5. Obstruction of urinary tract

A1-Type (20 questions)

When a patient has benign prostatic hyperplasia，which of the following symptoms should not be treated with drugs?

A. With bilateral hydronephrosis
B. Concomitant microscopic hematuria
C. Delayed urination
D. Frequent urination and urgency

Which of the following factors has nothing to do with urinary incontinence after benign prostatic hyperplasia?

A. Bladder urethral angle change
B. Long operation time
C. Low compliance bladder
D. Posterior urethral injury stimulation and prostatic fossa wound infection

Which of the following factors has nothing to do with the symptoms of patients with benign prostatic hyperplasia?

A. Is there any stone
B. Degree of lesion development
C. General health status of patients
D. Is it complicated with inflammation

If a patient with benign prostatic hyperplasia suspects prostate cancer, which of the following tests does not work?

A. Digital rectal examination（DRE）
B. CT
C. MRI
D. Serum PSA level

Which of the following is not included in the differential diagnosis of BPH？

A. Bladder neck contracture
B. Neurogenic bladder
C. Prostate cancer
D. Dladder diverticulum
E. Urethral stricture

Which of the following is the most common cause of hydronephrosis？

A. Double ureteral stenosis
B. Ureteral stone
C. Lower urinary tract obstruction
D. Bladder tumor
E. Ureteral malformation

Which of the following is the preferred method to relieve urinary tract obstruction

A. Indwelling catheterization
B. Cystostomy
C. Nephrostomy or percutaneous nephrostomy
D. Ureterostomy
E. Find out the cause and remove the primary disease

Which of the following conditions of benign prostatic hyperplasia is not suitable for drug treatment?

A. Concomitant microscopic hematuria
B. Frequent urination and urgent urination symptoms are serious
C. Concomitant hydronephrosis
D. Concomitant urinary tract infection
E. Delayed urination

Which of the following is the basis for distinguishing prostate cancer from benign prostatic hyperplasia?

A. Age of onset
B. Degree of dysuria
C. Determination of residual urine volume
D. PSA (prostate specific antigen)
E. Cystography

Which of the following is the most meaningful diagnostic method for hydronephrosis?

A. Physical examination renal palpation
B. Ultrasonic imaging
C. Isotope renal scan
D. Eexcretory and retrograde urography
E. Renal X-ray plain film

Which of the following renal function indicators is generally not affected after renal obstruction？

A. Glomerular filtration rate
B. Renal blood flow
C. urine concentration capacity
D. urinary acidification capacity
E. Urine dilution capacity

For the reference index of hydronephrosis, the thickness of most renal cortex is______

A. <3mm
B. <5mm
C. <2mm
D. >3mm
E. >2mm

Which of the following is a common cause of congenital ureteropelvic junction (UPJ) obstruction？

A. Stone
B. Intraluminal stenosis
C. Retroperitoneal fibrosis
D. Vagal vascular compression
E. Tuberculosis

Which area of the prostate is the main site of benign prostatic hyperplasia(BPH)?

A. Transition zone
B. Central zone
C. Peripheral zone
D. Urethral zone
E. Anterior fibromuscular stroma

What is the most important symptoms of benign prostatic hyperplasia?

A. Frequency of urination
B. Urgency of urination
C. Dysuria
D. Progressive difficulty urinating
E. Infection

What are the most common causes of ureteropelvic junction obstruction (UPJO)?

A. Stone
B. Stricture
C. Vascular compression
D. Tumour
E. Dynamic obstruction

What is the most common and earliest symptoms of benign prostatic hyperplasia?

A. Frequency of urination
B. Urgency of urination
C. Dysuria
D. Progressive difficulty urinating
E. Infection

What is the earliest symptom of BPH?

A．Hematuria
B．Difficulty in urination
C．Frequent urination
D．Urinary retention
E．Urinary pain

Which part of the prostate is the most common site of prostatic hyperplasia?

A. Bilateral lobe
B. Middle lobe
C. Transitional zone
D. Central zone
E. Peripheral zone

What is the differential basis between benign prostatic hyperplasia and prostate cancer?

A. Age of onset
B. Degree of dysuria
C. Measurement of residual urine volume
D. Serum PSA measurement
E. Cystography

A2-Type (15 questions)

The patient,a 28 years old male, right lumbar dull pain for 1 week with chills and fever for 3 days. Physical examination: T: 38.5 °, indifferent expression, percussion pain of right kidney, previous history of urinary stone. B-ultrasound of urinary system showed severe hydronephrosis in the right kidney, enhanced echo of hydronephrosis in the renal pelvis, mild hydronephrosis in the left kidney, 0.4cm thick right renal cortex and 1.6cm thick left renal cortex. The blood biochemical test showed that the renal function was normal. The first treatment for the patient is______

A. Right nephrostomy
B. Right ureteropelvic junction plasty
C. Right nephrectomy
D. Left nephrectomy

The patient, a 22-year-old male, was treated for “hydronephrosis for half a year”. Meningocele was found at birth and operated at 8 months old. The patient had difficulty urinating since childhood, accompanied by frequent urination and dry stool, but had not been examined. Hydronephrosis was found in both kidneys during physical examination half a year ago. Urinary B-ultrasound showed moderate hydronephrosis in both kidneys, and the residual urine volume was 50ml. The maximum urine flow rate was 12.3ml/s and the urine volume was 130ml. Serum creatinine was 150 μmol/L。What should you do with the patient at this time?

A. Double nephrostomy
B. Transfer to nephrology clinic
C. Indwelling catheter and continuous bladder drainage
D. Ask the patient to urinate by pressing the abdomen and recheck regularly

The patient, a 56 years old female, was hospitalized for “progressive aggravation of bilateral hydronephrosis for 3 months half a year after endometrial cancer surgery”. The patient underwent double adnexectomy and extended lymphadenectomy for endometrial cancer six months ago. Dysuria occurred after operation, and urinary B-ultrasound showed hydronephrosis. Hydrocephalus is gradually aggravated. At present, it is severe hydrocephalus, and the blood creatinine is 455 μmol/L.The residual urine of urinary system B-ultrasound was 230ml, the maximum urinary flow rate was 8.5ml/s, and the urine volume was 180ml. The most likely cause of bilateral hydronephrosis is_____

A. Indwelling urinary catheter during operation causes urethral injury and urethral stricture
B. The operation injured the pelvic plexus, resulting in neurogenic bladder dysfunction
C. Extensive dissection during operation damaged the blood supply of bladder and led to bladder dysfunction
D. Postoperative pain, resulting in dare not urinate

The patient, a 42 years old female, was hospitalized mainly because of “frequent urination with intermittent bed wetting at night for 1 year”. The patient had a history of diabetes for 10 years, oral hypoglycemic drugs, but poor blood glucose control. The patient had no obvious urinary incontinence and dysuria during the day. The best treatment for this patient is_____

A. Long term indwelling catheter
B. Long term indwelling cystostomy tube
C. Intermittent cleaning and self catheterization
D. Waiting for observation

The patient,a 70 years old male, was treated for acute urinary retention in emergency department. Physical examination: swelling of bladder area. At this point, the most important processing is_______

A.Contact the urologist on duty and perform B-ultrasound examination at the same time
B.Digital rectal examination was performed to determine the size of prostate
C.Indwelling catheterization and drainage of urine
D.Ask the patient to refrain from drinking and apply a hot towel to the lower abdomen

The patient,a 82 years old male. After drinking the day before yesterday, he had abdominal pain, frequent urination and less volume. Usually, the stool is dry, once every 2 ~ 3 days. Physical examination: the abdomen is swollen, the lower abdomen is marked, the whole abdomen is tender, the lower abdomen is heavier, the muscle tension is not obvious, and the bowel sound is active. After enema with soapy water, more feces were excreted, and abdominal pain was not significantly relieved. The most likely diagnosis for this patient is______

A. Acute cystitis
B. Acute urinary retention
C. Sigmoid volvulus
D. Habitual constipation

A 32 years old male patient was diagnosed with right renal tuberculosis one year ago and underwent right nephrectomy. He continued to use antituberculous drugs after operation, but his urinary frequency did not improve. IVP (intravenous pyelography) showed mild hydronephrosis in the left kidney and a bladder the size of a table tennis ball. Treatment should be considered______

A. Continue anti tuberculosis treatment
B. Nephrostomy
C. Left ureterostomy
D. Left nephrectomy
E. Colonic augmentation cystoplasty

A 29 years old male patient underwent left kidney and left ureterectomy for tuberculosis of the left kidney, left ureter and bladder one year ago. After the operation, he was treated with anti tuberculosis for 8 months. At present, the routine urine examination of the patient is negative. IVP shows mild hydronephrosis in the right kidney, but the symptoms of frequent urination are significantly aggravated. The reason is______

A. Urethral syndrome caused by tuberculosis
B. Failure to control bladder tuberculosis
C. Tuberculosis recurrence
D. Complicated with urinary system infection
E. Bladder contracture

The patient is a 70 years old male who can’t urinate for 8 hours after drinking, has unbearable lower abdominal distension, and has had “prostatic hypertrophy” for 5 years. Examination: suprapubic swelling and percussion sound. Which of the following processing is wrong?

A. Hot compress in bladder area
B. Catheterization
C. Intravenous diuretics
D. Suprapubic cystostomy
E. Oral antibiotics

A 80 years old male patient, had progressive dysuria and repeated urinary retention for 3 years. Past diabetes, coronary heart disease and hypertension. Physical examination: the prostate is Ⅱdegree hypertrophic, with smooth surface and hard elasticity. Urea nitrogen: 15mmol / L. The bottom of the bladder reaches the two transverse fingers under the umbilicus. Which of the following is the best treatment?

A. Simple catheterization
B. Suprapubic cystostomy
C. transurethral resection of the prostate
D. Transvesical prostatectomy
E. Oral diethylstilbestrol

The patient is a 30-year-old male with no urine for 1 day. He has had severe pain in the back waist twice in the past year. In order to clarify the cause of urinary closure. Which of the following is the preferred check?

A. Transvenous pyelography
B. Retrograde pyelography
C. Renal angiography
D. Renal CT examination
E. KUB plain film

The patient was 73 years old, with frequent micturition, weak voiding, thin urine, and not finishing urination , and had been aggravated for more than 10 years. Past: diabetes for 15 years, has been taking medication. Which of the examinations that should be done in the first visit is not necessary?

A. Anal examination
B. Urinary flow rate
C. Urinary ultrasound and residual urine volume examination
D. Blood biochemistry and PSA examination
E. IVP+KUB

The patient, a 5-year-old male, complained of intermittent swelling and pain in the right waist in recent 1 year, no hematuria, frequent urination, urgency and pain, and no dysuria. Physical examination: the right upper abdomen is slightly full. A soft mass can be touched in the right renal area, and move up and down with breathing. Which of the following diseases is the patient most likely to have?

A. Ureteropelvic junction stenosis
B. Nephroblastoma
C. Posterior urethral valve
D. Neurogenic bladder due to meningocele
E. Renal cell carcinoma

A 62 year old male patient came to see a doctor because of dysuria for 6 years and inability to urinate for 1 day. The cystic mass was palpated in the lower abdomen. By digital rectal examination, the prostate was II degree swollen, tough, smooth, and the central sulcus disappeared. Blood PSA 2ng / ml,BUN 15mmol/L, Cr 267μmol/L. Which of the following is the most likely diagnosis?

A. Prostate cancer
B. Benign prostatic hyperplasia
C. Prostate sarcoma
D. Prostatitis
E. None of the above

The patient was a 25-year-old female with right low back pain for 1 month. The right kidney hydronephrosis was found by B-ultrasound, the right kidney was not developed by IVP, and the left kidney was normal. The case was finally diagnosed as right pyeloureteral junction stenosis with huge hydronephrosis, and the thickness of renal cortex was 1.0cm. The best treatment is______

A. Right pyeloureteroplasty
B. Right pyelostomy
C. Right nephrectomy
D. Right ureteral dilatation
E. Close follow-up

A3-Type (20 questions)

Male, 73 years old, frequent micturition and urgent micturition for 5 years. In recent 1 year, he had slow micturition, thin urinary line and dripping after micturition. He had two cerebral infarction five years ago, which was significantly improved after 2 years of neurologic treatment. At present, he has no other obvious sequelae except walking slightly unstable

Which examination is not necessary at the first visit of the patient?

A. Cystoscopy for prostate size
B. Digital rectal examination
C. Serum PSA
D. urinary flow rate
E. Prostate ultrasound to understand the size of prostate and residual urine

The patient’s urine flow rate was checked three times, and the urine volume was 70 At 100, Qmax is 8ml / s. Which of the following is the most reasonable treatment methods？

A. Recheck the urine flow rate again, and the urine volume should be more than 150ml
B. The urine flow rate of the existing urine volume was used as a reference
C. The balloon urinary catheter was indwelling, 150 normal saline was injected, and then the urinary catheter was removed for urinary flow rate examination
D. Clamp the patient’s anterior urethra until 150ml is saved, and then check the urinary flow rate
E. After direct injection of more than 150ml normal saline through the urethra, the urinary flow rate was checked immediately

If you want to determine whether the patient has dysuria caused by benign prostatic hyperplasia to decide whether to perform prostatectomy, which of the following tests is best？ A. CT examination of prostate B. Cystourethrography c. Renogram or dynamic renal scan D. Urodynamic examination E. Prostate biopsy confirmed the presence or absence of benign prostatic hyperplasia D

A 5 years old boy, found right abdominal mass in bath for 1 month. Physical examination: There is a mass in the right upper abdomen, 3cm below the costal margin, soft. B-Ultrasound showed severe hydronephrosis in the right kidney, and the thickness of renal cortex was 0.5cm. He can not cooperate with intravenous nephrography.

In order to understand the location and degree of renal and ureteral obstruction, Which of the following is the most appropriate inspection?

A. CT plain scan
B. M positive water imaging examination
C. Radionuclide renogram
D. Dynamic scanning of radionuclides in kidney
E. Transvesicoscopic retrograde nephrography and ureterography

Under analgesic anesthesia, ultrasound-guided right nephrostomy and angiography showed that the junction of nephrostomy and ureter was narrow. The drainage volume of fistula tube was about 400ml per day, and the proportion of drainage urine was 1.015. What is the most reasonable treatment for the patient？

A. Right nephrectomy
B. Permanent right nephroplasty
C. Total resection of right kidney and ureter
D. Remove the nephrostomy tube and maintain the original state
E. Right nephroureteroplasty

Which of the following tests is most necessary before surgery to determine whether the affected kidney should be removed？

A. CT plain scan
B. MRI Hydrography
C. Radionuclide renogram
D. Dynamic scanning of radionuclides in kidney
E. IVP check

Male, 76 years old, was hospitalized because he could not urinate for 10 hours. The patient had dysuria for 3 years, often interrupted urinary flow, and could resume micturition after changing posture. Urinate 3 ~ 5 times at night. Physical examination: generally good, the lower abdomen is swollen, and the voiced boundary is located at 2 fingers under the umbilicus. There are several 2 ~ 4cm strong light masses in the bladder by B-ultrasound.

The patient’s diagnosis was

A. Benign prostatic hyperplasia with urinary tract infection
B. Urethral stricture
C. Benign prostatic hyperplasia
D. Neurogenic bladder
E. Benign prostatic hyperplasia with bladder stones

If the diagnosis is clear, the first reasonable treatment should be

A. Insert a catheter to make the urine flow out slowly without indwelling the catheter
B. Urgent cystostomy
C. Suprapubic bladder puncture to extract urine
D. Antibiotics and diuretic therapy, continue to observe
E. Indwelling catheter after catheterization

After admission, the patient’s heart, lung and kidney functions were good, and he was ready for open surgery to remove the prostate. The reasonable treatment was

A. Transurethral resection
B. transvesical resection
C. retropubic resection
D. transperineal resection
E. presacral resection

A 16-year-old male, with acid swelling in the right waist and aggravation after fatigue, came to see a doctor without a history of fever and renal colic. Ultrasound showed moderate hydronephrosis in the right kidney. Urine routine is normal.

The initial diagnosis should be considered as

A. Renal tuberculosis
B. Renal tumor
C. Congenital posterior urethral valve
D. Congenital stricture of nephroureteral junction
E. Right ureteral stone

What further inspection should be done first?

A. Retrograde ureterography
B. Intravenous urography
B. CT
D. Abdominal plain film
E. Radionuclide scanning

If the diagnosis is clear, which of following treatments should be selected？

A. Right nephrectomy
B. drug therapy
C. Permanent nephrostomy
D. Right nephroureteroplasty

Male, 76 years old, was hospitalized because he could not urinate for 10 hours. The patient had dysuria for 3 years, often interrupted urinary flow, and could resume micturition after changing posture. Urinate 3 ~ 5 times at night. Physical examination: the lower abdomen is swollen, and the voiced boundary is located at 2 fingers under the umbilicus. There are several 2 ~ 4cm strong light masses in the bladder by B-ultrasound.

The case has a 3-year history. After questioning the history, it should be emphasized that the initial symptoms of patients with benign prostatic hyperplasia is

A. Urinary leakage
B. Laborious urination
C. Frequent urination
D. Urinary incontinence
E. Hematuria

Which part of the patient’s prostate should be removed?

A. Compressed and narrow posterior urethra
B. Seminal caruncle
C. Total prostate
D. Benign prostatic hyperplasia
E. Benign prostatic hyperplasia and prostatic capsule

Which of the following is not a pathological change caused by lower urinary tract obstruction in benign prostatic hyperplasia?

A. Bladder wall hypertrophy
B. ureteral reflux
C. hydronephrosis
D. Impairment of renal function
E. Atypical hyperplasia of bladder mucosa

Male, 73 years old, has frequent micturition, weak voiding, thin urine, and not finishing urination. It has been aggravating for more than ten years and often occurs acute urinary retention. Past history: diabetes 15 years, medication treatment.

The most unlikely problem for patients is

A. Benign prostatic hyperplasia
B. Chronic urinary retention
C. Detrusor weakness
D. Detrusor - External sphincter dyssynergia
E. Overactive bladder

Which of the examinations that should be done in the first visit is not necessary?

A. Anal diagnosis
B. Urinary ultrasound and residual urine volume examination
C. Blood biochemistry and PSA
D. IVP and KUB

According to the examination results, the diagnosis of benign prostatic hyperplasia and diabetes is clear. In order to decide whether or not to undergo prostatectomy, which of the following examinations is the best?

A.prostate CT
B.Cystoscopy
C.Renal radionuclide scan
D.Urodynamic examination
E.Prostate biopsy

Female, 25 years old, right low back pain for 1 month, right hydronephrosis was found by B-ultrasound, IVP, right kidney did not develop, and left kidney was normal.

The next examination method is

A. Right retrograde intubation angiography
B. Right renal puncture angiography
C. CT
D. MRI
E. Renogram

The above case was finally diagnosed as right renal Meng ureteral junction stenosis with giant hydronephrosis, and the thickness of renal cortex was 1.0cm. The best treatment is

A. Angioplasty of right renal ureteral junction stenosis
B. Right nephrostomy
C. Right nephrectomy
D. Right ureteral dilatation
E. Conservative treatment

B1-Type (10 questions)

A. Radionuclide scanning
B. B-type ultrasonic
C. Intravenous pyelography
D. Puncture pathological examination
E. Urodynamic examination

It can be used to distinguish benign prostatic hyperplasia from prostate cancer
It can be used to distinguish benign prostatic hyperplasia from neurogenic bladder

A. Filling incontinence
B. Paroxysmal hypertension
C. Interruption of urination
D. Two upper abdominal masses
E. Painless hematuria

Benign prostatic hyperplasiamay cause
Polycystic kidney may cause
Pheochromocytoma may cause

A. Drug therapy, such as hormone and a receptor blocker
B. Catheterization
C. Prostatectomy or transurethral resection of prostate
D. cystostomy
E. Antibiotics

Male, 70 years old, with significant frequent urination in recent two years, laborious urination, gradually aggravating, unable to urinate for one day.
The patient was ineffective in taking medication, repeated urinary retention, physical examination, large degree prostate, anal sphincter.Normal tension normal ECG.
One month after prostatectomy, the patient still had frequent urination, routine urination and leukocyte 3-5 /HP.
male, 75 years old, had a urinary retention before March. At present, frequent micturition and dysuria occurred five years ago.Acute myocardial infarction occurs, and the current heart condition is relatively stable.
Male, 68 years old, progressive dysuria for three years, nocturia 4-5 times / day, no special diseases in other systems. B-ultrasound showed benign prostatic hyperplasia with residual urine of 120ml.

X-Type (5 questions)

What are the possible reasons of acute urinary retention？

A. Urethral injury
B. Benign prostatic hyperplasia
C. Acute injury of central nervous system
D. Drug factors

The determinations of urinary flow rate without clinical guiding significance are______

A. Maximum urinary flow rate
B. Mean urinary flow rate
C. Urinary flow time
D. Urethral pressure

The two most commonly used drugs for benign prostatic hyperplasia are_______ A. 5α Reductase inhibitor B. 5α Reductase agonist C. α Receptor agonist D. α Receptor blocker
Which of the following are complications of benign prostatic hyperplasia？

A. Renal failure
B. Canceration
C. Inguinal hernia
D. Painless hematuria

Which of the following are common causes of male acute urinary retention?

A. Benign prostatic hyperplasia
B. Urinary tract stenosis
C. Urinary stone
D. Prostatitis

Answer

A1-Type

ABCBD CECDD ECBAD BACCD

A2-Type

ACBCC BEECB EEABA

A3-Type

AADBA DEEBD BECDE EDDAA

B1-Type

DEADB BCECC

X-Type

ABCD BCD AD ACD ABC

Last updated on Nov 8, 2022