Rubin's 23: Lower Urinary/Male Reproductive

Question 1

Name the dx: Congenital defect; Absence of the anterior abdominal wall; Is associated with epispadias in some male infants; Increased risk of bladder carcinoma (squamous) later in life

Answer 1

Exstrophy of the urinary bladder

Question 2

Name the dx: Developmental abnormality resulting in a vesicle-umbilical fistula or urachal diverticulum

Answer 2

Failure of the urachus to involute

Question 3

Name the dx: Enlargement of the prostate gland leading to obstruction of urine flow; Proliferation of the glands and stroma; Repeated bouts of cystitis; Urinary retention leading to bladder diverticula and/or bladder stones

Answer 3

Nodular prostatic hyperplasia

Question 4

T/F: The risk of acute cystitis in females is higher in pregnancy.

Answer 4

True

Question 5

Acute cystitis involves what symptoms:

Answer 5

Pelvic pain; Hemorrhage; Stromal edema; Neutrophilic infiltrate on urinalysis

Question 6

Name the dx; Most common primary tumor of the bladder; Painless hematuria; Epithelial tumor; Papillary fronds lined by urothelial epithelium; Minimal cytologic atypia on histology

Answer 6

Exophytic papilloma;

Question 7

Most invasive urothelial cell carinomas arise from:

Answer 7

carcinoma in situ

Question 8

What are the most common risks for developing urothelial cell carinoma of the bladder?

Answer 8

Smoking; Exposure to azo dyes; Infection with Schistosoma haematobium; Cyclophosphamide; Use of certain analgesics; Radiation therapy

Question 9

Name the dx: Collection of serous fluid in the scrotal sac between two layers of the tunica vaginalis; Congenital version is often associated with inguinal hernia

Answer 9

Hydrocele

Question 10

Name the dx: Accumulation of blood between the layers of the tunica vaginalis; May develop after trauma or hemorrhage into hydrocele; Can also be caused by testicular tumors and infections

Answer 10

Hematocele

Question 11

Name the dx: Seen in children; Edematous, mucosal, polyploid masses with a “cluster of grapes” appearance;

Answer 11

Embryonal rhabdomyosarcoma aka sarcome botryoides

Question 12

Name the dx: Polyploid inflammatory lesions near the urethral meatus that produce pain and bleeding; Occur exclusively in women;

Answer 12

Urethral caruncle

Question 13

Parasitic infection of the bladder, such as with schistosomiasis, causes what kind of cancer?

Answer 13

Squamous cancer of the bladder epithelium (starts as metaplasia)

Question 14

Name the dx: Verrucae or condylomata; Can be on the shaft of the penis; Epidermal hyperkeratosis, paraketasosis, acanthosis, papillomatosis

Answer 14

HPV (genital warts); Can cause penile cancer

Question 15

Name the dx: Dysuria, urgency, urethral discharge; Suppurative urethritis; Acute onset, related to sexual intercourse

Answer 15

Gonorrhea (neisseria gonorrhoeae)

Question 16

Name the dx: The orifice of the prepuce cannot allow retraction over the glans penis, and can strangulate the glans and impede the outflow of venous blood

Answer 16

Phimosis Complication when blood flow is obstructed is paraphimosis

Question 17

Name the dx: Soft, shiny, erythematous plaques on the glans and foreskin

Answer 17

Erythroplasia of Querat A carcinoma in situ of the penis

Question 18

Name the dx: Lesions on the penis - shiny, soft, erythematous plaques on the glans and foreskin; Neoplastic epitheliam cells connected by intercellular bridges, with invasion to the dermis

Answer 18

Squamous cell carcinoma of the penis

Question 19

What is the complication of BPH untreated?

Answer 19

Hydroureter and hydronephrosis Can lead to renal failure

Question 20

Name the dx: Pain in the scrotum; Small, tender nodule attached to the testis; Caused by infection (chlamydia in young men, E. Coli in old);

Answer 20

Epididymitis

Question 21

Name the dx: Virilization of external genitalia; Still 46, XX; Often associated with CAH (21-hydroxylase deficiency); Adrenal hyperplasia; Ambiguous genitalia seen at birth

Answer 21

Female pseudohermaphroditism

Question 22

Name the dx: Born 46, XY; External genital organs appear female or with signs of virilization

Answer 22

Testicular feminization syndrome aka male pseudohermaphroditism

Question 23

What is the most common testicular tumor in children?

Answer 23

Mature teratoma

Question 24

Microscopic examination of a yolk sac tumor would reveal:

Answer 24

Interlacing strands of epithelial cells surrounded by loose connective stroma; Glomeruloid structures called “Schiller Duval” bodies; These tumors are malignant; treat with orchiectomy; First 4 years of life; Tumors produce alpha-fetoprotein

Question 25

Name the dx: Most common testicular cancer (germ cell tumor); Men 30-40; Additional fragment of chromosome 12 seen; Solid, rubbery, firm mass

Answer 25

Seminoma Neoplastic cells are arranged as nests that are separated by fibrous septae and infiltrated with chronic inflammatory cells (lymphocytes, plasma cells, macrophages) treat with radiation

Question 26

Tumors composed exclusively of malignant chorionic epithelium are termed:

Answer 26

Choriocarcinomas - a kind of testicular cancer - a “nonseminomatous germ cell tumor” trophoblastic cells give rise to multinucleatied giant cells –> hemorrhage hCG levels high

Question 27

Name the dx: Congenital abnormality in which one or both testes are not found in their normal position in the scrotum; Most common urologic condition in infants; Increased incidence of infertility AND germ cell neoplasia (ie seminoma)

Answer 27

Cryptorchidism (undescended testicle) Fix w surgery

Question 28

Name the dx: Congenital absence of testes.

Answer 28

Anorchia

Question 29

Name the dx: Finding in adults with fragile X syndrome

Answer 29

Macroorchidism

Question 30

Malignant lymphoma of the testes occurs in what population?

Answer 30

> 60 years; usually in the context of systemic disease (not usually primary); poor prognosis

Question 31

Name the dx: Precocious puberty in a male child (but can occur at any age); If in older age group, can be associated with feminization or gynecomastia Tumor secretes androgens, estrogens, or both

Answer 31

Leydig (interstitial) cell tumor;

Question 32

T/F: A 46,XX karyotype is found in some patients with classical signs of Klinefelter syndrome.

Answer 32

True

Question 33

In patients who develop adenocarcinoma of the prostate, what is the precursor?

Answer 33

Prostatic intraepithelial neoplasia

Question 34

Name the dx: Inflammatory disorder; uncommon; Accumulation of macrophages; Often associated with UTIs caused by E. Coli; Soft yellow plaques on the mucosal surface of the bladder

Answer 34

Malakoplakia

Question 35

What does malakoplakia show on histology?

Answer 35

Chronic inflammatory cell infiltrate composed mostly of large macrophages with abundant eosinophilic cytoplasm containing PAS-positive granules. Some of these macrophages exhibit laminated basophilic calcopherites called “Michaelis-Gutmann” bodies

Question 36

Hunner ulcers are seen in what condition?

Answer 36

Chronic interstitial cystitis Hunner ulcer is an intense, acute, inflammatory reaction

Question 37

Name the diagnosis: Long-standing suprapubic pain; Frequency and urgency; Can be with or withoug hematuria

Answer 37

Chronic interstitial cystitis

Question 38

Name the dx: Congenital anomaly in which the urethra opens on the underside of the penis so that the meatus is proximal to its normal glandular location

Answer 38

Hypospadias Incomplete closure of the urethral folds of the urogenital sinus

Question 39

Name the dx: Congenital anomaly in which the urethra opens on the upper side of the penis

Answer 39

Epispadias

Question 40

Name the dx: A cyst formed by the protrusions of widened efferent ducts of the rete testis or epididymis; Manifests as a hilar paratesticular nodule or as a fluctuating mass with milky fluid containing spermatozoa in various stages of degeneration

Answer 40

Spermatocele