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MS2 Unit 1 > Goljans > Flashcards

Goljans Flashcards

1
Q

What is the clinical presentation of lichen sclerosus?

A

Thinned epidermis of the vulva; parchment-like skin

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2
Q

What is the clinical presentation of lichen simplex chronicus?

A

Leukoplakia (hyperplasia) of the vulva

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3
Q

What is the clinical presentation of papillary hidradenoma?

A

Painful apocrine gland tumor; nodule on labia majora

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4
Q

What causes vulvar intraepithelial neoplasia?

A

HPV 16

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5
Q

What are the risk factors for squamous cell carcinoma of the vulva?

A

HPV 16

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6
Q

What is extramammary Paget disease?

A

Intraepithelial adenocarcinoma; PAS positive

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7
Q

What laboratory test can be used to differentiate extramammary Paget disease from vulvar melanoma?

A

PAS

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8
Q

What is the clinical finding in Rokitansky-Küster-Hauster syndrome?

A

Vagina/uterus underdeveloped or absent

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9
Q

What is a Gartner cyst?

A

Wolffian duct remnant in the lateral wall of the vagina

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10
Q

What is the most common sarcoma in girls?

A

Embryonal rhabdomyosarcoma

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11
Q

What is the clinical presentation of embryonal rhabdomyosarcoma?

A

Grape-like mass protruding from vagina

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12
Q

What are the effects of diethylstilbestrol?

A

Inhibits müllerian differentiation; used to prevent spontaneous abortion

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13
Q

What is the precursor lesion for clear cell adenocarcinoma?

A

Vaginal adenosis: red superficial ulcerations

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14
Q

What female reproductive pathology is highly associated with exposure to diethylstilbestrol?

A

Clear cell adenocarcinoma in vagina/cervix

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15
Q

What anatomical abnormalities are associated with intrauterine diethylstilbestrol exposure?

A

Incompetent cervix

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16
Q

What is the most common cause of vaginal squamous cell carcinoma?

A

Extension of cervical squamous cell carcinoma

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17
Q

What comprises the cervix?

A

Endocervix and exocervix

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18
Q

What is the role of lactobacillus in the vaginal flora?

A

[Gram+ rod]

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19
Q

What is the most common site of squamous dysplasia and squamous cell carcinoma in the cervix?

A

Transitional zone

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20
Q

What is the most common cause of vaginal discharge?

A

Cervicitis

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21
Q

What is the most common finding in acute cervicitis?

A

Vaginal discharge

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22
Q

What is the most common cause of acute cervicitis?

A

C. trachomatis and N. gonorrhoeae account for >50% of cases

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23
Q

What causes follicular cervicitis?

A

C. trachomatis

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24
Q

What are reticulate bodies?

A

Produce elementary bodies, the infective particle of Chlamydia

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25
Q

What is opthalmia neonatorum?

A

Neonatal conjunctivitis contracted during delivery; vertical transmission of C. trachomatis, N. gonorrhoeae

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26
Q

What is the purpose of a cervical Pap smear?

A

Screen for dysplasia/cancer

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27
Q

What Pap smear finding indicates adequate estrogen?

A

Superficial squamous cells

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28
Q

What Pap smear finding indicates adequate progesterone?

A

Intermediate squamous cells

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29
Q

What Pap smear finding indicates lack of estrogen/progesterone?

A

Parabasal cells

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30
Q

What are the Pap smear findings in a normal nonpregnant female?

A

70% superficial squamous cells

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31
Q

What are the Pap smear findings in a normal pregnant female?

A

100% intermediate squamous cells

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32
Q

What are the Pap smear findings in an elderly female?

A

100% parabasal (atrophic); inflammatory cells

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33
Q

What are the Pap smear findings in a woman taking estrogen-only hormone replacement?

A

100% superficial squamous cells

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34
Q

What is the typical presentation of a cervical polyp?

A

Postcoital bleeding; vaginal discharge

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35
Q

Are cervical polyps cancerous?

A

Nonneoplastic; not precancerous

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36
Q

What are most cases of cervical intraepithelial neoplasia associated with?

A

HPV

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37
Q

What effect does HPV have on squamous cells?

A

Koilocytosis; clear halo containing a wrinkled, pyknotic nucleus

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38
Q

What is the primary complication of cervical dysplasia?

A

Precursor for squamous cell carcinoma

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39
Q

What is the classification of cervical intraepithelial neoplasia?

A

CIN I: mild

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40
Q

What is the average age of presentation for squamous cell carcinoma of the cervix?

A

~45 years

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41
Q

What are some general epidemiological features of cervical cancer?

A

Least common gynecologic cancer

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42
Q

What accounts for the decreased incidence and mortality of cervical cancer in the US?

A

Cervical pap smears

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43
Q

What is the most common sign of cervical cancer?

A

Abnormal vaginal bleeding

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44
Q

How does cervical cancer typically spread?

A

Spreads down and out

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45
Q

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

A

Renal failure

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46
Q

What are the steps in the sequence to menarche?

A

Breast budding

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47
Q

What is the most variable phase of the menstrual cycle?

A

Proliferative phase

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48
Q

What hormone mediates the proliferative phase of the menstrual cycle?

A

Estrogen

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49
Q

What hormonal changes lead to ovulation?

A

Estrogen surge → LH surge → ovulation

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50
Q

When does ovulation occur?

A

Between days 14 and 16 o the menstrual cycle

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51
Q

What is the best sign of ovulation?

A

Subnuclear vacuoles in endometrial cells

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52
Q

What is the least variable phase of the menstrual cycle?

A

Secretory phase

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53
Q

What hormone mediates the secretory phase of the menstrual cycle?

A

Progesterone

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54
Q

Where does fertilization typically occur?

A

Ampullary portion of fallopian tube

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55
Q

How long does it take for the fertilized egg to implant?

A

5 days

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56
Q

What is the Arias-Stella phenomenon?

A

Exaggerated secretory phase that occurs in pregnancy

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57
Q

What occurs in menses?

A

Drop in hormones initiates apoptosis

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58
Q

Why does vaginal bleeding occur in newborn girls?

A

Mother’s estrogen causes endometrial hyperplasia; sudden drop following delivery induces bleeding

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59
Q

What changes are stimulated by FSH?

A

Prepares follicle

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60
Q

In what stage of division are unstimulated follicles arrested?

A

Meiosis I prophase

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61
Q

What is the function of LH in the proliferative phase?

A

Synthesis of testosterone for conversion by aromatase into estradiol in granulosa cells

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62
Q

What occurs when a follicle is stimulated by LH?

A

Follicle progresses to meiosis II metaphase

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63
Q

What happens after fertilization?

A

Fertilized follicle develops into mature oocyte with 23 chromosomes

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64
Q

What is the role of LH in the secretory phase?

A

Synthesizes 17-OH-progesterone

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65
Q

What is hCG?

A

LH analogue; synthesized in syncytiotrophoblast lining chorionic villus in the placenta

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66
Q

What is the function of hCG?

A

Maintains corpus luteum of pregnancy for 8-10 weeks

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67
Q

What is the mechanism of oral contraceptive pills?

A

Low estrogen prevents LH surge and ovulation; progestins cause gland atrophy and inhibit LH

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68
Q

What is the primary estrogen of non-pregnant women?

A

Estradiol

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69
Q

When is primary estrogen of post-menopausal women?

A

Estrone

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70
Q

How is estrone produced?

A

Adrenal androstenedione → estrone

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71
Q

What is the estrogen of pregnancy?

A

Estriol

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72
Q

Where is estriol produced?

A

Fetal adrenal/liver

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73
Q

Where is DHEA-sulfate synthesized in women?

A

Almost exclusively synthesized in adrenal cortex

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74
Q

Where is testosterone synthesized in women?

A

Synthesized in ovary/adrenals

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75
Q

Where is sex hormone-binding globulin synthesized?

A

Liver

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76
Q

What is the relative affinity of sex hormone-binding globulin?

A

Higher binding affinity for testosterone than estrogen

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77
Q

What hematologic changes occur in pregnancy?

A

↑RBC mass/↑↑plasma volume = ↓Hb/RBC count

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78
Q

What renal changes occur in pregnancy?

A

↑↑plasma volume causes ↑GFR/CCr

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79
Q

What respiratory changes occur in pregnancy?

A

Respiratory alkalosis

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80
Q

What is the mechanism of respiratory alkalosis in pregnancy?

A

Estrogen/progesterone stimulation of respiratory center

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81
Q

How do cortisol and thyroxine levels change in pregnancy?

A

↑total serum T₄/cortisol; ↑in binding proteins, no change in free hormones

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82
Q

What is the definition of menopause?

A

No menses for 1 year after age 40

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83
Q

What is the average age of menopause?

A

51 years [genetically determined]

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84
Q

What are the symptoms of menopause?

A

Hot flushes

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85
Q

What testosterone changes occur in menopause?

A

↑testosterone levels in menopause; leads to ↑libido in some women

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86
Q

What are the laboratory findings in menopause?

A

↑FSH best marker

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87
Q

What is the clinical presentation of hirsutism?

A

Excess hair in normal hair-bearing areas

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88
Q

What features define virilization?

A

Hirsutism + male secondary sex characteristics

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89
Q

What is the underlying mechanism of hirsutism and virilization?

A

↑ androgens of ovarian, adrenal, or drug origin

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90
Q

What is the mechanism of ovarian-mediated hirsutism?

A

↑testosterone

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91
Q

What is the mechanism of adrenal-mediated hirsutism?

A

↑DHEA-S, testosterone

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92
Q

What is the most common cause of hirsutism?

A

Polycystic ovary syndrome

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93
Q

Polycystic ovary syndrome is associated with an increased incidence of which conditions?

A

Insulin-resistance

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94
Q

What is the key pathogenic factor underlying polycystic ovary syndrome?

A

LH/FSH ratio >3

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95
Q

What is the pathogenesis of polycystic ovary syndrome?

A

↑secretion of LH → follicular hyperthecosis (hyperplasia of ovarian theca cells) → ↑production of testosterone, androstenedione → hyperandrogenicity (e.g., hirsutism)

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96
Q

What are the effects of polycystic ovary syndrome?

A

Chronic anovulation

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97
Q

What is the mechanism of anovulation in polycystic ovary syndrome?

A

Less aromatization of androgens to estrogen

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98
Q

What happens to the excess androstenedione generated in polycystic ovary syndrome?

A

↑conversion of androstenedione to estrone → ↑endometrial hyperplasia/cancer, breast cancer risk

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99
Q

What are the clinical findings in polycystic ovary syndrome?

A

Oligomenorrhea

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100
Q

What are the laboratory findings in polycystic ovary syndrome?

A

LH/FSH ratio >3

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101
Q

What is the definition of menorrhagia?

A

Loss of blood >80 mL per period

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102
Q

What findings should raise suspicion for menorrhagia?

A

Staining sheets at night

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103
Q

What is the definition of dysmenorrhea?

A

Painful menses

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104
Q

What is the mechanism of primary dysmenorrhea?

A

Due to PGF₂α; ↑uterine contractions

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105
Q

What is the most common cause of secondary dysmenorrhea?

A

Endometriosis

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106
Q

What is the definition of dysfunctional uterine bleeding?

A

Abnormal bleeding unrelated to an anatomic cause

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107
Q

What is the most common cause of abnormal bleeding?

A

Menorrhagia

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108
Q

What characterizes hypomenorrhea?

A

Regular normal intervals with decreased blood flow

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109
Q

What characterizes metrorrhagia?

A

Irregular intervals with excessive flow and duration

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110
Q

What characterizes menometrorrhagia?

A

Irregular or excessive bleeding during menstruation and between periods

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111
Q

What characterizes oligomenorrhea?

A

Menses at intervals >35 days

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112
Q

What characterizes polymenorrhea?

A

Menses at intervals

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113
Q

When do most cases of dysfunctional uterine bleeding occur?

A

Menarche and perimenopausal period

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114
Q

What is the most common type of dysfunctional uterine bleeding?

A

Anovulatory dysfunctional uterine bleeding

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115
Q

What is the mechanism of anovulatory dysfunctional uterine bleeding?

A

Excessive estrogen stimulation; occurs at the extremes of reproductive life

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116
Q

What is the mechanism of ovulatory dysfunctional uterine bleeding?

A

Inadequate luteal phase; irregular shedding of the endometrium

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117
Q

What is the pathogenesis of inadequate luteal phase in ovulatory dysfunctional uterine bleeding?

A

Inadequate maturation of corpus luteum; delayed secretory phase due to ↓17-OH progesterone synthesis

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118
Q

What is the pathogenesis of irregular endometrial shedding in ovulatory dysfunctional uterine bleeding?

A

Persistent luteal phase with continued secretion of progesterone; mixture of proliferative/secretory gland

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119
Q

What is the definition of primary amenorrhea?

A

No menses by age 16

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120
Q

What is the most common cause of primary amenorrhea?

A

Constitutional delay

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121
Q

What is the definition of secondary amenorrhea?

A

No menses for >6 months

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122
Q

What is the most common cause of secondary amenorrhea?

A

Pregnancy

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123
Q

What hormonal findings are associated with hypothalamic/pituitary causes of amenorrhea?

A

↓FSH, LH, estrogen

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124
Q

What are some examples of hypothalamic/pituitary disorders causing amenorrhea?

A

Anorexia nervosa

125
Q

What hormonal findings are associated with ovarian causes of amenorrhea?

A

↑FSH, LH; ↓estrogen

126
Q

What syndrome should be suspected with the combined findings of primary amenorrhea with poor secondary sex characteristics?

A

Turner syndrome

127
Q

What hormonal findings are associated with end-organ causes of amenorrhea?

A

Normal FSH, LH, estrogen

128
Q

What are some examples of end-organ defects causing amenorrhea?

A

Imperforate hymen

129
Q

What is Asherman syndrome?

A

Removal of stratum basalis by excessive curettage

130
Q

What is acute endometritis?

A

Uterine infection following delivery or abortion

131
Q

What is the most common pathogen associated with acute endometritis?

A

Group B streptococcus

132
Q

What are the clinical findings in acute endometritis?

A

Fever

133
Q

What pathogen causes infections associated with intrauterine devices?

A

Actinomyces

134
Q

What is the key histological finding in chronic endometritis?

A

Plasma cells in biopsy

135
Q

What is adenomyosis?

A

Functioning glands/stroma in myometrium

136
Q

What are the clinical findings in adenomyosis?

A

Menorrhagia

137
Q

What is endometriosis?

A

Functioning glands/stroma outside the confines of the uterus

138
Q

What is the most common cause of endometriosis?

A

Reverse menses

139
Q

What is the pathogenesis of endometriosis?

A

Reverse menses

140
Q

What site is most commonly involved in endometriosis?

A

Ovaries

141
Q

What is the clinical significance of the rectal pouch of Douglas?

A

Site for collection of blood, malignant cells, pus, endometrial implants

142
Q

What is the triad of symptoms in endometriosis?

A

Dysmenorrhea

143
Q

How can endometriosis be diagnosed and treated?

A

Laparoscopy

144
Q

What are the implications of an endometrial polyp?

A

Common cause of menorrhagia; no risk of endometrial cancer

145
Q

What is the pathogenesis of endometrial hyperplasia?

A

Prolonged estrogen stimulation

146
Q

What are the common risk factors associated with endometrial hyperplasia?

A

Early menarche/late menopause

147
Q

What type of endometrial hyperplasia has the greatest risk for endometrial cancer?

A

Atypical hyperplasia (glandular crowding and dysplastic epithelium)

148
Q

What is the main clinical finding in endometrial hyperplasia?

A

Postmenopausal bleeding

149
Q

What is the most common gynecologic cancer?

A

Endometrial carcinoma

150
Q

What is the effect of oral contraceptives on cancer risk?

A

↓risk of endometrial cancer

151
Q

What is the most common type of endometrial carcinoma?

A

Well-differentiated adenocarcinoma (vs papillary)

152
Q

What is the characteristic spread of endometrial carcinoma?

A

Spreads down and out

153
Q

What is the most common clinical finding in endometrial cancer?

A

Postmenopausal bleeding

154
Q

What is the most common benign connective tissue tumor in women?

A

Leiomyoma

155
Q

In which population are leiomyomas more common?

A

Blacks > whites

156
Q

What are the clinical findings of leiomyomas?

A

Menorrhagia

157
Q

What is the most common uterine sarcoma?

A

Leiomyosarcoma

158
Q

What are the histological characteristics of leiomyosarcoma?

A

Atypical mitotic spindles; ↑mitosis

159
Q

What gynecologic tumor is strongly associated with previous irradiation?

A

Carcinosarcoma (malignant mixed müllerian tumors)

160
Q

What are hydatid cysts?

A

Cystic müllerian remnant; may undergo torsion

161
Q

What is the most common cause of female infertility and ectopic pregnancy?

A

Pelvic inflammatory disease

162
Q

What is the most common cause of pelvic inflammatory disease?

A

N. gonorrhoeae and C. trachomatis; both present in 45% of cases

163
Q

What is one of the common findings of pelvic inflammatory disease?

A

Hydrosalpinx (tube fills with clear fluid after pus resorbs)

164
Q

What is the pharmacologic treatment of pelvic inflammatory disease?

A

Ceftriaxone (for N. gonorrhoeae)

165
Q

What occurs in salpingitis isthmica nodosa?

A

Tubal diverticulosis

166
Q

What complications are associated with salpingitis isthmica nodosa?

A

Infertility

167
Q

What is the most common cause of ectopic pregnancy?

A

Previous pelvic inflammatory disease

168
Q

What risk factors are associated with ectopic pregnancy?

A

Pelvic inflammatory disease

169
Q

What is the most common location of ectopic pregnancy?

A

Ampullary portion of fallopian tube

170
Q

When does an ectopic pregnancy present?

A

Usually presents ~6 weeks after previous normal menses

171
Q

What is the classic triad of symptoms associated with ectopic pregnancy?

A

Vaginal bleeding

172
Q

What are the complications of ectopic pregnancy?

A

Intraperitoneal hemorrhage and shock

173
Q

What term describes the presence of blood in the fallopian tube?

A

Hematosalpinx (usually due to ectopic pregnancy)

174
Q

How can an ectopic pregnancy diagnosed?

A

hCG is the best screening test; vaginal ultrasound is the confirmatory test

175
Q

What is the most common ovarian mass?

A

Follicular cyst (nonneoplastic)

176
Q

What is the most common ovarian mass in pregnancy?

A

Corpus luteum cyst (nonneoplastic)

177
Q

What causes oophoritis?

A

May be a complication of mumps or pelvic inflammatory disease

178
Q

What are the clinical findings of stromal hyperthecosis?

A

Hirsutism/virilization

179
Q

What age group is at highest risk for ovarian cancer?

A

Risk increases with age

180
Q

What risk factors are associated with the development of surface-derived ovarian tumors?

A

Genetic factors

181
Q

Patients with Turner syndrome are at increased risk for what neoplasm?

A

Dysgerminoma

182
Q

OCPs/pregnancy are associated with decreased risk for what type of malignancy?

A

Surface-derived ovarian tumors

183
Q

What is the most common group of ovarian tumors?

A

Surface-derived tumors

184
Q

What is the most common ovarian cancer?

A

Serous cystadenocarcinoma

185
Q

What are some key findings associated with serous cystadenocarcinoma?

A

Bilateral

186
Q

What is a complication of malignant surface-derived ovarian cancers?

A

Commonly seed the abdominal cavity

187
Q

What is the most common benign germ cell tumor?

A

Teratoma

188
Q

What is the most common malignant germ cell tumor?

A

Dysgerminoma

189
Q

What are sex cord-stromal tumors?

A

Hormone-producing tumors (estrogen/testosterone); most are benign

190
Q

What are Krukenberg tumors?

A

Metastasis to ovaries with signet ring cells

191
Q

What is the most common sign of ovarian cancer?

A

Abdominal enlargement due to fluid

192
Q

What causes malignant ascites?

A

Seeding

193
Q

What are the clinical signs of malignant ascites due to seeding?

A

Induration in rectal pouch

194
Q

What should be suspected in a postmenopausal woman with palpable ovaries?

A

Ovarian cancer

195
Q

What is a common site for ovarian metastasis?

A

Pleural cavity

196
Q

What clinical findings are associated with cystic teratomas?

A

Torsion with infarction

197
Q

What clinical findings are associated with sex cord-stromal tumors?

A

↑estrogen (granulosa cell)/↑androgens (Sertoli-Leydig cell)

198
Q

What is the tumor marker for surface-derived ovarian tumors?

A

↑CA125

199
Q

What covers the fetal surface of the placenta?

A

Chorionic plate

200
Q

What is found on the maternal surface of the placenta?

A

Cotyledons

201
Q

What is the function of chorionic villi?

A

Extract O₂ from maternal blood

202
Q

What type of tissue lines the chorionic villi?

A

Trophoblast: made up of outer layer of syncytiotrophoblast (synthesizes hCG, HPL) and inner layer of cytotrophoblast

203
Q

What is the function of human placental lactogen?

A

Anti-insulin activity; similar to human growth hormone

204
Q

What forms the umbilical vein?

A

Vessels in chorionic villi

205
Q

What structures are found within the umbilical cord?

A

Two arteries

206
Q

What are the implications of a single umbilical artery?

A

Increased incidence of congenital anomalies

207
Q

What is the most common cause of placental infection?

A

Ascending broup B streptococcus from vagina

208
Q

What is the definition of funisitis?

A

Infection of the umbilical cord

209
Q

What is the definition of placentitis?

A

Infection of the placenta

210
Q

What is chorioamnionitis?

A

Infection in fetal membranes; danger of neonatal sepsis/meningitis

211
Q

What is placenta previa?

A

Implantation over cervical os

212
Q

What risk factor is associated with placenta previa?

A

Previous C-section

213
Q

How does placenta previa present?

A

Painless vaginal bleeding

214
Q

What is the appropriate management of placenta previa?

A

Diagnose by ultrasound

215
Q

What causes abruptio placentae?

A

Retroplacental clot

216
Q

What is the most common cause of late pregnancy bleeding?

A

Abruptio placentae

217
Q

What is the greatest risk factor for abruptio placentae?

A

Hypertension

218
Q

What is the triad of clinical findings in abruptio placentae?

A

Painful vaginal bleeding

219
Q

What is the appropriate management of abruptio placentae?

A

No pelvic exam

220
Q

What are the implications of placenta increta/percreta?

A

Implantation into muscle; danger of hemorrhage at delivery

221
Q

What are the implications of velamentous insertion?

A

Cord inserts away from placental edge; danger of tearing vessels

222
Q

What are the implications of an accessory placental lobe?

A

↑risk of hemorrhage if detached

223
Q

What causes an enlarged placenta?

A

Rh hemolytic disease of newborn

224
Q

What type of twins form a monochorionic placenta?

A

Identical twins from a single fertilized egg

225
Q

What type of twins form a dichorionic placenta?

A

Identical or fraternal (separate fertilized eggs)

226
Q

When does preeclampsia occur?

A

Usually occurs after the 20th week of pregnancy

227
Q

What risk factors are associated with preeclampsia?

A

Young/advanced age

228
Q

What is the pathogenesis of preeclampsia?

A

Placental hypoperfusion

229
Q

What pathologic findings are associated with preeclampsia?

A

Hypertension

230
Q

What is eclampsia?

A

Preeclampsia + seizures

231
Q

What is the treatment for preeclampsia?

A

Delivery is the treatment of choice; methyldopa for hypertension

232
Q

What is a hydatidiform mole?

A

Benign tumor in chorionic villus; look like grapes

233
Q

What are the characteristics of a complete molar pregnancy?

A

All villi are neoplastic; dilated neoplastic villi with no fetal parts

234
Q

What causes a complete molar pregnancy?

A

Fertilization of empty ovum by 46XX/XY sperm or two separate 23X/Y sperm

235
Q

How does a complete molar pregnancy appear on ultrasound?

A

snowstorm appearance; too large for gestational age

236
Q

What are the characteristics of a partial molar pregnancy?

A

Normal villi intermixed with neoplastic villi; fetal parts intermixed with neoplastic villi

237
Q

What causes a partial molar pregnancy?

A

Fertilization of a 23X/Y ovum by two sperm

238
Q

What clinical findings are associated with a partial molar pregnancy?

A

Incomplete/missed abortion

239
Q

What is a choriocarcinoma?

A

Malignancy of trophoblastic tissue; no chorionic villi

240
Q

What risk factors are associated with choriocarcinoma?

A

Complete mole > spontaneous abortion > normal pregnancy > partial mole

241
Q

What are the common sites of metastasis associated with choriocarcinoma?

A

Lungs, vagina; lesions are hemorrhagic

242
Q

What is the composition of amniotic fluid?

A

Predominantly fetal urine

243
Q

Why does amniotic fluid cause “ferning” when dried on a glass slide?

A

High salt content

244
Q

What are the causes of polyhydramnios?

A

Tracheoesophageal fistula

245
Q

What is the main cause of oligohydramnios?

A

Juvenile polycystic kidney disease

246
Q

What underlying defect is implicated by ↑AFP?

A

Open neural tube defect; inadequate folic acid before pregnancy

247
Q

What underlying defect is implicated by ↓AFP?

A

Down syndrome

248
Q

What is indicated by an L/S ratio >2?

A

Adequate surfactant

249
Q

What factors influence surfactant synthesis?

A

↑ with glucocorticoids/thyroxine

250
Q

What is the source of urine estriol in pregnancy?

A

Fetal adrenal gland/liver

251
Q

What causes ↓estriol?

A

Sign of fetal-maternal-placental dysfunction

252
Q

What triad of laboratory findings is associated with Down syndrome?

A

↓urine estriol

253
Q

What is the most common location of breast cancer?

A

Upper outer quadrant

254
Q

What effect does estrogen have on breast tissue?

A

Stimulates ductal/alveolar growth, fat, stroma

255
Q

What effect does progesterone have on breast tissue?

A

Stimulates alveolar proliferation/lobule differentiation; breast swelling

256
Q

What is the role of prolactin in lactation

A

Stimulates/maintains lactogenesis and secretion

257
Q

What is the role of oxytocin in lactation?

A

Released by suckling; expulsion of milk into ducts

258
Q

Where do outer quadrant breast cancers drain?

A

Axillary nodes

259
Q

Where do inner quadrant breast cancers drain?

A

Internal mammary nodes

260
Q

What is the most common physiologic cause of galactorrhea?

A

Mechanical stimulation of the nipple

261
Q

What is the most common pathologic cause of galactorrhea?

A

Prolactinoma

262
Q

What is the most common nonpituitary cause of galactorrhea?

A

Primary hypothyroidism: ↑TRH stimulates prolactin release

263
Q

What drugs commonly cause galactorrhea?

A

Oral contraceptive pills

264
Q

What pathologies cause bloody nipple discharge?

A

Intraductal papilloma

265
Q

What causes purulent nipple discharge?

A

Acute mastitis during breast-feeding

266
Q

What causes greenish nipple discharge?

A

Mammary duct ectasia

267
Q

What is the most common cause of breast pain?

A

Fibrocystic change

268
Q

What is Mondor disease?

A

Superficial thrombophlebitis overlying breast

269
Q

What are some examples of benign calcifications in mammograms?

A

Popcorn calcifications

270
Q

What is the most common breast mass in women

A

Fibrocystic change

271
Q

How does fibrocystic change feel on breast examination?

A

Lumpy bumpy due to cysts and fibrosis

272
Q

Sclerosing adenosis is associated with what finding on mammogram?

A

Often contain microcalcifications

273
Q

What complication is associated with atypical ductal hyperplasia?

A

↑risk of breast cancer

274
Q

How does mammary duct ectasia present?

A

Greenish brown nipple discharge; common in menopause

275
Q

What is the presentation of traumatic fat necrosis?

A

Usually presents as a painless indurated mass; associated with trauma to breast tissue

276
Q

What happens if a silicone breast implant ruptures?

A

Silicone produces foreign body giant cell reaction

277
Q

What is the most common breast tumor in women

A

Fibroadenoma

278
Q

What drug is highly associated with the development of fibroadenomas?

A

Cyclosporine; 50% of women taking cyclosporine post renal transplantation develop fibroadenomas

279
Q

What is a fibroadenoma?

A

Benign tumor derived from stroma

280
Q

What are the characteristics of a Phyllodes tumor?

A

Benign, borderline, or malignant stromal tumor; depends on stromal cellularity

281
Q

What is the most common cause of bloody nipple discharge in women

A

Intraductal papilloma

282
Q

What is the most common cancer in women?

A

Breast cancer

283
Q

What is the most common breast mass in women >50 years old?

A

Breast cancer

284
Q

What factors increase the risk for breast cancer?

A

Prolonged estrogen stimulation

285
Q

What percent of breast cancers have a genetic basis?

A
286
Q

What risk factors are associated with breast cancer?

A

Unopposed estrogen

287
Q

What factors reduce the risk of breast cancer?

A

Breast-feeding

288
Q

What are the clinical findings of breast cancer?

A

Painless mass; skin/nipple retraction

289
Q

What is the purpose of mammography?

A

Screening to test for nonpalpable masses

290
Q

What causes microcalcifications in breast tissue?

A

Ductal carcinoma in-situ

291
Q

What are some features that can be used to distinguish malignant microcalcifications on mammography?

A

Clustered punctate, microlinear, or branching

292
Q

Breast cancer is the most common source of metastasis in which two sites?

A

Lungs and bone

293
Q

How can pain in bone metastasis be relieved?

A

Radiation

294
Q

What determines the staging of breast cancer?

A

Extranodal spread has greater significance than nodal metastasis alone

295
Q

Which node sampled in sentinel node biopsy?

A

Initial node draining the tumor

296
Q

What receptor assay confers better prognosis for breast cancer?

A

Positive assay for estrogen and progesterone receptors (ERA-PRA)

297
Q

What is the significance of ERBB2?

A

Oncogene; if positive in breast tissue, poor prognosis

298
Q

What physical finding is caused by damage to the long thoracic nerve?

A

Winged scapula

299
Q

What is the relative survival rate of breast conservation vs mastectomy?

A

Breast conservation therapy has similar survival rate as modified radical mastectomy

300
Q

What is the definition of gynecomastia?

A

Benign glandular proliferation of male breast tissue due to estrogen stimulation

301
Q

What are the sources of estrogen in males?

A

Peripheral aromatization of androgens

302
Q

When does physiological gynecomastia occur?

A

Gynecomastia is normal in newborns, adolescence, and elderly

303
Q

What is the most common pathologic cause of gynecomastia?

A

Cirrhosis (via hyperestrinism)

304
Q

What are some genetic causes of gynecomastia?

A

Klinefelter syndrome

305
Q

What drugs are associated with gynecomastia?

A

Spironolactone

306
Q

What malignancy causes gynecomastia?

A

Choriocarcinoma of testis (via production of hCG)

307
Q

What disorders cause gynecomastia via ↓androgens?

A

Leydig cell dysfunction

308
Q

What risk factors are associated with the development of breast cancer in men?

A

Klinefelter syndrome

MS2 Unit 1 (11 decks)

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