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Year 2 - Renal (DP) > Pathology > Flashcards

Flashcards in Pathology Deck (98):
1

What are some features of glomerulonephritis?

Glomerulo tufts
Secondary tubulointerstitial changes

2

What sort of distribution does pyelonephritis show?

Patchy

3

Why can pregnancy predispose to pyelonephritis?

Ureteric dilation
Stasis

4

Which of the following is not a risk factor for pyelonephritis:
- Instrumentation
- Obstruction
- Vesicoureteric reflux (Congenital/Acquired)
- Circumcision
- DM

Circumcision

5

What are some vague signs of chronic pyelonephritis?

Hypertension and/or anaemia
Polyuria

6

How does chronic pyelonephritis appear on imaging?

Coarse cortical scarring
Distortion of calyces

7

How does Tuberculosis Pyelonephritis spread?

Haematogenously

8

Where does Tuberculosis Pyelonephritis usually spread from?

Lungs

9

Which of the following is not a symptoms of Tuberculosis Pyelonephritis:
- Weight loss
- Anaemia
- Fever
- Loin pain
- Dysuria

Anaemia

10

Is the pyuria in TB pyelonephritis sterile or non-sterile?

Sterile

11

TB pyelonephritis has caseous foci, what does this result in?

Slow growth with progressive renal destruction:
- Ureters
- Bladder
- Other viscera

12

What can cause necrotising cystitis?

Outlet obstruction

13

What is characterised by multiple, small, fluid-filled cysts projecting into the lumen of the ureter. The cysts may resemble tumours?

Ureteritis + Cystitis Cystica

14

A 59 year old patient presents to her GP with haematuria and increased frequency. She notes that she had UTIs more frequently over the last 6 months and has also lost some weight. On further questioning, you find out that 3 years ago she went on a holiday to Egypt and returned with a papular rash and a dry cough, fever and some muscle aches. On pelvic x-ray, there is some calcification of her bladder walls. After cystoscopy and biopsy, the patient is found to have a squamous cell carcinoma of her bladder.

Schistosomiasis (caused by S. haematorium)

15

In males, what can cause urinary tract obstruction?

Stricture
Posterior urethral valves
Prostatic disease

16

What can happen in prolonged urinary tract obstruction?

Detrusor muscle hypertrophy -> Diverticulum

17

What is hydronephrosis?

Dilation of pelvicalyceal system with parenchymal atrophy

18

What are the two main causes of hydronephrosis?

Urinary tract obstruction
Vesicoureteric reflux

19

Which of the following is not a typical cause of bilateral hydronephrosis:
- Urethral obstruction
- Neurogenic disturbance
- Vesicoureteric reflux
- Congenital abnormality
- Bilateral ureteric obstruction (Advance cervical carcinoma)

Congenital abnormality

20

Which of the following is not a typical cause of unilateral hydronephrosis:
- Calculi
- Posterior urethral valve
- Neoplasms
- Pelvi-ureteric obstruction
- Strictures

Posterior urethral valve

21

If an obstruction is sudden and complete, what sort of hydronephrosis is seen?

As urine production is decreased quickly, there is little pelvicalyceal dilation

22

If hydronephrosis is severe, what effect does this have on the renal cortex?

Thinning
Atrophy
Fibrosis

23

What is the name given to a secondary infection due to urine stasis in hydronephrosis?

Pyonephrosis

24

A dry and crusty full thickness epidermal lesion of the penis

Bowen's Disease

25

A raised erythema on the glans

Erythroplasia of Queyrat

26

In what areas of the world is the incidence of squamous carcinoma of the penis increased?

Latin America
Africa
Far East

27

In what people is squamous carcinoma of the penis almost exclusive to and why?

Uncircumcised men -> Poor hygiene

28

What infection can increase the risk of squamous carcinoma of the penis?

HPV

29

How do squamous carcinomas of the penis of the penis usually appear?

On glans or prepuce:
- Ulcerated and indurated OR
- Exophytic mass (growing outward)

30

In what people is a squamous carcinoma of the scrotum common?

Chimney sweeps

31

What percentage of men over 70 have Benign Nodular Hyperplasia of the Prostate?

75%

32

What percentage of people with Benign Nodular Hyperplasia of the Prostate have significant symptoms?

~5%

33

What causes Benign Nodular Hyperplasia of the Prostate?

Irregular proliferation of:
- Glandular tissue
- Fibromuscular stromal tissue

34

What is the aetiology of Benign Nodular Hyperplasia of the Prostate?

Hormone imbalance:
- Altered androgen/oestrogen ratio
- Peri-urethral/Central gland involved
-> It is oestrogen-responsive

35

What are the three main features of prostatism?

Difficulty starting urination
Poor stream
Overflow incontinence

36

How is Benign Nodular Hyperplasia of the Prostate treated?

Transurethral resection
Drugs:
- α-blockers
- 5-α-reductase inhibitors

37

What is the peak age for prostate cancer?

60-80

38

What family history increases the risk of prostate cancer?

A first degree relative with prostate cancer

39

Where does prostate cancer usually arise?

Peripheral ducts and glands:
- Particularly the posterior lobe
- Peri-urethral zone involved later

40

If prostate cancer spreads lymphatically, where does it tend to go?

Lymphatic:
- Sacral
- Iliac
- Para-aortic nodes

41

If prostate cancer spreads haematogenously, where does it tend to go?

Lumbosacral bone:
- Osteosclerotic lesions
Lungs
Liver

42

What percentage of patients with prostate cancer have locally advanced or metastatic disease at presentation?

66%

43

How will prostate cancer feel on PR exam?

Craggy mass

44

What imaging modalities are useful in prostate cancer?

USS prostate
Skeletal x-ray
Bone scans

45

How are prostate biopsies taken?

Needle-core biopsies under USS

46

What hormonal therapy is used in prostate cancer?

Anti-androgens
Oestrogens
Cyproterone

47

What surgery can be used in prostate cancer?

Radical prostatectomy

48

Painless testicular enlargement, hydrocoele and gynaecomastia are common presenting features of what?

Testicular tumours

49

What are the most common testicular tumours?

Germ cell tumours:
- Seminomas
- Teratomas

50

What less common tumours can affect the testicles?

Lymphoma/Leukaemia
Stromal tumours:
- Sertoli cell
- Leydig cells
Metastases

51

What is the peak age for seminomas?

30-50

52

How do seminomas appear?

'Potato' tumour:
- Solid
- Homotogenous
- Pale

53

How do seminomas appear histologically?

Large
Clear (glycogen leaches out)
Stromal lymphocytic infiltrate (variable)

54

What seminoma variant is commoner in older men?

Spermatocytic

55

If a seminoma spreads lymphatically, where does it metastasize to?

Para-aortic LNs (massive)

56

If a seminoma spreads haematogenously, where does it metastasize to?

Lungs
Liver

57

What is the peak age for testicular teratomas?

20-30

58

How do testicular teratomas appear?

Solid areas
Cysts
Haemorrhage
Necrosis

59

Which of the following is not a class of teratoma:
- Differentiated
- Malignant Anaplastic
- Malignant Intermediate
- Malignant Undifferentiated
- Malignant Trophoblastic

Malignant Anaplastic

60

What does bHCG indicate?

Trophoblastic component of a teratoma

61

What does AFP (Alpha-fetoprotein) indicate?

Yolk sac component

62

What does PLAP (Placental alkaline phosphatase) indicate?

Seminoma

63

What can simple renal cysts be secondary to?

Native kidneys in long term dialysis

64

How do the kidneys in ARPKD appear?

Uniform and bilateral enlargement
Elongated cysts
Dilation of collecting ducts
Reniform shape maintained

65

What is ARPKD associated with?

Congenital Hepatic Fibrosis

66

A 36 year old man presents with haematuria. On examination there is an abdominal mass, he is hypertensive and has evidence of chronic renal failure

ADPKD

67

What benign renal tumour is common, originates in the medulla and has white nodules?

Fibroma

68

What benign renal tumour has yellowish nodules

Adenomas

69

What benign renal tumour can be multiple and bilateral, is associated with Tuberois sclerosis and is composed of a mixture of fat, muscle and blood vessels?

Angiomyolipoma

70

What does a Juxtaglomerular Cell Tumour secrete and what does this cause?

Renin -> Secondary hypertension

71

What is the commonest intra-abdominal tumour in children. It presents with an abdominal mass and arise from residual primitive renal tissue?

Nephroblastoma/Wilm's Tumour

72

What are the alternate names for a Renal Cell Carcinoma?

Clear cell carcinoma
Hypernephroma
Grawitz Tumour

73

Where do Renal Cell Carcinomas arise from?

Renal tubular epithelium

74

What is the peak age of incidence for Renal Cell Carcinomas?

55-60 years

75

What is the M:F ratio of Renal Cell Carcinomas?

2:1

76

What are the paraneoplastic manifestations of Renal Cell Carcinomas?

Polycythaemia
Hypercalcaemia

77

Which of the following is not a feature of a Renal Cell Carcinoma's appearance:
- Large
- Well circumscribed
- Multiple
- Centred on cortex
- Yellow
- Solid, cystic, necrotic and haemorrhagic areas

Multiple

78

If a Renal Cell Carcinoma extends into the renal vein, where can it spread?

IVC -> Right atrium

79

Where can Renal Cell Carcinomas spread haematogenously?

Lung
Bone

80

What is the commonest type of Renal Cell Carcinoma and how do they appear?

Clear cell:
- Rich in glycogen and lipids

81

What grading system is used in Renal Cell Carcinomas?

Fuhrman

82

Where can transitional cell carcinomas arise?

From pelvicalyceal system to the urethra

83

What percentage of bladder tumours do transitional cell carcinomas make up?

90%

84

What is the peak age for transitional cell carcinoma of the bladder?

>50 yeasr

85

What chemicals increase the risk of developing a transitional cell carcinoma of the bladder?

Aniline dies (β-naphthylamine)
Rubber
Benzidine
Smoking

86

What drugs increase the risk of developing a transitional cell carcinoma of the bladder?

Cyclophosphamide
Analgesics (renal pelvis)

87

What other factor can increase the risk of developing a transitional cell carcinoma of the bladder (ie. Not chemicals or drugs)?

Schistosomiasis

88

What is the most common symptoms of transitional cell carcinomas of the bladder?

Haematuria

89

Where do 75% of transitional cell carcinomas of the bladder arise? What can this cause?

Region of trigone:
- Ureteric obstruction

90

Papillary transitional cell carcinomas of the bladder have what characteristic?

Thicker lining than normal urothelium

91

How is transitional cell carcinoma of the bladder invasion graded?

By the invasion of the stroma and detrusor muscle:
- pT1 -> Stromal invasion
- pT2 -> Muscle invasion

92

In what part of the epithelium can a carcinoma-in-situ arise?

Flat

93

Where do transitional cell carcinomas of the bladder spread?

Local LNs (Obturator)
Lungs
Liver

94

What can predispose to bladder adenocarcinomas?

Extroversion (Glandular metaplasia)
Urachal remnants
Long standing Cystitis Cystica

95

What can predispose to bladder squamous cell carcinomas?

Calculi -> Squamous metaplasia
Schistosomiasis

96

What is the commonest bladder malignancy in children?

Embryonal Rhabdomyosarcoma

97

What causes glomerulosclerosis in DM?

Glucose deposits in basement membrane and forms complexes with proteins

98

Which of the following is very radiosensitive, and which is very chemosensitive:
- Seminoma
- Teratoma

Seminoma -> Radiosensitive
Teratoma -> Chemosensitive