KMU Past Paper Practice

Question:

A 29-year-old man develops severe flank pain that later becomes more prominent in the lower abdomen and groin. CT shows a ureteric calculus that has moved distally. Which feature best explains the changing pain distribution?

Options:

Correct Answer: Changing anatomical level of ureteric irritation

Explanation: As a calculus travels down the ureter, the site and radiation of pain may change according to the level of ureteric irritation.

Question:

A 55-year-old woman with suspected nephrolithiasis has ultrasonography showing hydronephrosis, but the ureteric calculus itself is not clearly visualized. Which next investigation would best define the stone’s location and size?

Repeat urinalysis only

Serum electrolyte measurement

Plain chest radiograph

Non-contrast CT of the urinary tract

Serum uric acid alone

Correct Answer: Non-contrast CT of the urinary tract

Explanation: CT can define the stone’s location and size and show associated obstruction when ultrasonography is incomplete.

Question:

A patient with recurrent nephrolithiasis brings a recently passed calculus to clinic. What is the most useful purpose of analyzing the stone?

To guide cause-specific recurrence prevention

To determine the degree of current obstruction

To establish the patient’s glomerular filtration rate

To identify the exact ureteric location

To assess the severity of renal colic

Correct Answer: To guide cause-specific recurrence prevention

Explanation: Stone composition provides etiological information and helps tailor preventive measures in recurrent stone disease.

Question:

A 41-year-old man has a known radiopaque renal calculus and is being followed after treatment. Which investigation may be useful for monitoring a suitable known radiopaque stone with relatively low complexity?

MRI abdomen

Contrast CT urography

Renal biopsy

Serum calcium only

Plain KUB radiograph

Correct Answer: Plain KUB radiograph

Explanation: Plain radiography can be useful for follow-up of suitable known radiopaque calculi, although it does not detect all stone types.

Question:

A 33-year-old man has recurrent nephrolithiasis. His clinician wants to identify modifiable causes rather than simply treat each painful episode. Which approach best addresses this objective?

Routine long-term analgesia

Repeated plain radiographs alone

Targeted metabolic evaluation

Prophylactic urinary catheterization

Routine surgical exploration

Correct Answer: Targeted metabolic evaluation

Explanation: Recurrent stone disease warrants evaluation for underlying metabolic or other correctable risk factors so prevention can be individualized.

Question:

A patient with recurrent stone disease asks whether he should completely stop eating calcium-containing foods. Which counselling response is most appropriate?

All stone formers require complete calcium restriction

Dietary advice should be individualized to stone type and risk factors

Diet has no role after the first stone episode

Only fluid restriction prevents calcium stones

All dietary minerals should be avoided

Correct Answer: Dietary advice should be individualized to stone type and risk factors

Explanation: Prevention should address the patient’s actual stone composition and metabolic risks rather than impose indiscriminate dietary restrictions.

Question:

A 46-year-old man with renal colic has imaging showing a small distal ureteric stone. Pain is controlled, renal function is preserved and there is no infection. Which factor is most important when estimating whether conservative management is reasonable?

Patient’s occupation

Presence of microscopic hematuria

Patient’s sex

Degree of nausea at presentation

Stone size and location

Correct Answer: Stone size and location

Explanation: The probability of spontaneous passage is strongly influenced by stone size and location and is central to choosing observation versus intervention.

Question:

A patient undergoes ESWL for a selected renal calculus. Which finding after treatment would indicate that the intended therapeutic effect has occurred?

The calculus has fragmented into smaller pieces

The ureter has been surgically removed

The kidney has been permanently drained externally

The stone has undergone metabolic dissolution

The bladder outlet has been widened

Correct Answer: The calculus has fragmented into smaller pieces

Explanation: ESWL uses externally generated shock waves to fragment suitable stones so the fragments can pass through the urinary tract.

Question:

A patient has a ureteric stone that is unlikely to pass and requires direct endoscopic treatment. Which intervention most directly provides access to the ureter for stone extraction or fragmentation?

Extracorporeal lithotripsy

Percutaneous nephrolithotomy

Open nephrectomy

Ureteroscopy

Suprapubic cystostomy

Correct Answer: Ureteroscopy

Explanation: Ureteroscopy provides direct endoscopic access to the ureter for removal or fragmentation of suitable ureteric calculi.

Question:

A patient has a large branching renal calculus occupying a substantial part of the collecting system. Which treatment option is most appropriate for a large complex renal stone burden?

Long-term observation alone

Repeated forced hydration

Percutaneous nephrolithotomy

Diagnostic cystoscopy alone

Antibiotic prophylaxis alone

Correct Answer: Percutaneous nephrolithotomy

Explanation: PCNL provides percutaneous access for removal of larger or complex renal stone burdens that are unsuitable for simple expectant management.

Question:

A 38-year-old man with previous renal stones presents for counselling before summer. He works outdoors in high temperatures and frequently becomes dehydrated. Which preventive advice is most important?

Avoid fluids while working to reduce urinary frequency

Increase fluid intake especially during heat exposure

Take routine antibiotics throughout summer

Avoid physical activity permanently

Restrict all dietary minerals

Correct Answer: Increase fluid intake especially during heat exposure

Explanation: Increased fluid loss concentrates urine and promotes crystallization; maintaining adequate hydration is central to recurrence prevention.

Question:

A patient with acute flank pain has urinalysis showing leukocytes and nitrites in addition to blood. Which interpretation is most appropriate?

The stone has definitely passed

The calculus must be uric acid

Renal function is necessarily normal

Associated urinary infection should be considered

Imaging is no longer required

Correct Answer: Associated urinary infection should be considered

Explanation: Pyuria and nitrite positivity raise concern for infection, which is especially important if urinary obstruction is also present.

Question:

A stone-forming patient has persistent urinary obstruction. Which downstream consequence would be most directly suggested by progressive dilatation of the collecting system on imaging?

Hydronephrosis from impaired urine drainage

Primary glomerular inflammation

Isolated bladder mucosal disease

Renal artery thrombosis

Primary nephrotic syndrome

Correct Answer: Hydronephrosis from impaired urine drainage

Explanation: Persistent obstruction causes upstream collecting-system dilatation, producing hydronephrosis.

Question:

A 50-year-old patient with a known ureteric stone develops progressive oliguria and rising renal-function markers. Which finding most strongly changes management away from simple observation?

Previous episode of colic

Microscopic hematuria

Nausea at initial presentation

Flank tenderness

Deteriorating renal function from obstruction

Correct Answer: Deteriorating renal function from obstruction

Explanation: Threatened renal function is an important indication for escalation and urological intervention rather than continued expectant management.

Question:

A patient with recurrent urinary infection develops a large renal stone. Urinary testing repeatedly shows an alkaline environment. Which pathophysiological association best explains this pattern?

Hyperuricosuria producing acidic urine

Inherited cystine transport abnormality

Urease-producing infection promoting stone formation

Low urinary volume without infection

Isolated glomerular protein loss

Correct Answer: Urease-producing infection promoting stone formation

Explanation: Urease-producing urinary infection creates an alkaline environment that favors formation of struvite infection stones.

Question:

A patient presents with suspected renal colic. During focused history taking, which question is most useful for estimating future recurrence risk rather than merely characterizing the current pain?

Have you previously passed urinary stones?

Does movement worsen today’s pain?

Did the pain begin suddenly?

Does the pain radiate toward the groin?

Did nausea occur with this episode?

Correct Answer: Have you previously passed urinary stones?

Explanation: Previous nephrolithiasis is a major historical clue to recurrence risk and helps identify patients who may require preventive evaluation.

Question:

A patient with renal colic is being examined in the emergency department. Which examination finding would most increase concern that the presentation is no longer uncomplicated stone disease?

Restlessness

Loin tenderness

Groin radiation of pain

Fever with systemic illness

Intermittent pain pattern

Correct Answer: Fever with systemic illness

Explanation: Fever and systemic illness raise concern for infection, which becomes particularly dangerous when associated with urinary obstruction.

Question:

A patient with recurrent calcium stones asks why his clinician has advised reducing excessive dietary salt. Which explanation best supports this recommendation?

Sodium completely prevents urinary calcium excretion

High sodium intake can promote urinary calcium loss

Salt directly dissolves renal calculi

Sodium deficiency is the main cause of cystine stones

Salt intake determines stone location in the ureter

Correct Answer: High sodium intake can promote urinary calcium loss

Explanation: Excessive dietary sodium can increase urinary calcium excretion, contributing to recurrent calcium stone formation in susceptible patients.

Question:

A patient treated for nephrolithiasis asks what symptoms should lead him to seek urgent medical review after discharge. Which combination is most concerning?

Mild thirst with normal urination

Occasional fatigue after work

Brief nausea after meals

Mild urinary frequency without pain

Flank pain with fever and reduced urine output

Correct Answer: Flank pain with fever and reduced urine output

Explanation: Fever suggests infection and reduced urine output may indicate significant obstruction or renal compromise, requiring urgent reassessment.

Question:

A 44-year-old man has completed treatment for recurrent nephrolithiasis. Stone analysis, dietary history and metabolic assessment have identified several modifiable risk factors. Which long-term strategy best addresses the overall purpose of prevention?

Repeat procedural treatment at fixed intervals

Use one identical diet for every stone former

Correct identified risks while maintaining adequate urine dilution

Continue analgesics regardless of symptoms

Avoid follow-up once the current stone is removed

Correct Answer: Correct identified risks while maintaining adequate urine dilution

Explanation: Effective prevention combines adequate hydration with correction of the individual metabolic, dietary, infectious or obstructive factors driving recurrence.