Urology Practice Questions

Q: Jack stone calculi are made up of which of the following?

Calcium oxalate. **Explanation:** **Jack stone calculi** are a specific morphological subtype of urinary stones, almost exclusively composed of **Calcium oxalate monohydrate**. The correct answer is **Calcium oxalate (Option D)**. These stones derive their name from their resemblance to the metal pieces used in the children's game "Jacks." They are characterized by a dense central core with multiple radiating spicules or "arms." Clinically, they are most commonly found in the **urinary bladder** and are typically associated with chronic bladder outlet obstruction or stasis. Their unique shape is thought to result from the jagged edges repeatedly hitting the bladder wall, breaking off fragile attachments while allowing the dense crystalline arms to grow. **Analysis of Incorrect Options:** * **A. Ammonium urate:** These are associated with malnutrition and chronic diarrhea; they typically form "hedgehog" stones but are not Jack stones. * **B. Uric acid:** These stones are radiolucent and usually smooth or faceted, forming in acidic urine. * **C. Struvite:** Also known as "Triple Phosphate" or "Infection stones," these are associated with Proteus infections and typically form large **Staghorn calculi** that fill the renal pelvis. **High-Yield Clinical Pearls for NEET-PG:** * **Composition:** Jack stones = Calcium oxalate monohydrate (Whewellite). * **Radiology:** They are **radio-opaque** due to their calcium content. * **Common Site:** Urinary bladder (rarely found in the upper urinary tract). * **Microscopy:** Calcium oxalate monohydrate crystals appear as **dumbbell-shaped**, whereas dihydrate crystals (Weddellite) appear as **envelope-shaped**.

Q: What is the investigation of choice for a ureteric stone?

CT scan. The investigation of choice for a ureteric stone is a **Non-Contrast Computed Tomography (NCCT) of the Kidney, Ureter, and Bladder (KUB)**. ### Why CT Scan is the Correct Answer NCCT KUB is the gold standard because it has the highest sensitivity (95-97%) and specificity (96-98%) for detecting urolithiasis. * **Detection:** It can identify almost all types of stones (including uric acid and xanthine stones, which are radiolucent on X-ray), except for rare indinavir stones. * **Secondary Signs:** It helps identify complications like hydroureteronephrosis, perinephric stranding, and the "rim sign" (edema around the stone). * **Planning:** It provides precise stone size, location, and **Hounsfield Units (HU)**, which helps predict stone hardness and the success of ESWL. ### Why Other Options are Incorrect * **USG (Ultrasonography):** While safe and radiation-free, it is operator-dependent and often misses small ureteric stones, especially in the mid-ureter, due to overlying bowel gas. It is the investigation of choice only in **pregnant women** and **children**. * **MIBG Scan:** This is a nuclear medicine study used to localize neuroendocrine tumors, specifically **pheochromocytoma** and neuroblastoma. It has no role in stone disease. * **DMSA Scan:** This is a static renal scan used to assess **functional renal cortical mass** and detect renal scarring (common in pediatric reflux or pyelonephritis). It does not visualize stones. ### High-Yield Clinical Pearls for NEET-PG * **Gold Standard:** NCCT KUB. * **Initial Investigation (Emergency):** USG + X-ray KUB (often used in clinical practice, though NCCT is the definitive choice). * **Investigation of choice in Pregnancy:** USG (1st line); MRI (2nd line, though stones are hard to see); Low-dose CT (last resort in 2nd/3rd trimester). * **Hardness Correlation:** Stones >1000 HU are generally resistant to ESWL.

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

Vas obstruction. **Explanation:** The clinical scenario describes **Obstructive Azoospermia**. The key to solving this is the triad of **azoospermia** (absence of sperm), **normal testicular volume**, and **normal hormonal profile** (FSH and Testosterone). 1. **Why Vas Obstruction is correct:** In obstructive azoospermia, the "machinery" (testis) is functioning perfectly, and the "fuel" (hormones) is adequate. Since FSH is normal, it indicates that spermatogenesis is occurring normally. The absence of sperm in the ejaculate is therefore due to a physical blockage in the exit pathway, most commonly in the epididymis or the vas deferens (e.g., post-inflammatory or congenital absence). 2. **Why other options are incorrect:** * **Non-descended testis:** Usually leads to testicular atrophy and impaired spermatogenesis due to higher intra-abdominal temperatures, often resulting in elevated FSH. * **Klinefelter’s Syndrome (47, XXY):** This is a form of primary testicular failure. It presents with **small, firm testes**, azoospermia, **elevated FSH/LH**, and low testosterone. * **Kallmann’s Syndrome:** This is hypogonadotropic hypogonadism. It presents with **low FSH/LH**, low testosterone, and small testes, often accompanied by anosmia. **NEET-PG High-Yield Pearls:** * **FSH is the best marker for spermatogenesis:** If FSH is >2x the upper limit of normal, it strongly suggests non-obstructive (primary) testicular failure. * **Normal FSH + Azoospermia + Normal Testis = Obstruction.** * **Most common site of obstruction:** Epididymis. * **Congenital Bilateral Absence of Vas Deferens (CBAVD):** Strongly associated with **CFTR gene mutations** (Cystic Fibrosis). Always check for the presence of the seminal vesicles and renal anomalies.

Q: Which of the following is NOT true about paraphimosis?

It is seen in patients with Diabetes Mellitus.. **Explanation:** **Paraphimosis** is a urological emergency where the prepuce (foreskin), once retracted behind the glans penis, cannot be reduced to its original position. This leads to a constricting ring that impairs venous and lymphatic drainage, causing edema and, if untreated, arterial compromise. **Why Option B is the Correct Answer (The False Statement):** While **Phimosis** (the inability to retract the foreskin) is strongly associated with Diabetes Mellitus due to recurrent balanoposthitis and scarring, **Paraphimosis** is not specifically a disease "seen in" or caused by Diabetes. It is a mechanical complication resulting from the failure to pull the foreskin back over the glans after retraction. **Analysis of Other Options:** * **Option A (Iatrogenic):** This is true. It often occurs in hospitals when a healthcare provider retracts the foreskin for catheterization or physical examination and forgets to replace it. * **Option C (Gangrene):** This is true. The constricting band causes progressive edema, which eventually leads to arterial occlusion, ischemia, and necrosis (gangrene) of the glans penis. * **Option D (Circumcision):** This is true. While the initial management involves manual reduction or the "Dorsal Slit" procedure, **circumcision** is the definitive elective treatment to prevent recurrence. **High-Yield Clinical Pearls for NEET-PG:** * **Emergency Management:** Manual compression to reduce edema followed by manual reduction. * **Dorsal Slit:** Indicated if manual reduction fails. * **Phimosis vs. Paraphimosis:** Phimosis is "cannot retract"; Paraphimosis is "cannot reduce." * **Key Risk Factor:** Chronic balanoposthitis (often in diabetics) leads to Phimosis, which is a prerequisite for Paraphimosis. However, the act of paraphimosis itself is an acute mechanical event.

Q: Which of the following local anesthetics is used in circumcision?

1% lignocaine without adrenaline. **Explanation:** The primary principle in choosing a local anesthetic for circumcision is the avoidance of vasoconstrictors. **1. Why 1% Lignocaine without Adrenaline is correct:** The penis is an anatomical structure supplied by **end-arteries**. The use of adrenaline (epinephrine) causes intense vasoconstriction of these terminal vessels. In the case of the penis, this can lead to prolonged ischemia, resulting in **gangrene and necrosis** of the distal tissue. Therefore, "plain" lignocaine is mandatory. 1% concentration is preferred over 2% to minimize the risk of systemic toxicity while providing adequate anesthesia for a dorsal nerve block or ring block. **2. Why the other options are incorrect:** * **Options B & C (With Adrenaline):** These are strictly contraindicated in surgeries involving "appendages" or areas with end-arterial supply (fingers, toes, nose, ears, and penis) due to the risk of ischemic necrosis. * **Option D (2% Lignocaine without Adrenaline):** While "without adrenaline" is correct, 2% lignocaine is generally avoided for routine circumcision blocks because the total dose required to achieve a circumferential block might approach toxic limits more quickly than the 1% concentration, especially in pediatric patients. **Clinical Pearls for NEET-PG:** * **Safe Sites for Adrenaline:** Scalp, trunk, and limbs (excluding digits). * **Maximum Dose of Lignocaine:** 4 mg/kg (without adrenaline) and 7 mg/kg (with adrenaline). * **Nerve Block for Circumcision:** The **Dorsal Penile Nerve Block (DPNB)** is the gold standard. The nerves are located in the sub-fascial space (deep to Buck’s fascia). * **Complication:** If accidental adrenaline injection occurs, the antidote is local infiltration of **Phentolamine** (an alpha-blocker) to induce vasodilation.

Q: Which of the following presents as a symptom of pelvic abscess?

Mucoid diarrhea. **Explanation:** A pelvic abscess typically occurs as a complication of appendicitis, pelvic inflammatory disease, or post-operative leakage. The correct answer is **Mucoid diarrhea** due to the anatomical proximity of the abscess to the rectum. **Why Mucoid Diarrhea is Correct:** The pelvic abscess rests in the Rectovesical pouch (in men) or the Pouch of Douglas (in women), directly abutting the anterior wall of the rectum. The inflammatory mass causes **biochemical and mechanical irritation** of the rectal mucosa. This irritation leads to: 1. **Tenesmus:** A constant, painful urge to defecate. 2. **Mucus Hypersecretion:** The irritated rectal lining produces excess mucus, which is passed as "spurious diarrhea" or mucoid stools. **Analysis of Incorrect Options:** * **A. Pain in the perineum:** While pelvic pathology can cause referred pain, it is not a classic diagnostic symptom of a localized pelvic abscess compared to rectal symptoms. * **C. Abdominal distension & D. Vomiting:** These are features of generalized peritonitis or intestinal obstruction. A pelvic abscess is a **localized** collection; unless it ruptures or causes a secondary paralytic ileus, these systemic obstructive symptoms are less characteristic than localized rectal irritation. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Contrast-Enhanced CT (CECT) of the abdomen and pelvis. * **Classic Physical Sign:** On **Digital Rectal Examination (DRE)**, one finds a tender, boggy swelling on the anterior rectal wall. * **Treatment:** Surgical drainage is required. This is often done via the route where the abscess is "pointing"—most commonly **transrectal drainage** (proctotomy) or transvaginal drainage (colpotomy). * **Mnemonic:** Remember the "Pelvic 3": **P**ain (suprapubic), **P**us (collection), and **P**oop (mucoid diarrhea/tenesmus).

Q: Which of the following statements is incorrect regarding the variables used to calculate the MELD score?

Serum albumin. The **MELD (Model for End-Stage Liver Disease)** score is a critical scoring system used to predict the 3-month mortality risk in patients with chronic liver disease and to prioritize patients for liver transplantation. ### Why Serum Albumin is the Correct Answer Serum albumin is **not** a component of the MELD score. While albumin is a marker of the liver's synthetic function and is included in the **Child-Pugh classification**, it was excluded from the original MELD formula because its levels can be easily influenced by external factors like intravenous albumin infusion or nutritional status, making it a less objective predictor of acute mortality compared to the other variables. ### Explanation of Incorrect Options The original MELD score is calculated using three objective laboratory variables: * **Serum Bilirubin (Option C):** Reflects the liver’s excretory function. * **INR (Option A):** Reflects the liver’s synthetic function (specifically coagulation factors). * **Serum Creatinine (Option D):** Reflects renal function, which is a powerful predictor of survival in patients with cirrhosis (e.g., Hepatorenal Syndrome). ### High-Yield Clinical Pearls for NEET-PG * **MELD-Na:** The modern version of the score now includes **Serum Sodium**, as hyponatremia is a strong independent predictor of mortality in waitlisted patients. * **PELD Score:** Used for children under 12 years; it includes Albumin, Bilirubin, INR, age (<1 year), and growth failure. * **Mnemonic for MELD:** "**I** **C**an **B**e **S**aved" (**I**NR, **C**reatinine, **B**ilirubin, **S**odium). * **Range:** Scores range from 6 to 40; a higher score indicates a higher priority for transplantation.

Question 1

Which of the following symptoms is NOT related to benign prostatic hyperplasia (BPH)?

Accepted Answer

Frequency

Answer

Dribbling

Answer

Poor flow

Answer

Intermittent stream

Question 2

Jack stone calculi are made up of which of the following?

Accepted Answer

Calcium oxalate

Answer

Ammonium urate

Answer

Uric acid

Answer

Struvite

Question 3

What is the investigation of choice for a ureteric stone?

Accepted Answer

CT scan

Answer

USG

Answer

MIBG scan

Answer

DMSA scan

Question 4

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

Accepted Answer

Vas obstruction

Answer

Non-descended testis

Answer

Klinefelter's syndrome

Answer

Kallmann's syndrome

Question 5

In carcinoma of the prostate, which of the following statements is false?

Accepted Answer

Skeletal metastases from prostate cancer are always osteolytic.

Answer

The histological type is an adenocarcinoma.

Answer

Gleason scoring system is based on the degree of glandular differentiation.

Answer

Prostate cancer is the commonest site for skeletal metastasis.

Question 6

Which of the following is NOT true about paraphimosis?

Accepted Answer

It is seen in patients with Diabetes Mellitus.

Answer

It can be iatrogenic.

Answer

It can lead to gangrene of the glans.

Answer

Circumcision is a treatment.

Question 7

Which of the following conditions is NOT considered precancerous?

Accepted Answer

Verrucous carcinoma

Answer

Lichen planus

Answer

Submucous fibrosis

Answer

Leukoplakia

Question 8

Which of the following local anesthetics is used in circumcision?

Accepted Answer

1% lignocaine without adrenaline

Answer

2% lignocaine with adrenaline

Answer

1% lignocaine with adrenaline

Answer

2% lignocaine without adrenaline

Question 9

Which of the following presents as a symptom of pelvic abscess?

Accepted Answer

Mucoid diarrhea

Answer

Pain in the perineum

Answer

Abdominal distension

Answer

Vomiting

Question 10

Which of the following statements is incorrect regarding the variables used to calculate the MELD score?

Accepted Answer

Serum albumin

Answer

Prothrombin time expressed as the international normalized ratio (INR)

Answer

Serum bilirubin

Answer

Serum creatinine

Urology — MCQs

Urology — MCQs

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