Urology Practice Questions

Q: Tuberculosis of the testis first affects which of the following structures?

Epididymis. **Explanation:** Genitourinary tuberculosis (GUTB) is almost always secondary to a primary focus elsewhere, usually the lungs [2]. In the male reproductive system, the **Epididymis** is the most common site of initial involvement. **Why Epididymis is the correct answer:** The spread of *Mycobacterium tuberculosis* to the male genital tract occurs primarily via two routes: **hematogenous** (blood-borne) or **descending infection** from the urinary tract (infected urine) [1]. The epididymis has a very high vascularity, particularly the globus minor (tail), making it the primary "landing site" for the bacilli. From the epididymis, the infection typically spreads to the testis via direct extension or through the lymphatics. **Analysis of Incorrect Options:** * **Vas deferens (A):** While the vas can be involved (leading to characteristic "beading" of the vas), it is usually affected secondary to epididymal involvement [1]. * **Body of testis (C):** Isolated orchitis is rare in TB. The testis is usually involved secondary to the epididymis (Epididymo-orchitis) because the blood-testis barrier provides some initial protection [3]. * **Tunica vaginalis (D):** This is a serous membrane. While it can develop a secondary hydrocele due to inflammation, it is not the primary site of infection [3]. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Presents as a painless, "craggy" (hard/irregular) enlargement of the epididymis. * **Beaded Vas Deferens:** A classic sign of TB caused by multiple granulomatous strictures along the vas. * **Scrotal Sinus:** Chronic TB epididymitis may lead to a cold abscess that bursts through the posterior scrotal skin, forming a sinus. * **Infertility:** Bilateral involvement often leads to obstructive azoospermia.

Q: A 18-year-old male presents with pain and tenderness in the left scrotum, with a normal right scrotum. What is the most appropriate investigation?

Color Doppler ultrasound. **Explanation:** The clinical presentation of acute scrotal pain and tenderness in a young male is a surgical emergency, with **Testicular Torsion** being the most critical diagnosis to rule out. 1. **Why Color Doppler Ultrasound (CDUS) is the correct answer:** CDUS is the **investigation of choice** for acute scrotum. While B-mode ultrasound can show structural changes (like edema or whirlpool sign), it cannot assess blood flow. The hallmark of testicular torsion is the **absence or reduction of blood flow** to the affected testis. CDUS has high sensitivity (82-100%) and specificity (88-100%) for diagnosing torsion and differentiating it from inflammatory conditions like epididymo-orchitis (where blood flow is increased). 2. **Why other options are incorrect:** * **B-mode Ultrasound:** Useful for identifying anatomy, hydrocele, or tumors, but insufficient for assessing the vascular compromise essential for diagnosing torsion. * **CT Scan and MRI:** These are time-consuming, expensive, and not readily available in emergency settings. They play no role in the primary evaluation of an acute scrotum where "time is muscle." **Clinical Pearls for NEET-PG:** * **Golden Period:** Surgical detorsion should ideally occur within **6 hours** of symptom onset to ensure a nearly 100% salvage rate. * **Clinical Diagnosis:** If clinical suspicion of torsion is very high, surgical exploration should not be delayed for imaging. * **Prehn’s Sign:** Elevation of the scrotum relieves pain in epididymitis but **not** in torsion (Negative Prehn's sign). * **Cremasteric Reflex:** Typically absent in testicular torsion; its presence makes torsion less likely.

Q: Which of the following statements about varicocele is FALSE?

Asymptomatic cases generally require surgical intervention.. **Explanation:** A varicocele is the abnormal dilation and tortuosity of the pampiniform plexus of veins within the spermatic cord. **1. Why Option C is the correct (False) statement:** The management of varicocele is primarily conservative unless specific indications are met. **Asymptomatic varicoceles do not require surgical intervention.** Surgery (Varicocelectomy) is indicated only if there is: * Documented infertility with abnormal semen analysis. * Significant testicular atrophy (especially in adolescents). * Severe, persistent pain or discomfort. **2. Analysis of other options:** * **Option A (True):** The primary pathophysiology involves **incompetent valves** in the internal spermatic (testicular) vein, leading to retrograde blood flow and venous hypertension. * **Option B (True):** **90% occur on the left side** due to anatomical factors: the left testicular vein enters the left renal vein at a **90-degree angle**, it lacks effective valves at its junction, and it may be compressed between the SMA and Aorta (Nutcracker phenomenon). * **Option D (True):** Percutaneous embolization/ablation via femoral or jugular catheterization is a recognized minimally invasive treatment, often preferred for **recurrent varicoceles** after failed primary surgery. **Clinical Pearls for NEET-PG:** * **Sudden onset right-sided varicocele:** Always rule out a retroperitoneal mass (e.g., **Renal Cell Carcinoma**) obstructing the IVC. * **Gold Standard Investigation:** Color Doppler Ultrasound (shows venous diameter >2mm and reversal of flow on Valsalva). * **Surgical Gold Standard:** Microsurgical Subinguinal Varicocelectomy (lowest recurrence and complication rates). * **Grading:** Grade I (Palpable only with Valsalva); Grade II (Palpable without Valsalva); Grade III (Visible through scrotal skin).

Q: What is the most common late complication of traumatic rupture of the urethra?

Stricture. **Explanation:** The correct answer is **Stricture**. Traumatic rupture of the urethra, whether involving the posterior urethra (associated with pelvic fractures) or the anterior urethra (associated with straddle injuries), leads to significant tissue damage and extravasation of urine and blood. **1. Why Stricture is Correct:** Healing of a urethral injury occurs through **fibrosis and scarring**. Because the urethra is a narrow conduit, the contraction of this fibrous tissue during the remodeling phase (weeks to months after injury) inevitably leads to a narrowing of the lumen, known as a **urethral stricture**. This is the most frequent and clinically significant late sequela, often requiring surgical intervention like urethroplasty or optical internal urethrotomy. **2. Why Other Options are Incorrect:** * **Diverticulum:** While a "false diverticulum" can occur due to localized urine extravasation or post-stenotic dilatation, it is a rare complication compared to the near-universal risk of scarring. * **Retrograde Ejaculation:** This is more commonly a complication of bladder neck surgeries (like TURP) where the internal sphincter is damaged, rather than a direct result of urethral rupture. * **Chordee:** This refers to a ventral curvature of the penis, usually associated with congenital hypospadias or Peyronie’s disease, not typically a late result of urethral rupture. **Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** For suspected urethral injury, the initial investigation of choice is **Retrograde Urethrogram (RUG)**. * **Posterior Urethra:** Most commonly injured in pelvic fractures (specifically the membranous part). * **Anterior Urethra:** Most commonly injured in "straddle injuries" (specifically the bulbar part). * **Classic Triad:** Blood at the meatus, inability to void, and a palpable distended bladder (with a "high-riding prostate" on DRE in posterior injuries).

Q: Assessment in suspected prostate cancer should include ALL EXCEPT?

Intravenous urogram (IVU). ### Explanation The assessment of suspected prostate cancer focuses on **diagnosis**, **risk stratification**, and **staging**. **Why Intravenous Urogram (IVU) is the Correct Answer:** IVU is a functional study used to visualize the collecting system of the kidneys, ureters, and bladder. While it was historically used to check for ureteric obstruction or bladder floor elevation (the "J-shaped" or "fish-hook" ureter) caused by an enlarged prostate, it provides **no diagnostic or staging information** regarding the malignancy itself. In modern urology, IVU has been largely replaced by CT Urography and has no role in the standard workup of prostate cancer. **Analysis of Other Options:** * **TRUS-guided Biopsy:** This is the traditional gold standard for obtaining a tissue diagnosis. It allows for systematic sampling (usually 12 cores) to determine the **Gleason Score**. * **Cross-sectional MRI:** Specifically **Multiparametric MRI (mpMRI)** is now the preferred initial investigation. It helps in local staging (T-staging), identifying extracapsular extension, and guiding targeted biopsies (MRI-TRUS fusion). * **Bone Scan:** Prostate cancer is highly osteoblastic. A Technetium-99m MDP bone scan is the standard investigation to rule out distant **skeletal metastasis** in patients with high PSA levels (>20 ng/ml) or high-grade tumors. ### High-Yield Clinical Pearls for NEET-PG * **Screening:** Digital Rectal Examination (DRE) and Serum PSA are the primary screening tools. * **Most Common Site:** 70% of prostate cancers arise in the **Peripheral Zone**. * **Metastasis:** The most common site of distant spread is the **bone** (specifically the lumbar spine via Batson’s venous plexus), typically presenting as **osteoblastic** lesions. * **Definitive Diagnosis:** Histopathological examination via biopsy is mandatory before definitive treatment.

Q: A 20-year-old female presented to the emergency department with high-grade swinging fever, abdominal tenderness, and a flank mass. On CT, there was a collection around the kidney. Antibiotics were started, but the patient's condition did not improve after 48 hours. What is the next best treatment option?

Percutaneous drainage under CT guidance. ### Explanation The clinical presentation of high-grade swinging fever, flank mass, and tenderness, combined with CT findings of a collection around the kidney, is diagnostic of a **Perinephric Abscess**. **1. Why Percutaneous Drainage (PCD) is the Correct Choice:** The standard management for a renal or perinephric abscess follows a step-wise approach. While small abscesses (<3 cm) may respond to intravenous antibiotics alone, larger collections or those failing to respond to medical therapy within 48–72 hours require **active drainage**. Percutaneous drainage under CT or ultrasound guidance is the **first-line intervention** because it is minimally invasive, allows for culture-specific antibiotic adjustment, and has a high success rate with lower morbidity compared to open surgery. **2. Why Other Options are Incorrect:** * **Open Surgical Drainage:** This is reserved for cases where percutaneous drainage fails, the abscess is multiloculated, or the collection is extremely viscous. It is not the initial procedural step. * **Nephrectomy:** This is a radical measure only indicated if the kidney is non-functional (e.g., due to chronic xanthogranulomatous pyelonephritis) or if there is uncontrollable sepsis despite drainage. * **Observation and Follow-up:** The patient is clinically deteriorating ("swinging fever," no improvement after 48 hours of antibiotics). Continued observation without intervention leads to high mortality. **Clinical Pearls for NEET-PG:** * **Most common cause:** Ascending urinary tract infection (E. coli, Proteus) or hematogenous spread (S. aureus). * **Triad of Perinephric Abscess:** Fever, flank pain, and a palpable mass. * **Imaging of Choice:** Contrast-Enhanced CT (CECT) is the gold standard for diagnosis and staging. * **Rule of Thumb:** If an "obstructed" kidney is infected (pyonephrosis), the immediate priority is **decompression** (via PCN or DJ stenting).

Question 1

Tuberculosis of the testis first affects which of the following structures?

Accepted Answer

Epididymis

Answer

Vas deferens

Answer

Body of testis

Answer

Tunica vaginalis

Question 2

A 18-year-old male presents with pain and tenderness in the left scrotum, with a normal right scrotum. What is the most appropriate investigation?

Accepted Answer

Color Doppler ultrasound

Answer

B-mode ultrasound

Answer

CT scan

Answer

MRI

Question 3

A scrotal swelling is non-reducible but disappears on lying overnight and reappears slowly during the daytime. What is the diagnosis?

Accepted Answer

Congenital hydrocele

Answer

Varicocele

Answer

Indirect hernia

Answer

Sliding hernia

Question 4

Which of the following statements about varicocele is FALSE?

Accepted Answer

Asymptomatic cases generally require surgical intervention.

Answer

Incompetent valves of the testicular vein are responsible for varicocele.

Answer

Approximately 90% of varicoceles occur on the left side.

Answer

Femoral catheterization with spermatic vein ablation is a treatment option for recurrent varicocele.

Question 5

What is the most common late complication of traumatic rupture of the urethra?

Accepted Answer

Stricture

Answer

Diverticulum

Answer

Retrograde ejaculation

Answer

Chordee

Question 6

Ligation of the spermatic cord in orchidectomy for the treatment of testicular tumor is performed at which anatomical landmark?

Accepted Answer

Internal inguinal ring

Answer

External inguinal ring

Answer

Base of the scrotum

Answer

Superior to the epididymis

Question 7

Orchidectomy is not indicated in which of the following conditions?

Accepted Answer

Filarial epididymo-orchitis

Answer

Prostate cancer

Answer

Seminoma testes

Answer

Male breast cancer

Question 8

Assessment in suspected prostate cancer should include ALL EXCEPT?

Accepted Answer

Intravenous urogram (IVU)

Answer

Transrectal ultrasound-guided biopsy (TRUS)

Answer

Cross-sectional MRI imaging

Answer

Bone scan

Question 9

A 20-year-old female presented to the emergency department with high-grade swinging fever, abdominal tenderness, and a flank mass. On CT, there was a collection around the kidney. Antibiotics were started, but the patient's condition did not improve after 48 hours. What is the next best treatment option?

Accepted Answer

Percutaneous drainage under CT guidance

Answer

Open surgical drainage

Answer

Nephrectomy

Answer

Observation and follow-up

Question 10

Which of the following is used for the prevention of struvite stones?

Accepted Answer

Acetohydroxamic acid

Answer

Urine alkalinizer

Answer

Tiopronin

Answer

D-Penicillamine

Urology — MCQs

Urology — MCQs

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