Urology Practice Questions

Q: A male patient presents with azoospermia. On examination, the testicular size is normal, and both FSH and testosterone levels are within normal limits. What is the most probable cause?

Vas obstruction. **Explanation:** The clinical scenario describes **Obstructive Azoospermia**. The key to solving this is the triad of **azoospermia** (absence of sperm), **normal testicular volume**, and **normal hormonal profile** (FSH and Testosterone). 1. **Why Vas Obstruction is correct:** In obstructive azoospermia, the "machinery" (testis) is functioning perfectly, and the "fuel" (hormones) is adequate. Since FSH is normal, it indicates that spermatogenesis is occurring normally. The absence of sperm in the ejaculate is therefore due to a physical blockage in the exit pathway, most commonly in the epididymis or the vas deferens (e.g., post-inflammatory or congenital absence). 2. **Why other options are incorrect:** * **Non-descended testis:** Usually leads to testicular atrophy and impaired spermatogenesis due to higher intra-abdominal temperatures, often resulting in elevated FSH. * **Klinefelter’s Syndrome (47, XXY):** This is a form of primary testicular failure. It presents with **small, firm testes**, azoospermia, **elevated FSH/LH**, and low testosterone. * **Kallmann’s Syndrome:** This is hypogonadotropic hypogonadism. It presents with **low FSH/LH**, low testosterone, and small testes, often accompanied by anosmia. **NEET-PG High-Yield Pearls:** * **FSH is the best marker for spermatogenesis:** If FSH is >2x the upper limit of normal, it strongly suggests non-obstructive (primary) testicular failure. * **Normal FSH + Azoospermia + Normal Testis = Obstruction.** * **Most common site of obstruction:** Epididymis. * **Congenital Bilateral Absence of Vas Deferens (CBAVD):** Strongly associated with **CFTR gene mutations** (Cystic Fibrosis). Always check for the presence of the seminal vesicles and renal anomalies.

Q: Which of the following is NOT true about paraphimosis?

It is seen in patients with Diabetes Mellitus.. **Explanation:** **Paraphimosis** is a urological emergency where the prepuce (foreskin), once retracted behind the glans penis, cannot be reduced to its original position. This leads to a constricting ring that impairs venous and lymphatic drainage, causing edema and, if untreated, arterial compromise. **Why Option B is the Correct Answer (The False Statement):** While **Phimosis** (the inability to retract the foreskin) is strongly associated with Diabetes Mellitus due to recurrent balanoposthitis and scarring, **Paraphimosis** is not specifically a disease "seen in" or caused by Diabetes. It is a mechanical complication resulting from the failure to pull the foreskin back over the glans after retraction. **Analysis of Other Options:** * **Option A (Iatrogenic):** This is true. It often occurs in hospitals when a healthcare provider retracts the foreskin for catheterization or physical examination and forgets to replace it. * **Option C (Gangrene):** This is true. The constricting band causes progressive edema, which eventually leads to arterial occlusion, ischemia, and necrosis (gangrene) of the glans penis. * **Option D (Circumcision):** This is true. While the initial management involves manual reduction or the "Dorsal Slit" procedure, **circumcision** is the definitive elective treatment to prevent recurrence. **High-Yield Clinical Pearls for NEET-PG:** * **Emergency Management:** Manual compression to reduce edema followed by manual reduction. * **Dorsal Slit:** Indicated if manual reduction fails. * **Phimosis vs. Paraphimosis:** Phimosis is "cannot retract"; Paraphimosis is "cannot reduce." * **Key Risk Factor:** Chronic balanoposthitis (often in diabetics) leads to Phimosis, which is a prerequisite for Paraphimosis. However, the act of paraphimosis itself is an acute mechanical event.

Q: Absent fructose content in the seminal fluid suggests which of the following conditions?

Both A and B. **Explanation:** The presence of fructose in seminal fluid is a critical marker for the patency and functional integrity of the male reproductive tract. Fructose is exclusively produced and secreted by the **seminal vesicles**; its primary role is to provide an energy source for sperm motility. **Why the correct answer is D (Both A and B):** 1. **Congenital Absence of Seminal Vesicles (Option A):** Since the seminal vesicles are the sole source of fructose, their absence (often associated with Congenital Bilateral Absence of the Vas Deferens - CBAVD) results in a total lack of fructose in the ejaculate. 2. **Ductal Obstruction (Option B):** If there is an obstruction at the level of the **ejaculatory ducts** (where the seminal vesicle ducts join the vas deferens), the secretions from the seminal vesicles cannot reach the urethra. This leads to an ejaculate that is low in volume, acidic, and fructose-negative. **Why other options are incorrect:** * **Option C** is incorrect because both A and B are established clinical causes for azoospermia with absent fructose. **Clinical Pearls for NEET-PG:** * **Normal Fructose Level:** >13 µmol per ejaculate. * **The "Fructose Test":** It is the first-line investigation in patients with **Azoospermia** and **Low Ejaculate Volume (<1.5 ml)**. * **CBAVD Link:** Congenital absence of the vas deferens and seminal vesicles is strongly associated with mutations in the **CFTR gene** (Cystic Fibrosis). * **pH Correlation:** Seminal vesicle fluid is alkaline. Therefore, absent fructose is usually accompanied by an **acidic pH (<7.0)** of the semen.

Q: Which of the following statements is incorrect regarding the variables used to calculate the MELD score?

Serum albumin. The **MELD (Model for End-Stage Liver Disease)** score is a critical scoring system used to predict the 3-month mortality risk in patients with chronic liver disease and to prioritize patients for liver transplantation. ### Why Serum Albumin is the Correct Answer Serum albumin is **not** a component of the MELD score. While albumin is a marker of the liver's synthetic function and is included in the **Child-Pugh classification**, it was excluded from the original MELD formula because its levels can be easily influenced by external factors like intravenous albumin infusion or nutritional status, making it a less objective predictor of acute mortality compared to the other variables. ### Explanation of Incorrect Options The original MELD score is calculated using three objective laboratory variables: * **Serum Bilirubin (Option C):** Reflects the liver’s excretory function. * **INR (Option A):** Reflects the liver’s synthetic function (specifically coagulation factors). * **Serum Creatinine (Option D):** Reflects renal function, which is a powerful predictor of survival in patients with cirrhosis (e.g., Hepatorenal Syndrome). ### High-Yield Clinical Pearls for NEET-PG * **MELD-Na:** The modern version of the score now includes **Serum Sodium**, as hyponatremia is a strong independent predictor of mortality in waitlisted patients. * **PELD Score:** Used for children under 12 years; it includes Albumin, Bilirubin, INR, age (<1 year), and growth failure. * **Mnemonic for MELD:** "**I** **C**an **B**e **S**aved" (**I**NR, **C**reatinine, **B**ilirubin, **S**odium). * **Range:** Scores range from 6 to 40; a higher score indicates a higher priority for transplantation.

Q: Cystoscopic findings in TB bladder are all except?

Whitish efflux from the ureteric holes. Explanation: The correct answer is **C (Whitish efflux from the ureteric holes)**. In Genitourinary Tuberculosis (GUTB), the efflux from the ureteric orifice is typically **clear**, even in the presence of sterile pyuria. This is because the "pus" cells in TB are microscopic and do not cause the thick, milky, or "whitish" discharge seen in acute pyogenic infections. **Analysis of Options:** * **Thimble Bladder (Option A):** This is a classic late-stage finding. Chronic inflammation and healing by fibrosis lead to a severely contracted, small-capacity, thick-walled bladder, often referred to as a "thimble bladder." * **Golf Hole Ureter (Option B):** Fibrosis and shortening of the ureter lead to the retraction of the ureteric orifice. This causes the orifice to become dilated, circular, and fixed, resembling a "golf hole." * **Cobblestone Mucosa (Option C):** Early cystoscopic findings include hyperemic patches and the formation of "tubercles" (small yellowish nodules). As these coalesce or become surrounded by edema and granulation tissue, the bladder mucosa takes on a "cobblestone" appearance. **High-Yield Clinical Pearls for NEET-PG:** * **Sterile Pyuria:** The hallmark of GUTB (pus cells in urine but negative routine bacterial culture). * **Putty Kidney:** Refers to autonephrectomy where the kidney is replaced by caseous, calcified material. * **Beaded Vas:** Granulomatous involvement of the vas deferens. * **Investigation of Choice:** Contrast-Enhanced CT (CECT) Urography is the gold standard for diagnosis and staging.

Q: Which type of kidney stone is most sensitive to extracorporeal shock wave lithotripsy (ESWL)?

Uric acid stone. **Explanation:** The sensitivity of a kidney stone to **Extracorporeal Shock Wave Lithotripsy (ESWL)** is primarily determined by its **Hounsfield Unit (HU)** value on CT scan and its crystalline structure. Stones with lower density and higher fragility fragment more easily. **Why Uric Acid is the Correct Answer:** Uric acid stones are the most "fragile" or sensitive to ESWL. They have a low density (typically <500 HU) and a non-compact crystalline structure, allowing shock waves to propagate through and shatter them effectively. While uric acid stones are often managed medically via urinary alkalinization (dissolution therapy), if ESWL is performed, they fragment with the least amount of energy. **Analysis of Incorrect Options:** * **Calcium Oxalate:** These are the most common stones. **Calcium oxalate dihydrate** stones are relatively sensitive, but **Calcium oxalate monohydrate** stones are very dense (>1000 HU) and notoriously resistant to ESWL. * **Struvite (Triple Phosphate):** These are associated with infections (Proteus). While they are relatively soft, they are often large (Staghorn calculi), making ESWL less effective as a monotherapy due to the high stone burden and risk of "Steinstrasse." * **Cystine Stone:** These are the **most resistant** to ESWL. They have a "waxy" consistency and a dense crystalline lattice that absorbs shock waves rather than fracturing. **NEET-PG High-Yield Pearls:** * **Order of ESWL Sensitivity:** Uric Acid > Calcium Oxalate Dihydrate > Struvite > Calcium Oxalate Monohydrate > Cystine (Least sensitive). * **Size Limit:** ESWL is generally preferred for stones ** 2 cm or lower pole stones >1 cm, PCNL is the gold standard. * **Contraindications for ESWL:** Pregnancy, uncorrected bleeding diathesis, distal obstruction, and uncontrolled UTI. * **Steinstrasse:** A complication of ESWL where fragmented stone gravel blocks the ureter ("stone street").

Question 1

A male patient presents with azoospermia. On examination, the testicular size is normal, and both FSH and testosterone levels are within normal limits. What is the most probable cause?

Accepted Answer

Vas obstruction

Answer

Non-descended testis

Answer

Klinefelter's syndrome

Answer

Kallmann's syndrome

Question 2

In carcinoma of the prostate, which of the following statements is false?

Accepted Answer

Skeletal metastases from prostate cancer are always osteolytic.

Answer

The histological type is an adenocarcinoma.

Answer

Gleason scoring system is based on the degree of glandular differentiation.

Answer

Prostate cancer is the commonest site for skeletal metastasis.

Question 3

Which of the following is NOT true about paraphimosis?

Accepted Answer

It is seen in patients with Diabetes Mellitus.

Answer

It can be iatrogenic.

Answer

It can lead to gangrene of the glans.

Answer

Circumcision is a treatment.

Question 4

Absent fructose content in the seminal fluid suggests which of the following conditions?

Accepted Answer

Both A and B

Answer

Congenital absence of seminal vesicle

Answer

Partial duct obstruction

Answer

None of the above

Question 5

Which of the following is true regarding obstructive azoospermia?

Accepted Answer

Normal FSH and normal LH

Answer

Low FSH and low LH

Answer

Low LH and normal FSH

Answer

Low FSH and normal LH

Question 6

Which of the following statements is incorrect regarding the variables used to calculate the MELD score?

Accepted Answer

Serum albumin

Answer

Prothrombin time expressed as the international normalized ratio (INR)

Answer

Serum bilirubin

Answer

Serum creatinine

Question 7

In pelvi-ureteric junction (PUJ) obstruction causing hydronephrosis, which of the following statements is false?

Accepted Answer

If there is more than 5 percent of function in the obstructed kidney, a procedure to preserve the kidney is carried out

Answer

The condition may be asymptomatic

Answer

It can be diagnosed in utero

Answer

Ultrasound scanning is the least invasive method of imaging

Question 8

Cystoscopic findings in TB bladder are all except?

Accepted Answer

Whitish efflux from the ureteric holes

Answer

Thimble bladder

Answer

Golf hole ureter

Answer

Cobblestone mucosa

Question 9

Which type of kidney stone is most sensitive to extracorporeal shock wave lithotripsy (ESWL)?

Accepted Answer

Uric acid stone

Answer

Calcium oxalate stone

Answer

Struvite (triple phosphate) stone

Answer

Cystine stone

Question 10

What is the standard treatment for Stage II testicular teratoma?

Accepted Answer

Orchidectomy + Retroperitoneal Lymph Node Dissection (RPLND)

Answer

Orchidectomy + Chemotherapy

Answer

Orchidectomy

Answer

Radiotherapy

Urology — MCQs

Urology — MCQs

On this page

Practice by Chapter

Want unlimited practice?