Ob/Gyn Flashcards
What are the 6 diagnostic tests in suspected ovarian cancer workup?
Baseline serum CA-125 CT abd/pelvis for staging CXR Mammogram Pap smear Colonoscopy
What are 2 major risk factors for ovarian cancer?
Family history
Increased ovulatory cycles (infertility, nulliparity, >50)
What is the most common treatment course for ovarian cancer?
Surgical debulking then chemotherapy
What is the most common type of ovarian cancer
Epithelial ovarian cancer
Af what stage are most ovarian cancers diagnosed?
Stage III
Virilization, hirsutism, acne, short stature, late onset menses – diagnosis?
Congenital adrenal hyperplasia due to 21 hydroxylase deficiency (inc levels of progesterone and 17 hydroxyprogesterone and testosterone but no cortisol or aldosterone)
How is the diagnosis of CAH due to 21 hydroxylase deficiency diagnosed?
ACTH challenge leading to increased levels of 17 hydroxyprogesterone
Inflammatory eczematous lesions of nipple and areola
Paget Disease of breast
If a patient presents with crusty, eczematous lesions on the breast, what MUST be performed and why?
Full thickness punch biopsy since paget disease of breast is highly associated with in site or invasive ductal carcinoma
Benign growths in milk ducts that cause nipple discharge
Intraductal papillomas
Lumpy breasts with midcycle tenderness
Fibrocystic changes of the breast
Benign but large, bulky breast tumor with cystic spaces, leaflike projections and myxoid contents
Phyllodes tumor
Diagnosis of paget disease of breast
Full thickness punch biopsy and mammogram
Treatment of paget disease of breast
Surgical excision and radiation
What is androgen insensitivity syndrome
X-linked recessive disorder where XY males have unresponsiveness of testosterone receptor to testosterone and DHT so they develop female external genitalia ad have male internal genitalia
Normal-appearing female with male genotype
Androgen insensitivity syndrome
How would a patient with androgen insensitivity syndrome present?
Amenorrhea, lack of axillary or pubic hair, cryptorchid testes, blind vaginal pouch
What is the mechanism of 5-alpha reductase deficiency?
XY males can’t convert testosterone to DHT so they have ambiguous external genitalia until puberty when they eventually become masculinized
What causes ovaries but ambiguous or masculine external genitalia in 46XX?
Exposure to androgen steroids during pregnancy
What causes testes but ambiguous or feminine external genitalia in 46XY?
Androgen insensitivity syndrome
What are the estrogen, LH ad FSH levels in menopause?
Estrogen = low LH = high FSH = high
What is the pathophysiology behind menopause?
Loss of ovarian follicles and ovary dysfunction leading to loss of response to GnRH ad therefore cessation of estrogen production
What are the symptoms of menopause?
HAVOCS = hot flashes, atrophy of vagina, osteoporosis, CAD, sleep disturbances
How does HPV lead to cervical cancer?
E6 and E7 proteins downregulate p53 and Rb tumor suppressors so G1 to S progression continues and leads to replication of damaged cells
What is the primary lesion of HPV and what do they look like?
Papules forming condylomata acuminata that are irregular, pinkish white raised cauliflower-appearing clusters
Papules that are irregular, pinkish white raised cauliflower-appearing clusters, pruritic and non-painful
HPV
How are HPV warts diagnosed?
Clinically and biopsy for confirmation
What is the treatment for HPV lesions?
- Cryotherapy, laser or excision
2. Topical agents – podophyllotoxin, imiquimod, trichloroacetic acid
Which HPV serotypes are associated with warts? Cancer?
Warts – 6, 11
Cancer – 16, 18, 31
What type of vaccine is the HPV vaccine?
Subunit
What are 4 risk factors for cervical cancer?
Early sexual activity
Multiple partners
Smoking
Low SES
What are 7 risk factors for endometrial cancer?
Late menopause Estrogen therapy Nulliparity Decreased fertility Diabetes Tamoxifen Obesity
Which cancers does nulliparity increase your risk for?
Breast
Endometrial
What are 6 risk factors for breast cancer?
Nulliparity Female gender Early first menarche (<12) Delayed first pregnancy (>30) Late menopause (>50) Family history
