CHAPTER 1: APPLIED ANATOMY OF THE GENITOURINARY TRACT
1. Which of the following structures is not typically encountered in the course of renal surgery
through a flank incision?
A. Internal obliquemuscle
B. Transversalis fascia
C. Rectusmuscle
D. Thoracolumbar fascia
E. Transversus abdominis
F. Obturator Internus
2. Regarding Gerota’s fascia, which of the following are true?
A. It is part of the inner stratumof
retroperitoneal tissue
B. Inferiorly there is an open potential space
C. Perinephric fat is outside of it
D. It is continuous with Colle’s fascia
E. Both A. and C.
F. None of the above
3. Which of the following is not typically a site of normal ureteral narrowing (where stones get
caught)?
A. UPJ
B. Iliac vessels
C. Pelvic ureter
D. UVJ
E. L4 level
F. Entrance to detrusor
4. Normal voiding is dependent on all of the following nerves except?
A. Pelvic
B. Hypogastric
C. Obturator
D. Pudendal
5. Which of the following is true about the prostate?
A.Most prostate cancer is fromthe transition
zone
B.Most normal volume is in the peripheral
zone
C. The central zone is primarily distal to the
verumontanum
D. The primary blood supply is fromthe
superior vesical artery
E. The average prostate volume in a young
male is 50cc.
F. It has only sympathetic innervation
6. The adrenal glands receive blood supply from all of the following except?
,A. Superior phrenic artery
B. Inferior phrenic artery
C. Adirect branch fromthe aorta
D. Abranch off of the renal artery
7. If one needs to ligate the hypogastric arteries for severe pelvic bleeding it should be done distal to
which area?
A. Posterior division
B. Umbilical artery
C. Inferior vesical artery
D. Obturator artery
E. Internal pudendal artery
F. Superior vesical artery
8. Which of the following nerves would one suspect was damaged if a patient lost the ability to adduct
the thighs after pelvic surgery?
A. Ilioinguinal
B. Femoral
C. Obturator
D. Sciatic
E. Genitofemoral
F. Internal pudenal
9. Which of the following structures do not make up part of Hesselbach’s triangle?
A. Inferior epigastric vessels
B. Lateralmargin of the rectusmuscle
C. Pectinealmuscle
D. Inguinal ligament
10. In women the ureter is in close proximity to and can be damaged during gynecologic surgery on
which of the following structures?
A. Ovary
B. Uterine artery
C. Cervix
D. Vaginal wall
E. All of the above
Answers
1. C.
The typical flank incision does not travel anteromedially to the border of the rectus. All other structures
noted are traversed.
2. B.
It is part of the intermediate stratumand the perinephric fat is within it. B. is correct.
3. C.
Ureteral caliber is typically narrowest at the UPJ, over the iliacs and at the UVJ. There is no particular
narrow point per se of the pelvic portion of the ureter or at the other sites.
4. C.
Obturator nerves allow for thigh adduction. Pelvic and hypogastric nerves carry the autonomic supply to
the bladder and innervation to the external sphincter is via the pudendal.
,5. B.
A., C. and D. are false—most cancer is in the peripheral zone, the central zone is proximal to the veru
and the primary blood supply is from the inferior vesical artery.
6. A.
The adrenal has a tripartite blood supply and receives blood fromall the options listed except the
superior phrenic artery.
7. A.
The posterior division includes the gluteal artery which supplies the gluteus. Ligating proximal to
this pointmay lead to pain in the buttocks.
8. C.
The obturator nerve is responsible for thigh adduction.
9. C.
Hesselbach’s triangle is borderedmedially by the rectusmuscle, laterally by the inferior epigastrics
and inferiorly by the inguinal ligament.
10. E.
All of these structures can be damaged during gynecological surgery.
CHAPTER 2: PEDIATRIC UROLOGY
1. On prenatal US during the third trimester, what are the AP diameter criteria used to
classifymoderate hydronephrosis?
A. <7mm
B. 7- <9mm
C. 10-15mm
D. 15-20mm
E. >20mm
2. What is the reported incidence of vesicoureteral reflux in children with prenatal
diagnosed hydronephrosis?
A. 50-70%
B. 40-60%
C. 5-20%
D. <5%
E. 1-2%
3. What is themost appropriate antibiotic used for prophylaxis in a newborn with prenatal
hydronephrosis?
A. Amoxicillin
B. Suprax
C. Bactrim
D. Nitrofuratoin
E. Ciprofloxacin
4. What ismost common abnormality in renal function associated with posterior urethral
valves?
A. Urine Concentration defect
B. Increased active sodiumabsorption
fromthe descending limb of the loop of
Henle
, C.Decreased calciumabsorption from
ascending limb of the loop of Henle
D. The presence of heavy proteinuria
E. None of the above
5. Which of the following is the most important in the treatment of VUR?
A. Age of the patients
B. Grade of reflux
C. Laterality
D. Breakthrough infection
E. All of the above
6. At the 30 weeks’gestation, bilateral hydroureteronephrosis, bladder distension
and oligohydramnios were detected. Which of the following ismore likely cause
of this condition?
A. Ureteropelvic junction obstruction
B. Ureterocele
C. Vesico-ureteral Reflux
D. Posterior urethral valve
E. Ectopic ureter
7. 38-week-gestation newborn with posterior urethral valves has a serumcreatinine of 1.6mg/dl. That
level:
A. Is an ominous predictor of future renal function
B.Will decrease with completion of nephrogenesis
C. Initially falls with a rapid rise in GFR
D.Will result in increased active sodium absorption fromthe descending limb of the loop of Henle.
E. Is not reflective of the degree of renal function impairment
Answers:
1. C.
2. C.
3. A.
4. A.
5. E.
6. D.
7. E. The creatinine in a newborn is reflective ofmaternal renal function and is not representative of the
degree of renal impairment or lack thereof due to the obstruction.
CHAPTER 3: PEDIATRIC UROLOGICAL ONCOLOGY
1. Wilms’tumor prognosis is primarily dictated by
A. Stage
B. Patient age
C. Resectability
D. Familial variant
E. Histology
2. A3 year old female undergoes right nephrectomy forWilms’tumor. The histology is described as
favorable and the tumor is surrounded by intralobar nephrogenic rests. This suggests
A. Incomplete resection
1. Which of the following structures is not typically encountered in the course of renal surgery
through a flank incision?
A. Internal obliquemuscle
B. Transversalis fascia
C. Rectusmuscle
D. Thoracolumbar fascia
E. Transversus abdominis
F. Obturator Internus
2. Regarding Gerota’s fascia, which of the following are true?
A. It is part of the inner stratumof
retroperitoneal tissue
B. Inferiorly there is an open potential space
C. Perinephric fat is outside of it
D. It is continuous with Colle’s fascia
E. Both A. and C.
F. None of the above
3. Which of the following is not typically a site of normal ureteral narrowing (where stones get
caught)?
A. UPJ
B. Iliac vessels
C. Pelvic ureter
D. UVJ
E. L4 level
F. Entrance to detrusor
4. Normal voiding is dependent on all of the following nerves except?
A. Pelvic
B. Hypogastric
C. Obturator
D. Pudendal
5. Which of the following is true about the prostate?
A.Most prostate cancer is fromthe transition
zone
B.Most normal volume is in the peripheral
zone
C. The central zone is primarily distal to the
verumontanum
D. The primary blood supply is fromthe
superior vesical artery
E. The average prostate volume in a young
male is 50cc.
F. It has only sympathetic innervation
6. The adrenal glands receive blood supply from all of the following except?
,A. Superior phrenic artery
B. Inferior phrenic artery
C. Adirect branch fromthe aorta
D. Abranch off of the renal artery
7. If one needs to ligate the hypogastric arteries for severe pelvic bleeding it should be done distal to
which area?
A. Posterior division
B. Umbilical artery
C. Inferior vesical artery
D. Obturator artery
E. Internal pudendal artery
F. Superior vesical artery
8. Which of the following nerves would one suspect was damaged if a patient lost the ability to adduct
the thighs after pelvic surgery?
A. Ilioinguinal
B. Femoral
C. Obturator
D. Sciatic
E. Genitofemoral
F. Internal pudenal
9. Which of the following structures do not make up part of Hesselbach’s triangle?
A. Inferior epigastric vessels
B. Lateralmargin of the rectusmuscle
C. Pectinealmuscle
D. Inguinal ligament
10. In women the ureter is in close proximity to and can be damaged during gynecologic surgery on
which of the following structures?
A. Ovary
B. Uterine artery
C. Cervix
D. Vaginal wall
E. All of the above
Answers
1. C.
The typical flank incision does not travel anteromedially to the border of the rectus. All other structures
noted are traversed.
2. B.
It is part of the intermediate stratumand the perinephric fat is within it. B. is correct.
3. C.
Ureteral caliber is typically narrowest at the UPJ, over the iliacs and at the UVJ. There is no particular
narrow point per se of the pelvic portion of the ureter or at the other sites.
4. C.
Obturator nerves allow for thigh adduction. Pelvic and hypogastric nerves carry the autonomic supply to
the bladder and innervation to the external sphincter is via the pudendal.
,5. B.
A., C. and D. are false—most cancer is in the peripheral zone, the central zone is proximal to the veru
and the primary blood supply is from the inferior vesical artery.
6. A.
The adrenal has a tripartite blood supply and receives blood fromall the options listed except the
superior phrenic artery.
7. A.
The posterior division includes the gluteal artery which supplies the gluteus. Ligating proximal to
this pointmay lead to pain in the buttocks.
8. C.
The obturator nerve is responsible for thigh adduction.
9. C.
Hesselbach’s triangle is borderedmedially by the rectusmuscle, laterally by the inferior epigastrics
and inferiorly by the inguinal ligament.
10. E.
All of these structures can be damaged during gynecological surgery.
CHAPTER 2: PEDIATRIC UROLOGY
1. On prenatal US during the third trimester, what are the AP diameter criteria used to
classifymoderate hydronephrosis?
A. <7mm
B. 7- <9mm
C. 10-15mm
D. 15-20mm
E. >20mm
2. What is the reported incidence of vesicoureteral reflux in children with prenatal
diagnosed hydronephrosis?
A. 50-70%
B. 40-60%
C. 5-20%
D. <5%
E. 1-2%
3. What is themost appropriate antibiotic used for prophylaxis in a newborn with prenatal
hydronephrosis?
A. Amoxicillin
B. Suprax
C. Bactrim
D. Nitrofuratoin
E. Ciprofloxacin
4. What ismost common abnormality in renal function associated with posterior urethral
valves?
A. Urine Concentration defect
B. Increased active sodiumabsorption
fromthe descending limb of the loop of
Henle
, C.Decreased calciumabsorption from
ascending limb of the loop of Henle
D. The presence of heavy proteinuria
E. None of the above
5. Which of the following is the most important in the treatment of VUR?
A. Age of the patients
B. Grade of reflux
C. Laterality
D. Breakthrough infection
E. All of the above
6. At the 30 weeks’gestation, bilateral hydroureteronephrosis, bladder distension
and oligohydramnios were detected. Which of the following ismore likely cause
of this condition?
A. Ureteropelvic junction obstruction
B. Ureterocele
C. Vesico-ureteral Reflux
D. Posterior urethral valve
E. Ectopic ureter
7. 38-week-gestation newborn with posterior urethral valves has a serumcreatinine of 1.6mg/dl. That
level:
A. Is an ominous predictor of future renal function
B.Will decrease with completion of nephrogenesis
C. Initially falls with a rapid rise in GFR
D.Will result in increased active sodium absorption fromthe descending limb of the loop of Henle.
E. Is not reflective of the degree of renal function impairment
Answers:
1. C.
2. C.
3. A.
4. A.
5. E.
6. D.
7. E. The creatinine in a newborn is reflective ofmaternal renal function and is not representative of the
degree of renal impairment or lack thereof due to the obstruction.
CHAPTER 3: PEDIATRIC UROLOGICAL ONCOLOGY
1. Wilms’tumor prognosis is primarily dictated by
A. Stage
B. Patient age
C. Resectability
D. Familial variant
E. Histology
2. A3 year old female undergoes right nephrectomy forWilms’tumor. The histology is described as
favorable and the tumor is surrounded by intralobar nephrogenic rests. This suggests
A. Incomplete resection
