Urology Practice Questions

Q: A 29-year-old male complains of flank pain that radiates from the loin to the groin region. What is the first investigation to be done?

USG abdomen. **Explanation:** The clinical presentation of flank pain radiating from the loin to the groin is classic for **ureteric colic**, most commonly caused by urolithiasis (urinary stones). **1. Why USG Abdomen is the Correct Answer:** In clinical practice and for exam purposes, **Ultrasonography (USG)** is considered the **first-line (initial) investigation** for suspected renal colic. It is non-invasive, radiation-free, readily available, and highly effective at detecting hydronephrosis (proximal dilatation) and stones in the radiopaque or radiolucent categories. While not as sensitive as CT for small ureteric stones, its safety profile makes it the starting point in the diagnostic algorithm. **2. Analysis of Incorrect Options:** * **Plain CT scan abdomen (NCCT):** This is the **Gold Standard** (most accurate) investigation for urolithiasis because it can detect almost all types of stones (except Indinavir stones) and their precise location. However, it is not the "first" investigation due to cost and radiation exposure. * **CECT abdomen:** Contrast-enhanced CT is generally avoided in acute renal colic as the excreted contrast can mask the presence of a stone (both appear white/hyperdense). It is used primarily to assess renal function or alternative pathologies. * **X-ray abdomen (KUB):** While useful for follow-up of radiopaque stones, it misses 10-20% of stones (radiolucent stones like uric acid) and has lower sensitivity compared to USG. **Clinical Pearls for NEET-PG:** * **Initial/First Investigation:** USG Abdomen. * **Gold Standard/Best Investigation:** Non-Contrast Computed Tomography (NCCT) KUB. * **Investigation of Choice in Pregnancy/Children:** USG. * **Most common site of stone obstruction:** Ureterovesical Junction (UVJ). * **Radiolucent stones on X-ray:** Uric acid, Xanthine, and Indinavir stones.

Q: After agreeing to have no more children, a man and his wife decided he should have a vasectomy. What structure would then be surgically ligated?

Ductus deferens. **Explanation:** **Vasectomy** is a permanent method of male sterilization. The procedure involves the surgical excision and ligation of a segment of the **Ductus deferens** (Vas deferens). **Why the Ductus deferens is the correct target:** The Ductus deferens is a thick-walled muscular tube that transports mature spermatozoa from the epididymis to the ejaculatory duct. By ligating this structure, the path for sperm to enter the ejaculate is physically blocked. Since the testes continue to produce sperm and testosterone, the sperm are simply reabsorbed by the body, and hormonal balance remains unaffected. **Analysis of Incorrect Options:** * **B. Ejaculatory duct:** This is formed by the union of the ductus deferens and the duct of the seminal vesicle within the prostate. It is surgically inaccessible for a simple sterilization procedure and its ligation would also block seminal vesicle fluid. * **C. Epididymis:** This is the site of sperm maturation and storage. While blocking it would prevent sperm transport, it is a complex, coiled structure that is technically difficult to ligate compared to the easily palpable vas deferens in the scrotal sac. * **D. Fossa navicularis:** This is the dilated distal portion of the male urethra located within the glans penis. It serves as a passage for both urine and semen; ligating it would cause urinary obstruction. **Clinical Pearls for NEET-PG:** * **Anatomy:** The vas deferens is a component of the spermatic cord. During a "No-Scalpel Vasectomy," it is isolated by palpation through the scrotal skin. * **Post-Op Counseling:** Vasectomy is **not immediately effective**. Patients must use alternative contraception until "azoospermia" is confirmed by semen analysis (usually after 12 weeks or 20 ejaculations) to clear stored sperm distal to the ligation site. * **Complications:** The most common long-term complication is a sperm granuloma or chronic post-vasectomy pain syndrome.

Q: Circumcision cannot be used in the management of which of the following conditions?

Penile cancer. **Explanation** The correct answer is **Penile cancer**. In the management of penile cancer, circumcision is insufficient as a definitive treatment. The standard of care involves wide local excision, partial penectomy, or total penectomy depending on the stage, often accompanied by inguinal lymph node dissection. Performing a simple circumcision in the presence of malignancy risks leaving behind positive margins and violating oncological principles. **Analysis of Options:** * **Phimosis:** This is the primary indication for circumcision. It involves the inability to retract the prepuce over the glans. Circumcision is the definitive surgical cure. * **Severe Balanitis Xerotica Obliterans (BXO):** Also known as Lichen Sclerosus, this is a chronic inflammatory condition. Circumcision is the treatment of choice as it removes the diseased preputial tissue, which is often the source of the pathology. * **Paraphimosis:** This is a urological emergency where the retracted foreskin becomes trapped behind the glans. While initial management involves manual reduction, a formal circumcision is recommended later to prevent recurrence. **Clinical Pearls for NEET-PG:** * **Contraindications to Circumcision:** The most important absolute contraindication is **Hypospadias**, as the prepuce is required for future reconstructive skin flaps (urethroplasty). Other contraindications include chordee and bleeding diathesis. * **BXO Association:** BXO is a premalignant condition; if left untreated, it can progress to Squamous Cell Carcinoma (SCC) of the penis. * **Protective Factor:** Neonatal circumcision is known to significantly reduce the lifetime risk of developing penile cancer and HIV transmission.

Q: Which of the following statements is not true regarding Familial adenomatous polyposis?

Polyps tend to develop in late adulthood.. **Explanation** **Familial Adenomatous Polyposis (FAP)** is an autosomal dominant condition caused by a germline mutation in the **APC (Adenomatous Polyposis Coli) gene** on chromosome 5q21. **Why Option C is the correct answer (The False Statement):** Polyps in FAP do **not** develop in late adulthood. Instead, they typically appear in the **second decade of life** (teens). By age 35, nearly 95% of patients have developed hundreds to thousands of adenomatous polyps. If left untreated (without prophylactic colectomy), the risk of progression to colorectal cancer is virtually 100% by age 40–50. **Analysis of Incorrect Options:** * **Option A:** FAP follows an **autosomal dominant** inheritance pattern. A child of an affected parent has a 50% chance of inheriting the mutation. * **Option B:** Screening starts early (age 10–12 years). Since polyps in FAP are distributed throughout the colon but are almost always present in the rectum, **annual flexible sigmoidoscopy** is the standard screening tool until polyps are detected. * **Option D:** FAP can present with extra-colonic manifestations. When associated with **epidermoid cysts, osteomas** (usually of the mandible), and soft tissue tumors (desmoids), it is known as **Gardner’s Syndrome**. **High-Yield Clinical Pearls for NEET-PG:** * **CHRPE:** Congenital Hypertrophy of Retinal Pigment Epithelium is the earliest detectable sign of FAP. * **Turcot Syndrome:** FAP/HNPCC associated with CNS tumors (Medulloblastoma/Glioma). * **Duodenal Adenoma:** The most common extra-colonic malignancy in FAP patients post-colectomy (Periampullary carcinoma). * **Management:** Total proctocolectomy with Ileal Pouch-Anal Anastomosis (IPAA) is the surgery of choice.

Q: Prostate Specific Antigen (PSA) is specific to which of the following conditions?

All of the above. **Explanation:** The core concept to understand for NEET-PG is that **Prostate Specific Antigen (PSA)** is **organ-specific, but not disease-specific.** It is a serine protease produced by the columnar epithelium of the prostatic ducts and acini, intended to liquefy the seminal coagulum. 1. **Why "All of the above" is correct:** Any condition that disrupts the normal architecture of the prostate gland allows PSA to leak into the systemic circulation. * **Prostatic Cancer:** Malignant cells produce PSA, and the disruption of the basement membrane leads to significant elevations. * **BPH:** An enlarged prostate has more epithelial cells producing PSA; generally, for every 1 gram of BPH tissue, serum PSA rises by 0.3 ng/mL. * **Prostatitis:** Inflammation and infection cause "leakage" of PSA into the blood, often causing the highest acute spikes in levels. 2. **Clinical Nuances:** * **Option A & B:** While these are benign, they frequently cause elevated PSA, leading to diagnostic dilemmas. This is why a single elevated PSA reading is never definitive for cancer. * **Option C:** While PSA is the primary screening tool for prostate cancer, it lacks the specificity to be used in isolation. **High-Yield Clinical Pearls for NEET-PG:** * **Normal Range:** 0–4 ng/mL. * **PSA Velocity:** A rise of **>0.75 ng/mL per year** is highly suggestive of malignancy, even if the total value is 25%** suggests BPH. * **Factors that increase PSA:** DRE (minor), Prostatitis, Ejaculation, Cystoscopy, and Prostate Biopsy. * **Factors that decrease PSA:** 5-alpha reductase inhibitors (Finasteride/Dutasteride) can reduce PSA levels by **50%**; therefore, the measured value should be doubled for accurate screening.

Q: A 13-year-old boy presents with acute onset right scrotal pain. The pain is not relieved on elevation of the scrotum, and he has no fever or dysuria. The testis is enlarged and tender. His routine urinary examination is normal, and there is no history of trauma. Which of the following is the most appropriate management?

Immediate exploration. **Explanation:** The clinical presentation of acute, spontaneous scrotal pain in an adolescent is **Testicular Torsion** until proven otherwise. This is a surgical emergency where the spermatic cord twists, leading to ischemia and potential necrosis of the testis. **Why Immediate Exploration is Correct:** The diagnosis of torsion is primarily clinical. The "Golden Period" for testicular salvage is **6 hours** from the onset of pain; delay beyond this significantly increases the risk of orchidectomy. The negative **Prehn’s sign** (pain not relieved by scrotal elevation) and the absence of urinary symptoms (normal urinalysis) strongly point away from inflammatory causes and toward torsion. Immediate surgical exploration is mandatory to detorse the testis and perform bilateral orchidopexy (fixation) to prevent recurrence. **Why Other Options are Incorrect:** * **Antibiotics / Antibiotics and Scrotal Elevation:** These are treatments for *Epididymo-orchitis*. While this also causes scrotal pain, it usually presents with fever, dysuria, and a positive Prehn’s sign. In a 13-year-old, waiting for antibiotics to work in a suspected torsion case would lead to a dead testis. * **Psychiatric Evaluation:** This is irrelevant as the symptoms are clearly organic and acute. **Clinical Pearls for NEET-PG:** * **Age Distribution:** Bimodal peaks (neonatal period and puberty). * **Prehn’s Sign:** Negative in Torsion (pain persists/worsens); Positive in Epididymitis (pain relieved). * **Cremasteric Reflex:** Usually absent in testicular torsion (High sensitivity). * **Investigation of Choice:** Color Doppler Ultrasound (shows decreased/absent blood flow), but **surgery should never be delayed** for imaging if clinical suspicion is high. * **Anatomical Predisposition:** "Bell-clapper deformity" (high tunica vaginalis attachment).

Q: All are features of Fournier's gangrene except?

Testicles are involved. **Fournier’s gangrene** is a life-threatening, rapidly progressive polymicrobial necrotizing fasciitis of the perineal, perianal, and genital regions. ### **Explanation of Options** * **Option A (Correct Answer):** The **testicles are typically spared** in Fournier’s gangrene. This is because the blood supply to the testes originates from the **internal spermatic (testicular) arteries**, which arise directly from the abdominal aorta. In contrast, the scrotum and perineal skin are supplied by the external and internal pudendal arteries. Since the infection spreads along the fascial planes (Colles’, Dartos, and Scarpa’s fascia), the deep-seated testes remain protected. * **Option B:** The hallmark pathophysiology is **obliterative arteritis** of the subcutaneous arterioles. This leads to local ischemia, which further promotes the growth of anaerobic bacteria and leads to rapid tissue necrosis. * **Option C:** It is a **polymicrobial infection**. Common isolates include aerobes (E. coli, Klebsiella, Staphylococci, Streptococci) and anaerobes (Bacteroides, Clostridium species like *C. welchii*). * **Option D:** By definition, it is a form of **necrotizing fasciitis** specifically involving the male genitalia and perineum. ### **Clinical Pearls for NEET-PG** * **Risk Factors:** Diabetes mellitus (most common), chronic alcoholism, and local trauma/surgery. * **Clinical Sign:** **Crepitus** on palpation (due to gas-forming organisms) and "woody" induration of the skin. * **Management:** This is a surgical emergency. Treatment involves **aggressive surgical debridement**, broad-spectrum intravenous antibiotics, and hemodynamic stabilization. * **Anatomical Spread:** The infection is limited by the attachments of **Colles' fascia** (to the perineal body and ischiopubic rami), but it can spread upward to the abdominal wall via **Scarpa’s fascia**.

Question 1

Which of the following is a known complication of modified retroperitoneal lymph node dissection (RPLND) performed for non-seminomatous germ cell tumors of the testis?

Accepted Answer

Retrograde ejaculation

Answer

Impotence

Answer

Bladder atony

Answer

Dry ejaculation

Question 2

A 29-year-old male complains of flank pain that radiates from the loin to the groin region. What is the first investigation to be done?

Accepted Answer

USG abdomen

Answer

CECT abdomen

Answer

Plain CT scan abdomen

Answer

X-ray abdomen

Question 3

After agreeing to have no more children, a man and his wife decided he should have a vasectomy. What structure would then be surgically ligated?

Accepted Answer

Ductus deferens

Answer

Ejaculatory duct

Answer

Epididymis

Answer

Fossa navicularis

Question 4

Which of the following statements about the prostate is incorrect?

Accepted Answer

Benign prostatic hyperplasia is common in the peripheral zone.

Answer

The normal adult prostate weighs around 20 grams.

Answer

Carcinomas are more common in the peripheral zone.

Answer

PSA is a sensitive marker in prostate pathology but lacks specificity.

Question 5

A 40-year-old patient with a single kidney presents with a solitary exophytic mass of 4 cm localized at its lower pole. What is the best-recommended management option?

Accepted Answer

Partial nephrectomy

Answer

Radical nephrectomy

Answer

Radical nephrectomy with dialysis

Answer

Radical nephrectomy with renal transplantation

Question 6

Circumcision cannot be used in the management of which of the following conditions?

Accepted Answer

Penile cancer

Answer

Phimosis

Answer

Severe balanitis xerotica obliterans

Answer

Paraphimosis

Question 7

Which of the following statements is not true regarding Familial adenomatous polyposis?

Accepted Answer

Polyps tend to develop in late adulthood.

Answer

It follows an autosomal dominant pattern of inheritance.

Answer

Screening is typically performed using sigmoidoscopy.

Answer

Epidermoid cysts and osteomas may be associated findings.

Question 8

Prostate Specific Antigen (PSA) is specific to which of the following conditions?

Accepted Answer

All of the above

Answer

Benign Prostatic Hyperplasia (BPH)

Answer

Prostatitis

Answer

Prostatic cancer

Question 9

A 13-year-old boy presents with acute onset right scrotal pain. The pain is not relieved on elevation of the scrotum, and he has no fever or dysuria. The testis is enlarged and tender. His routine urinary examination is normal, and there is no history of trauma. Which of the following is the most appropriate management?

Accepted Answer

Immediate exploration

Answer

Antibiotics

Answer

Psychiatric evaluation

Answer

Antibiotics and scrotal elevation

Question 10

All are features of Fournier's gangrene except?

Accepted Answer

Testicles are involved

Answer

Obliterative arteritis seen

Answer

Haemolytic streptococci, E.coli, Staphylococci, Cl. welchi can be isolated

Answer

Necrotising fasciitis

Urology — MCQs

Urology — MCQs

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