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Renal Path MC > Renal 6 > Flashcards

Renal 6 Flashcards

1
Q

classic triad of renal cell carcinoma presentation

A

hematuria (MOST COMMON), CV pain, palpable mass

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2
Q

common sites of extension of renal cell carcinoma

A

renal vein and IVC (stage 3), adrenal glands (stage 4)

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3
Q

most common sites of metastasis of renal cell carcinoma

A

lungs and bone

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4
Q

intrinsic causes of urinary obstruction

A

urinary calculi, sloughed papillae, blood clots, tumor, inflammation (prostattis, ureteritis), functional disorder (neurogenic)

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5
Q

progression of pathogenesis of hydronephrosis

A

dilation ureter/pelvis -> progressive atrophy (secondary to obstruction) -> medullary dysfunction -> drop in GFR

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6
Q

inborn errors of metabolism of these familial conditions lead to stone formation

A

gout, cystinuria, hyperoxaluria

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7
Q

makes up 75% of stones

A

calcium oxalate

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8
Q

this makes up 15% of stones

A

triple/strutive stones of magnesium ammonium phosphate

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9
Q

associated condition of triple or struvite stones

A

chronic pyelonephrosis due to Proteus or Staph infection (urea-splitting bacteria)

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10
Q

this favors formation of stones

A

low urine volumes and stasis

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11
Q

these are stones caused by urea-splitting bacteria -> conform to calyces (create casts of calyces) -> major obstruction due to granulomatous reaction around stone

A

staghorn calculi

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12
Q

these kinds of stones are radiopaque

A

calcium (uric acid = radiolucent)

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13
Q

inflammatory reaction associated that causes Staghorn calculi formation; what cells contribute to pathogenesis?

A

xanthogranulomatous pyelonephritis; foamy MP, plasma cells (often with Proteus infection)

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14
Q

signs/symptoms that suggest acute pyelonephritis related to UTI

A

fever, N/V, CV tenderness, WBC casts

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15
Q

cause of chronic pyelonephritis

A

bacteria in face of vesicuoureteral reflux or obstruction

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16
Q

unless this is present, infection will stay localized in the bladder

A

vesicoureteral reflux

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17
Q

these conditions can cause recurrence of infection in acute pyelonephritis

A

unrelieved obstruction, DM, immunosuppression

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18
Q

scarred kidneys are very indicative of this condition

A

chronic pyelonephritis (associated with obstruction)

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19
Q

these give yellow color in chronic pyelonephritis

A

lipid-laden foamy MP

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20
Q

do ureters pass anterior or posterior to common iliac/external iliac artery?

A

anterior

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21
Q

relaxation of pelvic floor of women may lead to this -> protrusion of bladder into vagina

A

cystocele

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22
Q

primary malignant tumor of ureter; what is benign tumor?

A

transitional cell carcinoma; fibroepithelial polyps

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23
Q

pattern of inflammation in bladder characterized by soft, yellow, raised mucosal plaques 3-4 cm in diameter

A

malacoplakia

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24
Q

cells presents in malacoplakia infiltration

A

large foamy MP, multinucleate giant cells, some lymphocytes

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25
Q

associated conditions of malacoplakia

A

chronic bacterial infection (E coli or Proteus) immunosuppressed, transplant recipients

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26
Q

usual organism causing UTI; bacteria causing UTI in women commonly

A

E coli (most common), Proteus, Klebsiella, Enterobacter (gram neg bacilli); Staph saprophyticus

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27
Q

risk factors for transitional cell carcinoma

A

cigarette smoking, 2-naphthylamine/aniline dyes, chronic analgesic use, cyclophosphamide, Schistosoma haematobium infection

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28
Q

bladder infection that causes squamous cell metaplasia -> leads to squamous cell cancer

A

Schistosoma haematobium

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29
Q

this is opening of urethra on ventral surface of penis

A

hypospadias

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30
Q

opening of urethra on dorsal surface of penis

A

epidspadias

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31
Q

zone of prostate most commonly involved with cancer

A

peripheral

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32
Q

zone of prostate where most of BPH occurs

A

periurethral (causes obstruction)

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33
Q

morphology of acute bacterial prostatitis

A

suppurative inflammation from E.coli/gram negatives (enterococci, Staph)

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34
Q

signs/symptoms of acute bacterial prostatitis

A

fever, chills, dysuria, tender and soft prostate (on rectal exam)

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35
Q

possible pathogenesis of BPH

A

dihydrotestosterone accumulation, estradiol increases effects (and DHT receptors) -> hyperplasia ->

36
Q

symptoms of BPH

A

urethral obstruction/urine retention -> dysuria, incontinence, dribbling, nocturia, increase frequency

37
Q

places for local invasion of prostate CA

A

seminal vesicles, base bladder, urethra

38
Q

complete or incomplete failure of abdominal testis to descend into scrotal sac -> possible increase risk of cancer, trauma

A

cryptorchidism

39
Q

possible sequel of cryptorchidism

A

trauma (if in inguinal canal), sterility, testicular cancer

40
Q

paraneoplastic syndromes that present with renal cell carcinoma

A

renin (HTN), EPO (p vera), PTHrP (hypercalcemia), hepatic dysfunction, Cushing syndrome, eosinophilia or leukemoid rxn

41
Q

complications of renal cell carcinoma that has poorer prognosis

A

renal vein invasion or extension into perinephric fat

42
Q

early symptomology of transitional cell carcinomas of the renal pelvis

A

obstruction, hematuria, and tumor fragmentation

43
Q

analgesic nephropathy is associated with this form of cancer

A

urothelial (transitional cell) carcinomas of renal pelvis

44
Q

where does urothelial (transitional cell) carcinomas of renal pelvis infiltrate?

A

pelvis wall and calyces

45
Q

major risk factor for renal cell carcinoma

A

acquired cystic disease/dialysis

46
Q

these organisms predominate in urethritis when associated with cystitis and prostatitis

A

enteric organisms

47
Q

organisms responsible for 25-60% of nongonococcal urethritis

A

Chlamydia trachomatis, Ureaplasma urealyticum

48
Q

triad of arthritis, conjunctivitis, and urethritis

A

Reiter’s syndrome

49
Q

symptomology of urethritis

A

local pain, itching, and frequency

50
Q

normal size/weight of prostate (at least men under 60)

51
Q

second layer of cells in glandular spaces of prostate -> cover basal cell layer

A

columnar mucus secreting

52
Q

morphology of cells of basal layer of glandular spaces of prostate

A

low cuboidal epithelium

53
Q

microscopic morphology of prostate

A

glandular space w/ 2 layers of cells (basal and columnar mucus-secreting), papillary projections in glands, fibromuscular stroma

54
Q

lab findings in bacterial prostatitis

A

> 15 WBC/HPF and bacterial growth prostatic secretion, prostatic count > 1 log urine count

55
Q

exogenous factors of acute bacterial prostatitis

A

surgery, catheterization, cystoscopy, obstruction

56
Q

morphology of chronic bacterial prostatitis

A

chronic inflammation (lymphocytes, MP, plasma cells, PMN, fibrosis)

57
Q

possible presentations/symptoms of chronic bacterial prostatitis

A

recurrent cystitis/urethritis, asymptomatic or dysuria/LBP/perianal or subpubic pain

58
Q

most common form of prostatitis

A

chronic abacterial prostatitis

59
Q

possible symptoms of chronic abacterial prostatitis (same as chronic bacterial)

A

dysuria, LBP, perianal/subpubic pain

60
Q

what do nodules in BPH compress?

A

lateral and ventral urethral wall (located in inner periurethral area of prostate)

61
Q

microscopic morphology of BPH

A

glandular/stromal hyperplasia, glandular dilatation, papilla projection into lumen (from 2 layers of epithelium), cystic dilatation (maybe)

62
Q

morphology of cystic dilatation that is possible in BPH

A

flattened epithelium, foci squamous metaplasia, infarcts

63
Q

most common form of cancer in males -> 10% lethal, usually affects men over 50

64
Q

risk factors for prostatic carcinoma

A

> 50, blacks, Orientals in USA, hormonal (epithelial cells have androgen receptors)

65
Q

gross morphology of prostatic carcinoma; microscopic morphology

A

periphery, gritty and firm; well defined glands w/ dysplastic epithelium, single layer cuboidal epithelium, large/vacuolated/multiple nucleoli

66
Q

areas of hematogenous dissemination of prostatic carcinoma; what is primary location hematogenous spread?

A

lumbar spine, proximal femur, pelvis, thoracic spine, ribs; axial skeleton -> via paravertebral venous plexus

67
Q

bone lesion in prostatic carcinoma

A

osteoblastic

68
Q

Gleason score that is considered high race or poorly differentiated (for prostatic carcinoma)

69
Q

normal cut-off for PSA

70
Q

MOA of PSA

A

liquefies seminal coagulum after ejaculation

71
Q

mainstay of treatment of metastatic prostatic carcinoma

A

endocrine therapy -> deprive of testosterone

72
Q

mechanism of endocrine therapy for metastatic prostatic carcinoma

A

estrogen and LHRH -> decrease LH (from pituitary) -> decrease testicular output testosterone (estrogen also directly decreases)

73
Q

this controls transabdominal descent of testis

A

Mullerian inhibiting substance

74
Q

this phase of testes development is androgen dependent

A

inguinoscrotal

75
Q

this testicular problem is often related with UTI

A

epididymitis/orchitis

76
Q

testicular involvement of mumps

77
Q

lining of these structures has urothelium/transitional epithelium

A

renal pelvis, ureteres, bladder, proximal urethra

78
Q

surface layer of transitional epithelium; what is shape of more basal cells?

A

flattened umbrella cells; cylindrical

79
Q

urothelium/transitional epithelium expresses these blood group antigens -> important in neoplastic transformation

A

A, B, and H

80
Q

this portion of transitional epithelium is capable of great thickening/hyperplasia -> leads to bands/trabeculae and outpocketings

A

lamina propria with smooth muscle

81
Q

3 areas of narrowing of ureters -> can lead to impaction by stones

A

ureteropelvic junction, crossing of iliac vessels, within bladder

82
Q

outlines the bladder trigone

A

ureteral orifices and urethral opening

83
Q

changes that occur due to increased pressures in urinary tract

A

reactive hypertrophy smooth muscle and thinning of epithelium

84
Q

results of proximal transmission of pressures in urinary tract

A

hydroureters, hydronephrosis, pyelonephritis

85
Q

most common source of renal tumors

A

transitional epithelium

Renal Path MC (5 decks)

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