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94 Cards in this Set

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174
174
What are the three components of an angiomyolipoma
Blood vessels, smooth muscle and fat.
What are the important etiologies of renal cell carcinoma
Smoking, Loss of VHL suppressor gene, 3P mutation
von Hippel Lindau Disaese
Loss of VHL suppressor --> Clear cell carcinoma, cysts, and rare pheochromocytoma
Hereditary papillary renal cell carcinoma involves what?
Overexpression of C-Met oncogene.
Hereditary Leiomyomatosis/papillary renal cell carcinoma involves what?
Fumurate Hydratase gene. Gives papillary RCCs and leiomyomas
What is Birt Hogg Debe syndrome?
Defective BHD tumor suppressor - RCC (oncocytic mostly, sometimes clear or chromophobe), renal oncocytoma, hair follicle tumors and lung cysts
What is the triad of RCC presentation
Hematuria, Palpable mass, and Pain (Not actually usually present nowadays)
Sarcomatoid RCC automatically is what grade?
Grade 4 - the worst.
Common clinical pres of RCC
occult hematuria, anemia, increased hematocrit, increased serum Ca
Clear cell - cytogentics
"-3p"
papillary cytogenetics
"+7, +17, loss of sex chromosome"
Aggressive type cytogenetics
9p, 14q, multiple abn in RCC
Which two (4) tumors are benign?
Oncocytoma, angiolipomyoma (Clear cell and papillary adenomas can be too)
Characteristic LM for oncocytoma
Granular. Round central bland nuclei. Nests & trebeculae
What 4 renal tumors can be malignant
Clear, Papillary, Chromophobe, Collecting duct
4 risk factors for urothelial carcinoma
1. Industrial chemicals/carcinogens 2. Smoking 3. Schistosoma infection 4. Drugs
Good prognosis genetic abnormalities in urothelial carcinoma
TCC -9p
Bad prognosis genetic abnormalities in urothelial carcinoma
TCC -17p, TCC -13q, -14q (Carcinoma in Situ)
175
175
What defines superficial versus invasive urothelial carcinoma?
Whether it invades the tunica muscularis propria or not. (if it does, T2 or greater.)
BCG Therapy
Affected area is treated with bovine tuberculosis virus.
Indications for renal biopsy
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
Which renal tumor can be treated immunologically?
Clear cell RCC
176
176
Explain eureter blood supply
Above iliac it's from the mdial side, bleow iliac its from the lateral side
Difference b/t obstructive uropathy and obstructive nephropathy
Nephropathy implies damage to renal perenchyma
Hydronephrosis
Describes the radioligic findings associated with renal obstruction
Gross changes in obstruction
Hydronephrosis possible, compression of papillae/calyceal blunting, thinning of perenchyma
3 phases of acute obstruction:
1. Increased BF and ureter pressure. 2. Decreased BF and increased ureter. 3. Decreased both
How long until an obstruction does permananet damage
2 weeks ("so you can follow up to 1 week")
What is diagnostic for a stone in Diuretic Renography
t1/2 > 20 (t1/2 = 10-20 is inconclusive)
What is diagnostic for a stone in a whitaker test?
> 22 cmH20
How much is too much w/ postobstructive diuresis
> 200 ml/hr for more than two hours requires treatment (D5 saline)
Which type of stone is radiolucent
uric acid
Which stones are the most common?
Calcium oxalate +/- calcium phosphate
Citrate & kidney stones?
Citrate inhibits stone formation (as does alkaline urine)
Which diuretics prevents calcium stone formation?
Thiazide
Name 4 urease producing bacteria
Proteus, Klebsiella, Pseudomonas, Staph
What amino acids are responsible in cystinuria
Cystine, Ornathine, Lysine, Arginine.
Thiola
Treatment for hypercystinuria --> prevents deposition.
177
177
Secretory status and recurr UTI
Recessive (a-b-) and nonsecreter (a+b-) are more disposed to recurrent UTI (Referes to secretion of Ab's)
Four factors that promote UTI
SEAS - Sex, Estrogen dep, Antimicrobials, Spermicide
Common pathogens in outpatient
E COLI, Staph, Proteus/Klebs/Enterococci
Common pathoegens in inpatient
E coli, Proteus/Klebs/Entercocci, Pseudomonas/Serratia/Achinetobacter
Where can you find quiescent bacteria in the bladder?
In the intermediate cells (below the umbrella cells)
What counts as a 'Complicated' urinary tract infect.
Immunocomp, Diabetic, Pregnant, Catheterized, Resistant bacteria.
First and second line UTI treatment
1: TMP 2. Usually Fluorquinolone or Fosfomycin (or nitrofurantoin)
178
178
Where is most BPH
periurethral region
Where is most Prostatic Cancer
Peripheral zone
Condyloma Acuminatum
Epithelial proliveration from HPV (venereal warts)
Which HPV strains cause condyloma acuminatum
HPV-6, 11, and sometime 16
What are the three zones of the prostate, and how are thye correlated w/ cancer/BPH
Central, Transition(BPH) and peripheral (Cancer or inflam)
Which type of cell most commonly develops prostatic adenocarcinoma?
Acinar type cells (And rarely - large duct, trans cell, small cell, mucinous)
PIN
Basically carcinoma in situ of the prostate. Hasn't broken the BM.
Which HPV strains cause squamous cell carcinoma?
HPV 16, 18
Where in the prostate does cancer usually develop?
Posteriorly
Name 3 penile in situ lesions
1. Erythroplasia of Queyrat(glans, 50-70) 2. Bowen's (shaft 40-60) 3. Bowenoid (shaft 30-50)
Which penile lesion is associated w/ malignancy
Bowen's
Koilocyte
Cell with shrunken hyperchromatic nucleus, esp in condylomas
179
179
Indications (4) for intervention in BPH
recurrent UTI, pers or rec hematuria, stones, obstructive uropathy
2 most common therapies for BPH
alpha blockers and 5 alpha reductase inhibitors
When should you use alpha blockers vs 5-a reductase inhibitors?
Alpha blockers for small prostate, 5 a red. Inhibt for large prostate (because efficacy of 5-a's is correlated w/ size)
Presentation for any prostatic inflammation
"HI FUN" - Hesitancy, incontinence/intermittency/incomplete, frequency, urgency, nocturia
How are bone scans relevant to prostatic cancer
Rapid bone turnover is indicative of prostatic metastases
Which a-adrenergic receptors are found in the prostate, bladder, respectively
alpha 1a in prostate, alpha 1d in bladder.
Which two a-blockers principally block a1a's
Tamsulosin, Alfuzosin
finasteride
5-a reductase inhibitor.
How does TUNA work
Heat ablation using a needles
How does TUMT work?
Microwave ablation
180
180
LDH as a testicular tumor marker
Nonspecific. Indicates tumor burden
AFP as a testicular tumor marker
Indicates yolk sac tumor
HCG as a testicular tumor marker
Chorocarcinoma or syncytiotrophoblastic tumor.
Treatment of seminoma
Small - Radiation - even after successful removal (10-15% have micro metastases). Large - PEB chemo.
Treatemnet of Non-sominoma
Chemo
Whats the common genetic abnormality in testicular germ cell tumors
i12 (cdkA)
What are the 4 types of nonseminoma?
Embryonal carcinoma, yolk sac tumor, teratoma, and choriocarcinoma
Which type on sonseminomatous GCT is the worst?
Embryonal carcinoma
What are the two types of nongerm cell tumors in the testes?
Sertoli and Leydig.
Rheinke crystals
Indicative of leydig cell carcinoma
181
181
Which types of cysts transilluminate?
Epididymal, spermatocele (Varicocele do not)
Which type of hernia can present as a scrotal mass?
Indirect
4 predisposing factors for testicular torsion
Mobile, anomalous suspension, abnormal anatomy, undescended testes.
How do you test for torsion
Doppler ultrasound
Microlithiasis
Visible on ultrasound. If infertile also, increases cancer risk
2 reasons testicular cancer surgery is done via inguinal region
1. Have to get whole spermatic cord. 2. Not to open up 2 sets of lymphatics.
Where are the normal sites of testicular cancer lymphatic involvement?
Landing zone - between renal and iliac arteries
Which type of HPV is common in penile cancer
HPV16
What is required in evaluation of penile cancer
Bilateral inguinal node dissection.