Urology Practice Questions

Q: What is the treatment of 'thimble bladder'?

Ileocystoplasty. **Explanation:** **Thimble bladder** (also known as a systolic bladder) is the end-stage manifestation of **Genitourinary Tuberculosis (GUTB)**. Chronic tuberculous infection leads to extensive transmural fibrosis and scarring of the bladder wall, resulting in a severely reduced capacity (often <50 ml) and high intravesical pressures. 1. **Why Ileocystoplasty is correct:** Once a thimble bladder has formed, the changes are irreversible and anatomical. Medical therapy cannot restore bladder volume. **Augmentation cystoplasty** (specifically **Ileocystoplasty**) is the treatment of choice. It involves using a detubularized segment of the ileum to increase bladder capacity and lower pressure, thereby protecting the upper urinary tract from reflux and renal failure. 2. **Why other options are incorrect:** * **Anti-tubercular treatment (ATT):** While ATT is mandatory to treat active TB, it cannot reverse established fibrosis. In fact, ATT can sometimes worsen the contracture during the healing phase due to further scarring. * **Corticosteroids:** These are used in early-stage GUTB to reduce edema and prevent ureteric strictures, but they have no role in treating a fibrotic, contracted thimble bladder. * **ATT + Steroids:** This combination is used for active inflammation but is ineffective for the end-stage mechanical failure of the bladder. **Clinical Pearls for NEET-PG:** * **Imaging:** On Intravenous Urogram (IVU), a thimble bladder appears as a small, smooth, rounded bladder shadow. * **Prerequisite for Surgery:** Surgery (Ileocystoplasty) should only be performed after the patient has completed at least **4–6 weeks of ATT** to ensure the urine is sterile and to prevent "miliary spread" during surgery. * **Contraindication:** If the bladder capacity is extremely small (<15 ml) or the urethra is involved, a **urinary diversion** (Ileal conduit) may be preferred over augmentation.

Q: A young male presents with abdominal pain. CT scan shows a heterogenous necrotizing mass at the left renal hilum. His AFP or hCG levels are elevated. What is the most likely diagnosis?

Metastatic germ cell tumor. **Explanation:** The presence of a **heterogenous necrotizing mass at the renal hilum (retroperitoneum)** in a young male, associated with elevated serum tumor markers (**AFP or β-hCG**), is a classic presentation of a **Metastatic Germ Cell Tumor (GCT)**. 1. **Why D is correct:** The retroperitoneum is the primary site for lymphatic spread from testicular germ cell tumors. In young men, any retroperitoneal mass should be considered a metastatic GCT until proven otherwise. Elevated **AFP** (Alpha-fetoprotein) is characteristic of Yolk Sac components, while elevated **β-hCG** is seen in Choriocarcinoma or Seminoma (mildly). A "necrotizing" appearance on CT often reflects the rapid growth and central ischemia typical of these aggressive tumors. 2. **Why other options are incorrect:** * **A. Lymphoma:** While common in the retroperitoneum, lymphoma typically presents as "bulky" homogenous lymphadenopathy that encases vessels without causing necrosis. It does **not** elevate AFP or hCG. * **B. Transitional Cell Carcinoma (TCC):** TCC arises from the urothelium (renal pelvis). While it can involve the hilum, it usually presents with hematuria in older patients and does not produce germ cell markers. * **C. Metastatic Melanoma:** Melanoma can metastasize anywhere, but it is not associated with elevated AFP/hCG and is less common than GCT in this demographic and location. **High-Yield Clinical Pearls for NEET-PG:** * **Rule of Thumb:** In a young male with a retroperitoneal mass, always perform a **scrotal examination** and ultrasound to rule out a primary testicular tumor. * **Primary Extragonadal GCT:** Occasionally, GCTs can arise primarily in the retroperitoneum without a testicular primary. * **Markers:** * ↑ AFP: Yolk sac tumor (never in pure seminoma). * ↑ β-hCG: Choriocarcinoma, Seminoma (10-15% of cases). * ↑ LDH: Correlates with tumor burden/bulk.

Q: An 18-year-old boy presents with groin pain for 2 days. On examination, the testis is high-lying and the cremasteric reflex is absent. Elevation of the testis worsens the pain. What is the probable diagnosis?

Right testicular torsion. **Explanation:** The clinical presentation of acute groin pain in an adolescent, combined with specific physical findings, points directly to **Testicular Torsion**. **Why the correct answer is right:** Testicular torsion is a surgical emergency caused by the twisting of the spermatic cord. * **High-lying testis:** The twisting causes shortening of the cord, pulling the testis upward (Angel’s sign). * **Absent Cremasteric Reflex:** This is the most sensitive physical finding for torsion; its presence almost always rules it out. * **Negative Prehn’s Sign:** Elevation of the testis worsens or does not relieve the pain in torsion (Positive Prehn's sign, where pain is relieved, is characteristic of epididymitis). **Why the incorrect options are wrong:** * **Epididymo-orchitis:** Usually presents with fever and pyuria. Crucially, Prehn’s sign is positive (pain relief on elevation) and the cremasteric reflex is typically preserved. * **Strangulated Hernia:** While it causes acute pain, it usually presents with a tense, tender, irreducible swelling in the inguinal canal and features of intestinal obstruction (vomiting, constipation), rather than isolated testicular displacement. * **Inguinal Hernia:** An uncomplicated hernia presents as a reducible swelling with a cough impulse and is generally not associated with acute, severe pain or an absent cremasteric reflex. **NEET-PG High-Yield Pearls:** * **Golden Period:** Detorsion must occur within **6 hours** to ensure a 90-100% salvage rate. * **Bell-Clapper Deformity:** The most common predisposing anatomical factor (high tunica vaginalis attachment). * **Investigation of Choice:** Color Doppler Ultrasound (shows decreased or absent blood flow). * **Management:** Immediate surgical exploration and **bilateral orchidopexy** (fixation), as the anatomical defect is usually bilateral.

Q: What is true about varicocele?

Can cause oligospermia. **Explanation:** A varicocele is the abnormal dilation and tortuosity of the pampiniform plexus of veins within the spermatic cord. It is the most common reversible cause of male infertility. **Why Option B is correct:** Varicoceles lead to **oligospermia** (low sperm count) and decreased sperm motility. The underlying pathophysiology involves the reflux of warm venous blood from the abdomen, which increases the intratesticular temperature. This thermal stress impairs spermatogenesis, as the testes require a temperature approximately 2°C lower than the core body temperature to function optimally. **Analysis of Incorrect Options:** * **Option A:** Varicoceles are significantly **more common on the left side (90%)**. This is due to the left testicular vein being longer, entering the left renal vein at a right angle (increasing hydrostatic pressure), and potentially being compressed between the SMA and Aorta ("Nutcracker effect"). A **solitary right-sided varicocele** is a red flag and necessitates imaging to rule out a retroperitoneal tumor (e.g., RCC). * **Option C:** Varicoceles typically **increase in size/prominence during the Valsalva maneuver** or upon standing, as these actions increase intra-abdominal pressure and venous reflux. * **Option D:** Anatomically, a varicocele is located **superior and posterior** to the testis, often described as a "bag of worms" feeling within the scrotum. **High-Yield Clinical Pearls for NEET-PG:** * **Grading:** Grade I (Palpable only with Valsalva), Grade II (Palpable without Valsalva), Grade III (Visible through scrotal skin). * **Surgical Indications:** Infertility with abnormal semen analysis, testicular atrophy, or severe pain. * **Gold Standard Treatment:** Microsurgical subinguinal varicocelectomy (lowest recurrence and complication rates).

Q: Which of the following is a type of stone seen in urinary tract infections?

Staghorn calculus. **Explanation:** The correct answer is **Staghorn calculus**. These stones are typically composed of **Struvite** (Magnesium Ammonium Phosphate) and are classically associated with chronic urinary tract infections (UTIs) caused by **urease-producing organisms** (e.g., *Proteus mirabilis*, *Klebsiella*, *Pseudomonas*). **Mechanism:** Urease-producing bacteria hydrolyze urea into ammonia, which increases urinary pH (alkaline urine). In this alkaline environment, phosphate solubility decreases, leading to the precipitation of struvite and carbonate apatite crystals. These stones grow rapidly and fill the renal pelvis and calyces, taking on the characteristic "staghorn" shape. **Analysis of Incorrect Options:** * **A. Calcium oxalate:** The most common type of renal stone overall. They are typically associated with metabolic factors (hypercalciuria, hyperoxaluria) rather than infection. * **B. Uric acid stones:** These form in **acidic urine** (pH < 5.5). They are radiolucent on X-ray and are associated with gout or high cell turnover states. * **D. Cysteine stones:** Caused by an autosomal recessive defect in the transport of dibasic amino acids (COLA: Cysteine, Ornithine, Lysine, Arginine). They are "hexagonal" on microscopy and not infection-induced. **High-Yield Clinical Pearls for NEET-PG:** * **Composition:** Struvite stones are also called "Triple Phosphate" stones. * **Microscopy:** They exhibit a characteristic **"Coffin-lid"** appearance. * **Radiology:** While the stone itself is radiopaque, it is less dense than calcium oxalate. * **Treatment:** Complete surgical removal (usually via PCNL) is necessary because the stone acts as a reservoir for bacteria, leading to recurrent sepsis.

Q: A patient with pelvic fracture presents with suprapubic pain, difficulty in passing urine, and hematuria. Cystography reveals findings suggestive of bladder injury. What are the indications for surgical repair of a bladder injury?

All of the above. Bladder injuries are broadly classified into **extraperitoneal (60-85%)** and **intraperitoneal (15-40%)**. While most uncomplicated extraperitoneal ruptures can be managed conservatively with catheter drainage, specific complications necessitate surgical intervention. **Explanation of Options:** * **A. Repeated blockage of the urinary catheter:** Persistent hematuria with clot formation can lead to catheter obstruction. If the bladder cannot be effectively drained, it remains distended, preventing the wound edges from apposing and healing, thus requiring surgical evacuation and repair. * **B. Projecting bone fragment:** In pelvic fractures, a sharp spicule of bone may penetrate or remain embedded in the bladder wall. This prevents spontaneous closure and carries a high risk of persistent leakage or infection if not surgically addressed. * **C. Tear extending to the bladder neck:** The bladder neck contains the internal sphincter mechanism. Injuries here rarely heal spontaneously with a catheter and often lead to future incontinence or strictures if not precisely repaired. **Why "All of the above" is correct:** Each of these scenarios represents a "complicated" extraperitoneal injury. Other mandatory indications for surgery include **intraperitoneal rupture** (due to risk of peritonitis), concomitant rectal/vaginal injury, or when the patient is already undergoing laparotomy for other pelvic injuries. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Retrograde Cystography (showing "flame-shaped" extravasation in extraperitoneal and "bowel loop outlining" in intraperitoneal tears). * **Management Rule:** Intraperitoneal = **Always Surgery**; Extraperitoneal = **Catheter first** (unless complicated). * **Associated Fracture:** Bladder rupture is most commonly associated with **pubic symphysis diastasis** or rami fractures.

Q: Which hormone is NOT given for palliative care of carcinoma of the prostate?

Progesterone. **Explanation:** The primary objective in the palliative management of advanced or metastatic **Carcinoma of the Prostate** is **Androgen Deprivation Therapy (ADT)**. Since prostate cancer cells are typically androgen-dependent, reducing testosterone levels to "castrate levels" (<50 ng/dL) inhibits tumor growth. **Why Progesterone is the correct answer:** Progesterone (Option B) has no established role in the standard hormonal manipulation of prostate cancer. While some progestational agents (like Cyproterone acetate) have antiandrogenic properties, pure progesterone itself does not effectively lower serum testosterone or block androgen receptors in a clinical setting for palliative care. **Analysis of incorrect options:** * **Estrogens (Option A):** Historically, Diethylstilbestrol (DES) was used to suppress the hypothalamic-pituitary-gonadal axis via negative feedback, reducing LH and testosterone. Its use has declined due to cardiovascular side effects (thromboembolism). * **LHRH Agonists/Antagonists (Option C):** These are the current "gold standard" for medical castration. Agonists (e.g., Leuprolide, Goserelin) initially cause a testosterone flare followed by downregulation of receptors, while Antagonists (e.g., Degarelix) cause an immediate drop in testosterone. * **Antiandrogens (Option D):** These drugs (e.g., Flutamide, Bicalutamide, Enzalutamide) compete with dihydrotestosterone (DHT) for the androgen receptor, preventing the tumor from utilizing circulating androgens. **High-Yield Clinical Pearls for NEET-PG:** * **Combined Androgen Blockade (CAB):** Refers to the use of an LHRH agonist plus an antiandrogen to prevent the "testosterone flare" phenomenon. * **Orchidectomy:** Bilateral subcapsular orchidectomy is the surgical gold standard for rapid androgen deprivation. * **Castration-Resistant Prostate Cancer (CRPC):** Defined as disease progression despite testosterone levels being at castrate levels (<50 ng/dL).

Question 1

A 60-year-old male presents with cancer of the prostate. The tumor is limited to the capsule and is palpable on per rectal examination. The patient is diagnosed as stage T1b. What is the best treatment?

Accepted Answer

Radical prostatectomy

Answer

Chemotherapy

Answer

Palliative radiotherapy

Answer

Orchidectomy

Question 2

What is the treatment of 'thimble bladder'?

Accepted Answer

Ileocystoplasty

Answer

Anti-tubercular treatment

Answer

Corticosteroids

Answer

Anti-tubercular drugs + steroids

Question 3

A young male presents with abdominal pain. CT scan shows a heterogenous necrotizing mass at the left renal hilum. His AFP or hCG levels are elevated. What is the most likely diagnosis?

Accepted Answer

Metastatic germ cell tumor

Answer

Lymphoma

Answer

Transitional cell carcinoma

Answer

Metastatic melanoma

Question 4

An 18-year-old boy presents with groin pain for 2 days. On examination, the testis is high-lying and the cremasteric reflex is absent. Elevation of the testis worsens the pain. What is the probable diagnosis?

Accepted Answer

Right testicular torsion

Answer

Right strangulated hernia

Answer

Right inguinal hernia

Answer

Right epididymo-orchitis

Question 5

What is true about varicocele?

Accepted Answer

Can cause oligospermia

Answer

More common on the right side

Answer

Has no effect on Valsalva maneuver

Answer

Lies anterior to the testis

Question 6

Which of the following is a type of stone seen in urinary tract infections?

Accepted Answer

Staghorn calculus

Answer

Calcium oxalate

Answer

Uric acid stones

Answer

Cysteine stones

Question 7

Peyronie's disease is characterized by which of the following?

Accepted Answer

Bowing of the penis during erection due to a fibrous plaque.

Answer

A curved deformity of the penis.

Answer

Ectopic opening of the urethra.

Answer

None of the above.

Question 8

A patient with pelvic fracture presents with suprapubic pain, difficulty in passing urine, and hematuria. Cystography reveals findings suggestive of bladder injury. What are the indications for surgical repair of a bladder injury?

Accepted Answer

All of the above

Answer

Repeated blockage of the urinary catheter due to bleeding

Answer

A projecting bone fragment impinging on the bladder wall

Answer

A tear extending to the bladder neck

Question 9

Which hormone is NOT given for palliative care of carcinoma of the prostate?

Accepted Answer

Progesterone

Answer

Estrogen

Answer

LHRH

Answer

Antiandrogens

Question 10

Which LASER can be used in the treatment of ureteric calculi?

Accepted Answer

Holmium laser

Answer

CO2 laser

Answer

Nd-Yag laser

Answer

All of the above

Urology — MCQs

Urology — MCQs

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