Genitourinary Embryology

Endocrine REF: Harrison’s Internal Medicine, Chapter 253, Davidson’s internal medicine 20^th edition page-685

FEATURES OF CYSTIC FIBROSIS:

• A- Autosomal recessive
• B- Bronchiectasis
• C- Chloride channel block/Ciliary dysfunction
• D- Diabetes mellitus
• E- Exocrine pancreatic failure (> 90% of patients with CF)
• F- Fat malabsorption (steatorrhoea)
• G- Gall stone/Gene mutation on chromosome 7
• H- Hepatic cirrhosis/Hemoptysis
• I- Intestinal obstruction/Infertility

Cowden’s syndrome or multiple hamartoma syndrome is a rare autosomal dominant syndrome characterised by orocutaneous hamartomatous tumours, gastrointestinal polyps, abnormalities of the breast, thyroid gland and genitourinary system. The gastrointestinal polyps are generally benign and malignant transformation is seen very rarely.

Muscles compress the vagina and act like sphincters: pubovaginalis, external urethral sphincter (especially its urethrovaginal sphincter part), and bulbospongiosus.
The internal urethral sphincter, which is formed from the detrusor muscle, is the upper and involuntary sphincter.

Ans. is ‘a’ i.e., Cardiac deformities

o It causes Ebstein anomaly.

Ans. is ‘c’ i.e., Genitourinary

Answer is ‘a’ i.e. Sterile pyuria is consistent finding

“Sterile pyuria is the rule” – CSDT 13/e p928

But about 15-20% of patients with tuberculosis have secondary pyogenic infection, obscuring the clue – sterile pyuria.

• The tubercle bacilli can be identified on AFB staining of 24 hr urine specimen or the first morning urine sample collected on 3 successive days.” AFB staining is positive in about 60% of cases – Smith’ Urology
• Most common site of genitourinary tuberculosis is – kidney
• Commonest cause of pyelonephritis is —> E. coli

Ans is `a’ i.e. Kidney 

“The kidney and possibly the prostate are the primary sites of tuberculous infection in the genitourinary tract. All other genitourinary organs become involved by either ascent (prostate to bladder) or descent (kidney to bladder, prostate to epididymis).” – Smith’s Urology

Also Know:

Pyuria without bacteriuria (or sterile pyuria) is associated with genitourinary tuberculosis

Answer is D (Endocrine):

Cystic fibrosis is typically charachterized by Exocrine Pancreatic insufficiency. Endocrine Pancreatic insufficiency is not seen as a tyical manifestation of cystic fibrosis.

Charachteristic Classical Manifestations of Cystic Fibrosis (Typical System Involvement)

Respiratory system (Sinopulmonary disease)

• Pulmonary infection
• Persistant colonization/infection with typical cystic fibrosis pathogens, including Staphylococcus aureus, nontypeable, Hemophilus influenzae, mucoid and nonmucoid Pseudomonas aeruginosa, Burkholderia cepase
• Chronic obstructive Pulmonary Disease
• Bronchiectasis is typical
• Airway obstruction manifested by wheezing and air trapping
• Chronic cough & sputum production
• Digital clubbing
• Persistent chest radiograph abnormalities (eg. Bronchiectasis, atelectasis, infiltrates, hyperinflation)
• Nasal Polyps radiographic or computed tomographic abnormalities of paranasal sinuses

Gastrointestinal System (Intestinal; Hepatobiliary; Pancreatic)

Intestinal meconium ileus, distal intestinal obstruction syndrome, rectal prolapse.

Pancreatic

Pancreatic exocrine deficiency

Hepatobiliary

Hepatic disease manifested by clinical or histologic evidence of focal biliary cirrhosis, or multilobular cirrhosis

Nutritional

Failure to thrive (protein-calorie malnutrition), hypoproteinemia, edema, complications secondary to fat-soluble vitamin deficiency

Genitourinary System

(Male Infertility)  Male urogenital abnormalites resulting in obstructive azoospermia are typical

Metabolic Abnormalities are typically charachterized by salt depletion syndrome, (Hyponatremia, Hypocholeremia and Hypokalemic Metabolic Alkalosis)

Ans. Emmenagogues

Ans. is ‘b’ i.e., Respiratory symptoms

Clinical manifestations of ascariasis can be divided into two groups :-

Due to adult worm : Adult worm causes malnutrition, abdominal pain, anorexia, intestinal obstruction, appendicitis, obstructive jaundice, pancreatitis, intestinal perforation and allergic manifestations. in Due to migrating larva : Loeffler’s syndrome (eosinophilic pneumonia).

The condition shown in the picture above represents pipe stem ureter.

Pipe stem ureter appearance is seen in patients with Genitourinary TB.

Ans. is ‘c’ i.e., Lymphnode

• Most common site of extra pulmonary TB is lymphnode
• Most children who develop tuberculosis disease experience pulmonary manifestations 25 to 35 percent of children have an extrapulmonary presentation.
• The most common extrapulmonary form of tuberculosis is lymphatic disease accounting for about two thirds of cases of extrapulmonary tuberculosis. the second most common form is meningeal disease occurring in 13% of patients

Ans. is ‘c’ i.e., Circulatory 

• Fetal period extends from the beginning of 3rd month to the end of intrauterine life (till birth).
• It is the period of maturation of tissues and organ and rapid growth of body occurs. 
• By the end of organogenesis (end of embryonic period) most of the organ systems are developed, however, the function of most of them is negligible except cardiovascular system (cardiovascular system is first to function).