Urology Practice Questions

Q: In renal injury following blunt abdominal trauma, which of the following procedures is not indicated?

Prophylactic nephrectomy. In the management of blunt renal trauma, the primary goal is **renal preservation**. Most renal injuries (Grades I-III and many Grade IV) are managed conservatively. ### **Explanation of the Correct Answer** **A. Prophylactic nephrectomy:** This is **never indicated**. Nephrectomy is a "last resort" procedure reserved for life-threatening hemorrhage or a shattered kidney (Grade V) that is non-reconstructible. Removing a kidney "prophylactically" (to prevent future complications) violates the principle of conservative management and unnecessarily renders the patient monorenal. ### **Analysis of Incorrect Options** * **B. Diagnostic Peritoneal Lavage (DPL):** While largely replaced by FAST, DPL remains a valid (though invasive) tool in hemodynamically unstable patients with blunt abdominal trauma to detect hemoperitoneum. * **C. Intravenous Pyelogram (IVP):** Although Contrast-Enhanced CT (CECT) is the gold standard, a **"One-shot IVP"** is specifically indicated in the operating room for unstable patients undergoing emergency laparotomy to confirm the presence of a functional contralateral kidney before contemplating any renal intervention. * **D. Exploratory Laparotomy:** This is indicated if there is hemodynamic instability, an expanding/pulsatile retroperitoneal hematoma, or associated intra-abdominal visceral injuries (e.g., bowel perforation). ### **NEET-PG High-Yield Pearls** * **Gold Standard Investigation:** CECT with delayed films (to visualize the collecting system). * **Most Common Organ Injured in Blunt Trauma:** Spleen (Renal is the most common urinary organ). * **Absolute Indications for Surgery in Renal Trauma:** Hemodynamic instability, expanding/pulsatile hematoma, and Grade V vascular pedicle avulsion. * **AAST Grading:** Grade I (Contusion/Hematoma) to Grade V (Shattered kidney/Ureteropelvic avulsion).

Q: The 'Brown sign' is characteristically seen in which of the following conditions?

Glomus tumor. **Explanation:** The **Brown sign** is a classic clinical finding associated with **Glomus tumors** (specifically Glomus jugulare and Glomus tympanicum). These are highly vascular, slow-growing tumors arising from paraganglia cells. **Why it occurs:** The Brown sign is observed during pneumatic otoscopy. When positive pressure is applied to the external auditory canal using a Siegle’s speculum, the pulsating, reddish-blue mass behind the intact tympanic membrane **blanches** (turns pale). This occurs because the external pressure exceeds the capillary pressure within the vascular tumor, temporarily impeding blood flow. **Analysis of Incorrect Options:** * **B. Cholesteatoma:** Characterized by a "pearly white" mass in the middle ear or attic. It is associated with the *Fistula test*, not the Brown sign. * **C. Acoustic neuroma:** A tumor of the 8th cranial nerve. It presents with sensorineural hearing loss and vertigo; there are no visible middle ear signs like the Brown sign. * **D. Hypothyroidism:** While it can cause hearing loss or myxedema, it does not present with vascular middle ear masses. **NEET-PG High-Yield Pearls:** * **Aquino’s Sign:** Pulsations of the glomus tumor cease upon manual compression of the ipsilateral common carotid artery. * **Phelps’ Sign:** Loss of the bony plate between the jugular bulb and the middle ear (seen on CT). * **Rising Sun Appearance:** The characteristic red/blue hue seen behind the tympanic membrane in Glomus tympanicum. * **Treatment of Choice:** Surgical excision; preoperative embolization is often used to reduce vascularity.

Q: Dietl crisis is seen in:

Intermittent hydronephrosis. **Explanation:** **Dietl’s Crisis** is a classic clinical phenomenon associated with **Intermittent Hydronephrosis (Option A)**. It is characterized by sudden, paroxysmal episodes of severe colicky renal pain, nausea, and vomiting, followed by the passage of a large volume of dilute urine as the pain subsides. The underlying pathophysiology involves a temporary obstruction at the **Pelvi-Ureteric Junction (PUJ)**. This is most commonly caused by an **aberrant renal artery** crossing the ureter or by **nephroptosis** (floating kidney), where the kidney drops when the patient stands, causing the ureter to kink. When the obstruction spontaneously resolves, the built-up pressure is released, leading to polyuria and immediate relief of symptoms. **Analysis of Incorrect Options:** * **B & C (Unilateral/Bilateral Hydronephrosis):** While Dietl’s crisis occurs in a unilateral kidney, these terms describe the anatomical state rather than the *functional pattern* of the obstruction. Chronic unilateral or bilateral hydronephrosis is often dull or asymptomatic; the "crisis" specifically requires the **intermittent** nature of the blockage. * **D (Refractory Hydronephrosis):** This refers to hydronephrosis that does not respond to standard treatment. It does not describe the episodic clinical presentation of Dietl’s crisis. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Episodic loin pain, nausea/vomiting, and polyuria (post-episode). * **Diagnosis:** Often confirmed via **Anderson-Hynes pyeloplasty** if the obstruction is significant. * **Imaging:** An IVP or ultrasound performed *during* the crisis will show hydronephrosis, but may appear normal between episodes. * **Differential:** Must be distinguished from renal calculi; however, the massive diuresis following pain relief is pathognomonic for Dietl's.

Q: A 29-year-old male complains of flank pain that radiates from the loin to the groin region. What is the first investigation to be done?

USG abdomen. **Explanation:** The clinical presentation of flank pain radiating from the loin to the groin is classic for **ureteric colic**, most commonly caused by urolithiasis (urinary stones). **1. Why USG Abdomen is the Correct Answer:** In clinical practice and for exam purposes, **Ultrasonography (USG)** is considered the **first-line (initial) investigation** for suspected renal colic. It is non-invasive, radiation-free, readily available, and highly effective at detecting hydronephrosis (proximal dilatation) and stones in the radiopaque or radiolucent categories. While not as sensitive as CT for small ureteric stones, its safety profile makes it the starting point in the diagnostic algorithm. **2. Analysis of Incorrect Options:** * **Plain CT scan abdomen (NCCT):** This is the **Gold Standard** (most accurate) investigation for urolithiasis because it can detect almost all types of stones (except Indinavir stones) and their precise location. However, it is not the "first" investigation due to cost and radiation exposure. * **CECT abdomen:** Contrast-enhanced CT is generally avoided in acute renal colic as the excreted contrast can mask the presence of a stone (both appear white/hyperdense). It is used primarily to assess renal function or alternative pathologies. * **X-ray abdomen (KUB):** While useful for follow-up of radiopaque stones, it misses 10-20% of stones (radiolucent stones like uric acid) and has lower sensitivity compared to USG. **Clinical Pearls for NEET-PG:** * **Initial/First Investigation:** USG Abdomen. * **Gold Standard/Best Investigation:** Non-Contrast Computed Tomography (NCCT) KUB. * **Investigation of Choice in Pregnancy/Children:** USG. * **Most common site of stone obstruction:** Ureterovesical Junction (UVJ). * **Radiolucent stones on X-ray:** Uric acid, Xanthine, and Indinavir stones.

Q: After agreeing to have no more children, a man and his wife decided he should have a vasectomy. What structure would then be surgically ligated?

Ductus deferens. **Explanation:** **Vasectomy** is a permanent method of male sterilization. The procedure involves the surgical excision and ligation of a segment of the **Ductus deferens** (Vas deferens). **Why the Ductus deferens is the correct target:** The Ductus deferens is a thick-walled muscular tube that transports mature spermatozoa from the epididymis to the ejaculatory duct. By ligating this structure, the path for sperm to enter the ejaculate is physically blocked. Since the testes continue to produce sperm and testosterone, the sperm are simply reabsorbed by the body, and hormonal balance remains unaffected. **Analysis of Incorrect Options:** * **B. Ejaculatory duct:** This is formed by the union of the ductus deferens and the duct of the seminal vesicle within the prostate. It is surgically inaccessible for a simple sterilization procedure and its ligation would also block seminal vesicle fluid. * **C. Epididymis:** This is the site of sperm maturation and storage. While blocking it would prevent sperm transport, it is a complex, coiled structure that is technically difficult to ligate compared to the easily palpable vas deferens in the scrotal sac. * **D. Fossa navicularis:** This is the dilated distal portion of the male urethra located within the glans penis. It serves as a passage for both urine and semen; ligating it would cause urinary obstruction. **Clinical Pearls for NEET-PG:** * **Anatomy:** The vas deferens is a component of the spermatic cord. During a "No-Scalpel Vasectomy," it is isolated by palpation through the scrotal skin. * **Post-Op Counseling:** Vasectomy is **not immediately effective**. Patients must use alternative contraception until "azoospermia" is confirmed by semen analysis (usually after 12 weeks or 20 ejaculations) to clear stored sperm distal to the ligation site. * **Complications:** The most common long-term complication is a sperm granuloma or chronic post-vasectomy pain syndrome.

Q: Circumcision cannot be used in the management of which of the following conditions?

Penile cancer. **Explanation** The correct answer is **Penile cancer**. In the management of penile cancer, circumcision is insufficient as a definitive treatment. The standard of care involves wide local excision, partial penectomy, or total penectomy depending on the stage, often accompanied by inguinal lymph node dissection. Performing a simple circumcision in the presence of malignancy risks leaving behind positive margins and violating oncological principles. **Analysis of Options:** * **Phimosis:** This is the primary indication for circumcision. It involves the inability to retract the prepuce over the glans. Circumcision is the definitive surgical cure. * **Severe Balanitis Xerotica Obliterans (BXO):** Also known as Lichen Sclerosus, this is a chronic inflammatory condition. Circumcision is the treatment of choice as it removes the diseased preputial tissue, which is often the source of the pathology. * **Paraphimosis:** This is a urological emergency where the retracted foreskin becomes trapped behind the glans. While initial management involves manual reduction, a formal circumcision is recommended later to prevent recurrence. **Clinical Pearls for NEET-PG:** * **Contraindications to Circumcision:** The most important absolute contraindication is **Hypospadias**, as the prepuce is required for future reconstructive skin flaps (urethroplasty). Other contraindications include chordee and bleeding diathesis. * **BXO Association:** BXO is a premalignant condition; if left untreated, it can progress to Squamous Cell Carcinoma (SCC) of the penis. * **Protective Factor:** Neonatal circumcision is known to significantly reduce the lifetime risk of developing penile cancer and HIV transmission.

Q: Which of the following statements is not true regarding Familial adenomatous polyposis?

Polyps tend to develop in late adulthood.. **Explanation** **Familial Adenomatous Polyposis (FAP)** is an autosomal dominant condition caused by a germline mutation in the **APC (Adenomatous Polyposis Coli) gene** on chromosome 5q21. **Why Option C is the correct answer (The False Statement):** Polyps in FAP do **not** develop in late adulthood. Instead, they typically appear in the **second decade of life** (teens). By age 35, nearly 95% of patients have developed hundreds to thousands of adenomatous polyps. If left untreated (without prophylactic colectomy), the risk of progression to colorectal cancer is virtually 100% by age 40–50. **Analysis of Incorrect Options:** * **Option A:** FAP follows an **autosomal dominant** inheritance pattern. A child of an affected parent has a 50% chance of inheriting the mutation. * **Option B:** Screening starts early (age 10–12 years). Since polyps in FAP are distributed throughout the colon but are almost always present in the rectum, **annual flexible sigmoidoscopy** is the standard screening tool until polyps are detected. * **Option D:** FAP can present with extra-colonic manifestations. When associated with **epidermoid cysts, osteomas** (usually of the mandible), and soft tissue tumors (desmoids), it is known as **Gardner’s Syndrome**. **High-Yield Clinical Pearls for NEET-PG:** * **CHRPE:** Congenital Hypertrophy of Retinal Pigment Epithelium is the earliest detectable sign of FAP. * **Turcot Syndrome:** FAP/HNPCC associated with CNS tumors (Medulloblastoma/Glioma). * **Duodenal Adenoma:** The most common extra-colonic malignancy in FAP patients post-colectomy (Periampullary carcinoma). * **Management:** Total proctocolectomy with Ileal Pouch-Anal Anastomosis (IPAA) is the surgery of choice.

Question 1

In renal injury following blunt abdominal trauma, which of the following procedures is not indicated?

Accepted Answer

Prophylactic nephrectomy

Answer

Diagnostic peritoneal lavage

Answer

Intravenous pyelogram (IVP)

Answer

Exploratory laparotomy

Question 2

The 'Brown sign' is characteristically seen in which of the following conditions?

Accepted Answer

Glomus tumor

Answer

Cholesteatoma

Answer

Acoustic neuroma

Answer

Hypothyroidism

Question 3

Dietl crisis is seen in:

Accepted Answer

Intermittent hydronephrosis

Answer

Unilateral hydronephrosis

Answer

Bilateral hydronephrosis

Answer

Refractory hydronephrosis

Question 4

Which of the following is a known complication of modified retroperitoneal lymph node dissection (RPLND) performed for non-seminomatous germ cell tumors of the testis?

Accepted Answer

Retrograde ejaculation

Answer

Impotence

Answer

Bladder atony

Answer

Dry ejaculation

Question 5

A 29-year-old male complains of flank pain that radiates from the loin to the groin region. What is the first investigation to be done?

Accepted Answer

USG abdomen

Answer

CECT abdomen

Answer

Plain CT scan abdomen

Answer

X-ray abdomen

Question 6

After agreeing to have no more children, a man and his wife decided he should have a vasectomy. What structure would then be surgically ligated?

Accepted Answer

Ductus deferens

Answer

Ejaculatory duct

Answer

Epididymis

Answer

Fossa navicularis

Question 7

Which of the following statements about the prostate is incorrect?

Accepted Answer

Benign prostatic hyperplasia is common in the peripheral zone.

Answer

The normal adult prostate weighs around 20 grams.

Answer

Carcinomas are more common in the peripheral zone.

Answer

PSA is a sensitive marker in prostate pathology but lacks specificity.

Question 8

A 40-year-old patient with a single kidney presents with a solitary exophytic mass of 4 cm localized at its lower pole. What is the best-recommended management option?

Accepted Answer

Partial nephrectomy

Answer

Radical nephrectomy

Answer

Radical nephrectomy with dialysis

Answer

Radical nephrectomy with renal transplantation

Question 9

Circumcision cannot be used in the management of which of the following conditions?

Accepted Answer

Penile cancer

Answer

Phimosis

Answer

Severe balanitis xerotica obliterans

Answer

Paraphimosis

Question 10

Which of the following statements is not true regarding Familial adenomatous polyposis?

Accepted Answer

Polyps tend to develop in late adulthood.

Answer

It follows an autosomal dominant pattern of inheritance.

Answer

Screening is typically performed using sigmoidoscopy.

Answer

Epidermoid cysts and osteomas may be associated findings.

Urology — MCQs

Urology — MCQs

On this page

Practice by Chapter

Want unlimited practice?