Repro Path Flashcards
1
Q
Male Testicular atrophy Eunechoid body shape Gynecomastia Female Hair distribution
A
Klinefelter’s Syndrome
2
Q
Klinefelter’s Syndrome Genotype
A
XXY
Barr body present
3
Q
Hormonal effect of dysgenesis of seminiferous tubules in Klinefelter’s
A
Decreased inhibin –> decreased FSH
4
Q
Hormonal effect of abnormal Leydig Cells in Klinefelter’s
A
increased LH –> increased Estrogen
5
Q
Most common cause of 1º amenorrhea
A
Turner Syndrome
6
Q
Turner Syndrome genotype
A
XO
No Barr Body
7
Q
Short stature Ovarian dysgenesis shield chest defects in lymphatics --> webbed neck Lymphedema in hands and feet
A
Turner Syndrome
XO
8
Q
Congenital defects associated with Turner Syndrome
A
Preductal Coarctation of Aorta
Horseshoe Kidney
Dysgerminoma
9
Q
Hormone levels seen in Turner syndrome
A
Decreased Estrogen –> increased LH/FSH
10
Q
Defective androgen receptor hormone levels
A
Increased T & LH
11
Q
Testosterone secreting tumor or exogenous steroids hormone levels
A
increased T
Decreased LH
12
Q
1º Hypogonadism hormone levels
A
Decreased T
Increased LH
13
Q
Hypogonadotropic hypogonadism hormone levels
A
Decreased T and LH
14
Q
Disagreement between phenotypic (external genitalia) and gonadal (testes/ovaries) sex
A
Pseudo-Hermaphoroditism
15
Q
Female Pseudo-Hermaphoroditism (46 XX)
A
Ovaries but virulized/ambiguous genitalia
Exposure to androgens in utero
16
Q
Male Pseudo-Hermaphoroditism (46 XY)
A
Testes present but female/ambiguous genitalia
Androgen insensitivity–most common cause
17
Q
True Hermaphoroditism (46 XX or 47 XXY)
A
Both ovary and Testes
ambiguous genitailia
Rare
18
Q
Increased E, T, and LH
Defect in Androgen Receptor
Genotypically male but Phenotypically female
Rudimentary vagina and no internal sex organs
Testes present in Labia
A
Androgen Insensitivity Syndrome
46 XY
19
Q
Why do testicles need to be removed from labia in androgen insensitivity syndrome?
A
Prevent Malignancy
20
Q
Male with ambiguous genitalia until puberty
Inability to convert T –> DHT
Autosomal Recessive
A
5alpha-reductase deficiency
21
Q
Anosmia
Decreased Synthesis of GnRH
Decreased FSH, LH, T, and sperm count
A
Kallmann Syndrome
22
Q
What causes Kallmann syndrome
A
failure of migration of GnRH cell and formation of olfactory bulb
23
Q
Female presents with uterine bleeding, increased hCG, honeycomb uterus, and no fetus.
A
Hydatidiform Mole
24
Q
Hydatidiform Mole is most common precursor of
A
Choriocarcinoma
25
Complete Hydatidiform Mole
```
VERY HIGH hCG
46 XX or XY
Increased Uterine size
Choriocarcinoma risk
2 sperm in empty egg
```
26
Partial Hydatiform Mole
```
69 XXX, XXY, XYY
increased hCG (not as much as complete)
normal uterus size
2 sperm 1 egg
Composed of fetal parts
RARELY becomes choriocarcinoma
```
27
Triad of preeclampsia
Edema
HTN
Proteinuria
28
Eclampsia
edema
HTN
Proteinuria
SEIZURES
29
HELLP Syndrome
Hemolysis
Elevated LV enzymes
Low Plts.
30
COD of pre-eclampsia
cerebral hemorrhage
| ARDS
31
What causes pre-eclampsia?
placental ischemia due to compressed spiral aa. --> increased vascular tone
32
Tx for pre-eclmapsia
Delivery ASAP
33
Seizure Tx/prophylaxis during pregnancy (eclampsia)
Mg Sulfate
Watch for hyporeflexia
34
Painful bleeding in 3rd trimester
smoking, coke head mom
Hx of HTN
Abruptio placentae
detachment of placenta
35
Placenta accreta
Defective decidual layer allows placenta to attach to myometrium
Massive bleeding AFTER delivery
36
Increased risk of placenta accreta
prior C-section
inflammation
placenta previa
37
PAINLESS bleeding anytime during pregnancy
Placenta attached in lower part of Uterus
Near or over Os
Placenta previa
38
Retained placental tissue problems
post partum hemorrhage
| infxn
39
Female presents with amenorrhea, RLQ pain, elevated hCG.
Endometrial Bx shows decidual endometrium but no chorionic villi
Ectopic pregnancy
40
Test of choice to Dx ectopic preg
ultrasound
41
Most common site for ectopic preg
fallopian tubes
42
Virus and genes associated with cervical CA
HPV 16--E6 inh. p53
HPV 18--E7 inh RB suppressor gene
43
complcation of invasive cervical CA
renal failure due to blocked ureters
44
Invasive cervical CA is usually what type of cell?
Squamous Cell CA
45
Inflammation of endometrium due to retained products of conception or foreign body (IUD)
Endometritis
46
Endometritis Tx
Gentamyxin + clindamycin
w/ or w/o ampicillin
47
```
Cyclic pelvic pain with menses--severe
cyclic bleeding
painful intercourse
infertility
Endometial tissue outside of uterus
```
Endometriosis
| Non-neoplastic
48
Endometrium within myometrium
Adenomyosis
49
Endometrial CA precurser
Endometrial Hyperplasia
50
What causes endometrial hyperplasia?
excess estrogen stimulation
51
Most common gyn malignancy
Endometrial CA
52
Endometrial CA presentation
most menopausal bleeding
53
Most common tumor in females
Leiomyoma (fibroids)
54
```
Benign smooth mm. tumor
Whorled pattern
Age 20-40
Located in myometrium
Black woman with anemia/vag bleeding
```
Leiomyoma (fibroids)
55
Bulky irregularly shaped tumor with areas of necrosis and hemorrhage in the uterus
black middle aged female
Leiomyosarcoma
56
Leiomyosarcoma arise from
de novo!!!!
Not from leiomyoma
57
Most common GYN tumor locations
endometrial > ovarian > cervical (US)
Cervical worldwide
58
GYN tumor locations with worst prognosis
Ovarian > cervical > endometrial
59
Menopause before 40
Low E,
High LH, FSH
atresia of ovarian follicles
Premature ovarian failure
60
```
Amenorrhea
infertility (anovulation)
obesity
hirsutism
Bilaterally enlarged ovaries
NO PROGESTERONE
High LH
```
Polycystic Ovarian Syndrome
61
why is there anovulation with Polycystic Ovarian Syndrome?
Increased LH --> anovulation --> NO PROGESTERONE
62
Why is there an increased risk of endometrial CA with Polycystic Ovarian Syndrome?
Incresaed E due to aromatization of T in FAT CELLS with NO PROGESTERONE opposition
63
Polycystic Ovarian Syndrome Tx
```
Weight loss
OCP
Spironolactone
clomiphene (pregnancy desire)
metformin
```
64
Distention of unruptured graafian follicle
Follicular cyst
65
Hemorrhage into persistent corpus luteum
Corpus luteum cyst
66
Bilater and multiple cysts
Gonadotropin stimulated
associated with chorio-CA and moles
Theca-Lutein cyst
67
Blood vessel rupture in cyst wall
| Grows with blood retention
Hemorrhagic Cyst
68
Mature Teratoma
| fat, hair, teeth, cartilage, bone
Dermoid Cyst
69
Endometriosis within ovary and cyst formation
blood accumulate--dark brown color
Endometrioid cyst
| Chocolate Cyst
70
Malignant tumor in females
Sheets of uniform cells
Turner Syndrome
hCG and LDH markers
Dysgerminoma
71
Tumor that presents with hyperthyroidsim due to functional thyroid tissue in ovary
Struma ovarii
72
Most common ovarian germ cell tumor
| benign
Mature teratoma
2-3 germ layers
73
Aggressively malignant ovarian germ cell tumor
Immature tertoma
74
Schiller Duvall bodies
yellow, friable, solid mass on ovary (testes)
Elevated AFP
Yolk Sac tumor
| endodermal sinus tumor
75
Increased hCG
Malignant ovarian tumor of Trophoblastic tissue
No chorionic villi
Occurs during/after preg in mom or baby
Choriocarcinoma
76
increased frequency of choriocarcinoma with
theca-lutein cysts
77
How does choriocarcinoma spread?
Hematogenously to lungs
78
These 2 tumors account for 90% of ovarian tumors
```
Serous Cystadenoma (45%)
Serous Cystadenocarcinoma (45%)
```
79
Bilateral benign ovarian tumor lined with fallopian tube-like epithelium
Serous Cystadenoma
80
malignant bilateral ovarian tumor
| Psammoma bodies
Serous cystadenocarcinoma
81
Serous cystadenoma tumor marker for prognosis
CA-125
not for screening
82
Serous cystadenocarcinoma
BRCA-1
BRCA-2
HNPCC
83
Multilocular cyst line by mucus secreting epithelium
benign intestine like tissue on ovary
Mucinous Cystadenoma
84
Malignant mucus secreting ovarian tumor
causes pseudomyxoma peritonei
Mucinous cystadenocarcinoma
85
pseudomyxoma peritonei
intrapericoneal accumulatoin (acites) of thick mucinous material from ovarian or appendiceal tumors
mucinous adenocarcinoma
86
```
Ovarian tumor that is bladder like tissue
bilateral or unilateral
solid pale yellow tan color
encapsulated
Coffe bean nuclei
```
Brenner Tumor
B's
Bean, bilateral, bladder
87
Bundles of spindle shaped fibroblasts
Ovarian tumor
causes Meig's Syndrome
Fibromas
88
Meig's Syndrome
ovarian fibroma
ascites
hydrothorax
caused by fibromas
89
Call-Exner Bodies
Secretes E --> presents with precocious puberty
Abnormal uterine bleeding
Ovarian tumor
Causes endometrial hyperplasia or CA in adults
Granulosa cell Tumor
90
GI Mets to ovaries (bilateral)
Mucin secreting signet cell adenocarcinoma
Krukenberg Tumor
91
Girls < 4
Spindle shaped tumor cells that are desmin +
Vaginal tumor
Sarcoma botryoides
(rhabdomyosarcoma variant)
looks like grapes coming out of vagina
92
Tumor associated with DES exposure in utero
Clear cell adenocarcinoma of the vagina
93
squamous cell CA of the vagina usually comes from
cervical SCC
94
Small mobile firm mass in breast--benign
Sharp edges
< 35 yrs
increase size and tenderness with E
Fibroadenoma
95
Small benign tumor in lactiferous ducts
usually bellow the areola
Serous/Bloody discharge
Intraductal papilloma
slight inc. risk of CA
96
Large bulky mass of CT and cysts in breast
Leaf like projections
6th decade
may become malignant
Phyllodes tumor
97
Single most important prognostic risk factor for malignant breast cancer
axillary lymph node involvement
98
Over expression of what 2 receptors is common in breast cancer?
Estrogen/Progesterone receptors
c-erbB2 (HER-2, EGF)
99
Risk factors of malignant breast cancer
```
Estrogen exposure
increased total # menstrual cycles
older age of 1st live birth
obestiy
BRCA 1 and 2
```
100
Breast tumor due to ductal hyperplasia that fills duct lumen
early malignancy w/o basement membrane penetration
Ductal CA in situ (DCIS)
101
Ductal and caseous necrosis
Subtype of DCIS
breast tumor
Comedocarcinoma
102
Most common of all breast cancers
Stellate morphology
Firm fibrous rock hard mass with sharp margins and small glandular duct-like cell
Invasice Ductal
103
Invasive breast cancer
Orderly row of cells
Bilateral with multiple lesions
Invasive lobular
104
Invasive breast cancer
Fleshy, cellular, lymphocytic infiltrate
Good prognosis
Medullary
105
Invasive breast cancer
Dermal lymphatic invasion by breast CA
blocked lymph drainage --> Peau d'orange
Inflammatory
106
Eczematous patches on nipple
large cells in epidermis with clear halo
suggestive of underlying DCIS
Paget's disease of the nipple
107
Types of fibrocystic disease
Fibrosis
Cystic
Sclerosing Adenosis
Epithelial Hyperplasia
108
fibrocystic disease with hyperplasia of breast stroma
fibrosis
109
fibrocystic disease with increased # of epithelial cell layers in terminal duct lobule
inc. risk of CA
Epithelial Hyperplasia
110
fibrocystic disease with increased acinin and intralobular fibrosis
calcifications
Sclerosing adenosis
111
fibrocystic disease with fluid filled blue dome
ductal dilation
cystic
112
Breast abscess due to infection from cracked nipple during breast feeding
Acute Mastitis
113
Most common bug for acute mastitis
S. aureus
114
Post breast injury
benign
painless lumps
Fat necrosis
may not report trauma (sports)
115
Rx's associated with Gynecomastia
```
Spironolactone
Digitalis
Cimetidine
Alcohol
Ketoconazole
```
Some drugs cause awkward knockers
116
Lobes in BPH
Lateral and middle
| periurethral
117
BPH Tx
Alpha-1 antagonists (terazosin, tamsulosin)
Finasteride
118
BPH marker
PSA
119
Lower back pain
| Incresaed Alk. Phos and PSA
Osteoblastic mets in bone from prostatic adenocarcinoma
120
Markers for Prostatic adenocarcinoma
PSA (inc. total, dec. free)
| Prostatic Acid Phosphatase (PAP)
121
Lobe most common for prostatic adenocarcinoma
posterior lobe
| peripheral zone
122
Varicocele Tx
Varicocelectomy
| Empolization by interventional radiologist
123
95% of all testicular tumors
Germ Cell Tumors
124
Malignant, painless, homogenous testicular enlargment
Radiosensitive
15-35
Large cells in lobules with watery cytosol
FRIED EGG APPEARANCE
Seminoma
125
Seminoma Labs
increased placental alkaline phosphatatse (PLAP)
126
Yellow mucinous tumor of testicle
Increased AFP
SCHILLER DUVALL BODIES
Yolk Sac tumor
| endodermal sinus
127
```
Malignant testicle tumor
inc. AFP
Disordered Syncytiotrophoblastci and cytotrophoblastic elements
Gynecomastia
Hematogentous spread
```
Choriocarcinoma
128
How are mature teratomas different in men than women?
they are malignant
129
Malignant, painful testicular mass
glandular/papillary morphology
Usually with another tumor type
Incresaed hCG and NORMAL AFP (pure)
Embryonal CA
AFP can be elevated if mixed (more common)
130
```
Reinke Crystals
Androgen producing
Gynecomastia in men
Precocious puberty in boys
Golden brown color
```
Leydig Cell
131
Androblastoma from sex cord stroma
Sertolli cell
132
Old men
Lymphoma mets to testes
Agressive
Testicular lymphoma
133
Hydrocele
increased fluid due ot incomplete fusion of processusu vaginalis
Illuminates
134
Spermatocele
Dilated epididymal duct
135
2 tunica vaginalis lesions
hydrocele
| spermatocele
136
Squamous cell CA of penis
HPV and lack circumcision assoc.
137
Bent penis due to aqcuired fibrosis
Peyronie's Disease
138
Painful sustained erections not due to sex
priapism
139
causes of priapism
```
Sickle cell
boner Rx
cocaine
alpha blockers
trauma
Rx
```
