Urology Practice Questions

Q: At what age is orchidopexy for cryptorchidism typically performed?

1 to 2 years. **Explanation:** The primary goal of orchidopexy in cryptorchidism (undescended testis) is to preserve fertility and facilitate early screening for malignancy. **1. Why 1 to 2 years is correct:** Spontaneous descent of the testis is common in the first few months of life but rarely occurs after the age of 6 months. Current clinical guidelines (including AUA and AAP) recommend performing orchidopexy between **6 to 18 months** of age. Histological changes, such as the loss of germ cells and Leydig cell atrophy, begin as early as 1 year. Therefore, performing the surgery by age 1 (and definitely before age 2) optimizes the chances of future spermatogenesis and reduces the risk of testicular torsion. **2. Why other options are incorrect:** * **Neonatal period:** Surgery is avoided here because many testes will descend spontaneously by 3–6 months of age. Additionally, anesthetic risks are higher in neonates. * **5 to 6 years:** Waiting until school age significantly increases the risk of irreversible germ cell damage and infertility. * **Puberty:** By puberty, the risk of malignant transformation (seminoma) is higher, and the fertility potential of the undescended testis is virtually lost. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Inguinal canal. * **Most common complication:** Infertility (bilateral > unilateral). * **Malignancy Risk:** Orchidopexy does *not* eliminate the risk of testicular cancer, but it makes the testis palpable for easier screening. The most common tumor in an undescended testis is **Seminoma**. * **Associated condition:** Indirect inguinal hernia is present in over 90% of cases due to a patent processus vaginalis. * **Hormonal therapy:** HCG or GnRH analogues have low success rates and are generally not recommended as primary treatment.

Q: Which of the following is NOT a cause of bladder cancer?

Alcohol. **Explanation:** The correct answer is **Alcohol**. While alcohol is a known risk factor for several malignancies (such as esophageal, hepatic, and breast cancer), it has **no proven epidemiological link** to the development of bladder cancer. **Analysis of Options:** * **Naphthylamine exposure (Option B):** This is a classic occupational risk factor. Aromatic amines (like 2-Naphthylamine and benzidine) used in the dye, rubber, and leather industries are potent bladder carcinogens. They are metabolized in the liver and excreted in the urine, where they induce DNA damage in the urothelium. * **Cigarette smoking (Option C):** This is the **most common** risk factor for bladder cancer (responsible for ~50% of cases). Tobacco contains alpha and beta-naphthylamine and nitrosamines. The risk is proportional to the duration and intensity of smoking. * **Schistosoma hematobium (Option D):** This parasite is a major cause of bladder cancer in endemic areas (e.g., Egypt). Chronic irritation and inflammation lead to **Squamous Cell Carcinoma (SCC)**, unlike smoking which typically causes Transitional Cell Carcinoma (TCC). **High-Yield Clinical Pearls for NEET-PG:** 1. **Most common type:** In the West, it is **Transitional Cell Carcinoma (Urothelial)**; in areas with endemic Schistosomiasis, it is **Squamous Cell Carcinoma**. 2. **Drugs:** Long-term use of **Cyclophosphamide** (metabolite Acrolein) and **Phenacetin** abuse are significant risk factors. 3. **Protective factor:** High fluid intake is generally considered protective as it dilutes carcinogens and increases voiding frequency. 4. **Presentation:** The classic presentation is **painless gross hematuria** in an elderly male.

Q: Which of the following statements is true regarding bladder stones?

Treatment involves lithopexy.. Bladder stones (vesical calculi) are a common urological condition, often associated with urinary stasis or infection. **Explanation of the Correct Option:** **Option B (Treatment involves lithopexy)** is the correct statement. **Lithopexy** (or cystolitholapaxy) is the surgical procedure where bladder stones are crushed using a lithotrite (mechanical, ultrasonic, or laser) and then irrigated out. For very large or hard stones, open suprapubic cystolithotomy may be required. **Explanation of Incorrect Options:** * **Option A:** Bladder stones are significantly **more common in boys** than girls. This is primarily due to the longer, narrower male urethra and the higher incidence of posterior urethral valves or bladder outlet obstruction in male children. * **Option C:** While some stones migrate from the kidneys (secondary stones), many bladder stones form **de novo** in the bladder (primary stones) due to stasis (e.g., BPH, neurogenic bladder) or foreign bodies (e.g., indwelling catheters). * **Option D:** Bladder stones are **rarely asymptomatic**. They typically present with the classic triad of frequency, dysuria, and **sudden interruption of the urinary stream** accompanied by referred pain to the tip of the penis (in males) or labia (in females). **High-Yield Clinical Pearls for NEET-PG:** * **Composition:** Most bladder stones are composed of **ammonium uric acid**, calcium oxalate, or magnesium ammonium phosphate (struvite). * **Jackstone Calculus:** A specific type of calcium oxalate dihydrate stone with a "spiky" appearance, often found in the bladder. * **Radiology:** Most bladder stones are radio-opaque; however, pure uric acid stones are radiolucent on X-ray but visible on CT or Ultrasound. * **Associated Risk:** Chronic irritation from long-standing bladder stones is a known risk factor for **Squamous Cell Carcinoma** of the bladder.

Q: Which of the following is NOT a characteristically brilliantly transilluminant swelling?

Lipoma. **Explanation:** The core concept behind **transillumination** is the ability of a swelling to allow light to pass through it. This occurs when the contents are clear, serous fluid and the covering is thin. **Why Lipoma is the Correct Answer:** A **Lipoma** is a benign tumor composed of **adipose (fat) tissue**. Because fat is a solid, opaque substance, it does not allow light to pass through. Therefore, lipomas are characteristically **non-transilluminant**. On clinical examination, they are typically soft, lobulated, and exhibit a "slippery sign." **Analysis of Incorrect Options:** * **Hydrocele:** This is a collection of clear serous fluid between the layers of the tunica vaginalis. It is the classic example of a **brilliantly transilluminant** swelling in the scrotum. * **Meningocele:** This involves the protrusion of meninges containing **Cerebrospinal Fluid (CSF)** through a vertebral defect. Since CSF is a clear fluid, these swellings are transilluminant. * **Cystic Hygroma:** A congenital multilocular lymphatic malformation (usually in the neck) filled with clear lymph. Due to its clear fluid content and thin walls, it is **brilliantly transilluminant**. **NEET-PG High-Yield Pearls:** 1. **Brilliantly Transilluminant Swellings:** Hydrocele, Cystic hygroma, Meningocele, Ranula, and Epididymal cyst. 2. **The "Slippery Sign":** Pathognomonic for Lipoma; the edge of the tumor eludes the finger on pressure. 3. **Differential Diagnosis:** If a scrotal swelling is *not* transilluminant, consider a Hematocele (blood), Pyocele (pus), or Testicular Tumor (solid tissue). 4. **Exception:** A long-standing hydrocele with a thickened, calcified wall may lose its transillumination.

Q: What is the optimal timing for performing an orchidopexy?

Before 12 months of age. **Explanation:** The optimal timing for orchidopexy in a child with an undescended testis (cryptorchidism) is currently recommended between **6 to 12 months of age**. **1. Why "Before 12 months" is correct:** Spontaneous descent of the testis is rare after the age of 6 months. Early surgical intervention is critical because histological changes, such as the loss of germ cells and Leydig cell atrophy, begin as early as 1 year of age. Performing orchidopexy before 12 months (ideally by 18 months at the latest) maximizes the potential for fertility, facilitates easier screening for testicular cancer (which has a higher incidence in these patients), and may reduce the risk of malignant transformation. **2. Why the other options are incorrect:** * **Options B, C, and D (After 24 months, 3 years, and 5 years):** Waiting beyond the first year of life significantly increases the risk of irreversible germ cell depletion and tubular fibrosis. Delayed surgery correlates with lower sperm counts in adulthood and a higher risk of infertility. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** The superficial inguinal pouch is the most common location for an undescended testis. * **Spontaneous Descent:** Most testes that are undescended at birth will descend by **3 months** of age. If not descended by 6 months, surgery is indicated. * **Malignancy Risk:** Orchidopexy does not eliminate the risk of testicular cancer (most commonly **Seminoma**), but it makes the testis accessible for clinical examination. * **Hormonal Therapy:** HCG or GnRH analogues are generally not recommended as primary treatment due to low efficacy compared to surgery. * **Associated Condition:** Patent processus vaginalis is found in over 90% of cases.

Q: The prostatic growth in benign prostatic hypertrophy is due to:

Dihydrotestosterone. **Explanation:** The development of Benign Prostatic Hyperplasia (BPH) is an androgen-dependent process. The primary mediator of prostatic growth is **Dihydrotestosterone (DHT)**. Inside the prostate, the enzyme **5-alpha reductase (Type 2)** converts circulating testosterone into DHT. DHT is significantly more potent than testosterone because it has a higher affinity for androgen receptors and forms a more stable receptor-ligand complex. Once bound, it induces the transcription of growth factors (like TGF-β and FGF) that lead to the hyperplasia of stromal and epithelial cells, particularly in the **transition zone** of the prostate. **Analysis of Options:** * **A. Testosterone:** While it is the precursor, testosterone itself does not directly stimulate significant prostatic growth. In men with a genetic deficiency of 5-alpha reductase, the prostate remains small despite normal testosterone levels. * **B & D. 17-estradiol/Oestrogen:** Although estrogen levels increase with age and may sensitize the prostate to DHT by increasing androgen receptor expression, they are not the primary drivers of growth in BPH. **High-Yield Clinical Pearls for NEET-PG:** * **Anatomical Site:** BPH occurs in the **Transition Zone**, whereas Prostate Cancer typically occurs in the **Peripheral Zone**. * **Pharmacology Link:** **Finasteride and Dutasteride** are 5-alpha reductase inhibitors used to treat BPH by lowering intraprostatic DHT levels, effectively shrinking the gland. * **Histology:** BPH is a true hyperplastic process (increase in cell number), not hypertrophy (increase in cell size), despite the name. * **Key Risk Factors:** Aging and the presence of functioning testes (androgens).

Question 1

Strangury is defined as:

Accepted Answer

Painful, frequent attempts at micturition with only a small quantity of urine passed each time

Answer

Renal colic

Answer

Pain due to a twisted ovarian cyst

Answer

Biliary colic

Question 2

At what age is orchidopexy for cryptorchidism typically performed?

Accepted Answer

1 to 2 years

Answer

5 to 6 years

Answer

Puberty

Answer

Neonatal period

Question 3

Which of the following is NOT a cause of bladder cancer?

Accepted Answer

Alcohol

Answer

Naphthylamine exposure

Answer

Cigarette smoking

Answer

Schistosoma hematobium

Question 4

Which of the following statements is true regarding bladder stones?

Accepted Answer

Treatment involves lithopexy.

Answer

More common in girls than boys.

Answer

Always form in the kidneys and pass down to the bladder.

Answer

Usually asymptomatic.

Question 5

Which of the following complications of cryptorchidism cannot be prevented by orchiopexy?

Accepted Answer

Testicular tumor

Answer

Epididymo-orchitis

Answer

Torsion of the testis

Answer

Sexual ambiguity

Question 6

Which of the following is NOT a characteristically brilliantly transilluminant swelling?

Accepted Answer

Lipoma

Answer

Hydrocele

Answer

Meningocele

Answer

Cystic hygroma

Question 7

What is the optimal timing for performing an orchidopexy?

Accepted Answer

Before 12 months of age

Answer

After 24 months of age

Answer

At 3 years of age

Answer

At 5 years of age

Question 8

Carcinoma of the prostate commonly metastasizes to the vertebrae, which of the following is the primary reason for this predilection?

Accepted Answer

Because valveless communication exists with Batson's periprostatic venous plexus.

Answer

Via lymphatic drainage to the sacral lymph nodes.

Answer

Due to direct anterior spread.

Answer

None of the above.

Question 9

A 5-year-old male child presents with a single testis in the scrotum. Examination reveals the contralateral testis is palpable in the inguinal canal. What is the recommended management for this child?

Accepted Answer

Orchiopexy

Answer

Observation until puberty

Answer

Orchidectomy

Answer

Androgen administration

Question 10

The prostatic growth in benign prostatic hypertrophy is due to:

Accepted Answer

Dihydrotestosterone

Answer

Testosterone

Answer

17 estradiol

Answer

Oestrogen

Urology — MCQs

Urology — MCQs

On this page

Practice by Chapter

Want unlimited practice?