Urology — MCQs
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All of the following are true for torsion of testes EXCEPT?
Which of the following statements about retroperitoneal fibrosis is FALSE?
What is the most important prognostic indicator for renal cell carcinoma?
A 60-year-old male, a chronic smoker, presented with gross hematuria, pain in the left flank, along with a significant history of weight loss, fever, and shortness of breath for 3 months. On examination, a firm mass measuring about 5x5 cm was palpated in the left flank, and a left-sided varicocele was noted. Lab findings revealed anemia along with hypercalcemia. Kidney biopsy was performed. All of the following are approved treatments for the condition described, except:
A 21-year-old man presents with scrotal swelling and pain. What is the MOST likely diagnosis?
Radiotherapy is the treatment of choice for which one of the following tumors?
What is the treatment for a complete staghorn calculus with mild hydronephrosis?
Which instrument is used for aerial embolectomy?
Transitional cell carcinoma is most commonly seen in which of the following anatomical locations?
Which of the following tumors causes invasion of the inferior vena cava (IVC)?
Urology Indian Medical PG Practice Questions and MCQs
Question 141: All of the following are true for torsion of testes EXCEPT?
- A. Trauma to testes
- B. Due to twisting of spermatic cord with respect to tunica vaginalis
- C. Cough impulse positive (Correct Answer)
- D. Intravaginal torsion is commoner
Explanation: ### Explanation **Torsion of the testis** is a surgical emergency caused by the twisting of the spermatic cord, leading to venous occlusion followed by arterial compromise and testicular infarction. #### Why "Cough Impulse Positive" is the Correct (False) Statement: A **positive cough impulse** is a hallmark sign of a **reducible inguinal hernia** or a varicocele. In testicular torsion, the pathology is an anatomical twist within the scrotum, not a protrusion of abdominal contents through the inguinal canal. Therefore, the cough impulse is **negative**. Additionally, in torsion, the testis is often high-riding (Angel’s sign) due to the shortening of the cord, and the **Prehn’s sign is negative** (elevation of the scrotum does not relieve pain, unlike in epididymo-orchitis). #### Analysis of Other Options: * **A. Trauma to testes:** While often spontaneous, physical trauma or vigorous activity can trigger the cremasteric reflex, leading to the rotation of a predisposed testis. * **B. Twisting of spermatic cord with respect to tunica vaginalis:** This describes the mechanism of **intravaginal torsion**, where the testis rotates freely within the tunica vaginalis due to an abnormally high attachment (Bell-clapper deformity). * **C. Intravaginal torsion is commoner:** Intravaginal torsion is the most common type, typically seen in adolescents. Extravaginal torsion (twisting of the cord *above* the tunica vaginalis) occurs almost exclusively in neonates. #### NEET-PG High-Yield Clinical Pearls: * **Golden Period:** Surgery must be performed within **6 hours** to ensure a 90-100% salvage rate. * **Bell-Clapper Deformity:** The most common predisposing anatomical factor (usually bilateral). * **Investigation of Choice:** **Color Doppler Ultrasound** (shows decreased or absent blood flow). * **Management:** Emergency surgical detorsion and **bilateral orchidopexy** (fixation of both testes) to prevent recurrence on the contralateral side.
Question 142: Which of the following statements about retroperitoneal fibrosis is FALSE?
- A. The ureter is the most commonly involved structure.
- B. It is more common in females. (Correct Answer)
- C. The primary idiopathic form is called Ormond's disease.
- D. Corticosteroids are the mainstay of treatment.
Explanation: **Explanation:** Retroperitoneal Fibrosis (RPF) is a rare fibro-inflammatory condition characterized by the development of extensive fibrosis throughout the retroperitoneum, which can entrap and compress vital structures. **Why Option B is the Correct Answer (The False Statement):** Retroperitoneal fibrosis is actually **more common in males**, with a male-to-female ratio of approximately **2:1 to 3:1**. It typically presents in the 5th to 6th decades of life. Therefore, the statement that it is more common in females is incorrect. **Analysis of Other Options:** * **Option A:** The **ureter** is indeed the most commonly involved structure. The fibrosis typically starts at the level of the aortic bifurcation and spreads laterally, causing **medial deviation** and extrinsic compression of the ureters, leading to hydronephrosis. * **Option C:** Approximately 70% of cases are idiopathic, and this primary form is eponymously known as **Ormond’s disease**. It is now frequently associated with **IgG4-related disease**. * **Option D:** **Corticosteroids** (e.g., Prednisolone) are the first-line medical treatment. They work by reducing the inflammatory response and halting the progression of fibrosis. Immunosuppressants like Azathioprine or Tamoxifen may be used as adjuncts. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad on IVP:** Hydronephrosis, medial deviation of the middle third of the ureters, and extrinsic ureteral compression. * **Secondary Causes:** Drugs (notably **Methysergide**, Beta-blockers, Hydralazine), malignancy, and infections (TB, Actinomycosis). * **Surgery:** If medical therapy fails or obstruction is severe, **Ureterolysis** (freeing the ureter from the fibrous plaque) with **omental wrapping** is the surgical procedure of choice. * **Lab Marker:** Elevated ESR and CRP are common indicators of disease activity.
Question 143: What is the most important prognostic indicator for renal cell carcinoma?
- A. Nuclear grade
- B. Histological type
- C. Tumor size
- D. Pathological staging (Correct Answer)
Explanation: **Explanation:** In Renal Cell Carcinoma (RCC), the **Pathological Stage (TNM staging)** is universally recognized as the **single most important prognostic factor** for determining patient survival. Staging reflects the anatomical extent of the disease, specifically whether the tumor is confined to the kidney, involves Gerota’s fascia, extends into the renal vein/vena cava, or has spread to lymph nodes and distant organs. * **Pathological Staging (Correct):** The 5-year survival rate is directly correlated with the TNM stage. For instance, Stage I (T1N0M0) has a survival rate of >90%, whereas Stage IV (metastatic) drops significantly to <10-15%. * **Nuclear Grade (Incorrect):** Specifically the **Fuhrman Grade** (or the newer WHO/ISUP system), assesses the aggressiveness of the cells based on nuclear size and prominence of nucleoli. While it is a strong predictor of survival, it is secondary to the anatomical stage. * **Histological Type (Incorrect):** While Clear Cell RCC generally has a worse prognosis than Chromophobe or Papillary types, staging remains the dominant predictor across all subtypes. * **Tumor Size (Incorrect):** Size is a component of the "T" (Tumor) in TNM staging. While important (e.g., T1a vs. T1b), it is the overall stage (including nodal and distant spread) that dictates prognosis. **High-Yield Clinical Pearls for NEET-PG:** * **Most common histological type:** Clear Cell RCC (associated with VHL gene deletion on Chromosome 3p). * **Most common site of metastasis:** Lung ("Cannonball" secondaries). * **Triad of RCC:** Hematuria, Flank pain, and Palpable mass (seen in only 10% of cases, usually indicates advanced stage). * **Robson’s Staging:** An older staging system for RCC, now largely replaced by the TNM system.
Question 144: A 60-year-old male, a chronic smoker, presented with gross hematuria, pain in the left flank, along with a significant history of weight loss, fever, and shortness of breath for 3 months. On examination, a firm mass measuring about 5x5 cm was palpated in the left flank, and a left-sided varicocele was noted. Lab findings revealed anemia along with hypercalcemia. Kidney biopsy was performed. All of the following are approved treatments for the condition described, except:
- A. Sunitinib
- B. Pazopanib
- C. Temsirolimus
- D. Nilotinib (Correct Answer)
Explanation: ### Explanation **Diagnosis: Metastatic Renal Cell Carcinoma (RCC)** The clinical presentation is a classic textbook case of **Renal Cell Carcinoma (RCC)**. The patient exhibits the "Too late triad" (Flank pain, Hematuria, and Palpable mass), systemic symptoms (weight loss, fever), and paraneoplastic syndromes (Hypercalcemia, Anemia). The **left-sided varicocele** is a high-yield sign caused by the tumor obstructing the left renal vein, into which the left gonadal vein drains. Shortness of breath suggests pulmonary metastasis. **Why Nilotinib is the Correct Answer:** * **Nilotinib** is a second-generation Tyrosine Kinase Inhibitor (TKI) specifically used for **Chronic Myeloid Leukemia (CML)**. It targets the BCR-ABL protein. It has no approved role in the management of RCC. **Why the other options are incorrect (Approved for RCC):** * **Sunitinib & Pazopanib (Options A & B):** These are multi-targeted TKIs that inhibit VEGF receptors. They are standard first-line targeted therapies for advanced or metastatic clear cell RCC. * **Temsirolimus (Option C):** This is an **mTOR inhibitor**. It is specifically indicated for patients with advanced RCC who have a poor prognosis (based on MSKCC/Heng criteria). **High-Yield Clinical Pearls for NEET-PG:** * **Most common histological type:** Clear cell RCC (originates from the Proximal Convoluted Tubule). * **Stauffer Syndrome:** Reversible hepatic dysfunction (elevated LFTs) in the absence of liver metastasis; a known paraneoplastic syndrome of RCC. * **Varicocele:** A right-sided varicocele is more concerning for an underlying mass because the right gonadal vein drains directly into the IVC; a new-onset left varicocele in an older male must always trigger a search for RCC. * **Treatment of Choice:** Radical Nephrectomy for localized disease; Targeted therapy (TKIs/mTOR inhibitors/Immunotherapy) for metastatic disease. RCC is notoriously **resistant** to chemotherapy and radiotherapy.
Question 145: A 21-year-old man presents with scrotal swelling and pain. What is the MOST likely diagnosis?
- A. Torsion with a blue testicle
- B. Torsion with an infarcted testicle (Correct Answer)
- C. Acute epididymo-orchitis
- D. Seminoma
Explanation: ***Torsion with an infarcted testicle*** - **Testicular torsion** beyond **12-24 hours** leads to complete **ischemic necrosis** and **infarction**, appearing **black/necrotic** grossly. - **Late presentation** with **infarcted testicle** requires **orchidectomy** rather than detorsion due to non-viable tissue and risk of complications. *Torsion with a blue testicle* - **Blue discoloration** indicates **early torsion** (typically **<6 hours**) where the testicle is still **viable** and salvageable. - **Blue color** suggests **venous congestion** without complete **arterial compromise** or tissue death. *Acute epididymo-orchitis* - Typically presents with **gradual onset** pain and swelling, often with **urinary symptoms** and **fever**. - **Cremasteric reflex** is usually **preserved**, and **elevation** of the scrotum may **relieve pain** (Prehn's sign). *Seminoma* - Presents as a **painless**, **firm testicular mass** rather than acute scrotal pain and swelling. - **Peak incidence** in **30-40 years** age group, and typically has **insidious onset** without acute inflammatory signs.
Question 146: Radiotherapy is the treatment of choice for which one of the following tumors?
- A. Verrucous carcinoma
- B. Malignant melanoma
- C. Marjolin's ulcer
- D. Rodent ulcer (Correct Answer)
Explanation: **Explanation:** **Rodent Ulcer (Basal Cell Carcinoma - BCC):** Rodent ulcer is the clinical term for Basal Cell Carcinoma (BCC). It is highly **radiosensitive**. While surgical excision is often the primary treatment for small lesions, radiotherapy is considered a **treatment of choice**, especially in elderly patients or for lesions located in areas where surgery would be disfiguring (e.g., medial canthus of the eye, nose, or ear). It provides excellent cosmetic results and high cure rates for superficial and nodular variants. **Why the other options are incorrect:** * **Verrucous Carcinoma:** This is a well-differentiated variant of Squamous Cell Carcinoma (SCC). It is notoriously **radioresistant**. Importantly, radiotherapy is contraindicated because it can trigger **anaplastic transformation** into a highly aggressive, metastatic spindle cell carcinoma. * **Malignant Melanoma:** Melanoma is traditionally considered **radioresistant**. The primary treatment is wide local excision with adequate margins. Radiotherapy is generally reserved for palliation or specific adjuvant settings (e.g., brain metastases). * **Marjolin’s Ulcer:** This is an aggressive SCC arising in chronic scars or non-healing wounds. It is relatively **radioresistant** and has a high risk of metastasis. The treatment of choice is wide local excision with a 2-cm margin; radiotherapy is only used if surgery is not possible. **High-Yield Clinical Pearls for NEET-PG:** * **BCC (Rodent Ulcer):** Most common skin cancer; characterized by "pearly" borders and telangiectasia; rarely metastasizes but is locally invasive. * **Radiosensitivity Rule:** BCC is more radiosensitive than SCC. * **Marjolin’s Ulcer:** Most common site is the lower limb; characterized by a long latent period (average 30 years). * **Verrucous Carcinoma:** Also known as **Ackerman’s tumor**; common in the oral cavity (tobacco chewers) and glans penis (Buschke-Löwenstein tumor).
Question 147: What is the treatment for a complete staghorn calculus with mild hydronephrosis?
- A. Extracorporeal Shock Wave Lithotripsy (ESWL)
- B. Ureteroscopy (URS)
- C. Open Nephrolithotomy
- D. Percutaneous Nephrolithotomy (PCNL) (Correct Answer)
Explanation: ### Explanation **Correct Answer: D. Percutaneous Nephrolithotomy (PCNL)** **Why PCNL is the Gold Standard:** For a **complete staghorn calculus** (a large stone filling the renal pelvis and at least two calyces), the primary goal is complete stone clearance to prevent recurrent infections and progressive renal damage. **PCNL** is the treatment of choice because it offers the highest stone-free rate for large stone burdens (>2 cm). Even with mild hydronephrosis, PCNL allows direct access to the collecting system, fragmentation of the stone, and immediate removal of debris. **Why Other Options are Incorrect:** * **ESWL (A):** ESWL is contraindicated for staghorn calculi as a monotherapy. The large stone volume would result in "Steinstrasse" (stone street), causing ureteric obstruction by fragmented debris. It also requires multiple sessions and has poor clearance rates for large stones. * **URS (B):** While Retrograde Intrarenal Surgery (RIRS) is evolving, standard URS is ineffective for the massive volume of a complete staghorn stone. It is typically reserved for smaller stones (<2 cm) or as an adjunct to PCNL. * **Open Nephrolithotomy (C):** Once the standard (e.g., Gil-Vernet extended pyelolithotomy), open surgery is now reserved only for complex cases with anatomical abnormalities or failed endoscopic attempts, due to higher morbidity and longer recovery times. **Clinical Pearls for NEET-PG:** * **Definition:** A staghorn calculus is most commonly composed of **Struvite** (Magnesium Ammonium Phosphate) and is associated with urease-producing bacteria like *Proteus* and *Klebsiella*. * **Sandwich Therapy:** In very complex staghorn stones, a combination of PCNL followed by ESWL, and then a "cleanup" PCNL, may be used. * **First-line for <2 cm stones:** ESWL or RIRS. * **First-line for >2 cm stones:** PCNL. * **Key Complication of PCNL:** Hemorrhage (most common) and injury to adjacent organs (e.g., pleura, colon).
Question 148: Which instrument is used for aerial embolectomy?
- A. Bladder catheterization
- B. Control of upper gastrointestinal bleeding
- C. Insertion of a central line
- D. Aerial embolectomy (Correct Answer)
Explanation: ### Explanation The correct answer is **Aerial Embolectomy**. The question refers to the **Fogarty Embolectomy Catheter**, which is the gold-standard instrument used for removing fresh arterial thrombi or emboli (aerial/arterial embolectomy). **Why it is correct:** The Fogarty catheter is a thin, flexible hollow tube with an inflatable balloon at its tip. During an embolectomy, the catheter is passed through an arteriotomy, distal to the clot. Once past the obstruction, the balloon is inflated and the catheter is withdrawn, effectively "dragging" the embolus out of the vessel. This procedure is crucial in managing acute limb ischemia. **Why the other options are incorrect:** * **Bladder catheterization:** This is typically performed using a **Foley catheter** (self-retaining) or a **Nélaton catheter** (straight). While they also use balloons, their design and material are not suited for the high-pressure environment of the arterial system. * **Control of upper GI bleeding:** This usually involves the **Sengstaken-Blakemore tube** or **Minnesota tube**, which are multi-lumen tubes with large gastric and esophageal balloons used specifically for esophageal variceal tamponade. * **Insertion of a central line:** This is performed using a **Triple Lumen Catheter** or a **PICC line**, typically via the Seldinger technique. These do not utilize the balloon-extraction mechanism characteristic of an embolectomy. **High-Yield Clinical Pearls for NEET-PG:** * **Inventor:** Thomas J. Fogarty (1961). * **Fluid used for inflation:** Always use **Normal Saline** (never air) to inflate the balloon to ensure controlled pressure and prevent air embolism in case of balloon rupture. * **Size:** Measured in **French (F)**; common sizes range from 2F to 7F. * **Complications:** Intimal injury, arterial dissection, or vessel rupture if the balloon is over-inflated.
Question 149: Transitional cell carcinoma is most commonly seen in which of the following anatomical locations?
- A. Prepuce
- B. Testis
- C. Prostate
- D. Urinary bladder (Correct Answer)
Explanation: **Explanation:** **1. Why Urinary Bladder is Correct:** Transitional Cell Carcinoma (TCC), now more commonly referred to as **Urothelial Carcinoma**, arises from the transitional epithelium (urothelium) that lines the urinary tract from the renal pelvis to the proximal urethra. The **urinary bladder** is the most common site for TCC, accounting for over 90% of all bladder cancers and approximately 90-95% of all urothelial tumors. The large surface area of the bladder and the prolonged contact time with concentrated carcinogens in the urine (like cigarette smoke metabolites or aniline dyes) make it the primary site for malignant transformation. **2. Why Other Options are Incorrect:** * **Prepuce:** The prepuce (foreskin) is covered by keratinized stratified squamous epithelium. Therefore, the most common malignancy here is **Squamous Cell Carcinoma (SCC)**. * **Testis:** The most common primary tumors of the testis are **Germ Cell Tumors (GCTs)**, such as Seminomas and Non-Seminomatous Germ Cell Tumors (NSGCTs). * **Prostate:** The prostate is a glandular organ; hence, the overwhelming majority (95%) of prostate cancers are **Adenocarcinomas**. **3. High-Yield Clinical Pearls for NEET-PG:** * **Risk Factors:** Smoking (most common), exposure to aromatic amines (2-Naphthylamine), and long-term Cyclophosphamide use. * **Field Cancerization:** TCC exhibits a "field effect," meaning the entire urothelium is at risk. Patients with bladder TCC must be monitored for synchronous or metachronous tumors in the ureters or renal pelvis. * **Presentation:** The classic presentation is **painless gross hematuria** in an elderly male. * **Schistosomiasis Link:** While TCC is the most common bladder cancer globally, *Schistosoma haematobium* infection is specifically associated with **Squamous Cell Carcinoma** of the bladder.
Question 150: Which of the following tumors causes invasion of the inferior vena cava (IVC)?
- A. Hepatocellular carcinoma
- B. Renal cell carcinoma (Correct Answer)
- C. Gallbladder carcinoma
- D. Pancreatic carcinoma
Explanation: **Explanation:** **Renal Cell Carcinoma (RCC)**, specifically the clear cell subtype, is notorious for its tendency to invade the venous system. The tumor cells grow as a solid column (tumor thrombus) into the renal vein and can extend superiorly into the **Inferior Vena Cava (IVC)**. In advanced cases, this thrombus can reach the right atrium. This occurs in approximately 4–10% of patients with RCC. The diagnosis is typically made using Doppler Ultrasound or Contrast-Enhanced CT (CECT), and the level of IVC involvement is a critical factor in surgical planning (Radical Nephrectomy with Thrombectomy). **Analysis of Incorrect Options:** * **Hepatocellular Carcinoma (HCC):** While HCC frequently invades the **portal vein** (leading to portal hypertension), it rarely involves the IVC compared to RCC. * **Gallbladder Carcinoma:** This tumor primarily spreads via direct local invasion into the liver (Segment IV and V) or through lymphatic spread to the cystic and pericholedochal nodes. * **Pancreatic Carcinoma:** Carcinoma of the head of the pancreas typically invades the **superior mesenteric vein (SMV)** or the **portal vein** due to anatomical proximity, rather than the IVC. **High-Yield Clinical Pearls for NEET-PG:** * **Staging:** IVC involvement in RCC is classified using the **Mayo Clinic Classification** (Levels 0 to IV). * **Varicocele:** A classic sign of RCC (especially on the left side) is a non-reducing varicocele, caused by the tumor thrombus obstructing the entry of the left gonadal vein into the left renal vein. * **Triad:** The classic triad of RCC (Flank pain, Hematuria, Palpable mass) is seen in only 10% of cases; hematuria is the most common individual symptom.
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Urological Anatomy
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Hematuria Evaluation
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Urinary Calculi
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Benign Prostatic Hyperplasia
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Prostate Cancer
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Bladder Cancer
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Renal Cell Carcinoma
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Testicular Tumors
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Urinary Tract Infections
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Urinary Incontinence
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Genitourinary Trauma
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Pediatric Urology Basics
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