| Question | Answer |
| 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 |
