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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
Q

risk factors for placenta previa?

A

multiparity

prior C section

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26
Q

membrane rupture, painless vaginal bleeding, fetal bradycardia?

A

vasa previa
assoc with velamentous umbilical cord insertion
may result in vessel rupture, exsanguination, fetal death
emergency C section

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27
Q

causes of polyhydramnios?

A

fetal malformations –> inability to swallow
maternal diabetes
fetal anemia
multiple gestations

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28
Q

causes of oligohydramnios?

A

placental insufficiency
B/L renal agenesis
posterior urethral valves

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29
Q

girl < 4yo, clear grape-like polypoid mass coming from vagina?

A

sarcoma botryoides - variant of rhabdomyosarcoma
spindle shaped cells
desmin +

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30
Q

pathogenesis of cervical ca?

A

HPV 16, HPV 18
E6 gene product –> inhib p53
E7 gene product –> inhib RB

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31
Q

risk factors for cervical ca?

A

** #1 = multiple sexual partners **
smoking
young age at first sexual intercourse
HIV infection

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32
Q

lateral invasion of cervical carcinoma?

A

can block ureters –> renal failure

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33
Q

MCCs of anovulation?

A 
pregnancy
PCOS
obesity
HPO axis abnormalities
premature ovarian failure
hyperprolactinemia
etc etc etc
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34
Q

pathogenesis of PCOS?

A

hyperinsulinemia/insulin resistance –> altered hypothalamic feedback loop
–> increased LH:FSH, increased androgens from theca cells, decreased follicular maturation

35
Q

tx of PCOS?

A 
weight reduction
OCPs
clomiphene
ketoconazole
spironolactone
36
Q

MC ovarian cyst in young women?

A

follicular cyst
distention of unruptured graafian follicle
assoc with hyperestrogenism, endometrial hyperplasia

37
Q

theca-lutein cyst?

A

due to gonadotropin stimulation
assoc with choriocarcinoma and hydaditiform moles
often B/L, multiple

38
Q

MC adnexal mass in women >55?

A

ovarian neoplasm

39
Q

ovarian neoplasm, lined with fallopian-tube like epithelium?

A

serous cystadenoma
MC ovarian neoplasm
often B/L

40
Q

ovarian neoplasm, multiloculated, lined with mucus-secreting epithelium?

A

mucinous cystadenoma

41
Q

chocolate cyst?

A

ovarian endometrioma

42
Q

MC ovarian tumor in women 20-30 yo?

A

mature teratoma = dermoid cyst
all 3 germ layers

** can contain functional thyroid tissue –> hyperthyroidism

43
Q

ovarian neoplasm, looks like bladder, yellow-tan, encapsulated?

A

Brenner tumor

** coffee bean nuclei on H&E

44
Q

fibroma?

A

ovarian neoplasm
bundle of spindle shaped fibroblasts
pulling sensation in groin

45
Q

Meigs syndrome?

A

ovarian fibroma
ascites
hydrothorax

46
Q

thecoma?

A

may produce E

presentation: AUB in post menopausal woman

47
Q

ovarian neoplasm, aggressive, contains fetal tissue, neuroectoderm?

A

immature teratoma

malignant

48
Q

ovarian neoplasm, produces E/P, Call Exner bodies on histo?

A

granulosa cell tumor
women in 50s, abnormal uterine bleeding

** C-E bodies = granulosa cells around collections of eosinophilic fluid - resemble primordial follicles

49
Q

serous cystadenocarcinoma?

A

MC malignant ovarian neoplasm
frequently B/L

** psammoma bodies

50
Q

ovarian neoplasm with intraperitoneal mucinous material?

A

mucinous cystadenocarcinoma

51
Q

ovarian neoplasm, sheets of fried egg cells?

A

dysgerminoma (equiv of seminoma in men)
MC in adolescents

** hCG, LDH = tumor markers

52
Q

choriocarcinoma?

A

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
Q

yolk sac tumor?

A

aggressive
ovaries/testes or sacrococcygeal area
yellow, friable solid mass
AFP = marker

** Schiller Duval bodies - look like glomeruli

54
Q

signet cells in ovarian neoplasm?

A

Krukenberg tumor
GI malignancy –> mets to ovary
mucin secreting adenocarcinoma

55
Q

uterine biopsy: whorled pattern of smooth mm bundles, well-demarcated borders?

A

leiomyoma

56
Q

causes of endometritis?

A

retained products of conception

foreign body

57
Q

tx of endometritis?

A

gent + clinda

+/- ampicillin

58
Q

small, mobile, firm breast mass with sharp edges; size and tenderness increased with estrogen?

A

fibroadenoma

MC tumor in <35yo

59
Q

serous or bloody nipple discharge?

A

intraductal papilloma

1.5-2x risk of carcinoma

60
Q

large bulky breast mass; leaf-like projections on biopsy?

A

phyllodes tumor
MC in 40s
some malignant potential

61
Q

histologic types of proliferative breast dz?

A

fibrosis
cystic - fluid filled, blue dome, ductal dilation
sclerosing adenosis - acini and intralobular fibrosis, calcifications
epithelial hyperplasia - in terminal duct lobule

62
Q

tx of lactational mastitis?

A

dicloxacillin

continue breastfeeding

63
Q

drugs that cause gynecomastia?

A 
spironolactone
digoxin
cimetidine
alcohol
ketoconazole

(some drugs cause awesome knockers)

64
Q

most important prognostic factor in breast ca?

A

axillary LN involvement - indication of metastasis

65
Q

what do Paget cells look like?

A

large cells in epidermis

clear halo

66
Q

firm fibrous rock hard breast mass; stellate infiltration, small glandular duct like cells?

A

invasive ductal ca

67
Q

breast mass, indian file cells?

A

invasive lobular ca
- rows of cells 2/2 decreased E-cadherin expression

often B/L, multiple lesions in same location

68
Q

breast mass: fleshy, cellular, lymphocytic infiltrate?

A

medullary ca

good prog

69
Q

abnormal curvature of penis, assoc with ED, pain, anxiety?

A

Peyronie disease
fibrous plaque w/in tunica albuginea
surgery once curvature stabilizes

70
Q

leukoplakia of penis?

A

Bowen disease

precursor of penile squamous cell ca

71
Q

erythroplakia of penis?

A

erythroplasia of Queyrat

cancer of glans penis; precursor of penile squamous cell ca

72
Q

reddish papules on penis?

A

Bowenoid papulosis

CIN of unclear malignant potential, possible precursor of squamous cell ca

73
Q

hormonal changes with cryptorchidism?

A

decreased inhibin
increased FSH, LH
T normal if unilateral, decreased if bilateral

74
Q

where do you find extragonadal germ cell tumors?

A

midline

adults: RP, mediastinum, pineal, suprasellar
kids: sacrococcygeal

75
Q

painless homogenous testicular enlargement; large cells with watery cytoplasm and “fried egg” appearance?

A

seminoma
MC testicular tumor
usually in 20s; NEVER infancy
increased ALP

** radiosensitive

76
Q

MC testicular tumor in boys < 3?

A

yolk sac tumor - aggressive
yellow, mucinous
increased AFP

** Schiller Duval bodies - resemble primitive glomeruli

77
Q

testicular tumor, may present with hemorrhagic stroke, gynecomastia, hyperthyroid sx?

A

choriocarcinoma
syncytiotrophoblast and cytotrophoblast elements
increased hCG

** hematogenous mets to lungs, brain

78
Q

teratoma in males?

A

mature teratoma in adult males may be malignant

benign in children

79
Q

painful, malignant, hemorrhagic testicular mass; glandular/papillary morphology?

A

embryonal carcinoma
most commonly mixed with other tumor types

increased hCG, normal AFP when PURE - increased AFP when mixed

80
Q

Leydig cell tumors?

A

usually produce androgens –> gynecomastia (adults), precocious puberty (boys)
golden brown

** Reinke crystals = eosinophilic cytoplasmic inclusions

81
Q

Sertoli cell tumors?

A

androblastomas - from sex cord stroma

82
Q

MC testicular ca in older men?

A

testicular lymphoma
NOT 1ary - arises from lymphoma mets to testes
aggressive

83
Q

which lobes of prostate involved in BPH?

A

lateral and middle (periurethral lobes)

84
Q

which lobes of prostate involved in prostate ca?

A

posterior lobe

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