Benign Prostatic Hyperplasia — MCQs
Which of the following drugs can decrease the size of the prostate?
Which of the following statements about benign prostatic hyperplasia (BPH) is true?
What is hyperplasia?
Acute urinary retention in a male child may be due to:
A 65 year old male presents with CA prostate. The tumour is limited to the capsule and it is palpable on PR examination. The patient is diagnosed as stage T2a. What is the most appropriate treatment option?
An elderly female presented with dribbling of urine only on coughing and straining. What type of urinary incontinence is she suffering from
Which of the following statements is MOST accurate regarding stress incontinence?
Which of the following is least likely to occur after transurethral resection of the prostate?
Indications of TURP for Benign Prostatic Hyperplasia (BPH) include: 1. Urinary flow rate of less than 10 mL/second 2. Residual volume of urine >100 mL 3. Serum level of prostatic specific antigen >10 ng/mL 4. Trabeculated Urinary bladder Select the correct answer using the code given below:
A patient is found to have an asymptomatic common bile duct (CBD) stone two years after cholecystectomy on routine imaging. What is the most appropriate initial management?
Benign Prostatic Hyperplasia Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following drugs can decrease the size of the prostate?
- A. Sildenafil
- B. Tamsulosin
- C. Finasteride (Correct Answer)
- D. Prazosin
Explanation: ***Finasteride***- **Finasteride** is a **5-alpha-reductase inhibitor** that blocks the conversion of testosterone to dihydrotestosterone (DHT), thereby reducing the size of the prostate. [1]- **DHT** is primarily responsible for the growth and enlargement of the prostate gland in benign prostatic hyperplasia (BPH).*Sildenafil*- **Sildenafil** is a **phosphodiesterase-5 (PDE5) inhibitor** used to treat erectile dysfunction and pulmonary hypertension.- It acts by increasing blood flow to the penis and does not affect prostate size.*Tamsulosin*- **Tamsulosin** is an **alpha-1 adrenergic antagonist** that relaxes smooth muscles in the prostate and bladder neck, improving urine flow.- While it alleviates symptoms of BPH, it does not reduce the actual size of the prostate gland. [2]*Prazosin*- **Prazosin** is also an **alpha-1 adrenergic antagonist** used to treat hypertension and, off-label, BPH symptoms by relaxing smooth muscles.- Similar to tamsulosin, it improves urine flow but does not decrease prostate volume. [2]
Question 2: Which of the following statements about benign prostatic hyperplasia (BPH) is true?
- A. Occurs in the periurethral region (Correct Answer)
- B. Increased risk of carcinoma
- C. Commonly causes hematuria as the initial symptom
- D. Primarily affects the peripheral zone
Explanation: ***Occurs in the periurethral region*** - **Benign prostatic hyperplasia (BPH)** typically originates in the **transition zone**, which is a part of the periurethral region of the prostate gland [1]. - This growth pattern explains why BPH commonly leads to **compression of the urethra** and subsequent lower urinary tract symptoms (LUTS) [1]. *Increased risk of carcinoma* - BPH is a **benign condition** and is not considered a premalignant lesion; it does **not increase the risk of prostate carcinoma** [1]. - Although both conditions are common in older men, they are distinct and BPH does not evolve into cancer [1]. *Commonly causes hematuria as the initial symptom* - While microscopic or macroscopic **hematuria** can occur in BPH due to friable blood vessels in the enlarged prostate, it is **not typically the initial or most common symptom**. - The most common initial symptoms are related to **urinary obstruction**, such as frequency, urgency, nocturia, and a weak stream [1]. *Primarily affects the peripheral zone* - The **peripheral zone** is the region of the prostate where **prostate carcinoma** most commonly originates [1, 2]. - BPH primarily affects the **transition zone** and, to a lesser extent, the central zone, leading to different clinical presentations and anatomical locations of disease [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 496-501. [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 3: What is hyperplasia?
- A. Decrease in cell size
- B. Increase in cell size
- C. Replacement of one cell type by another
- D. Increase in cell number (Correct Answer)
Explanation: ***Increase in cell size*** - Refers to the condition where individual **cells enlarge**, which is more accurately termed **hypertrophy**, not hyperplasia [1]. - **Hyperplasia** actually pertains to an increase in the **number of cells** due to cellular division [1]. *Decrease in cell number* - This indicates **atrophy**, which is the process of cell number reduction rather than an increase. - Hyperplasia is specifically defined by an **increase**, not a decrease, in cells [1]. *Decrease in cell size* - This also describes **atrophy**, marking a reduction in cell size rather than representing hyperplasia. - Hyperplasia involves an **increase** in the quantity of cells, not a decrease in size [1]. *Increase in cell number* - This is the correct definition of **hyperplasia** [1]; however, it was incorrectly matched to an increase in size in this context. - Hyperplasia is characterized by **increased cellular proliferation** rather than merely the size of existing cells [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 85-88.
Question 4: Acute urinary retention in a male child may be due to:
- A. Psychogenic urinary retention
- B. Prostatic radiotherapy
- C. Meatal ulcer with scabbing (Correct Answer)
- D. Urethral stricture
Explanation: ***Meatal ulcer with scabbing*** - A **meatal ulcer** in a male child, often caused by ammonia dermatitis or balanitis, can lead to **scabbing** that physically obstructs the urethral meatus. - This physical obstruction prevents the outflow of urine, causing acute urinary retention. - This is one of the **most common causes** of acute urinary retention in male children. *Psychogenic urinary retention* - **Psychogenic urinary retention** (previously termed 'hysterical retention') is rare in male children and is a diagnosis of exclusion. - While psychological factors can influence micturition, a physical obstruction is a more common and direct cause in children with acute retention. - Requires psychiatric evaluation and management. *Prostatic radiotherapy* - **Prostatic radiotherapy** is a treatment for **prostatic cancer**, a condition that primarily affects older adult males. - Prostate cancer and its treatments are virtually nonexistent in male children, making this an irrelevant option. *Urethral stricture* - While a **urethral stricture** can cause urinary retention, particularly in adult males, it is a less common cause of **acute urinary retention** in male children compared to meatal obstruction. - Congenital strictures are possible, but an acute presentation due to meatal scabbing is a more typical scenario in the pediatric population.
Question 5: A 65 year old male presents with CA prostate. The tumour is limited to the capsule and it is palpable on PR examination. The patient is diagnosed as stage T2a. What is the most appropriate treatment option?
- A. External beam radiation therapy
- B. Androgen deprivation therapy (ADT)
- C. Active surveillance
- D. Surgical removal of the prostate (Radical prostatectomy) (Correct Answer)
Explanation: ***Surgical removal of the prostate (Radical prostatectomy)*** - **Radical prostatectomy** is the **definitive treatment of choice** for **localized prostate cancer (T2a)** in patients with **good life expectancy (>10 years)**. - For a **65-year-old patient** with tumor confined to the prostate, **surgical removal offers excellent disease control** and potential cure. - This is the **preferred option** when the patient is **medically fit for surgery** and has adequate life expectancy. *External beam radiation therapy* - **External beam radiation therapy (EBRT)** is also an effective treatment for **localized T2a prostate cancer** with comparable long-term survival outcomes. - However, **radical prostatectomy is generally preferred** in younger, healthier patients as it: - Provides definitive pathological staging - Allows for immediate assessment of surgical margins - Preserves radiation as a salvage option if needed - EBRT is better suited for patients who are **not surgical candidates** due to comorbidities or patient preference. *Active surveillance* - **Active surveillance** is appropriate for **very low-risk prostate cancer** (T1c, PSA <10, Gleason ≤6). - For **T2a disease** (palpable tumor), the risk of progression is significant, making active surveillance **not the most appropriate first-line option**. - Would be considered only in patients with limited life expectancy or significant comorbidities. *Androgen deprivation therapy (ADT)* - **ADT** is used for **advanced, locally advanced, or metastatic prostate cancer** to reduce testosterone and slow tumor growth. - It is **not curative** and not appropriate as **monotherapy for localized T2a disease**. - May be used as adjuvant therapy with radiation in higher-risk cases, but not as primary treatment alone.
Question 6: An elderly female presented with dribbling of urine only on coughing and straining. What type of urinary incontinence is she suffering from
- A. Overflow incontinence
- B. Stress incontinence (Correct Answer)
- C. Urge incontinence
- D. Neurogenic bladder
Explanation: ***Stress incontinence*** - **Dribbling of urine** specifically with activities that increase intra-abdominal pressure like **coughing or straining** is the hallmark of stress incontinence. - This type of incontinence results from **weakness of the pelvic floor muscles** and/or intrinsic urethral sphincter deficiency. *Overflow incontinence* - This occurs when the bladder is **overfilled and unable to empty**, leading to constant dribbling or leakage. - Patients typically experience a **poor stream**, hesitancy, and a feeling of incomplete emptying, which are not described here. *Urge incontinence* - Characterized by a **sudden, strong urge to urinate** that is difficult to defer, often leading to involuntary leakage before reaching the toilet. - It is caused by **involuntary contractions of the detrusor muscle** and is not directly related to physical exertion like coughing. *Neurogenic bladder* - This refers to bladder dysfunction due to a **neurological condition** affecting bladder control, such as spinal cord injury or multiple sclerosis. - Symptoms can vary broadly (flaccid or spastic bladder) and are not limited to leakage with coughing alone.
Question 7: Which of the following statements is MOST accurate regarding stress incontinence?
- A. There is no complaint of urge to pass urine.
- B. Associated with alteration of the urethro-vesical angle.
- C. Coincides with periods of raised intra-abdominal pressure. (Correct Answer)
- D. Occurs primarily during sleep or at rest.
Explanation: ***Coincides with periods of raised intra-abdominal pressure.*** - **Stress incontinence** is defined by involuntary urine leakage during activities that increase intra-abdominal pressure, such as coughing, sneezing, laughing, or exercising. - This increased pressure overwhelms the weakened urethral sphincter or pelvic floor support. - This is the most accurate defining characteristic of stress incontinence. *There is no complaint of urge to pass urine.* - While **pure stress incontinence** does not involve an urge to void, this statement is too absolute. - **Mixed incontinence** (combination of stress and urge) is common, where patients may have both stress leakage and urgency symptoms. - Therefore, stating definitively "there is no complaint of urge" is not universally accurate. *Associated with alteration of the urethro-vesical angle.* - An **altered urethro-vesical angle** (specifically, loss of the posterior urethro-vesical angle) is a common anatomical finding in stress incontinence. - This represents the underlying anatomical defect contributing to poor bladder neck support. - However, this describes the anatomical consequence rather than the primary clinical presentation. *Occurs primarily during sleep or at rest.* - This is **incorrect** for stress incontinence. - Stress incontinence requires physical exertion or activities that increase intra-abdominal pressure. - Leakage during sleep or at rest would suggest other types of incontinence (overflow, urge, or continuous leakage from fistula).
Question 8: Which of the following is least likely to occur after transurethral resection of the prostate?
- A. Hyponatremia
- B. Congestive cardiac failure
- C. Transient blindness (Correct Answer)
- D. Convulsion
Explanation: ***Transient blindness*** - Transient blindness (amaurosis) is the **rarest complication** among the options listed, though it has been reported in severe TURP syndrome. - Ocular complications occur due to **severe hyponatremia** and cerebral edema affecting the visual cortex or retinal edema, but this is an **uncommon manifestation** compared to other neurological symptoms. - Most cases of TURP syndrome present with more typical features before visual symptoms develop. *Hyponatremia* - **Hyponatremia** is the **hallmark and most common feature** of TURP syndrome, occurring in up to 10-15% of procedures. - Caused by systemic absorption of **hypotonic irrigation fluid** (glycine or sorbitol solutions) during prolonged resection. - This is the primary electrolyte disturbance that leads to all other manifestations of TURP syndrome. *Convulsion* - **Convulsions (seizures)** are a **common neurological manifestation** of TURP syndrome when hyponatremia is severe (Na+ <120 mEq/L). - Result from **cerebral edema** and increased intracranial pressure due to rapid osmotic fluid shifts. - Generalized tonic-clonic seizures are well-recognized complications requiring immediate treatment. *Congestive cardiac failure* - **CHF** commonly occurs due to rapid absorption of **large volumes of irrigation fluid** causing acute **volume overload**. - The increased intravascular volume can precipitate pulmonary edema and cardiac decompensation, especially in elderly patients with pre-existing cardiac disease. - This is a frequent complication requiring diuretic therapy and fluid restriction.
Question 9: Indications of TURP for Benign Prostatic Hyperplasia (BPH) include: 1. Urinary flow rate of less than 10 mL/second 2. Residual volume of urine >100 mL 3. Serum level of prostatic specific antigen >10 ng/mL 4. Trabeculated Urinary bladder Select the correct answer using the code given below:
- A. 2, 3 and 4
- B. 1, 2 and 3
- C. 1, 3 and 4
- D. 1, 2 and 4 (Correct Answer)
Explanation: ***1, 2 and 4*** - Urinary flow rate **< 10 mL/s**, **residual urine volume > 100 mL**, and the presence of a **trabeculated bladder** (indicating chronic bladder outlet obstruction) are all relevant indications for considering TURP in BPH. - These findings collectively suggest significant **obstruction** and potential complications of BPH that may warrant surgical intervention. *2, 3 and 4* - This option incorrectly includes a **PSA level > 10 ng/mL** as an indication for TURP, which is primarily a marker for **prostate cancer screening** and not a direct surgical indication for BPH. - While an elevated PSA might prompt further investigation (e.g., biopsy), it doesn't alone necessitate TURP for BPH symptoms. *1, 2 and 3* - This option also incorrectly includes **PSA level > 10 ng/mL** as an indication for TURP. - The other two points (low flow rate and high residual volume) are appropriate indications, but the inclusion of PSA makes this option incorrect. *1, 3 and 4* - This option includes **PSA level > 10 ng/mL** as an indication for TURP, which is incorrect. - Additionally, it omits **residual urine volume > 100 mL**, which is a significant indicator of obstruction and a common reason for considering TURP.
Question 10: A patient is found to have an asymptomatic common bile duct (CBD) stone two years after cholecystectomy on routine imaging. What is the most appropriate initial management?
- A. ERCP with sphincterotomy and stone extraction (Correct Answer)
- B. Keep on active surveillance
- C. Medical dissolution therapy with ursodeoxycholic acid
- D. Surgical exploration and choledochotomy
Explanation: ***ERCP with sphincterotomy and stone extraction*** - This is the **gold standard management** for CBD stones discovered after cholecystectomy, even when asymptomatic - **Post-cholecystectomy CBD stones will not pass spontaneously** as there is no gallbladder to contract and propel stones forward - The **risk of complications** (acute cholangitis, acute pancreatitis, biliary obstruction) from leaving the stone in place outweighs the risk of ERCP - ERCP has a **high success rate (>90%)** with acceptable complication rates (pancreatitis 3-5%, bleeding <1%, perforation <1%) - **Prophylactic stone removal** prevents future emergency presentations and allows for planned intervention under optimal conditions *Keep on active surveillance* - **Not appropriate** for CBD stones in post-cholecystectomy patients, as these stones will not pass spontaneously - Unlike gallbladder stones, CBD stones carry a **significant risk of serious complications** including ascending cholangitis and acute biliary pancreatitis - Active surveillance might be considered only in patients with **prohibitive surgical risk** or very limited life expectancy - Modern guidelines recommend **intervention for all CBD stones** found post-cholecystectomy regardless of symptoms *Surgical exploration and choledochotomy* - This is a more **invasive approach** with higher morbidity compared to ERCP - Reserved for cases where **ERCP fails or is not feasible** (altered anatomy, large impacted stones, intrahepatic stones) - Not appropriate as **initial management** when less invasive endoscopic options are available - May be considered if ERCP is unsuccessful after 1-2 attempts *Medical dissolution therapy with ursodeoxycholic acid* - **Ineffective for CBD stones** - UDCA works only for small cholesterol stones in a functioning gallbladder - Requires months to years of therapy with **poor success rates** even for gallbladder stones - **Not recommended** for choledocholithiasis in any clinical scenario - This patient has already undergone cholecystectomy, making dissolution therapy completely irrelevant
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