Urology Practice Questions

Q: Treatment of Renal cell carcinoma of less than 4 cm will be?

Partial nephrectomy. ***Partial nephrectomy*** - For **renal cell carcinoma (RCC) less than 4 cm** (T1a tumors), **partial nephrectomy** is the preferred treatment. This approach aims to preserve as much healthy renal tissue as possible, reducing the risk of chronic kidney disease, especially in patients with normal contralateral kidneys. - Studies have shown that partial nephrectomy offers comparable **oncologic outcomes** to radical nephrectomy for small tumors while providing better overall kidney function. *Radical nephrectomy* - While effective for larger tumors or those invading surrounding structures, **radical nephrectomy** involves removing the entire kidney, which may lead to a higher risk of **chronic kidney disease** compared to partial nephrectomy for small tumors. - This option is generally reserved for **larger tumors** (T1b or greater), more complex cases, or when partial nephrectomy is not feasible due to tumor location or patient comorbidities. *Radical nephrectomy + postoperative radiotherapy* - **Radiotherapy** is generally not effective in treating renal cell carcinoma (RCC) due to the **radioresistant nature** of the tumor cells. It is rarely used in the primary treatment of RCC. - The combination of radical nephrectomy and postoperative radiotherapy would expose the patient to unnecessary treatment with significant side effects without clear survival benefits for localized disease. *Radical nephrectomy + chemotherapy* - **Chemotherapy** has historically shown **limited efficacy** in the treatment of renal cell carcinoma, particularly for localized disease. It is primarily used in advanced, metastatic RCC, and newer targeted therapies and immunotherapies are often preferred. - For small, localized tumors, surgery alone is curative, and adding chemotherapy to radical nephrectomy would introduce **unnecessary toxicity** without improving outcomes.

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: 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: 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: 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: 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 young male presents with a testicular mass on the right side. The AFP is elevated while the HCG is normal. The most appropriate next step is

Orchidectomy. ***Radical Inguinal Orchidectomy*** - In a patient who already presents with a **testicular mass** and **elevated AFP** (suggesting non-seminomatous germ cell tumor), the most appropriate next step is **radical inguinal orchidectomy**. - This procedure is both **diagnostic and therapeutic**, providing tissue for histopathological confirmation while removing the primary tumor. - The standard management sequence is: clinical examination → scrotal USG → tumor markers → **orchidectomy** → staging imaging → further treatment based on histology and stage. - Since the mass is already identified and tumor markers are done, proceeding directly to orchidectomy is appropriate. *USG* - Scrotal **ultrasound** is typically the **first imaging modality** when a testicular mass is suspected or palpated. - However, in this scenario, the mass is already clinically identified and tumor markers (AFP) have been measured, suggesting that initial workup including USG has likely been completed. - USG would have been the appropriate answer if the question asked for the "first investigation" before tumor markers were done. *Biopsy* - Direct **biopsy** of a testicular mass is **contraindicated** due to the high risk of tumor cell spillage along the needle tract, which can alter staging and worsen prognosis. - Testicular cancer is diagnosed via **radical inguinal orchidectomy**, not biopsy. *Wait and Watch* - A **wait and watch** approach is inappropriate and dangerous in the presence of a **testicular mass with elevated AFP**, which strongly suggests malignancy (non-seminomatous germ cell tumor). - Delayed treatment can lead to disease progression, metastasis, and poorer outcomes.

Q: A 45-year-old male is diagnosed with carcinoma of the penis. Which lymph nodes should the surgeon primarily consider for potential metastasis?

Inguinal lymph nodes (located in the groin region). ***Inguinal lymph nodes (located in the groin region)*** - The lymphatic drainage of the penis primarily bypasses the internal nodal basins and drains directly to the **superficial and deep inguinal lymph nodes**. - Metastasis to these nodes is the **most common initial spread** in penile carcinoma, making them the primary targets for surgical evaluation and dissection. *Para-aortic lymph nodes (located near the aorta)* - These nodes are typically involved in more advanced or widespread metastatic disease, following initial spread to the pelvic nodes. - They are not considered the primary draining lymph nodes for penile carcinoma. *External iliac lymph nodes (located along the external iliac vessels)* - While part of the pelvic lymph node chain, the external iliac nodes are usually involved after metastasis to the inguinal nodes, or in cases of direct invasion of the pelvic floor. - They are not the first echelon of lymphatic drainage for the penis. *Internal iliac lymph nodes (located along the internal iliac vessels)* - These nodes are involved in lymphatic drainage from organs like the bladder, prostate, and rectum. - The lymphatic drainage of the penis primarily bypasses these nodes for initial metastasis.

Q: A high-riding prostate is indicative of which injury?

Membranous Urethral Injury. ***Membranous Urethral Injury*** - A **high-riding prostate** is a classic sign of **membranous urethral injury**, often resulting from **pelvic fractures**. - The disruption of the **urethra** above the perineal membrane causes the prostate to be displaced superiorly and appear "high." *Extraperitoneal Bladder rupture* - This typically occurs with **pelvic fractures** and involves urine leaking into the **retropubic space**. - While associated with pelvic trauma, it does not directly cause a high-riding prostate; the bladder itself may be ruptured, but the relative position of the prostate is not significantly altered. *Intraperitoneal Bladder Rupture* - This type of rupture usually results from a direct blow to a **full bladder** and involves urine extravasating into the **peritoneal cavity**. - It does not cause a high-riding prostate, as the injury is to the dome of the bladder, not the structures supporting the prostate. *Bulbar Urethral Injury* - A **bulbar urethral injury** usually results from a **straddle injury** and is located in the anterior urethra. - This type of injury does not affect the anatomical position of the prostate, which is posterior and superior to the bulbar urethra.

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.

Question 1

Treatment of Renal cell carcinoma of less than 4 cm will be?

Accepted Answer

Partial nephrectomy

Answer

Radical nephrectomy

Answer

Radical nephrectomy + postoperative radiotherapy

Answer

Radical nephrectomy + chemotherapy

Question 2

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 3

ESWL is contraindicated in which of the following stones -

Accepted Answer

Cystine stones

Answer

Urate stones

Answer

Phosphate stones

Answer

Oxalate Stones

Question 4

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

Accepted Answer

Hypertension

Answer

Hematuria

Answer

Flank mass

Answer

Abdominal Pain

Question 5

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 6

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 7

A young male presents with a testicular mass on the right side. The AFP is elevated while the HCG is normal. The most appropriate next step is

Accepted Answer

Orchidectomy

Answer

Biopsy

Answer

USG

Answer

Wait and Watch

Question 8

A 45-year-old male is diagnosed with carcinoma of the penis. Which lymph nodes should the surgeon primarily consider for potential metastasis?

Accepted Answer

Inguinal lymph nodes (located in the groin region)

Answer

Para-aortic lymph nodes (located near the aorta)

Answer

External iliac lymph nodes (located along the external iliac vessels)

Answer

Internal iliac lymph nodes (located along the internal iliac vessels)

Question 9

A high-riding prostate is indicative of which injury?

Accepted Answer

Membranous Urethral Injury

Answer

Extraperitoneal Bladder rupture

Answer

Intraperitoneal Bladder Rupture

Answer

Bulbar Urethral Injury

Question 10

Which of the following urethral anomalies is the most common?

Accepted Answer

Hypospadias

Answer

Pinhole meatus

Answer

Epispadias

Answer

Stricture of the urethra

Urology — MCQs

Urology — MCQs

On this page

Practice by Chapter

Want unlimited practice?