Urology: renal cell carcinoma: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Urology: renal cell carcinoma

Sample item

A 58-year-old smoker has painless haematuria and a left flank mass. He also has a left varicocele that does not empty when he lies down. What is the explanation for the varicocele?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Tumour thrombus in the left renal vein obstructing the left testicular vein

The left testicular vein drains into the left renal vein, whereas the right drains directly into the inferior vena cava. Renal cell carcinoma has a tendency to invade the renal vein, so a thrombus blocks the left testicular vein outflow, causing a varicocele that does not decompress when supine. A new left varicocele in an older man should prompt imaging of the kidney.

Option by option

  • A. Tumour thrombus in the left renal vein obstructing the left testicular vein (correct)

    Renal vein invasion explains why a left-sided varicocele fails to empty on lying down.

  • B. Incompetent valves of the internal spermatic vein

    Valvular incompetence causes ordinary varicocele, which empties on lying down.

  • C. Obstruction of the inferior vena cava by the right testicular vein

    The right testicular vein is not the pathway affected in a left-sided varicocele.

  • D. Compression of the pampiniform plexus by inguinal lymph nodes

    Nodal compression at the groin is not the typical mechanism and would not be linked to the renal mass.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Tumour thrombus in the left renal vein obstructing the left testicular vein. The left testicular vein drains into the left renal vein, whereas the right drains directly into the inferior vena cava.

Why is "Incompetent valves of the internal spermatic vein" not the answer?

Valvular incompetence causes ordinary varicocele, which empties on lying down.

Why is "Obstruction of the inferior vena cava by the right testicular vein" not the answer?

The right testicular vein is not the pathway affected in a left-sided varicocele.

Why is "Compression of the pampiniform plexus by inguinal lymph nodes" not the answer?

Nodal compression at the groin is not the typical mechanism and would not be linked to the renal mass.

What concept does this question test?

It tests Urology: renal cell carcinoma in General Surgery. Renal cell carcinoma has a tendency to invade the renal vein, so a thrombus blocks the left testicular vein outflow, causing a varicocele that does not decompress when supine. A new left varicocele in an older man should prompt imaging of the kidney.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Urology: renal cell carcinoma?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.