1.Should the subclinical varicocele be operated?

Α. Only if it affects sperm parametres

Β. Only if it causes hormonal disorders (increase of FSH)

C. Only if it is accompanied with scrotal pain

D. No, it is not operated for it does not increase the chances of spontaneous gestation. 

Ε. Μόνο εάν παρατηρηθεί υστερημένη ανάπτυξη του όρχεως σε σχέση με τον ετερόπλευρο (ασυμμετρία >20%)

 

2. Does testis biopsy make sense during varicocele repair surgery and when?

Α. Only if we freeze testicular tissue and always from the fellow testis.

Β. Yes, and it could be conducted in every session of varicose surgery. 

C. No, it makes no sense according to existing literature data. 

D. Only if there are signs of progressive testicular impairment observed (e.g. asymmetry of right-left testes >20% or increase of FSH)

Ε. In cases A and D.

 

3. When is varicocele operated in children?

Α. When there is progressive testicular growth retardation observed, confirmed by a series of clinical examinations or scrotal pain.

Β. When varicocele is palpated bilaterally during clinical examination.

C. When another testicular pathology co-exists, which may affect future fertility, or when there is increased response to LHRH testing.

D. When there are poor sperm parameters observed (in older adolescents).

Ε. In all the above cases.

4. When performed before the use of some assisted-reproduction method in an infertile couple, varicocele surgery may result in:

Α. double chances for implantation of fertilized embryos

Β. reduction of miscarriage rate during the 2nd gestation trimester

C. high chances for twin gestation

D. maintaining a stable number of spermatozoa that can be retrieved

 

5. In which cases after varicocele surgery, may chances to achieve gestation increase?

Α. Only when the number of produced spermatozoa (sperm cells) increases.

Β. When motility of spermatozoa increases after the 2nd hour of their incubation.

C. When spermatozoa with normal morphology are more than 4%, according to WHO criteria.

D. Irrespective of changes in microscopic sperm parameters, due to the positive effect on the DNA package.

 

6. Which of the following statements about hydrocele surgical treatment is true?

A. Inguinal approach is the standard surgical approach when there is suspicion of testicular pathology or the testes has not been tested.

Β. The "excision" technique is superior to the "plication" technique, with reference to hydrocele relapse rate.

C. The most common surgical complication is hematoma followed by epididymal and spermatic cord injuries.

D. All the above are correct. 

Ε. None of the above is correct. 

 

7. Which of the following statements about spermatic vein ligation is true?

A. Subinguinal approach is characterized by lower morbidity than in the inguinal approach (as inguinal duct walls are not opened), but is a more demanding procedure from a technical point of view. 

Β. The most common complication from the inguinal or subinguinal approach without the use of microsurgery is hydrocele formation (according to literature rates, such risk ranges from 3 to 39%) .

C. Injury of the testicular artery during varicocelectomy typically leads to testicular atrophy. 

D. All above anwers are correct.  

Ε.  Α and Β are correct. 

 

8. In a patient with obstructive azoospermia and normal FSH levels participating in an assisted-reproduction program, the method of choice for collecting male gametes is: 

Α. Fine-needle aspiration of testicular cells 

Β. Open testicular biopsy

C. Microsurgical testis biopsy

D. Microsurgical sperm cell collection from the lumen of the epididymal head

Ε. Fine-needle puncture  from the epididymal tail

 

9. Male patient with non-obstructive azoospermia and normal karyotype presents total microdeletions of the AZFa region and left varicocele. What treatment would you recommend?

Α. Repair of the left varicocele.

Β. Bilateral spermatic vein ligation

C. Left testicular biopsy for identifying spermatozoa

D. Right testicular biopsy for identifying spermatozoa

Ε. None of the above methods

 

10. Which of the following statements is true?

Α. Androgens play an important role in the first phase of the testicular descending process.

Β. Androgens play an important role in the second phase of the testicular descending process.

C. Androgens play no role in the testicular descending process.

D. The second phase of the testicular descending process takes place due to oestrogen action. 

 

11. Cryopreservation of spermatozoa means: 

Α. Preservation of spermatozoa at ‐80^οC

Β. Preservation of spermatozoa at ‐120^οC

C. Preservation of spermatozoa at ‐196^οC

D. Preservation of spermatozoa at ‐0^οC

 

12. Which of the below agents has/have a negative effect on spermatogenesis?

A. Κetoconazole

Β. Spironolactone

C. Κolhikin

D. Estrogens

Ε. All the above

 

13. Spermatogenesis can be inhibited, if a male presented feverish disease: 

Α. 1 year before

Β. the last 7 days

C. the last 6 months

D. There is absolutely no correlation. 

 

14. When the man aims at conceiving, it is better to ejaculate during his female partner's productive phase: 

Α. every two days

Β. on a daily basis

C. when ovulation has been confirmed

 

15. Prostagladines are produced by the same male accessory reproductive gland that secretes also: 

Α. citric acid

Β. fructose

C. glucosidase

D. Zink

 

16. In non-mosaic Klinefelter's syndrome with left varicocele, it makes sense to: 

Α. repair the varicocele

Β.repair the varicocele and perform therapeutic testis biopsy

C. perform therapeutic testis biopsy only

 

17. Every man with azoospermia should: 

Α. undergo karyotype screening, as long as there is absence of spermatic duct on the left

Β. undergo karyotype screening, as long as there is absence of spermatic duct bilaterally

C. undergo karyotype screening, as long as the primary testicular lesion has been diagnosed

D. undergo karyotype screening,  only if there are microdeletions of the Y-chromosome

 

18. Seminovesiculography is:

Α. an essential examination that should be done in all azoospermic patients

Β. an essential examination that should be done in all patients with non-obstructive azoospermia

C an essential examination that should be done to diagnose obstructive azoospermia

D. an essential examination that should be done only before the surgical  procedure for restoring patency of reproductive ducts

 

19.  An azoospermic male patient with intratubular in situ neoplasia:

Α. will never develop testicular tumor

Β. is very unlikely to develop testicular tumor

C. will surely develop invasive testicular tumor, as long as he lives enough

 

20. In a patient with obstructive azoospermia and normal FSH levels participating in an assisted-reproduction program, the method of choice for collecting male gametes is: 

Α. Fine-needle aspiration of testicular cells 

Β. Open testicular biopsy

C. Microsurgical testis biopsy

D. Microsurgical sperm cell collection from the lumen of the epididymal head

Ε. Fine-needle puncture  from the epididymal tail

21. Male patient (30-year old fertile wife) with 13.000.000 spermatozoa/ mΙ, 10% quantitative motility of spermatozoa and 28%  spermatozoa with normal morphology (according to WHO) is diagnosed with left varicocele (normal hormone levels). Which therapy should the Expert follow so that the couple can achieve gestation?

Α. Collecting spermatozoa from seminal fluid with masturbation and then in-vitro fertilization (IVF)

Β.  Administration of R-FSH and R-LH 

C.  Varicocele sclerotherapy

D.  Surgical repair of varicocele 

 

22. Which surgical method for varicocele repair is the most appropriate?

Α. Palomo

Β. Ivanissevich

C. Laparoscopic

D. Robotic

Ε. Subinguinal microsurgical varicose repair     

 

23. For patients who presented biochemical relapse after radical prostatectomy, which of the following factors are related more to local relapse rather than with remote metastasis? 

 

Α. First measurable PSA value 6 months after surgery, Gleason score>7,  pathological stage Τ3

Β. Age below 70 at the time of relapse, first measurable PSA value < 2 ng/ml, Gleason score <5 

C. Histological absence of seminal vesicles and lymph-nodes, Gleason score <5, first measurable PSA value one year after surgery, PSA doubling-time (PSADT) >6 months

D. Pathological stage Τ2, Gleason score 8 to 10, negative bone scintigram

Ε. First measurable PSA value 4 months after surgery, negative biopsy of prostatic bed, PSA doubling-time (PSADT) <3 months 

                                                                                                                                        

Correct answers

1D	9 Ε	17 C
2 Ε	0 Β	18 D
3 Ε	1C	19 C
4 Α	2 Ε	20 C
5 D	13 C	21 D
6 D	14 Β	22 Ε
7 Ε	15 Β	23 C
8C	16 C	24