Urology Practice Questions

Q: A 70-year-old gentleman underwent TURP. Prostate specimen showed malignant histology. What is the next step?

Active surveillance. **Explanation:** This scenario describes an **incidental finding of prostate cancer** following a Transurethral Resection of the Prostate (TURP) performed for presumed benign prostatic hyperplasia (BPH). In the TNM staging system, this is classified as **Stage T1a or T1b**. **Why Active Surveillance is the correct answer:** For a 70-year-old patient with incidentally discovered prostate cancer (especially if it is low-grade, low-volume, and has a low PSA level), **Active Surveillance** is the preferred management. At this age, the natural progression of low-risk prostate cancer is often slower than the patient's life expectancy. Active surveillance avoids the significant morbidity associated with surgery or radiation (incontinence, impotence) while monitoring the disease closely via serial PSA levels and repeat biopsies. **Analysis of Incorrect Options:** * **A. Radical Prostatectomy:** This is typically reserved for younger patients ( 10-15 years and higher-stage localized disease (T2). In a 70-year-old with incidental T1 disease, the risks of surgery often outweigh the benefits. * **C. External Beam Radiotherapy (EBRT):** While an option for localized cancer, it is generally deferred in low-risk incidental cases in favor of surveillance to avoid radiation-induced proctitis or cystitis. * **D. Bilateral Orchiectomy:** This is a form of Androgen Deprivation Therapy (ADT) used for **metastatic (Stage D/M1)** prostate cancer. It is not indicated for localized, incidental findings. **Clinical Pearls for NEET-PG:** * **T1a:** Tumor involves ≤5% of resected tissue. * **T1b:** Tumor involves >5% of resected tissue. * **Most common site for Prostate Cancer:** Peripheral Zone (detected by DRE). * **Most common site for BPH:** Transition Zone (reason why TURP specimens occasionally show incidental cancer). * **Gleason Scoring:** The most important prognostic factor for prostate cancer.

Q: Which of the following is NOT a differential diagnosis for acute scrotum?

Testicular cancer. **Explanation:** The term **"Acute Scrotum"** refers to a clinical emergency characterized by the sudden onset of pain, swelling, and/or redness of the scrotum. The differential diagnosis for acute scrotum focuses on conditions that present **acutely** (within hours to a few days). **Why Testicular Cancer is the correct answer:** Testicular cancer typically presents as a **painless, hard, slow-growing mass** that is inseparable from the testis. While 10% of cases may present with acute pain due to intratumoral hemorrhage, it is fundamentally a chronic/subacute condition and is not considered a primary differential for the "acute scrotum" syndrome. **Analysis of Incorrect Options:** * **Testicular Torsion:** The most critical surgical emergency. It presents with sudden, severe pain, a high-riding testis, and a negative Prehn’s sign. * **Epididymitis/Epididymo-orchitis:** The most common cause of acute scrotum in post-pubertal males. It usually presents with fever, dysuria, and a positive Prehn’s sign (relief of pain on elevation of the scrotum). * **Hydatid Torsion (Torsion of the Appendix Testis):** The most common cause of acute scrotum in children (ages 7-12). It is characterized by the pathognomonic **"Blue Dot Sign"** on the upper pole of the testis. **NEET-PG High-Yield Pearls:** * **Golden Period:** For testicular torsion, detorsion within **6 hours** has a >90% salvage rate; this drops to <10% after 24 hours. * **Investigation of Choice:** Color Doppler Ultrasound is the gold standard to differentiate torsion (absent blood flow) from epididymitis (increased blood flow). * **Management:** If torsion is suspected clinically, immediate **surgical exploration** should not be delayed for imaging.

Q: Sterile pyuria is seen in which of the following conditions?

Renal tuberculosis. **Explanation:** **Sterile pyuria** is defined as the presence of white blood cells (pus cells >5/HPF) in the urine in the absence of growth on standard culture media. **Renal Tuberculosis (A)** is the classic and most common cause of sterile pyuria in surgical practice. In Genitourinary TB (GUTB), the *Mycobacterium tuberculosis* bacilli cause chronic inflammation and ulceration of the urothelium, leading to the shedding of pus cells. However, because *M. tuberculosis* does not grow on routine aerobic culture media (it requires specific media like Lowenstein-Jensen), the culture is reported as "sterile." **Analysis of Incorrect Options:** * **Wilms Tumor (B):** Typically presents as an asymptomatic abdominal mass in children. While microscopic hematuria may occur, pyuria is not a characteristic feature unless there is a secondary infection. * **Pelvic Inflammatory Disease (C):** While PID can cause pyuria due to urethral irritation, it is usually associated with sexually transmitted pathogens (like *Chlamydia* or *Gonorrhea*) or polymicrobial infections that are not primarily classified under the classic surgical presentation of sterile pyuria. * **Diabetes Mellitus (D):** Diabetics are prone to UTIs, but these are typically "infected pyuria" caused by common organisms like *E. coli*, which grow readily on standard cultures. **Clinical Pearls for NEET-PG:** * **Other causes of sterile pyuria:** Partially treated bacterial UTI (most common overall), Renal stones, Polycystic Kidney Disease, and interstitial nephritis. * **GUTB Triad:** Frequency (earliest symptom), painless hematuria, and sterile pyuria. * **Gold Standard Diagnosis for GUTB:** Culture on LJ medium (takes 6–8 weeks) or BACTEC (faster). * **Radiological sign:** "Thimble bladder" (small capacity, fibrotic bladder) is a late feature of GUTB.

Q: A 65-year-old female presents with recurrent episodes of gross painless hematuria. What is the most common cause of gross painless hematuria?

Carcinoma of the bladder. **Explanation:** **Why Carcinoma of the Bladder is Correct:** In any adult patient, particularly those over the age of 50, **painless gross hematuria** is considered **malignancy until proven otherwise**. Transitional Cell Carcinoma (TCC) of the urinary bladder is the most common cause of this presentation. The bleeding occurs due to the friable nature of the neoplastic tissue or the erosion of surface vessels by the tumor. In the context of NEET-PG, remember the "Rule of 60s": Bladder cancer typically presents in the 6th decade of life and is the most frequent urological malignancy causing visible, non-tender bleeding. **Why Other Options are Incorrect:** * **Renal Tuberculosis:** While it can cause hematuria, it is typically associated with "sterile pyuria" (pus cells in urine without bacterial growth) and irritative voiding symptoms (frequency, urgency). * **Urethral Stricture:** This usually presents with obstructive voiding symptoms (weak stream, straining, hesitancy). While it can cause terminal hematuria due to urethral mucosal irritation, it is rarely the cause of "gross painless hematuria." * **Interstitial Nephritis:** This is a renal parenchymal disease often presenting with microscopic hematuria, proteinuria, and sterile pyuria, usually secondary to drug reactions or systemic disease, rather than gross bleeding. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Cystoscopy is the most definitive investigation for bladder cancer. * **Initial Investigation:** Ultrasonography (USG) is usually the first-line screening tool. * **Most Common Type:** Transitional Cell Carcinoma (Urothelial Carcinoma) is the most common histological type (>90%). * **Risk Factors:** Smoking (most common) and occupational exposure to aromatic amines (e.g., Aniline dyes). * **Painful Hematuria:** Usually suggests calculi (stones) or infections (cystitis).

Q: What is the composition of this stone?

Calcium oxalate dihydrate. ***Calcium oxalate dihydrate*** - **Weddellite** stones have a characteristic **smooth, polished surface** with a **pyramidal or bipyramidal shape**. - Under microscopy, they appear as **octahedral or envelope-shaped crystals** that are typically **colorless and translucent**. *Calcium oxalate monohydrate* - **Whewellite** stones have a **rough, jagged surface** with **sharp projections** that can cause more tissue trauma. - Microscopically appears as **dumbbell or oval-shaped crystals** that are typically **yellow-brown in color**. *Ammonium urate* - These stones have a **yellow-brown color** and **smooth surface** but are **radiolucent** on plain X-rays. - Form in **alkaline urine** and are associated with **chronic diarrhea** or **ileostomy patients**. *Calcium oxalate* - This is a **generic term** that encompasses both monohydrate and dihydrate forms. - **Non-specific option** as it doesn't distinguish between the two distinct crystalline forms with different appearances.

Q: A 60-year-old male presents with a poor stream of urine, a post-void residual urine volume of 400 mL, bilateral hydronephrosis, and a prostate weighing 70 g. His urea is 120 mg/dL and creatinine is 3.5 mg/dL. What is the ideal next immediate step?

Catheterize with Foley catheter. ### **Explanation** The patient presents with **Benign Prostatic Hyperplasia (BPH)** complicated by **chronic urinary retention**, leading to obstructive uropathy (bilateral hydronephrosis) and **post-renal azotemia** (elevated urea and creatinine). **1. Why Option A is Correct:** The immediate priority in any patient with renal failure due to bladder outlet obstruction is to **relieve the obstruction**. Catheterization with a Foley catheter is the simplest, fastest, and most effective way to drain the bladder, reduce intravesical pressure, and allow the kidneys to recover. This is the first step in managing "obstructive uropathy" before any definitive surgical intervention (like TURP) can be considered. **2. Why Other Options are Incorrect:** * **Option B (Bilateral PCN):** Percutaneous nephrostomy is indicated for supra-vesical (ureteric) obstruction. In this case, the obstruction is at the level of the prostate (infra-vesical), so draining the bladder is sufficient. * **Option C & D (CT/MRI):** While imaging is useful for staging malignancy, they have no role in the **immediate** management of acute-on-chronic renal failure. Stabilizing renal function takes precedence over definitive diagnostic imaging. **3. Clinical Pearls for NEET-PG:** * **Post-obstructive Diuresis:** After catheterization, monitor the patient for massive diuresis. If output >200 mL/hr, replace fluids with ½ Normal Saline to prevent electrolyte imbalance. * **Azotemia in BPH:** Surgery (TURP) is contraindicated while the patient is in renal failure. Always stabilize creatinine levels via catheterization first. * **Indications for Surgery in BPH:** Refractory urinary retention, recurrent UTIs, hematuria, bladder stones, and **renal insufficiency** (post-renal failure).

Q: What is the treatment of choice for ureteric colic?

None of the above. **Explanation:** The treatment of choice for ureteric colic has evolved significantly in modern clinical practice. Currently, **Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)**, specifically **Diclofenac** (75mg IM or 50mg oral/rectal), are considered the first-line treatment of choice. They work by inhibiting prostaglandin synthesis, which reduces ureteric smooth muscle spasm, decreases renal pelvic pressure, and reduces local edema. **Analysis of Options:** * **A. Nitrites:** These are vasodilators primarily used in angina or cyanide poisoning. They have no proven clinical efficacy in relieving the intense visceral pain of ureteric colic. * **B. Pethidine:** While opioids were historically used, they are no longer the "choice" because they can induce vomiting and may cause spasm of the sphincter of Oddi. If an opioid is required for refractory pain, **Morphine** is generally preferred over Pethidine. * **C. Adrenaline:** This is a sympathomimetic used in anaphylaxis or cardiac arrest. It has no role in managing renal colic and could potentially worsen the patient's physiological stress. Since the gold standard (NSAIDs) is not listed, **Option D (None of the above)** is correct. **High-Yield Clinical Pearls for NEET-PG:** 1. **First-line Analgesia:** NSAIDs (Diclofenac) are superior to opioids for ureteric colic. 2. **Medical Expulsive Therapy (MET):** For stones <10mm, **Alpha-blockers (Tamsulosin)** are used to relax the distal ureter and facilitate stone passage. 3. **Gold Standard Investigation:** Non-contrast Computed Tomography (**NCCT KUB**) is the investigation of choice for diagnosing ureteric calculi. 4. **Emergency Indication:** If a patient has ureteric colic with fever (infected hydronephrosis), it is a surgical emergency requiring immediate decompression via a **DJ stent** or **percutaneous nephrostomy (PCN)**.

Question 1

Regarding testicular torsion, which of the following statements is FALSE?

Accepted Answer

Testicular salvage decreases to less than 5% if surgery is delayed beyond 6 hours.

Answer

Undescended testicle is a risk factor.

Answer

Decreased blood flow relative to the contralateral testicle can be demonstrated by ultrasound.

Answer

Surgical exploration should include fixation of the contralateral testicle.

Question 2

A 70-year-old gentleman underwent TURP. Prostate specimen showed malignant histology. What is the next step?

Accepted Answer

Active surveillance

Answer

Radical Prostatectomy

Answer

External beam radiotherapy

Answer

Bilateral orchiectomy

Question 3

A 3-year-old male patient presents with only one testis in the scrotum. On examination, the right testis is palpable in the inguinal canal. What is the preferred treatment?

Accepted Answer

Orchidopexy

Answer

Observation until puberty

Answer

Androgen therapy

Answer

Orchiectomy

Question 4

Which of the following is NOT a differential diagnosis for acute scrotum?

Accepted Answer

Testicular cancer

Answer

Epididymitis

Answer

Hydatid torsion

Answer

Testicular torsion

Question 5

Which of the following statements regarding ureteric stones is false?

Accepted Answer

Source is always the kidneys.

Answer

Urine is always infected.

Answer

Should be removed immediately.

Answer

Pain is referred to the tip of the penis in intramural stones.

Question 6

Sterile pyuria is seen in which of the following conditions?

Accepted Answer

Renal tuberculosis

Answer

Wilms tumor

Answer

Pelvic inflammatory disease

Answer

Diabetes mellitus

Question 7

A 65-year-old female presents with recurrent episodes of gross painless hematuria. What is the most common cause of gross painless hematuria?

Accepted Answer

Carcinoma of the bladder

Answer

Renal tuberculosis

Answer

Urethral stricture

Answer

Interstitial nephritis

Question 8

What is the composition of this stone?

Accepted Answer

Calcium oxalate dihydrate

Answer

Calcium oxalate monohydrate

Answer

Ammonium urate

Answer

Calcium oxalate

Question 9

A 60-year-old male presents with a poor stream of urine, a post-void residual urine volume of 400 mL, bilateral hydronephrosis, and a prostate weighing 70 g. His urea is 120 mg/dL and creatinine is 3.5 mg/dL. What is the ideal next immediate step?

Accepted Answer

Catheterize with Foley catheter

Answer

Bilateral percutaneous nephrostomies

Answer

CT scan to rule out carcinoma

Answer

MRI pelvis

Question 10

What is the treatment of choice for ureteric colic?

Accepted Answer

None of the above

Answer

Nitrites

Answer

Pethidine

Answer

Adrenaline

Urology — MCQs

Urology — MCQs

On this page

Practice by Chapter

Want unlimited practice?