Urinary Calculus Disease MCQ Solved Paper for ISRO Recruitment

1. 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

2. 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

3. What is the sure diagnostic finding of Ca.oxalate stones?
A. chemical analysis of a recovered stone
B. hypercalcemia
C. CT finding
D. high breakability on ESWL
Answer : A

4. What could high dietary protein result in?
A. increase urinary calcium, oxalate, and uric acid excretion
B. decrease urinary calcium; but increase oxalate, and uric acid excretion
C. increased urinary calcium and uric acid; but decrease oxalate excretion
D. decreased urinary calcium, oxalate, and uric acid excretion
Answer : A

5. What is false concerning struvite stones?
A. the commonest to form staghorn giant calculi
B. formed by urease producing bacteria
C. antibiotics have a role in the treatment
D. form at the two extremes of urinary pH range
Answer : D

6. 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

7. 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

8. 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

9. What is false concerning primary bladder stones?
A. commonly occur in patients with senile prostatic enlargement
B. common in children exposed to low-protein, low-phosphate diet
C. rarely recur after treatment
D. respond to ESWL
Answer : A

10. 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

11. What is the treatment of choice for a 15 mm stone in a mid calyceal diverticulum?
A. ESWL
B. PCNL with fulguration of the diverticulum
C. ureteroscopy with fulguration of the diverticulum
D. pyelolithotomy with diverticulectomy
Answer : B

12. On treating uric acid stones, excessive alkalinization with potassium citrate could result in all of the following, EXCEPT:
A. formation of triple-phosphate stones
B. infection with Proteus species
C. increase production of endogenous uric acid
D. increase level of uric acid in THE blood
Answer : C

13. 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

14. What is true concerning primary hyperparathyroidism and stone formation?
A. orthophosphates may have a role in the treatment
B. hyperparathyroidectomy and levothyroxine replacement is the optimum treatment
C. management includes Calcium chelating agent and repeat 24hr urine collection in 3 months
D. surgical excision of the adenoma(s) is the treatment of choice
Answer : D

15. 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

16. 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

17. What is false concerning staghorn calculus?
A. commonly unilateral
B. commonly due to repeated infections
C. urate stones are the second most common cause of staghorn calculi
D. ESWL monotherapy with ureteral stenting is the ideal treatment
Answer : D

18. How can the effectiveness of ESWL treatment session be enhanced?
A. by ensuring optimal coupling of the patient to the lithotripter
B. by running the treatment at a slower rate (60 shocks/min)
C. by running the treatment with general anesthesia
D. by all of the above
Answer : D

19. When should renal stone patients be evaluated for metabolic diseases?
A. when stones are multiple and/or recurrent
B. when stones form in childhood
C. in cases where nephrocalcinosis and urolithiasis are present
D. all of the above
Answer : D

20. 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

21. Which event is unlikely to occur after placing a DJ ureteral stent?
A. can be forgotten in place
B. vesico-renal reflux
C. calyceal perforation
D. detrusor irritability and/or hematuria
Answer : C

22. The process where nucleation and further precipitations occur by different components to form urinary stones, is called:
A. classical nucleation theory
B. heterogeneous nucleation
C. suspension solution
D. concentric lamination
Answer : B

23. What is the most common organism that might complicate PCNL?
A. Proteus mirabilis
B. E. coli
C. Pseudomonas aeruginosa
D. Staphylococcus epidermidis
Answer : D

24. What type of stones is most effectively treated with PCNL?
A. Ca.oxalate monohydrate
B. cystine
C. matrix
D. Ca.oxalate dihydrate
Answer : C

25. 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

26. 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

27. Patients having what kind of stones should refrain from eating purines?
A. cysteine
B. urate
C. calcium
D. none of the above
Answer : D

28. 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

29. 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

30. 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

31. 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

32. 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

33. What is true concerning the use of intravenous fluids in renal colic cases?
A. patients should be given large amounts of fluids to hasten stones passage
B. fluids are given to keep the patient well hydrated
C. the recommended regimen is 2 L of ringer lactate over 2 hours
D. fluids are contraindicated if desmopressin (DDAVP) was given
Answer : B

34. 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

35. Which of the following bacteria split urea?
A. Klebsiella pneumonia
B. Morganella morganii
C. Proteus mirabilis
D. all of the above
Answer : D

36. What parameter is NOT considered in the stone burden concept?
A. the surface area of the stones
B. the volume of the stones
C. the density of the stones
D. the number of the stones
Answer : C

37. What medications do NOT cause renal stones?
A. ciprofloxacin
B. indinavir
C. thiazides
D. triamterene
Answer : C

38. What is false concerning neonatal nephrolithiasis?
A. frequently caused by loop diuretics
B. stones are often radiolucent
C. may be reversed by the use of thiazides
D. low calcium-to-creatinine ratio predicts stones resolution
Answer : B

39. What condition might NOT cause uric acid stones?
A. Tumor lysis syndrome
B. hypoparathyroidism
C. myeloproliferativ disorder
D. Lesch-Nyhan syndrome
Answer : B

40. What is the most appropriate antibiotic class for prophylaxis before urologic surgery?
A. aminoglycosides
B. macrolides
C. cephalosporins
D. fluoroquinolones
Answer : C

41. What is the treatment of choice for a 15 mm stone in the lower calyx with a narrow infundibulum?
A. ESWL
B. PCNL
C. radial nephrolithotomy
D. pyelolithotomy with ureteral stenting
Answer : B

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

43. What stone is inherited as an autosomal recessive trait?
A. xanthine
B. ammonium urate
C. cystine
D. calcium oxalate dihydrate
Answer : C

44. Invasive intervention in stone patients is NOT indicated in the following condition:
A. stone size
B. unrelieved obstruction
C. infection and septicemia
D. recurrent stone formation
Answer : D

45. 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

46. What type of shockwaves is generated by spark-gap technology?
A. piezoelectric
B. electrohydraulic
C. electromagnetic
D. microexplosive
Answer : B

47. What is the composition of brushite stones?
A. calcium phosphate
B. calcium oxalate monohydrate
C. sodium urate
D. 2,8 dihydroxyadenine
Answer : A

48. 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

49. What is the Hounsfield density range of uric acid stones?
A. 400 600 HU
B. 600 800 HU
C. 800 1000 HU
D. 1000 1200 HU
Answer : A

50. What is false regarding DJ ureteral stents?
A. can be introduced from the bladder or kidney or any part of the ureter`s course
B. the standard adult size is 32 cm long, 4 mm calibre
C. might result in encrustations and ureteral obstruction
D. might result in ureteral dilation
Answer : B