Pathology Flashcards
1
Q
ESRD =
A
end stage renal disease
end stage of CKD
2
Q
++_+__ in diet should be restricted in those with ESRD
A
potassium
phosphate
salt
fluids
3
Q
physical effects of ESRD (7)
A
dehydration nausea depression anorexia malnutrition osteopenia anaemia
4
Q
anuria =
A
kidneys are no longer producing urine
IS NOT retention
5
Q
causes sterile pyuria
A
Tuberculous pyelonephritis
6
Q
4 orgs that cause cystitis
A
E. coli
pseudomonas
proteus
klebsiella
7
Q
schistosomiasis predisposes ptnt to ___
A
squamous cell carcinoma
8
Q
hydronephrosis =
A
dilatation of the renal pelvis and calyces with parenchymal atrophy
9
Q
5 types of incontinence
A
urge stress urethral overflow mixed
10
Q
compliance of the bladder =
A
its ability to keep its P unchanged despite volume and afferent stimulation
11
Q
___ assesses P in bladder and abdomen
the difference between the two Ps = ___ P
A
urodynamics
detrusor
12
Q
high detrusor P on urodynamics while voiding indicates
A
obstruction
13
Q
CNS centres involved in micturition reflex =
A
pons
S2 + 3 in spinal cord
14
Q
sympathetic for the bladder filling phase is from ___
A
hypogastric nerve (T10-L2)
15
Q
voiding phase of bladder is controlled by _____ nerves ie.
A
parasympathetic
plevic S2-4
16
Q
the ___ nerve controls the external sphincter in voluntary voiding
A
pudendal
17
Q
s+s of overflow incontinence
A
palpable bladder
insensible incontinence
nocturia
renal impairment (due to increased renal pelvis P)
18
Q
involuntary leakage immediately preceded by/accompanied by urgency =
A
urge incontinence
19
Q
s+s of urge incontinence
A
daytime freq
enuresis
small vol
urgency
20
Q
detrusor overactivity can cause ____
is diagnosed by ___
A
urge incontinence
urodynamics
21
Q
afferent overstimulation can cause urge incontinence
examples of these causes =
A
bladder stones
tumours
22
Q
urine leaks during increased intra-abdominal pressure without detrusor contraction =
A
stress incontinence
23
Q
Rx for overflow incontinence
A
treat obstruction
catheterise
rehabilitate bladder
teach intermittent self-catheterisation
24
Q
Rx for urge incontinence
A
avoid caffeine and alcohol lose wt pelvic floor exercises botox antimuscarinics/beta3 adrenergics enterocystoplasty
25
Rx for stress incontinence
```
lose wt
stop smoking
pelvic floor exercises
duloxetine (not v effective)
colposuspension/taping
```
26
ectopic ureter opens into where?
| diagnosed by ___
urethra below external urethral sphincter
| CT/MRI
27
caused by prolonged obstructed labour - more often sen in developing countries
vesico-vaginal fistula
28
a bladder diary is kept for how long?
3 days
29
FVC = __
| it records the volume voided and time of micturition over 24hrs
frequency volume chart
30
if have decreased kidney function in utero =>
oligohydramnios => flattened compressed face
31
infantile polycystic kidney disease =
| gross kidney features =
ARPKD
uniform bilateral renal enlargement
elongated cysts
reniform shape maintained - no gross distortion
32
ARPKD is ass with congenital __
hepatic fibrosis
33
adult polycystic kidney disease =
90% - 1 = chromosome __ mutation
2 = chromosome __
ADPKD
16
4
34
ADPKD gross features of the kidneys
massive bilateral renal enlargement
| distortion of reniform shape
35
In ADPKD cysts can also be present in _+_+_ but usually no ___ effect
lungs, liver and pancreas
| no functional effect
36
ADPKD is ass with __+__
Berry aneurysms in circle of Willis
| Subarachnoid haemorrhages
37
4 benign renal tumours
fibroma
adenoma
angiomyolipoma
JGCT
38
__ is produced by a JGCT => ___
renin
| 2ndry hbp
39
adenoma of kidney gross appearance
yellow nodules <2cm
| cortical
40
fibroma of kidney gross appearance
medullary origin
| white nodules
41
angiomyolipoma is ass with which condition?
tuberous sclerosis
42
commonest intra abdominal tumour in kids =
Wilms tumour/ nephroblastoma
43
3 other names for renal cell carcinoma
clear cell carcinoma
hypernephroma
Grawitz tumour
44
renal cell carcinoma arises from
renal tubular epithelium
45
age and F:M for renal cell carcinoma
55-60yo
| M2:1F
46
paraneoplastic syndromes caused by renal cell carcinoma
polycythaemia (Epo stimulating substance)
| hypercalcaemia
47
gross apearance of renal cell carcinoma
large, well circumscribed mass centred on cortex
| yellow with solid, cystic, necrotic and haemorrhagic areas
48
if a renal cell carcinoma invades this, which it commonly does, it is a bad prognosis
renal vein
49
grading system for renal cell carcinoma
Fuhrman
50
transitional cell carcinoma can occur anywhere from __ to ___
renal pelvis to urethra
51
75% of TCCs occur in __ area
trigone
52
risks for transitional cell carcinoma
```
aniline dyes
rubber
benzidine
analgesia
schistosomiasis
smoking
```
53
transitional cell carcinoma are __/__
papillary or solid
54
grading for TCCs =
pTa (no invasion)
pT1 (stromal invasion)
pT2 (muscle invasion)
55
TCC spreads to _+_+_
obturator lymph nodes
liver
lungs
56
causes of bladder adenocarcinomas
extroversion (congenital = post wall left open)
urachal remnants
long standing cystitis cystica
57
risk factors for urinary tract squamous cell carcinomas
schistosomiasis
| calculi
58
commonest malig bladder ca in kids and teens
embryonal rhabdomyosarcoma
59
2 squamous carcinoma in situ of the penis =
| both = full thickness dysplasia of __
Bowen's disease
Erythroplasia of Queyrat
epidermis
60
carcinogen that causes SCC of scrotum =
from chimney sweeps
61
hormonal cause of BPH
androgen decreased : oestrogen
62
prostatism sympts
retention
hesitancy
overflow incontinence
poor stream
63
drug Rx for BPH
alpha blockers
| 5 alpha reductase inhibitors
64
incidence peak for prostate carcinoma =
| arises esp in __ lobe
60-80yo
| posterior
65
spread of prostate cancer =
local - urethra, capsule, seminal vesicle, bladder, rectum
lymph - sacral, iliac and para-aortic nodes
blood - bone, lung and liver
66
Ix for prostate cancer =
PR, US
xray and bone scans
PSA
TUR biopsy
67
Rx for prostatic cancer
antiandrogens - oestrogens and cyproterone
radio (bone mets)
radical prostatectomy
68
painless testicular enlargement can be due to __
testicular tumours
69
germ cell tumours of the testicles
seminoma
teratoma
mixed
70
___ cell cancer is most ass wwith gynaecomastia of all the testicular cancers
Leydig ( a stromal cancer)
71
age of seminoma ptnts
gross appearance =
cells =
30-50yo - v rare before puberty
potato
large clear cells with variable stromal lymphatic infiltrate
72
marker for seminoma
PLAP
73
seminoma are very sensitive to __ and cure rate =
radiotherapy
| 95%
74
spread of seminomas
para aortic nodes
lungs
liver
75
age peak for teratomas =
| different types =
```
20-30yo - can occur in kids
differentiated
malignant teratoma intermediate
malig undifferentiated
malig trophoblastic
```
76
markers for teratomas =
betaHCG - trophoblastic parts - most malig
| AFP - yollk sac parts
77
2 types of non-visible haematuria
symptomatic/asymptomatic
78
microscopic haematuria is sig if
>= 3 RBCs per high power field on microscopic evaluation of urinary sediment from 2 out of 3 urinalysis specimens
79
why is BPH more likely to cause haematuria than prostate cancer?
it is central
80
after trauma can get ___ haematuria due to ateriovenous communications
deferred (2-3wks)
81
why do long distance runners get haematuria?
vasoconstriction of renal vessels (nephron hypoxia) and of efferent glomerular arteriole ( increase filtration P)
82
loin pain haematuria syndrome =
loin pain, dysuria, vomiting and low grade fever wo UTI - ass with disease of renal peripheral arteries
83
decompression haematuria occurs when
empty bladder too quickly after retention
84
timing of haematuria :
if is initial =
total =
terminal =
urethral
bladder/kidneys/ureters
prostate/bladder neck
85
vermiform clots in urine suggest ___ cause
upper UT
86
refer all ptnts with visible haematuria/sympt microscopic/asympt micro +>=4o yo to
urology
87
precipitators of acute urinary retention
Sx. catheterisation
anaesthetics
sympathomimetric/anticholinergic drugs
88
Rx for acute urinary retention =
catheterise
| then give uroselective alpha blocker (alfuzosin/tamsulosin) before TWOC (trial wo catheter)
89
after Rx for urinary retention may get
post obstructive diuresis -
due to solute diuresis and defect in concentrating ability of the kidneys
watch if >200ml/hr - resolves in 24-48hrs
90
Rx for acute loin pain due to calculi
NSAID +/- opiate
| alpha blocker for small stones
91
if calculi not passed in __ likely to need intervention
1 month
92
indications to treat renal stones early =
| Rx =
unrelieved pain
pyrexia
nausea and vom persistently
high grade obstruction
ureteric stent/fragmentation/removal
percutaneous nephrostomy for infected hydronephrosis
93
in frank haematuria if have clot retention Rx =
3 way irrigating haematuria catheter
94
Ix for frank haematuria =
CT urogram and cytoscopy
95
spermatic cord torsion is most common at which age
| usually occurs __
puberty
| spontaneously eg woken from sleep
96
examination findings in spermatic cord torsion =
testes high in scrotum
transverse lie
abscence of cremasteric reflex
97
Rx for spermatic cord torsion =
rapid 2/3 point fixation with fine non-absorbale sutures
| must fix contralateral side - otherwise = bell clapper deformity
98
signs of torsion of appendix testes =
| Rx =
local tenderness at upper pole
blue dot sign
testes mobile and cremasteric reflex present
resolve spontaneously
99
examination findings for epididymitis
cremasteric reflex present
pyuria
doppler = swollen epididymis with increased bloodflow
100
Rx for epididymitis
analgesia and scrotal support
| ofloxacin 400mg/day for 14 days
101
Rx for paraphimosis
iced glove
granular sugar
manual compression with distal traction
dorsal slit
102
priapism =
>4hrs erection, often painful and not ass with sexual arousal
103
causes of priapism
```
sickle cell
erectile dysfunction injections - papaverine
trauma
neurological
idiopathic
```
104
basis of ischaemic type (low flow/veno-occlusive) priapism
vascular stasis and decreased venous outflow
corpus cavernosa rigid and tender
painful penis
105
basis of non-ischaemic/arterial/high flow priapism
traumatic disruption of penile vasc => blood into corpora => fistula formation between cavernous arteries and lacunar spaces => blood bypasses normal helicine arteriolar bed
106
aspirate of corpus cavernosum in low flow priapism =
dark blood, low O2 and high CO2
107
aspirate of corpus cavernosum in high flow priapism =
normal arterial blood
108
Ix for priapism
aspirate corpus cavernosum
| colour duplex US
109
Rx for non-ischaemic priapism
may spont resolve if watch
| selective arterial embolisation with non permanent materials
110
Rx for ischaemic priapism
aspirate +/- saline irrigation
inject alpha agonist (phenylephrine)
may => Sx shunt
111
form of nec fasc around M genitalia
Fourniers gangrene
112
s+s of Fourniers gangrene
marked pain, fever, sepsis, swelling and crepitus of scrotum, dark purple areas
113
Ix for Fourniers gangrene
plain XR/US = gas in tissues
114
Rx for Founriers gangrene
Abx and surgical debridement
115
emphysematous pyelonephritis =
acute necrotising parenchymal and perianal infection due to gas forming uropathogens esp E coli
116
emphysematous pyelonephritis usually occurs in __ and is ass with _+_+_+_
diabetics
| ureteric obstruction, fever, vom, flank pain
117
Ix for emphysematous pyelonephritis =
palin abdo XR (KUB) = gas
| CT defines extent
118
Rx for emphysematous pyelonephritis =
nephrectomy
119
perinephric abscess is usually due to ___
Ix =
Rx =
rupture of an acute cortical abscess into perinephric space / from haem. seeding
CT
Abx and drain
120
Ix for renal trauma with haematuria/penetrating/shock
contrast CT
121
Rx for kidney trauma =
angiography/embolisation (98% Rx of blunt trauma)
| Sx
122
Ix for bladder trauma =
CT cystography
123
post urethral injusry is often ass with
pubic rami #
124
___ is most vulnerable part of urethra to trauma as is fixed at __+__
bulbomembranous junction
| urogenital diaphragm and puboprostatic ligaments
125
s+s of urethral trauma
```
blood at meatus
cant urinate
palpable bladder
high riding prostate
butterfly perineal haematoma
```
126
Ix for urethral trauma =
retrograde urogram
127
Rx for urethra trauma
suprapubic catheter
| delayed reconstruction >= 3 months later
128
in kidneys: petechial haemorrhages, arteriolosclerosis and hyalinosis suggests:
hypertension
129
in malignant hypertension ____ is seen in the kidneys
fibrinoid necrosis
130
lesions on the kidney seen in diabetes mellitus
Kimmelstiel-Wilson
131
form of inherited kidney disease ass with Berry aneurysms and subarachnoid haemorrhages
ADPKD
132
dilatation of the renal pelvis and calyces
hydronephrosis
133
renal cell carcinoma is derived from which tissue
renal tubular epithelium
134
the being present increases the likelihood of renal cell carcinoma metastasising
renal vein invasion
135
3/4 of bladder cancers are found in this area
trigone
136
used to treat superficial bladder cancers
mitomycin
137
the hormonal predisposers to BPH and prostate ca
```
BPH = oestrogen increased compared to testosterone
Ca= androgen driven
```
138
eGFR is not used in AKI because
Cr is changing rapidly
| and Cr lags behind GFR
139
Cr and urea tend to rise together but a disproportionate rise in urea can be because of __
high protein meal (eg. gut bleed)
hypercatabolic state
dehydration
140
NSAIDs have a worse effect on the kidneys if the ptnt is ___
dehydrated
