1000+ Kidney cysts and tumors Multiple Choice Question Answer [Solved]

1. What is the most powerful single predictor of oncologic outcomes in RCC cases?
A. margin status and grade
B. tumor size
C. tumor stage
D. the time interval between the tumor emergence and excision
Answer : C

2. Which of the following conditions carries the worst prognosis?
A. acquired cystic renal disease
B. juvenile nephronophthisis
C. medullary sponge kidney
D. bilateral multicystic dysplastic kidney
Answer : D

3. What is false concerning metanephric adenoma?
A. radiographically, it is indistinguishable from RCC
B. has a female predominance
C. has a benign clinical course
D. has a peak incidence in the third decade of life
Answer : D

4. d. CT can detect renal vein involvement in 82-95% of cases and vena caval involvement in 95-100% of cases
A. . In RCC, ipsilateral adrenal metastasis occurs in:
B. 0.3 - 2%
C. 2 - 10%
D. 11 - 18%
Answer : B

5. What can NOT be a manifestation of a renal tumor?
A. right hydrocele
B. left varicocele
C. painless hematuria
D. hypertension
Answer : A

6. What is false concerning renal angiomyolipoma (AML)?
A. most lesions ? 4 cm are asymptomatic
B. renal masses with fat content is pathognomonic for AML
C. renal biopsy from AML carries a high risk of hemorrhage
D. may coexist with malignant lesions, such as sarcomas and RCCs
Answer : B

7. What is the likelihood that simple renal cysts increase in size and number over time?
A. never
B. unlikely
C. likely
D. always
Answer : D

8. d. 19 - 26%
A. . What is false regarding radical nephrectomy operation?
B. nodal involvement doesn`t influence prognosis
C. renal artery should be ligated before the vein to avoid kidney ballooning
D. cardiopulmonary bypass with deep hypothermic circulatory arrest is performed in patients with supra-diaphragmatic tumor thrombi
Answer : A

9. Routine metastatic evaluation in RCC cases should include all of the following, EXCEPT:
A. abdominal CT
B. chest X-ray
C. renal function test
D. liver function test
Answer : C

10. CT shows a renal mass with calcifications associated with fat. What could the lesion be?
A. RCC
B. AML
C. teratoma
D. any of the above
Answer : A

11. What is the most common cause of genetic ESRD in children?
A. autosomal recessive polycystic kidney disease
B. autosomal dominant polycystic kidney disease
C. multicystic dysplastic kidney disease
D. juvenile nephronophthisis
Answer : D

12. What type of Bosniak renal cysts accompanies tumor masses in 5% of cases?
A. I
B. II
C. III
D. IV
Answer : B

13. After radical nephrectomy for organ-confined RCC, what is (are) the recommended surveillance radiologic examination(s)?
A. chest X-ray and abdominal ultrasonography every 3 months for the first year, and then annually for 3 years
B. annual chest X-ray for 3 years
C. abdominal and chest CT every 6 months for the first year, and then annually for 3 years
D. no radiological examination required
Answer : B

14. On ultrasonography, what are the percentages of incidentally discovered renal masses that will later be malignant on further workup?
A. 70 - 85%
B. 55 - 70%
C. 40 - 55%
D. 25 - 40%
Answer : A

15. Which of the following conditions carries the best prognosis?
A. acquired cystic renal disease
B. juvenile nephronophthisis
C. medullary sponge kidney
D. bilateral multicystic dysplastic kidney
Answer : C

16. According to Fuhrmans classification system for nuclear grading in RCC, nuclear size of 20 ?g with irregular outline and prominent nucleoli is grade:
A. 1
B. 2
C. 3
D. 4
Answer : C

17. Inherited renal cystic disease(s) include(s) the following:
A. glomerulocystic kidney disease (GCKD)
B. Juvenile nephronophthisis (JNPHP)
C. medullary cystic kidney disease
D. all of the above
Answer : D

18. d. unilateral RCC with a functioning opposite kidney, but at risk for future impairment
A. . What is the relapse rate for completely resected RCC after radical nephrectomy?
B. 1- 10%
C. 10 - 20%
D. 20 - 30%
Answer : C

19. What is (are) the risk factor(s) for developing simple renal cysts?
A. male gender
B. hypertension
C. renal insufficiency
D. all of the above
Answer : D

20. What is true regarding ADPKD patients?
A. progress to ESRD in the sixth decade of life
B. hypertension is seen in 80% of patients with ADPKD aged 20-34 years
C. aortic valve stenosis in 25%
D. manifestations are more significant in patients with the PKD2 genotype
Answer : A

21. What is tru regarding renal angiomyolipoma (AML)?
A. most classic AMLs eventually undergo malignant transformation to sarcomatoid and epithelioid AML
B. the preferred treatment is nephroureterectomy followed by active surveillance
C. angiographic embolization and/or nephron-sparing surgery is advised for symptomatic AMLs greater than 4 cm
D. extra-renal sites include the pancreas, salivary glands, and thyroids
Answer : C

22. After radical nephrectomy, what is the 5-year survival rate for stage I RCC?
A. 80%
B. 85%
C. 90%
D. 95%
Answer : D

23. d. renal vein thrombi can be resected after incising the vein between 2 vascular clamps
A. . Manifestations of paraneoplastic syndrome associated with RCC include all of the following, EXCEPT:
B. anemia and erythrocytosis
C. hepatic dysfunction and elevated human chorionic gonadotropin levels
D. hypocalcemia
Answer : C

24. On histological examination of a resected renal tumor, positive staining for human melanoma black (HMB)-45 is a distinctive and diagnostic feature for:
A. multiloculated cystic nephromas
B. angiomyolipoma
C. metanephric adenoma
D. adenoma with clear cell
Answer : B

25. In RCC cases where IVC involvement with tumor thrombi are suspected, venacavography:
A. is the first and most reliable radiologic examination to study IVC thrombi
B. is reserved for patients with equivocal MRI or CT findings
C. is obsolete and has fallen out of use
D. carries a risk of IVC terrible bleeding that outweighs the diagnostic merits
Answer : B

26. In a localized RCC, local recurrence after tumor ablation therapy is managed by any of the following options, EXCEPT:
A. repeat ablation
B. active surveillance
C. salvage surgery
D. radical nephrectomy
Answer : D

27. d. melanoma
A. . The second most common RCC subtype is:
B. collecting duct b. clear cell
C. papillary
D. chromophobe
Answer : C

28. What is false concerning renal cancers?
A. papillary subtype of RCC has a tendency to multifocality
B. chromosome 13 alterations are common in the development of clear cell renal carcinoma
C. a solid mass on CT that enhances more than 15 HU is suggestive of RCC
D. bilateral involvement in RCC either synchronously or metachronously occurs in 2% to 4% of patients
Answer : B

29. Fuhrmans grading system for renal cell carcinoma relies on:
A. nuclear size, outline, and nucleoli
B. cohesiveness and the degree of cellular atypia
C. chromatin structure and content of the interphase nucleus
D. multinucleation and mitosis
Answer : A

30. What is false concerning renal oncocytoma?
A. the central scar on CT or MRI, and the spoke-wheel pattern of vessels on angiograms are not specific to oncocytoma
B. calcification, necrosis, and hemorrhage are rare in oncocytomas
C. it is thought to arise from the basement membrane of proximal convoluted tubules
D. treatment is partial nephrectomy or tumor excision
Answer : C

31. Which of the following is NOT a risk factor for RCC?
A. type II DM, especially in males
B. hypertension
C. obesity, especially in females
D. cigarette smoking
Answer : A

32. What is the likelihood that Bosniak type III renal cysts accompany malignant masses?
A. never
B. unlikely
C. likely
D. always
Answer : C

33. What is the proper terminology of a renal cyst with the following characteristics: well-marginated, anechoic, with thin visible back wall, positive posterior acoustic enhancement, no septations, and no calcifications?
A. hyperattenuating renal cyst
B. solitary renal cyst
C. uncomplicated renal cyst
D. focal renal cyst
Answer : C

34. What type of renal adenomas is a precursor to papillary RCC?
A. adenoma with clear cell
B. papillary adenoma
C. metanephric adenoma
D. none of the above
Answer : B

35. d. hypertension
A. . Metastatic tumors to the kidney are common from all of the following organs, EXCEPT:
B. lungs
C. thyroid
D. breasts
Answer : B

36. What is false concerning renal malignancy?
A. RCC occurs in < 5% of patients with tuberous sclerosis
B. in glomerulocystic kidney disease, renal tumors are typically solitary, large, with central necrosis
C. in Von Hippel-Lindau syndrome, renal tumors are frequently bilateral and multicentric
D. in acquired cystic disease, tumors are commonly bilateral, and metastatic in 15% of cases
Answer : B

37. d. none of the above
A. . What is NOT an indication for simple nephrectomy?
B. symptomatic chronic renal infection with poor function
C. some cases of renovascular hypertension
D. symptomatic calculus disease with poor renal function
Answer : D

38. What is (are) true regarding the etiology of medullary cystic kidney disease (MCKD)?
A. mutations in the MCKD1 (chromosome 1q21) gene
B. mutations in the MCKD2 (chromosome 16q12) gene
C. inherited in an autosomal dominant fashion
D. all of the above
Answer : D

39. Which of the following factors is associated with increased survival in patients with metastatic kidney tumors?
A. physically active patients with good performance status
B. extirpation of the primary tumor
C. long disease-free interval between initial nephrectomy and the emergence of secondaries
D. all of the above
Answer : D

40. On histological examination of a resected renal tumor, the presence of multiple mitochondria observed on electron microscopy is diagnostic for:
A. renal oncocytoma
B. multiloculated cystic nephromas
C. metanephric adenoma
D. adenoma with clear cell
Answer : A

41. d. prior to kidney transplant
A. . What is an indication for radical nephrectomy?
B. a 6-cm, polar tumor
C. bilateral RCC
D. locally advanced RCC
Answer : C

42. What is the treatment of a 3-cm renal mass suggestive of RCC adjacent to a huge renal cyst?
A. cyst aspiration and sclerosis
B. partial nephrectomy
C. endoscopic marsupialization and fulguration of the cyst
D. administration of TKIs
Answer : B

43. d. all of the above
A. . What is the most common histologic subtype of renal sarcomas?
B. rhabdomyosarcoma
C. nephrosarcoma
D. leiomyosarcoma
Answer : C

44. What is false concerning ADPKD patients?
A. hepatic cysts are the most common extra-renal manifestation
B. might experience cyst hemorrhage, renal infection, or nephrolithiasis
C. typically, complain of flank pain or intermittent hematuria in the early twenties
D. hypertension and CRF commonly occur in the fifth decade of life
Answer : C

45. Regarding simple renal cysts, fluid attenuation on non-contrast CT series is:
A. < - 10 HU
B. < - 20 HU
C. < 10 HU
D. < 20 HU
Answer : D

46. What is false concerning end-stage renal disease (ESRD)?
A. ARPKD accounts for 5% of ESRD in children
B. more than one-half of patients with ARPKD require kidney transplant before age 20 years
C. ADPKD is a common cause of ESRD
D. uncommonly, juvenile nephronophthisis causes ESRD in children
Answer : D

47. d. 30 - 40%
A. . What is false concerning imaging studies for preoperative evaluation of RCC case?
B. in case of bone pain or elevated serum calcium and/or alkaline phosphatase levels, an isotopic bone scan is required
C. renal arteriography accurately localizes central scaring and tumor necrosis
D. trans-esophageal echocardiography helps assess vena caval and right atrial tumor thrombi
Answer : B

48. d. neurosarcoma
A. . What is false concerning targeted molecular therapy?
B. is a personalized medical therapy devised to meet each persons individual needs for cancer`s specifications
C. treats cancer by interrupting unique molecular abnormalities that drive cancer growth
D. some cancer types have different molecular targets
Answer : D

49. Which of the following renal tumors carries the best prognosis?
A. fibrosarcoma
B. leiomyosarcoma
C. carcinoid
D. adult Wilm`s tumor
Answer : C

50. What does determine the renal function status after partial nephrectomy of a single kidney?
A. the quality of the kidney and renal function prior to surgery
B. the quantity of vascularized parenchymal mass preserved after excision
C. the tumor
D. warm ischemia time
Answer : D