PATH

Question 1

This term describes the gross appearance of chorionic villi

Answer 1

cotyledons

Question 2

How does maternal blood enter the intervillous space?

Answer 2

via the spiral arteries of the uterus

Question 3

How does deoxygenated fetal blood enter the placenta?

Answer 3

via 2 umbilical arteries

Question 4

Radial branching of the umbilical arteries form _______

Answer 4

chorionic arteries

Question 5

What should you start thinking if you clamp the cord and there is only one umbilical artery?

Answer 5

other anomalies i.e. RENAL and HEART

Question 6

What should you start thinking if you clamp the cord and there is only one umbilical vein?

Answer 6

Nice

Question 7

Are there any ramifications to a cotyledon staying in the uterus after delivery?

Answer 7

yes they may lead to clotting and or hemorrhage

Question 8

How are first trimester chorionic villi different than third trimester chorionic villi (microscopically)

Answer 8

first trimester ones are edematous in the center with trophoblastic proliferation on the margins? A third trimester villus will have thinner trophoblast and the center will contain more vessels!

Question 9

What do syncytial knots tell you about the state of a 2nd trimester placenta? 1st trimester placenta?

Answer 9

These are normal in 2nd trimester as it is starting to mature but if in 1st trimester it is not good

Question 10

Why would you see intervillous fibrin deposition in a 3rd trimester slice of placenta?

Answer 10

because blood fills the intervillous spaces thus, this is a normal finding

Question 11

If you are looking at a slice of placenta and note an inflammatory infiltrate what is the likely Dx?

Answer 11

chorionitis (chorioamnionitis)

Question 12

This is the correct term for inflammation of Wharton’s Jelly?

Answer 12

Funisitis

Question 13

Define spontaneous abortion

Answer 13

pregnancy loss before 20 weeks of gestation

Question 14

What is the most likely fetal cause of spontaenous abortion (general)

Answer 14

chromosomal anomalies

Question 15

What is a major maternal factor for spontaneous pregnancy loss?

Answer 15

UNCONTROLLED DIABETES, but there are many others

Question 16

If you suspect a systemic disorder affecting maternal vasculature as the cause for a spontaneous abortion, what Ab should you test for?

Answer 16

anti-phospholipid antibodies, APA is assoc with SLE

Question 17

This is the most common site of ectopic pregnancy

Answer 17

fallopian tubes (90%)

Question 18

What is the most important predisposing factor to ectopic pregnancy?

Answer 18

Pelvic inflammatory Dz (C. trachomatis > N. gonorrhea)

Question 19

What is the most common cause of a hematosalpinx?

Answer 19

Tubal pregnancy

Question 20

If a woman is having problems late in pregnancy why are you no longer thinking of ectopic pregnancy (tubal)?

Answer 20

She would have had complications much earlier on from that, so a disorder late in pregnancy is not going to be in the fallopian tubes

Question 21

What is a major problem that ascending chorioamnionitis may cause?

Answer 21

PROM and delivery

Question 22

A calculation of fetal hyperactivity is directly proportional to the number of these

Answer 22

twists in the umbilical cord

Question 23

A retroplacental hemorrhage is aka _________ _____________

Answer 23

abruptio placentae

Question 24

What are the 3 types of twin placentas? Given that what combination is not possible?

Answer 24

diamnionicdichorionic, diamnionicmonochorionic, monoamnionicmonochorionic——-not possible to have 2 chorions and 1 amnion, which makes sense, really.

Question 25

What is implied by a monochorionic placenta in twins?

Answer 25

identical twinning

Question 26

What is implied by dichorionic placentation?

Answer 26

identical or fraternal twinning

Question 27

What is a possible complication (for the twins) of monochorionic placentation?

Answer 27

twin-twin transfusion syndrome, this is when one twin steals more of the blood supply and grows bigger than the other twin, this may even kill the other twin

Question 28

What is fetus papyrus?

Answer 28

a result of twin-twin transfusion syndrome where the dead twin regresses into the placenta

Question 29

If the placenta is delivered and contains some of the uterine wall, what did disorder of placentation probably occurred?

Answer 29

placenta accreta because it invaded the myometrium

Question 30

if the first thing to come out in deliver is the placenta, what disorder of placentation probably occurred?

Answer 30

placenta previa

Question 31

In placenta previa, the blastocyst implants over the \_\_\_\_\_\_\_\_\_\_

Answer 31

cervical os

Question 32

This disorder of placentation is a surgical emergency

Answer 32

abruptio placentae

Question 33

Differentiate among the following: placenta accreta, placenta increta, placenta percreta

Answer 33

accreta goes into superficial myometrium, increta is deep into it and PERcreta is all the way out through the myometrium into the PERimetrium

Question 34

These are the 2 pathways by which infection of fetus or extraembryonic membranes may occur

Answer 34

ascending or hematogenous/transplacental

Question 35

What is the most common pathway of infection, what type of organism?

Answer 35

ascending via birth canal; bacterial

Question 36

Describe what you would see on an amniocentesis sample if there was a bacterial chorioamnionitis?

Answer 36

it would be cloudy, just like a CSF sample from bacterial meningitis

Question 37

Describe how you would differentiate whether an infection of the chorionic villi was from a typical bacterial infection via the ascending route or a TORCH infection from the hematogenous route.

Answer 37

Ascending infections are usually bacterial which cause acute inflammation so you would see congestion, edema and PMN's. TORCH infections are hematogenous and elicit a chronic response so you would expect lymphocytes

Question 38

The triad of pre-eclampsia

Answer 38

edema, HTN, proteinuria

Question 39

Pre-ecclampsia is from widespread dysfunction of \_\_\_\_\_\_\_\_

Answer 39

endothelium

Question 40

Who is pre-ecclampsia the most common in?

Answer 40

primipara's

Question 41

What should the father think if he has 3 kids and the mom is always pre-ecclamptic?

Answer 41

she's got some 'splainin to do

Question 42

How is ecclampsia different from pre-ecclampsia?

Answer 42

They have seizures now

Question 43

Why are there areas of coagulative necrosis of the placenta in pre-ecclampsia?

Answer 43

because placental infarcts ( = coagulative necrosis) are common

Question 44

Given that there is an increase for risk of retroplacental hematomas in pre-ecclampsia one can deduce that there is likely an increased risk for this

Answer 44

abruptio placentae

Question 45

Pre-ecclampsia may show this type of necrosis in decidual vessels

Answer 45

fibrinoid

Question 46

Pre-ecclamptics may have deposition of this in their kidneys

Answer 46

FIBRIN

Question 47

Hydatidiforms are associated with these 2 persistent trophoblastic diseases

Answer 47

invasive mole, choriocarcinoma

Question 48

What is the bimodal age distribution for risk of hydatidiform moles?

Answer 48

at the tails of reproductive life i.e. teens and near-menopause

Question 49

Differentiate the karyotypes of complete moles and partial moles

Answer 49

A complete mole will have 46 XX, a partial mole is TRIPLOID and is 69 XXY

Question 50

T/F: complete moles are maternally derived

Answer 50

false, the karyotype arises from fertilization of an EMPTY OVUM with either a haploid sperm that duplicates (90%) or 2 sperm (dispermy, 10%)

Question 51

What are the 3 possibilities for how a partial mole is formed?

Answer 51

2 sperm fertilize an ovum (NOT an empty ovum), a diploid ovum fertilized by 1 sperm, a diploid sperm fertilizes an ovum

Question 52

T/F: a partial mole has an increased risk of choriocarcinoma

Answer 52

false

Question 53

T/F: a mole that has a coast of Norway appearance on H/E has an increased risk of choriocarcinoma

Answer 53

True, coast of Norway describes the appearance of a complete mole which is associated with increased risk of choriocarcinoma

Question 54

T/F: a partial mole has an increased risk of persistent molar disease

Answer 54

true but not choriocarcinoma

Question 55

Which type of mole can be described as having a grape-like appearance?

Answer 55

a complete mole, much more so than a partial mole

Question 56

THROWBACK: if a young girl came in with vaginal bleeding and you saw grape-like lesions in her vagina what would you diagnose her with?

Answer 56

Botryoides type rhabdomyosarcoma; botryo = "bunch of grapes"

Question 57

What term describes a mole that penetrates or even perforates the uterine wall?

Answer 57

invasive mole

Question 58

What are the malignant cells in a choriocarcinoma?

Answer 58

trophoblastic cells

Question 59

T/F: a woman who has never been pregnant can develop choriocarcinoma

Answer 59

FALSE

Question 60

Where do choriocarcinomas "love" to metastasize? Prognosis?

Answer 60

LUNGS (and brain) good prognosis with chemo

Question 61

Do choriocarcinomas produce chorionic villi?

Answer 61

nope

Question 62

What kind of trophoblastic tumor produces chorionic villi?

Answer 62

Placental site trophoblastic tumor

Question 63

Are placental site trophoblastic tumors benign or malignant?

Answer 63

malignant