Urology Practice Questions

Q: What procedure is shown in the ureter?

Dormia Basket. ***Dormia Basket*** - A **Dormia basket** is a wire mesh device used for **stone retrieval** from the ureter, appearing as a characteristic **basket-like radiopaque structure** on fluoroscopy. - The basket is deployed beyond the stone, then **withdrawn** to capture and extract the calculus under direct visualization. *Stenting* - **Ureteric stents** appear as **straight radiopaque tubes** extending from the renal pelvis to the bladder, not basket-shaped structures. - Used for **drainage** and **relief of obstruction** rather than stone extraction procedures. *Dilatation* - **Ureteric dilatation** involves **balloon catheters** that appear as **smooth, elongated structures** when inflated, not wire mesh patterns. - Used to **widen strictures** or **prepare the ureter** for other procedures, not for stone retrieval. *Cannulation* - **Ureteric cannulation** involves **thin catheters** appearing as **fine radiopaque lines** within the ureter. - Used for **contrast injection** during **retrograde pyelography** or **guidewire placement**, not stone extraction.

Q: All of the following are seen in cystitis EXCEPT:

Fever. **Explanation:** The correct answer is **Fever**. In clinical urology, it is crucial to differentiate between **Lower Urinary Tract Infections (UTIs)** and **Upper UTIs**. 1. **Why Fever is the correct answer:** Cystitis is a localized inflammation of the bladder mucosa (Lower UTI). Because it is a superficial mucosal infection without systemic involvement or tissue invasion, it typically **does not present with fever**. The presence of fever, chills, or flank pain in a patient with urinary symptoms strongly suggests **Acute Pyelonephritis** (Upper UTI) or systemic involvement like prostatitis. 2. **Analysis of incorrect options:** * **Dysuria:** This is the most common symptom of cystitis, caused by the irritation of the urethral and bladder neck mucosa during voiding. * **Nocturia & Frequency:** Inflammation reduces the functional capacity and compliance of the bladder, leading to an increased urge to void both day and night. * **Hematuria:** "Hemorrhagic cystitis" is common in bacterial infections where the friable, inflamed bladder mucosa bleeds easily. **NEET-PG High-Yield Pearls:** * **Triad of Cystitis:** Frequency, Urgency, and Dysuria. * **Most Common Organism:** *E. coli* (80-85% of cases). * **Gold Standard Diagnosis:** Urine culture (Significant bacteriuria is traditionally defined as $\geq 10^5$ CFU/mL). * **Sterile Pyuria:** If a patient has symptoms of cystitis but negative routine cultures, consider *Chlamydia trachomatis*, *Neisseria gonorrhoeae*, or Renal Tuberculosis. * **Treatment:** Uncomplicated cystitis is typically treated with Nitrofurantoin, Fosfomycin, or TMP-SMX.

Q: Epidermoid carcinoma of the renal pelvis is usually associated with:

Pelvic calculus. **Explanation:** Epidermoid carcinoma (Squamous Cell Carcinoma/SCC) of the renal pelvis is a rare but aggressive malignancy. The primary underlying mechanism is **chronic irritation**, which leads to squamous metaplasia of the urothelium, eventually progressing to dysplasia and carcinoma. * **Why Pelvic Calculus is Correct:** Long-standing **renal calculi** (specifically staghorn or pelvic stones) are the most common cause of chronic mechanical irritation and infection in the renal pelvis. Approximately 75–100% of patients with SCC of the renal pelvis have a history of chronic nephrolithiasis. * **Why Incorrect Options are Wrong:** * **Multiple Papillomas:** These are associated with **Transitional Cell Carcinoma (TCC)**, the most common type of renal pelvic tumor. TCC is often multifocal and associated with field defects. * **Tuberculosis of the Kidney:** While TB causes chronic inflammation, it typically leads to strictures, "putty kidney," or autonephrectomy rather than SCC. * **Filariasis:** This usually affects the lymphatic system, leading to chyluria or hydrocele, but is not a recognized risk factor for renal pelvic malignancy. **NEET-PG High-Yield Pearls:** 1. **Most common tumor** of the renal pelvis: **Transitional Cell Carcinoma (TCC)**. 2. **Most common risk factor** for SCC of the renal pelvis: **Chronic Calculi** (Stones). 3. **Schistosomiasis (S. haematobium)** is a major risk factor for SCC of the **Urinary Bladder**, not typically the renal pelvis. 4. SCC of the renal pelvis usually presents at an advanced stage and has a much poorer prognosis compared to TCC.

Q: A male patient presents with azoospermia. On examination, testicular size is normal, FSH is normal, and testosterone levels are normal. What is the most probable cause?

Vas obstruction. ### Explanation The clinical presentation of **azoospermia** (absence of sperm in the ejaculate) combined with **normal testicular size** and **normal hormonal profiles** (FSH, LH, and Testosterone) is the classic hallmark of **Obstructive Azoospermia**. **Why "Vas obstruction" is correct:** In obstructive azoospermia, the hypothalamic-pituitary-gonadal axis is intact, and spermatogenesis within the testes is functioning normally. Because the germinal epithelium is healthy, **FSH levels remain normal** (as Inhibin B production is not compromised). Since the Leydig cells are unaffected, **Testosterone** and testicular volume are also normal. The "blockage" is purely mechanical, occurring in the epididymis, vas deferens, or ejaculatory ducts. **Why the other options are incorrect:** * **Maldescended testis:** Usually leads to testicular atrophy and damage to the seminiferous tubules due to higher intra-abdominal temperatures, often resulting in elevated FSH and reduced testicular size. * **Klinefelter’s Syndrome (47,XXY):** This is a form of primary hypergonadotropic hypogonadism. It presents with **small, firm testes**, **elevated FSH/LH**, and low testosterone. * **Kallmann’s Syndrome:** This is hypogonadotropic hypogonadism. It presents with **low FSH/LH**, low testosterone, and prepubertal testicular volume (micropenis/small testes), often accompanied by anosmia. **High-Yield Clinical Pearls for NEET-PG:** * **FSH is the best marker for spermatogenesis:** Elevated FSH almost always indicates primary testicular failure (Non-obstructive azoospermia). * **Most common cause of Obstructive Azoospermia:** Post-inflammatory (e.g., post-gonorrheal) or Congenital Bilateral Absence of Vas Deferens (CBAVD), which is strongly associated with **Cystic Fibrosis (CFTR gene mutations)**. * **Management:** In obstructive cases, sperm can be retrieved directly from the testes/epididymis (TESA/MESA) for use in ICSI.

Q: A female patient presented with left iliac fossa pain for the past 6 months. On investigation, a 3 cm left renal pelvic stone was found with no hydroureteronephrosis, normal functioning kidneys on both sides, and no distal obstruction. What is the ideal management?

Percutaneous nephrolithotomy (PCNL). **Explanation:** The management of renal stones is primarily determined by the **size, location, and composition** of the stone. According to the EAU (European Association of Urology) guidelines, **Percutaneous Nephrolithotomy (PCNL)** is the gold standard and first-line treatment for renal pelvic stones **>2 cm** in diameter. 1. **Why PCNL is correct:** For a 3 cm stone, PCNL offers the highest stone-free rate (SFR) in a single session. It allows for direct fragmentation and physical removal of large stone burdens, which would otherwise be difficult to clear using less invasive methods. 2. **Why other options are incorrect:** * **ESWL:** Generally indicated for stones **<2 cm**. For a 3 cm stone, ESWL has a high failure rate, requires multiple sessions, and carries a significant risk of "Steinstrasse" (stone street), where fragmented debris obstructs the ureter. * **Laparoscopic Nephrolithotomy:** This is usually reserved for complex cases, failed endourological procedures, or when there is a concomitant anatomical abnormality (like a PUJ obstruction) requiring reconstruction. It is not the first-line "ideal" management for a simple 3 cm pelvic stone. * **Medical Dissolution:** This is only effective for **Uric Acid stones**. Most renal stones are Calcium Oxalate (radio-opaque), and a 3 cm stone is far too large to rely on dissolution therapy alone. **Clinical Pearls for NEET-PG:** * **Stone Size 2 cm:** PCNL is the treatment of choice. * **Lower Pole Stones:** PCNL is preferred if the stone is >1.5 cm due to poor clearance rates with ESWL in the lower calyx.

Q: Secondary deposits from prostatic carcinoma are commonest in which organ?

Bone. **Explanation:** Prostatic carcinoma is characterized by its high affinity for the skeletal system. The correct answer is **Bone**, which is the most common site for distant metastasis, occurring in approximately 85-90% of patients with advanced disease. **Why Bone is the correct answer:** The primary mechanism for this spread is the **Batson venous plexus**, a valveless vertebral venous system that connects the deep pelvic veins and thoracic veins to the internal vertebral venous plexuses. This allows retrograde flow of tumor cells directly to the axial skeleton (pelvis, lumbar spine, and femur) without passing through the lungs. Metastases from the prostate are characteristically **osteoblastic** (bone-forming), appearing as radiodense lesions on X-rays. **Why other options are incorrect:** * **Kidney:** While prostate cancer can cause obstructive uropathy by blocking the ureters, it rarely metastasizes to the renal parenchyma. * **Liver:** This is a common site for visceral metastasis in many cancers (like GI tract or lung), but in prostate cancer, visceral spread usually occurs much later in the disease progression, after bone involvement. * **Brain:** Brain metastases are rare in prostate cancer and typically signify an end-stage, androgen-independent phase of the disease. **High-Yield Clinical Pearls for NEET-PG:** * **Commonest site of bone metastasis:** Lumbar spine > Pelvis > Thoracic spine. * **Type of lesion:** Prostate cancer is the classic cause of **osteoblastic** lesions. (Contrast: Multiple myeloma and Breast cancer often cause osteolytic lesions). * **Tumor Marker:** PSA (Prostate-Specific Antigen) is used for screening and monitoring treatment response. * **Gold Standard Investigation for Bone Mets:** Bone Scan (Technetium-99m MDP) is more sensitive than X-ray for early detection.

Q: Urinary catheterization is indicated in cases of acute retention of urine due to which of the following conditions?

Postoperative status. **Explanation:** **Correct Answer: C. Postoperative status** In the postoperative period, acute retention of urine (ARU) is common due to the effects of anesthesia (which inhibits the detrusor reflex), pain, and the use of opioids. In these cases, the urethra is anatomically intact and unobstructed. Therefore, **urethral catheterization** is the first-line management to decompress the bladder and prevent myogenic damage. **Analysis of Incorrect Options:** * **A. Stricture:** In cases of urethral stricture, the lumen is narrowed and fibrotic. Forcing a catheter can cause a "false passage" or further trauma. While gentle catheterization with a small-bore or specialized catheter (e.g., Tiemann tip) is sometimes attempted, it is not the ideal indication compared to a clear passage. * **B. Rupture:** This is an absolute **contraindication** for urethral catheterization. If a urethral injury is suspected (e.g., blood at the meatus, high-riding prostate), a Retrograde Urethrogram (RUG) must be performed first. Blind catheterization can convert a partial tear into a complete rupture. * **C. Carcinoma of the Prostate:** Advanced prostate cancer causes mechanical obstruction and distortion of the prostatic urethra. Catheterization is often difficult and may require a Suprapubic Cystostomy (SPC) if the obstruction is complete. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard for ARU:** Urethral catheterization is the initial step unless trauma is suspected. * **Trauma Rule:** If "Blood at Meatus" is mentioned, the next best step is **RUG**, and the management for retention is **Suprapubic Catheterization (SPC)**. * **Post-obstructive Diuresis:** Monitor urine output and electrolytes closely after relieving chronic retention, as sudden decompression can lead to polyuria and hypotension. * **Size Matters:** A standard 16 Fr Foley catheter is typically used for adults.

Question 1

What procedure is shown in the ureter?

Accepted Answer

Dormia Basket

Answer

Stenting

Answer

Dilatation

Answer

Cannulation

Question 2

All of the following are seen in cystitis EXCEPT:

Accepted Answer

Fever

Answer

Hematuria

Answer

Dysuria

Answer

Nocturia

Question 3

A patient was brought to the hospital eight hours after an injury. A few drops of blood are noted at the external urethral meatus. He has not passed urine and his bladder is palpable per abdomen. What is the probable diagnosis?

Accepted Answer

Urethral injury

Answer

Rupture bladder

Answer

Urethral injury with extravasation of urine in the retroperitoneum

Answer

Anuria due to hypovolemia

Question 4

Epidermoid carcinoma of the renal pelvis is usually associated with:

Accepted Answer

Pelvic calculus

Answer

Multiple papilomas

Answer

Tuberculosis of the kidney

Answer

Filariasis

Question 5

A 32-year-old man with a pelvic fracture presents with urinary retention and blood at the external meatus. A retrograde urethrogram shows prostatomembranous disruption. What is the most appropriate immediate treatment?

Accepted Answer

Suprapubic cystostomy

Answer

Urethral catheterization

Answer

Exploration and repair of the urethra

Answer

Perineal urethrostomy

Question 6

A male patient presents with azoospermia. On examination, testicular size is normal, FSH is normal, and testosterone levels are normal. What is the most probable cause?

Accepted Answer

Vas obstruction

Answer

Maldescended testis

Answer

Klinefelter's syndrome

Answer

Kallmann's syndrome

Question 7

A 25-year-old married male presents with infertility. He underwent retroperitoneal lymph node dissection at age 15 for embryonal carcinoma of the right testis. Semen analysis shows a quantity of 0.5 ml, no sperm, and no fructose. Testis biopsy shows normal spermatogenesis. What is the best treatment?

Accepted Answer

Microtesticular sperm aspiration and intracytoplasmic injection

Answer

Artificial insemination with donor sperm

Answer

Penile prosthesis

Answer

None of the above

Question 8

A female patient presented with left iliac fossa pain for the past 6 months. On investigation, a 3 cm left renal pelvic stone was found with no hydroureteronephrosis, normal functioning kidneys on both sides, and no distal obstruction. What is the ideal management?

Accepted Answer

Percutaneous nephrolithotomy (PCNL)

Answer

Extra-corporeal shock wave lithotripsy (ESWL)

Answer

Laparoscopic nephrolithotomy

Answer

Medical dissolution therapy with oral potassium citrate

Question 9

Secondary deposits from prostatic carcinoma are commonest in which organ?

Accepted Answer

Bone

Answer

Kidney

Answer

Liver

Answer

Brain

Question 10

Urinary catheterization is indicated in cases of acute retention of urine due to which of the following conditions?

Accepted Answer

Postoperative status

Answer

Stricture

Answer

Rupture

Answer

Carcinoma of the prostate

Urology — MCQs

Urology — MCQs

On this page

Practice by Chapter

Want unlimited practice?