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Flashcards in Spring Exam 3 Deck (412):
1

what type of cast?
-Lump edges
-Contain anucleate, slightly reddish, pale discs
-Establishes kidney as source of bleeding, not lower urinary tract
-Signify glomerular disease**

Red cell casts

(type of cellular casts)

2

describe the kidney size and endocrine fxn in acute and chronic renal failure

Acute: normal or swollen, endocrine fxn is preserved

Chronic: normal or decreased, anemia, bone disease is common

3

-Frequency/age distribution: Extremely common in men over age 50 – incidence increased with age by “law of 10’s (e.g. 70% at age 70, etc)

Hyperplasia of the prostate (BPH)

4

Histologic Findings:
-Mesangial expansion (too many nucleli)
-Burning bush look on IF

IgA disease/nephropathy

5

7 Causes of testicular atrophy

1. Cryptorchidism
2. Atherosclerosis (most common is US)
3. Inflammation
4. Malnutrition
5. Hypopituitarism
6. Hormone therapy
7. Klinefelter's Syndrome (sclerosing tubular degeneration)

6

labs associated w/ acute renal failure

 Increased creatinine,  BUN, hyperkalemia, acidosis

7

Causes of what:
-Pulmonary hypertension, lung disease, and pulmonary embolism (cor pulmonale / due to primary lung disease)
-Valve damage

RHF

8

what type of crystal?
-Pink-red-brown granules

amorphous urate

type of acidic crystal

9

proteinuria is defined as what

greater than 150mg/dl or between 2+ and 3+ on dipstick

10

special considerations for a midstream clean catch

Must be refrigerated if not plated within 2 hours
-No 24-hour specimens
-If antibiotic therapy is noted on requisition, lab will process with longer incubation

11

RBC casts on microscopic examination of urine indicates

-glomerular hematuria

-if renal dysfucntion, nephritic syndrome

12

Symptoms:
-Often asymptomatic or similar to those for BPH (ie. LUTS)

adenocarcinoma

13

what type of cast?
-signifys Nephrotic syndrome*

fatty casts

(type of inclusion cast)

14

presents with:
-cysts w/ sponge like appearance
-Numerous SMALL cysts in the CORTEX and MEDULLA in a radial pattern

Childhood or autosomal recessive PKD

*Nearly always presents in infancy or childhood, possibly in utero

15

initial rise: 3-12 hrs
peak rise: 24 hrs
return to normal: 48-72 hrs
clinical relevance: cardiac- specific, best to calculate index

CK-MB

16

Symptoms:
-LUTS (Lower urinary tract symptoms)- difficulty in starting and stopping urination, frequency and nocturia
-voiding sx
-storage sx
*Incontinence is biggest complaint

Hyperplasia of the prostate (BPH)

17

-signifies increased nucleoprotein turnover, especially with chemotherapy

-Lesch-Nyhan (overproduce uric acid – hypoxanthine guanine phosphoribosyl-transferase deficiency)

large numbers of uric acid crystals

18

-Usually in patients with gout
-Slow chronic renal dysfunction

Chronic nephropathy

19

-the prostate is an accessory sex organ situated in the ___ and encircling the ___

retroperitoneum

urethra and bladder neck

*situated with its base at the bladder neck and its apex directed anterioinferiorly at the urogenital diaphragm

20

-5% of HTN cases
-identifiable cause (renal, CV, or endocrine disease typically)

Secondary HTN

21

-Proximal tubular cells affected preferentially
-caused by drugs, contrast, hemoglobin/myoglobin, heavy metals, glycols, organic solvents
*less likely to be reversible

toxic acute tubular necrosis/injury

22

what Renal diseases and Endocrine disease cause secondary HTN

-Renal diseases – acute glomerulonephritis, chronic renal disease, polycystic disease, renal artery stenosis

--Endocrine diseases – Cushing syndrome, excessive licorice ingestion, exogenous hormones (pregnancy, OCP), pheochromocytoma

23

symptoms of tetralogy of fallot

VSD
overriding aorta
pulmonary stenosis
RVH
Right to left shunt

24

3 types of urine collection and when they are used

1. midstream clean catch (for culture)
2. urine collection for 24 hr timed specimen (measure electroyltes, proteins and hormones)
3. random sample (routine screening)

25

what are the 6 germ cell tumors of the testes? (95% of testes tumors)

1. Seminoma
2. spermatocytic seminoma
3. embryonal carcinoma
4. yolk sac tumor
5. choriocarcinoma
6. Teratoma

26

what genetic mutations lead to HTN

-11b-hydroxylase (increase aldosterone)
-Liddle’s syndrome (Na+ channels)

27

-Almost always begins in epididymis with spread to testes*
-Usually part of systemic disease
-Caseating granulomas and infarct

tuberculus orchitis

28

describe how glucose is detected on a dipstick

glucose--> glucose oxidase--> peroxidase-> colored product

**only detects glucose not other sugars

29

4 Neoplastic conditions of the penis

1. Condyloma accuminatum
2. Verrucous Carcinoma
3. Carcinoma In-situ (CIS)
4. Squamous Carcinoma

30

Urine and fecal findings in jaudince:
Urinary bilirubin: INCREASED EARLY
Urobilinogen: decreased early, LATE INCREASE
fecal color: pale early and sometimes dark later

Liver damage
hepatitis (stool is pale early and dark later)
cholestasis (stool is pale)

31

how do you screen for CHF?

-BNP levels correlate with NYHA class
-BNP elevated in CHF NOT COPD

32

-Systemic deposition of IgA immune complexes
-May involve kidneys, skin, joints, GI tract
-Systemic Vasculiitis

Henoch-Scholein Purpura (HSP)

33

initial rise: 3-12 hrs
peak rise: 24 hrs
return to normal: 5-10 days
clinical relevance: cardiac- specific

Troponin I

34

-Grossly: can appear as yellowish nodule or be inapparent
-Histologically: composed of abnormal collections of atypical glands lined by single layer of malignant cuboidal to columnar cells (lack basal cells)
-Increased N:C ratio
-Prominent nucleoli

adenocarcinoma

35

-Most common GCT (30-50%)

Seminoma

36

complications of adenocarcinoma

-higher grades=larger, more invasive
-dx based on random needle biopsies (may miss)

37

Initial rise: 1-4 hrs
Peak rise: 6-7 hrs
Return to normal: 24 hrs
Clinical relevance: good neg. predictive value for myocardium

Myoglobin

38

describe the UA, BUN/CR, GFR, BP, albumin and serum lipid of a UTI

UA: (+) nitrites and leukocyte esterase
BUN/CR: nl
GFR: nl
BP: nl
Albumin, serum lipid: nl

39

what individual tests are part of a basic urinalysis? (9)

1. Sp. G (specific gravity)
2. pH
3. proteinuria
4. protein
5. glucose
6. ketones
7. blood
8. nitrite
9. leukocyte esterase

40

ischemic induced pain insufficient to cause myocyte death

angina

41

-metaplasia secondary to chronic inflammation
-Nonfunctioning bladder
-Schistosomiasis infection in Africa
-Presents at higher stage and has worse prognosis

Squamous cell carincoma of the UT

42

1. Progressive cardiac failure due to chronic ischemia myocyte injury secondary to coronary atherosclerosis
2. Contractile impairment is due to ischemic myocyte loss with interstitial fibrosis and hypoperfusion of residual myocardium leading to progressive left ventricle dysfunction

chronic ischemic heart disease

43

initial rise: 10 hrs
peak rise: 24-48 hrs
return to normal: 10-14 days
clinical relevance: non-specific

LDH

44

-Granulomatous form may occur surrounding “eroded” corpora amylacea

chronic prostatitis

45

what type of crystal?
white granules

amorphous phosphates

type of alkaline crystal

46

what type of cast?
-high refractive index, easier to see than hyaline casts
-Sharp margins, blunt ends, cracks in lateral margins
-8-12 RBC diameters wide
-Associated with advanced chronic renal failure**

waxy casts

(type of cellular casts)

47

what defines anuria

less than 100mL/24 hrs

48

-Increased “normal” sympathetic tone
-Altered Na/K transport efficiency
-Hyperactive renin-aldosterone system
-Polycythemia, smoking, sedentary life, and NSAID worsen it

Essential (primary) HTN

49

-cylinder of Tamm-Horsfall protein which has congealed and taken on form of tubule
-Will incorporate whatever is also in tubule at time of formation
-Will usually have two smooth parallel edges and blunt ends

Casts

50

6 complications of UTIs

1. Sepsis
2. Renal/perinephric abscess
3. Papillary necrosis (diabetes)
4. Staghorn calculi (Proteus)
5. Renal scarring
6. Chronic renal insufficiency

51

most congenital heart anomalies are ___
-such as:

-idiopathic developmental errors

-intrauterine infections (rubella in 1st trimester)
-Radiation exposure
-Maternal DM
-Alcohol abuse, smoking, phenytoin

52

-Pathogenetic mechanism involves development of immune complexes containing hepatitis B antigens that deposit in affected vessels with resultant inflammation and associated consequences

Polyarteritis Nodosa

53

Symptoms:
-Obstructive urinary symptoms due to swelling of gland
-Low back pain, dysuria due to infection

acute prostatitis

54

pathophysiology:
-Pulmonary edema and pleural effusion
-Decreased renal blood flow → retention of Na+ and H2O → increased blood volume → peripheral edema

LHF

55

Clinical Markers:
-Accumulate and secrete AFP (alpha-fetoprotein)

Yolk sac tumor

56

-Adenocarinoma: Risk of progression after 5 years to where

-Pelvic lymph nodes (95%)
-Seminal Vesicles (85%)
-Established capsule (48%)
-Focal capsular penetration (33%)
-Organ confined (10%)

57

-Proximal AND DISTAL tubular cells involved**
-Systemic hypotension (shock)
**likely to be reversible

ischemic acute tubular necrosis/injury

58

-Vasa vasorum neovascularization of plaque starts out to provide oxygen and remove lipid but fails as it results in RBC extravasation, inflammation, and hemorrhage
-intraplaque hemorrhage associated with extravasation of RBCs with their breakdown and further tissue damage

vulnerable plaque

59

cons of nitrite dipstick

-neg. results don't help bc low sensitivity
-Not all bacteria that cause UTI have ability to generate nitrite (enterococci)
---Urine must be present in bladder for few hours
-vit.C, urobilinogen, low pH interefere

60

-Gland forming malignancy of the bladder
-Arises from a urachal remnant or glandular metaplasia in cystitis glandularis

adenocarcinoma of the UT

61

presents with:
-Normal or abnormal valves
-Often asymptomatic
-Associated with endocardial trauma, hypercoagulation, cachexia, uremia, metastatic malignancy “marantic endocarditis”
-Systemic lupus erythematosus – Libman Saks endocarditis

non-infective endocarditis

62

-Secondary to infections where antibodies to microbial constituents form and deposit in vessels
-Antineutrophil cytoplasmic antibodies where autoantibodies against neutrophils deposit in vessels

non-infectious vasculitis

63

-Characterized by the formation of nodules primarily within the TRANSITION zone that enlarge to compress the urethra as well as the peripheral prostate
-Variable areas of glandular and stromal (often mixed) hyperplasia

Hyperplasia of the prostate (BPH)

64

-Nonenzymatic glucosylation of proteins (mesangial matrix, GBM, etc.)
-Hyperfiltration

Diabetic glomerulosclerosis (DM)

*consequence of altered glucose and insulin metabolism

65

-when there’s increased oxygen demand with >70% fixed obstruction “critical stenosis” = ____

-If greater than 90% stenosis, can lead to symptoms even at rest= _____

stable angina

unstable angina

66

Clinical presentation:
-HTN
-Glucose in urine

DM

67

-Fusion of two nephrogenic blastemas in early fetal development
-Usually occurs a the lower pole

horseshoe kidney

*Not usually clinically significant

68

presents with:
-urinary urgency
-hematuria due to free RBCs
-stone somewhere in the UT

nephrolithiasis

69

-MS more common than AS (stenosis)
-Thickening, fibrosis, fusion of valve cusps/leaflets/chordae tendinae with valve stenosis/incompetence
-LA dilatation with atrial fibrillation, mural thrombi, thromboemboli
-RVH and failure

chronic rheumatic heart disease


*presents more than 1- years after acute rheumatic fever

70

where does renal cell carcinoma typically metastasize to and how is it treated?

-Metastatic potential to lung and bone

-Treated with nephrectomy and chemotherapy

71

-Colonization/invasion or of valves or endocardium by organisms results in inflammatory damage, exposure of collagen and thrombus formation “vegetations” which are potential source of thromboemboli or septic emboli

infective endocarditis

72

what is considered HTN and malignant HTN

HTN: higher than 140/90
malignant: higher than 200/120

*malignant HTN: kidneys secrete more renin

73

Testis CA markers

-AFP
-hCG
-Placental-like Alkaline Phosphatase (PLAP)
-Human placental lactogen

74

Symptoms:
-Pulmonary congestion → edema → SOB; orthopnea; paroxysmal nocturnal dyspnea

LHF

75

3 types of renal cell carcinoma

-clear cell
-papillary
-chromophobe

76

what are inflammatory diseases of the testes?

-nonspecific epididymitis and orchitis (most common)
-Mumps orchitis
-tuberculus orchitis
-Syphilis orchitis

77

-Glands often cystically dilated and thrown into numerous papillary infoldings
-Stromal component involves increased density of spindle cells, vessels and in some cases progressive scarring

Hyperplasia of the prostate (BPH)

78

what is Childhood or autosomal recessive PKD associated with?

-liver cysts
-If surviving long enough, congenital hepatic fibrosis occurs (cirrhosis)

*very poor prognosis

79

-Mononuclear inflammatory infiltrate with interstitial edema +/-neutrophils
-usually subsequent to parotid involvement (1 week after)

mumps orchitis

-Can occur in pubertal or adult males who acquire mumps (30%)

80

=Pulmonary heart disease – structural/functional lung abnormalities can lead to pulmonary hypertension due to decrease in effective pulmonary vascular bed with PHTN and right ventricular hypertrophy/failure

cor pulmonale

81

10 Causes of male infertility

1. Congenital (Crypto., immotile cilia syndrome, anorchia, absent vas)
2. Acquired (Torsion, infarction, varicocele, obstruction, inflammation)
3. Klinefelter's Syndrome

82

pH range of urine

4.6 - 8.0 (mean 6.0= acidic)

83

what are routes of infection of UTI?

-ascending infection (most common
-Hematogenous (kidney injury and clinical setting of septicemia, endocardititis)

84

complications of MI

1. arrhythmias
2. percarditis (CP, friction rub)
3. LV failure w/ pulmonary edema
4. Cardiogenic shock
5. Infarction/rupture of papillary muscle w/ MV incomplete
6. Mural thrombus
7. LV aneurysm
8. LV rupture

85

sx:
generalized edema

nephrotic diseas

86

description:
smooth contour
avascular
fluid filled by US

simple cysts

87

most common proliferative disease of the prostate

Hyperplasia of the prostate (BPH)

88

Clinical presentation:
-Classic clinical situation in children:
-1-4 weeks status post Group A streptococcal infection (strep pharyngitis, otitis media, cellulitis)
-Elevated ASO titer
-nephritic disease

Post-infectious glomerulonephritis

*Prognosis depends on age and if it was caused by strep (99% of children recover, only 60% of adults (other bugs= worse prognosis))

89

-Immune or other substance deposition, loss of integrity of epithelial cell or basement membrane

nephrotic disease

90

-Effects PERIPHERAL zone most commonly, but tumors arise anywhere in the gland
-Often multifocal

adenocarcinoma

91

-Characterized histologically by aggregates of lymphocytes, plasma cells, and macrophages within the prostatic substance
-Mononuclear cell inflammation

chronic prostatitis

92

-involves inner third to half of myocardium
-Frequently due to hypoperfusion i.e. hypotensive episode, in presence of atherosclerosis reducing blood flow in narrowed atherosclerotic arteries

subendocardial infarct

93

Tubular sclerosis with NO of elastic fibers

Klinefelter's Syndrome (Sclerosing tubular degeneration)
-47 XXY

94

pros and cons of creatinine

practical use; fairly constant with relation to muscle mass; not bound to plasma proteins → filtered freely; not reabsorbed by renal tubules; small amount secreted by renal tubules (10%)

95

-Squamous CIS involving skin of genital region
-5-10% of cases will progress to invasive squamous carcinoma
-Associated with visceral cancers

Bowmen's disease

96

how does primary vesicoureteral reflux cause chronic pyelonephritis?

Bladder grows --> intravesical ureter increases in length --> improved function of the anti-reflux mechanism

97

Immune mediated systemic inflammatory disease following group A β hemolytic strep pharyngitis

rheumatic heart disease

98

-Usually due to direct extension from urinary tract/ UTI (vas deferens or lymphatics) and tends to effect epididymis first with subsequent orchitis
-acute inflammation- may develop abscesses

-nonspecific epididymitis and orchitis

99

what are the 2 main types of PKD (polycystic kidney disease)?

1. Adult or autosomal dominant

2. Childhood or Autosomal recessive

100

acute prostatitis is most commonly caused by what bacteria?

E. coli or other enterobacteria and S. aureus

--May be iatrogenic

101

the 6most common causes of chronic renal disease with subsequent need for dialysis and kidney transplantation

Diabetes- 38%
HTN/ vascular disease - 25%
Glomerulonephritis- 19%
Interstitial Nephritis- 4%
Polycystic Kidney Disease- 5%
Unknown/other- 9%

102

where do MI's most commonly occur

-LAD occlusion is most common (leading to anterior and apical LV and anterior 2/3 septal MI)

-majority of infarcts involve LV and septum (LV is more prone to ischemia due to larger mass, higher workload, and oxygen demand)

103

what is the cause of chronic prostatitis

-Etiology unknown – may be due to long-standing bacterial infections or dietary factors
-may be due to TB infection

104

free RBCs on microscopic examination of urine indicates

-non-glomerular hematuria

-(kidney (RCC), renal pelvis, ureter, bladder, urethra)
-( contaminant (i.e. hemorrhoids or vaginal bleeding))

105

what are complications of Hyperplasia of the prostate (BPH)

-Acute urinary retention
-Recurrent UTI/pyelonephritis
-Renal failure
-Incontinence

106

-Blood vessels (hypo-flow)
a. Medial and intimal thickening/hypertrophy
b. Hyaline deposition (Hyalinosis)

HTN

107

types of acidic crystals in urine

1. amophrous urates
2. uric acid cystrals

108

what type of crystal?
-Ammonium magnesium phosphate, struvite
-“Coffin lids”
-Form majority of staghorn calculi
-Related to Proteus mirabilis UTI**

triple phosphate crystal

type of alkaline crystal

109

cons of ketone dipsticks

-Dipsticks detect mostly acetoacetic acid, are less sensitive to acetone, don’t detect hydroxybutyrate

-False positives with some medications – L-dopa, phenolphthalein

110

-Sterile small platelet rich vegetations; larger ones can embolize

non-infective endocarditis

*non-bacterial thrombotic endocarditis

111

types of abnormal crystals in urine (6)

1. cystine crystals
2. tyrosine crystals
3. leucine crystals
4. Sulfonamide (Sulfadizaine) Crystals
5. ampicillin and other drugs
6. radiographic material (Renografin)

112

what are the most common causes of an MI

-Most often due to coronary artery thrombus superimposed on severe atherosclerosis
- (+/-) vasospasm and platelet aggregation (seldom sole cause of infarct)

113

what is cystitis

when UTI affects the bladder
*may have frequency and urgency and suprapubic pain

114

Seminiferous tubules connect with epididymis through ___

series of channels
(tubuli recti, rete testis, efferent ductules)

115

___ accepts cholesterol from tissues which can be absorbed by specific receptors in liver (reverse cholesterol transport) or ____

HDL apoprotein

recycled into LDL

116

what is primary vesicoureteral reflux caused by

-Due to angle or site of ureter entry into the bladder
-familial association

117

sx:
Hypertension, oliguria, +/-edema

nephritic disease

118

malignant transformations in the transitional epithelium lining from the renal pelvis through the urethra

Urothelial carcinoma

119

75-90% are secondary to ischemic heart disease

sudden cardiac death

120

sx:
Uremia, anemia, hypertension, hyperparathyroidism

chronic renal failure

121

What do these lead to?
-Adrenal cortex/medulla (catechols, cortisol, aldosterone; eg. pheochromocytoma)
-Hyperreninoma (renal Hemangiopericytoma)

HTN

122

-Directly compromises lumen
-Increases local mechanical shear forces which may contribute to plaque rupture

coronary artery vasospasm

123

presents with:
-typically asymptomatic until 30-40 years of age
-Hypertension is common, ESRD
-accounts for 10% of CRF cases

Adult or autosomal dominant PKD

*typically asymptomatic until age 30-40

124

pathology:
-Nonspecific myocyte hypertrophy and interstitial fibrosis

Idiopathic (Primary) Dilated cardiomyopathy

125

List common clinical sequelae of atherosclerotic disease

1. Thrombosis
2. Ulceration
3. Aneurysm
4. Dissection (layers of vessel pulling apart)
5. Rupture

126

presents with:
LVH
Angina
syncope
LHF in later stages

AV stenosis

-Angina (hypertrophied myocardium has increased oxygen requirements, decreased aortic flow)
-Syncope – reduced aortic outflow leads to poor brain perfusion

127

-Immune complex deposition (ANA and anti-dsDNA)
-Nephritic disease
-Focal segmental Necrotizing and Crescentic Glomerulonephritis

SLE

128

Primary glomerular disease

1. IgA disease/nephropathy
2. post-infectious glomerulonephritis
3. minimal change disease
4. Anti-GBM disease
5. thin basement membrane disease

129

-Anti streptococcal Ab cross react with glycoproteins in various tissues resulting in inflammation
-Long term valve sequelae occur IF following endocarditis / valvulitis there’s fibrosis instead of resolution of inflammation

rheumatic heart disease

130

outcomes of aortic dissections

1. Rupture into mediastinum or retroperitoneum
2. Back into pericardial cavity with tamponade
3. Double barreled aorta

131

Causes:
-Infiltrative process (i.e. amyloidosis)
-Fibrosis secondary to irradiation for mediastinal tumors, lymphoma
-Decrease in ventricle compliance with impaired diastole ventricle filling

Restrictive cardiomyopathy

132

-Diabetic ketonuria levels

up to 50 mg acetoacetic acid/dL urine before symptoms of ketosis

133

what is the staging/treatment of seminomas

-radiosensitive and chemosensitive
-good prognosis

134

-Acute renal failure
-Especially patients with hematologic tumors s/p chemotherapy
-Large wave of nucleic acid release including uric acid released by tumor cells
-Deposition in the renal tubules

acute nephropathy

135

what is the most common tumor of the kidney in adults (85% of all renal malignancies)

Renal cell carcinoma

136

-Normal basement membrane and glomeruli w/ foot processes effacement by EM

minimal change disease

137

Urine and fecal findings in jaundice:
Urinary bilirubin: absent
Urobilinogen: INCREASED
fecal color: dark

hemolysis, hemolytic anemia

138

what type of cast?
Almost entirely renal tubular cells, look for singular round nuclei
-Suggest acute tubular necrosis, viral disease, drug/toxin exposure**

tubular cell casts

(type of cellular casts)

139

Urine and fecal findings in jaundice:
Urinary bilirubin: absent
Urobilinogen: present, undetectable
fecal color: dark

Normal finding

140

7 causes of pericarditis

1. Myocardial infarction
2. Post cardiac surgery
3. Infectious (viral, bacterial, TB)
4. Mediastinal irradiation, uremia
5. Systemic Lupus Erythematosus (SLE)
6. Malignancy
7. Organization and fibrosis of inflammation can lead to obliteration of pericardial cavity- Fibrous encasement of heart and constrictive pericarditis

141

-Congenital defect of media of arteries at bifurcation of cerebral vessels (Circle of Willis)
-may be in multiple (25% of cases)
-may be sporadic or associated w/ polycystic renal disease

berry aneurysm

142

-Heart muscle disease of uncertain etiology
-Occurs in 20-60 y/o
-Systolic dysfunction with ineffective contraction

Idiopathic (Primary) Dilated cardiomyopathy

143

Histologic Findings:
-Usually shows “full house” on IF, granular immune-complex pattern with positive IgG, IgA, IgM, C1q, and C3

SLE

144

-May involve anterior mitral valve leaflet with mitral regurgitation
-Affects young adults – dyspnea, fatigue, syncope, arrhythmias, sudden death
-Sporadic or autosomal dominant inheritance with variable expression in about ½ patients

hypertrophic cardiomyopathy

145

-Nephrotoxic IgG antibody
-Rare autoimmune disease – Antibodies directed against the α-3 chain of collagen IV in the basement membrane of tissues

Anti-glomerular basement membrane disease

146

Basic pathology:
Epithelial cell (podocyte) injury, filter leakiness

nephrotic

147

--High specific gravity : greater than 1.01 suggests ___

intact tubular function and pre-renal source of oliguria

*Slight levels of protein or cells may be dismissed in setting of high sp.g.

148

risk factors of HTN

family hx, blak, stress, age, obesity, salt

149

-Unexplained (200/120), + papilledema, + encephalopathy or nephropathy
-1% of HTN cases
-young AA males
-

malignant HTN/ hypertensive emergency

*potentially fatal if untreated

150

staging and treatment of teratomas

-Good prognosis in children, variable in adult
-Chemoresistent- but slow to progress
*ALL considered malignant--> can be in any germ layer

151

electrophoresis can be used for proteinuria testing when?

for bence jones proteins
-selective proteinuria (ie. albumin only= minimal change, all proteins= more extensive glomerular disease)

152

2 layers (the visceral and the parietal) that are derived from peritoneum during descent

tunica vaginalis

153

rate at which fluid crosses glomerular filter (from capillary lumen to Bowman’s space)

GFR

154

what type of cast?
-Clear, colorless, very hard to see
-Nonspecific*, few are normal
-Rounded ends, parallel edges
-Increased in dehydration, physical exertion, fever, renal injury (only if large quantity)

hyaline casts

(type of cellular casts)

155

-Rare in U.S. due to hygiene practices (0.3-0.6% of all male malignancies)
-Significant health problem in areas of the world where good genital hygiene not practiced
-“chimney sweeps disease”

Squamous carcinoma

156

-Variations in glandular patterns in adenocarcinoma is related to ___

Gleason grade

-Based on glandular architecture and degree to which the tumor resembles “normal” prostate
-Tumors often strikingly heterogeneous

157

malignant HTN leads to what?

result in fibrinoid necrosis and hyperplasic arteriolitis

158

-Narrowing of lumen
-Destruction of internal elastic lamina
-Fibrosis
-Thrombosis with ischemia / infarction
-Aneurysm formation

vaculitis

159

Basic pathology:
Endothelial and mesangial cell injury, inflammation (nephritis)

nephritic

160

how to perform a 24 hr timed urine collection

-Void and discard this specimen; start collection timing at this point and write information on bottle; for next 24 hours (or required time), save all urine voided by adding to collection container; exactly 24 hours (or required time) from starting time, have patient void, completely emptying bladder and add this specimen to collection container

161

congenital abnormalities of the bladder

1. Exstrophy
2. persistent urachus
3. Congenital Diverticuli

162

2 types of benign renal neoplasms

1. oncocytoma (Difficult to differentiate from RCC by imaging)

2. angiomyolipoma (Usually can identify by imaging and Spontaneous hemorrhage if large)

163

Clinical presentation:
-Podocytes expand and leads to proteinuria
-Most common in kids (peak around age 5)
-Tx w/ steroids
-30%will be steroid dependent
-Adults are more steroid refractory

minimal change disease

164

-0.04% of all pregnancies
-Due to lack of induction of ureteric buds
-No kidneys --> No Urine --> No amniotic fluid --> No Lung Development --> Still Born
-Associated with other GU and CNS malformations

bilateral agenesis of the kidney

165

what prostate zone?
-two “lobes” that surround the prostatic urethra laterally and anteriorly
-Separated by fibrous band from peripheral zone

Transitional zone

166

what type of renal failure?
time course: Gradual decrease of GFR over months to years

chronic renal failure

167

Significant loss of function prior to rise in serum creatinine or BUN

GFR

168

-Heart contractions are ineffectual due to dilation or damage
-EF usually less than 40%

Systolic failure

169

-Cause of primary myxomatous degeneration is unknown but there may be intrinsic defect of connective tissue synthesis or remodeling

MV prolapse

170

what type of cast?
--2-6 x diameter of other casts
-Chronic renal failure

broad cast

171

what is pyuria and dysuria

Pyuria- leukocytes in the urine
Dysuria- painful or difficulty urinating

*classic UTI symptoms

172

the prostatic urethra joins with the ejaculatory ducts where?

verumontanum

173

Nondiabetic ketonuria symptoms

– fever, vomiting, cachexia

174

Histologic Findings:
-Neutrophils
- (+/-) crescents
-granular immune complex deposition of IgG or C3 along GBM (“starry sky”)
-Large subepithelial deposits (humps on EM)

Post-infectious glomerulonephritis

175

what are waxy casts associated w/

chronic renal failure

176

-Acidic urine is caused by

– drugs, metabolic or respiratory acidosis, diet high in meat, cranberries

177

1+, 2+, 3+, and 4+ on protein dipstick correlates w/ what protein concentrations

--1+ - ~30 mg/dl
--2+ ~100 mg/dl
--3+ ~400 mg/dl
--4+ ~1000 mg/dl

178

what can differentiat "hemo-" vs "myo-" globinuria

microscopy

179

Presentation
-sudden onset of severe pain radiating to back; hypotension and shock

aortic dissection

180

no RBCs on microscopic examination of urine indicates

free hemoglobin or myoglobin

(free hemoglobin in urine is usually due to intravascular hemolysis)

181

Clinical markers:
-May produce androgen, estrogen- gynecomastia, precocious puberty→ feminizing

Leydig cell tumor

182

-1-5 cm, clear fluid filled, smoothly lines cysts arising within the renal cortex
-Significance is in differentiating them from tumors

simply cysts

183

Symptoms:
-Often asymptomatic
-Often associated with atrophy

Chronic prostatitis

*chronic inflammation often present on biopsies

184

Histologic Findings:
-No proliferation, scarring or leukocyte infiltration on EM just thin BM

thin basement membrane disease

185

Clinical presentation:
-Episodic hematuria
-Nephritic or Nephrotic syndrome
-Often coinciding with URI or GI infection in those under 30 y/o

IgA disease/nephropathy

186

____ composed of seminiferous tubules which contain developing germ cells and supporting Sertoli cells

lobules/testes

187

Presents:
Kidney – hematuria, hypertension, failure
-Gastrointestinal tract – abdominal pain, melena
-Usually no lung involvement
-Middle aged males
-30% Hepatitis B sAg positive

Polyarteritis Nodosa

188

-Diffuse endOcapillary proliferation
-Capillary Occlusion due to proliferation and swelling of endothelial and mesangial cells

Post-infectious glomerulonephritis

189

predisposing factors of aortic dissections

-atherosclerosis
-hypertension (present in 90+% cases)
-cystic medial degeneration (age related or Marfan’s syndrome)

190

mutation in gene encoding fibrillin required for structural integrity of connective tissues

Marfan sydrome

191

-Solitary localized defect in the bladder wall
-Bladder mucosa herniated through the muscle layer
-Usually a developmental defect

Congenital diverticuli of the bladder

192

The seminiferous epithelium is surrounded by lamina propria called ___ and composed of __ and __

surrounded by: tunica propria

composed of: myofibroblasts and elastic fibers

193

-Progressive age related injury due to factors implicated in pathogenesis of atherosclerosis
-May occur in congenital bicuspid valve with earlier presentation (40-50 y/o)

Aortic valve stenosis

194

what type of crystal?
-Flat hexagonal plates, don’t polarize
-Rare but clinically important
-Occur in patients with cystinuria
--May be associated with severe and recurrent cysteine calculi
--Autosomal recessive

cystine crystal

*abnormal crystal

195

urinalysis must be tested w/in ___ of specimen collection or__

2hrs or refrigerate

*24 hr specimens are unacceptable for urinalysis

196

Histologic Findings:
-Linear staining on IF
-Focal segmental Necrotizing and Crescentic Glomerulonephritis

Anti-glomerular basement membrane disease

197

what biomarkers are most specific for myocardium

CK-MB
cTnT or cTnI

198

severity/duration of ischemia is sufficient to cause myocyte death

myocardial infarction

199

what type of crystal?
-Small colorless octahedron
-Resembles envelopes
-Most common component of renal stones**
-Excreted in ethylene glycol toxicity

calcium oxalate crystal

neural crystal

200

staging and treatment of embryonal carcinoma

-More aggressive than seminomas
-chemosensitive

201

-Left atrium pedunculated or sessile mass
-“Ball valve” mitral valve obstruction with episodic syncope or sudden death

Benign myxoma

202

-Segmental granulomatous inflammation of branches of carotid arteries with fragmentation of internal elastic lamina (temporal, ophthalmic)

Temporal (giant cell) arteritis

203

-Immune complex mediated
-Antigen antibody complexes are either deposited from circulation or from in-situ
-drug hypersensitivity vasculitis

non-infectious vasculitis

204

-Most common carincoma (excluding skin) of adult males in US

Adenocarcinoma of the testes

*Second most common cause of male cancer death in US (more die w/ it than of it)

205

-cysts that arise in the cortex and medulla
-Have a tendency to cause hematuria

dialysis associated cysts

206

compare use of leukocyte esterase and nitrite for UTI test

leukocyte esterase has higher sensitivity but lower specificity (for UTI) in comparison to nitrite

207

-Cardiomegaly with disproportionate septal hypertrophy, usually subaortic
-Results in inability to fill left ventricle with forceful but ineffective ejection
-+/- ventricular outflow obstruction

hypertrophic cardiomyopathy

208

describe the distribution and reversibility of acute and chronic renal failure

Acute: all nephrons severely affected at once, often reversible

Chronic: nephrons damaged one or a few at a time, rarely reversible

209

after a positive blood dipstick one must __

-Must differentiate (+) based on history and other tests – hemoglobinuria, myoglobinuria, hematuria

210

what defines
heavy proteinuria
moderate proteinuria
minimal proteinuria

-Heavy proteinuria - greater than 4 g/day (nephrotic syndrome)
-Moderate proteinuria – 1.0-4.0 g/day
-Minimal proteinuria - less than 1.0 g/day

211

where do adenocarcinomas typically metastasize to?

hematogenous to bones of axial skeleton (osteoblastic) or lymphatic to obturator lymph nodes (and others)

212

describe the different kinds of Anti-glomerular basement membrane disease

-If limited to Renal- anti-GBM
-If renal and lung involved- Goodpasture’s Syndrome

213

Morphological Findings:
-Placental differentiation – syncytiotrophoblast and cytotrophoblast

Choriocarcinoma

214

-developmental defect where bladder wall and mucosa are on the surface of the abdominal wall
-The pelvic bones can be separated.
-The remainder of the lower UT may also be flattened and exposed, with abnormal formation of prostate, penis, clitoris, vagina

exstrophy of the bladder

*increased risk of carcinoma

215

-non-obstructive plaques prone to rupture / superimposed acute thrombus
-Thin, fibrous cap which is unable to withstand circumferential stress

vulnerable plaque

216

describe the expected urine volume in acute and chronic renal disease

Acute: decreased to none

Chronic: often normal

217

-Virulent organisms (staph aureus)
-Normal and abnormal valves/endocardium
-Inflammatory damage with larger thrombotic vegetations
-Valve perforation
-Acute onset and high mortality
-IV drug abuse (right sided valves, staph aureus)

acute infective endocarditits

218

what type of cast?
-Composed of WBCs, look for lobed nuclei of neutrophils
-Signify inflammation within kidney (i.e. pyelonephritis, allergic interstitial nephritis, interstitial nephritis)**

WBC casts

(type of cellular casts)

219

Causes of what:
-Damaged myocardium, increased systemic pressure, valve damage

LHF

220

___ is a dense layer of tissue which encases the testes and connects to the layers of fibres which surround the epididymis, the first in a series of ducts which transport sperm out of the testes and into the penis

tunica albuginea (white coat)

221

-Congenital maldescent of one (75% of cases) or both (25%) testes
-May be found anywhere along pathway of descent (inguinal canal, midline, superficial canal)

Cryptorchidism

-atrophy as early as 2 y/o

222

-usually after trauma, causing defect in wall and hematoma on outside of vessel which communicates with lumen

False (pseudo) aneurysm

223

-calcium oxalate, 75-80% hypercalciuria and high uric acid (nucleation), hypercalcemia (5%),
-Cystine (↓AA absorption)
-Struvite, staghorn calculi (associated with Proteus bacterial infection)

Radipaque stones (seen on xray/CT)

224

when do you see a positive ketone urine dipstick?

Positive when there’s increase in lipid metabolism – diabetes, alcoholism, cirrhosis, prolonged fast, heavy exercise

225

Positive nitrite dipstick result strongly suggests

gram negative bacteria in urine (high specificity) – exception is if container has been open to air for long time

226

-Presents as a large abdominal mass with pain and hematuria
-WTI gene mutation
-peak age 1-4 years
-5-10% are bilateral

Nephroblastoma/Wilms' tumor

227

DM causing secondary glomerular disease can present in what 2 ways

1. Hyaline arteriolar disease
2. Diabetic glomerulosclerosis

(affects arteries and glomeruli)

228

Clinical markers:
-Serum markers often negative
-Can have syncytiotrophoblastic giant cells – produce hCG
-Homogenous “fish flesh” appearance

Seminoma

229

risk factors for renal infarction

-Atheromatous material: aorta
-Thrombotic material: atrial fibrillation, post MI, antiphospholipid syndrome
-Bacterial vegetations: infective endocarditis

230

-Helpful when patient has acute oliguria

-Helpful with subtle other abnormalities

specific gravity

231

how can prostatic carcinoma be dx?

-Diagnosis based upon random needle biopsies of the prostate
-Blind “random” biopsies are GOLD STANDARD for diagnosis
-Screen via PSA and digital rectal

232

what are the reasons for the urine color changes:
-Yellow-green-brown:
-Orange-red-brown:
-Red:
-Dark brown/black:

-Yellow-green-brown: bile pigments (mostly bilirubint) (dark foam if shaken, concentrated urine w/ white foam)

-Orange-red-brown: excreted urobilinogen

-Red: hematuria, hgb, myoglobin, porphyrias, beet ingestion

-Dark brown/black: methemoglobin, rhabdomyolysis (cola color), L-dopa, homogenetic acid (alkaptonuria)

233

labs:
Proteinuria, (>3.5g/day) hypoalbuminemialipiduria, hyperlipidemia

nephrotic disease

234

positive glucose in urine is seen w/

-diabetes
-pregnancy
-endocrine disorders
-pancreatic disorders

235

what disease is associated w/ adenocarcinoma

high grade PIN (prostatic intraepithelial neoplasia)

236

tx: treated with androgen ablation therapy (orchiectomy, anti-androgens, 5 alpha – reductase inhibitors, GNRH inhibitors, etc.) since most tumors are androgen responsive

Advanced disease (beyond the prostate)

-Hormone ablation therapy- mainline therapy for advanced metastatic PCa but has HIGH relapse rate
-majority will become androgen refractory with time (Note: does not mean androgen “resistant”)

237

Define dissection as it relates to vessels

characterized by intimal defect allowing tracking of blood into media of vessel wall with possible dissection back into lumen, into pericardial sac, or into cavities

238

-free wall or septum may occur within first 3 weeks, usually within 2-10 days post infarction
-3-7 days – maximal tissue lysis with soft friable granulation tissue (maximal softening)

LV rupture

239

Basic pathology:
Early epithelial cell injury or increased plasma protein or decreased tubular reabsorption

proteinuria

240

causes of Increased proteinura

(normal is less than 0.5g/day)

-postural proteinuria,
-proteinuria in elderly,
-glomerular disease (nephrotic syndrome; greater than 4 g/24 hours),
overflow (multiple myeloma)

241

Risk factors for what:
-Affects skin, mucosal surfaces, or deep organs
-In newborns may grow rapidly; 80% will spontaneously regress

Capillary/Cavernous Hemangiomas

242

-Markedly alkaline urine may give ___ results on dipstick, because reaction is pH dependent (acid environment)

falsely low protein results bc rxn is pH dependent (acid environemtn)

243

Measures concentrating ability of kidneys
-Reflects relative proportion of dissolved solid components to total volume of specimen

specific gravity

244

Reperfusion injury: damage that occurs to myocytes following restoration of blood flow due to

1. Mitochondrial dysfunction
2. Influx of calcium causing myofibril hypercontracture
3. Free radicals damaging membrane proteins and phospholipids
4. Leukocyte aggregation
5. Platelet and complement activation

245

Most common in mixed GCT's than as pure

Embryonal carcinoma

246

what are the steps in development and evolution of atherosclerotic plaques

1. initial lesion/insult
2. intermediate lesion/atherosclerotic plaques
3. fatty streak (mainly intracell. lipid accumulation)
4. intermediate lesion
5. atheroma
6. fibroatheroma
7. complicated lesion

247

-Most common cause of spontaneous subarachnoid hemorrhage

Berry aneurysm

248

what defines oliguria

less than 500 mL/24 hrs

249

labs associated w/ chronic renal failure

GFR less than 30% of normal, decreased albumin

250

5 causes of myocarditis

1. Idiopathic is most common (presumed viral but couldn’t identify)
2. Viral (i.e. Cocksackie A/B)
3. Bacterial, fungal, protozoal
4. Hypersensitivity due to drugs (eosinophilic infiltrate)- Dose independent
5. Toxic myocarditis- Dose dependent (i.e. adriamycin – chemotherapy drug), and Irreversible myofiibrillar loss

251

___ serves to store spermatozoa as they mature and to propel them down ductus deferens during ejaculation

Epididymis

252

extent of the MI depends on:

1. site of occlusion (small artery vs large)
2. duration of ischemia
3. extent of any collateral circulation
4. metabolic needs of "at risk" myocardium
5. Reperfusion injury

253

Morphological findings:
-Heterogeneous differentiated elements including any combination of neural tissue; muscle; cartilage; bronchial, intestinal, squamous epithelium, etc. within loose stroma
-incompletely differentiated elements of the 3 germ cell layers embryonic elements

Mature Teratoma

immature teratoma

*can occur at any age

254

less than 10% of ischemic heart disease is due to other uncommon causes such as

-increased myocardial oxygen demand (i.e. thyrotoxicosis, decreased oxygen carrying capacity (i.e. anemia)
-arteritis,
-emboli,
-cocaine abuse

255

Clinical markers:
-Effects older men (older than 50)
-Serum markers negative
-Slow growing- rarely metastasizes

Spermatocytic semioma

256

-Diffuse or nodular expansion of the mesangium
-Mesangial “lysis”
-Basement membrane thickening (scarring from w/in)
-Consequence of altered glucose and insulin metabolism

Diabetic glomerulosclerosis (DM)

257

--Fixed isosthenuria, (Sp. G) 1.008-1.012 suggests ___

renal tubular dysfunction, most likely renal tubular acidosis

258

-A “giant condyloma” with the tendency for local invasion
-Rarely, if ever, metastasizes
-HPV related

Verrucous carcinoma

259

how does UT obstruction lead to chronic pyleonephritis?

-Increased pressure above the obstruction (anywhere in the UT)

-Intrinsic: Stones, strictures, UT tumors, blood clot
-Extrinsic: BPH, extrinsic tumors

260

more common and typically due to occlusive thrombus; involves full thickness of myocardium

transmural infarct

261

what organisms cause ascending UTI?

-Fecal flora: gram-negative rods
-E. coli (~70%) – uropathogenic strains
-Proteus, Pseudomonas, Klebsiella, Enterobacter

262

what defines polyuria

greater than 200mL/24 hr
sp.g. less than 1.018

263

--Affects abnormal valves / endocardium
---i.e. chronic rheumatic heart disease, deg calc aortic stenosis, mitral prolapse, CHD, prosthetic valves
--Gradual valve destruction with incompetence
--Insidious clinical onset

subacute infective endocarditis

264

what are secondary causes of HTN

*most commonly renal disease
-Glomerulonephritis
-Chronic renal disease
-Renovascular
-endocrine tumors
-Coarctation of aorta
-genetic mutations

265

what prostate zone?
-an inverted cone with its base forming the base of the prostate and its apex at verumontanum

central zone

266

____ of heart are most common of all congenital anomalies

Malformations

267

not detected by dipstick

-microalbuminuria
-immunoglobulins (tetrabromophenol sensitive to albumin only)
-bence- jones proteins (need electrophoresis or immunofixation)

268

-Immune deposition of IgA in mesangium
-nephritic disease

IgA disease/nephropathy

269

Chromosomal abnormalities account for ____% of all cardiac anomalies
-such as:

- less than 5%

- i.e. Down’s syndrome and persistent ductus arteriosus

270

what is the prostate bounded by?

-fibromuscular “pseudocapsule”

*ill-defined anteriorly and along base of prostate

271

Intermediate lesion/atherosclerotic plaques

-Cells – macrophages, T-cells, smooth muscle
-Lipids – central lipid core
-Collagenous tissue cap
-Advanced plaques with calcifications

272

-Largely a disease of elderly (peak incidence ~ age 80)
-Blacks affected more than whites by almost 2:1
-HPV types 16 and 18 have been implicated
-Precursor lesion: carcinoma in situ

Squamos carcinoma

*prognosis depends on grade and stage

273

Morphological Findings:
-Characteristic granular eosinophilic cytoplasm and intracytoplasmic crystals

Leydig cell tumor

*90% are benign

274

gold standard of overall renal function

inulin

275

types of alkaline crystals in urine

1. amorphous phosphates
2. triple phosphate

276

-Some cases are associated with Marfan syndrome
-Secondary myxomatous change occurs as result of injury to valve myofibroblasts by hemodynamic forces

MV prolapse

277

-Resembles HTN but more severe
-Can occur without HTN (multifactorial)

Hyaline arteriolar disease (DM)

278

most common cardiac tumor

- Benign myxoma is most common tumor in adults
-Metastatic neoplasms are much more common than primary tumors
-primary care tumors are rare

279

what is polynephritis

when UTI affects the kidney
*CVA tenderness

280

produce testosterone in response to pituitary LH (luteinzing hormone)

Leydig cells

281

most common congenital heart disease

VSD

282

process of cytodifferentiation by which spermatids become spermatozoa

Spermiogensis

283

Clinical presentation:
-Serum/blood studies: anti-GBM Abs
-can be limited to renal or involve lungs
-RPGN and hemoptysis

Anti-glomerular basement membrane disease

284

-Refractory to therapy
-Poor prognosis w/o transplantation
-Hypertrophy/dilation of all chambers

Idiopathic (Primary) Dilated cardiomyopathy

285

___% sudden cardiac death prior to hospital arrival
___% arriving at hospital will have complications

25%

80-90%

286

Overall is most common type of vasculitis

Temporal (giant cell) arteritis

287

tx: treated with surgery (radical prostatectomy), external beam radiation, or radioactive “seeds” (aka brachytherapy)

localized prostatic carcinoma

288

-Necrotizing granulomatous inflammation of small to medium sized vessels
--May represent cell mediated hypersensitivity response directed against inhaled infectious or environmental antigens (with resultant tissue damage)

Wegener's Granulomatosis

289

Clinical presentation
-Often post URI, especially streptococcus
-Purpuric rash begins on arms and legs

HSP

290

what it the follow up of + glucose test

serum glucose and diabetes testing

291

densely collagenized thickened fibrous caps with minimal inflammation and small atheromatous/lipid cores

stable plaque

*more common than vulnerable plaque

292

how is prostatic carcinoma treatment determined

based on stage

293

how to perform a midstream clean catch

Wash with soap and rinse external genitalia; catch midstream specimen in sterile urine container

294

Morphologic findings:
-Stays looking like a germ cell
-Uniform population of large, polygonal cells with distinct cell membrane, cleared cytoplasm and central nucleus with prominent nucleolus
-May be “anaplastic” with high mitotic count (uncommon)

Seminoma

295

Leading cause of mortality in US and developed countries with improvement with interventions to decrease risk factors and diagnostic and therapeutic interventions

ischemic heart disease

296

-dilatation of vessel wall involving all 3 layers – saccular or fusiform
-Secondary to weakening of wall due to developmental defects (berry aneurysms), infection (syphilis), trauma, and systemic diseases (atherosclerosis, vasculitis)

True aneurysm

297

-Affects elderly females
-Symptoms: headache, localized tenderness, visual symptoms
Dx – ESR, biopsy (40% false negative rate)
-Rx – steroids

Temporal (giant cell) arteritis

298

alkaline urine is caused by

renal tubular acidosis*, UTIs, excess bicarbonate ingestion, respiratory or metabolic alkalosis, several foods especially citrus and with large meal (alkaline tide)

299

what is the hallmark of ischemic acute tubular necrosis/injury?

destruction of the tubular epithelial cells

300

Presents with:
fever
bacteriuria
pyuria
left shift on blood smear
*may be asymptomatic

UTI

301

what are the most common benign tumors of blood vessels

1. granuloma Pyogenicum (Pyogenic Granuloma)
2. Capillary/Cavernous Hemangiomas

302

Histologic Findings:
-Finely granular kidney surface (scarred glomeruli)
-onion skin lesion (from progressive endothelial injury followed by repair)

HTN

malignant HTN for onion skin lesion

303

-Koilocytes – epithelial cells with atypical crinkled nuclei and large perinuclear halo – a characteristic of human papilloma virus infection
-(most often types 6 and 11

Condyloma accuminatum

304

Excluding leukemia, third most common cancer of childhood

Nephroblastoma/Wilms' tumor

305

testis CA staging

-Stage I- confined to testis
-Stage II- Retroperitoneal nodes or below diaphragm
-Stage III- Outside retroperitoneal nodes or above diaphragm

306

cons of inulin

intravenous infusion; timed urine collections; expensive

307

Most common testicular tumor of infants and children

Yolk sac tumor

-most often mixed tumor in adults

308

labs:
Hematuria, azotemia, pyuria, casts, +/- proteinura

nephritic disease

309

Clinical Markers:
-PLAP, placental, lactogen, hCG

embryonal carcinoma

310

other sources of neutrophils and esterase from a UA

neutrophils: vaginal secretions and glomerulonephritis

esterase: trichomonads and eosinophils (lead to false +)

311

what are the 3 zones of the prostate

-central zone
-transitional zone
-peripheral zone

312

-Vegetations – fibrin, RBCs, inflammatory cells, organisms
-Organization with fibrosis leads to distortion of valves with functional stenosis/incompetence

infective endocarditis

313

inflammatory process involving vessel +/- fibrinoid necrosis, granulomatous inflammation

vasculitis

314

90% of bladder cancers

*smoking is a major risk factor and M:F 3:1 over 50

Urothelial carcinoma

*has a high rate of recurrence

315

what are 5 consequences of UT obstruction?

1. Infection (acute or recurrent/persistent)
2. Diverticula
3. Hydronephrosis
4. Chronic obstructive pyelonephritis
5. Renal failure

316

Morphological Findings:
-Characteristic loose or maze-like network of cells on thin fibrovascular cords or microcystic / myxomatous

Yolk sac tumor

-relatively good prognosis

317

Seen in 10% of patients with disseminated disease (i.e. breast, lung, melanomas, hematopoietic malignancies)

Metastatic neoplasms of the myocardium

318

Alkaline urine is hallmark of what

renal tubular acidosis – inability to acidify urine below 5.5 despite overnight fast and acidic load

319

Risk factors for what:
-Pregnancy
-Gingiva; often spontaneous regression after delivery
-Polypoid granulation tissue nodule on skin or mucosa trauma

granuloma Pyogenicum (Pyogenic Granuloma)

320

-most common site involved is lower abdominal aorta below renal arteries
-Asymptomatic, pulsating mass, thromboemboli, dissection rupture (11% if greater than 5 cm)

Atherosclerotic aneurysm

321

-SOB, edema, spleen and liver congestion, raised JVP
-Primary lung disease – Chronic obstructive airways disease, diffuse interstitial fibrosis, CF
-Pulmonary vascular disease – pulmonary emboli
-Disorders affecting chest movement – i.e. kyphoscoliosis

cor pulmonale

322

pathogenetic mechanism of glomerular disease

structure of anchoring and slit diaphragm proteins and relationship with actin cytoskeleton and cadherins loses integrity

323

-Low virulence organisms / normal commensals (strep viridans) enter blood in minor bacteremic episodes and become enmeshed with proliferation in platelet aggregates which have formed on abnormal endocardial surfaces

subacute infective endocarditits

324

morphological findings:
-Mixture of cells resembling primary and secondary spermatocytes in myxoid stroma

Spermatocytic seminoma

-good prognosis

325

Multiple LARGER expanding cysts that eventually destroy the RENAL PARENCHYMA

Adult or autosomal dominant PKD

326

-Poor refill of chamber after contraction due to stiff chamber wall (normal or pathologic fibrosis, amyloidosis, restrictive pericardium)
-EF usually normal or decreased

Diastolic failure

327

pigmented casts are caused by

1. Hbg (blood)
2. hemosiderin
3. myoglobin
4. bilirubin
5. other drugs

328

most common cyanotic congenital heart disease

Tetrology of fallot

329

what type of crystal?
-Black clumps or sheaves
-Severe liver disease

tyrosine crystal

*abnormal crystal

330

Clinical Marker:
-Produce hCG
-very rare in pure form (0.3% of GCTs)

Choriocarcinoma

331

what type of crystal?
-Variety of shapes including rhombic or 4-sided flat plates, prisms, oval forms
-Small numbers common and nonspecific

uric acid crystal

type of acidic crystal

332

Progression of spermatogenesis/spermiogenesis proceeds toward lumen:

primary spermatocytes (diploid) → secondary spermatocytes (haploid) → spermatids → spermatozoa

333

Varicocele is dilation and tortuosity of veins in pamipinform plexus because why?

-Possible epiphenomenon
-Possible thermal effect
-Maturationarrest, hypospermatogenesis, abnormal sperm morphology

334

what is secondary vesicoureteral reflux caused by

-Result of abnormally high pressure in the bladder --> failure of the closure of the valve during bladder contraction
-Associated with anatomic or functional bladder obstruction
-Bilateral reflux

335

risk factors for adenocarcinoma of the testes?

-age, race, genetics
-blacks more so than whites

336

2-3 days after hemolytic episode
-renal tubules catabolize Hgb to ferritin and hemosiderin;
-yellow-brown granules (Prussian Blue strain)

Hemosiderin

337

initial rise: 3-5 hrs
peak rise: 24 hrs
return to normal: 28-72 hrs
clinical relevance: not cardiac specific

Total CK

338

-Common valve abnormality with valve regurgitation (.5-2.4% of population)
-Asymptomatic in majority of people
-If symptomatic - palpitations, fatigue, arrhythmias, atypical CP, infective endocarditis, sudden death

MV prolapse

339

labs:
proteinuria

proteinuria

340

types of sex-cord stromal tumors

1. Leydig cell
2. Sertoli cell tumor (uncommon and very malignant)
(3. Lymphomas)--> most common testicular tumor in males over 60

341

-Large lipid core composed of extracellular lipid released by cell death
-Increased plaque inflammation (macrophages/T cells degrade extracellular matrix by phagocytosis or proteolytic enzyme secretion and weaken thin fibrous cap)
-Vascular remodeling which is associated with plaque inflammation

vulnerable plaque

342

-“Genital warts” composed of papillary projections of connective tissue covered with thickened hyperplastic epithelium

Condyloma accuminatum

343

Risk factors for what:
-Vascular neoplasm often affecting skin
-Associated with herpes virus 8
-Most often seen in patients with AIDS
--May start with skin / mucosal plaques / nodules with progression to involve internal organs

Kaposi's Sarcoma

344

somatic cells of tests and are essential for spermatogenesis

Sertoli cells

345

Risk Factors for what:
-Rare sarcoma involving skin, soft tissue, breast, liver
-Elderly Caucasians
-May be associated with thorotrast, arsenic, polyvinyl chloride

Angiosarcoma

346

types of inclusion casts

1. granular casts
2. fatty casts
3. crystal casts

347

types of cellular casts

1. hyaline cast
2. waxy cast
3. red cell cast
4. WBC cast
5. tubular cell cast

348

Why do you see Leydig cell nodules/hyperplasia in Klinefelter's syndrome?

Elevated FSH/LH and decreased testosterone

349

the most common cause of acute renal failure intrinsic to the kidney (60%)

acute tubular necrosis/injury

350

Morphological Findings:
-Usually found as small tumors in testes but has high potential for extension through tunica albuginea and into spermatic cord
-Large, hyperchromatic, pleomorphic nuclei and indistinct cytoplasm – mitoses frequent
-Glandular, trabecular, papillary arrangements

embryonal carcinoma

351

-blood dissects into media of vessel wall
-In majority of cases, intimal defect allows blood to dissect into wall

aortic dissection

352

-Segmental necrotizing vasculitis of small and medium size arteries with coexisting different stages of inflammation; +/- thrombosis, microaneurysms

Polyarteritis Nodosa

353

torsion/infarction of the male testes can lead to what?

hemorrhagic necrosis
-male infertility

354

-Most common type of aneurysm
-Often affect elderly males; more common with hypertension

Atherosclerotic aneurysm

355

net charge and color changes depending on ___

concentration of protein present due to pH changes

356

-Metastases can be of different type than primary
-Tend to occur in young men (15-35 years) – painless testicular enlargement
-pure or mixtures of tumor types

Germ cell tumors

357

-95% of HTN cases
-Often silent
-Multifactorial – multiple genetic variations (polymorphisms and environmental factors)
--Age, race (especially African American), underlies many other diseases

Essential (primary) HTN

358

what are 8 predisposing factors of UTIs?

1. females: male (5:1)- due to short urethra, trauma and bacterial colonization
2. Instrumentation
3. decreased urin flow/stasis (incomplete voiding, obstruction, diverticulum)
4. Calculi
5. Vesicoureteral reflux
6. immune compromised
7. Kidney/UT disease
8. Pregnancy

359

-Mutations in genes encoding collagen IV

thin basement membrane disease

360

sx:
Oliguria*, hypertension, edema*

acute renal failure

361

____ lie next to basement membrane and give rise to primary spermatocytes

Spermatogonia

362

what substances interfere with a nitrite dipstick test

Vit. C
urobilinogen
low pH

363

what type of cast?
--Urates, calcium, oxalates, sulfonamides

crystal casts

(type of inclusion cast)

364

In setting of UTI, markedly alkaline urine suggests ___

urea splitting organism (Proteus) which may be associated with staghorn calculi

365

how does a dipstick test for blood

tests for peroxidase-like activity of hgb (interference from vit. C)

366

staging and treatment of Choriocarinoma

-VERY Aggressive – often metastasizes
-Chemosensitive, but worse prognosis

367

initial rise: 3-12 hrs
peak rise: 12-48 hrs
return to normal: 5-14 days
clinical relevance: cardiac -specific

Troponin T

368

-Defects in interventricular septum
-small defects may spontaneously close

VSD

369

Adult or autosomal dominant PKD is associated w/ what?

-Berry aneurysms in the Circle of Willis and
-cysts in the liver, lungs, pancreas

370

what type of cast?
-Trapper cellular debris or protein aggregates
-Immune complexes, fibrinogen**

granular cast

(type of inclusion cast)

371

pathophysiology:
-Liver congestion → splenic congestion, ascites, and GI tract varices
-Nutmeg liver

RHF

372

why is chronic cystitis missed on a urine dipstick?

Chronic inflammatory cells (i.e. lymphocytes) will not be detected with the leukocyte esterase

373

what organisms cause hematogenous UTIs?

-S. aureus (catalase +)
-group A Strep

374

types of stones found in the UT

1. Radipaque (seen on xray/CT)
2. Radiolucent (uric acid-seen in urate nephropathy)

375

describe what gleason grading is and what its used for

prostatic carcinoma grading

-Morphologic resemblance to normal prostate
-Degree of invasiveness
-Score = most + 2nd most

*prognosis correlates w/ grade

376

Histologic Findings:
-Renal biopsies look like IgA nephropathy- more likely to have endocapillary proliferation or crescents

HSP

377

-Squamous CIS involving mucosal surfaces of glans penis in noncircumsized men
-Also can progress to invasive carcinoma

Erythroplasia of Queyrat

378

Irreversible myocardial necrosis due to ___

local ischemia

379

what causes false positive and false negative gluocse tests?

-False positive if collection jar is left open

-False negative results in presence of excess Vitamin C

380

With hyperglycemia, glucose appears in urine when blood glucose is ___-

greater than 180-200 mg/dL

381

describe what happens:
0-24 hrs
1- 10 days
3-7 days
4-8 weeks
post MI

-0-24 hours – no changes – wavy fibers, coagulation necrosis, contraction bands, neutrophils
-1-10 days – coagulation necrosis, neutrophils, myofiber disintegration and phagocytosis
-3-7 days – maximal tissue lysis with soft friable granulation tissue (maximal softening)
-4-8 weeks – fibrosis, firm and gray

382

-Presentation – gradual or sudden (organism dependent)
-Clinical – septicemia presentation vs. low grade fever, weight loss, murmurs, emboli
-Diagnosis – clinical and repeated blood cultures

infective endocarditis

383

most common malignant tumors of blood vessels

1. Angiosarcoma
2. Kaposi's Sarcoma

384

what organisms cause nonspecific epididymitis and orchitis in children, adults, and the elder?

-children – usually associated with urinary tract malformations (gm neg rods)
-in sexually active adults – Chlamydia trachomatis, N. gonorrhoeae
-Elderly – enterobacteria

385

indirect test for UTI

-nitrite on urine dipstick
-leukocyte esterase

*nitrate reduced to nitrite by some bacteria
*-Neutrophils make leukocyte esterase as part of lysosomal hydrolyzing mechanisms to destroy engulfed organisms
-Leukocyte esterase is indirect measure of number of neutrophils present in urine sample

386

-Problems with “over-diagnosis” of clinically nonaggressive tumors that leads to morbid treatment
-Many CA detected will never be life threatening

adenocarcinoma

387

what are the 2 major causes of chronic pyelonephritis (scarring and deformity of the kidney)

1. urinary tract obstruction
2. vesicoureteral reflux (primary and secondary)

388

Clinical presentation:
-Serum/blood studies: ANA, anti-dsDNA, complement depletion (C3 & C4)
-Present as nephritic syndrome, RPGN, nephrotic syndrome, or mixed nephritic-nephrotic
-Can look like whatever so it’s important to determine the pattern of injury

SLE

ex. renal lupus manifesting as membranous nephropathy--> Class V

389

most common glomerular disease world wide

IgA disease/nephropathy

390

-focal or diffuse suppurative (neutrophilic*) inflammation
-Usually evolves from direct extension of infections of bladder (urine)

acute prostatitis

-May be hematogenous

391

-Leads to excessive hemodynamic load
-Increased risk of infective endocarditis

aortic and mitral valve abnormalities

392

Clinical presentation:
-Excellent prognosis (does not lead to chronic renal disease)
-Periodic hematuria especially after UTI, URI, running
-nephritic disease

thin basement membrane disease

393

-Immune complex deposition, nephrotoxic antibody, vasculitis (ANCA)

Nephritic disease

394

Symptoms:
-Systemic congestion → diffuse edema
-Hepato- and splenomegaly
-Ascities

RHF

395

-Invasion of the renal vein with possible extension into the vena cava (T3)
-Smoking is highest risk factor
-VHL gene mutations: (Tumor suppresser gene and Most cases are sporadic)

Renal cell carcinoma

396

presentation:
-Upper and lower respiratory tract – chronic sinusitis, mucosal ulcers, pneumonitis
-Kidneys – focal/crescentic glomerulonephritis
-Affects males more so than females

Wegener's Granulomatosis

397

Malignant germ cells may reflect spermatocytic differentation (ex. __) or totipotential cells (ex. __) which can then transcend along various lines of intraembryonic (ex. __) or extraembryonic (ex. ___ ) differentiation

-spermatocytic differentation: seminoma
-totipotential cells: -embryonal carcinomas
-transcend along various lines of intraembryonic: teratoma
-transcentds along lines of extraembryonic: choriocarcinoma, yolk sac tumor

398

-Atherosclerotic plaque compresses underlying media causing degeneration and thinning of wall
-Inflammation mediates extracellular matrix degradation further weakening wall

Atherosclerotic aneurysm

399

what type of renal failure?
time course: Rapid decrease in GFR to 0 or near 0 in hours to days

acute renal failure

400

-Etiology unclear, but thought to involve androgen: estrogen imbalance
-Effects glandular/epithelial and stromal/fibroblasts cells

Hyperplasia of the prostate (BPH)

401

2 types of Carcinoma in-situ of the testes

1. Bowmen's disease
2. Erythroplasia of Queyrat

402

presents w/ hypertrophy of a single kidney

unilateral agenesis of the kidney

*0.1%

403

Useful marker for diagnosis and disease activity: PR3-ANCA

*which is present in almost 95% of cases (antiprotease-3 anti neutrophilic cytoplasmic antibodies; PR3 is neutrophil granule similar to microbial peptides)

Wegener's Granulomatosis

404

secondary glomerular diseases

1. SLE
2. Henoch-Schonlein purpura (HSP)
3. DM
4. HTN

405

Urine and fecal findings in jaundice:
Urinary bilirubin: INCREASED (DARK URINE)
Urobilinogen: neoplasm-low or undetected, gallstones- variable
fecal color: pale (intermittent w/ stones)

Obstruction to bile flow

406

congenital abnormalities of the kidney

1. Agenesis
2. Horseshoe kidney
3. Renal dysplasia
4. Simple cysts
5. Dialysis Associated cysts
6. renal medullary cysts
7. medullary sponge kidney

407

what prostate zone?
-major portion (~70%) of gland, which surrounds transition zone posteriorly, laterally, and apically

peripheral zone

408

congenital abnormalities of the urethra

1. congenital urethral valves

409

-Degenerative calcific age related sclerosis (DCAS) is most common cause of isolated ___ presenting in 70+ y/o

Aortic valve stenosis

410

what bacteria that causes UTI does not generate nitrite

enterococci

411

-Almost always involves testes first then spreads to epididymis*
- (+/-) gummas*
-Diffuse mononuclear interstitial inflammation rich in plasma cells and lymph

Syphilis Orchitis

-Congenital or acquired

412

sequelae of essential HTN

-Cardiac hypertrophy
-Heart failure (hypertensive cardiac disease)
-Multi-infarct dementia
-Aortic dissection
-Renal failure