KMU Past Paper Practice

Topic 8 — Renal Tumors: Renal Cell Carcinoma and Wilms Tumor

4th Year MBBS • 20 A-type Single Best Answer MCQs • Context-rich examination reasoning

Question:

A 56-year-old woman undergoes surgery for a well-circumscribed renal mass that could not be confidently distinguished from carcinoma on imaging. Histology shows a benign epithelial neoplasm composed of cells packed with mitochondria. Which diagnosis best fits these findings?

Question:

During microscopic examination of a nephrectomy specimen removed for an unrelated disorder, a very small localized epithelial lesion is found in the renal cortex. It shows no evidence of invasion or metastatic behavior. Which lesion is the best classification?

Question:

A 60-year-old man is being assessed after detection of a renal mass. His history includes obesity, hypertension and a 35-pack-year tobacco exposure. Which factor in his history represents a clearly established modifiable risk for renal cell carcinoma?

Question:

A 66-year-old man presents with visible hematuria, persistent flank discomfort and a palpable renal-region mass. Imaging confirms a malignant renal lesion. What is the most appropriate interpretation of this combination of findings?

Question:

A patient with an enhancing renal mass has difficult-to-control hypertension. There is no evidence of hypercalcemia or erythrocytosis. Which tumor-associated physiological change can explain the blood-pressure abnormality?

Question:

Histology from a renal cortical malignancy shows cells that appear optically clear on routine sections. Chemical analysis demonstrates abundant intracellular lipid and glycogen. What best explains the microscopic appearance?

Question:

A 4-year-old child is brought with a newly noticed abdominal mass. The clinician wants an initial study that can determine whether the lesion arises from the kidney and whether it is predominantly solid or cystic while avoiding ionizing radiation. Which investigation is most appropriate?

Question:

A 63-year-old patient has a renal mass requiring cross-sectional characterization, but use of the usual CT contrast agent is considered inappropriate. Which imaging modality provides a suitable alternative for further soft-tissue assessment?

Question:

A 59-year-old man with a localized renal malignancy is being evaluated before definitive surgery. Serum creatinine and estimated renal function are checked even though the tumor is confined to one kidney. What is the main purpose of this assessment?

Question:

A child with a confirmed renal embryonal malignancy undergoes abdominal staging. The pediatric oncology team also requests chest imaging before treatment. Which clinical concern most directly justifies this investigation?

Question:

A 72-year-old patient has a small localized renal mass but is a poor candidate for major surgery. The patient prefers active treatment rather than continued observation. Which management option can be considered in a carefully selected case?

Question:

A 64-year-old man with advanced RCC asks why the oncology team is discussing immune-based and pathway-targeted treatments rather than a traditional cytotoxic chemotherapy regimen. Which statement best explains this approach?

Question:

A young child with a renal mass also has severe renal disease and abnormalities of genital development. Genetic evaluation identifies a WT1-associated disorder. Which syndrome best fits this combination?

Question:

A nephrectomy specimen is obtained from a 3-year-old child with Wilms tumor. Which gross pathological appearance would be most consistent with this diagnosis?

Question:

A 4-year-old child with a large renal tumor is found to have persistent hypertension. There is no previous history of primary hypertension. Which mechanism most reasonably links the renal mass to the elevated blood pressure?

Question:

A child has undergone surgery and chemotherapy for Wilms tumor. The oncology team is now deciding whether an additional local treatment is necessary. Which principle best guides the use of radiotherapy in this disease?

Question:

Two patients have renal cell carcinomas confined to the kidney and otherwise similar clinical stages. Histology in one patient shows the subtype associated with relatively less aggressive behavior when localized. Which subtype is being described?

Question:

A man with an enlarging renal malignancy develops persistent dull flank discomfort before any distant metastases are detected. Which local pathological process most plausibly accounts for this symptom?

Question:

A patient with a renal cortical carcinoma develops intermittent visible blood in the urine despite preserved overall renal function. Which local tumor effect best explains this manifestation?

Question:

A 57-year-old woman undergoes abdominal imaging for an unrelated gastrointestinal complaint. A malignant renal mass is discovered, although she has no hematuria, flank pain or palpable mass. Which principle best explains this presentation?