Your-Doctor Multiple Choice Questions (MCQ)

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Category: Urology--->Bladder Cancer
Page: 2

Question 6#Print Question

Regarding non-muscle-invasive bladder cancer and adjuvant chemo/immunotherapy, which of the following statement is FALSE?

a. Recent evidence suggests no statistically significant benefit from early postoperative chemotherapeutic instillation in patients with large or recurrent tumours (i.e., intermediate risk) or in those with high-risk NMIBC
b. An EORTC meta-analysis showed that a single, immediate instillation of intravesical chemotherapy after TURBT results in a 11.7% absolute reduction in tumour recurrence (a decrease of 24% in the odds of recurrence). No significant differences in efficacy were noted among the chemotherapeutic agents studied, indicating that the choice of chemotherapeutic drug is optional
c. An EORTC meta-analysis showed that compared to TURBT alone, immediate adjuvant chemotherapy after TURBT significantly improves disease-free survival and reduces progression rates

Question 7#Print Question

Intravesical immunotherapy results in a massive local immune response characterised by induced expression of cytokines in the urine and bladder wall and by an influx of granulocytes, mononuclear and dendritic cells. Which of the following statements regarding intravesical BCG immunotherapy is FALSE?

a. The mechanism of action includes direct binding of BCG to fibronectin within the bladder wall, subsequently leading to direct stimulation of cell-based immunologic response and an anti-angiogenic state
b. Overall, response to intravesical immunotherapy may be limited if a patient has an immunosuppressive disease or by advanced age
c. The original regimen described by Morales included an intramuscular dose, which was discontinued after success using a similar intravesical regimen
d. The vaccine is reconstituted with 50 mL of saline and should be administered through a urethral catheter under gravity drainage soon thereafter to avoid aggregation

Question 8#Print Question

The limits of dissection of a standard pelvic lymphadenectomy in cases of radical cystectomy include the following, EXCEPT:

a. Obturator nerve laterally
b. Bladder medially
c. Bifurcation of the common iliac artery cephalad
d. Endopelvic fascia caudally

Question 9#Print Question

A 69-year-old woman has been diagnosed with muscle-invasive bladder cancer and is considering undergoing radical cystectomy with formation of an orthotopic neobladder. Her GFR is 52 mL/min and she has marked right-sided hydronephrosis. Which of the following statements is TRUE?

a. She should be counselled that orthotopic neobladder is contraindicated in her case in view of the low GFR and presence of hydronephrosis
b. Quality of life studies of patients with orthotopic diversion have uniformly shown that patients with continent diversions have a better quality of life than those with ileal conduits
c. Her pre-operative counselling can be facilitated by results of several randomised controlled studies which have become available in the past few years comparing neobladder to ileal conduit and other types of urinary diversion
d. If she had pre-existing significant stress incontinence, this would be a relative contra-indication for neobladder formation

Question 10#Print Question

Which of the following statements regarding the use of bowel for urinary diversion is TRUE?

a. Mild metabolic acidosis may be expected in up to half of the patients after ileal conduit diversion
b. The terminal ileum is the sole site of vitamin B12 and of bile acid absorption
c. Normal serum pH and bicarbonate exclude a severely compensated metabolic acidosis
d. The morbidity of radical cystectomy and urinary diversion is up to 25% diversion related

Category: Urology--->Bladder Cancer
Page: 2 of 2