Unit 1 Flashcards
1
Q
What is a Bartholin Cyst and what part of the genital tract is it located in?
A
Cystic dilation of Bartholin gland due to inflammation and obstruction of gland
Located on vulva
2
Q
What age group does a Bartholin Cyst affect?
A
Women of reproductive age
3
Q
How does a Bartholin Cyst present?
A
Unilateral, painful cystic lesion on lower vestibule
4
Q
What is the histologically defining characteristic of a Condyloma?
A
Koilocytes
5
Q
What is the major and minor causes of condylomas?
A
Major - HPV types 6 or 11
Minor - secondary syphilis
6
Q
Where is a condyloma located?
A
Vulva
7
Q
What is Lichen Sclerosis?
A
Thinning of epidermis and sclerosis of dermis on vulva
8
Q
How would you describe the skin of Lichen Sclerosis?
A
Parchment-like, white patch
9
Q
Age group associated with Lichen Sclerosis
A
Postmenopausal women
10
Q
What presents as hyperplasia of the vulvar squamous epithelium?
A
Lichen Simplex Chronicus
11
Q
HPV-Related vulvular carcinoma is due to which HPV types?
A
16 and 18
12
Q
What does HPV-related vulvular carcinoma arise from?
A
VIN - vulvular intraepithelial neoplasia
Characterized by koilocyte change, increased mitotic activity, disordered cell maturation, and nuclear atypia
13
Q
What does non-HPV-related vulvular carcinoma arise from?
A
Long standing Lichen Sclerosis
14
Q
What disease is characterized by malignant epithelial cells in epidermis of vulva?
A
Extramammary Paget Disease
15
Q
What is vaginal adenosis?
A
Persistence of columnar epithelium in upper vagina
16
Q
Risk factor for Vaginal Adenosis
A
Exposure to DES in utero
17
Q
Besides adenosis, other effect of DES exposure in utero
A
Clear Cell Adenocarcinoma
18
Q
Grape-like mass protruding from vagina or penis of child, usually less than 5 years old
A
Embryonal Rhabdomyosarcoma
19
Q
Cancer from lower 1/3 of vagina goes to ____ nodes, cancer from upper 2/3 of vagina goes to _____ nodes
A
Inguinal; iliac
20
Q
Persistent HPV infection can lead to increased risk for _____ ____ ______
A
Cervical Intraepithelial Neoplasia (CIN)
21
Q
High risk HPV types
A
16, 18, 31, 33
22
Q
Which tumor suppressor proteins are destroyed during a high risk HPV infection and how?
A
p53 and Rb
Through production of E6 and E7 proteins
23
Q
4 histological characteristics of Cervical Intraepithelial Neoplasia
A
Koilocyte change
Disordered cell maturation
Nuclear atypia
Increased mitotic activity
24
Q
What age group is cervical carcinoma most often seen in?
A
Middle aged women (40-50 years)
25
Primary and secondary risk factors for cervical carcinoma
Primary - High risk HPV infection
| Secondary - smoking, immunodeficiency (AIDs)
26
Common cause of death in advanced cervical carcinoma
Hydronephrosis with postrenal failure
27
How long does it take to progress from CIN to carcinoma?
10 - 20 years
28
Disease defined by secondary amenorrhea due to loss of basalis and scarring, usually from overaggressive D&C (abortion)
Asherman Syndrome
29
What is an anovulatory cycle?
Estrogen-driven proliferative phase without a progesterone-driven secretory phase
30
How does acute endometritis present?
Fever, abnormal uterine bleeding, pelvic pain
31
What are the characteristic cells of chronic endometritis?
Plasma cells (lymphocytes always present)
32
What are the four main causes of chronic endometritis?
Retained products of conception
Chronic Pelvic Inflammatory Disease
IUD
TB
33
What is an endometrial polyp and what drug can it be a side effect of?
Hyperplastic protrusion of endometrium
| Tamoxifen
34
Most common site and presentation of endometriosis?
Ovary - chocolate cyst
35
What is endometrial hyperplasia?
Hyperplasia of endometrial glands relative to stroma
36
What causes endometrial hyperplasia?
Unopposed estrogen (obesity, polycystic ovarian syndrome, estrogen replacement)
37
Two pathways for endometrial carcinoma & which is most common
```
Hyperplasia pathway (75%) - arises from endometrial hyperplasia
Sporadic pathway (25%) - little bit older population (70 years)
```
38
Which type of endometrial carcinoma is more aggressive and what is the histological characteristics of it?
Sporadic type
| Papillary structures with psammoma body formation
39
Benign neoplastic proliferation of smooth muscle arising from myometrium; most common tumor in females
Leiomyoma (Fibroids)
40
Malignant proliferation of smooth muscle arising from myometrium
Leiomyosarcoma
41
Characteristic hormone imbalance of Polycystic Ovarian Disease
Increased LH -- excess androgen production = excess hair
| Low FSH due to feedback
42
Classic presentation for Polycystic Ovarian Disease
Obese young woman with infertility, oligomenorrhea, and hirsutism
43
Most common type of ovarian tumor
Surface Epithelial Tumor
44
Benign ovarian tumors have a ____ lining, whereas malignant ovarian tumors have a ____ lining
SImple, flat lining
| Thick, shaggy lining
45
Two common subtypes of surface epithelial ovarian tumors and two less common subtypes of surface epithelial ovarian tumors
Serous tumors and mucinous tumors
| Endometroid tumors and Brenner tumors (bladder-like epithelium, usually benign)
46
BRCA1 mutation carriers have increased risk for ____ carcinoma of ovary and fallopian tube
Serous
47
Useful serum marker used to monitor the treatment response of surface epithelial ovarian tumors and screen for recurrance
CA-125
48
2nd most common type of ovarian tumor
Germ Cell Tumor
49
Benign germ cell ovarian tumor composed of fetal tissue from two or three embryological layers
Cystic Teratoma
50
Most common malignant germ cell ovarian tumor composed of large cells with clear cytoplasm and central nuclei
Dysgerminoma
51
Most common malignant germ cell ovarian tumor in children; Schiller-Duval bodies
Endodermal Sinus Tumor (Yolk Sac Tumor)
52
Malignant germ cell ovarian tumor that mimics placental tissue, hemorrhagic with early hematogenous spread
Choriocarcinoma
53
Malignant germ cell ovarian tumor that is composed of large, primitive cells that metastasizes early
Embryonal Carcinoma
54
3 types of Sex-Cord Stromal Ovarian Tumors
Granulosa-Theca cell tumor
Sertoli-Leydig cell tumor
Fibroma
55
_____ Tumor is a metastatic mucinous tumor that involves both ovaries (bilateral), commonly due to metastatic gastric carcinoma
Krukenberg Tumor
56
Key risk factor for ectopic pregnancy
Scarring (PID or endometriosis)
57
Implantation of placenta in lower uterine segment so it overlies cervical opening
Placenta Previa
58
Characteristics of Pre-Eclampsia
Hypertension, proteinuria, edema
59
Eclampsia is pre-eclampsia + _____
Seizures
60
What does HELLP stand for?
Hemolysis, Elevated Liver enzymes, Low Platelets
| Preeclampsia + thrombotic microangiopathy
61
Abnormal conception characterized by swollen and edematous villi with proliferation of trophoblasts; can be complete or partial
Hydatidiform Mole
62
Classic presentation of mole
Passage of grape-like masses through vaginal canal in second trimester
63
What is acute mastitis and what organism is it commonly caused by?
Bacterial infection of breast
| Staph Aureus
64
How does acute mastitis present?
Erythematous breast with purulent nipple discharge
65
Inflammation of subareolar ducts seen in smokers
Periductal Mastitis
66
Presentation of Periductal Mastitis
Subareolar mass with nipple retraction
67
Inflammation of subareolar ducts + dilation
Mammary Duct Ectasia
68
Presentation of Mammary Duct Ectasia
Periareolar mass with green-brown nipple discharge
69
What is fat necrosis usually caused by?
Trauma
70
What can you see on fat necrosis breast biopsy?
Necrotic fat with calcifications and giant cells
71
Most common change in premenopausal breast
Fibrocystic change
72
Fibrocystic Change associated with:
2X Increased risk for invasive carcinoma
5X increased risk for invasive carcinoma
2X - Ductal Hyperplasia & Sclerosing Adenosis
| 5X - Atypical Hyperplasia
73
Papillary growth in breast, usually into large duct
Intraductal Papilloma
74
Classic histological characterization and clinical presentation of Intraductal Papilloma
Histo - fibrovascular projections lined by epithelial and myoepithelial cells (2 cell layers)
Clinical - bloody nipple discharge in premenopausal woman
75
Most common benign neoplasm in breast
Fibroadenoma
76
What is a Phyllodes Tumor and what is defining about it?
Fibroadenoma-like tumor with overgrowth of fibrous component
| Defining leaf-life projections on biopsy
77
Risk factors for breast cancer
Female, postmenopausal, early menarche/late menopause, obesity, atypical hyperplasia, 1st degree relative with breast cancer
78
How does Ductal Carcinoma In Situ present?
Calcifications on mammography (biopsy needed to distinguish from benign conditions)
No masses
79
What is Paget Disease of the breast?
DCIS that extends up the ducts to involve skin of nipple
| Presents as nipple ulceration and erythema
80
Most common type of invasive cancer of the breast
Invasive Ductal Carcinoma
81
Presentation of Invasive Ductal Carcinoma
Mass with possible skin dimpling or nipple retraction
82
4 Subtypes of Invasive Ductal Carcinoma and descriptions
Tubular Carcinoma - well-differentiated tubules that lack myoepithelial cells
Mucinous Carcinoma - abundant extracellular mucin
Medullary Carcinoma - large, high grade cells growing in sheets with lymphocytes and plasma cells
Inflammatory Carcinoma - carcinoma in dermal lymphatics, poor prognosis, can be mistaken for acute mastitis
83
What is characteristic of Lobular Carcinoma In Situ and Invasive Lobular Carcinoma Cells?
Lack E-Cadherin (form single file pattern in invasive)
84
Most important factor in breast cancer staging and most useful factor
Important - metastasis
| Useful - spread to axillary lymph nodes
85
Receptor status on poorest prognostic breast cancer and population most at risk
```
Triple Negative (negative for ER, PR, and HER2/Neu)
African American women
```
86
Most common histological subtype of breast cancer in males
Invasive ductal carcinoma
87
Risk factors for males to develop breast cancer
BRCA2 mutation and Klinefelter's Syndrome
88
Impaired cartilage proliferation in the growth plate - common cause of dwarfism
Achondroplasia
89
Achondroplasia is due to ______
Activating mutation in fibroblast growth factor receptor 3 (FGFR3)
90
What is osteogenesis impefecta?
Congenital defect of bone formation resulting in structurally weak bone
91
Common cause of osteogenesis imperfecta
Autosomal dominant defect in Collagen Type I synthesis
92
Clinical features of osteogenesis imperfecta
Multiple fractures of bone, blue sclera, hearing loss
93
Inherited defect of bone resorption; results in abnormally thick, heavy bone that fractures easily
Osteopetrosis
94
What is the cause of Osteopetrosis and a common mutation that leads to it?
Poor osteoclast function
| Carbonic Anhydrase II mutation leads to loss of acidic microenvironment required for bone resorption
95
Clinical features of Osteopetrosis
```
Bone fractures
Anemia/thrombocytopenia/leukopenia
Vision and hearing impairment
Hydrocephalus
Renal Tubular Acidosis - seen with Carbonic Anhydrase II Mutation
```
96
What is Ricketts/Osteomalacia and what is the difference between the two?
Defective mineralization of osteoid due to low Vit D
| Ricketts = children, Osteomalacia = adults
97
Clinical features of Ricketts
```
Pigeon-breast deformity
Frontal Bossing (enlarged forehead)
Rachitic Rosary (osteoid deposition at costochondral junction)
Bowing of legs
```
98
What is Osteoporosis and what are the consequences?
Reduction in trabecular bone mass
| Results in porous bone with increased risk for fracture
99
How can you differentiate between osteoporosis and osteomalacia?
Labs - serum calcium, phosphate, PTH, and alkaline phosphate are normal in Osteoporosis
Osteomalacia - low calcium & phosphate, high PTH
100
Disease caused by imbalance between osteoblast and osteoclast activity
Paget Disease of Bone
101
Three Stages of Paget Disease of Bone
Osteoclastic
Mixed Osteoblastic/Osteoclastic
Osteoblastic
102
Clinical Features and Complications of Pagets Disease of Bone
```
Bone Pain
Increasing hat size
Hearing loss
Lion-like facies
Isolated elevated alkaline phosphate
```
Complications: high-output cardiac failure, osteosarcoma
103
Treatment for Paget Disease of Bone
Calcitonin and Bisphosphonates
104
What is Osteomyelitis and what population does it normally occur in?
Infection of marrow and bone, children
105
What part of the bone is affected in Osteomyelitis in kids vs. adults?
Kids - metaphysis
| Adults - epiphysis
106
How does osteomyelitis present on X Ray?
Lytic focus (sequestrum, abscess) surrounded by sclerosis (involucrum)
107
Common bacterial causes of Osteomyelitis and which is most common?
Staph Aureus - most common cause
N gonorrhoeae - sexually active young adults
Salmonella - sickle cell disease
Pseudomonas - diabetics, IV drug users
Pasteurella - cat, dog bites or scratches
TB - Pott disease
108
What are common causes and complications of Avascular Necrosis of bone?
Causes - trauma/fracture, steroids, sickle cell anemia, caisson disease
Complications - osteoarthritis, fracture
109
What is an Osteoma and what is it associated with?
Benign tumor of bone
| Associated with Gardner Syndrome (GI)
110
Benign tumor of osteoblasts surrounded by a rim of reactive bone
Osteoid Osteoma
111
Where does Osteoid Osteoma arise and in what patient population?
Cortex of long bones
| Young adults, males more commonly
112
Difference between Osteoid Osteoma and Osteoblastoma
Osteoid Osteoma pain is relieved with Aspirin
113
Most common benign tumor of bone
Osteochondroma
114
Benign tumor of bone with overlying cartilage cap
Osteochondroma
115
Malignant proliferation of osteoblasts
Osteosarcoma
116
Where does Osteosarcoma arise and what are some risk factors?
Metaphysis of long bone
| Familial Retinoblastoma, Paget Disease, Radiation exposure
117
Imaging characteristics of Osteosarcoma
Sunburst appearance, lifting of periosteum (Codman Triangle)
118
What is a Giant Cell Tumor?
Bone tumor comprised of multinucleated giant cells and stromal cells
119
Where does a Giant Cell Tumor arise?
Epiphysis of long bone (only one to do so)
120
What is the characteristic appearance of a Giant Cell Tumor on xray?
Soap Bubble appearance
121
Malignant proliferation of poorly-differentiated cells derived from neuroectoderm
Ewing Sarcoma
122
Where does Ewing Sarcoma normally arise and what is its appearance on xray?
Diaphysis of long bone
| Onion skin appearance
123
What is the characteristic translocation of Ewing Sarcoma?
11;22
124
Benign tumor of cartilage
Chondroma
125
Malignant cartilage-forming tumor
Chondrosarcoma
126
Which is more common in bone, metastatic tumors or primary tumors?
Metastatic tumors
127
What does metastatic bone cancer usually result in physically?
Osteolytic lesions (punched out)
128
Most common type of arthritis
Degenerative Joint Disease/Osteoarthritis
| Progressive degeneration of articular cartilage
129
Major risk factor for osteoarthritis + minor ones
Major - age (greater than 60)
| Minor - obesity, trauma
130
Classic presentation of osteoarthritis
Joint stiffness in the morning that worsens during the day
131
Important pathological features of Osteoarthritis
```
Disruption of cartilage that lines articular surface - fragments in joint space are called joint mice
Eburnation (polishing) of subchondral bone
Osteophyte formation (bony outgrowths) in DIP and PIP joints of fingers classically
```
132
What is Rheumatoid Arthritis and what population is it associated with?
Autoimmune disease associated with HLA-DR4
| Arises in women of late childbearing age
133
What is the hallmark pathology of Rheumatoid Arthritis?
Synovitis leading to formation of pannus (inflamed granulation tissue)
134
How to differentiate Rheumatoid Arthritis from Osteoarthritis clinically?
Joint stiffness improves with activity in RA
| DIP is spared in RA (unlike OA)
135
Clinical features of Rheumatoid Arthritis
Fever, malaise, weight loss, myalgias
Vasculitis, rheumatoid nodules
Baker Cyst (knee)
Pleural effusions, lymphadenopathy, interstitial lung fibrosis
136
Lab findings in Rheumatoid Arthritis
IgM autoantibody against Fc portion of IgG (rheumatoid factor)
Neutrophils and high protein in synovial fluid
137
Group of joint disorders characterized by lack of rheumatoid factor, axial skeleton involvement, and HLA-B27 involvement
Seronegative Spondyloarthropathies
138
3 disease included in Seronegative Spondyloarthropathies
Ankylosing Spondyloarthritis - sacroiliac joints & spine, young adults, fusion of vertebrae (bamboo spine)
Reiter Syndrome - arthritis, urethritis, conjunctivitis, young adults, GI or chlamydia infection
Psoriatic Arthritis - axial and peripheral joints, DIP joints of hands and feet often involved (sausage fingers/toes)
139
Common causes of infectious arthritis
```
N gonorrheae (most common)
S aureus
```
140
What is Gout?
Deposition of monosodium urate (MSU) crystals in tissue, especially the joints
141
What are some causes of secondary gout?
Leukemia/myeloproliferative diseases - hyperurecemia due to increased cell turnover
Lesch-Nyhan Syndrome - X linked deficiency of HGPRT
Renal Insufficiency
142
What is the presentation of acute gout?
Podagra - painful arthritis of big toe
143
Chronic gout can lead to _____ and _____
Development of tophi; renal failure
144
Inflammatory disease of the skin and skeletal muscle
Dermatomyositis
145
Clinical features of dermatomyositis
Bilateral proximal muscle weakness
Rash of upper eyelids, malar rash
Red papules on elbows, knuckles, knees
146
Difference between Dermatomyositis and Polymyositis
Polymyositis only involves skeletal muscle, not skin
147
Disorder characterized by muscle wasting and replacement of muscle tissue with adipose tissue
X-Linked Muscular Dystrophy
148
Benign tumor of adipose tissue
Lipoma
149
Malignant tumor of adipose tissue
Liposarcoma
150
Characteristic cell of Liposarcoma
Lipoblast
151
Benign tumor of skeletal muscle
Rhabdomyoma
152
What is a Rhabdomyosarcoma?
Malignant tumor of skeletal muscle
153
What is the most common malignant soft tissue tumor in children?
Rhabdomyosarcoma
154
Characteristic cell in Rhabdomyosarcoma and cell is ____ positive
Rhabdomyoblast; desmin positive
