Surgery1-Urology

A 65-year-old man presents with lower urinary tract symptoms. Digital rectal exam reveals a firm, nodular prostate. What is the most appropriate initial investigation?

A. PSA (Prostate-Specific Antigen) — PSA is the first-line investigation when prostate cancer is suspected based on DRE findings.

Which of the following is the most common type of renal stone?

D. Calcium oxalate — Calcium oxalate stones account for ~80% of all renal stones.

Which urological condition is most likely to cause a painless testicular mass in a 25-year-old male?

C. Testicular cancer — Painless testicular mass in a young male is testicular cancer until proven otherwise.

What is the most appropriate management of acute testicular torsion in a 16-year-old boy?

C. Emergent surgical exploration — Testicular torsion is a surgical emergency; time to detorsion determines viability.

Which of the following is the most common organism causing uncomplicated urinary tract infections in women?

D. Escherichia coli — E. coli causes ~80–85% of uncomplicated UTIs in women.

What is the first-line treatment for benign prostatic hyperplasia (BPH)?

A. Alpha-blockers — Alpha-blockers (e.g., tamsulosin) provide rapid symptom relief and are first-line for BPH.

What is the most common congenital anomaly of the urinary tract?

B. Vesicoureteral reflux — VUR is the most common congenital urinary tract anomaly.

Which of the following is a known risk factor for bladder cancer?

B. Cigarette smoking — Smoking is the #1 risk factor for bladder cancer, responsible for ~50% of cases.

In Peyronie's disease, which structure is most commonly affected?

C. Tunica albuginea — Peyronie's disease involves fibrotic plaque formation in the tunica albuginea of the penis.

Which of the following tumor markers is most commonly elevated in non-seminomatous testicular germ cell tumors?

B. AFP (Alpha-fetoprotein) — AFP is elevated in non-seminomatous GCTs (e.g., yolk sac tumor, embryonal carcinoma).

Which imaging modality is most sensitive for detecting renal stones?

C. CT without contrast — Non-contrast CT (NCCT) has ~98% sensitivity for renal stones and is the gold standard.

Which of the following is a clinical feature of nephrotic syndrome?

C. Proteinuria >3.5 g/day — Nephrotic syndrome is defined by massive proteinuria (>3.5 g/day), hypoalbuminemia, and edema.

What is the most common cause of acute scrotal pain in adolescents?

B. Testicular torsion — Testicular torsion is the most common cause of acute scrotal pain in adolescents.

A 60-year-old man has gross hematuria. What is the most important initial investigation?

B. Cystoscopy — Cystoscopy is the most important investigation for gross hematuria to rule out bladder cancer.

What is the most common histologic type of prostate cancer?

C. Adenocarcinoma — Over 95% of prostate cancers are adenocarcinomas arising from prostatic acini.

In a renal transplant patient, which immunosuppressive drug is associated with gum hypertrophy?

D. Cyclosporine — Cyclosporine (calcineurin inhibitor) is classically associated with gingival hyperplasia.

A ureteric stone is most likely to get lodged at which location?

D. Ureterovesical junction — The UVJ is the narrowest part of the ureter and the most common site of stone impaction.

Which test is used to assess bladder function and compliance?

B. Urodynamic study — Urodynamics measures bladder pressure, volume, and flow to assess function and compliance.

What is the classic triad of renal cell carcinoma?

B. Hematuria, flank pain, abdominal mass — This classic triad occurs in ~10% of RCC patients and indicates advanced disease.

Which of the following is associated with painless hematuria in a smoker?

C. Bladder cancer — Painless hematuria in a smoker is bladder cancer until proven otherwise.

What is the most common cause of scrotal swelling in newborns?

A. Hydrocele — Communicating hydrocele is the most common cause of scrotal swelling in newborns due to patent processus vaginalis.

Which organism is most associated with struvite stones?

C. Proteus mirabilis — Proteus mirabilis is a urease-producing organism that alkalinizes urine and forms struvite (infection) stones.

What is the first-line treatment for uncomplicated UTI in women?

B. Nitrofurantoin — Nitrofurantoin (or trimethoprim-sulfamethoxazole) is the first-line antibiotic for uncomplicated UTI.

A varicocele is more commonly found on which side?

B. Left — Left-sided varicocele is more common because the left testicular vein drains at a right angle into the left renal vein.

What is the treatment of choice for high-grade non-muscle invasive bladder cancer?

C. Intravesical BCG — BCG immunotherapy is the standard treatment after TURBT for high-grade non-muscle invasive bladder cancer.

What is the most appropriate next step in a child with posterior urethral valves?

D. Cystoscopy and ablation — After initial stabilization and VCUG diagnosis, cystoscopic valve ablation is the definitive treatment.

Which tumor marker is specific for seminoma?

D. None – no specific marker — Seminomas may elevate LDH or hCG mildly, but AFP is NOT elevated; there is no truly specific marker.

What is the most common site of metastasis in prostate cancer?

C. Bones — Prostate cancer preferentially metastasizes to bone (osteoblastic lesions), especially the lumbar spine and pelvis.

Which grade in Gleason scoring indicates poorly differentiated tumor?

D. Grade 5 — Gleason grade 5 represents the most poorly differentiated, anaplastic pattern with no glandular formation.

A man has a painless, transilluminating scrotal swelling. Likely diagnosis?

B. Hydrocele — A scrotal swelling that transilluminates (light passes through) is consistent with a fluid-filled hydrocele.

The gold standard investigation for vesicoureteral reflux is:

C. Voiding cystourethrogram (VCUG) — VCUG is the gold standard for diagnosing and grading vesicoureteral reflux.

Which condition shows a 'bag of worms' appearance on physical exam?

D. Varicocele — Dilated, tortuous veins of the pampiniform plexus in a varicocele feel like a bag of worms.

Priapism is most commonly associated with:

C. Sickle cell disease — Sickle cell disease causes vaso-occlusion in penile vasculature, leading to ischemic priapism.

The most common type of testicular cancer is:

B. Seminoma — Seminoma is the most common testicular germ cell tumor, typically in men aged 25–45.

A 5-year-old boy has enuresis. What is the most likely cause?

C. Delayed bladder maturation — Primary nocturnal enuresis in children is most commonly due to delayed maturation of bladder control.

Which antibiotic is best avoided in pyelonephritis due to poor tissue penetration?

C. Nitrofurantoin — Nitrofurantoin achieves urine but NOT adequate renal tissue concentrations, making it unsuitable for pyelonephritis.

The normal bladder capacity in adults is approximately:

C. 300–500 mL — Normal adult functional bladder capacity is 300–500 mL; first urge to void occurs around 150–200 mL.

What is the most common cause of obstructive uropathy in elderly men?

B. BPH — Benign prostatic hyperplasia is the most common cause of bladder outlet obstruction and obstructive uropathy in elderly men.

Bell-clapper deformity predisposes to which condition?

C. Testicular torsion — Bell-clapper deformity (high attachment of tunica vaginalis) allows the testis to rotate freely, predisposing to torsion.

Which of the following increases risk for penile cancer?

B. Poor hygiene — Poor hygiene (associated with phimosis and smegma accumulation) is a known risk factor for penile cancer.