Kidney cysts and tumors MCQ Solved Paper for SSC CPO

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

2. 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

3. 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

4. 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

5. The likelihood of malignancy in category IIF (indeterminate) renal cysts is:
A. 20%
B. 30%
C. 40%
D. 50%
Answer : A

6. 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

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. 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

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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. The etiology of renal cysts includes all of the following, EXCEPT:
A. autosomal dominant polycystic kidney disease (ADPKD)
B. developmental cystic renal disease
C. inherited cystic renal disease
D. systemic disease with associated renal cysts
Answer : A

18. In renal mass(es), the main indication to take a renal biopsy is the suspicion of:
A. papillary RCC
B. renal metastases
C. renal oncocytoma
D. renal xanthogranuloma
Answer : B

19. 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

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

21. The diagnosis of renal adenoma is commonly made:
A. at autopsy
B. by staining positive for human melanoma black (HMB)-45
C. by fine-needle aspiration cytology
D. by exclusion
Answer : A

22. 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

23. 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

24. What is true regarding cancer incidence in renal cystic diseases?
A. is > 90% in Bosniak type IV renal cysts
B. in patients receiving renal transplants for polycystic kidney disease is 48% higher than that expected in the general population
C. all of the above
D. simple renal cysts might turn malignant in < 4% of cases
Answer : C

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

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

37. 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

38. 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

39. 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

40. 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

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

42. 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

43. 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

44. 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

45. 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

46. 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

47. What is false regarding multiloculated cystic nephromas?
A. they follow a benign clinical course
B. they have a bimodal age distribution
C. they are more common in men than in women
D. none of the above
Answer : C

48. 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

49. What is true 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

50. 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