Urology Practice Questions

Q: Alpha fetoprotein is not raised in which testicular tumor?

Choriocarcinoma. **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.

Q: What is the most common congenital urethral abnormality?

Hypospadias. **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.

Q: 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?

Epididymo-orchitis. ### 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, 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).

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

Hysterectomy. **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.

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

Prevesical region. **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).

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

Fever. **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).

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

Stricture of the urethra. **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.

Question 1

Alpha fetoprotein is not raised in which testicular tumor?

Accepted Answer

Choriocarcinoma

Answer

Teratocarcinoma

Answer

Yolk sac tumor

Answer

Embryonal cell carcinoma

Question 2

What is the most common congenital urethral abnormality?

Accepted Answer

Hypospadias

Answer

Meatal stenosis

Answer

Epispadias

Answer

Diverticula

Question 3

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?

Accepted Answer

Epididymo-orchitis

Answer

Testicular torsion

Answer

Fournier's gangrene

Answer

Testicular cancer

Question 4

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

Accepted Answer

Hysterectomy

Answer

Abdomino-perineal resection

Answer

Prostatectomy

Answer

Colectomy

Question 5

What is a known complication of ectopic testis?

Accepted Answer

Torsion

Answer

Seminoma

Answer

Atrophy

Answer

All of the above

Question 6

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

Accepted Answer

Prevesical region

Answer

Groin

Answer

Paracolic gutter

Answer

None of the above

Question 7

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?

Accepted Answer

If the tumour is confined within the prostatic capsule, radical prostatectomy is an appropriate option.

Answer

If positive lymph nodes are detected on laparoscopic pelvic lymph node dissection, radical prostatectomy is indicated.

Answer

Radical prostatectomy is invariably associated with impotence.

Answer

There is currently no role for orchidectomy in the management of prostatic cancer.

Question 8

Which of the following is not a typical symptom of cystitis?

Accepted Answer

Fever

Answer

Nocturia

Answer

Hematuria

Answer

Urgency

Question 9

Screening increases life span in which cancer?

Accepted Answer

Breast

Answer

Colon

Answer

Prostate

Answer

Lung

Question 10

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

Accepted Answer

Stricture of the urethra

Answer

Benign prostatic hyperplasia (BPH)

Answer

Carcinoma of the prostate

Answer

All of the above

Urology — MCQs

Urology — MCQs

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