NIZAMS INSTITUTE OF MEDICAL SCIENCES

Punjagutta, Hyderabad 500 082, Telangana, India.

2015
Question Booklet
Entrance Examination for Admission to DM / M.Ch

UROLOGY

19 July 2015

Marks 90

Time: 01 Hr. 30 Mins

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1 of 21

Q1. Which of the following genetic alterations is a hallmark of low grade non-muscle
invasive malignant bladder tumors?
1. 9p and 9q deletion
2. 16q deletion
3. FGFR-3 mutations
4. PTEN deletion
A)
B)
C)
D)

Only 1, 2 and 3 are correct

Only 1 and 3 are correct
Only 2 and 4 are correct
Only 4 is correct

Q2.Which one of the following gases is used as a sterilizing agent

A)
B)
C)
D)

Carbon dioxide
Nitrogen
Hydrogen sulphide
Ethylene oxide

Q3.Crow- Fukase (POEMS) syndrome does not include

A)
B)
C)
D)

Polyneuropathy
Type II Diabetes mellitus
Hypertrichosis
Osteolytic lesions

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Q4. The following figure showing the distribution of ventilation and blood flow and the
ventilation/perfusion ratio in normal upright lung.

A)
B)
C)
D)

1= ventilation, 2 = perfusion, 3 = ventilation/perfusion ratio.

1 = ventilation/perfusion ratio, 2 = ventilation, 3 = perfusion.
1= perfusion, 2 = ventilation, 3 = ventilation/perfusion ratio.
1= ventilation/perfusion ratio, 2 = perfusion, 3 = ventilation.

Q5. Which of the following is an indication for the inguinal approach in a

varicocelectomy?
A)
B)
C)
D)

Obesity
Long cord with low lying testis
Solitary testis
Lax capacious external ring

Q6.Which of the following is/are the vasodilators of renal artery?

1. Endothelin
2. Atrial natriuretic peptide
3. Angiotensin II
4. Carbon monoxide
A)
B)
C)
D)

Only 1, 2 and 3 are correct

Only 1 and 3 are correct
Only 2 and 4 are correct
Only 4 is correct

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Q7. Which one of the following contrast media is a low-osmolar contrast medium?
A)
B)
C)
D)

Iothalamate
Iotrolan
Iodixanol
Iohexol

Q8. Which of the following is a part of the triad of the syndrome from which this child
is suffering?

A)
B)
C)
D)

Posterior urethral valve

Spinal cord defects
Stricture urethra
Cryptorchidism

Q9. Which subtype of renal carcinoma is more common in patients with end stage renal
failure when compared to those with normal renal function?
A)
B)
C)
D)

Clear cell carcinoma

Papillary carcinoma
Chromophobe renal cell carcinoma
Renal medullary carcinoma

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Q10. In BPH with LUTS, obstruction is present if BOOI (bladder outlet obstruction
index)
A)
B)
C)
D)

is 20-40
is greater than 40
is less than 20
is zero

Q11.Identify the Grade of VUR in the schematic image shown

A)
B)
C)
D)

Grade III
Grade IV
Grade V
Grade VI

Q12. Regarding Essential Thrombocytosis (ET), which of the following statements are
true?
1. It is characterized by thrombocytosis.
2. It is characterized by polycythemia and marrow fibrosis.
3. It is often associated with JAK 2 mutation (in 50% cases)
4. Megakaryocytes in the bone marrow are reduced in number and size.
A)
B)
C)
D)

Only 1, 2 and 3 are correct

Only 1 and 3 are correct
Only 2 and 4 are correct
Only 4 is correct

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Q13.A poor compliant bladder with poor capacity is consequent to the accumulation of
collagen of
A)
B)
C)
D)

Type I
Type II
Type III
Type IV

Q14.Brownish urine is seen with

A)
B)
C)
D)

Sulfasalazine treatment
Phenazopyridine tratment
Nitrofurantoin treatment
Riboflavin administration

Q15. Plasmid mediated bacterial resistance has not been reported in one of the drugs
given below
A)
B)
C)
D)

Sulfonamides
Nitrofurontoin
Fluroquinolones
Tetracyclines

Q16.In addition to an ACE inhibitor, patients with chronic kidney disease would benefit
from which drug to help in slowing progression of renal disease?
A)
B)
C)
D)

alpha blockers
diuretics
HMG CoA reductase inhibitors
beta blockers

Q17. A 30 yr. old male was investigated for primary infertility. Testicular biopsy showed
intratubular germ cell neoplasia on one side. Which is the most definitive
treatment option for him?
A)
B)
C)
D)

Low dose radiotherapy

Radical orchiectomy
Chemotherapy
Close observation

Q18.The most common cause of acute interstitial nephritis is

A)
B)
C)
D)

Sarccoidosis
Streptococal infection
Drug therapy
Viral infection

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Q19. If PSV is peak systolic velocity,END is end diastolic velocity then the resistive
index as determined by doppler ultrasonography is
A)
B)
C)
D)

PSV/END
PSV-EDV/EDV
PSV/PSV +END
PSV-END/PSV

Q20.The axillary lymph nodes described surgically as level 2 are located

A)
B)
C)
D)

Behind the pectoralis minor muscle

Between pectoralis major and minor muscles
At the upper border of pectoralis minor muscle
Below the lower border of pectoralis minor muscle

Q21.Most children with cerebral palsy have

A)
B)
C)
D)

Hyporeflexic bladder
Hypereflexic bladder
Hyperreflexic bladder with sphincter dyssynergia
Normal filling and normal voiding

Q22. Urease is produced by more than 90% of isolates of which one of the following
organisms?
A)
B)
C)
D)

Escherichia coli
Klebsiella pneumoniae
Staphylococcus aureus
Serratia marcescens

Q23. Complete transection of the ureter with less than 2 cm devascularisation can be
graded as
A)
B)
C)
D)

Grade 5 injury
Grade 4 injury
Grade 3 injury
Grade 2 injury

Q24. Acetohydroxamic acid contributes to reduction of infection mediated stone

formation by
A)
B)
C)
D)

Reversing associated metabolic defects

Preventing recurrent urinary tract infections
Irreversibly inhibiting urease
Alkalinization of the urine

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Q25.The most useful investigation for identifying renal cortical defect is

A)
B)
C)
D)

Technetium 99m MAG3 Scan

Technetium 99m DTPA Scan
Technetium 99m DMSA Scan
Ultrasonogram

Q26.The transducer normally used for renal ultrasonography in an adult is

A)
B)
C)
D)

7 - 9 MHz Linear array

3.5 - 5 MHz Linear array
3.5 - 5 MHz Curved array
7 - 9 MHz Dynamic array

Q27. Which of the following lithotriptors is recognized to be the gold standard for
ureteroscopic intracorporeal lithotripsy?
A)
B)
C)
D)

Pneumatic
Electrohydraulic
Ultrasonic
Holmium:YAG laser

Q28. Apart from introital and urethral mucosa women susceptible to E coli infections
show an increased epithelial receptivity on
A)
B)
C)
D)

Gastric mucosa
Nasal mucosa
Anal mucosa
Buccal mucosa

Q29. Which one of the following is a deep dorsal vein type of shunt done in the
management of priaprism?
A)
B)
C)
D)

Sacher
Al-Ghorab
Ebbehoj
Barry

Q30.Randall plaque originates from the basement membrane of

A)
B)
C)
D)

Proximal convoluted tubule

Thick limb of loop of Henle
Thin limb of loop of Henle
Collecting ducts

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Q31. Elevated fasting urinary calcium levels (> 0.11 mg/dl glomerular filtration) and
elevated serum PTH with normal serum calcium level is characteristic of
A)
B)
C)
D)

Idiopathic hypercalciuria
Absorptive hypercalciuria
Resorptive hypercalciuria
Renal hypercalciuria

Q32. Regarding abdominal leak point pressure (ALPP)

Assertion: ALPP is a measure of sphincteric strength or the ability of the
sphincter to resist changes in abdominal pressure
Reason: ALPP less than 60 cm H2O signifies no intrinsic sphincter deficiency
(ISD).
A) Both Assertion and Reason are true and Reason is the correct explanation
for the Assertion.
B) Both Assertion and Reason are true and Reason is not the correct
explanation for the Assertion.
C) Assertion is true but Reason is false.
D) Assertion is false but Reason is true.
Q33.Which of the following catheters is an end-hole catheter?
A)
B)
C)
D)

Pezzer
Councill
Nelaton
Coude

Q34. A 20 day old baby with posterior urethral valves on evaluation was found to have
ascites. if the aspirated fluid is analysed then it is seen that
A)
B)
C)
D)

Electrolytes in this fluid is less and creatinine in this fluid is more than serum
Electrolytes and creatinine of this fluid are more than serum
Electrolytes and creatinine of this fluid are less than serum
Electrolytes and creatinine of this fluid are similar to serum

Q35. Which one of the following biochemical testing represents the foundation for
diagnosis in pheochromocytoma?
A)
B)
C)
D)

Catecholamine testing
Metanephrine testing
VMA testing
Clonidine suppression testing

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Q36.Amoxicillin is combined with clavulinic acid because

A)
B)
C)
D)

Amoxicillin increases the activity of clavulinic acid

Amoxicillin decreases the side effects of clavulinic acid
Clavulinic acid increases the activity of amoxicillin
Clavulinic acid decreases the side effects of amoxicillin

Q37.The best reliable biochemical indicator of androgen status is

A)
B)
C)
D)

Measurement of total serum testosterone

Measurement of free serum testosterone
Measurement of bioavailable serum testosterone
Measurement of intratesticular testosterone

Q38.Which of the following is an mTOR inhibitor used in the treatment of advanced

renal cell carcinoma?
A)
B)
C)
D)

Bevacizumab
Sunitinib
Everolimus
Sorafenib

Q39."Ring sign" on CT scan is suggestive of

A)
B)
C)
D)

Renal papillary necrosis

Renal abscess
Staghorn Calculus
Acute pyelonephritis

Q40. Adrenal cortex is derived from which one of the following embryonic cells?
A)
B)
C)
D)

Neural crest cells

Ectoderm
Mesoderm
Endoderm

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Q41. Which of the following aromatic amines is/are definitely associated with urothelial
cancer formation?
1. 4 - Aminobiphenyl
2. Perchloroethylene
3. Benzidine
4. Trichloroethylene
A)
B)
C)
D)

Only 1, 2 and 3 are correct

Only 1 and 3 are correct
Only 2 and 4 are correct
Only 4 is correct

Q42. A "dismembered pyeloplasty" is not suitable in

A)
B)
C)
D)

High ureteral insertion

Large redundant pelvis
Accessory or aberrant lower pole vessels
Lengthy proximal ureteral stricture

Q43.What pattern of inheritance does the given pedigree suggest?

A)
B)
C)
D)

Autosomal recessive
Mitochondrial
Autosomal dominant
X-linked recessive

Q44. Which of the following is not used as an intravesical chemotherapeutic agent in the
treatment of carcinoma bladder?
A)
B)
C)
D)

doxorubicin
valrubicin
methotrexate
gemcitabine

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Q45. Which of the following hormone uses phospholipase c as second messenger

A)
B)
C)
D)

secretin
oxytocin
calcitonin
somatostatin

Q46. The order of return of function of the intestines after paralytic ileus is
A)
B)
C)
D)

Small bowel, large bowel, stomach

Small bowel, stomach, large bowel
Stomach , small bowel, large bowel
Large bowel, stomach, small bowel

Q47. A 60-year-old man with lower urinary tract symptoms has Pdet Q max of 60 cm
H2O and Q max of 7ml/sec. His bladder outlet obstruction index (BOOI) would be
A)
B)
C)
D)

53
39
67
46

Q48. Obstruction of the ureter in a case of preureteral iliac artery occurs at the level of
A)
B)
C)
D)

L2-L3
L3-L4
L4-L5
L5-S1

Q49.The most common risk factor for uric acid stone formation is
A)
B)
C)
D)

History of gout
Increased dietary purine intake
Dehydration
Endogenous production of urate

Q50. Which adrenal lesion will demonstrate high signal intensity on T1- weighted
images?
A) Pheochromocytoma
B) Adrenal cortical carcinoma
C) Benign adrenal myolipoma
D) Metastatic lesions

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Q51. Which of the following structures are preserved during Modified Radical Neck
Dissection.
1. Sternocleidomastoid
2. spinal accessory nerve
3. internal juglar vein
4. submandibular salivary gland.
A)
B)
C)
D)

Only 1, 2 and 3 are correct

Only 1 and 3 are correct
Only 2 and 4 are correct
Only 4 is correct.

Q52. The vector of major importance for transmission of malaria in urban areas
A)
B)
C)
D)

Anopheles philippinenss
Anopheles sundaicus
Anopheles culicifacies
Anopheles stephensi

Q53.The principal neurotransmitter mediating penile erection

A)
B)
C)
D)

Adrenaline
Acetyl choline
Nitric Oxide
Noradrenaline

Q54. If histopathology shows features consistent with "renal thyroidization" the diagnosis
is likely to be
A)
B)
C)
D)

Xanthogranulomatous pyelonephritis
Acute pyelonephritis
Emphysematous pyelonephritis
Chronic pyelonephritis

Q55. Which of the following renal tumors is/are benign?

1. Primitive neuroectodermal tumor
2. Mixed epithelial/stromal tumor
3. Carcinoid
4. Oncocytoma
A)
B)
C)
D)

only 1,2 and 3 are correct

only 1 and 3 are correct
only 2 and 4 are correct
only 4 is correct

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Q56. Following drugs have level 1 evidence in the treatment of detrusor overactivity
1. Darifenacin
2. Sildenafil
3. Tolterodine
4. Flavoxate
A)
B)
C)
D)

Only 1,2 and 3 are correct

Only 1 and 3 are correct
Only 2 and 4 are correct
Only 4 is correct

Q57. Chemotherapeutic agent proven to cause bladder cancer is

A)
B)
C)
D)

Methotrexate
Cyclophosphamide
Cisplatin
Mitomycin

Q58.Which sub type of renal tumors has a tendency toward multicentric origin?
A)
B)
C)
D)

Clear cell carcinoma

Papillary carcinoma
Chromophobe renal cell carcinoma
Renal medullary carcinoma

Q59.PDE5 (Phosphodiesterase type 5) inhibitors act by

A)
B)
C)
D)

Promoting cGMP intracellular formation

Reducing NO composition
Reducing cGMP degradation
Increasing free calcium levels

Q60. A 25 year old man who had a major accident with spinal cord injury is diagnosed
to have neurogenic anejaculation.He is a candidate for penile vibratory stimulation
if the level of his lesion is
A)
B)
C)
D)

Peripheral neural root injuries

Lower spinal cord injury
Complete upper motor neuron injury
Incomplete upper motor neuron injury

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Q61. What is the vessel that lies deep to pterion, an important landmark on the skull?
A)
B)
C)
D)

Middle cerebral artery

Anterior cerebral artery
Accessory meningeal artery
Middle meningeal artery

Q62. A 12 Fr nephrostomy tube was placed to drain a pyonephrotic kidney secondary to

impacted 1.5 cm upper ureteric calculus, 2 cm below PUJ. Follow up
nephrostogram reveals percutaneous nephrostomy tube enters directly into renal
pelvis. At the time of percutaneous nephrolithotomy, optimal access is obtained via
A)
B)
C)
D)

Dilating the established nephrostomy tube

A new nephrostomy tract- middle anterior calyx
A new percutaneous tract- inferior posterior calyx
A new percutaneous tract- superior posterior calyx

Q63.Oncocytomas are derived from

A)
B)
C)
D)

Proximal renal tubule

Distal renal tubule
Loop of henle
Glomerulus

Q64. Which part of the loop of Henle is critical to the formation of the interstitial
concentration gradient?
A)
B)
C)
D)

Thin descending loop of Henle in outer Zone

Thin descending loop of Henle in Inner zone
Thin ascending loop of Henle
Thick ascending Loop of Henle

Q65.Routine screening for renal cell carcinoma is justified in

A)
B)
C)
D)

Patients older than 55 years

Heavy tobacco users
Patients with autosomal dominant polycystic kidney disease
ESRD patients with long life expectancy

Q66. Corpora aranacea are calcareous deposits detectable in which of the following
structures.
A) Pineal gland
B) Anterior lobe of pituitary gland
C) Hypothalamus
D) Posterior lobe of pituitary gland

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Q67. Prostatic utricle is a remnant of

A) Mesonephric duct
B) Paramesonephric duct
C) Urogenital sinus
D) Metanephros
Q68. Incontinence after successful repair of post obstetric vescico-vaginal fistula is due
to
A) Small capacity bladder
B) Chronic cystitis
C) associated uretero vaginal fistula
D) Sphincteric incontinence
Q69. Which of the following imaging modality is highly sensitive
urothelial carcinoma?
A) Ultrasound
B) CT Urography
C) IV Urography
D) MRI

for upper tract

Q70. Schematic diagram of pyeloplasty shown is best applied to a ureteropelvic junction

obstruction associated with a high insertion of the ureter. What is the name of the
procedure?

A)
B)
C)
D)

Anderson-Hynes pyeloplasty
Culp-Deweerd spiral flap
Foley Y-V plasty
Scardino-Prince vertical flap

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Q71. Finding of numerous 150-300 nm microvesicles on electron microscopy is

characteristic of which renal cell carcinoma (RCC) variant
A)
B)
C)
D)

Clear cell RCC

Chromophobe RCC
Collecting duct RCC
Renal medullary RCC

Q72. Which of the following is a nucleotide reverse transcriptase inhibitor used as an

antiviral drug?
A) Indinavir
B) Abacavir
C) Ritonavir
D) Nelfinavir
Q73. The presence of which of the following blood group determinants on the surface of
uroepithelial cells in women is associated with recurrent UTI
A) Le(a-b+)
B) O group
C) Le(a-b-)
D) B group
Q74. A 7 year old boy underwent circumcision during which part of the glans penis was
transected. The appropriate treatment option is
A)
B)
C)
D)

repair of the remaining glans

suture back the excised glans part
split skin graft
healing by secondary intention,i.e dressings

Q75. The majority (90%) of kidney filtered bicarbonate is reclaimed in the

A)
B)
C)
D)

Collecting duct
Distal convoluted tubule
Loop of Henle
Proximal convoluted tubule

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Q76. The device shown in the image is used for port site wound closure. It is called

A)
B)
C)
D)

Laparoscopic stapling device

Disposable Endo Close suture carrier
Carter-Thomason needle point suture passer
Lapra-Ty clips

Q77. Assertion: Hydroureteronephrosis of pregnancy begins in the first trimester of

gestation and subsides within one month after parturition
Reason: Obstruction appears to be the primary factor in the development of
hydroureteronephrosis of pregnancy.
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
Q78. Which zone of prostate is most commonly affected by chronic prostatitis?
A)
B)
C)
D)

anterior fibromuscular
central
peripheral
transitional

Q79. Exenatide, which is approved for the treatment of type II diabetes mellitus:
A)
B)
C)
D)

Is a GLP-1 (glucagon like peptide) receptor antagonist

Is metabolized by dipeptidyl peptidase-4 (DPP-4)
Is administered orally
Causes glucose-dependent insulin secretion

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Q80.A 72 year old man incidentally detected to have right small solid renal mass on
routine ultrasound examination of abdomen..CECT examination revealed it to be a
small (size 2.8 cm), solid ,enhancing, well marginated, homogenous mass. What is
the line of management?
A)
B)
C)
D)

FNAC of the mass

Radiofrequency ablation
Active surveillance
Partial nephrectomy.

Q81.Marshall Marchetti Krantz procedure is performed by

A)
B)
C)
D)

The perineal route

The transvesical route
The transvaginal route
The retropubic route

Q82.Which one of the following statements is/are are correct regarding trigone of the
urinary bladder
1. Superficial trigone derived from longitudinal muscle of ureter and ends at
verumontanum
2. Deep trigone derived from longitudinal muscle of ureter and ends at
verumontanum
3. Deep trigone derived from Waldeyer sheath and ends at bladder neck
4. Superficial trigone derived from Waldeyer sheath and ends at bladder neck
A)
B)
C)
D)

Only 1, 2 and 3 are correct

Only 1 and 3 are correct
Only 2 and 4 are correct
Only 4 is correct

Q83.Predictive value of a positive test is calculated by using the formula:

A)
B)
C)
D)

True positive /(True positive + False negative) X 100

True positive /(True positive + False positive) X 100
False positive /(True positive + False negative) X 100
False positive /(True positive + False positive) X 100

Q84.Koff's formula for calculating bladder capacity (in mL) of children is

A)
B)
C)
D)

(Age in years +2) x 30

(Age in years +3) x 20
(Age in years +4) x 30
(Age in years +4) x 20

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Q85. Which type of urinary stones are often associated with laxative abuse?
A)
B)
C)
D)

Calcium
Oxalate
Ammonium acid urate
Cystine

Q86. During resection of prostate for BPH the most significant bleeding is commonly
encountered at
A)
B)
C)
D)

12 & 6 'o'clock position at prostatic apex

4 & 8'o'clock position at Bladder neck
12 & 6'o'clock position at Bladder neck
4 & 8'o'clock position at prostatic apex

Q87. Excisional tapering for more severely dilated mega ureters is named after
A)
B)
C)
D)

Kalicinski
Starr
Parrott
Hendren

Q88. Name the type of anti reflux surgery shown schematically in the image

A)
B)
C)
D)

Glenn-Anderson technique
Paquin technique
Cohen Cross-Trigonal technique
Lich-Gregoir technique
20 of 21

Q89. A 45 year old man presented with total painless hematuria of 2 weeks duration.Plain
X-ray KUB and Ultrasound scanning revealed 2 cm complex cyst with mural
calcification on right kidney.What is the investigation of choice to detect renal cell
carcinoma in the wall of the cyst?
A)
B)
C)
D)

CECT
MRI
PET-CT
Nuclear Scintigraphy

Q90. The renal artery occlusive disease most likely to be associated with stable renal
function is
A)
B)
C)
D)

Intimal fibroplasia.
Medial hyperplasia.
Medial fibroplasia.
Perimedial fibroplasia.

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