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JL Renal and Urology > Week 3 (2) > Flashcards

Week 3 (2) Flashcards

1
Q

What are the majority of tumours of the penis?

A

Squamosu carcinoma in situ

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2
Q

What do both bowens disease and erythroplasia of queyrat have in common?

A

Full thickness dysplasia of epidermis

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3
Q

Who do squamous cell carcinomas of penises almost exclusively occur in?

A

Uncircumsised men

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4
Q

What are two risk factors for squamous cell carcinoma of penis?

A

HPV and poor hygeine

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5
Q

What tumour did chimney sweeps used to get?

A

Squamouc cell carcinoma of the scrotum

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6
Q

Where do squamous cell carcinoma of penis tend to occur?

A

Glans/prepuce

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7
Q

What condition is common and involves irregular proliferation of both glandular and stromal prostatic tissue?

A

Benign Nodular Hyperplasia of Prostate - over 70 years of age

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8
Q

What is the aetiology of BNH?

A

Hormonal imbalance - androgen/oestrogen ratio

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9
Q

What gland tends to be involved in BNH and is oestrogen responsive?

A

Centrak (peri-urethral)

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10
Q

What are the symtpoms of prostatism in BNH?

A

Difficulty starting micturition, poor stream and overflow incontinence

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11
Q

What disturbance can BNH cause?

A

Disturbance of bladder sphincter

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12
Q

How is BNH treated?

A

Alpha blockers, 5 alpjha reductse inhibitors

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13
Q

Is BNH pre-malignant?

A

NO

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14
Q

Name two complications of BNH?

A

Bladder hypertrophy and diverticulum formation

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15
Q

When is peak incidence of carcinoma of prostate?

A

60-80 years

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16
Q

When is there an increased risk of carcinoma of prostate?

A

If 1st degree reltive is affected at young age

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17
Q

Is carcinoma of prostate associated with BNH

A

No

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18
Q

Where do carcinoma of prostate tend to arise?

A

Peripheral ducts and glands, particularly posterior lobe

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19
Q

Is peri-urethral zone involved in carcinoma of prostate?

A

Yes at later stage

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20
Q

Can prostaste cancer remain latent?

A

Yes - prostate biospy with small focus of carcinoma in 85/90 year old male then tend not to treat

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21
Q

Where does lymphatic spread occur in carcinoma of prostate?

A

Sacral
Iliac
Para aortic nodes

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22
Q

Carcinoma of prostate causes what on radiology in relation to bones?

A

Osteosclerotic metastases - blood spread to lungs, liver and bone (lumbosacral area)

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23
Q

What biochemical test is done in prostate cancer?

A

Increased prostate specific antigen (PSA) - but not all prostate cancers have this

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24
Q

How is definitive diagnosis of prostate canacer made?

A

Biospy. multiple needle core under ultrasound

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25
Q

How are prostate cancers managed?

A
  1. hORmonak therapy - anti-androgen, oestrogens, cyproterone
  2. Radiotherapy - bone metastases
  3. Surgery - radical prostatectomy
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26
Q

What is the usual presenting symptom of testicular tumours?

A

Painless testicular enlargement - can be associated with hydrocele, gynaecomastia

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27
Q

If you have a maldescended testicle are you more at risk of testicular tumours?

A

Yes - 10 times more

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28
Q

What are the commonest type of testicualr tumours?

A

Germ cell tumours - 90%. Can be seminoma, teratoma or mixed.

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29
Q

Who does leukaemia testicular tumours occur in usually?

A

Children

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30
Q

Name a paratesticular tumour of the testicle?

A

Adenomatoid tumour

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31
Q

What is the commonest germ cell tumpur of testicle?

A

Seminoma - 30-50 years

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32
Q

What tumour is solid, homogenous, pale macroscopic appearance is like a potato?

A

Seminoma

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33
Q

Where does lymphatic spread occur to in seminomas?

A

Para-aortic lymph nodes. Blood spread to lungs and liver.

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34
Q

How are seminomas managed?

A

Radiosensitivity - 95% cure rate!

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35
Q

What is the peak age for teratomas (tumour arising from all three cell lines) appearing?

A

20-30 - can occur in children

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36
Q

What macroscopic appearance do teratomas have?

A

Variable - solid areas, cysts, haemorrhage, necrosis

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37
Q

Is a differentiated teratoma benign?

A

Yes

38
Q

If there is a malignant teratoma trophoblastic teratoma (tissue resembling human placenta) is it malignant?

A

Yes - most malignant

39
Q

What are the three testicular tumour markers?

A
  1. bHCG - trophoblastic components
  2. AFP (alpha feto protein) - yolk sac components
  3. PLAP - seminoma
40
Q

Is Glomerulonephritis infective?

A

NO

41
Q

Is GN diffuse or focal?

A

Mainly diffuse

42
Q

What condition involves glomerular tufts with secondary tubulointerstitial changes?

A

Glomerulonephritis

43
Q

What is pyelonephritis usually associated with?

A

Bacterial infection of renal pelvis, calyces, tubules and interstitium

44
Q

What is the commonest organism causing pyelonephritis?

A

E.coli

then pseudomonas, strep. faecalis

45
Q

Is pyelonephritis commoner in females or males?

A

Females (shorter, wider urethra)

46
Q

What is the pathogenesis of pyelonephritis?

A

Blood-borne - sepsis or post surgery

Ascending infection - cystitis often present

47
Q

Give some risk factors for pyelonephritis?

A
  1. Female
  2. Pregnancy
  3. Ureteric dilatation - stasis due to hormonal effects
  4. Instrumentation
  5. Urinary tract obstruction (calculus, stricture, neoplasm, duplex system)
  6. Vesico-ureteric reflux
  7. Diabetes
48
Q

What condition involves: hypertension, uraemia, large volume of urine, coarse cortical scarring and distortion of calyces on renal imaging?

A

Chronic pyelonephritis

49
Q

What condition comes from tuberculosis in the urinary tract - haematogenous spread from lung?

A

Tuberculous Pyelonephritis

50
Q

What condition relates to sterile pyuria?

A

Tuberculous pyelonephritis

51
Q

What feature of tuberculus pyelonephritis involves slow growth with progressive renakl destruction, spread to ureters, bladder?

A

Caseous foci - typical caseatubg granuomatous infection

52
Q

Name four organissms which cause cystitis?

A
  1. E.coli
  2. Klebsiella
  3. Proteus
  4. Pseudomonas
53
Q

What does cystitis systica result in?

A

Multiple small fluid filled cysts projecting into lumen. Reactive process but can resemble tumour.

54
Q

In tropical africa and edgypt what can cause bladder infections?

A

Schistosomiasis. H. Haematobium - can cause SCC

55
Q

Give a cause of urinary tract obstruction?

A

Prolonged bladder outlet obstruction - hypertrophy of detrusor muscle - diverticulum formation

56
Q

What condition results from dilatation of pelvicalyceal system with parenchymal atrophy?

A

Hydronephrosis

57
Q

What are the main causes of hydronephrosis?

A
  1. UT obstruction

2. Reflux

58
Q

What is secondary infection of hydronephrotic kidney called?

A

Pyonephrosis

59
Q

What is the prostatic urethra covered with?

A

Transitional epithelium

60
Q

What part of the prostate is continuous with the bladder neck and is the superior portion?

A

Base

61
Q

What zone of the prostate gives rise to BPH?

A

Transitional zone

62
Q

Where do 70% of prostate adenocarcinomas occur?

A

Peripheral zone

63
Q

What zone of the prostate surroids the ejaculatory ducts?

A

Central zone

64
Q

What is the peak age for prostate cancer?

A

70-74 years

65
Q

What do genetic abnormalities on chromosomes 1q, 8p, Xp and mutations on BRCA2 gene lead to?

A

Prostate cancer

66
Q

Give some clinical features of prostate cancer presentation?

A

Lower UTI symtpoms
Haematuria/haematospermia
bone pain, anorexia, weight loss

67
Q

What does an abnormal digital rectal exam entail?

A
  1. Asymmetry
  2. Nodule
  3. Fixed craggy mass
68
Q

What is PSA?

A

A glycoprotein enzyme produced by the secretory epithelial cells of the prostate gland.

69
Q

What enzyme is involved in the liquifaction of semen?

A

PSA - prostate specific antigen

70
Q

In health - what are the levels of PSA like in semen and serum?

A

Semen - high

Serum - Low

71
Q

Name other conditions which elevate PSA?

A
  1. BPH
  2. Prostatitis/UTIs
  3. Retention
  4. Catheterisation
  5. DRE
72
Q

When would you do trans-Rectal USS guided prostate biospy?

A
  1. Men with abnormal DRE, an elevated PSA
  2. Previous biopsies showing PIN or ASAP
  3. Previous normal biopsies but rising PSA trends
73
Q

What are the majority of prostate cancers?

A

Multifocal adenocarcinomas

74
Q

What lesions are characterisitc in multifocal adenocarcinomas of prostate?

A

Sclerotic lesions

75
Q

Where are adenocarcinomas of prostate most likely to mestastasise to?

A

Pelvic lymph nodes and the skeleton

76
Q

What does the Gleason’s score base its score on?

A

Architectural appearance

77
Q

Name three imaging modalities for staging?

A
  1. Bone scan
  2. MRI
  3. CT scan
78
Q

What therapy can be used to manage locally advanced prostate cancer?

A
  1. Radiotherapy with neo-adjuvant hormonal therapy
79
Q

How is metastatic prostate cancer managed?

A 
1. Androgen deprivation therapy - 
(hormonal therapy LHRH analogues, anti-androgens)
(bilateral subscapular orchidectomy)
(maximal androgen blockade)
2. Diethylstilbesterol/steroids
3. Cytotoxic chemotherapy
80
Q

What is growth of prostate cncer cells under influence of?

A
  1. Testosterone

2. Dihydrotestosterone

81
Q

When treating malignant prostate cancer - what do LHRH agonists suppress?

A

LH and FSH and so testosterone production

82
Q

List some side effects of LHRH agonists?

A
  1. Loss of libido, ED
  2. Hot flushes and sweats
  3. Weight gain
  4. Gynaecoimastia
  5. Anaemia
  6. Cognitive changes
  7. Osteoporosis
83
Q

What do anti-androgens promote?

A

Apoptosis and inhibit CaP growth

84
Q

Name some side effects of steroidal anti-androgens (cyproterone acetate)

A

1/ Loss of libido and ED

  1. Gynaecomastia
  2. CVS toxicity
  3. Hepatotoxicity
85
Q

Name some side effects of non-steroidal anti0androgens (nilutamide, flutamide and bicalutamide)

A

Sexual interest and libido maintained. Side effects - glynaecomastia, breast pain and hot flushes, hepatotoxicity

86
Q

What are 90% of uroepithelial tumours?

A

Transitional cells

87
Q

What is the malignancy state of nonpapillary type transitional cell carcinomas?

A

all considered to be malignant

88
Q

What can excretory urogram, sonography, retrograde pyelogram and CT all image?

A

Uroepithelial tumours

89
Q

What appearance do papillary type uroepithelial tumours have?

A

Stippled appearance

90
Q

What imaging diagnoses bladder carcinomas?

A

CT urography or cystoscopy

91
Q

What sign is prsent in the urinary bladder to suggest cancer?

A

Halo sign

JL Renal and Urology (9 decks)

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