Exam 3 - Genitourinary Diseases

Question 1

What is the most common penile malformation?

Answer 1

abnormal location of the distal urethral orifice

Question 2

Describe hypospadias.

Answer 2

urethral orifice opening along the ventral aspect of the penis

Question 3

What can result from hypospadias?

Answer 3

UTI due to constricting

Question 4

Describe epispadias

Answer 4

urethral orifice along the dorsal aspect of the penis

Question 5

What can result from an epispadia?

Answer 5

UT obstruction
urinary incontinence (leaking urine)

Question 6

Which is a less common malformation of the penis, hypospadias or epispadias?

Answer 6

epispadias

Question 7

What are the different types of hypospadias?

Answer 7

glanular
subcoronal
distal penile
midshaft
proximal penile
penoscrotal
scrotal
perineal

Question 8

How can you treat hypospadias or epispadias?

Answer 8

reconstruction surgery at 6 mo. old to 1 yr old

Question 9

What is the most common penile neoplasm?

Answer 9

squamous cell carcinoma

Question 10

What precedes penile squamous cell carcinoma in some cases?

Answer 10

premalignant lesions of white plaque-like thickenings, irregular margins or areas of redness. OR
Bowen disease

Question 11

Who is at risk for squamous cell carcinoma?

Answer 11

uncircumcised men over age 40

Question 12

What type of infection is squamous cell carcinoma associated with?

Answer 12

HPV 16/18 infection

Question 13

Where does metastases of penile squamous cell carcinoma occur?

Answer 13

inguinal lymph nodes; distant metastases is not usually common

Question 14

What is the 5 year survival rate for penile squamous cell carcinoma?

Answer 14

66%

Question 15

What was the first human cancer associated with occupational/environmental factors?

Answer 15

Scrotum cancer (chimney sweeps)

Question 16

What is the most common neoplasm in scrotum cancer?

Answer 16

squamous cell carcinoma

Question 17

Describe cryptorchidism.

Answer 17

incomplete descent of the testis from the abdomen to the scrotum

Question 18

What is the prevalence of cryptorchidism?

Answer 18

1% of 1-yr old males

Question 19

What are the risks of untreated cryptorchidism?

Answer 19

sterility

3-5 fold increase for testicular cancer

Question 20

What surgical procedure can reduce the risk of sterility and cancer in patients with cryptorchidism?

Answer 20

orchiopexy - placing the testes in the scrotum.

Question 21

What area is it more common to find inflammation in the testes?

Answer 21

the epididymis as compared to the testis proper

Question 22

What are some symptoms involved with inflammation of the testes?

Answer 22

swelling
tenderness
complications from UTI
associated with STD
complication of mumps in adults

Question 23

What vascular disturbance can occur in the testes?

Answer 23

torsion - twisting of the spermatic cord

Question 24

How/Why is the spermatic cord able to twist?

Answer 24

It is not anchored to the posterior wall.

Question 25

What are the risks of torsion in the testes?

Answer 25

obstruction of venous drainage --> infarction

Question 26

What is the prognosis of someone with testicular torsion?

Answer 26

If surgical intervention is done within 6 hours, there is a good chance the testis will remain viable.

Question 27

What is the peak incidence of testicular neoplasms?

Answer 27

15-34 yrs of age

Question 28

What is the most common cause of painless testicular enlargement?

Answer 28

testicular neoplasms

Question 29

What cell type do most heterogeneous testicular tumors arise from?

Answer 29

95% arise from germ cells and are usually malignant | 5% arise from Sertoli or Leydig cells

Question 30

Is there a genetic component to testicular neoplasms?

Answer 30

No hereditary pattern, but familial clustering is noted

Question 31

What are the two groups of germ cell tumors?

Answer 31

seminomas and non-seminomatous tumors

Question 32

What tissue do seminomas arise from?

Answer 32

epithelium of the seminiferous tubules

Question 33

Can seminomas metastasize?

Answer 33

They are not aggressive, but can spread via lymphatics

Question 34

What is treatment for seminomas?

Answer 34

chemo or radiation

Question 35

Prognosis of seminomas?

Answer 35

one of most curable cancers - good!

Question 36

Do non-seminomatous tumors tend to spread?

Answer 36

yes, they spread early via lymphatica AND blood vessels

Question 37

What markers are important in diagnosis of germ cell tumors, specifically non-seminomatous tumors?

Answer 37

alpha-fetoprotein (AFP) | human chorionic gonadotropin (HCG)

Question 38

What is one type of non-seminomatous tumor?

Answer 38

embryonal carcinoma

Question 39

What is the survival/prognosis of germ cell tumors?

Answer 39

seminomas - 95% are cured non-seminomatous - 90% in remission or cured (like most, better prognosis when caught early)

Question 40

What is the one germ cell tumor that is the exception in terms of prognosis?

Answer 40

pure choriocarcinoma --> less chemosensitive

Question 41

Where do non-seminomatous tumors commonly metastasize?

Answer 41

liver and lungs

Question 42

What is typical treatment for non-seminomatous tumors?

Answer 42

chemo, they are less sensitive to radiation

Question 43

What are the different categories of prostate disorders?

Answer 43

inflammatory lesions nodular hyperplasia carcinoma

Question 44

What can be some symptoms of prostatitis?

Answer 44

``` enlarged and tender prostate UTI infection (E. coli) dysuria frequent urination lower back and pelvic pain ```

Question 45

What is the etiology of chronic nonbacterial prostatis (chronic pelvic pain syndrome)?

Answer 45

etiology is unknown

Question 46

What area of the prostate does nodular hyperplasia affect?

Answer 46

inner periurethral zone

Question 47

What is another name for nodular hyperplasia?

Answer 47

benign prostatic hyperplasia

Question 48

In whom does nodular hyperplasia occur?

Answer 48

can occur in every male to some extent, but prevalence increases with age. (males in 8th decade)

Question 49

What tissues proliferate to cause enlargement in nodular hyperplasia?

Answer 49

stromal and glandular tissue - urinary obstruction may occur

Question 50

What are clinical symptoms of nodular hyperplasia?

Answer 50

hesitancy, urgency, nocturia, poor urinary stream

Question 51

What is the considered etiology of nodular hyperplasia?

Answer 51

hormonal stimulus --> local increase in androgens

Question 52

What is the recommended treatment for nodular hyperplasia?

Answer 52

drug treatment | surgical treatment if there is obstruction --> Transurethral Resection of the Prostate (TURP) --> may result in fibrosis

Question 53

What is the most common cancer in men over 50?

Answer 53

prostate cancer -->adenocarcinoma

Question 54

Where does adenocarcinoma of the prostate metastasize?

Answer 54

lymph nodes and skeleton

Question 55

True or False: | Prostate Adenocarcinoma can be clinically latent or silent.

Answer 55

True

Question 56

What is the etiology of carcinomas in the prostate?

Answer 56

unknown, but thought to be androgens, genes, and environment

Question 57

What is the most common anatomical area in which prostate carcinomas arise?

Answer 57

outer/peripheral glands of the prostate

Question 58

Why are prostate exams needed?

Answer 58

you can palpate most carcinomas of the prostate because they are within the peripheral glands of the prostate

Question 59

What is the treatment for prostate cancers?

Answer 59

combinations of surgery, radiation, and hormonal therapy

Question 60

Name the antigen observed in serum when diagnosing prostate cancers?

Answer 60

prostate specific antigen ---> elevated levels can be due to non-neoplastic conditions!!!!!

Question 61

What determines prognosis of prostate cancer?

Answer 61

anatomic extent of disease with 98% 10 yr survival rate (10 % if spread)

Question 62

What is the most common type of bladder cancer?

Answer 62

urothelial carcinoma

Question 63

List some risk factors for urothelial carcinoma.

Answer 63

smoking, chronic cystitis, infection w/ schistosomiasis (parasitic flatworms), carcinogens

Question 64

Symptom of urothelial carcinoma

Answer 64

painless hematuria | tumor cells found in urine

Question 65

What are treatment options for urothelial carcinoma?

Answer 65

transurethral resection, immunotherapy, radical cystectomy

Question 66

What is bladder cancer usually preceded by?

Answer 66

premalignant papillary growth or flat growth.

Question 67

In whom does urothelial carcinoma occur?

Answer 67

men between ages 50-80

Question 68

What is prognosis of urothelial carcinoma dependent on?

Answer 68

tumor grade and stage (degree of atypia and extent of invasion)