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1
Q

Hormone closes epiphyseal plates

A

estrogen

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2
Q

Converts androsteinedione to estrogen

A

aromatase in sertoli or granulosa cell

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3
Q

LH –> ovary

A

desmolase in theca cell to convert cholesterol to androsteindione

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4
Q

FSH –> ovary

A

aromatase in granulosa cell to convert androsteindione to estrogen

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5
Q

Estrogen form high in pregnancy

A

estriol

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6
Q

Phase of constant 14d

A

Luteal

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7
Q

Oocyte phase until ovulation

A

Prophase I

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8
Q

Oocyte phase until fertilization

A

Metaphase II

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9
Q

Implantation day

A

6

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10
Q

What secretes hCG?

A

trophoblast

  • blood = 1wk
  • urine = 2wk

Syncytiotrophoblast –> maintains CL for 1st trimester

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11
Q

What causes lactation?

A

Dec in progesterone

Prolactin maintains
Oxytocin = let down

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12
Q

Best test to confirm menopause

A

INC FSH - loss of feedback from estrogen

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13
Q

Klinefelter

A

47 XXY

Abnormal sertoli/seminiferous = dec inhibin, high FSH
Abnormal Leydig = dec T, high LH, high estrogen

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14
Q

Turner

A

45 XO
Bicuspid aortic valve, webbing, horseshoe kidney
Low estrogen –> high LH, FSH

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15
Q

1 cause of amenorrhea

A

Turner

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16
Q

Inc T

Inc LH

A

Defective androgen receptor

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17
Q

Inc T

Dec LH

A

T secreting tumor, steroids

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18
Q

Dec T

Inc LH

A

primary hypogonadism

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19
Q

Dec T

Dec LH

A

Hypogonadotropic hypogonadism

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20
Q

Androgen insensitivity

A

Normal appearing female
Rudimentary vagina
Testes in labia
NO SEXUAL HAIR

Inc T, estrogen, LH

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21
Q

5 alpha reductase deficiency

A

Males w/ ambiguous genitalia UNTIL PUBERTY

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22
Q

Kallmann syndrome

A

Defective GnRH

Anomsia, lack of secondary sex

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23
Q

Cluster of grapes, honeycomb uterus, snowstorm US, hCG >100,000

A

Mole - swelling of chorionic villi

Most = complete
More = Asians, TAIWAN
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24
Q

Complete mole

A

> > > > > hCG
46 XX, XY
#1 –> choriocarcinoma/malignancy
2 sperm, EMPTY egg

Completely a mole = no fetal tissue
Completely edematous = all villi
Completely proliferated = diffuse trophoblast

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25
Partial Mole
69 XXX, XXY, XYY Little inc in uterine size, hCG RARE malignancy or choriocarcinoma 2 sperm, 1 egg
26
HELLP syndrome & Pre-eclampsia
HTN, proteinuria, edema after 20wks hemolysis elevated LFTs Low platelets Tx = IV Mag sulfate or diazepam
27
Painful bleeding in 3rd trimester, painful contractions
Abruption | - DIC, smoking, HTN, cocaine use
28
Painless bright red bleeding in any trimester
Previa | - inc w/ multiparity, prior C-section
29
Polyhydramnios
Esophageal/duodenal atresia | Anencephaly
30
Oligohydramnios
B/L renal agenesis (Potter seqence) | Post urethral valves
31
HPV 16
E6 inhibits p53
32
HPV 18
E7 inhibits RB
33
Endometritis
Retained product of conception after delivery Tx = Cefoxitin, ampicillin-sulbactam, ticarcillin-clavulanate
34
Cyclic bleeding, menorrhagia, dysmenorrhea, dysparenunia, infertility, chocolate cysts
Endometriosis Glands/Stroma OUTSIDE UTERUS Normal sized uterus (vs. adenomyosis) Inc risk of carcinoma Tx = Danazol
35
Menorrhagia, pelvic pain, dysmenorrhea, enlarged uterus
Adenomyosis - endometrium in myometrium ***Uniformly enlarged uterus*** Tx = hysterectomy
36
Endometrial hyperplasia
Post-menopausal bleeding - inc estrogen - risk of carcinoma - inc in glands:stroma
37
#1 GYN malignancy
Endometrial carcinoma - abnormal uterine bleeding in post-menopausal - preceded by endometrial hyperplasia
38
Prolonged use of estrogen w/o progestin, nulliparity, early menarche, late menopause risk for?
Endometrial carcinoma (endometrioid) - unopposed estrogen --> carcinoma - 50s
39
#1 tumor in females
Leiomyoma
40
Abnormal uterine bleeding, multiple miscarriages, iron deficiency, pre-menopasual women, multiple, well-defined, white, whorled masses
Leiomyoma - higher in blacks - inc in pregnancy, dec in menopasue - usually multiple, well- demarcaated
41
Abnormal uterine bleeding in post-menopasual women, single mass with hemorrhage and necrosis
Leiomyosarcoma | - NOT from leiomyoma = arise DE NOVO
42
Obese woman with infertility, amenorrhea, hirsutism, high LH, T, estrogen, low FSH
Polycystic ovarian syndrome - Inc LH --> inc androgens --> inc estrone in adipose --> dec FSH = follicle degeneration & ANOVULATION - B/L enlarged cystic ovaries LH:FSH >3:1 Tx = weight reduction, OCPs, Clomiphene
43
#1 ovarian mass in young women
Follicular cyst - hyperestrogen - endometrial hyperplasia - degeneration of follicles
44
Cyst assoc w/ teratoma
Dermoid
45
Cyst assoc w/ choriocarcinoma and moles
Theca-lutein cyst | - high serum hCG --> development
46
Amenorrhea and failure to have menarche in a girl with NORMAL secondary sexual characteristics, cyclic abdominal pain, vaginal or anterior rectal bulge
Either imperforate hymen OR Mullerian duct anomalies
47
Granulosa-Theca Cell Tumor
Yellow (lipid) Secretes ESTROGEN - feminizing, precocious puberty Sheets/cords of cuboidal cells Call-Exner
48
Unilateral painful cyst in vestibule
Bartholin cyst
49
HPV 6, 11
Condyloma of vulva & penis | - KOILOCYTES
50
Koilocytes
Condyloma of vulva & penis | - HPV 6, 11
51
Parchment-like, white vulvar skin
Lichen sclerosis - thinning of epidermis - fibrosis of dermis - benign, auto-immune - INC risk --> SCC
52
Thick leathery vulvar skin
Lichen simplex chronicus - scratching --> hyperplasia --> THICKENING - NO risk of SCC
53
How do you distinguish vulvar leukoplakia?
BIOPSY | - Lichen sclerosis vs. vulvar carcinoma
54
HPV vs. Non-HPV vulvar carcinoma
HPV = 40s, VIN, 16, 18 Non-HPV = 70s, lichen sclerosis
55
Carcinoma vs. Melanoma
Carcinoma = Keratin (epithelium), PAS + Melanoma = S100+
56
Upper 1/3 vagina origin & LN
Mullerian | Iliac LNs
57
Lower 2/3 vagina origin & LN
UG sinus | Inguinal
58
Persistence of columnar epithelium in upper 1/3 of vagina
Adenosis | - DES in utero
59
Feared complication of DES assoc adenosis
Clear cell adenocarcinoma
60
Mass with cytoplasmic cross-striations and desmin+, myogenin +
Embryonal Rhabdomyosarcoma | - grape-like mass from vagina or penis <5 y/o
61
Neoplasia vs. CIS
``` CIN/neoplasia = regresses Carcinoma = less likely to regress ```
62
Complication of advanced cervical carcinoma
Hydronephrosis --> post-renal failure --> death
63
Confirmatory test for abnormal pap smear?
Colposcopy
64
Limitations of pap smear
False - if not at transformation zone Limited for adenocarcinoma
65
Asherman syndrome
Secondary amenorrhea d/t loss of basalis (stem cells) --> can't regenerate functionalis cause = over aggressive D&C
66
Cause of anovulatory cycle
High estrogen w/o progesterone --> abnormal endometrial growth and shedding (irregular uterine bleeding)
67
SE of tamoxifen use
Endometrial polyp - pro-estrogenic effect in endometrium (vs. breast)
68
"Gun-powder" nodules
Endometriosis implants
69
#1 site of endometriosis
ovary (chocolate cysts)
70
Most important predictor for progression to carcinoma
Presence of cellular ATYPIA
71
Post-menopausal bleeding in 75 y/o, serous and papillary structures with psamomma bodies in endometrium
Serous/papillary endometrial cancer - p53 - SPORADIC
72
PPL with polycystic ovarian syndrome are at risk for?
Endometrial carcinoma d/t high estrogen | Type II DM
73
Most common ovarian tumor
Surface epithelial
74
Single cystic, surface tumor of the ovary in 30 y/o, tumor cells in peritoneum
BENIGN serous/mucinous cystadenoma | - from surface epithelium
75
Complex cyst of ovary with shaggy lining in 65 y/o, tumor cells in peritoneum
MALIGNANT serous/mucinous cystadenocarcinoma | - from surface epithelium
76
BRCA1 cancers
Breast Serous ovarian* Serous fallopian
77
Most common germ cell tumor in women
Cystic teratoma - #1 benign - immature tissue (NEURAL) = malignant potential - thyroid = struma ovarii
78
Ovarian tumor in 15-30 y/o
Germ cell tumor - tertoma - dysgerminoma - endodermal sinus
79
Most common malignant germ cell tumor
Dysgerminoma - large cells w/ clear cyto - high LDH
80
Most common germ cell tumor in kids
Endodermal sinus tumor (yolk sac) - HIGH AFP - SCHILLER-DUVAL bodies
81
Reinke crystals
Sertoli-Leydig cell tumor Women --> hirsutism, virilization Males --> precocious puberty, gynecomastia
82
Pelvic mass, fluid wave and SOB
Meigs syndrome - Ovarian fibroma - Pleural effusions - Ascites
83
B/L ovarian tumor assoc w/?
Krukenberg tumor from diffuse type (signet ring) GASTRIC carcinoma
84
Massive amounts of mucous in peritoneum
Psuedomyxoma peritonei | - mucinous tumor of the APPENDIX
85
Most common cause of spontaneous abortion
Chr abnormalities
86
Fetal alcohol syndrome
#1 MR, facial, microcephal
87
Fetal cocaine
IUGR | Abruption
88
Fetal thalidomide
Limb
89
Fetal Isotretinoin
spontaneous abortion | hearing, visual
90
Fetal smoking
IUGR
91
Fetal phenytoin
Digit hypoplasia | Cleft lip/palate
92
Germ cell vs. mole/gestational choriocarcinoma
Mole = RESPONDS to radiotherapy
93
Most impact in lowering the rate of cervical cancer
Cytology
94
Bleeding in 1st 20 wks, closed cervix, viable fetus on US
Threatened abortion --> bed rest Fetus not viable = missed Open cervix = inevitable
95
Pelvic pain, abnormal bleeding and hyperthyroid signs, high free T4/3
struma ovarii
96
#1 cause of infertility in women
PCOS
97
OCPs dec risk of?
Ovarian cancer
98
SE of OCPs
High TAGs, cholesterol, HTN, hypercoagulable,

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