Urology Practice Questions

Q: BCG is used for the treatment of:

Treatment of superficial bladder cancer. ***Treatment of superficial bladder cancer*** - **BCG (Bacille Calmette-Guérin)** is a live attenuated strain of *Mycobacterium bovis* that is effective as an **immunotherapy** for superficial bladder cancer. - It is instilled directly into the bladder, triggering a localized immune response that targets and destroys cancer cells, preventing recurrence and progression. *Treatment of tuberculosis* - While BCG is derived from *Mycobacterium bovis*, it is primarily used as a **vaccine** to prevent severe forms of tuberculosis, especially in children, rather than a treatment for active disease. - Active tuberculosis is typically treated with a multi-drug regimen of **antibiotics**, not BCG. *Treatment of anthrax* - Anthrax is caused by **Bacillus anthracis** and is treated with specific **antibiotics** such as ciprofloxacin or doxycycline. - **BCG has no role** in the treatment of anthrax. *All of the options* - As BCG is not used for the treatment of tuberculosis or anthrax, this option is incorrect. - Its established therapeutic use is primarily in the management of superficial bladder cancer.

Q: Most common cause of urinary obstruction in a male infant is -

Posterior urethral valves. ***Posterior urethral valves*** - **Posterior urethral valves (PUV)** are the most common cause of significant **urinary tract obstruction** in male infants and are a congenital anomaly. - They are a membrane-like structure in the **posterior urethra** that obstructs urine outflow from the bladder. *Stone* - **Urinary stones** are a less common cause of obstruction in infants and are often associated with metabolic disorders or anatomical abnormalities. - While they can cause obstruction, they are not the most frequent cause in male infants. *Anterior urethral valves* - **Anterior urethral valves (AUV)** are a much rarer cause of urethral obstruction than PUV. - They occur more distally in the urethra and typically present with a **dilated anterior urethra**. *Stricture* - **Urethral strictures** in infants are usually acquired due to trauma, instrumentation, or infection, rather than being congenital. - They are less common than PUV as a primary cause of congenital urinary obstruction.

Q: A lady underwent vaginal hysterectomy for Carcinoma cervix. Following the surgery after her urethral catheter was removed, she complained of urinary incontinence. On examination she had normal voiding as well as continuous incontinence. Methylene blue dye was instilled in her bladder through her urethra and she was given oral Phenazopyridine dye. After some time her pads were checked and it showed yellow staining at the top most pad, while the middle or bottom pads were unstained. She is likely to have:

Ureterovaginal fistula. ***Ureterovaginal fistula*** - The **yellow staining** on the topmost pad, resulting from oral **Phenazopyridine** excreted by the kidneys, indicates that the urine is bypassing the bladder and leaking into the vagina directly from a ureter. - The **negative methylene blue test** (no blue staining) rules out bladder involvement, confirming that the leak is from a higher part of the urinary tract (ureter). *Vesicouterine fistula* - This type of fistula involves a communication between the **bladder and the uterus**, which is not relevant in a patient who has undergone a hysterectomy. - The presence of continuous incontinence with a normal voiding pattern would not typically be seen with this type of fistula, especially after hysterectomy. *Vesicovaginal fistula* - If a vesicovaginal fistula were present, the patient's pads would show **blue staining** from the methylene blue instilled into the bladder, indicating a direct leak from the bladder into the vagina. - The absence of blue staining in the pads rules out this diagnosis. *Urethrovaginal fistula* - A urethrovaginal fistula would involve a connection between the **urethra and the vagina**, typically leading to leakage of urine from the urethra. - While it causes incontinence, the specific finding of **yellow staining from oral Phenazopyridine** without blue staining from bladder instillation points away from a urethral source.

Q: Posterior urethral valve is diagnosed on micturating cystourethrogram by-

Dilatation of posterior urethra. ***Dilatation of posterior urethra*** - **Posterior urethral valves (PUV)** create an obstruction in the **posterior urethra**, leading to its characteristic dilatation during micturition due to increased pressure. - This **dilatation** is a direct radiographic sign of the anatomical obstruction caused by the valves. *Bladder wall hypertrophy* - **Bladder wall hypertrophy** is a secondary change that occurs over time due to the bladder working harder against the obstruction caused by PUV, but it is not the primary diagnostic feature on a micturating cystourethrogram (MCU). - While present in many cases of PUV, it indicates chronic obstruction rather than directly imaging the valves themselves. *Bladder neck contracture* - **Bladder neck contracture** is a narrowing at the exit of the bladder, which is a different anatomical obstruction than PUV. - The primary pathology in PUV is within the **posterior urethra**, distal to the bladder neck. *Vesico-Ureteric reflux* - **Vesico-ureteric reflux (VUR)** is the retrograde flow of urine from the bladder into the ureters and kidneys, which is a common associated finding with PUV due to the high bladder pressures. - While often seen in PUV, VUR is a complication or associated condition, not the direct diagnostic indicator of the valves themselves.

Q: A 70 year old patient with benign prostatic hyperplasia underwent transurethral resection of prostate under spinal anaesthesia. One hour later, he developed vomiting and altered sensorium. Which of the following is the most probable cause?

Water intoxication (TURP syndrome). ***Water intoxication (TURP syndrome)*** - **Transurethral resection of the prostate (TURP)** uses a hypotonic irrigation solution, which can be absorbed through venous sinuses opened during resection. - This absorption leads to **dilutional hyponatremia** and **fluid overload**, causing symptoms such as vomiting, altered sensorium, and even seizures or coma, collectively known as **TURP syndrome**. *Hyperkalemia* - **Hyperkalemia** is not a common complication of TURP. While irrigation solutions can cause electrolyte imbalances, they usually lead to dilutional hyponatremia, not elevated potassium. - Symptoms of hyperkalemia typically include **cardiac arrhythmias** and muscle weakness, not primarily vomiting and altered sensorium in this rapid onset. *Over dosage of spinal anaesthetic agent* - An overdose of spinal anesthetic agent would likely manifest earlier during or immediately after the spinal injection, with symptoms like **hypotension**, **bradycardia**, or **respiratory depression**. - **Altered sensorium** and vomiting occurring one hour post-procedure with intact initial recovery from anesthesia are less typical for acute spinal overdose. *Rupture of bladder* - A **bladder rupture** during TURP would typically present with acute lower abdominal pain, abdominal distension, and signs of **peritonitis**, or oliguria/anuria. - While it can cause systemic effects, vomiting and altered sensorium as the primary symptoms one hour later are not the most characteristic presentation for bladder perforation.

Q: A man is brought to the emergency after he fell into a man hole and injured his perineum. He feels the urge to micturate but is unable to pass urine and there is blood at the tip of the meatus with extensive swelling of the penis and scrotum. What is the location of the injury?

Bulbar urethra. ***Bulbar urethra*** - Injury to the **bulbar (spongy) urethra** in the perineum, often from a straddle injury or fall into a manhole, typically causes the extravasation of urine and blood into the **superficial perineal pouch**. - This leads to **extensive swelling of the penis and scrotum** (butterfly hematoma) because the superficial perineal fascia (Colles' fascia) is continuous with dartos fascia of the penis and scrotum, preventing blood from extending into the thighs or abdominal wall, combined with an inability to micturate with blood at the meatus. *Membranous urethra* - Injury to the **membranous urethra** is usually associated with **pelvic fractures** and tends to cause extravasation into the **deep perineal space** and then the retroperitoneum, leading to swelling in the lower abdomen or around the anus, not primarily the penis and scrotum. - While it can cause inability to micturate and blood at the meatus, the characteristic extensive swelling of the penis and scrotum points away from this location. *Prostatic urethra* - Injuries to the **prostatic urethra** are rare and typically occur with **severe pelvic crush injuries** given its protected position deep within the pelvis. - While it would cause inability to urinate, the nature of the fall and the distribution of swelling (predominantly penis and scrotum) are not typical for prostatic urethral injury. *Bladder* - A bladder injury from a fall would likely present with suprapubic pain and hematuria, but the inability to urinate combined with **blood at the meatus** and extensive swelling limited to the penis and scrotum is not characteristic of isolated bladder trauma. - **Blood at the meatus** is a classic sign of urethral, not typically bladder, injury.

Q: A patient presents with a palpable mass in the right scrotum, separate from and above the testis. Ultrasound confirms a diagnosis of varicocele. Which structure is most likely involved?

Spermatic cord. ***Spermatic cord*** - A **varicocele** is defined as the dilation of the **pampiniform venous plexus**, which is a network of veins found within the spermatic cord. - The dilated veins in the spermatic cord are responsible for the **palpable mass** and the characteristic "bag of worms" sensation associated with varicocele. *Vas deferens* - The **vas deferens** is a muscular tube that transports sperm from the epididymis to the ejaculatory duct; it is not directly involved in varicocele formation. - While it is a component of the spermatic cord, a varicocele specifically refers to the **venous dilation**, not the vas deferens itself. *Prostate* - The **prostate gland** is located below the bladder and encircles the urethra, playing a role in semen production, but it is anatomically separate from the testis and the spermatic cord. - Prostate issues would typically present with **urinary symptoms** or pelvic pain, not a scrotal mass of dilated veins. *Epididymis* - The **epididymis** is a coiled tube located on the posterior aspect of the testis, responsible for sperm maturation and storage. - While it can be affected by conditions like epididymitis (inflammation), it is not the primary structure involved in the venous dilation characteristic of a varicocele.

Q: A 45-year-old man presents with gross hematuria and a palpable abdominal mass. A CT scan reveals a renal mass with metastasis to the lungs. What is the most appropriate treatment strategy for this patient?

Total nephrectomy and immunotherapy. **Total nephrectomy and immunotherapy** - The presence of a **palpable abdominal mass**, gross hematuria, and **pulmonary metastases** indicates advanced renal cell carcinoma, making **total nephrectomy** essential for tumor burden reduction. - **Immunotherapy** (e.g., PD-1 inhibitors) is the first-line systemic treatment for metastatic renal cell carcinoma, offering improved survival outcomes compared to traditional chemotherapy. *Partial nephrectomy and radiation therapy* - **Partial nephrectomy** is typically reserved for smaller, localized renal masses to preserve renal function, which is not indicated in the presence of **metastatic disease**. - **Radiation therapy** has a limited role in the primary treatment of renal cell carcinoma and is mostly used for **palliative care** for bone or brain metastases, not as a primary treatment for the renal tumor. *Transplantation with immunosuppression* - **Kidney transplantation** is only considered in patients with end-stage renal disease (ESRD) and no malignancy, or in highly selected cases of small, localized renal tumors in the explanted kidney, not for **metastatic cancer**. - **Immunosuppression** in the context of transplantation would actually be detrimental in a patient with metastatic cancer as it could accelerate tumor growth. *Chemotherapy only* - **Renal cell carcinoma** is notoriously **chemotherapy-resistant**, making it ineffective as a primary treatment for metastatic disease. - Targeted therapies or **immunotherapy** have largely replaced chemotherapy in the management of advanced renal cell carcinoma due to superior efficacy.

Q: A 30-year-old male presents with an acute onset of severe scrotal pain. The scrotum is swollen and tender. What is the most likely diagnosis?

Testicular torsion. ***Testicular torsion*** - The sudden onset of **severe scrotal pain** in a young male, accompanied by **swelling and tenderness**, is highly suggestive of testicular torsion. - Testicular torsion is a **surgical emergency** requiring prompt intervention to preserve testicular viability. *Epididymitis* - While epididymitis also causes scrotal pain and swelling, its onset is typically more **gradual** and is often associated with **dysuria or fever**. - Physical examination may reveal a **positive Prehn's sign** (pain relief with elevation of the testicle), which is usually absent in torsion. *Hydrocele* - A hydrocele is a collection of fluid around the testis, usually presenting as a **painless scrotal swelling** that can be transilluminated. - It does not typically cause acute, severe pain unless it becomes infected or acutely enlarges due to trauma. *Inguinal hernia* - An inguinal hernia can cause scrotal swelling, but the pain is often described as a **dull ache** or a feeling of heaviness, especially with straining, rather than acute severe pain. - A hernia typically presents as a **reducible mass** that may extend into the scrotum.

Q: A 45-year-old man presents with a painless, enlarged scrotum. The transillumination test reveals a cystic mass. What is the most likely diagnosis?

Hydrocele. ***Hydrocele*** - A **hydrocele** is a collection of fluid in the **tunica vaginalis**, which typically presents as a **painless, enlarged scrotum** that transilluminates. - The **transillumination test** is positive because the fluid within the hydrocele allows light to pass through. *Inguinal hernia* - An **inguinal hernia** usually presents as a scrotal swelling that does not transilluminate and may be **reducible**. - It involves the protrusion of abdominal contents, not fluid, into the scrotum. *Varicocele* - A **varicocele** is an enlargement of the **pampiniform plexus veins** within the scrotum, often described as feeling like a "bag of worms." - It does not transilluminate and is more commonly associated with a dull ache or heaviness, and can be associated with infertility. *Testicular torsion* - **Testicular torsion** is an acute, painful condition caused by the twisting of the **spermatic cord**, leading to inadequate blood flow to the testis. - It is characterized by sudden, severe pain and tenderness, and is a medical emergency that does not transilluminate.

Question 1

BCG is used for the treatment of:

Accepted Answer

Treatment of superficial bladder cancer

Answer

Treatment of tuberculosis

Answer

Treatment of anthrax

Answer

All of the options

Question 2

Most common cause of urinary obstruction in a male infant is -

Accepted Answer

Posterior urethral valves

Answer

Stone

Answer

Anterior urethral valves

Answer

Stricture

Question 3

A lady underwent vaginal hysterectomy for Carcinoma cervix. Following the surgery after her urethral catheter was removed, she complained of urinary incontinence. On examination she had normal voiding as well as continuous incontinence. Methylene blue dye was instilled in her bladder through her urethra and she was given oral Phenazopyridine dye. After some time her pads were checked and it showed yellow staining at the top most pad, while the middle or bottom pads were unstained. She is likely to have:

Accepted Answer

Ureterovaginal fistula

Answer

Vesicouterine fistula

Answer

Vesicovaginal fistula

Answer

Urethrovaginal fistula

Question 4

Posterior urethral valve is diagnosed on micturating cystourethrogram by-

Accepted Answer

Dilatation of posterior urethra

Answer

Bladder wall hypertrophy

Answer

Bladder neck contracture

Answer

Vesico-Ureteric reflux

Question 5

A 70 year old patient with benign prostatic hyperplasia underwent transurethral resection of prostate under spinal anaesthesia. One hour later, he developed vomiting and altered sensorium. Which of the following is the most probable cause?

Accepted Answer

Water intoxication (TURP syndrome)

Answer

Hyperkalemia

Answer

Overdose of spinal anaesthetic agent

Answer

Rupture of bladder

Question 6

A man is brought to the emergency after he fell into a man hole and injured his perineum. He feels the urge to micturate but is unable to pass urine and there is blood at the tip of the meatus with extensive swelling of the penis and scrotum. What is the location of the injury?

Accepted Answer

Bulbar urethra

Answer

Membranous urethra

Answer

Prostatic urethra

Answer

Bladder

Question 7

A patient presents with a palpable mass in the right scrotum, separate from and above the testis. Ultrasound confirms a diagnosis of varicocele. Which structure is most likely involved?

Accepted Answer

Spermatic cord

Answer

Vas deferens

Answer

Prostate

Answer

Epididymis

Question 8

A 45-year-old man presents with gross hematuria and a palpable abdominal mass. A CT scan reveals a renal mass with metastasis to the lungs. What is the most appropriate treatment strategy for this patient?

Accepted Answer

Total nephrectomy and immunotherapy

Answer

Partial nephrectomy and radiation therapy

Answer

Transplantation with immunosuppression

Answer

Chemotherapy only

Question 9

A 30-year-old male presents with an acute onset of severe scrotal pain. The scrotum is swollen and tender. What is the most likely diagnosis?

Accepted Answer

Testicular torsion

Answer

Epididymitis

Answer

Hydrocele

Answer

Inguinal hernia

Question 10

A 45-year-old man presents with a painless, enlarged scrotum. The transillumination test reveals a cystic mass. What is the most likely diagnosis?

Accepted Answer

Hydrocele

Answer

Inguinal hernia

Answer

Varicocele

Answer

Testicular torsion

Urology — MCQs

Urology — MCQs

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