WorksheetsGEM 7.04
Total questions: 151
Worksheet time: 3hrs 31mins
Name
Class
Date
1.
Which abdominal-wall layer does NOT contribute to the coverings of the testes?
a)
External oblique
b)
Internal oblique
c)
Transversus abdominis
d)
Transversalis fascia
e)
Scarpa's fascia
2.
The rete testis directly receives sperm from which structure?
a)
Epididymis
b)
Seminiferous tubules
c)
Ductus deferens
d)
Ampulla
e)
Prostatic urethra
3.
Which artery is a branch of the inferior epigastric artery?
a)
Testicular artery
b)
Artery to ductus deferens
c)
Cremasteric artery
d)
Prostatic artery
e)
Superior vesical artery
4.
The cremasteric reflex is mediated by which nerve for motor output?
a)
Pudendal nerve
b)
Ilioinguinal nerve
c)
Genitofemoral nerve
d)
Obturator nerve
e)
Pelvic splanchnic nerves
5.
During a vasectomy, which nerve must be protected?
a)
Ilioinguinal
b)
Pudendal
c)
Sciatic
d)
Femoral
e)
Obturator
6.
Which gland contributes the largest proportion of semen volume?
a)
Prostate
b)
Seminal vesicles
c)
Bulbourethral glands
d)
Epididymis
e)
Testes
7.
Benign prostatic hyperplasia (BPH) most commonly arises in which zone?
a)
Peripheral zone
b)
Central zone
c)
Transition zone
d)
Anterior fibromuscular stroma
e)
Median lobe
8.
Which part of the male urethra is most vulnerable to catheterisation difficulty at the glans penis?
a)
Preprostatic urethra
b)
Prostatic urethra
c)
Membranous urethra
d)
Spongy urethra – navicular fossa
e)
External urethral orifice
9.
Which female structure is homologous to the bulbourethral glands in males?
a)
Labia minora
b)
Labia majora
c)
Greater vestibular glands
d)
Vestibular bulbs
e)
Clitoris
10.
Which structure contributes to maintaining penile erection by restricting venous outflow?
a)
Dartos fascia
b)
Tunica vaginalis
c)
Tunica albuginea
d)
Buck's fascia
e)
Camper's fascia
11.
A 62-year-old man presents with urinary hesitancy. Imaging shows nodular enlargement of the transition zone of the prostate. Which structure is directly compressed?
a)
Prostatic urethra
b)
Ejaculatory ducts
c)
Peripheral zone
d)
Rectum
e)
Bulbourethral glands
12.
A testicular tumour drains lymph first to which group of nodes?
a)
Para-aortic
b)
Superficial inguinal
c)
External iliac
d)
Internal iliac
e)
Deep inguinal
13.
During catheterisation in a male, resistance is felt at the membranous urethra. Which structure causes this narrowing?
a)
External urethral sphincter
b)
Internal urethral sphincter
c)
Navicular fossa
d)
Prostatic urethra
e)
Ampulla of ductus deferens
14.
A patient undergoes vasectomy. Three years later, reversal is attempted. Which is the expected outcome in most cases?
a)
Sperm present in semen
b)
Permanent azoospermia
c)
Loss of testosterone production
d)
Reduced prostate size
e)
Loss of seminal fluid
15.
Digital rectal examination reveals a firm, irregular nodule in the posterior prostate. Which condition is most likely?
a)
Prostate cancer
b)
Benign prostatic hyperplasia
c)
Urethral stricture
d)
Urethritis
e)
Bulbourethral cyst
16.
The pampiniform plexus drains into the left renal vein on the left side. What clinical condition can result from failure of this drainage?
a)
Varicocele
b)
Hydrocele
c)
Epididymitis
d)
Testicular torsion
e)
Orchitis
17.
A penile fracture involves rupture of which structure?
a)
Tunica albuginea of corpora cavernosa
b)
Corpus spongiosum
c)
Buck's fascia
d)
Dartos fascia
e)
Colle's fascia
18.
Which female structure is homologous to the scrotum in the male?
a)
Labia majora
b)
Labia minora
c)
Clitoris
d)
Vestibular bulbs
e)
Greater vestibular glands
19.
A clinician palpates the spermatic cord and feels a thick muscular tube. Which structure is this?
a)
Ductus deferens
b)
Pampiniform plexus
c)
Testicular artery
d)
Cremaster muscle
e)
Genitofemoral nerve
20.
Which part of the urethra is most vulnerable to injury in a pelvic fracture?
a)
Membranous urethra
b)
Spongy urethra
c)
Prostatic urethra
d)
Preprostatic urethra
e)
Navicular fossa
21.
Which artery supplies the superior aspect of the bladder and ductus deferens?
a)
Superior vesical artery
b)
Inferior vesical artery
c)
Middle rectal artery
d)
Internal pudendal artery
e)
Umbilical artery (obliterated part)
22.
Which artery is the male equivalent of the vaginal artery?
a)
Inferior vesical artery
b)
Internal pudendal artery
c)
Superior vesical artery
d)
Middle rectal artery
e)
Obturator artery
23.
Venous drainage of the testes differs because:
a)
Right drains to IVC, left to renal vein
b)
Both veins drain directly to IVC
c)
Right drains to renal vein, left to IVC
d)
Both drain to common iliac veins
e)
Both drain via internal iliac veins
24.
Prostate cancer commonly metastasises to the spine because:
a)
Venous drainage communicates with vertebral venous plexus
b)
Venous drainage is valved
c)
Spread via lymphatics to para-aortic nodes
d)
Arterial spread from internal iliac
e)
Direct extension through pelvic floor
25.
Lymphatic drainage of the testes is to:
a)
Para-aortic (lateral aortic) nodes
b)
Internal iliac nodes
c)
External iliac nodes
d)
Superficial inguinal nodes
e)
Deep inguinal nodes
26.
Parasympathetic innervation of erection arises from:
a)
Pelvic splanchnic nerves (S2–S4)
b)
Lumbar splanchnic nerves (T10–L2)
c)
Pudendal nerve (S2–S4)
d)
Ilioinguinal nerve (L1–L2)
e)
Posterior cutaneous nerve of thigh (S1–S3)
27.
Which nerve provides sensory innervation to the penis?
a)
Pudendal nerve via dorsal nerve of penis
b)
Pelvic splanchnic nerves
c)
Sympathetic fibres from T12–L2
d)
Ilioinguinal nerve
e)
Genitofemoral nerve
28.
Which muscles help maintain erection by compressing venous outflow?
a)
Ischiocavernosus and bulbospongiosus
b)
Levator ani
c)
External anal sphincter
d)
Bulbospongiosus only
e)
Cremaster
29.
During ejaculation, which structure contracts to prevent retrograde flow into bladder?
a)
Internal urethral sphincter
b)
External urethral sphincter
c)
Bulbospongiosus muscle
d)
Ischiocavernosus muscle
e)
Urogenital diaphragm
30.
Which nerve contributes anterior scrotal innervation?
a)
Ilioinguinal nerve
b)
Pudendal nerve
c)
Posterior cutaneous nerve of thigh
d)
Genital branch of genitofemoral
e)
Sacral splanchnic nerve
31.
Which nerve travels inside the spermatic cord?
a)
Genital branch of genitofemoral nerve
b)
Ilioinguinal nerve
c)
Pudendal nerve
d)
Posterior cutaneous nerve of thigh
e)
Pelvic splanchnic nerve
32.
Which sympathetic nerves are most responsible for emission during ejaculation?
a)
Lumbar splanchnic nerves (T10–L2)
b)
Pelvic splanchnic nerves (S2–S4)
c)
Pudendal nerve (S2–S4)
d)
Ilioinguinal nerve (L1)
e)
Posterior cutaneous nerve of thigh (S1–S3)
33.
A lesion of the pudendal nerve would most directly impair which function?
a)
Somatic sensation of the penis
b)
Parasympathetic drive to erection
c)
Sympathetic contraction during emission
d)
Cremaster reflex
e)
Superior bladder sensation
34.
Which muscle contributes most to expulsion of semen during ejaculation?
a)
Bulbospongiosus
b)
Ischiocavernosus
c)
Levator ani
d)
External anal sphincter
e)
Piriformis
35.
A 62-year-old man with prostate cancer develops severe back pain. Which venous pathway best explains spinal metastasis?
a)
Lateral sacral veins → vertebral venous plexus
b)
Testicular veins → para-aortic nodes
c)
Superior vesical veins → hepatic portal system
d)
Internal pudendal veins → femoral vein
e)
Obturator veins → external iliac veins
36.
Referred pain from the superior bladder dome would most likely present in:
a)
Lower abdomen (T10–L2)
b)
Perineum (S2–S4)
c)
Gluteal region (L4–S1)
d)
Medial thigh (L2–L3)
e)
Posterior thigh (S1–S3)
37.
Which lymph nodes receive drainage from the seminal vesicles?
a)
External and internal iliac nodes
b)
Superficial inguinal nodes only
c)
Para-aortic nodes
d)
Deep inguinal nodes only
e)
Pre-aortic nodes (celiac)
38.
Which artery gives rise to the dorsal artery of the penis?
a)
Internal pudendal artery
b)
Inferior vesical artery
c)
Superior vesical artery
d)
Middle rectal artery
e)
External pudendal artery
39.
A patient undergoes orchiectomy for testicular cancer. Which nodes should be carefully assessed first for metastasis?
a)
Para-aortic nodes
b)
Internal iliac nodes
c)
External iliac nodes
d)
Deep inguinal nodes
e)
Superficial inguinal nodes
40.
During spinal anaesthesia for scrotal surgery, the block must be given above which spinal level to cover all innervation?
a)
L1
b)
L2
c)
S2
d)
S3
e)
T12
41.
Which intermediate mesoderm derivative forms the gonadal ridges?
a)
Gonadal ridges
b)
Notochord
c)
Somites
d)
Pleura
e)
Neural tube
42.
Which kidney stage is transient and non-functional in humans?
a)
Pronephros
b)
Mesonephros
c)
Metanephros
d)
Metanephric blastema
e)
Ureteric bud
43.
The mesonephric duct is essential in forming which structure in males?
a)
Vas deferens
b)
Collecting ducts
c)
Renal cortex
d)
Ureter
e)
Renal papilla
44.
The permanent kidneys first appear in which region?
a)
Pelvis
b)
Thorax
c)
Posterior mediastinum
d)
Lumbar region
e)
Abdomen at T12–L3
45.
The ureteric bud gives rise to which of the following?
a)
Major calyces
b)
Nephrons
c)
Glomeruli
d)
Renal cortex
e)
Gonadal ridges
46.
Horseshoe kidney typically fails to ascend due to obstruction by which artery?
a)
Inferior mesenteric artery
b)
Aortic bifurcation
c)
Superior mesenteric artery
d)
Renal artery
e)
Iliac artery
47.
Bilateral renal agenesis is incompatible with life because:
a)
No nephrons develop
b)
Placenta cannot excrete fetal waste
c)
No amniotic fluid is produced
d)
Both suprarenal glands fail
e)
Bladder cannot form
48.
A bifid ureter arises due to:
a)
Abnormal branching of ureteric bud
b)
Failed ascent of kidney
c)
Failure of pronephros regression
d)
Persistence of allantois
e)
Failure of mesonephric duct formation
49.
The urorectal septum divides the cloaca by which embryonic week?
a)
Week 7
b)
Week 3
c)
Week 4
d)
Week 9
e)
Week 12
50.
A patent urachus results in which clinical finding?
a)
Urine leakage from umbilicus
b)
Abdominal mass without symptoms
c)
Reflux of urine into ureters
d)
Failure of kidney ascent
e)
Renal calculi formation
51.
A 22-year-old man is found to have a single fused kidney lying at L3. Which embryological event explains this?
a)
Fusion of superior poles of metanephric kidneys
b)
Persistence of pronephros
c)
Arrest of ascent by inferior mesenteric artery
d)
Abnormal ureteric bud branching
e)
Failure of mesonephric duct regression
52.
A neonate presents with Potter sequence. Which developmental failure is the underlying cause?
a)
Failure of metanephric mesoderm to develop
b)
Failure of pronephros regression
c)
Failure of mesonephros degeneration
d)
Abnormal ureteric bud branching
e)
Failure of urorectal septum formation
53.
During development, which structure specifically induces branching morphogenesis of the ureteric bud?
a)
Metanephric mesoderm
b)
Mesonephric duct
c)
Paraxial mesoderm
d)
Lateral plate mesoderm
e)
Notochord
54.
At what embryonic week do the permanent kidneys typically begin to function?
a)
Week 12
b)
Week 5
c)
Week 7
d)
Week 9
e)
Week 16
55.
Which congenital abnormality results from premature branching of ureteric bud?
a)
Bifid ureter
b)
Pelvic kidney
c)
Unilateral renal agenesis
d)
Horseshoe kidney
e)
Bilateral renal agenesis
56.
The epithelial lining of the urinary bladder is derived from which germ layer?
a)
Endoderm
b)
Mesoderm (intermediate)
c)
Mesoderm (lateral plate)
d)
Ectoderm
e)
Neural crest
57.
Which structure represents the remnant of the allantois in the adult?
a)
Median umbilical ligament
b)
Medial umbilical ligaments
c)
Lateral umbilical fold
d)
Ligamentum teres hepatis
e)
Round ligament of uterus
58.
A 1-year-old presents with urine leakage from the umbilicus. Which defect?
a)
Patent urachus
b)
Urachal cyst
c)
Urachal sinus
d)
Cloacal membrane persistence
e)
Bifid ureter
59.
In a fetus with ectopic pelvic kidney, which embryological process has failed?
a)
Ascent of metanephros
b)
Formation of ureteric bud
c)
Induction of nephron formation
d)
Fusion of inferior poles
e)
Division of cloaca
60.
Which anomaly is most strongly associated with recurrent UTIs in childhood?
a)
Horseshoe kidney
b)
Pelvic kidney
c)
Urachal cyst
d)
Unilateral renal agenesis
e)
Mesonephric duct remnant
61.
Primordial germ cells originate in which structure before migrating?
a)
Yolk sac
b)
Primitive streak
c)
Mesonephros
d)
Allantois
e)
Hindgut
62.
Failure of primordial germ cells to reach the gonadal ridge results in:
a)
Gonadal agenesis
b)
Testicular torsion
c)
Cryptorchidism
d)
Azoospermia
e)
Bicornuate uterus
63.
At 6–7 weeks, gonads are termed “indifferent” because:
a)
No morphological distinction between testis and ovary
b)
Both ducts have regressed
c)
Testis cords have formed
d)
Oogonia are already present
e)
Tunica albuginea is visible
64.
The presence of SRY gene product results in:
a)
Maintenance of medullary (testis) cords
b)
Regression of mesonephric ducts
c)
Development of cortical cords
d)
Development of paramesonephric ducts
e)
Formation of broad ligament
65.
Leydig cells appear by week 8 and secrete:
a)
Testosterone
b)
Anti-Müllerian hormone
c)
Oestrogen
d)
Inhibin
e)
Dihydrotestosterone
66.
Which embryonic structure gives rise to the uterus and upper vagina?
a)
Paramesonephric ducts
b)
Mesonephric ducts
c)
Urogenital sinus
d)
Cloaca
e)
Allantois
67.
Failure of paramesonephric duct fusion can cause:
a)
Uterus didelphys
b)
Cryptorchidism
c)
Unicornuate uterus
d)
Testicular agenesis
e)
Hypospadias
68.
The gubernaculum in females forms which adult structures?
a)
Round ligament of uterus and ovarian ligament
b)
Broad ligament and mesovarium
c)
Suspensory ligament and mesometrium
d)
Processus vaginalis and tunica vaginalis
e)
Cremasteric muscle and spermatic cord
69.
Cryptorchidism increases risk of:
a)
Testicular torsion
b)
Endometrial carcinoma
c)
Polycystic ovarian syndrome
d)
Bicornuate uterus
e)
Placenta accreta
70.
The lower half of the vagina is derived from:
a)
Urogenital sinus
b)
Paramesonephric ducts
c)
Mesonephric ducts
d)
Wolffian ducts
e)
Cloacal membrane
71.
Which female structure is homologous to the scrotum?
a)
Labia majora
b)
Labia minora
c)
Clitoris
d)
Vestibular bulbs
e)
Greater vestibular glands
72.
The genital tubercle elongates in males to form:
a)
Penis
b)
Scrotum
c)
Prepuce
d)
Prostate
e)
Perineal raphe
73.
In females, failure of paramesonephric ducts to contact the urogenital sinus may cause:
a)
Vaginal agenesis
b)
Septate uterus
c)
Uterus didelphys
d)
Unicornuate uterus
e)
Imperforate hymen
74.
Which suspensory ligament contains the ovarian vessels?
a)
Suspensory ligament of ovary
b)
Round ligament remnant
c)
Mesonephric duct remnant
d)
Paramesonephric duct remnant
e)
Ovarian vessels
75.
Which congenital anomaly is most linked to renal agenesis?
a)
Unicornuate uterus
b)
Hypospadias
c)
Uterus didelphys
d)
Vaginal atresia
e)
Septate uterus
76.
The penile urethra (except navicular fossa) is formed from:
a)
Urogenital folds
b)
Mesonephric duct
c)
Paramesonephric duct
d)
Genital tubercle
e)
Cloacal membrane
77.
Persistent Müllerian duct syndrome occurs due to failure of which cell type?
a)
Sertoli cells
b)
Leydig cells
c)
Granulosa cells
d)
Theca cells
e)
Primordial germ cells
78.
The processus vaginalis normally closes after testicular descent. Persistence leads to:
a)
Hydrocoele
b)
Hypospadias
c)
Epispadias
d)
Varicocoele
e)
Phimosis
79.
A newborn with ambiguous genitalia is found to have androgen-insensitivity syndrome. Which duct derivative is absent?
a)
Uterine tube
b)
Epididymis
c)
Seminal vesicle
d)
Vas deferens
e)
Ejaculatory duct
80.
Which embryonic structure gives rise to the prostatic urethra in males?
a)
Urogenital sinus
b)
Mesonephric duct
c)
Paramesonephric duct
d)
Cloaca
e)
Allantois
81.
Failure of the urorectal septum to fully divide the cloaca results in:
a)
Rectovaginal fistula
b)
Bicornuate uterus
c)
Hypospadias
d)
Cryptorchidism
e)
Hydrocoele
82.
Which feature is typically associated with ductal adenocarcinoma of the prostate?
a)
More aggressive and presents late
b)
More indolent and PSA always raised
c)
Equal prognosis and PSA levels
d)
Always associated with BPH
e)
Found exclusively in the transition zone
83.
Which PSA level best represents the “grey zone”?
a)
4–10 ng/mL
b)
<2 ng/mL
c)
>20 ng/mL
d)
>100 ng/mL
e)
<0.5 ng/mL
84.
Which of the following best describes the four stages of the male sexual response cycle?
a)
Excitement → Plateau → Orgasm → Resolution
b)
Desire → Excitement → Plateau → Refractory
c)
Plateau → Orgasm → Resolution → Refractory
d)
Excitement → Plateau → Resolution → Orgasm
e)
Desire → Resolution → Orgasm → Plateau
85.
In males, which additional phase follows the resolution stage?
a)
Refractory phase
b)
Plateau phase
c)
Latent phase
d)
Resting phase
e)
Recovery phase
86.
Which hormone is the main modulator of libido in males?
a)
Testosterone
b)
Prolactin
c)
Oxytocin
d)
Cortisol
e)
Vasopressin
87.
Which spinal cord segments provide parasympathetic innervation for penile erection?
a)
S2–S4
b)
T10–L2
c)
L4–L5
d)
C5–C7
e)
T4–T6
88.
Which neurotransmitter is the most important mediator of penile erection?
a)
Nitric oxide
b)
Acetylcholine
c)
Noradrenaline
d)
Dopamine
e)
GABA
89.
Which structural feature limits excessive swelling of erectile tissue?
a)
Tunica albuginea
b)
Corpus spongiosum
c)
Dorsal vein
d)
Cavernosal artery
e)
Ischiocavernosus muscle
90.
Which systemic physiological response is observed during male sexual arousal?
a)
Hyperventilation
b)
Bradycardia
c)
Hypotension
d)
Pupillary constriction
e)
Muscle relaxation
91.
Which drug class is most commonly associated with reduced libido?
a)
Antihypertensives
b)
Corticosteroids
c)
NSAIDs
d)
Antihistamines
e)
Proton-pump inhibitors
92.
Which physiological process maintains penile erection?
a)
Compression of venous plexus
b)
Increased venous drainage
c)
Sympathetic vasoconstriction
d)
Increased calcium in smooth muscle
e)
Arteriolar constriction
93.
Which endocrine disorder is most strongly associated with reduced libido?
a)
Hypogonadism
b)
Hyperthyroidism
c)
Diabetes insipidus
d)
Addison's disease
e)
Hypertension
94.
Which neurotransmitter pathway activates eNOS in penile erection?
a)
Parasympathetic cholinergic fibres
b)
Sympathetic adrenergic fibres
c)
Somatic pudendal nerve
d)
Dopaminergic mesolimbic tract
e)
Hypothalamic oxytocinergic fibres
95.
Which change in smooth-muscle signalling maintains tumescence?
a)
Decreased intracellular calcium
b)
Increased MLCK activity
c)
Increased PLC activity
d)
Increased Ca²⁺–calmodulin
e)
Increased α1-adrenergic binding
96.
Which vascular structure compresses venous outflow during erection?
a)
Subtunical venules
b)
Dorsal vein of penis
c)
Superficial epigastric vein
d)
Pampiniform plexus
e)
Inferior vesical vein
97.
Which systemic feature is typical of the plateau phase?
a)
Sustained tachycardia & elevated BP
b)
Progressive hypotension
c)
Respiratory alkalosis
d)
Skeletal muscle relaxation
e)
Pupillary constriction
98.
Which phase is absent/minimal in females but prominent in males?
a)
Refractory
b)
Excitement
c)
Plateau
d)
Orgasm
e)
Resolution
99.
Which condition decreases libido by suppressing the HPG axis?
a)
Hyperprolactinaemia
b)
Hypertension
c)
Diabetes mellitus
d)
Chronic renal failure
e)
Major depressive disorder
100.
Which feature allows corpus spongiosum to remain less rigid?
a)
Thinner tunica albuginea
b)
Richer sympathetic innervation
c)
Higher arterial inflow
d)
Fewer sinusoidal lacunae
e)
Greater venous compression
101.
Which central brain region mediates sexual arousal?
a)
Limbic system
b)
Cerebellum
c)
Medulla oblongata
d)
Pons
e)
Occipital cortex
102.
Which feature is most typical of the excitement phase?
a)
Initial penile tumescence
b)
Ejaculatory emission
c)
Peak blood pressure
d)
Rhythmic pelvic contractions
e)
Detumescence
103.
Which drug class most reliably causes ED via reduced arterial inflow?
a)
β-blockers
b)
SSRIs
c)
Opioids
d)
Antihistamines
e)
Antipsychotics
104.
Which is the most appropriate definition of erectile dysfunction?
a)
Consistent inability to achieve/maintain erection for intercourse
b)
Inability to ejaculate during activity
c)
Loss of desire & arousal
d)
Intermittent failure to achieve orgasm
e)
Failure to produce normal testosterone
105.
Which is the most common vascular cause of ED?
a)
Atherosclerosis of cavernous arteries
b)
Varicocele
c)
Venous thrombosis of iliac veins
d)
Portal hypertension
e)
Deep-vein thrombosis
106.
Primary erectile dysfunction is best described as:
a)
Rare lifelong inability to achieve/maintain erection
b)
ED developing after normal function
c)
ED with premature ejaculation
d)
Drug-related ED
e)
Psychogenic stress-related ED
107.
Which neurotransmitter is most important for penile smooth-muscle relaxation?
a)
Nitric oxide
b)
Dopamine
c)
Serotonin
d)
Acetylcholine
e)
Noradrenaline
108.
Which drug is least likely to cause ED?
a)
Paracetamol
b)
Antihypertensives
c)
Antidepressants
d)
Alcohol
e)
Recreational drugs
109.
Which factor contributes to age-related ED?
a)
Endothelial dysfunction & ↓ NO
b)
Increased testosterone
c)
Improved smooth-muscle relaxation
d)
Increased penile arterial dilation
e)
Reduced atherosclerosis
110.
Retrograde ejaculation occurs due to:
a)
Failure of bladder-neck closure
b)
Fibrosis of corpus cavernosum
c)
Obstruction of seminal vesicles
d)
Low testosterone
e)
Premature detumescence
111.
Primary premature ejaculation is characterised by:
a)
Ejaculation ≤1 min from first intercourse onwards
b)
Ejaculation after >10 min
c)
Acquired inability to ejaculate
d)
Delay despite desire
e)
Due to venous leakage
112.
Which investigation is most appropriate first-line in ED?
a)
Serum testosterone
b)
CT pelvis
c)
Penile Doppler US
d)
Cystoscopy
e)
MRI brain
113.
Which feature best differentiates secondary from primary ED?
a)
Occurs after a period of normal erections
b)
Always psychological
c)
Occurs only in elderly
d)
Due to congenital anomalies
e)
Never coexists with PE
114.
Which best explains venous-leak ED?
a)
Failure of subtunical venules to be compressed
b)
Excess NO production
c)
Sympathetic overactivity
d)
Bladder-neck failure
e)
High testosterone
115.
Which antihypertensive class is most linked to ED?
a)
β-blockers
b)
ACE inhibitors
c)
Calcium-channel blockers
d)
Thiazides
e)
α1-blockers
116.
A 65-year-old smoker with diabetes presents with ED. Most likely mechanism?
a)
Atherosclerosis → impaired arterial inflow
b)
Fibrosis of corpus spongiosum
c)
Venous congestion of prostatic plexus
d)
Serotonin excess
e)
High oestrogen
117.
Which describes psychogenic ED?
a)
Normal nocturnal/morning erections but failure during intercourse
b)
Absent erections in all situations
c)
Caused only by antidepressants
d)
Linked to low testosterone
e)
Requires penile Doppler
118.
Which factor is least associated with ↓ NO bioavailability?
a)
Hyperthyroidism
b)
Smoking
c)
Diabetes
d)
Obesity
e)
Ageing
119.
A man reports lifelong ejaculation within 30 s. This is:
a)
Primary premature ejaculation
b)
Secondary premature ejaculation
c)
Delayed ejaculation
d)
Retrograde ejaculation
e)
Anorgasmia
120.
Which first-line test confirms retrograde ejaculation?
a)
Post-ejaculatory urine for sperm
b)
Penile Doppler
c)
Serum testosterone
d)
MRI pelvis
e)
Urodynamics
121.
Which intervention most likely improves vascular ED in an elderly man?
a)
PDE-5 inhibitor
b)
Antidepressant
c)
β-blocker
d)
Chronic alcohol
e)
High-dose thiazide
122.
Which feature defines secondary premature ejaculation?
a)
Acquired after previous normal latency
b)
≤1 min from first intercourse
c)
No orgasm
d)
Ejaculate into bladder
e)
Only with masturbation
123.
Low testosterone in a 55-year-old man is most likely accompanied by:
a)
Reduced libido
b)
Painful penile curvature
c)
Normal morning erections
d)
Increased facial hair
e)
Retrograde ejaculation
124.
A 24-year-old experiences sleep-related erections without stimulation. Mechanism?
a)
Spinal reflexes independent of stimuli
b)
Excessive T12–L2 outflow
c)
Continuous ACh release
d)
Venous outflow obstruction
e)
Hyperprolactinaemia
125.
Which change occurs in the flaccid state?
a)
Slight arterial smooth-muscle contraction
b)
High cGMP levels
c)
Closure of subtunical venules
d)
High NO release
e)
Sinusoidal expansion
126.
Spinal cord injury at T12 prevents ejaculation but preserves erection. Which pathway is disrupted?
a)
Hypogastric nerve
b)
Pudendal nerve
c)
Pelvic splanchnic nerve
d)
Dorsal nerve of penis
e)
Genitofemoral nerve
127.
Which structural change reduces venous outflow during erection?
a)
Compression of subtunical venular plexus
b)
Expansion of corpus spongiosum
c)
Relaxation of bulbospongiosus
d)
Contraction of external urethral sphincter
e)
Thickening of tunica albuginea
128.
During orgasm, rhythmic contractions occur every:
a)
0.8 s
b)
0.2 s
c)
1.5 s
d)
3 s
e)
5 s
129.
Which endocrine disorder most directly causes ED via low testosterone?
a)
Hypogonadism
b)
Hyperthyroidism
c)
Cushing's syndrome
d)
Phaeochromocytoma
e)
Addison's disease
130.
Which systemic event occurs in plateau phase?
a)
Enlargement of urethral bulb
b)
Loss of voluntary muscle control
c)
Marked sweating
d)
Rhythmic pelvic contractions
e)
Descent of testes
131.
Depression-related ED is best explained by:
a)
Central inhibition of parasympathetic pathways
b)
Sympathetic over-emission
c)
Increased NO production
d)
Pudendal nerve lesion
e)
Elevated testosterone
132.
Which phase contains the refractory period?
a)
Resolution
b)
Plateau
c)
Orgasm
d)
Excitement
e)
Emission
133.
Which of the following best describes the main function of prostate-specific antigen (PSA)?
a)
To initiate sperm capacitation
b)
To liquefy semen for sperm motility
c)
To neutralise vaginal acidity
d)
To activate fructose metabolism
e)
To provide zinc for antimicrobial defence
134.
Which pathogen is most commonly associated with acute bacterial prostatitis?
a)
Neisseria gonorrhoeae
b)
Staphylococcus aureus
c)
Escherichia coli
d)
Klebsiella pneumoniae
e)
Chlamydia trachomatis
135.
On digital rectal examination, which finding is most consistent with benign prostatic hyperplasia (BPH)?
a)
Enlarged, tender prostate
b)
Enlarged, smooth, non-tender prostate
c)
Hard, irregular nodular prostate
d)
Small, soft prostate
e)
Normal-sized prostate with lost median sulcus
136.
Which enzyme converts testosterone to dihydrotestosterone (DHT) in the prostate?
a)
Aromatase
b)
17β-hydroxysteroid dehydrogenase
c)
5α-reductase type II
d)
21-hydroxylase
e)
11β-hydroxylase
137.
Which complication is most associated with transurethral resection of the prostate (TURP)?
a)
Hyperkalaemia
b)
Hypernatraemia
c)
Hyponatraemia
d)
Hypocalcaemia
e)
Hypoglycaemia
138.
Which of the following is NOT a recognised complication of BPH?
a)
Bladder hypertrophy
b)
Hydronephrosis
c)
Renal failure
d)
Increased risk of prostate cancer
e)
Urinary tract infection
139.
Which pharmacological agent is a first-line treatment for BPH?
a)
Finasteride
b)
Leuprorelin
c)
Tamoxifen
d)
Cisplatin
e)
Prednisolone
140.
Which Gleason grade describes poorly differentiated prostate adenocarcinoma?
a)
Grade 1
b)
Grade 2
c)
Grade 3
d)
Grade 4
e)
Grade 5
141.
Which of the following can falsely elevate PSA levels?
a)
Ejaculation within 48 hours
b)
Vitamin D deficiency
c)
Low-fat diet
d)
Anaemia
e)
Diabetes mellitus
142.
Which histological feature distinguishes prostate adenocarcinoma from BPH?
a)
Absence of basal cell layer
b)
Presence of papillary infoldings
c)
Abundant fibromuscular stroma
d)
Two epithelial layers
e)
Dilated glandular lumina
143.
Which pathogen is most associated with granulomatous prostatitis?
a)
Mycobacterium tuberculosis
b)
Neisseria gonorrhoeae
c)
Escherichia coli
d)
Ureaplasma urealyticum
e)
Staphylococcus aureus
144.
Which ethnic group has the highest incidence of BPH and prostate cancer?
a)
African-Caribbean men
b)
White European men
c)
South Asian men
d)
East Asian men
e)
Middle Eastern men
145.
Which DRE finding most strongly suggests prostatitis?
a)
Enlarged, tender prostate
b)
Enlarged, smooth, non-tender prostate
c)
Hard, irregular nodular prostate
d)
Asymmetrically firm prostate
e)
Small atrophic prostate
146.
Which urinary symptom is a voiding symptom in BPH?
a)
Terminal dribbling
b)
Nocturia
c)
Urgency
d)
Frequency
e)
Urge incontinence
147.
Which drug reduces prostate smooth muscle tone?
a)
Tamsulosin
b)
Finasteride
c)
Leuprorelin
d)
Flutamide
e)
Bicalutamide
148.
In BPH pathogenesis, DHT binds androgen receptors located in:
a)
Nuclei of stromal and epithelial cells
b)
Cytoplasm of stromal cells only
c)
Nuclei of Sertoli cells
d)
Cytoplasm of hepatocytes
e)
Membrane receptors
149.
Which treatment is most appropriate for advanced prostate cancer with bone mets?
a)
LHRH agonist (e.g., leuprorelin)
b)
TURP
c)
Finasteride
d)
Alpha-1 blocker
e)
Antibiotics
150.
Which feature is typical of ductal adenocarcinoma of the prostate?
a)
More aggressive and presents late
b)
More indolent and PSA always raised
c)
Equal prognosis
d)
Always linked to BPH
e)
Found only in transition zone
151.
Which PSA range is the “grey zone”?
a)
4–10 ng/mL
b)
<2 ng/mL
c)
>20 ng/mL
d)
>100 ng/mL
e)
<0.5 ng/mL
100 %
