reproductive 2 Flashcards
(193 cards)
1
Q
unilateral cystic dilation lateral to vaginal canal lower vestibule in women of reproductive age
A
bartholin cyst (usually due to infection or obstruction)
2
Q
HPV 6 or 11
A
condyloma accuminata
3
Q
crinkled wrinkled nuclues, like a raisin
A
koilocytic change (HPV)
4
Q
high risk HPV
A
16 18 31 33
5
Q
lichen sclerosis
A
thinning of EPIdermis
fibrosis of DERMIS (parchment like vulvar skin)
leukoplakia with parchment like skin
MAY PROGRESS TO SQUAMOUS CELL
6
Q
thickening of skin leukoplkai LEATHER LIKE
A
hyperplasia of vulvar squamous epithelim
BENIGN
simplex = simple not malignant
7
Q
two ways vulvar carcinoma happens
A
HPV reltaed - Vulvar neoplasia (40-50yrs of age)
non hpv related - lngstanding lichen sclerosis (older than 70)
presents wiht leukokplakia
8
Q
erythematou, pruiritc, ulcerated skin vulva
A
extramammary paget disase (carc in situ)
9
Q
hallmark of extrmam paget disease
A
malignant epithelial cells
10
Q
how to differentiat ebetween melanoma and paget cells
A
paget cells - pas positiev, KERATIN POSITIVE (epithelial ) and S100 negative
melanoma - PAS neg, keratin neg, S100 positive
11
Q
histology of 3rs of vagina
A
proximal 1/3rd from mullerian duct (columnar epithelium)
distal 2/3rds - urogenital sinus…(squamous)
12
Q
DES exposure in utero
A
clear cell adenocarcinoma (glands with clear cytoplasm) in vagina
13
Q
grape like mas protruding from vagina/penis in child less than 5
A
rhabdomyosarcoma
psotive for cytopasmic cross striations, + desmin and myoglobin (muscle cells)
14
Q
vaginal carcinoma
A
suamousepitheliami
high risk HPV
15
Q
HPV E6 and e7 what do they do
A
E6 - desturction of p53 (g1-s phase)
E7 - increases destruction of Rb (retinoblastoma) holds e2f which is important in cell cycle
16
Q
risk factors HPV cervical cancer
A
smoking and immunodeficiency (potentially AIDS defining illness)
17
Q
patient with aggressive D and C evelops amenorrhea
A
asherman syndrome
loss of basalis layer (endometrium cannot regenerate for menses)
18
Q
retained products of conceptioin presents as fever, aormal bleeding, and peliv pain
A
acute endometritis
19
Q
histologic hallmark CHRONIC endometritis
A
plasma cells
20
Q
etiologies chronic endomet
A
PID, retaind coenception products, IUD use
21
Q
protruion into endometrium prsents with abnormal uterine bleeding
A
endometrial polyp
22
Q
what medication is assocaited with endometrial polyps
A
tamoxifen (antiesroginc in breast, but slightly proestrogenic in uterus)
23
Q
dysmenorrhea in conjunction with menstrual cycle and pelivc pain, infertility
A
endometriosis
gland AND stroma
24
Q
MCC site of endometirosis
A
ovary
25
presentation of endometriosis in ovary
chocolate cyst
| increasd risk of CARCINOMA
26
why can endometriosis cause infertility and ectopic pregnancy
if it occurs in fallopain tube!!!! it can cause scarring and increased risk ectopci pregnacy
27
endometriosis in uterine myometrium
adenomyosis
28
hypertrophy of endometrial glands relative to stroma
endomytrial hyperplasia
CONSEQUENCE OF UNOPPOSED ESTROGEN (not followed by progesterone phase)
29
most important factor for cancer is endometrial hyperplasia
presence or absence of cellular atypia
30
malignant proliferation of endometrial glands
endometrial carcinoma
presents with abnormal uterine bleeding
31
classic histology of hyperplastic endometrial carcinoma
"endometroid"
evident precursor legion from endometrial tissue
resembles uterine
32
endometrial carcinoma from ATROPHIC endometrium
comes from sporadic endometrial carcinoma
called SEROUS PAPILLARY (typically occurs in elderly)
aggresive
33
mutaiton that drives sporadic endometrial carcinoma
p53 mutations
34
psamoomma bodies found in...
serous endometrial carcinoma
papillary thyroid cancer
meningioma
mesothelioma
35
smooth muscle under myometrium
myometrium
36
benign proliferation of smooth muscle from myometrium (premenpausal women), multiple well defined white whorled masses
leiomyoma
37
multiple well defined white worled masses that are related to ESTROGEN EXPOSURE and shrink after menopause
leiomyoma (fibroids)
38
multiple leiomyoma vs single leiomoyoma
```
multiple = less likely to be malignant
single = more likely to be leiomyosarcoma (esp if not white and whirley but have necrosis/hemhorrage and happens in post menopausal women)
```
39
MCC clinical finding of fiborid
ASYMPTOMATIC
40
other symptoms of fibroids
uterine bleeding, infertility, pelvic mass
41
T:F leiomyoma can become leiomyosarcoma
noooooooo false
leiomyosarcoma arises de nova and happens in post menopausal women
42
multiple follicular cysts due to hormonal imbalance
POCD
43
how to diagnose PCOS with hormone checks
LH:FSH ratio >2
HIGH ANDROGENS leading to suppression of FSH and inability of follicule to mature (olgiomenorrhea, infertility, hirsuitism)
44
long term complications of PCOS
more estrone = increased risk endometrila carcinoma
insulin resistance = T2DM
45
rx to prevent peripheral estrone formation in PCOS
weight loss
46
rx to rpevent endometrila hyperplasia due to unopposed estrogen in PCOS
combined OCPs
47
rx to induce ovulation and fight insulin reisstance in PCOS
metformin
48
PCOS rx to preserve fertility
clomiphene
49
PCOS rx to block androgens and treat hirsuitism
ketoconazole
50
3 cell types of ovary
germ cell
sex chord stroma (supportive cells)
surface epithelium
51
MCC type of ovarian tumor
(coelomic epithelim) surface epithelial tumor
52
two most common esurface epithelial tumors
serous (water filled) and mucinous (mucus filled) tumors
| usually cystic
53
bening tumors of serous and mucin
cystadenoma
54
ovarian tumor single simple cyst flast lining, premenopausal women
benign mucinous or serous CYSTADENOMA
55
complex cysts with thick shaggy lining, post menopasual women...multiple cysts, unsmooth shaggy lining
cystadenoCARCIOMA
serous - watter filled
mucinous - thick mucus filled
clear INVASION into connective tissue
56
features in between benigna dn maligant tumors
```
borderline tumors
(carry metastatic potential) but not as aggressive and have better prognosis
```
57
BRCA1 mutation carriers have increasd risk of what ovarina cancer
SEROUS carcinoma both in ovary and follopian tube
58
if you have endometroid carcinoma in ovary...where to look for other carcinoma
in endometrium!!!! happens in 15% of people
59
UROthelium tumor in ovary
Brenner tumor (resmebles BLADDER)
60
when do surface tumors present typically
LATE (poor prognosis)
| vague abdominal sympstoms, signs of sompresssion (urinary frequency)
61
epithelial carcinomas in ovarylike to spread to what area
peritoneum and omentum
| OMENTAL CAKING
62
marker for SURFACE EPITHELIAL TUMOR
CA-125 (monitor treatmment and recurrence, not good for initial screening)...
for example if you remove ovarian tumor in sugery...check CA 125 to check to see if surgery was good or if it hasn't recurred
63
2nd most common ovarian tumor (15% cases)
GERM CELL TUMORS
| happens in REPRODUCTIVE AGE
64
15-30 year old with ovarian mass vs 30-40 with ovarian mass vs post menopasual women in 60 70s with ovarian mass)
15 - 30 - germ cell tumor
30-40 - benign surface epithelium tumors
post enopausal - malignant surface epithelial tumor
65
most common germ cell tumor, derieved 2-3 embryolagic layers
cystic teratoma
66
skin hair teeth thyroid in tumor
cystic teratoma
67
how to determine if cystic teratoma is malignant
look for IMMATURE TISSUE (malignant, typically neuroectoderm)
check if cells within teratoma HAVE CANCER...ex: skin tissue in teratoma has squamos cell carcinoma - malignancy)
any of these characterisitis indicated maligantn teratoma
68
lady with ovarian mass in reproductive age that develps hyperthyroidism
suspect STRUMA OVARII (mostly made of thyroid tissue)
69
mass of large cells with clear cytopalsm and central nuclei EGG CELLS
dysgerminoma
| MCC malignant germ cell tumor
70
tumor marker for dysgerminoma
LDH
71
LDH increasd in setting of ovarian tumor
dysgerminoma, hcG also inreased sometimes
72
most common germ cell tumor in children
endodermal sinus tumor (mimics yolk sac)
73
child with ovarian mass with elevated AFP
endodermal sinus tumor (yolk sac)
74
histologic hallmark of yolk sac tumor or endodermal sinus tumor
schiller duval bodies
| resemble GLOMERULI
75
child with ovarian mass that havs glomeruloid like structures on histology
endodermal sinus tumor
76
child with ovarian mass with schiller duval bodies and elevated AFP
endodrma lsinus tumor
77
malignant tumor of trophoblasts and synctiotrophoblasts with NO VILLI
choriocarcionma
78
ovarian mass with high bhcg usually spread to somewhere else
choriocarcinoma
79
prognosis of choriorcarcinoma
POOR RESPONSE TO CHEMO (germ cell variant)
80
sex cord stromal tumors have what cell types
granulosa cell
| theca cells
81
ovarian tumor with signs of estrogen excess
granulosa theca tumor
82
ovarian tumor in child with early puberity
granulosa theca cell
83
histologic hallmark of leaydig cells
REINKE CRYSTALS (pink cells with crystals)
84
ovarian tumor i woman who develops hirsutism or virilization
sertoli leydig tumor of ovary
85
bening tumor of fibroblasts
fibroma
86
ovarian tumo rin woman with pleural effusion and ascites
(meigs syndrome)
FROM FIBROMA
87
meigs syndrome from fibroma
pleural effusion and ascites assocaited with ovarian tumor
88
ovarina tumoor with "pulling sesnation of groin"
meigs syndrome (from fibroma)
89
mucin secreting cell with signet cell adenocarcinoma
kruckenberg tumor (GI metastases to ovary)...from diffuse type gastric cancer
90
abundant mucusy fluid in abdomen associated with tumor from where
appendix (primary) which produces abondunat mucus in peritoneum that can spread to ovary
91
MCC site ecotpic pregnancy
ampulla fallopian tube
92
spontaneous abortion happens when
before 20 weeks
93
MCC cause of spontaeous abortion
chromosomal anomalies
94
teratogenic affects aminobglycosides
OTOtoxicity
"A MIN guy, hit the baby in the ear"
95
third trimester painless bleeding
```
placental abruption (separation from placenta from uterin wall)
placenta previa
```
96
placenta accreta
placenta ATTACHES to myometrium does not penetrate (difficult delivery) often resuls in hysterectomy
97
placenta INcreta
penetraes INTO myometrium
98
placenta PERcreta
placenta PERforates into uterine serosa (invades entire wall)
99
fibrinoid nerosis in vessel of placenta
PREECLAMPSIA
100
eclampsia
preeclampsia WITH siezures
101
HELLP
Hemolysis (with schistocytes)
Elevated liver enzmyes
Low
Platelts
102
MOA iv mag in preeclampsia
PREVENTS SEIZURES
103
suddn infant death syndrome timing
1 mont to 1 year
104
increased risk of SIDS
sleeping on STOMACH
| and SMOKING
105
functional unit of placenta
villi
106
how to differentaite mole from normal pregnancy
moles - higher bCG that doesn't correlate with GA
| uterus will be bigger than normal (will not line up with gest age and size)
107
grape like masses protruding thorugh vaginal canal
hydratofirom mole
108
"snow storm appearance"
complete mole
109
complete mole vs parrial mole in terms of increased in chorio
complete mole - increased risk
| partial - no increased risk
110
mole epty egg with two sperm
COMPLETELY from dad
COMPLETELY a mole, no baby tissue
COMPLETE villi edematous, all of them
111
what to do after you remove molar pregnancy with bHCG
serial BHCGS!!!!!
| to check for choriocarciona devleopment
112
prognosis of chorio when it comes from sponataneous germ cell tumor vs from gestation
spontaneous - poor response to chemo
| gestational complication - good response to chemo
113
what is thelarche and when does it occur (tanner stage)
thelarche- formation beast bud
| Tanner Stage II (10-11.5 yrs)
114
necrotizing granulomatous inflammation of inguinal lymphatics and lymph nodes..fibrosis and perianal involvement due to what infection
```
chlamidy trachomatis (l1-l3)
lymphogranuloma venerum)
```
115
precursor lesions to squamous cell of squamous penis cancer
leukoplaki on shaft of penis - bowen disease
erythyroplasia of querat - erythroplaki on glans of penis
bowenoid papulosis - reddish papules
assocaited with HPV
116
when to surgically repair cryporrchidism
most resolve but if persisst greater than
117
complications cryporchidism
increased risk for testicular atrophy with infertility (needs low temp of scrotum and not high temp of abdomen)
incerase risk for seminoma
118
iinection that can cause orchitis
chalmydia trach (D-K), neisesria gonarreha
e coli pseudomonas
mumps
atuoimmune
119
testicular torsion what gets bocked and what doesn't
arterial blood can go in
| but veous blood cant get out (leads to hemorrhagic infarction)
120
renal cell carcinoma can lead to what testicular abnormality
varicocele (blockage of left renal vein)
121
hdrocele is fluid colelction ithin where
tunica vaginalis
122
hydrocele in infatns is due to incomplete closure of what
processus vaginalis
123
hydrocele in adults
blockage of lymphatic drainage
124
how to dx testicular tumors
YOU DON'T
DON'T BIOPSY THEM
95% ARE GERM CELL ANYWAY
125
risk factors germ cell tumors
kinefelter syndrome
| cryporchidism
126
seminoma in testicle = what in ovaries?
dysgerminoma
127
large watery cytoplasm and "fried eggg" appearance in testicle
seminoma
128
homogenous mass (painless) without hemorrhage or necrosis
seminoma
| MCC testicular tumor...excellent progosis, late metastasiss
129
tumor marker seminoma
bchcg
130
malignat tumor immature primiteve cells may form glands
| hemorrhagic mass with necrosis (painful)
embryonial carcinoma
131
yolk sac tumor marker
AFP
132
testicular tumor in child
yolk sac tumor
133
histologic marker yolk sac tumor
glomeruloid structure (schiller duval bodies)
134
male with testicular mass with hyperthyroidism or gynecomastia
choriocarcionma (hcg stimilar to lh , fsh, tsh....)
| can esaily spread to lungs and brain
135
difference in presentaiton of teratomas in females vs males
females - benign
| males - MALIGNANT
136
MCC testicular cancer in older men
testicular LYMPHOMA
| usually diffues large b cell type
137
dysuria fever chills, tender boggy prostate
prostatitis
138
MCC prostatitis young adults and elderly
young - gonarrhea/chlamydia
139
dysuria, lower back pain, cultures negative
chornic prostatitis
140
where does BPH occur
periurethra zone
141
rx BPH
a1 antagonist (terazosin) - relaxes smooth muscle
seletiev (tamsuolosin
5a reducatse inhibitor (finasteride)
142
where does prostatic adenocarcinoma
posterior periphery from prostate (far away from urethral zones)...
143
why is prostatic adenocarcinoma typically clinically silent
since it affects posterior peripherly, it DOESN'T impinge on urethra and will not cause symptoms
144
tumor markers prostate cancer
PSA and PAP 9prostatic acid phosphatise)
145
low back pain with high serum ALP and PSA
osteoblastic metastases in bone
146
rx prostate cancer
target anything that decerases production of androgens
Leuprolide - GnRH analog whih will decrease FSH and LH
flutamide - androgen
147
2 layers enveloping lobules and dcuts of breast
luminal cell layer (inner protective layer
| myoepithelial cell layer (projects milk out)
148
highest density of breast tissue in female
UPPER OUTER QUADRANT of breast
149
causess of galactorrhea
nipple stimulation
PROLACINOMA of anterior pituitary
drugs
150
etiology acute mastitis
s aureus that enters breast druing breast feeding (cracks in nipple)
warm erythematous breast with purulent nipple discharge
151
rx acute mastitis
drain, treat with abx (dicloxacillin) continue breast feeding
152
green brown nipple discharge
mammary duct ectasia (subareolar dcuts)
153
mammary duct ectasia biopsy
chronic inflammation with plasma cells
154
how does fat necrosis look on mammography
CACIFICATION (soponification)
155
MOA of mifepristone, misoprostol, and methotrexate in early pregnancy termination
miso - prostaglandin agonist
mifepristone - progesterone antagonist
methotrexate- folic acid antagonist
156
biopsy of fat necrosis
nectrotioc fat with caclifications and presence of GIANT CELLS
157
protein for gap junction
connexin (intercellular communication)
158
protein for tigh junctions
claudins, occludin (paracellular barrier)
159
adherenes junction protein
cadherin (cell anchor)
160
protein desmosomes
cadherin (desmoglein, desmoplakin) (cell anchor)
161
protein hemidesmosomes
integrin s(cell anchor)
162
MCC change in premenopausal bresat
fibrocystic change
163
feature fibrocystic change that has risks for malignancy
```
sclerosing adenosis (a/w calcificaitons)
and epithelial hyperplasia (WITH ATYPICAL CELLS)
```
164
apocrine metaplasia risk of cancer
none!
165
fluid filled duct dilation and blue dome
fibrocystic changes
166
bloody nipple discharge, (mcc cause) in premenopausal
```
intraductal papilloma
(two layers) of epithelial and myoepithelial cells (premenopause)
```
UST ALWAYS DISTINGUISH FROM PAPILLARY CARCINOMA (usu. affects older women), post menopausal
167
MCC benign tumor of breast, premenopausal women
fibroadenoma
168
mCC tumor in premenopasual woman
fibroadenoma
169
breast mass shrinks with menstrual cycle and moves
beningn fibroadenoma (no increased risk)
170
small mobile well defined breast mass
fibroadenoma
171
breast growth with "leaf like" projections
phyllodes (seen in postmenopausal)
172
normal appearing female with femal external genitalia (scant axillary/pubic hair), rudiemntary vagina, NO UTERUS OR FALLOPIAN TUBE (incresaed testosterone, estrogen, LH)
androgen insensitivity (testicular feminization)
173
female/ambiguous external genitalia, female appearing until puberty develops male secondary sex characterisitics
5a reductase def
46XY
autosomal recessive. iability to convert testosterone to DHT
normal testosterone/estrogen levels, normal LUH
internal genitalia (male internal) normal
174
failure to complete puberty, low GnRH, FSH< LH< testoserone
defective migration of GnRH releasing neurons and subsequent failure foGnRH releasing olfactory bulbs to develop
anosma
KALLMAN SYNDROME
175
born with ambiguous genitalia, increased serum testosterone and androstendione, mom developed virilazation during pregnancy because of high testosterone, female XX
aromatase deficiency (cannot convert androgen into estrogen)
176
malignant cells in DUCT bound by basement membrane
DCIS (NO INVASION of basement membrane)
177
DCIS that moved thorugh duct and into skin of nipple
Paget's diseas of nipple
178
high grade cells with necrosis and dystrophic calcificaiton in center of ducts
DCIS (comedo type) CENTRAL NECROSIS
179
nipple ulceration and erythema what to do next....
look for underlying DCIS somewwhere else in breast
180
duct like structures, presents as mas on phsical exam, can dimple skin and retract nipple
invasive ductal carcinoma
181
highly erythematous breast and swollen...given abx, doesn't resolve...
inflammatory breast cancer
182
histologic hallmark of inflammatory breast carcinoma
invasion of dermal lymphatics
183
lymphatic drainage blocked an dpeau dorange
inflammatory breast carcinoma
184
high grade maligantn cells with inflammatory background (lymphocytic infiltrate)
medullary carcinoma
185
BRCA1 mutations increase risk of what type of breast cancer
medullary carcinoma
186
orderly Lines of Cells
| decreased E-cardherin expression
lobular carcinoma
187
decreaesed E cadherin breast tissue
lobular carcinoma
188
tumor can deform suspensory ligaments
dimpling skin
| invasive ductal carcinoma
189
most useful tool in staing breast cancer
axillary lymph node biopsy
190
ER and PR positive...respond to...?
tamoxifen
191
her2nu positive
cell surface growth factor receptor (onco gene, tyrosine kinase)
RESPOND TO TRANSTUZIMAB
192
BRCA1 incraess suspectiblity to what cancers
breast (medullary carcinoma)
| ovarian (serous)
193
BRCA2 increasd risk of ...
male bresat carcionma (invasive ductal carcinoma)
