Urosurgery

Question 1

antitumor, antibiotic, alkylating agent that inhibits DNA synthesis

Answer 1

Mitomycin C

Question 2

Describe the anatomical structures responsible for penile erection.

Answer 2

The corpora cavernosa, which expand with parasympathetic stimulation, and the tunica albuginea, which provides rigidity.

Question 3

What is the most common site for squamous cell carcinoma of the penis?

Answer 3

The glans penis, followed by the prepuce and shaft.

Question 4

A 60-year-old male presents with a painless, red lesion on the glans penis. What is the likely diagnosis?

Answer 4

Erythroplasia of Queyrat, a carcinoma in situ.

Question 5

What is the primary blood supply to the penis?

Answer 5

The external and internal pudendal arteries.

Question 6

List the stages of penile cancer as per the TNM classification.

Answer 6

Tis (carcinoma in situ), Ta (noninvasive verrucous carcinoma), T1 (invades subepithelial connective tissue), T2 (invades corpus spongiosum or cavernosum), T3 (invades urethra or prostate), T4 (invades other structures).

Question 7

A 45-year-old male with a history of phimosis presents with a white patch on the glans penis. What are the possible diagnoses?

Answer 7

Leukoplakia, balanitis xerotica obliterans, or early carcinoma.

Question 8

What are the treatment options for localized renal cell carcinoma (RCC)?

Answer 8

Surgical removal, including nephrectomy or partial nephrectomy.

Question 9

What are the most common sites of metastasis in renal cell carcinoma?

Answer 9

Lungs, liver, bone, adrenal glands, brain, and opposite kidney.

Question 10

Describe the clinical triad often associated with renal cell carcinoma.

Answer 10

Gross hematuria, flank pain, and a palpable abdominal mass.

Question 11

A 50-year-old male with flank pain and hematuria is found to have a vascular renal mass on imaging. What is the likely diagnosis?

Answer 11

Renal cell carcinoma (RCC).

Question 12

What are the precancerous lesions of the penis?

Answer 12

Leukoplakia, balanitis xerotica obliterans, Bowen disease, erythroplasia of Queyrat, and giant condylomata acuminata.

Question 13

What histological features are observed in leukoplakia of the penis?

Answer 13

Acanthosis, hyperkeratosis, and parakeratosis.

Question 14

What is the clinical significance of a velvety red lesion with ulcerations on the glans penis?

Answer 14

It is likely erythroplasia of Queyrat, a carcinoma in situ.

Question 15

What differentiates verrucous carcinoma from other penile cancers?

Answer 15

Its papillary appearance and well-demarcated deep margins on histology.

Question 16

What is the most effective treatment for giant condylomata acuminata?

Answer 16

Excision and histopathological evaluation to rule out carcinoma.

Question 17

What role does poor hygiene play in the development of penile carcinoma?

Answer 17

Poor hygiene can lead to smegma accumulation, chronic inflammation, and eventually carcinoma.

Question 18

What are the treatment options for stage 4 penile carcinoma?

Answer 18

Chemotherapy, palliative care, or aggressive surgical resection if operable.

Question 19

A 40-year-old male presents with hematuria and a history of hypertension. What is a possible diagnosis?

Answer 19

Renal cell carcinoma (RCC), which can cause paraneoplastic hypertension.

Question 20

What are the common paraneoplastic syndromes associated with RCC?

Answer 20

Erythrocytosis, hypercalcemia, hypertension, and Stauffer syndrome.

Question 21

How is von Hippel-Lindau disease linked to RCC?

Answer 21

It is a genetic syndrome associated with bilateral clear cell RCC due to mutations on chromosome 3p.

Question 22

What imaging modality is most sensitive for detecting renal cell carcinoma?

Answer 22

CT scan or MRI for detailed evaluation of the renal mass.

Question 23

What is the role of fine needle aspiration in diagnosing RCC?

Answer 23

It is used to confirm the diagnosis through cytological examination of the renal mass.

Question 24

What is the most common cause of genital ulcers in the United States?

Answer 24

Genital herpes simplex virus (HSV).

Question 25

Describe the characteristic lesion of primary genital herpes infection.

Answer 25

Painful papules or vesicles that evolve into pustules or ulcers.

Question 26

What are the preferred antiviral medications for genital herpes?

Answer 26

Acyclovir, valacyclovir, and famciclovir.

Question 27

What is the classic presentation of primary syphilis?

Answer 27

A painless ulcer, or chancre, at the site of infection.

Question 28

How is chancroid diagnosed?

Answer 28

By identifying Haemophilus ducreyi on specialized culture media.

Question 29

A patient presents with beefy red genital ulcers and no inguinal lymphadenopathy. What is the likely diagnosis?

Answer 29

Granuloma inguinale (donovanosis).

Question 30

What is the causative agent of lymphogranuloma venereum (LGV)?

Answer 30

Invasive serovars of Chlamydia trachomatis (L1, L2, L3).

Question 31

What distinguishes genital ulcers caused by chancroid from syphilis?

Answer 31

Chancroid ulcers are painful, whereas syphilis ulcers are painless.

Question 32

What is the treatment for chancroid?

Answer 32

Azithromycin (1 g single oral dose) or ceftriaxone (250 mg single IM dose).

Question 33

A 30-year-old female has recurrent painful genital ulcers. HSV testing is negative. What other diagnosis should be considered?

Answer 33

Behçet's disease or chancroid.

Question 34

What laboratory tests are used for diagnosing syphilis?

Answer 34

VDRL, RPR, FTA-ABS, and MHA-TP.

Question 35

What are the key features of tertiary syphilis?

Answer 35

Cardiac, neurologic, ophthalmic, and gummatous lesions.

Question 36

A patient presents with painful urination and urethral discharge. Gram stain reveals intracellular diplococci. What is the likely diagnosis?

Answer 36

Gonococcal urethritis.

Question 37

What complications can arise from untreated gonococcal urethritis?

Answer 37

Urethral strictures and infertility.

Question 38

What is the treatment for gonococcal urethritis?

Answer 38

Ceftriaxone 250 mg IM plus azithromycin 1 g oral single dose.

Question 39

What are the symptoms of nongonococcal urethritis?

Answer 39

Mild dysuria, mucoid discharge, and absence of gram-negative diplococci on stain.

Question 40

What is the most common cause of nongonococcal urethritis?

Answer 40

Chlamydia trachomatis.

Question 41

A 50-year-old diabetic male presents with balanitis xerotica obliterans. What treatment options are available?

Answer 41

Topical steroids, circumcision, or surgical intervention.

Question 42

What are the common treatment options for genital herpes simplex virus infection?

Answer 42

Systemic antiviral therapy such as acyclovir, valacyclovir, or famciclovir.

Question 43

What differentiates primary HSV infection from recurrent HSV infection?

Answer 43

Primary HSV has systemic symptoms like fever and malaise, while recurrent HSV is localized and less severe.

Question 44

What are Donovan bodies, and what condition are they associated with?

Answer 44

Dark-staining intracellular organisms seen in granuloma inguinale (donovanosis).

Question 45

What is the management for a patient with granuloma inguinale?

Answer 45

Doxycycline 100 mg orally twice daily for at least 3 weeks.

Question 46

What are the radiological procedures commonly used in diagnosing RCC?

Answer 46

Ultrasound, CT scan, MRI, renal angiography, and radionuclide imaging.

Question 47

What is the characteristic clinical presentation of erythroplasia of Queyrat?

Answer 47

A velvety red lesion with ulcerations on the glans penis.

Question 48

What are the systemic therapies for disseminated renal cell carcinoma?

Answer 48

Interferon-alpha, IL-2, chemotherapy, and targeted therapies.

Question 49

A 55-year-old male presents with flank pain and elevated calcium levels. What is a likely underlying condition?

Answer 49

Renal cell carcinoma with paraneoplastic hypercalcemia.

Question 50

What are the common histological subtypes of RCC?

Answer 50

Clear cell carcinoma, papillary carcinoma, and chromophobe carcinoma.

Question 51

What is Stauffer syndrome, and which malignancy is it associated with?

Answer 51

Hepatic dysfunction without liver metastasis, associated with RCC.

Question 52

What is the role of tumor markers in RCC diagnosis?

Answer 52

Tumor markers are not specific but can assist in monitoring disease progression.

Question 53

What clinical signs suggest inguinal lymph node metastasis in penile carcinoma?

Answer 53

Enlarged, non-resolving lymph nodes despite antibiotic therapy.

Question 54

What is the significance of the tunica albuginea in penile anatomy?

Answer 54

It provides rigidity during erection by enclosing the corpora cavernosa.

Question 55

What are the histological characteristics of Bowen disease?

Answer 55

Squamous cell carcinoma in situ presenting as a red plaque with encrustations.

Question 56

What imaging modality is best for assessing the extent of penile carcinoma?

Answer 56

MRI for detailed evaluation of soft tissue involvement.

Question 57

What systemic diseases are associated with genital ulcers?

Answer 57

Behçet's disease, syphilis, and HIV.

Question 58

What diagnostic test confirms chancroid?

Answer 58

Culture of Haemophilus ducreyi on specialized media.

Question 59

What are the primary goals of treating stage 1 penile carcinoma?

Answer 59

Penile preservation and achieving negative surgical margins.

Question 60

What are the symptoms of primary HSV infection?

Answer 60

Painful genital papules, vesicles, fever, and myalgias.