Female Genitourinary Tract Flashcards
the most common cause of anovulatory cycles is ____
the most common cause of anovulatory cycles is extremes of reproductive life
list other causes of anovulatory cycles
unopposed estrogen
- PCOD
- estrogen producing neoplasms
- granulosa cell tumor & adrenal cortical adenoma (of zona reticularis)
____ and ____ are 2 neoplasms that can cause anovulatory cycles due to increased estrogen
granulosa cell tumor and adrenal cortical adenoma are 2 neoplasms that can cause anovulatory cycles due to increased estrogen
the effect of unopposed estrogen is persistent ____ leading to _____
the effect of unopposed estrogen is persistent proliferation leading to irregular bleeding, breakdown
exogenous progesterone effect leads to abundant ___, plump ___ and small ____ (caused by lack of ____)
exogenous progesterone effect leads to abundant stroma, plump cells and small glands (caused by lack of priming by estrogen)
in inadequate luteal phase, there is decreased function of ____, leading to decreased levels of ____
in inadequate luteal phase, there is decreased function of the corpus luteum, leading to decreased levels of progesterone
describe persistent luteal phase
“periods regular but bleeding excessive and prolonged (10-14 days)”
which condition?
persistent luteal phase
endometrial tissue within the uterine wall is called ____
endometrial tissue within the uterine wall is called adenomyosis
describe the 2 potential pathogenetic explanations of endometriosis
- metastatic pathogenesis = retrograde menstruation
- metaplasia of celomic epithelium
- inflammatory cascade (PGs, estrogen)
if endometriosis occurs near tubal tissues ___ can occur ultimately leading to ___
if endometriosis occurs near tubal tissues tubal scars can occur ultimately leading to infertility
endometriosis can lead to fibrosis; name 4 condition that occur from this
- infertility (tubes)
- intestinal obstruction
- risk of tubal pregnancy
- urinary obstruction
in acute endometritis, the glands are “stuffed” with ____
in acute endometritis, the glands are “stuffed” with neutrophils (NOT in stroma, in the glands)
name 3 scenarios where acute endometritis can occur
-
postpartum (puerperal sepsis, strep/staph)
- offensive smelling discharge
- ascending gonococcal/chlamydia infection from lower genital tract
- pyometrium = obstruction of os by neoplasm or fibrosis
chronic endometritis is characterized by the presence of ___
chronic endometritis is characterized by the presence of plasma cells
name 5 scenarios where chronic endometritis can occur
- chronic PID
- postpartum/postabortion (retained products)
- IUCD
- TB
- chlamydia
endometrial polyps are associated with certain drugs such as ____
endometrial polyps are associated with certain drugs such as Tamoxifen
the condition seen in the image is caused by excess, unopposed ____ effect
endometrial hyperplasia is caused by excess, unopposed estrogen effect
the condition seen in the image can be caused by a mutation in ____
endometrial hyperplasia can be caused by a mutation in PTEN (tumor suppressor gene)
what conditions are associated with the condition seen in the image?
- obesity
- PCOD
- menopause
- estrogen-producing tumors like granulosa cell tumor
- ERT
- adrenal disorders
list histological changes seen in the atypia form of the condition in the image
- nuclear enlargement
- pleomorphism
- vesicular change
- chromatin irregularity
- loss of polarity
- prominent nucleoli
- cellular stratification
the precursor lesion to the condition seen in the image is ____
the precursor lesion to the condition seen in the image is endometrial hyperplasia WITH atypia
type I of the condition seen in the image commonly occurs in which age group?
type I = obese 55-65 year old females
list the genetic mutations seen in the type I form of the condition seen in the image
what other conditions are these mutations similar to?
PTEN, KRAS, MSI
endometrioid tumor = PTEN, KRAS, B-catenin, MSI
list the causes of the type I form of the condition seen in the image
unopposed estrogen
- obesity
- diabetes
- hypertension
- nulliparous
the type II form of the condition seen in the image commonly occurs in which age group?
thin physiqued 65-75 year old females
describe the endometrium in the type II form of the condition seen in the image
endometrial atrophy
the mutation commonly seen in the type II form of the condition seen in the image is ____
the mutation commonly seen in the type II form of the condition seen in the image is p53
____ is the precursor lesion for the type II form of the condition seen in the image
endometrial intraepithelial carcinoma is the precursor lesion for the type II form of the condition seen in the image
in the condition seen in the image, the more ___ the tumor is, the higher the grade
in type I endometrial carcinoma, the more solid the tumor is, the higher the grade
in the MMMT type of the condition seen in the image, ___ and ___ have become malignant, which makes it a ___ tumor
in the MMMT type of the condition seen in the image, the epithelial and mesenchymal components have become malignant, which makes it a biphasic tumor
in the MMMT type of the condition seen in the image, the metastasis and behavior are defined by the ___ component
in the MMMT type of the condition seen in the image, the metastasis and behavior are defined by the epithelial component
the condition seen in the image is (slow or fast?) growing benign tumor in the ____
the condition seen in the image is fast growing benign tumor in the myometrium
the condition seen in the image is most common in ____ women
the condition seen in the image is most common in nulliparous women
the condition seen in the image causes ____ in women, leading to iron deficiency anemia
the condition seen in the image causes menorrhagia (heavy periods) in women, leading to iron deficiency anemia
the condition seen in the image can grow big enough to press on the ___ and the ___
the condition seen in the image can grow big enough to press on the bladder (causing urgency/frequency) and the rectum (constipation)
____ and ____ makes the condition in the image grow bigger
estrogen and pregnancy (also estrogen) makes the condition in the image grow bigger
____ makes the condition in the image become smaller
menopause makes the condition in the image become smaller
if the condition in the image becomes too big, it can undergo ___ and then ____
if the condition in the image becomes too big, it can undergo coagulative necrosis and then red degeneration/infarct (inflammation → pain, mediated by bradykinin)
the condition in the image can cause which 3 conditions due to mass effect?
- infertility if it impinges on tubes
- bladder → urinary freq./urgency
- rectum → constipation
“multiple masses in uterus, no mitosis, no necrosis”
what is a consequence of this condition?
infertility
describe the histology of the condition seen in the image
well-differentiated, whorling bundles of smooth muscle cells
describe the patient population normally affected by leiomyosarcoma
older women (40-60), postmenopausal bleeding
adenosarcoma has a benign ___ and a malignant ____
adenosarcoma has a benign epithelium and a malignant stroma
adenosarcoma resembles ____
adenosarcoma resembles phyllodes tumor in the breast
list the causes of acute cervicitis
- Gonococcal, Chlamydia, Candida, Trichomonas, Herpes
- postpartum, post dilation and curettage
- purulent vaginal discharge
the condition in the image is caused by HPV strains ___ and ___
the condition in the image is caused by HPV strains 6 and 11
the condition in the image results in (painful or painless?) ____ that undergo ___ change but are benign
the condition in the image results in painless genital warts that undergo koilocytic change (indicates presence of HPV) but are benign
___ is used to visualize the warts seen in the condition in the image
acetic acid is used to visualize the warts seen in the condition in the image
describe the histology of the condition seen in the image
koilocytes & epidermal thickening of stratum corneum (hyperkeratosis) and dermal mononuclear inflammatory infiltrate
describe the etiology of the condition seen in the image
cervical metaplasia (columnar → squamous at T-zone) = physiological due to decrease in pH (increased latic acid)
list the high-risk HPV strains that cause the condition in the image
HPV 16, 18, 31, 33, 35, 45
___ is the most important predisposing factor for in the condition seen in the image
multiple sexual partners is the most important predisposing factor for in the condition seen in the image
describe the presentation of the condition seen in the image
post-coital bleeding, dyspareunia (painful sex) , leukorrhea
___ is the most common cause of death from the condition seen in the image
bilateral hydronephrosis (ureteral obstruction), pyelonephritis, uremia is the most common cause of death from the condition seen in the image
___ test can be used to test for highly mitotic areas (site of carcinoma) in the condition seen in the image
Schiller’s test can be used to test for highly mitotic areas (site of carcinoma) in the condition seen in the image
paint cervix with iodine & look for unstained pale patches
sarcoma botryoides, aka ____, is described as “____” hanging in the vagina
sarcoma botryoides , aka embryonal rhabdomyosarcoma, is described as “a bunch of grapes” hanging in the vagina
____, aka embryonal rhabdomyosarcoma, affects which age group in females?
sarcoma botryoides, aka embryonal rhabdomyosarcoma, affects females < 5 years old
“unliteral painful cystic lesion at lower vestibule adjacent to the vaginal canal”
which condition is this describing?
describe vulvar intraepithelial neoplasia (VIN), classic type
VIN, differentiated type, is NOT caused by ___, but rather a mutation in ___
VIN, differentiated type, is NOT caused by HPV, but rather a mutation in p53
there is inguinal lymphadenopathy in ___ carcinoma and ___ carcinoma
there is inguinal lymphadenopathy in squamous carcinoma and vulvar carcinoma
describe the 2 types of vulvar carcinomas
list 4 risk factors for tubal pregnancy
- chronic PID
- endometriosis
- IUD
- prior surgery
list the 3 reasons tubal pregnancies are not viable
- lack of space
- poor vasculature
- limited placental size
describe placenta previa
abnormal placental implantation; implants on lower os
describe abruptio placenta
premature separation of placenta
hemorrhage behind maternal bed of placenta
describe placenta accreta
the chorionic villi implants directly into the myometrium (instead of the decidua)
list predisposing factor for pre-eclampsia
- primigravida, over 35 years age
- multiple pregnancies
- hydramnios
- preexisting HTN
- hydatiform mole
pre-eclampsia is caused by ____ which leads to an imbalance in circulating ___ and ___ factors (such as ____)
pre-eclampsia is caused by placental ischemia which leads to an imbalance in circulating angiogenic and antiangiogenic factors (such as sFlt1, endoglin)
describe the pathogenesis of preeclampsia
