Urology Practice Questions

Q: Epispadias is associated with which of the following?

Chordee. **Explanation:** **Epispadias** is a rare congenital malformation where the urethral meatus opens on the dorsal (upper) surface of the penis. It is part of the **Exstrophy-Epispadias Complex (EEC)**. 1. **Why Chordee is correct:** In epispadias, the urethral plate is short and the corpora cavernosa are often underdeveloped or tethered dorsally. This results in **dorsal chordee** (an upward curvature of the penis), which is a hallmark clinical feature. While chordee is more commonly associated with hypospadias (ventral curvature), it is a consistent finding in epispadias as well. 2. **Why the other options are incorrect:** * **Bifid pubic symphysis (Option A):** While this is a classic feature of **Bladder Exstrophy**, it is not a defining feature of isolated epispadias. In the spectrum of EEC, as the severity increases from epispadias to exstrophy, the pubic diastasis becomes prominent. * **Anal atresia (Option C) & Intestinal obstruction (Option D):** These are more commonly associated with **Cloacal Exstrophy** (the most severe form of the complex) or VACTERL association, rather than isolated epispadias. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Urethral opening is on the **dorsal** aspect (Hypospadias is ventral). * **Association:** Most cases of epispadias are associated with some degree of **urinary incontinence** due to poorly developed bladder necks. * **Gender:** More common in males (3:1 ratio). * **Surgical Repair:** The **Cantwell-Ransley procedure** is the gold standard for epispadias repair, involving tubularization of the urethra and correction of the dorsal chordee.

Q: Which of the following statements is NOT true about this condition?

Condition affects adolescent males. ***Condition affects adolescent males*** - **Peyronie's disease** typically affects **middle-aged to older men** (40-70 years), not adolescents. - The condition is characterized by **fibrous plaque formation** in the tunica albuginea, which is more common with aging and associated comorbidities. *Patient presents with complaints of painful erection* - **Painful erections** are a common presenting complaint, especially during the **acute inflammatory phase** of Peyronie's disease. - Patients often experience **pain during erection** along with **penile curvature** due to the fibrous plaque. *Galezia's Triad includes Dupuytren's contracture, Peyronie's disease, and retroperitoneal fibrosis* - **La Peyronie's triad** (also known as Galezia's triad) is a recognized association of **fibrotic conditions**. - These three conditions share similar **pathophysiology** involving abnormal **collagen deposition** and fibrosis. *Nesbitt's operation is performed* - **Nesbitt's procedure** is a surgical technique used to correct **penile curvature** in Peyronie's disease. - The operation involves **plication of the tunica albuginea** on the convex side to straighten the penis.

Q: A middle-aged diabetic female presented with flank pain and fever. On ultrasound, the kidney was irregular and showed fat density with calculi. What is the most probable diagnosis?

Xanthogranulomatous pyelonephritis. **Explanation:** The clinical presentation of a middle-aged diabetic female with fever, flank pain, and specific imaging findings is classic for **Xanthogranulomatous Pyelonephritis (XGP)**. **1. Why Option B is Correct:** XGP is a chronic inflammatory process characterized by the destruction of renal parenchyma and its replacement with lipid-laden foamy macrophages (**xanthoma cells**). * **The "Fat Density":** On imaging (USG/CT), these lipid-laden macrophages appear as areas of fat density, which is a pathognomonic finding. * **The "Calculi":** XGP is almost always associated with chronic urinary obstruction, often due to a large **staghorn calculus** (Proteus or E. coli infections). * **Demographics:** It most commonly affects middle-aged women, particularly those with diabetes. **2. Why Other Options are Incorrect:** * **A. Tuberculosis of Kidney:** While it causes chronic inflammation and "putty kidney" (calcification), it does not typically present with fat-density replacement of the parenchyma. * **C. Chronic Pyelonephritis:** This leads to a small, scarred, shrunken kidney with blunted calyces, but it lacks the specific "fat-density" masses seen in XGP. * **D. Renal Abscess:** This presents as a localized fluid collection (pus) with a thick wall. While it causes fever and pain, it does not explain the presence of diffuse fat density and chronic calculi. **Clinical Pearls for NEET-PG:** * **"Bear’s Paw Sign":** On CT, the cross-sectional appearance of dilated calyces surrounding a central calcification in XGP is known as the Bear’s Paw sign. * **The Great Mimicker:** XGP is often mistaken for Renal Cell Carcinoma (RCC) because it can be locally invasive. * **Treatment:** The gold standard treatment for the diffuse form is **Nephrectomy**.

Q: A prenatal ultrasound showed bilateral hydronephrosis in a male fetus. A repeat ultrasound scan done a few days later showed bilateral hydronephrosis with a full bladder and reduced amniotic fluid. An emergency Cesarean section was conducted. What is the first likely investigation for the newborn?

Micturating Cystourethrogram. **Explanation:** The clinical presentation of a male fetus with **bilateral hydronephrosis, a distended (full) bladder, and oligohydramnios** (reduced amniotic fluid) is the classic triad for **Posterior Urethral Valves (PUV)**. PUV is the most common cause of bladder outlet obstruction in male newborns and represents a urological emergency. 1. **Why Micturating Cystourethrogram (MCUG) is correct:** MCUG is the **gold standard** and the investigation of choice for diagnosing PUV. It confirms the diagnosis by demonstrating a dilated posterior urethra, a "valve" member, and a thick-walled, trabeculated bladder. It also helps assess for associated Vesicoureteral Reflux (VUR), which occurs in nearly 50% of these cases. 2. **Why other options are incorrect:** * **Ultrasonography (USG):** While USG is the initial screening tool (often showing the "keyhole sign"), it cannot definitively diagnose the cause of obstruction or differentiate between PUV and other conditions like prune belly syndrome. * **DMSA Scan:** This is a nuclear medicine scan used to detect renal scarring or functional cortical mass. It is not used in the acute diagnostic phase of outlet obstruction. * **Renal Doppler:** This assesses blood flow to the kidneys (e.g., renal artery stenosis) and has no role in diagnosing anatomical bladder outlet obstructions. **Clinical Pearls for NEET-PG:** * **Keyhole Sign:** On prenatal USG, the dilated posterior urethra and thick-walled bladder resemble a keyhole; this is highly suggestive of PUV. * **Initial Management:** The first step in management after birth is **bladder catheterization** (using a small feeding tube) to decompress the system, followed by an MCUG for diagnosis. * **Definitive Treatment:** Primary endoscopic fulguration of the valves. * **Potter Sequence:** Severe oligohydramnios due to PUV can lead to pulmonary hypoplasia, the most common cause of death in these neonates.

Q: Which of the following is NOT true about torsion of the testis?

Is commonly associated with pyuria.. **Explanation:** Testicular torsion is a surgical emergency caused by the twisting of the spermatic cord, leading to vascular compromise and potential infarction of the testis. **Why Option B is the Correct Answer (The False Statement):** Pyuria (pus cells in urine) is a hallmark of **Urinary Tract Infection (UTI) or Acute Epididymo-orchitis**, which is the primary differential diagnosis for torsion. Testicular torsion is a mechanical/vascular event, not an infectious one; therefore, the urinalysis is typically normal. The presence of pyuria strongly points away from torsion and toward an inflammatory etiology. **Analysis of Incorrect Options (True Statements):** * **Option A:** Torsion typically presents with a **sudden, agonizing onset of pain** in the groin or lower abdomen, often associated with nausea and vomiting. * **Option C:** **Color Doppler Ultrasound** is the investigation of choice. A positive finding for torsion is the absence or significant reduction of arterial blood flow to the affected testis. * **Option D:** Torsion often occurs due to a congenital anatomical anomaly known as the **"Bell-clapper deformity"** (high investment of tunica vaginalis). Since this anatomical defect is usually bilateral, **prophylactic contralateral orchidopexy** is mandatory to prevent future torsion on the opposite side. **High-Yield Clinical Pearls for NEET-PG:** * **Golden Period:** Salvage rate is nearly 100% if detorsion occurs within **6 hours**; it drops to <10% after 24 hours. * **Prehn’s Sign:** Negative in torsion (pain is not relieved by elevating the testis) but positive in epididymo-orchitis. * **Cremasteric Reflex:** Characteristically **absent** in testicular torsion. * **Angel’s Sign:** The affected testis lies in a high, horizontal position.

Q: What is the period of trial required for maximum response when treating benign prostatic hyperplasia with finasteride?

6 months. **Explanation:** **Finasteride** is a 5-alpha reductase inhibitor (5-ARI) used in the management of Benign Prostatic Hyperplasia (BPH). Its mechanism involves inhibiting the conversion of testosterone to dihydrotestosterone (DHT), the primary androgen responsible for prostatic growth. **Why 6 months is correct:** Unlike Alpha-blockers (e.g., Tamsulosin), which provide rapid symptomatic relief by relaxing smooth muscles, 5-ARIs work by inducing **epithelial atrophy**, leading to a physical reduction in prostate volume (approximately 20–25%). This process is slow and time-dependent. Clinical studies demonstrate that while some improvement may be seen earlier, it takes **6 months** of continuous therapy to achieve the **maximum clinical response** and significant reduction in prostate size. **Analysis of Incorrect Options:** * **1 month (A):** Too short for any significant structural change or volume reduction. * **3 months (B):** Onset of action begins, but peak efficacy regarding symptom score improvement and flow rate is not yet reached. * **18 months (D):** While the drug is taken long-term to prevent progression, the "trial period" to assess maximum initial response is established at 6 months. **High-Yield Clinical Pearls for NEET-PG:** * **Indication:** Best suited for patients with large prostates (**>30-40 grams**). * **PSA Effect:** Finasteride reduces serum PSA levels by **50%**. For screening purposes, the measured PSA in a patient on Finasteride should be **doubled** to estimate the true value. * **Clinical Benefits:** Reduces the risk of acute urinary retention (AUR) and the need for surgical intervention (TURP). * **Side Effects:** Erectile dysfunction, decreased libido, and gynecomastia.

Question 1

Epispadias is associated with which of the following?

Accepted Answer

Chordee

Answer

Bifid pubic symphysis

Answer

Anal atresia

Answer

Intestinal obstruction

Question 2

Which of the following statements regarding testicular tumors is false?

Accepted Answer

Seminomas are radiosensitive.

Answer

They are the commonest malignancy in older men.

Answer

Only 25% of Stage 1 teratomas are cured by surgery alone.

Answer

Chemotherapy rarely produces a cure in those with metastatic disease.

Question 3

Which of the following statements is NOT true about this condition?

Accepted Answer

Condition affects adolescent males

Answer

Patient presents with complaints of painful erection

Answer

Galezia's Triad includes Dupuytren's contracture, Peyronie's disease, and retroperitoneal fibrosis

Answer

Nesbitt's operation is performed

Question 4

Anorchia is best diagnosed by which of the following investigations?

Accepted Answer

Laparoscopy

Answer

Ultrasound (USG)

Answer

Single-photon emission computed tomography (SPECT)

Answer

Computed Tomography (CT)

Question 5

A middle-aged diabetic female presented with flank pain and fever. On ultrasound, the kidney was irregular and showed fat density with calculi. What is the most probable diagnosis?

Accepted Answer

Xanthogranulomatous pyelonephritis

Answer

Tuberculosis of kidney

Answer

Chronic pyelonephritis

Answer

Renal abscess

Question 6

A 40-year-old patient with a single kidney presents with a solitary exophytic mass of 4 cm localized at its lower pole. Which of the following is the best recommended management option?

Accepted Answer

Partial nephrectomy

Answer

Radical nephrectomy

Answer

Radical nephrectomy with dialysis

Answer

Radical nephrectomy with renal transplantation

Question 7

A prenatal ultrasound showed bilateral hydronephrosis in a male fetus. A repeat ultrasound scan done a few days later showed bilateral hydronephrosis with a full bladder and reduced amniotic fluid. An emergency Cesarean section was conducted. What is the first likely investigation for the newborn?

Accepted Answer

Micturating Cystourethrogram

Answer

Ultrasonography

Answer

DMSA Scan

Answer

Renal Doppler

Question 8

Which of the following is NOT true about torsion of the testis?

Accepted Answer

Is commonly associated with pyuria.

Answer

Presents with sudden pain in the testis.

Answer

Doppler ultrasound shows decreased blood flow to the testis.

Answer

Simultaneous orchidopexy of the contralateral testis should also be done.

Question 9

What is the period of trial required for maximum response when treating benign prostatic hyperplasia with finasteride?

Accepted Answer

6 months

Answer

1 month

Answer

3 months

Answer

18 months

Question 10

During an operation on an unstable, critically ill patient, the left ureter is lacerated through 50% of its circumference. If the patient's condition is too serious to allow time for definitive repair, what is an alternative method of management?

Accepted Answer

Ligation of the injured ureter and ipsilateral nephrostomy

Answer

Ipsilateral nephrectomy

Answer

Placement of a catheter from the distal ureter through an abdominal wall stab wound

Answer

Placement of a suction drain adjacent to the injury without further manipulation

Urology — MCQs

Urology — MCQs

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