Urology Practice Questions

Q: Which of the following is not a variant of PSA?

PSA nodularity. **Explanation:** Prostate-Specific Antigen (PSA) is a glycoprotein produced by the prostatic epithelium. While a total PSA level >4 ng/mL is traditionally considered suspicious, its low specificity for prostate cancer (as it also rises in BPH and prostatitis) has led to the development of several **PSA derivatives or variants** to improve diagnostic accuracy. **Why "PSA Nodularity" is the correct answer:** There is no clinical or biochemical parameter known as "PSA nodularity." Nodularity refers to a physical finding on **Digital Rectal Examination (DRE)**, where a hard, irregular surface suggests malignancy. It is a clinical sign, not a laboratory variant of the PSA molecule or its kinetics. **Analysis of incorrect options:** * **PSA Density (PSAD):** This is the total PSA divided by the volume of the prostate (measured via TRUS). A value **>0.15** is more suggestive of malignancy than BPH. * **PSA Velocity (PSAV):** This measures the rate of change in PSA levels over time. A rise of **>0.75 ng/mL per year** is highly suspicious for cancer, even if the total PSA is within the normal range. * **Ratio of Free to Bound PSA (f/t PSA):** PSA circulates in free and complexed (bound) forms. In prostate cancer, the percentage of free PSA decreases. A ratio **<10-15%** indicates a higher risk of malignancy. **High-Yield Clinical Pearls for NEET-PG:** * **PSA Doubling Time (PSADT):** Measures how quickly the PSA level doubles; it is a crucial prognostic marker for recurrence after treatment. * **Age-Specific PSA:** PSA levels naturally rise with age due to prostate growth (e.g., <2.5 for age 40-49; <6.5 for age 70-79). * **Most common bound form:** PSA is most commonly bound to **Alpha-1 Antichymotrypsin (ACT)**. * **Half-life of PSA:** Approximately **2.2 to 3.2 days**. Wait at least 4-6 weeks after biopsy or surgery to recheck levels.

Q: Jackstone calculi are seen in which anatomical part?

Bladder. **Explanation:** **Jackstone calculi** are a specific morphological type of urinary stone characterized by a central core with multiple radiating spicules, resembling the metal "jacks" used in the children's game. **Why Bladder is Correct:** Jackstone calculi are almost exclusively found in the **urinary bladder**. They are typically composed of **calcium oxalate monohydrate**. Their unique shape is attributed to the constant tumbling motion within the bladder during micturition and body movement. As the stone rolls, the fragile protrusions are broken off except for those that are structurally reinforced, leading to the characteristic "star-shaped" or "jagged" appearance. They are often associated with bladder outlet obstruction (e.g., BPH) or chronic cystitis. **Why Other Options are Incorrect:** * **Prostate:** Prostatic calculi are usually small, multiple, and composed of calcium phosphate. they are often asymptomatic and found within the glandular tissue, not the lumen. * **Kidney:** Renal stones (like Staghorn calculi) take the shape of the renal pelvis and calyces. The space constraints in the kidney do not allow for the "tumbling" motion required to form a Jackstone. * **Ureter:** Ureteral stones are typically small, oval, or elongated (seed-like) as they transit through the narrow lumen. **High-Yield Clinical Pearls for NEET-PG:** * **Composition:** Primarily Calcium Oxalate Monohydrate (Whewellite). * **Radiology:** They appear highly radiopaque on X-ray. * **Staghorn Calculus:** Associated with *Proteus* infections (Struvite stones) and found in the Renal Pelvis. * **Bladder Stone Triad:** Frequency, dysuria, and sudden interruption of the urinary stream.

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: Lord's and Jaboulay's operation is indicated for which condition?

Hydrocele. **Explanation:** **Lord’s and Jaboulay’s operations** are classic surgical procedures used for the definitive management of a **Primary Vaginal Hydrocele**. A hydrocele occurs due to an abnormal accumulation of serous fluid within the tunica vaginalis of the scrotum. 1. **Jaboulay’s Procedure (Eversion of Sac):** This is the procedure of choice for large, thin-walled hydroceles. The sac is opened, and the redundant tunica vaginalis is folded back (everted) behind the testis and epididymis and sutured. This allows the fluid to be absorbed by the scrotal lymphatics. 2. **Lord’s Procedure (Plication of Sac):** This is preferred for smaller, thin-walled hydroceles. Instead of eversion, the sac is "bunched up" or plicated using interrupted catgut sutures. This technique is associated with less postoperative trauma and reduced risk of hematoma compared to Jaboulay’s. **Why other options are incorrect:** * **Varicocele:** Managed by procedures like **Ivanissevich** (high ligation) or **Palomo’s** (sub-inguinal) operations. * **Seminoma & Teratoma:** These are malignant germ cell tumors. The standard management is a **Radical (High) Orchidectomy** via an inguinal approach. Scrotal approaches (like Lord’s/Jaboulay’s) are strictly contraindicated in suspected malignancy due to the risk of altering lymphatic drainage (scrotal skin drains to inguinal nodes, while testes drain to para-aortic nodes). **Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Transillumination test (positive in hydrocele). * **Complication:** The most common complication after hydrocele surgery is a **scrotal hematoma**. * **Note:** If the hydrocele sac is thick-walled or calcified, a **Subtotal Excision** of the sac is performed instead of plication or eversion.

Q: Thimble bladder is typically seen in which of the following conditions?

Tuberculosis. **Explanation:** **Thimble bladder** is a classic radiological and pathological hallmark of **Genitourinary Tuberculosis (GUTB)**. 1. **Why Tuberculosis is correct:** In GUTB, chronic inflammation leads to extensive ulceration of the bladder mucosa. As these ulcers heal, they undergo progressive **fibrosis and cicatrization** involving the detrusor muscle. This results in a permanent reduction in bladder capacity, making the bladder small, thick-walled, and non-distensible—resembling a "thimble." Patients typically present with "sterile pyuria" and increased frequency of micturition that does not respond to conventional antibiotics. 2. **Why other options are incorrect:** * **BPH:** Leads to a **"thick-walled, trabeculated bladder"** due to detrusor hypertrophy from outflow obstruction, but the bladder is usually enlarged or normal in size, not a small-capacity thimble bladder. * **Malignancy:** Bladder cancer typically presents with filling defects or irregular wall thickening, but does not cause uniform concentric contraction of the entire organ. * **Schistosomiasis:** Characteristically causes **bladder calcification** (fetal head appearance or "egg-shell" calcification) and increases the risk of Squamous Cell Carcinoma, rather than a thimble bladder. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest sign of GUTB on IVP:** "Moth-eaten" appearance of calyces (due to erosions). * **Putty Kidney:** Autonephrectomy occurring in end-stage renal TB due to caseous necrosis and calcification. * **Golf-hole Ureter:** Retraction and gaping of the ureteric orifice due to fibrosis. * **Sterile Pyuria:** Presence of WBCs in urine with negative routine bacterial cultures; always rule out TB.

Question 1

Which of the following is not a variant of PSA?

Accepted Answer

PSA nodularity

Answer

PSA density

Answer

PSA velocity

Answer

Ratio of free to bound PSA

Question 2

Jackstone calculi are seen in which anatomical part?

Accepted Answer

Bladder

Answer

Prostate

Answer

Kidney

Answer

Ureter

Question 3

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 4

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 5

What is the indication for radical prostatectomy?

Accepted Answer

Localized prostate cancer with a life expectancy of greater than 10 years

Answer

Localized prostate cancer with a life expectancy of less than 10 years

Answer

Locally advanced prostate cancer with a life expectancy of less than 10 years

Answer

Locally advanced disease with extension to the lateral pelvic fascia

Question 6

Which of the following is used for screening of prostate cancer?

Accepted Answer

Digital rectal examination

Answer

Transrectal ultrasound

Answer

Prostate-specific antigen test

Answer

CT scan

Question 7

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 8

In triage, what does the green color indicate?

Accepted Answer

Ambulatory patients

Answer

Dead or moribund patients

Answer

High priority treatment or transfer

Answer

Medium priority or transfer

Question 9

Lord's and Jaboulay's operation is indicated for which condition?

Accepted Answer

Hydrocele

Answer

Varicocele

Answer

Seminoma

Answer

Teratoma

Question 10

Thimble bladder is typically seen in which of the following conditions?

Accepted Answer

Tuberculosis

Answer

Benign Prostatic Hyperplasia (BPH)

Answer

Malignancy

Answer

Schistosomiasis

Urology — MCQs

Urology — MCQs

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