4. Genitourinary tuberculosis

A1-Type (10 questions)

1. Which of the following is the hematuria characteristic of renal tuberculosis?

• A. Mostly terminal hematuria
• B. Most of them are painless gross hematuria
• C. Concurrent with Renal colic
• D. Concurrent with bladder irritation

2. Which of the following is the hematuria characteristic of bladder tuberculosis?

• A. Painless gross hematuria
• B. Terminal hematuria with bladder irritation
• C. Initial hematuria
• D. Pain with hematuria

3. Which of the following is the most common complaint of kidney tuberculosis patients when attending a doctor?

• A. Renal pain and mass
• B. Urinary incontinence
• C. Pyuria
• D. Frequent urination and urinary pain
• E. Hematuria

4. Which of the following is the most common route of infection for renal tuberculosis?

• A. retrograde infection
• B. Hematogenous infection
• C. Direct infection
• D. Lymphatic infection
• E. Contact infection

5. Which of the following is the first site of urinary tuberculosis to be infected and have clinical manifestations?

• A. Ureter
• B. Bladder
• C. Urethra
• D. Unilateral kidney
• E. Bilateral kidney

6. When one side of renal tuberculosis has no function and the contralateral kidney is normal, which of the following treatment methods should be used?

• A. Antituberculous drug therapy
• B. Partial nephrectomy
• C. Bladder enlargement
• D. Nephrectomy of affected side
• E. Nephrostomy

7. Which of the following is the first site of male genital tuberculosis?

• A. Testicles
• B. Prostate
• C. Epididymis
• D. Seminal vesicle
• E. Vas deferens

8. Which of the following is true about urogenital tuberculosis?

• A. The incidence rate of renal tuberculosis is basically the same in men and women.
• B. Renal tuberculosis is mostly caused by blood infection
• C. Male genital tuberculosis first occurs in the testis
• D. Surgery is the main treatment
• E. Hematuria is the main symptom

9. Which treatment should be more suitable for patients with early renal tuberculosis?

• A. Active anti tuberculosis and conservative treatment
• B. Unilateral nephrostomy
• C. Colonic bladder surgery
• D. Cavity drainage
• E. Nephrectomy as soon as possible

10. What is the main infection pathway of urinary tuberculosis?

• A. Ascending infection
• B. Bloody infection
• C. Lymphatic infection
• D. Direct spread infection
• E. Indirect spread infection

A2-Type (17 questions)

1. The patient is a 30-year-old male with no function of left renal tuberculosis, 2 right ureteral stones with a diameter of 1.5cm, hydronephrosis in the right kidney and no uremia. What should be done first?

• A. anti tuberculosis treatment, waiting for stones to be discharged
• B. immediate ureterolithotomy
• C. right ureterolithotomy under anti tuberculosis treatment
• D. drainage of right hydronephrosis
• E. remove the nonfunctional left kidney

2. The patient is a 26 years old male. In the past 4 years, he has frequent urination, urgent urination, painful urination, sometimes turbid urine, with terminal hematuria. General antibiotics are ineffective. Urine examination: 40 ~ 50 pyocyte, red blood cells 20 ~ 30/ HP, protein (+). Right renal tuberculosis was diagnosed and right nephrectomy was performed. In the process of continuing anti tuberculosis after discharge, the most important thing to pay attention to is______

• A. Bed rest
• B. Epididymis resection
• C. regular chest CT
• D. B-ultrasound examination and renal function examination of contralateral kidney shall be performed regularly
• E. Regular tuberculosis examination

3. The patient was 23 years old and had mild swelling and pain in the right scrotum for 4 years. Physical examination: the right epididymal tail touches 1.5cmx1.0cmx1.0cm induration, without tenderness, and the ipsilateral vas deferens is thick and hard. The patient’s most likely diagnosis is_____

• A. Epididymitis
• B. Epididymal tumor
• C. epididymal tuberculosis
• D. Epididymal cyst
• E. Peyronie’s disease

4. The patient is a 25-year-old female with frequent micturition, urgency and pain for more than 1 year. Sometimes the urine is turbid, and the treatment effect of taking a variety of antibiotics is not good. Routine urine examination showed that pH was 5.0, specific gravity was 1.020, red blood cells 30 ~ 40 / HP, white blood cells and pyocyte were full of vision, protein (+ +). The patient’s most likely diagnosis is______

• A. Chronic cystitis
• B. Bladder tumor
• C. Acute cystitis
• D. Urinary tuberculosis
• E. Cystitis glandularis

5. The patient, a 24-year-old male, has a mass in the left scrotum in the past 3 months, which has gradually enlarged, no pain, no fever, punctured and purulent one month ago, and there is no significant improvement in anti infection treatment. The following most likely diagnosis is______

• A. Filariasis in scrotum
• B. Testicular tumors
• C. Acute epididymitis
• D. Acute orchitis
• E. Epididymal tuberculosis

6. The patient, male, 35 years old, is a migrant worker. In February 2000, he began to have frequent urination, urgent urination and urination pain, lower abdominal discomfort, irregular use of norfloxacin, no significant improvement in symptoms, and the frequent urination, urgent urination and urination pain became more and more serious. The most likely diagnosis is

• A. Renal tuberculosis
• B. Chronic prostatitis
• C. Bladder stones
• D. Bladder triangle tumor
• E. Bladder cancer

7. The patient, male, aged 65, has been diagnosed with right renal tuberculosis and bladder tuberculosis. Which of the following medical history and physical examination is wrong as the diagnostic basis of urogenital tuberculosis?

• A. Persistent progressive exacerbation of chronic cystitis
• B. The right kidney is palpable and the surface is uneven
• C. Palpable mass in bladder area
• D. Induration of prostate
• E. Nodular enlargement of epididymis and beaded induration of spermatic cord

8. The patient was a 28 years old male with frequent urination, urgency, pain and hematuria for 2 months. The red and white blood cells in urine were full of vision, and acid fast bacilli were found. IVP and retrograde pyelography showed that the left kidney was normal. There is a cavity with a diameter of 1.5cm on the upper calyce of the right kidney, which communicates with the renal pelvis. It has been treated with streptomycin and isoniazid for 6 months. The symptoms have not improved. Which of the following is an appropriate treatment?

• A. Continue anti tuberculosis treatment and regular review
• B. Right nephrectomy
• C. Right partial nephrectomy
• D. Right renal incision and drainage
• E. Right nephrotic focus removal

9. The patient, a 40 years old male, found swelling of the right scrotum for 2 weeks with no obvious pain. Physical examination: nodular mass of the right epididymis, thickening of the right vas deferens, beaded nodules. Which of the following diseases may the patient have?

• A. varicocele
• B. scrotal filariasis
• C. epididymitis
• D. epididymal tuberculosis
• E. testicular hydrocele

10. The patient was a 32 years old male with intractable bladder irritation. The symptoms were not significantly relieved after antibiotics. There are red and white blood cells in the urine, and the urine culture is negative for 3 times. Which of the following is the most likely diagnosis?

• A. Urinary tuberculosis
• B. Cystitis
• C. Urinary stone
• D. Pyelonephritis
• E. Bladder foreign body

11. The patient was a 31 years old female with frequent micturition, urgency and pain for 6 years. Routine urine examination showed 30 ~ 50 white blood cells / HP and 15 ~ 25 red blood cells / HP. Excretory urography showed scattered small flake high-density shadows in the right kidney, no development in the right kidney, moderate hydronephrosis in the left kidney, and the bladder on the film was the size of a table tennis ball. Which of the following is the most likely diagnosis？

• A. Bilateral renal tuberculosis
• B. Left renal tuberculosis
• C. Tuberculosis of right kidney and bladder
• D. Right renal tuberculosis
• E. Multiple stones in the right kidney + stones in the left ureter

12. The patient was a 36 years old male with frequent and urgent urination; Urination pain for 2 years, sometimes gross hematuria, has been treated in local hospitals, and has not improved. Urine routine pyocyte 20 ~ 30 / HP, red blood cells 10 ~ 20 / HP, which of the following is the most likely diagnosis？

• A. Chronic cystitis
• B. Chronic pyelonephritis
• C. Chronic prostatitis
• D. Chlamydia bladder infection
• E. Urinary tuberculosis

13. A 25-year-old female patient with bladder irritation symptoms for 2 years and 6 months. Routine urine examination showed that there were a large number of red blood cells and white blood cells in urine. Blood biochemical examination found that urea nitrogen and creatinine increased significantly. IVP showed no development of right kidney, severe hydronephrosis of left kidney and poor bladder development. What is the most likely disease for this patient?

• A. Chronic pyelonephritis
• B. Chronic cystitis
• C. Urinary tuberculosis
• D. Kidney stones with hydronephrosis
• E. Interstitial cystitis

14. The patient, a 32 years old male, found a vaginal cyst, swelling and mass for more than 2 months, which has increased in recent 3 months. He has been married for 5 years and has not given birth. Physical examination: irregular induration can be palpated on both epididymal tails and adhered to scrotal skin. The most effective treatment is______

• A. Antibiotic treatment
• B. Strengthen nutrition and bed rest
• C. Physiotherapy
• D. Antituberculous drug treatment
• E. Local hot compress

15. The patient is a 25-year-old female with frequent micturition, urgency and pain for more than 1 year. Sometimes the urine is turbid, and the treatment effect of taking a variety of antibiotics is not good. Routine examination of urine: red blood cell 30 ~ 40 / HP, white blood cell and pyocyte full field of vision. Urine pH 5.0, protein (+), the most likely diagnosis is______

• A. Chronic cystitis
• B. Bladder tumor
• C. Acute cystitis
• D. Urinary tuberculosis
• E. Cystitis glandularis

16. The patient was a 35 years old female with recurrent hematuria and pyuria for more than 3 years. The long-term use of antibiotics had poor efficacy. She had urine culture for 3 times and no bacterial growth was found. The most valuable auxiliary examination for this disease is______

• A. IVP
• B. B-ultrasound
• C. exfoliative cytology
• D. CT
• E. uroflowmetry

17. The patient was a 31 years old male with frequent urination, urgency and pain for more than 1 year. Sometimes the urine was turbid. Taking a variety of antibiotics was ineffective. Urine examination: purulent ball full field of vision, protein (++), the most valuable auxiliary examination for diagnosis is______

• A. cystoscopy
• B.MRI
• C. B-ultrasound of urinary tract
• D. IVP and urinary Mycobacterium tuberculosis examination
• E. radionuclide renogram

A3-Type (10 questions)

• Male, 31 years old, frequent micturition, urgent micturition and painful micturition for more than 1 year. Sometimes the urine is turbid. Taking a variety of antibiotics is ineffective. Urine examination: pyocyte filled the field of vision,Protein (++).

1. The patient was clinically diagnosed as urinary tuberculosis. In order to further clarify the diagnosis, the first choice is

• A. Radionuclide renogram
• B. IVP check
• C. B-ultrasound of urinary tract
• D. renal arteriography

2. What is most likely to occur in this patient on urography？

• A. The development time of renal parenchyma was prolonged during IVP
• B. The cancer body presents large soft tissue shadow or calcification shadow
• C. The renal pelvis has filling defect or part of the renal calyces is dilated
• D. The edge of the kidney is irregular, such as moth like or renal calyceal occlusion and cavity formation
• E. Renal angiogram showed irregular deformation, stenosis and elongation

3. One year after anti tuberculosis treatment, routine urine examination has returned to normal, but the frequency of urination has increased. The most likely reason is

• A. Bladder contracture
• B. Mental frequent micturition
• C. recurrence of urinary tract tuberculosis
• D. complicated with prostatitis
• E. With chronic cystitis

• Female, 24 years old, with a history of frequent micturition, urgent micturition and urinary pain for 3 months, the treatment with a variety of antibiotics did not improve, and there were many red and white blood cells in urine routine. Recently, the patient’s symptoms have worsened, accompanied by urinary incontinence.

4. Which of the following is the most likely diagnosis?

• A. Urinary tuberculosis
• B. glandular cystitis
• C. interstitial cystitis
• D. chronic cystitis
• E. acute cystitis

5. What kind of urinary incontinence does this patient have?

• A. True urinary incontinence
• B. filling urinary incontinence
• C. urgent urinary incontinence
• D. stress urinary incontinence
• E. mental urinary incontinence

6. Which of the following tests is not meaningful for diagnosis?

• A. CT
• B. IVP
• C. Cystoscopy
• D. Renal radionuclide scanning
• E.MRI

7. Which of the urine test items is not meaningful for diagnosis?

• A. Specific gravity of urine
• B. Urine pH test
• C. PCR detection of tuberculosis in urine
• D. Urine microscopy

–

• Male, 40 years old, frequent and urgent urination for more than 1 month. Routine urine examination: WBC 30-50/HP, RBC 10-20/HP, trace urinary protein. B-ultrasound showed mild hydronephrosis in the right kidney and no development in the ureter. Cystoscopy: extensive chronic inflammatory changes of bladder mucosa with multiple ulceration, especially near the right ureteral orifice.

8. The most likely manifestation of this patient on retrograde urography is

• A. Right whole kidney calcification
• B. The right renal calyce is occluded and forms a cavity.
• C. spot calcification shadow in the right kidney.
• D. irregular expansion of the right renal calyce and Meng
• E. The edge of the right renal calyces is irregular, such as insect erosion

9. The preferred treatment is

• A. Broad spectrum antibiotic therapy
• B. Combination therapy of anti tuberculosis drugs and interferon
• C. After 2 weeks of anti tuberculosis treatment, the affected side of the kidney was removed
• D. After 2 weeks of antituberculous treatment, the lesion of the affected side of the kidney was removed
• E. Combined with anti tuberculosis drugs for more than half a year before deciding on further treatment

10. After the above treatment, the symptoms disappeared and the routine urine examination was basically normal, but there was left hydronephrosis after 3 years. The impossible reason is

• A. Decreased bladder volume
• B. Increased pressure in the bladder
• C. Left ureteral orifice stenosis
• D. Reflux of bladder urine to left ureter
• E. scar stenosis of bladder neck

A4-Type (5 questions)

• Male, 26 years old, frequent micturition, urgent micturition, painful micturition with intermittent terminal hematuria for 2 years, sometimes urine turbidity, general antibiotic treatment is ineffective. Urine examination: 40 ~ 50 pyocytes /HP, 20 ~ 30 red blood cells / HP, protein (+).

1. In the process of continuing anti tuberculosis treatment after discharge, Which of the following is the most appropriate treatment?

• A. Bed rest
• B.B-ultrasound and renal function examination of contralateral kidney were performed regularly
• C. Epididymal tuberculosis resection
• D. regular chest X-ray fluoroscopy
• E. regular urine tuberculosis examination

2. In the process of anti tuberculosis treatment after nephrectomy, if the urine tuberculosis bacteria are negative for many times, the patient’s urine frequency is significantly worse than that before operation, and the urine volume is only tens of milliliters each time.The most likely cause of urine frequency is

• A. tuberculosis relapse
• B. coli infection
• C. mycoplasma infection
• D. mental factors
• E. Bladder contracture

3. During the postoperative follow-up, B-ultrasound and intravenous urography showed contralateral hydronephrosis, significant expansion of the full length of the ureter, bladder capacity of about 50ml, accompanied by urethral stricture, negative urinary tuberculosis culture, renal function examination: urea nitrogen 10.5mmol/L, creatinine 162mmol/L. at this time, the most suitable treatment is

• A. continue anti tuberculosis treatment

• B. Bladder augmentation

• C. Ureterostomy

• D. Nephrostomy

• E. Cystostomy

• A 32 years old female patient had repeated frequent urination, urgency and pain for 4 years. Urine examination showed a large number of red blood cells and white blood cells. IVP showed that there was a destructive focus in the lower calyce of the left kidney, forming a whole cavity.

4. The possible diagnosis is

• A. Hydronephrosis
• B. Renal cell carcinoma
• C. Nephroblastoma
• D. Renal tuberculosis
• E. Kidney Meng nephritis

5. Which of the following is the most appropriate treatment？

• A. nephrectomy
• B. Nephrostomy
• C. Partial nephrectomy
• D. anti tuberculosis treatment
• E. Immunotherapy

B1 5

• A. Mycobacterium tuberculosis can be found in urine, and only a small amount of leukocytes can be found
• B. Mycobacterium tuberculosis can be found in urine. Urine is acidic and has bladder irritation symptoms
• C. secondary to pulmonary tuberculosis
• D. symptoms of systemic tuberculosis

1. Renal cortical tuberculosis is characterized by

2. Clinical renal tuberculosis is characterized by

• A. nausea, edema, anemia, oliguria
• B. urgent urinary incontinence
• C. fever, night sweat, weight loss and poor appetite
• D. Autonephrectomy

3. The characteristic manifestation of ureteral tuberculosis is

4. The late manifestation of bladder contracture is

5. The main manifestation of bilateral renal tuberculosis

Answer

A1-Type

ABDBD DCBAB

A2-Type

CDCDE ACBDA CACDD AD

A3-Type

BDAAC DAECC

A4-Type

BECDD

B1-Type

ABDBA