Lecture 1 - Into to Gyn

Question 1

HPV:
What 2 serotypes are low risk? What STI does it cause?
What are the 4 high risk serotypes? high risk for what?

Answer 1

6,11; condyloma acuminata;

16, 18, 31, 33; cancer

Question 2

HPV vaccine:
what 4 serotypes are included?
what kind of vaccine is this?

Answer 2

6, 11, 16, 18;

subunit

Question 3

condyloma accuminata: described as “_____-like” lesions;

on histology, there is _____ hyperplasia, ____keratosis, and most importantly _____

Answer 3

cauliflower-like;

epidermal, hyper;
koilocytosis

Question 4

where do you take a pap smear from? can stain with _____ to cause lesions to appear white

Answer 4

transformation zone of cervix (squamocolumnar junction);

aceto-acid

Question 5

treatment of HPV or CIN = _____ ( an immune modulator), _____ ( a mitotic poison), chloracetic acid

Answer 5

imiquimod;
podophyllotoxin

also cryotherapy, CO2 laser, excision

Question 6

what does CIN usually present as?

Answer 6

abnormal vaginal bleeding (often post-coital)

Question 7

endometriosis:
non-neoplastic or neoplastic?
proliferation of endometrial like _____/____ outside endometrial cavity

Answer 7

non-neoplastic;

glands, stroma

Question 8

3 possible ways of dissemination of endometrial tissue:
_____ menstruation;
______ transformation of multipotent stem cells;
transportation of endometrial tissue via ____ or ____

Answer 8

retrograde;
metaplastic;
lymph, vascular

Question 9

3 common sites of endometriosis

Answer 9

ovary (Most common), pelvis, peritoneum

Question 10

endometriosis:

causes blood filled “_____ _____” in ovary; can cause PID or ectopic pregnancy if it is located in the _____

Answer 10

chocolate cysts;

fallopian tube

Question 11

endometriosis:

can cause _____ pelvic pain, bleeding, _____ (pain with defecation), _____ if near the bladder

Answer 11

cyclic;
dyschezia;
dysuria

also infertility, dysmenorrhea, dyspareunia

Question 12

endometriosis:

causes brown, hemorrhagic yellow “____ ____” nodules. abdominal pain and _____ in the peritoneum

Answer 12

gun powder;

adhesions

Question 13

gardenerella/bacterial vaginosis:
inflammation?
thin, white discharge with \_\_\_\_ odor. 
\_\_\_ cells;
ph = 
\+ \_\_\_\_ test

Answer 13

no;
fishy;
clue;
elevated ( greater than 4.5 );
whiff

Question 14

trichomonas:
inflammation?
frothy, \_\_\_\_\_ (color), foul smelling discharge;
see \_\_\_\_ \_\_\_\_ on wet mount;
ph =

Answer 14

yes (Strawberry cervix);
yellow-green;
motile trichomonads;
greater than 4.5

Question 15

candida:
inflammation?
thick, white "\_\_\_\_ \_\_\_\_" discharge;
\_\_\_\_\_ with KOH;
pH =

Answer 15

yes;
cottage cheese;
pseudohyphae;
normal (4-4.5)

Question 16

what 2 bacterial infections are most associated with Pellvic inflammatory disease (PID)

Answer 16

chlamydia, neisseria

Question 17

PID:

due to ____ infection from lower genital tract due to _____ levels of lactobacilli

Answer 17

ascending;

decreased

Question 18

PID:
what is the chandelier sign?
____ ____ discharge

Answer 18

cervical motion tenderness;

purulent cervical

Question 19

PID:
pain occurs shortly ____ menses;
increased risk of _____ pregnancy, infertility, chronic pain, adhesions of peritoneum to the liver (_______ syndrome)

Answer 19

after;
ectopic;
fitz-hugh-curtis syndrome

also salpingitis, endometritis, hydrosalpinx, abscesses

Question 20

ectopic pregnancy:
most often occurs where?
often clinically mistaken for ______

Answer 20

ampulla of fallopian tube;

appendicitis

Question 21

ectopic:

____ than expected rise in HCG, __menorrhea

Answer 21

lower;

amenorrhea

Question 22

what chemo drug can be used to treat ectopic pregnancy? (if diagnosed early/no pain)

Answer 22

methotrexate

Question 23

2 highest risk factors for ectopic pregnancy?

Answer 23

prior ectopic pregnancy, previous tubal surgery

also PID, infertility, ruptured appendix, IUD use

Question 24

leiomyoma/fibroids:
usually multiple or single?
described as "\_\_\_\_\_ (color), \_\_\_\_\_ tumors"
higher risk in what ethnicity?
sensitive to \_\_\_\_\_

Answer 24

multiple white whorled tumors;
african americans
estrogen

Question 25

leiomyoma:
tumor size ____ with pregnancy, ____ with menopause;
smoking and OCP’s _____ risk
most common presentation?

Answer 25

increases, decreases;
decreases;
asymptomatic (According to pathoma)

Question 26

leiomyoma:

presents as abnormal _____ bleeding, which if severe can cause _____ anemia

Answer 26

uterine;
iron-deficiency

also pelvic pain, miscarriage,

Question 27

fibroids:

interfere with _____ and ____ growth but not ovulation.

Answer 27

implantation, placental growth

Question 28

various menses definitions:
____ = pain with menses;
oligomenorrhea = bleeding ___ than 35 day cycle;
polymenorrhea = bleeding ____ than 21 day cycle

Answer 28

dysmenorrhea;
greater;
less

Question 29

menses definitions:
____ = heavy, irregular menstruation;
_____ = heavy menstrual bleeding with greater than 80 mL blood loss or more than ___ days of menses

Answer 29

menometorrhagia;

menorrhagia, 7 days

Question 30

Polycystic ovarian syndrome (PCOS)
increased _____ ratio; increased _____ from theca interna cells–> decreased rate of follicular maturation causing unruptured _____ and ___ovulation

Answer 30

LH:FSH;
androgens;
follicles (Cysts), anovulation

Question 31

PCOS:
\_\_\_\_\_ dysfunction (endocrine thing) is thought to alter hypothalamic hormonal feedback. associated with \_\_\_\_ (metabolic). increased androgens causes \_\_\_\_\_ and \_\_\_\_\_

Answer 31

insulin (ie resistance);
obesity;
acne, hirsuitism, fertility probs

Question 32

PCOS:
increased risk of _____ cancer due to unopposed ____
associated with ______ (endocrine disorder)

Answer 32

endometrial, estrogen;

Type II DM

Question 33

PCOS treatment:
\_\_\_\_ \_\_\_\_ (Decreases peripheral estrone formation);
\_\_\_\_\_\_ (prevent endometrial hyperplasia due to estrogen);

Answer 33

weight loss;

OCPs

Question 34

lichen sclerosis:
_____ of epidermis and dermal _____;
seen in ______ women;
“_____ like” vulvar skin

Answer 34

atrophy, fibrosis;
post-menopausal;
parchment;

abnormal bleeding in post-menopausal women

Question 35

_____ is extension of endometrial tissue into the uterine myometrium. causes pain and _____ during reproductive years

Answer 35

adenomyosis;

menorrhagia

Question 36

endometrial polyps can be a side effect of ____

Answer 36

tamoxifen