Midterm 2 Çıkmışları Flashcards

Question

A 24-year-old G1P0 female at 26-week gestation comes to the clinic for a routine antenatal care. Her vitals are normal and abdominal examination reveals uterine fundus nearby the xiphisternum. A transabdominal ultrasound reveals the presence of two fetuses with dual placentation and two amniotic sacs. Compared with a single fetus, her gestation has a reduced risk of which of the following condition? Abnormal placentation Gestational diabetes Maternal preeclampsia Post-term pregnancy

Answer 1

Post-term pregnancy Info: This patient has presented for a routine ante-natal follow up. Her physical examination reveals the presence of a uterus that is large for the date. Ultrasound confirms the presence of dichorionic diamniotic twins. Twin gestation is associated with an increased risk of many adverse pregnancy outcomes except post-term pregnancy. Multiple gestations lead to preterm labor rather than post-term pregnancy. The limited intrauterine space may cause fetal growth restriction and preterm labor. Roughly half of the multiple gestations are born before 37 weeks. The reasons include limited uterine expansion, abnormal placentation, and twin to twin transfusion syndrome. All pregnancy-related risks are increased in twin pregnancies except post-term pregnancy and fetal macrosomia. Increased placental mass increases the risk of maternal preeclampsia.

Answer 2

Carbamazepine Info: Spina bifida (a type of neural tube defect, NTD, that affects the spine and is usually apparent at birth) was the only major congenital abnormality that was confirmed to be related to carbamazepine use, with no increased risk of others such as cleft lip or diaphragmatic hernia. Carbamazepine is an anticonvulsant medication used in the treatment of epilepsy and neuropathic pain.

Answer 3

Intraductal papilloma Info: Solitary papillomas (solitary intraductal papillomas) are single tumors that often grow in the large milk ducts near the nipple. They are a common cause of clear or bloody nipple discharge, especially when it comes from only one breast. Also bloody discharge can be seen in breast carcinomas.

Answer 4

Preantral and early antral follicles Info: The described clinical condition is suggestive for PCOS, a disorder featuring excessive androjen, menstruel cycle abnormalities, and polycycstic ovaries. Polycycstic ovaries have increased numbers of preantral and early antral follicles. The follicles do not develop properly throught the antral stage and degenerate into cystic structures. Patients with PCOS also have an increased LH to FSH ratio with increased levels of androgens.

Answer 5

Sheets of malignant cells forming irregular tubules with infiltrative borders Correct Invasive Ductal Carcinoma Proliferation of stromal and epithelial (glandular) components, forming a well-circumscribed, rubbery mass Correct Fibroadenoma Proliferation of malignant ductal epithelial cells confined within the ductal structures, with an intact basement membrane Correct Ductal Carcinoma In Situ Uniform proliferation of malignant cells within the lobules, with loss of E-cadherin expression, with an intact basement membrane Correct Lobular Carcinoma In Situ Cysts lined by epithelial cells, accompanied by stromal fibrosis and varying degrees of inflammation Correct Fibrocystic disease Single-file infiltrative pattern of malignant cells, lacking cohesiveness Correct Invasive Lobular Carcinoma

Answer 6

According to the information above the pregnant patient has--> term pregnancy, and her labor phase is --> latent phase of first stage. Info: Early term: 37 0/7 weeks through 38 6/7 weeks Full term: 39 0/7 weeks through 40 6/7 weeks Late term: 41 0/7 weeks through 41 6/7 weeks Postterm: 42 0/7 weeks and beyond. The first stage of labor is further subdivides into two phases, defined by the degree of cervical dilation. The latent phase is commonly defined as the 0 to 6 cm, while the active phase commences from 6 cm to full cervical dilation.

Answer 7

A 33-year-old woman at 37 weeks’ gestation, presents with vaginal bleeding. She is noted on sonography to have an umbilical vessel is seen overlying the cervical internal os. Vasa Previa A transabdominal ultrasound examination of a 31-year-old female at 26 weeks’ gestation reveals the presence of two fetuses with dual placentation and two amniotic sacs. Dichorionic diamniotic twinnig A 25-year-old woman at 32 weeks’ gestation presents with painless vaginal bleeding. Leopold maneuvers shows that there is no presenting part. Placenta previa A 29-year-old woman has a scheduled cesarean at 37 weeks. Upon cesarean section, bluish tissue densely adherent between the uterus and maternal bladder is noted. Placenta percreat The blue tissue densely adherent between the uterus and bladder is ve characteristic of percreta, where the placenta penetrates entirely throug myometrium to the serosa and adheres to the bladder. In vasa previa, fetal blood vessels are present in the membranes cover internal cervical os. On ultrasound examination, vasa previa appears as sonolucent area that passes over the internal os. Color Doppler flow an analysis show umbilical artery or vein waveforms and confirms that the is a blood vessel.

Answer 8

Edema, Skin thickening, Peu d'orange skin changes, breast erythema, Info: Breast cancers clinically presenting with diffuse breast erythema, edema and skin thickening are named as inflammatory carcinoma. It is not a specific histologic or molecular type. Peau d’orange appearance can be seen and also it is a sign of very poor prognosis

Answer 9

Active phase of the first stage of the labor Station is not described

Answer 10

Estrogen ↓, Progesterone ↓, FSH ↑, LH ↑, Inhibin ↓ Info: Menopause occurs at approximately 51 years of age. Thus estradiol and progesterone levels are low. There is no negative feedback on GnRH, so LH and FSH are high. Because FSH is high, inhibin is low.

Answer 11

Endometrioma Acute endometritis is an uncommon disease and mostly limited to bacterial infections that arise after delivery, miscarriage or using an iud. The most common etiologic agents are group A hemolytic streptococci, staphylococci. In microscopy microabscesses consisted of neutrophils; infiltration and destruction of glandular epithelium is observed. Chronic endometritis is associated with chronic pelvic inflammatory disease (PID), retained gestational tissue, postpartum or post- abortion, IUD, tuberculosis or without a cause (non-specific endometritis). Clinical manifestations include abnormal bleeding, pain, discharge and infertility. In microscopy showed irregular proliferation of endometrial glands and plasma cells in the stroma are observed. Endometriosis is defined as ectopically located endometrial tissue (in rectovaginal septum, peritoneal surfaces, ovaries, etc.) consisting of both endometrial type glands and stroma. 6–10% of women of reproductive age is affected from endometriosis but the overall risk of an endometriosis-associated cancer is low (0.3–0.8%). Clear cell ovarian and endometrioid ovarian carcinomas may arise from endometriosis. The most common presenting symptom is cyclical pelvic pain, which occurs at time of menstruation. Also symptoms according to the locations can be observed like dysmenorrhea (Severe cramping or sharp, knifelike pelvic pain during menstruation), dyspareunia, dyscheiza, dysuria. 1/3 of the patients are asymptomatic. Endometriomas are endometriotic cyst of ovary which are also named as chocolate cyst. In microscopic evaluation presence of endometriotic glands (glandular lining of cyst wall) and stroma and hemosiderin-laden macrophages are seen. Adenomyosis is an endometrial tissue located within the myometrium. Symptoms similar to endometriosis including menorrhagia, metrorrhagia, menometrorrhagia, dysmenorrhea, chronic pelvic pain and dyspareunia. Endometrial Hyperplasias are important cause of abnormal bleeding (menorrhagia, metrorrhagia, menometrorrhagia). In microsopy increased proliferation of the endometrial glands relative to the stroma (increased gland-to-stroma ratio) is seen and this situation is associated with prolonged estrogenic stimulation of the endometrium. WHO classifies endometrial hyperplasias as Non-atypical endometrial hyperplasia (Benign EH) and Atypical hyperplasia /Endometrioid intraepithelial neoplasia (AH / EIN). AH / EIN is considered as a premalignant condition (risk of both progression to and simultaneous endometrial endometrioid adenocarcinoma)

Answer 12

Give reassurance and send home to come back if it happens again The most common cause of postmenopausal bleeding is atrophy of the vagina and/or endometrium. Transvaginal ultrasonography usually is sufficient for an initial evaluation of postmenopausal bleeding if the ultrasound images reveal a thin endometrial echo (less than or equal to 4 mm), given that an endometrial thickness of 4 mm or less has a greater than 99% negative predictive value for endometrial cancer.

Answer 13

Make the appropriate pairings between the contraceptive methods which given below and the main mechanisms of action. Levonogestrel releasing intrauterine device Correct making the endometrium atrophic Progestin only pills Correct thickening the mucus in the cervix Combined oral contraceptives Correct inhibition of ovulation Copper T intrauterine device Correct prevention of fertilization Vasectomy Correct blocking sperm travelling from testes

Answer 14

Incomplete abortion Info: Missed abortion: The missed death of the embryo or fetus without symptoms or expulsion of the products of conception (POC). Threatened pregnancy loss: Symptoms (eg, bleeding and cramping) of an impending early pregnancy loss; however, the cervical os remains closed, and the embryo or fetus still appears viable on ultrasound. Incomplete pregnancy loss: POC that remains within the uterus and the open cervical os after the diagnosis of an early pregnancy loss. Complete pregnancy loss: The passage of all POC.

Answer 15

Use of Tamoxifen Info: Although the peak age for endometrial cancer is 60 years, most clinicians agree that women who are 40 years of age or older are at increased risk. Contrary to its anti-estrogenic effect on breast tissue, tamoxifen has a stimulatory effect on the endometrium. As a result, patients taking tamoxifen are at an increased risk of developing endometrial cancer.Other risk factors include diabetes mellitus, irregular menstrual cycles, and the presence of atypical glandular cells (AGC) on a Pap smear. Use of oral contraceptive pills, cigarette smoking, and multiparity are considered protective factors.

Answer 16

Fetal nuchal translucency measurement, pregnancy-associated plasma protein A, human chorionic gonadotropin First-trimester screening is used to screen for trisomy (21, 18, and 13) which includes: *fetal nuchal translucency measurement *pregnancy-associated plasma protein A (PAPP-A) *free or total β-hCG

Answer 17

Previous PAP test result Menarche age Dyspareunia Info: Early stage cervical cancer is generally asymptomatic But if it is symptomatic or at the advanced stages; vaginal bleeding, vaginal discharge, dyspareunia, pelvic pain and weight loss can be seen. The known risk factors of developing cervical cancer are human papilloma virus (HPV), low socio-economic status, smoking, marrying before age 18 years, young age at the first coitus, multiple sexual partners, multiple childbirths, early menarche and late menopause.

Answer 18

Bartholin's gland cyst/abscess Info: Bartholin's gland cyst/abscess Bartholin's gland cyst or abscess presents with pain and swelling in the genital area, especially at the posterior aspect of the vaginal opening. It is characterized by the formation of a tender, fluctuant mass due to obstruction of the Bartholin's gland duct. Vaginal candidiasis can present with symptoms such as vaginal itching, burning, and discharge, it typically does not cause a palpable mass or localized swelling. Endometriosis can cause pelvic pain and discomfort, but it usually presents with symptoms related to menstruation and is not associated with a tender, fluctuant mass at the posterior aspect of the vaginal opening. Urethral diverticulum may cause symptoms such as dysuria, urinary frequency, and post-void dribbling, but it typically does not present as a tender mass in the genital area. Vulvar intraepithelial neoplasia (VIN) refers to precancerous changes in the skin of the vulva. While it may present with symptoms like itching or burning, it is not associated with a palpable mass or localized swelling.

Answer 19

Benign phyllodes tumor of the breast Info: Benign phyllodes tumors are rare fibroepithelial tumors of the breast, characterized by leaf-like projections lined by a double layer of epithelial and myoepithelial cells. They typically present as well-defined, firm masses and have low malignant potential. Microscopically, they show mild stromal cellularity, minimal nuclear atypia, and low mitotic activity. Malignant phyllodes tumors are aggressive fibroepithelial tumors with marked stromal cellularity, significant nuclear atypia, and increased mitotic activity. They have a higher risk of local recurrence and distant metastasis compared to benign phyllodes tumors. Fibroadenomas are benign breast tumors composed of both glandular (epithelial) and stromal (connective tissue) components. They typically present as well-defined, mobile, rubbery masses and are more common in younger women. Microscopically, fibroadenomas show epithelial and stromal proliferation without significant atypia. Invasive ductal carcinoma is the most common type of breast cancer, characterized by the infiltration of malignant cells through the ductal basement membrane into the surrounding stroma. It often presents as a firm, irregular mass with associated skin or nipple changes. Microscopically, invasive ductal carcinoma shows infiltrative growth patterns and nuclear atypia. Ductal carcinoma in situ (DCIS) is a non-invasive form of breast cancer where malignant cells are confined within the ductal system and have not invaded the surrounding tissue. It is typically detected on mammography as microcalcifications and presents as ductal proliferation without invasion on histopathology.

Answer 20

Presence of epithelial cells covered by adherent gram-negative rods on microscopy of a wet mount of a sample of vaginal discharge Correct Bacterial vaginosis Presence of motile flagellated protozoa on microscopy of a wet mount of a sample of vaginal discharge Correct Trichomonial vaginitis A thick, white vaginal discharge and vulvovaginal pruritus Correct Candidial vaginitis Purulent vaginal discharge and intermenstrual or postcoital vaginal bleeding Correct Chlamydial cervicitis Acidic vaginal pH Correct Candidial vaginitis Info: Typical symptoms reported include purulent or mucopurulent vaginal discharge and intermenstrual or post-coital bleeding Candidal vaginitis is vaginal infection with Candida species, usually C. albicans. Symptoms are usually a thick, white vaginal discharge and vulvovaginal pruritus that is often moderate to severe. Clue cells are epithelial cells covered by adherent gram-negative rods, observed in vaginal smears from women with bacterial vaginosis. Trichomoniasis is a common sexually transmitted infection caused by a parasite. In women, trichomoniasis can cause a foul-smelling vaginal discharge, genital itching and painful urination.

Answer 21

Serous adenocarcinoma Info: The weight loss in this patient would also point towards a malignant cause. The biopsy findings are characteristic of a serous adenocarcinoma. Psammoma bodies are collections of calcium. Brenner tumors contain Walthard cell rests that have a 'coffee bean' nuclei. Mucinous cystadenoma would be lined with mucous-secreting epithelium. Mucinous cystadenocarcinoma would contain irregular mucous-secreting epithelium. Serous cystadenoma would be lined with ciliated cells but it would not contain psammoma bodies.

Answer 22

Endometrial polyp

Answer 23

Seminal vesicle At least 65%-70% of ejaculate volume is derived from seminal vesicle eith the remainder from the sperm and prostatic secretions.

Answer 24

Periductal Mastitis Info: Periductal mastitis is an inflammatory condition of the breast characterized by chronic inflammation surrounding the mammary ducts. It typically presents with nipple discharge, breast pain, and erythema. Fibroadenomas are benign breast tumors characterized by well-defined, mobile masses with a rubbery consistency. They typically occur in younger women and are not associated with nipple discharge or inflammation. DCIS is a non-invasive breast cancer characterized by abnormal cells confined to the milk ducts. It may present with nipple discharge, but is usually asymptomatic or detected incidentally on mammography. LCIS is considered a marker of increased breast cancer risk and is classified as a premalignant lesion. It is typically asymptomatic and is often an incidental finding on breast biopsy. Invasive ductal carcinoma is the most common type of breast cancer, characterized by malignant cells that invade surrounding breast tissue. It may present with nipple discharge, but is usually associated with palpable breast masses.

Answer 25

All except pruritus and localized discoloration

Answer 26

Active phase of the first stage of the labor Station is not described

Answer 27

Estrogen ↓, Progesterone ↓, FSH ↑, LH ↑, Inhibin ↓

Answer 28

Endometrioma

Answer 29

The most common cause of postmenopausal bleeding is atrophy of the vagina and/or endometrium. Transvaginal ultrasonography usually is sufficient for an initial evaluation of postmenopausal bleeding if the ultrasound images reveal a thin endometrial echo (less than or equal to 4 mm), given that an endometrial thickness of 4 mm or less has a greater than 99% negative predictive value for endometrial cancer.

Answer 30

Levonogestrel releasing intrauterine device making the endometrium atrophic Progestin only pills thickening the mucus in the cervix Combined oral contraceptives inhibition of ovulation Copper T intrauterine device prevention of fertilization Vasectomy blocking sperm travelling from testes

Answer 31

Incomplete abortion Missed abortion: The missed death of the embryo or fetus without sym expulsion of the products of conception (POC). Threatened pregnancy loss: Symptoms (eg, bleeding and cramping) o impending early pregnancy loss; however, the cervical os remains clo embryo or fetus still appears viable on ultrasound. Incomplete pregnancy loss: POC that remains within the uterus and t cervical os after the diagnosis of an early pregnancy loss. Complete pregnancy loss: The passage of all POC.

Answer 32

Fetal nuchal translucency measurement, pregnancy-associated plasm human chorionic gonadotropin First-trimester screening is used to screen for trisomy (21, 18, an includes: *fetal nuchal translucency measurement *pregnancy-associated plasma protein A (PAPP-A) *free or total β-hCG

Answer 33

Use of tamoxifen Although the peak age for endometrial cancer is 60 years, most clinicians agree that women who are 40 years of age or older are at increased risk. Contrary to its anti-estrogenic effect on breast tissue, tamoxifen has a stimulatory effect on the endometrium. As a result, patients taking tamoxifen are at an increased risk of developing endometrial cancer.Other risk factors include diabetes mellitus, irregular menstrual cycles, and the presence of atypical glandular cells (AGC) on a Pap smear. Use of oral contraceptive pills, cigarette smoking, and multiparity are considered protective factors.

Answer 34

Previous PAP test result Menarche age Dyspareunia Info: Early stage cervical cancer is generally asymptomatic But if it is symptomatic or at the advanced stages; vaginal bleeding, vaginal discharge, dyspareunia, pelvic pain and weight loss can be seen. The known risk factors of developing cervical cancer are human papilloma virus (HPV), low socio-economic status, smoking, marrying before age 18 years, young age at the first coitus, multiple sexual partners, multiple childbirths, early menarche and late menopause.

Answer 35

Bartholin's gland cyst/abscess Info: Bartholin's gland cyst/abscess Bartholin's gland cyst or abscess prese and swelling in the genital area, especially at the posterior aspect of th opening. It is characterized by the formation of a tender, fluctuant mass obstruction of the Bartholin's gland duct. Vaginal candidiasis can present with symptoms such as vaginal itching discharge, it typically does not cause a palpable mass or localized swe Endometriosis can cause pelvic pain and discomfort, but it usually pres symptoms related to menstruation and is not associated with a tender, mass at the posterior aspect of the vaginal opening. Urethral diverticulum may cause symptoms such as dysuria, urinary fre post-void dribbling, but it typically does not present as a tender mass in area. Vulvar intraepithelial neoplasia (VIN) refers to precancerous changes i the vulva. While it may present with symptoms like itching or burning, i associated with a palpable mass or localized swelling.

Answer 36

Benign phyllodes tumor of the breast Info: Benign phyllodes tumors are rare fibroepithelial tumors of the breast, characterized by leaf-like projections lined by a double layer of epithelial and myoepithelial cells. They typically present as welldefined, firm masses and have low malignant potential. Microscopically, they show mild stromal cellularity, minimal nuclear atyp mitotic activity. Malignant phyllodes tumors are aggressive fibroepithelial tumors with m stromal cellularity, significant nuclear atypia, and increased mitotic activ a higher risk of local recurrence and distant metastasis compared to be phyllodes tumors. Fibroadenomas are benign breast tumors composed of both glandular and stromal (connective tissue) components. They typically present as mobile, rubbery masses and are more common in younger women. Mic fibroadenomas show epithelial and stromal proliferation without significa Invasive ductal carcinoma is the most common type of breast cancer, c by the infiltration of malignant cells through the ductal basement memb surrounding stroma. It often presents as a firm, irregular mass with asso or nipple changes. Microscopically, invasive ductal carcinoma shows in growth patterns and nuclear atypia. Ductal carcinoma in situ (DCIS) is a non-invasive form of breast cancer malignant cells are confined within the ductal system and have not inva surrounding tissue. It is typically detected on mammography as microca and presents as ductal proliferation without invasion on histopathology.

Answer 37

Presence of epithelial cells covered by adherent gram-negative rods o microscopy of a wet mount of a sample of vaginal discharge Bacte vaginosis Presence of motile flagellated protozoa on microscopy of a wet mount of vaginal discharge Trichomonial vaginitis A thick, white vaginal discharge and vulvovaginal pruritus Candidi Purulent vaginal discharge and intermenstrual or postcoital vaginal ble Chlamydial cervicitis Acidic vaginal pH Candidial vaginitis

Answer 38

Serous adenocarcinoma The weight loss in this patient would also point towards a malignant cause. The biopsy findings are characteristic of a serous adenocarcinoma. Psammoma bodies are collections of calcium. Brenner tumors contain Walthard cell rests that have a 'coffee bean' nuclei. Mucinous cystadenoma would be lined with mucous-secreting epithelium. Mucinous cystadenocarcinoma would contain irregular mucous-secreting epithelium. Serous cystadenoma would be lined with but it would not contain psammoma bodies.

Answer 39

Periductal Mastitis

Answer 40

Seminal vesicle

Answer 41

Endometrial polyp

Answer 42

Yolk sac tumour

Answer 43

Trauma to the chest The features that are described + trauma history indicates fat necrosis.

Answer 44

Ductal carcinoma in situ (DCIS) Feedback: Ductal carcinoma in situ (DCIS) is characterized by a proliferation of epithelial cells with significant cytological confined to the ducts. It is considered a non-invasive form of breast cancer and is typically detected through mammographic findings such as densities and calcifications. Epithelial hyperplasia (without atypia) involves the proliferation of epithelial cells without significant cytological is classified as proliferative breast disease without atypia. Sclerosing adenosis is a form of proliferative breast disease without atypia, involving the proliferation of acini a fibrosis. Complex sclerosing lesion is another form of proliferative breast disease without atypia that can mimic carcino its architectural complexity but lacks significant cytological atypia. Papilloma is a benign tumor that involves the proliferation of epithelial cells within the ducts and may present a nipple discharge but does not show significant cytological atypia confined to the ducts.

Answer 45

Core biopsy from the lesion

Answer 46

This type of tumor has a tendency of multicentricity. Feedback: The characteristic histologic feature of invasive lobular carcinoma is neoplastic discohesive cells organized in a (Indian file pattern), as defined in the case. Invasive lobular carcinoma also has a tendency for multicentricity, m and bilaterality. The cells of invasive lobular carcinoma do not show pleomorphism as seen in ductal carcinoma The cells of the tumor show pleomorphism: The cells of invasive lobular carcinoma do not typically show signifi pleomorphism. The arranged tumor cells form tubular structures: Tubular structures are characteristic of invasive ductal carcino lobular carcinoma. Breast erythema and edema are pathognomonic findings of this type of tumor: These are pathognomonic findin inflammatory carcinoma, not lobular carcinoma. This type of tumor is the most common histopathological type: Invasive ductal carcinoma is the most common histopathological type of breast cancer.

Answer 47

Paget’s disease of the nipple Feedback: Paget's disease of the nipple, also known as Paget's disease of the breast, is a rare condition associated with un breast cancer. It causes eczema-like changes, such as redness, scaling, itching, and ulceration, to the skin of th areola. These symptoms are typically resistant to topical treatments. The disease starts in the nipple and can ex areola. Given the patient's persistent symptoms and physical examination findings, Paget's disease of the nipple likely diagnosis.

Answer 48

Discharge from both breasts and Discharge triggered by breast examination, except these, all are to be rasiging concern

Answer 49

Squamous cell carcinoma Squamous cell carcinoma (SCC) is characterized by the presence of keratin pearls (KP), which are concentric layers of keratinized cells. These are a hallmark of well-differentiated squamous cell carcinoma and are easily recognized under a microscope. The presence of KP in the biopsy of an intravaginal lesion strongly indicates SCC. Leiomyomas are benign smooth muscle tumors and do not present with keratin pearls. Adenocarcinomas arise from glandular tissue and do not form keratin pearls. Vestibular adenitis is an inflammatory condition affecting the vestibular glands and does not involve keratin pearls. Bartholin gland cysts are fluid-filled and do not contain keratin pearls or indicate malignancy.

Answer 50

Endometrioid type endometrial carcinoma

Answer 51

Syphilis Syphilis is a disease in which the testis is involved first.Testicular involvement occurs in both acquired and con syphilis. Often orchitis is alone, not accompanied by epididymitis. Morphologically, gums may be present, as w interstitial inflammation characterized by lymphoplasmocytic inflammation and obliterative endarteritis. Local c fibrosis can be observed.

Answer 52

Solitary follicular cyst Info: Multiple follicle cysts in bilaterally enlarged ovaries characterized by anovulation or rare ovulation is observed in polycystic ovary sydrome. Typically the patient is young, anovulatory, infertile. The disease is presented with menstrual irregularities, hirsutism and obesity, hyperprolactinemia and late-onset congenital adrenal hyperplasia. Solitary follicular cysts are seen quite often enough to be considered physiological. The patients are in reproductive age and the cysts originate from uncracked Graff follicles. They are usually small, 1-1.5 cm in diameter and filled with clear serous fluid, rarely 5 cm or more. They produce palpable masses and pelvic pain. Hyperreaction luteinalis is presented as bilateral ovarian enlargement due to multiple luteinized follicle cysts in conditions that create high hCG levels. It creates pelvic mass and can ben manifested with multiple, bilateral, thin-walled, clear or hemorrhagic cysts that enlarge the ovary (35 cm). Stromal hyperthecosis is seen in 6th and 9th decades and presented with virilization. Stromal hyperplasia is seen in 6th and 7th decades and associated with endometrial carcinoma, obesity, hypertension, and glucose intolerance. Bilateral ovaries normal size or enlarged (7cm) with cut surface is solid, firm, homogeneous and yellow-white colored.

Answer 53

Trimorphic malignant trophoblasts Plasental site trophoblastic tumor (PSST) and epitheloid trophoblastic tumor (ETT) arise from intermediate troph generally serve to anchor the placenta into the uterus. The PSTT arises from intermediate trophoblasts at the vi surface, ETT arises from intermediate trophoblasts at the chorionic (fetal) surface. These patients often present metastases and the tumors are fairly resistant to chemotherapy, however both have excellent post-surgery outco Choriocarcinomas are the most common and most aggressive form gestational trophoblastic tumor. This malign trophoblastic tumor comprise a trimorphic proliferation of syncytiotrophoblast, cytotrophoblast and intermediate t The characteristic feature is the absence of chorionic villi. Choriocarcinomas are rapidly invasive with early hem metastasis and 50% are diagnosed following a term pregnancy (25% after a hydatidiform mole). Complete mole progress to choriocarcinoma in 2 - 3% and partial mole in < 0.5% of cases.

Answer 54

High grade serous carcinoma Endometrioid carcinoma, clear cell carcinoma, mucinous carcinoma and low grade serous carcinoma are type I epithelial ovarian cancers that are with more indolent clinical course and a relatively stable genomic profile and presented with slow-growing mass. High grade serous carcinoma, undifferentiated carcinoma and carcinosarcoma are associated with aggressive clinical course and mostly diagnoses advanced stage.

Answer 55

Seminoma Info: The probability of developing malignancy in such testicles is very high (30-50 times) compared to normal testicles in cryptorchism. The most common tumor in this case is seminoma. Descending the testis does not eliminate the risk of developing cancer, nor does it completely prevent infertility. Malignant transformation can also occur in the opposite normal testis.

Answer 56

Serous carcinoma Info: Endometrioid endometrial carcinomas are the most common histologic subtype of endometrial carcinoma (80% as prototype for the WHO (2014) classification of type 1 endometrial cancers. Tumor is associated with unopp estrogen stimulation and mostly low-grade (FIGO Grades 1 and 2) endometrioid carcinomas (usually good pro 1, low-grade endometrioid carcinomas are generally confined to the uterus when they are diagnosed.

Answer 57

All except radiotherapy, Upfront surgery and neoadjuvant chemotherapy

Answer 58

Seminal vesicle

Answer 59

Karyotype analysis - Turner syndrome Info: Short stature and a shield-shaped chest are suspicious findings of Turner syndrome (46,X0). And different mosaic forms of Turner syndrome can be seen. Therefore a karyotype test should be ordered. In androgen insenstivity syndrome, the patient has 46XY karyotype. There is an androgen receptor mutation which prevent testesterone binding and normal male ductal system and virilization. Kallmann syndrome is a neuronal migration defect with a mutation in Kal 1 gene on the short arm of X chromosome which is related with GnRH deficiency. It is not related with patient’s conditions. Mayer-Rokitansky- Kuster-Hauser syndrome is a complete müllerian agenesis and in which all of the müllerian structures failed to develop. There is only a vaginal dimple. They have 46XX karyotype and normal ovarian function.

Answer 60

Anovulation Info: Abnormal uterine bleeding is common among adolescent girls who have reached menarche. The first few years menstruation are often characterized by irregular cycles as a result of anovulation. Pregnancy and imperforate absence of menses, not irregular menses. While hyperthyroidism may lead to irregular cycles, it does not typica dysmenorrhea and is usually associated with other systemic complaints. Additionally, hyperthyroidism would be not out of the question, in a patient of this age. Endometriosis may cause dysmenorrhea but is unlikely to occur this young; most cases of endometriosis present in patients aged 20s to 30s.

Answer 61

Chlamydia trachomatis This patient most likely has pelvic inflammatory disease. The most common causative agents of PID are Neis gonorrhoeae and Chlamydia trachomatis. Chlamydia is culture and gram stain negative due to it being intracellular. Therefore, a negative culture or gram stain with signs of PID points towards the causal organism chlamydia. Many other organisms can cause PID, and they include Trichomonas, Mycoplasma genitalium, Gardnerella, H simplex virus, Enterococcus, and Peptococcus. Risk factors for PID include multiple sexual partners, history of sexual abuse, and a prior history of sexually tr infections (STIs). Inconsistent use of barrier protection is also a risk factor. The most likely organisms being Neisseria and Chlamydia, empiric antibiotic therapy, should thus be catered organisms.

Answer 62

Abortus incompletus Info: Threatened abortion: vaginal bleeding +closed cervical os +live fetus Inevitable abortion: vaginal bleeding+open cervical os +live fetus + no passage of products of conception Incomplete abortion: open cervical os+partial passage of products of conception Missed abortion: closed cervical os+dead fetus

Answer 63

Vulvar pruritus, vulvar erythema, a white, curd-like vaginal discharge, and acidic vaginal pH

Answer 64

History of motion sickness Multiple gestations Info: Risk factors of HEG (Hyperemesis gravidarum) includes younger mother, history of motion sickness, history of migraines, history of nausea and vomiting associated with OCP, with siblings or a mother with HEG, multiple gestations and molar pregnancy

Answer 65

Postpartum hemorrhage Sheehan's syndrome, also known as postpartum pituitary gland necrosis, occurs when the pituitary gland is damaged due to significant blood loss and hypovolemic shock (ischemic necrosis) usually during or after childbirth leading to decreased functioning of the pituitary gland (hypopituitarism).

Answer 66

Endometrial carcinoma Info: This patient’s presentation with irregular menses and obesity, together with findings concerning for hyperandrog (deepening of voice, receding hairline), is typical of polycystic ovarian syndrome (PCOS). Ultrasound should be confirm the diagnosis as per Rotterdam criteria. Such patients are at increased risk of developing endometrial c the long-term. PCOS is a result of dysfunction in the hypothalamic-pituitary-ovarian axis which causes high pulses of GnRH, r imbalance of LH/FSH release from the pituitary. The end result is a lack of LH surge, leading to failure of follicle and oocyte release. This causes unopposed estrogen exposure on the endometrium. Moreover, anovulation re decreased progesterone, allowing excessive endometrial build-up and thus increasing the risk of endometrial h and subsequent carcinoma. In addition, increased adiposity in PCOS also increases estrone, further raising the Polycystic ovarian syndrome causes a series of biochemical abnormalities that result in excess estrogen and d progesterone, thereby causing endometrial growth stimulation and increasing the risk of developing endometria in the long term. Other complications include nonalcoholic fatty liver disease, metabolic syndrome, coronary art mood disorders and sleep disorders.

Answer 67

Increased estrogen synthesis by the ovaries Increased luteinizing hormone Patients with polycystic ovarian syndrome (PCOS) have an increased androgen level and increased luteinizing hormone to follicular stimulating hormone ratio.

Answer 68

A decreased risk of preterm birth Info: FFN is a basement membrane protein produced by the fetal membranes. A negative test is useful in assessing the risk of preterm delivery during the following 2-week period. With a properly performed test in a symptomatic patient, up to 99.5% of patients with a negative FFN will not deliver in the subsequent 7 days. A positive test is not useful as the test has low positive predictive value. In performing FFN testing, the following criteria must be met: intact amniotic membranes, minimal cervical dilation (<3 cm), and sampling between 24 0/7 and 34 6/7 weeks. Recent sexual intercourse and the presence of vaginal discharge or bleeding may cause a false-positive test. Collect the swab in the posterior vaginal fornix before cervical checks and transvaginal ultrasound as these can also cause the test to be falsely positive. FFN does not assess fetal lung maturity. Ruptured membranes would cause a positive FFN.

Answer 69

Delayed transport of the zygote due to tubal scarring Probably the most common cause of ectopic gestation is scarring of the uterine tubes following infections - often gonococcal. The infection may also damage the ciliated cells and this can result in failure of the ovum to migrate. Some infections may also cause stricture formation and prevent the egg from reaching the uterus. Altered motility of the fallopian tube is also said to play a role in ectopic pregnancy.

Answer 70

Inhibition of 5α-reductase enzyme

Answer 71

Medroxyprogesterone

Answer 72

Pregnancy as a teenager

Answer 73

Nulliparity and heavy menses. Other risk factors: youngerage genetic early menarche shorter periods heavy menstrual bleeding nulliparity Trans fats and red meat consumption Low BMI

Answer 74

Combined oral contraceptives and copper containing intrauterine device

Answer 75

Breast and ovarian cancer The most common cancers that can occur after estrogen therapy include uterine, breast, ovarian cancer and liver adenomas.

Answer 76

Recommend preconceptional vaccination, after vaccine, delay conception for at least 1 month

Answer 77

Gestational hypertension *New onset hypertension ≥ 140/90 mm Hg on 2 occasions after 20th week of gestation *returns to normal by 12 weeks postpartum *proteinuria Ø

Answer 78

Latent phase of the first stage ınfo:

Answer 79

Smoking Maternal age : Risk factors for placenta previa: Advanced maternal age Multiparity Smoking Cocaine use Prior suction and curettage Assisted reproductive technology History of cesarean section Prior placenta previa

Answer 80

Respiratory rate: 45 breaths per minute, Heart rate: 150 beats per minute, Temperature: 36.5°C, Oxygen saturation: 97%