Urology Practice Questions

Q: Which is the earliest symptom of benign prostatic hyperplasia?

Frequency. ### Explanation **1. Why Frequency is the Correct Answer:** Benign Prostatic Hyperplasia (BPH) causes bladder outlet obstruction, leading to compensatory changes in the detrusor muscle. The **earliest symptoms** of BPH are typically **irritative symptoms**, of which **nocturia** and **frequency** are the most common initial presentations. * **Mechanism:** As the prostate enlarges, the bladder must work harder to push urine past the obstruction. This leads to detrusor hypertrophy and hypersensitivity. The bladder becomes "irritable," meaning it signals the urge to void even at low volumes, resulting in increased frequency. **2. Analysis of Incorrect Options:** * **B. Hematuria:** While BPH can cause hematuria (due to congestion of friable veins over the enlarged prostate), it is usually a later sign or a complication rather than the presenting symptom. * **C. Incontinence:** This is a late-stage symptom. It typically manifests as **overflow incontinence** when the bladder is chronically overdistended and can no longer compensate for the obstruction. * **D. Strangury:** This refers to slow, painful urination where urine is passed drop by drop. It is more characteristic of severe bladder neck obstruction, stones, or acute cystitis, rather than the early phase of BPH. **3. Clinical Pearls for NEET-PG:** * **Symptom Classification:** BPH symptoms are divided into **Storage (Irritative)** (Frequency, Urgency, Nocturia) and **Voiding (Obstructive)** (Hesitancy, Poor stream, Intermittency, Feeling of incomplete emptying). * **Earliest Symptom:** Frequency/Nocturia. * **Most Troublesome Symptom:** Nocturia (often cited as the reason patients seek medical help). * **First Obstructive Symptom:** Hesitancy. * **Gold Standard Investigation:** Uroflowmetry (shows a "prolonged, low-peak" flow rate). * **Gold Standard Treatment:** TURP (Transurethral Resection of the Prostate).

Q: Diversion of the urinary bladder is best achieved using which part of the gastrointestinal tract?

Ileum. **Explanation:** The **ileum** is the gold standard and most commonly used segment for urinary diversion (e.g., Ileal Conduit/Bricker’s procedure or Orthotopic Neobladder). **Why Ileum is the Correct Answer:** 1. **Anatomical Suitability:** It has a highly mobile mesentery with a robust, predictable blood supply (via the ileocolic and intestinal arteries), allowing it to be easily mobilized to the skin or the urethral stump. 2. **Functional Balance:** It has a smaller surface area and lower absorptive capacity compared to the jejunum, which minimizes life-threatening electrolyte imbalances. 3. **Compliance:** The terminal ileum is easily "detubularized" to create a low-pressure reservoir, which is essential for protecting the upper urinary tract from reflux and high pressures. **Analysis of Incorrect Options:** * **Jejunum (A):** Rarely used because it leads to severe **"Jejunal Conduit Syndrome"** (hyponatremia, hypochloremia, hyperkalemia, and metabolic acidosis) due to its high secretory and absorptive activity. * **Cecum (C) & Colon (D):** While the colon (especially the sigmoid) can be used, it has a higher bacterial load, thicker walls that are harder to detubularize, and is associated with a higher risk of hyperchloremic metabolic acidosis compared to the ileum. **High-Yield Clinical Pearls for NEET-PG:** * **Most common metabolic abnormality:** Hyperchloremic metabolic acidosis (seen with ileum and colon). * **Standard Procedure:** The **Ileal Conduit** is the most common non-continent urinary diversion. * **Contraindication:** Avoid using bowel segments in patients with pre-existing inflammatory bowel disease (IBD) or significant renal insufficiency (CrCl < 35-40 ml/min). * **Vitamin Deficiency:** Long-term use of the terminal ileum can lead to **Vitamin B12 deficiency** and bile acid malabsorption.

Q: All of the following are true about bladder cancer, except?

None of the above. **Explanation:** Bladder cancer is a high-yield topic in NEET-PG Surgery. This question tests the fundamental epidemiological and clinical characteristics of the disease. The correct answer is **"None of the above"** because all the statements provided (A, B, and C) are clinically accurate. 1. **Painless Hematuria (Option A):** This is the **most common presenting symptom** of bladder cancer (seen in ~85% of cases). It is typically intermittent, gross, and total (occurring throughout the stream). In urology, "painless gross hematuria in an elderly patient is bladder cancer until proven otherwise." 2. **Transitional Cell Carcinoma (Option B):** Also known as **Urothelial Carcinoma**, this is the most common histological type worldwide, accounting for >90% of cases. (Note: Squamous cell carcinoma is more common only in regions endemic for *Schistosoma haematobium*). 3. **Gender Predilection (Option C):** Bladder cancer is significantly more common in **males** than females (ratio approx. 3:1 to 4:1), largely due to historical differences in smoking prevalence and occupational exposure to carcinogens. **Clinical Pearls for NEET-PG:** * **Risk Factors:** Smoking (most common), Aniline dyes (2-Naphthylamine), Cyclophosphamide, and Chronic irritation (stones/catheters predisposing to SCC). * **Gold Standard Investigation:** Cystoscopy with biopsy. * **Staging:** The TNM system is used; the involvement of the **detrusor muscle (T2)** is the critical "watershed" line that determines whether treatment is breast-conserving (TURBT + intravesical BCG) or radical (Cystectomy). * **Most common site:** Lateral wall of the bladder.

Q: A man was brought to the emergency department after a perineal injury. He experiences an urge to micturate but is unable to pass urine. Blood is seen at the tip of the urethra, and there is swelling of the penis and scrotum. What is the most likely diagnosis?

Bulbar urethra injury. **Explanation:** The clinical presentation describes a classic case of **Bulbar Urethra Injury**, which is the most common site of anterior urethral trauma. **1. Why Bulbar Urethra Injury is correct:** The mechanism of injury is typically a **straddle injury** (perineal trauma), where the bulbar urethra is crushed against the pubic symphysis. The hallmark triad seen here includes: * **Urethrorrhagia:** Blood at the external meatus. * **Urinary retention:** Inability to void despite the urge. * **Butterfly Hematoma/Swelling:** If Buck’s fascia is breached, urine and blood extravasate into the scrotum and penis, limited by Colles' fascia (explaining the specific swelling pattern). **2. Why other options are incorrect:** * **Penile Urethra Rupture:** Usually occurs due to a "fracture" of the penis during intercourse. While it causes swelling, it is less common than bulbar injury in perineal trauma. * **Membranous Urethra Injury:** This is a **posterior urethral injury**, almost always associated with **pelvic fractures** (e.g., RTA). Key findings include a "high-riding prostate" on DRE and extravasation into the retropubic space (Space of Retzius), not the scrotum. * **Urinary Bladder Injury:** Intraperitoneal rupture presents with signs of peritonitis; extraperitoneal rupture is associated with pelvic fractures. Neither typically presents with blood at the urethral meatus or scrotal swelling. **Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Retrograde Urethrogram (RUG). **Never** attempt catheterization before RUG if urethral injury is suspected. * **Fascial Boundaries:** Extravasation in bulbar injury is limited by **Colles' fascia** (continuous with Scarpa’s fascia of the abdomen), preventing spread to the thighs but allowing spread to the abdominal wall. * **Management:** Initial management involves a **Suprapubic Cystostomy (SPC)** to divert urine.

Q: What is the most common site of genitourinary tuberculosis?

Kidney. **Explanation:** Genitourinary tuberculosis (GUTB) is the second most common form of extrapulmonary tuberculosis. The **Kidney** is the primary site of infection in the genitourinary tract. **Why Kidney is the Correct Answer:** The infection is almost always **hematogenous**, spreading from a primary focus (usually the lungs) via the bloodstream. The bacilli lodge in the highly vascularized glomerular and peritubular capillaries. Initially, these form microscopic cortical granulomas. If the body's immunity fails, these granulomas enlarge and rupture into the nephron, leading to "Putz's cast" (tuberculous debris) and the characteristic "moth-eaten" appearance of calyces on imaging. **Analysis of Incorrect Options:** * **Ureter:** Involvement is always **secondary** to renal TB. It occurs via "descending infection" through the urine. It commonly results in strictures, particularly at the ureterovesical junction (UVJ). * **Bladder:** This is also a secondary infection caused by infected urine from the kidney. It leads to characteristic findings like "golf-hole ureters" and a "thimble bladder" (fibrosed, low-capacity bladder). * **Urethra:** This is the least common site of GUTB and usually occurs secondary to advanced bladder or prostatic tuberculosis. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest Sign:** Sterile pyuria (pus cells in urine with no growth on routine culture). * **Earliest Radiological Sign:** Erosion/fuzziness of the minor calyces (moth-eaten appearance). * **Gold Standard Diagnosis:** Urine culture for *M. tuberculosis* (Lowenstein-Jensen medium), typically requiring three to five consecutive early morning midstream urine samples. * **Key Pathognomonic Finding:** Putty Kidney (autonephrectomy) – a non-functioning, calcified kidney seen in end-stage disease.

Q: Which of the following is NOT a feature of hypernephroma?

Lower pole involvement. **Explanation:** Hypernephroma, also known as **Renal Cell Carcinoma (RCC)**, is the most common primary renal malignancy. The correct answer is **D (Lower pole involvement)** because RCC classically has a predilection for the **upper pole** of the kidney. **Why the other options are features of RCC:** * **Hematuria (Option B):** This is the most common presenting symptom. Along with loin pain and a palpable mass, it forms the "Classic Triad" of RCC (though seen in only 10% of cases, usually indicating advanced disease). * **Persistent Pyrexia (Option A):** RCC is known as the "Internist's Tumor" because it frequently presents with **Paraneoplastic Syndromes (PNS)**. Pyrexia (fever) occurs due to the release of endogenous pyrogens like Interleukin-6. * **Polycythemia (Option C):** This is another classic PNS caused by the ectopic production of **Erythropoietin (EPO)** by the tumor cells, leading to an elevated red blood cell count. **High-Yield Clinical Pearls for NEET-PG:** 1. **Origin:** RCC arises from the **Proximal Convoluted Tubule (PCT)**. 2. **Risk Factors:** Smoking (most significant), obesity, hypertension, and Von Hippel-Lindau (VHL) syndrome. 3. **Stauffer’s Syndrome:** Reversible hepatic dysfunction (elevated LFTs) in the absence of liver metastases—a high-yield paraneoplastic feature. 4. **Varicocele:** A left-sided varicocele that does not empty in the supine position suggests a left renal tumor obstructing the left gonadal vein. 5. **Investigation of Choice:** Contrast-Enhanced CT (CECT) of the abdomen and pelvis.

Question 1

What is the most common cause of urinary ascites?

Accepted Answer

Posterior urethral valves

Answer

Pelviureteral junction obstruction

Answer

Urethral stricture

Answer

None of the above

Question 2

Which is the earliest symptom of benign prostatic hyperplasia?

Accepted Answer

Frequency

Answer

Hematuria

Answer

Incontinence

Answer

Strangury

Question 3

Diversion of the urinary bladder is best achieved using which part of the gastrointestinal tract?

Accepted Answer

Ileum

Answer

Jejunum

Answer

Cecum

Answer

Colon

Question 4

Which of the following procedures is suitable for day care surgery?

Accepted Answer

Lateral sphincterotomy

Answer

Rhinoplasty

Answer

Orchidectomy

Answer

Total thyroidectomy

Question 5

All of the following are true about bladder cancer, except?

Accepted Answer

None of the above

Answer

Painless hematuria is seen

Answer

Transitional cell carcinoma is the commonest type

Answer

It is more common in males

Question 6

A man was brought to the emergency department after a perineal injury. He experiences an urge to micturate but is unable to pass urine. Blood is seen at the tip of the urethra, and there is swelling of the penis and scrotum. What is the most likely diagnosis?

Accepted Answer

Bulbar urethra injury

Answer

Penile urethra rupture

Answer

Membranous urethra injury

Answer

Urinary bladder injury

Question 7

What is the most common cause of surgically treatable male infertility?

Accepted Answer

Varicocele

Answer

Cryptorchidism

Answer

Urethral stricture

Answer

Epididymitis

Question 8

What is the most common site of genitourinary tuberculosis?

Accepted Answer

Kidney

Answer

Ureter

Answer

Bladder

Answer

Urethra

Question 9

Which of the following is NOT a feature of hypernephroma?

Accepted Answer

Lower pole involvement

Answer

Persistent pyrexia

Answer

Hematuria

Answer

Polycythemia

Question 10

Postmicturition dribbling is due to

Accepted Answer

Collection of urine in the U-shaped curve of the bulb of the penis

Answer

Detrusor overactivity

Answer

Urethral stricture causing decreased dribbling

Answer

Neurogenic bladder

Urology — MCQs

Urology — MCQs

On this page

Practice by Chapter

Want unlimited practice?