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Renal 2 > Robbins Ch. 21 - Patient Presentations > Flashcards

Robbins Ch. 21 - Patient Presentations Flashcards

1
Q

Child with hydronephrosis: most likely cause

A

Ureteropelvic junction obstruction

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2
Q

Child with benign primary tumor of ureter (and other lower GU structures)

A

Fibroepithelial polyp

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3
Q

50-70
Obstruction of ureteral lumen
Other tumors in bladder or renal pelvis

A

Urothelial carcinoma

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4
Q

Adult male
Fibrotic tissue on ureters with lymphocytes, germinal centers, plasma cells, and eosinophils
Hydronephrosis
(Maybe elevated IgG4 in serum and lesions)

A

Sclerosing retroperitoneal fibrosis

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5
Q

Urinary frequency (q 15-20 min)
Suprapubic pain
Pain/burning on urination
Gram- rods on UA

Most likely organism?

A

Cystitis

E. coli

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6
Q

Cystitis

Egypt, middle east

A

Schistosomiasis

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7
Q

Cancer patient on treatment
Urinary frequency, suprapubic pain, burning on urination

Likely to develop what?

A

Hemorrhagic cystitis (via cyclophosphamide)

Bladder cancer

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8
Q

Intermittent, severe suprapubic pain
Urinary frequency
Hematuria, dysuria (burning/pain)
Increased mucosal mast cells

A

Interstitial cystitis (chronic pelvic pain syndrome)

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9
Q

AIDS patient w/ organ transplant
Suprapubic pain, urinary frequency, dysuria
Gram- rods on UA
Michaelis-Gutmann bodies

A

Malakoplakia

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10
Q

Hospital pt w/ catheter
Irritation of bladder mucosa
Suprapubic pain, dysuria, urinary frequency
Broad bulbous polyp lesions w/ submucosal edema

A

Polypoid cystitis

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11
Q

Patches of bladder urothelium growing into lamina propria w/ centers changing cellular type and retracting to form a cystic space lined w/ urothelium

A

Cystitis cystica et glandularis

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12
Q

Implantation of shed renal tubular cells into bladder urothelium
Papillary growth pattern of overlying epithelium

A

Nephrogenic adenoma

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13
Q

A patient has a bladder tumor. Most likely cell type origin?

A

Epithelial (urothelial)

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14
Q

Patient with bladder tumor. Pathology shows invasion of ___, which denotes decreased survival rate

A

Muscularis propria (detrusor muscle)

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15
Q

Male, 50-80
Chronic smoker
Bladder tumor w/ TP53 and RB LoF mutations

A

High-grade noninvasive urothelial carcinoma

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16
Q

9p and 9q monosomy/deletions

A

Urothelial carcinoma OR precursor lesion

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17
Q

TP53, RB loss-of-function

A

High grade urothelial carcinoma

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18
Q

Young patient

Small superficial structures on bladder wall w/ finger-like papillae covered w/ normal urothelium

A

Benign papillomas

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19
Q

Bladder tumor
Dyscohesive cells w/ large hyperchromatic nuclei
Mitotic figures
Loss of polarity

A

High-grade papillary urothelial carcinoma of bladder

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20
Q

Infant
Bladder extruding through anterior body wall
Glandular metaplasia of mucosa

Increased risk for?

A

Exstrophy of bladder

ADENOCARCINOMA of the bladder (otherwise uncommon)

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21
Q

Male, 50-80
Painless hematuria
Maybe other urinary symptoms

A

Bladder cancer

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22
Q

Patient with high risk for recurrence or progression of bladder cancer or preceding lesion. Treatment?

A

BCG (M. bovis strain) into bladder –> local inflammation –> kills tumor

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23
Q

Benign tumor of bladder

Intramural, encapsulated, mesenchymal

A

Leiomyoma

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24
Q

Infant/child
Polypoid grapelike mass
Soft, fleshy, gray-white

A

Embyonal rhabdomyosarcoma

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25
Q

Gain of function FGFR3 and HRAS mutations

A

Noninvasive low-grade papillary urothelial carcinoma

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26
Q

Male, 50+
Difficulty urinating
Frequent urination

A

Prostate nodular hyperplasia (BPH)

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27
Q

Proximal urethral tumor

A

Urothelial carcinoma

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28
Q

Distal urethral tumor

A

Squamous cell carcinoma

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29
Q

Male infant
Urine flows out of hole in underside of penis

Most likely associated deficits?
Increased risk for?

A

Hypospadia

Cryptorchidism, urinary tract malformation

Ascending UTIs

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30
Q

Prepuce is too small to retract

Accumulation of secretions, etc.

A

Phimosis

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31
Q

Lesion on external penis near corona of the glans

HPV 6

A

Condyloma acuminatum

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32
Q

Fibrous bands w/in corpus cavernosum
Curved penis
Painful intercourse

A

Peyronie disease

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33
Q

Patient 35+
Solitary, thick gray-white, opaque plaque on shaft of penis or scrotum
Hyperproliferative epidermis w/ mitoses
HPV 16

May progress to?

A

Bowen disease

Infiltrating squamous cell carcinoma

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34
Q

Patient under 35
Sexually active
Multiple, reddish-brown papular lesions on penis or scrotum
HPV 16

May progress to?

A

Bowenoid papulosis

NOTHING - often regresses spontaneously

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35
Q

Invasive carcinoma of penis

A

Squamous cell carcinoma

36
Q

Are squamous cell carcinomas of the penis painful?

A

Only once they undergo secondary ulceration and infection

37
Q

Prognosis for squamous cell carcinoma of penis

A

No inguinal LN = good

Inguinal LNs = poor

38
Q

Male child
Missing testicle

Most common location?
May lead to?

A

Cryptorchidism

Inguinal canal

Tubuar atrophy and sterility IF BILATERAL

39
Q

Sexually active male under 35
Inflammation of epididymis
Most likely organism?

A

Gonorrhea or Chlamydia

40
Q

Inflammation of testis

Most likely organism?

A

Syphilis

41
Q

Male, 35+
Inflammation of epididymis
Most likely organism?

A

E. coli, Pseudomonas

42
Q

Middle age male
Testicular mass (sudden onset)
Fever
Diffuse granulomas in seminiferous tubules

A

Granulomatous (autoimmune) orchitis

43
Q

Testicular inflammation

Obliterative endarteritis w/ perivascular cuffs of lymphocytes and plasma cells

A

Syphilis

44
Q

Bell-clapper abnormality

A

Bilateral anatomic defect leading to adult torsion

45
Q

Testicular tumor
Painless enlargement of testis
Most likely?

A

Germ cell tumor

46
Q

15-34, male
Testicular tumor
Painless enlargement of testis

A

Germ cell tumor

47
Q

KIT and BAK gene mutations

A

Germ cell tumor

48
Q

Male, 20’s
Testicular tumor
Grossly enlarged, painless testicle
Large, round/polyhedral cell shape, clear/watery cytoplasm, large central nucleus w/ prominent nucleoli

A

Classic/typical seminoma (germ cell tumor)

49
Q

Older male (65+)
Testicular tumor
3 cell populations (diff. sizes)

A

Spermatocytic seminoma (germ cell tumor)

50
Q

Male, 20-30
Testicular tumor
Alveolar or tubular growth
Punctate hemorrhage/necrosis

A

Embryonal carcinoma

51
Q

Isochrome 12p genetic alteration

A

Germ cell tumor (any)

52
Q

Testicular tumor

OCT3/4, NANOG in tact

A

Intratubular germ cell neoplasia (ITGCN) (precursor to germ cell tumor)

53
Q

Elevated hCG

A

Classic seminoma, choriocarcinoma

54
Q

CD30 positive
Cytokeratin positive
KIT negative

A

Embryonal carcinoma

55
Q

Infant - 3 years old
Testicular tumor
Schiller-Duval bodies
Alpha-fetoprotein on staining

A

Yolk sac tumor

56
Q

Small palpable nodule on testicle
Hemorrhage and necrosis
2 cell types
hCG detected on staining

A

Choriocarcinoma

57
Q

Infants, young children
Testicular tumor
Multiple germ layer cells (cartilage, epithelium, etc.)

A

Teratoma

58
Q

Prognosis of teratomas

A 
Pre-puberty = benign
Post-puberty = malignant
59
Q

Treatment for malignant testicular tumor

A

Radical orchiectomy

60
Q

Metastasis of testicular tumors

A

Lymphatic –> para-aortic nodes

Hematogenous –> lungs, liver

61
Q

Testicular mass, localized to testis over time, stage I

Painless, enlarged testis

A

Seminoma

62
Q

Testicular mass
Metastasis to lungs, liver
Stage II, III

A

Nonseminomatous germ cell tumor (NSGCT)

63
Q

Elevated lactate dehydrogenase

A

Tool for tumor burden/mass assessment

64
Q

Male, 20-60
Testicular swelling
Androgen elaboration
Gynecomastia, sexual precocity

A

Leydig cell tumors

65
Q

Male, 60+
Testicular tumor
Plasma cell increase

A

Testicular lymphoma

66
Q

Fever, chills, painful/burning urination
Very tender prostate on DRE
Previous catheterization

Organism?

A

Acute bacterial prostatitis

E. coli (or other gram- rod)

67
Q

Low back pain, dysuria, suprapubic/perineal dyscomfort
Recurrent UTIs
Leukocytosis in prostatic secretions

A

Chronic bacterial prostatitis

68
Q

Low back pain, dysuria, suprapubic/perineal dyscomfort
Denies having UTIs
Leukocytosis in prostatic secretions

A

Chronic abacterial prostatitis

69
Q

Bladder cancer
Treated with BCG (M. bacillus)
Suprapubic pain
Granulomas in prostate

A

Granulomatous prostatitis (via BCG)

70
Q 
Older male
Difficulty urinating
Nocturia
Frequent urination
Prostate enlargement w/in transition zone
Bladder hypertrophy and distention
Recurrent bacterial infection
A

Benign prostatic hyperplasia

71
Q

Male, 50+, black
Prostate cancer
Most likely type?

A

Adenocarcinoma

72
Q

Involvement of X-linked CAG repeat in AR gene

A

Prostate cancer RISK

Shorter sequence = more sensitive to androgens = more likely for cancer

73
Q

PTEN gene loss

PI3K/AKT signaling increase

A

Prostate cancer evolution via escaping androgen block

74
Q

Male

BRCA-2 mutation

A

20x increased risk for prostate cancer

75
Q

TMPRSS2-ETV gene combo

A

Prostate cancer

76
Q

Chr. 8q24 (MYC) amplification

A

Prostate cancer

77
Q

GSTP1 (Chr. 11q13) hypermethylation and down regulation

A

Prostate cancer

78
Q

Gleason score

A

Sum of 2 “grades” of the 2+ patterns w/in the prostate cancer tumor

79
Q

Gleason score 6-7

A

Potential treatment/cure

80
Q

Gleason score 8-10

A

Advanced, unlikely to be cured

81
Q

Older male
Urination difficulties
Osteoblastic metastases w/in vertebra, etc.

A

Prostate cancer FOR SURE

82
Q

Urination difficulties w/ prostate cancer denotes what?

A

Growth inward from the peripheral zone

83
Q

Use of PSA clinically

A

Serial measurements after therapy or prostatectomy to determine response or recurrence/dissemination

84
Q

Older male
Prostate cancer
Abundant mucinous secretions

A

Colloid carcinoma of the prostate

85
Q

Most likely tumor to 2º involve the prostate

A

Urothelial cancer

86
Q

Most aggressive prostate cancer

A

Small-cell cancer (neuroendocrine carcinoma)

Renal 2 (11 decks)

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