Urology Practice Questions

Q: Which one of the following does not indicate a good prognosis in carcinoma of the penis?

Tumor size less than 2 cm. In Penile Carcinoma, the prognosis is primarily determined by the **pathological stage (TNM)** and the **histological grade**, rather than the absolute physical size of the primary tumor. ### **Why Option A is the Correct Answer** **Tumor size (< 2 cm)** is not a reliable prognostic indicator in penile cancer. A small tumor (e.g., 1.5 cm) that is high-grade (undifferentiated) or has invaded the corpus cavernosum (T2) or corpus spongiosum carries a much worse prognosis than a large, 4 cm superficial verrucous carcinoma. In the current AJCC TNM staging, "size" is not a criteria; instead, the **depth of invasion** and **nodal status** are the critical determinants of survival. ### **Explanation of Incorrect Options** * **B. No regional lymph node metastasis:** This is the **most important** prognostic factor. The presence and extent of inguinal lymph node involvement directly correlate with 5-year survival rates. Absence of nodal spread indicates an excellent prognosis. * **C. No invasion of subepithelial connective tissue:** This refers to **Stage Ta/Tis**. Tumors confined to the epithelium without invading the subepithelial connective tissue (lamina propria) have a negligible risk of metastasis and an excellent prognosis. * **D. No distant metastases:** Distant metastasis (M1) in penile cancer is rare but fatal. Its absence is a prerequisite for a favorable long-term outcome. ### **Clinical Pearls for NEET-PG** * **Most common histological type:** Squamous Cell Carcinoma (95%). * **Most important prognostic factor:** Status of inguinal lymph nodes. * **Sentinel Lymph Node:** The "Sentinel node of Cabanas" is located near the superficial epigastric vein. * **Staging Insight:** T1 is divided into **T1a** (no lymphovascular invasion, well-differentiated) and **T1b** (lymphovascular invasion or high grade). T1b has a significantly higher risk of nodal micrometastasis.

Q: Which type of catheter is used for the removal of an embolus from blood vessels?

Removal of embolus from blood vessels. The question refers to the **Fogarty Catheter**, which is a specialized balloon-tipped catheter designed specifically for arterial embolectomy. ### **Explanation of the Correct Answer** The **Fogarty catheter** (Option C) is the gold standard for removing an embolus or thrombus from the vascular system. It is inserted past the site of the clot; the balloon is then inflated and the catheter is withdrawn, effectively "dragging" the embolus out of the vessel. This procedure is a critical intervention in cases of acute limb ischemia. ### **Analysis of Incorrect Options** * **Option A (Drainage of the urinary bladder):** This is typically performed using a **Foley catheter** (indwelling) or a **Nelaton catheter** (straight drainage). While these also use balloons for retention, they are not designed for endovascular use. * **Option B (Parenteral hyperalimentation):** This requires central venous access, usually via a **Central Venous Catheter (CVC)** or a **PICC line**, to deliver high-osmolarity nutrient solutions directly into the superior vena cava. * **Option C (Ureteric catheterization):** This involves the use of **Double-J (DJ) stents** or simple ureteric catheters to bypass obstructions or provide a template for healing. ### **High-Yield Clinical Pearls for NEET-PG** * **Inventor:** Thomas J. Fogarty (1963). * **Mechanism:** It is a "blind" procedure usually done under local anesthesia. * **Size:** Measured in **French (F)**; common sizes range from 2F to 7F. * **Complications:** Intimal injury, vessel perforation, or distal embolization of fragments. * **Key Identification:** Look for a thin, flexible catheter with a small, high-pressure balloon at the tip in surgical instrument images.

Q: What percentage of cases with kidney injury require surgical exploration?

20%. ### Explanation The management of renal trauma has shifted significantly toward a **non-operative approach**, even for high-grade injuries. Currently, approximately **80% of renal injuries** are managed conservatively, while only **20% require surgical exploration**. **Why 20% is the Correct Answer:** Most renal injuries (Grade I-III) are minor contusions or superficial lacerations that heal with bed rest, hydration, and monitoring. Even many Grade IV and V injuries (major lacerations or vascular injuries) can be managed with angioembolization or stenting. Surgical exploration is reserved for specific indications: * **Hemodynamic instability** (the absolute indication). * Expanding or pulsatile retroperitoneal hematoma. * Grade V vascular pedicle avulsion. **Analysis of Incorrect Options:** * **B (90%) and D (70%):** These figures are historically inaccurate. In the past, surgical rates were higher due to a lack of advanced imaging (CT scans) and interventional radiology. Today, such high rates would indicate unnecessary nephrectomies. * **C (50%):** This overestimates the need for surgery. With modern conservative protocols, even half of all major renal traumas (Grade IV) can often avoid the operating room. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Contrast-Enhanced CT (CECT) is the investigation of choice for stable patients. * **Most Common Organ Injured in Blunt Trauma Abdomen:** Spleen (Renal is less common). * **Absolute Indication for Surgery:** Persistent hemodynamic instability despite resuscitation. * **AAST Grading:** Remember that Grade IV involves the collecting system or main renal artery/vein thrombosis, while Grade V is a shattered kidney or hilar avulsion.

Q: Carcinoma of the prostate most commonly arises from which zone?

Peripheral zone. **Explanation:** The prostate gland is anatomically divided into distinct zones according to **McNeal’s classification**. Understanding these zones is crucial for diagnosing prostatic pathologies. **1. Why the Peripheral Zone (PZ) is correct:** Approximately **70–80% of prostatic adenocarcinomas** originate in the peripheral zone. This zone constitutes the bulk of the glandular tissue and is located posteriorly, surrounding the distal urethra. Because of its posterior location, tumors in this zone are easily palpable during a **Digital Rectal Examination (DRE)**, making DRE a vital screening tool. **2. Analysis of Incorrect Options:** * **Central Zone (CZ):** Only about 5–10% of cancers arise here. It surrounds the ejaculatory ducts. * **Transitional Zone (TZ):** This is the primary site for **Benign Prostatic Hyperplasia (BPH)**. While about 10–20% of prostate cancers can arise here, it is significantly less common than the peripheral zone. * **Periurethral Zone:** This area contains tiny glands involved in BPH but is rarely a primary site for malignancy. **High-Yield Clinical Pearls for NEET-PG:** * **Most common type:** Adenocarcinoma. * **Screening:** PSA (Prostate-Specific Antigen) + DRE. * **Diagnosis:** Transrectal Ultrasound (TRUS) guided biopsy (standard is a 12-core biopsy). * **Metastasis:** Most commonly spreads to the **bone (osteoblastic lesions)** via the **Batson venous plexus** (vertebral venous plexus). * **Grading:** The **Gleason Scoring System** is used to determine prognosis based on architectural patterns.

Q: Which of the following refinements of serum PSA is used to determine the need for TRUS guided biopsy of the prostate, even when the level of serum PSA is still in the normal range?

PSA velocity. **Explanation:** **PSA Velocity (PSAV)** refers to the rate of change in serum PSA levels over time. It is the most sensitive refinement for detecting prostate cancer in men whose absolute PSA levels are still within the "normal" range (typically 0.75 ng/mL per year**—is highly suggestive of malignancy and serves as an indication for a TRUS-guided biopsy, even if the total PSA value has not yet crossed the standard threshold. **Analysis of Incorrect Options:** * **PSA Density (PSAD):** This is the ratio of serum PSA to the volume of the prostate (measured by TRUS). It is primarily used to differentiate BPH from cancer in patients with "borderline" PSA levels (4–10 ng/mL). A value >0.15 is considered suspicious. * **Free/Total PSA Ratio:** Since prostate cancer produces more "bound" PSA, a lower percentage of free PSA (<15–20%) indicates a higher risk of cancer. Like PSAD, it is most useful in the 4–10 ng/mL "gray zone." * **Complexed/Total PSA Ratio:** Most PSA in the blood is complexed with alpha-1-antichymotrypsin. While useful, it does not supersede PSAV in identifying risk within the normal range. **High-Yield Clinical Pearls for NEET-PG:** * **Normal PSA:** <4 ng/mL. * **PSA Velocity Requirement:** To be accurate, at least 3 serial PSA measurements should be taken over a period of 18–24 months. * **Age-Specific PSA:** PSA levels naturally rise with age due to prostate volume increase (e.g., <2.5 for age 40–49; <6.5 for age 70–79). * **Most common site for Prostate Cancer:** Peripheral zone (70%). * **Standard Biopsy:** 12-core systematic TRUS-guided biopsy.

Q: Lord's and Jaboulay's operation is done for:

Hydrocele. **Explanation:** The correct answer is **D. Hydrocele**. Both Lord’s and Jaboulay’s procedures are surgical techniques used to treat a primary vaginal hydrocele by managing the redundant tunica vaginalis. * **Jaboulay’s Procedure (Eversion of Sac):** This is the most common surgery for large, thick-walled hydroceles. The sac is opened, and the redundant tunica vaginalis is folded back (everted) behind the testis and epididymis, then sutured. This allows the fluid-secreting surface to face the scrotal tissues, where fluid can be reabsorbed. * **Lord’s Procedure (Plication of Sac):** This is preferred for thin-walled hydroceles. Instead of eversion, the sac is gathered and bunched up using multiple "plication" sutures. This technique is associated with less postoperative hematoma compared to Jaboulay’s. **Why other options are incorrect:** * **Rectal Prolapse:** Treated via procedures like Wells (Rectopexy) or Thiersch wiring. * **Fistula in Ano:** Managed by Fistulectomy, Fistulotomy, or specialized techniques like LIFT and Seton placement. * **Inguinal Hernia:** Treated via Herniotomy (in children) or Hernioplasty (e.g., Lichtenstein tension-free repair). **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Transillumination test (positive in hydrocele). * **Differential:** A hydrocele is "get-above-able" on palpation, whereas an inguinal hernia is not. * **Complications:** Post-operative scrotal hematoma is the most common complication of hydrocele surgery. * **Other techniques:** **Subtotal Excision** is used for very thick, calcified sacs.

Question 1

Which one of the following does not indicate a good prognosis in carcinoma of the penis?

Accepted Answer

Tumor size less than 2 cm

Answer

No regional lymph node metastasis

Answer

No invasion of subepithelial connective tissue

Answer

No distant metastases

Question 2

Which of the following tumours are known to spontaneously regress?

Accepted Answer

Malignant melanoma

Answer

Neuroblastoma

Answer

Ewing's sarcoma

Answer

Wilm's tumour

Question 3

Which type of catheter is used for the removal of an embolus from blood vessels?

Accepted Answer

Removal of embolus from blood vessels

Answer

Drainage of the urinary bladder

Answer

Parenteral hyperalimentation

Answer

Ureteric catheterization

Question 4

What percentage of cases with kidney injury require surgical exploration?

Accepted Answer

20%

Answer

90%

Answer

50%

Answer

70%

Question 5

Carcinoma of the prostate most commonly arises from which zone?

Accepted Answer

Peripheral zone

Answer

Central zone

Answer

Transitional zone

Answer

Periurethral zone

Question 6

Endoscope washing with deionized water is associated with which organism?

Accepted Answer

Mycobacterium chelonae

Answer

Mycobacterium tuberculosis

Answer

Mycobacterium bovis

Answer

Mycobacterium ulcerans

Question 7

Which of the following refinements of serum PSA is used to determine the need for TRUS guided biopsy of the prostate, even when the level of serum PSA is still in the normal range?

Accepted Answer

PSA velocity

Answer

Prostate-specific antigen density (PSAD)

Answer

Free/Total PSA ratio

Answer

Complexed/Total PSA ratio

Question 8

Lord's and Jaboulay's operation is done for:

Accepted Answer

Hydrocele

Answer

Rectal prolapse

Answer

Fistula in Ano

Answer

Inguinal hernia

Question 9

In which of the following conditions is acquired (secondary) megacolon seen?

Accepted Answer

Rectal malignancy

Answer

Fissure in-ano

Answer

Complete absence of parasympathetic ganglion cells

Answer

Absence of sympathetic ganglion cells

Question 10

Early dumping syndrome consists of the following clinical features, except:

Accepted Answer

A fall in the packed cell volume is observed while the symptoms are present

Answer

Abdominal and vasomotor symptoms found in about 5%-10% of patients following gastrectomy or vagotomy and drainage

Answer

The small bowel is filled with foodstuffs from the stomach, which have a high osmotic load

Answer

This leads to the sequestration of fluid from the circulation to the gastrointestinal tract

Urology — MCQs

Urology — MCQs

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