Repro: Test 2: Taube : Greatest Hits-Week 2

Front 1

pt presents to your office complaining a breast pain shortly prior to menstruation. What is the likely developmental problem?

Back 1

a. Milkline Remnants

i. Supernumberary nipples or breasts result from persistence of epidermal thickening along milk line

usually come to attention as a result of painful premenstrual enlargements

Front 2

a pt comes to your office and says that they have been told that they have accessory axillary breast tissue that has expanded the normal ductal system into the chest wall and tail of Spence....they wonder why this is important. You tell them...

Back 2

the expansion can give rise to carcinomas outside the breast proper

Front 3

a pt presents to your office with an inverted nipple. You ask her if it has been like this her whole life or if it is a new finding. Why does it matter?

Back 3

if it is congenital, it will likely self correct

if it is new it may indicate presence of underlying cancer or inflammatory disorder

Front 4

When is a female most likely to obtain acute mastitis? What is the most common pathogen?

Back 4

i. Related to lactation and nursing --> during this time, breast is vulnerable to bacterial infection because of development of crack and fissures in the nipples --> s. aureus most common pathogen

Front 5

a patient presents to you with a painful subareolar mass. You suspect periductal mastitis. What is the most likely cause?

Back 5

SMOKING

Front 6

pt has a poorly defined palpable periareolar mass and is having thick white nipple secretions...what is this?

Back 6

Mammary duct ectasia

NOT ASSOC WITH SMOKING (like periductal mastitis)

often mistaken for ca

Front 7

an 18 year old skank shows up to your office with breast pain. On exam you see she has both nipples pierced. What is likely going on? What could be another presentation?

Back 7

d. Granulomatous Mastitis

due to foreign objects

Other presentation:
systemic granulomatous diseases (Wegners, TB, sarcoidosis)

Front 8

pt presents with a painless palpable mass with skin thickening and retraction. In her history you see both an injury and prior breast surgery. What is this mass?

Back 8

Fat Necrosis

Front 9

a 35 yo pt has a small mobile, firm mass with sharp edges composed of epitheilal and stromal tissue... what is this? benign or ca?

Back 9

Fibroadenoma

i. Most common benign tumor of the breast, normally around age 35

note: this can get bigger with increased estrogen (such as in preggo)

Front 10

a 60 year old woman comes in with a large bulky mass of connective tissue and cysts. It has "leaf like" projections..what is it? Benign or ca?

Back 10

Phyllodes tumor

benign but has potential to become malignant

Front 11

your 40 year old lady pt presents to you with concern over recent bloody nipple discharge...you immediately know she has:

Back 11

d. Intraductal Papilloma

Front 12

Why is obesity a risk factor for malignant cancer?

Back 12

adipose tissue serves as major source of estrogen in postementopausal women by converting androstenedione to estrone

Front 13

what race is at highest risk for malignant breast cancer?

Back 13

Whitey

Front 14

this malignant lesion is i. Always incidental biopsy finding since it is not associated with calcifications or stromal reactions that produce mammographic densities (ie mammograms not helpful)
and is More common in young women

Back 14

d. Lobar carcinoma in citu (SCIS)

Front 15

pt presents with is a palpable mass, dimpling of skin or nipple retraction...what does she likely have?

Back 15

Invasive ductal carcinoma not otherwise specified

i. Tumor that has extended across the basement membrane and has access to lymphatics and vessels

Front 16

early sexual intercourse, multiple partners, smoking, STD (HIV), HPV types 16, 18

are all risk factors for what?

Back 16

Cervical Intraepithelial Neoplasia

Front 17

c. Invasive cervical carcinoma manifests in three distinct patterns, what is the most common?

Back 17

fungating

Front 18

your damn tech dropped a whole pile of slides and now you have to go through them and figure out what's what. You pull up a slide and see whorls of kertinized cells...what is this?

Back 18

Squamous cell carcinoma of the cervix

'keratin pearls'

Front 19

you obtain an ultrasound of a woman's pelvis and note that she has fluid in the fallopian tubes (remember you can only see these if there is a problem!). You suspect suppurative salpingitis. The cause is normally?

Back 19

Gonoccus

Front 20

this is a common cause of infertility in areas of the world where TB is prevalent

Back 20

b. Tuberculous salpingitis

Front 21

Cystadenocarcinoma- most common malignant ovarian tumor; microscopically will see papillary structures with psammoma bodies; associated with tumor markers....? 3

Back 21

CA125,

BRCA1

Lynch syndrome

Front 22

a pt has an ovarian fibroma..(bundles of spindle shaped fibroblasts) what else might you see with this (2)

Back 22

Meigs syndrome

1. Meigs syndrome- triad of fibroma, ascities, pleural effusion (hydrothorax)

Front 23

this tumor can cause the following:

precocious puberty in kids
irregular menses in reproductive age
vaginal bleeding post menopause

Back 23

Granulosa (theca) cell- estrogen producing tumor

Front 24

this is the most frequent benign tumor of female germ cells and can contain hair or teeth..how is it different in males?

Back 24

Mature teratoma

in males this would be malignant!

Front 25

common lesions along lateral walls of vagina and derived from wolffian (mesonephric) duct rests; 1-2 cm fluid filled cysts in submucosa

Back 25

a. Gartner Duct cysts

Front 26

i. Papillomavirus induced squamous lesion --> mainly types 6 and 11
ii. Sexually transmitted, benign tumors with verrucous gross appearance, frequently multiple
iii. Involve perineal, vulvular and perianal regions
iv. Microscopic- proliferation of stratified squamous epithelium, acanthosis, hyperderatosis and nuclear atypia in surface cells

Back 26

a. Condyloma acuminatum (venereal warts)

Front 27

i. Patients present with thin, green/gray malodorous discharge
ii. Bacterial cultures show gram negative bacillus (g. vaginalis) and often other streptococci

Back 27

b. Gardnerella vaginalis (bacterial vaginosis)

Front 28

iii. Marked by pruritus, erythema, swelling and curdlike vaginal discharge

Back 28

c. Candidiasis

i. Yeasts are part of many women’s normal flora and the development of symptomatic candidiasis is typically a result of a disturbance in the vaginal microbial ecosystem
ii. Diabetes, antibiotics, pregnancy and compromised immunity are permissive to infection

Front 29

i. Yellow/green frothy vaginal discharge, vulvovaginal discomfort, dysuria, dyspareunia

ii. Characteristic ‘strawberry cervix’

Back 29

d. Trichomonas vaginalis

iii. Remember, you have to treat both partners with this **

Front 30

epithelial thinning and subepithelial fibrosis, resulting in the skin becoming thin, pale/grey and parchment-like. The labia becomes atrophied and the introitus in inward. This commonly occurs postmenopausal and has many features of an autoimmune disorder.

Back 30

Lichen Sclerosis (vulva)

Front 31

a non-specific condition caused by rubbing or scratching the skin. Characterized by acanthosis of the vulvar squamous epithelium causing hyperkeratosis. Not a major cancer risk.

Back 31

Lichen Simplex Chronicus (vulva)

Front 32

Patient is a 30 year old G3P2002 with a prior tubal ligation, reversed one year ago. She is 9 weeks by LMP with LLQ pain and spotting. She loses consciousness upon presentation, but on exam has a rigid, distended abdomen.

what is likely going on?

Back 32

Ectopic pregnancy

prior tube ligation with reversal, loses consciousness, etc makes you think this

Front 33

Second ectopic same tube
Childbearing completed
Uncontrolled bleeding
Severe tubal damage

are indications for what?

Back 33

Salpingectomy

removal of fallopian tubes

Front 34

Patient is a 25 year old G1P0010 who complains of heavy periods with cramps causing her to miss work. She complains of dyspareunia to avoidance at times.
Pertinent history – No STD’s, no abuse, prior elective abortion age 16, no family history of female cancers, nonsmoker, mother had a hysterectomy age 30 for pain and bleeding. What would you likely find on ultrasound?

What is this?

Back 34

An ovarian cyst

endometriosis

Front 35

Patient is a 45 year old black female who states her periods are heavy with the passage of golf ball sized clots. She soaks up to one pad per hour. Her periods have become more painful. She feels fatigued but thinks it is because she gets up several times per night to void. She has required blood transfusions recently because of a “blood count of 6”. She has been told she may need a hysterectomy but doesn’t want it. History otherwise is negative.
Exam – Pelvic mass to umbilicus

What would you find on ultrasound?

Diagnosis?

Back 35

Fibroid on the uterus

pt has a Symptomatic fibroid uterus that has lead to anemia