1000+ Urinary Calculus Disease MCQ for CEED [Solved]

1. What is (are) the indication(s) of ureteral stenting before ESWL?
A. stones in a solitary kidney
B. ureteral stones causing bilateral obstructions
C. a kidney stone of ? 2.5 cm in size
D. all of the above
Answer : D

2. Why do patients with cystic fibrosis form stones?
A. because urine and body secretions are highly concentrated
B. due to renal leak hypercalciuria
C. as a result of distal renal tubular acidosis type I
D. because of reduced or absent of oxalobacter formigenes colonization
Answer : D

3. What is true regarding DJ ureteral stents?
A. can be placed through perc. nephrostomy
B. might slip out, especially in females
C. usually radiopaque
D. all of the above
Answer : D

4. What is the most common composition of ureteral stones?
A. Ca.phosphate
B. Ca.oxalate
C. Na.urate
D. struvite
Answer : B

5. What is true regarding prostatic stones?
A. they are multiple and small in size
B. usually, they are voided spontaneously
C. they, rarely, form large stones within the peripheral zone
D. contrast CT is the conventional method for diagnosis
Answer : A

6. As per the fixed particle theory of stone formation:
A. the initial step is papillary plaque formation
B. crystals formation occurs inside the nephron
C. tubular precipitates form harmless crystalluria
D. the attraction of organic compounds and activation crystallization is regulated by osteopontin
Answer : A

7. In what kind of renal stones do antibiotics help most?
A. indinavir
B. magnesium ammonium phosphate
C. xanthine
D. matrix
Answer : B

8. What type of urinary diversion carries the highest risk of stone formation?
A. Kock pouch
B. Neobladder-to-urethra diversion
C. Florida pouch
D. Indiana pouch
Answer : A

9. What situation carries lower risk for lung injury during supracostal upper pole access for PCNL?
A. placing the patient in anti-Trendelenburg position
B. making the puncture under local anesthesia
C. injection Co2 gas to create a safety space under the diaphragm before puncturing
D. making the puncture during full expiration
Answer : D

10. What is a remarkable disadvantage of ultrasonic imaging for ESWL?
A. localization of stones in the ureter is difficult or impossible
B. inability to visualize stones breaking down in real time
C. c. patient`s position on ESWL table is uncomfortable
D. d. inability to visualize radiolucent stones
Answer : A

11. How does oral Mg.citrate inhibit Ca.oxalate stone formation?
A. by lowering urinary saturation of Ca.oxalate
B. by preventing heterogeneous nucleation of Ca.oxalate
C. by inhibiting spontaneous precipitation and agglomeration of Ca.oxalate
D. by all of the above
Answer : D

12. What medication(s) could be helpful in the management of cystinuria?
A. ?-Mercaptopropionylglycine
B. d-Penicillamine
C. a & b
D. none of the above
Answer : C

13. A 24-hr urine collection of a recurrent Ca. oxalate stone former patient having Crohn`s disease might reveal:
A. high citrate, high oxalate
B. low citrate, low oxalate
C. high citrate, low oxalate
D. low citrate, high oxalate
Answer : D

14. What is the least likely condition to form bladder stones?
A. spinal cord injury
B. senile enlargement of prostate
C. augmented bladder
D. neurogenic hyper-reflexive bladder
Answer : D

15. What is the most favorable stone characteristics for laparoscopic and robotic approaches for the treatment of a kidney stone?
A. a stone in the lower calyx with a wide mouth of infundibulum and obtuse lower calyx to ureter angle
B. a stone in an anterior group calyceal diverticulum with thin overlying renal parenchyma
C. 5 mm calcium-containing stone in an intrarenal pelvis and wide UPJ
D. 6 years post anatrophic nephrolithotomy, recurrent mid calyceal stone
Answer : B

16. Ureteral stones of ? 7 mm:
A. should be treated with more analgesics
B. must undergo metabolic worked out
C. are unlikely to pass out spontaneously
D. chemolysis should be tried first
Answer : C

17. What type of stones do laxative abusers might develop?
A. ammonium urate
B. sodium urate
C. calcium oxalate
D. calcium phosphate
Answer : A

18. What is the most important parameter that determines the treatment modality of a kidney stone?
A. stone chemical composition
B. stone burden
C. first stone vs. recurrent
D. stone density
Answer : B

19. Which of the following is a relative contra-indication to ESWL?
A. renal insufficiency
B. active urinary tract infection
C. uncorrected bleeding disorder
D. third trimester pregnancy
Answer : A

20. What stones are radiopaque on plain X-ray film?
A 2,8 dihydroxyadenine stones
B. sulfa medications-induced stones
C. calcium oxalate stones
D. matrix stones
Answer : C

21. What could high level of sulfate in 24-hr. urine collection mean?
A. dissolving homogenous nucleation
B. high tendency to form cystine sulfate stones
C. indicates the amount of dietary protein
D. post ESWL therapy
Answer : C

22. What is the principal defect in renal hypercalciuria?
A. impaired renal tubular calcium reabsorption
B. excessive glomerular leak of calcium
C. deficiency of the enzyme xanthine oxidase
D. hypercalcemia
Answer : A

23. When urine reaches a high tendency to form stones, the situation is called:
A. lithogenic anion to cation ratio
B. Randall cut off
C. saturation index
D. solubility product
Answer : C

24. What is the unfavorable stone characteristic for a rigid URS treatment?
A. size of 5 mm
B. location at the lower calyx
C. density of 400 HU
D. being recurrent
Answer : B

25. What is false concerning obesity and urinary stone formation?
A. obese patients have a higher tendency for uric acid stone formation
B. high-protein, low-carbohydrate diet might increase the risk of stone formation and bone loss
C. metabolic syndrome is associated with high urinary pH
D. Roux-en-Y-gastric bypass surgery may increase the risk for stone formation
Answer : C

26. What is false concerning cystine stones?
A. result from an inherited defect of renal tubular reabsorption of cysteine
B. characteristically, urate and cysteine stone are radiolucent
C. cysteine is a dibasic amino acid
D. on plain X-ray, cysteine stones exhibit ground-glass appearance
Answer : B

27. What is the most favorable stone characteristic for PCNL treatment?
A. ? 2 cm diameter
B. upper calyx location
C. Na.urate composition
D. 600 - 800 HU density
Answer : A

28. What is false concerning urethral stones?
A. stones at posterior urethra could be pushed back to the bladder
B. stones at anterior urethra have to undergo a trial of milking out, using copious intra-urethral xylocaine gel
C. often respond to a two-week course of tamsulosin
D. respond to Holmium laser treatment
Answer : C

29. Which statement is false concerning renal stones related to hyperparathyroidism (HPT)?
A. renal stones are found in 20% of patients with primary HPT
B. acidic arrest promotes crystallisation of calcium phosphate stones related to HPT
C. HPT, vitamin D excess, and malignancy could lead to hypercalcemia and hypercalciuria
D. only surgery can cure primary HPT
Answer : B

30. Which of the following factors, positively, affect lower calyceal stone clearance after ESWL?
A. short and wide infundibulum
B. large lower-pole infundibulo-pelvic angle
C. the adjunct usage of PCNL
D. all of the above
Answer : D

31. What is the immediate management of ureteral avulsion on retrieving an upper ureteral stone by a basket?
A. placement of a percutaneous nephrostomy drain
B. surgical exploration and primary repair
C. conservative management
D. endoscopic retrograde ureteral stenting
Answer : A

32. What is false concerning preputial stones?
A. form due to inspissated smegma
B. form due to stasis of urinary salts
C. cause inguinal lymphadenopathy
D. often associated with phimosis in uncircumcised males
Answer : C

33. Worldwide, the commonest type of urinary stones is:
A. calcium monohydrate
B. calcium oxalate
C. ammonium urate
D. none of the above
Answer : B

34. What kind of stones is most amenable to ESWL?
A. cystine
B. brushite
C. Ca.oxalate monohydrate
D. Ca.oxalate dihydrate
Answer : D

35. What is the least serious complications of PCNL?
A. uncontrollable bleeding
B. incomplete removal of stones
C. pneumothorax
D. colonic perforation
Answer : B

36. What metabolic disturbances could result from renal tubular acidosis type I?
A. hypercalciuria and hypocitraturia
B. hypercalciuria and hypercitraturia
C. hypocalciuria and hypocitraturia
D. hypocalciuria and hypercitraturia
Answer : A

37. What is false concerning the use of antibiotics in stone patients?
A. they are mandatory when urine shows ? 10 WBCs/hpf in symptomatic patients
B. they aim at treating pyonephrosis and urosepsis
C. they should cover Escherichia coli and Staphylococcus, Enterobacter, Proteus, and Klebsiella species
D. All of the above
Answer : D

38. Which method of the following stone analysis techniques is based on the interaction of polarized light with the stone crystals?
A. wet chemical analysis
B. thermogravimetry
C. scanning electron microscopy
D. none of the above
Answer : D

39. For how long a completely obstructed ureter could be respited with no expected permanent damage to renal functions?
A. 2 days
B. 2 weeks
C. 2 months
D. 4 6 hrs.
Answer : B

41. What is the preferred irrigation fluid during PCNL?
A. physiological saline 0.9%
B. glycine 1.5%
C. balanced salt solution
D. distilled water
Answer : A

42. What is false concerning primary bladder stones?
A. commoner in females than in males
B. in pediatrics, are of calcium oxalate and/or ammonium urate composition
C. caused by bladder outlet obstruction
D. might result in bladder cancer
Answer : A

43. What parameter impairs the kidney stone-free rate, after ESWL?
A. short skin-to-stone distance (SSD)
B. end-stage renal failure
C. a stone in the upper calyx
D. the presence of a 30 cm, 4.7 Fr ureteral stent in situ
Answer : B

44. What is the fatality risk if a triple-phosphate staghorn stone left untreated?
A. 0 10%
B. 10 20%
C. 20 30%
D. 30 40%
Answer : C

45. What is false concerning PCNL in horseshoe kidneys?
A. the preferred access into the collecting system is through a posterior calyx
B. the posterior calyceal group is typically more medial than in the normal kidney
C. in most cases the lower pole calyces are posterior
D. it is desirable to make an upper pole collecting system puncture
Answer : C

46. Expectant therapy for ureteral stones is indicated when:
A. stone size of ? 4 mm
B. stone burden of ? 22 mm
C. there is a distal partial obstruction
D. the patient has end-stage renal failure
Answer : A

47. What is false concerning prostatic stones?
A. composed of calcium phosphate and calcium carbonate
B. the vast majority are asymptomatic
C. most of the calculi are found in the transitional zone
D. they dont affect PSA levels
Answer : C

48. What could the discomfort experienced during ESWL session be related to?
A. the energy density of the shock waves as they pass through the skin
B. the size of the focal point
C. a & b
D. none of the above
Answer : C

49. During pyelolithotomy for removing a staghorn urate stone; how to ensure a complete removal of calyceal branches?
A. by performing intra-operative ultrasonography
B. by performing radial nephrotomies
C. by performing adjunct PCLN
D. by taking a scout KUB film
Answer : A

50. What bowel surgery could result in enteric hyperoxaluria?
A. right hemicolectomy
B. small bowel resection
C. Roux-en-Y gastric bypass
D. b & c
Answer : D