Urology Practice Questions

Q: Which of the following investigations is NOT appropriate for evaluating testicular tumors?

Testicular biopsy. ***Testicular biopsy*** - A **testicular biopsy** is contraindicated in the initial evaluation of suspected testicular tumors due to the risk of **tumor seeding** and potential spread. - The standard diagnostic approach involves **radical orchiectomy** via an inguinal approach, which is both diagnostic and therapeutic. *Chest x-ray* - A **chest x-ray** is appropriate for evaluating testicular tumors to check for **pulmonary metastases**, as the lungs are a common site for spread. - It helps in **staging** the disease and guiding subsequent treatment decisions. *Inguinal exploration* - **Inguinal exploration** (radical orchiectomy) is the gold standard for both **diagnosis and treatment** of a suspected testicular tumor. - It allows for complete tumor removal and pathological confirmation without increased risk of **tumor dissemination**. *CT abdomen* - A **CT scan of the abdomen** is appropriate for evaluating testicular tumors to assess for **retroperitoneal lymphadenopathy**, which is a common pattern of metastatic spread. - This imaging helps in **staging** the disease and determining the extent of nodal involvement.

Q: A couple complains of an inability to conceive despite staying together for 4 years and having unprotected intercourse, with all tests in the wife being normal. Semen analysis shows a volume of 0.8 mL, a sperm count of 0, and the absence of fructose. What is the next best step?

Local palpation of Vas. ***Local palpation of Vas*** - The findings of **azoospermia** (sperm count of 0), **low semen volume** (0.8 mL), and **absence of fructose** are highly suggestive of an **ejaculatory duct obstruction** or **congenital bilateral absence of the vas deferens (CBAVD)**, as seminal vesicles produce fructose and contribute to semen volume. - **Palpation of the vas deferens** is a simple, non-invasive initial step to assess for the presence or absence of the vas deferens, which would strongly indicate CBAVD and guide further management. *Testicular FNAC* - **Fine needle aspiration cytology (FNAC)** of the testis would demonstrate active **spermatogenesis** if the issue is a post-testicular obstruction, but it does not directly identify the site of obstruction or the absence of the vas deferens. - While it can differentiate between obstructive and non-obstructive azoospermia, it is typically performed after initial physical examination and imaging to locate the obstruction. *Ultrasound for obstruction* - An **ultrasound (transrectal)** can be used to visualize the ejaculatory ducts and seminal vesicles to identify an obstruction, but it is typically performed *after* physical examination, especially if there is suspicion of CBAVD following palpation. - If the vas deferens are already confirmed to be absent on palpation, the primary issue is likely CBAVD rather than solely an ejaculatory duct obstruction that could be visualized by ultrasound within the ejaculatory duct. *Karyotyping* - **Karyotyping** is useful in cases of **non-obstructive azoospermia** to detect chromosomal abnormalities (e.g., Klinefelter syndrome) or in cases of CBAVD to look for mutations in the CFTR gene related to cystic fibrosis. - However, given the specific semen analysis findings (low volume, absent fructose), a physical examination focusing on the vas deferens is a more immediate and targeted next step.

Q: Which of the following is not part of the classical triad of renal cell carcinoma?

Oliguria. ***Oliguria*** - **Oliguria** (decreased urine output) is not considered part of the classical triad for renal cell carcinoma. - It usually indicates significant **renal dysfunction** or **obstruction**, which might occur in advanced stages or with complications, but not always as an initial presenting symptom. *Loin Mass* - A **palpable abdominal or flank mass** is one of the key components of the classical triad, indicating a larger, more advanced tumor. - This symptom often suggests that the tumor has grown significantly to be detectable by physical exam or patient sensation. *Hematuria* - **Hematuria** (blood in the urine), often macroscopic and painless, is a common and important early symptom of renal cell carcinoma. - It results from the tumor invading the **collecting system** of the kidney, causing bleeding. *Loin Pain* - **Loin pain** (flank pain) is another component of the classical triad, often caused by tumor growth stretching the **renal capsule** or invading adjacent structures. - The pain can be dull, aching, or more severe if there is acute bleeding or obstruction.

Q: What is the most common type of bladder rupture?

Extraperitoneal bladder rupture. **Extraperitoneal bladder rupture** - This type of rupture is the most common kind, accounting for **80-85% of all bladder ruptures**. - It typically occurs due to high-energy blunt trauma to the lower abdomen or pelvis when the bladder is full, often associated with **pelvic fractures**. *Intraperitoneal bladder rupture* - This type is less common than extraperitoneal ruptures, representing about **15-20% of cases**. - It usually results from a direct blow to a **distended bladder** when the dome of the bladder, which is covered by peritoneum, ruptures. *Rupture at the trigone of the bladder* - Ruptures isolated to the **trigone** are rare and typically not a separate classification of bladder rupture type in terms of prevalence. - The trigone is a more robust area of the bladder, making rupture here less common without significant penetrating trauma or specific iatrogenic injury. *Both types occur with equal frequency* - This statement is incorrect as **extraperitoneal ruptures** are significantly more prevalent than intraperitoneal ruptures. - The mechanisms of injury and associated findings also differ between the two main types, distinguishing their frequency.

Q: Urine extravasation occurs in the following case of penile urethral rupture, except:

Ischiorectal fossa. ***Ischiorectal fossa (Correct - Urine does NOT extravasate here)*** - The **ischiorectal fossa** is protected superiorly by the **urogenital diaphragm** which is attached to the pubic rami and ischial tuberosities. - Urine extravasating from a **penile urethral rupture** is confined to the superficial perineal pouch and **cannot** freely spread into the deep perineal pouch or the ischiorectal fossae due to these fascial boundaries. - This is the exception - the urogenital diaphragm acts as a barrier preventing urine from reaching this space. *Scrotum (Incorrect - Urine DOES extravasate here)* - The **superficial perineal fascia (Colles' fascia)** is continuous with the dartos fascia of the scrotum, allowing urine from a penile urethral rupture to readily spread into the **scrotal sac**. - This results in significant swelling and discoloration of the scrotum. *Abdominal wall (Incorrect - Urine DOES extravasate here)* - **Colles' fascia** is continuous superiorly with **Scarpa's fascia** of the anterior abdominal wall. - Urine from a penile urethral rupture can track beneath Scarpa's fascia, leading to extravasation into the superficial layers of the **lower abdominal wall**. *Below superficial fascia of penis (Incorrect - Urine DOES extravasate here)* - The **penile urethra** is located within the superficial perineal pouch, and a rupture in this segment allows urine to extravasate into the space **below the superficial fascia of the penis**. - This is a direct pathway for urine to spread within the confines of the superficial perineal pouch.

Q: Which of the following is the most serious complication of untreated urethral stricture?

Periurethral abscess. ***Periurethral abscess*** - An untreated urethral stricture can lead to urinary stasis and infection, which can then progress to a **periurethral abscess**. - A periurethral abscess is a serious localized collection of pus that can rupture internally or externally, causing severe pain, infection, and potentially necessitating complex surgical intervention. *Urethral diverticulum* - While urethral strictures can contribute to the formation of a **urethral diverticulum** due to increased pressure and obstruction, it is generally considered a less immediate and life-threatening complication compared to an abscess. - A diverticulum is an outpouching of the urethra, which can cause symptoms like dysuria, recurrent UTIs, and post-void dribbling, but does not typically pose the same acute infectious risk as an abscess. *Retention of urine* - **Urinary retention** is a common and significant symptom of a urethral stricture, as the narrowing blocks the flow of urine. - While uncomfortable and requiring intervention, acute urinary retention itself is usually manageable with catheterization and does not carry the same degree of tissue destruction and systemic infection risk as a periurethral abscess. *All of these* - While all listed options can be complications of an untreated urethral stricture, **periurethral abscess** represents the most serious due to its potential for severe infection, tissue destruction, and more complex management. - The question asks for the **most serious** complication, which points to the one with the highest morbidity and potential for systemic consequences.

Q: In Testicular Feminization syndrome, when is gonadectomy indicated?

At puberty. ***At puberty*** - Gonadectomy is recommended at puberty in individuals with **Androgen Insensitivity Syndrome (Testicular Feminization)** to minimize the risk of gonadal malignancy. - Delaying until puberty allows for the spontaneous development of **secondary sexual characteristics** (e.g., breast development) from endogenous estrogen produced by the testes. *Immediately after diagnosis* - Performing gonadectomy immediately would prevent the natural pubertal development and necessitate earlier **estrogen replacement therapy**. - The risk of **gonadal malignancy** is low before puberty in AIS. *Only if malignancy develops* - This approach is not recommended due to the increased risk of **gonadal tumors (gonadoblastoma, dysgerminoma)** associated with undescended testes in AIS, especially after puberty. - Prophylactic removal is preferred to avoid the development and potential spread of malignancy. *When signs of androgenization appear* - **Androgenization** (virilization) does not typically occur in complete AIS because the androgen receptors are *non-functional*, making the body unable to respond to androgens. - Therefore, waiting for signs of androgenization would not be relevant in managing complete AIS.

Q: What is the definitive treatment for established 'Thimble bladder' with structural damage?

Ileocystoplasty. ***Ileocystoplasty*** - **Ileocystoplasty** is a surgical procedure to enlarge the bladder using a segment of the ileum, providing definitive treatment for the severely contracted and scarred bladder seen in "Thimble bladder" with structural damage. - This procedure addresses the **reduced bladder capacity** and functional problems caused by irreversible fibrosis. *Anti-tubercular treatment* - While essential for treating active **urogenital tuberculosis**, it does not reverse the established **structural damage and fibrosis** that characterize "Thimble bladder." - It prevents further progression of the disease but cannot restore lost bladder capacity or elasticity once scarring is significant. *Anti-tubercular drugs plus corticosteroids* - Adding **corticosteroids** might reduce inflammation in active tuberculosis but will not repair the extensive and long-standing **fibrotic changes and structural damage** in a developed "Thimble bladder." - The primary aim of ATD is to eradicate the infection, and corticosteroids are usually reserved for specific inflammatory complications. *Corticosteroids* - **Corticosteroids** primarily exert anti-inflammatory and immunosuppressive effects, which are not beneficial for reversing fixed **fibrotic changes** in a bladder with established "Thimble bladder." - Their use would be inappropriate as a standalone treatment for irreversible structural damage, as they do not address the underlying mechanical issue of a contracted bladder.

Q: Organ which is commonly involved in retroperitoneal fibrosis is

Ureter. ***Ureter*** - Retroperitoneal fibrosis is characterized by the proliferation of **fibrous tissue in the retroperitoneum**, which commonly encases the ureters. - This encasement can lead to **ureteral obstruction**, causing hydronephrosis and potential renal impairment. *Colon* - While the colon is located in the retroperitoneum for some segments (ascending, descending), it is **less commonly entrapped** and obstructed by retroperitoneal fibrosis compared to the ureters. - **Bowel obstruction** is not a primary or common clinical manifestation of retroperitoneal fibrosis. *Duodenum* - The duodenum is primarily located in the **upper retroperitoneum** but is generally less affected by the fibrotic process characteristic of retroperitoneal fibrosis. - **Obstructive symptoms related to the duodenum** are rare in this condition. *Kidneys* - The kidneys are retroperitoneal organs, but the fibrosis typically involves the **perirenal fat and surrounding structures**, not the kidney parenchyma itself. - Renal dysfunction in retroperitoneal fibrosis is usually a **secondary complication of ureteral obstruction**, not direct renal involvement.

Q: Which of the following is least likely to occur after transurethral resection of the prostate?

Transient blindness. ***Transient blindness*** - Transient blindness (amaurosis) is the **rarest complication** among the options listed, though it has been reported in severe TURP syndrome. - Ocular complications occur due to **severe hyponatremia** and cerebral edema affecting the visual cortex or retinal edema, but this is an **uncommon manifestation** compared to other neurological symptoms. - Most cases of TURP syndrome present with more typical features before visual symptoms develop. *Hyponatremia* - **Hyponatremia** is the **hallmark and most common feature** of TURP syndrome, occurring in up to 10-15% of procedures. - Caused by systemic absorption of **hypotonic irrigation fluid** (glycine or sorbitol solutions) during prolonged resection. - This is the primary electrolyte disturbance that leads to all other manifestations of TURP syndrome. *Convulsion* - **Convulsions (seizures)** are a **common neurological manifestation** of TURP syndrome when hyponatremia is severe (Na+ <120 mEq/L). - Result from **cerebral edema** and increased intracranial pressure due to rapid osmotic fluid shifts. - Generalized tonic-clonic seizures are well-recognized complications requiring immediate treatment. *Congestive cardiac failure* - **CHF** commonly occurs due to rapid absorption of **large volumes of irrigation fluid** causing acute **volume overload**. - The increased intravascular volume can precipitate pulmonary edema and cardiac decompensation, especially in elderly patients with pre-existing cardiac disease. - This is a frequent complication requiring diuretic therapy and fluid restriction.

Question 1

Which of the following investigations is NOT appropriate for evaluating testicular tumors?

Accepted Answer

Testicular biopsy

Answer

Chest x-ray

Answer

Inguinal exploration

Answer

CT abdomen

Question 2

A couple complains of an inability to conceive despite staying together for 4 years and having unprotected intercourse, with all tests in the wife being normal. Semen analysis shows a volume of 0.8 mL, a sperm count of 0, and the absence of fructose. What is the next best step?

Accepted Answer

Local palpation of Vas

Answer

Testicular FNAC

Answer

Karyotyping

Answer

Ultrasound for obstruction

Question 3

Which of the following is not part of the classical triad of renal cell carcinoma?

Accepted Answer

Oliguria

Answer

Loin Mass

Answer

Hematuria

Answer

Loin Pain

Question 4

What is the most common type of bladder rupture?

Accepted Answer

Extraperitoneal bladder rupture

Answer

Intraperitoneal bladder rupture

Answer

Rupture at the trigone of the bladder

Answer

Both types occur with equal frequency

Question 5

Urine extravasation occurs in the following case of penile urethral rupture, except:

Accepted Answer

Ischiorectal fossa

Answer

Abdominal wall

Answer

Below superficial fascia of penis

Answer

Scrotum

Question 6

Which of the following is the most serious complication of untreated urethral stricture?

Accepted Answer

Periurethral abscess

Answer

Urethral diverticulum

Answer

Retention of urine

Answer

All of these

Question 7

In Testicular Feminization syndrome, when is gonadectomy indicated?

Accepted Answer

At puberty

Answer

Only if malignancy develops

Answer

When signs of androgenization appear

Answer

Immediately after diagnosis

Question 8

What is the definitive treatment for established 'Thimble bladder' with structural damage?

Accepted Answer

Ileocystoplasty

Answer

Anti-tubercular treatment

Answer

Anti-tubercular drugs plus corticosteroids

Answer

Corticosteroids

Question 9

Organ which is commonly involved in retroperitoneal fibrosis is

Accepted Answer

Ureter

Answer

Kidneys

Answer

Colon

Answer

Duodenum

Question 10

Which of the following is least likely to occur after transurethral resection of the prostate?

Accepted Answer

Transient blindness

Answer

Hyponatremia

Answer

Congestive cardiac failure

Answer

Convulsion

Urology — MCQs

Urology — MCQs

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