Life Cycles Path Flashcards
1
Q
What is the premalignant lesion for Cervical Squamous Cell Carcinoma?
A
Cervical Intraepithelial Neoplasia (CIN)
2
Q
Female - vulvar skin is pale gray and parchment-like
A
Lichen Sclerosus/Chronic Atrophic Vulvulitis
3
Q
What is the premalignant lesion for Vulular Carcinoma?
A
Vulvular Intraepithelial Neoplasia (VIN)
4
Q
What is the premalignant lesion for Squamous Cell Carcinoma of the Vagina?
A
Vaginal Intraepithelial Neoplasia (VAIN)
5
Q
Location of Squamous Cell Carcinoma of the Vagina?
A
Upper posterior vagina
6
Q
Location of Clear Cell Adenocarcinoma of the Vagina?
A
Upper anterior vagina
7
Q
What is the premalignant lesion for Clear Cell Adenocarcinoma of the Vagina?
A
Atypical vaginal adenosis
8
Q
Amenorrhea definition
A
Absence of bleeding for at least 3 cycles
9
Q
Oligomenorrhea definition
A
Bleeding that occurs at an interval of >35 days
10
Q
Polymenorrhea definition
A
Bleeding that occurs at an interval of
11
Q
Menorrhagia definition
A
Excessive, prolonged, heavy bleeding
12
Q
Metorrhagia definition
A
Bleeding at irregular intervals
13
Q
Menometorrhagia definition
A
Heavy bleeding at irregular intervals
14
Q
Dysmenorrhea
A
Painful menstruation with abdominal cramps
15
Q
Difference between ectopic endometrium and eutopic endometrium?
A
Ectopic has aromatase P450 enzyme.
Eutopic does not have that enzyme.
16
Q
What is the premalignant lesion for Endometrial Adenocarcinoma?
A
Endometrial Intraepithlial Neoplasm (EIN)/ Complex endometrial hyperplasia with atypia
17
Q
Adenocarcinoma of the Fallopian Tube mutation?
A
p53 mutation -> dysplaisa
18
Q
Invasive Ductal Carcinoma mets locally and distant
A
local = axillary LN distant = lung, brain
19
Q
Invasive Lobular Carcinoma mets locally and distant
A
local = axillary LN distant = bone, GI, uterus, ovary, serosa
20
Q
Origin of ovarian epithelial tumors?
A
Fallopian tube fimbrae
21
Q
Endodermal sinus/Yolk sac tumors (female and male) stain for?
A
Alpha-fetoprotein positive (AFP +)
22
Q
Which ovarian tumors are hormonally active?
A
Sex cord stromal tumors
23
Q
Area of the prostate involved in BPH?
A
transitional zone, periurethral
24
Q
Area of the prostate involved in prostatic neoplasms?
A
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
