System Pathology II - Exam 3 (Part 2)

What is idiopathic increase in the overall size of the transitional zone of the prostate, with 10% being symptomatic and onset occurring >40 years?

Benign Prostatic Hyperplasia (BPH)

In benign prostatic hyperplasia (BPH), there is an age related increase in ___________ which promotes expression of receptors for residual DHT and encourages ____________ growth, even as ________ decreases.

Estrogens

Prostatic growth

Testosterone

What percent of males over the age of 70 have Benign Prostatic Hyperplasia (BPH)?

90%

What consequence of benign prostatic hyperplasia (BPH) is difficulty starting/maintaining urine stream, with increased frequency/urgency and nocturia?

Urethral obstruction (lower UT)

What diagnostic technique is when the doctor inserts a finger into the rectum to check the prostate for enlargement?

Digital rectal exam

What diagnostic technique is looking at a substance produced in the prostate (PSA) which increase when you have an enlarged prostate, however elevated levels can also be due to recent procedures infection, surgery, or prostate cancer?

Prostate-specific antigen (PSA) blood test

What 4 things does treatment of the prostate depend on?

1) size of prostate

2) age

3) overall health

4) amount of discomfort experiencing

T/F: The size of the prostate usually determines the severity of the symptoms

FALSE

-- does NOT necessarily determine severity of symptoms; some men w/ only slightly enlarged prostates can have significant symptoms, while other men w/ very enlarged prostates can have only minor urinary symptoms

What is the MC treatment for mild to moderate symptoms of prostate enlargement? What are 4 examples of this?

Medication

1) Alpha blockers (relax bladder neck muscles and muscle fibers in prostate, making urination easier)

2) 5-alpha reductase inhibitors (preventing hormonal changes that cause prostate growth)

3) Combination drug therapy

4) Tadalafil (Cialis)

Transurethral Resection of the Prostate (TURP) is used for what 2 conditions?

1) Incontinence

2) Erectile Dysfunction

T/F: When distinguishing chronic pelvic pain from BPH, one analysis found that most men with chronic pelvic pain syndrome see a doctor because of urinary or pelvic pain, while men with BPH seek medical attentions because of urinary problems, but not pain.

TRUE

Other than skin cancer, what is the most common cancer in American men, with about 1 in 8 men being diagnosed, and the second leading cause of cancer death in American men (only behind lung cancer)?

Carcinoma of the Prostate

What is the average age of diagnosis for carcinoma of the prostate?

66

(most in >65)

What is the cancer that forms in the glandular tissue of the prostate, a firm mass with ill-defined borders and may be palpated when large?

Adenocarcinomas

What are some risk factors of Carcinoma of the prostate?

>50 YO (MC 65-75)

increased androgens, mutations

family history (BRCA1/BRCA2)

obesity

race (African Americans; usually more aggressive too)

Prostate cancer in early stages may cause no signs/symptoms, but as it advances, what symptoms can it cause?

Trouble urination

Decreased urine stream force

Blood in urine

Blood in semen

Bone Pain

Losing weight w/o trying

Erectile dysfunction

Where do 80% (most) carcinomas of the prostate occur because of increased PSA?

Peripheral zone

What type of metastisis can occur with carcinoma of the prostate?

Osteoblastic metastisis (SPINE)

-- lab tests can indicate osteoblastic lesions; imaging bone scan can be done

What is a protein produced by both cancerous (malignant) and noncancerous (benign) prostate tissue, with a small amount entering the blood stream, and cancerous cells usually make more than benign cells do, causing levels in the blood to rise and a source of screening?

PSA (prostate-specific antigen)

T/F: Men ages >55 are recommended to be informed about the potential benefits/harms of PSA=based screening for prostate cancer.

FALSE

55-69 should make decision based on pros/cons (C recomm)

>70 recommended AGAINST PSA-based screening (D recomm)

What assessment is used for men >55 years of age with no past prostate cancer diagnosis and DRE & PSA results within the past year?

Online Risk Assessment for Prostate Cancer

What is the MC site of bone metastisis? What 4 malignancies metastisize to bone?

Spine

Bacon, Lettuce, Tomato, Kosher Pickle = Breast CA, Lung CA, Thyroid CA, Kidney & Prostate CA

What are 5 possible treatments for prostate cancer?

1) Watchful waiting

2) Prostatectomy

3) Radiation therapy

4) Anti-androgen therapy

5) Orhciectomy; removal of 1 or both testicles

What is regular or repeated inability to obtain or maintain an erection firm enough for sex, and can be caused by anxiety, stress, mental health disorder, smoking (arterial narrowing), hypertension, diabetes mellitus, obesity, trauma from prostatectomy surgery, hormone insufficiency (hypogonadism), or aging (4x higher risk in men over 40)

Erectile Dysfunction

How is erectile dysfunction treated?

1) Medication (viagra, adcirca cilis, levitra, staxyn, stendra)

2) Injections/urethral suppository

3) Hormone replacement (testosterone)

4) Vacuum erection device or Penile prosthesis

5) Reconstructive surgery

6) Exercise

Medications for erectile dysfunction help enhance the effects of nitric oxide, leading to what?

Vasodilation

What is dilation of the renal pelvis/calyces d/t obstruction that can block urination (dilation) and atrophy decreasing function?

Hydronephrosis (Swollen Kidney)

What type of Hydronephrosis (swollen kidney) is atresia or ureter of the urethra seen in male infants? Which type is often from a stone, BPH, or prostate cancer?

Congenital

Acquired

T/F: When hydronephrosis (swollen kidney) is bilateral (distal to ureter, it may be clinically silent, but when it is unilateral there may be polyuria (incomplete/partial) or anuria (complete)

FALSE

Unilateral = silent

Bilateral = polyuria or anuria

What can untreated hydronephrosis lead to?

Progressive renal atrophy

What is a concretion formed in any part of the body, most commonly in the passages of the biliary and urinary tracts; usually composed of salts of inorganic or organic acids or of other material such as cholesterol?

Calculus

What is 2-3mm, MC (80%) made of calcium oxalate in the renal pelvis/calyces with pain the renal colic that is intermittent and severe, and often pass within 4 weeks or lithotripsy?

Renal Calculus (Kidney stones, nephrolithiasis, urolithiasis)

With pain from Renal Calculus (Kidney stones, nephrolithiasis, urolithiasis), its present int he renal colic when presents where?

Flank pain --> Groin

Who is more at risk for Renal Calculus (Kidney stones, nephrolithiasis, urolithiasis)? What are some other risks? (5)

Males (3x)

Also family history, dehydration, UTIs, decreased vitamin A, gout

What is upper urinary tract stones in the cast of the renal pelvis made up of magnesium ammonium phosphate?

Staghorn Calculus

What are Staghorn Calculi linked to?

Recurrent UTIs with urease-producing bacteria

(urease = hydrolyzes urea into ammonium carbonate)

What are the 3 urease-producing bacteria?

1) Klebsiella

2) Pseudomonas

3) Enterobacter

T/F: Renal Colic is usually unilateral

TRUE

A deficiency in Vitamin A can lead to what two conditions?

1) Kidney Stones

2) Bitot Spots

If you overdose or have a toxic level of Vitamin A, what symptoms can you experience? (5)

1) Vomiting/weight loss

2) Arthritis

3) Headache

4) Dizziness/stupor

5) Diplopia

Calcium Kidney stones occur in ___% of cases, Struvite Stone in ___%, Uric Acid Stone in ___% cases, and Cystine stones in ___%

Calcium = 80%

(risk factors of calcium or vit D, dietary supplement, foods, very high in xoalates, avacados, dates, grapefruit, kiwi, oranges, rasberries, spinach, tomato sauce)

Struvite = 10%

(urinary tract infection, proteus mirabilis, klebsiella pneumonia, enterobacter, psudomonas aeruginosa)

Uric Acid = 9%

(diarrhea and gout)

Cystine = 1%

(rare disorder called cystinuria)

Struvite (magnesium ammonium phosphate) stones are often referred to as ____________ because they are strongly associated with ______________________ with urea-splitting organsisms

Infection stones

UTI's

If left untreated Struvite (magnesium ammonium phosphate) stones can lead to deterioration of ______ function and end-stage _________ disease. There can also be a risk of developing ______ if they remain infected.

Kidney function & Kidney disease

Developing Sepsis

What is evagination of the bladder wall, MC acquired (urethral obstruction (BPH)) and MC small & asymptomatic with a risk of infection?

Diverticulum (Urinary Bladder)

What is inflammation of the urinary bladder due to bacterial infection (E. coli), chemo/radiation, trauma, poor hygiene, diabetes mellitus, age, compromised immune system, or lack of urination, and can lead to suprapubic pain, dysuria/frequency, hematuria, or painful sex?

Cystitis

What are 4 risks for cystitis?

1) Sexual intercourse

2) Female

3) Elderly and/or Impaired bladder emptying (BPH)

4) Diabetes

What is a fairly common form of cancer (7%) in men, being the 4th MC cancer in men, 3% of all cancer-related death, with risk factors of 5-80 yo males, bladder infection, smoking, industrialized/urban environments, occupational carcinogens?

Bladder Cancer

T/F: Bladder cancer is often familial with TP53 or RB mutations

FALSE

NOT familial; its an ACQUIRED TP53/RB mutation

What type of bladder cancer makes up 90% of bladder cancers?

Urothelial Carcinoma (transitional cell carcinoma)

What type of bladder cancer makes up 1-2%, nearly all invasive?

Squamous Cell Carcinoma

What type of bladder cancer makes up 1% with nearly all invasive?

Adenocarcinoma

What type of bladder cancer makes up <1% and is quick growing, responding to chemo?

Small cell carcinoma

What type of bladder cancer starts in the muscle of the bladder and is very rare?

Sarcoma

What general category of bladder cancer are only in the inner layers of the cells (the transitional epithelium) and have not grown into the deeper layers?

Non-invasive cancers

What general category of bladder cancer have grown into deeper layers of the bladder wall and these cancers are more likely to spread and harder to treat?

Invasive cancer

NOTE: bladder cancer can also be described as superficial or non-muscle invasive

What subtype of bladder cancer, based on how they grow, grows in slender, finger-like projections from the inner surface of the bladder towards the hollow center, often growing toward the center of the bladder without growing into the deeper bladder layers?

Papillary Carcinomas

T/F: Papillary Carcinomas are called non-invasive papillary cancers since they're very low-grade (slow growing)

TRUE

also called papillary urothelial neoplasm of low-malignant potential (PUNLMP)

If a papillary tumor grows into deeper layers of the bladder, its called what?

Invasive urothelial (or transitional cell) carcinoma

What subtype of bladder cancer, based on how it grows, do not grow toward the hollow part of the bladder at all, and is only in the inner layer of bladder cells?

Flat carcinomas (non-invasive flat carcinoma or flat carcinoma in situ CIS)

If a flat tumor grows into deeper layers of the bladder, its called what?

Invasive urothelial (or transitional cells) carcinoma

What are 3 signs of bladder cancer?

1) Painless hematuria

2) Changes in bladder habits

3) High recurrence

How is bladder cancer diagnosed? Treated?

Cystoscopy

Chemo/radiation, cystectomy

Smoking cessation with bladder cancer can decrease the risk of ____________ and _______________

progression and recurrence

What are the 7 MC sexually transmitted diseases (venereal diseases, VD, STI)

1) HPV

2) Chlamydia

3) Trichomoniasis

4) Gonorrhea

5) Genital herpes

6) Syphilis

7) HIV

What is the MC STD in the US with more than 100+ types/strains, can be penile, vulvar, cervical, anal, or in the throat and will arise 2-12 days after exposure to the virus (years), with most cases being transient (months; normal immune system)?

HPV (Human Papillomavirus)

What 2 strains of HPV cause condyloma acuminatum (giant cauliflower like genital warts)?

HPV 6 & 11

- no malignant potential

What 2 strains of HPV are persistent with squamous cell proliferations, pre-neoplastic lesions, and associated with cervical and oropharyngeal cancer?

HPV 16 & 18

What is the MC bacterial STD in the US and the most reportable?

Chlamydia

Are males or females symptomatic with Chlamydia with painful urination or pus discharge?

females typically being asymptomatic

males typically symptomatic

How is Chlamydia diagnosed? Treated?

Genital swab or urine sample

(NAAT = nucleic acid amplification test)

Antibiotics

Chlamydia is an obligate intracellular parasite, therefore what does this mean?

it may not be detected even in purulent urethral or cervical discharge

If chlamydia is left untreated, what can it lead to in females? Males?

Females = PID

Males = Epididymitis

Chlamydia may stimulate what condition 1-6 weeks after a GI or GUI infection, affecting the joints, urinary tract, and eyes, if they are already susceptible and positive for HLA-B27?

("can't see, can't pee, can't climb a tree (or can't dance w/ me)")

Reactive arthritis (Reiter's syndrome)

What is a protozoa STD that usually does not spread to the mouth, anus, or other body parts and arises 5-28 days after exposure?

Trichomoniasis

- Trichomonas Vaginalis (Trich)

Are males or females more affected (symptomatically) by Trichomoniasis, with itching/burning during urination, yellow/green frothy/purulent/malodorous discharge

Females more likely to be symptomatic

Males typically asymptomatic (can have urethritis, prostatis, balanitis)

What STD is transmitted via mucosal contact (urethra, mouth, throat, eyes, anus) and arises 1-14 days after exposure, and is also known as the "clap"?

Gonorrhea (Neisseria gonorrhoeae; Ab-resistant strains)

Are males or females symptomatic with Gonorrhea, with extremely painful urination, and yellow/green purulent discharge?

Males symptomatic (urethral discharge)

Females often asymptomatic (but can have lower pelvic pain, vaginal discharge, PID (severe pain/sterility)

Gonorrhea is _____________ in 3% of cases, leading to arthritis, tenosynovitis, skin lesions (rash of pustules and paules), endocarditis & meningitis?

Disseminated (spread widely/systemically)

How is gonorrhea treated?

Antibiotics

-- prevent sterility (salpingitis/orchitis)

Gonorrhea can lead to possible transcervical infection, which leads to what blindness condition that arises 5 days after birth? What other condition can it cause in the throat?

Neonatal conjunctivitis (ophthalmia neonatorum)

Pharyngitis

How is neonatal conjunctivitis (ophthalmia neonatorum) treated?

Silver nitrate or antibiotics in the newborn's eyes

What is the difference between Chlamydia and Gonorrhea systemic effects?

Chlamydia will increase risk of Reactive Arthritis (Reiter's syndrome)

-- eyes, urinary tract, joints (can't see, can't pee, can't climb a tree)

Gonorrhea's will disseminate (spread widely), leading to arthritis, tenosynovitis, skin lesions, endocarditis, and meningitis

What STD can be vaginal, anal, oral, or transplacental with mild symptoms or none, arising 2-12 days after exposure and flu-like symptoms arising and outbreaks of lesions that look like blisters which break open and are painful sores, and has no cure, but there is medication to help prevent/shorten outbreaks?

HSV (Herpes Simplex Virus type 1 or 2)

T/F: The fluid inside the sores contains the HSV virus, and the only way HSV can be spread is if those sores are present

FALSE

-- can spread even if no sore is present

Where is HSV kept latent?

Sacral ganglia

What is a key cytologic feature of HSV infection?

Multinucleiated giant cells w/ viaral inclusion

What are the 3 diagnostic tests that can be used to diagnose herpes (HSV)?

1) Tzank smear

2) Monoclonal antibodies

3) Rapid antigen detection

What STD is caused by Treponema pallidum, is a transplacental or mucosal contact (genitals, anal, oral, transplacental) with lymphatic or hematogenous spread, and is diagnosed via a blood test?

Syphilis

What shape represents a chronic infection of Syphilis?

Spirochete

What are the 3 stages of Syphilis and what are some characteristic features of each stage?

1. Primary: (painless Chancre; arise around 21 days after infection; resolves 4-6 weeks)

2. Secondary: (Palmar rash (75-100%), lymphadenopathy (50-85%), condyloma latum (10-20%))

3. Tertiary: (neurosyphilis, aortitis, gummas in any tissue)

Primary Syphilis will transition to Secondary Syphilis in <2 months in ____% of cases, and Secondary Syphilis over 5-20 years to Tertiary in ____%

25%

30%

Which stage of syphilis is least infectious?

Tertiary

T/F: The treatment for all stages of syphilis is Penicillin C

FALSE

-- only primary and secondary treated via penicillin C

What is transplacental spread of syphilis where the mom may have subtle features and is involved in standard screening?

Congenital Syphilis

When left untreated, congenital syphilis can lead to ___% lethality in utero due to with widespread bone/visceral destruction (stillbirth). What are the 2 other possible outcomes of congenital syphilis?

40% lethality

2) Infantile (cutaneous, visceral, skeletal; hepatomegaly, pancreatic fibrosis, pneumonitis, endarteritis)

3) Tardive (2 years after birth w/ facial, dental, skeletal/periosteal)

What are 4 distinctive features of congenital syphilis?

1) Saddle nose deformity

2) Periostitis (saber skin)

3) Hutchinson Teeth (spaced/notched)

4) Mulberry Molars

What STD is a viral attack on the immune system that can have flu-like symptoms around 2 weeks after exposure, be asymptomatic for years, but decreases the WBC leading to serious conditions (pneumonia or TB), can spread thorough bodily fluids (blood/semen/vaginal secretions), transplacental spread, breast feeding, or IV transmission?

HIV

HIV will be positive on an antibody test within 3 weeks to 3 months of exposure, but HIV+ does NOT indicate having what condition? How is HIV diagnosed? Is there a cure?

AIDS

ELISA/Western blot test to diagnose

No cure

What condition is caused by Haemophilus ducreyi (bacteria) arising 4-10 days after exposure and are acute genital ulcerations that are soft & PAINFUL, diagnosed via a swab, and commonly seen in Africa and SE Asia (prostitutes, HIV)

Chancroid

(ducreyi = dudes cry)

Are men or women often asymptomatic with Chancroid?

Females asymptomatic