USMLE 1 Path Repro
Terms
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- What causes a bicornuate uterus?
-
incomplete fusion of
Paramesonepheric ducts -
Dx:
abnormal opening of penile urethra on inferior side of penis
Cause? -
Hypospadias
cause:
failure of Urethral folds to close
[Hypospadias in Inferior - can see w/ penis held HI] -
Dx:
abnormal opening of penile urethra on superior side of penis
Cause?
what is it assoc with? -
Epispadias
cause:
bad positioning of Genital Tubercle
assoc w/: Extrophy of bladder
[Epispadias = Extrophy] -
genotypic and gonadal female (XX) with ovaries but external genitalia is virilized or ambiguous
cause? -
Female Pseudohermaphrodite
cause:
extra exposure to androgens during early gestation -
genotypic and gonadal male (XY) with testis but external genitalia is female or ambiguous
(vagina that ends in blind pouch)
cause? -
Male Pseudohermaphrodite
cause:
loss of androgen receptor function - Another name for Male pseudohermaphrodism
- Androgen Insensitivity syndrome
-
Definition:
Both ovary and testicular tissue present (47,XXY) - True Hermaphrodite
-
Dx:
Ambiguous genitalia until puberty, when increase in testosterone causes masculinization - 5-alpha reductase deficiency
-
Dx:
tight foreskin that is difficult to retract over glans penis - Phimosis
-
Definition:
subcutaneous fibrosis of the dorsum of the penis in older men - Peyronie Dz
-
Dx:
painless chancre - Syphillis
-
Definition:
a single erythematous plaque most often on the shaft of the penis or scrotum - Bowen Dz
-
Definition:
a single erythematous plaque most often on the glans penis or the prepuce - Erythroplasia of Queyrat
-
Dx:
Multiple wart-like lesions that histologically resemble Bowens and Queyrat - Bowenoid Papulosis
-
Dx:
developmental failure of the testis to descend into the scrotum - Cryptorchidism
- where does the fluid of a Hydrocele fill?
- Tunica Vaginalis
-
Definition:
malignant germ cell tumor presenting as painless enlargement of testis in 35 yo men; radiosensitive and poss Inc hCG - Seminoma
- which testicular tumor is similar to a seminoma but at a younger age of onset?
- Embryonal CA
-
Definition:
malignant germ cell tumor of testis that has a peak in infancy and early childhood; Inc alpha-fetoprotein - Enodermal sinus (Yolk Sac) tumor
- difference b/t immature and mature teratoma
-
Immature:
resembles fetal tissue
Mature:
resembles adult tissue -
Definition:
benign testicluar stromal tumor that can produce androgens and estrogens, contains Reinke crystals
seen in precocious puberty or gynecomastia - Leydig cell Tumor
-
Definition:
benign testicular stromal tumor that forms cord-like structures with minor endocrine abnormalities - Sertoli cell tumor
-
Definition:
testicular tumor w/ trophoblastic cells and villous structures resembling a placenta, malignant, hemorrhagic and Inc b-hCG - Choriocarcinoma
- where in the prostate does Adenocarcinoma occur?
- Peripheral zone (Posterior lobe) only
-
Dx:
pruitis and leukoplakia in the vulvar region
(name benign and precancerous) -
Lichen Sclerosis
(benign)
Atypical hyperplastic dystrophy
(pre-CA) -
Dx:
Benign papilloma caused by HPV; koilocytes
which HPV types? -
Condyloma Acuminatum
(HPV 6 and 11) -
Squamous cell CA on penis, vulva, cervix is assoc w/ which HPV?
(4) - 16, 18, 31, 33
-
Dx:
in children younger then 5 yo, a "bunch of grapes" protruding from the vulva - Sarcoma Botryoides
-
Dx:
menstrual-related onset of pain in the entire pelvic area - Endometriosis
- what amniotic fluid abnormality is a cause of anencephaly?
-
Polyhydraminos
(due to esophageal/duodenal atresia) -
MC Uterine tumor
what is its size related to? -
Leiomyoma
(Fibroid)
size: Estrogen secretion
(more at Preg, less at Menopause) -
Dx:
abnormal endometrial gland proliferation due to excess estrogen; manifests as vaginal bleeding - Endometrial Hyperplasia
- What do HPV viral proteins E6 and E7 bind to?
-
E6 = p53
E7 = Rb -
Definition:
swelling of chorionic villi and proliferation of chorionic epithelium (trophoblast); high b-hCG; "honeycomb uterus" or "cluster of grapes" appearance - Hydatidiform mole
-
Dx:
46,XX and completely Paternal; without fetus - Complete Hydatidiform mole
-
Dx:
69,XXY (or tetraploidy); may contain fetal parts - Partial Hydatidiform mole
-
Dx:
pregnancy-induced HTN, proteinuria, and edema; HA, blurred vision, hyperreflexia, thrombocytopenia - Preeclampsia
-
Dx:
pregnancy-induced HTN, proteinuria, edema and seizures; HA, blurred vision, hyperreflexia, thrombocytopenia - Eclampsia
- What pregnancy Dx presents as RUQ pain and HTN in 50% of patients?
- HELLP syndrome
-
Tx for Eclampsia
(2) -
IV magnesium sulfate
and
Diazepam -
Dx:
premature separation of placenta w/ painful uterine bleeding (usu in 3rd trimester); fetal death; may be assoc w/ DIC - Abruptio Placentae
-
Dx:
defective decidual layer allows placenta to attach directly to myometrium; possibly due to previous c-section; may have massive hemorrhage post-delivery - Placenta Acreta
-
Dx:
attachment of placenta to lower uterine segment; may occlude cervical os; Painless bleeding in any trimester - Placenta Previa
- Which CIN is considered carcinoma in situ?
- CIN-3
-
what type of CA is assoc w/ cervix?
what is the Cause Of Death in 80% of patients? -
Squamous cell CA
COD:
UREMIA due to local extension to compress ureters -
Definition:
Endometriosis in the myometrium - Adenomyosis
-
MC GYN malignancy
what is presenting age range? -
Endometrial CA
age: 55-65 -
Dx:
Bulky tumor w/ areas of necrosis and hemorrhage, typically arising de novo, may protrude from cervix and bleed - Leiomyosarcoma
-
Ovarian Cyst:
distention of unruptured graafian follicle; may be assoc w/ hyperestrinism and endometrial hyperplasia - Follicular cyst
-
Ovarian Cyst:
hemorrhage into persistent corpus luteum; mentrual irregularities - Corpus Luteum cyst
-
Ovarian Cyst:
bilateral, multiple, due to gonadotropin stimulation; can be assoc w/ choriocarcinoma or hydatidiform moles - Theca-Lutein cyst
-
Ovarian Cyst:
blood-containing cyst from ovarian endometriosis; varies w/ mentrual cycle - Chocolate cyst
-
Dx:
amenorrhea, infertility, obesity, hirsutism, multiple small follicular cysts
what hormone is in excess? -
Polycystic Ovarian syndrome
Increased LH -
Dx:
frequently bilateral, lined w/ fallopian tube-like epithelium, benign; -
Serous Cystadenoma
(20% of ovarian tumors) -
Dx:
frequently bilateral, malignant, w/ fallopian tube-like epithelium; 50% of ovarian tumors - Serous Cystadenocarcinoma
-
Dx:
multilocular cyst lined by mucus-secreting epithelium; benign - Mucinous Cystadenoma
-
Dx:
malignant tumor w/ mucus-secreting epithelium, can rupture producing multiple peritoneal tumor implants that produce mucinous material - Mucinous Cystadenocarcinoma
-
Definition:
Rupture of a mucinous tumor that causes multiple peritoneal tumor implants, all producing large quantities of intraperitoneal mucinous material - Pseudomyxoma Peritonei
-
Dx:
benign ovarian tumor that resembles Bladder transitional epithelium -
Brenner tumor
[Brenner = Bladder] -
Dx:
Ovarian tumor w/ bundles of spindle-shaped fibroblasts
what cell does it originate from? -
Ovarian Fibroma
(Thecal cell) -
Dx:
Ovarian fibroma, ascites, hydrothorax - Meigs syndrome
-
Dx:
ovarian estrogen-secreting tumor causing precocious puberty in kids or endometrial hyperplasia in adults.
name and describe the characteristic cell -
Granulosa cell tumor
Call-Exner bodies:
small follicles filled w/ eosinophilic secretions -
Dx:
MC malignant germ cell tumor of the ovary; sheets of uniform cells w/ Inc hCG -
Dysgerminoma
(Seminoma in man) -
Dx:
aggressive malignancy in ovaries, produces alpha-fetoprotein, Schiller-Duval bodies - Endodermal Sinus (Yolk Sac) tumor
-
Dx:
rare, malignant ovarian tumor that can develop during pregnancy in mother or baby; large hyperchromatic syncytiotrophoblastic cells; high b-hCG - Choriocarcinoma
-
MC benign ovarian tumor
name and describe what it can contain? -
Teratoma
Stuma Ovarii - functional thyroid tissue - In females, how does the Immature vs Mature teratoma differ from Males?
-
Females:
Immature - aggressively Malignant
Mature - Benign
(Men Mature are Malignant) - MC testicular CA in older men
- Testicular lymphoma
-
Dx:
aggressive malignant neoplasm w/ Inc hCG and early spread to lungs; preceded by hydatidiform mole, abortion of ectopic or normal pregnancy -
Gestational Choriocarcinoma
(more common then Ovarian type) -
MC disorder of the breast b/t 25 - 50 yo
It may present w/ what characteristic? -
Fibrocystic Dz
(Blue dome cyst) -
Dx:
diffuse breast pain w/ fibrosis and multiple lesions bilaterally
what type has cellular atypia of small ducts w/ fibrosis? -
Fibrocystic Dz
(Sclerosing Adenosis) - MC benign breast tumor in women < 25 yo
- Fibroadenoma
-
Dx:
small, benign, firm, rubbery, painless, well-circuscribed lesion of breast -
Fibroadenoma
(less then 25 yo) -
Dx:
benign large bulky mass of connective tissue and cysts in breast; has "leaflike" projections - Cystosarcoma Phyllodes
-
Dx:
tumor of lactiferous duct, presenting w/ serous or bloody nipple discharge - Intraductal papilloma
-
What receptors are expressed in post-menopausal malignant CA of breast?
(2) -
Overexpression of E2/P4 receptors
erb-B2 (HER-2) - MC place for Malignant breast CA
- Upper, outer quadrant
-
Dx:
eczematous patches on nipple, characteristic large cells surrounded by clear halo area, invades epidermis, underlying ductal CA always present - Padget Dz of the Breast
-
Dx:
malignant breast CA w/ Lymphocytic infiltrate - Medullary CA
-
Dx:
multicentric or Bilateral breast CA w/ cells arranged in linear ("indian-file") fashion -
Invasive Lobular CA
[Invasive Lobular = Indian Line] -
Dx:
breast CA w/ lymphatic involvement of skin by underlying CA causing red, swollen and hot area on breast - Inflammatory CA
-
Dx:
tumor cells fill breast ducts resulting in necrosis and a cheese-like consistency
(2 names) -
Intraductal CA in situ
(Comedocarcinoma)
[Cheesy Comedian] -
Dx:
malignant breast CA w/ tumor cells in cords, islands and glands embedded in dense fibrous stroma; firm consistency -
Invasive Ductal CA
(MC malignant Breast CA) -
Dx:
clusters of neoplastic cells fill intralobular ductules and acini and don't pass BM, often metastasis to bilateral breast by time of initial Dx - Lobular CA in situ
-
Dx:
malignant breast CA w/ pools of extracellular mucus surrounding clusters of tumor cells; gelatinous consistency - Mucinous (Colloid) CA
-
Dx:
young adult w/ fever, vomiting and diarrhea, rapid pulse and hypotension, diffuse macular rash -
Toxic Shock syndrome
(S. aureus) - what bug causes PID in combo w/ monoarticular arthritis?
- Gonorrhea