genitourinary Flashcards
The most common malformations include abnormalities in the penis is…
location of the distal urethral orifice.
Hypospadias
refers to an abnormal opening of the urethra along the ventral aspect of the penis, and occurs in 1/300 live male births.
increased risk of what with hypospadias
UTI’s
Epispadias
refers to the urethral opening on the dorsal aspect of the penis.
T/F people with hypo and epi spadias have trouble with uriniary incontinence.
TRUE, opening is usually smaller.
Premalignant lesions of the penis appear as
white plaque-like thickenings, areas of redness or a mixture.
Bowen disease
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.
main carcinoma of the penis
squamous cell carcinoma
squamous cell carcinoma only accounts for ____% of cancer in males and less prevalent in males who are
.4% circumcised
________ may be involved with development of penile cancer
Human papillomavirus (HPV)
Squamous cell carcinoma normally begins as…
crusted papule that usually develops a central ulceration. can form a papillary mass but usually not.
treatment, survival and spread of squamous cell carcinoma
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%.
Cryptorchidism
refers to failure of testicular descent. can’t confirm until 1 year of age, can be unilateral or bilateral
Untreated bilateral cryptorchidism results in _______
sterility.
In unilateral cases, the contralateral descended testis may undergo ______, also leading to sterility.
atrophy
Failure of descent also is associated with a 3-5 times increased risk of _________
testicular malignancy
orchiopexy
Surgical placement of the testes into the scrotum before puberty reduces but does not eliminate the risk of cancer and infertility.
Orchitis
refers to inflammation of the testes. most cases starts as a primary UTI that ascends as secondary infection to the testis
origin of orchitis is usually from _____ but can be associated with _____
STD’s
mumps
Torsion
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.
what happens if torsion is not resolved
Intense vascular engorgement and venous infarction follow unless the torsion is relieved.
Testicular torsion is one of the few ________
urologic emergencies.
different kinds of torsion
neonatal and adult
occurs in adolescence secondary to an anatomic defect whereby the testis has increased mobility.
adult torsion of testes. sudden onset of pain in testicles
neoplasms of testes
firm, painless enlargements of the testis.
neoplasms Approximately 95% of these arise from the _______, with almost all _______
germ cells, malignant
peak age of neoplasms of testes
14-34 years of age
a 3-5x increased prevalence is noted in patients with ________
cryptorchidism
cancer of testes divided into 2 categories
seminomas or nonseminomatous germ cell tumors.
Two markers have proven to be helpful in diagnosis, staging and follow-up for these cancers:
α-fetoprotein and human chorionic gonadotropin (HCG).
α-fetoprotein and human chorionic gonadotropin (HCG). are positive in which category of cancer
frequently beneficial in nonseminomatous tumors.
Seminomas characteristics
ocalized for long periods,
extremely radiosensitive
spread occurs via lymphatics.
Nonseminomatous tumors characteristics
spread earlier,
less radiosensitive
utilize the hematogenous route, with the lungs and liver often involved at the time of diagnosis.
survival for testes tumors
good survival. 400 out of 8thousand die
Prostatitis
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).
presentation of prostatis
Both acute and chronic prostatitis present with dysuria, urinary frequency, lower back pain and poorly localized suprapubic or pelvic pain.
Antibiotics penetrate the prostate
poorly
Nodular hyperplasia
of the prostate refers to hyperplastic enlargement of the prostate, often associated with urinary symptoms.
benign prostatic hyperplasia
The alteration is a common pathosis that begins during the forties and increases with age; 90% are affected by the eighth decade.
whats involved most with benign prostatic hyperplasia
The central portions of the gland adjacent to the urethra are involved most frequently;
impingement on the urethra leads to _______
dysuria (difficulties in starting, maintaining and stopping the stream of urine).
causes of benign prostatic hyperplasia
unknown
_______ appear to have a central role in its development
androgens
Nodular hyperplasia also called what
benign prostatic hyperplasia
benign prostatic hyperplasia associated with _______
increased androgens
most common cancer of men over 50 years of age
Carcinoma of the Prostate, peak at 65-75 years old
many of these cancers of prostate are
are small, asymptomatic, progress slowly and are found incidentally at autopsy or when examining nodular hyperplasia specimens.
significant evidence suggests ________ contribute significantly to the development of this cancer.
androgens
frequent sexual activity has been associated with _______ prostate health.
improved
The clinically evident carcinomas invade adjacent structures and metastasize via both the _____ and the ______
lymphatics and the bloodstream.
Regional node involvement occurs ______
early
_____ metastasis is the most common form of hematogenous spread and the metastases may be radiolucent but are more commonly radiopaque.
Osseous
Careful digital ________ is a very useful method for detection of early prostatic cancers.
rectal examination
Both the incipient and clinically evident cancers usually begin in the ____________; therefore, dysuria is not frequently an early sign.
peripheral zones of the posterior lobe of the prostate
Prostate specific antigen (PSA), when is it useful?
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.
Localized cancer of the prostate is treated by _______
surgery and/or radiation
most common tumor of the urinary bladder
urothelial cell carcinoma. represents 90% of neoplasms of the bladder
This typically occurs in men between the ages of 50 and 80 years and the dominant presenting manifestation is __________
painless hematuria.
Predisposing factors of urinary factors
include cigarette smoking, chronic cystitis, infection with Schistosomiasis, and exposures to various carcinogens.
The tumor is preceded by a premalignant precursor lesion which often has a papillary growth pattern, but can also be flat.
yes
what is a reasonable method for detection
cytology
Tumor cells generally lack cohesion and are shed into the urine, making cytology
Syphilis is a venereal disease that is produced by a
spirochete, Treponema pallidum.
whose affected more? whites or blacks?
blacks 30 times more
whose the only natural host or syphilis?
humans
how is syphilis transmitted
direct contact.
infection of syphilis results in production of two antibodies
a nonspecific antibody, syphilitic reagin, and a
specific antibody, treponemal antibody.
The _______ can be detected by several simple screening serologic tests
reagin
screening test for STD’s not always specific for syphilis
VDRL: venereal disease research laboratory, RPR: rapid plasma reagin
which test is more specific for syphilis
FTA
FTA: fluorescent treponemal antibody absorption test
when should FTA be done?
after a positive screening test. they are more expensive and more difficult
3 stages of syphilis
1) primary, 2) secondary and 3) tertiary.
Primary syphilis
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
how are the organisms seen in primary syphilis
may be seen only in special stains or in smears that are examined under a dark field microscope.
Serologic tests begin to become positive after ____ weeks of infection and are positive in the vast majority by ____ weeks.
1-2
4-6
secondary syphilis
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.
at this point all serological test are _____
positive
In about 25% of untreated patients, the healing of the chancre is followed _______
within 2 months
Elevated large broad plaques can form in moist skin areas such as the axillae, called what
(condyloma lata)
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 _____
latent syphilis.
asymptomatic
positive
T/F Some develop relapses of secondary syphilis, while others progress on to tertiary syphilis.
TRUE
T/F Although variable, the vast majority never develop progressive disease.
TRUE
Tertiary syphilis arises in 30% of untreated people usually after a latent period of
of 5-20 years
Tertiary syphilis
It may affect any part of the body, but it shows a predilection for the cardiovascular system (80%) and the CNS (10%).
Tertiary syphilis
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.
Is tertiary stage more or less infectious than the previous stages
less. generally not.
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.
treponemes
In the absence of treatment, up to ____% die in utero, typically after the fourth month.
40%
Congenital syphilis can be divided into three patterns
stillbirth, infantile and late.
Infantile syphilis
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.
Late congenital syphilis
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.
Hutchinson triad
congenital syphilis
- Interstitial keratitis
- Hutchinson’s teeth
- Eighth nerve deafness
The treatment for syphilis is
penicillin
Gonorrhea is a frequent sexually transmitted disease caused by
Neisseria gonorrhoeae
who are the only natural reservoirs for Gonorrhea? how is it transmitted
Humans are the only natural reservoir, and spread requires direct contact with the mucosa of an infected person.
body reacts by a ______ inflammation with a lot of _____
neutrophilic, with lots of pus
________ 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.
Two to seven days
____% of the females and _____% of the males are asymptomatic.
80%
40%
acute salpingitis.
Ascending infection involving the uterus, fallopian tubes, and ovaries results in
untreated infection may result in what in both sexes
sterility
Following the acute infection, granulation tissue and fibrosis results in permanent deformities, giving rise to __________
pelvic inflammatory disease.
gonococcal ophthalmia neonatorum
Mothers may produce blindness in infants from gonococcal contamination at birth
gonococcal ophthalmia neonatorum
Mothers may produce blindness in infants from gonococcal contamination at birth. very very rare
the primary diagnostic test of gonorrhea
Culture of the organism from discharges
NONGONOCOCCAL URETHRITIS AND CERVICITIS
are the most common forms of sexually transmitted disease which must be reported to CDC. Most cases appear related to Chlamydia trachomatis
Males develop urethritis which may spread into the _______
epididymes
NONGONOCOCCAL URETHRITIS AND CERVICITIS is more or less infectious/serious than gonorrhea
less, with less complications
NONGONOCOCCAL URETHRITIS AND CERVICITIS also called what
chlamydia
chlamydia infection often is recognized by its persistence following ________
penicillin treatment for gonorrhea
T/F you can’t culture C. trachomatis
true
how do you diagnose and treat Chlamydia trachomatis
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
________ is a significant manifestation of chlamydial infection.
Reactive arthritis (Reiter Syndrome
Reactive arthritis (Reiter Syndrome presents as
It typically presents as a combination of urethritis/cervicitis, arthritis, conjunctivitis, and mucocutaneous lesions.
Reactive arthritis __________process that develops in response to genitourinary or gastrointestinal infections and predominates in patients who are HLA-B27 positive.
immune-mediated
most genital herpes caused by what
HSV type ll
infection can be _____ or ______ and have different manifestations
primary or recurrent
Primary infections may be asymptomatic; the remainder develop painful focal lesions with dysuria, fever, lymphadenopathy, headache and malaise.
what areas are affected in genital herpes
The glans penis or surrounding areas in men and the cervix in women are the usual sites. can spread to surrounding areas too though
lesions of HSV
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.
T/F More than 80% of the patients with HSV Type II genital herpes have one or more recurrences yearly for several years.
TRUE
Human papillomavirus (HPV)
is the cause of a number of epithelial proliferations in the genital tract, including condyloma acuminatum, some precancerous lesions and some carcinomas.
most common HPV infections
condyloma acuminatum
condyloma acuminatum also known as what
veneral warts
condyloma acuminatum caused by what HPV, what are they
6 and 11
benign papillary nodules appear in clusters
condyloma acuminatum arises where in the body
anogenital and oral
condyloma acuminatum transmitted how? from who
from mother to baby during delivery
histopathy of condlyoma acuminatum
papillary proliferation of squamous epithelium exhibiting koilocytic change
presence of ballooning degeneration of epithelial cells with large, often multinucleate, purple staining nuclei – “Tzanck cells” associated with what disease
genital herpes diagonisis
