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AA. Patho 2 > Female Reproductive Disorders > Flashcards

Female Reproductive Disorders Flashcards

1
Q

cervicitis

A

inflammation of cervix

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2
Q

vulvitis

A

inflammation of vulva

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3
Q

vaginitis

A

inflammation of vagina

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4
Q

vulvovaginotits

A

inflammation of vulva and vagina

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5
Q

endometritis

A

inflammation of endometrium

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6
Q

salpingitis

A

inflammation of fallopian tubes

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7
Q

oophoritis

A

inflammation of ovaries

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8
Q

PID

A

Pelvic Inflammatory Disease
an infection, which affects all or most of reproductive organs (cervix, tubes, uterus, ovaries)
commonly abscess is formed filled with pus

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9
Q

Adnexal

A

cervical tenderness
pelvic discomfort upon palpation of cervix or areas of Zi Gong Zhue points during abdominal palpation
-suggest PID

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10
Q

dysmenorrhea

A

pain upon menstruation

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11
Q

amenorrhea

A

absence of menstrual flow

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12
Q

oligomenorrhea

A

infrequent and heavy menstruation

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13
Q

menorrhagia

A

heavy menstrual flow

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14
Q

meno-metrorrhagia

A

irregular and heavy menstruations

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15
Q

metrorrhagia

A

heavy bleeding per vagina

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16
Q

hypomenorrhea

A

scanty menstruations

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17
Q

“break through” bleeding

A

irregular vaginal bleeding while on oral contraceptive

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18
Q

what are some bacterial infections of FRS?

A

STD such as gonorrhea, chlamydia, syphilis

or streptocococcus, staphylococcis species

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19
Q

viral infections of FRS?

A

herpes genitalis, HPV

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20
Q

fungal infections of FRS?

A

candida albicans

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21
Q

protozoal infection of FRS?

A

trichomonas vaginalis

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22
Q

what is the most commonly involved part of Pelvic Inflammatory Infections?

A

fallopian tubes

and it is most commonly bilateral

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23
Q

what are symptoms of PID?

A

localized or bi- or unilateral abdominal and pelvic pain, exceptional adnexal and cervical tenderness upon palpatory assessment to fever, nausea, vomiting, break-thourgh bleeding, peritoneal irritation (abd guarding, cessation of peristalsis, positive peritoneal signs)

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24
Q

in Cervicitis, what is the appearance of cervix?

A

cervix has an erythematous appearance extending to cervical os, consistent with chronic inflammation

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25
Q

what are the most important risk factors leading to PID?

A 
young age of sexual activity
STD
multiple sexual partners
intra-uterine contraceptive device (IUD)
neglect for routine GYN checkup
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26
Q

PID is the leading cause of what other condition?

it can also lead to?

A

ectopic pregnancy
infertility

systemic spread od infection
can cause pelvic adhesions, tubo-ovarian abscess, and chronic abdominal pain

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27
Q

cervical cancer risk factors are?

A

most common with the beginning of sexual activity at early age, multiple sexual partners, exposures to STD, especially HPV infections
-smoking also risk factor

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28
Q

which disease is considered the most easily screenable and preventable FRS malignancy via Pap smear and how is it identified?

A

Cervical Cancer

Pap Smear identification of dysplasia of cervical epithelium

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29
Q

Cervical cancer is also declared as?

A

STD

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30
Q

what is common etiology of Cervical Cancer?

A

it usually starts with dysplasia of cervical epithelium, which is absence of maturation of epithelial cells –> IEN (intra-epithelial neoplasia) –> Carcinoma in Situ (local pre-invasive cancer) –> invasive cervical carcinoma

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31
Q

how many types of HPV are acknowledged to exist?

and how many are classified as high risk types?

A

150 types

15 high risk types

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32
Q

which types of HPV are generally acknowledged to caue about 70% of cervical cancer>

A

16, 18, cause 70% of cervical cancer, with 31 - these 3 types are prime risk factors for cervical cancer

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33
Q

HPV vaccine is effective against ?

A

2 strains of HPV (16,18)

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34
Q

how is Cervical Cancer DX?

A
  • pap smear is effective screening test, but confirmation of dx requires biopsy of cervix - colposcopy (a magnified visual inspection of cervix aided by using dilute acetic acid (ex vinegar) solution to highlight abnormal cells on surface of cervix
  • loop electrical excision procedure (LEEP) and conization, in which the inner lining of cervix is removed to be examined pathologically
  • these are carried out if biopsy confirms severe cervical intraepithelial neoplasia
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35
Q

what is prognosis of Cervical Cancer?

A
  • depends on Stage of cancer
  • with tx 5 yr survival rate for earliest stage of invasive cervical cancer is 92%, and overall (all stages combined) 5 -yr survival rate is about 72%
  • w tx, 80 to 90% if women with stage I cancer and 50 to 65% of those with stage II cancer are alive 5 yrs after dx.
  • only 25 to 35% of women with stage III cancer and fewer than 15% of those with stage IV cancer are alive after 5 years
  • if cancer metastasized to other parts of the body, prognosis drops dramatically bc tx of local lesions is generally more effective than whole body tx such as chemotherapy
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36
Q

according to International Federation of Gynecology and Obstetrics, survival rate of Cervical Cancer improves with what types of tx?

A

when radiotherapy is combined with cisplatin-based chemotherapy

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37
Q

which part of the menstrual cycle is variable?

and what happens during this phase?

A

the proliferative phase

in this phase, tubular glands with columnar cells and surrounding dense stroma are proliferating to build up the endometrium following shedding with previous menstruation

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38
Q

infrequent or irregular ovulation (usually defined as cycles of less than 36 days or more than 8 cycles a year) is called?

A

oligoovulation

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39
Q

absence of ovulation when it would be normally expected (in a post-menarchial, premenopausal woman) is called?

this usually manifests itself as?

A

Anovulation

irregularity of menstrual periods, that is, unpredictable variability of intervals, duration, or bleeding

Anovulation can also be cause cessation of periods (secondary amenorrhea) or excessive bleeding (dysfunctional uterine bleeding)

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40
Q

primary amenorrhea is defined as ?

A

absence of secondary sexual characteristics by age 14 with no menarche
OR normal secondary sexual characteristics but no menarche by 16 years of age

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41
Q

secondary amenorrhea is defined as ?

A

absence of menses for 3 months in a woman with previously normal menstruation

OR 9 months for women with a history of oligomenorrhea

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42
Q

primary amenorrhea may be caused by?

A

(menstruation cycles never occurred)
developmental problems such as congenital absence of uterus, or failure of ovary to received or maintain egg cells

also, delay in pubertal development will lead to primary amenorrhea

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43
Q

secondary amenorrhea is often caused by?

A

(menstruation cycles ceasing)

hormonal disturbances from the hypothalamus and the pituitary gland or from premature menopause, or intrauterine scar formation

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44
Q

Endometrial hyperplasia usually results with conditions of prolonged __________ and can lead to what 3 conditions?

A

prolonged estrogen excess

can lead to

1) metrorrhagia (uterine bleeding at irregular intervals)
2) menorrhagia (excessive bleeding with menstrual periods)
3) menometrorrhagia

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45
Q

anovulation may be caused by?

A
  • anxiety, severe emotional or physical stress (acute disease, anorexia nervosa, bulimia, athletic competitions, or iatrogenic causes)
  • can also be consequence of organic causes, as abnormal hormonal stimulation due to Polycystic Ovarian Syndrome or Endometriosis, as well as para-neoplastic effects of some malignancies or side effects of drugs
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46
Q

what is Anovulation?

A

abnormal menstrual cycle

if ovulation does not occur, the superficial layers of thickened endometrium becomes hyperplastic –> ischemic and necrotic at the abnormal pace (either 2-3 weeks apart of infrequently, 6 and more days apart)

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47
Q

what is painful menstrual bleeding?

A

Dysmenorrhea - severe pain during menstruation that requires medication and disrupts normal activities

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48
Q

why is unexpected painless bleeding per vagina RED FLAG for immediate medical referral?

A

some forms of hyperplasia of endometrium (in cases of Anovulation for instance) can cause increased cystic glands, and may or may not progress to uterine malignancy

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49
Q

what kinds of pain with dysmenorrhea?

A

different kinds of pain - sharp, throbbing, dull, nauseating, burning or shooting pain

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50
Q

dysmenorrhea may coexist with excessively heavy blood loss, known as?

A

menorrhagia

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51
Q

secondary dysmenorrhea is diagnosed when?

A

when symtpoms are attributed are attributable to an underlying disease, or structural abnormality either within or outside the uterus

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52
Q

primary dysmenorrhea is diagnosed when?

A

when none of the secondary symptoms are detected

usually primary dysmenorrhea occurs at the beginning of menstrual life, while anovulatory menstrual cycle gradually changes for regular ovulation cycles. during or before ovulation the amount of prostaglandins produced may elicit painful uterine contractions

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53
Q

what are the different names for uterine fibroid?

A 
uterine leiomyoma
myoma
firbomyoma
leiofibromyoma
fibroleiomyoma
fibroma
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54
Q

what is uterine fibroid?

A

non-cancerous (benign) tumor that originates from smooth muscle layer (myometrium) and accompanying connective tissue of the uterus

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55
Q

Fibroids are the most common benign tumors in females and typically found when?

A

during the middle and later reproductive years

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56
Q

while most fibroids are asymptomatic, they can grow and cause?

A

heavy and painful menstruation, painful sexual intercourse, and urinary frequency and urgency

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57
Q

major indication for hysterectomy in US is?

A

uterine fibroids

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58
Q

Fibroids are often multiple, and if the uterus contains too many leiomyomatas to count this is called?

A

leiomyomatosis

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59
Q

what is malignant version of fibroid? is this common?

A

leiomyosarcoma

this is uncommon

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60
Q

Painless vaginal bleeding in postmenopausal female is RED FLAG for?

A

Endometrial Adenocarcinoma (cancer)

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61
Q

post-coital bleeding is RED FLAG for?

A

uterine or cervical cancer

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62
Q

the uterus is not enlarged, but there is an irregular mass in the upper fundus upon biopsy one can find?

A

endomterial adenocarcinoma (uterine cancer)

*such carcinomas are more likely to occure in postmenopausal women

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63
Q

Endometrial cancer (uterine cancer) refers to?

A

several types of malignancy which arise from endometrium, or lining of the uterus

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64
Q

what is the most common gynecologic cancers in US? how many women are dx each year in US?

A

endometrial cancer

over 35,000 women dx each year in US

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65
Q

what is the most common subtype of Endometrial (Uterine) Cancer?

A

Endometrioid Adenocarcinoma, which typically occurs within a few decades of menopause

66
Q

Endometrioid Adenocarcinoma is associated with?

A

excessive estrogen exposure, often develops in setting of endometrial hyperplasia, and presents most often with painless vaginal bleeding

67
Q

what are the top 3 causes of gynecologic cancer deaths in US, in order?

A
  1. Ovarian cancer
  2. Cervical cancer
  3. Endometrial carcinoma
68
Q

what is most common therapeutic approach to Endometrial carcinoma

A

a total abdominal hysterectomy (surgical removal of uterus) with bilateral salpingo-oophorectormy

69
Q

what types if different cancers can develop from Endometrial carcinoma?

A

other cancers may develop not only from endometrium itself but also from other tissues of uterus, including cervical cancer, sarcoma of myometrium, and trophoblastic disease

70
Q

what is Adenomyosis?

A

FRS disorder, characterized by presence of ectopic endometrial tissue (the inner lining of uterus) within the myometrium (the thick, muscular layer of uterus)

71
Q

Adenomyosis is typically found in women between what ages?

A

35 to 50

72
Q

women with Adenomyosis can have?

A

painful and/or profuse menses (dysmenorrhea & menorrhagia)

73
Q

Adenomyosis may involve the uterus focally, creating an?

A

adenomyoma

74
Q

Adenomyosis is most commonly diagnosed in what types of females?

A

multi-parous females (gave birth many times)

*when female expelling large babies or multiple gestation, the uterus does vigorous work, contract more vigorously, when last placenta expel, uterus needs to contract to stop bleeding, when uterus contracts creates suction and muscle gets sucked in
inadenomyosis,endometrialcellsdonotgosofar,theygetinsidemuscle, muscle is suffering bc tissues are responding to hormonal stimulation - lots of prostaglandin are produced- causing pain

75
Q

what is characteristics of endometrial tissues?

A

endometrial tissues are very whimsical-cancercells,endometrial can break
through basement menbranes, they can be planted anywhere - if planted in nose, menstruate through nose, can menstruate in plueral on any tube on rectum… respond to hormonal stimulation, and behave like cancer - they can spread by blood

76
Q

how is Adenomyosis diagnosed?

which is better dx method?

A

-uterus may be imaged using ultrasound (ransvaginal ultrasound is most cost effective and most available) or magnetic resonance imaging (MRI)

  • MRI better dx method -due to increased spatial and contrast resolution, and to not being limited by presence of bowel gas or calcified fibroids (as in ultrasound)
  • MRI better able to differentiate adenomyosis from multiple small uterine fibroids
  • MRI can be used to classify adenomyosis based on depth of penetration of ectopic endometrium into myometrium
77
Q

Adenomyosis treatment options are?

A

they range from use of NSAIDS & hormonal suppression for symptomatic relief, with hysterectomy the only permanent cure option

78
Q

what is endometrial ablation?

why is this not a good tx method for Adenomyosis?

A

electro-cauterization

-bc ablation only affects surface endometrial tissues, not the tissue that has grown into muscle lining.
the remaining tissue is still viable and will continue to cause pain. the result of failed ablation due to Adenomyosis is hysterectomy

79
Q

Those OB/GYN physicians, who postulate that an excess of estrogen is the cause or adenomyosis, or that it aggravates the symptoms, recommend avoiding products with?

A

xenoestrogen

80
Q

what is xenoestrogen?

A

Xenoestrogens are artificially produced estrogens (pharmaceutically derived, contained in plastics (bisphenols), sunscreen lotions, pesticides and insecticides

81
Q

what is Endometriosis?

A

endometrial- like cells appear and flourish in areas outside the uterine cavity, hence ectopically located.

The uterine cavity is lined by endometrial cells, which are under the influence of female hormones.
• These endometrial-like cells in areas outside the uterus (endometriosis) are influenced by hormonal changes and respond similarly as do those cells found inside the uterus

82
Q

in Endometriosis, symptoms often worsen during?

symptoms depend on?
main symptom?

A
  • in time with menstrual cycle
  • symptoms depend on site of active endometriosis
  • main (but not universal) symptom is pelvic pain in various manifestations
83
Q

Endometriosis is typically seen when?

A

during reproductive years - 5-10% in women

84
Q

40% of infertility cases are based on underlying what condition?

A

endometriosis occurrence

85
Q

what is most typical triad of clinical manifestation of Endometriosis?

A

1) Dysmenorrhea
2) Dyspareunia (painful intercourse)
3) infertility

86
Q

what are typical locations for Endometriosis?

A

ovaries, uterine ligaments, rectovaginal septum, pelvic peritoneum, and laparotomy scars

-can also be found at more distant locations such as appendix and vagina

87
Q

what are some clinical presentations of Endometriosis?

A
  • nausea, vomiting, fainting, dizzy spells, or diarrhea—particularly just prior to or during the period or after
  • frequent or constant menses flow
  • chronic fatigue
  • heavy or long uncontrollable menstrual periods with small or large blood clots
  • extreme pain in legs and thighs
  • back pain
  • mild to extreme rectal pain during intercourse or regardless of intercourse
  • extreme pain from frequent ovarian cysts
  • pain from adhesions which may bind an ovary to the side of the pelvic wall, or they may extend between the bladder and the bowel
  • extreme pain with or without the presence of menses
  • mild to severe constipation
  • Occasionally pain may also occur in other regions. Cysts can occur in the bladder (although rare) and cause pain and even bleeding during urination. Endometriosis can invade the intestine and cause painful bowel movements or diarrhea.
  • Nosebleeds (epistaxis) and/or occurrence of pneumothorax (air in the pleural cavity) are also described
88
Q

women who are diagnosed with Endometriosis may have gastrointestinal symptoms that mimic?

A

irritable bowel syndrome

89
Q

Locations of Ectopic Endometiral tissues (common sites):

A

pelvic cavity structures where it can produce mild, moderate, and/or severe pain felt in pelvis and/or lower back areas

Ovaries (the most common site)
• Fallopian tubes
• The back of the uterus and the posterior cul-de-sac
• The front of the uterus and the anterior cul-de-sac
• Uterine ligaments such as the broad or round ligament of the uterus
• Pelvic and back wall
• Intestines, most commonly the rectosigmoid
• Urinary bladder and ureters
Endometriosis may spread to the cervix and vagina or to sites of a surgical abdominal incision.

90
Q

what is most common site of Endometriosis?

A

ovaries

91
Q

Bowel endometriosis affects approximately 10% of women with endometriosis, and can cause?

A

severe pain with bowel movements

92
Q

less commonly Ectopic Endometiral tissues can be found where?

A

Less commonly lesions can be found on the diaphragm. Diaphragmatic endometriosis is rare, most always on the right hemidiaphragm, and may inflict cyclic pain of the right shoulder just before and during menses. Rarely, endometriosis can be extraperitoneal and is found in the lungs and CNS.

Endometriosis may also present with skin lesions in cutaneous endometriosis.

93
Q

Pleural implantations of Ectopic Endometiral tissues are associated with?

A

recurrent right pneumothoraces at times of menses, termed catamenial pneumothorax

94
Q

4 Major Theories of Endometriosis Etiology:

A
  • Retrograde menstrual flow: during vigorous contractions of the myometrium to expell menstrual necrotic epithelium, some of it being “pushed via the tubes and is seeding outside places.
  • Immune surveillance’ incompetence: ectopic embryonic endometrium has been not eliminated/ deleted by the immune system.
  • Genetics: findings of endometriosis in 1st and second degree relatives.
  • Neoplastic/metaplastic growth: findings similarities between endometriosis and cancer spread.

P.S. While there is no direct correlation between endometriosis and uterine or other reproductive cancers, the prevalence and incidence of these malignancies in patients, suffering with endometriosis is higher than in general population.

95
Q

Diagnosis of Endometriosis:

A
  • The only way to diagnose endometriosis is by laparoscopy or other types of surgery with lesion biopsy. The diagnosis is based on the characteristic appearance of the disease, and should be corroborated by a biopsy. Surgery for diagnoses also allows for surgical treatment of endometriosis at the same time.
  • Although doctors can often feel the endometrial growths during a pelvic exam, and the symptoms may be telltale signs of endometriosis, diagnosis cannot be confirmed without performing a laparoscopic procedure.
96
Q

often symptoms of endometriosis are identical to?

A

Ovarian Cancer

If a misdiagnosis of endometriosis occurs due to failure to confirm diagnosis through laparoscopy, early diagnosis of ovarian cancer, which is crucial for successful treatment, may have been missed.

97
Q

is there a cure for Endometriosis?

A

NO

but in many patients menopause (natural or surgical) will abate the process

98
Q

In patients in the reproductive years, endometriosis is managed how?

A

is palliatively managed: the goal is to provide pain relief, to restrict progression of the process, and to relieve infertility if that should be an issue

99
Q

In younger women with unfulfilled reproductive potential, endometriosis is managed how?

A

surgical treatment tends to be conservative, with the goal of removing endometrial tissue and preserving the ovaries without damaging normal tissue.

100
Q

In women who do not have need to maintain their reproductive potential, endometriosis is managed how?

A

hysterectomy and/or removal of the ovaries may be an option; however, this will not guarantee that the endometriosis and/or the symptoms of endometriosis will not come back, and surgery may induce adhesions which can lead to complications.

101
Q

In general, patients are diagnosed with endometriosis at time of?

further steps depends on?

A

at time of surgery, at which time ablative steps can be taken.

Further steps depend on circumstances: patients without infertility can be managed with hormonal medication that suppress the natural cycle and pain medication, while infertile patients may be treated expectantly after surgery, with fertility medication, or with IVF.

102
Q

what is used to monitor recurrence of endometriomas during treatments

A

Sonography

103
Q

acute abdominal pain in a woman of childbearing age is a differential diagnosis and RED FLAG for?

A

Ectopic pregnancy

104
Q

The most common form of ovarian cancer (≥80%) arises from?

A

outer lining (epithelium) of the ovary

However, recent evidence shows cells that line the Fallopian tube (epithelium) also to be prone to develop into the same kind of cancer as seen in the ovaries.

Since the ovaries and tubes are closely related to each other, it is hypothesized that these cells can mimick ovarian cancer. Other forms arise from the egg cells (germ cell tumor).

105
Q

Risk of Ovarian Cancer increase with?

decrease with?

A

The risk increases with AGE and decreases with PREGNANCY.

Lifetime risk is about 1.6%, but women with affected first-degree relatives have a 5% risk.

106
Q

women with which mutated gene have 24% risk of Ovarian Cancer?

A

Women with a mutated BRCA1 or BRCA2 gene have a 25% risk.

107
Q

what is the the fifth leading cause of death from cancer in women and the leading cause of death from gynecological cancer.

A

Ovarian Cancer

108
Q

what are symptoms of Ovarian Cancer?

A

Ovarian cancer causes non-specific symptoms (bloating, vague pelvic/ abdominal pains, indigestion). “TCM-ly” speaking, Dampness accumulation within the middle and/or lower burners.

Most women with ovarian cancer report one or more symptoms such as abdominal pain or discomfort, an abdominal mass, bloating, back pain, urinary urgency, constipation, tiredness and a range of other non-specific symptoms, as well as more specific symptoms such as pelvic pain, abnormal vaginal bleeding or involuntary weight loss.
• There can be a build-up of fluid (ascites) in the abdominal cavity.

109
Q

Early diagnosis of Ovarian Cancer would result in better?

A

survival, on the assumption that stage I and II cancers progress to stage III and IV cancers.

110
Q

how do you dx Ovarian Cancer?

A

Diagnosis of ovarian cancer starts with a physical examination (including a pelvic examination), a blood test (for CA-125 and sometimes other markers, and transvaginal ultrasound.
• The diagnosis must be confirmed with surgery to inspect the abdominal cavity, take biopsies, and examination for cancer cells in the abdominal fluid.

111
Q

Tx of Ovarian Cancer usually involves?

A

Treatment usually involves chemotherapy and surgery, and sometimes radiotherapy.

112
Q

Diethylstilbestrol (DES - in tablets up to 5 mg) was approved by the United States Food and Drug Administration on September 19, 1941 for four indications:

A

1) gonorrheal vaginitis*
2) atrophic vaginitis
3) menopausal symptoms, and 4) postpartum lactation suppression to prevent breast engorgement

*The gonorrheal vaginitis indication was dropped when the antibiotic penicillin became available.

113
Q

Diethylstilbestrol and Its Teratogenic and Carcinogenic Effects:

A

First generation: • Women prescribed DES while pregnant are at a modestly increased risk for
breast cancer.
• Second generation:
• Women exposed to DES before birth (in the womb), known as DES daughters, are at an increased risk for clear cell adenocarcinoma (CCA) of the vagina and cervix, reproductive tract structural differences, pregnancy complications, infertility, and auto-immune disorders.
• Although DES daughters appear to be at highest risk for in their teens and early 20s, cases have been reported in DES daughters in their 30s and 40s.
• A new study shows DES daughters as having a 2.5 fold increase in breast cancer after age 40.
• DES daughters have an elevated risk of ectopic pregnancy, up to 3 times the risk of unexposed women.
• In 2002, a study indicated that maternal usage of DES resulted in a 20-fold increase in prevalence of hypospadias in their sons.

114
Q

Polycystic ovary syndrome (PCOS) is?

A

an endocrine disorder that affects approximately 5% of all women.
• It occurs amongst all races and nationalities, is the most common hormonal disorder among women of reproductive age, and is a leading cause of infertility.

115
Q

The principal features of PCOS are

A

obesity, anovulation (resulting in irregular menstruation, primarily, amenorrhea or oligomenorrhea), acne, and excessive amounts or effects of androgenic (masculinizing) hormones, balding

116
Q

Etiology of PCOS?

A

While the causes are unknown, insulin resistance, diabetes, and obesity are all strongly correlated with PCOS

117
Q

Common Symptoms of PCOS?

A
  • Oligomenorrhea, amenorrhea — irregular, few, or absent menstrual periods.
  • Infertility, generally resulting from chronic anovulation (lack of ovulation).
  • Hirsutism — excessive and increased body hair, typically in a male pattern affecting face, chest and legs.
  • Hair loss appearing as thinning hair on the top of the head • Acne, oily skin, seborrhea. • Obesity or weight gain: one in two women with PCOS are obese. • Depression • Deepening of voice
  • Mild symptoms of hyperandrogenism, such as acne or hyperseborrhea, are frequent in adolescent girls and are often associated with irregular menstrual cycles.
118
Q

In most instance of PCOS, the symptoms are often?

A

symptoms are transient and only reflect the immaturity of the hypothalamic-pituitary-ovarian axis during the first years following menarche

119
Q

PCOS can present during what age?

A

any age during the reproductive years. Due to its often vague presentation it can take years to reach a diagnosis.

120
Q

Not all women with PCOS have?

A

polycystic ovaries (PCO),

and not all women with ovarian cysts have PCOS

121
Q

Diagnosis of Polycystic Ovaries Syndrome:

A

pelvic ultrasound is a major diagnostic tool (not the only one)

The diagnosis is supported by the so called Rotterdam criteria,

122
Q

what is Rotterdam criteria?

A

supports dx of PCOS

utilizes endocrine abnormalities, including:
• High level of androgens (free testosterone)
• Absence of mid-cycle peak of LH and FSH
• Excessive secretion of LH • Glucose intolerance

123
Q

Pathogenesis of PCOS:

A
  • Polycystic ovaries develop when the ovaries are stimulated to produce excessive amounts of male hormones (androgens), particularly testosterone, either through the release of excessive luteinizing hormone (LH) by the anterior pituitary gland or through high levels of insulin in the blood (hyperinsulinaemia) in women whose ovaries are sensitive to this stimulus.
  • The syndrome acquired its most widely used name due to the common sign on ultrasound examination of multiple (poly) ovarian cysts.
  • These “cysts” are actually immature follicles, not cysts (“polyfollicular ovary syndrome” would have been a more accurate name).
  • The follicles have developed from primordial follicles, but the development has stopped (“arrested”) at an early antral stage due to the disturbed ovarian function.
  • The follicles may be oriented along the ovarian periphery, appearing as a ‘string of pearls’ on ultrasound examination.
  • The condition was first described in 1935 by Dr. Stein and Dr. Leventhal, hence its original name of Stein-Leventhal syndrome.
124
Q

what are the 4 goals of tx of PCOS?

A
  • Lowering of insulin levels
  • Restoration of fertility
  • Treatment of hirsutism or acne
  • Restoration of regular menstruation, and prevention of endometrial hyperplasia and endometrial cancer
125
Q

preeclampsia

A

is a medical condition where hypertension arises in pregnancy (pregnancy-induced hypertension) in association with significant amounts of protein in the urine.

126
Q

what are some causes of pre-eclampsia?

A
  • Because pre-eclampsia refers to a set of symptoms rather than any causative factor, it is established that there are many different causes for the syndrome.
  • It also appears likely that there is a substance or substances from the placenta that may cause endothelial dysfunction in the maternal blood vessels of susceptible women.
127
Q

what are signs of pre-eclampsia?

A

• While blood pressure elevation is the most visible sign of the disease, it involves generalized damage to the maternal endothelium, kidneys and liver, with the release of vasoconstrictive substances.

128
Q

Conclusive diagnosis of pre-eclampsia?

A

Systemic arterial hypertension and albuminuria after 20 weeks of pregnancy (gestation)

129
Q

is there a cure for pre-eclampsia?

A

• Apart from Caesarean section, or induction of labor, and therefore delivery of the placenta, there is no known cure.

130
Q

can pre-eclampsia occur post-partum?

A

It may also occur up to six weeks post-partum.

131
Q

The most common condition of dangerous pregnancy complications, which may affect both the mother and the fetus is?

A

pre-eclampsia

132
Q

Diagnosis of Preeclampsia

A

hypertension and proteinuria are necessary for a diagnosis.

  • Pre-eclampsia is diagnosed when a pregnant female develops high blood pressure (two separate readings taken at least 4 hours apart of 140/90 or more) and more than 200-300 mg of protein in a 24- hour urine sample (proteinuria).
  • A rise in baseline BP of 30 systolic or 15 diastolic, while not meeting the absolute criteria of 140/90 is considered important as well.
  • unusual swelling, particularly of the hands, feet, or face, notable by leaving an indentation when pressed on) can be significant, and should be reported to a health care provider

In general, none of the signs of pre-eclampsia is specific; even convulsions in pregnancy are more likely to have causes other than eclampsia in modern practice.

Diagnosis, therefore, depends on finding a coincidence of several pre- eclamptic features, the final proof being their regression after delivery.

133
Q

Pre-eclampsia may progress to?

A

eclampsia, characterized by the appearance of tonic-clonic seizures

134
Q

Although eclampsia is potentially fatal, pre-eclampsia is often asymptomatic, hence its detection depends on signs or investigations.
But one symptom that is crucially important because it is so often misinterpreted is?

A

The epigastric pain, which reflects hepatic involvement and is typical of the HELLP syndrome, may easily be confused with heartburn, a very common problem of pregnancy.

  • However, it is not burning in quality, does not spread upwards towards the throat, is associated with hepatic tenderness, may radiate through to the back, and is not relieved by giving antacids.
  • It is often very severe, described by sufferers as the worst pain that they have ever experienced.
  • Affected women are not uncommonly referred to general surgeons as suffering from an acute abdomen, for example acute cholecystitis.
135
Q

Pregnancy-induced hypertension (PIH) is?

A

also called gestational hypertension]

condition when women develop high blood pressure without the proteinuria (protein in urine

136
Q

RED FLAG conditions and require careful monitoring of mother and fetus is?

A

both pre-eclampsia and Pregnancy Induced Hypertension (PIH)

137
Q

Pre-eclampsia is also more common in?

A

women who have preexisting hypertension, diabetes, autoimmune diseases like lupus, various inherited blood disorders, or renal disease, in women with a family history of pre- eclampsia, obese women, and in women with a multiple gestation (twins, triplets, and more).

138
Q

The single most significant risk for developing pre-eclampsia is?

A

having had pre-eclampsia in a previous pregnancy

139
Q

what is “postpartum pre-eclampsia”?

A

when Pre-eclampsia occurs in the immediate post-partum period or up to 6–8 weeks post-partum.

The most dangerous time for the mother is the 24–48 hours postpartum and
careful attention should be paid to pre-eclampsia signs and symptoms.

140
Q

Preeclampsia and eclampsia are also associated with use of what drug?

A

cocaine use

141
Q

Suggested Pathogenesis of Preeclampsia?

A
  • The pre-eclampsia syndrome is thought in many cases to be caused by a shallowly implanted placenta.
  • As a result, placenta becomes hypoxic, leading to an immune reaction characterized by secretion of upregulated inflammatory mediators from the placenta, and acting on the vascular endothelium.
  • The shallow implantation is thought to stem from the maternal immune system’s response to the placenta.
  • This theory emphasizes the role of the maternal immune system, and refers to evidence suggesting a lack of established immunological tolerance in pregnancy, resulting in an immune response against paternal antigens from the fetus and its placenta.
142
Q

women doing a breast exam by looking in the mirror looks for what S&S?

A

impling, swelling, or redness on or near the breasts

this is usually repeated in several positions, such as while having hands on the hips, and then again with arms held overhead.

143
Q

There are several common patterns, which are designed to ensure complete coverage in breast exams, they are?

A
  • The vertical strip pattern involves moving the fingers up and down over the breast.
  • The pie-wedge pattern starts at the nipple and moves outward.
  • The circular pattern involves moving the fingers in concentric circles from the nipple outward.

*Some guidelines suggest mentally dividing the breast into four quadrants and checking each quadrant separately. The palpation process covers the entire breast, including the “axillary tail” of each breast that extends toward the (armpit). This is usually done once while standing in front of the mirror and again while lying down.

144
Q

what is P’s of BSE?

A

they are 7 steps that are named to have the same first initial: Positions, Perimeter, Palpation, Pressure, Pattern, Practice, and Planning what to do if a change is found in the breast tissue.

145
Q

For pre-menopausal women, most methods suggest that the self-exam be performed at?

A

at the same stage of the woman’s menstrual cycle, because the normal hormone fluctuations can cause changes in the breasts.

The most commonly recommended time is just after the end of the period, because the breasts are least likely to be swollen and tender at this time.

Women who are postmenopausal or have irregular cycles might do a self-exam once a month regardless of their menstrual cycle.

146
Q

Breast cancer is a cancer that starts in?

A

the breast, usually in the inner lining of the milk ducts or lobules. There are different types of breast cancer, with different stages (spread), aggressiveness, and genetic makeup.

147
Q

Treatment for Breast cancer includes?

A

Treatment includes surgery, drugs (hormone therapy and chemotherapy), and radiation.

148
Q

what is survival rate of breast cancer?

other epidemiological information?

A

With best treatment, 10-year disease-free survival varies from 98% to 10%.

  • Worldwide, breast cancer is the second most common type of cancer after lung cancer (10.4% of all cancer incidence, both sexes counted) and the fifth most common cause of cancer death.
  • In 2009, breast cancer caused 497,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths).
  • Breast cancer is about 100 times as frequent among women as among men, but survival rates are equal in both sexes.
149
Q

The primary risk factors for Breast Cancer that have been identified are

A

sex, age, childbearing, hormones, a high-fat diet, alcohol intake obesity, and environmental factors such as tobacco use, radiation, endocrine disruptors and shift work

150
Q

No cause is known for 95% of breast cancer cases, while approximately 5% of new breast cancers are attributable to?

A

hereditary syndromes

In particular, carriers of the breast cancer susceptibility genes, BRCA1 and BRCA2, are at a 30-40% increased risk for breast and ovarian cancer, depending on in which portion of the protein the mutation occurs

151
Q

Personal history of breast cancer?

A

A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast.
• Family history: A woman’s risk of breast cancer is higher if her mother, sister, or daughter had breast cancer.
• The risk is higher if her family member got breast cancer before age 40. Having other relatives with breast cancer (in either her mother’s or father’s family) may also increase a woman’s risk.

152
Q

Diagnosis of Breast Cancer?

A

breast cancer is commonly diagnosed using a “triple test” of clinical breast examination (breast examination by a trained medical practitioner), mammography, and fine needle aspiration cytology

153
Q

what is Fine Needle Aspiration and Cytology (FNAC)?

A

procedure may be done in a GP’s office using local anaesthetic if required, involves attempting to extract a small portion of fluid from the lump

Clear fluid makes the lump highly unlikely to be cancerous, but bloody fluid may be sent off for inspection under a microscope for cancerous cells. Together, these three tools can be used to diagnose breast cancer with a good degree of accuracy.

154
Q

Other options for biopsy for breast cancer dx include

A

core biopsy, where a section of the breast lump is removed, and an excisional biopsy, where the entire lump is removed

155
Q

Tx of breast Cancer?

A

The mainstay of breast cancer treatment is surgery.

• Adjuvant hormonal therapy (with tamoxifen or an aromatase inhibitor) is given when the tumor expresses estrogen receptors or progesterone receptors.
• Chemotherapy is given for more advanced stages of disease. • Monoclonal antibodies are sometimes used, especially for HER2-
positive tumors.
• Radiotherapy is given after surgery to the region of the tumor bed, to destroy microscopic tumors that may have escaped surgery.
• Treatments are constantly being evaluated in randomized, controlled trials, to evaluate and compare individual drugs, combinations of drugs, and surgical and radiation techniques.

156
Q

Chemotherapy of Breast Cancer

A
  • Some breast cancers require the hormones estrogen and progesterone to grow, and have receptors for those hormones.
  • Those cancers are treated with drugs that interfere with hormones, usually tamoxifen, and with drugs that shut off the production of estrogen in the ovaries.
  • Low-risk, hormone-sensitive breast cancers may be treated with hormone therapy and radiation alone.
  • Breast cancers without hormone receptors, or which have spread to the lymph nodes in the armpits, or which express certain genetic characeristics, are higher-risk, and are treated more aggressively.
  • One standard regimen, popular in the U.S., is cycophosphamide plus doxorubicin (Adriomycin), known as CA; these drugs damage DNA in the cancer, but also in fast-growing normal cells where they cause serious side effects.
  • Sometimes a taxane drug, such as docetaxel, is added, and the regime is then known as CAT; taxane attacks the microtubules in cancer cells.
  • An equivalent treatment, popular in Europe, is cyclophosphamide, methotrexate, and fluorouracil (CMF).
  • Monoclonal antibodies, such as trastuzumab, are used for cancer cells that have the HER2 mutation. Radiation is usually added to the surgical bed to control cancer cells that were missed by the surgery, which usually extends survival, although radiation exposure to the heart may cause damage and heart failure in the following years.
157
Q

Fibrocystic breast changes or fibrocystic breast disease is a condition of breast tissue affecting an estimated 30-60% of women.

It is characterized by?

A

noncancerous breast lumps in the breast which can sometimes cause discomfort, often periodically related to hormonal influences from the menstrual cycle

158
Q

Fibrocystic Breast is also called?

A

diffuse cystic mastopathy, or, if there is epithelial proliferation, fibrosclerosis of the breast.
• Older names for this condition include chronic cystic mastitis, fibrocystic mastopathy and mammary dysplasia.
• Since it is a very common disorder, some authors have argued that it should not be termed a “disease”

159
Q

Clinical Presentations of Fibrocystic Breast:

A
  • The changes in fibrocystic breast disease are characterised by the appearance of fibrous tissue and a lumpy, cobblestone texture in the breasts.
  • These lumps are smooth with defined edges, and are usually free- moving in regard to adjacent structures. The bumps can sometimes be obscured by irregularities in the breast that are associated with the condition. The lumps are most often found in the upper, outer sections of the breast (nearest to the armpit).
  • Women with fibrocystic changes may experience a persistent or intermittent aching in their breasts related to periodic swelling. Breasts and nipples may be tender or itchy.
  • Symptoms follow a periodic trend tied closely to the menstrual cycle. Symptoms tend to peak immediately before each period and decrease afterwards.
  • At peak, breasts may feel full and swollen. No complications related to breastfeeding have been found.
160
Q

Possible Causes and Associations with FCB:

A
  • The causes of the condition are not fully understood, though it is known that they are tied to levels, as the condition usually subsides after menopause.
  • It is also related to the menstrual cycle and to dietary conditions.
  • The incidence is lower in women taking birth control, possibly because of the regulation of hormone levels.
  • Dietary fat levels and caffeine intake may have an effect on the onset of the condition, as may family history.
161
Q

Treatment for FCB (Fibrocystic Breast):

A

• There is no cure for the condition, but symptoms may be reduced by monitoring caffeine and fat intake, wearing a well fitting bra. In severe cases a synthetic androgen may be prescribed.

162
Q

Prognosis for FCB (Fibrocystic Breast):

A
  • There are usually no adverse side effects to this condition. In almost all cases it subsides after menopause.
  • A possible complication arises through the fact that cancerous tumors may be more difficult to detect in women with fibrocystic changes.
  • This condition does not seem to lead to increased breast cancer risk.

AA. Patho 2 (8 decks)

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