Urology Practice Questions

Q: A 60-year-old male undergoes TURP. After 3 days, the patient develops altered sensorium and drowsiness. What is the most probable diagnosis?

Hyponatremia. ### Explanation **Correct Answer: B. Hyponatremia** The clinical scenario describes **TURP Syndrome**, a classic complication of Transurethral Resection of the Prostate. During the procedure, large volumes of non-conductive irrigation fluids (traditionally **1.5% Glycine**) are used. These fluids can be absorbed into the systemic circulation through opened prostatic venous sinuses [1]. The absorption of this hypotonic, sodium-free fluid leads to **dilutional hyponatremia** and fluid overload [1]. The rapid drop in serum sodium levels causes cerebral edema, manifesting as altered sensorium, drowsiness, confusion, seizures, and potentially coma [1]. **Analysis of Incorrect Options:** * **A. Hypernatremia:** TURP syndrome causes a "dilutional" effect, lowering sodium concentration. Hypernatremia would involve water loss or sodium gain, which is the opposite of the pathophysiology here. * **C. Stroke:** While a stroke can cause altered sensorium in elderly patients, the specific temporal relationship with a TURP procedure strongly points toward a metabolic/electrolyte cause rather than a focal neurological event. * **D. Meningitis:** While spinal anesthesia is used for TURP, meningitis typically presents with fever, nuchal rigidity, and headache. It would not explain the systemic fluid shifts associated with this surgery. **NEET-PG High-Yield Pearls:** * **Irrigating Fluid:** 1.5% Glycine is most common. Others include Mannitol or Sorbitol. * **Triad of TURP Syndrome:** Hypertension (early), Bradycardia, and Altered Mental Status. * **Visual Disturbances:** Glycine is an inhibitory neurotransmitter in the retina; its toxicity can cause transient blindness. * **Prevention:** Limit resection time to <60 minutes and keep the irrigation bag height <60 cm above the patient. * **Treatment:** Fluid restriction and Diuretics (mild cases); **3% Hypertonic saline** (severe symptomatic hyponatremia).

Q: Jack stone calculi are made up of which of the following?

Calcium oxalate. **Explanation:** **Jack stone calculi** are a specific morphological subtype of urinary stones, almost exclusively composed of **Calcium oxalate monohydrate**. The correct answer is **Calcium oxalate (Option D)**. These stones derive their name from their resemblance to the metal pieces used in the children's game "Jacks." They are characterized by a dense central core with multiple radiating spicules or "arms." Clinically, they are most commonly found in the **urinary bladder** and are typically associated with chronic bladder outlet obstruction or stasis. Their unique shape is thought to result from the jagged edges repeatedly hitting the bladder wall, breaking off fragile attachments while allowing the dense crystalline arms to grow. **Analysis of Incorrect Options:** * **A. Ammonium urate:** These are associated with malnutrition and chronic diarrhea; they typically form "hedgehog" stones but are not Jack stones. * **B. Uric acid:** These stones are radiolucent and usually smooth or faceted, forming in acidic urine. * **C. Struvite:** Also known as "Triple Phosphate" or "Infection stones," these are associated with Proteus infections and typically form large **Staghorn calculi** that fill the renal pelvis. **High-Yield Clinical Pearls for NEET-PG:** * **Composition:** Jack stones = Calcium oxalate monohydrate (Whewellite). * **Radiology:** They are **radio-opaque** due to their calcium content. * **Common Site:** Urinary bladder (rarely found in the upper urinary tract). * **Microscopy:** Calcium oxalate monohydrate crystals appear as **dumbbell-shaped**, whereas dihydrate crystals (Weddellite) appear as **envelope-shaped**.

Q: What is the investigation of choice for a ureteric stone?

CT scan. The investigation of choice for a ureteric stone is a **Non-Contrast Computed Tomography (NCCT) of the Kidney, Ureter, and Bladder (KUB)**. ### Why CT Scan is the Correct Answer NCCT KUB is the gold standard because it has the highest sensitivity (95-97%) and specificity (96-98%) for detecting urolithiasis. * **Detection:** It can identify almost all types of stones (including uric acid and xanthine stones, which are radiolucent on X-ray), except for rare indinavir stones. * **Secondary Signs:** It helps identify complications like hydroureteronephrosis, perinephric stranding, and the "rim sign" (edema around the stone). * **Planning:** It provides precise stone size, location, and **Hounsfield Units (HU)**, which helps predict stone hardness and the success of ESWL. ### Why Other Options are Incorrect * **USG (Ultrasonography):** While safe and radiation-free, it is operator-dependent and often misses small ureteric stones, especially in the mid-ureter, due to overlying bowel gas. It is the investigation of choice only in **pregnant women** and **children**. * **MIBG Scan:** This is a nuclear medicine study used to localize neuroendocrine tumors, specifically **pheochromocytoma** and neuroblastoma. It has no role in stone disease. * **DMSA Scan:** This is a static renal scan used to assess **functional renal cortical mass** and detect renal scarring (common in pediatric reflux or pyelonephritis). It does not visualize stones. ### High-Yield Clinical Pearls for NEET-PG * **Gold Standard:** NCCT KUB. * **Initial Investigation (Emergency):** USG + X-ray KUB (often used in clinical practice, though NCCT is the definitive choice). * **Investigation of choice in Pregnancy:** USG (1st line); MRI (2nd line, though stones are hard to see); Low-dose CT (last resort in 2nd/3rd trimester). * **Hardness Correlation:** Stones >1000 HU are generally resistant to ESWL.

Q: A male patient presents with azoospermia. On examination, the testicular size is normal, and both FSH and testosterone levels are within normal limits. What is the most probable cause?

Vas obstruction. **Explanation:** The clinical scenario describes **Obstructive Azoospermia**. The key to solving this is the triad of **azoospermia** (absence of sperm), **normal testicular volume**, and **normal hormonal profile** (FSH and Testosterone). 1. **Why Vas Obstruction is correct:** In obstructive azoospermia, the "machinery" (testis) is functioning perfectly, and the "fuel" (hormones) is adequate. Since FSH is normal, it indicates that spermatogenesis is occurring normally. The absence of sperm in the ejaculate is therefore due to a physical blockage in the exit pathway, most commonly in the epididymis or the vas deferens (e.g., post-inflammatory or congenital absence). 2. **Why other options are incorrect:** * **Non-descended testis:** Usually leads to testicular atrophy and impaired spermatogenesis due to higher intra-abdominal temperatures, often resulting in elevated FSH. * **Klinefelter’s Syndrome (47, XXY):** This is a form of primary testicular failure. It presents with **small, firm testes**, azoospermia, **elevated FSH/LH**, and low testosterone. * **Kallmann’s Syndrome:** This is hypogonadotropic hypogonadism. It presents with **low FSH/LH**, low testosterone, and small testes, often accompanied by anosmia. **NEET-PG High-Yield Pearls:** * **FSH is the best marker for spermatogenesis:** If FSH is >2x the upper limit of normal, it strongly suggests non-obstructive (primary) testicular failure. * **Normal FSH + Azoospermia + Normal Testis = Obstruction.** * **Most common site of obstruction:** Epididymis. * **Congenital Bilateral Absence of Vas Deferens (CBAVD):** Strongly associated with **CFTR gene mutations** (Cystic Fibrosis). Always check for the presence of the seminal vesicles and renal anomalies.

Q: Which of the following is NOT true about paraphimosis?

It is seen in patients with Diabetes Mellitus.. **Explanation:** **Paraphimosis** is a urological emergency where the prepuce (foreskin), once retracted behind the glans penis, cannot be reduced to its original position. This leads to a constricting ring that impairs venous and lymphatic drainage, causing edema and, if untreated, arterial compromise. **Why Option B is the Correct Answer (The False Statement):** While **Phimosis** (the inability to retract the foreskin) is strongly associated with Diabetes Mellitus due to recurrent balanoposthitis and scarring, **Paraphimosis** is not specifically a disease "seen in" or caused by Diabetes. It is a mechanical complication resulting from the failure to pull the foreskin back over the glans after retraction. **Analysis of Other Options:** * **Option A (Iatrogenic):** This is true. It often occurs in hospitals when a healthcare provider retracts the foreskin for catheterization or physical examination and forgets to replace it. * **Option C (Gangrene):** This is true. The constricting band causes progressive edema, which eventually leads to arterial occlusion, ischemia, and necrosis (gangrene) of the glans penis. * **Option D (Circumcision):** This is true. While the initial management involves manual reduction or the "Dorsal Slit" procedure, **circumcision** is the definitive elective treatment to prevent recurrence. **High-Yield Clinical Pearls for NEET-PG:** * **Emergency Management:** Manual compression to reduce edema followed by manual reduction. * **Dorsal Slit:** Indicated if manual reduction fails. * **Phimosis vs. Paraphimosis:** Phimosis is "cannot retract"; Paraphimosis is "cannot reduce." * **Key Risk Factor:** Chronic balanoposthitis (often in diabetics) leads to Phimosis, which is a prerequisite for Paraphimosis. However, the act of paraphimosis itself is an acute mechanical event.

Q: Absent fructose content in the seminal fluid suggests which of the following conditions?

Both A and B. **Explanation:** The presence of fructose in seminal fluid is a critical marker for the patency and functional integrity of the male reproductive tract. Fructose is exclusively produced and secreted by the **seminal vesicles**; its primary role is to provide an energy source for sperm motility. **Why the correct answer is D (Both A and B):** 1. **Congenital Absence of Seminal Vesicles (Option A):** Since the seminal vesicles are the sole source of fructose, their absence (often associated with Congenital Bilateral Absence of the Vas Deferens - CBAVD) results in a total lack of fructose in the ejaculate. 2. **Ductal Obstruction (Option B):** If there is an obstruction at the level of the **ejaculatory ducts** (where the seminal vesicle ducts join the vas deferens), the secretions from the seminal vesicles cannot reach the urethra. This leads to an ejaculate that is low in volume, acidic, and fructose-negative. **Why other options are incorrect:** * **Option C** is incorrect because both A and B are established clinical causes for azoospermia with absent fructose. **Clinical Pearls for NEET-PG:** * **Normal Fructose Level:** >13 µmol per ejaculate. * **The "Fructose Test":** It is the first-line investigation in patients with **Azoospermia** and **Low Ejaculate Volume (<1.5 ml)**. * **CBAVD Link:** Congenital absence of the vas deferens and seminal vesicles is strongly associated with mutations in the **CFTR gene** (Cystic Fibrosis). * **pH Correlation:** Seminal vesicle fluid is alkaline. Therefore, absent fructose is usually accompanied by an **acidic pH (<7.0)** of the semen.

Q: Which of the following statements is incorrect regarding the variables used to calculate the MELD score?

Serum albumin. The **MELD (Model for End-Stage Liver Disease)** score is a critical scoring system used to predict the 3-month mortality risk in patients with chronic liver disease and to prioritize patients for liver transplantation. ### Why Serum Albumin is the Correct Answer Serum albumin is **not** a component of the MELD score. While albumin is a marker of the liver's synthetic function and is included in the **Child-Pugh classification**, it was excluded from the original MELD formula because its levels can be easily influenced by external factors like intravenous albumin infusion or nutritional status, making it a less objective predictor of acute mortality compared to the other variables. ### Explanation of Incorrect Options The original MELD score is calculated using three objective laboratory variables: * **Serum Bilirubin (Option C):** Reflects the liver’s excretory function. * **INR (Option A):** Reflects the liver’s synthetic function (specifically coagulation factors). * **Serum Creatinine (Option D):** Reflects renal function, which is a powerful predictor of survival in patients with cirrhosis (e.g., Hepatorenal Syndrome). ### High-Yield Clinical Pearls for NEET-PG * **MELD-Na:** The modern version of the score now includes **Serum Sodium**, as hyponatremia is a strong independent predictor of mortality in waitlisted patients. * **PELD Score:** Used for children under 12 years; it includes Albumin, Bilirubin, INR, age (<1 year), and growth failure. * **Mnemonic for MELD:** "**I** **C**an **B**e **S**aved" (**I**NR, **C**reatinine, **B**ilirubin, **S**odium). * **Range:** Scores range from 6 to 40; a higher score indicates a higher priority for transplantation.

Question 1

A 60-year-old male undergoes TURP. After 3 days, the patient develops altered sensorium and drowsiness. What is the most probable diagnosis?

Accepted Answer

Hyponatremia

Answer

Hypernatremia

Answer

Stroke

Answer

Meningitis due to spinal anesthesia

Question 2

Jack stone calculi are made up of which of the following?

Accepted Answer

Calcium oxalate

Answer

Ammonium urate

Answer

Uric acid

Answer

Struvite

Question 3

What is the investigation of choice for a ureteric stone?

Accepted Answer

CT scan

Answer

USG

Answer

MIBG scan

Answer

DMSA scan

Question 4

A male patient presents with azoospermia. On examination, the testicular size is normal, and both FSH and testosterone levels are within normal limits. What is the most probable cause?

Accepted Answer

Vas obstruction

Answer

Non-descended testis

Answer

Klinefelter's syndrome

Answer

Kallmann's syndrome

Question 5

In carcinoma of the prostate, which of the following statements is false?

Accepted Answer

Skeletal metastases from prostate cancer are always osteolytic.

Answer

The histological type is an adenocarcinoma.

Answer

Gleason scoring system is based on the degree of glandular differentiation.

Answer

Prostate cancer is the commonest site for skeletal metastasis.

Question 6

Which of the following is NOT true about paraphimosis?

Accepted Answer

It is seen in patients with Diabetes Mellitus.

Answer

It can be iatrogenic.

Answer

It can lead to gangrene of the glans.

Answer

Circumcision is a treatment.

Question 7

Absent fructose content in the seminal fluid suggests which of the following conditions?

Accepted Answer

Both A and B

Answer

Congenital absence of seminal vesicle

Answer

Partial duct obstruction

Answer

None of the above

Question 8

Which of the following is true regarding obstructive azoospermia?

Accepted Answer

Normal FSH and normal LH

Answer

Low FSH and low LH

Answer

Low LH and normal FSH

Answer

Low FSH and normal LH

Question 9

Which of the following statements is incorrect regarding the variables used to calculate the MELD score?

Accepted Answer

Serum albumin

Answer

Prothrombin time expressed as the international normalized ratio (INR)

Answer

Serum bilirubin

Answer

Serum creatinine

Question 10

In pelvi-ureteric junction (PUJ) obstruction causing hydronephrosis, which of the following statements is false?

Accepted Answer

If there is more than 5 percent of function in the obstructed kidney, a procedure to preserve the kidney is carried out

Answer

The condition may be asymptomatic

Answer

It can be diagnosed in utero

Answer

Ultrasound scanning is the least invasive method of imaging

Urology — MCQs

Urology — MCQs

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