Urology — MCQs
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A 42-year-old man presents with sudden onset, severe left-sided flank pain radiating into the groin. He experienced a similar episode years ago that resolved spontaneously. He denies fever, chills, nausea, vomiting, diarrhea, or dysuria. Physical examination reveals left flank and groin tenderness. Urinalysis shows microscopic hematuria without casts. Serum chemistry reveals: Sodium: 143 mEq/L, Potassium: 2.4 mEq/L, Bicarbonate: 17 mEq/L, Chloride: 115 mEq/L, Blood urea nitrogen: 12 mg/dL, Creatinine: 1.0 mg/dL, Glucose: 85 mg/dL. Which of the following acid-base disturbances is MOST likely present in this patient?
Which of the following brain tumors is highly vascular in nature?
Thimble bladder is seen in all conditions except?
Which structure is injured during the excision of a ranula?
Denver shunt is used in which condition?
Sister Mary Joseph nodule suggests?
Which of the following is NOT true about Prostate-Specific Antigen (PSA)?
For the treatment of ectopic vesicles, which of the following bones is divided to reach the surgical site?
A 36-year-old man presents with right scrotal swelling that began shortly after moving furniture. He denies nausea, vomiting, change in bowel habits, abdominal pain, or urinary tract symptoms. On examination, an enlarged right hemi-scrotum is noted, with a mass originating at the level of the external inguinal ring. The mass is reducible through the external inguinal ring. When the mass is reduced and the patient performs a Valsalva maneuver, a protrusion is felt at the external inguinal ring. The testicle appears normal after reduction. Which of the following pathological processes might cause the patient's underlying condition to occur in an infant?
Which dye is used in chromoendoscopy for the detection of cancer?
Urology Indian Medical PG Practice Questions and MCQs
Question 381: A 42-year-old man presents with sudden onset, severe left-sided flank pain radiating into the groin. He experienced a similar episode years ago that resolved spontaneously. He denies fever, chills, nausea, vomiting, diarrhea, or dysuria. Physical examination reveals left flank and groin tenderness. Urinalysis shows microscopic hematuria without casts. Serum chemistry reveals: Sodium: 143 mEq/L, Potassium: 2.4 mEq/L, Bicarbonate: 17 mEq/L, Chloride: 115 mEq/L, Blood urea nitrogen: 12 mg/dL, Creatinine: 1.0 mg/dL, Glucose: 85 mg/dL. Which of the following acid-base disturbances is MOST likely present in this patient?
- A. Normal acid-base status
- B. Metabolic acidosis (Correct Answer)
- C. Metabolic alkalosis
- D. Respiratory acidosis
Explanation: ### Explanation The patient presents with classic **ureterolithiasis** (renal colic), characterized by sudden flank pain radiating to the groin and microscopic hematuria. The key to this question lies in analyzing the serum electrolytes to identify the underlying metabolic condition predisposing him to recurrent stones. **1. Why Metabolic Acidosis is Correct:** By calculating the **Serum Anion Gap (AG)**: $AG = Na^+ - (Cl^- + HCO_3^-) = 143 - (115 + 17) = 11$ mEq/L (Normal range: 8–12). The patient has a **Normal Anion Gap Metabolic Acidosis (NAGMA)**, evidenced by low bicarbonate (17 mEq/L) and hyperchloremia (115 mEq/L). Combined with **hypokalemia** (2.4 mEq/L) and recurrent nephrolithiasis, this points to **Distal (Type 1) Renal Tubular Acidosis (RTA)**. In Type 1 RTA, the inability to secrete $H^+$ ions in the distal tubule leads to systemic acidosis, low urinary citrate (an inhibitor of stone formation), and alkaline urine, which promotes the formation of calcium phosphate stones. **2. Why the Other Options are Incorrect:** * **Normal acid-base status:** Ruled out by the low bicarbonate (17 mEq/L) and abnormal chloride levels. * **Metabolic alkalosis:** This would present with high bicarbonate (>24 mEq/L) and is often associated with vomiting or diuretic use, neither of which is present here. * **Respiratory acidosis:** This would require a primary elevation in $PCO_2$ (usually due to hypoventilation), which does not correlate with the electrolyte findings of NAGMA and hypokalemia. **Clinical Pearls for NEET-PG:** * **Distal RTA (Type 1):** Associated with hypokalemia, high urinary pH (>5.5), and **calcium phosphate stones** (nephrocalcinosis). * **Proximal RTA (Type 2):** Associated with hypokalemia and Fanconi syndrome, but *rarely* causes stones because the distal acidification mechanism remains intact. * **Hyperkalemic RTA (Type 4):** Associated with diabetes and hypoaldosteronism; characterized by **hyperkalemia**, not hypokalemia. * **Mnemonic:** "Type **1** is **D**istal (starts with **D**, the 4th letter; 4-1=3... no, just remember **1** is **D**istant/Distal)."
Question 382: Which of the following brain tumors is highly vascular in nature?
- A. Glioblastoma (Correct Answer)
- B. Meningiomas
- C. CP angle epidermoid
- D. Pituitary adenomas
Explanation: **Explanation:** **Glioblastoma (GBM)**, a Grade IV astrocytoma, is characterized by intense **angiogenesis** and is one of the most vascularized tumors in the human body. The hallmark histological features of GBM include microvascular proliferation (forming "glomeruloid bodies") and areas of necrosis with pseudopalisading cells. This extreme vascularity is driven by the high expression of Vascular Endothelial Growth Factor (VEGF), making it the most vascular option among the choices. **Analysis of Incorrect Options:** * **Meningiomas:** While these are highly vascular extra-axial tumors (often showing a "sunburst" appearance on angiography), they are generally less aggressive and have lower rates of neo-angiogenesis compared to the malignant proliferation seen in Glioblastoma. * **CP Angle Epidermoid:** These are "pearly tumors" arising from ectodermal remnants. They are characteristically **avascular** and do not enhance on contrast CT/MRI. * **Pituitary Adenomas:** While well-perfused, they do not exhibit the pathological neo-angiogenesis or the degree of hypervascularity seen in high-grade gliomas. **High-Yield Clinical Pearls for NEET-PG:** * **Imaging Gold Standard:** Contrast-enhanced MRI is the investigation of choice for GBM, typically showing a **ring-enhancing lesion** with central necrosis. * **Most Vascular CNS Tumor:** While GBM is highly vascular, the most vascular tumor of the CNS overall is often considered to be **Hemangioblastoma** (frequently associated with Von Hippel-Lindau syndrome). * **Histology Keyword:** Look for **"Glomeruloid bodies"** (tufts of multilayered proliferating endothelial cells) to identify high-grade vascularity in GBM.
Question 383: Thimble bladder is seen in all conditions except?
- A. Tuberculosis
- B. Benign Prostatic Hyperplasia (BPH) (Correct Answer)
- C. Malignancy
- D. Schistosomiasis
Explanation: **Explanation:** A **Thimble Bladder** (also known as a systolic bladder) refers to a severely contracted, small-capacity, thick-walled, and fibrotic bladder. It is the end-stage result of chronic inflammatory or neoplastic processes that lead to extensive fibrosis of the detrusor muscle. **Why BPH is the Correct Answer (Except):** In **Benign Prostatic Hyperplasia (BPH)**, the bladder undergoes compensatory changes due to outflow obstruction. Initially, there is hypertrophy of the detrusor muscle, leading to trabeculations, sacculations, and eventually **diverticula**. While the bladder wall thickens, the overall bladder capacity often increases or remains large (distended bladder) rather than shrinking into a tiny, fibrotic "thimble." **Analysis of Other Options:** * **Tuberculosis (Genitourinary TB):** This is the **most common cause** of a thimble bladder. Chronic tuberculous cystitis leads to extensive ulceration followed by transmural fibrosis, shrinking the bladder to a capacity of often less than 50ml. * **Malignancy:** Advanced infiltrating carcinomas (like T4 bladder cancer) or extrinsic pelvic malignancies can cause "Linitis Plastica" of the bladder, resulting in a rigid, small-capacity organ. * **Schistosomiasis:** Chronic infection by *Schistosoma haematobium* causes intense granulomatous inflammation and subsequent calcification ("calcified bladder") and fibrosis, leading to a contracted bladder. **Clinical Pearls for NEET-PG:** * **Classic Triad of GU-TB:** Sterile pyuria, frequency, and acid-fast bacilli in urine. * **Golf-hole ureter:** Seen in GU-TB due to fibrosis and shortening of the ureter, causing the orifice to be pulled up and gape open. * **Imaging:** A thimble bladder is best visualized on a **Cystogram** or IVP, showing a tiny, globular bladder shadow. * **Treatment:** For a thimble bladder, the treatment of choice is often **Augmentation Cystoplasty** (using a bowel segment to increase capacity).
Question 384: Which structure is injured during the excision of a ranula?
- A. Parotid duct
- B. Facial artery
- C. Submandibular duct (Correct Answer)
- D. Lingual nerve
Explanation: **Explanation:** A **ranula** is a clinical term for a mucous extravasation cyst or a mucous retention cyst occurring specifically in the floor of the mouth. It typically arises from the **sublingual gland**. **Why the Submandibular Duct is the Correct Answer:** The submandibular duct (Wharton’s duct) runs along the floor of the mouth, passing from lateral to medial and crossing the lingual nerve. During the surgical excision or marsupialization of a ranula, the duct is at high risk of injury because it lies in the immediate surgical field, often draped over or compressed by the cyst. Damage to this duct can lead to obstructive sialadenitis of the submandibular gland. **Analysis of Incorrect Options:** * **A. Parotid duct (Stensen’s duct):** This duct opens opposite the second upper molar tooth in the buccal mucosa. It is anatomically distant from the floor of the mouth where a ranula is located. * **B. Facial artery:** While the facial artery is closely related to the submandibular gland, it runs deep to the mandible and through the submandibular triangle. It is not encountered during the intra-oral excision of a superficial ranula. * **C. Lingual nerve:** Although the lingual nerve is in the floor of the mouth, it lies deeper and more medial/inferior to the submandibular duct in this specific region. While it is at risk in deep dissections (like a "Plunging Ranula"), the submandibular duct is the structure most intimately related to the cyst wall. **High-Yield Clinical Pearls for NEET-PG:** * **Source:** Most ranulas arise from the **sublingual gland** (specifically the glands of Rivinus). * **Plunging Ranula:** A clinical variant that herniates through the **mylohyoid muscle** to present as a swelling in the neck. * **Treatment of Choice:** Complete excision of the ranula along with the **offending sublingual gland** to prevent recurrence. Marsupialization has a higher recurrence rate.
Question 385: Denver shunt is used in which condition?
- A. Ascites (Correct Answer)
- B. Dialysis
- C. Raised ICP
- D. Raised IOP
Explanation: **Explanation:** The **Denver shunt** is a type of **peritoneovenous shunt (PVS)** specifically designed for the management of **refractory ascites**. **1. Why Ascites is Correct:** In patients with intractable ascites (often due to cirrhosis or malignancy), fluid accumulates in the peritoneal cavity. The Denver shunt consists of a catheter with a **pressure-sensitive one-way valve** and a small subcutaneous pump chamber. It is surgically implanted to divert ascitic fluid from the peritoneum into the internal jugular vein or superior vena cava. Unlike the LeVeen shunt (which is passive), the Denver shunt allows for manual pumping to clear debris and maintain patency. **2. Why Other Options are Incorrect:** * **Dialysis:** Dialysis utilizes an Arteriovenous (AV) fistula or a peritoneal dialysis (PD) catheter (e.g., Tenckhoff catheter), not a Denver shunt. * **Raised ICP (Intracranial Pressure):** This is managed using a **Ventriculoperitoneal (VP) shunt**, which moves CSF from the brain to the peritoneum. * **Raised IOP (Intraocular Pressure):** Glaucoma is managed with topical medications, laser trabeculoplasty, or surgical shunts like the Ahmed Glaucoma Valve, but not a Denver shunt. **Clinical Pearls for NEET-PG:** * **LeVeen vs. Denver:** Both are peritoneovenous shunts. The Denver shunt is preferred by some because its manual pump helps prevent clogging by fibrin. * **Complications:** The most serious complication of these shunts is **Disseminated Intravascular Coagulation (DIC)**, caused by the sudden infusion of ascitic clotting factors into the systemic circulation. Other risks include fluid overload and shunt infection. * **Current Status:** Due to high complication rates and the advent of **TIPS (Transjugular Intrahepatic Portosystemic Shunt)**, Denver shunts are now primarily reserved for malignant ascites where TIPS is not feasible.
Question 386: Sister Mary Joseph nodule suggests?
- A. Rheumatoid arthritis
- B. Intra-abdominal malignancy (Correct Answer)
- C. Generalized lymphadenopathy
- D. Congenital defect
Explanation: **Explanation:** **Sister Mary Joseph nodule** refers to a palpable, firm, and often painful nodule at the umbilicus. It represents a **cutaneous metastasis** from an underlying **intra-abdominal or pelvic malignancy**. The correct answer is **B** because the umbilicus is a site of complex lymphatic and venous drainage, as well as a remnant of embryonic structures (like the urachus and vitelline duct). Malignant cells spread to this site via hematogenous routes, lymphatic spread, or direct extension along the falciform ligament. The most common primary site is the **Stomach** (in men) and the **Ovaries** (in women), followed by the pancreas and colon. **Why other options are incorrect:** * **A. Rheumatoid arthritis:** This is associated with subcutaneous nodules (Rheumatoid nodules) typically found over extensor surfaces or pressure points, not the umbilicus. * **C. Generalized lymphadenopathy:** While malignancy can cause lymphadenopathy (e.g., Virchow’s node), Sister Mary Joseph nodule is a specific cutaneous metastatic deposit, not a lymph node. * **D. Congenital defect:** Umbilical abnormalities like omphalocele or umbilical hernias are congenital, but a firm nodule in an adult is a classic sign of advanced malignancy. **High-Yield Clinical Pearls for NEET-PG:** * **Primary Source:** Gastric adenocarcinoma is the most frequent primary source overall. * **Prognostic Significance:** Its presence usually indicates advanced, metastatic (Stage IV) disease and carries a poor prognosis. * **Historical Note:** Named after Sister Mary Joseph, the surgical assistant to Dr. William Mayo, who first noticed the correlation between the nodule and intra-abdominal cancer. * **Differential Diagnosis:** Must be distinguished from an umbilical hernia or a "Caput Medusae" (portal hypertension).
Question 387: Which of the following is NOT true about Prostate-Specific Antigen (PSA)?
- A. PSA levels increase in Benign Prostatic Hyperplasia (BPH).
- B. PSA levels increase with age.
- C. Finasteride increases PSA levels. (Correct Answer)
- D. Metastatic prostate cancer increases PSA levels.
Explanation: **Explanation:** The correct answer is **C. Finasteride increases PSA levels.** This statement is false because Finasteride, a 5-alpha reductase inhibitor (5-ARI) used to treat BPH, actually **decreases** serum PSA levels by approximately **50%** after six months of treatment. It works by inhibiting the conversion of testosterone to dihydrotestosterone (DHT), leading to a reduction in prostatic volume and epithelial activity. **Analysis of Options:** * **Option A:** PSA is produced by both normal and hyperplastic prostatic epithelium. In **BPH**, the increased volume of prostatic tissue leads to an elevation in serum PSA levels. * **Option B:** PSA levels naturally **increase with age** due to the physiological enlargement of the prostate gland and increased basement membrane permeability. Age-specific reference ranges are often used to improve diagnostic accuracy. * **Option D:** **Metastatic prostate cancer** typically involves a high burden of malignant cells producing PSA, leading to significantly elevated serum levels, often exceeding 20–100 ng/mL. **High-Yield Clinical Pearls for NEET-PG:** * **The "Rule of Two":** When interpreting PSA in a patient on Finasteride or Dutasteride for >6 months, you must **multiply the measured PSA value by 2** to estimate the true baseline. * **PSA Density:** PSA value divided by prostate volume (measured via TRUS). A value **>0.15** is suspicious for malignancy. * **PSA Velocity:** An increase of **>0.75 ng/mL per year** is highly suggestive of cancer, even if the absolute value is within the normal range. * **Free-to-Total PSA Ratio:** A lower ratio (**<15-20%**) is associated with a higher risk of prostate cancer, whereas a higher ratio is seen in BPH.
Question 388: For the treatment of ectopic vesicles, which of the following bones is divided to reach the surgical site?
- A. Pubic rami
- B. Iliac bone (Correct Answer)
- C. Ischium bone
- D. Symphysis
Explanation: **Explanation:** The question refers to the surgical management of **Exstrophy of the Bladder** (ectopic vesicae). The fundamental anatomical defect in this condition is a wide separation of the pubic symphysis, which leads to an outward rotation of the innominate bones and lateral displacement of the rectus abdominis muscles. **1. Why Iliac Bone is Correct:** To achieve a tension-free closure of the bladder, abdominal wall, and pelvic ring, a **bilateral iliac osteotomy** is performed. By dividing the iliac bones (usually posterior or transverse osteotomy), the surgeon can mobilize the pelvic halves medially. This allows the pubic bones to be brought together in the midline, facilitating the anatomical reconstruction of the bladder neck and the closure of the abdominal wall defect. **2. Why Other Options are Incorrect:** * **Pubic rami & Ischium bone:** While these are parts of the pelvic girdle, they are not the primary sites for osteotomy in exstrophy repair. Dividing these would not provide the necessary leverage or mobility required to rotate the pelvic wings inward effectively. * **Symphysis:** In ectopic vesicae, the symphysis is already widely separated (diastasis). The goal of the surgery is to *approximate* the symphysis, not to divide it further. **Clinical Pearls for NEET-PG:** * **Classic Triad of Exstrophy:** Epispadias, bifid clitoris/penis, and widely separated pubic symphysis. * **Radiological Sign:** The "Molar Tooth Sign" on imaging or a "widened pubic diastasis" on X-ray. * **Timing of Surgery:** Primary closure is ideally performed within the first 48–72 hours of life when the pelvis is still malleable (sometimes allowing closure without osteotomy). After 72 hours, iliac osteotomy becomes mandatory. * **Associated Finding:** Patients often have an "out-toeing" gait due to the external rotation of the acetabulum.
Question 389: A 36-year-old man presents with right scrotal swelling that began shortly after moving furniture. He denies nausea, vomiting, change in bowel habits, abdominal pain, or urinary tract symptoms. On examination, an enlarged right hemi-scrotum is noted, with a mass originating at the level of the external inguinal ring. The mass is reducible through the external inguinal ring. When the mass is reduced and the patient performs a Valsalva maneuver, a protrusion is felt at the external inguinal ring. The testicle appears normal after reduction. Which of the following pathological processes might cause the patient's underlying condition to occur in an infant?
- A. Defect in the floor of the inguinal canal
- B. Defect in the internal inguinal ring
- C. Defect in the linea semilunaris
- D. Patent processus vaginalis (Correct Answer)
Explanation: **Explanation:** The clinical presentation describes an **Indirect Inguinal Hernia**. The key diagnostic features are the mass originating at the external inguinal ring, its reducibility, and its reappearance upon Valsalva maneuver. In an adult, this often presents after heavy lifting (increased intra-abdominal pressure), but the underlying anatomical defect is the same across age groups. **1. Why the Correct Answer is Right:** An indirect inguinal hernia occurs when abdominal contents protrude through the **internal inguinal ring**, lateral to the inferior epigastric vessels. In infants and children, this is almost exclusively due to a **Patent Processus Vaginalis (PPV)**. The processus vaginalis is an invagination of the peritoneum that precedes the descent of the testes; failure of this tube to obliterate results in a ready-made sac through which viscera can herniate. **2. Analysis of Incorrect Options:** * **Option A (Defect in the floor):** This refers to a weakness in the transversalis fascia (Hesselbach’s triangle), which causes **Direct Inguinal Hernias**. These are acquired defects seen in the elderly, not infants. * **Option B (Defect in the internal ring):** While the hernia passes through the internal ring, the "defect" in pediatric cases is the patency of the sac (PPV) rather than a structural failure of the ring itself. * **Option C (Defect in the linea semilunaris):** This describes a **Spigelian Hernia**, which occurs at the lateral border of the rectus abdominis muscle, not the inguinal canal. **Clinical Pearls for NEET-PG:** * **Indirect Hernia:** Most common type in both sexes and all ages. Lateral to inferior epigastric artery. * **Direct Hernia:** Medial to inferior epigastric artery. Never congenital. * **Internal Ring Occlusion Test:** If the hernia is controlled by pressure over the internal ring (mid-inguinal point), it is Indirect. * **Gold Standard Treatment:** In infants, a simple **Herniotomy** (ligation of the sac) is sufficient because the posterior wall is usually strong.
Question 390: Which dye is used in chromoendoscopy for the detection of cancer?
- A. Gentian violet
- B. Toluidine blue
- C. Hematoxylin and Eosin
- D. Methylene blue (Correct Answer)
Explanation: **Explanation:** **Chromoendoscopy** is a clinical technique where dyes are applied topically during endoscopy to enhance tissue characterization, helping to differentiate between neoplastic (cancerous) and non-neoplastic lesions. **Why Methylene Blue is correct:** Methylene blue is a **vital stain** (absorptive stain) taken up by the cytoplasm of normal, mature cells of the gastrointestinal and urinary tracts. In the context of cancer detection, it is frequently used to identify **Barrett’s esophagus** (metaplasia) and early gastric or colonic cancers. In urology, it can be used to identify bladder mucosal changes. It highlights areas of abnormal cell turnover or loss of normal architecture, as cancerous cells often show different uptake patterns compared to healthy mucosa. **Analysis of Incorrect Options:** * **Gentian Violet:** Primarily used as a histological stain for bacteria (Gram stain) or as a topical antifungal/antiseptic; it is not standard for chromoendoscopy. * **Toluidine Blue:** While used as a topical agent to highlight oral cancers (dysplasia), it is less commonly used in systemic chromoendoscopy compared to Methylene blue or Indigo carmine. * **Hematoxylin and Eosin (H&E):** This is the standard stain used in **histopathology** laboratories for processed tissue biopsies under a microscope. It cannot be used in a living patient during an endoscopic procedure. **Clinical Pearls for NEET-PG:** * **Classification of Dyes:** * **Absorptive (Vital):** Methylene blue, Lugol’s iodine (used for squamous cell CA of the esophagus). * **Contrast (Non-vital):** Indigo carmine (highlights mucosal relief/topography). * **Reactive:** Congo red (detects acid-secreting areas). * **Narrow Band Imaging (NBI):** This is "optical chromoendoscopy" which uses specific wavelengths of light instead of chemical dyes to visualize sub-epithelial vascularity.
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
Practice Questions
Testicular Tumors
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Urinary Tract Infections
Practice Questions
Urinary Incontinence
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Genitourinary Trauma
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Pediatric Urology Basics
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