Genitourinary Disease Flashcards
(112 cards)
1
Q
where is the most common site for malformations in the penis
A
the distal urethral orifice
2
Q
what are the two malformations of the distal urethral orifice and which is more common?
A
hypospadias: more common
epispadias
3
Q
what is hypospadia?
complications?
incidence?
A
abnormality of the ventral aspect of the urethral opening of the penis
cause in increase in UTIs
1 in 300 live male births
4
Q
what is epispadia?
complications?
A
abnormality of the dorsal aspect of the urethral opening of the penis
cause an increase in UTIs and predisposition to urinary incontinence
5
Q
squamous cell carcinoma of the penis
- prevalence
- population it affects
- associated w/ what other disease (what type)
A
0.4% of all cancers in males
affects uncircumsized men over 40 (rare in those circumsized early in life)
associated with human papillomavirus
–>HPV type 16 and 18
6
Q
what is bowen’s disease
A
carcinoma in situ of the penis
not specific to the penis
usually progresses to squamous cell carcinoma of the penis
7
Q
what is the appearance of a premalignant lesion of the penis
what about histologically?
A
white plaque thickening
red areas
may have any level of epithelial dysplasia
8
Q
how many premalignant lesions progress to squamous cell carcinoma of the penis?
A
10%
9
Q
what is the appearance of squamous cell carcinoma of the penis?
A
crusted papule that usually develops a central ulceration
less frequently but can appear as a papillary mass
10
Q
tx for squamous cell carcinoma of the penis
survival rate?
metastasis?
A
surgical excision
5 yr survival rate 66% (widespread metastasis is rare)
local metastasis to inguinal lymph nodes makes 5 yr survival rate to 27%
11
Q
what was the first human malignancy associated with environmental influences
A
squamous cell carcinoma of the scrotum
chimney sweeps
12
Q
most important disorders of the scrotum involve what?
A
testes
13
Q
what is cryptorchidism
A
incomplete descent of the testes
can be unilateral or bilateral
14
Q
what is the relation to sterility with cryptorchidism
A
bilateral cryptorchidism usually causes sterility
unilateral cryptorchidism can also be associated with sterility of the descended testis atrophys
15
Q
cryptorchidism
diagnosis?
complication?
prevalence?
A
diagnosis cannot be confirmed until 1 yr of age
3rd mo gestation: testes normally descend into pelvis
last 2 mo interuterine: testes descend into scrotum
failure of descent associated w/ 3-5 times more likely to develop testicular malignancy
occurs in 1% of male population
16
Q
orchiopexy
A
surgical placement of the testes into the scrotum
done before puberty–>reduces but does not eliminate risk of cancer and infertility
17
Q
what is orchitis
A
inflammation of the testes
–>more common in epididymis (epididymitis)
swelling and tenderness
18
Q
etiology or orchitis
A
begins as primary UTI w/ secondary ascending infection of the testes
associated w/ STDs
can be caused by:
- nonspecific orchitis
- mumps
- tuberculosis
19
Q
orchitis connection to mumps
A
orchitis can complicate mumps in 20% of infected males
severe cases can lead to sterility
20
Q
what is torsion
A
twisting of spermatic cord
- *UROLOGIC EMERGENCY**
- ->if don’t tx will get infarction
21
Q
what happens to the blood flow in torsion
A
venous drainage is blocked but arteries remain patent
causes vascular engorgement
22
Q
neonatal torsion
A
occurs in utero or shortly after birth
no known cause
23
Q
adult torsion
- -main age group?
- -cause?
- -symptom?
A
usually in adolescents
secondary to anatomic defect–increased mobile testes
if occur spontaneously–>sudden onset of testicular pain
24
Q
testicular tumors (neoplasms)
- prevalence
- peak age it affects
- what cells do tumors arise from
A
6 per 100000
15-34 yrs old
95% arise from germ cells –>malignant
5% arise from sertoli or Leydig cells–>benign
25
sex cord-stromal tumors of testes
the 5% of tumors that arise from the sertoli or leydig cells
26
what is the most common cause for painless, firm enlargements of the testes?
testicular neoplasm (tumor)
27
germ cell tumors of the testes (95%)
- 2 categories
- what are the differences between the 2 categories
- ->prognosis
- ->markers
- ->spread (metastasis)
Seminomas vs nonseminomatous germ cell tumors
Seminomas:
- -localized tumor for long time
- -extremely radiosensitive
- -spread occurs via lymphatics
- -markers rarely found
- -respond well to tx
Non Seminomatous:
- -spread earlier...usually involve lung/liver at time of diagnosis
- -less radiosensitive
- -spreads via hematogenous route
- -markers found a-fetoprotein + human chorionic gonadotropin (HCG)
- -prognosis has improved recently since new chemotherapy regimens have been introduced
28
germ cell tumors:
| seminomas
one of the most curable cancers
| arise from epithelium of seminiferous tubules
29
three categories of prostate disorders
inflammatory
nodular hyperplasia
carcinoma
30
prostatitis
inflammation of the prostate
-->enlarged and tender
may be acute or chronic
31
prostatitis
- ->what bacteria is most commonly associated?
- ->symptoms?
- ->tx
bacterial prostatitis commonly caused by the same bacteria that causes UTIs-->E. Coli
dysuria, urinary frequency, lower back pain, suprapubis or pelvic pain
antibiotics penetrate the prostate poorly so causes recurrent UTIs in men
32
what is nodular hyperplasia of the prostate
used to be known and BPH (benign prostatic hypertrophy) now called Benign Prostatic Hyperplasia
hyperplastic enlargement or the prostate
33
what part of the prostate is most commonly affected in BPH and what does this cause
the inner periurethral zone which compresses on the urethra
34
symptoms of BPH
- dysuria (difficulty urinating, pain)
- difficulty starting, maintaining and stopping the stream of urine
- nocturia
35
why do men with BPH have a higher incidence of UTIs
because of the residual urine left in the bladder post urination
and the chronic obstruction
36
tx of BPH
drugs
| surgery-->no more than 10% need surgery to relieve symptoms
37
BPH
- age affected
- etiology
begins at age 40 (20%) and most are affected by age 70 (90%)
seems to have an association w/ androgens
--increase in androgens and androgen receptors; increase development of BPH
38
carcinoma of the prostate
- -prevalence
- -highly affected age
- -cause
50% of men over the age of 80
peak prevalence is 65-75 yrs
unknown cause
-->may have an association w/ increased androgens
39
what is the most common cancer in men over 50 yrs
carcinoma of the prostate
40
do carcinomas of the prostate spread?
many of these cancers are small, asymptomatic, and progress slowly and are found when examining nodular hyperplasia specimens
those that do spread do by lymphatics and bloodstream
-->osseous metastasis is common
41
where do carcinomas of the prostate begin anatomically
int he peripheral zones of the posterior lobe of the prostate
42
how are carcinomas of the prostate usually detected if they are clinically evident?
digital rectal exam
43
what is PSA (prostate specific antigen)
this is a marker useful in the management of prostate cancer (elevated in serum)
however it is not specific because also present in a normal prostate, prostatitis, or nodular hyperplasia
44
how is PSA used to help in cases of prostate cancer
it is used for staging and prediction of response to treatment
in conjunction w/ digital rectal exam, transrectal sonography, and needle biopsy; can be very helpful
45
treatment of carcinoma of the prostate and prognosis
surgery
radiation
hormone therapy used in advanced cases
disseminated cancers have a 10-40% 10 year survival rate
46
most common cancer of the bladder is...
urothelial carcinoma (90%)
47
incidence of urothelial carcinoma
symptoms
detection
men between the age of 50-80 yrs
presents with painless hematuria (blood in urine)
cytology: tumor cells shed into urine making this a common way of detection
precursor lesion: papillary growth, sometimes flat
48
risk factors for urinary bladder neoplasms
cigarette smoking
chronic cystitis
infection w/ schistosomia
exposure to carcinogens
49
tx of urothelial carcinoma
prognosis
transurethral ressection
immunotherapy
radical cystectomy
depends on extent of invasion and tumor grade
50
STD: sexually transmitted diseases
peak incidence
what are the most common STDs?
20-24 yrs of age
most common: genital herpes, genital HPV infection
51
what is syphilis? what bacteria is involved?
what race is affected most?
chronic infection caused by treponema pallidum (spirochete)
African Americans affected 30x more than Caucasians
52
what are the two antibodies produces by a syphilis infection
```
sphilitic reagin (non specific)
treponemal antibody (specific)
```
53
what are the several screening tests used to detect syphilis
serologic testing
1. VDRL: venereal disease research lab (not specific-false positive)
2. RPR: rapid plasma reagin (not specific-false positive)
3. FTA: fluorescent treponemal antibody absorption test
- ->most expensive, difficult; but most specific and should be performed following + tests from the other two
* *all serologic tests will be positve in Secondary Syphilis stage
* *FTA test is positive for life even after successful tx
54
what is the histopathologic hallmark of syphilis
lymphoplasmacytic infiltrate associated with obliterative endarteritis
55
what is the transmission of syphilis
direct contact (cutaneous or mucosal lesions) during early stages-->highly infectious
transplacental transmission readily occurs as well
56
syphilis presents in stages
what are the three stages?
what are the hallmark pathology present at each stage
primary syphilis-->chancre
secondary syphilis
-->lymphadenopathy, mucocutaneous lesions, mucous patches, condyloma lata
tertiary syphilis
- ->aortic scarring, weakening, dilation
- ->brain atrophy, dementia
- ->gumma
57
Primary Syphilis
- ->when do you see the chancre
- ->what occurs at this stage in addition to the chancre
- ->how long does the chancre take to heal
- ->how many pts progress to secondary syphilis
chancre arises 9-90 days after infection
-->seen at the site of infection
spirochetemia also occurs during this stage
chancre heals in 4-6 weeks
25% of untreated pts will progress to secondary 2 mos following the resolution of the chancre
58
appearance of the chancre
| where does it present
reddened papule that quickly ulcerates
most commonly found:
male-->glans penis
female-->vulva or cerix
also found on the lips, fingers, oropharynx, and anus
59
Secondary Syphilis
-->enlarged lymph nodes
-->mucocutaneous lesions
-->mucous patches
-->condyloma lata
all sites are infectious
all serologic tests are positive
most pts will clear over several weeks and enter LATENT STAGE-->asymptomatic but serologic markers are +
can develop relapse of secondary syphilis or progress to tertiary (30% of untreated)
60
tertiary syphilis
onset?
what part of the body does it usually affect?
infectious?
appears usually 5-20 yrs after an untreated patient enters the latent period
commonly affects the cardiovascular system (80%)
-->aortic scarring, dilation, weakening
sometimes affects the CNS
-->NEUROSYPHILIS: brain atrophy, dementia
gumma appears
this stage is much less infectious
**CVS and CNS damage is irreversible
61
widespread mucocutaneous lesions in secondary syphilis
maculopapular, scaly or pustular
| involves the palms and soles
62
mucous patches in secondary syphilis
found in oral and vaginal areas
| localized spongiotic mucositis
63
condyloma lata in secondary syphilis
elevated large broad plaques that develop in moist skin areas such as the axilla, inner thighs, and anobenital area
-->mucosa condyloma lata not rare (oral cavity, pharynx, and external genitalia)
64
what is gumma
rubbery gray-white areas of necrosis developed in tertiary syphilis
found on mucocutaneous tissue and bone
-->nasal and palatal bone
cause: products of the spirochete and ischemia
65
3 patterns of congenital syphilis
1. stillbirth
2. infantile syphilis
3. late congenital syphilis
66
how long does it take for fetal signs of syphilis to develop?
4 mos in utero
67
if treat within first 4 mos of pregnancy for syphilis how does this affect the outcome?
usually prevents clinical complications
68
does the mother need to have been newly affected by syphilis to pass the disease onto the unborn baby?
no, the mother can have contracted the disease in the last 5 years and still pass the spirochetes to the baby
69
what happens in the absence of tx for congenital syphilis while the baby is still in utero?
40% die
70
infantile syphilis
liveborn infants present with symptoms like secondary syphilis at birth or within the first few months of life
71
late congenital syphilis
if untreated more than 2 years
will present most famously w/ Hutchinson Triad
1. interstitial keratitis
2. Hutchinson's Teeth
3. Eighth nerve deafness
also may see: saber shins, saddle nose, mulberry molars, gumma, and neurosyphilis
72
what is the tx for syphilis
penicillin
if allergic use tetracycline
73
what causes gonorrhea
| transmission?
neiseria gonorrhoeae: gram (-) diplococcus
| transmitted by direct contact w/ mucosa of infected person
74
gonorrhea sites of entry
urethra, oropharynx, eyes, anorectum
75
prevalence of gonorrhea
650,000 cases a year
76
tx of gonorrhea
used to be penicillin but now with antibiotic resistance this has become a problem
77
how does gonorrhea present
neutrophilic inflamatory rxn which produces copious amounts of pus
78
how long after exposure can symptoms present?
what presents in symptomatic males, females?
what percent is asymptomatic
2-7 days after exposure
MALES (40% asymptomatic)
- ->dysuria
- ->urinary frequency
- ->mucopurulent exudation from urethra
females (80% asymptomatic)
- ->dysuria
- ->lower pelvic pain
- ->vaginal discharge
79
what happens if gonnorhea left untreated
1. spreads up genital tract and causes sterility in both sexes
2. female ascending infection: uterus, fallopian tubes, ovaries
- ->results in acute salpingitis
- ->scarring can cause pelvic inflammatory disease
3. male ascending infection: acute prostatitis, epididymitis, orchitis
80
what is gonococcal ophtalmia neonatorum
blindness in infants from gonococcal contamination at birth
rare: prophylactic antibiotic place on eyes of all newborns
81
what is the primary diagnostic test for gonorrhea
culture from discharges
82
nongonococcal urethritis and cervicitis
| presentation?
mimics gongococcal urethritis in males and mostly asymptomatic in females
83
what bacteria causes nongonococcal urethritis and cervicitis?
chlamydia trachomatis
84
how does the presentation of nongonococcal urethritis compare to gonococcal?
milder with less complications but does produce pus
85
what are complications for males when they develop urethritis?
spread into the epididymes
86
what are complications for females when they develop urethritis?
spread into the oviducts and produce pelvic inflammatory disease
87
what happens to infants if born of infected mothers with cervicitis?
conjunctivitis or neonatal pneumonia
88
how is usually the diagnosis made for nongonococcal urethritis/cervicitis?
persistent infection after tx of penicillin for gonnorhea
| there are other molecular tests done to exclude gonnorhea
89
tx of nongonococcal urethritis/cervicitis
ceftriaxone combined with doxycycline
| -->effective against chlamydia and gonorrhea
90
what is Reiter Syndrome
possible manifestation of chlamydia infection
reactive arthritis: immune mediated process
-->predominates in patients who are HLA-B27 +
presentation:
-->combination of urethritis/cervicitis, arthritis, conjunctivitis, and mucocutaneous lesions
91
genital herpes simplex prevalance
one of the most common STDs
| affect 50 million individuals in US
92
what virus causes herpes genitalis
herpes simplex virus
- ->most from HSV type II
- ->small % from type I
93
how is genital herpes simplex transmitted
direct contact w/ mucosal surface or broken skin
94
two types of genital herpes simplex
primary
| recurrent
95
primary infection of genital herpes simplex
symptoms?
heal?
```
can be asymptomatic
-OR-
have painful focal lesions w/
--dysuria
--fever
--lymphadenopathy
--headache
--malaise
```
heals in 3-6 weeks
96
usual sites for genital herpes simplex
Male: glans penis and surrounding area
Female: cervix, vagina, vulva, labia
97
painful focus lesions of primary genital herpes simplex
small vesicles that quickly ulcerate
98
diagnosis of genital herpes simplex
exfoliative cytology or biopsy
reveals viral cytopathic effect
99
Viral Cytopathic Effect
ballooning degeneration of epithelial cells in a positive test for genital herpes simplex
100
recurrent herpes presentation
| healing?
periodic vesiculo-erosive lesions
painful-->quick to ulcerate
heal in 7-10 days
**more than 80% of patients will have one or more recurrence yearly for several years
101
neonatal herpes
infection in newborns passed from the mother infected by genital herpes
about half of infants delivered vaginally by mothers who have either primary or recurrent genital herpes are infected
60% of infants then die from the infection
-->high mortality rate!
102
what other population of people is herpes simplex virus a major threat?
immunosuppressed individuals
| -->they can develop a fatal disseminated disease
103
Human Papillomavirus (HPV) causes what?
numerous epithelial proliferations in genital tract
Most common: CONDYLOMA ACUMINATUM
104
which HPV strains causes condyloma acuminatum
6 and 11
105
what is condyloma acuminatum
benign papillary nodule that frequently appear in clusters
106
where is condyloma acuminatum found mostly
arises on mucocutaneous surfaces
MALES: penis and anus
FEMALES: vulva is most frequent site
occasionally see intraoral lesions
107
what happens to infants delievered vaginally by HPV infected mothers
get life threatening papillomas of the upper respiratory tract
108
tx of HPV
surgery
laser ablation
cryotherapy
topical imiquimod
109
can HPV become malignant?
yes, but uncommon
110
what strains of HPV are found in epithelial neoplasias
HPV 16, 18, 31, 33, 35
111
what is another name for condyloma acuminatum
venereal warts
112
condyloma acuminatum histology
papillary proliferation of squamous epithelium exhibiting koilocytic change
