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60 Cards in this Set
- Front
- Back
Does tamsulosin increase risk of cataract surgery?
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Yes, 2.33 OR of adverse event within 14 days of cataract surgery.
Coffman et al. Ontario Health Insurance Plan database of 96,128 men undergoing cataract surgery (JAMA 2009). Theorized due to unopposed parasympathetic action in iris |
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most common parasite seen in urine in US
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trichomonas
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what virus:
enlarged nucleus with single, irregular blue-ish "bird eye's" inclusion |
CMV
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what virus:
multinucleated cells with "ground glass" nuclei and large eosinophilic intranuclear inclusions surrounded by halo |
HSV
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what cancer is long term phenacetin and acetaminophen exposure associated with?
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kidney cancer
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What GU cancer associated with "hypochromic anemia"?
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Kidney cancer from BM invasion
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What is Stauffer's syndrome?
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Hepatic dysfunction (elevated AP, ALT/AST, coagulopathy) from RCC
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What is associated with VHL syndrome?
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3p25
CNS/retinal heminagioblastoma Epididymal cystadenomas Pheochromocytomas Pancreatic cysts RCC (30-50% pts) |
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What is associated with tuberous sclerosis?
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hamartomas of brain, retina, skin, kidney, heart, bone and lung
Renal cysts AML RCC |
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On path slide, how can you differentiate clear cell RCC from XGP kidney?
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XGP- foam cells
RCC- look for "chicken wire" pattern |
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What are signs of Malakoplakia?
(path stuff) |
Michaelis-Gutmann bodies (spherical blue things in cytoplasm)
Van Hansemann cells (large eosinophilic histiocytes) |
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What are genetics of clear cell RCC?
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Loss 3p
Gain 5q c-myc (3p and 5q not seen in Papillary/Chromophil or chromophobe) |
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What are genetics of papillary (chromophil) RCC?
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trisomy of 7 and 17, loss Y chromosome
(NO loss of 3p or gain 5q) |
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What is importance of Hale's Colloidal Iron Stain
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Distinct for chromophobe (STAIN POSITIVE)
Allows differentiation from CLEAR and ONCOCYTOMA which are NEGATIVE |
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What kidney cancer stains
vimentin positive and is described with "hobnail" appearance? |
Collecting Duct Carcinoma (Belli's duct carcinoma)
-bad prognosis (UTUCC is vimentin negative) |
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What do you look at to determine the Fuhrman grading system?
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Nuclear size, shape, chromatin and nucleoli.
Mitotic figures are NOT part of system G1->86% 5 year CSS, G4->24% |
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Can you see areas of hemorrhage/necrosis with oncytoma?
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You shouldn't. This almost always mitigates dx of oncytoma
NO mitotic figures, papillary architecture, no clear cells or iron staining (later is chromophobe), no vascular invasion, no fat invasion |
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What RCC has mean survival of 15 weeks after resection?
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Medullary Carcinoma
-may be variant of collecting duct ca. -Seen in young pts with sickle cell -ill-define mass in medulla w/hemorrhage + necrosis |
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What renal tumor is HMB positive?
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This is typically melanoma marker:
-angiomyolipoma (AML) Intervene when > 4cm |
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what's most common enzyme defect with CAH?
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90% - 21-hydroxylase deficiency (virilization + salt wasting)
5% 11-beta hydroxylase (virilization + HTN from increase cortisol products) |
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What are pathologic features of adrenocortical carcinoma?
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-Giant cells with bizarre nuclei
-Nuclear grade III or IV -mitosis > 5/50HPF -Diffuse architecture -Necrosis -capsular/vascular invasion BUT NOTHING short of metastases can 100% differentiate benign from malignant |
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What pathologic characteristics are important with neuroblastoma?
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-Shimada FAVORABLE or UNFAVORABLE
-N-myc amplification (bad) -loss of chr 1p (bad) -extra 17q (bad) |
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Where is a pheo located if it's secreting high norepinephrine?
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Extra-adrenal
-methylation of NOR->Epi requires high glucocorticoid environment of adrenal cortex |
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What is Waterhouse-Friedrichsen syndrome?
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acute bilateral adrenal hemorrhage in infants, usually from memingococcal or pseudomonal septicemia (from DIC)
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What are two theories for the cause of renal dysplasia?
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-urinary obstruction in utero
-Inability of the ureteric bud to induce tissue; or failure of metanephric blastema to respond |
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Large red moist patch on glans of uncirc'd patient.
Bx->plasma cells. what is this? |
Zoon's Balanitis.
Benign. Need bx to rule out SCC |
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STD
gram negative "biscuit shaped" diplococci |
Neisseria gonorrhea
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what are the names for penile CIS?
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Erythroplasia of Queyrat->on glans
Bowen's disease-> on shaft |
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what cancer did chimney sweets get
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Pott's cancer
scrotal squamous cell carcinoma from 3,4'-benzpyrene |
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Most common cause of emphysematous cystitis
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E. coli or aerobacter aerogenes
female diabetics |
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What is cyclophosphamide use associated with?
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bladder cancer
-accumulation of metabolite acrolein -10.7% increased risk at 12 years |
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What is most common genetic abnormality in bladder cancer
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-Loss of chromosome 9q (in up to 50% cases)
-Also trisomy 7 and loss of Y |
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what is prognosis of TCC CIS?
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up to 1/3 already have microinvasive disease at time of dx
32-83% will progressive to invasive disease |
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who gets bladder SCC?
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-schitosomiasis (middle east)
-chronic irritation (SCI with foleys/stones) -bladder diverticula |
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which cells in the prostate stain positive for PSA?
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the columnar secretary epithelial cells.
also PAP+ Basal cells: PSA(-) |
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What should you look for to dx HGPIN?
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intact basal cells,
+nucleoli -basophilic glands due to increase N:C -glands intact |
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Where in prostate is cancer most commonly located?
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80% peripheral
20% TZ |
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Syndromes associated with UDT's
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prune belly
Klinefelt's Noonan's Kallman's Prader-Willi Trisomy 13,18, 21 |
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GU anomalies associated with UDT
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(10%)
hypospadias Duplication GU tract Kidney malrotation Valves Sperm excretory duct anomalies (ie poor fusion of epi to testis) |
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What clinical findings are associated with Klinefelters?
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47XXY karotype (80%)
Eunuchoid phenotype (long extremities) Incomplete virilization Gynecomastia Mental retardation Small, hyalinized testes Increased extragonadal germ cell tumors |
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Hypogonadism
Obesity Hypotonia Mental + Physical Retardation Chr 15p11-12 |
Prader-Willi
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Genetic syndrome associated with psychopathic personalities
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47 XYY syndrome
-tall 3% men in mental institutions + prison Nl ext genitalia but decreased fertility Mixed tubular atrophy on bx NL T and LH levels |
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Peak age incidence of testicular cancer
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30
(except spermatocytic seminoma which is in older men ~50) |
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What is risk of contralateral primary testicular cancer?
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2-5% in other testes
(esp. if bx proven IGCNU) 50% within 3-5 years of 1st tumor |
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Is family hx important in testicular cancer?
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Yes. 5.5x incidence if first degree relative
Also greater incidence b/l tumors (8-14%) |
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Does prior vasectomy increase risk of testicular cancer?
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NO.
Neither does EtOH or XRT |
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What percentage of pt with androgen insensitivity syndrome develop testes cancer?
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5-10%
Perform prophylactic orchiectomy |
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Why do men with seminoma sometimes have gynecomastia?
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HCG stimulating T secretion
(10-20% stage I pt with elevated HCG) HCG > 40/L poor px indicator |
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What type of seminoma do you see three different cell sizes?
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Spermatocytic
Peak age 52-58 whites > AA AFP, HCG, LDH negative |
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what tumor markers elevated with embryonal ca.?
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HCG in 60%
(AFP signifies non-pure; embryonal may transform into yolk sac) +LDH + PLAP elevated |
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What is rate of relapse after orchiectomy for stage I pure embryonal testicular ca?
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40% relapse
Most can be salvaged with chemoRx |
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Most common testicular tumor of prepubertal children
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yolk sac
average age = 18 months |
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What testicular tumor has Schiller Duval bodies?
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Yolk Sac
(also known as glomeruloid bodies) H&E: Yolk has honeycomb or vacuolated appearance |
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Do most children with yolk sac testicular tumor need RPLND?
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No. 80% are stage I and can be followed with surveillance.
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What is second most common testicular germ cell tumor in prepubertal children?
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Teratoma (14-18% cases)
Mean age = 20 months > 4 years is unusual |
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How do pts with pure choriocarcinoma present?
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Present with symptoms of metastatic dz (to lung, brain, and GI tract)
Pt 2nd to 3rd decades Rare, 0.3% of testicular tumors |
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What secondary hormone manifestations can pt with choriocarcinoma present with?
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High HCG->cross react with TSH and LH
-Can have gynecomastia or thyrotoxicosis |
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What markers do choriocarcinoma stain for?
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100% stain for HCG
-50% can have aFP |
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What testicular tumor has Reinke Crystals?
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Leydig Cell
(Assoc. with Klinefelter's and UDT) 3% bilateral |
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What paraneoplastic syndrome can Sertoli cells tumors be associated with?
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Gynecomastia
30% cases 10% malignant->orch + chemo/XRT |