Urology Practice Questions

Q: A male patient sustained blunt trauma to the left side of the abdomen. How would you assess for kidney injury if the patient is hemodynamically stable?

CT scan. **Explanation:** In the management of blunt abdominal trauma, the gold standard for evaluating renal injuries in a **hemodynamically stable** patient is a **Contrast-Enhanced Computed Tomography (CECT) scan**. **Why CT Scan is the Correct Choice:** CECT is highly sensitive and specific. It allows for precise grading of renal injuries (AAST Grading I-V), identifies the presence and extent of retroperitoneal hematomas, and detects urinary extravasation. Most importantly, it assesses the functional status of both the injured and the contralateral kidney, which is vital for surgical planning. **Analysis of Incorrect Options:** * **Ultrasound (USG/FAST):** While useful for detecting free intraperitoneal fluid (hemoperitoneum), USG is poor at evaluating the retroperitoneum where the kidneys are located. It cannot reliably grade the injury or detect urinary leaks. * **X-ray:** Plain radiographs (KUB) are non-specific. They may show indirect signs like an absent psoas shadow or scoliosis, but they cannot diagnose the grade of renal trauma. * **MRI:** Although highly detailed, MRI is time-consuming, expensive, and impractical in an acute trauma setting. It is generally reserved for patients with iodine allergies or those who are pregnant. **High-Yield Clinical Pearls for NEET-PG:** * **Indications for Imaging in Renal Trauma:** 1. All blunt trauma with gross hematuria. 2. Blunt trauma with microscopic hematuria AND hypotension (SBP <90 mmHg). 3. All penetrating trauma with any degree of hematuria. * **Management Rule:** Most blunt renal injuries (Grades I-IV) in stable patients are managed **conservatively**. Absolute indications for surgery include hemodynamic instability or a Grade V shattered kidney with hilar avulsion. * **Pediatric Note:** Children are more prone to renal injury due to less perirenal fat and a less protected rib cage.

Q: Which of the following is NOT true about Prostate-Specific Antigen (PSA)?

Finasteride increases PSA levels.. **Explanation:** The correct answer is **C. Finasteride increases PSA levels.** This statement is false because Finasteride, a 5-alpha reductase inhibitor (5-ARI) used to treat BPH, actually **decreases** serum PSA levels by approximately **50%** after six months of treatment. It works by inhibiting the conversion of testosterone to dihydrotestosterone (DHT), leading to a reduction in prostatic volume and epithelial activity. **Analysis of Options:** * **Option A:** PSA is produced by both normal and hyperplastic prostatic epithelium. In **BPH**, the increased volume of prostatic tissue leads to an elevation in serum PSA levels. * **Option B:** PSA levels naturally **increase with age** due to the physiological enlargement of the prostate gland and increased basement membrane permeability. Age-specific reference ranges are often used to improve diagnostic accuracy. * **Option D:** **Metastatic prostate cancer** typically involves a high burden of malignant cells producing PSA, leading to significantly elevated serum levels, often exceeding 20–100 ng/mL. **High-Yield Clinical Pearls for NEET-PG:** * **The "Rule of Two":** When interpreting PSA in a patient on Finasteride or Dutasteride for >6 months, you must **multiply the measured PSA value by 2** to estimate the true baseline. * **PSA Density:** PSA value divided by prostate volume (measured via TRUS). A value **>0.15** is suspicious for malignancy. * **PSA Velocity:** An increase of **>0.75 ng/mL per year** is highly suggestive of cancer, even if the absolute value is within the normal range. * **Free-to-Total PSA Ratio:** A lower ratio (**<15-20%**) is associated with a higher risk of prostate cancer, whereas a higher ratio is seen in BPH.

Q: For the treatment of ectopic vesicles, which of the following bones is divided to reach the surgical site?

Iliac bone. **Explanation:** The question refers to the surgical management of **Exstrophy of the Bladder** (ectopic vesicae). The fundamental anatomical defect in this condition is a wide separation of the pubic symphysis, which leads to an outward rotation of the innominate bones and lateral displacement of the rectus abdominis muscles. **1. Why Iliac Bone is Correct:** To achieve a tension-free closure of the bladder, abdominal wall, and pelvic ring, a **bilateral iliac osteotomy** is performed. By dividing the iliac bones (usually posterior or transverse osteotomy), the surgeon can mobilize the pelvic halves medially. This allows the pubic bones to be brought together in the midline, facilitating the anatomical reconstruction of the bladder neck and the closure of the abdominal wall defect. **2. Why Other Options are Incorrect:** * **Pubic rami & Ischium bone:** While these are parts of the pelvic girdle, they are not the primary sites for osteotomy in exstrophy repair. Dividing these would not provide the necessary leverage or mobility required to rotate the pelvic wings inward effectively. * **Symphysis:** In ectopic vesicae, the symphysis is already widely separated (diastasis). The goal of the surgery is to *approximate* the symphysis, not to divide it further. **Clinical Pearls for NEET-PG:** * **Classic Triad of Exstrophy:** Epispadias, bifid clitoris/penis, and widely separated pubic symphysis. * **Radiological Sign:** The "Molar Tooth Sign" on imaging or a "widened pubic diastasis" on X-ray. * **Timing of Surgery:** Primary closure is ideally performed within the first 48–72 hours of life when the pelvis is still malleable (sometimes allowing closure without osteotomy). After 72 hours, iliac osteotomy becomes mandatory. * **Associated Finding:** Patients often have an "out-toeing" gait due to the external rotation of the acetabulum.

Q: Which of the following does not occur in unilateral renal trauma?

Uremia. **Explanation:** The correct answer is **Uremia (Option B)**. In the setting of **unilateral renal trauma**, the contralateral (opposite) kidney is typically healthy and functioning. A single normal kidney is more than capable of maintaining adequate glomerular filtration and excreting nitrogenous waste products. Therefore, serum urea and creatinine levels remain within normal limits. Uremia only occurs in renal trauma if there is pre-existing chronic kidney disease, bilateral renal injury, or injury to a solitary functioning kidney. **Analysis of Incorrect Options:** * **Hypertension (A):** This can occur due to the **"Page Kidney"** phenomenon. Compression of the renal parenchyma by a subcapsular or perinephric hematoma leads to activation of the Renin-Angiotensin-Aldosterone System (RAAS) due to relative ischemia. * **Clot formation (C):** Trauma often leads to bleeding into the collecting system. This results in hematuria, where blood can clot within the ureter (causing clot colic) or the bladder. * **Perinephric hematoma (D):** This is a hallmark of renal trauma (Grades II-V). Laceration of the renal parenchyma or vessels leads to blood accumulation within Gerota’s fascia. **NEET-PG High-Yield Pearls:** * **Investigation of Choice:** Contrast-Enhanced CT (CECT) is the gold standard for staging stable renal trauma. * **Management Trend:** Most renal injuries (Grades I-III and many IV) are managed **conservatively**. * **Absolute Indication for Surgery:** Hemodynamic instability due to renal hemorrhage or an expanding/pulsatile hematoma. * **Most Common Organ Injured in Blunt Trauma:** Spleen (overall), but Kidney is the most common urogenital organ injured.

Q: What is the investigation of choice for advanced renal tuberculosis?

CT. **Explanation:** **1. Why CT is the Correct Answer:** Contrast-Enhanced Computed Tomography (CECT) is currently the **investigation of choice** for advanced renal tuberculosis (GU-TB). In advanced stages, CT provides superior anatomical detail regarding parenchymal destruction, cortical thinning, and the extent of calcification. It is highly sensitive for detecting "Putty Kidney" (autonephrectomy) and identifying extra-renal involvement, such as psoas abscesses or lymphadenopathy. CT Urography (CTU) has largely replaced conventional IVP as it can visualize both the renal parenchyma and the collecting system simultaneously, even in poorly functioning kidneys. **2. Why Other Options are Incorrect:** * **IVP (Intravenous Pyelogram):** Historically, IVP was the gold standard for early GU-TB (detecting "moth-eaten" calyces). However, in **advanced** disease, the kidney is often non-functional or poorly excreting, making IVP non-diagnostic and obsolete compared to CT. * **USG (Ultrasonography):** While useful for screening hydronephrosis or large masses, it lacks the specificity to differentiate TB from other chronic pyelonephritic changes and cannot accurately map the extent of the disease for surgical planning. * **MRI:** Generally reserved for patients with renal failure or contrast allergies. It is not the primary choice due to higher costs and lower sensitivity in detecting fine calcifications compared to CT. **3. Clinical Pearls for NEET-PG:** * **Earliest Radiological Sign:** "Moth-eaten" appearance of calyces (due to erosions) on IVP. * **Pathognomonic Sign:** Thimble bladder (small capacity, fibrotic bladder). * **Putty Kidney:** A classic end-stage feature representing a non-functioning, calcified kidney (autonephrectomy). * **Sterile Pyuria:** The hallmark laboratory finding (pus cells in urine but negative routine culture). Always rule out TB.

Q: Bladder outlet obstruction (BOO) is defined by:

Urine flow rate <10 mL/second. **Explanation:** Bladder Outlet Obstruction (BOO) is a clinical diagnosis characterized by the resistance to urine flow during voiding. The gold standard for diagnosing BOO is a **Pressure-Flow Study (Urodynamics)**, which demonstrates high voiding pressures in the presence of low flow rates. **1. Why Option B is Correct:** The hallmark of BOO is a reduced urinary flow rate. In clinical practice and for NEET-PG purposes, a **peak flow rate (Qmax) of 150 mL). A Qmax between 10–15 mL/s is considered equivocal, while >15 mL/s is usually normal. **2. Analysis of Incorrect Options:** * **Option A (PSA-10 mmol):** PSA is a marker for prostatic volume or malignancy, not a functional measure of obstruction. Furthermore, PSA is measured in ng/mL, not mmol. * **Option C (Urine voiding pressure decreased):** This is the most common distractor. In BOO, the detrusor muscle must contract harder to overcome the resistance; therefore, **voiding pressure is increased**, not decreased. A decreased pressure with low flow suggests *detrusor underactivity* (hypocontractility), not obstruction. * **Option D (Retained urine):** While Post-Void Residual (PVR) urine is often present in BOO, it is a *consequence* of the obstruction or bladder failure, not the definition itself. Many patients with BOO can still empty their bladders completely through high-pressure compensation. **High-Yield Clinical Pearls for NEET-PG:** * **Abrams-Griffiths Nomogram:** The graphical tool used to plot voiding pressure vs. flow rate to diagnose BOO. * **Most common cause:** Benign Prostatic Hyperplasia (BPH) in elderly males; Posterior Urethral Valves (PUV) in male infants. * **Urodynamic Triad of BOO:** Low Qmax + High Detrusor Pressure ($P_{det}Q_{max}$) + Delayed opening time.

Q: Urinary catheterization is indicated in cases of acute retention of urine, except in which of the following conditions?

Postoperative state. **Explanation:** The primary goal of urinary catheterization in acute retention of urine (ARU) is to relieve bladder distension. However, the procedure is contraindicated when there is a risk of further injury or when the underlying pathology prevents safe passage of the catheter. **Why "Postoperative state" is the correct answer:** In the postoperative state, acute retention of urine is a common complication (often due to anesthesia, pain, or anticholinergic drugs). In these cases, urinary catheterization is **indicated** and is the standard of care to drain the bladder and prevent myogenic damage. The question asks for the exception; since catheterization *is* indicated here, it stands out against conditions where it is contraindicated. **Analysis of Incorrect Options:** * **Rupture (Urethral):** This is an absolute **contraindication** for urethral catheterization. In cases of suspected urethral injury (e.g., pelvic fracture, blood at the meatus, high-riding prostate), a catheter should never be forced as it can convert a partial tear into a complete rupture. A Suprapubic Cystostomy (SPC) is preferred. * **Stricture:** While not an absolute contraindication, a known urethral stricture makes routine catheterization difficult and potentially hazardous. Forcing a catheter against a stricture can cause "false passages" and bleeding. These cases often require specialized dilation or suprapubic drainage rather than standard catheterization. **Clinical Pearls for NEET-PG:** * **Gold Standard for Urethral Injury:** If urethral rupture is suspected, the first investigation is a **Retrograde Urethrogram (RUG)**. * **Classic Triad of Urethral Injury:** Blood at the external meatus, inability to void, and a palpable distended bladder (often with a high-riding prostate on DRE). * **Management:** In ARU due to stricture or rupture, **Suprapubic Catheterization (SPC)** is the safest alternative to relieve the bladder.

Q: A 30-year-old male presents with erectile dysfunction. Basic screening evaluation is unremarkable. What is the next step in evaluation or management?

Oral sildenafil trial. **Explanation:** The management of erectile dysfunction (ED) follows a stepwise approach. In a 30-year-old patient where the basic screening (history, physical exam, and baseline labs like glucose and testosterone) is unremarkable, the most likely etiology is either psychogenic or early vasculogenic. **1. Why Oral Sildenafil is the correct next step:** Current clinical guidelines (AUA/EAU) recommend a **trial of Oral Phosphodiesterase-5 (PDE5) inhibitors**, such as Sildenafil, as both a first-line treatment and a diagnostic tool. If the patient responds well to Sildenafil, it confirms that the corporal tissue is functional and the blood supply is sufficient, often obviating the need for invasive, expensive, or specialized testing. **2. Why other options are incorrect:** * **Doppler study (Option C):** Penile Duplex Ultrasound is indicated only if the patient fails oral therapy or if there is a history of pelvic trauma/Peyronie’s disease. It is not a first-line investigation. * **Cavernosometry (Option B):** This is a highly invasive procedure used to diagnose venous leak (venous-occlusive dysfunction). It is reserved for surgical candidates and is never a primary step. * **Neurological testing (Option D):** This is indicated only if there is a specific history of spinal cord injury, pelvic surgery, or abnormal findings on neurological examination (e.g., decreased perianal sensation). **Clinical Pearls for NEET-PG:** * **First-line treatment for ED:** Lifestyle modifications + PDE5 inhibitors. * **Mechanism of Sildenafil:** Inhibits PDE5, increasing **cGMP** levels, leading to smooth muscle relaxation and increased blood flow. * **Contraindication:** Never co-administer PDE5 inhibitors with **Nitrates** (risk of severe hypotension). * **Psychogenic ED:** Characterized by sudden onset and the presence of **nocturnal/morning erections**.

Question 1

A male patient sustained blunt trauma to the left side of the abdomen. How would you assess for kidney injury if the patient is hemodynamically stable?

Accepted Answer

CT scan

Answer

Ultrasound (USG)

Answer

X-ray

Answer

MRI

Question 2

Thimble bladder is seen in all conditions except?

Accepted Answer

Benign Prostatic Hyperplasia (BPH)

Answer

Tuberculosis

Answer

Malignancy

Answer

Schistosomiasis

Question 3

Which of the following is NOT true about Prostate-Specific Antigen (PSA)?

Accepted Answer

Finasteride increases PSA levels.

Answer

PSA levels increase in Benign Prostatic Hyperplasia (BPH).

Answer

PSA levels increase with age.

Answer

Metastatic prostate cancer increases PSA levels.

Question 4

For the treatment of ectopic vesicles, which of the following bones is divided to reach the surgical site?

Accepted Answer

Iliac bone

Answer

Pubic rami

Answer

Ischium bone

Answer

Symphysis

Question 5

Which of the following does not occur in unilateral renal trauma?

Accepted Answer

Uremia

Answer

Hypertension

Answer

Clot formation

Answer

Perinephric hematoma

Question 6

Which of the following is a normal finding during cystometry?

Accepted Answer

Absence of systolic detrusor contraction

Answer

Residual volume of 75 ml

Answer

Leakage on coughing

Answer

First sensation of urination at 300 ml

Question 7

What is the investigation of choice for advanced renal tuberculosis?

Accepted Answer

CT

Answer

IVP

Answer

USG

Answer

MRI

Question 8

Bladder outlet obstruction (BOO) is defined by:

Accepted Answer

Urine flow rate <10 mL/second

Answer

PSA-10 mmol

Answer

Urine voiding pressure decreased

Answer

Retained urine

Question 9

Urinary catheterization is indicated in cases of acute retention of urine, except in which of the following conditions?

Accepted Answer

Postoperative state

Answer

Stricture

Answer

Rupture

Answer

All of the above

Question 10

A 30-year-old male presents with erectile dysfunction. Basic screening evaluation is unremarkable. What is the next step in evaluation or management?

Accepted Answer

Oral sildenafil trial

Answer

Cavernosometry

Answer

Doppler study

Answer

Neurological testing

Urology — MCQs

Urology — MCQs

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