Download Question 1 : SC

Case 926: Completion MCQs
Authors and Affiliations
Dr Simon Harley
A/Professor Nick Brook
Department of Urology
Royal Adelaide Hospital
Case Overview
Here are a series of 18 MCQs. Please go through them once you have completed the case studies in
this module. They are designed to match the MCQs provided in the Introduction.
Learning Objectives
We have devised an online Urology educational resource to help cover the nine core Urology Topics as
recommended by the American Urological Association (except for paediatric urinary tract infections).
The learning objectives will be defined for each case and will cover the following:
acute
scrotal problems
paediatric
urinary infections
adult
urinary tract infections
renal
tract stones
urinary
incontinence
benign
prostatic hypertrophy
erectile
dysfunction
haematuria
carcinoma
of the prostate
Question 1 : SC
Question Information:
Epididymitis is a relatively common problem in elderly men.
Question:
Which one of the following groups of pathogens is most commonly associated with this problem?
Choice 1: E.coli and other coliforms Score : 1
Choice Feedback:
Correct.
Choice 2: Chlamydia Score : 0
Choice Feedback:
Incorrect.
Choice 3: Mycoplasma species Score : 0
Choice Feedback:
Incorrect.
Choice 4: Corynebacterium species Score : 0
Choice Feedback:
Incorrect.
Choice 5: Haemophilus Score : 0
Choice Feedback:
Incorrect.
Question 2 : SC
Question Information:
James is a 17-year-old boy who presents with an episode of acute scrotal pain and swelling while
watching TV at home 3 hours ago. He has been febrile and complains of a discharge from his penis. He
is sexually active. On examination the whole scrotum appears to be red and swollen and it is too tender
to allow an adequate physical examination.
Question:
Which one of the following would be the most important next step in management?
Choice 1: Urine microscopy and culture Score : 0
Choice Feedback:
Incorrect.
Choice 2: Gram stain of urethral discharge Score : 0
Choice Feedback:
Incorrect.
Choice 3: Semen gram stain Score : 0
Choice Feedback:
Incorrect.
Choice 4: Scrotal ultrasound Score : 1
Choice Feedback:
Correct.
Choice 5: Surgical exploration Score : 0
Choice Feedback:
Incorrect.
Question 3 : SC
Question Information:
A 68-year-old man undergoes a transrectal ultrasound-guided (TRUS) biopsy of his prostate as part of
an assessment of possible carcinoma of that gland. A Gleason score will be determined.
Question:
Which one of the following most accurately determines the components of this score?
Choice 1: Prostate-specific antigen (PSA) + histological findings Score : 0
Choice Feedback:
Incorrect.
Choice 2: Cytological features Score : 0
Choice Feedback:
Incorrect.
Choice 3: Architectural features Score : 1
Choice Feedback:
Correct. The Gleason score consists of a primary + secondary grade. Grading is based on architecture
of the tissue biopsy ranging from a score of 1 (well differentiated) to 5 (poorly differentiated). The
primary grade indicates the most prevalent architectural pattern, and the secondary grade indicates the
next most prevalent architectural pattern (eg. 4+3).
Choice 4: Sonographic findings during TRUS Score : 0
Choice Feedback:
Incorrect.
Choice 5: Digital rectal examination (DRE) findings and clinical presentation Score : 0
Choice Feedback:
Incorrect.
Question 4 : SC
Question Information:
Graham is a 78-year-old man who has had two coronary artery bypass grafts, poorly controlled
diabetes and advanced COPD. He has had a TRUS biopsy for a PSA of 9 and this has revealed a small
focus of Gleason 6 prostate cancer.
Question:
Which of the following would be the most appropriate management options?
Choice 1: Watchful waiting Score : 1
Choice Feedback:
Correct. This is an appropriate management option, especially in those whose life expectancy is <10
years and there would be minimal mortality effect.
Choice 2: PSA monitoring Score : 0
Choice Feedback:
Incorrect.
Choice 3: Brachytherapy Score : 0
Choice Feedback:
Incorrect.
Choice 4: Prostatectomy Score : 0
Choice Feedback:
Incorrect.
Choice 5: Goserelin Score : 0
Choice Feedback:
Incorrect.
Question 5 : SC
Question Information:
A 56-year-old man presents to the emergency department with an episode of left-sided renal colic.
During his assessment the medical staff are mindful that some form of surgical intervention might be
required.
Question:
All of the following would be indications for some form of urological surgical intervention EXCEPT?
Choice 1: Ongoing intractable pain despite optimal medical management Score : 0
Choice Feedback:
Incorrect - some form of intervention would be indicated in such circumstances.
Choice 2: Impaired renal function Score : 0
Choice Feedback:
Incorrect. Any delay in treatment might further jeopardise renal function.
Choice 3: Signs of upper urinary tract infection Score : 0
Choice Feedback:
Incorrect. This would merit rapid surgical intervention.
Choice 4: Single left kidney Score : 0
Choice Feedback:
Incorrect. This would merit rapid surgical intervention.
Choice 5: Leukocytes on urine dipstick Score : 1
Choice Feedback:
Correct. This is a very non-specific finding.
Question 6 : SC
Question Information:
Renal stones have a variety of chemical compositions.
Question:
Which one of the following is the most common?
Choice 1: Calcium oxalate Score : 1
Choice Feedback:
Correct.
Choice 2: Calcium phosphate Score : 0
Choice Feedback:
Incorrect.
Choice 3: Uric acid Score : 0
Choice Feedback:
Incorrect.
Choice 4: Cystine Score : 0
Choice Feedback:
Incorrect.
Choice 5: Struvite Score : 0
Choice Feedback:
Incorrect.
Question 7 : SC
Question Information:
Problems related to the overactive bladder can have a variety of treatments.
Question:
All the following are appropriate management options EXCEPT?
Choice 1: Bladder diary and bladder training Score : 0
Choice Feedback:
Incorrect. This is an essential component of management.
Choice 2: Fluid restriction Score : 0
Choice Feedback:
Incorrect. This is an element of management.
Choice 3: Oxybutynin Score : 0
Choice Feedback:
Incorrect.
Choice 4: Tension-free vaginal tape Score : 1
Choice Feedback:
Correct. This is not a component of management of the overactive bladder.
Choice 5: Caffeine restriction/elimination Score : 0
Choice Feedback:
Incorrect.
Question 8 : SC
Question Information:
A 67-year-old woman presents with a six month history of urinary incontinence; her symptoms occurring
most noticeably when she coughs or sneezes. She drinks a glass of wine a day, smokes 10 cigarettes a
day and her BMI is 32. She has hypertension and type II diabetes and takes aspirin, perindopril and
metformin.
Question:
Which one of the following is the most appropriate initial plan of management?
Choice 1: Oxybutynin Score : 0
Choice Feedback:
Incorrect.
Choice 2: Lifestyle modifications and pelvic floor exercises Score : 1
Choice Feedback:
Correct.
Choice 3: Referral to specialist gynae-urologist Score : 0
Choice Feedback:
Incorrect.
Choice 4: Cystoscopy Score : 0
Choice Feedback:
Incorrect.
Choice 5: Urodynamics Score : 0
Choice Feedback:
Incorrect.
Question 9 : SC
Question Information:
A previously well 25-year-old man presents to the emergency department with a 12 hour history of right
testicular pain. His symptoms came on suddenly whilst at church. The pain peaked very quickly but he
felt he must last the bishops' s sermon. Once he got home he took some oxycodone and the pain
started to get settle, so that about 8 hours after the pain first started he was relatively pain-free. He then
noticed his testicle was 'funny shaped' and thought he should get it looked at. The right side of his
scrotum is swollen, with a horizontally-lying, tender testicle with a palpably twisted cord. These findings
are confirmed at operation, where the testicle is black and pulseless.
Question:
Which one of the following is the most appropriate procedure to perform?
Choice 1: Right detorsion, orchiopexy and left sided orchiopexy Score : 0
Choice Feedback:
Incorrect.
Choice 2: Right orchiectomy and left sided orchiopexy Score : 1
Choice Feedback:
Correct.
Choice 3: Right sided orchiectomy Score : 0
Choice Feedback:
Incorrect.
Choice 4: Right detorsion and orchiopexy Score : 0
Choice Feedback:
Incorrect.
Choice 5: Right detorsion and left sided orchiopexy Score : 0
Choice Feedback:
Incorrect.
Question 10 : SC
Question Information:
A 14-year-old boy presents to the emergency department with a two hour history of severe right-sided
testicular pain. Clinically, he has a torsion and the doctor decides to try and de-tort the testis whilst
waiting to get into the operating room.
Question:
Which one of the following situations is he most likely to be dealing with?
Choice 1: An intravaginal laterally torted testis Score : 0
Choice Feedback:
Incorrect.
Choice 2: An extravaginal laterally torted testis Score : 0
Choice Feedback:
Incorrect.
Choice 3: An intravaginal medially torted testis Score : 1
Choice Feedback:
Correct.
Choice 4: An extravaginal medially torted testis Score : 0
Choice Feedback:
Incorrect.
Choice 5: Bilateral torsion Score : 0
Choice Feedback:
Incorrect.
Question 11 : SC
Question Information:
A patient is being counselled for a trans-urethral resection of the prostate. The risks of the procedure
are explained.
Question:
Which one of the following is the most common long-term complication associated with the procedure?
Choice 1: Urinary incontinence Score : 0
Choice Feedback:
Incorrect.
Choice 2: Erectile dysfunction Score : 0
Choice Feedback:
Incorrect.
Choice 3: Retrograde ejaculation Score : 1
Choice Feedback:
Correct
Choice 4: Premature ejaculation Score : 0
Choice Feedback:
Incorrect.
Choice 5: Loss of libido Score : 0
Choice Feedback:
Incorrect.
Question 12 : SC
Question Information:
A 65-year-old man presents with a three week history of the intermittent passage of blood in his urine.
The blood is mixed in with the urine and not associated with any pain. He is otherwise well and not on
any medications. Physical examination is normal. Urine cytology and urine culture are arranged.
Question:
Which one of the following is the most appropriate next step in management?
Choice 1: CT urography Score : 1
Choice Feedback:
Correct.
Choice 2: Transrectal ultrasound guided biopsy of the prostate Score : 0
Choice Feedback:
Incorrect.
Choice 3: Ultrasound of the abdomen and pelvis Score : 0
Choice Feedback:
Incorrect.
Choice 4: Retrograde pyelogram Score : 0
Choice Feedback:
Incorrect.
Choice 5: Cystoscopy Score : 0
Choice Feedback:
Incorrect.
Question 13 : SC
Question Information:
Transitional cell carcinoma of the bladder has a number of risk factors.
Question:
Which one of the following is the most significant?
Choice 1: Smoking Score : 1
Choice Feedback:
Correct.
Choice 2: Family history Score : 0
Choice Feedback:
Incorrect.
Choice 3: Exposure to certain dyes Score : 0
Choice Feedback:
Incorrect.
Choice 4: Schistosomiasis Score : 0
Choice Feedback:
Incorrect. This is an important risk factor for squamous cell carcinoma of the bladder.
Choice 5: Cyclophosphamide chemotherapy Score : 0
Choice Feedback:
Incorrect.
Question 14 : SC
Question Information:
An otherwise well 50-year-old man presents to his general practitioner with issues passing urine. The
GP organises an ultrasound of his renal tract and in addition to an enlarged prostate, the scan shows a
7cm renal cyst with thin septations.
Question:
Which one of the following is the most appropriate management of this renal lesion?
Choice 1: Reassurance Score : 0
Choice Feedback:
Incorrect.
Choice 2: CT scan Score : 1
Choice Feedback:
Correct.
Choice 3: Repeat ultrasound scan in six months Score : 0
Choice Feedback:
Incorrect.
Choice 4: CT-guided biopsy Score : 0
Choice Feedback:
Incorrect.
Choice 5: Hydatid serology Score : 0
Choice Feedback:
Incorrect.
Question 15 : SC
Question Information:
A 50-year-old woman undergoes a total nephrectomy of an upper pole renal lesion. Histology shows
this to be a T3a clear cell carcinoma with invasion into the renal vein.
Question:
Which one of the following ongoing management options would be most appropriate?
Choice 1: Adjuvant radiotherapy Score : 0
Choice Feedback:
Incorrect.
Choice 2: Adjuvant chemotherapy Score : 0
Choice Feedback:
Incorrect.
Choice 3: Regular surveillance with CT imaging Score : 1
Choice Feedback:
Correct.
Choice 4: Targeted immunotherapy Score : 0
Choice Feedback:
Incorrect.
Choice 5: Annual bone scan Score : 0
Choice Feedback:
Incorrect.
Question 16 : SC
Question Information:
A 24-year-old man presents with a three week history of a painless swelling in the right side of the
scrotum. The testis feels firm and is 6 cm diameter. The rest of the physical examination is normal.
Tumour marker studies are performed.
Question:
Which one of the following is the most appropriate next step in management?
Choice 1: Scrotal ultrasound Score : 1
Choice Feedback:
Correct.
Choice 2: Scrotal ultrasound and fine needle aspiration biopsy Score : 0
Choice Feedback:
Incorrect.
Choice 3: CT pelvis and abdomen Score : 0
Choice Feedback:
Incorrect.
Choice 4: CT pelvis, chest and abdomen Score : 0
Choice Feedback:
Incorrect.
Choice 5: Open testicular biopsy Score : 0
Choice Feedback:
Incorrect.
Question 17 : SC
Question Information:
The spermatic cord contains a number of structures.
Question:
It contains all the following EXCEPT which one of the following?
Choice 1: Ilioinguinal nerve Score : 1
Choice Feedback:
Correct.
Choice 2: Vas deferens Score : 0
Choice Feedback:
Incorrect.
Choice 3: Genitofemoral nerve Score : 0
Choice Feedback:
Incorrect.
Choice 4: Testicular artery Score : 0
Choice Feedback:
Incorrect.
Choice 5: Pampiniform plexus Score : 0
Choice Feedback:
Incorrect.
Question 18 : SC
Question Information:
The tumour markers, alpha fetoprotein (AFP), the beta subunit of human chorionic gonadotrophin (bHCG) and lactate dehydrogenase (LDH) have characteristic patterns in the various types of testicular
cancer.
Question:
Which one of the following is the most common pattern for a pure seminomatous germ cell tumour?
Choice 1: Normal AFP, elevated b-HCG, elevated LDH Score : 0
Choice Feedback:
Incorrect.
Choice 2: Elevated AFP, elevated b-HCG, elevated LDH Score : 0
Choice Feedback:
Incorrect.
Choice 3: Normal AFP, normal b-HCG, elevated LDH Score : 1
Choice Feedback:
Correct.
Choice 4: Elevated AFP, elevated b-HCG, normal LDH Score : 0
Choice Feedback:
Incorrect.
Choice 5: Elevated AFP, normal b-HCG, normal LDH Score : 0
Choice Feedback:
Incorrect.
Synopsis
You have now completed the self-assessment and provided you have completed the case studies, you
will be entered into the prize draw once you have filled in the Post-Completion Questionnaire. It is
anticipated that the draw will be made and winners notified by the end of June.
Adelaide
January 2014