GYN&BREAST Flashcards
Amenorrhea and + progestin challenge
Anovulatory. Workup for PCOS
Order of events of normal female puberty
Adrenarche Gonadarche Thelarche Pubarche Growth spurt Menarche
Pubic hair dev at tanner stage 1
Prepubertal so no hair growth.
What tanner stage is breast budding seen?
Tanner Stage II
What tanner stage is slight growth of fine labial hair seen?
Stage II
What do the breasts look like in stage 4 (tanner)
Further breast enlargement: areola and papilla form secondary growth ABOVE level of breast.
Precocious puberty: Increased LH and FH with additional release following administration of GnRH suggest what etiology
Pituitary gland activation
Precocious puberty: low LH and FSH with no response to GnRH suggests what etiology?
Excess sex steroid production
Increased estrogen in the presence of low LH and FSH suggests ?
Exogenous hormone production (neoplasm)
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
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.
Diagnosis of menopause requires how long of amenorrhea?
One year
Which hormone induces LH surge?
Estrogen
What hormone is responsible for increasing the basal body temperature?
Progesterone
What is Asherman syndrome
Scarring of the uterus that follows infection or postpartum infection
Primary amenorrhea: no secondary sexual characteristics, high FSH, LH. Dx?
Gonadal agenesis
Gonadal dysgenesis
Ovarian failure
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
If estrogen-progesterone challenge is negative, dx?
Asherman syndrome
If estrogen-progesterone challenge test is positive, next step?
Check FSH, LH.
If high: ovarian failure
If low: HPA axis disfunction
Tx for PMS and PMDD
Exercise Vitamin B6 NSAIDS OCPs Progestins SSRIs with or without alprazolam
“Powder burn” lesions and cysts on laparoscopy
Endometriosis
Define abnormal uterine bleeding
Menses with 35 day intervals
Lasting >7 days
or
blood loss > 80 mL
most common cause of androgen excess in women
PCOS
What causes ovarian cysts in PCOS?
A result of androgen hyper secretion; do NOT cause the disease!!!
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.
