Urology Practice Questions

Q: Consider the following statements in respect of prostatic carcinoma : 1. Most originate from peripheral zone 2. Prostatic needle biopsy is better performed under trans rectal ultrasound 3. Prostate specific antigen is the specific test 4. L.H.R.H. analogues are used as medical treatment for metastatic disease Which of the statements given above is/are correct ?

1, 2 and 4. ***1, 2 and 4*** - **Most prostatic carcinomas originate from the peripheral zone** (approximately 70%), making this statement correct. This zone is palpable on digital rectal examination. - **Prostatic needle biopsy is indeed better performed under transrectal ultrasound (TRUS) guidance**, which allows for targeted and accurate sampling of suspicious areas. - **LHRH (Luteinizing Hormone-Releasing Hormone) analogues are a cornerstone of medical treatment for metastatic prostate cancer** as they suppress testosterone production, which fuels tumor growth. *1 and 3* - While statement 1 is correct (most prostate cancers originate from the peripheral zone), **prostate-specific antigen (PSA) is not a specific test** for prostate cancer. - **Elevated PSA can be caused by various conditions** such as benign prostatic hyperplasia (BPH), prostatitis, and even normal aging, making it a marker for prostate health rather than a definitive diagnostic test for cancer. *1 and 2 only* - Statements 1 and 2 are correct individually, but this option **incorrectly excludes statement 4**, which is also correct regarding the use of LHRH analogues in metastatic disease. - Therefore, this option is incomplete as it misses a true statement about prostate cancer management. *2, 3 and 4* - This option is incorrect because **statement 3 regarding PSA being a specific test is false**. - While PSA is used for screening and monitoring, its lack of specificity means it cannot definitively diagnose cancer.

Q: A patient is diagnosed to have a Stage T3a carcinoma of the prostate. Clinically, this implies

Extraprostatic extension through the prostatic capsule. ***Extraprostatic extension through the prostatic capsule*** - **T3a prostate cancer** indicates **extraprostatic extension** of the tumor, meaning it has grown beyond the boundaries of the prostate capsule [1]. - This stage specifically denotes microscopic or macroscopic extension through the capsule but without involvement of seminal vesicles or other adjacent structures [1]. *Involvement of the pelvic wall* - **Pelvic wall involvement** signifies a more advanced stage, typically **T4**, where the tumor has invaded adjacent organs or structures beyond the seminal vesicles. - This description goes beyond the definition of a T3a tumor, which is contained within the immediate periprostatic tissue. *Involvement of the seminal vesicles* - **Seminal vesicle invasion** is classified as **T3b** in the TNM staging system for prostate cancer, differentiating it from T3a [1]. - T3a specifically excludes seminal vesicle involvement, focusing solely on extraprostatic extension [1]. *Involvement of both the lobes but the disease is limited to within the prostatic capsule* - **Involvement of both lobes** while remaining within the prostatic capsule is characteristic of a **T2c** stage prostate cancer. - T3a implies extension *beyond* the capsule, which contradicts the statement that the disease is limited to within it.

Q: In a patient with stage T1 (tumor invading lamina propria) transitional cell carcinoma of the urinary bladder, the recommended treatment is

Trans urethral resection of bladder tumour (TURBT). ***Trans urethral resection of bladder tumour (TURBT)*** - For **stage 1 (confined to mucosa and submucosa) transitional cell carcinoma** of the urinary bladder, TURBT is the primary and often curative treatment. - This procedure allows for both diagnostic staging and complete resection of visible tumors. *Radiation therapy* - **Radiation therapy** is generally reserved for more advanced stages or for patients who are not surgical candidates. - It is often used in combination with chemotherapy or as a palliative measure, not typically as monotherapy for early-stage disease. *Systemic chemotherapy* - **Systemic chemotherapy** is typically indicated for advanced, metastatic bladder cancer or as neoadjuvant/adjuvant therapy in muscle-invasive disease. - It is not the primary treatment for early-stage, non-muscle invasive bladder cancer. *Radical cystectomy* - **Radical cystectomy** is a major surgical procedure involving removal of the entire bladder and surrounding structures. - It is reserved for **muscle-invasive bladder cancer** or recurrent high-grade non-muscle invasive bladder cancer that has failed conservative treatments.

Q: Renal carcinoma with solitary lung secondary is best treated by

surgery. ***Surgery*** - For **renal cell carcinoma** with a **solitary lung metastasis**, surgical resection of both the primary tumor (nephrectomy) and the lung metastasis is often the preferred treatment and offers the best chance for long-term survival. - This approach is particularly effective when the patient has a good performance status, the primary tumor is controlled, and the metastasis is truly solitary and resectable. *Chemotherapy* - **Renal cell carcinoma** is classically considered **chemotherapy-resistant**, meaning traditional chemotherapy agents generally have limited efficacy. - While some newer targeted therapies and immunotherapies are used, conventional chemotherapy is not the first-line treatment for metastatic RCC, especially when surgical options are available. *Immunotherapy* - **Immunotherapy** (e.g., nivolumab, pembrolizumab) is a common treatment for advanced or metastatic renal cell carcinoma, particularly when surgery is not feasible or after recurrence. - However, for a **solitary resectable metastasis**, it is typically considered after surgery, or in cases where surgery is contraindicated, rather than as a primary curative approach. *Radiotherapy* - **Radiotherapy** has a limited role in the primary treatment of renal cell carcinoma due to its relative radioresistance, though it can be used for palliative purposes (e.g., pain control, brain metastases). - For a solitary lung metastasis, while **stereotactic body radiation therapy (SBRT)** might be considered in select cases where surgery is not possible, surgical resection remains the gold standard for resectable lesions.

Q: A man falls astride a penetrating object. He develops retention of urine, perineal hematoma and bleeding from urinary meatus. The nature of injury would be

rupture of bulbar urethra. ***Rupture of bulbar urethra*** - An injury from falling astride a penetrating object, causing symptoms like **retention of urine**, **perineal hematoma**, and **bleeding from the urinary meatus**, is highly indicative of a **bulbar urethral rupture**. - The **bulbar urethra** is particularly vulnerable to crush injuries against the **pubic symphysis** in astride falls, leading to extravasation of urine and blood into the perineum. *Intraperitoneal rupture of bladder* - This typically occurs from a **direct blow to the lower abdomen** when the bladder is full, resulting in release of urine into the **peritoneal cavity**. - Symptoms would include generalized **abdominal pain**, **rebound tenderness**, and **peritonitis-like signs**, rather than localized perineal hematoma. *Rupture of membranous urethra* - A rupture of the **membranous urethra** is typically associated with **pelvic fractures** and is usually **above the urogenital diaphragm**. - While it can cause hematoma, the extravasation of urine and blood would more commonly track into the **retropubic space** and potentially the anterior abdominal wall, not primarily the perineum. *Extraperitoneal rupture of bladder* - This often results from **pelvic fractures** and is characterized by urine leaking into the **prevesical space**. - Symptoms include **suprapubic pain** and tenderness, but a perineal hematoma and meatal bleeding are less typical in isolation for this type of injury.

Q: A 70 year old man comes to Emergency with pain lower abdomen and not passing urine for eight hours. He has a past history of urgency, hesitancy and frequency of urine. On examination, he has a lump up to the umbilicus which is slightly tender. What is the next step of management?

Per urethral catheterise the patient. ***Per urethral catheterise the patient*** - The patient presents with **acute urinary retention**, indicated by the inability to pass urine for eight hours and a tender palpable bladder up to the umbilicus. - **Catheterization** is the immediate and most effective way to relieve bladder distension, pain, and prevent potential kidney damage. *Get an urgent USG* - While a **ultrasound** can confirm bladder distention and identify underlying causes, it is not the immediate priority. - Relieving the obstruction takes precedence over diagnostic imaging in **acute urinary retention**. *Start antibiotics* - There are no specific signs of infection (e.g., fever, dysuria) to necessitate **immediate antibiotic administration**. - While urinary retention can increase the risk of infection, **antibiotics** should be reserved for confirmed infections or as prophylaxis after catheterization in high-risk patients. *Per rectal examination* - A **per rectal examination** would be performed as part of the initial assessment to evaluate the prostate in a male patient with urinary symptoms. - However, it does not directly address the immediate need to relieve the **urinary obstruction** in acute retention.

Q: Anderson‐Hynes operation is performed for:

Pelvi-ureteric junction obstruction. ***Pelvi-ureteric junction obstruction*** - The **Anderson-Hynes pyeloplasty** is a widely used surgical procedure to correct obstruction at the **pelvi-ureteric junction (PUJ)**. - This operation involves **resecting the stenotic (narrowed) or obstructed part of the renal pelvis and ureter** and then rejoining the healthy segments to restore normal urine flow. *Pseudo-pancreatic cyst* - Management of a **pseudopancreatic cyst** typically involves percutaneous drainage, endoscopic transmural drainage, or surgical cyst-gastrostomy or cyst-jejunostomy. - The **Anderson-Hynes operation** is not indicated for this condition, which is a complication of pancreatitis. *Achalasia cardia* - **Achalasia cardia** is a disorder of esophageal motility, primarily treated with procedures like **Heller myotomy** (surgical cutting of the lower esophageal sphincter muscle) or pneumatic dilation. - The **Anderson-Hynes procedure** is entirely unrelated to the esophagus or its disorders. *Pyloric stenosis* - **Pyloric stenosis** in infants is generally treated with a **Ramstedt pyloromyotomy**, which involves surgically incising the hypertrophied pyloric muscle without opening the mucosa. - This condition involves the stomach outlet, and therefore, the **Anderson-Hynes operation** is not relevant.

Q: Which of the following is NOT true regarding ‘Renal Carbuncle’?

It is a type of renal tuberculosis. A **renal carbuncle** is essentially a **renal abscess** caused by bacterial infection, typically *Staphylococcus aureus* or *Escherichia coli*, not *Mycobacterium tuberculosis*. Renal tuberculosis manifests differently, often with **sterile pyuria** and granulomatous inflammation, and is not synonymous with a carbuncle. Patients with **diabetes mellitus** are at an increased risk of developing bacterial infections, including **renal carbuncles**, due to impaired immune function and glucose-rich urine. Poorly controlled diabetes is a significant **predisposing factor** for severe renal infections. **Intravenous drug users** are at higher risk of bloodstream infections, including **septic emboli** that can disseminate to the kidneys and form renal carbuncles. **Skin contaminants** and unsterile injection practices can introduce bacteria into the bloodstream that eventually localize in renal tissue. A **renal carbuncle** is defined as a focal collection of **pus** and necrotic tissue within the renal parenchyma, essentially a **renal abscess**. It results from the **hematogenous spread** of bacteria or, less commonly, from an ascending urinary tract infection [1].

Q: Which one of the following is NOT correct regarding Adenocarcinoma of the kidney ?

It always presents with haematuria. ***It always presents with haematuria*** - This statement is incorrect because **renal cell carcinoma** (adenocarcinoma of the kidney) often remains asymptomatic until a late stage, meaning **hematuria** is not always present, especially in early disease [1]. - While hematuria is a common symptom in later stages, occurring in about 60% of cases, its absence does not rule out the diagnosis, and many tumors are found incidentally [1]. *It may be associated with Pyrexia of unknown origin* - **Renal cell carcinoma** can produce various paraneoplastic syndromes, including **pyrexia of unknown origin (PUO)** [2]. - The tumor may release **pyrogenic cytokines** that lead to unexplained fever, making this a recognized systemic manifestation. *Renal vein extention may embolize to lungs* - **Renal cell carcinoma** has a propensity to invade the **renal vein** and extend into the inferior vena cava. - Tumor thrombi can then break off and travel to the lungs, resulting in **pulmonary embolism** of tumor cells or even macroscopic tumor emboli. *It is also called Grawitz tumour* - **Grawitz tumor** is an older, historical term used to refer to **renal cell carcinoma**, particularly the clear cell subtype. - This name originated from Paul Grawitz, who first described the tumor's histological features.

Q: Which of the following are correct about ectopic ureters? 1. They are more common in males 2. They drain the upper pole of kidney 3. They are associated with duplex ureter 4. They may cause incontinence

2, 3 and 4. ***2, 3 and 4*** - **Statement 2 is correct:** Ectopic ureters in duplex systems typically drain the **upper pole moiety** of the kidney (Weigert-Meyer rule) - **Statement 3 is correct:** Ectopic ureters are most commonly associated with **complete ureteral duplication** (duplex collecting system) - **Statement 4 is correct:** Ectopic ureters can cause **continuous urinary incontinence**, especially in females when insertion is below the sphincter mechanism (vagina, urethra, vestibule) - **Statement 1 is incorrect:** Ectopic ureters are **more common in females** (approximately 80% of cases), not males *1, 2 and 4* - Incorrectly includes statement 1 - ectopic ureters are **more common in females**, not males *1, 2 and 3* - Incorrectly includes statement 1 - ectopic ureters are **more common in females**, not males - Missing statement 4, which is correct - ectopic ureters **do cause incontinence** *1, 2, 3 and 4* - Incorrectly includes statement 1 - ectopic ureters are **more common in females**, not males

Question 1

Consider the following statements in respect of prostatic carcinoma :

1. Most originate from peripheral zone
2. Prostatic needle biopsy is better performed under trans rectal ultrasound
3. Prostate specific antigen is the specific test
4. L.H.R.H. analogues are used as medical treatment for metastatic disease Which of the statements given above is/are correct ?

Accepted Answer

1, 2 and 4

Answer

1 and 3

Answer

1 and 2 only

Answer

2, 3 and 4

Question 2

A patient is diagnosed to have a Stage T3a carcinoma of the prostate. Clinically, this implies

Accepted Answer

Extraprostatic extension through the prostatic capsule

Answer

Involvement of the pelvic wall

Answer

Involvement of the seminal vesicles

Answer

Involvement of both the lobes but the disease is limited to within the prostatic capsule

Question 3

In a patient with stage T1 (tumor invading lamina propria) transitional cell carcinoma of the urinary bladder, the recommended treatment is

Accepted Answer

Trans urethral resection of bladder tumour (TURBT)

Answer

Radiation therapy

Answer

Systemic chemotherapy

Answer

Radical cystectomy

Question 4

Renal carcinoma with solitary lung secondary is best treated by

Accepted Answer

surgery

Answer

chemotherapy

Answer

immunotherapy

Answer

radiotherapy

Question 5

A man falls astride a penetrating object. He develops retention of urine, perineal hematoma and bleeding from urinary meatus. The nature of injury would be

Accepted Answer

rupture of bulbar urethra

Answer

intraperitoneal rupture of bladder

Answer

rupture of membranous urethra

Answer

extraperitoneal rupture of bladder

Question 6

A 70 year old man comes to Emergency with pain lower abdomen and not passing urine for eight hours. He has a past history of urgency, hesitancy and frequency of urine. On examination, he has a lump up to the umbilicus which is slightly tender. What is the next step of management?

Accepted Answer

Per urethral catheterise the patient

Answer

Get an urgent USG

Answer

Start antibiotics

Answer

Per rectal examination

Question 7

Anderson‐Hynes operation is performed for:

Accepted Answer

Pelvi-ureteric junction obstruction

Answer

Pseudo-pancreatic cyst

Answer

Achalasia cardia

Answer

Pyloric stenosis

Question 8

Which of the following is NOT true regarding ‘Renal Carbuncle’?

Accepted Answer

It is a type of renal tuberculosis

Answer

It occurs in diabetic patient

Answer

It occurs in intravenous drug abusers

Answer

It is an abscess in renal parenchyma

Question 9

Which one of the following is NOT correct regarding Adenocarcinoma of the kidney ?

Accepted Answer

It always presents with haematuria

Answer

It may be associated with Pyrexia of unknown origin

Answer

Renal vein extention may embolize to lungs

Answer

It is also called Grawitz tumour

Question 10

Which of the following are correct about ectopic ureters?

1. They are more common in males
2. They drain the upper pole of kidney
3. They are associated with duplex ureter
4. They may cause incontinence

Accepted Answer

2, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

1, 2, 3 and 4

Urology — MCQs

Urology — MCQs

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