Urology quiz

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July 24, 2015

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Question 1
Correct

What is hypospadias?

A Opening of urethra on the ventral surface of the penis

B Opening of urethra on dorsal surface of the penis

C Inflammation of the testicle

D Benign warty growth on genital skin

Question 1 Explanation:
Hypospadias is due to failure of the urethral folds to fuse resulting in an abnormal opening
of the urethra on the inferior/ventral surface of penis. Epispadias is the condition associated
with the opening of urethra on superior/dorsal surface of penis, and it is linked with bladder
exstrophy.
1/7
 Question 2
Wrong

Do varicoceles typically appear on the right side or the left side?

A Right

B Left

Question 2 Explanation:
Varicoceles are caused by the dilation of the spermatic vein due to increased venous
pressure. It is usually left sided because there is an elevated resistance to flow on the left
side as the left gonadal vein drains into the left renal vein compared to the right which
drains into the inferior vena cava. Sometimes it is associated with a left sided renal cell
carcinoma. It causes scrotal enlargement in adults with a classic ‘bag of worms’
appearance. It can lead to infertility due to the increased temperature.

Question 3
Wrong

What type of testicular tumour fits this description? – A homogenous and painless mass
with the absence of haemorrhage. On histology, findings include large cells in lobules with
clear cytoplasm ‘fried egg appearance’.

A Teratoma

B Choriocarcinoma

C Leydig cell tumour

D Seminoma

Question 3 Explanation:
Seminoma fits this description. It is the most common testicular tumour. It is malignant,
metastasises late, responds to radiotherapy and has an excellent prognosis.

Question 4
Correct

What is the grading system for prostatic cancer?

A Breslow thickness

B Bloom Richardson

C Gleason

D Fuhrman

Question 4 Explanation:
The Gleason grading system is used to categorise prostate adenocarcinoma and focusses
on architecture of the tumour. A score of 2 -10 is obtained; the higher the score, the worse
the prognosis.
2/7
 Question 5
Wrong

What is the best description for the area of the prostate that the carcinoma usually affects?

A Posterior and peripheral region

B Anterior and peripheral region

C Periurethral region

D Entire anterior region

Question 5 Explanation:
Prostatic cancer typically arises from the posterior lobe and on the periphery. This is why it
is often asymptomatic as it does not compress the urethra producing no urinary symptoms
at an early stage. The prostate is located anterior to the rectum. Thus, on digital rectal
exam (DRE), a mass can be felt as the posterior and peripheral region is affected.

Question 6
Wrong

What is priapism?

A Inability to void the bladder

B Abnormal curvature of the penis

C Painful erection lasting > 4 hours

D Cyst due to a dilated testicular duct

Question 6 Explanation:
Priapism is a prolonged and painful erection of the penis. Sickle cell disease, trauma and
medications for erectile dysfunction e.g. sildenafil are all potential causes of this condition.
It requires prompt treatment to prevent ischemia. Treatment options include phenylephrine
injection, surgical decompression and corporal aspiration.

Question 7
Wrong

What area does prostate cancer spread to most frequently?

A Brain

B Lung

C Pancreas

D Lumbar spine

Question 7 Explanation:
Metastasis commonly involves the lumbar spine in late stages of the cancer creating
osteoblastic lesions on the bone. It presents as lower back pain. Serum alkaline
phosphatase (ALP) will be raised as well as prostatic specific antigen (PSA).
3/7
 Question 8
Wrong

Are testicular tumours usually biopsied?

A Yes

B No

Question 8 Explanation:
Usually they are not biopsied as there is a high risk of seeding the scrotum. Instead,
investigations include a scrotal ultrasound and blood tests for tumour markers. Treatment is
radical orchiectomy as most testicular tumours are malignant.

Question 9
Wrong

What is the most common congenital male reproductive disorder?

A Hydrocoele

B Testicular torsion

C Peyronie disease

D Cryptorchidism

Question 9 Explanation:
Cryptorchidism is where the person has undescended testis; it can involve one testicle or
both. Testicles are formed in the abdomen and descend into the scrotum during foetal
development. Failure to descend, results in this abnormality. Affected persons have an
increased risk for development of germ cell tumours and infertility. Some cases self-resolve
whereas orchiopexy is done to treat others.

Question 10
Correct

What tumour is characterised by findings of ‘Schiller Duval bodies’ on histology and raised
levels of AFP on blood tests?

A Yolk sac tumour

B Embryonal carcinoma

C Teratoma

D Sertoli cell tumour

Question 10 Explanation:
Yolk sac tumour is the most common testicular tumour in boys. An elevated AFP and
Schiller Duval bodies (resemble glomerulus) are important features to differentiate from the
other types of testicular tumours.

4/7
 Question 11
Wrong

What are risk factors for developing germ cell tumours?

A Orchitis

B Hydrocoele and Varicocele

C Klinefelter syndrome and Cryptorchidism

D Hypospadias and Epispadias

Question 11 Explanation:
Most frequently occur in young men with either Klinefelter syndrome or cryptorchidism.
Cryptorchidism is the failure of the testicle to descend into the scrotum. Klinefelter
syndrome: a chromosomal abnormality (47 XXY) leading to dysgenesis of seminiferous
tubules causing testicular atrophy, gynecomastia, infertility and eunuchoid body shape.

Question 12
Wrong

Is benign prostatic hyperplasia (BPH) a risk factor for prostate adenocarcinoma?

A Yes

B No

Question 12 Explanation:
BPH is not premalignant. It is common in men over the age of 50. It occurs as a result of
hyperplasia of the prostatic periurethral stroma and glands.

Question 13
Wrong

What is the causative agent of condyloma acuminatum?

A Chlamydia trachomatis

B HPV 6 or 11

C HSV

D E-coli

Question 13 Explanation:
Condyloma acuminatum is characterized by the growth of benign genital warts. On
histology, there will be koilocytic change. This condition is caused by HPV type 6 or 11.
Infection with HPV is also a risk factor for development of squamous cell carcinoma of the
penis.

Question 14
Correct

5/7
How does testicular torsion present?

A Sudden pain in the scrotum and an absent cremasteric reflex

B Swelling of the scrotum and fever

C A painless testicular mass that cannot be transilluminated

D ‘Bag of worms’ appearance of the scrotum

Question 14 Explanation:
Testicular torsion is usually seen in adolescents and presents as sudden pain in the
scrotum. On physical examination the cremasteric reflex will be absent. It is caused by the
twisting of the spermatic cord containing the pampiniform plexus, vas deferens and
testicular artery. The blood supply is impaired leading to congestion and necrosis of the
testicle. It is a surgical emergency.
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