Male Reproductive & Urinary Tract Pathology OmpathStudy

MOUNT KENYA UNIVERSITY — SCHOOL OF MEDICINE Programme: Bachelor of Medicine and Bachelor of Surgery, Year 3 Assessment: Mid of Semester 3 — Continuous Assessment Test One Unit Code: MBPA 3514A — Male Reproductive & Urinary Tract Systems Pathology Date: May 2026 Reg No: BMS/2023/60482 --- Q1. 66-year-old man, urinary obstruction, prostate biopsy shows infiltrative glands in cribriform pattern — which feature suggests aggressive disease? a. Basal cell layer present b. Well-formed glandular architecture c. Perineural invasion d. Cystic dilation of glands e. Stromal edema Answer: c — Perineural invasion Perineural invasion signals aggressive local spread and higher Gleason grade. Loss (not presence) of the basal cell layer (a) is actually what indicates malignancy, since normal/benign glands retain a basal layer. Q2. 28-year-old man, infertility, small testes, karyotype 47,XXY. a. Androgen receptor excess b. Meiotic nondisjunction c. Post-zygotic mutation d. Somatic mosaicism only e. Gene deletion on Y chromosome Answer: b — Meiotic nondisjunction Klinefelter syndrome (47,XXY) arises from nondisjunction of sex chromosomes during meiosis (in either parent's gametogenesis). Q3. 24-year-old man, painless scrotal mass, tumour cells positive for PLAP. a. Embryonal carcinoma b. Seminoma c. Teratoma d. Yolk sac tumor e. Leydig cell tumor Answer: b — Seminoma Placental alkaline phosphatase (PLAP) is a classic immunohistochemical marker for seminoma. Q4. Newborn, scrotal swelling containing milky fluid. a. Hydrocele b. Hematocele c. Varicocele d. Spermatocele e. Epididymitis Answer: a — Hydrocele (note: "milky fluid" is unusual phrasing — hydrocele fluid is typically clear/serous, but among the given options this remains the best fit for a congenital fluid-filled scrotal swelling in a newborn) Hydrocele is the classic congenital cause of scrotal swelling in newborns from a patent processus vaginalis, containing peritoneal fluid. Hematocele (b) would contain blood, not "milky" fluid. Q5. 31-year-old man, urethritis, NAAT confirms intracellular organism dependent on host ATP. a. Neisseria gonorrhoeae b. Chlamydia trachomatis c. Treponema pallidum d. HSV-2 e. Trichomonas vaginalis Answer: b — Chlamydia trachomatis Chlamydia is an obligate intracellular bacterium that depends on host-cell ATP ("energy parasite"), unlike Neisseria (a), which is extracellular/facultative intracellular but not ATP-dependent in this way. Q6. 40-year-old man, condyloma acuminata — responsible viral mechanism? a. Viral RNA integration b. Oncoproteins E6 and E7 inhibiting tumor suppressors c. Cell wall destruction d. Immune complex deposition e. Toxin-mediated injury Answer: b — Oncoproteins E6 and E7 inhibiting tumor suppressors HPV (cause of condyloma acuminata/genital warts) uses E6/E7 oncoproteins to degrade p53 and Rb respectively, disrupting normal cell cycle control. Q7. 50-year-old man, epididymo-orchitis, urine culture shows enteric gram-negative bacilli. a. Chlamydia trachomatis b. Escherichia coli c. Neisseria gonorrhoeae d. Treponema pallidum e. HSV Answer: b — Escherichia coli In older men, epididymo-orchitis is typically due to urinary tract pathogens (enteric gram-negative bacilli like E. coli) rather than STIs (which are more typical in younger, sexually active men). Q8. Painless penile ulcer, positive VDRL test — pathogenesis? a. Viral cytolysis b. Spirochete invasion with immune-mediated damage c. Fungal invasion d. Bacterial exotoxin e. Direct necrosis Answer: b — Spirochete invasion with immune-mediated damage Positive VDRL confirms syphilis (Treponema pallidum, a spirochete); tissue damage in the primary chancre results from spirochete invasion combined with host immune response. Q9. 60-year-old man, prostate cancer — which histological pattern correlates with high Gleason score? a. Well-formed glands b. Cribriform and fused glands c. Cystic glands d. Basal cell hyperplasia e. Squamous metaplasia Answer: b — Cribriform and fused glands Loss of distinct glandular architecture with cribriform/fused patterns reflects higher-grade, more aggressive prostate cancer (higher Gleason pattern). Q10. 45-year-old man, infertility, testicular biopsy shows Leydig cell hyperplasia — expected hormone abnormality? a. Low FSH b. High estrogen c. High testosterone d. Low cortisol e. High prolactin Answer: c — High testosterone Leydig cell hyperplasia reflects increased testosterone-producing tissue, consistent with elevated testosterone (though paradoxically this can occur alongside impaired spermatogenesis causing infertility). Q11. 30-year-old man, painful genital ulcers, multinucleated giant cells on histopathology. a. Syphilis b. HSV infection c. Chancroid d. HPV e. LGV Answer: b — HSV infection Multinucleated giant cells (Tzanck-type changes) with painful ulcers are classic for herpes simplex virus infection. Syphilis (a) and chancroid (c) don't show this specific cytopathic feature; syphilis ulcers are also classically painless. Q12. Man p