months ago, which was complicated by a 2 days stay in ICU. Otherwise he is healthy with no regular medications. His father had prostate cancer. His PSA is 0.6 ng / mL. Digital rectal exam shows a 25 g prostate with normal consistency. His uroflowmetry is shown below.What is the patient’s problem and why do you think it has occurred?

A) Urethral stricture - perioperative catheterization *
B) BPH – aging
C) Neurogenic bladder dysfunction - ICU stay
D) Bladder neck contracture-congenital
E) Prostate cancer - family history



57. A spermatocele is actually
A) cyst of the caput epididiymis *
B) cystic dilatation of ductus ejaculatorius
C) cystic dilatation of vesicula seminalis
D) torsion of appendix testis
E) an infected hydrocele

58. In an asymptomatic 32 years-old-female patient, abdominal ultrasound revealed a grade 2 pelvicalyceal ectasia with no visible ureteral pathology, no stones. She has no history of UTI and urine analysis is normal. A CT-Urography is shown below. What is your diagnosis and the next best management step?
(Imaging Modalities in Urology)
(To identify hydronephrosis on imaging studies)
(Learning)
(Tarık Esen, Bengi Gürses)






A) Ureteric stone and IVP (intravenous pyelography)
B) Vesicoureteric reflux and VCUG (voiding cystourethrography)
C) Parapelvic cyst and ultrasound controls
D) UPJ (ureteropelvic junction) obstruction and diuretic renogram *
E) Cystic RCC (renal cell carcinoma) and surgical excision




59. Which of the following studies brougt “Nobel Price in Physiology or Medicine” to its researchers and is still the mainstay of diagnosis and/or treatment in prostate cancer?
A) The surgical anatomy of neurovascular bundle by Walsh
B) The effect of castration on metastatic disease by Huggins and Hodges *
C) Isolation of Prostate Specific Antigen by Wang
D) Docetaxel chemotherapy in metastatic disease by Southwest Oncology Group
E) Dose escalation in radiation treatment for localized disease by Zelefsky
60) Below, you will find a list of drugs that can be used in metastatic RCC as targeted therapy agents. Which of them exerts its effect through the inhibition of mTOR pathway?
(Kidney Cancer)
(Recognize the targeted treatment approaches that are being applied in advanced kidney cancer.)
(Learning)
(Dr. Derya Balbay)


A) Bevacizumab
B) Sunitinib
C) Axitinib
D) Sorafenib
E) Everolimus *