Urology Practice Questions

Q: Percutaneous nephrostomy is indicated in:

Pyonephrosis. **Explanation:** Percutaneous Nephrostomy (PCN) is a procedure where a catheter is inserted through the skin into the renal pelvis to provide external drainage of the collecting system. **Why Pyonephrosis is the Correct Answer:** Pyonephrosis is a surgical emergency characterized by the presence of infected, purulent material (pus) under pressure in an obstructed collecting system. If left undrained, it rapidly leads to urosepsis and irreversible renal damage. PCN is the **gold standard emergency treatment** for pyonephrosis as it provides immediate decompression and drainage of the infected focus, stabilizing the patient before definitive management of the underlying obstruction (e.g., stones). **Analysis of Incorrect Options:** * **Polycystic Kidney Disease (PKD):** PCN is not a standard treatment for PKD. Management focuses on blood pressure control and managing complications like cyst hemorrhage or infection. PCN is only used if a specific cyst becomes infected and is refractory to antibiotics, or if there is secondary obstruction. * **Solitary Adenocarcinoma:** Renal Cell Carcinoma (RCC) is managed surgically via partial or radical nephrectomy. PCN is generally avoided in malignant tumors due to the risk of **needle-track seeding**. * **Simple Hydronephrosis:** While PCN can drain hydronephrosis, it is not routinely indicated unless the condition is symptomatic, bilateral (causing azotemia), or associated with infection. Most simple hydronephrosis cases are managed by treating the primary cause (e.g., DJ stenting for stones). **Clinical Pearls for NEET-PG:** * **Most common indication for PCN:** Supravesical obstruction (e.g., ureteric calculi, pelvic malignancies). * **Absolute Contraindication:** Uncorrected coagulopathy. * **Imaging Guidance:** PCN is most commonly performed under **Ultrasonography (USG)** or Fluoroscopy guidance. * **Triad of Pyonephrosis:** Fever, loin pain, and a palpable tender mass.

Q: A 40-year-old patient with a pelvic injury presents with a 1.5 cm length stricture of the bulbar urethra. What would be the management?

Excision and end-to-end urethroplasty. The management of urethral strictures depends primarily on the **location, length, and etiology** of the stricture. ### **Why Option B is Correct** For **bulbar urethral strictures** that are short (**< 2 cm**), the gold standard treatment is **Excision and Primary End-to-End Urethroplasty (EPA)**. * **The Concept:** The bulbar urethra is mobile and surrounded by the bulbospongiosus muscle, allowing for the mobilization and tension-free anastomosis of the two healthy ends after the fibrotic segment is excised. * **Success Rate:** This procedure has the highest long-term success rate (over 90-95%) for short, traumatic bulbar strictures. ### **Why Other Options are Incorrect** * **A & D (Urethral Dilatation & Urethrotomy):** While Direct Vision Internal Urethrotomy (DVIU) or dilatation can be used for very short ( 2 cm)** where an end-to-end anastomosis would cause chordee or excessive tension. ### **Clinical Pearls for NEET-PG** * **Gold Standard for Bulbar Stricture ( 2 cm):** Substitution urethroplasty (Buccal Mucosa Graft is the preferred material). * **Most common site of traumatic urethral stricture:** Bulbar urethra (due to straddle injury). * **Most common site of post-gonococcal stricture:** Bulbar urethra. * **Initial investigation of choice:** Retrograde Urethrogram (RUG) to define the site and length.

Q: What is the treatment of choice for TURP syndrome?

Furosemide. **Explanation:** **TURP Syndrome** is a clinical complication caused by the excessive systemic absorption of non-conductive irrigation fluid (traditionally 1.5% Glycine) through opened prostatic venous sinuses. This leads to **dilutional hyponatremia** and **hypervolemic fluid overload**. **Why Furosemide is the Correct Answer:** The primary goal in managing TURP syndrome is to address the fluid overload and promote the excretion of excess free water. **Furosemide (a loop diuretic)** is the treatment of choice because it rapidly induces diuresis, reducing the intravascular volume and helping to correct the dilutional state. In mild to moderate cases, fluid restriction and Furosemide are often sufficient to allow the body to naturally re-equilibrate sodium levels. **Analysis of Incorrect Options:** * **Normal Saline (0.9% NaCl):** While it contains sodium, it adds to the volume overload, potentially worsening pulmonary edema or congestive heart failure. * **1.5% NaCl:** This is a hypotonic solution relative to the body's needs in this scenario. If sodium replacement is required for severe symptoms (e.g., seizures), **Hypertonic Saline (3% NaCl)** is used, not 1.5%. * **Thiazides:** These are less potent than loop diuretics and can further lower serum sodium levels by inhibiting sodium reabsorption in the distal tubule, making them inappropriate for treating hyponatremia. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Hypertension (early), Bradycardia, and Mental status changes (due to cerebral edema). * **Severe Cases:** If sodium levels are <120 mEq/L or the patient has seizures, use **3% Hypertonic Saline** at a slow rate (not exceeding 10–12 mEq/L in 24 hours) to avoid **Central Pontine Myelinolysis**. * **Prevention:** Modern practice uses **Bipolar TURP** with Normal Saline irrigation, which significantly reduces the risk of this syndrome.

Q: Transurethral resection of the prostate (TURP) was performed in an elderly patient with benign prostatic hyperplasia (BPH). Postoperatively, the patient developed altered sensorium. What is the most likely cause?

Hyponatremia. The correct answer is **Hyponatremia (Option C)**. **Underlying Medical Concept:** This clinical scenario describes **TURP Syndrome**, a potentially life-threatening complication of transurethral resection of the prostate. During the procedure, large volumes of non-conductive irrigation fluid (traditionally **1.5% Glycine**) are used to maintain visibility. If the prostatic venous sinuses are opened, this hypotonic fluid is rapidly absorbed into the systemic circulation. This leads to **dilutional hyponatremia** and fluid overload [1]. The sudden drop in serum sodium causes cerebral edema, manifesting as altered sensorium, confusion, seizures, or even coma [1][2]. **Analysis of Incorrect Options:** * **Hypokalemia (A):** While fluid shifts can occur, the primary electrolyte disturbance in TURP syndrome is sodium dilution, not a significant drop in potassium. * **Hypernatremia (B):** This is the opposite of what occurs. The absorption of hypotonic irrigation fluid dilutes the extracellular sodium concentration [1]. * **Hypomagnesemia (D):** Magnesium levels are not typically affected by the irrigation fluids used in TURP. **Clinical Pearls for NEET-PG:** * **Irrigation Fluid:** Glycine is most commonly implicated. Other fluids include Sorbitol or Mannitol. * **Visual Disturbance:** Glycine is an inhibitory neurotransmitter in the retina; its toxicity can cause transient **blindness** or blurred vision. * **Management:** Treatment involves fluid restriction and loop diuretics. In severe cases with neurological symptoms, **hypertonic saline (3% NaCl)** is used to slowly correct sodium levels. * **Prevention:** Modern practice often uses **Bipolar TURP**, which allows the use of **Normal Saline (0.9% NaCl)**, significantly reducing the risk of hyponatremia.

Q: A 50-year-old male presents with scrotal pain for 2 days. The pain decreases with elevation of the testis. What is the most likely clinical diagnosis?

Epididymoorchitis. ### Explanation The clinical scenario describes a positive **Prehn’s sign**, which is a classic physical examination finding used to differentiate between causes of acute scrotum. **1. Why Epididymoorchitis is correct:** In **Epididymoorchitis**, inflammation of the epididymis and testis leads to congestion and gravity-dependent pain. When the scrotum is manually elevated, the physical support relieves the tension on the spermatic cord and suspensory structures, leading to a **decrease in pain (Positive Prehn’s sign)**. It typically presents in older men (or sexually active younger men) with a gradual onset of pain over 1–2 days, often accompanied by fever or urinary symptoms. **2. Why the other options are incorrect:** * **Testicular Torsion:** This is a surgical emergency. In torsion, elevation of the testis typically **increases the pain** (Negative Prehn’s sign) because the maneuver further twists the spermatic cord or aggravates the ischemia. The onset is usually sudden and occurs in a younger age group (adolescents). * **Inguinal Hernia:** While an incarcerated hernia can cause scrotal pain, it is usually associated with a cough impulse, intestinal symptoms (nausea/vomiting), and the inability to "get above the swelling." * **Hydrocele:** This is generally a painless, chronic swelling. While an infected hydrocele (pyocele) can be painful, it does not classically demonstrate a positive Prehn’s sign. **3. Clinical Pearls for NEET-PG:** * **Prehn’s Sign:** Positive (pain relief) = Epididymitis; Negative (no relief/increased pain) = Torsion. * **Cremasteric Reflex:** Usually **absent** in Testicular Torsion but **present** in Epididymoorchitis. * **Gold Standard Investigation:** Color Doppler Ultrasound (shows increased blood flow in epididymitis and decreased/absent flow in torsion). * **Age Factor:** Torsion is most common in the 12–18 age group; Epididymitis is more common in men >35 years.

Q: Ureteric colic is characterized by all of the following EXCEPT:

Responds to antispasmodics. **Explanation:** Ureteric colic is a classic surgical emergency caused by the sudden obstruction of the ureter, usually by a calculus. **Why "Responds to antispasmodics" is the correct (incorrect statement) answer:** The primary mechanism of pain in ureteric colic is **prostaglandin-mediated** smooth muscle hyperperistalsis and mucosal edema. While the term "colic" suggests spasm, clinical evidence shows that **NSAIDs (like Diclofenac)** are the first-line treatment because they inhibit prostaglandin synthesis, reducing ureteric pressure and inflammation. Pure antispasmodics (like Hyoscine) are generally ineffective as monotherapy for the intense pain of an obstructing stone. **Analysis of other options:** * **Acute onset:** Ureteric colic typically presents as a sudden, excruciating pain that reaches peak intensity rapidly as the stone enters the narrow ureter. * **Patients prefer to remain still:** This is **false** regarding ureteric colic; patients are typically **restless** and "writhing in pain," constantly changing positions to find relief. This distinguishes it from peritonitis (e.g., perforated peptic ulcer), where patients prefer to lie perfectly still. *Note: In the context of this MCQ, Option B is a known characteristic of peritonitis, making it a potential distractor, but Option C is the standard "except" answer in surgical textbooks regarding pharmacological management.* * **Pain radiates to the groin:** This is a hallmark feature. As the stone moves down the ureter, pain radiates from the **loin to the groin** (T11-L2 distribution), often reaching the scrotum, labia, or inner thigh. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Non-contrast CT (NCCT) KUB. * **Narrowest site of the ureter:** Vesicoureteric junction (VUJ). * **Management:** NSAIDs are superior to opioids for pain relief; Medical Expulsive Therapy (MET) involves Alpha-blockers (Tamsulosin).

Q: What is the cause of hydrocele in infants?

Patent processus vaginalis. **Explanation:** The correct answer is **B. Patent processus vaginalis.** **Underlying Concept:** In fetal development, the testis descends from the abdomen into the scrotum preceded by a peritoneal fold called the **processus vaginalis**. Normally, the upper portion of this sac obliterates shortly before or after birth. If the processus remains **patent** (open), peritoneal fluid can track down into the scrotum, resulting in a **communicating hydrocele**. This is the most common cause of hydrocele in infants and children. If the opening is wide enough to allow abdominal contents (like bowel) to pass through, it is termed an indirect inguinal hernia. **Analysis of Incorrect Options:** * **A. Patent gubernaculum:** The gubernaculum is a mesenchymal structure that guides the descent of the testis; it does not form a sac or channel for fluid. * **C. Cyst of Morgagni:** Also known as the appendix testis, this is a vestigial remnant of the Müllerian duct. While its torsion can cause acute scrotal pain, it is not the cause of a generalized hydrocele. * **D. Hormonal factors:** While maternal hormones may cause transient neonatal breast enlargement or vaginal bleeding, they do not play a role in the anatomical patency of the processus vaginalis. **High-Yield Clinical Pearls for NEET-PG:** * **Management:** Most congenital hydroceles are managed conservatively as they often resolve spontaneously by **1–2 years of age** as the processus obliterates. * **Surgical Timing:** Surgery (Herniotomy) is indicated if the hydrocele persists beyond 2 years or if an associated inguinal hernia is present. * **Key Difference:** Unlike adult hydroceles (usually primary/idiopathic and treated with Lord’s procedure or Jaboulay’s eversion), pediatric hydroceles are almost always **communicating** and require **high ligation** of the patent processus vaginalis.

Question 1

A 55-year-old male patient underwent cholecystectomy for gallstone calculus. During surgery, the patient's pulse was irregularly irregular, 160/min, BP = 80/50 mm Hg, temp = 40°C. On examination, a swelling in the neck was found. What is the most likely diagnosis?

Accepted Answer

Thyroid storm

Answer

Myocardial infarction

Answer

Arrhythmia

Answer

Stridor

Question 2

In which of the following conditions is neo-adjuvant chemotherapy NOT used?

Accepted Answer

Breast cancer stage 2

Answer

Osteosarcoma

Answer

Chest wall PNET

Answer

Ovarian cancer stage 3

Question 3

Percutaneous nephrostomy is indicated in:

Accepted Answer

Pyonephrosis

Answer

Polycystic kidney disease

Answer

Solitary adenocarcinoma

Answer

Simple hydronephrosis

Question 4

Which of the following statements about renal cell carcinoma is false?

Accepted Answer

It is radiosensitive.

Answer

It is also known as Grawitz tumor.

Answer

Tumors less than 4 cm are typically treated with partial nephrectomy.

Answer

It arises from the proximal convoluted tubule.

Question 5

A 40-year-old patient with a pelvic injury presents with a 1.5 cm length stricture of the bulbar urethra. What would be the management?

Accepted Answer

Excision and end-to-end urethroplasty

Answer

Urethral dilatation

Answer

Patch graft urethroplasty

Answer

Urethrotomy

Question 6

What is the treatment of choice for TURP syndrome?

Accepted Answer

Furosemide

Answer

Normal saline

Answer

1.5% NaCl

Answer

Thiazides

Question 7

Transurethral resection of the prostate (TURP) was performed in an elderly patient with benign prostatic hyperplasia (BPH). Postoperatively, the patient developed altered sensorium. What is the most likely cause?

Accepted Answer

Hyponatremia

Answer

Hypokalemia

Answer

Hypernatremia

Answer

Hypomagnesemia

Question 8

A 50-year-old male presents with scrotal pain for 2 days. The pain decreases with elevation of the testis. What is the most likely clinical diagnosis?

Accepted Answer

Epididymoorchitis

Answer

Testicular torsion

Answer

Inguinal hernia

Answer

Hydrocele

Question 9

Ureteric colic is characterized by all of the following EXCEPT:

Accepted Answer

Responds to antispasmodics

Answer

Acute onset

Answer

Patients often prefer to remain still

Answer

Pain radiates to the groin

Question 10

What is the cause of hydrocele in infants?

Accepted Answer

Patent processus vaginalis

Answer

Patent gubernaculum

Answer

Cyst of Morgagni

Answer

Hormonal factors

Urology — MCQs

Urology — MCQs

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