Urology Practice Questions

Q: Which of the following syndromes is associated with supernumerary teeth?

All of the above.. **Explanation:** Supernumerary teeth (hyperdontia) refer to the presence of teeth in excess of the normal dental formula. While often idiopathic, they are frequently associated with specific genetic syndromes. **1. Gardner’s Syndrome:** A variant of Familial Adenomatous Polyposis (FAP), it is characterized by the triad of intestinal polyposis, soft tissue tumors (desmoids/sebaceous cysts), and skeletal abnormalities (osteomas of the mandible/skull). Impacted supernumerary teeth are a classic diagnostic marker. **2. Cleidocranial Dysplasia:** This autosomal dominant condition affects bones formed by intramembranous ossification. Key features include aplastic/hypoplastic clavicles (allowing the patient to touch shoulders in the midline) and delayed closure of fontanelles. Multiple impacted supernumerary teeth and failure of permanent teeth to erupt are hallmark dental findings. **3. Cleft Lip and Palate:** These are common craniofacial anomalies. Supernumerary teeth often occur near the cleft site (especially the maxillary lateral incisor region) due to the fragmentation of the dental lamina during the developmental process. **Conclusion:** Since all three conditions are well-documented to present with supernumerary teeth, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** * **Most common supernumerary tooth:** Mesiodens (located between the maxillary central incisors). * **Gardner’s Syndrome Mnemonic:** "SOD" – **S**oft tissue tumors, **O**steomas, **D**ental anomalies (and Polyps). * **Cleidocranial Dysplasia:** Look for the *RUNX2* gene mutation in clinical vignettes. * **Differential Diagnosis:** Other syndromes with supernumerary teeth include Hallermann-Streiff syndrome and Orofaciodigital syndrome type I.

Q: Which of the following stones is hard to break by ESWL?

Calcium oxalate monohydrate. **Explanation:** Extracorporeal Shock Wave Lithotripsy (ESWL) effectiveness depends primarily on the stone's density and crystalline structure. The hardness of a stone is measured in Hounsfield Units (HU) on CT scan; stones with >1000 HU are generally resistant to ESWL. **1. Why Calcium Oxalate Monohydrate (COM) is correct:** COM (Whewellite) is the hardest common urinary stone. It has a dense, compact crystalline lattice and a smooth surface, making it highly resistant to fragmentation by shock waves. Patients with COM stones often require alternative procedures like Laser Lithotripsy (URS) or PCNL. **2. Why the other options are incorrect:** * **Calcium Oxalate Dihydrate (COD):** Unlike the monohydrate form, COD (Weddellite) has a jagged, spiky surface and a more porous internal structure, making it very **fragile** and easy to break with ESWL. * **Uric Acid:** These stones have low density (<500 HU) and are generally easy to fragment. However, they are radiolucent, often requiring contrast or ultrasound for targeting during ESWL. (Note: Medical dissolution is the first-line treatment for uric acid stones). * **Struvite (Triple Phosphate):** These are "soft" stones associated with infection. While they fragment easily, ESWL is often avoided for large staghorn struvite stones due to the risk of "Steinstrasse" and sepsis. **High-Yield Clinical Pearls for NEET-PG:** * **Hardest Stone:** Calcium Oxalate Monohydrate (COM). * **Softest/Most Fragile Stone:** Brushite (Calcium Phosphate) or Cystine (though Cystine is "tough" and resists fragmentation due to its rubbery consistency). * **ESWL Contraindications:** Pregnancy (absolute), uncorrected bleeding diathesis, distal obstruction, and AAA (near the stone). * **Hounsfield Unit (HU) Cut-off:** Stones >1000 HU have a high failure rate with ESWL.

Q: Which one of the following is used as an irrigation solution during transurethral resection of the prostate?

1.5% glycine. **Explanation:** The primary goal of an irrigation fluid during Transurethral Resection of the Prostate (TURP) is to provide clear visualization while remaining non-conductive and non-hemolytic. **1. Why 1.5% Glycine is the Correct Answer:** Glycine (1.5%) is a non-electrolytic, non-hemolytic, and transparent solution. Since TURP involves the use of **monopolar electrocautery**, the irrigation fluid must be **non-conductive** to prevent the electrical current from dispersing away from the loop. Glycine meets these criteria, making it the gold standard for monopolar TURP. **2. Why the Other Options are Incorrect:** * **Physiological Saline (0.9% NaCl) & Ringer's Lactate:** These are **isotonic electrolytes**. Because they conduct electricity, they would cause the electrical current to dissipate, potentially causing thermal injury to surrounding tissues and rendering the monopolar loop ineffective. (Note: Saline *is* used in Bipolar TURP). * **5% Dextrose:** While non-conductive, it is not used because it creates a "sticky" surgical field and can lead to significant hyperglycemia if absorbed systemically. **3. Clinical Pearls for NEET-PG:** * **TURP Syndrome:** This is a life-threatening complication caused by the systemic absorption of glycine. It presents with **dilutional hyponatremia**, fluid overload, and neurological symptoms (confusion, seizures). * **Glycine Toxicity:** Glycine is an inhibitory neurotransmitter. Its metabolism can lead to **hyperammonemia** and transient **visual disturbances/blindness**. * **Bipolar TURP:** The modern trend is shifting toward Bipolar TURP, which allows the use of **Normal Saline**, significantly reducing the risk of TURP syndrome. * **Other Fluids:** Distilled water (causes hemolysis) and Mannitol/Sorbitol (can cause osmotic diuresis) are less commonly used alternatives.

Q: Concomitant chemoradiotherapy is indicated in all of the following conditions EXCEPT:

T2 N0 M0 glottic cancer. **Explanation:** The core concept tested here is the standard of care for various malignancies. **Concomitant Chemoradiotherapy (CCRT)** is used as a primary treatment for advanced or aggressive tumors to improve local control and survival. **Why Option C is the Correct Answer:** For **Early Glottic Cancer (T1-T2, N0, M0)**, the standard of care is **single-modality therapy**—either radiotherapy alone or organ-preserving surgery (like CO2 laser excision). CCRT is not indicated because single-modality treatment achieves excellent cure rates (85-95%) while preserving voice quality. Adding chemotherapy would increase toxicity without providing a significant survival benefit in early-stage disease. CCRT is reserved for advanced laryngeal cancers (T3-T4) as an organ-preservation strategy. **Analysis of Incorrect Options:** * **Stage III B Ca Cervix:** CCRT (Cisplatin-based) is the gold standard for locally advanced cervical cancer (Stage IB3 to IVA). * **T2 N0 M0 Anal Cancer:** The **Nigro Protocol** (CCRT with 5-FU and Mitomycin-C) is the definitive treatment for squamous cell carcinoma of the anal canal, avoiding the need for permanent colostomy. * **T1 N2 M0 Nasopharyngeal Cancer:** Because of its high radiosensitivity and chemosensitivity, CCRT is the standard treatment for all nasopharyngeal cancers except Stage I (T1N0). **Clinical Pearls for NEET-PG:** * **Nigro Protocol:** Definitive CCRT for Anal Canal Cancer. * **Cisplatin:** The most common radiosensitizer used in CCRT for Head & Neck and Cervical cancers. * **Early Glottic Cancer:** Radiotherapy and Surgery are equally effective; the choice depends on patient preference and functional outcome.

Q: The penis is curved in a downward direction in all types of hypospadias except?

Glandular. **Explanation:** Hypospadias is a congenital anomaly characterized by the ectopic opening of the urethral meatus on the ventral aspect of the penis. It is classically associated with **chordee**, which is a ventral (downward) curvature of the penis caused by fibrous bands or a short urethra. **Why Glandular is the correct answer:** In **Glandular hypospadias**, the urethral opening is located on the glans penis, very close to its normal position. Because the defect is distal and minimal, there is usually no significant fibrous tissue development or urethral shortening proximal to the glans. Consequently, **chordee is typically absent** in the glandular variety. **Analysis of Incorrect Options:** * **Coronal:** This is a distal type of hypospadias where the opening is at the junction of the glans and the shaft. Chordee begins to appear at this level and is present in a significant number of cases. * **Penile:** In mid-shaft or proximal penile hypospadias, the degree of ventral curvature is usually marked due to the presence of well-developed fibrous bands (chordee) replacing the corpus spongiosum. * **Perineal:** This is the most severe form. The more proximal the urethral opening, the more severe the associated chordee. Perineal hypospadias is almost universally associated with significant downward curvature and often bifid scrotum. **Clinical Pearls for NEET-PG:** * **Triad of Hypospadias:** Ectopic urethral meatus, Chordee (ventral curvature), and Hooded prepuce (deficient ventral foreskin). * **Contraindication:** Circumcision is strictly contraindicated in neonates with hypospadias because the prepuce is required for future reconstructive surgery (urethroplasty). * **Best Time for Surgery:** Ideally between **6 to 12 months** of age. * **Common Procedures:** Snodgrass (TIP) repair is the most common for distal cases; Duckett’s procedure for proximal cases.

Q: Which of the following is NOT a risk factor for the development of critical limb ischemia?

Moderate alcohol intake. **Explanation:** Critical Limb Ischemia (CLI) is the most advanced stage of Peripheral Arterial Disease (PAD), characterized by chronic ischemic rest pain, ulcers, or gangrene. The pathophysiology involves systemic atherosclerosis, and its risk factors are identical to those of coronary artery disease. **Why Moderate Alcohol Intake is the Correct Answer:** Moderate alcohol consumption (typically defined as 1–2 drinks per day) has not been proven to be a risk factor for CLI. In fact, several epidemiological studies suggest a "U-shaped" relationship, where moderate intake may have a mild protective effect on the vascular endothelium and lipid profiles, unlike heavy consumption which increases cardiovascular risk. **Analysis of Incorrect Options:** * **Diabetes Mellitus:** This is the most potent risk factor for CLI. It promotes "Mönckeberg’s medial calcification" and leads to multisegmental, infrapopliteal (below-the-knee) arterial involvement, significantly increasing the risk of amputation. * **Hyperlipidemia:** Elevated LDL and low HDL levels promote the formation of atherosclerotic plaques within the arterial walls, narrowing the lumen and reducing distal perfusion. * **Hyperhomocysteinemia:** High levels of homocysteine cause endothelial damage and promote a pro-thrombotic state, acting as an independent risk factor for premature atherosclerosis and CLI. **Clinical Pearls for NEET-PG:** * **Strongest Risk Factor:** Smoking is the most significant modifiable risk factor for PAD/CLI. * **Fontaine Classification:** Stage III (Rest pain) and Stage IV (Ulceration/Gangrene) constitute CLI. * **Ankle-Brachial Index (ABI):** An ABI < 0.4 is typically associated with Critical Limb Ischemia. * **TASC II Criteria:** Used for the management of aorto-iliac and femoropopliteal lesions.

Q: Which of the following statements is true regarding testicular tumors?

Bilateral in up to 10% of cases. **Explanation:** Testicular tumors are the most common solid malignancy in men aged 15–35 years. Understanding their epidemiology and classification is high-yield for NEET-PG. **Why Option B is Correct:** While most testicular tumors are unilateral, **bilateral involvement occurs in approximately 1–10% of cases**. These can be synchronous (occurring at the same time) or metachronous (occurring at different times). The most common histological subtype found in bilateral cases is **Seminoma**. Additionally, Testicular Intraepithelial Neoplasia (TIN) is often found in the contralateral testis of patients with a known germ cell tumor (GCT). **Analysis of Incorrect Options:** * **Option A:** Approximately 95% of testicular tumors are **Germ Cell Tumors (GCTs)**, not specifically embryonal cell carcinomas. GCTs are further divided into Seminomas (~50%) and Non-Seminomatous Germ Cell Tumors (NSGCTs). * **Option C:** **Seminomas are the most common** single histological subtype of testicular GCTs. Teratomas are a subtype of NSGCTs and are less frequent than seminomas in adults. * **Option D:** Testicular tumors typically present in young men (**peak incidence 15–35 years**). A testicular mass in a man **over 50 years** is most likely **Lymphoma** (specifically Diffuse Large B-cell Lymphoma), which is the most common secondary testicular tumor in older age groups. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factor:** Cryptorchidism (undescended testis) is the most significant risk factor; orchiopexy reduces the risk of malignancy but does not eliminate it. * **Lymphatic Spread:** Testicular tumors primarily spread to **Para-aortic lymph nodes** (not inguinal nodes, unless the scrotum is involved). * **Tumor Markers:** * **AFP:** Never raised in pure Seminoma (if raised, suspect NSGCT). * **hCG:** Elevated in Choriocarcinoma and some Seminomas. * **LDH:** Correlates with tumor burden/bulk.

Q: A 10-mm calculus in the right lower ureter associated with proximal hydroureteronephrosis is best treated with?

Ureteroscopic retrieval. **Explanation:** The management of ureteric calculi depends on the size, location, and presence of complications. For a **10-mm calculus in the lower ureter**, **Ureteroscopic Retrieval (URS)** is the gold standard treatment. **Why URS is the correct choice:** 1. **Location:** The lower ureter is anatomically shielded by the bony pelvis, making it difficult to target with ESWL. URS provides direct access and high stone-free rates for distal stones. 2. **Size:** Stones >10 mm have a low probability of spontaneous passage and require active intervention. 3. **Complications:** The presence of proximal hydroureteronephrosis indicates significant obstruction, necessitating prompt relief which URS (with or without stenting) provides effectively. **Why other options are incorrect:** * **ESWL (Option A):** While effective for upper ureteric stones 1.5 cm) stones in the upper ureter or when retrograde access fails. It is too invasive for a simple lower ureteric stone. * **Open Ureterolithotomy (Option C):** This is now considered a "last resort" procedure, reserved for very large, impacted stones or when endoscopic/minimally invasive methods fail. **Clinical Pearls for NEET-PG:** * **Ureteric Stone Management Guidelines:** * ** 5 mm). * **Stone Composition:** Calcium oxalate monohydrate and Cystine stones are resistant to ESWL; URS/Laser lithotripsy is preferred. * **Emergency:** If a stone is associated with fever/infection (pyonephrosis), the priority is **drainage** (PCN or DJ stent), not definitive stone removal.

Q: Which of the following lasers is used in the treatment of benign prostatic hyperplasia and urinary calculi?

Ho: YAG laser. **Explanation:** The **Holmium: YAG (Ho:YAG)** laser is currently the "gold standard" multipurpose laser in urology because it operates at a wavelength of **2100 nm**, which is highly absorbed by water. 1. **Why it is correct:** The Ho:YAG laser works via a **thermo-mechanical mechanism**. When used for **urinary calculi**, it creates a vaporization bubble that pulverizes stones of all chemical compositions (Lithotripsy). When used for **BPH**, its shallow tissue penetration (0.4 mm) allows for precise tissue ablation and coagulation (HoLEP—Holmium Laser Enucleation of the Prostate) with minimal collateral thermal damage, making it safe and effective for both soft tissue and hard stones. 2. **Why the others are incorrect:** * **CO2 Laser (10,600 nm):** It is strongly absorbed by water but cannot be transmitted through flexible fiberoptics or liquid environments, making it unsuitable for endoscopic urological procedures. * **Excimer Laser:** This is an ultraviolet laser used primarily in ophthalmology (LASIK) and angioplasty; it lacks the power for stone fragmentation or prostate resection. * **Nd:YAG Laser (1064 nm):** While used in the past for BPH (VLAP), it has deep tissue penetration (up to 10 mm), leading to unpredictable sloughing, significant postoperative edema, and no effective stone-fragmenting properties. **High-Yield Clinical Pearls for NEET-PG:** * **HoLEP** is the procedure of choice for very large prostates (>80-100g) as an alternative to open prostatectomy. * **KTP (Potassium Titanyl Phosphate) Laser:** Also known as the "GreenLight" laser; used for photoselective vaporization of the prostate (PVP) but **cannot** treat stones. * **Thulium Laser:** Offers even shallower penetration than Holmium, providing excellent hemostasis for BPH.

Question 1

Which of the following syndromes is associated with supernumerary teeth?

Accepted Answer

All of the above.

Answer

Gardner's syndrome.

Answer

Cleidocranial dysplasia.

Answer

Cleft lip and palate.

Question 2

Which of the following stones is hard to break by ESWL?

Accepted Answer

Calcium oxalate monohydrate

Answer

Calcium oxalate dihydrate

Answer

Uric acid

Answer

Struvite

Question 3

Which one of the following is used as an irrigation solution during transurethral resection of the prostate?

Accepted Answer

1.5% glycine

Answer

Physiological saline

Answer

Ringer's lactate

Answer

5% dextrose

Question 4

Concomitant chemoradiotherapy is indicated in all of the following conditions EXCEPT:

Accepted Answer

T2 N0 M0 glottic cancer

Answer

Stage III B Ca cervix

Answer

T2 N0 M0 anal cancer

Answer

T1 N2 M0 nasopharyngeal cancer

Question 5

The penis is curved in a downward direction in all types of hypospadias except?

Accepted Answer

Glandular

Answer

Coronal

Answer

Penile

Answer

Perineal

Question 6

A 67-year-old man presented with a single episode of gross painless hematuria. An excretory urogram showed a 1.5 cm round filling defect in the right lower renal infundibulum. What is the best next study to obtain?

Accepted Answer

Ultrasonography

Answer

Urinary cytology

Answer

Cystoscopy

Answer

Retrograde pyelography

Question 7

Which of the following is NOT a risk factor for the development of critical limb ischemia?

Accepted Answer

Moderate alcohol intake

Answer

Diabetes

Answer

Hyperlipidemia

Answer

Hyperhomocysteinemia

Question 8

Which of the following statements is true regarding testicular tumors?

Accepted Answer

Bilateral in up to 10% of cases

Answer

Are embryonal cell carcinomas in 95% of cases

Answer

Teratomas are more common than seminomas

Answer

Usually present after 50 years of age

Question 9

A 10-mm calculus in the right lower ureter associated with proximal hydroureteronephrosis is best treated with?

Accepted Answer

Ureteroscopic retrieval

Answer

Extracorporeal shockwave lithotripsy

Answer

Antegrade percutaneous access

Answer

Open ureterolithotomy

Question 10

Which of the following lasers is used in the treatment of benign prostatic hyperplasia and urinary calculi?

Accepted Answer

Ho: YAG laser

Answer

C02 laser

Answer

Excimer laser

Answer

Nd: YAG laser

Urology — MCQs

Urology — MCQs

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