Urology — MCQs
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The Grayhack shunt is established between which of the following?
A 45-year-old male is diagnosed with carcinoma of the penis. Which lymph nodes should the surgeon primarily consider for potential metastasis?
A 54 year old woman is diagnosed as having carcinoma of the renal pelvis of size less than 4 cm without any metastasis. The best treatment option is
In which condition is the Prehn sign typically positive?
Young male with history of trauma having left sided testis swollen and erythematous. Other side normal. What is the diagnosis?
In testicular torsion, within what time frame should surgery be performed to save the viability of the testis?
All are true about carcinoma penis except which of the following?
Most common anomaly of upper urogenital tract is -
Diversion of urine is best done at
Circumcision is contraindicated in
Urology Indian Medical PG Practice Questions and MCQs
Question 1021: The Grayhack shunt is established between which of the following?
- A. Corpora cavernosa and dorsal vein
- B. Corpora cavernosa and saphenous vein (Correct Answer)
- C. Corpora cavernosa and glans
- D. Corpora cavernosa and corpora spongiosa
Explanation: ***Corpora cavernosa and saphenous vein*** - The **Grayhack shunt** is a type of **cavernosal-venous shunt**, specifically connecting the corpus cavernosum to the saphenous vein. - This procedure is typically performed to surgically manage **priapism** by diverting blood from the trapped penile cavernosal spaces. *Corpora cavernosa and dorsal vein* - While other **cavernosal-venous shunts** can be created between the corpora cavernosa and the dorsal vein (e.g., Al-Ghorab shunt), the Grayhack shunt specifically involves the **saphenous vein**. - The dorsal vein approach is usually considered for more distal shunts. *Corpora cavernosa and glans* - This describes a **distal cavernosal-glanular shunt** (e.g., Winter or Ebbehoj), which involves creating a communication between the corpus cavernosum and the glans penis to relieve priapism. - The Grayhack shunt is a more **proximal** and **cavernosal-venous** type of shunt. *Corpora cavernosa and corpora spongiosa* - This describes a **cavernosal-spongiosal shunt**, such as the Quackels shunt, where connection is made between the corpora cavernosa and the corpus spongiosum. - This type of shunt is also used for priapism but is distinct from the cavernosal-venous Grayhack shunt.
Question 1022: A 45-year-old male is diagnosed with carcinoma of the penis. Which lymph nodes should the surgeon primarily consider for potential metastasis?
- A. Inguinal lymph nodes (located in the groin region) (Correct Answer)
- B. Para-aortic lymph nodes (located near the aorta)
- C. External iliac lymph nodes (located along the external iliac vessels)
- D. Internal iliac lymph nodes (located along the internal iliac vessels)
Explanation: ***Inguinal lymph nodes (located in the groin region)*** - The lymphatic drainage of the penis primarily bypasses the internal nodal basins and drains directly to the **superficial and deep inguinal lymph nodes**. - Metastasis to these nodes is the **most common initial spread** in penile carcinoma, making them the primary targets for surgical evaluation and dissection. *Para-aortic lymph nodes (located near the aorta)* - These nodes are typically involved in more advanced or widespread metastatic disease, following initial spread to the pelvic nodes. - They are not considered the primary draining lymph nodes for penile carcinoma. *External iliac lymph nodes (located along the external iliac vessels)* - While part of the pelvic lymph node chain, the external iliac nodes are usually involved after metastasis to the inguinal nodes, or in cases of direct invasion of the pelvic floor. - They are not the first echelon of lymphatic drainage for the penis. *Internal iliac lymph nodes (located along the internal iliac vessels)* - These nodes are involved in lymphatic drainage from organs like the bladder, prostate, and rectum. - The lymphatic drainage of the penis primarily bypasses these nodes for initial metastasis.
Question 1023: A 54 year old woman is diagnosed as having carcinoma of the renal pelvis of size less than 4 cm without any metastasis. The best treatment option is
- A. Palliative Radiotherapy
- B. Chemotherapy and immunotherapy
- C. Partial nephrectomy
- D. Radical Nephroureterectomy (Correct Answer)
Explanation: ***Radical Nephroureterectomy*** - Carcinoma of the **renal pelvis** is a type of upper tract urothelial carcinoma (UTUC). Because of the multifocal nature and higher risk of recurrence of UTUC, **radical nephroureterectomy** (which includes removal of the kidney, ureter, and bladder cuff) is the standard treatment, even for smaller tumors. - Unlike renal cell carcinoma, partial nephrectomy is generally not recommended for renal pelvis carcinomas due to the risk of leaving behind residual disease in the ureter or bladder cuff. *Partial nephrectomy* - This is generally reserved for small, localized **renal cell carcinomas**, especially when kidney function preservation is a concern (e.g., solitary kidney, bilateral tumors). - For **renal pelvis carcinomas**, partial nephrectomy is associated with a higher risk of local recurrence because of the potential for tumor spread within the ureter and multifocal disease. *Chemotherapy and immunotherapy* - **Chemotherapy** (often cisplatin-based) might be used as neoadjuvant or adjuvant therapy for locally advanced or high-risk UTUC, or for metastatic disease. It is not the primary curative treatment for localized disease. - **Immunotherapy** is typically reserved for advanced or metastatic urothelial carcinoma that has progressed after chemotherapy. *Palliative Radiotherapy* - **Radiotherapy** has a limited role in the primary curative treatment of renal pelvis carcinoma. - It is mainly used in a **palliative setting** for symptom control (e.g., bone metastases, local pain) in advanced or metastatic disease, not for localized, resectable tumors.
Question 1024: In which condition is the Prehn sign typically positive?
- A. Acute epididymitis (Correct Answer)
- B. Chronic epididymitis
- C. Testicular torsion
- D. Acute scrotal pain due to other causes
Explanation: ***Acute epididymitis*** - **Prehn sign** is positive when lifting the scrotal sac alleviates pain, as it reduces pressure on the inflamed epididymis. - This sign is commonly used to differentiate **epididymitis** from **testicular torsion**, where pain typically worsens or remains unchanged with elevation. *Chronic epididymitis* - While potentially painful, **chronic epididymitis** usually presents with persistent, dull pain that is less likely to be acutely relieved by scrotal elevation. - The **Prehn sign** is primarily a diagnostic tool for **acute inflammatory conditions** of the epididymis. *Testicular torsion* - In **testicular torsion**, the pain is often sudden, severe, and typically **not relieved** by elevating the testicle; in fact, it may worsen. - This condition is a **surgical emergency** where blood flow to the testicle is compromised. *Acute scrotal pain due to other causes* - Other causes of **acute scrotal pain**, such as **trauma** or **incarcerated hernias**, generally do not exhibit a positive Prehn sign. - The **Prehn sign** is quite specific to the **inflammatory process** of epididymitis affecting pain perception.
Question 1025: Young male with history of trauma having left sided testis swollen and erythematous. Other side normal. What is the diagnosis?
- A. Carcinoma
- B. Hernia
- C. Hematoma (Correct Answer)
- D. Torsion
Explanation: ***Hematoma*** - A history of **trauma** leading to a **swollen and erythematous testis** is highly indicative of a testicular hematoma. Trauma can cause bleeding within the scrotal sac, leading to the observed symptoms. - A hematoma is a localized collection of **blood outside of blood vessels**, which in this case, results from the injury to the testis or surrounding structures. *Torsion* - Testicular torsion typically presents with **sudden, severe pain** and swelling, and can be associated with absent **cremasteric reflex**. While swelling is present, the clear history of trauma points away from spontaneous torsion. - Torsion is an **emergency** caused by the twisting of the spermatic cord, which **cuts off blood supply** to the testis, and usually lacks a direct antecedent trauma. *Carcinoma* - Testicular carcinoma usually presents as a **painless, firm mass** within the testis. Pain can occur if there is hemorrhage within the tumor or rapid growth. - While it can cause swelling, the acute onset and direct association with trauma make carcinoma less likely, as it is a **slowly progressive** condition. *Hernia* - An inguinal hernia typically presents as a **groin bulge** that can extend into the scrotum, and usually reduces with manipulation or lying down. It is often associated with a cough or strain. - While a hernia can cause scrotal swelling, the primary presentation is usually a reducible mass, and the direct link to trauma with associated erythema is not typical for a simple hernia.
Question 1026: In testicular torsion, within what time frame should surgery be performed to save the viability of the testis?
- A. 6 hr (Correct Answer)
- B. 12 hr
- C. 24 hr
- D. 1 week
Explanation: ***6 hr*** - Testicular viability is highest when **detorsion** occurs within **6 hours** of symptom onset. - Delay beyond this timeframe significantly increases the risk of **testicular ischemia** and necrosis. *12 hr* - While some viability may remain, the probability of **testicular salvage** decreases substantially after 6 hours. - Testicular function, including **sperm production**, is often compromised even if the testis is saved. *24 hr* - Beyond 12-24 hours, the likelihood of **testicular viability** is very low, and **orchiectomy** (testicle removal) is often necessary. - Prolonged ischemia leads to irreversible **tissue damage** and infarction. *1 week* - After one week, the testis is almost certainly non-viable due to **prolonged ischemia** and necrosis. - This delay would invariably result in the need for **orchiectomy**.
Question 1027: All are true about carcinoma penis except which of the following?
- A. Leads to erosion of artery
- B. Spreads by blood borne metastasis (Correct Answer)
- C. Slowly progressive
- D. Most common type is squamous cell carcinoma
Explanation: ***Spreads by blood borne metastasis*** - Carcinoma penis typically spreads initially via the **lymphatic system** to inguinal lymph nodes. - **Hematogenous spread** is a late event and generally rare, with the most common sites being the lung, liver, and bone. *Leads to erosion of artery* - Local advancement of penile carcinoma can lead to **erosion of penile arteries**, which can cause significant morbidity including bleeding and functional compromise. - This local tissue destruction is a characteristic feature of advanced, uncontrolled penile cancer. *Slowly progressive* - Carcinoma penis is generally a **slowly progressive** malignancy, allowing for early detection and intervention if patients seek medical attention promptly. - The slow growth rate contributes to the fact that many patients present with localized or regionally advanced disease before distant metastases occur. *Most common type is squamous cell carcinoma* - Approximately 95% of penile cancers are **squamous cell carcinomas (SCCs)**, arising from the epithelial cells of the glans or foreskin. - Other rare types include melanoma, basal cell carcinoma, and sarcomas, but SCC vastly predominates.
Question 1028: Most common anomaly of upper urogenital tract is -
- A. Uretero pelvic junction stenosis (Correct Answer)
- B. Ureterocele
- C. Ectopic ureter
- D. Ectopic urethral opening
Explanation: ***Uretero pelvic junction stenosis*** - **Ureteropelvic junction (UPJ) obstruction** is the most common cause of **antenatally detected hydronephrosis**, making it the most frequent anomaly of the upper urogenital tract. - It results from an intrinsic or extrinsic narrowing at the junction of the **renal pelvis** and the **ureter**, impeding urine flow. *Ectopic urethral opening* - This anomaly involves the **urethral opening** being in an abnormal location, such as **hypospadias** or **epispadias** in males, or into the vagina in females. - While relatively common, it is an anomaly of the **lower urogenital tract**, specifically the urethra, not the upper tract. *Ureterocele* - A ureterocele is a **cystic dilation** of the distal part of the ureter as it enters the bladder. - While it can be associated with varying degrees of **upper tract obstruction**, it is not as common as UPJ stenosis. *Ectopic ureter* - An ectopic ureter involves a ureter that drains into an abnormal location other than the **trigone of the bladder**. - This condition is less common than UPJ stenosis and is often associated with a **duplex collecting system**.
Question 1029: Diversion of urine is best done at
- A. Jejunum
- B. Colon
- C. Ileum (Correct Answer)
- D. Caecum
Explanation: ***Ileum*** - The **ileum** is the most commonly used segment for urinary diversion due to its **mobility**, adequate vascular supply, and low complication rates. - Its relatively **low absorptive capacity** for electrolytes, particularly urea and ammonia, minimizes metabolic disturbances. *Jejunum* - The **jejunum** has a high absorptive capacity, which can lead to significant **electrolyte imbalances** (e.g., hypochloremic, hypokalemic metabolic acidosis) when urine is diverted into it. - It is also more prone to **stomal stenosis** and bowel obstruction compared to the ileum. *Colon* - While the colon can be used, particularly in continent diversions, it has a **thicker wall** and can be less mobile, making surgical creation of a conduit more challenging. - Similar to the jejunum, it has a **higher absorptive capacity** than the ileum, which can lead to electrolyte disturbances. *Caecum* - The **caecum** is a possible site for continent urinary diversions (e.g., cecal pouch), but it is not typically used for simple incontinent conduits due to its **anatomical position** and surgical complexity. - Its use often requires additional procedures to ensure continence and prevent reflux.
Question 1030: Circumcision is contraindicated in
- A. Paraphimosis
- B. Exostrophy of bladder
- C. Balanitis
- D. Hypospadias (Correct Answer)
Explanation: ***Hypospadias*** - In **hypospadias**, the **urethral opening** is located on the underside of the penis, and the foreskin is **essential** for **reconstructive surgery** (urethroplasty) to correct the defect. - Removing the foreskin via circumcision would eliminate this vital tissue, making surgical repair extremely difficult or impossible. - This is the **most absolute contraindication** to circumcision in pediatric urology. *Balanitis* - **Balanitis** is inflammation of the glans penis, often due to poor hygiene or infection. - Circumcision is actually a **treatment** for recurrent balanitis, not a contraindication. - It represents an **indication** for circumcision, not a contraindication. *Paraphimosis* - **Paraphimosis** is a urological emergency where the retracted foreskin becomes trapped behind the glans, causing vascular compromise. - Immediate management involves manual reduction or dorsal slit procedure. - Once the acute condition is resolved, elective circumcision can be performed to prevent recurrence—**not a contraindication**. *Exstrophy of bladder* - **Bladder exstrophy** is a severe congenital anomaly involving the epispadias-exstrophy complex, where the bladder is exposed outside the body. - The foreskin is typically **preserved for penile reconstruction** during complex staged repairs. - While this is also considered a **contraindication to circumcision** in most cases, **hypospadias** remains the **classic and most absolute contraindication** taught in medical education and is the expected answer for this question.
Practice by Chapter
Urological Anatomy
Practice Questions
Hematuria Evaluation
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Urinary Calculi
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Benign Prostatic Hyperplasia
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Prostate Cancer
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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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Genitourinary Trauma
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Pediatric Urology Basics
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