Urology Practice Questions

Q: What procedure is shown in the ureter?

Dormia Basket. ***Dormia Basket*** - A **Dormia basket** is a wire mesh device used for **stone retrieval** from the ureter, appearing as a characteristic **basket-like radiopaque structure** on fluoroscopy. - The basket is deployed beyond the stone, then **withdrawn** to capture and extract the calculus under direct visualization. *Stenting* - **Ureteric stents** appear as **straight radiopaque tubes** extending from the renal pelvis to the bladder, not basket-shaped structures. - Used for **drainage** and **relief of obstruction** rather than stone extraction procedures. *Dilatation* - **Ureteric dilatation** involves **balloon catheters** that appear as **smooth, elongated structures** when inflated, not wire mesh patterns. - Used to **widen strictures** or **prepare the ureter** for other procedures, not for stone retrieval. *Cannulation* - **Ureteric cannulation** involves **thin catheters** appearing as **fine radiopaque lines** within the ureter. - Used for **contrast injection** during **retrograde pyelography** or **guidewire placement**, not stone extraction.

Q: All of the following are seen in cystitis EXCEPT:

Fever. **Explanation:** The correct answer is **Fever**. In clinical urology, it is crucial to differentiate between **Lower Urinary Tract Infections (UTIs)** and **Upper UTIs**. 1. **Why Fever is the correct answer:** Cystitis is a localized inflammation of the bladder mucosa (Lower UTI). Because it is a superficial mucosal infection without systemic involvement or tissue invasion, it typically **does not present with fever**. The presence of fever, chills, or flank pain in a patient with urinary symptoms strongly suggests **Acute Pyelonephritis** (Upper UTI) or systemic involvement like prostatitis. 2. **Analysis of incorrect options:** * **Dysuria:** This is the most common symptom of cystitis, caused by the irritation of the urethral and bladder neck mucosa during voiding. * **Nocturia & Frequency:** Inflammation reduces the functional capacity and compliance of the bladder, leading to an increased urge to void both day and night. * **Hematuria:** "Hemorrhagic cystitis" is common in bacterial infections where the friable, inflamed bladder mucosa bleeds easily. **NEET-PG High-Yield Pearls:** * **Triad of Cystitis:** Frequency, Urgency, and Dysuria. * **Most Common Organism:** *E. coli* (80-85% of cases). * **Gold Standard Diagnosis:** Urine culture (Significant bacteriuria is traditionally defined as $\geq 10^5$ CFU/mL). * **Sterile Pyuria:** If a patient has symptoms of cystitis but negative routine cultures, consider *Chlamydia trachomatis*, *Neisseria gonorrhoeae*, or Renal Tuberculosis. * **Treatment:** Uncomplicated cystitis is typically treated with Nitrofurantoin, Fosfomycin, or TMP-SMX.

Q: Epidermoid carcinoma of the renal pelvis is usually associated with:

Pelvic calculus. **Explanation:** Epidermoid carcinoma (Squamous Cell Carcinoma/SCC) of the renal pelvis is a rare but aggressive malignancy. The primary underlying mechanism is **chronic irritation**, which leads to squamous metaplasia of the urothelium, eventually progressing to dysplasia and carcinoma. * **Why Pelvic Calculus is Correct:** Long-standing **renal calculi** (specifically staghorn or pelvic stones) are the most common cause of chronic mechanical irritation and infection in the renal pelvis. Approximately 75–100% of patients with SCC of the renal pelvis have a history of chronic nephrolithiasis. * **Why Incorrect Options are Wrong:** * **Multiple Papillomas:** These are associated with **Transitional Cell Carcinoma (TCC)**, the most common type of renal pelvic tumor. TCC is often multifocal and associated with field defects. * **Tuberculosis of the Kidney:** While TB causes chronic inflammation, it typically leads to strictures, "putty kidney," or autonephrectomy rather than SCC. * **Filariasis:** This usually affects the lymphatic system, leading to chyluria or hydrocele, but is not a recognized risk factor for renal pelvic malignancy. **NEET-PG High-Yield Pearls:** 1. **Most common tumor** of the renal pelvis: **Transitional Cell Carcinoma (TCC)**. 2. **Most common risk factor** for SCC of the renal pelvis: **Chronic Calculi** (Stones). 3. **Schistosomiasis (S. haematobium)** is a major risk factor for SCC of the **Urinary Bladder**, not typically the renal pelvis. 4. SCC of the renal pelvis usually presents at an advanced stage and has a much poorer prognosis compared to TCC.

Q: Undescended testis can lead to all of the following complications except:

Hypertrophy of testes. **Explanation:** The correct answer is **Hypertrophy of testes**. In cases of cryptorchidism (undescended testis), the affected testis is typically **atrophic** (small and soft) rather than hypertrophied. This is due to the higher intra-abdominal temperature, which leads to the degeneration of germinal epithelium and peritubular fibrosis. While the contralateral descended testis may undergo compensatory hypertrophy, the undescended testis itself does not. **Analysis of Incorrect Options:** * **Torsion:** Undescended testes are more prone to torsion because they often lack the normal posterior attachment to the scrotum (gubernaculum abnormality) and are frequently associated with a patent processus vaginalis, allowing for increased mobility. * **Sterility:** The higher temperature of the inguinal canal or abdomen inhibits spermatogenesis. While Leydig cells (testosterone production) are relatively resistant, the Sertoli cells and germ cells are damaged, leading to infertility, especially in bilateral cases. * **Carcinoma:** There is a 10–40 times higher risk of germ cell tumors (most commonly **Seminoma**) in undescended testes. Orchiopexy does not eliminate the risk of malignancy but makes the testis accessible for clinical examination and screening. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Inguinal canal. * **Most common complication:** Inguinal hernia (associated with patent processus vaginalis in 90% of cases). * **Most common tumor:** Seminoma (overall); however, if the testis remains intra-abdominal, the risk of Seminoma is significantly higher. * **Timing of Surgery:** Orchiopexy is ideally performed between **6 to 12 months** of age to preserve fertility potential. * **Investigation of choice:** Ultrasonography (initial); Diagnostic Laparoscopy (Gold Standard for impalpable testes).

Q: Urinary retention in a child is most commonly caused by which of the following conditions?

Posterior urethral valve. **Explanation:** **Posterior Urethral Valve (PUV)** is the most common cause of lower urinary tract obstruction and urinary retention in **male infants and children**. It is a congenital condition where abnormal mucosal folds (valves) in the prostatic urethra act as a one-way flap, obstructing the outflow of urine. This leads to a classic clinical triad: a palpable distended bladder, a poor/dribbling urinary stream, and bilateral hydroureteronephrosis. **Analysis of Options:** * **Meatal stenosis with ulceration (Option A):** While it can cause painful micturition (dysuria) and a narrow stream, it rarely leads to complete urinary retention. It is usually an acquired condition following circumcision. * **Urethral stricture (Option C):** This is more common in adults (due to trauma or STIs). In children, it is rare and usually follows instrumentation or trauma, rather than being the primary congenital cause of retention. * **Epispadias (Option D):** This is a congenital malformation where the urethra opens on the dorsal aspect of the penis. It typically presents with **urinary incontinence** (due to sphincter defects) rather than retention. **Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Voiding Cystourethrogram (VCUG) is the investigation of choice; it classically shows a dilated posterior urethra with a "keyhole" appearance. * **Initial Management:** Catheterization (using a small feeding tube) to decompress the bladder. * **Definitive Treatment:** Endoscopic primary valve ablation (fulguration). * **Antenatal Clue:** Bilateral hydronephrosis and oligohydramnios on maternal ultrasound.

Question 1

What procedure is shown in the ureter?

Accepted Answer

Dormia Basket

Answer

Stenting

Answer

Dilatation

Answer

Cannulation

Question 2

All of the following are seen in cystitis EXCEPT:

Accepted Answer

Fever

Answer

Hematuria

Answer

Dysuria

Answer

Nocturia

Question 3

A patient was brought to the hospital eight hours after an injury. A few drops of blood are noted at the external urethral meatus. He has not passed urine and his bladder is palpable per abdomen. What is the probable diagnosis?

Accepted Answer

Urethral injury

Answer

Rupture bladder

Answer

Urethral injury with extravasation of urine in the retroperitoneum

Answer

Anuria due to hypovolemia

Question 4

Epidermoid carcinoma of the renal pelvis is usually associated with:

Accepted Answer

Pelvic calculus

Answer

Multiple papilomas

Answer

Tuberculosis of the kidney

Answer

Filariasis

Question 5

Undescended testis can lead to all of the following complications except:

Accepted Answer

Hypertrophy of testes

Answer

Torsion

Answer

Sterility

Answer

Carcinoma

Question 6

A 32-year-old man with a pelvic fracture presents with urinary retention and blood at the external meatus. A retrograde urethrogram shows prostatomembranous disruption. What is the most appropriate immediate treatment?

Accepted Answer

Suprapubic cystostomy

Answer

Urethral catheterization

Answer

Exploration and repair of the urethra

Answer

Perineal urethrostomy

Question 7

Urinary retention in a child is most commonly caused by which of the following conditions?

Accepted Answer

Posterior urethral valve

Answer

Meatal stenosis with ulceration

Answer

Urethral stricture

Answer

Epispadias

Question 8

All of the following are true about bulbar urethral rupture, except:

Accepted Answer

Floating prostate on per rectal examination

Answer

Perineal hematoma

Answer

Collection of urine in the perineum

Answer

Bleeding per urethra

Question 9

A 25-year-old married male presents with infertility. He underwent retroperitoneal lymph node dissection at age 15 for embryonal carcinoma of the right testis. Semen analysis shows a quantity of 0.5 ml, no sperm, and no fructose. Testis biopsy shows normal spermatogenesis. What is the best treatment?

Accepted Answer

Microtesticular sperm aspiration and intracytoplasmic injection

Answer

Artificial insemination with donor sperm

Answer

Penile prosthesis

Answer

None of the above

Question 10

Which is the most common site for ectopic testis?

Accepted Answer

Inguinal canal

Answer

Iliac fossa

Answer

Abdomen

Answer

Lumbar

Urology — MCQs

Urology — MCQs

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