Urology — MCQs

Urology Indian Medical PG Practice Questions and MCQs

Question 591: Which of the following statements about the prostate is incorrect?

A. Benign prostatic hyperplasia is common in the peripheral zone. (Correct Answer)
B. The normal adult prostate weighs around 20 grams.
C. Carcinomas are more common in the peripheral zone.
D. PSA is a sensitive marker in prostate pathology but lacks specificity.

Explanation: **Explanation:** The prostate gland is anatomically divided into distinct zones (McNeal’s classification), which is a high-yield concept for NEET-PG. **1. Why Option A is the Correct Answer (Incorrect Statement):** Benign Prostatic Hyperplasia (BPH) primarily originates in the **Transition Zone**, which surrounds the proximal urethra. This is why BPH typically presents with obstructive urinary symptoms early on. The **Peripheral Zone** is the site where approximately 70-80% of prostate cancers originate, not BPH. **2. Analysis of Other Options:** * **Option B:** The normal adult prostate is roughly the size of a walnut and weighs approximately **18–20 grams**. Significant increase in this weight is a diagnostic feature of BPH. * **Option C:** Prostate **adenocarcinoma** has a strong predilection for the **Peripheral Zone**. Because this zone is located posteriorly, these tumors are often palpable during a Digital Rectal Examination (DRE). * **Option D:** Prostate-Specific Antigen (PSA) is organ-specific but **not cancer-specific**. While it is a sensitive marker for monitoring prostate pathology, its specificity is low because levels can rise due to BPH, prostatitis, urinary tract infections, or even recent instrumentation (e.g., catheterization). **Clinical Pearls for NEET-PG:** * **Transition Zone:** Site of BPH. * **Peripheral Zone:** Site of Carcinoma and Prostatitis. * **Central Zone:** Surrounds the ejaculatory ducts; least likely to develop primary pathology. * **PSA Velocity:** A rise of >0.75 ng/mL per year is highly suggestive of malignancy, even if the absolute value is within the normal range (<4 ng/mL).

Question 592: Psammoma bodies are typically seen in which of the following conditions?

A. Follicular carcinoma of the thyroid (Correct Answer)
B. Papillary carcinoma of the thyroid
C. Serous cystadenocarcinoma of the ovary
D. Meningioma

Explanation: **Explanation** Psammoma bodies are round, microscopic calcifications with a concentric "laminated" or "onion-skin" appearance. They represent a process of dystrophic calcification occurring in necrotic tumor cells. **Why the Correct Answer is Right:** Wait—there is a critical correction needed based on standard pathology: **Psammoma bodies are NOT typically seen in Follicular Carcinoma of the Thyroid.** In fact, the absence of Psammoma bodies is a distinguishing feature of Follicular Carcinoma. They are most classically associated with **Papillary Carcinoma of the Thyroid**. *Note: If the question provided identifies Option A as correct, it is likely a "negative" question or a common distractor error in mock banks. In standard medical literature, Psammoma bodies are the hallmark of Papillary, not Follicular, carcinoma.* **Analysis of Options:** * **Papillary Carcinoma of the Thyroid (Option B):** The most common site for Psammoma bodies in the endocrine system. They are found in the cores of the papillae. * **Serous Cystadenocarcinoma of the Ovary (Option C):** Psammoma bodies are a classic finding in serous tumors of the ovary and are used to differentiate them from mucinous tumors. * **Meningioma (Option D):** These are frequently seen in the psammomatous variant of meningiomas. **High-Yield Clinical Pearls (Mnemonic: PSaMMoma):** To remember the conditions associated with Psammoma bodies, use the mnemonic **PSaMMoma**: 1. **P** - **P**apillary carcinoma of thyroid 2. **S** - **S**erous cystadenocarcinoma of ovary 3. **M** - **M**esothelioma 4. **M** - **M**eningioma **NEET-PG Key Fact:** If you see "Orphan Annie eye nuclei" and "Psammoma bodies" in a thyroid case, the diagnosis is always **Papillary Carcinoma**. Follicular carcinoma is characterized by capsular or vascular invasion, not Psammoma bodies.

Question 593: Which one of the following statements is true of an undescended testis?

A. Usually descends spontaneously at puberty.
B. Orchiopexy is to be done if no descent by puberty.
C. Has a higher incidence of malignancy. (Correct Answer)
D. Maintains normal sperm production.

Explanation: **Explanation:** **Correct Answer: C. Has a higher incidence of malignancy.** Undescended testis (Cryptorchidism) is associated with a **4 to 10 times higher risk** of developing testicular germ cell tumors (most commonly **Seminoma**). This risk is attributed to the higher core body temperature in the inguinal canal or abdomen, which leads to dysplastic changes in the germ cells. Notably, orchiopexy does not eliminate the risk of malignancy but makes the testis accessible for clinical examination and early detection. **Analysis of Incorrect Options:** * **Option A:** Spontaneous descent is common in the first few months of life but is **rare after 6 months of age**. If the testis has not descended by 6 months, it is unlikely to do so at puberty. * **Option B:** Current surgical guidelines recommend Orchiopexy be performed between **6 to 12 months of age**. Delaying surgery until puberty increases the risk of infertility and malignancy significantly. * **Option C:** Cryptorchidism leads to **impaired spermatogenesis** due to the higher thermal environment. Histological changes (reduced Leydig cells and fibrosis) begin as early as 1 year of age. While testosterone production (Leydig cell function) is often preserved, sperm production is usually subnormal. **High-Yield Facts for NEET-PG:** * **Most common site:** Inguinal canal. * **Most common tumor in undescended testis:** Seminoma. * **Most common tumor in a previously corrected (orchiopexy) testis:** Seminoma. * **Risk of Malignancy:** Highest in abdominal testes (1 in 20). * **Contralateral Risk:** The normally descended testis in a patient with unilateral cryptorchidism also carries an increased risk of malignancy.

Question 594: Circumcision cannot be used in the management of which of the following conditions?

A. Phimosis
B. Severe balanitis xerotica obliterans
C. Paraphimosis
D. Penile cancer (Correct Answer)

Explanation: **Explanation** The correct answer is **Penile cancer**. In the management of penile cancer, circumcision is insufficient as a definitive treatment. The standard of care involves wide local excision, partial penectomy, or total penectomy depending on the stage, often accompanied by inguinal lymph node dissection. Performing a simple circumcision in the presence of malignancy risks leaving behind positive margins and violating oncological principles. **Analysis of Options:** * **Phimosis:** This is the primary indication for circumcision. It involves the inability to retract the prepuce over the glans. Circumcision is the definitive surgical cure. * **Severe Balanitis Xerotica Obliterans (BXO):** Also known as Lichen Sclerosus, this is a chronic inflammatory condition. Circumcision is the treatment of choice as it removes the diseased preputial tissue, which is often the source of the pathology. * **Paraphimosis:** This is a urological emergency where the retracted foreskin becomes trapped behind the glans. While initial management involves manual reduction, a formal circumcision is recommended later to prevent recurrence. **Clinical Pearls for NEET-PG:** * **Contraindications to Circumcision:** The most important absolute contraindication is **Hypospadias**, as the prepuce is required for future reconstructive skin flaps (urethroplasty). Other contraindications include chordee and bleeding diathesis. * **BXO Association:** BXO is a premalignant condition; if left untreated, it can progress to Squamous Cell Carcinoma (SCC) of the penis. * **Protective Factor:** Neonatal circumcision is known to significantly reduce the lifetime risk of developing penile cancer and HIV transmission.

Question 595: Which of the following statements is not true regarding Familial adenomatous polyposis?

A. It follows an autosomal dominant pattern of inheritance.
B. Screening is typically performed using sigmoidoscopy.
C. Polyps tend to develop in late adulthood. (Correct Answer)
D. Epidermoid cysts and osteomas may be associated findings.

Explanation: **Explanation** **Familial Adenomatous Polyposis (FAP)** is an autosomal dominant condition caused by a germline mutation in the **APC (Adenomatous Polyposis Coli) gene** on chromosome 5q21. **Why Option C is the correct answer (The False Statement):** Polyps in FAP do **not** develop in late adulthood. Instead, they typically appear in the **second decade of life** (teens). By age 35, nearly 95% of patients have developed hundreds to thousands of adenomatous polyps. If left untreated (without prophylactic colectomy), the risk of progression to colorectal cancer is virtually 100% by age 40–50. **Analysis of Incorrect Options:** * **Option A:** FAP follows an **autosomal dominant** inheritance pattern. A child of an affected parent has a 50% chance of inheriting the mutation. * **Option B:** Screening starts early (age 10–12 years). Since polyps in FAP are distributed throughout the colon but are almost always present in the rectum, **annual flexible sigmoidoscopy** is the standard screening tool until polyps are detected. * **Option D:** FAP can present with extra-colonic manifestations. When associated with **epidermoid cysts, osteomas** (usually of the mandible), and soft tissue tumors (desmoids), it is known as **Gardner’s Syndrome**. **High-Yield Clinical Pearls for NEET-PG:** * **CHRPE:** Congenital Hypertrophy of Retinal Pigment Epithelium is the earliest detectable sign of FAP. * **Turcot Syndrome:** FAP/HNPCC associated with CNS tumors (Medulloblastoma/Glioma). * **Duodenal Adenoma:** The most common extra-colonic malignancy in FAP patients post-colectomy (Periampullary carcinoma). * **Management:** Total proctocolectomy with Ileal Pouch-Anal Anastomosis (IPAA) is the surgery of choice.

Question 596: Prostate Specific Antigen (PSA) is specific to which of the following conditions?

A. Benign Prostatic Hyperplasia (BPH)
B. Prostatitis
C. Prostatic cancer
D. All of the above (Correct Answer)

Explanation: **Explanation:** The core concept to understand for NEET-PG is that **Prostate Specific Antigen (PSA)** is **organ-specific, but not disease-specific.** It is a serine protease produced by the columnar epithelium of the prostatic ducts and acini, intended to liquefy the seminal coagulum. 1. **Why "All of the above" is correct:** Any condition that disrupts the normal architecture of the prostate gland allows PSA to leak into the systemic circulation. * **Prostatic Cancer:** Malignant cells produce PSA, and the disruption of the basement membrane leads to significant elevations. * **BPH:** An enlarged prostate has more epithelial cells producing PSA; generally, for every 1 gram of BPH tissue, serum PSA rises by 0.3 ng/mL. * **Prostatitis:** Inflammation and infection cause "leakage" of PSA into the blood, often causing the highest acute spikes in levels. 2. **Clinical Nuances:** * **Option A & B:** While these are benign, they frequently cause elevated PSA, leading to diagnostic dilemmas. This is why a single elevated PSA reading is never definitive for cancer. * **Option C:** While PSA is the primary screening tool for prostate cancer, it lacks the specificity to be used in isolation. **High-Yield Clinical Pearls for NEET-PG:** * **Normal Range:** 0–4 ng/mL. * **PSA Velocity:** A rise of **>0.75 ng/mL per year** is highly suggestive of malignancy, even if the total value is <4 ng/mL. * **Free-to-Total PSA Ratio:** A ratio **<10%** suggests cancer, while **>25%** suggests BPH. * **Factors that increase PSA:** DRE (minor), Prostatitis, Ejaculation, Cystoscopy, and Prostate Biopsy. * **Factors that decrease PSA:** 5-alpha reductase inhibitors (Finasteride/Dutasteride) can reduce PSA levels by **50%**; therefore, the measured value should be doubled for accurate screening.

Question 597: What is the most common cause of hydronephrosis in children?

A. Ureterocoele
B. Ureteric stricture
C. Watermelon prostate
D. Congenital PUJ obstruction (Correct Answer)

Explanation: **Explanation:** **Congenital Pelvi-Ureteric Junction (PUJ) Obstruction** is the most common cause of hydronephrosis in children and the most frequent cause of an abdominal mass in neonates. It occurs due to an anatomical or functional impairment of urine flow from the renal pelvis into the ureter. The most common underlying mechanism is an **aperistaltic segment** at the PUJ, though extrinsic compression by an accessory (aberrant) lower pole renal artery is also a significant cause. **Analysis of Options:** * **Ureterocoele (Option A):** This is a cystic dilatation of the distal intramural ureter. While it can cause hydroureteronephrosis, it is far less common than PUJ obstruction. * **Ureteric stricture (Option B):** These are usually acquired (post-inflammatory or post-surgical) and are rare in the pediatric population compared to congenital anomalies. * **Watermelon prostate (Option C):** This is a distractor term. "Watermelon stomach" (GAVE) is a clinical entity, but there is no such standard term for the prostate. Furthermore, prostatic pathologies typically cause bilateral hydronephrosis due to bladder outlet obstruction. **High-Yield Clinical Pearls for NEET-PG:** * **Presentation:** Most cases are now detected on **antenatal ultrasound**. Postnatally, it may present as a palpable flank mass or episodic loin pain (Dietl’s crisis) after increased fluid intake. * **Investigation of Choice:** **DTPA or MAG-3 scan** (Diuretic renogram) is used to assess the functional severity and drainage pattern. * **Surgical Gold Standard:** **Anderson-Hynes Dismembered Pyeloplasty** (can be open, laparoscopic, or robotic). * **Key Association:** If hydronephrosis is **bilateral** in a male infant, always suspect **Posterior Urethral Valves (PUV)** first.

Question 598: Malignant change in a retroperitoneal lipoma may present with which of the following?

A. Asymptomatic presentation
B. Renal failure
C. Abdominal pain
D. All of the above (Correct Answer)

Explanation: **Explanation:** Retroperitoneal liposarcomas (the malignant transformation of lipomatous tissue) are the most common primary retroperitoneal sarcomas. Their clinical presentation is dictated by their anatomical location and their tendency to grow to a massive size before detection. 1. **Asymptomatic presentation:** Because the retroperitoneum is a large, compliant space, these tumors often grow silently. They are frequently discovered incidentally during imaging for unrelated complaints. 2. **Abdominal pain:** As the tumor enlarges, it stretches the peritoneum or exerts pressure on adjacent viscera and nerves, leading to vague abdominal discomfort, a sense of fullness, or chronic pain. 3. **Renal failure:** Due to their retroperitoneal location, these tumors can compress the ureters (obstructive uropathy) or the renal vasculature. Bilateral involvement or compression of a solitary functioning kidney can lead to post-renal azotemia and renal failure. Since the tumor can manifest in any of these ways depending on its size and local invasion, **"All of the above"** is the correct choice. **High-Yield Facts for NEET-PG:** * **Most common subtype:** Well-differentiated liposarcoma is the most frequent, though dedifferentiated subtypes have a poorer prognosis. * **Imaging of choice:** Contrast-Enhanced CT (CECT) is the gold standard for assessing size, fat content, and anatomical relationships. * **Management:** Wide surgical excision (often involving "compartmental resection" of adjacent organs like the kidney or colon) is the primary treatment. * **Recurrence:** These tumors have a very high rate of local recurrence, even after seemingly complete surgical resection.

Question 599: Lord's plication is done for which of the following conditions?

A. Inguinal hernia
B. Testicular cancer
C. Hydrocele (Correct Answer)
D. Testicular varices

Explanation: **Explanation:** **Lord’s Plication** is a surgical technique used specifically for the treatment of a **primary vaginal hydrocele**. The procedure is indicated when the hydrocele sac is thin-walled. Unlike the Jaboulay’s procedure (which involves eversion of the sac), Lord’s plication involves making an incision into the sac, draining the fluid, and then bunching up (plicating) the redundant tunica vaginalis using a series of interrupted absorbable sutures. This prevents the re-accumulation of fluid without the need for extensive dissection, thereby reducing the risk of postoperative hematoma. **Analysis of Incorrect Options:** * **A. Inguinal Hernia:** Managed via herniotomy (in children) or lichenstein tension-free mesh repair (in adults). * **B. Testicular Cancer:** The gold standard treatment is **Radical High Inguinal Orchidectomy**. Scrotal approaches are contraindicated to avoid altering lymphatic drainage. * **D. Testicular Varices (Varicocele):** Managed via surgical ligation of the pampiniform plexus (e.g., Palomo’s or Ivanissevich procedure) or microsurgical subinguinal varicocelectomy. **Clinical Pearls for NEET-PG:** * **Jaboulay’s Procedure:** Preferred for **large, thick-walled hydroceles**; involves eversion and suturing the sac behind the testis. * **Lord’s Plication:** Best for **thin-walled hydroceles**; has the lowest incidence of postoperative hematoma. * **Transillumination Test:** The classic clinical sign for diagnosing a hydrocele. * **Aspiration:** Not recommended as a definitive treatment due to the high rate of recurrence and risk of infection.

Question 600: All of the following symptoms are seen in cystitis EXCEPT?

A. Fever (Correct Answer)
B. Hematuria
C. Dysuria
D. Nocturia

Explanation: **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 superficial mucosal inflammation of the bladder. Because the bladder mucosa lacks significant systemic absorption pathways for pyrogens, cystitis typically presents with **localizing symptoms** but **without systemic signs** like high-grade fever, chills, or rigors. The presence of fever in a patient with urinary symptoms strongly suggests that the infection has ascended to the kidneys (**Pyelonephritis**) or involves the prostate (**Prostatitis**). 2. **Analysis of other 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 bladder wall compliance and increases sensitivity to stretch, leading to the urge to void even at low volumes, both day and night. * **Hematuria:** "Hemorrhagic cystitis" is a well-known entity where mucosal friability leads to gross or microscopic hematuria. **Clinical Pearls for NEET-PG:** * **Triad of Cystitis:** Frequency, Urgency, and Dysuria. * **Pyelonephritis Triad:** Fever, Flank pain (Costo-vertebral angle tenderness), and Nausea/Vomiting. * **Most common organism:** *E. coli* (uropathogenic strains) remains the leading cause of both cystitis and pyelonephritis. * **Rule of Thumb:** If a patient has "cystitis symptoms" plus fever, always investigate for Pyelonephritis or an obstructed system (e.g., stone with infection).

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Renal Cell Carcinoma

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Testicular Tumors

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Urinary Incontinence

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