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Flashcards in Witrak Deck (75):
1

What is the most common breast disease in adult females?

Fibrocystic disease

2

What is the most common breast change in premenopausal women > 35?

Fibrocystic disease

3

What is the most common breast disease in males?

Gynecomastia

4

What can cause gynecomastia in males?

Spironolactone, hormones, cimetidine, alcohol/anti-androgens, ketoconazole

5

Why does gynecomastia develop?

Increased estrogen compared to androgen activity

6

What is the appearance of the simple cysts seen in fibrocystic disease?

Blue dome appearance

7

What changes are seen in fibrocystic disease?

Simple cysts, papillary apocrine metaplasia, stromal fibrosis

8

What is the appearance of papillary apocrine changes in fibrocystic disease?

Large eosinophilic cells w/scalloping border

9

What is the most common breast tumor in females less than 30 years of age?

Benign fibroadenoma

10

What is the appearance of a benign fibroadenoma?

Small, well-defined, mobile mass. Increased sized and tenderness with increased estrogen

11

30 yo pregnant F in 2nd trimester presents with firm, mobile mass in L breast. It is well defined, increasing with estrogen. What is it?

Like fibroadenoma

12

What is seen on gross examination of fibroadenoma?

Grey-white, rubbery nodule on gross examination

13

What is the treatment for lactational mastitis?

Dicloxicillin and continue breast feeding

14

What subtypes of fibrocystic disease have increased risk for cancer?

Sclerosing adenosis and epithelial hyperplasia

15

What are the two types of in-situ breast cancer?

Ductal in situ carcinoma and lobular in situ carcinoma

16

What in situ breast cancer is not seen on mammogram? Is there a mass present?

Lobular in situ carcinoma - no calcification seen, no mass

17

What is the pathogenesis of lobular in situ carcinoma?

Have decreased E cadherin expression, resulting in single file line of cells - cells don't stick together

18

Lobular in situ carcinoma has a risk of what?

Bilateral breast cancer over time

19

What is Paget disease of the breast?

Underlying DCIS that extends up the ducts to involve the skin of the nipple

20

How does Paget disease of the breast present?

Nipple ulceration with erythema

21

What family history is typical of hereditary breast cancer?

1st degree relatives with pre-menopausal bilateral breast cancer

22

BRCA 1 mutations are seen in what types of cancer?

Breast (medullary carcinoma) and ovarian serous carcinoma and fallopian carcinoma

23

In establishing degree of risk for a patient to develop invasive breast cancer, what is the first question to ask?

Family history

24

What patient population does preiductal mastitis present in? Why?

Smokers; smoking creates Vit A def which results in lactiferous duct squamous metaplasia; resulting in blockage and inflammation, nipple retraction and subareolar mass

25

What part of the breast does periductal mastitis occur in?

Lactiferous duct

26

White discoloration on the vulva constitutes what DDx?

Lichen sclerosis, lichen simplex chronicus, squamous cell carcinoma

27

White patch with parchment-like skin on the vulva is seen in what disease?

Lichen sclerosis

28

Patient complains on chronic itching of the vulva; physical exam shows hyperplasia of vulvar epithelium with a thick, leathery appearance of the skin. What is the likely diagnosis?

Lichen simplex chronicus

29

Between lichen sclerosis and lichen simplex chronicus, which has an increased risk for squamous cell carcinoma?

Lichen sclerosis

30

How does lichen simplex chronicus present?

Chronic irritation, hyperplasia of vulvar epithelium; thick, leathery appearance of vulvar skin

31

How does lichen sclerosis present?

White patch with parchment-like skin on vulva

32

What are the most common causes of vaginal bleeding in post-menopausal women?

Endometrial atrophy (59%), endometrial poly (12%), endometrial hyperplasia (10%), carcinoma (10%)

33

What are the two types of endometrial carcinoma?

Type I: endometrioid; type II serous/clear cell

34

What type of endometrial cancer is related to chronic estrogen use?

Type I: endometrioid

35

What mutation is associated with endometrioid carcinoma?

PTEN

36

What endometrial cancer is associated with precursor endometrial hyperplasia?

Endometrioid - type I

37

What type of endometrial cancer is associated with endometrial atrophy and no prior estrogen excess?

Type II: serous/clear cell

38

What population does type II serous/clear cell endometrial cancer present in?

Older women (70s +)

39

What mutation is associated with type II serous/clear cell endometrial cancer?

P53

40

What are seen on histology in serous/clear cell endometrial cancer?

Papillary structures and psamomma bodies

41

Is type II serous clear cell endometrial cancer aggressive or more indolent?

Aggressive

42

What is endometriosis?

Endometrial glands and stroma outside of the uterus

43

What can be seen histologically in endometriosis?

Chocolate cysts

44

What are potential sequelae of endometriosis?

Infertility; increased risk for carcinoma (esp at ovary)

45

What are the two most comon non-neoplastic tubal diseases? And their principal complications?

Salpingitis and endometriosis; can result in tubal infertility and ectopic pregnancy

46

What is the most common cause of abnormal vaginal bleeding in reproductive age females?

Dysfunctional anovulation = adequate estrogen but lack of progesterone

47

What is the most common cause of non-gestational uterine enlargement?

Leiomyoma (fibroids)

48

What are leiomyomas?

Benign, proliferations of smooth muscle arising from the myometrium

49

What is the most common tumor in females?

Leiomyoma

50

Why do leiomyomas enlarge during pregnancy and shrink after menopause?

Because they are related to estrogen exposure

51

What appears on gross examination of a leiomyoma?

Well-defined, white, whorled mass

52

What are the three categories of primary ovarian neoplasia?

Surface epithelium; ovarian stroma/sex cord; germ cell tumors

53

What category of primary ovarian tumors is most common? Responsible for the majority of ovarian cancer death?

Epithelial is most common overall and most common cause of ovarian cancer deaths

54

What is the most common germ cell tumor in women?

Mature cystic teratoma

55

What type of ovarian cancer do patients with BRCA1 mutations have an increased risk for?

Serous carcinoma

56

PCOS is characterized by what hormone? Ratio?

Excess LH, leading to excess androgens; LH:FSH > 2

57

Patients with PCOS are at increased risk for what cancer?

Endometrial carcinoma

58

What is the most common ovarian neoplasm in female 10 to 30 years of age?

Mature cystic teratoma

59

A mature cystic teratoma diagnosis can be strongly suggested by pelvic imaging studies, why?

Comprised of all 3 germ layers - some calcified (eg teeth); can be visualized on imaging

60

What is the ovarian tumor which holds the world record for neoplasm size?

Mucinous tumor of the ovary

61

What ovarian tumor category is most likely to present with either estrogenic or androgen excess?

Sex cord/stromal tumors

62

What ovarian tumor is most likely to behave in a recurrent/low-grade malignant fashion?

Granulosa cell tumor - causes estrogen excess (80% of all sex cord stromal tumor malignancy)

63

What sex cord tumors are usually non-functional and benign 90% of the time?

Fibroma/thecoma

64

What is Meig syndrome?

When a ovarian fibroma becomes very large and produces pleural effusions and ascites

65

What is the major cause of first trimester maternal death?

Ectopic pregnancy, resulting in tubal rupture and hemoperitoneum/shcok

66

What is characterized by onset of maternal hypertension and proteinuria at >34 weeks gestation?

Pre-eclampsia

67

What placental disorder has a strong association with prior C section?

Placenta accreta

68

What is placenta accreta?

Absence of decidua basalis; placenta invade through/ is in contact with myometrium

69

What is placenta previa?

Placenta is over cervical os

70

What is placental abruption?

Premature separation of placenta

71

What is the most common cause of postpartum hemorrhage?

Uterine atony

72

What is the second most common cause of postpartum hemorrhage?

Retained placenta

73

What are the most common causes of postpartum hemorrhage?

1st - uterine atony; 2nd - retained placenta; others: trauma (laceration) and thrombin

74

What is the most common form of gestational trophoblastic neoplasia?

Complete hydatidaform mole

75

What is seen on US and lab findings in a complete hydatidaform mole?

Uterus expands as if normal pregnancy, but expands much larger; see elevated beta-hCG and absent fetal heart tones on US with a "snowstorm" appearance