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98 Cards in this Set
- Front
- Back
What are podocytes?
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visceral epithelial cells
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What are the spaces between the podocytes called?
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split pores
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Which cells synthesis the glomerular BM?
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visceral epithelial cells (podocytes)
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What keeps albumin out of urine?
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strong negative charge of Glomerular BM
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What is responsible for charge of GBM?
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Heparan Sulfate (strong negative charge)
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damage to visceral epithelial cell results in what?
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damage to BM and leaking of albumin into urine --> nephrotic syndrome
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linear pattern outlining BM on Immunofluorescence
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goodpasture syndrome
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subendothelial immune complex deposits in glomeruli on EM (granular)
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lupus
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subepithelial immune complex deposits in glomeruli EM (granular)
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post-strep glomerulonephritis
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only glomerulonephritis one can diagnose with IF
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IgA glomerulonephritis
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granular pattern on IF. what does it mean?
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immunocomplex type III disease
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anti BM antibodies is what type of immune complex disease?
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Type II
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RBC casts in urine is unique to what class of diseases
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nephritic syndromes
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serum ANA shows rim pattern. what does that mean?
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anti-DNA --> lupus
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crescentic glomerulonephritis is most commonly seen in what syndrome?
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goodpasture's syndrome
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cholesterol casts in urine that when polarized look like maltese crosses. what is the diagnosis?
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nephrotic syndrome
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why does lipoid nephrosis occur (Minimal change disease)?
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loss of negative charge of GBM
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Nephrotic syndrome associated with HIV
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FSGS
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glomerular problem in HBV
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diffuse membraneous glomerulonephritis
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glomerular problem in HCV
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Membranoproliferative glomerulonephritis
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vasculitis associated with HBV
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polyarteritis nodosa
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large golf-ball appearing glomeruli on H&E
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diabetic nephropathy
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what happens to the GFR and creatinine clearance in early diabetic nephropathy?
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hyalinization of efferent arterioles, so Cr clearance and GFR increase. Also nonenzymatic glycosylation of BM cause microalbuminuria
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ACE inhibitors do what to glomerular arterioles?
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less angiotensin II dilates efferent arteriole
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mesangial cells split BM on EM. C3 deposited adjacent to but not within dense deposits. serum C3 is very low. what is the diagnosis?
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Type II membranoproliferative glomerulonephritis
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properties of BUN
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blood urea nitrogen - secreted and reabsorbed in PCT
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properties of Creatinine
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end-product of creatine - only filtered in kidney, neither reabsorbed nor secreted in kidney (can be in other places in very high levels)
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normal BUN and Cr levels
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BUN - 9-10
Cr - 1 mg/dl |
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normal BUN/Cr
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10
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pre-renal azotemia
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normal kidneys, but reduced Cardiac Output (e.g. CHF), ergo, GFR decreases. BUN/Cr >15
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renal failure (oliguria, renal tubular casts)
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affects BUN and Cr equally (increased BUN and Cr in equal proportion) BUN/Cr normal (10/1)
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most common cause of acute renal failure
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ischemic acute tubular necrosis
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Cardiac output decreases and oliguria, what do you worry about most?
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ischemic acute tubular necrosis
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most common cause of ischemic acute tubular necrosis
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not treating pre-renal azotemia
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BUN:Cr ~ 10:1 with oliguria and renal tubular casts
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acute tubular necrosis
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Why does acute tubular necrosis have such a bad diagnosis?
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ischemic cause also destroys basement membrane --> loss of structure --> can't regenerate renal tubular cell w/o BM. Even if one recovers, can never recover normal function
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What parts of nephron is most susceptible to ischemia?
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straight portion of proximal tubule and thick ascending limb (medullary part). Affects Na/K/Cl co-transport
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Nephrotoxic drugs...what are they and where do they affect? prognosis?
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gentamicin (aminoglycocides), dye from IV pyelograms; damages proximal tubule. prognosis good because they don't damage BM.
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How do you separate pyelonephritis from low UTIs?
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acute pyelonephritis is infection of kidney proper and has fever with flank pain (CVA tenderness) and WBC casts
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what is the mechanism of all UTIs
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ascending infection from introitus of urethra.
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scarred kidney with blunted calyces (beneath scarring)
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chronic pyelonephritis
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fever with rash, oliguria, eosinophiluria after starting drug
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acute drug-induced interstitial nephritis (methicillin)
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what kinds of hypersensitivity are associated with acute drug-induced interstitial nephritis?
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combination of type I and type IV hypersensitivities
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empty space on IV pyelogram
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analgesic nephropathy from acetaminophen and aspirin combo therapy long-term
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what is the mechanism of analgesic nephropathy?
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acetaminophen --> produces free radicals that damage tubular cells of medulla
aspirin blocks PGE2 so Angiotensin II is unopposed and peritubular capillaries have decreased blood flow causing ischemia in renal papillaries |
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causes of renal papillary necrosis
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aspirin/acetaminophen long-term, diabetes, sickle-cell disease, acute pyelonephritis (from abscess formation)
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BUN/Cr >10 for more than 3 months. what is the diagnosis?
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Chronic renal failure
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results of chronic renal failure
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anemia, anion-gap metabolic acidosis, osteoporosis, osteomalacia, secondary hyperparathyroidism
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uncontrolled essential hypertension (over ten years) causes what?
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nephrosclerosis --> hyaline arteriolosclerosis (cobblestone appearance of kidney)
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person with uncontrolled HTN, wakes up with bad HA, dizzy, blurred vision, BP 240/140, papilledema and flamed hemorrhages, hard and soft exudates, BUN/Cr 80/8. what is diagnosis?
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malignant hypertension (shows petechia visible on surface of kidney)
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Treatment of malignant hypertension?
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IV nitroprusside
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pale, depressed-looking lesions on gross examination of kidney. what do you see on LM?
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pale infarction --> coagulation necrosis
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causes of pale infarcts in kidneys in a patient with irregular irregular pulse?
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A-fib, causes thromboemboli
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little white dots and microabscesses on gross exam of kidneys probably caused by what?
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pyelonephritis
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hydronephrosis and increased pressure have what affect on renal cortex and medulla?
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compression atrophy
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staghorn calculi, alkaline urine and smells of ammonia, what is the cause?
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urease (+) bacteria: proteus, klebsiella, staph
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most common cause of compression atrophy?
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stone
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what is the composition of staghorn calculi
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magnesium ammonium phosphate
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mass in kidney adult what is it?
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renal adenocarcinoma
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mass in kidney in kid with hypertension?
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wilm's tumor
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cause of renal adenocarcinoma?
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derived from proximal tubule; most common cause is smoking
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what are results of renal adenocarcinoma?
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produce ectopic EPO, PTH-like peptide, and like to invade renal vein
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why hypertension in kid with Wilm's tumor?
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the tumor makes renin
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findings in Wilm's tumor?
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embryonic kidney structures; aniridia and hemi-hypertrophy of an extremity --> sign that Wilm's tumor has genetic basis
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genetic abnormality in Wilm's tumor?
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WT-1 tumor-suppressor gene on chrom 11. AD
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most common organism in cystitis?
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E. coli
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patient with increased urinary frequency, has positive leukocyte esterase, dysuria, neutrophils in urine, negative bacterial culture, negative nitrites. what is diagnosis?
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Chlamydia
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causes of sterile pyuria?
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chlamydia, TB
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most common cause of transitional cell carcinoma of bladder?
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smoking
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cyclophosphamide is used to treat what?
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Wegener's
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cyclophosphamide toxicity is prevented by what?
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Mesna
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hypospadias is caused by what?
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failure of closure of urethral folds
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most common cancer of penis is what? What is most common cause?
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squamous cell carcinoma due to lack of hygiene in uncircumcised penis. (shmegma)
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what are two phases of testicular descent?
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tans-abdominal migration caused by mullerian inhibitory factor, and shortening of gubernaculum due to testosterone and dihydrotestosterone
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undescended testicles before 2 years increased risk for what?
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seminomas in both testicles (even if appears normal)
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streak ovaries put woman at risk for what?
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dysgerminomas
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epididymitis at age <35 due to what?
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neisseria gonorrhea, chlamydia
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epididymitis at ages >35 due to what?
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pseudomonas, E. coli
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vericocoeles on what side and why?
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left, due to the spermatic vein on left is connected to left renal vein.
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most common cause of male infertility
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vericocoele
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what would happen if you block left renal vein?
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increases pressure on spermatic vein and causes vericocoele.
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torsion of spermatic cord causes what?
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shortens the cord, so the testicle ascends into inguinal canal; pain; loss of cremasteric reflex
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what is cremasteric reflex?
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scratching of scrotum causes the cremaster muscle to contract
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hydrocoele is what?
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persistence of tunica vaginalis
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painless enlargement of testicle has what on it's differential?
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cancer, cancer, cancer, cancer
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most common cause of testicular cancer
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seminoma --> highly responsive to radiation
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where do seminomas metastacize?
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para-aortic LNs
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most common testicular tumor in kid? what's the tumor marker?
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yolk sac tumor (Alpha fetoprotein)
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25 y/o male presents with unilateral gynecomastia and dyspnea. X-ray of lung shows numerous nodular masses. Where is the primary tumor and what kind?
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choriocarcinoma of testicle
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why do choriocarcinomas develop gynecomastia?
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B-HCG is a leutinizing hormone analog --> acts like leutenizing hormone, so stimulates progesterone and causes duct growth in breast tissue
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most common cause of testicular cancer in older men?
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malignant lymphoma metastaces
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where in prostate gland does hyperplasia occur?
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periurethral area
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where in prostate gland is cancer located?
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periphery (that's why you can feel it with your finger on rectal)
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75 y/o man has urinary retention and massive bladder with dribbling urine. what is cause?
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BPH.
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what hormone is totally responsible for prostate?
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dihydrotestosterone
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BPH and prostate cancer is under the control of what hormone?
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dihydrotestosterone
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how do you treat prostate cancer and BPH
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5-alpha-reductase inhibitor
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most common cancer in men?
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prostate cancer
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