Urology Practice Questions

Q: All of the following are true about prostate-specific antigen except?

Normal level is 10-14 ng/ml. **Explanation** Prostate-Specific Antigen (PSA) is a vital biomarker in urological practice. The correct answer is **Option A** because the statement is factually incorrect; the normal reference range for serum PSA is generally considered to be **0–4 ng/ml**. Levels between 4–10 ng/ml are often referred to as the "gray zone," while levels above 10 ng/ml significantly increase the suspicion of malignancy. **Analysis of other options:** * **Option B:** PSA is organ-specific but not cancer-specific. It can be elevated in both **Benign Prostatic Hyperplasia (BPH)** and **Carcinoma Prostate**, as well as in prostatitis, urinary retention, or following digital rectal examination (DRE) and biopsy. * **Option C:** It is produced by the **ductal and acinar epithelium** of the prostate gland. Its physiological function is to liquefy the seminal coagulum. * **Option D:** PSA is biochemically a **serine protease** (kallikrein-like) and is structurally a **glycoprotein**. **High-Yield Clinical Pearls for NEET-PG:** * **PSA Velocity:** An increase of >0.75 ng/ml per year is suspicious for malignancy, even if the total PSA is 0.15 is suggestive of cancer. * **Free/Total PSA Ratio:** In prostate cancer, the percentage of free PSA decreases. A ratio **<15-20%** is suspicious for malignancy. * **Age-specific PSA:** Normal limits increase with age (e.g., <2.5 for 40-49 years; <6.5 for 70-79 years) due to increasing prostate volume.

Q: A 19-year-old male college student presents with acute pain and swelling of the scrotum. Physical examination reveals an exquisitely tender, swollen right testis with an absent cremasteric reflex and no swelling in the inguinal area. A urine dipstick is negative for red and white blood cells. What is the most appropriate next step in management?

Ultrasound of the scrotum. **Explanation:** The clinical presentation of acute scrotal pain, swelling, and an **absent cremasteric reflex** in an adolescent/young adult is highly suggestive of **Testicular Torsion**. This is a surgical emergency where the spermatic cord twists, leading to ischemia. While the gold standard for a definitive diagnosis is surgical exploration, **Color Doppler Ultrasound** is the most appropriate next step to assess blood flow and confirm the diagnosis when the clinical picture requires differentiation from other causes. **Analysis of Options:** * **Option D (Correct):** Ultrasound of the scrotum (Doppler) is the imaging modality of choice. It shows decreased or absent blood flow to the affected testis, helping differentiate torsion from inflammatory conditions. * **Option A:** This describes the management for *Epididymitis*. While common in sexually active males, epididymitis usually presents with a positive Prehn’s sign (relief of pain with elevation) and a preserved cremasteric reflex. * **Option B:** Reassurance is inappropriate for a potential surgical emergency; delay in treatment (beyond 6 hours) leads to testicular necrosis. * **Option C:** This is the management for *Urolithiasis* (kidney stones). While stones cause acute pain, they do not typically cause testicular swelling or an absent cremasteric reflex. **NEET-PG High-Yield Pearls:** * **Cremasteric Reflex:** The most sensitive physical exam finding for testicular torsion (its presence strongly rules out torsion). * **Golden Period:** Detorsion within **6 hours** offers a >90% salvage rate; this drops to <10% after 24 hours. * **Prehn’s Sign:** Pain relief with scrotal elevation (suggests Epididymitis); no relief or worsening pain suggests Torsion. * **Bell-clapper deformity:** The most common anatomical predisposition (high tunica vaginalis attachment).

Q: A 10-year-old girl was evaluated for recurrent UTI and dysuria. An IVP finding is shown. What is the preferred treatment option for this case?

Endoscopic incision. ***Endoscopic incision*** - **Endoscopic incision** is the preferred first-line treatment for **ureterocele** (cobra head sign on IVP) in children, offering minimal invasivity with excellent success rates. - It provides immediate drainage relief and preserves **renal function** while avoiding major surgical complications in pediatric patients. *Nephrectomy with pyeloureterectomy* - This is an **extreme surgical approach** reserved for cases with **non-functioning kidneys** or severe complications, not as first-line treatment. - **Unnecessary loss of renal tissue** in a child when simpler endoscopic options can effectively treat the ureterocele. *STING operation* - **Subureteral injection** is used for **vesicoureteral reflux** treatment, not for ureterocele management. - Does not address the **anatomical obstruction** caused by the ureterocele that requires decompression. *Lich-Gregoir technique* - This **ureteroneocystostomy** technique is used for **ureteral reimplantation** in cases of reflux or ureteral strictures. - **Not indicated** for ureterocele treatment where endoscopic decompression is the preferred initial approach.

Q: Which of the following is an alkaline type of renal calculi?

Calcium stone. In renal stone pathology, the **urinary pH** plays a critical role in the precipitation of specific crystals. **Correct Option: A (Calcium stone)** Calcium-based stones, specifically **Calcium Phosphate**, typically form in **alkaline urine** (pH > 7.2). While Calcium Oxalate stones (the most common type) are relatively independent of pH, they are frequently grouped under alkaline-associated stones in competitive exams because their counterparts (Uric acid and Cystine) are strictly associated with acidic environments. Additionally, **Struvite stones** (Triple phosphate) are the classic alkaline stones, often associated with urea-splitting organisms like *Proteus*. **Incorrect Options:** * **B. Uric acid stone:** These form exclusively in **acidic urine** (pH 7.5 to increase cystine solubility. **High-Yield Clinical Pearls for NEET-PG:** * **Radiopacity:** Calcium and Struvite stones are **Radiopaque** (visible on X-ray). Uric acid stones are **Radiolucent** (invisible on X-ray, seen on CT). Cystine stones are **Semi-opaque** (ground-glass appearance). * **Morphology:** * Calcium Oxalate Dihydrate: Envelope/Star-shaped. * Calcium Oxalate Monohydrate: Dumbbell-shaped. * Struvite: Coffin-lid appearance. * Cystine: Hexagonal crystals. * Uric acid: Rhomboid/Rosette shape. * **Most common stone:** Calcium Oxalate (specifically the Monohydrate form is the hardest).

Q: Painless hematuria is seen in all of the following conditions except?

Renal infarction. **Explanation:** In clinical urology, the presence or absence of pain during hematuria is a critical diagnostic differentiator. **Renal Infarction** is the correct answer because it typically presents with **acute, severe flank pain** (simulating renal colic) due to sudden ischemia and capsular stretching, accompanied by hematuria. **Analysis of Options:** * **Hypernephroma (Renal Cell Carcinoma):** Classically presents with **painless hematuria** (the most common presenting symptom). The "classic triad" (hematuria, flank pain, and palpable mass) is seen in only 10% of cases and usually indicates advanced disease. * **Renal TB:** Often referred to as "sterile pyuria," but it frequently causes **painless total hematuria**. Pain only occurs if clots or debris cause ureteric obstruction. * **Bleeding Disorders:** Systemic coagulopathies or anticoagulation therapy lead to spontaneous, **painless bleeding** from the urinary tract unless a secondary obstructive clot forms. **Clinical Pearls for NEET-PG:** 1. **Rule of Thumb:** Painless hematuria in an elderly patient is **Malignancy** (RCC or Bladder Cancer) until proven otherwise. 2. **Painful Hematuria:** Usually suggests **Calculi** (urolithiasis), **Infections** (cystitis), or **Vascular events** (infarction). 3. **Total vs. Initial vs. Terminal Hematuria:** * *Initial:* Prostatic/Urethral source. * *Terminal:* Bladder neck/Trigone source. * *Total:* Kidney/Ureter source. 4. **Renal Infarction Triad:** Flank pain, hematuria, and elevated serum LDH.

Q: Interstitial cystitis is also known as?

Hunner's cystitis. **Explanation:** **Interstitial Cystitis (IC)**, also known as **Hunner’s cystitis** or Painful Bladder Syndrome, is a chronic inflammatory condition of the bladder wall. The hallmark of the disease is the presence of **Hunner’s ulcers** (or Hunner’s lesions), which are circumscribed, reddened mucosal areas with small vessels radiating towards a central scar. These are found in approximately 10–20% of cases during cystoscopy with hydrodistension. **Analysis of Options:** * **Option C (Correct):** IC is eponymously named Hunner’s cystitis after Guy Hunner, who first described the characteristic ulcers. It typically presents in middle-aged women with symptoms of increased frequency, urgency, and suprapubic pain that is relieved by voiding. * **Option A:** Eosinophilic cystitis is a rare inflammatory condition characterized by eosinophilic infiltration of the bladder wall, often associated with allergies or bladder injury. * **Option B:** Radiation cystitis is a complication of pelvic radiation therapy causing mucosal ischemia and fibrosis. * **Option D:** Tubercular cystitis (Secondary to Renal TB) typically results in a "thimble bladder" (small capacity, fibrotic bladder) and presents with sterile pyuria. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** It is a diagnosis of exclusion. Cystoscopy may show **Glomerulations** (petechial hemorrhages) after hydrodistension. * **Biopsy:** Essential to rule out Carcinoma-in-situ (CIS), which mimics IC symptoms. * **Nerve Involvement:** There is an increased density of **Mast cells** in the detrusor muscle. * **Treatment:** First-line oral drug is **Pentosan Polysulfate Sodium** (restores the GAG layer). Intravesical instillations include DMSO or Heparin.

Q: What is the commonest cause of death in carcinoma of the penis?

Erosion of femoral vessels. **Explanation:** Carcinoma of the penis is a squamous cell carcinoma that primarily spreads via the lymphatic system rather than the bloodstream. Understanding this lymphatic progression is key to identifying the cause of mortality. **Why "Erosion of femoral vessels" is correct:** The primary lymphatic drainage of the penis is to the **inguinal lymph nodes** (superficial and deep). As the disease progresses, these nodes become involved, forming large, fixed, and often ulcerated masses in the groin. These nodal masses can invade the underlying femoral triangle. The most dreaded complication is the erosion of the **femoral artery**, leading to massive, uncontrollable exsanguination (hemorrhage). This remains the leading cause of death in advanced cases. **Why the other options are incorrect:** * **Cerebral and Liver metastasis:** Hematogenous spread is rare and occurs very late in the disease course. Most patients succumb to local or regional complications before distant visceral metastases can manifest. * **Uremia:** While common in cervical or bladder cancers due to ureteric obstruction, penile cancer rarely involves the ureters. Urinary obstruction, if it occurs, is usually at the level of the distal urethra, which rarely leads to renal failure. **High-Yield Clinical Pearls for NEET-PG:** * **Staging:** The most important prognostic factor is the status of the inguinal lymph nodes. * **Sentinel Node:** The **Node of Cabanas** (sentinel node) is located medial to the epigastric vein. * **Management:** Prophylactic inguinal lymph node dissection (ILND) is often indicated because clinical examination of nodes is unreliable (50% of palpable nodes are inflammatory, while 20% of non-palpable nodes harbor micrometastasis). * **Risk Factors:** Phimosis and HPV (types 16 and 18) are strongly associated; neonatal circumcision is protective.

Q: A 28-year-old male presents with lower abdominal pain associated with groin pain and nausea. Elevation of the testis relieves his pain. What is your diagnosis?

Epididymo-orchitis. ### Explanation The clinical presentation described is a classic case of **Epididymo-orchitis**. The hallmark finding here is the relief of pain upon elevation of the scrotum, known as a **Positive Prehn’s Sign**. **1. Why Epididymo-orchitis is correct:** In inflammatory conditions like epididymo-orchitis, elevating the testis reduces the gravitational pull on the inflamed structures and improves venous drainage, thereby relieving pain. In a 28-year-old male, this is most commonly caused by sexually transmitted infections (e.g., *Chlamydia trachomatis* or *Neisseria gonorrhoeae*). **2. Why other options are incorrect:** * **Torsion of Testis:** This is the most critical differential. However, in torsion, elevating the testis typically **exacerbates** the pain (Negative Prehn’s sign) because it further twists the spermatic cord. Torsion is a surgical emergency characterized by a sudden onset of pain and an absent cremasteric reflex. * **Ureteric Colic:** While it causes groin pain and nausea, it does not present with testicular tenderness or relief upon scrotal elevation. The pain typically radiates from "loin to groin." * **Prostatitis:** This usually presents with perineal pain, dysuria, and obstructive voiding symptoms rather than localized testicular pain relieved by elevation. **3. NEET-PG High-Yield Pearls:** * **Prehn’s Sign:** Positive (relief) in Epididymo-orchitis; Negative (no relief/worse) in Testicular Torsion. * **Cremasteric Reflex:** Preserved in Epididymo-orchitis; **Absent** in Testicular Torsion (most sensitive physical finding for torsion). * **Age Factor:** In patients 35 years, think E. coli/UTI associated with BPH. * **Investigation of Choice:** Color Doppler Ultrasound (shows increased blood flow in orchitis, decreased/absent flow in torsion).

Question 1

All of the following are true about prostate-specific antigen except?

Accepted Answer

Normal level is 10-14 ng/ml

Answer

It may be elevated in BPH and Ca Prostate

Answer

It is produced by the prostate

Answer

It is a glycoprotein

Question 2

A 19-year-old male college student presents with acute pain and swelling of the scrotum. Physical examination reveals an exquisitely tender, swollen right testis with an absent cremasteric reflex and no swelling in the inguinal area. A urine dipstick is negative for red and white blood cells. What is the most appropriate next step in management?

Accepted Answer

Ultrasound of the scrotum

Answer

Administration of antibiotics after culture of urethra for Chlamydia and gonorrhea

Answer

Reassurance

Answer

Intravenous fluid administration, pain medications, and straining of all voids

Question 3

A patient with a suspected pelvic fracture presents with urethral bleeding and inability to pass urine. What is the immediate management step?

Accepted Answer

Prepare for surgery and attempt catheterization in the operating theatre.

Answer

Encourage voiding after administration of antibiotics and analgesics.

Answer

Immediate catheterization in the ward.

Answer

Application of a hot water bottle followed by carbachol injection.

Question 4

A 10-year-old girl was evaluated for recurrent UTI and dysuria. An IVP finding is shown. What is the preferred treatment option for this case?

Accepted Answer

Endoscopic incision

Answer

Nephrectomy with pyeloureterectomy

Answer

STING operation

Answer

Lich-Gregoir technique

Question 5

Which of the following is an alkaline type of renal calculi?

Accepted Answer

Calcium stone

Answer

Uric acid stone

Answer

Cystine stone

Answer

All of the above

Question 6

A patient presents with urethral bleeding and perineal swelling following a straddle injury, indicative of a ruptured bulbar urethra. Which of the following statements regarding his management is FALSE?

Accepted Answer

Immediate urethral catheterization is indicated.

Answer

Suprapubic cystostomy may be required.

Answer

Urethrography is a useful diagnostic tool.

Answer

Management should be symptomatic and supportive.

Question 7

Painless hematuria is seen in all of the following conditions except?

Accepted Answer

Renal infarction

Answer

Hypernephroma

Answer

Renal TB

Answer

Bleeding disorders

Question 8

Interstitial cystitis is also known as?

Accepted Answer

Hunner's cystitis

Answer

Eosinophilic cystitis

Answer

Radiation cystitis

Answer

Tubercular cystitis

Question 9

What is the commonest cause of death in carcinoma of the penis?

Accepted Answer

Erosion of femoral vessels

Answer

Cerebral metastasis

Answer

Liver metastasis

Answer

Uremia

Question 10

A 28-year-old male presents with lower abdominal pain associated with groin pain and nausea. Elevation of the testis relieves his pain. What is your diagnosis?

Accepted Answer

Epididymo-orchitis

Answer

Ureteric colic

Answer

Prostatitis

Answer

Torsion of testis

Urology — MCQs

Urology — MCQs

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