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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
Gain of function FGFR3 and HRAS mutations
Noninvasive low-grade papillary urothelial carcinoma
26
Male, 50+ Difficulty urinating Frequent urination
Prostate nodular hyperplasia (BPH)
27
Proximal urethral tumor
Urothelial carcinoma
28
Distal urethral tumor
Squamous cell carcinoma
29
Male infant Urine flows out of hole in underside of penis Most likely associated deficits? Increased risk for?
Hypospadia Cryptorchidism, urinary tract malformation Ascending UTIs
30
Prepuce is too small to retract | Accumulation of secretions, etc.
Phimosis
31
Lesion on external penis near corona of the glans | HPV 6
Condyloma acuminatum
32
Fibrous bands w/in corpus cavernosum Curved penis Painful intercourse
Peyronie disease
33
Patient 35+ Solitary, thick gray-white, opaque plaque on shaft of penis or scrotum Hyperproliferative epidermis w/ mitoses HPV 16 May progress to?
Bowen disease Infiltrating squamous cell carcinoma
34
Patient under 35 Sexually active Multiple, reddish-brown papular lesions on penis or scrotum HPV 16 May progress to?
Bowenoid papulosis NOTHING - often regresses spontaneously
35
Invasive carcinoma of penis
Squamous cell carcinoma
36
Are squamous cell carcinomas of the penis painful?
Only once they undergo secondary ulceration and infection
37
Prognosis for squamous cell carcinoma of penis
No inguinal LN = good | Inguinal LNs = poor
38
Male child Missing testicle Most common location? May lead to?
Cryptorchidism Inguinal canal Tubuar atrophy and sterility IF BILATERAL
39
Sexually active male under 35 Inflammation of epididymis Most likely organism?
Gonorrhea or Chlamydia
40
Inflammation of testis | Most likely organism?
Syphilis
41
Male, 35+ Inflammation of epididymis Most likely organism?
E. coli, Pseudomonas
42
Middle age male Testicular mass (sudden onset) Fever Diffuse granulomas in seminiferous tubules
Granulomatous (autoimmune) orchitis
43
Testicular inflammation | Obliterative endarteritis w/ perivascular cuffs of lymphocytes and plasma cells
Syphilis
44
Bell-clapper abnormality
Bilateral anatomic defect leading to adult torsion
45
Testicular tumor Painless enlargement of testis Most likely?
Germ cell tumor
46
15-34, male Testicular tumor Painless enlargement of testis
Germ cell tumor
47
KIT and BAK gene mutations
Germ cell tumor
48
Male, 20's Testicular tumor Grossly enlarged, painless testicle Large, round/polyhedral cell shape, clear/watery cytoplasm, large central nucleus w/ prominent nucleoli
Classic/typical seminoma (germ cell tumor)
49
Older male (65+) Testicular tumor 3 cell populations (diff. sizes)
Spermatocytic seminoma (germ cell tumor)
50
Male, 20-30 Testicular tumor Alveolar or tubular growth Punctate hemorrhage/necrosis
Embryonal carcinoma
51
Isochrome 12p genetic alteration
Germ cell tumor (any)
52
Testicular tumor | OCT3/4, NANOG in tact
Intratubular germ cell neoplasia (ITGCN) (precursor to germ cell tumor)
53
Elevated hCG
Classic seminoma, choriocarcinoma
54
CD30 positive Cytokeratin positive KIT negative
Embryonal carcinoma
55
Infant - 3 years old Testicular tumor Schiller-Duval bodies Alpha-fetoprotein on staining
Yolk sac tumor
56
Small palpable nodule on testicle Hemorrhage and necrosis 2 cell types hCG detected on staining
Choriocarcinoma
57
Infants, young children Testicular tumor Multiple germ layer cells (cartilage, epithelium, etc.)
Teratoma
58
Prognosis of teratomas
``` Pre-puberty = benign Post-puberty = malignant ```
59
Treatment for malignant testicular tumor
Radical orchiectomy
60
Metastasis of testicular tumors
Lymphatic --> para-aortic nodes | Hematogenous --> lungs, liver
61
Testicular mass, localized to testis over time, stage I | Painless, enlarged testis
Seminoma
62
Testicular mass Metastasis to lungs, liver Stage II, III
Nonseminomatous germ cell tumor (NSGCT)
63
Elevated lactate dehydrogenase
Tool for tumor burden/mass assessment
64
Male, 20-60 Testicular swelling Androgen elaboration Gynecomastia, sexual precocity
Leydig cell tumors
65
Male, 60+ Testicular tumor Plasma cell increase
Testicular lymphoma
66
Fever, chills, painful/burning urination Very tender prostate on DRE Previous catheterization Organism?
Acute bacterial prostatitis E. coli (or other gram- rod)
67
Low back pain, dysuria, suprapubic/perineal dyscomfort Recurrent UTIs Leukocytosis in prostatic secretions
Chronic bacterial prostatitis
68
Low back pain, dysuria, suprapubic/perineal dyscomfort Denies having UTIs Leukocytosis in prostatic secretions
Chronic abacterial prostatitis
69
Bladder cancer Treated with BCG (M. bacillus) Suprapubic pain Granulomas in prostate
Granulomatous prostatitis (via BCG)
70
``` Older male Difficulty urinating Nocturia Frequent urination Prostate enlargement w/in transition zone Bladder hypertrophy and distention Recurrent bacterial infection ```
Benign prostatic hyperplasia
71
Male, 50+, black Prostate cancer Most likely type?
Adenocarcinoma
72
Involvement of X-linked CAG repeat in AR gene
Prostate cancer RISK | Shorter sequence = more sensitive to androgens = more likely for cancer
73
PTEN gene loss | PI3K/AKT signaling increase
Prostate cancer evolution via escaping androgen block
74
Male | BRCA-2 mutation
20x increased risk for prostate cancer
75
TMPRSS2-ETV gene combo
Prostate cancer
76
Chr. 8q24 (MYC) amplification
Prostate cancer
77
GSTP1 (Chr. 11q13) hypermethylation and down regulation
Prostate cancer
78
Gleason score
Sum of 2 "grades" of the 2+ patterns w/in the prostate cancer tumor
79
Gleason score 6-7
Potential treatment/cure
80
Gleason score 8-10
Advanced, unlikely to be cured
81
Older male Urination difficulties Osteoblastic metastases w/in vertebra, etc.
Prostate cancer FOR SURE
82
Urination difficulties w/ prostate cancer denotes what?
Growth inward from the peripheral zone
83
Use of PSA clinically
Serial measurements after therapy or prostatectomy to determine response or recurrence/dissemination
84
Older male Prostate cancer Abundant mucinous secretions
Colloid carcinoma of the prostate
85
Most likely tumor to 2º involve the prostate
Urothelial cancer
86
Most aggressive prostate cancer
Small-cell cancer (neuroendocrine carcinoma)

Renal 2 (11 decks)

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