泌尿外科选择题(英语)

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1、Urology-11. An 84 year old man presents to your office complaining of a five day history of passing terminal bright red bloody urine. He reports marked urgency and frequency but is otherwise well and afebrile. In retrospect, he remembersbeing quite ill with an infection in the recent past. Analysis

2、of a voided specimen shows 3 smooth and rounded RBCs/hpf. Which of the following is NOT included in your differential diagnosis?a) benign prostatic hpertrophy (BPH)b) post-streptococcal glomerulonephritisc) a stone lodged at the vesico-ureteric junctiond) a superficial bladder tumoure) a coliform po

3、sitive UTI2. Of the following conditions, which is not considered a urological emergency?a) paraphimosisb) priapismc) orchitisd) testicular torsione) autonomic dysreflexia3. A normal semen analysis includes all of the following EXCEPT:a) pH between 7.5-8.1b) a sperm count 20 million sperm/mlc) WBC 5

4、0%e) 60% normal morphological forms4. A mother brings her toilet-trained, 5 year old daughter to see you with a 3 day history of dysuria, increased frequency, and urgency incontinence. Her past medical history is significant for a bag-specimen positive UTI charaterized by high fever and vomiting at

5、2 years of age. At the time, she was lost to follow up. Which of the following would be appropriate for your initial management of this patient?a) voiding cystourethrogram (VCUG)b) a mid stream urine specimenc) nuclear cystogramd) DMSA renal scane) abdominal ultrasound5. A 55 year old man reluctantl

6、y admits to difficulty in maintaining an erection sufficient for sexual intercourse for the past two years. He reports being healthy, however, he has not seen a physician in 10 years. Which of the following would not suggest a potential cause for his erectile dysfunction?a) elevated blood pressureb)

7、 galactorheac) acanthosis nigracansd) varicocelee) eruptive xanthoma6. A 50 year old man presents with a 2 month history of irritative voiding symptoms and a fever. He initially saw his family doctor who treated him for cystitis with ciprofloxacin for 5 days. He now presents to you because his sympt

8、oms have returned soon after he finished his course of antibiotics. All of the following are likely TRUE except:a) he never had a UTIb) he might have complained of discomfort when riding a bicyclec) he might have also experienced back paind) this patient does not need to be investigatede) he could o

9、f had prostatitis and should have been treated at least 3 weeks7.Which of the following is NOT a common place for impaction of a kidney stone?a) Ureteral pelvic junctionb) Pelvic brimc) Ureteral vesical junctiond) Vesicourethral junction8.Urinary continence in women is maintained by _?a) internal sp

10、hincterb) middle circular layer of the bladder neckc) external sphincterd) lower bladder pressure9.Prostate cancer occurs most commonly in which zone of the prostate?a) central zoneb) urethral zonec) transitional zoned) perioheral zone10.kidney function in a preoperative patient is best measured by_

11、?a) serum blood, urea, nitrogen, and creatinineb) creatinine clearancec) renal ultrasoundd) computed tomography scan11.which of the following studies is NOT useful in evaluating a patient with benign prostatic hypertrophy(BPH)?a) international prostate symptom score questionnaireb) cystoscopyc) pre-

12、void ultrasoundd) pressure-flow study12.transurethral resection syndrome after endoscopic resection of the prostate occurs because of_?a) air embolism during the procedureb) blood loss from postoperative irrigationc) absorption of irrigantd) relaxation of the urethral sphincter from spinal anesthesi

13、a13.which of the following can occur as a paraneoplastic manifestation of renal cell carcinoma?a) hepatic dysfunctionb) hypocalcemiac) thrombocytopeniad) pulmonary edema14.Appropriate treatment for a superficial bladder cancer is_?a) endoscopic resection and fulgurationb) full-thickness resection wi

14、th a 1-cm marginc) full-thickness resection with a 3-com margin(subtotal cystectomy)d) total cysterctomy15.Initial therapy for metastatic prostate cancer is_?a) total prostatectomy(sphincter-preserving)b) radical prostatectomyc) chemotherapyd) bilateral orchiectomy16. which of the following is an ab

15、solute indication for surgical treatment of a renal injury?a) major urinary extravasationb) vascular injuryc) expanding perirenal hematomad) 20% devitalized renal parenchymaAnswers to Q1-161. b 2. c 3. a 4. a 5. d 6. d 7.d 8.c 9.d 10. b 11. c 12.c 13. a 14. a 15.d 16.cUrology-2Questions 1 and 21. A

16、62-year-old African American male attorney presents to a prostate-screening clinic duringNational Awareness Week. On careful questioning, he has noted slight urgency, frequencynocturia, and a decrease in the force of micturition. He is referred to have blood tests toinclude which of the following?(A

17、) Carcinoembryonic antigen (CEA)(B) Prostatic acid phosphatase(C) Alkaline phosphatase(D) Prostate-specific antigen (PSA)(E) Lactic dehydrogenase (LDH)2. General examination from his urologist is noncontributory. Arectal examination reveals hemorrhoids and a left-sided irregular mass in the prostate

18、. Following normal blood tests, heshould have which of the following?(A) Computed tomography (CT) scan of the pelvis(B) Magnetic resonance image (MRI) of the prostate(C) Colonoscopy and biopsy of the prostate under general anesthetic(D) Biopsy of the nodule(E) Bone scan3. A 62-year-old postal office

19、r develops minimal urinary symptoms. His PSA level is elevatedand continues to increase during a 6-month period of observation. The next step in evaluation,if transrectal ultrasound (TRUS) prostate biopsy (Fig. 1) were positive for adenocarcinomaof prostate, would be:(A) Refer to oncologist for chem

20、otherapy(B) Metastatic evaluation including CT and bone scans(C) Repeat PSA and biospy(D) Evaluation by radiation oncologist(E) Start hormonal ablation treatment4. Because of positive biopsy findings and negative workup, he undergoes a radical prostatectomy.The pathology report reveals Gleason score

21、 9/10 and involvement of several pelvic lymph nodes. Which is the most likely site for prostatic cancer metastasis?(A) Liver(B) Kidney(C) Lung(D) Bone(E) Brain5. A 79-year-old man is examined for severe pain in the iliac crest. Metastatic disease from prostaticcancer is confirmed. What is the treatm

22、ent offered initially to most patients with metastatic prostatic cancer?(A) Cortisone and pituitary ablation(B) Radical prostatectomy(C) Luteinizing releasing hormone (LRH) agonist (Leuprolide)(D) Local irradiation and testosterone(E) Hyperthermia6. During her eighth month of pregnancy, a 29-year-ol

23、d woman is noted to have polyhydramnios.Further testing shows anencephalus. Polyhydramnios in this patient is caused by which of the following?(A) Impairment of the fetuss swallowing mechanism(B) Tumor of the fetuss brain(C) A secretory peptide from the placenta(D) Excess antidiuretic hormone (ADH)

24、from the fetus(E) Renal agenesis7. Several weeks after lifting a heavy object, a previously healthy 34-year-old man continuesto complain of heaviness in his left groin. Which of the following statements is true oftesticular cancer?(A) It is the most common solid tumor in men over 50 years of age.(B)

25、 It is not associated with a higher incidence of infertility.(C) It presents as a painless mass in the scrotum in more than 70% of patients.(D) It accounts for 10% of malignant tumors in men.(E) It rarely metastasizes.8. During a workup for infertility, a 34-year-old man is noted to have a solid tum

26、or in the anterioraspect of his right testis. What is the most likely diagnosis?(A) Torsion of the testis(B) Cyst of the epididymis(C) Lipoma of the cord(D) Cancer of the testis(E) Epididymo-orchitis9. Improved survival after lymphadenectomy for testicular tumors occurs after which of the following?

27、(A) Seminoma(B) Embryonal cell carcinoma(C) Leydig cell tumor(D) Sertoli cell tumor(E) Lymphoma10. A 38-year-old woman presents with shortness of breath and abdominal distention. Workupreveals presence of ascites and hydrothorax. What is the name of this condition?(A) Brenner tumor(B) Dysgerminoma(C

28、) Wolffian duct remnant(D) Krukenbergs tumor(E) Meigss syndrome11. A 41-year-old man requests information concerning vasectomy for sterilization. In thisprcedure, which of the following statements is true?(A) The incidence of sexual dysfunction is not influenced in those with dependent personalities

29、.(B) The success rate in reestablishing continuity of the vas deferens is greater than 80% at 10 years.(C) The failure rate occurs in 1/400 patients.(D) Recanalization of the vas deferens does not occur.(E) The procedure is difficult and requires laparotomy.12. A 6-month-old boy was born with hyposp

30、adias. This condition is due to failure in thedevelopment of which of the following?(A) Urogenital fold(B) Mllerian system(C) Genital tubercle(D) Urachus(E) Vitelline duct13. A64-year-old woman notes an ulcer on her left labia majora. Biospy reveals squamous cell carcinoma. What is the treatment?(A)

31、 Wide local excision(B) Radiotherapy(C) Preoperative radiotherapy followed by wide local excision(D) Wide excision and unilateral groin dissection(E) Radical vulvectomy and bilateral groin dissection14. A 6-year-old healthy appearing girl is brought for evaluation of bloody vaginal discharge. Themos

32、t likely diagnosis is:(A) Squamous cell carcinoma(B) Sarcoma botryoides(C) Carcinosarcoma(D) Clear cell adenocarcinoma(E) Lymphoma15. A healthy appearing, 8-year-old boy is evaluated for an abdominal mass, felt by his motherduring a bath. What is the most likely diagnosis?(A) Lymphoma(B) Rhabdomyosc

33、arcoma(C) Wilms tumor(D) Neuroblastoma(E) Renal cell carcinoma16. In repair of a third-degree perineal laceration, which structure shown in Fig. 2 is least likelyto be divided?(A) Bulbocavernosus muscle(B) Vaginal mucosa(C) Superficial transverse perineal lmuscle(D) External anal sphincter(E) Ischio

34、cavernosus muscle17. A 24-year-old man had been treated for gonorrhea 2 months previously. He developed anulcerative lesion in the glands of the penis that is noted to be condylomata lata. The etiology ofcondylomata lata is which of the following?(A) Mixture of organisms(B) Haemophilus ducreyi(C) He

35、rpesvirus hominis, type II(D) Treponema pallidum(E) Neisseria gonorrhoeae18. A 23-year-old woman has a cesarean section in which a Pfannenstiel incision (Fig. 3) is used.In the Pfannenstiel incision, which of the following is TRUE?(A) The recti and fascia are separated transversely.(B) The recti and

36、 fascia are separated vertically.(C) Fascia lata graft is used.(D) A prosthetic graft is used.(E) The upper abdomen can readily be explored.19. What is the most common cause of failure of radiotherapy for stage II cervical carcinoma?(A) Liver metastasis(B) Bone metastasis(C) Para-aortic node metasta

37、sis(D) Resistance of the central tumor(E) Undifferentiated tumor histology20. Twelve years after menopause, a 60-year-old woman undergoes laparotomy for an ovariancarcinoma. The ovarian tumor that is most likely to respond to radiotherapy is which of the following?(A) Dysgerminoma(B) Krukenbergs tum

38、or(C) Arrhenoblastoma(D) Granulosa cell tumor(E) Brenner tumor21. A 24-year-old woman has been unsuccessful becoming pregnant. She is admitted with abdominal pain; her blood pressure is 90/60 mm Hg, her pulse rate is 102 beats per minute (bpm), and her hematocrit (HCT) is 28%. Features of ectopic pr

39、egnancy include which of the following?(A) Elevated blood pressure on assuming an erect position(B) Pulsus paradoxus(C) Tenderness below the right subcostal margin (Murphys sign)(D) Pain referred to the supraclavicular region(E) Ecchymosis around the umbilicus22. After undergoing a partial cystectom

40、y for carcinoma of the rectum, a 76-year-old womandevelops a vesicovaginal fistula. The repair will have a higher chance of success if which of thefollowing occurs?(A) Scare tissue is not excised(B) The bladder wall is closed under tension(C) Repair is performed more than 6 months after the causativ

41、e operation(D) Repair is performed within 714 days of the onset of symptoms(E) Urethral catheters removed within 7 days23. After being treated for ovarian carcinoma, a 65-year-old woman develops complicationsattributed to cisplatin (cis-diamminedichloroplatinum). What is a common side effect ofcispl

42、atin?(A) Multiple lipoma(B) Ankylosing spondylitis(C) Megaloblastic anemia(D) Pulmonary fibrosis(E) Peripheral neuropathy24. A 33-year-old woman is seen for evaluation of infertility. She complains of dyspareunia. Onvaginal examination, tender nodularity along the uterosacral ligaments is noted. Wha

43、t is thediagnosis?(A) Adenomyosis(B) Diethylstilbestrol (DES)-related disease(C) Subserosal fibroids(D) Endometriosis(E) Adrenogenital syndrome25. Following a radical nephrectomy, a 60-year old, diabetic male develops necrotizing fasciitis.After treating the infection, the plastic surgeon places an

44、omental graft, which is based on blood supply from which of the following?(A) Omental branch of the abdominal aorta(B) Middle colic artery(C) Gastroepiploic artery(D) Middle sacral artery(E) Epigastric artery26. An otherwise healthy, 30-year-old man is brought to the emergency department afterbeing

45、thrown off the back of a motorcycle. During the assessment, blood is noted at theurethral meatus. Which of the following statement is TRUE?(A) A foley catheter should be inserted immediately.(B) Dislocation of the sacroiliac joint is usually associated with a fracture of the pubic ramus or separatio

46、n of the symphysis.(C) Open lavage is a useful indication for the need to perform laparotomy.(D) Fracture of the coccyx requires surgical excision in most patients.(E) Pain is relieved on walking.27. A 62-year-old woman with cardiac disease undergoes a pudendal nerve block to remove atumor from the

47、vulva. Fibers forming the pudendal nerve originate from which of thefollowing?(A) L2L4(B) L3L5(C) L4, L5, S1(D) S1S3(E) S2S428. A 42-year-old man has recurrent cystitis. Cystoscopic examination and biopsy confirmthe presence of locally muscle invasive (T2) carcinoma of the bladder (Fig.4)?(A) Repeat

48、 cystoscopic resection(B) Cystoscopic fulguration(C) Partial cystectomy(D) Radical cystoprostatectomy(E) Radiotherapy29. A healthy, 45-year-old woman undergoing abdominal hysterectomy and salpingooophrectomyfor benign disease. The right ureter is accidentally cut. To minimize injury to the ureter, t

49、he surgeon should recognize what about this structure?(A) It enters the pelvis at the level of the aortic bifurcation.(B) It passes posterior to the iliac vessels.(C) It passes above the uterine artery.(D) It enters the pelvis 4-cm medial to the bifurcation of the common iliac artery.(E) It enters the pelvis immediately distal to the common itiac artery bifurcation.30. A 56-year-old woman is admitted to the emergency department complaining of upper