Urology — MCQs

Urology Indian Medical PG Practice Questions and MCQs

Question 801: Hunner's ulcer is typically seen in which part of the urinary tract?

A. Ureter
B. Bladder (Correct Answer)
C. Urethra
D. Kidney

Explanation: **Explanation:** **Hunner’s ulcers** are a hallmark finding in **Interstitial Cystitis (IC)**, also known as Bladder Pain Syndrome. These are not true ulcers in the traditional sense but rather distinct inflammatory lesions characterized by circumscribed, reddened mucosal areas with small vessels radiating towards a central scar. When the bladder is distended during cystoscopy, these lesions often crack and bleed (the "cascade bleeding" sign). * **Why Bladder is Correct:** Interstitial cystitis is a chronic inflammatory condition specifically affecting the **bladder wall**. Hunner’s ulcers are found in approximately 5–10% of IC cases, typically located on the bladder dome or lateral walls. * **Why other options are incorrect:** * **Ureter & Urethra:** While these structures are part of the lower urinary tract, they do not develop Hunner’s ulcers. Ureteral pathology usually involves calculi or transitional cell carcinoma, while urethral pathology involves strictures or urethritis. * **Kidney:** Renal pathology involves the parenchyma or collecting system (e.g., glomerulonephritis or pyelonephritis), which is physiologically and histologically distinct from the inflammatory process of IC. **High-Yield Clinical Pearls for NEET-PG:** 1. **Glomerulations:** These are "strawberry-like" petechial hemorrhages seen on the bladder mucosa after hydrodistension; they are more common but less specific than Hunner’s ulcers for IC. 2. **Clinical Triad:** Increased urinary frequency, urgency, and pelvic pain (relieved by voiding). 3. **Demographics:** Predominantly affects middle-aged women. 4. **Diagnosis:** It is a diagnosis of exclusion. Cystoscopy with hydrodistension is the classic diagnostic maneuver. 5. **Treatment:** First-line includes lifestyle changes; **Pentosan Polysulfate Sodium** is the only FDA-approved oral drug. Intravesical instillations (e.g., DMSO) are also used.

Question 802: What is the most common paraneoplastic syndrome in hepatocellular carcinoma (HCC)?

A. Hypoglycaemia (Correct Answer)
B. Hypertension
C. Hypercalcemia
D. Erythrocytosis

Explanation: **Explanation:** Hepatocellular Carcinoma (HCC) is frequently associated with various paraneoplastic syndromes due to the liver's role in metabolism and hormone synthesis. **1. Why Hypoglycemia is Correct:** Hypoglycemia is the **most common** paraneoplastic manifestation of HCC, occurring in approximately 5–27% of patients. It occurs via two mechanisms: * **Type A:** Occurs in the terminal stages due to massive tumor burden and liver failure (inability to perform gluconeogenesis). * **Type B:** Occurs early in the disease due to the secretion of **IGF-II (Insulin-like Growth Factor-II)** by the tumor cells, which mimics insulin action. **2. Analysis of Incorrect Options:** * **B. Hypertension:** While HCC can rarely cause hypertension through the secretion of angiotensinogen, it is not a classic or common paraneoplastic feature. * **C. Hypercalcemia:** This is the most common paraneoplastic syndrome in **Renal Cell Carcinoma (RCC)** and Squamous Cell Carcinoma of the lung, caused by PTHrP secretion. In HCC, it is less common than hypoglycemia. * **D. Erythrocytosis:** This occurs in about 3–10% of HCC cases due to ectopic **Erythropoietin (EPO)** production. While high-yield, it is statistically less frequent than hypoglycemia. **Clinical Pearls for NEET-PG:** * **Most common paraneoplastic syndrome in HCC:** Hypoglycemia. * **Most common paraneoplastic syndrome in RCC:** Hypercalcemia (Stauffer’s syndrome is also specific to RCC). * **Hypercholesterolemia** is another notable paraneoplastic feature of HCC (seen in ~10-40% of cases). * **Tumor Marker:** Alpha-fetoprotein (AFP) is the primary marker used for screening and monitoring HCC.

Question 803: A young male falls from 15 feet and develops a perineal hematoma and suprapubic mass. Which of the following structures is most likely injured?

A. Urinary bladder
B. Anus
C. Urethra (Correct Answer)
D. Rectus abdominis

Explanation: **Explanation:** The clinical presentation of a **perineal hematoma** (often described as a "butterfly hematoma") and a **suprapubic mass** (representing a distended urinary bladder) in a trauma patient is a classic triad for **Urethral Injury**. 1. **Why Urethra is Correct:** In young males, a fall from a height often results in a "straddle injury," causing the bulbar urethra to be crushed against the pubic symphysis. If the **Buck’s fascia** is ruptured, urine and blood extravasate into the superficial perineal pouch, limited by Colles' fascia, leading to a perineal hematoma. The inability to void results in acute urinary retention, which presents as a palpable **suprapubic mass** (distended bladder). 2. **Why other options are incorrect:** * **Urinary Bladder:** While a bladder rupture can cause a suprapubic mass (if extraperitoneal), it typically does not present with a perineal hematoma unless associated with complex pelvic fractures. * **Anus:** Anal injuries present with rectal bleeding or sphincter dysfunction, not urinary retention or a suprapubic mass. * **Rectus Abdominis:** A rectus sheath hematoma can cause a suprapubic mass, but it would not cause a perineal hematoma or interfere with voiding. **High-Yield Clinical Pearls for NEET-PG:** * **Anterior Urethral Injury (Bulbar):** Most common cause is a straddle injury. Key sign: Butterfly perineal hematoma. * **Posterior Urethral Injury (Membranous):** Most common cause is Pelvic Fracture. Key sign: **High-riding prostate** on DRE. * **Gold Standard Investigation:** Retrograde Urethrogram (RUG). * **Management:** Do **NOT** insert a Foley catheter if urethral injury is suspected (blood at meatus). Perform a Suprapubic Cystostomy (SPC) instead.

Question 804: Reparative granuloma of the jaw is treated by which of the following methods?

A. Antibiotics
B. Wedge resection
C. Resection and bone grafting
D. Curettage (Correct Answer)

Explanation: **Explanation:** **Central Giant Cell Reparative Granuloma (CGCG)** of the jaw is a non-neoplastic, intraosseous lesion characterized by the proliferation of fibroblasts and multinucleated giant cells. It is most commonly seen in the mandible of children and young adults. **Why Curettage is the Correct Answer:** The standard of care for CGCG is **surgical curettage** or thorough local excision. Since the lesion is benign and well-demarcated from the surrounding bone, removing the soft tissue mass and scraping the bony walls (curettage) is usually sufficient to ensure healing. While it has a recurrence rate of roughly 10-20%, more aggressive primary surgery is generally avoided to preserve the jawline and developing teeth in young patients. **Why Other Options are Incorrect:** * **A. Antibiotics:** CGCG is a reactive/proliferative lesion, not an infectious process. Antibiotics have no role in its resolution. * **B. Wedge Resection:** This is an unnecessarily aggressive approach for a benign, non-infiltrative lesion. It is typically reserved for small malignant tumors. * **C. Resection and Bone Grafting:** This radical approach is only indicated for "aggressive" variants of CGCG that show rapid growth, cortical perforation, or high recurrence after curettage. It is not the primary treatment of choice. **NEET-PG High-Yield Pearls:** * **Location:** More common in the **mandible** than the maxilla; frequently crosses the midline. * **Radiology:** Appears as a **multilocular radiolucency** (soap-bubble appearance), similar to ameloblastoma or keratocystic odontogenic tumor (KCOT). * **Differential Diagnosis:** Histologically indistinguishable from a **Brown Tumor** of hyperparathyroidism. Always check serum calcium and PTH levels if a giant cell lesion is found. * **Medical Management:** In recurrent or aggressive cases, intralesional corticosteroids, Calcitonin, or Interferon-alpha may be used.

Question 805: Which tumour is most sensitive to radiotherapy?

A. Yolk sac tumour
B. Embryonal cell tumour
C. Teratoma
D. Seminoma (Correct Answer)

Explanation: **Explanation:** **Seminoma** is the correct answer because it is characteristically **exquisitely radiosensitive**. Among all germ cell tumors (GCTs), seminomas have a unique cellular biology that makes them highly susceptible to ionizing radiation. This property allows radiotherapy to be used as a primary treatment modality, particularly for Stage I and IIa/b seminomas, often leading to excellent cure rates. **Analysis of Incorrect Options:** * **Yolk Sac Tumour:** These are non-seminomatous germ cell tumors (NSGCTs). While they are chemosensitive, they do not share the same high degree of radiosensitivity as seminomas. They are the most common testicular tumor in infants and children. * **Embryonal Cell Tumour:** This is an aggressive NSGCT. It is highly sensitive to chemotherapy (platinum-based) but is considered radioresistant compared to seminomas. * **Teratoma:** These tumors are notorious for being **chemoresistant and radioresistant**. In adults, they are considered malignant and must be surgically excised (e.g., Retroperitoneal Lymph Node Dissection - RPLND) because they do not respond to non-surgical interventions. **Clinical Pearls for NEET-PG:** * **The "Rule of 90s" for Seminoma:** 90% occur in the 4th decade; 90% present with painless swelling; 90% are localized to the testis at presentation. * **Tumor Markers:** Seminomas may show elevated **hCG** (in 10-15% of cases) but **never** produce Alpha-Fetoprotein (AFP). If AFP is elevated, the diagnosis is automatically a Non-Seminomatous GCT. * **Management:** While radiotherapy was the historical gold standard for Stage I seminoma, single-agent Carboplatin or surveillance are now frequently preferred to avoid long-term radiation toxicity.

Question 806: What is the most indicative test for prostate cancer?

A. Digital rectal examination
B. Magnetic resonance imaging (MRI)
C. Excretory urography
D. Prostate-specific antigen (PSA) (Correct Answer)

Explanation: **Explanation:** **Prostate-specific antigen (PSA)** is the most indicative and widely used screening marker for prostate cancer. PSA is a serine protease produced by the ductal and acinar epithelium of the prostate. While it is organ-specific, it is not cancer-specific (levels can rise in BPH or prostatitis); however, a level **>4 ng/mL** significantly increases the suspicion of malignancy, and values **>10 ng/mL** are highly indicative of cancer, necessitating a biopsy. **Analysis of Options:** * **Digital Rectal Examination (DRE):** While crucial, DRE is subjective and often misses early-stage tumors located deep within the peripheral zone or those that are not yet palpable (T1 stage). * **Magnetic Resonance Imaging (MRI):** Multiparametric MRI (mpMRI) is excellent for localization and staging (PI-RADS scoring), but it is not the primary indicative screening test due to cost and accessibility. * **Excretory Urography (IVP):** This is largely obsolete for prostate cancer. It may show a "hooking of ureters" or a filling defect in the bladder base, but these are non-specific signs of prostatic enlargement. **Clinical Pearls for NEET-PG:** * **Gold Standard for Diagnosis:** Transrectal Ultrasound (TRUS) guided systematic **12-core biopsy**. * **Most Common Site:** Peripheral zone (70%). * **PSA Velocity:** A rise of **>0.75 ng/mL/year** is suspicious even if the total PSA is <4 ng/mL. * **Free-to-Total PSA Ratio:** A lower ratio (<10-15%) is more indicative of malignancy than BPH. * **Osteoblastic Metastases:** Prostate cancer characteristically spreads to the bone (lumbar spine), causing sclerotic/dense lesions.

Question 807: What is performed in Neibulowitz surgery?

A. Skin bridge
B. Lymph node with vein anastomosis (Correct Answer)
C. Ileal mucosal patch
D. All of the above

Explanation: **Explanation:** **Nielubowicz surgery** (often spelled Nielubowicz-Olszewski procedure) is a physiological surgical technique used to treat **obstructive lymphedema**, most commonly affecting the lower limbs. **1. Why Option B is Correct:** The underlying concept of this surgery is to create a bypass for stagnant lymph. In this procedure, a **lymph node-to-vein anastomosis** (Lymphovenous anastomosis) is performed. A nearby lymph node is transected, and its raw, cut surface (containing open lymphatic sinuses) is sutured into the lumen of a large adjacent vein (usually the great saphenous vein). This allows the lymph to drain directly into the venous system, bypassing the proximal lymphatic obstruction. **2. Why Other Options are Incorrect:** * **Option A (Skin Bridge):** This refers to the **Gillies and Fraser procedure**, where a bridge of skin and subcutaneous tissue is used to provide a conduit for lymphatic drainage. * **Option C (Ileal Mucosal Patch):** This refers to the **Kinmonth procedure**, where a pedicled segment of ileum (with the seromuscular layer stripped) is used to provide a mesenteric lymphatic pathway for drainage. **3. High-Yield Clinical Pearls for NEET-PG:** * **Classification:** Nielubowicz is a **physiological/reconstructive** procedure, unlike **excisional** procedures (e.g., Charles procedure, which involves radical excision of skin and subcutaneous tissue). * **Prerequisite:** For this surgery to be successful, the distal lymphatics must be functional, and the venous pressure must be lower than the lymphatic pressure. * **Other Lymphatic Procedures:** * **Charles Procedure:** Excision of skin/subcutaneous tissue + skin grafting (used for late-stage "Elephantiasis"). * **Sistrunk Procedure:** Wedge excision of skin and fat. * **Homan’s Procedure:** Reductioned excision with skin flaps.

Question 808: Tuberculosis of the testis first affects which structure?

A. Vas
B. Epididymis (Correct Answer)
C. Body of testis
D. Tunica vaginalis

Explanation: **Explanation:** In Genitourinary Tuberculosis (GUTB), the infection typically reaches the scrotal contents via the **hematogenous route** or by **retrograde spread** from a primary focus in the prostate or seminal vesicles. **1. Why Epididymis is correct:** The **epididymis** is the primary site of involvement in scrotal tuberculosis. This is due to its high vascularity, particularly in the **globus minor (tail)**, which is usually the first part to be affected. The infection causes chronic granulomatous inflammation, leading to a characteristic "craggy" or "nodular" enlargement. **2. Why other options are incorrect:** * **Vas (A):** The vas deferens is involved secondarily as the infection spreads from the epididymis. This leads to "beading" of the vas (multiple strictures and dilatations), a classic clinical sign. * **Body of testis (C):** The testis is relatively resistant to tuberculosis. It is almost always involved **secondarily** by direct extension from the epididymis (Epididymo-orchitis). Primary orchitis without epididymal involvement is extremely rare in TB. * **Tunica vaginalis (D):** Involvement of the tunica vaginalis occurs late in the disease process, often resulting in a "cold abscess" or a secondary hydrocele. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest site:** Tail of the epididymis (Globus minor). * **Clinical Presentation:** A painless, "craggy" epididymal mass. * **Classic Sign:** Beading of the vas deferens. * **Complication:** Formation of a posterior scrotal sinus (the sinus typically forms where the skin is adherent to the epididymis). * **Infertility:** Bilateral involvement often leads to obstructive azoospermia.

Question 809: Gleason's classification is used for which of the following carcinomas?

A. Carcinoma of the breast
B. Carcinoma of the prostate (Correct Answer)
C. Carcinoma of the pancreas
D. Carcinoma of the rectum

Explanation: **Explanation:** The **Gleason Scoring System** is the gold standard for grading **Prostate Adenocarcinoma**. It is a histological grading system based on the architectural pattern of the tumor cells rather than individual cellular morphology. 1. **Why Option B is Correct:** The Gleason score is determined by examining biopsy specimens under a microscope. The pathologist identifies the **primary pattern** (most common) and the **secondary pattern** (second most common) of cell differentiation, grading each from 1 (well-differentiated) to 5 (poorly differentiated/anaplastic). The sum of these two grades (e.g., 3+4=7) provides the Gleason Score, which is a critical prognostic factor and guides treatment decisions (Active Surveillance vs. Surgery/Radiation). 2. **Why Other Options are Incorrect:** * **Carcinoma of the Breast:** Graded using the **Nottingham Histologic Score** (Elston-Ellis modification of the Scarff-Bloom-Richardson system), which assesses tubule formation, nuclear pleomorphism, and mitotic count. * **Carcinoma of the Pancreas:** Usually graded based on the degree of glandular differentiation (WHO classification). * **Carcinoma of the Rectum:** Primarily staged using the **TNM system** and historically the **Dukes’ classification**. **High-Yield Clinical Pearls for NEET-PG:** * **ISUP Grade Groups:** Modern urology now groups Gleason scores into 5 Grade Groups (Group 1: Score ≤6; Group 5: Score 9-10) to better predict clinical outcomes. * **Most Common Site:** Prostate cancer most commonly arises in the **Peripheral Zone**. * **Screening:** PSA (Prostate Specific Antigen) is the screening marker; however, a definitive diagnosis requires a **TRUS-guided biopsy**. * **Osteoblastic Metastasis:** Prostate cancer characteristically spreads to the bone (lumbar spine), causing osteoblastic (sclerotic) lesions.

Question 810: Which of the following is NOT a complication of the irrigating fluid used in Transurethral Resection of the Prostate (TURP)?

A. Water intoxication
B. Hyperammonemia
C. Hyperthermia (Correct Answer)
D. Hyperglycemia

Explanation: In TURP, large volumes of irrigating fluid are used to maintain visibility and distend the bladder. These fluids can be absorbed into the systemic circulation through opened prostatic venous sinuses, leading to specific metabolic and systemic complications. **Explanation of the Correct Answer:** **C. Hyperthermia** is the correct answer because TURP is actually associated with **Hypothermia**, not hyperthermia. The irrigation fluid is typically stored at room temperature (around 20-22°C), which is significantly lower than body temperature. Large-scale absorption and continuous irrigation lead to core body heat loss. **Analysis of Incorrect Options:** * **A. Water Intoxication:** Using non-electrolyte solutes like Glycine or Sorbitol in water can lead to "TURP Syndrome." Excessive absorption causes dilutional hyponatremia and fluid overload, manifesting as confusion, visual disturbances, and seizures. * **B. Hyperammonemia:** This is a specific complication of **1.5% Glycine** irrigation. Glycine is metabolized in the liver into ammonia. Elevated levels can cross the blood-brain barrier, causing encephalopathy and delayed recovery from anesthesia. * **D. Hyperglycemia:** This occurs when **Sorbitol** is used as the irrigating fluid. Sorbitol is metabolized into fructose and then glucose, which can lead to elevated blood sugar levels, particularly concerning in diabetic patients. **Clinical Pearls for NEET-PG:** * **Ideal Irrigant:** Isotonic (Normal Saline) is ideal but can only be used with **Bipolar TURP** (to prevent electrical dissipation). Monopolar TURP requires non-conducting fluids (Glycine, Sorbitol, Mannitol). * **TURP Syndrome Triad:** Hypertension (early), Bradycardia, and Mental status changes (due to hyponatremia). * **Visual Loss:** Transient blindness post-TURP is specifically associated with Glycine toxicity affecting the retina.

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Urinary Calculi

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Benign Prostatic Hyperplasia

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Bladder Cancer

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Renal Cell Carcinoma

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Testicular Tumors

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Urinary Tract Infections

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Urinary Incontinence

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Urology — MCQs

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