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Our review is designed to help you maximize your score on the Urology Exam. StatPearls questions and articles are based on our experts review of the American Board of Urology® and American Osteopathic Board of Surgery® Primary Certification in Urology topics. Each review course is designed to empower you to assess your knowledge and understanding of medical principles and concepts found on the Urology Exam.

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Urology Exam Overview

The Urology Exam is 6 hours.

The Urology Exam is 300 questions.

Topics include: Anatomy, Adrenal, Benign Urethral Lesions, Bladder Cancer, Bladder Dysfunction, Embryology, Infertility, Trauma, Pediatric, Pelvic Pain, Nephrology, Nephrolithiasis, Penile tumors, Prostate, Renal Carcinomas, Testicular, Urologic Radiology, Sexual Dysfunction, Transplantation, Urogenital Anomalies, Infectious disease, and Retroperitoneal tumors

Urology Exam MCQs (1,324)

Our question bank for the Urology Exam covers four Cognitive Difficulty Levels:

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• Allergy and Immunology - 12 questions
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Urology Exam Articles (446)

Deep vein thrombosis (DVT) is the formation or presence of a thrombus in the deep veins. DVT occurs mainly in the lower extremities and, to a& ...

The anatomy of the urinary tract undergoes significant changes during pregnancy, with hormonal and mechanical factors contributing to ureteral dila ...

The utility of clinical ultrasonography has continued to expand over the last 50 years. Ultrasonography as an imaging modality has multiple benefit ...

Kidney transplantation is the treatment of choice in patients with end-stage renal disease or severe chronic kidney disease as it improves the ...

High-grade squamous intraepithelial lesion (HSIL) is a squamous cell abnormality associated with human papillomavirus (HPV). It encompasses the pre ...

Urinary incontinence is the involuntary leakage of urine. This medical condition is common i ...

Editor-In-Chief

Stephen w leslie md associate professor of surgery, urology creighton university school of medicine facs omaha ne, use the mouse wheel to zoom in and out, click and drag to pan the image.

So You Want to Be a Urologist

• By Kevin Jubbal, M.D.
• August 22, 2020
• Accompanying Video , Medical Student
• So You Want to Be , Specialty

Welcome to our next installment of So You Want to Be . In this series, we highlight a specific specialty within medicine, such as urology, and help you decide if it’s a good fit for you. 

So you want to be a urologist. You like the idea of dick jokes and, well, more dick jokes. Let’s debunk the public perception myths of what it means to be a urologist, and give it to you straight. This is the reality of urology.

What is Urology?

Urologists are surgeons of the urogenital tract. If you need it to urinate or to reproduce, chances are urologists operate on it. This includes the kidneys, ureters, bladders, prostate, urethra, testes, and more.

Urology also deals with some of the most sensitive parts of health, including sexual function, fertility, urinary continence, and gender identity. For this reason, urologists are well versed in having complex, quality of life conversations and delivering compassionate care.

Many people have never even heard of the field of urology. But when you get intractable pain from a kidney stone or a testis that has twisted on itself at 2 AM, you’ll thank your stars for the field of urology.

Contrary to popular belief, urologists are in fact real surgeons. They don’t just treat STI’s all day. Urology residency involves rigorous surgical training, and they are the experts at operating on various structures within the pelvis.

Many also believe that urology only applies to men. Turns out many women seek treatment from urologists for cancers of the urogenital tract and issues with voiding. In fact, there are even some subspecialties within urology that treat women almost exclusively.

Although there is some overlap between OBGYN and urology, gynecologists focus primarily on the female reproductive tract, whereas urologists typically focus on the male reproductive tract and the urinary tract of both men and women.

Clinic vs Operating Room

Urology is unique amongst surgical subspecialties because of the blend of clinical medicine and surgery. Earlier on in a urologists career, they may focus more on surgery, but it’s common for older urologists to phase out and focus more on clinic, as they may be less enthusiastic about standing in the operating room for hours at a time.

In clinic, urologists share many similarities with medical doctors. They’ll be counseling patients on lifestyle modifications for an overactive bladder, prescribing medications to assist with erectile dysfunction, and working up the causes of recurrent kidney stones. They may also perform small procedures in clinic, such as vasectomies and cystoscopies, where they insert a camera through the urethra to visualize the bladder. Sounds comfortable, right?

In the operating room, cases are varied. Urologists may break up kidney stones or vaporize prostates using lasers. Or they may use robots and laparoscopic procedures to remove kidney or bladder cancers. Urologists also perform a variety of open surgeries with kidney transplants or lymph node dissections.

Small vs Big Cases

Urology has a high degree of procedural variation. One day, you may be performing a quick in-office vasectomy that takes less than 30 minutes. And the next, a complex bladder reconstruction lasting several hours.

Some urologists may enjoy the complex, life-or-death surgeries where you carefully dissect all around the aorta and vena cava, removing lymph nodes and curing a patient of cancer. Others may like the quick but equally satisfying cases where you retrieve a large stone and relieve a patient of some of the worst pain of their life — all in under 30 mins.

You can be the cancer-slaying hero who saves the day or the quality-of-life captain that helps a man stay continent or anything in between.

Academic vs Community

Urologists that practice in academic settings focus on research , teach residents and take care of patients inside and outside of the operating room. Some academic urologists spend most of their time engaged with teaching and clinical work while others may have just a half-day of clinic and procedures per month while the rest of their time is spent doing basic science research.

The practice of a community urologist can vary quite a bit from spending most of their time in the clinic to spending the majority of their days in the operating room. Regardless, these urologists devote 100% of their time to patient care.

How to Become a Urologist

After 4 years of medical school, urology residency is an additional 5 or 6 years, depending on the program (6-year programs have a dedicated research year built-in).

In your first year of residency, also known as the intern year, you’ll be developing fundamental operating room skills, but the majority of your time will be spent learning how to manage floor patients. As a PGY2 and PGY3 (meaning postgraduate year 2 and 3) you’re a urology junior resident, and you’ll be seeing urology patients that come in from the emergency department, managing patients on the urology floor, and working on smaller cases. As a fourth and fifth year, you’re now a senior resident, and you’ve paid your dues. Now, it’s time to shine and learn as much as you can in the OR. You’ll be doing larger open cases, like kidney transplants and large reconstructive and oncologic cases. You’ll also be mastering the use of the surgical robot to resect kidney, bladder, and prostate cancers. While it’s much more fun, there’s also much more responsibility that comes with it. You’ll be the top-level resident, and as such, there are additional administrative duties to make sure everything within the urology service is running smoothly.

If a program has a research year, it’s typically done between the third and fourth years. However, these are becoming less common as urology trainees are valuing the prospect of shorter training and sooner opportunity for independent practice.

There are several benefits to a research year , though. You can explore an intellectual curiosity whether it’s basic science research to understand how checkpoint inhibitors work in prostate cancer or develop a new device to address premature ejaculation. You can explore barriers to healthcare access and many other facets applicable to urology. If you have a research itch, this is your time to scratch it full time, for an entire year.

Research years are also often a much-appreciated pause from the rigorous and high-intensity surgical training that is the norm of residency. If you’re interested in a career in academic medicine, a research year gives you an opportunity to publish additional papers, present at conferences, and network with the top dogs in the field.

Urology is unique in that it participates in its own match , rather than the NRMP that is the norm for other medical and surgical specialties. The application process is quite similar, but you’ll be applying sooner than your NRMP colleagues, and you’ll match in January or February, rather than March.

As I’ve covered in my Surgical Stereotypes post , urologists have the best jokes in the business. A robust sense of humor is almost required to be a part of this field. After all, a good part of your day is speaking with patients about their erections. The stereotypical medical student applying to urology has a great sense of humor, doesn’t take themself too seriously, and loves to be in the OR. These are the “happy surgeons”, some of the kindest and most affable in the operating room. Unlike some other surgeons, you won’t see them throwing instruments in the OR or having a temper tantrum with the scrub nurse. Think of them as having the skills of a general surgeon, but the kindness of a family medicine doctor.

In terms of competitiveness , urology is up there with other surgical subspecialties. In 2020, 484 applied and 354 successfully matched. That’s a match rate of 73%. The precise Step scores are not well defined since they don’t participate in NRMP. Estimates for Step 1 and Step 2 are similar to those of something like ENT or orthopedic surgery, around 245 to 250.

While board scores are important, letters of recommendation hold heavier weight than usual . That’s because urology is a smaller specialty where urologists all know one another more or less. A glowing letter from a prominent urologist can transform an applicant with below-average board scores into a more attractive applicant. For this reason, away rotations, whereby medical students rotate for 1 month at an outside program, are quite important in urology. This allows students to impress prominent leaders in the field and secure strong letters of recommendation.

Subspecialties within Urology

After completing a urology residency, you can subspecialize further with a 1 or 2-year fellowship.

Andrology/Infertility

Little known fact: 50% of infertility in couples is due to the man. Urologists specializing in andrology are men’s health champions and specialists in infertility and sexual dysfunction disorders. The bread-and-butter is varied, including varicocelectomies (surgically treating dilated veins near the testis which can compromise fertility), or even performing surgical sperm extraction while operating under a microscope! If you want to get botox on your scrotum, also known as scrotox, then these are your guys.

Andrology fellowship will also teach you how to perform penile prostheses, spermatic cord denervation, and even reverse a vasectomy. This is a 1-year clinical fellowship but may also include 1 year of research as well.

Female Pelvic Medicine & Reconstructive Surgery (FPMRS)

Female pelvic medicine and reconstructive surgery, or FPMRS for short, is a fellowship available to those who have completed either urology or OBGYN residency. From urology, it’s a 2-year fellowship, and if you’re coming from OBGYN, it’s 3 years.

These are the masters of reconstructive surgery of the urogenital region, including repairing fistulas, reconstructing urethras, creating urinary diversions from the intestine, and resolving vaginal prolapse, just to name a few.

Many FPMRS programs also offer training in gender-affirming surgery for transgender patients. Examples include metoidioplasties, or female-to-male surgery, whereby you reconstruct the lower urogenital tract to create a small penis from the clitoris. Depending on the complexity of the surgery, urologists may work alongside plastic surgeons during these cases. If you want to learn more about plastic surgeons, including gender reassignment surgery, we’ve covered that in a previous post of So You Want to Be .

A transplant fellowship in urology, lasting 2 years, is relatively small compared to others, as most transplant surgeons come from general surgery residency and are trained to perform other solid-organ transplants in addition to the kidney.

The hours for this fellowship are intense, as you’ll be woken up in the middle of the night to take a private plane or helicopter to harvest an organ and transplant it to a new recipient. These are the adrenaline junkies and perfectionists of urology. After all, every detail and every suture needs to be perfect to have a successful transplant.

Endourology/Robotics

Endourology and robotics is a 1-year fellowship dealing with the sci-fi of urology. You’ll hone your skills on the surgical robot, dealing with some of the most complicated urology cases with minimally-invasive approaches. There are even treatment modalities for benign prostate disease using lasers and water vapor. Talk about futuristic!

Uro-oncology

Uro-oncology is a 2 or 3-year fellowship, often with a dedicated research year, where you’ll be specializing in the minutiae of urological cancers. These surgeons have a reputation of being more on the serious side, as their bread-and-butter is something life or death for their patients.

Urologic oncologists build long-term relationships with their patients, as they’ll follow a patient’s cancer for several years before deciding to operate, and will continue to follow their patients for the rest of their lives, as urologic cancers tend to recur.

Pediatric Urology

Pediatric urology is a 2-year fellowship, but don’t worry. It’s much more than just circumcisions. They deal with all the urologic issues of children, including hypospadias repairs whereby the urethra opening is on the underside of the penis rather than at the tip. There are more complex cases too. For example, children born with severe anatomical birth defects precluding normal urination may need surgery that allows them to catheterize themselves from their belly button.

Peds urologists are especially meticulous and precise as they are dealing with smaller structures than other urologists.

What You’ll Love About Urology

There’s a lot to love about urology. First, life as an attending has a much better work/life balance compared to most other surgical specialties. After residency, expect 40-60 hour work weeks.

Your patients will also love you because many of your interventions will have an immediate and positive effect on their quality of life. Urology patients tend to suffer from sensitive health issues for many years before they seek care, and they’re understandably incredibly grateful when you can help them maintain a robust sex life or even help them be continent (not leaking urine) throughout the day.

There’s a great deal of variety in urology and you can adjust based on your preferences over the course of your career. Younger urologists with more energy may choose to perform more complex oncologic surgeries most days of the week. But as you get older, maybe you want to transition to primarily a clinic-focused practice with some minor surgeries on the side.

Compensation is also on the higher end, as it is with most surgical subspecialties, and urologists make on average $408,000 per year.

What You Won’t Love About Urology

While urology is an amazing field, it’s not perfect. In fact, urologists have some of the highest burnout rates reported amongst all of the medical fields. In a recent Medscape Burnout report , urologists topped the list at 54%.

As with other surgical residencies, you can expect 80-hour workweeks as the norm during your training.

Urology is also a specialty that has conditions requiring immediate and urgent treatment. That means you can be called in during the middle of the night for a patient that is septic from an infected kidney stone.

Although infrequent, urological complications can be some of the worst including gnarly penile prosthesis infections and extreme electrolyte abnormalities that can be life-threatening in patients who have had their bladders or kidneys removed.

Should You Become a Urologist?

If you want to work with your hands, enjoy the pathophysiology of medicine, like building long-lasting relationships, love the operating room, and are prone to making dick jokes, then urology may be a good fit for you.

If you want to be a surgeon but still have a healthy work-life balance, urology is unique in being able to provide that. Urologists also love playing with new gadgets, lasers, and toys in the operating room, as it’s a highly innovative field.

And in terms of personality, those who are happiest in urology have a great sense of humor and don’t take themselves too seriously.

Lastly, because urology is a highly competitive field, you’ll need to crush your boards, home and away rotations, and knock it out of the park with research too. And who better to learn from and be mentored by than urologists themselves! Big shout out to the urologists at Med School Insiders that helped me in the creation of this post. If you need help acing your MCAT, USMLE, or other exams, our tutors can maximize your test-day performance. If you’re applying to medical school or urology residency, our urologists can share the ins and outs of what it takes and how to navigate the competitive process most effectively.

Thank you all so much for reading! See you in the next one.

Kevin Jubbal, M.D.

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This Post Has 3 Comments

Please it’s a request! I want SO YOU WANT TO BE A SURGICAL ONCOLOGIST badly! Hope you recieve this message

Urology is awesome! This is a great overall summary of the field, nice job.

It got me when you discussed that a robust sense of humor is crucial in urology. My friend wants to visit a urology health center. I should advise him to go for it to ensure his health.

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Urology Essay Examples and Topics

Healthcare: mrs. maggie meriwether case study, urinary tract infection pathophysiology, educating on clinical urinary catheter insertion.

• Words: 2492

Atherosclerosis and Prostatitis: Inflammatory Markers

Nosocomial urinary infection in the icu, the urinary disease and the use of diuretics, catheter-acquired urinary tract infection problem, epididymitis and orchitis: uropathogenic escherichia, the urinal human chorionic gonadotropin test, causative pathogen for ana’s infection, dysuria: physical examination and diagnostics, the urinary tract infection clinical case study, overactive bladder: diagnostic and treatment, pre-diabetes and urinary incontinence, educating on urinary tract infections in pregnancy, urinary tract infection in pregnant women, pathophysiology of benign prostatic hyperplasia (bph).

• Words: 1519

Benign Prostatic Hyperplasia and Its Treatment

The urinary tract infection in the elderly, care plan: genitourinary case, end-stage renal disease: creating awareness among patients.

• Words: 3581

Health Disparities & Chronic Kidney Disease

Urinary incontinence causes and remedies.

• Words: 1454

Male Circumcision in South Africa and Uganda

• Words: 1437

Evidence-Based Practice in Healthcare

Female genital mutilation and urological problems, reproductive system disorders, urinary tract disorders: exploring patient’s symptoms.

• Words: 1484

Prevention of Urinary Catheter-Associated Infection in ICU Patients

• Words: 1840

Pathogenesis of Urinary Tract Infections (UTIs)

Urinary tract infections: e. coli.

• Words: 1229

Foley Urinary Catheters

• Words: 1113

Sexual Dysfunction: Classification, Causes and Treatment

Foley catheter related urinary tract infections..

• Words: 3503

Urinary Frequency: Diagnostics and Treatment

Urinary frequency and pyelonephritis treatment, management of benign prostatic hyperplasia.

• Words: 1477

Urinary Tract Infection and Differential Diagnoses

Benign prostatic hyperplasia and prostate cancer, pelvic inflammatory disease: diagnosis and treatment.

• Words: 1271

Urinary Tract Infection: Clinical Practices

• Words: 1664

Lower Urinary Tract Infection: Clinical Scenario

• Words: 1980

Acute Pyelonephritis and Acute Prostatitis

Urine composition and properties: signs of illness, concept of testicular torsion in medicine, urinary tract infection diagnosis and treatment.

• Words: 1771

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• Healthy Living

Urology 101, an Introduction to Urology

By: Urology Care Foundation | Posted on: 12 Aug 2020

This week's episode of the Urology Care Podcast serves as an introduction, or friendly reminder about the basics of urology.

Urology is a branch of medicine that deals with health issues of the male and female urinary tract, and the male reproductive system. A urologist is a doctor that focuses on these parts of the body.

The urinary tract is a pathway made up of the kidneys, ureters, bladder and urethra. These parts of your body make, store and get rid of the urine in your body. Your body makes urine to get rid of waste. It also makes it to get rid of the extra water that it doesn't need. Before leaving your body, urine travels through the urinary tract.

The male reproductive system makes, stores, and transports semen for reproduction. It is made up of the penis, testes, scrotum and prostate.

As you can tell, your urologic health is important. Issues in this part of the body are vital to your total health. Urologists treat both men and women, from newborns to older adults.

Men, women and children can be referred to a urologist for many reasons. These may involve problems with bladder infections or incontinence. A man with erectile dysfunction or a child with bed wetting challenges may also be referred. As would a patient with kidney stones, an injury to the urinary system or a male infertility concern.

Urologists also handle such health problems as cancer of the prostate, bladder, kidneys and testicles. These are just a few of the types of health issues a urologist treats.

Urology is a large field so they take care of many health issues.

Most physicians are either medical doctors OR surgeons, but urologists are both. They have more than 15 years of schooling and training before they can become a board certified urologist.

Due to the wide variety of health care problems linked to urology, urologists also know about internal medicine, pediatrics, gynecology and other parts of medicine.

Urologists care about you and your health. Learn more by checking out the following resources:

• How to Prep for a Urology Visit Podcast
• Pediatric Urology - Transitioning from Pediatric to Adult Care Video
• Pediatric Urology Video

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Bladder catheterization.

Mobeen Z. Haider ; Pavan Annamaraju .

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Last Update: August 8, 2023 .

• Continuing Education Activity

Bladder catheterization is a commonly performed procedure in all hospitals. It can be performed by external, urethral, and suprapubic techniques. It is associated with complications including but not limited to urinary tract infection which is the most common hospital-acquired infection. This activity describes in detail the working knowledge for urethral catheterization, which is the most commonly used method worldwide and highlights the role of an interprofessional healthcare team in improving care for patients who undergo urethral catheterization.

• Describe the process involved in bladder catheterization
• Identify the indications for bladder catheterization.
• Outlines the complications associated with bladder catheterization.
• Explain the importance of improving care coordination amongst the interprofessional team to improve outcomes for patients with bladder catheters.
• Introduction

Urinary bladder catheterization is performed for both therapeutic and diagnostic purposes. [1] [2] . Based on the dwell time, the urinary catheter can be either intermittent (short-term) or indwelling (long-term).

There are three types of urinary catheters based on the approach of insertion.

• External catheters adhere to the external genitalia in men or pubic area in women and collect the urine. They are useful for the management of urinary incontinence.
• Urethral catheters are inserted through the urethra, with the tip advanced into the base of the bladder.
• Suprapubic catheters are inserted into the bladder surgically via a suprapubic approach.

Urethral catheterization is most commonly performed in routine clinical practice and is discussed in this article. [2]

• Anatomy and Physiology

The urinary system comprising of kidneys, ureter, bladder, and urethra is involved in the production, storage, and excretion of urine. Under normal conditions, in an adult, the kidneys produce approximately 1500 ml of urine in a day. After passing through the ureters, the urine is stored in the bladder. The capacity of the bladder can vary between 350 ml - 500 ml. Three sets of muscles control urinary drainage from the bladder into the urethra. The internal sphincter located at the base of the bladder is an involuntary smooth muscle. The voluntary striated external sphincter muscles encompass the proximal part of the urethra. Lastly, the pelvic floor muscles support and provide additional control. [3]

• Indications

The indications for bladder catheterization are:

Therapeutic

• Urinary retention

Urinary retention can be acute or chronic. The causes of urinary retention can be:

• Obstructive:  Urinary obstruction can be intrinsic  (within the urinary system) or extrinsic . Benign prostatic hyperplasia (BPH), stones, strictures, stenosis, or a tumor can cause intrinsic obstruction. BPH is the most common cause of urinary retention. If the blockage is from a pathology outside the bladder, it is classified as extrinsic. An enlarged abdominal or pelvic organ can compress on the bladder neck resulting in extrinsic obstruction. [1]
• Infectious & Inflammatory: Cystitis, urethritis, prostatitis (common infectious etiology in men), and vulvovaginitis in the woman can cause urinary retention.
• Pharmacologic: Drugs with anticholinergic or alpha-adrenergic agonist properties.
• Neurologic : Brain or spinal cord injury, cerebrovascular accident, multiple sclerosis, Parkinson disease, and dementia can lead to urinary retention. [4]
• Others : Trauma, psychogenic, Fowler syndrome in women. [1] [5] [6]
• Perioperative

Bladder catheterization is performed perioperatively in most abdominopelvic surgeries, such as urological and gynecological procedures. In cases of surgery on structures adjacent to the genitourinary tract, sheath catheters are recommended. [1]  Bladder catheterization is also useful in surgical patients who require strict intraoperative urine output. Besides, it is helpful for the management of postoperative urinary retention due to anesthesia, and to achieve better postoperative pain control. [7]

• Neurogenic bladder dysfunction
• Urinary incontinence
• Social and hygiene reasons [1]  
• Acutely ill patients requiring close urinary output measurement [8]
• Chemotherapy drug delivery [8]
• Bladder irrigation [8]
• Measurement of urodynamics
• Sample collection for urinalysis [8]
• Radiographic studies (cystogram)

Indications for Removal

The need for a bladder catheter should be assessed daily and must be removed when the purpose of the catheter insertion is served. [9]  For intraperitoneal colorectal surgeries, the catheter can be removed on postoperative day 1. In the case of mid to low rectal operations, the catheter can be removed between postoperative days 3-6 based on the risk of urinary retention. [10]

Early removal of urinary catheters helps with ambulation and better post-op recovery. [7]  For patients with chronic urinary retention and incomplete bladder evacuation, intermittent catheterization is useful.

• Contraindications

Contraindications to bladder catheterization include:

• Blood at the meatus. Insertion of the catheter can worsen an underlying injury.
• Gross hematuria 
• Evidence of urethral infection
• Urethral pain or discomfort
• Low bladder volume/compliance
• Patient refusal  [11]

Bladder catheterization requires the following equipment:

• Sterile gloves
• Sterile water
• Single-use lubricant and anesthetic gel
• Catheter bag
• Waterproof pad (disposable) [9]

Type and Choice of Catheter

The catheters can vary with the composition and coating material.

• Composition: Silicone, latex, and PVC.
• Coating: Teflon, hydrogel, and antimicrobial or latex with a silicone elastomer coat. [12]

The selection of a catheter type depends upon the clinical indication, dwell time, and individual patient's risks. [2] A trained physician must perform catheterization with a Coude or suprapubic catheter in cases where standard catheterization is unsuccessful. Silver alloy impregnated catheters are preferred for short term catheterization(≤14 days) as they reduce the incidence of UTI and bacteremia. [13]

• Preparation

Preparing for a catheterization involves the following steps:

• Review indications and contraindications for the procedure. A careful history can help to assess the need for urological referral. [14]
• Give clear instructions to the patient about the procedure. Allow appropriate time to respond to the queries of the patient.
• A proper light source should be present. [9]
• Maintain patient's privacy during the procedure. [9]
• The patient should lie down on a firm flat surface with the head resting on a pillow. [15]
• Appropriate positioning of the patient. Supine position for men and frog-leg position for women is recommended.
• Place a disposable pad beneath the patient's buttocks. [9]
• Perform hand hygiene.
• Wear sterile gloves.
• Appropriately drape the patient.
• Prepare the glans penis and the urethral meatus using a sterile technique. In women use the non-dominant hand to expose the urethral meatus by separating the labia and prepare the meatus with an antiseptic solution. [7]
• Technique or Treatment

Local anesthesia and the lubricant must be generously used. The lubricant gel should be milked proximally with the distal urethra compressed to occlusion. [15] The penis is held using the nondominant hand directed towards the ceiling or the umbilicus. The catheter is inserted into the urethral meatus with the dominant hand until the Y of the catheter is at the urethral meatus. [15]  The return of urine in the attached bag is a sign of correct placement into the bladder. The catheter balloon is then inflated using sterile water. The amount of water used for inflation varies with the manufacturer’s recommendations. [7]

After exposing the urethral meatus, a lubricated catheter tip is advanced in the meatus until there is a spontaneous return of urine. The catheter balloon is then inflated as per the manufacturer’s recommendations. In morbidly obese patients, exposing the meatus may require help from a second person or placing the patient in a Trendelenburg position. Adequate swabbing with povidone-iodine helps with visualizing the meatus. In the event a catheter is inserted in the vagina, it should be left there until a new sterile catheter is successfully inserted into the meatus. [7] Analgesia is of no proven clinical use in women. [15] Lubrication jelly should be applied to the tip of the catheter. The application of lubricant to the urethral meatus is associated with difficulty in catheter insertion. [15]

• Complications

Complications of urethral catheterization include:

• Urinary tract infection (UTI) is the most common complication that occurs as a result of long term catheterization. [7] The normal urinary flow prevents the ascension of microbes from the periurethral skin avoiding the infection. Alteration of the defensive mechanism from the catheter results in an increased risk of UTIs. [3]   Escherichia coil and Klebsiella pneumonia are the most common organisms implicated in UTIs. [3]  Recurrent UTIs are associated with increased antibiotic resistance.
• A chronic bladder infection can occur from urinary (10-100 ml) stasis at the base of the bladder, which is obstructed by the balloon of the catheter. [16]
• Pain due to traction on the drainage bag. [8]
• A transitory stinging sensation is common in men that often occurs during lubrication and can be minimized by cooling the gel to 4°C. [8]
• Paraphimosis [8]
• Urethral injury [17]
• Catheter obstruction can occur due to the sediment buildup in patients with subclinical bacteriuria. Flushing can often relieve the blockage. If unsuccessful catheter replacement may be required. [18]
• Urine leakage from the urethral meatus extrinsic to the catheter may occur as a result of bladder spasms. These spasms can be painful and can be alleviated with anticholinergic medications like oxybutynin.
• A negative effect on the quality of life, especially for patients with longterm indwelling catheters. [6]

Due to these complications, indications for the bladder catheterization must be carefully reviewed before the procedure.

• Clinical Significance

Bladder catheterization is a commonly performed hospital procedure. Therefore physicians and nurses must be aware of its indications, contraindications, and be familiar with the scenarios where a urology consultation is warranted. [15]  The need for a bladder catheter should be evaluated daily. Prompt removal of the catheter decreases the risk of urinary tract infection. [9]

Catheter-associated urinary tract infection (CAUTI) is the most common healthcare-associated infection and accounts for more than $131 million of medical expenditure annually. [19] [20]  70% of healthcare-associated UTIs are attributed to catheters. The risk of bacterial colonization of the catheter increases with the duration ranging from 3-10% per day to 100% in long term indwelling catheters. According to the National Healthcare Safety Network (NHSN), a diagnosis of CAUTI is considered in a patient with fever and bacteriuria, who has an indwelling catheter for at least two days. [19]  The IDSA (Infectious Diseases Society of America) recommends considering CAUTI as a diagnosis of exclusion in a febrile patient. Antibiotic therapy for asymptomatic bacteriuria is inappropriate and is associated with drug resistance and increased risk of  Clostridium difficile infection. [21]  When treating a catheter-associated UTI, indwelling catheters for greater than two weeks must be removed. [20] CAUTI prevention is possible by avoiding unnecessary catheter insertion and by frequently assessing the need and aiming for early removal. [20] [21]

Acute urinary retention is an emergency that requires urinary catheterization. Urethral strictures are one of the leading causes of urinary retention in patients younger than fifty years. Urethral catheterization can be challenging in the presence of urethral strictures and must be attempted with a 14 French catheter. If an obstruction is encountered, the catheter should not be forced into the urethra. [9] Blood at the meatus can be due to urethral trauma. Repeated attempts of catheter insertion may further increase the risk of injury and the creation of a false passage. Urology must be promptly consulted in challenging cases of urinary catheterization. [15]

Asymptomatic bacteriuria (ASB) is defined by at least ≥ 100,000 colony-forming units [CFU]/mL or ≥100,000,000 CFU/L of a bacteria isolated from a voided urine specimen without any signs or symptoms of UTI. Antimicrobial therapy should not be prescribed for ASB due to an increased risk of antimicrobial resistance and adverse effects. Screening and treatment of asymptomatic bacteriuria are indicated in pregnant women and in patients expected to have a urologic endoscopic procedure that is associated with mucosal trauma. [22]

• Enhancing Healthcare Team Outcomes

A myriad of clinical conditions may require bladder catheterization. While a physician or a nurse can place the catheter in most cases, consultation with urology is necessary for specific patients. The nurses are essential members of the interprofessional group, as they will predominantly perform the procedure. They also monitor the catheter and assist with the education of the patient and family as needed. The pharmacist will ensure that the patient is not on any medication that can precipitate urinary retention. The physical therapist also plays a role in early mobilization, voiding exercises, and rehabilitation. Interprofessional communication and care coordination among health professionals are vital to enhancing patient-centered care and improve outcomes.

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Disclosure: Pavan Annamaraju declares no relevant financial relationships with ineligible companies.

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• Review Long-term bladder drainage: Suprapubic catheter versus other methods: a scoping review. [Neurourol Urodyn. 2013] Review Long-term bladder drainage: Suprapubic catheter versus other methods: a scoping review. Hunter KF, Bharmal A, Moore KN. Neurourol Urodyn. 2013 Sep; 32(7):944-51. Epub 2012 Nov 28.
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Biology Short Essay Free Response Questions

10 min read • june 11, 2020

Jessica Nadzam

Overview of the Short Essay (FRQ) Questions

The AP Biology exam used to consist of eight long-form free response questions, but in 2019 it was redesigned to consist of only six free response questions. Two of those questions are in the “short” form, and these consist of 50% of the free response score, or 25% of your total score. 

Long story short, those four questions may not be as long as the first two, but they still pack a big punch on your score.

The short essay questions will always be the last four on your exam. They’re very different than the first two in length and point-value, but you can use the same techniques as the others. You still need to know the content and utilize the “essential verbage” to write an appropriate response, but this response will be shorter and take less time to complete. 

You have to write in blue or black ink (for all things that are good, please do not use a pencil), so have a few of your favorite pens ready. You’ll have lots of pages to write on (if you use all of them, you may have written too much), and you’ll be given a copy of the Formulas and Equations Sheet for any calculations you need to do. 

Questions are 4 points apiece, and they typically contain content and problems concerning multiple content areas. Since they are shorter they are less likely to cover multiple topics, but it does still happen. You could initially respond about protein structure in the first part and then end up describing the evidence of evolution by the end of the question. There’s a lot of points on the table, and CollegeBoard will make you work for them. 

Response Grading (from an AP Reader)

There are 16 points for the last four questions of the FRQ test, and they make up 25% of your AP Biology score. So, how are those points calculated and scored? CollegeBoard is fantastic at writing rigorous questions, but they’re also very good at training their graders (called AP Readers) how to objectively score the questions. Readers spend a whole day training to grade just two of the questions (they don’t get to look at the other four at all), and then spend a whole week grading only those questions, eight hours a day . 

A well-oiled machine may be an understatement. The bottom of the line is, AP Readers know exactly what they’re looking for when they’re grading. They read a hundred tests a day (minimum), and if you don’t have the answer they’ve been told is the right answer, they tend to move on pretty quickly. 

While this seems intimidating, it’s actually good news for you - but only if you pay very close attention to the next section on verbiage. You see, the bolded verbs in AP free response questions are just hints as to what AP Readers are looking for in an answer. If you know those verbs backwards and forwards, you will know what type of response AP Readers want. And if you know that, you don’t have to worry about writing something that may be right content-wise, but still missing a point on a technicality. 

Essential Verbiage

There are a lot of verbs used in AP exams to pose questions for students to ponder and rip their hair out over. 

To keep all that hair on your head, we’ve made you a table. It’s pretty easy - if you know exactly what to do when you encounter each bolded verb , you know exactly what to do to answer the question the way the Reader wants to see it. You know how many points it’s worth, and therefore can figure out how much time to spend on it. 

Side note - keep in mind that if a question asks you do something more than once - maybe to describe two factors or explain three phenomenon, you should multiple that # Points by however many things it expects you to do. 

Strategies for 5able Responses

Do you want a 5 on this test? Then here’s what you need to know and be able to do:

Read. The. Question. Carefully. Seriously. You don’t know how many students miss points because they were skimming and missed a critical word. It’s a heartbreaker for Readers, who want to give you that point, but can’t. Also, read the directions carefully. Your papers always say something about how responses on the actual question page will not be scored. Do not write on the question page . You can use it for brainstorming or outlining as scratch paper, but if your words aren’t written on lined paper or a graph or table, they won’t be scored. So make sure you put your answers in the right place! 

Complete. Sentences. Unless it’s an identify or construct or calculate question, you need a capital letter and a period, or the Reader will not grade that response. Period. Outlines, bulleted lists, and drawings won’t be graded unless specified in the question’s directions. 

Circle your bolded verbs . Find them. Figure out which are worth the most points, the least points, will take the longest, will be the quickest, etc. Then, figure out which ones to answer first. 

When you start the test, you don’t have to go in order. If your mind goes blank on question one, skip it . It’s not going anywhere, you can come back to it. But don’t waste time on it when there are others you can definitely answer later in the booklet. 

The identify and graph/draw questions are some of the quickest to respond to because they don’t require complete sentences, and the answers are usually very quick to come up with. Answer these questions first to get them out of the way. 

Time yourself. You get 90 minutes, but it goes by fast. Keep a digital watch that does not beep , and refer to it regularly. Plot how long you want to spend on each question so you don’t waste time in one area and lose points on another question you could have easily answered. Since the short questions are worth half your free-response score, you shouldn’t spend any more than 45 minutes on these four questions, or about 10-11 minutes apiece. 

This is not AP English. The graders are not English teachers. They don’t care how pretty your introduction is or how ~thought-provoking~ your thesis statement is. They just want to finish your paper and move on, so don’t ramble on and on. Skip the fluff and go straight to the point. Don’t restate the question or introduce the topic or regurgitate random knowledge - it won’t get you extra points, it’s a waste of time for you, and the Readers get bored sorting through all your thoughts and writing. 

Label your responses . While you still have to write in complete sentences, please label each response with a, b, c, etc. if the essay question has multiple parts. You don’t even have to go in order, but this helps Readers find your answer so they don’t have to sift and guess what you meant.

COMMIT TO YOUR ANSWER . Readers don’t like wishy-washy papers. Erase the words “might” and “possible” and “I think” from your vocabulary. You could be completely wrong, but if you’re writing about a purple hippopotamus, COMMIT to that purple hippopotamus. Don’t say “I think the purple hippopotamus might possibly maybe do photosynthesis if it feels like it.” That’s wishy washy, and Readers don’t accept that as an actual answer, so they won’t give points for it. Be committed , and loudly proclaim “This purple hippopotamus does photosynthesis!” Ta-da! 

If possible, always give an example. We said earlier not to mind dump and regurgitate, but examples are usually a good way to sweep up an extra point or two if you have budgeted your time wisely and can accurately apply it to the scenario. 

So, now that you know what the Readers are looking for in your responses, let’s talk about the types of questions they will ask you. 

Question Types

The short version of the free-response test has four questions, and each of those four questions has a distinct question type. These are based on “science practices” that CollegeBoard expects students to develop to be more ~well-rounded~ and ~critical thinkers~. Luckily, these questions go in a distinct order, too. Those types and order is as follows:

Scientific Investigation 

Conceptual Analysis

Analysis of Model or Visual Representation 

Analysis of Data 

With this, you can get a good idea of what to expect on the 3rd, 4th, 5th, and 6th question. And if you’re used to studying for the science section of the ACT, you probably recognize these question types. It’s all about analyzing graphs and tables, pulling information from passages, and performing analysis on data. 

Oh, while remembering all that AP Biology knowledge your teacher tried to get into your brain for the past 6-9 months. No pressure. 

Let’s break down what each of those question types is asking for, and the best ways to respond to maximize your time and your points. 

Scientific Analysis - this question will describe a lab experiment scenario, and expect you to be able to describe the biological concept or process involved, identify an experimental procedure, predict results, and justify your prediction.

Conceptual Analysis - in this question, CollegeBoard will present a question that describes a real-life scenario. It will relate that scenario to a biological phenomenon and tell you something has disrupted the process. To get all four points, you will have to describe the biological process that is happening, explain that biological concept, predict the causes and effects of the disruption, and justify your prediction. 

Analysis of Model or Visual Representation may seem like two separate question types, but they will ask you to do the same thing. Both will give you a description of some biological scenario with a visual model. You will be asked to analyze that model, and then describe different biological characteristics of the model, explain the relationships between the different characteristics, identify or draw the relationships within that model, and then explain how the scenario relates to a larger idea or concept. 

Analysis of Data - for the final question of the exam (and then you’re freeeeee !), you will receive data on a graph or table. You will then have to describe the data (twice), evaluate a hypothesis or prediction using the data, and then explain how the experimental results relate to some biological concept. 

These descriptions can seem a bit confusing on their own. Therefore, some examples are provided below. 

Sample Question 1 - Scientific Investigation  

A forest ecosystem has a delicate balance of life. Autotrophs, heterotrophs, and decomposers live together and exchange resources to survive. Sometimes their relationships are mutually beneficial, but sometimes they can be harmful for one species and beneficial for another. Buteo jumaicensis , or the red-tailed hawk, consumes smaller organisms such as small reptiles and small mammals. Recently, the ecosystem has been disturbed by deforestation of pine trees. Hawks typically roost on the crowns of tall trees, and as a result their habitat begins to diminish. 

a) Describe the niche of the red-tailed hawk. 

b) Identify the type of relationship shared between the red-tailed hawk and a common forest mouse. 

c) Predict the short-term impact of the decline of the red-tailed hawk due to deforestation, and how it will impact the rest of the ecosystem. 

d) Provide reasoning to justify your prediction. 

Sample Question 2 - Conceptual Analysis  

The lac operon model is a common phenomenon used to demonstrate the regulation of gene expression. In this model, a gene is essentially turned “on” and “off” to produce proteins only when they are necessary. This allows a bacteria called Escherichia coli ( E. coli) to metabolize lactose. 

a) Describe the gene expression process from DNA to protein. 

b) Explain why operons are an evolutionary advantage over allowing genes to undergo transcription and translation constantly. 

c) Although less commonly used for demonstration, the trp operon is another bacterial operon found in E. coli. Predict what would occur if a lac repressor was used on the trp operon. 

d) Provide evidence to support your prediction. 

Sample Question 3 - Analyze Model or Visual Representation  

Signal transduction pathways occur when cells receive signals from outside their membranes, and transduct those messages through the cell to a predetermined location. These signals are used for a variety of reasons including growth, division, mating, protein production, and more. In order for a cell to experience signal transduction, it must receive some signal that binds to a receptor and triggers the pathway. 

a) Referring to the figure, predict a possible response that may occur as a result of this signal. b) Describe the steps of the signal transduction pathway that must occur to elicit a response. 

c) Sometimes secondary messengers may enter the cell only after a ligand has bound to a receptor. Explain why secondary messengers may be necessary for cell signalling. 

d) Identify the ligand in the figure. 

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3 Questions to Ask a Urologist During Your First Visit

Asking about specialized expertise and experience in treating your problem should be top of the list.

Questions When Visiting a Urologist

Most of us use the bathroom multiple times a day and think nothing of it. After all, when you gotta go, you gotta go. But for some people, a range of disruptions to the system and organs involved with excreting fluid waste from the body may send them in search of a specialist doctor, called a urologist , to help fix the problem.

Urologists are "physicians and surgeons who are specially trained for the diagnosis and treatment of genitourinary and adrenal gland diseases in patients of any age and of either sex," as the American Urological Association puts it. This system includes organs such as the kidneys and bladder as well the prostate, penis and testicles. Urologists also address problems and diseases in other important structures such as the ureters – tubes that run from the kidneys to the bladder – and the urethra – the duct that drains urine from the bladder and out of the body. Sometimes things go wrong in this complicated web of bodily plumbing, and the urologist is the specialist who can take care of problems within this system.

While it's true that men are more likely to seek the assistance of a urologist, these specialist doctors can treat a range of diseases that affect patients of both sexes, of all ages with surgery, medications and other treatments. "One of the most common misconceptions is we only see men, but the reality is we see women as well because women have kidneys and bladders and ureters, and we're the surgeons that take care of problems that happen to women as well," says Dr. Jamin V. Brahmbhatt, a urologist with Orlando Health . "We do tend to see more men than women, but we see both sexes and all age ranges," from newborns up to elderly patients.

[See: 8 Possible Signs of Testicular Cancer .]

Some of the most common conditions a urologist sees in daily practice can range from sexual dysfunction, problems voiding, overactive bladder , urinary tract infections , kidney and bladder stones , even cancer. The number and range of problems are many, so when you look to make an appointment with a new doctor, you should first "do some homework," Brahmbhatt says. "Research the condition you're having, but don't freak out if you read the word cancer. Just make sure you know a little about what you're getting yourself into," such as what condition might be causing the symptoms you're having and whether a general urologist or a subspecialist might be a better fit. This can help guide you in finding the right doctor.

"Sometimes when you go see a specialist, it might be a long wait to get into the office," Brahmbhatt notes, which in some cases might be a big problem. "Your problem may be the worst thing for you right now, but to the office everything is triage." If the specialist you want to see can't fit you in right away, Brahmbhatt recommends asking the appointment scheduler if there's a way to get in sooner. "It's always good to ask if there's a waitlist or cancellations or the possibility to see a physician extender such as a nurse practitioner or physician assistant. We all work together as a team, and while there might be a wait for a specific doctor, if you want to get in sooner, it's always OK to ask if you can see someone else sooner," he says.

Once you've gotten into the room with the provider, consider asking the following questions to be sure your concerns are being appropriately addressed:

1. What level of experience do you have with this particular issue?

Like many other specialists, urologists may focus their training and practice in a subspecialty area. The American Board of Urology offers certification in two subspecialties – pediatric urology (disorders in children) and female pelvic medicine and reconstructive surgery (disorders in women), but many doctors focus their practice on treating specific diseases or disorders. For example, Dr. Behfar Ehdaie, attending surgeon at Memorial Sloan Kettering Cancer Center in New York in the department of surgery and urology service, specializes in treating urological cancers. Much of his practice is in prostate cancer because it's "the second most common cancer among men," and a top reason men seek appointments with a urologist.

For people who live in areas "in which there might be a higher concentration of urologists, the key would be to find a specialist within the field of urology that's specific to your condition," Ehdaie says. "So if your diagnosis is prostate cancer or you're concerned about prostate cancer, if you live in an area with a high concentration of urologists," you may do well seeking help from a subspecialist who's a urologic oncologist . "Even more importantly, someone who sees many prostate cancer patients specifically would yield the most important characteristics to look for."

This might not be an option for patients in all areas of the country, especially in more rural regions. In those instances, a general urologist will likely be able to help or get you coordinated with the care you need. Ehdaie suggests "seeking care at academic medical centers," which may provide access to more specialists in urology.

For all other urological concerns, you should also ask how equipped the doctor is to treat the problem. Brahmbhatt says patients often ask him how many of a certain procedure he's done, and he'll be honest with patients about his experience and confidence level in treating the problem. Still, he says getting a second opinion is always an option he encourages patients to explore.

[See: 10 Questions to Ask Your Doctor About Prostate Cancer .]

2. Do you have enough information about me?

It's always smart to come prepared to any doctor's appointment with your complete medical history, all your medications and as much information as you can about your own health and any procedures you've had. It's also important to be proactive about getting all the information pulled together, Brahmbhatt says. "Don't assume we're going to get your records from the other doctor's office. It's always good to keep a copy of your records," and he says "the best patients are the ones who have spreadsheets," or walk in with a whole packet of information and a list of questions they want to ask the doctor. He recommends giving this all to the person who checks you in so that the doctor can review it before he even gets into the room with you. Often, he says he can address the questions most patients have during the initial discussion. "It makes it a much more meaningful visit for you because we're not just data mining, and it makes it easy for us to have access to that beforehand," he says.

On a related issue, Brahmbhatt notes that sometimes patients aren't always completely honest about why they're making an appointment to see a urologist. But this only hinders a doctor's ability to help you with the real issue you're facing. "First and foremost, the patient has to be honest about what they're coming to see their doctor for. Urologists are experts on men's health and there's certain things that could be happening down there that men particularly may be embarrassed to talk about like erectile dysfunction or a wart or a lump in the testicle." He says sometimes patients schedule the appointment to see the doctor citing a different, less embarrassing issue and "they go through the whole process and paperwork. I get into the room with them and only then do they say, 'I want to talk about erectile dysfunction.' I can understand the hesitation about talking about some of these sensitive topics. But if you're honest from the get-go it helps prepare you and our entire team." In some cases, advance lab work or imaging might go a long way toward making the visit more productive, or you may need to see a different doctor in the practice. He urges patients to "just be honest about why you want to see us."

3. What's my risk of prostate cancer? (Or how will we treat my prostate cancer?)

Because one of the most common reasons to see a urologist is screening or treatment for prostate cancer, asking about your risk of developing the disease and when and whether you should begin screening are important aspects of your relationship with a urologist. If you haven't been diagnosed with cancer but are concerned about your risk for the disease, ask questions about whether it's time to start screening and how often you should be screened. "The questions there are more focused on [the patients'] preferences and their thresholds for risk," Ehdaie says.

[See: 10 Things Younger Men Should Know About Prostate Cancer .]

For patients who do have prostate cancer, Ehdaie recommends you ask your urologic oncologist specific questions about treatment options. "When we see patients with cancer specifically it's important to discuss and focus in on the cancer and impact on survival. However, I think a critical component of that discussion should also be focused on quality of life." Ask about the common side effects of different treatment options and discuss with your doctor what your risk tolerance is and how you'd be most comfortable moving forward with treatment.

Along similar lines, Ehdaie also points out that it's important to seek a doctor who has access to a variety of treatment modalities. In these instances, "the focus can be on what's the best treatment for my quality of life that can also provide me the best outcomes with regard to survival."

Brahmbhatt also recommends asking whether there are non-surgical interventions that might be a good option as well. "Is there anything else we can do from an observation standpoint for this? Is there any new technology out there or new surgeries or procedures that will reduce side effects?" Particularly for patients with enlarged prostates , he encourages you to have a discussion with your doctor about all your options because treatment advances in that specific field have changed the way some cases are handled.

What Younger Men Should Know About Prostate Cancer

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