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197 Cards in this Set
- Front
- Back
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Congenital megaloureter is associated with what?
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Hirschsprung's disease
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How does ureteritis cystica result? What changes occur to ureters? What is someone predisposed to?
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1) Manifestation of chronic inflammation
2) Smooth cysts project from the mucosa into the lumen. *Similar findings may be present in the bladder. 3) May undergo glandular metaplasia and predispose to adenocarcinoma |
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Someone with Ureteritis cystica is at risk for what?
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bladder adenocarcinoma
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Where is the most common site for kidney stone obstruction?
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ureter
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what are causes of retroperitoneal fibrosis?
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1) Majority are idiopathic.
2) Ergot derivatives used in the treatment of migraines 3) Association with other sclerosing conditions a) Primary sclerosing cholangitis b) Sclerosing mediastinitis, Reidel's fibrosing thyroiditis 4) Retroperitoneal malignant lymphoma |
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What are the complications of retroperitoneal fibrosis?
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1) Hydronephrosis is the most common complication.
2) May cause right scrotal varicocele a. Blocks the drainage of the right spermatic vein into the vena cava |
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What is the most common ureteral cancer?
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Transitional cell carcinoma
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What causes extrophy of the bladder? What is exposed? what is it associated with?
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Developmental failure of the anterior abdominal wall and bladder
(1) Bladder mucosa is exposed to the body surface. (2) Often associated with epispadias |
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Someone with extrophic bladder is predisposed to what?
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1) Inflammation predisposes to glandular metaplasia.
(2) Predisposition for adenocarcinoma of the bladder |
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What is the urachus? Where does the cyst form? What is someone predisposed to?
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1) a fibrous remnant of the allantois, a canal that drains the urinary bladder of the fetus that joins and runs within the umbilical cord
2) midline urachal cyst 3) Predispose to adenocarcinoma of the bladder *Most common cause of bladder adenocarcinoma |
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What are the risk factors for a LUTI?
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1) Female sex
2) Ascending infection 3) Indwelling urinary catheter *Most common cause of sepsis in hospitalized patients 4) Sexual intercourse a) "Honeymoon cystitis" from trauma to the urethra b) Voiding after intercourse reduces the risk for infection 5) Diabetes mellitus, neurogenic bladder 6) Cyclophosphamide: hemorrhagic cystitis; prevented with mesna 7) Schistosoma hematobium |
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How is Schistosoma hematobium transmitted? What does it lead to?
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a) Penetration of the skin by the fork-tailed cercariae
b) Larvae enter veins in urinary bladder wall. c) Larvae develop into adult worms that deposit eggs. d) Host develops an intense inflammatory response. e) Produce squamous metaplasia of bladder epithelium |
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How are the eggs of S hematobium identified? How is it treated?
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1) Eggs have a large terminal spine
2) praziquantel. |
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What are common causes of acute cystitis?
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1) Escherichia coli
a) Most common uropathogen (80-90%) b) Most common cause of sepsis in a hospitalized patient 2) Adenovirus a) Causes hemorrhagic cystitis 3) Staphylococcus saprophyticus a) Causes acute cystitis in young sexually active women b) Accounts for ∼10% to 20% of LUT infections 4) Acute urethral syndrome in women a) Female counterpart to nonspecific urethritis (NSU) in men 5) Chlamydia trachomatis a) Most common cause of acute urethral syndrome b) Identification of Chlamydia with (PCR) testing of voided urine 6) Other pathogens Mycoplasma hominis, Ureaplasma urealyticum, Neisseria gonorrhoeae |
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How is E. coli treated? Staphylococcus saprophyticus? What is unique about this species of staph?
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1) trimethoprim-sulfamethoxazole
2) trimethoprim-sulfamethoxazole 3) Coagulase negative |
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What is chlamydia the most common cause of? How is it treated?
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1) Most common cause of acute urethral syndrome
2) Treatment is azithromycin 1 g orally |
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Who does S saprophyticus occur in? What does it cause?
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LUTI in young, sexually active female; coagulase negative
cystitis |
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Someone with a LUTI will present with what?
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1) Dysuria (painful urination)
2) Increased frequency, urgency, nocturia 3) Suprapubic discomfort 4) Gross hematuria |
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Laboratory findings in someone with a LUTI will present with what? What is the gold standard criterion?
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1) Pyuria at or above 10 WBCs per high-power field in a centrifuged specimen
2) More than 2 WBCs/HPF in an uncentrifuged specimen 3) Bacteriuria, hematuria 4) Positive dipstick for leukocyte esterase and nitrite 5) At or above 105 colony-forming units (CFUs)/mL *Gold standard criterion of infection |
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What are causes of asymptomatic bactiuria in women? How is it treated?
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1) pregnancy (amoxicillin)
* may develop acute pyelonephritis 2) elderly women in nursing homes (no tx) |
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What is sterile pyuria? What urine tests are positive and negative? what are the causes?
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1) having Neutrophils in the urine and negative standard culture after 24 hours
2) Positive leukocyte esterase, negative nitrite Causes: (1) Chlamydia trachomatis (2) Renal tuberculosis (3) Acute tubulointerstitial nephritis |
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What is malplakia associated with?
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E. coli infection of bladder
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What is seen microscopically in malplakia? What is defective?
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1) Yellow, raised mucosal plaques
2) Foamy macrophages filled with laminated mineralized concretions a) Called Michaelis-Gutmann bodies b) Defective phagosomes that cannot degrade bacterial products |
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The sympathetics effect what parts of the bladder?
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relaxes the detrusor muscle and contracts the internal sphincter
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What are the 4 types of incontinence?
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1) urge incontinence (40-70% of cases)
2) overflow incontinence 3) stress incontinence 4) functional incontinence |
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What is overactive in urge incontinence? What are symptoms? What are common causes?
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1) overactivity of the detrusor muscle resulting in the production of low volumes of urine
2) Symptoms include increased urinary frequency, urgency, small volume voids, and nocturia. 3)The most common causes are bladder irritation due to BPH, atrophic urethritis, and infection |
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How is urge incontinence treated?
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anticholinergics, which inhibit parasympathetic stimulation of detrusor contraction
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How can someone develop overflow incontinence?
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1) outflow obstruction (e.g., BPH)
2) detrusor underactivity related to autonomic neuropathy (e.g., diabetes mellitus) |
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What are symptoms of overflow incontinence?
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1) dribbling and low urine flow.
2) cholinergic drugs to increase detrusor contraction or, if obstruction is the cause (e.g., BPH), α-adrenergic blockers to relax smooth muscles in the bladder neck |
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How does stress incontinence develop? does it occur more in men or women?
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1) laxity of pelvic floor muscles with a concomitant lack of bladder support from not maintaining the posterior urethrovesical angle of 90-100 degrees or a lack of estrogen
2) women |
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What are symptoms of stress incontinence?
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loss of urine when there is an increase in intra-abdominal pressure (e.g., laughing, cough, sneezing)
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How is stress in continence treated?
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1) increase internal sphincter tone with α-adrenergic agonists (contract smooth muscle cells at the bladder neck)
2) using topical estrogen therapy 3) Kegel pelvic floor muscle exercises |
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What defines functional incontinence? What causes it?
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1) inability to reach toilet facilities in time
2) Patients are normally continent 3) if they are taking diuretics or drinking too many caffeinated beverages incontinence may occur |
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How does someone acquire bladder diverticula? What are common complications?
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1) Most are due to benign prostatic hyperplasia
2) Causes obstruction of urine outflow and increased intravesical pressure 3) Diverticulitis and stone formation are common complications |
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Who do cystocele's primarily occurin? How does one form?
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1) Common in middle-aged to elderly women
Mechanism: (1) Relaxation of pelvic support causes descent of the uterus (2) Bladder wall protrudes into the vagina (3) Creates a pouch that collects residual urine |
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What are Cystitis cystica and glandularis? What is the person predisposed to?
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1) Smooth cysts project into the bladder from the mucosa
2) Increased risk for developing bladder adenocarcinoma Note: if glandular cells become goblets it is now called intestinal metaplasia of bladder |
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Is bladder papilloma a common tumor?
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no
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What is the most common bladder cancer and what are causes?
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(1) Transitional cell carcinoma (>95% of cases)
(2) More common in men than women (3) Incidence increases with age. (4) Causes (a) Smoking cigarettes (most common cause) (b) Workers in dye, rubber, or leather industries (c) Cyclophosphamide (d) Arsenic exposure (e) Beer consumption *Due to nitrosamines in beer (f) Schistosoma hematobium *70% produce squamous cell carcinoma, 30% TCC |
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S. hematobium primarily causes what type of cancer in bladder?
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70% produce squamous cell carcinoma, 30% TCC
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What are genetic factors that increased risk of developing tranistional cell carcinoma?
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(a) Numerous chromosomes implicated
(b) Genes implicated: TP53 and RB suppressor genes; HRAS protooncogene (c) Alteration in epidermal derived growth factor receptor |
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What is the rule with TCC?
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multifocal tumor and recurrences are the rule
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Microscopically and on gross exam what is seen in TCC with high and low grade cancers? Where are most common sites? How are blood groups related?
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(1) Low-grade cancers
Usually papillary and are not usually invasive (2) High-grade cancers Papillary or flat and are usually invasive (3) Lateral or posterior walls at the base of the bladder (4) Significance of blood group antigens (A, B, or H) *Better prognosis if the tumor has the antigens |
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How will someone present with TCC of the bladder?
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(1) Painless gross/microscopic hematuria
*Most common sign (70-90%) (2) Dysuria, increased frequency of urination |
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What is the prognosis of TCC in the bladder? How is it treated?
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Five-year survival rate for all stages combined is 80%.
(1) Surgical resection (2) Intravesical chemotherapy (3) Radiotherapy |
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SCC of the bladder is caused by what? What country?
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(1) Association with Schistosoma hematobium
a. Eggs are located in the urinary bladder venous plexus. (2) Common cancer in Egypt (3) 70% of cancers are squamous cell carcinoma, 30% are TCC |
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Pathologically what occurs in SCC of the bladder? What type of hypersensitivity is it?
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(1) Eggs of S hametobium are surrounded by eosinophils.
(2) IgE antibodies are attached to the eggs. (3) Eosinophils have Fc receptors for IgE. (4) Eosinophils attach to receptors and release major basic protein, which destroys the egg. a. Type II hypersensitivity reaction (5) Chronic bladder irritation/infection produces squamous metaplasia. 6) Metaplasia can progress to dysplasia and squamous cell carcinoma |
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What are some causes of adenocarcinoma?
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1) Urachal remnants (most common cause)
2) Cystitis glandularis 3) Exstrophy of the bladder |
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What is another name for Embryonal rhabdomyosarcoma?
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sarcoma botryoides
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Who is an embryonal rhabdomyosarcoma common in? Where are the most common sites?
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1) Most common sarcoma in children
2) Accounts for ∼3% of childhood cancer 3) Most common site for boys is urinary system. 4) Presents as grape-like masses protruding from the urethral orifice 5) Most common site in girls is the vagina |
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What are invasive cancers that go to the bladder? What do they result in?
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1) Invasive cervical cancer and prostate cancer
2) Produce obstruction of the urethra and the ureters 3) Produce hydronephrosis, postrenal azotemia, and death by renal failure |
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What are complications of nonvenereal urethritis in men and women?
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(1) Cystitis in women
(2) Prostatitis in men |
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What is the most common component of Reiter's syndrome in men?
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Chlamydial urethritis
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What are the components of Reiters syndrome?
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1) Urethritis
2) Sterile conjunctivitis 3) HLA-B27-associated arthritis Note: caused by chlamydia |
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Who does a Urethral caruncle predominately occur in? How is it characterized?
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1) Female dominant disease
2) Friable, red painful mass is present at the urethral orifice. 3) Chronically inflamed granulation tissue causes bleeding. |
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What is the most common cancer of the urethra?
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SCC
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What is the most common malformation of the urethral groove?
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Hypospadias: abnormal opening on ventral surface of penis
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What are risk factors for hypospadias?
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(1) Father or previous male sibling had defect
(2) Monozygotic twins a. Insufficient production of human chorionic gonadotropin by single placenta (3) Frequently associated with ventral curvature of penis **Called chordee |
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What are causes of hypospadias?
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faulty closure urethral folds; androgen dysfunction
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Where does the defect occur in epispadias? What is defective in epispadias?
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abnormal opening on dorsal surface of penis; defect of genital tubercle
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What causes phimosis?
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Orifice of the prepuce is too small to retract over the head of the penis
Frequent infections |
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How does Balanoposthitis occur? In who? What accumulates? What organisms cause? What can it lead to?
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1) Infection of the glans and prepuce
2) Usually occurs in uncircumcised males with poor hygiene 3) Accumulation of smegma leads to infection. 4) Candida, pyogenic bacteria, and anaerobes 5) Inflammatory scarring may produce an acquired phimosis. |
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what is Peyronie's disease? What can it lead to?
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1) Type of fibromatosis
2) Painful contractures of the penis 3) Causes lateral curvature of the penis 4) May cause infertility |
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What is priapism? What are causes?
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1) Persistent and painful erection
2) Causes include sickle cell disease, penile trauma, leukemia |
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What are 3 types of carcinoma in situ that occur in males?
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1) Bowen's disease
2) Erythroplasia of Queyrat 3) Bowenoid papulosis |
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What is the definition of carcinoma in situ? How is it different from dysplasia?
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1) early form of carcinoma defined by the absence of invasion of surrounding tissues
2) a. Dysplasia is the earliest form of pre-cancerous lesion recognizable in a biopsy by a pathologist. Dysplasia can be low grade or high grade. The risk of low-grade dysplasia transforming into cancer is low. b. Carcinoma in situ is synonymous with high-grade dysplasia in most organs. The risk of transforming into cancer is high |
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where does Bowmans disease occur? What causes it? Who does it occur in? what is it a precursor of?
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1) Leukoplakia involving the shaft of the penis and scrotum
2) Patients usually >35 years old 3) Association with human papillomavirus (HPV) type 16 4) Precursor for invasive squamous cell carcinoma (∼10% of cases) 5) Association with other types of visceral cancer |
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what is Peyronie's disease? What can it lead to?
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1) Type of fibromatosis
2) Painful contractures of the penis 3) Causes lateral curvature of the penis 4) May cause infertility |
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What is priapism? What are causes?
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1) Persistent and painful erection
2) Causes include sickle cell disease, penile trauma, leukemia |
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What are 3 types of carcinoma in situ that occur in males?
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1) Bowen's disease
2) Erythroplasia of Queyrat 3) Bowenoid papulosis |
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What is the definition of carcinoma in situ? How is it different from dysplasia?
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1) early form of carcinoma defined by the absence of invasion of surrounding tissues
2) a. Dysplasia is the earliest form of pre-cancerous lesion recognizable in a biopsy by a pathologist. Dysplasia can be low grade or high grade. The risk of low-grade dysplasia transforming into cancer is low. b. Carcinoma in situ is synonymous with high-grade dysplasia in most organs. The risk of transforming into cancer is high |
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where does Bowmans disease occur? What causes it? Who does it occur in? what is it a precursor of?
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1) Leukoplakia involving the shaft of the penis and scrotum
2) Patients usually >35 years old 3) Association with human papillomavirus (HPV) type 16 4) Precursor for invasive squamous cell carcinoma (∼10% of cases) 5) Association with other types of visceral cancer |
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What are risk factors for invasive squamous cell carcinoma?
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Bowen's disease, erythroplasia of Queyrat
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What occurs in Erythroplasia of Queyrat? What is it associated with? What is it a precursor for?
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1) Erythroplakia located on the mucosal surface of the glans and prepuce
2) HPV type 16 association 3) Precursor for invasive squamous cell carcinoma |
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What occurs in Bowenoid papulosis? What is it associated with? What makes it unique amongst the cacinoma in situs?
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1) Multiple pigmented reddish brown papules on the external genitalia
2) Association with HPV type 16 3) Does not develop into invasive squamous cell carcinoma *Only CIS with no predisposition for invasion |
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Which type of cancer is most common in the penis? Who does it occur in? Where on penis?
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1) SCC
2) Usually affects men 40 to 70 years old 3) Most common sites are the Glans or mucosal surface of prepuce |
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What strains of HPV are associated with SCC? What acts a cocarcinogen?
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1) HPV type 16, 18 association in two thirds of cases
2) Smoking may act as a cocarcinogen with HPV |
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What are risk factors for SCC of the penis? where does SCC of the penis metastisize to?
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1) Lack of circumcision
2) Greatest risk factor: Bowen's disease, erythroplasia of Queyrat 3) Metastasizes to inguinal and iliac nodes |
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where does the transabdominal descent of the testes end? What regulates this phase?
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(1) Testes descend to lower abdomen or pelvic brim
(2) Müllerian inhibitory factor (anti-müllerian hormone) is responsible for this phase |
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What regulates the descent of the testes through the inguinal canal into the scrotum?
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1) Androgen- and human chorionic gonadotropin (hCG)-dependent
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What is cryptochordism? Does it occur more in premature or full-term babies?
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1) Incomplete or improper descent of the testis into the scrotal sac
2) Most common genitourinary disorder in male children 3) Occurs 30% premature and 5% of full-term males |
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What is cryptochrodism associated with? where are the testes most often located? by what age will most descend?
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1) Associations
Testicular feminization, Kallmann's syndrome, cystic fibrosis 2) Locations (a) Inguinal canal most common site (80%) Palpable mass; majority are unilateral (90%) (b) Intra-abdominal (5-10% of cases) 3) Many will spontaneously descend by 3 months of age (a) Due to combination of androgens and hCG (b) Spontaneous descent uncommon after 3 months |
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What is the most common GU disorder in male children?
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Cryptorchid testis
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What are complications of crytochorditis if uncorrected?
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1) Potential for infertility
(a) Arrest in germ cell maturation (b) Testicular atrophy (c) Similar changes occur in the normally descended contralateral testis. (d) Greatest risk if intra-abdominal or long duration in inguinal canal (2) Increased risk for developing a seminoma (a) Five- to tenfold increased risk for cancer in cryptorchid testis (b) Risk also applies to the normally descended testicle (3) Increased risk for undescended testis to undergo torsion |
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If only one testis descends is it as likely to develop cancer?
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yes
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How is crytorchidism treated? By what age? What may help with fertility?
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(1) Orchiopexy as early as 6 months; should be completed by 2 years of age
(2) Hormonal therapy with hCG produces variable results (3) Administration gonadotropin-releasing hormone (GnRH) prior to orchiopexy may improve fertility in adult. |
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What are causes of orchitis?
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1) Mumps
a.Infertility is uncommon. b.Most cases are unilateral. c.Orchitis is more likely in an older child or adult. 2) Congenital or acquired syphilis 3) HIV 4) Extension of acute epididymitis |
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Does mumps cause unilateral or bilateral orchitis?
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unilateral
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What are causes of epididimytitis in adults less than 35?
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(1) Neisseria gonorrhoeae
(2) Chlamydia trachomatis |
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What are causes of epididimytitis in adults greater than 35?
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(1) E. coli
(2) Pseudomonas aeruginosa |
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how does tuberculosis effect the male GU? what type of inflammation is seen?
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(1) Begins in the epididymis
Spreads to the seminal vesicles, prostate, and testicles (2) Caseating granulomatous inflammation |
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An AIDS patient has epididimytis. What is the differential?
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cytomegalovirus, Toxoplasma, Salmonella
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Signs and symptoms of epididimytis are what?
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1) Usually unilateral scrotal pain with radiation into spermatic cord or flank
2) Scrotal swelling, epididymal tenderness 3) Urethral discharge if it is sexually transmitted 4) Prehn's sign: elevation of scrotum ↓ pain Note: no scrotal discoloration like with testicular torsion |
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what is phrens sign?
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elevation of scrotum relieves pain with epididimytis
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How is epididymitis treated in a man less than 35 and greater than 35?
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If <35 years old, ceftriaxone + doxycycline (STD treatment)
If >35 years old, ciprofloxacin extended release |
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How many males experience varicocele? What age group? What about in infertile males?
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Occurs in 15% to 20% of all males
(1) Usually between 15 and 25 years of age (2) Rarely occurs after 40 years old Occurs in 40% of infertile males |
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What is the "Bag of worms" appearance?
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varicocele
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Where does a varicocele predominately occur? why?
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most often left-sided; spermatic vein empties into left renal vein
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What can block the left renal vein?
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Examples-renal cell carcinoma invading renal vein; superior mesenteric artery compressing left renal vein
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If a smoker has a sudden onset of varicocele what should you suspect?
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renal carcinoma invading renal vein
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Where does the right spermatic vein drain? What can block it?
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Right spermatic vein drains into the vena cava
(1) Blockage of right spermatic vein produces right-sided varicocele. (2) Examples-retroperitoneal fibrosis; thrombosis inferior vena cava |
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What is usually defective in left sided varicocele?
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Incompetent valves in left spermatic vein from increased pressure
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What are clinical findings in someone with a varicocele?
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1) Aching pain in scrotum
2) Dragging sensation in testicle 3) Visible "bag of worms" 4) Infertility (controversial) a. Heat decreases spermatogenesis |
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How is a varicocele treated?
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Varicocelectomy
Embolization by intervention radiologist Note: varicocele is a dilation of the pampinform plexus in the spermatic cord |
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At what age does testicular torsion occur? What are predisposing factors? What is the danger if not corrected?
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1) Majority occur between 12 and 18 years old.
Predisposing factors: (1) Violent movement or physical trauma Most common causes: (2) Cryptorchid testis (3) Atrophy of testis 4) Twisting of spermatic cord cuts off the venous/arterial blood supply 5) Danger for hemorrhagic infarction of the testicle |
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What are clinical findings in someone with testicular torsion? What is the key diagnostic finding?
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1) Sudden onset of testicular pain
2) Absent cremasteric reflex (key diagnostic finding) 3) Stroking the inner thigh with a tongue blade normally causes the scrotum to retract. 4) Testicle is drawn up into the inguinal canal. 5) scrotal skin may be pigmented |
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How is testicular torsion treated?
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One third spontaneously remit.
Surgery is imperative within 12 hours for those that do not remit. |
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What is the most common cause of testicular enlargement? What failed to close? What is it associated with?
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1) hydrocele
2) Due to a failure of closure of the tunica vaginalis 3) Fluid accumulates in serous space between the layers of the tunica vaginalis. 4) Invariably associated with an indirect inguinal hernia |
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What are 3 fluid accumulations in the testes?
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1. hydrocele
2. Hematocele contains blood 3. Spermatocele contains sperm |
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When do testicular tumors present? What race are they more common in?
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1) Most common malignancy between ages 15 and 35
2) Occurs more often in whites than blacks |
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What are the types of testicular tumors and what is the origin?
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1) Malignant testicular tumors are most often germ cell in origin (95% of cases).
2) Benign testicular tumors are usually sex-cord stromal tumors (5% of cases) |
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how are germ cell testicular tumors classified?
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1) 40% are of one cell type
a. Seminoma is the most common type (40%). 2) 60% are mixtures of two or more patterns. a. Most common mixture is embryonal carcinoma, teratoma, choriocarcinoma, yolk sac tumor. (3) Best classified as seminomas or nonseminomatous |
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What are risk factors for a testicular tumor?
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1) Cryptorchid testicle
a. Overall most common risk factor b. Greatest risk is an intra-abdominal cryptorchid testis. 2) Testicular feminization 3) Klinefelter's syndrome (XXY) 4) Inguinal hernia, mumps orchitis |
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How do people with a testicular tumor present?
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Unilateral, painless enlargement of the testis
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What are testicular tumor markers in the blood?
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1) α-Fetoprotein (AFP)
a. Yolk sac (endodermal sinus) tumor origin b. Human chorionic gonadotropin (hCG) for a Choriocarcinoma 2) Lactate dehydrogenase a. Nonspecific cancer enzyme b. Degree of elevation correlates with tumor mass |
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Why is it important to do a chest x ray of someone with unilateral scrotal enlargement?
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Testicular cancer most often involves para-aortic lymph nodes
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Which hormone forms the prostate? What are the 3 zones of the prostate? What pathologically occurs in each zone?
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1) DHT
2) Peripheral zone a. Palpated during a digital rectal examination (DRE) b. Primary site for prostate cancer 3) Transitional zone a. Primary site for the glandular component of BPH 4) Periurethral zone a. Primary site for the fibromuscular (stromal) component of BPH |
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How many men will develop prostitis? Is chronic or acute more common?
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1) Approximately 50%
2) Chronic prostatitis is more common than acute prostatitis |
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What are causes of acute prostitis?
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1) Intraprostate reflux of urine from the posterior urethra or urinary bladder
2) Often associated with acute cystitis 3) Pathogens in patients < 35 years old Consider Chlamydia trachomatis, Neisseria gonorrhoeae b. Pathogens in patients > 35 years old E. coli, Pseudomonas aeruginosa, Klebsiella pneumoniae |
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What pathogens should be considered in someone less than 35 with acute prostitis? What about greater than 35?
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a. Pathogens in patients < 35 years old Consider Chlamydia trachomatis, Neisseria gonorrhoeae
b. Pathogens in patients > 35 years old E. coli, Pseudomonas aeruginosa, Klebsiella pneumoniae |
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What are causes of chronic prostitis?
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(a) Majority are abacterial
(b) Common in bicycle riders (c) Chronic bacterial infection *Due to recurrent acute prostatitis |
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What are clinical findings in prostitis? (acute and chronic)
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1) Dysuria, urgency, increased frequency
2) Fever occurs in acute prostatitis. 3) Chronic prostatitis: can radiate to lower back, perineum, suprapubic area 4) Painful/swollen gland on rectal examination 5) Hematuria may occur. |
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How is a fractionated urine sample obtained for prostitis?
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(1) First 10 mL is the urethral component.
(2) Second midstream sample is the bladder component. (3) Third specimen at the end of micturition is the prostate component. (4) Fourth specimen is secretions milked out after prostate massage. a. Contraindicated in acute prostatitis |
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How is prostitis diagnosed?
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1) More than 20 WBCs/HPF in the third and fourth samples suggests acute prostatitis.
2) Increased bacterial count in third and fourth specimens is confirmatory. see specimen collections page 429 goljan review |
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How is acute prostitis treated in someone less than 35? greater than 35? chronic?
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1) If acute prostatitis in men < 35 years old, ceftriaxone + doxycycline (STD treatment)
2) If acute prostatitis in men > 35 years old, ciprofloxacin extended release of trimethoprim-sulfamethoxazole 3) If chronic bacterial prostatitis, ciprofloxacin |
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What is the incidence of BPH? Which race is it more common in? Where in the prostate does it develop? What do 30% of men with BPH have?
|
1) Approximately 80% have BPH at 80 years of age.
2) More common in blacks than whites 3) Develops in the transitional and periurethral zones 4) DRE has a sensitivity of 50% in detecting BPH. 5) Approximately 30% of men with BPH have occult prostate cancer |
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How do the hormones work to cause BPH?
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1) DHT is the primary mediator.
2) Causes hyperplasia of glandular and stromal cells 3) Stromal cells are the site of DHT synthesis. 4) Estrogen is a co-mediator. Increases the synthesis of androgen receptors |
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What is seen on gross and microscopic exam of BPH?
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1) Hyperplasia of glandular cells and stromal cells
a. Leads to nodule formation b. Nodules are yellow-pink and are soft. 2) Glandular hyperplasia develops nodules in the transitional zone. 3) Stromal hyperplasia develops nodules in the periurethral zone. a. Most responsible for obstruction of the urethra |
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What are signs of someone with BPH?
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(1) Trouble initiating and stopping the urinary stream
(2) Dribbling, incomplete emptying (3) Nocturia, dysuria 4) Hematuria |
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What are the functions of PSA?
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(a) Increases sperm motility
(b) Maintains seminal secretions in the liquid state (c) serine protease |
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What is the normal level of PSA?
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PSA is usually normal (0-4 ng/mL) or between 4 and 10 ng/mL (30-50%)
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What is the most common complication of BPH? What results?
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1) obstructive uropathy
2) Postrenal azotemia 3) Potential for progressing to acute renal failure if left untreated 4) Bilateral hydronephrosis 5) Bladder diverticula from increased pressure 6) Bladder wall smooth muscle hypertrophy |
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What is the most common cause of bladder diverticula?
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BPH
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BPH can result in prostatic infarcts. What are signs?
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(a) Pain on DRE
(b) Enlarged, indurated gland (c) Increased PSA values due to infarction |
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How high is the risk for BPH progressing into a carcinoma?
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no risk
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How is BPH diagnosed?
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1) DRE is insensitive test.
2) Transrectal ultrasound if nodules palpated or increased PSA |
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How is BPH treated?
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1) Avoid caffeine
2) α-adrenergic blockers a. Relax smooth muscle tone in capsule/bladder neck 3) 5α-Reductase inhibitors a. Block conversion of testosterone to DHT (c) ? Usefulness of saw palmetto; 5α-reductase inhibitor (2) Transurethral resection of the prostate (TURP) is most commonly used |
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What is the most common cancer in men?
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prostate
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What is the Second most common cancer-related death in adult males?
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prostate cancer
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65% of men are diagnosed with prostate cancer at what age?
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1) 65
2) More common in blacks than whites and Rare in Asians |
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Which zone does prostate cancer occur in?
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peripheral in location
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What are risk factors for prostate cancer?
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1) Advancing age (most important)
2) First-degree relatives (father and brothers) 3) Black men 4) Smoking cigarettes, high saturated fat diet |
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What is prostate cancer dependent on?
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DHT-dependent
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What are gross and microscopic findings in prostate cancer?
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1) Palpable by DRE
2) Obstructive uropathy is not an early finding. 3) Prostate intraepithelial neoplasia a. Foci of atypia/dysplasia b. May be a precursor lesion for prostate cancer Invasive cancer has a firm, gritty, yellow appearance Hallmarks of malignancy: (1) Invasion of the capsule around the prostate (2) Blood vessel/lymphatic invasion (3) Perineural invasion (4) Extension into the seminal vesicles or base of the bladder |
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What are clinical findings in prostatic cancer?
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1) Generally silent until advanced stage
2) Obstructive uropathy implies extension into the bladder base 3) Low back/pelvic pain 4) Portends bony metastases to vertebra and pelvic bones a. Due to spread via the Batson venous plexus b. Alkaline phosphatase is increased. 5) Compression of the spinal cord |
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When should screening for prostate cancer begin? Is PSA sensitive or specific? What PSA level is indicative of cancer?
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1) 50 (DRE and PSA)
2) sensitive 3) PSA > 10 ng/mL is highly predictive of cancer. a. 70% positive predictive value 4) PSA between 4 and 10 ng/mL is a gray zone. a. Overlap between early cancer and BPH |
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What are good screening tools for prostate cancer besides DRE?
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Measurement of free versus bound forms of circulating PSA
a. Increased free levels are seen in BPH, while increased bound levels are seen in prostate cancer b. The shorter the PSA doubling time, the more aggressive the tumor c. Rate of change of PSA values with time (PSA velocity) d. Yearly PSA velocity > 0.75 ng/mL increases likelihood of developing prostate cancer if total serum PSA is normal. d. Age-adjustment of total serum PSA (controversial) e. Ratio between serum PSA and volume of the prostate gland (prostate density) |
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How does prostate cancer spread and where to?
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1) Perineural invasion
2) Lymphatic spread to regional lymph nodes 3) Hematogenous spread a. Bone is the most common extranodal site 4) In descending order-lumbar spine, proximal femur, and pelvis 5) Lungs and liver |
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How is prostate cancer diagnosed?
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1) Transrectal needle core biopsies of prostate
2) Abnormal PSA value 3) Abnormal DRE 4) Previous diagnosis of atypia or carcinoma in situ |
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What is the prognosis of prostate cancer?
|
Five-year survival rate for all stages is almost 99%.
Ten-year relative survival rate is 91%. Fifteen-year relative survival rate is 76% |
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What are the gross and microscopic findings of a seminoma?
|
1) Gray tumor without hemorrhage or necrosis.
2) Large cells with centrally located nucleus containing prominent nucleoli. 3) Lymphocytic infiltrate |
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Where do seminomas metastisize? When do spermatocytic variants occur?
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1) lymphatic (para-aortic lymph nodes) before hematogenous (lungs)
2) Spermatocytic variant occurs in older individuals and rarely metastasizes |
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What is the marker in seminomas?What is the prognosis?
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↑ hCG in 10%
excellent |
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What are gross and microscopic findings in embryonal carcinoma? How do they metastisize?
|
1) Bulky tumor with hemorrhage and necrosis. Other tumor types often present
2) Metastasis: hematogenous before lymphatic |
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What are markers in embryonal carcinoma? What is the prognosis?
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1) ↑ AFP and/or hCG in 90%
2) Intermediate (less than seminoma) |
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What are gross and microscopic findings in yolk sac tumor? What marker is elevated? What is the prognosis?
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1) Characteristic Schiller-Duval bodies resemble primitive glomeruli
2) ↑ AFP in all cases, alpha-1 antitrypsin 3) good |
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What are microscopic findings in choriocarcinoma? What marker is elevated? What is the prognosis? Where and how does it spread?
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1) Most commonly mixed with other tumor types. Cells are polygonal, uniform cytotrophoblastic growing in sheets and cords and mixed with multinucleated syncytiotrophoblastic cells
2) Contains trophoblastic tissue (syncytiotrophoblast and cytotrophoblast) 3) ↑ hCG in all cases 4) poor most aggressive tumor 5) hematogenous to lungs |
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Microscopically how does a tertatoma appear?
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1) Contains derivatives from ectoderm, endoderm, mesoderm
Mixed with embryonal carcinoma (teratocarcinoma) 2) ↑ AFP and/or hCG in 50% |
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What is the prognosis of a teratoma in adults and children?
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Good
Usually benign in children and malignant in adults (usually squamous cell carcinoma)s |
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What is seen grossly and microscopically in malignant lymphoma?
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1) Secondary involvement of both testes by diffuse large cell lymphoma
2) poor 3) no blood marker |
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What is the Most common testicular cancer in men > 60 years of age?
|
malignant lymphoma
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What ages does a seminoma occur in? Embryonal carcinoma? Yolk sac (endodermal sinus) tumor? choriocarcinoma? Teratoma?
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1) 30-35; >65
2) 20-25 3) Most common testicular tumor in children < 4 years old 4) 20-30 5) Affects males of all ages |
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What is the function of FSH? What regulates it and where is this regulator made?
|
1) Stimulates spermatogenesis in the seminiferous tubules
2) Negative feedback relationship with inhibin a. Inhibin is synthesized in Sertoli cells in seminiferous tubules. b. Decreased inhibin causes an increase in FSH 3) produce estrogens and androgen binding protein |
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What is the function of LH? What negatively feeds back to regulate it?
|
1) Stimulates testosterone synthesis in the Leydig cells.
2) Testosterone has a negative feedback with LH. 3) Decreased testosterone causes an increase in LH |
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Where is SHBG made? What is estrogens effect on SHBG? What factors can decrease SHBG?
|
1) In both men and women, SHBG is mainly synthesized in the liver.
2) In men, the Sertoli cells also synthesize SHBG. 3) Estrogen increases synthesis of SHBG in the liver. 4) Androgens, insulin, obesity, and hypothyroidism all cause decreased synthesis of SHBG |
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Is estrogen or testosterone a stronger regulator of SHBG? which binds more tightly? What happens to free hormone levels with increased and decreased SHBG?
|
1) SHBG has a higher binding affinity for testosterone than estrogen.
2) "Estrogen is an SHBG amplifier" 3) Increased SHBG decreases free testosterone levels. 4) Decreased SHBG increases free testosterone levels |
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What are findings in hypogonadism?
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1) Impotence
a. Most common manifestation b. Failure to sustain an erection during attempted intercourse or during intercourse 2) Loss of male secondary sex characteristics a. Estrogen activity is unopposed. b. Findings include female hair distribution, gynecomastia 3) Osteoporosis 4) infertility |
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why is there osteoporosis with hypogonadism?
|
Testosterone normally inhibits osteoclastic activity and increases osteoblastic activity
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What happens in primary hypogonadism? What are findings?
|
1) Due to Leydig cell dysfunction
a. LH is increased. b. Loss of negative feedback imposed by testosterone c. Hypergonadotropic (increased LH) hypogonadism |
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What happens in secondary hypogonadism? What are findings?
|
1) Due to hypothalamic/pituitary dysfunction
a. Decreased LH b. Hypogonadotropic (decreased LH) hypogonadism |
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What are causes of primary hypogonadism?
|
1) Chronic alcoholic liver disease
a. Inhibits binding of LH to Leydig cells (? mechanism) 2) Chronic renal failure a. Toxins have a direct toxic effect on Leydig cell 3) Irradiation, orchitis, trauma |
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Leydig dysfunction results in primary hypogonadism. What are findings?
|
1. Decreased testosterone
a. Due to destruction of Leydig cells 2. Increased LH a. Due to decreased testosterone 3. Decreased sperm count a. Due to testosterone deficiency 4. Normal FSH a. Inhibin is present in Sertoli cells. |
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Leydig cell and seminiferous tubule dysfunction results in hypogonadism. What are findings?
|
1. Decreased testosterone
a. Due to destruction of Leydig cells 2. Increased LH a. Due to decreased testosterone 3. Decreased sperm count a. Due to testosterone deficiency and seminiferous tubule dysfunction 4. Increased FSH a. Due to decrease in inhibin |
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At what testicular volume puberty has begun?
|
> 4 mL
|
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|
What are causes of secondary hypopituitarism?
|
1) Kallmann's syndrome
2) Craniopharyngioma in children 3) Nonfunctioning pituitary adenoma in adults |
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What is Kallmanns syndrome? What are laboratory and clinical findings?
|
1. Autosomal dominant disorder
2. Maldevelopment of the olfactory bulbs and GnRH-producing cells 3. Clinical findings a) Delayed puberty b) Anosmia, color blindness 4. Laboratory findings a) Decreased FSH, LH, testosterone, and sperm count |
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What are lab findings in hypopituitarism?
|
Decreased FSH, LH, testosterone, and sperm count
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What accounts for ∼90% of cases of male infertility? What are causes of this and findings?
|
1) seminiferous tubule dysfunction
2) Varicocele, Klinefelter's syndrome, orchitis 3) Normal testosterone and LH a. Leydig cells are intact. b. Decreased sperm count c. Loss of seminiferous tubules and decreased testosterone d. Increased FSH e. Inhibin is decreased. |
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What are causes of end-organ dysfunction that result in infertility? what are findings?
|
1. Obstruction of vas deferens
2. Disorders involving accessory sex organs or ejaculation 3. Normal testosterone, FSH, LH, prolactin 4. Sperm count variable |
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|
What are the components of semen?
|
1) Spermatozoa derive from the seminiferous tubules.
2) Coagulant derives from the seminal vesicles. 3) Enzymes to liquefy semen derive from the prostate gland |
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|
What are the components of semen used to evaluate infertility?
|
1) Volume
a. Volume does not correlate with the number of sperm. 2) Sperm count a. Normal is 20 to 150 million sperm/mL. 3) Sperm morphology a. Morphology is very abnormal in reconnections of a vasectomy. 4) Sperm motility |
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|
What are serum factors used to evaluate infertility?
|
gonadotropins, testosterone, prolactin
|
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In a Seminiferous tubule dysfunction is the sperm count low or high? testosterone? LH? FSH?
|
SC = ↓
T = N LH = N FSH = ↑ |
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|
What is the most common cause of impotence in young men?
|
1) psychogenic
2) Stress at work, marital conflicts, performance anxiety |
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|
What is Nocturnal penile tumescence? When is it present and not present?
|
1) Average male has ∼5 erections while sleeping at night.
2) NPT is preserved in impotence that is due to psychogenic causes. 3) All other causes of impotence have a loss of NPT |
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|
What is the Most common cause of impotence in men > 50 years old?
|
vascular insufficiency
|
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|
What does Leriche syndrome do in a man? What else occurs?
|
1) Impotence due to vascular insufficiency
2) Aortoiliac atherosclerosis with decreased penal blood flow 3) Calf claudication with atrophy 4) Diminished femoral pulse |
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|
What are Neurologic causes of erectile dysfunction?
|
1) multiple sclerosis
2) diabetes mellitus 3) radical prostectomy |
|
|
Which drugs can cause erectile dysfunction?
|
1. Leuprolide (GnRH agonist)
2. Methyldopa, psychotropics |
|
|
What hormone secreting brain tumor can cause erectile dysfuction?
|
1) prolactinoma
2) Prolactin inhibits GnRH release |
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|
What are some penile disorders that can cause erectile dysfunction?
|
1. Peyronie's disease (fibromatosis)
2. Priapism |
|
|
What is the Most common drug used for the treatment of erectile dysfunction? What is its mechanism?
|
1) Sildenafil (Viagra)
2) Inhibits the breakdown of cyclic guanosine monophosphate (cGMP) by type 5 phosphodiesterase 3) Increased levels of cGMP cause vasodilation in the corpus cavernosum and the penis |
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|
What herb is used in erectile dysfuction? Why?
|
1) yohimbe
2) Herb that produces vasodilatation of vessels |
|
|
What happens with Leydig tumors? what is seen on histologic exam?
|
1) there is a testicular mass
2) precosius puberty 3) increased androgens and estrogens 4) gynecomastia 5) On cross section tumors have lipochrome pigment and Reinke crystaloids |
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|
Polygonal germ cells with clear cytoplasm and round nuclei, prominent nucleoli and Arranged in lobules, which are separated by fibrous septae and Lymphocytes,granulomas, and giant cells may be seen
|
seminoma
|
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|
placental alkaline phosphatase increased with what tumor?
|
seminoma
|
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|
Are seminomas or nonseminomas sensitive to radiation?
|
seminomas
|
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|
associated with exposure to soot (chimney
sweeps) |
SCC
|
