Urology — MCQs

Urology Indian Medical PG Practice Questions and MCQs

Question 741: A 60-year-old male presents with cancer of the prostate. The tumor is limited to the capsule and is palpable on per rectal examination. The patient is diagnosed as stage T1b. What is the best treatment?

A. Radical prostatectomy (Correct Answer)
B. Chemotherapy
C. Palliative radiotherapy
D. Orchidectomy

Explanation: ### Explanation **Correct Option: A. Radical Prostatectomy** The patient is a 60-year-old male with localized prostate cancer (Stage T1/T2). For patients with a life expectancy of more than 10 years and localized disease (tumor confined to the prostate), **Radical Prostatectomy (RP)** or **Radical Radiotherapy** are the treatments of choice with curative intent. Since the tumor is limited to the capsule and the patient is relatively young (60 years), surgical removal (RP) offers the best chance for long-term survival and definitive cure. **Analysis of Incorrect Options:** * **B. Chemotherapy:** Chemotherapy (e.g., Docetaxel) is generally reserved for metastatic hormone-refractory prostate cancer (mCRPC). It is not a primary treatment for localized disease. * **C. Palliative Radiotherapy:** Palliative care is indicated for advanced, symptomatic stage IV disease (e.g., bone pain from metastasis). This patient has localized disease where the goal is curative, not palliative. * **D. Orchidectomy:** Bilateral orchidectomy is a form of Androgen Deprivation Therapy (ADT). It is the gold standard for metastatic prostate cancer (Stage D/T4) to reduce testosterone levels but is not indicated as monotherapy for localized Stage T1/T2 disease. **High-Yield Clinical Pearls for NEET-PG:** * **Staging Note:** While the question mentions "palpable" and "T1b," technically, a palpable tumor is staged as **T2**. T1 is clinically inapparent (found via TURP or PSA). However, for both T1 and T2 (localized), the management remains Radical Prostatectomy. * **Radical Prostatectomy:** Involves removal of the prostate, seminal vesicles, and distal vas deferens. * **Most Common Site:** Peripheral zone (70%), which is why it is palpable on Digital Rectal Examination (DRE). * **Osteoblastic Metastasis:** Prostate cancer characteristically spreads to the lumbar spine via **Batson’s venous plexus**, causing osteoblastic (sclerotic) lesions. * **Tumor Marker:** PSA (Prostate Specific Antigen) is used for screening and monitoring recurrence, but the definitive diagnosis is via **TRUS-guided biopsy**.

Question 742: What is the treatment of 'thimble bladder'?

A. Anti-tubercular treatment
B. Corticosteroids
C. Ileocystoplasty (Correct Answer)
D. Anti-tubercular drugs + steroids

Explanation: **Explanation:** **Thimble bladder** (also known as a systolic bladder) is the end-stage manifestation of **Genitourinary Tuberculosis (GUTB)**. Chronic tuberculous infection leads to extensive transmural fibrosis and scarring of the bladder wall, resulting in a severely reduced capacity (often <50 ml) and high intravesical pressures. 1. **Why Ileocystoplasty is correct:** Once a thimble bladder has formed, the changes are irreversible and anatomical. Medical therapy cannot restore bladder volume. **Augmentation cystoplasty** (specifically **Ileocystoplasty**) is the treatment of choice. It involves using a detubularized segment of the ileum to increase bladder capacity and lower pressure, thereby protecting the upper urinary tract from reflux and renal failure. 2. **Why other options are incorrect:** * **Anti-tubercular treatment (ATT):** While ATT is mandatory to treat active TB, it cannot reverse established fibrosis. In fact, ATT can sometimes worsen the contracture during the healing phase due to further scarring. * **Corticosteroids:** These are used in early-stage GUTB to reduce edema and prevent ureteric strictures, but they have no role in treating a fibrotic, contracted thimble bladder. * **ATT + Steroids:** This combination is used for active inflammation but is ineffective for the end-stage mechanical failure of the bladder. **Clinical Pearls for NEET-PG:** * **Imaging:** On Intravenous Urogram (IVU), a thimble bladder appears as a small, smooth, rounded bladder shadow. * **Prerequisite for Surgery:** Surgery (Ileocystoplasty) should only be performed after the patient has completed at least **4–6 weeks of ATT** to ensure the urine is sterile and to prevent "miliary spread" during surgery. * **Contraindication:** If the bladder capacity is extremely small (<15 ml) or the urethra is involved, a **urinary diversion** (Ileal conduit) may be preferred over augmentation.

Question 743: A young male presents with abdominal pain. CT scan shows a heterogenous necrotizing mass at the left renal hilum. His AFP or hCG levels are elevated. What is the most likely diagnosis?

A. Lymphoma
B. Transitional cell carcinoma
C. Metastatic melanoma
D. Metastatic germ cell tumor (Correct Answer)

Explanation: **Explanation:** The presence of a **heterogenous necrotizing mass at the renal hilum (retroperitoneum)** in a young male, associated with elevated serum tumor markers (**AFP or β-hCG**), is a classic presentation of a **Metastatic Germ Cell Tumor (GCT)**. 1. **Why D is correct:** The retroperitoneum is the primary site for lymphatic spread from testicular germ cell tumors. In young men, any retroperitoneal mass should be considered a metastatic GCT until proven otherwise. Elevated **AFP** (Alpha-fetoprotein) is characteristic of Yolk Sac components, while elevated **β-hCG** is seen in Choriocarcinoma or Seminoma (mildly). A "necrotizing" appearance on CT often reflects the rapid growth and central ischemia typical of these aggressive tumors. 2. **Why other options are incorrect:** * **A. Lymphoma:** While common in the retroperitoneum, lymphoma typically presents as "bulky" homogenous lymphadenopathy that encases vessels without causing necrosis. It does **not** elevate AFP or hCG. * **B. Transitional Cell Carcinoma (TCC):** TCC arises from the urothelium (renal pelvis). While it can involve the hilum, it usually presents with hematuria in older patients and does not produce germ cell markers. * **C. Metastatic Melanoma:** Melanoma can metastasize anywhere, but it is not associated with elevated AFP/hCG and is less common than GCT in this demographic and location. **High-Yield Clinical Pearls for NEET-PG:** * **Rule of Thumb:** In a young male with a retroperitoneal mass, always perform a **scrotal examination** and ultrasound to rule out a primary testicular tumor. * **Primary Extragonadal GCT:** Occasionally, GCTs can arise primarily in the retroperitoneum without a testicular primary. * **Markers:** * ↑ AFP: Yolk sac tumor (never in pure seminoma). * ↑ β-hCG: Choriocarcinoma, Seminoma (10-15% of cases). * ↑ LDH: Correlates with tumor burden/bulk.

Question 744: Prostate cancer typically metastasizes to the vertebrae through which pathway?

A. Direct spread
B. Lymphatic spread
C. Batson's plexus (Correct Answer)
D. All of the above

Explanation: **Explanation:** **Why Batson’s Plexus is correct:** Prostate cancer has a unique predilection for the axial skeleton (vertebrae, pelvis, and ribs). The primary pathway for this spread is the **Batson’s venous plexus**, a network of **valveless** paravertebral veins. Because these veins lack valves, changes in intra-abdominal pressure (e.g., coughing or straining) can cause retrograde blood flow. This allows malignant cells from the prostatic venous plexus to travel directly to the vertebral venous system, bypassing the systemic circulation (caval system) and the lungs. This explains why bone metastasis often occurs in the absence of lung involvement. **Why other options are incorrect:** * **Direct spread:** While prostate cancer can locally invade the seminal vesicles, bladder neck, or rectum (Denonvilliers' fascia acts as a temporary barrier), it is not the primary mechanism for distant vertebral metastasis. * **Lymphatic spread:** This is the primary route for spread to regional nodes (obturator and internal iliac nodes). While it can lead to systemic disease, it is not the specific pathway responsible for the characteristic vertebral "drop-metastasis" pattern. **Clinical Pearls for NEET-PG:** * **Osteoblastic Lesions:** Prostate cancer is the most common cause of **osteoblastic (bone-forming)** metastases in elderly males. * **PSA & Acid Phosphatase:** Elevated PSA is the most sensitive marker for screening and monitoring, while **Prostatic Acid Phosphatase (PAP)** is historically associated with bony metastasis. * **Most Common Site:** The lumbar spine is the most frequent site of vertebral involvement. * **Imaging:** A **Technetium-99m bone scan** is the most sensitive investigation to detect these metastases.

Question 745: An 18-year-old boy presents with groin pain for 2 days. On examination, the testis is high-lying and the cremasteric reflex is absent. Elevation of the testis worsens the pain. What is the probable diagnosis?

A. Right testicular torsion (Correct Answer)
B. Right strangulated hernia
C. Right inguinal hernia
D. Right epididymo-orchitis

Explanation: **Explanation:** The clinical presentation of acute groin pain in an adolescent, combined with specific physical findings, points directly to **Testicular Torsion**. **Why the correct answer is right:** Testicular torsion is a surgical emergency caused by the twisting of the spermatic cord. * **High-lying testis:** The twisting causes shortening of the cord, pulling the testis upward (Angel’s sign). * **Absent Cremasteric Reflex:** This is the most sensitive physical finding for torsion; its presence almost always rules it out. * **Negative Prehn’s Sign:** Elevation of the testis worsens or does not relieve the pain in torsion (Positive Prehn's sign, where pain is relieved, is characteristic of epididymitis). **Why the incorrect options are wrong:** * **Epididymo-orchitis:** Usually presents with fever and pyuria. Crucially, Prehn’s sign is positive (pain relief on elevation) and the cremasteric reflex is typically preserved. * **Strangulated Hernia:** While it causes acute pain, it usually presents with a tense, tender, irreducible swelling in the inguinal canal and features of intestinal obstruction (vomiting, constipation), rather than isolated testicular displacement. * **Inguinal Hernia:** An uncomplicated hernia presents as a reducible swelling with a cough impulse and is generally not associated with acute, severe pain or an absent cremasteric reflex. **NEET-PG High-Yield Pearls:** * **Golden Period:** Detorsion must occur within **6 hours** to ensure a 90-100% salvage rate. * **Bell-Clapper Deformity:** The most common predisposing anatomical factor (high tunica vaginalis attachment). * **Investigation of Choice:** Color Doppler Ultrasound (shows decreased or absent blood flow). * **Management:** Immediate surgical exploration and **bilateral orchidopexy** (fixation), as the anatomical defect is usually bilateral.

Question 746: What is true about varicocele?

A. More common on the right side
B. Can cause oligospermia (Correct Answer)
C. Has no effect on Valsalva maneuver
D. Lies anterior to the testis

Explanation: **Explanation:** A varicocele is the abnormal dilation and tortuosity of the pampiniform plexus of veins within the spermatic cord. It is the most common reversible cause of male infertility. **Why Option B is correct:** Varicoceles lead to **oligospermia** (low sperm count) and decreased sperm motility. The underlying pathophysiology involves the reflux of warm venous blood from the abdomen, which increases the intratesticular temperature. This thermal stress impairs spermatogenesis, as the testes require a temperature approximately 2°C lower than the core body temperature to function optimally. **Analysis of Incorrect Options:** * **Option A:** Varicoceles are significantly **more common on the left side (90%)**. This is due to the left testicular vein being longer, entering the left renal vein at a right angle (increasing hydrostatic pressure), and potentially being compressed between the SMA and Aorta ("Nutcracker effect"). A **solitary right-sided varicocele** is a red flag and necessitates imaging to rule out a retroperitoneal tumor (e.g., RCC). * **Option C:** Varicoceles typically **increase in size/prominence during the Valsalva maneuver** or upon standing, as these actions increase intra-abdominal pressure and venous reflux. * **Option D:** Anatomically, a varicocele is located **superior and posterior** to the testis, often described as a "bag of worms" feeling within the scrotum. **High-Yield Clinical Pearls for NEET-PG:** * **Grading:** Grade I (Palpable only with Valsalva), Grade II (Palpable without Valsalva), Grade III (Visible through scrotal skin). * **Surgical Indications:** Infertility with abnormal semen analysis, testicular atrophy, or severe pain. * **Gold Standard Treatment:** Microsurgical subinguinal varicocelectomy (lowest recurrence and complication rates).

Question 747: Which of the following is a type of stone seen in urinary tract infections?

A. Calcium oxalate
B. Uric acid stones
C. Staghorn calculus (Correct Answer)
D. Cysteine stones

Explanation: **Explanation:** The correct answer is **Staghorn calculus**. These stones are typically composed of **Struvite** (Magnesium Ammonium Phosphate) and are classically associated with chronic urinary tract infections (UTIs) caused by **urease-producing organisms** (e.g., *Proteus mirabilis*, *Klebsiella*, *Pseudomonas*). **Mechanism:** Urease-producing bacteria hydrolyze urea into ammonia, which increases urinary pH (alkaline urine). In this alkaline environment, phosphate solubility decreases, leading to the precipitation of struvite and carbonate apatite crystals. These stones grow rapidly and fill the renal pelvis and calyces, taking on the characteristic "staghorn" shape. **Analysis of Incorrect Options:** * **A. Calcium oxalate:** The most common type of renal stone overall. They are typically associated with metabolic factors (hypercalciuria, hyperoxaluria) rather than infection. * **B. Uric acid stones:** These form in **acidic urine** (pH < 5.5). They are radiolucent on X-ray and are associated with gout or high cell turnover states. * **D. Cysteine stones:** Caused by an autosomal recessive defect in the transport of dibasic amino acids (COLA: Cysteine, Ornithine, Lysine, Arginine). They are "hexagonal" on microscopy and not infection-induced. **High-Yield Clinical Pearls for NEET-PG:** * **Composition:** Struvite stones are also called "Triple Phosphate" stones. * **Microscopy:** They exhibit a characteristic **"Coffin-lid"** appearance. * **Radiology:** While the stone itself is radiopaque, it is less dense than calcium oxalate. * **Treatment:** Complete surgical removal (usually via PCNL) is necessary because the stone acts as a reservoir for bacteria, leading to recurrent sepsis.

Question 748: Benign prostatic hypertrophy results in obstruction of the urinary tract. The specific condition is associated with enlargement of which part of the prostate?

A. Entire prostate gland
B. Lateral lobes
C. Median lobe (Correct Answer)
D. Posterior lobes

Explanation: **Explanation:** Benign Prostatic Hyperplasia (BPH) is a common condition in aging men characterized by the proliferation of stromal and epithelial cells. **Why the Median Lobe is Correct:** Anatomically, the prostate is divided into lobes (Lowsley’s classification) and zones (McNeal’s classification). BPH primarily involves the **Median lobe** and the **Lateral lobes**. However, the median lobe (located between the ejaculatory ducts and the urethra) is specifically responsible for the **mechanical obstruction** of the internal urethral orifice. As it enlarges, it projects into the bladder floor, creating a "ball-valve" effect that obstructs urine flow, leading to the classic symptoms of hesitancy and straining. **Analysis of Incorrect Options:** * **A. Entire prostate gland:** While the gland increases in overall volume, the hypertrophy is localized to specific regions (Transition Zone) rather than a uniform enlargement of the entire organ. * **B. Lateral lobes:** These do enlarge in BPH and contribute to the compression of the prostatic urethra, but the median lobe is the classic anatomical answer associated with the specific "uvula vesicae" elevation and significant outlet obstruction. * **D. Posterior lobes:** This is the most common site for **Prostate Cancer (Adenocarcinoma)**. It is rarely involved in BPH and is easily palpable via Digital Rectal Examination (DRE). **High-Yield Clinical Pearls for NEET-PG:** * **McNeal’s Zonal Anatomy:** BPH originates in the **Transition Zone**, whereas Carcinoma originates in the **Peripheral Zone**. * **Earliest Sign:** The earliest physiological change in the bladder due to BPH is **trabeculation** (due to detrusor hypertrophy). * **J-shaped Ureter:** Significant median lobe enlargement can displace the ureters, leading to a "fish-hooking" or "J-shaped" appearance on intravenous pyelogram (IVP). * **Surgical Landmark:** The **verumontanum** is the key landmark used during TURP (Transurethral Resection of the Prostate) to avoid damaging the external sphincter.

Question 749: Peyronie's disease is characterized by which of the following?

A. A curved deformity of the penis.
B. Bowing of the penis during erection due to a fibrous plaque. (Correct Answer)
C. Ectopic opening of the urethra.
D. None of the above.

Explanation: **Explanation:** **Peyronie’s Disease** is an acquired inflammatory condition characterized by the formation of a **fibrous, non-compliant plaque** within the **tunica albuginea** of the penis. 1. **Why Option B is Correct:** During an erection, the healthy corpora cavernosa expand. However, the inelastic fibrous plaque (most commonly located on the dorsal aspect) prevents expansion on the affected side. This creates a "tethering" effect, resulting in **bowing or curvature of the penis** toward the side of the plaque. This is often associated with pain and, in severe cases, erectile dysfunction. 2. **Why Other Options are Incorrect:** * **Option A:** While "curved deformity" is a feature, it is too vague. Option B is the superior answer as it specifies the **pathophysiology** (fibrous plaque) and the **timing** (during erection). * **Option C:** An ectopic opening of the urethra refers to **Hypospadias** (ventral opening) or **Epispadias** (dorsal opening), which are congenital anomalies, not acquired fibrotic conditions. **High-Yield Clinical Pearls for NEET-PG:** * **Associated Condition:** Strongly associated with **Dupuytren’s contracture** (palmar fascia fibrosis) in about 10-20% of cases. * **Clinical Presentation:** Patients typically present with a palpable hard nodule, painful erections, and chordee-like curvature. * **Management:** * *Medical:* Vitamin E, Potaba, or intralesional injections (Collagenase *Clostridium histolyticum*). * *Surgical:* Indicated only after the disease stabilizes (usually 12 months). Options include **Nesbit’s procedure** (plication of the unaffected side) or plaque excision with grafting.

Question 750: Which of the following are risk factors for inguinal hernia?

A. COPD
B. BPH
C. Cigarette smoking
D. All of the above (Correct Answer)

Explanation: **Explanation:** The development of an inguinal hernia is primarily driven by two mechanisms: **increased intra-abdominal pressure** and **weakness of the abdominal wall musculature/collagen.** 1. **COPD (Chronic Obstructive Pulmonary Disease):** Patients with COPD suffer from a chronic cough. This repetitive, forceful contraction of the abdominal muscles leads to sustained increases in intra-abdominal pressure, which pushes peritoneal contents through weak points like the internal ring or Hesselbach’s triangle. 2. **BPH (Benign Prostatic Hyperplasia):** BPH causes bladder outlet obstruction, forcing the patient to use the **Valsalva maneuver** (straining) to void. This chronic straining significantly raises intra-abdominal pressure, making it a classic risk factor for hernia development in elderly males. 3. **Cigarette Smoking:** Smoking is a systemic risk factor. It contributes in two ways: it induces a chronic cough (increasing pressure) and, more importantly, it alters **collagen metabolism**. Smoking increases elastase activity and decreases protease inhibitors, leading to the degradation of Type I and Type III collagen, which weakens the transversalis fascia. **Clinical Pearls for NEET-PG:** * **Most common type:** Indirect inguinal hernia is the most common type in both males and females. * **The "Gold Standard" Repair:** Lichtenstein tension-free mesh repair. * **Nyhus Classification:** Frequently tested; remember that Type IIIa is a Direct hernia and Type IIIb is an Indirect hernia with a large internal ring (sliding/pantaloon). * **Other Risk Factors:** Ascites, pregnancy, heavy lifting, and previous lower abdominal incisions (incisional hernia).

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?