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Reproductive + Urogenital Flashcards

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1
Q

Functional Hypothalamic Amenorrhea

what is it? causes? complications?

A

a SECONDARY amenorrhea due to LOW LEPTIN via low adipose tissue

causes: excess weight loss, exercise, chronic illness and eating disorders
decr. leptin > decr. pulsatile GnRH secretion > decr. FSH/LH > low estrogen

also causes OSTEOPOROSIS

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2
Q

Granulosa Cell Tumor

type, histo (2 special features)

macro - color, size, location

A

sex cord stromal tumor

cuboidal cells in sheets/cords with COFFEE-BEAN nuclei and CALL-EXNER BODIES (follicle/rosette-like) with pink center

high lipid content = YELLOW/firm macro

mostly unilateral + large in post-menopausal women (but can cause precocious puberty in young pt)

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3
Q

Small underdeveloped ovaries primarily composed of CT with no follicles.

What is this, what disease is it assoc. with + what are the other features?

A

“Streak ovaries” ofTurner Syndrome

45, X- lack of paternal X causes loss of ovarian follicles by age 2 > high FSH and LH

withamenorrheaandinfertility
short stature, shield chest, webbed neck, low posterior hairline

lymphedema,bicuspid aortic valve(25%) oraortic coarctation(5%)

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4
Q

Newborn girl with posterior neck mass, bilateral nonpitting edema of hands and feet, diminished femoral pulse.

Neck US > cystic spaces separated by CT

What is the mass, why is it there, what causes the condition + explain other findings?

A

Turner syndrome

45, X due to loss of paternal X

cystic hygromaon neck due to abnormal lymph flow

edema common to Turner’s, diminished femoral pulse due toaorctic coarcation(2nd commonest CV abn in Turner’s after bicuspid aortic valve)

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5
Q

14 yr old with soft, hyperpigmented non-tender bump below rt breast; has always been there, but got bigger at puberty; becomes tender just before menses

what is it?

A

accessory nippleAKApolythelia / supernumerary nipple

failed involution ofmammary ridge; histo same as normal nipple; may swell / be tender during menses, pregnancy or lactation

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6
Q

Spina bifida - type of inheritance?

A

Multifactorial

  • many genesplay role in neurulation; folic acid deficiency is major factor
  • common in first-degree relatives of those affected
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7
Q

1 cause of pathological

physiological vs. patho nipple discharge

A

1 =intraductal papilloma- usually no mass or skin change, bloody/serosanguinous dischargeunilaterally due to proliferation of papillary cells in duct/cyst wall withfibrovascularcore (twisting of stalk > bleed), with foci of atypia orductal carcinoma in situ

physio = bilateral, nonbloody / milky without masses or skin changes

patho = bloody or serosanguinous w/ or w/o mass or skin change

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8
Q

Differential dx of abnormal menstrual bleeding

3 diagnoses + their features

A

Fibroids - heavy menses; constipation, polyuria, pelvic pain/heaviness; ENLARGED uterus

Adenomyosis - dysmenorrhea, pelvic pain; heavy menses; “bulky, globular + tender uterus” (endometrial tissue in myometrium)

Endometrial cancer/hyperplasia - history of obesity, nulliparity, chronic anovulation; irregular, intermenstrual or postmenopausal bleed; NONTENDER uterus

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9
Q

Endometriosis

risk factors? protective factors?

A

Risk - nulliparity, early menarche or prolonged menses

Protective - multiparity, extended lactation, late menarche

less frequent menstrual cycles > less opportunity for endometrium to disseminate out of uterus

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10
Q

Endometriosis

s/s? (uterine position, menstrual changes)

locations + associated complications?

A

responds to menstrual hormonal changes > bleeding + shedding > collections of blood in ectopic loci > hemolysis can cause inflammation + adhesions

Infertility - adhesions interfere with ovulation + Fallopia

Fixed, RETROVERTED uterus - adhesions on uterosacral ligament

PAINFUL SEX - infiltration of Douglas pouch; tender palpation of posterior vaginal fornix

DYSMENORRHEA - shedding of ectopic tissues

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11
Q

Estrogen deficiency

causes? vaginal changes? sx?

A

premature ovarian failure or menopause

glycogen-deficient epithelium; flattened labial folds + vaginal rugae > DYSPAREUNIA + menstrual irregularity

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12
Q

Congenital Torticollis

causes? associated issues?

A

Causes include…
BIRTH TRAUMA - breech delivery, etc.
IN UTERO MALPOSITION - fetal macrosomia or oligohydramnios
(cervical spine deformities)

cause SCM injury + fibrosis

May also have…
hip dysplasia
metatarsus adductus - forefoot adduction
clubfoot - “talipes equinovarus”

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13
Q

Congenital Torticollis

presentation? dx?

A

develops by 2-4 WEEKS of age

HEAD TILT TOWARDS affected side, with CHIN POINTED AWAY

Soft tissue mass palpable in inferior 1/3 of SCM

Plagiocephaly - “flat head syndrome” skull malformation sometimes seen

Facial asymmetry - sometimes

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14
Q

Maternal hypertension during gestation

can cause what?

A

asymmetric intrauterine growth restriction

normal/near-normal head size with REDUCED ABDOMINAL CIRCUMFERENCE

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15
Q

Hypertension in pregnancy

Chronic htn vs. gestational htn?

A

Chronic - greater than/equal to 140/90 PRIOR TO CONCEPTION or 20 WEEKS

Gestational - new-onset high BP AFTER 20 WEEKS (with no proteinuria or end-organ damage)

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16
Q

Pre-eclampsia vs. eclampsia

A

Pre-eclampsia - new-onset high BP AFTER 20 WEEKS plus PROTEINURIA or END-ORGAN DAMAGE

Eclampsia - pre-clampsia plus new-onset GRAND MAL SEIZURE

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17
Q

Pre-eclampsia

risks + pathophys

A

nulliparity, personal/fam history, obesity + chronic htn

abnormal placental vasculature > placental hypoxia + ischemia > ANTIANGIOGENIC FACTORS into maternal circ > endothelial injury with permeability increase and PROTEINURIA

end-organ damage includes HA, visual changes, and abdominal pain from liver damage

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18
Q

HELLP syndrome

acronym?
cause?

A

Hemolysis
Elevated Liver enzymes
Low Platelets

manifestation of severe pre-eclampsia

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19
Q

Adenomyosis

what? in whom?

A

endometrial glandular tissue in the myometrium

common in MIDDLE-AGED PAROUS women

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20
Q

Adenomyosis

s/s? definitive dx?

A

heavy menstruation
dysmenorrhea
UNIFORMLY ENLARGED uterus

definitive dx is by HYSTERECTOMY BIOPSY bc normal endometrial biopsy doesn’t reach myometrium

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21
Q

Endometrial polyps

what? how? s/s?

A

benign projections of uterine lining

hyperplastic growth of endometrial glands + stroma

abnormal bleeding
NO uterine enlargement

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22
Q

Endometrial hyperplasia

what? s/s?

A

greater increase in gland proliferation as compared to stroma (polyps are both glands + stroma)

irregular menstrual bleeding that is NOT painful

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23
Q

Uterine Leiomyoma

what? s/s?

A

proliferation of myometrial SM

heavy menstrual bleeding
uterus is IRREGULARLY ENLARGED

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24
Q

Urachal abnormalities (3)

urachus is a remnant of the allantois

A
  1. Patent urachus - all the way open
  2. Urachal sinus - adjacent to umbilicus
  3. Urachal cyst - midway btwn bladder + umbilicus
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25
Straw-colored discharge at umbilicus, worsened by crying, straining or lying prone local skin irritation + erythema
Patent Urachus
26
Periumbilical tenderness Purulent umbilical discharge
Urachal sinus periumbilical sinus is prone to persistent and recurrent infections
27
Menopause hormonal changes
FSH increases, due to... 1. resistant ovarian follicles 2. lack of inhibin low estrogen also > less feedback inhibition on GnRH and pituitary (ESTRONE, not estradiol, produced outside ovary becomes major estrogen) progesterone decreases as well
28
Sertoli-Leydig cell ovarian tumor presentation? who? histo?
SEX CORD-STROMAL tumor in YOUNG WOMEN with adnexal mass, amenorrhea and VIRILIZATION hollow/solid tubes lined by round Sertoli cells w/ fibrous stroma
29
what is VACTERL association?
syndrome of birth defects with at least 3 of: ``` vertebral anomalies anal atresia cardiac defects tracheoesophageal fistula renal defects limb defects ```
30
Maternal Serum AFP Screening Increased in? Decreased in?
Increased: Open NT Defects (anencephaly, open spina bifida) Ventral Wall Defects (omphalocele, gastroschisis) Multiple Gestation Decreased: Aneuploidy (trisomy 18, 21 etc.)
31
AFP Where is it made? How/when does it change? Clinical consequence of this?
Fetal liver, GI tract and yolk sac (early gestation) Increases with gestational age Correct gestation aging is important in determining what normal AFP levels should be. In mothers with previously irregular menses this can be hard, and may require ultrasound.
32
dizygotic twins how do they form? how many chorions/amnions? how many placentas?
2 oocytes + 2 sperm > twins' sex may differ 2 amnions + 2 chorions (dichorionic, diamniotic) chorions may fuse if close > 1 or 2 placentas
33
monozygotic twins most common time it starts? most common amniotic/chorionic situation?
usually occurs at END OF 1st WEEK > 2 embryos, each with their own amnion, but a SINGLE CHORION and COMMON PLACENTA monochorionic, diamniotic
34
monozygotic twins early separation > what chorionic/amniotic situation
separation at days 0-4 similar to dizygotic twins > 2 chorions, 2 amnions and 2 placentae +/- placental fusion
35
monozygotic twins late separation > what chorionic/amniotic situation
separation at 8-12 days 1 amniotic sac + 1 chorion > high fetal fatality rate via umbilical cord entanglement
36
what is the cause of conjoined twins?
monozygotic twins separating LATER THAN 13 DAYS after fertilization monoamniotic, monochorionic
37
most common site of ectopic pregnancy? imaging? risk factors?
FALLOPIAN AMPULLA, will appear as an ADNEXAL MASS on US Any tubal pathology, such as... Previous infection Surgery - eg, TUBAL LIGATION (pregnancy rare after ligation, but 1/3 are ectopic if they implant!)
38
ectopic pregnancy Treatment Dx including endometrial histo
Tx - surgical removal and hemostatic maintenance Dilation + curettage of uterus - can stop bleeding and determine ectopia vs. normal preg Histo - "decidualized endometrium" with DILATED, COILED GLANDS and VASCULAR EDEMATOUS STROMA (normal changes for the "luteal" phase of cycle via progesterone)
39
Urethral injury in men most common site?
Membranous part less supported/protected than prostatic or penile parts pelvic fracture often injures it
40
Mechanism for formation of a COMPLETE MOLE? most common mech, less common mech
most common - fertilization of an "empty" ovum with NO MATERNAL CHROMOSOMES by a single 23, X sperm > duplicates its chroms. to form ***46, XX*** complete mole (46, YY have not been observed b/c they just die) less common - fertilization of empty ovum with 2 DIFFERENT SPERM > can be 46, XX or 46, XY
41
Mechanism of formation of PARTIAL MOLE?
an egg WITH ITS CHROMOSOMES (23, X) is fertilized by TWO SPERM resulting in 3 possibilities... 69, XXX 69, XXY 69, XYY
42
Risk factors for molar pregnancy (4)
Advanced maternal age Prior molar pregnancy Prior miscarriage Infertility
43
Complete molar pregnancy gross morpho? ultrasound? histo?
NO FETAL STRUCTURES, with large edematous disorded "bunch of grapes" chorionic villi US shows "swiss cheese" or "snowstorm" - a central heterogenous mass with MULTIPLE CYSTIC areas histo - trophoblastic hyperplasia
44
Complete molar pregnancy s/s? labs?
pelvic pain + vaginal bleeding uterus larger than expected for gestational age HIGH beta-hCG!!! (via trophoblastic hyperplasia)
45
two drugs used in tx of infertility for 2 phases of menstrual cycle
MENOTROPIN (human menopausal gonadotropin) - mimics FSH to form dominant follicle hCG - mimics LH > surge causes ovulation (alpha subunit of hCG is similar to LH)
46
Gestational choriocarcinoma from what cells? when? s/s?
malignant TROPHOBLAST tumor preceded by NORMAL PREGNANCY usually, but can be after molar, ectopic or aborted preg vaginal bleeding, uterine enlargement and VERY HIGH BETA-hCG!!
47
Gestational choriocarcinoma spread? macro? histo?
hematogenous spread after uterine wall invasion #1 site is LUNGS bulky mass in uterus that is SOFT, YELLOW-WHITE and with NECROSIS + HEMORRHAGE may or may not have fetal tissue histo - proliferation of mononuclear CYTOTROPHOBLASTS and multinuclear SYNCYTIOTROPHOBLASTS with NO VILLI
48
what is the difference in chorionic villi in a PARTIAL vs. COMPLETE vs. INVASIVE mole?
partial - FOCALLY enlarged + hydropic villi complete - DIFFUSELY enlarged + hydropic invasive - same as complete, but TROPHOBLASTS INVADE MYOMETRIUM (thus is malignant)
49
Aromatase deficiency inheritance? fetal effect? maternal effect?
AR inheritance high androgens, low estrogens in fetus maternal virilization - later in preg fetus has NORMAL INTERNAL but AMBIGUOUS EXTERNAL genitalia later, primary amenorrhea, OSTEOPOROSIS with TALL STATURE (late epi plate closure)
50
Nicotine use during pregnancy what baby effects? what pregnancy effects?
increased prematurity / low birth weight risk placenta previa + abruption risk
51
Phenytoin during pregnancy what anomalies can result? 3 things
cardiac defects cleft lip/palate hypoplastic nails
52
Congenital Rubella Syndrome basic triad... i think Sketchy has much more, so make another card on that
hearing loss cataracts cardiac defects
53
Indirect Inguinal Hernia cause? presentation? in whom?
failed obliteration of processus vaginalis (as in hydrocele) indirect inguinal hernia (and hydrocele) can present as an asymptomatic scrotal mass that INCREASES WITH VALSALVA seen in children (as they are a developmental abnormality and not acquired)
54
Indirect Inguinal Hernia pass through? covered by? locational landmark?
thru deep inguinal ring covered by INTERNAL SPERMATIC FASCIA (continuation of transverse fascia) ... so intestine is INSIDE the spermatic cord LATERAL to the INFERIOR EPIGASTRIC VESSELS
55
Direct Inguinal Hernia cause? location (triangle)?
ACQUIRED protrusion of abdominal contents through a weak portion of abdominal wall does NOT pass through inguinal canal or within spermatic cord HESSELBACH'S TRIANGLE - medial to inf. epigastric vessels; lateral to rectus abdominis; superior to inguinal ligament
56
another name for the infundibulopelvic ligament? what does it contain?
suspensory ligament of the ovary ovarian artery, vein and nerve plexus
57
ovarian torsion main risk factor presentation dx
large ovarian masses (cyst or tumor) - weight of mass can cause ovary to twist around suspensory ligament + cut off its own blood supply sudden-onset unilateral pelvic pain and nausea (sometimes vomiting, fever) pelvic US for dx; doppler shows low/no flow
58
hormonal changes in anovulatory cycles
immature hypothalamic-pituitary-ovarian axis in early puberty leads to... anovulation > no corpus luteum > no progesterone and persistently high estrogen endometrium remains in PROLIFERATIVE phase > disorganized + fragile tissue with irregular, often heavy bleeding
59
What is "complex atypical hyperplasia of the endometrium"? what causes it? in whom?
Prolonged exposure to estrogen without opposing progesterone Chronic anovulation can cause it, as may be seen in OBESE OLDER WOMEN or ESTROGEN-ONLY hormone therapy
60
Progesterone secretion throughout pregnancy how does it change?
1st trimester - via corpus luteum, stimulated by beta-hCG 2nd/3rd trimester - progesterone from placenta; (b-hCG drops to very low levels)
61
What inhibits lactation during pregnancy, despite rising prolactin levels?
Progesterone
62
Adenomyosis what is it? who gets it?
endometrial glandular tissue in the myometrium middle-aged parous women
63
Adenomyosis s/s? dx?
heavy menstrual bleeding dysmenorrhea UNIFORMLY enlarged uterus endometrial biopsy is normal; must to MICROSCOPY HYSTERECTOMY for definitive dx
64
amniotic fluid analysis in NEURAL TUBE DEFECTS
failure of either neural pore to fuse (rostral > anencephaly; caudal > spina bifida) causes leakage + thus HIGH levels of... ALPHA-FETOPROTEIN, and... ACETYLCHOLINESTERASE
65
GI cause of polyhydramnios
duodenal atresia
66
amniotic fluid analysis in DOWNS SYNDROME
shows LOW ALPHA-FETOPROTEIN | normal acetylcholinesterase
67
On which side is varicocele more common and why?
left left renal vein is often compressed between aorta and SMA as it courses from the kidney to the IVC left gonadal vein branches off the left renal vein + this compression can cause stasis and backwards flow to the pampiniform plexus
68
What muscle do Kegel exercises strengthen? How does this help stress incontinence?
LEVATOR ANI (iliococcygeus, pubococcygeus + puborectalis) levator ani holds bladder and urethra in correct position... injury during childbirth causes URETHRAL HYPERMOBILITY and/or pelvic organ prolapse when urethra is hypermobile, incomplete closure of urethra + bladder neck against anterior vaginal wall causes stress incontinence
69
#1 cause of bloody or "serosanguinous" (blood-tinged) nipple discharge other aspects of presentation? histo?
intraductal papilloma presents WITHOUT a mass or skin changes papillary cells in duct/cyst wall with FIBROVASCULAR core +/- foci of atypia or DCIS
70
what causes nipple bleeding in intraductal papilloma?
twisting of fibrovascular core
71
what causes Paget disease of nipple?
DUCTAL spread of malignant cells to nipple surface eczematous exudate on nipple/areola
72
CYCLIC breast pain without nipple discharge cause? histo?
FIBROCYSTIC changes in breast DIFFUSE small cysts +/- metaplasia
73
Local trauma to breast later develops an irregular mass without discharge what is it? histo?
FAT NECROSIS liquefactive adipocyte necrosis + hemorrhage
74
Fibroadenoma of breast proliferation of what? causing what in histo? presentation?
proliferation of stroma + ducts small, mobile, firm mass COMPRESSES DUCTS into slits on histo
75
What occurs in vagina of daughter of pt exposed to DIETHYLSTILBESTROL? precursor to what?
Vaginal adenosis - replacement of squamous epi with columnar glandular epi precursor to CLEAR CELL ADC of vagina
76
Maternal Serum Quadruple Screen when + what does it test for?
second trimester AFP, estriol, b-hCG, inhibin A
77
How does AFP change as pregnancy progresses? Why is this important in serum + amniotic fluid testing? where is it made in the fetus?
it INCREASES with gestational age requires ACCURATE DATING of gestational age, which can be difficult in patients with irregular menses prior to pregnancy made by LIVER, GI TRACT and YOLK SAC (early gestation)
78
Which 3 things can cause INCREASED AFP in maternal serum testing (quadruple screen in 2nd trimester)?
1. Neural tube defects - spin bif, anenceph 2. Ventral midline defects - omphalo, gastrosch. 3. Multiple gestation
79
What can DECREASE AFP in maternal serum testing?
Aneuploidies (trisomy 18, 21)
80
Exclusively breastfed infant not receiving post-natal care is at risk of deficiency of what? why?
Vitamin K poor placental transfer, sterile gut and low content in breast milk results in low levels of carboxylated clotting factors
81
Presentation of complications in vitamin K dependent infant?
intracranial, GI, cutaneous, UMBILICAL and surgical site bleeding in exclusively breastfed infant without postnatal care
82
Signs of increased ICP in infant (4)
1. Altered mental status 2. ENLARGED HEAD circumference 3. BULGING FONTANEL 4. "sunset eyes" DOWNWARD-DRIVEN + can't look up
83
when is intracranial hemorrhage from birth injury common?
presents SHORTLY AFTER BIRTH when the birth was operative and involved VACUUM or FORCEPS
84
INTRAVENTRICULAR hemorrhage in newborn caused by what? in whom?
GERMINAL MATRIX FRAGILITY in a PREMATURE infant germinal matrix involutes from week 28 to birth
85
estrogen levels in PCOS? result?
also INCREASED (along with testo) LH affects THECAL cells and is increased, so affects both testo and estrogen precursor synth endometrial hyperplasia with INCREASED ENDOMETRIAL CANCER RISK due to unopposed estrogen effects
86
Female equivalent of Leydig cell? Female equivalent of Sertoli cell?
leydig > THECA sertoli > GRANULOSA SGLT ... like SGLT2 in kidney...
87
Genes involved in sertoli cell dysfunction and genital malformations in males?
SF-1 / NR5A1 SF-1 = steroidogenic factor result in decreased inhibin > increased FSH genital malformation includes micropenis
88
Symptoms (other than mass effects) in male with FSH-secreting pituitary adenoma?
usually none, because FSH adenomas usually only produce the inactive alpha subunit (FSH is a glycoprotein hormone with inactive alpha and active beta subunits) few will have testicular enlargement
89
Bone lesions in prostate cancer... clastic or blastic?
osteoBLASTIC
90
stridor in newborn of mother with Graves cause?
enlargement of infant's thyroid by anti-TSH-R IgG transfer transplacentally
91
PCOS - other name and general pathogenesis
Stein-Leventhal hyperinsulinemia / insulin resistance thought to alter hypothalamic hormone feedback responses... high LH:FSH ratio high androgens from theca interna low rate of follicle maturation > unruptured follicles form cysts
92
PCOS tx for 1) cycle regulation, and 2) endometrial hyperplasia
1. cycle reg by WEIGHT LOSS (decr. peripheral ESTRONE formation in adipose) 2. OCPs - opposes estrogen excess
93
PCOS tx for 1) ovulation induction, and 2) hirsutism
1. Clomiphene + metformin - induce ovulation (and control glucose) 2. Ketoconazole - antiandrogenic for hair
94
fever, chills, dysuria and tender, large prostate most common organism?
E. coli
95
Structure at greatest risk of injury during radical prostatectomy
Pelvic parasympathetic nerves > erectile dysfunction
96
What are the TWO GENERAL causes of polyhydramnios? And examples of things that contribute to these two causes?
1. IMPAIRED FETAL SWALLOWING - any GI obstruction; esophageal, duodenal or intestinal atresia; ANENCEPHALY 2. INCREASED FETAL URINATION - anything causing high fetal cardiac output: a) alloimmunization, b) parvovirus, c) fetomaternal hemorrhage, d) twin-twin transfusion syndrome (milder cases can be caused by MATERNAL DM or MULTIPLE GESTATION)
97
What are FOUR COMPLICATIONS of polyhydramnios?
1. preterm labor 2. placental abruption 3. uterine atony - via distension 4. maternal respiratory compromise
98
Postpartum Ovarian Vein Thrombosis 3 risk factors, all related to pregnancy
1. VENOUS DILATION - stasis in the ovarian v. 2. HYPERCOAGULABILITY - preg. causes incr. clotting factors 3. INTRAPARTUM VASCULAR INJURY - endothelial damage
99
Postpartum Ovarian Vein Thrombosis 1 non-specific feature with a more specific characteristic to it 1 other feature
1. PERSISTENT FEVER after delivery that DOES NOT RESPOND TO ABX - usually hospitalized for presumed infection and ct/mri confirms thrombosis 2. FLANK / ABD. PAIN
100
Prostatic plexus ``` injury during what + causing what? from what (1 + 3) and innervates what? ```
can be injured during prostatectomy > erectile dysfunction from 1) INFERIOR HYPOGASTRIC PLEXUS... which has inputs from a) HYPOGASTRIC N., b) PELVIC SPLANCHNIC N. (S2-S3) and c) SACRAL SPLANCHNIC N. innervates penis via CAVERNOUS NERVES
101
Pudendal nerve from what? innervates what? injury causes what?
S2-S4 innervates external anal + urethral sphincters and sensory innervation to genitals injury > fecal incontinence, decreased penile sensation, external urethral sphincter paralysis
102
Cremasteric reflex what nerve mediates (+ roots) ? lost in what 2 conditions?
Genitofemoral nerve (L1-L2) 1) testicular torsion 2) L1-L2 injury
103
Detrusor muscle innervated by what? dysfunction causes what?
PSNS fibers from PELVIC SPLANCHNIC and INFERIOR HYPOGASTRIC PLEXUS overactivity > URGE incontinence (mostly women)
104
Adolescent girl with primary amenorrhea with normal secondary sex char. Cyclic abdominal/pelvic pain +/- back pain and defecation issues Dx? Examination signs? (2)
Imperforate Hymen exam shows... 1. Vaginal bulge - the "hematocolpos" (blood in uterus + vagina) bulges out of the vaginal orifice 2. Anterior rectal mass - can palpate the hematocolpos transrectally
105
Asherman syndrome what is it? how does it happen (2)?
SECONDARY amenorrhea via obstruction due to scarring of uterus 1. INFECTION - eg, postpartum endometritis 2. PROCEDURES - eg, dilation + curettage
106
Androgen Insensitivity Syndrome karyotype? phenotype? defect?
46, XY phenotypically female androgen receptor defect
107
Androgen Insensitivity Syndrome Internal + external genitalia? Secondary sex char?
46, XY phenotypically female with... Internal - CRYPTORCHID testes; no uterus/ovaries External - no penis/scrotum Secondary - no axillary/pubic hair; breast development (due to aromatized androgens)
108
Characteristic cell on HPV pap smear (name + 3 features)
Koilocyte immature squamous cell with.. 1. DENSE, irregular cytoplasm 2. PERINUCLEAR HALO 3. RAISIN NUCLEUS - large + pyknotic
109
Incidental finding in Pap of pt with IUD
Actinomyces like organisms clusters of basophilic thin filaments like cotton candy
110
Cell that may be seen on Pap during menses
endometrial cell look like histiocytes; very SMALL DARK NUCLEI and homogenous light cytoplasm (no perinuclear clearing)
111
Cell type on Pap whose presence indicates ADEQUATE SAMPLING
glandular endocervical cell columnar cells with vacuolated/granular cytoplasm + prominent borders clump together into HONEYCOMB pattern
112
Cell type seen in Pap of POSTMENOPAUSAL / POSTPARTUM women
PARABASAL cell round with basophilic cytoplasm finely granular chromatin FRIED EGG WITH LARGE CENTRAL YOLK
113
Progestin challenge what is it + why is it used?
tests for reason for amenorrhea 1. Progestin given either IM or oral 2. Watch for bleeding within 2-7 days ("withdrawal bleeding") 3a. If bleeding occurs > ESTROGEN IS SUFFICIENT and ANOVULATION is issue 3b. if no bleed > either LOW ESTROGEN, HPA axis dysfunction, nonreactive endometrium, or outflow tract issues
114
If NO WITHDRAWAL BLEEDING occurs on progestin challenge, how can the different causes of amenorrhea be differentiated?
causes can be 1) low estrogen, 2) HPA axis dysfunction, 3) nonreactive endometrium or 4) outflow tract issues can give ESTROGEN followed by PROGESTIN and then watch again for withdrawal bleeding > - if bleeding, issue was low E - if no bleeding issue is nonreactive endometrium or outflow issue
115
What are two possible OUTFLOW TRACT issues that can cause AMENORRHEA?
1. Asherman syndrome - "uterine synechiae" intrauterine fibrous scarring (via procedures, infections, obesity, etc.) 2. Cervical stenosis
116
Cervical lymph drainage goes where first?
Internal iliac nodes
117
Bartholin cyst / abscess description? cause?
PAINFUL swelling in the posterior part of labia majora blockage of Bartholin gland duct + fluid accumulation; may lead to abscess via obstruction/inflammation
118
Bartholin cyst / abscess in whom? associations?
reproductive-age females (but not necessarily sexually active!) assoc. with N. gonorrhoeae infection
119
Vulvar lichen sclerosus how is epidermis + dermis affected? derma description?
epidermis is THINNER dermis is FIBROTIC / SCLEROTIC "PORCELAIN-white" plaques with RED/VIOLET border skin fragility with erosions
120
Vulvar lichen sclerosus in whom? increased risk for?
in POSTMENOPAUSAL women incr. risk for SCC
121
Vulvar lichen simplex chronicus how is epidermis affected? derma description? increased risk for?
HYPERPLASIA of vulvar squamous epi LEATHERY thick vulvar skin with markins from rubbing / scratching totally benign... NO increased scc risk (diff from lichen sclerosus)
122
Vulvar carcinoma HPV-related vs. non-HPV-related in whom?
HPV - types 16/8; multiple partners + early "coitarche" in reproductive age females non-HPV - via long-standing lichen sclerosus in women >70 both have LEUKOPLAKIA
123
What breast disease can also present in the vulva?
"Extramammary" Paget disease an intraepithelial ADC - is in situ and low risk of invasion pruritus, redness, crusting + ulcers
124
What main gestational issue can arise from cocaine use during pregnancy?
PREMATURITY
125
HELLP syndrome smear? complications (2, one hemo one GI) tx?
SCHISTOCYTES 1. DIC 2. HEPATIC SUBCAPSULAR HEMATOMA - may rupture and cause severe hypotension tx is immediate delivery
126
US incidence of gynecologic tumors in descending order | 3 tumors, by organ not specific subtype; how is it different in worldwide?
endometrial > ovarian > cervical cervical more common worldwide due to lack of screening + HPV vacc.
127
Gynecological tumor prognosis in worsening order | 3 tumors, by organ not specific subtype
1. Cervical - best progno; dx < 45 yrs old 2. Endometrial - dx at middle-age; ~55 yrs 3. Ovarian - worst progno; dx > 65 yrs ("CEOs go from good to bad as they get older")
128
Histo of proliferative endometrium (glands + stroma)
- STRAIGHT + SHORT glands - COMPACT stroma (1st half of menstrual cycle, as estrogen causes endometrial proliferation 4-7 days after menses onset until ovulation)
129
Endometritis infection of what? presentation (3)? histo?
infection of DECIDUA (term for endometrium during preg) - uterine tenderness - fever - tachycardia - inflammatory infiltrate of endometrium
130
Uterine curettage (histo) finding in... either MOLAR PREG or SPONTANEOUS ABORTION (2 things)
1. enlarged CHORIONIC VILLI | 2. AVASCULAR EDEMATOUS stroma
131
Histo in ENDOMETRIAL ADC (3 things) in whom? primary symptom?
1. ATYPICAL endometrial cells that... 2. form DISORGANIZED GLANDS, and have... 3. ... many MITOSES in POSTMENOPAUSAL women with VAGINAL BLEEDING
132
Effect of estrogen on hypothalamus and pituitary secretion throughout menstrual cycle
Most of the time it is INHIBITORY but MID-CYCLE high estrogen levels STIMULATE the LH + to lesser extent FSH surge
133
Granulosa Cell Tumor secretes what (2)? which causes what? causes what special sign in whom? increases risk of what other tumor?
- ESTROGEN > endometrial hyperplasia (thick on US) and/or precocious puberty in young pt - INHIBIN - inhibits FSH postmenopausal bleeding - occur mostly in older women endometrial carcinoma risk due to unopposed estrogen stimulation
134
CA-125 differentiates what two categories of ovarian tumor?
epithelial tumors (serous, endometrioid, clear cell) DO SECRETE ca-125 stromal tumors (granulosa etc.) do not

*USMLE* (28 decks)

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