A 15-year-old boy is brought to casualty with sudden severe left scrotal pain for 3 hours, with vomiting. The left testis lies high with a horizontal lie and is exquisitely tender, and the left cremasteric reflex is absent. Lifting the testis does not ease the pain. What is the most appropriate next step?

Immediate scrotal exploration and fixation

Antibiotics and scrotal support

Manual detorsion and discharge home

Colour Doppler ultrasound before deciding

A 56-year-old man has had painless haematuria and has noticed a swelling in the left side of the scrotum for 3 weeks. It feels like a bag of worms and does not empty when he lies down. Haemoglobin is 18.4 g/dL. What is the most appropriate investigation?

Contrast-enhanced CT of the abdomen

Scrotal Doppler ultrasound only

Semen analysis and hormone profile

Cystoscopy with bladder washings

Urolithiasis, BPH, urological cancers and emergencies

37 NEET-PG practice questions on Urolithiasis, BPH, urological cancers and emergencies, part of General Surgery. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A 15-year-old boy is brought to casualty with sudden severe left scrotal pain for 3 hours, with vomiting. The left testis lies high with a horizontal lie and is exquisitely tender, and the left cremasteric reflex is absent. Lifting the testis does not ease the pain. What is the most appropriate next step?
1. AImmediate scrotal exploration and fixation
2. BAntibiotics and scrotal support
3. CManual detorsion and discharge home
4. DColour Doppler ultrasound before deciding
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Answer: A · Immediate scrotal exploration and fixation
Sudden pain, a high-riding horizontal testis, an absent cremasteric reflex and a negative Prehn sign in an adolescent is testicular torsion until proved otherwise. Testicular salvage falls steeply after about 6 hours, so a clear clinical diagnosis goes straight to exploration, untwisting and fixation of both testes (the bell-clapper anomaly is usually bilateral). Doppler is useful only when the diagnosis is genuinely in doubt and must not delay surgery. As he is a minor, consent for exploration and possible orchidectomy is taken from a parent or guardian, with the boy's assent.
- B: Antibiotics treat epididymo-orchitis, which is gradual and eased by lifting the testis.
- C: Manual detorsion is only a bridge; the testis still needs exploration and fixation.
- D: Doppler delays surgery when the clinical picture is already clear.
Question 2 · Easy
A 35-year-old man passes a small stone in his urine after an episode of renal colic and brings it to the urology OPD for analysis. Which stone composition is most likely?
1. ACalcium phosphate
2. BUric acid
3. CStruvite (triple phosphate)
4. DCalcium oxalate
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Answer: D · Calcium oxalate
Calcium-containing stones, mostly calcium oxalate (alone or mixed with calcium phosphate), make up the large majority of urinary stones. Risk factors include low fluid intake (common in hot climates), hypercalciuria, hyperoxaluria, hypocitraturia and a high salt and animal-protein diet. Calcium stones are radio-opaque, which is why most stones are visible on plain X-ray KUB.
- A: Pure calcium phosphate stones are much less common and suggest renal tubular acidosis or hyperparathyroidism.
- B: Uric acid stones are a small minority, seen with gout and low urinary pH.
- C: Struvite stones form with urease-producing infection and are less common.
Question 3 · Medium
A 66-year-old man has nocturia three times a night, a weak stream and hesitancy, with an IPSS of 19. DRE shows a smooth, enlarged, firm prostate, and ultrasound estimates the volume at 65 mL with a post-void residual of 70 mL. PSA is 2.6 ng/mL and creatinine normal. He started tamsulosin a month ago. Which addition would reduce his long-term risk of acute retention and of needing surgery?
1. ATolterodine
2. BTadalafil
3. CFinasteride
4. DDesmopressin
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Answer: C · Finasteride
In a large prostate (over about 40 mL) with moderate to severe symptoms, adding a 5-alpha reductase inhibitor to an alpha blocker shrinks the gland by blocking conversion of testosterone to dihydrotestosterone. Combination therapy reduces the long-term risk of acute urinary retention and of prostate surgery more than either drug alone. Its effect takes about 6 months, and it reduces PSA by about half.
- A: Antimuscarinics treat storage symptoms and can worsen voiding in a large obstructing gland.
- B: Tadalafil improves symptoms but does not shrink the prostate or prevent retention.
- D: Desmopressin reduces nocturnal urine production and is risky for hyponatraemia in older men.
Question 4 · Medium
In the urology OPD, a resident lists situations in men with BPH: 1. Acute retention that recurs after a failed trial without catheter on an alpha blocker. 2. Bladder stones secondary to outflow obstruction. 3. IPSS of 9 with little bother. 4. Bilateral hydronephrosis with a raised creatinine due to obstruction. Which are indications for surgery such as TURP?
1. A1 and 2 only
2. B1, 3 and 4 only
3. C1, 2 and 4 only
4. D2 and 4 only
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Answer: C · 1, 2 and 4 only
Situations 1, 2 and 4 are indications for surgery. Refractory retention, bladder stones, renal impairment from obstruction, recurrent urinary infection and recurrent gross haematuria from the prostate are complications of BPH that drugs cannot reliably treat. Mild symptoms with little bother (IPSS 0-7 is mild, 8-19 moderate) are managed by watchful waiting, lifestyle advice or drugs.
- A: Leaves out obstructive renal impairment, a clear indication for surgery.
- B: Includes mild, low-bother symptoms and leaves out bladder stones.
- D: Leaves out refractory retention, the commonest indication for TURP.
Question 5 · Medium
A 56-year-old man has had painless haematuria and has noticed a swelling in the left side of the scrotum for 3 weeks. It feels like a bag of worms and does not empty when he lies down. Haemoglobin is 18.4 g/dL. What is the most appropriate investigation?
1. AScrotal Doppler ultrasound only
2. BContrast-enhanced CT of the abdomen
3. CSemen analysis and hormone profile
4. DCystoscopy with bladder washings
Show answerHide answer
Answer: B · Contrast-enhanced CT of the abdomen
A new left varicocele in an older man that does not empty on lying down suggests obstruction of the left renal vein, into which the left testicular vein drains, typically by tumour thrombus from renal cell carcinoma. Haematuria and polycythaemia (from tumour erythropoietin) support the diagnosis. Contrast-enhanced CT of the abdomen shows the renal mass, renal vein and IVC involvement and stages the disease.
- A: Scrotal ultrasound shows the varicocele but not its renal cause.
- C: Semen analysis is for fertility work-up in young men with a varicocele.
- D: Cystoscopy looks for a bladder cause of haematuria but misses the kidney and vein.
Question 6 · Hard
A 44-year-old woman with right loin pain for 3 days now has fever with rigors. Temperature 39.2 °C, pulse 118/min, BP 94/60 mmHg. WBC 19,800/µL, creatinine 1.6 mg/dL. Non-contrast CT shows an 8 mm stone in the right upper ureter with moderate hydronephrosis. IV fluids and antibiotics are started after blood and urine cultures. What is the next best step?
1. AMedical expulsive therapy with tamsulosin
2. BUrgent decompression by nephrostomy or ureteric stent
3. CShock wave lithotripsy once afebrile
4. DEmergency ureteroscopy with laser lithotripsy
Answer and explanation in LearnFree account
Question 7 · Hard
A 59-year-old man who smokes has right loin pain, haematuria and weight loss. Contrast CT shows a 9 cm enhancing mass in the right kidney with tumour thrombus filling the right renal vein and extending into the IVC to below the hepatic veins. There are no lymph node, lung or bone metastases, and the left kidney is normal. What is the most appropriate treatment?
1. ARadical nephrectomy with IVC tumour thrombectomy
2. BSystemic therapy alone as it is inoperable
3. CRadiofrequency ablation of the mass
4. DPartial nephrectomy of the right kidney
Answer and explanation in LearnFree account
Question 8 · Medium
A 70-year-old man has taken finasteride for BPH for 2 years. His PSA at a health check is 2.8 ng/mL, and his family doctor wants to know how to interpret it for prostate cancer screening. What is the correct approach?
1. AHalve the value, giving about 1.4 ng/mL
2. BAccept 2.8 ng/mL as a normal result
3. CDouble the value, giving about 5.6 ng/mL
4. DIgnore PSA in men on finasteride
Answer and explanation in LearnFree account
Question 9 · Hard
A 36-year-old bank cashier from Chennai, who drinks little water at work, has formed her fourth calcium-containing renal stone. Her metabolic work-up on her usual diet gives: urine volume 1.0 L/day; urinary calcium 310 mg/day (normal below 250 in women); oxalate 30 mg/day (below 45); citrate 140 mg/day (above 320); uric acid 480 mg/day (below 750). Serum calcium and PTH are normal. Which combination best corrects her metabolic risks?
1. AMore fluids, allopurinol and low-calcium diet
2. BMore fluids, potassium citrate and allopurinol
3. CMore fluids, thiazide and potassium citrate
4. DMore fluids, thiazide and low-oxalate diet
Answer and explanation in LearnFree account
Question 10 · Easy
A 64-year-old man who has smoked bidis for 40 years has had two episodes of painless, total haematuria with clots. Urine culture is sterile. Which investigation is essential to diagnose a bladder tumour?
1. AUrine cytology
2. BUltrasound of the bladder
3. CSerum PSA estimation
4. DCystoscopy
Answer and explanation in LearnFree account
Question 11 · Medium
A 45-year-old man who worked for 15 years on irrigation projects in Egypt has painful haematuria. Cystoscopy shows a large tumour, and the biopsy reports keratinising squamous cell carcinoma. Urine microscopy from years ago showed eggs with a terminal spine. Which agent is linked with his cancer?
1. AAromatic amine dyes
2. BSchistosoma haematobium
3. CSchistosoma mansoni
4. DHuman papillomavirus
Answer and explanation in LearnFree account
Question 12 · Hard
A 61-year-old man has a TURBT for haematuria. Histology shows high-grade urothelial carcinoma invading the muscularis propria. CT of the chest, abdomen and pelvis shows no enlarged nodes and no metastases, and his creatinine clearance and performance status are good. What is the most appropriate treatment?
1. AExternal beam radiotherapy alone
2. BIntravesical BCG induction and maintenance
3. CNeoadjuvant cisplatin chemotherapy, then radical cystectomy
4. DRepeat TURBT every 3 months
Answer and explanation in LearnFree account
Question 13 · Medium
A 52-year-old man with tophaceous gout has right loin pain. Plain X-ray KUB shows no opacity, but non-contrast CT shows a 9 mm stone in the right renal pelvis. His urine pH is 5.0 and he has no infection. Which treatment can dissolve this stone?
1. AOral potassium citrate to alkalinise urine
2. BThiazide diuretic with low-calcium diet
3. COral D-penicillamine
4. DAcidification of urine with ammonium chloride
Answer and explanation in LearnFree account
Question 14 · Medium
A 58-year-old man with poorly controlled diabetes is brought to casualty with fever, severe pain and swelling of the scrotum for 2 days. The scrotal skin is black in patches with crepitus and a foul smell, and the redness is spreading to the perineum. BP is 90/60 mmHg. After resuscitation and blood cultures, what is the most important next step?
1. ASuprapubic catheter and scrotal elevation
2. BIV antibiotics and review after 48 hours
3. CEmergency radical surgical debridement
4. DHyperbaric oxygen before any surgery
Answer and explanation in LearnFree account
Question 15 · Hard
A 27-year-old software engineer has a hard, painless swelling of the right testis. Ultrasound shows a 4 cm heterogeneous intratesticular mass. AFP is 1,850 ng/mL, beta-hCG 2,400 mIU/mL and LDH raised. CT shows 3 cm para-aortic lymph nodes; the chest is clear. He is well, and he asks to bank sperm. What is the most appropriate first surgical step?
1. ATrans-scrotal biopsy of the testicular mass
2. BTrans-scrotal orchidectomy
3. CRadical inguinal orchidectomy with high cord ligation
4. DRetroperitoneal lymph node dissection first
Answer and explanation in LearnFree account
Question 16 · Easy
A 66-year-old man has a hard, irregular nodule felt on digital rectal examination and a raised PSA. In which zone of the prostate does carcinoma most commonly arise?
1. APeripheral zone
2. BTransition zone
3. CAnterior fibromuscular stroma
4. DCentral zone
Answer and explanation in LearnFree account
Question 17 · Medium
A 40-year-old man in casualty is writhing with left ureteric colic. He has no history of peptic ulcer, his creatinine is normal and he is not pregnant or asthmatic. Which drug is preferred first-line for his pain?
1. AIntravenous hyoscine butylbromide
2. BIntramuscular diclofenac
3. CIntramuscular pethidine
4. DOral paracetamol alone
Answer and explanation in LearnFree account
Question 18 · Medium
A 32-year-old man comes to casualty with a painful, rigid erection lasting 6 hours after an intracavernosal injection given at a private clinic. The glans is soft and the shaft is tense and tender. Blood aspirated from the corpora is dark, with low pO2 and acidosis. What is the first-line treatment?
1. ASelective arterial embolisation
2. BIce packs and an analgesic only
3. CCorporal aspiration and intracavernosal phenylephrine
4. DOral pseudoephedrine and observation
Answer and explanation in LearnFree account
Question 19 · Medium
During monopolar TURP under spinal anaesthesia, with 1.5% glycine irrigation, a 74-year-old man becomes restless and confused after 80 minutes. He complains of blurred vision, his pulse falls to 48/min, BP rises to 170/100 mmHg, and serum sodium is 119 mmol/L. What is the most likely diagnosis?
1. ATURP syndrome
2. BBladder perforation
3. CBacteraemic septic shock
4. DTotal spinal anaesthesia
Answer and explanation in LearnFree account
Question 20 · Easy
A 13-year-old boy is explored for left testicular torsion at a district hospital. The surgeon finds that the tunica vaginalis covers the testis and epididymis completely and attaches high on the cord, so the testis hangs free. What is this anomaly called?
1. APatent processus vaginalis
2. BHydatid of Morgagni
3. CBell-clapper deformity
4. DUndescended testis
Answer and explanation in LearnFree account
Question 21 · Medium
A 67-year-old man has prostate biopsies showing adenocarcinoma in which the most common pattern is Gleason 4 and the second most common is Gleason 3. What is his ISUP grade group?
1. AGrade group 2
2. BGrade group 1
3. CGrade group 4
4. DGrade group 3
Answer and explanation in LearnFree account
Question 22 · Easy
A 46-year-old woman with recurrent Proteus urinary infections has a large branched stone filling the renal pelvis and calyces of the right kidney. Her urine pH is 8.0, and microscopy shows 'coffin-lid' crystals. What is the stone made of?
1. ACalcium oxalate monohydrate
2. BMagnesium ammonium phosphate
3. CCystine
4. DUric acid
Answer and explanation in LearnFree account
Question 23 · Medium
A 63-year-old schoolteacher has a PSA of 9.4 ng/mL on two readings, and DRE shows a firm nodule in the left lobe. He has no bone pain and his urine is sterile. What is the most appropriate next step?
1. ARepeat PSA after a course of antibiotics
2. BRadical prostatectomy without a biopsy
3. CMultiparametric MRI of the prostate, then biopsy
4. DIsotope bone scan to look for metastases
Answer and explanation in LearnFree account
Question 24 · Medium
A 72-year-old man has prostate cancer with multiple osteoblastic metastases in the spine and pelvis and back pain, but no neurological deficit. Androgen deprivation with a depot LHRH agonist (goserelin) is planned. What should be started with or before the first injection?
1. AAn antiandrogen such as bicalutamide
2. BTamsulosin for urinary symptoms
3. CA 5-alpha reductase inhibitor
4. DOral prednisolone for 1 week
Answer and explanation in LearnFree account
Question 25 · Easy
A 32-year-old man is brought to casualty with sudden, severe, colicky left loin pain radiating to the groin, with vomiting. Urine shows red cells. He is not febrile and his creatinine is normal. Which investigation is the investigation of choice to confirm a ureteric stone?
1. AContrast-enhanced CT abdomen
2. BIntravenous urography
3. CNon-contrast CT KUB
4. DPlain X-ray KUB alone
Answer and explanation in LearnFree account

12 more Urolithiasis, BPH, urological cancers and emergencies questions

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Urolithiasis, BPH, urological cancers and emergencies

A 35-year-old man passes a small stone in his urine after an episode of renal colic and brings it to the urology OPD for analysis. Which stone composition is most likely?

A 56-year-old man has had painless haematuria and has noticed a swelling in the left side of the scrotum for 3 weeks. It feels like a bag of worms and does not empty when he lies down. Haemoglobin is 18.4 g/dL. What is the most appropriate investigation?

A 70-year-old man has taken finasteride for BPH for 2 years. His PSA at a health check is 2.8 ng/mL, and his family doctor wants to know how to interpret it for prostate cancer screening. What is the correct approach?

A 64-year-old man who has smoked bidis for 40 years has had two episodes of painless, total haematuria with clots. Urine culture is sterile. Which investigation is essential to diagnose a bladder tumour?

A 45-year-old man who worked for 15 years on irrigation projects in Egypt has painful haematuria. Cystoscopy shows a large tumour, and the biopsy reports keratinising squamous cell carcinoma. Urine microscopy from years ago showed eggs with a terminal spine. Which agent is linked with his cancer?

A 52-year-old man with tophaceous gout has right loin pain. Plain X-ray KUB shows no opacity, but non-contrast CT shows a 9 mm stone in the right renal pelvis. His urine pH is 5.0 and he has no infection. Which treatment can dissolve this stone?

A 66-year-old man has a hard, irregular nodule felt on digital rectal examination and a raised PSA. In which zone of the prostate does carcinoma most commonly arise?

A 40-year-old man in casualty is writhing with left ureteric colic. He has no history of peptic ulcer, his creatinine is normal and he is not pregnant or asthmatic. Which drug is preferred first-line for his pain?

During monopolar TURP under spinal anaesthesia, with 1.5% glycine irrigation, a 74-year-old man becomes restless and confused after 80 minutes. He complains of blurred vision, his pulse falls to 48/min, BP rises to 170/100 mmHg, and serum sodium is 119 mmol/L. What is the most likely diagnosis?

A 13-year-old boy is explored for left testicular torsion at a district hospital. The surgeon finds that the tunica vaginalis covers the testis and epididymis completely and attaches high on the cord, so the testis hangs free. What is this anomaly called?

A 67-year-old man has prostate biopsies showing adenocarcinoma in which the most common pattern is Gleason 4 and the second most common is Gleason 3. What is his ISUP grade group?

A 46-year-old woman with recurrent Proteus urinary infections has a large branched stone filling the renal pelvis and calyces of the right kidney. Her urine pH is 8.0, and microscopy shows 'coffin-lid' crystals. What is the stone made of?

A 63-year-old schoolteacher has a PSA of 9.4 ng/mL on two readings, and DRE shows a firm nodule in the left lobe. He has no bone pain and his urine is sterile. What is the most appropriate next step?

A 72-year-old man has prostate cancer with multiple osteoblastic metastases in the spine and pelvis and back pain, but no neurological deficit. Androgen deprivation with a depot LHRH agonist (goserelin) is planned. What should be started with or before the first injection?

A 32-year-old man is brought to casualty with sudden, severe, colicky left loin pain radiating to the groin, with vomiting. Urine shows red cells. He is not febrile and his creatinine is normal. Which investigation is the investigation of choice to confirm a ureteric stone?