Urology Practice Questions

Q: A 40-year-old female with progressive left flank pain, no mass or fever. What is the next best step?

Ultrasound followed by non-contrast CT. ***Ultrasound followed by non-contrast CT*** - In a non-pregnant patient with classic symptoms of suspected **urolithiasis** (flank pain without systemic signs of infection), initial imaging often involves low-dose **non-contrast CT (NCCT)** of the abdomen and pelvis as the study of choice, - However, to minimize radiation exposure in appropriate clinical settings, an initial **ultrasound** can identify hydronephrosis; if the diagnosis remains uncertain or if complications are suspected, a **non-contrast CT** remains the gold standard to pinpoint stone size and location. *CECT followed by MRI* - **Contrast-enhanced CT (CECT)** is not typically indicated as the first step for suspected kidney stones because intravenous contrast can obscure small stones on the scan. - **MRI** is generally reserved for special populations like pregnant patients or those where radiation must be strictly avoided, and it is not the primary diagnostic tool for stone detection. *Contrast-enhanced CT abdomen* - **Intravenous contrast** is not required to diagnose nephrolithiasis and may actually make stones harder to visualize, as iodine density can mimic stone high-density appearance. - This study is more appropriate if one is ruling out vascular abnormalities, complex masses, or bowel pathology, rather than evaluating for uncomplicated flank pain. *Non-contrast CT followed by contrast CT* - An initial **non-contrast CT** is sufficient to diagnose most cases of nephrolithiasis; performing a follow-up **contrast CT** exposes the patient to unnecessary, excessive radiation and contrast-related risks. - **Contrast enhancement** should only be added if there is a suspicion of alternative pathologies (like complex cysts, tumors, or renal infarction) after the initial NCCT results are reviewed.

Q: A prostatic biopsy report reveals a Gleason score of 8 (4 + 4). What is the corresponding Grade Group classification of this tumor?

Grade Group 4. ***Grade Group 4*** - The current **Grade Group** system for prostate cancer consolidates Gleason scores into five groups; a **Gleason score of 8** corresponds directly to **Grade Group 4**. - The **International Society of Urological Pathology (ISUP)** developed this system to simplify prognosis and clinical decision-making based on biopsy specimens. *Grade Group 2* - This grade group refers to a **Gleason score of 3 + 4 = 7**. - It represents a **favorable intermediate-risk** tumor with 3 as the primary pattern. *Grade Group 3* - This classification corresponds to a **Gleason score of 4 + 3 = 7**. - It indicates a higher risk profile than Group 2, as the **predominant pattern is 4**. *Grade Group 5* - This group is assigned to **Gleason scores 9 and 10**. - It represents the most aggressive tumors with the highest potential for **distant metastasis** and poorer prognosis.

Q: What is the first-line treatment for overactive bladder?

Behavioural therapy. **Explanation:** **Overactive Bladder (OAB)** is a clinical syndrome characterized by urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence. **Why Behavioural Therapy is Correct:** According to the American Urological Association (AUA) and European Association of Urology (EAU) guidelines, **Behavioural Therapy is the first-line treatment** for OAB. It is non-invasive, has no systemic side effects, and is highly effective. It includes: * **Bladder training:** Scheduled voiding to increase bladder capacity. * **Pelvic floor muscle training (Kegel exercises):** To inhibit detrusor contractions. * **Lifestyle modifications:** Fluid management, caffeine reduction, and weight loss. **Analysis of Incorrect Options:** * **A. Antimuscarinic drugs (e.g., Oxybutynin, Tolterodine):** These are **second-line** treatments. They work by blocking M3 receptors on the detrusor muscle but are often limited by side effects like dry mouth, constipation, and blurred vision. * **C. Cholinergic drugs:** These (e.g., Bethanechol) stimulate bladder contraction and are used in urinary retention/hypotonic bladder, not OAB. OAB requires *anti*-cholinergics. * **D. Botulinum toxin type A:** This is a **third-line** treatment. It is reserved for patients refractory to behavioural and pharmacological therapies and is administered via intra-detrusor injection. **NEET-PG High-Yield Pearls:** * **Gold Standard Investigation:** Urodynamic study (shows detrusor overactivity). * **Mirabegron:** A $\beta_3$-adrenoceptor agonist, used as a second-line alternative to antimuscarinics (preferred in elderly to avoid cognitive side effects). * **Surgical Management:** Augmentation cystoplasty is the last resort for refractory cases.

Q: A 55-year-old smoker presents with a history of five episodes of macroscopic hematuria, each lasting for about 4-5 days over the past five years. Which of the following investigations should be performed to evaluate the suspected diagnosis?

Urine microscopy and cytology. **Explanation:** The clinical presentation of a 55-year-old smoker with recurrent episodes of painless macroscopic hematuria is highly suspicious for **Bladder Cancer (Urothelial Carcinoma)**. In any patient over 40 with painless hematuria, malignancy must be ruled out until proven otherwise. **Why Option A is correct:** **Urine cytology** is a critical initial screening tool for urothelial malignancy. It has high specificity (up to 95%) for detecting high-grade malignant cells shed into the urine. **Urine microscopy** is essential to confirm the presence of RBCs and rule out other causes like infection (pyuria) or glomerular disease (dysmorphic RBCs/casts). **Why other options are incorrect:** * **B. X-ray KUB:** Primarily used to detect radiopaque renal calculi. It has no role in diagnosing soft tissue bladder tumors. * **C. Ultrasound KUB:** While useful for screening the upper tract and identifying large bladder masses, it can miss small or flat (CIS) lesions. It is often an adjunct, but cytology is more specific for malignancy screening. * **D. DTPA Scan:** This is a nuclear medicine study used to assess the Glomerular Filtration Rate (GFR) and renal function/obstruction. It provides no diagnostic information regarding hematuria or malignancy. **Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Cystoscopy is the definitive investigation for bladder cancer as it allows direct visualization and biopsy. * **Risk Factors:** Smoking is the most significant risk factor for bladder cancer (linked to β-naphthylamine). * **Imaging of Choice:** For staging and upper tract evaluation, **CT Urography** is the preferred modality. * **Classic Triad:** Painless, intermittent, macroscopic hematuria in an elderly smoker = Bladder Cancer.

Question 1

Assertion (A): In a patient with scrotal swelling, examination of the superficial inguinal lymph
nodes should always be performed. Reason (R): Most lymphatic drainage from scrotal skin goes to
the superficial inguinal lymph nodes. Choose the correct option:

Accepted Answer

Both A and R are true, and R is the correct explanation of A

Answer

Both A and R are true, but R is not the correct explanation of A

Answer

A is true, but R is false

Answer

A is false, but R is true

Question 2

A 40-year-old female with progressive left flank pain, no mass or fever. What is the next best
step?

Accepted Answer

Ultrasound followed by non-contrast CT

Answer

CECT followed by MRI

Answer

Contrast-enhanced CT abdomen

Answer

Non-contrast CT followed by contrast CT

Question 3

A prostatic biopsy report reveals a Gleason score of 8 (4 + 4). What is the corresponding Grade
Group classification of this tumor?

Accepted Answer

Grade Group 4

Answer

Grade Group 2

Answer

Grade Group 3

Answer

Grade Group 5

Question 4

What is the first-line treatment for overactive bladder?

Accepted Answer

Behavioural therapy

Answer

Antimuscarinic drug

Answer

Cholinergic drug

Answer

Botulinum toxin type A

Question 5

A 55-year-old smoker presents with a history of five episodes of macroscopic hematuria, each lasting for about 4-5 days over the past five years. Which of the following investigations should be performed to evaluate the suspected diagnosis?

Accepted Answer

Urine microscopy and cytology

Answer

X-ray KUB

Answer

Ultrasound KUB

Answer

DTPA scan

Urology — MCQs

Urology — MCQs

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