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(Duluth) HRM Final Review > Witrak > Flashcards

Witrak Flashcards

1
Q

What is the most common breast disease in adult females?

A

Fibrocystic disease

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2
Q

What is the most common breast change in premenopausal women > 35?

A

Fibrocystic disease

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3
Q

What is the most common breast disease in males?

A

Gynecomastia

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4
Q

What can cause gynecomastia in males?

A

Spironolactone, hormones, cimetidine, alcohol/anti-androgens, ketoconazole

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5
Q

Why does gynecomastia develop?

A

Increased estrogen compared to androgen activity

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6
Q

What is the appearance of the simple cysts seen in fibrocystic disease?

A

Blue dome appearance

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7
Q

What changes are seen in fibrocystic disease?

A

Simple cysts, papillary apocrine metaplasia, stromal fibrosis

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8
Q

What is the appearance of papillary apocrine changes in fibrocystic disease?

A

Large eosinophilic cells w/scalloping border

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9
Q

What is the most common breast tumor in females less than 30 years of age?

A

Benign fibroadenoma

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10
Q

What is the appearance of a benign fibroadenoma?

A

Small, well-defined, mobile mass. Increased sized and tenderness with increased estrogen

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11
Q

30 yo pregnant F in 2nd trimester presents with firm, mobile mass in L breast. It is well defined, increasing with estrogen. What is it?

A

Like fibroadenoma

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12
Q

What is seen on gross examination of fibroadenoma?

A

Grey-white, rubbery nodule on gross examination

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13
Q

What is the treatment for lactational mastitis?

A

Dicloxicillin and continue breast feeding

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14
Q

What subtypes of fibrocystic disease have increased risk for cancer?

A

Sclerosing adenosis and epithelial hyperplasia

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15
Q

What are the two types of in-situ breast cancer?

A

Ductal in situ carcinoma and lobular in situ carcinoma

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16
Q

What in situ breast cancer is not seen on mammogram? Is there a mass present?

A

Lobular in situ carcinoma - no calcification seen, no mass

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17
Q

What is the pathogenesis of lobular in situ carcinoma?

A

Have decreased E cadherin expression, resulting in single file line of cells - cells don’t stick together

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18
Q

Lobular in situ carcinoma has a risk of what?

A

Bilateral breast cancer over time

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19
Q

What is Paget disease of the breast?

A

Underlying DCIS that extends up the ducts to involve the skin of the nipple

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20
Q

How does Paget disease of the breast present?

A

Nipple ulceration with erythema

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21
Q

What family history is typical of hereditary breast cancer?

A

1st degree relatives with pre-menopausal bilateral breast cancer

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22
Q

BRCA 1 mutations are seen in what types of cancer?

A

Breast (medullary carcinoma) and ovarian serous carcinoma and fallopian carcinoma

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23
Q

In establishing degree of risk for a patient to develop invasive breast cancer, what is the first question to ask?

A

Family history

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24
Q

What patient population does preiductal mastitis present in? Why?

A

Smokers; smoking creates Vit A def which results in lactiferous duct squamous metaplasia; resulting in blockage and inflammation, nipple retraction and subareolar mass

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25
Q

What part of the breast does periductal mastitis occur in?

A

Lactiferous duct

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26
Q

White discoloration on the vulva constitutes what DDx?

A

Lichen sclerosis, lichen simplex chronicus, squamous cell carcinoma

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27
Q

White patch with parchment-like skin on the vulva is seen in what disease?

A

Lichen sclerosis

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28
Q

Patient complains on chronic itching of the vulva; physical exam shows hyperplasia of vulvar epithelium with a thick, leathery appearance of the skin. What is the likely diagnosis?

A

Lichen simplex chronicus

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29
Q

Between lichen sclerosis and lichen simplex chronicus, which has an increased risk for squamous cell carcinoma?

A

Lichen sclerosis

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30
Q

How does lichen simplex chronicus present?

A

Chronic irritation, hyperplasia of vulvar epithelium; thick, leathery appearance of vulvar skin

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31
Q

How does lichen sclerosis present?

A

White patch with parchment-like skin on vulva

32
Q

What are the most common causes of vaginal bleeding in post-menopausal women?

A

Endometrial atrophy (59%), endometrial poly (12%), endometrial hyperplasia (10%), carcinoma (10%)

33
Q

What are the two types of endometrial carcinoma?

A

Type I: endometrioid; type II serous/clear cell

34
Q

What type of endometrial cancer is related to chronic estrogen use?

A

Type I: endometrioid

35
Q

What mutation is associated with endometrioid carcinoma?

A

PTEN

36
Q

What endometrial cancer is associated with precursor endometrial hyperplasia?

A

Endometrioid - type I

37
Q

What type of endometrial cancer is associated with endometrial atrophy and no prior estrogen excess?

A

Type II: serous/clear cell

38
Q

What population does type II serous/clear cell endometrial cancer present in?

A

Older women (70s +)

39
Q

What mutation is associated with type II serous/clear cell endometrial cancer?

A

P53

40
Q

What are seen on histology in serous/clear cell endometrial cancer?

A

Papillary structures and psamomma bodies

41
Q

Is type II serous clear cell endometrial cancer aggressive or more indolent?

A

Aggressive

42
Q

What is endometriosis?

A

Endometrial glands and stroma outside of the uterus

43
Q

What can be seen histologically in endometriosis?

A

Chocolate cysts

44
Q

What are potential sequelae of endometriosis?

A

Infertility; increased risk for carcinoma (esp at ovary)

45
Q

What are the two most comon non-neoplastic tubal diseases? And their principal complications?

A

Salpingitis and endometriosis; can result in tubal infertility and ectopic pregnancy

46
Q

What is the most common cause of abnormal vaginal bleeding in reproductive age females?

A

Dysfunctional anovulation = adequate estrogen but lack of progesterone

47
Q

What is the most common cause of non-gestational uterine enlargement?

A

Leiomyoma (fibroids)

48
Q

What are leiomyomas?

A

Benign, proliferations of smooth muscle arising from the myometrium

49
Q

What is the most common tumor in females?

A

Leiomyoma

50
Q

Why do leiomyomas enlarge during pregnancy and shrink after menopause?

A

Because they are related to estrogen exposure

51
Q

What appears on gross examination of a leiomyoma?

A

Well-defined, white, whorled mass

52
Q

What are the three categories of primary ovarian neoplasia?

A

Surface epithelium; ovarian stroma/sex cord; germ cell tumors

53
Q

What category of primary ovarian tumors is most common? Responsible for the majority of ovarian cancer death?

A

Epithelial is most common overall and most common cause of ovarian cancer deaths

54
Q

What is the most common germ cell tumor in women?

A

Mature cystic teratoma

55
Q

What type of ovarian cancer do patients with BRCA1 mutations have an increased risk for?

A

Serous carcinoma

56
Q

PCOS is characterized by what hormone? Ratio?

A

Excess LH, leading to excess androgens; LH:FSH > 2

57
Q

Patients with PCOS are at increased risk for what cancer?

A

Endometrial carcinoma

58
Q

What is the most common ovarian neoplasm in female 10 to 30 years of age?

A

Mature cystic teratoma

59
Q

A mature cystic teratoma diagnosis can be strongly suggested by pelvic imaging studies, why?

A

Comprised of all 3 germ layers - some calcified (eg teeth); can be visualized on imaging

60
Q

What is the ovarian tumor which holds the world record for neoplasm size?

A

Mucinous tumor of the ovary

61
Q

What ovarian tumor category is most likely to present with either estrogenic or androgen excess?

A

Sex cord/stromal tumors

62
Q

What ovarian tumor is most likely to behave in a recurrent/low-grade malignant fashion?

A

Granulosa cell tumor - causes estrogen excess (80% of all sex cord stromal tumor malignancy)

63
Q

What sex cord tumors are usually non-functional and benign 90% of the time?

A

Fibroma/thecoma

64
Q

What is Meig syndrome?

A

When a ovarian fibroma becomes very large and produces pleural effusions and ascites

65
Q

What is the major cause of first trimester maternal death?

A

Ectopic pregnancy, resulting in tubal rupture and hemoperitoneum/shcok

66
Q

What is characterized by onset of maternal hypertension and proteinuria at >34 weeks gestation?

A

Pre-eclampsia

67
Q

What placental disorder has a strong association with prior C section?

A

Placenta accreta

68
Q

What is placenta accreta?

A

Absence of decidua basalis; placenta invade through/ is in contact with myometrium

69
Q

What is placenta previa?

A

Placenta is over cervical os

70
Q

What is placental abruption?

A

Premature separation of placenta

71
Q

What is the most common cause of postpartum hemorrhage?

A

Uterine atony

72
Q

What is the second most common cause of postpartum hemorrhage?

A

Retained placenta

73
Q

What are the most common causes of postpartum hemorrhage?

A

1st - uterine atony; 2nd - retained placenta; others: trauma (laceration) and thrombin

74
Q

What is the most common form of gestational trophoblastic neoplasia?

A

Complete hydatidaform mole

75
Q

What is seen on US and lab findings in a complete hydatidaform mole?

A

Uterus expands as if normal pregnancy, but expands much larger; see elevated beta-hCG and absent fetal heart tones on US with a “snowstorm” appearance

(Duluth) HRM Final Review (22 decks)

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