URO TMR

Question 1

Transitional cell epithelium lines the urinary tract from the renal pelvis up to the ________

Answer 1

proximal 2/3 of the urethra

Question 2

What is the most frequent risk factor of urothelial tumors?

Answer 2

tobacco use

Question 3

This symptom occurs in 85% of patients with urothelial tumors

Answer 3

Painless gross hematuria

Question 4

The following are true regarding recurrent significant hematuria EXCEPT

a. >3 RBCs/HPF on 2 urinalysis
b. single urinalysis with >100 RBCs
c. Gross hematuria
d. NOTA

Answer 4

A; 3x

Question 5

Recurrent significant hematuria of

• > 3 RBCs/HPF on 3 urinalysis
• single urinalysis with >100RBCx
• Gross Hematuria

is associated with renal or urologic lesions in what percentage of patients

Answer 5

9.1%

Question 6

True about detection of urothelial cancer EXCEPT

a. patients with microscopic hematuria require a full evaluation
b. low-risk patients do not require repeat evaluations
c. High risk individuals primarily those with history of smoking should be evaluated every 3 months.
d. the level of suspicion for urogenital neoplasms in patients with isolated plainless hematuria and nondysmorphic RBCs increases with age.
e. NOTA

Answer 6

C; should be evaluated every 6 months

Question 7

What is the gold standard for tumor detection

Answer 7

White light cystoscopy with random bladder biopsies

Question 8

True about history and staging of urothelial tumors
a. Low-grade papillary lesions are likely to recur in up to 10% of patients but invade in up to 60% of cases
b. High grade lesions also recur, invasion and subsequent stage progression can occur in 40% of the tumors
c. The most important risk factor for progression of urothelial tumors is grade.
D. NOTA

Answer 8

C

a. 60%, 10%
b. 50%

Question 9

Bladder cancer that is confined to the bladder mucosa or submucosa

Answer 9

non muscle invasive bladder CA

Question 10

Non- muscle invasive Bladder CA can be managed with

Answer 10

TUR alone and adjuvant intravesical chemotherapy/immunotherapy

Question 11

Patient with non muscle invasive bladder CA, diffuse CIS, recurrent disease, >40% involvement of the bladder surface by tumor.

Is intravesical treatment advised?

Answer 11

yes

Question 12

True of TURBT

a. TURBT is performed both to remove all visible tumors and to provide specimens for pathologic examination to determine stage and grade
b. repeat resection within 2-4 weeks is usually indicated in patients with high grade disease
c. Single dose intravesical chemo within 24 hours of resection reduces recurrence of low-risk tumors
d. all suspicious lesions should be sampled. random biopsies are required in low risk patients

Answer 12

A

b. 3-6 weeks
c. 6 hours
d. random biopsies are not required

Question 13

True about medical therapy for urothelial tumors EXCEPT

a. intravesical BCG has higher efficacy than intravesical chemo
b. BCG is the only agent shown to delay or reduce high-grade tumor progression.
c. standard therapy is bacillus calmette- guerin in 8 weekly instillations followed by maintaenance administrations for >1 year.
d. BCG is contraindicated in the setting of disrupted urothelium because of the risk of intravasation and septic death

Answer 13

C. 6 weekly installations

Question 14

diagnostic modalities used for surveillance of upper tract recurrence

Answer 14

retrograde pyelogram or CT urograms

Question 15

How often should patients be monitored for recurrence of urothelial tumors

Answer 15

3 month intervals during the 1st year

Question 16

What are the boundaries of dissection of standard pelvic lymph node dissection

Answer 16

lateral: genitofemoral nerve
medial: internal iliac artery
caudal: Cooper ligament
Cranial: crossing of the ureter at the common iliac artery

Question 17

Who are candidates for orthotopic neobladder construction?

Answer 17

Female patients with stage T1 or T2 bladder tumors that are distal to the bladder trigone are candidates for orthotopic neobladder construction

Question 18

orthotopic neobladder has emerged as a popular urinary diversion for patients without urethral involvement. Most common diversion is

Answer 18

noncontinent ileal conduit

Question 19

metastatic disease: Overall response rates of >50% have been reported using combinations of MVAC. MVAC stands for?

Answer 19

Methotrexate
Vinblastine
Doxorubicin
Cisplatin

Question 20

metastatic disease: Overall response rates of >50% have been reported using combinations of GC

Answer 20

Gemcitabine and cisplatin

Question 21

metastatic disease: Overall response rates of >50% have been reported using combinations of GPC

Answer 21

gemcitabine, paclitaxel and cisplatin

Question 22

Management of bladder cancer general principles

Non-muscle-invasive disease

Answer 22

endoscopic removal usually with intravesical therapy

Question 23

Management of bladder cancer general principles

Muscle invasive disease

Answer 23

cystectomy +- systemic chemo(before or after surgery)

Question 24

Metastatic disease

Answer 24

curative or palliative chemotherapy+- surgery