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Gen path 3 > genitourinary > Flashcards

genitourinary Flashcards

1
Q

The most common malformations include abnormalities in the penis is…

A

location of the distal urethral orifice.

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2
Q

Hypospadias

A

refers to an abnormal opening of the urethra along the ventral aspect of the penis, and occurs in 1/300 live male births.

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3
Q

increased risk of what with hypospadias

A

UTI’s

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4
Q

Epispadias

A

refers to the urethral opening on the dorsal aspect of the penis.

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5
Q

T/F people with hypo and epi spadias have trouble with uriniary incontinence.

A

TRUE, opening is usually smaller.

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6
Q

Premalignant lesions of the penis appear as

A

white plaque-like thickenings, areas of redness or a mixture.

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7
Q

Bowen disease

A

is a synonym for carcinoma in situ of the penis. Bowen disease is not specific to the penis but may occur on other cutaneous or mucosal surfaces. Its major clinical importance lies in the potential progression to invasive squamous cell carcinoma.

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8
Q

main carcinoma of the penis

A

squamous cell carcinoma

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9
Q

squamous cell carcinoma only accounts for ____% of cancer in males and less prevalent in males who are

A

.4% circumcised

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10
Q

________ may be involved with development of penile cancer

A

Human papillomavirus (HPV)

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11
Q

Squamous cell carcinoma normally begins as…

A

crusted papule that usually develops a central ulceration. can form a papillary mass but usually not.

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12
Q

treatment, survival and spread of squamous cell carcinoma

A

Treatment is surgical excision. 5-year survival is 66%. Widespread metastasis is rare; however local metastasis to inguinal lymph nodes reduces 5-yr survival to 27%.

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13
Q

Cryptorchidism

A

refers to failure of testicular descent. can’t confirm until 1 year of age, can be unilateral or bilateral

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14
Q

Untreated bilateral cryptorchidism results in _______

A

sterility.

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15
Q

In unilateral cases, the contralateral descended testis may undergo ______, also leading to sterility.

A

atrophy

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16
Q

Failure of descent also is associated with a 3-5 times increased risk of _________

A

testicular malignancy

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17
Q

orchiopexy

A

Surgical placement of the testes into the scrotum before puberty reduces but does not eliminate the risk of cancer and infertility.

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18
Q

Orchitis

A

refers to inflammation of the testes. most cases starts as a primary UTI that ascends as secondary infection to the testis

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19
Q

origin of orchitis is usually from _____ but can be associated with _____

A

STD’s

mumps

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20
Q

Torsion

A

occurs when the spermatic cord (from which the testicle is suspended) twists, resulting in obstruction of venous drainage while leaving the thick-walled more resilient arteries patent.

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21
Q

what happens if torsion is not resolved

A

Intense vascular engorgement and venous infarction follow unless the torsion is relieved.

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22
Q

Testicular torsion is one of the few ________

A

urologic emergencies.

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23
Q

different kinds of torsion

A

neonatal and adult

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24
Q

occurs in adolescence secondary to an anatomic defect whereby the testis has increased mobility.

A

adult torsion of testes. sudden onset of pain in testicles

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25
Q

neoplasms of testes

A

firm, painless enlargements of the testis.

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26
Q

neoplasms Approximately 95% of these arise from the _______, with almost all _______

A

germ cells, malignant

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27
Q

peak age of neoplasms of testes

A

14-34 years of age

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28
Q

a 3-5x increased prevalence is noted in patients with ________

A

cryptorchidism

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29
Q

cancer of testes divided into 2 categories

A

seminomas or nonseminomatous germ cell tumors.

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30
Q

Two markers have proven to be helpful in diagnosis, staging and follow-up for these cancers:

A

α-fetoprotein and human chorionic gonadotropin (HCG).

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31
Q

α-fetoprotein and human chorionic gonadotropin (HCG). are positive in which category of cancer

A

frequently beneficial in nonseminomatous tumors.

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32
Q

Seminomas characteristics

A

ocalized for long periods,
extremely radiosensitive
spread occurs via lymphatics.

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33
Q

Nonseminomatous tumors characteristics

A

spread earlier,
less radiosensitive
utilize the hematogenous route, with the lungs and liver often involved at the time of diagnosis.

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34
Q

survival for testes tumors

A

good survival. 400 out of 8thousand die

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35
Q

Prostatitis

A

is clinically apparent inflammation of the prostate which may be acute or chronic. Bacterial prostatitis may be acute or chronic and is caused by the same organisms which commonly produce urinary tract infections (E. coli).

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36
Q

presentation of prostatis

A

Both acute and chronic prostatitis present with dysuria, urinary frequency, lower back pain and poorly localized suprapubic or pelvic pain.

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37
Q

Antibiotics penetrate the prostate

A

poorly

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38
Q

Nodular hyperplasia

A

of the prostate refers to hyperplastic enlargement of the prostate, often associated with urinary symptoms.

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39
Q

benign prostatic hyperplasia

A

The alteration is a common pathosis that begins during the forties and increases with age; 90% are affected by the eighth decade.

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40
Q

whats involved most with benign prostatic hyperplasia

A

The central portions of the gland adjacent to the urethra are involved most frequently;

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41
Q

impingement on the urethra leads to _______

A

dysuria (difficulties in starting, maintaining and stopping the stream of urine).

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42
Q

causes of benign prostatic hyperplasia

A

unknown

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43
Q

_______ appear to have a central role in its development

A

androgens

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44
Q

Nodular hyperplasia also called what

A

benign prostatic hyperplasia

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45
Q

benign prostatic hyperplasia associated with _______

A

increased androgens

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46
Q

most common cancer of men over 50 years of age

A

Carcinoma of the Prostate, peak at 65-75 years old

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47
Q

many of these cancers of prostate are

A

are small, asymptomatic, progress slowly and are found incidentally at autopsy or when examining nodular hyperplasia specimens.

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48
Q

significant evidence suggests ________ contribute significantly to the development of this cancer.

A

androgens

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49
Q

frequent sexual activity has been associated with _______ prostate health.

A

improved

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50
Q

The clinically evident carcinomas invade adjacent structures and metastasize via both the _____ and the ______

A

lymphatics and the bloodstream.

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51
Q

Regional node involvement occurs ______

A

early

52
Q

_____ metastasis is the most common form of hematogenous spread and the metastases may be radiolucent but are more commonly radiopaque.

A

Osseous

53
Q

Careful digital ________ is a very useful method for detection of early prostatic cancers.

A

rectal examination

54
Q

Both the incipient and clinically evident cancers usually begin in the ____________; therefore, dysuria is not frequently an early sign.

A

peripheral zones of the posterior lobe of the prostate

55
Q

Prostate specific antigen (PSA), when is it useful?

A

limited value when used as an isolated screening test,
when combined with digital rectal examination, transrectal sonography, and needle biopsy.
also staging and response to treatment.

56
Q

Localized cancer of the prostate is treated by _______

A

surgery and/or radiation

57
Q

most common tumor of the urinary bladder

A

urothelial cell carcinoma. represents 90% of neoplasms of the bladder

58
Q

This typically occurs in men between the ages of 50 and 80 years and the dominant presenting manifestation is __________

A

painless hematuria.

59
Q

Predisposing factors of urinary factors

A

include cigarette smoking, chronic cystitis, infection with Schistosomiasis, and exposures to various carcinogens.

60
Q

The tumor is preceded by a premalignant precursor lesion which often has a papillary growth pattern, but can also be flat.

A

yes

61
Q

what is a reasonable method for detection

A

cytology

Tumor cells generally lack cohesion and are shed into the urine, making cytology

62
Q

Syphilis is a venereal disease that is produced by a

A

spirochete, Treponema pallidum.

63
Q

whose affected more? whites or blacks?

A

blacks 30 times more

64
Q

whose the only natural host or syphilis?

A

humans

65
Q

how is syphilis transmitted

A

direct contact.

66
Q

infection of syphilis results in production of two antibodies

A

a nonspecific antibody, syphilitic reagin, and a

specific antibody, treponemal antibody.

67
Q

The _______ can be detected by several simple screening serologic tests

A

reagin

68
Q

screening test for STD’s not always specific for syphilis

A

VDRL: venereal disease research laboratory, RPR: rapid plasma reagin

69
Q

which test is more specific for syphilis

A

FTA

FTA: fluorescent treponemal antibody absorption test

70
Q

when should FTA be done?

A

after a positive screening test. they are more expensive and more difficult

71
Q

3 stages of syphilis

A

1) primary, 2) secondary and 3) tertiary.

72
Q

Primary syphilis

A

is characterized by the painless chancre which arises at the site of entry 9-90 days (mean of 21 days) after exposure. Glans penis in the male and the vulva or cervix in females are common sites. Lips, fingers, oropharynx and anus are also possible sites

73
Q

how are the organisms seen in primary syphilis

A

may be seen only in special stains or in smears that are examined under a dark field microscope.

74
Q

Serologic tests begin to become positive after ____ weeks of infection and are positive in the vast majority by ____ weeks.

A

1-2

4-6

75
Q

secondary syphilis

A

presenting with generalized lymph node enlargement combined with widespread mucocutaneous lesions that are maculopapular, scaly or pustular and even involve the palms and soles. Oral and vaginal areas of localized spongiotic mucositis are called MUCOUS PATCHES. Elevated large broad plaques (condyloma lata) can form in moist skin areas such as the axillae, inner thighs and anogenital area.

76
Q

at this point all serological test are _____

A

positive

77
Q

In about 25% of untreated patients, the healing of the chancre is followed _______

A

within 2 months

78
Q

Elevated large broad plaques can form in moist skin areas such as the axillae, called what

A

(condyloma lata)

79
Q

Virtually all untreated patients with secondary syphilis will clear over several weeks and enter a phase called. these patients are _______ and serological markers are all _____

A

latent syphilis.
asymptomatic
positive

80
Q

T/F Some develop relapses of secondary syphilis, while others progress on to tertiary syphilis.

A

TRUE

81
Q

T/F Although variable, the vast majority never develop progressive disease.

A

TRUE

82
Q

Tertiary syphilis arises in 30% of untreated people usually after a latent period of

A

of 5-20 years

83
Q

Tertiary syphilis

A

It may affect any part of the body, but it shows a predilection for the cardiovascular system (80%) and the CNS (10%).

84
Q

Tertiary syphilis

A

It may affect any part of the body, but it shows a predilection for the cardiovascular system (80%) and the CNS (10%). irreversible damage. The aorta may develop scarring, weakening and dilation secondary to obliterative endarteritis. Brain atrophy produces dementia. Rubbery gray-white areas of total necrosis (gumma) may be seen most frequently in mucocutaneous tissue and bone. Nasal and palatal bones are not uncommon sites. The gumma is due to a hypersensitivity to products of the spirochete and to ischemia from obliterative endarteritis.

85
Q

Is tertiary stage more or less infectious than the previous stages

A

less. generally not.

86
Q

Although the _______may be transmitted across the placenta at any time during pregnancy, fetal signs of infection typically do not develop until after the fourth month of pregnancy.

A

treponemes

87
Q

In the absence of treatment, up to ____% die in utero, typically after the fourth month.

A

40%

88
Q

Congenital syphilis can be divided into three patterns

A

stillbirth, infantile and late.

89
Q

Infantile syphilis

A

refers to liveborn infants that at birth or within the first few months of life present with clinical lesions similar to those seen in secondary syphilis.

90
Q

Late congenital syphilis

A

refers to cases of untreated congenital syphilis of more than 2 years duration. Classic manifestations of this chronic infection include interstitial keratitis of the eyes, saber shins, saddle nose, Hutchinson’s incisors, mulberry molars, eighth nerve deafness, gummas and neurosyphilis.

91
Q

Hutchinson triad

A

congenital syphilis

  1. Interstitial keratitis
  2. Hutchinson’s teeth
  3. Eighth nerve deafness
92
Q

The treatment for syphilis is

A

penicillin

93
Q

Gonorrhea is a frequent sexually transmitted disease caused by

A

Neisseria gonorrhoeae

94
Q

who are the only natural reservoirs for Gonorrhea? how is it transmitted

A

Humans are the only natural reservoir, and spread requires direct contact with the mucosa of an infected person.

95
Q

body reacts by a ______ inflammation with a lot of _____

A

neutrophilic, with lots of pus

96
Q

________ after exposure, symptomatic males exhibit dysuria, urinary frequency and mucopurulent exudation from the urethra; the main symptoms in females are dysuria, lower pelvic pain and vaginal discharge.

A

Two to seven days

97
Q

____% of the females and _____% of the males are asymptomatic.

A

80%

40%

98
Q

acute salpingitis.

A

Ascending infection involving the uterus, fallopian tubes, and ovaries results in

99
Q

untreated infection may result in what in both sexes

A

sterility

100
Q

Following the acute infection, granulation tissue and fibrosis results in permanent deformities, giving rise to __________

A

pelvic inflammatory disease.

101
Q

gonococcal ophthalmia neonatorum

A

Mothers may produce blindness in infants from gonococcal contamination at birth

102
Q

gonococcal ophthalmia neonatorum

A

Mothers may produce blindness in infants from gonococcal contamination at birth. very very rare

103
Q

the primary diagnostic test of gonorrhea

A

Culture of the organism from discharges

104
Q

NONGONOCOCCAL URETHRITIS AND CERVICITIS

A

are the most common forms of sexually transmitted disease which must be reported to CDC. Most cases appear related to Chlamydia trachomatis

105
Q

Males develop urethritis which may spread into the _______

A

epididymes

106
Q

NONGONOCOCCAL URETHRITIS AND CERVICITIS is more or less infectious/serious than gonorrhea

A

less, with less complications

107
Q

NONGONOCOCCAL URETHRITIS AND CERVICITIS also called what

A

chlamydia

108
Q

chlamydia infection often is recognized by its persistence following ________

A

penicillin treatment for gonorrhea

109
Q

T/F you can’t culture C. trachomatis

A

true

110
Q

how do you diagnose and treat Chlamydia trachomatis

A

exclusion of gonorrhea by smear and culture and possibly with detection of bacteria by molecular techniques. Best approach is to treat all patients with gonorrhea-like symptoms with a regimen which is effective against both gonorrhea and chlamydia

111
Q

________ is a significant manifestation of chlamydial infection.

A

Reactive arthritis (Reiter Syndrome

112
Q

Reactive arthritis (Reiter Syndrome presents as

A

It typically presents as a combination of urethritis/cervicitis, arthritis, conjunctivitis, and mucocutaneous lesions.

113
Q

Reactive arthritis __________process that develops in response to genitourinary or gastrointestinal infections and predominates in patients who are HLA-B27 positive.

A

immune-mediated

114
Q

most genital herpes caused by what

A

HSV type ll

115
Q

infection can be _____ or ______ and have different manifestations

A

primary or recurrent
Primary infections may be asymptomatic; the remainder develop painful focal lesions with dysuria, fever, lymphadenopathy, headache and malaise.

116
Q

what areas are affected in genital herpes

A

The glans penis or surrounding areas in men and the cervix in women are the usual sites. can spread to surrounding areas too though

117
Q

lesions of HSV

A

small vesicles that quickly ulcerate; the diagnosis is made via a smear or biopsy which will reveal the cytopathologic effects of the virus in epithelial cells.

118
Q

T/F More than 80% of the patients with HSV Type II genital herpes have one or more recurrences yearly for several years.

A

TRUE

119
Q

Human papillomavirus (HPV)

A

is the cause of a number of epithelial proliferations in the genital tract, including condyloma acuminatum, some precancerous lesions and some carcinomas.

120
Q

most common HPV infections

A

condyloma acuminatum

121
Q

condyloma acuminatum also known as what

A

veneral warts

122
Q

condyloma acuminatum caused by what HPV, what are they

A

6 and 11

benign papillary nodules appear in clusters

123
Q

condyloma acuminatum arises where in the body

A

anogenital and oral

124
Q

condyloma acuminatum transmitted how? from who

A

from mother to baby during delivery

125
Q

histopathy of condlyoma acuminatum

A

papillary proliferation of squamous epithelium exhibiting koilocytic change

126
Q

presence of ballooning degeneration of epithelial cells with large, often multinucleate, purple staining nuclei – “Tzanck cells” associated with what disease

A

genital herpes diagonisis

Gen path 3 (6 decks)

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