EXAM #4 (1-of-2)

Question 1

a. Cervical Intraepithelial Neoplasia (CIN)

b. Epithelial changes that sometimes leads to invasive _____.
c. Some _____; some do not go on to cancer.
d. Represents dysplasia of the cervical epithelium.
e. Is graded based on _____ of changes.
f. Can be evaluated by cytologic or by biopsy methods
i. Clinically:
1. Peak incidence – __ years
2. Risk factors
a. Early age of _____ intercourse
b. _____ sexual partners
c. _____ partner with multiple sexual partners
d. Persistence of infection by high-risk _____ _____ _____

• g. CIN I – Mild _____
• h. CIN II – Moderate _____
• i. CIN III – Severe _____ and _____ _____ _____

Answer 1

a. Cervical Intraepithelial Neoplasia (CIN)

b. Epithelial changes that sometimes leads to invasive carcinoma.
c. Some regress; some do not go on to cancer.
d. Represents dysplasia of the cervical epithelium.
e. Is graded based on severity of changes.
f. Can be evaluated by cytologic or by biopsy methods
i. Clinically:
1. Peak incidence – 30 years
2. Risk factors
a. Early age of first intercourse
b. Multiple sexual partners
c. Male partner with multiple sexual partners
d. Persistence of infection by high-risk human papilloma virus

• g. CIN I – Mild Dysplasia
• h. CIN II – Moderate dysplasia
• i. CIN III – Severe carcinoma and carcinoma in situ

Question 2

3. Low Grade Squamous Intraepithelial Lesion (LGSIL)
   a. _____ or _____
   b. __% likelihood of regression
   c. Only __-__% likelihood of progression to invasive carcinoma

Answer 2

3. Low Grade Squamous Intraepithelial Lesion (LGSIL)
   a. CIN I or flat condyloma
   b. 50% likelihood of regression
   c. Only 1-5% likelihood of progression to invasive carcinoma

Question 3

4. High Grade Squamous Intraepithelial Lesion (HGSIL)
   a. _____
   b. _____
   c. __% likelihood of regression
   d. In some studies – __-__% likelihood of progression to carcinoma

Answer 3

4. High Grade Squamous Intraepithelial Lesion (HGSIL)
   a. CIN II
   b. CIN III
   c. 33% likelihood of regression
   d. In some studies – 60-74% likelihood of progression to carcinoma

Question 4

5. Endometriosis
   a. Presence of endometrial glands and stroma outside _____ cavity; responds cyclically
   b. Effects 10% of women in _____ years
   c. 50% of women with _____
   d. Can present anywhere in pelvis – frequently on surface of _____
   e. Can produce _____ (chocolate _____) areas
   f. Possible causes: regurgitation of menstruated _____; _____, and _____ or _____ spread pain,
   g. Clinically – _____, _____, _____, dysmenorrhea _____

Answer 4

5. Endometriosis
   a. Presence of endometrial glands and stroma outside endometrial cavity; responds cyclically
   b. Effects 10% of women in reproductive years
   c. 50% of women with infertility
   d. Can present anywhere in pelvis – frequently on surface of ovary
   e. Can produce cystic (chocolate cysts) areas
   f. Possible causes: regurgitation of menstruated endometrium; metaplasia, and blood or lymphatic spread pain,
   g. Clinically – scarring, pain, dysuria, dysmenorrhea infertility

Question 5

6. Adenomyosis
   a. Presence of _____ and _____ down in _____
   b. Causes enlargement of uterine _____
   c. Consist of _____ layer and do not respond cyclically
   d. Still evoke reaction of _____
   e. Cause: _____, _____, _____ pain

Answer 5

6. Adenomyosis
   a. Presence of endometrium and stroma down in myometrium
   b. Causes enlargement of uterine wall
   c. Consist of basal layer and do not respond cyclically
   d. Still evoke reaction of muscle
   e. Cause: menorrhagia, dysmenorrhea, pelvic pain

Question 6

7. Menorrhagia/Metrorrhagia/Post Menopausal bleeding
   a. Menorrhagia – prolonged or heavy bleeding during _____
   b. Metrorrhagia – irregular bleeding between _____
   c. Post menopausal bleeding

Answer 6

7. Menorrhagia/Metrorrhagia/Post Menopausal bleeding
   a. Menorrhagia – prolonged or heavy bleeding during menstruation
   b. Metrorrhagia – irregular bleeding between periods
   c. Post menopausal bleeding

Question 7

10. Salpingitis

Infection/inflammation of the _____

a. STD’s, coliforms

Answer 7

10. Salpingitis

Infection/inflammation of the fallopian tubes

a. STD’s, coliforms (bacteria)

Question 8

9. Endometrial Carcinoma
   a. Now most _____ _____ of female genital tract
   b. Occurs most frequently ages __ – __

c. Risk Factors
i. _____
ii. _____
iii. _____
iv. _____

d. Occurs as endometriod pattern or serous pattern
i. Endometriod - usually _____ women with excess estrogen
ii. Serous – usually atrophic _____ or in _____

e. Clinically depends on stage; serous can spread more extensively with minimal invasion of uterus
i. Stage depends on invasion of _____

Answer 8

9. Endometrial Carcinoma
   a. Now most common tumor of female genital tract
   b. Occurs most frequently ages 55 – 65

c. Risk Factors
i. Obesity
ii. Diabetes
iii. Hypertension
iv. Infertility

d. Occurs as endometriod pattern or serous pattern
i. Endometriod - usually perimenopausal women with excess estrogen
ii. Serous – usually atrophic endometrium or in polyps

e. Clinically depends on stage; serous can spread more extensively with minimal invasion of uterus
i. Stage depends on invasion of myometrium

Question 9

14. Chorioamnionits

a. _____ of _____ membranes

Answer 9

14. Chorioamnionits

a. Inflammation of placental membranes

Question 10

13. Ovarian teratomas
    a. __-__% of ovarian neoplasms
    b. 1st _____ decades of life
    c. _____ the patient – more likely malignant
    d. Most _____

e. Benign (Mature) Cystic Teratoma
i. Contains derivations of all _____ germ cell layers
ii. Are cystic and contain skin/epidermal structures – “dermoid cyst”

f. Immature Malignant Teratoma
i. Mean age – __ years
ii. Mostly _____

g. Monodermal Teratomas
i. Contain _____ cell line – i.e. struma ovarii - thyroid

Answer 10

13. Ovarian teratomas
    a. 15-20% of ovarian neoplasms
    b. 1st two decades of life
    c. Younger the patient – more likely malignant
    d. Most benign

e. Benign (Mature) Cystic Teratoma
i. Contains derivations of all three germ cell layers
ii. Are cystic and contain skin/epidermal structures – “dermoid cyst”

f. Immature Malignant Teratoma
i. Mean age – 18 years
ii. Mostly solid

g. Monodermal Teratomas
i. Contain one cell line – i.e. struma ovarii - thyroid

Question 11

14. Chorioamnionits

a. Inflammation of _____ membranes

Answer 11

14. Chorioamnionits

a. Inflammation of placental membranes

Question 12

15. Funisitis

a. Inflammation of _____ cord

Answer 12

15. Funisitis

a. Inflammation of umbilical cord

Question 13

16. Placenta abruption

a. Premature separation of _____ from _____ lining

Answer 13

16. Placenta abruption

a. Premature separation of placenta from uterine lining

Question 14

17. Placenta previa

a. Placenta _____ _____ _____

Answer 14

17. Placenta previa

a. Placenta overlies cervical opening

Question 15

1. Osteoporosis
   a. Increased _____ of bone; diagnosed by accessing bone density
   b. Disruption of bone _____ and _____
   c. Results in increase of bone _____

d. Clinically: depends on bones involved
i. Thoracic/lumbar fractures common – lead to _____ deformities
ii. Fractures of femoral necks/pelvis/spine – lead to prolonged _____ _____ and pulmonary _____

e. Types:
i. Senile
ii. Postmenopausal – decreased _____ leads to bone loss

Answer 15

1. Osteoporosis
   a. Increased porosity of bone; diagnosed by accessing bone density
   b. Disruption of bone formation and reabsorption
   c. Results in increase of bone fragility

d. Clinically: depends on bones involved
i. Thoracic/lumbar fractures common – lead to spinal deformities
ii. Fractures of femoral necks/pelvis/spine – lead to prolonged bed rest and pulmonary thromboemboli

e. Types:
i. Senile
ii. Postmenopausal – decreased estrogen leads to bone loss

Question 16

2. Pagets Disease
   a. Results in increased mass of _____ _____

b. Three stages:
i. _____ stage – surge of osteoclastic activity
ii. _____ stage – surge of bone formation
iii. _____ stage – scarring stage

c. Begins in _____

d. Clinically: depends on bones affected
i. Can lead to _____ compression, _____
ii. Cardiologic symptoms from increased vascularity of bones
iii. Many have minimal symptoms

Answer 16

2. Pagets Disease
   a. Results in increased mass of disordered bone

b. Three stages:
i. Osteolytic stage – surge of osteoclastic activity
ii. Osteoclastic-osteoblastic stage – surge of bone formation
iii. Osteosclerotic stage – scarring stage

c. Begins in mid-adulthood

d. Clinically: depends on bones affected
i. Can lead to nerve compression, headaches
ii. Cardiologic symptoms from increased vascularity of bones
iii. Many have minimal symptoms

Question 17

3. Osteomalacia/rickets
   a. Results from decreased _____ or abnormal absorption
   b. Bones have decreased _____
   c. Get _____
   d. _____ – childhood disease
   e. _____ – adult disease
   f. “_____” – indicates softening

Answer 17

3. Osteomalacia/rickets
   a. Results from decreased Vitamin D or abnormal absorption
   b. Bones have decreased mineralization
   c. Get deformities
   d. Rickets – childhood disease
   e. Osteomalacia – adult disease
   f. “malacia” – indicates softening

Question 18

4. Osteonecrosis/Avascular necrosis
   a. _____ injury to bone
   b. Results in _____ of bone tissue
   c. Clinically: depends on location of infarcts
   d. _____ – pain during physical activity; lead to _____
   e. _____ - silent

Answer 18

4. Osteonecrosis/Avascular necrosis
   a. Ischemic injury to bone
   b. Results in infarction of bone tissue
   c. Clinically: depends on location of infarcts
   d. Subchondral – pain during physical activity; lead to osteoarthritis
   e. Medullary - silent

Question 19

5. Osteomyelitis
   a. _____ of bone and bone marrow

b. Pyogenic
i. Most cases _____
1. Most common _____ aureus
ii. Routes of infection:
1. _____ dissemination
2. Extension from _____/_____ infection
3. Implantation from _____

c. Tuberculosis
i. Occurs in __-__% of tuberculosis
ii. Usually by _____ spread
iii. Potts Disease – when _____ bones are affected

Answer 19

5. Osteomyelitis
   a. Inflammation of bone and bone marrow

b. Pyogenic
i. Most cases bacterial
1. Most common Staphylococcus aureus
ii. Routes of infection:
1. Hematogenous dissemination
2. Extension from joint/soft tissue infection
3. Implantation from fracture

c. Tuberculosis
i. Occurs in 1-3% of tuberculosis
ii. Usually by hematogenous spread
iii. Potts Disease – when vertebral bones are affected

Question 20

a. Bone Forming Tumors

i. Osteoma
1. Benign
2. May represent _____ versus _____ growths
3. _____ and _____ most common location

ii. Osteosarcoma
1. __% primary bone cancers
2. __% of patients are <20 years old
3. Most common location – metaphysical regions of long bones of extremities – most around _____
4. Clinically – painful enlarging masses; pulmonary metastasis most common; long term survival with therapy – 60-70

Answer 20

a. Bone Forming Tumors

i. Osteoma
1. Benign
2. May represent reactive versus neoplastic growths
3. Head and neck most common location

ii. Osteosarcoma
1. 20% primary bone cancers
2. 75% of patients are <20 years old
3. Most common location – metaphysical regions of long bones of extremities – most around knees
4. Clinically – painful enlarging masses; pulmonary metastasis most common; long term survival with therapy – 60-70

Question 21

7. Osteoarthritis
   a. Also known as Degenerative Joint Disease
   b. Most common _____ disorder
   c. Primary feature – degeneration of _____ _____
   d. Causes: _____, previous _____ injury; _____ deformity; _____; underlying _____ diseases
   e. Pathologic changes:

granularity of cartilage – _____;

smooth bone devoid of cartilage – _____;

formation of loose fragments – _____ (joint mice)

Answer 21

7. Osteoarthritis
   a. Also known as Degenerative Joint Disease
   b. Most common joint disorder
   c. Primary feature – degeneration of articular cartilage
   d. Causes: age, previous traumatic injury; developmental deformity; obesity; underlying metabolic diseases
   e. Pathologic changes:

granularity of cartilage – fibrillation;

smooth bone devoid of cartilage – eburnation;

formation of loose fragments – osteophytes (joint mice)

Question 22

8. Lyme Disease
   a. Caused by infection with: _____ burgdorferi
   b. Transmitted by _____ _____

c. Occurs in stages:
i. Stage 1 – skin _____
ii. Stage 2 – early dissemination, skin lesions, _____, migratory _____ and _____ pain, cardiac _____, meningitis
iii. Stage 3 – __-__ years after bite; late dissemination; leads to sometimes severe _____ changes

Answer 22

8. Lyme Disease
   a. Caused by infection with: Borrelia burgdorferi
   b. Transmitted by deer ticks

c. Occurs in stages:
i. Stage 1 – skin lesion
ii. Stage 2 – early dissemination, skin lesions, lymphadenopathy, migratory joint and muscle pain, cardiac arrhythmias, meningitis
iii. Stage 3 – 2 -3 years after bite; late dissemination; leads to sometimes severe arthritis changes

Question 23

9. Gout/Pseudogout
   a. Accumulation in tissue of _____ _____
   b. Results in recurrent episodes of _____ _____
   c. Sometimes leads to aggregates of crystalline material – tophus (uric acid crystals)
   d. _____ is common location
   e. Can be primary – due to _____ or _____ causes
   f. Can be secondary – due to _____ disorders or diseases where the cause of _____ is known

Answer 23

9. Gout/Pseudogout
   a. Accumulation in tissue of uric acid
   b. Results in recurrent episodes of acute arthritis
   c. Sometimes leads to aggregates of crystalline material – tophus (uric acid crystals)
   d. Great toe is common location
   e. Can be primary – due to unknown or genetic causes
   f. Can be secondary – due to kidney disorders or diseases where the cause of hyperurecemia is known

Question 24

10. Myasthenia gravis
    a. Autoimmune disorder of _____ _____
    b. Characterized by _____ weakness
    c. Incidence 3 in 100,000 persons
    d. Can present at any _____
    e. Thymic hyperplasia or thymoma found in 65% of people affected
    f. Antibodies are to _____ receptors on _____
    g. Clinical presentation: weakness commonly starts in _____ (pstosis) and double vision; effects are variable; can lead to respiratory compromise
    h. Better therapies exist now

Answer 24

10. Myasthenia gravis
    a. Autoimmune disorder of neuromuscular junction
    b. Characterized by muscle weakness
    c. Incidence 3 in 100,000 persons
    d. Can present at any age
    e. Thymic hyperplasia or thymoma found in 65% of people affected
    f. Antibodies are to acetylcholine receptors on muscle
    g. Clinical presentation: weakness commonly starts in eyelids (pstosis) and double vision; effects are variable; can lead to respiratory compromise
    h. Better therapies exist now

Question 25

11. Osteopetrosis a. Rare genetic group of disorders b. Characterized by reduced _____ resorption c. Leads to defective bone _____ d. Get extremely _____ bone, “stone like” e. Not organized correctly, though, - _____ occur f. In addition – patients get _____ problems – such as _____ g. Can develop hepatosplenomegaly – excessive extramedullary hematopoiesis (can not occur in bone)

Answer 25

11. Osteopetrosis a. Rare genetic group of disorders b. Characterized by reduced osteoclast resorption c. Leads to defective bone remodeling d. Get extremely dense bone, “stone like” e. Not organized correctly, though, - fractures occur f. In addition – patients get compression problems – such as nerves g. Can develop hepatosplenomegaly – excessive extramedullary hematopoiesis (can not occur in bone)

Question 26

1. Verrucae - benign _____ _____ of the skin caused by the human _____ (_____).

Answer 26

1. Verrucae - benign warty lesions of the skin caused by the human papillomavirus (HPV).

Question 27

2. Seborrheic keratosis – benign, round, flat, coin-like _____ on the skin microscopically consisting of _____ of the epidermis and hyperkeratosis; NOT associated with development of _____ _____.

Answer 27

2. Seborrheic keratosis – benign, round, flat, coin-like plaques on the skin microscopically consisting of hyperplasia of the epidermis and hyperkeratosis; NOT associated with development of skin cancer.

Question 28

3. Actinic keratosis – rough, sand-paper like _____ on the skin representing _____, _____ changes which may develop to _____ _____ _____.

Answer 28

3. Actinic keratosis – rough, sand-paper like lesions on the skin representing dysplastic, pre-cancerous changes which may develop to squamous cell carcinoma.

Question 29

4. Squamous cell carcinoma – _____ _____ tumor arising from upper layers of _____ found on sun-exposed areas of the body; advanced cases may spread to regional _____ _____.

Answer 29

4. Squamous cell carcinoma – malignant epidermal tumor arising from upper layers of epidermis found on sun-exposed areas of the body; advanced cases may spread to regional lymph nodes.

Question 30

5. Basal cell carcinoma – most common human cancer; _____ _____ tumor arising from _____ layer of epidermis found on sun exposed areas of the body; rarely (if ever) _____ to distant organs or lymph nodes.

Answer 30

5. Basal cell carcinoma – most common human cancer; malignant epidermal tumor arising from basal layer of epidermis found on sun exposed areas of the body; rarely (if ever) metastasizes to distant organs or lymph nodes.

Question 31

6. Melanocytic nevus – _____ congenital or acquired neoplasm of melanocytes (_____).

Answer 31

6. Melanocytic nevus – benign congenital or acquired neoplasm of melanocytes (mole).

Question 32

7. Dysplastic nevus – melanocytic nevus occurring on both _____-exposed and _____-sun exposed areas of the body showing _____ features; sporadic (non-inherited) lesions rarely associated with progression to melanoma; inherited forms may progress to _____.

Answer 32

7. Dysplastic nevus – melanocytic nevus occurring on both sun-exposed and non-sun exposed areas of the body showing pre-malignant features; sporadic (non-inherited) lesions rarely associated with progression to melanoma; inherited forms may progress to melanoma.

Question 33

8. Melanoma – _____ of melanocytes; advanced lesions capable of spread to regional _____ _____ and distant sites; key factor to prognosis is vertical growth (depth) of lesion.

Answer 33

8. Melanoma – malignancy of melanocytes; advanced lesions capable of spread to regional lymph nodes and distant sites; key factor to prognosis is vertical growth (depth) of lesion.

Question 34

9. ABC’s of Melanoma (warning signs) a. A – _____ - melanomas more likely to be _____; nevi _____. b. B – _____ – melanomas more likely to have _____ borders; nevi have _____ borders. c. C – _____ – melanomas more likely to be _____; nevi can be _____ colors but are often _____ d. D – _____ – melanomas less likely to be smaller than __mm e. E – _____ – change in moles can be a danger sign

Answer 34

9. ABC’s of Melanoma (warning signs) a. A – asymmetry - melanomas more likely to be non-symmetric; nevi symmetric. b. B – borders – melanomas more likely to have notched irregular borders; nevi have rounded borders. c. C – color – melanomas more likely to be variegated; nevi can be different colors but are often uniform d. D – diameter – melanomas less likely to be smaller than 4mm e. E – evolution – change in moles can be a danger sign

Question 35

b. Cartilage Forming Tumors i. Osteochondroma 1. Also known as _____ 2. Attached to bone by _____; have _____ overlying bone ii. Chondroma 1. _____ tumors of _____ 2. Within the _____ – enchondroma 3. On the _____ of the _____ – juxtacortical chondroma 4. Clinically – can be _____ or lead to _____ iii. Chondrosarcoma 1. _____ tumors of cartilage 2. __ as frequent as osteosarcoma 3. Most common sites – _____, _____ and _____ 4. Clinically – painful enlarging _____; metastatic potential correlates to grade

Answer 35

b. Cartilage Forming Tumors i. Osteochondroma 1. Also known as exostosis 2. Attached to bone by stalks; have cartilage overlying bone ii. Chondroma 1. Benign tumors of cartilage 2. Within the medulla – enchondroma 3. On the surface of the bone – juxtacortical chondroma 4. Clinically – can be painful or lead to fractures iii. Chondrosarcoma 1. Malignant tumors of cartilage 2. ½ as frequent as osteosarcoma 3. Most common sites – pelvis, shoulder and ribs 4. Clinically – painful enlarging masses; metastatic potential correlates to grade

Question 36

c. Metastatic Bone Tumors i. Are more common than _____ _____ _____ _____ ii. Occurs by: 1. Direct _____ 2. _____ or _____ spread 3. _____ seeding iii. Most common: 1. Adults – _____; _____; _____ and _____ 2. Children – _____; _____ tumor, _____, Ewing Sarcoma, rhabdomyosarcoma

Answer 36

c. Metastatic Bone Tumors i. Are more common than primary malignant bone tumors ii. Occurs by: 1. Direct extension 2. Lymphatic or hematogenous spread 3. Intraspinal seeding iii. Most common: 1. Adults – prostate; breast; kidney and lung 2. Children – neuroblastoma; Wilms tumor, osteosarcoma, Ewing Sarcoma, rhabdomyosarcoma