GYN&BREAST Flashcards by Meghan Czajka

Amenorrhea and + progestin challenge

Anovulatory. Workup for PCOS

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Order of events of normal female puberty

Adrenarche
Gonadarche
Thelarche
Pubarche
Growth spurt
Menarche

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Pubic hair dev at tanner stage 1

Prepubertal so no hair growth.

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What tanner stage is breast budding seen?

Tanner Stage II

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What tanner stage is slight growth of fine labial hair seen?

Stage II

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What do the breasts look like in stage 4 (tanner)

Further breast enlargement: areola and papilla form secondary growth ABOVE level of breast.

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Precocious puberty: Increased LH and FH with additional release following administration of GnRH suggest what etiology

Pituitary gland activation

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Precocious puberty: low LH and FSH with no response to GnRH suggests what etiology?

Excess sex steroid production

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Increased estrogen in the presence of low LH and FSH suggests ?

Exogenous hormone production (neoplasm)

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Describe follicular phase

FSH stimulates GROWTH of OVARIAN FOLLICLE (granolas cells) which in turn secretes estradiol.
ESTRADIOL induces ENDOMETRIAL PROLIFERATION and further increases FSH and LH secretion from positive feedback of pituitary

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Describe luteal phase

Residual follicle (i.e., CORPUS LUTEUM) secretes estradiol and progesterone to MAINTAIN ENDOMETRIUM and induce devo of secretory ducts.
High estradiol levels inhibit FSH and LH.
IF egg is NOT fertilized, corpus lute degrades, progesterone and estradiol levels decrease, and the ENDOMETRIAL LINING DEGRADES.

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Diagnosis of menopause requires how long of amenorrhea?

One year

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Which hormone induces LH surge?

Estrogen

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What hormone is responsible for increasing the basal body temperature?

Progesterone

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What is Asherman syndrome

Scarring of the uterus that follows infection or postpartum infection

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Primary amenorrhea: no secondary sexual characteristics, high FSH, LH. Dx?

Gonadal agenesis
Gonadal dysgenesis
Ovarian failure

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Next step in primary amenorrhea with no secondary sexual characteristics and LOW FSH, LH

Prolactin level. If normal, its a GnRH deficiency or other hypothalamic-pituitary dysfunction

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If estrogen-progesterone challenge is negative, dx?

Asherman syndrome

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If estrogen-progesterone challenge test is positive, next step?

Check FSH, LH.
If high: ovarian failure
If low: HPA axis disfunction

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Tx for PMS and PMDD

Exercise
Vitamin B6
NSAIDS
OCPs
Progestins
SSRIs with or without alprazolam

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“Powder burn” lesions and cysts on laparoscopy

Endometriosis

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Define abnormal uterine bleeding

Menses with 35 day intervals
Lasting >7 days
or
blood loss > 80 mL

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most common cause of androgen excess in women

PCOS

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What causes ovarian cysts in PCOS?

A result of androgen hyper secretion; do NOT cause the disease!!!

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Labs in PCOS

``` Increased LH LH:FSH ratio >3 Increased DHEA Increased androstenedione Positive progestin challenge ```

What kind of cancer are patients with PCOS at higher risk for?

Endometrial cancer, secondary to chronically high estrogen levels.

2 infections that cause vaginal pH >4.5

Gardnerella and trichomonas

What are gumbos?

Granulomatous lesions of skin, bone, and liver seen in tertiary syphilis

Labs FOLLOWING syphilis tx

RPR and VDRL will become negative | FTA-ABS will remain positive FO LIFE

Bubo formation seen in what STDS

Chancroid and lymphogranuloma venereum! Significant inguinal swelling

Which STD is commonly mistaken for IBD due to fistula formation

Lymphogranuloma venereum

Donovan bodies

Red encapsulated intracellular bacteria seen in granuloma inguinale

Painless ulcer with beefy red base and irregular borders

Granuloma inguinale

Tx for fibroids

First you use GnRH agonists to reduce bleeding and size. Then do a myomectomy or hysterectomy

When do you perform uterine artery embolization

Tx of fibroids following a pelvic MRI to rule out other soft tissue pathology to selectively infarct small fibroids in women wishing to avoid surgery but carries a HIGH likelihood of impaired fertility

Endometrial cancer with worse prognosis

If its not related to excess endogenous or oxogenous estrogen exposure

Most common cause of vaginal bleeding in postmenopausal women

Atrophic vaginitis

Which cancer is associated with endometrial cancer?

Colon cancer (HNPCC)

Origin of mutinous or serous cystadenoma

Epithelial tissue

Psammoma bodies are seen in what ovarian mass

Serous cystadenocarcinoma

Follicular cysts are made up of what kind of cells?

Granulosa cells

Corpus luteum cysts are made up of what kind of cells?

Theca cells

Precocious puberty can be due to what kind of ovarian tumor

Granulosa theca cell tumor

Virilization can be due to what kind of ovarian tumor

Sertoli-Leydig cell tumors

What is vital to establishing an accurate cytologic diagnosis of suspected ovarian malignancy?

Surgical resection

Bloody or non-bloody discharge from nipple on stimulation?

Intraductal papilloma

Lower risk of invasion but increased risk of contralateral malignnacy

Lobular carcinoma in situ

Which in situ breast cancer carries higher risk of subsequent invasive cancer

DCIS

Most common form of invasive brareast cancer

Infiltrating ductal carcinoma

Fibrotic response in surrounding breast tissue (cancer)

infiltrating ductal carcinoma

More frequently bilateral/multifocal form of breast CA

Infiltrating lobular carcinoma

Rapid growth of a SOFT well circumscribed breast mass

Medullary carcinoma

Which form of breast ca is angioinvasive?

Inflammatory carcinoma

How is DCIS treated

lumpectomy

How is LCIS treated

Close observation, possibly adding tamoxifen or raloxifine.

Trastuzumab

anti-HER-2/neu receptor antibody

Which ligament contains the uterine vessels

Cardinal ligament, attaches cervix to side wall of pelvis.

Which ligament contains ovarian vessels

Suspensory ligament of the ovaries.

Histological difference between ectocervix and endocervix

Stratified squamous epithelium -- >simple columnar epithelium

Which cells secrete testosterone

Leydig cells

What happens to GnRH during menopause

Increases

LH and FSH in Turners

Increases due to decreases in estrogen

FSH and LH in XXY

Klinefelters. Dysgenesis of semifinal tubules causes decreased inhibin, increasing FSH. Abnormal leydig cell function causes decreased testosterone, which increases LH and increases estrogen.

Fertility of XYY males

Normal. They're just very tall and have severe acne, antisocial behavior.

Increased testosterone | Increased LH

Defective androgen receptor (like in testicular feminization)

Increased testosterone | Decreased LH

Testosterone secreting tumor or exogenous steroid use

Decreasd testoerone, increased LH

Primary hypogonadism

Decreased testosterone | decreased LH

Hyponadotrophic hypogonadism

A male has ambiguous genitalia until puberty. What happened?

5a reductase deficiency caused the inability to convert testosterone to DHT. However, in puberty, increased testosterone causes masculinization and the increased growth of external genitalia. Lh is normal or increased. Testosterone is normal.

Hormone levels in androgen insensitivity syndrome

Increased testosterone, estrogen, and LH. | A defect in androgen receptor.

Which moles have increased risk of malignant trophoblastic disease

Complete moles

Which mole contains fetal parts

Partial

2 sperm in an empty egg results in what kind of mole

Complete

Stages of mag sulfate toxicity

Decreased DTR -- > hypotension -- > respiratory paralysis -- > cardiac arrest.

Increased risk for placenta previa

Multiparity | Prior c section

Tx of endometritis

Gentamicin + clindamycin +/- ampicillin.

4 tx for endometriosis

OCP NSAIDs Leuprolide Danazol

Most common gynecological malignancy

Endometrial CA

Whorled pattern of smooth muscle bundles in a pt with AUB

Leiomyoma

Incidence of gynecologic tumor

Endometrial > ovarin > cervical | Cervical CA is most common worldwide.

Worst prognosis for gynecologic tumors

Ovarin > cervical > endommetrial

What is a dermoid cyst

Mature teratoma

What is a theca lutein cyst

Due to gonadotropin stimulation and a/w chorio and moles.

Hormone levels in PCOS

Increased LH, testosterone, and estrogen (from testosterone aromatization) Decreased FSH.

Increased hCG and LDH indicate which ovarian tumor

Dysgerminoma

Schiller Duval bodies

Resemble glomeruli and are found in yolk sac/endodermal sinus tumors. Remember these are germ cell tumors.

Most common ovarian germ cell tumors

Teratoma.

Yolk sac/endodermal sinus tumors present with what increase tumor marker

AFP

Call Exner bodies

Small follicles filled with eosinophilic secretions and a/w granolas cell tumors

Pseudomyxoma peritonei is caused by what kind of tumor

Mucinous cystadenocarcinoma or an appendiceal tumor

Psammoma bodies are seen in which non-germ cell tumor of ovary

Serous cystadenocarcinoma

Most important risk factor for ovarian CA

FAMILY HX

Which type of ovarian neoplasm has coffee bean nuclei on H&E staining

Brenner tumor. Benign, unilateral. Looks like BLADDER.

Spindle shaped gynecological tumor cells that are design positive

Sarcoma botyroides

Which invasive breast tumor is often bilateral

Invasive lobular

Which invasive breast CA is fleshy, cellular and has a lymphocytic infiltrate

Medullary. Good prognosis!

Pages disease of breast indicates an underlying what

DCIS

Describe paget cells histologically

Large cells in epidermis with clear halo.

Single most important prognostic factor in malignant breast tumor

Axillary LN involvement

Estrogen increases risk for what CA?

Endometrial cancer.

How is leuprolide used in prostate CA, uterine fibroids and precocious puberty

Continuous! Downregulates GnRH receptor causing decreased FSH and LH. In prostate cancer its used with flutamide.

Flutamide MOA

Nonsteroidal competitive inhibitor of androgens at the testosterone receptor. Used in prostate CA.

Ketoconazole and spironolactone can help treat what disease

PCOS

Raloxifene MOA

AGonist on bone and reduces the resoprtion. Treats osteoporosis.

How does tamoxifen work

Antagonist on breast tissue and treats ER positive breast cancer.

How does clomiphene work

Partial agonist at estrogen receptors in hypothalamus. Prevents normal FB and increases release of LH and FSH which stimulates ovulation. Therefore its used to treat infertility and PCOS (if pt wants to get preg)

SE of clomiphene

Hot flashes Ovarian enlargement Multiple simultaneous pregnancies Visual disturbances

Postmenopausal women with breast cancer can use what meds

Anastrozole/exemastane

Progestins can also be used in tx of

Endometrial CA and AUB

Terbutaline MOA

Beta 2 agonist that relaxes the uterus

Danazol can be used to treat which 2 conditions

Endometriosis, hereditary angioedema

Danazol MOA and toxicity

Synthetic androgen that acts as partial agonist at androgen receptors. May cause weight gain edema acne hirsutism masculinization decreased HDL and hepatotoxicity.