MCQs on Renal & Bladder Tumors

Written by Dr. Daniel Fraser (MBBS, FRACP) – Physician

Question 1

Liam, a 66-year-old retired industrial worker, presents with painless visible hematuria for the past week. He denies fever, dysuria, or flank pain. He has a 40-pack-year smoking history and worked for decades in a factory handling dyes and solvents. Physical examination is unremarkable. Urinalysis confirms hematuria, and urine cytology shows malignant cells.

Which of the following is the most likely diagnosis?

A) Renal cell carcinoma
B) Urothelial carcinoma of the bladder
C) Acute cystitis
D) Benign prostatic hyperplasia
E) Nephrolithiasis

Correct Answer: B) Urothelial carcinoma of the bladder

Explanation:

Painless visible hematuria is a classic presentation of urothelial (transitional cell) carcinoma of the bladder, especially in older adults with significant risk factors such as smoking and exposure to industrial chemicals like aromatic amines (found in dyes, rubber, and solvents). Liam’s occupational history and smoking history place him at high risk. The presence of malignant cells on urine cytology is further diagnostic and rules out benign causes of hematuria.

Urothelial carcinoma is the most common type of bladder cancer. Risk factors include age, male gender, smoking, occupational exposure to carcinogens (e.g., benzidine, beta-naphthylamine), and chronic irritation of the bladder mucosa.

Why the other options are incorrect:

A) Renal cell carcinoma may present with hematuria, but it is more often associated with flank pain, palpable mass, or constitutional symptoms like fever or weight loss. It also typically originates from the renal parenchyma, not the urothelium.

C) Acute cystitis usually causes painful hematuria, dysuria, urgency, and frequency. It’s more common in younger women and does not result in malignant cytology.

D) Benign prostatic hyperplasia may cause microscopic hematuria but typically presents with lower urinary tract symptoms (LUTS) such as hesitancy, weak stream, nocturia, and does not account for malignant cells in the urine.

E) Nephrolithiasis often causes sudden, severe flank pain, sometimes with hematuria, but again, would not show malignant cells on cytology and typically presents with colicky pain, not painless hematuria.

Question 2

Noah, a 62-year-old man, presents with dull left flank pain and an unintentional weight loss of 5 kg over the past 2 months. He also reports intermittent fever and night sweats. On examination, a palpable left-sided abdominal mass is noted. His blood pressure is 160/95 mmHg. Laboratory investigations reveal elevated erythrocyte sedimentation rate (ESR), normocytic anemia, and microscopic hematuria. Ultrasound shows a solid mass in the left kidney.

Which of the following is the most likely diagnosis?

A) Renal cell carcinoma
B) Wilms tumor
C) Polycystic kidney disease
D) Pyelonephritis
E) Hydronephrosis

Correct Answer: A) Renal cell carcinoma

Explanation:

Renal cell carcinoma (RCC) commonly presents with a classic triad of flank pain, hematuria, and a palpable abdominal mass, although all three features occur together in only a minority of patients. Constitutional symptoms such as fever, weight loss, and night sweats may also be present, mimicking infections or systemic malignancy. The patient’s age, systemic features, hematuria, and solid renal mass on imaging strongly support RCC.

RCC is also associated with paraneoplastic syndromes such as hypertension (due to increased renin), polycythemia (due to ectopic erythropoietin production), hypercalcemia, and hepatic dysfunction (Stauffer syndrome). The elevated ESR and anemia are common non-specific findings.

Why the other options are incorrect:

B) Wilms tumor is a pediatric renal tumor, typically occurring in children under 5 years. It is not seen in adults like Noah.

C) Polycystic kidney disease may cause flank pain and hematuria but is usually bilateral and associated with a family history. Also, cysts, not solid masses, are seen on imaging.

D) Pyelonephritis may cause flank pain and fever, but it usually presents with acute symptoms, pyuria, and urinary tract infection signs, and would not cause a palpable mass or weight loss.

E) Hydronephrosis results from urinary tract obstruction and presents with flank pain and sometimes a mass, but not systemic symptoms like weight loss or fever. Imaging would show dilated renal collecting systems, not a solid mass.

Question 3

Ethan, a 55-year-old man, presents with fatigue, unintentional weight loss, and intermittent gross hematuria over the past month. He also reports right-sided flank discomfort but denies fever or urinary frequency. He has a 30-pack-year smoking history. On examination, there is mild right flank tenderness but no palpable mass. His blood tests reveal a hematocrit of 60% and mildly elevated creatinine. Ultrasound of the abdomen reveals a mass in the upper pole of the right kidney.

Which of the following is the most likely paraneoplastic syndrome associated with this patient’s condition?

A) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
B) Hyperparathyroidism
C) Erythrocytosis
D) Cushing’s syndrome
E) Lambert-Eaton myasthenic syndrome

Correct Answer: C) Erythrocytosis

Explanation:

This patient’s presentation suggests renal cell carcinoma (RCC), particularly with hematuria, flank discomfort, and a renal mass found on imaging. A key paraneoplastic feature of RCC is erythrocytosis, which results from ectopic production of erythropoietin by tumor cells. His elevated hematocrit (60%) is consistent with this.

Paraneoplastic syndromes are common in RCC and may precede diagnosis. These include:

Erythrocytosis (↑ erythropoietin)
Hypercalcemia (↑ parathyroid hormone–related peptide)
Hypertension (↑ renin)
Hepatic dysfunction (Stauffer syndrome)
Fever and anemia

Why the other options are incorrect:

A) SIADH is most commonly associated with small cell lung carcinoma, not RCC.

B) Hyperparathyroidism (primary) is typically due to parathyroid adenomas and is unrelated to RCC. RCC can cause hypercalcemia, but via PTHrP, not actual PTH.

D) Cushing’s syndrome is most often associated with ectopic ACTH production in small cell lung cancer or adrenal tumors.

E) Lambert-Eaton myasthenic syndrome is a neuromuscular paraneoplastic syndrome seen in association with small cell lung cancer, not RCC.

Previous Next

4. Nephrology & Urology Module

4.1 Hematuria

4.2 Chronic Kidney Disease

4.3 Urinary Incontinence

4.4 Prostate

4.5 Renal Tumors

4.6 Other Renal Disorders

Back to MCQ Bank