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Flashcards in Life Cycles Path Deck (128):
1

What is the premalignant lesion for Cervical Squamous Cell Carcinoma?

Cervical Intraepithelial Neoplasia (CIN)

2

Female - vulvar skin is pale gray and parchment-like

Lichen Sclerosus/Chronic Atrophic Vulvulitis

3

What is the premalignant lesion for Vulular Carcinoma?

Vulvular Intraepithelial Neoplasia (VIN)

4

What is the premalignant lesion for Squamous Cell Carcinoma of the Vagina?

Vaginal Intraepithelial Neoplasia (VAIN)

5

Location of Squamous Cell Carcinoma of the Vagina?

Upper posterior vagina

6

Location of Clear Cell Adenocarcinoma of the Vagina?

Upper anterior vagina

7

What is the premalignant lesion for Clear Cell Adenocarcinoma of the Vagina?

Atypical vaginal adenosis

8

Amenorrhea definition

Absence of bleeding for at least 3 cycles

9

Oligomenorrhea definition

Bleeding that occurs at an interval of >35 days

10

Polymenorrhea definition

Bleeding that occurs at an interval of

11

Menorrhagia definition

Excessive, prolonged, heavy bleeding

12

Metorrhagia definition

Bleeding at irregular intervals

13

Menometorrhagia definition

Heavy bleeding at irregular intervals

14

Dysmenorrhea

Painful menstruation with abdominal cramps

15

Difference between ectopic endometrium and eutopic endometrium?

Ectopic has aromatase P450 enzyme.
Eutopic does not have that enzyme.

16

What is the premalignant lesion for Endometrial Adenocarcinoma?

Endometrial Intraepithlial Neoplasm (EIN)/ Complex endometrial hyperplasia with atypia

17

Adenocarcinoma of the Fallopian Tube mutation?

p53 mutation -> dysplaisa

18

Invasive Ductal Carcinoma mets locally and distant

local = axillary LN
distant = lung, brain

19

Invasive Lobular Carcinoma mets locally and distant

local = axillary LN
distant = bone, GI, uterus, ovary, serosa

20

Origin of ovarian epithelial tumors?

Fallopian tube fimbrae

21

Endodermal sinus/Yolk sac tumors (female and male) stain for?

Alpha-fetoprotein positive (AFP +)

22

Which ovarian tumors are hormonally active?

Sex cord stromal tumors

23

Area of the prostate involved in BPH?

transitional zone, periurethral

24

Area of the prostate involved in prostatic neoplasms?

peripheral zone

25

What is the premalignant lesion for Prostate Adenocarcinoma?

Prostatic Intraepithelial Neoplasia (PIN) - still has outer basal cell layer

26

Prostate Adenocarcinoma mets - local and distant

local = early - obturator; late - para-aortic
distant = bone, brain, lungs

27

Bell Clapper Deformity?

cause of testicular torsion in adolescents. lack of posterior attachment of the scrotum and testicle due to tunica vaginalis wrapping all the way around the testicle.

28

Male germ cell tumor mutation

Isochromosome of Chr 12 - loss of long arm with duplication of the short arm

29

Characteristics of Seminomatous type germ cell tumors in males (5)

-older patients
-low tumor marker expression
-late mets
-met via lymphatics
-radiosensitive

30

Characteristics of Non-seminomatous type germ cell tumors in males (5)

-younger patients
-elevated tumor marker expression
-early met
-met via hematogenous and lymphatics
-radioresistant

31

Schiller-Duval bodies are found in what male tumor?

Yolk Sac Tumor

32

Reinke Crystals are found in what male tumor?

Leydig cell tumor

33

What is the premalignant lesion for Squamous Cell Carcinoma of the Penis?

Bowen Disease caused by HPV 16

34

Thick, leathery vulvar skin?

Lichen simplex chronicus

35

What 3 conditions present as leukoplakia in females?

-Lichen Sclerosis
-Lichen Simplex Chronicus
-Vulvar Carcinoma

36

Paget's disease stains? PAS, Keratin, S100

PAS+
Keratin+
S100-

37

Melanoma stains? PAS, Keratin, S100

PAS-
Keratin-
S100+

38

Vaginal CA from the lower 1/3 of the vagina locally mets to?

Superficial Inguinal LN

39

Vaginal CA from the upper 2/3 of the vagina locally mets to?

Illiac nodes

40

High risk HPV produces what proteins (2) and what are their functions?

E6 -> inhibits p53 (Normally, p53 regulates G1->S transition and monitors for DNA mutations/damage. Without p53, DNA mutations are allowed to continue through the cell cycle.)

E7->inhibits Rb (Normally, Rb holds onto E2F which regulates when cells move into G2. Without Rb, E2F just allows everything to go into G2 whether it is normal DNA or damaged DNA.)

41

Desmin is what?

Intermediate filament for muscle cells

42

Myogenin is what?

Nuclear transcription factor in immature skeletal muscle

Seen in sarcoma botryoides (rhabdosarcoma variant)
-girls under 4 yo
-spindle shaped cells
-clear, grape-like polypoid mass emerging from vagina

43

Proliferation phase is driven by? What is happening during this phase?

Estrogen.

Growth of the endometrium (functionalis layer)

44

Secretory phase is driven by? What is happening during this phase?

Progesterone.

Preparation of the endometrium for implantation (secretion of products from the functionalis layer glands)

45

Menstrual phase is driven by? What is happening during this phase?

Decline of progesterone.

Shedding of the functionalis layer of the endometrium

46

What 3 conditions show up as calcifications on mammography?

-Ductal Carcinoma In Situ
-Fibrocystic change - Sclerosing Adenosis
-Fat Necrosis

47

BRCA1 mutation predisposes to (2)

-Female IDC - Medullary CA type
-Serous CA of the ovary or fallopian tube

48

BRCA2 mutation predisposes to (1)

-Male IDC

49

Mutation found in LCIS and ILC?

Inhibition of E-cadherin

50

Retraction of the nipple is found in what 2 conditions?

-Invasive ductal carcinoma
-Periductal mastitis

51

2 types of choriocarcinoma and their treatments?

-Gestational Choriocarcinoma - complication of a complete mole, chemotherapy is effective

-Germ Cell Choriocarcinoma of the Ovary - malignant tumor of trophoblast cells, no villi, chemotherapy is NOT effective

52

Leukoplakia in males?

Bowen Disease

53

How does elevated beta-hCG cause hyperthyroidism and gynecomastia in males?

The alpha subunit of LH, FSH, TSH and beta-hCG is all the same

54

CA-125 =

ovarian tumor marker

55

Positive beta-hCG in a male (3) =

-embryonal carcinoma germ cell tumor
-teratoma germ cell tumor
-choriocarcinoma germ cell tumor

56

What type of leiomyoma is worst?

Submucosal leiomyoma -> menometrorrhagia

57

Choriocarcinoma CAN/CANNOT follow a normal pregnancy?

CAN!

58

Most important risk factor for ectopic pregnancy?

History of PID

59

CAH - XX with no secondary sexual characteristics

17-alpha hydroxylase deficiency

60

CAH - XY with salt wasting and increased 17-hydroxyprogesterone

21 hydroxylase deficiency

61

CAH - XX with virilization and increased 17-hydroxyprogesterone

21 hydroxylase deficiency

62

CAH - XX with virilization and hypertension

11-beta hydroxylase deficiency

63

increased beta-hCG in males = (3)

-Embryonal testicular CA (Germ cell tumor)
-Choriocarcinoma (Germ cell tumor)
-Teratoma (Germ cell tumor)

64

How is Leuprolide administered for infertility vs prostate cancer?

Infertility = Pulsatile
Prostate cancer = Continuous

65

GnRH is released from where?

Pre-optic nucleus in the hypothalamus

66

Cri-du-chat syndrome mutation?

Terminal deletion of the short arm of chromosome 5

67

Holoprosencephaly, small head, absent eyebrows, cleft lip or palate, dysplastic ears, polydactyly, decreased viability

Trisomy 13 (Patau syndrome)

68

Low birth weight, small mouth/jaw, shield chest, prominent occiput, dysplastic ears, clenched hand with overlapping fingers, life expectancy 1 week

Trisomy 18 (Edward's Syndrome)

69

What is a robersonian translocation and what chromosomes can be affected?

Rearrangement in acrosomic chromosomes (13, 14, 15, 21, 22). Results in a centric fusion of the two long arms and the loss of the short arms. Balanced = 45 chromosomes; Unbalanced = 46 chromosomes.

70

female phenotype, short stature, broad chest, streak gonads, aortic constriction, bicuspid aortic valve =

Turner Syndrome (45, XO)

71

Male phenotype, tall stature, gynecomastia, small testis =

Kleinfelter Syndrome (47, XXY)

72

What is noticed first in female pubertal development?

Breast development

73

What is noticed first in male pubertal development?

Testicular enlargement

74

Central precocious puberty is caused by?

Premature reactivation of the HA axis. Increased secretion of GnRH results in increased sex steroids.

75

Peripheral precocious puberty is caused by?

Non-GnRH stimulated sex steroid secretion.

76

Fallopian tube epithelium = ? What are the names and functions of those cells?

Simple columnar epithelium.
Ciliated cells - beat towards the uterus
Peg cells - secrete nutrients, carbohydrates, enzymes for capacitation of sperm

77

Basal body temperature drops right before _

Menstruation

78

Blood supply to ovary travels in?

Suspensory ligament of the ovary (ovarian artery and vein)

79

Blood supply to the uterus (5)

Uterine artery -> arcuate artery (perimetrium) -> radial artery (myometrium) -> straight artery (stratum basalis - endometrium) -> spiral artery (stratum functionalis - endometrium)

80

Location of the cervical squamocolumnar junction 1) pre-puberty 2) post-pubrty/post-partum

1) inside the cervical os
2) outside the cervical os

81

Path of sperm (starting from seminiferous ducts ->-> exit)

Seminiferous tubules -> Straight tubles -> Rete testes -> Efferent tubules -> Epididymis -> Ductus Deferens -> Prostatic urethra -> Membranous urethra -> Spongy urethra -> exit

82

What are in seminal vesicle secretions? (3)

-fructose
-prostaglandins
-proteins

83

Which placental cells are in direct contact with maternal blood?

Synctiotrophoblasts

84

Which placental cells invade maternal spiral arteries?

Cytotrophoblasts

85

Monozygotic twins -
1) split at 0-4 days
2) split at 4-8 days
3) split at 8-12 days

1) 2 chorions, 2 amnions
2) 1 chorion, 2 amnions
3) 1 chorion, 1 amnion

86

How do fraternal/dizygotic twins occur?

Two eggs are ovulated in the same cycle and are fertilized by two different sperms.

87

Painless bleeding the 2nd-3rd trimester?

Placenta previa

88

Painful bleeding the 2nd-3rd trimester? (2)

-Placental abruption
-Uterine rupture

89

PCOS hormones

increase in GnRH, LH
increase in LH -> increase in androgens -> hair + acne
low FSH
increased LH -> increased E

hyperinsulinemia/insulin resistance

90

Preeclapmsia vs Eclampsia?

Preeclampsia = HTN post 20 weeks gestation + proteinuria + edema

Eclampsia = preeclampsia + seizures

91

epithelium of the epididymis? what are the cell types (2)?

pseudostratified columnar epithelium

principle cells
basal cells

92

When does the baby begin producing its own IgM?

In utero

93

Female labia majora = Male _

Scrotum

94

Male ventral shaft of penis + penile urethra = Female _

Labia minora

95

Primary oocytes are arrested in _ I/II?

Prophase I

Remain here until ovulation

96

Secondary oocyes are arrested in _ I/II?

Metaphase II

Remain here until fertilization

97

Bloody nipple discharge with no associated breast changes?

Intraductal papilloma
-Benign
-Proliferation of papillary cells in a duct/cyst with a fibrovascular core

98

What hormone ensures that lactation does not occur during pregnancy even though prolactin levels are rising?

Progesterone

99

Female (46 XX) newborn with ambiguous genitalia and clitoromegaly with elevated levels of androstenedione. Mother had virilization during pregnancy.

Aromatase deficiency (AR)
-Increased T, Decreased E
-Normal female internal genitalia
-Virilized external genitalia
-As she grows up, due to the lack of estrogen: primary amenorrhea, osteoporosis, tall stature
-Maternal virilization is due to the androgens crossing the placenta and affecting the mother

Similar presentation to 21 hydroxylase deficiency except for the lack of estrogen symptoms as she grows up and the lack of maternal virilization

100

Genetics of a partial mole

69XXX, 69 XXY, 69 XYY

Normal egg + sperm + sperm

Will see some fetal tissue

101

Genetics of a complete mole

Most common: 46 XX - empty egg + X sperm that duplicates
Less common: 46 XY - empty egg + X sperm + Y sperm

No fetal tissue will be present

102

Most common pathogen found in septic abortions?

Staph aureus
Also might be found: E coli, Group B Strep
Septic abortion = retained products of conception in uterine cavity

103

Pulmonary artery branches with swirls of fetal squamous cells seen on autopsy

Amniotic fluid embolism

Often this is fatal

104

What cells in female ovaries secrete androgens?

Theca interna cells
-Stimulated by LH

105

What cells in female ovaries secrete estrogen?

Granulosa cells (contain aromatase)
-Stimulated by FSH

106

Perineal straddle injury in men injures the _ urethra. Urine leaks into the _.

Anterior urethra - bulbar and penile

Deep fascia of Buck or Superficial perineal space

107

Pelvic fracture in men injures the _ urethra. Urine leaks into the _.

Posterior urethra - prostatic + membranous

Retropubic space

108

ovarian mass that looks like the bladder and has coffee bean nuclei on H&E

Brenner tumor

109

mass of spindle shaped cells in the ovary. creates a "pulling" sensation.

Fibroma

110

Ovarian fibroma + Ascites + Hydrothorax

Meigs syndrome

111

adolescent with an ovarian mass. sheets of uniform fried-egg looking cells on LM. increased LDH and beta-hCG.

Dysgerminoma

112

What male testicular tumor is radiosensitive?

Seminoma
-painless
-never seen in infancy
-fried egg appearance of cells
-increased ALP

113

Proliferation of ducts in hyalinized fibrous tissue with periductal edema

Gynecomastia

114

Ovarian tumor: Call exner bodies + positive inhibin stain

Granulosa cell tumor
-Secretes estrogen

115

Cells found in chronic endometritis?

Plasma cells are diagnostic

116

Superficial inguinal ring is made out of

External oblique

117

Deep inguinal ring is made out of

Transversalis fascia

118

Malformation vs Deformation

Malformation = primary intrinsic defect that results in downstream effects

Deformation = structural anomalies that occur due to extrinsic forces

119

What 4 things does human placental lactogen do in the second half of pregnancy?

-Increases insulin resistance - increases blood glucose
-Increases proteolysis
-Increases lipolysis
-Increases insulin secretion

120

Painless scrotal mass + increased heat intolerance + elevated T4/T3 + normal TSH

Germ cell tumor - secretes beta-hCG

121

When do the syncytiotrophoblasts begin secreting beta-hCG?

Implantation and secretion begin around day 6-7 post-fertilization

@day 8 the levels can be detected in serum
@day 14 the levels can be detected in urine

122

CA-125 is a marker for?

Epithelial ovarian tumors

123

Uterine atony

-Failure of the uterus to contract adequately post-delivery
-Most common cause of postpartum hemorrhage
-If uterus does not respond to uterotonic agents, then do surgery to ligate the internal iliac a bilateral (-> uterine artery)

There is enough collateral supply to all things that internal iliac artery gives rise to

124

Uncomplicated delivery 9 weeks prior. Woman presents with shortness of breath. Uterus is enlarged and beta-hCG is elevated. Chest x-ray shows multiple lung nodules bilaterally.

Gestational choriocarcinoma
-Malignant proliferation of cytotrophoblasts and syncytiotrophoblasts
-Hematogenous spread to lungs - pulmonary symptoms are usually the presenting symptoms
-No villi present

125

Vitamin A supplementation during pregnancy - yes or no?

NO
-In well developed countries, mothers get enough vitamin A from diet
-Excess vitamin A is teratogenic

126

First line treatment for vomiting and nausea in pregnancy

Vitamin B6 supplementation

127

4 causes of hydrops fetalis

-Parvovirus B19
-CMV
-Syphilis
-Alpha-thalassemia - HbBarts (no viable alpha gene)

128

Heavy menstrual bleeding + anemia + enlarged uterus + pelvic heaviness + premenopausal woman

Leiomyoma