Genitourinary (AKA "dat dick stuff") Flashcards
what is a Hypospadias? how prevalent is it?
- an abnormal opening of the urethra along the ventral aspect of the penis
- occurs in 1/300 live male births
what is the possible complication of a Hypospadias?
can be constricted and cause UTI
what is a Epispadias?
urethral opening on the dorsal aspect of the penis
which type of urethra malformation can lead to incontinence?
Epispadias
_________ disease is a synonym for carcinoma in situ of the penis
Bowen
what are the risk factors for developing Penile neoplasms?
- uncircumcised
- over 40
- associated with HPV infection types 16 & 18
what do Premalignant Lesions on the penis appear as clinically?
Presents as a solitary white and/or red plaque
about __% of premalignant penile lesions will progress to invasive squamous cell carcinoma
10%
what is the 5 year survival rate for penis carcinomas?
66%
in carcinomas of the penis, local metastasis to what location reduces the 5-yr survival to 27%?
inguinal lymph nodes
what is Cryptorchidism?
Incomplete descent of the testis from the abdomen to the scrotum
T/F: Scrotum Neoplasms are rare, but most are squamous cell carcinomas
true
scrotum carcinomas were first associated with what group?
chimney sweeps
what condition leads to a 3 to 5 fold increased risk of testicular cancer?
Cryptorchidism
failure of testes to descend
what location/cell type do most testicular cancers arise from?
arising in intratubular germ cell neoplasia
within the atrophic tubules
what surgery will reduce risk of sterility and cancer due to cryptochidism?
Orchiopexy
surgery to move an undescended testicle down
inflammation in the testes is more common in the ____________ than testis proper (orchitis)
epididymis (epididymitis)
___________ refers to inflammation of the testes proper
Orchitis
In most cases, inflammation of the testes begins as what?
a primary urinary tract infection
with secondary ascending infection of the testes
what conditions can cause orchitis (testicular inflammation)?
- main cause = STD’s
- mumps = effects adults (can cause sterility)
Orchitis is a complication of mumps in ___% of infected adult males
20%
______ occurs when the spermatic cord (from which the testicle is suspended) twists
Torsion
what is the result of the testicular torsion?
obstruction of venous drainage while leaving the thick-walled more resilient arteries patent (open)
_________ torsion occurs either in utero or shortly after birth, without know cause
Neonatal
T/F: Intense vascular engorgement and venous infarction follow unless the torsion is relieved
true
Adult testicular torsion generally occurs in adolescence secondary to _______________, whereby the testis has increased mobility
an anatomic defect
T/F: Testicular torsion is usually not a medical emergency
FALSE
Testicular torsion is one of the few urologic emergencies
________ of the testis are the most common causes of firm, painless enlargements of the testis
Tumors
where do 95% of testicular tumors arise from?
are these malignant or benign
arise from the germ cells
- germ cell tumors = MALIGNANT
(95% of testicular tumors are malignant)
what age group is at the highest risk for testicular tumors?
15-34 years of age
only ___% of patients with testicular germ cell cancer have a history of cryptorchidism
only 10%
Germ cell tumors (malignancies) are divided into what 2 categories?
1) seminomas
2) nonseminomatous germ cell tumors
what 2 markers can help diagnose testicular cancer?
1) α-fetoprotein
2) human chorionic gonadotropin (HCG).
what cell type do seminoma tumors arise from?
- arise from Sertoli or Leydig cells
- make up 5% of all testicular cancers
why are non-seminotomatous tumors likely to metastasize?
- likely to spread early
- spread thru lymphatics & blood vessels
- even SMALL malignancies can metastasize
(opposite of seminomas)
T/F: Seminomas typically respond poorly to treatment, and have a low 5-yr survival rate
FALSE
they are one of the most curable cancers
(its the germ cell ones that will get you)
which type of testicular germ cell tumor tends to spread early via lymphatics and blood vessels
Non-seminomatous tumors
which tumor markers are associated with Non-seminomatous GERM CELL tumors?
1) α-fetoprotein
2) human chorionic gonadotropin (HCG).
what are the 3 main categories of prostate disease?
inflammatory lesions (prostatitis)
nodular hyperplasia
carcinoma
_________ is clinically apparent inflammation of the prostate which may be acute or chronic
Prostatitis
Prostatitis is an important cause of what other condition?
RECURRENT E. coli urinary tract infection
- swelling of prostate fucks up normal flow of urine, allows E.coli to invade
Both acute and chronic prostatitis present with what symptoms?
dysuria
urinary frequency
lower back pain
poorly localized suprapubic or pelvic pain
_____________________ refers to hyperplastic enlargement of the prostate, often associated with urinary symptoms
Nodular hyperplasia of the prostate
- AKA “benign prostatic hypertrophy”= BHP
Nodular hyperplasia (benign prostatic hypertrophy) Generally affects what region of the prostate?
affects the INNER PERIURETHRAL zone of the prostate
- compresses the prostatic urethra
During BHP, Proliferation of stromal & glandular elements in the prostate causes what?
enlargement of gland ± urinary obstruction
T/F: benign prostatic hypertrophy effects 20% of men at age 40; and 90% of men age 70
True
In patients with BPH, there is a local increase in what hormone?
androgens
What is the acronym for the surgery that treats benign prostatic hypertrophy?
TURP
Trans urethral resection of the prostate
what is the most common cancer of men over age 50 in the U.S ?
Adenocarcinoma of the prostate
adenocarcinomas of the prostate can metastisize to what locations?
lymph nodes and bone
Adenocarcinoma of the prostate accounts for ____% of all cancer
25% of all cancers
only 9% of these will be fatal
the Majority of urinary bladder neoplasms are what type?
urothelial carcinoma
urothelial carcinomas are most common in what age group? what is the most common clinical sign of it?
- most common in men btw ages 50-80 yrs
- Present with painless hematuria
Worldwide, how many new cases of STDs occur annually?
15 million
what are the 2 most common STD’s?
1) genital herpes
2) genital HPV infection
Syphilis is a chronic infection caused by what organism?
Treponema pallidum
its a spirochete
what are the characteristics of primary syphilis?
1) Painless CHANCRE forms
- 9-90 days after infection
2) Resolves spontaneously in 4-6 weeks
3) If untreated, ~25% of patients develop secondary syphilis
Secondary Syphilis Occurs within 2 months following resolution of what?
the primary chancre
what types of lesions are found during secondary syphilis?
1) maculopapular rash affecting skin (palms and soles)
2) condyloma lata (wart-like lesions on the genitals)
3) mucous patches (may affect oral mucosa)
After secondary syphilis spontaneously resolves, it enters a ________ phase
latency
If secondary syphilis is left untreated, close to ____ of patients develop tertiary syphilis over a period of 5 to 20 years
one-third
Tertiary syphilis develops after latent period of _____ years
5+
what are the 3 types of TERTIARY Syphilis?
1) Aortitis (80% of patients)
2) Neurosyphilis (10%)
3) Gummas
________ is also known as “cardiovascular syphilis”
Aortitis
what is effected during Neurosyphilis?
involvement of the brain, meninges and spinal cord
what are “gummas”? (result of tertiary syphilis)
focal granulomatous lesions develop in bone, skin, and mucous membranes of the UPPER AIRWAY and MOUTH
what are the 3 forms of Congenital Syphilis?
1) Stillbirth
2) Infantile syphilis
3) Late congenital syphilis
what is “Hutchinson’s Triad”? what form of syphilis is it associated with?
- from Late congenital syphilis
Triad:
1) Hutchinson’s Teeth
2) Interstitial keratitis
3) Eighth cranial nerve deafness
“saddle nose deformities” formations are secondary to _______
gummas
focal granulomatous lesions
up to _____% of infants with congenital syphilis will die
40%
what 2 SCREENING tests can be used to detect syphilis?
RPR (rapid plasma reagin)
VDRL (Venereal Disease Research Laboratory)
what SPECIFIC test is used for the detection of syphilis?
FTA (Fluorescent Treponemal Antibody)
T/F: FTA tests have about 15% false-positive results
FALSE
the Screening tests (RPR & VDRL) have a 15% false positive rate
what agent causes Gonorrhea? what % of males and females are Asymptomatic?
- caused by Neisseria gonorrhoeae infection
Males: 40% asymptomatic
Females: 80% asymptomatic
what type of host reaction is elicited by Gonorrhea?
Provokes an intense, suppurative, inflammatory reaction (purulent exudate)
Untreated gonorrhea can lead to _____
sterility
Gonorrhea Ascending infection results in:
what happens in males? females?
A) acute prostatitis, epididymitis, or orchitis in MALES
B) inflammation of the uterus, fallopian tubes, and ovaries (acute salpingitis) in FEMALES
C) secondary scarring gives rise to pelvic inflammatory disease
what is gonococcal ophthalmia neonatorum?
Blindness in infants from gonococcal contamination at birth
what are the most common STDs reportable to CDC
Nongonococcal Urethritis and Cervicitis
a majority of Nongonococcal Urethritis and Cervicitis cases are caused by what?
Chlamydia trachomatis
Chlamydia trachomatis infections are similar to what other STD?
gonorrhea
________ tests can be used for the diagnosis of Chlamydia
Molecular
what is Reactive arthritis (Reiter Syndrome)?
- possible manifestation of Chlamydia
- immune response to infection
- combination of urethritis/cervicitis, conjunctivitis, arthritis, and mucocutaneous lesions
Genital Herpes Affects how many people in the US? what virus is responsible for most of the cases?
- 50 million people a year
- Most caused by HSV-2 (less commonly HSV-1)
name the characteristics of an Initial herpes simplex infection:
- asymptomatic vs painful mucocutaneous eruptions
- lymphadenopathy and malaise
- heal 3-6 weeks
name the characteristics of a RECURRENT herpes simplex infection:
- small painful vesicles that quickly ulcerate
- heal in 7-10 days
HSV are actively shed during what times?
periods of clinical lesions (ulcers during recurrent infection)
what is the mortality rate for Neonatal herpes?
60%
very high
what is the “viral cytopathic effect “ on cells infected with HSV?
- ballooning degeneration of epithelial cells
- with large, often multinucleate, purple staining nuclei
“_______ cells “ are the cells suffering from viral cytopathic effects associated with a HSV (herpes simplex) infection
“Tzanck cells”
what is the most common lesion from the Human Papilloma Virus (HPV)?
condyloma acuminatum
- AKA venereal warts
condyloma acuminatum is caused by HPV ___ and ___
6 and 11
name the characteristics of condyloma acuminatum:
- Benign papillary nodules that frequently appear in clusters
- Occur in anogenital region and oral mucosa
T/F: Malignant transformation of genital condyloma acuminatum lesions often occurs
FALSE
- uncommon for genital warts to become malignant
what is the Histology AND Treatment for condyloma acuminatum?
- Histology: KOILOCYTIC changes, papillary proliferation of epithelium
- Treatment: surgical excision, laser treatment, cryotherapy, imiquimod
