Urology — MCQs

Urology Indian Medical PG Practice Questions and MCQs

Question 1011: A patient presents with abdominal swelling and inguinal lymphadenopathy. Considering the clinical presentation, which carcinoma is most likely associated with these findings?

A. Ca testis
B. Ca penis (Correct Answer)
C. Ca prostate
D. Ca bladder

Explanation: ***Ca penis*** - **Carcinoma of the penis** commonly metastasizes to the **inguinal lymph nodes** due to its lymphatic drainage patterns. - Advanced penile cancer with extensive nodal involvement can lead to **abdominal swelling** from large retroperitoneal nodes compressing structures or generalized edema. *Ca testis* - **Testicular cancer** typically metastasizes to **retroperitoneal lymph nodes** first, not inguinal nodes. - While retroperitoneal nodes can cause abdominal swelling, **inguinal involvement is rare** unless there is scrotal invasion or prior surgery. *Ca prostate* - **Prostate cancer** primarily metastasizes to **pelvic lymph nodes** (obturator, internal iliac) and bone, rarely to inguinal lymph nodes. - Abdominal swelling would more likely be due to **bone metastases** causing painful compression or uremia from urinary obstruction rather than inguinal adenopathy. *Ca bladder* - **Bladder cancer** tends to spread to **pelvic lymph nodes**, similar to prostate cancer, and can cause abdominal swelling if it obstructs ureters or involves extensive pelvic spread. - **Inguinal lymphadenopathy is uncommon** in bladder cancer unless there is direct extension into the groin or superficial involvement.

Question 1012: A 45-year-old male presenting with penile cancer extending up to the glans penis is treated with which of the following surgical options?

A. Partial penectomy with a 2 cm margin (Correct Answer)
B. Simple circumcision
C. Partial penectomy with a 4 cm margin
D. Partial penectomy with inguinal lymph node dissection

Explanation: ***Partial penectomy with a 2 cm margin*** - For **penile cancer** confined to the glans, **partial penectomy** is the standard surgical approach to achieve local control while preserving penile length. - Historically, a **2 cm tumor-free margin** was recommended as the standard of care (reflected in older guidelines and exam questions). - **Modern evidence** suggests that narrower margins of **5-8 mm** are oncologically safe with comparable local control rates, but the **2 cm margin** was the traditional teaching and remains the expected answer for this question context. *Simple circumcision* - **Simple circumcision** is indicated for benign conditions like **phimosis** or **premalignant lesions** (carcinoma in situ), not for invasive cancer. - It does not provide adequate oncological clearance for **invasive penile cancer** and carries a high risk of **local recurrence**. *Partial penectomy with a 4 cm margin* - A **4 cm margin** is excessively radical and would result in unnecessary loss of penile length and function. - Even by historical standards, this exceeds the recommended **2 cm margin** and would cause significant functional and psychological morbidity. *Partial penectomy with inguinal lymph node dissection* - **Inguinal lymph node dissection** is indicated when there is **clinical or radiological evidence of lymph node metastasis** or high-risk pathological features. - Without evidence of nodal involvement, routine prophylactic lymphadenectomy is not performed due to significant morbidity (lymphedema, wound complications). - The question does not specify nodal involvement, making this option unnecessarily aggressive.

Question 1013: A young male presents with a testicular mass on the right side. The AFP is elevated while the HCG is normal. The most appropriate next step is

A. Biopsy
B. Orchidectomy (Correct Answer)
C. USG
D. Wait and Watch

Explanation: ***Radical Inguinal Orchidectomy*** - In a patient who already presents with a **testicular mass** and **elevated AFP** (suggesting non-seminomatous germ cell tumor), the most appropriate next step is **radical inguinal orchidectomy**. - This procedure is both **diagnostic and therapeutic**, providing tissue for histopathological confirmation while removing the primary tumor. - The standard management sequence is: clinical examination → scrotal USG → tumor markers → **orchidectomy** → staging imaging → further treatment based on histology and stage. - Since the mass is already identified and tumor markers are done, proceeding directly to orchidectomy is appropriate. *USG* - Scrotal **ultrasound** is typically the **first imaging modality** when a testicular mass is suspected or palpated. - However, in this scenario, the mass is already clinically identified and tumor markers (AFP) have been measured, suggesting that initial workup including USG has likely been completed. - USG would have been the appropriate answer if the question asked for the "first investigation" before tumor markers were done. *Biopsy* - Direct **biopsy** of a testicular mass is **contraindicated** due to the high risk of tumor cell spillage along the needle tract, which can alter staging and worsen prognosis. - Testicular cancer is diagnosed via **radical inguinal orchidectomy**, not biopsy. *Wait and Watch* - A **wait and watch** approach is inappropriate and dangerous in the presence of a **testicular mass with elevated AFP**, which strongly suggests malignancy (non-seminomatous germ cell tumor). - Delayed treatment can lead to disease progression, metastasis, and poorer outcomes.

Question 1014: Which of the following statements about undescended testis is true?

A. Hormonal therapy is effective
B. More common on the right side
C. Increased risk of malignancy (Correct Answer)
D. Secondary sexual characteristics are universally normal

Explanation: ***Increased risk of malignancy*** - Undescended testis is associated with a **3 to 14 times increased risk** of testicular malignancy, particularly **seminoma**. - The risk remains elevated even after orchiopexy, though the procedure allows for **easier surveillance and examination**. - This is one of the **most important clinical features** of cryptorchidism and a key reason for early surgical correction. - Even a **corrected cryptorchid testis** maintains higher cancer risk compared to normally descended testes. *Secondary sexual characteristics are universally normal* - In **unilateral cryptorchidism** (90% of cases), the normally descended contralateral testis produces **adequate testosterone** for normal secondary sexual development. - However, in **bilateral cryptorchidism** or if the descended testis is functionally impaired, **testosterone deficiency** can occur, leading to delayed or abnormal sexual development. - Therefore, secondary sexual characteristics are **not universally normal** in all cases of undescended testis. *Hormonal therapy is effective* - Hormonal therapy with **hCG (human chorionic gonadotropin)** or **GnRH (gonadotropin-releasing hormone)** has **limited and inconsistent effectiveness**. - Success rates are generally **low** (10-30%), particularly for truly undescended testes (as opposed to retractile testes). - **Orchiopexy** (surgical correction) remains the **definitive treatment**, ideally performed between **6-18 months of age** to optimize fertility potential. *More common on the right side* - Undescended testis is actually **slightly more common on the left side** (~55-60%) than the right (~40-45%). - **Bilateral cryptorchidism** occurs in approximately 10-20% of cases. - There is no significant right-sided predilection.

Question 1015: In which of the following surgeries is monopolar cautery preferred over bipolar cautery?

A. Surgery around Penis
B. Surgery of the Hip (Correct Answer)
C. Hand Surgery
D. Surgery around the face

Explanation: ***Surgery of the Hip*** - **Monopolar cautery** is preferred in surgeries like hip surgery where a larger area needs to be coagulated, as it provides a wider field of effect and can be more efficient for **deep tissue coagulation**. - Its mechanism relies on the current passing through the patient to a large **dispersive electrode (grounding pad)**, making it suitable for extensive tissue work. *Hand Surgery* - In **hand surgery**, delicate structures like nerves and tendons are abundant, making **bipolar cautery** safer due to its localized current flow and reduced risk of inadvertent thermal spread. - **Bipolar cautery** limits the current to a small area between the two prongs of the instrument, thus minimizing damage to surrounding tissues. *Surgery around Penis* - **Bipolar cautery** is generally preferred in sensitive areas like the penis, due to its localized effect and reduced risk of thermal injury to adjacent delicate structures. - The avoidance of current passing through the body to a grounding pad in **bipolar modality** is especially important in areas with potential for nerve damage or scarring. *Surgery around the face* - Surgically around the face often involves delicate tissues and structures where **bipolar cautery** is favored to prevent widespread thermal damage and minimize scarring or nerve injury. - The confined current path of **bipolar cautery** makes it ideal for precision work in cosmetic or reconstructive facial surgery.

Question 1016: ESWL is contraindicated in which of the following stones -

A. Urate stones
B. Phosphate stones
C. Oxalate Stones
D. Cystine stones (Correct Answer)

Explanation: ***Cysteine stones*** - **Cystine stones** are very dense and hard, making them resistant to fragmentation by the shock waves generated during **Extracorporeal Shock Wave Lithotripsy (ESWL)**. - Due to their resistance to fragmentation, ESWL is generally ineffective for cystine stones, and other treatments like **ureteroscopy** or **percutaneous nephrolithotomy (PCNL)** are often preferred. *Oxalate Stones* - **Calcium oxalate stones** are generally **amenable to ESWL** as they are effectively fragmented by shock waves. - They are the **most common type of kidney stone** and often respond well to lithotripsy. *Urate stones* - **Uric acid stones** are typically **radiolucent** but are often **well-fragmented by ESWL**. - Their non-calcium composition does not hinder the effectiveness of shock waves. *Phosphate stones* - **Struvite (magnesium ammonium phosphate) stones** and **calcium phosphate stones** generally respond well to ESWL. - While sometimes large and branched (**staghorn calculi**), the individual components are susceptible to shock wave fragmentation, though multiple sessions or adjunctive therapies might be needed.

Question 1017: Which of the following is NOT a feature of membranous urethral injury?

A. blood at the meatus
B. Retention of urine
C. Pelvic fracture
D. Perineal butterfly hematoma (Correct Answer)

Explanation: ***Perineal butterfly hematoma*** - A **perineal butterfly hematoma** is more characteristic of an injury to the **anterior urethra**, specifically the bulbar urethra, often caused by a straddle injury. - It occurs due to the extravasation of blood into the subcutaneous tissue of the perineum, outlining the shape of a butterfly. *blood at the meatus* - **Blood at the meatus** is a classic sign of urethral injury, regardless of the segment (anterior or posterior). - It indicates disruption of the urethral mucosa and bleeding from the damaged blood vessels. *Retention of urine* - **Retention of urine** can occur due to either a complete or partial urethral transection, preventing normal urine flow. - The inability to void can lead to bladder distension and is a significant symptom in assessing urethral trauma severity. *Pelvic fracture* - **Pelvic fractures** are frequently associated with **membranous urethral injuries** because the membranous urethra is fixed within the pelvic ring. - Shear forces from pelvic trauma can cause the prostatomembranous junction to avulse.

Question 1018: Which of the following statements about hypernephroma is true?

A. May present with rapidly developing varicocele
B. Usually an adenocarcinoma
C. Not radiosensitive (Correct Answer)
D. Arises from the cortex, usually from a pre-existing adenoma

Explanation: ***Radiosensitive*** - Hypernephroma, or renal cell carcinoma, is typically resistant to **radiation therapy**, making this statement false. - It is generally treated with **surgery** and targeted therapies rather than radiation. *Usually adenocarcinoma* - Hypernephroma is indeed a type of **adenocarcinoma**, as it originates from the renal tubular epithelium [1]. - It is the most common form of **kidney cancer**, supporting this as a true statement. *May present with rapidly developing varicocele* - Rapidly developing **varicocele** can occur due to **renal vein obstruction** associated with renal tumors [2], so this statement is true. - Varicocele is a recognized clinical feature in renal cell carcinoma due to its anatomical relationships. *Arise from cortex usually from pre existing adenoma* - Hypernephroma does arise from the **renal cortex**, often from pre-existing renal adenomas or other lesions. - This establishes its origin, making the statement accurate. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 959-961. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 492-493.

Question 1019: A 65 year old male presents with CA prostate. The tumour is limited to the capsule and it is palpable on PR examination. The patient is diagnosed as stage T2a. What is the most appropriate treatment option?

A. External beam radiation therapy
B. Androgen deprivation therapy (ADT)
C. Active surveillance
D. Surgical removal of the prostate (Radical prostatectomy) (Correct Answer)

Explanation: ***Surgical removal of the prostate (Radical prostatectomy)*** - **Radical prostatectomy** is the **definitive treatment of choice** for **localized prostate cancer (T2a)** in patients with **good life expectancy (>10 years)**. - For a **65-year-old patient** with tumor confined to the prostate, **surgical removal offers excellent disease control** and potential cure. - This is the **preferred option** when the patient is **medically fit for surgery** and has adequate life expectancy. *External beam radiation therapy* - **External beam radiation therapy (EBRT)** is also an effective treatment for **localized T2a prostate cancer** with comparable long-term survival outcomes. - However, **radical prostatectomy is generally preferred** in younger, healthier patients as it: - Provides definitive pathological staging - Allows for immediate assessment of surgical margins - Preserves radiation as a salvage option if needed - EBRT is better suited for patients who are **not surgical candidates** due to comorbidities or patient preference. *Active surveillance* - **Active surveillance** is appropriate for **very low-risk prostate cancer** (T1c, PSA <10, Gleason ≤6). - For **T2a disease** (palpable tumor), the risk of progression is significant, making active surveillance **not the most appropriate first-line option**. - Would be considered only in patients with limited life expectancy or significant comorbidities. *Androgen deprivation therapy (ADT)* - **ADT** is used for **advanced, locally advanced, or metastatic prostate cancer** to reduce testosterone and slow tumor growth. - It is **not curative** and not appropriate as **monotherapy for localized T2a disease**. - May be used as adjuvant therapy with radiation in higher-risk cases, but not as primary treatment alone.

Question 1020: Prostate cancer that is limited to the capsule and not the urethra would be staged as -

A. T1
B. T2 (Correct Answer)
C. T3
D. T0

Explanation: ***T2*** - A T2 stage indicates that the prostate cancer is **confined within the prostate capsule**, meaning it has not spread beyond the outer layer of the prostate gland. - While it is not limited to the urethra, the key defining characteristic of T2 is **capsular confinement**, which is described in the question. *T1* - T1 stage prostate cancer is typically **non-palpable** on digital rectal exam (DRE) and not visible on imaging. - It is often found incidentally, for example, during a **transurethral resection of the prostate (TURP)** for benign prostatic hyperplasia. *T3* - A T3 stage indicates that the prostate cancer has **extended beyond the prostate capsule**, but has not metastasized to distant sites. - This typically involves invasion into the **seminal vesicles** or other periprostatic tissues. *T0* - T0 means there is **no evidence of primary tumor**, which is not consistent with a diagnosed prostate cancer. - This staging is used when there is no measurable tumor.

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Hematuria Evaluation

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Bladder Cancer

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Renal Cell Carcinoma

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Testicular Tumors

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Urinary Tract Infections

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Urinary Incontinence

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Urology — MCQs

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