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Renal II Midterm > Ch 21 > Flashcards

Ch 21 Flashcards

1
Q

Opening of urethra on inferior surface of penis as seen in hypospadias is due to failure of what embryological process?

A

urethral folds to close

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2
Q

Opening of the urethra on superior surface of penis as seen in Epispadias is due to what embryological process?

A

Abnormal positioning of genital tubercle. also associated with bladder extrophy

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3
Q

A benign warty growth on genital skin due to HPV 6 or 11 characterized by koilocytic change is known as

A

Condyloma acuminatum

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4
Q

Necrotizing granulomatous inflammation of inguinal lymphatics and lymph nodes commonly caused by chlamydia trachomatis (L1-3) is known as _

A

Lymphogranuloma venereum. Can cause fibrosis or perianal area resulting in rectal structures

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5
Q

Malignant proliferation of squamous cells of penile skin leading to ssqumaous cell carcinoma have three precursor lesions. what are they?

A
  1. Bowen disease
  2. Erythroplasia of Queyrat (glans)
  3. Bowenoid papulosis (reddish papules)
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6
Q

A 40 year old male finally presents to to his doctor complaining of abnormal lesion on the shaft of his penis. The doctor worried that it might be cancerous does a biopsy and finds that epidermis tissue is hyperproliferative with some atypical mitosis and have large hypercrhomatic neuclei and lack orderly mutation. Doc does some further viral testing and finds pt is positive for HPV 16. What is the most likely diagnosis?
B. this lesion has the potential to become what?

A

Bowen’s disease.

B. Squamous cell carcinoma of the penis

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7
Q

Both bowen’s disease and bowenoid papulosis have strong association with what infection?

A

HPV 16

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8
Q

Complete or partial failure of the testes to descend into the scrotal sac with testicular dysfunction has an increased risk of developing what cancer?

A

Cryptorchidism is associated with germ cell tumor (seminoma)

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9
Q

In younger adults, common bugs causing orchitis includes _. In older adults _

A

younger adults: Chamydia (D-K) or N. Gonorrhoeae.

Older adults: E coli and pseudomonas

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10
Q

In nonspecific inflammatory orchitis, edema and infiltration by neutrophils macrophages and lymphocytes starts _ and then spreads to _ with possible abscess formation.

A

Starts in interstitial CT and spreads to tubules

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11
Q

A middle aged men presents to clinic with tender testicular mass of sudden onset. Upon work up, it was determined to be granulomatous orchitis. This form of orchitis is distinguished by granulomas restricted to _

A

Spermatic tubules.

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12
Q

A person with Bell-clapper abnormality are at risked risk of what testicular disorder?

A

Testicular torsion.

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13
Q

What kind of infarcts are associated with testicular torsion?

A

Hemorrhagic since the arteries remain open brining blood in, but the thin walled veins are closed.

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14
Q

Testicular varicocele affects veins in _ on _ side of the body.

A

Veins in the spermatic cord on the left side of the body.

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15
Q

Testicular hydrocele are fluid collection within what structure and due to what?

A

Tunica vaginalis. Associated with incompelte closure of processus vaginalis (infants) or lymphatic block of drainage (adults)

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16
Q

What is the common presentation of testicular tumors?

A

Firm, painless that cannot be transilluminated.

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17
Q

What are the two common class of testicular tumors

A
  1. Germ cell tumors

2. Sex-cord stromal tumors

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18
Q

what is the age group commonly affected by germ cell tumors of the testes?

A

15-40

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19
Q

Environmental factors causing Germ tumors of the testis include -

A
  1. testicular dysgenesis syndrome
  2. cryptorchidism
  3. hypospadias
  4. Poor sperm quality
  5. Klinefelter (highest risk)
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20
Q

What genetic factors are linked to Germ cell tumors of the testes?

A
  • Strong familial predisposition linked to TK’s KIT and BAK
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21
Q

Germ cell tumors of testes is divided into what two broad categories?

A
  1. Seminomas (cells that resemble primordial germ cells)

2. Nonseminomas (undifferentiated cells that resemble embryonic stem cells)

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22
Q

Grossly how do seminomas appear?

A

Homogenous mass with NO hemorrhage or necrosis.

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23
Q

Except for pediatric yolk sac tumors, teratomas, speratocytic seminomas, most germ cells tumors arise form what precursor lesion?

A

Intratubular germ cell neoplasia (ITGCN). Stays dorment until puberty and then can become seminomas or nonseminomas

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24
Q

ITGCN retains expression of what transcription factors/cells?
B. genetic alterations are seen in what chromosome?
C. Activation mutation in gene encoding _ receptors

A

TF OCT3/4
pluripotent stem cells: NANOG.
B. reduplication of short arm of chromosome 12
C. KIT receptor tyrosine kinase

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25
Q

This germ cell tumor of the testes is the most common and occurs in man in their 30s and almost never in infants. Has isochromosome 12p and express OCT3/4 and NANG. 25% also have KIT mutation

A

Seminomas

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26
Q

what are some common nonseminomas?

A
  1. embryonal carcinoma
  2. Yolk sac tumors
  3. Choriocarcinoma
  4. Teratomas
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27
Q

_ is a rare slow growing germ cell tumor in older men and does not produce metastases. Morphologically have soft paly gray, mucoid cysts, associated ITGCN.

A

Spermatocytic seminoma

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28
Q

What is the age group of embryonal carcinoma?

A

20-30

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29
Q

Compared to seminomas, how aggressive is embryonal carcioma?

A

More aggressive

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30
Q

_ small tumors extending through tunica albuginea into epididymis or cord. Grow in alveolar or tubular pattersn with papillary demarcated and have foci of hemorrhage or necrosis. Share seminoma markers like OCT3/4 and PLAP but differ by psitive for cytokeratin and CD30, negative for KIT

A

Embryonal carcinoma (form of nonseminoma)

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31
Q

This nonseminoma is common in infants and young kids, but very rare in adults.

A

Yolk sac tumor

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32
Q

_ is nonencapsulated, homogenous, yellow white, mucinous appearance. Lacelike reticular network of cuboidal or flattened cells. Schiller-Duval bodies that have mesodermal core with central capillary and visceral and parietal layer of cells resembling primitive glomeruli. Can be stained for AFP and alpha-antitrypsin

A

Yolk sac tumor

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33
Q

_ is a malignant tumor of syntiotrophoblast and cytotrophoblasts that spreads via blood and is very aggressive. Forms as a small palpable node, no enlargement of the testicle.

A

Choriocarcinoma

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34
Q

HCG, AFP and lactate dehydrogenase are biomarkers for what tumors?

A

Testicular germ cell tumors

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35
Q

9 year old presents with testicular swelling, gynecomastia, and sexual precocity. It was found to be a sex cord stromal tumor that which elaborates androgens and estrogens. What is the likely diagnosis? Morphologically what is a characteristic finding?

A

Lydig cell tumor

Crystalloids or REinke

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36
Q

_ is hormonally silent and present with testicular mass. Firm, small nodules with gray white to yellow cut surface arranged in distinctive trabeculae forming cordlike structures and tubules.

A

Sertoli cell tumors (sex cord stromal tumor)

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37
Q

Pt presents with pysuria with fever and chills. Culture was positive for growth. On a rectal exam, prostate was tender and boggy. What is the likely diagnosis?

A

Acute prostatitis

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38
Q

Patient presents with dysuria with pelvic and low back pain. Culture was positive for growth. Pt states he has had many of these episodes in the past. To confirm diagnosis of chronic bacterial prostatitis, what must be seen on prostatic secretion?

A

Growth and leukocytosis

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39
Q

BPH occurs in what area of the prostate?

A

periurethral zone

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40
Q

what are common clinical features of BPH?

A
  • problems starting and stopping urine stream
  • impaired bladder emptying
  • Dribbling
  • hypertropphy of bladder wall smooth muscle
  • microscopic hematuria
  • elevated PSA
41
Q

on biopsy the characteristic findings of prostatic adenocarcioma is _

A

nucleus with a prominent nucleoli

42
Q

The most common cause of hydronephrosis in infants and kids

A

ureteropelvic junction obstruction, a congenital anomaly.

43
Q

_ are tumor like lesion projecting into the lumen of the ureter seen in kids. Polyps are composed of loose, vascularized connecting tissue overlaid by urothelium

A

Fibroepithelial polyps of the ureter

44
Q

what is the most common tumors of the ureters?

A

Urothelial carcinomas

45
Q

_ is a fibrotic proliferative inflammatory process encasing the retroperitoneal structures causing hydronephrosis. Occurs in middle to late age common in male. Related to IgG4-related disease. Can also involve exocrine organs like pancreas and salivary glands. can be associated with drug exposures like ergot, beta adrenergic , inflammatory conditions etc. Responds well to coricosteroid treatment.

A

Sclerosing retroperitoneal fibrosis causing obstruction of the ureters.

46
Q

All forms of cystitis follows what triad of symptoms?

A
  1. Frequency
  2. lower abd pain, localized to bladder or suprapubic region
  3. Dysuria
47
Q

A 35 year old woman presents to her doctor complaining of increasingly frequency in voiding. Her chief complaint today is same as few other times in the past: severe suprapubic pain and urinary frequency and dysuria. On urine sample hematuria was noted. On cystoscopy fissures and punctate hemorrhages were noted.
A. what is the diagnosis?
B. what is causing her increasingly frequency in voiding?

A

A. Interstitial cystitis (chronic pelvic pain syndrome)
B. It’s possible she’s in her late phase of the disease where she now has transmural fibrosis leading to a contracted bladder.

48
Q

A form of cystitis as a result of indwelling catheter is known as _

A

Polypoid cystitis. often confused with papillary urothelial carcinoma

49
Q

what is cystitis glanduaris and cystitis cystica?

A

A form of metaplastic lesion of the bladder where lesions of the bladder nest (brunn nests) grow downward into the lamina propria. The metaplasia take on cuboidal or columnar or flattened

50
Q

Neoplasms of the bladder is of what origin?

A

urothelial or transitional tumors

51
Q

The most common type of bladder tumors are _

A

urothelial tumors

52
Q

What are the two precursor lesion to invasive urothelial carcinoma?

A
  1. Noninvasive papillary tumors - most common and originates from papillary urothelial hyperplasia
  2. Flat noninvasive urothelial carcinoma
53
Q

In bladder cancer, invasion of what structures is associated with decreased survival (30% 5 yr mortality rate)?

A

Invasion of muscularis propria

54
Q

What is the common age group and gender of urothelial carcinoma?

A

Man in their 50-80

55
Q

What are some risk factors associated with urothelial carcinoma of the bladder?

A
  • cigs
  • aryl amines exposure
  • Schistosoma haematobium
  • long term use of analgesics
  • heavy long term exposure to cyclophosphamide
  • irrradiation
56
Q

Urothelial carcinoma take on two pathway, what are they?

A
  1. Low grade; superficial papillary tumors, characterized by FGFR3 and RAS mutation and chromosome 9 deletions. some may even lose TP53/RB
  2. Aggressive pathway, noninvasive high grade flat or papillary lesion are initiated by TP53 mutation with loss of chromosome 9
57
Q

Squamous cell carcinoma of the bladder is not so common in the US, but are pretty common in _ where this fungi is endemic.

A

Middle East. Schistosomiasis

58
Q

Which forms of urothelial cancers have a 90% 10yr survival rate?

A

Pappilomas, papillary urothelial of low malignant potentia, low grade papillary urothelial cancers

59
Q

Overall, which of the followings have the worst prognosis?
A. Squamous cell carcinoma of the bladder
B. Adenocarcinoma of the bladder
C. urothelial carcinoma of the bladder

A

A and B have the worst prognosis

60
Q

sarcomas in general are rare in the bladder, however, the most common sarcoma arising from the bladder in infants and kids is _

A

Leiomyosarcoma

61
Q

Urethritis that show no organism growth on culture can be due to _ which is associated with clinical triad of arteritis, conjunctivitis, and urethritis

A

reactive arteritis

62
Q

A 65 yr old woman presents to her OB with pain in her vaginal area. She stated she had a minor fall and hit her pubic area. On PE a small red, bleeding mass was seen on the external urethral meatus. Woman stated she’s had this mass for a while never really caused her trouble until recently it started to be painful. What is the likely diagnosis?

A

Urethral caruncle - a tumor-like leasion

63
Q

what is balanoposthitis?

A

Infection of glans and prepuce

64
Q

A 25 yr old man presents to your office, complaining of pain during intercourse and that it’s affecting his relationship. He also states that he noticed this penis has been becoming more curved than it it used to be. Upon work up everything else seem normal. What is the likely reason for this penile issues? what tissues are involved?

A

Peyronie’s disease fibrous bands involving the corpus cavernosum of the penis

65
Q

A 46 yr old man presents with grossly solitary, thickened, gray white opaque plaques on the shaft of this penis. Upon work up he was positive for HPV type 16. In 10% of this disease, this disease progresses to _

A

Pt has bowen’s disease. in 10% of cases it transforms to squamous cell carcinoma.

Occurs in pts older than 35

66
Q

A 17 yr old boy presents to this doc complaining of multiple reddish brown papular lesion on his penis. Upon work up he was positive for HPV 16. what is the likely diagnosis?

A

Bowneoid papulosis

67
Q

Three points of narrowing int he urinary tract includes _

A
  1. Ureteropelvic junction
  2. Where the ureters enter the bladder
  3. Ureters cross the iliac vessels
68
Q

what are some common congenital anomalies of the ureters?

A
  1. Double and bifid ureters,
  2. ureteropelvic junction obstruction
  3. Divericula
69
Q

Double renal pelves or large kidney with bidfid pelvises is due to what congenital defect?

A

Double and bifid ureters

70
Q

__ can cause hydronephrosis in infants and kids. Agenesis of contralateral kidney in some cases. more common in women in adults. From abnormal organization of smooth muscle bundles at the UPJ.

A

ureteropelvic junction obstruction

71
Q

What are some extrinsic causes of obstruction of the ureters?

A
  • pregnancy
  • periureteral inflammation
  • endometriosis,
  • tumors
72
Q

_ is a form of chronic inflammatory reaction that is from acquired defects in phagocyte function. Arises in chronic bacterial infection, usually e coli or proteus. On morphology, Michaelis-Gutmann Bodies are seen.

A

Malakoplakia.

73
Q

In cystitis glanduralis and cystitis cystica, the urothelium of _ grow into lamina propria. They take on cuboidal or columnar appearance OR retract to make cystic spaces.

A

Brunn nests

74
Q

In nephrogenic adenoma of the bladder, the cells implanted into the injured urothelium arise from _

A

shed renal tubular cells. and then assumes papillary growth pattern

75
Q

A 30 year old man presents complaining of an abnormal curvature in his penis particularly when he has an erection. He denies symptoms of dysuria and is otherwise in good health. He states that engaging in intercourse has been painful for his wife.
A. what is the likely diagnosis?
B. Fibrosis of what structure is implicated?

A

A. Peyronie’s disease

B. Tunica albuginea which is contained within the corpus cavernosum

76
Q

A newborn male is found to have the urethral opening on the ventral side of his penis. Figure A demonstrates this defect in an adult. This abnormality is a result of which of the following?

  1. Incomplete fusion of the urachal duct
  2. Incomplete fusion of the urethral folds
  3. Incomplete fusion of the labioscrotal swellings
  4. Dysgenesis of the genital tubercle
  5. Vitelline fistula
A
  1. Incomplete fusion of the urethral folds
77
Q

A 27-year-old avid bicylist presents with fever, chills, lower back pain, dysuria, and urinary frequency. Rectal exam reveals a tender prostate, the prostate message specimen contains no growth. What is the the likely diagnosis?

A

Chronic Prostatits. in this case it was due to the avid bicycling.

78
Q

A 71-year-old male complains of urinary hesitancy and nocturia of increasing frequency over the past several months. Digital rectal exam was positive for a slightly enlarged prostate but did not detect any additional abnormalities of the prostate or rectum. The patient’s serum PSA was measured to be 6 ng/mL. Image A shows a transabdominal ultrasound of the patient. Which of the following medications should be included to optimally treat the patient’s condition?

  1. Clonidine
  2. Finasteride
  3. Dihydrotestosterone
  4. Diphenhydramine
  5. Furosemide
A
  1. Finasteride
79
Q

A 2-year-old male is brought to his pediatrician by his parents because of a lack of testes in his scrotum. Physical examination confirms that testes are absent from the scrotal sac and palpable masses are found bilaterally around the inguinal canal. If the child’s condition is left untreated, levels of which of the following hormones is most likely to be decreased when the child reaches sexual maturity:

  1. FSH
  2. LH
  3. Testosterone
  4. Inhibin
  5. Prolactin
A
  1. Inhibin

Cryptorchidism is the unilateral or bilateral failure of testes to descend into the scrotal sac. This condition is associated with decreased sperm count and low levels of inhibin. Inhibin is made in the seminiferous tubules and acts as a negative regulator of FSH.

80
Q

A 27-year-old male presents with primary complaints of a palpable mass in his scrotum and mild testicular pain. Physical exam reveals an abnormal appearing scrotum around the left testis, as depicted in image A (testicle looks like a bag of worms). Which of the following is the most likely etiology of this presentation?

  1. Compression of the left renal vein at the aortic origin of the superior mesenteric artery
  2. Patent processus vaginalis allowing fluid entry into the scrotum
  3. Neisseria gonorrhoeae Infection of the left testis leading to epididymitis
  4. Unilateral failure of the left testis to descend into the scrotum
  5. Twisting of the spermatic cord secondary to rotation of the left testis
A
  1. Compression of the left renal vein at the aortic origin of the superior mesenteric artery

This patient’s presentation is consistent with a varicocele. Varicocele commonly results from blockage of blood drainage from the pampiniform plexus in the scrotum, resulting in engorgement of this venous network and the resulting classic appearance of the scrotum as a “bag of worms.”

81
Q

A 6-month-old male presents with a painless, enlarged left scrotum. After examining the patient, you suspect this enlargement is secondary to serous fluid entering and accumulating in the scrotum through a patent processus vaginalis. Which of the following would be the most useful next step in confirming the diagnosis of this patient’s condition?

  1. Measurement of AFP and hCG levels
  2. Transillumination test followed by scrotal ultrasound
  3. Evaluation of cremasteric reflex on physical exam
  4. Measurement of serum testosterone levels
  5. Standard urinalysis
A
  1. Transillumination test followed by scrotal ultrasound

This patient’s presentation is consistent with a left-sided hydrocele. The diagnosis of hydrocele is confirmed through a positive illumination test and a scrotal ultrasound, which can differentiate solid masses from fluid.

82
Q

A 30-year-old man has had a feeling of heaviness in his left testis for the past 6 months. Physical examination reveals enlargement of the left testis, while the right testis appears normal. There is a palpable left inguinal lymph node. An ultrasound reveals a 4 cm solid mass within the body of the left testis. Laboratory findings included a serum beta-HCG of 5 IU/L and alpha-fetoprotein of 2 ng/mL. The left testis is removed and with on sectioning reveals a firm, lobulated light tan mass without hemorrhage or necrosis. He receives radiation therapy. Which of the following neoplasms is he most likely to have?

A Choriocarcinoma

B Embryonal carcinoma

C Seminoma

D Yolk sac tumor

E Leydig cell tumor

A

C. Seminoma

The most common pure form of testicular cancer is seminoma, a type of germ cell tumor which is radiosensitive. The tumor markers are not markedly elevated. This form of testicular carcinoma has the best prognosis overall, when not mixed with other elements.

83
Q

A 35-year-old man goes to his physician for a routine examination. On physical examination there is a left inguinal mass. The right testis is palpated in the scrotum and is of normal size, but a left testis cannot be palpated in the scrotum. An ultrasound scan shows that there is a solid inguinal mass. Which of the following approaches is most appropriate to deal with this patient’s testicular abnormality?

A Put the mass into the scrotum surgically

B Remove the mass along with the opposite testis

C Remove the mass and biopsy the right testis

D Put the patient on testosterone therapy

E Put the patient on chemotherapy

A

C. Remove the mass and biopsy the right testis

A cryptorchid testis that is not treated in early childhood no longer functions in spermatogenesis and presents a risk for subsequent development of seminoma. The earlier in life that an orchiopexy is performed, generally under the age of 5, the more likely the testis will function properly. The opposite testis is also at increased risk for development of carcinoma.

84
Q

A 70-year-old healthy man has a routine check-up. On physical examination there is a firm nodule palpable in the prostate via digital rectal examination. Prostate biopsies are performed and on microscopic examination show small, crowded glands containing cells with prominent nucleoli within the nuclei. Which of the following is the most likely diagnosis?

A Adenocarcinoma

B Nodular hyperplasia

C Chronic prostatitis

D Urothelial carcinoma

E Recent infarction

A

A. Adenocarcinoma

Such a nodule at that age strongly suggests carcinoma. Most carcinomas of the prostate arise in the posterior portion of the gland where they can be palpated on digital rectal examination. Microscopically, prostatic adenocarcinomas have irregular glands without intervening stroma. Large nucleoli are a characteristic microscopic feature.

85
Q

A 20-year-old man has noted a penile discharge with some pain on urination for the last 2 days. On physical examination there is a small amount of whitish exudate that can be expressed from the urethral meatus. Laboratory studies with culture of the penile discharge reveal Neisseria gonorrheae. If untreated, which of the following complications is he most likely to develop as a consequence of his disease?

A Aortitis

B Balanitis

C Epididymitis

D Orchitis

E Sacroiliitis

A

C. Epididymitis

When the testis is involved by gonorrhea, it is typically the epididymis. Many male gonorrheal infections are asymptomatic and not followed by significant complications. Urethritis with stricture is a possible complication.

86
Q

A 31-year-old man has had a feeling of heaviness in his scrotum for over 6 months. On exam he has an enlarged right testis. An ultrasound reveals a solid 5 cm mass in the body of the right testis. Laboratory studies show a serum alpha-fetoprotein (AFP) of 81 ng/mL and human chorionic gonadotrophin (HCG) of 15 IU/L. A right orchiectomy is performed, and on gross examination the testicular mass is soft and reddish brown. Microscopic examination shows cords and sheets of primitive cells with large nuclei. Which of the following is the most likely diagnosis?

A Teratoma

B Embryonal carcinoma

C Mumps orchitis

D Leydig cell tumor

E Squamous cell carcinoma

F Choriocarcinoma

A

B. Embryonal carcinoma

The embryonal carcinoma is likely to have an elevated AFP. Many malignant testicular neoplasms produce some detectable HCG, but this does not mean that choriocarcinoma is present.

87
Q

A clinical study is performed with subjects who are sexually active 30- to 45-year-old men. A subset of these subjects are found to have a history of pelvic pain with enlarged, tender prostates on digital rectal examination. However, routine microbiologic cultures from prostatic secretions in this subset of men show no growth. Which of the following infectious agents is most likely to produce the condition seen in this subset of subjects?

A Human papillomavirus

B Herpes simplex virus

C Human immunodeficiency virus

D Chlamydia trachomatis

E Candida albicans

A

D. Chlamydia trachomatis

C. trachomatitis, the leading cause of non-gonococcal urethritis, is the most frequent form of prostatitis in young adult men. There is typically no history of chronic urinary tract infection.

88
Q

A 30-year-old sexually active man has experienced a burning pain with urination for the past 5 days. On physical examination there is a scant pale yellowish urethral discharge. He is afebrile. He is most likely to be infected with which of the following organisms?

A Herpes simplex virus

B Treponema pallidum

C Chlamydia trachomatis

D Mumps virus

E Hemophilus ducreyi

A

C. Chlamydia trachomatis.

This is the most common non-gonococcal urethritis in males. An acute urethritis is described.

89
Q

adenocarcinoma of the prostate arise in which regions of the prostate?

A Anterior fibromuscular stroma

B Central zone

C Peripheral zone

D Periurethral zone

E Transitional zone

A

C. Peripheral zone

Most prostatic adenocarcinomas arise in the peripheral zone posteriorly where they can potentially be palpated by digital rectal examination.

90
Q

which of the following responds best to radiation therapy?
A Choriocarcinoma

B Embryonal carcinoma

C Seminoma

D Teratoma

E Yolk sac tumor

A

C. Seminoma

91
Q

A 35-year-old man has a routine check of his health status. On physical examination the prepuce cannot be fully retracted from the glans of his penis. No other abnormalities are noted. Which of the following is the most likely diagnosis?

A Balanoposthitis

B Epispadias

C Exstrophy

D Hypospadias

E Phimosis

A

E. Phimosis

Inflammation with scarring may prevent full retraction. There is an increased risk for phimosis and for balanitis in uncircumcised males.

92
Q

A 2-year-old boy is brought to the physician because his mother (a geometry teacher) has observed that his scrotum is no longer symmetrical. On physical examination the child has enlargement of the left testis. An ultrasound scan shows a 2 cm solid mass within the body of the testis. Laboratory studies show a serum alpha-fetoprotein of 226 ng/mL. Which of the following neoplasms is this child most likely to have?

A Leydig cell tumor

B Neuroblastoma

C Rhabdomyosarcoma

D Teratoma

E Yolk sac tumor

A

E. Yolk sac tumor
The most common testicular tumor under the age of 3 is a yolk sac tumor (infantile embryonal carcinoma). However, finding any testicular tumor in children is uncommon. The prognosis is good in most cases.

93
Q

A 43-year-old man has noted a lesion on his penis for the past year. On physical examination there is a 0.9 cm diameter rough, tan, firm, slightly raised area at the right lateral base of the glans. He is uncircumcised, and there is difficulty in retracting the foreskin. Which of the following is the most likely diagnosis?

A Angiokeratoma

B Balanitis xerotica obliterans

C Bowen disease

D Hard chancre

E Lichen simplex chronicus

F Paraphimosis

A

C. Bowen disease

94
Q

A 32-year-old has noted bilateral breast enlargement over the past 7 months. On physical examination there is bilateral gynecomastia without tenderness or masses. His external genitalia appear normal. An ultrasound scan reveals a 1 cm solid mass within the body of the right testis. Laboratory studies show a serum testosterone of 550 ng/dL and estradiol of 36 pg/mL. His serum alpha-fetoprotein is 9 ng/mL and HCG non-detectable. Which of the following neoplasms is this man most likely to have?

A Choriocarcinoma

B Embryonal carcinoma

C Leydig cell tumor

D Seminoma

E Yolk sac tumor

A

C. Leydig cell tumor

A Leydig cell tumor is most often seen in adult men. It may produce androgens and/or estrogens, leading to gynecomastia and/or feminization. It is histologically benign. Most are small in size.

95
Q

An infant boy has had recurrent urinary tract infections since birth. Ultrasonography reveals dilated pelvis and calyces in the left kidney; the right kidney is absent. Surgical repair of an obstruction is performed. Which of the following patho-
logic findings is most likely present at the site of obstruction?

A. Adenocarcinoma within bladder exstrophy

B. Diverticulum with hemorrhage in the wall of the ureter

C. Granulomatous inflammation within a double ureter

D. Smooth muscle discontinuity at the uteropelvic junction

E. Urachal remnant at the dome of the bladder

A

D. smooth muscle discontinuity UPJ

96
Q

Schiller Duval bodies is associated with which tumors?

A

Yolk sac tumors.

97
Q

Elevated AFP is associated with what testicular tumors?

A

Yolk sac tumors

98
Q

How would you differentiate Acute bacterial prostatitis

from Chronic abacterial prostatitis?

A

In both you’ll see more than 10 leukocytes per high power field indicating prostattis.

Acute bacterial prostatis would have fever, chills and dysuria along with a tender prostate.

chronic abacterial prostatisis is most common form of this disorder, pts are afebrile with increased frequency and urgency of urination with mild back pain and no CVA tenderness.

Renal II Midterm (5 decks)

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