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USMLE® Step 1 flashcards
1
Q

Cancers of pelvis, including prostate, spread to lumbar spine via the

A

Vertebral venous plexus (including prostatic venous plexus in men)

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2
Q

breast and lung cancers metastasize to spine via

A

Vertebral venous plexus (communicates with azygos vein)

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3
Q

Venous drainage from testis, epididymis and ductus deferences. Drains into testicular veins

A

Pampiniform plexus

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4
Q

Classic triad of congenital rubella

A

Cataracts, sensory-neural deafness and PDA

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5
Q

How do progestin-only (norethindrone) and levonorgestrel IUD work as contraceptives

A

Thicken cervical mucus to impair sperm motility

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6
Q

How do combined hormonal contraceptives and progestin implant/injection function as contraceptives

A

Suppress GnRH and gonadotropin secretion to inhibit ovulation

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7
Q

How does Copper IUD function

A

Cytotoxic inflammatory response in uterus to impair sperm migration

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8
Q

Which hormone causes increased insulin resistance in pregnancy during second and third trimester

A

Human placental lactogen (Secreted by synctiotrophoblast)

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9
Q

Bulk-related symptoms like pressure and constipation that are relieved by “splinting” to defecate (manual deflection of obstruction) likely indicate

A

Posterior subserosal uterline leiyomyoma (fibroid)

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10
Q

How does progesterone withdrawal cause menses

A

Loss of progesterone leads to increased prostaglandin, which vasoconstricts spiral arteries. Increased metalloproteases by endometrial stromal cells degrade ECM and endometrial epithelium undergoes apoptosis, thus leading to menstruation

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11
Q

Which arteries can be ligated during postpartum hemorrhage to stop bleeding and maintain fertility?

A

Internal iliac arteries (Uterine is branch of them); blood flow maintained by ovarian anastamoses

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12
Q

Which blood pressure medications are teratogens that can lead to renal agenesis/malformation (oligohydramnios) and hypoplasia of skull?

A

ACE inhibitors or ARBs (Angiotensin II is needed for renal function in babies)

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13
Q

Peyronie disease

A

Fibrotic plaque of tunica albuginea causes abnormal curvature of penis and erectile dysfunction

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14
Q

Bowen disease

A

In situ carcinoma of penile shaft that presents as leukoplakia

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15
Q

Erythroplasia of Queyrat

A

In situ carcinoma of glans that presents as erythroplakia

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16
Q

Bowenoid papulosis

A

In situ squamous cell carcinoma of penis that presents as reddish papules

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17
Q

HPV causes which cancer in males

A

Penile squamous cell carcinoma

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18
Q

Cause of hypospadias (opening of urethra on inferior fold)

A

Failure of urethral folds to close

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19
Q

Cause of epispadias (opening of urethra on superior surface of penis)

A

Abnormal positioning of genital tubercle. Associated with bladder exstrophy

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20
Q

Which HPV strains cause condyloma acuminatum

A

6 and 11

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21
Q

Necrotizing granulomatous inflammation of inguinal lymphatics and lymph nodes caused by

A

Chlamydia trachomatis

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22
Q

Fibrotic healing of lymphogranuloma venerum can involve perianal area with

A

rectal strictures

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23
Q

Cryptorchidism increases risk of which condition

A

Germ cell tumors (seminomas)

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24
Q

Common cause of orchitis in older adults

A

E. Coli or Pseudomonas

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25
Q

Non-necrotizing granulomas involving seminiferous tubules suggest

A

Autoimmune orchitis

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26
Q

Can occur due to failure of testes to attach to inner lining of scrotum via processus vaginalis

A

Testicular torsion

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27
Q

An adolescent male presenting with sudden, unilateral testicular pain, absent cremasteric reflex, nausea/vomiting and fever likely has

A

Testicular torsion

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28
Q

Left scrotum with “bag of worms” appearance is associated with increased risk of

A

Left-sided renal cell carcinoma

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29
Q

Scrotum that is “bag of worms” in appearance occurs due to

A

Dilation of spermatic vein due to impaired drainage (varicocele)

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30
Q

Common cause of hydroceles

A

Incomplete closure of processus vaginalis

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31
Q

Scrotal swelling that can be transilluminated is likely

A

Hydrocele

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32
Q

Cyst due to dilated epididymal duct or rete testes is a

A

Spermatocele

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33
Q

Lymph drainage of testes and epididymis

A

Para-aortic and lumbar lymph nodes

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34
Q

Small nodule on testes with elevated beta-hCG, symptoms of hyperthyroidism (weight loss, heat intolerance, lack of sleep) and gynecomastia are suggestive of what in a male?

A

Choriocarcinoma

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35
Q

Choriocarcinoma is a malignant tumor of which origin

A

Synctiotrophoblasts and cytotrophoblasts

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36
Q

Teratomas in males vs females

A

Malignant in males if found in 20s-40s; benign in females

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37
Q

Most common testicular tumor in male infants, characteristically elevated AFP

A

Yolk sac tumor

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38
Q

Testicular tumor with poorest prognosis ; chemo can cause differentiation into different type of tumor

A

Embryonic carcinoma

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39
Q

Characterized by immature, primitive cells organized in irregular patterns that may produce glands and sites of necrosis and hemorrhage

A

Embryonic carcinoma

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40
Q

Rapidly metastasize, variable response to cancer therapy

A

Non-seminoma germ cell tumors

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41
Q

Slow to metastasize, excellent response to therapy

A

Seminoma

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42
Q

Tumor of maternal fetal tissue composed of elements from 2-3 germ layers

A

Teratoma

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43
Q

Increased placental ALP

A

Seminoma

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44
Q

Hemategnous mets to lungs and brain in male

A

Choriocarcinoma

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45
Q

Presents as painful hemorrhagic testicular mass; usually mixed with other tumor types (increased AFP when mixed)

A

Embryonic carcinoma

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46
Q

Which male organ is located below bladder and anterior to rectum?

A

Prostate

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47
Q

Which two lobes tend to undergo hyperplasia in BPH?

A

Lateral and middle lobes

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48
Q

Increased risk of bladder diverticuli, hydronephrosis and UTIs associated with which condition?

A

BPH

49
Q

Side effects of 5-alpha-reductase inhibitors

A

Sexual dysfunction (decreased libido), gynecomastia

50
Q

Treatment for BPH

A

alpha-1-receptor antagonists (Terazosin) to relax smooth muscle; 5-alpha-reductase inhibitors (finasteride) to decrease DHT production

51
Q

treatment for prostate cancer

A

Leuprolide (continuous GnRH to shut down FSH and LH)

Flutamide (competitive androgen receptor antagonist)

52
Q

Injury to which nerve can cause erectile dysfunction after prostatectomy

A

Prostatic plexus

53
Q

This nerve innervates the external urethral and anal sphincters and provides sensory innervation of external gnitalia

A

Pudendal

54
Q

Injury to this nerve can cause fecal incontinence, decreased penile sensation or external urethral sphincter paralysis

A

Pudendal

55
Q

Which nerve mediates the cremasteric reflex

A

Genitofemoral (L1-L2)

56
Q

Gonadal arteries and veins are branches of

A

abdominal aorta, slightly below renal arteries

57
Q

This artery travels in front of IVC and behind ileum

A

Right gonadal artery

58
Q

This artery travels behind left colic and sigmoid arteries and iliac colon

A

Left gonadal artery

59
Q

Arises off common iliac artery and becomes femoral artery

A

External iliac artery

60
Q

Arises off common iliac artery and supplies pelvic wall/viscera, buttock, female repro organs, bladder and medial thigh

A

Internal iliac artery

61
Q

Branch of internal iliac that provides blood to anal canal, scrotum and penis

A

Pudendal

62
Q

Small/firm testes, azoospermia, tall stature and gynecomastia suggest

A

Klinefelter syndrome (XXY)

63
Q

Levels of testosterone, LH and FSH and estradiol in Klinefelter

A

Decreased testosterone, increased LH and FSH,, increased estradiol

64
Q

Lymph drainage of glans penis and superficial nodes

A

Deep inguinal nodes

65
Q

Triad of Kartagener syndrome (primary ciliary dyskinesia)

A

Situs inversus, chronic sinusitis, bronchiectasis (persistent bronchial dilation)

66
Q

Most common causative pathogen for acute mastitis

A

S. Aureus (Tx: Dicloxacillin)

67
Q

Erythematous nipple with purulent discharge in a breast-feeding woman suggets

A

Acute mastitis

68
Q

Subareolar mass with nipple retraction in a female smoker suggests

A

Periductal mastitis

69
Q

What causes periductal mastitis

A

Vitamin A deficiency results in squamous metaplasia of lactiferous ducts, producing some degree of keratin that plug/block ducts leading to inflammation

70
Q

Periareolar mass (inverted nipple) with green-brown nipple discharge in multi-parous post-menopausal woman

A

Mammary duct ectasia

71
Q

Biopsy of Mammary duct ectasia would show

A

Inflammation with plasma cells

72
Q

50% of cases are the result of trauma. Biopsy reveals giant cells and calcifications

A

Fat necrosis of breast

73
Q

Risk of invasive cancer with fibrosis, cysts and apocrine metaplasia

A

No risk

74
Q

Risk of invasive breast cancer with ductal hyperplasia and sclerosing adenosis

A

2x increased risk

75
Q

Risk of invasive breast cancer with atypical hyperplasia (dark nuclei that fill acini space)

A

5x increased risk

76
Q

Inner layer of lobules and ducts

A

Luminal cell layer (produces milk)

77
Q

Outer layer of ducts and lobules

A

Myoepithelial cell layer (pushes milk forward)

78
Q

What causes nipple retraction in periductal mastitis?

A

Myofibroblasts contract during healing process (fibrosis) of breast tissue, pulling in nipple tissue

79
Q

Two characteristics of mammary duct ectasia

A

green-brown nipple discharge and plasma cells on biopsy

80
Q

Unilateral bloody nipple discharge in a premenopausal woman. Biopsy reveals papillae with two cell layers.

A

Intradutal papilloma

81
Q

Papillary carcinoma vs adenoma

A

Papillary carcinoma is more common in older women (post-menopausal). Both have bloody nipple discharge due to fibrovascular papillae, but the papillae in carcinoma do not have myoepithelial layer

82
Q

Well-circumscribed, mobile marble-like mass in pre-menopausal woman likely suggests

A

Fibroadenoma (most common benign tumor in pre-meni females. no risk of carcinoma. Estrogen sensitive)

83
Q

Difference between fibroadenoma and Phylloides tumor

A

Both are tumor of fibrous tissue and glands but Phyllodes has OVERGROWTH of fibrous component and is found in post-menopausal women

84
Q

“Leaf-like” projections seen on biopsy suggest

A

Phyllodes tumor (can be malignant in some cases), seen in post-menopausal women; suggestive of genetic inheritance of breast cancer

85
Q

6 risk factors for breast cancer

A

female gender, age, early menarche/late menopause, obesity, atypical hyperplasia, first-degree relative (sister, mother, daughter)

86
Q

Which part of breast do most malignant tumors arise from?

A

Duct lobular unit

87
Q

Which test distinguishes benign from malignant breast pathologies

A

Biopsy

88
Q

High grade cells with necrosis and dystrophic calcification inc enter of ducts is what type of DCIS

A

Comedo type

89
Q

Define Paget disease of breast

A

DCIS that moves up to skin of nipple. Presents with nipple ulceration and erythema

90
Q

Detection of Paget disease of breast is important because

A

It is almost always associated with ductal carcinoma of breast (malignant breast cancer)

91
Q

Appearance of Paget disease on biopsy

A

Scattered “fried egg” appearance cells

92
Q

Most common type of malignant breast cancer

A

Invasive ductal carcinoma

93
Q

How does DCIS present on mammography

A

calcifications in breast (no mass)

94
Q

How does Invasive ductal carcinoma present on mammography

A

Mass greater than 1cm)

95
Q

Appearance of invasive ductal carcinoma on biopsy

A

Duct-like structures in connective tissue stroma

96
Q

Biopsy of Tubular carcinoma (Invasive ductal carcinoma)

A

You see a lot of ducts, but they lack myoepithelial cells

also see stromal background
good prognosis

97
Q

Biopsy of Mucinous carcinoma (Invasive ductal carcinoma subtype)

A

Ductal cells floating in mucus pool (light-lavendar background)

98
Q

Prognosis of tubular and mucinous carcinoma

A

Excellent

99
Q

Average age of occurrence for mucinous caricnoma

A

70 years

100
Q

Highly erythematous and inflamed breast that does not resolve with antibiotics is suggestive of

A

Inflammatory carcinoma

101
Q

Biopsy of Inflammatory carcinoma (subtype of Invasive Ductal carcinoma)

A

Hyperplasia of cells in dermal lymphatics, decreasing their drainage and causing inflammation (filled circle of purple cells in pink stromal tissue)

102
Q

Prognosis of inflammatory carcinoma

A

Very poor (double negative, ER-/PR-)

103
Q

Inflammatory carcinoma is more common in

A

African American women around 50 years, higher BMI (obese)

104
Q

Well circumscribed mass that mimics fibroadenoma on mammography. Biopsy characterized by large, high-grade cells growing in sheets with lymphocytes and plasma cells

A

Medullary carcinoma (Invasive duct carcinoma

105
Q

Patients with BRCA1 mutations have an increased risk of which type of Invasive Duct Carcinoma subtype?

A

Medullary carcinoma

106
Q

Multifocial and bilateral masses that have been incidentally found on mammography suggest

A

Lobular carinoma in situ (mutation in E-cadherin so cells are not attached to one another)

107
Q

Treatment for lobular carcinoma in situ

A

Tamoxifen (estrogen antagonist)

108
Q

Risk of progression to invasive carcinoma for LCIS

A

Low

109
Q

Biopsy showing cells in single-file pattern and E-cadherin mutations suggest

A

Invasive lobular carcinoma

110
Q

Most useful prognostic factor in breast cancer

A

Spread to axillary lymph nodes

111
Q

ER and PR associated breast cancers are treated with

A

Tamoxifen (antiestrogenic agents)

112
Q

Her2/neu (c-erbB2) amplication is treated with

A

Traztuzumab (anti-Her2/neu)

113
Q

What is Her2/neu

A

Cell membrane growth receptor (oncogene)

114
Q

Which population is susceptible to triple negative breast carcinoma?

A

African American womoen

115
Q

Gene responsible for breast cancer in males

A

BRCA2

116
Q

Gene associated with familial breast and ovarian cancers

A

BRCA1

117
Q

Where is the highest density of breast tissue in males

A

Underneath nipple (subareolar) ; may produce discharge

118
Q

In pregnancy, DIC is mediated by which factor

A

Tissue factor produced by placental trophoblast

USMLE (36 decks)

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