Urology — MCQs

Urology Indian Medical PG Practice Questions and MCQs

Question 671: Alpha fetoprotein is not raised in which testicular tumor?

A. Choriocarcinoma (Correct Answer)
B. Teratocarcinoma
C. Yolk sac tumor
D. Embryonal cell carcinoma

Explanation: **Explanation:** The diagnosis and management of Germ Cell Tumors (GCTs) rely heavily on serum tumor markers: **Alpha-Fetoprotein (AFP)**, **beta-hCG**, and **LDH**. **Why Choriocarcinoma is the correct answer:** Choriocarcinoma is a highly aggressive tumor composed of syncytiotrophoblasts and cytotrophoblasts. It characteristically produces extremely high levels of **beta-hCG** but **never produces AFP**. If a suspected choriocarcinoma shows elevated AFP, it indicates a mixed germ cell component (usually Yolk sac or Embryonal). **Analysis of incorrect options:** * **Yolk Sac Tumor:** This is the most common testicular tumor in infants. It is the definitive producer of **AFP** (virtually 100% of cases). * **Embryonal Cell Carcinoma:** This is a pleomorphic tumor that can differentiate into other lineages. It is associated with elevated **AFP and/or beta-hCG** in about 70% of cases. * **Teratocarcinoma:** This is a mixed germ cell tumor containing both Teratoma and Embryonal carcinoma elements. Due to the embryonal component, **AFP** is frequently elevated. **High-Yield Clinical Pearls for NEET-PG:** 1. **Pure Seminoma:** Never produces AFP. If AFP is elevated in a patient with a "seminoma" histology, it must be treated as a Non-Seminomatous Germ Cell Tumor (NSGCT). 2. **Pure Choriocarcinoma:** Associated with hematogenous spread (lungs/brain) and "burned-out" primary testicular tumors. 3. **LDH:** Reflects tumor burden and growth rate rather than specific histology. 4. **Rule of Thumb:** AFP is elevated in NSGCTs (except pure Choriocarcinoma), while beta-hCG can be elevated in both Seminomas (10-15%) and NSGCTs.

Question 672: What is the most common congenital urethral abnormality?

A. Meatal stenosis
B. Hypospadias (Correct Answer)
C. Epispadias
D. Diverticula

Explanation: **Explanation:** **Hypospadias** is the most common congenital anomaly of the urethra, occurring in approximately **1 in 200 to 1 in 300 male births**. It is characterized by the failure of the urethral folds to fuse completely, resulting in the urethral meatus opening on the ventral (underside) aspect of the penis, anywhere from the glans to the perineum. It is frequently associated with **chordee** (ventral curvature) and a **hooded prepuce** (deficient ventral foreskin). **Analysis of Options:** * **Meatal Stenosis (Option A):** While common, it is most often an **acquired** condition following neonatal circumcision (due to ammoniacal dermatitis) rather than a primary congenital abnormality. * **Epispadias (Option C):** This is a rare malformation (1 in 117,000 males) where the urethra opens on the **dorsal** aspect of the penis. It is often associated with the bladder exstrophy complex. * **Diverticula (Option D):** Congenital urethral diverticula are extremely rare and usually occur in the posterior urethra or as a result of a wide-mouthed syringocele. **High-Yield Clinical Pearls for NEET-PG:** * **Triad of Hypospadias:** Ectopic urethral meatus (ventral), Chordee, and Hooded prepuce. * **Contraindication:** Circumcision is **strictly contraindicated** in these infants because the preputial skin is required for future surgical reconstruction (urethroplasty). * **Most Common Site:** Glandular/Sub-coronal (Distal hypospadias). * **Associated Anomalies:** Cryptorchidism (undescended testis) and inguinal hernias are the most common associated conditions. If a patient has hypospadias and undescended testes, an intersex disorder (DSD) should be suspected.

Question 673: A 25-year-old male presents with a red, swollen testis. Upon examination, the testis is felt separate from the epididymis due to marked swelling in the epididymis. What is the diagnosis?

A. Testicular torsion
B. Fournier's gangrene
C. Epididymo-orchitis (Correct Answer)
D. Testicular cancer

Explanation: ### Explanation **Correct Answer: C. Epididymo-orchitis** The clinical presentation of a red, swollen testis where the **epididymis is felt separate from the testis** (due to localized inflammation/swelling of the epididymis) is a classic sign of early **Epididymo-orchitis**. In this condition, inflammation typically begins in the epididymis (epididymitis) before spreading to the body of the testis (orchitis). The presence of inflammatory signs (redness, warmth, swelling) and the anatomical distinction between the two structures help differentiate it from other acute scrotal pathologies. **Why other options are incorrect:** * **Testicular Torsion:** This is a surgical emergency. In torsion, the anatomy becomes distorted; the testis is usually high-riding with a horizontal lie. A key differentiator is **Prehn’s sign**: elevation of the scrotum relieves pain in epididymitis but worsens it in torsion. * **Fournier’s Gangrene:** This is a necrotizing fasciitis of the perineum. It presents with systemic sepsis, crepitus, and black eschar (gangrene) of the scrotal skin, rather than localized swelling of the epididymis. * **Testicular Cancer:** Usually presents as a **painless**, hard, heavy lump. It does not typically present with acute inflammatory signs like redness or warmth unless there is associated hemorrhage. **NEET-PG High-Yield Pearls:** * **Age Factor:** In men <35 years, the most common cause is *Chlamydia trachomatis* or *Neisseria gonorrhoeae*. In men >35 years, it is usually *E. coli* associated with UTI or BPH. * **Prehn’s Sign:** Positive (pain relief on elevation) in Epididymo-orchitis; Negative in Torsion. * **Phren's Sign vs. Angel's Sign:** Angel's sign (horizontal lie) is seen in torsion. * **Investigation of Choice:** Color Doppler Ultrasound (shows **increased blood flow** in epididymitis, but **decreased/absent flow** in torsion).

Question 674: What is the commonest cause of ureteric injury during surgical operations?

A. Abdomino-perineal resection
B. Hysterectomy (Correct Answer)
C. Prostatectomy
D. Colectomy

Explanation: **Explanation:** Ureteric injury is a significant complication of pelvic and abdominal surgeries. **Hysterectomy** (Option B) is the most common cause, accounting for over 50–70% of all iatrogenic ureteric injuries. This high incidence is due to the close anatomical proximity of the ureter to the female reproductive organs. The most vulnerable site is where the ureter passes **under the uterine artery** ("water under the bridge") near the level of the internal os. Injury typically occurs during clamping of the uterine vessels or during the closure of the vaginal vault. **Analysis of Incorrect Options:** * **Abdomino-perineal resection (Option A) & Colectomy (Option D):** While colorectal surgeries are the second most common cause of ureteric injury, they occur less frequently than gynecological procedures. In these cases, the left ureter is more commonly injured during the mobilization of the sigmoid colon or ligation of the inferior mesenteric artery. * **Prostatectomy (Option C):** Ureteric injury is rare during prostatectomy because the ureters enter the bladder trigone superior to the surgical field of the prostate. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of injury:** The lower third of the ureter (pelvic segment). * **Most common mechanism:** Crushing (clamping) or ligation; less commonly transection or thermal injury. * **Gold standard for diagnosis:** Intravenous Urogram (IVU) or CT Urogram. * **Intraoperative detection:** If suspected, intravenous **indigo carmine** or methylene blue can be administered to check for dye leakage. * **Management:** If detected intraoperatively, primary repair (ureteroureterostomy) or ureteric reimplantation (ureteroneocystostomy) is performed depending on the site of injury.

Question 675: What is a known complication of ectopic testis?

A. Seminoma
B. Atrophy
C. Torsion (Correct Answer)
D. All of the above

Explanation: ### Explanation The correct answer is **Torsion**. **1. Why Torsion is the correct answer:** An **ectopic testis** is a condition where the testis deviates from the normal path of descent and is found in locations like the superficial inguinal pouch (most common), perineum, or femoral canal. Because the testis is not fixed within the scrotum by the gubernaculum in its anatomical position, it lacks the normal stabilization. This increased mobility, combined with the absence of the scrotal attachments, makes an ectopic testis highly prone to **torsion** (axial rotation of the spermatic cord), which is a surgical emergency. **2. Why the other options are incorrect:** * **Seminoma (Malignancy):** While malignancy is a major risk in **undescended testis (cryptorchidism)**, the risk in a true ectopic testis is generally considered much lower. In cryptorchidism, the abnormal temperature and dysgenesis lead to germ cell tumors (most commonly seminoma); however, for the purpose of standard surgical teaching, torsion is the classic complication associated specifically with the abnormal position of ectopia. * **Atrophy:** Atrophy is primarily a consequence of the high intra-abdominal temperature affecting an undescended testis. Since many ectopic testes (like those in the superficial inguinal pouch) are located in cooler, extra-abdominal sites, atrophy is less characteristic than it is for cryptorchidism. * **All of the above:** While these are complications of maldescended testes in general, **Torsion** is the most specific and high-yield complication associated with the abnormal fixation of an ectopic testis. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common site of Ectopia:** Superficial inguinal pouch (Lockwood’s pouch). * **Ectopia vs. Cryptorchidism:** In ectopia, the testis has passed through the external inguinal ring; in cryptorchidism, it is often arrested within the canal. * **Surgical Management:** The procedure of choice is **Orchidopexy**. * **Key Distinction:** An ectopic testis rarely descends spontaneously, whereas a truly undescended testis may descend within the first 3–6 months of life.

Question 676: Which is the site for urine extravasation in an extraperitoneal bladder rupture?

A. Prevesical region (Correct Answer)
B. Groin
C. Paracolic gutter
D. None of the above

Explanation: **Explanation:** Bladder rupture is categorized into extraperitoneal and intraperitoneal types, usually resulting from blunt trauma associated with pelvic fractures. **1. Why Option A is correct:** In an **extraperitoneal bladder rupture** (the most common type, ~80%), the tear occurs in the anterolateral wall or the bladder neck. The urine leaks into the **Prevesical space (Space of Retzius)**, which is the potential space between the pubic symphysis and the bladder. On imaging (Cystogram), this appears as a characteristic "sunburst" or "flame-shaped" extravasation of contrast confined to the pelvis. **2. Why other options are incorrect:** * **Option B (Groin):** While urine can occasionally track toward the inguinal canal in severe pelvic injuries, it is not the primary or diagnostic site of extravasation for extraperitoneal rupture. * **Option C (Paracolic gutter):** This is a feature of **intraperitoneal bladder rupture**. In intraperitoneal tears (usually at the dome), urine enters the peritoneal cavity and flows along the paracolic gutters, outlining bowel loops on a cystogram. **Clinical Pearls for NEET-PG:** * **Mechanism:** Extraperitoneal rupture is almost always associated with **pelvic fractures** (bony spicules piercing the bladder). Intraperitoneal rupture occurs due to a blow to a **full bladder**. * **Management:** Most extraperitoneal ruptures are managed **conservatively** with a percutaneous or urethral catheter for 10–14 days. Intraperitoneal ruptures require **emergency surgical repair**. * **Gold Standard Investigation:** Retrograde Cystography (showing "flame-shaped" extravasation for extraperitoneal and "contrast outlining bowel" for intraperitoneal).

Question 677: A 65-year-old male is diagnosed with prostatic cancer based on transrectal biopsy of a 1 cm palpable nodule. Which of the following statements are true concerning his management?

A. If the tumour is confined within the prostatic capsule, radical prostatectomy is an appropriate option. (Correct Answer)
B. If positive lymph nodes are detected on laparoscopic pelvic lymph node dissection, radical prostatectomy is indicated.
C. Radical prostatectomy is invariably associated with impotence.
D. There is currently no role for orchidectomy in the management of prostatic cancer.

Explanation: ### Explanation **1. Why Option A is Correct:** Radical prostatectomy (RP) is the gold standard surgical treatment for **localized prostate cancer** (Stage T1 and T2). In this 65-year-old patient, a 1 cm palpable nodule confined within the capsule (Stage T2a) represents an ideal candidate for RP, provided his life expectancy is >10 years. The goal is curative, involving the removal of the entire prostate, seminal vesicles, and vas deferens. **2. Why the Other Options are Incorrect:** * **Option B:** If lymph nodes are positive (Stage N1), the disease is considered systemic. Radical prostatectomy is generally **not indicated** as a primary curative treatment in the presence of nodal metastasis; instead, androgen deprivation therapy (ADT) or radiation with ADT is preferred. * **Option C:** While impotence (erectile dysfunction) is a common complication due to injury to the cavernous nerves, it is **not invariable**. With the advent of **nerve-sparing radical prostatectomy** techniques, potency can be preserved in many patients, especially those with low-volume disease. * **Option D:** Bilateral orchidectomy remains the **gold standard for surgical androgen deprivation** in metastatic prostate cancer. It is a cost-effective, one-time procedure that rapidly reduces testosterone levels (castration levels). **Clinical Pearls for NEET-PG:** * **Most common site:** Peripheral zone (70%), which is why it is palpable on Digital Rectal Examination (DRE). * **Gleason Scoring:** Based on glandular architectural patterns (Primary + Secondary grade); it is the most important prognostic factor. * **Osteoblastic Metastasis:** Prostate cancer characteristically spreads to the bone (lumbar spine) via **Batson’s plexus**, causing osteoblastic (sclerotic) lesions. * **Tumor Marker:** PSA is organ-specific but not cancer-specific. Velocity >0.75 ng/mL/year is highly suspicious.

Question 678: Which of the following is not a typical symptom of cystitis?

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

Explanation: **Explanation:** In clinical urology, it is crucial to differentiate between **Lower Urinary Tract Infections (LUTI)** and **Upper Urinary Tract Infections**. **Cystitis** is an inflammation of the bladder, typically presenting with localized irritative symptoms. **Fever** is notably absent in uncomplicated cystitis. The presence of high-grade fever, chills, and rigors suggests that the infection has ascended to the kidneys (**Pyelonephritis**) or has become systemic (Urosepsis). In cystitis, the mucosal inflammation is superficial and does not typically trigger a systemic inflammatory response. **Analysis of Options:** * **Nocturia (A):** This is a common symptom of cystitis. Inflammation increases bladder sensitivity and reduces functional capacity, leading to the need to void during the night. * **Hematuria (B):** "Hemorrhagic cystitis" is a well-recognized entity where mucosal friability leads to gross or microscopic blood in the urine. * **Urgency (D):** This is a hallmark of bladder irritation. The inflamed bladder wall triggers the micturition reflex even at low volumes, causing a sudden, compelling desire to pass urine. **Clinical Pearls for NEET-PG:** * **Triad of Cystitis:** Frequency, Urgency, and Dysuria. * **Pyelonephritis Triad:** Fever, Flank pain (Loin pain), and Tenderness at the Costovertebral Angle (CVA). * **Diagnosis:** The most reliable finding on urinalysis for UTI is the presence of **Pyuria** (>10 WBCs/hpf). * **Gold Standard:** Urine culture remains the gold standard for diagnosis (significant bacteriuria is traditionally defined as $\geq 10^5$ CFU/mL).

Question 679: Screening increases life span in which cancer?

A. Breast (Correct Answer)
B. Colon
C. Prostate
D. Lung

Explanation: **Explanation:** The primary goal of cancer screening is to reduce mortality and increase the overall life span of the population. Among the options provided, **Breast Cancer** has the most robust evidence supporting that organized screening (via Mammography) leads to early detection and a significant increase in life span. **1. Why Breast Cancer is Correct:** Mammography is the gold standard for screening. Large-scale randomized controlled trials have demonstrated that screening women (typically aged 50–74) reduces breast cancer mortality by approximately 20–30%. By detecting lesions at the "carcinoma in situ" or early invasive stage, it allows for curative treatment, thereby directly increasing life expectancy. **2. Analysis of Incorrect Options:** * **Colon Cancer:** While screening (Colonoscopy/FOBT) is highly effective at reducing mortality by removing precancerous polyps, in many standardized surgical exams, Breast cancer is considered the "classic" example of screening efficacy regarding life span extension. * **Prostate Cancer:** Screening with PSA (Prostate-Specific Antigen) is controversial. While it detects more cases, it leads to significant "overdiagnosis" of indolent tumors that would never have caused death. Current evidence suggests PSA screening has a minimal to negligible impact on overall life span. * **Lung Cancer:** Screening with Low-Dose CT (LDCT) is only recommended for high-risk smokers. It does not increase life span in the general population and carries a high rate of false positives. **Clinical Pearls for NEET-PG:** * **Breast Cancer:** Most common cancer in Indian females. Screening Mammography starts at age 40–50. * **Cervical Cancer:** The only cancer that can be effectively "prevented" by screening (Pap smear/HPV DNA) due to the long pre-invasive stage. * **Lead-time bias:** The illusion of increased survival time due to earlier diagnosis, without actually delaying the time of death. * **Length-time bias:** Screening tends to detect slow-growing, less aggressive tumors with a better prognosis.

Question 680: Catheterisation should not be done in case of acute retention of urine due to which of the following conditions?

A. Benign prostatic hyperplasia (BPH)
B. Carcinoma of the prostate
C. Stricture of the urethra (Correct Answer)
D. All of the above

Explanation: **Explanation:** In the management of acute retention of urine (ARU), the primary goal is to decompress the bladder. However, the method of decompression depends on the underlying pathology. **Why Stricture Urethra is the Correct Answer:** A urethral stricture is a narrowing of the lumen due to cicatrization (scarring). Attempting to pass a standard Foley catheter in a patient with a stricture is contraindicated because it can lead to **urethral trauma, false passage formation, and hemorrhage**. In such cases, the narrow segment acts as a physical barrier. If a gentle attempt with a small-caliber catheter or a Coude tip fails, the preferred management is **Suprapubic Cystostomy (SPC)** to bypass the obstruction and prevent further urethral damage. **Why Other Options are Incorrect:** * **BPH and Carcinoma Prostate:** These conditions cause obstruction at the level of the prostatic urethra due to extrinsic compression or enlargement. In most cases, a catheter can still be navigated through the prostatic urethra into the bladder. These are, in fact, the most common indications for urethral catheterization in ARU. **Clinical Pearls for NEET-PG:** * **Absolute Contraindication:** The most critical contraindication for urethral catheterization is **suspected urethral injury** (indicated by blood at the meatus, high-riding prostate, or perineal hematoma) following trauma. * **Management Priority:** In stricture urethra with ARU, if catheterization fails, **SPC** is the procedure of choice. * **High-Yield Fact:** For BPH patients where a standard Foley fails, a **Coude (curved) tip catheter** is often the next step before considering more invasive measures.

Practice by Chapter

Urological Anatomy

Practice Questions

Hematuria Evaluation

Practice Questions

Urinary Calculi

Practice Questions

Benign Prostatic Hyperplasia

Practice Questions

Prostate Cancer

Practice Questions

Bladder Cancer

Practice Questions

Renal Cell Carcinoma

Practice Questions

Testicular Tumors

Practice Questions

Urinary Tract Infections

Practice Questions

Urinary Incontinence

Practice Questions

Genitourinary Trauma

Practice Questions

Pediatric Urology Basics

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free

Urology — MCQs

Urology — MCQs

On this page

Practice by Chapter

Want unlimited practice?