Test 3

Question 1

what initiates formation of the definitive kidney

Answer 1

ureteric bud (AKA metanephric diverticulum - coming off of the mesonephric duct) grows into the intermediate mesoderm and initiates formation of the METANEPHROS, which becomes the permanent kidney

failure of the kidney to develope is probably due to failure of interaction between ureteric bud and metanephric mesoderm.

Question 2

what mature structures does the ureteric bud make

Answer 2

collecting ducts, major and minor calyces, renal pelvis, ureter

Question 3

what does the allantois become

Answer 3

the urachus, which later becomes the median umbilical ligament

Question 4

medial umbilical ligament is remnant of what

Answer 4

umbilical arteries

Question 5

mesonephric ducts give rise to what

Answer 5

SEED - Seminal vesicles, Epididymis, Ejaculatory duct, Ductus deferens

AKA wolffian duct

caudal end gives rise to the ureteric bud - forms ureter, pelvises, calyces, collecting ducts; fully canalized by 10th week

degenerates in females (paramesonephric duct develops) (leydig cells secrete androgens that stimulate the development of the mesonephric ducts in males)

Question 6

commonest ovarian tumor below the age of 30

Answer 6

dermoid cyst

Question 7

commonest benign breast tumor below the age of 30

Answer 7

fibroadenoma - rubbery, circumscribed mass with no spikey borders

Question 8

most common cause of a lump in women of a reproductive age

Answer 8

fibrocystic disease

cystic change and epithelial hyperplasia

Question 9

bloody nipple discharge

Answer 9

infarcted intraductal papilloma

rarely cancer

Question 10

what cancer is usually bilateral - DCIS or LCIS

Answer 10

LCIS (lobular)

Question 11

majority of invasive carcinoma is what type

Answer 11

ductal - 90+%

lobular - less that 10

Question 12

rare - larhe mass of connective tissue and cysts with “leaf-like” lobulations

common in 5th decade

Answer 12

phyllodes tumor

phyllodes means leaf like

only other stromal tumor besides fibroadenoma

Question 13

breast biopsy

ducts have a peculiar hyperplastic “busy” look

periductal edema

no lobules

what is it

Answer 13

gynecomastia

Question 14

antibiotic used to treat mastitis in breast feeding mom

Answer 14

dicloxcillin

Question 15

breast lump

cellular stroma with nuclear atypia and mitotic figures (lesion may have thinning of overlying skin with increased vascularity, may acutely enlarge)

Answer 15

cystosarcoma phyllodes

large mass of connective tissue and cysts with leaf like lobulations

fibroadenoma is only other stromal tumor

Question 16

what type of patient do you use an aromatase inhibitor in

Answer 16

post menopausal women with breast cancer

Question 17

infiltrating lobular carcinoma - what is possible to see on mammography

Answer 17

it’s possible that it is mammographically silent

infiltrating ductal is often not silent

Question 18

how do you induce menopause

Answer 18

leuprolide shots

GnRH agonist

Question 19

man has breast cancer

what genetics are you thinking

Answer 19

BRCA gene mutation

Question 20

girl with BRCA 1 or 2 mutation

what will oral contraceptives to to cancer risk

Answer 20

decrease the risk of ovarian cancer

preserves fertility until often inevitable bilarteral oopherectomy

Question 21

gametes migrate form the ____________ into the __________ during the VERY early indifferent stage of sexual development

Answer 21

from the umbilical vesicle (yolk sac) to the genital ridge

Question 22

after the germ cells are in the genital ridge, where do they go in the male? female?

Answer 22

male: primordial germ cells migrate into the cortical cords (aka gonadal cords), which then form the seminiferous tubules, straight tubules, rete testis, and sertoli cells (these all lie within the “ball,” before the efferent ductules and epididymis) (spermatogonia lie inside the cords)

in the female, the primordial cords break apart, but form the follicular cells the surround the oogonia

Question 23

what portion of the testis is derived from the mesonephric ductules and not the cortical cords

Answer 23

efferent ductules. Connect the rete testis to the mesonephric duct, the distal part of which becomes the epididymis

Question 24

only portion of the paramesonephric ducts that are in males

Answer 24

prostatic utricle and the appendix of the testis

Question 25

embryological origins of the prostate gland

Answer 25

urogenital sinus

Question 26

gartner’s duct

Answer 26

remnants of the mesonephric ducts found lateral to the uterus and sometimes as superior as the fallopian tubes

Question 27

BRCA1 mutation in sporadic tumor - what is going on with the DNA?

Answer 27

BRCA1 (tumor suppressor gene) is often inactivated in sporadic tumors by epigenetic mechanism (promoter methylation)

Question 28

function of BRCA1 and 2

Answer 28

homologous recombination repairs double stranded DNA breaks

BRCA1 extends single strands from the ends of the break and recruits repair machinery

BRCA2 recruits RAD51 which promotes strand “invasion” i.e. new DNA synthesis starts when the single stranded ends invade intact DNA and replicate

Question 29

HER2 (AKA ERBB2 or Neu)

what kind of gene
mech of cancer if the gene is abnormal

Answer 29

oncogene - tyrosine kinase (

overexpression usually due to genomic amplification - ERBB2 surface proteins can dimerize (homo with self or hetero with EGFR) and promote RAS/MAPK and therefore G1 to S without ligand binding

Question 30

role of FOXA1 in breast cancer

Answer 30

FOXA1 binds to closed chromatin at select sites and opens it. allows access to Estrogen Receptor (ER) binding

one of the sites opened by FOXA1 is the cyclin D1 promoter

cyclin D1 (chromosome 11 - also activated in mantle cell) is a key regulator of the G1/S transition in the cell cycle. Increased transcription of cyclin D1 causes dysregulation of proliferation (tamoxifen stops cyclin D1)

Question 31

lapatinib and trastuzumab

Answer 31

small molecule inhibiter - binds and blocks kinase active site

lapatinib blocks EGFR-ERBB2 heterodimer activity (trastuzumab blocks homodimers of ERBB2)

Question 32

when to screen for gestational diabetes in a normal bmi lady

Answer 32

24-28 weeks

Question 33

what BP medication do you not use in someone who is preeclampsic

Answer 33

ACEs

Question 34

Tx for depression in preg

Answer 34

ssri

buproprion

Question 35

three things made by lactobacilli that protect the vagina from infections

Answer 35

lactic acid

hydrogen peroxide - made from pyruvate via pyruvate oxidase (PO) - does not inhibit the growth of gardnerella, others

bacteriocins, proteins that depolarize pathogenic bacteria by forming pores (class II e.g. sakacin) or interfering with peptidoglycan polymers as well as make pores (class I e.g. nisin)

Question 36

metronidazole mech

Answer 36

reduced by the pyruvate:feredoxin oxidoreductase

interferes with bacteria’s fuel metabolism - bacteria can no longer generate acetate from pyruvate

generates reactive nitrogen damaging nucleic acids

Question 37

how does staph a. form a “wall” that protects the colony

Answer 37

cleaves the A and B peptides from fibrinogen to activate fibrin

Question 38

function of staph A super antigen

Answer 38

binds the MHC and T cell receptors together nonspecifically and causes a huge activation of immune cells - causes toxic shock syndrome

is located on a pathogenicity island (non neccesary extra chromosomal DNA that can integrate into the chromosome)