Unit 7 SIGs Cases 7-12 | Baamboozle - Baamboozle

How can you confirm a diagnosis of HSV-2 infection? (** indicates gold standard) (Wild Card week 7)

PCR for HSV genome**;Tzanck smear (syncytia & Cowdry type A inclusion bodies); immunofluorescence assay (DFA); observe cytopathologic effects in cell culture

What are lifestyle approaches that could improve a patient's testosterone levels? (Wild Card Week 7)

healthy body weight, exercise, quality sleep, limit alcohol, avoid xenobiotics, manage stress, healthier diet, loose-fitting underwear

What factors increase and what factors decrease risk of developing serous carcinoma ovarian tumor? (Wild Card WFA 7.6)

increase risk: nulliparity, FHx BRCA1 and BRCA2 germline mutation; decrease risk: hx oral contraceptive use, tubal ligation

List two major products of the cells within the box in the image on the right and explain the significance of the presence of plasma cells in the breast stroma (“P” in the left image- lactating breast) during lactation. (Wild Card WFA 7.6)

products: proteins, carbs/sugars, lipids; plasma cells secrete IgA which passes into breast milk to convey passive immunity to the neonate

What is the malignant potential, pathogenesis, and possible karyotypes of a mature cystic teratoma/dermoid cyst? (Wild Card WFA 7.6)

1% become malignant (squamous cell carcinoma most common); majority arise from ovum after 1st meiotic division, karyotype 46,XX

What are the roles of cell types and androgen production in the pathogenesis of BPH? (Sigs 7.7b)

AR of epithelial attracts macrophages-> TGF-b2-> EMT-> proliferation epithelial; AR of stromal attracts macrophages-> incr CCL3-> proliferation stromal

Describe structure of the normal and hypertrophied prostate and the significance of the prostatic zones to the development of proliferative lesions (Sigs 7.7b)

4 zones: ant. fibromuscular stroma, central, peripheral, transition; transition zone is the exclusive site of BPH

Contrast the mechanism and onset of action of tamsulosin and finasteride for managing BPH urinary symptoms. Why is Tamsulosin associated with orthostatic hypotension and syncope? (Sigs 7.7b)

T: competitive alpha-1 receptor antagonist (a1a & a1d selective- prostate)--> improve flow; F: competitive 5-a reductase inhibitor-> reduce DHT & prostate size

What are risk factors for progression from endometrial hyperplasia to endometrial carcinoma, including specific genetic mutations (Sigs 7.7a)

See image

Describe the pathways by which synthetic progesterones or progestins act to stabilize the endometrium (Sigs 7.7b)

blocks proliferative effect of estrogen; induces expression of 17beta-hydroxysteroid dehydrogenase type 2 (metabolizes estradiol to less potent estrone)

What is the MOA and indications for medroxyprogesterone acetate (MPA) (Sigs 7.7a)

inhibits production of gonadotropin-> no follicular maturation and ovulation, thins endometrium;heavy menstrual bleeding, contraception, endometrial hyperplasia

Explain the pathogenesis and clinical features of torsion and adhesions as sequelae of an ovarian neoplasm. (SIGs 7.6b)

fibroma continues to grow-> twisting of ligaments (suspensory lig)-> compression of ovarian artery and vein-> ischemia-> acute abdominal pain

Discuss the role of serum CA-125 levels in the diagnosis and monitoring of ovarian neoplasms (SIGs 7.6b)

biomarker for ovarian cancer; can be used to monitor response to treatment. See image

Characterize the indications, risks, benefits, and role of screening vs. diagnostic mammography. (Sigs 7.6a)

40-49 if high risk, 50-75 every 2 years; benefits: diagnose early; risks: overdiagnosis, false-positive, radiation

Describe the pathogenesis of the three principal morphologic features of non-proliferative fibrocystic breast changes (SIGs 7.6a)

Apocrine metaplasia, fibrosis, adenosis (see image for details)

Relate the clinical features of intraductal papilloma to the tumor's characteristic morphology. (SIGs 7.6a)

papillary growth of luminal cells into a large duct, bloody nipple discharge; finger-like projections; benign, but if no myoepithelial--> papillary carcinoma

List diagnostic criteria for PCOS (SIGs 7.4a)

Rotterham Criteria:2+ of: oligoovulation/anovulation, hyperandrogenism, enlarged/polycystic ovary, ovarian volume>10mL, multiple cystic follicle(string of pearl

Define the progestin challenge test and relate it to PCOS. (SIGs 7.4a)

progesterone given to test for amenorrhea by attempting to induce menstratuion; + if light bleeding occurs w/in 2 wks-> PCOS; - if no bleeding

Compare/contrast the clinical presentation and underlying pathophysiology of Sertoli-Leydig cell tumors and polycystic ovary syndrome (PCOS) (Sigs 7.4a)

S-L: neoplasm; hypersecrete testosterone/estrogen; PCOS: not neoplasm, disbalance of hormonal axis-> overgrowth dominant follicle-> hypersecrete horm.

Distinguish fibroadenoma and phyllodes tumor in terms of clinical features, morphology and prognosis. (SIGS 7.6a)

Fibro: most common, benign, <25 years, firm, solitary, rarely malignant; Phy: from intralobular stroma, older pts, massive size, leaf-like appearance, 15% malig

Relate the actions of methotrexate to the underlying pathophysiology of ectopic pregnancy. (SIGS 7.4)

folic acid antagonist that competitively inhibits folate-dependent steps in nucleic acid synthesis. inhibits DNA synthesis/reproduction in proliferating cells

Contrast the diagnostic work-up and management for a hemodynamically stable vs. unstable patient with ectopic pregnancy. (SIGS Case 7.4b)

stable: laparoscopic surgery OR methotrexate ; unstable: immediate laparotomy and treatment for hemorrhagic shock

Relate human chorionic gonadotropin levels to ultrasound findings for normal pregnancies. (SIGS Case 7.4b)

Pregnancy will generally be visible on ultrasound if beta-hCG is greater than 1500-2000

Discuss human chorionic gonadotropin levels in normal and abnormal pregnancies. (SIGS Case 7.4b)

Normal: levels double every 48 hours; Abnormal: falling= failed IUP or ectopic; drop >21% = failed IUP; drop < 21% = ectopic pregnancy