Urology Practice Questions

Q: A 40-year-old male presented with severe pain in the left upper abdomen radiating to the groin. Urine routine examination shows 6-8 pus cells and 15-20 RBCs. A CT scan was performed. What is the most likely diagnosis?

Left ureteric calculus. ***Left ureteric calculus*** - **Severe colicky pain** in the left upper abdomen radiating to the **groin** is classic for ureteric stone, following the path of the ureter. - **Hematuria** (15-20 RBCs) on urine analysis is a key finding, along with **pyuria** (6-8 pus cells) due to associated inflammation. *Aortic aneurysm* - Typically presents with **tearing back pain** radiating to the abdomen, not specifically to the groin. - **No hematuria** would be expected, and pain is usually constant rather than colicky. *Acute cholecystitis* - Pain is typically in the **right upper quadrant** radiating to the **right shoulder**, not to the groin. - **No hematuria** or pyuria would be present, and pain is usually related to **fatty meals**. *Acute colitis* - Presents with **diarrhea**, **blood in stool**, and **lower abdominal cramping**, not upper abdominal pain. - **No hematuria** would be expected, and pain doesn't radiate to the groin.

Q: A 60-year-old male presents with a poor stream of urine and a post-void residual volume of 400ml. He has bilateral hydronephrosis and his prostate weighs 70g. His urea is 120 mg/dL and creatinine is 3.5 mg/dL. What is the ideal next immediate step?

Catheterize with a Foley catheter. The clinical presentation describes a classic case of **Benign Prostatic Hyperplasia (BPH)** leading to acute-on-chronic urinary retention [1]. The patient has significant bladder outlet obstruction (70g prostate), evidenced by a high post-void residual (400ml) and secondary complications: bilateral hydronephrosis and **post-renal azotemia** (elevated urea and creatinine). **1. Why Option A is Correct:** The immediate priority in post-renal failure is to **relieve the obstruction**. Catheterization with a Foley catheter is the simplest, fastest, and most effective bedside procedure to decompress the bladder. Once the pressure is relieved, the hydronephrosis usually resolves, and renal function (urea/creatinine) typically improves. **2. Why Incorrect Options are Wrong:** * **Option B:** Percutaneous nephrostomies are invasive and reserved for supra-vesical obstructions (e.g., ureteric stones or tumors) where a bladder catheter cannot bypass the blockage. * **Options C & D:** While imaging is useful for staging or ruling out malignancy, they are diagnostic steps. In an emergency setting with deranged renal parameters (azotemia), **therapeutic intervention** (drainage) must precede elective imaging. Furthermore, CT contrast is contraindicated in patients with high creatinine due to the risk of Contrast-Induced Nephropathy. **Clinical Pearls for NEET-PG:** * **Definition of BPH:** Histologically, it involves hyperplasia of both glandular and stromal elements, primarily in the **Transition Zone** of the prostate [1]. * **Post-obstructive Diuresis:** After catheterization, monitor the patient for massive diuresis and electrolyte imbalances. * **Normal Prostate Weight:** ~20g. A 70g prostate is significantly enlarged. * **Management Priority:** Always address the "ABC" and immediate life-threatening complications (like renal failure) before definitive surgical management (e.g., TURP).

Q: Which of the following is a complication of total parenteral nutrition?

Metabolic acidosis. **Explanation:** Total Parenteral Nutrition (TPN) is associated with several metabolic complications. **Metabolic acidosis** is a well-recognized complication, primarily occurring due to the high concentration of cationic amino acids (such as arginine, histidine, and lysine) in older TPN formulations. When these amino acids are metabolized, they release hydrogen ions. Additionally, the presence of acetate or chloride salts in the solution can influence the acid-base balance; an excess of chloride relative to sodium can lead to **hyperchloremic metabolic acidosis**. **Analysis of Options:** * **A. Congestive Heart Failure (CHF):** While fluid overload can occur if TPN is administered too rapidly, CHF is not a direct metabolic complication of the TPN constituents themselves. * **B. Hypochloremia:** TPN is more likely to cause **hyperchloremia** (due to high chloride content in certain formulations), which contributes to the metabolic acidosis mentioned above. * **D. Leukopenia:** TPN does not typically cause a decrease in white blood cell counts. In fact, catheter-related bloodstream infections (CRBSI) are a common complication, which would lead to leukocytosis. **High-Yield Clinical Pearls for NEET-PG:** * **Most common metabolic complication:** Hyperglycemia (due to high glucose infusion rates). * **Refeeding Syndrome:** Characterized by **Hypophosphatemia** (most important), hypokalemia, and hypomagnesemia when feeding is restarted in a malnourished patient. * **Hepatobiliary complications:** Cholestasis, steatosis, and cholelithiasis (gallstones) are common with long-term TPN use due to lack of enteral stimulation. * **Trace element deficiency:** Zinc deficiency is common, presenting as perioral dermatitis and alopecia.

Q: A 30-year-old patient presents with scrotal swelling. Transillumination is positive, and a large hydrocoele is suspected. What is the preferred treatment?

Jaboulay's procedure. **Explanation:** The clinical presentation of a positive transillumination test in a 30-year-old male is diagnostic of a **primary vaginal hydrocele**. The surgical management of hydrocele is determined by the size and thickness of the tunica vaginalis sac. **Why Jaboulay’s Procedure is correct:** Jaboulay’s procedure (eversion of the sac) is the preferred treatment for **large hydroceles** where the sac is thin and lax. In this procedure, the sac is opened, redundant tissue is trimmed, and the edges are sutured behind the testis and spermatic cord. This allows the fluid to be absorbed by the scrotal lymphatics. **Analysis of Incorrect Options:** * **Lord’s Plication:** This is preferred for **small to medium-sized** hydroceles with a thin sac. The sac is not everted but gathered by multiple plicating sutures. It is less suitable for large sacs as it creates a bulky mass. * **Excision of Sac (Subtotal Excision):** This is reserved for **chronic, large hydroceles with a thick, calcified, or multilocular sac** where eversion is technically difficult. * **Incision and Drainage:** This is not a definitive treatment for hydrocele. Simple aspiration has a near 100% recurrence rate and carries a risk of infection/hematocele. **High-Yield Clinical Pearls for NEET-PG:** 1. **Gold Standard Diagnosis:** Clinical examination (Transillumination + "Getting above the swelling" is possible). 2. **Infantile Hydrocele:** Usually resolves spontaneously by 1-2 years of age. If it persists, the treatment of choice is **Herniotomy** (not hydrocelectomy) because it is a communicating type. 3. **Complication:** The most common complication of hydrocele surgery is a **scrotal hematoma**. 4. **Bergmann’s Operation:** Another term for the partial excision of the sac used in very thick-walled hydroceles.

Q: Which statement about Horseshoe Kidney is false?

Heminephrectomy improves function. **Explanation:** Horseshoe kidney is the most common renal fusion anomaly, occurring when the lower poles of the kidneys fuse across the midline (isthmus). **Why Option D is the Correct (False) Statement:** Heminephrectomy (removal of one half of the kidney) is **not** a treatment to improve renal function. Surgery in horseshoe kidney is only indicated for complications such as symptomatic calculi, severe obstruction, or tumors. Dividing the isthmus (symphysiotomy) was historically performed but is now obsolete as it does not improve drainage or function and carries a high risk of hemorrhage and devascularization. **Analysis of Other Options:** * **Option A (Spider-like appearance):** Due to the failure of normal rotation (malrotation), the renal pelvis is anterior, and the calyces are directed medially and posteriorly. On Intravenous Pyelogram (IVP), this orientation creates a characteristic "spider-leg" or "hand-shaking" appearance. * **Option B (Ureteral obstruction):** This is common due to the high insertion of the ureter into the renal pelvis and the ureter crossing over the fused isthmus, often leading to Pelviureteric Junction (PUJ) obstruction. * **Option C (Lower calyx reversed):** Because the lower poles are fused and the kidney fails to rotate medially, the lower calyces point toward the midline (medially), which is the reverse of the normal lateral orientation. **High-Yield Clinical Pearls for NEET-PG:** * **Embryology:** The ascent of the horseshoe kidney is arrested by the **Inferior Mesenteric Artery (IMA)** at the level of L3. * **Associated Risks:** Increased incidence of **Renal Calculi** (stasis), **UTIs**, and specific tumors like **Wilms’ tumor** (in children) and **Transitional Cell Carcinoma**. * **Rovsing Sign:** Abdominal pain on hyperextension of the spine (rarely seen clinically but high-yield for exams).

Q: What is the investigation of choice for torsion testis?

Colour Doppler. **Explanation:** **Testicular Torsion** is a surgical emergency caused by the twisting of the spermatic cord, leading to venous occlusion followed by arterial compromise and testicular ischemia. **1. Why Colour Doppler is the Investigation of Choice (IOC):** The gold standard for diagnosing torsion is clinical evaluation; however, **Colour Doppler Ultrasonography** is the investigation of choice because it directly assesses **blood flow**. In torsion, the Doppler signal will show absent or significantly reduced arterial flow to the affected testis compared to the normal side. It is non-invasive, rapid, and has a high sensitivity (82–100%) and specificity. **2. Why other options are incorrect:** * **Routine USG (B-mode):** While it can show secondary signs like an enlarged, heterogeneous testis or a "whirlpool sign," it cannot reliably assess blood flow, which is the hallmark of torsion. * **MRI & CT:** These are time-consuming and expensive. Since "Time is Muscle" in torsion (salvage rates drop significantly after 6 hours), these modalities are impractical for an acute scrotal emergency. **Clinical Pearls for NEET-PG:** * **Golden Period:** Testicular salvage rate is nearly 100% if detorsion occurs within **6 hours**. * **Management:** Immediate **Surgical Exploration**. If the testis is viable, orchidopexy is performed. If gangrenous, orchidectomy. * **Prophylaxis:** Always perform **bilateral orchidopexy** because the anatomical defect (e.g., Bell-clapper deformity) is usually bilateral. * **Reflex:** The **Cremasteric reflex is absent** in testicular torsion (a key differentiator from epididymo-orchitis). * **Prehn’s Sign:** Negative in torsion (pain is not relieved by lifting the scrotum).

Q: A patient with benign prostatic hyperplasia (BHP) underwent transurethral resection of the prostate (TURP). Postoperatively, the patient developed altered sensorium. What is the most likely cause?

Hyponatremia. **Explanation:** The patient is presenting with **TURP Syndrome**, a classic complication occurring due to the systemic absorption of large volumes of non-conductive irrigation fluid (traditionally **1.5% Glycine**) through the prostatic venous sinuses during the procedure. **Why Hyponatremia is correct:** The primary mechanism is **dilutional hyponatremia**. As the irrigation fluid enters the circulation, it expands the intravascular volume, leading to a rapid drop in serum sodium levels. This causes cerebral edema, which manifests clinically as altered sensorium, confusion, headache, seizures, and in severe cases, coma. Additionally, the metabolism of Glycine into ammonia can further contribute to encephalopathy. **Why the other options are incorrect:** * **Hypernatremia:** TURP syndrome involves fluid overload and dilution; hypernatremia would imply dehydration or salt gain, which is the opposite of the pathophysiology here. * **Hypokalemia & Hypomagnesemia:** While electrolyte shifts can occur during massive fluid resuscitation, they are not the primary or hallmark cause of the acute neurological symptoms seen immediately post-TURP. Hyponatremia is the definitive diagnostic feature of TURP syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **Triad of TURP Syndrome:** Hypertension (early), Bradycardia, and Altered Mental Status. * **Prevention:** Limit resection time to **<60 minutes**, keep the irrigation bag height **<60 cm** above the patient, and use Bipolar TURP (which allows the use of Normal Saline, eliminating the risk of hyponatremia). * **Management:** Stop the procedure, administer diuretics (Furosemide), and use **3% Hypertonic Saline** (slowly) for severe symptomatic hyponatremia.

Q: Which of the following is false about hypospadias?

Defect seen in the dorsal aspect of the penis. **Explanation:** Hypospadias is a common congenital anomaly of the penis characterized by the incomplete development of the anterior urethra. **1. Why Option A is the Correct Answer (False Statement):** In hypospadias, the urethral meatus opens on the **ventral (underside)** aspect of the penis, anywhere from the glans to the perineum. A defect on the **dorsal (top)** aspect is characteristic of **Epispadias**, which is often associated with bladder exstrophy. Therefore, stating the defect is on the dorsal aspect is incorrect. **2. Analysis of Other Options (True Statements):** * **Option B (Chordee):** This refers to the ventral curvature of the penis, often caused by fibrous bands or skin deficiency. It is a classic feature associated with hypospadias. * **Option C (Hooded Prepuce):** Due to the failure of the ventral foreskin to fuse, there is an excess of dorsal skin, leading to a "hooded" appearance. * **Option D (Circumcision avoidance):** This is a critical clinical rule. The prepuce (foreskin) must be preserved because it is frequently used as a vascularized flap or graft for surgical reconstruction (urethroplasty). **Clinical Pearls for NEET-PG:** * **Incidence:** Approximately 1 in 300 live male births. * **Associated Anomalies:** Cryptorchidism (undescended testis) and inguinal hernias are the most common. * **Management:** The ideal age for surgical repair is **6 to 12 months**. * **Common Procedures:** Snodgrass technique (TIP - Tubularized Incised Plate), MAGPI (for distal cases), and Mathieu’s repair.

Question 1

A 40-year-old male presented with severe pain in the left upper abdomen radiating to the groin. Urine routine examination shows 6-8 pus cells and 15-20 RBCs. A CT scan was performed. What is the most likely diagnosis?

Accepted Answer

Left ureteric calculus

Answer

Aortic aneurysm

Answer

Acute cholecystitis

Answer

Acute colitis

Question 2

Which of the following are indications for percutaneous nephrostomy?

Accepted Answer

Stone removal, ureteral obstruction, renal tumor resection, antegrade renography

Answer

Stone removal, ureteral obstruction, renal tumor resection, ischemic renal failure

Answer

Stone removal, renal tumor resection, ischemic renal failure, antegrade renography

Answer

Stone removal, ureteral obstruction, ischemic renal failure, antegrade renography

Question 3

A 60-year-old male presents with a poor stream of urine and a post-void residual volume of 400ml. He has bilateral hydronephrosis and his prostate weighs 70g. His urea is 120 mg/dL and creatinine is 3.5 mg/dL. What is the ideal next immediate step?

Accepted Answer

Catheterize with a Foley catheter

Answer

Bilateral percutaneous nephrostomies

Answer

CT scan to rule out malignancy

Answer

MRI pelvis

Question 4

A young man presents with primary infertility, and semen analysis reveals low volume, fructose-negative ejaculate with azoospermia. Which of the following is the most useful imaging modality to evaluate the cause of his infertility?

Accepted Answer

Transrectal ultrasonography

Answer

Colour duplex ultrasonography of the scrotum

Answer

Retrograde urethrography

Answer

Spermatic venography

Question 5

Which of the following is a complication of total parenteral nutrition?

Accepted Answer

Metabolic acidosis

Answer

Congestive heart failure (CHF)

Answer

Hypochloremia

Answer

Leukopenia

Question 6

A 30-year-old patient presents with scrotal swelling. Transillumination is positive, and a large hydrocoele is suspected. What is the preferred treatment?

Accepted Answer

Jaboulay's procedure

Answer

Lord’s plication

Answer

Excision of sac

Answer

Incision and drainage

Question 7

Which statement about Horseshoe Kidney is false?

Accepted Answer

Heminephrectomy improves function

Answer

Spider-like appearance in IVP

Answer

Ureteral obstruction is common

Answer

Lower calyx is reversed

Question 8

What is the investigation of choice for torsion testis?

Accepted Answer

Colour Doppler

Answer

MRI

Answer

CT

Answer

Routine USG

Question 9

A patient with benign prostatic hyperplasia (BHP) underwent transurethral resection of the prostate (TURP). Postoperatively, the patient developed altered sensorium. What is the most likely cause?

Accepted Answer

Hyponatremia

Answer

Hypernatremia

Answer

Hypokalemia

Answer

Hypomagnesemia

Question 10

Which of the following is false about hypospadias?

Accepted Answer

Defect seen in the dorsal aspect of the penis

Answer

Associated with chordee

Answer

Associated with a hooded prepuce

Answer

Circumcision should be avoided

Urology — MCQs

Urology — MCQs

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