7. Tumor of urinary and male-genital system

A1-Type (25 questions)

1. Which of the following does not belong to the histopathological type of renal cell carcinoma in 2004 WHO?

• A. Mucinous tubular and spindle cell carcinoma
• B. Papillary adenocarcinoma
• C. Chromophobe cell carcinoma
• D. Sarcomatoid carcinoma

2. Which of the following is not the manifestation of bladder cancer?

• A. DWI was high signal, and the apparent diffusion coefficient was significantly lower than that of urine
• B. Most of the tumors were found in bladder triangle and bilateral walls
• C. T1w1 shows equal signal or high signal, and t2w1 shows slightly low signal
• D. The first symptom is usually painless gross hematuria

3. Which of the following is the most common symptom of ureteral cancer ?

• A. Frequent urination
• B. Gross or microscopic hematuria
• C. Urgent urination
• D. Dysuria

4. Which of the following is the most reliable test for the diagnosis of renal cell carcinoma？

• A. B-ultrasound
• B. KUB and IVU
• C. Renal arteriography
• D. CT

5. Which of the following is the characteristics of bladder cancer?

• A. Initial hematuria
• B. Terminal hematuria
• C. Painless gross hematuria
• D. Hematuria

6. Which of the following is typical of hematuria in bladder cancer?

• A. Painless gross hematuria
• B. Terminal hematuria with bladder irritation
• C. Initial hematuria
• D. Pain with hematuria

7. Where is the most common metastasis site of prostate cancer?

• A.Liver
• B.Bone
• C.Lung
• D.Bladder
• E.Brain

8. Which of the following types of hematuria should be considered first for bladder tumor?

• A. Painless total hematuria
• B. Terminal hematuria
• C. Post-actively hematuria
• D. Initial hematuria
• E. Severe hematuria with blood clots

9. Initial hematuria indicates where the lesion is located?

• A. Urethra
• B. Bladder
• C. The upper urinary tract
• D. Bladder neck
• E. Trigone of bladder

10. What diseases are most common in painless gross total hematuria?

• A.Urinary tract tumors
• B.Urinary tract infection
• C.Urinary tract stone
• D.Urinary tract anomalies
• E.Urinary tract obstruction

11. Which of the following is a benign renal tumor?

• A. Renal clear cell carcinoma
• B. Nephroblastoma
• C. Renal angiomyolipoma
• D. Renal papillary cell carcinoma
• E. Collecting duct carcinoma

12. What is the earliest clinical manifestation of nephroblastoma (William’s tumor)

• A. Hematuria
• B. Lower back pain
• C. Abdominal mass
• D. Hypertension
• E. Fever

13. Which of the following is the most common cystic disease in human body? A. Renal cyst B. Liver cyst C. Prostate cyst D. Ureter cyst E. Spleen cyst A

14. What is the preferred treatment for non-muscle invasive bladder cancer?

• A. TURBt
• B. Radical cystectomy
• C. Radiotherapy
• D. Chemotherapy
• E. Immunotherapy

15. What is the preferred treatment for muscle invasive bladder cancer?

• A. TURBt
• B. Radical cystectomy
• C. Radiotherapy
• D. Chemotherapy
• E. Immunotherapy

16. What is the examination with the highest accuracy rate to diagnose prostate cancer?

• A. Serum PSA level
• B. DRE
• C. MR of prostate
• D. Transrectal ultrasound
• E. Prostate biopsy

17. Which area of the prostate is the main site of prostate cancer?

• A. Transition zone
• B. Central zone
• C. Peripheral zone
• D. Urethral zone
• E. Anterior fibromuscular stroma

18. Total hematuria indicates where the lesion is located?

• A. Urethra
• B. Prostatic Urethra
• C. The upper urinary tract
• D. Bladder neck
• E. Trigone of bladder

19. What is the first choice examination for renal tumor?

• A. X -ray examination
• B. Ultrasonic examination
• C. CT examination
• D. MR examination
• E. Endoscopic examination

20. What is the preferred treatment for kidney cancer smaller than 4cm?

• A. Nephron sparing surgery
• B. Radical nephrectomy
• C. Radiotherapy
• D. Chemotherapy
• E. Immunotherapy

21. What kind of disease is the first consideration for infants with kidney tumor?

• A. Renal cell carcinoma
• B. Renal AML
• C. Polycystic kidney disease
• D. Wilms tumor
• E. Renal pelvis cancer

22. When a high suspicion of prostate cancer is indicated, the serum PSA should be greater than__.

• A. 4 ng/L
• B. 10 ng/L
• C. 20 ng/L
• D. 30 ng/L
• E. 40 ng/L

23. Painless hematuria in middle age should first be considered __.

• A. Upper urinary tract stones
• B. Urological tumor
• C. urinary tract infection
• D. urinary tract malformation
• E. Prostatic hyperplasia

24. Which part of the prostate is the most common site of prostate cancer?

• A. Bilateral lobe
• B. Middle lobe
• C. Transitional zone
• D. Central zone
• E. Peripheral zone

25. A 40-year-old female was found to have 2 × 3cm solid masses occupying in her left kidney by ultrasound during a physical examination. In order to further confirm the diagnosis, which of the following examination is most helpful?

• A. CT
• B. Urine cytology for malignant cells
• C. excretory urography
• D. Nuclear renin imaging
• E. Retrograde pyelogram

A4-Type (20 questions)

• Male, 56 years old, intermittent whole course gross hematuria with irregular blood clots and mild bladder irritation symptoms for more than 1 year. Weight loss of about 5kg since illness B-ultrasound showed that there was a space occupying lesion with a diameter of 5cm on the left wall of bladder, invading the bladder wall almost to the whole layer, and the lower segment of left ureter was dilated. General examination after admission: normal temperature, pulse 70 times / min, respiration 18 times / min, blood pressure 24 / 12kpa.

1. The most helpful diagnostic items for bladder cancer are

• A. Urine cytology
• B. Cystoscopy
• C. Intravenous urography
• D. Urine culture
• E. Radionuclide renogram

2. The most suitable treatment is

• A. transurethral resection of bladder tumor
• B. partial cystectomy
• C. Transurethral laser resection
• D. Total cystectomy, urinary diversion
• E. Intravesical chemotherapy and drug infusion

3. The most suitable treatment is

• A. Transurethral resection of bladder tumor
• B. partial cystectomy
• C. Transurethral laser resection
• D. Total cystectomy, urinary diversion
• E. Intravesical chemotherapy and drug infusion

• Female, 58 years old, intermittent painless gross hematuria for more than 2 months. No abnormality was found in physical examination. B-ultrasound examination showed that “there is a hypoechoic mass with a diameter of 4.5cm in the middle and lower part of the right kidney”

4. The most likely abnormality of this patient during intravenous nephrography is

• A. Right hydronephrosis
• B. The right kidney does not develop
• C. Delayed development of right kidney
• D. The middle and lower calices of the right kidney are elongated and displaced
• E. The middle and lower calices of the right kidney are irregular, showing insect erosion like changes

5. The diagnosis is most likely

• A. Renal cell carcinoma
• B. Carcinoma of renal pelvis
• C. Renal cyst
• D. Renal hamartoma
• E. Nephroblastoma

6. Which of following operation mode should be selected ?

• A. Removal of right renal tumor
• B. Right partial nephrectomy
• C. Right kidney and partial ureterectomy
• D. Excision of right kidney, perirenal fat sac andHilar lymphadenectomy
• E. Sleeve resection of right kidney, right ureter and bladder near the orifice

7. No tumor metastasis was found during the operation. The first choice of treatment after operation is

• A. Adjuvant chemotherapy
• B. Adjuvant radiotherapy
• C. Traditional Chinese medicine
• D. Immunotherapy
• E. Clinical observation

• A 35 years old woman with persistent hypertension 24 / 16kpa (180/120mmhg), no obvious paroxysmal sharp rise in blood pressure, polyuria at ordinary times, polyuria at night, fatigue of limbs, inconvenient movement, suspected urinary tract infection, taking a variety of antibiotics, traditional Chinese medicine and general antihypertensive drugs have no obvious effect, and the similar situation has been more than years. Admission inspection: normal blood routine, urine culture: no bacterial growth, blood electrolyte: K +: 2.9mmol/L, Na +: 1 48mmol/L, total CO2: 38mmol /L, residual alkali: 5mmol/L, blood glucose: 6.0mmol/L, urea nitrogen: 9.3mmol/L, B-ultrasound: there is a left adrenal gland with a size of 1.6cm × 1.5cm space occupying lesion, initially diagnosed as left adrenocortical tumor, and the proposed treatment scheme is surgical treatment.

8. What kind of drugs are used for preoperative preparation 1 to 2 weeks before operation?

• A. Blood transfusion and rehydration
• B. Receptor stimulant
• C. Supplement potassium ion solution or spironolactone diuretic
• D. Use α Receptor stimulants
• E. use of corticosteroids

9. What treatment do you choose ?

• A. Total left adrenalectomy
• B. Left adrenal tumor resection
• C. Double adrenalectomy + corticosteroid replacement therapy
• D. Total left adrenalectomy + partial right adrenalectomy
• E. Non-surgical drug therapy

10. This patient may have

• A. Adrenal reticular zone cortical adenoma
• B. Adrenal fascicular zone cortical adenoma
• C. Adrenal globular zone cortical adenoma
• D. Adrenal medullary hyperplasia
• E. Adrenocortical hyperplasia

• Male, 56 years old, intermittent whole course gross hematuria for more than 1 year. Hematuria is accompanied by irregular small blood clots and mild bladder irritation symptoms, no fever, and the weight loss is about 3kg. B-ultrasound revealed a diameter 4cm tumor on the left wall of the bladder. The invasion of the bladder wall reached almost full thickness, and the upper segment of the left ureter was dilated,suggesting bladder cancer. Physical examination: the temperature is normal.

11. Which of the following is the most helpful examination for bladder cancer?

• A. Urine cytology
• B. Intravenous urography
• C. Urine culture
• D. Cystoscopy
• E. Radionuclide renogram

12. The most appropriate treatment for this patient is

• A. Transurethral resection of bladder cancer

• B. Partial cystectomy

• C. Total cystectomy and urinary diversion

• D. Transurethral laser resection of bladder tumor

• E. Intravesical infusion of chemical drugs

• Male, 51 years old, who was healthy in the past and had two times of gross hematuria in recent 4 months. CT examination found solid space occupying lesions in the right renal parenchyma and right renal vein. The outpatient was admitted to the hospital with “right renal cancer and right renal vein embolism”

13. Which of the following medical history is least likely to exist?

• A. Fever
• B. Low back pain
• C. Frequent urination
• D. Emaciation
• E. Hemoptysis

14. The patient also had inferior vena cava thrombosis. The signs reflecting this situation should be

• A. Anemia appearance
• B. Hypertension
• C. Right upper abdominal mass
• D. Right varicocele
• E. Right lower limb paralysis

15. KUB + IVP showed that the right renal collecting system was compressed and deformed, the right ureter was normal, the morphology and function of the left kidney was normal, the left ureter was normal, the bladder was normal, and B-ultrasound: the hepatobiliary membrane and spleen were normal. Which of the following examinations is essential to further diagnosis?

• A. Renal CT
• B. Chest anteroposterior and lateral film
• C. Cystoscopy
• D. Renal arteriography
• E. Right retrograde nephrography

• Male, 66 years old. Painless gross hematuria with strip blood mass for 2 months. B-ultrasound showed mild hydronephrosis in the left kidney. No cancer cells were found in 2 times cytological examinations.

16. Which of the following tests is most valuable for further diagnosis and treatment

• A. Blood routine, liver and kidney function
• B. Urography and excretory urography
• C. Cystoscopy
• D. Cystography
• E. MRI

17. If there seems to be a filling defect in the left renal pelvis, urine cytology is suspicious cells. Which of the following is the most reasonable inspection?

• A. CT
• B. MRI
• C. IVU
• D. Left renal retrograde angiography
• E. Left renal puncture angiography

• Patient, male, 53 years old. In the past week, there was no inducement, terminal hematuria 3 times, no fever, no frequent urination, urinary pain and other discomfort. Smoking for 20 years. Chest X-ray showed old pulmonary tuberculosis with a large number of red blood cells by uroscopy.

19. The most likely diagnosis for this patient is

• A. Acute nephritis
• B. Bladder cancer
• C. Renal cell carcinoma
• D. Renal tuberculosis

20. What is most helpful for the patient to make a clear diagnosis?

• A. Urine cytology
• B. Intravenous urography
• C. B-ultrasound of urinary tract
• D. Cystoscopy

X-Type (5 questions)

1.Familial renal cell carcinoma mainly includes

• A. VHL syndrome
• B. Hereditary papillary renal cancer
• C. Hereditary leiomyomatosis renal cell carcinoma
• D. BHD syndrome

2. Which of the following are absolute indications for nephron sparing renal cell carcinoma surgery？

• A. Congenital solitary kidney
• B. Contralateral renal insufficiency or nonfunction
• C. Hereditary renal cell carcinoma
• D. Stage T1b renal cell carcinoma (contralateral renal function normal)

3. Which of the following are indications for bacillus calmette guerin(BCG) intravesical instillation therapy?

• A. T1 G3 bladder tumor (or high-grade urothelial carcinoma)
• B. Carcinoma in situ of bladder
• C. Stage T2 (myometrial invasive) bladder tumor
• D. Multiple and recurrent TaG1 or G2 bladder tumors (or low-grade urothelial carcinoma)

4. Which of the following are Indications for prostate biopsy?

• A. Abnormal images of prostate were found by B-ultrasound, CT or MRI, or nodules were touched by digital rectal examination
• B. FPSA > 10NG / ml
• C. TPSA > 10NG / ml
• D. TPSA is 4-10ng / ml, fPSA / TPSA ratio is abnormal or PSAD value is abnormal

5. Which of the following are Indications of endocrine therapy for prostate cancer?

• A.Patients with urinary incontinence after radical surgery for prostate cancer
• B.Recurrent and metastatic prostate cancer
• C.Adjuvant therapy before radical surgery or radiotherapy for prostate cancer
• D.Patients with localized early prostate cancer, or local progressive prostate can not be operated on

Answer

A1-Type

DCBDC ABAAA BCAAB ECCBA DBBEA

A4-Type

BBEDA DDEAC DCEDA BDEBD

X-Type

ABCD ABC ABD ACD BCD