Urology — MCQs

Urology Indian Medical PG Practice Questions and MCQs

Question 1001: Radical nephrectomy involves resection of the following structures, which one is not typically resected?

A. Gerota's fascia
B. Surrounding hilar lymph nodes
C. Proximal para-aortic lymph nodes (Correct Answer)
D. Ipsilateral adrenal gland (in classical approach)

Explanation: ***Proximal para-aortic lymph nodes*** - **Proximal para-aortic lymph nodes** are NOT routinely resected during radical nephrectomy unless there is evidence of gross nodal involvement on imaging or intraoperatively. - The extent of lymph node dissection is tailored to individual disease burden; hilar and regional nodes are addressed, but distant nodal groups like proximal para-aortic nodes are only resected when clearly involved. - Extended lymphadenectomy to proximal para-aortic regions is not part of standard radical nephrectomy. *Gerota's fascia* - **Gerota's fascia** (perirenal fascia) is **always resected** in radical nephrectomy as it encases the kidney and perirenal fat. - En bloc resection of Gerota's fascia with the kidney ensures complete tumor removal, clear margins, and prevents tumor spillage. - This is a defining component of "radical" versus "simple" nephrectomy. *Ipsilateral adrenal gland (in classical approach)* - In **classical radical nephrectomy** (Campbell-Walsh traditional description), the ipsilateral adrenal gland was routinely removed due to proximity and concern for tumor extension. - **Modern practice** has shifted to adrenal-sparing nephrectomy as the standard, with adrenalectomy reserved for upper pole tumors with direct invasion, bulky tumors, or imaging abnormalities. - For this question's context of "classical radical nephrectomy," the adrenal gland **IS typically resected** in the traditional approach. *Surrounding hilar lymph nodes* - **Hilar lymph nodes** are routinely resected during radical nephrectomy for staging and regional disease control. - These nodes are the first-line lymphatic drainage sites and their removal is integral to proper oncologic surgery. - Hilar lymphadenectomy is a standard component of radical nephrectomy.

Question 1002: Normal urine flow rate in healthy adults in urodynamic study is -

A. 10 ml/sec
B. 5 ml/sec
C. 20 ml/sec (Correct Answer)
D. 25 ml/sec

Explanation: ***20 ml/sec*** - A peak urinary flow rate of **20 mL/second** is considered normal in healthy adult males when voiding a volume of 200 mL or more. - In women, a maximum flow rate above **25 mL/second** is considered normal when voiding similar volumes. *10 ml/sec* - A maximum flow rate of less than **15 mL/second** is commonly considered to suggest significant bladder outlet obstruction in men. - This value is generally indicative of a potentially abnormal urinary flow, requiring further investigation. *25 ml/sec* - While **25 mL/second** or more is considered normal for women, for men, this rate is at the higher end of the normal range and not the average healthy adult flow rate. - This option is more typically associated with unimpeded flow in females, not the general population of healthy adults. *5 ml/sec* - A flow rate of **5 mL/second** is significantly below the normal range for healthy adults and would suggest a severe urinary obstruction or very poor detrusor function. - This value is usually seen in patients with significant bladder outlet obstruction or compromised bladder muscle function.

Question 1003: What is the most appropriate treatment for a patient with symptomatic bladder stones?

A. Transurethral litholapaxy (Correct Answer)
B. Percutaneous suprapubic litholapaxy
C. Vesicotomy and stone retrieval
D. Intravenous antibiotics

Explanation: ***Transurethral litholapaxy*** - This procedure involves inserting a **cystoscope** through the urethra into the bladder to visualize and then fragment the stone using various energy sources (e.g., laser, pneumatic, ultrasound). - The fragmented pieces are then irrigated and removed, offering a **minimally invasive** and highly effective treatment for most bladder stones. *Percutaneous suprapubic litholapaxy* - This method is typically reserved for very **large or complex bladder stones** that are difficult to manage transurethrally. - It involves accessing the bladder directly through a **suprapubic incision**, which is more invasive than the transurethral approach. *Vesicotomy and stone retrieval* - A **vesicotomy** (open surgical incision into the bladder) is a more invasive procedure, usually considered when other less invasive methods have failed or are not feasible. - This approach carries higher risks, including **longer recovery times** and potential for greater complications compared to endoscopic options. *Intravenous antibiotics* - **Antibiotics** are used to treat or prevent urinary tract infections that may be associated with bladder stones, but they do not remove or dissolve the stones themselves. - While infection may be a concurrent issue, antibiotics alone **do not address the physical obstruction** or symptomatic cause of bladder stones.

Question 1004: What is the main hazard of ectopic testis -

A. Risk of carcinoma development (Correct Answer)
B. Increased risk of impotence
C. Risk of hernia development
D. Liable to injury

Explanation: ***Risk of carcinoma development*** - Ectopic testis, like undescended testis (cryptorchidism), carries an **increased risk of germ cell tumors**, particularly **seminoma**. - An **ectopic testis** is one that has descended but deviated from the normal path and is located in an abnormal position (superficial inguinal pouch, perineum, femoral triangle, etc.). - While the malignancy risk in ectopic testis may be **slightly lower than true cryptorchidism**, it remains the **most significant long-term hazard**. - The increased risk is attributed to **abnormal testicular development** and **dysgenesis**, leading to potential malignant transformation. - Risk is estimated at **4-10 times higher** than normally descended testes. *Increased risk of impotence* - Ectopic testes can affect **fertility** due to impaired spermatogenesis from abnormal positioning and higher temperatures. - However, they do **not directly cause impotence** (erectile dysfunction). - Impotence relates to inability to achieve or maintain erection, which is a vascular, neurological, or psychological issue, not affected by testicular position. *Risk of hernia development* - An **inguinal hernia** can be associated with undescended testis if the processus vaginalis remains patent. - An ectopic testis, having deviated outside the normal path of descent, does **not typically predispose to hernia** formation in the same manner. - This is not the primary concern with ectopic testis. *Liable to injury* - An ectopic testis located in superficial positions (superficial inguinal pouch, perineum) is **more vulnerable to trauma** than a normally descended scrotal testis. - While trauma risk is a legitimate concern, it is **secondary** to the long-term risk of **malignancy**. - The risk of cancer development far outweighs the risk of traumatic injury in clinical significance.

Question 1005: A 40-year-old male presents with translucent scrotal swelling in which it is possible to get above the swelling on examination. What is the most probable diagnosis?

A. Hydrocele (Correct Answer)
B. Indirect inguinal hernia
C. Varicocele
D. Sebaceous cyst

Explanation: ***Hydrocele*** - A **hydrocele** is characterized by a translucent scrotal swelling because it contains **serous fluid**, allowing light to pass through. - The ability to **get above the swelling** on examination indicates that it is confined to the scrotum and not extending into the inguinal canal, differentiating it from an indirect inguinal hernia. *Indirect inguinal hernia* - An **indirect inguinal hernia** is a protrusion of abdominal contents through the deep inguinal ring into the scrotum, meaning it would **not be possible to get above the swelling**. - It would typically be **non-translucent** as it contains bowel or omentum, not serous fluid. *Varicocele* - A **varicocele** is a collection of dilated veins in the pampiniform plexus, often described as a **"bag of worms"** on palpation, and is typically not translucent. - While located in the scrotum, it is usually distinguishable by its **palpable vascular nature** and often changes with Valsalva maneuver. *Sebaceous cyst* - A **sebaceous cyst** is a benign growth filled with keratinous material, originating from a blocked sebaceous gland. - It would be a **firm, non-translucent lump** and not a generalized scrotal swelling that allows light transmission.

Question 1006: Which type of renal stone is known to have less satisfactory results with extracorporeal shock wave lithotripsy (ESWL)?

A. Oxalate stone
B. Phosphate stone
C. Urate stone
D. Cystine stone (Correct Answer)

Explanation: ***Cystine stone*** - **Cystine stones** are known for their high **elasticity** and durable molecular bonds, making them resistant to fragmentation by **extracorporeal shock wave lithotripsy (ESWL)**. - Their physical properties result in **less satisfactory fragmentation rates** compared to other stone types, often requiring multiple ESWL sessions or alternative treatments. *Oxalate stone* - **Calcium oxalate stones** are generally **amenable to ESWL**, especially smaller ones, as they tend to fragment well. - They are the **most common type of kidney stone**, and ESWL is a primary treatment modality for many of these. *Phosphate stone* - **Calcium phosphate stones** (e.g., brushite, apatite) and **struvite stones** also tend to respond reasonably well to ESWL. - While sometimes harder than oxalate stones, they usually **fragment effectively** with shock waves. *Urate stone* - **Uric acid stones** are typically **radiolucent** but generally respond well to ESWL, often fragmenting into small pieces. - They can also be dissolved with **urinary alkalinization**, which is a unique therapeutic option for this stone type.

Question 1007: What is the most common site of penile carcinoma?

A. Glans (Correct Answer)
B. Prepuce
C. Shaft
D. Coronal sulcus

Explanation: ***Glans*** - The **glans penis** is the most frequent site of origin for penile carcinoma due to its exposure and susceptibility to chronic irritation and inflammation. - Approximately **50-70%** of penile cancers originate on the glans. *Prepuce* - The **prepuce** (foreskin) is the second most common site, often affected in uncircumcised males, but less frequently than the glans itself. - Carcinomas here often develop at the **mucocutaneous junction** of the prepuce. *Shaft* - The **penile shaft** is a much less common site for penile carcinoma, accounting for a smaller percentage of cases. - Cancers on the shaft tend to be **more aggressive** and may present with different clinical features. *Coronal sulcus* - The **coronal sulcus** is the groove between the glans and the shaft. While it's a common site for lesions, it is still less common than the glans itself for the primary origin of carcinoma. - Lesions here can often spread to the glans or prepuce, making the distinction difficult without a clear point of origin.

Question 1008: At what age is orchidopexy for an incompletely descended testis typically performed?

A. At birth
B. 1 year (Correct Answer)
C. 2 years
D. 5 years

Explanation: ***1 year*** - Orchidopexy is typically recommended between **6 and 12 months** of age to prevent long-term complications like **infertility** and **malignancy**. - Performing the surgery at this age maximizes the chances of **normal testicular development** and reduces the risk of germ cell destruction. *At birth* - It is generally not performed at birth because **spontaneous descent** can still occur within the first few months of life. - Early intervention is usually reserved for specific conditions like **testicular torsion**. *2 years* - Waiting until 2 years of age is considered **too late**, as prolonged exposure to higher abdominal temperatures can cause **irreversible damage** to the testicular tissue. - This delay increases the risk of **compromised fertility** and a higher incidence of **testicular cancer**. *5 years* - Performing orchidopexy at 5 years is significantly **too late**, leading to a high risk of **infertility** and a severely increased risk of **testicular cancer**. - By this age, the potential for normal testicular development is greatly diminished.

Question 1009: An elderly male patient presented with a sudden onset of scrotal pain and discharge as shown in the image. What is the likely diagnosis?

A. Fournier’s gangrene (Correct Answer)
B. Torsion of testis
C. Scrotal carcinoma
D. Acute epididymo-orchitis

Explanation: ***Fournier's gangrene*** - The sudden onset of scrotal pain with discharge in an elderly male, combined with **tissue necrosis** and extensive scrotal skin changes, is characteristic of **Fournier's gangrene** (necrotizing fasciitis of the genitalia). - Elderly males are at higher risk due to **diabetes**, **immunocompromise**, and **urogenital infections**, making this a rapidly progressive and potentially life-threatening condition requiring urgent surgical debridement. *Acute epididymo-orchitis* - While epididymo-orchitis can cause scrotal pain and discharge, it typically does **not cause tissue necrosis** or the extensive scrotal skin changes described. - It presents as **localized inflammation** of the epididymis/testis without the widespread necrotizing changes seen in this case. *Torsion of testis* - Testicular torsion typically presents with **abrupt, severe scrotal pain** and swelling, but usually **without discharge** or the extensive scrotal skin changes seen here. - It constitutes a **surgical emergency** due to compromised blood supply to the testis, but doesn't involve necrotizing infection. *Scrotal carcinoma* - Scrotal carcinoma usually presents as a **painless mass or ulceration** that grows over time, rather than a sudden onset of severe pain and discharge. - It represents a **chronic process** and doesn't typically cause the acute necrotizing inflammatory changes observed in this case.

Question 1010: A patient presents with abdominal swelling and inguinal lymphadenopathy. Considering the clinical presentation, which carcinoma is most likely associated with these findings?

A. Ca testis
B. Ca penis (Correct Answer)
C. Ca prostate
D. Ca bladder

Explanation: ***Ca penis*** - **Carcinoma of the penis** commonly metastasizes to the **inguinal lymph nodes** due to its lymphatic drainage patterns. - Advanced penile cancer with extensive nodal involvement can lead to **abdominal swelling** from large retroperitoneal nodes compressing structures or generalized edema. *Ca testis* - **Testicular cancer** typically metastasizes to **retroperitoneal lymph nodes** first, not inguinal nodes. - While retroperitoneal nodes can cause abdominal swelling, **inguinal involvement is rare** unless there is scrotal invasion or prior surgery. *Ca prostate* - **Prostate cancer** primarily metastasizes to **pelvic lymph nodes** (obturator, internal iliac) and bone, rarely to inguinal lymph nodes. - Abdominal swelling would more likely be due to **bone metastases** causing painful compression or uremia from urinary obstruction rather than inguinal adenopathy. *Ca bladder* - **Bladder cancer** tends to spread to **pelvic lymph nodes**, similar to prostate cancer, and can cause abdominal swelling if it obstructs ureters or involves extensive pelvic spread. - **Inguinal lymphadenopathy is uncommon** in bladder cancer unless there is direct extension into the groin or superficial involvement.

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Renal Cell Carcinoma

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Testicular Tumors

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