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pathology > Lower Urinary And Male Reproductive > Flashcards

Lower Urinary And Male Reproductive Flashcards

1
Q

Developmental failure of anterior abdominal wall and bladder with bladder mucosa exposed to body surface. Associated condition?

A

Epispadias

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2
Q

Urine flow through umbilicus in infant. Diagnosis?

A

Urachal fistula

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3
Q

Most common cause of bladder adenocarcinoma?

A

Urachal cyst

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4
Q

Pathogenesis of urachal fistula formation?

A

Allantois obliterated->urachus that connects apex of bladder to umbilicus-> forms median umbilical ligament in adult; patent

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5
Q

Females are at increased risk for Lower urinary tract infections. Why?

A

Short urethra and ascending infection (vesicoureteral reflux)

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6
Q

Disease conditions that predispose to LUTI?

A

Diabetes mellitus and neurogenic bladder

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7
Q

Most common cause of nosocomial LUTI?

A

Indwelling catheters

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8
Q

Drug that causes hemorrhagic cystitis?

A

Cyclophosphamide

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9
Q

Hemorrhagic cystitis due to cyclophosphamide can be prevented by?

A

Mesna

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10
Q

Parasite causing LUTI?

A

Schistosoma hematobium

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11
Q

Schistosoma hematobium causes what disease?

A

LUTI

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12
Q

Morphology of eggs of schistosoma hematobium?

A

Terminal spike, bile staining

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13
Q

Pathogenesis of LUTI due to schistosoma hematobium?

A

Transmission- via skin; inflammatory response to eggs of schistosoma in bladder (IgE)

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14
Q

Increased risk of what malignancy with schistosoma hematobium infection?

A

SCC of bladder

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15
Q

Increased risk of SCC of bladder is associated with which organism?

A

Schistosoma hematobium infection

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16
Q

Most common uropathogen?

A

E.coli

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17
Q

Most common cause of sepsis in hospitalised patient?

A

E. Coli

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18
Q

Most common cause of LUTI in young sexually active women?

A

Staphylococcus saprophyticus

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19
Q

Most common cause of acute urethral syndrome in women?

A

Clamydia trachomatis

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20
Q

Virus causing hemorrhagic cystitis?

A

Adenovirus

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21
Q

Leukocyte esterase and nitrite +, WBC and RBC in urine. Dysuria, suprapubic discomfort and increased frequency of urination. Diagnosis?

A

Cystitis

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22
Q

2 successive urine culture +. No associated symptoms. Predisposed individual of this condition?

A

Asymptomatic bacteruria; pregnant women and elderly women

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23
Q

Treatment of of symptomatic bacteruria in elderly women vs. pregnant women?

A

Elderly women- no treatment; pregnant wome-treat with amoxicillin

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24
Q

Complication of asymptomatic bacteruria in pregnant women?

A

Acute pyelonephritis

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25
Q

Why are pregnant women with asymptomatic bacteruria treated but healthy elderly women are not?

A

Pregnant women predisposed to developing acute pyelonephritis

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26
Q

Gold standard criterion for cystitis?

A

Urine culture-> 10^5 CFU/ml

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27
Q

Neutrophils in urine, culture -, leukocyte esterase + but nitrite -. Diagnosis?

A

Sterile pyuria

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28
Q

Aetiology of sterile pyuria?

A

Chlamydia trachomatis, renal TB, TIN (non infectious)

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29
Q

Diagnosis of acute urethra syndrome?

A

Urine PCR to detect chlamydia trachomatis

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30
Q

Yellow, raised plaques in bladder. Foamy macrophages filled with laminated mineralised concretions. Diagnosis?

A

Malacoplakia

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31
Q

Causative organism of Malacoplakia?

A

E.Coli (chronic infection)

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32
Q

Michaelis Gutman bodies are associated with which disease?

A

Malacoplakia

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33
Q

Morphology of michaelis Gutman bodies?

A

Foamy macrophages filled with laminated concretions

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34
Q

Why are michaelis Gutman bodies associated with Malacoplakia?

A

Chronic E. coli infection-> defective phagosomes that cannot degrade bacterial products (michaelis Gutman bodies)

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35
Q

Most common cause of acquired diverticula of bladder?

A

BPH

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36
Q

Complication of bladder diverticula?

A

Stone formation and diverticulitis

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37
Q

Pathogenesis of bladder diverticula?

A

Outflow obstruction-> increased intravesical pressure-> diverticula in areas of weakness of bladder wall

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38
Q

Which people are predisposed to cystoceles?

A

Middle aged and elderly women

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39
Q

Most common cancer of bladder?

A

Transitional cell carcinoma

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40
Q

Cystitis cystica and glandularis predispose to what bladder disease?

A

Bladder adenocarcinoma

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41
Q

Increased urine frequency, urgency, small volume voids and nocturia. What type of urinary incontinence do these symptoms indicate?

A

Urge incontinence

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42
Q

Dribbling and low urine flow.what type of urinary incontinence do these symptoms indicate?

A

Overflow incontinence

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43
Q

Loss of urine during sneezing, coughing and laughing. What type of urinary incontinence do these symptoms indicate?

A

Stress incontinence

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44
Q

Normally continent patient experiences incontinence after administration of diuretics. What type of incontinence do these symptoms indicate?

A

Functional incontinence

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45
Q

Aetiology of urge incontinence?

A

Bladder irritation due to BPH, atrophic urethritis and infection; lesion above sacral nerves

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46
Q

Pathogenesis of urge incontinence?

A

Over activity of the detrusor muscle

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47
Q

Aetiology of overflow incontinence?

A

DM, BPH

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48
Q

Pathogenesis of overflow incontinence?

A

Under activity of detrusor muscle due to obstruction/autonomic dysfunction

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49
Q

Aetiology of stress incontinence?

A

Women (lack of estrogen), posterior urethrovesical angle is 90 degrees

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50
Q

Pathogenesis of stress incontinence?

A

Laxity of pelvic floor muscles + lack of bladder support

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51
Q

Aetiology of functional incontinence?

A

Diuretics

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52
Q

Therapy for urge incontinence?

A

Anticholinergic–> oxybutinine

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53
Q

Therapy for overflow incontinence?

A

Cholinergic drugs

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54
Q

Therapy for stress incontinence?

A

Kegel pelvic exercises, topical estrogen therapy

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55
Q

Increased risk of TCC bladder?

A

Increasing age, men

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56
Q

Most common cause of bladder TCC?

A

Smoking

57
Q

Anti cancer drug that can cause TCC bladder?

A

Cyclophosphamide

58
Q

Which occupations are associated with bladder TCC?

A

Dye, rubber, leather industries

59
Q

Proton oncogene implicated in TCC bladder?

A

HRAS–> alters epidermal growth factor receptor

60
Q

Why is multifocality and recurrence the rule in TCC bladder?

A

Malignant stem cell abnormality-> reimplantation of tumor from another site

61
Q

Histologic findings in TCC bladder cancer low grade vs. high grade?

A

Low grade: papillary, non invasive

High grade: papillary/flat, invasive

62
Q

Grade histologic finding in bladder TCC if flat/papillary and invasive?

A

High grade

63
Q

Papillary, non invasive mass in posterior (and lateral) wall at the base of the bladder. Diagnosis?

A

TCC bladder

64
Q

Sites of TCC in bladder?

A

Posterior/lateral wall at base of bladder

65
Q

Elderly male, smoker, complains of painful gross hematuria. Diagnosis?

A

TCC bladder

66
Q

Parasitic infection associated with bladder SCC?

A

Schistosoma hematobium

67
Q

Pathogenesis of SCC due to Schistosoma hematobium?

A

Type 2 hypersensitivity reaction-> chronic bladder infection/irritation-> squamous metaplasia

68
Q

Most common cause of adenocarcinoma of bladder?

A

Urachal remnants

69
Q

Complication of exstrophy of bladder?

A

Bladder adenocarcinoma

70
Q

Complication of cystitis glandularis?

A

Adenocarcinoma bladder

71
Q

Diseases associated with bladder cancer?

A

Urachal remnants, cystitis glandularis, exstrophy of bladder

72
Q

Boy aged 6 yrs, presents as a grape like mass protruding from urethral orifice. Diagnosis?

A

Embryonal rhabdomyosarcoma

73
Q

Girl aged 6 yrs presents with grape like mass from vagina. Diagnosis?

A

Embryonal rhabdomyosarcoma

74
Q

Elderly male presents with urethritis. Most common cause?

A

E. Coli

75
Q

E. Coli is the MCC of urethritis in which patients?

A

Sexually inactive

76
Q

Adolescent male presents with urethritis. Most common cause?

A

Chlamydia/ gonococcal infection

77
Q

Adolescent man presents with urethritis, sterile conjunctivitis and HLA-B27 arthritis. Diagnosis?

A

Reiters syndrome

78
Q

Components of reiters syndrome in men?

A

Chlamydial urethritis, conjunctivitis and HLA-B27 arthritis

79
Q

Young female complains of bleeding from urethral orifice, and a painful friable mass at the site. Diagnosis?

A

Urethral caruncle

80
Q

Most common cancer of urethra?

A

SCC

81
Q

Male patients complains of urination through hole on undersurface of penis and curving of the shaft towards undersurface. What is the cause?

A

Patient suffers from hypospadias

faulty closure of urethral folds 2 to androgen deficiency

82
Q

Patient complains of urinating through hole on the surface of the penis. What is the cause?

A

Patients suffers from epispadias

abnormal development of genital tubercle

83
Q

Patient complains of inability to retract prepuce over head of penis. What is the cause?

A

Patients suffers from phimosis.

It is due to infections

84
Q

Adolescent male, uncircumcised with poor hygiene presents with red, swollen and hot glans penis and prepuce. What is the cause?

A

Patient has balanoposthitis

Accumulation of smegma-> infection with anaerobes/candida/pyogenic bacteria

85
Q

Married male patient presents with laterally curved penis with painful contracture. Patient gives no history of any children. What is the cause?

A

Patient has pyronie disease

It is a type of fibromatosis->may lead to sterility

86
Q

Male patient presents with persistent and painful erection. What are the possible causes?

A

Patient has priapism

Sickle cell anaemia/penile trauma

87
Q

Carcinomas in situ associated with HPV-16 infection?

A

Bowens disease
Erythroplakia of queyrat
Bowenoid papulosis

88
Q

Male patient, 40 yrs of age, presents with leukoplakia in shaft of penis and scrotum. What is the prognosis?

A

Patient has bowens disease- carcinoma in situ.

10% progress to invasive SCC of penis/ associated with other visceral cancers

89
Q

Adolescent male presents with erythroplakia on mucosal surface of glans and prepuce. Which cancer is it a precursor lesion of?

A

Patient has erythroplakia of queyrat.

It is a precursor lesion of invasive SCC

90
Q

Male patient presents with multiple pigmented reddish brown papules on external genitalia. What is the prognosis?

A

Patient has bowenoid papulosis.

Does not develop into invasive SCC.

91
Q

Male patient 50yrs, smoker, presents mass on glans penis and enlarged inguinal and iliac lymph nodes. What risk factors for SCC of penis assessed?

A
  1. Most impt- uncircumcised

2. Bowens disease and erythroplakia of queyrat-HPV-16

92
Q

Premature male patient with palpable unilateral mass in inguinal canal, with no testes detected in scrotal sac of same side. What is this condition associated with?

A

Patient has cryptorchidism.

  1. Androgen insensitivity syndrome
  2. Kallmann syndrome
  3. Cystic fibrosis
93
Q

Premature male patient with palpable unilateral mass in inguinal canal, with no testes detected in scrotal sac of same side. What is the cause?

A

Patient has cryptorchidism.

Androgen/hCG hormone deficiency in inguinoscrotal phase of normal descent of testes

94
Q

Male patient with undescended testes in abdomen. What is the cause?

A

Patient has cryptorchidism.

Deficiency of mullerian inhibiting substance in trans abdominal phase of normal descent of testes

95
Q

Male patient presents with bilaterally undescended testes. What are the complications if untreated?

A

Patient has cryptorchidism.

  1. Infertility- temperature dependent spermatogenesis
  2. Seminoma risk
  3. Torsion risk
96
Q

Management of male with cryptorchidism?

A

Orchiopexy after 6 months to 2 years of age of male

[GnRH before orchiopexy may improve fertility]

97
Q

Male 20 yrs of age presents with unilateral scrotal pain with radiation to spermatic cord, scrotal swelling, urethral discharge and prehns sign +. What is the cause?

A

Patient suffers from epididymitis.

Common pathogens

98
Q

Male patient 50 years, presents with unilateral scrotal pain radiating into spermatic cord, scrotal swelling with prehns sign +. What is the cause?

A

Patients has epididymitis.

Most common pathogens >35years
E. Coli
Pseudomonas aeruginosa

99
Q

20 year old male complains of aching pain in R. scrotum with dragging sensation in R. testicles and presents with visible bag of worms in scrotum. What is the cause?

A

Patient has R. Sided varicocele.

Retro peritoneal fibrosis, thrombosis of IVC

100
Q

20 year old male complains of aching pain in L. scrotum with dragging sensation in L. testicles and presents with enlarged scrotum with visible bag of worms. What is the cause?

A

Patient has L. Sided variocele

Renal cell carcinoma, compression by superior mesenteric artery

101
Q

20 year old male complains of aching pain in L. scrotum with dragging sensation in L. testicles and presents with enlarged scrotum with visible bag of worms. What is the treatment?

A

Patient has a variocele.

Treatment is variocelectomy or embolization by radiologist.

102
Q

16 year old male patient complains

of sudden onset testicular pain and presents with testicles drawn up into inguinal canal. What is the cause?

A

Patient has torsion of testicle.

Physical trauma (MC)
Cryptorchidism
Atrophy of testes

103
Q

16 year old male patient complains

of sudden onset testicular pain and presents with testicles drawn up into inguinal canal. What sign is + in this patient

A

Absent cremastric reflex- scrotum does not retract on stroking inner thigh.

104
Q

17 year old male patient with sudden onset testicular pain and absent cremastric reflex. Complications if left untreated?

A

Patient has testicular torsion

Risk for hemorrhagic infarction of testicles as twisting of spermatic cord cuts off blood supply

105
Q

10 year old male presents with scrotal enlargement. Most common cause?

A

Hydrocele

106
Q

10year old male presents with scrotal swelling. Which associated condition is he most likely to have?

A

Patient has Hydrocele.

Associated with indirect inguinal hernia

107
Q

10 year old male presents with scrotal enlargement. What is the Pathogenesis?

A

Patient has Hydrocele

Persistent tunica vaginalis-> fluid accumulates in serous space between layers of tunica vaginalis

108
Q

20 year old male presents with unilateral painless testicular enlargement. What risk factors for testicular tumours must be assessed?

A
  1. Cryptorchidism (esp abdominal)
  2. Androgen insensitivity
  3. Klinefelters
  4. Peutz-jeghers syndrome-sertoli leydig tumour
  5. Inguinal hernia/mumps orchitis
109
Q

3 yr old male patient presents with unilateral painless testicular enlargement. What tumour marker will be + in this patient?

A

Patient may have yolk sac tumour.

Alpha-feto protein is +

110
Q

20 year old male presents with gynaecomastia and unilateral painless testicular swelling. What tumour marker is + in this patient?

A

Patient has choriocarcinoma

hCG is +

111
Q

20 year old male patient presents with unilateral painless testicular swelling and +hCG. What is the prognosis of this testicular tumour?

A

Poor; most aggressive

112
Q

20 year old male patient presents with unilateral painless testicular swelling and +hCG. What do you expect on histologic biopsy?

A

Patient has choriocarcinoma.

Histologic biopsy will show trophoblastic tissue-synciotrophoblast, cytotrophoblast

113
Q

25 year old male presents with unilateral painless scrotal swelling, histologic biopsy shows trophoblastic tissue. Which is the most common site for metastasis in this tumour?

A

Patient has Choriocarcinoma

Hematogenous spread to lungs

114
Q

70 year old black male presents to hospital with an enlarged prostate. On lab investigation PSA was 12ng/ml. What is the most common sites of metastasis in this condition?

A

Patient has prostate cancer

Most common sites of metastasis are: lumbar spine>femur>pelvis

115
Q

75 year old male patient is suspected of prostate cancer. What lab investigations will be elevated?

A

PSA >10ng/ml
Doubling time of PSA; >0.75ng/dl increase in PSA/yr; increased PSA density

ALP is increased in metastasis

116
Q

80 year old male patient died with unilateral painless testicular swelling. On gross examination it was a yellow tumour without haemorrhage or necrosis. What is the prognosis of this condition?

A

Patient has a seminoma

Excellent, extremely radio sensitive

117
Q

65 year old patient presents with unilateral painless testicular swelling. It is diagnosed as a seminoma. There isenlargement of para aortic lymph nodes. What is the prognosis of this condition?

A

Patients seminoma may have metastasised as hematogenous spread follows lymph node involvement.

118
Q

20 year old patient dies of unilateral painless testicular enlargement. Hematogenous spread of the tumour occurred before lymph node enlargement. What do you expect on gross examination of testes?

A

Patient died of embryonal carcinoma.

Gross- bulky tumour with haemorrhage and necrosis

119
Q

3 year old boy presents with painless unilateral painless enlargement of testis. AFP is +. What characteristic finding is observed on histologic biopsy?

A

Schiller duval bodies. (Resemble primitive glomeruli)

120
Q

50 year old male presents with unilateral painless testicular swelling. Mass is composed of ectoderm, mesoderm, endoderm. What is its prognosis?

A

Patient suffers from testicular seminoma.

Bad prognosis in adults-malignant; children- benign

121
Q

Male aged 70 years presents with unilateral painless testicular enlargement. He is diagnosed with malignant lymphoma. What is the prognosis?

A

2 to diffuse large cell lymphoma; prognosis poor

122
Q

20 year old male patient presents with unilateral painless testicular swelling. He is diagnosed with testicular tumour. Which nodes are most commonly involved in lymphatic spread?

A

Para aortic lymph nodes

123
Q

25 year old male patient presents with fever, dysuria, increased frequency and urgency, enlarged swelling of prostate gland on DRE. What sample of fluid must be sent for lab diagnosis?

A

3rd specimen at end of micturition and 4th specimen milked after prostate massage

124
Q

Male patient presents with dysuria, increased frequency and urgency of urination and fever. Prostate gland is enlarged on DRE. What is the Pathogenesis?

A

Patient has acute prostatis

Intraprostate reflux of urine from posterior urethra/bladder

125
Q

Male patient evaluated for acute prostatis- urine examination shows 10WBC/ high power field. What is the diagnosis?

A

Does not confirm acute prostatis as WBC >20ng/ml for + result

126
Q

Male bicycle rider (Louis Armstrong) complains of dysuria, urgency and increased frequency of urination. Prostate gland is swollen on DRE. Urine analysis shows >30 WBCs/HPF but culture is -. Diagnosis?

A

Chronic prostatis; common in bicycle riders due to compression of prostate.

127
Q

82 year old male patients complains of trouble initiating urination and stopping, nocturia and dysuria. PSA is 5 ng/dl. What is the Pathogenesis of this condition?

A

Patient has BPH.

Increased sensitivity to DHT; stromal cells produce 5 alpha reductase-concerts T->DHT.

128
Q

83 year old male patient has enlarged prostate on DRE and PSA 6 ng/dl. What complications can be expected?

A

Patient has BPH

  1. Obstructive uropathy-> hydronephrosis, post renal azotemia, bladder diverticula
  2. Infection
  3. Prostate infarction-»PSA
129
Q

83 year old patient with enlarged prostate on DRE and PSA=5ng/dl. What is the prognosis?

A

Patient has BPH.

No risk for cancer progression

130
Q

90 year old male, complains of difficulty in initiating and stopping urination, nocturia and dysuria. He presents with an enlarged prostate on DRE. Alpha adrenergic blockers and 5 alpha reductase inhibitors are advised. Why?

A

Alpha adrenergic blockers- decrease tone of bladder neck

5-alpha reductase inhibitors-decrease synthesis of DHT

[patient has BPH]

131
Q

73 yr old black male, complains of low back pain and difficulty in initiating and stopping urination. Prostate is enlarged on DRE. What lab value will be elevated in case of metastasis?

A

Patient has prostate cancer.

Bony metastasis to vertebra and pelvic bones via Bateson venous plexus.

ALP elevated

131
Q

73 yr old black, smoker male. Presents with enlarged prostate on DRE. PSA=11ng/ml, elevated free PSA, doubling time PSA elevated, rate of change of PSA=1ng/ml. Pt. dies. What findings are expected on autopsy?

A

Patient has prostatic cancer.

  1. It has a firm gritty yellow appearance.
  2. Invasion of capsule.
  3. Hematogenous/venous/perinueral Invasion
131
Q

80 year old black male smoker. Family history of prostatic cancer. What is the prognosis of the disease.

A

Early detection and therapy-dramatic increase in survival

131
Q

Married male patient complains of inability to sustain erection, gives h/o fall 2 months back resulting in fracture. Lab tests show decreased testosterone, LH elevated, sperm count decreased, FSH normal. What is the aetiology?

A

Man has primary hypogonadism due to leydig dysfunction

Causes include: alcoholic liver disease, chronic renal failure, irradiation, orchitis and trauma to testes

131
Q

Married male patient complains of inability to sustain erection, gives h/o fall 2 months back resulting in fracture. Lab tests show decreased testosterone, LH elevated, sperm count decreases, FSH elevated. What is the aetiology?

A

Man has primary hypogonadism due to leydig and Seminiferous tube dysfunction

alcoholic liver disease, chronic renal failure, orchitis, trauma, irradiation

131
Q

Married male patient complains of inability to sustain erection, gives h/o fall 2 months back resulting in fracture. Lab tests show decreased testosterone, LH decreased, sperm count decreased, FSH decreased. What is the aetiology?

A

Patient has primary hypopituitarism/hypothalamic dysfunction

Non functioning pituitary, adenoma, prolactinoma-> hypopituitarism

Kallmann syndrome-> hypothalamic dysfunction

131
Q

5 yr male patient presents with female distribution of hair, gynaecomastia. Lab tests show decreased testosterone, LH decreased, sperm count decreased, FSH decreased. What is the aetiology?

A

Patient has hypopituitarism/hypothalamic

Craniopharyngioma and prolactinoma -> hypopituitarism

Kallmann syndrome-> hypothalamic dysfunction

131
Q

5 yr male patient presents with female distribution of hair, gynaecomastia. Lab tests show decreased testosterone, LH decreased, sperm count decreased, FSH decreased. He is diagnosed with kallmann syndrome. What is the type of inheritance?

A

Autosomal dominant

131
Q

Male patients lab reports show decreased testosterone, sperm count. What is the mechanism of osteoporosis in this patient?

A

Testosterone inhibits osteoclastic activity and increases osteoclastic activity.

Decrease in testosterone does the opposite.

pathology (6 decks)

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