# AMC MCQ Urology Questions: 10 Free Practice MCQs

> 10 free AMC MCQ urology questions with answers and explanations, from a bank of 20 urology questions. Try them now, no sign up.

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Last updated: 2026-10-29

Ten AMC MCQ-style urology questions with the answer and the reasoning behind it. They come from the AU.med bank, which has 20 urology questions and many more across every topic.

1. 1 / 10  
A 45-year-old man has a 6 mm stone in the distal ureter confirmed on non-contrast CT. His pain is controlled with analgesia, he is afebrile, his renal function is normal and there is no evidence of obstruction requiring intervention.  
In addition to analgesia, which therapy is most likely to help this stone pass?  
Show answer

**Answer: B.** Tamsulosin

**Why:** Alpha-blockers increase the rate of stone expulsion and reduce time to expulsion, and tamsulosin has been shown to be most effective for stones larger than 5 mm in the distal ureter, which matches this man's presentation. Frusemide is listed among medicines that predispose to stone formation rather than helping passage, and oral alkalinising agents are used to reduce new calculus formation in patients with a bladder diverticulum. Antibiotics have no role because there is no infection in this afebrile patient.

  * **A.** Loop diuretics are listed among medications that predispose to stone formation rather than helping stones to pass.
  * **C.** Alkalinising agents are used to reduce the risk of new calculi in patients with a bladder diverticulum, not to expel a distal ureteric stone.
  * **D.** There is no infection in this afebrile patient, and antibiotics do not influence stone passage.  
Sources: AJGP An update on management of renal colic (2021)
2. 2 / 10  
A 72-year-old man presents with a six-hour history of inability to pass urine. He has suprapubic pain and a palpable bladder, and a bladder scan measures 900 mL of retained urine. He is afebrile and haemodynamically stable.  
What is the most appropriate immediate management?  
Show answer

**Answer: A.** Insert a urethral catheter to decompress the bladder

**Why:** Relief of acute urinary retention or bladder outlet obstruction is one of the recognised indications for urinary catheter insertion, and this man has a painful palpable bladder with 900 mL of retained urine, so catheter decompression is the immediate priority. An alpha-blocker may assist a later trial of voiding but does not relieve the retention now, and fluid restriction or an outpatient appointment would prolong obstruction and risk bladder and kidney injury.

  * **B.** Medication may help with subsequent voiding trials but does nothing to relieve the painful retention now.
  * **C.** Deferring decompression risks bladder and kidney injury and worsening of the patient's pain.
  * **D.** Fluid restriction does not relieve an obstructed bladder and risks dehydration in an older man.  
Sources: Queensland Health Clinical Pathway: Urinary catheter insertion or change (2023)
3. 3 / 10  
A 35-year-old woman has an incidental finding of blood on a urine dipstick performed during a pre-employment medical. She is a never-smoker, has no lower urinary tract symptoms, no family history of urological cancer and no other risk factors. She is not menstruating.  
What is the most appropriate next step?  
Show answer

**Answer: C.** Confirm the finding with formal urine microscopy and repeat testing

**Why:** A positive dipstick is not sufficient to diagnose microscopic haematuria and should prompt formal urine microscopy, and this woman is low risk because she is under 50 years, a never smoker, has no symptoms of bladder carcinoma in situ and no other risk factors. Cystoscopy and CT intravenous pyelogram are reserved for higher-risk presentations, and empirical antibiotics are inappropriate because she has no infective symptoms to explain the finding.

  * **A.** Cystoscopy is invasive and is reserved for patients whose risk stratification warrants it, not for a low-risk incidental dipstick result.
  * **B.** Upper tract imaging is indicated before urological referral when risk factors are present, and this woman has none.
  * **D.** She has no symptoms or signs of urinary tract infection, and treating her empirically would not explain the isolated finding.  
Sources: AJGP Haematuria in the general practice setting (2021)
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5. 4 / 10  
A 19-year-old man presents to a rural emergency department 90 minutes after the sudden onset of severe left scrotal pain that woke him from sleep. The left testis is high-riding and exquisitely tender, and the cremasteric reflex is absent on that side. Vital signs are normal. The nearest urologist is four hours away by road.  
What is the most appropriate initial management?  
Show answer

**Answer: C.** Proceed to scrotal exploration at the presenting hospital by the on-call surgeon

**Why:** Testicular torsion causes ischaemia through rotation of the spermatic cord, and the RACS guideline states that emergency assessment by the nearest available surgeon is mandatory when torsion is suspected. Confirmatory investigations and transfer usually result in organ-threatening delay and should not occur, so exploration at the presenting hospital is correct. Ultrasound cannot reliably exclude torsion, and neither manual de-torsion nor a period of observation justifies delaying surgery, because salvage rates fall when de-torsion is delayed beyond six hours.

  * **A.** Transferring the patient for confirmatory assessment or specialist care introduces organ-threatening delay, and the RACS guideline states that suspected torsion should be managed at the hospital of presentation.
  * **B.** Doppler studies are unable to exclude torsion reliably, and the RACS guideline warns that confirmatory investigations must not delay operative treatment.
  * **D.** Manual de-torsion may be attempted but the guideline is explicit that it must never delay surgery, so it cannot replace immediate exploration.  
Sources: RACS Acute Scrotal Pain and Suspected Testicular Torsion Guidelines (2022)
6. 5 / 10  
A 67-year-old man with visible haematuria is being investigated for possible bladder cancer. The urology service has requested urinary cytology as an adjunct to cystoscopy.  
How should the urine specimens for cytology be collected?  
Show answer

**Answer: A.** Three mid-morning midstream samples on three consecutive days

**Why:** Urinary cytology requires three mid-morning midstream urine samples collected on three consecutive days, which is the collection method specified in the guideline. A single first-pass specimen is used to investigate infection rather than for cytology, and neither a pooled 24-hour collection nor three samples taken on one day provides the intended serial sampling. Cytology is not recommended as a sole diagnostic tool and is used as an adjunct to cystoscopy.

  * **B.** A single specimen is used for microscopy and culture testing, but cytology requires samples collected over three days.
  * **C.** Pooling urine over 24 hours is not the collection method described for urinary cytology.
  * **D.** The samples are taken on three consecutive days rather than all on one day.  
Sources: AJGP Haematuria in the general practice setting (2021)
7. 6 / 10  
A 55-year-old woman was treated two weeks ago for a urinary tract infection with a course of antibiotics. Her dysuria has resolved but blood is still present on repeat urine microscopy.  
What is the most appropriate next step?  
Show answer

**Answer: B.** Repeat urine microscopy in 6 to 12 weeks after treatment

**Why:** The recommended approach after treating a urinary tract infection is to repeat urine microscopy after an interval of 6 to 12 weeks to confirm that the haematuria has resolved, or to refer onward if it persists. Simply accepting the result would miss persistent bleeding, while antibiotic suppression and renal biopsy are not indicated without evidence of recurrent infection or a glomerular process such as proteinuria or red cell casts.

  * **A.** Persistent haematuria after treatment should not simply be dismissed, and the guideline advises rechecking it at a defined interval.
  * **C.** Suppressive antibiotics are not indicated, and blood on microscopy rather than active infection is the outstanding finding.
  * **D.** There is no evidence of a glomerular process such as proteinuria or dysmorphic red cells to justify biopsy.  
Sources: AJGP Haematuria in the general practice setting (2021)
8. 7 / 10  
A 28-year-old woman who is 20 weeks pregnant presents with severe right loin pain, vomiting and microscopic haematuria. She is afebrile and her renal function is normal. Ureteric calculus is suspected.  
Which imaging investigation should be performed first?  
Show answer

**Answer: C.** Renal tract ultrasonography

**Why:** Ultrasonography is the useful first-line tool in pregnancy because it identifies calculi in the renal calyx, pelvis and ureter and detects hydroureter or hydronephrosis without radiation. Non-contrast CT is the gold standard for most patients but its radiation dose makes it less appropriate here, and intravenous pyelography adds both radiation and contrast exposure. Magnetic resonance imaging is not the recommended first-line study for suspected ureteric calculi and is reserved for selected problem solving.

  * **A.** CT is the gold standard for most patients, but its radiation exposure makes it a less appropriate first test in pregnancy.
  * **B.** Intravenous pyelography exposes both the woman and the fetus to radiation and contrast and is not the preferred initial study.
  * **D.** MRI is not the first-line modality recommended for suspected ureteric calculi and is reserved for selected problem solving.  
Sources: AJGP An update on management of renal colic (2021)
9. 8 / 10  
A 38-year-old man is reviewed in general practice after an episode of uncomplicated left renal colic. He has a 3 mm stone in the distal ureter and asks how likely it is to pass without an operation.  
Roughly what proportion of renal calculi pass spontaneously without intervention?  
Show answer

**Answer: D.** About 75 to 90 per cent

**Why:** The Australian review reports that 75 to 90 per cent of renal calculi pass spontaneously without intervention, and one in 10 Australians will have kidney stones in their lifetime. Lower figures such as 25 to 30, 50 to 60 or 65 to 70 per cent would wrongly suggest that most patients require procedural treatment, when in fact conservative management with analgesia and medical expulsive therapy is successful in the great majority of uncomplicated cases.

  * **A.** Passage rates are considerably higher than this figure, which would wrongly imply that most patients need surgery.
  * **B.** Half of all stones do not represent the reported spontaneous passage rate, which is substantially higher.
  * **C.** This figure falls below the passage rate reported in the Australian review of renal colic.  
Sources: AJGP An update on management of renal colic (2021)
10. 9 / 10  
A 56-year-old woman presents with a two-day history of right loin pain. She is now febrile at 38.9 degrees Celsius with rigors and right renal angle tenderness. CT shows a 9 mm obstructing right ureteric calculus with hydronephrosis. She is not pregnant.  
What is the most appropriate management?  
Show answer

**Answer: A.** Urgent decompression of the obstructed kidney

**Why:** An obstructed infected kidney is a urological emergency, and the obstruction must be relieved by cystoscopic retrograde stenting or nephrostomy drainage in addition to antimicrobial therapy. Antibiotics alone do not decompress the infected collecting system, and definitive stone clearance such as lithotripsy is deferred until infection is controlled. Medical expulsive therapy has no role when there is concomitant infection with obstruction, because the priority is urgent drainage rather than stone passage.

  * **B.** Antibiotics without relief of the obstruction do not drain the infected collecting system and risk rapid deterioration.
  * **C.** Definitive stone clearance is deferred until the infection has been controlled and the obstruction relieved.
  * **D.** Expulsive therapy has no role when there is concomitant infection and obstruction requiring immediate drainage.  
Sources: AJGP An update on management of renal colic (2021)
11. 10 / 10  
A 70-year-old man taking warfarin for atrial fibrillation presents with two episodes of visible haematuria. He has no pain, fever or trauma. He requests that the blood be attributed to his anticoagulant so that he can avoid further tests.  
What is the most appropriate response?  
Show answer

**Answer: D.** Proceed with a comprehensive haematuria work-up

**Why:** Commencement or use of anticoagulant and antiplatelet agents does not exclude a patient from requiring a comprehensive haematuria work-up, because the drug may merely have unmasked an underlying lesion. Reducing the warfarin dose, reassuring the patient, or checking the international normalised ratio alone would not identify a possible urological malignancy, so upper tract imaging and urological referral with cystoscopy remain necessary.

  * **A.** Adjusting anticoagulation does not address the possibility of an underlying malignancy and would delay diagnosis.
  * **B.** Anticoagulation may worsen the degree of haematuria but does not exclude an underlying cause that has simply been unmasked.
  * **C.** Assessing the coagulation result alone will not identify the source of bleeding, which requires imaging and cystoscopy.  
Sources: AJGP Haematuria in the general practice setting (2021)

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