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4. To treat priapism after the use of intracavernosal injections, the first step is:
Α. intracavernosal administration of a sympathomimetic agent
Β. bloodletting
C. cold packs
D. invasive manipulation
9. PDE5 inhibitors:
Α. should be provided with caution to patients taking nitrates
Β. can be administered independently from food intake
C. must be provided to the maximul tolerated dose before characterizing a patient as "non-responsive"
to PDEi
D. is contra-indicated when the patient receives alfuzosin at the same time
10. A 45-year old diabetic patient responding initially to sildenafil for about 3 years, reports that his
erection is no longer sufficient enough to achieve sexual intercourse. The next step is to:
Α. increase the dose on demand up to 200mg
Β. test serum testosterone level
C. check diabetes control
D. test serum testosterone level, control diabetes and re-administrate sildenafil (100mg)
14. In a patient with moderate insufficiency of the corpora cavernosa, what do we expect from the
shock-wave therapy?
Α. Functional restoration
Β. Improvement, but also need for permanent use of PDE5i for functional erection
C. No clinically significant improvement
D. All the above are equally possible to occur
15. A 67-year old hypertensive patient with erectile dysfunction for 5 years, was prescribed with
sildenafil 100mg. The patient took tablets at 10 different instances always with empty stomach and at
least 1 hour before sexual contact. 5 out of 10 times, his erection was satisfactory with regard to
rigidity and duration. Two (2) times his erection was sufficient for penetration, without though
satisfactory duration. The other 3 times there was penile tumescence but this was not enough for
penetration. This patient is considered:
Α. to respond to sildenafil treatment
Β. not to respond to sildenafil treatment
16. According to a prospective, placebo-controlled, crossover clinical study, the add-on therapy with
intracavernosal PGE-1 every 2 weeks in patients with partial response even to the maximum sildenafil
dose significantly improves IIEF‐EF score by:
Α. 15%
Β. 65%
C. 25%
D. 30%
21. All medications mentioned below may cause erectile dysfunction, apart from:
Α. antihypertensives
Β. antifungals
C. tranquillizers
D. anithistamines
22. Which hormonal factor is not required in order to assess erectile dysfunction?
Α. ACTH
Β. Prolactin
C. TSH
D. Τestosterone
23. Pharmaceutical agents for the treatment of erectile dysfunction act by inhibiting the PDE5 action,
which is responsible for:
Α. testosterone degradation
Β. degradation of cyclic-GMP in the penis
C.degradation of NO in the penis
D. None of the above
24. A 50-year hypertensive man visits the Urologist due to erectile dysfunction. He tried a PDE5
inhibitor with no result. The next step should be:
Α. to use another PDE5 inhibitor
Β. to switch to intracavernosal injections
C. to check thoroughly the drug administration route and dosage
D. to discontinue immediately the antihypertensive regimen
25. Which of the factors below contribute to the emergence of erectile dysfunction?
Α. Depression and unemployment
Β. Hypertension and heart diseases
C. Diabetes
D. All the above
26. Which of the conditions below may be related to normal erectile function?
A. Mild arterial insufficiency with normal venous closure mechanism
Β. Severe arterial insufficiency with normal venous closure mechanism
C Normal arterial blow with insufficient venous closure mechanism
D. All the above
28. Why does the relaxation of a few cavernosous muscle fibres induce erection?
Α. Because the two corpora cavernosa communicate with each other
Β. Because there are gap junctions among smooth muscle fibers
C. Because the drug diffuses
D. None of the above
29. What pO2 values of the penis are required to achieve erection?
Α. <20mmHg
Β. 40-50mmHg
C. 60-70mmHg
D. >80mmHg
1. In 100 male patients visiting the Outpatient Clinic with LUTS and OAB:
Α. 1% are likely to develop bladder cancer
Β. 60% are likely to develop benign prostatic obstruction (BPO)
C.22% are likely to develop benign prostatic obstruction (BPO)
D. A & B are correct
E. A & C are correct
2. How many patients with bladder cancer undergoing secondary re-staging transurethral
resection (re-TUR), will be substaged after the re-TUR?
Α. 5%
Β. 13%
C. 25%
D. 40%
3. Which of the following factors plays the least role for survival in muscle-invasive bladder
cancer?
Α. Age
Β. Lymphnode metastases
C. The pathoanatomical stage of the disease
D. The ratio infiltrated : removed lymphnodes
4. The best time period for assessing mortality and complications after radical cystectomy is:
Α. 30 days after radical cystectomy
Β. 60 days after radical cystectomy
C. 90 days after radical cystectomy
D. throughout the patient's hospital stay
7. Candidates for partial cystecomy after preoperative chemotherapy ARE NOT the patients with:
Α. CIS (carcinoma in situ)
Β. good bladder capacity
C. solitary tumor
D. full response to chemotherapy
8. Which of the following statements about preoperative chemotherapy in bladder cancer is true?
Α. Response is the most important prognostic factor.
Β. Preoperative chemotherapy is more effective than adjuvant chemotherapy.
C. Preoperative chemotherapy can be used in patients with lymphnode or visceral disease.
D. Preoperative chemotherapy should be used in all patients.
13.The most effective adjuvant intravesical BCG therapy in patients with T1G3 tumor ........
Α. starts on the 3rd postoperative day, with only one single 12-week continuous infusion therapeutic
cycle
Β. consists of only one single 6-week continuous infusion therapeutic cycle
C. consists of one single 6-week infusion therapeutic cycle, followed by a maintenance scheme of one
infusion/time during the follow-up period
D.consists of an initial 6-week infusion therapeutic cycle, followed by a maintenance scheme of three
weekly infusions/time during follow-up
24. Which of the following is TRUE with regard to the value of intravesical infusion of cytotoxic
agents immediately after the transurethral resection (TUR) of a non-invasive tumor ?
A. It reduces the relative relapse risk by 40%.
B. It is beneficial both in solitary and multiple tumors.
C. The greatest benefit occurs when the infusion takes place within 24 hours after TUR.
D. There are no differences between drugs, with regard to efficacy.
E. All the above
26. How likely is it for a Τ1G3 bladder tumor that has relapsed within the first trimester after
intravesical BCG infusions to invade the muscular wall?
A. < 10%
B. 20%
C. 30-50%
D. >80%
PART 3
Renal Cancer
1. RCC is multifocal in:
Α. 1% of cases
Β. 5% of cases
C. 10% of cases
D. 15% of cases
7. Which of the following statements about metastatic renal cancer therapy is FALSE?
Α. Targeted therapy with Sunitinib is the first-line treatment for high-risk patients.
Β. Targeted therapy with Temsorilimus is the first-line treatment for high-risk patients.
C. Partial response rate to Sunitinib amounts to 40%.
D. Sorafenib is a second-line treatment in metastatic renal cancer.
Ε. Targeted therapy usually does not provide cure.
8. The strongest indication for using radio waves on the kidney is:
Α. transitional cell carcinoma of the renal pelvis
Β. angiomyolipoma of 4cm
C. renal tumor 7cm of the lower pole
D. renal tumor 3cm and ASA score 3
Ε. renal tumor 3cm and a normal contralateral kidney
PART 4
Prostate Cancer
1. Which of the following IS NOT a contra-indication for brachytherapy?
Α. Prostate size 90cm3
Β. Clinical stageΤ3α
C. IPSS=9
D. Gleason Score 9(4+5)
Ε. None of the above
F. Β and C
2. Which of the following factors DOES NOT AFFECT survival rate after prostate cancer
therapy?
Α. iPSA
Β. Type of therapy
C. Clinical stage
D. Age
Ε. Β and D
F. Α and Β
4. With regard to urinary symptoms after brachytherapy, which of the following is FALSE?
Α. Post-brachytherapy incontinence is very common.
Β. More than 90% of patients present increase of IPSS within the first months following brachyterapy
C. Bladder-neck resection before brachytherapy may improve IPSS.
D. None of the above
5. In a patient with T1 prostate cancer and survival expectancy over 10 years, radical
prostatectomy:
Α. provides cure
Β. improves quality of life
C. increases the survival rate
D. reduces the risk for metastasis
Ε. C and D
F. B and C
6. Which therapeutic method for localized prostate cancer is more effective according to
literature?
Α. Radical prostatectomy
Β. Radical external radiation
C. HDR brachytherapy
D. LDR brachytherapy
12. Which finding from prostate biopsy is the most useful to predict extraprostatic expansion of
cancer?
Α. Degree of differentiation
Β. Number of positive biopsies
C. Perineural invasion
D. All the above
13. According to TNM 2009, microscopic bladder neck invasion is classified as:
Α. Τ4
Β. Τ3α
C. Τ3β
D. Τ2β
15. The risk for lymph-node metastasis in a patient with prostate cancer depends mainly on the:
Α. age
Β. stage
C. Gleason score
D. B and C
18. For patients who presented biochemical relapse after radical prostatectomy, which of the
following factors are related more to local relapse than to remote metastasis?
Α. First measurable PSA value 6 months after surgery, Gleason score >7, pathological stage Τ3
Β. Age below 70y.o. at the time of relapse, first measurable PSA value < 2 ng/ml, Gleason score <5
C. Histological absence of seminal vesicles and lymph-nodes, Gleason score <5, first measurable PSA
value one year after surgery, PSA doubling-time (PSADT) >6 months
D. Pathological stage Τ2, Gleason score 8 to 10, negative bone scintigram
Ε. First measurable PSA value 4 months after surgery, negative biopsy of prostatic bed, PSA doubling-
time (PSADT) <3 months
19. In clinically localized prostate cancer, what are the chances for biochemical relapse-free
survival within 5 years?
Α.. 0-10%
Β. 20-30%
C. 40-50%
D. 60-70%
Ε. 70-80%
20. According to Partin's Tables, a patient with PSA 7.4 before biopsy, Gleason score 3+4=7 at
biopsy and negative digital examination (Τ1c) before biopsy has all following risks APART
FROM:
Α. 49% risk for localized disease inside the gland
Β. 40% risk for focal invasion of the capsule
C. 22% risk for pelvic lymph-node invasion
D. 97% risk for in situ/ localized disease
Ε. 8% risk for seminal vesicle invasion
21. All the following are prognostic factors for radiotherapy salvage after radical prostatectomy,
APART FROM:
Α. PSA levels before radiation therapy
Β. PSA doubling time (< 10-12 months)
C. time until the occurrence of biochemical relapse (< 2-3 years)
D. the patient's age
22. Which of the following statements is TRUE?
Α. Laparoscopic radical prostatectomy is a new minimally invasive method for the treatment of
prostate cancer.
Β. Robot-assisted radical prostatectomy is a well-documented radical oncological procedure that can
be performed even with minimal access
24. In order to achieve higher neuroprotection during nerve-sparing radical prostatectomy, the
periprostatic fascia (PPF) is incised:
Α. on the ventral aspect of the prostate
Β. superiorly, on the dorso-lateral aspect of the prostate
C.on the mid-lateral aspect of the prostate
D. at the apex of the prostate
Ε. at any point of the prostate - this does not seem to affect the number of nerve fibers spared.
25. During radical prostatectomy and in order to achieve a better oncological result, the surgeon
will procceed to prostate dissection following the:
A. interfascial technique
Β. intrafascial technique
C. extrafascial technique
D. posterior technique, through Denonvillier's fascia
Ε. All above techniques have the same oncological result.
26. Which of the following surgical procedures does NOT seem to play a particular role in
achieving continence after radical prostatectomy?
Α. Preservation of puboprostatic ligaments
Β. Fixation of the vesico-urethral anastomosis
C. Restoration/ preservation of puboperineal muscles
D. At least 8 sutures for the vesicourethral anastomosis
Ε. Α and D
27. According to the latest literature on prostate biopsy, the following is true:
Α. Aspirin administration has to be discontinued and there is need for periprostatic xylocaine
infiltration.
Β. Aspirin administration has to be discontinued. Local anesthesia does not help.
C. Aspirin administration can continue. Local application of xylocaine gel reduces pain.
D. Aspirin has to be replaced with heparin. Local anesthesia with xylocaine gel is preferrable.
28. Which of the following clinical factors is positively correlated with the pathoanatomical stage
following salvage radical prostatectomy?
Α. The time period since the completion of radiation therapy.
Β. The degree of malignancy at the time of biopsy.
C. PSA<10ng/ml at the time of salvage surgery.
D. The patient's age at the initial diagnosis of prostate cancer.
Ε. PSADT (PSA doubling-time)
30. One year following radiation therapy, serum PSA dropped within "normal
values" (2,5 ng/ml) and started rising again, with consecutive values 3,5 and 5,1 ng/ml within 6
months. What should be done next?
Α. Inform the patient that radiation therapy "did not work" and recommend salvage prostatectomy and
cryotherapy.
Β. Explain to the patient that his PSA is still normal and he should not worry.
C. Inform the patient that his disease has relapsed and that increase in PSA implicates systemic
disease.
D. None of the above.
Ε. Α and Β
PART 5
BPH
1. Which of the following statements about transurethral laser is TRUE?
Α. Transurethral laser can reduce prostatic volume even up to 45%
Β. Transurethral laser can reduce IPSS by 60-92%
C. Transurethral laser can reduce post-void residual urine by 60-88%
D. Α and Β
Ε. Α , Β and C
2. The use of KTP (Greenlight Laser) may lead to the following complication/s:
Α. urinary incontinence <1%
Β. urethral stricture <1%
C. urinary tract infection (UTI) 15-20%
D Α and Β
Ε. A, B and C
3. Marginal factor/s that may lead to failure with α-blockers include the following:
Α. prostate size > 50ml
B. Qmax < 15 ml/s
C. PSA > 2,5ng/ml
D. None of the above
Ε. All the above
8. Which of the following techniques is NOT used for removing the Foley catheter?
Α. Overfilling of the balloon.
Β. Cross-section οf the balloon filling lumen.
C. Balloon perforation through the filling lumen.
D. Transrectal ultrasound-guided balloon perforation
Ε. Mild continuous traction.
F. Through suprapubic cystotomy.
9. When complications of transvesical prostatectomy arise, there is need for blood transfusion in:
Α. < 1% of cases
Β. <5% of cases
C. 5‐15% of cases
D. >30% of cases
12. The most common complication from Greenlight Laser prostatectomy is:
Α. bleeding
Β. persistent irritating symptoms during urination
C. erectile dysfunction
D. urinary incontinence
14. Switching from original to generic α‐adrenergic blockers in BPH patients may:
Α. increase urinary flow.
Β. reduce post-void residual urine.
C. reduce adverse events.
D. reduce IPSS score.
Ε. None of the above.
25. Ultrasound screening (U/S) of the urinary tract and the other diagnostic tests:
Α. set the diagnosis of a urological disease.
Β. are all conducted and then studied by the physician who sets the diagnosis.
C. aim at answering specific diagnostic questions, in order to draw close to a diagnosis or exclude a
diagnosis.
D. All above answers are correct.
Ε. All above answers are wrong.
26. Photoselective Vaporization of Prostate (PVP) with Greenlight Laser (KTP) gives results that
are:
Α. equivalent to the results of Transurethral Prostatectomy (TURP)
Β. equivalent to the results of Transurethral Prostatectomy (TURP) but not equivalent to the results of
Open Prostatectomy.
C. satisfactory only in prostate glands < 50ml
D. are equivalent to pharmacotherapy with α-adrenergic inhibitors
Ε. not possible to assess, for the method is still new.
27. Photoselective Vaporization of Prostate (PVP) with Greenlight Laser (KTP) .....
Α. is a safe method but the risk for the TURP syndrome still remains.
Β. is practically a non-invasive method and the catheter usually stays for less than 24 hours.
C. is performed with the use of straight-emitting Laser optic fibers.
D. is performed with the use of side-emitting Laser optic fibers, and a resectoscope to achieve
hemostasis.
Ε. has a big learning curve.
PART 6
Lithiasis
1. Which of the following method/s is/are believed to have the lowest risk for stone retropulsion
during ureteroscopic lithotripsy?
Α. Ballistic Lithotripsy
Β. Ultrasounds (U/S)
C. Electrohydraulic waves
D. Holmium: YAG laser
Ε. C and D
2. Which of the following methods can achieve the most satisfactory ureteral orifice dilatation
during ureteroscopy?
Α. Balloon - dilator
Β. Plastic ureteral dilators
C. Dual-lumen ureteral catheter
D. Α and Β
Ε. Α, Β and C
4. Which of the following methods can achieve the final dilatation of the percutaneous tract
during percutaneous nephrolithotripsy?
Α. Balloon-dilator
Β. Plastic Amplatz dilators
C. Metallic Alken dilators
D. Only Α and Β are used today
Ε. Α, Β and C
6. Which of the following techniques is NOT USED for removing a calcified self-retaining
ureteral catheter?
Α. Extracorporeal lithotripsy
Β. Ureterolithotripsy
C. Open uretero-cystotomy
D. Watchful waiting while exerting mild traction on the catheter tip having pulled it to the outer
urethral orifice
Ε. C and D
7. One week after extracorporeal lithotripsy of a renal stone, a steinstrasse is formed at the lower
segment of the ureter. The patient complains about strong colic-like pain in the ipsilateral
lumbar region that responds only a little to analgesics. Which therapeutic method will you
choose next?
Α. Placement of percutaneous nephrostomy and watchful waiting
Β. Ureteroscopic lithotripsy
C. Extracorporeal lithotripsy of the steinstrasse
D. All the above are acceptable therapeutic options
Ε. Only Β and C have therapeutic value in the specific case
8. In an asymptomatic patient with a stone in the upper ureteral segment (maximum diameter
0,8cm) and mild (first grade) dilatation of the ipsilateral pyelocalyceal system, which therapeutic
option will you choose once the conservative treatment (watchful waiting) has failed?
Α. Percutaneous (descending) ureteroscopy
Β. Extracorporeal in situ lithotripsy
C. Extracorporeal lithotripsy using the 'push-back' technique
D. Placement of percutaneous nephrostomy and extracorporeal lithotripsy
Ε. Laparoscopic ureterolithotomy
9. Which is considered today the method of choice for the treatment of staghorn calculi (coral
stones)?
Α. Monotherapy with extracorporeal lithotripsy
Β. Percutaneous Nephrolithotomy + extracorporeal lithotripsy
C. Anatrophic nephrolithotomy
D. Pyelolithotomy in combination with nephrolithotomies
E. Flexible ureteronephroscopic lithotripsy
10. Which is the treatment of choice for a uric acid stone (maximum diameter 2cm) lodged in the
renal pelvis ?
Α. Percutaneous nephrolithotripsy
Β. Extracorporeal lithotripsy
C. Alkalization of urine
D. Laparoscopic pyelolithotomy
Ε. Open pyelolithotomy
11. The best approach for a symptomatic posterior calyceal diverticulum complicated with
lithiasis is:
Α. Watchful waiting
Β. Extracorporeal lithotripsy
C. Open surgery
D. Percutaneous nephrolithotomy (PCNL) - puncturing directly into the diverticulum and removing the
stone
Ε. None of the above
13. The flexible ureteroscope is usually inserted into the ureter .....:
Α. alongside (adjacent to) a guidewire
Β. through a ureteroscopic access sheath
C. directly, as it happens with the the semi-flexible ureteroscope
D. Α and Β
Ε. Α, Β and C
14. Which of the following statement/s about the semi-flexible ureteroscope is/are true?
Α. It provides better visual field than the flexible ureteroscope.
Β. It is easier to handle.
C. It is the insturment-of-choice for removing stones lodged in the upper segment and ureteropelvic
junction
D. Α and Β
Ε. Α, Β and C
15. What type of guidewire will you use to bypass an impacted ureteral stone in the midline of
the ureter?
Α. Simple PTFE guidewire 0,038 inch
B. Super stiff Amplatz guidewire 0,038 inch
C. Hydrophilic Terumo Glidewire 0,038 inch
D. Simple PTFE guidewire 0,038 inch with J-type tip
Ε. Nitinol guidewire 0,018 inch
17. Which of the following statements about the anatomic position of kidneys and percutaneous
procedures is/are TRUE?
Α. When the patient is in the prone position, the angle formed by the posterior renal calyces and the
imaginary axis transversing the spine is about 30o.
Β. A part of the upper renal pole at the posterior-lateral aspect of the kidney, is covered by the liver on
the right and by the splene on the left.
C. The posterior calyces are usually projected distally from the anterior calyces.
D. Α, Β and C
Ε. Α and Β
21. Which of the following is an absolute contra-indication for performing endoscopic procedures
in the upper urinary tract?
Α. Pathological obesity
Β. Prostatic hypertrophy
C. Pregnancy
D. Anticoagulant therapy
Ε. Active urinary tract infection
F. All the above
22. Which is the most appropriate therapeutic option for a patient with solitary stone 1,5cm in
diameter lodged in the renal pelvis?
Α. pyelolithotomy
Β. ureteroscopy and lithotripsy with Ho:YAG laser
C. SWL and placement of ureteral stent
D. PNL
Ε. SWL in situ
23. Patient with congenital soliltary kidney presents staghorn calculi (coral stones) branching in
the lower and middle calyx. There is mild hydronephrosis, while renal function is slightly affected.
Which is the most appropriate therapeutic option?
Α. PNL
Β. Close monitoring with regular ultrasound screening, serum creatinine and general urine tests.
C. ESWL with placement of ureteral stent
D. Percutaneous nephrostomy followed by PNL
Ε. Anatrophic Nephrolithotomy
24. Patient presents a stone, 0,8 in diameter, at the upper left ureter and concomitant
hydronephrosis. Which is the indicated treatment?
Α. ESWL in situ
Β. ESWL with placement of ureteral stent
C. Administration of Tamsulosin and 1-month monitoring
D. URS
Ε. Placement of ureteral stent and URS 1 week later
26. Which of the following statements about staghorn renal calculi (coral stones) is true?
Α. ESWL as monotherapy is the treatment of choice.
Β. ESWL should be the primary therapeutic step and other methods (e.g. percutaneous lithotripsy) should
follow as supplementary treatment.
C. Open surgery is the treatment of choice.
D. Flexible ureteronephroscopy with the use of holmium:YAG laser is the most modern and effective
therapeutic method for this type of stones.
Ε. Percutaneous lithotripsy is the primary therapeutic choice, with supplementary use of ESWL wherever
needed.
28. Patient with sizeable complicated staghorn calculus (coral stone) presents considerable
residual stone load after sandwich-PNL session. What is the most appropriate therapeutic option?
Α. Open nephrolithotomy
Β. Flexible nephroscopy
C. Flexible uretero-nephroscopy
D. Monitoring
Ε. Nephrectomy
29. Woman 140kg in weight presents a renal pelvic stone of 4cm. What treatment will you follow?
Α. ESWL in situ
Β. Administration of α-blocker
C. URS
D. Pyelolithotomy
Ε. Chemolysis
30. According to international data, the number of open procedures performed for the treatment
of urolithiasis is:
Α. 1-5%
Β. 5-10%
C. 10-15%
D. 15-20%
Ε. >20%
8. When there is mixed incontinence and the bladder neck is open, the best surgical treatment is:
Α. Placement of a sling at the level of the urinary bladder neck
Β. Burch colposuspension
C. Non-stress midurethral sling placement
10. The evidence basis for surgical treatment of mixed incontinence concerns:
Α. Activation of urethral sensory fibers by leaking urine
Β. Activation of detrusor contraction through stimulatory vesicourethral reflex
C. Both of the above
D. None of the above is correct
15. For preventing incontinence after radical prostatectomy pelvic floor muscle retraining must
commence
Α. 2 weeks after catheter removal
Β. Pre-operatively and directly after surgery
C. 1 month after surgery
D. 3 months after surgery
16. What would you consult patients to do so as to decrease incontinence episodes after radical
prostatectomy:
Α. Practice bulbar urethral massage after urinating
Β. Treating their constipation
C. Decreasing their alcohol intake
D. All of the above
18. In incontinence after radical prostatectomy the pelvic floor muscle rehabilitation plan should
last:
Α. 3 weeks
Β. 8 weeks
C. 12 weeks
D. More than 18 weeks
24. Mixed urinary incontinence, when compared to effort incontinence, is believed to affect
quality of life:
Α. more
Β. less
C. equally
D. there are no relevant data
32. The degree to which a drug affects the central nervous system depends on
Α. Whether it crosses the blood-brain barrier
Β. Its lipophilicity
C. Α+Β
D. None of the above
34. Anticholinergics:
Α. Are of comparable effectiveness
Β. Have different safety and tolerance profiles
C. Both Α+Β are correct
38. The most serious undesirable side effect of BOTOX bladder injection is:
Α. Developing antibodies/tolerance
Β. Needing intermittent catheterization post-operatively
C. General muscular weakness
D. Increased frequency of UTIs
40. The most appropriate antibiotics for the treatment of urinary tract mycoplasma infection
are:
Α. Tetracyclines
Β. Quinolones
C. Macrolides
D. Cephalosporins
41. What does the general pelvic floor neurological assessment include?
Α. The bulbar-cavernosus reflex
Β. Involuntary anal sphincter tone
C. Voluntary anal sphincter tone
D. Perineal sensitivity
E. All of the above
42. Which of the following is the correct treatment for overactive/hyper-reflexive bladder?
Α. Pelvic floor physical therapy is a b line treatment following anticholinergic treatment failure
Β. Sacral root neuro-stimulation is an approved b line treatment
C. Urethra dilation is highly documented
D. Bladder botulinum toxin injections are an approved b line treatment
46. In children with persistent nocturnal enuresis when treated with scheduled awakenings and
desmopressin:
Α. Nocturnal polyuria
Β. 44% present detrusor overactivity only during the night
C. Awakening disorders
D. Treatment was not performed as it should have been
47. The pelvic floor muscle which DOES NOT seem to play an important role in urine continence
is:
Α. The puboperinealis
Β. The puborectalis
C. The rectourethralis
D. The pubococcyggealis
Ε. Α+D
50. Following cystocele repair using a mesh, de nuovo effort incontinence ratios are:
Α. 5%
Β. 10%
C. 30%
D. 50%
Ε. 60%
PART 8
External Genitalia Diseases
1. Which is the most reliable examination for the diagnosis of syphilis?
Α. Dark-field examination
Β. Culture from genital ulcer material
C. PRL & VDRL
D. FTA abs & TPHA
4. What should be done in a recently-occurring solitary pigmented lesion on the penile glans or
vaginal lips?
Α. Removal of the lesion
Β. Clinical/ Dermatoscopic monitoring
C. Histological examination
D. Ablation with Cryopexy, Diathermy or Laser
6. Which of the following statements about the treatment of genitalia condylomas is true?
A. The most common etiological factor is HPV, types 6 and 11.
Β. Histological examination is necessary only in atypical pigmented ulcerated lesions.
C. Lesions of the outer urethral orifice are an absolute indication for screening the bladder and urethral
mucosa with urethrocystoscopy.
D. All the above are correct.
Ε. Α and Β are correct.
7. Which of the following statements is true concerning Balanitis Xerotica Obliterans in children?
Α. Balanitis Xerotica Obliterans is 1-3% likely to progress into penile cancer before the age of 20.
Β. Topical corticosteroid therapy replaces surgery in 80-85% of cases.
C. The penile glans participates in the disease by 5-7%.
D.Balanitis Xerotica Obliterans is rare in children below 5 years old.
8. What is the proper order of steps for the surgical reconstruction of hypospadias?
Α. Straightening of the penis -Urethroplasty -Balanoplasty
Β. Urethroplasty -Balanoplasty -Straightneing of the penis
C. Balanoplasty - Straightening of the penis - Urethroplasty
D. Balanoplasty - Urehtroplasty - Straightening of the penis
9. All the following are mentioned as causes of chronic testicular pain apart from:
Α. Spermatocele
Β. Inguinal hernia
C.Constipation
D. Irritable bowel syndrome
Ε. Urethral stricture
2. Does testis biopsy make sense during varicocele repair surgery and when?
Α. Only if we freeze testicular tissue and always from the fellow testis.
Β. Yes, and it could be conducted in every session of varicose surgery.
C. No, it makes no sense according to existing literature data.
D. Only if there are signs of progressive testicular impairment observed (e.g. asymmetry of right-left
testes >20% or increase of FSH)
Ε. In cases A and D.
5. In which cases after varicocele surgery, may chances to achieve gestation increase?
Α. Only when the number of produced spermatozoa (sperm cells) increases.
Β. When motility of spermatozoa increases after the 2nd hour of their incubation.
C. When spermatozoa with normal morphology are more than 4%, according to WHO criteria.
D. Irrespective of changes in microscopic sperm parameters, due to the positive effect on the DNA
package.
8. In a patient with obstructive azoospermia and normal FSH levels participating in an assisted-
reproduction program, the method of choice for collecting male gametes is:
Α. Fine-needle aspiration of testicular cells
Β. Open testicular biopsy
C. Microsurgical testis biopsy
D. Microsurgical sperm cell collection from the lumen of the epididymal head
Ε. Fine-needle puncture from the epididymal tail
9. Male patient with non-obstructive azoospermia and normal karyotype presents total
microdeletions of the AZFa region and left varicocele. What treatment would you recommend?
Α. Repair of the left varicocele.
Β. Bilateral spermatic vein ligation
C. Left testicular biopsy for identifying spermatozoa
D. Right testicular biopsy for identifying spermatozoa
Ε. None of the above methods
14. When the man aims at conceiving, it is better to ejaculate during his female partner's
productive phase:
Α. every two days
Β. on a daily basis
C. when ovulation has been confirmed
15. Prostagladines are produced by the same male accessory reproductive gland that secretes also:
Α. citric acid
Β. fructose
C. glucosidase
D. Zink
16. In non-mosaic Klinefelter's syndrome with left varicocele, it makes sense to:
Α. repair the varicocele
Β.repair the varicocele and perform therapeutic testis biopsy
C. perform therapeutic testis biopsy only
20. In a patient with obstructive azoospermia and normal FSH levels participating in an assisted-
reproduction program, the method of choice for collecting male gametes is:
Α. Fine-needle aspiration of testicular cells
Β. Open testicular biopsy
C. Microsurgical testis biopsy
D. Microsurgical sperm cell collection from the lumen of the epididymal head
Ε. Fine-needle puncture from the epididymal tail
21. Male patient (30-year old fertile wife) with 13.000.000 spermatozoa/ mΙ, 10% quantitative
motility of spermatozoa and 28% spermatozoa with normal morphology (according to WHO) is
diagnosed with left varicocele (normal hormone levels). Which therapy should the Expert follow
so that the couple can achieve gestation?
Α. Collecting spermatozoa from seminal fluid with masturbation and then in-vitro fertilization (IVF)
Β. Administration of R-FSH and R-LH
C. Varicocele sclerotherapy
D. Surgical repair of varicocele
22. Which surgical method for varicocele repair is the most appropriate?
Α. Palomo
Β. Ivanissevich
C. Laparoscopic
D. Robotic
Ε. Subinguinal microsurgical varicose repair
23. For patients who presented biochemical relapse after radical prostatectomy, which of the
following factors are related more to local relapse rather than with remote metastasis?
Α. First measurable PSA value 6 months after surgery, Gleason score>7, pathological stage Τ3
Β. Age below 70 at the time of relapse, first measurable PSA value < 2 ng/ml, Gleason score <5
C. Histological absence of seminal vesicles and lymph-nodes, Gleason score <5, first measurable PSA
value one year after surgery, PSA doubling-time (PSADT) >6 months
D. Pathological stage Τ2, Gleason score 8 to 10, negative bone scintigram
Ε. First measurable PSA value 4 months after surgery, negative biopsy of prostatic bed, PSA doubling-
time (PSADT) <3 months
PART 10
Chronic Pelvic Pain
1. What is the main characteristic element of the Pelvic Pain Syndrome?
Α. Pain, pressure or discomfort localized in the pelvis.
Β. Pain, pressure or discomfort related to bladder filling, relieved with urination.
C. Pain, pressure or discomfort related to the bladder.
D. None of the above.
2. Which of the following conditions occur/s in the pelvic pain syndrome more frequently than in
the general population?
Α. Allergies and autoimmune diseases
Β. Crohn's disease
C. Sjogren's syndrome
D. Fibromyalgia
Ε. All the above.
3. The various Pelvic Pain Syndrome types are classified based on:
Α. cystoscopic findings with hydrodilation, morphological elements from bladder biopsies and
localization of pain.
Β. cystoscopic findings with hydrodilation, morphological elements from bladder biopsies.
C. cystoscopic findings and symptoms.
D. cystoscopic findings with hydrodilation, symptoms and urodynamic findings.
4. Which of the following is NOT a 2nd-line treatment in the Pelvic Pain Syndrome?
Α. Analgesics
Β. Αntidepressants
C. Αntihistamines
D. Botulinum toxin Α
Ε. Pentosan Polysulfate Sodium (Na-PPS)
5. Pelvic Pain Syndrome: Transurethral Resection, Cautery or Laser are applied mainly:
Α. after relapse of BCG
Β. in the Bladder Pain Syndrome, type 3X
C. in every type of Bladder Pain Syndrome
D. in none of the above cases
6. In the lower urinary tract, the pain is characterized as 'chronic', when lasting at least:
Α. 1 month
Β. 2 months
C. 3 months
D 6 months
Ε. 9 months
8. In the therapeutic treatment of chronic prostatic pain (prostatodynia), the following has no
documented indication:
Α. COX2 inhibitors
Β. Phytotherapy
C. Supportive care and acupuncture
D. α-inhibitors
Ε. Quinolones
9. All conditions below are mentioned as causes of chronic testicular pain APART FROM:
Α. Spermatocele
Β. Inguinal hernia
C. Constipation
D. Irritable bowel syndrome
Ε. Urethral stricture