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Pathology I > Renal, Genitourinary, and Breast Pathology > Flashcards

Renal, Genitourinary, and Breast Pathology Flashcards

1
Q

kidney is _____ of body weight

A

0.4%

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2
Q

what are kidney functions

A
  • filters 25% of blood through glomeruli
  • excretes nitrogenous waste products of metabolism- cleans the blood- turns 1.5L into urine
  • regulates body water and electrolytes
  • maintains appropriate acid-base balance
  • endocrine organ- secretes hormones
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3
Q

what hormones does kidney excrete and what does it control

A
  • renin - blood pressure
  • erythropoietin- proliferative effect on bone marrow to make RBCs
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4
Q

what are the morphologic components of the nephron

A
  • glomeruli
  • convoluted tubules
  • collecting ducts
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5
Q

what does the juxtagomerular complex do

A

controls BP

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6
Q

where are the juxtaglomerular cells located

A

in the afferent arteriole

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7
Q

what is in the juxtaglomerular complex

A
  • juxtaglomerular cells
  • macula densa
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8
Q

where is the macula densa located and what does it do

A
  • in wall of DCT
  • sensor for sodium
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9
Q

describe azotemia

A
  • elevation of blood urea nitrogen and creatinine levels
  • usually related to reduced glomerular filtration rate
  • associated with many primary renal disorders
  • may also be associated with extra renal disroders
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10
Q

what is pre-renal azotemia

A

hypoperfusion of the kidneys decreases GFR in the absence of parenchymal damage

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11
Q

what is post renal azotemia

A

urine flow obstructed below the level of the kidney

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12
Q

what is uremia

A

progression of azotemia to produce clinical manifestations and systemic biochemical abnormalities
- failure of renal excretory function
- metabolic and endocrine alterations

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13
Q

what organs are secondarily involved in uremia

A
  • uremic gastroenteritis
  • peripheral neuropathy
  • uremic fibrinous pericarditis
  • uremic stomatitis
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14
Q

what are the clinical manifestations of renal diseases

A
  • nephrotic syndrome
  • nephritic syndrome
  • acute renal failure
  • chronic renal failure
  • urinary tract infections
  • nephrolithiasis
  • urinary tract obstruction
  • renal tumors
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15
Q

describe nephrotic syndrome

A
  • glomerular syndrome
  • heavy proteinuria
  • hypoalbuminemia
  • severe edema
  • hyperlipidemia
  • lipiduria
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16
Q

describe nephritic syndrome

A
  • glomerular syndrome
  • acute onset of grossly- visible hematuria
  • mild to moderate proteinuria
  • azotemia
  • edema
  • hypertension
  • classic presentation of acute post streptococcal glomerulonephritis
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17
Q

describe acute renal failure and what might it result from

A

oliguria or anuria with recent onset of azotemia
- may result from glomerular injury or acute tubular necrosis

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18
Q

describe urinary tract infections

A
  • bacteriuria and pyuria - symptomatic or asymptomatic- kidney (pyelonephritis) or bladder (cystits)
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19
Q

what are nephrolithiasis and what are they caused by

A
  • kidney stones
  • colic
  • hematuria
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20
Q

describe what causes nephrotic syndrome

A

a non specific disorder in which the kidneys are damaged, causing them to leak large amounts of protein from the blood into the urine

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21
Q

describe what causes nephritis syndrome

A

a non specific disorder in which the kidneys are damaged causing them to leak protein and red blood cells from the blood into the urine

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22
Q

what is glomerulonephritis and what is it treated with

A
  • an immune mediated disease of the renal glomeruli
  • treated with steroids
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23
Q

what is pyelonephritis and what is it treated with

A
  • an infection of the kidney ( not the glomerulus) usually caused by bacteria and of retrograde origin
  • treated with antibiotics
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24
Q

describe post streptococcal glomerulonephritis

A
  • acute onset of nephritic syndrome in 9-14 days following streptococcal infection
  • type III immune injury ( immune complex mediated inflammation)
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25
Q

what are the pathways of renal infection in pyelonephritis and which is mroe common

A
  • hematogenous dissemination
  • ascending infection- more comon
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26
Q

how is pyelonephritis spread and what is the tx

A
  • fecal bacteria from perineal area
  • bactrim
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27
Q

pyelonephritis is ____ common than glomerulonephritis

A

more

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28
Q

what are the symptoms of kidney stones

A
  • may cause obstruction
  • pain
  • ascending infection
  • hematuria
  • pyuria
  • lithotripsy
  • may be associated with hypercalcemia
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29
Q

how are kidney stones treated

A

extracorporeal shock wave lithotripsy (ESWL)

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30
Q

describe the renin- angiotensin- aldosterone axis

A
  • blood pressure drop detected by JG cells
  • secretes renin
  • converts to angiotensin I
  • ACE converts to ANG II
  • ANGII does vasoconstriction and increases aldosterone which increased Na+ retention and increases BP
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31
Q

what are the organs involved in end organ damage in complications of HTN

A
  • cardiovascular system
  • peripheral vascular system
  • renal system
  • central nervous system
  • visual system
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32
Q

how is the CVS affected in end organ damage in HTN

A
  • accelerated coronary atherosclerosis
  • increased myocardial oxygen demand
  • ventricular remodeling
  • heart failure
  • increased risk for arrythmias
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33
Q

how is the peripheral vascular system affected in end organ damage in HTN

A
  • atherosclerosis
  • aortic dissection
    -abdominal aortic aneurysm
  • peripheral vascular disease
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34
Q

how is the renal system affected in end organ damage in HTN

A
  • hypertensive nephrosclerosis
  • end stage renal disease
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35
Q

how is the CNS affected in end stage organ disease with HTN

A
  • hemorrhagic CVA
  • thromboembolic CVA
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36
Q

how is the visual system affected in end organ damage in HTN

A
  • retinal infarction
  • hypertensive retinopathy
  • blindness
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37
Q

what is arteriosclerosis

A
  • affects arterioles
  • thickened walls reduce lumen diameter causing ischemic injury
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38
Q

what are the types of arteriosclerosis and what diseases are each associated with

A
  • hyaline arteriosclerosis: benign hypertension, diabetes mellitus
  • hyperplastic arteriosclerosis: malignant hypertension
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39
Q

what is the inheritance pattern for adult polycystic renal disease

A

autosomal dominant

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40
Q

what is a cause of renal cell carcinoma

A

cystic changes associated with renal dialysis

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41
Q

describe renal cell carcinoma

A
  • arises from renal tubular epithelium
  • often silent
  • may grow into renal vein
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42
Q

is metastasis to kidney a normal site

A

no

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43
Q

describe Wilm’s tumor, who it affects, symptoms, histopathology and survival

A
  • nephroblastoma
  • children under 5 years
  • abdominal mass
  • chronic low grade fever
  • histopathology of several cell types, some of which resemble abortive glomeruli and others that resemble skeletal muscle
  • better than 90% 5 year survival
44
Q

describe urothelial carcinoma and causes

A
  • arises from the urinary tract lining epithelium
  • bladder most common site
  • painless hematuria
  • cigarette smoking, industrial solvents (beta- napththlyamine), chronic cystitis, schistosomiasis, drugs (cyclosphamide)
45
Q

the clinical significance of urothelial carcinoma depends on:

A

histologic grade, differentiation and depth of invasion

46
Q

what are the three major diseases of the prostate

A
  • prostatits
  • benign prostatic hyperplasia
  • adenocarcinoma of prostate
47
Q

what is the normal serum level of prostate specific antigen(PSA)

A

< 4ng/ml

48
Q

what are the physiologic functions of PSA

A
  • liquefy semen, allowing sperm to swim freely
  • dissolution of cervical mucous cap
49
Q

increased levels of PSA may suggest:

A

the presence of prostate cancer

50
Q

PSA is elevated in:

A

prostatitis

51
Q

what is prostatitis

A

acute bacterial disease treated with antibiotics

52
Q

describe nodular (benign) prostatic hyperplasia- BPH

A
  • obstruction to flow
  • urinary frequency
  • ascending infections
  • rule-out neoplasia
  • pharmacologic treatment
  • surgical treatment (TURP)
53
Q

describe adenocarcinoma of prostate

A
  • 70% of men develop prostate cancer by 70-80 years of age
  • digital prostate examination
  • biopsy - multiple cores
  • wide variation in clinical behavior
  • gleason grading
54
Q

what is cryptorchidism

A

undescended testes

55
Q

what is seminoma

A

germ cell tumor- malignant

56
Q

what are infections of the tested

A
  • TB
  • mumps
  • syphilis
  • gonorrhea
57
Q

describe cryptorchidism

A
  • absence of one or both testes in the scrotum
  • failure of testis to descend from an abdominal position through the inguinal canal into the scrotum
  • infertility
  • increased risk for neoplasia
  • orchiopexy
58
Q

describe seminoma

A
  • most common germ cell tumor of testis
  • young adults: 15-34 years
  • surgery plus radiation therapy and chemotherapy
  • one of the most treatable and curable cancers
  • over 95% long term survival in early stages
59
Q

what are the complications of mumps

A
  • orchitis
  • oophoritis
  • mastitis
  • meningitis
  • thyroiditis
  • pancreatitis
  • sterility
  • hearing loss
60
Q

when are complications common in the course of mumps

A

in older individuals

61
Q

what are hypospadias

A
  • developmental defect of the urethra in the male
  • abnormally placed urethral meatus
  • urethral meatus open on the glans penis most commonly
62
Q

what is phimosis

A
  • foreskin cannot be fully retracted from the head of the penis
63
Q

what is priapism

A
  • erect penis or clitoris does not return to its flaccid state despite the absence of both physical and psychological stimulation within four hours
  • medical emergency
64
Q

what is priapism caused by

A
  • hematologic diseases: sickle cell disease, leukemia
  • trauma
65
Q

what is uterine leiomyoma

A
  • benign smooth muscle neoplasm
  • fibroids
  • may cause irregular bleeding (metrorrhagia) or painful intercourse (dyspareunia)
66
Q

what are the proliferative lesions of the endometrium

A

-endometrial hyperplasia
- polyps

67
Q

what is associated with proliferative lesions of the endometrium

A
  • glandular epithelium
  • bleeding
68
Q

what are the two major diseases of the endometrium

A
  • endometriosis
  • adenocarcinoma
69
Q

describe endometriosis

A
  • endometrial tissue outside the uterine cavity
  • ectopic endometrial tissue influenced by hormonal chnages
  • recurring pelvic pain
  • symptoms depend on the site involved and worsen with the menstrual cycle
70
Q

what are the risk factors for endometrial carcinoma

A
  • age: most common in 55-65 age group
  • obesity- greater synthesis of estrogen in body fat
  • infertility- women who are nulliparoud are at increased risk
71
Q

describe cervical squamous cell carcinoma

A
  • exfoliative cytologic screening for early detection - papanicolau smear
  • squamo- columnar junction
  • high risk HPV subtypes- 16,18
  • vaccination
72
Q

what are the types of cervical intraepithelial neoplasia

A
  • Grades I, II, and III
  • LSIL- low grade squamous intraepithelial lesion
  • HSIL- high grade squamous intraepithelial lesion
73
Q

what is a teratoma

A
  • a tumor containing tissues from all three germ layers
  • arise in gonadal tissues
  • most commonly seen in the ovary
  • dermoid cyst of the ovary - a benign cystic teratoma
74
Q

describe gonorhhea

A
  • neisseria gonorrhea
  • “mother natures brith control”
  • pelvic inflammatory disease
  • tubal scarring
  • ectopic pregnancy
75
Q

what microbe causes acute epididymitis

A
  • neisseria gonorrhea
76
Q

what are in breasts

A
  • glandular epithelium
  • ducts
  • lobules
  • interstitial tissue
  • lymphatics
77
Q

what is gynecomastia

A
  • enlargement of male breast may occur in response to estrogen
  • hyperestrinism in male
  • bilateral - rule out hormonal
  • unilateral- rule out tumor
78
Q

what are the causes of hyperestrinism in male

A
  • cirrhosis of liver- inability to metabolize estrogens
  • klinefeller syndrome
  • estrogen- secreting tumors
  • estrogen therapy
79
Q

describe fibroadenoma

A
  • most common benign neoplasm of breast
  • discrete usually solitary, moveable nodule
  • young women
80
Q

what are the types of malignant neoplasms of the breast/breast cancer

A
  • lobules- lobular carcinoma
  • ducts- ductal carcinom
81
Q

describe lobular carcinoma

A
  • lobular carcinoma in situ
  • invasive lobular carcinoma
82
Q

describe ductal carcinoma

A
  • ductal carcinoma- in situ
  • invasive ductal carcinoma
83
Q

what is the pathogenesis of breast cancer

A
  • genetic changes
  • hormonal influences
  • environmental variables
84
Q

what are the well established risk factors for breast cancer

A
  • age: uncommon less than 30 years old
  • genetic and family history
  • menstrual history- early periods less than 12 years old or late menopasue greater than 55 years old
  • length of reproductive life
  • nulliparous- having children in protective
  • geographic variation
85
Q

what genes are associated with breast cancer

A
  • p53
  • BRCA 1/2 genes
86
Q

what are other risk factors of breast cancer

A
  • exogenous estrogens- postmenopausal hormone replacement therapy
  • oral contraceptives- newer formulations of balanced,low doses of estrogen and progesterone are safe
  • ionizing radiation during breast development
87
Q

what are less established risk factors associted with breast cancer

A
  • alcohol consumption
  • high fat diet
  • obesity
  • cigarette smoking
88
Q

what are the genetic changes associated with breast cancer

A
  • familial syndromes
  • HER2/NEU proto oncogene
  • amplification of RAS and MYC- proto-oncogenes
  • mutations of Rb and p53 - tumor suppressors
  • estrogen receptor positivity
    -progesterone receptor positivity
89
Q

what are the familial syndromes associated in breast cancer

A
  • Li- Fraumeni syndrome- p53
  • cowden syndrome- PTEN
  • ataxia- telangiectasia- DNA repair genes
  • BRCA1/2
90
Q

describe the associated of HER2/NEU with breast cancer and how is it treated

A
  • epidermal growth factor receptor
  • amplified in 30% of breast cancers
  • overexpression associated with poor prognosis
  • therapeutic intervention- herceptin
91
Q

what therapeutic intervention is used with estrogen receptor positivity

A

tamoxifen

92
Q

what is increased exposure to estrogen caused by

A

-long duration of reproductive life
- nulliparity- having children in protective
- late age at birth of first child

93
Q

how does obesity affect breast cancer risk

A
  • adipose tissue produces small amounts of estrogen
  • after menopauseobesity increases breast cancer risk by increasing level of estrogen
  • the more fat the higher the estrogen level
  • premenopausal obesity does not increase breast cancer risk
94
Q

what is the affect of age on breast cancer risk

A
  • there is a change in the structure of breast lobule at pregnancy with first child
  • late age at birth of first child increases breast cancer risk
  • with late age of birth of first child, type 1 and type 2 breast lobules persist longer and are more sensitive to carcinogens
  • during 3rd trimester lobules mature into type 3 lobules
  • type 4 lobules are formed after childbirth and produce milk
  • type 3 and type 4 are resistant to carcinogens
95
Q

what are the locations and prevalcne of breast cancer

A
  • upper outer quadrant- 50%
  • central portion - 20%
  • lower outer quadrant- 10%
  • upper inner quadrant - 10%
  • lower inner quadrant - 10 %
96
Q

what are the classifications of breast cancers

A
  • non invasive
  • invasive
97
Q

describe noninvasive breast cancers

A
  • have not penetrated the basement membrane
  • ductal carcinoma in situ (DCIS, intraductal carcinoma)
  • lobular carcinoma in situ (LCIS)
98
Q

describe invasive breast carcinoma

A
  • have penetrated the basement membrane (infiltrating)
  • invasive ductal carcinoma- most common- scirrhous carcinoma
  • invasive lobular carcinoma
99
Q

describe ductal carcinoma in situ

A
  • precursor lesion to invasive carcinoma
  • when invasive carcinoma develops in a woman with a previuous diagnosis of DCIS usually in same breast
  • good long term prognosis
100
Q

what are the treatments for ductal carcinoma in situ

A
  • surgery and radiation
  • tamoxifen- antiestrogenic if estrogen receptor- blocks estrogen receptor
  • aromatase inhibitors- post menopausal women - blocks estrogen formation
101
Q

describe paget’s disease of the nipple

A
  • clinical variant of DCIS
  • extension of DCIS up to the lactiferous ducts and into the contiugous skin of the nipple
  • crustating exudate over the nipple and areolar skin
  • underlying invasive carcinoma in 50%
102
Q

describe lobular carcinoma in situ

A
  • one third of women with LCIS develop invasive carcinoma
  • the invasive carcinoma may arise in either breast
  • LCIS is a marker of increased ridk for developing breast cancer in either breast
  • bilateral prophylactic mastectomy may be performed
103
Q

describe invasive ductal carcinomas

A
  • most breast carcinomas (70-80%)
  • term used for all carcinomas that cannot be sub- classified into a specific type
  • does not imply that the tumor specificity arises from the duct system
  • carcinoma of no special type or not otherwise specified are synonyms for invasive ductal carcinoma
104
Q

what are the clinical features common to invasive carcinomas

A
  • fixation secondary to adherence to pectoral muscles or deep fascia of chest wall
  • adherence to overlying skin with retraction or dimpling of the skin or nipple
  • lymphatic involvement may cause localized lymphedema with the skin thickened around exaggerated hair follicles- peau d’orange
105
Q

what is the TNM staging of breast cancer

A
  • stage 1: tumor less than 2cm, without nodal involvement, no metastases
  • stage 2: tumor <5cm with <3 nodes and no distant metastases
  • stage 3: many categories any cancer infiltration into skin and chest wall, with nodes, without disseminated metastases
  • stage 4: any cancer with disseminated metastates
106
Q

what are prognostic factors for breast cancer

A
  • size of primary carcinoma
  • lymph node involvement and number of nodes
  • distant metastases
  • histologic grade
  • histologic type
  • estrogen or progesterone receptor expression - tamoxifen
  • proliferative rate
  • aneuploidy
  • HER2/NEU overexpression- herceptin
107
Q

what are the five year survival rates by stage of breast cancer

A
  • DCIS or LCIS- 92%
  • stage 1: 87%
  • stage 2: 75%
  • stage 3: 46%
  • stage 4: 13%
  • for all stages combine 10 year surivial is 50%

Pathology I (24 decks)

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