Urology Practice Questions

Q: A 65-year-old patient presents with sudden pain in the scrotum associated with prostration, pallor and pyrexia. What could be the most probable diagnosis?

Fournier's gangrene. **Fournier's gangrene** - **Fournier's gangrene** is a rapidly progressive, necrotizing fasciitis of the perineum and genital region, often presenting with sudden severe pain, prostration, pallor, and **fever (pyrexia)** in elderly patients. - The image likely shows extensive tissue necrosis and inflammation consistent with **Fournier's gangrene**, as the described symptoms and the patient's age (often associated with comorbidities like diabetes) increase suspicion for this life-threatening condition. *Torsion testis* - Testicular torsion typically presents with **acute, severe scrotal pain** and is more common in adolescents and young adults. - While it causes acute pain and possibly pallor from severe pain, it is less likely to cause widespread systemic symptoms like **pyrexia and prostration** in an elderly patient and does not involve the diffuse skin and subcutaneous tissue necrosis seen in the image. *Spermatocele* - A spermatocele is a **benign cyst** in the epididymis that usually presents as a painless mass. - It does not cause sudden pain, prostration, pallor, or pyrexia, nor does it involve tissue destruction. *Varicocele* - A varicocele is an **enlargement of veins within the scrotum** (pampiniform plexus), often described as feeling like a "bag of worms." - It typically causes a **dull ache** or heaviness, but not sudden severe pain, prostration, pallor, or pyrexia, and is not associated with the necrotic appearance.

Q: The following instrument is used for:

Bladder wash when urinary catheter gets blocked. ***Bladder wash when urinary catheter gets blocked*** - The image shows a **rubber bulb syringe**, also known as an **irrigation syringe** or **bulb syringe**. This instrument is commonly used to create suction or to instill fluid, making it ideal for procedures like bladder irrigation. - In cases where a **urinary catheter becomes blocked** by mucus plugs, clots, or debris, a bladder wash (irrigation) with sterile saline can help clear the obstruction and restore drainage. This syringe would enable a nurse or physician to manually flush the catheter. *Dilate urethral stricture* - **Urethral stricture dilation** requires specialized instruments such as **urethral dilators** or **balloon catheters**, which are designed to gradually widen the narrowed part of the urethra. - The flexible, bulb-type syringe shown is not rigid enough nor designed with the specific shape or size increments required for urethral dilation. *Relieve bladder outlet obstruction temporarily* - Temporary relief of **bladder outlet obstruction** (BOO) typically involves inserting a **urinary catheter** (e.g., Foley catheter) to drain urine directly from the bladder. - While a syringe can connect to a catheter for drainage, the syringe itself is not the primary instrument for relieving the obstruction; the catheter is. This syringe is for irrigation purposes, not direct catheterization to relieve obstruction. *Perform uroflowmetry* - **Uroflowmetry** is a diagnostic test that measures the **rate of urine flow** during voiding. It requires a specialized device called a **uroflowmeter**, which is typically a funnel or toilet-like apparatus connected to a sensor that measures flow rate and volume. - The pictured syringe plays no role in measuring the natural flow of urine during micturition.

Q: What is the most likely diagnosis based on the clinical image?

Hydrocele. **Hydrocele** - The image shows a **swollen scrotum** that is likely **non-tender** and **transilluminable**, characteristic findings of a hydrocele, which is a collection of fluid around the testis. - The swelling appears smooth and confined to the scrotum, consistent with fluid accumulation within the **tunica vaginalis**. *Direct inguinal hernia* - A direct inguinal hernia typically presents as a bulge in the **inguinal region** that protrudes directly through the posterior wall of the inguinal canal (Hesselbach's triangle). - It usually **does not extend into the scrotum** or cause such a generalized scrotal enlargement as seen here. *Indirect inguinal hernia* - An indirect inguinal hernia protrudes through the **deep inguinal ring** and often descends into the scrotum, alongside the spermatic cord. - Unlike a hydrocele, it is typically **reducible** bulge of bowel or omentum, thus feeling more solid and not transilluminating. *Varicocele* - A varicocele is characterized by a "bag of worms" feeling due to **dilated pampiniform plexus veins** in the scrotum. - It often appears as an irregular, soft mass that is more prominent when standing and typically **does not transilluminate**.

Q: Which is incorrect about the swelling shown below?

Not possible to get above the swelling. ***Not possible to get above the swelling*** - The image shows a **transilluminating scrotal swelling**, characteristic of a **hydrocele**. - A hydrocele (vaginal hydrocele) originates from within the scrotum, so you **CAN get above the swelling** during physical examination. - The statement "Not possible to get above swelling" is **INCORRECT** for a hydrocele - this is the key distinguishing feature. - In contrast, an **inguinoscrotal hernia** descends from the inguinal canal, so you **CANNOT get above it** and cannot feel the neck of the hernia. - Since the question asks "which is incorrect," this option is the **correct answer**. *Fluctuation positive* - Hydroceles contain clear fluid, making them **fluctuant** on palpation. - A wave-like impulse can be transmitted through the fluid from one side to the other. - This statement is **correct** about hydroceles. *Contains fluid that can be aspirated* - **Aspiration of fluid** from a hydrocele is possible for diagnostic or therapeutic purposes. - The aspirated fluid is typically straw-colored and clear if uncomplicated. - This statement is **correct** about hydroceles. *Transillumination positive* - The image clearly shows **positive transillumination**, where light passes through the swelling. - This indicates the swelling is **fluid-filled** and not solid. - This is a hallmark sign of hydrocele, distinguishing it from hernia or tumor. - This statement is **correct** about hydroceles.

Q: During evaluation of a male child with recurrent UTI, VCUG is performed and the following finding is observed. What is the diagnosis?

Posterior urethral valves. ***Posterior urethral valves*** - The image shows a **dilated and elongated posterior urethra** which is characteristic of posterior urethral valves (PUV). Also evident is **trabeculation of the bladder wall** and significant **bilateral vesicoureteral reflux (VUR)**, with a dilated and tortuous left ureter. - PUV frequently cause **recurrent UTIs** in male infants and children due to urinary obstruction and stasis, leading to bladder and upper tract damage. *Ureterocele* - A ureterocele would appear as a **cystic dilation of the distal ureter** into the bladder, typically visualized as a lucent defect within the opaque bladder on VCUG. The image does not show this specific finding. - While it can cause obstruction and VUR, the obstruction pattern observed in the image (especially the posterior urethra) is not consistent with a ureterocele. *Ectopic ureter* - An ectopic ureter involves the ureter inserting into an abnormal location, such as the vagina, urethra, or seminal vesicle, often bypassing the bladder. This would lead to a more direct drainage outside the bladder or into another structure without the gross changes seen in the posterior urethra. - While an ectopic ureter can lead to reflux or obstruction affecting the kidney, the primary obstruction in the **posterior urethra** with characteristic valve morphology is absent with an ectopic ureter. *Hydronephrosis* - **Hydronephrosis** refers to the swelling of a kidney due to a backup of urine, often caused by an obstruction or VUR. While hydronephrosis is a *consequence* of conditions like PUV, it is not the *diagnosis* explaining the direct VCUG findings in the bladder and urethra. - The VCUG directly visualizes the obstruction in the posterior urethra and associated reflux/bladder changes, which are the primary diagnostic features, rather than just the renal swelling.

Q: The radiographic image shows a double-J stent in the urinary tract. Which procedure routinely uses a double-J stent to splint a ureteropelvic anastomosis?

Pyeloplasty. ***Pyeloplasty*** - **Double J stents** are commonly placed in pyeloplasties (Anderson-Hynes dismembered pyeloplasty for **UPJO - Ureteropelvic Junction Obstruction**) to stent the anastomosis and ensure proper **urine drainage**, though stentless and externally drained techniques also exist. - The stent supports **anastomotic healing and drainage**, making it a standard postoperative measure. *ESWL* - **Extracorporeal Shock Wave Lithotripsy (ESWL)** rarely requires routine stenting unless there is **large stone burden** or risk of steinstrasse (stone fragment obstruction). - Stenting after ESWL is **selective**, not universally performed, unlike the routine nature implied by the question. *PCNL* - **Percutaneous Nephrolithotomy (PCNL)** primarily uses **nephrostomy tube** for drainage rather than double J stents as the first-line drainage method. - DJ stent placement after PCNL is **optional/selective**, not the most common stenting indication compared to pyeloplasty. *Ureteroscopy (URS)* - **Ureteroscopy** may require stenting in cases of **ureteral injury**, significant edema, or large stone burden, but it's placed **selectively**. - Unlike pyeloplasty, stenting after URS is **not universal** and depends on specific procedural factors and complications.

Q: Which of the following uroflowmetry recording indicates bladder outlet obstruction?

Curve 3. ***Curve 3*** - Curve 3 shows a **low, flattened peak flow rate** and a **prolonged voiding time**, which is a pattern most suggestive of bladder outlet obstruction. - The **sustained low flow** indicates constant effort to overcome resistance, a pattern commonly associated with bladder outlet obstruction. - Note that uroflowmetry alone does not prove bladder outlet obstruction; definitive distinction from detrusor underactivity requires adequate voided volume and pressure-flow studies. *Curve 1* - Curve 1 depicts a **high peak flow rate** and a **short voiding time**, representing a normal and efficient urinary flow pattern. - This pattern is inconsistent with bladder outlet obstruction, which is characterized by obstructed flow. *Curve 2* - Curve 2 indicates a **moderately reduced peak flow rate** and a somewhat prolonged voiding time compared to normal. - While reflecting some degree of obstruction or weaker detrusor function, it is less severe than curve 3 and may represent early obstruction or other conditions. *Curve 4* - Curve 4 shows a **prolonged low-flow pattern** with a broad, smooth curve, which may be associated with impaired detrusor contractility. - This pattern is not characteristic of bladder outlet obstruction, which typically shows a sustained low flow as seen in curve 3.

Question 1

A 65-year-old patient presents with sudden pain in the scrotum associated with prostration, pallor and pyrexia. What could be the most probable diagnosis?

Accepted Answer

Fournier's gangrene

Answer

Torsion testis

Answer

Spermatocele

Answer

Varicocele

Question 2

All are true about the conditions shown in the figure except?

Accepted Answer

Typically presents solely with painless intermittent hematuria

Answer

Vesical calculus

Answer

Litholapaxy

Answer

Holmium laser

Question 3

The following instrument is used for:

Accepted Answer

Bladder wash when urinary catheter gets blocked

Answer

Dilate urethral stricture

Answer

Relieve bladder outlet obstruction temporarily

Answer

Perform uroflowmetry

Question 4

What is the most likely diagnosis based on the clinical image?

Accepted Answer

Hydrocele

Answer

Direct inguinal hernia

Answer

Indirect inguinal hernia

Answer

Varicocele

Question 5

Which is incorrect about the swelling shown below?

Accepted Answer

Not possible to get above the swelling

Answer

Fluctuation positive

Answer

Contains fluid that can be aspirated

Answer

Transillumination positive

Question 6

Which is incorrect about Extracorporeal Shockwave Lithotripsy (ESWL) in the management of the patient with right flank pain shown in the image?

Accepted Answer

No analgesia or sedation is required

Answer

Done as outpatient procedure

Answer

Hard stones have lower fragmentation and stone-free rates with ESWL

Answer

In modern lithotripters, shockwaves are coupled via a water cushion or gel pad placed on the skin

Question 7

A patient underwent pyeloplasty. The following radiograph was obtained postoperatively. What does the image show?

Accepted Answer

A double J stent with proximal coil in the renal pelvis and distal coil in the bladder

Answer

A Foley catheter within the urinary bladder

Answer

A nephrostomy tube draining the right renal pelvis

Answer

A ureteric calculus obstructing the right ureter

Question 8

During evaluation of a male child with recurrent UTI, VCUG is performed and the following finding is observed. What is the diagnosis?

Accepted Answer

Posterior urethral valves

Answer

Ureterocele

Answer

Ectopic ureter

Answer

Hydronephrosis

Question 9

The radiographic image shows a double-J stent in the urinary tract. Which procedure routinely uses a double-J stent to splint a ureteropelvic anastomosis?

Accepted Answer

Pyeloplasty

Answer

PCNL

Answer

ESWL

Answer

Ureteroscopy (URS)

Question 10

Which of the following uroflowmetry recording indicates bladder outlet obstruction?

Accepted Answer

Curve 3

Answer

Curve 1

Answer

Curve 2

Answer

Curve 4

Urology — MCQs

Urology — MCQs

On this page

Practice by Chapter

Want unlimited practice?