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ER Week 5 > Gynecologic and Obstetric Pathology STARRED ONLY > Flashcards

Gynecologic and Obstetric Pathology STARRED ONLY Flashcards

1
Q

What is the most common cause of abnormal vaginal bleeding?

A

Dysfunctional uterine bleeding - a disorder of the ovulatory cycle (anovulation)

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2
Q

What are the common causes of this anovulatory bleeding?

A 
IDIOPATHIC is the most common
perimenarchal
perimnopausal
PCOS
sex cord tumors
primary endocine disorders
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3
Q

What is the most common reason for post-menopausal endometrial bleeding?

A

endometrial atrophy

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4
Q

What are other endometrial problems that cause bleeding?

A 
endometrial hyperplasia
endometrial carcinoma
endometrial polyps
submucosal leiomyomas
adenomyosis
endometriosis
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5
Q

Any time you have abnormal bleeding in someone of reproductive age, what’s the first thing to think about?

A

abnormal gestation - early trimester miscarriage, ectopic gestation or mid/late trimester bleeding

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6
Q

Chief pearl: post-menopausal vaginal bleeding needs to be what until proven otherwise?

A

endometrial carcinoma

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7
Q

If you feel an adnexal mass, what is the main NON-NEOPLASTIC source?

A

pelvic inflammatory disease

But also ectopic pregnancy, cysts, or endometriosis

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8
Q

What are the primary ovarian neoplasms?

A
  1. epithelial: serous vs. mucinous
  2. sex cord/stromal
  3. germ cell - dermoid cyst especially
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9
Q

Tumors that are metastatic to the ovary tend to be from where?

A

adjacent gynecological tumors or appendix, colon, breast, stomach

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10
Q

Chief pearl: adnexal mass in a post-menopausal female is what until proven otherwise

A

cancer

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11
Q

What is the most common gestational disorder in the first trimester?

A

early trimester miscarriage

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12
Q

Those were the stars from the overview….now on to the specifics….

A

……..

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13
Q

Almost all of the vulvar infections are due to what?

A

sexually transmitted diseases (except for candida, GBS, etc)

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14
Q

What is the most common cause of post-partum obstetrical infection in the US today?

A

retained placenta

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15
Q

What is the clinical presentation of PID?

A 
lower abdominal pain
endocervical discharge
deep dyspareunia
acute cervical motion tenderness
adnexal tenderness on bimanual exam
fever

but…many cases are subclinical

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16
Q

Can the diagnosis of PID be clinical only?

A

yes - especially in the chronic form - you’r eunlikely to find evidence of the bug on tests

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17
Q

What is the most common cause of vaginal discharge?

A

bacterial vaginosis

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18
Q

How do we diagnose HSV

A

PCR for the HSV DNA

used to do viral culture or Tzanck smear, but PCR is so much better now

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19
Q

What are the two classic vulvar dermatoses?

A

lichen simplex chronicus

lichen sclerosus et atrophicus

both present with white leukoplakia - either thick skin (chronicus) or thin skin (atrophicus)

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20
Q

over 90% of the vulvar malignancies are what kind of carcinoma?

A

squamous (most related to HPV)

the other 10 percent are melanoma, basal cell carcinoma, soft tissue sarcoma, angiomyxoma, and extra-mammary paget’s disease

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21
Q

What are the two types of invasive cervical carcinoma due to HPV?

A

69% squamous carcinoma

25% adenocarcinoma

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22
Q

What does pap smear screening capitalize on?

A

the fact that CIN disease exofliates abnormal dysplastic cells for many years PRIOR to actually becoming invasive cancer

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23
Q

For reproductive women, dysfunctional uterine bleeding is the main consideration for what type of pathology?

A

endometrial pathology

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24
Q

What are hormone issues with anovulation?

A

you have adequate estrgen, but lack of progesterone leading to non-cyclical bleeding

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25
Q

What is a major cause of anovulation bleeding in reproductive age women?

A

PCOS

26
Q

What are a major causes of vaginal bleeding in postmenopausal women?

A

endometrial atrophy or endometrial polyp

but nonetheless….it’s endometrial carcinoma until proven otherwise because you don’t want to miss it

27
Q

Describe the sequence leading to endometrial cancer from chronic estrogen excess?

A
  1. simple glandular enlargment wihtout atypia
  2. complex enlargement without atypia
  3. complex with atypia
  4. carcinoma
28
Q

For most post-menopausal endometrial hyperplasia, where is most of that estrogen coming from?

A

OBESITY

but could also be exogenous or an estrogen-producing tumors (ovarian vs adrenal)

29
Q

How does endometrial carcinoma present?

A

75-90% present with abnormal vaginal bleeding early on in the disease course

30
Q

Type 2 endometrial carcinoma is what kind?

A

serous/clear cell carcinoma

31
Q

What is the precursor for serous/clear cell endometrial carcinoma?

A

endometrial intraepithelial carcinoma

32
Q

Is the serous clear cell endo CA associatd with estrogen and hyperplasia?

A

no - associated with atrophy

33
Q

What is the most common soft tissue tumor in women?

A

leiomyomas

34
Q

What is adenomyosis?

A

when there are endometrial glands and stroma present within myometrium in up to 20% of the uteri (basically endometriosis of the myometrium)

this causes typically poorly circumscribed myometrial wall thickening

this can be associated with menstrual irregularity/dysmenorrhea/dyspareunia na dpelvic pain

35
Q

Uterine leiomyomas are foudn in what percentage of hysterectomy specimens?

A

77%

36
Q

WHat ethic group has the highest rate of leiomyoma?

A

african american

37
Q

What are the main symptoms of leiomyomas?

A

pelvic pressure/pain, urinary frequency, difficult defectaion, abnormal uterine bleeding with dysmenorrhea, impaired fertility, or adverse pregnancy outcomes

38
Q

True or false: uterine fibroids can develop into uterine leiomyosarcoma.

A

false - they arise on their own

39
Q

What percentage of women are affected by PCOS?

A

6-8%

40
Q

What hormones are elevated in PCOS?

A

hyperandrogenism

causation is uncertain

41
Q

What is the most common ovarian neoplasm in young women?

A

teratoma - dermoid cyst

42
Q

What are the two main types of epithelial ovarian tumors?

A

serous
mucinonus

can be benign (adenoma) or malignant (carcinoma) or borderline

43
Q

Which one is often bilateral?

A

serous (mucinous is typically unilateral)

44
Q

What is the most common germ cell ovarian tumor?

A

dermoid cyst

45
Q

What is the most common tissue seen in dermoid cysts?

A

skin and hair

but also fat, brain, retina, bronchus, instestein, teeth, bone, cartilage, thyroid, etc.

46
Q

99% of dermoid cysts are benign in women, but 1% are focally malignant with what type of cancer?

A

usually squamous CA

47
Q

Dermoid cysts are usually asymptomatic, but why would they present acutely?

A
  1. torsion/infarction

2. rupture with chemical peritonitis

48
Q

What is the most common source for a metastasis to the ovary?

A

colorectum

49
Q

What is the most common pregnancy pathology?

A

first trimester miscarriage - in about 10-20% of diagnosed pregnancies

50
Q

What are the two general categories of early miscarriage?

A

threatened vs inevitable
complete vs incomplete
missed vs recurrent

51
Q

What are the major risk factors for early trimester miscarriage?

A
  1. PCOS
  2. Chromosome abnormalities
  3. structural uterine anomalies
  4. cervical incompetence
  5. systemic maternal disease like diabetes or thyroid disorders
52
Q

What is the most common cause of post-partum hemorrhage?

A

uterine atony - 80%

other issues are retained placenta, drug effects, infection, coagulation defects

53
Q

What are the two general types of placental/maternal infections?

A

ascending infections

hematogenous infections

54
Q

Ascending infection from the vagina or cervix usually causes what?

A

chorioamnionitis

55
Q

What does chorioamnionitis increase the risk for?

A

premature membrane rupture
preterm delivery
fetal sepsis
endomyometritis

56
Q

Almost all of these infections are caused by what?

A

bacteria -polymicrobial with strep, e coli, ureaplasma, fusobacterium, anaerobes

57
Q

What are the bugs that can cross the placenta as a hematogenos infection?

A

malaria, syphilis, HIV, toxo, TB, rubella, listeriosis, hep B, hep C, CMV

58
Q

What are the bugs we really worry about for the baby crossing through the birth canal?

A

HSV if ulceration
group B strep
chlamydia
gonococcus

59
Q

Why do we worry about group B strep?

A

it’s the most common cause of life-threatening bacterial sepsis in newborns

60
Q

What are the three possible entities when the placenta basically comes a tumor?

A
  1. hydatidiform mole
  2. choriocarcinoma
  3. placental site trophoblastic tumor
61
Q

What is the most accurate tumor marker for these hydatidiform moles or choriocarcinoma?

A

increased serum hCG

ER Week 5 (6 decks)

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