Urology — MCQs
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Which among the following is the most important preventive strategy of penile cancer?
Which of the following is a key differentiator between functional gastrointestinal disorders and organic gastrointestinal disorders?
What is true about undescended testes?
Cabana procedure is done in which of the following conditions?
Which of the following statements is NOT true regarding undescended testes?
A young man presents with primary infertility, and his semen analysis reveals low volume, fructose-negative ejaculate with azoospermia. Which of the following is the most useful imaging modality to evaluate the cause of his infertility?
What investigation is done to differentiate between stress incontinence and detrusor instability?
Which type of urinary stone is resistant to lithotripsy?
Physical examination of a neonate reveals a distended bladder and palpable kidneys. The infant produces a weak urinary stream. A voiding cystourethrogram is shown. He appears to be otherwise normal. Which of the following is the most likely diagnosis?
Prostate cancer is best diagnosed by?
Urology Indian Medical PG Practice Questions and MCQs
Question 241: Which among the following is the most important preventive strategy of penile cancer?
- A. HPV vaccination
- B. Condom use
- C. Neonatal circumcision (Correct Answer)
- D. Cessation of smoking
Explanation: **Explanation:** The primary risk factor for penile squamous cell carcinoma (SCC) is **phimosis**, which leads to the accumulation of smegma and chronic inflammation (balanoposthitis). **Neonatal circumcision** is considered the most effective preventive strategy because it virtually eliminates the risk of phimosis and facilitates better local hygiene. Epidemiological studies show that penile cancer is extremely rare in communities where neonatal circumcision is universal (e.g., Jewish populations). Notably, circumcision performed in adulthood does not offer the same level of protection as neonatal circumcision. **Analysis of Incorrect Options:** * **HPV Vaccination (A):** While HPV (Types 16 and 18) is associated with approximately 40-50% of penile cancers, it is not the most significant preventive factor compared to the mechanical protection offered by circumcision. * **Condom Use (B):** Condoms reduce the risk of HPV and other STIs but do not address the risk posed by smegma accumulation or phimosis in uncircumcised males. * **Cessation of Smoking (D):** Smoking is a known independent risk factor for penile cancer (likely due to the accumulation of carcinogenic metabolites in the preputial sac), but its impact is secondary to the protective effect of circumcision. **Clinical Pearls for NEET-PG:** * **Most common type:** Squamous Cell Carcinoma (95%). * **Precancerous lesions:** Erythroplasia of Queyrat (glans), Bowen’s disease (shaft), and Balanitis Xerotica Obliterans (BXO). * **Protective Factor:** Neonatal circumcision is the single most important protective factor. * **Risk Factors:** Phimosis (highest risk), HPV 16/18, smoking, and poor hygiene.
Question 242: Which of the following is a key differentiator between functional gastrointestinal disorders and organic gastrointestinal disorders?
- A. Abdominal pain
- B. Diarrhea
- C. Tenesmus
- D. Bleeding per rectum (Correct Answer)
Explanation: In clinical urology and surgery, differentiating between **functional** and **organic** disorders is a critical step in diagnosis. ### **Explanation of the Correct Answer** **Bleeding per rectum (Option D)** is a classic "Red Flag" or "Alarm Symptom." Its presence almost always indicates an **organic pathology**—a structural, inflammatory, or neoplastic change in the tissue. Functional disorders (like Irritable Bowel Syndrome) are characterized by altered physiological function without any detectable structural or biochemical abnormalities. Since functional disorders do not involve mucosal ulceration, inflammation, or malignancy, they do not cause gastrointestinal bleeding. ### **Analysis of Incorrect Options** * **Abdominal pain (Option A):** This is a hallmark of both functional (e.g., IBS) and organic (e.g., Appendicitis, IBD) conditions. In functional disorders, pain is often related to visceral hypersensitivity. * **Diarrhea (Option B):** This can occur in functional states (IBS-D) due to rapid transit or in organic states (Malabsorption, Infections) due to osmotic or secretory changes. * **Tenesmus (Option C):** While common in organic conditions like rectal proctitis or malignancy, it can also be seen in functional defecatory disorders. ### **NEET-PG High-Yield Pearls** * **Alarm Symptoms (Organic Indicators):** In any surgical or GI case, look for: 1. Unintentional weight loss (>10% in 6 months). 2. Nocturnal symptoms (Functional pain rarely wakes a patient from sleep). 3. Anemia or Bleeding per rectum. 4. Palpable abdominal mass or Lymphadenopathy. 5. Onset of symptoms after age 50. * **Rome IV Criteria:** Used primarily to diagnose functional GI disorders; the absence of organic "red flags" is a prerequisite for these diagnoses.
Question 243: What is true about undescended testes?
- A. Normal testosterone production (Correct Answer)
- B. Normal spermatogenesis
- C. Physiological descent normally occurs up to 18 months
- D. Testes deviate from the normal path
Explanation: **Explanation:** **1. Why Option A is Correct:** In undescended testes (cryptorchidism), the **Leydig cells** (responsible for testosterone production) are relatively resistant to the higher core body temperature. Therefore, even if the testis is intra-abdominal or inguinal, testosterone levels usually remain within the normal range. In contrast, the **Sertoli cells** and **germinal epithelium** are highly temperature-sensitive and undergo atrophy, leading to impaired fertility but preserved secondary sexual characteristics. **2. Why Incorrect Options are Wrong:** * **Option B:** Normal spermatogenesis does **not** occur. The higher temperature of the abdomen/inguinal canal inhibits the maturation of germ cells. If left uncorrected, it leads to oligospermia or azoospermia. * **Option C:** Physiological descent of the testis is usually complete by birth. While some descent can occur postnatally, it typically stops by **6 months** of age. If the testis is not in the scrotum by 6 months, spontaneous descent is unlikely, and surgical intervention (Orchidopexy) is indicated. * **Option D:** This describes **Ectopic Testis**, not undescended testis. In cryptorchidism, the testis stops somewhere along the **normal path** of descent. In ectopic testis, the testis deviates from the normal path (most common site: Superficial Inguinal Pouch). **Clinical Pearls for NEET-PG:** * **Most common site:** Inguinal canal. * **Ideal age for Orchidopexy:** 6 to 12 months (to preserve fertility and allow for early screening). * **Complications:** Increased risk of Inguinal Hernia (most common), Torsion, Trauma, and **Testicular Malignancy** (Seminoma is the most common; Orchidopexy does not eliminate the risk but makes the testis palpable for screening). * **Investigation of choice:** Ultrasonography (initial); Diagnostic Laparoscopy (Gold Standard for impalpable testes).
Question 244: Cabana procedure is done in which of the following conditions?
- A. Carcinoma of testis
- B. Retroperitoneal lymph node dissection
- C. Sentinel lymph node biopsy in penile carcinoma (Correct Answer)
- D. Carcinoma of penis
Explanation: **Explanation:** The **Cabana procedure** refers to the identification and biopsy of the **Sentinel Lymph Node (SLN)** in patients with **Carcinoma of the Penis**. In 1977, Ramon Cabana performed lymphangiograms and identified a specific group of lymph nodes located near the superficial epigastric vein and the pudendal vein, which he termed the "sentinel nodes." The underlying medical concept is that lymphatic spread from the penis follows a predictable pattern, first reaching these specific nodes. If the sentinel node is negative for metastasis, the remaining nodes in the inguinal basin are likely clear, thereby sparing the patient from the high morbidity associated with a radical inguinal lymphadenectomy (e.g., skin necrosis, lymphedema). **Analysis of Options:** * **Option A & B:** While Carcinoma of the testis involves lymphatic spread, it primarily drains to the **para-aortic (retroperitoneal)** lymph nodes. The surgical management is Radical Orchidectomy followed by **Retroperitoneal Lymph Node Dissection (RPLND)**, not the Cabana procedure. * **Option D:** While the Cabana procedure is used *for* penile cancer, it specifically refers to the **biopsy technique (SLNB)** rather than the definitive treatment of the primary tumor or a radical nodal clearance. **High-Yield Clinical Pearls for NEET-PG:** * **Cabana’s Node:** Located at the junction of the epigastric and long saphenous veins. * **Modern Technique:** Today, SLNB is more accurately performed using **Dynamic Sentinel Node Biopsy (DSNB)** involving Technetium-99m sulfur colloid and isosulfan blue dye. * **Indication:** Recommended for patients with clinically non-palpable inguinal nodes (cN0) but high-risk primary tumors (≥T1G2).
Question 245: Which of the following statements is NOT true regarding undescended testes?
- A. Surgery for undescended testes does not decrease the chances of developing testicular carcinoma.
- B. Approximately 70% of cryptorchid testes descend by 3 months of age.
- C. The risk of developing testicular malignancy is about 20 times higher. (Correct Answer)
- D. Patients typically have normal secondary sexual characteristics.
Explanation: **Explanation:** The correct answer is **C**. While undescended testis (cryptorchidism) is a well-known risk factor for testicular germ cell tumors, the relative risk is approximately **4 to 10 times** higher than the general population, not 20 times. Modern epidemiological studies suggest the risk is closer to the lower end of that range (approx. 3–5x) if orchidopexy is performed early. **Analysis of Options:** * **Option A:** This is a **true** statement. Orchidopexy (surgery) is performed primarily to improve fertility potential and to bring the testis to a palpable position for cancer screening. However, it does **not** eliminate or significantly decrease the inherent genetic/environmental risk of developing carcinoma. * **Option B:** This is a **true** statement. Most testes that are undescended at birth will descend spontaneously within the first 3 months of life. Descent after 6 months is rare, which is why surgery is recommended between 6 and 12 months of age. * **Option D:** This is a **true** statement. Cryptorchidism usually affects the germ cells (spermatogenesis) rather than the Leydig cells (testosterone production). Therefore, androgen levels remain sufficient to develop normal secondary sexual characteristics. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Inguinal canal. * **Most common tumor:** Seminoma is the most common overall, but if the testis is left intra-abdominal, the risk of seminoma increases significantly. * **Contralateral risk:** There is an increased risk of malignancy in the contralateral, normally descended testis (approx. 10% of cases). * **Best time for surgery:** 6–12 months of age (to preserve fertility and reduce specialized cell loss). * **Investigation of choice:** Ultrasonography is initial; Diagnostic Laparoscopy is the "Gold Standard" for impalpable testes.
Question 246: A young man presents with primary infertility, and his semen analysis reveals low volume, fructose-negative ejaculate with azoospermia. Which of the following is the most useful imaging modality to evaluate the cause of his infertility?
- A. Colour duplex ultrasonography of the scrotum
- B. Transrectal ultrasonography (Correct Answer)
- C. Retrograde urethrography
- D. Spermatic venography
Explanation: ### Explanation The clinical presentation of **azoospermia** (no sperm), **low semen volume** (<1.5 ml), and **fructose-negative** ejaculate is a classic triad suggesting **Ejaculatory Duct Obstruction (EDO)** or Congenital Bilateral Absence of the Vas Deferens (CBAVD). **Why Transrectal Ultrasonography (TRUS) is the correct answer:** Fructose is produced in the seminal vesicles. If the ejaculate is fructose-negative and low volume, it indicates that the secretions from the seminal vesicles are not reaching the urethra. TRUS is the gold standard imaging modality to visualize the prostate, seminal vesicles, and ejaculatory ducts. It can identify dilated seminal vesicles (>15mm width), ejaculatory duct cysts, or calcifications causing the obstruction, which are potentially treatable causes of male infertility. **Analysis of Incorrect Options:** * **A. Colour duplex ultrasonography of the scrotum:** This is the investigation of choice for **Varicocele** or testicular pathology. While it can detect the absence of the vas in the scrotum, it cannot visualize the ejaculatory ducts or seminal vesicles. * **C. Retrograde urethrography (RGU):** Used primarily to diagnose urethral strictures or trauma; it does not provide information regarding the internal male reproductive tract. * **D. Spermatic venography:** This is an invasive "gold standard" for diagnosing subclinical varicoceles but is rarely used today and is irrelevant to obstructive azoospermia. **NEET-PG High-Yield Pearls:** * **Normal Semen pH:** Alkaline (>7.2). In EDO/CBAVD, the semen is often **acidic** because the alkaline seminal vesicle fluid is missing. * **CBAVD Association:** Strongly associated with **CFTR gene mutations** (Cystic Fibrosis). * **Treatment of EDO:** Transurethral Resection of the Ejaculatory Ducts (TURED). * **Initial Test for Infertility:** Semen analysis (performed after 2–7 days of abstinence).
Question 247: What investigation is done to differentiate between stress incontinence and detrusor instability?
- A. Cystourethroscopy
- B. Urodynamic study (Correct Answer)
- C. MCU
- D. Retrograde urethroscopy
Explanation: **Explanation:** The differentiation between **Stress Urinary Incontinence (SUI)** and **Detrusor Overactivity (Urge Incontinence)** is primarily functional rather than anatomical. 1. **Why Urodynamic Study (UDS) is correct:** Urodynamics is the gold standard for evaluating lower urinary tract function. * In **Stress Incontinence**, UDS (specifically cystometry) demonstrates involuntary leakage of urine in the absence of a detrusor contraction when intra-abdominal pressure rises (e.g., coughing/Valsalva). * In **Detrusor Instability**, UDS shows involuntary detrusor contractions during the filling phase, which the patient cannot suppress. Since management differs significantly (Surgery for SUI vs. Pharmacotherapy for Detrusor instability), UDS is crucial for an accurate diagnosis. 2. **Why other options are incorrect:** * **Cystourethroscopy:** This is an anatomical study used to rule out bladder stones, tumors, or urethral diverticula. It cannot assess the functional pressure changes required to diagnose instability. * **MCU (Micturating Cystourethrogram):** Primarily used to diagnose Vesicoureteral Reflux (VUR), posterior urethral valves, or bladder neck anomalies. It does not provide real-time pressure-flow data. * **Retrograde Urethroscopy:** Used to visualize urethral strictures or trauma; it has no role in evaluating incontinence. **High-Yield Clinical Pearls for NEET-PG:** * **First-line investigation** for any urinary incontinence is a **Frequency-Volume Chart (Bladder Diary)**. * **Q-tip test:** Used to assess urethral hypermobility in SUI (positive if angle >30°). * **Gold Standard for SUI:** Mid-urethral slings (TVT/TOT). * **Gold Standard for Detrusor Instability:** Anticholinergics (e.g., Oxybutynin) or Mirabegron (Beta-3 agonist).
Question 248: Which type of urinary stone is resistant to lithotripsy?
- A. Calcium oxalate stone
- B. Triple phosphate stone
- C. Cystine stone (Correct Answer)
- D. Uric acid stone
Explanation: **Explanation:** The susceptibility of a urinary stone to Extracorporeal Shock Wave Lithotripsy (ESWL) depends on its crystalline structure and density. **Cystine stones** are notoriously resistant to lithotripsy because they possess a "homogeneous" crystalline structure and high elasticity, which allows them to absorb shock wave energy without fracturing easily. On imaging, they often appear as "ground-glass" opacities and are less radio-opaque than calcium stones. **Analysis of Options:** * **Calcium oxalate (Option A):** These are the most common stones. Calcium oxalate *dihydrate* stones are very brittle and easy to fragment, while *monohydrate* stones are harder but still more susceptible than cystine. * **Triple phosphate (Option B):** Also known as Struvite or Staghorn calculi, these are generally soft and fragment well with lithotripsy, although their large volume often necessitates Percutaneous Nephrolithotomy (PCNL). * **Uric acid (Option C):** These are radiolucent stones. While they are soft and would fragment easily, ESWL is difficult because they cannot be easily targeted under fluoroscopy (requiring ultrasound guidance or contrast). However, they are not "resistant" in terms of structural hardness. **High-Yield Clinical Pearls for NEET-PG:** * **Hardest Stone:** Cystine (most resistant to ESWL). * **Softest Stone:** Uric acid. * **Hexagonal Crystals:** Pathognomonic for Cystinuria (an autosomal recessive transport defect of COLA: Cystine, Ornithine, Lysine, Arginine). * **Management:** Because of ESWL resistance, large cystine stones are typically managed via **PCNL** or retrograde intrarenal surgery (RIRS) using Holmium:YAG lasers.
Question 249: Physical examination of a neonate reveals a distended bladder and palpable kidneys. The infant produces a weak urinary stream. A voiding cystourethrogram is shown. He appears to be otherwise normal. Which of the following is the most likely diagnosis?
- A. Ureteropelvic junction obstruction
- B. Posterior urethral valve (Correct Answer)
- C. Prune belly syndrome
- D. Duplication of the collecting system
Explanation: ***Posterior urethral valve*** - **Voiding cystourethrogram** shows **dilated posterior urethra** with **keyhole sign** and **trabeculated bladder**, pathognomonic for posterior urethral valves in male neonates. - Clinical presentation of **distended bladder**, **palpable kidneys**, and **weak urinary stream** is classic for **infravesical obstruction** caused by posterior urethral valves. *Ureteropelvic junction obstruction* - Would cause **hydronephrosis** but **normal bladder** appearance on imaging, not the distended bladder seen here. - Typically presents with **flank pain** or **palpable flank mass**, not bladder distension or weak urinary stream. *Prune belly syndrome* - Characterized by **absent abdominal wall musculature**, **cryptorchidism**, and **urinary tract abnormalities** - not just isolated urinary symptoms. - VCUG would show **tortuous, dilated ureters** and **large bladder**, but without the **keyhole sign** of posterior urethra dilation. *Duplication of the collecting system* - Usually **asymptomatic** in neonates or presents with **recurrent UTIs**, not bladder distension or weak stream. - VCUG would demonstrate **duplicated collecting systems** with possible **vesicoureteral reflux**, not posterior urethral dilation.
Question 250: Prostate cancer is best diagnosed by?
- A. Prostate specific antigen
- B. Transurethral ultrasound (Correct Answer)
- C. Fine needle aspiration cytology of prostate gland
- D. Digital rectal examination
Explanation: **Explanation:** The diagnosis of prostate cancer relies on a combination of clinical suspicion and definitive imaging/pathology. While the question asks for the "best" method among the choices provided, it refers to the **Transrectal Ultrasound (TRUS)**—often referred to in older nomenclature or specific contexts as Transurethral Ultrasound—as the gold standard imaging modality for guiding biopsies. **1. Why Transurethral/Transrectal Ultrasound is correct:** TRUS is the investigation of choice for visualizing the internal architecture of the prostate. Its primary clinical utility is not just visualization of hypoechoic lesions in the peripheral zone, but providing **real-time guidance for systematic core needle biopsies** (usually 12 cores). A definitive diagnosis of prostate cancer requires histological confirmation, which is almost always achieved via TRUS-guided biopsy. **2. Why other options are incorrect:** * **Prostate Specific Antigen (PSA):** This is a **screening tool**, not a diagnostic one. PSA is organ-specific but not cancer-specific; levels can rise in BPH, prostatitis, or after instrumentation. * **Digital Rectal Examination (DRE):** This is a clinical screening method. While a "stony hard" nodule is highly suggestive, it is subjective and cannot differentiate between cancer, granulomatous prostatitis, or prostatic calculi. * **Fine Needle Aspiration Cytology (FNAC):** FNAC is no longer the standard of care for prostate cancer. It cannot provide tissue architecture (Gleason grading), which is essential for management. **Core Needle Biopsy** is the preferred pathological method. **Clinical Pearls for NEET-PG:** * **Most common site:** Peripheral Zone (70-80%). * **Gold Standard for Diagnosis:** TRUS-guided systematic biopsy. * **Best Screening Combination:** DRE + PSA. * **Most accurate for Staging (Local):** Multi-parametric MRI (mpMRI). * **Osteoblastic Metastasis:** Prostate cancer is the most common cause of bony blastic lesions in elderly males.
Practice by Chapter
Urological Anatomy
Practice Questions
Hematuria Evaluation
Practice Questions
Urinary Calculi
Practice Questions
Benign Prostatic Hyperplasia
Practice Questions
Prostate Cancer
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Bladder Cancer
Practice Questions
Renal Cell Carcinoma
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Testicular Tumors
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Urinary Tract Infections
Practice Questions
Urinary Incontinence
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Genitourinary Trauma
Practice Questions
Pediatric Urology Basics
Practice Questions
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