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EAU pocket 2020 MCQs
EAU · MBBS / Medicine · 23 practice questions
- TNM staging categories
- Regional lymph node staging
- Variant histology and prognosis
- Classification and grading systems
- Prostatic urethral biopsy indications
- Indications for second TURB
- TNM staging of bladder cancer
- Prostatic urethra biopsy technique
1. During TURB, a surgeon needs to biopsy the prostatic urethra in a patient with suspected bladder CIS. The area to be sampled is the precollicular region, and there is no suspicion of stromal invasion since this is a primary non-muscle-invasive tumour. Which biopsy technique is appropriate for sampling this precollicular area, and with what instrument?
- AFluorescence-guided biopsy exclusively, avoiding mechanical instruments
- BA resection loop, from the 5 to 7 o'clock precollicular position
- CCold-cup biopsy with forceps, from the 12 o'clock position only
- DA resection loop, from the bladder dome mapping sites
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B. A resection loop, from the 5 to 7 o'clock precollicular position The guideline specifies taking the biopsy from the precollicular area (between the 5 and 7 o'clock position) using a resection loop, though cold-cup biopsy with forceps can alternatively be used when stromal invasion is not suspected in primary tumours — but the described precollicular sampling itself is via resection loop at 5-7 o'clock, not at 12 o'clock or via fluorescence alone, and bladder dome is unrelated to prostatic urethra biopsy.
2. A urology resident collects a first-morning voided urine sample from a patient with suspected high-grade bladder cancer and sends 15 mL for cytological analysis. What is the most significant flaw in this approach?
- AThe sample should have been unfixed and analysed within 1 hour
- BCytology cannot detect high-grade tumours regardless of technique
- CThe specimen is too small and morning urine is prone to cytolysis
- DCytology should never be used as an adjunct to cystoscopy
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C. The specimen is too small and morning urine is prone to cytolysis Guidelines specify at least 25 mL of fresh urine or urine with adequate fixation, and explicitly state morning urine is unsuitable due to frequent cytolysis, so both the volume and timing here are flawed. Cytology is in fact useful specifically for detecting high-grade tumours as an adjunct to cystoscopy, making the other statements about its uselessness incorrect. There's no requirement stated for analysis within 1 hour of an unfixed sample.
3. A patient with a documented history of low-grade Ta (TaG1/LG) bladder tumours presents with a small papillary recurrence on surveillance cystoscopy. Which management approach is supported as an option for this specific patient profile, distinct from the standard formal TURB pathway?
- AImmediate radical cystectomy
- BMandatory second TURB within two weeks regardless of resection completeness
- CIntravesical BCG induction without tissue sampling
- DOutpatient fulguration or laser vaporisation of the lesion
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D. Outpatient fulguration or laser vaporisation of the lesion Outpatient fulguration or laser vaporisation of small papillary recurrences is supported specifically in patients with a history of TaG1/LG tumours, reflecting their low-risk nature. Radical cystectomy is disproportionate for low-grade recurrence, intravesical BCG without any tissue diagnosis is not the described pathway, and mandatory second TURB is reserved for specific higher-risk situations, not routinely for low-grade recurrences managed as outpatient procedures.
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