Exam 3: Pelvis and Perineum

Question 1

What does the expression "bridge over troubled water" mean?

Accepted Answer

Female: Uterine artery/vein pass over urether. Male: ductus deferens passes over urether.

Question 2

Sciatic nerve is a combination of which spinal levers of anterior rami?

Accepted Answer

L4-S3. Motor innervation from the dorsal divisions of spinal segments L5-S2.

Question 3

What muscles are innervated by this nerve? Sensory, motor, or mixed innervation?

Accepted Answer

Levator ani, coccygeus, external anal sphincter. Sensory innervation from the ventral divisions of the coccygeal plexus (S4, S5, Co)

Question 4

S1-3 anterio rami nerves sit superior to which muscle?

Accepted Answer

S1-3 are part of the sacral plexus (L4-S4) and sit on top of piriformis muscle on the posterior wall of pelvic cavity.

Question 5

ANTERIOR-POSTERIOR RELATIONSHIPS OF THE PELVIC VISCERA List the main pelvic visceral structures front to back.

Accepted Answer

Female: bladder, uterus and vagina (most commonly anteroflexed and anteroverted), sigmoid colon and rectum. Male: bladder, seminal vesicles, prostate, vas deferens, sigmoid colon and rectum.

Question 6

Name the borders of the perineum. *Hint: perineum is the most inferior part of the trunk where some viscera exit and external genitalia attach.

Accepted Answer

Superior- pelvic diaphragm anterior- pubic symphysis posterior- coccyx lateral- ischial tuberosities

Question 7

List the muscles of the perineum in the superficial perineal pouch.

Accepted Answer

Ischiocavernosus: anchors erectile tissues to perineal membrane. Contracts to push blood from crura of clitoris/penis to distal parts.
Bulbospongiosus: Contracts to push blood to glans clitoris/penis. Anchors erectile tissues to perineal membrane. In males, contracts to assist with emptying urine and ejaculation.
Superficial transverse perineal for stability.
External anal sphincter: constricts anal canal, supports pelvic floor. Under voluntary control by somatic nervous system and stays contracted until relaxed to poop.

Question 8

List the clitoral erectile tissues, which lie just below the skin of the vulva and labia.

Accepted Answer

Glans clitoris, bulb of vestibule (come together to form glans clitoris), corpus cavernosum (crura and body come together).

Question 9

List the penile erectile tissues.

Accepted Answer

Corpus cavernosum forms the crura. Corpus spongiosum forms the glans penis.

Question 10

List the structures in the deep perineal pouch.

Accepted Answer

The deep transverse perineus muscle, sphincter urethrae, and perineal membrane form the urogenital diaphragm.
Sphincter urethrae [external urethral sphincter], deep transverse perineal, and compressor urethrae [in females]
MALES: membranous urethra, which passes through the deep perineal pouch. Bulbourethral glands secrete mucous fluid that neutralizes urine and lubricates semen.

Question 11

Identify the structures pointed with the arrow. Describe their function.

Accepted Answer

Sertoli cells are avoid or triangular, euchromatic with a prominent and basophilic nucleolus. Usually located close to lumen.

Physical and nutritional support of the developing germ cells
Phagocytosis of cytoplasm eliminated during spermiogenesis.
Synthesis and secretion of:
- inhibin, a hormone that inhibits the release of follicle-stimulating hormone (FSH) by the anterior pituitary.
- androgen-binding protein (ABP), a macromolecule that facilitates an increase in the concentration of testosterone in the seminiferous tubule.
- (during embryogenesis) of antimüllerian hormone, which suppresses the formation of the müllerian duct (precursor of the female reproductive system) and thus establishes the "maleness" of the developing embryo
- fructose-rich medium into the seminiferous tubule lumen that nourishes and facilitates the transport of spermatozoa to the genital ducts
- testicular transferrin, an apoprotein that accepts iron from serum transferrin and conveys it to maturing gametes

Question 12

what are these?

Accepted Answer

Reinke crystal in the cytoplasm of a human Leydig cell, which are crystallized proteins that have precipitated. Also note the smooth endoplasmic reticulum (sER) (arrows) and a lipid droplet (L) in the cytoplasm. More obvious in Leydig cell tumors.

Question 13

What is this?

Accepted Answer

Reinke crystal in Leydig cell.

Question 14

What surrounds seminiferous tubules?

Accepted Answer

Fibrous connective tissue containing smooth muscle-like myoid cells. Thick complex germinal epithelium.

Question 15

What is the function of the structures pointed by the arrows? What happens if this structure is compromised?

Accepted Answer

gap/tight junctions formed between sertoli cells and primary spermatocytes in the basal compartment of seminiferous tubules. Form the blood-testis barrier and prevents autoimmune reactions.
Autoimmune attack against seminiferous tubules and developing sperm, leading to infertility.

Question 16

Which of the labeled structures in this seminiferous tubule histologic slide produces testosterone?

Accepted Answer

IC = interstitial (Leydig) cells. Characterized by location in the interstitial space between seminiferous tubules (ST) and their association with lipid droplets, better visualized in figure b.
M= myeloid cells
CT= connective tissue

Question 17

What is spermiogenesis? List the basic steps in order,

Accepted Answer

Process of spermatid maturation into spem.
1) Golgi phase: Golgi forms proacrosomal vesicles, which merge to form the acrosomal vesicle. Centrioles move to the opposite side of acrosomal vesicle and one of them emerge from the basal body of the sperm cell to begin forming the flagellum.
2) Cap phase: acrosomal vesicle spreads over half of the condensing nucleus to form the acrosomal cap (acrosome).
3) Acrosome phase: axoneme (developing flagellum) extends into the lumen of the feminiferous tubule. Sperm cell's nucleus becomes elongated and more condensed. Histomes are replaced by protamines. Mitochondria move to the future middle piece of the sperm.
4) Maturation phase: extra cytoplasm is shed as a residual body and is phagocytosed by Sertoli cells. Intercellular bridges in sperm cell are cut. Differentiated spermatozoon are released into the lumen, this is spermiation.

Question 18

What are the labeled structures in these histolical sections of the testes?

Accepted Answer

Showing the transition of a seminiferous tubule into a straight tubule, and then into the rete testis.

(a) The seminiferous tubules (S) drain into short, much narrower straight tubules (T), which connect to the rete testis (R), a network of channels embedded along with blood vessels (V) in the connective tissue (CT) of the mediastinum testis.

(b) Transition from wide seminiferous tubule (S) to the straight tubule (T). Initially, the straight tubule wall has only tall Sertoli cells devoid of germ cells. The wall becomes a simple cuboidal epithelium near its connection to the rete testis (R), which is also lined with simple cuboidal epithelium.

Question 19

What is this structure and what gives it its scalloped appearance?

Accepted Answer

Efferent ductules are lined by alternating clusters of simple non-ciliated cuboidal cells and simple ciliated columnar cells, which gives a scalloped appearance.
The cuboidal cells have many lysosomes and the apical plasmalemmae have numerous invaginations indicative of endocytosis; they're involved in resorption of luminal fluid.
The cilia of the columnar cells probably move the spermatozoa toward the epididymis.

Question 20

Identify this structure:

Accepted Answer

Epididymis characterized by stereociliated pseudostratified columnar epithelium with basal stem cells in the basal domain, which regenerated the principal cells closer to the adluminal domain. Principal cells resorb luminal fluid, phagocytose cytoplasmic remnants, and secret glycerophosphocholine to inhibit spermatozoa capacitacion.
Note the surrounding circular smooth muscle, which conducts the spermatozoa to ductus deferens by peristalsis (contraction).

Question 21

What extratesticular duct is characterized by having 3 surrounding muscular layers and a lamina propria with many elastic fibers?

Accepted Answer

Ductus deferens

Question 22

Identify the structure in these histological slides (H&E and Mallory trichrome stains),

Accepted Answer

(a) Cross section of the vas deferens shows the mucosa (M), a thick muscularis with inner and outer layers of longitudinal smooth muscle (L-SM) and an intervening layer of circular smooth muscle (C-SM), and an external adventitia (A). The muscularis is specialized for powerful peristaltic movement of sperm at ejaculation.

(b) The lamina propria (LP) is rich in elastic fibers and the thick epithelial lining (E) shows longitudinal folds.

(c) Higher magnification of the mucosa shows that the epithelium is pseudostratified with basal cells and many columnar cells, some with stereocilia.

Question 23

Identify the structure in the histological slides (H&E and PSH).

Accepted Answer

Seminal vesicles characterized by:

2 layers of smooth muscle (SM) surrounding the organ arranged in an inner circular and outer longitudinal layers.
SM are deep to the thin lamina propia (LP).
Mucosal folds with simple columnar epithelium of principal secretory cells:
70% of the ejaculate
Fructose
Prostaglandins
Fibrinogen
Lipochrome
Pigment that gives the pale yellow color of semen

Question 24

Identify the structure in these micrographs:

Accepted Answer

30-50 compound tubuloalveolar glands
Types of glands arranged in the different zones of the prostate
Transitional zone-> mucosal glands with short ducts
Central zone-> submucosal glands with intermediate length ducts
Peripheral zone-> main glands with long ducts
Simple or pseudostratified columnar epithelium
Fibromuscular stroma
Corpora amylacea are Calcified concretions of glycoproteins and keratan sulfate.

Prostate gland.

(a) The prostate has a dense fibromuscular stroma (S) in which are embedded a large number of small tubuloacinar glands (G).
(b) A micrograph of one prostatic gland, showing a corpus amylaceum (CA) concretion and the secretory epithelium (E) surrounded by a thin lamina propria (LP) and thick smooth muscle (M).
(c) Higher magnification shows the lamellar nature of a corpus amylaceum (CA) and the pseudostratified columnar epithelium underlain by lamina propria (LP).

Question 25

List the major prostatic secretions. What is their main function? Synthesis of these secretions is regulated by what hormone?

Accepted Answer

1) Acid phosphatase, Fibrinolysin, Prostate-specific antigen (liquifies coagulated semen). 2) Help spermatozoa achieve motility 3) Synthesis of secretions regulated by dihydrotestosterone

Question 26

Identify the structure in this micrograph. Hint: part of the masculine reproductive organs.

Accepted Answer

Bulbourethral glands are characterized by simple columnar epithelium, fibroelastic capsule with fibroblasts, smooth muscle, and some skeletal muscle surrounding the ducts, Connective tissue septa divide the tubuloalveolar gland into several tubules.

Question 27

Occlusion of this duct can result in infection, or at least mucin accummulation (what does it form?) Most common site of origin for vulvar adenocarcinomas. Pathogenic organisms can cause inflammation (what is this condition called?)

Accepted Answer

Greater vestibular (Bartholin) glands. Forms Bartholin cyst. Bartholinitis.

Question 28

What is the most common pelvic tumor in females?

Accepted Answer

Uterine fibroids.

Question 29

Describe the relationship between the rectouterine pouch and the posterior fornix of the vagina and the important clinical correlation discussed in class.

Accepted Answer

When supine, the rectouterine pouch is the most inferior space in the pelvic cavity. This space is more prone to collection of fluid, such as in the case of inflammation and/or infection. Possible pathologies are abscess formation, followed by rupture and material pooling in the rectouterine pouch. Also the rupture of an ectopic pregnancy can compromise the retroperitoneal aspect of the membrane (between the anterior wall of rectum and posterior wall of uterus) and result in pooling of blood in this space. This can be palpated via rectal exam. The posterior fornix of the vagina provides a gatway into the retrouterine pouch, facilitating the expiration/draining of accummulated fluid in this space.

Question 30

What is the typical cause of uterine prolapse? List 3 possible treatments.

Accepted Answer

Typically, a result of stretching or tearing of the pelvic floor in childbirth or aging Treatment: Surgical; Placing a mesh to support pelvic floor; Tightening the fascial ligaments.

Question 31

In this micrograph of a myometrium, identify the area lebeled with the red arrow.

Accepted Answer

At low power the uterus has a superficial columnar layer of cells, seen here overlying a stratum basalis layer with developing proliferative phase endometrium. The myometrium composed of smooth muscle bundles is below the endometrial layer which lines the central endometrial cavity of the uterus.

Question 32

In this micrograph of a myometrium, identify the layer lebeled with the red arrow.

Accepted Answer

At low power the uterus has a superficial columnar layer of cells, seen here overlying a stratum basalis layer with developing proliferative phase endometrium. The myometrium composed of smooth muscle bundles is below the endometrial layer which lines the central endometrial cavity of the uterus.

Question 33

In this micrograph of a myometrium, identify the region lebeled with the red arrow.

Accepted Answer

At low power the uterus has a superficial columnar layer of cells, seen here overlying a stratum basalis layer with developing proliferative phase endometrium. The myometrium composed of smooth muscle bundles is below the endometrial layer which lines the central endometrial cavity of the uterus.

Question 34

What pathology is shown in this histologic slide?

Accepted Answer

A) Endometriosis involving the mucosa of the colon, B) Higher magnification showing endometrial glands and stroma adjacent to normal colonic mucosa. Basically endometrial tissue in the colon, which doesn't belong there,

Question 35

In this close up of the serosa in the pouch of Douglas, identify and describe the pathology behind what is labeled with the red arrow.

Accepted Answer

Small foci of endometrial glands and stroma found outside the uterus (posterior side), namely endometriosis. There's bleeding into these foci and the dark blood is due to deoxygenation and hemosiderin breakdown (because this is old, displaced blood from menses). These foci are small nodules described as "powder burns."

Question 36

Explain the pathology behind what is being shown in the picture.

Accepted Answer

This is a section through an enlarnged 12 cm ovary to demonstrate a cystic cavity filled with old blood typical for endometriosis with formation of an endometriotic, or "chocolate", cyst. The hemorrhage from endometriosis into the ovary may give rise to a large "chocolate cyst" so named because the old blood in the cystic space formed by the hemorrhage is broken down to produce much hemosiderin and a brown to black color.

Question 37

What pathology can be seen in this histologic slide?

Accepted Answer

Endometriosis, microscopic A focus of endometriosis (◀) with a small cluster of endometrial glands and stroma with hemorrhage is seen within smooth muscle, adjacent to mucosa of appendix at the left. Theories for the origin of endometriosis include metaplastic change in coelomic epithelium.

Question 38

List the treatments of endometriosis discussed in class.

Accepted Answer

1) NSAIDs for symptomatic relief. 2) Estrogen antagonists to inhibit aromatase for symptomatic relief. 3) Surgery, depending on location, effects, and secondary changes of the lesions.

Question 39

What structure is shown in this picture? Identify the parts labeled with symbols (except black rhombus ♦ and upwards arrowhead ▲).

Accepted Answer

Normal testis, gross anatomy. Here is a normal testis and adjacent structures, including the body of the testis (∗), epididymis (▪), and spermatic cord (white ▼). Note the presence of two vestigial structures, the appendix testis (♦) and the appendix epididymis (▲). The pampiniform plexus of veins (◼) lies posterior to the body of the testis.

Question 40

In this histologic slide of a Sertoli cell tumor, identify what is labeled with the arrowheads.

Accepted Answer

The neoplastic cells shown form cord-like structures (▲) and primitive tubular structures (▼). They have the elongated shape of normal testicular Sertoli cells, or sustentacular cells, that reside in seminiferous tubules and provide support for developing germ cells.

Question 41

What pathology is shown in this image?

Accepted Answer

The cut surface of this normal-sized adult testis reveals a small discrete brown mass (▲). Most of these interstitial (Leydig) cell tumors arise in men 20 to 60 years old. Although often less than 1 cm in diameter, some may reach several centimeters in size, enough to produce palpable testicular enlargement.

Question 42

What is the pathology shown in this histologic slide?

Accepted Answer

Leydig cell tumor, microscopic. The small round cells of this tumor are found in nests or clusters, and there are many intervening capillaries, typical of endocrine tissue. A distinctive electron microscopic feature is the cytoplasmic rod-shaped crystalloid of Reinke.

Question 43

Identify and describe the pathology in this histologic slide?

Accepted Answer

Choriocarcinoma, microscopic. Pure testicular choriocarcinomas are rare. The primary lesion is often small at the time of detection, because these tumors are aggressive and metastasize early. Some cases may exhibit the phenomenon of the “disappearing primary” tumor, when the rapidly enlarging tumor outgrows its blood supply and infarcts with hemorrhage (♦) and necrosis, eventually leaving only a small scar, although the metastases continue to grow. Seen here are large syncytiotrophoblastic cells (▲) with abundant pink cytoplasm (positive for human chorionic gonadotropin) and a highly pleomorphic nuclei. Smaller cytotrophoblastic cells with clear cytoplasm are present.

Question 44

This histologic slide shows a morphologicsally normal structure on one side, and an abnormal one on the other. Compare both sides of the section and determine which is pathologic and identify the areas labeled with the shapes.

Accepted Answer

"Classic" form of seminoma. Normal testis appears on the left and seminoma is present on the right. Note the difference in size and staining quality of the nests of neoplastic cells compared with normal germ cells (◼) in seminiferous tubules. The large seminoma cells (▲) have vesicular nuclei and pale watery cytoplasm. Lobules of neoplastic cells have an intervening stroma with characteristic T-cell lymphoid infiltrates (♦).

Question 45

Identify the pathology shown here.

Accepted Answer

Seminoma, gross. The germ cell tumor most likely to be a single histologic type is seminoma, shown here as a uniform solid tan mass (▲) within the body of the testis. Germ cell neoplasms are the most common forms of testicular neoplasia. They may be a “mixed germ cell tumor” and have more than one histologic component—seminoma, embryonal carcinoma, yolk sac tumor, teratoma, or choriocarcinoma. Most testicular germ cell tumors arise from a focus of intratubular germ cell neoplasia.

Question 46

What are the risk factors associated with higher incidence of testicular tumors?

Accepted Answer

DISCUSSED IN CLASS: 1) Family history is important, as fathers and sons of affected patients have a 4-fold increased risk and brothers of males with germ cell tumors have an 8- to 10-fold increased risk. 2) Cryptorchidism is associated with an increased risk for cancer in the undescended testis, as well as in the contralateral descended testis. In keeping with this, a history of cryptorchidism is present in approximately 10% of cases of testicular cancer. 3) The development of cancer in one testis is associated with a markedly increased risk for neoplasia in the contralateral testis. OTHERS, PER TEXTBOOK: Intersex syndromes, including androgen insensitivity syndrome and gonadal dysgenesis, are also associated with an increased frequency of testicular cancer. Extra copies of the short arm of chromosome 12, usually due to the presence of an isochromosome 12 [i(12p)], are found in virtually all germ cell tumors; it is not known which genes in this chromosomal segment are linked to tumorigenesis. Oncogenic mutations in KIT are found in up to 25% of tumors.

Question 47

What are possible causes of luminal obstruction that leads to acute appendecitis?

Accepted Answer

1) Intrinsic appendiceal obstruction caused by inspissated fecal material (a fecalith) is found in 30% to 50% of patients at the time of surgery. 2) Lymphoid tissue hyperplasia. Extrinsic compression of the appendix is usually caused by enlarged lymph nodes associated with bacterial or viral infections. 3) Vegetable, fruit seeds, and other foreign bodies . 4) Intestinal worms (ascarids), fibrosis, neoplasms.

Question 48

What are the histological findings associated with acute appendicits?

Accepted Answer

Neutrophil invasion. Serosal exudate.

Question 49

What is the Alvarado scale used for and what are the characteristics used to evaluate score?

Accepted Answer

Used to evaluate need for imaging and surgical consult of a possible case of acute appendicitis. Characteristics are MANTRELS: M= Migration of pain to the RLQ A= anorexia N=nausea and vomiting T= tenderness in RLQ (2 points) R= rebound pain E= elevated temperature L= leukocytosis (2 points) S= shift of WBC to the left Score ≥ 7=surgical consult Score of 4-6=CT scan Score ≤ 3=no CT scan

Question 50

What are the conventional treatments for acute appendicitis?

Accepted Answer

Appendectomy to prevent perforation. If perforation already occurred, additional treatment of IV antibiotics and fluid replacement. If abscess is present, incision and drainage. Nonoperative management with antibiotics is an alternative, but has a reccurence of 12-20% in the 1st year.

Question 51

What is a Meckel diverticulum? Is it considered a true or false type of diverticulitis? What organ is usually involved in this condition? Be specific. The presentation of this condition is similar to what other? How can I rule out differentials (2 ways)? How does this commonly present/manifest in young children? What histological findings are expected for a Meckle diverticulum?

Accepted Answer

Meckel diverticulum is a true congenital diverticulum arising from failed developmental obliteration of the vitelline (AKA omphalomesenteric) duct. Typically results in a diverticulum of the ileum that is often associated with a fibrous band connecting the diverticulum to the umbilicus. 1) Meckel's diverticulitis can give rise to a clinical picture similar to that of acute appendicitis. CT scan may be helpful in making the diagnosis. 2) A Meckel scan, using radioisotope 99mTc-pertechnetate which is taken up by gastric mucosa, can aid in the identification of a Meckel diverticulum. Younger children (10 yo or less) usually present with hemorrhage (due to bleeding caused by heterotopic gastric mucosa that can be present in a Meckel diverticulum). Histology: often see gastric mucosa (less commonly pancreatic mucosa), neutrophils and serosal exudate when acutely inflamed.

Question 52

Describe the pathophysiologic similarities between acute appendicitis and Meckel diverticulitis.

Accepted Answer

Cause: luminal obstruction, leading to swelling, ischemia, and bacterial overgrowth. If not treated, can lead to perfortation and subsequently abscess fomation or peritonitis. Common obstruction: enterolith (Meckel) and fecalith (acute appendecitis).

Question 53

What are the differences between acute appendicitis and Meckel diverticulitis?

Accepted Answer

Epidemiology for MD: 2:1 male:female predominance. Obstruction usually occurs in older children (>10 yo) and adults. Younger children usually present with hemorrhage (bleeding from heterotopic gastric mucosa). Depending on the distance of the diverticulum from the ileocecal valve, the location of maximal abdominal tenderness may be in the mid lower abdomen or LLQ. For AA: Occurs in people between the ages of 10-30 years old, usually. Hemorrhage due to rupture of ulceration may happen, but not a finding most often seen in a specific demographic. Pain is located in periumbilical region at first, then moves to RLQ within 48 hours of onset.

Question 54

What are the risk factors for ectopic pregnancy? Ectopic pregancies are usually diagnosed at what gestational age?

Accepted Answer

Impaired movement of the fertilized ovum to the uterine cavity due to dysfunction of the tubal cilia or due to scarring or narrowing of the tubal lumen. Conditions causing damage to the fallopian tube pose the highest risk for subsequent ectopic pregnancy: surgical history of tubal ligation, assisted reproductive techniques, pelvic inflammatory disease, IUD, in utero exposure to diethylstillbestrol, previous ectopic pregnancy, history of endometriosis, sexually transmitted gonorrhea/chlamydia, cigarette smoking. Most cases of ectopic pregnancy present at gestational age of 4-12 weeks.

Question 55

What are the common symptoms and signs of an ectopic pregnancy? How does a ruptured ectopic pregnancy manifest?

Accepted Answer

Ipsilateral abdominal pain (if ectopic pregnancy is in right fallopian tube abdominal pain is often in right lower quadrant). Nausea and vomiting. Irregular vaginal bleeding (50% of cases) or cessation of menstrual bleeding. Usually afebrile (even in cases of rupture). Abdominal and/or pelvic tenderness to direct palpation. May have guarding and/or rebound tenderness. In cases of rupture of the ectopic pregnancy with significant intraperitoneal bleeding, signs of shock such as pallor, tachycardia, and hypotension may be present.

Question 56

What findings in lab and imaging support a diagnosis of ectopic pregnancy?

Accepted Answer

Positive β-HCG (human chorionic gonadotropin) test. Serial quantitative serum β-HCG levels normally increase by at least 66% every 48 hours in the first 8 weeks of pregnancy. A deviation from the normal rise should raise suspicion for ectopic pregnancy. Progesterone value of greater than 25 ng/mL excluded ectopic pregnancy with 97.4% certainty. Furthermore, levels of 5 ng/mL or less indicated a nonviable pregnancy, ectopic or intrauterine, and excluded normal pregnancy with 100% sensitivity. Although inexpensive, the usefulness of serum progesterone is limited by the fact that a significant number of results fall in the equivocal range of 5-25 ng/mL. Transvaginal US (TVUS) is the gold standard for diagnosis. Failure to visualize a normal intrauterine gestational sac in a patient with a significant positive serum β-HCG level suggests the possibility of an ectopic pregnancy.

Question 57

Treatments for ectopic pregnancy?

Accepted Answer

Methotrexate for unruptured tubal pregnancy or for treatment of remaining ectopic pregnancy tissue after laparoscopic salpingostomy (cut into tube and remove ectopic pregnancy tissue). Preferred in patients who wish to maintain fertility. Slightly higher recurrence rate because persistent ectopic pregnancy tissue remains in the fallopian tube in 5-20% of cases. Salpingectomy (removal of fallopian tube) is indicated for uncontrolled bleeding, recurrent ectopic pregnancy, severely damaged tube, patient desire for sterilization.

Question 58

What are the risk factors of urolithiasis?

Accepted Answer

Predominant age: Mean age is 40-60 years. Predominant sex: Male > Female (˜2:1) Diet rich in protein, refined carbohydrates, and sodium Occupations associated with a sedentary lifestyle or with a hot, dry workplace Incidence rates peak during summer secondary to dehydration Obesity Family history Genetics - up to 20% of patients have a family history. However, spouses of those who form stones have higher calcium excretion rates than controls, suggesting strong dietary-environmental factors. Caucasian> African American in regions with both populations Pregnancy Surgically/Medically induced malabsorption (Crohn disease, gastric bypass, celiac disease) In children: Usually due to malnutrition

Question 59

What are the usual signs and symptoms of urolithiasis?

Accepted Answer

Acute and severe flank pain (may be intermittent aka colicky) Ipsilateral abdominal pain (if stone is the right ureter the abdominal pain is often in right lower quadrant) Pain radiating to groin Nausea and vomiting Low-grade fever without signs of infection Infectious origin: Associated with high-grade fevers Polyuria, dysuria, hermaturia May have costovertebral angle tenderness to percussion or palpation

Question 60

What lab and imaging findings support a diagnosis of urolithiasis?

Accepted Answer

Urinalysis: blood, leukocytes. Culture and sensitivity tests if infection is suspected. Stone analysis after it’s been passed. CT scan of abdomen and pelvis. If the patient is pregnant, opt for ultrasound.

Question 61

Treatments for urolithiasis?

Accepted Answer

Hydration, pain medication, calcium channel blockers, terazosin About 75-90% of patients will pass the stone spontaneously, but Stones larger than 6 mm usually require physician intervention. ESWL (extracorporeal shock wave lithotripsy) Use sound waves (aka shock waves) to break stone into pieces Ureteroscopy with stone extraction Open surgery is uncommon

Question 62

What is hematopoiesis? Where does it take place?

Accepted Answer

The process of production, multiplication, and specialization of blood cells. This process allows for the production of all the types of blood cells from a hematopoietic stem cell. Typically occurs in the bone marrow.

Question 63

What grade of non-Hodgkin lymphoma is characterized by: Affects adults. Slow progression. Small, mature, monotonous cells. Typically not curable. Small lymphocytic lymphoma, follicular lymphoma.

Accepted Answer

Low grade

Question 64

What grade of non-Hodgkin lymphoma is characterized by: Affects adults and children. Rapid progression. Larger, varied cells. May be curable. Diffuse large B cell lymphoma, mantle cell lymphoma.

Accepted Answer

High grade

Exam 3: Pelvis and Perineum

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