Urology Practice Questions

Q: What is the classic symptom of an ectopic ureter in females?

Ureteral incontinence with otherwise normal voiding. **Explanation:** The classic presentation of an ectopic ureter in females is **continuous dribbling of urine despite a normal voiding pattern**. This occurs because the ectopic ureter bypasses the external urethral sphincter, opening into sites such as the vestibule, vagina, or uterus. Since the bladder and its sphincter remain intact, the patient can store urine and void normally, but urine from the ectopic ureter constantly leaks out. **Why the other options are incorrect:** * **Painful defecation:** This is typically associated with proctitis, anal fissures, or endometriosis, not urinary tract malformations. * **Urinary frequency:** While common in UTIs or overactive bladder, it is not the pathognomonic sign of an ectopic ureter. * **Labial swelling:** This may suggest a Bartholin’s cyst or inguinal hernia. While an ectopic ureter can open near the labia, it causes wetness rather than a distinct swelling. **High-Yield Clinical Pearls for NEET-PG:** * **Embryology:** Ectopic ureters are more common in females and are frequently associated with a **duplicated collecting system** (Weigert-Meyer Law: the ureter from the upper pole is the one that is ectopic and prone to obstruction). * **Male Presentation:** In males, ectopic ureters always enter the urinary system **above the external sphincter** (e.g., prostatic urethra, seminal vesicles). Therefore, males present with UTIs or epididymitis but **never** with incontinence. * **Diagnosis:** The investigation of choice is often a Contrast-Enhanced CT (CECT) or an IVP to visualize the anatomy. * **Key Distinction:** If a child is "never dry" but can still "void normally," think Ectopic Ureter.

Q: The triad of renal colic, swelling in the loin which disappears after passing urine, is called which of the following?

Dietel’s crisis. **Explanation:** The correct answer is **Dietel’s crisis**. This clinical triad is a classic presentation of intermittent hydronephrosis, most commonly caused by **Ureteropelvic Junction (UPJ) obstruction** (often due to an aberrant polar renal artery). The pathophysiology involves a kink or compression of the ureter that leads to acute obstruction. This causes: 1. **Renal Colic:** Severe loin pain due to sudden distension of the renal capsule. 2. **Loin Swelling:** A palpable mass formed by the acutely hydronephrotic kidney. 3. **Polyuria/Disappearance of Swelling:** Once the obstruction is relieved (often by a change in posture), a large volume of urine passes, and the palpable mass subsides. **Analysis of Incorrect Options:** * **Borchardt’s Triad:** Associated with **Acute Gastric Volvulus**. It consists of epigastric pain/distension, inability to vomit, and inability to pass a nasogastric tube. * **Beck’s Triad:** Associated with **Cardiac Tamponade**. It consists of hypotension, muffled heart sounds, and raised JVP (distended neck veins). * **Stauffer’s Syndrome:** (Often confused with "Stuffer's") This is a paraneoplastic syndrome associated with **Renal Cell Carcinoma (RCC)**, characterized by hepatic dysfunction (elevated LFTs) in the absence of liver metastases. **High-Yield Facts for NEET-PG:** * **Dietel’s Crisis** is most frequently seen in "floating kidneys" (nephroptosis) or UPJ obstruction. * The gold standard investigation for UPJ obstruction is a **DTPA scan** (with Lasix) to assess the drainage pattern. * The surgical treatment of choice for symptomatic UPJ obstruction is **Anderson-Hynes Dismembered Pyeloplasty**.

Q: In a child with acute scrotal pain and swelling where testicular torsion is highly suspected, how would you proceed?

Immediate scrotal exploration on both sides. **Explanation:** **1. Why Option C is Correct:** Testicular torsion is a surgical emergency where the "golden period" for salvage is within **6 hours**. The underlying anatomical defect is typically the **"Bell-clapper deformity"** (high investment of the tunica vaginalis), which allows the testis to rotate freely. Crucially, this anatomical predisposition is almost always **bilateral**. Therefore, when one side undergoes torsion, the contralateral side is at high risk for a future event. Immediate exploration of both sides is mandatory: the affected side is detorsed and fixed (orchidopexy), and the unaffected side is fixed prophylactically to prevent future torsion. **2. Why Other Options are Incorrect:** * **Option A & B:** These are inadequate because they leave the contralateral testis at risk. Since the anatomical defect is bilateral, "delayed" or "no" exploration of the normal side invites a secondary emergency that could lead to bilateral testicular loss and infertility. * **Option D:** Observation is contraindicated. Torsion is a clinical diagnosis. If suspected, one should not even wait for a Doppler ultrasound if it delays surgery, as ischemia leads to irreversible necrosis within hours. **3. Clinical Pearls for NEET-PG:** * **Diagnosis:** Primarily clinical. Look for a high-riding testis with a horizontal lie and a **negative Prehn’s sign** (pain is not relieved by lifting the scrotum). * **Reflex:** The **Cremasteric reflex is absent** in torsion (High specificity). * **Golden Period:** Best salvage rate (<90%) if operated within 6 hours; drops to <10% after 24 hours. * **Surgical Procedure:** Orchidopexy is performed using non-absorbable sutures (e.g., Prolene). If the testis is gangrenous, orchidectomy is performed, but the contralateral side **must still be fixed.**

Q: Transurethral resection (T.U.R.) syndrome is due to which of the following electrolyte disturbances?

Hyponatremia. **Explanation:** **TUR Syndrome** is a life-threatening complication occurring during Transurethral Resection of the Prostate (TURP) due to the systemic absorption of large volumes of non-conductive irrigation fluid (commonly 1.5% Glycine) through opened prostatic venous sinuses. **Why Hyponatremia is correct:** The primary mechanism is **dilutional hyponatremia**. As the irrigation fluid enters the circulation, it expands the intravascular volume and dilutes the serum sodium levels. If Glycine is used, its metabolism into ammonia can further cause neurotoxicity. Clinical features include confusion, seizures, visual disturbances, and bradycardia. **Why the other options are incorrect:** * **Hypokalemia:** While electrolyte shifts occur, potassium levels are generally stable or may even increase (hyperkalemia) if significant hemolysis occurs. It is not the defining feature of TUR syndrome. * **Hypovolemia:** TUR syndrome actually causes **hypervolemia** (fluid overload) due to massive absorption of irrigation fluid, potentially leading to pulmonary edema and hypertension. * **Hypoxia:** While hypoxia can occur secondary to pulmonary edema, it is a late-stage complication rather than the primary electrolyte disturbance. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal Irrigation Fluid:** Normal Saline is preferred to avoid TUR syndrome, but it can only be used with **Bipolar Cautery**. * **Classic Triad:** Hypertension (early), Bradycardia, and altered mental status. * **Management:** Stop the procedure, administer diuretics (Furosemide), and in severe symptomatic cases (Na <120 mEq/L), use **3% Hypertonic Saline** at a controlled rate to avoid Central Pontine Myelinolysis.

Q: Which of the following is false regarding hypernephroma?

Radiosensitive. **Explanation:** Hypernephroma, now more commonly known as **Renal Cell Carcinoma (RCC)**, is the most common primary malignancy of the kidney. **1. Why Option A is the correct (False) statement:** Renal Cell Carcinoma is notoriously **radioresistant**. Radiotherapy is not used as a primary treatment for the tumor itself. Its role in RCC is limited strictly to **palliative care**, such as managing pain from bone metastases or controlling symptoms in brain metastases. The primary definitive treatment for localized RCC remains surgical (Partial or Radical Nephrectomy). **2. Analysis of other options:** * **Option B (Origin):** RCC arises from the renal cortex, specifically the **proximal convoluted tubule (PCT)** epithelium. While most cases are sporadic, some are believed to arise from pre-existing renal adenomas (the "adenoma-carcinoma sequence"). * **Option C (Varicocele):** A classic clinical sign of RCC is a **left-sided varicocele** that does not disappear on lying down. This occurs because the left gonadal vein drains into the left renal vein; a tumor thrombus obstructing the renal vein causes retrograde pressure, leading to rapid varicocele formation. * **Option D (Pathology):** Histologically, over 80-90% of hypernephromas are **adenocarcinomas**, with the "Clear Cell" subtype being the most common. **Clinical Pearls for NEET-PG:** * **Classic Triad:** Hematuria (most common), flank pain, and palpable mass (seen in only 10% of cases). * **Paraneoplastic Syndromes:** RCC is the "Internist’s Tumor" because it secretes hormones leading to polycythemia (EPO), hypercalcemia (PTHrP), and hypertension (Renin). * **Stauffer Syndrome:** Reversible hepatic dysfunction (elevated LFTs) in the absence of liver metastases. * **Chemotherapy:** RCC is also largely chemoresistant; management of metastatic disease involves targeted therapy (Tyrosine Kinase Inhibitors like Sunitinib) or Immunotherapy.

Question 1

What is the classic symptom of an ectopic ureter in females?

Accepted Answer

Ureteral incontinence with otherwise normal voiding

Answer

Painful defecation

Answer

Urinary frequency

Answer

Labial swelling

Question 2

The triad of renal colic, swelling in the loin which disappears after passing urine, is called which of the following?

Accepted Answer

Dietel’s crisis

Answer

Borchardt’s triad

Answer

Beck’s triad

Answer

Stuffer’s triad

Question 3

In a child with acute scrotal pain and swelling where testicular torsion is highly suspected, how would you proceed?

Accepted Answer

Immediate scrotal exploration on both sides

Answer

Immediate scrotal exploration only on the side of swelling

Answer

Immediate scrotal exploration on the same side and delayed exploration on the other side

Answer

Observation

Question 4

Which of the following statements is not true regarding hydrocele?

Accepted Answer

It is not possible to get above the swelling on examination of the scrotum.

Answer

It is an abnormal collection of serous fluid within the tunica vaginalis.

Answer

Vaginal hydrocele is associated with 5% of inguinal hernias.

Answer

In a congenital hydrocele, the processus vaginalis is patent and connects to the peritoneal cavity.

Question 5

A 51-year-old man with a history of passing stones in urine presents with excruciating flank pain and hematuria. Imaging reveals staghorn calculi occupying the right renal pelvis. Which of the following underlying disorders is most likely responsible?

Accepted Answer

Chronic Proteus infection

Answer

Anemia of chronic disease

Answer

Hyperparathyroidism

Answer

Hyperaldosteronism

Question 6

A 55-year-old male presented with painless terminal hematuria. Cystoscopic examination revealed a solitary papillary tumor. Histopathological examination of the completely resected tumor is suggestive of grade III transitional cell carcinoma with no muscle invasion. What is the next best step in management?

Accepted Answer

Intravesical BCG

Answer

Follow up

Answer

Cystectomy

Answer

Intravesical chemotherapy

Question 7

Transurethral resection (T.U.R.) syndrome is due to which of the following electrolyte disturbances?

Accepted Answer

Hyponatremia

Answer

Hypokalemia

Answer

Hypovolemia

Answer

Hypoxia

Question 8

Orchidopexy in an undescended testes decreases all except?

Accepted Answer

Tumour incidence

Answer

Epididymoorchitis

Answer

Torsion

Answer

Avoid sexual ambiguity

Question 9

A 20-year-old man suffers an injury to the posterior urethra. What is the most likely late complication after appropriate initial management and follow-up care of this injury?

Accepted Answer

Urethral stricture

Answer

Ascending urinary tract infection

Answer

Retrograde ejaculation

Answer

Sterility

Question 10

Which of the following is false regarding hypernephroma?

Accepted Answer

Radiosensitive

Answer

Arises from coex, usually from pre-existing adenoma

Answer

May present with a rapidly developing varicocele

Answer

Usually adenocarcinoma

Urology — MCQs

Urology — MCQs

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