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ABU URPS practice questions

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Question 1General Urology and Office Practice

A 62-year-old man has a serum PSA of 5.8 ng/mL and a normal digital rectal examination. Which factor most strongly increases the likelihood that his elevated PSA reflects prostate cancer rather than benign prostatic enlargement?

  1. Patient age above 60 years
  2. A single mildly elevated value with stable readings
  3. Presence of nocturia and weak stream
  4. A rising PSA velocity over serial measurements Correct answer.

Explanation

Serial PSA kinetics, particularly a rapid rate of rise, add predictive value beyond a single value because benign enlargement typically produces slow changes. A single stable value and lower urinary tract symptoms are common in benign disease and do not discriminate well. Age raises baseline risk but is a weaker discriminator than PSA velocity.

Question 2General Urology and Office Practice

Which organism is the most common cause of uncomplicated community-acquired urinary tract infection in adult women?

  1. Escherichia coli Correct answer.
  2. Klebsiella pneumoniae
  3. Staphylococcus saprophyticus
  4. Proteus mirabilis

Explanation

Escherichia coli accounts for the large majority of uncomplicated community-acquired cystitis in women. Proteus and Klebsiella are more associated with complicated infections or stone disease, and S. saprophyticus is a distant second in young sexually active women.

Question 3General Urology and Office Practice

A 30-year-old man has sudden severe left flank pain radiating to the groin with microscopic hematuria. Non-contrast CT shows a 4-mm distal ureteral stone with mild hydronephrosis. He is afebrile with controlled pain. What is the most appropriate initial management?

  1. Observation with analgesia and medical expulsive therapy consideration Correct answer.
  2. Extracorporeal shock wave lithotripsy
  3. Ureteroscopy with stone extraction
  4. Percutaneous nephrostomy

Explanation

Small distal ureteral stones under 5-6 mm have a high likelihood of spontaneous passage, so observation with analgesia is first-line in the absence of infection or refractory pain. Intervention is reserved for failure of passage, sepsis, or uncontrolled symptoms.

Question 4General Urology and Office Practice

Which finding on urinalysis most specifically suggests a upper urinary tract source rather than bladder inflammation?

  1. Alkaline urine pH
  2. Positive leukocyte esterase
  3. Presence of white blood cell casts Correct answer.
  4. Microscopic hematuria

Explanation

White blood cell casts form within renal tubules and therefore indicate inflammation originating in the kidney, such as pyelonephritis or interstitial nephritis. Leukocyte esterase, hematuria, and pH changes can arise from bladder or systemic factors and are less localizing.

Question 5General Urology and Office Practice

A 70-year-old man with benign prostatic hyperplasia has an IPSS of 22 and a post-void residual of 250 mL. Which finding most strongly indicates that watchful waiting is inadequate?

  1. Detrusor overactivity on filling
  2. Nocturia twice nightly
  3. Elevated post-void residual volume Correct answer.
  4. Age over 65 years

Explanation

A large post-void residual signals bladder outlet obstruction with incomplete emptying and raises risk of retention, infection, and renal deterioration, favoring active treatment. Age, nocturia, and detrusor overactivity alone do not mandate intervention.

Question 6General Urology and Office Practice

Which medication class is most commonly associated with acute urinary retention in older men with prostatic enlargement?

  1. Beta-blockers
  2. Proton pump inhibitors
  3. Thiazide diuretics
  4. Anticholinergic agents Correct answer.

Explanation

Anticholinergic drugs impair detrusor contractility and are a well-recognized precipitant of acute retention in men with outlet obstruction. Beta-blockers, proton pump inhibitors, and thiazides do not have this prominent effect.

Question 7General Urology and Office Practice

A 25-year-old woman has recurrent dysuria and frequency with urine cultures repeatedly sterile and no growth on standard media. Which diagnosis should be considered?

  1. Genital herpes
  2. Interstitial cystitis Correct answer.
  3. Urethral diverticulum
  4. Acute bacterial cystitis

Explanation

Sterile urine cultures with chronic irritative voiding symptoms suggest a non-infectious cause such as interstitial cystitis, especially after infection is excluded. Bacterial cystitis would grow organisms, and diverticulum or herpes usually produce structural or visible lesions.

Question 8General Urology and Office Practice

Which is the most appropriate initial imaging study for a patient with painless gross hematuria and normal renal function?

  1. Plain abdominal radiograph
  2. Renal ultrasound alone
  3. Retrograde urethrography
  4. Multiphasic CT urography Correct answer.

Explanation

CT urography evaluates the upper tracts and bladder for stones, tumors, and structural lesions and is the preferred initial study for painless gross hematuria in adults with normal renal function. Ultrasound alone is less sensitive for urothelial lesions, and plain films and urethrography address different questions.

Question 9General Urology and Office Practice

A 45-year-old man presents with a painless, firm testicular mass. Which tumor marker is most likely to be elevated in a pure seminoma?

  1. Lactate dehydrogenase Correct answer.
  2. Beta-hCG
  3. Alpha-fetoprotein
  4. Carcinoembryonic antigen

Explanation

Pure seminomas may elevate beta-hCG or LDH but never alpha-fetoprotein; LDH is a commonly elevated marker reflecting tumor burden. An elevated AFP indicates a nonseminomatous component. CEA is not a testicular tumor marker.

Question 10General Urology and Office Practice

What is the recommended initial management of a hemodynamically stable patient with a blunt scrotal trauma and a small hematocele but an intact testis on ultrasound?

  1. Aspiration of the hematocele
  2. Bilateral orchiectomy
  3. Immediate surgical exploration
  4. Scrotal support, analgesia, and observation Correct answer.

Explanation

When ultrasound shows an intact testis and the patient is stable, conservative management with support and analgesia is appropriate. Exploration is reserved for suspected rupture, expanding hematoma, or instability.

Question 11General Urology and Office Practice

Which finding best distinguishes epididymitis from testicular torsion on physical examination?

  1. Relief of pain with scrotal elevation Correct answer.
  2. Nausea and vomiting
  3. Sudden onset of severe pain
  4. High-riding testis

Explanation

The Prehn sign, relief of pain with elevation of the scrotum, favors epididymitis, whereas torsion typically worsens or does not improve with elevation. Sudden severe pain, nausea, and a high-riding testis are more concerning for torsion.

Question 12General Urology and Office Practice

A 68-year-old man has an elevated PSA of 12 ng/mL and a hard nodule on digital rectal examination. What is the most appropriate next step?

  1. MRI without biopsy
  2. Repeat PSA in 6 months
  3. Trial of antibiotics then recheck PSA
  4. Prostate biopsy Correct answer.

Explanation

A markedly elevated PSA with a palpable hard nodule is highly suspicious for prostate cancer and warrants biopsy. Repeat testing or an antibiotic trial delays diagnosis, and MRI alone does not provide tissue diagnosis.

Question 13General Urology and Office Practice

Which of the following is the most common cause of acute pyelonephritis requiring hospitalization in a patient with an obstructing stone?

  1. Sterile hydronephrosis
  2. Renal vein thrombosis
  3. Glomerulonephritis
  4. Obstruction with infected urine Correct answer.

Explanation

An obstructed, infected collecting system is a urologic emergency because pressure and infected urine lead to rapid parenchymal destruction and sepsis. Sterile hydronephrosis, renal vein thrombosis, and glomerulonephritis do not produce this infectious obstructive picture.

Question 14General Urology and Office Practice

Which parameter is most important when deciding whether a patient can undergo same-day discharge after transurethral resection of the prostate?

  1. Serum PSA level
  2. History of hypertension
  3. Ability to void and adequate hemostasis Correct answer.
  4. Preoperative prostate volume

Explanation

Safe discharge depends on the patient's ability to void and the absence of significant bleeding, which are the immediate postoperative concerns. Prostate volume, PSA, and hypertension history are less directly relevant to same-day readiness.

Question 15General Urology and Office Practice

What is the most common cause of acute urinary retention in a young woman?

  1. Postoperative state
  2. Multiple sclerosis
  3. Pelvic mass
  4. Urinary tract infection Correct answer.

Explanation

In young women, urinary tract infection is the most frequent precipitant of acute retention, likely through urethral inflammation and detrusor irritation. Neurologic disease, pelvic masses, and postoperative states are less common causes in this population.

Question 16General Urology and Office Practice

Which of the following best describes the mechanism of action of tamsulosin in benign prostatic hyperplasia?

  1. 5-alpha reductase inhibition
  2. Muscarinic receptor antagonism
  3. Phosphodiesterase-5 inhibition
  4. Alpha-1 adrenergic receptor blockade Correct answer.

Explanation

Tamsulosin is a selective alpha-1 blocker that relaxes prostatic smooth muscle to improve urine flow. 5-alpha reductase inhibitors shrink gland volume, antimuscarinics target overactive bladder, and PDE-5 inhibitors treat erectile dysfunction.

Question 17General Urology and Office Practice

A 55-year-old man has a serum creatinine of 2.8 mg/dL and bilateral hydronephrosis. Which intervention is most appropriate for relieving the obstruction while preserving renal function?

  1. Increased fluid intake
  2. Oral alpha-blocker therapy
  3. Antibiotic therapy alone
  4. Bilateral ureteral stents or nephrostomy tubes Correct answer.

Explanation

Bilateral obstruction with renal impairment requires prompt decompression, typically with ureteral stents or percutaneous nephrostomy, to preserve renal function. Medical therapy alone does not relieve mechanical obstruction.

Question 18General Urology and Office Practice

Which is the most appropriate treatment for a patient with a symptomatic 8-mm proximal ureteral stone that has not passed after 4 weeks?

  1. Medical expulsive therapy alone
  2. Observation with repeat imaging
  3. Percutaneous nephrostomy
  4. Ureteroscopy or shock wave lithotripsy Correct answer.

Explanation

Stones 8 mm and larger, or those failing to pass after reasonable observation, warrant intervention such as ureteroscopy or shock wave lithotripsy. Continued observation or medical expulsive therapy alone is unlikely to succeed for a stone this size.

Question 19General Urology and Office Practice

A patient reports erectile dysfunction and has a history of radical prostatectomy. Which mechanism best explains his erectile dysfunction?

  1. Venous leak
  2. Psychogenic causes
  3. Cavernous nerve injury Correct answer.
  4. Arterial insufficiency

Explanation

Radical prostatectomy places the cavernous nerves at risk, and their injury is the principal cause of postoperative erectile dysfunction. Venous leak, arterial insufficiency, and psychogenic factors are less directly tied to this surgery.

Question 20General Urology and Office Practice

Which of the following is the most appropriate first-line treatment for premature ejaculation?

  1. Penile prosthesis
  2. Daily tadalafil
  3. Intracavernosal injections
  4. Topical anesthetic agents Correct answer.

Explanation

Topical anesthetics and behavioral techniques are first-line for premature ejaculation. Tadalafil, injections, and prostheses are treatments for erectile dysfunction, not premature ejaculation.

Question 21General Urology and Office Practice

A 40-year-old man has a painless penile ulcer with a clean base and bilateral inguinal lymphadenopathy. Which is the most likely diagnosis?

  1. Genital herpes
  2. Chancroid
  3. Primary syphilis Correct answer.
  4. Lymphogranuloma venereum

Explanation

A painless, indurated ulcer with a clean base and bilateral adenopathy is classic for primary syphilis. Chancroid is painful with a ragged base, herpes produces vesicles and ulcers, and LGV causes painful adenopathy with a small transient ulcer.

Question 22General Urology and Office Practice

Which condition is most strongly associated with the development of squamous cell carcinoma of the penis?

  1. Prior circumcision
  2. Human papillomavirus infection Correct answer.
  3. Phimosis with poor hygiene
  4. Hypospadias

Explanation

HPV infection, particularly types 16 and 18, is strongly associated with penile squamous cell carcinoma. Phimosis and poor hygiene are risk factors, but HPV is the strongest viral association. Circumcision is protective, and hypospadias is unrelated.

Question 23General Urology and Office Practice

A 28-year-old woman has recurrent urinary tract infections, and imaging shows a duplicated collecting system with an upper pole ureter inserting ectopically. Which presentation is most likely?

  1. Gross hematuria with flank pain
  2. Continuous incontinence despite normal voiding Correct answer.
  3. Acute urinary retention
  4. Severe dysuria with fever

Explanation

An ectopic ureter from a duplicated system often inserts below the sphincter, causing continuous incontinence in women despite normal voiding. Retention, hematuria with stones, and febrile dysuria do not fit this anomaly.

Question 24General Urology and Office Practice

Which is the most appropriate initial step in evaluating a patient with suspected acute prostatitis who is systemically unwell?

  1. Watchful waiting
  2. Urine culture and empiric antibiotics Correct answer.
  3. Prostate biopsy
  4. Transrectal ultrasound-guided drainage

Explanation

Acute prostatitis with systemic symptoms requires urine culture and prompt empiric antibiotics; imaging or drainage is reserved for abscess. Biopsy is contraindicated in acute infection, and watchful waiting is unsafe.

Question 25Urologic Oncology

A 62-year-old man has a 3 cm solid enhancing left renal mass with no evidence of metastasis. Which finding most strongly supports partial rather than radical nephrectomy?

  1. Ipsilateral hilar lymphadenopathy on imaging
  2. Tumor confined to the upper pole with normal contralateral kidney Correct answer.
  3. Serum creatinine at the upper limit of normal with a solitary kidney
  4. Presence of a tumor thrombus in the renal vein

Explanation

Partial nephrectomy is preferred for T1 tumors when technically feasible, particularly to preserve renal function. A polar tumor with a normal contralateral kidney is the classic favorable setting, though solitary kidney also favors nephron-sparing surgery.

Question 26Urologic Oncology

Which histologic subtype of renal cell carcinoma is most commonly associated with loss of the VHL gene on chromosome 3p?

  1. Collecting duct
  2. Chromophobe
  3. Papillary
  4. Clear cell Correct answer.

Explanation

Clear cell RCC is characterized by inactivation of the von Hippel-Lindau gene at 3p25 in the majority of sporadic cases, leading to HIF accumulation. Papillary, chromophobe, and collecting duct tumors have different characteristic genetic alterations.

Question 27Urologic Oncology

A patient with muscle-invasive bladder cancer is being counseled on cystectomy versus bladder preservation. Which factor most strongly favors radical cystectomy over trimodality therapy?

  1. Complete transurethral resection of the tumor
  2. Presence of extensive carcinoma in situ and multifocal disease Correct answer.
  3. Patient preference for bladder preservation
  4. A solitary T2 tumor smaller than 3 cm

Explanation

Trimodality therapy requires complete TURBT and is less suitable for multifocal disease or extensive CIS, which carry high recurrence risk. Radical cystectomy is favored in such cases.

Question 28Urologic Oncology

Which agent is the first-line intravesical therapy for induction treatment of high-grade non-muscle-invasive bladder cancer?

  1. Gemcitabine
  2. Valrubicin
  3. Bacillus Calmette-Guérin Correct answer.
  4. Mitomycin C

Explanation

Intravesical BCG is the standard first-line induction therapy for high-risk non-muscle-invasive bladder cancer, reducing recurrence and progression. Mitomycin C is an alternative, particularly where BCG is unavailable.

Question 29Urologic Oncology

A 55-year-old man has a serum PSA of 8 ng/mL and a normal digital rectal exam. Which statement best reflects current evidence regarding prostate cancer screening?

  1. PSA screening has no role in any population
  2. PSA screening should be offered only after shared decision-making discussing benefits and harms Correct answer.
  3. PSA screening should be performed annually in all men over age 40 regardless of risk
  4. PSA screening should be avoided until symptoms develop

Explanation

Guidelines recommend shared decision-making before PSA screening, weighing reduced mortality against overdiagnosis and overtreatment. Screening is not recommended universally or only after symptoms.

Question 30Urologic Oncology

Which Gleason pattern combination corresponds to Gleason score 7 (3+4) prostate cancer?

  1. Equal patterns 4 and 5
  2. Predominantly pattern 5 with secondary pattern 3
  3. Predominantly pattern 3 with secondary pattern 4 Correct answer.
  4. Predominantly pattern 4 with secondary pattern 3

Explanation

Gleason score is the sum of the most prevalent and second most prevalent patterns. A primary pattern 3 with secondary pattern 4 yields 3+4=7. The reverse (4+3) is also score 7 but with worse prognosis.

Question 31Urologic Oncology

A 68-year-old man with metastatic castration-resistant prostate cancer has progressed on enzalutamide and docetaxel. Which agent is a PARP inhibitor approved for patients with BRCA1/2 alterations?

  1. Olaparib Correct answer.
  2. Sipuleucel-T
  3. Apalutamide
  4. Cabazitaxel

Explanation

Olaparib is a PARP inhibitor approved for mCRPC with homologous recombination repair gene alterations including BRCA1/2. Apalutamide is an androgen receptor antagonist, cabazitaxel a taxane, and sipuleucel-T an autologous cellular immunotherapy.

Question 32Urologic Oncology

Which imaging modality is most appropriate for initial staging of a patient with newly diagnosed high-risk prostate cancer (PSA 25 ng/mL, Gleason 8)?

  1. Transrectal ultrasound alone
  2. Intravenous pyelogram
  3. Bone scan and CT or PSMA PET imaging Correct answer.
  4. Retrograde urethrogram

Explanation

High-risk prostate cancer warrants staging with conventional imaging (bone scan and CT) or PSMA PET. Ultrasound, IVP, and urethrography do not assess metastatic spread.

Question 33Urologic Oncology

A 30-year-old man has a painless right testicular mass. Serum AFP is elevated and hCG is normal. Which histologic type is most likely?

  1. Mixed germ cell tumor with yolk sac elements Correct answer.
  2. Pure seminoma
  3. Sertoli cell tumor
  4. Leydig cell tumor

Explanation

Elevated AFP indicates yolk sac elements and excludes pure seminoma, making a mixed nonseminomatous germ cell tumor likely. Pure seminomas do not produce AFP.

Question 34Urologic Oncology

Which is the standard first-line chemotherapy regimen for metastatic nonseminomatous germ cell tumors?

  1. BEP (bleomycin, etoposide, cisplatin) Correct answer.
  2. MVAC
  3. CHOP
  4. FOLFIRINOX

Explanation

BEP is the standard first-line regimen for metastatic germ cell tumors, with cure rates exceeding 80% in good-risk disease. CHOP, MVAC, and FOLFIRINOX are used for other malignancies.

Question 35Urologic Oncology

A 65-year-old man has a 4 cm upper tract urothelial carcinoma with a normal contralateral kidney. Which treatment is standard for a localized, resectable tumor of this size?

  1. BCG instillation into the renal pelvis
  2. Radical nephroureterectomy with bladder cuff excision Correct answer.
  3. Partial ureterectomy alone
  4. Surveillance

Explanation

Radical nephroureterectomy with bladder cuff excision is standard for large or high-grade upper tract urothelial carcinoma. Kidney-sparing approaches are reserved for selected low-risk tumors.

Question 36Urologic Oncology

Which feature is most characteristic of a small renal mass that is benign rather than malignant?

  1. Nephrographic phase hyperenhancement
  2. Homogeneous low attenuation on unenhanced CT
  3. Fat-containing lesion on MRI Correct answer.
  4. Heterogeneous enhancement after contrast

Explanation

Macroscopic fat within a renal lesion is characteristic of an angiomyolipoma, which is benign. Enhancement patterns and heterogeneity are more typical of malignancy.

Question 37Urologic Oncology

Which is the most common histologic type of bladder cancer in developed countries?

  1. Urothelial carcinoma Correct answer.
  2. Squamous cell carcinoma
  3. Adenocarcinoma
  4. Small cell carcinoma

Explanation

Urothelial (transitional cell) carcinoma accounts for the vast majority of bladder cancers in developed countries. Squamous cell carcinoma is more common in regions with schistosomiasis.

Question 38Urologic Oncology

A 70-year-old woman has a 2 cm distal ureteral tumor causing hydronephrosis and a solitary kidney. Which approach best balances oncologic control and renal preservation?

  1. Radical nephroureterectomy
  2. Distal ureterectomy with reimplantation Correct answer.
  3. Systemic chemotherapy alone
  4. Nephrostomy tube placement alone

Explanation

In a solitary kidney, kidney-sparing distal ureterectomy with reimplantation can preserve renal function while achieving oncologic control for a small distal tumor. Radical nephroureterectomy would render the patient anephric.

Question 39Urologic Oncology

Which molecular pathway alteration is most characteristic of papillary renal cell carcinoma type 1?

  1. SDHB mutation
  2. VHL deletion
  3. MET mutation Correct answer.
  4. TFE3 translocation

Explanation

Type 1 papillary RCC is associated with MET mutations and trisomy 7/17. VHL deletion characterizes clear cell RCC, TFE3 translocation defines Xp11 translocation RCC, and SDHB mutations occur in hereditary leiomyomatosis and RCC.

Question 40Urologic Oncology

Which of the following is a recognized risk factor for urothelial carcinoma of the bladder?

  1. Cigarette smoking Correct answer.
  2. Regular aspirin use
  3. High dietary calcium
  4. Vigorous exercise

Explanation

Cigarette smoking is the strongest modifiable risk factor for bladder cancer, accounting for roughly half of cases. Dietary calcium, aspirin, and exercise are not established risk factors.

Question 41Urologic Oncology

A 58-year-old man has a PSA of 15 ng/mL and a prior negative 12-core biopsy. Which next step is most appropriate?

  1. Repeat standard biopsy immediately
  2. Radical prostatectomy without further biopsy
  3. Observation with PSA in 5 years
  4. Multiparametric MRI followed by targeted biopsy if indicated Correct answer.

Explanation

Multiparametric MRI before repeat biopsy improves detection of clinically significant cancer and can guide targeted sampling. Immediate repeat standard biopsy or empiric surgery is not appropriate.

Question 42Urologic Oncology

Which finding on semen analysis is most consistent with obstructive azoospermia?

  1. Normal testicular volume with normal FSH and absent ejaculate fructose Correct answer.
  2. Low volume with normal fructose
  3. Normal volume with low sperm concentration
  4. Small testes with elevated FSH

Explanation

Obstructive azoospermia typically shows normal testicular volume and FSH, and absent fructose suggests ejaculatory duct obstruction or congenital bilateral absence of the vas deferens. Small testes with elevated FSH suggest nonobstructive causes.

Question 43Urologic Oncology

Which is the most appropriate treatment for a patient with clinical stage I nonseminomatous germ cell tumor and normal postorchiectomy tumor markers?

  1. Radiation therapy to the retroperitoneum
  2. Inguinal orchiectomy alone with no follow-up
  3. Immediate cisplatin-based chemotherapy for all patients
  4. Surveillance, nerve-sparing RPLND, or adjuvant chemotherapy depending on risk Correct answer.

Explanation

Stage I NSGCT with normal markers can be managed with surveillance, RPLND, or adjuvant chemotherapy based on risk features. Radiation is not effective for nonseminomatous tumors.

Question 44Urologic Oncology

Which condition is associated with an increased risk of renal cell carcinoma?

  1. Hydronephrosis from ureteral stone
  2. Autosomal dominant polycystic kidney disease
  3. Nephrolithiasis
  4. Von Hippel-Lindau disease Correct answer.

Explanation

Von Hippel-Lindau disease predisposes to bilateral clear cell RCC due to germline VHL mutation. ADPKD, stones, and hydronephrosis are not established RCC risk factors.

Question 45Urologic Oncology

Which agent is used as intravesical therapy for BCG-unresponsive carcinoma in situ in patients who are not candidates for cystectomy?

  1. Cisplatin
  2. Methotrexate
  3. Doxorubicin
  4. Pembrolizumab Correct answer.

Explanation

Pembrolizumab, a PD-1 inhibitor, is approved for BCG-unresponsive CIS in patients ineligible for or declining cystectomy. Cisplatin, doxorubicin, and methotrexate are not used intravesically for this indication.

Question 46Urologic Oncology

Which is the strongest prognostic factor in patients with newly diagnosed metastatic renal cell carcinoma treated with systemic therapy?

  1. Patient blood type
  2. International Metastatic RCC Database Consortium risk group Correct answer.
  3. Presence of varicocele
  4. Tumor laterality

Explanation

The IMDC risk model, incorporating Karnofsky performance status, time from diagnosis to treatment, hemoglobin, calcium, neutrophils, and platelets, stratifies survival and guides therapy selection. Laterality, blood type, and varicocele are not prognostic.

Question 47Urologic Oncology

A 45-year-old man has a 1.5 cm low-grade-appearing bladder tumor on cystoscopy. Which management step is most appropriate initially?

  1. Intravesical BCG without resection
  2. Radical cystectomy
  3. Partial cystectomy
  4. Complete transurethral resection of the bladder tumor Correct answer.

Explanation

TURBT is the initial diagnostic and therapeutic step for bladder tumors, providing staging and resection. Radical cystectomy and partial cystectomy are not first-line for a small tumor.

Question 48Urologic Oncology

Which is the recommended treatment for a patient with a 2 cm renal mass and biopsy-proven oncocytoma who is asymptomatic?

  1. Radical nephrectomy
  2. Systemic targeted therapy
  3. Active surveillance Correct answer.
  4. Partial nephrectomy

Explanation

Oncocytoma is benign, and asymptomatic small lesions can be managed with active surveillance. Surgery and systemic therapy are unnecessary for confirmed benign disease.

Question 49Urologic Oncology

Which of the following best describes the role of lymph node dissection in radical cystectomy for bladder cancer?

  1. It replaces the need for neoadjuvant chemotherapy
  2. It provides staging and may have therapeutic benefit in node-positive disease Correct answer.
  3. It is not performed during cystectomy
  4. It is performed only for palliative purposes

Explanation

Pelvic lymph node dissection during radical cystectomy provides accurate staging and may confer a survival benefit, particularly in patients with limited nodal involvement. It does not replace systemic therapy.

Question 50Urologic Oncology

A 62-year-old man undergoes radical nephrectomy for a 7 cm renal mass. Final pathology reveals clear cell renal cell carcinoma with invasion into the renal vein. According to the TNM staging system, what is the T category?

  1. T3a Correct answer.
  2. T2a
  3. T4
  4. T1b

Explanation

Renal vein invasion by tumor thrombus is classified as T3a in the TNM staging system for renal cell carcinoma. T1 and T2 tumors are confined to the kidney and do not involve the renal vein. T4 tumors invade beyond Gerota's fascia.