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
2
Q
Urine flow through umbilicus in infant. Diagnosis?
A
Urachal fistula
3
Q
Most common cause of bladder adenocarcinoma?
A
Urachal cyst
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
5
Q
Females are at increased risk for Lower urinary tract infections. Why?
A
Short urethra and ascending infection (vesicoureteral reflux)
6
Q
Disease conditions that predispose to LUTI?
A
Diabetes mellitus and neurogenic bladder
7
Q
Most common cause of nosocomial LUTI?
A
Indwelling catheters
8
Q
Drug that causes hemorrhagic cystitis?
A
Cyclophosphamide
9
Q
Hemorrhagic cystitis due to cyclophosphamide can be prevented by?
A
Mesna
10
Q
Parasite causing LUTI?
A
Schistosoma hematobium
11
Q
Schistosoma hematobium causes what disease?
A
LUTI
12
Q
Morphology of eggs of schistosoma hematobium?
A
Terminal spike, bile staining
13
Q
Pathogenesis of LUTI due to schistosoma hematobium?
A
Transmission- via skin; inflammatory response to eggs of schistosoma in bladder (IgE)
14
Q
Increased risk of what malignancy with schistosoma hematobium infection?
A
SCC of bladder
15
Q
Increased risk of SCC of bladder is associated with which organism?
A
Schistosoma hematobium infection
16
Q
Most common uropathogen?
A
E.coli
17
Q
Most common cause of sepsis in hospitalised patient?
A
E. Coli
18
Q
Most common cause of LUTI in young sexually active women?
A
Staphylococcus saprophyticus
19
Q
Most common cause of acute urethral syndrome in women?
A
Clamydia trachomatis
20
Q
Virus causing hemorrhagic cystitis?
A
Adenovirus
21
Q
Leukocyte esterase and nitrite +, WBC and RBC in urine. Dysuria, suprapubic discomfort and increased frequency of urination. Diagnosis?
A
Cystitis
22
Q
2 successive urine culture +. No associated symptoms. Predisposed individual of this condition?
A
Asymptomatic bacteruria; pregnant women and elderly women
23
Q
Treatment of of symptomatic bacteruria in elderly women vs. pregnant women?
A
Elderly women- no treatment; pregnant wome-treat with amoxicillin
24
Q
Complication of asymptomatic bacteruria in pregnant women?
A
Acute pyelonephritis
25
Why are pregnant women with asymptomatic bacteruria treated but healthy elderly women are not?
Pregnant women predisposed to developing acute pyelonephritis
26
Gold standard criterion for cystitis?
Urine culture-> 10^5 CFU/ml
27
Neutrophils in urine, culture -, leukocyte esterase + but nitrite -. Diagnosis?
Sterile pyuria
28
Aetiology of sterile pyuria?
Chlamydia trachomatis, renal TB, TIN (non infectious)
29
Diagnosis of acute urethra syndrome?
Urine PCR to detect chlamydia trachomatis
30
Yellow, raised plaques in bladder. Foamy macrophages filled with laminated mineralised concretions. Diagnosis?
Malacoplakia
31
Causative organism of Malacoplakia?
E.Coli (chronic infection)
32
Michaelis Gutman bodies are associated with which disease?
Malacoplakia
33
Morphology of michaelis Gutman bodies?
Foamy macrophages filled with laminated concretions
34
Why are michaelis Gutman bodies associated with Malacoplakia?
Chronic E. coli infection-> defective phagosomes that cannot degrade bacterial products (michaelis Gutman bodies)
35
Most common cause of acquired diverticula of bladder?
BPH
36
Complication of bladder diverticula?
Stone formation and diverticulitis
37
Pathogenesis of bladder diverticula?
Outflow obstruction-> increased intravesical pressure-> diverticula in areas of weakness of bladder wall
38
Which people are predisposed to cystoceles?
Middle aged and elderly women
39
Most common cancer of bladder?
Transitional cell carcinoma
40
Cystitis cystica and glandularis predispose to what bladder disease?
Bladder adenocarcinoma
41
Increased urine frequency, urgency, small volume voids and nocturia. What type of urinary incontinence do these symptoms indicate?
Urge incontinence
42
Dribbling and low urine flow.what type of urinary incontinence do these symptoms indicate?
Overflow incontinence
43
Loss of urine during sneezing, coughing and laughing. What type of urinary incontinence do these symptoms indicate?
Stress incontinence
44
Normally continent patient experiences incontinence after administration of diuretics. What type of incontinence do these symptoms indicate?
Functional incontinence
45
Aetiology of urge incontinence?
Bladder irritation due to BPH, atrophic urethritis and infection; lesion above sacral nerves
46
Pathogenesis of urge incontinence?
Over activity of the detrusor muscle
47
Aetiology of overflow incontinence?
DM, BPH
48
Pathogenesis of overflow incontinence?
Under activity of detrusor muscle due to obstruction/autonomic dysfunction
49
Aetiology of stress incontinence?
Women (lack of estrogen), posterior urethrovesical angle is 90 degrees
50
Pathogenesis of stress incontinence?
Laxity of pelvic floor muscles + lack of bladder support
51
Aetiology of functional incontinence?
Diuretics
52
Therapy for urge incontinence?
Anticholinergic--> oxybutinine
53
Therapy for overflow incontinence?
Cholinergic drugs
54
Therapy for stress incontinence?
Kegel pelvic exercises, topical estrogen therapy
55
Increased risk of TCC bladder?
Increasing age, men
56
Most common cause of bladder TCC?
Smoking
57
Anti cancer drug that can cause TCC bladder?
Cyclophosphamide
58
Which occupations are associated with bladder TCC?
Dye, rubber, leather industries
59
Proton oncogene implicated in TCC bladder?
HRAS--> alters epidermal growth factor receptor
60
Why is multifocality and recurrence the rule in TCC bladder?
Malignant stem cell abnormality-> reimplantation of tumor from another site
61
Histologic findings in TCC bladder cancer low grade vs. high grade?
Low grade: papillary, non invasive
| High grade: papillary/flat, invasive
62
Grade histologic finding in bladder TCC if flat/papillary and invasive?
High grade
63
Papillary, non invasive mass in posterior (and lateral) wall at the base of the bladder. Diagnosis?
TCC bladder
64
Sites of TCC in bladder?
Posterior/lateral wall at base of bladder
65
Elderly male, smoker, complains of painful gross hematuria. Diagnosis?
TCC bladder
66
Parasitic infection associated with bladder SCC?
Schistosoma hematobium
67
Pathogenesis of SCC due to Schistosoma hematobium?
Type 2 hypersensitivity reaction-> chronic bladder infection/irritation-> squamous metaplasia
68
Most common cause of adenocarcinoma of bladder?
Urachal remnants
69
Complication of exstrophy of bladder?
Bladder adenocarcinoma
70
Complication of cystitis glandularis?
Adenocarcinoma bladder
71
Diseases associated with bladder cancer?
Urachal remnants, cystitis glandularis, exstrophy of bladder
72
Boy aged 6 yrs, presents as a grape like mass protruding from urethral orifice. Diagnosis?
Embryonal rhabdomyosarcoma
73
Girl aged 6 yrs presents with grape like mass from vagina. Diagnosis?
Embryonal rhabdomyosarcoma
74
Elderly male presents with urethritis. Most common cause?
E. Coli
75
E. Coli is the MCC of urethritis in which patients?
Sexually inactive
76
Adolescent male presents with urethritis. Most common cause?
Chlamydia/ gonococcal infection
77
Adolescent man presents with urethritis, sterile conjunctivitis and HLA-B27 arthritis. Diagnosis?
Reiters syndrome
78
Components of reiters syndrome in men?
Chlamydial urethritis, conjunctivitis and HLA-B27 arthritis
79
Young female complains of bleeding from urethral orifice, and a painful friable mass at the site. Diagnosis?
Urethral caruncle
80
Most common cancer of urethra?
SCC
81
Male patients complains of urination through hole on undersurface of penis and curving of the shaft towards undersurface. What is the cause?
Patient suffers from hypospadias
faulty closure of urethral folds 2 to androgen deficiency
82
Patient complains of urinating through hole on the surface of the penis. What is the cause?
Patients suffers from epispadias
abnormal development of genital tubercle
83
Patient complains of inability to retract prepuce over head of penis. What is the cause?
Patients suffers from phimosis.
It is due to infections
84
Adolescent male, uncircumcised with poor hygiene presents with red, swollen and hot glans penis and prepuce. What is the cause?
Patient has balanoposthitis
Accumulation of smegma-> infection with anaerobes/candida/pyogenic bacteria
85
Married male patient presents with laterally curved penis with painful contracture. Patient gives no history of any children. What is the cause?
Patient has pyronie disease
It is a type of fibromatosis->may lead to sterility
86
Male patient presents with persistent and painful erection. What are the possible causes?
Patient has priapism
Sickle cell anaemia/penile trauma
87
Carcinomas in situ associated with HPV-16 infection?
Bowens disease
Erythroplakia of queyrat
Bowenoid papulosis
88
Male patient, 40 yrs of age, presents with leukoplakia in shaft of penis and scrotum. What is the prognosis?
Patient has bowens disease- carcinoma in situ.
10% progress to invasive SCC of penis/ associated with other visceral cancers
89
Adolescent male presents with erythroplakia on mucosal surface of glans and prepuce. Which cancer is it a precursor lesion of?
Patient has erythroplakia of queyrat.
It is a precursor lesion of invasive SCC
90
Male patient presents with multiple pigmented reddish brown papules on external genitalia. What is the prognosis?
Patient has bowenoid papulosis.
Does not develop into invasive SCC.
91
Male patient 50yrs, smoker, presents mass on glans penis and enlarged inguinal and iliac lymph nodes. What risk factors for SCC of penis assessed?
1. Most impt- uncircumcised
| 2. Bowens disease and erythroplakia of queyrat-HPV-16
92
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?
Patient has cryptorchidism.
1. Androgen insensitivity syndrome
2. Kallmann syndrome
3. Cystic fibrosis
93
Premature male patient with palpable unilateral mass in inguinal canal, with no testes detected in scrotal sac of same side. What is the cause?
Patient has cryptorchidism.
Androgen/hCG hormone deficiency in inguinoscrotal phase of normal descent of testes
94
Male patient with undescended testes in abdomen. What is the cause?
Patient has cryptorchidism.
Deficiency of mullerian inhibiting substance in trans abdominal phase of normal descent of testes
95
Male patient presents with bilaterally undescended testes. What are the complications if untreated?
Patient has cryptorchidism.
1. Infertility- temperature dependent spermatogenesis
2. Seminoma risk
3. Torsion risk
96
Management of male with cryptorchidism?
Orchiopexy after 6 months to 2 years of age of male
[GnRH before orchiopexy may improve fertility]
97
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?
Patient suffers from epididymitis.
Common pathogens
98
Male patient 50 years, presents with unilateral scrotal pain radiating into spermatic cord, scrotal swelling with prehns sign +. What is the cause?
Patients has epididymitis.
Most common pathogens >35years
E. Coli
Pseudomonas aeruginosa
99
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?
Patient has R. Sided varicocele.
Retro peritoneal fibrosis, thrombosis of IVC
100
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?
Patient has L. Sided variocele
Renal cell carcinoma, compression by superior mesenteric artery
101
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?
Patient has a variocele.
Treatment is variocelectomy or embolization by radiologist.
102
16 year old male patient complains
| of sudden onset testicular pain and presents with testicles drawn up into inguinal canal. What is the cause?
Patient has torsion of testicle.
Physical trauma (MC)
Cryptorchidism
Atrophy of testes
103
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
Absent cremastric reflex- scrotum does not retract on stroking inner thigh.
104
17 year old male patient with sudden onset testicular pain and absent cremastric reflex. Complications if left untreated?
Patient has testicular torsion
Risk for hemorrhagic infarction of testicles as twisting of spermatic cord cuts off blood supply
105
10 year old male presents with scrotal enlargement. Most common cause?
Hydrocele
106
10year old male presents with scrotal swelling. Which associated condition is he most likely to have?
Patient has Hydrocele.
Associated with indirect inguinal hernia
107
10 year old male presents with scrotal enlargement. What is the Pathogenesis?
Patient has Hydrocele
Persistent tunica vaginalis-> fluid accumulates in serous space between layers of tunica vaginalis
108
20 year old male presents with unilateral painless testicular enlargement. What risk factors for testicular tumours must be assessed?
1. Cryptorchidism (esp abdominal)
2. Androgen insensitivity
3. Klinefelters
4. Peutz-jeghers syndrome-sertoli leydig tumour
5. Inguinal hernia/mumps orchitis
109
3 yr old male patient presents with unilateral painless testicular enlargement. What tumour marker will be + in this patient?
Patient may have yolk sac tumour.
Alpha-feto protein is +
110
20 year old male presents with gynaecomastia and unilateral painless testicular swelling. What tumour marker is + in this patient?
Patient has choriocarcinoma
hCG is +
111
20 year old male patient presents with unilateral painless testicular swelling and +hCG. What is the prognosis of this testicular tumour?
Poor; most aggressive
112
20 year old male patient presents with unilateral painless testicular swelling and +hCG. What do you expect on histologic biopsy?
Patient has choriocarcinoma.
Histologic biopsy will show trophoblastic tissue-synciotrophoblast, cytotrophoblast
113
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?
Patient has Choriocarcinoma
Hematogenous spread to lungs
114
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?
Patient has prostate cancer
Most common sites of metastasis are: lumbar spine>femur>pelvis
115
75 year old male patient is suspected of prostate cancer. What lab investigations will be elevated?
PSA >10ng/ml
Doubling time of PSA; >0.75ng/dl increase in PSA/yr; increased PSA density
ALP is increased in metastasis
116
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?
Patient has a seminoma
Excellent, extremely radio sensitive
117
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?
Patients seminoma may have metastasised as hematogenous spread follows lymph node involvement.
118
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?
Patient died of embryonal carcinoma.
Gross- bulky tumour with haemorrhage and necrosis
119
3 year old boy presents with painless unilateral painless enlargement of testis. AFP is +. What characteristic finding is observed on histologic biopsy?
Schiller duval bodies. (Resemble primitive glomeruli)
120
50 year old male presents with unilateral painless testicular swelling. Mass is composed of ectoderm, mesoderm, endoderm. What is its prognosis?
Patient suffers from testicular seminoma.
Bad prognosis in adults-malignant; children- benign
121
Male aged 70 years presents with unilateral painless testicular enlargement. He is diagnosed with malignant lymphoma. What is the prognosis?
2 to diffuse large cell lymphoma; prognosis poor
122
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?
Para aortic lymph nodes
123
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?
3rd specimen at end of micturition and 4th specimen milked after prostate massage
124
Male patient presents with dysuria, increased frequency and urgency of urination and fever. Prostate gland is enlarged on DRE. What is the Pathogenesis?
Patient has acute prostatis
Intraprostate reflux of urine from posterior urethra/bladder
125
Male patient evaluated for acute prostatis- urine examination shows 10WBC/ high power field. What is the diagnosis?
Does not confirm acute prostatis as WBC >20ng/ml for + result
126
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?
Chronic prostatis; common in bicycle riders due to compression of prostate.
127
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?
Patient has BPH.
Increased sensitivity to DHT; stromal cells produce 5 alpha reductase-concerts T->DHT.
128
83 year old male patient has enlarged prostate on DRE and PSA 6 ng/dl. What complications can be expected?
Patient has BPH
1. Obstructive uropathy-> hydronephrosis, post renal azotemia, bladder diverticula
2. Infection
3. Prostate infarction->>PSA
129
83 year old patient with enlarged prostate on DRE and PSA=5ng/dl. What is the prognosis?
Patient has BPH.
No risk for cancer progression
130
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?
Alpha adrenergic blockers- decrease tone of bladder neck
5-alpha reductase inhibitors-decrease synthesis of DHT
[patient has BPH]
131
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?
Patient has prostate cancer.
Bony metastasis to vertebra and pelvic bones via Bateson venous plexus.
ALP elevated
131
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?
Patient has prostatic cancer.
1. It has a firm gritty yellow appearance.
2. Invasion of capsule.
3. Hematogenous/venous/perinueral Invasion
131
80 year old black male smoker. Family history of prostatic cancer. What is the prognosis of the disease.
Early detection and therapy-dramatic increase in survival
131
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?
Man has primary hypogonadism due to leydig dysfunction
Causes include: alcoholic liver disease, chronic renal failure, irradiation, orchitis and trauma to testes
131
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?
Man has primary hypogonadism due to leydig and Seminiferous tube dysfunction
alcoholic liver disease, chronic renal failure, orchitis, trauma, irradiation
131
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?
Patient has primary hypopituitarism/hypothalamic dysfunction
Non functioning pituitary, adenoma, prolactinoma-> hypopituitarism
Kallmann syndrome-> hypothalamic dysfunction
131
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?
Patient has hypopituitarism/hypothalamic
Craniopharyngioma and prolactinoma -> hypopituitarism
Kallmann syndrome-> hypothalamic dysfunction
131
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?
Autosomal dominant
131
Male patients lab reports show decreased testosterone, sperm count. What is the mechanism of osteoporosis in this patient?
Testosterone inhibits osteoclastic activity and increases osteoclastic activity.
Decrease in testosterone does the opposite.
