renal, penis, balls, female reproductive Flashcards

(128 cards)

1
Q

kidney functions
 Structure: filter %
 Excretes what waste?
 Regulates?
 Maintains what balance?
 Endocrine?

A

 Structurally complex - 0.4% of body weight, but filters 25% of blood through glomeruli
 Excretes nitrogenous waste products of metabolism - cleans the blood – turns 1.5 L into urine
 Regulates body water and electrolytes
 Maintains appropriate acid-base balance
 Endocrine organ – secretes hormones
 Renin – blood pressure
 Erythropoietin – proliferative effect on bone marrow to make RBCs

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2
Q

components of the nephron

A

 Glomeruli
 Convoluted tubules
 Collecting ducts

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3
Q

JGA controls? how/components?

A

BP
 Juxtaglomerular cells in wall of afferent arteriole: Sensor for blood pressure
 Macula densa in wall of distal convoluted tubule: Sensor for sodium

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4
Q

Azotemia – Laboratory Findings

A

 Elevation of blood urea nitrogen and creatinine levels

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5
Q

azotemia usually related to what?

A

 Usually related to reduced glomerular filtration rate (GFR)

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6
Q

azotemia can be associated with what disorders?

A

Associated with many primary renal disorders or May also be associated with extra-renal disorders

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7
Q

pre and post renal azotemia

A

 Pre-renal azotemia – hypoperfusion of the kidneys decreases GFR in the absence of parenchymal damage

 Post-renal azotemia – urine flow obstructed below the level of the kidney

both lead to azometia

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8
Q

Uremia – Clinical Findings

A

 Progression of azotemia to produce clinical manifestations and systemic
biochemical abnormalities

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9
Q

causes of uremia

A

failure of excretion or metabolic/endocrine alterations

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10
Q

gastric? nn? pericadium? skin?

uremia secondary involvment of organ systems

A

 Uremic gastroenteritis
 Peripheral neuropathy
 Uremic fibrinous pericarditis
 Uremic stomatitis

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11
Q

possible clinical manifestations of renal dx

A

nephritic
nephrotic
acute failure
chronic failure
UTI
nephrolithsatsis
UT obstructiuon
renal tumors

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12
Q

signs?

nephrotic syndrome

A

Glomerular syndrome
 A non-specific disorder in which the kidneys are damaged, causing them to leak large amounts of protein from the blood into the urine.
 Heavy proteinuria
 Hypoalbuminemia
 Severe edema
 Hyperlipidemia
 Lipiduria

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13
Q

nephritic syndrome
 onset?
 signs?

A

 Glomerular syndrome
 A non-specific disorder in which the kidneys are damaged, causing them to leak protein and red blood cells from the blood into the urine.
 Acute onset
 Grossly-visible hematuria
 Mild-to-moderate proteinuria
 Azotemia
 Edema
 Hypertension

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14
Q

 Glomerulonephritis
 tx?

A

an immune mediated disease of the renal glomeruli
 Treated with steroids

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15
Q

 Pyelonephritis
 Treated with?

A

an infection of the kidney (not the glomerulus) usually caused by bacteria and of retrograde origin
 Treated with antibiotics

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16
Q

Post-Streptococcal Glomerulonephritis
(Postinfectious Glomerulonephtitis)
 onset?
 Type of immune injury

A

 Acute onset of nephritic syndrome in 9-14 days following
Streptococcal infection
 Type III immune injury (Immune complex-mediated inflammation)

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17
Q

Pyelonephritis paths of infection

A

 Hematogenous dissemination – least common
 Ascending infection – most common
 Fecal bacteria from perineal area

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18
Q

tx?

how to test for polynephritis

A

Culture and sensitivity – Bactrim tx

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19
Q

Pyelonephritis is much ______ common than glomerulonephritis

A

Pyelonephritis is much more common than glomerulonephritis

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20
Q

Kidney Stones (Nephrolithiasis)
Urolithiasis
common? may cause?

A

 Common
 May cause obstruction

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21
Q

signs of nephrolithstasis
tx?

A

 Pain
 Hematuria
 Pyuria (pus in urine)
 Lithotripsy= sound waves to break up stones

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22
Q

those with kdney stones are prone to?

A

ascending infections

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23
Q

nephrolithstasis may be associated with?

A

 May be associated with hypercalcemia (for example,
hyperparathyroidism, metastatic skeletal disease, multiple myeloma

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24
Q

tx of kidney stones

A

Extracorporeal Shock
Wave Lithotripsy (ESWL)= break up to smaller pieces

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25
Staghorn Calculus
large calculus deposit in the kidney
26
forms of nephrosclerosis
benign and malignant, both often due to hyperBP
27
malignant nephrosclerosis
CM junction is obstrucuted
28
simple renal cyst
common, benign can be single or many
29
genetic dx of polycystic kidneys
Autosomal Dominant Polycystic Renal Disease
30
# where are the dialysis tubes dialysis vessel complication
Dialysis Shunt - Arterio-Venous Fistula possible | both tubes in the vv
31
what changes can occur at kidneys due to dialysis
cystic changes
32
what can result from cystic chnages of the kidneys with dialysis
renal cell carcinoma
33
# how can. this be done potentially End Stage Renal Disease long term tx
End Stage Renal Disease - Transplant | can simply add adiitonal kidney-do not remove other two
34
what is a comoplication of trnasplant for renal failure
rejection, tx with immunosupressants
35
Renal Cell Carcinoma  Arises from?  Often present how?  May grow into?
 Arises from renal tubular epithelium  Often silent, non-specific S/S  May grow into renal vein
36
infarcts and renal cell Ca
can lead to infarct such as adrenal gland
37
is metastisis common at kidney
no, but possible
38
Wilm’s Tumor (Nephroblastoma)  demo  presentation  sign survival rate?
 Children under 5 years  Abdominal mass  Chronic low-grade fever high survival rate (95%)
39
Wilm’s Tumor (Nephroblastoma) histo
Histopathology consists of several cell types, some of which resemble abortive glomeruli and others that resemble skeletal muscle
40
Urothelial Carcinoma  Arises from?  most common site?  sign?
 Arises from the urinary tract lining epithelium (transitional epithelium)  Bladder most common site  Painless hematuria
41
urothelial carcinoma risk factors
 Cigarette smoking, industrial solvents (beta-naphthlylamine), chronic cystitis, schistosomiasis, drugs (cyclophosphamide)
42
Urothelial Carcinoma Clinical significance depends on:
histologic grade, differentiation and depth of invasion
43
where else can urothelial Ca occur?
Renal Calyces kidney
44
Prostate – Three Major Diseases
 Prostatitis  Benign prostatic hyperplasia  Adenocarcinoma of prostate
45
Prostate-Specific Antigen - PSA  WNL ?  Increased levels may suggest?  Elevated in?  Velocity of change?
 Protein present in the serum at low levels (nl: < 4 ng/mL)  Increased levels may suggest the presence of prostate cancer  Elevated in prostatitis  Velocity of change significant
46
PSA physio functions
 Liquefy semen, allowing sperm to swim freely  Dissolution of cervical mucous cap
47
Prostatitis tx?
 Acute bacterial disease treated with antibiotics
48
Nodular (Benign) Prostatic Hyperplasia - BPH can lead to?
 Obstruction to flow  Urinary frequency  Ascending infections
49
with BPH what should be ruled out
neoplasia
50
tx BPH
 Pharmacologic treatment  Surgical treatment (TURP)
51
Adenocarcinoma of Prostate common?
 70% of men develop prostate cancer by 70-80 years of age
52
# clnical behavior? diagnosis of prostate adeno-Ca
 Digital rectal prostate examination  Biopsy – multiple cores  Wide variation in clinical behavior
53
grading of prostate cancer scale name
 Gleason grading
54
Metastatic Prostatic Adenocarcinoma can go to?
the spine
55
what lesion can be seen on xray with metastic prostate adeno-Ca
Osteoblastic Lesion
56
Testes dx's
 Cryptorchidism  Seminoma  Infections
57
Cryptorchidism
Cryptorchidism  Absence of one or both testes in the scrotum  Failure of testis to descend from an abdominal position through the inguinal canal into the scrotum (“undescended” testes)
58
Cryptorchidism can lead to
 Infertility  Increased risk for neoplasia
59
Cryptorchidism tx
orchiopexy
60
Seminoma  common?  demo?  tx?  treatable and curable?
 Most common germ cell tumor of testis  Young adults (15-34 years)  Surgery plus radiation therapy and chemotherapy  One of the most treatable and curable cancers  Over 95% long-term survival in early stages
61
Infectious Parotitis (Mumps) and testes
 Complications rare in the young and more common in older individuals  Orchitis can occur
62
Hypospadias
 Developmental defect of the urethra in the male  Abnormally placed urethral meatus  Urethral meatus opens on the glans penis most commonly (first degree hypospadias)
63
Peyronie’s Disease
fibrous cord in the penis causing curve
64
Phimosis
 Foreskin cannot be fully retracted from the head of the penis
65
Priapism
 Erect penis or clitoris does not return to its flaccid state, despite the absence of both physical and psychological stimulation, within four hours  Medical emergency  Hematologic diseases are predesposition: Sickle cell disease and Leukemia  Trauma
66
Erythroplasia of Querat
decreased thickness of tissue at head causing ulceration (immature keratinocytes)
67
can SCCa occur at penis
yes
68
Uterine Leiomyoma  B/M? tissue?  May cause?
 Benign smooth muscle neoplasm= “Fibroids”  May cause irregular bleeding (metrorrhagia) or Painful intercourse (dyspareunia)
69
# what can these cause? Proliferative Lesions of the endometrium
Endometrial Hyperplasia and Polyps Glandular epithelium Bleeding
70
Two Major Diseases of the Endometrium
 Endometriosis  Adenocarcinoma
71
Endometriosis  what/where?  influenced by?  sign?  Symptoms depend on? worsen with?
 Endometrial tissue outside the uterine cavity  Ectopic endometrial tissue influenced by hormonal changes  Recurring pelvic pain  Symptoms depend on the site involved and worsen with the menstrual cycle
72
endometriosis can cause what at ovaries
ovarian adhesions and choclate cysts
73
Risk Factors for Endometrial Carcinoma
 Age – most common in the 55 to 65 age group  Obesity – greater synthesis of estrogen in body fat  Infertility – women who are nulliparous are at increased risk of endometrial carcinoma
74
Cervical Squamous Cell Carcinoma detection
 Exfoliative cytologic screening for early detection (Papanicolau smear)
75
where does cervical SCCa occur?
 Squamo-columnar junction
76
HPV and cervical cancer
 High risk HPV sub-types – 16, 18
77
can cervical cancer be prevented
yes HPV vax
78
Sequence of Events That May Follow HPV Infection
79
premalignant lesion of cervical cancer
Cervical Intraepithelial Neoplasia - Grades I, II, III  LSIL (low-grade squamous intraepithelial lesion)  HSIL (high-grade squamous intraepithelial lesion) depends on level of epithelial invasion
80
Teratoma  contains?  Generally arise in?  Most commonly seen in?  app? – B/M? – may contain?
 A tumor containing tissues from all three germ layers (Most tumors are derived from one cell layer)  Generally arise in gonadal tissues  Most commonly seen in the ovary  “Dermoid cyst” of the ovary – a benign cystic teratoma – may contain a variety of tissues including hair, teeth, bone, cartillage, thyroid, etc.
81
ectopic pregnancy
fertilized egg embeds in the tube potetnial for rupture and massive internal bleeding, must be removed
82
pelvic inflam dx
usually inflammatory mass occrung in F tract that can obscure ovary/tubes
83
Gonorrhea and PID  microbe?  can lead to?
 Neisseria gonorrhea  “Mother nature’s birth control”  causes Pelvic inflammatory disease  can lead to Tubal scarring and Ectopic pregnancy (infertility)
84
Neisseria Gonorrhea in males may cause?
Acute Epididymitis –
85
Neisseria Gonorrheae in females can form?
Tubo-Ovarian Abscess
86
Accessory Nipples
many forms
87
Breast components?
 Glandular epithelium  Ducts  Lobules  Interstitial tissue  Lymphatics
88
Lymphatic Drainage of Breast
mainly to axillary LN
89
Physiologic Hyperplasia of Female Breast / Breast Development
based on hormone levels, increased at puberty/preg and lactation
90
Fibrocystic Changes of the breast
often occur at breasts and do present as masses but are benign, most common finding at breasts
91
Gynecomastia causes? if bi/unilateral?
 Enlargement of male breast may occur in response to estrogen  Hyperestrinism in male Cirrhosis of liver – inability to metabolize estrogens Klinefelter syndrome Estrogen-secreting tumors Estrogen therapy  Bilateral – rule-out hormonal  Unilateral – rule out tumor
92
Fibroadenoma  common? B/M?  present as?  demo?
 Most common benign neoplasm of breast  Discrete, usually solitary, moveable nodule  Young women (third decade)
93
forms of malignant breast cancer
Lobules - lobular carcinoma * Lobular carcinoma-in-situ * Invasive lobular carcinoma Ducts - ductal carcinoma * Ductal carcinoma-in-situ * Invasive ductal carcinoma
94
Pathogenesis of Breast Cancer  Genetic?  Hormonal?  Environmental?
 Genetic changes  Hormonal influences  Environmental variables
95
Risk Factors in Breast Cancer  Well-established risk factors  Age?  Genetics/genes?  Menstrual history?  Length of?  Nulliparous?  Geographic?
 Age – uncommon < 30 y  Genetics and family history - p53, BRCA1/2 genes  Menstrual history – early menarche (<12y), late menopause (>55y)  Length of reproductive life  Nulliparous – having children is protective  Geographic variation
96
other risk factors of breast cancer  Exogenous?  contrceptives?  Ionizing radiation?
 Exogenous estrogens -postmenopausal hormone replacement therapy  Oral contraceptives – newer formulations of balanced, low doses of estrogen and progestin safe  Ionizing radiation during breast development
97
 Less well-established risk factors of breast cancer
 Alcohol consumption  High fat diet  Obesity  Cigarette smoking
98
# what is mutated?  Familial syndromes and breast cancer
Li-Fraumeni Syndrome –germ-line mutations in p53 Cowden Syndrome –germ-line mutations in PTEN Ataxia-telangiectasia gene – DNA repair genes BRCA1/BRCA2 – germ-line mutations
99
HER2/NEU proto-oncogene  normal function? Amplified in? Overexpression associated with? Therapeutic intervention?
Epidermal growth factor receptor Amplified in 30% of breast cancers Overexpression associated with poor prognosis Therapeutic intervention –Herceptin (trastuzumab)
100
amplifications of what genes can lead to breast cancer
Amplification of RAS and MYC (proto-oncogenes)
101
mutations to what genes can lead to breast cancer
Mutations of Rb and p53 (tumor suppressor genes)
102
 Estrogen receptor positivity indicates what tx?
Therapeutic intervention - Tamoxifen
103
Hormonal Changes – Risk Factors for breast cancer
 Increased exposure to estrogen Long duration of reproductive life (More estrogen) Nulliparity – having children is protective Late age at birth of first child
104
estrogen effect on breast tissue
Estrogen exposure has a proliferative effect on breast tissue. Proliferative breast disease found on biopsy indicates an exposure to increased levels of estrogen. An increased risk of breast cancer is found in women who have proliferative breast disease
105
The more estrogen the breasts are exposed to over a lifetime, the ____ risk of cancer? when are these levels higher
The more estrogen the breasts are exposed to over a lifetime, the higher the risk of breast cancer. During each monthly menstrual cycle, the breasts are exposed to increased estrogen levels, especially at the time of ovulation.
106
early age of menses and late menopause effect for breast cancer?
 Both early age at the start of menstrual cycles (menarche) and late menopause increase breast cancer risk through increased exposure to estrogen during more menstrual cycles.
107
Late age for menarche and early age for menopause and breast cancer risk?
ate age for menarche and early age for menopause decrease breast cancer risk through fewer menstrual cycles.
108
Birth control pills and hormone replacement therapy _______ breast cancer risk why?
Birth control pills and hormone replacement therapy increase breast cancer risk through increased exposure to estrogen.
109
Removal of both ovaries before natural menopause ______ breast cancer risk why?
Removal of both ovaries before natural menopause decreases breast cancer risk by decreasing levels of estrogen.
110
how can OH cause breast cancer?
Alcohol consumption. The more alcohol consumed, the more impaired the liver becomes in its ability to metabolize estrogen. Therefore, alcohol consumption increases breast cancer.
111
# pre and post menopause obesity and breast cancer
dipose tissue produces small amounts of estrogen. After menopause, obesity increases breast cancer risk by increasing the level of estrogen. The more fat, the higher the estrogen level. Premenopausal obesity does not increase breast cancer risk. Before menopause, obesity causes hormonal changes which decrease estrogen production by the ovaries and can even result in infertility.
112
age at birth of first child and breast cancer
There is a change in structure of breast lobule at pregnancy. Late age at birth of first child increases breast cancer risk. With late age at birth of first child, type 1 and type 2 breast lobules persist longer. They are more sensitive to carcinogens. Therefore, risk increases. During the 3rd trimester of pregnancy (after 32 weeks), the breast lobules mature into Type 3 lobules. Type 4 lobules are formed after childbirth and produce milk. Both Type 3 and Type 4 lobules are resistant to carcinogens.
113
main breast cancer location
upper outer quadrant
114
Classification of Breast Cancers (Abridged)
Noninvasive – have not penetrated the basement membrane  Ductal carcinoma in situ (DCIS, intraductal carcinoma)  Lobular carcinoma in situ (LCIS) Invasive – have penetrated the basement membrane (infiltrating)  Invasive ductal carcinoma – most common (scirrhous carcinoma)  Invasive lobular carcinoma
115
# precursor to? if it progresses where will it form? Ductal Carcinoma in Situ
 Precursor lesion to invasive carcinoma  When invasive carcinoma develops in a woman with a previous diagnosis of DCIS, it is usually in the same breast.
116
# if estrogen receptor +? post-menopause? ductal Ca in situ tx
surgery and radiation  Tamoxifen – antiestrogenic if estrogen receptor + (blocks estrogen receptor)  Aromatase inhibitors – post-menopausal women (blocks estrogen formation)
117
Paget’s Disease of Nipple  variant of? how?  app?  Underlying invasive carcinoma?
Clinical variant of DCIS  Extension of DCIS up to the lactiferous ducts and into the contiguous skin of the nipple  Crusting exudate over the nipple and areolar skin  Underlying invasive carcinoma in 50%
118
Lobular Carcinoma in Situ  proportion developing invasive carcinoma?  The invasive carcinoma may arise in?  LCIS is a marker of?  prophylactic mastectomy?
 One-third of women with LCIS develop invasive carcinoma  The invasive carcinoma may arise in either breast  LCIS is a marker of increased risk for developing breast cancer in either breast  Bilateral prophylactic mastectomy may be performed
119
Invasive Ductal Carcinoma  % breast carcinomas  Term used for? does not imply?  synonyms for invasive ductal carcinoma?
Invasive Ductal Carcinoma  Most breast carcinomas (70-80%)  Term used for all carcinomas that cannot be sub-classified into a specific type (not discussed)  Does not imply that the tumor specifically arises from the duct system  Carcinoma of “no special type” or “not otherwise specified” (NOS) are synonyms for invasive ductal carcinoma
120
Invasive Ductal Carcinoma has what response?
IDC has a Scirrhous Response (hardening/induration, dense stroma)
121
invasive ductal Ca invades what tissue of the breast?
adipose
122
Clinical Features Common to all Invasive Carcinomas  Fixation?  Adherence?  Lymphatic involvement may cause?
 Fixation secondary to adherence to pectoral muscles or deep fascia of chest wall  Adherence to overlying skin with retraction or dimpling of the skin or nipple  Lymphatic involvement may cause localized lymphedema with the skin thickened around exaggerated hair follicles (peau d’orange – orange peel appearance)
123
TNM Staging of Breast Cancer
satges 1-4
124
stage 1 breast cancer
umor <2 cm, without nodal involvement, no metastases
125
stage 2 breast cancer
tumor <5 cm with <3 nodes and no distant metastases (or more than 5 cm without nodes)
126
stage 3 breast cancer
many categories, any cancer infiltration into skin and chest wall, with nodes, without disseminated metastases
127
stage 4 breast cancer
any cancer with disseminated metastases
128
Prognostic Factors of breast cancer  Size of?  Lymph node?  Distant?  Histologic?  Estrogen or progesterone receptor? tx?  Proliferative?  Aneuploidy?  HER2/NEU? tx?
 Size of primary carcinoma  Lymph node involvement and number of nodes  Distant metastases  Histologic grade  Histologic type  Estrogen or progesterone receptor expression - Tamoxifen  Proliferative rate  Aneuploidy  HER2/NEU overexpression - Herceptin