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DIT STEP 2 > GYN&BREAST > Flashcards

GYN&BREAST Flashcards

1
Q

Amenorrhea and + progestin challenge

A

Anovulatory. Workup for PCOS

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2
Q

Order of events of normal female puberty

A 
Adrenarche
Gonadarche
Thelarche
Pubarche
Growth spurt
Menarche
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3
Q

Pubic hair dev at tanner stage 1

A

Prepubertal so no hair growth.

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4
Q

What tanner stage is breast budding seen?

A

Tanner Stage II

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5
Q

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

A

Stage II

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6
Q

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

A

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

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7
Q

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

A

Pituitary gland activation

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8
Q

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

A

Excess sex steroid production

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9
Q

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

A

Exogenous hormone production (neoplasm)

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10
Q

Describe follicular phase

A

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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11
Q

Describe luteal phase

A

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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12
Q

Diagnosis of menopause requires how long of amenorrhea?

A

One year

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13
Q

Which hormone induces LH surge?

A

Estrogen

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14
Q

What hormone is responsible for increasing the basal body temperature?

A

Progesterone

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15
Q

What is Asherman syndrome

A

Scarring of the uterus that follows infection or postpartum infection

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16
Q

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

A

Gonadal agenesis
Gonadal dysgenesis
Ovarian failure

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17
Q

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

A

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

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18
Q

If estrogen-progesterone challenge is negative, dx?

A

Asherman syndrome

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19
Q

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

A

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

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20
Q

Tx for PMS and PMDD

A 
Exercise
Vitamin B6
NSAIDS
OCPs
Progestins
SSRIs with or without alprazolam
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21
Q

“Powder burn” lesions and cysts on laparoscopy

A

Endometriosis

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22
Q

Define abnormal uterine bleeding

A

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

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23
Q

most common cause of androgen excess in women

A

PCOS

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24
Q

What causes ovarian cysts in PCOS?

A

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

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25
Q

Labs in PCOS

A 
Increased LH
LH:FSH ratio >3
Increased DHEA
Increased androstenedione
Positive progestin challenge
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26
Q

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

A

Endometrial cancer, secondary to chronically high estrogen levels.

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27
Q

2 infections that cause vaginal pH >4.5

A

Gardnerella and trichomonas

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28
Q

What are gumbos?

A

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

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29
Q

Labs FOLLOWING syphilis tx

A

RPR and VDRL will become negative

FTA-ABS will remain positive FO LIFE

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30
Q

Bubo formation seen in what STDS

A

Chancroid and lymphogranuloma venereum! Significant inguinal swelling

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31
Q

Which STD is commonly mistaken for IBD due to fistula formation

A

Lymphogranuloma venereum

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32
Q

Donovan bodies

A

Red encapsulated intracellular bacteria seen in granuloma inguinale

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33
Q

Painless ulcer with beefy red base and irregular borders

A

Granuloma inguinale

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34
Q

Tx for fibroids

A

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

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35
Q

When do you perform uterine artery embolization

A

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

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36
Q

Endometrial cancer with worse prognosis

A

If its not related to excess endogenous or oxogenous estrogen exposure

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37
Q

Most common cause of vaginal bleeding in postmenopausal women

A

Atrophic vaginitis

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38
Q

Which cancer is associated with endometrial cancer?

A

Colon cancer (HNPCC)

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39
Q

Origin of mutinous or serous cystadenoma

A

Epithelial tissue

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40
Q

Psammoma bodies are seen in what ovarian mass

A

Serous cystadenocarcinoma

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41
Q

Follicular cysts are made up of what kind of cells?

A

Granulosa cells

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42
Q

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

A

Theca cells

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43
Q

Precocious puberty can be due to what kind of ovarian tumor

A

Granulosa theca cell tumor

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44
Q

Virilization can be due to what kind of ovarian tumor

A

Sertoli-Leydig cell tumors

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45
Q

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

A

Surgical resection

46
Q

Bloody or non-bloody discharge from nipple on stimulation?

A

Intraductal papilloma

47
Q

Lower risk of invasion but increased risk of contralateral malignnacy

A

Lobular carcinoma in situ

48
Q

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

A

DCIS

49
Q

Most common form of invasive brareast cancer

A

Infiltrating ductal carcinoma

50
Q

Fibrotic response in surrounding breast tissue (cancer)

A

infiltrating ductal carcinoma

51
Q

More frequently bilateral/multifocal form of breast CA

A

Infiltrating lobular carcinoma

52
Q

Rapid growth of a SOFT well circumscribed breast mass

A

Medullary carcinoma

53
Q

Which form of breast ca is angioinvasive?

A

Inflammatory carcinoma

54
Q

How is DCIS treated

A

lumpectomy

55
Q

How is LCIS treated

A

Close observation, possibly adding tamoxifen or raloxifine.

56
Q

Trastuzumab

A

anti-HER-2/neu receptor antibody

57
Q

Which ligament contains the uterine vessels

A

Cardinal ligament, attaches cervix to side wall of pelvis.

58
Q

Which ligament contains ovarian vessels

A

Suspensory ligament of the ovaries.

59
Q

Histological difference between ectocervix and endocervix

A

Stratified squamous epithelium – >simple columnar epithelium

60
Q

Which cells secrete testosterone

A

Leydig cells

61
Q

What happens to GnRH during menopause

A

Increases

62
Q

LH and FSH in Turners

A

Increases due to decreases in estrogen

63
Q

FSH and LH in XXY

A

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

64
Q

Fertility of XYY males

A

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

65
Q

Increased testosterone

Increased LH

A

Defective androgen receptor (like in testicular feminization)

66
Q

Increased testosterone

Decreased LH

A

Testosterone secreting tumor or exogenous steroid use

67
Q

Decreasd testoerone, increased LH

A

Primary hypogonadism

68
Q

Decreased testosterone

decreased LH

A

Hyponadotrophic hypogonadism

69
Q

A male has ambiguous genitalia until puberty. What happened?

A

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.

70
Q

Hormone levels in androgen insensitivity syndrome

A

Increased testosterone, estrogen, and LH.

A defect in androgen receptor.

71
Q

Which moles have increased risk of malignant trophoblastic disease

A

Complete moles

72
Q

Which mole contains fetal parts

A

Partial

73
Q

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

A

Complete

74
Q

Stages of mag sulfate toxicity

A

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

75
Q

Increased risk for placenta previa

A

Multiparity

Prior c section

76
Q

Tx of endometritis

A

Gentamicin + clindamycin +/- ampicillin.

77
Q

4 tx for endometriosis

A

OCP
NSAIDs
Leuprolide
Danazol

78
Q

Most common gynecological malignancy

A

Endometrial CA

79
Q

Whorled pattern of smooth muscle bundles in a pt with AUB

A

Leiomyoma

80
Q

Incidence of gynecologic tumor

A

Endometrial > ovarin > cervical

Cervical CA is most common worldwide.

81
Q

Worst prognosis for gynecologic tumors

A

Ovarin > cervical > endommetrial

82
Q

What is a dermoid cyst

A

Mature teratoma

83
Q

What is a theca lutein cyst

A

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

84
Q

Hormone levels in PCOS

A

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

85
Q

Increased hCG and LDH indicate which ovarian tumor

A

Dysgerminoma

86
Q

Schiller Duval bodies

A

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

87
Q

Most common ovarian germ cell tumors

A

Teratoma.

88
Q

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

A

AFP

89
Q

Call Exner bodies

A

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

90
Q

Pseudomyxoma peritonei is caused by what kind of tumor

A

Mucinous cystadenocarcinoma or an appendiceal tumor

91
Q

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

A

Serous cystadenocarcinoma

92
Q

Most important risk factor for ovarian CA

A

FAMILY HX

93
Q

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

A

Brenner tumor. Benign, unilateral. Looks like BLADDER.

94
Q

Spindle shaped gynecological tumor cells that are design positive

A

Sarcoma botyroides

95
Q

Which invasive breast tumor is often bilateral

A

Invasive lobular

96
Q

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

A

Medullary. Good prognosis!

97
Q

Pages disease of breast indicates an underlying what

A

DCIS

98
Q

Describe paget cells histologically

A

Large cells in epidermis with clear halo.

99
Q

Single most important prognostic factor in malignant breast tumor

A

Axillary LN involvement

100
Q

Estrogen increases risk for what CA?

A

Endometrial cancer.

101
Q

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

A

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

102
Q

Flutamide MOA

A

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

103
Q

Ketoconazole and spironolactone can help treat what disease

A

PCOS

104
Q

Raloxifene MOA

A

AGonist on bone and reduces the resoprtion. Treats osteoporosis.

105
Q

How does tamoxifen work

A

Antagonist on breast tissue and treats ER positive breast cancer.

106
Q

How does clomiphene work

A

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)

107
Q

SE of clomiphene

A

Hot flashes
Ovarian enlargement
Multiple simultaneous pregnancies
Visual disturbances

108
Q

Postmenopausal women with breast cancer can use what meds

A

Anastrozole/exemastane

109
Q

Progestins can also be used in tx of

A

Endometrial CA and AUB

110
Q

Terbutaline MOA

A

Beta 2 agonist that relaxes the uterus

111
Q

Danazol can be used to treat which 2 conditions

A

Endometriosis, hereditary angioedema

112
Q

Danazol MOA and toxicity

A

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

DIT STEP 2 (17 decks)

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