2. Injury of Urinary System

A1-Type (20 qustions)

1. Which of the following is the most reliable way to diagnose the type of bladder rupture？

• A. Abdominal CT
• B. Metal probe
• C. Subpubic bladder puncture
• D. Cystography

2. Which of the following is not the clinical manifestation after bladder rupture?

• A. Massive chyluria
• B. Abdominal pain
• C. Shock
• D. Dysuria, hematuria

3. The causes of ureteral injury do not include ________

• A. Urethrography
• B. Intraluminal instrument operation
• C. Radiation therapy
• D. Violent trauma

4. What is the main clinical manifestation of severe kidney injury?

• A. Shock
• B. Hematuria
• C. Pain
• D. Mass
• E. Fever

5.which organ is the most common injured genitourinary organs in closed injuries?

• A. Kidney
• B. Bladder
• C. Urethra
• D. Prostate
• E. Testicle

6. What is the most common site of male urinary system injury?

• A. Kidney injury
• B. Ureteral injury
• C. Bladder injury
• D. Urethral injury
• E. Penile injury

7. Which is the most common route of urinary tract infection in women?

• A. Descending infection
• B. Ascending infection
• C. Direct infection
• D. Hematogenous infection
• E. Lymphatic infection

8. Which of the following is the mildest type of kidney injury?

• A. Renal Contusion
• B. Total renal laceration
• C. Partial renal laceration <1cm
• D. Partial renal laceration >1cm
• E. Renal hilar Injury

9. Which of the following symptoms can be used to distinguish between intraperitoneal bladder rupture and extraperitoneal bladder rupture?

• A. Shock
• B. Difficulty urinating and hematuria
• C. Pain
• D. Urinary fistula
• E. Local symptoms

10. Where is the anterior urethral injury mainly located?

• A. Penile urethra
• B. Membranous urethra
• C. Bulbar urethra
• D. Prostatic urethra
• E. General urethra

11. What is the main causes of posterior urethral injury?

• A. Iatrogenic injury
• B. Violent sex
• C. Direct violence in the perineum
• D. straddle injury
• E. Pelvic fracture

12. Which of the following is NOT a urinary tract injury?

• A. Kidney injury
• B. Ureteral injury
• C. Testicular injury
• D. Urethral injury
• E. Bladder injury

13. Which of the following is the most severe type of kidney injury?

• A.Renal Contusion
• B. Total renal laceration
• C. Partial renal laceration <1cm
• D. Partial renal laceration >1cm
• E. Renal hilar Injury

14. What is the most common cause of ureter injury?

• A. Spontaneous rupture
• B. Pelvic fracture
• C. Direct violence injury
• D. Latrogenic injury
• E. Open injury

15. Which of the following is NOT an indication for surgical exploration of kidney injury?

• A. No improvement in active anti-shock therapy
• B. Progressive increase in hematuria
• C. Progressive increase in abdominal mass
• D. Suspected abdominal organ injuries
• E. Obvious pain in waist and abdomen

16. What is the most common cause of bladder injury?

• A. Spontaneous rupture
• B. Pelvic fracture
• C. Direct violence injury
• D. Latrogenic injury
• E. Open injury

17. Where is the posterior urethral injury mainly located?

• A. Penile urethra
• B. Membranous urethra
• C. Bulbar urethra
• D. Prostatic urethra
• E. General urethra

18. What is the main causes of anterior urethral injury?

• A. Iatrogenic injury
• B. Violent sex
• C. Direct violence in the perineum
• D. Straddle injury
• E. Pelvic fracture

19. Which of the following is not a clinical manifestation of kidney injury?

• A．Shock
• B．Abdominal mass
• C．Hematuria
• D．Fever
• E. Pusuria

20. What is the most common treatment for closed renal injury

• A．Surgery
• B．Drainage
• C．Temporary conservative treatment and close observation
• D．Nephrectomy
• E. Renal repair

A2-Type (14 qustions)

1. The patient, a 25-year-old male, had dysuria and urethral orifice bleeding 3 days after riding injury. Physical examination: fever, obvious swelling of scrotum and cyanosis. The correct treatment is ________

• A. Immediate urethral repair
• B. Immediately catheterize with a metal catheter
• C. Urethral reunion operation
• D. Suprapubic cystostomy and drainage of extravasated urine
• E. Subpubic bladder puncture

2. An athlete has sudden left lumbar colic and hematuria during running. What is his possible disease？

• A. Urethral stone
• B. Ureter stone
• C. Bladder stone
• D. Sprain of left waist
• E. Left ureteral injury

3. The patient, a 45 years old male, was hospitalized with hematuria after being injured in his right waist. It is diagnosed as closed renal injury. In order to further understand the degree of injury and observe the patient’s general condition, which of the following judgment values is the least?

• A. According to the severity of hematuria
• B. Changes in blood pressure and pulse
• C. Hemoglobin and hematocrit
• D. The patient has fever, and the body temperature reaches 38.5℃
• E. Abdominal palpation to understand the expansion of perirenal hematoma

4. The patient was a 36 years old male who was kicked in the lower abdomen and felt severe pain in the lower abdomen, abdominal distension and obvious tenderness. He was initially diagnosed as closed bladder rupture.Which of the following checks is not normally used？

• A. Abdominal plain film
• B. Catheterization and bladder leak test
• C. B-ultrasound examination of bladder
• D. Cystography
• E. Cystoscopy

5. The patient, male, 20 years old, fell from a height of 6m 3 hours ago. Low back pain, hematuria, . Blood pressure: 10 / 6kpa (75 / 45mmHg), pulse: 120 times / min, left lumbar skin abrasion, local slight bulge, positive tenderness, palpable mass in the right upper abdomen, mild muscle tension. B-ultrasound: there is a 3. 0cm×3. 0cm×2. 0cm dark area around the left kidney, the liver and spleen capsule are complete, and the abdominal puncture is negative. The most important treatment should be ________

• A. Antibiotic application
• B. Hemostatic application
• C. Analgesic application
• D. Transfusion and rehydration
• E. Immediate surgical exploration

6. The patient was injured in the waist with obvious gross hematuria, tenderness in the waist on the injured side, no muscle tension, no mass, normal pulse and blood pressure. The most likely diagnosis is______

• A. Partial renal laceration leading to the renal capsule
• B. Renal contusion
• C. Renal pedicle injury
• D. Partial renal laceration leading to the renal pelvis
• E. Full thickness renal laceration

7. The patient was a 30-year-old male with perineal crush injury for 3 hours. He collided with people on a bicycle 3 hours ago.he was unable to urinate.Blood dripping from the urethral orifice, perineal hematoma such as table tennis, normal blood pressure and pulse; Urethrography showed complete urethral bulbar rupture. At this time, the best treatment for admission is______

• A. Try indwelling catheter for continuous drainage
• B. Suprapubic cystostomy
• C. Transperineal, urethral end-to-end anastomosis
• D. Suprapubic cystostomy
• E. Urethral realignment reduction and hematoma drainage

8. An 18-year-old male patient with urethral injury caused by traumatic pelvic fracture was unable to urinate on his own. Physical examination: the general condition is good. The prostate can’t be touched when it moves up. What’s the best treatment for this patient?

• A. Urethral intubation and drainage
• B. Suprapubic bladder leakage
• C. Urethral realignment
• D. Urethral anastomosis
• E. Suprapubic aspiration

9. A 30-year-old female patient was treated 1 hour after the impact on her left waist. Physical examination: BP: 120/70 mmHg, Hb: 110 g/L, no muscle tension and tenderness in the abdomen, the left abdomen touches the mass, the range is limited, and there is no mobile voiced sound.The most likely diagnosis is ______

• A. Contralateral hydronephrosis
• B. Liver rupture
• C. Gastric perforation
• D. Hydronephrosis after renal trauma
• E. Renal trauma, extravasation of renal blood and urine

10. The patient, a 24-year-old male, was unable to urinate because of the car squeezed the lower abdomen. Physical examination: blood pressure 110/75 mmHg, heart rate 78 beats/min. The X-ray film showed that the pubic branch was fractured and the urinary catheter could not be inserted into the bladder. What is the cause of urethral rupture？

• A. The bladder was not emptied at the time of injury
• B. Increased abdominal pressure
• C. Penile hyperemia and high urethral tension
• D. Pelvic fracture tearing membrane urethra
• E. Hematoma extrusion and traction

11. The patient, a 30-year-old male, came to see a doctor urgently because of urethral dripping blood after the perineum rode over a hard object. Physical examination showed that the perineum was swollen. Which of the following is the most appropriate measure?

• A. Cystostomy
• B. Analgesia
• C. Incision and drainage of perineum
• D. Urethrography
• E. Trial catheterization

12. The patient was a 26 years old male with open perineal laceration, perineal hematoma, urinary extravasation and blood outflow from the external orifice of the urethra. The first best treatment is ________

• A. Debridement, incision and drainage
• B. Suprapubic cystostomy
• C. Indwelling catheter
• D. Debridement urethroplasty
• E. Infusion, anti infection

13. The patient was a 26 years old male with open perineal laceration, perineal hematoma, urinary extravasation and blood outflow from the external orifice of the urethra. The most common complication after repair of urethral injury is______

• A. Urethral perineal fistula
• B. Prostatitis
• C. Wound infection
• D. Urethral stricture
• E. Urethrorectal fistula

14. The patient, a 32 years old male, was hospitalized because he was unable to urinate on his own after falling from a high place. Physical examination: the abdomen is soft without tenderness, the round mass can be touched 3cm below the umbilicus, the percussion is voiced, and the pelvic film shows the fracture of the upper and lower limbs of the right pubis. The catheter can be inserted for 20cm, flowing out bright red blood liquid, and no urine is found. Which of the following injuries should be diagnosed?

• A. Posterior urethral contusion
• B. Extraperitoneal bladder rupture
• C. Bulbar urethral rupture
• D. Intraperitoneal bladder rupture
• E. Posterior urethral rupture

A3-Type (20 qustions)

• The patient, a 21-year-old male, continued to overflow light red liquid after being stabbed at the left waist. Physical examination: blood pressure 12 / 9.3kpa (90 / 70mmhg), pulse 120 times / min, tenderness in the left upper abdomen, no muscle tension and rebound pain.

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

• A. Kidney injury
• B. Gastric perforation
• C. Splenic rupture
• D. Intestinal rupture
• E. Pancreatic injury

2. What else should be done to clarify the diagnosis?

• A. Barium meal radiography
• B. Excretory urography
• C. Abdominal puncture
• D. Barium enema
• E. Determination of amylase in wound overflow

3. The principle of treatment should be

• A. Immediate surgical exploration
• B. Non-surgical treatment
• C. Surgical exploration in case of gross hematuria
• D. Surgical exploration in case of shock again
• E. Surgical exploration in case of peritonitis

• Male, 35, a construction worker on the construction site, was hospitalized with pelvic crush injury before work. Physical examination: Bp 90/50mmhg, P 120 times/min, pale complexion.White, tenderness in the lower abdomen. Hb11 g/dl.X-ray showed linear fracture of iliac bone. After rehydration treatment, the vital signs were stable, but there was still no urine, and the indwelling catheter was only used 50ml urine flowed out at night, light red. Abdominal distension, positive shifting dullness.

4. What kind of visceral injury is more likely in the following example?

• A. Renal injury
• B. Bladder injury
• C. Urethral injury
• D. Rectal injury
• E. Ureteral injury

5. Which check should I do first?

• A. CT
• B. B-ultrasound
• C. Cystography
• D. Urethrography
• E. Celiac Arteriography

6. Which of the following is the correct choice for treatment?

• A. Urethral repair
• B. Treatment of ascites by abdominal puncture and aspiration
• C. Suprapubic cystostomy
• D. Laparotomy for bladder repair
• E. Continue clinical observation

• Male: 39 years old, drunk, fell 1 hour ago, abdominal pain, gross hematuria. Physical examination: bp100/60mmHg, P 100 times/min, pale face, extensive tenderness in the lower abdomen, muscle tension and rebound pain. B-ultrasound showed normal liver and spleen with a small amount of ascites. There is light red liquid on the abdomen. Smooth indwelling of urinary catheter, a small amount of bloody urine outflow, light color. Hb120g/L.

7. What kind of visceral injury is more likely in this patient?

• A. Renal injury
• B. Bladder injury
• C. ureteral injury
• D. rectal injury
• E. urethral injury

8. Which of the following tests is the first choice for the diagnosis of urinary system injury?

• A. Celiac Arteriography
• B. B-ultrasound
• C. CT
• D. Contrast radiography
• E. Urethrography

• Male, 34 years old, unable to urinate due to riding injury of perineum. He developed fever after 3 days of suprapubic cystostomy in a grass-roots hospital, with a body temperature of 38.5. Come to see a doctor. Physical examination: blood pressure 110/75 mmHg, heart rate 78 beats/min, obvious swelling of perineum and scrotum, dark red skin and obvious local tenderness.

9. Which of the following treatment options is correct

• A. Try indwelling catheter again while antibiotic treatment
• B. Rethral realignment was performed simultaneously with antibiotic treatment
• C. Transperineal urethroplasty was performed at the same time as antibiotic treatment
• D. Perineal incision and drainage was performed at the same time as antibiotic treatment
• E. The changes of the condition were closely observed

10. What check should not be done at this time

• A. Blood bacterial culture
• B. Urine bacterial culture
• C. Urethrography to understand the injury
• D. B-ultrasound examination of perineum
• E. X-ray plain film of pelvis

• A 34 years old male was injured in the lower abdomen by a wall fall. Physical examination: blood pressure 110 / 75mmhg, heart rate 78 beats / min, slight tenderness in the lower abdomen, a small amount of bloody urine in catheterization, urine volume only 120ml after 4 hours, light red. The patient’s lower abdominal pain was aggravated, extended to the whole abdomen, and the mobile voiced sound was positive.

11. The patient’s more likely diagnosis is

• A. Urethral bulbar injury
• B. Urethral membrane injury
• C. Bladder injury
• D. Ureteral injury
• E. Prostate injury

12. Which of the following is a simple and effective examination method for clear diagnosis？

• A. Abdominal plain film
• B. Diuretic test
• C. Cystoscopy
• D. Intravenous nephrography
• E. Bladder water injection test

13. The preferred treatment for this patient is

• A. Emergency surgical exploration
• B. Suprapubic cystostomy
• c. Drug control of bleeding and infection
• D. Indwelling catheterization, anti infection treatment
• E. Surgical treatment was performed after comprehensive urinary examination

• Female, 55 years old. After urinating in the morning, she wiped it with paper and saw that it was full of blood. The chief complaint was that he felt waist pain after massage in the health salon. Examination: normal blood routine. B-ultrasound showed that the renal enlargement and renal rupture were consistent with CT diagnosis.

14. Which of the following is the most likely cause of bleeding?

• A. Renal cyst
• B. Polycystic kidney
• C. Renal cell carcinoma
• D. Hydronephrosis
• E. Renal hamartoma

15. In order to make a definite diagnosis, which examination should be carried out

• A. Urography
• B. Puncture biopsy
• C. MRI
• D. Renal arteriography
• E. KUB

16. The preferred treatment is _____

• A. Hematoma removal
• B. Partial nephrectomy
• C. Nephrectomy
• D. Interventional therapy
• E. Observe

• Male, 35 years old. 2 hours ago, he fell from a height of 3 meters. His right waist hit a hard object. He immediately felt severe pain in the waist, and then he had gross hematuria. Physical examination: P 120 / min, BP 80 / 50mmhg, right waist extravasated blood, obvious tenderness, blood HB 86g / L. B-ultrasound showed enlargement of right renal shadow.

17. The pathological type of right kidney injury is _______

• A. Laceration of renal pelvis
• B. Renal laceration
• C. Renal contusion
• D. Renal pedicle injury
• E. Renal subcapsular hematoma

18. The correct treatment is ______

• A. Infusion and blood transfusion to stabilize blood pressure
• B. Continue to observe blood pressure and pulse
• C. Bed rest
• D. Anti inflammatory treatment
• E. Anti shock therapy + surgical exploration

• Male, 50 years old. Two hours after the traffic accident, he was admitted to the emergency hospital. After rescue, his vital signs were stable and his mind was clear. Now he has lower abdominal pain and can’t urinate for 4 hours. Physical examination: the percussion of the lower abdomen is voiced, the digital rectal examination can touch the front of the rectum, the front of the rectum is full.X-ray showed pelvic fracture (fracture of inferior pubic branch).

19. The most likely diagnosis is

• A. Renal injury
• B. Anterior urethral injury
• C. Urethral injury
• D. Posterior urethral injury
• E. Bladder rupture

20. The most important inspection to be supplemented in the later stage is

• A. B-ultrasound
• B. Urethrography
• C. CT
• D. Cystography
• E. Intravenous urography

A4-Type (10 qustions)

• Male, 22 years old, fell and rode on the cross bar, with swelling and pain in the perineum, ecchymosis and hematoma, bleeding at the urethral orifice, unable to urinate. The No. 14 urinary catheter can be inserted into the bladder to lead out clear urine

1. The best treatment is _______

• A.Incision and drainage of perineum
• B. urethra realignment with traction
• C. retention of urinary catheter for more than two weeks
• D. Perineal incision and urethral repair
• E. Pull out the catheter and treat with antibiotics

2. If the urinary catheter cannot be inserted into the bladder, what examination cannot be performed on the patient?

• A. Abdominal plain film
• B. IVP examination
• C. Urethrography
• D. Cystoscopy
• E. Digital rectal examination

3. If the urinary catheter cannot be inserted into the bladder, the treatment method is

• A.Incision and drainage of perineum
• B. Multiple incision and drainage of perineum
• C.Suprapubic cystostomy
• D.Perineal urethrostomy
• E.Transperineal incision urethroplasty

• Male, 36 years old, unable to urinate on his own for 3 hours. Three hours ago, his hip was hit by a car. Physical examination: blood pressure 16 / 9kpa (120 / 70mmhg), body temperature 37.8 ℃. Perineum is swollen and purplish red. Digital rectal examination: soft sensation in front of rectum, floating tip of prostate, catheter can not be inserted into bladder. Pelvic X-ray shows pubic fracture.

4. Most likely diagnosed is

• A. Bladder injury
• B. Penile urethral injury
• C. prostatic urethral injury
• D. bulbar urethral injury
• E. Membranous urethral injury

5. The most appropriate treatment at this time is

• A. Bladder repair
• B. Suprapubic bladder puncture
• C. Two stage urethroplasty with suprapubic fistulation
• D. urethral realignment
• E. Urethral repair or anastomosis was performed

• Male, 38 years old. straddle injury, blood dripping from the external orifice of the urethra, swelling, ecchymosis and butterfly hematoma in the perineum and scrotum.

6. The site of urinary system injury in this patient is

• A. Urethral penis
• B. Bulbar urethra
• C. Bladder
• D. Urethral prostate
• E. Urethral membrane

7. The patient’s most likely diagnosis is

• A. Posterior urethral contusion and laceration
• B. Bladder rupture
• C. Bladder contusion
• D. Anterior urethral laceration
• E. Anterior urethral contusion

8. The preferred treatment is

• A. Simple hematoma removal
• B. Cystostomy
• C. Try inserting catheter to drain urine + anti infection treatment
• D. urethral realignment
• E. Urethral broken end anastomosis

• Male, 34 years old, unable to urinate due to riding injury to perineum. At that time, three days after suprapubic cystostomy in a primary hospital, he had a fever and a temperature of 38.5 degrees. He came to see a doctor. Physical examination: blood pressure 110 / 75mmhg, heart rate 78 beats / min, obvious swelling of perineum and scrotum, dark red skin and obvious local tenderness

9. Which of the following treatment options is correct?

• A.Try indwelling the catheter again during antibiotic treatment
• B.Urethral rearrangement was performed simultaneously with antibiotic treatment
• C.Transperineal urethroplasty was performed simultaneously with antibiotic treatment
• D.Episiotomy and drainage were performed simultaneously with antibiotic treatment
• E.Closely observe the changes of the disease after antibiotic treatment

10. What should not be done at this time?

• A. Blood bacterial culture
• B. Urine bacterial culture
• C. Urethrography to understand the injury
• D. Perineal B-ultrasonography
• E. Pelvic X-ray plain film

X-Type (5 qusiotns)

1. Common ureteral injuries include____

• A. Ureteral injury during radical surgery for endometrial carcinoma
• B. Ureteral knife puncture
• C. Ureteral occlusion after radiotherapy
• D. Severe hydronephrosis due to ureteropelvic junction stenosis

2. Which of the following statements are correct about the value of excretory urography in the diagnosis of renal injury?

• A. It can show renal contusion
• B. Contralateral renal function can be displayed
• C. It can show the leakage of renal contrast medium on the affected side
• D. It can show the deformation of the patient’s renal pelvis and kidney calices

3. Local treatment after urethral injury includes ______

• A. Restore urethral continuity
• B. Drainage of bladder urine
• C. Complete drainage of urinary extravasation
• D. Complete drainage of hematocele
• E. Systemic anti-inflammatory therapy

4. Which of the following are the main pathological manifestations after urinary injury?

• A. Bleeding
• B. Infection
• C. Urinary extravasation
• D. Shock
• E. Fever

5. Which of the following are non-surgical measures for renal injury?

• A. Bed rest
• B. Give hemostatic
• C. Control and prevention of infection
• D. Observe the development of lumbar mass and hematuria
• E. Supplementary blood volume

Answer

A1-Type

DACAA DAACC ECEDE BBDEC

A2-Type

DBDADDECED EDDE

A3-Type

ABABC DBDEC CEAEC DDEDB

A4-Type

CDEED BDCEC

X-Type

ABCD BCD ABCD ABC ABCDE