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Flashcards in Repro Deck (98)
1

Hormone closes epiphyseal plates

estrogen

2

Converts androsteinedione to estrogen

aromatase in sertoli or granulosa cell

3

LH --> ovary

desmolase in theca cell to convert cholesterol to androsteindione

4

FSH --> ovary

aromatase in granulosa cell to convert androsteindione to estrogen

5

Estrogen form high in pregnancy

estriol

6

Phase of constant 14d

Luteal

7

Oocyte phase until ovulation

Prophase I

8

Oocyte phase until fertilization

Metaphase II

9

Implantation day

6

10

What secretes hCG?

trophoblast
- blood = 1wk
- urine = 2wk

Syncytiotrophoblast --> maintains CL for 1st trimester

11

What causes lactation?

Dec in progesterone

Prolactin maintains
Oxytocin = let down

12

Best test to confirm menopause

INC FSH - loss of feedback from estrogen

13

Klinefelter

47 XXY

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

14

Turner

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

15

#1 cause of amenorrhea

Turner

16

Inc T
Inc LH

Defective androgen receptor

17

Inc T
Dec LH

T secreting tumor, steroids

18

Dec T
Inc LH

primary hypogonadism

19

Dec T
Dec LH

Hypogonadotropic hypogonadism

20

Androgen insensitivity

Normal appearing female
Rudimentary vagina
Testes in labia
NO SEXUAL HAIR

Inc T, estrogen, LH

21

5 alpha reductase deficiency

Males w/ ambiguous genitalia UNTIL PUBERTY

22

Kallmann syndrome

Defective GnRH
Anomsia, lack of secondary sex

23

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

Mole - swelling of chorionic villi

Most = complete
More = Asians, TAIWAN

24

Complete mole

>>>>>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

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,