Lecture 8.1 highlights Flashcards
* = also MJ slide
Vulvitis:
1) Reactive _____________ in response to exogenous stimulus.
2) List 5 sexually transmitted infections that can cause it.
3) What is 1 complication?
1) inflammation
2) HPV, HSV, N. gonorrhea, chlamydia, Treponema pallidum
3) Bartholin’s cyst
1) What condition is characterized by epithelial thickening and pruritis?
2) What condition involves Thinning and hardening of the epidermis?
1) Lichen Simplex Chronicus
2) Lichen Sclerosis
Carcinoma of the Vulva: What are the 2 main categories? Which is more common?
1) HPV-related
2) Non-HPV related: more common
Carcinoma of the Vulva:
What are the 2 categories of causes? Give an example of one of them and list its risk factors
1) HPV related (least common)
2) Non-HPV related: dVIN : differentiated vulvar intraepithelial neoplasia
-Age (older) & H/o reactive epithelial changes (lichen sclerosis)
Paget’s Disease of the Vulva: What are the 2 different locations of each? What are the risks?
1) Extramammary: vulva; usually no association w/ carcinoma
2) Breast: almost always associated w/ underlying carcinoma
Vaginitis:
1) Is characterized by _______________-.
2) Often caused by _________________.
3) Can also be caused by _____________; when this is the cause, ____________ will be visible on microscopy.
1) Discharge (leukorrhea)
2) Candida albicans
3) Trichomonas vaginalis; Flagellated protozoa
Malignant Neoplasms of the Vagina:
1) Which kind is described as a Vaginal epithelial neoplasia? [hint: almost always HPV-assoc.]
2) Which is rare and usually secondary to to diethylstilbestrol (DES)?
3) Who are Sarcoma Botryoides usually found in?
1) SCC
2) Clear Cell Adenocarcinoma
3) Children <5
Premenarchal:
1) What is the most common cause of vaginal bleeding?
2) What are 2 other causes?
1) FB (foreign body)
2) -Sexual Abuse
-Precocious puberty (usually last stage of menarche)
Reproductive stage of life:
1) What is the most common cause of vaginal bleeding?
2) What is another cause?
1) Pregnancy
- 1st trimester bleed
-2ND and 3rd trimester bleed
2) Abnormal uterine bleeding (PALM COEIN)
Post menopausal: MC cause of vaginal bleeding?
Vaginal atrophy + intercourse
(make sure to prove it’s not endometrial cancer/hyperplasia tho)
Average ages of menarche and menopause?
11; 51
1) List potential causes of premenarchal bleeding
2) List 2 potential causes of reproductive stage bleeding
3) List 2 potential causes of postmenopausal bleeding
1) FB, sexual Abuse, precocious puberty (usually last stage of menarche)
2) Pregnancy (MC)
Abnormal uterine bleeding (PALM COEIN)
3) Vaginal atrophy + intercourse
-Endometrial cancer/ hyperplasia
Explain the PALM COIEN mnemonic
Polyp: endometrial polyp
Adenomyosis: endometrial glands present in uterine musculature
Leiomyoma: “fibroid” noncancerous neoplasm
Malignancy: reproductive cancer
Coagulopathy: PT/INR, CBC
Ovulation dysfxn: FSH:LH imbalance
Idiopathic: ask about IUD
Endometrial (other): dx of exclusion
NOS
Vaginal atrophy?
1) Vaginal atrophy is associated with what 2 main things?
2) What 2 things are often pale and reduced in size?
3) What may be narrowed?
4) What happens to the vaginal walls?
1) Pale, dry, shiny vulvar tissue + loss of adipose tissue.
2) Prepuce and clitoris.
3) Introitus may narrowed .
4) Lack rugae and may be pale and/ or erythematous.
2nd / 3rd Trimester Vaginal Bleeding: What are 3 causes? Specify if each is painful
1) Abruption: painful
2) Previa: painless
3) Uterine rupture: painful
True or false: there can be cases of abruption with no vaginal bleeding when placenta remains attached with hematoma forming behind it
True
List the 5 infections (all of which are often STD) that can cause cervicitis
1+2) Chlamydia & Neisseria gonorrhea
3) Trichomonas Vaginalis
4) HSV 2*
5) Certain HPV
*Cervical Neoplasia:
1) What is causative?
2) What are the high risk types of this?
1) HPV
2) 16, 18, 31, 33
What precedes cancer by years to decades?
SIL (Squamous intraepithelial lesion)
Endometritis:
1) What are the most common causes of pelvic inflammatory disease?
2) What occurs during PID?
3) What are some other causes of endometritis?
1) Most common: N. gonorrhea or C. trich
2) Neutrophilic infiltrate in the superficial endometrium
3) Retained products of conception
Foreign body (IUD)
Ascending infection of GI tract flora
1) Growth of endometrium into the myometrium is called what?
2) Endometrial glands and stroma located outside of the uterus are called what?
1) Adenomyosis
2) Endometriosis
Nonneoplastic Disorders of the Endometrium: What are 2 of these?
Adenomyosis and endometriosis
1) What is adenomyosis the growth of?
2) What is endometriosis?
1) Endometrium into the myometrium
2) Endometrial glands and stroma located outside of the uterus
True or false: Tissue is both displaced and abnormal in endometriosis
True
What is the Regurgitation Theory of endometriosis? (most favored)
Menstrual backflow through fallopian tubes leads to implantation
*Proliferative lesions: List 2 types
1) Endometrial Hyperplasia
2) Endometrial carcinoma
*What results from unopposed endogenous or exogenous estrogen?
Endometrial hyperplasia
*What type of carcinoma can cause post menopausal bleeding?
Endometrial carcinoma
All causes of Endometrial Hyperplasia equate to ___________ exposure
estrogen
*Endometrial Carcinoma: What are the 2 major types? Give the major points of each
1) Endometrioid carcinoma: estrogen excess
2) Serous carcinoma: TP53
-common Sx: most menopausal bleeding
Salpingitis:
1) What does it almost always result from?
2) What are the S/Sx?
3) What may it lead to increased risk of?
1) Infections resulting from PID (like G and C)
2) Fever, lower abdominal/pelvic pain, masses, distended tubes
3) Tubal ectopic or sterility
Describe the pathophys of PCOS in 5 steps
1) GnRH released rapidly and daily instead of cyclically
2) LH goes up and FSH goes down
3) Ovary makes more testosterone
4) Hirsutism and acne
5) Inhibited ovulation
What does the genetic mechanism of PCOS appear to act upon in recent studies? Explain
Body’s insulin receptors
-phosphorylation > insulin resistance develops
Ovarian tumors: Most common malignant type (90%) is what? What age group is it more common in?
Epithelium; >40
Placenta stops growing at week ~_____
26
What are 2 things that decrease SVR in pregnancy?
1) Progesterone
2) Placental growth
Cardiovascular: Increase in Volume in pregnancy
1) What system further compensates for falling SVR?
2) When does it match the pace of falling SVR?
1) RAAS
2) After week 26
What is most directly related to stroke volume?
Preload
*Does increased blood volume have symptoms?
Yes
(more fluid leads to daytime pedal edema and nocturia)
1) How much does the blood pressure change in pregnancy?
2) Why do we care?
1) Diastolic BP decreases beginning week 7 and reaches maximal decline of about 10mmHg by about week 26.
2) Bc we may misdiagnose hypotension.
How much does HR increase in pregnancy?
By about 10-20 BPM over baseline
*True or false: Mild anemia is common in pregnancy
True
If anemia is normal in pregnancy, how low is too low?
Shouldn’t fall below 10.5
Hypercoagubility:
*1) Estrogen regulates gene transcription in the liver, telling it to make more of which clotting factors and fewer what?
2) What does estrogen regulate? What does this tell them to do?
1) Factors 2, 7, 9, 10 and fewer protein C and S
2) Gene transcription in epithelial cells, telling them to make more fibrinogen!
*1) What happens to creatinine in pregnancy?
2) What type of infection are pregnant pts more at risk for?
1) Decreased creatinine
2) UTI
*List 3 GI changes that can occur in pregnancy
1) Constipation
2) GERD
3) Gallbladder disease
*List 3 skin changes that can occur in pregnancy
1) Hyperpigmentation
2) Palmar erythema
3) Spider angiomata
Weight gain in pregnancy should be due to what 4 things?
Amniotic fluid, placenta, fetus, maternal adipose stores
*What are the 2 types of molar pregnancy?
1) Incomplete (partial) mole
2) Complete mole
List 2 old teratogenic drugs
1) Thaliomide
2) Diethylstilbestrol
Diethylstilbestrol led to the children of mothers who took it getting what?
Clear cell carcinoma
1) What is an issue associated with Warfarin?
2) Give 3 examples
1) Unsafe in pregnancy
2) Brachydactyly; shortening of lower extremities; dots on growth plate (stippled epiphyses)
List epileptic medications that are unsafe in pregnancy
1) Valproate
2) Phenytoin
3) Phenobarbital
4) Topiramate
5) Carbamazepine (not always stopped though)
6) Levetiracetam and Lamotrigine (must be monitored)
1) What can ACE/ARB (for HTN) cause?
2) List 3 antibiotics that cannot be used in pregnancy
3) What acne med can cause teratomas?
1) Teratomas
2) Bactrim, Fluoroquinolone, Tetracycline
3) Isotretinoin
During implantation, the trophoblast gives off the cytotrophoblast, which further gives off ________________ which “eats” its way into endometrium
synctiotrophoblast
1) Define gestational HTN numerically
2) Define preeclampsia without
3) Preeclampsia: what is the ratio if positive?
1) 140/90 after wk 20
2) 140/90 after week 20 + proteinuria
3) Protein to creatinine ratio: positive if > 0.3
More than 300 mg protein on 24-hour collection
How is preeclampsia with diagnosed?
Sustained readings of 160/110 + any one:
1) Platelets < 100
2) AST or ALT 2x UNL
3) RUQ or epigastric pain
4) Cr > 1.1 or 2x baseline
5) Pulmonary edema
6) HA or vision changes
1) HELLP = Preeclampsia + what?
2) What is eclampsia?
1) Elevated Liver Enzymes AND Low Platelets
2) Preeclampsia + Seizure
Alloimmunization: Fertilization between Rh-negative ______ and an Rh-positive __________
female; male
In order for Mom’s immune system to become primed against Rhesus antigen, she must be ___________
exposed
1) Alloimmunization can lead to what?
2) When do you give rhogam?
3) When does rhogam do its job?
1) Fetal anemia
2) If Dad is Rh positive or unknown
3) Before mom’s immune system ever recognizes the antigen cells
*Define TORCH
Toxoplasmosis
“Other”
Syphilis
Rubella
CMV
HSV
1) What are the most infectious stages of syphilis?
2) When would a fetus get it?
1) Primary and Secondary stages
2) Through placenta after 16 weeks
Which condition has less of a TORCH presentation, because it’s usually contracted at delivery?
Herpes simplex virus (HSV)
Varicella: Is mom vaccinated or unvaccinated?
Mom is unvaccinated with no history of infxn
What are the two main types of diabetes? (we are not talking abt diabetes insipidus here)
1) Diabetes Meletus
2) Gestational diabetes
How is pregestational diabetes diagnosed?
HgbA1C obtained before conception that shows elevation
*125
Post-prandial: Postprandial hyperglycemia and insulinemia
Pre-prandial: Pre-prandial hypoglycemia
126
*Macrosomia is a potential complication of what?
Hyperglycemia in pregnancy
[Macrosomia = big baby]
128
All diabetes in pregnancy:
Last 20 weeks
Increases risk of eclampsia spectrum, placental abruption, pre-term delivery
Cardiac defects
129
Treat with glucagon to oppose insulin and dextrose to support baby while insulin levels are high
Ectopic pregnancy
132
1) Chronic salpingitis with scarring is a major risk factor for tubal ectopic pregnancy.
2) Emergency: Rupture of an ectopic pregnancy may result in exsanguination and death.
Breast cancer is most commonly detected by screening or by ____________ of a mass in younger women and in unscreened older women
palpation
1) What is the most common benign neoplasm of the breast?
2) What does it present as?
3) Does it change?
1) Fibroadenoma of the Breast
2) Solitary, discrete, movable masses
3) May enlarge late in menstrual cycle and during pregnancy
The lifetime risk of developingbreastcancer for an American woman is 1 in ____
1 in 8
*True or false: only small percentage of breast cancer is inherited.
True
*About 12% of allbreastcancers are caused by identified germline mutations;___________ and _____________ genes account for one-half of the cases associated with single-gene mutations
BRCA1andBRCA2
139*
Estrogen receptor (ER)
Progesterone receptor (PR)
Human epidermal growth factor receptor 2 (HER 2)
141
What happens to each of the following cardiovascular factors in pregnancy?
1) Systemic vascular resistance
2) HR
3) Blood volume and preload
1) Goes DOWN
2) Goes UP (a little)
3) Blood volume goes UP, so Preload goes UP
What happens to each of the following cardiovascular factors in pregnancy?
1) Stroke volume
2) Cardiac output
3) BP
1) Goes UP
2) Gradually goes UP
3) Falls to 26 weeks, then it gradually (and nearly) returns to baseline
