Urology — MCQs

Urology Indian Medical PG Practice Questions and MCQs

Question 391: What is the most common testicular tumor in prepubertal individuals?

A. Yolk sac tumor (Correct Answer)
B. Embryonal cell carcinoma
C. Seminoma
D. Teratoma

Explanation: **Explanation:** The correct answer is **Yolk sac tumor** (also known as Endodermal Sinus Tumor). In the prepubertal population, yolk sac tumors account for approximately 70–80% of all germ cell tumors (GCTs), making them the most common testicular malignancy in children (typically occurring before age 3). **Why the correct answer is right:** * **Yolk Sac Tumor:** These are non-seminomatous germ cell tumors (NSGCT) that characteristically produce **Alpha-Fetoprotein (AFP)**, which serves as a reliable diagnostic and prognostic marker. Histologically, they are identified by the presence of **Schiller-Duval bodies** (glomeruloid-like structures). In children, they usually present as a pure form and have a very favorable prognosis compared to the adult variant. **Why the other options are incorrect:** * **Embryonal cell carcinoma:** These are aggressive tumors typically seen in adults (ages 20–30) as part of mixed germ cell tumors; they are rare in prepubertal children. * **Seminoma:** This is the most common testicular tumor in **adults** (4th decade). It is virtually never seen in prepubertal children. * **Teratoma:** While the second most common GCT in children, prepubertal teratomas are usually **benign** (unlike post-pubertal teratomas, which are considered malignant). **High-Yield Clinical Pearls for NEET-PG:** * **Most common overall testicular tumor in children:** Yolk sac tumor. * **Most common benign testicular tumor in children:** Teratoma. * **Most common testicular tumor in elderly (>60 years):** Lymphoma (Secondary). * **Tumor Marker:** AFP is elevated in Yolk sac tumors but **never** in pure Seminomas. * **Reinke Crystals:** Pathognomonic for Leydig cell tumors.

Question 392: Which of the following is a normal finding during cystometry?

A. Absence of systolic detrusor contraction (Correct Answer)
B. Residual volume of 75 ml
C. Leakage on coughing
D. First sensation of urination at 300 ml

Explanation: **Explanation:** Cystometry is the component of a urodynamic study that measures the relationship between intravesical pressure and volume during bladder filling. A normal cystometrogram (CMG) reflects a stable, compliant bladder capable of storing urine at low pressures without involuntary contractions. **1. Why Option A is Correct:** A normal bladder exhibits **detrusor stability**. This means there should be an **absence of involuntary (systolic) detrusor contractions** during the filling phase. The detrusor muscle should remain relaxed to allow for low-pressure filling (accommodation). The presence of involuntary contractions indicates detrusor overactivity (e.g., urge incontinence). **2. Why the Other Options are Incorrect:** * **Option B (Residual volume of 75 ml):** Normal post-void residual (PVR) volume is typically **less than 50 ml**. A volume of 75 ml is considered borderline or elevated, often suggesting bladder outlet obstruction or detrusor underactivity. * **Option C (Leakage on coughing):** Leakage during a cough (stress maneuver) is a hallmark of **Stress Urinary Incontinence (SUI)**, usually due to urethral hypermobility or intrinsic sphincter deficiency. In a normal study, the sphincteric mechanism should maintain continence despite increases in intra-abdominal pressure. * **Option D (First sensation at 300 ml):** This is delayed. In a normal adult, the **first sensation of filling** typically occurs between **150–250 ml**. A sensation first occurring at 300 ml suggests a hyposensitive bladder. **High-Yield Clinical Pearls for NEET-PG:** * **Normal Bladder Capacity:** 300–500 ml. * **Compliance:** Calculated as $\Delta \text{Volume} / \Delta \text{Pressure}$. Normal compliance is $>20 \text{ ml/cm H}_2\text{O}$. * **Law of Laplace:** Explains why the bladder can increase in volume with minimal pressure increase during filling. * **Phases of CMG:** Phase I (Initial rise), Phase II (Tonus limb/Filling phase - most important for stability), Phase III (Terminal rise at capacity).

Question 393: What is the investigation of choice for advanced renal tuberculosis?

A. CT (Correct Answer)
B. IVP
C. USG
D. MRI

Explanation: **Explanation:** **1. Why CT is the Correct Answer:** Contrast-Enhanced Computed Tomography (CECT) is currently the **investigation of choice** for advanced renal tuberculosis (GU-TB). In advanced stages, CT provides superior anatomical detail regarding parenchymal destruction, cortical thinning, and the extent of calcification. It is highly sensitive for detecting "Putty Kidney" (autonephrectomy) and identifying extra-renal involvement, such as psoas abscesses or lymphadenopathy. CT Urography (CTU) has largely replaced conventional IVP as it can visualize both the renal parenchyma and the collecting system simultaneously, even in poorly functioning kidneys. **2. Why Other Options are Incorrect:** * **IVP (Intravenous Pyelogram):** Historically, IVP was the gold standard for early GU-TB (detecting "moth-eaten" calyces). However, in **advanced** disease, the kidney is often non-functional or poorly excreting, making IVP non-diagnostic and obsolete compared to CT. * **USG (Ultrasonography):** While useful for screening hydronephrosis or large masses, it lacks the specificity to differentiate TB from other chronic pyelonephritic changes and cannot accurately map the extent of the disease for surgical planning. * **MRI:** Generally reserved for patients with renal failure or contrast allergies. It is not the primary choice due to higher costs and lower sensitivity in detecting fine calcifications compared to CT. **3. Clinical Pearls for NEET-PG:** * **Earliest Radiological Sign:** "Moth-eaten" appearance of calyces (due to erosions) on IVP. * **Pathognomonic Sign:** Thimble bladder (small capacity, fibrotic bladder). * **Putty Kidney:** A classic end-stage feature representing a non-functioning, calcified kidney (autonephrectomy). * **Sterile Pyuria:** The hallmark laboratory finding (pus cells in urine but negative routine culture). Always rule out TB.

Question 394: Bladder outlet obstruction (BOO) is defined by:

A. PSA-10 mmol
B. Urine flow rate <10 mL/second (Correct Answer)
C. Urine voiding pressure decreased
D. Retained urine

Explanation: **Explanation:** Bladder Outlet Obstruction (BOO) is a clinical diagnosis characterized by the resistance to urine flow during voiding. The gold standard for diagnosing BOO is a **Pressure-Flow Study (Urodynamics)**, which demonstrates high voiding pressures in the presence of low flow rates. **1. Why Option B is Correct:** The hallmark of BOO is a reduced urinary flow rate. In clinical practice and for NEET-PG purposes, a **peak flow rate (Qmax) of <10 mL/second** is the classic threshold used to define significant obstruction (provided the voided volume is >150 mL). A Qmax between 10–15 mL/s is considered equivocal, while >15 mL/s is usually normal. **2. Analysis of Incorrect Options:** * **Option A (PSA-10 mmol):** PSA is a marker for prostatic volume or malignancy, not a functional measure of obstruction. Furthermore, PSA is measured in ng/mL, not mmol. * **Option C (Urine voiding pressure decreased):** This is the most common distractor. In BOO, the detrusor muscle must contract harder to overcome the resistance; therefore, **voiding pressure is increased**, not decreased. A decreased pressure with low flow suggests *detrusor underactivity* (hypocontractility), not obstruction. * **Option D (Retained urine):** While Post-Void Residual (PVR) urine is often present in BOO, it is a *consequence* of the obstruction or bladder failure, not the definition itself. Many patients with BOO can still empty their bladders completely through high-pressure compensation. **High-Yield Clinical Pearls for NEET-PG:** * **Abrams-Griffiths Nomogram:** The graphical tool used to plot voiding pressure vs. flow rate to diagnose BOO. * **Most common cause:** Benign Prostatic Hyperplasia (BPH) in elderly males; Posterior Urethral Valves (PUV) in male infants. * **Urodynamic Triad of BOO:** Low Qmax + High Detrusor Pressure ($P_{det}Q_{max}$) + Delayed opening time.

Question 395: What complication should one expect when percutaneous nephrolithotomy (PCNL) is performed through the 11th intercostal space?

A. Hematuria
B. Hydrothorax (Correct Answer)
C. Injury to colon
D. Remnant fragments

Explanation: **Explanation:** The primary anatomical concern during **Percutaneous Nephrolithotomy (PCNL)** is the relationship between the kidneys and the pleura. The kidneys are retroperitoneal organs; however, their upper poles are related to the diaphragm and the pleural reflections. **1. Why Hydrothorax is the correct answer:** The pleura typically crosses the 12th rib at the mid-axillary line and the 11th rib at the scapular line. When a PCNL tract is created via a **supracostal approach** (above the 12th rib, through the 11th intercostal space), the needle must pass through the diaphragm and the costodiaphragmatic recess of the pleura. This significantly increases the risk of pleural injury, leading to complications such as **hydrothorax**, pneumothorax, or hemothorax. The incidence of pleural complications is approximately 10–15% for supracostal punctures compared to <0.5% for infracostal punctures. **2. Why other options are incorrect:** * **Hematuria (A):** While common in PCNL due to parenchymal trauma, it is a general risk of the procedure regardless of the entry site and is not specifically linked to the 11th intercostal space. * **Injury to Colon (C):** Colonic injury is more common with **infracostal** or lateral punctures, particularly in patients with a "retrorenal colon" or those who are very thin. * **Remnant Fragments (D):** This is a technical outcome related to stone burden and visibility, not the anatomical level of the puncture. **Clinical Pearls for NEET-PG:** * **Preferred Puncture:** Most PCNL tracts are **infracostal** (below the 12th rib) to avoid the pleura. * **Supracostal PCNL:** Often required for staghorn calculi or upper pole stones to provide a straight-line access to the upper calyx. * **Post-op Protocol:** A chest X-ray is mandatory in the recovery room for any patient who underwent a supracostal puncture to rule out hydrothorax.

Question 396: Urinary catheterization is indicated in cases of acute retention of urine, except in which of the following conditions?

A. Stricture
B. Rupture
C. Postoperative state (Correct Answer)
D. All of the above

Explanation: **Explanation:** The primary goal of urinary catheterization in acute retention of urine (ARU) is to relieve bladder distension. However, the procedure is contraindicated when there is a risk of further injury or when the underlying pathology prevents safe passage of the catheter. **Why "Postoperative state" is the correct answer:** In the postoperative state, acute retention of urine is a common complication (often due to anesthesia, pain, or anticholinergic drugs). In these cases, urinary catheterization is **indicated** and is the standard of care to drain the bladder and prevent myogenic damage. The question asks for the exception; since catheterization *is* indicated here, it stands out against conditions where it is contraindicated. **Analysis of Incorrect Options:** * **Rupture (Urethral):** This is an absolute **contraindication** for urethral catheterization. In cases of suspected urethral injury (e.g., pelvic fracture, blood at the meatus, high-riding prostate), a catheter should never be forced as it can convert a partial tear into a complete rupture. A Suprapubic Cystostomy (SPC) is preferred. * **Stricture:** While not an absolute contraindication, a known urethral stricture makes routine catheterization difficult and potentially hazardous. Forcing a catheter against a stricture can cause "false passages" and bleeding. These cases often require specialized dilation or suprapubic drainage rather than standard catheterization. **Clinical Pearls for NEET-PG:** * **Gold Standard for Urethral Injury:** If urethral rupture is suspected, the first investigation is a **Retrograde Urethrogram (RUG)**. * **Classic Triad of Urethral Injury:** Blood at the external meatus, inability to void, and a palpable distended bladder (often with a high-riding prostate on DRE). * **Management:** In ARU due to stricture or rupture, **Suprapubic Catheterization (SPC)** is the safest alternative to relieve the bladder.

Question 397: Which of the following are radiolucent renal stones?

A. Uric acid stones (Correct Answer)
B. Cystine stones
C. Mixed stones
D. Calcium oxalate stones

Explanation: **Explanation:** The visibility of renal stones on a plain X-ray (KUB) depends on their atomic weight and density. Calcium, having a high atomic number, absorbs X-rays effectively, making calcium-based stones **radiopaque**. **1. Why Uric Acid is the Correct Answer:** Uric acid stones are composed of light elements (Carbon, Nitrogen, Oxygen, and Hydrogen). Because they lack heavy atoms like Calcium or Magnesium, they do not attenuate X-ray beams and appear **radiolucent** (invisible) on plain radiography. They are typically formed in acidic urine and are best visualized using Non-Contrast Computed Tomography (NCCT) or Ultrasound. **2. Analysis of Incorrect Options:** * **Cystine stones:** These contain sulfur atoms. While they are less dense than calcium stones, they are **faintly radiopaque** (often described as having a "ground-glass" appearance). They are not truly radiolucent. * **Calcium oxalate stones:** These are the most common type of renal stones and are **highly radiopaque** due to their dense calcium content. * **Mixed stones:** Most mixed stones contain a calcium component (like calcium phosphate or oxalate), which renders the entire stone **radiopaque** on an X-ray. **High-Yield Clinical Pearls for NEET-PG:** * **Pure Radiolucent Stones:** Uric acid, Xanthine, and Indinavir (protease inhibitor) stones. * **NCCT KUB** is the gold standard investigation for urolithiasis as it detects all stones *except* Indinavir stones. * **Management Tip:** Uric acid stones can often be dissolved via **medical dissolution therapy** (alkalinization of urine using potassium citrate), whereas radiopaque stones usually require procedural intervention (ESWL/PCNL).

Question 398: What percentage of testicular cancer is associated with cryptorchidism?

A. 10% (Correct Answer)
B. 30%
C. 70%
D. 90%

Explanation: **Explanation:** **1. Why 10% is Correct:** Cryptorchidism (undescended testis) is the most significant risk factor for the development of testicular germ cell tumors (GCTs). Epidemiological studies consistently show that approximately **10%** of patients diagnosed with testicular cancer have a history of cryptorchidism. The risk is significantly higher for intra-abdominal testes compared to inguinal testes. Orchiopexy, while recommended before age 1 to preserve fertility and facilitate screening, does not completely eliminate the long-term risk of malignancy. **2. Why the Other Options are Incorrect:** * **30%:** This overestimates the prevalence. While the *relative risk* of cancer in an undescended testis is significantly higher (approx. 4–10 times) than in the general population, it only accounts for 10% of total cases. * **70% & 90%:** These values are far too high. The vast majority (90%) of testicular cancers occur in men with normally descended testes, as cryptorchidism itself is relatively rare in the adult population. **3. NEET-PG High-Yield Pearls:** * **Most Common Histology:** The most common tumor associated with cryptorchidism is **Seminoma**. However, if the cancer develops *after* orchiopexy, the incidence of non-seminomatous germ cell tumors (NSGCT) increases. * **Contralateral Risk:** In patients with unilateral cryptorchidism, there is a small but increased risk of cancer in the **contralateral, normally descended testis** (approx. 1 in 5 cases of cancer in these patients occur on the normal side), suggesting a dysgenetic origin. * **Best Time for Surgery:** Current guidelines recommend orchiopexy between **6 to 12 months** of age to optimize germ cell maturation. * **Most Common Site:** The most common site for an undescended testis is the **superficial inguinal pouch**.

Question 399: Steinstrasse is defined as:

A. Staining of stones
B. Stones because of stress
C. Failure of extracorporeal shock wave lithotripsy (ESWL)
D. Ureteric obstruction due to stone fragments in the ureter (Correct Answer)

Explanation: ### Explanation **Steinstrasse** (German for "Stone Street") is a specific complication that occurs most commonly following **Extracorporeal Shock Wave Lithotripsy (ESWL)** for large renal calculi. **1. Why the Correct Answer is Right:** When a large kidney stone (usually >2 cm) is fragmented by ESWL, the resulting small pieces (gravel) pass into the ureter simultaneously. If these fragments become wedged and accumulate, they form a continuous column of debris that obstructs the ureter. This "street of stones" prevents the normal flow of urine, leading to hydroureteronephrosis and potentially colicky pain or infection. **2. Analysis of Incorrect Options:** * **Option A:** "Staining of stones" is a literal but incorrect interpretation of the prefix "Stein." There is no clinical condition by this name. * **Option B:** "Stones because of stress" is incorrect. While metabolic stress can influence stone formation, Steinstrasse refers to a mechanical arrangement of fragments, not an etiology. * **Option C:** While Steinstrasse is a *complication* of ESWL, it does not define the "failure" of the procedure itself. In many cases, the stone was successfully fragmented; the failure lies in the clearance of those fragments. **3. High-Yield Clinical Pearls for NEET-PG:** * **Incidence:** Most common when treating stones >2 cm without a pre-procedural stent. * **Prevention:** Placement of a **Double-J (DJ) stent** prior to ESWL significantly reduces the risk of Steinstrasse in patients with large stone burdens. * **Management:** * Asymptomatic: Observation (fragments may pass spontaneously). * Symptomatic/Obstructive: Nephrostomy or Ureteroscopy (URS) to clear the "street." * **Imaging:** Classically seen on KUB (Kidney, Ureter, Bladder) X-ray as a linear radio-opaque column in the line of the ureter.

Question 400: Peyronie's disease affects which organ?

A. Prostate
B. Penis (Correct Answer)
C. Urinary bladder
D. Kidneys

Explanation: **Explanation:** **Peyronie’s Disease** is a connective tissue disorder characterized by the formation of fibrous inelastic scar tissue (collagen plaques) within the **Tunica Albuginea** of the **Penis**. This results in a palpable nodule, painful erections, and a characteristic curvature of the penis during erection, which can lead to erectile dysfunction or difficulty with intercourse. **Analysis of Options:** * **Option B (Penis):** This is the correct site. The disease specifically involves the sheath surrounding the corpora cavernosa. * **Option A (Prostate):** Diseases of the prostate typically involve hyperplasia (BPH) or adenocarcinoma, presenting with lower urinary tract symptoms (LUTS), not anatomical curvature. * **Option C (Urinary Bladder):** Bladder pathologies usually involve transitional cell carcinoma or cystitis, affecting storage and voiding. * **Option D (Kidneys):** Renal pathologies involve filtration issues, stones, or tumors (RCC), unrelated to penile fibrous plaques. **High-Yield Clinical Pearls for NEET-PG:** * **Associated Condition:** It is frequently associated with **Dupuytren’s contracture** (fibrosis of the palmar fascia) in about 10-20% of cases. * **Pathophysiology:** Often attributed to repetitive micro-vascular trauma during intercourse in predisposed individuals. * **Clinical Presentation:** Pain, curvature (chordee), and a palpable plaque on the dorsal aspect (most common). * **Management:** * *Medical:* Vitamin E, Potaba, or Intralesional Collagenase (*Clostridium histolyticum*). * *Surgical:* Indicated if the deformity persists >12 months or prevents intercourse. Procedures include **Nesbit’s procedure** (plication of the unaffected side) or plaque excision with grafting.

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Renal Cell Carcinoma

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Testicular Tumors

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Urology — MCQs

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