GU/Breast

Question 1

what are the two types of epithelium that line the glandular tissue and ducts in the breast

Answer 1

inner: luminal
outer: myoepthelial

Question 2

What is the commonest type of congenital breast abnormality

Answer 2

ectopic/heterotopic breast tissue

Question 3

what is breast hypoplasia associated with

Answer 3

ulnar-mammary syndrome, polands syndrome, turners syndrome and congenital adrenal hyperplasia

Question 4

what are the two types of stromal overgrgowth

Answer 4

juvenile hypertrophy and gestational hypertrophy

Question 5

two strains of inflammatory infections

Answer 5

infective and non-infective

Question 6

acute mastitis

Answer 6

a cellulitis associated with breast feeding, the skin fissuring may let the bacteria in and the milk stasis favours their growth which leads to the infection of the breast tissue

Question 7

granulomatous inflammation

Answer 7

can occur is systemic diseases including sarcoidosis, and infections including tuberculosis

Question 8

recurrent subareolar abscesses

Answer 8

these can be associated with maxillary fistula and is said to be associated with squamous metaplasia of lactiferous ducts and smoking

Question 9

periductal mastitis/duct ectasia

Answer 9

dilation of the central lactiferous ducts, periductal chronic inflammation and scarring

CALCIFIED LUMINAL SECRETIONS SEEN ON MAMOGRAM

Question 10

adenosis

Answer 10

increase in glandular breast tissue

Question 11

Radial scars

Answer 11

benign lesions characterised by a fibrotic core with elastic fibres, trapped glands and a pseudo-infiltrative appearance

Question 12

intraduct papilloma

Answer 12

benign tumour of the epithelium lining the mammary ducts

Question 13

Phyllodes Tumour

Answer 13

they are like fibroadenomas, combine epithelium and mesenchyme, but with more celullar stroma, mitotic activity, cytological atypic and an infiltrative border

Question 13

Phyllodes Tumour

Answer 13

they are like fibroadenomas, combine epithelium and mesenchyme, but with more celullar stroma, mitotic activity, cytological atypic and an infiltrative border

Question 14

When is axillary clearance necessary

Answer 14

if the sentinel node biopsy is positive (but sometimes not even then)

Question 15

what would you treat breast tumours with if they were ER/PR-positive carcinomas

Answer 15

response to endocrine treatment with tamoxifen (predominantly an ER antagonist)

Question 16

what are aromatase inhibitors used for

Answer 16

postmenopausal women are given this to prevent oestrogen stimulation of tumour growth as it blocks the conversion of adrenal (androgens) to oestrogen’s, a process which usually occurs within adipose tissue (link between obesity and breast cancer?)

Question 17

HER2 Positive cancers

Answer 17

worse prognosis and are treated with monoclonal antibody Trastuzymab (Herceptin) AND others

this reduces risk of relapse and prolongs survival

Question 18

what is breast cancer grading based off of

Answer 18

1. nuclear pleomorphism
2. the number of mitosis per mm2
3. the degree of gland formation by the cancer cells

grade 1 = well differentiated and slow growing
grade 3 = poorly differentiated and fast growing

Question 19

what are the three main imaging modalities used in imaging of the pelvis in relation to female anatomy

Answer 19

MRI
CT
US - requires a full bladder as it opens up a good window to the uterus as the fluid does not reflect the beams

Question 20

why is US less effective in people with obesity

Answer 20

the sonar beam gets reflected by the fat, this means there is less beam to penetrate deeper tissues

Question 21

what can you see on a normal MRI in terms of pelvic imaging

Answer 21

in terms of T2 imaging it shows water and fat as bright areas and junctional zones as dark with the myometrium in the middle

Question 22

what are some examples of benign ovarian pathology

Answer 22

ovarian follicle
dermoid cysts
haemorrhage cysts
endometriosis
polycystic ovarian syndrome
ovarian torsion

Question 23

what size do follicles have to exceed to be diagnosed as cysts

Answer 23

above 2.5cm - these appear with completely dark centres

Question 24

hemorrhagic cysts

Answer 24

the US would not appear just dark it would also show internal echos that appear like speckles and this is a sign its blood mostly symptomatic but can present with pain

Question 25

endometrioma

Answer 25

this is also known as the chocolate cyst it appears much more dense on US as it also has haemorrhage debris and won't go away after 6 weeks

Question 26

dermoid cysts

Answer 26

this is usually incidentally found in young women and is a very common benign neoplasm this contains elements from multiple germ cells laters (teeth/calcification) and appear dark due to its fat content (on US its got a variable appearance on CT it appears well defined and dark with calcification)

Question 27

PCOS

Answer 27

this is a syndrome associated with excess androgens - on US it would present with multiple immature follicles (they often lack a central oocyte) as development has been prematurely stopped - patients have irregular periods and androgen excess leading to hirsutism, acne and weight gain can also result in fertility problems

Question 28

ovarian torsion

Answer 28

this is when he ovary twists on its vascular pedicle - young women present with abdominal/pelvic pain, nausea and vomitting and its mostly associated with an ovarian mass such as a dermoid cyst

Question 29

symptoms of ovarian cancer

Answer 29

feeling the need to urinate urgently or often trouble eating or feeling full quickly pelvic or abdo pain bloating persistently

Question 30

how do you calculate the RMI (risk of malignancy index)

Answer 30

ultrasound score x menopausal score x CA 125 Premenopausal = 1 post menopausal = 3 ultrasound abnormalities: 0 = 0 1 = 1 3 = two or more more than 200 is concerning

Question 31

what are some features of malignancy on an US

Answer 31

irregular solid or multi-lobulated cystic mass solid components on the cyst wall bilateral ovarian less ascites, peritoneal nodules, or other evidence of metastases

Question 32

staging of endometrial cancer

Answer 32

1 = carcinoma in the uterus 2 = spread to the cervix 3 = outside the uterus but is still within the pelvis 4 = beyond the pelvis such as the bladder or bowel

Question 33

parametrium

Answer 33

this is a fibrous band that separates the cervic from the bladder this is often invaded in stage 2b and above if its invaded then surgery is not an option and it must be treated with chemo or radiation

Question 34

what is the metastatic theory of endometriosis

Answer 34

retrograde menstruation or surgical procedures introduce endometrium to sites outwit the uterine cavity

Question 35

what is the metaplastic theory of endometriosis

Answer 35

endometrium arises directly from the coelomic epithelium (i.e the peritoneum) of the pelvis

Question 36

leiomyoma

Answer 36

benign smooth muscle tumour of the myometrium

Question 37

leiomyosarcoma

Answer 37

malignant smooth muscle tumour of the myometrium

Question 38

most common cause of enlarged ovaries in post-menopausal women

Answer 38

ovarian stromal hyperplasia

Question 39

inflammation of the fallopian tube

Answer 39

salpingitis

Question 40

what is the presentation of PID

Answer 40

abdominal/pelvic pain, adnexal tenderness, fever and vaginal discharge REQUIRES ANTIBIOTICS aggregates of neutrophils are present

Question 41

molecular abnormalities in low grade serous carcinomas

Answer 41

BRAF and KRAS there is an absence of the p53 mutation

Question 42

molecular abnormalities in high grade serous carcinomas

Answer 42

can be associated with the BRCA mutation in younger patients but this condition usually effects peri-menopausal and post-menopausal women. it is also associated with the p53 mutation SURGERY AND CHEMO thought to originate from the Fallopian tube as a STIC

Question 43

epithelial clear cell carcinomas

Answer 43

these are associated with endometriosis but can also occur in women without this resistant to platinum based chemotherapy NO P53 MUTATION this is what can differentiate between high grade serious and clear cell