Post-Test Questions

Article 1 (163–169)

1. All of the following are true of varicoceles EXCEPT:

   • They are present in approximately 15% of the general population.

   • They are diagnosed with scrotal ultrasound.

   • They typically present without symptoms.

   • They can contribute to testicular growth arrest and male infertility.

2. Which of the following is NOT an indication for varicocele repair?

   • An adult with a palpable varicocele and abnormal semen analysis

   • An adult with a palpable varicocele with scrotal pain

   • An adolescent with a palpable varicocele and testicular growth arrest

   • Nonpalpable varicocele incidentally discovered on scrotal ultrasound

3. Which of the following surgical approaches has been shown to offer the highest pregnancy rates and lowest rates of postoperative hydrocele?

   • Open retroperitoneal repair

   • Open inguinal repair

   • Microscopic subinguinal repair

   • Laparoscopic repair

   Article 2 (170–176)

4. An isolated varicocele on the right should raise concern for which of the following?

   • Variant anatomy

   • Retroperitoneal mass

   • Iatrogenic etiology

   • Arteriovenous malformation

5. Embolization as an initial treatment of varicocele has an overall success rate of:

   • 20%

   • 50%

   • 70%

   • 90%

6. The most common complication of embolization of the internal spermatic vein is:

   • Sterility

   • Nontarget embolization

   • Pain

   • Epididymitis

   Article 3 (177–181)

7. Which of the following is a typical corporal blood gas analysis in a patient with high-flow priapism?

   • pO₂ = 95 mm Hg

   • pCO₂ = 60 mm Hg

   • pH = 7.2

   • pO₂ = 25 mm Hg

8. Which of the following is a typical clinical presentation of high-flow priapism?

   • Painful erection longer than 4 hours in a patient with leukemia

   • Painless erection for 1 week after straddle injury

   • Prolonged erection after intracavernosal injection of vasoactive agent in a patient with erectile disorder

   • Intermittent repeated erection lasting longer than 3 hours in a patient with sickle-cell disease

9. Which of the following is the first-line treatment of high-flow priapism in a 6-year-old boy?

   • Intracavernosal instillation of phenylephrine

   • Ultrasound-guided compression of the arteriocavernosal fistula

   • Surgical ligation of the arteriocavernosal fistula

   • Selective embolization of the arteriocavernosal fistula using gelatin sponge

   Article 4 (182–185)

10. Which of the following is NOT a known risk factor for testicular cancer?

    • Personal history

    • Cryptorchidism

    • Smoking

    • Family history

11. A 34-year-old obese man presents to your clinic with a new left testicular mass. He has a history of cryptorchidism and testicular cancer of his right testicle and is status-post right orchiectomy 5 years ago. Which of the following patient characteristics confers the most risk of this patient having current testicular cancer?

    • Obesity

    • Age

    • History of cancer in the contralateral testicle

    • Cryptorchidism

12. Which of the following populations have the highest age-adjusted prostate cancer-specific death rate in the United States?

    • White men

    • African American men

    • Hispanic men

    • Asian men

    Article 5 (186–195)

13. Which one of the following techniques can be used for focal therapy of prostate cancer?

    • Laser ablation

    • High-intensity focused ultrasound

    • Cryoablation

    • All of the above

14. Which one of the following is true regarding the appearance of the prostate after radiation and hormone therapy?

    • The differentiation between PZ and TZ is usually diminished on T2-weighted images.

    • Prostate gland is enlarged.

    • Enhancement of prostate usually increases on DCE-MRI.

    • T2-weighted images are the most helpful sequences in detection of recurrence in these cases.

15. What is the significance of an increasing PSA after radical prostatectomy?

    • This is an expected finding after surgery.

    • Rising PSA specifically indicates recurrence at the pelvis.

    • Rising PSA is an indication for metastatic disease.

    • Rising PSA indicates pelvic recurrence or metastatic disease. Imaging is required to localize the recurrence.

    Article 6 (196–205)

16. According to a meta-analysis of 68 studies, random sextant core biopsies are associated with a false-negative rate of:

    • 5–10%

    • 10–15%

    • 15–20%

    • 20–25%

    • 25–30%

17. MRI-guided biopsy devices:

    • Must be used free hand

    • Have a proven cost–benefit over other biopsy techniques

    • Can be used in a transrectal or transperineal fashion, depending on the system

    • Must be used in-bore

    • None of the above

18. The benefits of using the PI-RADS v2 (an organized reporting system for mpMRI findings in the prostate) is that is should improve all of the following EXCEPT:

    • Detection

    • Localization

    • Postoperative changes

    • Characterization

    • Risk stratification

    Article 7 (206–216)

19. The development of tissue necrosis associated with thermal ablation involves which of the following processes?

    • Denaturation

    • Shrinkage

    • Aggregation of cytoplasmic proteins

    • Increased hydrophobic interactions resulting in the extrusion of water

    • All of the above

20. MRI has been reported to guide all of the following ablative therapies of the prostate EXCEPT:

    • Cryotherapy

    • Ultrasound ablation

    • Laser ablations of the prostate gland

    • Irreversible electroporation

    • All of the above are true

21. Performing minimally invasive image-guided thermal ablation is all of the following processes EXCEPT:

    • Guiding the ablative device to the target

    • Confirming placement relative to the 3D geometry of the target

    • Deploying the ablative energy with the goal of achieving complete tissue necrosis of the tumor along with a rim of adjacent normal tissue

    • Real-time observation of the ablated tissue

    • All of the above are true

    Article 8 (217–223)

22. An initial evaluation of bothersome lower urinary tract symptoms in a male patient may include all of the following, except:

    • Urinalysis

    • International Prostate Symptom Score questionnaire

    • Serum creatinine

    • Digital rectal exam

    • Measurement of postvoid residual

23. All of the following statements regarding medical therapy for BPH are true, except:

    • Tamsulosin should be considered first-line medical therapy in patients without a contraindication.

    • Finasteride decreases intraprostatic dihydrotestosterone and decreases PSA levels by ∼50%.

    • Among alpha-antagonists, retrograde ejaculation occurs most commonly with silodosin.

    • Sildenafil is approved for use as a treatment option in men with BPH.

24. All of the following statements regarding surgical treatment of BPH are true, except:

    • The risk of TUR syndrome has been eliminated with utilization of newer bipolar cautery resection loops and laser vaporization.

    • Simple prostatectomy is more commonly utilized for very large prostate glands (>100 g).

    • Incontinence is a very common side effect of TURP.

    • Underlying detrusor overactivity is a common cause of incontinence in immediate postoperative period after TURP.

    Article 9 (224–230)

25. Pelvic CTA can be used prior to prostatic artery embolization for:

    • Determining from what vessels the prostatic arteries arise.

    • Evaluating the degree of atherosclerosis within the pelvic arteries.

    • Creating 3D images from different obliquities to help with guidance during the procedure.

    • Calculating the volume of the prostate gland.

    • All of the above.

26. The anterior/lateral prostatic arteries can arise from:

    • The internal pudendal artery

    • The anterior division of the internal iliac artery

    • The obturator artery

    • The gluteal pudendal trunk

    • All of the above

27. Concerning prostate volume calculation on CTA:

    • Volume calculation is more accurate on CT than on MRI.

    • The most commonly used formula is the bullet formula.

    • The ellipsoid formula overestimates the volume of larger prostates

    • Volume can be calculated using segmentation software after demarcating the prostate borders on axial slices.

    • None of the above.

    Article 10 (231–235)

28. Anatomic origin of the prostatic arteries can occur from all of the following, EXCEPT:

    • Anterior division of the internal iliac artery

    • The superior vesical artery

    • The internal pudendal artery

    • Adjacent pelvic arteries outside the prostate

    • All of the above can serve as the origin of the prostatic arteries

29. True or false? The cranial prostatic artery is typically enlarged in the setting of benign prostatic hypertrophy?

    True

    False

30. Patients with moderate-to-severe LUTS may benefit from medical therapy, including all of the following EXCEPT:

    • Alpha-adrenergic blockers

    • 5-Alpha-reductase inhibitors muscarinic receptor antagonists

    • Sildenafil citrate

    • Phosphodiesterase inhibitors

    • All of the above can be used

    Article 11 (236–239)

31. Which of the following is INCORRECT?

    • Preshaped microcatheters are especially helpful when the prostatic artery arises from the obturator artery due to the acute angle at the origin.

    • The “buddy wire” technique is useful for maintaining a sheath in the proximal anterior division when the internal iliac is tortuous.

    • A small coil in the origin of a nontarget artery can help deflect the guidewire into the prostatic artery.

    • A coil or Gelfoam can be used for proximal embolization of a collateral vessel to avoid nontarget embolization.

32. Identification of the prostatic arteries can be challenging for all of the following reasons, EXCEPT:

    • The variable locations from which they arise

    • Their small diameter

    • Their proximity to other small pelvic arteries

    • All of the above are correct

33. The following imaging modalities can be used for prostatic artery identification:

    • CTA

    • DSA

    • Cone beam CT

    • All of the above