repro Flashcards
testicular atrophy, tall, long extremities, gynecomastia, female hair distribution?
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
short stature, streak ovary, shield chest, bicuspid aortic valve, preductal coarctation, webbed neck, lymphedema, horseshoe kidney?
Turner - 45 XO
MCC of 1ary amenorrhea
mitotic or meiotic error; complete monosomy or mosaicism
decreased estrogen –> increased LH/FSH
phenotypically normal, tall male; severe acne, learning disability, autism spectrum?
double Y male - XYY
random nondisjunction event in paternal meisosi II
normal fertility
non-inherited
ovaries, virilized/ambiguous external genitalia?
female pseudohermaphrodite
2/2 excessive exposure to androgens in early gestation - CAH, exogenous
testes, feminized/ambiguous genitalia?
male psedohermaphrodite
MCC androgen insensitivity syndrome
female infant with ambiguous genitalia, maternal virilization during pregnancy?
aromatase deficiency
increased serum T and androstenedione
female external genitalia, scant sexual hair, rudimentary vagina, testes in labia majora?
androgen insensitivity - 46XY
defect in androgen receptor
increased T, estrogen, LH
ambiguous genitalia until puberty –> masculinization/growth of external genitalia?
5alpha reductase deficiency - AR
T/E normal
LH normal or increased
failure to complete puberty, anosmia?
Kallmann syndrome
defective migration of GnRH cells and formation of olfactory bulb
decreased GnRH, FSH, LH, T
infertility
complete vs partial mole: karyotype?
complete: 46 XX, 46 XY
partial: 69 XXX, 69 XXY, 69 XYY
complete vs partial mole: hCG?
complete: very elevated
partial: elevated
complete vs partial mole: conversion to choriocarcinoma?
complete: 2%
partial: rare
complete vs partial mole: fetal parts?
complete: no
partial: yep
complete vs partial mole: components?
complete: enucleated egg + single sperm (paternal DNA duplicates)
partial: 2 sperm + 1 egg
complete vs partial mole: complication risk?
complete: 15-20% malignant trophoblastic dz
partial: 5%
complete vs partial mole: symptoms?
compelte: 1st tri bleeding, enlarged uterus, hyperemesis, pre-eclampsia, hyperthyroidism
partial: bleeding, abd pain
complete vs partial mole: imaging?
complete: honeycomb/grape/snowstowm
partial: fetal parts
tx of gestational HTN?
alpha-methyldopa
labetalol
hydralazine
nifedipine
** deliver at 37-39 weeks
cause of preeclampsia?
abnormal placental spiral aa –> endothelial dysfunction, vasoconstriction, ischemia
causes of maternal death in eclampsia?
stroke
intracranial hemorrhage
ARDS
complications of HELLP?
hepatic subcapsular hematomas –> rupture –> hypotension
risk factors for placental abruption?
trauma smoking HTN preeclampsia cocaine abuse
risk factors for placenta accreta/increta/percreta?
prior C section
inflammation
placenta previa
complication of placenta percreta?
placental attachment to rectum or bladder
risk factors for placenta previa?
multiparity
prior C section
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
causes of polyhydramnios?
fetal malformations –> inability to swallow
maternal diabetes
fetal anemia
multiple gestations
causes of oligohydramnios?
placental insufficiency
B/L renal agenesis
posterior urethral valves
girl < 4yo, clear grape-like polypoid mass coming from vagina?
sarcoma botryoides - variant of rhabdomyosarcoma
spindle shaped cells
desmin +
pathogenesis of cervical ca?
HPV 16, HPV 18
E6 gene product –> inhib p53
E7 gene product –> inhib RB
risk factors for cervical ca?
** #1 = multiple sexual partners **
smoking
young age at first sexual intercourse
HIV infection
lateral invasion of cervical carcinoma?
can block ureters –> renal failure
MCCs of anovulation?
pregnancy PCOS obesity HPO axis abnormalities premature ovarian failure hyperprolactinemia etc etc etc
pathogenesis of PCOS?
hyperinsulinemia/insulin resistance –> altered hypothalamic feedback loop
–> increased LH:FSH, increased androgens from theca cells, decreased follicular maturation
tx of PCOS?
weight reduction OCPs clomiphene ketoconazole spironolactone
MC ovarian cyst in young women?
follicular cyst
distention of unruptured graafian follicle
assoc with hyperestrogenism, endometrial hyperplasia
theca-lutein cyst?
due to gonadotropin stimulation
assoc with choriocarcinoma and hydaditiform moles
often B/L, multiple
MC adnexal mass in women >55?
ovarian neoplasm
ovarian neoplasm, lined with fallopian-tube like epithelium?
serous cystadenoma
MC ovarian neoplasm
often B/L
ovarian neoplasm, multiloculated, lined with mucus-secreting epithelium?
mucinous cystadenoma
chocolate cyst?
ovarian endometrioma
MC ovarian tumor in women 20-30 yo?
mature teratoma = dermoid cyst
all 3 germ layers
** can contain functional thyroid tissue –> hyperthyroidism
ovarian neoplasm, looks like bladder, yellow-tan, encapsulated?
Brenner tumor
** coffee bean nuclei on H&E
fibroma?
ovarian neoplasm
bundle of spindle shaped fibroblasts
pulling sensation in groin
Meigs syndrome?
ovarian fibroma
ascites
hydrothorax
thecoma?
may produce E
presentation: AUB in post menopausal woman
ovarian neoplasm, aggressive, contains fetal tissue, neuroectoderm?
immature teratoma
malignant
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
serous cystadenocarcinoma?
MC malignant ovarian neoplasm
frequently B/L
** psammoma bodies
ovarian neoplasm with intraperitoneal mucinous material?
mucinous cystadenocarcinoma
ovarian neoplasm, sheets of fried egg cells?
dysgerminoma (equiv of seminoma in men)
MC in adolescents
** hCG, LDH = tumor markers
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
yolk sac tumor?
aggressive
ovaries/testes or sacrococcygeal area
yellow, friable solid mass
AFP = marker
** Schiller Duval bodies - look like glomeruli
signet cells in ovarian neoplasm?
Krukenberg tumor
GI malignancy –> mets to ovary
mucin secreting adenocarcinoma
uterine biopsy: whorled pattern of smooth mm bundles, well-demarcated borders?
leiomyoma
causes of endometritis?
retained products of conception
foreign body
tx of endometritis?
gent + clinda
+/- ampicillin
small, mobile, firm breast mass with sharp edges; size and tenderness increased with estrogen?
fibroadenoma
MC tumor in <35yo
serous or bloody nipple discharge?
intraductal papilloma
1.5-2x risk of carcinoma
large bulky breast mass; leaf-like projections on biopsy?
phyllodes tumor
MC in 40s
some malignant potential
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
tx of lactational mastitis?
dicloxacillin
continue breastfeeding
drugs that cause gynecomastia?
spironolactone digoxin cimetidine alcohol ketoconazole
(some drugs cause awesome knockers)
most important prognostic factor in breast ca?
axillary LN involvement - indication of metastasis
what do Paget cells look like?
large cells in epidermis
clear halo
firm fibrous rock hard breast mass; stellate infiltration, small glandular duct like cells?
invasive ductal ca
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
breast mass: fleshy, cellular, lymphocytic infiltrate?
medullary ca
good prog
abnormal curvature of penis, assoc with ED, pain, anxiety?
Peyronie disease
fibrous plaque w/in tunica albuginea
surgery once curvature stabilizes
leukoplakia of penis?
Bowen disease
precursor of penile squamous cell ca
erythroplakia of penis?
erythroplasia of Queyrat
cancer of glans penis; precursor of penile squamous cell ca
reddish papules on penis?
Bowenoid papulosis
CIN of unclear malignant potential, possible precursor of squamous cell ca
hormonal changes with cryptorchidism?
decreased inhibin
increased FSH, LH
T normal if unilateral, decreased if bilateral
where do you find extragonadal germ cell tumors?
midline
adults: RP, mediastinum, pineal, suprasellar
kids: sacrococcygeal
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
MC testicular tumor in boys < 3?
yolk sac tumor - aggressive
yellow, mucinous
increased AFP
** Schiller Duval bodies - resemble primitive glomeruli
testicular tumor, may present with hemorrhagic stroke, gynecomastia, hyperthyroid sx?
choriocarcinoma
syncytiotrophoblast and cytotrophoblast elements
increased hCG
** hematogenous mets to lungs, brain
teratoma in males?
mature teratoma in adult males may be malignant
benign in children
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
Leydig cell tumors?
usually produce androgens –> gynecomastia (adults), precocious puberty (boys)
golden brown
** Reinke crystals = eosinophilic cytoplasmic inclusions
Sertoli cell tumors?
androblastomas - from sex cord stroma
MC testicular ca in older men?
testicular lymphoma
NOT 1ary - arises from lymphoma mets to testes
aggressive
which lobes of prostate involved in BPH?
lateral and middle (periurethral lobes)
which lobes of prostate involved in prostate ca?
posterior lobe
