KMU Past Paper Practice

Question:

A 62-year-old woman undergoes ultrasonography for nonspecific abdominal discomfort. A single, thin-walled renal cyst with clear fluid and no solid component is found. Renal function is normal and there is no family history of renal disease. Which classification best fits this lesion?

Correct Answer: Simple renal cyst

Explanation: An isolated thin-walled cyst in an older adult with preserved renal function and no inherited pattern is most consistent with a simple renal cyst.

Question:

A 58-year-old man with longstanding advanced renal failure has been receiving dialysis. Imaging now demonstrates numerous bilateral renal cysts. His kidneys had previously become small and there is no family history of cystic renal disease. Which disorder best explains the new imaging finding?

Correct Answer: Acquired cystic kidney disease

Explanation: Multiple cysts developing in the setting of longstanding advanced renal failure without an inherited pattern indicate acquired cystic kidney disease.

Question:

A 49-year-old woman with ADPKD undergoes abdominal imaging because of increasing abdominal fullness. In addition to enlarged cystic kidneys, multiple cysts are seen in the liver while liver function remains preserved. Which interpretation is most appropriate?

Correct Answer: The hepatic cysts are a recognized extrarenal manifestation of ADPKD

Explanation: ADPKD is a systemic cystic disorder; hepatic cysts are a well-recognized extrarenal manifestation and do not imply hepatic failure.

Question:

A young adult whose father has ADPKD is being assessed as a potential living kidney donor. Ultrasonography is equivocal, but establishing whether the patient carries the familial disorder is important before donation. Which additional investigation is most appropriate?

Correct Answer: Targeted genetic testing

Explanation: Genetic testing is useful when imaging is equivocal and establishing a definite diagnosis has major implications, such as evaluation of a potential kidney donor.

Question:

A 44-year-old man with established ADPKD develops recurrent episodes of severe colicky loin pain. Imaging identifies a ureteric calculus. Which feature of ADPKD most plausibly contributes to this complication?

Correct Answer: Abnormal urinary drainage with stone-promoting factors

Explanation: Distortion of renal architecture and urinary drainage, together with metabolic factors, increases the risk of nephrolithiasis in ADPKD.

Question:

A 21-year-old man has intermittent left loin pain that becomes particularly severe after drinking a large volume of fluid. Ultrasound shows marked renal pelvic dilatation with a nondilated ureter. Which mechanism best explains the worsening pain after increased fluid intake?

Correct Answer: Rapid pelvic distension occurs behind a fixed outflow obstruction

Explanation: Increased urine production rapidly distends the obstructed renal pelvis in PUJ obstruction, producing intermittent flank pain despite a nondilated distal ureter.

Question:

A young adult with intermittent flank pain has imaging evidence of PUJ obstruction. Cross-sectional imaging shows a lower-pole renal vessel crossing the junction and compressing the urinary outflow tract. How should this cause be classified?

Correct Answer: Congenital extrinsic anatomical obstruction

Explanation: A crossing lower-pole vessel can externally compress the PUJ and represents an anatomical extrinsic factor contributing to congenital PUJ obstruction.

Question:

A 46-year-old man develops progressive hydronephrosis several months after treatment for an impacted stone near the pelviureteric junction. Imaging shows a short narrowed segment at the previous site of instrumentation. Which mechanism is most likely?

Correct Answer: Acquired scar-related narrowing

Explanation: Previous stones or instrumentation can produce fibrosis and secondary narrowing at the PUJ, creating an acquired rather than congenital obstruction.

Question:

A patient with suspected PUJ obstruction has hydronephrosis on ultrasound and recurrent renal colic. The urologist wants an investigation that can better define the urinary tract anatomy and simultaneously identify a possible calculus. Which study is most useful?

Correct Answer: CT urography

Explanation: CT urography provides detailed anatomical information and can detect calculi or other structural causes contributing to upper urinary tract obstruction.

Question:

A 29-year-old man is found to have a horseshoe kidney during investigation of recurrent urinary infections and renal stones. Renal function is preserved. Which feature of this anomaly best explains these complications?

Correct Answer: Abnormal position and drainage causing urinary stasis

Explanation: Horseshoe kidneys have altered position and drainage, predisposing to urinary stasis, PUJ obstruction, infection and stone formation.

Question:

A woman with a pelvic ectopic kidney has recurrent urinary infections despite normal overall renal function. Which anatomical consequence of renal ectopia most plausibly predisposes her to infection?

Correct Answer: Abnormal ureteric course with impaired urinary drainage

Explanation: An ectopic kidney can have an abnormal ureteric course and drainage pattern, promoting urinary stasis and recurrent infection despite preserved filtration.

Question:

Imaging in a child shows two ureters arising from one kidney. The two channels join together before entering the urinary bladder through a single terminal ureter. Which description best fits this anomaly?

Correct Answer: Incomplete collecting-system duplication

Explanation: In incomplete duplication, two ureteric channels arise proximally but unite before entering the bladder; complete duplication retains two separate distal insertions.

Question:

A child develops a tender midline swelling between the umbilicus and bladder. Imaging shows a closed cystic cavity along the embryological urachal tract without communication with either the bladder or umbilicus. Which anomaly is most likely?

Correct Answer: Urachal cyst

Explanation: Persistence of the central portion of the urachus with closure at both ends produces a urachal cyst along the bladder-to-umbilicus tract.

Question:

A premature male infant with severe posterior urethral valves has bilateral hydronephrosis and cannot be adequately decompressed through the urethra. A temporary method of low-pressure bladder drainage is required before later definitive management. Which procedure is most appropriate?

Correct Answer: Vesicostomy

Explanation: Vesicostomy can provide temporary low-pressure urinary diversion when adequate urethral decompression or immediate valve ablation is not feasible.

Question:

A boy with suspected congenital bladder outlet obstruction undergoes voiding cystourethrography. The study shows a dilated posterior urethra, a thick-walled bladder and bilateral vesicoureteric reflux. Which physiological disturbance best explains these findings?

Correct Answer: High intravesical pressure from persistent outlet obstruction

Explanation: Posterior urethral valves create a high-pressure bladder, causing muscular hypertrophy and transmitting pressure backward to the ureters and kidneys.

Question:

A 12-week pregnant woman has no urinary symptoms, but a properly collected urine culture shows significant bacterial growth. She feels well and asks whether treatment can be postponed because she has no dysuria or fever. What is the most appropriate management principle?

Correct Answer: Treat with an appropriate pregnancy-safe antimicrobial

Explanation: Asymptomatic bacteriuria in pregnancy warrants treatment because untreated bacteriuria can ascend and cause clinically important maternal and pregnancy complications.

Question:

A 24-week pregnant woman reports dysuria, urinary frequency and suprapubic discomfort. She is afebrile, has no vomiting and has no costovertebral angle tenderness. Urinalysis supports a lower urinary infection. Which management approach is most appropriate?

Correct Answer: Obtain urine culture and give an appropriate oral antimicrobial

Explanation: The absence of systemic features supports acute cystitis rather than pyelonephritis; pregnancy requires microbiological assessment and appropriate antimicrobial treatment.

Question:

A 28-week pregnant woman presents with fever, vomiting, flank pain and marked costovertebral angle tenderness. A colleague suggests oral nitrofurantoin because it is commonly used for lower urinary infection. Why is this choice unsuitable for the current illness?

Correct Answer: It does not achieve adequate renal tissue levels for pyelonephritis

Explanation: Nitrofurantoin concentrates in urine and is useful for lower UTI, but inadequate renal parenchymal penetration makes it unsuitable for acute pyelonephritis.

Question:

A 30-week pregnant woman is admitted with acute pyelonephritis. During observation she develops regular painful uterine contractions. Which pregnancy complication is most directly associated with this infection?

Correct Answer: Preterm labor

Explanation: Acute pyelonephritis during pregnancy can provoke uterine activity and is associated with important pregnancy complications including preterm labor.

Question:

A 27-week pregnant woman with pyelonephritis is febrile, vomiting and tachycardic, with low blood pressure and marked flank tenderness. She cannot tolerate oral fluids. Which management principle is most appropriate?

Correct Answer: Provide hospital care with parenteral antimicrobials and supportive therapy

Explanation: Systemically ill pregnant patients with acute pyelonephritis require prompt hospital management, parenteral antimicrobial therapy, hydration and close maternal-fetal monitoring.