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Elliot > Repro Questions (with some micro) Main > Flashcards

Repro Questions (with some micro) Main Flashcards

1
Q

What is the most important mechanism of pathogenesis for Gonorrhea? Name some of sx of gonorrhea

A

Pilli! allows for adherence to mucosa so it can evade phagocytosis
When you stick your pilli in bad places, you’re going to need a pil(i) to make you feel better
Sx: Abdominal pain and discharge

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2
Q

Name a unique feature of gm+ (other than peptidoglycan wall)

A

lipoteichoic acid

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3
Q

What virulence factor does Staph aureus express? and what is its function?

A

Protein A– binds Fc-IgG and inhibits complement fixation and phagocytosis

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4
Q

What virulence factor does Group A strep express?

A

M protein– antiphagocytic

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5
Q

What are the urease positive bacteria? and what does urease do?

A

1) PUNCH: Proteus; Ureaplasma; Nocardia; Cryptococcus; Helicobacter (Getting PUNCHed in the UREter arEAS does not feel good)
2) converts urea into ammonia and CO2

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6
Q

What does Treponema Pallidum cause? type of bug? other bugs of this type?

A

1) Syph
2) Spirochetes (BLT- Borrelia, Leptospira, and Treponema)
(What makes the syph better? penicillin with a BLT so medication doesn’t bother stomach)

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7
Q

50 yo woman presents with thinning epidermis, fibrotic dermis and white patches on vulva– diagnosis?

A

Lichen Sclerosis- characterized by thinning ski and SCLEROTIC (fibrotic) dermis; see leukoplakia (or white patches) with parchment like skin; seen in postmenopausal women

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8
Q

A 32yo woman presents with white patches and thick leathery skin. She says she’s been using a new detergent for the past 6 months and been very itchy down there. She admits that she has been scratching a lot. Diagnosis? What would you see on histology?

A

Lichen simplex chronicus

See hyperplasia of vulvar squamous epithelium

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9
Q

Differential Diagnosis for Leukoplakia? (3 things)

A

1) Vulvar Carcinoma
2) Lichen Sclerosis
3) Lichen Simplex Chronicus

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10
Q

50yo presents with white patchy areas around vulva with irritation. Patient is positive for HPV 16. What is diagnosis and what are we likely to see on histology?

A

1) Vulvar Carcinoma
2) Will see koilocytic change, disordered cellular maturation, nuclear atypia, and INCREASED MITOTIC ACTIVITY (most importantly)

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11
Q

Extramammary Pagets Disease: histology? presentation?

A

1) Histology: malignant epithelial cells in vulva

2) Presentations: pruritic, ulcerated vulvar skin

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12
Q

Woman presents with pruritic, ulcerated skin on her vulva. What are the two possible diagnoses? What tests will distinguish the two? (PAS; Kertain; S100)

A

a) Extramammary Pagets disease or Melanoma
b)EMPD: PAS+, kertain+, S100-
c) Melanoma: PAS-, keratin-, S100+
(By the time someone is 100, they look like they’ve had melanoma)

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13
Q

What does PAS test for?

A

Mucous; only found in carcinomas not melanomas

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14
Q

What is the lining of the vaginal mucosa?

A

non-keratinized squamous epithelium

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15
Q

Where does lower 1/3 of vagina stem from embryologically? What type of epithelium is seen in lower 1/3 of vagina during development?

A

1) Lower 1/3 of vagina stems from UROGENITAL Sinus

2) Squamous epithelium

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16
Q

Describe the evolution of the vaginal epithelium? i.e. how it begins, how it ends, where it comes from etc…

A

The lower 1/3 of the vaginal epithelium, which is squamous epithelium, is derived from the urogenital sinus. The upper 2/3 of the vaginal epithelium is derived from the Mullerian ducts. The squamous cells grow upward and take over the upper 2/3 of the vaginal epithelium

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17
Q

Woman who was exposed to DES in utero presents with columnar epithelium in the upper portion of her vagina. What is the diagnosis? Where does the columnar epithelium come from?

A

1) Adenosis

2) Columnar epi on upper 2/3 of vagina comes from the Mullerian Ducts

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18
Q

What is clear cell adenocarcinoma of vagina? Most likely cause?

A

1) Proliferation of glands with clear cytoplasm

2) DES!!! DES!!! DES!!!

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19
Q

25yo patient presents to doctor’s office out of concern that her mother took DES while she was in utero. Which type of cancer is patient at risk for? What will you look for on histology?

A

1) Clear cell carcinoma of the Vagina

2) glands with clear cytoplasm

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20
Q

5yo pt. presents with penile bleeding and a mass protruding from his penis. Likely diagnosis? What should we see on histology? What will we stain for?

A

1) Embryonal Rhabdomyosarcoma
2) mesenchymal proliferation of immature skeletal muscle
3) desmin (muscle) and myogenin (immature skeletal muscle)

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21
Q

35 yo female pt. presents to GYN office complaining on of swollen lymph nodes in her inguinal area. She says she has not been to the GYN office in 15 years. Possible diagnosis? Describe pathology

A

1) Vaginal Carcinoma of lower 1/3; caused by HPV 16 or 18 (high grade)
2) carcinoma of squamous epithelium; precursor is vaginal intraepithelial neoplasia

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22
Q

35 yo female pt. presents to GYN office with swollen lymph nodes in her iliac nodes. She says she has not been to the GYN office in 15 years. Possible diagnosis? Describe pathology

A

1) Vaginal carcinoma of upper 2/3 of vagina; caused by high grade HPV
2) VIN is precursor to carcinoma

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23
Q

Epithelium of exocervix?

A

Squamous (ex”S”o to remember that exo is “S”quamous)

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24
Q

Epithelium of endocervix?

A

Columnar (en”D”o C,D)

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25
Q

High risk HPV produces E6 and E7. What are functions of E6 and E7?

A

1) E6= destroys p53–>cannot block BCL2
2) E7= destroys Rb– Rb usually binds E2F. E2F is necessary for cell cycle. If bound to Rb, cannot go through cycle– good for cancers.

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26
Q

43yo pt with a 22 pack/year hx of smoking presents to GYN with vaginal bleeding after sex. She denies discharge. Admits she hasn’t been to gyn in a while. 1) What disease are we nervous about? 2) subtypes? 3) Describe pathogenesis of the disease 4) How do most patients die?

A

1) Nervous about Cervical Carcinoma
2) 80% are squamous cell, 15% are adeno
3) Tumors invade through anterior uterine wall into bladder–>block ureters
4) Block ureters–> hydronephrosis–>renal failure

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27
Q

What is the pathology of Ashermans Syndrome? What does it lead to? What causes it?

A

1) Loss of basalis, which is the regenerative layer of the endometrium. Functionalis can no longer grow on top of it.
2) Secondary amenorrhea
3) Overaggressive dilation and curettage (D&C)

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28
Q

Explain anovulatory cycle. Why does the woman bleed? Length of cycle.

A

There is an estrogen drive proliferative phase without a subsequent progesterone phase. The bleeding occurs due to the inability of estrogen to maintain the corpus luteum, as opposed to a regular cycle when bleeding takes place due to progesterone withdrawal.

Length of cycles vary…

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29
Q

28 yo F presents to ER with fever, pelvic pain and abnormal uterine bleeding. She reports having a baby 3 weeks ago. Possible diagnosis?

A

Acute Endometritis– often caused by retained products of conception

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30
Q

30yo F presents with uterine bleeding, pain and infertility for past few months.See plasma cells on biopsy. She has multiple sex partners and does not always use protection. Possible diagnosis? possible causes (at least 3)? What would we see on histology?

A

1) Chronic Endometritis
2) Caused by retained products of conception; Chlamydia (PID); TB; IUD
3) PLASMA cells and Lymphocytes. Lymphocytes are always present. Must see plasma cells to make the diagnosis

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31
Q

40yo F presents with abnormal uterine bleeding. She says she is taking medication for breast cancer but cannot remember the name. What is likely diagnosis? What is the medication? MOA of medication?

A

1) Endometrial Polyp
2) Tamoxifen
3) antiestrogenic effects on breast but weak PROestrogenic effects on endometrium

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32
Q

What is the number one symptoms of a woman presenting with an endometrial polyp? Name a common cause

A

1) Abnormal uterine bleeding

2) Tamoxifen

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33
Q

34yo presents with dysmenorrhea and pelvic pain. She says that she and her husband have been trying to get pregnant for years but to no avail. Likely diagnosis? Be specific in describing this disease i.e. which specific structures are affected.

A

1) Endometriosis– involves endometrial glands and stroma

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34
Q

Endometriosis in ovary presents grossly as:

Endometriosis in fallopian tube presents grossly as:

A

1) chocolate cyst

2) gun powder nodules

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35
Q

Endometriosis in the uterine myometrium is called?

A

Adenomyosis

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36
Q

53yo F presents with uterine bleeding. Patient is obese and also takes estrogen replacements. Likely diagnosis? Pathophys? Most impt factor to determine risk of future cancer?

A

1) Endometrial hyperplasia or carcinoma– occurs in patients who are obese; pcos; estrogen therapy
2) Unopposed estrogen
3) Cellular atypia will determine if Endometrial hyperplasia will progress to carcinoma

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37
Q

2 types of endometrial carcinoma? Most common subtype? Histology?

A

1) hyperplasia vs sporadic
2) Adenocarcinomas are 80% of hyperplasias; the other 20 are squamous cell
3a) Hyperplasia= endometroid
3b) Sporadic= serous with papillary structures and PSAMMOMA BODIES

38
Q

70yo F with painless uterine bleeding. Possible diagnosis? Histology? Pathophys?

A

1) Sporadic Endometrial carcinoma (typeII)– arises from atrophic endometrium
2) Serous with papillary structures and PSAMOMMA BODIES
3) p53 mutation

39
Q

Where do we see psamomma bodies? (4 places)

A

1) Papillary Ca. of Thyroid
2) Papillary serous carcinoma
3) meningioma
4) Mesothelioma of pleura

40
Q

34 yo F, see multiple masses in endomtrium on CT after presenting with some uterine bleeding and infertility. Likely diagnosis? See on gross examination?

A

1) Leiomyoma– seen in premenopausal women; goes away postmenopausal; fibroids get bigger during pregnancy
2) Gross: multiple, well-defined, WHORLED masses

41
Q

Histological features of Leiomyosarcoma? Gross features?

A

1) Histology- necrosis, MITOTIC ACTIVITY; cellular atypia

2) Single lesion with areas of necrosis and hemorrhage

42
Q

Obese pt presents with many follicular cysts, infertility, and hirsutism. Disease? Explain the hirsutism; What are these patients at increased risk for?

A

1) PCOS (also see oligomenorrhea, insulin resistance, often)
2) There is increased LH without subsequent increase in FSH. LH acts on thecal cells to produce androgen–>hirsutism. The excess androgens are converted estrogen in the adipose tissue thereby providing negative feedback on FSH.
3) Endometrial carcinoma dt high estrone

43
Q

34yo patient presents with high levels of LH and low levels of FSH. She is infertile. Possible diagnosis?

A

PCOS– hirsutism, insulin resistance, oligomenorrhea,

44
Q

Two most common types of surface epithelial tumors. Benign and malignant?
Other types?

A

1) Serous and mucinous
2) Benign= cystadenomas; single cyst with flat lining–premenopausal
3) Malignant= cystadenocarcinomas; complex cysts thick shaggylining– postmenopausal women
4) Endometroid and Clear cell

45
Q

65yo F presents with multiple ovarian cysts with thick, shaggy, lining. Possible diagnosis?

A

1) cystadenocarcinoma (surface epithelial tumor)

46
Q

Brenner tumor (surface epithelial) characteristics

A

Bening, Bladder-like epithelium, shaped like coffee-Bean

47
Q

Cystic teratoma: Age group? Thyroid? When is it malignant?

A

1) Tumor composed of more than one germ layer
2) Premenopausal– most common Germ cell tumor
3) Struma ovarii= tumor composed of thyroid tissue
4) Malignant when immature tissue is present

48
Q

20yo F presents with hyperthyroidism and mass in ovary. Diagnosis?

A

1) Cystic teratoma– Struma Ovarii

49
Q

25yo F presents with ovarian mass. Mass has clear cytoplasm and central nuclei. LDH is elevated. Diagnosis? Prognosis?

A

1) Dysgerminoma (female counterpart to seminoma)

2) Responds well to radiotherapy

50
Q

8yo presents with ovarian tumor. What is the most common germ cell tumor in children? What protein will be elevated? What characteristic cell will we see on histology? What do these cells resemble?

A

1) Endodermal sinus tumor (yolk sac tumor)
2) Elevated AFP
3) Schiller Duval bodies
4) Resemble glomeruli

51
Q

28yo F is diagnosed with a malignant ovarian tumor. She exhibits elevated levels of hCG. Trophoblasts and syncytiotrophoblasts are see on histology. Diagnosis? What does this tumor mimic? What is it missing?

A

1) Choriocarcinoma
2) Mimics placental tissue
3) Missing VILLI
Remember: hCG is LH analog

52
Q

30yo F presents with a painful mass in ovaries. The mass is discovered to be a tumor composed of large primitive cells. Diagnosis? Prognosis

A

1) Embryonal carcinoma

2) Fucked

53
Q

12 yo presents with signs of precocious puberty. You suspect a tumor of the ovaries. What is a likely diagnosis? What cells might be found on histology?

A

1) Granulosa cell tumor

2) Call Exner bodies (Call GRAN Exner)

54
Q

Reinke crystals, ovarian tumor. Diagnosis? Possible sx?

A

1) Sertoli-Leydig cell tumor

2) Hirsutism (from androgens) and virilization

55
Q

Cyclical bilateral breast pain with heaviness. Which part of cycle is this taking place? What is name of disease? Epi?

A

1) Late luteal phase and resolves at onset of menses
2) Cyclical Mastodynia
3) Premenopausal

56
Q

Noncylical unilateral sharp/burning localized breast pain

A

Noncylical mastodynia

57
Q

Thrombophlebitis of the subcutaneous veins of the anterolateral thoracoabdominal wall in breast– disease? Prognosis?

A

1) Mondor disease

2) Benign and self-limited

58
Q

Mondor disease pathogenesis? Prognosis

A

1) Thrombophlebitis of subcutaneous veins of anterolateral thoracoabdominal wall in breast
2) Benign and self-limited

59
Q

Dark green, bilateral nipple discharge=

A

Physiologic discharge

60
Q

Spontaneous, bloody, unilateral nipple discharge=

A

Pathologic discharge

61
Q

Intraductal Papilloma: describe tumor. Sx?

A

1) Papillary growth into a large duct lined by luminal AND MYOEPITHELIAL cells
2) Bloody nipple discharge; unilateral

62
Q

Unilateral bloody discharge involving myoepithelial and luminal duct cells– possible diagnosis?

A

Intraductal Papilloma

63
Q

Acute Mastitis: pathogenesis? Bugs? Sx? Treatment? MOA of drug?

A

1) Assoc with breast feeding; breaks tissue; allows bug to get in
2) S. aureus
3) Erythematous and warm with purulent nipple discharge
4) Dicloxacillin (Beta lactam for gm+)

64
Q

Recently pregnant mother presents with erythematous breast which is warm to the touch. She is breastfeeding– possible diagnosis? be specific

A

1) Acute Mastitis

2) Caused by S. aureus

65
Q

Periductal Mastitis: pathogenesis? presentation?

A

1) Vit. A deficiency–>squamous metaplasia of lactiferous ducts–>duct blockage and inflammation
2) Nipple retraction (fibrosis pulls in nipple) and subareolar mass

66
Q

Nipple retraction with subareolar mass– possible diagnosis?

A

1) Periductal Mastitis

67
Q

Mammary duct ectasia: Pathophys? Presentation? Histology? Epi?

A

1) Inflammation and dilatation (ectasia) of subareolar ducts
2) green-brown discharge from inflam debris
3) inflammation with PLASMA cells
4) Postmenopausal women

68
Q

Fat Necrosis: Pathogenesis? Presentation/Mammography? Biopsy?

A

1) Usually trauma related
2) Calcified mass on mammography
3) Necrotic fat with calcification and GIANT CELLS

69
Q

Fibrocystic change: Presentation? Epi?

A

1) Irregularity of breast tissue (lumpy breast) with cysts with BLUE DOME appearance
2) Premenopausal women

70
Q

3 types of fibrocystic change and chance of development of cancer:

A

1) Apocrine metaplasia= no risk
2) Ductal hyperplasia and sclerosing adenosis (too many glands; usually calcified)= 2x inc. risk
3) Atypical hyperplasia= 5x

71
Q

Cysts with BLUE DOME apperance on exam

A

Fibrocystic change

72
Q

Papillary carcinoma: presentation/epi? histologically?

A

1) Bloody nipple discharge in premenopausal women

2) Fibrovascular projections lined with luminal but NO MYOEPITHELIAL cells

73
Q

Bloody nipple discharge; fibrovascular projections with no myoepithelial cells– diagnosis?

A

Papillary carcinoma

74
Q

Fibroadenoma: Epi? Histologically? Presentation? When it is worse?

A

1) Most common benign tumor of breast and most common tumor in premenopausal women 15-25yo
2) Tumor of fibrous tissue and glands; well circumscribed
3) Mobile marble-like mass; well circumscribed
4) Grows during pregnancy and may be painful during menstrual cycle
NOT CANCER

75
Q

32yo PT with well circumscribed marble like mass; pain during menstruation

A

Fibroadenoma (fibrous glands)

76
Q

Phyllodes Tumor: Epi? Histologically?

A

1) Postmenopausal women

2) Overgrowth of fibrous component; LEAF-LIKE projections

77
Q

DCIS: Mammography? Histology?

A

1) Calcification on mammography

2) Comedo type characterized by high grade cells with necrosis and dystrophic calcification in center of ducts

78
Q

Calcification is seen on mammography: 3 possible diagnoses

A

1) Sclerosing adenosis
2) DCIS
3) Fat necrosis

79
Q

Paget Disease of Breast: pathophys? Presentation?

A

1) DCIS that extends up the ducts to involve skin of nipple
2) Nipple ulceration and erythema
CANCER

80
Q

Nipple ulceration with erythema– possible diagnosis?

A

Pagets disease of breast

81
Q

Invasive ductal carcinoma: Presentation? Subtypes?

A

1) Mass with dimpling of skin or retraction of nipple
2) a) Tubular
b) Mucinous aka colloid
c) Medullary
d) Inflammatory

82
Q

Retraction of nipple: 2 possible Ds

A

1) Periductal mastitis

2) Invasive Carcinoma

83
Q

52yo bloody nipple discharge. Well differentiated tubules that lack myoepithelial cells on histology. Diagnosis?

A

1) Invasive Ductal Carcinoma– Tubular Ca

84
Q

70yo bloody nipple discharge. On histology we see a lot of clearish translucent material. Diagnosis? Prognosis?

A

1) Invasive ductal ca– Mucinous Ca aka colloid
2) Good prognosis
May be mistaken for fibroadenoma

85
Q

52 yo bloody nipple discharge. On histology you see many many lymphocytes and plasma cells; well circumscribed. ER/PR negative. Diagnosis?

A

1) Invasive Ductal Ca– Medullary Ca

86
Q

52yo bloody nipple discharge with swollen breast. Dimpled skin. No mass is detected. Acute mastitis is ruled out. Diagnosis? Histology? Prognosis? ER/PR?

A

1) Invasive Ductal Ca– Inflammatory Ca
2) Ca in dermal lymphatics–>blocks up duct–>decreased drainage–>inflammation
3) BAD prognosis
4) ER/PR negative

87
Q

Lobular Carcinoma in Situ: Path? Presentation? Treatment?

A

1) Dyscohesive cells lacking E-cadherin adhesion protein
2) Often multifocal and bilateral
3) Tamoxifen

88
Q

Invasive Lobular Carcinoma: Path? Signature cell?

A

1) Missing E-cadherin; cells line up SINGLE file

2) Signet ring cell

89
Q

Invasive ductal carcinoma–luminal A?

A

1) ER+PR+Her2-

2) Best outcome

90
Q

Invasive ductal carcinoma–luminal B?

A

1) ER+PR+ Her2+

91
Q

Her2+

A

1) ER/PR-

92
Q

Basal like invasive ductal carcinoma

A

1) ER/PR/Her2 negative

EGFR+

Elliot (11 decks)

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