Urology Practice Questions

Q: All of the following are true about gonococcal epididymitis, EXCEPT?

Immediate surgical intervention is needed.. **Explanation:** The core management of **acute epididymitis**, whether caused by *Neisseria gonorrhoeae* (common in men <35 years) or enteric organisms, is **medical, not surgical**. **Why Option D is the Correct Answer (The "Except"):** Immediate surgical intervention is **not indicated** for epididymitis. Surgery is reserved for complications like abscess formation or when **testicular torsion** cannot be ruled out. In torsion, "time is muscle," and immediate surgery is mandatory; however, in epididymitis, the inflammation is managed conservatively. **Analysis of Other Options:** * **Option A (Antibiotics):** Since the etiology is bacterial (*N. gonorrhoeae*), targeted antibiotic therapy (e.g., Ceftriaxone plus Doxycycline/Azithromycin) is the cornerstone of treatment to eradicate the pathogen. * **Option B (Anti-inflammatories):** NSAIDs are standard supportive care to reduce pain, scrotal edema, and inflammatory markers. * **Option C (Surgery after infection subsides):** While rare, chronic complications like epididymal obstruction or persistent pain may necessitate surgical intervention (e.g., epididymectomy or vasoepididymostomy) *after* the acute infection has been fully resolved. **NEET-PG High-Yield Pearls:** * **Prehn’s Sign:** Elevation of the scrotum relieves pain in epididymitis (Positive Prehn’s) but worsens or has no effect on pain in testicular torsion (Negative Prehn’s). * **Cremasteric Reflex:** Usually **present** in epididymitis but **absent** in testicular torsion. * **Age Factor:** In patients 35 years, *E. coli* is the most common cause. * **Investigation of Choice:** Color Doppler Ultrasound (shows increased blood flow/hyperemia in epididymitis).

Q: Which of the following is NOT a typical cystoscopic finding in TB bladder?

Whitish efflux from the ureteric openings. **Explanation:** In Genitourinary Tuberculosis (GUTB), the bladder is typically affected secondary to renal tuberculosis. The cystoscopic findings are a result of chronic inflammation, ulceration, and subsequent fibrosis. **Why Option D is the correct answer:** **Whitish efflux from the ureteric openings** is not a feature of TB bladder. In active renal TB, the urine is typically clear but contains microscopic pus cells (**Sterile Pyuria**). Thick, whitish, or "milky" efflux is characteristic of **Chyluria** (seen in Filariasis) or severe pyogenic infections (pyonephrosis), but not typically TB. **Analysis of Incorrect Options:** * **Cobblestone mucosa:** Early TB cystitis presents with tubercles (yellowish-white nodules) surrounded by a zone of hyperemia. When these coalesce and the mucosa becomes edematous and inflamed, it gives a "cobblestone" appearance. * **Thimble bladder:** Chronic TB leads to extensive fibrosis and cicatrization of the bladder wall. This results in a severely reduced bladder capacity (often <50ml), known as a "Thimble bladder" or "Systolic bladder." * **Golf hole ureter:** Fibrosis and shortening of the ureter (due to ureteritis) lead to the retraction of the ureteric orifice. This causes the orifice to remain permanently patent and gaping, resembling a "golf hole." **Clinical Pearls for NEET-PG:** * **Sterile Pyuria:** Presence of pus cells in acidic urine with no growth on routine culture media is the hallmark of GUTB. * **Gold Standard Diagnosis:** Culture on **Lowenstein-Jensen (LJ) medium** (takes 6–8 weeks) or rapid BACTEC. * **Imaging:** The earliest radiological sign of GUTB is "moth-eaten" appearance of the calyces on IVU. * **Putty Kidney:** Refers to autonephrectomy where the kidney is replaced by a bag of caseous material.

Q: A 70-year-old gentleman underwent TURP. Prostate specimen showed malignant histology. What is the next step?

Active surveillance. **Explanation:** This scenario describes an **incidental finding of prostate cancer** following a Transurethral Resection of the Prostate (TURP) performed for presumed benign prostatic hyperplasia (BPH). In the TNM staging system, this is classified as **Stage T1a or T1b**. **Why Active Surveillance is the correct answer:** For a 70-year-old patient with incidentally discovered prostate cancer (especially if it is low-grade, low-volume, and has a low PSA level), **Active Surveillance** is the preferred management. At this age, the natural progression of low-risk prostate cancer is often slower than the patient's life expectancy. Active surveillance avoids the significant morbidity associated with surgery or radiation (incontinence, impotence) while monitoring the disease closely via serial PSA levels and repeat biopsies. **Analysis of Incorrect Options:** * **A. Radical Prostatectomy:** This is typically reserved for younger patients ( 10-15 years and higher-stage localized disease (T2). In a 70-year-old with incidental T1 disease, the risks of surgery often outweigh the benefits. * **C. External Beam Radiotherapy (EBRT):** While an option for localized cancer, it is generally deferred in low-risk incidental cases in favor of surveillance to avoid radiation-induced proctitis or cystitis. * **D. Bilateral Orchiectomy:** This is a form of Androgen Deprivation Therapy (ADT) used for **metastatic (Stage D/M1)** prostate cancer. It is not indicated for localized, incidental findings. **Clinical Pearls for NEET-PG:** * **T1a:** Tumor involves ≤5% of resected tissue. * **T1b:** Tumor involves >5% of resected tissue. * **Most common site for Prostate Cancer:** Peripheral Zone (detected by DRE). * **Most common site for BPH:** Transition Zone (reason why TURP specimens occasionally show incidental cancer). * **Gleason Scoring:** The most important prognostic factor for prostate cancer.

Q: Which of the following is NOT a differential diagnosis for acute scrotum?

Testicular cancer. **Explanation:** The term **"Acute Scrotum"** refers to a clinical emergency characterized by the sudden onset of pain, swelling, and/or redness of the scrotum. The differential diagnosis for acute scrotum focuses on conditions that present **acutely** (within hours to a few days). **Why Testicular Cancer is the correct answer:** Testicular cancer typically presents as a **painless, hard, slow-growing mass** that is inseparable from the testis. While 10% of cases may present with acute pain due to intratumoral hemorrhage, it is fundamentally a chronic/subacute condition and is not considered a primary differential for the "acute scrotum" syndrome. **Analysis of Incorrect Options:** * **Testicular Torsion:** The most critical surgical emergency. It presents with sudden, severe pain, a high-riding testis, and a negative Prehn’s sign. * **Epididymitis/Epididymo-orchitis:** The most common cause of acute scrotum in post-pubertal males. It usually presents with fever, dysuria, and a positive Prehn’s sign (relief of pain on elevation of the scrotum). * **Hydatid Torsion (Torsion of the Appendix Testis):** The most common cause of acute scrotum in children (ages 7-12). It is characterized by the pathognomonic **"Blue Dot Sign"** on the upper pole of the testis. **NEET-PG High-Yield Pearls:** * **Golden Period:** For testicular torsion, detorsion within **6 hours** has a >90% salvage rate; this drops to <10% after 24 hours. * **Investigation of Choice:** Color Doppler Ultrasound is the gold standard to differentiate torsion (absent blood flow) from epididymitis (increased blood flow). * **Management:** If torsion is suspected clinically, immediate **surgical exploration** should not be delayed for imaging.

Q: Sterile pyuria is seen in which of the following conditions?

Renal tuberculosis. **Explanation:** **Sterile pyuria** is defined as the presence of white blood cells (pus cells >5/HPF) in the urine in the absence of growth on standard culture media. **Renal Tuberculosis (A)** is the classic and most common cause of sterile pyuria in surgical practice. In Genitourinary TB (GUTB), the *Mycobacterium tuberculosis* bacilli cause chronic inflammation and ulceration of the urothelium, leading to the shedding of pus cells. However, because *M. tuberculosis* does not grow on routine aerobic culture media (it requires specific media like Lowenstein-Jensen), the culture is reported as "sterile." **Analysis of Incorrect Options:** * **Wilms Tumor (B):** Typically presents as an asymptomatic abdominal mass in children. While microscopic hematuria may occur, pyuria is not a characteristic feature unless there is a secondary infection. * **Pelvic Inflammatory Disease (C):** While PID can cause pyuria due to urethral irritation, it is usually associated with sexually transmitted pathogens (like *Chlamydia* or *Gonorrhea*) or polymicrobial infections that are not primarily classified under the classic surgical presentation of sterile pyuria. * **Diabetes Mellitus (D):** Diabetics are prone to UTIs, but these are typically "infected pyuria" caused by common organisms like *E. coli*, which grow readily on standard cultures. **Clinical Pearls for NEET-PG:** * **Other causes of sterile pyuria:** Partially treated bacterial UTI (most common overall), Renal stones, Polycystic Kidney Disease, and interstitial nephritis. * **GUTB Triad:** Frequency (earliest symptom), painless hematuria, and sterile pyuria. * **Gold Standard Diagnosis for GUTB:** Culture on LJ medium (takes 6–8 weeks) or BACTEC (faster). * **Radiological sign:** "Thimble bladder" (small capacity, fibrotic bladder) is a late feature of GUTB.

Q: A 65-year-old female presents with recurrent episodes of gross painless hematuria. What is the most common cause of gross painless hematuria?

Carcinoma of the bladder. **Explanation:** **Why Carcinoma of the Bladder is Correct:** In any adult patient, particularly those over the age of 50, **painless gross hematuria** is considered **malignancy until proven otherwise**. Transitional Cell Carcinoma (TCC) of the urinary bladder is the most common cause of this presentation. The bleeding occurs due to the friable nature of the neoplastic tissue or the erosion of surface vessels by the tumor. In the context of NEET-PG, remember the "Rule of 60s": Bladder cancer typically presents in the 6th decade of life and is the most frequent urological malignancy causing visible, non-tender bleeding. **Why Other Options are Incorrect:** * **Renal Tuberculosis:** While it can cause hematuria, it is typically associated with "sterile pyuria" (pus cells in urine without bacterial growth) and irritative voiding symptoms (frequency, urgency). * **Urethral Stricture:** This usually presents with obstructive voiding symptoms (weak stream, straining, hesitancy). While it can cause terminal hematuria due to urethral mucosal irritation, it is rarely the cause of "gross painless hematuria." * **Interstitial Nephritis:** This is a renal parenchymal disease often presenting with microscopic hematuria, proteinuria, and sterile pyuria, usually secondary to drug reactions or systemic disease, rather than gross bleeding. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Cystoscopy is the most definitive investigation for bladder cancer. * **Initial Investigation:** Ultrasonography (USG) is usually the first-line screening tool. * **Most Common Type:** Transitional Cell Carcinoma (Urothelial Carcinoma) is the most common histological type (>90%). * **Risk Factors:** Smoking (most common) and occupational exposure to aromatic amines (e.g., Aniline dyes). * **Painful Hematuria:** Usually suggests calculi (stones) or infections (cystitis).

Question 1

Which of the following statements about erectile dysfunction are false?

Accepted Answer

Psychogenic erectile dysfunction is distinguished from organic erectile dysfunction by PIPE therapy.

Answer

Sildenafil is used for treatment.

Answer

Nocturnal penile tumescence is maintained in psychological erectile dysfunction.

Answer

Sensate focus therapy aims at sensitizing nongenital areas.

Question 2

All of the following are true about gonococcal epididymitis, EXCEPT?

Accepted Answer

Immediate surgical intervention is needed.

Answer

Antibiotics are indicated.

Answer

Anti-inflammatories may be used.

Answer

Surgery may be considered after infection subsides.

Question 3

Which of the following is NOT a typical cystoscopic finding in TB bladder?

Accepted Answer

Whitish efflux from the ureteric openings

Answer

Cobblestone mucosa

Answer

Thimble bladder

Answer

Golf hole ureter

Question 4

Regarding testicular torsion, which of the following statements is FALSE?

Accepted Answer

Testicular salvage decreases to less than 5% if surgery is delayed beyond 6 hours.

Answer

Undescended testicle is a risk factor.

Answer

Decreased blood flow relative to the contralateral testicle can be demonstrated by ultrasound.

Answer

Surgical exploration should include fixation of the contralateral testicle.

Question 5

A 70-year-old gentleman underwent TURP. Prostate specimen showed malignant histology. What is the next step?

Accepted Answer

Active surveillance

Answer

Radical Prostatectomy

Answer

External beam radiotherapy

Answer

Bilateral orchiectomy

Question 6

A 3-year-old male patient presents with only one testis in the scrotum. On examination, the right testis is palpable in the inguinal canal. What is the preferred treatment?

Accepted Answer

Orchidopexy

Answer

Observation until puberty

Answer

Androgen therapy

Answer

Orchiectomy

Question 7

Which of the following is NOT a differential diagnosis for acute scrotum?

Accepted Answer

Testicular cancer

Answer

Epididymitis

Answer

Hydatid torsion

Answer

Testicular torsion

Question 8

Which of the following statements regarding ureteric stones is false?

Accepted Answer

Source is always the kidneys.

Answer

Urine is always infected.

Answer

Should be removed immediately.

Answer

Pain is referred to the tip of the penis in intramural stones.

Question 9

Sterile pyuria is seen in which of the following conditions?

Accepted Answer

Renal tuberculosis

Answer

Wilms tumor

Answer

Pelvic inflammatory disease

Answer

Diabetes mellitus

Question 10

A 65-year-old female presents with recurrent episodes of gross painless hematuria. What is the most common cause of gross painless hematuria?

Accepted Answer

Carcinoma of the bladder

Answer

Renal tuberculosis

Answer

Urethral stricture

Answer

Interstitial nephritis

Urology — MCQs

Urology — MCQs

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