Urology Practice Questions

Q: What is the most common cause of renal artery stenosis in individuals above 50 years of age?

Atherosclerosis. **Explanation:** Renal Artery Stenosis (RAS) is a common cause of secondary hypertension. The etiology varies significantly based on the patient's age and gender. **1. Why Atherosclerosis is Correct:** Atherosclerosis is the most common cause of renal artery stenosis overall, accounting for approximately **90% of cases**. It typically affects individuals **above 50 years of age** and is often associated with other cardiovascular risk factors like smoking, diabetes, and hyperlipidemia. The lesion usually involves the **proximal third (ostium)** of the renal artery. **2. Analysis of Incorrect Options:** * **Fibromuscular Dysplasia (FMD):** This is the second most common cause but typically affects **younger females (20–40 years)**. It involves the distal two-thirds of the artery and presents with a characteristic "string of beads" appearance on angiography. * **Takayasu Arteritis:** A large-vessel vasculitis that can involve the renal artery ostium, but it primarily affects young Asian women and presents with systemic symptoms and absent pulses. * **Renal Cell Carcinoma (RCC):** While a tumor can compress the renal artery, it is a rare mechanical cause and not a primary vascular pathology for stenosis. **Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Digital Subtraction Angiography (DSA). * **Initial Screening Tool:** Duplex Doppler Ultrasound or CT Angiography. * **Classic Sign:** An abdominal bruit may be heard on auscultation. * **Treatment:** Medical management (ACE inhibitors/ARBs—*caution: contraindicated in bilateral RAS*), or Revascularization (Angioplasty with stenting) for atherosclerotic lesions.

Q: What is the column of Bertin in the kidney?

Tongue-like papillary projection. ### Explanation **Concept Overview:** The **Columns of Bertin** (also known as renal columns) are extensions of the renal cortical tissue that project into the renal medulla, separating the renal pyramids. Anatomically, they represent the lateral portions of adjacent renal lobes. **Why Option B is Correct:** The columns of Bertin are characterized as **tongue-like papillary projections** of cortical tissue. They contain blood vessels and urinary tubes and are located between the renal pyramids. During development, they are formed by the fusion of the cortical caps of adjacent lobes. **Why Other Options are Incorrect:** * **Option A (Renal Tumour):** While a "Hypertrophied Column of Bertin" can sometimes mimic a renal mass on an ultrasound or CT scan (often called a **pseudotumor**), it is a normal anatomical variant, not a malignancy. * **Option C (Calculus):** A calculus is a solid piece of material (stone) formed from minerals in the urine. The Column of Bertin is soft tissue (parenchyma), not a calcification. **High-Yield Clinical Pearls for NEET-PG:** * **Pseudotumor:** A hypertrophied Column of Bertin is the most common cause of a "renal pseudotumor." It is typically found in the **middle third** of the kidney. * **Radiological Identification:** On a DMSA scan or contrast CT, a Column of Bertin shows the **same uptake/enhancement as the rest of the renal cortex**, which helps differentiate it from a true renal cell carcinoma (RCC). * **Location:** They are most frequently found on the left side and are often duplicated. * **Key Feature:** They do not distort the renal contour, unlike most true tumours.

Q: A 55-year-old diabetic patient presented with impotence and a history of failure to achieve erection after papaverine intracavernous injection. Color Doppler shows no abnormality of arteries but shows mild venous run-off. What is the treatment of choice?

Vacuum constriction device. **Explanation:** The patient presents with organic erectile dysfunction (ED) characterized by **venous leak** (mild venous run-off on Doppler) and a failure to respond to intracavernous pharmacotherapy (papaverine). **1. Why Option C is Correct:** In patients who fail pharmacological therapy (intracavernous injections) or have contraindications to them, the **Vacuum Constriction Device (VCD)** is a highly effective, non-invasive second-line treatment. It works by creating a negative pressure vacuum that draws blood into the corpora cavernosa, which is then maintained by a constriction ring at the base of the penis. It is particularly useful in diabetic patients and those with venous leak, as the ring prevents the premature venous outflow described in the question. **2. Why the other options are incorrect:** * **Option A (Papaverine):** The patient has already failed this treatment ("history of failure to achieve erection after papaverine"). Repeating it would be ineffective. * **Option B (Penile Prosthetic Implants):** This is the "gold standard" for refractory ED, but it is considered a **third-line** surgical intervention. One should attempt non-invasive second-line options like VCD before proceeding to irreversible surgery. * **Option D (Psychotherapy):** This is indicated for psychogenic ED. The presence of diabetes and the Doppler finding of venous run-off confirm an **organic** etiology. **Clinical Pearls for NEET-PG:** * **First-line treatment for ED:** Oral PDE-5 inhibitors (e.g., Sildenafil). * **Venogenic ED:** Characterized by normal arterial inflow but inability to maintain an erection due to "venous leak." * **Contraindication for VCD:** Patients with blood dyscrasias or those on anticoagulants (risk of priapism/hematoma). * **Papaverine:** A non-specific PDE inhibitor; its main side effect is priapism and corporal fibrosis.

Q: Which of the following is NOT a radiolucent stone?

Cystine stones. ### Explanation In urology, renal stones are classified based on their appearance on a plain X-ray (KUB). The visibility of a stone depends on its atomic weight and density. **1. Why Cystine stones are the correct answer:** Cystine stones are **radio-opaque** (visible on X-ray), though they appear less dense than calcium stones. They are often described as having a **"ground-glass"** or faint appearance. This is due to the presence of **sulfur atoms** within the cystine molecules, which have a higher atomic number, allowing them to attenuate X-rays. Therefore, they are NOT radiolucent. **2. Analysis of Incorrect Options (Radiolucent Stones):** * **Uric acid stones:** These are the most common radiolucent stones. They are composed of light elements (C, H, N, O) that do not stop X-rays. They are visible on CT scans or as filling defects on IVP. * **Xanthine stones:** Rare stones caused by genetic xanthine oxidase deficiency or Allopurinol therapy. Like uric acid, they lack heavy atoms and are radiolucent. * **Triamterene stones:** These are medication-induced stones. Triamterene (a potassium-sparing diuretic) is poorly soluble in urine and forms radiolucent calculi. **3. High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for Radiolucent stones (PURE):** **P**rotease inhibitors (Indinavir), **U**ric acid, **R**are (Xanthine/Matrix), **E**phedrine/Triamterene. * **Cystine Stones:** Associated with a hexagonal crystal shape in urine and a positive **Cyanide-Nitroprusside test**. * **Most Radio-opaque:** Calcium oxalate and Calcium phosphate (highest density). * **Intermediate/Faintly Opaque:** Cystine and Magnesium Ammonium Phosphate (Struvite). * **Gold Standard Investigation:** Non-contrast CT (NCCT) KUB detects almost all stones, including radiolucent ones (except Indinavir stones).

Q: Which of the following is the MOST common histological variant of prostate cancer?

Adenocarcinoma. **Explanation:** **Prostate cancer** is the most common malignancy in men globally. The correct answer is **Adenocarcinoma** because more than **95%** of all primary prostatic malignancies are histologically classified as acinar adenocarcinomas. These tumors typically arise from the **peripheral zone** of the prostate gland (70-80% of cases), which is why they are often detectable via Digital Rectal Examination (DRE). **Analysis of Options:** * **A. Adenocarcinoma (Correct):** As mentioned, acinar adenocarcinoma is the standard histological type. A less common subtype is ductal adenocarcinoma, which is more aggressive. * **B. Sarcoma:** Primary prostatic sarcomas (e.g., Rhabdomyosarcoma in children or Leiomyosarcoma in adults) are extremely rare, accounting for less than 0.1% of cases. * **C. Seminoma:** This is a germ cell tumor primarily found in the **testis**, not the prostate. While it can occur extragonadally (e.g., mediastinum), it is not a variant of prostate cancer. * **D. Squamous cell carcinoma:** This is an exceptionally rare variant (<0.5%) of prostate cancer, often associated with prior radiation therapy or hormonal treatment, and carries a very poor prognosis. **High-Yield Clinical Pearls for NEET-PG:** * **Gleason Scoring:** The grading system used for prognosis, based on architectural patterns (Score 2–10). * **Tumor Marker:** **PSA (Prostate Specific Antigen)** is the most important marker for screening and monitoring. * **Metastasis:** The most common site for distant metastasis is the **bone** (specifically the lumbar spine), typically presenting as **osteoblastic (sclerotic) lesions**. * **Spread:** Venous spread occurs via the **Baston’s vertebral venous plexus**, which explains the early spinal involvement without pulmonary involvement.

Q: What is the most common malignancy found in Marjolin's ulcer?

Squamous cell carcinoma (SCC). **Explanation:** A **Marjolin’s ulcer** refers to a malignancy arising in a site of chronic inflammation, long-standing scars, or non-healing wounds. The most common underlying cause is a **chronic burn scar** (cicatrix), though it can also occur in chronic osteomyelitis sinuses, venous stasis ulcers, and vaccination scars. **1. Why Squamous Cell Carcinoma (SCC) is correct:** The vast majority (approximately **75–90%**) of malignancies arising in Marjolin’s ulcers are **Squamous Cell Carcinomas**. The chronic irritation and repeated cycles of tissue damage and repair lead to cellular dysplasia and eventual malignant transformation into SCC. Notably, Marjolin’s SCC is typically more aggressive and has a higher rate of lymph node metastasis compared to SCC arising from sun-damaged skin. **2. Why other options are incorrect:** * **Basal Cell Carcinoma (BCC):** While BCC is the most common skin cancer overall, it is the second most common malignancy in Marjolin’s ulcers (approx. 10%). It is less frequent than SCC in this specific clinical context. * **Malignant Melanoma & Fibrous Histiocytoma:** These are extremely rare occurrences in chronic scars and do not represent the standard presentation of a Marjolin’s ulcer. **High-Yield Clinical Pearls for NEET-PG:** * **Latency Period:** The average time for malignant transformation is **30–35 years**. * **Characteristic Feature:** A Marjolin’s ulcer typically lacks the "everted edges" seen in standard SCC; instead, it presents as a persistent ulcer with indurated borders. * **Diagnosis:** Biopsy must be taken from the **edge/margin** of the ulcer. * **Treatment:** Wide local excision (usually with a 2 cm margin) or amputation, depending on the site and depth of invasion.

Question 1

What is the most common cause of renal artery stenosis in individuals above 50 years of age?

Accepted Answer

Atherosclerosis

Answer

Fibromuscular dysplasia (FMD)

Answer

Takayasu arteritis

Answer

Renal cell carcinoma (RCC)

Question 2

Which of the following statements regarding vasectomy is false?

Accepted Answer

Sperm production is completely stopped following the procedure.

Answer

Approximately 1 in 2000 men can become fertile again after the procedure.

Answer

Sperm granuloma is a common complication.

Answer

The procedure is typically performed under local anesthesia.

Question 3

What is the column of Bertin in the kidney?

Accepted Answer

Tongue-like papillary projection

Answer

Renal tumour

Answer

Calculus

Answer

None

Question 4

A 55-year-old diabetic patient presented with impotence and a history of failure to achieve erection after papaverine intracavernous injection. Color Doppler shows no abnormality of arteries but shows mild venous run-off. What is the treatment of choice?

Accepted Answer

Vacuum constriction device

Answer

Intracavernous injection of papaverine

Answer

Penile prosthetic implants

Answer

Psychotherapy

Question 5

In a cystometrogram, where does LaPlace's law have its primary application?

Accepted Answer

Phase Ib (bladder volume between 100-400 mL)

Answer

Phase Ia (bladder volume less than 100 mL)

Answer

Phase II (bladder volume more than 450 mL)

Answer

All phases of the cystometrogram

Question 6

All are true regarding membranous urethral injury except?

Accepted Answer

It occurs due to a direct blow to the perineum.

Answer

High lying prostate is seen.

Answer

Pelvic hematoma occurs.

Answer

Urine collects in the perivesical space due to deep extravasation.

Question 7

Which of the following is NOT a radiolucent stone?

Accepted Answer

Cystine stones

Answer

Triamterene stones

Answer

Uric acid stone

Answer

Xanthine stones

Question 8

Which of the following is the MOST common histological variant of prostate cancer?

Accepted Answer

Adenocarcinoma

Answer

Sarcoma

Answer

Seminoma

Answer

Squamous cell carcinoma

Question 9

Which of the following are indications for Transurethral Resection of the Prostate (TURP) in Benign Prostatic Hyperplasia (BHP)?

Accepted Answer

Prostatism, acute retention of urine, haematuria, and complications like hydronephrosis

Answer

Prostatism, acute retention of urine, and haematuria

Answer

Acute retention of urine, haematuria, and complications like hydronephrosis

Answer

Prostatism, acute retention of urine, and complications like hydronephrosis

Question 10

What is the most common malignancy found in Marjolin's ulcer?

Accepted Answer

Squamous cell carcinoma (SCC)

Answer

Basal cell carcinoma (BCC)

Answer

Malignant fibrous histiocytoma

Answer

Malignant melanoma

Urology — MCQs

Urology — MCQs

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