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Uworld Journal > Life Cycles Path > Flashcards

Life Cycles Path Flashcards

1
Q

What is the premalignant lesion for Cervical Squamous Cell Carcinoma?

A

Cervical Intraepithelial Neoplasia (CIN)

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2
Q

Female - vulvar skin is pale gray and parchment-like

A

Lichen Sclerosus/Chronic Atrophic Vulvulitis

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3
Q

What is the premalignant lesion for Vulular Carcinoma?

A

Vulvular Intraepithelial Neoplasia (VIN)

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4
Q

What is the premalignant lesion for Squamous Cell Carcinoma of the Vagina?

A

Vaginal Intraepithelial Neoplasia (VAIN)

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5
Q

Location of Squamous Cell Carcinoma of the Vagina?

A

Upper posterior vagina

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6
Q

Location of Clear Cell Adenocarcinoma of the Vagina?

A

Upper anterior vagina

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7
Q

What is the premalignant lesion for Clear Cell Adenocarcinoma of the Vagina?

A

Atypical vaginal adenosis

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8
Q

Amenorrhea definition

A

Absence of bleeding for at least 3 cycles

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9
Q

Oligomenorrhea definition

A

Bleeding that occurs at an interval of >35 days

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10
Q

Polymenorrhea definition

A

Bleeding that occurs at an interval of

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11
Q

Menorrhagia definition

A

Excessive, prolonged, heavy bleeding

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12
Q

Metorrhagia definition

A

Bleeding at irregular intervals

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13
Q

Menometorrhagia definition

A

Heavy bleeding at irregular intervals

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14
Q

Dysmenorrhea

A

Painful menstruation with abdominal cramps

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15
Q

Difference between ectopic endometrium and eutopic endometrium?

A

Ectopic has aromatase P450 enzyme.

Eutopic does not have that enzyme.

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16
Q

What is the premalignant lesion for Endometrial Adenocarcinoma?

A

Endometrial Intraepithlial Neoplasm (EIN)/ Complex endometrial hyperplasia with atypia

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17
Q

Adenocarcinoma of the Fallopian Tube mutation?

A

p53 mutation -> dysplaisa

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18
Q

Invasive Ductal Carcinoma mets locally and distant

A 
local = axillary LN
distant = lung, brain
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19
Q

Invasive Lobular Carcinoma mets locally and distant

A 
local = axillary LN
distant = bone, GI, uterus, ovary, serosa
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20
Q

Origin of ovarian epithelial tumors?

A

Fallopian tube fimbrae

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21
Q

Endodermal sinus/Yolk sac tumors (female and male) stain for?

A

Alpha-fetoprotein positive (AFP +)

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22
Q

Which ovarian tumors are hormonally active?

A

Sex cord stromal tumors

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23
Q

Area of the prostate involved in BPH?

A

transitional zone, periurethral

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24
Q

Area of the prostate involved in prostatic neoplasms?

A

peripheral zone

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25
Q

What is the premalignant lesion for Prostate Adenocarcinoma?

A

Prostatic Intraepithelial Neoplasia (PIN) - still has outer basal cell layer

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26
Q

Prostate Adenocarcinoma mets - local and distant

A 
local = early - obturator; late - para-aortic 
distant = bone, brain, lungs
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27
Q

Bell Clapper Deformity?

A

cause of testicular torsion in adolescents. lack of posterior attachment of the scrotum and testicle due to tunica vaginalis wrapping all the way around the testicle.

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28
Q

Male germ cell tumor mutation

A

Isochromosome of Chr 12 - loss of long arm with duplication of the short arm

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29
Q

Characteristics of Seminomatous type germ cell tumors in males (5)

A
  • older patients
  • low tumor marker expression
  • late mets
  • met via lymphatics
  • radiosensitive
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30
Q

Characteristics of Non-seminomatous type germ cell tumors in males (5)

A
  • younger patients
  • elevated tumor marker expression
  • early met
  • met via hematogenous and lymphatics
  • radioresistant
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31
Q

Schiller-Duval bodies are found in what male tumor?

A

Yolk Sac Tumor

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32
Q

Reinke Crystals are found in what male tumor?

A

Leydig cell tumor

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33
Q

What is the premalignant lesion for Squamous Cell Carcinoma of the Penis?

A

Bowen Disease caused by HPV 16

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34
Q

Thick, leathery vulvar skin?

A

Lichen simplex chronicus

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35
Q

What 3 conditions present as leukoplakia in females?

A
  • Lichen Sclerosis
  • Lichen Simplex Chronicus
  • Vulvar Carcinoma
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36
Q

Paget’s disease stains? PAS, Keratin, S100

A

PAS+
Keratin+
S100-

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37
Q

Melanoma stains? PAS, Keratin, S100

A

PAS-
Keratin-
S100+

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38
Q

Vaginal CA from the lower 1/3 of the vagina locally mets to?

A

Superficial Inguinal LN

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39
Q

Vaginal CA from the upper 2/3 of the vagina locally mets to?

A

Illiac nodes

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40
Q

High risk HPV produces what proteins (2) and what are their functions?

A

E6 -> inhibits p53 (Normally, p53 regulates G1->S transition and monitors for DNA mutations/damage. Without p53, DNA mutations are allowed to continue through the cell cycle.)

E7->inhibits Rb (Normally, Rb holds onto E2F which regulates when cells move into G2. Without Rb, E2F just allows everything to go into G2 whether it is normal DNA or damaged DNA.)

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41
Q

Desmin is what?

A

Intermediate filament for muscle cells

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42
Q

Myogenin is what?

A

Nuclear transcription factor in immature skeletal muscle

Seen in sarcoma botryoides (rhabdosarcoma variant)

  • girls under 4 yo
  • spindle shaped cells
  • clear, grape-like polypoid mass emerging from vagina
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43
Q

Proliferation phase is driven by? What is happening during this phase?

A

Estrogen.

Growth of the endometrium (functionalis layer)

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44
Q

Secretory phase is driven by? What is happening during this phase?

A

Progesterone.

Preparation of the endometrium for implantation (secretion of products from the functionalis layer glands)

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45
Q

Menstrual phase is driven by? What is happening during this phase?

A

Decline of progesterone.

Shedding of the functionalis layer of the endometrium

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46
Q

What 3 conditions show up as calcifications on mammography?

A
  • Ductal Carcinoma In Situ
  • Fibrocystic change - Sclerosing Adenosis
  • Fat Necrosis
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47
Q

BRCA1 mutation predisposes to (2)

A
  • Female IDC - Medullary CA type

- Serous CA of the ovary or fallopian tube

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48
Q

BRCA2 mutation predisposes to (1)

A

-Male IDC

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49
Q

Mutation found in LCIS and ILC?

A

Inhibition of E-cadherin

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50
Q

Retraction of the nipple is found in what 2 conditions?

A
  • Invasive ductal carcinoma

- Periductal mastitis

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51
Q

2 types of choriocarcinoma and their treatments?

A
  • Gestational Choriocarcinoma - complication of a complete mole, chemotherapy is effective
  • Germ Cell Choriocarcinoma of the Ovary - malignant tumor of trophoblast cells, no villi, chemotherapy is NOT effective
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52
Q

Leukoplakia in males?

A

Bowen Disease

53
Q

How does elevated beta-hCG cause hyperthyroidism and gynecomastia in males?

A

The alpha subunit of LH, FSH, TSH and beta-hCG is all the same

54
Q

CA-125 =

A

ovarian tumor marker

55
Q

Positive beta-hCG in a male (3) =

A
  • embryonal carcinoma germ cell tumor
  • teratoma germ cell tumor
  • choriocarcinoma germ cell tumor
56
Q

What type of leiomyoma is worst?

A

Submucosal leiomyoma -> menometrorrhagia

57
Q

Choriocarcinoma CAN/CANNOT follow a normal pregnancy?

58
Q

Most important risk factor for ectopic pregnancy?

A

History of PID

59
Q

CAH - XX with no secondary sexual characteristics

A

17-alpha hydroxylase deficiency

60
Q

CAH - XY with salt wasting and increased 17-hydroxyprogesterone

A

21 hydroxylase deficiency

61
Q

CAH - XX with virilization and increased 17-hydroxyprogesterone

A

21 hydroxylase deficiency

62
Q

CAH - XX with virilization and hypertension

A

11-beta hydroxylase deficiency

63
Q

increased beta-hCG in males = (3)

A
  • Embryonal testicular CA (Germ cell tumor)
  • Choriocarcinoma (Germ cell tumor)
  • Teratoma (Germ cell tumor)
64
Q

How is Leuprolide administered for infertility vs prostate cancer?

A

Infertility = Pulsatile

Prostate cancer = Continuous

65
Q

GnRH is released from where?

A

Pre-optic nucleus in the hypothalamus

66
Q

Cri-du-chat syndrome mutation?

A

Terminal deletion of the short arm of chromosome 5

67
Q

Holoprosencephaly, small head, absent eyebrows, cleft lip or palate, dysplastic ears, polydactyly, decreased viability

A

Trisomy 13 (Patau syndrome)

68
Q

Low birth weight, small mouth/jaw, shield chest, prominent occiput, dysplastic ears, clenched hand with overlapping fingers, life expectancy 1 week

A

Trisomy 18 (Edward’s Syndrome)

69
Q

What is a robersonian translocation and what chromosomes can be affected?

A

Rearrangement in acrosomic chromosomes (13, 14, 15, 21, 22). Results in a centric fusion of the two long arms and the loss of the short arms. Balanced = 45 chromosomes; Unbalanced = 46 chromosomes.

70
Q

female phenotype, short stature, broad chest, streak gonads, aortic constriction, bicuspid aortic valve =

A

Turner Syndrome (45, XO)

71
Q

Male phenotype, tall stature, gynecomastia, small testis =

A

Kleinfelter Syndrome (47, XXY)

72
Q

What is noticed first in female pubertal development?

A

Breast development

73
Q

What is noticed first in male pubertal development?

A

Testicular enlargement

74
Q

Central precocious puberty is caused by?

A

Premature reactivation of the HA axis. Increased secretion of GnRH results in increased sex steroids.

75
Q

Peripheral precocious puberty is caused by?

A

Non-GnRH stimulated sex steroid secretion.

76
Q

Fallopian tube epithelium = ? What are the names and functions of those cells?

A

Simple columnar epithelium.
Ciliated cells - beat towards the uterus
Peg cells - secrete nutrients, carbohydrates, enzymes for capacitation of sperm

77
Q

Basal body temperature drops right before _

A

Menstruation

78
Q

Blood supply to ovary travels in?

A

Suspensory ligament of the ovary (ovarian artery and vein)

79
Q

Blood supply to the uterus (5)

A

Uterine artery -> arcuate artery (perimetrium) -> radial artery (myometrium) -> straight artery (stratum basalis - endometrium) -> spiral artery (stratum functionalis - endometrium)

80
Q

Location of the cervical squamocolumnar junction 1) pre-puberty 2) post-pubrty/post-partum

A

1) inside the cervical os

2) outside the cervical os

81
Q

Path of sperm (starting from seminiferous ducts ->-> exit)

A

Seminiferous tubules -> Straight tubles -> Rete testes -> Efferent tubules -> Epididymis -> Ductus Deferens -> Prostatic urethra -> Membranous urethra -> Spongy urethra -> exit

82
Q

What are in seminal vesicle secretions? (3)

A
  • fructose
  • prostaglandins
  • proteins
83
Q

Which placental cells are in direct contact with maternal blood?

A

Synctiotrophoblasts

84
Q

Which placental cells invade maternal spiral arteries?

A

Cytotrophoblasts

85
Q

Monozygotic twins -

1) split at 0-4 days
2) split at 4-8 days
3) split at 8-12 days

A

1) 2 chorions, 2 amnions
2) 1 chorion, 2 amnions
3) 1 chorion, 1 amnion

86
Q

How do fraternal/dizygotic twins occur?

A

Two eggs are ovulated in the same cycle and are fertilized by two different sperms.

87
Q

Painless bleeding the 2nd-3rd trimester?

A

Placenta previa

88
Q

Painful bleeding the 2nd-3rd trimester? (2)

A
  • Placental abruption

- Uterine rupture

89
Q

PCOS hormones

A

increase in GnRH, LH
increase in LH -> increase in androgens -> hair + acne
low FSH
increased LH -> increased E

hyperinsulinemia/insulin resistance

90
Q

Preeclapmsia vs Eclampsia?

A

Preeclampsia = HTN post 20 weeks gestation + proteinuria + edema

Eclampsia = preeclampsia + seizures

91
Q

epithelium of the epididymis? what are the cell types (2)?

A

pseudostratified columnar epithelium

principle cells
basal cells

92
Q

When does the baby begin producing its own IgM?

93
Q

Female labia majora = Male _

94
Q

Male ventral shaft of penis + penile urethra = Female _

A

Labia minora

95
Q

Primary oocytes are arrested in _ I/II?

A

Prophase I

Remain here until ovulation

96
Q

Secondary oocyes are arrested in _ I/II?

A

Metaphase II

Remain here until fertilization

97
Q

Bloody nipple discharge with no associated breast changes?

A

Intraductal papilloma

  • Benign
  • Proliferation of papillary cells in a duct/cyst with a fibrovascular core
98
Q

What hormone ensures that lactation does not occur during pregnancy even though prolactin levels are rising?

A

Progesterone

99
Q

Female (46 XX) newborn with ambiguous genitalia and clitoromegaly with elevated levels of androstenedione. Mother had virilization during pregnancy.

A

Aromatase deficiency (AR)

  • Increased T, Decreased E
  • Normal female internal genitalia
  • Virilized external genitalia
  • As she grows up, due to the lack of estrogen: primary amenorrhea, osteoporosis, tall stature
  • Maternal virilization is due to the androgens crossing the placenta and affecting the mother

Similar presentation to 21 hydroxylase deficiency except for the lack of estrogen symptoms as she grows up and the lack of maternal virilization

100
Q

Genetics of a partial mole

A

69XXX, 69 XXY, 69 XYY

Normal egg + sperm + sperm

Will see some fetal tissue

101
Q

Genetics of a complete mole

A

Most common: 46 XX - empty egg + X sperm that duplicates
Less common: 46 XY - empty egg + X sperm + Y sperm

No fetal tissue will be present

102
Q

Most common pathogen found in septic abortions?

A

Staph aureus
Also might be found: E coli, Group B Strep
Septic abortion = retained products of conception in uterine cavity

103
Q

Pulmonary artery branches with swirls of fetal squamous cells seen on autopsy

A

Amniotic fluid embolism

Often this is fatal

104
Q

What cells in female ovaries secrete androgens?

A

Theca interna cells

-Stimulated by LH

105
Q

What cells in female ovaries secrete estrogen?

A 
Granulosa cells (contain aromatase)
-Stimulated by FSH
106
Q

Perineal straddle injury in men injures the _ urethra. Urine leaks into the _.

A

Anterior urethra - bulbar and penile

Deep fascia of Buck or Superficial perineal space

107
Q

Pelvic fracture in men injures the _ urethra. Urine leaks into the _.

A

Posterior urethra - prostatic + membranous

Retropubic space

108
Q

ovarian mass that looks like the bladder and has coffee bean nuclei on H&E

A

Brenner tumor

109
Q

mass of spindle shaped cells in the ovary. creates a “pulling” sensation.

110
Q

Ovarian fibroma + Ascites + Hydrothorax

A

Meigs syndrome

111
Q

adolescent with an ovarian mass. sheets of uniform fried-egg looking cells on LM. increased LDH and beta-hCG.

A

Dysgerminoma

112
Q

What male testicular tumor is radiosensitive?

A

Seminoma

  • painless
  • never seen in infancy
  • fried egg appearance of cells
  • increased ALP
113
Q

Proliferation of ducts in hyalinized fibrous tissue with periductal edema

A

Gynecomastia

114
Q

Ovarian tumor: Call exner bodies + positive inhibin stain

A

Granulosa cell tumor

-Secretes estrogen

115
Q

Cells found in chronic endometritis?

A

Plasma cells are diagnostic

116
Q

Superficial inguinal ring is made out of

A

External oblique

117
Q

Deep inguinal ring is made out of

A

Transversalis fascia

118
Q

Malformation vs Deformation

A

Malformation = primary intrinsic defect that results in downstream effects

Deformation = structural anomalies that occur due to extrinsic forces

119
Q

What 4 things does human placental lactogen do in the second half of pregnancy?

A
  • Increases insulin resistance - increases blood glucose
  • Increases proteolysis
  • Increases lipolysis
  • Increases insulin secretion
120
Q

Painless scrotal mass + increased heat intolerance + elevated T4/T3 + normal TSH

A

Germ cell tumor - secretes beta-hCG

121
Q

When do the syncytiotrophoblasts begin secreting beta-hCG?

A

Implantation and secretion begin around day 6-7 post-fertilization

@day 8 the levels can be detected in serum
@day 14 the levels can be detected in urine

122
Q

CA-125 is a marker for?

A

Epithelial ovarian tumors

123
Q

Uterine atony

A
  • Failure of the uterus to contract adequately post-delivery
  • Most common cause of postpartum hemorrhage
  • If uterus does not respond to uterotonic agents, then do surgery to ligate the internal iliac a bilateral (-> uterine artery)

There is enough collateral supply to all things that internal iliac artery gives rise to

124
Q

Uncomplicated delivery 9 weeks prior. Woman presents with shortness of breath. Uterus is enlarged and beta-hCG is elevated. Chest x-ray shows multiple lung nodules bilaterally.

A

Gestational choriocarcinoma

  • Malignant proliferation of cytotrophoblasts and syncytiotrophoblasts
  • Hematogenous spread to lungs - pulmonary symptoms are usually the presenting symptoms
  • No villi present
125
Q

Vitamin A supplementation during pregnancy - yes or no?

A

NO

  • In well developed countries, mothers get enough vitamin A from diet
  • Excess vitamin A is teratogenic
126
Q

First line treatment for vomiting and nausea in pregnancy

A

Vitamin B6 supplementation

127
Q

4 causes of hydrops fetalis

A
  • Parvovirus B19
  • CMV
  • Syphilis
  • Alpha-thalassemia - HbBarts (no viable alpha gene)
128
Q

Heavy menstrual bleeding + anemia + enlarged uterus + pelvic heaviness + premenopausal woman

Uworld Journal (12 decks)

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