Reproductive

Question 1

34 yr old with bleeding from right nipple. whats the finding?

Answer 1

intraductal papilloma is the most common cause of bloody nipple charge. Caused by proliferation of papillary cells in duct or cyst wall with fibrovascular core

Question 2

22 yo pregnant female with maculopapular rash that spreads from face to trunk + postauricular lymphadenopathy. Whats the mother and infant at risk for?

Answer 2

Pt has measles. Mother will get polyangitis and fetus will develop sensorineural deafness, cataracts and PDA.

Question 3

Medication for female with PCOS and want to get pregnant?

Answer 3

SERM: clomiphene, prevent negative feedback inhibition of hypothalamus and pituitary by circulating estrogen

Question 4

Mechanism of action of mifepristone

Answer 4

progesterone antagonist, causing necrosis of uterine decidua and prevents development of first trimester pregnancy

Question 5

screening during pregnancy: low AFP, low estriol, high beta hcg, high inhibin. What’s the diagnosis?

Answer 5

Down syndrome: typically see decrease AFP and unconjugated estriol due to suboptimal fetal tissue function. Increased beta hcg and inhibin A are secreted in compensation

Question 6

Malignant infiltration is which structure of the breast causes dimpling?

Answer 6

suspensory ligament

Question 7

when is b HCG first be detectable in the serum?

Answer 7

8 days after fertilization

Question 8

52yo women with leakage of urine with coughing and sneezing. Diagnosis and treatment?

Answer 8

Stress incontinence, and Kegels will target levator ani muscles that hold the bladder and urethra in appropriate anatomic position

Question 9

15 yo patient with impaired writing and reading skills, misbehaviors, mild intellectual disability. Karyotype is 47. Diagnosis and other findings?

Answer 9

Klinefilters/ tall stature, gynecomastia, azoospermia (primary testicular failure) ** remember that macroorchidism is a result of fragile x

Question 10

eval for amenorrhea –> oral medroxyprogesterone is administered. A few days after, pt has heavy bleeding and cramping. Why?

Answer 10

due to progesterone withdrawal –> increase in prostaglandin production that leads to vasoconstriction of spiral arteries and acause apoptosis of endometrial epithelium

Question 11

After radical prostatectomy, nerves within fascia surrounding the gland are injured, which one?

Answer 11

prostatic plexus that can lead to erectile dysfunction

Question 12

testicular mass is discovered. Which lymph node if malignant will it spread to first?

Answer 12

paraaortic

Question 13

lymph drainage:

1. superficial inguinal lymph nodes
2. deep inguinal nodes
3. external iliac
4. common iliac
5. inferior mesenteric

Answer 13

1. cutaneous inferior to umbilicus, external genitalia anus up to pectiate line
2. glans penis and clitoris
3. superficial and deep inguinal nodes
4. internal and external nodes
5. descending colon, upper part of rectum

Question 14

female with irregular menses has decreased alpha fetoprotein level during second trimester. what do you suspect?

Answer 14

Dating error: AFP levels increase with gestational age –> need an ultrasound to determine gestational age. normally, increased AFP= neural tube defect, ventral wall defect, multiple gestation. decrease = down

Question 15

no blood flow to the ovary? with structure is involved

Answer 15

suspensory ligament (aka infundibulopelvic ligament)

Question 16

23 yo female with R lower ab pain with bloody vaginal bleeding. Tachy and ill appearing with positive urine B HCG , prior history of infection. Diagnosis?

Answer 16

Suspect ectopic pregnancy. Common risk factors are PID –> usually from untreated gonorrhea or chlamydia infection.

Question 17

40yo women with vaginal bleeding, midline pelvic pain, severe nausea, vomiting –> super high B HCG, US with no fetus and uterine cavity with multiple small cysts. What is it? and karyotype?

Answer 17

complete hydatidiform mole. Usually these are 46 XX

Question 18

16yo girl with vaginal bleeding. Path shows fetal tissue, focal trophoblastic hyperplasia, enlarged villi. Diagnosis?

Answer 18

Partial mole

Question 19

Path characteristics of ectopic pregnancy?

Answer 19

dilated coiled endometrail glands and edematous stroma

Question 20

mammography reveals microcalcifications. histology shows pleomorphic cells with prominent central necrosis. What type of lesions? origin?

Answer 20

ductal carcinoma in situ –> arises from the ducts

Question 21

33 yo women comes to the office for evaluation of infertility. Pt has pelvic pain, suspected to be endometriosis. Biopsies contain simple cuboidal epithelial cells. Where is the biopsy happen?

Answer 21

Ovary. ovaries are simple cuboidal epithelial, vagina/cervix= stratified squamous, uterine and fallopian = simple columnar.