Free CUNP Practice Questions

Question 1

CT shows hydronephrosis above a 7-mm ureteral stone in a patient with fever, rigors, and an initial blood pressure of 86/52 mmHg. After cultures are collected and IV antibiotics and fluids are given, blood pressure improves to 112/68 mmHg and pain decreases. The stone remains in place. What is the appropriate next urologic step?

Accepted Answer

Collecting-system drainage by ureteral stent or percutaneous nephrostomy

Answer

Ureteroscopy with definitive laser fragmentation during the current infection

Answer

Alpha-blocker expulsive therapy followed by an outpatient stone-passage trial

Answer

Repeat imaging once antibiotics have produced a negative urine culture

Question 2

During a technically adequate pressure-flow study in a 66-year-old woman with weak stream and incomplete emptying, urinary flow remains low and detrusor pressure during voiding is also low. She does not strain with her abdomen, and 340 mL remains afterward. Which mechanism best explains this pressure-flow pattern?

Accepted Answer

Reduced force of the detrusor contraction

Answer

Fixed narrowing of the urethral outlet

Answer

Failure of the urethral sphincter to relax

Answer

Failure of the bladder neck to open

Question 3

An 81-year-old woman returns after an emergency visit for a fall. Cephalexin was started for pyuria, and the urine culture now shows more than 100,000 CFU/mL of E. coli. She is afebrile, hemodynamically stable, and at her cognitive baseline. Her longstanding urgency is unchanged, with no dysuria, suprapubic discomfort, or flank pain. No invasive urologic procedure is planned. How should the NP handle the antibiotic prescription?

Accepted Answer

Stop cephalexin; assess the fall and observe clinically

Answer

Complete cephalexin because pyuria supports treatment

Answer

Replace cephalexin with a single fosfomycin dose

Answer

Continue cephalexin until a urine culture is negative

Question 4

Microscopy identifies 7 RBC/HPF in a properly collected urine specimen from a 67-year-old woman. She has never smoked and has no visible hematuria, urinary symptoms, vaginal bleeding, additional urothelial cancer risk factors, or hereditary cancer history. Culture is negative and kidney function is normal. She accepts cystoscopy if indicated. Under the 2025 AUA/SUFU recommendations, what should her initial evaluation include?

Accepted Answer

Cystoscopy and renal ultrasonography

Answer

Repeat urinalysis in six months without immediate imaging or cystoscopy

Answer

Cystoscopy and CT urography

Answer

Urine cytology and renal ultrasonography instead of cystoscopy

Question 5

Since toilet training, a 6-year-old girl's underwear has remained damp between bathroom visits and during sleep. She nevertheless passes normal volumes with a normal stream several times daily. There is no urgency, dysuria, constipation, or history of pelvic surgery. Scheduled voiding has not changed the leakage. Which mechanism best explains persistent leakage despite normal voluntary bladder emptying?

Accepted Answer

A ureter draining below the continence mechanism

Answer

Reflux through an incompetent ureterovesical junction

Answer

Failure of pelvic floor relaxation during voiding

Answer

Involuntary detrusor contractions during bladder filling

Question 6

A cardiologist considers sexual activity acceptable for a 61-year-old man but advises continued daily isosorbide mononitrate for angina. The man wants help with erectile dysfunction and prefers to avoid injections. He has no bleeding disorder and takes no anticoagulant. Which option can be offered while he continues the prescribed nitrate regimen?

Accepted Answer

A vacuum device, with the constriction ring removed within 30 minutes

Answer

Sildenafil as needed, with a 12-hour interval after the nitrate

Answer

Tadalafil 2.5 mg daily, with home blood-pressure monitoring

Answer

A vacuum device, with the constriction ring left in place for up to 60 minutes

Question 7

An IPSS assessment records a seven-item symptom total of 17 and a separate quality-of-life response of 5, "unhappy." The man seeking care has a normal urinalysis, stable renal function, a 45-mL postvoid residual, and no history of retention, recurrent infection, or bladder stones. How should the NP use these scores when discussing treatment?

Accepted Answer

Moderate symptoms; incorporate his bother and preferences into treatment decisions

Answer

Severe symptom burden; the quality-of-life response raises his severity category

Answer

Moderate symptom burden; the score itself establishes a need for outlet surgery

Answer

Mild symptom burden; preserved emptying makes treatment unnecessary despite his bother

Question 8

"I go to the bathroom to stop the aching, not because I am about to leak," a 39-year-old woman explains. For four months, bladder filling has caused suprapubic pressure that eases after voiding. Cultures are repeatedly negative, microscopy shows no hematuria, and evaluation has found no other cause. Palpation reproduces her pain over tight, tender pelvic floor muscles. Which referral best fits her presentation?

Accepted Answer

Pelvic floor therapy emphasizing manual release

Answer

Pelvic floor therapy emphasizing strengthening

Answer

Urodynamic testing to document detrusor overactivity before treatment

Answer

Cystoscopy with hydrodistention before starting conservative treatment

Question 9

For a 73-year-old woman who awakens three times nightly to void, a diary records 2,000 mL of urine in 24 hours: 500 mL from the overnight voids and another 300 mL from the first morning void are included in that total. Sodium is 139 mmol/L and eGFR is 42 mL/min/1.73 m². She asks about sublingual desmopressin (NOCDURNA). Which paired conclusion correctly interprets the nocturnal urine fraction and prescribing eligibility?

Accepted Answer

40%; renal impairment precludes treatment with sublingual desmopressin

Answer

25%; normal sodium permits a monitored trial of sublingual desmopressin

Answer

25%; renal impairment precludes treatment with sublingual desmopressin

Answer

40%; normal sodium permits a monitored trial of sublingual desmopressin

Question 10

At a follow-up visit one week after TURBT, a patient is relieved that all visible tumor was removed. Pathology shows high-grade urothelial carcinoma invading the lamina propria, but muscularis propria is absent from the specimen. Intravesical BCG is being considered. Before committing to that plan, what is the next step?

Accepted Answer

Repeat TURBT two to six weeks after the initial resection

Answer

Begin induction BCG after healing, without another resection

Answer

Obtain pelvic MRI and proceed to BCG if the bladder muscle appears uninvolved

Answer

Defer further resection unless surveillance cystoscopy at three months shows regrowth

Free CUNP Practice Questions

Domain 1: Common Pediatric Disorders 6% of exam

Question 1

Domain 2: Urinary Tract Inflammations and Disorders 24% of exam

Question 2

Question 3

Domain 3: Voiding Dysfunctions, Including Incontinence 23% of exam

Question 4

Question 5

Domain 4: Obstructive Uropathies and Trauma, Including Stones and BPH 20% of exam

Question 6

Question 7

Domain 5: Sexual Dysfunctions, Disorders of Genitalia and Male Infertility 10% of exam

Question 8

Domain 6: Genitourinary Lesions, Benign and Malignant 17% of exam

Question 9

Question 10

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