SAS/Review Flashcards
1
Q
Which antibiotic is associated with pumonary fibrosis?
A
Nitrofurantoin
2
Q
What is the treatment for endometrial hyperplasia?
A
Progesterone therapy or hysterectomy
(Sometimes do progesterone now, plan hysterectomy for later if pt wants to have more children)
3
Q
A
B - rule out other sources of hyperandrogenism
Most likely PCOS, but cannot say definitively until other causes (tumor, CAH, Cushing) are ruled out
4
Q
List the estrogenic (4) and anti-estrogenic (2) effects of tamoxifen
A
-
Estrogenic
- Venous thrombosis :(
- Endometrium: polyps, hyperplasia, risk of cancer :(
- Maintains bone density :)
- Maintains vaginal mucosa :)
-
Anti-estrogenic
- Breast :) - fights cancer!
- Hot flashes :(
5
Q
List 2 nerves that innervate levator ani
A
Pudendal nerve (inferior rectal branch)
Nerve to the levator ani
Nerve to the levator ani is also from the anterior branches of S2, S3, S4, but not the same as the pudendal
6
Q
Which kidney stones are diamond-shaped?
A
Calcium oxalate
7
Q
What is the most malignant tumor involving the spermatic cord?
A
Liposarcoma
8
Q
Describe the management of placenta previa
A
- Pelvic rest
- Expectant management
- Give antenatal steroids if <34 weeks
- Planned C-section at 37 weeks
9
Q
What is the function of prostate-specific antigen?
A
Liquifies semen
(And also used as a marker for prostate cancer)
10
Q
In a patient with functional hypothalamic amenorrhea, what would you expect the results to be from:
- Prostestin challenge:
- Estrogen + progestin challenge:
A
- Prostestin challenge: No bleeding (negative)
- Implies either outflow obstruction OR low estrogen
- Estrogen + progestin challenge: Bleeding (positive)
- Implies low estrogen; cause of amenorrhea is central
- Functional hypothalamic amenorreha = suppresed GnRH -> no LH/FSH -> no estrogen or progesterone*
- NOTE: GnRH levels cannot be measured in the blood*
11
Q
Which nerve is responsible for emission?
Which one is responsible for ejaculation (aka expulsion)?
(How are these two entities different?
A
Emission: Lumbar sympathetic nerves
Ejaculation (expulsion): Pudendal nerve (somatic)
- Emission gets semen to the posterior urethra*
- Ejaculation gets it out into the world*
12
Q
What kind of renal cancer is associated with hereditary leiomyomatosis renal cell cancer?
What is the causative gene?
A
Papillary RCC type 2 or collecting duct carcinoma
FH
13
Q
List 3 features of koliocytes
A
- Large cells
- Large, crinkled, possibly binucleated nuclei (raisin-like)
- Perinuclear clear halo
14
Q
Which of the following is a contraindication to medical abortion?
- Inadequate cervical cancer screening
- Long term OCP use
- IUD in place
- Liver disease
A
c. IUD in place
15
Q
Which imaging study is most useful for diagnosing hydronephrosis?
A
Ultrasound
CT is pretty good, but, not the best for imaging things with a large cavity in the middle
16
Q
A patient on a combined OCP is experiencing nausea and breast tenderness.
Which hormone is most likely responsible for these effects?
How would you modify her OCP to mitigate these effects?
A
Estrogen
Switch to a combined OCP with a lower dose of estrogen
17
Q
What is the usual natural history of mild cervical dysplasia due to HPV infection?
A
Usually, the dysplasia will regress and resolve
- Can progress - slow growing
- More likely to progress in immunocompromised individuals
18
Q
Which hormone can be measured (and when) to predict ovulatioN?
A
Serum progesterone on day 21 and 27
More reliable than temperature charting
19
Q
MOA: Finasteride
A
5-alpha-reductase inhibitor
Acts as an anti-androgen by preventing the conversion of testosterone to the more potent DHT
Anti-androgen therapy helpful in the treatment of BPH
20
Q
6 weeks after surgical removal of a cancerous prostate lesion, a patient’s PSA is elevated (>0.1 ng/mL)
What is the best adjuvant approach?
A
Combined androgen ablation + radiation
21
Q
What is the female homolog of the male prostate?
Where is it located?
A
Skene gland
Around the opening of the urethra
(In the vestibule, anterior to the opening of the vagina)
22
Q
Where would a Gartner’s duct cyst be located?
What cause this cyst?
A
Anterolateral aspect of the proxmal vagina
Wolffian duct remnant
23
Q
Which GI complaint is most common in the first trimester of pregnancy?
Why?
A
Nausea + vomiting
Caused by high hCG
24
Q
What are the histologic features of a mixed germ cell tumor (embryonal carcinoma) of the testes?
A
Solid, glandular, and papillary patterns
25
What is the primary arterial blood supply to the prostate?
Inferior vesical artery
26
What is the half life of PSA?
2-3 days
27
What is the differece between mild, moderate, and severe cervical dysplasia?
* **Mild** = lower 1/3 of epithelum only
* **Moderate** = Involves middle 1/3 and lower 1/3 of the epithelium
* **Severe** = Involves the hwol epithelium
28
What is the most serious and likely side effect estrogen-only hormone replacement therapy?
Endometrial cancer
*DVT also possible, but less common?*
29
What is the histologic hallmark of a yok sac tumor?
Schiller-duvall body
30
If a patient's testicular tumor markers do not normalize after orchiectomy, what is the next step in their managment?
**Start chemotherapy**
* If tumor markers don't normalize, implies metastatic disease*
* Do chemotherapy; if tumor markers normalize, can do **post-chemotherapy surgical resection (PC-RPLND)***
31
What is the most common position of the uterus on bimanual exam?
Anteverted
(Why we can feel the uterus on bimanual exam)
32
Which of the following is NOT a contraindication to hormone replacement therapy?
1. Active breast cancer
2. Unexplained vaginal bleeding
3. History of endometrial cancer
4. Liver disease
5. Previous VTE
c. History of endometrial cancer
* Active endometrial cancer would be a contraindication, but if it's gone then go for it*
33
Which laboratory test is most valueable in monitoring a patient's response to syphilis treatment?
Rapid plasma reagent
*FTA and NAAT are used for **diagnosis***
34
Which kidney stones are "coffin shaped"?
Struvite
*Associated with urease-producing bacteria*
35
D: Platinum-based chemotherapy
*Chemotherapy is not effective on metastatic RCC!*
36
Abnromalities in what non-repro organ system are commonly associated with Mullerian duct anomalies?
Renal
## Footnote
*Unilateral anomalies*
37
The protein product of which gene is responsible for HIF-alpha ubiquitination?
What is the consequence of a mutation in this gene?
VHL gene
Von-Hippel Lindau syndrome
Bilateral clear cell RCC, adrenal enlargement, pancreatic masses
38
What kind of renal cancer is associated with hereditary papillary renal carcinoma?
What is the causative gene?
Papillary RCC type 1
MET (7q31)
39
Which lymph nodes drain the left testis?
Right testis?
Left -\> Paraaortic nodes
Rigth -\> Interaortocaval nodes
40
Which muscles make up the levator ani? (3)
* Puborectalis
* Pubococcygeus
* Iliococcygeus
\*\*Ischiococcygeus (aka coccygeus) is NOT part of levator ani
*Note: Cochard kind of groups the puborectalis as part of the puboccygeus*
41
What is the serum half life of AFP?
5-7 days
*Relevant b/c need to measure AFP to make sure there are no metastases after removing testicular tumor, but need to wait long enough for previous levels to go down*
42
What feature of a patient's history would make anovulation **VERY** unlikely?
**Regular periods** (in a patient not taking any contraceptives)
43
What percentage of prostate cancers are hereditary?
15%
44
Which nerve is labeled by #3?
Dorsal nerve of the penis or clitoris
45
What is the first imaging method used to evaluate a suspected ectopic pregnancy?
Ultrasound
46
What is the most appropriate next step in management of a patient who has **blood at the urethral meatus** following blunt trauma to the pelvis and perineum?
Retrograde urethrogram (RUG)
*Do not attemt to fully insert catheter if there is any blood (need to rule out urethral injury first)*
***If there is blood, do a RUG!***
47
What is the primary venous drainage from the prostate?
Dorsal vein of the penis
Internal iliac veins
*Venous plexus in the prostate drains there, but presence of plexus = large potential for bleeding*
48
What are the borders of the femoral triangle?
* **Inguinal ligament** (superior)
* **Adductor longus** (medial)
* **Sartorius** (lateral)
*Fascia lata separates superficial and deep compartments*
49
Which lymph nodes is cervical cancer likely to metastasize to first?
Which nerve is at risk when these nodes are dissected?
Peri-aortic and para-aortic nodes
Obturator nerve
50
Which 3 nerves innervate the scrotum?
Genitofemoral = lateral and anterior
Ilioinguinal = anterior
Pudendal = posterior
*Genitofemoral is also motor to cremaaster muscle*
51
D - poor response to appropriate abx after 3 days
Imaging indicated after 5-6 days without improvement for pyelonephritis
*I think the key is that A, B, and C might constitute a "complicated" pyelonephritis and should be imaged?*
***Note:** wait 5-6 days in tx of _pyelonephritis_, but 3 days in tx of _UTI_*
52
Which nerve is labeled by #2?
Perineal nerve
53
Which gonadotropin promotes glomerulosa cell proliferation?
As a result, levels of which hormone will increase?
FSH
- \> Incresed estrogen
* Granulosa cells have aromatase that converts androgens from theca cells to estrogen -\> proliferation of endometrial lining*
54
Which gonadotropin is most important for stimulating ovulation?
LH **spike**
## Footnote
*Stimulated by faster GnRH pulses*
55
How can you differentiate between an intraperitoneal and an extraperitoneal bladder rupture?
(Diagnostic test and findings)
How does the management differ?
**Cystoscopy**
* Intraperitoneal
* **Contrast goes up**
* **Need to do surgery**
* Exraperitoneal
* **Contrast stays below bladder or goes sideways**
* **Can cath and observe**
* Unless bladder neck, vaginal, rectal, large injury or bone fragments - then do surgery
56
Which cells create the blood-testis barrier?
Sertoli cells
57
List 3 HPV-related pre-malignant penile legions
* Erythroplasia of Queyrat (glans)
* Bowen's diesase (shaft)
* Bowenoid papulosis
*Erythroplasia of Queryrat and Bowen's disease are both CIS, but in different locations*
58
Which embryonic structure is the origin of the prostate?
UG sinus (pelvic part)
59
The urinary bladder, rectum, and vagina are...
1. Peritonealized
2. Retroperitoneal
Retroperitoneal
*Uterus and sigmoid are peritoneal*
60
Which anatomic structure separates superficial and deep inguinal lymph nodes?
Fascia lata
61
What kind of renal cancer is associated with Birt-Hogg-Dube?
What is the causative gene?
Hybrid oncocytic RCC, Chromophobe RCC, clear cell RCC\< oncocytoma
(Basically, many possiblilities)
BHD
62
What is the zonal origin of most prostate cancers?
Peripheral zone
63
Which artery supplies the urinary bladder and prostate?
Internal iliac - anterior division
*More specifically:*
* *Bladder supplied by superior and inferior vesical arteries*
* *Prostate supplied by inferior vesicle*
* *Secondary supply = middle rectal, internal pudendal arteries*
*Supplies most of the pelvic organs*
64
When should a retroperitoneal lymh node dissection (RPLND) be performed in the setting of metastatic testicular cancer?
AFTER chemotherapy (PC-RPLND)
* If tumor markers are abnormal following orchiectomy -\> **do chemo** (pt has metastatic disease)
* **After chemo,** IF tumor markers normalize but there are retroperitoneal tumors/affected nodes, **can do lymph node dissection**
65
Which fascia envelops the blood vessels, nerves, lymphatics, and muscles of the pelvic side wall?
Endopelvic fascia
66
Which kidney stones are hexagon-shaped?
Cystine
67
List 3 risk factors for penile cancer
* Uncircumcised (or circumsised after puberty)
* Tobacco consumption
* Increased # of sexual partners
68
What is the appropriate management for an **intraperitoneal bladder rupture?**
Immediate surgery
* Intraperitoneal = contrast travels superiorly to bladder, around bowel loops
* If contrast stays below the baldder or to the sides, likely extraperitoneal; can catheterize and observe
69
In a normal pregnancy, hydronephrosis is most likely to occur in which kidney?
Right
*Uterus displaces ureters; hydronephrosis/enlargement of kidneys is normal (even if not symmetric)*
70
What histological finding would you expect in a fibroid (aka leiomyoma)?
**Smooth muscle bundles at various angles**
* Presents in pts with heavy menstrual bleeding, bad cramps
* This is a benign lesion
*Leiomyosarcoma will have 2/3 of: tumor necrosis, high mitotic activity, atypia*
71
What are the indications for radiologic assessment after urologic trauma?
* _Penetrating_ trauma (to the flank/abdomen)
* _Blunt_ trauma IF either of the following:
* Gross hematuria
* Microscopic hematuria + _shock_
* _Deceleration_ injuries
* _Pediatric_ injuries if ANY hematuria
72
Which nerves are usually responsible for erectile dysfunction?
Pelvic splanchnic nerves (parasympathetic)
* Erection is parasympathetic*
* TY @Will Schwartz!*
73
Which glands are responsible for lubricating the vagina?
Where are they located?
Bartholin glands
Just posterior to the vagina, in the vestibule
74
Describe the presentation of **complete androgen insensitivity** in a 46, XY individual
* Female external genitalia and development
* secondary sexual characeristics
* Often presents with primary amenorrhea or bilateral "inguinal hernias"
* Testes intact, but not descended
* Blind vagina
* Uterus does not form; sertoli cells produce AMH in an XY individual
*Ex: 17-18 year old who never had their period*
75
If you see these Call-Exner bodies on an ovarian histologic specimen, which kind of tumor is most likely?
Granulosa cell tumor
* Low malignant potential
* Produce estorgen =\> Associated with endometrial hyperplasia
76
Which structure induces the metanerphic blastema to form the definitive adult kidney?
Ureteric bud
77
Describe the criteria for diagnosis of PCOS
2/3 of the following:
* Oligo and/or anovulation
* Signs of hyperandrogenism
* Ultrasound with ≥ 12 follicles in each ovary (2-9 mm) **OR** increased ovarian volume (\>10mL)
78
What is the function of the nerve that transverses this foramen?
Adduction of the thigh
*This is the obturator nerve*
79
From which embryonic structure is the urinary bladder derived?
Urogenital sinus
* Mesonephric duct -\> Epididymis, vas deferens, seminal vesicle*
* Ureteric bud -\> kidney stuff*
* UG sinus -\> Penis, scrotum, urethra, bladder*
80
Intravesical botox injections
81
To which lymph nodes will penile cancer drain first?
What is the next "echlon" of nods
Superficial and deep **inguinal** lymph nodes first
Then **external iliac (aka pelvic)**
Usually **bilateral**
*If you're dissecting the nodes, do both sides!*
82
Which imaging study is best for assessing tubal patency?
Hysterosalpingogram
83
Describe the differences in presentation of **placenta previa** vs. **placental abruption** vs. **vasa previa**
**All: bleeding**
* Placenta previa
* Painless
* **Reassuring fetal monitoring**
* Placental abruption
* **Painful**
* Vasa previa
* Painless
* **Worrisome fetal monitoring**
* Placenta previa = maternal blood*
* Vasa previa = fetal blood; can bleed out very quickly*
* Premature rupture of membranes = clear fluid*
84
A uterine fundus palpable at the umbillicus corresponds to which estimated week of pregnancy?
20-22 weeks
85
Which GU structure is at risk when ligating the uterine artery during a radical hysterectomy?
Ureter
*Note: obturator nerve more at risk when dissecting lymph nodes, but it's around here too*
86
An invasive urothelial cancer lesion is most likley to have (at least) one of which two mutations?
p53 mutation
Rb mutation
*Most common mutations found in invasive urothelial cancers*
87
Who should be treated with hormone replacement therapy?
People with **moderate to severe vasomotor symptoms that affect their QOL,**
as long as:
* They are \<10 years out from their last menstrual period (and \<60 years old)
* They have **none** of the following contraindications
* History of breast cancer
* Chronic heart disease
* VTE
* Active liver disease
* Unexplained vaginal bleeding (merits work-up)
88
What is the best pharmacological treatment option for a patient wtih metastatic prostate cancer?
Anti-androgen therapy
*Options:*
* Surgical castration
* LHRH agonists and antagonists
* But probably not great to give an agonist b/c initial rise in hormones could make mets worse
* Antiandrogens
* Androgen biosynthesis inhibitors
* Androgen receptor cofactor interaction inhibitors
89
In ureteral duplication anomalies, which complications are most likely from:
* Ureter from the upper moiety:
* Ureter from the lower moiety:
* Ureter from the upper moiety: **Obstruction**
* Inserts distally; longer tube, things more likely to get stuck?
* Also ectopic ureter, ureterocele
* Ureter from the lower moiety: **Reflux**
* ****Inserts proximally and laterally
* Shoter tube -\> valve mechanism not strong enough to prevent reflux
90
What is the lesser known HPV viral protein emphasized in the penile cancer lecture?
What normal cell processes does it disrupt?
E5
Results in increased **EGFR** -\> increased mitosis
91
List the Gleason scores that correspond with each prostate cancer grade group
* Group 1: **Gleason score \<6**
* Group 2: **3+4**
* Group 3: **4+3**
* Group 4: **4+4**
* Group 5: **9 or 10**
92
How does renal blood flow and ureteral pressure change in each phase of acute obstruction?
* Phase I
* Phase II
* Phase III
* Phase I:
* Both increase
* Phase II:
* Renal blood flow decreases
* Ureteral pressure stays high
* Phase III
* Both decrease
93
Which is more likely to produce a live-born child?
1. Oocyte preservation
2. Embryo preservation
If one is more effecctive, why is the other option even offered?
**Embryo preservation is more effective**
BUT it requires an egg AND a sperm to make an embryo; increased divorce rates in couples who go through a cancer dianosis/pt may not have a chosen partner at the time of diagnosis = **oocyte may be the best option**
94
What are the borders of the inguinal triangle?
Rectus muscle (medial border)
Inferior epigastric vessels (lateral border)
Inguinal ligament (inferior border)
*Thank you @Vineeth!*
95
What is this vulvar legion:
Itchy, whitish-appearing, butteryfly distrubuted skin changes
Does this legion carry a risk of turning into cancer?
**Lichen sclerosis**
* More likely in an older patinet
* Cause: autoimmune or low estrogen
* **Invasive squamous cell carcinoma can arise**
*Note: lichen simplex chronicus is NOT a SCC precursor; caused by irritation -\> itching*
96
Which pharmacologic agent, used to treat ER+ breast cancer, is associated with endometrial hyperplasia?
Tamoxifen
97
What is the most common ovarian germ cell tumor?
How will it apear on ultrasound?
Mature teratoma
* Cystic (smooth)
* Calcifications due to mulitple germ layers
98
BPH develps in which area of the prostate?
Transition zone
*Prostate cancer in peripheral zone*
99
What is the pathologic hallmark of endometriosis?
Hemosiderin-laden macrophages
=\> evidence of prior bleeding
*Hemosiderin-laden macrophages are not specific to endometriosis*
100
How does the management of anterior vs. posterior urethral trauma differ?
Anterior -\> **repair immediately**
Posterior -\> **suprapubic diversion, delay repair**
*Suprapubic diversion = insert catheter through the abdomen*
101
Which nerves are at risk during a sacrospinus ligament suspension?(surgery to treat pelvic organ prolapse)
Hint: Just medial to the ischial spine
Pudendal neurovascular bundle
102
What are the indications for exploratory surgery following urologic trauma? (4)
* _Medial_ hematoma
* _Large_ hematoma (rim distance \>3.5 cm)
* Active _blush_ on CT scan w/contrast
* _Deep_ laceration (\>2.5 cm)
* Grade 5 will always meet these criteria; grade 4 if the renal vein is injuried*
* Important to remember that "exploratory surgery" is to save the pt from bleeding out - will likely lose a kidney so only do if you really need to*
103
A - recurrent episodes of gross hematuria and clot retention
104
Normal, squamous cervical mucosa is on the left
What change has occured in the slide on the right?
What most likely caused this change?
**Mild dysplasia - koliocytes present (arrows)**
Most likley due to HPV infection
105
What is the best treatment for an 80 year old female pt with no symptoms and bacturia?
No treatment!
*Only treat asymptomatic bacturia in pregnant patients*
106
Which perineal structures would be cut in a **mediolateral episiotomy?**
* UG diaphragm
* Bulbospongiosus
* Superficial transverse perineal muscles
107
What is the most common germ cell tumor of the ovary?
Teratoma
108
C. Chromophobe
* Most favorable survival of all malignant renal tumors*
* Onchocytoma has better survival, but it's not malignant*
109
What is the important bony landmark for performing a pudendal nerve block?
Ischial spine
110
Which cells of the prostate produce the majority of prostate-specific antigen (PSA)?
Adluminal cells (aka secretory cells)
111
What is the current regimen for medical abortion?
Mifepristone + Misoprostol
* Mifipriston = anti-progestin
* Misoprostol = prostaglandin analog
* Helps with expulsion
*Note: Methotrexate used for _ectopic_ pregnancies; technically does not count as a medical abortion*
112
Which cancer syndrome is associated with an increased frequency of upper tract urothelial cancer?
What other cancers are associated with this syndrome?
Lynch II
* Colon
* Enodmetrial
* Urinary tract
* Ovarian
113
Which part of the hypothalamic-pituitary-gonadal axis is most likely disrupted in hypothalamic amenorrhea?
Pulsatile GnRH secretion from the hypothalamus
114
The uterus and sigmoid colon are...
1. Peritonealized
2. Retroperitoneal
Peritonealized
115
Which nerve is labeled by #1?
Inferior rectal nerve
116
D. Urachus
117
What kind of cells are classically "spindle-shaped"?
Fibroblasts
118
What is the best initial managment for a patient with a fever, bacturia, ureteral stone, and hydronephrosis?
Stent placement + antibiotics
*Eventually will want to treat stone, but this pt is sick! Immediate relierf with stent, wait for them to stabilize, then can do a stone ablating or removal procedure*
119
Which retroperitoneal space is responsible for containing bleeding following renal trauma?
Peri-renal space
120
In a combined OCP, which hormone...
* Suppresses the LH surge?
* Suppresses FSH?
* Produces secretory changes in the endometrium?
* Stabilizes the endometrium?
* Suppresses the LH surge? **Progesterone**
* Suppresses FSH? **Estrogen**
* Produces secretory changes in the endometrium? **Progesterone**
* Stabilizes the endometrium? **Estrogen**
121
When should platinum-based chemotherapy be started in a patient with invasive bladder cancer?
Only **after** tumor removal
Use intravesical BCG for superficial tumors to activate the immune system against the tumor or cystectomy if invasive
(Local tumors will not respond to chemo - deal with these first before systemic tx)
122
Which genetic abnormality is most likly present in an embryonal carcinoma of the testes?
Isochrome 12p
123
Arterial supply and lymphatic drainage to the anterior urethra:
* **Arterial**: Internal pudendal artery
* **Lymphatic**: Inguinal nodes
*Vowels + n stick together:*
***in**ternal pudendal, **in**guinal nodes for the **an**terior urethra*
124
Which nerve is motor to the cremaster muscle?
Genitofemoral
*Also sensory to anterior thigh/scrotum*
125
Which segmetn of the fallopina tube is the most common site of implantation of an ectopic pregnancy?
Ampulla
126
In terms of lower urinary tract symptoms, when woudl a beta-3 agonist vs. an alpha agonist be helpful?
* Beta 3 agonist
* Helps relax the detrusor
* Relieves **irritative** symptoms of urgency, frequency, urge incontinence
* *I think muscarinic antagonists have a similar effect*
* Alpha agonist
* Helps contract the external urethral sphincter
* Helps hold pee in - may help **stress incontinence**
127
Which relevant kidney stone is NOT radiopaque?
(Cannot be seen on KUB, aka radiolucent)
Uric acid
128
An injury to which nerve is most likely to cause urinary retention?
**Pelvic nerve**
* **P**elvic nerve = **p**arasymathetics
* Active during peeing
* Hypogastric = sympathetic
* Inhibits parasymathetics for contience
* Injury = incontinence
* Pudendal nerve = somatic
* Baseline tone = contraction of external urethral sphincter
* Injury -\> incontinence
129
Levator ani complex:
* Type of muscle:
* Innervation:
* Type of muscle: **Striated (skeletal)**
* Innervation: **Somatic control (pudendal nerve)**
130
Which inherited genetic anomlay is associated with an absent vas deferens?
CFTR gene mutation
*Asymptomatic carriers may be affected too!*
131
Which nerve traverses the lesser sciatic foramen?
What are its functions? (5)
Pudendal nerve
Innervates the perineum body wall
* UG diaphram
* Pelvic diaphragm
* External anal sphincter
* Skin of perineum
* External genitalia
132
List 3 possible Tamoxifen-induced changes that can occur in the endometrium
* Endometrial polyps
* Endometrial hyperplasia
* Type 1 Endometrial cancer
* Endometroid (hormone-responsive) type
*NOT fibroids or endometriosis*
133
What is the appropriate management for a patient with a grade 3 urothelial cancer involving the lamina propria, s/p TURBT with poor margins?
Repeat TURBT
Key is that most bladder cancers are under-staged at first; need to look at tissue, upstage, then repeat TURBT (pretty common to need a repeat TURBT)
134
When in the menstrual cycle does positive feedback occur?
What is the result?
Near the end of the follicular phase, **sustained high estrogen** (and the bump of progesterone) **trigger an LH surge, resulting in ovulation**
*Normally, negative feedback occurs: Estrogen dereases GnRH -\> Decresed FSH/LH*
135
Which gonadotropin supports the corpus luteum?
LH
* When LH falls, the corpus luteum dies and stops producing progesterone -\> menstruation*
* In the event of pregnancy, hCG takes over the role of LH and supports the corpus luteum*
136
From which cells of the nephron are clear cell RCCs derived?
Proximal tubular cells
| (Proximal convoluted tubule)
137
What kind of renal cancer is associated with a mutation in the VHL gene?
Clear cell RCC
* But not all RCC is due to VHL*
* VHL is responsible for HIF-alpha ubiquitination*
138
Which nerve is sensory to the posterior scrotum?
Pudendal nerve
* Can think of the posterior scrotum as kind of part of the perineum?*
* Ilioinguinal innervates anterior scrotum, labia majora*
* Genitofemoral innervates lateral scrotum*
139
What criteria differentiates a leiomyoma (fibroid) from a leiomyosarcoma?
≥ 2 of the following =\> **leiomyosarcoma** (malignant)
* ≥10 mitotic figures per HPF
* Tumor necrosis
* Moderate to severe atypia
140
List the structures in the renal hilum from anterior to posterior
Renal vein
Renal artery
Renal pelvis
141
Which ovarian tumors are associated with Mieg's syndrome
(Mieg's = the tumor + ascites + pleural effustion\_
Ovarian **fibrothecomas**
Made up of fibroblasts and theca cells
142
Arterial supply and lymphatic drainage to the posterior urethra:
* **Arterial:** inferior vesicle, middle rectal
* **Lymphatic**: pelvic
***P**osterior urethra to **p**elvic nodes*
143
Which pelvic foramen is transversed by the pudendal nerve?
Lesser sciatic foramen
144
Which arteries are responsible for blood flow in an erection?
Deep cavernosal arteries
* These arteries fill the sinusoids in the corpus cavernosa
* -\> Expansion aginst the tunica albuginia
* -\> Veins are compressed, blood can't flow out of the penis
* -\> **Erection**
