Urology Practice Questions

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.

Q: What is the first symptom of tuberculosis of the kidney?

Increased frequency of micturition. **Explanation:** Genitourinary tuberculosis (GUTB) is almost always secondary to a primary focus in the lungs. The **earliest and most common symptom** of renal tuberculosis is **increased frequency of micturition**, which is often painless and progressive. **Why "Increased frequency of micturition" is correct:** In the early stages, frequency occurs due to the presence of mycobacteria and inflammatory products in the urine, which irritate the bladder mucosa. Initially, this is more pronounced at night (**nocturia**). As the disease progresses, the bladder wall undergoes fibrosis and cicatrization, leading to a "thimble bladder" (reduced capacity), which further worsens the frequency. A classic finding is **sterile pyuria** (pus cells in urine with no growth on routine culture). **Why other options are incorrect:** * **Hematuria:** While common (occurring in about 50% of cases), it is usually a later sign resulting from ulceration in the renal pelvis or bladder. * **Pain:** Pain is typically a late feature. It may manifest as a dull ache in the loin or "strangury" (painful micturition) once the bladder is extensively involved. Renal colic may occur if a clot or a piece of debris obstructs the ureter. * **Hesitancy:** This is a symptom of bladder outlet obstruction (e.g., BPH) and is not a characteristic feature of renal TB. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Culture on **Lowenstein-Jensen (LJ) medium** (takes 6–8 weeks). * **Earliest Radiological Sign:** "Moth-eaten" appearance of the calyces due to cortical necrosis. * **Putty Kidney:** A late-stage finding where the kidney is completely destroyed and replaced by caseous calcified material (autonephrectomy). * **Classic Triad:** Increased frequency + Sterile pyuria + Acid-fast bacilli (AFB) in urine.

Q: A 56-year-old smoker with renal clear cell carcinoma has LFTs showing SGOT/PT of 65/45 and ALP of 465. Abdominal ultrasound does not reveal liver metastasis. What is the likely diagnosis?

Stauffer's syndrome. ### **Explanation** The correct answer is **Stauffer’s syndrome**. **1. Understanding the Correct Answer:** Stauffer’s syndrome is a **paraneoplastic syndrome** associated with Renal Cell Carcinoma (RCC). It is characterized by **non-metastatic hepatic dysfunction** in the absence of direct liver involvement or biliary obstruction. * **Pathophysiology:** It is believed to be caused by the systemic release of cytokines, particularly **Interleukin-6 (IL-6)**, which affects liver function. * **Clinical Presentation:** Patients typically show elevated **Alkaline Phosphatase (ALP)**, prolonged prothrombin time, and hypoalbuminemia. Transaminases (SGOT/PT) are usually only mildly elevated. * **Key Feature:** The liver function tests (LFTs) typically normalize following a radical nephrectomy (removal of the primary tumor). **2. Why Other Options are Incorrect:** * **Hutchinson's Syndrome:** Refers to orbital metastases from Neuroblastoma (typically in children), leading to proptosis and periorbital ecchymosis ("raccoon eyes"). * **Goldenhar Syndrome:** A congenital condition (Oculo-Auriculo-Vertebral dysplasia) characterized by hemifacial microsomia, ear abnormalities, and epibulbar dermoids. * **Cornelia de Lange Syndrome:** A genetic disorder characterized by intellectual disability, growth retardation, and distinctive facial features (synophrys/joined eyebrows). **3. NEET-PG High-Yield Pearls:** * **RCC Paraneoplastic Syndromes:** RCC is known as the "Internist's Tumor" because it produces many syndromes: Polycythemia (via Erythropoietin), Hypercalcemia (via PTHrP), and Hypertension (via Renin). * **Stauffer’s Variant:** A rare variant exists where cholestatic jaundice occurs; if LFTs do *not* normalize after nephrectomy, it suggests a poor prognosis or occult metastasis. * **Smoker + Hematuria/Mass + High ALP (with normal imaging):** Always think of Stauffer’s syndrome in a surgical context.

Q: What is the best screening marker for prostate cancer?

Prostate-specific antigen. **Explanation:** **Prostate-specific antigen (PSA)** is the correct answer because it is the most widely used and effective screening marker for prostate cancer. PSA is a serine protease enzyme produced by the ductal and acinar epithelium of the prostate gland. While it is organ-specific, it is not cancer-specific (levels can rise in BPH, prostatitis, or after instrumentation). However, a threshold of **>4 ng/mL** is traditionally used to prompt further investigation, such as a digital rectal examination (DRE) and biopsy. **Analysis of Incorrect Options:** * **Alpha-fetoprotein (AFP):** A marker used for Hepatocellular Carcinoma (HCC) and non-seminomatous germ cell tumors (NSGCT) of the testis (e.g., Yolk sac tumor). * **CA 19-9:** Primarily used as a tumor marker for pancreatic adenocarcinoma and some hepatobiliary cancers. * **CA 125:** The standard marker for monitoring and screening (in high-risk cases) epithelial ovarian cancer. **High-Yield Clinical Pearls for NEET-PG:** * **PSA Velocity:** An increase in PSA level of **>0.75 ng/mL per year** is highly suggestive of malignancy, even if the absolute value is <4 ng/mL. * **Free-to-Total PSA Ratio:** A lower ratio (typically ** 0.15** is suspicious.

Q: Which is the most common risk factor for Renal Cell Carcinoma (RCC)?

Smoking. **Explanation:** **Renal Cell Carcinoma (RCC)**, specifically the clear cell subtype, is the most common primary renal malignancy. Among the various modifiable risk factors, **Smoking** is considered the most significant and established risk factor. 1. **Why Smoking is Correct:** Tobacco use has a dose-dependent relationship with RCC. It is estimated that smoking doubles the risk of developing renal cancer. The mechanism involves the systemic absorption of carcinogens (like polycyclic aromatic hydrocarbons) which are filtered by the kidneys, leading to chronic urothelial irritation and DNA damage. 2. **Why Incorrect Options are Wrong:** * **Urinary Tract Infection (UTI) & Renal Calculi:** While chronic irritation from stones or infections is a known risk factor for **Squamous Cell Carcinoma** of the renal pelvis or bladder, they are not primary drivers for RCC (which arises from the tubular epithelium). * **Hypertension:** Hypertension is indeed an independent risk factor for RCC, but statistically, smoking remains the more prevalent and potent contributor in epidemiological studies. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Subtype:** Clear Cell RCC (arises from the **Proximal Convoluted Tubule**). * **Genetic Association:** Deletion of the **VHL gene** on Chromosome 3p. * **Classic Triad:** Hematuria, Flank pain, and Palpable mass (seen in only 10% of cases; usually signifies advanced disease). * **Other Risk Factors:** Obesity (especially in women), Occupational exposure to Cadmium/Asbestos, and Acquired Cystic Kidney Disease (ACKD) in dialysis patients. * **Paraneoplastic Syndromes:** RCC is the "Internist's Tumor" because it frequently produces EPO (Polycythemia), PTHrP (Hypercalcemia), and Renin (Hypertension).

Q: The Gail model of risk assessment is used for which of the following conditions?

Carcinoma of the breast. **Explanation:** The **Gail Model** (also known as the Breast Cancer Risk Assessment Tool) is a statistical model used to estimate a woman's risk of developing invasive breast cancer over the next 5 years and over her lifetime (up to age 90). It is the most widely used risk assessment tool in clinical practice for breast cancer. **Why Option C is correct:** The model incorporates specific personal and family history factors to calculate risk, including: * Current age * Age at menarche * Age at first live birth * Number of first-degree relatives with breast cancer * Number of previous benign breast biopsies * Presence of atypical hyperplasia on biopsy **Why other options are incorrect:** * **Carcinoma of the stomach (A) and Esophagus (B):** These do not use the Gail model. Risk assessment for GI malignancies typically relies on endoscopic surveillance (e.g., for Barrett's esophagus) or screening for *H. pylori* and genetic syndromes like HDGC (CDH1 mutation). * **Carcinoma of the prostate (D):** Risk assessment for prostate cancer primarily utilizes the **PSA (Prostate-Specific Antigen)** levels, Digital Rectal Examination (DRE), and tools like the **Partin Tables** or **MSKCC Nomograms** to predict pathological stage and prognosis. **High-Yield Clinical Pearls for NEET-PG:** * **Cut-off point:** A 5-year risk score of **≥ 1.67%** is considered "high risk" and is the threshold used to discuss chemoprevention (e.g., Tamoxifen or Raloxifene). * **Limitation:** The Gail model **underestimates** risk in women with hereditary syndromes like BRCA1/2 mutations. For these patients, the **Claus model** or **BRCAPRO** is preferred. * **BI-RADS:** Remember that BI-RADS is for *radiological reporting*, while Gail is for *clinical risk assessment*.

Q: Secondary vesical calculus refers to stones formed due to which of the following?

Infection. **Explanation:** Vesical calculi (bladder stones) are classified into two types based on their site of origin and etiology: **Primary** and **Secondary**. **Why C is Correct:** **Secondary vesical calculi** are stones that form *de novo* within the bladder due to pre-existing bladder pathology. The most common causes are **urinary stasis** (e.g., Benign Prostatic Hyperplasia, urethral stricture) and **chronic urinary tract infection (UTI)**. Infections caused by urea-splitting organisms (like *Proteus* or *Klebsiella*) increase urinary pH, leading to the precipitation of magnesium ammonium phosphate, forming **struvite or triple phosphate stones**. **Why Other Options are Incorrect:** * **A. Hypercalciuria:** This is a metabolic abnormality that typically leads to the formation of **Primary** calculi (stones forming in sterile, non-obstructed urine). * **B. Injury:** While a foreign body (like a non-absorbable suture or fragment from an injury) can act as a nidus for a stone, "Injury" itself is not the standard definition for secondary stones. * **D. Migrating from kidney:** These are termed **Migratory calculi**. Although they are found in the bladder, they originated in the renal pelvis and are not considered "secondary" bladder stones in the classic surgical classification. **High-Yield Clinical Pearls for NEET-PG:** * **Primary Vesical Calculi:** Usually seen in children; often composed of ammonium acid urate or calcium oxalate; associated with low-protein, low-phosphate diets. * **Secondary Vesical Calculi:** Usually seen in adult males; associated with **BPH** (most common cause of stasis). * **Classic Symptom:** "Interruption of urinary stream" or "Pain at the end of micturition" referred to the tip of the penis (due to the stone hitting the sensitive trigone). * **Investigation of Choice:** Non-contrast CT (NCCT) is most sensitive, but Ultrasound is often the initial screening tool.

Question 1

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 2

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 3

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

Question 4

A 30-year-old male presents with right flank pain and hematuria. A CECT abdomen reveals an 8x8 cm solid mass in the right kidney and a 3x3 cm solid mass in the upper pole of the left kidney. What is the most appropriate surgical treatment for this patient?

Accepted Answer

Right radical nephrectomy and left partial nephrectomy

Answer

Bilateral radical nephrectomy

Answer

Right radical nephrectomy and biopsy of the mass from the opposite kidney

Question 5

What is the first symptom of tuberculosis of the kidney?

Accepted Answer

Increased frequency of micturition

Answer

Hematuria

Answer

Hesitancy

Answer

Pain

Question 6

A 56-year-old smoker with renal clear cell carcinoma has LFTs showing SGOT/PT of 65/45 and ALP of 465. Abdominal ultrasound does not reveal liver metastasis. What is the likely diagnosis?

Accepted Answer

Stauffer's syndrome

Answer

Hutchinson's syndrome

Answer

Goldenhar Syndrome

Answer

Cornelia de Lange Syndrome

Question 7

What is the best screening marker for prostate cancer?

Accepted Answer

Prostate-specific antigen

Answer

Alpha-fetoprotein

Answer

CA 19-9

Answer

CA 125

Question 8

Which is the most common risk factor for Renal Cell Carcinoma (RCC)?

Accepted Answer

Smoking

Answer

Urinary tract infection

Answer

Renal calculi

Answer

Hypertension

Question 9

The Gail model of risk assessment is used for which of the following conditions?

Accepted Answer

Carcinoma of the breast

Answer

Carcinoma of the stomach

Answer

Carcinoma of the esophagus

Answer

Carcinoma of the prostate

Question 10

Secondary vesical calculus refers to stones formed due to which of the following?

Accepted Answer

Infection

Answer

Hypercalciuria

Answer

Injury

Answer

Migrating from kidney

Urology — MCQs

Urology — MCQs

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