Urology Practice Questions

Q: Prostate Specific Antigen (PSA) is specific to which of the following conditions?

All of the above. **Explanation:** The core concept to understand for NEET-PG is that **Prostate Specific Antigen (PSA)** is **organ-specific, but not disease-specific.** It is a serine protease produced by the columnar epithelium of the prostatic ducts and acini, intended to liquefy the seminal coagulum. 1. **Why "All of the above" is correct:** Any condition that disrupts the normal architecture of the prostate gland allows PSA to leak into the systemic circulation. * **Prostatic Cancer:** Malignant cells produce PSA, and the disruption of the basement membrane leads to significant elevations. * **BPH:** An enlarged prostate has more epithelial cells producing PSA; generally, for every 1 gram of BPH tissue, serum PSA rises by 0.3 ng/mL. * **Prostatitis:** Inflammation and infection cause "leakage" of PSA into the blood, often causing the highest acute spikes in levels. 2. **Clinical Nuances:** * **Option A & B:** While these are benign, they frequently cause elevated PSA, leading to diagnostic dilemmas. This is why a single elevated PSA reading is never definitive for cancer. * **Option C:** While PSA is the primary screening tool for prostate cancer, it lacks the specificity to be used in isolation. **High-Yield Clinical Pearls for NEET-PG:** * **Normal Range:** 0–4 ng/mL. * **PSA Velocity:** A rise of **>0.75 ng/mL per year** is highly suggestive of malignancy, even if the total value is 25%** suggests BPH. * **Factors that increase PSA:** DRE (minor), Prostatitis, Ejaculation, Cystoscopy, and Prostate Biopsy. * **Factors that decrease PSA:** 5-alpha reductase inhibitors (Finasteride/Dutasteride) can reduce PSA levels by **50%**; therefore, the measured value should be doubled for accurate screening.

Q: A 13-year-old boy presents with acute onset right scrotal pain. The pain is not relieved on elevation of the scrotum, and he has no fever or dysuria. The testis is enlarged and tender. His routine urinary examination is normal, and there is no history of trauma. Which of the following is the most appropriate management?

Immediate exploration. **Explanation:** The clinical presentation of acute, spontaneous scrotal pain in an adolescent is **Testicular Torsion** until proven otherwise. This is a surgical emergency where the spermatic cord twists, leading to ischemia and potential necrosis of the testis. **Why Immediate Exploration is Correct:** The diagnosis of torsion is primarily clinical. The "Golden Period" for testicular salvage is **6 hours** from the onset of pain; delay beyond this significantly increases the risk of orchidectomy. The negative **Prehn’s sign** (pain not relieved by scrotal elevation) and the absence of urinary symptoms (normal urinalysis) strongly point away from inflammatory causes and toward torsion. Immediate surgical exploration is mandatory to detorse the testis and perform bilateral orchidopexy (fixation) to prevent recurrence. **Why Other Options are Incorrect:** * **Antibiotics / Antibiotics and Scrotal Elevation:** These are treatments for *Epididymo-orchitis*. While this also causes scrotal pain, it usually presents with fever, dysuria, and a positive Prehn’s sign. In a 13-year-old, waiting for antibiotics to work in a suspected torsion case would lead to a dead testis. * **Psychiatric Evaluation:** This is irrelevant as the symptoms are clearly organic and acute. **Clinical Pearls for NEET-PG:** * **Age Distribution:** Bimodal peaks (neonatal period and puberty). * **Prehn’s Sign:** Negative in Torsion (pain persists/worsens); Positive in Epididymitis (pain relieved). * **Cremasteric Reflex:** Usually absent in testicular torsion (High sensitivity). * **Investigation of Choice:** Color Doppler Ultrasound (shows decreased/absent blood flow), but **surgery should never be delayed** for imaging if clinical suspicion is high. * **Anatomical Predisposition:** "Bell-clapper deformity" (high tunica vaginalis attachment).

Q: All are features of Fournier's gangrene except?

Testicles are involved. **Fournier’s gangrene** is a life-threatening, rapidly progressive polymicrobial necrotizing fasciitis of the perineal, perianal, and genital regions. ### **Explanation of Options** * **Option A (Correct Answer):** The **testicles are typically spared** in Fournier’s gangrene. This is because the blood supply to the testes originates from the **internal spermatic (testicular) arteries**, which arise directly from the abdominal aorta. In contrast, the scrotum and perineal skin are supplied by the external and internal pudendal arteries. Since the infection spreads along the fascial planes (Colles’, Dartos, and Scarpa’s fascia), the deep-seated testes remain protected. * **Option B:** The hallmark pathophysiology is **obliterative arteritis** of the subcutaneous arterioles. This leads to local ischemia, which further promotes the growth of anaerobic bacteria and leads to rapid tissue necrosis. * **Option C:** It is a **polymicrobial infection**. Common isolates include aerobes (E. coli, Klebsiella, Staphylococci, Streptococci) and anaerobes (Bacteroides, Clostridium species like *C. welchii*). * **Option D:** By definition, it is a form of **necrotizing fasciitis** specifically involving the male genitalia and perineum. ### **Clinical Pearls for NEET-PG** * **Risk Factors:** Diabetes mellitus (most common), chronic alcoholism, and local trauma/surgery. * **Clinical Sign:** **Crepitus** on palpation (due to gas-forming organisms) and "woody" induration of the skin. * **Management:** This is a surgical emergency. Treatment involves **aggressive surgical debridement**, broad-spectrum intravenous antibiotics, and hemodynamic stabilization. * **Anatomical Spread:** The infection is limited by the attachments of **Colles' fascia** (to the perineal body and ischiopubic rami), but it can spread upward to the abdominal wall via **Scarpa’s fascia**.

Q: A 40-year-old male presented with severe pain in the left upper abdomen radiating to the groin. Urine routine examination shows 6-8 pus cells and 15-20 RBCs. A CT scan was performed. What is the most likely diagnosis?

Left ureteric calculus. ***Left ureteric calculus*** - **Severe colicky pain** in the left upper abdomen radiating to the **groin** is classic for ureteric stone, following the path of the ureter. - **Hematuria** (15-20 RBCs) on urine analysis is a key finding, along with **pyuria** (6-8 pus cells) due to associated inflammation. *Aortic aneurysm* - Typically presents with **tearing back pain** radiating to the abdomen, not specifically to the groin. - **No hematuria** would be expected, and pain is usually constant rather than colicky. *Acute cholecystitis* - Pain is typically in the **right upper quadrant** radiating to the **right shoulder**, not to the groin. - **No hematuria** or pyuria would be present, and pain is usually related to **fatty meals**. *Acute colitis* - Presents with **diarrhea**, **blood in stool**, and **lower abdominal cramping**, not upper abdominal pain. - **No hematuria** would be expected, and pain doesn't radiate to the groin.

Q: A 60-year-old male presents with a poor stream of urine and a post-void residual volume of 400ml. He has bilateral hydronephrosis and his prostate weighs 70g. His urea is 120 mg/dL and creatinine is 3.5 mg/dL. What is the ideal next immediate step?

Catheterize with a Foley catheter. The clinical presentation describes a classic case of **Benign Prostatic Hyperplasia (BPH)** leading to acute-on-chronic urinary retention [1]. The patient has significant bladder outlet obstruction (70g prostate), evidenced by a high post-void residual (400ml) and secondary complications: bilateral hydronephrosis and **post-renal azotemia** (elevated urea and creatinine). **1. Why Option A is Correct:** The immediate priority in post-renal failure is to **relieve the obstruction**. Catheterization with a Foley catheter is the simplest, fastest, and most effective bedside procedure to decompress the bladder. Once the pressure is relieved, the hydronephrosis usually resolves, and renal function (urea/creatinine) typically improves. **2. Why Incorrect Options are Wrong:** * **Option B:** Percutaneous nephrostomies are invasive and reserved for supra-vesical obstructions (e.g., ureteric stones or tumors) where a bladder catheter cannot bypass the blockage. * **Options C & D:** While imaging is useful for staging or ruling out malignancy, they are diagnostic steps. In an emergency setting with deranged renal parameters (azotemia), **therapeutic intervention** (drainage) must precede elective imaging. Furthermore, CT contrast is contraindicated in patients with high creatinine due to the risk of Contrast-Induced Nephropathy. **Clinical Pearls for NEET-PG:** * **Definition of BPH:** Histologically, it involves hyperplasia of both glandular and stromal elements, primarily in the **Transition Zone** of the prostate [1]. * **Post-obstructive Diuresis:** After catheterization, monitor the patient for massive diuresis and electrolyte imbalances. * **Normal Prostate Weight:** ~20g. A 70g prostate is significantly enlarged. * **Management Priority:** Always address the "ABC" and immediate life-threatening complications (like renal failure) before definitive surgical management (e.g., TURP).

Q: Which of the following is a complication of total parenteral nutrition?

Metabolic acidosis. **Explanation:** Total Parenteral Nutrition (TPN) is associated with several metabolic complications. **Metabolic acidosis** is a well-recognized complication, primarily occurring due to the high concentration of cationic amino acids (such as arginine, histidine, and lysine) in older TPN formulations. When these amino acids are metabolized, they release hydrogen ions. Additionally, the presence of acetate or chloride salts in the solution can influence the acid-base balance; an excess of chloride relative to sodium can lead to **hyperchloremic metabolic acidosis**. **Analysis of Options:** * **A. Congestive Heart Failure (CHF):** While fluid overload can occur if TPN is administered too rapidly, CHF is not a direct metabolic complication of the TPN constituents themselves. * **B. Hypochloremia:** TPN is more likely to cause **hyperchloremia** (due to high chloride content in certain formulations), which contributes to the metabolic acidosis mentioned above. * **D. Leukopenia:** TPN does not typically cause a decrease in white blood cell counts. In fact, catheter-related bloodstream infections (CRBSI) are a common complication, which would lead to leukocytosis. **High-Yield Clinical Pearls for NEET-PG:** * **Most common metabolic complication:** Hyperglycemia (due to high glucose infusion rates). * **Refeeding Syndrome:** Characterized by **Hypophosphatemia** (most important), hypokalemia, and hypomagnesemia when feeding is restarted in a malnourished patient. * **Hepatobiliary complications:** Cholestasis, steatosis, and cholelithiasis (gallstones) are common with long-term TPN use due to lack of enteral stimulation. * **Trace element deficiency:** Zinc deficiency is common, presenting as perioral dermatitis and alopecia.

Q: A 30-year-old patient presents with scrotal swelling. Transillumination is positive, and a large hydrocoele is suspected. What is the preferred treatment?

Jaboulay's procedure. **Explanation:** The clinical presentation of a positive transillumination test in a 30-year-old male is diagnostic of a **primary vaginal hydrocele**. The surgical management of hydrocele is determined by the size and thickness of the tunica vaginalis sac. **Why Jaboulay’s Procedure is correct:** Jaboulay’s procedure (eversion of the sac) is the preferred treatment for **large hydroceles** where the sac is thin and lax. In this procedure, the sac is opened, redundant tissue is trimmed, and the edges are sutured behind the testis and spermatic cord. This allows the fluid to be absorbed by the scrotal lymphatics. **Analysis of Incorrect Options:** * **Lord’s Plication:** This is preferred for **small to medium-sized** hydroceles with a thin sac. The sac is not everted but gathered by multiple plicating sutures. It is less suitable for large sacs as it creates a bulky mass. * **Excision of Sac (Subtotal Excision):** This is reserved for **chronic, large hydroceles with a thick, calcified, or multilocular sac** where eversion is technically difficult. * **Incision and Drainage:** This is not a definitive treatment for hydrocele. Simple aspiration has a near 100% recurrence rate and carries a risk of infection/hematocele. **High-Yield Clinical Pearls for NEET-PG:** 1. **Gold Standard Diagnosis:** Clinical examination (Transillumination + "Getting above the swelling" is possible). 2. **Infantile Hydrocele:** Usually resolves spontaneously by 1-2 years of age. If it persists, the treatment of choice is **Herniotomy** (not hydrocelectomy) because it is a communicating type. 3. **Complication:** The most common complication of hydrocele surgery is a **scrotal hematoma**. 4. **Bergmann’s Operation:** Another term for the partial excision of the sac used in very thick-walled hydroceles.

Q: Which statement about Horseshoe Kidney is false?

Heminephrectomy improves function. **Explanation:** Horseshoe kidney is the most common renal fusion anomaly, occurring when the lower poles of the kidneys fuse across the midline (isthmus). **Why Option D is the Correct (False) Statement:** Heminephrectomy (removal of one half of the kidney) is **not** a treatment to improve renal function. Surgery in horseshoe kidney is only indicated for complications such as symptomatic calculi, severe obstruction, or tumors. Dividing the isthmus (symphysiotomy) was historically performed but is now obsolete as it does not improve drainage or function and carries a high risk of hemorrhage and devascularization. **Analysis of Other Options:** * **Option A (Spider-like appearance):** Due to the failure of normal rotation (malrotation), the renal pelvis is anterior, and the calyces are directed medially and posteriorly. On Intravenous Pyelogram (IVP), this orientation creates a characteristic "spider-leg" or "hand-shaking" appearance. * **Option B (Ureteral obstruction):** This is common due to the high insertion of the ureter into the renal pelvis and the ureter crossing over the fused isthmus, often leading to Pelviureteric Junction (PUJ) obstruction. * **Option C (Lower calyx reversed):** Because the lower poles are fused and the kidney fails to rotate medially, the lower calyces point toward the midline (medially), which is the reverse of the normal lateral orientation. **High-Yield Clinical Pearls for NEET-PG:** * **Embryology:** The ascent of the horseshoe kidney is arrested by the **Inferior Mesenteric Artery (IMA)** at the level of L3. * **Associated Risks:** Increased incidence of **Renal Calculi** (stasis), **UTIs**, and specific tumors like **Wilms’ tumor** (in children) and **Transitional Cell Carcinoma**. * **Rovsing Sign:** Abdominal pain on hyperextension of the spine (rarely seen clinically but high-yield for exams).

Question 1

Prostate Specific Antigen (PSA) is specific to which of the following conditions?

Accepted Answer

All of the above

Answer

Benign Prostatic Hyperplasia (BPH)

Answer

Prostatitis

Answer

Prostatic cancer

Question 2

A 13-year-old boy presents with acute onset right scrotal pain. The pain is not relieved on elevation of the scrotum, and he has no fever or dysuria. The testis is enlarged and tender. His routine urinary examination is normal, and there is no history of trauma. Which of the following is the most appropriate management?

Accepted Answer

Immediate exploration

Answer

Antibiotics

Answer

Psychiatric evaluation

Answer

Antibiotics and scrotal elevation

Question 3

All are features of Fournier's gangrene except?

Accepted Answer

Testicles are involved

Answer

Obliterative arteritis seen

Answer

Haemolytic streptococci, E.coli, Staphylococci, Cl. welchi can be isolated

Answer

Necrotising fasciitis

Question 4

A 40-year-old male presented with severe pain in the left upper abdomen radiating to the groin. Urine routine examination shows 6-8 pus cells and 15-20 RBCs. A CT scan was performed. What is the most likely diagnosis?

Accepted Answer

Left ureteric calculus

Answer

Aortic aneurysm

Answer

Acute cholecystitis

Answer

Acute colitis

Question 5

Which of the following are indications for percutaneous nephrostomy?

Accepted Answer

Stone removal, ureteral obstruction, renal tumor resection, antegrade renography

Answer

Stone removal, ureteral obstruction, renal tumor resection, ischemic renal failure

Answer

Stone removal, renal tumor resection, ischemic renal failure, antegrade renography

Answer

Stone removal, ureteral obstruction, ischemic renal failure, antegrade renography

Question 6

A 60-year-old male presents with a poor stream of urine and a post-void residual volume of 400ml. He has bilateral hydronephrosis and his prostate weighs 70g. His urea is 120 mg/dL and creatinine is 3.5 mg/dL. What is the ideal next immediate step?

Accepted Answer

Catheterize with a Foley catheter

Answer

Bilateral percutaneous nephrostomies

Answer

CT scan to rule out malignancy

Answer

MRI pelvis

Question 7

A young man presents with primary infertility, and 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?

Accepted Answer

Transrectal ultrasonography

Answer

Colour duplex ultrasonography of the scrotum

Answer

Retrograde urethrography

Answer

Spermatic venography

Question 8

Which of the following is a complication of total parenteral nutrition?

Accepted Answer

Metabolic acidosis

Answer

Congestive heart failure (CHF)

Answer

Hypochloremia

Answer

Leukopenia

Question 9

A 30-year-old patient presents with scrotal swelling. Transillumination is positive, and a large hydrocoele is suspected. What is the preferred treatment?

Accepted Answer

Jaboulay's procedure

Answer

Lord’s plication

Answer

Excision of sac

Answer

Incision and drainage

Question 10

Which statement about Horseshoe Kidney is false?

Accepted Answer

Heminephrectomy improves function

Answer

Spider-like appearance in IVP

Answer

Ureteral obstruction is common

Answer

Lower calyx is reversed

Urology — MCQs

Urology — MCQs

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