Urology Practice Questions

Q: An 18-year-old boy presents with groin pain for 2 days. On examination, the testis is high-lying and the cremasteric reflex is absent. Elevation of the testis worsens the pain. What is the probable diagnosis?

Right testicular torsion. **Explanation:** The clinical presentation of acute groin pain in an adolescent, combined with specific physical findings, points directly to **Testicular Torsion**. **Why the correct answer is right:** Testicular torsion is a surgical emergency caused by the twisting of the spermatic cord. * **High-lying testis:** The twisting causes shortening of the cord, pulling the testis upward (Angel’s sign). * **Absent Cremasteric Reflex:** This is the most sensitive physical finding for torsion; its presence almost always rules it out. * **Negative Prehn’s Sign:** Elevation of the testis worsens or does not relieve the pain in torsion (Positive Prehn's sign, where pain is relieved, is characteristic of epididymitis). **Why the incorrect options are wrong:** * **Epididymo-orchitis:** Usually presents with fever and pyuria. Crucially, Prehn’s sign is positive (pain relief on elevation) and the cremasteric reflex is typically preserved. * **Strangulated Hernia:** While it causes acute pain, it usually presents with a tense, tender, irreducible swelling in the inguinal canal and features of intestinal obstruction (vomiting, constipation), rather than isolated testicular displacement. * **Inguinal Hernia:** An uncomplicated hernia presents as a reducible swelling with a cough impulse and is generally not associated with acute, severe pain or an absent cremasteric reflex. **NEET-PG High-Yield Pearls:** * **Golden Period:** Detorsion must occur within **6 hours** to ensure a 90-100% salvage rate. * **Bell-Clapper Deformity:** The most common predisposing anatomical factor (high tunica vaginalis attachment). * **Investigation of Choice:** Color Doppler Ultrasound (shows decreased or absent blood flow). * **Management:** Immediate surgical exploration and **bilateral orchidopexy** (fixation), as the anatomical defect is usually bilateral.

Q: What is true about varicocele?

Can cause oligospermia. **Explanation:** A varicocele is the abnormal dilation and tortuosity of the pampiniform plexus of veins within the spermatic cord. It is the most common reversible cause of male infertility. **Why Option B is correct:** Varicoceles lead to **oligospermia** (low sperm count) and decreased sperm motility. The underlying pathophysiology involves the reflux of warm venous blood from the abdomen, which increases the intratesticular temperature. This thermal stress impairs spermatogenesis, as the testes require a temperature approximately 2°C lower than the core body temperature to function optimally. **Analysis of Incorrect Options:** * **Option A:** Varicoceles are significantly **more common on the left side (90%)**. This is due to the left testicular vein being longer, entering the left renal vein at a right angle (increasing hydrostatic pressure), and potentially being compressed between the SMA and Aorta ("Nutcracker effect"). A **solitary right-sided varicocele** is a red flag and necessitates imaging to rule out a retroperitoneal tumor (e.g., RCC). * **Option C:** Varicoceles typically **increase in size/prominence during the Valsalva maneuver** or upon standing, as these actions increase intra-abdominal pressure and venous reflux. * **Option D:** Anatomically, a varicocele is located **superior and posterior** to the testis, often described as a "bag of worms" feeling within the scrotum. **High-Yield Clinical Pearls for NEET-PG:** * **Grading:** Grade I (Palpable only with Valsalva), Grade II (Palpable without Valsalva), Grade III (Visible through scrotal skin). * **Surgical Indications:** Infertility with abnormal semen analysis, testicular atrophy, or severe pain. * **Gold Standard Treatment:** Microsurgical subinguinal varicocelectomy (lowest recurrence and complication rates).

Q: Which of the following is a type of stone seen in urinary tract infections?

Staghorn calculus. **Explanation:** The correct answer is **Staghorn calculus**. These stones are typically composed of **Struvite** (Magnesium Ammonium Phosphate) and are classically associated with chronic urinary tract infections (UTIs) caused by **urease-producing organisms** (e.g., *Proteus mirabilis*, *Klebsiella*, *Pseudomonas*). **Mechanism:** Urease-producing bacteria hydrolyze urea into ammonia, which increases urinary pH (alkaline urine). In this alkaline environment, phosphate solubility decreases, leading to the precipitation of struvite and carbonate apatite crystals. These stones grow rapidly and fill the renal pelvis and calyces, taking on the characteristic "staghorn" shape. **Analysis of Incorrect Options:** * **A. Calcium oxalate:** The most common type of renal stone overall. They are typically associated with metabolic factors (hypercalciuria, hyperoxaluria) rather than infection. * **B. Uric acid stones:** These form in **acidic urine** (pH < 5.5). They are radiolucent on X-ray and are associated with gout or high cell turnover states. * **D. Cysteine stones:** Caused by an autosomal recessive defect in the transport of dibasic amino acids (COLA: Cysteine, Ornithine, Lysine, Arginine). They are "hexagonal" on microscopy and not infection-induced. **High-Yield Clinical Pearls for NEET-PG:** * **Composition:** Struvite stones are also called "Triple Phosphate" stones. * **Microscopy:** They exhibit a characteristic **"Coffin-lid"** appearance. * **Radiology:** While the stone itself is radiopaque, it is less dense than calcium oxalate. * **Treatment:** Complete surgical removal (usually via PCNL) is necessary because the stone acts as a reservoir for bacteria, leading to recurrent sepsis.

Q: A patient with pelvic fracture presents with suprapubic pain, difficulty in passing urine, and hematuria. Cystography reveals findings suggestive of bladder injury. What are the indications for surgical repair of a bladder injury?

All of the above. Bladder injuries are broadly classified into **extraperitoneal (60-85%)** and **intraperitoneal (15-40%)**. While most uncomplicated extraperitoneal ruptures can be managed conservatively with catheter drainage, specific complications necessitate surgical intervention. **Explanation of Options:** * **A. Repeated blockage of the urinary catheter:** Persistent hematuria with clot formation can lead to catheter obstruction. If the bladder cannot be effectively drained, it remains distended, preventing the wound edges from apposing and healing, thus requiring surgical evacuation and repair. * **B. Projecting bone fragment:** In pelvic fractures, a sharp spicule of bone may penetrate or remain embedded in the bladder wall. This prevents spontaneous closure and carries a high risk of persistent leakage or infection if not surgically addressed. * **C. Tear extending to the bladder neck:** The bladder neck contains the internal sphincter mechanism. Injuries here rarely heal spontaneously with a catheter and often lead to future incontinence or strictures if not precisely repaired. **Why "All of the above" is correct:** Each of these scenarios represents a "complicated" extraperitoneal injury. Other mandatory indications for surgery include **intraperitoneal rupture** (due to risk of peritonitis), concomitant rectal/vaginal injury, or when the patient is already undergoing laparotomy for other pelvic injuries. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Retrograde Cystography (showing "flame-shaped" extravasation in extraperitoneal and "bowel loop outlining" in intraperitoneal tears). * **Management Rule:** Intraperitoneal = **Always Surgery**; Extraperitoneal = **Catheter first** (unless complicated). * **Associated Fracture:** Bladder rupture is most commonly associated with **pubic symphysis diastasis** or rami fractures.

Q: Which hormone is NOT given for palliative care of carcinoma of the prostate?

Progesterone. **Explanation:** The primary objective in the palliative management of advanced or metastatic **Carcinoma of the Prostate** is **Androgen Deprivation Therapy (ADT)**. Since prostate cancer cells are typically androgen-dependent, reducing testosterone levels to "castrate levels" (<50 ng/dL) inhibits tumor growth. **Why Progesterone is the correct answer:** Progesterone (Option B) has no established role in the standard hormonal manipulation of prostate cancer. While some progestational agents (like Cyproterone acetate) have antiandrogenic properties, pure progesterone itself does not effectively lower serum testosterone or block androgen receptors in a clinical setting for palliative care. **Analysis of incorrect options:** * **Estrogens (Option A):** Historically, Diethylstilbestrol (DES) was used to suppress the hypothalamic-pituitary-gonadal axis via negative feedback, reducing LH and testosterone. Its use has declined due to cardiovascular side effects (thromboembolism). * **LHRH Agonists/Antagonists (Option C):** These are the current "gold standard" for medical castration. Agonists (e.g., Leuprolide, Goserelin) initially cause a testosterone flare followed by downregulation of receptors, while Antagonists (e.g., Degarelix) cause an immediate drop in testosterone. * **Antiandrogens (Option D):** These drugs (e.g., Flutamide, Bicalutamide, Enzalutamide) compete with dihydrotestosterone (DHT) for the androgen receptor, preventing the tumor from utilizing circulating androgens. **High-Yield Clinical Pearls for NEET-PG:** * **Combined Androgen Blockade (CAB):** Refers to the use of an LHRH agonist plus an antiandrogen to prevent the "testosterone flare" phenomenon. * **Orchidectomy:** Bilateral subcapsular orchidectomy is the surgical gold standard for rapid androgen deprivation. * **Castration-Resistant Prostate Cancer (CRPC):** Defined as disease progression despite testosterone levels being at castrate levels (<50 ng/dL).

Q: What is the commonest presentation of bilateral ureteric stones?

Pain. **Explanation:** **1. Why Pain is the Correct Answer:** Pain is the most common presenting symptom of ureteric calculi, whether unilateral or bilateral. The pain is typically described as **ureteric colic**—a sudden, severe, spasmodic pain originating in the loin and radiating to the groin. This occurs due to the sudden increase in intraluminal pressure and hyperperistalsis of the ureteric smooth muscle in an attempt to bypass the obstruction. Even in bilateral cases, it is rare for both ureters to obstruct simultaneously and silently; patients usually present due to the acute distress caused by the colic. **2. Why Other Options are Incorrect:** * **Chronic Renal Failure (CRF):** While bilateral obstruction can lead to post-renal azotemia and eventually renal failure if left untreated, it is usually a late consequence rather than the initial "presentation." * **Urinary Tract Infection (UTI):** Stasis of urine due to stones predisposes a patient to infection (pyelonephritis or pyonephrosis), but this is a secondary complication. * **Hematuria:** This is a very common associated sign (found in ~90% of cases on microscopy), but it is rarely the primary reason a patient seeks medical attention compared to the agonizing nature of the pain. **3. Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Non-contrast Computed Tomography (NCCT) KUB is the investigation of choice for ureteric stones. * **Narrowest Point:** The most common site for a stone to impact is the **Vesicoureteric Junction (VUJ)**, which is the narrowest part of the ureter. * **Management:** Stones <5 mm usually pass spontaneously. For bilateral obstructing stones with rising creatinine, the priority is urgent decompression via **DJ stenting** or percutaneous nephrostomy (PCN).

Q: Polycystic kidney disease is associated with all of the following except?

Renal cell carcinoma. **Explanation:** Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a systemic multisystem disorder characterized by the development of cysts in the renal parenchyma and various extra-renal manifestations. **Why Renal Cell Carcinoma (RCC) is the correct answer:** While patients with ADPKD who are on long-term dialysis have an increased risk of developing **Acquired Cystic Kidney Disease (ACKD)**—which itself carries a higher risk of RCC—the ADPKD condition **per se** is not considered a direct premalignant condition for Renal Cell Carcinoma. The incidence of RCC in ADPKD patients is roughly the same as in the general population. **Analysis of Incorrect Options:** * **Cerebral Aneurysms (Option A):** Approximately 5-10% of ADPKD patients develop intracranial "berry" aneurysms, particularly in the Circle of Willis. Rupture leading to subarachnoid hemorrhage is a major cause of morbidity. * **Mitral Valve Prolapse (Option B):** Cardiovascular involvement is common. MVP occurs in up to 25% of patients. Other associations include aortic root dilatation and left ventricular hypertrophy. * **Hepatic Cysts (Option D):** This is the most common extra-renal manifestation of ADPKD (occurring in ~70% of patients). While they rarely cause liver failure, they can cause symptomatic hepatomegaly. **NEET-PG High-Yield Pearls:** * **Genetics:** Most common mutation is **PKD1** (Chromosome 16), which is more severe; **PKD2** (Chromosome 4) has a slower progression. * **Extra-renal manifestations mnemonic (BARBS):** **B**erry aneurysms, **A**bdominal/Inguinal hernias, **R**enal cysts, **B**iliary/Hepatic cysts, **S**plenic cysts/ **S**ystolic murmurs (MVP). * **Diverticulosis:** ADPKD patients have an increased incidence of colonic diverticula. * **Screening:** Family members are screened primarily via **Ultrasonography**.

Q: Which one of the following is not an intravesical chemotherapeutic agent?

BCG. The question asks to identify which agent is **not** a chemotherapeutic agent. The key to answering this correctly lies in distinguishing between **chemotherapy** and **immunotherapy** in the management of Non-Muscle Invasive Bladder Cancer (NMIBC). ### **Explanation of the Correct Answer** * **BCG (Bacillus Calmette-Guérin):** While BCG is administered intravesically, it is a live-attenuated strain of *Mycobacterium bovis*. It acts as an **immunotherapeutic agent**, not a cytotoxic chemical. It works by inducing a local immune response (granulomatous reaction) that recruits T-lymphocytes and natural killer cells to destroy tumor cells. It is the gold standard for high-risk NMIBC and CIS (Carcinoma in situ). ### **Explanation of Incorrect Options** * **Mitomycin C (Option A):** An alkylating agent that inhibits DNA synthesis. It is the most commonly used intravesical **chemotherapeutic** agent, often given as a single immediate post-operative dose to prevent tumor cell implantation. * **Epirubicin (Option C):** An anthracycline antibiotic that acts as a cytotoxic **chemotherapeutic** agent by intercalating DNA and inhibiting Topoisomerase II. * **Thiotepa (Option D):** An ethylenimine-type alkylating **chemotherapeutic** agent. Though historically popular, its use has declined due to the risk of systemic absorption leading to myelosuppression (bone marrow toxicity). ### **NEET-PG High-Yield Pearls** * **Immediate Post-op Dose:** A single dose of intravesical chemotherapy (usually Mitomycin C) should be given within **6 hours** of TURBT to reduce recurrence. * **BCG Contraindications:** Active TB, gross hematuria (risk of systemic BCG-osis), immunosuppression, and traumatic catheterization. * **Side Effects:** The most common side effect of intravesical chemotherapy is **chemical cystitis**, whereas BCG can cause systemic flu-like symptoms or "BCG-osis" (treated with antitubercular drugs).

Question 1

An 18-year-old boy presents with groin pain for 2 days. On examination, the testis is high-lying and the cremasteric reflex is absent. Elevation of the testis worsens the pain. What is the probable diagnosis?

Accepted Answer

Right testicular torsion

Answer

Right strangulated hernia

Answer

Right inguinal hernia

Answer

Right epididymo-orchitis

Question 2

What is true about varicocele?

Accepted Answer

Can cause oligospermia

Answer

More common on the right side

Answer

Has no effect on Valsalva maneuver

Answer

Lies anterior to the testis

Question 3

Which of the following is a type of stone seen in urinary tract infections?

Accepted Answer

Staghorn calculus

Answer

Calcium oxalate

Answer

Uric acid stones

Answer

Cysteine stones

Question 4

Peyronie's disease is characterized by which of the following?

Accepted Answer

Bowing of the penis during erection due to a fibrous plaque.

Answer

A curved deformity of the penis.

Answer

Ectopic opening of the urethra.

Answer

None of the above.

Question 5

A patient with pelvic fracture presents with suprapubic pain, difficulty in passing urine, and hematuria. Cystography reveals findings suggestive of bladder injury. What are the indications for surgical repair of a bladder injury?

Accepted Answer

All of the above

Answer

Repeated blockage of the urinary catheter due to bleeding

Answer

A projecting bone fragment impinging on the bladder wall

Answer

A tear extending to the bladder neck

Question 6

Which hormone is NOT given for palliative care of carcinoma of the prostate?

Accepted Answer

Progesterone

Answer

Estrogen

Answer

LHRH

Answer

Antiandrogens

Question 7

Which LASER can be used in the treatment of ureteric calculi?

Accepted Answer

Holmium laser

Answer

CO2 laser

Answer

Nd-Yag laser

Answer

All of the above

Question 8

What is the commonest presentation of bilateral ureteric stones?

Accepted Answer

Pain

Answer

Chronic renal failure

Answer

Urinary tract infection

Answer

Hematuria

Question 9

Polycystic kidney disease is associated with all of the following except?

Accepted Answer

Renal cell carcinoma

Answer

Cerebral aneurysms

Answer

Mitral valve prolapse

Answer

Hepatic cysts

Question 10

Which one of the following is not an intravesical chemotherapeutic agent?

Accepted Answer

BCG

Answer

Mitomycin C

Answer

Epirubicin

Answer

Thiotepa

Urology — MCQs

Urology — MCQs

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