Pathology - repro

Question 1

Klinefelter syndrome (47, XXY)

Answer 1

hypogonadism! testicular atrophy, gynecomastia

abnormal seminiferous tubules and abnormal Leydig cell function (low inhibin, low testosterone), leads to increased FSH/LH, incr. estrogen

Barr body present

Question 2

Turner syndrome (45, XO)

Answer 2

female, short stature w. primary amenorrhea (most common)

no Barr body

menopause before menarche, decr. estrogen leads to incr. FSH/LH

pregnancy is possible w/ oocyte donation and exogenous estradiol/progesterone

Question 3

Aromatase deficiency

Answer 3

No estrogen synthesis

Masculinization of female infants, incr. serum testosterone, incr. serum androstenedione

Can present with maternal virilization during pregnancy

Question 4

Androgen insensitivity syndrome (46, XY)

Answer 4

Defect in androgen receptor

Normal-appearing female with female external genitalia, no uterus/fallopian tubes

testes are surgically removed to prevent malignancy

incr. testosterone, estrogen and LH

Question 5

5a reductase deficiency

Answer 5

no testosterone –> DHT

ambiguous genitalia until puberty, incr. testosterone causes masculinization

normal internal genitalia (testosterone intact)

Question 6

Kallmann syndrome

Answer 6

defective migration of GnRH cells and defective development of olfactory bulb

decr. synthesis of GnRH in the hypothalamus, decr. FSH/LH/testosterone

infertility in males and females

Question 7

Complete mole

Answer 7

46, very high hCG, enucleated egg + single sperm (duplicated paternal sperm), elevated risk of malignant disease, lots of maternal symptoms

honeycombed uterus (clusters of grapes)

Question 8

Partial mole

Answer 8

69 chromosomes, fetal parts present, 2 sperm + 1 egg, low risk of malignancy

Question 9

Treatment for gestational hypertension

Answer 9

alpha-methyldopa, labetalol, hydralazine, nifedipine

Question 10

Cause of pre-eclampsia

Answer 10

Abnormal placental spiral arteries, leads to endothelial dysfunction, vasoconstriction, ischemia

Look for proteinuria or end-organ dysfunction after 20th week of pregnancy

Question 11

Complications of pre-eclampsia

Answer 11

Placental abruption
Coagulopathy
Renal failure
Uteroplacental insufficiency
Eclampsia

Question 12

Causes of death in eclampsia

Answer 12

stroke, intracranial hemorrhage, ARDS

Question 13

HELLP syndrome

Answer 13

Hemolysis, elevated liver enzymes, low platelets

Look for schistocytes

Rupture of subcapsular liver hematomas can lead to severe hypotension

Question 14

Placenta accreta vs. increta vs. percreta

Answer 14

accreta - attachment to myometrium (no penetration)

increta - placenta penetrates into myometrium

percreta - placenta perforates through myometrium and into serosa

Question 15

Vasa previa triad

Answer 15

Membrane rupture, painless vaginal bleeding, fetal bradycardia

Question 16

HPV and cervical cancer

Answer 16

subtypes 16 and 18

produce E6 (flags p53 for ubiquitin degradation) and E7 (competitively inhibits RB)

lateral invasion of tumor can block ureters

Question 17

PCOS pathophysiology

Answer 17

hyperinsulinism/insulin resistance

incr. LH:FSH ratio
incr. androgens from theca interna cells
decr. follicular maturation

Question 18

ovarian cysts

Answer 18

follicular cyst - unruptured graffian cyst, most common ovarian mass

theca-lutein cyst - bilateral/multiple, due to gonadotropin stimulation, associated with choriocarcinoma/hydatidform moles

Question 19

mitigating risk factors for ovarian cancer

Answer 19

previous pregnancies, breastfeeding, OCPs, tubal ligation

Question 20

benign neoplasms

Answer 20

serous cystadenoma: lined with fallopian tube-like epithelium

mucinous cystadenoma: lined by mucus-secreting epithelium

endometrioma, mature teratoma (can present as hyperthyroidism), Brenner tumor (looks like bladder, coffee bean appearance), fibroma, thecoma

Question 21

Meigs syndrome

Answer 21

ovarian fibroma, ascites, hydrothorax

Question 22

dysgerminoma

Answer 22

most common ovarian tumor in adolescents

Question 23

Krukenberg tumor

Answer 23

GI tumor that metastasizes to ovaries (mucin-secreting signet cell adenocarcinoma)

Question 24

treatment of endometritis

Answer 24

gentamicin + clindamycin w/ or w/o ampillin

Question 25

breast pathology by location

Answer 25

nipple: Paget dz, breast abscess
lactiferous sinus: intraductal papilloma, mastitis
major duct: fibrocystic change, DCIS, invasive ductal carcinoma
terminal duct: tubular carcinoma
lobules: lobular carcinoma
stroma: fibroadenoma, Phyllodes

Question 26

phyllodes tumor

Answer 26

leaf-like projections, large bulky mass of connective tissue and cysts

may become malignant

Question 27

Drugs that cause gynecomastia

Answer 27

Spironolactone
Digoxin
Cimetidine
Alcohol
Ketoconazole

Question 28

Most important prognostic factor for breast cancer

Answer 28

Axillary node involvement

Question 29

Paget disease histology

Answer 29

large cells in epidermis with clear halo

Question 30

Invasive ductal vs. lobular

Answer 30

ductal - rock-hard with sharp margins, stellate infiltration

lobular - orderly row of cells, decr. E-cadherin

Question 31

Effects of cryptorchidism

Answer 31

Impaired spermatogenesis w/ normal testosterone levels (unilateral) or low T (bilateral)

incr. risk of germ cell tumors (hCG)

loss of inhibin = incr. in FSH

Question 32

Spermatocele

Answer 32

Cyst due to dilated epididymal duct or rete testis

Question 33

BPH location

Answer 33

periurethral (lateral and middle) lobes, compresses urethra into a vertical slit

hyperplasia not hypertrophy

Question 34

Prostate cancer location

Answer 34

posterior lobe (peripheral zone)

look for signs of bone mets