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Dr. Seva Visc. final

Dr. Seva's NYCC visceral pathology final

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
Created by: kabrown
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