LOWER URINARY TRACT

Question 1

2 causes for hemorrhagic cystitis

Answer 1

Cyclophosphamide

Adenovirus

Question 2

Which developmental anomaly presents with urinary discharge from the umbilicus?

Answer 2

Urachal Cyst remnant

Question 3

Risk factors for urothelial (transitional cell) tumors

Answer 3

Mnemonic : Pee SAC

1. Schistosoma haematobium
2. Analgesics, anniline dyes
3. Cigarette smoking (most imp influence), Cyclophosphamide

Question 4

Low Grade/ High rade papillary urothelial carcinoma?

Answer 4

Low Grade

1. MAINTAINED POLARITY
2. NUCLEAR ATYPIA

Question 5

Name the lesion characterised by protrusion of the bladder wall into the vagina

Answer 5

Cystocele

Question 6

1. Identify the condition shown in the image; name the special stain used
2. Name the structure indicated by the arrow.
3. Within which cells are the Michaelis gutman bodies located?

Answer 6

1. Malakoplakia; PAS stain
2. Michaelis- Gutman bodies
3. Macrophages

Question 7

Low grade/ High grade papillary urothelial carcinoma?

Answer 7

High Grade papillary urothelial carcinoma

a. Loss of polarity
b. Large hyperchromatic nuclei
c. Bizarre mitotic figures
d. Anaplasia

Question 8

Name 2 conditions predisposing to adenocarcinoma of the bladder

Answer 8

1. Exstrophy
2. Urachal Cyst remnant

Question 9

Name the risk factors for transitional cell carcinoma (urothelial carcinoma) of the bladder

Answer 9

Mnemonic: Pee SAC

Phenacetin

Smoking, Schistosoma hematobium

Analgesics, aryl amines

Cyclophosphamide

Question 10

1. What is the lesion resulting from developmental failure of the anterior wall of the abdomen and bladder?

Answer 10

Exstrophy

Question 11

Identify the lesion described

Older woman,

small, red, painful mass about the external urethral meatus

ulcerate and bleed with the slightest trauma

consists of inflamed granulation tissue

Answer 11

Urethral caruncle

Question 12

Identify the condition described

urinary tract symptoms of more than six weeks duration

urine culture negative

more frequent in women

Cystoscopy- mucosal fissures and punctate hemorrhage

Biopsy - Hunner’s ulcer

Answer 12

Interstitial cystitis (chronic pelvic pain syndrome)

See attached image of Hunner’s ulcer

Question 13

Bladder morphology following outlet obstruction due to prostatic hyperplasia

Answer 13

detrusor smooth muscle hypertrophy

trabeculation

Question 14

Underlying defect in urge incontinence

Answer 14

Detrusor hyperactivity [eg: aging, local irritation of the bladder as with infection]

Question 15

Underlying defect in stress incontinence

Answer 15

weakness of the pelvic floor musculature - Obesity, pregnancy, vaginal delivery

intrinsic weakness of the urethral sphincter - surgery, radiation, trauma

Question 16

Underlying defect in overflow incontinence

Answer 16

Outlet obstruction -BPH

Detrusor hypoactivity- Neurogenic bladder in diabetes, multiple sclerosis

Question 17

Type of incontinence described

Restricted mobility or the inability to physically get to the bathroom in time to avoid incontinence

Answer 17

Functional Incontinence

Question 18

Type of incontinence described

loss of urine associated with increases in intraabdominal pressure - coughing, laughing, sneezing, or exercising

Answer 18

Stress Incontinence

Question 19

Precursors to invasive urothelial carcinoma

Answer 19

Noninvasive papillary tumors

Flat noninvasive urothelial carcinoma in situ (CIS)

Question 20

Most important prognostic factor for invasive urothelial carcinoma

Answer 20

depth of invasion

For example, invasion of the lamina propria (Stage T2) leads to a 30% 5-year mortality rate

Question 21

most common presenting symptom of urothelial carcinoma

Answer 21

painless hematuria

Question 22

Name one risk factor for squamous cell carcinoma of the bladder

Answer 22

Schistosomiasis

Worm eggs in bladder wall→ Chronic irritation → squamous metaplasia → dysplasia → SCC