Renal 2 Test 1

Front 1

Why does the ureter not have a serosa?

Back 1

Because it is retroperitoneal. Only Intraperitoneal structures have it.

Front 2

Of a tumor invaded the lamina propria but not the muscularis, is it considered low or high stage?

Back 2

Low

Front 3

Name the cell layers of of the UTI tract from out to in.

Back 3

Transitional epithelium, basement membrane, lamina propria, muscularis, adventitia

Front 4

Tumor that has not invaded the basement membrane is called?

Back 4

Carcinoma Insitu

Front 5

What is another name for transitional epithelium?

Back 5

Urothelium

Front 6

T/F: Von Brunn Nests can give rise to neoplasia

Back 6

True

Front 7

T/F Von Brunn nests can only occur in the ureter.

Back 7

False, also can occurs in bladder

Front 8

What is the pathogenesis of double ureter

Back 8

Double or split uretic bud

Front 9

Congenital megaloureter is associated with what condtion?

Back 9

Hirsprung (Megacolon) dz

Front 10

What is the complication of congential megaloureter?

Back 10

The ureter doesn't, this leads to dilation, which could cause hydronephrosis and renal failure.

Front 11

What is the cause of ureteritis cystica? Can it become metaplastic?

Back 11

Chronic inflammation? yes

Front 12

A calculi can get stuck in what three places?

Back 12

UPJ, Iliac vessals, bladder entrance----becaues the ureter is narrower at this sites.

Front 13

Ergot Derivatives and b-blockers are the known drug causes for what ureteral disorder?

Back 13

Sclerosing retroperitoneal fibrosis.

Front 14

Sclerosing retroperitoneal fibrosis is caused by what other conditions?

Back 14

Sclerosing cholangitis
Sclerosing mediastinitis
Ridell's fibrosing thyroiditis
Lymphoma
AND idiopathic

Front 15

What is the complication of sclerosing mediastinitis?

Back 15

Hydronephrosis due to obstruction of the ureter.

Front 16

What is the most common neoplasm in the ureter?

Back 16

TCC

Front 17

What are the risk facts for TCC of the ureter.

Back 17

Same as that of the bladder (smoking, etc)

Front 18

what is the clinical significance of a transition cell carcinoma?

Back 18

It causes obstruction

Front 19

This condition can black venous drainage of the right spermatic vein cause right scrotal varicocele?

Back 19

Sclerotic retroperitoneal fibrosis

Front 20

Pt with this condition has feces draining out of the umbillicus.

Back 20

Perisitent (Vitelline) Sinus

Front 21

Pt with this condition has urine draining out of his umbillical

Back 21

Persistant urachus sinus. (urachal cysts)

Front 22

Having urachal cysts predisposes one to?

Back 22

Adenocarcinoma of the bladder.

Front 23

What is the most common acquired cause of bladder diverticula?

Back 23

BPH

Front 24

What are the complications of bladder diverticula?

Back 24

Diverticulitis and calculi

Front 25

Exostrophy of the bladder is related to what condition?

Predisposed to? and how?

Back 25

Epispadias

Adenocarcinoma because of glandular metaplasia due to inflammation.

Front 26

What is the most common cause of bladder adenocarcinoma?

Back 26

Urachus remnant

Front 27

What is the most common urinary pathogen?

Most common bacterial infection in elderly.

Most common cause of sepsis in hospitalized pts?

Back 27

E. Coli

E. Coli

E. Coli

Front 28

MC viral cause of hemorrhagic cystitis?

Back 28

Adenovirus

Front 29

Name 4 causes of acute cystitis.

Back 29

E. Coli MC
Staphylococcus saprophyticus
Adenovirus
Acute urethral syndrome

Front 30

2nd cause of Acute cystitis in sexually active women, what bug?

Back 30

Staph saprophyticus

Front 31

What is the MCC of acute urethral syndrome?

Back 31

Clamydia Trachomonus

also mycoplasma, ureaplasma, neisseria gonorrhea

Front 32

Acute urethral syndrome in women is analogous to what in men?

Back 32

non-specific urethritis

Front 33

T/F: acute and chronic cystitis usually present with fever?

Back 33

False. fever usually means acute pyelonephritis

Front 34

What are the signs of acute and chronic cystitis?

Back 34

Dysuria, frenquency, urgency, nocturia, suprapubic pain, gross hematuria

Front 35

Another name for interstitial cystitis? is it acute or chronic?

Back 35

Hunner's ulcer
Chronic

Front 36

What is the histology of Hunner's ulcer.

Back 36

Inflammation and fibrosis involving all layers of bladder with MAST CELLS.

Front 37

What is the probable cause of Hunner's ulcer?

Back 37

Autoimmune

Front 38

Who of asymtomatic bacteriuria in women

Back 38

Pregnant women, elderly women in nursing home, diabetic women

Front 39

Pt comes in your with Hunner's ulcer, what do you do first?

Back 39

Biopsy it, to rule out carcinoma

Front 40

What are causes of sterile pyuria?

Back 40

Clamydia, Renal tuberculosis, acute tubulointerstitial nephritis.

Front 41

Malakoplakia is related to?
Who usually get it?

Back 41

Chronic E. Coli infectino of the bladder.
Immunosuppressed folks.

Front 42

What is the histology of malakoplakia?

Back 42

Foamy macrophages filled with mineralized secretions. Michalis Guttman bodies

Front 43

Do cystitis cystic and glandularis have Von Brunn Nests

Back 43

YES they do

Front 44

Transitional cell papilloma: is it benign or malignant? Common or rare. How does it look?

Back 44

Rare benign tumor. Some consider it a low grade transitional cell carcinoma. It looks like a wart.

Front 45

What are the causes of transitional cell carcinoma?

Back 45

Smoking
Aniline dyes
Cyclophosphamide
Schistosoma Hematobium
LONG TERM ANALGESIC USE

Front 46

What chromosomal event is related to transitional cell carcinoma?

Back 46

Deletion of chromosome 9

Front 47

TCC is more common in?

Back 47

Male

Front 48

Three causes of adenocarcinoma of the bladder?

Back 48

Urachal remnant (MCC)
Cytitis glandularis
Exostrophy of the bladder

Front 49

what is the most common sarcoma in children? Where is it most common in boys? girls?.

Back 49

Embryonal rhabdomyosarcoma (sarcoma botryoides).
Urinary system-urethra=boys.
Vagina=girls

Front 50

A boy with a grape like mass protruding from urethral orifice, what is it?

Back 50

Embryonal rhabdomyosarcoma

Front 51

In the TNM staging system, what do TIS, T1, T2 mean.

Back 51

TIS = Carcinoma In Situ
T1 = in lamina propria
T2 = in muscularis

Front 52

Most common sites of bladder transitional cell carcinoma?

Back 52

Lateral or posterior wall at the base of the bladder.

Front 53

Do TCC tumors that have the A, B, H antigens have better or worse prognosis?

Back 53

Better

Front 54

What are the complications of bladder that invade the bladder?

Back 54

Hydronephrosis, post-renal azotemia, death by renal failure

Front 55

Squamous cell carcinoma of bladder is caused by. How is the histology?

Back 55

Schistosoma Haematobium - chronic inflammation

Egg with nipple on end. Egg is surrounded by Eosinophils that try to kill it w/ type II hypersensitivity --> chronic inflammation --> squamous metaplasia

Front 56

Invasive cervical or prostate carcinoma common invade what? and so what is the cause of death?

Back 56

Bladder.
Obstruction-> hydronephrosis-->renal failure

Front 57

Three symptoms of Reiters syndrome in men.

A common component of which is?

Back 57

Urethritis
Conjunctivitis (sterile)
HLA-B27 arthritis

Chlamydia urethritis

Front 58

What is the mos common carcinoma of urethra?
Who gets it?
Usually involve?

Back 58

Squamous cell carcinoma.
Older patients
External meatus

Front 59

Urethral Caruncle dominant in male or female?

Back 59

female.

Front 60

Causes of urinary tract obstructions:

Back 60

Congenital anomalies (posterior urethral valves, strictures)
Stones, Tumors, inflammations, sloughed papilla, blood clots, pregnancy, uterine prolapse, functional disorders

Front 61

E. Coli causes cystitis in women and what in men?

Back 61

Protatitis

Front 62

Stones are more common in males or females?

Back 62

Males

Front 63

Most common type of stones. what are the common risk factors?

Back 63

Calcium phoshate or calcium oxylate.

Hypercalciumia, hyperphosphatemia, and high pH

Front 64

What are "triple stones" made of? what are the other names?

Are they formed at high or low pH

Back 64

Magnesium ammonium phosphate.
Struvite, staghorn. 2nd most common stone.
high pH (NOT LOW)

Front 65

Uric acid stones and cystic stone, which is more common

Back 65

Uric acid (6%)

Cystine is only 1-2 %

Front 66

Is BPH a risk factor for carcinoma?

Back 66

NO

Front 67

How does BPH affect the bladder?

Back 67

Obstruct --> hypertrophy

Front 68

In cystocele, the bladder is pulled into the vagina by?

Back 68

The prolapsing uterus due to the weekend pelvic floor.
This creates a pouch that collects residual urine --> problems

Front 69

What congenital abnormality of the kind is related to Turner Syndrome

Back 69

Renal agenesis

Front 70

Unilateral renal agenesis is more common in male or females? Which side is more frequent? It is a predisposition for what?

Back 70

Males.
Left side
Vesicoureteral reflux

Front 71

Horseshoe kidney more in male or females?

Back 71

Male

Front 72

What is the most common cause of Acute Renal Failure.
What are the other causes?

Back 72

Acute tubular necrosis.
Post renal obstruction (ex BPH), Vascular dz (malignant HTN,RPGN, DIC, Urate Nephropathy.

Front 73

Name to main causes of ATN

Back 73

Ischemic and Nephrotoxic

Front 74

What is the pathogenesis of ischemic ATN.

Back 74

1. Hypoxia damages endothelial cells --> decrease vasodilators (NO2, PGI2), increase vasoconstrictors (endothelin)--> Vasoconstriction of afferent arterioles --> decrease GFR.
1. Ischemia also kills tubules cells, it sloughs and obstruct (make pigmented tubular cell casts)-> cast obstruct lumen, dec GFR, push fluid into interstitium --> oliguria

Front 75

What is the most common site of tubular damnage in ischemic ATN?

Back 75

The straight segment of prox tubule and medullary segment of thick ascending limb. The BM is affected so tubular cells can't regenerate.

Front 76

Name the causes of nephrotoxic ATN. (MCC?)

Back 76

Aminoglycosides (most common)
Radiocontrasts
Heavy metals (lead, mercury)

Front 77

Which ATN is reversible, why?

Back 77

Nephrotoxic ATN, because the basement membrane is still intact.

Front 78

Where is the damage in nephrotoxic ATN?

Back 78

Proximal tubular cells

Front 79

Clinical findings of ATN

Back 79

Oliguria, in most cases
Pigmented renal tubular cell casts
Hyperkalemia, increased anion gap metabolic acidosis
Hypokalemia (diuresis phase) and infection are common problems

Front 80

What are three stages of ATN?

Back 80

Initial stage (first 36 hrs), Oliuria, Diuretic

Front 81

Causes on tubulointerstitial nephritis (TIN). Most common cause?

Back 81

Acute pyelonephritis
Drugs
Infection
SLE, lead poisoning, urate nephropathy, multiple myeloma

Front 82

Most common cause of acute pyelonephritis. It is more common in

Back 82

Ascending infections.
Female (short urethra)

Front 83

What are the risk factors for acute pyelonephritis

Back 83

Urinary tract obstruction (reflux),
Medullar sponge dz, DM, Sickle cell dz/trait

Front 84

Pathogenesis of acute pyelonephritis caused by reflux (ascending inf)

Back 84

The intravesicular region is not compressed during micturition --> Reflux of urine into bladder

Front 85

What is the gross and microscopic histlogy of acute pyelonephritis?

Back 85

Gray and white areas of abscess formation in cortex and medulla, micro abscess in tubular lumens and interstitium

Front 86

Lab findings of acute pyelonephritis?

Back 86

WBC casts (key finding)
Pyuria, bacteriuria (usually E. coli), hematuria

Front 87

Acute pyelonephritis can lead to these complications:

Back 87

Chronic pyelonephritis
Perinephric abscess
Renal papillar necrosis

Front 88

Two causes of chronic pyelonephritis (CPN)

Back 88

VUR starting in young girls
Urinary tract obstruction (BPH etc)

Front 89

Gross finding of obstructive CPN? Reflux type?

Back 89

Dilation of calyces
Diffuse thinning of cortical tissue

Cortical Scar Over blunt calyx

Front 90

What is thyroidization?

Back 90

Tubular atrophy in CPN

Front 91

Drug Induced tubulointerstitial nephritis (TIN) is associated with what drugs?

Back 91

Pennicillins, Rifampin, Sulfonamides, NSAIDS, Diuretic

Front 92

Pathogenesis for drug induced TIN. Is it reversible?

How is the BUN/Cr ratio?

Back 92

Combination of type I and type IV hypersensitivity
Occurs ∼2 weeks after beginning a drug.

Yes it is reversible

BUN/Cr < 15 (renal)

Front 93

What is the most predictive lab finding in drug induced TIN?

Back 93

Eosinophilia, and eosinophiluria ===> it's an allergic reaction.

Front 94

What is the most common cause of drug induced TIN?

Back 94

Analgesic nephropathy

Front 95

Is analgesic nephropathy more common in males or females?
It occurs in what other patients?

Back 95

Females.
People with chronic pain who takes lots of analgesic

Front 96

Pathogenesis of analgesic nephropathy.

Back 96

Chronic pain-> use of acetaminophen + aspirin for more than 3 yrs.

Acetaminophen - free radical damnage to tubular cells in medulla.
Aspirin decreases PGI2 --> decrease O2 supply to medulla.

Front 97

Complications of analgesic nephropathy.

Back 97

Renal papillar necrosis (colicky pain, ring defect where papilla used to be)
HTN-> Chronic renal failure
Transitional Cell carcinoma of the renal pelvis and bladder

Front 98

How does urate nephropathy affect kidney?

Who gets it?

Back 98

Deposition of urate crystals in tubule and interstitium

Leukemia pt (acute), gout (chronic), lead poisoning

Front 99

How does lead poisoning lead to urate nephropathy? (indirect effect)

What does the direct effect of lead cause?

Back 99

Lead decrease secretion of uric acid in kidney. In direct effect.

Tubulointersitial nephritis

Front 100

How multiple myeloma cause renal dz.

Back 100

1. Bence Jones protein produce tubular casts, light chains are toxic to tubular epithelium. Cast obstruct lumen and start a foreign body giant cell reaction.--> renal failure
2. Nephrocalcinosis (hypercalcemia) - Metastatic calcification of the basement membrane of collecting tubules

3. Light chains make amyloid --> amylodosis (nephrotic syndrome)

Front 101

Most common cause of Chronic Renal failure (decending)

Back 101

Diabete mellitus
HTN
Glomerulonephritis (PRGN, FSGN)
Cystic renal diz (children and adult)

Front 102

Prescence of glycated squamous epitheliam in the trigone on a female's bladder is normal or abdnormal?

Back 102

It is normal, not metaplastic

Front 103

Doubl ureters drain through different orifices into the bladder T/F

Back 103

False

Front 104

Ureteral junction usually occurs in children or adults? More common in boys/girls? which side?

Back 104

Children.
Common in boys, left side.

Front 105

Most common cause of hydronephrosis in infants and children

Back 105

Ureteropelvic junction obstruction.

Front 106

UPJ obstruction in adults is more common males/females? Often unilateral or bilateral?

Back 106

Females,
Unilateral

Front 107

Fibroepithelial polyps and leomyoma are common benign tumor in the?

Back 107

ureter, but may occur in renal pelvis, bladder, and urethra

Front 108

Suprapubic pain, dysuria, frequency, hematuria w/ no evidence of infection in female, what is the dx

Back 108

Hunner's Ulcer (Intersitial cystitis)

Front 109

Most common bladder malignant sarcoma in children.
In adult?

Back 109

Embryono rhabdomyosarcoma..

Leomyosarcoma

Front 110

Most common benign mesenchymal tumor in children is?

Back 110

Leomyoma

Front 111

Polypid cystitis is most common caused by?
This looks like what kind of tumor histologically and grossly?

Back 111

Catheters.
Looks like papillary urothelial carcinoma

Front 112

Cystitis cystic et glandularis that have extensive intestinal metaplasia have high hisk for developing adenocarcinoma T/F

Back 112

False.

Front 113

Carcinoma insitu is high or low grade?

Back 113

High

Front 114

Urothelial papilloma
Urothelial neoplasm of low malignant potential
Papillary urothelial carcinoma- low grade
Papillary urothelial carcinoma - high grade.

Which is least malignant? highest?

Back 114

Urothelial papilloma
Papillary urothelial carcinoma-high grade

Front 115

Urothelial tumors have a tendency to develop new tumors even after excision. T/F

Back 115

True

Front 116

Cystic renal dysplasia is caused by

Back 116

abnormal metanephric differentiation.
-persistence of abnormal structure
-cartilage
-undifferentiated mesenchym
-immature collecting tubules
-abnormal lobar organizations

Front 117

AD polycystic kidney is bilateral or unilateral?

PKD1 and PKD2 are on which chromosomes?

Back 117

Bilateral

PKD1=16, PKD2=4

Front 118

Polycystin-1 (PKD1) is involved in?

Polycystin-2 (PKD2) involves in

Back 118

Cell to cell-matrix interactions.

It is an integral membrane protein and acts as a Ca+ cation channel.

Front 119

Why do the cysts in ADPKD look irregular?

Back 119

The cysts come from tubules from throughout the nephrons so they have variable lining epithelia

Front 120

Are the polycysts liver in (ADPKD) asymtomatic or asymptomatic?

Back 120

usually asymptomatic

Front 121

How do ADPKD end up dying?

Back 121

about 40% of adult patients die of coronary or hypertensive heart disease, 25% of
infection, 15% of a ruptured berry aneurysm or hypertensive intracerebral hemorrhage

Front 122

AR PKD is linked to what gene on what chromosome?

What is the gene product? and what does it do?

Back 122

PKHD1 on chromosome 6
Fibrocystin-may be a cell surface receptor in the collecting biliary differentiation

Front 123

AR PKD children who survive infancy end up with what condition?

Back 123

Liver fibrosis

Front 124

in ARPKD, how are the cyst oriented?

Back 124

Dilated elongated channels are present at right angles to the cortical surface,
completely replacing the medulla and cortex

Front 125

In Medulary Sponge Kidney, the cysts arise from?

Are renal function normal or abnormal?

Back 125

The collecting ducts in the medulla.

Normal renal function.

Front 126

Nephronophthisis-Medullary Cystic Disease Complex have onset during adulthood or childhood

Back 126

Childhood

Front 127

In Nephronophthisis-Medullary Cystic Disease Complex, where are the cysts commonly located?

Back 127

at the corticomedullary junction

Front 128

In Nephronophthisis-Medullary Cystic Disease Complex, what is the cause for the "eventual" renal insufficiency

Back 128

Cortical tubulointerstitial damage (some call it hereditary tubulointerstitial nephritis)

Front 129

What are the 4 variants from nephronophthisis-Medullary Cystic Complex? Which is most common?

Back 129

1)Sporadic nonfamilial(20%)
2)familial juvenile nephronopthisis (40-50)
3)Renal Retina Dysplasia (15%)- AR
4) Adult onset medullary cystic disease (AD)
4)

Front 130

What is the most common genetic cause of end stage renal dz in children and young adults?

Back 130

Nephronophthisis-Medullary Cystic Disease Complex

Front 131

What are the 5 related genes in Nephronophthisis-Medullary Cystic Disease Complex

Back 131

NPH1, 2, %3 = autosomal recessive juvenile form

MCKD1, &2 = autosomal dominant, identified as causing medullary cystic disease that is characterized by progression to endstage kidney disease in adult life

Front 132

A children or adolescents with otherwise unexplained chronic renal failure, a positive family history, and chronic tubulointerstitial nephritis on biopsy comes in, what you should consider in your differentials?

Back 132

Nephronophthisis-Medullary Cystic Complex

Front 133

How does Nephronophthisis-Medullary Cystic Complex look grossly?

Back 133

Kidney with cysts in the medulla at the Corticomedullary Junction, no cysts on the cortex. Glomerular structure is preserved.

Front 134

The cysts in acquired (dialysis) cystic dz usually contain what?

Are they asymtomatic or symtomatic?

Back 134

Clear fluid and CALCIUM OXALATE.

Most are symtomatic

Front 135

Acquired (dialysis) cystic dz patients are predisposed to what?

Back 135

Renal Cell Carcinoma of the cyst walls

Front 136

Patients with tuberous sclerosis, a disease characterized by lesions of the cerebral cortex that produce epilepsy and mental retardation as well
as a variety of skin abnormalities are predisposed to what benign tumor of the kidney?

Back 136

Angiomyolipoma (vessel,smooth muscle, fat)

Front 137

Name 3 benign tumor of the kidney.

Back 137

Renal fibroma or hamartoma
Angiomyolipoma
Oncocytoma

Front 138

Hypernephroma is the same as

Back 138

renal cell carcinoma

Front 139

Renal cell carcinoma arise from?

What is the most common risk factor?

Back 139

Tubular epithelium.

Tobacco smoking. Others are obesity, HTN, estrogen therapy, asbestos, petroleum, heavy metals.

Front 140

Renal cell carcinoma are related to what protooncotene? (not 100%)

Back 140

VHL

Front 141

Most common type of renal cell carcinoma.

What is the chromosomal event here?

Back 141

Clear cell carcinoma (70-80%)

Loss of short arm of chromosome 3.

Front 142

The 4 types of renal cell carcinoma.

Which is the hereditary form?
TRisomy 7

Back 142

Clear Cell carcinoma-3p deletion
Papillary carcinoma - related to trisomy 16,17, Y..Related to MET gene
Chromophobe renal carcinoma-prominent cell membrane, pale eosinophillic w/ halo around nucleas. Multiple chromosome loss and hypoploidy
Collecting duct (bellini duct) carcinoma- least common

Front 143

most common type of renal cancer in patients who develop dialysis-associated cystic disease

Back 143

Papillary carcinoma

Front 144

What tumor likes to invade vena cava and end up in the right said of the heart?

Back 144

Renal cell carcinoma

Front 145

These tumor cells have a rounded or polygonal shape and abundant clear or granular cytoplasm;

Back 145

Clear cell carcinoma

Front 146

Three diagnostic features for renal cell carcinoma.
Which is most reliabl?

Back 146

Costovertebral pain, hematuria, flank mass

Hematuria

Front 147

T/F: renal cell carcinoma tend to metatasize widely before they give rise to any local symptoms

Back 147

True

Front 148

Which bug has protein II

Back 148

Neisseria gonorrhea

Front 149

You see psommoma bodies in?

Back 149

Papillary Carcinoma (Trisomy 7 related)

Front 150

do chromophobe renal carcinoma have good or bad prognosis?

Back 150

goood

Front 151

Kidneys in nephronophthesis are small or large?

Describe the basement membranes.

Back 151

small

thickened in prox and dist tubules with interstitial fibrosis

Front 152

In diminished renal reserve, how are GFR, BUN, Crt.
Symtopmatic?

Back 152

GFR=50%, BUN,crt normal. Asymptomatic.
Can develop azotemia w/ more insult.

Front 153

GFR in renal insufficiency

Back 153

20-50%

Front 154

cystic renal dyplasia is associated with what conditions?

Back 154

UPJ obstruction, ureteral agenesis.

Front 155

If a patient comes in with multicystic kidney unilaterally. Is it PKD? what is it?

Back 155

It's Polycystic dysplasia

Front 156

ocular motor abnormalities, retinitis pigmentosa, liver fibrosis, and cerebellar abnormalities are associated with?

Back 156

Nephronopthisis complex

Front 157

Morphology of acute pyelonephritis

Back 157

patchy intersititial suppurative inflammation

Front 158

Pus the in pelvis, calyces, and ureter is known as?

Back 158

Pyonephrosis

Front 159

Aristolochic acid?

Back 159

Chinese erbal nephropathy

Front 160

Carbonic anhydrase inhibitor acts where?

Back 160

Proximal Convoluted Tubules

Front 161

When do you use a loop diuretic?

Back 161

Emergency or Chrx edematous states (CHF, renal failure)

Also for quick fix of hypercalcemia

Front 162

Why does furosamide require intact kidney?

This is why you don't have furosamid with NSAIDS

Back 162

so it can produce appropriate prostiglandins to keep the kidney from ischemia and produce it's vasodialation effect to help CHF.

Front 163

Hobnail pattern?

Back 163

collecting duct carcinoma

Front 164

Patient on ergot deriv and b blocker and has lymphoma, what is the predisposition?

Back 164

Sclerosing Retroperitoneal Fibrosis

Front 165

Oncocytoma is often mistaken for?

Back 165

Chromophobe renal carcinoma

Front 166

What is ormond dz?

Back 166

Sclerosing retroperitoneal fibrosis

Front 167

T/F all adenomas need treatment until benignity is confirmed?

Back 167

true

Front 168

Ultrastructure of oncocytoma.

Back 168

Large eosinophil cell filled with mitochondria

Front 169

Renal cell carcinomas come from what cell? This is the reason why it is called Renal adenocarcinoma

Back 169

Tubular epithelium

Front 170

Clear cell carcinomas are 95% sporadic (true/f)

Back 170

True

Front 171

The VHL gene encodes a protein that is part of a
ubiquitin ligase complex involved in targeting other proteins for degradation.

Back 171

That was just a fac tto know

Front 172

Papillary carcinoma (familial) is on what chromosome? and what gene is turned on?

Back 172

Chromome 7, MET (protooncogene) is turned on

Front 173

Chromophobe carcinoma- chromosomes? diploidy?

Back 173

Many chromosomal losses and extremely hypodiploidy

Front 174

Renal cell carcinoma mostly affect which pole of the kiddey?

Back 174

Upper pole

Front 175

Mech of nonbacterial thrombotic endocarditis.

Risk factor?

What pt get it?

Back 175

depo of small fibrin, platelets and other blood componenets on leaflet of cardiac valves-vegetations are sterile, no organism

Endocardial trauma -Catheter

debilitated pts (cancer or sepsis)

Front 176

pathophysiology?

Back 176

frequently occurs w/ venous thrombosis or pulnonary embolism--> suggest common orgin w/ hyperoagulable state w/ systemic activation of blood coag such as DIC

may be related to underlying dz--cancer (mucinous adenocarcinomas of pancreas)

Procoagulant effect could be part of Trousseau syndrome

Front 177

Morphology?


Clinical signif?

Back 177

Sterile-nondestructive, small lesion occur singly or multiply along line of closure of leaflets

can produce emboli and resultant infarcts in brain, heart

Front 178

Mech of infective endocarditis?

What bacteria?

Back 178

colonization of bugs on heart valves--> thrombotic vegetation-->valve desctruction

50-56% = Streptococcus Viridans
10-20% = Staph aureus (IV USERS)
Remain = HACEK (haemophilus, actinobacillus, cardiobacterium, Eikenella, Kingella) **in oral cavity

Front 179

Condition the predisposed to infective endocarditis?

Back 179

-seeding of blood w/ microbes
-valve deformities (myxomatous valve, degenerative calcific valvular stenosis, bicuspid aortic valve, artificial valve)
-neutropenia, immunodef, malignancy, diabetes, alcohol & IV use.

Front 180

Pathophys for acute endocardititis?

Subacute endocarditis?

What does danger of the septic emboli?

Back 180

destructive tumultous infection, us. of a previously normal heart valve --50% death in days even w/ antibiotics

organism of low virulence cause infection in previously abnormal heart (go away in wks or month)

it can go up and infarct the brain

Front 181

What valves are most commonly affected?

Which valves are more affected in IV users?

How is fungal endocarditis different?

Back 181

Aortic and mitral

Right heart valves

Larger vegetation than bact infection

Front 182

What do you see in subacute case?

What is the DUKE critia for dx infective endocarditis?

Back 182

Granulation tissue at the base (chronicity)--> fibrosis, calcification

Presence of microbe| valvular lesion| pos blood culture| echocardiogram| new valv regurge| predisposing heart lesion| fever| Vascular lesions (microemboli)| immuno phenomenon

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What is the immunologic phenomenon?

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Glomerulonephritis due to immune complex trapping in kidney.

Subcutaneous nodules in pulp of digits (osler nodes)

Retinal hemorrhage (Roth spots)

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What are the clinical finds other than microemboli?

What is Janeway lesions?

***Give prophylactic antibiotic to people with cardiac problem or artificial valve before surgica (dental) procedures

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petechia; red streaks in nail bed of digits (splinter or subungual hemorrhages);

erythematous or hemorrhage nontender lesion on plams or soles

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Libman Sacks endocarditis is assc with?

Which valves affected?

Morphology?

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SLE (antiphospholipid)

Mitral and tricuspid vlave w/ small sterile vegetations

-small, single or multiple, sterile granular pink vegetations
-lesion can be on undersurface of AV, on valve endocardium, on cords or walls of atria and ventricle
-Histo=finely granular, fibrinous eosinophillic material that may contain hematoxylin bodies

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Which valves are involved in carcinoid Heart dz?

Caused by?

Why is it right sided?

**If the tumor is outside of the portal system you can get right sided sydrome...if in the hepatic portal, you won't see because liver neutralize serotonin first.

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Right heart valve and endocardium

Carcinoid tumors (pancreas?)

Serotonin and bradykinin are inactivated during by monoamine oxidase in lung --> no change to go to left side (check/ with pt..descrepency here)

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WHen do you see left sided carcinoid?

What lab values to check for?

What are all the bioactive prodcts?

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pulmonary carcinoid patent foramen ovale

Serotonin, urinary excretion of 5-hydroxyindoleacetic acid (serotonin metab)--> severity of RH lesion

Serotonin, kallikrein, bradykinin, histamine, prostaglandin, tachykinins

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What are the complications of artificial valves?

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Thromoboembolic complications - obstuction of prosthesis by thrombus (MAJOR problem)--give anti coag med

Infective endocarditis- rare (step epidermitis, staph aureus)

Structural deteriorate - uncommon cause of mechanical valve failure ; MAJOR cause for bioprothetic valve

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What is cardiomyopathies?

Familial/genetic relation?

How to dx?

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Dz who cause is intrinsic to the myocardium

Yes, 20-35%

Endomyocardial biopsy

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Cardiomyopathies are assc with?

What is myxedema heart?

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-infections- coxsacchie B, chlamydia, rickettsia
-Toxins: EtOH, cobalt, catecholamines, CO, lithium, hydrocarbons, arsenic, cyclophosphamide

Metabolic discorders:
Hyperthyroid = tachycardia
Hypothyroid - long circulation
Hemochromatosis

-flabby enlarge, dilated due to myofiber swelling w/ loss of striations --accmpn by mucopolysaccharide rich edema fluid

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More asscs?

Autosomal dominant famility transthyretin amyloidosis?

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-Neuromuscular disease = Friedreich ataxia, muscular dystrophy
-Storage disorders: hunter hurler sx, glycogen storage dz, Fabry dz, amyloidosis
-Leukemia, carcinoimatosis, sarcoidosis, radiation induced

4% of african have isoleucine substituted for valine at pos 122

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Young athletes are susceptible to what?

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Hypertrophy cardiomyopathy