Quiz 1, Genitalia SP2015

Question 1

What is a DNA Poxvirus that looks similar to herpes?

Answer 1

Molluscum contagiosum

Question 2

How does molluscum contagiosum present compared to herpes viruses?

Answer 2

MCV does not remain in the body after lesions heal. You can become reinfected though.

Question 3

When psoriasis is present on the vulva, where does it usually occur? And what can it resemble?

Answer 3

Hear bearing portions.

Fungal infections

Question 4

What term describes the epithelial extensions that project into the underlying connective tissue in both skin and mucous membranes?

Answer 4

Rete pegs

Question 5

What is a non-specific skin condition that develops as a consequence of chronic pruritus and scratching?

Answer 5

Lichen simplex chronicus

Question 6

Microscopic findings consist of elongation, widening and irregular thickenings of rete ridges, acanthosis, hyperkeratosis and chronic inflammation in dermis.

Answer 6

Lichen simplex chronicus

Question 7

What skin condition that often happens in other regions of the body, can also occur around the vulva in women of childbearing age?

Answer 7

Lichen planus

Question 8

What is the microscopic appearance of lichen planus?

Answer 8

Degeneration of the basal cell layer
Thickening of the granular cell layer
Infiltration of inflamm cells into the sub-epithelial layer of CT
“Saw-tooth” appearance of rete pegs

Question 9

What vulvar skin condition is associated with vulvar cancer?

Answer 9

Lichen sclerosus

Question 10

What are the histological characteristics of lichen sclerosus?

Answer 10

Edematous degeneration of basal layer
Atrophy of epidermis w/disappearance of the rete pegs
Underlying dermis is replaced by dense collagenous fibrous tissue
Infiltrates of band-like lymphocytes

Question 11

Bartholin’s duct cysts are lined by either of what two types of cells?

Answer 11

Transitional epithelium of the normal duct, or

Epithelium that reveals squamous metaplasia

Question 12

What STI reveals multinucleated giant cells on microscopy?

Answer 12

Herpes simplex

Question 13

What STI is spread via skin-to-skin contact and is a sub-type of HPV?

Answer 13

Condyloma acuminata (genital warts)

Question 14

Which two types of HPV are responsible for 90% of genital wart cases?

Answer 14

6 & 11

Question 15

Which two types of HPV are responsible for 70% of cases of cervical cancer?

Answer 15

16 & 18

Question 16

What are the histological findings of condyloma acuminata?

Answer 16

Acanthosis
Hyperkeratosis
Cytoplasmic vacuolation

Question 17

What is the spirochete bacterium that causes syphilis?

Answer 17

Treponema pallidum

Question 18

What lesions are typical of secondary syphilis?

Answer 18

Condyloma latum (flat warts)

Question 19

Which two conditions are associated with a fishy odor and a high vaginal pH?

Answer 19

Bacterial vaginosis
Trichomonas vaginitis
(Candida has no odor and low pH)

Question 20

What condition sometimes has a cottage cheese appearance?

Answer 20

Candida vaginitis

Question 21

What are epithelial cells that are coated with bacteria and are associated with bacterial vaginosis?

Answer 21

Clue cells

Question 22

What condition is characterized by the presence of hyperpigmented skin plaques?

Answer 22

Vulvar intraepithelial neoplasia

Question 23

Vulvar intraepithelial neoplasia is associated with was condition in 10-30% of cases?

Answer 23

Primary squamous neoplasm in either the vagina or cervix.

Question 24

What is the histologic appearance of HPV positive VIN?

Answer 24

Diffuse cellular atypia
Nuclear crowding
Increased mitotic index

Question 25

~85% of vulvar cancers are of what type?

Answer 25

Squamous cell carcinoma

Question 26

What factors are linked to metastatic spread of vulvar carcinoma?

Answer 26

Size of primary tumor Depth of invasion Involvement of lymphatic vessels

Question 27

Adenocarcinoma of the vagina is rare, but associated with clear cell carcinoma in what population?

Answer 27

Young women whose mothers had been treated with diethylstilbestrol during pregnancy

Question 28

Cervical Intraepithelial Neoplasia has three classification. What are they?

Answer 28

CIN1 (LSIL)- mild dysplasia CIN2 (HSIL)- moderate dysplasia CIN3 (HSIL)- severe dysplasia and carcinoma in situ

Question 29

What term is used to describe cellular changes in which cells nuclei are enlarged and often stain with a halo-like appearance?

Answer 29

Koilocytosis

Question 30

Koilocytosis is characteristic of what condition?

Answer 30

Atypical squamous cells of undetermined significance ASC-US

Question 31

What are the histologic findings with endocervical cancer?

Answer 31

Cluster of endocervical cancer cells with enlarged round or oval nuclei, irregular chromatin distribution and prominent nucleoli

Question 32

What characterizes stage 1 cervical cancer?

Answer 32

Carcinoma confined to the cervix

Question 33

What characterizes stage 2 cervical cancer?

Answer 33

Carcinoma extends beyond the cervix but not onto the pelvic wall (vagina, but not lower 1/3)

Question 34

What characterizes stage 3 cervical cancer?

Answer 34

Carcinoma extended to pelvic wall. No space b/t tumor and pelvic wall on DRE

Question 35

What characterizes stage 4 cervical cancer?

Answer 35

Carcinoma beyond true pelvis or mucosa of bladder/rectum. Metastatic dissemination also.

Question 36

What is the primary characteristic feature of endometriosis?

Answer 36

Cells from the endometrial lining of the uterus appear and flourish outside the uterine cavity

Question 37

What is the most common site of implantation for ectopic endometrial cells?

Answer 37

Ovaries

Question 38

How is endometrioma different from endometriosis?

Answer 38

(chocolate cyst) is an ovarian cyst formed from endometrial tissue that bleeds within the ovary

Question 39

What is adenomyosis?

Answer 39

The presence of ectopic endometrial tissue within the myometrium. "adenomyometritis" is specific to the uterus.

Question 40

What is characteristic of acute endometritis?

Answer 40

Micro-abscesses or neutrophils within the endometrial glands

Question 41

What is characteristic of chronic endometritis?

Answer 41

The presence of plasma cells in the stroma

Question 42

What type of gynecologic cancers are most common in the US?

Answer 42

Endometrial

Question 43

What is the most common type of endometrial cancer?

Answer 43

Adenocarcinoma

Question 44

What are the risk factors for endometrial cancers?

Answer 44

``` Age 55-65 Nulliparity Obesity Hyperglycemia/DM Hypertension ```

Question 45

What distinguishes carcinoma from hyperplasia?

Answer 45

In well differentiated endometrial adenocarcinoma, the glandular architecture is preserved but the tissue is confluent without intervening stroma

Question 46

What condition is notable for the accumulation of p53 protein?

Answer 46

Papillary serous carcinoma

Question 47

What are benign smooth muscle tumors of the uterus, also known as fibroids?

Answer 47

Leiomyomas

Question 48

What is the microscopic appearance of leiomyomas?

Answer 48

Muscle cells generally uniform in size and shape with oval nuclei. Characteristic whorled pattern of smooth muscle

Question 49

How does a leiomyosarcoma compare to a leiomyoma?

Answer 49

Greater density of cells More pleomorphic More hyperchromatic

Question 50

What condition is the most commonly diagnosed causes of female infertility and one of the most common endocrine disorders?

Answer 50

Polycystic ovary syndrome

Question 51

Polycystic ovaries can develop when the ovaries are stimulated to produce what?

Answer 51

Excessive amounts of male hormones by the release of excessive LH from the anterior pituitary.

Question 52

What are common concomitants with PCOS?

Answer 52

``` Insulin resistance weight gain high cholesterol hyperglycemia DM ```

Question 53

What are the principal lab findings with PCOS?

Answer 53

LH > FSH 3:1 or greater elevated testosterone estrogen dominance

Question 54

80% of epithelial tumors of the ovaries are what type?

Answer 54

Serous (benign)

Question 55

Serous tumors of the ovary are characterized by what?

Answer 55

Proliferation of epithelium resembling that seen in the lining of the fallopian tubes

Question 56

What is the histologic appearance of a serous cystadenoma of the ovary?

Answer 56

Single layer of cuboidal or epithelial cells with or without cilia

Question 57

What histologic finding is commonly found in ovarian serous cystadenocarcinoma, among other neoplasms?

Answer 57

Psammoma bodies

Question 58

What is the most common birth defect of the male genitalia?

Answer 58

Cryptorchidism

Question 59

Differentiate phimosis and paraphimosis. For what condition are they both a risk factor?

Answer 59

Phimosis - foreskin cannot fully retract Para- foreskin is trapped behind the glans Penile cancer

Question 60

What condition is caused by defective valves or compression of the veins that drain the testis?

Answer 60

Varicocele

Question 61

Which side does 98% of idiopathic varicocele occur on and why?

Answer 61

Left because the left testicular vein connects to the renal vein at a 90 degree angle.

Question 62

What causes hydrocele?

Answer 62

Accumulation of fluids around a testicle caused by fluid secreted by the tunica vaginalis. It is often the result of trauma, hernia, orchitis, or cancer.

Question 63

What is the most common underlying cause of testicular torsion?

Answer 63

A congenital malformation known as bell-clapper deformity. The testis is inadequately affixed to the spermatic cord.

Question 64

What is the most common cause of non-gonococcal urethritis (NGU)?

Answer 64

Chlamydia trachomatis

Question 65

How do you differentiate gonococcal from non-specific urethritis (NSU) or NGU?

Answer 65

Gonococcal has a purulent d/c, while others have a clear d/c

Question 66

What condition is characterized by the triad of urethritis(M)/cervicitis(F), inflammation of the eyes, and inflammatory arthritis of large joints?

Answer 66

Reactive arthritis or Reiter's syndrome

Question 67

What condition is characterized by shallow painless ulcers at meatus and glans penis?

Answer 67

Balanitis circinata

Question 68

What histologic finding is characteristic of HSV?

Answer 68

Multinucleated giant cell

Question 69

What bacteria is responsible for syphilis?

Answer 69

Treponema pallidum (a spirochete bacterium)

Question 70

What is a soft, non-cancerous growth resulting from the tertiary stage of syphilis?

Answer 70

Gumma

Question 71

Around 95% of penile cancers are what type?

Answer 71

Squamous cell carcinomas

Question 72

What HPV strain if the leading cause of HPV positive tumors?

Answer 72

16

Question 73

What is the most common solid malignant tumor in men aged 20-35?

Answer 73

Primary testicular tumors

Question 74

What is the most common classification of testicular cancer?

Answer 74

Seminoma (~35%)

Question 75

What are the blood test findings of a seminoma case?

Answer 75

+placental alkaline phosphatase +hCG -alpha-fetoprotein

Question 76

What is the microscopic appearance of a seminoma?

Answer 76

(lymphoid stroma) Sheet-like or lobular pattern of cells with a fibrous stromal network Abundant clear to pale pink cytoplasm containing abundant glycogen with prominent nuclei that usually contain 1 or 2 large nucleoli and have prominent nuclear membranes

Question 77

What is a germ cell tumor that occurs in the ovaries and testes causing hCG and AFP to be increased?

Answer 77

Embryonal carcinoma

Question 78

What tumor presents microscopically with nuclear atypia, prominent nucleoli, nuclei overlap and mitoses common?

Answer 78

Embryonal carcinoma

Question 79

What is the second most common cause of cancer related death in men in the US?

Answer 79

Prostate cancer

Question 80

95% of prostate cancers are of what type?

Answer 80

Adenocarcinoma

Question 81

At high magnification what is the appearance of prostate adenocarcinoma?

Answer 81

Still appear as glands, but there is no intervening stroma and the nuclei are hyperchromatic. Enlarged nucleoli and mitotic figures.