Urology Practice Questions

Q: What is the most likely diagnosis based on the clinical image?

Hydrocele. **Hydrocele** - The image shows a **swollen scrotum** that is likely **non-tender** and **transilluminable**, characteristic findings of a hydrocele, which is a collection of fluid around the testis. - The swelling appears smooth and confined to the scrotum, consistent with fluid accumulation within the **tunica vaginalis**. *Direct inguinal hernia* - A direct inguinal hernia typically presents as a bulge in the **inguinal region** that protrudes directly through the posterior wall of the inguinal canal (Hesselbach's triangle). - It usually **does not extend into the scrotum** or cause such a generalized scrotal enlargement as seen here. *Indirect inguinal hernia* - An indirect inguinal hernia protrudes through the **deep inguinal ring** and often descends into the scrotum, alongside the spermatic cord. - Unlike a hydrocele, it is typically **reducible** bulge of bowel or omentum, thus feeling more solid and not transilluminating. *Varicocele* - A varicocele is characterized by a "bag of worms" feeling due to **dilated pampiniform plexus veins** in the scrotum. - It often appears as an irregular, soft mass that is more prominent when standing and typically **does not transilluminate**.

Q: Which is incorrect about the swelling shown below?

Possible to get above swelling. ***Possible to get above swelling*** - The image shows a **transilluminating scrotal swelling**, characteristic of a **hydrocele**. - A hydrocele originates from within the scrotum (testicular origin), so you **CANNOT get above the swelling** during physical examination. - The statement "Possible to get above swelling" is **INCORRECT** for a hydrocele - this is the key distinguishing feature. - In contrast, an **inguinoscrotal hernia** descends from the inguinal canal, so you **CAN get above it** and feel the neck of the hernia. - Since the question asks "which is incorrect," this option is the **correct answer**. *Fluctuation positive* - Hydroceles contain clear fluid, making them **fluctuant** on palpation. - A wave-like impulse can be transmitted through the fluid from one side to the other. - This statement is **correct** about hydroceles. *Fluid aspiration* - **Aspiration of fluid** from a hydrocele is possible for diagnostic or therapeutic purposes. - The aspirated fluid is typically straw-colored and clear if uncomplicated. - This statement is **correct** about hydroceles. *Transillumination positive* - The image clearly shows **positive transillumination**, where light passes through the swelling. - This indicates the swelling is **fluid-filled** and not solid. - This is a hallmark sign of hydrocele, distinguishing it from hernia or tumor. - This statement is **correct** about hydroceles.

Q: What does the following image show?

Stenting for pyeloplasty. ***Stenting for pyeloplasty*** - The image shows a **double J stent** placed in the ureter, which is commonly used to ensure **urine drainage** and **prevent stricture** after reconstructive surgeries like pyeloplasty. - The stent extends from the renal pelvis (upper coiled end) down into the bladder (lower coiled end), typical positioning for urinary tract procedures. *Stenting for bile duct obstruction* - Stents for **bile duct obstruction** are placed within the biliary system, which is anatomically distinct from the urinary tract shown. - These stents would be visible in the upper abdomen, associated with the liver and pancreas, not spanning the kidney and bladder as seen here. *Stenting for ESWL* - **Extracorporeal Shock Wave Lithotripsy (ESWL)** is a procedure to break up kidney stones; stents may be placed before or after to facilitate stone fragment passage or relieve obstruction. - While a stent might be placed after ESWL, the image itself shows the placement and course of the stent, which is a common intervention following reconstructive procedures such as pyeloplasty. *Stenting for PCNL* - **Percutaneous Nephrolithotomy (PCNL)** is a surgical procedure to remove large kidney stones directly from the kidney. - After PCNL, a **nephrostomy tube** or a **ureteral stent** may be placed, but the primary indication shown in the image (a long-term indwelling stent from kidney to bladder) is most consistent with facilitating healing and drainage after reconstruction such as pyeloplasty.

Q: During evaluation of a child with recurrent UTI, VCUG is performed and the following finding is observed. What is the diagnosis?

Posterior urethral valves. ***Posterior urethral valves*** - The image shows a **dilated and elongated posterior urethra** which is characteristic of posterior urethral valves (PUV). Also evident is **trabeculation of the bladder wall** and significant **bilateral vesicoureteral reflux (VUR)**, with a dilated and tortuous left ureter. - PUV frequently cause **recurrent UTIs** in male infants and children due to urinary obstruction and stasis, leading to bladder and upper tract damage. *Ureterocele* - A ureterocele would appear as a **cystic dilation of the distal ureter** into the bladder, typically visualized as a lucent defect within the opaque bladder on VCUG. The image does not show this specific finding. - While it can cause obstruction and VUR, the obstruction pattern observed in the image (especially the posterior urethra) is not consistent with a ureterocele. *Ectopic ureter* - An ectopic ureter involves the ureter inserting into an abnormal location, such as the vagina, urethra, or seminal vesicle, often bypassing the bladder. This would lead to a more direct drainage outside the bladder or into another structure without the gross changes seen in the posterior urethra. - While an ectopic ureter can lead to reflux or obstruction affecting the kidney, the primary obstruction in the **posterior urethra** with characteristic valve morphology is absent with an ectopic ureter. *Hydronephrosis* - **Hydronephrosis** refers to the swelling of a kidney due to a backup of urine, often caused by an obstruction or VUR. While hydronephrosis is a *consequence* of conditions like PUV, it is not the *diagnosis* explaining the direct VCUG findings in the bladder and urethra. - The VCUG directly visualizes the obstruction in the posterior urethra and associated reflux/bladder changes, which are the primary diagnostic features, rather than just the renal swelling.

Q: The radiographic image shows a stent in the urinary tract. This type of stenting is most commonly performed following which procedure?

Pyeloplasty. ***Pyeloplasty*** - **Double J stents** are routinely placed in virtually all pyeloplasties (Anderson-Hynes dismembered pyeloplasty for **UPJO - Ureteropelvic Junction Obstruction**) to stent the anastomosis and ensure proper **urine drainage**. - The stent prevents **PUJ stricture** formation and supports healing of the surgical anastomosis, making it a standard postoperative measure. *ESWL* - **Extracorporeal Shock Wave Lithotripsy (ESWL)** rarely requires routine stenting unless there is **large stone burden** or risk of steinstrasse (stone fragment obstruction). - Stenting after ESWL is **selective**, not universally performed, unlike the routine nature implied by the question. *PCNL* - **Percutaneous Nephrolithotomy (PCNL)** primarily uses **nephrostomy tube** for drainage rather than double J stents as the first-line drainage method. - DJ stent placement after PCNL is **optional/selective**, not the most common stenting indication compared to pyeloplasty. *Ureteroscopy (URS)* - **Ureteroscopy** may require stenting in cases of **ureteral injury**, significant edema, or large stone burden, but it's placed **selectively**. - Unlike pyeloplasty, stenting after URS is **not universal** and depends on specific procedural factors and complications.

Q: Which of the following uroflowmetry recording indicates BPH?

Curve 3. ***Curve 3*** - Curve 3 shows a **low, flattened peak flow rate** (around 5 mL/sec) and a **prolonged voiding time**, which is characteristic of significant bladder outlet obstruction due to BPH. - The **sustained low flow** indicates constant effort to overcome resistance, a common finding in BPH. *Curve 1* - Curve 1 depicts a **high peak flow rate** (around 30 mL/sec) and a **short voiding time**, representing a normal and efficient urinary flow pattern. - This pattern is inconsistent with BPH, which is characterized by obstructed flow. *Curve 2* - Curve 2 indicates a **moderately reduced peak flow rate** (around 15 mL/sec) and a somewhat prolonged voiding time compared to normal. - While reflecting some degree of obstruction or weaker detrusor function, it is less severe than curve 3 and may represent early BPH or other conditions. *Curve 4* - Curve 4 shows an **intermittent or staccato flow pattern**, which typically indicates detrusor-sphincter dyssynergia or abdominal straining during voiding. - This pattern is not characteristic of BPH, which typically shows a continuous low flow rather than intermittent flow.

Q: A 70-year-old man underwent the procedure shown below. 3rd day he develops seizures. What is the diagnosis?

Water intoxication. ***Water intoxication*** - The image depicts a **transurethral resection of the prostate (TURP)** using a resectoscope. During TURP, large volumes of **hypotonic irrigation fluid** are used. - If excess fluid is absorbed into the systemic circulation, it can lead to **dilutional hyponatremia** and subsequent **cerebral edema**, causing neurological symptoms like **seizures** post-operatively. *Anesthetic over-dosage* - Anesthetic overdose would typically manifest during or immediately after the procedure with respiratory and cardiovascular depression, not delayed seizures on the third day. - The patient's presentation of seizures several days post-operatively does not align with acute anesthetic toxicity. *Mismatched blood transfusion* - A mismatched blood transfusion would present with acute symptoms like fever, chills, hemoglobinuria, and hypotension, usually *during* or immediately after the transfusion, not delayed neurological symptoms. - Blood transfusions are not routinely part of a TURP procedure unless significant bleeding occurs. *Malignant hyperthermia* - Malignant hyperthermia is a rare, life-threatening **hypermetabolic state** triggered by certain general anesthetics, characterized by rapid onset of high fever, muscle rigidity, and tachycardia. - It occurs *during* or very soon after anesthesia and would not typically present as seizures on the third post-operative day.

Q: A 60-year-old male smoker presents with discoloration of urine and has brought a sample to your clinic. He denies any pain or discomfort while passing urine. No history of fever is present. IVU of the patient is shown. Which is the next best investigation to be done?

Cystoscopy. ***Cystoscopy*** - The patient presents with **painless hematuria** and a history of smoking, which are classic indicators of **bladder cancer**. The IVU may also suggest filling defects or abnormalities in the bladder. - Cystoscopy offers **direct visualization of the bladder and urethra**, allowing for biopsy of any suspicious lesions, which is crucial for diagnosis and staging of bladder cancer. *Urine cytology* - While urine cytology can detect malignant cells, its **sensitivity for low-grade tumors is limited**, and it cannot pinpoint the exact location or extent of the lesion. - A definitive diagnosis of bladder cancer requires **histopathological confirmation**, which cytology alone cannot provide. *USG abdomen* - USG can detect some renal and bladder abnormalities, but it is **not as sensitive or specific as cystoscopy** for detecting small or flat bladder lesions. - It's a good initial screening tool but **lacks the diagnostic precision** needed to investigate painless hematuria suspected to be from the bladder. *DMSA scan* - A DMSA scan is primarily used to assess **renal cortical function** and identify cortical scarring or anomalies, not for investigating hematuria or bladder pathologies. - It provides no information about the **urethra or bladder lumen**, which are critical for evaluating the cause of painless hematuria in this patient.

Q: A person could not pass urine after a fall shown below. On examination vitals are stable but bladder is palpable. What is the probable diagnosis? (NEET Pattern 2018)

Anterior urethra rupture. ***Anterior urethra rupture*** - The mechanism of injury - a **fall causing straddle trauma** (man falling into manhole) - is the classic cause of **bulbar urethral injury**, affecting the anterior urethra where it passes through the urogenital diaphragm. - Inability to pass urine with **palpable bladder** indicates urinary retention from complete urethral disruption, with the classic triad of **inability to void, blood at urethral meatus, and distended bladder**. *Posterior urethra rupture* - Requires **high-energy trauma** causing **pelvic fractures** (like road traffic accidents), not the straddle injury mechanism shown in the fall. - Associated with **membranous urethral injury** above the urogenital diaphragm, typically seen with **symphysis pubis or sacroiliac joint disruption**. *Penile avulsion* - Involves **complete or partial tearing** of penile skin or deeper structures, presenting with **obvious external hemorrhage and tissue loss**. - Would not primarily present as urinary retention without visible **external genital trauma or bleeding**. *Recto-urethral injury* - Results from **penetrating trauma** or severe **crush injuries** affecting both rectum and urethra simultaneously. - Would present with additional signs like **rectal bleeding, fecaluria, or pneumaturia**, which are not described in this case.

Question 1

What is the most likely diagnosis based on the clinical image?

Accepted Answer

Hydrocele

Answer

Direct inguinal hernia

Answer

Indirect inguinal hernia

Answer

Varicocele

Question 2

Which is incorrect about the swelling shown below?

Accepted Answer

Possible to get above swelling

Answer

Fluctuation positive

Answer

Fluid aspiration

Answer

Transillumination positive

Question 3

Which is incorrect about the procedure shown in the patient with right flank pain?

Accepted Answer

No anesthesia is required

Answer

Done as outpatient procedure

Answer

Contraindicated in hard stones

Answer

Shockwaves pass through a water bath

Question 4

What does the following image show?

Accepted Answer

Stenting for pyeloplasty

Answer

Stenting for bile duct obstruction

Answer

Stenting for ESWL

Answer

Stenting for PCNL

Question 5

During evaluation of a child with recurrent UTI, VCUG is performed and the following finding is observed. What is the diagnosis?

Accepted Answer

Posterior urethral valves

Answer

Ureterocele

Answer

Ectopic ureter

Answer

Hydronephrosis

Question 6

The radiographic image shows a stent in the urinary tract. This type of stenting is most commonly performed following which procedure?

Accepted Answer

Pyeloplasty

Answer

ESWL

Answer

PCNL

Answer

Ureteroscopy (URS)

Question 7

Which of the following uroflowmetry recording indicates BPH?

Accepted Answer

Curve 3

Answer

Curve 1

Answer

Curve 2

Answer

Curve 4

Question 8

A 70-year-old man underwent the procedure shown below. 3rd day he develops seizures. What is the diagnosis?

Accepted Answer

Water intoxication

Answer

Anesthetic over-dosage

Answer

Mismatched blood transfusion

Answer

Malignant hyperthermia

Question 9

A 60-year-old male smoker presents with discoloration of urine and has brought a sample to your clinic. He denies any pain or discomfort while passing urine. No history of fever is present. IVU of the patient is shown. Which is the next best investigation to be done?

Accepted Answer

Cystoscopy

Answer

Urine cytology

Answer

USG abdomen

Answer

DMSA scan

Question 10

A person could not pass urine after a fall shown below. On examination vitals are stable but bladder is palpable. What is the probable diagnosis? (NEET Pattern 2018)

Accepted Answer

Anterior urethra rupture

Answer

Posterior urethra rupture

Answer

Penile avulsion

Answer

Recto-urethral injury

Urology — MCQs

Urology — MCQs

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