Prostate Pathology — MCQs
Which is the least invasive and effective option for high-grade squamous intraepithelial lesion (HSIL) on Pap smear?
A boy is suffering from acute pyelonephritis. The most specific investigation to confirm the diagnosis is:
All of the following statements are true about Gleason score, except:
Which of the following is true about bone metastasis?
Screening of prostate cancer is commonly done by
A patient from the Ohio River valley presents with granulomatous prostatitis showing broad-based budding organisms on microscopy. What is the most likely infecting organism?
Which zone of the prostate is primarily involved in Benign Prostatic Hyperplasia (BPH)?
Most common site of osteochondritis dissecans?
A chest X-ray (CXR) of a patient is shown. What is the next step in management of this patient?
Identify the stain shown in the liver section.
Prostate Pathology Indian Medical PG Practice Questions and MCQs
Question 1: Which is the least invasive and effective option for high-grade squamous intraepithelial lesion (HSIL) on Pap smear?
- A. Laser ablation
- B. Cone biopsy
- C. Cryotherapy
- D. LEEP (Correct Answer)
Explanation: ***LEEP*** - **LEEP (Loop Electrosurgical Excision Procedure)** is a highly effective treatment for HSIL, offering both diagnostic and therapeutic benefits. - It involves using a thin, electrified wire loop to remove the abnormal tissue, and it is considered less invasive than a cold knife cone biopsy while maintaining high efficacy. *Laser ablation* - **Laser ablation** destroys abnormal tissue but does not provide a specimen for histological examination, which is crucial for confirming the diagnosis and ensuring clear margins in HSIL. - While minimally invasive, its effectiveness for HSIL treatment is generally considered lower than LEEP due to the lack of a histological specimen and potential for incomplete eradication. *Cone biopsy* - **Cold knife cone biopsy** is highly effective but more invasive than LEEP, carrying a higher risk of complications such as bleeding, infection, and cervical incompetence. - It involves surgical removal of a larger cone-shaped piece of tissue, often requiring general anesthesia. *Cryotherapy* - **Cryotherapy** involves freezing and destroying abnormal cells; however, it is primarily recommended for **low-grade squamous intraepithelial lesions (LSIL)**. - It is generally considered less effective for HSIL compared to excisional procedures like LEEP, as it also does not provide a specimen for histological evaluation.
Question 2: A boy is suffering from acute pyelonephritis. The most specific investigation to confirm the diagnosis is:
- A. Urine culture (Correct Answer)
- B. Leucocyte esterase test
- C. Nitrite test
- D. Bacteria in gram stain
Explanation: Urine culture - A **urine culture** is considered the gold standard for diagnosing urinary tract infections, including pyelonephritis, as it identifies the specific **pathogen** and its **antibiotic susceptibility** [1]. - It quantifies the number of bacteria present (colony-forming units/mL), confirming significant bacteriuria indicative of infection [2]. *Leucocyte esterase test* - The **leucocyte esterase test** detects enzymes produced by neutrophils, indicating the presence of **white blood cells (pyuria)** in the urine. - While suggestive of inflammation and infection, it is not specific to pyelonephritis and can be positive in other conditions like cystitis or contamination. *Nitrite test* - The **nitrite test** detects nitrites produced by some gram-negative bacteria (e.g., *E. coli*) that convert urinary nitrates to nitrites. - A positive result suggests bacteriuria but is not specific, as some pathogens do not produce nitrite, and it doesn't quantify bacterial load or identify the organism. *Bacteria in gram stain* - Direct visualization of **bacteria in a Gram stain** of uncentrifuged urine can indicate bacteriuria, especially if numerous organisms are seen [1]. - However, it provides preliminary information and cannot definitively identify the species, quantify bacterial load, or determine antibiotic sensitivity, which are crucial for confirming pyelonephilitis and guiding treatment [1].
Question 3: All of the following statements are true about Gleason score, except:
- A. Used for grading prostate cancer
- B. Higher the score, poorer the prognosis
- C. Helps in planning management
- D. Scores range from 2-10 (Correct Answer)
Explanation: ***Scores range from 2-10*** - The **Gleason score** is obtained by summing the two most predominant architectural patterns of tumor growth, with each pattern graded from 1 to 5. The lowest possible sum is 2 (1+1) and the highest is 10 (5+5). However, **Gleason scores are now reported from 6 to 10** for clinical purposes, as grade 1 and 2 patterns are rarely seen in biopsies, and for practical purposes, anything less than a 3+3=6 is considered benign or low-risk. [1] - While mathematically the range is 2-10, in modern clinical practice, a score of 6 is the lowest grade assigned to prostate cancer, making the statement that scores range from 2-10 clinically inaccurate. *Used for grading prostate cancer* - The **Gleason score** is a well-established and widely used histological grading system specifically for prostate adenocarcinoma. [2] - It assesses the **architectural patterns** of glandular differentiation in prostate cancer to predict its aggressiveness. *Higher the score, poorer the prognosis* - A **higher Gleason score** indicates a more poorly differentiated and aggressive tumor, which correlates with a greater likelihood of metastasis and recurrence. [2] - This directly translates to a **poorer prognosis** for the patient. *Helps in planning management* - The **Gleason score** is a critical factor, along with PSA levels and clinical staging, in determining the risk stratification of prostate cancer. - This risk stratification guides treatment decisions, such as whether to pursue active surveillance, radiation therapy, surgery, or systemic therapy. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 990-992. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 993-994.
Question 4: Which of the following is true about bone metastasis?
- A. Most common secondary tumor in females is from breast (Correct Answer)
- B. Higher serum levels of alkaline phosphatase
- C. Bone metastases are often symptomatic
- D. Prostate cancer produces only lytic lesions
Explanation: ***Most common secondary tumor in females is from breast*** - **Breast cancer** is the most common cause of skeletal metastases in women, frequently affecting the **axial skeleton** (spine, pelvis, ribs) [1]. - These metastases can be **osteolytic**, **osteoblastic**, or mixed, often leading to bone pain and pathological fractures. *Higher serum levels of alkaline phosphatase* - While **elevated alkaline phosphatase** can be seen in bone metastasis due to increased osteoblastic activity [2], it is not universally true for *all* bone metastases. - Many bone metastases, especially purely **lytic lesions**, may not significantly elevate alkaline phosphatase; instead, they might raise calcium levels. *Bone metastases are often symptomatic* - Bone metastases can be **asymptomatic** for extended periods, especially early in their development [2], only becoming symptomatic when significant bone destruction or nerve compression occurs [1]. - While pain is the most common symptom, **pathological fractures** and **spinal cord compression** can also be initial presentations [2]. *Prostate cancer produces only lytic lesions* - **Prostate cancer** characteristically produces **osteoblastic (bone-forming) metastases**, which appear as sclerotic lesions on imaging [2],[3]. - While rarely some lytic components can be present, the predominant feature is increased bone density. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Osteoarticular And Connective Tissue Disease, pp. 671-672. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 501-502. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 993-994.
Question 5: Screening of prostate cancer is commonly done by
- A. DRE (digital rectal exam) & PSA (Correct Answer)
- B. MRI imaging
- C. Surgical intervention
- D. Ultrasound-guided procedure
Explanation: ***DRE (digital rectal exam) & PSA*** - **Digital Rectal Exam (DRE)** allows for palpation of the prostate gland to detect **nodules**, **hardness**, or **asymmetry** that may indicate cancer. [1] - **Prostate-Specific Antigen (PSA)** is a blood test that measures a protein produced by the prostate gland; elevated levels can suggest prostate cancer. *MRI imaging* - While **MRI** is used for **staging** and sometimes for **targeted biopsies** of suspicious lesions, it is not a primary screening tool due to its cost and limited availability for broad population screening. - It is typically used *after* abnormal DRE or PSA results, or for monitoring. *Surgical intervention* - **Surgical intervention** (e.g., radical prostatectomy) is a **treatment** for prostate cancer confirmed by biopsy, not a screening method. - Screening aims to *detect* the disease, not to treat it. *Ultrasound-guided procedure* - **Transrectal ultrasound (TRUS)** is primarily used to **guide prostate biopsies** and determine prostate volume, not as a standalone screening test. - It does not have sufficient sensitivity or specificity to be routinely used for initial cancer screening.
Question 6: A patient from the Ohio River valley presents with granulomatous prostatitis showing broad-based budding organisms on microscopy. What is the most likely infecting organism?
- A. Escherichia coli
- B. Histoplasma capsulatum
- C. Pseudomonas aeruginosa
- D. Blastomyces dermatitidis (Correct Answer)
Explanation: ***Blastomyces dermatitidis*** - This organism is endemic to the **Ohio River valley** and is known to cause **granulomatous inflammation**, including in the prostate. - Its characteristic morphology is **broad-based budding yeast** on microscopy, fitting the description. *Escherichia coli* - While *E. coli* is a common cause of **bacterial prostatitis**, it does not present as granulomatous inflammation. - It is a **bacterium**, not a fungus, and would not show broad-based budding organisms. *Histoplasma capsulatum* - **Histoplasma** is also endemic to the Ohio River valley and causes granulomatous disease, but its yeast forms are **small**, intracellular, and do not exhibit broad-based budding. - It is often associated with a history of exposure to **bat or bird droppings** and commonly affects the lungs. *Pseudomonas aeruginosa* - *Pseudomonas aeruginosa* causes **bacterial infections**, often in immunocompromised individuals or associated with catheter use, and is not a fungus. - It causes **acute inflammation**, not chronic granulomatous inflammation, and does not show broad-based budding.
Question 7: Which zone of the prostate is primarily involved in Benign Prostatic Hyperplasia (BPH)?
- A. Central zone
- B. Peripheral zone
- C. Transitional zone (Correct Answer)
- D. Prostate capsule
Explanation: ***Transitional zone*** - The **transitional zone** surrounds the urethra and is the primary site of origin and enlargement in **Benign Prostatic Hyperplasia (BPH)**. - Its hypertrophy leads to compression of the urethra, causing **lower urinary tract symptoms (LUTS)**. *Central zone* - The **central zone** surrounds the ejaculatory ducts and is less commonly involved in BPH. - It is more frequently associated with the development of **prostate carcinoma**. *Peripheral zone* - The **peripheral zone** is the largest zone of the prostate and is where the majority of prostate cancers originate. - While it can be affected by BPH, it is not the primary zone for hypertrophy. *Prostate capsule* - The **prostate capsule** is the outer fibrous layer that encloses the prostate gland. - It does not undergo hyperplasia in BPH; rather, it encases the enlarging gland.
Question 8: Most common site of osteochondritis dissecans?
- A. Lateral part of the medial femoral condyle (Correct Answer)
- B. Medial part of the medial femoral condyle
- C. Lateral part of the lateral femoral condyle
- D. Medial part of the lateral femoral condyle
Explanation: ***Lateral part of the medial femoral condyle*** - This is the **most common site** for osteochondritis dissecans in the knee, accounting for about 85% of cases. - The condition involves a localized area of **osteonecrosis and subchondral bone separation** from the epiphysis, typically afflicting this specific load-bearing region. *Medial part of the medial femoral condyle* - This location is **less common** for osteochondritis dissecans compared to the lateral aspect of the medial femoral condyle. - While osteochondral lesions can occur on any part of the condyle, the specific biomechanical stresses make the lateral part more susceptible. *Lateral part of the lateral femoral condyle* - Osteochondritis dissecans is **rarely found** in this location. - The lateral femoral condyle is generally less involved in osteochondritis dissecans of the knee. *Medial part of the lateral femoral condyle* - This site is also an **uncommon location** for osteochondritis dissecans. - The disease has a strong predilection for the medial femoral condyle, particularly its lateral aspect.
Question 9: A chest X-ray (CXR) of a patient is shown. What is the next step in management of this patient?
- A. Ventilation perfusion scan
- B. Bronchoalveolar lavage
- C. High resolution CT scan
- D. Exploratory laparotomy (Correct Answer)
Explanation: ***Exploratory laparotomy*** - The chest X-ray shows **free air under the diaphragm** on the right side, indicating **pneumoperitoneum**. - **Pneumoperitoneum** usually signifies a **perforated abdominal viscus**, a surgical emergency requiring immediate exploration to identify and repair the perforation. *Ventilation perfusion scan* - This scan is primarily used to diagnose **pulmonary embolism** and is not indicated for the current finding. - The chest X-ray does not show any signs suggestive of pulmonary embolism, such as a **Westermark sign** or a **Hampton hump**. *Bronchoalveolar lavage* - **Bronchoalveolar lavage (BAL)** is a diagnostic procedure used to retrieve fluid from the lower respiratory tract for analysis, typically for infections or inflammatory conditions. - It would not be helpful in evaluating **subdiaphragmatic free air**, which is an abdominal issue. *High resolution CT scan* - While a **CT scan** could further characterize the pneumoperitoneum, the presence of clear free air on a plain film warrants **immediate surgical intervention** rather than further imaging, especially in an acute setting. - A CT scan might be considered if the diagnosis is equivocal, but in this case, the finding is unequivocal and indicates an emergency.
Question 10: Identify the stain shown in the liver section.
- A. Warthin starry
- B. Steiner silver stain
- C. Grimelius silver stain
- D. Gordon and Sweet's reticulin stain (Correct Answer)
Explanation: ***Gordon and Sweet's reticulin stain*** - The image shows **reticular fibers** in the liver, which appear as a delicate, branching network stained in **black**. This pattern is characteristic of a reticulin stain. - Reticulin stains are used to evaluate the **hepatic architecture** and detect its disruption in various liver diseases like cirrhosis. *Warthin starry* - The **Warthin-Starry stain** is primarily used to detect **spirochetes** (e.g., *Treponema pallidum* for syphilis) and certain bacteria like *Helicobacter pylori*. - It would show these organisms as black or brown, usually in a tissue section, but not the widespread network of reticular fibers seen here. *Steiner silver stain* - The **Steiner silver stain** is another type of silver impregnation stain used to detect **spirochetes** and other microorganisms, similar to Warthin-Starry. - It would not highlight the reticular fiber network of the liver in this specific pattern. *Grimelius silver stain* - The **Grimelius silver stain** is used to identify **neuroendocrine cells** and their granules, especially in tumors like carcinoids. - It stains the argyrophilic granules within these cells dark brown or black, which is distinct from the reticular network observed in the image.
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