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Renal Path MC > Renal 6 > Flashcards

Renal 6 Flashcards

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1
Q

classic triad of renal cell carcinoma presentation

A

hematuria (MOST COMMON), CV pain, palpable mass

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2
Q

common sites of extension of renal cell carcinoma

A

renal vein and IVC (stage 3), adrenal glands (stage 4)

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3
Q

most common sites of metastasis of renal cell carcinoma

A

lungs and bone

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4
Q

intrinsic causes of urinary obstruction

A

urinary calculi, sloughed papillae, blood clots, tumor, inflammation (prostattis, ureteritis), functional disorder (neurogenic)

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5
Q

progression of pathogenesis of hydronephrosis

A

dilation ureter/pelvis -> progressive atrophy (secondary to obstruction) -> medullary dysfunction -> drop in GFR

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6
Q

inborn errors of metabolism of these familial conditions lead to stone formation

A

gout, cystinuria, hyperoxaluria

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7
Q

makes up 75% of stones

A

calcium oxalate

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8
Q

this makes up 15% of stones

A

triple/strutive stones of magnesium ammonium phosphate

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9
Q

associated condition of triple or struvite stones

A

chronic pyelonephrosis due to Proteus or Staph infection (urea-splitting bacteria)

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10
Q

this favors formation of stones

A

low urine volumes and stasis

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11
Q

these are stones caused by urea-splitting bacteria -> conform to calyces (create casts of calyces) -> major obstruction due to granulomatous reaction around stone

A

staghorn calculi

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12
Q

these kinds of stones are radiopaque

A

calcium (uric acid = radiolucent)

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13
Q

inflammatory reaction associated that causes Staghorn calculi formation; what cells contribute to pathogenesis?

A

xanthogranulomatous pyelonephritis; foamy MP, plasma cells (often with Proteus infection)

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14
Q

signs/symptoms that suggest acute pyelonephritis related to UTI

A

fever, N/V, CV tenderness, WBC casts

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15
Q

cause of chronic pyelonephritis

A

bacteria in face of vesicuoureteral reflux or obstruction

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16
Q

unless this is present, infection will stay localized in the bladder

A

vesicoureteral reflux

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17
Q

these conditions can cause recurrence of infection in acute pyelonephritis

A

unrelieved obstruction, DM, immunosuppression

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18
Q

scarred kidneys are very indicative of this condition

A

chronic pyelonephritis (associated with obstruction)

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19
Q

these give yellow color in chronic pyelonephritis

A

lipid-laden foamy MP

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20
Q

do ureters pass anterior or posterior to common iliac/external iliac artery?

A

anterior

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21
Q

relaxation of pelvic floor of women may lead to this -> protrusion of bladder into vagina

A

cystocele

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22
Q

primary malignant tumor of ureter; what is benign tumor?

A

transitional cell carcinoma; fibroepithelial polyps

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23
Q

pattern of inflammation in bladder characterized by soft, yellow, raised mucosal plaques 3-4 cm in diameter

A

malacoplakia

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24
Q

cells presents in malacoplakia infiltration

A

large foamy MP, multinucleate giant cells, some lymphocytes

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25
associated conditions of malacoplakia
chronic bacterial infection (E coli or Proteus) immunosuppressed, transplant recipients
26
usual organism causing UTI; bacteria causing UTI in women commonly
E coli (most common), Proteus, Klebsiella, Enterobacter (gram neg bacilli); Staph saprophyticus
27
risk factors for transitional cell carcinoma
cigarette smoking, 2-naphthylamine/aniline dyes, chronic analgesic use, cyclophosphamide, Schistosoma haematobium infection
28
bladder infection that causes squamous cell metaplasia -> leads to squamous cell cancer
Schistosoma haematobium
29
this is opening of urethra on ventral surface of penis
hypospadias
30
opening of urethra on dorsal surface of penis
epidspadias
31
zone of prostate most commonly involved with cancer
peripheral
32
zone of prostate where most of BPH occurs
periurethral (causes obstruction)
33
morphology of acute bacterial prostatitis
suppurative inflammation from E.coli/gram negatives (enterococci, Staph)
34
signs/symptoms of acute bacterial prostatitis
fever, chills, dysuria, tender and soft prostate (on rectal exam)
35
possible pathogenesis of BPH
dihydrotestosterone accumulation, estradiol increases effects (and DHT receptors) -> hyperplasia ->
36
symptoms of BPH
urethral obstruction/urine retention -> dysuria, incontinence, dribbling, nocturia, increase frequency
37
places for local invasion of prostate CA
seminal vesicles, base bladder, urethra
38
complete or incomplete failure of abdominal testis to descend into scrotal sac -> possible increase risk of cancer, trauma
cryptorchidism
39
possible sequel of cryptorchidism
trauma (if in inguinal canal), sterility, testicular cancer
40
paraneoplastic syndromes that present with renal cell carcinoma
renin (HTN), EPO (p vera), PTHrP (hypercalcemia), hepatic dysfunction, Cushing syndrome, eosinophilia or leukemoid rxn
41
complications of renal cell carcinoma that has poorer prognosis
renal vein invasion or extension into perinephric fat
42
early symptomology of transitional cell carcinomas of the renal pelvis
obstruction, hematuria, and tumor fragmentation
43
analgesic nephropathy is associated with this form of cancer
urothelial (transitional cell) carcinomas of renal pelvis
44
where does urothelial (transitional cell) carcinomas of renal pelvis infiltrate?
pelvis wall and calyces
45
major risk factor for renal cell carcinoma
acquired cystic disease/dialysis
46
these organisms predominate in urethritis when associated with cystitis and prostatitis
enteric organisms
47
organisms responsible for 25-60% of nongonococcal urethritis
Chlamydia trachomatis, Ureaplasma urealyticum
48
triad of arthritis, conjunctivitis, and urethritis
Reiter's syndrome
49
symptomology of urethritis
local pain, itching, and frequency
50
normal size/weight of prostate (at least men under 60)
20 gm
51
second layer of cells in glandular spaces of prostate -> cover basal cell layer
columnar mucus secreting
52
morphology of cells of basal layer of glandular spaces of prostate
low cuboidal epithelium
53
microscopic morphology of prostate
glandular space w/ 2 layers of cells (basal and columnar mucus-secreting), papillary projections in glands, fibromuscular stroma
54
lab findings in bacterial prostatitis
>15 WBC/HPF and bacterial growth prostatic secretion, prostatic count > 1 log urine count
55
exogenous factors of acute bacterial prostatitis
surgery, catheterization, cystoscopy, obstruction
56
morphology of chronic bacterial prostatitis
chronic inflammation (lymphocytes, MP, plasma cells, PMN, fibrosis)
57
possible presentations/symptoms of chronic bacterial prostatitis
recurrent cystitis/urethritis, asymptomatic or dysuria/LBP/perianal or subpubic pain
58
most common form of prostatitis
chronic abacterial prostatitis
59
possible symptoms of chronic abacterial prostatitis (same as chronic bacterial)
dysuria, LBP, perianal/subpubic pain
60
what do nodules in BPH compress?
lateral and ventral urethral wall (located in inner periurethral area of prostate)
61
microscopic morphology of BPH
glandular/stromal hyperplasia, glandular dilatation, papilla projection into lumen (from 2 layers of epithelium), cystic dilatation (maybe)
62
morphology of cystic dilatation that is possible in BPH
flattened epithelium, foci squamous metaplasia, infarcts
63
most common form of cancer in males -> 10% lethal, usually affects men over 50
prostate
64
risk factors for prostatic carcinoma
>50, blacks, Orientals in USA, hormonal (epithelial cells have androgen receptors)
65
gross morphology of prostatic carcinoma; microscopic morphology
periphery, gritty and firm; well defined glands w/ dysplastic epithelium, single layer cuboidal epithelium, large/vacuolated/multiple nucleoli
66
areas of hematogenous dissemination of prostatic carcinoma; what is primary location hematogenous spread?
lumbar spine, proximal femur, pelvis, thoracic spine, ribs; axial skeleton -> via paravertebral venous plexus
67
bone lesion in prostatic carcinoma
osteoblastic
68
Gleason score that is considered high race or poorly differentiated (for prostatic carcinoma)
8/10/2015
69
normal cut-off for PSA
4 ng/mL
70
MOA of PSA
liquefies seminal coagulum after ejaculation
71
mainstay of treatment of metastatic prostatic carcinoma
endocrine therapy -> deprive of testosterone
72
mechanism of endocrine therapy for metastatic prostatic carcinoma
estrogen and LHRH -> decrease LH (from pituitary) -> decrease testicular output testosterone (estrogen also directly decreases)
73
this controls transabdominal descent of testis
Mullerian inhibiting substance
74
this phase of testes development is androgen dependent
inguinoscrotal
75
this testicular problem is often related with UTI
epididymitis/orchitis
76
testicular involvement of mumps
orchitis
77
lining of these structures has urothelium/transitional epithelium
renal pelvis, ureteres, bladder, proximal urethra
78
surface layer of transitional epithelium; what is shape of more basal cells?
flattened umbrella cells; cylindrical
79
urothelium/transitional epithelium expresses these blood group antigens -> important in neoplastic transformation
A, B, and H
80
this portion of transitional epithelium is capable of great thickening/hyperplasia -> leads to bands/trabeculae and outpocketings
lamina propria with smooth muscle
81
3 areas of narrowing of ureters -> can lead to impaction by stones
ureteropelvic junction, crossing of iliac vessels, within bladder
82
outlines the bladder trigone
ureteral orifices and urethral opening
83
changes that occur due to increased pressures in urinary tract
reactive hypertrophy smooth muscle and thinning of epithelium
84
results of proximal transmission of pressures in urinary tract
hydroureters, hydronephrosis, pyelonephritis
85
most common source of renal tumors
transitional epithelium

Renal Path MC (5 decks)

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