Urology Practice Questions

Q: Most common presentation of renal cell carcinoma is

Hematuria. ***Hematuria*** - **Hematuria** (blood in the urine) is the **most common presenting symptom** of renal cell carcinoma, occurring in about 60% of patients [1]. It is often **painless** [2] and can be gross or microscopic. - This symptom occurs due to the tumor eroding into the collecting system of the kidney, causing blood to mix with urine. *Abdominal mass* - While an **abdominal mass** can be a symptom of renal cell carcinoma [1], it is generally less common than hematuria as the initial presentation, occurring in about 45% of cases. - The mass is often **palpable** when the tumor has grown to a significant size [3], indicating a more advanced stage. *Flank pain* - **Flank pain** is another common symptom, but typically ranks third in frequency after hematuria and abdominal mass, presenting in about 40% of patients. - Pain usually arises when the tumor grows large enough to **compress surrounding structures** or invades the renal capsule. *Nocturia* - **Nocturia** (frequent urination at night) is **not a direct symptom** of renal cell carcinoma. - It is more commonly associated with benign conditions like **benign prostatic hyperplasia (BPH)**, urinary tract infections, or bladder overactivity.

Q: Which of the following statements about Varicocele is false?

More common on right side. ***More common on right side*** - Varicoceles are significantly **more common on the left side** due to anatomical differences, specifically the longer left testicular vein draining into the left renal vein at a perpendicular angle. - The perpendicular drainage and longer course of the left testicular vein create a higher pressure environment, predisposing to venous incompetence and dilation. *Dilated pampiniform plexus veins* - This statement is **true** because a varicocele is, by definition, an abnormal dilation and tortuosity of the veins of the **pampiniform plexus** within the spermatic cord. - The dilation occurs due to incompetent valves in the spermatic veins, leading to reflux of blood. *Doppler USG is best investigation* - This statement is **true** as **Doppler ultrasonography** is considered the gold standard for diagnosing varicoceles. - It allows visualization of dilated veins, demonstrates reflux with Valsalva maneuver, and helps grade the severity of the varicocele. *Abnormality increases on Valsalva* - This statement is **true** because the **Valsalva maneuver** increases intra-abdominal pressure, which impedes venous return and accentuates the reflux of blood into the testicular veins. - This maneuver helps to confirm the presence of a varicocele on physical examination and during Doppler ultrasonography.

Q: In which of the following conditions is circumcision specifically indicated?

Phimosis (when non-retractable). ***Phimosis (when non-retractable)*** - **Circumcision** is the definitive treatment for **pathological phimosis** where the foreskin cannot be retracted and causes symptoms like pain, dysuria, or recurrent infections. - This is a **primary and specific indication** for circumcision in both children (after conservative measures fail) and adults. - Phimosis can lead to complications like balanitis, urinary retention, and in severe cases, malignancy risk. *Paraphimosis (as primary emergency treatment)* - **Paraphimosis** is a urological emergency requiring **immediate manual reduction** or dorsal slit procedure to relieve strangulation of the glans. - **Circumcision is NOT the primary emergency treatment** - it is performed **electively later** to prevent recurrence after the acute episode is resolved. - The immediate priority is reduction of the paraphimosis, not circumcision. *Balanitis (as first-line treatment)* - **First-line treatment** for balanitis involves **topical antifungals, antibiotics, or corticosteroids** depending on the etiology. - **Circumcision** is indicated for **recurrent or refractory balanitis** after conservative measures have failed, not as initial first-line therapy. - It is a definitive preventive measure but not the primary treatment approach. *None of the above (not indicated)* - This is incorrect because **circumcision has clear medical indications** in urology and pediatric surgery. - Pathological phimosis is a well-established specific indication for the procedure.

Q: A 40-year-old male presented to the casualty with severe pain in the left upper abdomen radiating to the groin. Urine routine examination shows 6-8 pus cells and 15-20 red blood cells. What is the diagnosis based on the CT scan findings?

Left ureteric calculus. ***Left ureteric calculus*** - The combination of severe left flank pain radiating to the groin, along with 6-8 pus cells and 15-20 red blood cells in the urine, is highly suggestive of **renal or ureteric colic** due to a calculus. - A CT scan is the **gold standard** for diagnosing urinary tract stones, definitively identifying their presence, size, and location within the left ureter, confirming the diagnosis. *Aortic Aneurysm* - Aortic aneurysm typically presents with **abdominal or back pain**, but it lacks the characteristic urinary symptoms like hematuria and pyuria seen in this case. - Imaging for an aneurysm would show an **enlarged aorta**, not findings related to the urinary tract. *Acute cholecystitis* - Acute cholecystitis causes **right upper quadrant pain**, often radiating to the right shoulder or back, and is associated with **fever and nausea**. - It does not present with **urinary symptoms** like pus cells and red blood cells in the urine. *Acute Colitis* - Acute colitis typically presents with **abdominal pain**, diarrhea (often bloody), fever, and tenesmus, primarily affecting the colon. - While it can cause abdominal pain, it does not explain the **radiating groin pain** or the specific urinary findings of pus and red blood cells.

Q: During TURP, the surgeon takes care to dissect above the verumontanum to avoid injury to

External urethral sphincter. ***External urethral sphincter*** - The **external urethral sphincter** is located just inferior to the verumontanum, meaning dissecting above the verumontanum helps preserve its function. - Injury to this sphincter is a major cause of **post-TURP incontinence**. *Urethral crest* - The **urethral crest** is a midline ridge on the posterior wall of the prostatic urethra, containing the verumontanum - Dissecting above the verumontanum would still be within the region of the urethral crest, not specifically to protect it. *Prostatic utricle* - The **prostatic utricle** is a small blind-ending pouch located within the verumontanum itself. - Dissecting above the verumontanum would not specifically prevent injury to the utricle, as it is integral to the verumontanum structure. *Trigone of bladder* - The **trigone of the bladder** is located superior to the prostatic urethra, forming the base of the bladder. - TURP primarily involves resection of prostatic tissue, and the trigone is not typically at risk if dissection is confined to the prostatic urethra.

Q: What is the most common type of stone found in the bladder?

Calcium oxalate. ***Calcium oxalate*** - **Calcium oxalate** is the most common type of urinary stone overall, accounting for up to 80% of all stones, and is consequently the most frequent type found in the bladder. - The formation of **calcium oxalate stones** in the bladder is often associated with conditions causing stasis or high calcium excretion, although they can also form in the kidneys and descend [1]. *Ammonium urate* - **Ammonium urate stones** are relatively rare in developed countries but are more common in regions with endemic bladder stones, often linked to chronic urinary tract infections [1]. - These stones are typically soft, friable, and radiolucent, and are often a component of mixed stones. *Uric acid* - **Uric acid stones** are more common in patients with gout, metabolic syndrome, or conditions leading to persistently acidic urine, and are usually radiolucent [1]. - While they can occur in the bladder, they are not as prevalent as calcium oxalate stones in this location. *Struvite* - **Struvite stones** (magnesium ammonium phosphate) are strongly associated with **urinary tract infections** caused by **urea-splitting bacteria** (e.g., *Proteus* spp.) [1]. - They tend to grow rapidly and can form large, staghorn calculi, but are not the most common type of bladder stone overall [1].

Q: Which of the following is NOT a suitable management option for accidental injury of the ureter during an abdominal operation?

Ligation of the ureter. ***Ligation of the ureter*** - **Ligation** of the ureter is generally not a suitable management option as it typically leads to **kidney damage** due to obstruction and hydronephrosis, potentially necessitating **nephrectomy** if renal function is severely compromised. - This approach permanently blocks urine flow, causing **irreversible renal damage** unless the ureter is repaired or diverted very soon after injury. *End-to-end anastomosis through an ureteric catheter* - This is a common and appropriate technique for repairing a **transected ureter**, particularly when the injury is clean and there is minimal tissue loss. - An **ureteric catheter** acts as a stent, maintaining patency and facilitating healing while preventing stricture formation at the repair site. *Implantation into the bladder* - **Ureteroneocystostomy (implantation into the bladder)** is suitable for **distal ureteral injuries** where a sufficient length of ureter remains to reach the bladder without tension. - This procedure re-establishes continuity of the urinary tract directly into the bladder, bypassing the injured segment. *Colonic implantation* - **Colonic implantation** (ureterosigmoidostomy or ureterocolonic anastomosis) is a more complex procedure reserved for specific situations, such as extensive ureteral loss or bladder exstrophy, where direct bladder implantation is not feasible. - It involves diverting urine into the colon, allowing for reabsorption of water, but can lead to complications such as **hyperchloremic metabolic acidosis** and an increased risk of urinary tract infections.

Q: What is the term for the triad of renal colic, loin swelling that resolves after urination?

Dietel's crisis. ***Dietel's crisis*** * It is characterized by recurrent attacks of **renal colic**, **loin swelling** (due to hydronephrosis), and hematuria, which resolve after increased urine output [1]. * This triad is typically associated with **intermittent ureteropelvic junction (UPJ) obstruction**, where urine outflow is temporarily blocked [1]. *Kocher's triad* * This triad refers to the classic symptoms of acute appendicitis: **pain shifting from the periumbilical region to the right iliac fossa**, **anorexia**, and **nausea/vomiting**. * It is not related to renal issues or loin swelling. *Saint's triad* * This triad describes the coexistence of **gallstones**, **diverticulosis**, and **hiatal hernia**. * It represents three common conditions often found together in older adults but has no connection to kidney problems. *Charcot's triad* * This triad is composed of **jaundice**, **right upper quadrant pain**, and **fever**, which are indicative of acute cholangitis. * It is entirely distinct from renal colic and loin swelling.

Q: Penile angiography is reliable only after intracavernosal injection of vasoactive substances. All are indications for penile angiography, EXCEPT:

Painful priapism. ***Painful priapism*** - Penile angiography is generally **contraindicated** in painful priapism because the condition is an **emergency** requiring immediate intervention to restore blood flow and prevent irreversible cavernosal damage. - The goal in priapism is detumescence, not vascular mapping, and angiography could delay necessary treatment, potentially worsening outcomes. *Peyronie's disease* - Angiography can be used in select cases of Peyronie's disease to evaluate the **vascularity of plaques** or to identify associated vascular abnormalities that may contribute to erectile dysfunction alongside the curvature. - It helps in surgical planning, especially when considering **penile revascularization procedures** if vascular insufficiency is suspected. *Erectile dysfunction* - Penile angiography is a useful diagnostic tool for identifying the cause of certain types of **erectile dysfunction**, particularly those suspected to have a vascular origin like **arterial insufficiency** or **venous leak**. - It helps map the penile vasculature, providing precise anatomical information for potential **revascularization surgery** in carefully selected patients. *Arteriovenous malformation* - Angiography is the **gold standard** for diagnosing and characterizing **arteriovenous malformations (AVMs)** in the penis. - It provides detailed information on the feeding arteries and draining veins, which is crucial for planning **embolization** or **surgical resection** to treat the AVM.

Question 1

Most common presentation of renal cell carcinoma is

Accepted Answer

Hematuria

Answer

Abdominal mass

Answer

Flank pain

Answer

Nocturia

Question 2

Which of the following statements about Varicocele is false?

Accepted Answer

More common on right side

Answer

Dilated pampiniform plexus veins

Answer

Doppler USG is best investigation

Answer

Abnormality increases on Valsalva

Question 3

In which of the following conditions is circumcision specifically indicated?

Accepted Answer

Phimosis (when non-retractable)

Answer

None of the above (not indicated)

Answer

Paraphimosis (as primary emergency treatment)

Answer

Balanitis (as first-line treatment)

Question 4

A 60-year-old smoker presented with a history of a single episode of painless gross hematuria. The most logical investigation would be.

Accepted Answer

Cystoscopy

Answer

Urine cytology

Answer

X-ray of the kidneys, ureters, and bladder (KUB)

Answer

Ultrasound of the abdomen

Question 5

A 40-year-old male presented to the casualty with severe pain in the left upper abdomen radiating to the groin. Urine routine examination shows 6-8 pus cells and 15-20 red blood cells. What is the diagnosis based on the CT scan findings?

Accepted Answer

Left ureteric calculus

Answer

Acute cholecystitis

Answer

Acute Colitis

Answer

Aortic Aneurysm

Question 6

During TURP, the surgeon takes care to dissect above the verumontanum to avoid injury to

Accepted Answer

External urethral sphincter

Answer

Urethral crest

Answer

Prostatic utricle

Answer

Trigone of bladder

Question 7

What is the most common type of stone found in the bladder?

Accepted Answer

Calcium oxalate

Answer

Ammonium urate

Answer

Struvite

Answer

Uric acid

Question 8

Which of the following is NOT a suitable management option for accidental injury of the ureter during an abdominal operation?

Accepted Answer

Ligation of the ureter

Answer

Colonic implantation

Answer

End-to-end anastomosis through an ureteric catheter

Answer

Implantation into the bladder

Question 9

What is the term for the triad of renal colic, loin swelling that resolves after urination?

Accepted Answer

Dietel's crisis

Answer

Kocher's triad

Answer

Saint's triad

Answer

Charcot's triad

Question 10

Penile angiography is reliable only after intracavernosal injection of vasoactive substances. All are indications for penile angiography, EXCEPT:

Accepted Answer

Painful priapism

Answer

Arteriovenous malformation

Answer

Peyronie's disease

Answer

Erectile dysfunction

Urology — MCQs

Urology — MCQs

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