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Step1 > Step Review 3: GI, Repro > Flashcards

Step Review 3: GI, Repro Flashcards

1
Q

Describe the rotation of the midgut in development

A

270 degree counterclockwise around SMA

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2
Q

What GI development defect is associated with Down Syndrome? Radiographic finding?

A

Duodenal atresia, double bubble finding

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3
Q

Olive mass in epigastric region? Associated with exposure to what antibiotics?

A

Hypertrophic pyloric stenosis, Macrolides

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4
Q

What ligament contains the portal triad?

A

The hepatoduodenal ligament

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5
Q

What ligament contains the splenic artery and vein?

A

Splenorenal ligament

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6
Q

What layers are Meissners and Myenteric plexus in? Function?

A

Meissner: Submucosa, secretes fluid
Myenteric: Muscularis, motility

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7
Q

How deep do ulers and erosions penetrate?

A

Ulcers into submucosa and inner or outer muscular layer while erosions are confined to the mucosa

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8
Q

Where do you find peyer patches?

A

Ileum

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9
Q

Are there villi in the colon? Crypts?

A

Crypts are present but no villi

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10
Q

What portion of the duodenum is compressed in SMA syndrome?

A

Transverse (3rd portion)

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11
Q

Vertebral levels of Celiac trunk, SMA, and IMA

A

T12, L1, L3

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12
Q

What are the three branches of the celiac trunk?

A

Common hepatic, left gastric and splenic

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13
Q

Which rectal vessels are part of the portal circulation?

A

Superior only, middle and inferior are systemic

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14
Q

Lymphatic drainage above and below pectinate line? Cancers?

A

Above: Internal iliac nodes, adenocarcinoma
Below: superficial inguinal nodes, squamous cell

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15
Q

What hepatic cells store vitamin A when quiescent and produce ECM when stimulated? Where are they located?

A

Stellate (ito) cells in the space of Disse

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16
Q

Where is zone 1 in liver? What affects it?

A

Periportal: ingested toxins and viral hepatitis (also where hepatic artery comes in)

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17
Q

What affects zone 2 of the liver?

A

Yellow fever

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18
Q

Where is zone 3 of the liver? What affects it? What is important here?

A

Pericentral vein. 1st affected by ischemia, contains cytochrome p450 and is thus most sensitive to metabolic toxins and the site of alcoholic hepatitis

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19
Q

What is the portal triad? What zone is it in?

A

Bile duct, portal vein branch and hepatic artery branch. Zone 1

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20
Q

What is a classic cause of painless jaundice?

A

Tumor in the head of the pancreas (ex. ductal adenocarcinoma)

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21
Q

What is in the femoral sheath?

A

Femoral vein, artery and deep inguinal lymph nodes BUT NOT FEMORAL NERVE

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22
Q

Where does a femoral hernia occur compared to the nerve, artery, vein, etc.

A

Very medial (femoral ring)

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23
Q

What covers direct hernias? What is this derived from?

A

External spermatic fascia only. External oblique

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24
Q

Watery Diarrhea, low potassium and low stomach acid?

A

VIPoma

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25
Q

Where is ghrelin produced?

A

Stomach

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26
Q

What converts pepsinogen to pepsin?

A

Acid (H+)

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27
Q

Where in the stomach do you find G cells? Pareital and Chief cells?

A

Antrum, body (note: D cells are also in the antrum)

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28
Q

How does gastrin mainly cause acid secretion?

A

By its action on ECL cells which release histamine rather than its direct effect on parietal cells

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29
Q

Describe the concentration of bicarbonate in pancreatic secretions based on flow rate? Cl-?

A

High flow is high bicarbonate (makes sense because this is the job). Low flow is high Cl-

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30
Q

What converts trypsinogen to trypsin?

A

Enterokinase/enteropeptidase (brush border enzyme in duodenal and jejunal mucosa)

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31
Q

What specialized cells do you find in peter patches?

A

M cells which sample and present antigens to immune cells (submucosa of ileum)

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32
Q

Where do IgA secreting plasma cells of the GIT eventually reside?

A

Lamina propria in ileum (post stimulation that begins in Peyer patches)

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33
Q

What catalyzes rate limiting step of bile acid synthesis? What are bile acids conjugated to?

A

Cholesterol 7 alpha hydroxylase, glycine or taurine

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34
Q

What is an intermediate in heme conversion to bilirubin? What enzyme mediates this step?

A

Heme oxygenase catalyzes the formation of bilverdin from heme (green in bruises)

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35
Q

Enzyme that conjugates bilirubin?

A

UDG-glucuronsyl transferase

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36
Q

Most common salivary gland tumor? Most common malignant? Which one is a benign cystic tumor with germinal centers and often bilateral?

A

Pleomorphic adenoma: most common (pleomorphic)
Mucoepidermoid carcinoma: most common malignant
Warthin tumor: bilateral, smoking, germinal centers

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37
Q

Cause of eosinophilic esophagitis?

A

Food allergens–> dysphagia causing rings and linear furrows

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38
Q

Dysphagia, IDA and esophageal webs with glossitis too

A

Plummer-Vinson syndrome

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39
Q

How does scleroderma cause esophageal dysmotility?

A

Esophageal smooth muscle atrophy

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40
Q

What are curling and cushing ulcers?

A

Curling: burns–> hypovolemia–> mucosal ischemia
Cushing: brain injury–> inc. vagal stimulation–> inc. ACh–> increased H+ production

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41
Q

What prostaglandin is protective to the gastric mucosa?

A

PGE2

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42
Q

What area of the stomach does H. pylori preferentially affect?

A

Antrum

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43
Q

What do you suspect if you see gastric mucosa with hypertrophied rugae?

A

Menetrier disease. Gastric hyperplasia of mucosa causes excess mucus production with excess protein loss and parietal cell atrophy with decreased acid production

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44
Q

Where do you most often see gastric intestinal adenocarcinoma?

A

Lesser curvature

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45
Q

Grossly thickened and “leathery” stomach wall. What is this called?

A

Linitis plastica (diffus gastric cancer- signet ring cells)

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46
Q

What is a Sister Mary Joseph Nodule?

A

Subcutaneous periumbilical metastasis from gastric tumor (also famous is the virchow node)

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47
Q

Where is the virchow node?

A

Left supraclavicular node

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48
Q

If you suspect a malabsorption syndrome, where should you start the workup?

A

Screen for fecal fat (Sudan stain)

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49
Q

HLA for celiac? Antibody that you might not know?

A

HLA DQ2 and DQ8. Anti-endomysial

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50
Q

What do you see on histology with celiac?

A

Villous atrophy, crypt hyperplasia, intraepithelial lymphocytosis

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51
Q

What area must be biopsied for celiac?

A

Duodenum

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52
Q

What does it mean with the D-xylose test if you see normal amounts in blood/urine? Low?

A

Normal: pancreatic insufficiency
Low: mucosa defects or bacterial overgrowth

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53
Q

What does low fecal elastase indicate? What pH will you see?

A

Pancreatic insufficiency which will also cause a decrease in duodenal pH

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54
Q

Describe Topheryma whipplei

A

Intracellular gram (+) that will stain PAS positive

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55
Q

Crohn or UC?

1) Cobblestone mucosa
2) Transmural
3) Psuedopolyps
4) Lead pipe
5) Crypt abscesses
6) Kidney stones

A

1,2,6 are crohn

3-5 are UC

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56
Q

What type of diverticula are most in GIT? Why?

A

False, only mucosa and submucosa out pouch (lack or have attenuated muscular is externa)

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57
Q

Where is diverticulosis most commonly located?

A

Sigmoid colon

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58
Q

Muscle involved in Zenker?

A

Inferior pharyngeal constictor

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59
Q

What types of tissue may be in a Meckel diverticulum?

A

Pancreatic or gastric

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60
Q

What mutations are associated with Hirschsprung disease? Increased risk for it with what?

A

RET, Down syndrome

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61
Q

Fibrous bands in midgut leading to obstruction?

A

Malrotation

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62
Q

Where do you see volvulus in infants? Elderly?

A

Midgut, sigmoid

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63
Q

Currant jelly stools?

A

Intussusception or acute mesenteric ischemia

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64
Q

Two possible lead points that can cause intussusception?

A

1) Virus–> peyer patch hypertrophy

2) Meckel diverticulum

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65
Q

What is angiodysplasia?

A

Tortuous dilation of vessels in GIT leads to hematochezia. Most often in cecum, terminal ileum or ascending colon

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66
Q

When should you pick hyper plastic polyp as an answer?

A

Basically never. They are small and non-neoplastic

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67
Q

Two syndromes with hamartomatous polyps?

A

PJ and juvenile polyposis

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68
Q

Pathway for adenomatous polyps? How do they present?

A

AK53 pathway (Chromosomal instability pathway-CIN) and although usually asymptomatic may present with occult bleeding

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69
Q

Saw tooth pattern of crypt, premalignant polyps. How do they arise?

A

Serrated polyps via CpG hypermethylation path with microsatellite instability and BRAF mutations

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70
Q

Genetics and chromosome with FAP? Which side do these carcinomas typically present on if it progresses that far?

A

APC tumor suppressor on c5, AD, left side

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71
Q

What do you suspect if you see supernumerary teeth?

A

Gardner: FAP +osteomas and congenital hypertrophy of retinal pigment epithelium

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72
Q

Turcot syndrome

A

FAP + malignant CNS tumor

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73
Q

What is the heritability of any polyp syndrome?

A

AD

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74
Q

Cancer risk with PJ? Lynch (HNPCC)?

A

Breast/GI for PJ

Endometrial, ovarian and skin with lynch

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75
Q

What are the genetics associated with Lynch syndrome?

A

AD mutation of mismatch repeater genes with subsequent microsatellite instability (right sided)

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76
Q

What part of the GIT is ALWAYS involved with Lynch syndrome? Are there polyps?

A

Proximal colon, NOOOOO (HNPCC)

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77
Q

Describe, in short, right vs. left sided colorectal cancer presentation?

A

Right side bleeds, left side obstructs

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78
Q

What type of endocarditis should be suspected with CRC?

A

Steptococcus bovis

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79
Q

Tumor marker for CRC?

A

CEA

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80
Q

Name the two pathways to CRC. What syndromes/problems are associated with each?

A

CIN (AK-53): FAP, sporadic (this is APC)

MSI: Lynch syndrome and some sporadic via serrated polyp pathway

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81
Q

What cells cause fibrosis in cirrhosis? What cells are in the nodules?

A

Stellate cells, hepatocytes

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82
Q

Whats free points you should always look for when given liver function test markers?

A

AST>ALT think alcohol

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83
Q

Why is gamma glutamyl transpeptidase better than ALP?

A

ALP can also increase with bone activity

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84
Q

What happens to platelets with liver disease?

A

Decrease due to decreased thrombopoietin and liver sequestration

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85
Q

What type of liver change is seen with Reye syndrome? Pathogenesis?

A

Microvesicular fatty change caused by decrease in beta oxidation by reversible inhibition of mitochondrial enzymes

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86
Q

What is a mallory body?

A

Associated with alcoholic liver disease and an intracytoplasmic eosinophilic inclusion of damaged keratin filaments.

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87
Q

Where do you see sclerosis in alcoholic cirrhosis?

A

Zone 3 (Peri hepatic vein)

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88
Q

What most likely leads to non-alcoholic fatty liver disease? How do you distinguish it from alcoholic liver disease?

A

Metabolic syndrome/ obesity, ALT will be> AST

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89
Q

Treatment for hepatic encephalopathy? What is fidaxomycin?

A

Lactulose (turns NH3 to NH4) and rifaximin or neomycin. Fidaxomycin is for C. diff.

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90
Q

Tumor marker for hepatocellular carcinoma?

A

AFP

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91
Q

What is a common benign liver tumor that you see blood on histology? What should you not do?

A

Cavernous hemangioma: do not biopsy due to risk of hemorhage

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92
Q

Liver tumor that is related to OCPs or steroid use

A

Hepatic adenoma

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93
Q

Tumor associated with arsenic and vinyl chloride exposure.

A

Angiosarcoma

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94
Q

Do you see JVD in Budd-Chiari syndrome? What should you immediately associate?

A

No, Polycythemia vera

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95
Q

Why do newborns get jaundice? Where can it cause problems?

A

Immature UDP-glucuronsyltransferase leads to unconjugated hyperbilirubinemia that can build up in the brain and cause kernicterus (specifically basal ganglia)

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96
Q

Does UV radiation on neonates conjugate bilirubin?

A

No

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97
Q

Inheritance of all of the hyperblirubinemia, wilsons disease and hemochromatosis?

A

AR

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98
Q

Specific finding in dubin johnson syndrome?

A

Black liver (conjugated bilirubin)

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99
Q

Which type of Crigler-Najjar might be survived? What helps it?

A

Type II, phenobarbital because it increases liver enzyme synthesis

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100
Q

Chromosome and defect in Wilson disease? What is a very close mutation disease?

A

Copper transporting ATPase (ATP7B gene on c13), Menkes disease

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101
Q

What are the levels of ceruloplasmin and urine copper in wilson disease? Where does it accumulate in the eyes?

A

Decreased ceruloplasmin, increased urine copper. Cornea

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102
Q

Mutation and chromosome for hemochromatosis?

A

HFE gene on c6 (C282Y>H63D)

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103
Q

Common cause of death with hemochromatosis?

A

HCC

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104
Q

Immediate association with light colored stool?

A

Biliary tract disease

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105
Q

Which biliary tract disease is intrahepatic only? Which is extra hepatic too?

A

PSC is both, PBC is in

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106
Q

Anti-mitochondrial antibody?

A

PBC

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107
Q

Onion skin bile duct fibrosis?

A

PSC

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108
Q

What does PSC increase risk for? Classic association and marker?

A

Increased risk for cholangiocarcinoma and gallbladder cancer. Associated with UC and p-anca

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109
Q

Relationship of bile salts and gallstones?

A

Decreased bile salts increases risk of stones

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110
Q

Is serum amylase or lipase more specific for pancreatitis?

A

Lipase (amylase is in mouth too)

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111
Q

What lines the cyst with pancreatitis?

A

Granulation tissue, not epithelium

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112
Q

Where does pancreatic adenocarcinoma arise from? Tumor marker? Odd risk factor?

A

Pancreatic ducts, CA 19-9, tobacco use

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113
Q

What cancer is associated with migratory thrombophlebitis?

A

Trosseau syndrome, pancreatic adenocarcinoma

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114
Q

What happens to blood pH when the stomach secretes acid?

A

It increases (HCO3 that was formed with the H+ is pushed into blood)

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115
Q

What kind of electrolyte disturbance can be caused by all antacids?

A

Hypokalemia

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116
Q

How does sucralfate work?

A

Binds to ulcer base providing physical protection and allowing bicarbonate secretion to reestablish pH gradient in mucus layer

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117
Q

What is misoprostol?

A

PGE1 analog. Increases gastric protection (don’t use in pregnant women, can cause abortion)

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118
Q

What is sulfasalazine?

A

Combo of sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-inflammatory) that is activated by colonic bacteria. Used for UC and the colitis component of Crohn disease

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119
Q

Odansetron mechanism and use? (SE?)

A

5-HT3 antagonist that decreases vagal stimulation (may prolong QT interval)

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120
Q

Metoclopramide MOA?

A

D2 antagonist that increases resting tone, contractility, LES tone and motility (don’t use in obstructed patients or Parkinsons)

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121
Q

Orlistat MOA?

A

Inhibits gastric and pan creating lipase leading to decreased breakdown and absorption of dietary fats

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122
Q

What is Ursodiol?

A

Nontoxic bile acid that increases bile secretion and decreases cholesterol secretion and reabsorption

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123
Q

Recurrent aphthous ulcers, genital ulcers, and uveitis. Pathology?

A

Behcet syndrome, which is due to immune complex vasculitis involving small vessels

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124
Q

Most common location for oral cavity SCC? Major risk factors?

A

Floor of mouth. Tobacco and alcohol

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125
Q

White patch on lateral tongue that cannot be scraped away. Pre-malignant?

A

Oral hairy leukoplakia, not pre-malignant rather it is EBV induced squamous cell hyperplasia

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126
Q

Salivary gland tumor composed of stromal (e.g. cartilage) and epithelial tissue. Major fact relevant to treatment?

A

Pleomorphic adenoma, high rate of recurrence due to incomplete resection (small islands penetrate through the capsule)

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127
Q

Parotid gland tumor that resembles lymph tissue (lymphocytes and germinal centers)

A

Warthin tumor

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128
Q

What part of the esophageal wall is involved in esophageal web?

A

Mucosa only

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129
Q

Painful hematemesis? Painless?

A

Painful: Mallory-Weiss
Painless: Esophageal varicies

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130
Q

Most common esophageal cancer worldwide?

A

Squamous cell carcinoma

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131
Q

When does esophageal cancer present?

A

Late thus poor prognosis

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132
Q

Where is lymph node spread from esophagus in:
upper 1/3
middle 1/3
lower 1/3

A

upper 1/3: cervical nodes
middle 1/3: mediastinal or tracheobronchial nodes
lower 1/3: celiac or gastric nodes

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133
Q

What is the pathogenesis of a cushing ulcer?

A

Increased ICP causes increased vagus stimulation and acid secretion

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134
Q

Where do you find parietal cells?

A

Body and fundus of stomach

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135
Q

HSR type in pernicious anemia?

A

HSR type IV (t-cells)

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136
Q

What layer of lymph tissues is only present in inflammation? Tumor that does this?

A

Marginal zone, MALToma

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137
Q

How to tell difference in benign peptic ulcers and malignant ulcers

A

Malignant are large and irregular with heaped up margins as opposed to sharply demarcated benign ulcers

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138
Q

What blood type increases risk for gastric carcinoma?

A

Type A

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139
Q

What do the intestinal and diffuse types of gastric carcinoma physically look like?

A

Intestinal: ulcer
Diffuse: thickened gastric wall (linitis plastica)

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140
Q

What vasculitis might affect the SMA?

A

PAN

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141
Q

Where is lactase found?

A

Brush border of enterocytes

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142
Q

What type of HSR is celiac?

A

Type IV

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143
Q

What cancers could celiac potentially cause late in the course?

A

Small bowel carcinoma and T-Cell Lymphoma (EATL)

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144
Q

Apparent celiac that responds to antibiotics? Where is it probably located?

A

Tropical sprue. Not duodenum like celiac but jejunum and ileum

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145
Q

Classic site of whipple disease? Pathogenesis?

A

Small bowel lamina propria. Bacteria builds up in lysosomes of macrophages, macrophages accumulate and compress lacteals, chylomicrons cannot be transferred from enterocytes to lymphatics

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146
Q

Low VLDL and LDL with malabsorption?

A

Possibly abetalipoproteinemia (AR deficiency of B-48 and B-100 with malabsorption due to defective chylomicron formation)

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147
Q

Why is carcinoid syndrome heart effect limited to right side?

A

MAO in lungs metabolize serotonin to 5-HIAA

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148
Q

Does smoking increase UC risk? What about Crohn?

A

Protects against UC, Increases Crohn risk

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149
Q

Is Crohn or UC more likely to cause bloody diarrhea?

A

UC

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150
Q

What type of biopsy is useful in diagnosing Hirschsprung disease?

A

Rectal suction biopsy

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151
Q

What provides the weak point in the colonic wall to allow diverticula to form?

A

Where vasa recta traverse muscularis propria

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152
Q

Where does angiodysplasia classically arise?

A

Right colon (think of it as the result of high pressure in right colon as diverticulosis is to the left colon)

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153
Q

Most common site of ischemic colitis?

A

Splenic flexure

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154
Q

Mouth and GI bleeds? Inheritance?

A

Hereditary hemorrhagic telangiectasia (AD)

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155
Q

Why might aspirin help prevention of colonic carcinoma?

A

At the same point as P53 on the AK53 progression there is an increase in COX expression that is needed as well. Aspirin prevents this and impedes progression

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156
Q

Which colorectal carcinoma syndrome do you associate with ovarian/endometrial cancer? Breast?

A

Ovarian/endometrial: HNPCC

Breast: PJ

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157
Q

Which side of tumor do you see HNPCC on?

A

Right, polyps are in the left

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158
Q

Gene leading to appendages in wrong places? Gene for proper organization along dorsal-ventral axis?

A

Homeobox, Wnt-7

159
Q

When does the blastocyst implant? What happens?

A

Day 6, hCG secretion begins

160
Q

What week starts the fetal heartbeat? What else happens this week?

A

4, the limbs begin to develop

161
Q

Disruption vs deformation vs malformation

A

Disruption: secondary breakdown of previously normal tissue
Deformation: extrinsic disruption that occurs after embryonic period
Malformation: Intrinsic disruption that occurs in embryonic period (week 3-8)

162
Q

Teratogenic agents that cause:
Absence of digits
Limb defects
Caudal regression syndrome

A

Alkylating agents, thaldiomide, maternal diabetes

163
Q

Mechanism of fetal alcohol syndrome?

A

Failure of cell migration

164
Q

Type of twins formed most often? When does the split occur?

A

Monochorionic diamnionic (4-8 days with the morula)

165
Q

What if twinning happens after blastocyst stage?

A

Monochorionic, mono amniotic with the possibility of being conjoined if also after the embryonic disc is formed

166
Q

What does the syncytiotrophoblast do?

A

Secretes/synthesizes hormones such as hCG which stimulates the corpus luteum to secrete progesterone during first trimester

167
Q

What is the outer layer of chorionic villi? Why does this make sense?

A

Synctiotrophoblast- these cells lack MHC-I which decreases the chance of them being attacked by the maternal immune system

168
Q

Where do the umbilical arteries arise?

A

Fetal internal iliac arteries

169
Q

What are the umbilical arteries and veins derived from? What else is derived from this?

A

Allantois, urachus- duct between fetal bladder and umbilicus

170
Q

Duct involved if urine is coming from umbilicus? What if it is meconium?

A

Uracus

Vitelline (omphalo-mesenteric duct)

171
Q

What do the left and right recurrent laryngeal nerves wrap around?

A

Left: Ligamentum arteriosum/ aortic arch
Right: subclavian artery

172
Q

What does the 1st pharyngeal cleft form? 2-4?

A

1st: external auditory meatus

2-4: temporary cervical sinuses which are obliterated by proliferation of 2nd arch mesenchyme

173
Q

If you see an immobile (upon swallowing) mass on lateral neck, what is it?

A

Persistent cervical sinus

174
Q 
Which arch develops into the:
Malleus, incus, stapes?
Stylopharyngeus?
Artenyoids?
Which intrinsic laryngeal muscle does the 6th arch not do?
A

Malleus and incus: 1
Stapes: 2
Artenyoids: 4,6
Cricothyroid

175
Q

What nerves are associated with the 4th and 6th pharyngeal arches?

A

4th: superior laryngeal nerve (CN X)
6th: recurrent laryngeal nerve (CN X)

176
Q

What nerve does the anterior belly of the digastric? Posterior?

A

Anterior is CN V, Posterior is CN 7

177
Q

Heart defects associated with DiGeorge syndrome?

A

Conotruncal defects TOF, PTA

178
Q

What causes cleft lip? Cleft palate?

A

Failure of fusion of the maxillary and medial nasal processes (formation of the primary palate)
-Failure of fusion of the two lateral palatine shelves

179
Q

Other names for the mesonephric and paramesonephric ducts?

A 
Mesonephric= wolffian
Paramesonephric= Mullerian
180
Q

What does the SRY gene mediate?

A

Y-chromosome gene that mediates testicular development.

181
Q

What causes the paramesonephric duct to not develop in males? Internal genitalia development? External?

A

1) Sertoli cell–> mullerian inhibitory factor
2) internal–> testosterone
3) external–> DHT from 5 alpha reductase on testosterone

182
Q

What forms the upper and lower portions of the vagina?

A

Upper: paramesonephric duct
Lower: urogenital sinus

183
Q

What can cause amenorrhea in females with fully developed secondary sexual characteristics?

A

Mullerian agenesis (ovaries are still fully functional)

184
Q

What would cause a XY fetus to develop both male and female internal genitalia with male external genitalia?

A

Absence of sertoli cells or MIF in XY fetus (mullerian duct is not suppressed, but testosterone still present)

185
Q

What do the urogenital folds on an undifferentiated fetus develop into in male and female?

A

Male: ventral shaft of penis
Female: labia minora

186
Q

What does the urogenital sinus develop into in male and female?

A

Male: bulbourethral glands and prostate gland
Female: Greater vestibular glands and urethral and paraurethral glands

187
Q

Is hypo or epi spadias more common? What is associated with the less common one?

A

Hypospadias is more common and epispadias is associated with exstrophy of the bladder

188
Q

What causes hypospadias? Epispadias?

A

Hypo: failure of the urethral folds to fuse
Epi: faulty positioning of the genital tubercle

189
Q

What does the gubernaculum do in male and female after descent of testes and ovaries?

A

Male: anchors testes within scrotum
Female: ovarian ligament + round ligament of uterus

190
Q

Which side of the scrotum is more likely to develop varicocele?

A

Left, gonadal vein here drains into renal vein rather than straight into IVC. Renal vein could be compromised or just the turbulence around the turn causing fluid back up into the testes

191
Q

What lymph nodes do the ovaries/testes drain to?

A

Para-aortic lymph nodes

192
Q

Where does the scrotum drain to? Glans penis?

A

Scrotum- superficial inguinal lymph nodes

Penis: deep inguinal

193
Q

Which ovarian ligament contains the ovarian vessels? (2 names)

A

Infundibulopelvic ligament or suspensory ligament

194
Q

Which ovarian ligament travels through the inguinal canal?

A

The round ligament goes through the round inguinal canal

195
Q

Where does the ovarian ligament attach to the uterus?

A

Lateral uterus. Ovarian Ligament Latches to Lateral uterus

196
Q

Normal position of the uterus?

A

Anteverted and anteflexed

197
Q

What is the epithelium transition at the transformation zone?

A

From stratified squamous of the vagina and ectocervix to simple columnar epithelium

198
Q

What type of epithelium lines the ovary?

A

Simple cuboidal

199
Q

Urine leak into retropubic space? What about beneath fascia of buck/superficial perineal space?

A

1) Posterior (membranous) urethra injury

2) Anterior (straddle injury)

200
Q

What nerve is responsible for emission in the male sexual response? Ejaculation?

A

Emission: sympathetic (hypogastric)
Ejaculation: visceral and Somatic (pudendal)

201
Q

Where do you find spermatogonia?

A

Lining the seminiferous tubules

202
Q

Name three important products of sertoli cells

A

Inhibin B (inhibits FSH), Androgen binding protein (maintain local levels of testosterone for sperm production), Produce MIF (important in development)

203
Q

Are leydig cells temperature sensitive?

A

No

204
Q

What type of estrogen comes from ovary, placenta, and fat? Relative potency?

A

Estradiol (ovary)> estrone (fat)> estriol (placenta)

205
Q

What does estrogen do to the levels of progesterone receptors? What does progesterone do to the level of estrogen receptors?

A

Estrogen increases progesterone receptors

Progesterone decreases estrogen receptors

206
Q

Why do you not lactate during pregnancy?

A

Progesterone inhibits prolactin, when progesterone falls after delivery–> prolactin is disinhibited

207
Q

What and when are the two arrest phases in oogenesis?

A

1) prophase I until ovulation

2) metaphase II until fertilization (an egg MET a sperm)

208
Q

Transient mid cycle ovulatory pain classically associated with peritoneal irritation

A

Mittelschmerz

209
Q

What causes the LH surge to kick off ovulation?

A

An estrogen surge

210
Q

How long is the luteal phase? How long is the follicular phase?

A

The luteal phase is 14 days, the follicular phase is classically 14 but can be variable in length

211
Q

In the menstrual cycle, when is LH concentration higher than FSH?

A

Only right around ovulation

212
Q

What is dysmenorrhea often associated with?

A

Endometriosis

213
Q

Where does fertilization most often occur?

A

Upper end of fallopian tube (ampulla)

214
Q

When is hCG detectable in blood? Urine?

A

Blood: 1 week after conception
Urine: 2 weeks after conception

215
Q

Difference in gestational age vs. embryonic age?

A

Gestational: from last menstrual period
Embryonic: calculated from conception date (subtract 2 weeks from gestational)

216
Q

Why do you see anemia in pregnancy? Hypercoagulability?

A

Anemia- relative increase in plasma to RBC concentration

Hypercoag.- To decrease blood loss at delivery

217
Q

Which hormone does not continually increase through pregnancy?

A

hCG (it peaks at 8-10 weeks)

218
Q

How doe hCG work?

A

Just assume always that hCG gets the job done by acting like LH (this is how it maintains the corpus luteum and thus progesterone concentration for pregnancy)

219
Q

What are the hCG levels in the three major trisomies? What can high levels of hCG cause and why?

A

Inc. in Down, Decreased in patau and edwards

Identical alpha subunit to TSH and thus can cause hyperthyroidism (symptoms in pregnancy perhaps)

220
Q

What does apgar stand for? What number?

A 
Appearance (blue or pink)
Pulse (>100)
Grimace
Activity
Respiration (crying)
221
Q

Which pro-milk hormone provides protection against pregnancy?

A

Prolactin (decreases GnRH)

222
Q

What vitamin must be supplemented to exclusively breastfed infants?

A

Vitamin D

223
Q

What future benefits might a mother get out of breast feeding?

A

Decreased risk of breast and ovarian cancer due to decreased estrogen exposure

224
Q

What hormone level is specific for menopause?

A

Very increased FSH (no estrogen feedback)

225
Q

What androgen is secreted from the adrenals?

A

Androstenedione

226
Q

What causes differentiation of the prostate?

A

DHT

227
Q

Which is mature: spermatogonium of spermatozoon

A

zoon is zooming to egg

228
Q

What gonadotropin levels will you see in Klinefelter disorder? Why?

A

Increased LH and FSH. FSH up due to dysgenesis of seminiferous tubules and thus decreased inhibin B. LH up due to abnormal leydig cell functions

229
Q

Renal defect associated with turner syndrome?

A

Horseshoe kidney

230
Q

What is a non meiotic cause of turner syndrome?

A

Mosaicism from mitotic error causing some normal cells and some of the turner syndrome genotype

231
Q

Very tall male with learning disability and severe acne may have what genetic disorder?

A

Double Y male

232
Q

Incomplete puberty and lack of smell?

A

Kallmann syndrome. Hypogonadotropic hypogonadism due to decreased GnRH cells and messed up formation of the olfactory bulb

233
Q

What are the common karyotypes of complete and partial moles?

A

Complete: 46 XX or XY (usually from an enucleated egg+ single sperm that duplicates paternal DNA)
Partial: 69 XXX, XXY or XYY from 2 sperm + 1 egg

234
Q

Clusters of grapes or snowstorm on fetal ultrasound?

A

Complete mole

235
Q

No chorionic villi are present.

A

Choriocarcinoma (like mole, proliferation of trophoblastic tissue)

236
Q

Where might choriocarcinoma spread and how?

A

Hematogenously to the lungs

237
Q

Painless vs painful bleeding in third trimester

A

Painless: Placenta previa
Painful: placental abruption

238
Q

Membrane rupture, painless vaginal bleeding and fetal bradycardia

A

Vasa previa

239
Q

Difference in gestational hypertension and preeclampsia? Preeclampsia to eclampsia?

A

Preeclampsia is new-onset HTN with proteinuria or end organ dysfunction
Eclampsia is preeclampsia plus seizures

240
Q

What causes preeclampsia?

A

Abnormal placental spiral arteries–> endothelial dysfunction–> vasoconstriction–> ischemia

241
Q

Why would you give IV magnesium sulfate to a pregnant woman?

A

To prevent seizures

242
Q

Pregnant lady with schistocytes and high ALT, AST

A

HELLP: Hemolysis, Elevated Liver enzymes, Low Platelets

243
Q

How do you treat Eclampsia or HELLP syndrome?

A

Immediate delivery is important

244
Q

Incidence of gynecologic tumors in US? Worldwide?

A

US: Endometrial> ovarian> cervical

Cervical is most worldwide (HPV screening)

245
Q

In utero exposure leading to vaginal clear cell carcinoma

A

DES

246
Q

Most common cause of vaginal SCC?

A

Cervical SCC, primary vaginal carcinoma is rare

247
Q

How does HPV cause CIN and cancer?

A

E6- inhibits p53

E7- inhibits RB

248
Q

Risk factors for cervical dysplasia (4). Which is biggest?

A

1) Multiple sexual partners (#1)
2) Smoking
3) Starting sexual intercourse at young age
4) HIV infection

249
Q

Signs of menopause before 40?

A

Premature ovarian failure

250
Q

Abnormal vaginal bleeding that is often postcoital?

A

Possible cervical dysplasia or carcinoma in situ

251
Q

Main thing to remember about PCOS?

A

LH:FSH ratio increases

252
Q

Diabetes, hirsutism, acne, obesity?

A

PCOS

253
Q

Treatment for PCOS?

A

Clomiphene, ketoconazole, spironolactone

254
Q

What risk increases with PCOS?

A

Endometrial cancer secondary to unopposed estrogen from repeated anovulatory cycles?

255
Q

Why do follicles not mature well in PCOS?

A

Increased LH causes peripheral conversion to estrogen which causes feedback inhibition of FSH in the pituitary

256
Q

Most common ovarian mass in young women?

A

Follicular cyst

257
Q

Most common group of ovarian neoplasms? Most common of this group?

A

Epithelial- most often serous cytadenocarcinoma

258
Q

What polyp syndrome increases ovarian cancer risk?

A

Lynch syndrome

259
Q

Pelvic pain, dysmenorrhea, dyspareunia and symptoms that vary with menstrual cycle

A

Endometrioma

260
Q

What type of ovarian tumor can cause hyperthyroidism directly?

A

Mature cystic teratoma with thyroid tissue (struma ovarii)

261
Q

Coffee bean nuclei on H & E?

A

Brenner tumor

262
Q

Ascites and hydrothorax can be combined with what ovarian neoplasm to form a common syndrome? Name?

A

Meigs syndrome- ovarian fibroma, ascites, hydrothorax

263
Q

Abnormal uterine bleeding in a postmenopausal woman ovarian neoplasm? Why?

A

Thecoma- produces estrogen and thus can cause bleeding

264
Q

Three types of ovarian neoplasms?

A

Surface epithelium, germ cells, or sex cord stromal tissue

265
Q

Call exner bodies ovarian tumor? Type?

A

Granulosa cell tumor- most common malignant stromal tumor

266
Q

Psammoma bodies in ovarian tumor?

A

Serous cystadenocarcinoma

267
Q

If you see an accumulation of mucinous material on the ovary what should you check?

A

Appendix! Mucinous cystadenocarcinoma

268
Q

What makes a teratoma immature in a female? Is it malignant?

A

Presence of fetal tissue or neuroectoderm. Yes, it is malignant unlike the mature form

269
Q

Fried egg cells in ovarian tumor. Tumor markers?

A

Dysgerminoma, LDH and hCG

270
Q

Glomeruli-like structures in ovarian tumor? Marker?

A

Schiller-Duval bodies in yolk sac tumor, AFP

271
Q

Signet cell adenocarcinoma that metastasizes? Where is it from?

A

Krukenberg tumor most often from stomach

272
Q

Uniformly enlarged, soft uterus. What causes it?

A

Adenomyosis- caused by extension of endometrial tissue into uterine myometrium

273
Q

Most common tumor in females?

A

Leiomyoma (fibroid)

274
Q

Endometrial tumor that is estrogen sensitive?

A

Leiomyoma

275
Q

Endometrial condition causing postmenopausal vaginal bleeding? Major risk factor for progression to carcinoma?

A

Endometrial hyperplasia (nuclear atypia is a greater risk factor than complex architecture)

276
Q

Small, well-defined breast mass that increases in size and tenderness with increased estrogen

A

Fibroadenoma

277
Q

Increased acini and stromal fibrosis in breast with calcification? Does it increase cancer risk?

A

Sclerosing adenosis, does increase cancer risk (1.5-2x)

278
Q

Most common cause of nipple discharge?

A

Intraductal papilloma

279
Q

Eczematous patches on nipple? Association?

A

Paget disease: intraepithelial adenocarcinoma cells

UNDERLYING DCIS

280
Q

Carcinoma of the breast that forms linear cell formulations? How?

A

ILC: invasive lobular carcinoma due to decreased E-cadherin expression

281
Q

Abnormal curvature of penis due to fibrous plaque within tunica albuginea?

A

Peyronie disease

282
Q

Leukoplakia on penile shaft? Erythroplakia of glans?

A

Leuko: Bowen disease
Erythro: Queyrat

283
Q

Two associations with SCC of the penis?

A

HPV, lack of circumcision

284
Q

Testicular mass that increases with standing and regresses with sitting and does not transilluminate

A

Varicocele

285
Q

Fried egg appearance testicular tumor? Marker?

A

Seminoma, increased placental ALP

286
Q

Most common testicular tumor in boys less than 3 years old?

A

Yolk sac tumor (endodermal sinus tumor)

287
Q

Is a mature teratoma benign in men? how do you tell?

A

Not necessarily. May be malignant in adult males, benign in children

288
Q

Testicular tumor with Reinke crystals?

A

Leydig cell tumor (testosterone)

289
Q

Most common testicular cancer in older men?

A

Lymphoma

290
Q

What is the cause of BPH?

A

HYPERPLASIA not hypertrophy of periurethral lobes of prostate (lateral and middle lobes)

291
Q

Treatments for BPH?

A

Finasteride, alpha 1 antagonists like terazosin and tamsulosin), tadalafil

292
Q

MOA of clomiphene

A

Blocks estrogen negative feedback at the hypothalamus

293
Q

What is leuprolide?

A

GnRH analog

294
Q

Actions of tamoxifen and raloxifene?

A

Tamoxifen: agonist at bone and uterus, antagonist at breast
Raloxifene: agonist at bone, antagonist at breast and uterus

295
Q

Any drug that ends with gestural or norethindrone

A

Progestins

296
Q

Can estrogen or progesterone stop bleeding after birth?

A

Progesterone

297
Q

How does combined contraception stop pregnancy?

A

Inhibit LH and FSH via feedback and thus prevent estrogen surge. No ovulation= no pregnancy chance

298
Q

What are two major contraindications of OCPs?

A

Smoking and increased risk of CV disease

299
Q

How does a copper IUD work?

A

Produces local inflammatory reaction toxic to sperm and ova

300
Q

What is danazol?

A

Partial agonist at androgen receptors

301
Q

What do testosterone and methyl testosterone do to lipid levels?

A

Increased LDL and decreased HDL

302
Q

Flutamide MOA?

A

Comeptitive inhibition at androgen receptors

303
Q

What do ketoconazole and spironolactone inhibit? When might you use them?

A

Ketoconazole: 17-20 desmolase
Spironolactone: 17 alpha hydroxylase and 17,20 desmolase
Both used in PCOS to reduce androgenic sx

304
Q

Why is tamsulosin used in BPH?

A

Specific alpha 1 antagonist for alpha 1A,D receptors on prostate vs alpha 1B receptors in vasculature

305
Q

Which PDE-5 inhibitor can be used for BPH?

A

Tadalafil

306
Q

What is minoxidil?

A

Direct arteriolar vasodilator used for androgenetic alopecia and severe refractory hypertension

307
Q

Unilateral, painful cystic lesion at the lower vestibule adjacent to the vaginal canal

A

Bartholin cyst

308
Q

What causes condyloma latum? Accuminatum?

A

Latum: secondary syphilis
Accuminatum: HPV 6 and 11 (more common)

309
Q

White vulvar patch with parchment-like skin. Risk for cancer down the road?

A

Lichen sclerosis, yes a slightly increased risk of SCC

310
Q

Leukoplakia with leathery, thick vulvar skin. Risk of cancer down the road?

A

Lichen simplex chronicus, no increased risk of SCC

311
Q

What is the major cause of non-HPV related vulvar carcinoma? Age group?

A

Lichen sclerosis, old (>70) chronic inflammation takes a long time to cause cancer

312
Q

Erythematous, pruritic and ulcerated vulvar skin with malignant epithelial cells in the epidermis.

A

Extramammary Paget disease (not associated with carcinoma like the form in the breast)

313
Q

How do you differentiate Melanoma from Paget disease of the vulva with PAS, keratin and S100

A

Paget: PAS and keratin positive, S100 negative
Melanoma: S100 positive, PAS and keratin negative

314
Q

What forms the upper 2/3 and lower 1/3 of the vagina?

A

Upper: Mullerian ducts
Lower: urogenital sinus

315
Q

What is adenosis? What increases the risk of it?

A

Focal persistence of columnar epithelium (from mullerian duct) in the upper vagina. Increased risk with DES in utero

316
Q

Grape-like mass protruding from vagina or penis of a child? What is it called?

A

Embryonal rhabdomyosarcoma (sarcoma Botryoides)

317
Q

Where does the lower 1/3 of the vagina drain to (LN), upper 2/3?

A

Lower 1/3–> inguinal nodes

Upper 1/3–> iliac nodes

318
Q

How does RB work?

A

RB holds E2F which is needed for cell cycle progression. When RB is phosphorylated by CDKs it releases E2F and the cell cycle may proceed

319
Q

Is CIN irreversible?

A

No, it may reverse- it is dysplasia. However, the higher grade of CIN, the less likely this is

320
Q

What type of vaginal bleeding is a big hint for cervical carcinoma?

A

Postcoital vaginal bleeding

321
Q

What are two secondary risk factors to cervical carcinoma besides HPV?

A

Immunodeficiency, and SMOKING

322
Q

What is a common cause of death in advanced cervical carcinoma? Is it metastasis?

A

Hydronephrosis with post renal failure due to invasion through the anterior uterine wall into the bladder. This is not metastasis but local invasion

323
Q

What follow an abnormal pap smear?

A

Confirmatory colposcopy and biopsy

324
Q

What are the two major limitations of the Pap smear?

A

1) inadequate sampling of T-zone (false negative)

2) Doesn’t detect adenocarcinoma since it doesn’t arise via the CIN sequence

325
Q

Why do we need pap smears if there is a vaccine for HPV?

A

The vaccine only covers 6, 11, 16 and 18 types, and these are not all of them

326
Q

What is asherman syndrome?

A

Secondary amenorrhea due to loss of basalis (regenerative endometrium layer) and scarring. It is caused by overaggressive dilation and curettage

327
Q

What happens in anovulatory cycles. Why does bleeding eventually occur?

A

Results in estrogen-driven proliferative phase without a progesterone-driven secretory phase. Eventually the glands break down and shed due to overgrowth compared to the blood supply

328
Q

What do you suspect if you see plasma cells in the endometrium?

A

Chronic endometritis (plasma cells are necessary for the diagnosis given that lymphocytes are normally in the endometrium)

329
Q

What drug may cause endometrial polyps?

A

Tamoxifen (no surprise here)

330
Q

What is a major effect of endometriosis?

A

Infertility

331
Q

What is adenomyosis?

A

Involvement of the uterine myometrium with endometriosis

332
Q

What benign condition classically presents as postmenopausal uterine bleeding? What is the biggest predictor for it progressing to carcinoma?

A

Endometrial hyperplasia. Cellular atypia

333
Q

What are the two pathways that endometrial carcinoma may arise?

A

1) Hyperplasia leads to carcinoma (endometroid histology, risk is increased estrogen exposure)
2) Sporadic arises in elderly and usually has serous or papillary-serous histology with psammoma body formation and p53 mutations (aggressive)

334
Q

Most common outcome of leiomyomas?

A

Asymptomatic but can cause bleeding and infertility

335
Q

Do leiomyomas progress to leiomyosarcoma?

A

NOOOO! Leiomyosarcoma arises de novo

336
Q

What is the gross presentation of leiomyosarcoma?

A

Single lesion with areas of necrosis and hemorrhage

337
Q

LH:FSH ratio >2

A

PCOS

338
Q

Obese woman with infertility, oligomenorrhea and hirsutism. May develop type II DM 10-15 years later.

A

PCOS

339
Q

What are serous and mucinous cells in regard to ovarian epithelium?

A

Serous: line fallopian tube
Mucinous: line the endocervix

340
Q

What type of ovarian cancer do BRCA1 mutation carriers have a greater risk for? What other mutation can do this?

A

Serous carcinoma of the ovary and fallopian tube. Lynch syndrome

341
Q

What type of ovarian tumor is most associated with endometriosis?

A

Clear cell carcinoma (also endometroid tumors to a lesser extent)

342
Q

Which type of tumor specifically carries the worst prognosis of female genital tract tumors, why?

A

Surface epithelial carcinoma because it is often discovered late

343
Q

What is CA-125 good for monitoring?

A

Surface epithelial ovarian carcinomas

344
Q

Name the types of germ cell tumors of the ovary

A

Cystic teratoma, embryonal carcinoma, dysgerminoma, choriocarcinoma, endodermal sinus tumor (yolk sac)

345
Q

What indicates malignancy in a female teratoma?

A

Immature tissue (usually neural) or somatic malignancy within the teratoma

346
Q

Fried egg cell tumor in women (clear cytoplasm and central nuclei)

A

Dysgerminoma (seminoma is male counterpart)

347
Q

Most common germ cell tumor in children? Marker? Histology?

A

Yolk sac tumor. AFP. Schiller-Duval bodies

348
Q

What proliferates in choriocarcinoma?

A

Syncytiontrophoblasts and cytotrophoblasts

349
Q

Ovarian tumor with large primitive cells and aggressive/early metastasis?

A

Embryonal carcinoma

350
Q

Reinke crystals in female? Male?

A

Sertoli-leydig tumor in both

351
Q

Meigs syndrome?

A

Fibromas, pleural effusion and ascites

352
Q

Drug that causes digit hypoplasia and cleft lip/palate in fetus?

A

Phenytoin

353
Q

What type of necrosis do you see in preeclampsia?

A

Fibrinoid necrosis in placental vessels

354
Q

Much larger uterus and higher B-hCG than expected for date of gestation.

A

Hydatidiform mole

355
Q

Do choriocarcinomas respond well to chemo?

A

Yes only if the arise from the gestational pathway. If they arise from the germ cell pathway they do not

356
Q

Necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes

A

Lymphogranuloma venereum

357
Q

Multiple reddish papules on penis. Does it progress?

A

Bowenoid papulosis, it is carcinoma in situ that does not progress to invasive carcinoma

358
Q

Are leydig cells affected in orchitis?

A

No, they seemingly are never infected with anything (e.g. cryptorchidism)

359
Q

What causes testicular torsion symptoms?

A

Vein (thin walled) is obstructed leading to congestion and hemorrhagic infarction

360
Q

What is the state of the cremasteric reflex in testicular torsion?

A

Absent

361
Q

Is it a patent tunica vaginalis that allows hydrocele?

A

No, processus vaginalis

362
Q

What types of testicular tumors are there generally?

A

Germ cell and sex-cord stroma tumors

363
Q

Do we biopsy testicular tumors?

A

No, risk of seeding scrotum. We just cut them out :/

364
Q

What is the most common type of testicular tumors by far?

A

Germ cell

365
Q

Homogenous mass with no hemorrhage or necrosis in testicle with large cells that have clear cytoplasm and central nuclei

A

Seminoma

366
Q

What histology helps to distinguish an embryonal carcinoma in a male? Gross?

A

Hemorrhagic mass with necrosis with histology showing primitive cells that may PRODUCE GLANDS

367
Q

What cell markers are with testicular embryonal carcinoma? What may chemo do?

A

AFP or B-hCG and chemo may result in differentiation into another type of germ cell tumor

368
Q

What symptoms might choriocarcinoma present with due to its marker?

A

B-hCG may cause it to present with gynecomastia (similar to LH) or hyperthyroidism (similarity with TSH)

369
Q

Is teratoma malignant in males?

A

Yes, after puberty it is malignant

370
Q

What is the most common type of germ cell tumor in males?

A

Mixed… No clear boundaries

371
Q

Reinke crystals in male?

A

Leydig cell tumor

372
Q

Tender/boggy prostate on DRE?

A

Acute prostatitis (enterics in older males, ST bugs in younger)

373
Q

Does BPH increase cancer risk?

A

No…

374
Q

Whats the problem with finasteride tx for BPH?

A

Takes months to produce any results

375
Q

What is the Gleason grading system for prostatic adenocarcinoma based on? How does it work?

A

Architecture alone, not nuclear atypia. Multiple areas of tumor are assessed and a score is assigned (1-5) for two distinct areas. Higher score is worse prognosis

376
Q

Type of bone lesions with prostatic adenocarcinoma? How do we know it is happening?

A

OsteoBLASTIC (sclerotic). ALP rises

377
Q

Where does the milk line run?

A

Axilla to vulva

378
Q

How many layers of epithelium are there in breast lobules and ducts? Name them

A

2- myoepithelial cells, luminal cell layer (milk production)

379
Q

Subareolar mass with nipple inflammation (not malignant). What is the pathology? Major association?

A

Periductal mastitis.
Usually seen in smokers since smoking causes a relative Vit. A deficiency. The specialized ductal epithelium (like many specialized epithelial surfaces) is highly dependent on vitamin A. This causes squamous metaplasia of the ducts producing duct blockage and inflammation.

380
Q

Periareolar mass with green-brown nipple discharge? Cells on biopsy? Malignant?

A

Mammary duct ectasia. Not malignant. Plasma cells on biopsy

381
Q

Among fibrocystic change, which cause increased cancer risk? Most? Cysts, ductal hyperplasia, atypical hyperplasia, apocrine metaplasia, sclerosing adenosis

A

5x risk: atypical hyperplasia
2x risk: ductal hyperplasia and sclerosing adenosis
No risk: Cysts, APOCRINE METAPLASIA

382
Q

What body metaplasia carries no increased risk for carcinoma?

A

Apocrine metaplasia of the breat

383
Q

Benign cause of bloody nipple discharge? How to discern from malignant?

A

Intraductal papilloma. This still has both epithelial layers while the carcinoma has no myoepithelial cell layer (also typically the carcinoma is in a postmenopausal woman)

384
Q

Describe a phyllodes tumor of the breast

A

Leaf like projections with overgrowth of the fibrous component. Can be malignant, but is most often benign

385
Q

Why does obesity increase risk for breast cancer?

A

Increased aromatase in adipose tissue increases estrogen exposure.

386
Q

What cancer of the breast is often detected as calcification on mammography and does not cause a mass?

A

DCIS

387
Q

Name two benign breast conditions associated with calcification.

A

Fat necrosis (trauma) and sclerosing adenosis

388
Q

Breast carcinoma with large, high grade cells growing in sheets with lymphocytes and plasma cells. Association? Prognosis?

A 
Medullary carcinoma (subtype of IDC)
BRCA1 mutation, good prognosis
389
Q

What two main cancers does BRCA1 mutation predispose to?

A

Medullary carcinoma in breast and serous carcinoma in ovary/fallopian tube

390
Q

Type of invasive ductal carcinoma with poor prognosis?

A

Inflammatory carcinoma

391
Q

What breast cancer may show signet ring morphology? What else is significant?

A

ILC (in line carcinoma due to decreased E-cadherin)

392
Q

What are the most important and useful prognostic factors for breast cancer?

A

Important: metastasis (but most present before this)
Useful: Spread to axillary lymph nodes

393
Q

Describe BRCA1 and 2 in regard to the chromosome and associated cancers

A

BRCA1: c17, breast and ovarian
BRCA2: c13 breast carcinoma in males

394
Q

Two associations with male breast cancer? Subtype and location that are most common?

A

BRCA2 and Klinefelter syndrome

Invasive ductal carcinoma (male breast doesn’t really have lobules) and subareolar

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