Urology Practice Questions

Q: Which of the following is NOT a radiolucent stone?

Cystine stones. ### Explanation In urology, renal stones are classified based on their appearance on a plain X-ray (KUB). The visibility of a stone depends on its atomic weight and density. **1. Why Cystine stones are the correct answer:** Cystine stones are **radio-opaque** (visible on X-ray), though they appear less dense than calcium stones. They are often described as having a **"ground-glass"** or faint appearance. This is due to the presence of **sulfur atoms** within the cystine molecules, which have a higher atomic number, allowing them to attenuate X-rays. Therefore, they are NOT radiolucent. **2. Analysis of Incorrect Options (Radiolucent Stones):** * **Uric acid stones:** These are the most common radiolucent stones. They are composed of light elements (C, H, N, O) that do not stop X-rays. They are visible on CT scans or as filling defects on IVP. * **Xanthine stones:** Rare stones caused by genetic xanthine oxidase deficiency or Allopurinol therapy. Like uric acid, they lack heavy atoms and are radiolucent. * **Triamterene stones:** These are medication-induced stones. Triamterene (a potassium-sparing diuretic) is poorly soluble in urine and forms radiolucent calculi. **3. High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for Radiolucent stones (PURE):** **P**rotease inhibitors (Indinavir), **U**ric acid, **R**are (Xanthine/Matrix), **E**phedrine/Triamterene. * **Cystine Stones:** Associated with a hexagonal crystal shape in urine and a positive **Cyanide-Nitroprusside test**. * **Most Radio-opaque:** Calcium oxalate and Calcium phosphate (highest density). * **Intermediate/Faintly Opaque:** Cystine and Magnesium Ammonium Phosphate (Struvite). * **Gold Standard Investigation:** Non-contrast CT (NCCT) KUB detects almost all stones, including radiolucent ones (except Indinavir stones).

Q: Which of the following is the MOST common histological variant of prostate cancer?

Adenocarcinoma. **Explanation:** **Prostate cancer** is the most common malignancy in men globally. The correct answer is **Adenocarcinoma** because more than **95%** of all primary prostatic malignancies are histologically classified as acinar adenocarcinomas. These tumors typically arise from the **peripheral zone** of the prostate gland (70-80% of cases), which is why they are often detectable via Digital Rectal Examination (DRE). **Analysis of Options:** * **A. Adenocarcinoma (Correct):** As mentioned, acinar adenocarcinoma is the standard histological type. A less common subtype is ductal adenocarcinoma, which is more aggressive. * **B. Sarcoma:** Primary prostatic sarcomas (e.g., Rhabdomyosarcoma in children or Leiomyosarcoma in adults) are extremely rare, accounting for less than 0.1% of cases. * **C. Seminoma:** This is a germ cell tumor primarily found in the **testis**, not the prostate. While it can occur extragonadally (e.g., mediastinum), it is not a variant of prostate cancer. * **D. Squamous cell carcinoma:** This is an exceptionally rare variant (<0.5%) of prostate cancer, often associated with prior radiation therapy or hormonal treatment, and carries a very poor prognosis. **High-Yield Clinical Pearls for NEET-PG:** * **Gleason Scoring:** The grading system used for prognosis, based on architectural patterns (Score 2–10). * **Tumor Marker:** **PSA (Prostate Specific Antigen)** is the most important marker for screening and monitoring. * **Metastasis:** The most common site for distant metastasis is the **bone** (specifically the lumbar spine), typically presenting as **osteoblastic (sclerotic) lesions**. * **Spread:** Venous spread occurs via the **Baston’s vertebral venous plexus**, which explains the early spinal involvement without pulmonary involvement.

Q: What is true about carcinoma of the bladder?

It is common in smokers.. **Explanation:** **Carcinoma of the bladder** is a high-yield topic in NEET-PG, primarily focusing on **Urothelial (Transitional Cell) Carcinoma**, which accounts for over 90% of cases. 1. **Why Option A is correct:** Smoking is the most significant risk factor for bladder cancer, increasing the risk by 3–4 times. Carcinogens in cigarette smoke (like alpha and beta-naphthylamine) are absorbed into the blood, filtered by the kidneys, and stored in the bladder, where they cause chronic irritation and DNA damage to the urothelium. 2. **Why Option B is incorrect:** The most common histological type is **Transitional Cell Carcinoma (TCC)**. Adenocarcinoma is rare (<2%) and usually associated with urachal remnants or cystitis glandularis. Squamous cell carcinoma is more common in regions with endemic Schistosomiasis. 3. **Why Option C is incorrect:** Bladder cancer shows a strong male predilection, being **3 to 4 times more common in males** than in females. 4. **Why Option D is incorrect:** The classic "first" and most common symptom is **painless, intermittent gross hematuria**. Pain (suprapubic or dysuria) usually signifies advanced disease or secondary infection. **Clinical Pearls for NEET-PG:** * **Occupational Risks:** Exposure to **Azo dyes**, rubber, and leather industries (Benzidine and 2-Naphthylamine). * **Drug-induced:** Long-term use of **Cyclophosphamide** (causes hemorrhagic cystitis and TCC). * **Schistosoma haematobium:** Specifically associated with **Squamous Cell Carcinoma**, not TCC. * **Field Cancerization:** The entire urothelium (from renal pelvis to urethra) is at risk due to exposure to the same urinary carcinogens.

Q: Which of the following statements about retroperitoneal fibrosis is FALSE?

It is more common in females.. **Explanation:** Retroperitoneal Fibrosis (RPF) is a rare fibro-inflammatory condition characterized by the development of extensive fibrosis throughout the retroperitoneum, which can entrap and compress vital structures. **Why Option B is the Correct Answer (The False Statement):** Retroperitoneal fibrosis is actually **more common in males**, with a male-to-female ratio of approximately **2:1 to 3:1**. It typically presents in the 5th to 6th decades of life. Therefore, the statement that it is more common in females is incorrect. **Analysis of Other Options:** * **Option A:** The **ureter** is indeed the most commonly involved structure. The fibrosis typically starts at the level of the aortic bifurcation and spreads laterally, causing **medial deviation** and extrinsic compression of the ureters, leading to hydronephrosis. * **Option C:** Approximately 70% of cases are idiopathic, and this primary form is eponymously known as **Ormond’s disease**. It is now frequently associated with **IgG4-related disease**. * **Option D:** **Corticosteroids** (e.g., Prednisolone) are the first-line medical treatment. They work by reducing the inflammatory response and halting the progression of fibrosis. Immunosuppressants like Azathioprine or Tamoxifen may be used as adjuncts. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad on IVP:** Hydronephrosis, medial deviation of the middle third of the ureters, and extrinsic ureteral compression. * **Secondary Causes:** Drugs (notably **Methysergide**, Beta-blockers, Hydralazine), malignancy, and infections (TB, Actinomycosis). * **Surgery:** If medical therapy fails or obstruction is severe, **Ureterolysis** (freeing the ureter from the fibrous plaque) with **omental wrapping** is the surgical procedure of choice. * **Lab Marker:** Elevated ESR and CRP are common indicators of disease activity.

Q: What is the most important prognostic indicator for renal cell carcinoma?

Pathological staging. **Explanation:** In Renal Cell Carcinoma (RCC), the **Pathological Stage (TNM staging)** is universally recognized as the **single most important prognostic factor** for determining patient survival. Staging reflects the anatomical extent of the disease, specifically whether the tumor is confined to the kidney, involves Gerota’s fascia, extends into the renal vein/vena cava, or has spread to lymph nodes and distant organs. * **Pathological Staging (Correct):** The 5-year survival rate is directly correlated with the TNM stage. For instance, Stage I (T1N0M0) has a survival rate of >90%, whereas Stage IV (metastatic) drops significantly to <10-15%. * **Nuclear Grade (Incorrect):** Specifically the **Fuhrman Grade** (or the newer WHO/ISUP system), assesses the aggressiveness of the cells based on nuclear size and prominence of nucleoli. While it is a strong predictor of survival, it is secondary to the anatomical stage. * **Histological Type (Incorrect):** While Clear Cell RCC generally has a worse prognosis than Chromophobe or Papillary types, staging remains the dominant predictor across all subtypes. * **Tumor Size (Incorrect):** Size is a component of the "T" (Tumor) in TNM staging. While important (e.g., T1a vs. T1b), it is the overall stage (including nodal and distant spread) that dictates prognosis. **High-Yield Clinical Pearls for NEET-PG:** * **Most common histological type:** Clear Cell RCC (associated with VHL gene deletion on Chromosome 3p). * **Most common site of metastasis:** Lung ("Cannonball" secondaries). * **Triad of RCC:** Hematuria, Flank pain, and Palpable mass (seen in only 10% of cases, usually indicates advanced stage). * **Robson’s Staging:** An older staging system for RCC, now largely replaced by the TNM system.

Q: A 60-year-old male, a chronic smoker, presented with gross hematuria, pain in the left flank, along with a significant history of weight loss, fever, and shortness of breath for 3 months. On examination, a firm mass measuring about 5x5 cm was palpated in the left flank, and a left-sided varicocele was noted. Lab findings revealed anemia along with hypercalcemia. Kidney biopsy was performed. All of the following are approved treatments for the condition described, except:

Nilotinib. ### Explanation **Diagnosis: Metastatic Renal Cell Carcinoma (RCC)** The clinical presentation is a classic textbook case of **Renal Cell Carcinoma (RCC)**. The patient exhibits the "Too late triad" (Flank pain, Hematuria, and Palpable mass), systemic symptoms (weight loss, fever), and paraneoplastic syndromes (Hypercalcemia, Anemia). The **left-sided varicocele** is a high-yield sign caused by the tumor obstructing the left renal vein, into which the left gonadal vein drains. Shortness of breath suggests pulmonary metastasis. **Why Nilotinib is the Correct Answer:** * **Nilotinib** is a second-generation Tyrosine Kinase Inhibitor (TKI) specifically used for **Chronic Myeloid Leukemia (CML)**. It targets the BCR-ABL protein. It has no approved role in the management of RCC. **Why the other options are incorrect (Approved for RCC):** * **Sunitinib & Pazopanib (Options A & B):** These are multi-targeted TKIs that inhibit VEGF receptors. They are standard first-line targeted therapies for advanced or metastatic clear cell RCC. * **Temsirolimus (Option C):** This is an **mTOR inhibitor**. It is specifically indicated for patients with advanced RCC who have a poor prognosis (based on MSKCC/Heng criteria). **High-Yield Clinical Pearls for NEET-PG:** * **Most common histological type:** Clear cell RCC (originates from the Proximal Convoluted Tubule). * **Stauffer Syndrome:** Reversible hepatic dysfunction (elevated LFTs) in the absence of liver metastasis; a known paraneoplastic syndrome of RCC. * **Varicocele:** A right-sided varicocele is more concerning for an underlying mass because the right gonadal vein drains directly into the IVC; a new-onset left varicocele in an older male must always trigger a search for RCC. * **Treatment of Choice:** Radical Nephrectomy for localized disease; Targeted therapy (TKIs/mTOR inhibitors/Immunotherapy) for metastatic disease. RCC is notoriously **resistant** to chemotherapy and radiotherapy.

Q: A 21-year-old man presents with scrotal swelling and pain. What is the MOST likely diagnosis?

Torsion with an infarcted testicle. ***Torsion with an infarcted testicle*** - **Testicular torsion** beyond **12-24 hours** leads to complete **ischemic necrosis** and **infarction**, appearing **black/necrotic** grossly. - **Late presentation** with **infarcted testicle** requires **orchidectomy** rather than detorsion due to non-viable tissue and risk of complications. *Torsion with a blue testicle* - **Blue discoloration** indicates **early torsion** (typically **<6 hours**) where the testicle is still **viable** and salvageable. - **Blue color** suggests **venous congestion** without complete **arterial compromise** or tissue death. *Acute epididymo-orchitis* - Typically presents with **gradual onset** pain and swelling, often with **urinary symptoms** and **fever**. - **Cremasteric reflex** is usually **preserved**, and **elevation** of the scrotum may **relieve pain** (Prehn's sign). *Seminoma* - Presents as a **painless**, **firm testicular mass** rather than acute scrotal pain and swelling. - **Peak incidence** in **30-40 years** age group, and typically has **insidious onset** without acute inflammatory signs.

Question 1

Which of the following is NOT a radiolucent stone?

Accepted Answer

Cystine stones

Answer

Triamterene stones

Answer

Uric acid stone

Answer

Xanthine stones

Question 2

Which of the following is the MOST common histological variant of prostate cancer?

Accepted Answer

Adenocarcinoma

Answer

Sarcoma

Answer

Seminoma

Answer

Squamous cell carcinoma

Question 3

What is true about carcinoma of the bladder?

Accepted Answer

It is common in smokers.

Answer

It is mostly adenocarcinoma.

Answer

It is more common in females than in males.

Answer

Pain in the suprapubic region is the first symptom.

Question 4

All of the following are true for torsion of testes EXCEPT?

Accepted Answer

Cough impulse positive

Answer

Trauma to testes

Answer

Due to twisting of spermatic cord with respect to tunica vaginalis

Answer

Intravaginal torsion is commoner

Question 5

Which of the following statements about retroperitoneal fibrosis is FALSE?

Accepted Answer

It is more common in females.

Answer

The ureter is the most commonly involved structure.

Answer

The primary idiopathic form is called Ormond's disease.

Answer

Corticosteroids are the mainstay of treatment.

Question 6

What is the most important prognostic indicator for renal cell carcinoma?

Accepted Answer

Pathological staging

Answer

Nuclear grade

Answer

Histological type

Answer

Tumor size

Question 7

A 60-year-old male, a chronic smoker, presented with gross hematuria, pain in the left flank, along with a significant history of weight loss, fever, and shortness of breath for 3 months. On examination, a firm mass measuring about 5x5 cm was palpated in the left flank, and a left-sided varicocele was noted. Lab findings revealed anemia along with hypercalcemia. Kidney biopsy was performed. All of the following are approved treatments for the condition described, except:

Accepted Answer

Nilotinib

Answer

Sunitinib

Answer

Pazopanib

Answer

Temsirolimus

Question 8

A 21-year-old man presents with scrotal swelling and pain. What is the MOST likely diagnosis?

Accepted Answer

Torsion with an infarcted testicle

Answer

Torsion with a blue testicle

Answer

Acute epididymo-orchitis

Answer

Seminoma

Question 9

What is the treatment for a complete staghorn calculus with mild hydronephrosis?

Accepted Answer

Percutaneous Nephrolithotomy (PCNL)

Answer

Extracorporeal Shock Wave Lithotripsy (ESWL)

Answer

Ureteroscopy (URS)

Answer

Open Nephrolithotomy

Question 10

A paralyzed bladder following spinal injury is best managed by:

Accepted Answer

Foley's catheter

Answer

Gibbon's catheter

Answer

Malicot catheter

Answer

Metallic catheter

Urology — MCQs

Urology — MCQs

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