Urologic Associate Exam Prep Exam Questions & Answers 2026 (11–20)

Question 1

A 4-year-old girl presents with her first febrile urinary tract infection. A renal and bladder ultrasound reveals normal kidneys and bladder. Parents ask if more invasive testing is needed. Which management step is most appropriate?

TheoryPractice · Accepted Answer

Continue observation without further imaging. A voiding cystourethrogram (VCUG) is not indicated for a first febrile UTI if the renal ultrasound is normal. VCUG is reserved for recurrent UTIs or abnormal ultrasound findings. DMSA scans and cystoscopy are not standard for routine first-time workups. Prophylaxis requires confirmed reflux.

Question 2

A 9-month-old male is being evaluated for a unilateral undescended testis palpable in the inguinal canal. The parents inquire about using hormone injections to avoid surgery. Which statement accurately reflects current urologic standards?

TheoryPractice · Accepted Answer

Hormonal therapy is not recommended. The correct answer is that hormonal therapy is not recommended. Current urology guidelines advise against using hormonal therapy (such as hCG or GnRH) as a standard treatment for undescended testes due to low efficacy rates (often <20%) and potential side effects. Surgical orchiopexy is the gold standard. Distractor 1 is incorrect because hCG was historically used but is no longer a first-line recommendation. Distractor 2 is incorrect because GnRH is not a prerequisite for surgery. Distractor 3 is incorrect because palpable vs. non-palpable status does not make hormonal therapy the preferred choice over surgical exploration. Distractor 4 is incorrect as topical testosterone is not a standard treatment for promoting testicular descent.

Question 3

A 4-week-old infant has a history of mild antenatal hydronephrosis. A postnatal ultrasound confirms mild hydronephrosis (SFU grade 1) with a normal bladder and no dilated ureter. Which diagnostic plan is most appropriate?

TheoryPractice · Accepted Answer

Continue observation without a VCUG. Voiding cystourethrograms (VCUG) are invasive and not routinely indicated for mild postnatal hydronephrosis without ureteral dilation or history of febrile UTI. Observation is preferred to avoid infection risks. MAG-3 scans are for significant hydronephrosis. Prophylaxis and cystoscopy are not standard for low-grade findings.

Question 4

A 3-year-old girl presents after her mother discovered a firm, smooth, painless mass on the left side of her abdomen. The child is otherwise asymptomatic. Which action should be prioritized?

TheoryPractice · Accepted Answer

Facilitate immediate referral for specialist evaluation. A painless abdominal mass in a toddler suggests Wilms tumor. This requires immediate referral for imaging and specialist evaluation; observation allows progression. Vigorous palpation is contraindicated as it may rupture the tumor, spilling contents into the peritoneum and worsening the prognosis.

Question 5

A newborn assessment reveals severe perineal hypospadias, a bifid scrotum, and non-palpable testes bilaterally. Which clinical concern necessitates a prompt multidisciplinary evaluation involving endocrinology and urology?

TheoryPractice · Accepted Answer

Underlying disorders of sexual development. Severe hypospadias with bilateral cryptorchidism and bifid scrotum indicates possible disorders of sexual development (DSD), such as congenital adrenal hyperplasia. This requires immediate endocrine and urologic evaluation to prevent life-threatening complications. Isolated cryptorchidism or chordee typically presents with less severe anomalies.

Question 6

A 7-year-old child is started on desmopressin (DDAVP) for severe nocturnal enuresis. To prevent a potentially serious adverse effect, which instruction is most critical for the nurse to provide to the parents?

TheoryPractice · Accepted Answer

Limit fluid intake starting 1 hour before bedtime. Desmopressin reduces urine production. Fluid intake must be restricted to prevent water intoxication and dilutional hyponatremia, which can cause seizures. Fluids are typically limited 1 hour before administration until morning. Taking medication with water increases hyponatremia risk. Desmopressin does not cause hyperglycemia. Bedtime administration is standard, but safety relies on fluid restriction. Salt supplementation is not indicated.

Question 7

During a well-child exam of a 5-year-old boy, the left testis is not immediately visible. However, it can be brought down into the scrotum with gentle manipulation and remains there temporarily without tension. How should this finding be classified?

TheoryPractice · Accepted Answer

Retractile testis variant. Retractile testes reside in the inguinal canal due to an active cremasteric reflex but can be manipulated into the scrotum without tension. This is a normal variant. Ectopic testes are outside the normal descent path. Gliding testes retract immediately under tension. Ascending testes move up after previous descent. True undescended testes cannot be brought into the scrotum.

Question 8

An infant born with unilateral high-grade hydronephrosis (SFU grade 3) has a patent contralateral kidney. The diuretic renogram shows 45% split function in the affected kidney with good drainage. Which management strategy is most indicated?

TheoryPractice · Accepted Answer

Serial ultrasound monitoring. The correct answer is serial ultrasound monitoring. In cases of unilateral hydronephrosis where renal function is preserved (typically >40%) and drainage is adequate, observation is the preferred initial strategy. Many cases of antenatal hydronephrosis resolve or stabilize without surgery. Distractor 1 is incorrect because pyeloplasty is reserved for cases with worsening hydronephrosis, significant obstruction, or loss of renal function (<40%). Distractor 2 is incorrect because nephrostomy is for acute, severe obstruction or infection. Distractor 3 is incorrect because the kidney has viable function (45%). Distractor 4 is incorrect as stenting is not the standard management for congenital UPJ obstruction unless acute temporizing is needed.

Question 9

A nurse is admitting a 4-year-old child with a suspected Wilms tumor (nephroblastoma). In addition to assessing the abdominal mass, which vital sign assessment requires specific attention due to the tumor's potential systemic effects?

TheoryPractice · Accepted Answer

Blood pressure assessment. Wilms tumor often causes hypertension due to increased renin secretion or renal artery compression. Blood pressure monitoring is critical. Oxygen saturation is usually unaffected unless pulmonary metastases exist. Fever is less specific to the tumor's pathophysiology than hypertension. Other vital signs are routine but do not reflect the tumor's specific paraneoplastic effects.

Question 10

A 6-month-old female with a high fever has a bag urine specimen that tests positive for leukocytes and nitrites. To confirm the diagnosis of a urinary tract infection and determine the causative organism, which action is necessary?

TheoryPractice · Accepted Answer

Obtain a catheterized specimen. The correct answer is to obtain a catheterized specimen. Bag urine specimens have a very high rate of contamination from skin flora (false positives). While a negative bag result can rule out UTI, a positive result in a non-toilet-trained child must be confirmed with a catheterized specimen (or suprapubic aspiration) to ensure accurate culture results before starting antibiotics. Distractor 1 is incorrect because culturing a bag specimen is unreliable. Distractor 2 is incorrect because treating based on a likely contaminated specimen leads to antibiotic overuse. Distractor 3 is incorrect because clean-catch is not feasible in a 6-month-old. Distractor 4 is incorrect because another bag specimen will have the same contamination issues.

Urologic Associate Exam Prep Exam Questions & Answers 2026 (11–20)

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