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  • Question 1 - If a tumour is found in both lobes of the prostate, without nodal...

    Incorrect

    • If a tumour is found in both lobes of the prostate, without nodal involvement or metastases, a histological grade of G2 and elevated PSA, what is the overall prostatic cancer stage?

      Your Answer: Stage I

      Correct Answer: Stage II

      Explanation:

      The AJCC uses the TNM, Gleason score and PSA levels to determine the overall stage of prostatic cancer. This staging is as follows:

      Stage I: T1, N0, M0, Gleason score 6 or less, PSA less than 10; or T2a, N0, M0, Gleason score 6 or less, PSA less than 10

      Stage IIa: T1, N0, M0, Gleason score of 7, PSA less than 20; or T1, N0, M0, Gleason score of 6 or less, PSA at least 10 but less than 20; or T2a or T2b, N0, M0, Gleason score of 7 or less, PSA less than 20

      Stage IIb: T2c, N0, M0, any Gleason score, any PSA; or T1 or T2, N0, M0, any Gleason score PSA of 20 or more; or T1 or T2, N0, M0, Gleason score of 8 or higher, any PSA

      Stage III: T3, N0, M0, any Gleason score, any PSA Stage IV: T4, N0, M0,any Gleason score, any PSA; or any T, N1, M0,any Gleason score, any PSA; or Any T, any N, M1, any Gleason score, any PSA.

      The patient in this case has a T2 N0 M0 G2 tumour, meaning it belongs in stage II

    • This question is part of the following fields:

      • Pathology
      • Urology
      14.5
      Seconds
  • Question 2 - Out of the given options, which of the following is the most likely...

    Incorrect

    • Out of the given options, which of the following is the most likely diagnosis in a 25-year old gentleman presenting with a testicular germ cell tumour?

      Your Answer: Sertoli cell tumour

      Correct Answer: Embryonal carcinoma

      Explanation:

      Embryonal carcinoma is a non-seminomatous germ cell tumour of the testis, accounting for 25% testicular tumours. Other germ cell tumours include seminoma, teratoma and choriocarcinoma. Embryonal carcinomas are known to occur in men aged 25-35 years, and occasionally in teens. They are rarely seen in ovaries of females. It can spread to the vas deferens and also to the aortic lymph nodes. Embryonal carcinomas are known to have elements of fetal origin such as cartilage. Usually, the main tumour is about 2.5cm long, with an extension of 8-9cm along the testicular cord. Contiguous spread to the testicle is seen in less than 1% cases.

    • This question is part of the following fields:

      • Pathology
      • Urology
      27.9
      Seconds
  • Question 3 - A biopsy is performed on a 67-year-old-man with testicular seminoma; it reveals that...

    Correct

    • A biopsy is performed on a 67-year-old-man with testicular seminoma; it reveals that the tumour affects the tunica vaginalis. The tumour stage in this case is:

      Your Answer: T2

      Explanation:

      The primary tumour staging for testicular seminoma is as follows, according to AJCC guidelines:

      Tis: intratubular germ cell neoplasia (carcinoma in situ)

      T1: tumour limited to testis/epididymis without vascular or lymphatic invasion; the tumour can invade into the tunica albuginea but not the tunica vaginalis

      T2: tumour limited to testis/epididymis with vascular or lymphatic invasion or tumour extending through the tunica albuginea with involvement of the tunica vaginalis

      T3: tumour invading the spermatic cord, with or without vascular/lymphatic invasion

      T4: tumour invading the scrotum, with or without vascular/lymphatic invasion.

      According to these guidelines, the tumour in this case has a T2 stage.

    • This question is part of the following fields:

      • Pathology
      • Urology
      9.3
      Seconds
  • Question 4 - A 30 year old male has a painless and transilluminant swelling at the...

    Correct

    • A 30 year old male has a painless and transilluminant swelling at the upper pole of his left testi. There is a negative cough test. Which of the following is the likely diagnosis?

      Your Answer: Spermatocoele

      Explanation:

      Spermatocele, also known as a spermatic cyst is a cystic mass usually occurring at the upper pole of the testis. Differential diagnosis included hydrocele as both are cystic, painless and transilluminant. Ultrasound is a useful modality. If symptomatic or large, surgical excision can be done.

    • This question is part of the following fields:

      • Pathology
      • Urology
      11.6
      Seconds
  • Question 5 - When a penile tumour invades the subepithelial connective tissue of the penis, what...

    Incorrect

    • When a penile tumour invades the subepithelial connective tissue of the penis, what is its stage?

      Your Answer: T2

      Correct Answer: T1

      Explanation:

      The TNM staging used for penile cancer is as follows:

      TX: primary tumour cannot be assessed

      T0: primary tumour is not evident

      Tis: carcinoma in situ is present

      Ta: non-invasive verrucous carcinoma is present

      T1: tumour is invading subepithelial connective tissue

      T2: tumour is invading the corpora spongiosum or cavernosum

      T3: tumour invading the urethra or prostate

      T4: tumour invading other adjacent structures.

      In this case, the patient has a T1 tumour.

    • This question is part of the following fields:

      • Pathology
      • Urology
      14.9
      Seconds
  • Question 6 - What's the nodal stage of a testicular seminoma if several lymph nodes between...

    Correct

    • What's the nodal stage of a testicular seminoma if several lymph nodes between 2cm and 5cm are found?

      Your Answer: N2

      Explanation:

      According to the American Joint Committee on Cancer (AJCC) 2002 guidelines, the nodal staging of testicular seminoma is the following:

      N0: no regional lymph node metastases

      N1: metastasis with lymph nodes 2 cm or less in their greatest dimension or multiple lymph nodes, none more than 2 cm

      N2: metastasis with lymph nodes greater than 2 cm but not greater than 5 cm in their greatest dimension, or multiple lymph nodes, any one mass greater than 2 cm, but not more than 5 cm

      N3: metastasis with lymph nodes greater than 5 cm in their greatest dimension.

      The patient in this case has N2 testicular seminoma. This TNM staging is extremely important because treatment options are decided depending on this classification.

    • This question is part of the following fields:

      • Pathology
      • Urology
      17.5
      Seconds
  • Question 7 - If a 68-year-old man is diagnosed with a testicular seminoma that reaches the...

    Incorrect

    • If a 68-year-old man is diagnosed with a testicular seminoma that reaches the tunica albuginea and involves the tunica vaginalis, with retroperitoneal lymph nodes greater than 5cm, LDH 1.4 times the reference levels, β-hCG 4250 mIU/ml and AFP 780 ng/ml, what's the clinical stage in this case?

      Your Answer: Stage IIB

      Correct Answer: Stage IIC

      Explanation:

      According to the AJCC, the clinical staging for testicular seminoma is:
      Stage IA: T1 N0 M0 S0
      Stage IB: T2/3/4 N0 M0 S0
      Stage IC: any T N0 M0 S1/2/3
      Stage IIA: any T N1 M0 S0/1
      Stage IIB: any T N2 M0 S0/1
      Stage IIC: any T N3 M0 S0/1
      Stage IIIA: any T any N M1a S0/1
      Stage IIIB: any T any N M0/1a S2
      Stage IIIC: any T any N M1a/1b S3.
      The patient in this case has IIC stage

    • This question is part of the following fields:

      • Pathology
      • Urology
      23.5
      Seconds
  • Question 8 - After finding elevated PSA levels, a 69-year-old man undergoes a needle biopsy and...

    Correct

    • After finding elevated PSA levels, a 69-year-old man undergoes a needle biopsy and is diagnosed with prostatic cancer. What is the stage of this primary tumour?

      Your Answer: T1c

      Explanation:

      The AJCC uses a TNM system to stage prostatic cancer, with categories for the primary tumour, regional lymph nodes and distant metastases:

      TX: cannot evaluate the primary tumour T0: no evidence of tumour

      T1: tumour present, but not detectable clinically or with imaging T1a: tumour was incidentally found in less than 5% of prostate tissue resected (for other reasons)

      T1b: tumour was incidentally found in more than 5% of prostate tissue resected

      T1c: tumour was found in a needle biopsy performed due to an elevated serum prostate-specific antigen

      T2: the tumour can be felt (palpated) on examination, but has not spread outside the prostate

      T2a: the tumour is in half or less than half of one of the prostate gland’s two lobes

      T2b: the tumour is in more than half of one lobe, but not both

      T2c: the tumour is in both lobes

      T3: the tumour has spread through the prostatic capsule (if it is only part-way through, it is still T2)

      T3a: the tumour has spread through the capsule on one or both sides

      T3b: the tumour has invaded one or both seminal vesicles

      T4: the tumour has invaded other nearby structures.

      In this case, the tumour has a T1c stage.

    • This question is part of the following fields:

      • Pathology
      • Urology
      14.9
      Seconds
  • Question 9 - An abnormal opening of the urethra on the under surface of the penis...

    Correct

    • An abnormal opening of the urethra on the under surface of the penis (ventral surface) is known as:

      Your Answer: Hypospadias

      Explanation:

      Hypospadias is the condition where the urethra opens along the underside or ventral aspect of penile shaft. First-degree hypospadias is seen in 50-75% cases, where the urethra open on the glans penis. Second-degree hypospadias is seen in 20% cases where the urethra opens on the shaft, and third-degree in 30% cases with the urethra opening on the perineum. The severe cases are usually associated with undescended testis (cryptorchidism) or chordee, where the penis is tethered downwards and not completely separated from the perineum.

      It is a common male genital birth defect but varying incidences are noted in different countries. There is no obvious inheritance pattern noted. No exact cause has been determined, however several hypotheses include poor response to androgen, or interference by environmental factors.

    • This question is part of the following fields:

      • Pathology
      • Urology
      8.7
      Seconds
  • Question 10 - Difficulty in retracting the foreskin of the penis in an uncircumcised male is...

    Correct

    • Difficulty in retracting the foreskin of the penis in an uncircumcised male is known as:

      Your Answer: Phimosis

      Explanation:

      Phimosis is the inability to fully retract the foreskin of the penis in an uncircumcised male. It can be physiological in infancy, in which it could be referred to as ‘developmental non-retractility of the foreskin. However, it is almost always pathological in older children and men. Causes include chronic inflammation (e.g. balanoposthitis), multiple catheterisations, or forceful foreskin retraction. One of the causes is chronic balanitis xerotica obliterans. It leads to development of a ring of indurated tissue near the tip of the prepuce, which prevents retraction. Contributory factors include infections, hormonal and inflammatory factors. The recommended treatment includes circumcision.

    • This question is part of the following fields:

      • Pathology
      • Urology
      9.6
      Seconds
  • Question 11 - Painful erections along with deviation of the penis to one side when erect...

    Correct

    • Painful erections along with deviation of the penis to one side when erect are seen in which of the following conditions?

      Your Answer: Peyronie’s disease

      Explanation:

      Peyronie’s disease leads to development of fibrous plaques in the penile soft tissue and occurs in 1% of men, most commonly affecting white males above 40 years age. It is a connective tissue disorder named after a French surgeon, François de la Peyronie who first described it. Symptoms include pain, hard lesions on the penis, abnormal curvature of erect penis, narrowing/shortening, painful sexual intercourse and in later stages, erectile dysfunction. 30% cases report fibrosis in other elastic tissues such as Dupuytren’s contractures of the hand. There is likely a genetic predisposition as increased incidence is noted among the male relatives of an affected individual.

    • This question is part of the following fields:

      • Pathology
      • Urology
      11.4
      Seconds
  • Question 12 - Which of the following is the most common germ cell tumour of the...

    Correct

    • Which of the following is the most common germ cell tumour of the testis affecting an adult male?

      Your Answer: Seminoma

      Explanation:

      Germ cell tumours represent 90% of primary tumours arising in the testis. They are broadly divided into seminomas and non-seminomas. Seminomas are the most common testicular germ cell tumour seen in 40% cases. The other non-seminomatous histological subtypes include embryonal (25%), teratocarcinoma (25%), teratoma (5%) and pure choriocarcinoma (1%).

    • This question is part of the following fields:

      • Pathology
      • Urology
      8.4
      Seconds
  • Question 13 - A 25-year old man presented to the clinic with swelling of the penis....

    Correct

    • A 25-year old man presented to the clinic with swelling of the penis. His uncircumcised penis was erythematous and oedematous. The foreskin could not be retracted over the glans. Which of the following agents is the likely cause of his condition?

      Your Answer: Staphylococcus aureus

      Explanation:

      Inflammation of the glans penis is known as balanitis. Associated involvement of the foreskin is then known as balanoposthitis. More likely to occur in men who have a tight foreskin that is difficult to pull back, or poor hygiene.

    • This question is part of the following fields:

      • Pathology
      • Urology
      34.9
      Seconds
  • Question 14 - A patient with testicular seminoma has the following tumour markers: LDH 1.3 times...

    Incorrect

    • A patient with testicular seminoma has the following tumour markers: LDH 1.3 times the reference levels, β-hCG 4500 mIU/ml and AFP 875 ng/ml. What's the serum tumour marker stage in this case?

      Your Answer: S2

      Correct Answer: S1

      Explanation:

      According to AJCC guidelines, the serum tumour marker staging is the following:

      S0: marker studies within normal limits

      S1: lactate dehydrogenase (LDH) less than 1.5 times the reference range, beta-human chorionic gonadotrophin (β-hCG) <5000 mIU/ml, and alpha-fetoprotein (AFP) <1000 ng/ml S2: LDH 1.5–10 times the reference range, β-hCG 5000–50,000 mIU/ml or AFP 1000–10,000 ng/ml S3: LDH greater than 10 times the reference range, β-hCG >50,000 mIU/ml or AFP >10,000 ng/ml.

      According to this, the patient’s tumour belongs to the S1 stage.

    • This question is part of the following fields:

      • Pathology
      • Urology
      12
      Seconds
  • Question 15 - Which of the following is the most accurate test for the diagnosis of...

    Correct

    • Which of the following is the most accurate test for the diagnosis of primary syphilis?

      Your Answer: Dark-field microscopy

      Explanation:

      Primary syphilis is transmitted via sexual contact. Lesions on genitalia, called a chancre occur after an asymptomatic incubation period of 10-90 days (average 21 days) after exposure. This chancre is a typically solitary (can be multiple), firm, painless, ulceration over the skin at the point of exposure to spirochete, seen on penis, vagina or rectum. It heals spontaneously after 4-6 weeks. Local lymphadenopathy can be seen.

      Diagnosis is made by microscopy of fluid from lesion using dark-field illumination, taking care to not confuse with other treponemal disease. Screening tests include rapid plasma regain (RPR) and Venereal Diseases Research Laboratory (VDRL) tests. False positives are known to occur with these tests and can be seen in viral infections like hepatitis, varicella, Epstein-Barr virus, tuberculosis, lymphoma, pregnancy and IV drug use. More specific tests should therefore be carried out in case these screening tests are positive.

      The Treponema pallidum hemagglutination assay (TPHA) and the fluorescent treponemal antibody absorption (FTAABS) test are based on monoclonal antibodies and immunofluorescence and are more specific. However, they can too show false positives with other treponemal diseases like yaws or pinta. Other confirmatory tests include those based on enzyme-linked immunoassays.

    • This question is part of the following fields:

      • Pathology
      • Urology
      11.7
      Seconds
  • Question 16 - Digital rectal examination of a 75-year old gentleman who presented to the surgical...

    Incorrect

    • Digital rectal examination of a 75-year old gentleman who presented to the surgical clinic with urinary retention revealed an enlarged, nodular prostate. PSA was found to be elevated, favouring the diagnosis of prostatic malignancy. Which of the given options is the most common malignant lesion affecting the prostate gland?

      Your Answer: Prostatic intraepithelial neoplasia

      Correct Answer: Adenocarcinoma

      Explanation:

      Prostatic adenocarcinoma is the commonest solid malignancy and non-dermatological cancer in men above 50 years age. Increasing in incidence with age and the highest risk seen in the black population. About 75% of cases are seen in men over 65 years. Other tumours affecting the prostate include undifferentiated prostate cancer, squamous cell carcinoma, and ductal transitional carcinoma, but these occur less commonly. Sarcomas usually affect children. Hormones play a role in the aetiology of prostate adenocarcinoma unlike the other types. Intraepithelial neoplasia is considered a precursor of invasive malignancy.

    • This question is part of the following fields:

      • Pathology
      • Urology
      29.1
      Seconds
  • Question 17 - A 7-year-old boys undergoes a testicular biopsy after a tumour is found in...

    Correct

    • A 7-year-old boys undergoes a testicular biopsy after a tumour is found in his right testis. Elements similar to hair and teeth are found in it. What kind of tumour is this?

      Your Answer: Teratoma

      Explanation:

      A teratoma is a tumour containing tissue elements that are similar to normal derivatives of more than one germ layer. They usually contain skin, hair, teeth and bone tissue and are more common in children, behaving as a benign tumour. After puberty, they are regarded as malignant and can metastasise.

    • This question is part of the following fields:

      • Pathology
      • Urology
      10.8
      Seconds
  • Question 18 - A 22-year old man presented with a mass in his left scrotum which...

    Incorrect

    • A 22-year old man presented with a mass in his left scrotum which was more prominent when standing and felt like a 'bag of worms'. Examination revealed a non-tender mass along the spermatic cord. Also, the right testis was larger than the left testis. What is the likely diagnosis?

      Your Answer: Haematocele

      Correct Answer: Varicocele

      Explanation:

      Varicocele refers to dilatation and increased tortuosity of the pampiniform plexus – which is a network of veins found in spermatic cord that drain the testicle. Defective valves or extrinsic compression can result in outflow obstruction and cause dilatation near the testis. Normal diameter of the small vessels ranges from 0.5 – 1.5mm. A varicocele is a dilatation more than 2mm.

      The plexus travels from the posterior aspect of testis into the inguinal canal with other structures forming the spermatic cord. They then form the testicular veins out of which the right testicular vein drains into the inferior vena cava and the left into the left renal vein.

      It affects 15-20% men, and 40% of infertile males. Usually diagnosed in 15-25 years of age, they are rarely seen after 40 years of age. Because of the vertical path taken by the left testicular vein to drain into left renal vein, 98% idiopathic varicoceles occur on the left side. It is bilateral in 70% cases. Right-sided varicoceles are rare.

      Symptoms include pain or heaviness in the testis, infertility, testicular atrophy, a palpable mass, which is non-tender and along the spermatic cord (resembling a ‘bag of worms’). The testis on the affected side might be smaller.

      Diagnosis can be made by ultrasound. Provocative measures such as Valsalva manoeuvre or making the patient stand up to increase the dilatation by increasing the intra-abdominal venous pressure.

    • This question is part of the following fields:

      • Pathology
      • Urology
      21.8
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Pathology (11/18) 61%
Urology (11/18) 61%
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