GU

Question 1

Most common type of testicular cancer

Answer 1

Seminoma: best prognosis. Made of germ cells that multiply without differentiation

Question 2

Testicular cancer composed of tissue from different germinal layers e.g. teeth, common in children. Can contain all types of tissues!

Answer 2

Teratoma

Question 3

Yolk-sac tumour

Answer 3

Testicular Cancer common in children and aggressive. Made from germ cells that differentiate into yolk sac tissue

Question 4

Non-germ cell tumours

Answer 4

Arise from diploid sex-cord stroma cells.

• Leydig cell tumours:** androgen secreting. Testosterone causes premature puberty. Excess oestrogen can cause delayed puberty and feminisation
• Sertoli cell tumour: usually clinically silent and benign

Question 5

basement membrane of the prostate

Answer 5

Sitting within the basement membrane, is a ring of cube-shaped basal cells as well as a few neuroendocrine cells interspersed throughout

Question 6

Inner ring of luminar columnar cells

Answer 6

Luminal cells secrete substances into the prostatic fluid, that make it slightly alkaline that give it nutrients which nourish the sperm and help it survive in the acidic environment of the vagina.

Question 7

prostate specific antigen

Answer 7

The luminal cells also produce prostate specific antigen, or PSA, which helps to liquefy the gel-like semen after ejaculation, thereby freeing the sperm to swim.

Question 8

Most common type of prostate cancer

Answer 8

Adenocarcinomas are the most common type of prostate cancer, and these most commonly arise from the peripheral zone of the prostate.

Question 9

Prostate adenocarcinomas

Answer 9

They most often results from a genetic mutation in a luminal cell, but can also be a basal cell

Question 10

Gold standard for prostate cancer

Answer 10

• Multiparametric MRI: first line for suspected localised cancer
  (Previously,transrectal ultrasound (TRUS)-guided needle biopsywas the gold-standard diagnostic investigation)

Question 11

Bladder cancer removal name

Answer 11

Cystectomy is a medical term for surgical removal of all or part of the urinary bladder.

Question 12

Squamous Cell carcinoma (bladder)

Answer 12

These tumours typically pop up in multiple locations, and show extensive keratinization.
Typically arise due to chronic inflammation:

Question 13

The Genetic mutations in polycystic kidney disease (autosomal dominant)

Answer 13

PKD1 and PKD2

Question 14

Extra-renal manifestations in polycystic kidney disease (autosomal dominant)

Answer 14

Patients can have cysts that are typically benign pop up in the liver, seminal vesicles, and pancreas.

The vasculature can also be affected, for example individuals might develop aorticroot dilation which can lead to heart failure, and have berry aneurysmsof the cerebral arteries, usually in the Circle of Willis. These aneurysmscan have a thin wall, allowing them to rupture and develop into a subarachnoid haemorrhage

Question 15

The Genetic mutations in polycystic kidney disease (autosomal recessive)

Answer 15

PKHD1 mutation on long arm (q) of chromosome 6

Question 16

CM of PCKD (AR)

Answer 16

• Oligohydramnios,pulmonary hypoplasiaandPotter syndrome
• Cystic enlargementof therenalcollecting ducts
• May present with renal failure at birth
• Congenital liver fibrosis

Question 17

Lifestyle management of nephrotic syndrome

Answer 17

• Low salt, protein and fat diet**

- Improve cardiovascular risk factors**

Question 18

Glomerular Basement Membrane thickening due to diabetes

Answer 18

On light microscopy, there’s mesangial expansion, glomerular basement membrane thickening and Kimmelstiel-Wilson nodules.

Question 19

frothy urine

Answer 19

CKD and Nephrotic Syndrome

Question 20

Urine Dip for CKD

Answer 20

Proteinuria and haematuria

Question 21

ACR for CKD

Answer 21

a ratio of >3 mg/mmol is clinically significant proteinuria. This test is nowpreferredover other tests such as protein:creatinine ratio or 24-hour urinary collection

Question 22

Treatment for neisseria Gonorrhoeae

Answer 22

Azithromycin is also used with 500mg of ceftriaxone

Question 23

the one-way valve that allows urine to flow from each ureter into the bladder

Answer 23

vesicoureteral orifice

Question 24

Leukocyte esterase in pyelonephritis

Answer 24

produced by neutrophils

Question 25

Nitrite in pyelonephritis

Answer 25

gram negative organisms metabolise nitrates in the urine to nitrites

Question 26

Gold standard for pyelonephritis

Answer 26

Mid-stream urine MCS: white blood cell in the urine. Sometimes white blood cell cast - white blood cells and surrounding inflammatory protein debris is “casted” into the shape of the tubule, which is then peed out

Question 27

First line management of pyelonephritis

Answer 27

Broad-spectrum antibiotic (co-amoxiclav)

Hydration

Question 28

What is nephritic syndrome

Answer 28

Nephritic syndrome is typically caused by inflammation that damages the glomerular basement membrane, leading to haematuria and red blood cell casts in the urine.

Question 29

What are the overall clinical manifestations of nephritic syndrome

Answer 29

• Haematuria
• Proteinuria
• Arterial hypertension
• Peripheral and peri-orbital oedema
• Decreased urine output

Question 30

blood investigations for nephritic syndrome

Answer 30

increased creatinine and BUN (blood urea nitrogen)

Question 31

Nephritic syndrome caused by type 3 hypersensitivity

Answer 31

• Post-streptococcal glomerulonephritis
• IgA nephropathy
• Diffuse proliferative glomerulonephritis

Question 32

Post-streptococcal glomerulonephritis

Answer 32

Post-streptococcal glomerulonephritis (PSGN) is usually an immunologically-mediated delayed consequence of pharyngitis or skin infections caused by streptococcus pyogenes

Question 33

what would you see in post-streptococcal glomerulonephritis

Answer 33

Bloods: low levels of C3 and CH50
Positive streptozyme test confirms recent group A streptococcal infection
-Kidney biopsy:
- On light microscopy: the glomeruli are enlarged and hypercellular.
- On immunofluorescence: IgG, IgM and C3 deposits along the glomerular basement membrane and the mesangium, which create a “starry sky” appearance.

Question 34

Iga Nephropathy (nephritic syndrome)

Answer 34

IgA nephropathy (IgAN) is defined by the presence of dominant or co-dominant mesangial IgA immune deposits, often accompanied by C3 and IgG in association with a mesangial proliferative glomerulonephritis of varying severity.

Question 35

What would you see in Iga Nephropathy

Answer 35

Renal biopsy:**definitivediagnosticinvestigation

- On light microscopy: see mesangial proliferation.
- On immunofluorescence: IgA immune complexes in the mesangium
- On electron microscopy: immune complexes are seen in the mesangium.

Question 36

Defuse proliferative glomerulonephritis

Answer 36

Diffuse proliferative glomerulonephritis is the most common form of lupus nephritis.
Often caused by systemic lupus erythematosus.
Type 3 Hypersensitivity