Unit Iv Cancers & Week 3

Front 1

174

Back 1

174

Front 2

What are the three components of an angiomyolipoma

Back 2

Blood vessels, smooth muscle and fat.

Front 3

What are the important etiologies of renal cell carcinoma

Back 3

Smoking, Loss of VHL suppressor gene, 3P mutation

Front 4

von Hippel Lindau Disaese

Back 4

Loss of VHL suppressor --> Clear cell carcinoma, cysts, and rare pheochromocytoma

Front 5

Hereditary papillary renal cell carcinoma involves what?

Back 5

Overexpression of C-Met oncogene.

Front 6

Hereditary Leiomyomatosis/papillary renal cell carcinoma involves what?

Back 6

Fumurate Hydratase gene. Gives papillary RCCs and leiomyomas

Front 7

What is Birt Hogg Debe syndrome?

Back 7

Defective BHD tumor suppressor - RCC (oncocytic mostly, sometimes clear or chromophobe), renal oncocytoma, hair follicle tumors and lung cysts

Front 8

What is the triad of RCC presentation

Back 8

Hematuria, Palpable mass, and Pain (Not actually usually present nowadays)

Front 9

Sarcomatoid RCC automatically is what grade?

Back 9

Grade 4 - the worst.

Front 10

Common clinical pres of RCC

Back 10

occult hematuria, anemia, increased hematocrit, increased serum Ca

Front 11

Clear cell - cytogentics

Back 11

"-3p"

Front 12

papillary cytogenetics

Back 12

"+7, +17, loss of sex chromosome"

Front 13

Aggressive type cytogenetics

Back 13

9p, 14q, multiple abn in RCC

Front 14

Which two (4) tumors are benign?

Back 14

Oncocytoma, angiolipomyoma (Clear cell and papillary adenomas can be too)

Front 15

Characteristic LM for oncocytoma

Back 15

Granular. Round central bland nuclei. Nests & trebeculae

Front 16

What 4 renal tumors can be malignant

Back 16

Clear, Papillary, Chromophobe, Collecting duct

Front 17

4 risk factors for urothelial carcinoma

Back 17

1. Industrial chemicals/carcinogens 2. Smoking 3. Schistosoma infection 4. Drugs

Front 18

Good prognosis genetic abnormalities in urothelial carcinoma

Back 18

TCC -9p

Front 19

Bad prognosis genetic abnormalities in urothelial carcinoma

Back 19

TCC -17p, TCC -13q, -14q (Carcinoma in Situ)

Front 20

175

Back 20

175

Front 21

What defines superficial versus invasive urothelial carcinoma?

Back 21

Whether it invades the tunica muscularis propria or not. (if it does, T2 or greater.)

Front 22

BCG Therapy

Back 22

Affected area is treated with bovine tuberculosis virus.

Front 23

Indications for renal biopsy

Back 23

1. Rule out lymphoma 2. Rule out foreign metastasis 3. Establish tissue diagnosis for non-surgical treat. 4. Rule out cancer in post inflammatory pseudotumro

Front 24

Which renal tumor can be treated immunologically?

Back 24

Clear cell RCC

Front 25

176

Back 25

176

Front 26

Explain eureter blood supply

Back 26

Above iliac it's from the mdial side, bleow iliac its from the lateral side

Front 27

Difference b/t obstructive uropathy and obstructive nephropathy

Back 27

Nephropathy implies damage to renal perenchyma

Front 28

Hydronephrosis

Back 28

Describes the radioligic findings associated with renal obstruction

Front 29

Gross changes in obstruction

Back 29

Hydronephrosis possible, compression of papillae/calyceal blunting, thinning of perenchyma

Front 30

3 phases of acute obstruction:

Back 30

1. Increased BF and ureter pressure. 2. Decreased BF and increased ureter. 3. Decreased both

Front 31

How long until an obstruction does permananet damage

Back 31

2 weeks ("so you can follow up to 1 week")

Front 32

What is diagnostic for a stone in Diuretic Renography

Back 32

t1/2 > 20 (t1/2 = 10-20 is inconclusive)

Front 33

What is diagnostic for a stone in a whitaker test?

Back 33

> 22 cmH20

Front 34

How much is too much w/ postobstructive diuresis

Back 34

> 200 ml/hr for more than two hours requires treatment (D5 saline)

Front 35

Which type of stone is radiolucent

Back 35

uric acid

Front 36

Which stones are the most common?

Back 36

Calcium oxalate +/- calcium phosphate

Front 37

Citrate & kidney stones?

Back 37

Citrate inhibits stone formation (as does alkaline urine)

Front 38

Which diuretics prevents calcium stone formation?

Back 38

Thiazide

Front 39

Name 4 urease producing bacteria

Back 39

Proteus, Klebsiella, Pseudomonas, Staph

Front 40

What amino acids are responsible in cystinuria

Back 40

Cystine, Ornathine, Lysine, Arginine.

Front 41

Thiola

Back 41

Treatment for hypercystinuria --> prevents deposition.

Front 42

177

Back 42

177

Front 43

Secretory status and recurr UTI

Back 43

Recessive (a-b-) and nonsecreter (a+b-) are more disposed to recurrent UTI (Referes to secretion of Ab's)

Front 44

Four factors that promote UTI

Back 44

SEAS - Sex, Estrogen dep, Antimicrobials, Spermicide

Front 45

Common pathogens in outpatient

Back 45

E COLI, Staph, Proteus/Klebs/Enterococci

Front 46

Common pathoegens in inpatient

Back 46

E coli, Proteus/Klebs/Entercocci, Pseudomonas/Serratia/Achinetobacter

Front 47

Where can you find quiescent bacteria in the bladder?

Back 47

In the intermediate cells (below the umbrella cells)

Front 48

What counts as a 'Complicated' urinary tract infect.

Back 48

Immunocomp, Diabetic, Pregnant, Catheterized, Resistant bacteria.

Front 49

First and second line UTI treatment

Back 49

1: TMP 2. Usually Fluorquinolone or Fosfomycin (or nitrofurantoin)

Front 50

178

Back 50

178

Front 51

Where is most BPH

Back 51

periurethral region

Front 52

Where is most Prostatic Cancer

Back 52

Peripheral zone

Front 53

Condyloma Acuminatum

Back 53

Epithelial proliveration from HPV (venereal warts)

Front 54

Which HPV strains cause condyloma acuminatum

Back 54

HPV-6, 11, and sometime 16

Front 55

What are the three zones of the prostate, and how are thye correlated w/ cancer/BPH

Back 55

Central, Transition(BPH) and peripheral (Cancer or inflam)

Front 56

Which type of cell most commonly develops prostatic adenocarcinoma?

Back 56

Acinar type cells (And rarely - large duct, trans cell, small cell, mucinous)

Front 57

PIN

Back 57

Basically carcinoma in situ of the prostate. Hasn't broken the BM.

Front 58

Which HPV strains cause squamous cell carcinoma?

Back 58

HPV 16, 18

Front 59

Where in the prostate does cancer usually develop?

Back 59

Posteriorly

Front 60

Name 3 penile in situ lesions

Back 60

1. Erythroplasia of Queyrat(glans, 50-70) 2. Bowen's (shaft 40-60) 3. Bowenoid (shaft 30-50)

Front 61

Which penile lesion is associated w/ malignancy

Back 61

Bowen's

Front 62

Koilocyte

Back 62

Cell with shrunken hyperchromatic nucleus, esp in condylomas

Front 63

179

Back 63

179

Front 64

Indications (4) for intervention in BPH

Back 64

recurrent UTI, pers or rec hematuria, stones, obstructive uropathy

Front 65

2 most common therapies for BPH

Back 65

alpha blockers and 5 alpha reductase inhibitors

Front 66

When should you use alpha blockers vs 5-a reductase inhibitors?

Back 66

Alpha blockers for small prostate, 5 a red. Inhibt for large prostate (because efficacy of 5-a's is correlated w/ size)

Front 67

Presentation for any prostatic inflammation

Back 67

"HI FUN" - Hesitancy, incontinence/intermittency/incomplete, frequency, urgency, nocturia

Front 68

How are bone scans relevant to prostatic cancer

Back 68

Rapid bone turnover is indicative of prostatic metastases

Front 69

Which a-adrenergic receptors are found in the prostate, bladder, respectively

Back 69

alpha 1a in prostate, alpha 1d in bladder.

Front 70

Which two a-blockers principally block a1a's

Back 70

Tamsulosin, Alfuzosin

Front 71

finasteride

Back 71

5-a reductase inhibitor.

Front 72

How does TUNA work

Back 72

Heat ablation using a needles

Front 73

How does TUMT work?

Back 73

Microwave ablation

Front 74

180

Back 74

180

Front 75

LDH as a testicular tumor marker

Back 75

Nonspecific. Indicates tumor burden

Front 76

AFP as a testicular tumor marker

Back 76

Indicates yolk sac tumor

Front 77

HCG as a testicular tumor marker

Back 77

Chorocarcinoma or syncytiotrophoblastic tumor.

Front 78

Treatment of seminoma

Back 78

Small - Radiation - even after successful removal (10-15% have micro metastases). Large - PEB chemo.

Front 79

Treatemnet of Non-sominoma

Back 79

Chemo

Front 80

Whats the common genetic abnormality in testicular germ cell tumors

Back 80

i12 (cdkA)

Front 81

What are the 4 types of nonseminoma?

Back 81

Embryonal carcinoma, yolk sac tumor, teratoma, and choriocarcinoma

Front 82

Which type on sonseminomatous GCT is the worst?

Back 82

Embryonal carcinoma

Front 83

What are the two types of nongerm cell tumors in the testes?

Back 83

Sertoli and Leydig.

Front 84

Rheinke crystals

Back 84

Indicative of leydig cell carcinoma

Front 85

181

Back 85

181

Front 86

Which types of cysts transilluminate?

Back 86

Epididymal, spermatocele (Varicocele do not)

Front 87

Which type of hernia can present as a scrotal mass?

Back 87

Indirect

Front 88

4 predisposing factors for testicular torsion

Back 88

Mobile, anomalous suspension, abnormal anatomy, undescended testes.

Front 89

How do you test for torsion

Back 89

Doppler ultrasound

Front 90

Microlithiasis

Back 90

Visible on ultrasound. If infertile also, increases cancer risk

Front 91

2 reasons testicular cancer surgery is done via inguinal region

Back 91

1. Have to get whole spermatic cord. 2. Not to open up 2 sets of lymphatics.

Front 92

Where are the normal sites of testicular cancer lymphatic involvement?

Back 92

Landing zone - between renal and iliac arteries

Front 93

Which type of HPV is common in penile cancer

Back 93

HPV16

Front 94

What is required in evaluation of penile cancer

Back 94

Bilateral inguinal node dissection.