Goljan 3 - Sheet1 Flashcards
1
Q
Achalasia
A
failure of LES relaxation (no VIP); absent ganglion cells in the myenteric plexus
2
Q
S/S
A
aperistalsis/dilation of esophagus; regurgitation of undigested food at night
3
Q
X-ray achalasia
A
birdÕs beak appearance
4
Q
Acquired achalasia
A
ChagasÕ disease; leishmania destroy ganglion cells
5
Q
Distal adenocarcinoma esophagus
A
MC primary cancer; due to BarrettÕs esophagus
6
Q
Squamous cell carcinoma of esophagus
A
smoking MCC; alcohol also causes
7
Q
Melena
A
sign of upper GI bleed; acid changes Hb to hematin; peptic ulcer disease MCC
8
Q
Hematemesis
A
vomiting blood; peptic ulcers MCC
9
Q
Congenital pyloric stenosis
A
hypertrophy pyloric muscle; vomiting non-bile stained fluid in 2-4 weeks
10
Q
Acute hemorrhagic (erosive) gastritis
A
NSAIDs MCC
11
Q
Mucous barrier stomach
A
maintained by PGE; misoprostol PGE analog
12
Q
Type A chronic gastritis
A
due to PA; achlorhydria with ? serum gastrin
13
Q
Type B chronic gastritis
A
due to H. pylori; involves pylorus and antrum
14
Q
H. pylori
A
curved rod; urease producer; MCC PUD, adenocarcinoma, gastric lymphoma
15
Q
Gastric ulcer
A
lesser curvature pylorus and antrum; poor defense against acid; food aggravates pain
16
Q
Duodenal ulcer
A
never malignant; ? acid production; food relieves pain
17
Q
Perforated peptic ulcer
A
air under diaphragm causes pain in left shoulder
18
Q
MenetrierÕs disease
A
giant rugal hyperplasia; protein loss from increased mucus
19
Q
Zollinger-Ellison syndrome
A
malignant islet cell tumor secreting gastrin; part of MEN I syndrome
20
Q
S/S
A
PUD in usual locations; sometimes multiple ulcers
21
Q
Hypergastrinemia
A
ZE, achlorhydria, gastric distention, H2 or proton blockers; renal failure
22
Q
Leiomyoma
A
MC benign tumor of stomach
23
Q
Intestinal type adenocarcinoma
A
H pylori related; ? incidence; lesser curvature pylorus/antrum
24
Q
Diffuse type adenocarcinoma
A
linitis plastica; signet ring cells; Krukenberg tumors ovaries
25
Gastric lymphoma
stomach MC site for extranodal lymphomas; H. pylori associated
26
Malabsorption
steatorrhea; chronic pancreatitis, bile salt deficiency, small bowel disease
27
Causes bile salt deficiency
liver disease, bile salt resins, cholestasis, bacterial overgrowth, CrohnÕs
28
D-xylose screen
failure to reabsorb xylose indicates small bowel disease
29
Calcification of pancreas
chronic pancreatitis cause of malabsorption
30
Celiac disease
autoimmune disease; antibodies against gliadin in gluten; flat villi
31
Celiac disease
association with dermatitis herpetiformis
32
WhippleÕs disease
systemic infection; foamy macrophages with bacteria (PAS+ inclusions) in small bowel submucosa
33
S/S
fever, polyarthritis, skin pigmentation
34
Invasive diarrhea
Campylobacter jejuni MCC; positive fecal smear for leukocytes
35
Secretory diarrhea
loss isotonic fluid; enterotoxins from E. coli and V. cholerae
36
Osmotic diarrhea
hypotonic loss fluid; laxatives, lactase deficiency
37
Rotavirus
MCC diarrhea in children
38
Norwalk virus
MCC diarrhea in adults
39
Cytomegalovirus
common cause diarrhea in AIDS; MCC cholecystitis and pancreatitis in AIDS
40
Staphylococcus aureus
preformed toxin causes food poisoning; culture food
41
Bacillus cereus
preformed toxin in fried rice and tacos; gram positive rods in stool
42
Clostridium botulinum (adult)
preformed neurotoxin (blocks acetylcholine release); paralysis and mydriasis
43
Clostridium botulinum (child)
colonization of bowel with release of neurotoxin; eating honey
44
Clostridium difficile
pseudomembranous colitis; post-antibiotics; toxin assay stool; Rx metronidazole
45
Shigella sonnei
produces dysentery (bloody diarrhea); associated with HUS
46
Salmonella enteritidis
gastroenteritis; animal reservoirs - poultry, turtles
47
Salmonella paratyphi
sepsis; osteomyelitis in HbSS
48
Salmonella typhi
typhoid fever; human transmission; bradycardia, neutropenia, splenomegaly
49
Carrier state site
gallbladder
50
M. tuberculosis
MCC intestinal TB in United States (swallow TB); PeyerÕs patch site of infection
51
Enterotoxigenic E. coli
secretory diarrhea (travelerÕs diarrhea); toxin stimulates guanylate cyclase
52
Vibrio cholerae
secretory diarrhea; toxin stimulates adenylate cyclase to produce cAMP
53
Oral Rx cholera
solution must contain glucose to reabsorb Na+ (co-transport)
54
Yersinia enterocolitica
mesenteric lymphadenitis; sepsis in iron overload states
55
Entamoeba histolytica
dysentery; trophozoites phagocytose RBCs; liver abscess; Rx metronidazole
56
Cryptosporidium parvum
MCC diarrhea in AIDS; acid-fast oocysts
57
Giardia lamblia
MC protozoal cause of diarrhea; cause of malabsorption; Rx metronidazole
58
Trichuris trichiura
rectal prolapse in children
59
Enterobius vermicularis
anal pruritus; urethritis in girls; no eosinophilia
60
Ascaris lumbricoides
intestinal obstruction due to adult worms; no eosinophilia
61
Necator americanus
hookworm; iron deficiency anemia
62
Strongyloides stercoralis
rhabditiform larvae in stool not eggs
63
Diphyllobothrium latum
fish tapeworm; vitamin B12 deficiency
64
Signs of small bowel obstruction
colicky pain; constipation and obstipation
65
Radiograph small bowel obstruction
air-fluid levels on x-ray
66
MCC small bowel obstruction
adhesions from previous surgery
67
Duodenal atresia
vomiting bile-stained fluid at birth; double bubble sign; Down syndrome
68
Hirschsprung disease
absent ganglion cells in submucosal/myenteric plexus rectosigmoid
69
S/S
proximal bowel dilated but peristalses; no stool in rectal vault
70
Hirschsprung association
Down syndrome; Chagas disease
71
Intussusception
terminal ileum telescopes into cecum; obstruction plus bloody diarrhea
72
Meconium ileus
complication of cystic fibrosis
73
Indirect inguinal hernia
second MCC of small bowel obstruction; common in weight lifting
74
Gallstone ileus
obstruction of small bowel with gallstone + air in biliary tree
75
Volvulus
MC due to sigmoid colon twisting around mesentery
76
Direct inguinal hernia
protrudes through center of triangle of Hesselbach; no obstruction
77
Umbilical hernia
common in black children; may entrap bowel in adults
78
Sigmoid colon
MC site for polyps, cancer, diverticula
79
Small bowel infarction
diffuse abdominal pain with bloody diarrhea
80
Causes small bowel infarction
embolism (atrial fibrillation), thrombosis SMA or SMV
81
Ischemic colitis
splenic flexure pain with bloody diarrhea
82
Mesenteric angina
pain in splenic flexure 30 minutes after eating
83
Angiodysplasia
submucosal dilation of venules in cecum; cause of hematochezia
84
Hematochezia
massive loss of blood per rectum; diverticulosis MCC
85
MeckelÕs diverticulum
persistence omphalomesenteric duct
86
S/S
bleeding MC (iron deficiency in children), diverticulitis
87
MeckelÕs diverticulitis
mimics acute appendicitis; cannot differentiate without radionuclide scan
88
Sigmoid diverticulum
diverticulitis MC complication; MCC hematochezia and fistula formation
89
Diverticulitis
Òleft-sided acute appendicitisÓ
90
Ulcerative colitis
mucosal/submucosal ulceration; starts in rectum; crypt abscess; ? risk adenocarcinoma
91
S/S
left lower quadrant crampy pain with bloody diarrhea
92
UC associations
primary sclerosing cholangitis, seronegative HLA B27 + spondyloarthropathy
93
CrohnÕs disease
transmural inflammation; terminal ileum involved 80%; granulomas; skip lesions
94
S/S
colicky pain and diarrhea; fistulas (anal, bowl to bowel)
95
Carcinoid tumor
appendix MC site; terminal ileum MC site for carcinoid syndrome
96
Carcinoid syndrome
liver metastasis; flushing/diarrhea due to serotonin; increased urine 5-HIAA
97
Tubular adenomas
precursor lesion colon cancer; size and number determine risk of malignancy
98
Villous adenoma
greatest risk for colon cancer (30%); secrete mucus rich in protein and potassium
99
Familial polyposis
AD with 100% penetrance for developing colon cancer
100
GardnerÕs syndrome
AD, polyposis plus osteomas and desmoid tumors
101
TurcotÕs syndrome
AD, polyposis plus brain tumors
102
Colorectal cancer
second MC cancer and cancer killer in adults
103
Left-sided colorectal cancer
obstruct; MC location rectosigmoid
104
Right-sided colorectal cancer
bleed
105
Acute appendicitis
due to lymphoid hyperplasia in children and obstruction by fecalith in adults
106
External hemorrhoids
thrombose
107
Internal hemorrhoids
bleed; prolapse out of rectum
108
Urobilinogen (UBG)
breakdown product CB in bowel (color of stool)
109
UBG
enterohepatic circulation to liver and kidney (color of urine)
110
Alcoholic liver disease
serum AST>ALT; ? serum GGT
111
Viral hepatitis
serum ALT>AST
112
Cholestasis markers
serum AP and GGT
113
Unconjugated bilirubin
macrophage degradation of heme; lipid soluble; never in urine
114
Conjugated bilirubin (CB)
water soluble; never normal in urine
115
% CB <20% (unconjugated)
Gilberts, spherocytosis, physiologic jaundice newborn, ABO/Rh HDN
116
GilbertÕs disease
AD; ? uptake and conjugation; bilirubin increases with fasting
117
Physiologic jaundice newborn
unconjugated hyperbilirubinemia; begins on day three
118
% CB 20-50%
viral/alcoholic hepatitis
119
% CB >50%
bile duct obstruction (intra or extrahepatic); carcinoma head of pancreas
120
Negative urine bilirubin + trace urobilinogen
normal urine
121
Positive urine bilirubin, absent urobilinogen
obstructive jaundice
122
Positive urine bilirubin + increased urobilinogen
hepatitis
123
Negative urine bilirubin + increased urobilinogen
extravascular hemolytic anemia
124
Markers of severity of liver disease
albumin, PT
125
Hepatitis A
protective antibodies; day care centers, jails, homosexuals, traveling; not chronic
126
Hepatitis B
protective antibodies; accidental needle stick, IVDA; hepatocellular carcinoma
127
Hepatitis C
no protective antibodies; post-transfusion hepatitis; chronic state; hepatocellular carcinoma
128
Hepatitis D
no protective antibodies; requires HBsAg to replicate
129
Anti-HBs alone
vaccination
130
Anti-HBs + anti-HBc-IgG
recovered from HBV
131
HBsAg + HBeAg + HBVDNA + anti-HBc-IgM
acute HBV/chronic HBV infective carrier if >6 months
132
Anti HBc-IgM alone
serologic gap; not infective
133
HBsAg + anti-HBc-IgM
chronic HBV healthy carrier
134
Fulminant hepatic failure
viral hepatitis and acetaminophen MCCs
135
Spontaneous peritonitis
E. coli in adults; S. pneumoniae in children; complication of ascites
136
Granulomatous hepatitis
TB MC bacteria
137
Amebiasis
Entamoeba histolytica; flash shaped ulcers in cecum; liver abscess; Rx
138
Echinococcosis
Echinococcus granulosis; sheep dog definitive host; man intermediate host
139
Schistosomiasis
Schistosoma mansoni; adult worms in portal vein; Òpipe stem cirrhosisÓ
140
Clonorchiasis
Clonorchis sinensis; ingesting encysted larvae in fish; cholangiocarcinoma
141
Congestive hepatomegaly (centrilobular necrosis)
ÒnutmegÓ liver; RHF MCC
142
Hepatic vein thrombosis
Budd-Chiari syndrome; painful hepatomegaly; ascites; portal hypertension
143
Portal vein thrombosis
ascites, portal hypertension, no hepatomegaly
144
Alcohol related disorders
fatty change; alcoholic hepatitis; cirrhosis
145
Hypertriglyceridemia in alcoholics
? synthesis of glycerol 3P (substrate for TG synthesis)
146
Hypoglycemia in alcoholics
? gluconeogenesis (? NADH causes pyruvate to convert to lactate)
147
Ketoacidosis in alcoholics
? lactate, ? §OHB (acetyl CoA converted to AcAc and then §OHB)
148
Primary biliary cirrhosis
granulomatous destruction triad bile ducts; anti-mitochondrial antibody
149
Primary sclerosing cholangitis
association with ulcerative colitis; MCC of cholangiocarcinoma
150
Extrahepatic biliary atresia
neonatal cholestasis
151
Drugs causing hepatitis
acetaminophen, isoniazid, halothane
152
Anabolic steroids
intrahepatic cholestasis
153
Estrogen/oral contraceptives
intrahepatic cholestasis; hepatic adenoma (intraperitoneal hemorrhage)
154
Methotrexate
liver fibrosis, fatty change
155
Liver angiosarcoma
vinyl chloride
156
Hemochromatosis
AR; increased iron reabsorption; liver target organ
157
S/S
cirrhosis; Òbronze diabetesÓ - skin pigmentation + destruction of islet cells; malabsorption
158
Lab
? serum ferritin, iron, % saturation; ? TIBC
159
WilsonÕs disease
AR disease; defect in copper excretion in bile and synthesis of ceruloplasmin
160
S/S
cirrhosis, movement disorder (necrosis in putamen), Kayser Fleisher ring (DescemetÕs membrane)
161
Lab
? ceruloplasmin (causes ? total copper); ? serum/urine free copper
162
HELLP syndrome
pre-eclampsia; Hemolytic anemia, ELevated transaminases, Low Platelets
163
AAT deficiency in child
AR, cannot secrete AAT from liver cell; cirrhosis; hepatocellular carcinoma
164
Reye syndrome
coma and microvesicular fatty change post viral infection; increased ammonia
165
Cirrhosis
irreversible fibrosis; regenerative nodules; portal hypertension
166
Causes cirrhosis
alcohol (MC), HBV/HCV, hemochromatosis, WilsonÕs, AAT deficiency, 1¡ biliary
167
Hepatic encephalopathy
mental status changes; ? serum ammonia
168
Portal hypertension
ascites; varices; splenomegaly; hemorrhoids; caput medusae
169
Cause of ascites
portal hypertension; hypoalbuminemia; secondary aldosteronism
170
Rx
use aldosterone blocker (acidosis increases loss ammonium in stool)
171
Hyperestrinism in men
gynecomastia; spider angiomas; female hair distribution
172
Lab findings cirrhosis
? BUN, glucose, sodium, potassium, calcium (? vitamin D); ? PT
173
Liver cell adenoma
estrogen related (steroids, oral contraceptives); intraperitoneal hemorrhage
174
Liver cancer
metastasis MC cancer; lung cancer MC primary site
175
Hepatocellular carcinoma
chronic HBV and HCV MCC; ? AFP; hepatic/portal vein invasion
176
Cholangiocarcinoma
primary sclerosing cholangitis MCC, C.C sinensis
177
Pathogenesis of cholesterol stones
bile with too much cholesterol and too little bile salts
178
Black pigment stones
sign of extravascular hemolytic anemia (spherocytosis, HbSS)
179
Acute cholecystitis
stone impacted in cystic duct; right upper quadrant colicky pain with radiation to shoulder
180
Chronic cholecystitis
chemical inflammation
181
Gallbladder cancer
risk factors - cholelithiasis and porcelain gallbladder
182
Acute pancreatitis
causes - alcohol and gallstones; ? amylase and lipase (more specific)
183
S/S
epigastric pain with radiation into back
184
Sentinel loop
localized ileus of duodenum due to acute pancreatitis
185
Pancreatic pseudocyst
abdominal mass; persistence of ? serum amylase >1 week
186
Chronic pancreatitis
alcohol abuse, CF; malabsorption, pain, type I diabetes
187
Pancreatic cancer
smoking MCC
188
S/S
jaundice/acholic (gray/pale) stools; palpable gallbladder; superficial migratory thrombophlebitis (Trousseau's sign); ? CA 19-9
189
First sign tubule cell dysfunction
inability to concentrate urine
190
Fixed specific gravity
chronic renal failure; cannot concentrate or dilute urine
191
Negative urine bilirubin + trace urobilinogen
normal urine
192
Positive urine bilirubin, absent urobilinogen
obstructive jaundice
193
Positive urine bilirubin + increased urobilinogen
hepatitis
194
Negative urine bilirubin + increased urobilinogen
extravascular hemolytic anemia
195
Positive urine nitrite + positive urine leukocyte esterase
urinary tract infection
196
Sterile pyuria
positive urine leukocyte esterase but negative standard culture; TB, C. trachomatis
197
Prerenal azotemia
? BUN and creatinine; ? renal blood flow (e.g. heart failure, hypovolemia)
198
Renal azotemia
? BUN and creatinine due to intrinsic renal disease (acute tubular necrosis)
199
Postrenal azotemia
? BUN and creatinine due to obstruction to urine flow
200
Serum BUN:creatinine ratio
15:1 (prerenal or postrenal azotemia)
201
BUN 80 mg/dL:creatinine 8 mg/dL
ratio 10/1 - renal failure
202
BUN 80 mg/dL:creatinine 2 mg/dL
ratio 40/1 - prerenal azotemia or postrenal azotemia
203
Creatinine clearance
measures GFR
204
Proteinuria
important sign of renal dysfunction
205
RBC casts
nephritic type of glomerulonephritis
206
WBC casts
acute pyelonephritis, acute tubulointerstitial nephritis
207
Fatty casts with Maltese crosses
nephrotic syndrome
208
Hyaline casts
normal unless associated with proteinuria
209
Renal tubular cell casts
acute tubular necrosis
210
Waxy or broad casts
chronic renal failure
211
Cystinuria
hexagonal crystals
212
Horseshoe kidney
TurnerÕs syndrome; lower poles fused
213
Renal dysplasia
MC childhood cystic disease; abnormal development; flank mass
214
Maternal oligohydramnios
fetal juvenile polycystic kidney disease; PotterÕs facies in newborn
215
Adult polycystic kidney disease
AD; hypertension MC sign; cerebral berry aneurysms
216
Visceral epithelial cells
synthesize basement membrane
217
Glomerular BM
negative charge due to heparan sulfate
218
Nephritic syndrome
oliguria; RBC casts; hypertension; mild to moderate proteinuria
219
Nephrotic syndrome
proteinuria >3.5 g/day; ascites and pitting edema; fatty casts; fusion of podocytes
220
Immunofluorescence
linear (anti-glomerular BM antibodies); granular (IC deposition)
221
IgA GN
MC GN; usually nephritic; episodic hematuria; mesangial IC (lgA-anti-IgA) deposits
222
Post-streptococcal GN
nephritic; subepithelial deposits; skin/pharyngeal infections; anti-DNAase B
223
SLE type IV GN
nephritic; subendothelial deposits; anti-DNA antibodies
224
Crescentic GN
crescents from parietal cell proliferation; worst GN; GoodpastureÕs, WegenerÕs
225
GoodpastureÕs
nephritic; anti-BM antibodies (glomerular + pulmonary capillary); crescentic GN
226
S/S
young male with hemoptysis progressing to renal failure
227
Minimal change disease (lipoid nephrosis)
MCC childhood nephrotic syndrome
228
Lipoid nephrosis
podocyte fusion; loss of negative charge in glomerular BM
229
Focal segmental glomerulosclerosis
nephrotic syndrome; AIDS and IV heroin abuse
230
Membranous GN
MCC adult nephrotic syndrome; subepithelial deposits; epimembranous spikes
231
Causes membranous GN
HBV, ACE inhibitors, cancer
232
Type I MPGN
nephrotic; subepithelial deposits; HCV association; tram tracks
233
Type II MPGN
nephrotic; C3 nephritic factor; intramembranous ICs (dense deposit disease)
234
DM nodular glomerulosclerosis
microalbuminuria first sign
235
DM glomerulosclerosis
nodules with collagen in mesangium; hyaline arteriolosclerosis of arterioles
236
ACE inhibitors
inhibit angiotensin II vasoconstriction of efferent arterioles
237
AlportÕs syndrome
XD hereditary nephritis with sensorineural hearing loss
238
Ischemic ATN
prerenal azotemia MCC; renal tubular cell casts; BUN:creatinine ratio <15:1
239
Ischemic ATN
disruption of BM in proximal tubule and thick ascending limb
240
Nephrotoxic ATN
aminoglycosides, IVP dye, Pb/mercury poisoning
241
Nephrotoxic ATN
proximal tubule dysfunction; intact BM
242
Oliguria
prerenal azotemia, ATN, glomerulonephritis, postrenal azotemia
243
Acute pyelonephritis
vesicoureteral reflux with ascending infection; WBC casts, fever, flank pain
244
Chronic pyelonephritis
U-shaped scars overlying blunt calyces
245
Drug-induced tubulointerstitial nephritis
type I/IV reaction; e.g., penicillin
246
S/S
ARF, fever, rash, eosinophilia, eosinophiluria, WBC casts
247
Analgesic nephropathy
aspirin plus acetaminophen; renal papillary necrosis; IVP with ring defect
248
Myeloma kidney
BJ protein produces foreign body reaction in tubules
249
Urate nephropathy
prevent by giving allopurinol prior to chemotherapy
250
CRF
fixed specific gravity; BUN:creatinine <15:1; waxy and broad casts
251
Renal osteodystrophy CRF
hypovitaminosis D (no 1-?-hydroxylase); produces osteomalacia
252
Renal osteodystrophy CRF
osteoporosis from metabolic acidosis
253
Renal osteodystrophy CRF
secondary HPTH with increased osteoclastic activity
254
S/S CRF
pericarditis, prolonged bleeding time, normocytic anemia, pathologic fractures
255
Benign nephrosclerosis
kidney of hypertension; shrunken kidneys due to hyaline arteriolosclerosis
256
Malignant hypertension
renal failure; encephalopathy; BP >210/120 mm Hg; IV nitroprusside
257
Renal findings
necrotizing arteriolitis; Òflea bittenÓ kidney; hyperplastic arteriolosclerosis
258
Renal infarction
pale infarcts; hematuria; common in polyarteritis nodosa
259
Hydronephrosis
renal stone MCC; atrophy of cortex/medulla; postrenal azotemia
260
Renal stones
most contain calcium (calcium oxalate/phosphate); hypercalciuria MC risk factor
261
S/S
colicky pain radiating into groin, hematuria; x-ray usually shows stone
262
Staghorn calculus
due to urease producing organisms (Proteus); alkaline urine pH; ammonia smell
263
Angiomyolipoma
hamartoma; associated with tuberous sclerosis
264
Renal cell carcinoma
smoking MCC; invasion renal vein/vena cava; lung, bone mets; yellow colored
265
S/S
flank mass, hematuria; ectopic hormones (EPO, PTH related peptide), left-sided varicocele
266
Renal pelvis transitional cell carcinoma
smoking MCC, phenacetin, aniline dyes, cyclophosphamide
267
WilmÕs tumor
hypertension, unilateral abdominal mass in child; aniridia/hemihypertrophy in AD types
268
Urine draining from umbilicus
persistent urachus
269
Retroperitoneal fibrosis
produces hydronephrosis
270
Bladder extrophy
abdominal wall defect + epispadias
271
Bladder diverticula
most commonly due to prostatic hyperplasia with urethral obstruction
272
Acute cystitis
E. coli; females > males; no fever, flank pain, or WBC casts
273
Bladder transitional cell carcinoma
smoking MCC, aniline dyes, cyclophosphamide; papillary
274
S/S
hematuria; hydronephrosis
275
Bladder adenocarcinoma
risk factors persistent urachus, extrophy
276
Bladder squamous cell carcinoma
Schistosoma hematobium infection
277
Hypospadias
ventral opening on penis due to failure closure of urethral folds
278
Epispadias
dorsal opening on penis due to defect in genital tubercle
279
PeyronieÕs disease
painful curvature penis due to fibromatosis
280
Priapism
persistent/painful erection; HbSS
281
Squamous cell carcinoma penis
HPV and lack of circumcision most important risk factors
282
Cryptorchidism
undescended testis; risk for seminoma applies to cryptorchid testis and normal testis
283
Orchitis
mumps usually unilateral (infertility uncommon)
284
Epididymitis
35 - E. coli, P. aeruginosa
285
S/S
scrotal pain relieved by elevation of scrotum (PrehnÕs sign)
286
Varicocele
left-sided scrotal mass; spermatic vein drains into left renal vein; infertility common
287
Varicocele
may be due to invasion of left renal vein by renal cell carcinoma
288
Hydrocele
persistent tunica vaginalis; scrotum transilluminates
289
Torsion of testicle
testicle high in canal; absent cremasteric reflex
290
Testicular cancer
unilateral painless mass that does not transilluminate
291
Risk factors
cryptorchid testis, KlinefelterÕs, testicular feminization
292
Seminoma
MC cancer; radiosensitive; large cells with lymphoid infiltrate; small percentage have ?hCG
293
Spermatocytic variant
>65 yrs of age
294
Embryonal carcinoma
hemorrhage/necrosis; hematogenous spread before lymphatic; ?AFP, hCG
295
Yolk sac tumor
MC testicular cancer in boys; ?AFP
296
Choriocarcinoma
most aggressive testicle cancer; ?hCG
297
Teratoma
more often benign in children than adult
298
Teratocarcinoma
teratoma + embryonal carcinoma
299
Malignant lymphoma
MC type in elderly; metastasis not primary cancer
300
Prostate
DHT derived stimulation embryo; periurethral area - hyperplasia; peripheral area - cancer
301
Prostatitis
perineal pain, fever; WBCs at end of voiding
302
Benign prostatic hyperplasia
DHT/estrogen-mediated; glandular/smooth muscle hyperplasia
303
S/S
all men develop; urethral obstruction MC (hesitancy, dribbling, nocturia), hematuria, dysuria Rx
304
Prostate cancer
DHT-mediated; palpable with rectal exam; osteoblastic metastasis (? AP)
305
PSA
sensitive but not specific for prostate cancer; ? in hyperplasia
306
KallmannÕs syndrome
absent GnRH, anosmia, absence of taste
307
Impotence
failure to sustain an erection; psychogenic in most cases (erections present at night)
308
Erection
parasympathetic response
309
Ejaculation
sympathetic response
310
Leydig cell failure
? LH; ? testosterone, sperm count; normal FSH
311
Seminiferous tubule failure
? FSH (?inhibin); ? sperm count; normal LH and testosterone
312
Leydig and seminiferous tubule failure
? FSH and LH; ? testosterone and sperm count
313
Y chromosome
determines genetic sex
314
Testosterone
develops seminal vesicles, epididymis, vas deferens
