Urology Practice Questions

Q: A young male presents with a scrotal swelling of 3 years duration. On examination, the swelling is fluctuant, and the testis is not separately felt. There is no history of trauma or fever. What is the most likely diagnosis?

Vaginal hydrocele. **Explanation:** The clinical presentation of a long-standing, painless, fluctuant scrotal swelling where the testis is not separately palpable is the classic description of a **Vaginal Hydrocele**. **Why it is correct:** A vaginal hydrocele occurs due to the accumulation of fluid within the *tunica vaginalis*. Because the fluid surrounds the testis anteriorly and laterally, the testis becomes "buried" and cannot be felt separately on palpation. The "fluctuant" nature confirms the presence of fluid, and the 3-year duration without fever or trauma points toward a chronic, primary (idiopathic) etiology. **Why the other options are incorrect:** * **Hemorrhagic hydrocele:** This typically follows a history of trauma or surgery and is often painful or associated with rapid enlargement. * **Carcinoma of the testis:** Testicular tumors present as a hard, painless mass. Crucially, in malignancy, the testis is palpable (as the mass itself), and the swelling is not fluctuant unless a secondary hydrocele is present (which occurs in only 10% of cases). * **Varicocele:** This feels like a "bag of worms" on palpation. It is not fluctuant and does not obscure the testis; it is usually located superior to the testis. **NEET-PG High-Yield Pearls:** * **Transillumination Test:** The gold standard clinical test for hydrocele. It is positive in vaginal hydroceles but negative in hematocele, chylocele, or solid tumors. * **"Getting above the swelling":** You can get above a hydrocele (unlike an inguinal hernia). * **Lord’s Plication:** Surgical procedure used for small, thin-walled hydroceles. * **Jaboulay’s Procedure:** Eversion of the sac, used for large, thick-walled hydroceles.

Q: Which of the following statements is true about seminoma?

AFP is increased. **Explanation:** In the context of testicular germ cell tumors (GCTs), the biochemical marker profile is a high-yield distinction. **Why the correct answer is C:** Actually, there appears to be a discrepancy in the provided key. In standard surgical teaching (Bailey & Love, Sabiston), **Seminoma is characterized by normal AFP levels.** If AFP is elevated, the tumor is classified as a Non-Seminomatous Germ Cell Tumor (NSGCT), even if the histology looks like a seminoma. However, **hCG** can be elevated in 10-15% of seminomas (due to syncytiotrophoblastic giant cells), and **LDH** is often raised. If the question implies "AFP is increased" as the correct statement, it contradicts standard pathology; typically, the hallmark of pure seminoma is the **absence** of AFP elevation. **Analysis of Options:** * **A & D (Radiosensitivity/Chemosensitivity):** Seminomas are famously **both** highly radiosensitive and chemosensitive. Historically, radiotherapy was the mainstay for Stage I/II, though carboplatin (chemo) is now often preferred to reduce long-term toxicity. * **B (Cryptorchidism):** While cryptorchidism is the strongest risk factor for seminoma, the majority of cases occur in normally descended testes. **NEET-PG High-Yield Pearls:** 1. **Marker Rule:** Elevated AFP = NSGCT (Always). Never a pure seminoma. 2. **Most Common:** Seminoma is the most common testicular tumor in the 4th decade. 3. **Microscopy:** Classic "fried egg" appearance (clear cytoplasm, central nuclei) with fibrous septa and lymphocytic infiltration. 4. **Spermatocytic Seminoma:** Occurs in older men (>65); excellent prognosis, rarely metastasizes. 5. **Treatment:** Radical Inguinal Orchidectomy is the gold standard for all suspected testicular masses. *Never perform a trans-scrotal biopsy.*

Q: According to the classification of renal injuries, which grade is assigned to a laceration more than 1 cm deep without extension into the renal pelvis or collecting system?

Grade III. The classification of renal trauma is based on the **AAST (American Association for the Surgery of Trauma) Renal Injury Scale**, which is a high-yield topic for NEET-PG. ### **Explanation of the Correct Answer** **Grade III** injuries are defined by a renal cortex laceration that is **greater than 1 cm in depth** but **does not involve the collecting system** (no urinary extravasation). There is also no evidence of a perirenal hematoma expanding into the renal pelvis. Since the question specifies a laceration >1 cm without collecting system involvement, Grade III is the correct classification. ### **Why Other Options are Incorrect** * **Grade I (Option A):** Involves only a **contusion** (microscopic or macroscopic hematuria with normal imaging) or a **non-expanding subcapsular hematoma** without a parenchymal laceration. * **Grade IV (Option C):** This grade involves a laceration extending into the **renal collecting system** (demonstrated by urinary extravasation on CT) OR injury to the main renal artery or vein with contained hemorrhage. * **Grade V (Option D):** This is the most severe stage, involving a **completely shattered kidney** or **avulsion of the renal hilum** (devascularization of the kidney). ### **High-Yield Clinical Pearls for NEET-PG** * **Grade II:** Laceration **<1 cm** in depth confined to the cortex (no collecting system involvement). * **Imaging Gold Standard:** Contrast-enhanced CT (CECT) is the investigation of choice for stable patients with suspected renal trauma. * **Management:** Most Grade I-III injuries (and even many Grade IV) are managed **conservatively** in hemodynamically stable patients. * **Key Distinction:** The presence of **urinary extravasation** is the primary differentiator between Grade III and Grade IV.

Q: A 23-year-old male presented with fever, chills, and back pain. He also complained of increased frequency of voiding. Ultrasonography revealed bladder stones. All of the following are true about bladder stones, EXCEPT:

Rare in Indian children. **Explanation:** The correct answer is **A (Rare in Indian children)** because this statement is false. In developing countries like India, endemic bladder stones are historically common among children, particularly boys. These are often associated with a diet high in cereal and low in animal protein, leading to hyperoxaluria. **Analysis of Options:** * **Option A (False/Correct Answer):** Bladder stones are **not rare** in Indian children; they are a classic presentation in pediatric urology in the Indian subcontinent, often linked to nutritional factors. * **Option B (True):** Bladder calculi are significantly more common in men. This is primarily due to **Bladder Outlet Obstruction (BOO)** caused by conditions like Benign Prostatic Hyperplasia (BPH) or urethral strictures, which lead to urinary stasis. * **Option C (True):** Small stones can be managed via **Cystolitholapaxy**, where stones are fragmented and removed through the urethra using a cystoscope. * **Option D (True):** In the majority of cases, a **solitary** bladder stone is the rule, although multiple stones can occur in cases of severe stasis or diverticula. **Clinical Pearls for NEET-PG:** * **Composition:** Most bladder stones are composed of **Ammonium Acid Urate**, Calcium Oxalate, or Uric Acid. * **The "Jackstone" Calculus:** A specific type of calcium oxalate dihydrate stone with a spiked appearance, typically found in the bladder. * **Clinical Presentation:** Characterized by "interruption of urinary stream" and pain referred to the tip of the penis (mediated by the S2-S3 nerve roots). * **Gold Standard Investigation:** Non-contrast CT (NCCT) is the most sensitive, though Ultrasound is often the initial screening tool.

Q: A male has a history of bilateral undescended testes. What is the most likely consequence?

He is likely to be sterile.. ### Explanation **1. Why Option A is Correct:** The primary consequence of bilateral undescended testes (cryptorchidism) is **infertility/sterility**. Normal spermatogenesis requires a temperature approximately 2–3°C lower than the core body temperature. When testes remain in the inguinal canal or abdomen, they are exposed to higher temperatures, leading to progressive degeneration of germ cells and tubular atrophy. While unilateral cryptorchidism carries a lower risk of infertility (~10%), **bilateral** involvement results in a significantly higher risk, with nearly 75–100% of untreated patients becoming sterile. **2. Why the Other Options are Incorrect:** * **Option B:** This is incorrect. Cryptorchidism is the most significant risk factor for **testicular germ cell tumors** (most commonly Seminoma). The risk is 5 to 10 times higher than in the general population. * **Option C:** This is incorrect. While mechanical factors (e.g., short spermatic vessels or narrow inguinal canal) play a role, the pathophysiology is often **multifactorial**, involving hormonal deficiencies (H-P-G axis) and genetic predispositions. * **Option D:** This is incorrect. Psychological well-being is a valid indication for intervention. An empty scrotum can lead to body image issues and anxiety during adolescence, making orchidopexy or prosthetic insertion necessary. **3. NEET-PG High-Yield Pearls:** * **Most common site:** Inguinal canal (specifically just outside the external ring). * **Most common tumor:** Seminoma (overall); however, if the testis is intra-abdominal, the risk of malignancy is higher. * **Ideal age for surgery:** Orchidopexy should ideally be performed between **6 to 12 months** of age to preserve fertility and allow for easier screening of malignancy. * **Orchidopexy** does not eliminate the risk of cancer, but it makes the testis palpable for early detection.

Q: The Hunt-Hess scale is used for the grading of which condition?

Subarachnoid hemorrhage (SAH). **Explanation:** The **Hunt-Hess scale** is a clinical grading system used to assess the severity of a **Subarachnoid Hemorrhage (SAH)** based on the patient’s clinical presentation. It is a critical tool for predicting perioperative mortality and determining the timing of surgical intervention (clipping or coiling). * **Grade I:** Asymptomatic or mild headache. * **Grade II:** Moderate to severe headache, nuchal rigidity, no neurological deficit (except cranial nerve palsy). * **Grade III:** Drowsiness, confusion, or mild focal deficit. * **Grade IV:** Stupor, moderate to severe hemiparesis. * **Grade V:** Deep coma, decerebrate rigidity, moribund appearance. **Analysis of Incorrect Options:** * **Subdural Hematoma (SDH):** Typically assessed using the Glasgow Coma Scale (GCS) and CT imaging (crescent-shaped hematoma) rather than a specific clinical grading scale like Hunt-Hess. * **Meningiomas:** These are graded using the **WHO Classification** (Grade I-III) based on histopathology, not clinical presentation. * **Tuberculosis:** CNS tuberculosis is often graded using the **British Medical Research Council (BMRC)** staging for tuberculous meningitis. **NEET-PG High-Yield Pearls:** 1. **Fisher Scale:** Used alongside Hunt-Hess for SAH, but it is based on **CT findings** to predict the risk of cerebral vasospasm. 2. **Most common cause of SAH:** Trauma (Overall); Rupture of Saccular (Berry) aneurysm (Spontaneous). 3. **Gold Standard Investigation:** Digital Subtraction Angiography (DSA). 4. **Management:** Nimodipine is administered to prevent vasospasm-induced delayed ischemic neurological deficits.

Q: The graph shown in the illustration is known as:

Cystometrogram. ***Cystometrogram*** - A **cystometrogram** is a urodynamic graph that plots **bladder pressure** against **bladder volume** during bladder filling. - Used to assess **bladder compliance** and **detrusor muscle activity** in patients with voiding dysfunction or neurogenic bladder. *Nephrogram* - A **nephrogram** is a radiological imaging study showing the **kidney parenchyma** after contrast administration. - It represents the **nephron phase** of contrast excretion, not a pressure-volume graph. *Pyelograph* - A **pyelograph** (or pyelogram) is an imaging study visualizing the **renal pelvis** and **ureter** using contrast. - It's a **radiological procedure**, not a graphical representation of bladder dynamics. *None of the above* - This option is incorrect as **cystometrogram** accurately describes the urodynamic graph shown. - The graph specifically measures **bladder pressure-volume relationships**, which is the definition of cystometrography.

Q: What is the best treatment for Grade I benign prostate with outflow obstruction?

Transurethral resection. **Explanation:** The management of Benign Prostatic Hyperplasia (BPH) with outflow obstruction depends on the size of the gland and the severity of symptoms. **Transurethral Resection of the Prostate (TURP)** is considered the "Gold Standard" surgical treatment for small to moderate-sized glands (typically <60–80 grams). **Grade I BPH** refers to a small enlargement (usually <25 grams). In cases where medical management fails or outflow obstruction is significant, TURP is the preferred modality because it is minimally invasive, offers excellent functional outcomes, and has a lower morbidity rate compared to open surgeries. **Analysis of Incorrect Options:** * **Retropubic (Millin’s) & Transvesical (Freyer’s) Prostatectomy:** These are open surgical procedures reserved for **large prostates** (typically >80–100 grams) or when there are associated bladder stones/diverticula that cannot be managed endoscopically. * **Androgen Therapy:** This is incorrect. While 5-alpha reductase inhibitors (like Finasteride) reduce DHT levels, "Androgen therapy" (testosterone) would actually worsen BPH symptoms. Medical management usually involves Alpha-blockers or 5-ARIs, but once "outflow obstruction" requires definitive intervention, surgery is indicated. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard for BPH:** TURP. * **TURP Syndrome:** Caused by the absorption of glycine (irrigating fluid), leading to dilutional hyponatremia and CNS symptoms. * **Most common complication of TURP:** Retrograde ejaculation (up to 75%). * **Most common late complication:** Urethral stricture or bladder neck contracture. * **Laser of choice:** Holmium Laser Enucleation of the Prostate (HoLEP) is now preferred for very large glands as an alternative to open surgery.

Q: Which of the following is NOT a contraindication for extracorporeal shockwave lithotripsy for renal calculi?

Stone in a calyceal diverticulum. **Explanation:** Extracorporeal Shockwave Lithotripsy (ESWL) is a non-invasive treatment for renal calculi, but its success depends on the ability of the fragmented stones to pass through the urinary tract. **Why "Stone in a calyceal diverticulum" is the correct answer:** A stone in a calyceal diverticulum is considered a **relative contraindication** or a factor for poor clearance, but it is **not an absolute contraindication**. While ESWL can fragment the stone, the narrow neck of the diverticulum often prevents the passage of fragments. However, ESWL may still be attempted for symptomatic relief in specific cases, unlike the other options which pose significant safety risks. **Analysis of Incorrect Options:** * **Pregnancy (Option A):** This is an **absolute contraindication**. Shockwaves can cause fetal injury, placental abruption, or miscarriage. * **Bleeding Disorder (Option B):** Uncorrected coagulopathy is an **absolute contraindication** due to the high risk of life-threatening perinephric hematoma. * **Stone >2 cm (Option C):** Large stones (>2 cm) are a **relative contraindication**. They have a low clearance rate and carry a high risk of *Steinstrasse* (stone street), where fragments obstruct the ureter. Percutaneous Nephrolithotomy (PCNL) is the preferred treatment for stones >2 cm. **High-Yield Clinical Pearls for NEET-PG:** * **Best candidate for ESWL:** Small (<1.5 cm), radiopaque, friable stones (e.g., Calcium oxalate dihydrate) located in the upper or middle calyx. * **Hardest stones to fragment:** Calcium oxalate monohydrate, Cystine, and Brushite stones. * **Anatomical Contraindications:** Distal obstruction (fragments won't pass), uncontrolled UTI, and abdominal aortic aneurysm (risk of rupture). * **Ideal Location:** Lower pole stones have the poorest clearance rates due to gravity.

Question 1

A young male presents with a scrotal swelling of 3 years duration. On examination, the swelling is fluctuant, and the testis is not separately felt. There is no history of trauma or fever. What is the most likely diagnosis?

Accepted Answer

Vaginal hydrocele

Answer

Hemorrhagic hydrocele

Answer

Carcinoma of the testis

Answer

Varicocele

Question 2

Which of the following statements is true about seminoma?

Accepted Answer

AFP is increased

Answer

It is radiosensitive

Answer

It arises only from cryptorchid testes

Answer

It is chemosensitive

Question 3

According to the classification of renal injuries, which grade is assigned to a laceration more than 1 cm deep without extension into the renal pelvis or collecting system?

Accepted Answer

Grade III

Answer

Grade I

Answer

Grade IV

Answer

Grade V

Question 4

A 23-year-old male presented with fever, chills, and back pain. He also complained of increased frequency of voiding. Ultrasonography revealed bladder stones. All of the following are true about bladder stones, EXCEPT:

Accepted Answer

Rare in Indian children

Answer

Most bladder calculi are seen in men

Answer

Small stones can be removed per urethra

Answer

Solitary bladder stone is the rule

Question 5

A male has a history of bilateral undescended testes. What is the most likely consequence?

Accepted Answer

He is likely to be sterile.

Answer

His risk of testicular neoplasm is the same as other males.

Answer

The pathophysiology is merely a mechanical problem in the descent of the testes.

Answer

Intervention for psychological purposes is not a requirement.

Question 6

The Hunt-Hess scale is used for the grading of which condition?

Accepted Answer

Subarachnoid hemorrhage (SAH)

Answer

Subdural hematoma (SDH)

Answer

Meningiomas

Answer

Tuberculosis

Question 7

The graph shown in the illustration is known as:

Accepted Answer

Cystometrogram

Answer

Nephrogram

Answer

Pyelograph

Answer

None of the above

Question 8

What is the best treatment for Grade I benign prostate with outflow obstruction?

Accepted Answer

Transurethral resection

Answer

Retropubic prostatectomy

Answer

Transvesical prostatectomy

Answer

Androgen therapy

Question 9

Which of the following is NOT a contraindication for extracorporeal shockwave lithotripsy for renal calculi?

Accepted Answer

Stone in a calyceal diverticulum

Answer

Pregnancy

Answer

Bleeding disorder

Answer

Stone >2 cm

Question 10

All the following statements are true regarding torsion of testis EXCEPT?

Accepted Answer

Anatomical abnormality is unilateral and contralateral testis should not be fixed

Answer

Prompt exploration and twisting & fixation is the only way to save the torted testis

Answer

Most common between 10 and 25 years of age

Answer

Inversion of testis is the most common predisposing cause

Urology — MCQs

Urology — MCQs

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