Urology Practice Questions

Q: What is the commonest systemic abnormality associated with renal cell carcinoma?

Elevated ESR. **Explanation:** Renal Cell Carcinoma (RCC) is famously known as the **"Internist’s Tumor"** because of its frequent association with diverse paraneoplastic syndromes and systemic manifestations. **Why Elevated ESR is the Correct Answer:** Elevated Erythrocyte Sedimentation Rate (ESR) is the **most common** systemic/laboratory abnormality in RCC, occurring in approximately **50% to 60%** of patients. It is a non-specific marker of inflammation and tissue destruction. While it lacks diagnostic specificity, a very high ESR often correlates with advanced stage or metastatic disease. **Analysis of Incorrect Options:** * **Hypertension (A):** Occurs in about 20–40% of cases. It is caused by renin secretion by the tumor, compression of the renal artery (Goldblatt mechanism), or hypercalcemia. While common, its frequency is lower than elevated ESR. * **Polycythemia (B):** This is a classic "textbook" association due to excess Erythropoietin (EPO) production, but it actually occurs in only **3–5%** of patients. Interestingly, **anemia** is far more common in RCC than polycythemia. * **Pyrexia (D):** Fever is seen in about 20% of patients, likely due to the release of endogenous pyrogens like Interleukin-6 (IL-6). **High-Yield Clinical Pearls for NEET-PG:** * **Stauffer’s Syndrome:** Reversible hepatic dysfunction (elevated ALP, bilirubin) in the absence of liver metastases. * **Classic Triad:** Hematuria, flank pain, and palpable mass (seen in only 10% of cases, usually indicates advanced disease). * **Most Common Histology:** Clear cell carcinoma (originates from the Proximal Convoluted Tubule). * **Most Common Site of Metastasis:** Lung ("Cannonball" secondaries).

Q: Benign prostatic hyperplasia first develops in which zone of the prostate?

Periurethral transition zone. **Explanation:** The prostate gland is anatomically divided into distinct zones according to **McNeal’s classification**. Understanding these zones is crucial for differentiating between benign and malignant pathologies. **1. Why the Transition Zone is Correct:** Benign Prostatic Hyperplasia (BPH) is a nodular proliferation of epithelial and stromal cells that characteristically originates in the **Transition Zone (TZ)**, which surrounds the proximal prostatic urethra. As these nodules enlarge, they compress the urethra, leading to the classic Lower Urinary Tract Symptoms (LUTS) such as hesitancy, weak stream, and urgency. **2. Analysis of Incorrect Options:** * **Peripheral Zone (PZ):** This is the largest zone (70% of glandular tissue) and is the primary site for **Prostate Cancer (70-80%)** and prostatitis. Because it is located posteriorly, tumors here are easily palpable via Digital Rectal Examination (DRE). * **Central Zone (CZ):** This zone surrounds the ejaculatory ducts. It is rarely the primary site for BPH or carcinoma (only about 1-5% of cancers). * **Anterior Fibromuscular Stroma:** This is a non-glandular region composed of muscular and fibrous tissue. It does not contain the glandular elements required for BPH or adenocarcinoma development. **High-Yield Clinical Pearls for NEET-PG:** * **BPH vs. Cancer:** BPH starts "inside" (Transition Zone/Periurethral), causing early urinary symptoms. Cancer starts "outside" (Peripheral Zone), often remaining asymptomatic until advanced. * **DRE Findings:** In BPH, the prostate feels smooth, elastic, and firm with a lost median sulcus. In malignancy, it feels hard, nodular, and irregular. * **Surgical Landmark:** During TURP (Transurethral Resection of the Prostate), the surgeon removes the hyperplastic tissue of the transition zone down to the "surgical capsule."

Q: What procedure is shown in the ureter?

Dormia Basket. ***Dormia Basket*** - A **Dormia basket** is a wire mesh device used for **stone retrieval** from the ureter, appearing as a characteristic **basket-like radiopaque structure** on fluoroscopy. - The basket is deployed beyond the stone, then **withdrawn** to capture and extract the calculus under direct visualization. *Stenting* - **Ureteric stents** appear as **straight radiopaque tubes** extending from the renal pelvis to the bladder, not basket-shaped structures. - Used for **drainage** and **relief of obstruction** rather than stone extraction procedures. *Dilatation* - **Ureteric dilatation** involves **balloon catheters** that appear as **smooth, elongated structures** when inflated, not wire mesh patterns. - Used to **widen strictures** or **prepare the ureter** for other procedures, not for stone retrieval. *Cannulation* - **Ureteric cannulation** involves **thin catheters** appearing as **fine radiopaque lines** within the ureter. - Used for **contrast injection** during **retrograde pyelography** or **guidewire placement**, not stone extraction.

Q: All of the following are seen in cystitis EXCEPT:

Fever. **Explanation:** The correct answer is **Fever**. In clinical urology, it is crucial to differentiate between **Lower Urinary Tract Infections (UTIs)** and **Upper UTIs**. 1. **Why Fever is the correct answer:** Cystitis is a localized inflammation of the bladder mucosa (Lower UTI). Because it is a superficial mucosal infection without systemic involvement or tissue invasion, it typically **does not present with fever**. The presence of fever, chills, or flank pain in a patient with urinary symptoms strongly suggests **Acute Pyelonephritis** (Upper UTI) or systemic involvement like prostatitis. 2. **Analysis of incorrect options:** * **Dysuria:** This is the most common symptom of cystitis, caused by the irritation of the urethral and bladder neck mucosa during voiding. * **Nocturia & Frequency:** Inflammation reduces the functional capacity and compliance of the bladder, leading to an increased urge to void both day and night. * **Hematuria:** "Hemorrhagic cystitis" is common in bacterial infections where the friable, inflamed bladder mucosa bleeds easily. **NEET-PG High-Yield Pearls:** * **Triad of Cystitis:** Frequency, Urgency, and Dysuria. * **Most Common Organism:** *E. coli* (80-85% of cases). * **Gold Standard Diagnosis:** Urine culture (Significant bacteriuria is traditionally defined as $\geq 10^5$ CFU/mL). * **Sterile Pyuria:** If a patient has symptoms of cystitis but negative routine cultures, consider *Chlamydia trachomatis*, *Neisseria gonorrhoeae*, or Renal Tuberculosis. * **Treatment:** Uncomplicated cystitis is typically treated with Nitrofurantoin, Fosfomycin, or TMP-SMX.

Q: Epidermoid carcinoma of the renal pelvis is usually associated with:

Pelvic calculus. **Explanation:** Epidermoid carcinoma (Squamous Cell Carcinoma/SCC) of the renal pelvis is a rare but aggressive malignancy. The primary underlying mechanism is **chronic irritation**, which leads to squamous metaplasia of the urothelium, eventually progressing to dysplasia and carcinoma. * **Why Pelvic Calculus is Correct:** Long-standing **renal calculi** (specifically staghorn or pelvic stones) are the most common cause of chronic mechanical irritation and infection in the renal pelvis. Approximately 75–100% of patients with SCC of the renal pelvis have a history of chronic nephrolithiasis. * **Why Incorrect Options are Wrong:** * **Multiple Papillomas:** These are associated with **Transitional Cell Carcinoma (TCC)**, the most common type of renal pelvic tumor. TCC is often multifocal and associated with field defects. * **Tuberculosis of the Kidney:** While TB causes chronic inflammation, it typically leads to strictures, "putty kidney," or autonephrectomy rather than SCC. * **Filariasis:** This usually affects the lymphatic system, leading to chyluria or hydrocele, but is not a recognized risk factor for renal pelvic malignancy. **NEET-PG High-Yield Pearls:** 1. **Most common tumor** of the renal pelvis: **Transitional Cell Carcinoma (TCC)**. 2. **Most common risk factor** for SCC of the renal pelvis: **Chronic Calculi** (Stones). 3. **Schistosomiasis (S. haematobium)** is a major risk factor for SCC of the **Urinary Bladder**, not typically the renal pelvis. 4. SCC of the renal pelvis usually presents at an advanced stage and has a much poorer prognosis compared to TCC.

Q: A male patient presents with azoospermia. On examination, testicular size is normal, FSH is normal, and testosterone levels are normal. What is the most probable cause?

Vas obstruction. ### Explanation The clinical presentation of **azoospermia** (absence of sperm in the ejaculate) combined with **normal testicular size** and **normal hormonal profiles** (FSH, LH, and Testosterone) is the classic hallmark of **Obstructive Azoospermia**. **Why "Vas obstruction" is correct:** In obstructive azoospermia, the hypothalamic-pituitary-gonadal axis is intact, and spermatogenesis within the testes is functioning normally. Because the germinal epithelium is healthy, **FSH levels remain normal** (as Inhibin B production is not compromised). Since the Leydig cells are unaffected, **Testosterone** and testicular volume are also normal. The "blockage" is purely mechanical, occurring in the epididymis, vas deferens, or ejaculatory ducts. **Why the other options are incorrect:** * **Maldescended testis:** Usually leads to testicular atrophy and damage to the seminiferous tubules due to higher intra-abdominal temperatures, often resulting in elevated FSH and reduced testicular size. * **Klinefelter’s Syndrome (47,XXY):** This is a form of primary hypergonadotropic hypogonadism. It presents with **small, firm testes**, **elevated FSH/LH**, and low testosterone. * **Kallmann’s Syndrome:** This is hypogonadotropic hypogonadism. It presents with **low FSH/LH**, low testosterone, and prepubertal testicular volume (micropenis/small testes), often accompanied by anosmia. **High-Yield Clinical Pearls for NEET-PG:** * **FSH is the best marker for spermatogenesis:** Elevated FSH almost always indicates primary testicular failure (Non-obstructive azoospermia). * **Most common cause of Obstructive Azoospermia:** Post-inflammatory (e.g., post-gonorrheal) or Congenital Bilateral Absence of Vas Deferens (CBAVD), which is strongly associated with **Cystic Fibrosis (CFTR gene mutations)**. * **Management:** In obstructive cases, sperm can be retrieved directly from the testes/epididymis (TESA/MESA) for use in ICSI.

Question 1

What is the commonest systemic abnormality associated with renal cell carcinoma?

Accepted Answer

Elevated ESR

Answer

Hypertension

Answer

Polycythemia

Answer

Pyrexia

Question 2

Benign prostatic hyperplasia first develops in which zone of the prostate?

Accepted Answer

Periurethral transition zone

Answer

Peripheral zone

Answer

Central zone

Answer

Anterior fibromuscular stroma

Question 3

Terminal hematuria is most commonly associated with which anatomical structure?

Accepted Answer

Prostatic urethra

Answer

Urethra

Answer

Kidney

Answer

Bladder

Question 4

What procedure is shown in the ureter?

Accepted Answer

Dormia Basket

Answer

Stenting

Answer

Dilatation

Answer

Cannulation

Question 5

All of the following are seen in cystitis EXCEPT:

Accepted Answer

Fever

Answer

Hematuria

Answer

Dysuria

Answer

Nocturia

Question 6

A patient was brought to the hospital eight hours after an injury. A few drops of blood are noted at the external urethral meatus. He has not passed urine and his bladder is palpable per abdomen. What is the probable diagnosis?

Accepted Answer

Urethral injury

Answer

Rupture bladder

Answer

Urethral injury with extravasation of urine in the retroperitoneum

Answer

Anuria due to hypovolemia

Question 7

Epidermoid carcinoma of the renal pelvis is usually associated with:

Accepted Answer

Pelvic calculus

Answer

Multiple papilomas

Answer

Tuberculosis of the kidney

Answer

Filariasis

Question 8

A 32-year-old man with a pelvic fracture presents with urinary retention and blood at the external meatus. A retrograde urethrogram shows prostatomembranous disruption. What is the most appropriate immediate treatment?

Accepted Answer

Suprapubic cystostomy

Answer

Urethral catheterization

Answer

Exploration and repair of the urethra

Answer

Perineal urethrostomy

Question 9

A male patient presents with azoospermia. On examination, testicular size is normal, FSH is normal, and testosterone levels are normal. What is the most probable cause?

Accepted Answer

Vas obstruction

Answer

Maldescended testis

Answer

Klinefelter's syndrome

Answer

Kallmann's syndrome

Question 10

A 25-year-old married male presents with infertility. He underwent retroperitoneal lymph node dissection at age 15 for embryonal carcinoma of the right testis. Semen analysis shows a quantity of 0.5 ml, no sperm, and no fructose. Testis biopsy shows normal spermatogenesis. What is the best treatment?

Accepted Answer

Microtesticular sperm aspiration and intracytoplasmic injection

Answer

Artificial insemination with donor sperm

Answer

Penile prosthesis

Answer

None of the above

Urology — MCQs

Urology — MCQs

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