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Created: 8/12/2007
Updated: 11/1/2008

1 Which of the following was not defined as clinical progression in the MTOPS study?

A Recurrent haematuria
B Renal failure
C Increase of 4 points in the AUA symptom score
D Urinary incontinence
E Recurrent urinary tract infection

2 In the PLESS study what is the effect of finasteride on acute urinary retention versus placebo?

A Reduces retention by 30%
B Reduces retention by 55%
C Associated with a risk reduction of 57%
D Associated with a risk reduction of 50%
E Reduces rention by 57%

3 Which of the following is not assessed on the IPSS questionaire?

A Incomplete emptying
B Frequency
C Quality of life
D Incontinence
E Straining

4 What proportion of patients with a flow rate of more than 15mls/sec are obstructed?

A 25%
B 30%
C 35%
D 65%
E 40%

5 What is the bladder outlet obstruction index for a man with a voided volume of 310mls, a Qmax of 13mls/sec and a pdet at Qmax of 90cmH20?

A 76
B 72
C 74
D 64
E 82

6 In the development of BPH which of the following is not a growth stimulating factor?


7 What is the risk of retention in a 70-79 year old with moderate lower urinary tract symptoms?

A 3 per 1000 person years
B 9 per 1000 person years
C 18 per 1000 person years
D 26 per 1000 person years
E 34 per 1000 person years

8 Regarding the natural history of BPH, what is the average decline in peak urinary flow rate?

A 0.1mls/sec/year
B 0.2mls/sec/year
C 0.3mls/sec/year
D 0.4mls/sec/year
E 0.5mls/sec/year  

9 What proportion of men age 61-70 have pathological evidence of BPH?

A 70%
B 65%
C 60%
D 55%
E 50%

10 What proportion of men aged 50-59 with BPH have clinical symptoms?

A 15%
B 20%
C 25%
D 30%
E 35%

11 What is the most important predictor of clinical progression in BPH

A Gland size
B Symptom severity
D Age
E High post-void residual

12 What is the risk of erectile dysfunction after TURP?

A 36%
B 30%
C 20%
D 16%
E 6%

13 What is the arterial supply of the prostate?

A Superior vesical artery
B Obturator artery
C Inferior vesical artery
D Inferior epigastric artery
E External iliac artery

14 What are the arteries seen after middle lobe resection during a TURP?

A Capsular arteries
B Badenoch's arteries
C Floch's arteries
D Branches of the internal pudendal artery
E Branches of the superior vesical artery

15 What is the embryological origin of the transition zone?

A Mesoderm
B Ectoderm
C Endoderm
D Mullerian duct
E Mesonephric duct

16 Which alpha-blocker has the strongest association with floppy iris syndrome?

A Alfuzosin
B Indoramin
C Prazosin
D Tamsulosin
E Doxasosin

17 How much is serum dihydrotestosteronedoes reduced by dutasteride?

A 50%
B 60%
C 70%
D 80%
E 90%

18 Which adrenoreceptor subtype mediates prostatic smooth muscle contraction?

A alpha1-a
B alpha1-b
C alpha2
D alpha1
E alpha1-L

19 What is the risk reduction for clinical progression with combination treatment in the MTOPS study?

A 66%
B 44%
C 39%
D 34%
E 28%

20 What is the change in symptom score in the placebo arm of the PLESS study?

A 3.3 increase
B 1.3 decrease
C 1.0 decrease
D 1.3 increase
E 3.3 decrease

Clinical progression was defined in the MTOPS study as

Increase of 4 points in the AUA symptom score
Acute urinary retention
Renal failure
Urinary incontinence
Recurrent urinary tract infection

99(7%) patients in placebo group compared to 42(3%) in finasteride group suffered acute urinary retention– Risk reduction of 57%

3D The following symptoms are assessed
incomplete emptying, frequency, intermittency, urgency, weak stream, straining and nocturia. In addition there is a quality of life score

4B <10mls/sec 90% obstructed, 10-15mls/sec 65%, >15mls/sec 30%

5D BOOI = pdet@Qmax- 2Qmax

6B Transforming growth factor beta ihibits epithelial cell proliferation, the other growth factors stimulate cell division and differentiation

7E This data comes from the Olmstead County Study (required reading)  which showed that men aged 70-79 with moderate/severe symptoms had a retention risk of 34.7 /1000 person years

8B You are required to be aware of the natural history of BPH and the Olmstead study showed an average decline of 0.2mls/sec/year in patients with BPH

9A This figure comes from Barry et al J Urol 1984 which is a useful paper

10C Garraway et al Lancet 1991 found that 25% of men with a TRUSS volume of >20mls had an IPSS of >11

11C A PSA of >1.4ng/ml ids the most important predictor of progression

12E The national prostatectomy audit quotes a rate of 31%  however it appears the risk is much lower. Wasson's TURP vs watchful waiting study found no difference in the rates of ED between the 2 groups and Marberger's BJU 1999 meta-analysis indicated a rate of 6.5%

13A The inferior vesical artery supplies the prostate-as it approaches the gland it divides into urethral and capsular branches

14B The arteries seen at 5 and 7 o clock after middle lobe resection are urethral branches of the inferior vesical artery known as Badenoch's arteries. The smaller arteries seen at 2 and 10 clock are known as Floch's arteries

15A Transition zone arises from mesoderm, peripheral zone arises from endoderm and central zone appears to be embryologically distinct possibly mullerian in origin

16D Although described as a class effect, the incidence of floppy iris syndrome with tamsulosin is approx 85%-90%

17E The dual 5ARI reduces serum DHT levels by 90%, the reduction achieved by finasteride is less but this does not appear to translate into an increased clinical effect

18A The alpha1-a subtype predominates in human stroma and therefore mediates prostatic smooth muscle contraction

19A The risk reduction for clinical progression is 66% with combination, 39% with doxazosin and 34% with finasteride

20B Patients in the placebo arm noticed a 1.3 point improvement/decrease in their symptom score versus a 3.3 improvement on finasteride. The fact that symptoms improved on placebo is useful to remember in discussions about treatment in the viva

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