Urology Practice Questions

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

Rupture. In urological emergencies, the primary goal of managing acute urinary retention (AUR) is to decompress the bladder. However, the method of decompression depends on the integrity of the urinary tract. **Why "Rupture" is the correct answer:** In cases of suspected **urethral rupture** (often associated with pelvic fractures or straddle injuries), blind urethral catheterization is **strictly contraindicated**. Attempting to pass a catheter can convert a partial urethral tear into a complete transection, introduce infection into a perivesical hematoma, or create a false passage. Clinical signs such as **blood at the meatus**, a **high-riding prostate** on digital rectal examination, or **perineal ecchymosis** (butterfly bruising) mandate a **Retrograde Urethrogram (RUG)** before any instrumentation. In these cases, a Suprapubic Cystostomy (SPC) is the preferred method of bladder drainage. **Analysis of incorrect options:** * **Stricture:** While a urethral stricture makes catheterization difficult, it is not an absolute contraindication. If a standard Foley fails, smaller caliber catheters or filiforms and followers are used. * **Postoperative:** AUR is a common complication after spinal anesthesia or pelvic surgery; urethral catheterization is the standard first-line management. * **Carcinoma of the Prostate:** Prostatic enlargement (benign or malignant) is a leading cause of AUR. Catheterization is indicated, though a Coudé tip catheter may be required to bypass the prostatic obstruction. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation** for suspected urethral injury: Retrograde Urethrogram (RUG). * **Triad of Urethral Injury:** Blood at meatus, inability to void, and palpable distended bladder. * **Membranous Urethra:** The most common site of rupture in pelvic fractures. * **Bulbar Urethra:** The most common site of rupture in "straddle" (fall-a-stride) injuries.

Q: All of the following can be seen in hypernephroma, except:

None of the above. **Explanation:** Hypernephroma, now more commonly known as **Renal Cell Carcinoma (RCC)**, is famously referred to as the "Internist's Tumor" because of its diverse systemic manifestations and paraneoplastic syndromes. The correct answer is **None of the above** because all three listed conditions are well-recognized features of the disease. 1. **Polycythemia (Option A):** RCC can produce ectopic **Erythropoietin (EPO)**, which stimulates the bone marrow to increase red blood cell production. While anemia is more common in RCC, polycythemia occurs in about 1–5% of cases. 2. **Renal Vein Thrombosis (Option B):** RCC has a unique propensity for **angioinvasion**. The tumor often forms a "tumor thrombus" that extends into the renal vein and can propagate further into the Inferior Vena Cava (IVC), sometimes reaching the right atrium. 3. **Hypertension (Option C):** This occurs in up to 40% of patients. It can be caused by the secretion of **Renin** by the tumor, compression of the intrarenal vasculature (Goldblatt phenomenon), or hypercalcemia. **Clinical Pearls for NEET-PG:** * **Classic Triad:** Hematuria, Flank pain, and Palpable mass (seen in only 10% of cases; signifies advanced disease). * **Stauffer’s Syndrome:** Reversible hepatic dysfunction (elevated LFTs) in the absence of liver metastases. * **Left-sided Varicocele:** Occurs if the tumor thrombus obstructs the left renal vein, preventing drainage of the left gonadal vein. * **Most common histological subtype:** Clear cell carcinoma (originates from the Proximal Convoluted Tubule).

Q: Marion's disease is due to which of the following?

Muscular hypertrophy of the internal sphincter of the urinary bladder. **Explanation:** **Marion’s Disease**, also known as **Primary Bladder Neck Obstruction (PBNO)**, is a condition characterized by a functional or mechanical obstruction of the bladder neck in the absence of prostatic enlargement or urethral stricture. 1. **Why Option A is Correct:** The underlying pathophysiology of Marion’s disease is the **muscular hypertrophy of the internal sphincter** (bladder neck). This leads to a failure of the bladder neck to open or relax sufficiently during voiding, resulting in symptoms of bladder outlet obstruction. It is most commonly seen in middle-aged men but can occur in younger populations. 2. **Why the Incorrect Options are Wrong:** * **Option B (Fibrosis of the neck of the bladder):** While fibrosis can cause bladder neck contracture (often secondary to surgery like TURP or chronic inflammation), Marion’s disease specifically refers to the *congenital or idiopathic muscular hypertrophy* rather than acquired scarring. * **Option C & D (Vesicular diverticula and calculi):** These are typically **consequences** or complications of chronic bladder outlet obstruction (due to high intravesical pressure and stasis) rather than the primary cause of Marion’s disease itself. **Clinical Pearls for NEET-PG:** * **Presentation:** Patients present with obstructive voiding symptoms (hesitancy, weak stream, straining) despite a normal-sized prostate on digital rectal examination (DRE). * **Diagnosis:** The gold standard is **Video-Urodynamics (VUDS)**, which shows high voiding pressures associated with poor opening of the bladder neck. * **Cystoscopy:** Often reveals a "high" or "elevated" bladder neck and secondary changes like trabeculations. * **Management:** Alpha-blockers are the first-line medical therapy. If refractory, **Transurethral Incision of the Bladder Neck (TUIBN)** is the surgical treatment of choice.

Q: All of the following are complications of an undescended testis EXCEPT?

Hydrocoele. **Explanation:** The correct answer is **B. Hydrocoele**. In an undescended testis (cryptorchidism), the testis is located along the normal path of descent but fails to reach the scrotum. While it is frequently associated with a **patent processus vaginalis (PPV)**, which leads to an **indirect inguinal hernia**, a simple hydrocoele is not considered a direct complication of the malposition itself. Hydrocoeles are more commonly associated with a normally descended testis where the processus vaginalis fails to obliterate or where there is an imbalance in fluid production/absorption. **Analysis of other options:** * **Torsion (A):** Undescended testes are at a significantly higher risk of torsion (often due to increased mobility or associated mesenteric abnormalities). Torsion in an inguinal testis can present as an empty scrotum with an exquisitely tender inguinal lump. * **Trauma (C):** When the testis is located in the inguinal canal, it is prone to trauma as it can be compressed against the pubic bone or inguinal ligaments, unlike the mobile scrotum which provides a cushioning effect. * **Malignant change (D):** This is the most dreaded complication. The risk of testicular cancer (most commonly **Seminoma**) is 4–10 times higher in undescended testes compared to the general population. Orchiopexy does not eliminate the risk but makes the testis accessible for clinical examination. **NEET-PG High-Yield Pearls:** * **Most common site:** Inguinal canal. * **Most common complication:** Indirect Inguinal Hernia (due to PPV). * **Most common malignancy:** Seminoma (overall); however, if it occurs in an abdominal testis, the risk of malignancy is even higher. * **Ideal age for surgery:** Orchiopexy should ideally be performed between **6 to 12 months** of age to preserve fertility and reduce malignancy risk.

Q: All of the following are indications of percutaneous nephrostomy, EXCEPT:

Ischemic renal failure. **Explanation:** Percutaneous Nephrostomy (PCN) is an interventional radiological procedure used primarily to provide external drainage of an obstructed collecting system or to gain access to the upper urinary tract for therapeutic maneuvers. **Why "Ischemic Renal Failure" is the correct answer:** Ischemic renal failure (a form of Acute Tubular Necrosis) is a **parenchymal/intrinsic** cause of renal failure. It results from decreased perfusion or cellular damage to the nephrons, not from a mechanical blockage of urine flow. Since PCN is designed to bypass **post-renal (obstructive)** pathology, it has no role in managing intrinsic ischemic damage. **Analysis of Incorrect Options:** * **Stone Removal:** PCN is the standard initial step for **Percutaneous Nephrolithotomy (PCNL)**, providing the tract necessary to fragment and remove large or complex staghorn calculi. * **Anterograde Renography:** When retrograde access fails, PCN allows for the injection of contrast or radiopharmaceuticals directly into the pelvis to assess anatomy and drainage (Anterograde Pyelography/Renography). * **Renal Tubular Obstruction:** While PCN primarily treats pelvic/ureteric obstruction, it is indicated in any scenario where there is a "distal" blockage causing high-pressure backflow (hydronephrosis) to preserve nephron function. **High-Yield Clinical Pearls for NEET-PG:** * **Most common indication:** Obstructive uropathy with associated infection (Pyonephrosis) or azotemia. * **Absolute Contraindication:** Uncorrected coagulopathy (due to the high vascularity of the kidney). * **Anatomical Landmark:** The needle is typically inserted through **Brodel’s line** (the relatively avascular plane on the lateral border of the kidney) to minimize hemorrhage. * **Urgency:** In the presence of fever and obstruction (Pyonephrosis), PCN is an emergency procedure.

Q: What scoring system is used to grade the symptoms of Benign Prostatic Hyperplasia (BPH)?

International Prostate Symptom Score (IPSS). The **International Prostate Symptom Score (IPSS)** is the gold-standard diagnostic tool used to assess the severity of Lower Urinary Tract Symptoms (LUTS) in patients with Benign Prostatic Hyperplasia (BPH). ### **Explanation of Options** * **Correct Answer (B):** The IPSS is based on the American Urological Association (AUA) symptom index. It consists of **7 questions** related to voiding symptoms (Incomplete emptying, Frequency, Intermittency, Urgency, Weak stream, Hesitancy, and Nocturia) and **1 question** regarding the patient’s Quality of Life (QoL). * **Mild:** 0–7 points * **Moderate:** 8–19 points * **Severe:** 20–35 points * **Option A:** The **Gleason Score** is used for the histological grading of **Prostate Adenocarcinoma**, not for symptom assessment in BPH. It evaluates the glandular architecture to determine the aggressiveness of the cancer. * **Option C:** **SBPH** is not a standard medical scoring system; it is a distractor. ### **Clinical Pearls for NEET-PG** * **Medical Management:** Alpha-blockers (e.g., Tamsulosin) are the first-line treatment for moderate symptoms. 5-alpha reductase inhibitors (e.g., Finasteride) are added if the prostate volume is >30–40 cc. * **Surgical Threshold:** Surgery (TURP) is generally indicated if the IPSS is **>19 (Severe)** or if complications occur (refractory retention, bladder stones, recurrent UTIs, or hematuria). * **IPSS Limitation:** It is a subjective score used for symptom severity and monitoring treatment response; it does **not** correlate directly with the size of the prostate or the degree of obstruction.

Question 1

A 50-year-old male presented to the ER with complaints of inability to pass urine after a recent accident. On examination, he has a scrotal hematoma, blood at the urethral meatus, and a high-riding prostate. A retrograde urethrogram has been performed. What should be the next step in the management of the patient?

Accepted Answer

Foley's catheterization

Answer

Immediate surgical repair of the urethra

Answer

Diuretic to increase urine output

Answer

Conservative management

Question 2

Which of the following statements is true regarding the management of a patient with hematuria diagnosed to have Stage II Transitional Cell Carcinoma of the bladder?

Accepted Answer

There is a 70% chance of requiring cystectomy within 5 years after transurethral resection.

Answer

Cystoscopic fulguration is the standard treatment.

Answer

History of smoking is not a risk factor.

Answer

There is no role for chemotherapy.

Question 3

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

Accepted Answer

Rupture

Answer

Stricture

Answer

Postoperative

Answer

Carcinoma of the prostate

Question 4

All of the following can be seen in hypernephroma, except:

Accepted Answer

None of the above

Answer

Polycythemia

Answer

Renal vein thrombosis

Answer

Hypertension

Question 5

Which of the following statements about testicular seminoma is FALSE?

Accepted Answer

Pure seminoma is generally less aggressive than non-seminoma.

Answer

Seminoma is radiosensitive.

Answer

Seminoma can be treated with orchidectomy and radiotherapy.

Answer

Seminoma commonly spreads through lymphatics.

Question 6

What is the most important prognostic factor in a case of penile carcinoma?

Accepted Answer

Lymph node metastasis

Answer

Tumor size <2 cm

Answer

Involvement of connective tissue

Answer

Distant metastasis

Question 7

Marion's disease is due to which of the following?

Accepted Answer

Muscular hypertrophy of the internal sphincter of the urinary bladder

Answer

Fibrosis of the neck of the bladder

Answer

Vesicular diverticula

Answer

Vesicular calculi

Question 8

All of the following are complications of an undescended testis EXCEPT?

Accepted Answer

Hydrocoele

Answer

Torsion

Answer

Trauma

Answer

Malignant change

Question 9

All of the following are indications of percutaneous nephrostomy, EXCEPT:

Accepted Answer

Ischemic renal failure

Answer

Stone removal

Answer

Anterograde renography

Answer

Renal tubular obstruction

Question 10

What scoring system is used to grade the symptoms of Benign Prostatic Hyperplasia (BPH)?

Accepted Answer

International Prostate Symptom Score (IPSS)

Answer

Gleason score

Answer

Symptom Score for Benign Prostatic Hyperplasia (SBPH) score

Answer

None of the above

Urology — MCQs

Urology — MCQs

On this page

Practice by Chapter

Want unlimited practice?