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RenalJaz > Pathology > Flashcards

Pathology Flashcards

1
Q

ESRD =

A

end stage renal disease

end stage of CKD

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2
Q

++_+__ in diet should be restricted in those with ESRD

A

potassium
phosphate
salt
fluids

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3
Q

physical effects of ESRD (7)

A 
dehydration
nausea
depression
anorexia
malnutrition
osteopenia
anaemia
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4
Q

anuria =

A

kidneys are no longer producing urine

IS NOT retention

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5
Q

causes sterile pyuria

A

Tuberculous pyelonephritis

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6
Q

4 orgs that cause cystitis

A

E. coli
pseudomonas
proteus
klebsiella

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7
Q

schistosomiasis predisposes ptnt to ___

A

squamous cell carcinoma

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8
Q

hydronephrosis =

A

dilatation of the renal pelvis and calyces with parenchymal atrophy

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9
Q

5 types of incontinence

A 
urge
stress
urethral
overflow
mixed
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10
Q

compliance of the bladder =

A

its ability to keep its P unchanged despite volume and afferent stimulation

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11
Q

___ assesses P in bladder and abdomen

the difference between the two Ps = ___ P

A

urodynamics

detrusor

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12
Q

high detrusor P on urodynamics while voiding indicates

A

obstruction

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13
Q

CNS centres involved in micturition reflex =

A

pons

S2 + 3 in spinal cord

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14
Q

sympathetic for the bladder filling phase is from ___

A

hypogastric nerve (T10-L2)

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15
Q

voiding phase of bladder is controlled by _____ nerves ie.

A

parasympathetic

plevic S2-4

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16
Q

the ___ nerve controls the external sphincter in voluntary voiding

A

pudendal

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17
Q

s+s of overflow incontinence

A

palpable bladder
insensible incontinence
nocturia
renal impairment (due to increased renal pelvis P)

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18
Q

involuntary leakage immediately preceded by/accompanied by urgency =

A

urge incontinence

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19
Q

s+s of urge incontinence

A

daytime freq
enuresis
small vol
urgency

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20
Q

detrusor overactivity can cause ____

is diagnosed by ___

A

urge incontinence

urodynamics

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21
Q

afferent overstimulation can cause urge incontinence

examples of these causes =

A

bladder stones

tumours

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22
Q

urine leaks during increased intra-abdominal pressure without detrusor contraction =

A

stress incontinence

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23
Q

Rx for overflow incontinence

A

treat obstruction
catheterise
rehabilitate bladder
teach intermittent self-catheterisation

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24
Q

Rx for urge incontinence

A 
avoid caffeine and alcohol
lose wt
pelvic floor exercises
botox
antimuscarinics/beta3 adrenergics
enterocystoplasty
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25
Q

Rx for stress incontinence

A 
lose wt
stop smoking 
pelvic floor exercises
duloxetine (not v effective)
colposuspension/taping
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26
Q

ectopic ureter opens into where?

diagnosed by ___

A

urethra below external urethral sphincter

CT/MRI

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27
Q

caused by prolonged obstructed labour - more often sen in developing countries

A

vesico-vaginal fistula

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28
Q

a bladder diary is kept for how long?

A

3 days

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29
Q

FVC = __

it records the volume voided and time of micturition over 24hrs

A

frequency volume chart

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30
Q

if have decreased kidney function in utero =>

A

oligohydramnios => flattened compressed face

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31
Q

infantile polycystic kidney disease =

gross kidney features =

A

ARPKD
uniform bilateral renal enlargement
elongated cysts
reniform shape maintained - no gross distortion

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32
Q

ARPKD is ass with congenital __

A

hepatic fibrosis

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33
Q

adult polycystic kidney disease =
90% - 1 = chromosome __ mutation
2 = chromosome __

A

ADPKD
16
4

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34
Q

ADPKD gross features of the kidneys

A

massive bilateral renal enlargement

distortion of reniform shape

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35
Q

In ADPKD cysts can also be present in ++_ but usually no ___ effect

A

lungs, liver and pancreas

no functional effect

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36
Q

ADPKD is ass with __+__

A

Berry aneurysms in circle of Willis

Subarachnoid haemorrhages

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37
Q

4 benign renal tumours

A

fibroma
adenoma
angiomyolipoma
JGCT

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38
Q

__ is produced by a JGCT => ___

A

renin

2ndry hbp

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39
Q

adenoma of kidney gross appearance

A

yellow nodules <2cm

cortical

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40
Q

fibroma of kidney gross appearance

A

medullary origin

white nodules

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41
Q

angiomyolipoma is ass with which condition?

A

tuberous sclerosis

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42
Q

commonest intra abdominal tumour in kids =

A

Wilms tumour/ nephroblastoma

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43
Q

3 other names for renal cell carcinoma

A

clear cell carcinoma
hypernephroma
Grawitz tumour

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44
Q

renal cell carcinoma arises from

A

renal tubular epithelium

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45
Q

age and F:M for renal cell carcinoma

A

55-60yo

M2:1F

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46
Q

paraneoplastic syndromes caused by renal cell carcinoma

A

polycythaemia (Epo stimulating substance)

hypercalcaemia

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47
Q

gross apearance of renal cell carcinoma

A

large, well circumscribed mass centred on cortex

yellow with solid, cystic, necrotic and haemorrhagic areas

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48
Q

if a renal cell carcinoma invades this, which it commonly does, it is a bad prognosis

A

renal vein

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49
Q

grading system for renal cell carcinoma

A

Fuhrman

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50
Q

transitional cell carcinoma can occur anywhere from __ to ___

A

renal pelvis to urethra

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51
Q

75% of TCCs occur in __ area

A

trigone

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52
Q

risks for transitional cell carcinoma

A 
aniline dyes 
rubber
benzidine
analgesia
schistosomiasis
smoking
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53
Q

transitional cell carcinoma are __/__

A

papillary or solid

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54
Q

grading for TCCs =

A

pTa (no invasion)
pT1 (stromal invasion)
pT2 (muscle invasion)

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55
Q

TCC spreads to ++_

A

obturator lymph nodes
liver
lungs

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56
Q

causes of bladder adenocarcinomas

A

extroversion (congenital = post wall left open)
urachal remnants
long standing cystitis cystica

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57
Q

risk factors for urinary tract squamous cell carcinomas

A

schistosomiasis

calculi

58
Q

commonest malig bladder ca in kids and teens

A

embryonal rhabdomyosarcoma

59
Q

2 squamous carcinoma in situ of the penis =

both = full thickness dysplasia of __

A

Bowen’s disease
Erythroplasia of Queyrat
epidermis

60
Q

carcinogen that causes SCC of scrotum =

A

from chimney sweeps

61
Q

hormonal cause of BPH

A

androgen decreased : oestrogen

62
Q

prostatism sympts

A

retention
hesitancy
overflow incontinence
poor stream

63
Q

drug Rx for BPH

A

alpha blockers

5 alpha reductase inhibitors

64
Q

incidence peak for prostate carcinoma =

arises esp in __ lobe

A

60-80yo

posterior

65
Q

spread of prostate cancer =

A

local - urethra, capsule, seminal vesicle, bladder, rectum
lymph - sacral, iliac and para-aortic nodes
blood - bone, lung and liver

66
Q

Ix for prostate cancer =

A

PR, US
xray and bone scans
PSA
TUR biopsy

67
Q

Rx for prostatic cancer

A

antiandrogens - oestrogens and cyproterone
radio (bone mets)
radical prostatectomy

68
Q

painless testicular enlargement can be due to __

A

testicular tumours

69
Q

germ cell tumours of the testicles

A

seminoma
teratoma
mixed

70
Q

___ cell cancer is most ass wwith gynaecomastia of all the testicular cancers

A

Leydig ( a stromal cancer)

71
Q

age of seminoma ptnts
gross appearance =
cells =

A

30-50yo - v rare before puberty
potato
large clear cells with variable stromal lymphatic infiltrate

72
Q

marker for seminoma

A

PLAP

73
Q

seminoma are very sensitive to __ and cure rate =

A

radiotherapy

95%

74
Q

spread of seminomas

A

para aortic nodes
lungs
liver

75
Q

age peak for teratomas =

different types =

A 
20-30yo - can occur in kids
differentiated
malignant teratoma intermediate
malig undifferentiated
malig trophoblastic
76
Q

markers for teratomas =

A

betaHCG - trophoblastic parts - most malig

AFP - yollk sac parts

77
Q

2 types of non-visible haematuria

A

symptomatic/asymptomatic

78
Q

microscopic haematuria is sig if

A

> = 3 RBCs per high power field on microscopic evaluation of urinary sediment from 2 out of 3 urinalysis specimens

79
Q

why is BPH more likely to cause haematuria than prostate cancer?

A

it is central

80
Q

after trauma can get ___ haematuria due to ateriovenous communications

A

deferred (2-3wks)

81
Q

why do long distance runners get haematuria?

A

vasoconstriction of renal vessels (nephron hypoxia) and of efferent glomerular arteriole ( increase filtration P)

82
Q

loin pain haematuria syndrome =

A

loin pain, dysuria, vomiting and low grade fever wo UTI - ass with disease of renal peripheral arteries

83
Q

decompression haematuria occurs when

A

empty bladder too quickly after retention

84
Q

timing of haematuria :
if is initial =
total =
terminal =

A

urethral
bladder/kidneys/ureters
prostate/bladder neck

85
Q

vermiform clots in urine suggest ___ cause

A

upper UT

86
Q

refer all ptnts with visible haematuria/sympt microscopic/asympt micro +>=4o yo to

A

urology

87
Q

precipitators of acute urinary retention

A

Sx. catheterisation
anaesthetics
sympathomimetric/anticholinergic drugs

88
Q

Rx for acute urinary retention =

A

catheterise

then give uroselective alpha blocker (alfuzosin/tamsulosin) before TWOC (trial wo catheter)

89
Q

after Rx for urinary retention may get

A

post obstructive diuresis -
due to solute diuresis and defect in concentrating ability of the kidneys
watch if >200ml/hr - resolves in 24-48hrs

90
Q

Rx for acute loin pain due to calculi

A

NSAID +/- opiate

alpha blocker for small stones

91
Q

if calculi not passed in __ likely to need intervention

A

1 month

92
Q

indications to treat renal stones early =

Rx =

A

unrelieved pain
pyrexia
nausea and vom persistently
high grade obstruction

ureteric stent/fragmentation/removal
percutaneous nephrostomy for infected hydronephrosis

93
Q

in frank haematuria if have clot retention Rx =

A

3 way irrigating haematuria catheter

94
Q

Ix for frank haematuria =

A

CT urogram and cytoscopy

95
Q

spermatic cord torsion is most common at which age

usually occurs __

A

puberty

spontaneously eg woken from sleep

96
Q

examination findings in spermatic cord torsion =

A

testes high in scrotum
transverse lie
abscence of cremasteric reflex

97
Q

Rx for spermatic cord torsion =

A

rapid 2/3 point fixation with fine non-absorbale sutures

must fix contralateral side - otherwise = bell clapper deformity

98
Q

signs of torsion of appendix testes =

Rx =

A

local tenderness at upper pole
blue dot sign
testes mobile and cremasteric reflex present
resolve spontaneously

99
Q

examination findings for epididymitis

A

cremasteric reflex present
pyuria
doppler = swollen epididymis with increased bloodflow

100
Q

Rx for epididymitis

A

analgesia and scrotal support

ofloxacin 400mg/day for 14 days

101
Q

Rx for paraphimosis

A

iced glove
granular sugar
manual compression with distal traction
dorsal slit

102
Q

priapism =

A

> 4hrs erection, often painful and not ass with sexual arousal

103
Q

causes of priapism

A 
sickle cell
erectile dysfunction injections - papaverine
trauma
neurological
idiopathic
104
Q

basis of ischaemic type (low flow/veno-occlusive) priapism

A

vascular stasis and decreased venous outflow
corpus cavernosa rigid and tender
painful penis

105
Q

basis of non-ischaemic/arterial/high flow priapism

A

traumatic disruption of penile vasc => blood into corpora => fistula formation between cavernous arteries and lacunar spaces => blood bypasses normal helicine arteriolar bed

106
Q

aspirate of corpus cavernosum in low flow priapism =

A

dark blood, low O2 and high CO2

107
Q

aspirate of corpus cavernosum in high flow priapism =

A

normal arterial blood

108
Q

Ix for priapism

A

aspirate corpus cavernosum

colour duplex US

109
Q

Rx for non-ischaemic priapism

A

may spont resolve if watch

selective arterial embolisation with non permanent materials

110
Q

Rx for ischaemic priapism

A

aspirate +/- saline irrigation
inject alpha agonist (phenylephrine)
may => Sx shunt

111
Q

form of nec fasc around M genitalia

A

Fourniers gangrene

112
Q

s+s of Fourniers gangrene

A

marked pain, fever, sepsis, swelling and crepitus of scrotum, dark purple areas

113
Q

Ix for Fourniers gangrene

A

plain XR/US = gas in tissues

114
Q

Rx for Founriers gangrene

A

Abx and surgical debridement

115
Q

emphysematous pyelonephritis =

A

acute necrotising parenchymal and perianal infection due to gas forming uropathogens esp E coli

116
Q

emphysematous pyelonephritis usually occurs in __ and is ass with +++

A

diabetics

ureteric obstruction, fever, vom, flank pain

117
Q

Ix for emphysematous pyelonephritis =

A

palin abdo XR (KUB) = gas

CT defines extent

118
Q

Rx for emphysematous pyelonephritis =

A

nephrectomy

119
Q

perinephric abscess is usually due to ___
Ix =
Rx =

A

rupture of an acute cortical abscess into perinephric space / from haem. seeding
CT
Abx and drain

120
Q

Ix for renal trauma with haematuria/penetrating/shock

A

contrast CT

121
Q

Rx for kidney trauma =

A

angiography/embolisation (98% Rx of blunt trauma)

Sx

122
Q

Ix for bladder trauma =

A

CT cystography

123
Q

post urethral injusry is often ass with

A

pubic rami #

124
Q

___ is most vulnerable part of urethra to trauma as is fixed at __+__

A

bulbomembranous junction

urogenital diaphragm and puboprostatic ligaments

125
Q

s+s of urethral trauma

A 
blood at meatus
cant urinate
palpable bladder
high riding prostate
butterfly perineal haematoma
126
Q

Ix for urethral trauma =

A

retrograde urogram

127
Q

Rx for urethra trauma

A

suprapubic catheter

delayed reconstruction >= 3 months later

128
Q

in kidneys: petechial haemorrhages, arteriolosclerosis and hyalinosis suggests:

A

hypertension

129
Q

in malignant hypertension ____ is seen in the kidneys

A

fibrinoid necrosis

130
Q

lesions on the kidney seen in diabetes mellitus

A

Kimmelstiel-Wilson

131
Q

form of inherited kidney disease ass with Berry aneurysms and subarachnoid haemorrhages

A

ADPKD

132
Q

dilatation of the renal pelvis and calyces

A

hydronephrosis

133
Q

renal cell carcinoma is derived from which tissue

A

renal tubular epithelium

134
Q

the being present increases the likelihood of renal cell carcinoma metastasising

A

renal vein invasion

135
Q

3/4 of bladder cancers are found in this area

A

trigone

136
Q

used to treat superficial bladder cancers

A

mitomycin

137
Q

the hormonal predisposers to BPH and prostate ca

A 
BPH = oestrogen increased compared to testosterone
Ca= androgen driven
138
Q

eGFR is not used in AKI because

A

Cr is changing rapidly

and Cr lags behind GFR

139
Q

Cr and urea tend to rise together but a disproportionate rise in urea can be because of __

A

high protein meal (eg. gut bleed)
hypercatabolic state
dehydration

140
Q

NSAIDs have a worse effect on the kidneys if the ptnt is ___

A

dehydrated

RenalJaz (10 decks)

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