Question 1

Which of the following risk factors is most often encountered in patients with urothelial carcinoma?
A) Industrial exposure to arylamines
B) Industrial exposure to azo dyes
C) Cigarette smoking
D) Long-term use of analgesics
E) Infection with Schistosoma haematobium

Accepted Answer

Cigarette smoking is the most important influence and most commonly encountered risk factor for urinary bladder cancer.

Question 2

Which of the following infectious agents is the most common cause of urinary tract infection?
A) Escherichia coli
B) Proteus vulgaris
C) Klebsiella sp
D) Streptococcus faecalis
E) Staphylococcus aureus

Accepted Answer

More than 85% of all urinary tract infections are caused by gram-negative bacteria. Escherichia coli is the most common pathogen from the group of bacteria listed in the question.

Question 3

This testis was removed from a 30-year-old man. It most likely represents 
A) an adenocarcinoma
B) a squamous cell carcinoma
C) a seminoma
D) a nonseminomatous germ cell tumor
E) a Leydig cell tumor

Accepted Answer

The two most common tumors in 30-year-old men are seminomas and nonseminomatous germ cell tumors (NSGCT). In contrast to seminomas, which appear homogeneous on cross section, this tumor is inhomogeneous and contains numerous cystic spaces. Accordingly, it is most likely a nonseminomatous germ cell tumor.

Question 4

Nephrotic syndrome related to minimal change disease, combined with acute renal failure related to acute interstitial nephritis, is a well-documented adverse reaction to which of the following drugs?
A) Methicillin
B) Ampicillin
C) Rifampin
D) Ibuprofen
E) Hydrochlorothiazide

Accepted Answer

Nonsteroidal anti-inflammatory drugs, such as ibuprofen, can cause several renal syndromes, and one of them is the peculiar association of acute interstitial nephritis and minimal change disease.

Question 5

Seminomas tend to metastasize first to which of the following sites?
A) Internal iliac lymph nodes
B) External iliac lymph nodes
C) Mesenteric lymph nodes
D) Retroperitoneal para-aortic lymph nodes
E) Urinary bladder

Accepted Answer

Seminomas, similar to all other testicular tumors, tend to metastasize to the retroperitoneal para-aortic lymph nodes.

Question 6

A papillary urinary bladder tumor composed of multilayered hyperchromatic transitional epithelium shows significant nuclear atypia. This type of tumor is best classified as which of the following?
A) Urothelial papilloma
B) Urothelial neoplasm of low malignant potential
C) Papillary urothelial carcinoma, low grade
D) Papillary urothelial carcinoma, high grade
E) Anaplastic carcinoma

Accepted Answer

The World Health Organization/International Society of Urologic Pathology classification of urothelial tumors of the urinary bladder recognizes four categories: urothelial papilloma; urothelial neoplasm of low malignant potential; papillary urothelial carcinoma, low grade; and papillary urothelial carcinoma, high grade. The description of this tumor corresponds to papillary urothelial carcinoma, high grade.

Question 7

Penile carcinomas tend to metastasize first to which of the following nodes?
A) Inguinal lymph nodes
B) Obturator lymph nodes
C) Internal ileac lymph nodes
D) External iliac lymph nodes
E) Paraortic abdominal lymph nodes

Accepted Answer

Penile carcinomas tend to metastasize first to the inguinal lymph nodes. However, only 50% of patients who have penile carcinoma with enlarged inguinal lymph nodes at the time of diagnosis have lymph node metastases; the enlarged lymph nodes in the remaining half histologically show only lymphoid hyperplasia.

Question 8

A patient who develops cancer later in life shows an increased tendency to develop urogenital congenital anomalies of the lower urinary tract. Which of the following anomalies is this patient most likely to develop?
A) Bladder diverticular
B) Bladder exstrophy
C) Hypospadia
D) Congenital urethral stenosis
E) Megaureters

Accepted Answer

Urinary bladder exstrophy is associated in later life with an increased incidence of adenocarcinoma of the urinary bladder and also with adenocarcinomas of the colon.

Question 9

A 22-year-old man sees his physician because of painful enlargement of the testis. On gross examination, the tumor measures 4 cm in diameter and is dark red. Histologically, it is composed of mononuclear cytotrophoblastic and multinucleated syncytiotrophoblastic cells surrounded by blood and necrotic tissue. Serologic studies would most likely show that the patient's blood contains elevated levels of which of the following hormones?
A) Alpha-fetoprotein
B) External iliac lymph nodes
C) Androstenedione
D) Estriol
E) Inhibin

Accepted Answer

The tumor in this patient is a choriocarcinoma; this type of tumor typically secretes human chorionic gonadotropin (HCG). Alpha-fetoprotein (AFP) is secreted by yolk sac tumors. Nonseminomatous germ cell tumors (NSGCT) often contain both choriocarcinoma and yolk sac tumor elements; therefore the blood of patients who have NSGCT contains both AFP and HCG.

Question 10

A 60-year-old man is being treated for cancer with several cytotoxic drugs, including cyclophosphamide. He developed hematuria and later died. At autopsy, cystitis is noted. Which specific form of cystitis did this patient most likely develop?
A) Interstitial cystitis
B) Follicular cystitis
C) Emphysematous cystitis
D) Hemorrhagic cystitis
E) Malakoplakia

Accepted Answer

Hemorrhagic cystitis is a well-known complication of anticancer treatment and is most often seen in patients who receive cyclophosphamide.

Question 11

Which of the following infectious agents causes condyloma acuminatum of the penis?
A) Human papillomavirus types 6 and 11
B) Human papillomavirus types 16 and 18
C) Herpesvirus type 1
D) Herpesvirus type 2
E) Ureaplasma urealyticum

Accepted Answer

Condyloma acuminatum is caused by the noncarcinogenic strains of human papillomavirus types 6 and 11. Human papillomaviruses types 16 and 18 are found in squamous cell carcinoma of the penis.

Quiz 17: Male Genital System and Lower Urinary Tract

Which of the following risk factors is most often encountered in patients with urothelial carcinoma?

Which of the following infectious agents is the most common cause of urinary tract infection?

This testis was removed from a 30-year-old man. It most likely represents

Nephrotic syndrome related to minimal change disease, combined with acute renal failure related to acute interstitial nephritis, is a well-documented adverse reaction to which of the following drugs?

Seminomas tend to metastasize first to which of the following sites?

A papillary urinary bladder tumor composed of multilayered hyperchromatic transitional epithelium shows significant nuclear atypia. This type of tumor is best classified as which of the following?

Penile carcinomas tend to metastasize first to which of the following nodes?

A patient who develops cancer later in life shows an increased tendency to develop urogenital congenital anomalies of the lower urinary tract. Which of the following anomalies is this patient most likely to develop?

A 60-year-old man is being treated for cancer with several cytotoxic drugs, including cyclophosphamide. He developed hematuria and later died. At autopsy, cystitis is noted. Which specific form of cystitis did this patient most likely develop?

Which of the following infectious agents causes condyloma acuminatum of the penis?