Cardio + Female Repro

Question 1

What is the hallmark of reversible injury?

Answer 1

Cellular swelling

[seen in stable angina]

Question 2

What is the different pathogenesis b/t Stable and Unstable angina?

Answer 2

Stable angina - atherosclerosis

Unstable angina - ruptured atherosclerotic plaque with thrombi formation

Question 3

What would cause a continued increase in cardiac enzymes post fibrinolytic administration or angioplasty?

Answer 3

Reperfusion injury – release of free radical generation which further damages the myocytes

Question 4

What are the major microscopic changes post cardiac MI?

Answer 4

1. coagulative necrosis (loss of nucleus!)
2. inflammation (neutrophils followed by macrophages) [creates a gross change of yellow pallor]
3. granulation tissue
4. scar

Question 5

When would you see fibrinous pericarditis post MI?

Answer 5

at 1-3 days when the neutrophils have infiltrated the tissue – only occurs with a Transmural wall infarct – will never get it with a subendocardial

Question 6

What type of collagen is found in the scar post MI?

Answer 6

Type I collagen – watch out b/c the wall is not as strong as regular myocardium so there is a high risk for aneurysm which will cause stasis and increase the risk for more thrombus formation

Question 7

What cardiac defect is associated with maternal diabetes?

Answer 7

Transposition of the great vessels

Question 8

What is the difference in presentation b/t infantile vs adult form coarctation of the aorta?

Answer 8

Infantile – coarctation prior to PDA - cyanosis on lower extremities only

Adult – Hypertension on upper extremities, Hypotension on lower extremities, you may also see notching of the ribs due to collateral circulation

Question 9

How would histologically describe Aschoff bodies?

Answer 9

Foci of chronic inflammation, with Aschoff bodies (reactive histiocytes with slender and wavy nuclei), giant cells and fibrinoid material

Question 10

What is the most common cause of death during the acute phase of rheumatic fever?

Answer 10

myocarditis

Question 11

Heart pathology - bounding pulse, head bobbing?

Answer 11

Aortic regurgitation

**creates hyperdynamic circulation

Question 12

What is the composition of thrombotic vegetations on the heart valve?

Answer 12

platelets + fibrin

Question 13

Which bacteria infects prosthetic valves?

Answer 13

Staph epidermidis

Question 14

What are the HACEK organisms and why are they special?

Answer 14

Hemophilus
Actinobacter
Cardiobacterium
Eikenella
Kingella

**cause endocarditis with NEGATIVE BLOOD CULTURES

Question 15

Where are vegetations found in Libman-Sacks endocarditis?

Answer 15

BOTH SIDES of the mitral valve resulting in mitral regurg

**Lupus association (sterile vegetations)

Question 16

What are the EKG findings for congestive heart failure due to restrictive cardiomyopathy?

Answer 16

low-voltage EKG with diminished QRS amplitude

Question 17

What does metastasis to the heart usually involve and what does it cause?

Answer 17

Involves the pericardium – resulting in pericardial effusion

Question 18

What is the difference in histology b/t lichen sclerosis and lichen simplex chronicus?

Answer 18

Lichen sclerosis – thinning of epidermis with fibrosis of dermis [may progress to non-HPV related vulvar carcinoma]

Lichen simplex chronicus – thickening of skin (hyperplasia) due to chronic irritation and scratching

Question 19

What are the different stains to differentiate paget disease of the vulva vs melanoma?

Answer 19

Paget disease – PAS+, Keratin+, S100-

Melanoma – PAS-, Keratin-, S100+

Question 20

What are two immunohistochemical markers for rhabdomyosarcomas?

Answer 20

Desmin – skeletal muscles

Myogenin – transcription factor found in Immature skeletal muscle

Question 21

What type of cancers in the cervix are driven by HPV?

Answer 21

Squamous cell AND adenocarcinoma

[only squamous lesions can be detected on pap smears at transitional zones]

Question 22

What is the most common cause of death in pts with cervical cancer?

Answer 22

Hydronephrosis with postrenal failure - due to local invasion through anterior uterine wall into the bladder blocking the ureters

Question 23

What is Asherman Syndrome?

Answer 23

loss of BASALIS LAYER (regenerative layer/stem cells of endometrium) and scarring causing secondary amenorrhea

**generally due to overaggressive dilation and curettage (D&C)

Question 24

What is the cause of uterine bleeding in anovulatory cycles?

Answer 24

Estrogen-driven proliferative phase WITHOUT subsequent progesterone-drive secretory phase – with progressive proliferative phase overtime the proliferative glands will break down and shed resulting in uterine bleeding

Question 25

Use of what drug may lead to a side effect of ENDOMETRIAL POLYPS?

Answer 25

TAMOXIFEN USE – it is pro-estrogen on the endometrium leading to the hyperplastic polyp growth

Question 26

What are the two pathways of endometrial carcinoma?

Answer 26

1. Hyperplasia pathway - endometrioid histology (looks like the normal endometrium), due to unopposed estrogen, occurs around age 60yo
2. Sporadic pathway - no hyperplasia, you get cancer form an atrophic endometrium (no precursor lesion), serous histology(so you have papillae structures with psammoma bodies (due to necrosis of the papillae that calcify) and a p53 tumor), occurs around age 70yo, very aggressive

**presents with postmenopausal bleeding

Question 27

What is the most common class of ovarian tumor in pts with BRCA1 mutations?

Answer 27

serous carcinoma of the ovary and fallopian tube

Question 28

What is the most common type of tissue in an immature teratoma?

Answer 28

neural ectoderm

Question 29

What is the most common type of carcinoma within a mature teratoma?

Answer 29

squamous cell carcinoma of the skin within the teratoma

Question 30

What serum marker is elevated in a dysgerminoma of the ovaries?

Answer 30

LDH

Question 31

What is a characteristic feature of Leydig cells?

Answer 31

Reinke crystals

Question 32

What is the cause of a pseudomyxoma peritonei?

Answer 32

mucinous tumor of the appendix that metastasizes to the ovaries

Question 33

What is the most common cause of miscarriages?

Answer 33

CHROMOSOMAL ANOMALIES

[could also be hypercoagulable states, congenital infections, exposure to teratogens]

Question 34

What is the cause of pre-eclampsia?

Answer 34

Fibrinoid necrosis in the blood vessels of the placenta (maternal-fetal vascular interface) – resolves with delivery

Question 35

What is the difference b/t choriocarcinoma of the ovary and uterus?

Answer 35

ovary (germ cell tumor) - does NOT respond to chemo

Uterus (ex. in response to gestation) - responds to chemo

[arise from cytotrophoblasts and syncytiotrophoblasts]