Urology — MCQs

Urology Indian Medical PG Practice Questions and MCQs

Question 611: A 30-year-old patient presents with scrotal swelling. Transillumination is positive, and a large hydrocoele is suspected. What is the preferred treatment?

A. Lord’s plication
B. Jaboulay's procedure (Correct Answer)
C. Excision of sac
D. Incision and drainage

Explanation: **Explanation:** The clinical presentation of a positive transillumination test in a 30-year-old male is diagnostic of a **primary vaginal hydrocele**. The surgical management of hydrocele is determined by the size and thickness of the tunica vaginalis sac. **Why Jaboulay’s Procedure is correct:** Jaboulay’s procedure (eversion of the sac) is the preferred treatment for **large hydroceles** where the sac is thin and lax. In this procedure, the sac is opened, redundant tissue is trimmed, and the edges are sutured behind the testis and spermatic cord. This allows the fluid to be absorbed by the scrotal lymphatics. **Analysis of Incorrect Options:** * **Lord’s Plication:** This is preferred for **small to medium-sized** hydroceles with a thin sac. The sac is not everted but gathered by multiple plicating sutures. It is less suitable for large sacs as it creates a bulky mass. * **Excision of Sac (Subtotal Excision):** This is reserved for **chronic, large hydroceles with a thick, calcified, or multilocular sac** where eversion is technically difficult. * **Incision and Drainage:** This is not a definitive treatment for hydrocele. Simple aspiration has a near 100% recurrence rate and carries a risk of infection/hematocele. **High-Yield Clinical Pearls for NEET-PG:** 1. **Gold Standard Diagnosis:** Clinical examination (Transillumination + "Getting above the swelling" is possible). 2. **Infantile Hydrocele:** Usually resolves spontaneously by 1-2 years of age. If it persists, the treatment of choice is **Herniotomy** (not hydrocelectomy) because it is a communicating type. 3. **Complication:** The most common complication of hydrocele surgery is a **scrotal hematoma**. 4. **Bergmann’s Operation:** Another term for the partial excision of the sac used in very thick-walled hydroceles.

Question 612: What is the most common carcinoma following renal transplantation?

A. Skin (Correct Answer)
B. Renal cell carcinoma
C. Lung
D. Adrenal carcinoma

Explanation: **Explanation:** The most common malignancy following solid organ transplantation, including renal transplantation, is **Skin Cancer**. **1. Why Skin Cancer is the correct answer:** Post-transplant patients require lifelong **immunosuppressive therapy** (e.g., Cyclosporine, Tacrolimus, Azathioprine) to prevent graft rejection. These drugs impair the body’s immunosurveillance against oncogenic viruses and UV-induced DNA damage. * **Squamous Cell Carcinoma (SCC)** is the most frequent subtype (unlike the general population where Basal Cell Carcinoma is more common). * The risk of SCC in transplant recipients is increased up to 65–100 times compared to the general population. **2. Analysis of Incorrect Options:** * **B. Renal Cell Carcinoma (RCC):** While there is an increased risk of RCC in the native kidneys (especially in patients with Acquired Cystic Kidney Disease), it is significantly less common than skin malignancies. * **C. Lung Cancer:** Although the risk of various solid tumors increases post-transplant due to immunosuppression, lung cancer does not reach the high incidence rates seen in skin cancers. * **D. Adrenal Carcinoma:** This is a rare malignancy and is not specifically associated with the post-renal transplant period. **3. High-Yield Facts for NEET-PG:** * **Most common malignancy overall:** Skin Cancer (SCC > BCC). * **Most common non-skin malignancy:** Post-Transplant Lymphoproliferative Disorder (PTLD), often associated with **EBV infection**. * **Kaposi Sarcoma:** Highly associated with **HHV-8** in transplant patients. * **Screening:** Transplant recipients require aggressive annual dermatological screening and strict sun protection.

Question 613: Which operation is typically done concurrently with a prostatectomy?

A. Vasectomy
B. Circumcision
C. Hernia repair
D. None of the above (Correct Answer)

Explanation: **Explanation:** The correct answer is **None of the above**. In modern surgical practice, there is no standard requirement to perform a concurrent procedure alongside a prostatectomy (whether for Benign Prostatic Hyperplasia or Prostate Cancer). **Why the options are incorrect:** * **Vasectomy (Option A):** Historically, bilateral vasectomy was performed during Open Prostatectomy (like Freyer’s or Millin’s) to prevent **retrograde spread of infection** and subsequent **acute epididymo-orchitis**. However, with the advent of potent broad-spectrum antibiotics and minimally invasive techniques (TURP, Robotic Prostatectomy), this is no longer a routine or mandatory practice. * **Circumcision (Option B):** This is only performed if the patient has symptomatic phimosis that interferes with catheterization or hygiene; it is not a standard concurrent step. * **Hernia Repair (Option C):** While an inguinal hernia may coexist with BPH due to chronic straining (increased intra-abdominal pressure), they are generally treated as separate surgical indications. While "combined" surgeries are possible, they are not "typically" or routinely done together as a standard of care. **High-Yield Clinical Pearls for NEET-PG:** * **Epididymo-orchitis:** The most common complication of prostatectomy that vasectomy aimed to prevent. * **Gold Standard:** Transurethral Resection of the Prostate (TURP) remains the gold standard for BPH surgical management. * **Retrograde Ejaculation:** The most common long-term complication following any form of prostatectomy (TURP or Open). * **Incontinence:** The most feared complication, usually due to damage to the external urethral sphincter.

Question 614: What is the most common presenting symptom of urinary bladder cancer?

A. Haematuria (Correct Answer)
B. Frequency
C. Dysuria
D. Abdominal lump

Explanation: **Explanation:** **Bladder cancer** is the most common malignancy of the urinary tract, with **Transitional Cell Carcinoma (TCC)**, also known as Urothelial Carcinoma, being the most frequent histological type. **Why Haematuria is the correct answer:** The hallmark presentation of bladder cancer is **painless, intermittent, gross (total) haematuria**. It occurs in approximately 85-90% of patients. The bleeding is typically "total," meaning blood is present throughout the entire stream of micturition, indicating a vesical or supra-vesical origin. Because it is often intermittent, patients may delay seeking medical attention, making it a critical "red flag" symptom in older adults (especially smokers). **Analysis of Incorrect Options:** * **B & C (Frequency and Dysuria):** These are "irritative" voiding symptoms. While they occur in about 20% of cases, they are more commonly associated with **Carcinoma in situ (CIS)** or secondary infections. They are usually secondary to the primary bleeding or tumor mass effect. * **D (Abdominal lump):** A palpable mass is a sign of **advanced, locally invasive disease**. It is a late finding and not a common initial presenting symptom. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Cystoscopy with biopsy is the definitive diagnostic tool. * **Initial Investigation of Choice:** Contrast-Enhanced CT (CECT) Urography. * **Risk Factors:** Smoking (most common), occupational exposure to aromatic amines (beta-naphthylamine), and *Schistosoma haematobium* (specifically associated with **Squamous Cell Carcinoma**). * **Rule of Thumb:** Any patient over 40 presenting with painless haematuria is considered to have a urological malignancy until proven otherwise.

Question 615: What is the recommended treatment for stage I bladder cancer?

A. Radical cystectomy
B. Endoscopic removal with intravesical chemotherapy (Correct Answer)
C. Systemic chemotherapy
D. Radiotherapy

Explanation: **Explanation:** Bladder cancer staging is primarily divided into **Non-Muscle Invasive Bladder Cancer (NMIBC)** and **Muscle Invasive Bladder Cancer (MIBC)**. Stage I (T1) involves the subepithelial connective tissue (lamina propria) but has not yet invaded the detrusor muscle. **Why Option B is Correct:** The standard of care for Stage I (T1) bladder cancer is **Transurethral Resection of Bladder Tumor (TURBT)**—the "endoscopic removal." Because T1 tumors have a high risk of recurrence and progression, TURBT is followed by **intravesical therapy** (e.g., BCG or Mitomycin C). This localized treatment eliminates residual microscopic disease and reduces the risk of recurrence while preserving the bladder. **Why Other Options are Incorrect:** * **A. Radical Cystectomy:** This is the gold standard for **Stage II (T2)** and above (Muscle Invasive disease). It is considered "over-treatment" for most Stage I cases, though it may be considered for "very high-risk" NMIBC that fails intravesical therapy. * **C. Systemic Chemotherapy:** This is reserved for metastatic disease (Stage IV) or as neoadjuvant therapy prior to radical surgery in muscle-invasive cases. * **D. Radiotherapy:** Usually reserved as part of a bladder-preserving protocol for MIBC in patients unfit for surgery, or for palliative care. **Clinical Pearls for NEET-PG:** * **Most common histological type:** Transitional Cell Carcinoma (Urothelial Carcinoma). * **Gold standard investigation:** Cystoscopy with biopsy. * **The "Rule of T2":** If the tumor reaches the muscle (T2), the treatment shifts from endoscopic (TURBT) to radical (Cystectomy). * **BCG Contraindication:** Do not administer intravesical BCG if there is gross hematuria or traumatic catheterization (risk of systemic BCG-osis).

Question 616: Which statement about Horseshoe Kidney is false?

A. Spider-like appearance in IVP
B. Ureteral obstruction is common
C. Lower calyx is reversed
D. Heminephrectomy improves function (Correct Answer)

Explanation: **Explanation:** Horseshoe kidney is the most common renal fusion anomaly, occurring when the lower poles of the kidneys fuse across the midline (isthmus). **Why Option D is the Correct (False) Statement:** Heminephrectomy (removal of one half of the kidney) is **not** a treatment to improve renal function. Surgery in horseshoe kidney is only indicated for complications such as symptomatic calculi, severe obstruction, or tumors. Dividing the isthmus (symphysiotomy) was historically performed but is now obsolete as it does not improve drainage or function and carries a high risk of hemorrhage and devascularization. **Analysis of Other Options:** * **Option A (Spider-like appearance):** Due to the failure of normal rotation (malrotation), the renal pelvis is anterior, and the calyces are directed medially and posteriorly. On Intravenous Pyelogram (IVP), this orientation creates a characteristic "spider-leg" or "hand-shaking" appearance. * **Option B (Ureteral obstruction):** This is common due to the high insertion of the ureter into the renal pelvis and the ureter crossing over the fused isthmus, often leading to Pelviureteric Junction (PUJ) obstruction. * **Option C (Lower calyx reversed):** Because the lower poles are fused and the kidney fails to rotate medially, the lower calyces point toward the midline (medially), which is the reverse of the normal lateral orientation. **High-Yield Clinical Pearls for NEET-PG:** * **Embryology:** The ascent of the horseshoe kidney is arrested by the **Inferior Mesenteric Artery (IMA)** at the level of L3. * **Associated Risks:** Increased incidence of **Renal Calculi** (stasis), **UTIs**, and specific tumors like **Wilms’ tumor** (in children) and **Transitional Cell Carcinoma**. * **Rovsing Sign:** Abdominal pain on hyperextension of the spine (rarely seen clinically but high-yield for exams).

Question 617: What is the investigation of choice for torsion testis?

A. Colour Doppler (Correct Answer)
B. MRI
C. CT
D. Routine USG

Explanation: **Explanation:** **Testicular Torsion** is a surgical emergency caused by the twisting of the spermatic cord, leading to venous occlusion followed by arterial compromise and testicular ischemia. **1. Why Colour Doppler is the Investigation of Choice (IOC):** The gold standard for diagnosing torsion is clinical evaluation; however, **Colour Doppler Ultrasonography** is the investigation of choice because it directly assesses **blood flow**. In torsion, the Doppler signal will show absent or significantly reduced arterial flow to the affected testis compared to the normal side. It is non-invasive, rapid, and has a high sensitivity (82–100%) and specificity. **2. Why other options are incorrect:** * **Routine USG (B-mode):** While it can show secondary signs like an enlarged, heterogeneous testis or a "whirlpool sign," it cannot reliably assess blood flow, which is the hallmark of torsion. * **MRI & CT:** These are time-consuming and expensive. Since "Time is Muscle" in torsion (salvage rates drop significantly after 6 hours), these modalities are impractical for an acute scrotal emergency. **Clinical Pearls for NEET-PG:** * **Golden Period:** Testicular salvage rate is nearly 100% if detorsion occurs within **6 hours**. * **Management:** Immediate **Surgical Exploration**. If the testis is viable, orchidopexy is performed. If gangrenous, orchidectomy. * **Prophylaxis:** Always perform **bilateral orchidopexy** because the anatomical defect (e.g., Bell-clapper deformity) is usually bilateral. * **Reflex:** The **Cremasteric reflex is absent** in testicular torsion (a key differentiator from epididymo-orchitis). * **Prehn’s Sign:** Negative in torsion (pain is not relieved by lifting the scrotum).

Question 618: A patient with benign prostatic hyperplasia (BHP) underwent transurethral resection of the prostate (TURP). Postoperatively, the patient developed altered sensorium. What is the most likely cause?

A. Hypernatremia
B. Hypokalemia
C. Hyponatremia (Correct Answer)
D. Hypomagnesemia

Explanation: **Explanation:** The patient is presenting with **TURP Syndrome**, a classic complication occurring due to the systemic absorption of large volumes of non-conductive irrigation fluid (traditionally **1.5% Glycine**) through the prostatic venous sinuses during the procedure. **Why Hyponatremia is correct:** The primary mechanism is **dilutional hyponatremia**. As the irrigation fluid enters the circulation, it expands the intravascular volume, leading to a rapid drop in serum sodium levels. This causes cerebral edema, which manifests clinically as altered sensorium, confusion, headache, seizures, and in severe cases, coma. Additionally, the metabolism of Glycine into ammonia can further contribute to encephalopathy. **Why the other options are incorrect:** * **Hypernatremia:** TURP syndrome involves fluid overload and dilution; hypernatremia would imply dehydration or salt gain, which is the opposite of the pathophysiology here. * **Hypokalemia & Hypomagnesemia:** While electrolyte shifts can occur during massive fluid resuscitation, they are not the primary or hallmark cause of the acute neurological symptoms seen immediately post-TURP. Hyponatremia is the definitive diagnostic feature of TURP syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **Triad of TURP Syndrome:** Hypertension (early), Bradycardia, and Altered Mental Status. * **Prevention:** Limit resection time to **<60 minutes**, keep the irrigation bag height **<60 cm** above the patient, and use Bipolar TURP (which allows the use of Normal Saline, eliminating the risk of hyponatremia). * **Management:** Stop the procedure, administer diuretics (Furosemide), and use **3% Hypertonic Saline** (slowly) for severe symptomatic hyponatremia.

Question 619: Which of the following is a specific marker for prostatic cancer?

A. Alkaline phosphatase
B. Prostate specific antigen (Correct Answer)
C. Acid phosphatase
D. CA 125

Explanation: **Explanation:** **Prostate Specific Antigen (PSA)** is the correct answer because it is a glycoprotein enzyme produced almost exclusively by the epithelial cells of the prostate gland. While it can be elevated in benign conditions like BPH or prostatitis, it remains the most widely used and specific clinical marker for screening, monitoring treatment response, and detecting recurrence in **prostate cancer**. **Analysis of Incorrect Options:** * **Alkaline Phosphatase (ALP):** This is a non-specific marker. In the context of prostate cancer, elevated ALP levels typically indicate **osteoblastic bone metastases**, but it is not specific to the prostate itself as it also rises in liver diseases and other bone pathologies. * **Acid Phosphatase (Prostatic Acid Phosphatase - PAP):** Historically used for prostate cancer, PAP has been largely replaced by PSA. It is less sensitive for early-stage disease and is generally only elevated once the cancer has breached the prostatic capsule. * **CA 125:** This is the primary tumor marker for **ovarian cancer**. It has no clinical relevance in the diagnosis or management of prostate cancer. **High-Yield Clinical Pearls for NEET-PG:** * **Normal PSA Range:** Generally <4 ng/mL. * **PSA Velocity:** An increase of >0.75 ng/mL per year is highly suspicious for malignancy, even if the absolute value is <4 ng/mL. * **Free-to-Total PSA Ratio:** A lower ratio (<10-15%) is more suggestive of cancer, whereas a higher ratio is seen in BPH. * **Osteoblastic Metastasis:** Prostate cancer is the classic cause of sclerotic/osteoblastic bone lesions (detected via increased ALP and Bone Scan).

Question 620: When extravasated urine passes from the superficial perineal space into the anterior abdominal wall, it is found immediately deep to which layer of the anterior abdominal wall?

A. Scarpa's fascia (Correct Answer)
B. External oblique muscle
C. Internal oblique muscle
D. Transversus abdominis muscle

Explanation: ### Explanation The correct answer is **Scarpa’s fascia**. This question tests the understanding of the fascial planes of the perineum and their continuity with the anterior abdominal wall. **1. Why Scarpa’s Fascia is Correct:** The superficial perineal fascia (Colles' fascia) is continuous with the membranous layer of the superficial fascia of the abdominal wall, known as **Scarpa’s fascia**. When the bulbous urethra is ruptured (e.g., in a straddle injury) while the **Buck’s fascia** is also torn, urine extravasates into the superficial perineal space. * Because Colles' fascia is attached posteriorly to the perineal body and laterally to the ischiopubic rami, the urine cannot move backward or into the thighs. * Instead, it tracks forward into the scrotum and penis, and then upward onto the anterior abdominal wall. * As it moves upward, it remains trapped in the potential space **deep to Scarpa’s fascia** and superficial to the external oblique aponeurosis. **2. Why the Other Options are Incorrect:** * **External Oblique Muscle:** This is a deep muscular layer. Urine tracks superficial to the muscles and their aponeuroses. * **Internal Oblique & Transversus Abdominis:** These are even deeper muscular layers. Extravasated urine from a urethral injury does not penetrate the muscular wall unless there is associated penetrating trauma. **3. High-Yield Clinical Pearls for NEET-PG:** * **Butterfly Hematoma:** Classic description of perineal extravasation limited by the attachments of Colles' fascia. * **Buck’s Fascia Intact:** If the urethra is torn but Buck’s fascia remains intact, the extravasation is confined to the penis (sleevelike swelling). * **Superior Limit:** Urine can track as high as the axilla but cannot enter the thigh because Scarpa’s fascia fuses with the **fascia lata** of the thigh just below the inguinal ligament (Holden’s line).

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Urological Anatomy

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Hematuria Evaluation

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Urinary Calculi

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Benign Prostatic Hyperplasia

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Prostate Cancer

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Bladder Cancer

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Renal Cell Carcinoma

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Testicular Tumors

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Urinary Tract Infections

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Urinary Incontinence

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Genitourinary Trauma

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Pediatric Urology Basics

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Urology — MCQs

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