Notes

Friday, 13 March 2015 12:54 pm

1. Obesity is a complication of endometrial hyperplasia:

a. Adipocytes - site of peripheral conversion of sterols to estrogens

2. Hypothalamic eunuchism/ Frohlich syndrome

a. Inability of the hypothalamus to secrete normal amounts of GnRH
b. Abnormality of feeding centre - overeating and obesity

3. GnRH, Dopamine, GHRH released by the arcuate nuclei of the hypothalamus

a. Indirectly inhibits release of Prolactin

4. HLA-1B class (HLA G):

a. Prevents recognition of the conceptus as foreign by the mother
b. This + other immunosuppressive cytokines

5. Paternal genes code for trophoblast formation:

a. Evidence: H moles without maternal nucleus

6. Stanozolol and Oxandrolone:

a. Anabolic steroid
b. Less androgenic action in lab testing
c. Have full androgenic agonist effect in humans

7. hCG similar to LH, FSH and TSH; hence can bind to TSH receptors and produce hyperthyroidism

8. Estrogen:
a. Increases production of SHBG (Sex hormone binding globulin) in the liver
b. Hence decreases free testosterone

9. SHBG decreased by:

a. Obesity
b. Androgens
c. Insulun

10. Mifepristone:
a. Atypical infections - Clostridium sordelli
11. Gonadal dysgenesis:
a. Streak ovaries but phenotypically female
i. 46 XY
1) Swyer syndrome
2) Caused by point mutations in the SRY gene
ii. 45 X
1) Turner syndrome

12. Female pseudohermaphrodism:

a. Ovaries present; 46 XY; Chromatin body present
b. Appearance is however masculine
c. Caused by 21-hydroxylase deficiency (adrenogenital syndrome)

13. Androgen insensitivity syndrome:

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 13. Androgen insensitivity syndrome:
a. XR
b. Failure of receptor formation, or failure of tissues to respond to receptor-DHT complex
c. Testes and MIS present
i. Paramesonephric derivatives suppressed
ii. Vagina is small and blind

14. Adenocarcinoma of bladder causes:

a. Exstrophy of bladder
b. Urachal remanants (mcc)
c. Cystitis glandularis

15. Kallmann syndrome:

a. AD
b. Failure of GnRH secreting neurons to migrate into the hypothalamus during embryonic dev.
i. GnRH secreting cells originate from the olfactory placode
ii. Hypogonadism
c. Decreased FSH, LH, Testosterone
d. Failure of development of olfactory bulbs
i. Hyposmia / anosmia
e. Failure to start puberty / failure to fully complete it

16. Mumps (Paramyxovirus) causes orchitis

17. TRH leads to an increase in Prolactin

18. Perihepatitis:
a. Inflammation of the serous / peritoneal lining of the liver
b. Complication of PID
i. Chlamydia trachomatis
ii. Neisseria gonorrhoeae
c. Can lead to Fitz Hugh Curtis syndrome:
i. Formation of perihepatic adhesions
ii. RUQ pain - breathing / coughing / laughing

19. Klebsiella granulomatis, gram negative; Donovan bodies

a. Rx: Doxycycline

20. Mixed cell tumours:

a. May present with elevation of both aFP and hCG.
i. aFP - Yolk cell tumour
ii. hCG - Seminoma
21. Choriocarcinoma:
a. Soft hemorrhagic tumours
b. Syncitiotrophoblast and cytotrophoblast
c. hCG
d. Most aggressive, metastasizes early and fast
22. Embryonal cell carcinoma:
a. No marker as such
b. But often mixed with other tumour types
23. Yolk sac tumour:
a. Primitive endodermal sinuses
b. Kinda like primitive glomeruli (Schiller-duval bodies)
c. Eosinphilic hyaline globules
24. Testicular lymphomas are a disease associated with advancing age
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 24. Testicular lymphomas are a disease associated with advancing age
a. No hormonal product
b. Large B cell lymphoma

25. BPH causes obstruction of the prostatic urethrae - predisposes to bacterial infections
26. Seminomas have lymphoid infilterates; very good prognosis (treatable by radiotherapy)

27. Leydig cell tumours:

a. Presents with gynaecomastia
i. By increase in androgens / estrogens
b. Large granular eosinophilic cytoplasm
c. Rod shaped crystalloids of Reinke
28. Balanitis:
a. Inflammation of the glans penis or foreskin
b. No dyslpasia
c. Leads to phimosis

29. Paraphimosis:
a. Forcible retraction of prepuce that produces pain and urinary obstruction
b. Vascular compromise, inflamm and swelling

30. Neisseria infection:

a. Suppurative lesions
b. Liquefactive necrosis
c. Neutrophilic exudate + mixed inflammatory infilterates

31. Acute bacterial prostatitis:

a. Tender and very painful
b. Dysuria, fever, chills
c. E coli mcc

32. Chronic abacterial prostatitis:

a. >10 neutrophils per HPF
b. Long history of back pain and dysuria
c. No recurrent UTI

33. Tumour markers:

a. CA-125 - Best marker for ovarian epithelial carcinoma
b. CEA - Adenocarcinoma
c. Vimentin - Sarcomas (mesenchymal marker)

34. Prostatic intraepithelial neoplasia:

a. Precursor to Adenocarcinoma
b. Doesn’t lead to a crazy increase in PSA
35. Adenocarcinoma of prostate:
a. GSTP1 gene mutations (Glutathione S transferase) allow for carcinogen mediated damage
b. CAG repeat variations - androgen receptor gene
c. ETS family transcription genes
d. Rx:
i. Estrogen therapy
ii. Mitoxantrone + Prednisone

36. Mumps virus:

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 36. Mumps virus:
a. Patchy involvement of testis
b. No infertility

37. Cryptorchidism:
a. Failure of testis to descend normally
b. Atrophic testis throughout

38. Klinefelters syndrome:

a. 47 XXY
b. Testicular tubular atrophy (similar effect seen in estrogen therapy)

39. Chronic endometritis:

a. Retained placenta
b. Gonorrhoea
c. Intra uterine device (Actinomyces israelii)
d. Plasma cells present

40. HPL (human placental lactogen)

a. Anti insulin activity
b. Similar to human growth hormone
c. Directly correlates with placental mass

41. Stanzolol:
a. Synthetic anabolic steroid

42. Breast ducts:

a. Inner cell layer: Luminal layer
i. Produces milk
b. Outer layer: Myoepithelial layer
c. Milk production outside of lactation: Galactorrhea

43. Neural tube defects:

a. High AFP and anticholinesterase in amniocentesis
b. In Spina bifida occulta - AFP is normal.

44. Androgen & Estrogen synthesis:

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 a.

45. Extramammary Paget's disease

a. Red crusted vulvar lesion
b. Intraepithelial adenocarcinoma
c. Mucin producing; PAS +

46. Markers for Cervical carcinoma:

a. Ki-67 marker (Immunohistochemical)
b. P16/INK4A (Immunohistochemical)
47.

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