An organ that is absent due to absent primordial tissue
An organ that is absent despite presence of primordial tissue
Extrinsic fetal disruption after embryonic period
Incomplete organ development with present primordial tissue
Intrinsic embryonic disruption
Drug that causes fetal renal damage
Drug that causes fetal ototoxicity
Drug that causes vaginal clear cell adenocarcinoma and adenosis in fetus
Drug that causes microcephaly, dysmorphic craniofacial features, hypoplastic fingers, cardiac defects, IUGR and mental retardation in fetus
Drug that causes discolored teeth in fetus
Drug that causes limb defects
Drug that causes neural tube defects
Valproic acid (inhibits folate absorption)
Drug that causes fetal bone deformities, fetal hemorrhage, spontaneous abortion and eye abnormalities.
Drug that causes Ebstein’s anomaly
Drug that causes neural tube defects, craniofacial defects, fingernail hypoplasia, developmental delay and IUGR
Leading cause of birth defects and mental retardation in US. Can also cause microcephaly, holoprosencephaly, facial abnormalities, limb discoloration and heart -> lung fistulas
Fetal Alcohol Syndrome
Drug that causes fetal addiction, abnormal development and placental abruption
Drug that causes preterm labor, placental problems, IUGR and ADHD
Cause of congenital goiter or cretinism
Iodine (excess and deficiency = goiter and cretinism respectfully)
Cause of anal atresia, congenital heart defects and neural tube defects
Extremely high risk for spontaneous abortion, can also cause cleft palate and cardiac abnormalities
Isotretinoin (Vitamin A excess)
Physical exposure that can cause microcephaly and mental retardation
Monozygotic, same sperm same egg
Dizygotic, two sperms and two eggs, diamniotic and dichorionic
Cells that secrete hCG
Syncytiotrophoblasts: hCG stimulates corpus luteum to secrete progesterone during the 1st trimester
Where does nutrient exchange occur between the mother and the fetus?
Decidua basalis. This is where maternal blood enters from the spiral arteries into the intervillous spaces and bathes chorionic villi in maternal blood.
How does maternal blood get to the fetal heart?
Umbilical vein -> Ductus venosus -> IVC
What degenerates and what develops in development of a female fetus?
Mesonephric duct (Wolffian) degenerates. Paramesonephric duct (Mullerian) develops.
What develops from the urogenital sinus in a female?
What develops from the paramesonephric (Mullerian) duct in the female?
Upper vagina, uterus, fallopian tubes
What happens when the two paramesonephric ducts fail to fuse completely?
Lymphatic drainage from vulva and distal 1/3 of vagina? Proximal 2/3 of vagina and uterus? Ovaries?
Distal vagina and vulva: Superficial inguinal nodes. Proximal vagina and uterus: External iliac, obturator and hypogastric nodes. Ovary: Para-aortic nodes.
What ligament contains the ovarian blood vessels? When is the ureter at risk around this ligament?
Infundibulopelvic (suspensory) ligament: suspends the ovary to the pelvic wall. Ureter at risk when ligating ovarian vessels in oophorectomy.
What ligament contains the uterine blood vessels? When is the ureter at risk around this ligament?
Cardinal ligament: connects cervix to side wall of pelvis. Ureter at risk when ligating uterine vessels for hysterectomy.
What ligament contains the artery of Sampson?
Round ligament: connects uterine fundus to labia majora via the inguinal canal
What ligament is made of up the mesosalpinx, mesometrium and mesovarium?
Broad ligament: connects the uterus, fallopian tubes and ovaries to the side pelvic wall.
What ligament connects the medial pole of the ovary to the lateral uterus?
Ligament of the ovary
Female sources of estrogen? Where does the most potent estrogen come from?
1) 17-beta Estradiol (most potent) from ovary. 2) Estrone from adipose 3) Estriol from placenta (least potent)
Where does estrogen find its receptors?
Cytoplasm. Once estrogen binds, they move as a dimer to the nucleus.
Pubertal effects of estrogen
Breast development and change in fat distribution
Menstrual effects of estrogen
Follicle growth, endometrial proliferation, increased excitability of myometrium
Central effects of estrogen
Feedback inhibition of FSH and LH. Growing profile triggers LH surge. Stimulates PRL secretion, but blocks action on breast.
Hepatic effects of estrogen
Increased SHBG, HDL and decreased LDL
How is estrogen production stimulated in the ovary by the CNS?
Pulsatile GnRH -> FSH/LH secretion -> Activation of desmolase and aromatase -> Conversion of cholesterol to androstenedione by theca cells (desmolase) and conversion to estrogen by granulosa cells (aromatase)
Female sources of progesterone?
Corpus luteum, placenta, adrenal cortex
Menstrual effects of progesterone
Spiral artery development, endometrial gland secretion, decreased myometrial excitability and thickens cervical mucous
Pregnancy effects of progesterone
Maintenance of pregnancy, inhibition of gonadotropins LH/FSH
Tanner stages of sexual development
1) Child 2) Pubarche & Thelarche 3) Pubic hairs darkens/curls, penis/breasts grow 4) Areolae raise, penis widens, darkens and glans develops 5) Adult
Which menstrual phase is more often the one that varies in length?
Follicular phase. The luteal phase is usually a constant 14 days, ending in menstruation.
When is follicular growth most rapid in the menstrual cycle?
2nd week of the proliferative phase
What defines oligomenorrhea
> 35 day cycle
What defines metorrhagia
Frequent, irregular menstruation
What defines menorrhagia
> 80 mL blood loss or > 7 day long menses
What defines menometrorrhagia
Heavy, irregular menstruation at irregular intervals
What defines polymenorrhea
< 21 day cycles
How do hormones change with each of the events shown below?
FSH causes follicles to mature and estrogen rises w/follicle maturation. High estrogen profile increases anterior pituitary GnRH receptors and triggers LH release which triggers ovulation and formation of corpus luteum which secretes progesterone. As the corpus luteum regresses, progesterone levels fall, the decidua functionalis sloughs off and menstruation begins.
What phases does the egg arrest in during oogenesis?
Primary oocytes begin meiosis I during fetal life, arrest in prophase I, and complete meiosis I just prior to ovulation. Secondary oocytes begin meiosis II, arrest in metaphase II and complete meiosis II once fertilized. If not fertilized within 1 day the secondary oocyte degenerates.
How many polar bodies are formed during oogenesis?
3. On completion of meiosis I the primary oocyte splits into the secondary oocyte and a polar body. On completion of meiosis II, the secondary oocyte splits to form another polar body and the ovum. The other polar body also splits to form 2 polar bodies, for an end total of 3
When in the menstrual cycle will basal body temperature increase?
When progesterone is secreted by the corpus luteum
What is the transient mid-cycle ovulatory pain called than can mimic appendicitis?
Mittelschmerz. This is due to follicular swelling, rupture and fallopian tube contraction.
What is the timeline from ovulation to fertilization to implantation? When will a woman finally test positive for pregnancy?
Fertilization: 1 day after ovulation. Implantation: 6 days after fertilization. Once syncytiotrophoblasts are established, they secrete hCG, which can be detected on a blood test within 7 days after fertilization or on a home test 2 weeks after conception.
What are the factors that stimulate the breast to begin producing milk once the baby is born?
Delivery of the placenta decreases progesterone and estrogen levels. This disinhibits lactation. Nipple stimulation increases oxytocin and prolactin which assists in milk letdown and milk production respectively.
Immune factors found in breastmilk
Mostly IgA immunoglobulins, macrophages and lymphocytes.
What supplementation do infants who are fed only breastmilk require?
Benefits of breast feeding?
Decreased childhood asthma, allergies, diabetes and obesity. Decreased maternal breast and ovarian cancer.
When during pregnancy does the corpus luteum degenerate?
2nd and 3rd trimesters. The placenta can produce its own estriol and progesterone at these stages and the corpus luteum is no longer needed.
What part of hCG is the functional part in early detection of pregnancy?
The alpha subunit is similar to LH, FSH and TSH. The beta subunit is what is unique to hCG.
What hormonal changes take place during menopause? What symptoms does this result in?
Decline in follicle number = decrease in estrogen = disinhibition of estrogen on pituitary = increased FSH, LH and GnRH. “HAVOCS” Hot flashes, Atrophy of Vagina, Osteoporosis, Coronary artery disease and Sleep disturbances.
When would you worry about premature ovarian failure in a female?
Menopause before age 40. Note that the average age of menopause is 51, but it also occurs earlier in smokers.
A 27 year old male presents with infertility. Physical exam reveals testicular atrophy, eunuchoid body shape, tall, gynecomastia and poor hair distribution. What sex chromosome disorder does he most likely have? What labs might you do to confirm your diagnosis?
Klinefelter syndrome (XXY) results in inactivation of one X chromosome (Barr body). The patients have seminiferous tubule dysgenesis -> decreased inhibin -> increased FSH. Leydig cells are abnormal and testosterone is decreased -> increased LH and increased estrogen.
A female presents with amenorrhea. Physical exam reveals short stature, shield chest, a weak femoral pulse compared to radial pulse, webbed neck and edema. Medical history is significant for a bicuspid aortic valve and a horseshoe kidney. What is causing her condition?
Turner syndrome (XO). These women have menopause before they ever hit menarche due to decreased levels of estrogen.
A woman presents with vaginal bleeding, an enlarged uterus, vomiting, pre-eclampsia and hyperthyroidism. Ultrasound reveals a “snowstorm” appearance and MRI shows “clusters of grapes”. Labs show dramatically elevated beta-hCG. What complications is this patient at risk for?
She has a complete mole (46 XX or XY). This occurs when an enucleated egg + a single sperm combine and the single sperm replicates its DNA or when 2 sperm fertilize the egg. Risks include conversion to choriocarcinoma and malignant trophoblastic disease.
A woman presents with vaginal bleeding and abdominal pain. Labs show a mildly elevated beta-hCG and imaging shows incomplete fetal parts. What is her risk for malignancy?
She has a partial mole (69 XXX, XXY or XYY). This is from 2 sperm fertilizing 1 egg. She has a low risk of malignancy transformation.
A woman presents at 20 weeks gestation with a blood pressure of 140/90. Prior to pregnancy her blood pressure was 120/80. Labs reveal no proteinuria. How do you treat her?
She has gestational hypertension. You treat with alpha-methyldopa, labetalol, hydralazine, nifedipine or delivery at 39 weeks.
A woman presents at 20 weeks gestation with a blood pressure of 140/90. Labs show proteinuria > 300mg/24 hours, elevated AST/ALT and thrombocytopenia. She complains of headache, scotoma and oliguria. What is causing her condition and how should you treat her?
She has pre-eclampsia. This is caused by abnormal placental spiral arteries, maternal endothelial dysfunction, vasoconstriction or hyperreflexia. Treatment included antihypertensives and delivery at 34 weeks if severe (BP > 160/110), 37 weeks if mild, IV MgSO4 to prevent seizure and progression to eclampsia.
A woman presents at 20 weeks gestation with a blood pressure of 140/90. Labs show proteinuria > 300mg/24 hours, elevated AST/ALT and thrombocytopenia. She complains of headache, scotoma and oliguria. What are risk factors and complications of this condition?
Risk factors for pre-eclampsia: preexisting hypertension, diabetes, renal disease or autoimmune disorder. Complications include placental abruption, coagulopathy, renal failure, uteroplacental insufficiency and eclampsia.
How does eclampsia typically cause maternal death?
Stroke, intracranial hemorrhage or ARDS
A woman presents at 20 weeks gestation with a blood pressure of 140/90. Labs show proteinuria > 300mg/24 hours, elevated AST/ALT, thrombocytopenia and unconjugated hyperbilirubinemia. She complains of headache, scotoma and oliguria. How do you treat her?
Hemolysis, Elevated liver enzymes and Low Platelets = HELLP syndrome. Treatment is immediate delivery of the fetus.
An expecting mother presents with sudden onset, painful bleeding in her third trimester. She starts to go into shock and fetal distress is apparent. History reveals recent car accident, smoking, hypertension, preeclampsia and cocaine use. What is the most likely cause of her condition?
All the things in her history are risk factors for placental abruption.
A mother presents with life-threatening bleeding after delivery of the baby. The placenta cannot be delivered. What is causing her condition? What are risk factors for this?
Prior C-section, inflammation and placenta previa are risk factors for placenta accreta (placenta attached to myometrium), increta (placenta penetrates into myometrium) and percreta (placenta penetrates through myometrium into uterine serosa).
Attachment of the placenta to the lower uterine segment by the cervical os
A 23 year old woman presents with amenorrhea for 7 weeks, a minimally elevate beta-hCG and sudden lower abdominal pain. Ultrasound reveals ectopic pregnancy. What are risk factors for this condition?
Hx of infertility, PID, ruptured appendix and prior tubal surgery.
Result of > 1.5-2 L of amniotic fluid? Causes of such a thing?
Polyhydramnios can be caused by esophageal/duodenal atresia, anencephaly, maternal diabetes, fetal anemia and multiple gestations.
Result of < 0.5 L of amniotic fluid?
Oligohydramnios can be caused by placental insufficiency, bilateral renal agenesis or posterior urethral valves in males. This results in Potter sequence.
Histology of a woman’s cervix who has had multiple sex partners at an early age, smokes and has HIV.
These are all risk factors for dysplasia and carcinoma in situ from HPV 16, 18, 31 and 33. Note the kilobytes with their raisinoid nuclei and perinuclear halo.
Histology of a woman’s uterus who had retained products of conception after a miscarriage. How do you treat her?
Note abundance of plasma cells and lymphocytes. Retained material in uterus promotes infection by vaginal and intestinal normal flora, which causes endometritis. Treat with gentamicin + clindamycin with or w/o ampicillin.
Histology of a woman’s ovary who has cyclic pelvic pain, irregular bleeding, dysmenorrhea, dyspareunia, dyschezia, infertility and a normal-sized uterus. How do you treat her?
Endometriosis presents with ectopic (picture below is in abdominal wall muscle) endometrial glands and stroma. Treat with NSAIDs, OCPs, progestins, GnRH agonists and surgery.
What causes the corpus luteum to regress after 14 days?
It can’t sustain itself with low levels of gonadotropins w/o implantation and release of beta-hCG.
Function of hCG
Stimulates fetal testes testosterone production. Fetal immunologic protection. Maintenance of placental structure and function.
Function of placental lactogen
Stimulate breast proliferation and increase maternal insulin insensitivity.
A 20-year-old women presents at a local clinic with fever and abdominal tenderness. She is at day 2 of her menstrual cycle and reports having had unprotected sexual intercourse a few weeks earlier. Gram-negative diplococci are seen in a Gram stain of vaginal secretions, many of the bacteria inside polymorphonuclear leukocytes. Which of the following is the most important virulence factor necessary for this organism to initiate infection? A) invasive genes B) pili C) capsule D) endotoxin E) hyaluronidase
Hematogenous (blood-borne) spread of T. pallidum from a chancre throughout the body is characteristic of which stage of the disease syphilis? A) Primary B) Secondary C) Tertiary D) Quaternary
To confirm the diagnosis of syphilis in a newborn baby, one needs to find: A) IgG antibodies against Treponema pallidum in the baby B) a positive culture of T. pallidum on blood agar C) IgM antibodies against T. pallidum in the baby D) rhinitis, rash and leukocytosis E) evidence of child abuse
Which of the following is consistent with syphilis acquired congenitally? A) Mother is VDRL positive B) Mother is RPR positive C) Baby shows peeling of skin associated with a rash on the palms and sides D) Spirochetes are visible in the placenta and umbilical cord tissues when they are stained by silver or visualized using dark field E) All of the above (A-D)
An 18-year-old woman awoke to find her left knee was hot, swollen, and very painful. A friend offered her a ride to the clinic. While she was completing her paperwork, she realized that her right hand was becoming very stiff, and she had difficulty gripping the pen. The history taken of the woman by a medical student revealed she had 3 male sexual partners during the last month. She never had a swollen joint before, but often experienced a slight burning sensation upon urination. Physical examination revealed a tender knee joint, which yielded purulent synovial fluid on aspiration. The fluid had 80,000leukocytes/mm3. She was found to have a cervical discharge that, on Gram staining, revealed small intracellular Gram-negative diplococci. Blood culture and synovial fluid were negative for the presence of bacteria, but the discharge grew out small, translucent colonies on both Chocolate Agar and Thayer Martin Agar. The Blood Agar plate streaked with the discharge showed no growth. What is the most likely organism causing this infection? A) Neisseria meningitidis B) Chlamydia trachomatis C) Treponema pallidum D) Neisseria gonorrhoeae E) Staphylococcus aureus
A female patient presents with swollen inguinal lymph nodes and painful lesions on the genitalia and perianal region. Of the agents below, which of the organisms below is the most likely causative agent for this infection? A) Group B streptococci B) Neisseria gonorrhoeae C) Haemophilus ducreyi D) Moraxella catarrhalis E) Haemophilus aegypticus
Which one of the following tests is NOT used for the diagnosis of syphilis? A) VDRL B) Culture C) FTA-ABS D) Dark field microscopy E) Direct fluorescent antibody staining
A 25-year-old female reports having vulvo-vaginal irritation and a thick white discharge. There is no pronounced odor associated with the exudate. The patient indicates she has not engaged in sexual activity for three months, but states that she has recently been treated with antibiotics to treat persistent acne. A smear of vaginal secretions is likely to reveal A) Budding yeast cells B) Clue cells C) Flagellated protozoan parasites D) Gram-negative diplococci E) Thin spirochetal rods
Which of the following statements about serologic tests for syphilis is true? A) The rapid plasma reagin (RPR) test is a specific anti-treponemal antibody test B) Following successful antibiotic therapy, the rapid plasma reagin (RPR) serum titer should fall C) The rapid plasma reagin (RPR) serum test is positive in 99% of cases of primary syphilis D) The MHA-TP (microhemagglutination) test measures IgG and IgM antibodies directed against a lipoidal antigen produced by interaction of Treponema pallidum with host tissues
An endocervical swab taken from a patient suspected to be infected with Chlamydia trachomatis is processed by the microbiology laboratory. Which one of the following test results is consistent with infection by Chlamydia trachomatis? A) Gram negative diplococci B) Growth on cysteine tellurite agar C) Inclusion formation within tissue culture cells D) Luxuriant growth on chocolate agar E) Positive Schick test
Which one of the following can infect the joints via hematogenous spread from the upper reproductive tract? A) Chlamydia trachomatis, serovars D-K B) Chlamydia trachomatis, serovars L1, L2, L2a and L3 C) Haemophilus ducreyi D) Mycoplasma genitalium E) Neisseria gonorrhoeae
In a 25-year old patient, a vaginal discharge in which epithelial cells with numerous adherent bacteria predominate is characteristic of A) bacterial vaginosis B) normal flora C) physiologic leukorrhea D) trichomoniasis E) vaginal yeast infection
A 17-year-old female reports to clinic with lower abdominal pain and dysuria. A urinalysis shows white blood cells but no bacteria. An endocervical smear shows no growth on Thayer Martin agar, but a fluorescent antibody smear is positive for an agent that produces bacterial inclusions in the endocervix. You treat the patient with doxycycline in an effort to prevent: A) Bacterial Vaginosis B) Blindness C) Chancroid D) Disseminated gonorrheal infection E) Infertility
A 26-year-old male presents with a urethral discharge. The exudate is screened with a highly sensitive DNA probe test for Chlamydia trachomatis and Neisseria gonorrhoeae. Both of these assays are negative. The most likely agent associated with this patient’s purulent discharge is A) Candida albicans B) Gardnerella vaginalis C) Mycoplasma genitalium D) Neisseria gonorrhoeae E) Treponema pallidum
A 30-year-old homosexual male presents at clinic with a single non-tender penile ulcer that has a discrete margin. A diagnosis of the causative agent can be made directly from this lesion with which of the following tests? A) antigen assay for p24 B) Culture for small gram negative coccobacilli C) Darkfield microscopy D) Fluorescent antibody stain for intracellular bacteria E) Gram stain
A newborn infant is evaluated because of the concern that the child has microcephaly, hepatospenomegaly, and purpuric skin lesions. It is likely that he has developed a congenital infection associated with A) Cytomegalovirus B) Escherichia coli C) Herpes Simplex virus type 2 D) Group B Streptococcus E) Rubella virus
A young mother who had no prenatal care brings her three-day-old infant that was born at home to the emergency room because he has a purulent ocular exudate. A Gram stain of the exudate shows numerous PMNs but no bacteria. The likely cause of this infection is: A) Chlamydia trachomatis B) Human Immunodeficiency Virus C) Neisseria gonorrhoeae D) Rubella virus E) Treponema pallidum
A 26-year-old bisexual male is seen in the outpatient clinic complaining of 1 week history of fever, swollen lymph nodes, and headache. This follows sexual relations with a new male partner 3 weeks ago. He also has a red inflamed pharynx and a splotchy rash all over his body. Concerned that this is a primary HIV infection, the most sensitive diagnostic tool at this stage is: A) Detection of anti-HIV IgM B) Detection of anti-HIV IgG C) Reduced CD4+ cell count D) Detection of Viral mRNA by RT PCR
A 6-year-old boy is seen in Ear Nose and Throat clinic because of increasing hoarseness in the absence of any upper respiratory infection symptoms. Laryngeal exam reveals a neoplastic polyp that is surgically excised. The majority of such growths in children result from A) Primary HSV1 oral infection B) HSV 2 infection acquired during birth from infection in the genital tract C) Human papilloma virus infection acquired at birth D) Rubella infection acquired in utero
A polyvalent vaccine against HPV can protect against the majority of cervical cancers and genital warts. The vaccine is composed of: A) Attenuated papilloma virus types 16, 18, 6, and 11 B) Heat-killed papilloma virus raised in tissue culture C) HPV E6 and E7 proteins D) Pseudovirus particles composed only of capsid proteins
A woman presents with dysmenorrhea and menorrhagia. She has a uniformly enlarged, soft and globular uterus. Biopsy shows extension of endometrial glands into the myometrium. What is causing her condition?
Adenomyosis is a result of hyperplasia of the basalis layer of the endometrium.
Risk factors for endometrial hyperplasia
Anovulatory cycles, hormone replacement therapy, PCOS and granulosa cell tumors. All of these increase endometrial stimulation by estrogen.
Risk factors for endometrial carcinoma
Estrogen supplementation, obesity, diabetes, hypertension, nulliparity and late menopause.
Most common gynecologic malignancy
Endometrial carcinoma. Ovarian is the next most common and then cervical cancer. Note that cervical cancer is most common worldwide.
Most common female tumor? Peak incidence?
Leiomyoma. Peak incidence is 20-40 years old because they are estrogen sensitive.
A 30 year old woman presents to the fertility clinic complaining of amenorrhea, hirsutism, acne and infertility. Physical exam reveals obesity and ovarian ultrasound is shown below. How do you treat this woman?
She has PCOS (Stein-Leventhal syndrome), the most common cause of infertility in women. This condition is a result of excess LH secretion by the anterior pituitary and androgen synthesis by theca cells. Estrogen levels increase via aromatization and inhibit folliculogenesis. Other androgen is converted to testosterone and causes hirsutism. The first step in treating her is weight reduction. OCP estrogen will increase SHBG, decrease LH and decrease testosterone to treat hirsutism. Metformin will increase insulin sensitivity, decrease insulin levels, decrease testosterone and enable LH surge. Cyclic progestin will antagonize endometrial proliferation and protect against endometrial carcinoma. Finally, you could give Clomid for fertility.
Most common ovarian mass in young women
Follicular cysts. These are unruptured Graafian follicles.
Common ovarian cyst that regresses spontaneously
Bilateral ovarian cysts associated with choriocarcinoma and molar pregnancy
Theca-lutein cysts, these often arise as a result of gonadotropin stimulation (hCG in the case of choriocarcinoma and moles)
Ovarian cyst due to rupture blood vessel in cyst call
Ovarian cyst filled with various types of tissue such as fat, hair, teeth, thyroid and cartilage. What age does this typically present in?
Dermoid cyst (mature cystic teratoma). 20-30 year old women.
Ovarian cyst that happens as a result of endometriosis
Chocolate cyst (endometrioid cyst)
Most common ovarian mass in women > 55 years old
Most common ovarian neoplasm’s histological characteristics
Serous cystadenoma. This is a thin-walled, multilocular cystic mass.
Histology of a mucinous cystadenoma
Multiloculated, large, mucus-secreting epithelium.
“Coffee bean” nuclei on H&E stain
Brenner tumor, made up of transitional epithelium
A patient presents with an ovarian fibroma, ascites and a hydrothorax. She also notes a pulling sensation in her groin. What is your diagnosis?
Ovarian neoplasm that can present with abnormal uterine bleeding in post menopausal women?
Granulosa theca cell tumors can produce estrogen and cause endometrial proliferation.
Malignant ovarian teratoma histological characteristics
Embryonic-like neural tissue
Granulosa cell tumor. These resemble primordial follicles.
Which cystadenocarcinoma typically occurs bilaterally and has Psammoma bodies? Which can cause pseudomyxoma peritonei?
Serous occurs bilaterally and has Psammoma bodies. Mucinous can cause jelly belly.
Histological appearance of the most common ovarian neoplasm in adolescents. Tumor markers?
Dysgerminoma: uniform “fried egg cells”. hCG and LDH are elevated.
Histology of the most common germ cell tumor in male infants. Tumor marker?
Yolk sac: Schiller-Duval bodies. AFP is elevated.
Ovarian signet cell adenocarcinoma
Kruckenberg tumor, usually from diffuse gastric adenocarcinoma metastasis.
Drug that can cause vaginal clear cell adenocarcinoma
DES exposure in utero
Typical vaginal tumor seen in girls < 4 years old. Tumor marker?
Sarcoma botryoides (rhabdomyosarcoma). These cells are spindle-shaped and desmin positive.
A woman < 35 years old presents with a small, mobile, firm mass that increased in size during her last pregnancy. Histology shows sharp edges and antler-like glands. What is the most likely lesion?
A woman presents with bloody nipple discharge. What is your differential diagnosis?
A woman > 60 years old presents with a large, bulky mass in her breast. Histology shows leaf-like projections. What is the most likely diagnosis?
Single most important prognostic factor for malignant breast tumors
Axillary lymph node metastasis
Risk factors for malignant breast tumors
Increased estrogen exposure (nulliparity, early menarche, late menopause, obesity), BRCA1/2 and African American ethnicity.
A woman presents with micro calcifications on mammography. Breast biopsy is shown below. What is your diagnosis?
DCIS: comedo type. Note central necrosis surrounded by tumor cells.
A woman presents with micro calcifications on mammography. Breast biopsy is shown below. What is your diagnosis?
DCIS: note neoplastic cells confined to the duct.
Histology of the worst, most invasive and most common type of breast cancer
Invasive ductal carcinoma. Fibrosis, sharp margins, small, glandular, duct-like cells.
What are the histological types of the most common cause of breast lumps age 25 to menopause?
Fibrocystic change types: Fibrotic: stromal hyperplasia, Cystic: fluid-filled, “blue dome”, Sclerosing adenosis: increased acini and intralobular fibrosis, Epithelial hyperplasia: increased epithelial cell layer in TDLU.
Most common pathogen in acute mastitis? How do you treat?
S. aureus. Treat with dicloxacillin and breast-feeding.
Etiologies of gynecomastia
Cirrhosis, testicular tumors, puberty, old age, Klinefelter, spironolactone, THC, digitalis, estrogen, cimetidine, alcohol, heroin, D2 antagonists, ketoconazole.
Drugs used to treat hirsutism in women with PCOS?
Ketoconazole and spironolactone. They both inhibit stood synthesis and decrease androgen levels.
Gram + cocci that are catalase negative, beta hemolytic, CAMP +, and bacitracin resistant
Intracellular gram + rods that are beta hemolytic and CAMP +
Non-encapsulated, gram-negative diplococci that do not ferment maltose
Gram negative rods that are fast lactose fermenters
Only spirochete that can be visualized with Wright or Giemsa stain instead of dark-field microscopy
Borrelia. Treponema and leptospira require dark field microscopy.
Primary syphilis lesion. Serologic tests?
Painles chancre. Serologic tests: VDRL/RPR are non-specific, FTA-ABS is specific.
Secondary syphilis lesion
Maculopapular rash and condyloma lata.
Tertiary syphilis lesions
Gumma (chronic granulomas), aortitis, neurosyphilis and Argyll Robertson pupil
Gram-variable rods, beta-hemolytic, metronidazole sensitive, covering vaginal epithelial cells. How do you treat
Gardnerella vaginalis is treated with metronidazole or clindamycin.
Ceftriaxone (for gonorrhea) and azithromycin (to cover chlamydia)
Small, painless ulcers on the genitalia that later present and painful inguinal lymph nodes that ulcerate
Chlamydia trachomatis L1-L3 = lymphogranuloma venereum.
Treatment if you see trophozoites on wet mount