Block 2 Exam total prep (GI/Gallbladder/Male-repro/Pancreas) Flashcards
1
Q
Describe the following for a Horseshoe kidney:
What is it?
A
The kidney gets caught on the IMA casing a conjoined kidney connected at the lower pole
2
Q
conjoined kidney connected at the lower pole
A
Horseshoe kidney
3
Q
Describe the following for a unilateral Renal agenesis:
What is it?
A
One kidney gets hypertrophied & hyperinflated to compensate for the other being atrophied/not formed this carries the risk of renal failure later on though
4
Q
One kidney gets hypertrophied & hyperinflated to compensate for the other being atrophied/not formed this carries the risk of renal failure later on though
A
Unilateral renal agenesis
5
Q
Describe the following for a bilateral Renal agenesis:
What is it?
A
Both kidneys are atrophied & don’t function causing potter sequence (oligohydramnios, lung hypoplasia, flat face/low set ears, & extremity defects)
This one is fatal :(
6
Q
Both kidneys are atrophied & don’t function causing potter sequence (oligohydramnios, lung hypoplasia, flat face/low set ears, & extremity defects)
This one is fatal :(
A
Bilateral renal agenesis
7
Q
What are the symptoms of Potter sequence & what congenital condition is it associated with?
A
oligohydramnios, lung hypoplasia, flat face/low set ears, & extremity defects
ass with bilateral renal agenesis
8
Q
Describe the following for a Dysplastic kidney:
What is it?
A
a congenital defect causing abnormal kidney tissue & cysts it’s usually bilateral (but not always)
9
Q
a congenital defect causing abnormal kidney tissue & cysts it’s usually bilateral (but not always)
A
Dysplastic kidney
10
Q
Describe the following for a polycystic kidney disease:
What is it?
A
It causes enlarged kidneys with cysts in the renal cortex/medulla it can be autosomal dominant or recessive
11
Q
What are the features of autosomal dominant polycystic kidney disease?
What is it?
- who/what
What causes it?
What conditions is it associated with?
A
Patho:
Usually in young adults it presents with HTN, hematuria, & worsening renal failure.
Causes:
It is caused by either an APKD1/2 mutation
Ass conditions:
It’s associated with Berry aneurysm, MVP, or hepatic cysts
12
Q
Usually in young adults it presents with HTN, hematuria, & worsening renal failure. It is caused by either an APKD1/2 mutation and it’s associated with Berry aneurysm, MVP, or hepatic cysts
A
Autosomal dominant polycystic kidney disease
13
Q
What are the features of autosomal recessive polycystic kidney disease?
What is it?
- who/what
A
Patho:
It typically affects infants & it presents as HTN, worsening renal failure, & eventually as potters (this one is fatal)
14
Q
It typically affects infants & it presents as HTN, worsening renal failure, & eventually as potters (this one is fatal)
A
Autosomal recessive polycystic kidney disease
15
Q
Describe the following for a Medullary cystic kidney disease:
What is it?
A
Aka the medullary sponge kidney.
It’s an autosomal dominant mutation that causes cysts in the medullary collecting ducts & fibrosis of the kidney. It makes the kidneys shrink & causes worsening renal failure
16
Q
Cystic dilatation of the collecting ducts & fibrosis of the kidney parenchyma
A
Medullary cystic kidney disease
17
Q
What is the most common cause of kidney failure in children & what organisms cause it?
A
Hemolytic uremic syndrome, which can be caused by E.coli, VTEC, or Shigella (i.e undercooked ground beef)
It forms platelet fibrin thrombi in the glomerular capillaries which cause thrombotic microangiopathy
18
Q
The most common cause of renal failure in children, can be caused by E.coli, VTEC, or Shigella (i.e undercooked ground beef)
It forms platelet fibrin thrombi in the glomerular capillaries which cause thrombotic microangiopathy
A
Hemolytic uremic syndrome
19
Q
Describe the following for prerenal azotemia:
What is it?
What are the lab findings?
A
Path:
Reduced blood flow to the kidneys (like from heart failure) cause worsening renal failure
Labs:
Azotemia (BUN:CR >15/20) Elevated
Oliguria (urine osmo >500)
Reduced GFR
20
Q
It causes reduced blood flow to the kidneys (like from heart failure) cause worsening renal failure
Labs show the following:
Azotemia (BUN:CR >15/20) Elevated
Oliguria (urine osmo >500)
Reduced GFR
A
Prerenal Azotemia
21
Q
Describe the following for postrenal azotemia:
What is it?
What are the lab findings?
A
Path:
Due to an obstruction downstream from the kidneys (i.e in the ureters) that reduces the glomerular filtration rate
Early stage only has azotemia, oliguria & reduced GFR but as it progresses to late stage the labs show this:
Reduced GFR
Azotemia (BUN:CR >15/20) Elevated
Inability to concentrate the urine (urine osmo >500)
Reduced Na resorption (FENa >2%)
22
Q
Due to an obstruction downstream from the kidneys (i.e in the ureters) that reduces the glomerular filtration rate
Labs show:
Reduced GFR
Azotemia (BUN:CR >15/20) Elevated
Inability to concentrate the urine (urine osmo >500)
Reduced Na resorption (FENa >2%)
A
Post renal azotemia
23
Q
Describe the following for acute tubular necrosis:
What is it? What are the symptoms?
A
Path:
Reduced blood flow to the kidneys tubules causes ischemia/necrosis it tends to happen after prerenal azotemia in the PCT & Medullary seg of the thick ascending LOH
Signs:
1) Renal failure
2) Brown granular casts in the urine
24
Q
What are the lab findings in acute tubular sclerosis?
A
Labs:
decreased reabsorption of BUN (serum BUN:Cr ratio < 15), decreased reabsorption of sodium (FENa > 2%), and inability to concentrate urine (urine osm < 500 mOsm/kg).
25
What can cause acute tubular necrosis?
Causes:
1) Severe hypotension (hypovolemic, hemorrhage, severe dehydration), septic shock)
26
What are the two types of acute tubular necrosis?
1) Ischemic type: due to reduced to the tubules which is proceeded by prerenal azotemia in the PCT & Medullary thick ascending limb of the LOH
2) Nephrotic type: caused by toxic agents like heavy metals (lead), myoglobinuria (crushing injury), ethylene glycol (antifreeze) & radiocontrast (tumor lysis syndrome) cause necrosis in the PCT
27
1) Ischemic type: due to reduced to the tubules which is proceeded by prerenal azotemia in the PCT & Medullary thick ascending limb of the LOH
2) Nephrotic type: caused by toxic agents like heavy metals (lead), myoglobinuria (crushing injury), ethylene glycol (antifreeze) & radiocontrast (tumor lysis syndrome) cause necrosis in the PCT
Are features of which condition?
Acute Tubular necrosis
28
How does acute tubular necrosis (aka intrarenal azotemia) cause brown casts in the urine?
The ischemia/necrosis of the tubular epithelium causes necrotic plugs in the tubules which cause the renal dysfunction & brown/granular casts
29
What is acute interstitial nephritis?
Aka drug induced nephritis (a hypersensitivity reaction) it can cause renal papillary necrosis
Key signs include:
1. Oliguria
2. Fever/rash
3. Elevated eosinophils in the urine
30
Aka drug induced nephritis (a hypersensitivity reaction) it can cause renal papillary necrosis
Key signs include:
1. Oliguria
2. Fever/rash
3. Elevated eosinophils in the urine
Describes which condition?
Acute interstitial nephritis
31
What is renal papillary necrosis?
Necrosis of the renal papillae due to chronic conditions like analgesic abuse (phenacetin/aspirin), diabetes mellitus, sickle cell T/D, or severe acute pyelonephritis
Key signs:
1. Gross hematuria
2. Flank pain
32
What condition can lead to renal papillary necrosis as a complication?
Acute interstitial nephritis
33
What is Minimal change disease?
Aka Nil disease, its the most common cause of nephrotic syndrome in children. It's the production of too many cytokines & it causes the effacement of podocytes resulting in selective albuminuria & lipid droplets in the urine.
Signs:
Pitting edema
Hyperlipidemia
Cholesterolemia
It has an excellent response to steroids & its associated with Hodgkin Lymphoma
34
Nephrotic vs Nephritic syndromes are related to what in the urine &
Nephrotic = protein in the urine
1. Minimal change disease
2. Focal segmental glomerulonephritis
3. Diabetic mellitus
4. systemic amyloidosis
5. Membranoproliferative glomerulonephritis
6. membranous nephropathy)
Nephrotic = Blood in the urine
1. Post Streptococcal Glomerulonephritis
2. IgA Nephropathy (Bergers)
3. Alport Syndrome
4. Rapidly progressive glomerulonephritis (Goodpasture's, Wegner's, Chrug-strauss, & micro polyangiitis)
35
Aka Nil disease, its the most common cause of nephrotic syndrome in children. It's the production of too many cytokines & it causes the effacement of podocytes resulting in selective albuminuria & lipid droplets in the urine.
Signs:
Pitting edema
Hyperlipidemia
Cholesterolemia
It has an excellent response to steroids & its associated with Hodgkin Lymphoma
Describes which condition?
Minimal change disease
36
What are the lab findings seen in minimal change disease?
1. Lipids in the PCT
2. -ve immunofluorescence
3. Hypoalbuminemia
4. Effacement of foot processes
5. Fatty casts in the urine
37
1. Lipids in the PCT
2. -ve immunofluorescence
3. Hypoalbuminemia
4. Effacement of foot processes
5. Fatty casts in the urine
Are the lab findings of which condition?
Minimal change disease
38
What is focal segmental glomerulonephritis?
The most common cause of nephrotic syndrome in Hispanics & African Americans. It's associated with HIV infection, Heroin use, & sickle cell disease which can progress to chronic renal failure. The lesions can be focal or segmental on H&E staining
39
The most common cause of nephrotic syndrome in Hispanics & African Americans. It's associated with HIV infection, Heroin use, & sickle cell disease which can progress to chronic renal failure. The lesions can be focal or segmental on H&E staining
Which condition?
Focal segmental glomerulonephritis
40
Key words:
1. Focal/segmental lesions
2. Hispanic & African Americans
3. Heroine, HIV, SLE, & Sickle cell association
5. Subepithelial & spike/dome app
Membranous nephropathy
41
What is Diabetic Nephropathy?
Elevated serum glucose causes hyaline arteriosclerosis that causes non-enzymatic glycosylation of the blood vessel walls making them more permeable to protein (i.e the proteins leak through) resulting in more glomerular infiltration pressure & hyperinflation which can cause injury & nephrotic syndrome
42
Elevated serum glucose causes hyaline arteriosclerosis that causes non-enzymatic glycosylation of the blood vessel walls making them more permeable to protein (i.e the proteins leak through) resulting in more glomerular infiltration pressure & hyperinflation which can cause injury & nephrotic syndrome
Formation of Kimmestiel-wilson nodules
Describes which condition?
Diabetic nephropathy
43
What are the lab findings of diabetic nephropathy?
1. Hypoalbuminemia (loss of albumin)
2. Hyperglycemia
44
What is used to treat diabetic nephropathy?
ACE inhibitors
45
Hypoalbuminemia & formation of Kimmestiel-wilson nodules are indicative of which condition?
Diabetic nephropathy
46
What is systemic amyloidosis?
Amyloid deposits in the mesangium of the kidney that is associated with chromic inflammatory conditions
47
Amyloid deposits in the mesangium of the kidney that is associated with chromic inflammatory conditions
Describes which condition?
Systemic amyloidosis
48
Amyloidosis deposits are pink amorphous materials in the mesangium of the kidney that show apple-green birefringent under polarized light
Systemic amyloidosis
49
What is membranoproliferative glomerulonephritis?
Immune complex deposition in the glomerular basement membrane causing mesangial proliferation giving it a tram-track appearance
Type 1 sub endothelium & type 2 intramembranous both progress to chronic renal failure
50
Which conditions present with
1.Proteinuria (>3.5 g/day)
2.Hypoalbuminemia (pitting edema)
3.Hypercoagulability (reduced anti thrombin 3)
4.Hyperlipidemia/cholesterolemia (fatty casts in urine)
5. Hypogammaglobulinemia (inflammation)
Nephrotic syndromes:
Minimal change disease
Diabetic nephropathy
Focal/Segmental glomerulonephritis
Systemic amyloidosis
Membranoproliferative glomerulonephritis
Membranous nephropathy
51
Nephrotic syndromes:
Minimal change disease
Diabetic nephropathy
Focal/Segmental glomerulonephritis
Systemic amyloidosis
Membranoproliferative glomerulonephritis
Membranous nephropathy
All present with which common lab findings?
1.Proteinuria (>3.5 g/day)
2.Hypoalbuminemia (pitting edema)
3.Hypercoagulability (reduced anti thrombin 3)
4.Hyperlipidemia/cholesterolemia (fatty casts in urine)
5. Hypogammaglobulinemia (inflammation)
52
What is type 1 membranoproliferative glomerulonephritis
Type 1 is subendothelial & is associated with HBV & HCV infections
53
What is type 2 membranoproliferative glomerulonephritis
Intramembranous infiltration associated with IgG mediated C3 factor (chemotactic)
54
Key words:
1. Affects children (nephropathy)
2. Mesangial proliferation & tram track appearance
3. Thickened & splitting basement membrane
4. Immune complex deposition
Membranoproliferative glomerulonephritis
55
What is membranous nephropathy
The most common cause of nephrotic syndrome in white men that is associated by HBV/HCV, SLE, & Malignant cancers.
There is subepithelial immune complex deposition causing thickening glomerular basement membrane with an epi-membranous spike & done appearance
56
The most common cause of nephrotic syndrome in white men that is associated by HBV/HCV, SLE, & Malignant cancers.
There is subepithelial immune complex deposition causing thickening glomerular basement membrane with an epi-membranous spike & done appearance
membranous nephropathy
57
What is seen of immunofluorescence in membranous nephropathy
Granular fluorescence
58
What is a complication of membranous nephropathy
Chronic renal failure
59
Key words:
1. Most common nephrotic syndrome in white men
2. Subepithelial immune complex depositions
3. Thickened GBM with epimembranous spikes & a dome appearance
4. Associated with conditions like Hep B/C, SLE, & Malignant cancers
Membranous nephropathy
60
What is cystitis (UTI)? & What are the symptoms?
A bladder infection from E.coli (usually)
Signs:
1) Dysuria
2) Increased urinary frequency & urgency
3) Suprapubic pain
61
A bladder infection from E.coli (usually)
Signs:
1) Dysuria
2) Increased urinary frequency & urgency
3) Suprapubic pain
Cystitis
62
What lab work up would indicate cystitis?
1) Cloudy urine with elevated WBC (>10)
2) +ve leukocyte esterase
3) +ve nitrates
4) >100,000 CFU
63
1) Cloudy urine with elevated WBC (>10)
2) +ve leukocyte esterase
3) +ve nitrates
4) >100,000 CFU
These labs indicate which condition?
Cystitis
64
What are the organisms that can cause a cystitis infection?
Number one is E.coli
Others:
K. pneumoniae
Proteus microbilis (alkalinizes the urine to make it smell like pneumonia)
Enterococcus faecalis
65
What is urethritis & how does it differ from cystitis?
It has the same symptoms (dysuria, urine frequency/urgency, & suprapubic pain), but it is caused by C. trachomatis & N. gonorrhea
Labs:
Sterile pyuria (-ve bacterial cultures)
66
It has the same symptoms (dysuria, urine frequency/urgency, & suprapubic pain), but it is caused by C. trachomatis & N. gonorrhea
Labs:
Sterile pyuria (-ve bacterial cultures)
What type of UTI?
Urethritis
67
What is acute pyelonephritis? & what are the symptoms?
Infection of the kidney that ascends causing scarring of the upper/lower poles giving it a staghorn appearance. Acute pyelonephritis is a progression of ascending infections like cystitis caused by E. coli & proteus mirabilis
Signs:
1) Fever & chills
2) Flank pain
3) Costovertebral angle tenderness
4) Dysuria & hematuria
68
Infection of the kidney that ascends causing scarring of the upper/lower poles giving it a staghorn appearance. It's a progression of ascending infections like cystitis caused by E. coli & proteus mirabilis
Signs:
1) Fever & chills
2) Flank pain
3) Costovertebral angle tenderness
4) Dysuria & hematuria
Acute pyelonephritis
69
What are the lab findings in acute pyelonephritis?
Elevated cysteine (in children)
WBC casts
Leukocytosis
Elevated CRP & ESR
70
What are risk factors associated with pyelonephritis?
1. Being female (shorter UT)
2. The vesicoureteral reflex (urine backflow usually in children)
3. Obstruction (BPH or cervical cancer)
71
1. Being female (shorter UT)
2. The vesicoureteral reflex (urine backflow usually in children)
3. Obstruction (BPH or cervical cancer)
Are all associated with an increased risk of developing which condition?
Pyelonephritis
72
What is chronic pyelonephritis? What condition is it associated with?
It is a complication of recurrent bouts of acute pyelonephritis which leads to interstitial fibrosis & atrophy of the renal tubules. It is associated with all the risk factors for acute pyelonephritis as well as multiple myeloma
73
It is a complication of recurrent bouts of acute pyelonephritis which leads to interstitial fibrosis, atrophy of the renal tubules, & thyroidization of the kidney. It is associated with all the risk factors for acute pyelonephritis as well as multiple myeloma
Chronic pyelonephritis
74
What are the lab findings in chronic pyelonephritis?
1) Blunted calyces/cortical scarring
2) Thyroidization of the kidney
3) Waxy & colloid casts in the urine
75
Key words:
1) Vesicoureteral reflux
2) Recurrent pyelonephritis
3) Blunted calyces
4) Thyroidization of kidney
5) Waxy & colloid casts
chronic pyelonephritis?
76
What is rapidly progressive glomerular nephritis & what conditions can lead to it?
An inflammatory disease of the kidney that rapidly destroys the renal glomeruli & leads to end-stage renal disease.
The conditions that can cause it include good pastures, Microscopic polyangiitis, Churg Strauss syndrome, PSGN, Diffuse proliferative glomerulonephritis, or Wegner's granulomatosis.
77
An inflammatory disease of the kidney that rapidly destroys the renal glomeruli & leads to end-stage renal disease.
The conditions that can cause it include good pastures, Microscopic polyangiitis, Churg Strauss syndrome, PSGN, Diffuse proliferative glomerulonephritis, or Wegner's granulomatosis.
Rapidly progressive Glomerulonephritis
78
What are the symptoms & a key lab finding of glomerulonephritis?
Signs:
1) HTN
2) Oliguria
3) Hematuria + RBC casts
4) Edema
5) Azotemia (elevated BUN:CR serum)
79
Signs:
1) HTN
2) Oliguria
3) Hematuria + RBC casts
4) Edema
5) Azotemia (elevated BUN:CR serum)
A rapidly progressive renal condition
Rapidly progressive glomerulonephritis
80
If you see granular +ve immunofluorescence in rapidly progressive glomerulonephritis the causal condition is likely what?
PSGN or Diffuse proliferative glomerulonephritis
81
If you see linear +ve immunofluorescence in rapidly progressive glomerulonephritis the causal condition is likely what?
Good pastures
82
If you see linear -ve immunofluorescence aka pauci glomerulonephritis in rapidly progressive glomerulonephritis the causal condition is likely what?
Wegner's (C-ANCA +ve)
Microscopic polyangiitis (P-ANCA +ve)
Churg Strauss (P-ANCA +ve)
83
What is good pastures?
What are the symptoms?
What is a complication of this condition?
It's antibodies against type IV collagen (A3 chain) in the basement membranes of the glomeruli & alveoli
Signs:
1) Hematuria
2) Hemoptysis
3) +ve linear IF deposition
Complication is rapidly progressive glomerulonephritis
84
It's antibodies against type IV collagen (A3 chain) in the basement membranes of the glomeruli & alveoli
Signs:
1) Hematuria
2) Hemoptysis
3) +ve linear IF deposition
4) Bowmans space crescents
Complication is rapidly progressive glomerulonephritis
Describes which condition?
Good pastures
85
What is Churg-Strauss?
What are the symptoms?
What are the key lab findings?
What is a major complication?
A P-ANCA +ve form of granulomatous inflammation divided into phases prodromal, eosinophilic, & vasculitic
Signs:
1) Prodromal (Asthma/allergic asthmatic reactions)
2) Eosinophilic (Pericarditis & Gi inv)
3) Vasculitic (Cutaneous lesions & palpable purpura)
Labs:
1) Bowmans space crescents
2) -ve IF deposition (Pauci GN)
3) Eosinophilia
4) Elevated IgEs
A complication is RPGN
86
A P-ANCA +ve form of granulomatous inflammation divided into phases prodromal, eosinophilic, & vasculitic
Signs:
1) Prodromal (Asthma/allergic asthmatic reactions)
2) Eosinophilic (Pericarditis & Gi inv)
3) Vasculitic (Cutaneous lesions & palpable purpura)
Labs:
1) Bowmans space crescents
2) -ve IF deposition (Pauci GN)
3) Eosinophilia
4) Elevated IgEs
A complication is RPGN
Churg-Strauss syndrome
87
What is Microscopic polyangiitis?
What are the symptoms?
What are the key lab findings?
What is a major complication?
P-ANCA +ve granulomatous inflammation affecting the lungs, kidneys, & skin
Signs:
1) Hemoptysis
2) Palpable purpura
3) HTN
Labs:
1. Bowman space crescents
2. -ve IF (Pauci's GN)
A complication is RPGN
88
P-ANCA +ve granulomatous inflammation affecting the lungs, kidneys, & skin
Signs:
1) Hemoptysis
2) Palpable purpura
3) HTN
Labs:
1. Bowman space crescents
2. -ve IF (Pauci's GN)
A complication is RPGN
Microscopic polyangiitis
89
What is Diffuse proliferative glomerulonephritis?
What are the key lab findings?
What is a major complication?
Diffuse antigen-antibody complex deposition in the subENDOthelial layers of tissues, that is very associated with SLE
Labs:
1. Bowman crescents
2. +ve granular deposition on IF
A complication is RPGN
90
What is PSGN?
What are the symptoms?
What are the key lab findings?
What is a major complication?
Immune complex deposition in the glomerular basement membrane triggering complement activation & tissue damage after an infection with group A B-hemolytic strep (impetigo or strep throat)
Signs:
1. Hematuria
2. Azotemia (elevated BUN:CR)
3. HTN
4. Periorbital edema
5. Oliguria
Labs:
1) Bowman crescents (fibrin & macrophages)
2) Hypercellular & inflamed glomeruli
3) SubEPIthelial humps (a lumpy bumpy appearance)
4) +ve granular IF
Comp: RPGN
91
Immune complex deposition in the glomerular basement membrane triggering complement activation & tissue damage after an infection with group A B-hemolytic strep (impetigo or strep throat)
Signs:
1. Hematuria
2. Azotemia (elevated BUN:CR)
3. HTN
4. Periorbital edema
5. Oliguria
Labs:
1) Bowman crescents (fibrin & macrophages)
2) Hypercellular & inflamed glomeruli
3) SubEPIthelial humps (a lumpy bumpy appearance)
4) +ve granular IF
Comp: RPGN
PSGN
92
How does glomerular damage lead to edema & hyperlipidemia/cholesterolemia?
The edema comes from protein loss (i.e albumin & others) the hyperlipidemia/cholesterolemia comes from the liver making more lipoproteins to try to compensate for the proteins lost in the urine
93
What is nephrolithiasis?
What are the symptoms?
What are the types of stones seen?
kidney stones that form when there is low urine volume output or high solute concentrations
Signs:
1) Colicky pain
2) Hematuria
3) Periumbilical & flank pain
Stone types:
Calcium oxalate or phosphate (most common)
Ammonium, magnesium, or phosphate (infection)
Cysteine (rare & in children)
94
kidney stones that form when there is low urine volume output or high solute concentrations
Signs:
1) Colicky pain
2) Hematuria
3) Periumbilical & flank pain
Stone types:
Calcium oxalate or phosphate (most common)
Ammonium, magnesium, or phosphate (infection)
Cysteine (rare & in children)
Nephrolithiasis
95
Nephrolithiasis:
What condition is associated with the formation of cysteine stones in children? How do you treat them?
Cysteine stones are associated with cystinuria a genetic tubule defect with impaired cysteine resorption & the tendency to form staghorn in the kidney
Rx: Hydration & alkalinize the urine
96
Nephrolithiasis:
Which conditions are associated with the formation of uric acid stones? What is the treatment?
Conditions like Gout or hyperuricemia (i.e leukemia or myeloproliferative disease) tend to form uric kidney stones
They can be treated with hydration & by alkalinizing the urine
97
Nephrolithiasis:
Which conditions are associated with the formation of calcium oxalate or phosphate stones? What is the treatment?
The formation is either idiopathic or from states of hypercalcemia/hypercalciuria.
It could be associated with Crohn's or indicate acute tubular necrosis syndrome or consumption of ethylene glycol
Treat them by giving a ca2+ sparring diuretic like hydrochlorothiazide
98
Nephrolithiasis:
Which conditions are associated with the formation of ammonium, magnesium, & phosphate stones? What is the treatment?
They're usually due to infections with urease +ve organisms (inflammation) via klebsiella or proteus vulgaris because they tend to alkalinize the urine causing staghorn calculi that are a niche for UTIs
99
What is chronic renal failure & what conditions can lead to it?
What are the symptoms?
What are the lab findings?
What does it predispose to?
Long-standing pressure on the kidney from conditions like diabetes, HTN, & glomerular disease cause them be become shrunken (atrophy) & cystic
Signs:
1) Encephalopathy (waste in the blood)
2) HTN
3) Anemia (low EPO)
4) Edema (protein loss)
5) Osteodystrophy
6) Secondary hyperparathyroidism + osteoporosis
7) Asterixis
8) Platelet dysfunction
Labs:
Uremia (high nitrates)
Azotemia (high BUN:CR)
Metabolic acidosis
Hypercalcemia/phosphatemia/kalemia
High risk of progressing to Renal cell carcinoma!!
100
What complication does chronic renal failure often lead to ?
Renal cell carcinoma
101
Long-standing pressure on the kidney from conditions like diabetes, HTN, & glomerular disease cause them be become shrunken (atrophy) & cystic
Signs:
1) Encephalopathy (waste in the blood)
2) HTN
3) Anemia (low EPO)
4) Edema (protein loss)
5) Osteodystrophy
6) Secondary hyperparathyroidism + osteoporosis
7) Asterixis
8) Platelet dysfunction
Labs:
Uremia (high nitrates)
Azotemia (high BUN:CR)
Metabolic acidosis
Hypercalcemia/phosphatemia/kalemia
High risk of progressing to Renal cell carcinoma!!
Chronic renal failure
102
Signs:
1) Encephalopathy (waste in the blood)
2) HTN
3) Anemia (low EPO)
4) Edema (protein loss)
5) Osteodystrophy
6) Secondary hyperparathyroidism + osteoporosis
7) Asterixis
8) Platelet dysfunction
Labs:
Uremia (high nitrates)
Azotemia (high BUN:CR)
Metabolic acidosis
Hypercalcemia/phosphatemia/kalemia
All indicate which condition?
Chronic renal failure
103
What is a angiomyolipoma?
A benign hamartoma (made up of blood vessels, smooth muscle, & fat) that is very common in tuberous sclerosis
104
What is hereditary renal cell carcinoma, papillary type?
A MET oncogene mutation that results in altered papillae tissue & psammoma bodies
105
What is renal cell carcinoma?
- What are its subtypes?
What are the symptoms?
A malignant epithelial tumor of the tubules caused by genetic defects in tumor suppressor genes (VHL), growth (IGF-1) & transcription (HIF) factors. It can be either sporadic or hereditary.
1) Sporadic type is more common in older men (~60yrs) who smoke, it's a single tumor in the upper pole of the kidney
- Clear cell
- Papillary
- Chromophobe
2) Hereditary type is more common in young adults & is associated with genetic conditions
Signs:
1) Triad (Hematuria, Palpable mass, & flank pain (never at the same time))
2) Fever
3) Weigt loss
4) Left varicocele (rare)
5) Large yellowish mass
106
A malignant epithelial tumor of the tubules caused by genetic defects in tumor suppressor genes (VHL), growth (IGF-1) & transcription (HIF) factors. It can be either sporadic or hereditary.
1) Sporadic type is more common in older men (~60yrs) who smoke, it's a single tumor in the upper pole of the kidney
- Clear cell
- Papillary
- Chromophobe
2) Hereditary type is more common in young adults & is associated with genetic conditions
Signs:
1) Triad (Hematuria, Palpable mass, & flank pain (never at the same time))
2) Fever
3) Weigt loss
4) Left varicocele (rare)
5) Large yellowish mass
Renal cell carcinoma
107
What is the sporadic type renal cell carcinoma?
1) Sporadic type is more common in older men (~60yrs) who smoke, it's a single tumor in the upper pole of the kidney
108
common in older men (~60yrs) who smoke, it's a single tumor in the upper pole of the kidney
Sporadic type RCC
109
What is the sporadic clear cell type RCC
clear cell type is associated with a VHL mutation or pseudohypoxia that affects the PCT it has a higher risk of hemangioblastomas in the cerebellum or further RCC
110
What is the sporadic papillary type RCC?
Papillary type is associated with MET oncogene mutations casing the formation of psammomas bodies in the renal papillae.
111
What is the sporadic chromophobe type RCC?
Chromophobe RCC causes pale eosinophils in cells lining the DCT it is associated with mitochondrial mutations & TP53 mutations
112
What is a Wilms tumor?
What are some conditions that can lead to it?
What are it's symptoms?
A malignant tumor of the kidney made from blastema (immature mesenchyme) & Primitive glomeruli/tubular stroma. It's usually seen in children under 5yrs old and is associated with the following condition:
1. WAGR
2. Denys-Drash
3. Beckwith-Wiedemann
Signs:
1) A large unilateral flank mass
2) Hematuria
3) HTN (high renin)
113
A malignant tumor of the kidney made from blastema (immature mesenchyme) & Primitive glomeruli/tubular stroma. It's usually seen in children under 5yrs old and is associated with the following condition:
1. WAGR
2. Denys-Drash
3. Beckwith-Wiedemann
Signs:
1) A large unilateral flank mass
2) Hematuria
3) HTN (high renin)
Wilms tumor
114
What is WAGR syndrome & what is a potential complication?
Due to a deleted WT1 gene (11p13)
Wilms tumor
Aniridia
Genitourinary abnormalities
Retardation (motor/mental)
Risk of metastasizing to the lungs
115
What is Denys-Drash syndrome?
A mutated WT1 gene:
Male pseudo hermaphroditism
Progressive glomeruli disease (diffuse mesangial sclerosis)
Wilms tumor
116
What is Beckwith-Weidmann syndrome?
Mutated WT2 clusters on (11p15.5) causing dysfunctional IGF1 (growth factor):
Organomegaly/macroglossia
Muscular hemihypertrophy
Neonatal hypoglycemia
Wilms tumor
## Footnote
"WOMMaN"
117
What is an oncocytoma?
A benign tumor with increased levels of mitochondria & mahogany brown central hyaline scarring on microscopy
118
What is transitional cell carcinoma?
Aka urothelial cell carcinoma, a malignant cancer of the lining of the bladder, renal pelvis, & urethra. Usually appearing in older adults as either flat (high grade malignancy) or papillary (low grade malignancy). These tumors are multifocal and tend to reoccur (field defect)
119
Aka urothelial cell carcinoma, a malignant cancer of the lining of the bladder, renal pelvis, & urethra. Usually appearing in older adults as either flat (high grade malignancy) or papillary (low grade malignancy). These tumors are multifocal and tend to reoccur (field defect)
Transitional cell carcinoma
120
What is a flat transitional/urothelial cell cancer?
A high-grade malignant cancer that invades surrounding tissue right away because of its early P53 mutations
121
A high-grade malignant cancer that invades surrounding tissue right away because of its early P53 mutations (usually affects the bladder, renal pelvis, or urethra)
flat transitional/urothelial cell cancer
122
What is a papillary transitional/urothelial cell cancer?
Low-grade malignancy that needs to progress to high-grade before invading any other tissues.
123
Low-grade malignancy that needs to progress to high-grade before invading any other tissues. (usually affects the bladder, renal pelvis, or urethra)
papillary transitional/urothelial cell cancer?
124
What is the sign of transitional cell carcinoma of the bladder (aka bladder cancer)?
What part of the bladder is likely affected?
What is the number one risk factor?
Painless hematuria
Lateral wall near the trigone
Smoking
125
Naphythylamine exposure, Azodyes, long term cyclophosphamide or phenacetine use are all associated with which type of cancer?
Transitional cell caner of the bladder/renal pelvis, or urethra
126
What is squamous cell cancer of the lower urinary tract?
What causes?
Malignant proliferation aka squamous metaplasia of the bladder, renal pelvis or urethra due to consistent stress/trauma
Causes:
1. Chronic cystitis (seen in older women)
2. Schistosomiasis (Egyptian men)
3. Long-term nephrolithiasis
127
Malignant proliferation aka squamous metaplasia of the bladder, renal pelvis or urethra due to consistent stress/trauma
Causes:
1. Chronic cystitis (seen in older women)
2. Schistosomiasis (Egyptian men)
3. Long-term nephrolithiasis
Squamous cell carcinoma of the lower urinary tract
128
What is adenocarcinoma of the lower urinary tract?
What causes it?
It is malignant proliferation of the glands involving the bladder. It can arise from
1) urachal remnants as a cyst like tumor in the dome of the bladder
or
2) From cystitis granularize or exstrophy of the bladder (when the anterior wall of the bladder fail to form)
129
It is malignant proliferation of the glands involving the bladder. It can arise from
1) urachal remnants as a cyst like tumor in the dome of the bladder
or
2) From cystitis granularize or exstrophy of the bladder (when the anterior wall of the bladder fail to form)
Adenocarcinoma of the bladder
130
What is squamous cell carcinoma of the penis?
- What are it's precursors?
What are the major risk factors of this condition?
Malignant proliferation from in situ precursor lesions such as Bowen disease, Erythroplakia of Queyrat, & Bowenoid papulosis
Risk factors:
#1 HPV infection
Uncircumcision (site for inflammation)
131
Malignant proliferation from in situ precursor lesions such as Bowen disease, Erythroplakia of Queyrat, & Bowenoid papulosis
Risk factors:
#1 HPV infection
Uncircumcision (site for inflammation)
squamous cell carcinoma of the penis
132
How is Bowen disease a precursor for penile squamous cell carcinoma?
carcinoma of the shaft & scrotum presenting as leukoplakia
133
How is Erythroplakia of Queyrat a precursor for penile squamous cell carcinoma?
(in situ carcinoma on the glans that presents as erythroplakia)
134
How is Bowenoid papulosis a precursor for penile squamous cell carcinoma?
(an in situ carcinoma that presents as multiple reddish papules, seen in younger patients (40yrs) that don't usually progress to invasive carcinoma)
135
What is condyloma Acuminatum?
A benign watery growth on the genital skin from an HPV 6/11 infection. It's characterized by Koilocytic change
136
A benign watery growth on the genital skin from an HPV 6/11 infection. It's characterized by Koilocytic change
condyloma Acuminatum?
137
What is a lymphogranuloma venereum?
What causes it?
What are its complications?
Necrotizing granulomatous inflammation of the inguinal lymphatics & LN that heals over with fibrosis. It's caused by C. Trachomatis (L1-3)
Complications include:
Rectal Strictures
138
Necrotizing granulomatous inflammation of the inguinal lymphatics & LN that heals over with fibrosis. It's caused by C. Trachomatis (L1-3)
Complications include:
Rectal Strictures
139
What are hypospadias?
A congenital opening on the underside of the urethra because the urothelial folds failed to close
140
What are epispadias?
A congenital opening on the upper side of the urethra because the genital tubercles were positioned abnormally during development it's associated with bladder exstrophy
141
A congenital opening on the upper side of the urethra because the genital tubercles were positioned abnormally during development it's associated with bladder exstrophy
epispadias
142
A congenital opening on the underside of the urethra because the urothelial folds failed to close
hypospadias
143
What is a seminoma?
A germ cell tumor that is typically malignant but has a very good prognosis as it is radiosensitive & slow to metastasize
Labs will show
A painless testicular lump with large cells with clear cytoplasm without hemorrhage or necrosis
144
A germ cell tumor that is typically malignant but has a very good prognosis as it is radiosensitive & slow to metastasize
Labs will show
A painless testicular lump with large cells with clear cytoplasm without hemorrhage or necrosis
seminoma
145
What is a teratoma?
A tumor that is usually benign except in men, its made of mature fetal tissue that's derived from 2-3 embryonic layers giving it things like teeth, hair, & skin
Labs:
Elevated AFP & B-hcG
Non-seminoma germ cell tumor
146
List the non-seminoma Germ cell tumors?
147
A tumor that is usually benign except in men, its made of mature fetal tissue that's derived from 2-3 embryonic layers giving it things like teeth, hair, & skin
Labs:
Elevated AFP & B-hcG
Non-seminoma germ cell tumor
Teratoma
148
What is an embryological carcinoma?
An aggressively malignant tumor with early hematogenous spread. It's made of primitive glandular cells & forms a hemorrhagic mass with necrosis.
Labs:
Elevated AFP & B-hcG
Non-seminoma germ cell tumor
149
An aggressively malignant tumor with early hematogenous spread. It's made of primitive glandular cells & forms a hemorrhagic mass with necrosis.
Labs:
Elevated AFP & B-hcG
Non-seminoma germ cell tumor
embryological carcinoma
150
What is a yolk sac tumor?
A malignant tumor more common in children it looks like a yolk-sac & has Schiller-Duval bodies (look like glomeruli)
Labs: Elevated AFP
151
A malignant tumor more common in children it looks like a yolk-sac & has Schiller-Duval bodies (look like glomeruli)
Labs: Elevated AFP
yolk sac tumor
152
What is a choriocarcinoma (testes)?
The most aggressive & malignant tumor it's made up of syncytiotrophoblastic & cytotrophoblast multinucleated giant cells (placenta-like tissues) that spreads early through the blood
Labs: Elevated B-hcG
Complications can be hyperthyroidism & gynecomastia
153
The most aggressive & malignant tumor it's made up of syncytiotrophoblastic & cytotrophoblast multinucleated giant cells (placenta-like tissues) that spreads early through the blood
Labs: Elevated B-hcG
Complications can be hyperthyroidism & gynecomastia
choriocarcinoma
154
What are two main risk factors for developing germ cell tumors?
Cryptorchidism & Klinefelter syndrome
155
What is a mixed germ cell tumor?
A mix of seminoma & non seminoma that is always treated as a non-seminoma a. It is a mass with hemorrhage, and necrosis
156
A mix of seminoma & non seminoma that is always treated as a non-seminoma a. It is a mass with hemorrhage, and necrosis
mixed germ cell tumor
157
What is a Leydig cell tumor?
A Rare tumor that comes from leydig cells causing more production of testosterone. They usually develop after 4yrs old & are very rarely malignant
Labs:
They are golden brown in color with Reinke crystals on histology
158
A Rare tumor that comes from leydig cells causing more production of testosterone. They usually develop after 4yrs old & are very rarely malignant
Labs:
They are golden brown in color with Reinke crystals on histology
Leydig cell tumor
159
What is a Sertoli cell tumor?
a rare tumor made of Sertoli cells
that makes more estrogen and lead to gynecomastia in affected men
160
a rare tumor made of Sertoli cells
that makes more estrogen and lead to gynecomastia in affected men
Sertoli tumor
161
What is a lymphoma?
A very common testicular tumor in men over 60yrs. It tends to be bilateral & is made of diffuse B cells
162
Where do testicular tumors spread to ?
Testicular tumors drain into the para-aortic (lumbar Ln) first then the mediastinal & supraclavicular LN)
163
What is cryptorchidism?
What are the potential complications?
When the testes fail to descend into the scrotum (either resolves on its own or needs an orchidectomy)
Complications include:
Testicular atrophy & infertility
Higher risk of seminomas
164
When the testes fail to descend into the scrotum (either resolves on its own or needs an orchidectomy)
Complications include:
Testicular atrophy & infertility
Higher risk of seminomas
Cryptorchidism
165
What is orchitis?
Inflammation of the testicles usually caused by infection from C. trachomatis & N. gonorrhea (in young adults) & E.coli & pseudomonas (In older adults)
166
What are the two other ways someone can experience orchitis not due to infection?
MUMPS virus (teens) & Autoimmune orchitis (granulomas of the seminiferous tubules)
167
Inflammation of the testicles usually caused by infection from C. trachomatis & N. gonorrhea (in young adults) & E.coli & pseudomonas (In older adults)
Orchitis
168
What is varicocele?
What condition is it associated with?
What are the signs?
Dilation of the spermatic veins giving it a bag of worm's appearance due to reduced drainage
Associated with left sided renal cell carcinoma & infertility.
Signs:
1) Scrotal swelling
2) Bag of worm's appearance
169
Why does a varicocele appear on the left side?
Because the right testicle drains into the IMA whereas the left drains into the left renal vein where the RCC can spread to
170
Dilation of the spermatic veins giving it a bag of worms appearance due to reduced drainage
Associated with left sided renal cell carcinoma & infertility
Signs:
1) Scrotal swelling
2) Bag of worms appearance
Varicocele
171
What is testicular torsion?
What are the causes?
What are the symptoms?
Usually in adolescents it's twisting of the spermatocord that causes vein obstruction causing congestion & hemorrhagic infarction.
Causes:
Congenital failure of the testes to attach to the processes vaginalis
Signs:
1) Sudden testicular pain
2) Absent cremasteric reflex
3) Negative Prehn sign
172
Usually in adolescents it's twisting of the spermatocord that causes vein obstruction causing congestion & hemorrhagic infarction.
Causes:
Congenital failure of the testes to attach to the processes vaginalis
Signs:
1) Sudden testicular pain
2) Absent cremasteric reflex
Testicular torsion
173
What is a hydrocele?
Fluid that collects in the tunica vaginalis, scrotal swelling that can be transilluminated
Caused by incomplete closure of the processus vaginalis
(causes a connection between the peritoneal cavity & the tunica vaginalis or blocked LN drainage in adults)
174
Fluid that collects in the tunica vaginalis
Caused by incomplete closure of the processus vaginalis (causes a connection between the peritoneal cavity & the tunica vaginalis or blocked LN drainage in adults)
Hydrocele
175
What is acute prostatitis?
Acute inflammation from a bacterial infection like E.coli & pseudomonas (older) & c.trachomatis & N. gonorrhea (younger)
Signs:
1) Dysuria
2) Fever & chills
3) Tender & boggy testes prostate on DRE
Labs:
WBC in prostatic secretions with +ve bacterial culture
176
Acute inflammation from a bacterial infection like E.coli & pseudomonas (older) & c.trachomatis & N. gonorrhea (younger)
Signs:
1) Dysuria
2) Fever & chills
3) Tender & boggy testes prostate on DRE
Labs:
WBC in prostatic secretions with +ve bacterial culture
Acute prostatitis
177
What is chronic prostatitis?
Chronic inflammation that's not from infection
Signs:
1) Dysuria
2) Pelvic & lower back pain
Labs:
WBCs in the prostatic secretions with -ve bacterial cultures
178
Chronic inflammation that's not from infection
Signs:
1) Dysuria
2) Pelvic & lower back pain
Labs:
WBCs in the prostatic secretions with -ve bacterial cultures
Chronic prostatitis
179
What is BPH?
What are the causes?
What are the symptoms?
Hyperplasia of the stroma & glands in the periurethral zone
causes:
1. old age
2. Increase in DHT (via 5 alpha reductase to increase the conversion of dihydrotestosterone in the stromal cells which act on androgen receptors causing hyperplasia)
Signs:
1) Difficulty starting/stopping a urine stream
2) Urine retention
3) Dribbling urine
180
Hyperplasia of the stroma & glands in the periurethral zone
causes:
1. old age
2. Increase in DHT (via 5 alpha reductase to increase the conversion of dihydrotestosterone in the stromal cells which act on androgen receptors causing hyperplasia)
Signs:
1) Difficulty starting/stopping a urine stream
2) Urine retention
3) Dribbling urine
BPH
181
What are the complications of BPH?
Risk on infection
Hydronephrosis
Bladder diverticula
182
Risk on infection
Hydronephrosis
Bladder diverticula
Are complication of which condition?
BPH
183
What are the lab findings of BPH?
Microscopic hematuria
Slightly elevated PSA (<10ng/day)
184
Microscopic hematuria
Slightly elevated PSA (<10ng/day)
& difficulty starting/stopping urine
Is indicative of which condition?
BPH
185
How would you treat BPH?
Alpha 1 antagonist (terazosin)
Selective alpa1 antagonist (tamsulosin)
5 alpha reductase inhibitors
186
What is prostate adenocarcinoma?
Malignant proliferation of the prostate that arises in the peripheral & posterior region of the prostate
Labs:
PSA >10
Reduced free PSA
Palpation on DRE
Biopsy shows small invasive glands with prominent nucleoli
187
Increased age (50+yrs), race (Afro Americans>white>Asians)
High saturated fat diet are all risk factors for which condition?
Prostate adenocarcinoma
188
Malignant proliferation of the prostate that arises in the peripheral & posterior region of the prostate
Labs:
PSA >10
Reduced free PSA
Palpation on DRE
Biopsy shows small invasive glands with prominent nucleoli
Prostate adenocarcinoma
189
What are the complications of prostatic carcinoma?
Osteoblastic metastases to the lower spine
(Lower back pain)
High serum alkaline phosphatase
High PSA & PAP
190
Osteoblastic metastases to the lower spine
(Lower back pain)
High serum alkaline phosphatase
High PSA & PAP
Are all complications of which condition?
Prostatic adenocarcinoma
191
What is acute pancreatitis?
Inflammation & hemorrhaging of pancreas due to autodigestion from prematurely activated enzyme trypsin which activates other pancreatic enzymes caused by alcohol & gallstones
Signs:
1) Grey turners (ecchymosis flank)
2) Cullen sign (ecchymosis umbilicus)
3) epigastric pain radiating to the back
192
Inflammation & hemorrhaging of pancreas due to autodigestion from prematurely activated enzyme trypsin which activates other pancreatic enzymes caused by alcohol & gallstones
Signs:
1) Grey turners (ecchymosis flank)
2) Cullen sign (ecchymosis umbilicus)
3) epigastric pain radiating to the back
Acute pancreatitis
193
What is MEN1?
Pituitary tumor
Parathyroid tumor
Pancreatic tumor
194
Pituitary tumor
Parathyroid tumor
Pancreatic tumor
Describes which condition?
MEN1
195
What is the MEN2 Type A tumor?
Due to RET oncogene mutations causing:
Parathyroid tumor
Pheochromocytoma
Medullary thyroid carcinoma
196
Due to RET oncogene mutations causing:
Parathyroid tumor
Pheochromocytoma
Medullary thyroid carcinoma
MEN2 A
197
What is the MEN2 Type B?
Mucosal neuromas
Pheochromocytomas
Medullary thyroid carcinoma
Marfan habitus
198
Mucosal neuromas
Pheochromocytomas
Medullary thyroid carcinoma
Marfan habitus
MEN2B
199
What is a glucagonoma?
What are the signs?
How do you treat it?
An aloha cell tumor that causes anemia, diabetes with mild hyperglycemia, & necrolytic migratory erythema
Treat it with octreotide
200
An aloha cell tumor that causes anemia, diabetes with mild hyperglycemia, & necrolytic migratory erythema
Treat it with octreotide
Glucagonoma tumor
