Patho 2 Final exam

Phimosis

Refers to the inability to retract the prepuce over the glans, if not corrected it may be associated with secondary bacterial infection of glans or glansand prepuce

Cryptorchidism

Failure of the testes to descend into the scrotum (about 1% of 1 year old boys)
Due to a combination of genetic, hormonal, neural, and mechanical factors
It is bilateral in 75% of children's cases and unilateral in 80% of adults
Most common location is th

Balanitis

Inflammation of the glans

Posthitis

inflammation of the prepuce

Balanoposthitis

inflammation of both glans and prepuce

Hypospadias

urethral opening on the ventral surface of the penis, occurs in 1 in 125-4000 live male birth
May be associated with undescended testes (cryptorchidism), have increased risk for UTI's and infertility

Epispadias

urethral opening on the dorsal surface of the penis
may be associated with undescended testes (cryptorchidism), have increased risk for UTI's and infertility

Varicocele testis

dilated vein within the spermatic cord
occurs when the valves within the veins along the spermatic cord don't work properly, essentially the same process as varicose veins
May cause infertility

Hydrocele and hematocele testis

accumulation of clear fluid or blood within the tunica vaginalis
the accumulation can be a marker of physical trauma, infection, or tumor
May cause infertility

Testicular tortion

Twisting of the spermatic cord
Sudden, severe testicular pain
Painful hemorrhagic infarction which is a medical emergency
May be associated with physical activity or trauma

orchitis

inflammation of the testis
If often very painful condition of the testicles involving inflammation, swelling, and frequently infection
associated with mumps, HIV, and syphilis

Epididymitis

inflammation of the epididymis
Acute: this condition may be mildly to very painful, < 35 the cause is N. gonnorrhea or Chlamydia trachomatis, Age >35 the cause is E. coli or P. aeruginosa
Chronic: TB

Benign prostatic hyperplasia: def, epi, patho, presentation

Def: glandular and stromal hyperplasia resulting in prostate enlargement
Epidemilogy: extremely common, not premalignant, incidence increases with age (age 60: 70%, age 70: 80%)
Pathogenesis: age-related increases in estrogen lead to increased expression

BPH: diagnosis, complications, treatment

Dx: rectal examination, ultrasound examination, blood tests are performed to rule out prostatic malignancy, elevated prostate specific antigen levels suggest prostate cancer
complications: UTI's, hydronephrosis and renal failure (rare)
Treatment: TURP or

Prostate cancer: epidemiology, presentation, detection

epidemilogy: most common cancer in men in the US, second most common cause of cancer death in men, castrated men do not develop prostate cancer, age is the most important risk fact, diets low in Vit E, lycopene, omega-3 fatty acids, medications like NSAID

Prostate cancer: metastasis, treatment

Metastasis: through both lymphotic (first) and hemotogenous (later), commonly goes to the obturator and pelvic lymph nodes, osteoblastic bone metastasis to lumbar spine, serum alkaline phosphatase elevated with bone metastasis
Local treatment: prostatecto

Testicular cancer: epi, clinical pres, risk factors, dx, tx, prognosis

epi: life time chance is 1/250, aged 15-40 yoa
clinical pres: firm, painless testicular mass, non-seminomatous tumors may present with widespread metastasis
Risk factors: cryptorchidism (increases risk by 5-10 times), testicular dysgenesis (testicular fem

Germ-cell tumors

Often malignant, make up 95% of testicular cancer
seminoma, embryonal carcinoma, choricarcinoma, yolk sac tumor, teratoma, mixed-germ-cell tumors

Seminoma

Germ-cell tumor, most frequent type of cancer, MC germ cell tumor in adults aged 15-35, tumor marker is PLAP, excellent prognosis, cure rate is 95% when caught early

Embryonal carcinoma

germ-cell carcinoma
Ages 20-40, more aggressive than seminoma
tumor markers are unspecific, may have AFT and or beta hCG

Choriocarcinoma

Less than 1%
highly malignant with hematogenous spread to lungs and liver
Tumor marker beta hCG

Yolk sac tumor

most common germ cell tumor in children under 4 years old, tumor marker AFP

Teratoma

Majority are derived from two or more embryonic layers, contains multiple tissue types

Mixed germ-cell tumors

as many as 60% of ger-cell tumors are mixed and contain more than one component
teratocarcinoma: teratoma + embryonal carcinoma

Non-germ cell tumors of the testes

leydig cell tumors, sertoli cell tumors, testicular lymphoma

Leydig cell tumors

benign
when the produce androgens it leads to precocious puberty in boys
when they produce estrogen it leads to gynocomastia in men

Sertoli cell tumor

non-germ cell tumor
rare, derived from sex cord-stroma, no endocrine manifestations

Testicular lymphoma

most common testicular tumor in men over age 50
Non-hodgkin lymphoma, diffuse, large cell type

seminomatous vs non seminomatous

seminomatous: seminoma, radiosensitive, chemosensitive, late metastasis, excellent prognosis
Non-seminomatous: examples include embryonal, yolk sac, choricarcinoma, teratoma; not radiosenstive, chemosensitive, early metastases to retroperitoneal lymph nod

Male malformations

hypospadias, epispadias
both can cause increased risk of UTI and infertility

Male malformations: inflammation

balanitis, posthitis, balanoposthitis
caused by poor hygiene, and phimosis without circumcision

Vaginitis

Def: inflammation of the vaginal mucosa, one of the most common reasons women see their doctors
Risk factors: decreased acidity of the vajay (normally pH is 3.8-4.2 which is maintained by the normal flora lactobacili and keeps the lining of the vagina hea

Cervical carcinoma: epi and risk factors

epi: third most common malignant tumor of the femal genital tract in the US, peak incidence is 40 yoa
Risk factors: early age of first intercourse, multiple sex partners, multiple pregnancies, immunosuppression, oral contraceptive use, smoking, STD's
HPV

Cervical carcinoma: clinical pres, dx, tx, prognosis

clinical pres: asymptomatic, painful intercourse, post-coital vaginal bleeding, malodorous discharge
dx: PAP smear for early detection, colonoscopy with biopsy
Tx: usually treated by hysterectomy, radiation therapy, chemotherapy
Prognosis: 5 year survival

Endometriosis: def, causes, risk factors

Def: presence of endometrial glands and stroma in abnormal locations outside the uterus, most commonly affects women of reproductive age
Causes: unknown, but may include the following: endometriosis is an estrogen-dependent condition as it is seen primari

endometriosis: theories about lesions

regurgitation/implantation theory: retrograde menstruation through the Fallopian tubes occurs regularly even in normal women
Metaplastic theory: endometrium could arise directly from coelomic epithelium, from which the mullenian ducts and ultimately the e

Endometriosis: clinical pres, Dx, Tx

clinical presentation: chronic pelvic pain is the most common symptom, dysmenorrhea and painful intercourse, pain with defecation and urination due to adhesions, possible intestinal disturbances, infertility
Dx: certain symptoms or unexplained infertility

Leiomyoma

Def: a benign smooth muscle tumor of the myometrium that is not premalignant, fibroid, most common overall tumor of the female (25-35%), high incidence in AA, estrogen-sensitive tumor (increase in size during pregs or estrogen therapy and decreases in siz

Endometrial carcinoma: epi, risk factors

epi: most common malignant tumor of the female genital tract, most commonly affect postmenopausal women
Risk factors: unopposed estrogen stimulation (one of estrogen's normal functions is to stimulate the buildup of the endometrial lining of the uterus),

Endometrial carcinoma: patho, clinical, dx, tx, prognosis

patho: tan polypoid endometrial mass, invasion of myometrium, endometroid adenocarcinoma
clinical pres: postmenstraul vaginal bleeding, lower abdominal pain
dx: endometrial curettage is the diagnostic test of choice
tx: primary treatment is surgical, surg

Polycystic ovary disease: etiology, patho, clinical pres

also known as stein-leventhal syndrom
Etiology: unknown, may be associated with obesity
pathogensis: excess production of LH by the pituitary gland, LH leads to increased production of male hormones in the ovaries
Clinical presentation: young females of r

Polycycstic ovarian disease: patho, lab, dx, tx

patho: bilaterally enlarged ovaries with multiple cysts
Lab findings: increased LH, decreased FSH, and increased testosterone
Dx: often based on symptoms, pelvic ultrasound is a major diagnostic tool, blood test for LH and testosterone, 2 hour glucose tol

Pelvic inflammatory disease: def, organisms, presentation

Def: an ascending infection and inflammation of the female reproductive organs, ascending infection from the cervix to the endometrium, fallopian tubes, and pelvic cavity; In the US more than 1m women are affected by PID each year, leading cause of infert

PID: risk factors, dx, tx, complications

risk factors: sexually active and younger than 25, more than one sex partner, douching
dx: symptoms of PID, increased WBC count, pelvic exams, PAP smear, biopsy, radical surgery, and radiation, ultrasonography of the pelvis, laparoscope
treatment: antibio

Breast cancer: epi, risk factors

epi: most common cancer in females, second most common cause of cancer death, US > Japan, incidence is increasing, mortality is decreasing owing to screening mammography
risk factors: incidence increases with age, first degree relative with breast cancer,

BC: clinical pres, histologic variants

clinical: often no symptoms at first, painless breast mass is first sign, mammographic calcifications or architectural distortion, nipple retraction or skin dimpling, fixation to the chest wall, most common in upper outer quadrent
histologic variants: Inv

BC: dx, tx

diagnosis: mammography is effective screening, fine needle aspiration and biopsy for definitive diagnosis, tumor study of estrogen and progesterone receptors, node involvement
treatment for local disease: mastectomy or lumpectomy with radiation, axillary

BC: prognosis

rests of prognostic factors associated with breast cancer
axillary lymph node status, size of tumor, histological type and grade of tumor
Er/Pr receptor status
overexpression of c-erbB2
the overall 5 year survival is 60%

Ovarian tumors: general

tumors are more likely to be benign in women < 45 years old and malignant in women >45 years old, second most common malignant tumor of the female genital tract, highest mortality of all gynecologic tumors, no good screening test available, up to 75% of t

Ovarian tumors: risk factors, symptoms

risk factors: infertility, low parity, use of perineal talc, high fact diets, lactose intolerance, previous breast or colon cancer, family history of ovarian cancer
symptoms: asymptomatic in it's early stages, symptomatic in later stages, chronic pelvic p

Types of ovarian cancer

surface epithelial stroma tumors, sex cord-stroma tumors, gram cell tumors, tumors matestatic to the ovary

Ovarian tumor: surface epithelial stromal tumors

most common, 65-75%
serous cystadenocarcinoma (50% of ovarian cancer, bilaterally)
Mucinous cystadenocarcinoma (may form very large cycstic masses with recorded weights at 25kg)
clear cell carcinoma (very rare)

Sex-cord stromal tumors

5-10%
ovarian fibroma which is associated with Meig's syndrome (ovarian fibroma, ascites and right-sided pleural effeusion)
Granulosa cell tumor (assocated with estrogen-production): prepuberal leads to precocious puberty, reproductive age leads to irregu

Meig's syndrome

ovarian fibroma, ascites and right sided pleural effeusion
Found in ovarian fibroma which is a sex cord-stromal tumor

Ovarian cancer: germ cell tumor

tend to occur in young women and girls
dysgerminoma (homologous to testicular seminoma)
ovarian choriocarcinoma
teratoma (derived from >2 or 3 layers)

Tumors metastatic to the ovary

about 5% of cases
Krukenberg cancer is ovarian cancer originating from GI cancer
Burkitt's lymphoma

Ovarian cancer: dx, tx, prog

diagnosis: pelvic exam, CT scan, trans-vaginal ultrasound
tumor marker CA-125 is useful in the differential diagnosis and in follow up of the disease
Treatment: surgery, chemotherapy, radiation therapy
Prognosis: ovarian cancer has a poor prognosis, 5 yea

Gynecological cancers by decreasing incidence

endometrial > ovarian > cervial

Gynecological cancers by decreasing mortality

ovarian > cervical > endometrial

Gynecological cancers by age

cervical: 45
endometrial: 55
ovarian: 65

Glaucoma:def, epi, patho, risk factors

def: optic nerve damage often associated with increased intraocular pressure leading to progressive, irreversible visual field loss
epi: almost 3 million people in the US and 14 million people in the world have it, worldwide it is the second leading cause

glaucoma: dx, tx

dx: four parts of the eye exam include 1) eye pressure by tonometer (>20-22mmHg), 2) use an ophthalmoscope and a slit lamp to look for changes in the optic nerve, 3) visual field testing, 4) examine the drainage channels by gonioscopy to determine open an

Open angle glaucoma

Most common
Def: drainage canals in the eyes become clogged gradually over months or years, pressure in the eye rises slowly because fluid is produced at a normal rate but drains sluggishly
Symptoms: painless and causes no early symptoms, development of b

closed angle glaucoma

far less common than open angle glaucoma
Def: pressure in the eye rises rapidly because fluid drainage is abruptly blocked while production continues
Causes: eye injury, infection
Symptoms: abrupt onset of severe eye pain, n&v, headaches, blurred vision,

Cataracts: def, epi, types, symptoms

def: clouding of the lens of the eye that causes a progressive, painless loss of vision
Epi: leading cause of blindness in the world, 20% of people between 65-74
Two types: senile (most common in people >60), congenital (present at birth, often bilateral)

Cataracts: risk, treatment

risks: aging, diabetes, genetic influences, smoking and alcohol use, environmental (radiation) and metabolic influences, drugs (phenytoin, corticosteroids), injury/eye trauma
treatment: surgically remove cloudy lens

Otitis media

Def: bacterial or viral infection of the middle ear
susceptibility in children: children below the age of 7 are much more prone to infection because eustachian tube is shorter and at a more horizontal angle than in the adult ear, most common in children u

Meniere's diease

def: disorder caused by recurring attacks of disabling vertigo, hearing loss, and tinnitus
cause: exact cause is unknown, may be due to excess fluid in the inner ear
manifestations: periodic episodes of rotary vertigo (abdominal sensation of movement) or

pupillary light reflex

pupillary light reflex is the reduction of pupil size in response to light, useful for gauging brain stem function
Optic nerve (CNII) is responsible for the afferent limb of the pupillary reflex (senses incoming light)
Oculomotor nerve (CNIII) is responsi

Psoriasis

def: chronic disorder characterized by erythematous plaques secondary to an unregulated proliferation of keratinocytes
epi: affects 1% of the US population, most common form is psoiasis vulgaris, unknown etiology, clear genetic component, may be associate

Herpes zoster

def: reactivation of herpes virus which remains dormant in sensory dorsal root ganglia for decades after the primary infection
pathogensis: virus travels out nerve to skin and causes a new inflammation in patients whose immune system is being suppressed
c

Dermatitis

def: inflammation of the upper layers of the skin causing itching, blisters, reddress, swelling and often oozing, scabbing, and scaling, "eczema"
Atopic or contact

Atopic dermatitis

one of the most common skin diseases affecting 15 million people in the US
half of these people the disorder will be gone by teenage years, in others it is a lifelong problem
the cause is unknown, genetics (often runs in families whose members also have h

Contact dermatitis

allergic: type IV hypersensitivy reaction to some allergen such as poison ivy or nickle
irritant: non-immunologic reaction due to local toxin effect of a chemical on the skin such as soaps

squamous cell carcinoma

Incidence: a common skin tumor, peaks at 60 years of age
Risk factors: chronic sun exposure, fair complexion, chronic skin ulcers or sinus tracts, long term exposure to chemical carcinogens such as hydrocarbons, arsenic, radiation or burns, ummunosuppress

Basal cell carcinoma

epi: most common form of skin cancer, more common in fair skinned individuals, most common in middle-aged or elderly individuals
risk factors: chronic sun exposure, fair complexion, immunosuppression, xeroderma pigmentosum
Patho: ulceration, pink pearl, w

Malignant melanoma: def, location, incidence, risk factors, patho

def: cancer of the melanocytes, least common and most dangerous, often associated with excessive exposure to light
Locations: males is upper back, females is back and legs
incidence: increasing at a rapid rate, peaks in ages 40-70
risk factors: chronic su

Malignant melanoma varients

superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma, acral-lentiginous

superficial spreading melanoma

most common form of cutaneous melanoma in Caucasians, especially in 5th decade
occur on sun-exposed skin, especially on the backs of males and lower limbs of females

nodular melanoma

most aggresive form, worst prognosis
dome-shaped, blue black, lesions tend to bleed

Lentigo maligna

older age, around 9th decade, usually on the face or neck, slow growing, flat, can remain non-invasive for years

Acral-lentiginous melanoma

most common in asian and blacks
often seen on palms, soles, and under nails (non-hair bearing surfaces, not exposed to light

Malignant melanoma: treatment, prog, detection

treatment: surgical excision, systemic disease is treated with chemotherapy, may resolve spontaneously
Prognosis: is dependent on tumor thickness, depth related to skin structures, type of melanoma, presence of ulceration, presence of lymphatic invasion,