Urology Practice Questions

Q: A 25-year-old male presents with a red, swollen testis. Upon examination, the testis is felt separate from the epididymis due to marked swelling in the epididymis. What is the diagnosis?

Epididymo-orchitis. ### Explanation **Correct Answer: C. Epididymo-orchitis** The clinical presentation of a red, swollen testis where the **epididymis is felt separate from the testis** (due to localized inflammation/swelling of the epididymis) is a classic sign of early **Epididymo-orchitis**. In this condition, inflammation typically begins in the epididymis (epididymitis) before spreading to the body of the testis (orchitis). The presence of inflammatory signs (redness, warmth, swelling) and the anatomical distinction between the two structures help differentiate it from other acute scrotal pathologies. **Why other options are incorrect:** * **Testicular Torsion:** This is a surgical emergency. In torsion, the anatomy becomes distorted; the testis is usually high-riding with a horizontal lie. A key differentiator is **Prehn’s sign**: elevation of the scrotum relieves pain in epididymitis but worsens it in torsion. * **Fournier’s Gangrene:** This is a necrotizing fasciitis of the perineum. It presents with systemic sepsis, crepitus, and black eschar (gangrene) of the scrotal skin, rather than localized swelling of the epididymis. * **Testicular Cancer:** Usually presents as a **painless**, hard, heavy lump. It does not typically present with acute inflammatory signs like redness or warmth unless there is associated hemorrhage. **NEET-PG High-Yield Pearls:** * **Age Factor:** In men 35 years, it is usually *E. coli* associated with UTI or BPH. * **Prehn’s Sign:** Positive (pain relief on elevation) in Epididymo-orchitis; Negative in Torsion. * **Phren's Sign vs. Angel's Sign:** Angel's sign (horizontal lie) is seen in torsion. * **Investigation of Choice:** Color Doppler Ultrasound (shows **increased blood flow** in epididymitis, but **decreased/absent flow** in torsion).

Q: What is the commonest cause of ureteric injury during surgical operations?

Hysterectomy. **Explanation:** Ureteric injury is a significant complication of pelvic and abdominal surgeries. **Hysterectomy** (Option B) is the most common cause, accounting for over 50–70% of all iatrogenic ureteric injuries. This high incidence is due to the close anatomical proximity of the ureter to the female reproductive organs. The most vulnerable site is where the ureter passes **under the uterine artery** ("water under the bridge") near the level of the internal os. Injury typically occurs during clamping of the uterine vessels or during the closure of the vaginal vault. **Analysis of Incorrect Options:** * **Abdomino-perineal resection (Option A) & Colectomy (Option D):** While colorectal surgeries are the second most common cause of ureteric injury, they occur less frequently than gynecological procedures. In these cases, the left ureter is more commonly injured during the mobilization of the sigmoid colon or ligation of the inferior mesenteric artery. * **Prostatectomy (Option C):** Ureteric injury is rare during prostatectomy because the ureters enter the bladder trigone superior to the surgical field of the prostate. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of injury:** The lower third of the ureter (pelvic segment). * **Most common mechanism:** Crushing (clamping) or ligation; less commonly transection or thermal injury. * **Gold standard for diagnosis:** Intravenous Urogram (IVU) or CT Urogram. * **Intraoperative detection:** If suspected, intravenous **indigo carmine** or methylene blue can be administered to check for dye leakage. * **Management:** If detected intraoperatively, primary repair (ureteroureterostomy) or ureteric reimplantation (ureteroneocystostomy) is performed depending on the site of injury.

Q: Which is the site for urine extravasation in an extraperitoneal bladder rupture?

Prevesical region. **Explanation:** Bladder rupture is categorized into extraperitoneal and intraperitoneal types, usually resulting from blunt trauma associated with pelvic fractures. **1. Why Option A is correct:** In an **extraperitoneal bladder rupture** (the most common type, ~80%), the tear occurs in the anterolateral wall or the bladder neck. The urine leaks into the **Prevesical space (Space of Retzius)**, which is the potential space between the pubic symphysis and the bladder. On imaging (Cystogram), this appears as a characteristic "sunburst" or "flame-shaped" extravasation of contrast confined to the pelvis. **2. Why other options are incorrect:** * **Option B (Groin):** While urine can occasionally track toward the inguinal canal in severe pelvic injuries, it is not the primary or diagnostic site of extravasation for extraperitoneal rupture. * **Option C (Paracolic gutter):** This is a feature of **intraperitoneal bladder rupture**. In intraperitoneal tears (usually at the dome), urine enters the peritoneal cavity and flows along the paracolic gutters, outlining bowel loops on a cystogram. **Clinical Pearls for NEET-PG:** * **Mechanism:** Extraperitoneal rupture is almost always associated with **pelvic fractures** (bony spicules piercing the bladder). Intraperitoneal rupture occurs due to a blow to a **full bladder**. * **Management:** Most extraperitoneal ruptures are managed **conservatively** with a percutaneous or urethral catheter for 10–14 days. Intraperitoneal ruptures require **emergency surgical repair**. * **Gold Standard Investigation:** Retrograde Cystography (showing "flame-shaped" extravasation for extraperitoneal and "contrast outlining bowel" for intraperitoneal).

Q: Which of the following is NOT an obstructive cause of acute renal failure?

Duplex ureter. **Explanation:** Acute Renal Failure (ARF), or Acute Kidney Injury (AKI), can be classified into pre-renal, intrinsic renal, and post-renal (obstructive) causes. Post-renal ARF occurs when there is a physical blockage to the flow of urine, leading to increased retrograde pressure and decreased GFR. **Why Duplex Ureter is the correct answer:** A **Duplex Ureter** is a congenital anatomical variation where the kidney has two separate ureters. While it can be associated with complications like vesicoureteral reflux (VUR) or ureteroceles, the presence of a double ureter itself does **not** cause obstruction or renal failure. It is an anatomical anomaly rather than an obstructive pathology. **Analysis of Incorrect Options (Obstructive Causes):** * **Bilharzia (Schistosomiasis):** Chronic infection by *Schistosoma haematobium* leads to inflammation and fibrosis of the ureteric walls (ureteritis cystica) and bladder, causing strictures and obstructive uropathy. * **Retroperitoneal Fibrosis (Ormond’s Disease):** This condition involves the proliferation of fibrous tissue in the retroperitoneum, which characteristically encases and compresses the ureters medially, leading to bilateral obstruction. * **Renal Calculi:** Stones lodged in the ureter or renal pelvis are the most common cause of acute post-renal obstruction. Bilateral calculi or a stone in a solitary kidney can precipitate acute renal failure. **Clinical Pearls for NEET-PG:** * **Post-renal ARF** typically requires bilateral obstruction (or unilateral obstruction in a patient with a single functioning kidney) to cause a significant rise in serum creatinine. * **Retroperitoneal Fibrosis** is often idiopathic but can be associated with drugs like **Methysergide** or Ergotamine. * On imaging, retroperitoneal fibrosis classically causes **medial deviation** of the ureters.

Q: A 67-year-old chronic heavy smoker presents with a 2-week history of frank hematuria. Ultrasound of the pelvis shows a filling defect. What is the most probable diagnosis?

Transitional cell carcinoma of the bladder. **Explanation:** The clinical presentation of **painless frank hematuria** in an elderly male with a significant **smoking history** is the classic triad for **Transitional Cell Carcinoma (TCC)**, also known as Urothelial Carcinoma. 1. **Why TCC is correct:** TCC is the most common primary malignancy of the urinary bladder (accounting for >90% of cases). Smoking is the most significant risk factor, increasing the risk 3–4 fold due to alpha and beta-naphthylamines. On imaging (Ultrasound or CT), a bladder tumor typically appears as a **fixed filling defect** or an intraluminal mass. 2. **Why other options are incorrect:** * **Bladder Diverticula:** These are outpouchings of the bladder wall. While they can cause urinary stasis or stones, they do not typically present with frank hematuria unless complicated by a tumor within the diverticulum. * **Adenocarcinoma:** This is rare (<2% of bladder cancers). It is usually associated with urachal remnants (at the dome of the bladder) or cystitis glandularis. * **Squamous Cell Carcinoma (SCC):** This accounts for ~5% of cases. It is strongly associated with **chronic irritation**, such as Schistosomiasis (common in Egypt), long-term indwelling catheters, or chronic bladder stones, rather than smoking alone. **Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Cystoscopy with biopsy is the definitive diagnostic tool. * **Most common site:** Lateral walls of the bladder. * **Field Change Effect:** The entire urothelium (from renal pelvis to urethra) is at risk; therefore, patients with bladder TCC need evaluation of the upper tracts. * **Occupational Risks:** Exposure to arylamines in rubber, dye, and leather industries.

Q: Imatinib mesylate, used in the treatment of GIST, is an inhibitor of which of the following?

Tyrosine kinase. **Explanation:** **Imatinib mesylate** is a revolutionary targeted therapy that acts as a selective **Tyrosine Kinase Inhibitor (TKI)**. In the context of Gastrointestinal Stromal Tumors (GIST), it specifically targets the **KIT (CD117)** proto-oncogene, which encodes a type II receptor tyrosine kinase. In most GIST cases, a gain-of-function mutation leads to constitutive activation of this receptor, driving uncontrolled cell proliferation. Imatinib binds to the ATP-binding site of the kinase domain, effectively "switching off" the signaling pathway. **Analysis of Options:** * **Option A (IL-12):** Interleukin-12 is a cytokine involved in T-cell differentiation. Inhibitors like Ustekinumab target IL-12/IL-23 and are used in Psoriasis/Crohn’s disease, not GIST. * **Option B (TNF-alpha):** Tumor Necrosis Factor-alpha inhibitors (e.g., Infliximab, Adalimumab) are used in inflammatory conditions like Rheumatoid Arthritis and IBD. * **Option D (VEGF):** Vascular Endothelial Growth Factor inhibitors (e.g., Bevacizumab) target angiogenesis. While some TKIs (like Sunitinib) have anti-VEGF activity, Imatinib’s primary mechanism in GIST is KIT and PDGFR inhibition. **High-Yield Clinical Pearls for NEET-PG:** * **GIST Marker:** The most sensitive and specific marker for GIST is **CD117 (c-KIT)**. **DOG1** is another highly specific marker. * **Other Indications:** Imatinib is also the first-line treatment for **Chronic Myeloid Leukemia (CML)**, where it targets the **BCR-ABL** tyrosine kinase (Philadelphia chromosome). * **Resistance:** If a GIST patient becomes resistant to Imatinib, the second-line drug of choice is **Sunitinib**, followed by **Regorafenib**. * **Origin:** GIST arises from the **Interstitial Cells of Cajal (ICC)**, the pacemakers of the GI tract.

Q: Carcinoma of the penis is rarest among which population group?

Jews. **Explanation:** The correct answer is **Jews**. The rarity of penile carcinoma in this population is attributed to the practice of **neonatal circumcision**. **1. Why Jews?** Penile carcinoma is strongly associated with chronic irritation caused by **smegma** (a byproduct of desquamated epithelial cells and bacteria) accumulating under the prepuce in uncircumcised males. Smegma acts as a potential carcinogen. In the Jewish community, ritual circumcision (Brit Milah) is performed on the **8th day of life**. Early circumcision prevents the accumulation of smegma and significantly reduces the risk of Human Papillomavirus (HPV) infection (specifically types 16 and 18), which are major risk factors for the disease. **2. Why other options are incorrect:** * **Americans and Swedes:** While these populations have lower incidences compared to developing nations, circumcision is not universal or performed as early as in the Jewish faith. In these regions, the incidence is roughly 1 per 100,000. * **Indians:** India has a higher incidence of penile cancer, particularly in rural areas where hygiene may be poor and circumcision is not a routine practice among the majority population. **High-Yield Clinical Pearls for NEET-PG:** * **Protective Factor:** Circumcision is only protective if performed in **neonatal life/infancy**. Circumcision performed in adulthood does not provide the same level of protection against penile cancer. * **Risk Factors:** Phimosis (present in ~25-75% of cases), HPV 16 & 18, smoking, and poor hygiene. * **Premalignant Lesions:** Erythroplasia of Queyrat (on the glans), Bowen’s disease (on the shaft), and Balanitis Xerotica Obliterans (BXO). * **Most Common Histology:** Squamous Cell Carcinoma (SCC). * **Lymphatic Spread:** Usually follows a step-wise pattern to the **superficial inguinal nodes** first.

Q: Which statement is false regarding hydrocele?

The testis is separate from the swelling.. **Explanation:** In a vaginal hydrocele, the fluid accumulates within the **tunica vaginalis**, which is a serous sac that almost entirely surrounds the testis (except for the posterior border). Because the testis is enveloped by this fluid-filled sac, it is **not separate** from the swelling; rather, the testis lies within it and is typically non-palpable unless the fluid is drained or the hydrocele is very lax. **Analysis of Options:** * **Option C (Correct):** This is the false statement. In a hydrocele, the testis is "invaginated" into the sac and cannot be felt as a distinct entity. In contrast, in a **spermatocele** or **epididymal cyst**, the testis can be felt separately from the swelling. * **Option A:** True. Hydrocele fluid is typically a clear, straw-colored **transudate** containing albumin and fibrinogen. If it becomes an exudate, it usually indicates secondary infection or underlying malignancy. * **Option B:** True. This is a key clinical feature used to differentiate a hydrocele from an inguinal hernia. In a hydrocele, you can **"get above the swelling"** because the pathology is confined to the scrotum, allowing palpation of the spermatic cord at the neck of the scrotum. * **Option D:** True. A large or tense hydrocele can extend upwards toward the external inguinal ring, making it difficult to clinically identify a concomitant inguinal hernia. **NEET-PG High-Yield Pearls:** * **Transillumination Test:** The classic diagnostic sign for hydrocele (positive due to clear serous fluid). * **Lord’s Plication:** Surgical technique used for thin-walled hydroceles. * **Jaboulay’s Procedure:** Eversion of the sac, used for large, thick-walled hydroceles. * **Primary vs. Secondary:** Always perform an ultrasound in young men with a sudden hydrocele to rule out **testicular tumors**, which can cause a secondary hydrocele.

Question 1

A 25-year-old male presents with a red, swollen testis. Upon examination, the testis is felt separate from the epididymis due to marked swelling in the epididymis. What is the diagnosis?

Accepted Answer

Epididymo-orchitis

Answer

Testicular torsion

Answer

Fournier's gangrene

Answer

Testicular cancer

Question 2

What is the commonest cause of ureteric injury during surgical operations?

Accepted Answer

Hysterectomy

Answer

Abdomino-perineal resection

Answer

Prostatectomy

Answer

Colectomy

Question 3

What is a known complication of ectopic testis?

Accepted Answer

Torsion

Answer

Seminoma

Answer

Atrophy

Answer

All of the above

Question 4

Which is the site for urine extravasation in an extraperitoneal bladder rupture?

Accepted Answer

Prevesical region

Answer

Groin

Answer

Paracolic gutter

Answer

None of the above

Question 5

A 65-year-old male is diagnosed with prostatic cancer based on transrectal biopsy of a 1 cm palpable nodule. Which of the following statements are true concerning his management?

Accepted Answer

If the tumour is confined within the prostatic capsule, radical prostatectomy is an appropriate option.

Answer

If positive lymph nodes are detected on laparoscopic pelvic lymph node dissection, radical prostatectomy is indicated.

Answer

Radical prostatectomy is invariably associated with impotence.

Answer

There is currently no role for orchidectomy in the management of prostatic cancer.

Question 6

Which of the following is NOT an obstructive cause of acute renal failure?

Accepted Answer

Duplex ureter

Answer

Bilharzia

Answer

Retroperitoneal fibrosis

Answer

Renal calculi

Question 7

A 67-year-old chronic heavy smoker presents with a 2-week history of frank hematuria. Ultrasound of the pelvis shows a filling defect. What is the most probable diagnosis?

Accepted Answer

Transitional cell carcinoma of the bladder

Answer

Bladder diverticula

Answer

Adenocarcinoma of the bladder

Answer

Squamous cell carcinoma of the bladder

Question 8

Imatinib mesylate, used in the treatment of GIST, is an inhibitor of which of the following?

Accepted Answer

Tyrosine kinase

Answer

IL-12

Answer

TNF-alpha

Answer

VEGF

Question 9

Carcinoma of the penis is rarest among which population group?

Accepted Answer

Jews

Answer

Americans

Answer

Indians

Answer

Swedes

Question 10

Which statement is false regarding hydrocele?

Accepted Answer

The testis is separate from the swelling.

Answer

The fluid is almost always a transudate.

Answer

A hydrocele allows palpation of the spermatic cord above the swelling.

Answer

A hydrocele can obscure an inguinal hernia.

Urology — MCQs

Urology — MCQs

On this page

Practice by Chapter

Want unlimited practice?