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Dr. Seva Visc. final
Dr. Seva's NYCC visceral pathology final
| Question | Answer |
|---|---|
| What are the congenital disorders of the penis? | 1. Hypospadias 2. Epispadias 3. Phimosis 4. Paraphimosis |
| What is hypospadias? | Abnormal ventral urethral opening; may be associated w/ other urogenital abnormalities; sperm motility decreased -> infertility |
| What is epispadias? | Abnormal dorsal urethral opening; may be associated w/ other urogenital abnormalities. |
| What is phimosis? | Prepuse too tight to allow retraction over the glans penis like an adhesion; predisposes to infection; may lead to squamous cell carcinoma |
| What is paraphimosis? | When the tight foreskin is retracted, sometimes it may be difficult to return & paraphimosis results. Venous and lymphatic return fromt eh glans is obstructed and glans swells. |
| What is a hydrocele? | Accumulation of serous fluid b/w the 2 layers of tunica vaginalis. |
| What is congenital hydrocele? | Patent processus vaginalis testis or its incomplete obliteration. Common in infants and associated w/ inguinal hernia. |
| What is acquired hydrocele? | In adults, secondary to infection, tumor or trauma. Long-standing hydrocele may compress testis or epididymis. If fluid gets infected leads to periorchitis. |
| What is hematocele? | Accumulation of blood secondary to tumor or trauma. |
| What is spermatocele? | A cyst filled w/ milky fluid and spermatozoa of various stages of degeneration secondary to epididymitis or physical trauma. |
| What is varicocele? | Dilation of testicular veins (pampiniform plexus -> bag of worms); may be associated w/ renal adenocarcinoma or idiopathic. |
| What is scrotal edema? | Lymph edema d/t filiarisis or pelvid or abdominal tumors. Transudation of plasma may be d/t anasarca - congestive heart failure, cirrhosis, nephritic syndrome. |
| What is priapism? | Persistent painful erection unrelated to sexual excitation. Idiopathic or secondary to intracavernosal injections of medications to treat impotence or antidepressants or cocaine. |
| What are 9 inflammatory lesions of the penis? | 1. herpes genitalis 2. syphilis 3. chancroid 4. granuloma inguinale 5. lymphgranuloma venereum 6. condyloma acuminatum 7. balanitis 8. posthitis 9. peyronie Dz |
| What does herpes genitalis do as a inflammatory lesion of the penis? | Most common STD; painful vesicles on glans that later ulcerate. |
| What does syphilis do as a inflammatory lesion of the penis? | solitary soft ulcer - chancre |
| What does chancroid do as a inflammatory lesion of the penis? | Vesicle - pustule - ulcer on the glans or the shaft w/ painful suppurative inguinal lymphadenitis. |
| What does granuloma inguinale do as a inflammatory lesion of the penis? | Raised ulcer w/ lots of inflammatory exudate & granulation tissue. |
| What does lymphogranuloma venereum do as a inflammatory lesion of the penis? | Small vesicle breaks & ulcerates; associated w/ inguinal lymph adenopathy. |
| What does condyloma acuminatum do as a inflammatory lesion of the penis? | HPV. Flat warts on the shaft or cauliflower like growth. |
| What does balanitis do as a inflammatory lesion of the penis? | Inflammation of the glans. |
| What does posthitis do as a inflammatory lesion of the penis? | Inflammation of the prepuce (foreskin) |
| What does peyronie Dz do as a inflammatory lesion of the penis? | Idiopathic asymmetric fibrosis of penile shaft (penile strabismus) accompanied by painful erection. |
| What plays a role in penile cancer? | Smegma and HPV; occurs as squamous cell carcinoma in situ. |
| What 2 forms does squamous cell carcinoma occur in in the penis? | Bowen's Dz and erythroplasia of queyrat (red/white structures on penis) |
| What is Bowen's Dz? | Demarcated, erythematous or white plaque on the shaft. |
| What is erythroplasia of queyrat? | Solitary or multiple shiny plaques on the glans. |
| What causes bowenoid papulosis? | HPV in sexually active young men. Multiple violaceous papules |
| What is verrucous carcinoma? | Microscopically benign but clinically malignant exophytic squamous cell carcinoma. Grossly similar to condyloma accuminatum but locally invasive. No metastases & surgical removal is curative. |
| What are 3 types of penile carcinoma? | 1. Squamous cell carcinoma 2. Bowenoid papulosis 3. Verucous carcinoma |
| What is the type of cancer of the scrotum and what type of exposure causes it? | Squamous cell carcinoma; exposure to soot, occupational cancer of chimney sweeps. |
| What is cryptorchidism? | Undescended or ectopic testicle; incomplete or abnormal descent of testes; complications are infertility and higher risk of neoplasia. |
| What are causes of male infertility? | Supratesticular causes: pituitary or thyroid pathology; Testicular causes: orchitis, cryptorchidism, azoospermia (very few), radiation. |
| What causes epididymitis? | bacterial: associated w/ UTI & intrascrotal pain w/ or w/o fever; TB: Hx of pulmonary TB - a painless and chronic palpable enlargement. |
| What are the 3 types of orchitis (inflammation of the testes)? | Acute: bacterial, MC associated w/ UTI; Mumps orchitis: unilateral gonadal swelling (could be bilat. and lead to invertility); Chronic: always d/t TB. |
| What glands are affected by paramyxo virus? | Parotid, pancreas, testes (other glands too but these were pointed out) |
| What is torsion of the testis? | Vas deferens is horizontal and shorter d/t congenital anomaly like inversion of the testis. |
| Who is affected w/ torsion of the testis and what occurs? | b/w 10-15 y/o, rare after 25; sudden agonizing pain in the groin and lower abdomen; unilateral painful red testicle; testis hangs higher in the scrotum and very tender. |
| What are the 2 types of testicular tumors? | 1. Germ cell tumors (90%) 2. Sex cord cell tumors (5%) |
| What are the 4 germ cell tumors? | 1. Seminoma (MC) 2. Choriocarcinoma 3. Teratocarcinoma 4. Embryonal carcinoma |
| What are the 2 sex cord cell tumors? | 1. Leydig cell tumor 2. Sertoli cell tumor |
| How do testicular tumors generally present? | 80% as a painless small hard lump (pea size) in one testis or one testis is larger than the other and does not transilluminate. May or may not be associated w/ hydrocele and metastasis to lymph nodes. |
| What lymph nodes do testicular tumors metastasize to? | Abdominal paraaortic lymph nodes then left supraclavicular (Virchow's) node. |
| What do testicular tumors secrete? | HCG (human chorionic gonadotropin) and AFP (alpha feto protein) |
| How are testicular tumors staged? | Stage 1: only to testis Stage 2: testis and nodes below diaphragm Stage 3: testis and nodes above diaphragm Stage 4: plus liver and lung mets |
| What is the last 5% of testicular tumors d/t? | Metastasis; 5% from prostate, colon or urinary bladder (direct extension) |
| What is the etiology and clinical features of acute prostatitis? | Et: UTI; reflux of infected urine into the prostate; CF: dysuria, fever, chills and perineal pain, enlarged soft and tender prostate. |
| What is the etiology and clinical features of chronic prostatitis? | Et: nonspecific abacterial prostatitis; CF: vague symptoms, perineal or LBP |
| What is benign prostatic hypertrophy? | Fibromuscular adenoma median lobe enlarged, obstructs urinary flow; common in older men >60 y/o d/t relative increase in estrogen; idiopathic |
| What are clinical features and complications of BPH? | CF: UT obstruction, prostatism, nocturia, hematuria, rubbery prostate on P/R exam; complications: hydroureter, hydronephrosis, chronic renal failure. |
| What are clinical features of prostatic adenocarcinoma? | Asymptomatic or LBP, UT obstruction, hematuria, pathological Fx or anemia; P/R: hard, stony, craggy prostate |
| How is prostatic adenocarcinoma screened and how does it spread? | Dx before biopsy by screening by P/R and serum PSA (very high in CA); direct spread to urinary bladder, urethra, seminal vesicle; hematogenous to bone, lung, liver; lymphatic to lymph nodes. |
| In the vulva, what is condyloma acuminatum? | A wart by HPV w/ neoplastic potential |
| What type of cancer is in the vulva? | squamous cell carcinoma |
| What type of vaginal cancer is found in women 50 - 70 y/o? | squamous cell carcinoma |
| What type of vaginal cancer is found in girls under 5 y/o? | Sarcoma botryoides - embryonal rhabdomyosarcoma |
| What is acute cervicitis? | 1-2 days of painful cervix w/ purulent fluid occurs before sexually active. |
| What is chronic cervicitis? | No pain, thick mucus discharge - leukorrhea - gives discomfort and infertility. |
| What are benign tumors of the cervix? | Endocervical polyps. Not lethal but may rupture and lead to bleeding. |
| What are premalignant lesions of the cervix? | Cervical intraepithelial neoplasia (CIN) from HPV 16 & 18; starts at the squamocellular junction; is a squamous cell carcinoma and number of partners increases risk. |
| What are the series of events w/ cervical cancer and how is it identified? | CIN I, II, III or mild, moderate and severe dysplasia/ca in situ progress to squamous cell carcinoma; usually asymptomatic identified w/ pap smear and colposcopy. |
| What is the difference b/w micro- and macroinvasive squamous cell carcinoma? | Micro-: minimal invasion w/ a depth of 3mm below the basement membrane. Macro-: 80% of cervical cancer, vaginal bleeding after coitus and douching. |
| What is endometritis? | Inflammation of the endometruim; pelvic pain and vaginal bleeding. |
| What is pyometra? | Pus in the uterine cavity d/t bacteria not treated properly. |
| What is adenomyosis? | Presence of endometrial glands in the myometrium; presents w/ pelvic pain, dysmenorrhea, menorrhagia or dyspareunia. |
| What is leiomyoma of the uterus? | MC benign tumor of the uterus during reproductive age group d/t estrogen stimulation; rarely transforms into leiomyosarcoma. |
| What are s/s of leiomyoma of the uterus? | Hypermenorrhea; dysmenorrhea; abdominal pain; impaired fertility: difficulty conceiving, miscarriage, preterm delivery; may cause pressure sx when big (polyuria or constipation) |
| What is endometrial hyperplasia induced by and how does it present? | Induced by estrogen stimulation and results in endometrial adenocarcinoma; presents w/ vaginal bleeding. |
| Who gets endometrial adenocarcinoma, what are clinical features and risk factors? | women age 50-70; abnormal uterine bleeding; obesity, diabetes, nulliparity, HTN |
| What is endometriosis? | Extopic endometrium (and myometrium) found on the tube, ovary, urinary bladder or rectum; a developmental abnormality; don't release every cycle -> "chocolate cysts"; dyspareunia if on broad ligament |
| What is acute and chronic salpingitis? | Acute: painful; Chronic: may cause stenosis of the tube -> eggs don't come out -> infertility |
| What is hydrosalpinx? | Watery fluid collection w/ a dilated fallopian tube |
| What is pyosalpinx? | Pus collection in the tube usually d/t infection. |
| What is tuboovarian abscess? | Purulent inflammation of the tube and ovary common w/ ascending bacterial infection. |
| What is ectopic pregnancy? | Tubal pregnancy d/t chronic salpingitis (stenosis allows sperm through) |
| What is a follicular cyst? | From ovarian follicles; filled w/ serous fluid; d/t menstrual irregularites (before egg matures and released) (one side affected) |
| What is a corpus luteal cyst? | From corpus luteum d/t progesterone synthesis (painful; only one side affected) |
| What is a theca lutein cyst? | bilateral; associated w/ pregnancy; hydatid mole - placenta, amniotic sac but no fetus, find grape-like structures in urine; need DNC |
| What is polycystic ovarian syndrome? | Stein Leventhal syndrome: multiple small bilateral cysts in the ovary (enlargement of ovaries) |
| What are clinical features of polycystic ovarian syndrome? | Pt presents w/ obesity, amenorrhea, hirsutism and infertility. Abnormal levels of gonadotropins in the blood (high GnTH will give multiple cysts at same time, no ovulation) |
| What are 3 types of ovarian cancers? | 1. Epithelial tumors 2. Teratomas 3. Krukenberg tumors |
| Who commonly gets epithelial tumors of the ovary and what is the late clinical feature? | 90% of ovarian cancers; common in nulliparous female w/ a family Hx of ovarian cancer; ascites is the common late clincal feature (R/O cirrhosis) |
| What are teratomas in the ovary? | Germ cell tumors which are most common |
| What are Krunkenberg tumors of the ovary? | Metastatic from gastric cancer. |
| What are polythelia and polymastia? | Both congenital Polythelia: multiple nipple Polymastia: multiple breast |
| What is gynacomastia? | Enlargement of the adult male breast d/t exogenous estrogen, cirrhosis and castration |
| What is acute mastitis? | Painful (red and swollen) bacterial infection (febrile) during lactation (staph. from child's nasopharynx) |
| What is duct ectasia? | dilated lactiferous ducts filled w/ pasty material and macrophage in old women |
| What is fat necrosis of the breast associated w/? | Trauma to breast; firm, fixed mass |
| What is fibrocystic change? | Most common in women b/w 30-55 y/o; cystic dilations, increased dense fibrous stroma; proliferation of small ducts (sclerosing adenosis); associated w/ increased incidence of breast cancer |
| What is a fibroadenoma? | Most common rubbery mobile benign tumor; round encapsulated mass in young women (20-30 y/o); no adenosis |
| What is a benign cystosarcoma phyllodes? | giant fibroadenoma |
| What are the 5 types of breast cancer? | 1. Infiltrating ductal carcinoma 2. Lobular carcinoma 3. Medullary carcinoma 4. Mucinous carcinoma 5. Paget's Dz of the breast |
| What is infiltrating ductal carcinoma? | 80% of breast cancers, aka scirrhous carcinoma d/t high fibrosis; bad Px |
| What is lobular carcinoma? | Adenocarcinoma of the terminal ducts |
| Medullary carcinoma has a better ________. | Prognosis |
| What is mucinous carcinoma? | Mucin producing cancer in the elderly |
| What is Paget's Dz of the breast? | Adenocarcinoma of the nipple and areola (not inside, bleeding from nipple and areola). Poor Px. |
| What are presentations of all breast cancers? | Present w/ a painless lump, more common in the upper quadrant of right breast; skin puckering, nipple retraction, peau d'orange, bloody nipple discharge in late stages (mainly Paget's) |
| What causes nipple retraction and skin puckering in breast cancer? | Cooper's ligament pulls on skin b/c mass pulls on the ligament |
| What is staging in breast cancer? | I: T1 N0 M0; II: T2 movable axillary nodes; III: T3, fixed to the skin or m. or fascia, fixed lymph nodes M0; IV: tumor fixed to chest wall; distant metastasis |
| What are 5 congenital renal disorders? | 1. Bilateral renal agenesis 2. Unilateral kidney agenesis 3. Horse-shoe kidney 4. Ectopic kidney 5. Adult polycystic kidney |
| What is bilateral renal agenesis? | Congenital absence of both kidneys; infants are stillborn or die w/in a few days. |
| What is unilateral kidney agenesis? | Congenital absence of one kidney; asymptomatic |
| What is horse-shoe kidney? | Fusion of lower poles of kidney; common anomaly, 1 in 400 births; kidneys connected w/ isthmus, stuck b/w pelvis and L/B area -> ectopic kidney (not where should be); ureters travel w/ angle - stagnation of urine -> repeated UTI and stone form'n |
| What is adult polycystic kidney? | Autosomal dominant; fluid filled cysts; bilateral loin pain and masses; hematuria; HTN (secondary, younger age group) and renal failure (stretched capsule -> pain) |
| What is acute pyelonephritis? | Common in female d/t e. coli, ascending infection (pregnant or sexually active) |
| What are clinical features of acute pyelonephritis? | High fever, rigor, painful scalding/burning urination |
| What is renal papillary necrosis? | Complication of acute pyelonephritis in diabetes mellitus patients |
| What is chronic pyelonephritis? | common in male, diabetic (M/F) and in patients w/ nephrolithiasis; CF: chronic renal failure d/t CT build up |
| What is analgesic nephritis? | Papillary necrosis from excessive use of aspirin like drugs |
| What are 4 inflammatory disorders of the kidney that affect the tubules? | 1. Metal toxicity 2. Gout 3. Multiple myeloma 4. Hypercalcemia |
| What occurs in the kidneys w/ metal toxicity? | Mercury, arsenic, lead (any metal) poisoning -> coagulative necrosis of the tubules |
| How does gout affect the kidneys? | Urate crystals deposited in the tubules causing obstruction and fibrosis |
| How does multiple myeloma affect the kidneys? | Toxic tubular injury from bence-jones proteinuria |
| How does hypercalcemia affect the kidneys? | Increased calcium excretion in the urine leads to renal calculi/stones (UT) |
| What is cystitis? | Bladder inflammation; dysuria, urinary frequency, lower pelvic discomfort. |
| What are glomerular diseases? | Immune mechanisms are involved (antibodies against glomeruli); nephritic and nephrotic |
| What are the 4 types of glomerulonephritis? | 1. Focal: few glomeruli involved 2. Diffuse: spread widely (morphological and functional abnormalities of glomeruli) 3. Segmental: part of glomerulus involved 4. Global: entire glomerulus is involved |
| What is nephrotic syndrome? | The glomerulus loses its capacity for selective retention of protein in the blood d/t the abnormality in the glomerular basement membrane |
| What are results of nephrotic syndrome? | Proteinuria, hypoalbuminemia, generalized pitting edema (mainly face), hypercholesterolemia |
| What is nephritic syndrome? | d/t the disturbance of glomerular structure that involves reactive cellular proliferation. |
| What are results of nephritic syndrome? | Oliguria (dec. amt urinary output), hematuria, uremia (high blood urea nitrogen (BUN); toxic mat'l in blood), HTN, periorbital edema. |
| What is minimal change disease? | Most common in children - fusion of foot processes of the epithelial cells; features of nephrotic syndrome are present (easy Tx) |
| What is post-streptococcal glomerulonephritis? | common in childhood; 1-2 weeks after a strept infection; most of them show the features of nephritic syndrome. |
| What is rapidly progressive glomerulonephritis? | End result of post-streptococcal GN or Goodpasture's syndrome; formation of epithelial crescents; nephritic syndrome |
| What is henoch-shnolein purpura? | In children, characteristic of systemic vasculitis, involving skin, kidney, abdomen and joints; CF: rash on the gluteal reagion, arthritis, abdominal pain and mild proteinuria; nephrotic syndrome |
| What is Membranous glomerulonephritis? | In adults, characteristic of nephrotic syndrome |
| What is Goodpasture's syndrome as it relates to the UT? | Nephritic syndrome, in adults affecting lungs (hemoptysis)and kidneys (hematuria) |
| What glomerular diseases show s/s of nephritic syndrome? (3) | 1. Post-streptococcal glomerulonephritis 2. Rapidly progressive glomerulonephritis 3. Goodpasture's syndrome |
| What glomerular diseases show s/s of nephrotic syndrome? (3) | 1. Minimal change Dz 2. Henoch-Schnolein purpura 3. Membranous glomerulonephritis |
| What is nephrocalcinosis? | Deposition of calcium phosphate in renal parenchyma associated w/ hypercalcemia -> stones in UT |
| What is nephrosclerosis? | Changes in the kidneys caused by the effects of HTN; Hardening of kidneys |
| What are 2 types of nephrosclerosis? | 1. Hyaline arteriosclerosis in essential HTN and hyperplastic arteriosclerosis in malignant HTN 2. Renal artery stenosis: leads to HTN associated w/ high rennin-angiotensin-aldosterone system. |
| What are CFs of renal artery stenosis? | Elderly people, atherosclerosis ->renal ischemia -> decreased GFR -> increased renin -> increased aldosterone -> sodium and water retention -> HTN (renal perfusion affected dec. UO) |
| What is acute tubular necrosis? | Mercury poisoning results in acute renal failure |
| Who gets renal cortical necrosis? | Shock patients |
| What is hydronephrosis? | Dilatation of renal pelvis d/t obstruction of urinary tract at any level (BPH) |
| What are nephrolithiasis / urolithiasis and who normally gets them? | Kidney stones (U.T. not only kidney); common in men, colicky pain from loin to groin. |
| What are etiologic factors of nephrolithiasis? (7) | 1. Diet - deficiency of vit. A 2. Dehydration 3. Decreased urinary citrate 4. Renal infection 5. Inadequate urinary drainage, urinary stasis 6. Prolonged immobilization 7. Hyperparathyroidism |
| What types of stones are there and the most common? | oxalate, phosphate, uric acid, cystine, calcium; calcium oxalate or calcium phosphate |
| What are CFs of kidney stones? | sometimes asymptomatic; pain: fixed renal pain or ureteric colicky pain (spasmodic pain) |
| What are strvite stones, staghorn caliculi and uric acid stones? | Strvite: magnesium ammonium phosphate; Staghorn: caused by a cast like formation of the renal pelvis (lg. stone that resembles stag's horn, same shape of major/minor calices); uric acid stones: in gouty patients |
| What is nephroblastoma? | Wilm's tumor. Most common in children 2-6 y/o from the embryonic nephrogenic tissue; back pain and respiratory Sx, bilateral |
| What is renal cell carcinoma: hypernephroma? | common kidney tumor in adults, upper pole, unilateral back pain, loin pain, loin mass |
| What re CFs of renal cell carcinoma? | hematuria, mets to lung, liver ad bone. Locally invade the renal vein - varicocele (bag of worms) or if invades the IVC -> edema in LE |
| What is urniary bladder carcinoma? | 90% transitional cell carcinoma and 10% in schistosoma infection |
| What are risk factors for transitional cell carcinoma? | cigarette smoking, hair dyes (salon workers) and analgesic abuse |
| What is a risk factor for squamous cell carcinoma of the bladder? | Schistosoma infection; hydatid cyst |
| Where are bladder cancers commonly located and the CFs? | Trigone of the bladder; painless hematuria (coffee/tea color urine), frequency, urgency, dysuria |
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kabrown
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