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Year 2 - Renal (DP) > Pathology > Flashcards

Pathology Flashcards

1
Q

What are some features of glomerulonephritis?

A

Glomerulo tufts

Secondary tubulointerstitial changes

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2
Q

What sort of distribution does pyelonephritis show?

A

Patchy

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3
Q

Why can pregnancy predispose to pyelonephritis?

A

Ureteric dilation

Stasis

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4
Q

Which of the following is not a risk factor for pyelonephritis:

  • Instrumentation
  • Obstruction
  • Vesicoureteric reflux (Congenital/Acquired)
  • Circumcision
  • DM
A

Circumcision

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5
Q

What are some vague signs of chronic pyelonephritis?

A

Hypertension and/or anaemia

Polyuria

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6
Q

How does chronic pyelonephritis appear on imaging?

A

Coarse cortical scarring

Distortion of calyces

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7
Q

How does Tuberculosis Pyelonephritis spread?

A

Haematogenously

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8
Q

Where does Tuberculosis Pyelonephritis usually spread from?

A

Lungs

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9
Q

Which of the following is not a symptoms of Tuberculosis Pyelonephritis:

  • Weight loss
  • Anaemia
  • Fever
  • Loin pain
  • Dysuria
A

Anaemia

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10
Q

Is the pyuria in TB pyelonephritis sterile or non-sterile?

A

Sterile

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11
Q

TB pyelonephritis has caseous foci, what does this result in?

A

Slow growth with progressive renal destruction:

 - Ureters
 - Bladder
 - Other viscera
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12
Q

What can cause necrotising cystitis?

A

Outlet obstruction

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13
Q

What is characterised by multiple, small, fluid-filled cysts projecting into the lumen of the ureter. The cysts may resemble tumours?

A

Ureteritis + Cystitis Cystica

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14
Q

A 59 year old patient presents to her GP with haematuria and increased frequency. She notes that she had UTIs more frequently over the last 6 months and has also lost some weight. On further questioning, you find out that 3 years ago she went on a holiday to Egypt and returned with a papular rash and a dry cough, fever and some muscle aches. On pelvic x-ray, there is some calcification of her bladder walls. After cystoscopy and biopsy, the patient is found to have a squamous cell carcinoma of her bladder.

A

Schistosomiasis (caused by S. haematorium)

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15
Q

In males, what can cause urinary tract obstruction?

A

Stricture
Posterior urethral valves
Prostatic disease

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16
Q

What can happen in prolonged urinary tract obstruction?

A

Detrusor muscle hypertrophy -> Diverticulum

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17
Q

What is hydronephrosis?

A

Dilation of pelvicalyceal system with parenchymal atrophy

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18
Q

What are the two main causes of hydronephrosis?

A

Urinary tract obstruction

Vesicoureteric reflux

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19
Q

Which of the following is not a typical cause of bilateral hydronephrosis:

  • Urethral obstruction
  • Neurogenic disturbance
  • Vesicoureteric reflux
  • Congenital abnormality
  • Bilateral ureteric obstruction (Advance cervical carcinoma)
A

Congenital abnormality

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20
Q

Which of the following is not a typical cause of unilateral hydronephrosis:

  • Calculi
  • Posterior urethral valve
  • Neoplasms
  • Pelvi-ureteric obstruction
  • Strictures
A

Posterior urethral valve

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21
Q

If an obstruction is sudden and complete, what sort of hydronephrosis is seen?

A

As urine production is decreased quickly, there is little pelvicalyceal dilation

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22
Q

If hydronephrosis is severe, what effect does this have on the renal cortex?

A

Thinning
Atrophy
Fibrosis

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23
Q

What is the name given to a secondary infection due to urine stasis in hydronephrosis?

A

Pyonephrosis

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24
Q

A dry and crusty full thickness epidermal lesion of the penis

A

Bowen’s Disease

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25
Q

A raised erythema on the glans

A

Erythroplasia of Queyrat

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26
Q

In what areas of the world is the incidence of squamous carcinoma of the penis increased?

A

Latin America
Africa
Far East

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27
Q

In what people is squamous carcinoma of the penis almost exclusive to and why?

A

Uncircumcised men -> Poor hygiene

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28
Q

What infection can increase the risk of squamous carcinoma of the penis?

A

HPV

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29
Q

How do squamous carcinomas of the penis of the penis usually appear?

A

On glans or prepuce:

 - Ulcerated and indurated OR
 - Exophytic mass (growing outward)
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30
Q

In what people is a squamous carcinoma of the scrotum common?

A

Chimney sweeps

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31
Q

What percentage of men over 70 have Benign Nodular Hyperplasia of the Prostate?

A

75%

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32
Q

What percentage of people with Benign Nodular Hyperplasia of the Prostate have significant symptoms?

A

~5%

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33
Q

What causes Benign Nodular Hyperplasia of the Prostate?

A

Irregular proliferation of:

 - Glandular tissue
 - Fibromuscular stromal tissue
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34
Q

What is the aetiology of Benign Nodular Hyperplasia of the Prostate?

A

Hormone imbalance:

 - Altered androgen/oestrogen ratio
 - Peri-urethral/Central gland involved
           - > It is oestrogen-responsive
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35
Q

What are the three main features of prostatism?

A

Difficulty starting urination
Poor stream
Overflow incontinence

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36
Q

How is Benign Nodular Hyperplasia of the Prostate treated?

A

Transurethral resection
Drugs:
- α-blockers
- 5-α-reductase inhibitors

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37
Q

What is the peak age for prostate cancer?

A

60-80

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38
Q

What family history increases the risk of prostate cancer?

A

A first degree relative with prostate cancer

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39
Q

Where does prostate cancer usually arise?

A

Peripheral ducts and glands:

 - Particularly the posterior lobe
 - Peri-urethral zone involved later
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40
Q

If prostate cancer spreads lymphatically, where does it tend to go?

A

Lymphatic:

 - Sacral
 - Iliac
 - Para-aortic nodes
41
Q

If prostate cancer spreads haematogenously, where does it tend to go?

A

Lumbosacral bone:
- Osteosclerotic lesions
Lungs
Liver

42
Q

What percentage of patients with prostate cancer have locally advanced or metastatic disease at presentation?

A

66%

43
Q

How will prostate cancer feel on PR exam?

A

Craggy mass

44
Q

What imaging modalities are useful in prostate cancer?

A

USS prostate
Skeletal x-ray
Bone scans

45
Q

How are prostate biopsies taken?

A

Needle-core biopsies under USS

46
Q

What hormonal therapy is used in prostate cancer?

A

Anti-androgens
Oestrogens
Cyproterone

47
Q

What surgery can be used in prostate cancer?

A

Radical prostatectomy

48
Q

Painless testicular enlargement, hydrocoele and gynaecomastia are common presenting features of what?

A

Testicular tumours

49
Q

What are the most common testicular tumours?

A

Germ cell tumours:

 - Seminomas
 - Teratomas
50
Q

What less common tumours can affect the testicles?

A 
Lymphoma/Leukaemia
Stromal tumours:
     - Sertoli cell
     - Leydig cells
Metastases
51
Q

What is the peak age for seminomas?

A

30-50

52
Q

How do seminomas appear?

A

‘Potato’ tumour:

 - Solid
 - Homotogenous
 - Pale
53
Q

How do seminomas appear histologically?

A

Large
Clear (glycogen leaches out)
Stromal lymphocytic infiltrate (variable)

54
Q

What seminoma variant is commoner in older men?

A

Spermatocytic

55
Q

If a seminoma spreads lymphatically, where does it metastasize to?

A

Para-aortic LNs (massive)

56
Q

If a seminoma spreads haematogenously, where does it metastasize to?

A

Lungs

Liver

57
Q

What is the peak age for testicular teratomas?

A

20-30

58
Q

How do testicular teratomas appear?

A

Solid areas
Cysts
Haemorrhage
Necrosis

59
Q

Which of the following is not a class of teratoma:

  • Differentiated
  • Malignant Anaplastic
  • Malignant Intermediate
  • Malignant Undifferentiated
  • Malignant Trophoblastic
A

Malignant Anaplastic

60
Q

What does bHCG indicate?

A

Trophoblastic component of a teratoma

61
Q

What does AFP (Alpha-fetoprotein) indicate?

A

Yolk sac component

62
Q

What does PLAP (Placental alkaline phosphatase) indicate?

A

Seminoma

63
Q

What can simple renal cysts be secondary to?

A

Native kidneys in long term dialysis

64
Q

How do the kidneys in ARPKD appear?

A

Uniform and bilateral enlargement
Elongated cysts
Dilation of collecting ducts
Reniform shape maintained

65
Q

What is ARPKD associated with?

A

Congenital Hepatic Fibrosis

66
Q

A 36 year old man presents with haematuria. On examination there is an abdominal mass, he is hypertensive and has evidence of chronic renal failure

A

ADPKD

67
Q

What benign renal tumour is common, originates in the medulla and has white nodules?

A

Fibroma

68
Q

What benign renal tumour has yellowish nodules

A

Adenomas

69
Q

What benign renal tumour can be multiple and bilateral, is associated with Tuberois sclerosis and is composed of a mixture of fat, muscle and blood vessels?

A

Angiomyolipoma

70
Q

What does a Juxtaglomerular Cell Tumour secrete and what does this cause?

A

Renin -> Secondary hypertension

71
Q

What is the commonest intra-abdominal tumour in children. It presents with an abdominal mass and arise from residual primitive renal tissue?

A

Nephroblastoma/Wilm’s Tumour

72
Q

What are the alternate names for a Renal Cell Carcinoma?

A

Clear cell carcinoma
Hypernephroma
Grawitz Tumour

73
Q

Where do Renal Cell Carcinomas arise from?

A

Renal tubular epithelium

74
Q

What is the peak age of incidence for Renal Cell Carcinomas?

A

55-60 years

75
Q

What is the M:F ratio of Renal Cell Carcinomas?

A

2:1

76
Q

What are the paraneoplastic manifestations of Renal Cell Carcinomas?

A

Polycythaemia

Hypercalcaemia

77
Q

Which of the following is not a feature of a Renal Cell Carcinoma’s appearance:

  • Large
  • Well circumscribed
  • Multiple
  • Centred on cortex
  • Yellow
  • Solid, cystic, necrotic and haemorrhagic areas
A

Multiple

78
Q

If a Renal Cell Carcinoma extends into the renal vein, where can it spread?

A

IVC -> Right atrium

79
Q

Where can Renal Cell Carcinomas spread haematogenously?

A

Lung

Bone

80
Q

What is the commonest type of Renal Cell Carcinoma and how do they appear?

A

Clear cell:

- Rich in glycogen and lipids

81
Q

What grading system is used in Renal Cell Carcinomas?

A

Fuhrman

82
Q

Where can transitional cell carcinomas arise?

A

From pelvicalyceal system to the urethra

83
Q

What percentage of bladder tumours do transitional cell carcinomas make up?

A

90%

84
Q

What is the peak age for transitional cell carcinoma of the bladder?

A

> 50 yeasr

85
Q

What chemicals increase the risk of developing a transitional cell carcinoma of the bladder?

A

Aniline dies (β-naphthylamine)
Rubber
Benzidine
Smoking

86
Q

What drugs increase the risk of developing a transitional cell carcinoma of the bladder?

A

Cyclophosphamide

Analgesics (renal pelvis)

87
Q

What other factor can increase the risk of developing a transitional cell carcinoma of the bladder (ie. Not chemicals or drugs)?

A

Schistosomiasis

88
Q

What is the most common symptoms of transitional cell carcinomas of the bladder?

A

Haematuria

89
Q

Where do 75% of transitional cell carcinomas of the bladder arise? What can this cause?

A

Region of trigone:

- Ureteric obstruction

90
Q

Papillary transitional cell carcinomas of the bladder have what characteristic?

A

Thicker lining than normal urothelium

91
Q

How is transitional cell carcinoma of the bladder invasion graded?

A

By the invasion of the stroma and detrusor muscle:

 - pT1 -> Stromal invasion
 - pT2 -> Muscle invasion
92
Q

In what part of the epithelium can a carcinoma-in-situ arise?

A

Flat

93
Q

Where do transitional cell carcinomas of the bladder spread?

A

Local LNs (Obturator)
Lungs
Liver

94
Q

What can predispose to bladder adenocarcinomas?

A

Extroversion (Glandular metaplasia)
Urachal remnants
Long standing Cystitis Cystica

95
Q

What can predispose to bladder squamous cell carcinomas?

A

Calculi -> Squamous metaplasia

Schistosomiasis

96
Q

What is the commonest bladder malignancy in children?

A

Embryonal Rhabdomyosarcoma

97
Q

What causes glomerulosclerosis in DM?

A

Glucose deposits in basement membrane and forms complexes with proteins

98
Q

Which of the following is very radiosensitive, and which is very chemosensitive:

  • Seminoma
  • Teratoma
A

Seminoma -> Radiosensitive

Teratoma -> Chemosensitive

Year 2 - Renal (DP) (15 decks)

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