Urology Practice Questions

Q: Penile angiography is reliable only after intracavernosal injection of vasoactive substances. All are indications for penile angiography, EXCEPT:

Painful priapism. ***Painful priapism*** - Penile angiography is generally **contraindicated** in painful priapism because the condition is an **emergency** requiring immediate intervention to restore blood flow and prevent irreversible cavernosal damage. - The goal in priapism is detumescence, not vascular mapping, and angiography could delay necessary treatment, potentially worsening outcomes. *Peyronie's disease* - Angiography can be used in select cases of Peyronie's disease to evaluate the **vascularity of plaques** or to identify associated vascular abnormalities that may contribute to erectile dysfunction alongside the curvature. - It helps in surgical planning, especially when considering **penile revascularization procedures** if vascular insufficiency is suspected. *Erectile dysfunction* - Penile angiography is a useful diagnostic tool for identifying the cause of certain types of **erectile dysfunction**, particularly those suspected to have a vascular origin like **arterial insufficiency** or **venous leak**. - It helps map the penile vasculature, providing precise anatomical information for potential **revascularization surgery** in carefully selected patients. *Arteriovenous malformation* - Angiography is the **gold standard** for diagnosing and characterizing **arteriovenous malformations (AVMs)** in the penis. - It provides detailed information on the feeding arteries and draining veins, which is crucial for planning **embolization** or **surgical resection** to treat the AVM.

Q: What is the term for the triad of renal colic, loin swelling that resolves after urination?

Dietel's crisis. ***Dietel's crisis*** * It is characterized by recurrent attacks of **renal colic**, **loin swelling** (due to hydronephrosis), and hematuria, which resolve after increased urine output [1]. * This triad is typically associated with **intermittent ureteropelvic junction (UPJ) obstruction**, where urine outflow is temporarily blocked [1]. *Kocher's triad* * This triad refers to the classic symptoms of acute appendicitis: **pain shifting from the periumbilical region to the right iliac fossa**, **anorexia**, and **nausea/vomiting**. * It is not related to renal issues or loin swelling. *Saint's triad* * This triad describes the coexistence of **gallstones**, **diverticulosis**, and **hiatal hernia**. * It represents three common conditions often found together in older adults but has no connection to kidney problems. *Charcot's triad* * This triad is composed of **jaundice**, **right upper quadrant pain**, and **fever**, which are indicative of acute cholangitis. * It is entirely distinct from renal colic and loin swelling.

Q: Which of the following is the most appropriate investigation for an anterior urethral stricture?

Retrograde urethrogram. ***Retrograde urethrogram*** - A **retrograde urethrogram (RUG)** is the **gold standard** for diagnosing and characterizing **anterior urethral strictures**, as it directly visualizes the anterior urethra by injecting contrast medium retrograde from the urethral meatus. - It provides detailed information on the **length, location, and severity** of the stricture, which is crucial for surgical planning. - RUG is particularly superior for **anterior urethral pathology** (bulbar and penile urethra) as the contrast is instilled from below, filling this segment optimally. *Micturating cystourethrogram* - A **micturating cystourethrogram (MCUG/VCUG)** is primarily used to evaluate the **posterior urethra** (prostatic and membranous urethra) and bladder neck during voiding. - It visualizes the urethra as urine flows from the bladder during micturition, making it ideal for posterior urethral pathology and vesicoureteral reflux. - For **complete urethral assessment**, RUG and MCUG are often performed together (combined study), but for isolated **anterior strictures**, RUG alone is most appropriate. *High frequency ultrasound* - While **high-frequency ultrasound** can assess spongiofibrosis and periurethral tissues, it is an **adjunct** rather than the primary investigation. - It provides complementary information about stricture depth and spongiosal involvement but cannot replace RUG for defining urethral lumen anatomy and stricture length. *Computed Tomography Urography* - **CT Urography** is mainly used for imaging the **upper urinary tract** (kidneys, ureters, and bladder) to detect stones, tumors, or anatomical abnormalities. - It provides **poor spatial resolution** for the fine urethral anatomy and is not the primary imaging modality for urethral strictures.

Q: What is the recommended treatment approach for disseminated seminoma?

CT and orchidectomy. ***CT and orchidectomy*** - For disseminated seminoma, **chemotherapy (CT)** is the primary systemic treatment due to its high sensitivity to platinum-based regimens. - **Orchidectomy** (surgical removal of the testis) is crucial for both diagnosis and disease control, even in metastatic settings, to prevent local recurrence and provide tissue for definitive pathology. *Only RT* - **Radiotherapy (RT)** is effective for localized seminoma or adjuvant treatment of retroperitoneal disease, but it is insufficient as a standalone treatment for disseminated disease due to its limited reach. - While RT has a role in specific situations (e.g., residual masses post-chemotherapy), it cannot eradicate widespread metastatic seminoma on its own. *Only CT* - While chemotherapy is vital for disseminated seminoma, omitting **orchidectomy** would leave the primary tumor in situ, risking continued growth, bleeding, infection, and incomplete staging. - **Orchidectomy** provides definitive pathological diagnosis and removes the source of potential further spread, complementing the systemic effects of chemotherapy. *Retroperitoneal lymph node dissection* - **Retroperitoneal lymph node dissection (RPLND)** is a primary treatment modality for non-seminomatous germ cell tumors, particularly for persistent retroperitoneal disease after chemotherapy. - For seminoma, **chemotherapy** (and sometimes radiotherapy) is generally preferred for retroperitoneal involvement due to seminoma's high chemosensitivity, making RPLND less common and usually reserved for residual masses after chemotherapy.

Q: Test to differentiate between psychological and organic erectile dysfunction is:

Nocturnal penile tumescence. ***Nocturnal penile tumescence*** - **Nocturnal penile tumescence (NPT)** testing measures the occurrence and quality of **erections during sleep**. - Healthy men experience erections during REM sleep; their presence suggests a **psychological cause** for erectile dysfunction as the neural pathways for erection are intact. *Pharmacologically induced penile erection therapy* - This involves injecting **vasodilating agents** directly into the penis to induce an erection. - While it can confirm the capacity for erection, it does not differentiate between psychological and organic causes since both types of ED can respond to direct pharmacological intervention. *Sildenafil induced erection* - Sildenafil (Viagra) is a **PDE5 inhibitor** that works by enhancing the effects of nitric oxide during sexual stimulation. - An erection induced by sildenafil can occur in both psychological and organic ED as long as there is some capacity for vasodilation, thus it does not differentiate the underlying cause. *Squeeze technique* - The **squeeze technique** is a behavioral therapy used to treat **premature ejaculation**, not erectile dysfunction. - It involves stopping stimulation at the point of impending ejaculation and applying pressure to the penis to reduce arousal.

Q: What is the percentage of testicular cancer cases that are associated with cryptorchidism?

30%. ***30%*** - While cryptorchidism is a significant risk factor for testicular cancer, it is associated with approximately **30%** of all testicular cancer cases. - The remaining 70% of testicular cancer cases occur in men with normally descended testes, indicating that other factors are also involved in its etiology. *10%* - This percentage is too low to represent the known association between cryptorchidism and testicular cancer. - Cryptorchidism is a well-established and more prominent risk factor than what 10% would suggest. *50%* - This percentage is higher than the generally accepted figure for the association between cryptorchidism and testicular cancer. - While cryptorchidism significantly increases the risk, it does not account for half of all cases. *70%* - This percentage is significantly higher than current epidemiological data suggest for the proportion of testicular cancer cases linked to cryptorchidism. - This would imply that cryptorchidism is almost the sole cause, which is not accurate.

Q: A patient presented with renal cell carcinoma invading the IVC and the renal vein. Which of the following statements is false?

IVC involvement indicates inoperability. ***Correct: IVC involvement indicates inoperability*** - This statement is **FALSE** and therefore the correct answer to this question - IVC involvement does NOT render RCC inoperable - Surgical resection with **radical nephrectomy and tumor thrombectomy** (cavotomy) can be performed successfully - **Even IVC tumor thrombus extending to the right atrium** can be surgically managed by experienced teams - Level of tumor thrombus determines surgical approach but not operability *Incorrect: Preop biopsy is not necessary* - This statement is **TRUE** (not the answer we're looking for) - Pre-operative biopsy typically not required when imaging is diagnostic for RCC - Cross-sectional imaging (CT/MRI) with characteristic features is usually sufficient - Biopsy risks include **tumor seeding** along the tract and potential for non-diagnostic sampling - Biopsy reserved for atypical presentations or when diagnosis unclear *Incorrect: Pre op radiotherapy is not essential* - This statement is **TRUE** (not the answer we're looking for) - RCC is **radioresistant** and responds poorly to radiation therapy - Pre-operative radiotherapy is NOT part of standard management for localized RCC - Surgery (radical nephrectomy) remains the primary curative treatment - Radiation may have palliative role in metastatic disease (bone mets, brain mets) *Incorrect: Chest x-ray should be done to rule out pulmonary metastasis* - This statement is **TRUE** (not the answer we're looking for) - **Lungs are the most common site** of RCC metastases - Chest imaging is essential component of pre-operative staging - **CT chest is preferred** over plain X-ray for better sensitivity in detecting pulmonary metastases - Complete staging includes CT chest, abdomen, and pelvis

Q: What is the tumor marker that can be indicative of disease relapse in a 65-year-old male who was diagnosed with prostate cancer three years ago and treated with surgery and hormone therapy, and is now experiencing urinary symptoms and progressive backache?

PSA. ***PSA*** - **Prostate-specific antigen (PSA)** is the primary tumor marker for prostate cancer and is used for screening, monitoring treatment response [2], and detecting **disease relapse** [4]. - Rising PSA levels in a patient with a history of prostate cancer, especially with new urinary symptoms and backache (suggesting **metastasis**), are highly indicative of recurrence [1]. *CA 125* - **CA 125** is primarily a tumor marker for **ovarian cancer** and is not used for monitoring prostate cancer. - While it can be elevated in some non-malignant conditions, it has no diagnostic or prognostic value for prostate cancer. *Beta-HCG* - **Beta-HCG** is a tumor marker typically associated with **germ cell tumors** (e.g., testicular cancer) and **choriocarcinoma** [3]. - It is not used for the diagnosis or monitoring of prostate cancer [3]. *Carcinoembryonic antigen (CEA)* - **CEA** is a tumor marker often associated with **colorectal cancer**, and less commonly with other adenocarcinomas such as lung or breast cancer. - It is not a specific or reliable marker for prostate cancer [4].

Q: Commonest manifestation of Grawitz's tumor in males is

Hematuria. ***Hematuria*** - **Grawitz's tumor**, also known as **renal cell carcinoma (RCC)**, commonly presents with macroscopic or microscopic **hematuria** due to tumor invasion of the collecting system [1]. - While other symptoms can occur, **painless hematuria** is often the primary and most frequently observed symptom, leading to medical evaluation [1]. *Secondary deposits* - While **metastasis** is common in RCC, especially in advanced stages, it usually occurs later in the disease progression [1]. - Patients often present with local symptoms like **hematuria** before widespread secondary deposits become the predominant manifestation [1]. *Pathological fracture* - **Pathological fractures** are a manifestation of **bone metastasis**, which is a secondary deposit. - This symptom implies advanced disease and is not typically the initial or most common presentation of Grawitz's tumor. *Rapidly developing varicocele* - A rapidly developing **left-sided varicocele** can be a sign of RCC, specifically due to **renal vein obstruction** by the tumor or thrombus. - However, this is a less common initial presentation compared to **hematuria**, which directly reflects tumor involvement of the kidney's excretory system.

Q: Screening of prostate cancer is commonly done by

DRE (digital rectal exam) & PSA. ***DRE (digital rectal exam) & PSA*** - **Digital Rectal Exam (DRE)** allows for palpation of the prostate gland to detect **nodules**, **hardness**, or **asymmetry** that may indicate cancer. [1] - **Prostate-Specific Antigen (PSA)** is a blood test that measures a protein produced by the prostate gland; elevated levels can suggest prostate cancer. *MRI imaging* - While **MRI** is used for **staging** and sometimes for **targeted biopsies** of suspicious lesions, it is not a primary screening tool due to its cost and limited availability for broad population screening. - It is typically used *after* abnormal DRE or PSA results, or for monitoring. *Surgical intervention* - **Surgical intervention** (e.g., radical prostatectomy) is a **treatment** for prostate cancer confirmed by biopsy, not a screening method. - Screening aims to *detect* the disease, not to treat it. *Ultrasound-guided procedure* - **Transrectal ultrasound (TRUS)** is primarily used to **guide prostate biopsies** and determine prostate volume, not as a standalone screening test. - It does not have sufficient sensitivity or specificity to be routinely used for initial cancer screening.

Question 1

Penile angiography is reliable only after intracavernosal injection of vasoactive substances. All are indications for penile angiography, EXCEPT:

Accepted Answer

Painful priapism

Answer

Arteriovenous malformation

Answer

Peyronie's disease

Answer

Erectile dysfunction

Question 2

What is the term for the triad of renal colic, loin swelling that resolves after urination?

Accepted Answer

Dietel's crisis

Answer

Kocher's triad

Answer

Saint's triad

Answer

Charcot's triad

Question 3

Which of the following is the most appropriate investigation for an anterior urethral stricture?

Accepted Answer

Retrograde urethrogram

Answer

High frequency ultrasound

Answer

Micturating cystourethrogram

Answer

Computed Tomography Urography

Question 4

What is the recommended treatment approach for disseminated seminoma?

Accepted Answer

CT and orchidectomy

Answer

Only RT

Answer

Only CT

Answer

Retroperitoneal lymph node dissection

Question 5

Test to differentiate between psychological and organic erectile dysfunction is:

Accepted Answer

Nocturnal penile tumescence

Answer

Pharmacologically induced penile erection therapy

Answer

Sildenafil induced erection

Answer

Squeeze technique

Question 6

What is the percentage of testicular cancer cases that are associated with cryptorchidism?

Accepted Answer

30%

Answer

50%

Answer

70%

Answer

10%

Question 7

A patient presented with renal cell carcinoma invading the IVC and the renal vein. Which of the following statements is false?

Accepted Answer

IVC involvement indicates inoperability

Answer

Pre op radiotherapy is not essential

Answer

Chest x-ray should be done to rule out pulmonary metastasis.

Answer

Preop biopsy is not necessary

Question 8

What is the tumor marker that can be indicative of disease relapse in a 65-year-old male who was diagnosed with prostate cancer three years ago and treated with surgery and hormone therapy, and is now experiencing urinary symptoms and progressive backache?

Accepted Answer

PSA

Answer

CA 125

Answer

Beta-HCG

Answer

Carcinoembryonic antigen (CEA)

Question 9

Commonest manifestation of Grawitz's tumor in males is

Accepted Answer

Hematuria

Answer

Secondary deposits

Answer

Pathological fracture

Answer

Rapidly developing varicocele

Question 10

Screening of prostate cancer is commonly done by

Accepted Answer

DRE (digital rectal exam) & PSA

Answer

MRI imaging

Answer

Surgical intervention

Answer

Ultrasound-guided procedure

Urology — MCQs

Urology — MCQs

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