Urology — MCQs

Urology Indian Medical PG Practice Questions and MCQs

Question 781: Which of the following statements is false regarding hypernephroma?

A. Leather workers have an increased risk
B. Arises from the proximal tubular epithelium
C. Hb levels may be elevated
D. It produces osteosclerotic secondaries on flat bone (Correct Answer)

Explanation: **Explanation:** Hypernephroma, also known as **Renal Cell Carcinoma (RCC)**, is the most common primary renal malignancy. **Why Option D is False (The Correct Answer):** RCC is notorious for causing **osteolytic** (bone-destroying) metastases, not osteosclerotic ones. These lesions are characteristically "blow-out" in appearance, highly vascular, and can present with pathological fractures. In contrast, osteosclerotic (bone-forming) metastases are typically associated with Prostate Cancer. **Analysis of Other Options:** * **Option A:** Occupational exposure to **leather tanning chemicals**, cadmium, petroleum products, and asbestos are established risk factors for RCC. * **Option B:** Histologically, the most common subtype (Clear Cell RCC) originates from the **proximal convoluted tubular epithelium**. * **Option C:** RCC is a "great imitator" and often presents with paraneoplastic syndromes. It can produce **Erythropoietin**, leading to polycythemia (elevated Hb levels). **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Hematuria (most common), loin pain, and a palpable mass (seen in only 10% of cases, usually advanced). * **Most Common Subtype:** Clear cell carcinoma (associated with VHL gene deletion on Chromosome 3p). * **Staging:** The most important prognostic factor is the stage at presentation. It has a unique propensity for **venous invasion** (renal vein and IVC). * **Paraneoplastic Syndromes:** Hypercalcemia (PTHrP), Hypertension (Renin), and Stauffer’s syndrome (reversible hepatic dysfunction without metastases). * **Treatment of Choice:** Radical nephrectomy (or partial nephrectomy for T1 tumors). It is generally resistant to chemotherapy and radiotherapy.

Question 782: A 20-year-old man suffers an injury to the posterior urethra. What is the most likely late complication after appropriate initial management and follow-up care of this injury?

A. Ascending urinary tract infection
B. Retrograde ejaculation
C. Sterility
D. Urethral stricture (Correct Answer)

Explanation: ### Explanation **1. Why Urethral Stricture is the Correct Answer** Posterior urethral injuries (PUI) most commonly occur in the setting of pelvic fractures (e.g., motor vehicle accidents). The mechanism involves the shearing of the membranous urethra at the puboprostatic ligament. Even with appropriate initial management—whether via primary endoscopic realignment or delayed urethroplasty—the healing process involves the formation of fibrotic scar tissue (fibroblasts and collagen deposition) at the site of the disruption. This fibrosis leads to luminal narrowing, making **urethral stricture** the most common and significant late complication of posterior urethral trauma. **2. Why the Other Options are Incorrect** * **Ascending Urinary Tract Infection (A):** While infections can occur post-operatively or due to stasis, they are usually acute or subacute issues rather than the primary long-term structural complication. * **Retrograde Ejaculation (B):** This is more commonly a complication of bladder neck surgery (like TURP) where the internal sphincter is damaged. In PUI, the pathology is distal to the bladder neck. * **Sterility (C):** While PUI can be associated with **erectile dysfunction** (due to cavernous nerve damage) or **ejaculatory duct injury**, it does not typically cause sterility (the inability to produce sperm). **3. Clinical Pearls for NEET-PG** * **Classic Triad of Urethral Injury:** Blood at the meatus, inability to void, and a palpable distended bladder. * **Gold Standard Investigation:** Retrograde Urethrogram (RUG). Never attempt catheterization before an RUG if a urethral injury is suspected. * **High-Yield Association:** Posterior urethral injury is associated with **Pelvic Fractures**, whereas Anterior urethral injury (bulbar) is associated with **Saddle Injuries**. * **Triad of Late Complications in PUI:** Stricture, Impotence (Erectile Dysfunction), and Incontinence. Of these, stricture is the most frequent.

Question 783: Which cranial nerve is most commonly involved in the development or symptoms of intracranial aneurysms?

A. Trochlear nerve (CN IV)
B. Facial nerve (CN VII)
C. Vestibulocochlear nerve (CN VIII)
D. Oculomotor nerve (CN III) (Correct Answer)

Explanation: **Explanation:** The **Oculomotor nerve (CN III)** is the most commonly involved cranial nerve in intracranial aneurysms due to its precise anatomical proximity to the **Posterior Communicating Artery (PComA)**. As the nerve exits the midbrain, it passes between the Superior Cerebellar Artery and the Posterior Cerebral Artery, running parallel and lateral to the PComA. An aneurysm at the junction of the Internal Carotid Artery and PComA can compress the nerve, leading to a classic "surgical" third nerve palsy. **Why the other options are incorrect:** * **Trochlear nerve (CN IV):** While it also passes near the tentorial notch, it is rarely the primary nerve involved in symptomatic aneurysms compared to CN III. * **Facial (CN VII) and Vestibulocochlear (CN VIII) nerves:** These nerves are located in the cerebellopontine angle. They are more commonly affected by acoustic neuromas (vestibular schwannomas) or vascular loops rather than typical berry aneurysms. **Clinical Pearls for NEET-PG:** 1. **Rule of Pupil:** In CN III palsy due to **aneurysmal compression** (e.g., PComA), the **pupil is dilated and non-reactive** because parasympathetic fibers are located superficially on the nerve. In **medical causes** (e.g., Diabetes), the pupil is usually spared as the central fibers are affected by ischemia. 2. **Presentation:** A patient presenting with "Down and Out" eye position, ptosis, and a dilated pupil is a neurosurgical emergency until an aneurysm is ruled out. 3. **Most common site of Berry Aneurysm:** Anterior Communicating Artery (AComA), but the most common site causing **cranial nerve palsy** is the PComA.

Question 784: Which of the following is false regarding hypernephroma?

A. Radiosensitive (Correct Answer)
B. Arises from coex, usually from pre-existing adenoma
C. May present with a rapidly developing varicocele
D. Usually adenocarcinoma

Explanation: **Explanation:** Hypernephroma, now more commonly known as **Renal Cell Carcinoma (RCC)**, is the most common primary malignancy of the kidney. **1. Why Option A is the correct (False) statement:** Renal Cell Carcinoma is notoriously **radioresistant**. Radiotherapy is not used as a primary treatment for the tumor itself. Its role in RCC is limited strictly to **palliative care**, such as managing pain from bone metastases or controlling symptoms in brain metastases. The primary definitive treatment for localized RCC remains surgical (Partial or Radical Nephrectomy). **2. Analysis of other options:** * **Option B (Origin):** RCC arises from the renal cortex, specifically the **proximal convoluted tubule (PCT)** epithelium. While most cases are sporadic, some are believed to arise from pre-existing renal adenomas (the "adenoma-carcinoma sequence"). * **Option C (Varicocele):** A classic clinical sign of RCC is a **left-sided varicocele** that does not disappear on lying down. This occurs because the left gonadal vein drains into the left renal vein; a tumor thrombus obstructing the renal vein causes retrograde pressure, leading to rapid varicocele formation. * **Option D (Pathology):** Histologically, over 80-90% of hypernephromas are **adenocarcinomas**, with the "Clear Cell" subtype being the most common. **Clinical Pearls for NEET-PG:** * **Classic Triad:** Hematuria (most common), flank pain, and palpable mass (seen in only 10% of cases). * **Paraneoplastic Syndromes:** RCC is the "Internist’s Tumor" because it secretes hormones leading to polycythemia (EPO), hypercalcemia (PTHrP), and hypertension (Renin). * **Stauffer Syndrome:** Reversible hepatic dysfunction (elevated LFTs) in the absence of liver metastases. * **Chemotherapy:** RCC is also largely chemoresistant; management of metastatic disease involves targeted therapy (Tyrosine Kinase Inhibitors like Sunitinib) or Immunotherapy.

Question 785: Which renal tumour has a multicentric origin?

A. Wilm's tumour (Correct Answer)
B. Transitional cell carcinoma
C. Squamous cell carcinoma
D. Renal cell carcinoma

Explanation: **Explanation:** **Wilms’ Tumour (Nephroblastoma)** is the correct answer because it is characteristically associated with **nephrogenic rests**—persistent foci of embryonal cells that fail to mature. These rests serve as precursors and are found in approximately 35-40% of cases, leading to **multicentricity** (multiple independent foci within the same kidney) and a higher risk of **bilateral** involvement (synchronous or metachronous). **Analysis of Options:** * **Transitional Cell Carcinoma (TCC):** While TCC of the renal pelvis exhibits "field cancerization" (leading to multiple tumors across the urothelium), it is typically described as **multifocal** rather than multicentric in the context of renal parenchymal development. * **Squamous Cell Carcinoma (SCC):** Usually arises due to chronic irritation (e.g., staghorn calculi). It is generally a solitary, aggressive lesion. * **Renal Cell Carcinoma (RCC):** Most sporadic RCCs are solitary. While specific hereditary types (like Von Hippel-Lindau) can be multifocal and bilateral, Wilms’ tumour is the classic textbook example of a multicentric renal malignancy in pediatric surgery. **High-Yield Clinical Pearls for NEET-PG:** * **Triphasic Histology:** Wilms’ tumour consists of Blastemal, Stromal, and Epithelial components. * **WAGR Syndrome:** Wilms’ tumour, Aniridia, Genitourinary anomalies, and intellectual disability (formerly Retardation). * **Most Common Presentation:** An asymptomatic, large abdominal mass that does **not** cross the midline (unlike Neuroblastoma). * **Staging:** Unlike many adult tumors, Wilms’ is staged based on both surgical findings and pathological examination.

Question 786: What is the most common site for extragonadal germ cell tumors?

A. Retroperitoneum
B. Sacrococcygeal region
C. Pineal gland
D. Mediastinum (Correct Answer)

Explanation: **Explanation:** Extragonadal Germ Cell Tumors (EGCTs) arise from primordial germ cells that fail to migrate correctly to the gonadal ridges during embryogenesis. These cells typically arrest in midline structures. **Why Mediastinum is Correct:** The **mediastinum (specifically the anterior mediastinum)** is the most common site for extragonadal germ cell tumors in **adults**, accounting for approximately 50–70% of all EGCT cases. They represent about 15% of all anterior mediastinal masses. **Analysis of Incorrect Options:** * **Retroperitoneum:** This is the second most common site in adults. It is crucial to distinguish a primary retroperitoneal EGCT from a metastasis of an occult testicular primary (via ultrasound). * **Sacrococcygeal region:** This is the most common site for EGCTs in **infants and neonates** (e.g., Sacrococcygeal Teratoma), but it is not the most common site overall across the general population or in adults. * **Pineal gland:** Intracranial EGCTs (Germinomas) occur primarily in the midline (pineal and suprasellar regions), but they are less frequent than mediastinal presentations. **High-Yield Clinical Pearls for NEET-PG:** * **Most common mediastinal GCT:** Teratoma (usually benign in children/females, potentially malignant in adult males). * **Tumor Markers:** Always check AFP and β-hCG. Elevated AFP in a mediastinal mass strongly suggests a Yolk Sac component. * **Klinefelter Syndrome (47, XXY):** There is a strong clinical association between Klinefelter syndrome and the development of mediastinal EGCTs. * **Hematologic Malignancy:** Mediastinal non-seminomatous GCTs are uniquely associated with the subsequent development of hematologic disorders like Acute Myeloid Leukemia (AML).

Question 787: What is the most common congenital anomaly of the upper renal tract?

A. Duplication of renal pelvis (Correct Answer)
B. Duplication of ureter
C. Ectopic ureteric orifice
D. Congenital megaureter

Explanation: **Explanation:** **Correct Answer: A. Duplication of renal pelvis** The most common congenital anomaly of the upper urinary tract is a **duplicated collecting system**. Among the variations of this anomaly, **duplication of the renal pelvis** (bifid pelvis) is the most frequent. It occurs when the ureteric bud bifurcates before it enters the metanephros. This condition is often asymptomatic and discovered incidentally during imaging. **Analysis of Options:** * **B. Duplication of ureter:** While common, a complete duplication (two separate ureters entering the bladder) is less frequent than a simple duplication of the renal pelvis or a partial (Y-shaped) ureter. * **C. Ectopic ureteric orifice:** This is a relatively rare anomaly where the ureter opens at a site other than the posterolateral angle of the bladder trigone. It is more common in females and often associated with a duplicated system, but it is not the most common overall. * **D. Congenital megaureter:** This refers to an intrinsic functional or organic obstruction at the vesicoureteric junction leading to dilatation. It is a significant cause of hydroureteronephrosis in children but is less common than pelvic duplication. **Clinical Pearls for NEET-PG:** * **Weigert-Meyer Law:** In complete ureteric duplication, the ureter from the **upper pole** opens **medially and inferiorly** to the normal insertion and is prone to **obstruction (ureterocele)**. The ureter from the **lower pole** opens laterally and superiorly and is prone to **vesicoureteric reflux (VUR)**. * **Most common renal fusion anomaly:** Horseshoe kidney. * **Most common cause of bladder outlet obstruction in male infants:** Posterior Urethral Valves (PUV). * **Most common site of urinary obstruction in children:** Pelviureteric junction (PUJ) obstruction.

Question 788: Dietl's crises are typically seen in which of the following conditions?

A. Pyelonephritis
B. Pelviureteric junction obstruction (Correct Answer)
C. Renal trauma
D. Chronic renal failure

Explanation: **Explanation:** **Dietl’s crisis** is a classic clinical phenomenon associated with **Pelviureteric Junction Obstruction (PUJO)**. It is characterized by episodic, severe colicky renal pain, nausea, and vomiting, often triggered by the consumption of large amounts of fluids or alcohol (diuresis). 1. **Why PUJO is correct:** In PUJO, the narrow junction cannot handle a sudden increase in urine volume. When a diuretic load occurs, the renal pelvis becomes acutely over-distended. This stretching of the renal capsule causes intense pain. Interestingly, the pain often subsides after the patient voids or when the fluid load passes, sometimes accompanied by a "polyuric phase" as the obstruction is partially relieved. 2. **Why other options are incorrect:** * **Pyelonephritis:** Presents with constant flank pain, high-grade fever with chills, and pyuria, rather than episodic crises related to fluid intake. * **Renal Trauma:** Presents with a history of injury, hematuria, and potentially a palpable mass (hematoma) or shock, but not intermittent Dietl's crises. * **Chronic Renal Failure:** Is typically a painless, progressive condition characterized by azotemia and systemic complications; it does not present with acute obstructive episodes. **Clinical Pearls for NEET-PG:** * **Crossing Vessel:** A common cause of extrinsic PUJO is an accessory renal artery (lower pole vessel) crossing the ureter. * **Investigation of Choice:** **DTPA scan** (with Lasix) is the gold standard to differentiate between obstructive and non-obstructive hydronephrosis. * **Standard Treatment:** **Anderson-Hynes Dismembered Pyeloplasty** (can be open, laparoscopic, or robotic). * **Whitaker Test:** An invasive pressure-flow study used when isotope scans are equivocal.

Question 789: Clostridial organisms are:

A. Gram-positive aerobes
B. Gram-positive anaerobes (Correct Answer)
C. Gram-positive aerobes
D. Gram-negative anaerobes

Explanation: **Explanation:** **Clostridial organisms** are a genus of bacteria characterized by being **Gram-positive, spore-forming, obligate anaerobes**. In the context of surgery and urology, they are clinically significant due to their ability to cause severe soft tissue infections, such as gas gangrene (Clostridial myonecrosis) and Fournier’s gangrene. 1. **Why Option B is Correct:** Clostridia (e.g., *C. perfringens*, *C. tetani*, *C. botulinum*) lack the enzymes superoxide dismutase and catalase, making them unable to survive in oxygenated environments (**Obligate Anaerobes**). Their thick peptidoglycan cell wall retains the crystal violet stain, classifying them as **Gram-positive**. 2. **Why Other Options are Incorrect:** * **Options A & C (Gram-positive aerobes):** While some Gram-positive bacteria are aerobic (e.g., *Staphylococcus*, *Streptococcus*), Clostridia are strictly anaerobic. Aerobes require oxygen for growth, which is lethal to Clostridial species. * **Option D (Gram-negative anaerobes):** Gram-negative anaerobes (e.g., *Bacteroides fragilis*) have a different cell wall structure (lipopolysaccharide layer) and do not form spores. Clostridia are distinctly Gram-positive. **High-Yield Clinical Pearls for NEET-PG:** * **Fournier’s Gangrene:** A necrotizing fasciitis of the perineum often involving a polymicrobial mix of aerobes and anaerobes (including *Clostridium*). It is a surgical emergency requiring aggressive debridement. * **Gas Gangrene:** Characterized by "woody" edema, crepitus (due to gas production by *C. perfringens*), and a dishwater discharge. * **Morphology:** They are often described as "box-car shaped" bacilli. * **Treatment:** Penicillin G is the drug of choice, often combined with Clindamycin (to inhibit toxin production) and surgical debridement.

Question 790: Which of the following is NOT a predisposing cause for testicular torsion?

A. Inversion of the testis
B. Low investment of the tunica vaginalis (Correct Answer)
C. Age between 10 to 25 years
D. Separation of the epididymis

Explanation: **Explanation:** Testicular torsion occurs when the spermatic cord twists, leading to vascular compromise. The primary predisposing factor is an anatomical anomaly that allows the testis to rotate freely within the tunica vaginalis. **1. Why "Low investment of the tunica vaginalis" is the correct answer:** This is a distractor because the actual predisposing factor is **High investment of the tunica vaginalis**. Normally, the tunica vaginalis attaches to the posterior aspect of the testis, anchoring it. In the **"Bell-clapper deformity,"** the tunica vaginalis invests the testis, epididymis, and the spermatic cord much higher than usual. This leaves the testis hanging freely like a clapper inside a bell, allowing it to rotate and undergo torsion. **2. Analysis of incorrect options:** * **Inversion of the testis (A):** If the testis is situated abnormally (e.g., horizontal lie), it is more prone to axial rotation. * **Age between 10 to 25 years (C):** This is the peak incidence period. Rapid testicular growth during puberty increases the weight and volume of the gland, making it more susceptible to twisting. * **Separation of the epididymis (D):** An elongated mesorchium (the fold between the testis and epididymis) or a wide separation between them allows for increased mobility, predisposing the testis to torsion. **High-Yield Clinical Pearls for NEET-PG:** * **Golden Period:** Salvage rate is nearly 100% if detorsion occurs within **6 hours**; it drops to <20% after 12 hours. * **Reflex:** The **Cremasteric reflex is absent** in testicular torsion (a key differentiator from epididymo-orchitis). * **Prehn’s Sign:** Elevation of the scrotum does **not** relieve pain in torsion (Negative Prehn's sign). * **Management:** Immediate surgical exploration and **bilateral orchidopexy** (fixation of both testes) because the anatomical defect is usually bilateral.

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