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Thread: Urology MCQs/EMQs

  1. #1
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    Thumbs up Urology MCQs/EMQs

    1 Which of the following was not defined as clinical progression in the MTOPS study?

    A Recurrent haematuria
    B Renal failure
    C Increase of 4 points in the AUA symptom score
    D Urinary incontinence
    E Recurrent urinary tract infection

    2 In the PLESS study what is the effect of finasteride on acute urinary retention versus placebo?

    A Reduces retention by 30%
    B Reduces retention by 55%
    C Associated with a risk reduction of 57%
    D Associated with a risk reduction of 50%
    E Reduces rention by 57%

    3 Which of the following is not assessed on the IPSS questionaire?

    A Incomplete emptying
    B Frequency
    C Quality of life
    D Incontinence
    E Straining

    4 What proportion of patients with a flow rate of more than 15mls/sec are obstructed?

    A 25%
    B 30%
    C 35%
    D 65%
    E 40%

    5 What is the bladder outlet obstruction index for a man with a voided volume of 310mls, a Qmax of 13mls/sec and a pdet at Qmax of 90cmH20?

    A 76
    B 72
    C 74
    D 64
    E 82

    6 In the development of BPH which of the following is not a growth stimulating factor?

    A KGF
    B TGFb
    C IGF
    D EGF
    E bFGF

    7 What is the risk of retention in a 70-79 year old with moderate lower urinary tract symptoms?

    A 3 per 1000 person years
    B 9 per 1000 person years
    C 18 per 1000 person years
    D 26 per 1000 person years
    E 34 per 1000 person years

    8 Regarding the natural history of BPH, what is the average decline in peak urinary flow rate?

    A 0.1mls/sec/year
    B 0.2mls/sec/year
    C 0.3mls/sec/year
    D 0.4mls/sec/year
    E 0.5mls/sec/year

    9 What proportion of men age 61-70 have pathological evidence of BPH?

    A 70%
    B 65%
    C 60%
    D 55%
    E 50%

    10 What proportion of men aged 50-59 with BPH have clinical symptoms?

    A 15%
    B 20%
    C 25%
    D 30%
    E 35%

    11 What is the most important predictor of clinical progression in BPH

    A Gland size
    B Symptom severity
    C PSA
    D Age
    E High post-void residual

    12 What is the risk of erectile dysfunction after TURP?

    A 36%
    B 30%
    C 20%
    D 16%
    E 6%

    13 What is the arterial supply of the prostate?

    A Superior vesical artery
    B Obturator artery
    C Inferior vesical artery
    D Inferior epigastric artery
    E External iliac artery

    14 What are the arteries seen after middle lobe resection during a TURP?

    A Capsular arteries
    B Badenoch's arteries
    C Floch's arteries
    D Branches of the internal pudendal artery
    E Branches of the superior vesical artery

    15 What is the embryological origin of the transition zone?

    A Mesoderm
    B Ectoderm
    C Endoderm
    D Mullerian duct
    E Mesonephric duct

    16 Which alpha-blocker has the strongest association with floppy iris syndrome?

    A Alfuzosin
    B Indoramin
    C Prazosin
    D Tamsulosin
    E Doxasosin

    17 How much is serum dihydrotestosteronedoes reduced by dutasteride?

    A 50%
    B 60%
    C 70%
    D 80%
    E 90%

    18 Which adrenoreceptor subtype mediates prostatic smooth muscle contraction?

    A alpha1-a
    B alpha1-b
    C alpha2
    D alpha1
    E alpha1-L

    19 What is the risk reduction for clinical progression with combination treatment in the MTOPS study?

    A 66%
    B 44%
    C 39%
    D 34%

    E 28%

    20 What is the change in symptom score in the placebo arm of the PLESS study?

    A 3.3 increase
    B 1.3 decrease
    C 1.0 decrease
    D 1.3 increase
    E 3.3 decrease

    Answers
    [HIDE]1A
    Clinical progression was defined in the MTOPS study as

    Increase of 4 points in the AUA symptom score
    Acute urinary retention
    Renal failure
    Urinary incontinence
    Recurrent urinary tract infection

    2C
    99(7%) patients in placebo group compared to 42(3%) in finasteride group suffered acute urinary retentionĖ Risk reduction of 57%

    3D The following symptoms are assessed
    incomplete emptying, frequency, intermittency, urgency, weak stream, straining and nocturia. In addition there is a quality of life score

    4B <10mls/sec 90% obstructed, 10-15mls/sec 65%, >15mls/sec 30%

    5D BOOI = pdet@Qmax- 2Qmax

    6B Transforming growth factor beta ihibits epithelial cell proliferation, the other growth factors stimulate cell division and differentiation

    7E This data comes from the Olmstead County Study (required reading) which showed that men aged 70-79 with moderate/severe symptoms had a retention risk of 34.7 /1000 person years

    8B You are required to be aware of the natural history of BPH and the Olmstead study showed an average decline of 0.2mls/sec/year in patients with BPH

    9A This figure comes from Barry et al J Urol 1984 which is a useful paper

    10C Garraway et al Lancet 1991 found that 25% of men with a TRUSS volume of >20mls had an IPSS of >11

    11C A PSA of >1.4ng/ml ids the most important predictor of progression

    12E The national prostatectomy audit quotes a rate of 31% however it appears the risk is much lower. Wasson's TURP vs watchful waiting study found no difference in the rates of ED between the 2 groups and Marberger's BJU 1999 meta-analysis indicated a rate of 6.5%

    13A The inferior vesical artery supplies the prostate-as it approaches the gland it divides into urethral and capsular branches

    14B The arteries seen at 5 and 7 o clock after middle lobe resection are urethral branches of the inferior vesical artery known as Badenoch's arteries. The smaller arteries seen at 2 and 10 clock are known as Floch's arteries

    15A Transition zone arises from mesoderm, peripheral zone arises from endoderm and central zone appears to be embryologically distinct possibly mullerian in origin

    16D Although described as a class effect, the incidence of floppy iris syndrome with tamsulosin is approx 85%-90%

    17E The dual 5ARI reduces serum DHT levels by 90%, the reduction achieved by finasteride is less but this does not appear to translate into an increased clinical effect

    18A The alpha1-a subtype predominates in human stroma and therefore mediates prostatic smooth muscle contraction

    19A The risk reduction for clinical progression is 66% with combination, 39% with doxazosin and 34% with finasteride

    20B Patients in the placebo arm noticed a 1.3 point improvement/decrease in their symptom score versus a 3.3 improvement on finasteride. The fact that symptoms improved on placebo is useful to remember in discussions about treatment in the viva
    [/HIDE]

  2. #2
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    1 What was Kassís proposed criteria for urinary tract infection?

    A > 101 bacteria/ml
    B > 102 bacteria/ml
    C > 103 bacteria/ml
    D > 104 bacteria/ml
    E > 105 bacteria/ml

    2 What was Stamís proposed criteria for urinary tract infection?

    A > 101 bacteria/ml
    B > 102 bacteria/ml
    C > 103 bacteria/ml
    D > 104 bacteria/ml
    E > 105 bacteria/ml

    3 Which of the following types of adhesion molecules is associated with pyelonephritis in the general population?

    A Type I mannose sensitive
    B Dr adhesin
    C Type S pili
    D Type II mannose resistant
    E F adhesin

    4 36 year old man has symptoms of prostatitis, his 4 glass localisation test reveals WBCís in VB3. What is the type of prostatitis?

    A Type IV
    B Type IIIa
    C Type IIIb
    D Type II
    E Type I

    5 What is the first 10mls of urine collected after prostatic massage known as?

    A EPS
    B VB3
    C VB2
    D Midstream urine
    E VB1

    6 Which of the following is not one of the defining factors of the systemic inflammatory response syndrome (SIRS)

    A Temperature >38 o C
    B Respiratory rate >20 breaths/minute
    C White cell count > 15000cells/mm3
    D Pulse > 90 beats/minute
    E PaCO2 < 4.3kPa

    7 What is staphylococcus saprophyticus?

    A Gram negative cocci
    B Anaerobic Gram positive bacilli
    C Aerobic Gram negative bacilli
    D Gram positive cocci
    E Anaerobic Gram negative bacilli

    8 What proportion of hospital-acquired UTIís are caused by E-coli?

    A 40%
    B 50%
    C 65%
    D 75%
    E 85%

    9 Which of the following is not a recognised side-effect of trimethoprim?

    A Tendon damage
    B Rash
    C Worsening hyperkalaemia in patients with renal failure
    D Folate deficiency
    E Stevens-Johnson syndrome

    10 Which of the following is not a recognised cause of epididymo-orchitis?

    A E-coli
    B Chlamydia trachomatis
    C N. gonorrhoeae
    D Mycobacterium TB
    E Amlodipine

    Answers

    [HIDE]1 E > 105 bacteria/ml
    After measuring bacterial counts in women with pyelonephritis and controls Kass proposed contamination can be distinguished from true UTI by a threshold of > 105 bacteria/ml

    2 B > 102 bacteria/ml
    Stam re-evaluated this by examining women with symptoms of UTI and concluded > 102 bacteria/ml was the best criteria with a positive predictive value of 0.88

    3 D Type II mannose resistant
    Type II mannose resistant pili are associated with pyelonephritis. Type I mannose sensitive are associated with lower urinary tract infections, Dr adhesion is associated with paediatric UTI and pyelonephritis in pregnancy, and Type S pili are associated with bacterial dissemination

    4 B Type IIIa inflammatory chronic pelvic pain syndrome, according to the NIH classification

    5 The first 10mls of urine collected after prostatic massage is known as VB3. The 4 glass Stamey localisation test includes VB1-1st 10mls of urine, VB2-MSU, VB3-1st 10mls after prostatic massage and EPS-expressed prostatic secretions

    6C SIRS is defined as 2 or more of the following

    Temperature >38 o C or <36 o C
    Respiratory rate >20 breaths/minute or PaCO2 < 4.3kPa
    White cell count > 12000cells/mm3 or <4000cells/mm3
    Pulse > 90 beats/minute

    7D Staphylococcus saprophyticus causes approx 10% of symptomatic UTIís in young women

    8B E-coli is responsible for 50% of hospital-acquired UTIís and 85% of community-acquired UTIís

    9A Tendon damage is a recognised complication of treatment with flouroquinolones

    10E Amiodarone not amlodipine is a rare cause of epididymo-orchitis[/HIDE]

  3. #3
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    Concerning antibiotics

    A trimethoprim
    B gentamicin
    C amoxicillin
    D nitrofurantoin
    E ciprofloxacin
    F cefotaxime
    G augmentin
    H cefuroxime

    1 Acts on the alpha subunit of DNA gyrase
    2 If used in pregnancy carries a risk of teratogenesis
    3 Is a dihydrofolate reductase inhibitor
    4 Is a second generation cephalosporin
    5 Binds to the 30S subunit of ribosomal RNA

    The life-cycle of bilharzia

    A Sporocysts
    B Proceroid
    C Schistosomule
    D Cercaria
    E Coracidia
    F Pleroceroid
    G Miracidia

    6 Enter fresh water snails and develop into sporocysts
    7 Produced after cercariae shed their tales
    8 Migrate to the liver
    9 Produced from sporocysts
    10 Released from eggs laid by the adult flukes

    Infections and inflammatory conditions

    A Malacoplakia
    B HIV
    C Xanthogranulomatous pyelonephritis
    D TB
    E Emphysematous pyelonephritis
    F Acute pyelonephritis
    G Pyonephrosis
    H Perinephric abscess

    11 von-Hansemann cells containing Michaelis-Gutmann bodies which are pathognomic
    12 Often associated with underlying renal calculi
    13 Most commonly caused by Proteus
    14 Usually occurs in diabetics
    15 Associated with macrophage dysfunction

    Classification of uropathogens

    A Gram-positive cocci
    B Trematode
    C Gram-negative cocci
    D Tapeworm
    E Nematode
    F Gram-positive anaerobic bacilli
    G Gram-negative aerobic bacilli
    H Gram-negative anaerobic bacilli

    16 Echinococcus granulosus
    17 Mycobacterium tuberculosis
    18 Lactobacillus acidophilus
    19 Enterococcus faecalis
    20 Pseudomonas

    Answers

    [HIDE]1 E Ciprofloxacin acts on the alpha subunit of DNA gyrase to cause DNA unwinding
    2 A
    3 A
    4 H cefuroxime is a 2nd generation cephalosporin, cefotaxime is a 3rd generation cephalosporin
    5 B gentamicin blocks protein synthesis by binding to the 30S subunit of ribosomal RNA

    6 G
    7 C
    8 C
    9 D
    10 G

    Miracidia eggs enter fresh water, swell and release miracidia larvae. These enter fresh water snails to produce sporocysts. Each sporocyst releases 200-400 cercaria which are infected minature worms with a forked tail. The cercariae penetrate unbroken skin and become shistosomules after shedding their tales. They travel to the liver to mature. Mature adults then couple and migrate to vesical veins. Here they lay eggs which penetrate the bladder and enter the urine.

    11A
    12C XGP is usually (but not always) associated with underlying calculi
    13C XGP can also be caused by E-coli but Proteus is more common
    14E The high glucose levels in diabetics provide an ideal environment for fermentation by enterobacteria with the production of CO2. XGP can also occur in diabetics
    15A Macrophages are unable to completely lyse bacteria which are phagocytosed in malacoplakia

    16D
    17I
    18F
    19A
    20G[/HIDE]

  4. #4
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    Thumbs up Imaging and Technology

    1 What is the wavelength of a holmium:YAG laser?

    A 532 nm
    B 2140 nm
    C 980 nm
    D 1650nm
    E 1860 nm

    2 Which of the following is not important in determining radio-sensitivity?

    A DNA repair
    B Re-oxygenation
    C Re-accumulation
    D Re-assortment
    E Re-population

    3 What is the unit for the absorbed dose of radiation?

    A Gray
    B Sievert
    C Rad
    D Roentgen
    E becquerels

    4 Which of the following detects protein on dipstik urinalysis?

    A Peroxidase
    B Red azo dye
    C Indoxyl
    D Tetrabromophenol blue dye
    E Diazonium salt

    5 What is the approximate mortality rate associated with non-ionic contrast media?

    A 1/200,000
    B 1/100,000
    C 1/50,000
    D 1/25,000
    E 1/10,000

    6 Which of the following types of diuretic renogram curve refers to a system which is dilated without obstruction?

    A Type IV
    B Type IIIa
    C Type IIIb
    D Type II
    E Type I

    7 When referring to adrenaline what does a 1 in 10,000 solution equate to?

    A 10 mg per 10 ml
    B 1 mg per ml
    C 10 mg per ml
    D 0.1mg per ml
    E 1mg per 100ml

    8 What frequency of transducer is used during transrectal ultrasound?

    A 3.5 MHz
    B 4.5 MHz
    C 5.5 MHz
    D 6.5 MHz
    E 7.5 MHz

    9 What is the "French" or "Charriere" guage equal to?

    A Circumference in mm
    B Circumference multiplied by 3 in mm
    C Diameter in mm
    D Circumference in cm
    E Diameter multiplied by 3 in mm

    10 Which of the following statements regarding JJ stents is correct?

    A Stents aid stone passage
    B Stents increase intrarenal pressures
    C A nephrostomy is better for the relief of an obstructing stone with infection
    D Stents lower intrarenal pressure
    E Stents are extremely effective at relieving obstruction from extrinsic compression

    11 What stage of chronic kidney disease has a patient with an estimated GFR of 26ml/min/1.73m2?

    A Stage 4
    B Stage 1
    C Stage 3
    D Stage 5
    E Stage 2

    12 What is the 1 year graft survival following living-donor kidney transplantation?

    A 95%
    B 90%
    C 80%
    D 70%
    E 65%

    13 What is the most common new tumour in recipients after transplantation?

    A Renal
    B Lung
    C Lymphoproliferative
    D Skin
    E Cervical

    14 Which of the following immunosuppresive agents is associated with diabetes?

    A Mycophenolate mofetil
    B Cyclosporine A
    C Tacrolimus
    D Azathioprine
    E Sirolimus

    15 What is the radiation dose in mSv associated with a CTKUB?

    A 1.0
    B 2.5
    C 3.0
    D 4.7
    E 10

    16 Which of the following best describes the thin descending limb of the loop of Henle?

    A Impermeable to water
    B Permeable to water and less permeable to sodium, chloride and urea
    C Impermeable to water, highly permeable to sodium and chloride and slightly permeable to urea
    D Permeable to water, sodium, chloride and urea
    E Impermeable to water and urea with sodium and chloride actively reabsorbed

    17 What is the typical Hounsfield unit for fat on CT?

    A +300
    B +40
    C 0
    D -50
    E -1000

    18 Which drug trial phase primarily assesses the safety of a drug?

    A Phase IV
    B Phase III
    C Phase II
    D Phase I
    E Phase 0

    19 How is leucocyte esterase detected by dipstik urinalysis?

    A Peroxidase
    B Red azo dye
    C The production of indoxyl and oxidation of a diazonium salt
    D Tetrabromophenol blue dye
    E Double oxidation reaction

    20 What is the normal amount of protein excreted by the kidney?

    A 50-80 mg/day
    B 80-150 mg/day
    C 150-200 mg/day
    D 200-230 mg/day
    E 230-250 mg/day

    Answers

    [HIDE]1B
    2C
    The "four R's" which determine radiosensitivity are repair, re-oxygenation, re-assortment and re-population

    3A
    In SI units, the activity of a radioactive source is measured in becquerels (symbol Bq). The absorbed dose of ionizing radiation is measured in grays (symbol Gy) where one gray is equal to one joule of energy being imparted to one kilogram of matter (the rad is the previously used unit). The dose equivalent, which is a measure of the effects of radiation on living organisms, is measured in sieverts (symbol Sv)

    4D
    5A
    6B
    Type IV Delayed double peak pattern (Homsey)
    Type IIIa Dilated without obstruction
    Type IIIb Equivocal
    Type II Obstructed
    Type I Normal

    7D 1 in 10,000 or 1mg per 10ml adrenaline solution is often used during cardiace arrest in prepared syringes. A 1 in 1000 or 1mg per ml adrenaline solution is often used IM for anaphylactic reactions.

    UrologyUK comment: Although this seems like a fairly non-urological question there are a significant number of everyday clinical MCQ's and EMQ's in the exam.

    8E A 7.5Mhz biplane probe is used for TRUS

    9E
    The French guage is equal to the diameter of the tube multiplied by 3 in mm, not as is often thought the circumference in mm. However, remember that the circumference is diameter multiplied by Pi (3.14) so it is nearly correct!!

    10B
    Stents paralyse peristalsis and therefore do not aid stone passage. They increase intrarenal pressures. Pearle, M; J Urol 1998 demonstrated that there was no difference in recovery between patients treated with nephrostomy vs JJ stent. JJ stents are less effective at relieving obstruction from extrinsic compression.

    11A
    12B
    1 year graft survival for living donor nephrectomy is 95% with HLA-identical siblings, 90% for 1-haplotype-identical related donor and 80% for cadaveric kidneys

    13D
    The approximate distribution of new cancers is renal 5%, lung 5%, lymphoproliferative 11%, skin 40% and cervical 4%

    14C
    Tacrolimus is nephrotoxic and in approximately 20% of patients causes diabetes

    15D

    16B
    The thin descending limb is best described by B, the thin ascending limb is best described by C and the thick ascending limb best described by E

    17D
    Substance Hounsfield Unit
    Air -1000
    Fat -50
    Water 0
    Soft tissue (eg muscle) +40
    Calculus +100 to +400
    Bone +1000

    18D
    Phase IV - Post-launch safety surveillance
    Phase III - Randomised control trial
    Phase II - Assesses how well the drug works as well as continued safety
    Phase I - Assesses safety
    Phase 0 - First human trial - does it behave in humans as expected

    19C
    Leucocyte esterase catalyses the production of indoxyl which oxidises a diazonium salt leading to a colour change

    20B Normal excretion is 80-150 mg/day[/HIDE]

  5. #5
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    Embryology

    A 2 weeks
    B 32 days
    C 7 weeks
    D 42 days
    E 36 weeks
    F 5 weeks
    G 9 weeks
    H 3 months
    I 21 days
    J 6 weeks
    K 4 weeks

    1 Nephrogenesis complete
    2 Pronephros arises from intermediate mesoderm
    3 Testosterone production from the Leydig cells commences
    4 Ureteric buds arise from the mesonephric ducts
    5 Paramesonephric ducts appear
    6 Sertoli cells begin to produce anti-Mullerian hormone
    7 Formation of the prostate commences

    General paediatric urology

    A 10%
    B 17%
    C 20%
    D 80%
    E 30%
    F 33%
    G 45%
    H 1%

    8 Percentage of patients with BXO with glans involvement
    9 Percentage of patients with multicystic dysplastic kidney with VUR in the contralateral kidney
    10 Proportion of patients with PUJ obstruction who undergo a pyeloplasty
    11 Proportion of term children with undescended testes at 1 year
    12 Proportion of patients with posterior urethral valves with long-term renal dysfunction
    13 Proportion of ureteroceles associated with an upper pole duplex system

    Disorders of sexual differentiation/intersex

    A 21 hydroxylase deficiency
    B Autosomal dominant
    C 50%
    D Over-virilised female
    E Autosomal recessive
    F 17-OH progesterone
    G Mixed gonadal dysgenesis
    H True hermaphrodite
    I 95%
    J 11B-hydroxylase
    K 85%

    14 Proportion of patients with disorders of sexual differentiation/intersex in which the underlying disorder is congenital adrenal hyperplasia (CAH)
    15 Proportion of CAH-patients with salt-losing crisis
    16 Raised serum levels indicate CAH
    17 The most common cause of CAH
    18 The inheritance pattern of the most common cause of CAH
    19 Associated with palpable gonads and an abnormal sex chromosome karyotype

    Vesicoureteric reflux

    A 10%
    B 50%
    C 3:1
    D Grade 3
    E 30%
    F 60%
    G 5:1
    H 2:1
    I Grade 2
    K Grade 4

    20 Proportion of patients with a family history
    21 The grade of reflux with contrast passing into ureter, pelvis and calyces with no dilatation
    22 Proportion of patients with VUR who have renal scarring on presentation
    23 Submucosal tunnel to ureter diameter ratio (Paquinís law)
    24 Grade of VUR with a slightly tortuous ureter, with moderate dilatation of pelvis and blunting of calyces

    Answers

    [HIDE]1E, 2K, 3G, 4F, 5J, 6C, 7H

    8C, 9E
    10B This figure comes from Dhillon HK. Great Ormond Street Experience BJU 1998
    11H
    12F Which is why patients should be followed up into adolescence
    13E

    14K It is responsible for 85% of intersex disorders overall and 95% of cases of female pseudohermaphroditism/over-virilised female
    15C
    16F, 17A, 18E 21 hydroxylase deficiency is inherited in an autosomal recessive fashion and is the most common cause of CAH. It catalyses the conversion of 17-OH progesterone to 11-deoxycortisol, its absence therefore results in an increase in 17-OH progesterone levels
    19G Mixed gonadal dysgenesis is a spectrum of gonadal and genital abnormalities associated with absence of the 1 of the pair of sex chromosomes

    20E, 21I, 22E
    23G The Leadbetter-Politano anti-reflux submucosal tunnel should have a tunnel length to ureter diameter ratio of 5:1 (Paquin A. J Urol. 1959; 82: 573)
    24K

    International Reflux Classification

    Grade 1 Contrast into a non-dilated ureter
    Grade II Ė reflux into the renal pelvis and calyces without dilatation
    Grade III Ė mild/moderate dilatation of the ureter, renal pelvis and calyces
    Grade IV Ė dilation of the renal pelvis and calyces with moderate ureteral tortuosity Grade V Ė gross dilatation and tortuosity of the ureter, pelvis and calyces[/HIDE]

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    Hereditary renal cancer

    A VHL syndrome
    B Birt-Hogg-Dube
    C Short arm of chromosome 7
    D Hereditary renal cell carcinoma syndrome
    E Hypoxia-inducible factor
    F X-linked
    G Short arm of chromosome 3
    H Hereditary leiomyomatosis and renal cell cancer syndrome (HLRCC)
    I Fumarate hydratase
    J Hereditary papillary renal carcinoma syndrome(HPRC)
    K VEGF

    1 Associated with type 2 papillary renal cell carcinoma
    2 Associated with loss of 2 copies of a tumour suppressor gene
    3 Location of the VHL gene
    4 Associated with chromophobe RCC
    5 The causative gene is the proto-oncogene c-MET
    6 Inhibited by the VHL gene product

    Pathology

    A Adenocarcinoma
    B Squamous cell carcinoma
    C Papillary carcinoma
    D Carcinoma in situ
    E Sarcoma
    F Oncocytoma
    G Conventional
    H Chromophobe
    I Transitional cell carcinoma
    I Medullary cell
    J Angiomyolipoma

    7 Arises from calyceal epithelium
    8 Associated with sickle-cell
    9 Do not require follow-up
    10 Wunderlich's syndrome occurs in up to 10% of cases
    11 80% occur sporadically
    12 Have a mahogony appearance and a spoke-wheel appearance on CT
    13 The most common histological type of RCC

    Immunotherapy/Chemotherapy

    A Thiotepa
    B Sorafenib
    C Mitomycin
    D Intravesical Bacille-Calmette-Guerin
    E Sunitinib
    F Doxorubicin
    G Temsirolimus
    H Methotrexate
    I Taxanes

    14 Interfere with the mitotic spindle
    15 Cross-linking agent which inhibits DNA synthesis
    16 Local immune-stimulant
    17 Effective in the M-phase of the cell cycle
    18 Has shown benefit versus placebo after failed prior immunotherapy in metastatic RCC
    19 Antimetabolite
    20 Has shown benefit over interferon as a first line agent in metastatic RCC

    Answers

    [HIDE]1H
    2A
    3G
    4B
    5J
    6E The VHL gene product destabilises HIF-1a and HIF-2a which in turn prevent overexpression of VEGF


    7I Medullary RCC's are thought to arise from calyceal epithelium
    8I Medullary RCC's are associated with sickle-cell and carry a poor prognosis
    9F Straight forward oncocytomas require no follow-up
    10J Life-threatening retroperitoneal haemorrhage occurs in up to 10% of patients with AML's , and is known as Wunderlich's syndrome
    11J 80% of AML's occur sporadically and 20% occur in association with tuberous sclerosis
    12F Oncocytoma's characteristically have a brown/tan appearance and a spoke-wheel appearance on CT due to their central stellate scar
    13G Conventional RCC includes clear-cell and granular-cell and is the most common histological subtype

    14I Taxanes are spindle-tubule inhibitors and interfere with the mitotic spindle
    15C Mitomycin is an antibiotic chemotherapeutic agent which is a cross-linking agent and inhibits DNA synthesis
    16D The mechanism of action of intravesical BCG is unclear but it appears to be an immune stimulant, activating dendritic cells and upregulating cytokines in the bladder wall
    17I As taxanes interfere with mitosis they are active in the M-phase
    18B This was demonstrated by the Target Study NEJM 2007
    19H Antimetabolites include methotrexate and gemcitibine
    20E This was demonstrated by Motzer's phase III trial in NEJM 2007[/HIDE]

  7. #7
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    Default where is the answers

    Quote Originally Posted by mohammed155 View Post
    thank you
    i could not get the answers

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    Default me too

    Quote Originally Posted by mohammed155 View Post
    i could not get the answers
    ..i also cud not get ...

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    Default

    got it ...thanks a lot .. keep feedin in more questions...

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    Default

    Quote Originally Posted by mohammed155 View Post
    i could not get the answers
    to see the answers u have to click the thanks button below the post...

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