NEET-SS Urology

presents
National-level Free
MOCK EXAM on
NEET-SS:
Urology
DISCLAIMER: The questions here
have been created by experts in
line with exam patterns and the
syllabus. Questions from previous
NEET-SS exams have not been
reproduced here.
NEET-SS Urology
Part A
1. Metabolic response to injury consists of Ebb and Flow phases. Ebb phase lasts for about?
A. 0-6 hrs
B. 6-12 hrs
C. 12-24 hrs
D. 24-48 hrs
D. 24 - 48 hrs
The Ebb phase lasts for 24-48 hours. The catabolic part flow phase lasts for 3 to 10 days. The
anabolic phase or recovery phase lasts for weeks.
Ref: Bailey & Love's Short Practice of Surgery, 27th Edition, Chapter 1
2. Which of the following is true regarding shock?
A.Metabolic acidosis, respiratory acidosis

B.Metabolic alkalosis, respiratory acidosis
C.Metabolic acidosis, respiratory alkalosis
D.Metabolic alkalosis, respiratory alkalosis
C. Metabolic acidosis, respiratory alkalosis
The metabolic acidosis and increased sympathetic response in shock result in an increased respiratory
rate and minute ventilation to increase the excretion of carbon dioxide (and so produce a
compensatory respiratory alkalosis).
3. Mr Rajamannar had a pressure sore with loss of epidermis and a part of dermis. What stage is the
bedsore?
A.1
B.2
C.3
D.4
B.2
STAGING - PRESSURE SORES

Stage 1: Non-blanchable erythema without a breach in the epidermis
Stage 2: Partial-thickness skin loss involving the epidermis and dermis
Stage 3: Full-thickness skin loss extending into the subcutaneous tissue but not through underlying
fascia
Stage 4: Full-thickness skin loss through fascia with extensive tissue destruction, maybe involving
muscle, bone, tendon or joint.
4. Dr Prakash Natarajan is working on induced pluripotent stem cells(iPSCs) in a lab at Cambridge

University. He is posing some questions for you. Which statement is not true?
A.Re-programming factors such as NANOG and LIN28 are required to induce differentiation
B.They are inherently safe as there is no risk of oncogenic activation
C.iPSCs proliferate in vitro as efficiently as ESCs and are pluripotent
D.They were developed in 2006 by Dr Shinya Yamanaka
B. They are inherently safe as there is no risk of oncogenic activation
Induced PSCs were developed in 2006 by Dr Shinya Yamanaka based on earlier work by Dr John
Gordon. Retroviral or lentiviral transfection is used to introduce a combination of transcription factors
(OCT3/4, SOX2, and either Kruppel-like factor and C-MYC (together designated the OSKM
reprogramming factors) or NANOG and LIN28), it was shown that specialised somatic cells can be
reprogrammed to become stem cells.
Moreover, iPSCs proliferate in vitro as efficiently as ESCs and are pluripotent, thereby circumventing
concerns about the use of human embryos. Reprogramming somatic cells to become iPSCs using
retroviruses is that genomic integration of the virus may lead to activation of oncogenic genes,
causing tumorigenesis. To reduce this risk, non-retroviral vectors have been used (such as
adenovirus and Sandai virus vectors, that do not insert their own genes into the host cell genome), or
plasmids, episomal vectors and synthetic RNA.
5. Not true regarding non-surgical management of Mycetoma is
A. Actinomycetoma is treated with Amikacin and Co-Trimoxazole

B. Eumycetoma is managed with Ketoconazole
C. Adequate surgery will eliminate the need for continuing medical treatment
D. Antifungals are not curative of mycetoma but are nonetheless used
C. Adequate surgery will eliminate the need for continuing medical treatment
In actinomycetoma, cyclical, combined drug therapy with amikacin sulphate and co-trimoxazole is the
treatment of choice. In eumycetoma, ketoconazole, itraconazole and voriconazole are the drugs of
choice. They may need to be used for up to a year. Use of these drugs should be closely monitored for
side effects. While not curative, these drugs help to localise the disease by forming thickly
encapsulated lesions which are then amenable to surgical excision.
Postoperative medical treatment should continue for an adequate period to prevent recurrence.
This can be local or distant to regional lymph nodes. Recurrence is usually due to inadequate surgical
excision, use of local anaesthesia, lack of surgical experience, non-compliance with drugs.
6. Polydioxanone (PDS) is a suture that is commonly used for abdominal closure. It is completely
absorbed in
A. 90 days
B. 180 days
C. Never completely absorbed
D. Non-absorbable
B. 180 days
Polydioxanone (PDS)
● Monofilament polyester polymer

● Tensile strength: 70% at 2 weeks, 50% at 4 weeks and 14% at 8 weeks
● Absorption: Completely absorbed in 180 days
● Ideally used in abdominal closure or where absorbable sutures are needed for a longer time.
7. Which one of these is true about cancer growth with respect to the Gompertzian growth pattern?
A. Post diagnostic tumours are most susceptible to antiproliferative drugs

B. Norton-Simon hypothesis is supported by this patten
C. A period of rapid growth is followed by a quick decline
D. Systemic spread of a cancer begins late, often after diagnosis
B. Norton-Simon hypothesis is supported by this patten
Gompertzian growth: In its early stages, growth is exponential but, as the tumour grows, the growth
rate slows.
● The majority of the growth of a tumour occurs before it is clinically detectable
● By the time they are detected, tumours have passed the period of most rapid growth, that period
when they might be most sensitive to antiproliferative drugs
● There has been plenty of time, before diagnosis, for individual cells to detach, invade, implant, and
form distant metastases. In many patients cancer may, at the time of presentation, be a systemic
disease
● ‘Early tumours’ are genetically old, yielding many opportunities for mutations to occur, mutations
that might confer spontaneous drug resistance (a probability greatly increased by the existence of cell
loss)
● The rate of regression of a tumour will depend upon its age (the Norton–Simon hypothesis extends
this: chemotherapy results in a rate of regression in tumour volume that is proportional to the rate of
growth for an unperturbed tumour of that size)
8. A bacterium can divide every 20 minutes. Beginning with a single individual, how many bacteria
will be there in the population if there is exponential growth for 3 hours?
A. 18
B. 440
C. 512
D. 1024
C. 512.
A bacterium can divide every 20 minutes. In 3 hours there will be 9 divisions. Thus we will have 29
bacteria in 3 hours, which is equal to 512.
9. Rejecting a null hypothesis when it is true is called as:
A. Type 1 error
B. Type 2 error
C. Type 3 error
D. Type 4 error
A. Type 1 error
Null hypothesis - Statement opposite to hypothesis.

10. With regards to the WHO surgical safety checklist, sign in is done
A. Before skin incision

B. Before induction of anaesthesia
C. Before patient leaves operating room
D. When patient enters operating room
B. Before induction of anaesthesia
Sign in - Before Induction of anaesthesia

Time out - Before skin incision
Sign out – Before patient leaves operating room
11. Narrow band imaging (NBI) is useful in visualising various fine structures during endoscopy.
Which of the following is false?
A. Blue light at 415 nm displays superficial capillary networks

B. Green light at 540 nm displays sub epithelial vessels
C. Indigo carmine is a stain used to enhance diagnostic yield in NBI
D. NBI offers high contrast image of tissue surface
C. Indigo carmine is a stain used to enhance diagnostic yield in NBI
NBI uses two discrete bands of light: blue at 415 nm and green at 540 nm. Narrow band blue light
displays superficial capillary networks, whereas green light displays subepithelial vessels; when
combined, they offer an extremely high contrast image of the tissue surface. Indigo carmine is not
used in NBI. It is used in chromo-endoscopy.
12. MRI abdomen was performed in a patient with ascites. In T2 phase ascitic fluid appears
A. White
B. Black
C. None
D. Both, depending on the case
A. White
Remember World War 2 = WW2. Water appears white in the T2 phase.

The image characteristic and signal intensity from different tissues are governed by the pulse
sequence employed and whether it is T1-weighted or T2-weighted. For instance, fat, methaemoglobin
and mucinous fluid are bright on T1-weighted images, whereas, water and thus most pathological
processes, which tend to increase tissue water content, are bright on T2-weighted images. Cortical
bone, air, hemosiderin and ferromagnetic materials are of very low signal on all pulse sequences. In
general, T1-weighted images are superior in the delineation of anatomy, while T2-weighted images
tend to highlight pathology better.
Ref: Bailey & Love's Short

Practice of Surgery, 27th
Edition, Chapter 14
13. Which of the following special stain and tissue combinations is incorrect?
A. Reticulin: iron
B. Van Gieson: collagen
C. Congo red: amyloid
D. Ziehl-Neelsen: mycobacteria
A. Reticulin: iron
Common special stains

● PAS: glycogen, fungi
● D-PAS: mucin
● Perls’ Prussian blue: iron
● Reticulin: reticulin fibres, fibrosis
● Van Gieson: collagen
● Congo red: amyloid
● Ziehl-Neelsen: mycobacteria
14. Airway assessment is done with modified Mallampati testing. On assessment of the patient
planned for elective Modified radical mastectomy, only hard palate was seen. What is the modified
Mallampati grade?
A. Grade 1
B. Grade 2
C. Grade 3
D. Grade 4
D. Grade 4
15. Which of the following is a non-depolarizing muscle relaxant?
A. Suxamethonium
B. Rocuronium
C. Decamethonium
D. Di-acetylcholine
B. Rocuronium
Muscle relaxants are categorized into depolarizing and nondepolarizing agents. Suxamethonium (prev
called Di-acetylcholine) is the most common depolarizing agent despite its adverse effects (eg.
Hyperkalemia, myalgia, anaphylaxis, malignant hyperthermia) because of quick onset and short
duration of action. Non-depolarizing agents provide longer, predictable activity but require careful
monitoring, appropriate timing and action reversal. Eg. Rocuronium, Pancuronium, Atracurium.
Decamethonium is an obsolete agent (depolarizing blocker).
16. Malnutrition universal screening tool (MUST). What score do you treat?
A. >3
B. 2 or >2
C. 1 or >1
D. >4
B. 2 or >2
Risk of undernutrition is high when the score is 2 or above. It certainly requires treatment.
17. Which of the following is a classical feature of metabolic response seen in trauma and sepsis
which differentiates it from starvation by?
A. Hepatic glycogenolysis
B. High plasma glucagon levels
C. Loss of adaptive ketogenesis
D. Lipid oxidation
C. Loss of adaptive ketogenesis
Metabolic changes in starvation are often similar to changes in trauma and sepsis. Adaptive
ketogenesis doesn’t however occur in trauma and sepsis
Metabolic response to trauma and sepsis

o Increased counter-regulatory hormones: adrenaline, noradrenaline, cortisol, glucagon
and growth hormone
o Increased energy requirements (up to 40 kcal/kg per day)
o Increased nitrogen requirements
o Insulin resistance and glucose intolerance
o Preferential oxidation of lipids
o Increased gluconeogenesis and protein catabolism
o Loss of adaptive ketogenesis
o Fluid retention with associated hypoalbuminemia
18. Which of the following is not true about flail chest?
A. It is a clinical diagnosis
B. CT with contrast and 3D reconstruction of chest wall is the gold standard for diagnosis
C. Best treatment is with mechanical ventilation to splint the ribs
D. Surgery is useful in case of underlying pulmonary contusion
C. Best treatment is with mechanical ventilation to splint the ribs
The diagnosis is made clinically in patients who are not ventilated, not by radiography. To confirm
the diagnosis the chest wall can be observed for paradoxical motion of a chest wall segment. The CT
scan, with contrast to display the vascular structures and a 3-D reconstruction of the chest wall, is the
gold standard for diagnosis of this condition. Traditionally, mechanical ventilation was used to
‘internally splint’ the chest, but had a price in terms of intensive care unit resources and ventilation-
dependent morbidity.
Currently, treatment consists of oxygen administration, adequate analgesia (including opiates) and
physiotherapy. If a chest tube is in situ, topical intrapleural local analgesia introduced via the tube, can
also be used. Ventilation is reserved for cases developing respiratory failure despite adequate
analgesia and oxygen. Surgery to stabilise the flail segment using internal fixation of the ribs may be
useful in a selected group of patients with isolated or severe chest injury and pulmonary contusion.
Ref: Bailey & Love's Short Practice of Surgery, 27th Edition, Chapter 27 
19. Which of the following is a principle of Damage Control Resuscitation (DCR) ?
A. Should be initiated after DCS

B. Use of crystalloid with haemostatic resuscitation
C. Permissive hypotension
D. Both A & C
C. Permissive hypotension
Damage control resuscitation (DCR) should be concurrent with DCS. The principles of DCR include
permissive hypotension, avoidance of crystalloid with haemostatic resuscitation, and recognition and
management of acute traumatic coagulopathy.
20. Which of the following treatment strategies in the treatment of trench foot is not correct?
A. TPA
B. NSAIDS
C. Rapid rewarming
D. Nerve blocks
C. Rapid rewarming
In Immersion injuries, treatment should focus on:
● Gentle warming (Rapid rewarming can lead to burns)
● NSAIDs
● Rehydration with warm fluids
● Surgery only after demarcation occurs naturally
● Protect against further trauma and infection
● Recent developments, such as the use of tissue plasminogen activator (TPA) and nerve blocks,
show promising results in reducing amputations, but have to be started within 24 hours.
21. Which of the following statements is not true about the use of tranexamic acid in trauma?
A. Useful only when given within 24 hrs of injury

B. Given in all trauma patients with systolic BP <110 mm Hg
C. Tranexamic acid reduces mortality after trauma
D. Useful in both blunt and penetrating trauma
A. Useful only when given within 24 hrs of injury
It is useful only when given within 3 hours of injury.

Tranexamic acid is an antifibrinolytic drug that reduces the risk of mortality from bleeding in both
blunt and penetrating trauma. One gram is given intravenously over 10 minutes, followed by a further
1g dose over 8 hours. Tranexamic acid should be given to all trauma patients suspected to have
significant haemorrhage, including those with a systolic blood pressure of <110 mmHg or a pulse of
over 110 per minute.
22. 70 yr old Mr Varadarajan suffered an head injury 6 months ago. His neuro-rehabilitation specialist
termed his Glasgow outcome score as 4. He has:
A. Good recovery
B. Moderate disability
C. Severe disability
D. Persistent vegetative state
B. Moderate disability
A Glasgow outcome score of 4 signifies moderate disability.

23. A TOTAL trial was started in leading European Pediatric surgery centres as a means to managing
which Pediatric surgical condition?
A. Duodenal atresia
B. Congenital diaphragmatic hernia
C. Undescended testis
D. Bronchopulmonary malformations
The Tracheal Occlusion To Accelerate Lung growth (TOTAL) trial is led by several European centers
as a means to treat CDH. It has not yet been approved by the FDA. Occlusion of trachea leads to
accumulation of lung fluid which stimulates lung growth.
Ref: Sabiston Textbook of Surgery, 20th edition, Chapter 66
24. A paediatric tertiary care hospital in Cochin is planning to purchase a Extracorporeal membrane
oxygenator. Which among the following is the most common indication for ECMO?
A. Meconium aspiration
C. Respiratory distress syndrome
D. Sepsis
A. Meconium aspiration
Meconium aspiration is the most common application for neonatal ECMO with the highest survival
rate (>90%) among all conditions. Other indications include respiratory distress syndrome, PPHN,
sepsis, and congenital diaphragmatic hernia.

25. Which of the following statements is not true about Purpura fulminans?
A. Neonatal form is the most common

B. Protein C deficiency is seen
C. Hard eschars are formed
D. Causes hemorrhagic infarctions
A. Neonatal form is the most common
Purpura fulminans is a rare condition in which intravascular thrombosis produces rapid skin necrosis
and hemorrhagic infarction, which progresses rapidly to septic shock and disseminated intravascular
coagulation. It may be subdivided into three types based on etiology - acute infectious, neonatal and
idiopathic purpura fulminans.
Acute infectious is the commonest form. It is most common in children under 7 years of age,
following an upper respiratory tract, infection, or in asplenia. Endotoxins produce an imbalance in
procoagulant and anticoagulant endothelial activity, producing protein C deficiency. This gives the
clinical picture of an initial petechial rash developing into confluent ecchymoses and hemorrhagic
bullae, which necrose to form well demarcated lesions that form hard eschars. Extensive tissue loss is
common.
26. Muir and Barclay formula is often used to calculate the colloid requirement in patients with burns.
Which of the following is accurate regarding the volume of one portion of colloid to be given in a
specific time period?
A. 0.5 x TBSA x weight of patient

B. 5.6 x TBSA x weight of patient
C. 3 x {TBSA of 2nd degree burn/2 + TBSA of 3rd degree burn} x weight of patient
D. O.25 x {TBSA of 2nd and 3rd degree burn} x weight of patient
A. 0.5 x TBSA x weight of patient
The most common colloid-based formula is the Muir and Barclay formula:
● 0.5 × percentage body surface area burnt × weight = one portion

● periods of 4/4/4, 6/6 and 12 hours, respectively
● one portion to be given in each period
Plasma proteins are responsible for the inward oncotic pressure that counteracts the outward capillary
hydrostatic pressure. Without proteins, plasma volumes would not be maintained as there would be
oedema. Proteins should be given after the first 12 hours of burn because, before this time, the
massive fluid shifts cause proteins to leak out of the cells
27. Which of the following statements regarding grafts are true?
A. Imbibition is not a process associated with survival of split-skin grafts in the first 48 hours.
B. Gentle handling and the best postoperative care play only a minor role to ensure the successful
take of a full-thickness graft.
C. Grafts will take on exposed tendons and cortical bone.
D. Contraction occurs in all grafts used in tissue repair but is dependent on the amount of dermis
taken with the graft.
D. Contraction occurs in all grafts used in tissue repair but is dependent on the amount of
dermis taken with the graft
Imbibition is the means whereby a split-skin graft is nourished during the first 48 hours of life in its
recipient site. Gentle handling is important to create the best conditions for taking a full-thickness
graft. Grafts do not take on bare tendon or cortical bone, because these do not produce granulations or
vascular support. Graft contraction depends on the amount of dermis in the graft and is thus greatest
in split-skin grafts and least in full-thickness grafts. More the dermis, lesser the contraction.
28. Which among the following is an indication of combined liver & lung transplant?
A. Cystic fibrosis
B. Amyloidosis
C. Hyperoxalosis
D. None
A. Cystic fibrosis
Sequential bilateral single lung-liver transplantation (SBSL-LTx) is a therapeutic option for patients
with end stage lung and liver disease (ESLLD) due to cystic fibrosis (CF).
29. A 49 year old woman, Raveena Bhat, with end stage renal failure undergoes a cadaveric renal
transplant. However, after reviewing the patient after 4 months she presented with oliguria and right
lower leg edema. What is the probable etiology?
A. Lymphocele
B. Acute rejection
C. Renal vein thrombosis
D. CNI toxicity
A. Lymphocele
Lymphocele is a fluid collection between the renal graft and the urinary bladder. It is an uncommon
complication (0.6% to 18%) following renal transplantation. The development of lymphocele has
been ascribed to inadequate ligation of the afferent lymphatics coursing over the recipient iliac vessels
or located within the allograft hilum. Many collections remain subclinical. In fact, up to 50% of
patients may show a small collection on ultrasound scanning after renal transplantation and most of
them resolve spontaneously. Large collections may present clinically by deterioration of renal graft
function or as a painless ipsilateral lower limb edema, at 2 weeks to 6 months after transplantation.
Ultrasound is the key to diagnosis, but other radiological procedures such as the isotope renal
scanning, computed tomography, intravenous urography and magnetic resonance imaging might be
necessary in complicated cases. Prevention by careful ligation of lymphatics during the dissection of
iliac vessels is better than intervention later for cure.
30. The transplant team at Pittsburgh was discussing NODAT in a few patients after a series of Liver
transplants. NODAT is a complication of
A. Ciclosporin
B. Tacrolimus
C. Azathioprine
D. Rituximab
B. Tacrolimus
New Onset Diabetes After Transplant (NODAT a common and serious complication after solid organ
transplantation. NODAT is more common with Tacrolimus. It decreases the insulin release and
increases beta cell toxicity. Kidney transplant recipients who develop NODAT have variably been
reported to be at increased risk of fatal and nonfatal cardiovascular events and other adverse outcomes
including infection, reduced patient survival, graft rejection, and accelerated graft loss compared with
those who do not develop diabetes.
31. Ravi Rajkumar, a famous film director was diagnosed with leukaemia. He was treated at a
renowned hemato oncology centre in Chennai. He was diagnosed with renal stones within a few
weeks of his treatment. What is the most probable stone?
A. Cysteine
B. Uric acid
C. Calcium phosphate
D. Calcium oxalate
B. Uric acid
Uric acid (10% of all stones)
● Uric acid is a product of purine metabolism

● May precipitate when urinary pH low
● May be caused by diseases with extensive tissue breakdown e.g. malignancy as in leukemia
● More common in children with inborn errors of metabolism
● Radiolucent stone
32. A 40 year old male Raghavan Gunda presented with complaints of penile deformity and pain on
erection causing difficulty in intercourse. True regarding the management is
A. Immediate Nesbitt procedure to correct deformity.

B. Wait for 18-24 months for stabilisation of disease
C. Sildenafil causes pain in acute phase
D. Injection of collagenase can prevent disease from getting into chronic phase
B. Wait for 18-24 months for stabilisation of disease
The man suffers from Peyronie’s disease. The cause is not clearly known - probably involves minor
injury to the erect penis with secondary microhemorrhage beneath the tunica albuginea and secondary
fibrosis resulting in classic dorsal deformity.
During the active phase (18-24 months) medical treatment has little efficacy. After the disease
stabilises, surgery is indicated to correct deformity only when it interferes with sexual intercourse.
Nesbitt procedure is the name of the surgical procedure to treat Peyronie’s disease. Injection of
collagenase is a newer modality of treatment also to be used only in chronic phase.
33. Identify the image
A. Urinary catheter
B. Varicel catheter
C. Epistaxis catheter
D. None
C. Epistaxis catheter
Anterior bleeding from Kiesselbach’s plexus may be controlled by silver nitrate cautery under local
anaesthesia. Even in more posterior epistaxis, the bleeding point can often be Vaseline-impregnated
ribbon gauze or a non-absorbable sponge. There are also many haemostatic, absorbable materials that
can be used to pack the nose to help control bleeding. An alternative to anterior packing is the use of
an inflatable epistaxis balloon catheter. The catheter is passed into the nose and the distal balloon is
inflated in the nasopharynx to secure it. The proximal balloon, which is sausage shaped, is then
inflated within the nasal fossa to compress the bleeding point. Although usually effective, they can be
uncomfortable.
34. 12 years after undergoing left modified radical mastectomy, a 70-year-old woman develops raised
red subcutaneous nodules over the left arm. What is the most likely diagnosis?
A. Lymphangitis
B. Lymphedema tarda
C. Lymphangiosarcoma
D. Metastatic breast cancer
C. Lymphangiosarcoma
It is a rare tumor that develops as a complication of long-standing (usually more than 10 years)
lymphedema, most frequently described in a patient who has previously undergone radical
mastectomy (Stewart-Treves syndrome). Clinically, patients present with acute worsening of the
edema and appearance of subcutaneous nodules that have a propensity toward hemorrhage and
ulceration. The tumor can be treated, as other sarcomas, with preoperative chemotherapy and radiation
followed by surgical excision, which usually takes the form of radical amputation. Overall, the tumor
has a poor prognosis.
35. Superficial vein reflux is effectively demonstrated by Doppler scans. Superficial or crural vein
reflux is defined as retrograde flow in the reverse direction to physiological flow which lasts for ___
seconds or more.
A. 2
B. 1
C. 0.5
D. 0.25
C. 0.5
Superficial or crural vein reflux is defined as retrograde flow in the reverse direction to physiological
flow lasting for 0.5 seconds or more. The proximal deep veins require a duration of 1 second or more
to be classified as incompetent.
36. Strawberry gallbladder is seen in
A. Mirizzi syndrome
B. Porcelain gallbladder
C. Cholesterosis
D. Diverticulosis of gallbladder
C. Cholesterosis
Strawberry gallbladder is seen in cholesterosis. It is characterised by submucous aggregations of

cholesterol crystals and cholesterol esters.
37. An ill male infant presents with vomiting and diarrhoea. Na is 128mmol/L, K is 5.5 mmol/L,
blood glucose is 126mg/dL and cortisol is 50 nmol/L. Which of the following is false about this
condition?
A. Autosomal Recessive
B. Inadequate ACTH seen
C. Can present with short stature and hypertension.
D. 21 Hydroxylase deficiency is a common cause.
B. Inadequate ACTH seen
The child has congenital adrenal hyperplasia which presents with virilization and adrenal
insufficiency in children. Most commonly, it is due to a defect in 21-hydroxylase. Low cortisol leads
to excessive ACTH secretion and an increase in androgen precursors. Hypertension and short stature
are common signs. Affected patients are treated by cortisol and fludrocortisone.
38. Calcification uraemic arteriolopathy (Calciphylaxis) is associated with reduction in levels of
which is named calcification inhibitory protein ?
A. α-2 vlad glycation protein

B. α-2-Heremans–Schmid glycoprotein
C. Calcicardin associated protein
D. Anti-parafibromin
B. α-2-Heremans–Schmid glycoprotein
The underlying aetiology of calcific uraemic arteriolopathy (Calciphylaxis) remains unclear but a
number of potential factors have been postulated. A reduction in the serum levels of a calcification
inhibitory protein, α-2-Heremans–Schmid glycoprotein, and abnormalities in smooth muscle cell
biology in uraemic patients may play a role in the development of the syndrome.
39. Which is true regarding the etiology of proximal gastric cancer?
A. Epstein-Barr virus is associated with proximal gastric cancer

B. Obesity is never associated with proximal gastric tumours
C. Smoking is usually implicated only in distal gastric cancers
D. Diffuse gastric cancers in proximal stomach are seen in thin malnourished men
A. Epstein-Barr virus is associated with proximal gastric cancer
Epstein–Barr virus infection is associated with a specific form of gastric adenocarcinoma, one that is
more prevalent in Hispanics and non-Hispanic whites compared to Asians, more often in the cardia
and body, and more often diffuse type. Obesity is associated with proximal gastric cancers. Cigarette
smokers have a two to three times increased risk of proximal gastric cancer. Diffuse-type tumors are
more common in younger patients with no history of gastritis and spread transmurally and by
lymphatic invasion. Diffuse-type tumors appear to be associated with obesity.
Ref: MD Anderson, Surgical Oncology Handbook, 6th edition, Chapter 9
40. Dr Rajan Sivakumar, consultant paediatric surgeon has a few questions for you. He was planning
a Nuss procedure on a young boy Nuss procedure is used for the correction of
A. Cervical rib
B. Depressed sternum
C. Scapular deformity
D. Spine deformity
B. Depressed sternum
Pectus excavatum
The sternum is depressed, with a dish-shaped deformity of the anterior portions of the ribs on one or
both sides. It is never a cause of respiratory problems. It can be repaired to improve its cosmetic
appearance either as an open procedure (the Ravitch procedure) which involves resecting the affected
costal cartilages and mobilising the sternum, or as a minimally invasive technique, the Nuss
procedure. A metal bar is placed behind the sternum to hold this central panel in its new position and
has to be removed after a period of time.
Part B
1. Which among the following is true statement about urine analysis
A. Glucose will be detected in urine when serum glucose > 150mg/dl

B. Nitrites are not commonly seen in urine
C. Urine pH is alkaline in patients with uric acid calculi
D. Most common cause of cloudy urine is pyuria
Ans B. Nitrites are not commonly seen in urine
Nitrites are not normally found in the urine, but many species of gram-negative bacteria can convert
nitrates to nitrites. Renal threshold corresponds to serum glucose of about 180 mg/ dL; above this
level, glucose will be detected in the urine. Urinary pH is usually acidic in patients with uric acid and
cystine lithiasis. Alkalinization of the urine is an important feature of therapy in both of these
conditions.
Freshly voided urine is clear. Cloudy urine is most commonly due to phosphaturia, a benign process
in which excess phosphate crystals precipitate in an alkaline urine. Pyuria, usually associated with a
UTI, is another common cause of cloudy urine. The large numbers of white blood cells cause the
urine to become turbid. Pyuria is readily distinguished from phosphaturia either by smelling the urine
(infected urine has a characteristic pungent odor) or by microscopic examination, which readily
distinguishes amorphous phosphate crystals.
Ref: Campbell Walsh Wein Urology, 12th edition, Chapter 2
2. For a patient with horseshoe kidney, percutaneous access is best attained via
A. Superior pole
B. Inferior pole
C. Anterior aspect
D. Posterior aspect
Ans A. Superior pole
The anterior posterior tilt of horseshoe kidney is prominent, which makes the upper pole the
most superficial and posterior aspect of the horseshoe kidney. In addition, the upper pole is usually
inferior to the ribs. Upper pole access is useful in horseshoe kidneys because this is the easiest calyx
to enter, the puncture rarely needs to be supracostal, and it provides excellent access to most of the
kidney and the ureter owing to the alignment of the long axis of the moiety.
3. During percutaneous access to which of the following poles is colon injury risk the greatest?
A. Right lower pole

B. Right upper pole
C. Left upper pole
D. Left lower pole
Ans D. Left lower pole
Colon injury occurs during percutaneous renal surgery in the prone position at a rate of less than 1%.
With the apposition of the colon to the kidney being greatest on the left side and at the lower pole, the
left colon is injured twice as often as the right colon, and the majority of colon injuries involve access
to the lower pole. Additional risk factors include advanced patient age, dilated colon, previous colon
surgery or disease, thin body habitus, and the presence of a horseshoe kidney.
4. A 45 year old man with microscopic hematuria is referred to the Urology clinic. The following is
not a common association with microscopic hematuria
A. Age > 35 years

B. Obstructive urinary symptoms
C. Analgesic abuse
D. History of urinary tract disorders
Ans B. Obstructive urinary symptoms

Ref:
Campbell Walsh Wein Urology, 12th edition, Chapter 16
5. In a patient with asymptomatic micro hematuria the following is not recommended
A. Do white light cystoscopy if he is 40 years

B. CT urogram is preferred imaging modality
C. Urine cytology needs to be sent if he is 40 years
D. Upper tract imaging is essential in all patients
Ans C. Urine cytology needs to be sent if he is 40 years

6. Mucosal stripping is a complication of which of the following lithotripters?
A. Electro hydraulic
B. Ultrasonic
C. Ballistic
D. Laser
Ans B. Ultrasonic
7. Michaelis - Gutmann bodies are seen in
A. Malakoplakia
B. Xanthogranulomatous pyelonephritis
C. Renal echinococcosis
D. Perinephric abscess
Ans A. Malakoplakia
Malakoplakia, from the Greek word meaning “soft plaque,” is an unusual inflammatory disease that
was originally described to affect the bladder but has been found to affect the genitourinary and
gastrointestinal tracts, skin, lungs, bones, and mesenteric lymph nodes. It is an inflammatory lesion
described originally by Michaelis and Gutmann (1902). It was characterized by von Hansemann
(1903) as soft, yellow-brown plaques with granulomatous lesions in which the histiocytes contain
distinct basophilic lysosomal inclusion bodies or Michaelis-Gutmann bodies. Although its exact
pathogenesis is unknown, malakoplakia probably results from abnormal macrophage function in
response to a bacterial infection, which is most often E. coli.
8. The following is not a true statement on vas deferens
A. Derivative of Wolffian duct

B. Lumen diameter is 0.2 to 0.7 mm
C. Length is 10 to 15 cm
D. Travels posteriorly along the spermatic cord
Ans C. Length is 10 to 15 cm
The vas deferens, also known as the ductus deferens, extends from the distal end of the cauda
epididymis. It is tubular and its embryologic origin is the mesonephric (wolffian) duct. The vas
deferens is tortuous for 2 to 3 cm as it leaves the epididymis (the convoluted vas deferens). From the
cauda epididymis to its termination at the ejaculatory duct, the vas deferens measures between 30 and
35 cm in length. The vas deferens travels posteriorly along the spermatic cord, behind the vessels in
the cord. The vas deferens passes through the inguinal canal and enters the pelvis lateral to
the epigastric vessels.
The lumen of the vas deferens ranges between 0.2 and 0.7 mm in diameter, depending on the
segment. The outer diameter of the vas deferens ranges between 1.5 and 2.7 mm.
9. The true statement on inhibin is
A. Produced by prostate epithelial cells

B. Structure similar to TGF beta
C. FSH stimulates its production
D. Measured in urine specimen
Ans C. FSH stimulates its production
The testis also produces the protein hormones inhibin and activin. Inhibin is a 32-kD protein made
by Sertoli cells that inhibits FSH release from the pituitary. Within the testis, inhibin production is
stimulated by FSH and acts by negative feedback at the pituitary or hypothalamus. Activin, a
testis protein with close structural homology to transforming growth factor-β (TGF-β), exerts a
stimulatory effect on FSH secretion. Activin receptors are found in a host of extragonadal tissues,
suggesting that this hormone may have growth factor or regulatory roles in the body.
10. Which among the following is a contraindication to testosterone therapy?
A. Breast cancer
B. Kallmann syndrome
C. Low bone mass
D. Hypopituitarism
Ans A. Breast cancer
Indications for Testosterone Therapy:
Delayed puberty (idiopathic, Kallmann syndrome)

Klinefelter syndrome with hypogonadism
Sexual dysfunction with low testosterone
Low bone mass in hypogonadism
Adult men with signs and symptoms of hypogonadism
Hypopituitarism
Testicular dysgenesis with low testosterone
11. Which among the following statement is not true on Vasography
A. It's of no use if testicular biopsy confirms obstructive azoospermia

B. It's performed only at the time of planned vas reconstruction
C. Indigo carmine is used to confirm patency
D. Sperm granuloma can happen after the procedure
Ans A. It's of no use if testicular biopsy confirms obstructive azoospermia
12. Post orgasmic illness syndrome is an example of what type of hypersensitivity reaction?
A. I
B. II
C. III
D. IV
Ans A. I
POST ORGASMIC ILLNESS SYNDROME:

• The symptoms of POIS occur after ejaculation and are severe myalgia, fatigue associated with a flu
like state, nasal congestion, and itching eyes.
• POIS symptoms commence within 30 minutes of ejaculation in 87% of men and increase in intensity
to a peak on day 2.
• A type 1 hypersensitivity immunogenic reaction has been proposed as the underlying mechanism.
• A prolonged hyposensitization program with multiple subcutaneous injections of autologous semen
has been suggested as a possible treatment.
13. The gold standard management of Peyronie's disease is
A. Surgical reconstruction
B. Clostridial collagenase
C. PDE 5 inhibitors
D. Pentoxifylline
Ans A. Surgical reconstruction
Surgery remains the gold standard treatment to most rapidly and reliably correct the deformity
associated with PD; and for men who also have ED, placement of a penile prosthesis can provide
rigidity for penetrative sexual activity. The indications for surgical correction include stable disease,
which is defined as disease that is at least 1 year from onset, and at least 6 months of stable
deformity.
14. The pH of vagina is
A. 4 to 5
B. 5 to 6
C. 6 to 7
D. 7 to 8
Ans A. 4 to 5
The vagina is acidic at baseline with a pH between 4 and 5 and is colonized with a variety of
microorganisms, predominantly Lactobacillus and/or other lactic acid–producing species. The acidity
of the vagina is maintained in part by the metabolism of glycogen from the vaginal mucosa into
lactic acid.
15. The following is not a true statement on spermatocytic seminoma
A. Accounts for less than 1% of GCT

B. Usually arise from ITGCN
C. Not associated with history of cryptorchidism
D. Do not demonstrate isochromosome 12p
Ans B. Usually arise from ITGCN
Spermatocytic seminoma is rare and accounts for less than 1% of GCTs. Although classified as a
variant of seminoma, these tumors represent a distinct clinicopathologic entity from other GCTs.
In contrast to other GCTs, spermatocytic seminomas do not arise from ITGCN, are not associated
with a history of cryptorchidism or bilaterality, do not demonstrate i(12p), and do not occur as part
of mixed GCTs. Histopathologically, they differ from seminoma in that they do not stain for PLAP or
glycogen.
16. The following testicular tumor is associated with brain metastases
A. Spermatocytic seminoma
B. Choriocarcinoma
C. Yolk sac tumor
D. Leydig cell tumor
Ans B. Choriocarcinoma
About 1% of men with disseminated GCT have brain metastases detected before initiating
chemotherapy, and between 0.4% and 3% develop brain metastases after first-line chemotherapy.
Brain metastases are associated with choriocarcinoma and should be suspected in any patient with a
very high serum hCG level. Choriocarcinomas are highly vascular and tend to hemorrhage during
chemotherapy, and death rates of 4% to 10% secondary to intracranial hemorrhage have been
reported.

17. Which among the following is a late toxicity of Cisplatin based chemotherapy?
A. Infection
B. Diminished renal function
C. Raynaud phenomenon
D. Death
Ans C. Raynaud phenomenon
Cisplatin-based chemotherapy is associated with numerous early complications and side effects,
including fatigue, myelosuppression, infection, peripheral neuropathy, hearing loss, diminished renal
function, and death.
Numerous long-term sequelae have been reported in GCT survivors, including peripheral neuropathy,
Raynaud phenomenon, hearing loss, hypogonadism, infertility, SMN, and cardiovascular disease.
18. All are true about leydig cell tumor except
A. No association with cryptorchidism

B. Present with symptoms of androgen deficiency
C. Usually benign
D. One fourth of tumors are seen in children
B. Present with symptoms of androgen deficiency
Leydig cell tumors account for 75% to 80% of sex cord–stromal tumors. There is no association with
cryptorchidism. Most of these tumors occur in men 30 to 60 years old, although approximately one
fourth occur in children. Adults may present with painless testis mass, testicular pain, gynecomastia
(as a result of androgen excess and peripheral estrogen conversion), impotence, decreased libido, and
infertility. Boys usually present with a testis mass and isosexual precocious puberty (prominent
external genitalia, pubic hair growth, and masculine voice).
In the past, radical inguinal orchiectomy was the initial treatment of choice. If the diagnosis is
suspected preoperatively, given the 90% incidence of benign histology, testis-sparing surgery may
be considered for lesions less than 3 cm with intraoperative frozen-section histologic confirmation.
Completion orchiectomy should be performed if GCT histology is seen (either on intraoperative
frozen section or on final pathology) or if malignant features (listed earlier) are present on final
pathologic examination of the resected tumor.

19. The following statement is true on adenomatoid paratesticular tumor except
A. Most common paratesticular tumor

B. Usually malignant
C. Inguinal exploration and surgical excision is recommended
D. Common in third or fourth decade
Ans B. Usually malignant
Adenomatoid tumor is the most common paratesticular tumor, most commonly involving the
epididymis (although these tumors may also arise within the testicular tunicae or the spermatic cord).
The most common presentation is a small (0.5 to 5 cm), painless paratesticular mass detected on
routine examination in a man in his third or fourth decade. These tumors are benign and managed by
inguinal exploration and surgical excision. On microscopic examination, tumors are composed
of epithelial-like cells that contain vacuoles and fibrous stroma.
20. The following is untrue on the role of partial orchiectomy for testicular tumour
A. Ideal for tumour less than 2cm

B. There is preservation of Leydig cell function after partial orchiectomy
C. Adjuvant radiotherapy is recommended with a dose of 38 to 40Gy after partial orchiectomy
D. If malignant nature of tumour is uncertain then inguinal approach and excision always biopsy
should be considered
Ans C. Adjuvant radiotherapy is recommended with a dose of 38 to 40Gy after partial

orchiectomy
Partial orchiectomy should be considered in patients with a polar tumor measuring 2 cm or less and
an abnormal or absent contralateral testicle. In circumstances in which the malignant nature of
the tumor is uncertain, inguinal exploration and excisional biopsy can be done.
Adjuvant radiotherapy with a dosage of 18 to 20 Gy is recommended to prevent local tumor

recurrence in all patients treated with partial orchiectomy for the management of GCT in a
functionally solitary testis. In these patients, the only benefit of partial orchiectomy is preservation of
Leydig cell function. Any local recurrence within the ipsilateral testis occurring with or without
adjuvant therapy should be managed with completion radical orchiectomy.
21. Incorrect statement on penile cutaneous horn is

A. Associated with HPV 16
B. Usually develops over a pre existing wart or nevus
C. Topical 5 FU is used in management
D. All are true statements
Ans C. Topical 5 FU is used in management
The penile cutaneous horn is a rare lesion. It usually develops over a preexisting skin lesion (wart,
nevus, traumatic abrasion, or malignant neoplasm) and is characterized by overgrowth and
cornification of the epithelium, which forms a solid protuberance. On microscopic examination,
extreme hyperkeratosis, dyskeratosis, and acanthosis are noted. It is associated with HPV type 16.
Treatment consists of surgical excision with a margin of normal tissue about the base of the horn.
These lesions may recur and may demonstrate malignant change on subsequent biopsy, even when
initial histologic appearance is benign. Because this tumor may evolve into a carcinoma or may
develop as a result of an underlying carcinoma, careful histologic evaluation of the base and close
follow-up of the excision site are essential.
22. Hypercalcaemia without detectable osseous metastasis is associated with
A. Follicular carcinoma thyroid

B. Renal cell carcinoma
C. Penile carcinoma
D. Prostate cancer
Ans C. Penile carcinoma
Hypercalcemia without detectable osseous metastases has been associated with penile cancer.
Hypercalcemia seems to be largely a function of the bulk of the disease. It is often associated with
inguinal metastases and may resolve after excision of involved inguinal nodes. Parathyroid hormone
and related substances may be produced by both tumor and metastases that activate osteoclastic bone
resorption.
23. The following is a true statement on urethral hemangioma
A. Common in females
B. Associated with May Thurner syndrome
C. Common in second and third decade
D. Never associated with cutaneous hemangiomas
Ans C. Common in second and third decade
Urethral hemangiomas are more common in males, and the majority of tumors initially described in
the literature were located within the anterior urethra. Most patients present within the second or
third decade of life, although it is not uncommon for symptoms to have been present for years.
Urinary tract hemangiomas may be associated with the presence of cutaneous hemangiomas or
congenital disorders such as Klippel-Trenaunay syndrome. The most common symptom of a urethral
hemangioma is intermittent hematuria, which can be massive at times.
24. Which among the following is diagnostic of reactive arthritis?
A. Arthritis
B. Conjunctivitis
C. Urethritis
D. Circinate balanitis
Ans D. Circinate balanitis
Reactive arthritis is characterized by a classic triad of arthritis, conjunctivitis, and urethritis. In

addition, some patients have had an episode of diarrhea that preceded the development of arthritis.
However, the classic triad is not present in most cases, and patients present with only arthritis
affecting the knees, ankles, and feet in an asymmetrical distribution. The history of urethritis
is obtained on detailed questioning.
Urethral involvement is usually mild and self-limited and constitutes a minor portion of the disease.
In approximately 10% to 20% of patients, a glandular lesion is present. Referred to as circinate
balanitis, this lesion is diagnostic of reactive arthritis and typically appears as a shallow, painless ulcer
with gray borders.
25. The following area is usually spared in genital lymphedema
A. Posterior and lateral aspect of scrotum

B. Medial and posterior aspect of scrotum
C. Anterior and medial aspect of scrotum
D. Posterior and anterior aspect of scrotum
Ans A. Posterior and lateral aspect of scrotum

In many cases of genital lymphedema, the posterior scrotum and the lateral scrotal wall are spared
from the edematous process; in these cases, the bulk of the scrotum is excised, and closure
is accomplished with use of the posterior and lateral scrotum. If the edematous process also involves
the lower extremities, it is best to reconstruct the scrotum with a graft as opposed to the local
tissues.
26. The following is true on vasectomy / it's surgical modifications
A. No scalpel vasectomy is 100% effective

B. Patients can have unprotected intercourse 4 weeks after vasectomy
C. No scalpel technique is associated with increased rate of infections
D. There is no association between vasectomy and prostate cancer
Ans D. There is no association between vasectomy and prostate cancer
• No vasectomy technique is 100% effective.

• Patients can be advised to initiate unprotected intercourse following a semen analysis obtained 8 to
16 weeks after vasectomy that demonstrates azoospermia or rare nonmotile sperm.
• The no-scalpel technique significantly decreases the rate of hematomas, infections, and pain during
the procedure.
• Fascial interposition is the occlusion technique that has been found to decrease vasectomy failure
rates the most significantly.
• Technical aspects of performing vasectomy can affect the ease of microsurgical vasectomy reversal
in the future if needed.
• There is no association between vasectomy and prostate cancer or cardiovascular disease.
27. The mainstay investigation of choice for seminal vesicle pathology is
A. Digital rectal examination

B. Semen analysis
C. TRUS
D. Rectal biopsy of seminal vesicle
Ans C. TRUS
Normal seminal vesicles are not palpable on digital rectal examination. When a seminal vesicle cyst is
present, the area immediately above the prostate may be compressible on digital rectal examination.
This same area may feel firm or solid when a seminal vesicle tumor is present. Semen analysis
revealing a low seminal volume (<1.0 mL) and a lack of liquefaction and fructose may
indicate ejaculatory duct obstruction or the absence of seminal vesicles.
High-resolution transrectal ultrasonography (TRUS) has become the mainstay of imaging for the
diagnostic evaluation of seminal vesicle pathology because it is a reliable and inexpensive imaging
modality. On TRUS, the seminal vesicles can be found just superior to the prostate, between the
bladder and the rectum, and can be well visualized in the anteroposterior and sagittal views.
28. Dromedary hump is commonly seen in
A. Prostate
B. Seminal vesicle
C. Right kidney
D. Left kidney
Ans D. Left kidney
The adult kidney’s lateral contour might have a focal renal parenchymal bulge known as a
dromedary hump, which is more common on the left side and has no pathologic significance. These
dromedary humps are thought to be caused by the downward pressure from the liver or the spleen.
29. The following is not true on Gerota's fascia
A. Encloses kidney including perirenal fat

B. Encloses adrenal gland
C. It's open superolaterally
D. Perinephric collections can reach pelvis without breaching Gerota's fascia
Ans C. It's open superolaterally
The kidneys and adrenal glands, including the perirenal fat surrounding them, are enclosed by a
condensed, membranous layer of renal (Gerota) fascia, which continues medially to fuse with the
contralateral side. This fascia extends inferomedially along the abdominal ureter as a periureteral
fascia. The Gerota fascia encasing the kidneys, adrenal glands, and abdominal ureters is closed
superiorly and laterally and serves as an anatomic barrier to the spread of malignancy and a means of
containing perinephric fluid collections. Because it is open inferiorly, perinephric fluid collections
can track inferiorly into the pelvis without violating the Gerota fascia.
30. Endoureterotomy is done at the following position in distal ureter
A. Lateral
B. Anterior
C. Medial
D. Posterior
Ans C. Medial
Surgeons are trained to handle ureters gently to avoid unnecessary lateral retraction and removing
periureteral adventitial tissues containing the blood supply to minimize ureteral ischemia and
subsequent stricture. The mid-ureter is supplied by branches arising posteriorly from the common
iliac arteries. The blood supply to the distal ureter comes laterally from the superior vesical artery, a
branch of the internal iliac artery. Therefore the blood supply of the ureter is medially in the
proximal part, posteriorly in the mid-portion, and laterally in the distal portion. Therefore
endoureterotomy should be performed laterally in the proximal ureter, anteriorly in the mid-portion,
and medially in the distal ureter.
31. Which among the following does not cause ureteric smooth muscle relaxation
A. Beta adrenergic agonists

B. Carbachol
C. Theophylline
D. Papaverine
Ans B. Carbachol
Agents that either increase adenylyl cyclase activity, such as the β-adrenergic agonist isoproterenol,
or decrease PDE activity, that is, phosphodiesterase inhibitors such as theophylline and papaverine,
increase intracellular cAMP levels and cause smooth muscle relaxation.
Cholinergic agonists, including ACh, methacholine (Mecholyl), carbamylcholine (carbachol), and

bethanechol (Urecholine), in general have been observed to have an excitatory effect on ureteral and
renal pelvic function—that is, they increase the frequency and force of contractions.
32. The baseline resting ureteral pressure is

A. 0 to 5 cm H20
B. 10 to 20 cm H2O
C. 20 to 40 cm H2O
D. 20 to 80 cm H2O
Ans A. 0 to 5 cm H20
Baseline, or resting, ureteral pressure is approximately 0 to 5 cm H2O, and superimposed ureteral

contractions ranging from 20 to 80 cm H2O occur two to six times per minute.
The ureter has been shown to decompensate when sustained intravesical pressure approaches 40 cm
H2O.
33. Which among the following substance causes renal arterial dilatation?
A. Glucocorticoids
B. Atrial natriuretic peptide
C. Endothelin
D. Norepinephrine
Ans A. Glucocorticoids
34. Hyperchloremic metabolic acidosis with urine pH > 5.6 with low serum bicarbonate is suggestive
of
A. Type 1 RTA
B. Type 2 RTA
C. Type 3 RTA
D. Type 4 RTA
Ans A. Type 1 RTA
RTA type 1 is the most common form and is the most clinically significant to the urologist. It has
also been called “classic” RTA and distal RTA. The old classification of RTA type 3 is now
recognized as a type 1 variant. The underlying problem is failure of H+ secretion in the distal
nephron, which can be congenital or acquired. Associated disorders include autoimmune diseases
(thyroiditis), toxic nephropathy, and chronic ureteral obstruction. The hallmark is a hyperchloremic
metabolic acidosis with a high urinary pH (>5.5) in the face of persistently low serum HCO3.

35. "String of beads" appearance on angiography is seen in renovascular hypertension secondary to
A. Medial fibroplasia
B. Perimedial fibroplasia
C. Intimal fibroplasia
D. Medial hyperplasia
Ans A. Medial fibroplasia
• There are four types of fibrous dysplasia: medial fibroplasia, perimedial fibroplasia, intimal
fibroplasia, and medial hyperplasia.
• Medial fibroplasia is the most common lesion and typically presents with a characteristic “string-of-
beads” appearance.
• These patients are not likely to show progression of the occlusion or to experience a decrease in
overall renal function.
• Perimedial fibroplasia and intimal fibroplasia, however, are likely to progress if left untreated,
resulting in loss of renal function.
36. Which among the following is not an indication for initiation of renal replacement therapy
A. K+ > 6.5
B. Na+ > 150
C. pH < 7.1
D. Urine output < 200ml in 12 hours
Ans B. Na+ > 150

Ref: Campbell Walsh Wein Urology, 12th edition,Chapter 46 Etiology, Pathogenesis, and
Management of Renal Failure
37. FENa of greater than 4% is associated with
A. Acute tubular necrosis

B. Bilateral ureteral obstruction
C. Sepsis
D. Renal artery stenosis
Ans B. Bilateral ureteral obstruction
The FENa test often is used to differentiate among the three types of acute renal injury: prerenal,
intrinsic, and postrenal.
FENa = (PCr × UNa )/(PNa × UCr )
where PCr is defined as the serum creatinine level, UNa is urine sodium level, PNa is serum sodium
level, and UCr is the urine creatinine level. An FENa less than 1% suggests a prerenal cause of
acute renal failure (i.e., hypovolemia, congestive heart failure, renal artery stenosis, sepsis). An
FENa greater than 1% will indicate intrinsic causes of acute renal failure (i.e., acute tubular necrosis,
glomerulonephritis, acute interstitial nephritis), and an FENa greater than 4% indicates postrenal
causes of acute renal failure (i.e., benign prostatic hyperplasia [BPH], bladder stones, bilateral ureteral
obstruction [BUO]).

38. The following is not associated with increased risk of nephrolithiasis
A. Low protein diet

B. Low carbohydrate diet
C. Obesity
D. Roux en Y gastric bypass surgery
Ans A. Low protein diet
• Obesity is an independent risk factor for nephrolithiasis, particularly for women.

• Metabolic syndrome is associated with lower urinary pH.
• Obese patients have a higher propensity for uric acid calculi.
• High-protein, low-carbohydrate diets alter urinary parameters and may increase the risk for stone
formation.
• Roux-en-Y-gastric bypass surgery may significantly increase the overall risk for stone formation.
39. Acetohydroxamic acid is used in management of
A. Uric acid calculi

B. Calcium oxalate calculi
C. Calcium phosphate calculi
D. Struvite calculi
Ans D. Struvite calculi
Acetohydroxamic acid, a urease inhibitor, may reduce the urinary saturation of struvite and therefore
retard stone formation. When given at a dose of 250 mg three times per day, acetohydroxamic acid
has been shown to prevent recurrence of new stones and inhibit the growth of stones in patients with
chronic urea-splitting infections.
A significant percentage of patients receiving chronic acetohydroxamic acid therapy have
experienced minor side effects and 15% developed deep venous thrombosis.
40. Which among the following drug provokes stone formation (the stone is not formed by the drug
per se)
A. Ephedrine
B. Triamterene
C. Indinavir
D. Furosemide
Ans D. Furosemide
41. A 32 year old pregnant lady presents with a symptomatic proximal ureteric calculi. The chances
that she will pass her stone on conservative management is
A. 20 to 30%
B. 30 to 50%
C. 50 to 80%
D. 70 to 90%
Ans C. 50 to 80%
Of pregnant patients with symptomatic calculi, 50% to 80% will pass their stones spontaneously
when treated conservatively with hydration and analgesia. Intervention is required in approximately
one third of patients, usually for pain uncontrolled by analgesia or signs of persistent obstruction and
infection. When treatment is selected, it should be recognized that there is some controversy
regarding the most appropriate method of intervention. Some have maintained that ureteral stents are
the optimal treatment of such patients. Although ureteral stents do effectively drain an obstructed
collecting system, they are by no means the perfect solution to this problem. The changes in
urinary chemistry that occur during pregnancy, in particular the hypercalciuria and hyperuricosuria,
have been implicated in the accelerated encrustation of ureteral stents that is encountered in this
population. As a consequence of this phenomenon it has been recommended that ureteral stents placed
in pregnant women be exchanged every 4 to 6 weeks.
42. The correct statement on primary bladder calculi is
A. Common in 2 to 4 year old girls

B. Recur after treatment
C. Associated with low protein diet
D. Cystine is the most common type of primary bladder calculi
Ans C. Associated with low protein diet
Primary bladder calculi are most common in children younger than the age of 10, with a peak
incidence at 2 to 4 years of age. The disease is much more common in boys than in girls, with ratios
ranging from 9 : 1 to as high as 33 : 1 in areas of India. Stones are usually solitary and after removal
they rarely recur. Ammonium acid urate, calcium oxalate, uric acid, and calcium phosphate are the
most common components of primary bladder calculi.
Predisposition to the formation of bladder calculi appears to arise from a number of nutritional and
socioeconomic factors. Children in endemic regions often consume a predominantly cereal based diet
that is poor in animal protein and low in phosphate.
43. The incidence of malignancy in Bosniak class III renal cyst is
A. 5%
B. 20%
C. 30%
D. 50%
Ans C. 30%
44. Which among the following tumors are AMACR positive?
A. Papillary RCC
B. Metanephric adenoma
C. Wilms tumor
D. Cystic nephroma
Ans A. Papillary RCC
The Wilms tumor marker WT1 is frequently expressed in metanephric adenoma. α-Methylacyl-CoA
racemase (AMACR) is poorly expressed in metanephric adenoma but highly expressed in papillary
RCC, whereas S-100 protein expression is very high in metanephric adenoma, weak in Wilms tumor,
and absent in papillary RCC.
45. A 50 year old gentleman after his master health check-up presents to you with a USG report
stating complex renal cyst. He gives a history of contrast allergy. His creatinine is 1.1. Next line
management would be
A. CT with iv contrast
B. Plain CT
C. MRI with Gadolinium
D. Observation
Ans C. MRI with Gadolinium
46. Cutaneous and uterine leiomyomas are associated with
A. Papillary type 1 RCC

B. Papillary type 2 RCC
C. BHD syndrome
D. Clear cell RCC
Ans B. Papillary type 2 RCC
In 2001, Launonen and colleagues described a new familial renal cancer syndrome in which patients
commonly develop cutaneous and uterine leiomyomas and type 2 papillary RCC. Mean age at
diagnosis is in the early 40s. Renal tumors in this syndrome are unusual for familial RCC in that they
are often solitary and unilateral, and they are more likely to be aggressive than other forms of familial
RCC. Collecting duct carcinoma, another highly malignant variant of RCC, has also been observed
in this syndrome, which was named hereditary leiomyomatosis and renal cell carcinoma (HLRCC)
syndrome.
The HLRCC locus was mapped to a region on 1q42-44, and this was later shown to be the site of the
fumarate hydratase gene.
47. Perinuclear clearing or halo is a pathological feature of
A. Papillary RCC
B. Clear cell RCC
C. Chromophobe RCC
D. Medullary RCC
Ans C. Chromophobe RCC
Chromophobe RCC is a distinctive histologic subtype of RCC that represents 5% of all RCCs and
appears to be derived from the cortical portion of the collecting duct. The tumor cells typically
exhibit a relatively transparent cytoplasm with a fine reticular pattern that has been described as a
“plant cell” appearance. Most chromophobe RCCs are resistant to the pigment used during typical
hematoxylin and eosin staining, but eosinophilic variants constitute about 30% of cases.
A perinuclear clearing or “halo” is typically found and electron microscopic findings consist
of numerous 150- to 300-nm microvesicles, which are the single most distinctive and defining
feature of chromophobe cell carcinoma. These microvesicles characteristically stain positive for Hale
colloidal iron, indicating the presence of a mucopolysaccharide unique to chromophobe RCC.
48. The following group of patients need not be screened regularly for Renal cell carcinoma
A. ADPKD
B. Relatives of patients with VHL disease
C. End stage renal disease
D. Tuberous Sclerosis
Ans A. ADPKD

49. A 5 cm renal mass with IVC thrombus belongs to stage
A. I
B. II
C. III
D. IV
Ans C. III
50. The following type of RCC needs to be treated aggressively
A. HPRCC
B. RCC in BHD syndrome
C. Clear cell RCC
D. HLRCC
Ans D. HLRCC
Duffey and colleagues (2004) at the National Cancer Institute have defined a 3-cm threshold for
intervention in patients with von Hippel-Lindau disease. In their series, a total of 108 patients with
von Hippel-Lindau disease and solid renal tumors smaller than 3 cm were observed and none
developed metastatic disease during mean follow-up of 58 months. This recommendation
also applies to patients with HPRCC and Birt-Hogg-Dubé syndromes. However, HLRCC and SDH-
RCC are exceptions in that tumors in these syndromes are typically more aggressive and should be
managed accordingly, even when less than 3 cm.
Taken together, these studies suggest that PN can provide effective initial treatment of patients with
RCC and von Hippel-Lindau disease but should be withheld until tumor size reaches or eclipses 3.0
cm.
51. Staging of IVC thrombus for a patient with 6.5 cm right renal mass with thrombus in intrahepatic
portion of IVC is
A. I
B. II
C. III
D. IV
Ans C. III
Overall, involvement of the venous system with RCC occurs in 4% to 10% of patients. IVC tumor
thrombus should be suspected in patients with a renal tumor who also have lower extremity edema,
isolated right-sided varicocele or one that does not collapse with recumbency, dilated superficial
abdominal veins, proteinuria, pulmonary embolism, right atrial mass, or nonfunction of the involved
kidney. Staging of the level of IVC thrombus is as follows: I, adjacent to the ostium of the renal vein;
II, extending up to the lower aspect of the liver; III, involving the intrahepatic portion of the IVC but
below the diaphragm; and IV, extending above the diaphragm.
52. Aristolochic acid is associated with
A. Renal cancer
B. Urothelial cancers of upper tract
C. Prostate cancer
D. Bladder cancer
Ans B. Urothelial cancers of upper tract

Several studies have suggested that aristolochic acid, which is found in plants Aristolochia fangchi
and Aristolochia clematitis, has a mutagenic action on codon 139 of p53 gene. This mutation is
predominant in patients with Balkan endemic nephropathy (BEN) and Chinese herb nephropathy.
BEN is characterized by a degenerative interstitial nephropathy occurring in Balkan countries where
these plants are endemic and grow as weeds in wheat fields. It has a familial, but not inherited pattern,
and incidence has been declining over the past 20 years. The role of dietary exposure to aristolochic
acid in BEN is supported by the fact that the family members who leave home early in life may not
be affected (Radovanovic et al, 1985). Affected families display a much higher incidence of UTUC,
but not bladder cancer.
53. The following is not an indication for extracorporeal renal surgery
A. Segmental renal arterial disease

B. Ischemia > 20 minutes is anticipated
C. Large malignancy in a solitary kidney
D. Repair of collecting system anomaly during transplant
Ans B. Ischemia > 20 minutes is anticipated
Specific indications for which ECRS may be a valid option are listed below:
Renovascular diseases
• Prolonged ischemia (>45 minutes) is anticipated
• Segmental renal artery disease
• Multivessel disease
• Arteriovenous malformations refractory to embolization
• Large intrarenal arterial aneurysms
Renal transplantation
• Repair of vascular anomaly
• Repair of collecting system anomaly
Malignancy in solitary kidney

• Large, central mass encroaching on the renal pedicle
• Large, central renal pelvic tumor
• Multiple subcortical neoplasms
54. Hammock hypothesis is related to

A. Intrinsic sphincter
B. Extrinsic sphincter
C. Suburethral layer
D. Bladder neck
Ans C. Suburethral layer
Hammock hypothesis of DeLancey (1994) proposes that for stress incontinence to occur with
hypermobility, there must be a lack of stability of the suburethral supportive layer. This
theory proposes that the effect of abdominal pressure increases on the normal bladder outlet, if the
suburethral supportive layer is firm, is to compress the urethra rapidly and effectively. If the
supportive suburethral layer is lax and/or movable, compression is not as effective.
55. The following is not a true statement on bladder outlet obstruction index
A. Normal value is less than 20

B. Calculated by the formula PdetQmax - 2 (Qmax)
C. Also called as Abrams Griffiths number
D. All are true
D. All are true
Abrams-Griffiths (AG) number (now known as the bladder outlet obstruction index [BOOI])
derived from the equation for the slope of the line dividing obstructed from equivocal in the Abrams-
Griffiths nomogram, which is the same line dividing obstructed from slightly obstructed in
the Schafer nomogram: BOOI = PdetQmax − 2(Qmax). Subsequently Griffiths and colleagues (1997)
described the ICS provisional nomogram, which is now suggested for use for the diagnosis of
obstruction in men with LUTS suggestive of BPH . Men are considered obstructed if the BOOI is 40
or greater, unobstructed if the BOOI is 20 or less, and equivocal if the BOOI is 20 to 40.
56. The following is not a risk factor for urinary incontinence
A. Depressive disorder
B. Type 1 diabetes
C. Oral estrogen therapy
D. Topical estrogen therapy
Ans D. Topical estrogen therapy
UI appears to be more prevalent among women with certain medical conditions, including diabetes
mellitus (DM) and depression. The prevalence of UI among type 2 diabetic women may be as high
as two times greater than age-matched nondiabetic women, with emerging evidence suggesting the
same finding in women with type 1 DM.
Hormonal therapy: Oral estrogen use with or without progestogen is associated with the development
of SUI in middle-aged and older women. Topical estrogen has not been clearly associated with this
finding, and it can be used for the treatment of vaginal atrophy and, frequently, associated UTIs.
57. Which among the following statements is not true on management of non muscle invasive bladder
tumors
A. Intravesical chemotherapy is contraindicated if there is a perforation after TUR

B. Intravesical BCG is best given immediately after surgery
C. Intravesical BCG results in massive local immune response
D. All are true
B. Intravesical BCG is best given immediately after surgery
BCG powdered vaccine is reconstituted with 50 mL of saline and should be administered through a
urethral catheter under gravity. Treatments are typically begun 2 to 4 weeks after tumor resection,
allowing time for re-epithelialization, which minimizes the potential for intravasation of live
bacteria. For the same reason, a urinalysis is usually performed immediately before instillation to
further confirm absence of infection or significant bleeding to decrease the likelihood of
systemic uptake of BCG. In the event of a traumatic catheterization, the treatment should be delayed
for several days to 1 week.
Intravesical immunotherapy results in a massive local immune response characterized by induced
expression of cytokines in the urine and bladder wall and by an influx of granulocytes and
mononuclear and dendritic cells.
Chemotherapy should be withheld in patients with extensive resection or when there is concern about
perforation.
BCG can never be safely administered immediately after TUR because the risk of bacterial sepsis and
death is high.
58. A 65 year old gentleman underwent a prostate biopsy that showed "a focus of atypical glands".
What is the appropriate follow up plan?
A. Robotic prostatectomy
B. Follow up with PSA
C. Follow up with PSA and digital rectal examination
D. Repeat biopsy in 6 months
D. Repeat biopsy in 6 months
In certain cases, there are findings suggestive of, but not diagnostic of, carcinoma. The incidence of
atypical needle biopsy specimens is about 5%. Pathologists should sign out atypical cases
descriptively as “a focus of atypical glands” rather than using ambiguous terminology such as
“atypical hyperplasia” or “atypical small acinar proliferation.” A comment should be added in the
report describing why the focus is suggestive of cancer yet is not diagnostic, with a recommendation
for repeat biopsy. In this way, there is no confusion in the urologist’s mind that the lesion is likely to
be infiltrating cancer but that the pathologist is not comfortable in establishing the diagnosis.
The likelihood of cancer after an atypical diagnosis is about 40% to 50%. Surprisingly, in men with a
previous atypical biopsy result, the level of serum PSA elevation or the results of digital rectal
examination do not correlate with the risk of a subsequent biopsy specimen showing carcinoma.
Regardless of the serum PSA level, all patients with an initial atypical diagnosis on needle biopsy
should undergo a repeat biopsy, typically within 6 months.
59. Most of the prostate ductal adenocarcinoma belong to a Gleason pattern of
A. 2
B. 3
C. 4
D. 5
C. 4
Most prostatic duct adenocarcinomas should be regarded as Gleason pattern 4 because of their shared
cribriform morphologic features with acinar adenocarcinoma Gleason score 8 and a similar prognosis
(Brinker et al, 1999). Exceptions are the PIN-like ductal adenocarcinoma, which is assigned Gleason
pattern 3 and the ductal adenocarcinoma with comedonecrosis, which is assigned a Gleason pattern 5.
60. Cryotherapy for prostate cancer acts by the following mechanisms except
A. Induction of apoptosis
B. Ischemic necrosis
C. Activation of antitumor immune response
D. None of the above
D. None of the above
Cryotherapy exerts its effects via a number of pathways, namely:

1. Direct cytolysis through extracellular and intracellular ice crystal formation
2. Intracellular dehydration and pH changes
3. Ischemic necrosis via vascular injury
4. Cryoactivation of antitumor immune responses
5. Induction of apoptosis
6. Endothelial damage, which leads to platelet aggregation and microthrombosis

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presents

2. Which of the following is true regarding shock?

A.Metabolic acidosis, respiratory acidosis

C. Metabolic acidosis, respiratory alkalosis

STAGING - PRESSURE SORES

4. Dr Prakash Natarajan is working on induced pluripotent stem cells(iPSCs) in a lab at Cambridge

5. Not true regarding non-surgical management of Mycetoma is

A. Actinomycetoma is treated with Amikacin and Co-Trimoxazole

● Monofilament polyester polymer

A. Post diagnostic tumours are most susceptible to antiproliferative drugs

B. Norton-Simon hypothesis is supported by this patten

9. Rejecting a null hypothesis when it is true is called as:

Null hypothesis - Statement opposite to hypothesis.

A. Before skin incision

B. Before induction of anaesthesia

Sign in - Before Induction of anaesthesia

A. Blue light at 415 nm displays superficial capillary networks

C. Indigo carmine is a stain used to enhance diagnostic yield in NBI

Remember World War 2 = WW2. Water appears white in the T2 phase.

Ref: Bailey & Love's Short

Common special stains

15. Which of the following is a non-depolarizing muscle relaxant?

C. Loss of adaptive ketogenesis

Metabolic response to trauma and sepsis

18. Which of the following is not true about flail chest?

C. Best treatment is with mechanical ventilation to splint the ribs

19. Which of the following is a principle of Damage Control Resuscitation (DCR) ?

A. Should be initiated after DCS

A. Useful only when given within 24 hrs of injury

A. Useful only when given within 24 hrs of injury

It is useful only when given within 3 hours of injury.

A Glasgow outcome score of 4 signifies moderate disability.

B. Congenital diaphragmatic hernia

Ref: Sabiston Textbook of Surgery, 20th edition, Chapter 66

Ref: Sabiston Textbook of Surgery, 20th edition, Chapter 66

A. Neonatal form is the most common

A. Neonatal form is the most common

A. 0.5 x TBSA x weight of patient

● 0.5 × percentage body surface area burnt × weight = one portion

27. Which of the following statements regarding grafts are true?

Uric acid (10% of all stones)

● Uric acid is a product of purine metabolism

A. Immediate Nesbitt procedure to correct deformity.

B. Wait for 18-24 months for stabilisation of disease

33. Identify the image

36. Strawberry gallbladder is seen in

Strawberry gallbladder is seen in cholesterosis. It is characterised by submucous aggregations of

B. Inadequate ACTH seen

A. α-2 vlad glycation protein

39. Which is true regarding the etiology of proximal gastric cancer?

A. Epstein-Barr virus is associated with proximal gastric cancer

A. Epstein-Barr virus is associated with proximal gastric cancer

Ref: MD Anderson, Surgical Oncology Handbook, 6th edition, Chapter 9

1. Which among the following is true statement about urine analysis

A. Glucose will be detected in urine when serum glucose > 150mg/dl

Ans B. Nitrites are not commonly seen in urine

Ref: Campbell Walsh Wein Urology, 12th edition, Chapter 2

Ans A. Superior pole

A. Right lower pole

Ans D. Left lower pole

Ref: Campbell Walsh Wein Urology, 12th edition, Chapter 12

A. Age > 35 years

Ans B. Obstructive urinary symptoms