Urology Practice Questions

Q: Which of the following is the treatment of choice for Stage I Wilm's Tumor?

Open nephroureterectomy. **Explanation:** The treatment of choice for **Stage I Wilms’ Tumor (Nephroblastoma)** is a radical **Open Nephroureterectomy**. **1. Why Open Nephroureterectomy is correct:** In pediatric oncology, the primary goal is complete surgical excision without tumor spillage. An open approach (usually via a wide transperitoneal incision) allows for: * **Thorough Exploration:** Inspection of the contralateral kidney to rule out synchronous tumors. * **Safe Handling:** Minimizing the risk of capsular rupture, which would upstage the tumor to Stage III and necessitate abdominal radiation. * **Lymph Node Sampling:** Essential for accurate pathological staging. **2. Why other options are incorrect:** * **Laparoscopic Nephroureterectomy:** While common in adults, it is generally avoided in Wilms’ tumor due to the high risk of **tumor seeding and spillage** during morcellation or manipulation, which worsens the prognosis. * **Chemotherapy:** While Wilms' is highly chemosensitive (using Vincristine and Dactinomycin), in the **NWTS (National Wilms Tumor Study)** protocol followed in the US, surgery is the *initial* step for Stage I. (Note: The SIOP protocol in Europe uses pre-operative chemo, but surgery remains the definitive treatment). * **Observation:** Wilms’ tumor is a malignant neoplasm; observation is never an option. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of metastasis:** Lungs (Cannon-ball metastasis). * **Staging:** Stage I is limited to the kidney and is **completely excised** with an intact capsule. * **WAGR Syndrome:** Wilms tumor, Aniridia, Genitourinary anomalies, and mental Retardation (associated with WT1 gene deletion on Chromosome 11p13). * **Prognosis:** Wilms’ tumor has an excellent prognosis, with cure rates exceeding 90% for localized disease.

Q: What is the most common site of prostatic carcinoma?

Posterior lobe. **Explanation:** Prostatic carcinoma primarily originates in the **peripheral zone** of the prostate gland. In the traditional anatomical classification (Lowsley’s lobes), the peripheral zone corresponds most closely to the **posterior lobe**. Approximately 70–80% of prostate cancers arise here, making it the most common site. * **Why Posterior Lobe is Correct:** Anatomically, the posterior lobe is located peripherally and is easily accessible during a **Digital Rectal Examination (DRE)**. Because most cancers start here, DRE is a vital screening tool for detecting firm, irregular nodules. * **Why Other Options are Incorrect:** * **Anterior Lobe:** This is largely fibromuscular stroma and rarely contains glandular tissue; hence, it is an uncommon site for malignancy. * **Median Lobe:** This area, along with the transition zone, is the primary site for **Benign Prostatic Hyperplasia (BPH)**. BPH typically causes obstructive symptoms early, whereas posterior lobe cancers may remain asymptomatic until advanced. * **Central Zone:** This zone surrounds the ejaculatory ducts and accounts for only about 5–10% of prostate cancers. **Clinical Pearls for NEET-PG:** * **Zonal Anatomy (McNeal):** Peripheral Zone (70% Cancer), Transition Zone (Main site of BPH), Central Zone (5-10% Cancer). * **Screening:** The combination of **PSA (Prostate Specific Antigen)** and **DRE** is the gold standard for early detection. * **Diagnosis:** Transrectal Ultrasound (TRUS) guided biopsy is the definitive diagnostic step. * **Metastasis:** Prostate cancer characteristically spreads to the bone (lumbar spine) via **Batson’s plexus**, resulting in **osteoblastic** (sclerotic) lesions.

Q: In a child with acute scrotal pain and swelling where testicular torsion is highly suspected, how would you proceed?

Immediate scrotal exploration on both sides. **Explanation:** **1. Why Option C is Correct:** Testicular torsion is a surgical emergency where the "golden period" for salvage is within **6 hours**. The underlying anatomical defect is typically the **"Bell-clapper deformity"** (high investment of the tunica vaginalis), which allows the testis to rotate freely. Crucially, this anatomical predisposition is almost always **bilateral**. Therefore, when one side undergoes torsion, the contralateral side is at high risk for a future event. Immediate exploration of both sides is mandatory: the affected side is detorsed and fixed (orchidopexy), and the unaffected side is fixed prophylactically to prevent future torsion. **2. Why Other Options are Incorrect:** * **Option A & B:** These are inadequate because they leave the contralateral testis at risk. Since the anatomical defect is bilateral, "delayed" or "no" exploration of the normal side invites a secondary emergency that could lead to bilateral testicular loss and infertility. * **Option D:** Observation is contraindicated. Torsion is a clinical diagnosis. If suspected, one should not even wait for a Doppler ultrasound if it delays surgery, as ischemia leads to irreversible necrosis within hours. **3. Clinical Pearls for NEET-PG:** * **Diagnosis:** Primarily clinical. Look for a high-riding testis with a horizontal lie and a **negative Prehn’s sign** (pain is not relieved by lifting the scrotum). * **Reflex:** The **Cremasteric reflex is absent** in torsion (High specificity). * **Golden Period:** Best salvage rate (<90%) if operated within 6 hours; drops to <10% after 24 hours. * **Surgical Procedure:** Orchidopexy is performed using non-absorbable sutures (e.g., Prolene). If the testis is gangrenous, orchidectomy is performed, but the contralateral side **must still be fixed.**

Q: Transurethral resection (T.U.R.) syndrome is due to which of the following electrolyte disturbances?

Hyponatremia. **Explanation:** **TUR Syndrome** is a life-threatening complication occurring during Transurethral Resection of the Prostate (TURP) due to the systemic absorption of large volumes of non-conductive irrigation fluid (commonly 1.5% Glycine) through opened prostatic venous sinuses. **Why Hyponatremia is correct:** The primary mechanism is **dilutional hyponatremia**. As the irrigation fluid enters the circulation, it expands the intravascular volume and dilutes the serum sodium levels. If Glycine is used, its metabolism into ammonia can further cause neurotoxicity. Clinical features include confusion, seizures, visual disturbances, and bradycardia. **Why the other options are incorrect:** * **Hypokalemia:** While electrolyte shifts occur, potassium levels are generally stable or may even increase (hyperkalemia) if significant hemolysis occurs. It is not the defining feature of TUR syndrome. * **Hypovolemia:** TUR syndrome actually causes **hypervolemia** (fluid overload) due to massive absorption of irrigation fluid, potentially leading to pulmonary edema and hypertension. * **Hypoxia:** While hypoxia can occur secondary to pulmonary edema, it is a late-stage complication rather than the primary electrolyte disturbance. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal Irrigation Fluid:** Normal Saline is preferred to avoid TUR syndrome, but it can only be used with **Bipolar Cautery**. * **Classic Triad:** Hypertension (early), Bradycardia, and altered mental status. * **Management:** Stop the procedure, administer diuretics (Furosemide), and in severe symptomatic cases (Na <120 mEq/L), use **3% Hypertonic Saline** at a controlled rate to avoid Central Pontine Myelinolysis.

Q: Fogarty's catheter is used for?

Removal of blood clots from the arteries. **Explanation:** **Fogarty’s catheter** is a specialized embolectomy catheter primarily used for the **removal of blood clots (emboli or thrombi) from the arterial system**. It consists of a thin, hollow tube with an inflatable balloon at the tip. During a procedure (embolectomy), the catheter is passed beyond the clot, the balloon is inflated, and the catheter is withdrawn, effectively "dragging" the clot out of the vessel to restore distal blood flow. **Analysis of Options:** * **Option B (Correct):** This is the classic use of the Fogarty catheter in vascular surgery to treat acute limb ischemia. * **Option A & C (Incorrect):** Urethral catheterization and bladder drainage typically utilize **Foley catheters** (for indwelling drainage) or **Robinson/Nelaton catheters** (for straight drainage). While both Foley and Fogarty catheters have balloons, the Fogarty is much thinner and designed for vascular lumens, not the urinary tract. * **Option D (Incorrect):** Total Parenteral Nutrition (TPN) requires central venous access via specialized catheters like **Hickman, Broviac, or PICC lines**, which are designed for long-term infusion rather than mechanical clot removal. **High-Yield Clinical Pearls for NEET-PG:** * **Inventor:** Developed by Dr. Thomas J. Fogarty in 1961; it revolutionized vascular surgery. * **Sizing:** Fogarty catheters are sized in **French (F)** units (e.g., 2F to 7F). A common rule of thumb: the French size divided by 3 equals the diameter in millimeters. * **Balloon Inflation:** The balloon should always be inflated with **saline or air** (as per manufacturer) and never over-inflated to avoid arterial rupture or intimal damage. * **Other Uses:** Occasionally used in biliary surgery (to remove gallstones from the common bile duct) or to remove foreign bodies from the airway/esophagus.

Question 1

Which of the following is the treatment of choice for Stage I Wilm's Tumor?

Accepted Answer

Open nephroureterectomy

Answer

Laparoscopic nephroureterectomy

Answer

Chemotherapy

Answer

Observation

Question 2

What is the most common site of prostatic carcinoma?

Accepted Answer

Posterior lobe

Answer

Anterior lobe

Answer

Median lobe

Answer

Central zone

Question 3

In a child with acute scrotal pain and swelling where testicular torsion is highly suspected, how would you proceed?

Accepted Answer

Immediate scrotal exploration on both sides

Answer

Immediate scrotal exploration only on the side of swelling

Answer

Immediate scrotal exploration on the same side and delayed exploration on the other side

Answer

Observation

Question 4

Which of the following statements is not true regarding hydrocele?

Accepted Answer

It is not possible to get above the swelling on examination of the scrotum.

Answer

It is an abnormal collection of serous fluid within the tunica vaginalis.

Answer

Vaginal hydrocele is associated with 5% of inguinal hernias.

Answer

In a congenital hydrocele, the processus vaginalis is patent and connects to the peritoneal cavity.

Question 5

A 51-year-old man with a history of passing stones in urine presents with excruciating flank pain and hematuria. Imaging reveals staghorn calculi occupying the right renal pelvis. Which of the following underlying disorders is most likely responsible?

Accepted Answer

Chronic Proteus infection

Answer

Anemia of chronic disease

Answer

Hyperparathyroidism

Answer

Hyperaldosteronism

Question 6

A 55-year-old male presented with painless terminal hematuria. Cystoscopic examination revealed a solitary papillary tumor. Histopathological examination of the completely resected tumor is suggestive of grade III transitional cell carcinoma with no muscle invasion. What is the next best step in management?

Accepted Answer

Intravesical BCG

Answer

Follow up

Answer

Cystectomy

Answer

Intravesical chemotherapy

Question 7

Transurethral resection (T.U.R.) syndrome is due to which of the following electrolyte disturbances?

Accepted Answer

Hyponatremia

Answer

Hypokalemia

Answer

Hypovolemia

Answer

Hypoxia

Question 8

Fogarty's catheter is used for?

Accepted Answer

Removal of blood clots from the arteries

Answer

Urethral catheterization

Answer

Bladder drainage

Answer

Total Parenteral Nutrition (TPN)

Question 9

A patient on warfarin therapy can be taken for elective surgery if the INR is?

Accepted Answer

2

Answer

1.4

Answer

1.6

Answer

1.8

Question 10

Orchidopexy in an undescended testes decreases all except?

Accepted Answer

Tumour incidence

Answer

Epididymoorchitis

Answer

Torsion

Answer

Avoid sexual ambiguity

Urology — MCQs

Urology — MCQs

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