Spotter Flashcards

Question

Label A-E

Answer 1

A) Ischioanal fossa B) obturator internus C) levator ani D) pudendal canal E) Internal and external anal sphincters

Answer 2

Yellow: **deep perineal pouch** Red: **perineal membrane** Green: **superficial perineal pouch** Blue: **deep perineal fascia**

Answer 3

A) levator ani B) external urinary sphincter C) in males, Bulbourethral gland (Cowper's gland) - accessory sexual organ, involved in producing pre-ejaculare D) perineal membrane E) deep transverse perineal muscle

Answer 4

A) Colle's fascia B) perineal membrane C) corpus spongiosum D) bulb of penis (proximal corpus spongiosum) E) R and L crura of penis (part of corpus cavernosum)

Answer 5

Yellow: **perineal body** Red: **ischiocavernosus** (from ischiopubic rami) Green: **bulbocavernosus** Blue: **transverse perineal**

Answer 6

A) **bulbiospongiousus**, covers bulb and corpus spongiosum, compresses uretha and dorsal vein B) **superficial transverse perineal muscles** C) **ischiocavernosus**, covers and compresses crura *Help keep blood in corpus cavernosum during erection*

Answer 7

A) **prepuce of clitoris** B) **glans of clitoris** C) opening of greater vestibular (**Bartholin's gland**) - secretes mucus into vagina D) **perineal raphe**

Answer 8

A) **bulbiospongiosus** (reduces size of vaginal orifice, compresses dorsal vein of clitoris, fused in middle in male but not in female) B) **ischiocavernosus** (assists clitoral erection) C) **superfical transverse perineal** (same as in male) D) **Bartholin's gland** E) **bulb of vestibule** F) **clitoris**

Answer 9

Bartholin's cyst. Duct from Bartholin's gland becomes blocked, causes swelling of gland (cyst), can become infected, may need surgical drainage

Answer 10

Spermatozoa

Answer 11

A) spermatogonia B) spermatocytes C) spermatids D) spermatozoa

Answer 12

A) Epididimis B) Testis

Answer 13

A) pseudostratified columnar epithelium B) spermatozoa

Answer 14

A) smooth muscle B) pseudostratified columnar epithelium C) lumen of the ductus vas deferens

Answer 15

**Seminal vesicle**, a ductile organ, has a fibromuscular wall and mucosa with many folds

Answer 16

High power view of **prostate gland**. The coumpound tubuloacinar glands (g) are surrounded by the stroma made of connective tissue (ct) and smooth muscle (SM). They produce a watery secretion that is thought to aid motility of the sperm in the ejaculate. Contraction of the smooth muscle by sympathetic stimulation expels stored secretions from the lumina of the glands. ## Footnote **Urothelium**

Answer 17

The penis has three columns of erectile tissue in its centre that contain many vascular spaces. The two columns located dorsally are the **corpora cavernosa** of the penis (ccp). The ventral column surrounds the penile urethra and is called the **corpus spongiosum** (ccu).

Answer 18

Primordial follicle

Answer 19

A) zona pellucida B) oocyte C) granulosa cells

Answer 20

A) fluid filled antrum B) cumulus layer of granulosa cells C) theca layer D) oocyte E) zona pellucida F) peripheral granulosa cells

Answer 21

Corpus albicans

Answer 22

A) smooth muscle B) folded mucous membrane

Answer 23

A) Developing glands B) Endometrium C) Myometrium

Answer 24

Black line

Answer 25

The glands are **coiled, mature, active**, and secreting **thick, glycogen and glycoprotein rich material**

Answer 26

1. **myometrium** 2. smooth muscle with a network of arteries and veins supported by dense collagenous tissue

Answer 27

A) stratified squamous epithelium B) subepithelial tissue/submucosa C) blood vessels

Answer 28

A: endocervical mucosa (glandular epithelium), B: ectocervical mucosa (squamous cell epithelium) This is the site of origin of most cervical carcinomas.

Answer 29

Spermatozoa

Answer 30

A) primary spermatocyte B) spermatogonia C) Spermatid (late) D) myeloid cell (myofibroblast) E) spermatid (early) F) Sertoli cell G) Leydig cell

Answer 31

A) sertoli cell B) Leydig cell C) spermatocyte (primary) D) spermatogonia E) myeloid cell (fibroblast) F) spermatid (early)

Answer 32

Smooth muscle pseudostratified columnar

Answer 33

A) glands B) fibromuscular stroma C) epithelium of urethra

Answer 34

A) primary follicle B) Graafian follicle C) theca interna

Answer 35

A) antrum B) corona radiata C) theca externa D) oocyte E) zona pellucida F) zona granulosa G) theca interna

Answer 36

Proliferative Endometrium (top) Myometrium (bottom)

Answer 37

A: **Proliferative endometrium:** stright glands have mitotic profiles B: **Secretory endometrium:** glands coiled and cells bunched up secreting glycogen rich mucus visible in lumen that provides nutrition for fertilised ovum

Answer 38

1) serosa 2) smooth muscle

Answer 39

A) mesonephros B) gonadal ridges C) metanephros (kidney) D) Wolffian duct (mesonephric) E) Mullerian duct (paramesonephric) F) Cloaca

Answer 40

A) prostate B) pubic symphysis C) external urinary sphincter D) rectovesical pouch E) seminal vesicle F) common ejaculatory duct G) Cowper's gland

Answer 41

A) ovarian ligament B) round ligament C) broad ligament (hangs down either side = fold of peritoneum)

Answer 42

A) **vesicouterine pouch** B) **rectouterine pouch (Douglas pouch)**, can accumulate pus/blood, can be drained through anterior wall of vagina

Answer 43

A) fallopian tube B) suspensory ligament - contains ovarian vessels C) ureter D) ovary E) cervix F) bladder G) round ligament

Answer 44

A) suspensory ligament (vessels) B) ovarian/round ligament C) broad ligament (mesometrium) D) isthmus E) ampulla F) infundibulum G) fimbriae

Answer 45

Anencephaly - some defects are not compatible with life.

Answer 46

**Hypospadias** - opening of the urethra is on the underside of the penis. Classified as major defect but rarely life threatening.

Answer 47

**Cryptorchidism** - undescended testis, 1-4% male live births, most spontaneously correct within 3 months. Can affect developing sperm and lead to **testicular malignancy** later in life, so need to operate on and if \>1 year may remove it entirely.

Answer 48

**Holoprosencephaly** - varies from mild (L) to severe (R) and causes can be **genetic or environmental** (alcohol consumption). Due to loss of midline structures.

Answer 49

**Congenital diaphragmatic hernia**: diaphragm (seperates thorax from abdomen) doesn't close properly allowing GI system to enter thorax. Loops of intestines enter the chest and **prevent proper lung development**. Defect usually on L side of diaphragm. *Treating depends on defect size - if small stictch up, if bigger - synthetic patch. Can have in utero repair.*

Answer 50

A) endothelial cells B) syncytiotrophoblast *The synciyiotrophoblasts are always the cells in contact with the maternal blood in the lacunae*

Answer 51

4 ## Footnote *Syncytiotrophoblast nuclei cluster together leaving zones of thin cytoplasm between them, reducing the diffusion barrier in these intervening areas.*

Answer 52

Maternal ## Footnote *Bumpy and has the shape of the villus masses. The foetal side is smooth and the umbilical cord projects from it.*

Answer 53

L = secretory phase (pre implantation) R = endometrium during early pregnancy *Stromal cells take up most of the space in the R and they are smaller on the L* S = syncytiotrophoblasts I = cytotrophoblasts

Answer 54

Secondary ## Footnote *Primary = only syncytiotrophoblasts, tertiary = would contain BV*

Answer 55

Blastocyst

Answer 56

A) mesenchyme B) extravillous cytotrophoblasts forming a branch villus/invading C) villous cytotrophoblasts D) syncytiotrophoblasts

Answer 57

A) areolar glands B) fat tissue C) alveoli D) lactiferous ducts E) lobule (contains alveoli) F) lactiferous sinuses G) areola

Answer 58

**_L = spina bifida**_: failure of closure of posterior neural pore. _**R = anencephaly:_** failure of closure of anterior neural pore = skull doesn't close fully.

Answer 59

_L:_ **transposition of great vessels** - pulmonary trunk coming out of L vein. Hypertrophy of R ventricle. _Middle_: **persistant truncus arteriosus** - mixing O₂ and unO₂ blood, **acyanotic** _R:_ **tetralogy of fallot**, aorta 3x size it should be and pulmonary trunk v small, R sided hypertrophy of walls, **cyanosis** becuase 2 parallel systems of O₂ and unO₂ blood

Answer 60

L: horseshoe kidney Middle: pelvic kidney R: bifid ureter

Answer 61

**Omphalocele/exomphalos**: failure of **umbilicus to close** completely combined with **failure of mid-gut to herniate back** into abdominal cavity fully.

Answer 62

Top 2: **vitelline duct abnormalities.** 2-4% have small portion of **vitelline duct forming outpocketing of ileum**. Can become blocked and lead to trapped food and appendicitis but usually no symptoms. Bottom 3: **gastroschisis**, usually to R of umbilical cord. **Body wall muscle doesn't form - lateral mesoderm doesn't close properly**. Gut not protected. More prone to infections and dehydrated. Covered with plastic silo.

Answer 63

Duodenal atresia: see double bubbles: gastric bubble (black arrow) and big swollen duodenum with bubble (white arrow). *If blockage in duodenum, presents with vomiting but takes longer than if oesophageal atresia.*

Answer 64

Diaphragmatic hernia. *Baby has bowel in chest. As it developed, diaphragm had hole in it and bowel slipped up into pleural cavity so lung on R not developed. Baby: blue, tachycardia.*

Answer 65

**Gastroschisis**. *Don't want to put in back in right away or else baby can't breathe b/c lungs and diaphragm splinted by pressure from reintroduced bowel, so have to do it slowly day by day.*

Answer 66

Omphalocele

Answer 67

A) Goblet cell B) Absorptive cell C) Crypt cell D) Paneth cell

Answer 68

Chicken pox

Answer 69

Shingles: reactivation of VZV later in life, usually in one dermatome only b/c VZV forms latent infection in one of the dorsal root ganglia. R = opthalmis VZV, serious.

Answer 70

Neonatal HSV

Answer 71

**Syphilis.** L = primary syphilis - ulcer. Top R = secondary syphillis, blistering rash usually on hands and feet Bottom R = tertiary syphillus = erosions of nasal bone and cartilage, don't see anymore.

Answer 72

**Chlamydia**. Top L: discharge clear and watery. Top R: cervix down speculum Bottom L: arthritis. Bottom R: advanced PID - massive ovarian abcess on L, lifethreatening.

Answer 73

**Genital warts (HPV)** Top 2: warts Bottom L: laryngeal infection, oropharyngeal HPV, warts on folds Bottom R: cervix neck

Answer 74

*Neisseria gonorrhoea*. Top L: thick purulent discharge from urethra Bottom R: disseminated gonorrhoea - arthritis

Answer 75

Far L: HSV1 - oral herpes (cold sore). Middle and far R: HSV2 - genital herpes (ulcers and blisters).

Answer 76

Top 2: **primary syphilis** (single ulcer (chancre) and dark ground +ve) Bottom 2: **secondary syphilis** (condyloma lata and lesions of palms and soles)

Answer 77

**Bronchiectasis**: enlarged airway. Arrow = cignet ring sign.

Answer 78

**1) Hyaline membrane disease:** Formation of membranes in the peripheral airways (fibrin & cellular debris). Architectural & functional immaturity of lungs, surfactant deficiency. In uncomplicated cases reparative changes begin within 3-4 days. 2) **PROM** (premature rupture of membranes) *30-40%*. **Intrauterine infection** *25%*. **Uterine anomalies** (fibroids, bicornuate). **Cervical incompetence. Placental problems** (abruption, pl. praevia). **Multiple gestation. IOL** for maternal or fetal disease. 3) **Hyaline membrane disease** (HMD). **Intraventricular haemorrhage** (IVH). **Necrotizing enterocolitis** (NEC)[Pic]. **Neonatal sepsis**. 4) Gestational **age** (\>35/40). **Size** (BW \>2500g). Antenatally: **corticosteroids**. **Exogenous surfactant** at delivery. Postnatally: management - **treating the underlying disease**. 5) Confirm clinical diagnosis. Additional pathologies. Congenital malformations. Infection. Assess intrauterine growth restriction (IUGR).

Answer 79

Pneumopericardium.

Answer 80

**SGA**: Birth weight \<10th centile - at term \<2500g. _Causes:_ constitutional (**genetic**), **IUGR** (small, dysmature). ## Footnote *IUGR: _Symmetric:_ **proportional** underdevelopment, **early** onset, chromosomal abnormality, chronic infection. _Asymmetric:_ **disproportional** underdevelopment (“brain sparing” effect), **late** onset \>25/40, causes incl. chronic placental disease and chronic cord problem.*

Answer 81

A) Hypercoiled umbilical cord B) Cord stricture C) Thrombus in a chorionic vessel D) Thrombi in stem vessels

Answer 82

A) Recent thrombus in a chorionic vessel B) Old thrombus in a chorionic vessel C) Recent event: haemorrhagic endovasculosis D) Remote event: avascular villi

Answer 83

1) Contact the **coroner** - natural death, accident or non-accidental injury? **Blood & urine tests** in A&E. **Complete autopsy**. Examination of the death **scene**. Review of **clinical history**. 2) **Infection**. Undiagnosed **congenital abnormality**. Undiagnosed **tumour**. Undiagnosed **genetic or metabolic defect**. **Accident**. **Non accidental** injury (NAI). 3) SIDS risk 1-2 per 1000 live births. Risk of recurrence **1 : 8000** due to **other diseases or inherited conditions**, and **same risk factors** may be repeated in subsequent pregnancies. 4) Baby on the **back**. Stable surface. **Safe bedding**. **No co-sleeping**. No hyperthermia. **No smoking** in the baby’s room. * Sudden unexpected death in infancy (SUDI) - death \<24h. SIDS - death \<1 year old occuring during sleep, remains unexplained, typical findings: serosal petechiae, focal lung haemorrhage, acute stress in thymus, extramedullary haemopoiesis, mild URTI.*

Answer 84

1) Haemorrhagic, purpuric, petechial 2) **Oedema** 3) **Bilateral haemorrhagic infarct** (Waterhouse-Friderichsen syndrome) 4) **Meningococcus septicaemia**: shock, bilateral adrenal haemorrhage, widespread purpura, meningitis. Underlying pathology: deranged clotting / Disseminated Intravascular Coagulation (DIC). 5) An overwhelming bacterial infection caused by: ***Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, Pseudomonas sp., Staphylococcus sp***. 6) **Meningeal irritation**: headache, photophobia, neck stiffness, vomiting. Clouding of consciousness.

Answer 85

Haemorrhage and necrosis

Answer 86

Intravascular thrombus

Answer 87

1) **Dysmorphic features**: hypertelorism, low-set ears, small chin, short neck, broad thorax, polydactyly, rocker-bottom feet. 2) Chromosomal abnormality **Trisomy 18: Edwards syndrome** - karyotype 47,XX,+18 or 47,XY,+18, 1:8000 births, advanced maternal age. 3) Antenatally: chorionic villous sampling CVS, amniocentesis. Postnatally or at PM: blood, skin, sternum. 4) **Congenital heart defects**: septal defects, aortic/pulmonary valve stenosis. **Renal anomalies**: horse-shoe kidney, polycystic kidney disease. **Exomphalos. CNS anomalies**: hydrocephaly, meningomyelocoele.

Answer 88

A) omphalocoele B) Diaphragmatic hernia C) Univentricular heart D) spina bifida

Answer 89

Turner syndrome, monosomy 45, X0 at 18 weeks. Female is partly/completely missing an X chromosome.

Answer 90

**Meckel-Gruber syndrome** (autosomal recessive) at 42w. Characterized by renal cystic dysplasia, central nervous system malformations (occipital encephalocele), polydactyly (post axial), hepatic developmental defects, and pulmonary hypoplasia due to oligohydramnios

Answer 91

Sirenomielia

Answer 92

1) C shows a normal cervical smear: squamous cells have a low nuclear:cytoplasmic ratio and no nuclear pleomorphism. D shows many cells with a **high nuclear:cytoplasmic ratio**, show **nuclear pleomorphism and hyperchromasia**. 2) A shows normal cervical epithelium with maturation towards the surface, the cells becoming progressively more flattened as they reach the surface. B shows **lack of maturation of epithelium** - no flattening of cells as they reach the surface. The nuclei are **hyperchromatic and pleomorphic**. 3) CIN 3 (**Cervical Intraepithelial Neoplasia** Grade 3). 4) CIN: refers to the spectrum of epithelial changes that take place in the squamous epithelium as the precursors of invasive squamous carcinoma. Lesion severity is assessed subjectively as **Grade 1, 2, and 3** according to the level in the epithelium at which cytoplasmic maturation is taking place. Any grade of CIN is potentially invasive, although the **risk of invasion becomes greater as the severity of the lesion increases**. _Squamous neoplasia of the cervix is associated with:_ sexual activity, early age at first intercourse, frequency of intercourse, number of sexual partners, cigarette smoking, sexual behaviour of male partner, family history of cervical neoplasia, wives of men with carcinoma of the penis, urban areas. HPV is the main aetiological factor. **60 subtypes** of HPV. HPV 6, 11 are associated with **genital warts** and are not usually implicated in malignant transformation. **HPV 16, 18, 31, 33** have been isolated from **carcinoma**. *Mechanism: Papillomavirus DNA is incorporated into host genome. Produces proteins (E6, E7) which form complexes with anti-oncogenes such as p53, thereby inactivating the normal cellular response to DNA damage. This results in accumulation of genetic abnormalities. HPV is also implicated in vulval and vaginal intraepithelial neoplasia. CIN may progress to invasive carcinoma or regress. The higher the grade of CIN, the less likely the lesion is to spontaneously regress.*

Answer 93

1) 4 investigations: **mammogram, ultrasound, fine needle aspiration cytology +/- core biopsy**. 2) _Benign:_ **slow growth rate, rounded/ovoid, smooth edge**, pushing growth - easy to **shell out**, close resemblance to normal, no atypia/necrosis or invasion, never metastasises. _Malignant:_ **rapid growth, irregular shape**, infiltrative edge, **tethered** to surrounding structures, variable resemblance to normal, atypia, necrosis, high mitotic activity, **invasion, frequent metastasis**. 3) [Pic] 4) Commonest benign tumour of the breast, common before 30, in a breast lobule, presents as a **mobile mass** often described as a breast ‘mouse’. Multiple in 20% cases. 5) **Fibroadenoma**

Answer 94

1) Ovary is enlarged into a multicystic mass with protrusions over the inner and outer surface producing a cauliflower-like appearance. The tumour is formed by glands arranged back-to-back with marked cytological atypia. This is an **ovarian adenocarcinoma**. Adenocarcinomas constitute **90%** of all ovarian malignancies. Arise from **surface epithelium** of ovary. Account for a disproportionate number of fatal malignancies - commonly asymptomatic until they have reached a large size. Prognosis is very poor - overall 5-year survival of about 25%. 2) Functions: **produce female gametes/ova** - develop from oocytes present in the ovary from birth. **Produce female sex hormones**, oestrogen and progesterone - development of female sexual characteristics, support development of the embryo in early pregnancy. These are produced by specialised stromal cells of ovary. Ovarian tumours are classified into three major types according to their cell of origin, the remainder being mixtures of these tumours metastatic to the ovaries. The 3 categories are: * *a. Epithelial tumours** - arising from the surface epithelium, as the one here. These may be benign or malignant and are of several subtypes: serous, mucinous, endometriod, and Brenner tumour. * *b. Germ cell tumours** - eg. teratoma, yolk sac tumour, dysgermonoma, embryonal carcinoma, choriocarcinoma. * *c. Sex cord-stromal tumours** - eg. granulosa cell tumour, thecoma-fibroma and Sertoli-Leydig cell tumour. 3) **Cystic tumour** containing hair and sticky sebaceous material. Sometimes these tumours may have teeth, cartilage and bone. The diagnosis is **mature cystic teratoma**. * The vast majority are completely begnign and do not recur when removed surgically.*

Answer 95

Normal cells and **koliocytes** (halo cells) exhibiting pale cytoplasmic halos around irregular nuclei - these cells have mild dyskaryosis (abnormal nuclei) - characteristic of **HPV**.

Answer 96

Asterix: **interlobular stroma** (dense fibrocollagenous tissue mixed with adipose tissue) Arrow: **intralobular stroma** (looser fibrocollagenous tissue containing hormonally-responsive breast-specific fibroblasts imp in mammary gland remodelling)

Answer 97

Dense (irregular) fibrocollagenous tissue: interlobular stroma

Answer 98

A) oocyte B) surface ovarian epithilium/germinal epithelium C) stromal cell D) granulosa cell E) thecal cell

Answer 99

Epidermis of skin.

Answer 100

**Thecoma**: characteristic foamy cytoplasm due to large numbers of lipid droplets.

Answer 101

A) uterine artery B) ovarian artery C) vaginal artery D) spiral arteries E) suspensory ligament

Answer 102

A) ureter B) ligament of ovary C) round ligament of uterus D) ovarian artery and vein E) suspensory ligament of ovary F) broad ligament of uterus

Answer 103

1) uterus 2) round ligament 3) ovarian ligament 4) uterosacral ligament 5) ovary 6) suspensory ligament of the ovary 7) ureter * 6 accompanied by 7*

Answer 104

A) uterine artery B) inferior gluteal artery C) vaginal artery D) internal pudendal artery

Answer 105

A) suspensory ligament B) ovarian/round ligament C) broad ligament D) isthmus E) ampulla F) infundibulum

Answer 106

A) piriformis B) ischial spine C) coccygeus D) levator ani

Answer 107

A) lumbosacral trunk B) obturator nerve C) pudendal nerve *PSN: pelvic cplanchnic nerves (cut), parasympathetic to inferior hypogastric plexus*

Answer 108

A and B) puborectalis, pubococcyygeus C) Iliococcygeus D) Coccygeus E) piriformis

Answer 109

1) superficial pouch (erectile tissue + associated muscles) 2) deep pouch (deep perineal muscles and EUS (and Cowper's glands in male)) A) levator ani B) Colles' fascia C) round ligament D) perineal membrane E) urogenital diaphragm F) obturator internus

Answer 110

A) bulbospongiosus - reduces size of vaginal orifice, compresses dorsal vein of clitoris B) ischiocavernosis - assists in clitoral erection C) superficial transverse perineal D) Bartholin's gland E) bulb of vestibule

Answer 111

Head growing along **50^th centile = good**. But abdo circumference has increased above 95^th centile b/c baby is well nourished = **typical of diabetic baby**, lots of glycogen stored in liver so abdo larger and may get **stuck** in delivery. *Normal baby = head should be largest bit*.

Answer 112

_Trace A:_ **tachycardia** - foetal HR consistantly above the normal 120-160bpm. _Trace B:_ **type II dips** - foetal HR returns to baseline only after contraction ends.

Answer 113

**HMD**. Collapsed air spaces, distal airways lined by necrotic material later by eosinophilic hyaline membranes, dilation of septal lymphatics, oedema and focal haemorrhage, capillary thrombi.

Answer 114

**Necrotising enterocolitis**. Dilation of involved segments, dusky serosal surface, deeply congested mucosa, patchy/diffuse ulceration, perforations often multiple.

Answer 115

**Intraventricular haemorrhage**. ## Footnote *Usually 2⁰ to bleeding in the germinal matrix. Haemorrhage can occur at one/several sites. Blood may fill entire ventricle system. When ventricles overdistended, blood dissects into parenchyma.*

Answer 116

**Periventricular leucomalacia**. Oedema and lack of grey and white matter differentiation.

Answer 117

**Acute myocarditis** - can see lots of neutrophils.

Answer 118

**Petechiae** - small (1–2 mm) red or purple spot on the skin, caused by a minor bleed from broken capillary blood vessels

Answer 119

**Waterhouse-Friderichsen** - bilateral necrosis of adrenals. Commonly caused by severe bacterial infection.

Answer 120

L: bronchiolitis, R: haemorrhage

Answer 121

**DIC (disseminated intravascular coagulation)**: blood constantly clotted and fibrolysed so lots of haemorrhages and clots at the same time; clots hard to find (destroyed fast) but haemorrhages stay.

Answer 122

**Meckel-Gruber syndrome** (autosomal recessive) at 42w. Characterised by triad of _occipital encephalocele_, _large polycystic kidneys_, and _postaxial polydactyly_

Answer 123

L: **hypercoiling**. R: **stricture** in cord. Both compromis blood flow to foetus. *Group B*.

Answer 124

**Placental abruption**. *Group C*.

Answer 125

**L: acute chorioamnionitis**: membranes inflamed, lots of inflammatory cells present. **R: funisitis**: cord vessels inflamed, clot within cord vessels -\> hypoxic insult to foetus.

Answer 126

**Macrosomia** and all visceral organs quite big, **maternal diabetes/gestational diabetes**.

Answer 127

a) bladder b) prostate (middle lobe) c) prostate (isthmus)(anterior lobe) d) EUS e) seminal gland f) prostate (inferoposterior lobe)

Answer 128

a) bladder b) peritoneum c) levator ani d) membranous urethra e) prostatic urethra f) obturator internus

Answer 129

a) inferior epigastric artery b) deep inguinal ring c) rectus abdominus muscle d) superficial inguinal ring e) inguinal ligament f) exernal iliac vessels g) ductus deferens Traingle: Hesselbach's triangle - **direct** inguinal hernias leave abdomen through this triangle. (Hernia **medial** to epigastric vessels).

Answer 130

**Direct inguinal hernial**. Tx: truss if reducable (can push hernia back with finger), otherwise surgery.

Answer 131

**Indirect inguinal hernia**. **Failure of inguinal canal to close properly** after passage of testes in utero. **60% to R** b/c R testes takes longer to get into scrotum. Loops of intestine can go through **processus vaginalis** if not closed, go through deep and inguinal ring. Always need surgery, done **laproscopically**.

Answer 132

Variocele.

Answer 133

1. PSA is **secreted by the prostate**, but **more** is secreted in cancer than normal, and it is used by some as a screening test. 2. The normal shows **well organised** glands within fibrous stroma. The patient’s tissue shows **fibrous tissue** with **infiltration** by cells with **irregular hyperchromatic nuclei** and almost total **lack of organisation**. Some vacuolation of cells is seen. 3. **Prostate cancer - adenocarcinoma**. 4. Very common, increases in frequency in **elderly**, v common in African-Americans, unusual geographic incidence; common in West but rare in China, causes are unknown, but diet is thought to play a factor. Most diagnosed by **PSA test**. Some men present with **urinary symptoms**. Later they may present with metastatic disease. Cancers used to present late, as the tumours arise in the gland periphery and only cause symptoms after they have spread. However the **PSA test** means many cancers present much earlier. The disease is very common and most cases **do not spread** when diagnosed early. Most men die WITH their prostate cancer rather than FROM it. The tumour may **spread locally** to the bladder, urethra, seminal vesicles, pelvic wall and rectum, but will usually metastasize before this. The tumour shows a preference for **bones**, and gives rise to sclerotic metastases. The **grading** of the tumour is very important. The **Gleason grading system** is used. The Gleason grade of this tumour is **5** (on a scale of 1-5). Implications for prognosis and management. 5. Very early prostate cancer may not be treated, especially if the patient is elderly or unwell. Cancers in younger men which have not spread may be treated by **surgery** (**Radical prostatectomy**) or **radiotherapy**. Cancers which have spread are given **anti androgenic hormonal therapy** which often controls the disease.

Answer 134

1. **testis** - intraoperative and post surgical specimens. 2. grossly **swollen**, dusky **black** on the external surface, **black** internally, **necrotic with early cystic degeneration**, necrosis appears to extend into the cord. 3. **testicular torsion**. 4. Testicular torsion is a **urologic emergency**. Delay in diagnosis and management can lead to **testicle loss**. Most commonly occurs in **adolescents** and is the most frequent cause of testicle loss in that population. Normally testicle covered by **tunica vaginalis** which attaches to the **posterolateral surface** of the testicle and allows for **little mobility** of the testicle within the scrotum. In men who have an inappropriately **high attachment of the tunica vaginalis**, the testicle can **rotate freely on the spermatic cord** within the tunica vaginalis (intravaginal testicular torsion). This congenital anomaly, called the **bell clapper deformity**, can result in the long axis of the testicle being oriented transversely. _Presentation:_ sudden onset of severe unilateral scrotal pain. Onset of pain can occur more slowly, but this is an uncommon presentation of torsion. Torsion can occur with activity, can be related to trauma in 4-8% of cases or can develop during sleep. Relief of torsion can be **performed manually** but in most cases **surgical exploration** is necessary and **excision if the tissue is necrotic**. Later diagnosis means an orchidectomy is necessary.

Answer 135

1. Testis is **entirely replaced by a firm white mass** (often described as looking like a cut potato) with some **central cystic degeneration and necrosis**. 2. Testis is replaced by **sheets of pleomorphic cells** with some **prominent nucleoli** and **clear cytoplasm** with **well defined cell boundaries**. On the left there are **lymphocytes and fibrous tissue**. 3. **Classical seminoma**. 4. Seminomas are a type of germ cell tumour. Other testicular tumours are usually **nonseminomatous germ cell tumours** and can be a mixture of different tissues including: **teratoma, yolk sac tumour, choriocarcinoma**. 5. **Maldescended or undescended testis**. Rare **genetic conditions**. **Geographical variation** in incidence: high in Europe and in Maoris, low in Africa. Generally very rare. 6. **Primary excision** for localised tumours, **radiotherapy to the paraaortic nodes for aggressive**, vascular invasive tumours, a single dose of a chemotherapy agent, carboplatin, may be equally effective with fewer side effects. V. responsive to treatment: **5 year survival of \> 98%**. **Non-seminomas** may be treated by **more intensive** chemotherapy - slightly worse prognosis.

Answer 136

a) urethra b) ureter c) seminal vesicle d) ejaculatory duct e) prostate gland f) vas deferens g) epididymis

Answer 137

A) transitional B) periurethral (A and B around prostatic urethra) C) central (around ejaculatory ducts) D) peripheral

Answer 138

A) BPH - retains glandular structure of tissue, usually nodular. B) adenocarcinoma of the prostate - (\*) = small crowded gland has cells with enlarged nuclei, darker cytoplasmic staining, and prominent nucleoli. Basal layer is absent in adenocarcinoma

Answer 139

Gubernaculum

Answer 140

A) spermatids (late) B) spermatids (early) C) spermatocyte D) spermatogonia

Answer 141

A) sertoli cell - *elongated nucleus and cytoplasm, supports and nourishes, forms blood-testis barrier, regulates hormone production and function, secretion of tubular fluid, phagocytosis of spermatid cytoplasm.* B) leydig cell - *looks foamy, makes androgenic steroids.*

Answer 142

**Teratoma**: consists of foetal type tissues like cartilage C, poorly differentiated epithelial structures E, and primitive mesenchyme M. They tend to behave in a malignant fashion.

Answer 143

**Seminoma** - lobulated, pale mass usually devoid of necrosis and haemorrhage. It is more homogenous compared to the mixed germ cell tumor (L) which is cystic and haemorrhagic. Necrosis and haemorrhage often reflect choriocarcinoma and/or embryonal carcinoma admixtures with different tissue components of teratoma found in 45% of germ cell tumours.

Answer 144

**Turner syndrome**: a female is partly or completely missing an X chromosome. _Phenotype:_ short stature, SHOX haplo-insufficiency, gonadal dysgenesis, webbed neck, shield chest, widely spaced nipples, cubitus valgus, lymphodema of hands, shortening of 4th/5th metacarpal, knock-knees.

Answer 145

Eosinophillic Oesophagitis.

Answer 146

Crohn's disease.

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