Urology Practice Questions

Q: A man under alcohol intoxication fell into a manhole and sustained a perineal injury with a swollen scrotum and upper thigh, along with blood at the meatus. The patient is experiencing difficulty passing urine. What is the most likely injury associated with this trauma?

Bulbar urethral injury. ***Bulbar urethra*** - The combination of a **perineal injury** (falling into a manhole), **scrotal and upper thigh swelling**, and **blood at the meatus** strongly indicates a **bulbar urethral injury**. - **Difficulty passing urine** further supports urethral damage, as the bulbar urethra is the most common site of injury from straddle or crush injuries to the perineum. *Bladder rupture* - While bladder rupture can cause difficulty urinating, the primary findings would typically be **suprapubic pain**, a **distended abdomen**, and possibly **hematuria**, not necessarily significant scrotal swelling or blood at the meatus alone. - A bladder rupture is more common with a **direct blow to a full bladder** or a pelvic fracture, rather than a direct perineal impact. *Penile fracture* - **Penile fracture** results from penile trauma during intercourse (or forced bending) and presents with a sudden "snapping" sound, immediate pain, detumescence, and a characteristic "eggplant deformity" due to a ruptured tunica albuginea. - It does not typically involve significant perineal swelling or blood at the meatus in the absence of concomitant urethral injury. *Membranous urethra* - Injuries to the **membranous urethra** are usually associated with **pelvic fractures** and are less commonly linked with direct perineal trauma without evidence of a bony injury. - While blood at the meatus and difficulty urinating can occur, the prominent scrotal and upper thigh swelling from a direct perineal impact points more specifically to the **bulbar urethra**.

Q: A patient presents with abdominal swelling and inguinal lymphadenopathy. Considering the clinical presentation, which carcinoma is most likely associated with these findings?

Ca penis. ***Ca penis*** - **Carcinoma of the penis** commonly metastasizes to the **inguinal lymph nodes** due to its lymphatic drainage patterns. - Advanced penile cancer with extensive nodal involvement can lead to **abdominal swelling** from large retroperitoneal nodes compressing structures or generalized edema. *Ca testis* - **Testicular cancer** typically metastasizes to **retroperitoneal lymph nodes** first, not inguinal nodes. - While retroperitoneal nodes can cause abdominal swelling, **inguinal involvement is rare** unless there is scrotal invasion or prior surgery. *Ca prostate* - **Prostate cancer** primarily metastasizes to **pelvic lymph nodes** (obturator, internal iliac) and bone, rarely to inguinal lymph nodes. - Abdominal swelling would more likely be due to **bone metastases** causing painful compression or uremia from urinary obstruction rather than inguinal adenopathy. *Ca bladder* - **Bladder cancer** tends to spread to **pelvic lymph nodes**, similar to prostate cancer, and can cause abdominal swelling if it obstructs ureters or involves extensive pelvic spread. - **Inguinal lymphadenopathy is uncommon** in bladder cancer unless there is direct extension into the groin or superficial involvement.

Q: In which of the following surgeries is monopolar cautery preferred over bipolar cautery?

Surgery of the Hip. ***Surgery of the Hip*** - **Monopolar cautery** is preferred in surgeries like hip surgery where a larger area needs to be coagulated, as it provides a wider field of effect and can be more efficient for **deep tissue coagulation**. - Its mechanism relies on the current passing through the patient to a large **dispersive electrode (grounding pad)**, making it suitable for extensive tissue work. *Hand Surgery* - In **hand surgery**, delicate structures like nerves and tendons are abundant, making **bipolar cautery** safer due to its localized current flow and reduced risk of inadvertent thermal spread. - **Bipolar cautery** limits the current to a small area between the two prongs of the instrument, thus minimizing damage to surrounding tissues. *Surgery around Penis* - **Bipolar cautery** is generally preferred in sensitive areas like the penis, due to its localized effect and reduced risk of thermal injury to adjacent delicate structures. - The avoidance of current passing through the body to a grounding pad in **bipolar modality** is especially important in areas with potential for nerve damage or scarring. *Surgery around the face* - Surgically around the face often involves delicate tissues and structures where **bipolar cautery** is favored to prevent widespread thermal damage and minimize scarring or nerve injury. - The confined current path of **bipolar cautery** makes it ideal for precision work in cosmetic or reconstructive facial surgery.

Q: Which of the following urethral anomalies is the most common?

Hypospadias. ***Hypospadias*** - **Hypospadias** is the most common urethral anomaly, occurring when the **urethral opening** is located on the underside of the penis rather than at the tip. - Its prevalence ranges from approximately **1 in 150 to 1 in 300 live male births**, making it significantly more frequent than other urethral malformations. *Pinhole meatus* - A **pinhole meatus** refers to an abnormally small urethral opening. - While it can be a component or consequence of other anomalies, it is **less common as a standalone finding** compared to hypospadias. *Epispadias* - **Epispadias** is a rare anomaly where the urethra opens on the **dorsal (top) aspect** of the penis. - Its incidence is much lower than hypospadias, estimated at **1 in 100,000 to 1 in 500,000 live births**. *Stricture of the urethra* - A **urethral stricture** is a narrowing of the urethra, often due to **scar tissue** from inflammation, trauma, or infection. - Although it can present at any age, it is more commonly an **acquired condition** rather than a congenital anomaly like hypospadias or epispadias.

Q: Which of the following is NOT a feature of membranous urethral injury?

Perineal butterfly hematoma. ***Perineal butterfly hematoma*** - A **perineal butterfly hematoma** is more characteristic of an injury to the **anterior urethra**, specifically the bulbar urethra, often caused by a straddle injury. - It occurs due to the extravasation of blood into the subcutaneous tissue of the perineum, outlining the shape of a butterfly. *blood at the meatus* - **Blood at the meatus** is a classic sign of urethral injury, regardless of the segment (anterior or posterior). - It indicates disruption of the urethral mucosa and bleeding from the damaged blood vessels. *Retention of urine* - **Retention of urine** can occur due to either a complete or partial urethral transection, preventing normal urine flow. - The inability to void can lead to bladder distension and is a significant symptom in assessing urethral trauma severity. *Pelvic fracture* - **Pelvic fractures** are frequently associated with **membranous urethral injuries** because the membranous urethra is fixed within the pelvic ring. - Shear forces from pelvic trauma can cause the prostatomembranous junction to avulse.

Q: ESWL is contraindicated in which of the following stones -

Cystine stones. ***Cysteine stones*** - **Cystine stones** are very dense and hard, making them resistant to fragmentation by the shock waves generated during **Extracorporeal Shock Wave Lithotripsy (ESWL)**. - Due to their resistance to fragmentation, ESWL is generally ineffective for cystine stones, and other treatments like **ureteroscopy** or **percutaneous nephrolithotomy (PCNL)** are often preferred. *Oxalate Stones* - **Calcium oxalate stones** are generally **amenable to ESWL** as they are effectively fragmented by shock waves. - They are the **most common type of kidney stone** and often respond well to lithotripsy. *Urate stones* - **Uric acid stones** are typically **radiolucent** but are often **well-fragmented by ESWL**. - Their non-calcium composition does not hinder the effectiveness of shock waves. *Phosphate stones* - **Struvite (magnesium ammonium phosphate) stones** and **calcium phosphate stones** generally respond well to ESWL. - While sometimes large and branched (**staghorn calculi**), the individual components are susceptible to shock wave fragmentation, though multiple sessions or adjunctive therapies might be needed.

Q: RPLND and Chemotherapy may be used in management of?

Non-seminomatous germ cell tumors of the testis. ***Non-seminomatous germ cell tumors of the testis*** - **Retroperitoneal lymph node dissection (RPLND)** and **chemotherapy** are key components in the management of non-seminomatous germ cell tumors (NSGCTs), especially for metastatic disease or after initial orchidectomy. - The combination therapy addresses both local nodal involvement (RPLND) and widespread micrometastases (chemotherapy), which are common in NSGCTs. *Non-germ cell tumors* - This is a broad category, and while some non-germ cell testicular tumors may require surgery or chemotherapy, **RPLND** is not a standard part of their management in the same way it is for germ cell tumors. - The specific treatment depends on the tumor type (e.g., Leydig cell tumor, Sertoli cell tumor), stage, and histology, and often involves less aggressive approaches. *Seminomatous germ cell tumors* - **Seminomas** are highly radiosensitive and often respond well to **radiation therapy**, particularly for localized disease or retroperitoneal nodal involvement. - While chemotherapy is used for metastatic seminoma, **RPLND** is generally not indicated for seminomas due to their radiosensitivity and different metastatic patterns compared to NSGCTs. *Lymphoma of the testis* - Testicular lymphoma is a type of **non-Hodgkin lymphoma** and is primarily managed with systemic **chemotherapy** (e.g., R-CHOP) and sometimes radiation therapy. - **RPLND** is not a standard treatment modality for testicular lymphoma, as it is a systemic disease requiring systemic treatment, not local surgical excision of retroperitoneal nodes.

Q: Classic triad in Renal cell carcinoma includes all of the following, Except:

Hypertension. ***Hypertension*** - While hypertension can occur in patients with renal cell carcinoma due to **renin secretion** or other mechanisms, it is **not considered one of the classic triad symptoms**. - The classic triad represents symptoms that historically led to diagnosis, though most RCCs are now discovered incidentally. *Hematuria* - **Gross or microscopic hematuria** is a common symptom of renal cell carcinoma [1], resulting from tumor invasion into the collecting system. - It is one of the **three classic symptoms** associated with advanced disease. *Flank mass* - A palpable **flank mass** indicates a sizable tumor infiltrating the renal parenchyma and is a classic sign of renal cell carcinoma [1]. - This symptom is often associated with later-stage disease. *Abdominal Pain* - **Flank pain** or abdominal pain is a frequent symptom of renal cell carcinoma, which may be caused by tumor growth, hemorrhage, or obstruction. - This symptom, along with hematuria and a flank mass, constitutes the **classic diagnostic triad**.

Q: Prostate cancer that is limited to the capsule and not the urethra would be staged as -

T2. ***T2*** - A T2 stage indicates that the prostate cancer is **confined within the prostate capsule**, meaning it has not spread beyond the outer layer of the prostate gland. - While it is not limited to the urethra, the key defining characteristic of T2 is **capsular confinement**, which is described in the question. *T1* - T1 stage prostate cancer is typically **non-palpable** on digital rectal exam (DRE) and not visible on imaging. - It is often found incidentally, for example, during a **transurethral resection of the prostate (TURP)** for benign prostatic hyperplasia. *T3* - A T3 stage indicates that the prostate cancer has **extended beyond the prostate capsule**, but has not metastasized to distant sites. - This typically involves invasion into the **seminal vesicles** or other periprostatic tissues. *T0* - T0 means there is **no evidence of primary tumor**, which is not consistent with a diagnosed prostate cancer. - This staging is used when there is no measurable tumor.

Q: A 45-year-old male presenting with penile cancer extending up to the glans penis is treated with which of the following surgical options?

Partial penectomy with a 2 cm margin. ***Partial penectomy with a 2 cm margin*** - For **penile cancer** confined to the glans, **partial penectomy** is the standard surgical approach to achieve local control while preserving penile length. - Historically, a **2 cm tumor-free margin** was recommended as the standard of care (reflected in older guidelines and exam questions). - **Modern evidence** suggests that narrower margins of **5-8 mm** are oncologically safe with comparable local control rates, but the **2 cm margin** was the traditional teaching and remains the expected answer for this question context. *Simple circumcision* - **Simple circumcision** is indicated for benign conditions like **phimosis** or **premalignant lesions** (carcinoma in situ), not for invasive cancer. - It does not provide adequate oncological clearance for **invasive penile cancer** and carries a high risk of **local recurrence**. *Partial penectomy with a 4 cm margin* - A **4 cm margin** is excessively radical and would result in unnecessary loss of penile length and function. - Even by historical standards, this exceeds the recommended **2 cm margin** and would cause significant functional and psychological morbidity. *Partial penectomy with inguinal lymph node dissection* - **Inguinal lymph node dissection** is indicated when there is **clinical or radiological evidence of lymph node metastasis** or high-risk pathological features. - Without evidence of nodal involvement, routine prophylactic lymphadenectomy is not performed due to significant morbidity (lymphedema, wound complications). - The question does not specify nodal involvement, making this option unnecessarily aggressive.

Question 1

A man under alcohol intoxication fell into a manhole and sustained a perineal injury with a swollen scrotum and upper thigh, along with blood at the meatus. The patient is experiencing difficulty passing urine. What is the most likely injury associated with this trauma?

Accepted Answer

Bulbar urethral injury

Answer

Bladder rupture

Answer

Penile fracture

Answer

Membranous urethral injury

Question 2

A patient presents with abdominal swelling and inguinal lymphadenopathy. Considering the clinical presentation, which carcinoma is most likely associated with these findings?

Accepted Answer

Ca penis

Answer

Ca testis

Answer

Ca prostate

Answer

Ca bladder

Question 3

In which of the following surgeries is monopolar cautery preferred over bipolar cautery?

Accepted Answer

Surgery of the Hip

Answer

Surgery around Penis

Answer

Hand Surgery

Answer

Surgery around the face

Question 4

Which of the following urethral anomalies is the most common?

Accepted Answer

Hypospadias

Answer

Pinhole meatus

Answer

Epispadias

Answer

Stricture of the urethra

Question 5

Which of the following is NOT a feature of membranous urethral injury?

Accepted Answer

Perineal butterfly hematoma

Answer

blood at the meatus

Answer

Retention of urine

Answer

Pelvic fracture

Question 6

ESWL is contraindicated in which of the following stones -

Accepted Answer

Cystine stones

Answer

Urate stones

Answer

Phosphate stones

Answer

Oxalate Stones

Question 7

RPLND and Chemotherapy may be used in management of?

Accepted Answer

Non-seminomatous germ cell tumors of the testis

Answer

Non-germ cell tumors

Answer

Seminomatous germ cell tumors

Answer

Lymphoma of the testis

Question 8

Classic triad in Renal cell carcinoma includes all of the following, Except:

Accepted Answer

Hypertension

Answer

Hematuria

Answer

Flank mass

Answer

Abdominal Pain

Question 9

Prostate cancer that is limited to the capsule and not the urethra would be staged as -

Accepted Answer

T2

Answer

T1

Answer

T3

Answer

T0

Question 10

A 45-year-old male presenting with penile cancer extending up to the glans penis is treated with which of the following surgical options?

Accepted Answer

Partial penectomy with a 2 cm margin

Answer

Simple circumcision

Answer

Partial penectomy with a 4 cm margin

Answer

Partial penectomy with inguinal lymph node dissection

Urology — MCQs

Urology — MCQs

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