NIZAM’S INSTITUTE OF MEDICAL SCIENCES
Punjagutta, Hyderabad - 500 082, A.P., India.
Set: A
Question Booklet
Entrance Examination for Admission to MCh Urology
Subject MCh Urology
26 June 2011 Marks 90 Time: 01 hr : 30 min
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Q1. A 65-year-old male is being worked up for invasive bladder cancer (T3, N1, and
M0). Regarding the optimum management of this case, which of the following statements
is true?
A) radical cystectomy with adjuvant chemotherapy
B) radical cystectomy with extended lymph node dissection (ELND)
C) Neoadjuvant chemotherapy with radical cystectomy
D) Neoadjuvant/adjuvant chemotherapy with radical cystectomy and ELND
Q2. All of the following statements are correct regarding uroflowmetry except
A) in men Qmax decreases with age where as in women it is not influenced by age
B) the voided volume should be at least less than 150ml
C) multiple flow rates be recorded to improve accurancy of the test
D) uroflowmetry alone is insufficient to diagnose bladder out flow obstruction
Q3. A woman aged 50 years who underwent renal transplantation 2 years earlier
presented with pain in the left hip joint. She was receiving prednisolone, azathioprine, and cyclosporin. Shown below is the radiograph of the hip joint.
The most appropriate line of management is
A) replacement of prednisolone with deflazacort
B) parathyroidectomy
C) treatment with calcitriol
D) hip replacement
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Q4. All of the following drugs can cause urinary retention except
A) tricyclic antidepressants
B) anticholinergics
C) alpha - adrenergic receptor blockers
D) antihistamines
Q5. A patient with complete lesion of the spinal cord between spinal cord level T6 and S2 generally exhibits the following involuntary features
1. involuntary bladder contractions.
2. detrusor areflexia.
3. detrusor sphincter dyssynergia.
4. autonomic hyperreflexia
A) Only 1,2 and 3 are correct.
B) Only 1 and 3 are correct.
C) Only 2 and 4 are correct.
D) Only 4 is correct.
Q6. The most common renal vascular anomaly
A) supernumerary left renal artery
B) supernumerary right renal artery
C) supernumerary left renal vein
D) supernumerary right renal vein
Q7. Which one of the following procedures is recommended before resection of a large right-sided hepatocellular carcinoma?
A) left transarterial chemoembolization and left portal-vein embolization
B) left transarterial chemoembolization and right portal-vein embolization
C) right transarterial chemoembolization and left portal-vein embolization
D) right transarterial chemoembolization and right portal-vein embolization
Q8. According to the Center for Disease Control and Prevention (CDC) definition for surgical site infection in a surgery with an implant, the maximum time considered to define infection in a surgical implant is
A) 15 days
B) 30 days
C) six months
D) twelve months
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Q9. Histologically renal ischemia is most damaging to
A) proximal tubular cells
B) distal tubular cells
C) glomeruli
D) blood vessels
Q10. The most common cause of fetal hydronephrosis is
A) vesicoureteric reflux
B) posterior urethral valve
C) megaureter
D) PUJ obstruction
Q11. In a male patient with a pelvic fracture due to blunt trauma, retrograde
urethrography demonstrates disruption of membranous urethra. Which one of the following constitutes the appropriate initial treatment
A) passage of transurethral catheter
B) suprapubic cystostomy
C) perineal urethrostomy
D) bilateral percutaneous nephrostomy
Q12. The shock wave during extracorporeal shock wave lithotripsy is timed to coincide with a particular point in the electrocardiogram (ECG) and occurs
A) at the peak of the P wave
B) 20 msec after the peak of the R wave
C) 200 msec after the peak of the R wave
D) at the peak of the T wave
Q13. Most common cause of acquired renal arterio-venous fistula
A) needle biopsy of kidney
B) renal trauma
C) renal surgery
D) renal cell carcinoma
Q14. The growth of which one of the following renal calculi is not affected by
manipulation of urinary pH
A) cystine
B) uric acid
C) calcium oxalate
D) ammonium magnesium phosphate
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Q15. The number of ureteric constrictions along its course include
A) one
B) two
C) three
D) four
Q16. A 28-year old man presented with bilateral saddle anesthesia, prominent bowel and bladder dysfunction with relative preservation of muscle strength in the lower extremities. The most likely site of lesion is
A) cauda equina
B) peripheral neuropathy
C) lumbar segments (L3-L4) of the spinal cord
D) conus medullaris
Q17. In which of the following situations following a blunt trauma to abdomen will a CT imaging with contrast pick up significant renal injury
1. microscopic hematuria
2. microscopic hematuria with shock
3. urinary obstruction
4. gross hematuria
A) only 1, 2 and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct
Q18. What is the single most important preventive measure to control cross- infection
in hospitals.
A) use of gloves by health care workers
B) fumigation
C) prophylactic antibiotics
D) hand hygiene
Q19. All of the following are the indications for nephrectomy in a patient symptomatic
with genitourinary tuberculosis except
A) nonfunctioning kidney with calcification
B) nonfunctioning kidney without calcification
C) hydronephrosis due to PUJ stricture
D) extensive disease with hypertension
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Q20. Shown below is the distribution of the laboratory test results in normal and two different disease states (disease 1 and disease 2).
Assertion: The laboratory test is more reliable to diagnose disease 1 than the disease 2 Reason : Test reliability decreases if test result values in diseased population overlap with those of the normal population
A) Assertion and Reason are correct and Reason is the correct explanation of the Assertion
B) Assertion and Reason are correct and Reason is not the correct explanation of the Assertion
C) Assertion is true and Reason is false
D) Assertion is false and Reason is true
Q21. A 3-day old infant presented with gross hematuria. The child was born at 31 weeks of gestation by Cesarean section with meconium contamination. Examination revealed dehydrated child with unilateral palpable flank mass. The most probable
clinical diagnosis is
A) Wilm's tumor
B) infantile polycystic kidney disease
C) neuroblastoma
D) renal vein thrombosis
Q22. Which one of the following anatomical zones most commonly gives rise to benign prostatic hyperplasia
A) central zone
B) peripheral zone
C) transition zone
D) anterior fibromuscular stroma
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Q23. Which one of the following is the treatment of choice in children with normal renal function, mild bilateral hydronephrosis, and posterior urethral valves
A) primary endoscopic valve fulguration
B) percutaneous nephrostomy
C) vesicostomy
D) bilateral ureterostomy
Q24. A new serum marker that increases in a particular disease state is being evaluated. The graph below depicts the relationship between sensitivity and false positive rate for different cut-off values for the marker concentration in the serum.
Assuming that both correct diagnosis and ruling out the disease are equally important clinically, which one of the values represents the appropriate cut-off value
A) 200
B) 5
C) 75
D) 50
Q25. The principal mechanism for moving spermatozoa through the epididymis is
A) contraction of the cells around the epididymal duct
B) inherent spermatozoal mobility
C) movement of rete testis fluid
D) movement of cilia
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Q26. Lumbodorsal fascia connects anteriorly with
A) transversalis fascia
B) transversus abdominis muscle
C) internal oblique muscle
D) external oblique muscle
Q27. During developmental process of nephron, the ability to concentrate the urine reaches an adult value at the age of about
A) 8 months
B) 18 months
C) 48 months
D) 60 months
Q28. Which one of the following regimens is correct for basiliximab administration in renal transplantation
A) regimen 1
B) regimen 2
C) regimen 3
D) regimen 4
Q29. Which is safe and effective energy available today to fragment renal stones?
A) Pnuematic lithotripsy
B) Ultrasound lithotripsy
C) Laser lithotripsy
D) Electrohydraulic lithotripsy.
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Q30. The cell of origin of renal cell carcinoma is
A) proximal convoluted tubule
B) loop of Henle
C) distal convoluted tubule
D) collecting duct
Q31. Which of the following is commonly associated with the syndrome shown in the following clinical photograph
A) ureterocele
B) tethered cord syndrome
C) undescended testes
D) hypospadiasis
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Q32. Which one of the following types of exstrophy of the urinary bladder depicted in the diagrams below is most suitable for functional closure
A) diagram 1
B) diagram 2
C) diagram 3
D) diagram 4
Q33. To suspect ejaculatory duct obstruction, in a azoospermic man, all the following
findings are necessary except
A) both vas should necessarily be palpable
B) low semen volume
C) acidic semen pH
D) low semen fructose
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Q34. Regarding diagnosis of inflammatory carcinoma of breast
Assertion: It is best done by biopsy of breast lump
Reason: There is extensive involvement of dermal lymphatics
A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true
Q35. 25 year old male presents with primary infertility. On examination secondary
sexual characters are well developed, bilateral vasa are present and testis are normal.
Semen analysis reveals azoospermia. Which investigation is required next for further
evaluation.
A) vasography
B) serum FSH
C) testicular biopsy
D) serum testosterone
Q36. In a carcinoma rectum, the contraindication to anterior resection of rectum is
A) age >60 years
B) poorly differentiated histology
C) sigmoid lymphnodes
D) single hepatic metastasis
Q37. A 26 year old man is investigated for infertility associated with a low sperm count. Plasma FSH and LH are elevated with low testosterone level.Which of the following statements is/are correct?
1. A history of mumps may be relevant to his problem.
2.Testosterone concentration will increase on administration of clomiphene.
3. Data are consistent with primary testicular failure.
4. The presence of a pituitary tumour secreting gonadotrophins explains the data.
A) only 1,2 and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct
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Q38. Predictor/predictors of urosepsis following percutaneous nephrolithotomy
1.midstream clean catch
2. renal pelvic urine culture
3. bladder urine culture
4. stone culture
A) only 1,2 and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct
Q39. In the analysis of evidence for efficacy of therapy, highest weightage is given to
A) randomised controlled clinical trials
B) systematic reviews
C) cohort studies
D) meta-analysis
Q40. The ureter gets its blood supply from which of the following artery/ateries
1. common iliac artery
2. internal iliac artery
3. middle rectal artery
4. inferior vesical artery
A) only 1, 2 and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct
Q41. Management of renal abscess less than 3cms
A) observation
B) intravenous antibiotics and observation
C) USG / CT guided percutaneous drainage
D) open surgical drainage
Q42. Most effective long term treatment for post-prostatectomy incontinence secondary to sphincter dysfunction is
A) artificial urinary sphincter
B) urethral bulking agents
C) pharmacotherapy
D) bio feedback and pelvic floor exercises
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Q43. Radionuclide used for the treatment of bone metastasis is
A) technetium - 99
B) yittrium - 90
C) strontium - 89
D) Indium-111
Q44. A patient with bronchial asthma on bronchodilator therapy is scheduled for
laparotomy. The most suitable pulmonary function test to assess improvement in lung function is
A) forced vital capacity
B) total lung capacity
C) peak exporatory flow rate
D) maximum breathing capacity
Q45. The following drugs are used in Renal cell carcinoma
1. Sorafenib
2. Sunitinib
3. Temsirolimus
4. Dasatinib
A) Only 1,2 and 3 are correct
B) Only 1, and 3 are correct
C) Only 2 and 4 are correct
D) Only 4 is correct
Q46. The interlobular artery in the kidney arises from
A) segmental artery
B) lobular artery
C) interlobar artery
D) arcuate artery
Q47. A 10-month old girl was admitted with high grade fever associated with recurrent urinary tract infection. On the right side, ultrasound scanning revealed a duplex moiety with hydroureteronephrosis and ureterocele of the upper moiety with internal echos. Left kidney was normal. Immediate treatment of choice
A) percutaneous nephrostomy of the upper moiety
B) cutaneous ureterostomy
C) heminephroureterectomy of the upper moiety
D) endoscopic decompression of ureterocele
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Q48. Muscles (1,2 and 3) related to the posterior surface of right kidney in the diagram shown below represent which one of the following respectively
A) psoas major, quadratus lumborum, transversus abdominis
B) transversus abdominis, psoas major, quadratus lumborum
C) psoas major, transversus abdominis, quadratus lumborum
D) transversus abdominis, quadratus lumborum, psoas major
Q49. A 17-yr old boy is admitted to the hospital after an automobile accident. Except for a quiet abdomen, he has no localizing physical findings. After receiving 2000 mL of lactated Ringer's solution intravenously, his pulse rate is 90 beats per minute and blood pressure 110/70 mmHg. Abdominal CT scan reveals a laceration of the left lobe of the liver extending from the dome more than halfway through the parenchyma. Appropriate mangement at this time would be
A) bed rest and observation
B) abdominal exploration and ligature of intrahepatic blood vessels
C) abdominal exploration and packing of the hepatic wound
D) abdominal exploration and left hepatic artery ligation
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Q50. A kidney transplant recipient on multiple immunosuppressive drugs develops leukopenia. Which of the following is least likely to be the culprit drug
A) sirolimus
B) mycophenolate mofetil
C) azathioprine
D) tacrolimus
Q51. The findings of increased FSH level, normal LH and normal testestorone are suggestive of
A) isolated spermatogenic failure
B) post vasectomy
C) testicular failure
D) hypoganodotropic hypogonadism
Q52. Which one of the following drugs used in the management of prostatic cancer is an androgen receptor antagonist
A) goserelin
B) flutamide
C) finasteride
D) leuprolide
Q53. In endopyelotomy for PUJ obstruction, the recommended site of incision is
A) medial
B) anterior
C) lateral
D) posterior
Q54. Regarding flaccid state of the penis
1. smooth muscles are relaxed
2. smooth muscles are tonically contracted
3. arterial flow is significant
4. arterial flow is minimal
A) only 1, 2 and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct
Q55. Urine sample is not a midstream collection if there is presence of
A) Pus cells of 3 per high power field
B) Presence of corynebacteria
C) Presence of squamous epithelium
D) Presence of lactobacilli specially in females.
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Q56. Essential clinical evidence of brain death
1.unresponsiveness to all forms of stimuli
2.absent pupillary reaction
3.positive apnea test
4.absent deep tendon reflexes
A) only 1, 2 and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct
Q57. Anal incontinence will result from division of
A) the first sacral nerve roots bilaterally
B) the second sacral nerve roots bilaterally
C) the third sacral nerve roots bilaterally
D) the fourth sacral nerve roots bilaterally
Q58. The role of microbial biofilm in pathogenesis of infections
1. provides protection against epithelial adherence by microbes
2. conisists of many cells and polysaccharides
3. is important in microbial shedding from host
4. contributes to drug resistance of microbes
A) only 1, 2, and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct
Q59. BRCA-1associated breast cancer is most often associated with which of the following characteristics
A) infiltrative lobular cell type
B) her2/neu overexpression
C) well differentiated histology
D) hormone receptor negative
Q60. The avascular plane in the kidney runs
A) anterior to the anterior calyces
B) posterior to the anterior calyces
C) anterior to the posterior calyces
D) posterior to the posterior calyces
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Q61. Regarding renal cell carcinoma,
Assertion: There is little evidence of immune response to tumor cells
Reason: Tumor cells do not express specific tumor associated antigens on cell surface
A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion
B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion
C) Assertion is true, but Reason is false
D) Assertion is false, but Reason is true
Q62. The anterior urethra receives dual blood supply from
A) circumflex and cavernosal arteries
B) bulbar and dorsal artery of the penis
C) bulbar and circumflex arteries
D) cavernosal and bulbar arteries
Q63. Ability of sperm to fertilize the ova in humans is acheived maximally in
A) testes
B) proximal corpus of epiddidymis
C) distal corpus of epididymis
D) ductus deferens
Q64. Which of the following is the most essential interaction molecule for T cell activation?
A) CD4/CD8 molecule
B) CTLA 4 (CD52)/B7
C) CD28/B7
D) CD19/CD20
Q65. Which of the following malignancies has a high risk of recurrence after renal transplantation?
A) basal cell cancer
B) testicular cancer
C) thyroid cancer
D) myeloma
Q66. All types of primary neoplasms metastasize to the liver except those arising from
A) Lung
B) Brain
C) Gastrointestinal tract
D) Melanomas
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Q67. Keyhole sign in the fetus during antenatal ultrasonography is diagnostic of
A) hydronephrosis
B) hydroureteronephrosis
C) medullary pyramids
D) posterior urethral valves
Q68. A 12 year old boy presented with fresh bleeding per rectum. Colonoscopy
revealed a pedunculated single rectal polyp-1cm in diameter with a smooth and glistening surface. This type of rectal polyp would be
A) tubulovillous adenoma
B) inflammatory pseudopolyp
C) lymphomatous polyp
D) juvenile polyp
Q69. All of the following statements regarding postvoid residual (PVR) urine volume
associated with BPH are true except
A) residual (PVR) urine volume measurement has significant intraindividual variability
B) PVR does not correlate well with other signs or symptoms of prostatism
C) PVR can be measured with sufficient accuracy by ultrasound scanning
D) increased PVR indicates impending damage to bladder and kidneys
Q70. Most of the women who develop pyelonephritis in pregnancy, acquire it during
A) first month of pregnancy
B) first trimester of pregnancy
C) second trimester of pregnancy
D) third trimester of pregnancy
Q71. A 30 year male presented to emergency with acute right loin pain radiating to
groin of 2 hrs duration. What is your choice of investigation to manage this case
A) plain X-ray KUB
B) ultrasonography of the abdomen
C) unenhanced CT
D) MRI
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Q72. In the treatment of lower calyceal stones by extracorporial shock wave lithotripsy (ESWL), all of the following factors are important except
A) infundibulopelvic angle
B) position of the patient
C) lower calyceal pattern
D) infundibular diameter
Q73. An obese woman aged 50 years presenting with grade III stress urinary
incontinence, of the surgical procedures listed below, the preferred method is
A) tension free vaginal tape (TVT)procedure
B) tension free vaginal trans obturatory tape (TOT)
C) Gittes Bladder neck suspension
D) anterior colporrhaphy
Q74. Components of seminal vesicle secretion includes all of the following except
A) D-fructose
B) prostaglandin-A
C) Ig A antibodies
D) prostaglandin-E
Q75. The mechanism of action of sildenafil citrate is through
A) inhibition of type II alpha reductase
B) nitric oxide /cyclic GMP pathway
C) local release of endothelins
D) inhibition of cytochrome P-450 enzyme
Q76. The normal volume of renal pelvis and calyces is not more than
A) 0.8 mL
B) 8.0 mL
C) 80 ml
D) 800 mL
Q77. Urine production in the fetus of human kidney is known to begin at about
A) 10-12 weeks
B) 14-16 weeks
C) 20-22 weeks
D) 24-26 weeks
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Q78. Spastic bladder can be treated with
A) tizanidine
B) oxybutynin
C) bethanechol
D) baclofen
Q79. In a patient with chronic renal failure, renal ultrasound showed the presence of a
more than one cm difference in kidney size.The etiology of the renal disease could be
1. diabetes
2. ureteric reflux
3. amyloidosis
4. fibromuscular dysplasia
A) only 1, 2 and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct
Q80. The cuff of an endotracheal tube should be inflated to what pressure to prevent aspiration while not causing ischemia to underlying laryngeal mucosa
A) 5 mm Hg
B) 20 mm Hg
C) 40 mm Hg
D) 60 mm Hg
Q81. The concept of urethral plate 'relaxing incision' as an adjunct to hypospadias repair is used in
A) Snodgrass's TIP urethroplasty
B) MAGPI
C) Duckett's preputial island flap
D) Mathieu's perimeatal based flap
Q82. On T1 weighted MRI images, fluid appears
A) bright
B) dark
C) not seen
D) variable
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Q83. The parotid salivary gland receives its parasympathetic innervation from which one of the following nerves
A) Vagus
B) Facial
C) glossopharyngeal
D) oculomotor
Q84. All of the following are the requirements for fluids suitable for irrigation during transurethral resection of the prostate except
A) clear to vision
B) capability of conducting electricity
C) isotonic
D) nonhemolytic
Q85. End-stage testes are seen in
A) bilateral cryptorchidism
B) maturation arrest
C) Young's syndrome
D) Klinefelter's syndrome
Q86. Which one of the following drugs used in the treatment of human immunodeficiency virus infection is known to cause urolithiasis
A) zidovudine
B) lamivudine
C) indinavir
D) stavudine
Q87. The following are true in development of human kidney
1. the kidney derives from the intermediate endoderm
2. the ureteric bud developes as an outgrowth of the Wolffian duct
3. cells of the pre-tubular aggregates undergo epithelial-to-mesenchymal conversion to become renal vesicle
4. the renal vesicle forms the glomerulus and tubule from the proximal convoluted tubule to the distal convoluted tubule
A) only 1,2 and 3 are correct
B) only 1 and 3 are correct
C) only 2 and 4 are correct
D) only 4 is correct
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Q88. A 45-year old man presented with raised renal parameters six weeks after renal transplantation. Ultrasound examination revealed a large lymphocele compressing the graft ureter with hydroureteronephrosis. The next line of management
A) percutaneous catheter drainage
B) double "J" stenting of the graft ureter
C) percutaneous nephrostomy
D) laparoscopic deroofing of the lymphocele
Q89. Which one of the following diagrams depicted below represents the correct nephrotomy incision (dashed line)
A) diagram 1
B) diagram 2
C) diagram 3
D) diagram 4
Q90. In male infertility, indication for endocrinal evaluation includes
A) absent ejaculation
B) asthenospermia
C) sperm density between 5-10 million per ml
D) maturation arrest