GYN 1 Flashcards
E2 aka ?
Estradiol
Normal Pap smear results ?
No atypical cells
Hysterogram own notes ?
Bicornuate uterus - impartial development
Septate uterus - sometimes the septet restricts fetal growth and leads to fetal demise
Asherman syndrome - adhesions , incompletely filling pockets
FSH / LH decreased ?
Pituitary failure
Hypothalamus failure
E3 decreased indicates ?
failing pregnancy
like : Fetal distress, Rh incompatibility, preeclampsia, anencephaly, fetal death
- *not everyone gets tested
- *
Schiller Test: ______ _______ is an aqueousiodinepreparation and is commonly used for the Schiller test.
Lugol’s solution
Dx tests: Ovarian torsion ?
US
E2 and GRH ratio ?
↓ E2 = ↑ GRH (hypothalamus)
- *negative feedback to GnRH in hypo
- *
What is the main screening for carvical CA ?
Pap smear
Hysterosalpingography (HSP) indications ?
Usually a work-up for infertility
Testosterone increased in females ?
Ovarian tumor
Adrenal tumor
PCOS
-hirsutism and acne = sxs. anovulatory cycles and get all these follicles floating around in the opvarys and they never get periods and they get infertility with it.
E3 Increases at _____ gestation and rises throughout _________
8 wks
pregnancy
What is a Laparoscopy ?
Allows direct visualization of the intraabdominal and pelvic organs.
**just LOOKing!
using tools to go in through puncture wounds but this is no procedure ( this is just looking)
endometriosis or fibroid on outside of uterus in the myometrium**
Ovarian Disorder examples ?
Ovarian Cysts
PCOS
Ovarian CA
Ovarian Torsion
Normal Testosterone in females ?
< 300 pg/ml
Pap Smear guidelines: Women age 21-65 ?
Pap tests no more than Q 3 years
D & C indications ?
DUB
Abnormal vaginal bleeding
Endometrial hyperplasia or carcinoma
Therapeutic:
- Remove embedded IUD
- DUB
E2 (Estradiol): premarin ?
methylestradiol - made from pregnant mare urine ( horse pee)
Uterine disorder examples ?
Asherman Syndrome Endometrial Ca Endometriosis Leiomyoma Adenomyoma PID Toxic Shock Syndrome
What is the major circulating estrogen after menopause ?
E1 (Estrone)
Pap smear: What is the purpose of Bethesda System for Reporting Cervical and Vaginal Cytologic Diagnoses ?
Minimize discrepancy between reports on cervical cytologic findings ( across PAP smear results)
- Adequacy ( of specimen)
- General Categorization
- Interpretation/Result
- Ancillary tests
Box 7-1 Mosby’s p.744
Dx tests: Leiomyoma ?
US
Laparoscopy
Hysteroscopy
Hysterogram
Dx tests: PID ?
GC/ CT Swabs
US
Culdocentesis
Colposcopy findings: carcinoma in situ ?
Pink or red well-circumscribed punctate lesion
Dx tests: Bartholin cyst ?
culture
When is E2(Estradiol) elevated ?
Precocious puberty
early age
Ovarian tumor
Testicular tumor
Adrenal tumor
Pregnancy
Liver necrosis
Hyperthyroidism
**
adrenal tumor cause they increase sterols and then the hormones ( cortisol is related)
liver necrosis - nothing is being metabolized
hyperthyroidism - problems with hypothalamic pituitary access **
Mammogram: own notes ?
right is speculated and breast may be deformed here and mass may be pulling on tissue
MC in a breast are typically precursors to CA
right - smooth, uniform but suspicion enough for a bx
benign cysts you usually just leave it and no BX so you can get a US cause they are fluid filled
Cervical Ca usually starts with ?
HPV infection
Culdocentesis own notes ?
Pouch of Douglas - rectouterine pouch and this collects fluid in the area - infection to get a culture and for relief of sxs. and for a rupture ectopic and there is blood in there
2000 beta HCG - and they do a US and they see nothing and the woman has pain and is tachy - then they do a US and see ultrasound and see fluid here they can do this procedure and maybe see blood there
Gonadotropins own notes ?
FSH and LH go to the ovary and it secretes estrogen when then does the negative feedback
Dx tests: Ovarian cysts ?
US
Laparascopy
FSH in males aids in the development of ?
sertoli cells
which develop into sperm
Estradiol is produced where ?
ovary
LEEP aka ?
Loop Electrosurgical Excision Procedure
**the MC procedure done and it used electrosurgical loop and it cauterizes as it excises **
Cervical Biopsy what is it ?
Biopsy of the cervix to identify and treat premalignant cells and superficial malignancies
Bx that area away
What are the 3 major estrogens ?
E1
E2
E3
Estrogen’s order of potency ?
estriol < estrone < estradiol
Hysterosalpingography (HSG) own notes ?
this one shows the fallopian tubes
sapling shows fallopian tubes
**this procedure is kinda painful and can cause cramping
some women have an easier time getting pregnant after this exam**
Other cervical tests: Review ?
Chlamydia (NAAP is the most common test for G and C)
Gonorrhea
Wet Mount
BV ( clue cells = epithelial cells coating in bacteria and trichomonal - mobile flagellate )
KOH prep - viruses and it dissolves the epithelial cells
Dx tests: Endometrial CA ?
Pap smear
Endometrial bx
Hysteroscopy
When is a Colposcopy used ?
Used to evaluate patients that have an abnormal Pap with a grossly normal cervix
More thorough eval of an abnl Pap
more through evaluation
Estrogen and Progesterone own notes ?
if you are taking P then you are keeping the endometrium thin - cause is is a continous amount this is no surge to thicken it
taking steady P and E prevents the spike
E have an affect on the clotting mechanism so there is a risk of DVT and TE
What estrogen develops secondary sex characteristic in females ?
estradiol
Diagnostic tests: galactorrhea ?
Prolactin
MRI brain
Prolactin is used to evaluate: Galactorrhea ?
elevated with pituitary adenomas or cancers
What estrogen assess placental function ?
E3
Diagnostic tests: infertility ?
See Clin Med for work-up
What is a Pap smear ?
✪Mainstay screening exam for cervical CA
**you need a speculum and a spatula and an endocervical brush **
Prolactin is used to evaluate: Sheehan syndrome ?
pituitary infarct- level will be decreased
- caused from hemorrhage during birth anf you get decreased prolactin levels
- postpartum amenorrhea
Estrone is more potent than _______ but is less potent than _______.
estriol
estradiol
Normal Testosterone in males ?
240-650 pg/ml
Dx tests: Syphillis ?
Review (RPR, FTA-ABS)
Abnormal Pap smear results ?
ASCUS - the least
LGSIL
HGSIL
Cervical Cancer (SCC)
Can also lend information on nonneoplastic findings and infectious organisms
- *least amount of dysplasia to most
- *
- *CA is basically a an abnormal growth of cell in a different ways and lose the function of the tissue they are supposed to be
- *
Cervical Biopsy: punch ?
punch is good for depth of the lesion and for small smapling of a large dysplastic area ( see how deep it goes) or something that is suspicious
small tissue samples are taken from the cervix and examined for disease or other problems
Laparoscopy results ?
Abdominal adhesions Ovarian tumor or cysts Endometriosis Ectopic pregnancy Fibroids Abscess Cancer Ascites
What does menstruation interfere with Pap ?
endometrial cell
contaminate smear,
if you do get these cells and they are not menstruating then it could mean endometrial CA
Dx tests: PCOS ?
GTT US Serum androgen LH/FSH ratio Lipid panel
Hysteroscopy own notes?
“looking inside the uterus “
Dx tests: Ovarian CA ?
BRCA gene 1 CA 125 marker P53 tumor suppressor gene US Surgical bx
E3 begin testing at ?
28 – 30 weeks
Get baseline then test daily / weekly
Reflex HPV Testing: Low risk ?
HPV 6,11 ( gardasil protection)
42,43, and 44
Dx tests: cervical dysplasia ?
HPV PAP Cervical biopsy Colposcopy LEEP
When would you want to do a urine culture instead of a swab culture ?
pediatric patients ( sexual assault or molestation) no pelvic exam on these patient
Prolactin is used to evaluate ?
Galactorrhea - milky discharge for the nipples
Sheehan syndrome
FSH in females aids in the development of ?
follicles in the ovary
Estrogen testing evaluates what in females ?
Sexual maturity
Menstrual and fertility problems
Fetal-placental health
Estrogen producing tumors
Cervical Biopsy: cone ?
a large area of tissue around the cervix is excised for examination
Estrogen testing evaluates what in males ?
Gynecomastia
Dx tests: ashermans syndrome ?
hysteroscopy
What is the major estrogen during pregnancy ?
E3
Pap Smear guidelines: Pap tests for women > 65 years old with hx of NL pap tests ?
None
** if the have a abnormal then yes test them, over 65 and getting cervial CA it is slim, low risk of contracting virus ( no sex) **
Reflex HPV Testing: High risk ?
HPV 16,18, 31, 33,45, 52, 58 (gardasil protection)
35, 39, 51, 56, 59, 68
Diagnostic tests: fibroadenoma ?
Breast US
Septate Uterus ?
wedge of fibrous tissue dividing uterine cavity
E3 aka ?
Estriol
Pap Smear guidelines: Women age 30-65 ?
Q 5 years if pap with HPV testing
- *HPV test is neg. then every 5 years
- *
E1 aka ?
Estrone
High risk HPV is associated with ?
severe lesions and cervical cancer
Testosterone decreased in males ?
Klinefelter syndrome (XXY)
Cryptochordism
Hypogonadism
Orchiectomy
Hepatic cirrhosis
**important to keep this on your differential for men with depression or loss of libido **
E3 is produced in the ?
placenta
Dx tests: TSS ?
US
CBC, CMP
GC/CT Swabs
Reflex HPV Testing: involves what type of virus ?
DNA tumor virus
What Interferes with Pap test results ?
Menstruation
Lubricating jelly
Infections
Delay in specimen transport
Testosterone increased in males ?
Pinealoma
affects hypothalamus
Encephalitis
Testicular tumor
Hyperthryoidism
Colposcopy findings: invasive CA ?
Disarray of blood vessels and mass effect
When is E2(Estradiol) decreased ?
Turner syndrome (XO) wide neck, heart problems - COA
Hypopituitarism - decrease sex hormones
Primary and secondary hypogonadism
Menopause
Anorexia nervosa
**primary hypogonadism - ovarian failure ( happens with early menopause ( premature menopasuse)
secondary - anything else that cause hypogonadism - many had ovaries removed **
Hysteroscopy indications ?
Abnormal Pap
-proliferation of endometrial cells
DUB
Postmenopausal bleeding
-endometrial CA then do a bx.
Diagnostic tests: breast carcinoma ?
Mammogram
Breast US
Biopsy
Colposcopy findings: own notes ?
coat the cervix with Acetic acid and if there is a dysplastic area it will light us
ASCUS / LGSIL - it will just have a sharply demarcated area ( just dyplasiea)
if it is CA punctate pink and dyplasitc area
Hysterosalpingography (HSP) can also see ?
Uterine tumors
Adhesions
Developmental anomalies
Tubal obstruction (kinking, scarring) -scarring maybe from PID which obstructs the egg from traveling
Asherman’s syndrome ?
Adhesions ( band-like formations) crossing the lining of the Uterus
E1 (Estrone) is secreted by ?
ovary
Diagnostic tests: fibrocystic breast disease ?
Breast US
FNA
LH in females forms the ?
corpus luteum
FSH / LH increased ?
Gonadal failure
-trying to stimulate gonads to secrete
Precocious puberty
Pituitary adenoma
What is a Dilation and Curettage (D&C) ?
Dilation of the cervix
Curettage of the endometrium
**use sounds to dilate the cervix using a large and larger sound
called a sound cause you are testing/measuring how deep the U is ( like when u are placing instruments you do not want to go to deep)
cervix has stretch receptors and no pain receptors - so this procedure does not help but they get cramping
Curettage is the scraping with a sharp rounded tool **
LH in males is involved with ?
testosterone production (Leydig cells)
What is prolactin ?
Hormone that is secreted by the anterior pituitary
Promotes lactation (feedback mechanism)
- *Breast feeding release prolactin and oxytocin
- *
Hyster = ?
uterus
Low risk HPV is associated with ?
genital warts and low grade dysplasia
Dx tests: Condylomata acuminata ?
biopsy
Pap Smear guidelines: Pap tests for women < 21 years old ?
None
- *regardless of sexual activity
- *
Dx tests: cervicitis ?
CT/ GC
Trichomonas
BV
Schiller Test is based on ?
the principle that normal mature squamous epithelium of the cervix contains glycogen, which combines withiodineto produce a deep mahogany-brown color.
What is a Colposcopy ?
Macroscopic examination of the vagina and the cervix
**looking for areas of dysplasia **
Dx tests: Adenomyoma ?
US
Endometrial bx
Pap Smear guidelines:HPV testing in women < 30 years old ?
None
- *some women test positive and then clear the virus
- *
ASCUS ?
Atypical squamous cells of undetermined significance - does not mean CA ( few cells that are atypical and they dont know what it means)
Schiller Test: __________ constitutes a positive Schiller test.
Nonstaining
**if it does not turn brown it is abnormal cells **
**abnormal cells stay llgiith , no matter what you put on them **
Hormones own notes
they all start as sterols
androgen into estrogens? what enzyme ?
men who do steroid get breast cause the estrodiol conversion ( most potent and most common)
T and converted to estradiol ( too commons was to covert it and that is why it is most common)
some tumors feed on estrogen so give a aromatase inhibitor to patient with breast CA to stop the production of E to starve the tumor
E2 (Estradiol) own notes ?
most potent and prevalent
give to patients with post menopausal issues
osteoporosis
hot flashes
vaginal atrophy - it thickens walls
E2 increase right before the spike of LH
FSH stimulate the follicle and the ovary starts to make the follicle and secret the follicle within the ovary and the E2 during this cycle is starting to rise and when E2 spikes it causes the LH to spike which is the major hormone for the development of the corpus leuteum and cause ovulation. corpus hemorrhagiousum.
the eggs is then releases and trasv=fered to the uterus and the CH turing to the CL and CL releases hormones P and E that are responsible for thickening endmetrium(P) if there is no implantation the P drops off and the endometrium drops off and this is menstariton
E2 linked to reduction binge eating in mood , depression, bone density, atherosclerotic lesions ( only thing that it is linked to that is unhealthy is breast CA)
LGSIL & HGSIL ?
low or high grade squamous intrahepathelail leasion - there is dysplasia and precursor to CA there ( comes before a formal dx. of cervial CA)
- *LGSIL or HGSIL then they usually run a reflex test after
- *
FSH/ LH acts on the ?
ovaries or testes
Reflex HPV Testing: virus pathology ?
HPV DNA incorporates itself into the cervical cell genome activating oncogenes and suppressing the cell immune response
E3 can be tested in the ?
plasma / urine
Dx tests: vaginal neoplasm ?
biopsy
Colposcopy findings: Dysplasia ?
White, sharply demarcated after acetic acid
Dx tests: Endometriosis ?
US
Laparoscopy
Bicornuate Uterus ?
incomplete uniting of uterus
