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reproductive 2 Flashcards

1
Q

unilateral cystic dilation lateral to vaginal canal lower vestibule in women of reproductive age

A 
bartholin cyst
(usually due to infection or obstruction)
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2
Q

HPV 6 or 11

A

condyloma accuminata

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3
Q

crinkled wrinkled nuclues, like a raisin

A

koilocytic change (HPV)

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4
Q

high risk HPV

A

16 18 31 33

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5
Q

lichen sclerosis

A

thinning of EPIdermis
fibrosis of DERMIS (parchment like vulvar skin)

leukoplakia with parchment like skin

MAY PROGRESS TO SQUAMOUS CELL

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6
Q

thickening of skin leukoplkai LEATHER LIKE

A

hyperplasia of vulvar squamous epithelim

BENIGN

simplex = simple not malignant

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7
Q

two ways vulvar carcinoma happens

A

HPV reltaed - Vulvar neoplasia (40-50yrs of age)
non hpv related - lngstanding lichen sclerosis (older than 70)

presents wiht leukokplakia

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8
Q

erythematou, pruiritc, ulcerated skin vulva

A

extramammary paget disase (carc in situ)

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9
Q

hallmark of extrmam paget disease

A

malignant epithelial cells

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10
Q

how to differentiat ebetween melanoma and paget cells

A

paget cells - pas positiev, KERATIN POSITIVE (epithelial ) and S100 negative
melanoma - PAS neg, keratin neg, S100 positive

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11
Q

histology of 3rs of vagina

A

proximal 1/3rd from mullerian duct (columnar epithelium)

distal 2/3rds - urogenital sinus…(squamous)

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12
Q

DES exposure in utero

A

clear cell adenocarcinoma (glands with clear cytoplasm) in vagina

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13
Q

grape like mas protruding from vagina/penis in child less than 5

A

rhabdomyosarcoma

psotive for cytopasmic cross striations, + desmin and myoglobin (muscle cells)

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14
Q

vaginal carcinoma

A

suamousepitheliami

high risk HPV

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15
Q

HPV E6 and e7 what do they do

A

E6 - desturction of p53 (g1-s phase)

E7 - increases destruction of Rb (retinoblastoma) holds e2f which is important in cell cycle

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16
Q

risk factors HPV cervical cancer

A

smoking and immunodeficiency (potentially AIDS defining illness)

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17
Q

patient with aggressive D and C evelops amenorrhea

A

asherman syndrome

loss of basalis layer (endometrium cannot regenerate for menses)

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18
Q

retained products of conceptioin presents as fever, aormal bleeding, and peliv pain

A

acute endometritis

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19
Q

histologic hallmark CHRONIC endometritis

A

plasma cells

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20
Q

etiologies chronic endomet

A

PID, retaind coenception products, IUD use

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21
Q

protruion into endometrium prsents with abnormal uterine bleeding

A

endometrial polyp

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22
Q

what medication is assocaited with endometrial polyps

A

tamoxifen (antiesroginc in breast, but slightly proestrogenic in uterus)

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23
Q

dysmenorrhea in conjunction with menstrual cycle and pelivc pain, infertility

A

endometriosis

gland AND stroma

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24
Q

MCC site of endometirosis

A

ovary

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25
Q

presentation of endometriosis in ovary

A

chocolate cyst

increasd risk of CARCINOMA

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26
Q

why can endometriosis cause infertility and ectopic pregnancy

A

if it occurs in fallopain tube!!!! it can cause scarring and increased risk ectopci pregnacy

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27
Q

endometriosis in uterine myometrium

A

adenomyosis

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28
Q

hypertrophy of endometrial glands relative to stroma

A

endomytrial hyperplasia

CONSEQUENCE OF UNOPPOSED ESTROGEN (not followed by progesterone phase)

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29
Q

most important factor for cancer is endometrial hyperplasia

A

presence or absence of cellular atypia

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30
Q

malignant proliferation of endometrial glands

A

endometrial carcinoma

presents with abnormal uterine bleeding

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31
Q

classic histology of hyperplastic endometrial carcinoma

A

“endometroid”
evident precursor legion from endometrial tissue

resembles uterine

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32
Q

endometrial carcinoma from ATROPHIC endometrium

A

comes from sporadic endometrial carcinoma
called SEROUS PAPILLARY (typically occurs in elderly)
aggresive

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33
Q

mutaiton that drives sporadic endometrial carcinoma

A

p53 mutations

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34
Q

psamoomma bodies found in…

A

serous endometrial carcinoma
papillary thyroid cancer
meningioma
mesothelioma

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35
Q

smooth muscle under myometrium

A

myometrium

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36
Q

benign proliferation of smooth muscle from myometrium (premenpausal women), multiple well defined white whorled masses

A

leiomyoma

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37
Q

multiple well defined white worled masses that are related to ESTROGEN EXPOSURE and shrink after menopause

A

leiomyoma (fibroids)

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38
Q

multiple leiomyoma vs single leiomoyoma

A 
multiple = less likely to be malignant
single = more likely to be leiomyosarcoma (esp if not white and whirley but have necrosis/hemhorrage and happens in post menopausal women)
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39
Q

MCC clinical finding of fiborid

A

ASYMPTOMATIC

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40
Q

other symptoms of fibroids

A

uterine bleeding, infertility, pelvic mass

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41
Q

T:F leiomyoma can become leiomyosarcoma

A

noooooooo false

leiomyosarcoma arises de nova and happens in post menopausal women

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42
Q

multiple follicular cysts due to hormonal imbalance

A

POCD

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43
Q

how to diagnose PCOS with hormone checks

A

LH:FSH ratio >2

HIGH ANDROGENS leading to suppression of FSH and inability of follicule to mature (olgiomenorrhea, infertility, hirsuitism)

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44
Q

long term complications of PCOS

A

more estrone = increased risk endometrila carcinoma

insulin resistance = T2DM

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45
Q

rx to prevent peripheral estrone formation in PCOS

A

weight loss

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46
Q

rx to rpevent endometrila hyperplasia due to unopposed estrogen in PCOS

A

combined OCPs

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47
Q

rx to induce ovulation and fight insulin reisstance in PCOS

A

metformin

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48
Q

PCOS rx to preserve fertility

A

clomiphene

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49
Q

PCOS rx to block androgens and treat hirsuitism

A

ketoconazole

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50
Q

3 cell types of ovary

A

germ cell
sex chord stroma (supportive cells)
surface epithelium

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51
Q

MCC type of ovarian tumor

A

(coelomic epithelim) surface epithelial tumor

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52
Q

two most common esurface epithelial tumors

A

serous (water filled) and mucinous (mucus filled) tumors

usually cystic

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53
Q

bening tumors of serous and mucin

A

cystadenoma

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54
Q

ovarian tumor single simple cyst flast lining, premenopausal women

A

benign mucinous or serous CYSTADENOMA

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55
Q

complex cysts with thick shaggy lining, post menopasual women…multiple cysts, unsmooth shaggy lining

A

cystadenoCARCIOMA

serous - watter filled
mucinous - thick mucus filled

clear INVASION into connective tissue

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56
Q

features in between benigna dn maligant tumors

A 
borderline tumors
(carry metastatic potential) but not as aggressive and have better prognosis
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57
Q

BRCA1 mutation carriers have increasd risk of what ovarina cancer

A

SEROUS carcinoma both in ovary and follopian tube

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58
Q

if you have endometroid carcinoma in ovary…where to look for other carcinoma

A

in endometrium!!!! happens in 15% of people

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59
Q

UROthelium tumor in ovary

A

Brenner tumor (resmebles BLADDER)

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60
Q

when do surface tumors present typically

A

LATE (poor prognosis)

vague abdominal sympstoms, signs of sompresssion (urinary frequency)

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61
Q

epithelial carcinomas in ovarylike to spread to what area

A

peritoneum and omentum

OMENTAL CAKING

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62
Q

marker for SURFACE EPITHELIAL TUMOR

A

CA-125 (monitor treatmment and recurrence, not good for initial screening)…

for example if you remove ovarian tumor in sugery…check CA 125 to check to see if surgery was good or if it hasn’t recurred

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63
Q

2nd most common ovarian tumor (15% cases)

A

GERM CELL TUMORS

happens in REPRODUCTIVE AGE

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64
Q

15-30 year old with ovarian mass vs 30-40 with ovarian mass vs post menopasual women in 60 70s with ovarian mass)

A

15 - 30 - germ cell tumor
30-40 - benign surface epithelium tumors
post enopausal - malignant surface epithelial tumor

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65
Q

most common germ cell tumor, derieved 2-3 embryolagic layers

A

cystic teratoma

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66
Q

skin hair teeth thyroid in tumor

A

cystic teratoma

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67
Q

how to determine if cystic teratoma is malignant

A

look for IMMATURE TISSUE (malignant, typically neuroectoderm)
check if cells within teratoma HAVE CANCER…ex: skin tissue in teratoma has squamos cell carcinoma - malignancy)

any of these characterisitis indicated maligantn teratoma

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68
Q

lady with ovarian mass in reproductive age that develps hyperthyroidism

A

suspect STRUMA OVARII (mostly made of thyroid tissue)

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69
Q

mass of large cells with clear cytopalsm and central nuclei EGG CELLS

A

dysgerminoma

MCC malignant germ cell tumor

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70
Q

tumor marker for dysgerminoma

A

LDH

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71
Q

LDH increasd in setting of ovarian tumor

A

dysgerminoma, hcG also inreased sometimes

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72
Q

most common germ cell tumor in children

A

endodermal sinus tumor (mimics yolk sac)

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73
Q

child with ovarian mass with elevated AFP

A

endodermal sinus tumor (yolk sac)

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74
Q

histologic hallmark of yolk sac tumor or endodermal sinus tumor

A

schiller duval bodies

resemble GLOMERULI

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75
Q

child with ovarian mass that havs glomeruloid like structures on histology

A

endodermal sinus tumor

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76
Q

child with ovarian mass with schiller duval bodies and elevated AFP

A

endodrma lsinus tumor

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77
Q

malignant tumor of trophoblasts and synctiotrophoblasts with NO VILLI

A

choriocarcionma

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78
Q

ovarian mass with high bhcg usually spread to somewhere else

A

choriocarcinoma

79
Q

prognosis of choriorcarcinoma

A

POOR RESPONSE TO CHEMO (germ cell variant)

80
Q

sex cord stromal tumors have what cell types

A

granulosa cell

theca cells

81
Q

ovarian tumor with signs of estrogen excess

A

granulosa theca tumor

82
Q

ovarian tumor in child with early puberity

A

granulosa theca cell

83
Q

histologic hallmark of leaydig cells

A

REINKE CRYSTALS (pink cells with crystals)

84
Q

ovarian tumor i woman who develops hirsutism or virilization

A

sertoli leydig tumor of ovary

85
Q

bening tumor of fibroblasts

86
Q

ovarian tumo rin woman with pleural effusion and ascites

A

(meigs syndrome)

FROM FIBROMA

87
Q

meigs syndrome from fibroma

A

pleural effusion and ascites assocaited with ovarian tumor

88
Q

ovarina tumoor with “pulling sesnation of groin”

A

meigs syndrome (from fibroma)

89
Q

mucin secreting cell with signet cell adenocarcinoma

A

kruckenberg tumor (GI metastases to ovary)…from diffuse type gastric cancer

90
Q

abundant mucusy fluid in abdomen associated with tumor from where

A

appendix (primary) which produces abondunat mucus in peritoneum that can spread to ovary

91
Q

MCC site ecotpic pregnancy

A

ampulla fallopian tube

92
Q

spontaneous abortion happens when

A

before 20 weeks

93
Q

MCC cause of spontaeous abortion

A

chromosomal anomalies

94
Q

teratogenic affects aminobglycosides

A

OTOtoxicity

“A MIN guy, hit the baby in the ear”

95
Q

third trimester painless bleeding

A 
placental abruption (separation from placenta from uterin wall)
placenta previa
96
Q

placenta accreta

A

placenta ATTACHES to myometrium does not penetrate (difficult delivery) often resuls in hysterectomy

97
Q

placenta INcreta

A

penetraes INTO myometrium

98
Q

placenta PERcreta

A

placenta PERforates into uterine serosa (invades entire wall)

99
Q

fibrinoid nerosis in vessel of placenta

A

PREECLAMPSIA

100
Q

eclampsia

A

preeclampsia WITH siezures

101
Q

HELLP

A

Hemolysis (with schistocytes)
Elevated liver enzmyes
Low
Platelts

102
Q

MOA iv mag in preeclampsia

A

PREVENTS SEIZURES

103
Q

suddn infant death syndrome timing

A

1 mont to 1 year

104
Q

increased risk of SIDS

A

sleeping on STOMACH

and SMOKING

105
Q

functional unit of placenta

106
Q

how to differentaite mole from normal pregnancy

A

moles - higher bCG that doesn’t correlate with GA

uterus will be bigger than normal (will not line up with gest age and size)

107
Q

grape like masses protruding thorugh vaginal canal

A

hydratofirom mole

108
Q

“snow storm appearance”

A

complete mole

109
Q

complete mole vs parrial mole in terms of increased in chorio

A

complete mole - increased risk

partial - no increased risk

110
Q

mole epty egg with two sperm

A

COMPLETELY from dad
COMPLETELY a mole, no baby tissue
COMPLETE villi edematous, all of them

111
Q

what to do after you remove molar pregnancy with bHCG

A

serial BHCGS!!!!!

to check for choriocarciona devleopment

112
Q

prognosis of chorio when it comes from sponataneous germ cell tumor vs from gestation

A

spontaneous - poor response to chemo

gestational complication - good response to chemo

113
Q

what is thelarche and when does it occur (tanner stage)

A

thelarche- formation beast bud

Tanner Stage II (10-11.5 yrs)

114
Q

necrotizing granulomatous inflammation of inguinal lymphatics and lymph nodes..fibrosis and perianal involvement due to what infection

A 
chlamidy trachomatis (l1-l3)
lymphogranuloma venerum)
115
Q

precursor lesions to squamous cell of squamous penis cancer

A

leukoplaki on shaft of penis - bowen disease
erythyroplasia of querat - erythroplaki on glans of penis
bowenoid papulosis - reddish papules

assocaited with HPV

116
Q

when to surgically repair cryporrchidism

A

most resolve but if persisst greater than

117
Q

complications cryporchidism

A

increased risk for testicular atrophy with infertility (needs low temp of scrotum and not high temp of abdomen)
incerase risk for seminoma

118
Q

iinection that can cause orchitis

A

chalmydia trach (D-K), neisesria gonarreha
e coli pseudomonas
mumps
atuoimmune

119
Q

testicular torsion what gets bocked and what doesn’t

A

arterial blood can go in

but veous blood cant get out (leads to hemorrhagic infarction)

120
Q

renal cell carcinoma can lead to what testicular abnormality

A

varicocele (blockage of left renal vein)

121
Q

hdrocele is fluid colelction ithin where

A

tunica vaginalis

122
Q

hydrocele in infatns is due to incomplete closure of what

A

processus vaginalis

123
Q

hydrocele in adults

A

blockage of lymphatic drainage

124
Q

how to dx testicular tumors

A

YOU DON’T
DON’T BIOPSY THEM
95% ARE GERM CELL ANYWAY

125
Q

risk factors germ cell tumors

A

kinefelter syndrome

cryporchidism

126
Q

seminoma in testicle = what in ovaries?

A

dysgerminoma

127
Q

large watery cytoplasm and “fried eggg” appearance in testicle

128
Q

homogenous mass (painless) without hemorrhage or necrosis

A

seminoma

MCC testicular tumor…excellent progosis, late metastasiss

129
Q

tumor marker seminoma

130
Q

malignat tumor immature primiteve cells may form glands

hemorrhagic mass with necrosis (painful)

A

embryonial carcinoma

131
Q

yolk sac tumor marker

132
Q

testicular tumor in child

A

yolk sac tumor

133
Q

histologic marker yolk sac tumor

A

glomeruloid structure (schiller duval bodies)

134
Q

male with testicular mass with hyperthyroidism or gynecomastia

A

choriocarcionma (hcg stimilar to lh , fsh, tsh….)

can esaily spread to lungs and brain

135
Q

difference in presentaiton of teratomas in females vs males

A

females - benign

males - MALIGNANT

136
Q

MCC testicular cancer in older men

A

testicular LYMPHOMA

usually diffues large b cell type

137
Q

dysuria fever chills, tender boggy prostate

A

prostatitis

138
Q

MCC prostatitis young adults and elderly

A

young - gonarrhea/chlamydia

139
Q

dysuria, lower back pain, cultures negative

A

chornic prostatitis

140
Q

where does BPH occur

A

periurethra zone

141
Q

rx BPH

A

a1 antagonist (terazosin) - relaxes smooth muscle
seletiev (tamsuolosin
5a reducatse inhibitor (finasteride)

142
Q

where does prostatic adenocarcinoma

A

posterior periphery from prostate (far away from urethral zones)…

143
Q

why is prostatic adenocarcinoma typically clinically silent

A

since it affects posterior peripherly, it DOESN’T impinge on urethra and will not cause symptoms

144
Q

tumor markers prostate cancer

A

PSA and PAP 9prostatic acid phosphatise)

145
Q

low back pain with high serum ALP and PSA

A

osteoblastic metastases in bone

146
Q

rx prostate cancer

A

target anything that decerases production of androgens

Leuprolide - GnRH analog whih will decrease FSH and LH
flutamide - androgen

147
Q

2 layers enveloping lobules and dcuts of breast

A

luminal cell layer (inner protective layer

myoepithelial cell layer (projects milk out)

148
Q

highest density of breast tissue in female

A

UPPER OUTER QUADRANT of breast

149
Q

causess of galactorrhea

A

nipple stimulation
PROLACINOMA of anterior pituitary
drugs

150
Q

etiology acute mastitis

A

s aureus that enters breast druing breast feeding (cracks in nipple)
warm erythematous breast with purulent nipple discharge

151
Q

rx acute mastitis

A

drain, treat with abx (dicloxacillin) continue breast feeding

152
Q

green brown nipple discharge

A

mammary duct ectasia (subareolar dcuts)

153
Q

mammary duct ectasia biopsy

A

chronic inflammation with plasma cells

154
Q

how does fat necrosis look on mammography

A

CACIFICATION (soponification)

155
Q

MOA of mifepristone, misoprostol, and methotrexate in early pregnancy termination

A

miso - prostaglandin agonist
mifepristone - progesterone antagonist
methotrexate- folic acid antagonist

156
Q

biopsy of fat necrosis

A

nectrotioc fat with caclifications and presence of GIANT CELLS

157
Q

protein for gap junction

A

connexin (intercellular communication)

158
Q

protein for tigh junctions

A

claudins, occludin (paracellular barrier)

159
Q

adherenes junction protein

A

cadherin (cell anchor)

160
Q

protein desmosomes

A

cadherin (desmoglein, desmoplakin) (cell anchor)

161
Q

protein hemidesmosomes

A

integrin s(cell anchor)

162
Q

MCC change in premenopausal bresat

A

fibrocystic change

163
Q

feature fibrocystic change that has risks for malignancy

A 
sclerosing adenosis (a/w calcificaitons)
and epithelial hyperplasia (WITH ATYPICAL CELLS)
164
Q

apocrine metaplasia risk of cancer

165
Q

fluid filled duct dilation and blue dome

A

fibrocystic changes

166
Q

bloody nipple discharge, (mcc cause) in premenopausal

A 
intraductal papilloma
(two layers)  of epithelial and myoepithelial cells (premenopause)

UST ALWAYS DISTINGUISH FROM PAPILLARY CARCINOMA (usu. affects older women), post menopausal

167
Q

MCC benign tumor of breast, premenopausal women

A

fibroadenoma

168
Q

mCC tumor in premenopasual woman

A

fibroadenoma

169
Q

breast mass shrinks with menstrual cycle and moves

A

beningn fibroadenoma (no increased risk)

170
Q

small mobile well defined breast mass

A

fibroadenoma

171
Q

breast growth with “leaf like” projections

A

phyllodes (seen in postmenopausal)

172
Q

normal appearing female with femal external genitalia (scant axillary/pubic hair), rudiemntary vagina, NO UTERUS OR FALLOPIAN TUBE (incresaed testosterone, estrogen, LH)

A

androgen insensitivity (testicular feminization)

173
Q

female/ambiguous external genitalia, female appearing until puberty develops male secondary sex characterisitics

A

5a reductase def
46XY
autosomal recessive. iability to convert testosterone to DHT
normal testosterone/estrogen levels, normal LUH
internal genitalia (male internal) normal

174
Q

failure to complete puberty, low GnRH, FSH< LH< testoserone

A

defective migration of GnRH releasing neurons and subsequent failure foGnRH releasing olfactory bulbs to develop

anosma

KALLMAN SYNDROME

175
Q

born with ambiguous genitalia, increased serum testosterone and androstendione, mom developed virilazation during pregnancy because of high testosterone, female XX

A

aromatase deficiency (cannot convert androgen into estrogen)

176
Q

malignant cells in DUCT bound by basement membrane

A

DCIS (NO INVASION of basement membrane)

177
Q

DCIS that moved thorugh duct and into skin of nipple

A

Paget’s diseas of nipple

178
Q

high grade cells with necrosis and dystrophic calcificaiton in center of ducts

A

DCIS (comedo type) CENTRAL NECROSIS

179
Q

nipple ulceration and erythema what to do next….

A

look for underlying DCIS somewwhere else in breast

180
Q

duct like structures, presents as mas on phsical exam, can dimple skin and retract nipple

A

invasive ductal carcinoma

181
Q

highly erythematous breast and swollen…given abx, doesn’t resolve…

A

inflammatory breast cancer

182
Q

histologic hallmark of inflammatory breast carcinoma

A

invasion of dermal lymphatics

183
Q

lymphatic drainage blocked an dpeau dorange

A

inflammatory breast carcinoma

184
Q

high grade maligantn cells with inflammatory background (lymphocytic infiltrate)

A

medullary carcinoma

185
Q

BRCA1 mutations increase risk of what type of breast cancer

A

medullary carcinoma

186
Q

orderly Lines of Cells

decreased E-cardherin expression

A

lobular carcinoma

187
Q

decreaesed E cadherin breast tissue

A

lobular carcinoma

188
Q

tumor can deform suspensory ligaments

A

dimpling skin

invasive ductal carcinoma

189
Q

most useful tool in staing breast cancer

A

axillary lymph node biopsy

190
Q

ER and PR positive…respond to…?

191
Q

her2nu positive

A

cell surface growth factor receptor (onco gene, tyrosine kinase)

RESPOND TO TRANSTUZIMAB

192
Q

BRCA1 incraess suspectiblity to what cancers

A

breast (medullary carcinoma)

ovarian (serous)

193
Q

BRCA2 increasd risk of …

A

male bresat carcionma (invasive ductal carcinoma)

A_First Aid Random Memorizing (17 decks)

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