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Med School Year 2 Flash Cards > Robbins > Flashcards

Robbins Flashcards

1
Q

What is hypospadias?

A

Opening of the urethral canal on the ventral surface of the penis

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2
Q

What is epispadias?

A

Opening of the urethra on the dorsal surfaces

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3
Q

What are the complications of hypospadias and epispadias?

A

The abnormal opening is often constricted, resulting in urinary tract obstruction and a higher risk for UTI.
Could also block normal ejaculation – sterility

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4
Q

What is phimosis?

A

When the orifice of the prepuce is too small to permit normal retraction

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5
Q

What usually causes phimosis?

A

Repeated attacks of infection that cause scarring of the preputial ring

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6
Q

What are the complications of phimosis?

A

Permits accumulation of secretions and detritus under the prepuce

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7
Q

What is balanoposthitis?

A

Infections of the glans and prepuce caused by a wide variety of organisms.

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8
Q

What are the common microbes that cause balanoposthitis?

A

Candida, Anaerobic bacteria, Gardernella, Pyogenic bac

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9
Q

What is smegma?

A

Accumulation of desquamated epi cells, sweat, debris that can act as an irritant

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10
Q

What does smegma cause?

A

Phimosis

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11
Q

What is Bowen disease?

A

CIS of genital region
Appears as solitary, thickened, gray-white, opaque-plaque on shaft
Appears as multiple, red, velvety plaques

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12
Q

What kind of cells do you see in Bowen disease?

A

Markedly dysplastic with large hyperchromatic nuclei and lack of orderly maturation

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13
Q

How old are the patients with Bowen disease?

A

Over the age of 35

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14
Q

What percentage of Bowen disease transforms into SCC?

A

10%

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15
Q

Who gets bowenoid papulosis?

A

Occurs in sexually active adults

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16
Q

What does bowenoid papulosis?

A

The presence of reddish brown papular lesions.

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17
Q

What is the natural outcome of bowenoid papulosis?

A

Spontaneous regresses sometimes

Never develops into invasive carcinoma

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18
Q

What offers protection against invasive carcinoma?

A

Circumcision

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19
Q

What elevates the risk of developing cancer of the penis?

A

Cigarette smoking

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20
Q

What age do patients typically get carcinoma of the penis?

A

40-70

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21
Q

What does the papillary type SCC of the penis look like?

A

Cauliflower-like fungating mass

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22
Q

What does the flat type of SCC of the penis look like?

A

Areas of epithelial thickening accompanied by fraying and fissuring of the mucosal surface —- ulcerates

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23
Q

What does the verrucous carcinoma of penis look like?

A

Exophytic well-differentiated variant

Low malignant potential

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24
Q

What is the pathological potential of SCC of penis?

A

Slow growing
Locally invasive
Not painful

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25
Q

What is the prognosis to the SCC of the penis related to?

A

Stage of the tumor

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26
Q

What is cryptorchidism?

A

Complete or incomplete failure of the intra-abdominal testes to descend into the scrotal sac

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27
Q

In what phase do the testis settle into the lower abdomen?

A

The phase controlled by Müllerian inhibiting substance.

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28
Q

In what phase do the testes descend through the inguinal canal into the scrotal sac?

A

Androgen dependent phase 2 mediated by calcitonin gene-related peptide, from the genitofemoral nerve.

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29
Q

What does the histo of cryptorchidic testes look like?

A

Arrest in development of germ cells
Marked hyalinization and thickening of basement membrane of the spermatic tubules.
Leydig cells are prominent
Contralateral testis has paucity of germ cells too

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30
Q

What do cryptorchidic testes look like?

A

Small and firm

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31
Q

What are the complications of cryptorchidism?

A

Sterility
Trauma
Inguinal hernia (10-20%)
Higher risk of testicular cancer

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32
Q

What is the treatment for an undescended testicle?

A

Surgical correction - orchiopexy

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33
Q

What is orchiopexy?

A

Placing the undescended testicle into the scrotal sac surgically

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34
Q

What is cryptorchidism associated with?

A

An intrinsic defect in testicular development and cellular differentiation

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35
Q

What are the causes of atrophy of the testes?

A
  1. Progressive atherosclerosis narrowing the blood supply
  2. End stage of inflammatory orchitis
  3. Cryptorchidism
  4. Hypopituitarism
  5. Malnutrition or cachexia
  6. Irradiation
  7. Prolonged admin of anti-androgens
  8. Exhaustion following persistent stimulation of FSH
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36
Q

What is the histo of atrophy of the testes?

A

Same as for cryptorchidism

No spermatogenesis, thickened basement membrane and hyalinization. Prominent Leydig cells

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37
Q

What is atrophy of the testicles?

A

The end stage to testicular injury characterized by:
Hypospermatogenesis
Maturation arrest
Vas deferens obstruction

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38
Q

Where do gonorrhea and TB arise in the male genital tract?

A

Epididymis

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39
Q

What organ does syphilis arise in first in the male genital tract?

A

Testes

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40
Q

What is epididymis is usually caused by in children?

A

Congenital genitourinary abnormalities and infection with gram neg rods

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41
Q

What is the cause of epididymitis in sexually active men below the age of 35?

A

STDs - chlamydia and gonorrhea

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42
Q

What is the cause of epididymitis in men older than 35?

A

UTI pathogens - E.coli, Pseudomonas

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43
Q

What can epididymitis and orchitis lead to?

A

Abscess formation and suppurating necrosis

Fibrous scarring —- infertility

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44
Q

What disease presents in the Middle Ages with fever and sudden onset of moderately tender testicular mass?

A

Granulomatous orchitis

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45
Q

What is the histo of granulomatous autoimmune orchitis?

A

Granulomas only in the spermatic tubules - look like tubercles

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46
Q

What kind of infection is usually from the posterior urethra to the prostate to the seminal vesicles to the epididymis?

A

A neglected gonorrheal infection

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47
Q

What viral diseases may cause orchitis?

A

Mumps
Orchitis develops one week after swelling of the parotid glands.
Happens in 20-30% of postpubertal males

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48
Q

What does syphilis produce?

A

Gummas, diffuse inflammation + obliterative endarteritis, peri secular cuffing of lymphocytes and plasma cells.

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49
Q

What happens in a torsion?

A

The venous drainage of the testis is cut off and there is vascular engorgement from the arteries leading to infarction

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50
Q

What are the 2 types of torsion?

A
  1. Neonatal

2. Adult

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51
Q

What is the time frame for saving a testicle from torsion?

A

Under 6 hours for it to remain viable

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52
Q

What is adult torsion a result of?

A

Bilateral anatomical defect where the testis has hyper mobility and has the bell clapper effect

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53
Q

What is the treatment for torsion?

A

Untwist it and fix it to the scrotum

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54
Q

What is the most common benign paratesticular tumor?

A

Adenomatoid tumor

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55
Q

What are adenomatoid tumors?

A

Small nodules occurring at the top of the epididymis that can be minimally invasive to the testes.

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56
Q

What are the most common malignant paratesticular tumors?

A

Rhabdomyosarcomas in kids

Liposarcomas in adults

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57
Q

What are common lesions found in the spermatic cord during inguinal hernia repair?

A

Lipoma

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58
Q

Where do most testicular tumors arise from?

A

95% from germ cells

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59
Q

Are sex cord STROMAL cell tumors usually benign or malignant?

A

Benign

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60
Q

At what age is testicular cancer most common?

A

15-34 years old

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61
Q

What are germ cell tumors associated with?

A

TDS - testicular dysgenesis syndrome: cryptorchidism, hypospadias, poor sperm quality

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62
Q

What can cause TDS?

A

In uteri exposure to pesticides and non steroidal estrogens

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63
Q

What is the most important risk factor for testicular cancer?

A

Cryptochidism

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64
Q

What kind do cancers do patients with Klinefelter’s develop?

A

Mediastinal germ cell tumors

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65
Q

What are seminomatous tumors composed of?

A

Cells that resemble primordial germ cells

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66
Q

What are the non-seminomatous tumors composed of?

A

Undifferentiated cells that resemble embryonic stem cells

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67
Q

What percentage of germ cell tumors are mixed?

A

60%

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68
Q

What is the most common testicular tumor?

A

Seminoma

69
Q

What lesion do testicular germ cell tumors originate from?

A

Intra tubular germ cell neoplasia

70
Q

What have ITGCN not been implicated in?

A

A precursor lesion to pedi yolk sac tumors, teratomas or adult spermatocytic seminoma.

71
Q

When does ITGCN occur?

A

In utero

Stay dormant until puberty

72
Q

What does ITGCN consist of?

A

Atypical primordial germ cells with large nuclei and clear cytoplasm.

73
Q

What do the cells of ITGCN express?

A

OCT3/4, NANOC
Copies of 12p
Activating muts of ckit

74
Q

What percentage of patients develop invasive tumors from ITGCN.?

A

100%

75
Q

When do patients get seminoma?

A

Third decade

76
Q

What do seminomas express?

A

OCT3/4, NANOC
Ckit activation
12p copies

77
Q

What do seminomas look like?

A

Bulky grey-white masses

Do not penetrate tunica albuginea

78
Q

What is the histo of a seminoma?

A

Composed of sheets of uniform cells divided into lobules by fibrous septa containing lymphocytes.
The cell = large, round, watery cytoplasm, large central nucleus with 1-2 prominent nucleoli.
15% contain synctiotrohphoblasts
Can increase hCG!
Can also see granulomas

79
Q

What are seminoma cells positive for?

A

Ckit
PLAP - placental alkaline phosphatase
OCT3/4

80
Q

What does anaplastic seminoma look like?

A

More mitosis
Nuclear irregularity
Not associated with a worse prog

81
Q

Who gets spermatocytic seminoma?

A

Over 65

82
Q

What is a spermatocytic seminoma?

A

Slow growing tumor that does not mets!

Soft, pale grey tumor with mucous cysts

83
Q

What is the histo of spermatocytic seminoma?

A

3 cells:

  1. Medium with round nucleus and Eosinophilic cytoplasm
  2. Small with rim of Eosinophilic cytoplasm resembling secondary spermatocytes
  3. Giant cells
84
Q

Who gets embryonal carcinoma of the testes?

A

20-30 years old

85
Q

What does an embryonal carcinoma of the testis look like?

A

Smaller and more aggressive than a seminoma punctuated by foci of hemorrhage and necrosis
Extends thru tunica albuginea

86
Q

What is the histo of embryonal carcinoma of the testis?

A

Cells grow in alveolar or tubular patterns with papillary convolutions
Large anaplastic cells with hyperchromatic nuclei with prominent nucleoli
Lots of mitotes and tumor giant cells

87
Q

What markers do embryonal carcinoma of the testis express?

A

OCT3/4, PLAP
Cytokeratin 34
CD 30

88
Q

What is the most common testicular tumor in children and infants (younger than 3)?

A

Yolk sac endodermal sinus tumor

89
Q

What does a yolk sac tumor of the testis look like?

A

Nonencapsulated yellow-white homogenous mucinous tumor

90
Q

What is the histo of a yolk sac tumor of the testis?

A

Lacelike reticular network of cuboidal / flattened cells
May see Schiller Duvall bodies
Also see hyaline-like globules with alpha fetoprotein and alpha1 antitrypsin

91
Q

What testicular tumor is detected as a small palpable nodule?

A

Choriocarcinoma

92
Q

What is the histo of choriocarcinoma of the testis?

A

Hemorrhage and necrosis
Synctiotrohphoblasts and cytotrophoblastic cells
Make high levels of hCG

93
Q

What does a synctiotrohphoblast look like?

A

Cell with irregular lobular hyperchromatic nuclei in Eosinophilic cytoplasm

94
Q

What does a cytotrophoblast look like?

A

Polygonal cell with distinct borders and clear cytoplasm

95
Q

What is the second most common testicular tumor in children?

A

Pure teratomas

96
Q

What is the importance of recognizing a non-germ cell malignancy in a teratoma?

A

Because the non-germ cell component does not respond to chemo when it spreads outside the testis.
Have isochromosome 12p

97
Q

What is the course of a teratoma?

A

In children - benign

In postpubertal male - all malignant

98
Q

What is the standard tx of a testicular mass?

A

Radical orchiectomy

99
Q

What is the mode of spread of testicular cancer?

A

Lymph: to para-aortic nodes to mediastinal and supraclavicular
Blood: to the lungs primarily

100
Q

What kind of testicular tumor tends to stay in the testis for a long time and so is often discovered at stage 1?

A

Seminoma

101
Q

In what stage are the non-seminomatous tumors found?

A

Stage II and III

102
Q

How do non-seminomatous tumors usually spread?

A

Hematogenously

103
Q

What tx are seminomas sensitive to?

A

Radiation

104
Q

What are the clinical stages of testicular tumors?

A

Stage I: tumor confined to testis,epididymis, spermatic cord
Stage II: spread to retroperitoneal nodes and below diaphragm
Stage III: mets outside the retro nodes and above diaphragm

105
Q

What peptide correlates with the mass of tumor cells providing a marker for tumor burden?

A

LDH

106
Q

How can remission be achieved in someone with non-seminomatous tumor?

A

Aggressive chemo

107
Q

What are the sex cord stromal tumors?

A

Leydig cell tumors

Sertoli cell tumors

108
Q

What are the germ cell tumors of the testis?

A 
Seminoma
Spermatocytic seminoma
Embryonal carcinoma
Yolk sac tumor
Choriocarcinoma 
Teratomas
109
Q

When do leydig cell tumors usually happen?

A

Between 20 and 60

110
Q

How do leydig cell tumors present?

A

Testicular swelling, gynecomastia precocious puberty

111
Q

What do leydig cell tumors look like?

A

They are well circumscribed modules that are golden brown

112
Q

What is the histo of leydig cell tumors?

A

Cells look like normal leydig cells

Contain crystals of Reinke

113
Q

Is a leydig cell benign or malignant?

A

Benign

114
Q

What do Sertoli cell tumors look like?

A

Firm small nodules with gray white to yellow color.

115
Q

What is the histo of a Sertoli cell tumor?

A

Cells arranged in trabeculae

116
Q

Which sex cord stromal tumor is hormonally active?

A

Leydig cell

117
Q

What are gonadoblastomas?

A

Neoplasm containing a mix of germ cells and gonadal stromal elements

118
Q

What is the most common form of testicular neoplasms in men over 60?

A

Aggressive non-Hodgkins lymphoma

Most common: diffuse large B cell, Burkett lymphoma, EBV-positive extra nodal NK/T lymphoma

119
Q

What is a hydrocele?

A

Accumulation of serous fluid in the tunica vaginalis

120
Q

What is a hematocrit caused by?

A

Trauma or torsion or hemorrhagic disease

121
Q

Who gets chyloceles?

A

Patients with elephantiasis or filariasis

122
Q

What is a complication of a varicocele?

A

Infertility

123
Q

What controls the growth of the prostate?

A

Testicular androgens

124
Q

What is acute bacterial prostatitis caused by?

A

UTI or after surgical manipulation of the urethra

125
Q

What is the clinical presentation of acute prostatitis?

A

Fever. Chills, dysuria

DRE reveals tender, boggy prostate

126
Q

How does chronic bacterial prostatitis present?

A

Low back pain, dysuria, perineal and suprapubic pain

127
Q

What do patients with chronic bacterial prostatitis have a hx of?

A

Recurrent UTIs with the same organism

128
Q

How do you diagnose prostatitis?

A

With leukocytes in the prostatic secretions and positive bac cultures

129
Q

What is the most common form of prostatitis?

A

Chronic abacterial prostatitis

130
Q

How is chronic abac prostatitis diagnosed?

A

More than 10 leukocytes per hpf and negative bac cultures

131
Q

What is the most common cause of granulomatous prostatitis?

A

Instillation of BCG in the bladder for tx of bladder cancer

132
Q

Why is biopsy of the prostate contraindicated in prostatitis?

A

It may lead to sepsis

133
Q

What is BPH?

A

Hyperplasia of stromal and epi cells in periurethal region of prostate.

134
Q

What is the pathogenesis of BPH?

A

Impaired cell death

135
Q

What is the main androgen of the prostate?

A

DHT

136
Q

What cell converts testosterone to DHT

A

Stromal cells by 5 alpha reductase

137
Q

What does DHT do?

A

Binds the AR and mediates transcription of genes for growth factors and receptors

138
Q

What is the most important GF stimulated by DHT contributing to BPH?

A

FGF-7

139
Q

What does BPH look like?

A

Tissue is yellow-pink with soft consistency and milky ooze if made of glands
Firm and grey is fibromuscular stroma
Glandular prolif = cystically dilated glands lined by inner columnar and outer cuboidal epi

140
Q

What are the complications of BPH?

A

Bladder hypertrophy and distention
Urinary retention
Urethral obstruction
Higher risk of infection

141
Q

What are the tx for BPH?

A

Lower caffeine and alcohol intake
Timed voiding schedule
Alpha blockers

142
Q

What is the gold standard for reducing BPH symptoms?

A

TURP - transurethral resection

143
Q

What is the most common form of cancer in men?

A

Adenocarcinoma of the prostate

144
Q

Who gets adenocarcinoma of the prostate?

A

Men over 50

Most common in AAs

145
Q

What are the factors that increase the risk for adenocarcinoma of the prostate?

A 
High fat diet 
Short repeats of CAG - more sensitivity to androgens
Increased androgens
First degree relative
BRCA2 mutation
Mut at 8q24
Overexpression of ETS
hyper methylation of GSTP1
Loss of e-cadherin
Upreg of AMACR
Overexpression of EZH-2
PCA3
146
Q

What does over expression of ETS do?

A

Makes normal prostate epi cells more invasive thru upreg of MMPs

147
Q

What is the most common epi genetic alteration in prostate cancer?

A

Hyper methylation of glutathione s-transferase

148
Q

Where does prostate cancer usually arise?

A

In the peripheral zone and posteriorly

149
Q

What does prostate cancer look like?

A

It’s embedded in the tissues

Gritty and firm

150
Q

What is the lymphatic pattern of spread for prostate cancer?

A

Obturator nodes to para-aortic nodes

151
Q

What is the hematogenous pattern of spread?

A

To the bones of the axial skeleton

Lumbar spine to proximal femur to pelvis, thoracic spine, ribs

152
Q

What is the histo of prostate cancer?

A

Crowded Glands lined by cuboidal cells
No outer basal layer
Tumor cells = pale clear to amphophilic. Large nuclei

153
Q

What are some markers for prostate cancer?

A

AMACR

154
Q

What is PIN?

A

Benign prostatic acini lined by cytologically atypical cells with prominent nucleoli
Larger branching glands and papillary infoldings surrounded by basal cells and basement membrane

155
Q

What is the grading system of prostate cancer?

A

The Gleason system
Grade 2-4: well-diff, small in transition zone
Grade 5-7: intermediate - treatable
Grade 8-10: no differentiation and tumor cells infiltrate the stroma - unlikely to be cured

156
Q

What are the best prognostic indicators for prostate cancer?

A

Grade and stage

157
Q

What are the stages for prostate cancer?.

A

T1- found incidentally
T2 - organ confined
T3 - extra prostatic extension
T4 - direct invasion of other organs

158
Q

What is required for dx of prostate cancer?

A

A transrectal needle biopsy

159
Q

What is PSA?

A

A product of prostatic epithelium normally secreted n semen.

It is a serine protease

160
Q

What is a normal level of PSA?

A

Less than 4 ng/ml

161
Q

What is the most important test used in diagnosis and management of prostate cancer?

A

PSA level

162
Q

How is PSA velocity used?

A

Used for distinguishing between men with and without prostate cancer.
More than .75ng/ml per year is bad!

163
Q

What percentage of free PSA confers a lower risk to prostate cancer?

A

Above 25%

164
Q

What is the most common treatment for localized prostate cancer?

A

Radical prostatectomy

165
Q

What therapy is used for prostate cancer that is too far advanced for surgery?

A

External beam radiation

166
Q

What therapy is used for advanced mets from prostate?

A

Androgen deprivation by orchiectomy or LHRH agonists

167
Q

What is the most aggressive variant of prostate cancer?

A

Small cell

168
Q

What is the most common tumor to secondarily involve the prostate?

A

Urothelial cancer

169
Q

What is the prognosis of ductal adenocarcinoma of the prostate
.

A

Poor

Med School Year 2 Flash Cards (18 decks)

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