Urology Practice Questions

Q: A 50-year-old male with a positive family history of prostate cancer presents for a screening test. Which is the most sensitive screening test to detect prostate cancer?

Digital Rectal Examination (DRE) + PSA. **Explanation:** The screening for prostate cancer relies on the principle that combining a biochemical marker with a physical examination significantly increases the **sensitivity** and **positive predictive value (PPV)** compared to using either test alone. 1. **Why Option C is Correct:** * **PSA (Prostate-Specific Antigen):** It is a highly sensitive organ-specific marker but lacks specificity for cancer (it can be elevated in BPH or prostatitis). * **DRE (Digital Rectal Examination):** It can detect tumors in the posterior and lateral aspects of the prostate, even when PSA levels are within the normal range (approximately 25% of men with prostate cancer have a PSA <4 ng/mL). * **Synergy:** Combining DRE + PSA is the gold standard for screening because it captures cases that one modality might miss, achieving the highest sensitivity for early detection. 2. **Why Other Options are Incorrect:** * **Option A (DRE alone):** It is subjective and often misses small or non-palpable (T1 stage) tumors. * **Option B (PSA alone):** While more sensitive than DRE, relying solely on PSA misses cancers in patients with low PSA production. * **Option D (MRI):** While Multiparametric MRI (mpMRI) is excellent for localization and staging (PI-RADS scoring), it is not used as a primary screening tool due to high costs and lack of accessibility. **High-Yield Clinical Pearls for NEET-PG:** * **Age to start screening:** Usually 50 years; however, in high-risk patients (positive family history or African American ethnicity), screening should start at **40–45 years**. * **PSA Velocity:** A rise of **>0.75 ng/mL per year** is suspicious, even if the total PSA is 25% suggests BPH. * **Definitive Diagnosis:** Always requires a **TRUS-guided biopsy** (usually 12-core).

Q: True about congenital sho [should have been 'short'] urethra?

Urethra is short. **Explanation:** **Congenital Short Urethra** is a rare urological anomaly characterized by a urethra that is shorter than the length of the corpora cavernosa. 1. **Why Option A is Correct:** The defining feature of this condition is that the urethra is anatomically short. This creates a "bowstring" effect, pulling the glans penis toward the perineum, which results in **congenital chordee** (ventral curvature) even though the urethral meatus is usually located at the tip of the glans (orthotopic). 2. **Why the other options are incorrect:** * **Option B:** In congenital short urethra, the opening is typically **normal (at the tip)**, not ventral. A ventral opening is characteristic of Hypospadias. * **Option C:** The prepuce (foreskin) in this condition is usually **circumferential and normal**. A ventrally deficient "hooded" prepuce is a classic hallmark of Hypospadias, not a short urethra. * **Option D:** Splitting of the scrotum (bifid scrotum) is seen in severe degrees of hypospadias (penoscrotal or perineal types) or disorders of sexual development (DSD), but is not a feature of a simple short urethra. **Clinical Pearls for NEET-PG:** * **Chordee without Hypospadias:** This is the clinical category where congenital short urethra belongs. The patient presents with a curved penis during erection but a normally located meatus. * **Diagnosis:** Often confirmed during surgery (artificial erection test) when the skin is degloved and the curvature persists due to the short urethral tether. * **Treatment:** Surgical management involves mobilizing the urethra or, in severe cases, dividing the short urethra and performing a formal urethroplasty.

Q: Which of the following statements is true regarding Renal Cell Carcinoma?

All the above. **Renal Cell Carcinoma (RCC)**, also known as Grawitz tumor or Hypernephroma, is the most common primary renal malignancy. The correct answer is **D (All the above)** because: 1. **Gender Predominance (Option A):** RCC shows a clear male preponderance, with a male-to-female ratio of approximately **2:1**. It typically occurs in the 6th to 7th decades of life. 2. **Varicocele (Option B):** A classic clinical feature is a **left-sided varicocele** that does not empty in the supine position. This occurs because the left gonadal vein drains into the left renal vein. If a tumor thrombus obstructs the left renal vein, it causes retrograde pressure, leading to pampiniform plexus dilation. 3. **Venous Invasion (Option C):** RCC is notorious for its **angioinvasive nature**. It frequently invades the renal vein and can extend as a "tumor thrombus" into the Inferior Vena Cava (IVC), sometimes reaching as high as the right atrium. **Clinical Pearls for NEET-PG:** * **Classic Triad:** Hematuria (most common), flank pain, and a palpable mass (seen in only <10% of cases; indicates advanced disease). * **Risk Factors:** Smoking (most significant), obesity, hypertension, and von Hippel-Lindau (VHL) syndrome. * **Paraneoplastic Syndromes:** RCC is the "Physician’s Tumor" because it secretes various hormones leading to Erythrocytosis (EPO), Hypercalcemia (PTHrP), and Stauffer’s Syndrome (reversible hepatic dysfunction). * **Investigation of Choice:** Contrast-Enhanced CT (CECT) of the abdomen and pelvis. * **Histology:** **Clear cell carcinoma** is the most common subtype (associated with 3p deletion).

Q: Pseudoachalasia may be caused by which of the following malignancies?

All of the above. **Explanation:** **Pseudoachalasia** (also known as secondary achalasia) is a clinical condition that mimics the symptomatic, manometric, and radiologic features of idiopathic achalasia. It is primarily caused by a malignancy that either mechanically obstructs the gastroesophageal junction (GEJ) or infiltrates the esophageal myenteric plexus, disrupting normal peristalsis. **Why "All of the Above" is Correct:** The underlying mechanism involves the destruction of the inhibitory neurons in the distal esophagus. * **Gastric Adenocarcinoma:** This is the **most common cause** of pseudoachalasia. Tumors of the gastric cardia frequently invade the GEJ directly, causing mechanical narrowing and functional aperistalsis. * **Lung Carcinoma:** Small cell lung cancer can cause pseudoachalasia via a **paraneoplastic syndrome** (anti-Hu antibodies) or through direct mediastinal spread affecting the vagal nerve or esophageal wall. * **Pancreatic Carcinoma:** Advanced pancreatic tumors can metastasize to the retroperitoneal lymph nodes or the GEJ, leading to extrinsic compression and secondary motility disorders. **Clinical Pearls for NEET-PG:** * **Red Flags for Pseudoachalasia:** Unlike idiopathic achalasia, pseudoachalasia typically presents in patients **>60 years old**, with a **short duration of symptoms** (<6 months), and **significant weight loss**. * **Diagnosis:** Endoscopy is mandatory to rule out malignancy. If endoscopy is inconclusive but suspicion is high, **Endoscopic Ultrasound (EUS)** or CT scans are the next steps to visualize submucosal or extrinsic masses. * **High-Yield Fact:** While Gastric cancer is the most frequent cause, other associated malignancies include esophageal squamous cell carcinoma, lymphoma, and breast cancer.

Q: A 20-year-old male presents with a scrotal mass. What is the first investigation to be done?

Clinical evaluation (Palpation and transillumination). **Explanation:** In clinical surgery, the diagnostic sequence always begins with a thorough physical examination. For a scrotal mass, **Clinical Evaluation (Palpation and Transillumination)** is the mandatory first step to differentiate between testicular (solid) and extra-testicular (often cystic) pathologies. * **Why Option A is Correct:** Palpation helps determine if the mass is separate from the testis (like an epididymal cyst) or part of the testis itself (suggestive of malignancy). **Transillumination** is a bedside test that immediately identifies fluid-filled structures like hydroceles. This clinical assessment guides the necessity and urgency of further imaging. * **Why Options B, C, and D are Incorrect:** * **Ultrasound (USG):** While USG is the *investigation of choice* (most accurate) for scrotal masses, it is the *second* step after clinical suspicion is established. * **Biopsy:** This is **strictly contraindicated** in suspected testicular tumors. Scrotal biopsy or aspiration risks "scrotal seeding," where tumor cells spread to the inguinal lymph nodes, altering the lymphatic drainage and worsening the prognosis. * **AFP Level:** This is a tumor marker used for diagnosis and staging of Non-Seminomatous Germ Cell Tumors (NSGCT), but it is performed only after a mass is clinically and radiologically identified. **Clinical Pearls for NEET-PG:** * **Gold Standard/IOC:** Scrotal Ultrasound (High-frequency linear probe). * **Rule of Thumb:** Any firm, non-tender mass within the substance of the testis in a young male is **testicular cancer** until proven otherwise. * **Surgical Approach:** If malignancy is suspected, the definitive procedure is **Radical Inguinal Orchidectomy** (never trans-scrotal).

Q: Gleason scoring is done for which of the following conditions?

Prostatic cancer. **Explanation:** **Gleason scoring** is the standard histological grading system used specifically for **Prostatic Adenocarcinoma**. It is the most important prognostic factor for prostate cancer, as it reflects the degree of glandular differentiation and the biological aggressiveness of the tumor. * **Why Option A is correct:** The Gleason score is determined by examining the architectural pattern of the prostate cells under a microscope. The pathologist identifies the **primary pattern** (most common) and the **secondary pattern** (second most common), grading each from 1 (well-differentiated) to 5 (poorly differentiated). The sum of these two grades (e.g., 3+4=7) provides the final Gleason score, ranging from 2 to 10. * **Why Option B is wrong:** Benign Prostatic Hyperplasia (BPH) is a non-malignant enlargement of the prostate transition zone [1], [2]. It does not require grading for malignancy. * **Why Option C is wrong:** Bladder cancer is typically graded using the WHO/ISUP classification (Low grade vs. High grade) based on cellular atypia and architectural features, not the Gleason system. * **Why Option D is wrong:** Colon cancer is graded based on the degree of gland formation (Well, Moderately, or Poorly differentiated) and staged using the TNM/Dukes classification. **High-Yield Clinical Pearls for NEET-PG:** 1. **ISUP Grade Groups:** Modern practice groups Gleason scores into 5 categories (Grade Group 1: ≤6; Grade Group 5: 9-10) to better predict clinical outcomes. 2. **Location:** Prostate cancer most commonly arises in the **Peripheral Zone**, whereas BPH arises in the **Transition Zone**. 3. **Screening:** PSA (Prostate Specific Antigen) is the screening marker [2], but definitive diagnosis requires a **TRUS-guided biopsy**. 4. **Osteoblastic Metastasis:** Prostate cancer characteristically spreads to the bone (lumbar spine), causing osteoblastic (sclerotic) lesions [1].

Q: A patient presents with acute renal failure and anuria. The ultrasound is normal. Which of the following investigations will provide the best information regarding renal function?

DTPA scan. **Explanation:** In a patient with acute renal failure (ARF) and anuria where the ultrasound is normal, the primary goal is to differentiate between **pre-renal/intrinsic renal failure** and **obstructive uropathy** (post-renal failure) that might not yet show hydronephrosis. **Why DTPA Scan is the Correct Answer:** Technetium-99m DTPA (Diethylene Triamine Penta-acetic Acid) is a radioisotope handled almost exclusively by **glomerular filtration**. It is the gold standard for calculating the **Glomerular Filtration Rate (GFR)** and assessing individual renal perfusion and function. In the context of anuria, a DTPA scan provides a dynamic functional assessment, helping to determine if the kidneys are being perfused and if there is any tracer excretion, which is vital for prognosticating recovery in ARF. **Why Other Options are Incorrect:** * **Intravenous Pyelogram (IVP):** This is **contraindicated** in acute renal failure. The iodinated contrast is nephrotoxic and, in a failing kidney, the concentration of contrast will be insufficient to opacify the collecting system, making it diagnostically useless. * **Retrograde Pyelography (RGP):** This is an invasive procedure used to visualize the anatomy of the ureters and collecting system. While useful to rule out obstruction, it provides **no information** regarding the functional status or GFR of the kidney. * **Antegrade Pyelography:** This requires a dilated system (hydronephrosis) to puncture the pelvicalyceal system. Since the ultrasound is normal, this is technically difficult and inappropriate. **Clinical Pearls for NEET-PG:** * **DTPA:** Best for GFR and functional assessment. * **MAG3:** Best for pediatric imaging and patients with impaired renal function (secreted by tubules). * **DMSA:** Best for cortical scarring (static scan). * **Rule of Thumb:** In ARF with a normal USG, think of medical causes (ATN, Glomerulonephritis) or early/hyperacute obstruction.

Question 1

A 50-year-old male with a positive family history of prostate cancer presents for a screening test. Which is the most sensitive screening test to detect prostate cancer?

Accepted Answer

Digital Rectal Examination (DRE) + PSA

Answer

Digital Rectal Examination (DRE)

Answer

Prostate-Specific Antigen (PSA)

Answer

Endorectal Coil MRI with T1W and T2W images

Question 2

A 35-year-old male presents to a health clinic with fever, difficulty in urination, and associated pain in the groin. On digital rectal examination, extreme tenderness is felt on the anterior aspect. Laboratory examination of urine revealed leucocytosis and findings consistent with bacterial infection. What is the most likely diagnosis for this condition?

Accepted Answer

Prostatitis

Answer

Pyelonephritis

Answer

Urinary tract infection

Answer

Benign prostatic hyperplasia

Question 3

True about congenital sho [should have been 'short'] urethra?

Accepted Answer

Urethra is short

Answer

Opening is always ventral

Answer

Prepuce deficient ventrally

Answer

Splitting of the two scrotum in the midline

Question 4

Which of the following statements is true regarding Renal Cell Carcinoma?

Accepted Answer

All the above

Answer

More common in males

Answer

May cause varicocele

Answer

May invade the renal vein

Question 5

Pseudoachalasia may be caused by which of the following malignancies?

Accepted Answer

All of the above

Answer

Gastric adenocarcinoma

Answer

Lung carcinoma

Answer

Pancreatic carcinoma

Question 6

A 45-year-old man presents with complaints of left-sided flank pain radiating into his groin. The pain began suddenly and has increased in intensity. He had a similar problem several years ago, but his symptoms resolved spontaneously. He denies fever, chills, nausea, or vomiting, and has had no diarrhea or difficulty urinating. Physical examination is remarkable for tenderness along the left flank and into the groin. A urinalysis reveals 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 represents this patient's anion gap?

Accepted Answer

13.4 mEq/L

Answer

3.4 mEq/L

Answer

8.4 mEq/L

Answer

21.4 mEq/L

Question 7

Cystitis is most commonly caused by:

Accepted Answer

E. coli

Answer

Pseudomonas

Answer

Proteus mirabilis

Answer

Neisseria gonorrhea

Question 8

A 20-year-old male presents with a scrotal mass. What is the first investigation to be done?

Accepted Answer

Clinical evaluation (Palpation and transillumination)

Answer

Ultrasound (USG)

Answer

Biopsy

Answer

Alpha-fetoprotein (AFP) level

Question 9

Gleason scoring is done for which of the following conditions?

Accepted Answer

Prostatic cancer

Answer

Benign prostatic hypertrophy

Answer

Bladder cancer

Answer

Colon cancer

Question 10

A patient presents with acute renal failure and anuria. The ultrasound is normal. Which of the following investigations will provide the best information regarding renal function?

Accepted Answer

DTPA scan

Answer

Intravenous Pyelogram

Answer

Retrograde Pyelography

Answer

Antegrade Pyelography

Urology — MCQs

Urology — MCQs

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