Urology — MCQs

Urology Indian Medical PG Practice Questions and MCQs

Question 811: Thimble bladder is seen in which of the following conditions?

A. Cystitis
B. Chronic tubercular cystitis
C. Neurogenic bladder
D. Acute tubercular cystitis (Correct Answer)

Explanation: ### Explanation **Correct Answer: D. Acute tubercular cystitis** **Underlying Medical Concept:** A **Thimble Bladder** (also known as a "systolic bladder") is the characteristic end-stage radiological and pathological finding of **Genitourinary Tuberculosis (GUTB)**. In the acute or active phase of tubercular cystitis, the bladder wall undergoes intense inflammation, followed by extensive fibrosis and scarring of the detrusor muscle. This leads to a permanent reduction in bladder capacity (often <50 ml), making the bladder small, thick-walled, and non-distensible—resembling the shape of a tailor's thimble. **Analysis of Options:** * **A. Cystitis:** General bacterial cystitis causes mucosal inflammation and frequency, but it does not lead to the profound transmural fibrosis and permanent contraction seen in tuberculosis. * **B. Chronic tubercular cystitis:** While "chronic" implies long-standing disease, the term **Acute tubercular cystitis** in many surgical textbooks (like Bailey & Love) refers to the active inflammatory process that initiates the rapid fibrotic destruction leading to a thimble bladder. (Note: In some contexts, thimble bladder is considered the "sequela" of TB, but it is classically associated with the tubercular infective process). * **C. Neurogenic bladder:** Depending on the level of the lesion, this usually results in either a large, atonic bladder (Lower Motor Neuron) or a small, spastic "Christmas Tree" bladder (Upper Motor Neuron), but not a "thimble" bladder. **Clinical Pearls for NEET-PG:** * **Golf-hole Ureter:** Seen in GUTB due to fibrosis and shortening of the ureter, leading to a retracted, gaping ureteric orifice. * **Putty Kidney:** Refers to autonephrectomy in GUTB where the kidney becomes a bag of caseous material and calcification. * **Beaded Ureter:** Multiple strictures in the ureter due to TB. * **Investigation of Choice:** For thimble bladder, a **Cystogram** or **IVU** will show the characteristic small capacity. For diagnosis of GUTB, **3 consecutive early morning mid-stream urine samples** for AFB culture (Lowenstein-Jensen medium) is the gold standard.

Question 812: The "Triangle of Doom" is bounded by all of the following structures except?

A. Cooper's ligament (Correct Answer)
B. Vas deferens
C. Gonadal vessels
D. Peritoneal reflection

Explanation: The **Triangle of Doom** is a critical anatomical landmark in laparoscopic inguinal hernia repair (TEP/TAPP). It is an inverted V-shaped area located at the internal inguinal ring. ### **Explanation of the Correct Answer** **A. Cooper’s Ligament:** This is the correct answer because it does **not** form a boundary of the Triangle of Doom. Instead, Cooper’s ligament (pectineal ligament) forms the posterior boundary of the **Triangle of Pain**. In laparoscopic surgery, Cooper’s ligament is used as a landmark for anchoring the mesh, but it lies inferior to the Triangle of Doom. ### **Analysis of Incorrect Options (Boundaries of the Triangle)** The Triangle of Doom is defined by: * **B. Vas Deferens:** Forms the **medial** boundary. * **C. Gonadal Vessels:** Form the **lateral** boundary. * **D. Peritoneal Reflection:** Forms the **superior** boundary (base). ### **Clinical Significance & High-Yield Pearls** * **Contents:** The most critical structure within this triangle is the **External Iliac Artery and Vein**. * **Surgical Importance:** Surgeons must avoid placing tacks, staples, or sutures within this triangle. Injury to the vessels here can lead to catastrophic, life-threatening hemorrhage. * **Triangle of Pain:** Located **lateral** to the Triangle of Doom (lateral to the gonadal vessels). It is bounded by the gonadal vessels (medially) and the iliopubic tract (laterally). It contains the **Femoral nerve, Genitofemoral nerve (genital branch), and Lateral femoral cutaneous nerve**. Tacking here leads to chronic post-operative neuralgia. * **Mnemonic:** "Doom" involves **Vessels** (Iliacs); "Pain" involves **Nerves**.

Question 813: What are the common complications of ureterosigmoidostomy?

A. Hyperchloremic with hypokalemic acidosis (Correct Answer)
B. Hyperkalemia
C. Metabolic alkalosis
D. Hyponatremia

Explanation: **Explanation:** Ureterosigmoidostomy is a form of urinary diversion where the ureters are implanted into the sigmoid colon. While largely replaced by ileal conduits, it remains a high-yield topic in NEET-PG due to its classic metabolic complications. **Why Option A is correct:** The primary complication is **Hyperchloremic Hypokalemic Metabolic Acidosis**. This occurs due to the prolonged contact of urine with the colonic mucosa: 1. **Chloride/Bicarbonate Exchange:** The colonic mucosa actively reabsorbs chloride ions from the urine in exchange for bicarbonate ions, leading to bicarbonate loss and systemic acidosis. 2. **Ammonium Reabsorption:** The bowel reabsorbs urinary ammonium ($NH_4^+$), which is metabolized in the liver to urea and hydrogen ions, further worsening the acidosis. 3. **Potassium Loss:** To maintain electrical neutrality and due to the secretory nature of the colon, potassium is excreted into the bowel lumen and lost in the stool, resulting in hypokalemia. **Why other options are incorrect:** * **B & C:** Metabolic alkalosis and hyperkalemia are physiologically opposite to the effects of colonic urinary diversion. * **D:** While minor electrolyte shifts occur, hyponatremia is not the hallmark metabolic derangement of this procedure. **High-Yield Clinical Pearls for NEET-PG:** * **Late Complication:** The most dreaded long-term complication is **Adenocarcinoma of the colon** (usually at the site of ureteric implantation), occurring 10–20 years post-surgery. * **Other Complications:** Ascending pyelonephritis (due to fecal reflux), urolithiasis, and growth retardation in children. * **Contraindication:** It should never be performed in patients with a weak anal sphincter, as it leads to total urinary/fecal incontinence.

Question 814: In a patient suspected to be suffering from vesicoureteric reflux, which one of the following radiological investigations may confirm the diagnosis?

A. Intravenous urography
B. Micturating cystourethrography (Correct Answer)
C. Pelvic ultrasound
D. Antegrade pyelography

Explanation: **Explanation:** **Vesicoureteric Reflux (VUR)** is the retrograde flow of urine from the bladder into the ureters and potentially the kidneys. This occurs due to an incompetent or short intramural ureteric tunnel (the "valve" mechanism). **Why Micturating Cystourethrography (MCU/VCUG) is the Correct Answer:** MCU is the **Gold Standard** investigation for diagnosing and grading VUR. The procedure involves filling the bladder with radiopaque contrast via a catheter and taking fluoroscopic images during the act of voiding. Voiding increases intravesical pressure, which is the precise moment reflux is most likely to occur. It allows for the definitive visualization of contrast moving backward into the ureters and helps in grading the severity (Grades I-V). **Why Other Options are Incorrect:** * **A. Intravenous Urography (IVU):** IVU visualizes the anatomy of the upper urinary tract as contrast is excreted downwards. While it may show secondary signs like a dilated ureter or scarred kidney, it cannot demonstrate the dynamic retrograde flow of urine. * **C. Pelvic Ultrasound:** This is often the initial screening tool. It can detect hydronephrosis or bladder wall thickening but cannot confirm VUR, as many patients with low-grade reflux have normal ultrasounds. * **D. Antegrade Pyelography:** This involves injecting contrast directly into the renal pelvis (usually via a nephrostomy). It is used to identify distal obstructions, not reflux from the bladder. **Clinical Pearls for NEET-PG:** * **Grading:** VUR is graded I (ureter only) to V (gross dilation/tortuosity) based on the **International Reflux Study** classification. * **Radionuclide Cystography (RNC):** This is more sensitive than MCU and involves less radiation; it is preferred for **follow-up** and screening siblings, though MCU remains better for initial anatomical grading. * **Management:** Low-grade VUR (I-III) often resolves spontaneously with prophylactic antibiotics; high-grade VUR (IV-V) or breakthrough infections may require surgical re-implantation (e.g., Cohen’s procedure).

Question 815: All of the following are seen in hypospadias except?

A. Ectopia vesicae (Correct Answer)
B. Hooded prepuce
C. Chordee
D. Infertility

Explanation: **Explanation:** Hypospadias is a congenital anomaly characterized by the failure of the urethral folds to fuse, resulting in the urethral meatus opening on the ventral aspect of the penis. **Why Ectopia Vesicae is the correct answer:** Ectopia vesicae (bladder exstrophy) is a severe midline defect involving the failure of the infra-umbilical abdominal wall and anterior bladder wall to close. While it is associated with **epispadias** (urethral opening on the *dorsal* aspect), it is not a feature of hypospadias. These two conditions arise from different embryological failures. **Analysis of other options:** * **Hooded Prepuce:** This is a hallmark of hypospadias. Due to the failure of the ventral prepuce to develop, the dorsal foreskin becomes redundant and hangs over the glans like a "hood." * **Chordee:** This refers to the ventral curvature of the penis, often caused by a fibrous band of tissue or skin tethering. It is a classic component of the hypospadias triad. * **Infertility:** While not universal, hypospadias can lead to infertility due to the abnormal position of the meatus (causing failure of sperm deposition in the vaginal vault) or associated undescended testes (cryptorchidism). **High-Yield Clinical Pearls for NEET-PG:** * **The Hypospadias Triad:** 1. Ventral meatus, 2. Ventral chordee, 3. Hooded dorsal prepuce. * **Contraindication:** Circumcision is strictly contraindicated in these infants because the prepuce is required for future surgical reconstruction (urethroplasty). * **Commonest Site:** Glandular/Coronal (Distal). * **Associated Anomalies:** Cryptorchidism (10%) and Inguinal hernia. If a child has hypospadias and undescended testes, always screen for Disorders of Sex Development (DSD).

Question 816: What is the most common location of an anorectal fistula?

A. Intersphincteric (Correct Answer)
B. Transsphincteric
C. Suprasphincteric
D. Extrasphincteric

Explanation: **Explanation:** The classification of anorectal fistulae is based on the **Parks Classification**, which categorizes them according to their relationship with the internal and external anal sphincters. **1. Why Intersphincteric is Correct:** The **intersphincteric fistula** is the most common type, accounting for approximately **45% to 70%** of all cases. It originates at the dentate line (cryptoglandular infection) and tracks through the internal sphincter into the space between the internal and external sphincters, eventually opening onto the perianal skin. Because it does not involve the external sphincter, it carries the lowest risk of fecal incontinence during surgical management (fistulotomy). **2. Analysis of Incorrect Options:** * **Transsphincteric (Option B):** The second most common type (~20-30%). The tract passes from the intersphincteric space through the external sphincter into the ischiorectal fossa. * **Suprasphincteric (Option C):** Rare (~5%). The tract loops over the top of the puborectalis muscle and descends through the levator ani to the skin. * **Extrasphincteric (Option D):** Most rare (~1-3%). The tract runs from the rectum above the levator ani, through the levator muscles, to the perianal skin, completely bypassing the sphincter complex. These are often secondary to trauma, Crohn’s disease, or pelvic inflammation. **Clinical Pearls for NEET-PG:** * **Goodsall’s Rule:** Predicts the trajectory of the fistula tract. Anterior openings (within 3cm of the anus) usually follow a straight radial path; posterior openings usually follow a curved path to the midline. * **Etiology:** Most fistulae result from an **acute anorectal abscess** (cryptoglandular hypothesis). * **Investigation of Choice:** **MRI (Pelvis)** is the gold standard for complex or recurrent fistulae. * **Treatment:** Simple fistulae are treated with a **fistulotomy**, while complex ones may require a **Seton** or LIFT procedure to preserve continence.

Question 817: What is the commonest cause of urethral stricture in a young person?

A. Trauma (Correct Answer)
B. Gonococcal infection
C. Syphilis
D. Tuberculosis

Explanation: **Explanation:** The epidemiology of urethral strictures has shifted significantly in recent decades. In modern clinical practice, **Trauma** is the most common cause of urethral strictures in young individuals in developed and developing nations alike. 1. **Why Trauma is Correct:** In young patients, trauma typically occurs via two mechanisms: **Straddle injuries** (falling astride an object), which lead to bulbar urethral strictures, and **Pelvic fractures** (often from motor vehicle accidents), which typically cause posterior urethral distractions. These injuries lead to scarring and fibrosis of the urethral corpus spongiosum (spongiofibrosis), resulting in a narrowed lumen. 2. **Why Incorrect Options are Wrong:** * **Gonococcal infection:** Historically, this was the leading cause worldwide. However, with the advent of effective antibiotic therapy, post-inflammatory strictures have become less common, though they remain a significant cause in specific geographic regions. * **Syphilis and Tuberculosis:** These are extremely rare causes of urethral strictures. Syphilis rarely involves the urethra in a way that leads to stricture, and TB typically affects the upper urinary tract or the prostate/epididymis rather than the penile urethra. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of Traumatic stricture:** Bulbar urethra (following straddle injury). * **Most common site of Post-TURP stricture:** Fossa navicularis or bladder neck. * **Gold Standard Investigation:** Retrograde Urethrogram (RUG) combined with Voiding Cystourethrogram (VCUG) to define the length and location. * **Management:** Short strictures (<2cm) are often treated with **Direct Vision Internal Urethrotomy (DVIU)**; longer or recurrent strictures require **Urethroplasty** (e.g., Buccal Mucosa Graft).

Question 818: What is the most common site for tumors of the minor salivary glands?

A. Pharyngeal cavities
B. Paranasal sinuses
C. Retromolar area (Correct Answer)
D. Nasal cavity

Explanation: **Explanation:** The minor salivary glands are distributed throughout the upper aerodigestive tract, with an estimated 500 to 1,000 glands located in the submucosa. **Why Retromolar Area is Correct:** While the **palate** (specifically the junction of the hard and soft palate) is the single most common site overall for minor salivary gland tumors, among the options provided, the **retromolar area** (or retromolar trigone) represents a high-frequency site. In the context of standard surgical textbooks and NEET-PG patterns, when the palate is not listed, the retromolar area/buccal mucosa complex is the preferred answer. It is important to note that minor salivary gland tumors have a higher malignancy rate (approx. 50-80%) compared to parotid tumors. **Why Other Options are Incorrect:** * **Pharyngeal cavities:** While glands exist here, tumors are significantly rarer than in the oral cavity. * **Paranasal sinuses:** These are infrequent sites; however, tumors here (like Adenoid Cystic Carcinoma) carry a poorer prognosis due to late presentation. * **Nasal cavity:** Similar to the sinuses, these account for a small percentage of minor salivary gland neoplasms. **High-Yield Clinical Pearls for NEET-PG:** * **Rule of 80s (Parotid):** 80% are in the parotid, 80% are Pleomorphic Adenoma, 80% are in the superficial lobe. * **Malignancy Ratio:** The smaller the gland, the higher the chance of malignancy (Parotid ~25%, Submandibular ~40%, Minor glands >50%). * **Most Common Benign Tumor:** Pleomorphic Adenoma (even in minor glands). * **Most Common Malignant Tumor:** Mucoepidermoid Carcinoma (overall); however, Adenoid Cystic Carcinoma is very common in minor glands and is known for **perineural invasion**.

Question 819: What is the treatment of choice for grade IV vesicoureteric reflux with recurrent UTI?

A. Cotrimoxazole (Correct Answer)
B. Bilateral reimplantation of ureter
C. Injection of collagen in the ureter
D. Endoscopic resection of ureter

Explanation: The management of Vesicoureteric Reflux (VUR) in children is primarily focused on preventing renal scarring and permanent damage (reflux nephropathy) by controlling urinary tract infections (UTIs). ### **Explanation of the Correct Answer** **A. Cotrimoxazole:** The standard initial management for VUR, including Grade IV, is **Continuous Antibiotic Prophylaxis (CAP)**. The goal is to keep the urine sterile while waiting for spontaneous resolution, which occurs in a significant percentage of high-grade cases (up to 40-60% in Grade IV). Low-dose Cotrimoxazole (Trimethoprim-Sulfamethoxazole) or Nitrofurantoin are the drugs of choice. Surgery is reserved only for cases where medical management fails. ### **Why Other Options are Incorrect** * **B. Bilateral reimplantation of ureter:** This is a surgical intervention (e.g., Cohen’s or Leadbetter-Politano technique). It is indicated only if there is breakthrough UTI despite prophylaxis, non-compliance with medication, or worsening renal function. It is **not** the first-line treatment. * **C. Injection of collagen/Deflux:** This is an endoscopic treatment (STING procedure). While less invasive than surgery, it is typically considered if prophylaxis fails or as an alternative to major surgery, not as the primary treatment of choice. * **D. Endoscopic resection of ureter:** This is not a treatment for VUR; it is used for conditions like ureteroceles or bladder outlet obstructions. ### **Clinical Pearls for NEET-PG** * **Grading (International Reflux Study):** Grade IV involves gross dilation of the ureter and pelvis with moderate tortuosity and blunting of fornices. * **Spontaneous Resolution:** Most VUR (Grades I-III) resolves spontaneously. Grade IV has a moderate chance, while Grade V rarely resolves. * **Gold Standard Investigation:** Voiding Cystourethrogram (VCUG/MCU). * **Surgery Indications:** Breakthrough UTIs, Grade V reflux in older children, or failure of renal growth.

Question 820: Which of the following statements concerning carcinoma of the prostate is FALSE?

A. Annual digital rectal examination and serum prostate specific antigen (PSA) determinations are recommended for screening.
B. Lung metastasis is less common than bone metastasis.
C. Radical prostatectomy is associated with a 5% incidence of permanent urinary incontinence. (Correct Answer)
D. Once prostate cancer has spread, it is no longer curable but can be contained by lowering serum testosterone and/or by administration of androgen receptor blockers.

Explanation: ### Explanation **1. Why Option C is the Correct (False) Statement:** While urinary incontinence is a known complication of radical prostatectomy, the incidence of **permanent, severe urinary incontinence** is generally lower than 5% in modern surgical series (typically **1–3%**). Most patients experience transient stress incontinence postoperatively, which improves significantly within 6–12 months. In contrast, **erectile dysfunction (impotence)** is a much more frequent complication, occurring in 30–70% of cases depending on nerve-sparing techniques. **2. Analysis of Other Options:** * **Option A (True):** Screening for prostate cancer typically involves a combination of **Digital Rectal Examination (DRE)** and **Serum PSA**. While controversial in some guidelines, this remains the standard recommendation for early detection in men over 50 (or 45 for high-risk groups). * **Option B (True):** Prostate cancer is highly osteoblastic. **Bone metastasis** (specifically to the axial skeleton via Batson’s plexus) is the most common site of distant spread. Visceral metastases, such as to the **lungs**, occur much later and are less frequent. * **Option D (True):** Metastatic prostate cancer is considered incurable. Management focuses on **Androgen Deprivation Therapy (ADT)**, achieved via surgical castration (orchiectomy) or medical castration (LHRH agonists/antagonists and androgen receptor blockers like Bicalutamide). **Clinical Pearls for NEET-PG:** * **Most common site:** Peripheral zone (70-80%); hence palpable on DRE. * **Gleason Scoring:** Based on glandular architecture, not nuclear grade. It is the most important prognostic factor. * **Osteoblastic lesions:** Prostate cancer is the classic cause of sclerotic/radio-opaque bone secondaries. * **PSA Velocity:** An increase of >0.75 ng/mL per year is suspicious, even if the absolute value is <4 ng/mL.

Practice by Chapter

Urological Anatomy

Practice Questions

Hematuria Evaluation

Practice Questions

Urinary Calculi

Practice Questions

Benign Prostatic Hyperplasia

Practice Questions

Prostate Cancer

Practice Questions

Bladder Cancer

Practice Questions

Renal Cell Carcinoma

Practice Questions

Testicular Tumors

Practice Questions

Urinary Tract Infections

Practice Questions

Urinary Incontinence

Practice Questions

Genitourinary Trauma

Practice Questions

Pediatric Urology Basics

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free

Urology — MCQs

Urology — MCQs

On this page

Practice by Chapter

Want unlimited practice?