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Pathology: Reproduction

Chromosomal male with female genetalia, hypertension and hypokalemia 17α-hydroxylase deficiency
1. Most common cause of congenital adrenal hyperplasia (CAH) 2. What accounts for the adrenal hyperplasia in CAH? 1. 21-hydroxylase deficiency 2. low cortisol leads to increase ACTH which stimulates the adrenal cortex
1. chromosomal female with male genitalia and salt wasting 2. Cause of pituitary enlargement during pregnancy 1. 21-hydroxylase deficiency 2. increased estrogen
Cause of pituitary ischemia following pregnancy 1. ↑ estrogen → pituitary enlargement 2. significant hypotension (i.e. postpartum hemorrhage) can lead to ischemic necrosis of pituitary
What is the cause of polycystic ovarian syndrome? increased LH to FSH ratio leads to increased androgen production by theca cells of the ovary
Most common cause of hirsutism in females polycystic ovarian syndrome
1. Which two hormones lead to hirsutism or virilization in females? 2. Which organs secrete these hormones? 1. testosterone from ovaries 2. DHEA-sulfate from adrenal gland
1. Menorrhagia 2. Dysmenorrhea 1. loss of > 80 mL of blood per period 2. painful menses
Primary cause of painful menses increased prostaglandin F2α → increased uterine contractions
1. abnormal uterine bleeding unrelated to an anatomic cause 2. What is the most common reason for anovulatory abnormal uterine bleeding without anatomic cause 1. dysfunctional uterine bleeding (DUB) 2. excessive estrogen stimulation relative to progesterone (leads to endometrial hyperplasia)
At what ages does anovulatory dysfunctional uterine bleeding occur? extremes of reproductive life: 1. menarche to age 20 2. menopause
1. Amenorrhea from curettage 2. Uterine infection following delivery. What is the common pathogen. 1. Asherman syndrome (removal of stratum basalis) 2. Endometritis (bacterial infection of the endometrium). Streptococcus agalactiae
Menorrhagia, dysmenorrhea with glands and stroma thickening of myometrial tissue on biopsy Adenomyosis (invagination of stratum basalis into myometrium on biopsy)
1. What is endometriosis? 2. What is thought to be the cause? 1. abnormal placement of endometrial glands and stroma outside the uterus 2. retrograde menstration through fallopian tubes and ectopic implantation
What are the most common causes of pelvic inflammatory disease? Neisseria gonorrhoeae or Chlamydia trachomatis
Right upper quadrant pain following pelvic inflammatory disease inflammation of the liver capsule that spread form the uterus (Fitz-Hughes-Curtis syndrome)
Where is the most common site of implantation resulting in ectopic pregnancy? ampulla of the fallopian tubes
What is the workup for a woman with a presumed ectopic pregnancy? β-hCG as a screening test followed by vaginal ultrasound
1. Ovary tumor from hematogenous spread of gastric cancer 2. implantation of placenta over the cervical os 1. Krukenberg tumor 2. Placenta previa
Direct implantation of placenta into myometrium without intervening decidua placenta accreta
1. Decreased α-fetoprotein 2. Increased α-fetoprotein 1. Down syndrome 2. open neural tube defect
How is estriol produced in pregnancy? 1. placenta secretes pregnenolone 2. fetal adrenal gland converts prgenenolone to DHEA-S 3. placenta converts DHEA to estriol by aromatase
Peritoneal irritation from blood of ruptured follicle Mittelschmerz
what would FSH and LH be? 1. If pt has hypothalamic-pit problem 2. ovarian problem 3. end organ defect 1. Low. 2. High. 3. Normal.
Patient has painful defecation during menses that resolved after period is over. Diagnosis? endometriosis from bleeding into the rectal pouch of Douglas
1. What is the most common cause of endometrial carcinoma? 2. How does obesity increase the risk for cancer? 1. unopposed estrogen leading to endometrial hyperplasia 2. increase adipocytes leading to increased aromatization of testosterone into estrogen
Cancer and age brackets 1. 45 2. 55 3. 65 1. cervical 2. endometrial 3. ovarian
1. 65 year old woman with bilateral ovarian enlargement 2. thyroid secreting teratoma 1. cystadenoma 2. struma ovarii
Benign ovarian fibroma, ascites, and right side pleural effusion Meigs syndrome
Unilateral, painful lesion at the lower vestibule adjacent to the vaginal canal. How does it arise? 1. Bartholin cyst 2. inflammation and obstruction of the Bartholin gland
1. Warty neoplasm of vulvar skin 2. What is the most common cause? 3. Second most common cause 1. condyloma 2. HPV type 6 or 11 (condyloma acuminatum) 3. secondary syphilis (condyloma latum)
1. Clear halo containing a wrinkled, pyknotic nucleus on histological examination of warty vulvular lesion? 2. Which patch around genitals with thinning of the epidermis 1. koilocyte 2. lichen sclerosis
Thick, leathery vulvar skin from hyperplasia of the squamous epithelium. Lichen simplex chronicus
1. Which serotypes of HPV confer a higher risk for carcinoma? 2. Which area of the female genital tract does HPV most commonly infect? 1. type 16, 18 2. transformation zone (site of cell scraping for pap smear)
What are the two causes of vulvar carcinoma? 1. HPV type 16, 18 2. long standing lichen sclerosis
1. erythematous, pruritic, ulcerated vulvar skin 2. Persistence of columnar epithelium in the upper 1/3 of the vagina during development 1. Extramammary Paget Disease 2. vaginal adenosis
What is the greatest difference between Paget disease of the breast and extramammary Paget disease both represent a carcinoma in situ but extramammary Paget disease does not have an underlying carcinoma while Paget disease of the breast does
What is the pathophysiology of a clear cell adenocarcinoma of the vagina persistent columnar epithelium of the upper 1/3 of the vagina (adenosis) undergoes malignant proliferation
Bleeding and grape-like mass protruding from vagina or penis of a child Embryonal rhabdomyosarcoma
Which proteins produced by HPV result in the destruction of p53 and Rb E6 and E7 destroy p53 and Rb respectively
1. What is the most common site of involvement of endometriosis 2. Most common tumor in females 1. ovary 2. leiomyoma (smooth muscle tumor of uterus, aka fibroids)
What is the pathophysiology for the following types of endometrial carcinoma: 1. endometrioid 2. serous 1. endometrial hyperplasia 2. sporadic p53 mutation
Leiomyoma vs leiomyosarcoma 1. single mass 2. premenopausal 3. proliferation of myometrium 4. necrosis and hemorrhage 1. leiomyosarcoma 2. leiomyoma 3. both 4. leiomyosarcoma
1. chocolate cyst 2. psammoma bodies in a reproductive neoplasm 1. endometriosis involving ovary 2. uterine serous cystadenocarcinoma
Germ cell tumor with elevated serum AFP choriocarcinoma
1. massive amount of mucus in the peritoneum from tumor 2. What is the most common etiology? 3. What is a common ovarian origin? 1. Pseudomyxoma peritonei 2. appendiceal carcinoma 3. mucinous cystadenocarcinoma
What is HELLP syndrome and its characteristics? preeclampsia with microangiopathy involving the liver - Hemolysis - Elevated Liver enzymes - Low Platelets
1. What is eclampsia 2. What are the three characteristics of pre-eclampsia? 1. pre-eclampsia with seizures 2. pregnancy-induced hypertension, proteinuria and edema
Passage of grape-like masses through the vaginal canal in the second trimester Hydatidiform mole (masses are edematous villi from the trophoblast)
Describe the difference in pathophysiology between a partial hydatidiform mole and complete mole. How many chromoomes are in each? 1. partial arises from normal ovum fertilization by two sperm (23 x 3 = 69 chromosomes) 2. complete arises when an empty ovum is fertilized by two sperm (23 x 2 = 46 chromosomes)
1. Absence of the upper vagina and uterus 2. Signs of rash and sepsis after initiation of penicillin therapy for syphilis 1. Rokitanski-Kuster-Hauser syndrome 2. Jarisch-Herxheimer reaction due to proteins released form dead organisms
1. Gram-negative rod that causes bacterial vaginosis 2. Gram-negative rod that causes painful genital ulcer 3. Protozoan that causes vaginitis 1. Gardnerella vaginalis 2. Haemophilus ducreyi 3. Trichomonas vaginalis
1. Vaginosis with fishy smell upon KOH prep 2. What are Clue cells 1. Gardnerella vaginalis 2. vaginal epithelial cells covered with bacteria
How many chromosomes are found in patients with: 1. Klinefelters 2. Turner syndrome 1. 47 XXY 2. 45 XO
In Klinefelter's syndrome, what are the levels of: 1. LH 2. FSH 3. estrogen 4. testosterone 5. inhibin Seminiferous tubule dysgenesis and Leydig cell dysfunction lead to 1. ↑ LH 2. ↑ FSH 3. ↑ estrogen 4. ↓ testosterone 5. ↓ inhibin
1. What are the levels of LH and FSH in Turner's syndrome 2. What is a cardiac complication of Turner's syndrome? 1. ↓estrogen → ↑LH and FSH 2. preductal coarctation of the aorta
What is the most likely problem if: 1. ↑ testosterone, ↑ LH 2. ↑ testosterone, ↓ LH 1. defective angroen receptor (androgen insensitivity) 2. testosterone-secreting tumor, exogenous steroids
What is the internal and external genitalia of a male with androgen insensitivity syndrome? 1. Mullerian inhibitory factor produced by testes and inhibits internal female genitalia development. Testosterone unable to produce male internal genitalia 2. Female external genitalia with rudimentary vagina
1. What is the internal and external genitalia of a male with 5α-reductase deficiency? 2. What happens at puberty? 1. testosterone and MIF and produced so internal genitalia are male and intact; external genitalia rely on DHT and are ambiguous 2. ↑ testosterone cause penis development
1. principal characteristics of Kallmann syndrome 2. Pathogenesis of Kallmann syndrome 1. anosmia and lack of secondary sexual characteristics 2. GnRH neurons fail to migrate from olfactory tissue to their correct location in the hypothalamus
1. Which tumor do Hydatidiform moles predispose to? 2. Premature detachment of placenta from implantation site. 1. choriocarcinoma 2. Abruptio placentae
↑β-hCG with uterus that is abnormally enlarged for the gestational age hydatidiform mole
What is the common cause of miscarriage in: 1. First weeks 2. 1st trimester 3. 2nd trimester 1. low progesterone levels 2. chromosome abnormalities 3. bicornuate uterus
Primary risk factor for cervical carcinoma multiple sexual partners (↑ risk for HPV)
Malignant proliferation of syncytiotrophoblastic cells choriocarcinoma
1. What is the general ovarian cancer marker 2. Multiple tumors within uterus 1. CA-125 2. leiomyoma
Which is the most likely benign breast tumor: 1. small mass in 20 year old 2. large mass in 50 year old 3. small tumor with nipple discharge 1. fibroadenoma 2. phyllodes tumor 3. intraductal papilloma
What is the source of increased estrogen and androgens in polycystic ovary syndrome? LH leads to increased androgen production by thecal cells; decreased FSH so cannot converts androgen to estrogen in granulosa cells; adipocytes aromatize androgen to estrogen
1. Most common cancer of the penis 2. Most important prognostic factor for malignant breast tumors 1. squamous cell carcinoma 2. axillary lymph node involvement
1. free PSA levels in benign prostatic hyperplasia 2. free PSA levels in prostatic adenocarcinoma 1. increased 2. decreased; total PSA is increased
1. What is cryptorchidism? 2. Which periurethral lobes are involved in benign prostatic hyperplasia? 3. Which periurethral lobes are involved in prostatic adenocarcinoma? 1. undescended testis 2. lateral and middle lobe 3. posterior lobe
Estrogen: 1. How does it predispose to thromboembolism 2. antagonize warfarin estrogen increases protein synthesis in the liver with increased production of coagulation factors
How can anabolic steroid usage lead to feminization? androgens are aromatized to estrogens
Erythematous, tender breast with purulent nipple discharge Acute mastitis usually from Staphylococcus aureus
subareolar mass with nipple retraction from vitamin A deficiency. What is the pathophysiolgic mechanism? 1. vitamin A deficiency results in squamous metaplasia (columnar becomes squamous) 2. ducts become blocked 3. inflammation behind blocked duct
Benign estrogen sensitive breast neoplasm in premenopausal women. fibroadenoma
Fibrous tumor in postmenopausal woman with leaf-like projection on biopsy Phyllodes tumor
Lumpy breast in upper outer quadrant of premenopausal woman. Mostly benign Fibrocystic change
1. Blood nipple discharge in premenopausal woman 2. Bloody nipple discharge in postmenopausal woman 1. intraductal papilloma 2. papillary carcinoma
DCIS that extends up the ducts to involve the skin of the nipple Paget disease
Carcinoma in dermal lymphatics, presents as inflamed, swollen breast. Inflammatory carcinoma (similar presentation to acute mastitis)
What is HER2/neu? growth factor receptor
1. Which gonadal tumors have glomerulus-like structures on histological examination? 2. Which testicular tumors contain Reinke crystals 1. Schiller-Duval bodies are found in yolk sac tumors in both men and women 2. Leydig cell tumor
Most common germ cell tumor in women. teratoma
Which ovarian tumor has transitional-type epithelium? Brenner tumor
What is the relative incidence of the following female reproductive tumors: 1. cervical 2. endometrial 3. ovarian endometrial > ovarian > cervical
1. Which type of breast cancer resembles an orange peel? 2. What is the pathological cause of this presentation? 1. inflammatory 2. neoplastic cells block lymphatic drainage
1. Most common testicular tumor. 2. Most common testicular cancer in older men 1. Seminoma 2. lymphoma
Necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes lymphogranuloma venereum cased by Chlamydia trachomatis (L1-L3)
1. Failure of urethral folds to close leads to 2. opening of urethra on surface of penis 3. Which of the to above is associated with exstrophy of the bladder 1. Hypospadias 2. epispadias 3. epispadias
Carcinoma in situ of: 1. penile shaft presenting as leukoplakia 2. penile glans presenting as erythroplakia 3. multiple reddish papules 1. Bowen disease 2. Erythroplasia of Queyrat 3. Bowenoid papulosis
Failure of testicle to descend cryptorchidism
Most common cause of orchitis: 1. young adults 2. older adults 1. chlamydia trachomatis (D-K) or Neisseria gonorrhoeae 2. Escherichia coli
Firm, painless testicular mass that cannot be transilluminated characteristic of a testicular tumor
Which have a better prognosis: seminoma or nonseminomas. seminoma is highly responsive to radiotherapy and metastasize late
Tumor causing precocious puberty in children or gynecomastia in adults Leydig cell tumor
Which hormone causes prostatic hyperplasia? dihydrotestosterone (DHT)
BPH vs prostate carcinoma: 1. periurethral zone 2. peripheral regions 1. BPH 2. prostate adenocarcinoma
Created by: amichael87
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