Urology Practice Questions

Q: What is the most common organic cause of erectile dysfunction?

Atherosclerosis. **Explanation:** **Atherosclerosis** is the most common organic cause of erectile dysfunction (ED). The underlying mechanism is **vasculogenic**; since the penile arteries are small in diameter (1–2 mm), they are often the first to be affected by atherosclerotic plaque formation. This leads to impaired blood flow to the corpora cavernosa, preventing the pressure required for a rigid erection. It is frequently considered a "sentinel symptom" for systemic cardiovascular disease. **Analysis of Incorrect Options:** * **Multiple Sclerosis (B):** This is a neurogenic cause of ED. While common in MS patients, neurogenic causes are statistically less frequent than vasculogenic causes in the general population. * **Penile Fibrosis (C):** This refers to the replacement of smooth muscle with collagen, often due to chronic ischemia or post-priapism. It is a structural cause but not the primary epidemiological driver of ED. * **Peyronie’s Disease (D):** This involves the formation of a fibrous plaque in the tunica albuginea, leading to penile curvature and painful erections. While it causes ED, its prevalence is much lower than systemic atherosclerosis. **Clinical Pearls for NEET-PG:** * **Most common cause of ED overall:** Psychogenic (especially in younger men). * **Most common organic cause:** Vasculogenic (Atherosclerosis/Diabetes Mellitus). * **The "Artery Size Hypothesis":** ED often precedes Coronary Artery Disease (CAD) by 3–5 years because penile arteries are smaller than coronary arteries. * **First-line Investigation:** Detailed history and IIEF-5 (International Index of Erectile Function) questionnaire. * **Gold Standard for Vasculogenic ED:** Duplex Doppler Ultrasound of penile arteries.

Q: All of the following are true about gonococcal epididymitis, EXCEPT?

Immediate surgical intervention is needed.. **Explanation:** The core management of **acute epididymitis**, whether caused by *Neisseria gonorrhoeae* (common in men <35 years) or enteric organisms, is **medical, not surgical**. **Why Option D is the Correct Answer (The "Except"):** Immediate surgical intervention is **not indicated** for epididymitis. Surgery is reserved for complications like abscess formation or when **testicular torsion** cannot be ruled out. In torsion, "time is muscle," and immediate surgery is mandatory; however, in epididymitis, the inflammation is managed conservatively. **Analysis of Other Options:** * **Option A (Antibiotics):** Since the etiology is bacterial (*N. gonorrhoeae*), targeted antibiotic therapy (e.g., Ceftriaxone plus Doxycycline/Azithromycin) is the cornerstone of treatment to eradicate the pathogen. * **Option B (Anti-inflammatories):** NSAIDs are standard supportive care to reduce pain, scrotal edema, and inflammatory markers. * **Option C (Surgery after infection subsides):** While rare, chronic complications like epididymal obstruction or persistent pain may necessitate surgical intervention (e.g., epididymectomy or vasoepididymostomy) *after* the acute infection has been fully resolved. **NEET-PG High-Yield Pearls:** * **Prehn’s Sign:** Elevation of the scrotum relieves pain in epididymitis (Positive Prehn’s) but worsens or has no effect on pain in testicular torsion (Negative Prehn’s). * **Cremasteric Reflex:** Usually **present** in epididymitis but **absent** in testicular torsion. * **Age Factor:** In patients 35 years, *E. coli* is the most common cause. * **Investigation of Choice:** Color Doppler Ultrasound (shows increased blood flow/hyperemia in epididymitis).

Q: Which of the following is NOT a typical cystoscopic finding in TB bladder?

Whitish efflux from the ureteric openings. **Explanation:** In Genitourinary Tuberculosis (GUTB), the bladder is typically affected secondary to renal tuberculosis. The cystoscopic findings are a result of chronic inflammation, ulceration, and subsequent fibrosis. **Why Option D is the correct answer:** **Whitish efflux from the ureteric openings** is not a feature of TB bladder. In active renal TB, the urine is typically clear but contains microscopic pus cells (**Sterile Pyuria**). Thick, whitish, or "milky" efflux is characteristic of **Chyluria** (seen in Filariasis) or severe pyogenic infections (pyonephrosis), but not typically TB. **Analysis of Incorrect Options:** * **Cobblestone mucosa:** Early TB cystitis presents with tubercles (yellowish-white nodules) surrounded by a zone of hyperemia. When these coalesce and the mucosa becomes edematous and inflamed, it gives a "cobblestone" appearance. * **Thimble bladder:** Chronic TB leads to extensive fibrosis and cicatrization of the bladder wall. This results in a severely reduced bladder capacity (often <50ml), known as a "Thimble bladder" or "Systolic bladder." * **Golf hole ureter:** Fibrosis and shortening of the ureter (due to ureteritis) lead to the retraction of the ureteric orifice. This causes the orifice to remain permanently patent and gaping, resembling a "golf hole." **Clinical Pearls for NEET-PG:** * **Sterile Pyuria:** Presence of pus cells in acidic urine with no growth on routine culture media is the hallmark of GUTB. * **Gold Standard Diagnosis:** Culture on **Lowenstein-Jensen (LJ) medium** (takes 6–8 weeks) or rapid BACTEC. * **Imaging:** The earliest radiological sign of GUTB is "moth-eaten" appearance of the calyces on IVU. * **Putty Kidney:** Refers to autonephrectomy where the kidney is replaced by a bag of caseous material.

Q: A 50-year-old woman presents with acute right flank pain of 72 hours in duration. Her temperature is 37°C, BP 140/85 mm Hg, and pulse 85/minute. A CBC is normal. Urinalysis reveals hematuria and urine cultures are negative. Imaging studies show stones in the right renal pelvis and ureter. This patient's condition may be associated with which of the following endocrine disorders?

Hyperparathyroidism. ### Explanation **Correct Answer: C. Hyperparathyroidism** The clinical presentation of acute flank pain, hematuria, and imaging evidence of renal and ureteral stones (nephrolithiasis) is a classic manifestation of **Primary Hyperparathyroidism (PHPT)**. **Pathophysiology:** PHPT is characterized by the autonomous overproduction of Parathyroid Hormone (PTH), usually due to a parathyroid adenoma. PTH increases bone resorption and distal tubular calcium reabsorption while stimulating the synthesis of 1,25-dihydroxyvitamin D. This leads to **hypercalcemia** and **hypercalciuria** (as the filtered load of calcium exceeds reabsorptive capacity). The excess urinary calcium precipitates with oxalate or phosphate, forming stones. PHPT is a leading cause of recurrent or bilateral renal calculi in middle-aged women. **Why Incorrect Options are Wrong:** * **A & B (Conn and Cushing Syndromes):** These adrenal disorders primarily involve mineralocorticoid or glucocorticoid excess. While they cause hypertension and metabolic derangements, they are not classically associated with calcium-based nephrolithiasis. * **D (Hyperthyroidism):** While severe hyperthyroidism can cause increased bone turnover and mild hypercalcemia, it is a rare cause of clinical nephrolithiasis compared to PHPT. **NEET-PG High-Yield Pearls:** * **Classic Triad of PHPT:** "Stones (Renal), Bones (Osteitis fibrosa cystica), Groans (Abdominal pain/Constipation), and Psychic Moans (Depression/Confusion)." * **Most Common Stone:** Calcium oxalate is the most common type of stone in PHPT. * **Screening:** In any patient with recurrent or bilateral renal stones, always check **Serum Calcium** and **Serum PTH** levels. * **Imaging:** Sestamibi scan is the investigation of choice to localize a parathyroid adenoma.

Q: Distention of the abdomen with the passage of a large amount of urine is known as?

Dietl's crisis. **Explanation:** The correct answer is **Dietl’s crisis**. This clinical phenomenon is classically associated with **Pelviureteric Junction (PUJ) obstruction**, often caused by an aberrant renal artery or nephroptosis (wandering kidney). 1. **Why Dietl’s Crisis is correct:** When the kidney is obstructed, it becomes acutely distended with urine (hydronephrosis), leading to severe episodic loin pain and a palpable abdominal mass (distention). As the obstruction spontaneously relieves—often due to a change in posture—the accumulated urine drains rapidly into the bladder. This results in the sudden disappearance of the mass/pain followed by the **passage of a large volume of urine (polyuria)**. 2. **Why other options are incorrect:** * **Anderson-Hynes crisis:** This is a distractor. Anderson-Hynes is actually the name of the **dismembered pyeloplasty** surgical procedure used to treat PUJ obstruction, not the name of the clinical crisis itself. * **Meteorism:** This refers to abdominal distention caused by excessive gas in the gastrointestinal tract (tympanites), unrelated to urinary output or renal pathology. **Clinical Pearls for NEET-PG:** * **Triad of Dietl’s Crisis:** Episodic renal colic, abdominal swelling (hydronephrosis), and relief of pain followed by polyuria. * **Gold Standard Investigation:** For PUJ obstruction, the investigation of choice is **DTPA scan (Renogram)** with Lasix to assess the degree of obstruction. * **Surgical Management:** The gold standard treatment is **Anderson-Hynes Dismembered Pyeloplasty** (can be open, laparoscopic, or robotic).

Q: A 70-year-old gentleman underwent TURP. Prostate specimen showed malignant histology. What is the next step?

Active surveillance. **Explanation:** This scenario describes an **incidental finding of prostate cancer** following a Transurethral Resection of the Prostate (TURP) performed for presumed benign prostatic hyperplasia (BPH). In the TNM staging system, this is classified as **Stage T1a or T1b**. **Why Active Surveillance is the correct answer:** For a 70-year-old patient with incidentally discovered prostate cancer (especially if it is low-grade, low-volume, and has a low PSA level), **Active Surveillance** is the preferred management. At this age, the natural progression of low-risk prostate cancer is often slower than the patient's life expectancy. Active surveillance avoids the significant morbidity associated with surgery or radiation (incontinence, impotence) while monitoring the disease closely via serial PSA levels and repeat biopsies. **Analysis of Incorrect Options:** * **A. Radical Prostatectomy:** This is typically reserved for younger patients ( 10-15 years and higher-stage localized disease (T2). In a 70-year-old with incidental T1 disease, the risks of surgery often outweigh the benefits. * **C. External Beam Radiotherapy (EBRT):** While an option for localized cancer, it is generally deferred in low-risk incidental cases in favor of surveillance to avoid radiation-induced proctitis or cystitis. * **D. Bilateral Orchiectomy:** This is a form of Androgen Deprivation Therapy (ADT) used for **metastatic (Stage D/M1)** prostate cancer. It is not indicated for localized, incidental findings. **Clinical Pearls for NEET-PG:** * **T1a:** Tumor involves ≤5% of resected tissue. * **T1b:** Tumor involves >5% of resected tissue. * **Most common site for Prostate Cancer:** Peripheral Zone (detected by DRE). * **Most common site for BPH:** Transition Zone (reason why TURP specimens occasionally show incidental cancer). * **Gleason Scoring:** The most important prognostic factor for prostate cancer.

Q: What is the treatment of choice for a stone in the submandibular duct located distal to the lingual nerve?

Intraoral removal. **Explanation:** The treatment of choice for a submandibular duct stone (sialolithiasis) depends primarily on its location. The submandibular duct (Wharton’s duct) runs along the floor of the mouth, crossing the lingual nerve. 1. **Why Intraoral Removal is Correct:** When a stone is located **distal to the lingual nerve** (closer to the duct orifice/anteriorly), it is easily accessible through the oral cavity. An **intraoral sialolithotomy** is performed by making a small incision directly over the stone in the floor of the mouth. This approach is minimally invasive, preserves the gland, and avoids the risks associated with major surgery. 2. **Why Other Options are Incorrect:** * **Submandibular Excision:** This is reserved for stones located within the gland parenchyma or proximal to the lingual nerve (posteriorly) that cannot be reached intraorally, or in cases of chronic permanent gland damage. * **Antibiotics:** These are used to treat secondary infection (sialadenitis) but do not remove the mechanical obstruction (the stone). * **Observation:** Sialolithiasis rarely resolves spontaneously and typically leads to recurrent pain and swelling (mealtime syndrome) or infection if left untreated. **High-Yield Clinical Pearls for NEET-PG:** * **80% Rule:** 80% of all salivary stones occur in the submandibular gland (due to alkaline pH, high calcium/mucin content, and antigravity flow). * **Radiopacity:** 80% of submandibular stones are radiopaque (visible on X-ray), whereas 80% of parotid stones are radiolucent. * **Imaging:** The best initial imaging for a suspected ductal stone is an **intraoral occlusal radiograph**. * **Anatomy:** The lingual nerve "loops" under Wharton’s duct from lateral to medial. Stones distal to this loop are palpable and surgically accessible intraorally.

Question 1

What is the most common organic cause of erectile dysfunction?

Accepted Answer

Atherosclerosis

Answer

Multiple sclerosis

Answer

Penile fibrosis

Answer

Peyronie's disease

Question 2

All of the following are true about gonococcal epididymitis, EXCEPT?

Accepted Answer

Immediate surgical intervention is needed.

Answer

Antibiotics are indicated.

Answer

Anti-inflammatories may be used.

Answer

Surgery may be considered after infection subsides.

Question 3

Which of the following is NOT a typical cystoscopic finding in TB bladder?

Accepted Answer

Whitish efflux from the ureteric openings

Answer

Cobblestone mucosa

Answer

Thimble bladder

Answer

Golf hole ureter

Question 4

A 50-year-old woman presents with acute right flank pain of 72 hours in duration. Her temperature is 37°C, BP 140/85 mm Hg, and pulse 85/minute. A CBC is normal. Urinalysis reveals hematuria and urine cultures are negative. Imaging studies show stones in the right renal pelvis and ureter. This patient's condition may be associated with which of the following endocrine disorders?

Accepted Answer

Hyperparathyroidism

Answer

Conn syndrome

Answer

Cushing syndrome

Answer

Hyperthyroidism

Question 5

Regarding testicular torsion, which of the following statements is FALSE?

Accepted Answer

Testicular salvage decreases to less than 5% if surgery is delayed beyond 6 hours.

Answer

Undescended testicle is a risk factor.

Answer

Decreased blood flow relative to the contralateral testicle can be demonstrated by ultrasound.

Answer

Surgical exploration should include fixation of the contralateral testicle.

Question 6

Which of the following conditions is associated with asymptomatic bacteriuria?

Accepted Answer

Pelvic Inflammatory Disease

Answer

Anemia

Answer

Hypertension

Answer

Gestational diabetes

Question 7

Distention of the abdomen with the passage of a large amount of urine is known as?

Accepted Answer

Dietl's crisis

Answer

Anderson-Hynes crisis

Answer

Meteorism

Answer

None of the above

Question 8

A 70-year-old gentleman underwent TURP. Prostate specimen showed malignant histology. What is the next step?

Accepted Answer

Active surveillance

Answer

Radical Prostatectomy

Answer

External beam radiotherapy

Answer

Bilateral orchiectomy

Question 9

What is the treatment of choice for a stone in the submandibular duct located distal to the lingual nerve?

Accepted Answer

Intraoral removal

Answer

Submandibular excision

Answer

Antibiotics

Answer

Observation

Question 10

A 3-year-old male patient presents with only one testis in the scrotum. On examination, the right testis is palpable in the inguinal canal. What is the preferred treatment?

Accepted Answer

Orchidopexy

Answer

Observation until puberty

Answer

Androgen therapy

Answer

Orchiectomy

Urology — MCQs

Urology — MCQs

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