Thread: 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 retention– 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]

1 What was Kass’s 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 Stam’s 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 WBC’s 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 UTI’s 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 UTI’s in young women

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

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

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

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]

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]

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 (Paquin’s 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 – reflux into the renal pelvis and calyces without dilatation
Grade III – mild/moderate dilatation of the ureter, renal pelvis and calyces
Grade IV – dilation of the renal pelvis and calyces with moderate ureteral tortuosity Grade V – gross dilatation and tortuosity of the ureter, pelvis and calyces[/HIDE]

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]

Originally Posted by mohammed155

thank you

i could not get the answers

Originally Posted by mohammed155

i could not get the answers

..i also cud not get ...

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

Originally Posted by mohammed155

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