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  • Question 1 - If a 68-year-old man is diagnosed with a testicular seminoma that reaches the...

    Correct

    • 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 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
      14.2
      Seconds
  • Question 2 - A 22-year old man presented with a mass in his left scrotum which...

    Correct

    • 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: 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
      20.1
      Seconds
  • Question 3 - 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
      3
      Seconds
  • Question 4 - 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
      4.7
      Seconds
  • Question 5 - 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
      11.4
      Seconds
  • Question 6 - A patient with testicular seminoma has the following tumour markers: LDH 1.3 times...

    Correct

    • 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: 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
      10.5
      Seconds
  • Question 7 - 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
      6
      Seconds
  • Question 8 - 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
      7.3
      Seconds
  • Question 9 - 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
      4.7
      Seconds
  • Question 10 - 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 III

      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
      12.2
      Seconds

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Pathology (9/10) 90%
Urology (9/10) 90%
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