Urology Practice Questions

Q: All of the following can be seen in hypernephroma, except:

None of the above. **Explanation:** Hypernephroma, now more commonly known as **Renal Cell Carcinoma (RCC)**, is famously referred to as the "Internist's Tumor" because of its diverse systemic manifestations and paraneoplastic syndromes. The correct answer is **None of the above** because all three listed conditions are well-recognized features of the disease. 1. **Polycythemia (Option A):** RCC can produce ectopic **Erythropoietin (EPO)**, which stimulates the bone marrow to increase red blood cell production. While anemia is more common in RCC, polycythemia occurs in about 1–5% of cases. 2. **Renal Vein Thrombosis (Option B):** RCC has a unique propensity for **angioinvasion**. The tumor often forms a "tumor thrombus" that extends into the renal vein and can propagate further into the Inferior Vena Cava (IVC), sometimes reaching the right atrium. 3. **Hypertension (Option C):** This occurs in up to 40% of patients. It can be caused by the secretion of **Renin** by the tumor, compression of the intrarenal vasculature (Goldblatt phenomenon), or hypercalcemia. **Clinical Pearls for NEET-PG:** * **Classic Triad:** Hematuria, Flank pain, and Palpable mass (seen in only 10% of cases; signifies advanced disease). * **Stauffer’s Syndrome:** Reversible hepatic dysfunction (elevated LFTs) in the absence of liver metastases. * **Left-sided Varicocele:** Occurs if the tumor thrombus obstructs the left renal vein, preventing drainage of the left gonadal vein. * **Most common histological subtype:** Clear cell carcinoma (originates from the Proximal Convoluted Tubule).

Q: Marion's disease is due to which of the following?

Muscular hypertrophy of the internal sphincter of the urinary bladder. **Explanation:** **Marion’s Disease**, also known as **Primary Bladder Neck Obstruction (PBNO)**, is a condition characterized by a functional or mechanical obstruction of the bladder neck in the absence of prostatic enlargement or urethral stricture. 1. **Why Option A is Correct:** The underlying pathophysiology of Marion’s disease is the **muscular hypertrophy of the internal sphincter** (bladder neck). This leads to a failure of the bladder neck to open or relax sufficiently during voiding, resulting in symptoms of bladder outlet obstruction. It is most commonly seen in middle-aged men but can occur in younger populations. 2. **Why the Incorrect Options are Wrong:** * **Option B (Fibrosis of the neck of the bladder):** While fibrosis can cause bladder neck contracture (often secondary to surgery like TURP or chronic inflammation), Marion’s disease specifically refers to the *congenital or idiopathic muscular hypertrophy* rather than acquired scarring. * **Option C & D (Vesicular diverticula and calculi):** These are typically **consequences** or complications of chronic bladder outlet obstruction (due to high intravesical pressure and stasis) rather than the primary cause of Marion’s disease itself. **Clinical Pearls for NEET-PG:** * **Presentation:** Patients present with obstructive voiding symptoms (hesitancy, weak stream, straining) despite a normal-sized prostate on digital rectal examination (DRE). * **Diagnosis:** The gold standard is **Video-Urodynamics (VUDS)**, which shows high voiding pressures associated with poor opening of the bladder neck. * **Cystoscopy:** Often reveals a "high" or "elevated" bladder neck and secondary changes like trabeculations. * **Management:** Alpha-blockers are the first-line medical therapy. If refractory, **Transurethral Incision of the Bladder Neck (TUIBN)** is the surgical treatment of choice.

Q: All of the following are complications of an undescended testis EXCEPT?

Hydrocoele. **Explanation:** The correct answer is **B. Hydrocoele**. In an undescended testis (cryptorchidism), the testis is located along the normal path of descent but fails to reach the scrotum. While it is frequently associated with a **patent processus vaginalis (PPV)**, which leads to an **indirect inguinal hernia**, a simple hydrocoele is not considered a direct complication of the malposition itself. Hydrocoeles are more commonly associated with a normally descended testis where the processus vaginalis fails to obliterate or where there is an imbalance in fluid production/absorption. **Analysis of other options:** * **Torsion (A):** Undescended testes are at a significantly higher risk of torsion (often due to increased mobility or associated mesenteric abnormalities). Torsion in an inguinal testis can present as an empty scrotum with an exquisitely tender inguinal lump. * **Trauma (C):** When the testis is located in the inguinal canal, it is prone to trauma as it can be compressed against the pubic bone or inguinal ligaments, unlike the mobile scrotum which provides a cushioning effect. * **Malignant change (D):** This is the most dreaded complication. The risk of testicular cancer (most commonly **Seminoma**) is 4–10 times higher in undescended testes compared to the general population. Orchiopexy does not eliminate the risk but makes the testis accessible for clinical examination. **NEET-PG High-Yield Pearls:** * **Most common site:** Inguinal canal. * **Most common complication:** Indirect Inguinal Hernia (due to PPV). * **Most common malignancy:** Seminoma (overall); however, if it occurs in an abdominal testis, the risk of malignancy is even higher. * **Ideal age for surgery:** Orchiopexy should ideally be performed between **6 to 12 months** of age to preserve fertility and reduce malignancy risk.

Q: All of the following are indications of percutaneous nephrostomy, EXCEPT:

Ischemic renal failure. **Explanation:** Percutaneous Nephrostomy (PCN) is an interventional radiological procedure used primarily to provide external drainage of an obstructed collecting system or to gain access to the upper urinary tract for therapeutic maneuvers. **Why "Ischemic Renal Failure" is the correct answer:** Ischemic renal failure (a form of Acute Tubular Necrosis) is a **parenchymal/intrinsic** cause of renal failure. It results from decreased perfusion or cellular damage to the nephrons, not from a mechanical blockage of urine flow. Since PCN is designed to bypass **post-renal (obstructive)** pathology, it has no role in managing intrinsic ischemic damage. **Analysis of Incorrect Options:** * **Stone Removal:** PCN is the standard initial step for **Percutaneous Nephrolithotomy (PCNL)**, providing the tract necessary to fragment and remove large or complex staghorn calculi. * **Anterograde Renography:** When retrograde access fails, PCN allows for the injection of contrast or radiopharmaceuticals directly into the pelvis to assess anatomy and drainage (Anterograde Pyelography/Renography). * **Renal Tubular Obstruction:** While PCN primarily treats pelvic/ureteric obstruction, it is indicated in any scenario where there is a "distal" blockage causing high-pressure backflow (hydronephrosis) to preserve nephron function. **High-Yield Clinical Pearls for NEET-PG:** * **Most common indication:** Obstructive uropathy with associated infection (Pyonephrosis) or azotemia. * **Absolute Contraindication:** Uncorrected coagulopathy (due to the high vascularity of the kidney). * **Anatomical Landmark:** The needle is typically inserted through **Brodel’s line** (the relatively avascular plane on the lateral border of the kidney) to minimize hemorrhage. * **Urgency:** In the presence of fever and obstruction (Pyonephrosis), PCN is an emergency procedure.

Q: What scoring system is used to grade the symptoms of Benign Prostatic Hyperplasia (BPH)?

International Prostate Symptom Score (IPSS). The **International Prostate Symptom Score (IPSS)** is the gold-standard diagnostic tool used to assess the severity of Lower Urinary Tract Symptoms (LUTS) in patients with Benign Prostatic Hyperplasia (BPH). ### **Explanation of Options** * **Correct Answer (B):** The IPSS is based on the American Urological Association (AUA) symptom index. It consists of **7 questions** related to voiding symptoms (Incomplete emptying, Frequency, Intermittency, Urgency, Weak stream, Hesitancy, and Nocturia) and **1 question** regarding the patient’s Quality of Life (QoL). * **Mild:** 0–7 points * **Moderate:** 8–19 points * **Severe:** 20–35 points * **Option A:** The **Gleason Score** is used for the histological grading of **Prostate Adenocarcinoma**, not for symptom assessment in BPH. It evaluates the glandular architecture to determine the aggressiveness of the cancer. * **Option C:** **SBPH** is not a standard medical scoring system; it is a distractor. ### **Clinical Pearls for NEET-PG** * **Medical Management:** Alpha-blockers (e.g., Tamsulosin) are the first-line treatment for moderate symptoms. 5-alpha reductase inhibitors (e.g., Finasteride) are added if the prostate volume is >30–40 cc. * **Surgical Threshold:** Surgery (TURP) is generally indicated if the IPSS is **>19 (Severe)** or if complications occur (refractory retention, bladder stones, recurrent UTIs, or hematuria). * **IPSS Limitation:** It is a subjective score used for symptom severity and monitoring treatment response; it does **not** correlate directly with the size of the prostate or the degree of obstruction.

Q: What fluid is typically used during Transurethral Resection of the Prostate (TURP)?

Glycine. **Explanation:** The primary goal of irrigation fluid during **Transurethral Resection of the Prostate (TURP)** is to maintain a clear surgical field by washing away blood and debris while distending the prostatic urethra. **Why Glycine is the Correct Answer:** Glycine (1.5%) is a non-electrolytic, non-hemolytic, and transparent solution. Because TURP involves the use of **monopolar electrocautery**, the irrigation fluid must be **non-conductive**. If a conductive fluid (like Normal Saline) were used, the electrical current would dissipate into the fluid rather than cutting the tissue. Glycine provides excellent visibility and safety for monopolar cautery. **Analysis of Incorrect Options:** * **Normal Saline (NS):** Being an isotonic electrolyte solution, it is highly conductive. It is avoided in conventional monopolar TURP but is the fluid of choice for **Bipolar TURP**, which allows for safer resection and reduces the risk of TURP syndrome. * **Hemaccel:** This is a plasma expander used for volume replacement in shock; it is not used as a surgical irrigant. * **Methylcellulose:** This is a viscoelastic agent used primarily in ophthalmic surgeries (e.g., cataract surgery) to maintain anterior chamber depth, not for urological irrigation. **High-Yield Clinical Pearls for NEET-PG:** * **TURP Syndrome:** Caused by the systemic absorption of large volumes of Glycine. It presents with **dilutional hyponatremia**, confusion, visual disturbances (due to glycine’s role as an inhibitory neurotransmitter in the retina), and fluid overload. * **Ideal Irrigant Properties:** Isotonic, non-conductive, non-hemolytic, and transparent. * **Other Options:** Sorbitol and Mannitol can also be used, but Glycine is the most common. * **Bipolar TURP:** The "Gold Standard" for preventing TURP syndrome because it allows the use of **Normal Saline**.

Q: What is the best treatment modality for squamous cell carcinoma (SCC) of the bladder?

Radical cystectomy. **Explanation:** **Squamous Cell Carcinoma (SCC)** of the bladder is the second most common histological type of bladder cancer globally, though it is highly prevalent in regions where *Schistosoma haematobium* is endemic. Unlike the more common Urothelial (Transitional Cell) Carcinoma, SCC of the bladder is characterized by its aggressive local behavior and poor response to non-surgical treatments. **Why Radical Cystectomy is the Correct Answer:** Radical cystectomy with urinary diversion is the **gold standard and treatment of choice** for SCC of the bladder. This is because SCC typically presents at an advanced stage, is deeply invasive into the bladder wall at the time of diagnosis, and is notoriously **chemoresistant and radioresistant**. Surgical extirpation offers the only realistic chance for long-term survival and local disease control. **Why Other Options are Incorrect:** * **Chemotherapy (A) & Radiotherapy (B):** SCC of the bladder shows a very poor response to standard cisplatin-based chemotherapy and conventional radiation. These are generally reserved for palliative intent or as part of experimental protocols, but they are never the primary treatment of choice. * **TURBT (D):** While TURBT is essential for the initial diagnosis and staging (biopsy), it is insufficient as a definitive treatment for SCC because these tumors are almost always muscle-invasive at presentation. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factors:** Chronic irritation is the key. Think of **Schistosomiasis** (most common cause worldwide), long-term indwelling catheters, and chronic bladder stones. * **Pathology:** Look for "keratin pearls" and intercellular bridges on histology. * **Prognosis:** Generally poorer than urothelial carcinoma because it is usually diagnosed at a higher stage (T3 or T4). * **Key Association:** In India, non-schistosomal SCC is often associated with chronic cystitis and bladder calculi.

Q: Which of the following is NOT a complication of urethral stricture?

Papilloma of the bladder. **Explanation:** Urethral stricture is a narrowing of the urethra caused by scarring, leading to **bladder outlet obstruction (BOO)**. The complications of stricture arise from chronic high-pressure voiding and urinary stasis. **Why Papilloma of the bladder is the correct answer:** A papilloma is a neoplastic growth (benign tumor). While chronic irritation from stones or infections (common in strictures) can predispose to Squamous Cell Carcinoma, a **Papilloma** is not a direct complication of the mechanical obstruction or the resulting stasis caused by a stricture. **Analysis of Incorrect Options:** * **Periurethral abscess:** High voiding pressure can cause infected urine to extravasate into the periurethral glands or through small mucosal tears, leading to abscess formation and potentially "Watering Can Perineum." * **Inguinal hernia:** To overcome the resistance of the stricture, patients must use the abdominal muscle pump (Valsalva maneuver) to void. This chronic increase in intra-abdominal pressure weakens the inguinal canal, leading to hernias. * **Hydronephrosis:** Chronic obstruction leads to increased intravesical pressure, causing bladder wall hypertrophy, trabeculations, and eventually vesicoureteral reflux or ureteric obstruction, resulting in bilateral hydroureteronephrosis and potential renal failure. **NEET-PG High-Yield Pearls:** * **Most common site:** Bulbar urethra (especially post-inflammatory/gonococcal). * **Most common cause (Overall):** Idiopathic or Iatrogenic (e.g., prolonged catheterization, TURP). * **Gold Standard Investigation:** Retrograde Urethrogram (RGU) to define the site and length; Micturating Cystourethrogram (MCU) to see the proximal extent. * **Watering Can Perineum:** A classic complication where multiple fistulae form in the perineum due to neglected periurethral abscesses.

Question 1

All of the following can be seen in hypernephroma, except:

Accepted Answer

None of the above

Answer

Polycythemia

Answer

Renal vein thrombosis

Answer

Hypertension

Question 2

Which of the following statements about testicular seminoma is FALSE?

Accepted Answer

Pure seminoma is generally less aggressive than non-seminoma.

Answer

Seminoma is radiosensitive.

Answer

Seminoma can be treated with orchidectomy and radiotherapy.

Answer

Seminoma commonly spreads through lymphatics.

Question 3

What is the most important prognostic factor in a case of penile carcinoma?

Accepted Answer

Lymph node metastasis

Answer

Tumor size <2 cm

Answer

Involvement of connective tissue

Answer

Distant metastasis

Question 4

Marion's disease is due to which of the following?

Accepted Answer

Muscular hypertrophy of the internal sphincter of the urinary bladder

Answer

Fibrosis of the neck of the bladder

Answer

Vesicular diverticula

Answer

Vesicular calculi

Question 5

All of the following are complications of an undescended testis EXCEPT?

Accepted Answer

Hydrocoele

Answer

Torsion

Answer

Trauma

Answer

Malignant change

Question 6

All of the following are indications of percutaneous nephrostomy, EXCEPT:

Accepted Answer

Ischemic renal failure

Answer

Stone removal

Answer

Anterograde renography

Answer

Renal tubular obstruction

Question 7

What scoring system is used to grade the symptoms of Benign Prostatic Hyperplasia (BPH)?

Accepted Answer

International Prostate Symptom Score (IPSS)

Answer

Gleason score

Answer

Symptom Score for Benign Prostatic Hyperplasia (SBPH) score

Answer

None of the above

Question 8

What fluid is typically used during Transurethral Resection of the Prostate (TURP)?

Accepted Answer

Glycine

Answer

Normal Saline (NS)

Answer

Hemaccel

Answer

Methylcellulose

Question 9

What is the best treatment modality for squamous cell carcinoma (SCC) of the bladder?

Accepted Answer

Radical cystectomy

Answer

Chemotherapy

Answer

Radiotherapy

Answer

Transurethral resection of bladder tumor (TURBT)

Question 10

Which of the following is NOT a complication of urethral stricture?

Accepted Answer

Papilloma of the bladder

Answer

Periurethral abscess

Answer

Inguinal hernia

Answer

Hydronephrosis

Urology — MCQs

Urology — MCQs

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