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OBGyn > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Are uterine leiomyomas hormonally responsive?

A
  • High E states like pregnancy may induce their growth
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2
Q

Tx of intraductal papillomas

A
  • Duct excision
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3
Q

Most common hypothalamic-pituitary dysfunction leading to amenorrhea? Tx?

A
  • Functional (weight loss, excessive exercise, obesity). - Tx by modifying behavior, by stimulating FSH/LH or by giving exogenous hormones
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4
Q

T/F. Imaging should not be done before breast biopsy for workup of mass

A
  • False. Do imaging before biopsy. Biopsy can alter appearance.
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5
Q

Embryologic origin of dermoid cyst (aka mature teratoma)?

A
  • Germ cell tumor containing all three germ layers
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6
Q

Does body weight affect menarche

A
  • Moderately obese girls have earlier menarche. Morbidly obese girls and intense exercisers with normal weight have delayed menarche.
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7
Q

5-year survival of breast cancer at stage II

A
  • 93%
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8
Q

What lab studies should be ordered on partner when evaluating female for infertility?

A
  • Semen analysis with morphology
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9
Q

What is radical hysterectomy?

A
  • Resection of uterus and cervix, pelvic side wall, upper 2/3rds vagina, pelvic nodes, sampling of para-aortic nodes
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10
Q

Describe progression from normal to CIN1, CIN2, CIN3, CIS and invasive cervical cancer

A

** - Normal: BM, basal cells, parabasal cells, superficial cells - Mild dysplasia (CIN1): atypia in basal cell layer (lower 1/3rd) - Moderate dysplasia (CIN2): dysplasia to basal cell and parabasal cell layers, not upper 1/3rd - Severe dysplasia (CIN3): dysplasia in all layers with some normal cells present - CIS: dysplasia in all layers of cells with all cells affected - Invasive: invasion of dysplastic cells through basement membrane

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11
Q

Most common malignant ovarian tumor? Histological features?

A
  • Serous cystadenocarcinoma. Psammoma bodies.
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12
Q

Define menorrhagia

A
  • Prolonged (> 7 days) or excessive (> 80 ml) uterine bleeding at regular intervals
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13
Q

HPV screening recommendation for women 21-29

A
  • Begins at age 21 - Test with cytology alone q 3 years - Co-testing not recommended d/t high prevalence of infection and low incidence of cervical cancer
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14
Q

Define polymenorrhea

A
  • Uterine bleeding occurring at regular intervals of less than 21 days
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15
Q

Rare uterine cancers

A
  • Uterine sarcomas (
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16
Q

Tx of Paget’s disease

A
  • Treat with wide local excision
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17
Q

What is Bartholin’s gland cyst?

A
  • Obstruction of mucous-secreting glands
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18
Q

Microscopic findings of medullary carcinoma of breast

A
  • Fleshy, cellular, lymphocytic infiltrate
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19
Q

Tx of complex breast cysts?

A
  • Surgical excision if discordance bw imaging and path results - If concordant: CBE, US and mammogram q 6-12 mo for 1-2 years
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20
Q

Define hypomenorrhea

A
  • Cycle length of 2 days or less or also can be a reduction in flow
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21
Q

What endometrial thickness is abnormal in post-menopausal women?

A
  • 4 mm
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22
Q

Progression from normal duct to invasive ductal carcinoma

A
  • Normal duct => ductal hyperplasia => atypical hyperplasia => DCIS => invasive ductal carcinoma
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23
Q

What are skip lesions?

A
  • Found in cervical adenocarcinomas, more aggressive cancer. These start in multiple areas, therefore skip.
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24
Q

What lab studies should be order when evaluating female for infertility?

A
  • UA, vaginal culture, pap smear, wet mount - CBC, TSH, T4, day 3 FSH, prolactin, DHEA-S and total testosterone if signs of masculinization - BBT or ovulation predictor kit (LH) - Day 21 serum progesterone test (when highest in cycle and sign of ovulation) - 17-hydroxy P if late-onset CAH with anovulation and androgen excess
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25
Q

Are fibroadenomas precursors to breast cancer?

A
  • No
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26
Q

Common locations of ectopic pregnancies. What is most common?

A
  • Most common = tubal - Others = ovarian > interstitial (intramural uterine) > abdominal
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27
Q

Tx of vulvar dermatitis

A
  • Remove offending agent - Good perineal hygiene - 5% solution of aluminum acetate several times / day followed by drying - Topical corticosteroids - Oral antipruritic agents at bedtime
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28
Q

How to health needs for elderly women differ than younger?

A
  • Significant health issues, visits need extra time (eg. For hormone replacement), surveillance for malignancies/osteoporosis, pelvic still advised periodically (maybe annually), counsel for hearing/vision/injury prevention, coordinate care with other providers
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29
Q

What cancers is Paget disease of nipple associated with?

A
  • DCIS or IDC
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30
Q

Where is human placental lactogen produced (aka human chorionic somatomammotropin) produced? Role?

A
  • Produced in STBs of placenta - Role: fetal metabolism, fetal growth and development, stimulates production of IGF, insulin, adrenocortical hormones, surfactant
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31
Q

Risk factors for endometriosis

A
  • Early menarche (
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32
Q

Changes to following structures during menstrual cycle a. Endocervix b. Breasts c. Vagina

A

a. Endocervix: Increased cervical mucous facilitates sperm capture, storage and transport b. Breasts: more tenderness and fullness in luteal phase 2nd to progesterone c. Vagina: E increases lubrication which facilitates intercourse

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33
Q

What is Mondor’s disease?

A
  • Phlebitis of thoraco-epigastric vein. Feels like a lump of string.
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34
Q

What does PE look like for 21+ year old female?

A
  • Annual HT, WT, BMI, BP - Neck, thyroid, breasts, abdomen, pelvic exam, skin
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35
Q

Microscopic findings of invasive lobular carcinoma of breast

A
  • Indian file strands of neoplastic cells (see L11): cells follow each other one by one - Cells small and uniform - Dense stroma
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36
Q

Tx of abnormal cervical lesions

A
  • Ablative (cryo), excisional (LEEP, cone biopsy)
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37
Q

Define pubarche

A
  • Onset of pubic hair occurring at ~ 12 accompanies by axillary hair growth. Note: follows thelarche, precedes menarche by ~ 2 years. AA girls can have pubarche before thelarche.
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38
Q

Mgmt. strategies for ectopic pregnancies

A
  1. Medical: methotrexate 2. Surgical: salpingectomy (take it out) and salpingotomy (opening)
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39
Q

What is an endometrioid cyst?

A
  • This is endometriosis within ovary with cyst formation. Can become filled with blood and called chocolate cyst.
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40
Q

Theories of pathogenesis of endometriosis

A
  1. Retrograde menstruation (aka Sampson theory): during menstruation, some blood flows out fallopian tubes into pelvic cavity, direct implantation of endometrial cells with predilection for ovaries and pelvic peritoneum and in abdomen and episiotomy scar 2. Vascular/lymphatic dissemination (aka Halban theory): distant sites of endometriosis explained by this theory 3. Coelomic metaplasia (aka Meyer theory): multipotential cells in peritoneal cavity under certain conditions develop into functional endometrial cells
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41
Q

See L14 cases

A

See L14 cases

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42
Q

How is uterine leiomyoma diagnosed?

A
  • PE: midline, irregularly contoured mobile mass, hard/solid feel - US - CT/MRI if large
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43
Q

Describe staging of cervical cancer with 5-year survival

A
  • Stage 2 (involvement of vagina except lower 1/3rd and not pelvic wall) or less has 75% of higher 5-year survival with tx.
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44
Q

Describe management of endometrial hyperplasia

A
  • Progesterone (causes withdrawal bleeds by counteracting effects of estrogen-induced hyperplasia) - If severe bleeding, hysterectomy
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45
Q

Classifications of ovarian neoplasm. Which is most common?

A
  • Classified based on origin 1. Surface epithelial = most common 2. Stromal 3. Germ cell tumors 4. Metastatic tumors
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46
Q

Cell types seen with low-grade squamous intraepithelial lesions of cervix

A
  • Koilocytes
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47
Q

At what BHCG level can you see an IUP gestational sac via abdominal probe US?

A
  • 6000
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48
Q

Causes of urge incontinence

A
  • UTIs or vaginal infections - Bladder stones/tumor - Neurological causes (injury, MS, Parkinson’s)
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49
Q

Pre-malignant conditions of vulva

A
  • Paget’s dz - Vulvar intraepithelial neoplasia (VIN)
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50
Q

Elements of dermoid cyst?

A
  • Teeth, hair, sebum, bone, cartilage. Can also contain functional thyroid tissue.
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51
Q

What is a choriocarcinoma? Clinical features?

A
  • Highly malignant, uncommon, neoplasm of trophoblastic cells derived mostly from complete moles (50%). Also from normal pregnancies, spontaneous abortions and ectopic pregnancies. - Clinical features: irregular spotting of brown, bloody, foul-smelling fluid; irregular HCG levels
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52
Q

Typical conditions associated with PCOS

A
  • Obesity, T2DM, OSA, dyslipidemia, infertility, autoimmune thyroiditis, mood disorders
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53
Q

What is the corpus luteum?

A
  • Temporary endocrine gland that synthesizes estrogen and progesterone in the luteal phase. - It is formed from thecal, granulosa, fibroblast, endothelium, immune cells and lipids.
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54
Q

Risk factors for endometrial cancer

A
  • Unopposed E - Menopause after 52 years - Obesity - Nulliparity - DM - Feminizing ovarian tumors - PCOS - Tamoxifen therapy
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55
Q

When is thyroid testing needed for women?

A
  • Q5 years after age 50
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56
Q

Tx of choriocarcinoma

A
  • VERY RESPONSIVE TO CHEMO
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57
Q

Tx of VaIN

A
  • Local resection/ablation - 5-FU topically - F/U: colpo q 6 months until disease-free for 2 years then annually
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58
Q

Causes of stress UI

A
  • Pregnancy and childbirth - Pelvic injury / surgery - Estrogen deficiency: E keeps tissues moist and plump. With loss, tissues become thin and atrophic and urethral opening appears larger. - Weak pelvic floor muscles - Back injury or surgery
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59
Q

Are intraductal papillomas pre-malignant?

A
  • Not
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60
Q

What are the non-surgical tx options for pelvic organ prolapse?

A
  • PT, pessary (device placed into vagina to support uterus/bladder/rectum)
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61
Q

Microscopic findings of inflammatory carcinoma

A
  • Dermal lymphatic invasion - Neoplastic cells block lymphatic drainage
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62
Q

Most common uterine cancer

A
  • Adenocarcinoma
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63
Q

Most common type of vulvar cancer

A
  • Squamous cell carcinoma
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64
Q

Describe Tanner pubic hair staging

A

** - Stage PH1 (aka preadolescent): none - Stage PH2: sparse growth of long, slightly pigmented, downy hair, straight or only slightly curled appearing chiefly along labia - Stage PH3: hair darker, coarser and curlier, spreads to extend sparsely over junction of the pubes - Stage PH4: hair adult in type, spreads over mons, but not to medial surface of thighs - Stage PH5 (aka mature): hair adult in quality and type, spreads to medial surface of thighs, distribution in inverse triangle forms classic feminine pattern

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65
Q

What other cancers should VIN patients be checked for?

A
  • 60% of them have CIN (cervical)
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66
Q

What does PE look like for 13-20 year old female?

A
  • HT, WT, BMI, BP - Tanner staging in early teens - Pelvic ONLY if indicated, external genital exam appropriate - Skin
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67
Q

What should be evaluated on male PE for infertility?

A
  • Signs of under-masculinization like gynecomastia, small testes - Testicular exam - Hernias, varicosities
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68
Q

Describe age-specific and risk identification history-taking for the following age groups a. 13-18 b. 19-39 c. 40-64 d. 65+

A

a. 13-18: Risk-taking behavior, sexual practices, driving habits, etoh, drugs, eating disorders b. 19-39: Nutrition, physical activity, sexual practices, pregnancy desires, contraception concerns, etoh, smoking, drug use, IPV (intimate partner violence), breast CA risk assessment c. 40-64: menopause sx, sexual function, incontinence d. 65+: nutrition, ADLs, fall prevention, abuse or neglect

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69
Q

What is stuma ovarii?

A
  • Hyperthyroidism secondary to dermoid cyst with functional thyroid tissue secreting T3/4
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70
Q

When is operative management of ovarian cyst indicated?

A
  • Any child with a pelvic mass - Any reproductive age woman with persistent cyst > 6 cm or complex or symptomatic mass - Any menopausal woman w/ persistent or complex mass
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71
Q

Define intermenstrual bleeding

A
  • Bleeding of variable amounts between regular periods
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72
Q

In what age group are malignant breast tumors more common?

A
  • Postmenopausal
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73
Q

Causes of pelvic floor damage/problems in women

A
  • Pregnancy, delivery - Strenuous activity, chronic cough, smoking, chronic constipation, gravity, genetics
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74
Q

Presentation of ectopic pregnancy

A
  • First TM bleeding, abdominal / pelvic pain, asymptomatic sometimes
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75
Q

What takes over production of progesterone and estrogen after the CL if pregnancy occurs?

A
  • STBs of placenta
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76
Q

When should HPV screening begin?

A
  • At age 21 regardless of first intercourse
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77
Q

Most common gynecologic malignancy?

A
  • Endometrial. Primarily a tumor in post-menopausal women.
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78
Q

What is a lactating adenoma? Tx?

A
  • Benign stroma tumor occurs only in association with gestation. Typically seen from third TM through period of lactation. Regresses spontaneously after cessation of breast feeding. - Clinically: firm, mobile and non-tender. - Tx: bromocriptine induces shrinkage. Surgical excision is persistent.
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79
Q

How long does normal puberty take in girl?

A
  • ~ 4.5 years
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80
Q

What is a Krukenberg tumor?

A
  • **GI malignancy which metastasizes to ovaries causing mucin-secreting signet cell adenocarcinoma (mucin pushes nuclei to edge of cell)
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81
Q

Most common mucinous ovarian tumor? Percentage of tumors in this category that are malignant?

A
  • Mucinous cystadenoma = benign. 10% of tumors in this category are malignant.
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82
Q

Tx of ovarian torsion

A
  • Surgery (untwisting or removal)
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83
Q

Tx of fibrocystic breast disease?

A
  • Reassurance. D/C hormones/estrogen. Avoid caffeine/xanthine. These exacerbate fibrocystic disease.
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84
Q

What are the major factors that dictate the timing of puberty? Minor determinants?

A
  • Major = genetics - Minor = nutritional status, general health, geographic location
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85
Q

Route of metastasis of endometrial cancers

A
  • Lymph nodes or local extension - Rarely hematogenous
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86
Q

What is sperm capacitation?

A
  • Increased motility and preparation for acrosome reaction.
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87
Q

Typical sequence of pubertal development?

A
  • Accelerated growth, thelarche, pubarche, menarche
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88
Q

Do simple breast cysts have risk for cancer?

A
  • No
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89
Q

HPV screening recommendation for women 30-65

A
  • Co-testing (cytology & HPV q 5 years) preferred - Screening with cytology q 3 years acceptable - Discontinue > 65 if adequate negative screening and no hx of CIN2 or higher or total hysterectomy
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90
Q

Bi-RADS results of mammography

A
  • BiRADS1: normal mammogram - 2: benign - 3: probably benign, short interval follow-up suggested - 4: suspicious for malignancy - 5: strongly suggestive of malignancy - 6: imaging in patient with known malignancy
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91
Q

Most common cervical cancer

A
  • Squamous cell
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92
Q

Define fecundability

A
  • Ability to conceive within a given month/cycle
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93
Q

When is chlamydia screening needed for women?

A
  • Age 25 or less if sexually active
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94
Q

After having MTX for ectopic pregnancy, woman experiences increased abdominal pain and rise in BHCG. Should you take her off the drug?

A
  • No. This is usual effect. BHCG rises days 1-3.
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95
Q

What is the risk of abnormal uterine bleeding?

A
  • Endometrial cancer. Chronic unopposed E leads to endometrial proliferation, followed by hyperplasia and ultimately cancer.
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96
Q

Presentation of proliferative breast disease?

A
  • PMS breast pain and multiple lesions - Usually no increased risk for cancer
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97
Q

Populations that don’t fit standard HPV screening protocol

A
  • HIV infections, immunocompromised, previously tx for CIN2/3 or cancer
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98
Q

DeLancey level 2 loss of support results in what?

A
  • Cystocele, rectocele d/t loss of mid-level support
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99
Q

How to test for hypermobile urethra?

A
  • Insert Q-tip. > 30 degrees from horizontal = hypermobile.
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100
Q

Types of malignant breast tumors

A
  1. Noninvasive: DCIS (subtype = comedocarcinoma), Paget dz 2. Invasive: invasive ductal, invasive lobular, medullary, inflammatory
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101
Q

What is duct ectasia?

A
  • Non-proliferative breast disorder. Dilated duct that widens and duct walls thicken, filling duct with fluid. Milk duct can become blocked with substance. Can be asymptomatic or present as nodule or nipple discharge. Infection can cause periductal mastitis.
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102
Q

What anatomy is important to know?

A

What anatomy is important to know?

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103
Q

When is glucose testing needed for women?

A
  • Q3 years after 45
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104
Q

Tx of vaginal cancer

A
  • Stage I and II = surgical resection - Stage III and IV = radiation
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105
Q

Define amenorrhea – primary and secondary.

A
  • Amenorrhea = absence of menstruation for 6 months - Primary = female who has never menstruated by age 13 without secondary sex development or by age 15 with secondary sex development - Secondary = if a previously menstruating female has not menstruated for 3 to 6 months
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106
Q

How is endometriosis diagnosed?

A
  • Suspect in patients with dysmenorrhea that doesn’t respond to oral contraceptives or NSAIDs - Normal pelvic exam - Imaging studies if pelvic mass, otherwise not helpful - CA125 has limited utility - Trial of GnRH agonist (leuprolide): initially surge FSH/LH with worse flare and then with subsequent dosing, negative feedback loop is engaged and everything is shut down. - Definitive diagnosis with tissue bx and histology (looking for endometrial glands and stroma)
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107
Q

See L9 cases

A

See L9 cases

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108
Q

Review stats from L1

A

Review stats from L1

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109
Q

With gynecologic cystic structure most often times leads to torsion of ovaries?

A
  • Benign cystic teratoma (weighty structure)
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110
Q

Non-gynecologic non-neoplastic origin for adnexal mass

A
  • Appendiceal abscess, diverticulosis, adhesions, peritoneal cyst, feces in rectosigmoid, urine in bladder, pelvic kidney, urachal cyst
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111
Q

What is VaIN (vaginal intraepithelial neoplasia)?

A
  • Premalignant neoplasia of vagina
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112
Q

Histologic types of proliferative breast disease

A
  1. Fibrosis 2. Cystic changes 3. Sclerosing adenosis 4. Epithelial hyperplasia
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113
Q

Define metrorrhagia

A
  • Bleeding at irregular but frequent intervals of variable amount
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114
Q

What should be evaluated on female PE for infertility?

A
  • Weight, BMI, skin (acne, hirsutism, acanthosis nigricans), visual fields, goiter, galactorrhea, pelvic exam
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115
Q

What is function of progesterone under the luteal phase?

A
  • Endometrial differentiation and secretory development. This creates an environment rich in nutrients.
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116
Q

Predictive factors for recurrence of ectopic pregnancy

A
  • 30% if patient has had 2+ ectopics
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117
Q

How does raid loss vs delayed/incomplete loss of endometrium correspond to duration of menstrual blood flow?

A
  • Rapid loss = short duration flow - Delayed / incomplete = heavier flow and greater blood loss
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118
Q

Gold standard for vaginal vault prolapse repair

A
  • Sacrocolpopexy: y-shaped mesh, anchor to top of vagina with two pieces, tail piece to sacrum
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119
Q

Absolute indications and contraindications to methotrexate use as far as ectopic pregnancy mgmt.?

A
  1. Indications: hemodynamically stable patient, non-lap diagnosis, patient desires future fertility, general anesthesia poses a risk, pt able to comply with follow-up 2. Contraindications: breastfeeding, immune deficiency disorders, chronic liver dz, pre-existing blood dyscrasias, sensitivity to methotrexate, acute pulm disease, PUD
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120
Q

Mole vs hydatid

A
  • Mole: abnormal mass of tissue in uterus - Hydatid: cyst containing watery fluid
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121
Q

Causes of precocious puberty. What is most common?

A
  1. GnRH-dependent (aka true PP): early activation of HPG axis - Most common = idiopathic - Other = infection, inflammation, injury to CNS 2. GnRH-independent (aka pseudopuberty): production of androgens and E independently of HPG axis - Ovarian cysts/tumors, McCune-Albright syndrome, adrenal tumors, hormone and alternative medicinal ingestions
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122
Q

Tx of amenorrhea is hyperprolactinemia is the source

A
  • Tx with cabergoline or bromocriptine. Check for underlying hypothyroidism.
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123
Q

Risk factors for cervical cancer

A
  • HPV 16 & 18 - Infection of squamocolumnar junction in cervix (transitional zone) - Early age at sexual debut - Multiple partners - Genital infections: HSV2, HIV - Cigarette smoking - Immunocompromise - DES exposure in utero
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124
Q

Management of most ovarian cysts?

A
  • Most functional (follicle or CL cysts) regress in 1-2 months
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125
Q

Presentation of vaginal cancer

A
  • Mostly asymptomatic, watery/blood-tinged discharge, postmenopausal bleeding, pruritus
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126
Q

Prevalence of ectopic pregnancies. Why is incidence rising?

A
  • 2% of all pregnancies. Note: most common cause of 1st TM pregnancy related deaths (9% of all pregnancy related death). - Rising: PID, IVF, early diagnosis (given technology)
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127
Q

Tx of amenorrhea if patient desires pregnancy

A
  • Induce ovulation with clomiphene citrate, human menopausal gonadotropins, pulsatile GnRH or aromatase inhibitors
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128
Q

Clinical features of choriocarcinoma

A
  • SOB, abnormal beta-HCG, hemoptysis. Spreads hematogenously to lung.
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129
Q

Prevalence of uterine leiomyoma?

A
  • 5th decade. Higher incidence in AA women.
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130
Q

What produces hCG? Function in pregnancy? When is it detectable? Peak?

A
  • STBs of placenta - Bind LH receptors and maintain CL to maintain ovarian steroidogenesis for first 8 weeks of gestation - Detectable at day 6-8 post-implantation, peaks at 10 weeks
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131
Q

Most common serous ovarian tumor? Percentage of tumors in this category that are malignant?

A
  • Serous cystadenoma = benign. 25% of tumors in this category are malignant.
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132
Q

Where do the substrates/ precursor androgens come from in pregnancy? What are these? Why is this necessary?

A
  • Maternal adrenal gland (DHEA), fetal adrenal gland (DHEA) and liver (16-hydroxy). Specifically DHEA or 16 alpha hydroxy DHEA. Not placenta! - This is essential for E production in placenta
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133
Q

Histologic appearance of breast sclerosing adenosis

A
  • Increased acini and intralobular fibrosis - Associated with calcification (often confused with cancer) - 1-2 time increased risk for cancer development
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134
Q

Most common type of breast cancer

A
  • Invasive ductal carcinoma - 80% are infiltrating ductal carcinoma!!!! - 10% are infiltrating lobular - Most breast cancers are ER/PR+, HER2Neu -
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135
Q

What is a follicular cyst? Clinical course?

A
  • Distended unruptured Graafian follicle - Insignificant unless lining secretes estrogen resulting in endometrial hyperplasia
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136
Q

Describe how the hormonal axis regulated by the CL transitions to pregnancy. Function of relaxin, progesterone and estrogen in pregnancy?

A
  • CL doesn’t regress if pregnancy occurs. hCG binds to receptors on theca and granulosa lutein cells stimulating steroidogenesis. - CL also secretes relaxin to inhibit myometrial activity - After week 8, maintenance of pregnancy is not dependent on the CL, but rather the placenta. - Progesterone: suppress uterine contractions, inhibit PG synthesis, impact on immune response - Estrogen: stimulate uterine growth, thicken vaginal epithelium, growth and development of mammary epithelium, promote PG synthesis, oxytocin sensitization, inhibition of milk production
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137
Q

Tx for cervical cancer

A
  • Depending on stage - 1A1: large cold knife cone biopsy or simple hysterectomy - 1A2 + 2A: radical hysterectomy - 2B, III and IV: radiation tx + possible chemo
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138
Q

What is an imperforate hymen? Presentation? Tx?

A
  • Simplest genital tract anomaly resulting from incomplete canalization of genital plate. Menarche occurs normally, but little or no blood seen d/t hymenal obstruction. - Presentation: pelvic pain, bulging bluish vaginal introitus - Tx = hymenectomy
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139
Q

Morphologic features of granulosa cell tumors

A
  • Call-Exner bodies (resemble primordial follicles)
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140
Q

Presentation of vulvar cancer

A
  • Vulvar pruritus, vulvar pain, bleeding, usually unifocal
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141
Q

Define menometrorrhagia

A
  • Frequent bleeding that is excessive and irregular in amount and duration
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142
Q

Signs of abuse in adolescent pelvic exam?

A
  • Friable tissue, labia separate too widely, acquired hymenal abnormalities
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143
Q

In general, what is the difference between stress UI or urge UI in terms of treatments?

A
  • Stress UI treated with surgery - Urge UI with anticholinergic medications
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144
Q

Function of progesterone challenge test in infertility evaluation

A
  • Proves HPO axis is intact
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145
Q

Lab findings in hypergonadotropic hypogonadism

A
  • High FSH and LH with no E & P
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146
Q

Clinical features that help distinguish benign from malignant breast lumps

A
  1. Benign: painful, warm, bruising, thickening without mass, symmetrical, smooth borders, mobile, no skin dimpling, bilateral nipple discharge, multiple ducts 2. Malignant: painless, firm, bloody nipple discharge unilateral, skin dimpling, irregular margins, LAD, fixed to chest wall, nipple retraction
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147
Q

Risk factors for malignant breast tumors

A
  • Increased E exposure - Increased total # of menstrual cycles (early start, late end) - Older age at 1st live birth - Obesity/high fat diet - BRCA1 and 2 gene mutations - AA ethnicity - Radiation exposure
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148
Q

Where is vulvar cancer usually found?

A
  • Labia majora. Lesion presents as: cauliflower-like masses to hard indurated ulcers
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149
Q

Causes of ovarian dysfunction leading to amenorrhea

A
  • Chromosomal - Other = Gonadotropin-resistant ovary syndrome, premature natural menopause, autoimmune ovarian failure
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150
Q

Compare and contrast the laboratory findings/diagnosis for BV (bacterial vaginosis), vulvovaginal candidiasis, trichomoniasis, atrophic vaginitis

A
  1. BV: pH>4.5, KOH test/whiff test +ve amine odor, microscopy (clue cells which are epithelial cells with cocci bacteria attached). Gold std = gram stain. Dx usually made clinically by ¾: abnormal gray discharge, ph > 4.5, +ve whiff, +ve clue 2. Candidiasis: microscopy (visualization of blastospores or pseudohyphae on saline or KOH slide), ph 4-5 3. Trich: microscopy (trichomonads + WBCs), can use nucleic acid probe test 4. Atrophic vaginitis: ph 4.7+, clinical diagnosis, see presentations
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151
Q

Two categories of stress UI

A
  1. Hypermobility: loss of urine related to movement of bladder neck and urethra d/t abdominal straining 2. Intrinsic sphincter deficiency: leakage related to intrinsic weakening of bladder outlet closure mechanism
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152
Q

Most common malignant ovarian tumor among children and adolescents? Tumor markers?

A
  • Dysgerminoma. HCG & LDH.
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153
Q

Define oligomenorrhea

A
  • Cycle frequency of greater than 40 days but less than 6 months
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154
Q

Staging of cervical cancer

A

0: CIS 1: confined to cervix (1B = lesion apparent clinically) 2: extends beyond cervix either to vagina or parametrium, but not to lower 1/3rd of vagina or pelvic side wall 3: extends to lower 1/3rd vagina or pelvic side wall and/or causes hydronephrosis or non-functioning kidney 4: extends beyond true pelvis or involves mucosa of bladder or rectum

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155
Q

What is the most common form of CAH? How does this present in infancy? What is late onset? Lab work found in this disorder?

A
  • Most common = 21-hydroxylase deficiency (excess androgens) - Early-onset: ambiguous genitalia - Late-onset seen in adolescence typically: premature adrenarche, anovulation and hyperandrogenism (similar to PCOS). - Labs: 17-OH progesterone = pathognomonic for 21-hydroxylase deficiency
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156
Q

Imaging characteristics of simple breast cysts?

A
  • Thin-walled, non-septated fluid filled structure
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157
Q

5 year survival for breast cancer

A
  • Stage 2 or below has 75% 5 year survival or higher
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158
Q

Most common organism responsible for breast infection? Tx?

A
  • Staph aureus. Tx = dicloxacillin or 1st gen cephalosporin. MRSA: TMP/SMX or vanco.
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159
Q

Etiologies of delayed puberty.

A
  1. Hypergonadotropic hypogonadism - Turner syndrome (gonadal dysgenesis) 2. Hypogonadotropic hypogonadism - Constitutional (physiologic) delay: most common - Other = nutritional status (chronic dz, poor intake, malabsorption, poor nutrition, eating disorder, competitive endurance sports), hyperprolactinemia, Kallman syndrome, craniopharyngioma 3. Anatomic causes - Mullerian agenesis - Imperforate hymen - Transverse vaginal septum
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160
Q

Are Brenner tumors benign?

A
  • Mostly benign
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161
Q

How do females develop embryologically?

A
  • In absence of SRY gene on Y, the mesonephric (Wolffian) ducts degenerate and the paramesonephric (Mullerian) ducts develop. - Gonads arise from intermediate mesoderm in urogenital ridges of embryo - Paramesonephric ducts give rise to upper 1/3rd vagina, cervix, uterus and fallopian tubes - Urogenital sinus gives rise to lower 2/3rd vagina, bulbourethral glands and vestibule
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162
Q

Presentation of breast carcinoma

A
  • Painless mass - Other complaints: skin dimpling, ulceration, nipple retraction or discharge, Peau d’orange, abnormal mammogram (pleomorphic microcalcifications)
163
Q

Causes of amenorrhea. What is the most common cause?

A
  1. Pregnancy (most common) 2. Hypothalamic-pituitary dysfunction (see next flash card) 3. Ovarian dysfunction 4. Alteration of genital outflow tract
164
Q

Function of insulin in PCOS

A
  • Increases ovarian androgen production = inhibition of hepatic SHBG production = increased free androgens = alteration of follicular development** ** want follicular development to be more on FSH side and less on LH side otherwise follicles never fully develop
165
Q

Tx of abnormal uterine bleeding

A
  • Give progestin for 10-14 days, which mimics the physiologic withdrawal of P - OR - Combo oral contraception to suppress endometrium and also establish a regular withdrawal cycle - For acute bleeding: give high dose E and or P. If E, follow by P to counteractive proliferation you have caused. If not responsive to medical mgmt., tx with D&C, endometrial ablation or hysterectomy.
166
Q

What is Kallman syndrome? Tx?

A
  • Arcuate nucleus of hypothalamus does not secrete GnRH and olfactory tracts are hypoplastic. - SSx = delayed puberty (no breast development), little or no sense of smell - Tx = exogenous hormones or pulsatile (non-continuous use) GnRH. Note: non-continuous increases FSH/LH.
167
Q

When is bone density screening needed for women?

A
  • 65+ unless other risks
168
Q

How quickly does BHCG rise in first trimester?

A
  • Roughly doubles every 48 hours
169
Q

Presentation of Paget disease of the nipple

A
  • Type of breast cancer - Starts in breast ducts and spreads to skin of nipple and then to areola - Skin of nipple and areola appears crusted, scaly and red with areas of bleeding/oozing. May be itchy / burning.
170
Q

Clinical presentation of endometrial cancer

A
  • Post-menopausal bleeding (90% of endometrial cancers). Note: most women with post-menopausal bleeding don’t have cancer or atypical hyperplasia. - Asymptomatic (may have abnormal endometrial cells on cytology screening) - Other = lower abdominal pain, hematuria, urinary frequency, rectal bleeding, constipation, hip / back pain, abdominal distension
171
Q

Protective factors for endometriosis

A
  • Higher parity, increased duration of lactation, regular exercise
172
Q

Describe workup/evaluation of abnormal bleeding thinking endometrial hyperplasia

A
  • # 1 (per Shaw) = endometrial biopsy - US for mass, anomalies, endometrial thickness - If advanced dz suspected: CT, MRI - Hysteroscopy D&C - Blood work
173
Q

Types of pelvic floor prolapse

A
  • Anterior compartment prolapse: Cystocele, cystourethrocele, hypermobile urethra - Posterior compartment prolapse: rectocele - Apical vaginal prolapse: vaginal vault prolapses - Uterine prolapse
174
Q

Most common gynecologic cancer in world?

A
  • Cervical
175
Q

Causes of gynecomastia in males

A
  • Hyperestrogenism: cirrhosis, testicular tumor, puberty, old age - Klinefelter - Drugs: spirono, marijuana, digitalis, estrogen, cimetidine, alcohol, heroin, dopamine D2 antagonists, ketoconazole
176
Q

HCG levels in placental site tumor?

A
  • Low HCG levels
177
Q

What is the acrosomal reaction that occurs with fertilization?

A
  • Sperm binds to zona pellucida. This reaction allows penetration of ZP by proteolytic degradation.
178
Q

When is BRCA testing warranted?

A
  • FHx of breast/ovarian cancers especially at young age - New dx of breast cancer under 45 yrs of age esp with family hx - Triple neg breast cancer at age
179
Q

Role of CRH in pregnancy? Where is it produced?

A
  • Role: spikes at end of pregnancy, onset of labor, PG production, maintains blood flow in placenta - Produced in STBs and TBs of placenta
180
Q

Is HPV testing alone (without cytology) a recommended screening test?

A
  • Not currently
181
Q

What are the lifelong complications from PCOS?

A
  • CV disease, DM2, endometrial cancer
182
Q

What are the risks for rupture of ovarian cysts?

A
  • Rupture: Pain d/t leakage of blood/prostaglandins. Know that when blood touches the peritoneum it is wildly painful. Mittelschmerz (midcycle pain). Hemoperitoneum - Torsion: ischemia
183
Q

See IDPH L19 SG for STIs

A

See IDPH L19 SG for STIs

184
Q

Compare and contrast the presentations of lichen sclerosis, lichen simplex chronicus and lichen planus

A
  1. Lichen sclerosis (chronic vulvar disease, common, age range from childhood to elderly) - Sx: commonly vulvar pruritus (severe, intolerable), often asymptomatic, other (burning, soreness, dysuria, dyspareunia, pain with defecation, constipation in children) - Lesion: atrophic, thin (cigarette / parchment paper) epithelium with perianal halo (keyhole) and shiny distribution 2. Lichen simplex chronicus (itch that rashes, usually 2nd to irritant dermatitis d/t detergent etc.) - Sx: progressive vulvar pruritus / burning temporarily relieved by scratching/rubbing - Lesion: diffusely reddened with occasional hyperpigmented / hyperplastic plaques of red to reddish brown 3. Lichen planus (rare inflammatory condition) - Sx: chronic vulvar burning/pruritus, insertional dyspareunia, profuse vaginal discharge - Lesion: erosive vaginitis (desquamation) with demarcated edges, white lacy network (Wickham striae) of keratosis near ulcerated-like lesions
185
Q

Staging of breast cancer

A
  • TNM - T0: no evidence of primary tumor, T2: tumor > 2 cm
186
Q

Most common pathogen that causes acute mastitis? How does it occur? Tx?

A
  • S. Aureus - Cracks in nipple from breastfeeding = increased risk of bacterial infection - Tx with dicloxacillin
187
Q

Describe how extent of endometrial cancer surgery is determined by myometrial invasion depth

A

Describe how extent of endometrial cancer surgery is determined by myometrial invasion depth

188
Q

Describe the layers/components of the placenta between the mother and the fetus. Label which belongs to fetus and which belongs to mother.

A
  1. Fetal component of placenta: STBs, CTBs, mesenchyme, fetal blood vessels 2. Intervillous space: blood trapped between fetal villous and maternal endometrium (no mixing) 3. Maternal component of placenta: decidual cells, maternal arteries and veins
189
Q

What is a hemorrhagic ovarian cyst? Clinical course?

A
  • When BV ruptures in cyst wall causing cyst to grow. Usually self-resolves.
190
Q

Compare and contrast the etiologies for BV (bacterial vaginosis), vulvovaginal candidiasis, trichomoniasis, atrophic vaginitis

A
  1. BV: polymicrobial infection characterized by lack of normal lactobacilli and overgrowth of various anaerobes 2. Candidiasis: 90% d/t C.albicans, not STI. More likely in pregnant, obese, diabetic, immunosuppressed, combo contraception use, steroid use or recent broad-spectrum abx use. Requires estrogenized tissue, therefore this is more prevalent in younger group. 3. Trichomoniasis: STI or fomites (swimming pools, hot tubs). Associated with other conditions (PID, endometriosis, infertility, ectopic, preterm birth) 4. Atrophic vaginitis: atrophy of vaginal epithelium d/t decreased E levels usually in postmenopausal women
191
Q

Histologic appearance of epithelial hyperplasia

A
  • Patient > 30 yo - Increase in epithelial cell layers in terminal duct lobules - Increased risk of cancer with atypia
192
Q

Mammographic and microscopic findings for DCIS

A
  • Mammography: pleomorphic microcalcifications, typically non-palpable - Microscopic: basement membrane intact, fills ductal lumen
193
Q

What is considered the 1st day of menstrual bleeding?

A
  • First day of full flow blood, not mucous
194
Q

Types of cervical cancer

A
  • squamous carcinoma - adenocarcinoma
195
Q

What is unique about cervical cancer staging?

A
  • Only gynecological cancer that is staged clinically!
196
Q

Compare and contrast the treatments of lichen sclerosis, lichen simplex chronicus and lichen planus

A
  1. Lichen sclerosis - Biopsy to rule out cancer, tx secondary infection, general care (bland emollients, 100% cotton underwear, avoid occlusive clothing, no soaps), superpotent class 4 steroid (clobetasol propionate) over extended period with reduction in use, oral steroids rarely required, surgery for adhesions/narrowing 2. Lichen simplex chronicus - Discontinue irritant use, tx empirically with antipruritic (diphenhydramine, hydroxyzine) combined with steroid (hydrocortisone or triamcinolone), trial of antidepressant to break itch/scratch cycle. Biopsy if not relieved in 3 months. 3. Lichen planus - Biopsy to confirm no atypias, vaginal discharge shows acute inflammatory cells without significant bacteria, histology (thinned, loss of rete ridges, lymphocytic infiltrate). Tx with topical steroid cream.
197
Q

Most common indication for hysterectomy

A
  • Uterine leiomyoma
198
Q

View L11 for normal breast tissue under microscopy

A

View L11 for normal breast tissue under microscopy

199
Q

What is McCune Albright syndrome? SSx?

A
  • Mutation causes ovary to produce E without need for FSH resulting in GnRH-independent precocious puberty. - SSx: multiple bone fx, café-au-lait spots, precocious puberty (may be first sign of syndrome)
200
Q

Significance about calcium lay down in body in puberty for girls?

A
  • About half of total body calcium is laid down during puberty.
201
Q

Are dermoid cysts malignant or benign?

A
  • Dermoid cysts = mature teratoma = benign
202
Q

Presentation of vulvar Paget’s disease

A
  • Chronic pruritus with velvety-red lesions that become eczematous and scar into white plaques. Fatal if spreads to lymph nodes. - More common in women over 60
203
Q

Describe antral follicular phase

A
  • Increase in follicular fluid, granulosa cells acquire LH receptors to respond to ovulation (induced by FSH, enhanced by E)
204
Q

Morphological features of yolk sac tumor

A
  • Yellow, friable/hemorrhage, solid mass, 50% have Schiller-Duval bodies (resemble glomeruli)
205
Q

Compare and contrast between a partial and complete mole in terms of: a. Path morphology b. BHCG findings c. Risk for malignancy

A
  1. Complete mole a. Uterus with large, bizarre, gelatinous mass with chorionic villi (AVASCULAR) that are edematous (grape-like appearance) with variable degrees of trophoblast proliferation. NO FETAL PARTS HERE. b. BHCG levels high >> normal pregnancy c. 10% chance of progressing to invasive mole, 2% of choriocarcinoma, US shows snowstorm image 2. Incomplete mole a. Uterus may not be large. Some, not all villi are edematous. FETAL PARTS/FETUS present. Slight trophoblastic hyperplasia. b. BHCG not has markedly elevated, but still high. c. Rarely evolves into invasive mole or choriocarcinoma
206
Q

What is the most common tumor associated with delayed puberty?

A
  • Craniopharyngioma
207
Q

Blood nipple discharge think…

A
  • Intraductal papilloma of breast = most common cause of bloody nipple discharge
208
Q

Gross and microscopic findings of invasive ductal carcinoma of breast

A
  • Gross: firm, fibrous, rock-hard mass with sharp margins - Microscopic: small, duct-like or glandular cells with collagenous stroma
209
Q

Tx for hypergonadotropic hypogonadism

A
  • GH initiated early to normalize adult height - E administered at normal time of puberty (low dose as high dose can close epiphyseal plates) - Progestins not given until Tanner stage IV (as you can prevent breast from developing completing = abnml contour)
210
Q

Define urinary incontinence?

A
  • Involuntary loss of urine
211
Q

How is it possible to get an increase in estrogen in the follicular phase, while estrogen exerts a negative feedback on the gonadotropins released from the anterior pituitary?

A
  • During the follicular phase: Rapid follicular growth (of granulosa and theca cells) is occurring. - Don’t need to memorize, but understand: E increases expression of FSH receptors resulting in increased granulosa cell sensitivity to FSH with more follicular secretion. E and FSH increase expression of LH receptors on theca cells. Rise in E and LH induce proliferation of thecal cells resulting in more follicular secretion.
212
Q

Presentation of granulosa cell tumor

A
  • These tumors often produce E and or P and present with abnormal uterine bleeding, sexual precocity and breast tenderness - Malignancy
213
Q

What is the sngl most useful test in evaluation of premature development?

A
  • Bone age. Correlates best with pubertal age.
214
Q

Clinical presentation of PCOS

A
  • Menstrual irregularities, acne, hirsutism, androgenic alopecia (temporal balding), obesity
215
Q

DeLancey level 1 loss of support results in what?

A
  • Uterine or vaginal vault prolapse d/t loss of apical support
216
Q

When do progesterone levels peak in luteal phase?

A
  • 8 days after LH surge (around day 21)
217
Q

Risk factors for breast cancer

A
  • Nulliparity, first pregnancy after age 30, fhx, phx, increasing age, early menarche/late menopause (exposed to estrogen longer), postmenopausal obesity (estrogen produced by fat), etoh, combination HRT, dense breast tissue, hx radiation therapy, BRCA1/2
218
Q

When you see Peau d’orange, what type of breast pathology do you think of?

A
  • Inflammatory carcinoma
219
Q

Is there a role for metformin in tx PCOS?

A
  • No longer recommended as first line or additive tx unless diabetic or glucose intolerant - Can restore ovulation in 50% of PCOS patients
220
Q

Most common sites of endometriosis

A
  • Most commonly on ovaries (typically bilaterally). - Other sites = posterior cul-de-sac (Pouch of Douglas, which is behind uterus, anterior to retctum), round ligament, Fallopian tubes, sigmoid colon - Rare = surgical scars/organs outside pelvis.
221
Q

SSx of pelvic floor prolapse

A
  • Pelvic pressure or pain - Bulging from the vagina - Dysparenuia or difficulties with intercourse - Difficulties voiding or evacuating bowels
222
Q

See L7 cases

A

See L7 cases

223
Q

When do hydatidiform moles manifest in pregnancy?

A
  • 4-5th month. Discordance between uterine size and dates. Also vaginal bleeding and possible expulsion of vesicles.
224
Q

Compare and contrast the presentations for BV (bacterial vaginosis), vulvovaginal candidiasis, trichomoniasis, atrophic vaginitis

A
  1. BV: odor (musty/fishy), discharge (thin gray-white to yellow), perhaps mild vulvar irritation 2. Candidiasis: odor (odorless), discharge (adherent cottage cheese), itching is most common, burning, external dysuria, dyspareunia, tissue bright red 3. Trich: odor (rancid), discharge (copious frothy yellow-green-gray), itching/burning, dysuria, dyspareunia, STRAWBERRY CERVIX (petechiae) in 10% of patients 4. Atrophic vaginitis: ph 4.7+, discharge (decreased), dry, itching, burning, dyspareunia, urinary sx (recurrent UTIs, UI, frequency)
225
Q

Risk for contralateral breast cancer after primary diagnosis of unilateral breast cancer without BRCA or family hx.

A

-

226
Q

Describe pre-antral follicular phase

A
  • Oocyte enlarges and surrounded by a single layer of granulosa cells and a membrane called zona pellucida
227
Q

Why is estrogen a risk factor for endometrial cancer?

A
  • Uncontrolled E = proliferation of endometrial cells without P opposition
228
Q

In what group is cervical cancer mortality rates the highest?

A
  • Black women, follows = Hispanic women
229
Q

Most common cause of infertility

A
  • PCOS: polycystic ovarian syndrome
230
Q

If a patient is diagnosed with trich, what else should they be screened for?

A
  • GC and chlamydia
231
Q

Gross and microscopic findings of fibroadenoma

A
  • Gross: small, mobile, firm with sharp edges - Microscopic: circumscribed, fibroblastic stroma enclosing glandular structures lined by epithelium
232
Q

How is abnormal uterine bleeding diagnosed?

A
  • Hx: bleeding not regular and not associated with PMS signs (breast tenderness, bloating etc) - Exclude: neoplasia, pregnancy complications, anatomic causes, infection, carcinoma, polyps, lesions in vagina - Biopsy to diagnose (see the chronic unopposed E stimulation effects)
233
Q

If conception is achieved after fertility, what should you do?

A
  • Check quant BHCG, maybe serum progesterone - Repeat quant in 48 hrs - Start P vaginal suppositories. Note: not EBM, just in case of unfound luteal phase defect. - TV US if quant > 1500, pelvic > 6500.
234
Q

Top 3 causes of death in women

A
  1. Heart disease 2. Cancer: lung, breast, colorectal (in order) 3. Stroke
235
Q

Risk factors for lesbian women compared to heterosexual women

A
  • Etoh abuse more common - Smoking 4 x greater in college age lesbians - Contraception use less often - Note: sexual abuse hx same
236
Q

Function of estrogen in follicular phase?

A
  • Proliferation of uterine endometrium (epithelial cells, stroma, endometrium glands), blood vessel development, mucus secretion
237
Q

What are special type of invasive breast cancer?

A
  • Medullary, mucinous, papillary, tubular. Most breast cancers are a mix of these. Tumors must be at least 90% pure to be labelled as such. - Better prognosis than infiltrating ductal carcinoma
238
Q

Most common location for malignant breast tumors

A
  • Upper-outer quadrant
239
Q

Most common cause of delayed puberty with elevated FSH?

A
  • Gonadal dysgenesis (Turner syndrome 45 XO)
240
Q

Function of acetic acid in colposcopy

A
  • Dehydrate squamous cells to improve visualization of abnormal areas. Dense nuclei cells appear white.
241
Q

Define precocious puberty. Define delayed puberty.

A
  1. Precocious puberty - Breast development in girls before 7 years (nml = 11) - Pubic hair development in girls before 8 (nml = 12) - Menstruation before 10 (nml = 12-13) 2. Delayed puberty - No secondary sex characteristics by age 13 - No evidence of menarche by age 15-16 - Menses haven’t begun 5 years after onset of thelarche (nml = menarche ~ 2.5 years following thelarche)
242
Q

Compare and contrast the treatment for BV (bacterial vaginosis), vulvovaginal candidiasis, trichomoniasis, atrophic vaginitis

A
  1. BV: oral/topical metronidazole OR topical clindamycin (incl. in high-risk pregnancies) 2. Candidiasis: application of –azole OR sngl dose oral fluconazole or nystatin. If recurrence, weekly oral fluconazole x 6 months. T. glabrata = resistant to azoles – use intravag boric acid or gentian violet. Evaluate recurrence for diabetes and autoimmune disease. 3. Trich: oral metronidazole or tinidazole. Tx partner too. Tx in pregnancy 4. Atrophic vaginitis: local water-based moisturizing, topical/oral E
243
Q

What are imaging characteristics of complex breast cysts?

A
  • Thick-walled, septated, cystic and solid components internally
244
Q

What is mullerian agenesis?

A
  • Aka Mayer-Rokitansky-Kuster-Hauser syndrome - Congenital absence of vagina and probably also uterus and fallopian tubes. Ovarian function is normal. Also renal abnormalities seen in up to 50%. - Cause of delayed puberty.
245
Q

Describe what happens to the hormonal axis in girls in infancy and early childhood

A
  • GnRH is high in utero, eventually decreasing d/t negative feedback by FSH and LH. After delivery, large drop in hormones. Continue to have pulsatile release of GnRH in infancy with high FSH. Levels peak at 12-18 months when normal negative feedback ensues. Gonadotropins remain low until 6-8 when gonadarche occurs.
246
Q

Types of Mullerian anomalies. What is septate uterus, bicornate uterus and uterine didelphys?

A
  • Incomplete fusion or resorption of septum where bilateral ducts fuse 1. Septate uterus: incomplete resorption of uterine septum 2. Bicornate uterus: incomplete fusion of Mullerian ducts 3. Uterine didelphys: complete failure of fusion leading to double uterus, vagina and cervix
247
Q

Presentation of uterine leiomyoma

A
  • Bleeding (most common) as incomplete sloughing, pelvic pressure, lumpy-bumpy sensation on exam, hydroureter/hydronephrosis, secondary dysmenorrhea, acute pain from torsion of a leiomyoma, cramping pain if prolapses through cervix
248
Q

Where is LDL derived from for progesterone synthesis in placenta?

A
  • Mother
249
Q

How is precocious puberty treated?

A
  • Goal = arrest and diminish sexual maturation until normal pubertal age and to maximize adult height - Tx = GnRH agonists used continuously to decrease E to pre-pubertal range such that regression of breast development occurs and cessation of menses. Note: continuous use causes a decreased release of LH/FSH through negative feedback loop, while non-continuous use stimulates pituitary - Controlling weight might be helpful in delaying puberty.
250
Q

Differential diagnosis for vulvovaginitis

A
  • Bacterial vaginosis, candidiasis, trichomoniasis, atrophic vaginitis
251
Q

From what type of mole does an invasive mole arise? Morphological features? Signs?

A
  • Usually from complete hydatidiform mole. - Features = trophoblast invasion into myometrium, possibly through serosal surface - Signs = uterine rupture, embolization of villi to lungs, elevated BHCG after uterine cavity evacuation
252
Q

Types of benign tumors

A
  • Fibroadenoma, intraductal papilloma, phylloides tumor
253
Q

What is stress UI? Urge UI? Overflow incontinence? Functional incontinence?

A
  • Stress UI: involuntary loss of urine during exertion (lifting, jogging, sneezing, laughing) - Urge UI: sudden, uncontrollable urge to void resulting in leakage of urine, may be associated with nocturia and detrusor overactivity - Overflow: involuntary loss of urine associated with bladder overdistension and non complete emptying of bladder at void d/t inability for detrusor to contract; often no urge to urinate, continuous leakages of small amounts of urine - Functional: urine loss by factors outside urinary tract
254
Q

When should fasting insulin and glucose ratio testing necessary in infertility?

A
  • If LH/FSH is abnormal - Want to see if insulin is causing glucose down.
255
Q

Causes of hypothalamic-pituitary dysfunction that leads to amenorrhea

A
  1. Functional: weight loss, excessive exercise, obesity 2. Drug-induced: marijuana, psychoactive drugs (antidepressants included) 3. Neoplasm: prolactin-secreting pit adenomas, craniopharyngioma, hypothalamic hamartoma 4. Psychogenic: chronic anxiety, pseudocyesis (woman believes she is pregnant, feels movement and cycles stop, not true pregnancy), anorexia nervosa 5. Other: head injury, chronic medical illness
256
Q

Causes of abnormal uterine bleeding. What is each?

A
  1. Anovulatory: - These patients have constant non-cyclic E that stimulates the growth and development of the endometrium. As they never ovulate, they never cross over into the progesterone phase. Initially amenorrheic, but eventually the endometrium outgrows blood supply and sloughs at unpredictable times and amounts. 2. Luteal phase defect: - Ovulation occurs but CL doesn’t secrete adequate quantities of P to support endometrium and is not adequate to support a pregnancy if one occurs. Menstrual cycle shortened, occurring earlier than expected. 3. Mid-cycle spotting: - Bleeding at time of ovulation in absence of other pathology. Usually self-limited and attributed to sudden drop in E after ovulation.
257
Q

At what BHCG level can you see an IUP gestational sac via TV US?

A
  • 2500
258
Q

Do we need to know types of surgery?

A

Do we need to know types of surgery?

259
Q

PE findings for intraductal papilloma

A
  • Small, non-palpable mass close to nipple, may be beneath, bloody nipple discharge
260
Q

What causes follicle progression in the follicular phase? Why?

A

** - FSH elevated and LH low - Why? Success of a follicle depends upon its ability to convert androgen microenvironment to an estrogen environment. Presence of FSH, E is dominant. In present of LH, androgens rise, which antagonizes the granulosa cell proliferation and promotes degenerative changes in oocyte.

261
Q

What is fibrocystic breast disease? Sx? PE?

A
  • Progressive breast condition. - Sx = breast pain, nipple discharge (non-bloody usually bilateral), lumpy breasts, varies with hormonal cycle - PE: lumpy breasts without discrete mass
262
Q

What type of cancer is associated with in utero DES?

A
  • Clear cell adenocarcinoma. - DES was used in 70s for women having recurrent miscarriages
263
Q

HPV screening recommendation for women

A
  • No screening
264
Q

Define infertility. When should infertility testing/evaluation begin?

A
  • Regular, unprotected intercourse without conception for 12 months - 6 months if >= 35 - If known risk factors: irregular cycles, endometriosis, male factor etc, can start testing sooner
265
Q

How is precocious puberty diagnosed?

A
  • H&P: nutrition, FMHx, hx of signs/sx of CNS damage, growth charts, Tanner staging, evidence of estrogenization, signs of virilization, etc. - Labs: bone age (sngl most useful test in evaluation of premature development), vaginal smear for E effect, LH, FSH, E, DHEAS, TSH, 17OH-P - Imaging: CT or MRI of brain, US - Refer to peds endocrinologist
266
Q

Describe Tanner breast staging

A

** - Stage B1 (aka preadolescent): elevation of papilla only - Stage B2 (aka breast bud): elevation of breast and papilla as small mound with enlargement of areolar diameter - Stage B3: further enlargement of breast and areola with no separation of contours - Stage B4: further enlargement with projection of areola and papilla to form a secondary mound above level of breast - Stage B5 (aka mature): projection of papilla only resulting from recession of areola to general contour of breast

267
Q

Do complex breast cysts have increased risk for cancer?

A
  • Yes
268
Q

First and second line tx for PCOS

A
  1. Lifestyle changes (diet, exercise), oral contraceptive pills (protects against endometrial hyperplasia, helps with acne/hirsutism): use one with minimal androgenicity 2. Spironolactone (aldosterone and androgen antagonist), must use with contraception - Tx of infertility: if no menses, do progesterone challenge. If no ovulation, give clomiphene (BMI 30) on day 3-5 to induce ovulation. If no ovulation indicating by P change on day 21, increase dosage.
269
Q

Length of avg menstrual cycle

A
  • 28 days (+/- 7)
270
Q

Risk factors for ectopic pregnancy

A
  • Highest = prior ectopic, prior tubal surgery incl ligation, IUD (unlikely to fail, but if they do, high chance ectopic) - Moderate = prior PID, infertility, multiple partners (high risk infection), smoking - Slight = IVF, older > 35, prior spontaneous abortion
271
Q

Components of women’s health care

A
  1. Well woman/preventive care - health maintenance, preventive services (immunizations, labs), early disease detection (pap smears), continuity of care 2. Symptom-based care 3. Health screening 4. Obstetrical care
272
Q

Single most important prognostic factor for metastasis of malignant breast cancer

A
  • Axillary LN involvement
273
Q

Findings of inflammatory breast cancer

A
  • Lymphatic invasion of skin = Peau d’orange w/erythema - May not be lump - Usually mimics mastitis and pts sent home on abx, but sx don’t improve
274
Q

Non-gynecologic neoplastic origin for adnexal mass

A
  • Carcinoma of appendix, large intestine, bladder - Retroperitoneal neoplasm - Presacral teratoma
275
Q

What is a choriocarcinoma? What other pathology is present?

A
  • Malignancy of trophoblastic tissue. Note: no chorionic villi present. - Increased frequency of theca-lutein cysts with these
276
Q

Tx of vulvar cancer

A
  • Wide local excision with inguinal LN dissection - Pelvic radiation of +ve mets to nodes
277
Q

Are most breast cancers positive or negative for E/P/Her2 receptors?

A
  • 2/3rd are +ve for at least one of these receptors.
278
Q

What do psoriasis lesions on vulva look like?

A
  • Annular pink plaques with silvery scale that bleed if removed. Check other parts of body: elbows, knees and scalp.
279
Q

General tx guidelines for PCOS

A
  • Lessen sx of hyperandrogenism, manage metabolic comorbidities, prevent chronic anovulation which leads to endometrial hyperplasia and carcinoma, contraception or ovulation induction if desired
280
Q

Define puberty

A
  • Childhood to adulthood: development of secondary sex characteristics, growth spurt, achievement of fertility
281
Q

Characteristics of HER2 Neu breast cancers?

A
  • Grow faster or spread more aggressively than others
282
Q

Typical route of spread of breast carcinoma

A
  • Lymphatics - Can be local or blood
283
Q

Non-cancerous proliferative lesions of the breast. Risk for cancer?

A
  • Fibroadenoma, fibromatosis, adenomas, intraductal papillomas - Risk up to 2 x
284
Q

Where are inhibins produced? Function of inhibin A and B?

A
  • Produced in granulosa cells of ovary - Inhibin B: secreted in follicular phase to decrease FSH secretion (allows maturation of only one follicle), spikes just after ovulation to decrease FSH secretion - Inhibin A: secreted by CL (granulosa cells) in luteal phase to inhibit gonadotropin secretion
285
Q

Three phases of the ovarian cycle and time frame. Describe what happens in each.

A
  1. Follicular phase (onset of menses (day 1) and ends on day of LH surge): follicle development, endometrial proliferation 2. Ovulation: within ~36 hrs of LH surge 3. Luteal phase (on day of LH surge and ends with onset of menses): CL formation, endometrial differentiation, followed by menses
286
Q

What is atypical ductal hyperplasia?

A
  • Spectrum between normal breast tissue and DCIS - Association with adjacent invasion or in situ carcinoma - Raises breast cancer risk 5 x higher than normal
287
Q

What other pathology are theca-lutein cysts associated with? In other words, if someone was diagnosed with one of these, what else could they have?

A
  • Choriocarcinoma and moles - Note: often bilateral and multiple
288
Q

Morphological features of choriocarcinoma

A
  • Fleshy, hemorrhagic tumor consisting of cytotrophoblast and syncytiotrophoblast. NO VILLI. - Can rapidly invade and metastasize to lung, vagina, brain, liver and kidney
289
Q

Presentation of fallopian tube cancers

A
  • Hydrops tubae profluens: intermittent expulsion of clear or serosanguinous fluid from vagina - Latzko’s triad: intermittent serosanguineous discharge, colicky pain, mass. Only 15% of patients.
290
Q

How common/rare is vaginal cancer? What is the most common type?

A
  • Rare - Most common = squamous cell carcinoma
291
Q

Describe pre-ovulatory follicle

A
  • Granulosa cells enlarge and acquire lipids. Oocyte resumes meiosis as previously arrested in prophase of first meiotic division. Estrogens peak, which induces positive feedback on pituitary to stimulate mid-cycle surge of LH.
292
Q

How does menstrual phase of ovarian cycle occur?

A
  • Decline in E and P production = release of proteolytic enzymes causing lysis of tissue, increase of PG production = myometrial contractions.
293
Q

Describe synthesis of estradiol including cell types / receptors involved during the follicular phase

A
  • Two cell theory - Theca cell with LH receptor binds LH, which leads to synthesis of androstenedione from cholesterol - Granulosa cell with FSH receptor binds FSH, which leads to synthesis of estradiol from androstenedione (from theca cell)
294
Q

Describe how HPV precipitates cervical cancer?

A
  • Has viral proteins E6 and E7 - E6: inhibits p53 (mnemonic = 6/2 = 3, so p53) - E7: inhibits p53, p21, Rb
295
Q

Management of Bartholin’s gland cyst?

A
  • If 1st time in 40+ year patient, do biopsy to rule out rare gland carcinoma - I&D, place Word catheter, abx if +ve for GC or if cellulitis d/t skin flora - Recurrent cysts may be marsupialized (exteriorized)
296
Q

Location of Bartholin gland cyst

A
  • 4 and 8 o’clock positions on postero-lateral aspect of introitus
297
Q

What is uterine leiomyoma?

A
  • Aka fibroids/myomas. These are proliferation of smooth muscle surrounded by a pseudocapsule of compressed muscle fibers.
298
Q

% of unintended pregnancies

A
  • ~ 50%
299
Q

Etiology of infertility

A
  • 1/3rd female, 1/3rd male, 1/3rd both - Female side: ovulatory dysfunction, endometriosis, tubal damage, cervical factor
300
Q

Morphological characteristics of a mucinous cystadenocarcinoma

A
  • Complex architecture, nuclear atypia, stromal invasion
301
Q

Describe steroid production in the luteal phase. What cell types? Receptors?

A
  • Luteinized theca cells have LH receptors and produce androstenedione under LH response. This is no difference than what occurs in the follicular phase. - Luteinized granulosa cells have LH receptors and produce a lot of progesterone as well as estrogen under LH response. Note: previously these cells had FSH receptors, but those are downregulated and the cells are no longer FSH responsive.
302
Q

Gross and Microscopic appearance of phyllodes tumor

A
  • Gross: Large mass with cysts - Microscopic: leaf-like projections
303
Q

What do vulvar seborrheic dermatitis lesions look like?

A
  • This is chronic inflammation of sebaceous glands - Lesions pale, red to yellow-pink and may be covered by oily scaly crust
304
Q

Prognostic factors of endometrial cancer

A
  1. Most critical = tumor, grade and histology 2. 2nd most critical = depth of myometrial invasion 3. Staging 4. Clinical factors (age, ethnicity)
305
Q

T/F. Breast CA is most commonly diagnosed cancer in women?

A
  • True
306
Q

Diagnostic criteria for PCOS

A
  • Typical to use Rotterdam Consensus Criteria - Hyperandrogenism, ovulatory dysfunction, polycystic ovaries on US (>=12 cysts/”string of pearls” or increases ovarian volume) - Need 2 out of 3 of above.
307
Q

Most common breast cancers? Least common?

A
  • Most common (nearly 90%) = invasive breast cancers, which are ductal carcinoma (76%) > lobular carcinoma (10%) - Least common (less than 2%) = papillary carcinoma > inflammatory carcinoma
308
Q

How is H-P dysfunction that leads to amenorrhea diagnosed?

A
  • Measure FSH, LH and prolactin serum levels - FSH, LH will be low - Prolactin nml except when elevated by prolactin-adenoma
309
Q

What is a corpus luteum cyst? Clinical course? What does this mimic?

A
  • Cystic enlargement of CL with central hemorrhage - May rupture resulting in peritoneal reaction with fibrosis and hemorrhage mimicking endometriosis. Regresses spontaneously.
310
Q

DeLancey level 3 loss of support results in what?

A
  • Anterior part loss = hypermobile urethra - Posterior part loss = perineocele
311
Q

Typical etiologies leading to high rates of maternal death in developing countries?

A
  • Blood loss, infection, HTN, unsafe abortion
312
Q

Pathophys of uterine cancer

A
  • Tumor invades stroma, penetrates myometrium, invades myometrial lymphatics, metastasis to pelvic, para-aortic and inguinal nodes
313
Q

Describe implantation and formation of the placenta.

A
  1. Hatching: break down of ZP 2. Apposition: trophoblastic cells of blastocyst make contact with endometrium 3. Adhesion: integrin mediated attachment between trophoblast and stromal (decidual) cells of endometrium 4. Invasion: trophoblast differentiates into cytotrophoblast and syncytiotrophoblast. Syncytiotrophoblasts send out protrusions and invade endometrium. These break through maternal veins and arteries allowing for pools of maternal blood to interact with these cells. Primary chorionic villi forms and within these villi, capillaries form.
314
Q

Signs of MTX tx failure

A
  • Significant abdominal pain, hemodynamic instability, BHCG not declining by day 7 or even plateauing
315
Q

Boxers or briefs when trying to conceive?

A
  •  Boxers
316
Q

Relative contraindications to methotrexate for ectopic

A
  • Unruptured mass > 3.5 cm, fetal cardiac activity seen, quant BHCG > 6K to 15K - These cannot be managed with MTX
317
Q

Describe gonads in Turner syndrome

A
  • Streak gonads with absence of ovarian follicles. Absence therefore of gonadal sex hormone production at puberty. - This is most common cause of delayed puberty with elevated FSH
318
Q

From where does DCIS (ductal carcinoma in situ) arise?

A
  • Breast duct
319
Q

Risk factors for fecal incontinence in women

A
  • Instrumental delivery, prolonged 2nd stage labor, birth wt > 4kg, OP position, episiotomy - Associated factors: first vaginal delivery, induction of labor, epidural, early pushing, active restraint of the head
320
Q

Most common ovarian tumor? Ovarian mass in young women? Ovarian tumor in women 20-30 yo? Most common ovarian malignancy?

A
  • Most common ovarian tumor: Serous cystadenoma - Most common mass in young women: Follicular cyst - Most common tumor in women 20-30 yo: Dermoid cyst (aka mature teratoma) - Most common ovarian malignancy: serous cystadenocarcinoma
321
Q

What is a constitutional delay?

A
  • Child healthy, slower rate of physical development than avg. Hx of stature shorter than their age-matched peers. Height appropriate for bone age and skeletal development delayed more than 2.5 SD. Usually thin and often have family hx of delayed puberty.
322
Q

Are screening pelvic exams recommended?

A
  • May not be in asymptomatic non-pregnant adult. Per ACOG: shared decision.
323
Q

How many women die daily from preventable causes related to pregnancy and childbirth?

A
  • 800 worldwide - 99% of these in developing countries
324
Q

How is ovarian dysfunction leading to amenorrhea diagnosed?

A
  • FSH & LH will be increased
325
Q

Tx for infertility

A
  • Tx underlying cause incl. endometriosis - Counsel on healthy practices for conception - Clomiphene/letrozole for PCOS and unknown anovulation - Progesterone if luteal phase defects - Control co-morbidities such as HoThyroidism, DM, HTN - Refer to REI
326
Q

Muscle that is most often damaged after first vaginal birth

A
  • Pubococcygeal portion
327
Q

Clinical findings for Paget disease of breast

A
  • Eczematous patches on nipple
328
Q

Presentation of VIN

A
  • 50% asymptomatic - Vulvar pruritus or vulvodynia
329
Q

Characterize DeLancey’s vaginal support levels

A
  • Level I: CT support upper vagina - Level II: fascial arcus in mid vagina - Level III: Anterior: Fusion of anterior vagina and urethra muscles involved in urethral support. Posterior: Fusion of posterior vagina and perineal body
330
Q

Define menarche

A
  • Onset of menses at approximately 12-13 years or ~ 2.5 years after thelarche.
331
Q

How long does it take for ovulatory menstrual cycles in young women to become regular?

A
  • ~ 2 years
332
Q

How long after LH peak does CL form?

A
  • About 10-12 hrs. - This is about 24-36 hrs after E peak
333
Q

Describe progesterone challenge test when testing for amenorrhea

A
  • Test is seeing if patient has adequate estrogen, competent endometrium and an adequate genital outflow tract - Give progesterone 10-14 days and then withdraw - If bleeding occurs, patient is anovulatory - If no bleeding, pt is hypoestrogenic or anatomic (outflow issue)
334
Q

Morphological characteristics of ovarian mucinous cystadenoma. Include the type of epithelium it is lined by?

A
  • Multiloculated filled with sticky gelatinous material - Unilateral, large often - Lined with endocervical-like epithelium (columnar epithelium that is mucus-secreting)
335
Q

T/F. Pelvic floor repairs should treat the only defect that is present.

A
  • False. Repair all co-existent pelvic floor defects. Look at levels 1-3.
336
Q

Define thelarche

A
  • Occurs around 11 and is breast bud development, which is the first phenotypic sign of puberty. Occurs in response to E.
337
Q

What endometrial changes occur during the luteal phase?

A
  • Increased complexity of vascular and glandular structures - Accumulation of substances in glands - Deposition of lipids and glycogen in stromal cells - Increased blood supply
338
Q

Morphological characteristics of ovarian serous cystadenoma. Include the type of epithelium it is lined by?

A
  • Thin and smooth walled - Large, single or multiloculated cystic masses filled with serous fluid - Lined with fallopian-like epithelium (ciliated, columnar secretory epithelium) - Bilateral
339
Q

Is the degree of urinary incontinence commensurate with the degree of pelvic relaxation? Explain.

A
  • Not commensurate - Patients with stage III or IV prolapse present without incontinence because they have a functional obstruction in outflow tract that stimulates continence.
340
Q

Risk factors for ovarian neoplasias

A
  • Family hx, BRCA1/2, nulliparity
341
Q

Presentation of cervical cancer

A
  • Early = asymptomatic. Can be non-peculiar such as vaginal discharge, odor, abnormal vaginal bleeding, bleeding with intercourse
342
Q

Tx of Paget’s disease of nipple?

A
  • Mastectomy. Prognosis generally good.
343
Q

In a regularly menstruating woman with 28 day cycle, how long do the follicular and luteal phases each last? In an irregularly menstruating women with a 40 day cycle, how long do each of the phases last?

A
  • Duration of luteal phase remains constant at ~ 14 days and follicular varies - 28 day cycle: 14 follicular, 14 luteal - 40 day cycle: 26 follicular, 14 luteal
344
Q

How is ectopic pregnancy diagnosed?

A
  • US: looking to see for normal IUP and don’t - Quant BHCG: 1500-2000 (5-6 weeks post LMP, 2 weeks after pos urine test) - Progesterone: > 25 = viable pregnancies (97%),
345
Q

Incidence of urinary incontinence in women. Which is more common – stress or urge incontinence?

A
  • 85% - More common in women = stress UI (specifically hypermobility subtype). Urge more common in men.
346
Q

What is the most common cause of primary amenorrhea in women with normal breast development?

A
  • Mullerian agenesis (aka Mayer-Rokitansky-Kuster-Hauser syndrome)
347
Q

Composition of pelvic diaphragm

A
  • Levator ani: iliococcygeus, pubococcygeus, obturator
348
Q

Compare and contrast the following vulvar lesions: sebaceous cysts and cyst of canal of Nuck (hydrocele). What is the treatment?

A
  1. Sebaceous inclusion cysts: blockage of sebaceous gland ducts with cheesy/sebaceous material. Tx = excision. 2. Hydrocele: peritoneal fluid collection where the round ligament inserts into labia majora. Tx = excision.
349
Q

Types of benign non-invasive moles

A
  1. Complete mole (think of this as having a complete c/s number): 46 XX or 46 XY Results from a. Empty egg fused with sperm (that duplicates later) b. Empty egg fused with 2 sperm 2. Partial mole (think of this as having not a full c/s number): 69XXX/XXY/XYY results from 1 egg + 2 sperm
350
Q

Why does on mature dominant follicle win out during follicle development?

A
  • Inhibin B secreted by granulosa cells exerts negative feedback regulation at the level of anterior pituitary to decrease FSH secretion.
351
Q

Most common ovarian tumor in female adolescents?

A
  • Dysgerminoma
352
Q

Rank the following gynecologic tumors in terms of incidence in USA

A
  • Endometrial > Ovarian > Cervical
353
Q

Tx / mgmt. options for endometriosis

A
  • Goals = reduce pelvic pain, minimize surgical intervention, preserve fertility - Tx depending on circumstances 1. Expectant: if patient has limited dz who wants to conceive or is nearing menopause, just provide reassurance 2. Medical: if patient is symptomatic and desires pregnancy in future, *don’t require surgical diagnosis for this, just try empirically. Tx = combined OCPs with NSAID continuously, progesterone (SE), danazol (suppresses FSH/LH with significant SEs so rarely used), GnRH agonist used continuously (SEs significant sometimes: hot flushes, night sweats, vaginal dryness) 3. Surgical: excision, cauterization, ablation or electrocoagulation done to preserve fertility. If not needed, do total hysterectomy, bilateral salpingo-oophorectomy, lysis of adhesions and removal of implants 4. Medical & Surgical: see above
354
Q

How can BBT (basal body temp) be used as an indicator of ovulation? What causes this?

A
  • Up to 0.8 degree increase in BBT causes by rapid rise in progesterone after ovulation.
355
Q

Pearls for breast cancer management

A
  • Any atypia needs removal - Any DCIS/LCIS needs removal with margin - LNs suspicious by exam should signal locally advanced dz late stage II or III. Consider neoadjuvant chemo. - Mastectomy = survival with lumpectomy + radiation - Axillary sampling for any invasive cancer - Always perform diagnostic imaging prior to biopsy even if palpable lump - Image guided biopsy (needle located or stereotactic) for non-palpable abnormalities
356
Q

How common/rare is fallopian tube cancer?

A
  • 0.41/100K in US. Most are adenocarcinomas. - Risk factors: BRCA, infertility, low parity
357
Q

Microscopic findings for Paget disease of breast

A
  • Large cells in epidermis with clear halo aka Paget cells
358
Q

Secondary causes of PCOS

A
  • Hypothyroids, hyperprolactinemia, androgen-secreting tumors, adult-onset CAH, Cushing syndrome, Pregnancy! - Rule these out first
359
Q

Define adrenarche

A
  • Regeneration of ZR in adrenal cortex responsible for secretion of sex steroid hormones that occurs bw age 6-8
360
Q

Ovarian Fibroma. Presentation? Morphological appearance?

A
  • Presents with Meigs syndrome (triad): ovarian fibroma + ascites + hydrothorax. Pulling sensation felt in groin. - Morpho: bundles of spindle-shaped fibroblasts
361
Q

What is mixed incontinence?

A
  • Combination of stress and urge UI - Most common in older women
362
Q

Morphological characteristics of a serous cystadenocarcinoma

A
  • Bilateral, PSAMMOMA BODIES (also seen in PTC) which is dystrophic calcification, papillary growth, hyperchromatic cells
363
Q

Which gynecologic cancer has the worst prognosis?

A
  • Ovarian
364
Q

Morphological characteristics of immature teratoma. How do you differentiated this from a dermoid cyst (aka mature teratoma)?

A
  • Immature/embryonic elements often neuroectoderm - Mature more likely to contain thyroid tissue
365
Q

Are sx in endometriosis related to extent/amount of endometriosis?

A
  • No
366
Q

When is mammogram best for women?

A
  • 30+ start with mammo +/- US -
367
Q

Tumor marker for yolk sac tumor

A
  • AFP
368
Q

Causes of overflow incontinence?

A
  • Obstructive-fecal impaction - Non-obstructive-MS, spinal bifida, spinal cord injury
369
Q

Risk factors for vulvar cancer

A
  • Menopausal status - CIN, VIN, HPV - Smoking - Immunosuppression - H/o cervical cancer
370
Q

Clinical factors that make it more or less likely that mass is benign? Malignant?

A
  1. Benign: unilateral, cystic, thin-walled, mobile, smooth, no ascites, slow growth, younger women 2. Malignant: bilateral, solid, thick-walled, fixed, irregular, ascites, rapid growth, older women
371
Q

Tx of VIN

A
  • Wide local or laser excision because assumption is that it will progress to vulvar cancer - F/U: colposcopy q 6 months until disease-free for 2 years then annual colpo
372
Q

When is colorectal screening needed for women?

A
  • After age 50. Sooner if risks (family hx)
373
Q

What is the transformation zone of the cervix? Pathological relevance of this zone?

A
  • Columnar (endocervix) epithelium to squamous (ectocervix) epithelium. Aka squamocolumnar junction. - Relevance: CIN and carcinoma original in this zone
374
Q

Causes of functional incontinence?

A
  • Decreased mobility, dementia, injury (fistulae)
375
Q

How often should sex happen if attempting to conceive?

A
  • Every other day. Not every day. Recommended day 10-20
376
Q

Tx of endometrial cancer

A
  • Most cases = total abdominal hysterectomy + removal of tubes and ovaries. Some performed laparoscopically. - If poor surgical candidate: radiation or progesterone, chemo
377
Q

Most common breast tumor in female patients

A
  • Most common tumor in female pt
378
Q

Are phyllodes tumors malignant?

A
  • Benign. Some may become malignant
379
Q

Tx of vulvar psoriasis?

A
  • Topical steroids like betamethasone valerate
380
Q

What hormone stimulates ovulation? How?

A
  • LH absolutely required. Remodels the follicle through changes in gene expression and signaling patterns (COX, plasminogen, MMPs) = rupture. - FSH also helps
381
Q

Describe the pattern of GnRH release

A
  • Pulsatile
382
Q

Survival rates between lumpectomy+radiation vs mastectomy

A
  • Same - Recurrence slightly higher with lumpectomy. With surveillance, recurrence found early and may result in mastectomy with no impact on survival.
383
Q

Name the types of ovarian cysts, benign ovarian tumors and malignant ovarian tumors

A
  1. Ovarian cysts: follicular cysts, CL cysts, theca-lutein cysts, hemorrhagic cysts, dermoid cysts, endometrial cysts, inflammatory cysts 2. Benign ovarian tumors: serous cystadenoma, mucinous cystadenoma, endometrioma, mature cystic teratoma (dermoid cyst), Brenner tumor, fibroma, thecoma 3. Malignant ovarian tumors: serous cystadenocarcinoma, mucinous cystadenocarcinoma, granulosa cell tumor, immature teratoma, dysgerminoma, choriocarcinoma, yolk sac tumor, Krukenberg tumor
384
Q

What is the most frequent anatomic cause of secondary amenorrhea? Tx?

A
  • Asherman syndrome: scarring of uterine cavity. Can occur after D&C esp if infection present. - Tx = surgical lysis by hysteroscopy. Give E post-op to stimulate endometrial regeneration/heal.
385
Q

How are uterine leiomyomas treated?

A
  1. Medically: - Progestin to minimize bleeding - High dose NSAIDS or antifibrinolytic agents to tx menorrhagia - GnRH agonist to reduce fibroid size 2. Surgically: - Myomectomy (if wants to be childbearing), hysterectomy, endometrial ablation, myolysis 3. Other: - Uterine artery embolization, MRI-guided focused US surgery
386
Q

Types of uterine leiomyomas

A
  • Intramural, subserosal, submucosal
387
Q

Microscopic findings for comedocarcinoma

A
  • Ductal caseous necrosis surrounded by cancer cells
388
Q

Why does endometrial breakdown occur?

A
  • Loss of E and P initiates vasomotor reactions, tissue loss and menstruation
389
Q

Morphological features of dysgerminoma. What tumor markers are present for this malignancy?

A
  • Sheets of uniform fried egg cells - Markers: hCG, LDH
390
Q

What is a thecoma?

A
  • Like a granulosa cell tumor, which may produce estrogen. Therefore can present with abnormal uterine bleeding in post-menopausal women.
391
Q

Biochemical/lab findings in PCOS

A
  • Hyperandrogenism (free T and or total T elevated) - LH:FSH > 2 - Hyperinsulinemia - Dyslipidemia
392
Q

Location of intraductal papilloma

A
  • Beneath areola, growing in lactiferous ducts
393
Q

Endometrial phases in an ovulatory cycle

A
  1. Menstrual endometrium and uterine proliferative phase 2. Ovulation 3. Secretory phase
394
Q

Define gonadarche

A
  • Begins around 8 and is pulsatile GnRH secretion from hypothalamus stimulate FSH/LH secretion w/o phenotypic changes. LH rises to a larger extent.
395
Q

Morphological characteristics of a Brenner tumor

A
  • Ovarian nodules of TRANSITIONAL TYPE epithelial cells in dense fibrous stroma - Solid tumor that is pale yellow-tan in color - Encapsulate - COFFEE BEAN nuclei (also seen in PTC) - Unilateral
396
Q

At phase in the ovarian cycle does estrogen have a negative feedback? Positive feedback?

A
  • Follicular phase: negative feedback - Mid-cycle, prior to ovulation: positive feedback - Luteal phase: with progesterone exerts negative feedback
397
Q

Presentation of intraductal papilloma

A
  • Serous or bloody nipple discharge
398
Q

Sx and PE findings in a patient with endometriosis

A
  • Sx/PE (variable and unpredictable): progressive dysmenorrhea (not responding to NSAIDS), deep sypareunia, chronic pelvic pain, sacral backache, dyschezia, uterosacral nodularity, adnexal mass, asymptomatic
399
Q

Normal volume of blood loss in menstrual cycle. What is considered abnormal?

A
  • 30 ml +/- 20 = normal. Avg Fe loss = 13 mg. - Abnormal = > 80 ml
400
Q

What stimulates libido in menstrual cycle?

A
  • Midcycle rise in androgens
401
Q

Lab findings in hypogonadotropic hypogonadism

A
  • Low FSH & LH levels with no E and P
402
Q

Baden-Walker classification of pelvic floor prolapse

A
  • Note: two classification systems (POP-Q = objective/quantitative; Baden-Walker = subjective/clinical) - Grade I: prolapsed tissue descends halfway to hymen - II: …to level of hymen - III: …to outside the hymen with straining - IV: …to outside the hymen without straining
403
Q

What imaging studies are necessary in infertility testing?

A
  • Test for tubal patency with HSG (hysterosalpingogram) or sonohystogram - HSG: inject dye, imaging to make sure dye runs out into pelvic cavity

OBGyn (2 decks)

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