Urology Practice Questions

Q: Zuska's syndrome, common in smokers, causes which of the following conditions?

Chronic areolar abscess. **Explanation:** **Zuska’s Syndrome** (also known as Zuska’s disease or Smoker’s Mastitis) is a condition characterized by a triad of **retroareolar abscess, chronic discharging fistula, and nipple retraction.** 1. **Why Option B is Correct:** The underlying pathophysiology involves **squamous metaplasia of the lactiferous ducts**. In smokers, the toxic effects of cigarette smoke lead to the replacement of the normal cuboidal epithelium of the ducts with squamous cells. These cells produce keratin, which plugs the ducts, leading to stasis, infection, and the formation of a **chronic recurrent areolar abscess**. Because the underlying cause (metaplasia) persists, these abscesses frequently recur and form fistulous tracts (fistula-at-the-nipple). 2. **Why Other Options are Incorrect:** * **Option A & D:** While Zuska’s involves an abscess, it is specifically a **chronic, recurrent** condition related to ductal metaplasia. "Acute mastitis" and "Acute abscess" usually refer to lactational infections caused by *Staphylococcus aureus* entering through nipple cracks, which is a different clinical entity. * **Option C:** Fibroadenosis (ANDI) refers to benign cyclical breast pain and lumpiness related to hormonal changes, not an inflammatory or infectious process involving squamous metaplasia. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factor:** Smoking is the strongest independent risk factor (strong association with squamous metaplasia). * **Management:** Simple incision and drainage often lead to recurrence. The definitive treatment is the **Hadfield’s Procedure** (Total excision of the major lactiferous ducts). * **Differential Diagnosis:** Must be distinguished from periductal mastitis and mammary duct ectasia.

Q: All of the following are true about testicular dysgenesis syndrome EXCEPT:

Epispadias. **Testicular Dysgenesis Syndrome (TDS)** is a clinical concept suggesting that several male reproductive disorders share a common developmental origin during fetal life, often linked to environmental endocrine disruptors and genetic factors. ### **Why Epispadias is the Correct Answer** **Epispadias** is a congenital malformation where the urethra opens on the dorsal (upper) surface of the penis. It is primarily a defect in the migration of the cloacal membrane and is frequently associated with **bladder exstrophy**. It is **not** part of the TDS spectrum. ### **Analysis of Incorrect Options (Components of TDS)** The TDS hypothesis includes four main clinical manifestations resulting from impaired Leydig and Sertoli cell function during embryogenesis: * **Cryptorchidism (Option A):** Failure of testicular descent is a hallmark of TDS due to hormonal imbalances (low testosterone/INSL3). * **Hypospadias (Option C):** An opening of the urethra on the ventral (underside) of the penis, resulting from incomplete fusion of urethral folds under insufficient androgenic stimulation. * **Poor Sperm Motility/Infertility (Option D):** TDS leads to impaired spermatogenesis, manifested as low sperm count and poor motility in adulthood. * **Testicular Germ Cell Tumors (TGCT):** Though not listed in the options, this is the fourth major component of the syndrome. ### **High-Yield Clinical Pearls for NEET-PG** * **The TDS Tetrad:** 1. Cryptorchidism, 2. Hypospadias, 3. Reduced Semen Quality, 4. Testicular Cancer. * **Pathogenesis:** It is thought to be caused by a "window of susceptibility" in the first trimester where androgen action is disrupted. * **Hypospadias vs. Epispadias:** Remember **"Ventral = Hypospadias (TDS)"** and **"Dorsal = Epispadias (Exstrophy complex)."** * **Most common site of Hypospadias:** Glanular/Distal (most common); **Most common site of Cryptorchidism:** Inguinal canal.

Q: Most surgeons prefer incomplete fistulous tract excision (Latzko repair) to avoid which of the following complications?

Preserving scar tissue surrounding the fistula.. ### Explanation The **Latzko procedure** is a vaginal approach used for the repair of vesicovaginal fistulas (VVF), particularly those occurring after a total hysterectomy. **Why Option C is Correct:** The core principle of the Latzko repair is **partial colpocleisis**. Unlike traditional fistula repairs that involve radical excision of the fistulous tract, the Latzko technique involves denuding only the vaginal mucosa around the fistula (about 1–2 cm). The **scar tissue surrounding the fistula is intentionally preserved** rather than excised. This scar tissue provides a tough, fibrous foundation that adds structural integrity to the repair and supports the multiple layers of closure. Excising the tract entirely would create a larger defect in a poorly vascularized area, increasing the risk of failure. **Analysis of Incorrect Options:** * **A & B:** While enlarging the defect and weakening tissue are consequences of radical excision, the specific surgical *intent* of the Latzko technique is the utilization of the existing fibrotic ring (scar) as a biological "washer" to reinforce the suture line. * **D:** Compromising the repair is a general outcome of poor technique, but the question asks for the specific anatomical/pathological reason for choosing incomplete excision. **High-Yield Clinical Pearls for NEET-PG:** * **Indications:** Best for post-hysterectomy VVFs located at the vaginal vault. * **Technique:** It involves a layered closure (vesical muscularis, perivesical fascia, and vaginal mucosa) without entering the peritoneal cavity. * **Success Rate:** Very high (>90-95%) due to the preservation of the blood supply and the use of the sturdy scar tissue. * **Limitation:** It results in slight shortening of the vagina, though usually not enough to cause significant dyspareunia.

Q: Which one of the following is not used as a tumor marker in testicular tumors?

CEA. **Explanation:** In the management of testicular germ cell tumors (GCTs), tumor markers are essential for diagnosis, staging, prognosis, and monitoring treatment response. **Why CEA is the correct answer:** **Carcinoembryonic Antigen (CEA)** is a non-specific oncofetal antigen primarily used in the management of colorectal, gastrointestinal, and medullary thyroid carcinomas. It has no clinical utility or diagnostic value in testicular germ cell tumors. **Why the other options are incorrect:** * **AFP (Alpha-Fetoprotein):** Produced by the yolk sac element. It is elevated in **Yolk Sac Tumors** and many Non-Seminomatous Germ Cell Tumors (NSGCTs). Crucially, AFP is **never** elevated in pure seminomas. * **HCG (Human Chorionic Gonadotropin):** Produced by syncytiotrophoblasts. It is always elevated in **Choriocarcinoma** and elevated in about 10-15% of pure seminomas. * **LDH (Lactate Dehydrogenase):** A marker of tumor burden, growth rate, and cellular turnover. While less specific than AFP or HCG, it is an independent prognostic indicator in the International Germ Cell Cancer Collaborative Group (IGCCCG) classification. **High-Yield Clinical Pearls for NEET-PG:** * **Pure Seminoma:** May have elevated HCG, but **AFP is always normal**. If AFP is elevated, the tumor must be treated as an NSGCT. * **Most sensitive marker for monitoring:** HCG (due to its short half-life of 24-36 hours). * **Teratoma:** Usually does not produce AFP or HCG (unless mixed). * **Yolk Sac Tumor:** Most common testicular tumor in infants; AFP is the hallmark marker.

Q: A child presents with complaints of abdominal colic and hematuria. USG showed a renal stone 2.5 cm in diameter in the renal pelvis. What is the next step in management?

Percutaneous nephrolithotomy (PCNL). **Explanation:** The management of pediatric renal stones is primarily guided by the size, location, and composition of the stone. **1. Why PCNL is the Correct Answer:** According to the European Association of Urology (EAU) and American Urological Association (AUA) guidelines, **Percutaneous Nephrolithotomy (PCNL)** is the gold standard for renal stones **>2 cm** in diameter. In this case, the child has a 2.5 cm stone in the renal pelvis. PCNL offers the highest stone-free rate (SFR) for large stones in a single session compared to other modalities. In children, "mini-PCNL" is often preferred to reduce parenchymal damage. **2. Why Other Options are Incorrect:** * **ESWL (Option B):** While ESWL is non-invasive and effective for smaller stones, its efficacy drops significantly for stones **>1.5–2 cm**. Large stones often require multiple sessions and carry a high risk of "Steinstrasse" (stone street), where fragments block the ureter. * **Nephroureterostomy (Option C):** This is a diversion procedure used to drain an obstructed system; it is not a definitive treatment for stone removal. * **Conservative Management (Option D):** Stones >5–7 mm are unlikely to pass spontaneously, especially a 2.5 cm stone [1]. Delaying treatment in a symptomatic child (colic, hematuria) risks infection and renal damage [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Stone 1 cm favor PCNL/RIRS). * **Stone >2 cm:** PCNL is the treatment of choice. * **Staghorn Calculus:** PCNL is the gold standard. * **Cystine/Calcium Oxalate Monohydrate stones:** These are "hard" stones and are relatively resistant to ESWL; PCNL is preferred.

Q: Which of the following kidney stones is radiolucent?

Uric acid. **Explanation:** The radiopacity of a kidney stone depends on its atomic weight and density. Most kidney stones contain calcium, which has a high atomic number, making them radiopaque (visible on X-ray). **Correct Answer: B. Uric acid** Uric acid stones are composed of light elements (Carbon, Nitrogen, Oxygen, and Hydrogen). Because they lack heavy minerals like calcium, they do not attenuate X-rays and appear **radiolucent** on plain films. However, they are visible on Non-Contrast Computed Tomography (NCCT) and Ultrasound. **Analysis of Incorrect Options:** * **A. Cysteine:** These stones contain sulfur atoms. While less dense than calcium stones, they are **faintly radiopaque** (often described as having a "ground-glass" appearance). * **C. Oxalate:** Calcium oxalate (monohydrate and dihydrate) is the most common type of stone. Due to the high calcium content, these are **highly radiopaque**. * **D. Struvite:** Also known as "triple phosphate" or "infection stones" (Magnesium Ammonium Phosphate), these contain magnesium and phosphate. They are **radiopaque** and often form large staghorn calculi. **High-Yield Clinical Pearls for NEET-PG:** 1. **Mnemonic for Radiopacity:** "I **C**an **C**learly **S**ee **U**" (In order of decreasing opacity: **C**alcium oxalate > **C**alcium phosphate > **S**truvite > **C**ysteine > **U**ric acid). 2. **Pure Uric Acid stones** are the only truly radiolucent stones. 3. **Management:** Uric acid stones can often be dissolved via **medical alkalization of urine** (pH > 6.5) using potassium citrate. 4. **Gold Standard Investigation:** NCCT KUB is the investigation of choice for all stones, as it detects even radiolucent uric acid stones.

Q: All of the following are true about prostate-specific antigen except?

Normal level is 10-14 ng/ml. **Explanation** Prostate-Specific Antigen (PSA) is a vital biomarker in urological practice. The correct answer is **Option A** because the statement is factually incorrect; the normal reference range for serum PSA is generally considered to be **0–4 ng/ml**. Levels between 4–10 ng/ml are often referred to as the "gray zone," while levels above 10 ng/ml significantly increase the suspicion of malignancy. **Analysis of other options:** * **Option B:** PSA is organ-specific but not cancer-specific. It can be elevated in both **Benign Prostatic Hyperplasia (BPH)** and **Carcinoma Prostate**, as well as in prostatitis, urinary retention, or following digital rectal examination (DRE) and biopsy. * **Option C:** It is produced by the **ductal and acinar epithelium** of the prostate gland. Its physiological function is to liquefy the seminal coagulum. * **Option D:** PSA is biochemically a **serine protease** (kallikrein-like) and is structurally a **glycoprotein**. **High-Yield Clinical Pearls for NEET-PG:** * **PSA Velocity:** An increase of >0.75 ng/ml per year is suspicious for malignancy, even if the total PSA is 0.15 is suggestive of cancer. * **Free/Total PSA Ratio:** In prostate cancer, the percentage of free PSA decreases. A ratio **<15-20%** is suspicious for malignancy. * **Age-specific PSA:** Normal limits increase with age (e.g., <2.5 for 40-49 years; <6.5 for 70-79 years) due to increasing prostate volume.

Q: A 19-year-old male college student presents with acute pain and swelling of the scrotum. Physical examination reveals an exquisitely tender, swollen right testis with an absent cremasteric reflex and no swelling in the inguinal area. A urine dipstick is negative for red and white blood cells. What is the most appropriate next step in management?

Ultrasound of the scrotum. **Explanation:** The clinical presentation of acute scrotal pain, swelling, and an **absent cremasteric reflex** in an adolescent/young adult is highly suggestive of **Testicular Torsion**. This is a surgical emergency where the spermatic cord twists, leading to ischemia. While the gold standard for a definitive diagnosis is surgical exploration, **Color Doppler Ultrasound** is the most appropriate next step to assess blood flow and confirm the diagnosis when the clinical picture requires differentiation from other causes. **Analysis of Options:** * **Option D (Correct):** Ultrasound of the scrotum (Doppler) is the imaging modality of choice. It shows decreased or absent blood flow to the affected testis, helping differentiate torsion from inflammatory conditions. * **Option A:** This describes the management for *Epididymitis*. While common in sexually active males, epididymitis usually presents with a positive Prehn’s sign (relief of pain with elevation) and a preserved cremasteric reflex. * **Option B:** Reassurance is inappropriate for a potential surgical emergency; delay in treatment (beyond 6 hours) leads to testicular necrosis. * **Option C:** This is the management for *Urolithiasis* (kidney stones). While stones cause acute pain, they do not typically cause testicular swelling or an absent cremasteric reflex. **NEET-PG High-Yield Pearls:** * **Cremasteric Reflex:** The most sensitive physical exam finding for testicular torsion (its presence strongly rules out torsion). * **Golden Period:** Detorsion within **6 hours** offers a >90% salvage rate; this drops to <10% after 24 hours. * **Prehn’s Sign:** Pain relief with scrotal elevation (suggests Epididymitis); no relief or worsening pain suggests Torsion. * **Bell-clapper deformity:** The most common anatomical predisposition (high tunica vaginalis attachment).

Question 1

Zuska's syndrome, common in smokers, causes which of the following conditions?

Accepted Answer

Chronic areolar abscess

Answer

Acute mastitis

Answer

Fibroadenosis

Answer

Acute abscess formation

Question 2

All of the following are true about testicular dysgenesis syndrome EXCEPT:

Accepted Answer

Epispadias

Answer

Cryptorchidism

Answer

Hypospadias

Answer

Poor sperm motility

Question 3

Most surgeons prefer incomplete fistulous tract excision (Latzko repair) to avoid which of the following complications?

Accepted Answer

Preserving scar tissue surrounding the fistula.

Answer

Enlarging of the defect.

Answer

Weakening of surrounding tissue.

Answer

Compromising the repair.

Question 4

A 35-year-old engineer presented with bleeding from the external meatus and a perineal hematoma after falling astride on scaffolding half an hour ago. The patient has not passed urine since the accident. On physical examination, there was no evidence of extravasation of urine, and the bladder was not distended. What is the immediate management?

Accepted Answer

Assess the urethral injury by ascending urethrography.

Answer

Encourage the patient to pass urine after adequate pain control.

Answer

Percutaneous suprapubic catheterization of the bladder.

Answer

Catheterization of the urethra.

Question 5

Which one of the following is not used as a tumor marker in testicular tumors?

Accepted Answer

CEA

Answer

AFP

Answer

LDH

Answer

HCG

Question 6

A child presents with complaints of abdominal colic and hematuria. USG showed a renal stone 2.5 cm in diameter in the renal pelvis. What is the next step in management?

Accepted Answer

Percutaneous nephrolithotomy (PCNL)

Answer

Extracorporeal shock wave lithotripsy (ESWL)

Answer

Nephroureterostomy

Answer

Conservative management

Question 7

Which of the following kidney stones is radiolucent?

Accepted Answer

Uric acid

Answer

Cysteine

Answer

Oxalate

Answer

Struvite

Question 8

All of the following are true about prostate-specific antigen except?

Accepted Answer

Normal level is 10-14 ng/ml

Answer

It may be elevated in BPH and Ca Prostate

Answer

It is produced by the prostate

Answer

It is a glycoprotein

Question 9

A 19-year-old male college student presents with acute pain and swelling of the scrotum. Physical examination reveals an exquisitely tender, swollen right testis with an absent cremasteric reflex and no swelling in the inguinal area. A urine dipstick is negative for red and white blood cells. What is the most appropriate next step in management?

Accepted Answer

Ultrasound of the scrotum

Answer

Administration of antibiotics after culture of urethra for Chlamydia and gonorrhea

Answer

Reassurance

Answer

Intravenous fluid administration, pain medications, and straining of all voids

Question 10

A patient with a suspected pelvic fracture presents with urethral bleeding and inability to pass urine. What is the immediate management step?

Accepted Answer

Prepare for surgery and attempt catheterization in the operating theatre.

Answer

Encourage voiding after administration of antibiotics and analgesics.

Answer

Immediate catheterization in the ward.

Answer

Application of a hot water bottle followed by carbachol injection.

Urology — MCQs

Urology — MCQs

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