Renal and Genito-urinary system Flashcards

Question

Pathology of renal disease: What are the risk factors for transitional cell carcinoma of the renal pelvis?

Answer 1

cigarette smoking industrial dyes e.g. aniline long term painkillers

Answer 2

Small virus 120-200 nm Icosahedral (viral shape) capsid surrounding ds (double stranded)DNA 80 genes coding for ~ 100 proteins

Answer 3

α-herpesviruses - epidermal/neuronal viruses with a wide host range Type 1 Herpes Simplex Virus Type 2 Herpes Simplex Virus Varicella-Zoster Virus (VZV) HHV-1 HHV-2 HHV-3 β-herpesviruses - slow growth, primarily in T-cells and leukocytes Cytomegalovirus (HCMV) Human Herpesvirus 6 Human Herpesvirus 7 γ-herpesviruses - primarily B-lymphocytes Epstein-Barr virus (EBV) Human Herpesvirus 8 HHV-5 HHV-6 HHV-7 HHV-4 HHV-8

Answer 4

check slides

Answer 5

virus binds to host receptor - binds to glycoproteins, then receptor taken inside cell dna released from virus particle - (uncoated) translocates to the nucleus viral dna in the nucleus interacts with host polymerases Transcription occurs - mrna of viral protein, gets translated then, viral proteins produced viral protein binds to host polymerase - makes it more efficient machinery replicates viral dna - lots of copies everything is assembled - translocates to nucleus to get packaged to make new viral particles host cell membrane bursts and releases viral particles to infect other cells lots of cell damage occurs

Answer 6

HSV 1 n Mainly Oral Infections HSV 2 n Mainly Genital Infections 1° Herpes Simplex (infection) n also called Herpetic Gingivostomatitis 2° Herpes Simplex (reactivation) n Herpes Labialis (cold sores)

Answer 7

Virus enters trigeminal sensory neurones Migrates to trigeminal ganglion Becomes Latent in the Trigeminal Ganglion In 50% of cases it remains dormant in the trigeminal ganglion

Answer 8

In 50% of cases it becomes reactivated Migrates to peripheral nerve endings Where active viral particles are shed

Answer 9

``` Reactivation caused by: n UV light Stress n Illness n Immuno-suppression ``` also causes herpes labialise - cold sores - Lesion resolves Virus lays dormant again in trigeminal ganglion until reactivated

Answer 10

Incubation period around 5 days Drinking and eating painful, often bad breath (halitosis) Multiple oral vesicles - rupture to form extensive sloughing ulcers Gingivitis with erythema (increased redness of the gums) Malaise, pyrexia (temperature), lymphadenopathy (enlarged lymph nodes) Duration 5-14 days

Answer 11

Typical clinical appearance | Main diagnostic difficulty with erythema multiforme

Answer 12

Not normally done Rising antibody titre / presence of IgM antibodies Viral culture or now mainly PCR

Answer 13

Denature DNA to single strands - 95 degrees Annealing of specific primers to DNA Extension by polymerase - 55 degrees, then 72 degrees Repeat 30-35 times

Answer 14

Acyclovir (200mg 5 x daily for 5 days) if found early or in immunocompromised - must apply when tingling lips Fluids and soft diet Analgesics / antipyretics (paracetamol) Local antiseptics e.g. chlorhexidine Topical analgesics e.g. Difflam X-infection control

Answer 15

HSV thymidine kinase (TK) is more effective at phosphorylating nucleotides than human TK. TK used to make bases for DNA ie viral DNA replication ACV is a false nucleotide. Human cells cannot phosphorylate ACV very well In HSV-infected cells, ACV is phosphorylated by the viral TK enzyme to ACV- P ACV- P then inhibits virus replication – i) Get incorporated into replicating viral DNA but further bases cannot be added as ACV- P lack a terminal hydroxyl group. It is a chain terminator. ii) ACV- P acts on the virus DNA complex and inhibits the activity of DNA polymerase, so virus DNA manufacture is markedly inhibited.

Answer 16

Prodromal irritation Vesicles at or near mucocutaneous junction of lips Crusting lesions lasting 7-10 days Usually re-occurs at the same sites Rarely: - may occur, intra-orally, in nose or elsewhere on ski

Answer 17

Management: Acyclovir cream 5% if used very early OTC drying and antibacterial agents Prophylactic treatment: Rarely justified Prophylactic acyclovir will prevent lesions in the immunocompromised or those susceptible to erythema multiforme

Answer 18

Herpetic infection of the fingers from handling the oral tissues of someone with active 1° or 2° Herpes simplex lesions (mainly dentists) Very painful Very difficult to treat Prevention better than cure - wear gloves

Answer 19

Mainly affects frontal lobes of the brain 70% - 80% mortality if untreated Of survivors, only 3% return to normal Usually only people >50 years (HSV-1) and neonates (HSV-2) affected.

Answer 20

Adults (HSV-1) • Headache and behavioural changes over several days • Fever • only 11% of cases have a history of recurrent HSV infection

Answer 21

Neonates (HSV-2) • Skin rash, lesions and CNS symptoms • Virus present in liver, lung and adrenal glands • Respiratory distress • Fits and convulsions • Raised intracranial pressure • Incidence is approximately one case per 300,000 live births in the UK

Answer 22

Chicken pox - varicella zoster virus secondary - herpes zoster (shingles)

Answer 23

In the dorsal root/ trigeminal ganglia

Answer 24

Age (70% >50yrs) • Stress • Illness • Immunosuppression leads to secondary hsv - shingles, but seldom reoccurs

Answer 25

chest and back belt like rash - zoster

Answer 26

Pre-herpetic neuralgia Rash Post-herpetic neuralgia

Answer 27

Pain in the distribution of the affected division of the trigeminal nerve Prior to the development of the rash May mimic dental pain

Answer 28

``` Unilateral vesicles in the distribution of a branch of the trigeminal nerve n Ophthalmic n Maxillary n Mandibular ``` Vesicles break down to form n Ulcers (mucosa) n Crusting lesions (skin) Last 2-3 weeks

Answer 29

glaucoma, cataract, double vision and scaring of the cornea

Answer 30

Acyclovir 800mg 5 x daily for 7 days if seen soon after lesions develop Analgesics Ophthalmic referral if eye involved Avoid contact with children

Answer 31

Valaciclovir 1g 3 x daily for 7 days Famiciclovir 250mg 3 x daily for 7 days bit more specific

Answer 32

10% of patients go on to get extremely unpleasant intractable burning pain in the distribution of the affected nerve More common in the elderly Effective early treatment of zoster may ↓ risk of neuralgia Treat pain with tricyclic anti-depressants and neuropathic pain drugs

Answer 33

Infectious Mononucleosis (Glandular Fever) – acute 1o infection with EBV Burkitt’s Lymphoma – a B-cell malignancy Nasopharyngeal Carcinoma – an epithelial cell malignancy Oral Hairy Leukoplakia – seen i

Answer 34

oro- pharyngeal epithelial cells but then establishes latency in B-lymphocytes

Answer 35

Symptoms include sore throat, swollen cervical lymph nodes and mild fever Petechiae on soft palate Creamy exudates on fauces Cervical lymphadenopathy Infections in the western world are usually seen in young adults

Answer 36

EBV gets into B cells - causes malignant B cell lymphoma treatment - cyclophosphamide (chemo)

Answer 37

Large ragged oral mucosal ulcers Salivary gland swelling Retinitis

Answer 38

lesions all over the body driven by HSV in aids patients

Answer 39

External site up the UT continuum which can lead to involvement of the kidneys

Answer 40

catheterisation

Answer 41

Shorter ureter and nearer to anus pregnancy - pressure on bladde reduces ability to empty bladder and some immunosuppression so higher chance of UTI

Answer 42

Painful urination urine that contains pus

Answer 43

kidney infection, characterised by fever and back pain

Answer 44

Urethra infection bladder infection

Answer 45

``` Renal calculi ureteric reflux tumours bladder stones pregnancy neurologic problems prostatic hypertrophy short urethra catherisation ```

Answer 46

``` capsular antigens hemolysins urease - raises pH so it can grow adhesion to uroepithelium introital colonisation ```

Answer 47

Sampling of midstream Urine (with care) - cloudy or clear - haematuria? (urine might be pink) culture on agar plates > 2x105 cells/ml *around 500 on a plate) - traces of protein, leukocytes >10/ml - Raised nitrites (NO3- > NO2-)- from bacterial metabolism Pure or mixed growth? - Gram Stain of isolated bacteria or direct staining from urine sample

Answer 48

E coli - gram negative rod Proteus mirabilis- Gram negative pleomorphic rod- swarming motility Staphylococcus saprophyticus- Gram positive coccus

Answer 49

Cysteine-lactose-electrolyte-deficient (CLED) media (turquoise coloured) rich media containing lactose and lacking electrolytes (salt) to repress swarming Subsequent plating on Macconkey agar if E.coli suspected (although Gram stain informative). - produces pink colonies then strain designation by PCR and sequencing

Answer 50

Gram-negative motile bacillus - Also causes GI-infections, but UTIs commonly caused by specific strains of E.coli known as UPEC - These differ at the genome level from enteric strains by having up to 1000 extra genes - Possesses potent adhesins for attachment to epithelium - pili

Answer 51

Type 1 pili - Binds mannose receptors, common on glycoproteins in uroepithelium P-fimbriae: (often found in pyelonephritis strains) Binds to globobiose (aD-Gal-(1,4)-aD-Gal) made up of linked ceramide host lipids

Answer 52

for antibiotic resistance

Answer 53

ability to move over a surface

Answer 54

Urease: urea>> ammonia + CO2, raises pH of urine>>> can cause precipitation of minerals to form kidney and bladder stones IgA protease- reduces flushing… Many pili adhesins

Answer 55

Gram positive- cocci Haemagglutinin key to attachment to cells common cause of UTIs in young women Coagulase negative Novobiocin resistant - used in diagnosis Most common in young women

Answer 56

New guidelines do NOT indicate antibiotic use for uncomplicated lower UTI in Non-Pregnant women Fever, pain in kidney area- antibiotics recommended, in men and pregnant women always indicated > 3-day course in women, 7-day in men (infection is less common, can be more serious by the time detected) Common antibiotics: Nitrofurantoin (1st-line) Ciprofloxacin, penicillins and trimethoprim Resistance a growing issue, esp. for E. coli (>30% are Tm resistant)

Answer 57

Usually skin commensals like S. aureus and epidermidis or Pseudomonas spp. (Strict aerobe), Klebsiella and Enterococcus become opportunistic and a lot of them are resistant ESKAPE pathogens

Answer 58

``` Enterococcus faecium Staphylococcus aureus Klebsiella pneumoniae Acinetobacter baumannii Pseudomonas aruginosa Enterobacter species ```

Answer 59

Similar to community but may require IV antibiotics: nitrofurantoin, cefalexin, Penicillins- depends on microbiological data, resistance profiles Immediate removal and changing of catheter and bag Super-resistant E.coli infections now treated with Plazomicin in USA_ expected to come to UK soon.

Answer 60

Any form of sexual activity in which no barrier is used and exchange of fluid or contact with mucosal epithelium occurs

Answer 61

Neisseria gonnorhoea >>> Gonnnorhoea Chlamydia trachomatis >>> chlamydia Treponema pallidum >>> Syphilis

Answer 62

Exclusively a fully virulent human pathogen; - never found as a commensal Asymptomatic carrier state: mainly females - Acute urethritis in 95% males - only ~ 50% women show discharge, dysuria Ascend to Fallopian tubes - acute salpingitis (infection of the Fallopian tubes), pelvic inflammatory disease - sterility Ophthalmia neonatorum – infant blindness Oral gonnorhea (bacteria prefers columnar epithelium instead of squamous)– very rare, but can result from oral sex with infected man

Answer 63

Surface pili- pil proteins- attachment Opa proteins- aid attachment Lipo-ologosaccharide: sialylated (sialic acid is a host sugar)- complement resistance- host mimicry Por proteins- nucleate actin aiding cell invasion Possesses IgA protease- aids survival inside host cells Release into bloodstream disseminates infection to other sites fever, arthiritis (1-3% women, much lower in men), endocarditis

Answer 64

Hiv x5 Co-infection of HIV and N. gonorrhoeae increases transmission of HIV by 500% (WHO)

Answer 65

Urethral swab - Susceptible to dessication, so transport medium used - Sub-culture on chocolate agar - Sugar fermentation tests–glucose +ve - Oxidase test positive

Answer 66

Contact tracing- antibiotic prophylaxis of contacts Historically penicillin and tetracyclines were drugs of choice Ceftriaxone (IM) and azithromycin - most common (1g orally) recommended first line choice (also kills chlamydia). Many 3rd world strains are Penicillin and Tetracycline resistant, susceptibility tests must be performed

Answer 67

Initial incubation period (2- 10 weeks) Primary lesion: chancre at site of infection - Resolves spontaneously Secondary syphilis : - 6-8 weeks post-infection, Bacteria disseminate around body - Flu-like illness: myalgia, headache, fever, rashes. Latent syphilis: 3-30 years- no symptoms Tertiary Syphilis: - Neurosyphilis- CNS - CV sequelae- aortic lesions, heart failure - skin and bone deformity Treponema sensitive to long-acting penicillin- easily treatable - slow-growth means long-acting course required.

Answer 68

Treponema pallidum TRANSMISSION: Sexual contact via minute skin abrasions Vertical transmission- cross placental: Congenital syphilis

Answer 69

check slide 52

Answer 70

Crosses placenta - Can lead to still-birth - Congenital infection - Birth deformities, silent infection – presents as facial and tooth deformities at 2 years of age

Answer 71

Often asymptomatic in females 50% symptomatic in males Re-infection common as immunity weak Incubation period 7 – 14 days Disease due to direct damage to cells and immunopathology causing fibrosis and scarring Can also cause conjunctivitis- common co-occurence.

Answer 72

Asymptomatic infection = 70 % Mucopurulent cervicitis Urethral infection Pelvic inflammatory disease in up to 40% - ascending infection involving uterus, fallopian tubes, and other pelvic structures Complications include chronic pelvic pain, ectopic pregnancy and infertility

Answer 73

Inflammation of rectum

Answer 74

Very small obligate intracellular parasite Small genome Enters through minute abrasions Specialised life-cycle Seems to avoid and not stimulate immune responses (privileged site?) Prefers to infect non-ciliated columnar and cubiodal epithelium: genital tract from urethra up to fallopian tubes and rectum Also respiratory and conjunctival cells

Answer 75

Tests are available on NHS (and free in Gyms etc): Culture in cells Direct immunofluorescence and ELISA PCR tests (known as NAAT) TREATMENT: Azithromycin (single dose). Doxycycline (longer course).