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