Female Flashcards
(130 cards)
1
Q
The central pathologic abnormality of PCOS is?
A
Numerous cystic follicles or follicle cysts
In reproductive age women
2
Q
Common S/Sx of PCOS
A
- Persistent anovulation
- Obesity (40%)
- Hirsutism (50%)
- Virilism (rare)
3
Q
Recent studies link PCOS to {{…}}
A
Insulin resistance
4
Q
Unlike PCOS, ovarian stroma, display…
A
- Post-menopausal women
- B/L symmetrical enlargement of ovaries
- Similar S/Sx: hirsutism, obesity
PCOS: cysts; pre-menopausal
5
Q
What is the earliest sign of an endometrial cancer?
A
Post-menopausal bleeding
6
Q
Why are ovarian neoplasms related to a higher rate of mortality when compared to cervical or other female reproductive tract cancers?
A
- Hard to detect early
- Not many S/Sx
- Most are benign & occur 20-45 yo (80%)
- Malignant tumors: 40-65 yo
7
Q
What is the main risk factor for cervical cancer?
A
HPV infection
8
Q
What is the main risk factor for endometrial cancer?
A
Estrogen excess
Exogenous estrogen; early menarche
9
Q
What are the most common S/Sx of ovarian neoplasms?
A
- Abdominal pain
- Abdominal distention
- Urinary & GI Sx
General Sx due to non-functional nature of neoplasms
10
Q
{{…}} are the origin of most ovarian cancers
A
Surface epithelial cells
90% malignant
11
Q
What are the most common types of surface epithelial cell ovarian cancers?
A
- Serous tumor
- Mucinous tumor
- Endometroid tumor
12
Q
The risk of malignancy of ovarian cancers is directly propertional to {{…}}
A
Solid mass
Not fluid –> solid mass only
13
Q
{{…}}, are concentric calcifications that are frequently seen in serous ovarian neoplasms
A
Psamomma bodies
14
Q
A cancer features the following histopathology image. What type of ovarian tumor do you suspect?
A
Serous ovarian tumor
15
Q
The {{…}} type of ovarian tumors are more likley to grow in large size with less surface inolvement
A
Mucinous tumors
16
Q
Upon exploratory laporotomy, it is found that a patient suffering from a large ovarian tumor and has a large quantity of mucin within their peritoneal cavity. What type of tumor do you suspect they suffer from?
A
Mucinous
17
Q
{{…}} type of ovarian tumors are mostly carcinomas that involve the endometrium and can coexist with endometriosis
Usually found in 50-70 yo
A
Endometrioid
18
Q
What biomarker may be used to evaluate for ovarian neoplasm in BRCA1 or BRCA2 patients?
Only used for those at risk or to monitor treatment
A
CA-125
19
Q
What procedure(s) can be used to reduce the risk of ovarian cancer in those with BRCA mutations?
A
- Tubal ligation
- Oral contraceptive therapy
20
Q
{{…}} are benign tumors that can undergo malignant transformation of any of the components
A
Teratomas
21
Q
Teratomas are most commonly found in women of {{…}}
A
Reproductive years
22
Q
Are dermoid cysts can be used to desribe benign cancerous lesions called {{…}}
A
Teratomas
23
Q
The karyotype of all teratomas will be {{…}}
A
46,XX
Same # as female has
24
Q
A {{…}} type of teratoma is composed almost of entirely mature thyroid tissue that can hyperfunction and cause hyperthyroidism
Tachycardia, exothalmos, etc
A
Struma ovarii
25
{{...}} is the most common germ cell tumor in children and can elaborate α-FP
| Can contain schiller-duval bodies (glomerulus-like structures)
Endodermal sinus tumors
26
{{...}} produce large amounts of **estrogen** linked to **endometrial hyperplasia**, endometrial carcinoma, and breast carcinoma (breast cancer)
Granulosa-theca cell tumor
27
Krukenberg or metastatic tumors of the ovaries are highly related to {{...}} cancers
| Signet ring histologic pattern
GIT
28
A {{...}} type of cancer is associated with right-sided hydrothorax known as Meign's syndrome
Fibrothecoma
29
The {{...}} tumors can be masculinizing or defeminizing but are not as common as PCOS
Sertoli-Leydig cell tumors
30
The most common site of ectopic pregnancy is?
Fallopian tubes (90%)
31
The most common risk factor for ectopic pregnancy?
PID (w/ chronic salpingitis)
32
Diethylstilbestrol (DES) exposure increases the risk of what type of cancer?
Vaginal clear cell adenocarcinoma
| In utero exposure
33
{{...}} is the Dx procedure of choice along with **β-hCG** testing to evaluate for **ectopic pregnancy**
Transvaginal ultrasound
34
A normal rise in {{...}} is not seen in ectopic pregnancy
β-hCG
35
First trimester bleeding is typically associated with?
Normal implantation
| 2nd/3rd trimester assoc. w/ abnormal implantation
36
A sudden onset of pain during 27-32 weeks gestation w/ or w/o vaginal bleeding you should suspect & rule out {{...}}
Abruptio placentae
37
In {{...}} the placenta is near the internal os of the cervix and can lead to significant hemorrhaging during delivery
| Adv maternal age, multiple gestations, previous C-section, etc.
Placenta previa
38
In {{...}} there is partial or complete absence of the **decidua** of the endometrium w/ adherence of the placenta directly to the myometrium
| Can be a cause of obstetric bleeding
Placenta accreta
39
S/Sx of preeclampsia
* HTN
* Proteinuria
Both must be present
| After 20 weeks gestation; if < 20 weeks then chronic HTN
40
{{...}} is similar to preeclampsia (proteinuria & HTN) with new onset of **seizures**
Eclampsia
| Can occur before & after delivery
41
What is the main mechanism behind preeclampsia?
Reduced placental perfusion
| Maternal antioxidants & endothelial dysfunction --> reduced perfusion
42
What arteries display abnormal remodeling in the mechanism behind preeclampsia & eclampsia?
Remodeling of Spiral Arteries
43
What are some risk factors for preeclampsia/eclampsia?
* FMH of preeclampsia
* Preeclampsia w/ a previous pregnancy (man or woman)
* Fetus w/ a karyotypic abnormality
44
β-hCG level is much higher than that seen in pregnancy in what type of diseases?
Gestational trophoblastic disease
* Hydatidiform mole
* Invasive mole
* Choriocarcinoma
| More hCG more malignant
45
{{...}} are a gestational trophoblastic disease characterized as "grape-like" swellings of the chorionic villi
Hydatidiform mole
46
Complete hydatidiform moles are genotypically {{...}}
Dilpoid (46,XX or 46,XY)
47
Partial hydatidiform moles are genotypically {{...}}
Triploid (69,XXY or 69,XXX)
48
Which type of hydatidiform mole will not display fetal parts?
Complete hydatidiform moles
| Maternal egg is absent of DNA; All genes from paternal origin (sperm)
49
Which type of hydatidiform mole can produce fetal parts w/ a viable embryo maintained for up to weeks?
Partial mole (sperm has diploid DNA or 2 sperm fertilize the egg)
| Maternal egg (DNA) is normal; Sperm or action of sperm is abnormal
50
A complete hydatidiform mole is completely a {{...}}
Cystic/villous mass
| no fetal parts
51
Which type of hydatidiform mole is most likely to become a choriocarcinoma?
Complete hydatidiform mole (46,XX or 46,XY)
52
How are hydatidiform moles identified?
* Ultrasound at 12-14 weeks (too large for dates)
* Cystic appearance upon ultrasound
* Detected earlier via β-hCG
53
What are the risk of not removing all of the hydatidiform mole?
* Invasion of myometrium
* Rupturing & life-threatening hemorrhaging
* Embolization
| Can spread to broad ligament & vagina; monitor via hCG
54
Months after a normal pregnancy, a patient comes in complaining of bloody, **brown** discharge with high levels of hCG still in their laboratory work. What do you suspect?
Choriocarcinoma
| Necrotic mass --> brown; roughly 100% cure rate
55
Why is bacterial vaginosis important to treat during pregnancy?
Can lead to premature rupture of the membrane (premature birth)
56
What is the Dx criteria for bacterial vaginosis?
| Amsel's criteria
* Clue cells
* Fishy odor upon KOH
* Vaginal pH > 4.5
* Thin homogenous discharge
| 3 of the above
57
S/Sx of PID
* Pelvic pain
* Adnexal tenderness (implies infection)
* Fever
* Vaginal discharge
| Adnexa = appendages of organ
58
A patient comes into your office complaining of a greenish-yellow vaginal discharge along with a fever of 101F. You perform a vaginal swab which indicates WBCs on wet mount. What is your preliminary Dx?
| Pt has no other S/Sx pointing to other cause
PID
59
In gonococcal PID, it is common for the {{...}} to be involved in disease
Cervix
60
Acute suppurative salpingitis that spares the endometrium can be a sign of {{...}} PID
Gonococcal PID
61
How does a salpingo-oophoritis develop in gonococcal PID?
* Tubal fimbriae leak exudate w/ fibrin
* Fimbriae seal to ovaries leading to combining of tubes with ovaries
| An abscess can develop
62
Why is post-partum and post-abortion PID important to treat? Especially after pregnancy?
* The sequelae are bad: salpingo-oophoritis & abscess formation
* In post-partum & post-abortion, lymphatic/blood spread is more common leading to bacteremia
| Tx before comfirmation to avoid sequelae
63
Lichen sclerosus leads to...
* Atrophy of epidermis (labia; rete peds)
* Subepithelial (dermal) fibrosis
* Narrowing of introitus
* Bandlike lymphocytic infiltrate
| Most commonly occurs after menopause
64
{{...}} is a non-specific condition that results from rubbing or scratching the skin to relieve pruritus
| Characterized by acanthosis & hyperkeratosis
Lichen simplex chronicus
| Itching can be due to various conditions (e.g., bacterial vaginosis)
65
Lichen simplex chronicus is different from lichen sclerosis as there can be {{...}} of the epithelium
thickening
| Hyperkeratosis & Acanthosis (thickening of epidermis)
66
How & why do you treat lichen sclerosis?
* Tx with steroids
* Prevents cancer development (increased cell turnover)
| No cancer risk in lichen simplex chronicus -- no constant turnover
67
Benign venereal warts (condyloma acuminatum) are typically caused by HPV {{...}} & {{...}}
HPV 6 and HPV 11
68
What are the major pathohistologic features of condyloma acuminatum?
* Koilocytes
* Acanthosis
* Parakeratosis
* Hyperkeratosis
| Frequently regress spontaneously
69
You perform a biopsy of a condyloma along a female patients perineum and note the following cells in the image attached. What is the etiology?
Koilocytes; HPV
70
most carcinoma & vulvar intraepithelial neoplasia (VIN) are {{...}}
Squamous cell carcinomas
| 2 groups: HPV-assoc. or VNED
71
What is the most common vulvar intraepithelial neoplasia (VIN)?
Type I (HPV-assoc.)
| Most frequent in younger patients
72
What are the more oncogenic types of HPV?
HPV types 16 & 18
73
What are the strongest risk factors for Type I VIN (vulvar intraepithelial neoplasia)?
* HPV infection (16 & 18)
* Hx of Condyloma (warts)
* Hx of STD
* Cigarette smoking
74
What are the most common S/Sx of Vulvar intraepithelial neoplasia (VIN)?
* Long hx of **pruritus**
* Vulvar bleeding discharge
* Dysuria
* Pain
* **Vulvar lump or mass** most common on labia majora
| Mass can be leukoplakic, ulcerated, fleshy, warty
75
Vulvar carcinoma is dangerous as it likes to...
* Spread early in **inguinal** and **femoral** nodes
* Metastasis occurs early
76
Dx of vulvar carcinoma is based on?
Biopsy
77
You treat a patient with a vaginal condyloma and it comes back and is resistant to further treatment. What do you suspect to be the possible cause?
Verrucous carcinoma
* Appears as a condyloma acuminatum but it is resistant to Tx
| Biopsy any condyloma that doesn't respond to Tx as you would expect
78
What are Dx features of extramammary paget disease?
* Large tumor cells (Paget cells)
* Distinguished by other cells by a "Halo"
* Mucopolysaccharide within cells
* Keratin-positive
79
What is the major difference between malignant melanoma of the vulva versus extramammary paget disease of the vulva?
Paget Disease
* S100 negative
* Mucopolysaccharide positive
* Keratin positive
80
Why is marsupialization of the bartholin gland preferred over excision in bartholin cyst treatment?
In excision, recurrence is likely
81
What is the greatest risk factor for vaginal intraepithelial neoplasia (VIN) and squamous cell carcinoma?
HPV
| Greatest risk factor in cervical & vulvar cancers
82
VIN & squamous cell carcinoma are dangers regarding vaginal cancers because...
* Clinically silent until urinary or rectal fistulas develop (grows/spreads)
* Irregular spotting & leukorrhea may occur
83
Adenocarcinoma (clear cell carcinoma) has the highest risk factor for presentation in young women of?
DES (diethylstilbestrol) administration to their mothers during gestation
84
The attached image displays what type of cells associated with clear cell carcinoma?
Adenocarcinoma
85
What type of staining is used to Dx embryonal rhabdomyosarcoma (Sarcoma Botryoides)?
* Desmin
* Myogenin
86
A 3 yo female patient presents with vaginal masses that have grapelike clustering that are projecting out of the vaginal opening. What neoplasm is suspected?
Embryonal rhabdomyosarcoma (Sarcoma Botryoides)
87
In cervicitis, atypical cells can be indicative of?
Normal inflammatory processes and will likely regress spontaneously within the next few months
88
Endocervical polyps, a benign inflammatory tumor of the cervix, are more likely to occur due to?
Pregnancy
* due to hormone exposure
| Can occur during pregnancy & rupture or tear during parturition (bleed)
89
Which type of CIN lesion (I, II, or III) is a cancer?
| CIN = cervical intraepithelial neoplasia
None
* I = mild dysplasia
* II = moderate dysplasia
* III = severe dysplasia (carcinoma in situ)
| Basement Membrane (BM) remains intact -when it escapes- CIN IV (cancer)
90
What does ASC-H or ASC-US on a pap smear?
* ASC-US: atypical squamous cells w/ undetermined significance
* ASC-H: atypical squamous cells w/ high risk HPV infection (e.g., HPV 16 or 18)
| ASC -- will typical go away
91
T/F: All CIN lesions progress orderly regarding intensity of dysplasia
False, CIN lesions can enter into any stage w/o beginning or entering the previous stage
92
T/F: most CIN lesions, especially in younger women, will progress to cancer
False, most will spontaneously regress
| 50-80% will regress; lower chance if CIN II or CIN III
93
{{...}} DNA is present in 99.7% of cervical cancer cases
HPV
94
Regarding HPV, what is the role of HPV E7?
* Inhibition of p21
* Increased CDK4/Cyclin D
* Inhibition of **RB-E2F**
95
Regarding HPV, what is the role of HPV E6?
* Increased telomerase expression
* Inhibition of **p53**
96
What are the risk factors for cervical cancer?
* **HPV**
* Cigarette smoking
* Increased parity/oral contraceptives
* Vitamin A or C deficiency
* Host factors (e.g., immunodeficiency)
| Parity/OC is only correlated via increased sexual activity
97
The most common invasive cancers of the cervix are?
| Also, vulva & vagina
Squamous cell carcinomas
98
How long does it take cervical cancer (invasive carcinoma) to progress from precancerous to cancer?
~10-15 years
| Precancer ~30 yo, cancer presents 40-45 yo
99
What type of spread is related to invasive cervical carcinoma mortality?
Direct/Local extension
* peritoneum, urinary bladder, ureters, rectum, and vagina
| Not distant metastasis
100
The cytologic screening for cervical cancer should begin around {{...}} since HPV lesions can spontaneously regress & CIN lesions progress slowly
25 yo
* HPV testing every 5 years
* Cytology alone every 3 years
* Stop at 65 yo if negative last 10 years & no Hx of ≥ CIN II last 25 years
101
What type of biopsy confirm abnormalities (CIN lesions) of cytologic investigation of pap smear?
Punch biopsy
| CIN II or CIN III lesions
102
Most commonly, uterine and endometrial disorders are due to?
Endocrine abnormalities
103
A rise of {{...}} occurs in the later half of the menstrual cycle post-ovulation.
Progesterone
104
In anovulatory cycles, there is prolonged excessive {{...}} stimulation leading to endometrial proliferation
* Estrogen
* No progesterone rise (due to LH) to decrease endometrium
105
Why is endometrial cancer a higher risk for anovulatory cycle patients?
Prolonged estrogen mediated hyperplasia of endometrium
106
An inadequate luteal phase can be due to an inadequate corpus luteum that maintains a low {{...}} output
Low progesterone output
107
Acute endometritis is uncommon and is limited to bacterial infections that arise after?
* post-parturition
* post miscarriage
108
Where is endometrial tissue found in adenomyosis?
Deeper into the uterine wall
| Occurs in up to 20% of uteri
109
Where is endometrial tissue located in endometriosis?
* Outside of uterus
* Sites: ovaries, uterine ligaments, rectovaginal septum, pelvic peritoneum, laparotomy scars, umbilicus, vagina, vulva, or appendix
| An important cause of infertility, dysmenorrhea, pelvic pain
110
Endometriosis is typically Dx during...
20-30s
111
A chocolate cyst is indicative of {{...}} (disease)
Endometriosis
111
In endometriosis, there is bleeding, why?
* Hormone sensitive
* Bleeds during normal menstrual cycle
111
A 38 yo woman developed recurrent right-sided chest pain synchronously with her menses. What is the most likely diagnosis?
Meig's syndrome
| Endometrial tissue implanted in chest cavity leading to pneumothorax
112
What is surprising regarding risk factors for endometriosis?
Decreased risk with:
* Obesity
* Smoking
113
What are some things that can increase risk for endometriosis?
* FMH
* EtOH consumption
114
What are the most common S/Sx of endometriosis?
* Severe dysmenorrhea
* Dyspnareunia
* Pelvic pain
* Intrapelvic bleeding
* Periuterine adhesions
* Menstrual irregularities
* **Infertility**
| Dysuria = affects bladder, Rectal blood = rectum, etc
115
Endometrial polyps are associated with {{...}}
Tamoxifen
116
Endometrial polyps come in {{...}} endometrium and {{...}} endometrium
* Functional
* Functional but hyperplastic
117
{{...}} is characterized by increased gland to stroma ratio and abnormalities in epithelial growth
Endometrial intraepithelial neoplasia (EIN)
118
Endometrial intraepithelial neoplasia (EIN) is linked to prolonged exposure to {{...}}
Estrogen
| Can be a drug, anovulatory, etc.
119
The most common mutation seen in transformation of benign to precancerous endometrial intraepithelial neoplasia (EIN) is?
PTEN
120
In endometrial intraepithelial neoplasia (EIN) there will be glands colored?
| Normal = brown
Pale blue
121
What is the most common invasive cancer of the female genital tract?
Endometrial carcinoma
122
You should be suspicious of {{...}} for post-menopausal vaginal bleeding.
Endometrial carcinoma
123
What are common patient characteristics for someone with endometrial carcinoma?
Hx of Estrogen stimulation (excess)
* Hx of anovulation
* No Hx of children (nulliparous)
* Hx of breast cancer
* Obesity
| Sometimes it does not relate to estrogen
124
Individuals with endometrial carcinoma (adenocarcinoma) can be asymptomatic for a prolonged epriod of time; however, they will likely present to your office for?
Abnormal vaginal bleeding
| Excessive leukorrhea
125
{{...}} are perhaps the most common tumor in humans
Leiomyomas
| 3/4 of reproduction age women have ~6.5 tumors
126
{{...}} of the myometrium are benign tumors of smooth muscle of the uterus that appear as sharply circumscribed, discrete, round, gray-white
Leiomyomas
127
Most commonly, leiomyomas are asymptomatic, but they can cause what S/Sx?
* Abnormal vaginal bleeding
* Bladder compression
* Sudden pain
* Infertility (compression of fallopian tube)
| Note treated unless need to (e.g., infertility)
128
Leiomyosarcomas have a peak incidence of {{...}} age
40-60 yo
| Very aggressive: lung, brain, bone
