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Male Genital And LUTS Flashcards

1
Q

Abnormal opening of urethra on ventral aspect of penis along shaft

A

Hypospadia

Sometimes constricted -> UTI

Assoc with hernia and undescended testis sometimes

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2
Q

Abnormal urethral orifice on dorsal aspect of penis

A

Epispadia

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3
Q

Inflammation of glans penis

A

Balanitis

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4
Q

Inflammation of prepuce

A

Balanopthitis

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5
Q

Agents causing balanopthitis and balanitis

A

Candida

Anaerobic: Gardnerella, pyogenic bateria

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6
Q

Rf for balanitis/balanopthitis

A

Poor hygiene
Uncircumcision
Smegma accumulation

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7
Q

Prepuce cannot be retracted easily over glans penis

Congenital anomaly or scarring

A

Phimosis

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8
Q

Pelves, ureter, bladder and urethra lining

A

urothelium

Lamina propria
Muscularis propria (detrussor muscle)
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9
Q

Most common Congenital disorder resulting in hydronephrosis

A

Ureteropelvicjunction obstruction

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10
Q

Uncommon cause of ureteral narrowing or obstruction by fibrous proliferative inflammatory processes encasing retroperitoneal structures causing hydronephrosis

A

Retroperitoneal fibrosis

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11
Q

Primary malignant tumors of ureter, renal pelvis, calyx, bladder are mostly

A

urothelial

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12
Q

Elevations associated with fibroinflammatory lesions

A

IgG4

Other rf of retroperitoneal fibrosis:
Ergot derivative
Adrenergic blocker
Lymphoma, urinary tract carcinoma

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13
Q

Idiopathic retroperitoneal fibrosis

A

Ormond disease

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14
Q

Arise from persistent urethral obstruction (bph) resulting in pouchlike evagination of bladder wall

A

Diverticulum

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15
Q

Common agents causing bacterial cystitis

A

Coliform bacteria

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16
Q

Hemorrhagic cystitis arise from (2)

A

cyclophosphamide (cytotoxic) use

adenovirus

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17
Q

Chronic pelvic pain syndrome
Persistent painful occuring in women
Intermittent, suprapubic pain, urinary freq, urgency, hematuria, dysuria,
fissures and punctate hemorrhage (glomerulation) in bladder

A

Interstitial cystitis

Later may develop into transmural fibrosis

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18
Q

Phagocytic and degradative function of macrophage overloaded with bacterial product
Laminated calcium deposition in lysosomes known as

A

Malakoplakia

Michaelis-Gutmann bodies within mac

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19
Q

Inflammation from irritation to mucosa where urothelium is thrown to bulbous polypoid projections from submucosal edema
May be confused with papillary urothelial ca

A

Polypoid cystitis

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20
Q

Metaplastic downward growth of urothelium into lamina propria with central epithelial cells diff into cuboidal or columnar lining cystitis glandularis

A

Brunn Nests

cystic spaces may be filled with clear fluid (cystitis cystica); goblet cells like intestinal mucosa (colonic metaplasia)

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21
Q

In response to injury bladder urothelium results to

A

squamous metaplasia (differentiate from glycogenated squamous epithelium)

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22
Q

More common in countries where schistosomiasis is endemic

A

3-7% SCC of bladder

extensive keratinization
chronic bladder irritation; infection

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23
Q

Urothelial ca rf (3)

A

smoking
occupational carcinogen
Schistosoma haematobium

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24
Q

Bladder carcinogenesis is initiated by

A

deletion of tumor-supressor gene on 9p and 9q leading to superficial papillary tumor
acquiring TP53 mutation

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25
Q

Genetic alterations in bladder ca:

A

FGFR3 mutation activating Ras oncogene

Loss of function mutation TP53 and RB

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26
Q

2 precursor lesions of bladder ca

A

Noninvasive papillary tumor (most c)

carcinoma-in-situ

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27
Q

Noninvasive papillary urothelial neoplasm range of atypia and grade:

A

1 papilloma
2 papillary urothelial neoplasm of low malig potential (PUNLMP)
3 low grade papillary urothelial carcinoma
4 high grade papillary urothelial carcinoma

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28
Q

Benign

Not associated with inc risk for subsequent carcinoma

A

Inverted urothelial papilloma

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29
Q

Cytologically malignant cells with flat urothelium
Behaves like high grade papillary urothelial ca
Sheds malignant cells into urine

A

CIS

Detected by cytology

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30
Q

50-70% of CIS cases progress to

A

Muscle invasive cancer

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31
Q

CIS or highgrade papillary invading lamina propria extending to muscle

A

Invasive urothelial cancer

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32
Q

Most important prognostic factor in urothelial carcinoma

A

Extent of invasion and spread (staging) at time of initial diagnosis

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33
Q

Most common presentation of bladder CA

A

painless hematuria

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34
Q

Recurrece is high in urothelial ca bec

A

Of tendency to develop new tumors whatever grade with recurrence exhibiting higher grade at different sites from original lesion

Shedding and implantation of original tumor cells at new sites

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35
Q

Risk factor for tumor recurrence

A 
Tumor size
Stage
Grade
Multifocality
Mitotic index
Dysplasia/cis surrounding mucosa
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36
Q

Small localized papillary tumors not high grade tx

A

transurethral resection

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37
Q

Tumors at high risk for recurrence and progression tx

A

Immunotherapy of intravesicular installation of TB strain BCG Bacille Calmette-Guerin

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38
Q

BCG may be effective in high risk bladder CA bec

A

BCG elicits granulomatous reaction triggering effective local antitumor response

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39
Q

HGUC

recurrence:
coexistent invasion:

A

45%

80%

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40
Q

Radical cystectomy is reserved for (3)

A

1 muscularis propria invasion
2 CIS/Highgrade papillary CA refractory to BCG
3 CIS extending to prostatic urethra and duct not reached by BCG

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41
Q

Chronic venereal infection by spirochete T pallidum

A

Syphilis
Lues
Great Pox

African America 30x > Whites

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42
Q

Syphilis is transmitted via

and disseminates through

A

contact with cutaneous or mucosal lesion in sexual partner in early or primary and secondary stages in skin break
Vertical (placental)

Lymphatics and blood widespread

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43
Q

Primary syphilitic lesion appearing a mean 21 days postinfection or anytime bet 9-90 days at point of entry
Indurated hard with clean moist base

A

Chancre

Resolves over 4-6weeks

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44
Q

Systemic dissemination of treponema continues mounting immune response in the form of 2 antibodies:

A 
1 nontreponemal (antibodies cross-reacting with host constituents)
2 antibodies to specific treponemal antigen

Both failing to eradicate organism

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45
Q

In 25% of untreated syphilis, chancre is followed by

A

Secondary syphilis

Generalized LN, mucocutaneous lesions

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46
Q

Mucocutaneous lesions of primary and secondary syphilis are

A

teeming with spirochetes and are highly infectious

Resolve spontaneously
Early latent phase syphilis

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47
Q

Parenchymal damage in tertiary syphilis

Irregular, firm, mass of necrotic tissue surrounded by CT with mixed inflamm infiltrate

48
Q

Generalized LN enlargement and mucocutaneous lesions symmetrically distributed
Maculopapular, scaly, pustular
Involvement of palms and soles is common

A

Secondary syphilis

49
Q

Lesion of secondary syphilis appearing in anogenital, inner thigh, axilla
Broad based, elevated, superficial mucosal

A

Condyloma lata

50
Q

Histologic exam of secondary syphilis lesions

A

Proliferative endarteritis
Lymphoplasmacytic inflammatory infiltrate
Spirochete abdundant

Other manif: hepatitis, renal disease, iritis, GI

51
Q

Major complications of tertiary syphilis

A

1 cardiovascular
2 neurosyphilis
3 benign tertiary

52
Q

Cardiovascular syphilis manifestation

A

Syphilitic aortitis 80%

53
Q

Occurs in those with concomittant HIV infection

A

Neurosyphilis 10%

54
Q

Gummas in various sites (bone, skin, mucous membrane of URT) due to delayed hypersensitivity

A

Benign tertiary

55
Q

Syphilis tx

A

Penicillin

56
Q

Greatest during primary and secondary stage when spirochetes are numerous any time during pregnancy

A

Congenital syphilis vertical transmission

57
Q

Congenital syphilis manifestation (3)

A

Stillbirth
Infantile
Late/Tardive

58
Q

Syphilis manifestation in infants (4)

A

1 hepatomegaly
2 bone abnormalities
3 pancreatic fibrosis
4 pneumonitis (pneumonia alba alveolar fibrosis)

59
Q

Stigmata of congenital syphilis develops at

In absence of tx,

A

4th month

40% of babies die in utero after 4th month

60
Q

Congenital syphilis in liveborn within first few months of life
Presents with chronic rhinits (snuffles) and mucocutaneous lesions like in secondary syphilis

A

Infantile syphilis

61
Q

Untreated congenital syphilis of more than 2 yrs

A

Late or Tardive

62
Q

Hutchinson triad of Tardive Congenital Syphilis

A

1 notched central incisor
2 interstitial keratitis with blindness
3 deafness from cranial nerve injury

63
Q

deformity by chronic inflammation of tibial periosteum:

deformed molar teeth:

A

saber-shin deformity

mulberry molars

Other sx: meningitis, chorioretinitis, gummas of nasal bone and cartilage (saddlenose)

64
Q

Mainstay of diagnosis in syphilis

65
Q

Nontreponemal tests (2)

66
Q

Non treponemal tests RPR and VDRL measure antibody against

A

Cardiolipin

present in host tissue and treponemal cell wall

67
Q

Nontreponemal antibody tests are positive during

stage

A

4-6w infection and strongly positive in secondary stage

But appear negative during tertiary phase or positive after successful treatment

68
Q

In presence of primary chance the only way to confirm is:

A

Direct visualization of spirochete by darkfield or immunoflorescence

bec nontreponemal antibody tests are often negative in early stage

69
Q

False positive VDRL results occur in

A

15% usually from a variety of conditions like APAS

70
Q

Give strongly positive results in virtually all cases of secondary syphilis and even after successful treatment

A

Treponemal antibody test
Confirmatory

Not used to screen bec 2% have false positive rate and remain positive after treatment

71
Q

Central area of necrosis surrounded by lymphoplasmacytic infiltrate and epitheloid cell

72
Q

STI by Neisseria gonorrhoeae

Spread by direct contact with mucosa of infected person

73
Q

Pili of N gonorrhoeae has affinity for

A

Columnar and transition epithelium

74
Q

Pilli attachment of gonorrhea

A

Prevents the organism from being unceremoniously flushed away by urine

75
Q

Intense suppurative inflammation
Purulent urethral discharge
Gram neg diplo within cytoplasm of neutrophils
Acute prostatitis, epididymitis, orchitis
In females, acute salpingitis, PID

76
Q

Gonococcal infections may be transmitted to infants developing

A

purulent infection of eyes (opthalmia neonatorum)

77
Q

More sensitive and rapid for gonorrhea testing

A

NAAT

Culture for antibiotic sens

78
Q

Most common bacterial cause of STD

A

Chlamydia trachomatis
frequently accompanies gonorrheal infection

Next most common nonGU U. urealyticum

79
Q

Infectious form of C trachomatis

Limited survival in extracellular environment

A

Elementary body

80
Q

In the host cell, once taken up via receptor mediated endocytosis elementary body becomes

A

reticulate body

81
Q

Chlamydia trachomatis has preference for

A

columnar epithelial cell

82
Q

Chlamydia trachomatis NGU is diagnosed by

A

Nucleic acid amplification test on voided urine

83
Q

Chlamydial infection may manifest as

A

reactive arthritis

Reiter syndrome

84
Q

Reiter syndrome is common in patients positive fr

85
Q

Reiter syndrome (4)

A

Urethritis
Conjunctivitis
Arthritis
Generalized mucocutaneous lesions

86
Q

Chronic ulcerative disease by C trachomatis
Rf: multiple sexual partner
Nonspecific urethritis, papular or ulcerative lesion of lower genitalia, tender inguinal LN unilateral with proctocolitis

A

Lymphogranuloma venereum

87
Q

Mixed granulomatous and neutrophilic inflamm response
Variable chlamydial inclusion
Irregularly shaped foci of necrosis and neutrophilic infiltration (stellate abscess)
Lymphedema
Rectal stricture in women

88
Q

LGV dx in active lesion

A

Organism in Biopsy or smear of exudate

89
Q

LGV dx chronic

A

antibodies

NAAT

90
Q

Third venereal disease from H ducreyi

Cofactor in HIV

A

Chancroid (soft chancre)

91
Q

Painful erythematous papule 4-7 days post inoculation
Errodes into multiple irregular ulcers
Shaggy yellow gray exudate base
Enlarged inguinal LN (buboes)
Neutrophilic debris and fibrin with granulation of necrosis and vessel thrombosis

92
Q

Chancroid dx

A

Identification of organism on culture

93
Q

Chronic inflammatory disease by Calymmatobacterium granulomatis
Rf: multiple sexual partners

A

Granuloma inguinale

94
Q

Raised papular lesion of moist, stratified squamous epithelium
Ulceration, granulation, soft, painless mass with raised indurated border
No regional lymphnode involvement
Pseudoepitheliomatous hyperplasia

A

Granuloma inguinale

95
Q

Pathognomonic of granuloma inguinale

A

Donovan bodies

Coccobacilli within vacuoles in mac

96
Q

urethritis, ulcerative genital lesions, lymphadenopathy and rectal involvement
lymphedema

97
Q

Painful ulcerative infection, chancroid

Inguinal node involvement

98
Q

Chronic fibrosing STD with initial papular lesion on genitalia expanding and ulcerating
Granulation tissue and epithelial hyperplasia mimicking SCC

A

Granuloma inguinale

99
Q

Vaginitis caused by protozoan

A

Trichimoniasis

100
Q

Form of t vaginalis that adheres at mucosa

A

trophozoite

101
Q

Pruritis
Profuse, frothy, yellow vaginal discharge
Colonization cause urinary frequency and dysuria

Dx

A

Trichomoniasis

Smear

102
Q

Anogenital herpes cause

A

HSV 2

in recent years, it may also be caused by 1

103
Q

Painful erythematous vesicles on mucosa
Intraepithelial vesicle with necrotic debris, neutrophil
Cowdry type A

A

Genital herpes simplex

104
Q

Recurrence is more common in 1 or 2

105
Q

Neonatal herpes 2nd wk of life (4)

A

Rash
Encephalitis
Pneumonitis
Hepatic necrosis

106
Q

Herpes dx

A

Viral culture

107
Q

Condyloma acuminatum caused by

A

HPV 6 and 11

108
Q

Condyloma acuminata occurs in males on

A

Coronal sulcus
Inner surface of prepuce

Females seen vulva

109
Q

Painful erythematous intraepithelial vesicle on mucosa and skin of external genitalia with regional LN enlargement

A

Primary HSV lesion

110
Q

Necrotic cells and multinucleate giant cell with intranuclear inclusion

A

Cowdry type A

111
Q

Neonatal herpes complication

A

Encephalitis

112
Q

HPV in males cause

in females

A

Penile cancer

Cervical dysplasia and cancer
Vulvar cancer

113
Q

Ureaplasma urealyticum in males cause

A

Urethritis

114
Q

Ureaplasma urealyticum in females cause

A

Cervicitis

115
Q

T vaginalis in males cause

In females cause

A

Urethritis, balanitis

Vaginitis

Pathology (24 decks)

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