6. Urinary stone disease (Urolithiasis)

A1-Type (20 questions)

1. Which of the following is the best treatment for bladder diverticulum stones?

• A. Transurethral electrohydraulic lithotripsy
• B. Transvesical mechanical lithotripsy
• C. Suprapubic bladder lithotomy
• D. Expel stones through Chinese herbal medicine
• E. Extracorporeal shock wave lithotripsy

2. Which of the following is not a concomitant sign of downward movement of ureteral stones?

• A. Fever
• B. Hematuria
• C. Lumbar colic
• D. Nausea and vomiting
• E. Irritability

3. Which of the following is wrong when using antibiotics in extracorporeal shock lithotripsy?

• A. Antibiotics are generally not given
• B. Use when white blood cells in urine exceed normal before treatment
• C. Use when stones are large
• D. Conventional application
• E. Use when there are symptoms of infection

4. Which of the following is the characteristic of hematuria of renal ureteral stones?

• A. Painless gross hematuria
• B. End stage hematuria
• C. Hematuria with bladder irritation
• D. Hematuria with dysuria
• E. Low back pain and hematuria after exercise

5. On the incidence of urinary stones, which of the following is wrong?

• A. More men than women
• B. More south than North
• C. Upper urinary stones are common in China
• D. There are more primary stones than secondary stones in bladder stones
• E. The etiology of urinary stone is unknown

6. After unilateral ureteral obstruction for more than _______, renal function will change irreversibly to a certain extent.

• A. 1 hour
• B. 12 hours
• C. 24 hours
• D. 48 hours
• E. 72 hours

7. Which of the following is a typical feature of bladder stones?

• A. Hematuria with lumbar colic
• B. Frequent urination, urgency and pain
• C. Pyuria
• D. Dysuria, interruption of urine flow, and urination after changing body position
• E. Increased nocturia and progressive aggravation of dysuria

8. The main method to diagnose urinary stone is______

• A. Ultrasonic examination
• B. Radionuclide renogram
• C. Radionuclide renal scan
• D. Excretory urography
• E. Feeling of falling in perineum

9. Which of the following is most likely to have hematuria with colic?

• A. Kidney stone
• B. Renal tuberculosis
• C. Renal tumor
• D. Nephroptosis
• E. Renal edema

10. The patient had bladder irritation and radiation pain in the urethra and penile head. The most likely diagnosis was？

• A. Distal ureteral stone
• B. Middle ureteral stone
• C. Renal pelvis stones
• D. Upper ureteral stone
• E. Renal calyceal stones

11. What is the preferred treatment for urinary stones below 2cm?

• A. MET
• B. ESWL
• C. URL
• D. PCNL
• E. LUL

12. Which of the following types of stone is not urinary tract stone?

• A. Kidney stone
• B. Ureter stone
• C. Gallbladder stone
• D. Bladder stone
• E. Urethral stone

13. Which is the most chemical type of urinary stone?

• A. Calcium stone
• B. Struvite stone
• C. Uric acid stone
• D. Cystine stone
• E. Phosphate stone

14. What is the preferred treatment for urinary stones above 2cm?

• A. MET
• B. ESWL
• C. URL
• D. PCNL
• E. LUL

15. Which are the typical symptoms of bladder stones?

• A. Hematuria with lumbar colic
• B. Pus urine
• C. Increased nocturia and aggravation of urination
• D. Difficulty in urination, interruption of urine flow, change of position can be urinated again
• E. Urinary frequency, urinary urgency, and pain

16. Which is the most common clinical urinary tract stones?

• A. Uric acid stones
• B. Phosphate stones
• C. Oxalate stones
• D. Cysteine stones
• E. Xanthine stones

17.Pain and hematuria associated with activity should first be considered ___.

• A. Upper urinary tract stones
• B. Urological tumor
• C. Urinary tract infection
• D. Urinary tract malformation
• E. Prostatic hyperplasia

18. Which of the following types of hematuria should be considered first for renal and ureteral stone?

• A. Painless total hematuria
• B. Terminal hematuria
• C. Post-actively hematuria
• D. Initial hematuria
• E. Severe hematuria with blood clots

19. Which disease is commonly associated with symptoms of interrupted urination.

• A. Bladder cancer
• B. Kidney stone
• C. Ureteral stones
• D. Bladder stones
• E. Penile cancer

20. Which of the following types of hematuria should be considered first for renal and ureteral stone?

• A. Painless total hematuria
• B. Terminal hematuria
• C. Post-actively hematuria
• D. Initial hematuria
• E. Severe hematuria with blood clots

A2-Type (20 questions)

1. The patient, a 39 years old female, was hospitalized for left lumbar acid and swelling. Ultrasound showed hydronephrosis in the left renal pelvis and a 2.1cm stone in the renal pelvis. IVP showed moderate hydronephrosis in the left kidney, unobstructed ureter and normal right kidney. The best treatment for this patient is____

• A. Transrenal sinus lithotomy
• B. Percutaneous nephrolithotomy
• C. Observe and wait for the aggravation of ponding before treatment
• D. Extracorporeal Shock Wave Lithotripsy (ESWL)

2. The patient, a 25-year-old female, had right lower abdominal pain with irritation sigh of bladder in recent six months. Physical examination: soft abdomen, deep tenderness in the right lower abdomen and tapping pain in the right waist. Urine routine: red blood cell(+ +), white blood cell (+). Renogram: right obstructive curve, what disease should be considered?

• A. Right lower ureteral stone
• B. Acute appendicitis
• C. Chronic adnexitis
• D. Chronic cystitis

3. The patient, a 32-year-old male with severe pain in the right waist for 1 hour,was accompanied by nausea and vomiting. The pain radiated to the inner thigh. Urine routine: red blood cell: 10 ~ 20 / HP, white blood cell: observed occasionally. The most reasonable diagnosis for the patient was______

• A. Staghorn stone of right kidney
• B. Ureteral stone
• C. Bladder stone
• D. Renal tuberculosis
• E. Renal tumor

4. Male, 50 years old, recurrent renal colic for 3 years, often with small stones in urine. He came to the outpatient department and asked the doctor to guide preventive measures. Which of the following factors has nothing to do with promoting the formation of upper urinary tract stones?

• A. There is too much meat in the diet
• B. Long term bedridden
• C. There is too little cellulose in the diet
• D .Increased urinary citrate
• E. Renal tubular acidosis

5. The patient, a 45 years old female, with a history of recurrent urinary tract infection for 4 years. Recently, B-ultrasound found right kidney stone with hydronephrosis. The urinary pH was 7.5. The most likely component of this stone was_____

• A. Cystine stones
• B. Xanthine stones
• C. Urate stones
• D. Oxalate stone
• E. Phosphate stoness

6. 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

7. The patient was a young male with sudden epigastric pain, nausea and vomiting. Routine urine examination showed that the field of vision was full of red blood cells, 5-10 white blood cells / HP, and the blood routine was normal. Considering the right ureteral stone, the most appropriate emergency treatment method was_______

• A. Drink plenty of water
• B. Oral antibiotics
• C. Anti inflammatory, antispasmodic and analgesic
• D. ESWL
• E. Surgical exploration

8. The patient, a 29 years old female, was treated for 3 months due to blunt pain in the left waist. After B-ultrasound and KUB + IVP examination, it was found that there was a 2.0cm×3.0cm stone in the left renal pelvis, left hydronephrosis, left ureter and right kidney and ureter were normal. The preferred treatment for the patient was_____

• A. Traditional Chinese medicine stone removal
• B. Temporary observation
• C. Endoscopic lithotripsy
• D. Open surgery
• E. Extracorporeal shock wave lithotripsy (ESWL)

9. The patient was male, 67 years old. B-ultrasound found that the diameter of bladder stones was 1.5cm, combined with bladder diverticulum. Which of the following treatments is most appropriate？

• A. ESWL
• B. Traditional Chinese medicine stone removal
• C. Self dumping
• D. Cystoscopic mechanical lithotripsy
• E. Cystolithotomy

10. The patient was a 47 years old male with a height of 170cm and a weight of 110kg. Pyelography showed moderate hydronephrosis in the left kidney and stones in the middle of the left ureter, with a diameter of 1.5cm,the stone in the upper segment of the right ureter is 1.2cm, and there is no hydronephrosis in the right kidney. The best treatment is_____

• A. Simultaneous bilateral extracorporeal impact lithotripsy
• B. First left extracorporeal impact lithotripsy
• C. First left nephrostomy
• D. Open the left ureter and take stones first
• E. Retrograde catheterization of left ureter to drain urine

11. The patient had a stone in the upper right ureter with a diameter of 1.0cm. Excretory urography showed mild hydronephrosis in the right kidney. After 3 months of non-surgical treatment, KUB rechecked that the stone moved down 1.0cm. How should it be treated？

• A. Right pyelostomy
• B. Review after 3 months of non-surgical treatment
• C. Integrated traditional Chinese and Western medicine treatment
• D. Ureterolithotomy
• E. Oral antibiotics to prevent infection

12. The patient was a 36 years old female with recurrent right low back pain and microscopic hematuria for 2 years. Kub showed multiple stones under the right kidney and the diameter of stones in the lower segment of the right ureter was 2cm. What kind of operation should we consider first?

• A. Right nephrectomy
• B. Right pyelolithotomy
• C. Right renal parenchyma lithotomy
• D. Right nephrostomy
• E. Right ureterolithotomy

13. The patient is a 35 years old female with sudden right upper abdominal pain with nausea and vomiting. She has a history of stone excretion in the past. Which of the following is the most likely diagnosis?

• A. Right kidney stone
• B. Right ureteral stone
• C. Gallstones
• D. Right renal tuberculosis
• E. Choledocholithiasis

14. The patient had a right kidney stone with a diameter of 1.8 cm and a narrow right ureteropelvic junction. The appropriate treatment is______

• A. Pyelolithotomy + Pyeloplasty
• B. Ureteroscopy and nephrolithotomy
• C. Ureterolithotomy
• D. Drug conservative treatment
• E. ESWL

15. The patient, a 56 years old male, had left nephrectomy 4 years ago, right lumbar pain with repeated episodes of microscopic hematuria for 1 year, and had no urine for nearly 3 days. Physical examination: hazy mind, systemic edema, blood pressure 180 / 100mmhg, blood creatinine 560 μ Mol / L, no obvious abnormality is found in abdominal plain film, and the most likely diagnosis of the patient is______

• A. Ureteral stone
• B. Calyceal stones
• C. Renal artery embolization
• D. Rupture of renal cyst
• E. Renal pelvis tumor

16. A 43 years old female patient was treated for left lumbar pain. Ultrasound examination found hydronephrosis in the left renal pelvis. There was a stone with a diameter of 2.0cm in the renal pelvis. IVP: moderate hydronephrosis in the left kidney, unobstructed ureter and normal right kidney. At this time, the best treatment is______

• A. Pyelolithotomy
• B. Percutaneous nephrolithotomy
• C. ESWL (extracorporeal shock wave lithotripsy)
• D. Observe and re treat after the water accumulation is aggravated
• E. Transrenal sinus lithotomy

17. A 36 years old female with recurrent right low back pain and microscopic hematuria for 2 years. KUB and IVP showed multiple stones in the right kidney and stones in the upper segment of the left ureter, with a diameter of 1.2cm, hydronephrosis in both kidneys and good renal function. What kind of treatment should we consider first?

• A. Left ureteral extracorporeal lithotripsy
• B. Right pyelolithotomy
• C. Right renal parenchyma lithotomy
• D. Right nephrostomy
• E. Left ureterolithotomy

18. The patient was a 42 years old male. The size of left kidney stone was 1.0cm found by B-ultrasound. He had no obvious symptoms at ordinary times, occasional discomfort of lumbar acid swelling, previous health and no history of stone excretion. The patient’s preferred treatment is?

• A. Pyelolithotomy
• B. Percutaneous nephrolithotomy
• C. Oral lithotripsy drugs
• D. Extracorporeal shock wave lithotripsy
• E. Litholytic therapy

19. The patient was a young woman who came to the emergency department with right renal colic and accompanied by gross hematuria. After examination, it was determined that there was a stone with a diameter of 3.0cm in the right renal pelvis, irregular shape and mild hydronephrosis. Which of the following is the most suitable treatment？

• A. Right nephrostomy and nephrolithotomy
• B. ESWL
• C. Ureteroscopy
• D. Double-J + ESWL
• E. Nephrolithotomy

20. The patient was a 70 years old male with dysuria for 10 years, aggravated in recent one year, accompanied by frequent urination, urgency and pain. Physical examination: the second degree of prostate is enlarged and smooth. The size of prostate by B-ultrasound is 2cm × 6cm × 8cm, multiple strong light mass echoes with sound shadow in the bladder, with a diameter of 0.5cm. No stone shadow was found on the X-ray plain film of the bladder. What is the most likely component of the bladder stone in this patient?

• A. Calcium oxalate stone
• B. Calcium phosphate stones
• C. Uric acid stones
• D. Cystine stones
• E. Magnesium amine phosphate stone

A4-Type (20 questions)

• Male, 26 years old, due to repeated right lumbar colic and sometimes spread to the right lower abdomen for 4 months, was treated by outpatient, outpatient blood routine examination and urine routine examination once.Normal, the pain attack mostly occurs after work, smokeless and alcoholic. No relevant family history.

1. In order to diagnose whether there is renal and ureteral stone, what is the most important method to use at this time?

• A. Isotope renogram
• B. CT
• C. B-ultrasound
• D. Cystoscopy
• E. Abdominal plain film and intravenous pyelography

2. The size of right renal pelvis stone was 2.0cm x 0.9cm confirmed by plain film and IVP, with mild to moderate hydronephrosis. The best treatment to take at this time is

• A. Taking traditional Chinese medicine to expel stones
• B. Extracorporeal shock wave lithotripsy (ESWL)
• C. Antispasmodic, analgesic, diuretic, hot compress, infusion and other palliative treatment
• D. Ureteroscopic lithotomy

3. After ESWL fails, the most inappropriate treatment at this time is

• A. Pyelolithotomy
• B. Nephrostomy perfusion of litholytic drugs and ultrasonic lithotripsy
• C. Right nephrectomy
• D. Percutaneous nephrolithotomy
• E. Ureteroscopic lithotripsy and lithotomy

• Male, 65 years old, had progressive dysuria for 4 years and intermittent dysuria for 10 days. The abdominal plain film showed that there was a round dense shadow with a diameter of 2.5cm in the bladder area.

4. The most valuable auxiliary examination for diagnosis is

• A. Cystoscopy
• B. Intravenous nephrography
• C.CT
• D.MRI
• E. Lateral abdominal plain film

5. The treatment that the patient should take is

• A. Extracorporeal shock wave lithotripsy
• B. Transurethral resection of prostate
• C. Lithotomy of bladder and prostatectomy
• D. Transurethral lithotripsy
• E. Drug exclusion of stones

• Male, 43 years old, right lumbar dull pain for 2 years. B-ultrasound examination showed that the diameter of right kidney stone was 2cm, the right kidney had mild hydronephrosis, and the left kidney had no abnormality.

6. On KUB plain film, what disease should distinguish with right kidney stone?

• A. Appendicitis
• B. Gastric ulcer
• C. Horseshoe kidney
• D. Gallstone
• E. Right kidney double kidney double ureter malformation

7. The stone usually causes damage to the human body

• A. Canceration, obstruction and secondary infection
• B. Direct injury, obstruction, infection and malignant transformation
• C. Acute complete obstruction and chronic incomplete obstruction
• D. Hydronephrosis, impairment of renal function, atrophy of renal parenchyma and canceration
• E. Bleeding, infection, scar formation and perirenal infection

8. The most common complication caused by ESWL in this patient was

• A. Osteoarthropathy
• B. Urine alkalization
• C. renal failure
• D. Hematuria
• E. Severe cardio cerebrovascular disease

9. If stones accumulate in the lower ureter after ESWL, what method can be considered to deal with?

• A. Nephrectomy
• B. Diet regulation, drinking plenty of water
• C. Percutaneous nephrolithotomy
• D. Ureteroscopic lithotripsy
• E. Litholytic therapy

• The patient, a 20-year-old female, had right lower abdominal pain with bladder irritation in the past year. Physical examination showed soft abdomen, deep tenderness in the right lower abdomen and tapping pain in the right waist. Urine routine red blood cell: + + / HP, white blood cell: + / HP.

10. What kind of examination should be performed for further diagnosis?

• A. Renal ultrasound
• B. Cystoscopy
• C. Blood routine
• D. Renal CT
• E. All the above are right

11. Renogram: the right side shows an obstructive curve,which of the following are the most likely diagnoses?

• A. Chronic cystitis
• B. Acute appendicitis
• C. Chronic adnexitis
• D. Acute pyelonephritis
• E. Lower ureteral stone

12. According to the above examination results, the treatment methods that can be taken are

• A. Extracorporeal shock wave lithotripsy
• B. Oral traditional Chinese medicine stone removal
• C. Percutaneous nephrolithotripsy
• D. Antibiotics
• E. Drinking plenty of water

• The patient, a 10-year-old boy, had frequent micturition, urgency, pain, difficulty in micturition and interruption of urinary flow in the past year. He could continue micturition after changing his body position.

13. First of all, we should consider

• A. Acute cystitis
• B. Prostatitis
• C. Urethral stricture
• D. Bladder stones
• E. Ureteral stone

14. In order to make a clear diagnosis, the examination to be taken is

• A. Bladder B-ultrasound
• B. Cystoscopy
• C. Blood routine
• D. Renal CT
• E. All the above are right

15. In the ultrasonic examination, it was found that the internal diameter of the bladder was about 5cm, and the strong echo was considered to be bladder stone. Which of the following is the most reasonable treatment?

• A. Extracorporeal shock wave lithotripsy
• B. Oral traditional Chinese medicine stone removal
• C. Percutaneous nephrolithotripsy
• D. Surgical lithotomy
• E. Drinking plenty of water

• The patient was a 42 years old male. The size of left kidney stone was 1cm found by B-ultrasound. He had no obvious symptoms at ordinary times, occasional discomfort of lumbar acid swelling, previous health and no history of stone excretion.

16. The patient’s preferred treatment is

• A. Pyelolithotomy
• B. Percutaneous nephrolithotomy
• C. Oral lithotripsy drugs
• D. Extracorporeal shock wave lithotripsy
• E. Litholytic therapy

17. What are the most common symptoms of upper urinary tract stones

• A. Pain and hematuria
• B. Frequent urination, urgency and pain
• C. Frequent urination and hematuria
• D. Pain and hematuria
• E. Remove stones and pain

18. Which of the following is the most appropriate treatment for a clear diagnosis？

• A. Urine culture
• B. Cystoscopy
• C．CT
• D．KUB+IVP
• E. Urine flow rate examination

• The patient was a young woman who came to the emergency department with right renal colic and accompanied by gross hematuria. After examination, it was determined that there was a stone with a diameter of 3.0cm in the right renal pelvis, irregular shape and mild hydronephrosis.

19. Which of the following is the most suitable treatment？

• A.Right nephrostomy and nephrolithotomy
• B.ESWL
• C. Ureteroscopy
• D. Double-J + ESWL
• E. Nephrolithotomy

20. What is the most appropriate examination?

• A. Intravenous pyelography
• B. Renal, ureteral CT
• C. B-ultrasound examination of kidney and ureter
• D. Right renal retrograde angiography
• E. Perform abdominal X-ray plain film after enema

B1-Type (10 questions)

• A. Hard, rough, irregular, often mulberry like, brown
• B. Fragile, rough, irregular, grayish white, yellow or brown
• C. X-ray is not displayed
• D. Smooth, yellowish to brown, waxy appearance

1. Which of the following is the characteristic of urinary calcium oxalate stones?

2. Which of the following is the characteristic of urinary cystine stones ?

• A. Hematuria characteristics of renal tuberculosis
• B. Hematuria characteristics of renal tumors
• C. Hematuria characteristics of renal stone
• D. Hematuria characteristics of nephritis
• E. Hematuria characteristics of cystitis

3. Terminal hematuria with frequent urination, urgency and pain

4. Painless gross hematuria is

5. Gross hematuria with renal colic

• A. Renal colic
• B. Lumbar mass
• C. Low back pain hematuria with bladder irritation syndrome
• D. Low back pain, with chills, fever and other systemic symptoms
• E. No obvious clinical symptoms, only hematuria after activity. Which of the following cases is most likely to have the above symptoms

6. Upper urinary tract stones, secondary to acute nephritis

7. When the stone causes complete obstruction of the nephroureteral junction or ureter A

• A. Nephrectomy
• B. Non operative treatment
• C. Nephrolithotomy
• D. Ureteroscopic lithotripsy
• E. Extracorporeal shock wave lithotripsy (ESWL) Which treatment method should be given priority in the following cases?

8.The woman was pregnant for 3 months and had a stone at the lower end of the right ureter with a diameter of 0.6cm.

9.The diameter of right kidney stone is 2.0cm.

X-Type (5 questions)

1. Typical manifestations of kidney and ureteral stone include_____

• A. Renal colic
• B. Microscopic hematuria
• C. Shiver
• D. Tenderness

2. Which of the following stones prevent recurrence by alkalizing urine_____

• A. Cystine stone
• B. Calcium phosphate stone
• C. Uric acid stone
• D. Magnesium ammonium phosphate stone

3. Which of the following are the common features of urolithiasis and cholelithiasis?

• A. Abnormal calcium metabolism
• B.The incidence rate of B. is related to the geographical distribution.
• C. Stones contain a certain amount of calcium
• D. It can be treated by extracorporeal lithotripsy

4. Which of the following are the factors that affect the formation of urinary stone？

• A. Infection
• B. Obstruction
• C. Foreign matter
• D. Renal injury
• E. Physical strength

5. Which of the following are indications for ureteral stone surgery?

• A. Non operative treatment is ineffective
• B. Stone diameter greater than 1.0cm
• C. Obstruction caused by stones affects renal function
• D. Stones cause colic intolerable
• E. Hard stones that are difficult to break with shock waves

Answer

A1-Type

CADED CDDAA BCADD CACDC

A2-Type

DABDE CCCED DEBAA CADAC

A4-Type

EBCAC DBDDA EADAD DADAC

B1-Type

ADABC DABE

X-Type

AB AC BC ABCD ABC