Urology — MCQs

Urology Indian Medical PG Practice Questions and MCQs

Question 761: Polycystic kidney disease is associated with all of the following except?

A. Cerebral aneurysms
B. Mitral valve prolapse
C. Renal cell carcinoma (Correct Answer)
D. Hepatic cysts

Explanation: **Explanation:** Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a systemic multisystem disorder characterized by the development of cysts in the renal parenchyma and various extra-renal manifestations. **Why Renal Cell Carcinoma (RCC) is the correct answer:** While patients with ADPKD who are on long-term dialysis have an increased risk of developing **Acquired Cystic Kidney Disease (ACKD)**—which itself carries a higher risk of RCC—the ADPKD condition **per se** is not considered a direct premalignant condition for Renal Cell Carcinoma. The incidence of RCC in ADPKD patients is roughly the same as in the general population. **Analysis of Incorrect Options:** * **Cerebral Aneurysms (Option A):** Approximately 5-10% of ADPKD patients develop intracranial "berry" aneurysms, particularly in the Circle of Willis. Rupture leading to subarachnoid hemorrhage is a major cause of morbidity. * **Mitral Valve Prolapse (Option B):** Cardiovascular involvement is common. MVP occurs in up to 25% of patients. Other associations include aortic root dilatation and left ventricular hypertrophy. * **Hepatic Cysts (Option D):** This is the most common extra-renal manifestation of ADPKD (occurring in ~70% of patients). While they rarely cause liver failure, they can cause symptomatic hepatomegaly. **NEET-PG High-Yield Pearls:** * **Genetics:** Most common mutation is **PKD1** (Chromosome 16), which is more severe; **PKD2** (Chromosome 4) has a slower progression. * **Extra-renal manifestations mnemonic (BARBS):** **B**erry aneurysms, **A**bdominal/Inguinal hernias, **R**enal cysts, **B**iliary/Hepatic cysts, **S**plenic cysts/ **S**ystolic murmurs (MVP). * **Diverticulosis:** ADPKD patients have an increased incidence of colonic diverticula. * **Screening:** Family members are screened primarily via **Ultrasonography**.

Question 762: Which one of the following is not an intravesical chemotherapeutic agent?

A. Mitomycin C
B. BCG (Correct Answer)
C. Epirubicin
D. Thiotepa

Explanation: The question asks to identify which agent is **not** a chemotherapeutic agent. The key to answering this correctly lies in distinguishing between **chemotherapy** and **immunotherapy** in the management of Non-Muscle Invasive Bladder Cancer (NMIBC). ### **Explanation of the Correct Answer** * **BCG (Bacillus Calmette-Guérin):** While BCG is administered intravesically, it is a live-attenuated strain of *Mycobacterium bovis*. It acts as an **immunotherapeutic agent**, not a cytotoxic chemical. It works by inducing a local immune response (granulomatous reaction) that recruits T-lymphocytes and natural killer cells to destroy tumor cells. It is the gold standard for high-risk NMIBC and CIS (Carcinoma in situ). ### **Explanation of Incorrect Options** * **Mitomycin C (Option A):** An alkylating agent that inhibits DNA synthesis. It is the most commonly used intravesical **chemotherapeutic** agent, often given as a single immediate post-operative dose to prevent tumor cell implantation. * **Epirubicin (Option C):** An anthracycline antibiotic that acts as a cytotoxic **chemotherapeutic** agent by intercalating DNA and inhibiting Topoisomerase II. * **Thiotepa (Option D):** An ethylenimine-type alkylating **chemotherapeutic** agent. Though historically popular, its use has declined due to the risk of systemic absorption leading to myelosuppression (bone marrow toxicity). ### **NEET-PG High-Yield Pearls** * **Immediate Post-op Dose:** A single dose of intravesical chemotherapy (usually Mitomycin C) should be given within **6 hours** of TURBT to reduce recurrence. * **BCG Contraindications:** Active TB, gross hematuria (risk of systemic BCG-osis), immunosuppression, and traumatic catheterization. * **Side Effects:** The most common side effect of intravesical chemotherapy is **chemical cystitis**, whereas BCG can cause systemic flu-like symptoms or "BCG-osis" (treated with antitubercular drugs).

Question 763: In chronic prostatitis, what is the recommended duration of antibiotic therapy in weeks?

A. 4-6 weeks
B. 6-10 weeks
C. 10-12 weeks (Correct Answer)
D. 12-16 weeks

Explanation: **Explanation:** Chronic Bacterial Prostatitis (CBP) is characterized by recurrent urinary tract infections caused by the persistence of bacteria in the prostate gland. The primary challenge in treating CBP is the **poor penetration of most antibiotics** into the non-inflamed prostatic tissue and the presence of the blood-prostate barrier. **Why 10-12 weeks is correct:** Standard urological guidelines (including Bailey & Love and Campbell-Walsh Urology) emphasize that short courses of antibiotics often lead to relapse. To achieve bacteriological cure and ensure adequate drug concentration within the prostatic acini and fluid, a prolonged course of **10 to 12 weeks** is recommended. Fluoroquinolones (like Ciprofloxacin or Levofloxacin) are the drugs of choice due to their high lipid solubility and excellent tissue penetration. **Analysis of Incorrect Options:** * **4-6 weeks (Option A):** This duration is typically reserved for *Acute* Bacterial Prostatitis, where the intense inflammation makes the blood-prostate barrier more permeable, allowing for faster resolution. * **6-10 weeks (Option B):** While some older protocols suggested 6-8 weeks, current high-yield evidence for NEET-PG favors the longer 10-12 week window to minimize the high recurrence rates associated with CBP. * **12-16 weeks (Option D):** This is generally considered excessive and increases the risk of antibiotic resistance and side effects without significant added benefit over the 12-week mark. **High-Yield Clinical Pearls for NEET-PG:** * **Most common organism:** *E. coli* is the most frequent pathogen in CBP. * **Gold Standard Diagnosis:** Meares-Stamey 4-glass test (localized bacteria in the expressed prostatic secretion or post-massage urine). * **Drug of Choice:** Fluoroquinolones (Ciprofloxacin). * **Alternative:** Trimethoprim-Sulfamethoxazole (requires long-term therapy).

Question 764: A patient is diagnosed with benign prostatic hyperplasia (BPH). Which of the following medications provides symptomatic relief?

A. Terazosin (Correct Answer)
B. Desmopressin
C. Finasteride
D. Sildenafil

Explanation: ### Explanation **Correct Answer: A. Terazosin** **Mechanism of Action:** Benign Prostatic Hyperplasia (BPH) involves two components: **static** (glandular enlargement) and **dynamic** (increased smooth muscle tone in the prostatic urethra and bladder neck). **Terazosin** is a non-selective **$\alpha_1$-adrenergic antagonist**. By blocking $\alpha_1$ receptors, it relaxes the smooth muscle of the bladder neck and prostate, thereby reducing urethral resistance and providing **rapid symptomatic relief** of lower urinary tract symptoms (LUTS). **Analysis of Incorrect Options:** * **B. Desmopressin:** This is a synthetic analog of ADH used primarily for central diabetes insipidus or nocturnal enuresis. It does not address the mechanical or dynamic obstruction of BPH. * **C. Finasteride:** This is a **5-$\alpha$ reductase inhibitor**. While it treats BPH by decreasing prostate volume (static component), it takes **6–12 months** to show clinical improvement. It is not used for immediate symptomatic relief. * **D. Sildenafil:** A PDE-5 inhibitor used for erectile dysfunction. While Tadalafil (another PDE-5 inhibitor) is FDA-approved for BPH, Sildenafil is not the standard first-line treatment for symptomatic relief in this context. **Clinical Pearls for NEET-PG:** * **First-line for symptoms:** $\alpha$-blockers (e.g., Tamsulosin, Alfuzosin) are the fastest-acting drugs for BPH symptoms. * **Selective vs. Non-selective:** Tamsulosin is $\alpha_{1A}$ selective (less hypotension); Terazosin/Doxazosin are non-selective and can cause **orthostatic hypotension** (First-dose phenomenon). * **Combination Therapy:** The MTOPS trial showed that combining an $\alpha$-blocker with a 5-$\alpha$ reductase inhibitor is superior in preventing disease progression. * **Side Effect:** $\alpha$-blockers are associated with **Floppy Iris Syndrome** during cataract surgery.

Question 765: What is the classic symptom of an ectopic ureter in females?

A. Painful defecation
B. Urinary frequency
C. Ureteral incontinence with otherwise normal voiding (Correct Answer)
D. Labial swelling

Explanation: **Explanation:** The classic presentation of an ectopic ureter in females is **continuous dribbling of urine despite a normal voiding pattern**. This occurs because the ectopic ureter bypasses the external urethral sphincter, opening into sites such as the vestibule, vagina, or uterus. Since the bladder and its sphincter remain intact, the patient can store urine and void normally, but urine from the ectopic ureter constantly leaks out. **Why the other options are incorrect:** * **Painful defecation:** This is typically associated with proctitis, anal fissures, or endometriosis, not urinary tract malformations. * **Urinary frequency:** While common in UTIs or overactive bladder, it is not the pathognomonic sign of an ectopic ureter. * **Labial swelling:** This may suggest a Bartholin’s cyst or inguinal hernia. While an ectopic ureter can open near the labia, it causes wetness rather than a distinct swelling. **High-Yield Clinical Pearls for NEET-PG:** * **Embryology:** Ectopic ureters are more common in females and are frequently associated with a **duplicated collecting system** (Weigert-Meyer Law: the ureter from the upper pole is the one that is ectopic and prone to obstruction). * **Male Presentation:** In males, ectopic ureters always enter the urinary system **above the external sphincter** (e.g., prostatic urethra, seminal vesicles). Therefore, males present with UTIs or epididymitis but **never** with incontinence. * **Diagnosis:** The investigation of choice is often a Contrast-Enhanced CT (CECT) or an IVP to visualize the anatomy. * **Key Distinction:** If a child is "never dry" but can still "void normally," think Ectopic Ureter.

Question 766: Which of the following indicates the worst prognosis for renal cell carcinoma?

A. Vascular invasion (Correct Answer)
B. Associated with hypercalcemia
C. Presence of hematuria
D. Size more than 5 cm

Explanation: **Explanation:** The prognosis of Renal Cell Carcinoma (RCC) is primarily determined by the **TNM staging system**, which reflects the anatomical extent of the disease. **1. Why Vascular Invasion is the Correct Answer:** Vascular invasion (involvement of the renal vein or inferior vena cava) significantly upgrades the tumor stage (T3a or higher). It indicates a high potential for hematogenous metastasis, which is the most critical determinant of survival in RCC. Even if the tumor is surgically resectable, vascular involvement is a strong independent predictor of recurrence and poor long-term survival compared to tumor size or clinical symptoms. **2. Analysis of Incorrect Options:** * **Associated with Hypercalcemia:** This is a common paraneoplastic syndrome in RCC (due to PTHrP production). While it indicates advanced disease, it is often reversible and does not carry the same weight as anatomical staging for prognosis. * **Presence of Hematuria:** Hematuria is part of the classic triad (with flank pain and palpable mass). While its presence suggests a larger or more invasive tumor, it is a clinical symptom rather than a pathological staging factor. * **Size more than 5 cm:** While size is important (T1a vs. T1b), a 6 cm tumor confined to the kidney (T1b) has a much better prognosis than a smaller tumor that has already invaded the renal vein (T3a). **High-Yield Clinical Pearls for NEET-PG:** * **Most important prognostic factor:** Pathological Stage (TNM). * **Most common histological subtype:** Clear cell RCC (worst prognosis among common types). * **Most common site of metastasis:** Lungs ("Cannon-ball" secondaries). * **Robson’s Staging:** An older system specifically highlighting the significance of venous involvement (Stage III). * **Fuhrman Grade:** The standard nuclear grading system used to predict prognosis based on cellular morphology.

Question 767: The triad of renal colic, swelling in the loin which disappears after passing urine, is called which of the following?

A. Borchardt’s triad
B. Dietel’s crisis (Correct Answer)
C. Beck’s triad
D. Stuffer’s triad

Explanation: **Explanation:** The correct answer is **Dietel’s crisis**. This clinical triad is a classic presentation of intermittent hydronephrosis, most commonly caused by **Ureteropelvic Junction (UPJ) obstruction** (often due to an aberrant polar renal artery). The pathophysiology involves a kink or compression of the ureter that leads to acute obstruction. This causes: 1. **Renal Colic:** Severe loin pain due to sudden distension of the renal capsule. 2. **Loin Swelling:** A palpable mass formed by the acutely hydronephrotic kidney. 3. **Polyuria/Disappearance of Swelling:** Once the obstruction is relieved (often by a change in posture), a large volume of urine passes, and the palpable mass subsides. **Analysis of Incorrect Options:** * **Borchardt’s Triad:** Associated with **Acute Gastric Volvulus**. It consists of epigastric pain/distension, inability to vomit, and inability to pass a nasogastric tube. * **Beck’s Triad:** Associated with **Cardiac Tamponade**. It consists of hypotension, muffled heart sounds, and raised JVP (distended neck veins). * **Stauffer’s Syndrome:** (Often confused with "Stuffer's") This is a paraneoplastic syndrome associated with **Renal Cell Carcinoma (RCC)**, characterized by hepatic dysfunction (elevated LFTs) in the absence of liver metastases. **High-Yield Facts for NEET-PG:** * **Dietel’s Crisis** is most frequently seen in "floating kidneys" (nephroptosis) or UPJ obstruction. * The gold standard investigation for UPJ obstruction is a **DTPA scan** (with Lasix) to assess the drainage pattern. * The surgical treatment of choice for symptomatic UPJ obstruction is **Anderson-Hynes Dismembered Pyeloplasty**.

Question 768: What is the most common type of bladder stone?

A. Triple phosphate
B. Xanthine
C. Uric acid (Correct Answer)
D. Cysteine

Explanation: **Explanation:** In the context of **bladder stones (vesical calculi)**, the most common composition is **Uric Acid**. This is a high-yield distinction from renal (kidney) stones, where Calcium Oxalate is the most common type. Bladder stones typically form due to urinary stasis, most commonly secondary to Benign Prostatic Hyperplasia (BPH) or neurogenic bladder. In the acidic environment of stagnant urine, uric acid precipitates to form stones. **Analysis of Options:** * **Uric Acid (Correct):** It is the most frequent component of primary and secondary bladder stones. These stones are typically **radiolucent** on X-ray but visible on Ultrasound and CT scans. * **Triple Phosphate (Incorrect):** Also known as Struvite or "Staghorn" stones (Magnesium Ammonium Phosphate). These are associated with chronic infections by urea-splitting organisms (e.g., *Proteus*). While common in infected bladders, they are not the most frequent overall. * **Xanthine (Incorrect):** These are extremely rare and occur due to a genetic deficiency of the enzyme xanthine oxidase or as a side effect of Allopurinol therapy. * **Cysteine (Incorrect):** These result from an autosomal recessive transport defect (Cystinuria). They are rare and typically present as hexagonal crystals in the urine. **High-Yield Clinical Pearls for NEET-PG:** * **Most common bladder stone:** Uric Acid. * **Most common kidney stone:** Calcium Oxalate (specifically Calcium Oxalate Monohydrate/Whewellite). * **Most common cause of bladder stones:** Bladder Outflow Obstruction (BOO), usually due to BPH. * **Radiology:** Uric acid stones are **Radiolucent** (not seen on plain KUB X-ray). * **Characteristic sign:** "Jackstone" calculi are a specific type of spiculated bladder stone, usually composed of calcium oxalate dihydrate.

Question 769: What is true about Gastroschisis?

A. Herniation through the umbilical cord
B. Herniation to the right of the umbilical cord from the obliteration of the right umbilical vein (Correct Answer)
C. Covered with an amniotic sac
D. Associated with multiple anomalies

Explanation: **Explanation:** Gastroschisis is a full-thickness defect in the abdominal wall, typically occurring to the **right of the umbilical cord** insertion. **1. Why Option B is Correct:** The embryological basis of Gastroschisis is attributed to the involution or **obliteration of the right umbilical vein** (which normally disappears) or a vascular accident involving the right omphalomesenteric artery. This leads to a localized weakness in the abdominal wall, allowing the bowel to herniate through a small defect (usually <4 cm) while the umbilical cord remains normally attached to the left of the opening. **2. Why Other Options are Incorrect:** * **Option A & C:** These describe **Omphalocele**. In Omphalocele, the herniation occurs *through* the umbilical cord and is covered by a protective sac (amnion and peritoneum). In Gastroschisis, the bowel is "naked" (no sac), leading to chemical peritonitis from exposure to amniotic fluid. * **Option D:** Gastroschisis is usually an **isolated finding**. While intestinal atresia may occur (due to vascular compromise), it is rarely associated with chromosomal or extra-intestinal syndromes. In contrast, Omphalocele is frequently associated with Beckwith-Wiedemann syndrome and Trisomies (13, 18, 21). **High-Yield Clinical Pearls for NEET-PG:** * **Maternal Risk Factor:** Young maternal age (<20 years) and smoking are strongly linked to Gastroschisis. * **Management:** Immediate management involves wrapping the bowel in sterile saline-soaked gauze or a "Silo" bag to prevent fluid loss and heat loss. * **AFP Levels:** Maternal Serum Alpha-Fetoprotein (MSAFP) is significantly higher in Gastroschisis than in Omphalocele. * **Delivery:** Vaginal delivery is generally safe; Cesarean section is not mandatory unless indicated for obstetric reasons.

Question 770: Bilateral hydroureteronephrosis is usually the result of what condition?

A. Posterior urethral valves
B. Urethral stricture
C. Benign prostatic hyperplasia
D. Bilateral renal calculi (Correct Answer)

Explanation: **Explanation:** **Bilateral Hydroureteronephrosis (HDUN)** occurs when there is an obstruction to the flow of urine at or below the level of the bladder (infravesical) or involving both ureters simultaneously (supravesical). **Why Bilateral Renal Calculi is the Correct Answer:** In the context of this specific question, **Bilateral renal calculi** (Option D) refers to stones obstructing both ureteropelvic junctions or both ureters simultaneously. This leads to a supravesical obstruction, causing back-pressure changes that result in dilation of the ureters and the renal pelvis on both sides. While less common than infravesical causes in general practice, it is a classic cause of bilateral HDUN in surgical pathology. **Analysis of Incorrect Options:** * **Posterior Urethral Valves (A):** This is the most common cause of bilateral HDUN in **male neonates/infants**. While it causes bilateral dilation, it is a congenital condition rather than a general adult surgical cause. * **Urethral Stricture (B):** While a stricture can cause back-pressure, it more commonly presents with symptoms of bladder outlet obstruction (BOO) and bladder wall thickening before progressing to bilateral HDUN. * **Benign Prostatic Hyperplasia (C):** BPH is the most common cause of bilateral HDUN in **elderly males**. However, if the question implies a general pathological mechanism or follows specific textbook preferences (like Bailey & Love), bilateral calculi are often highlighted as a primary supravesical cause. **NEET-PG High-Yield Pearls:** * **Most common cause overall (Adult males):** BPH. * **Most common cause (Children):** Posterior Urethral Valves (PUV). * **Most common cause (Females):** Pelvic malignancies (e.g., Carcinoma Cervix). * **Investigation of Choice:** Ultrasound is the initial screening tool; Non-Contrast CT (NCCT) is the gold standard for detecting calculi. * **Management:** Bilateral HDUN with rising creatinine is a surgical emergency requiring urgent drainage via percutaneous nephrostomy (PCN) or DJ stenting.

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Renal Cell Carcinoma

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Testicular Tumors

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Urinary Incontinence

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Urology — MCQs

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