Urology Practice Questions

Q: A 10-year-old girl was evaluated for recurrent UTI and dysuria. An IVP finding is shown. What is the preferred treatment option for this case?

Endoscopic incision. ***Endoscopic incision*** - **Endoscopic incision** is the preferred first-line treatment for **ureterocele** (cobra head sign on IVP) in children, offering minimal invasivity with excellent success rates. - It provides immediate drainage relief and preserves **renal function** while avoiding major surgical complications in pediatric patients. *Nephrectomy with pyeloureterectomy* - This is an **extreme surgical approach** reserved for cases with **non-functioning kidneys** or severe complications, not as first-line treatment. - **Unnecessary loss of renal tissue** in a child when simpler endoscopic options can effectively treat the ureterocele. *STING operation* - **Subureteral injection** is used for **vesicoureteral reflux** treatment, not for ureterocele management. - Does not address the **anatomical obstruction** caused by the ureterocele that requires decompression. *Lich-Gregoir technique* - This **ureteroneocystostomy** technique is used for **ureteral reimplantation** in cases of reflux or ureteral strictures. - **Not indicated** for ureterocele treatment where endoscopic decompression is the preferred initial approach.

Q: Which of the following is an alkaline type of renal calculi?

Calcium stone. In renal stone pathology, the **urinary pH** plays a critical role in the precipitation of specific crystals. **Correct Option: A (Calcium stone)** Calcium-based stones, specifically **Calcium Phosphate**, typically form in **alkaline urine** (pH > 7.2). While Calcium Oxalate stones (the most common type) are relatively independent of pH, they are frequently grouped under alkaline-associated stones in competitive exams because their counterparts (Uric acid and Cystine) are strictly associated with acidic environments. Additionally, **Struvite stones** (Triple phosphate) are the classic alkaline stones, often associated with urea-splitting organisms like *Proteus*. **Incorrect Options:** * **B. Uric acid stone:** These form exclusively in **acidic urine** (pH 7.5 to increase cystine solubility. **High-Yield Clinical Pearls for NEET-PG:** * **Radiopacity:** Calcium and Struvite stones are **Radiopaque** (visible on X-ray). Uric acid stones are **Radiolucent** (invisible on X-ray, seen on CT). Cystine stones are **Semi-opaque** (ground-glass appearance). * **Morphology:** * Calcium Oxalate Dihydrate: Envelope/Star-shaped. * Calcium Oxalate Monohydrate: Dumbbell-shaped. * Struvite: Coffin-lid appearance. * Cystine: Hexagonal crystals. * Uric acid: Rhomboid/Rosette shape. * **Most common stone:** Calcium Oxalate (specifically the Monohydrate form is the hardest).

Q: Painless hematuria is seen in all of the following conditions except?

Renal infarction. **Explanation:** In clinical urology, the presence or absence of pain during hematuria is a critical diagnostic differentiator. **Renal Infarction** is the correct answer because it typically presents with **acute, severe flank pain** (simulating renal colic) due to sudden ischemia and capsular stretching, accompanied by hematuria. **Analysis of Options:** * **Hypernephroma (Renal Cell Carcinoma):** Classically presents with **painless hematuria** (the most common presenting symptom). The "classic triad" (hematuria, flank pain, and palpable mass) is seen in only 10% of cases and usually indicates advanced disease. * **Renal TB:** Often referred to as "sterile pyuria," but it frequently causes **painless total hematuria**. Pain only occurs if clots or debris cause ureteric obstruction. * **Bleeding Disorders:** Systemic coagulopathies or anticoagulation therapy lead to spontaneous, **painless bleeding** from the urinary tract unless a secondary obstructive clot forms. **Clinical Pearls for NEET-PG:** 1. **Rule of Thumb:** Painless hematuria in an elderly patient is **Malignancy** (RCC or Bladder Cancer) until proven otherwise. 2. **Painful Hematuria:** Usually suggests **Calculi** (urolithiasis), **Infections** (cystitis), or **Vascular events** (infarction). 3. **Total vs. Initial vs. Terminal Hematuria:** * *Initial:* Prostatic/Urethral source. * *Terminal:* Bladder neck/Trigone source. * *Total:* Kidney/Ureter source. 4. **Renal Infarction Triad:** Flank pain, hematuria, and elevated serum LDH.

Q: Interstitial cystitis is also known as?

Hunner's cystitis. **Explanation:** **Interstitial Cystitis (IC)**, also known as **Hunner’s cystitis** or Painful Bladder Syndrome, is a chronic inflammatory condition of the bladder wall. The hallmark of the disease is the presence of **Hunner’s ulcers** (or Hunner’s lesions), which are circumscribed, reddened mucosal areas with small vessels radiating towards a central scar. These are found in approximately 10–20% of cases during cystoscopy with hydrodistension. **Analysis of Options:** * **Option C (Correct):** IC is eponymously named Hunner’s cystitis after Guy Hunner, who first described the characteristic ulcers. It typically presents in middle-aged women with symptoms of increased frequency, urgency, and suprapubic pain that is relieved by voiding. * **Option A:** Eosinophilic cystitis is a rare inflammatory condition characterized by eosinophilic infiltration of the bladder wall, often associated with allergies or bladder injury. * **Option B:** Radiation cystitis is a complication of pelvic radiation therapy causing mucosal ischemia and fibrosis. * **Option D:** Tubercular cystitis (Secondary to Renal TB) typically results in a "thimble bladder" (small capacity, fibrotic bladder) and presents with sterile pyuria. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** It is a diagnosis of exclusion. Cystoscopy may show **Glomerulations** (petechial hemorrhages) after hydrodistension. * **Biopsy:** Essential to rule out Carcinoma-in-situ (CIS), which mimics IC symptoms. * **Nerve Involvement:** There is an increased density of **Mast cells** in the detrusor muscle. * **Treatment:** First-line oral drug is **Pentosan Polysulfate Sodium** (restores the GAG layer). Intravesical instillations include DMSO or Heparin.

Q: What is the commonest cause of death in carcinoma of the penis?

Erosion of femoral vessels. **Explanation:** Carcinoma of the penis is a squamous cell carcinoma that primarily spreads via the lymphatic system rather than the bloodstream. Understanding this lymphatic progression is key to identifying the cause of mortality. **Why "Erosion of femoral vessels" is correct:** The primary lymphatic drainage of the penis is to the **inguinal lymph nodes** (superficial and deep). As the disease progresses, these nodes become involved, forming large, fixed, and often ulcerated masses in the groin. These nodal masses can invade the underlying femoral triangle. The most dreaded complication is the erosion of the **femoral artery**, leading to massive, uncontrollable exsanguination (hemorrhage). This remains the leading cause of death in advanced cases. **Why the other options are incorrect:** * **Cerebral and Liver metastasis:** Hematogenous spread is rare and occurs very late in the disease course. Most patients succumb to local or regional complications before distant visceral metastases can manifest. * **Uremia:** While common in cervical or bladder cancers due to ureteric obstruction, penile cancer rarely involves the ureters. Urinary obstruction, if it occurs, is usually at the level of the distal urethra, which rarely leads to renal failure. **High-Yield Clinical Pearls for NEET-PG:** * **Staging:** The most important prognostic factor is the status of the inguinal lymph nodes. * **Sentinel Node:** The **Node of Cabanas** (sentinel node) is located medial to the epigastric vein. * **Management:** Prophylactic inguinal lymph node dissection (ILND) is often indicated because clinical examination of nodes is unreliable (50% of palpable nodes are inflammatory, while 20% of non-palpable nodes harbor micrometastasis). * **Risk Factors:** Phimosis and HPV (types 16 and 18) are strongly associated; neonatal circumcision is protective.

Q: A 28-year-old male presents with lower abdominal pain associated with groin pain and nausea. Elevation of the testis relieves his pain. What is your diagnosis?

Epididymo-orchitis. ### Explanation The clinical presentation described is a classic case of **Epididymo-orchitis**. The hallmark finding here is the relief of pain upon elevation of the scrotum, known as a **Positive Prehn’s Sign**. **1. Why Epididymo-orchitis is correct:** In inflammatory conditions like epididymo-orchitis, elevating the testis reduces the gravitational pull on the inflamed structures and improves venous drainage, thereby relieving pain. In a 28-year-old male, this is most commonly caused by sexually transmitted infections (e.g., *Chlamydia trachomatis* or *Neisseria gonorrhoeae*). **2. Why other options are incorrect:** * **Torsion of Testis:** This is the most critical differential. However, in torsion, elevating the testis typically **exacerbates** the pain (Negative Prehn’s sign) because it further twists the spermatic cord. Torsion is a surgical emergency characterized by a sudden onset of pain and an absent cremasteric reflex. * **Ureteric Colic:** While it causes groin pain and nausea, it does not present with testicular tenderness or relief upon scrotal elevation. The pain typically radiates from "loin to groin." * **Prostatitis:** This usually presents with perineal pain, dysuria, and obstructive voiding symptoms rather than localized testicular pain relieved by elevation. **3. NEET-PG High-Yield Pearls:** * **Prehn’s Sign:** Positive (relief) in Epididymo-orchitis; Negative (no relief/worse) in Testicular Torsion. * **Cremasteric Reflex:** Preserved in Epididymo-orchitis; **Absent** in Testicular Torsion (most sensitive physical finding for torsion). * **Age Factor:** In patients 35 years, think E. coli/UTI associated with BPH. * **Investigation of Choice:** Color Doppler Ultrasound (shows increased blood flow in orchitis, decreased/absent flow in torsion).

Q: A palpable plaque with a curved penis is indicative of which condition?

Peyronie disease. **Explanation:** The clinical presentation of a **palpable plaque** associated with a **curved penis** (especially during erection) is the classic hallmark of **Peyronie’s Disease**. **1. Why Peyronie’s Disease is correct:** Peyronie’s disease is a connective tissue disorder involving the development of fibrous scar tissue (collagen plaques) within the **tunica albuginea** of the penis. Because this scarred area is inelastic, it does not expand during tumescence, causing the penis to bend toward the side of the plaque. It is often associated with painful erections and erectile dysfunction. **2. Why the other options are incorrect:** * **Condylomata (Genital Warts):** These are caused by HPV (Types 6 and 11) and present as soft, cauliflower-like fleshy growths on the skin or mucous membranes. They do not involve the tunica albuginea or cause penile curvature. * **Penile Cancer:** Typically presents as a painless, indurated ulcer or a fungating mass, usually on the glans or prepuce. While it involves a mass, it does not typically present as a discrete fibrous plaque causing curvature. * **Hypospadias:** This is a congenital anomaly where the urethral meatus is on the ventral aspect of the penis. While it can be associated with "chordee" (ventral curvature), it is present from birth and does not feature a palpable acquired plaque. **Clinical Pearls for NEET-PG:** * **Association:** Peyronie’s disease is strongly associated with **Dupuytren’s contracture** (palmar fascia fibrosis). * **Site:** The dorsal surface is the most common site for plaques, leading to upward curvature. * **Management:** Medical management includes Vitamin E, Potaba, or intralesional Collagenase (*Clostridium histolyticum*). Surgery (e.g., Nesbit procedure) is reserved for stable, severe cases interfering with intercourse.

Q: Circumcision is included in the management of carcinoma of the penis at which anatomical location?

Prepuce. **Explanation:** The management of penile carcinoma is primarily determined by the anatomical location and the stage of the tumor. **Why Option B is Correct:** When a carcinoma is localized strictly to the **prepuce (foreskin)**, the standard surgical treatment is **radical circumcision**. This procedure ensures the complete removal of the primary lesion with adequate oncological margins while preserving the glans and the shaft of the penis. It is considered definitive treatment for Stage Tis, Ta, and T1a lesions, provided they are confined to the prepuce. **Why Other Options are Incorrect:** * **A. Glans:** Tumors of the glans usually require more extensive procedures such as glansectomy or partial penectomy to ensure clear margins, as circumcision does not remove the glans tissue. * **C. Glanduloprepucial fold:** Lesions involving the sulcus or the fold often involve both the glans and the prepuce. Simple circumcision is insufficient here; a partial penectomy is typically required to achieve a 1–2 cm margin. * **D. Shaft of penis:** Carcinoma of the shaft necessitates a partial or total penectomy depending on the depth of invasion and the ability to maintain a functional stump for micturition. **Clinical Pearls for NEET-PG:** * **Risk Factor:** Phimosis is the most significant risk factor for penile cancer (due to chronic inflammation/smegma). Neonatal circumcision is protective. * **Most Common Histology:** Squamous Cell Carcinoma (SCC) is the most common type (>95%). * **Lymph Node Spread:** Penile cancer spreads primarily via the lymphatics to the **Inguinal Lymph Nodes** (Sentinel node: Sentinel node of Cabanas). * **Surgical Margin:** Modern guidelines suggest that a **3–5 mm** surgical margin is often sufficient for low-grade lesions, though traditionally 1–2 cm was taught.

Q: Which of the following procedures uses a trans-vesical approach in the surgical removal of prostate?

Freyer prostatectomy. **Explanation:** The surgical management of Benign Prostatic Hyperplasia (BPH) involves different approaches depending on the size of the gland and the route taken to reach the prostate. **Why Freyer Prostatectomy is correct:** **Freyer’s procedure** is a **trans-vesical (suprapubic)** open prostatectomy. In this approach, the surgeon makes a midline subumbilical incision, opens the urinary bladder (cystotomy), and enucleates the adenoma through the bladder lumen. It is particularly indicated for very large prostates (>80-100g) or when there are associated bladder pathologies like large calculi or diverticula. **Analysis of Incorrect Options:** * **A. TURP (Transurethral Resection of the Prostate):** This is an endoscopic procedure where the prostate is reached via the **urethra**. It is the "Gold Standard" for moderate-sized glands but does not involve a trans-vesical incision. * **B. Millin Prostatectomy:** This is a **retropubic** open prostatectomy. The surgeon reaches the prostate through the space of Retzius without opening the bladder. The prostatic capsule is incised directly. * **C. Young’s Prostatectomy:** This uses a **perineal approach** to reach the prostate. It is rarely used for BPH today but was historically used for prostatic carcinoma. **High-Yield Clinical Pearls for NEET-PG:** * **Freyer’s:** Trans-vesical; main complication is primary/reactionary hemorrhage from the prostatic bed. * **Millin’s:** Retropubic; advantage is better visualization of the prostatic bed and no bladder injury, but it cannot address bladder stones. * **TURP Syndrome:** Caused by systemic absorption of glycine (irrigation fluid), leading to hyponatremia and neurological symptoms. * **Indication for Open Prostatectomy:** Generally reserved for prostate volume **>80-100 ml**.

Question 1

A 10-year-old girl was evaluated for recurrent UTI and dysuria. An IVP finding is shown. What is the preferred treatment option for this case?

Accepted Answer

Endoscopic incision

Answer

Nephrectomy with pyeloureterectomy

Answer

STING operation

Answer

Lich-Gregoir technique

Question 2

Which of the following is an alkaline type of renal calculi?

Accepted Answer

Calcium stone

Answer

Uric acid stone

Answer

Cystine stone

Answer

All of the above

Question 3

A patient presents with urethral bleeding and perineal swelling following a straddle injury, indicative of a ruptured bulbar urethra. Which of the following statements regarding his management is FALSE?

Accepted Answer

Immediate urethral catheterization is indicated.

Answer

Suprapubic cystostomy may be required.

Answer

Urethrography is a useful diagnostic tool.

Answer

Management should be symptomatic and supportive.

Question 4

Painless hematuria is seen in all of the following conditions except?

Accepted Answer

Renal infarction

Answer

Hypernephroma

Answer

Renal TB

Answer

Bleeding disorders

Question 5

Interstitial cystitis is also known as?

Accepted Answer

Hunner's cystitis

Answer

Eosinophilic cystitis

Answer

Radiation cystitis

Answer

Tubercular cystitis

Question 6

What is the commonest cause of death in carcinoma of the penis?

Accepted Answer

Erosion of femoral vessels

Answer

Cerebral metastasis

Answer

Liver metastasis

Answer

Uremia

Question 7

A 28-year-old male presents with lower abdominal pain associated with groin pain and nausea. Elevation of the testis relieves his pain. What is your diagnosis?

Accepted Answer

Epididymo-orchitis

Answer

Ureteric colic

Answer

Prostatitis

Answer

Torsion of testis

Question 8

A palpable plaque with a curved penis is indicative of which condition?

Accepted Answer

Peyronie disease

Answer

Condylomata

Answer

Penile cancer

Answer

Hypospadias

Question 9

Circumcision is included in the management of carcinoma of the penis at which anatomical location?

Accepted Answer

Prepuce

Answer

Glans

Answer

Glanduloprepucial fold

Answer

Shaft of penis

Question 10

Which of the following procedures uses a trans-vesical approach in the surgical removal of prostate?

Accepted Answer

Freyer prostatectomy

Answer

TURP

Answer

Millin prostatectomy

Answer

Young's prostatectomy

Urology — MCQs

Urology — MCQs

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