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1
Q

testicular atrophy, tall, long extremities, gynecomastia, female hair distribution?

A

Klinefelter - 47 XXY
presence of inactivated X chromosome = Barr body

dysgenesis of seminiferous tubules –> decreased inhibin –> increased FSH
abnormal Leydig cell fn –> decreased T –> increased LH –> increased E

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2
Q

short stature, streak ovary, shield chest, bicuspid aortic valve, preductal coarctation, webbed neck, lymphedema, horseshoe kidney?

A

Turner - 45 XO
MCC of 1ary amenorrhea
mitotic or meiotic error; complete monosomy or mosaicism

decreased estrogen –> increased LH/FSH

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3
Q

phenotypically normal, tall male; severe acne, learning disability, autism spectrum?

A

double Y male - XYY
random nondisjunction event in paternal meisosi II
normal fertility
non-inherited

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4
Q

ovaries, virilized/ambiguous external genitalia?

A

female pseudohermaphrodite

2/2 excessive exposure to androgens in early gestation - CAH, exogenous

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5
Q

testes, feminized/ambiguous genitalia?

A

male psedohermaphrodite

MCC androgen insensitivity syndrome

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6
Q

female infant with ambiguous genitalia, maternal virilization during pregnancy?

A

aromatase deficiency

increased serum T and androstenedione

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7
Q

female external genitalia, scant sexual hair, rudimentary vagina, testes in labia majora?

A

androgen insensitivity - 46XY
defect in androgen receptor
increased T, estrogen, LH

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8
Q

ambiguous genitalia until puberty –> masculinization/growth of external genitalia?

A

5alpha reductase deficiency - AR
T/E normal
LH normal or increased

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9
Q

failure to complete puberty, anosmia?

A

Kallmann syndrome
defective migration of GnRH cells and formation of olfactory bulb
decreased GnRH, FSH, LH, T
infertility

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10
Q

complete vs partial mole: karyotype?

A

complete: 46 XX, 46 XY
partial: 69 XXX, 69 XXY, 69 XYY

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11
Q

complete vs partial mole: hCG?

A

complete: very elevated
partial: elevated

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12
Q

complete vs partial mole: conversion to choriocarcinoma?

A

complete: 2%
partial: rare

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13
Q

complete vs partial mole: fetal parts?

A

complete: no
partial: yep

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14
Q

complete vs partial mole: components?

A

complete: enucleated egg + single sperm (paternal DNA duplicates)
partial: 2 sperm + 1 egg

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15
Q

complete vs partial mole: complication risk?

A

complete: 15-20% malignant trophoblastic dz
partial: 5%

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16
Q

complete vs partial mole: symptoms?

A

compelte: 1st tri bleeding, enlarged uterus, hyperemesis, pre-eclampsia, hyperthyroidism
partial: bleeding, abd pain

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17
Q

complete vs partial mole: imaging?

A

complete: honeycomb/grape/snowstowm
partial: fetal parts

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18
Q

tx of gestational HTN?

A

alpha-methyldopa
labetalol
hydralazine
nifedipine

** deliver at 37-39 weeks

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19
Q

cause of preeclampsia?

A

abnormal placental spiral aa –> endothelial dysfunction, vasoconstriction, ischemia

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20
Q

causes of maternal death in eclampsia?

A

stroke
intracranial hemorrhage
ARDS

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21
Q

complications of HELLP?

A

hepatic subcapsular hematomas –> rupture –> hypotension

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22
Q

risk factors for placental abruption?

A 
trauma
smoking
HTN
preeclampsia
cocaine abuse
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23
Q

risk factors for placenta accreta/increta/percreta?

A

prior C section
inflammation
placenta previa

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24
Q

complication of placenta percreta?

A

placental attachment to rectum or bladder

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25
risk factors for placenta previa?
multiparity | prior C section
26
membrane rupture, painless vaginal bleeding, fetal bradycardia?
vasa previa assoc with velamentous umbilical cord insertion may result in vessel rupture, exsanguination, fetal death emergency C section
27
causes of polyhydramnios?
fetal malformations --> inability to swallow maternal diabetes fetal anemia multiple gestations
28
causes of oligohydramnios?
placental insufficiency B/L renal agenesis posterior urethral valves
29
girl < 4yo, clear grape-like polypoid mass coming from vagina?
sarcoma botryoides - variant of rhabdomyosarcoma spindle shaped cells desmin +
30
pathogenesis of cervical ca?
HPV 16, HPV 18 E6 gene product --> inhib p53 E7 gene product --> inhib RB
31
risk factors for cervical ca?
*** #1 = multiple sexual partners *** smoking young age at first sexual intercourse HIV infection
32
lateral invasion of cervical carcinoma?
can block ureters --> renal failure
33
MCCs of anovulation?
``` pregnancy PCOS obesity HPO axis abnormalities premature ovarian failure hyperprolactinemia etc etc etc ```
34
pathogenesis of PCOS?
hyperinsulinemia/insulin resistance --> altered hypothalamic feedback loop --> increased LH:FSH, increased androgens from theca cells, decreased follicular maturation
35
tx of PCOS?
``` weight reduction OCPs clomiphene ketoconazole spironolactone ```
36
MC ovarian cyst in young women?
follicular cyst distention of unruptured graafian follicle assoc with hyperestrogenism, endometrial hyperplasia
37
theca-lutein cyst?
due to gonadotropin stimulation assoc with choriocarcinoma and hydaditiform moles often B/L, multiple
38
MC adnexal mass in women >55?
ovarian neoplasm
39
ovarian neoplasm, lined with fallopian-tube like epithelium?
serous cystadenoma MC ovarian neoplasm often B/L
40
ovarian neoplasm, multiloculated, lined with mucus-secreting epithelium?
mucinous cystadenoma
41
chocolate cyst?
ovarian endometrioma
42
MC ovarian tumor in women 20-30 yo?
mature teratoma = dermoid cyst all 3 germ layers ** can contain functional thyroid tissue --> hyperthyroidism
43
ovarian neoplasm, looks like bladder, yellow-tan, encapsulated?
Brenner tumor ** coffee bean nuclei on H&E
44
fibroma?
ovarian neoplasm bundle of spindle shaped fibroblasts pulling sensation in groin
45
Meigs syndrome?
ovarian fibroma ascites hydrothorax
46
thecoma?
may produce E | presentation: AUB in post menopausal woman
47
ovarian neoplasm, aggressive, contains fetal tissue, neuroectoderm?
immature teratoma | malignant
48
ovarian neoplasm, produces E/P, Call Exner bodies on histo?
granulosa cell tumor women in 50s, abnormal uterine bleeding ** C-E bodies = granulosa cells around collections of eosinophilic fluid - resemble primordial follicles
49
serous cystadenocarcinoma?
MC malignant ovarian neoplasm frequently B/L ** psammoma bodies
50
ovarian neoplasm with intraperitoneal mucinous material?
mucinous cystadenocarcinoma
51
ovarian neoplasm, sheets of fried egg cells?
dysgerminoma (equiv of seminoma in men) MC in adolescents ** hCG, LDH = tumor markers
52
choriocarcinoma?
during/after preg, mother or baby cytotrophoblasts and syncytiotrophoblasts, NO chorionic villi elevated bHC, SOB, hemoptysis (hematogenous spread to lungs) * * very responsive to chemo * * increased freq of theca lutein cysts
53
yolk sac tumor?
aggressive ovaries/testes or sacrococcygeal area yellow, friable solid mass AFP = marker ** Schiller Duval bodies - look like glomeruli
54
signet cells in ovarian neoplasm?
Krukenberg tumor GI malignancy --> mets to ovary mucin secreting adenocarcinoma
55
uterine biopsy: whorled pattern of smooth mm bundles, well-demarcated borders?
leiomyoma
56
causes of endometritis?
retained products of conception | foreign body
57
tx of endometritis?
gent + clinda | +/- ampicillin
58
small, mobile, firm breast mass with sharp edges; size and tenderness increased with estrogen?
fibroadenoma | MC tumor in <35yo
59
serous or bloody nipple discharge?
intraductal papilloma | 1.5-2x risk of carcinoma
60
large bulky breast mass; leaf-like projections on biopsy?
phyllodes tumor MC in 40s some malignant potential
61
histologic types of proliferative breast dz?
fibrosis cystic - fluid filled, blue dome, ductal dilation sclerosing adenosis - acini and intralobular fibrosis, calcifications epithelial hyperplasia - in terminal duct lobule
62
tx of lactational mastitis?
dicloxacillin | continue breastfeeding
63
drugs that cause gynecomastia?
``` spironolactone digoxin cimetidine alcohol ketoconazole ``` (some drugs cause awesome knockers)
64
most important prognostic factor in breast ca?
axillary LN involvement - indication of metastasis
65
what do Paget cells look like?
large cells in epidermis | clear halo
66
firm fibrous rock hard breast mass; stellate infiltration, small glandular duct like cells?
invasive ductal ca
67
breast mass, indian file cells?
invasive lobular ca - rows of cells 2/2 decreased E-cadherin expression often B/L, multiple lesions in same location
68
breast mass: fleshy, cellular, lymphocytic infiltrate?
medullary ca | good prog
69
abnormal curvature of penis, assoc with ED, pain, anxiety?
Peyronie disease fibrous plaque w/in tunica albuginea surgery once curvature stabilizes
70
leukoplakia of penis?
Bowen disease | precursor of penile squamous cell ca
71
erythroplakia of penis?
erythroplasia of Queyrat | cancer of glans penis; precursor of penile squamous cell ca
72
reddish papules on penis?
Bowenoid papulosis | CIN of unclear malignant potential, possible precursor of squamous cell ca
73
hormonal changes with cryptorchidism?
decreased inhibin increased FSH, LH T normal if unilateral, decreased if bilateral
74
where do you find extragonadal germ cell tumors?
midline adults: RP, mediastinum, pineal, suprasellar kids: sacrococcygeal
75
painless homogenous testicular enlargement; large cells with watery cytoplasm and "fried egg" appearance?
seminoma MC testicular tumor usually in 20s; NEVER infancy increased ALP ** radiosensitive
76
MC testicular tumor in boys < 3?
yolk sac tumor - aggressive yellow, mucinous increased AFP ** Schiller Duval bodies - resemble primitive glomeruli
77
testicular tumor, may present with hemorrhagic stroke, gynecomastia, hyperthyroid sx?
choriocarcinoma syncytiotrophoblast and cytotrophoblast elements increased hCG ** hematogenous mets to lungs, brain
78
teratoma in males?
mature teratoma in adult males may be malignant | benign in children
79
painful, malignant, hemorrhagic testicular mass; glandular/papillary morphology?
embryonal carcinoma most commonly mixed with other tumor types increased hCG, normal AFP when PURE - increased AFP when mixed
80
Leydig cell tumors?
usually produce androgens --> gynecomastia (adults), precocious puberty (boys) golden brown ** Reinke crystals = eosinophilic cytoplasmic inclusions
81
Sertoli cell tumors?
androblastomas - from sex cord stroma
82
MC testicular ca in older men?
testicular lymphoma NOT 1ary - arises from lymphoma mets to testes aggressive
83
which lobes of prostate involved in BPH?
lateral and middle (periurethral lobes)
84
which lobes of prostate involved in prostate ca?
posterior lobe

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