Gyn1

Question 1

Virilization

Answer 1

Hirsuitism + male secondary sex characteristics (zits, deeper voice, clitoromegaly - pathognomonic)

Question 2

Most testosterone in a woman is predominantly diagnosed in the ovary. DHEA sulfate is 95% from adrenal

Answer 2

Tests are testosterone lvl (fractionate) and DHEA sulfate. If predominantly testosterone - ovary origin. DHEA up, then adrenal origin (hydroxyls deficiencies, etc.)

Question 3

PCOS

Answer 3

Hypothalamic-pituitary abnormality. FSH suppressed but LH is increased. LH -> hormone synthesis around follicle (theca interna) –> DHEA, androstendione –> testosterone -(across into granulosa cells w/ aromatase)-> estradiol. Good percentage of PCOS has obesity. Aromatase (adipose). Hirsuitism, acne BUT being converted in estrogens -> endometrial hyperplasia/ca risk. Both increased. Estrogens –> suppress FSH but INC LH -> cycle. Tx = birth control pills. Cysts develop b/c FSH suppressed and follicle degenerates.

Question 4

Dysmenorrhea

Answer 4

Painful menses. Primary - too much PGF. Inc. contractions of uterine musculature. Secondary - endometriosis is most common.

Question 5

Dysfunctional uterine bleeding

Answer 5

It’s not bleeding abnormality from anatomical or organic cause. HORMONE imbalance causing an abnormality in bleeding. 1. Anovulatory cycles. 2 and 3 - inadequate luteal phase and irregular shedding of endometrium

Question 6

Anovulatory cycles

Answer 6

Menarche to age 20. Usual cause. Persistent estrogen w/o enough progesterone –> hyperplasia -> sloughs

Question 7

Primary amenorrhea

Answer 7

Hypothalamus or pituitary? Is it ovarian problem? End-organ problem (Anatomical)?

Question 8

Secondary amenorrhea

Answer 8

Asherman (too many D&C’s, scrape to muscle).

Question 9

Turner syndrome

Answer 9

XO. No Barr body. Defects in lymphatics - swelling of hand and feet. 4th metacarpal decreased. Webbed neck 2/2 cystic hygromas (dilated lymphatics in neck). Preductal coarctations. No ID. Sometimes mosaics. Menopause before menarche. All their follicles gone = streak gonad -> dysgerminomas.

Question 10

Adenomyosis vs. endometriosis

Answer 10

Adenomyosis = glands and stroma within the myometrium. Dysmenorrhea, dyspauerenia. No predisposition to cancer. Endometriosis = functioning gland and stroma outside of the uterus. Ovary is common. Bleeding in ovary -> chocolate cysts. Tube, Pouch of Douglas -> hurts when defecates during period.

Question 11

Endometrial hyperplasia

Answer 11

Unopposed estrogen -> risk for endometrial cancer. PCOS. Early menarche. Late menopause. Obesity.

Question 12

45, 55, 65

Answer 12

Cervical, endometrial ca, ovarian ca. Anyone over age 55 with palpable ovarian mass = ca until proven otherwise.

Question 13

Leiomyoma vs leiomyosarcoma

Answer 13

Leiomyoma is NOT precursor for leiomyosarcoma

Question 14

Ovarian masses

Answer 14

Derived from lining of ovary - surface-derived. Germ-cell types (yolk sacs, teratomas). Sex-chord stromal tumors - can make estrogens (granulsoma), sertoli/leydig cell (testosterone). 35 yrs cutoff for malignancy

Question 15

Surface-derived (most common)

Answer 15

Serous cystadenoma - benign. Serous cysadenocarcinoma - malignant, PSAMOMMA bodies (apoptosis -> dystrophic Ca). Most commonly b/l.

Question 16

Cystic teratoma

Answer 16

Most common overall germ-cell tumor. Cartilage, glands, tooth, thyroid.

Question 17

Sex chord stromal tumors

Answer 17

Fibromas most common. MEIG syndrome ( ).

Question 18

Granulosa cell tumor

Answer 18

Low-grade. Normally aromatizes test -> Estrogen producing.

Question 19

Chorionic villus

Answer 19

syncitiotrophoblast (outside - bcg and hpl), cytotrophoblast (middle). Myxomatous stroma. Vessels -> umbilical vein (highest o2 content)

Question 20

Hydaditiform mole

Answer 20

Complete, partial. Complete = 46XX (both from dad). Partial = triploid 69. Complete more malignant (choriocarcinoma - malignancy of trophoblastic tissue. NO chorionic villi -> lungs; responds well to chemo)

Question 21

Breast lesions

Answer 21

Nipple, lactiferous duct, major duct, terminal lobules, stroma.

Question 22

Nipple

Answer 22

Paget’s disase

Question 23

Lactiferous duct

Answer 23

Intraductal papilloma - most common cause of bloody nipple discharge < 50y/o. Benign papillary tumor.

Question 24

Major ducts

Answer 24

Invasive, medullary carcinoma, mucinous

Question 25

Terminal lobules

Answer 25

Lobular carcinoma - BILATERAL!

Question 26

Most common mass in breast < 50

Answer 26

Fibrocystic change. Cysts, fibrosis, sclerosing adenosis.

Question 27

Most common mass in breast > 50

Answer 27

Infiltrative ductal carcinoma.

Question 28

35 movable mass, gets bigger during cycle, painful

Answer 28

Fibroadenoma. Stroma is neoplastic.

Question 29

PAINLESS OVER 50

Answer 29

cancer; outer quadrants are most common b/c most amount of tissue.

Question 30

Stellate appearing, white mass

Answer 30

Invasive cancer. On mammography with spicules.

Question 31

Comedocarcinoma

Answer 31

ERb2 oncogene. Pus stuff.

Question 32

Paget’s disease

Answer 32

Rash on the nipple. Cancer of the duct underneath that has spread into the skin.

Question 33

Inflammatory carcinoma

Answer 33

Dimpled skin b/c LYMPHATICS are plugged w/ tumor. Peau d’ orange.

Question 34

Mod radical mastectomy

Answer 34

Leaving behind pectorals major. Axillary resection. Take away pectoralis minor. WINGED scapular b/c cut LONG thoracic nerve is common complication.

Question 35

Lumpectomy

Answer 35

Removes underlying tumor w/ border. A few nodes of axillary chain. Then radiation.

Question 36

ERA, PRA Assay

Answer 36

Women that are young, USUALLY ER, PR negative (b/c estrogen down regulate receptor synthesis). Postmenopausal often get up-regulation of receptors -> ER, PR +. ER, PR + tumors req. get rid of estrogen effect. Tamoxifen is a weak estrogen (risk of endometrial cancer, prevent osteoporosis)