Urology Practice Questions

Q: Which of the following statements is NOT true regarding Renal Cell Carcinoma?

Hematuria is not a feature.. **Explanation:** Renal Cell Carcinoma (RCC), also known as Grawitz tumor or Hypernephroma, is the most common primary malignancy of the kidney. **Why Option D is the correct answer (NOT true):** Hematuria is, in fact, the **most common presenting symptom** of RCC, occurring in approximately 60% of patients. It is typically intermittent, painless, and total (present throughout the stream). The classic "Robson’s Triad" of RCC includes hematuria, flank pain, and a palpable abdominal mass; however, this triad is only seen in about 10% of cases and usually indicates advanced disease. **Analysis of other options:** * **Option A (True):** RCC shows a distinct male preponderance, with a male-to-female ratio of approximately 2:1. * **Option B (True):** RCC is notorious for its **angiotropism**. It has a unique tendency to invade the renal vein and can extend as a tumor thrombus into the Inferior Vena Cava (IVC), sometimes reaching as far as the right atrium. * **Option C (True):** These tumors are typically cortical and most commonly arise from the tubular epithelium at the **upper or lower poles** of the kidney. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factors:** Smoking (most significant), obesity, hypertension, and acquired cystic kidney disease (in dialysis patients). * **Genetic Association:** Most common type is **Clear Cell RCC**, associated with the **VHL gene** on chromosome 3p. * **Paraneoplastic Syndromes:** RCC is known as the "Internist's Tumor" because it can secrete various hormones leading to polycythemia (Erythropoietin), hypercalcemia (PTHrP), and hypertension (Renin). * **Stauffer’s Syndrome:** Reversible hepatic dysfunction (elevated LFTs) in the absence of liver metastases. * **Metastasis:** Most common site is the **Lung** (Cannon-ball secondaries). It also spreads to bones (osteolytic lesions).

Q: What is the best treatment for a urethral caruncle?

Excision followed by repeated dilatation. ### Explanation A **urethral caruncle** is a benign, red, vascularized polypoid outgrowth typically found at the posterior margin of the external urethral meatus. It occurs most commonly in **postmenopausal women** due to chronic irritation and urogenital atrophy caused by estrogen deficiency. **Why Option B is Correct:** The definitive management for a symptomatic or large urethral caruncle is **surgical excision**. However, because the excision involves the urethral meatus, the resulting scar tissue can lead to **urethral stenosis (stricture)**. Therefore, the standard surgical protocol involves complete excision followed by **repeated urethral dilatation** to ensure patency of the meatus during the healing process. **Why Other Options are Incorrect:** * **Option A:** Antibiotics are ineffective as the condition is inflammatory/proliferative, not primarily infectious. * **Option C:** Resection and end-to-end anastomosis is a major reconstructive procedure used for long-segment urethral strictures or trauma, not for a small superficial caruncle. * **Option D:** Chemical cauterization is outdated, carries a high risk of recurrence, and may cause uncontrolled tissue damage compared to precise surgical excision. **NEET-PG High-Yield Pearls:** * **Most common site:** Posterior lip of the female external urethral meatus. * **Clinical presentation:** Often asymptomatic, but can present with spotting (postmenopausal bleeding), dysuria, or a painful "raspberry-like" mass. * **Differential Diagnosis:** Must be differentiated from **Urethral Carcinoma**; if the lesion is firm, friable, or atypical, a biopsy is mandatory. * **Initial Conservative Management:** Mild cases are often treated first with **topical estrogen cream** and sitz baths.

Q: Percutaneous nephrostomy is indicated in:

Pyonephrosis. **Explanation:** Percutaneous Nephrostomy (PCN) is a procedure where a catheter is inserted through the skin into the renal pelvis to provide external drainage of the collecting system. **Why Pyonephrosis is the Correct Answer:** Pyonephrosis is a surgical emergency characterized by the presence of infected, purulent material (pus) under pressure in an obstructed collecting system. If left undrained, it rapidly leads to urosepsis and irreversible renal damage. PCN is the **gold standard emergency treatment** for pyonephrosis as it provides immediate decompression and drainage of the infected focus, stabilizing the patient before definitive management of the underlying obstruction (e.g., stones). **Analysis of Incorrect Options:** * **Polycystic Kidney Disease (PKD):** PCN is not a standard treatment for PKD. Management focuses on blood pressure control and managing complications like cyst hemorrhage or infection. PCN is only used if a specific cyst becomes infected and is refractory to antibiotics, or if there is secondary obstruction. * **Solitary Adenocarcinoma:** Renal Cell Carcinoma (RCC) is managed surgically via partial or radical nephrectomy. PCN is generally avoided in malignant tumors due to the risk of **needle-track seeding**. * **Simple Hydronephrosis:** While PCN can drain hydronephrosis, it is not routinely indicated unless the condition is symptomatic, bilateral (causing azotemia), or associated with infection. Most simple hydronephrosis cases are managed by treating the primary cause (e.g., DJ stenting for stones). **Clinical Pearls for NEET-PG:** * **Most common indication for PCN:** Supravesical obstruction (e.g., ureteric calculi, pelvic malignancies). * **Absolute Contraindication:** Uncorrected coagulopathy. * **Imaging Guidance:** PCN is most commonly performed under **Ultrasonography (USG)** or Fluoroscopy guidance. * **Triad of Pyonephrosis:** Fever, loin pain, and a palpable tender mass.

Q: A 40-year-old patient with a pelvic injury presents with a 1.5 cm length stricture of the bulbar urethra. What would be the management?

Excision and end-to-end urethroplasty. The management of urethral strictures depends primarily on the **location, length, and etiology** of the stricture. ### **Why Option B is Correct** For **bulbar urethral strictures** that are short (**< 2 cm**), the gold standard treatment is **Excision and Primary End-to-End Urethroplasty (EPA)**. * **The Concept:** The bulbar urethra is mobile and surrounded by the bulbospongiosus muscle, allowing for the mobilization and tension-free anastomosis of the two healthy ends after the fibrotic segment is excised. * **Success Rate:** This procedure has the highest long-term success rate (over 90-95%) for short, traumatic bulbar strictures. ### **Why Other Options are Incorrect** * **A & D (Urethral Dilatation & Urethrotomy):** While Direct Vision Internal Urethrotomy (DVIU) or dilatation can be used for very short ( 2 cm)** where an end-to-end anastomosis would cause chordee or excessive tension. ### **Clinical Pearls for NEET-PG** * **Gold Standard for Bulbar Stricture ( 2 cm):** Substitution urethroplasty (Buccal Mucosa Graft is the preferred material). * **Most common site of traumatic urethral stricture:** Bulbar urethra (due to straddle injury). * **Most common site of post-gonococcal stricture:** Bulbar urethra. * **Initial investigation of choice:** Retrograde Urethrogram (RUG) to define the site and length.

Q: What is the treatment of choice for TURP syndrome?

Furosemide. **Explanation:** **TURP Syndrome** is a clinical complication caused by the excessive systemic absorption of non-conductive irrigation fluid (traditionally 1.5% Glycine) through opened prostatic venous sinuses. This leads to **dilutional hyponatremia** and **hypervolemic fluid overload**. **Why Furosemide is the Correct Answer:** The primary goal in managing TURP syndrome is to address the fluid overload and promote the excretion of excess free water. **Furosemide (a loop diuretic)** is the treatment of choice because it rapidly induces diuresis, reducing the intravascular volume and helping to correct the dilutional state. In mild to moderate cases, fluid restriction and Furosemide are often sufficient to allow the body to naturally re-equilibrate sodium levels. **Analysis of Incorrect Options:** * **Normal Saline (0.9% NaCl):** While it contains sodium, it adds to the volume overload, potentially worsening pulmonary edema or congestive heart failure. * **1.5% NaCl:** This is a hypotonic solution relative to the body's needs in this scenario. If sodium replacement is required for severe symptoms (e.g., seizures), **Hypertonic Saline (3% NaCl)** is used, not 1.5%. * **Thiazides:** These are less potent than loop diuretics and can further lower serum sodium levels by inhibiting sodium reabsorption in the distal tubule, making them inappropriate for treating hyponatremia. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Hypertension (early), Bradycardia, and Mental status changes (due to cerebral edema). * **Severe Cases:** If sodium levels are <120 mEq/L or the patient has seizures, use **3% Hypertonic Saline** at a slow rate (not exceeding 10–12 mEq/L in 24 hours) to avoid **Central Pontine Myelinolysis**. * **Prevention:** Modern practice uses **Bipolar TURP** with Normal Saline irrigation, which significantly reduces the risk of this syndrome.

Q: Transurethral resection of the prostate (TURP) was performed in an elderly patient with benign prostatic hyperplasia (BPH). Postoperatively, the patient developed altered sensorium. What is the most likely cause?

Hyponatremia. The correct answer is **Hyponatremia (Option C)**. **Underlying Medical Concept:** This clinical scenario describes **TURP Syndrome**, a potentially life-threatening complication of transurethral resection of the prostate. During the procedure, large volumes of non-conductive irrigation fluid (traditionally **1.5% Glycine**) are used to maintain visibility. If the prostatic venous sinuses are opened, this hypotonic fluid is rapidly absorbed into the systemic circulation. This leads to **dilutional hyponatremia** and fluid overload [1]. The sudden drop in serum sodium causes cerebral edema, manifesting as altered sensorium, confusion, seizures, or even coma [1][2]. **Analysis of Incorrect Options:** * **Hypokalemia (A):** While fluid shifts can occur, the primary electrolyte disturbance in TURP syndrome is sodium dilution, not a significant drop in potassium. * **Hypernatremia (B):** This is the opposite of what occurs. The absorption of hypotonic irrigation fluid dilutes the extracellular sodium concentration [1]. * **Hypomagnesemia (D):** Magnesium levels are not typically affected by the irrigation fluids used in TURP. **Clinical Pearls for NEET-PG:** * **Irrigation Fluid:** Glycine is most commonly implicated. Other fluids include Sorbitol or Mannitol. * **Visual Disturbance:** Glycine is an inhibitory neurotransmitter in the retina; its toxicity can cause transient **blindness** or blurred vision. * **Management:** Treatment involves fluid restriction and loop diuretics. In severe cases with neurological symptoms, **hypertonic saline (3% NaCl)** is used to slowly correct sodium levels. * **Prevention:** Modern practice often uses **Bipolar TURP**, which allows the use of **Normal Saline (0.9% NaCl)**, significantly reducing the risk of hyponatremia.

Question 1

Which of the following statements is NOT true regarding Renal Cell Carcinoma?

Accepted Answer

Hematuria is not a feature.

Answer

More common in males.

Answer

Has a tendency to invade the renal vessels.

Answer

Usually situated near the poles.

Question 2

What is the best treatment for a urethral caruncle?

Accepted Answer

Excision followed by repeated dilatation

Answer

Administration of antibiotics

Answer

Resection and end to end anastomosis

Answer

Chemical cauterization

Question 3

A couple presents with infertility. The husband is found to have azoospermia on semen analysis. The vas was not palpable on rectal examination. Semen has low volume, high viscosity, and fructose is present. What is the next best step?

Accepted Answer

CFTR gene mutation analysis

Answer

Karyotype

Answer

Prostate-Specific Antigen (PSA) test

Answer

Transrectal ultrasound

Question 4

A 55-year-old male patient underwent cholecystectomy for gallstone calculus. During surgery, the patient's pulse was irregularly irregular, 160/min, BP = 80/50 mm Hg, temp = 40°C. On examination, a swelling in the neck was found. What is the most likely diagnosis?

Accepted Answer

Thyroid storm

Answer

Myocardial infarction

Answer

Arrhythmia

Answer

Stridor

Question 5

In which of the following conditions is neo-adjuvant chemotherapy NOT used?

Accepted Answer

Breast cancer stage 2

Answer

Osteosarcoma

Answer

Chest wall PNET

Answer

Ovarian cancer stage 3

Question 6

Percutaneous nephrostomy is indicated in:

Accepted Answer

Pyonephrosis

Answer

Polycystic kidney disease

Answer

Solitary adenocarcinoma

Answer

Simple hydronephrosis

Question 7

Which of the following statements about renal cell carcinoma is false?

Accepted Answer

It is radiosensitive.

Answer

It is also known as Grawitz tumor.

Answer

Tumors less than 4 cm are typically treated with partial nephrectomy.

Answer

It arises from the proximal convoluted tubule.

Question 8

A 40-year-old patient with a pelvic injury presents with a 1.5 cm length stricture of the bulbar urethra. What would be the management?

Accepted Answer

Excision and end-to-end urethroplasty

Answer

Urethral dilatation

Answer

Patch graft urethroplasty

Answer

Urethrotomy

Question 9

What is the treatment of choice for TURP syndrome?

Accepted Answer

Furosemide

Answer

Normal saline

Answer

1.5% NaCl

Answer

Thiazides

Question 10

Transurethral resection of the prostate (TURP) was performed in an elderly patient with benign prostatic hyperplasia (BPH). Postoperatively, the patient developed altered sensorium. What is the most likely cause?

Accepted Answer

Hyponatremia

Answer

Hypokalemia

Answer

Hypernatremia

Answer

Hypomagnesemia

Urology — MCQs

Urology — MCQs

On this page

Practice by Chapter

Want unlimited practice?