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Question 1
Incorrect
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A 31-year-old man visits his doctor with complaints of back pain that has been gradually worsening over the past few months. The man works as a graphic designer and denies any history of heavy lifting or back trauma. An MRI of the back is ordered, which reveals a mass compressing the lumbar vertebrae. The radiology report suggests that this could be a metastatic mass, and the patient is referred to the oncology service for further evaluation. Upon diagnosis, the man is found to have testicular seminoma. What are the typical lymph nodes that this type of cancer spreads to?
Your Answer: External iliac
Correct Answer: Lateral aortic
Explanation:Lymphatic Drainage of the Testes: Understanding the Different Nodes Involved
The lymphatic drainage of the testes is an important aspect to consider in the diagnosis and treatment of testicular cancer. Here are the different nodes involved in the drainage process:
Lateral Aortic Nodes: The testes (and ovaries in women) drain to the lateral aortic nodes, also known as the para-aortic nodes. These nodes cannot be palpated but can be seen on a CT scan. Nodal metastasis is part of the grading of testicular cancer using the Royal Marsden staging system.
Inferior Mesenteric Nodes: These nodes drain structures of hindgut such as the colon, the last third of the transverse colon, the descending colon, the splenic flexure, and the rectum. The testes do not drain to the inferior mesenteric nodes.
Inguinal Nodes: Located in the groin, these nodes receive lymphatic drainage from the lower limbs, the scrotum or vulva, the perineum, the buttock, the anus below the pectinate line, and the abdominal wall. The testes do not drain to the inguinal lymph nodes.
Internal Iliac Nodes: The common iliac nodes receive drainage from the external iliac nodes, which receive drainage from glans penis, glans clitoris, and the prostate among others. The testes do not drain to the common iliac nodes.
External Iliac Nodes: These nodes receive drainage from glans penis, glans clitoris, and the prostate among others. The testes do not drain to the common iliac nodes. The external iliac nodes eventually drain into the common iliac nodes.
Understanding the lymphatic drainage of the testes is crucial in determining the extent of cancer spread and in planning appropriate treatment.
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This question is part of the following fields:
- Genitourinary
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Question 2
Correct
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A 65-year-old man presents with symptoms of difficulty initiating the flow of urine, increased frequency, and urgency for the past six months. His serum prostate-specific antigen level is 1.5 ng/ml (normal < 2.5 ng/ml) and a prostatic biopsy is performed, revealing glandular and stromal hyperplasia with an increased number of epithelial and stromal cells. What is the most suitable treatment for this patient's condition?
Your Answer: Prazosin
Explanation:Treatment options for Benign Prostatic Hypertrophy
Benign Prostatic Hypertrophy (BPH) is a common condition in older men that causes urinary symptoms. Prazosin is a preferred treatment option for BPH as it relaxes the smooth muscle of the neck of the bladder and improves urinary flow rates. Dutasteride, a 5-alpha-reductase inhibitor, is not recommended as it inhibits all three isoenzymes of 5-alpha-reductase, causing side effects such as hypogonadism, gynaecomastia, and ejaculation disorders. Propranolol, a beta-blocker, and ephedrine, an alpha-agonist, have no role in the treatment of BPH. Testosterone replacement is not used in the treatment of BPH but is used for hypogonadism. When medical therapy fails or carcinoma of the prostate is suspected, urology referral should be considered.
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This question is part of the following fields:
- Genitourinary
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Question 3
Incorrect
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A 28-year-old male patient visits his general practitioner complaining of a discharge from his urethra. Upon laboratory examination of the discharge, it is found to contain numerous neutrophils, some of which contain Gram-negative intracellular diplococci. The patient is administered ceftriaxone 250 mg intramuscularly, which initially resolves the symptoms. However, the patient returns five days later with the same complaint. What is the most probable cause of this discharge?
Your Answer: Re-infection with Neisseria gonorrhoeae
Correct Answer: Chlamydia trachomatis
Explanation:Chlamydia is a common sexually transmitted disease that often has no symptoms, especially in women. It can lead to infertility and presents with discharge, dysurea, and itching in men. Azithromycin is the preferred treatment.
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This question is part of the following fields:
- Genitourinary
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Question 4
Incorrect
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A 35-year-old man visits his doctor with a complaint about his penis. He explains that he experiences a noticeable curvature during erection, which has become more severe in recent years. He feels ashamed and worried that it could be cancerous.
What is the probable diagnosis?Your Answer: Penile lymphoma
Correct Answer: Peyronie’s disease
Explanation:The patient is exhibiting symptoms of Peyronie’s disease, a condition where fibrous tissue accumulates in the penis, causing it to curve or bend in a particular direction. This is a non-malignant connective tissue disorder that affects approximately 5% of men. The condition results in scar tissue forming in the tunica albuginea, the thick sheath of tissue surrounding the corpora cavernosa, leading to pain, abnormal curvature, erectile dysfunction, indentation, loss of girth, and shortening.
Bowenoid papulosis, on the other hand, is a rare pre-cancerous skin condition that causes the accumulation of red or dark papules on the penis, but does not cause curvature. It is linked to human papillomavirus (HPV) and can transform into invasive squamous cell carcinoma in a small percentage of cases.
Bowen’s disease is a neoplastic skin disease that causes a grey plaque to form on the penis or scrotum, usually affecting older men. It is an early stage or intraepidermal form of squamous cell carcinoma.
Penile lymphoma is unlikely in a young man without associated systemic symptoms, and a history of progressive curvature of the penis is more suggestive of Peyronie’s disease. Erythroplasia of Queyrat is another in situ squamous cell carcinoma of the penis that causes red patches to form.
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This question is part of the following fields:
- Genitourinary
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