PLAB 1 Urology Questions: 10 Free Practice MCQs

Ten PLAB 1-style urology questions with the answer and the reasoning behind it. They come from the UK.med bank, which has 16 urology questions and many more across every topic.

1. 1 / 10

   A 52-year-old male presents to his GP after noticing painless red urine on two occasions over the last week. He has a 30 pack-year smoking history. Physical examination is unremarkable, and urine dipstick confirms 3+ blood. Renal function is normal, and there are no signs of a urinary tract infection.

   What is the most appropriate next step in management according to NICE guidelines?

   • A. Prescribe a 3-day course of Nitrofurantoin and repeat urine dipstick in 2 weeks
   • B. Refer to urology via an urgent 2-week-wait cancer pathway
   • C. Order an outpatient renal and bladder ultrasound scan from the GP surgery
   • D. Reassure the patient and advise him to return if the haematuria recurs
   Show answer

   Answer: B. Refer to urology via an urgent 2-week-wait cancer pathway

   Why: NICE guideline NG12 mandates an urgent 2-week-wait referral to urology for suspected cancer in patients aged 45 and over with unexplained visible haematuria (in the absence of UTI or persisting after successful treatment of UTI), or patients aged 60 and over with unexplained non-visible haematuria accompanied by dysuria or elevated white blood cell count.

   • A. Since the patient has no symptoms of a urinary tract infection, empiric antibiotics are inappropriate and will delay the necessary cancer investigation.
   • C. GP-ordered imaging should not delay an urgent urology referral. The urologist will coordinate triple assessment (ultrasound/CT, cystoscopy, and cytology).
   • D. Painless visible haematuria in a smoker is a major red flag for transitional cell carcinoma of the bladder and must be investigated urgently.

   Sources: NICE NG12

2. 2 / 10

   A 32-year-old man presents to the emergency department with sudden-onset, severe, colicky left loin pain that radiates to his groin, accompanied by nausea and hematuria. On examination, he is writhing in pain. His temperature is 36.8°C, and urine dipstick shows 3+ blood.

   What is the recommended first-line analgesic and the timeline for diagnostic imaging according to NICE guidelines?

   • A. Intravenous Morphine boluses as first line; perform a renal and bladder ultrasound within 2 hours of arrival
   • B. Oral Paracetamol and Codeine; perform an intravenous urogram (IVU) immediately, before analgesia takes effect, to confirm stone position and size
   • C. Non-steroidal anti-inflammatory drug (NSAID) such as rectal Diclofenac or IV Ketorolac; perform a non-contrast CT KUB within 14 hours of presentation
   • D. Intramuscular Pethidine; perform an MRI abdomen and pelvis within 24 hours
   Show answer

   Answer: C. Non-steroidal anti-inflammatory drug (NSAID) such as rectal Diclofenac or IV Ketorolac; perform a non-contrast CT KUB within 14 hours of presentation

   Why: NICE guideline NG118 states that for acute renal/ureteric colic, NSAIDs (by any route) should be offered as first-line analgesia. If NSAIDs are contraindicated or fail to control pain, IV morphine is the alternative. The diagnostic imaging of choice is a non-contrast CT KUB, which should be performed within 14 hours of presentation (or immediately if there are signs of infection, solitary kidney, or diagnostic uncertainty).

   • A. While opioids can be used if NSAIDs are contraindicated, NSAIDs are more effective at relieving renal colic pain. Ultrasound is not the primary diagnostic modality for ureteric stones in adults, as CT KUB is far more sensitive.
   • B. Paracetamol/Codeine is insufficient for acute renal colic. Intravenous urogram is an obsolete imaging modality that has been replaced by non-contrast CT KUB.
   • D. Pethidine is not first-line, and MRI is not the recommended imaging for renal stones due to poor visualization of calcified stones.

   Sources: NICE NG118

3. 3 / 10

   A 40-year-old male presents to the emergency department with acute severe unilateral loin-to-groin pain and hematuria. Non-contrast CT KUB confirms renal colic.

   What is the first-line analgesia according to NICE guidelines?

   • A. Oral Paracetamol and Codeine
   • B. Intravenous Opioids (e.g. Morphine) as first line
   • C. NSAIDs (e.g. Diclofenac/Naproxen) PR or IM
   • D. Antispasmodics (Buscopan)
   Show answer

   Answer: C. NSAIDs (e.g. Diclofenac/Naproxen) PR or IM

   Why: NICE guidelines (NG118) recommend NSAIDs (such as intramuscular or rectal diclofenac, or oral naproxen) as first-line analgesia for acute renal colic. NSAIDs reduce ureteric smooth muscle spasm and prostaglandin-mediated renal pelvic distension, proving superior to opioids.

   • A. Insufficient.
   • B. Second line.
   • D. Little evidence of benefit.

   Sources: NICE NG118

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5. 4 / 10

   A 68-year-old man presents with progressive lower urinary tract symptoms (LUTS) over the last 12 months, including weak urinary stream, hesitancy, and nocturia 3 times a night. On digital rectal examination, his prostate is enlarged, smooth, and non-tender, estimated at 45g. PSA is normal. He is bothered by these symptoms.

   What is the recommended initial drug therapy for this patient according to NICE guidelines?

   • A. An alpha-blocker only (e.g. Tamsulosin), with review in 4 to 6 weeks
   • B. An alpha-blocker (e.g. Tamsulosin) AND a 5-alpha reductase inhibitor (e.g. Finasteride)
   • C. A loop diuretic (e.g. Furosemide) taken at bedtime to reduce nocturia and bladder filling
   • D. An anticholinergic agent (e.g. Solifenacin)
   Show answer

   Answer: B. An alpha-blocker (e.g. Tamsulosin) AND a 5-alpha reductase inhibitor (e.g. Finasteride)

   Why: NICE guideline CG97 outlines the management of male LUTS. For patients with moderate-to-severe symptoms: (1) Alpha-blocker (Tamsulosin) is first-line for quick symptom relief (relaxes prostate smooth muscle). (2) 5-alpha reductase inhibitor (Finasteride) is offered if the prostate is enlarged (>30g) to prevent disease progression (works by blocking DHT, shrinking the prostate over 3-6 months). Combination therapy is highly effective for patients with both symptoms and significant enlargement.

   • A. While an alpha-blocker is used for fast symptom relief, for patients with significantly enlarged prostates (>30g), adding a 5-ARI (Finasteride) is recommended to reduce prostate size and prevent long-term complications.
   • C. Loop diuretics increase urine output and taking them at bedtime will significantly worsen nocturia, not treat BPH.
   • D. Anticholinergics are used for storage symptoms (urgency/urge incontinence) but should not be used as monotherapy in patients with significant voiding symptoms (hesitancy, weak stream) as they can precipitate acute urinary retention.

   Sources: NICE CG97

6. 5 / 10

   A 40-year-old man presents with waves of right flank pain radiating to the groin and microscopic haematuria. CT KUB shows an 8 mm right ureteric calculus; he is afebrile and his creatinine is normal.

   What is the most likely diagnosis?

   • A. Right ureteric calculus causing renal colic
   • B. Acute kidney injury, which requires a rise in creatinine or other evidence of impaired renal function and is not shown here.
   • C. Acute pyelonephritis
   • D. Renal malignancy
   Show answer

   Answer: A. Right ureteric calculus causing renal colic

   Why: The acute colicky flank pain radiating to the groin, microscopic haematuria and CT-confirmed ureteric calculus indicate renal colic. Normal renal function and absence of fever suggest an uncomplicated presentation at this time. Check for infection and provide appropriate analgesia, follow-up and safety-net advice.

   • B. Acute kidney injury is a renal function diagnosis and is not present with the stated normal creatinine.
   • C. Pyelonephritis usually has fever or urinary infection findings, which are absent here.
   • D. Renal malignancy does not explain a small ureteric calculus and episodic colicky pain.

   Sources: NICE NG118: Renal and ureteric stones

7. 6 / 10

   A 48-year-old woman develops sudden waves of left flank pain radiating towards the groin with microscopic haematuria. CT KUB shows an 8 mm distal left ureteric calculus; she is afebrile and renal function is normal.

   What is the most likely diagnosis causing her acute flank pain?

   • A. Acute pyelonephritis
   • B. Renal cell carcinoma, which may cause visible haematuria and a renal mass but does not account for the ureteric calculus.
   • C. Ureteric colic from the obstructing calculus
   • D. Chronic kidney disease
   Show answer

   Answer: C. Ureteric colic from the obstructing calculus

   Why: Acute colicky flank pain with a radiologically confirmed obstructing ureteric stone is ureteric colic. The absence of fever and normal renal function make infected obstruction or acute kidney injury less likely at presentation. Assess urine and provide analgesia and stone-specific follow-up.

   • A. Pyelonephritis is less likely without fever or urinary infection findings, although infection must be checked clinically.
   • B. Renal cell carcinoma more often presents with haematuria or an incidental mass and does not explain a ureteric calculus.
   • D. Chronic kidney disease is a long-term loss of renal function, not an acute pain syndrome with normal renal function.

   Sources: NICE NG118: Renal and ureteric stones

8. 7 / 10

   A 76-year-old man is admitted with acute urinary retention. Urethral catheterisation is successful, and 850 mL of urine is drained. He has a history of benign prostatic hyperplasia. The team plans to attempt a Trial Without Catheter (TWOC) in 48 hours.

   What pharmacological therapy should be initiated immediately to increase the likelihood of a successful TWOC?

   • A. A 5-alpha reductase inhibitor (e.g. Finasteride 5mg once daily)
   • B. An anticholinergic agent (e.g. Oxybutynin 5mg three times daily)
   • C. Prophylactic oral Trimethoprim for 7 days
   • D. An alpha-blocker (e.g. Tamsulosin 400mcg once daily)
   Show answer

   Answer: D. An alpha-blocker (e.g. Tamsulosin 400mcg once daily)

   Why: British Association of Urological Surgeons (BAUS) guidelines recommend that for men with acute urinary retention secondary to suspected BPH, an alpha-blocker (e.g. Tamsulosin) should be started immediately and taken for at least 48 hours before the catheter is removed (TWOC). Alpha-blockers work rapidly to decrease prostatic urethral resistance. If the TWOC fails, the catheter is re-inserted and surgical options (TURP) are considered.

   • A. Finasteride takes 3-6 months to reduce prostate volume and has no acute effect. It is not useful for a TWOC planned in 48 hours.
   • B. Anticholinergics relax the detrusor muscle, which reduces bladder contraction strength and actually increases the risk of urinary retention and TWOC failure.
   • C. Routine prophylactic antibiotics are not recommended for patients undergoing catheterization or TWOC unless there are active signs of urinary tract infection.

   Sources: BAUS Guidelines on Acute Urinary Retention

9. 8 / 10

   A 48-year-old woman has an 8 mm stone in the distal left ureter on CT KUB. Her pain is controlled, renal function is normal and she is afebrile with no evidence of urinary infection.

   What is the most appropriate initial management of this uncomplicated distal ureteric stone?

   • A. Offer an alpha blocker as medical expulsive therapy, with analgesia and safety-net advice.
   • B. Perform percutaneous nephrolithotomy, which is used primarily for large renal stones.
   • C. Arrange emergency ureteroscopy despite controlled pain and no infection or renal impairment.
   • D. Explore the ureter through an open operation as first-line treatment for an 8 mm distal stone.
   Show answer

   Answer: A. Offer an alpha blocker as medical expulsive therapy, with analgesia and safety-net advice.

   Why: NICE recommends considering an alpha blocker for an adult with a distal ureteric stone smaller than 10 mm. Continue appropriate analgesia and provide follow-up and return advice; forced high fluid intake does not expel an obstructing stone. Infection, uncontrolled pain or threatened renal function would change the urgency.

   • B. PCNL is generally used for larger renal stones or when other approaches fail, not as first-line treatment here.
   • C. Urgent intervention is not indicated solely by size when pain is controlled and there is no infection or renal impairment.
   • D. Open ureteric surgery is not first-line; less invasive management is preferred if intervention becomes necessary.

   Sources: NICE NG118: Renal and ureteric stones, recommendation 1.3.1

10. 9 / 10

    A 78-year-old male is admitted with lower abdominal pain and inability to pass urine for 12 hours. On examination, he has a palpable, dull-to-percuss, tender mass in the suprapubic area. A urethral catheter is inserted, and 1200 mL of urine is drained immediately, relieving his pain.

    What is the most important monitoring requirement immediately following decompression?

    • A. Perform a repeat renal ultrasound scan within 2 hours
    • B. Clamp the catheter after every 500 mL to prevent bladder spasms
    • C. Prescribe immediate low-dose oral Finasteride
    • D. Monitor urine output and check electrolytes for post-obstructive diuresis
    Show answer

    Answer: D. Monitor urine output and check electrolytes for post-obstructive diuresis

    Why: Decompression of severe acute-on-chronic urinary retention (typically >1000 mL) can lead to post-obstructive diuresis. This is characterized by polyuria (>200 mL/hour for 2 consecutive hours) due to loss of the renal medullary concentration gradient. Patients require monitoring of hourly urine output, vital signs, and serum electrolytes. IV fluid replacement is initiated if signs of dehydration or electrolyte instability appear.

    • A. Ultrasound is not needed immediately post-catheterization if the retention has been successfully relieved and urine is draining freely.
    • B. Clamping catheters during decompression is an outdated practice and is no longer recommended as it does not prevent haematuria or bladder spasm and increases infection risk.
    • C. Finasteride takes 3-6 months to reduce prostate volume. An alpha-blocker (like Tamsulosin) is started for a Trial Without Catheter (TWOC), not Finasteride acutely.

    Sources: BAUS Guidelines on Acute Urinary Retention

11. 10 / 10

    A 52-year-old woman presents with intermittent left flank pain radiating to the groin and microscopic haematuria. CT KUB shows an 8 mm obstructing left ureteric calculus; she is afebrile, with normal renal function.

    What is the most likely diagnosis?

    • A. Left ureteric calculus causing renal colic
    • B. Acute pyelonephritis, which is usually accompanied by fever, systemic illness or urinary infection findings.
    • C. Renal cell carcinoma
    • D. Ureteric stricture
    Show answer

    Answer: A. Left ureteric calculus causing renal colic

    Why: The episodic flank pain radiating to the groin, microscopic haematuria and CT-confirmed ureteric calculus indicate renal colic. Normal renal function and absence of infection support uncomplicated presentation, although the obstruction still requires follow-up. Fever, anuria, worsening renal function or uncontrolled pain would require urgent reassessment.

    • B. Pyelonephritis is more likely with fever, systemic illness and urinary infection findings.
    • C. A renal mass does not explain the demonstrated ureteric calculus and acute colicky pain.
    • D. A stricture can obstruct the ureter but is not the CT finding described in this case.

    Sources: NICE NG118: Renal and ureteric stones

Exam-style questions written by MedHub for practice. They are not official exam questions.