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REPRO Flashcards

1
Q

Epispadias

Def’n, Cause (Embryo), Comp?

A

Abnormal opening of penile urethra on SUP / DORSAL side.

CAUSE = Faulty positioning of genital tubercle.

COMP:
- Exstrophy of Bladder

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2
Q

Hypospadias

Def’n, Cause (Embryo), Comp?

A

Abnormal opening of penile urethra on INF / VENTRAL side.

CAUSE = Failure of urogenital folds to close.

COMP:
- UTIs (Must fix hypospadias to prevent UTIs)

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3
Q

NO Sertoli Cells or LACK of Anti-Mullerian hormone / Mullerian IF
(Male)

  • Devel of Internal Genitalia = ?
  • Devel of External Genitalia = ?
A
  • Internal genitalia = Male + Female

- External genitalia = Male (unaffected)

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5
Q

Klinefelter Sx

Def’n, Mech, RF, Assoc (2), Pres (5), Labs (4), RX?

A

47 XXY Male = Male with extra X chr / barr body = 1ry Hypogonadism.

MECH = MATERNAL Meiotic ND.

RF = ↑maternal age.

ASSOC:

  • Autoimmune disorders (eg RA, SLE, Sjorgens)
  • Testicular GC tumors

PRES: “Hypogonadism, UNILAT Gynecomastia + MR”

  • Hypogonadism / Testicular atrophy ->
  • Infertility
  • UNILAT Gynecomastia
  • Female hair distribution
  • Devel delay (possible)

LABS:

  • FSH↑(due to dysgenesis of seminiferous tubules ->↓Inhibin)
  • LH↑(due to↓Testosterone)
  • Testosterone↓
  • Estrogen↑

RX:
- Testosterone therapy

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5
Q

Turner’s Sx

Def’n, Mech, Pres (7), Labs (3)?

A

45 XO Female = Primary Hypogonadism.

MECH = Monosomy (Partial or Complete).

PRES: “Newborn female with cystic mass (hygroma) in neck + edema,
triangular face + coarctation of aorta.”

** Either 1ry ovarian failure / amenorrhea OR
Premature menopause with streak ovary **

  • Ovarian dysgenesis / “streak ovary” ->
  • Infertility
  • Infantile genitalia with little pubic hair
  • Short stature
  • Cystic Hygroma (“webbing” of neck)
  • Lymphedema in hands + feet
  • Horseshoe kidney

LABS:

  • FSH↑(High FSH : LH ratio due to↓Estrogen)
  • LH↑
  • Estrogen ↓
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7
Q
  • Hypogonadism
  • Short + Obese
  • MR

Mech?

A

Prader-Willi Sx

MECH = Microdeletion.

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8
Q

Androgen Insensitivity Sx / Testicular Feminization

** Genotypic Male (46 XY) ; Phenotypic Female **

Def’n, Pres (5), Labs (3)?

A

Deficiency of Androgen receptors ->
Normal-appearing phenotypic female, however genotypic male.

PRES:

  • Rudimentary Vagina: ends as blind pouch
  • Uterus + Uterine tubes generally absent (MIF present)
  • Testes present: commonly found in ab cavity or inguinal canal
  • Female external genitalia (due to no DHT effect)
  • No sexual hair

LABS:

  • LH ↑
  • Testosterone + DHT: Normal Male levels or↑
  • Estrogen↑(unopposed)
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9
Q

5a-reductase Deficiency (Male)

Def’n, Internal / External Genitalia, Inher, Labs (3)?

A

Inability to convert Testosterone -> DHT.

Internal genitalia = Male (unaffected)
External genitalia = AMBIGUOUS until puberty
(when↑Testosterone stims their devel)

AR.

LABS:

  • LH normal or↑
  • Testosterone normal
  • Estrogen normal
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10
Q

Kallman Sx

Def’n, Inher, Pres (2 “categories”), Labs (4)?

A

Absent GnRH.↓synthesis of GnRH in hypothalamus.
(Undeveloped olfactory bulbs + GnRH-producing cells)

AD.

PRES:

  • Hypogonadism, lack of secondary sexual chars + delayed puberty
  • Color Blindness + Anosmia

LABS:

  • GnRH↓
  • FSH + LH ↓
  • Testosterone ↓
  • Sperm count ↓
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12
Q

Hydatidiform Mole

Def’n, Mech (2), Pres (Trimester + General + 1 + 2 CLUES),
DX, Comp (2), RX (2), Mgmt?

A

ABNORMAL FERTILIZATION of ovum.

MECH:

  • ‘Cystic swelling’ of villi: swollen / edematous / hydropic villi
  • Abnormal prolif of trophoblasts / chorionic epithelium around villi

PRES: MC in 2nd trimester.

  • Uterus expands as if normal pregnancy is present, however uterus much larger and b-HCG much higher than expected for gestation date*.
  • Abnormal vaginal bleeding
  • “Honeycombed uterus”
  • “Cluster of grapes” masses passing thr vaginal canal

DX: Fetal U/S in 1st trimester

COMP:

  • Uterine rupture
  • Choriocarcinoma (MC precursor of)

RX:

  • D and C
  • Methotrexate

MGMT:

  • Monitoring of b-HCG -> Ensure adequate mole removal
    - > Screen for Choriocarcinoma
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13
Q

Clear Cell Adenocarcinoma of Vagina

Causes?

A

CAUSES:

* - DES exposure in utero

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14
Q

Pregnancy

Systemic Conditions at↑Risk For (2)?

A
  • Pyelonephritis

- Pyogenic granuloma (hemangioma = vasc tumor)

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14
Q

Abruptio Placentae

Def’n, RF (4), Pres (CLUE)?

A

SEPARATION of placenta from decidua / implantation site
prior to delivery.
** ABRUPT detachment -> stillbirth / fetal death **

RF:

  • DIC
  • Htn
  • Smoking
  • Cocaine use

PRES:
- “Painful bleeding in 3rd trimester”

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15
Q

Placenta Accreta

THINK: Accreta = “encased in”
(Placenta encased in myometrium)

Def’n (3 steps), RF (3), Pres (CLUE), Mgmt?

A

DEFECTIVE / LITTLE OR NO DECIDUA ->
Improper implantation of placenta into myometrium ->
NO SEPARATION of placenta after birth.

RF:

  • Placenta Previa
  • Infl
  • Prior C-Section

PRES:
- “Massive bleeding after delivery”

MGMT:
- Hysterectomy often required

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16
Q

Placenta Previa

Def’n, RF (2), Pres (CLUE), Comp, Mgmt?

A

Attachment of placenta to lower uterine segment.
* May occlude os (cervical opening) *

RF:

  • Multiparity
  • Prior C-Section

PRES:
- “Painless bleeding in any trimester (esp 3rd trimester)”

COMP:
- Placenta Accreta

MGMT:
- C-Section delivery often required

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17
Q

CIN + Cervical Carcinoma In Situ

CB + Subtypes, Def’n, Classification, Mech (2), RF (4), Prog?

A

HPV (DNA virus that infects lower genital tract,
esp cervix in transformation zone).
- High-Risk HPV types: 16, 18, 31, 33
- Low-Risk HPV types: 6, 11

Cervical dysplasia (disordered epithelial growth) that begins at
basal layer of squamo-columnar junction (transformation zone) and
extends outwards.

Classified as CIN I, II or III depending on extent of dysplasia.

MECH:

  • HPV 16 -> produces E6 protein -> destruction of p53
  • HPV 18 -> produces E7 protein -> destruction of Rb

RF:

  • Immunodeficiency / HIV
  • Early sexual intercourse
  • Multiple sexual partners
  • Smoking

PROG:

  • Infection usually eradicated by acute infl *
  • Persistent infection -> CIN -> Carcinoma
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18
Q

Invasive Cervical Carcinoma In Situ

Def’n + Classifications (2 possible), Pres (Epi + 2), Comp, Prev?

A

Carcinoma that arises from cervical epithelium.
MC SCC, however Adenocarcinoma in 15% of cases.

PRES: MC in 40-50

  • Cervical discharge
  • Vaginal bleeding, esp post-coital

COMP:

  • Lateral invasion (to bladder) can block Ureters -> Renal Failure.
    • Common cause of death in advanced cases *

PREV:
- Pap Smear (detection of koilocytes / cervical dysplasia)

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19
Q

Endometritis

Def’n, Mech (2 steps), Causes / Assoc (2), Pres (5), RX (3)?

A

Infl of endometrium.

MECH:
RETAINED MATERIAL in uterus ->
INFECTION by bacterial flora from vagina or intestinal tract.

CAUSES / ASSOC:
- Retained products of conception following delivery
(vaginal / c-section / miscarriage / abortion)
- Foreign body (ie IUD)

PRES:

  • Fever
  • Ab pain
  • Uterine tenderness
  • Menstrual abnormalities
  • Infertility

RX:

  • Ampicillin-Sulfabactam
  • Cefoxitin
  • Ticarcillin-Clavulanate
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20
Q

Acute Endometritis

Def’n, Pres?

A

(only including additional info to general endometritis)
BACTERIAL INFECTION of endometrium.

PRES:
- Abnormal uterine bleeding

21
Q

Chronic Endometritis

Def’n, Causes / Assoc (2), Blood (2), DX?

A

(only including additional info to general endometritis)
Chronic infl of endometrium.

CAUSES / ASSOC:

  • Chronic PID
  • TB

HISTO:

  • Lymphocytes
  • Plasma cells

DX:
- Plasma cells (because lymphocytes normally found in endometrium)

22
Q

Maternal Diabetes

Comp (Fetal)?

A

COMP (Fetal):

- D-Transposition of Great Vessels

23
Q

Asherman Sx

Def’n, Causes (CLUE)?

A

Amenorrhea (2ry amenorrhea) due to loss of basalis + scarring.

CAUSES:
- “Over-aggressive D and C”

24
Q

Endometrial Hyperplasia

Def’n, Causes (5: 3 ovarian + 2), Pres, Comp, Dx?

A

Hyperplasia / abnormal proliferation of endometrial GLANDS relative to stroma.

CAUSES: ↑Estrogen exposure (ie↑w pregnancy +↓w menopause)

  • Anovulatory cycles
  • PCOS
  • Granulosa cell tumor
  • Obesity
  • Estrogen replacement

PRES:
- Post-menopausal vaginal bleeding

COMP:
-↑risk for endometrial carcinoma

DX:

  • Presence / absence of cellular atypia
    • Most important predictor for progression to carcinoma *
25
Q

Endometrial Polyps

Def’n, Causes, Pres?

A

Hyperplastic PROTRUSIONS of endometrium.

CAUSES: ↑Estrogen exposure
- Tamoxifen (weak pro-estrogen effects on endometrium)

PRES:
- Abnormal uterine bleeding

26
Q

Peripartum Cardiomyopathy

Timing?

A

Seen during LATE pregnancy / soon after birth.

27
Q

Pregnancy-Induced Htn: Preeclampsia + Eclampsia

Def’n (preeclampsia + eclampsia),
Mech, RF (4), Assoc (3: “HELLP”),
Pres (Timing + Triad + 2), Blood (2), Labs (2),
Comp (2)

A

** Usually warrants immediate delivery **

Preeclampsia = htn + edema + proteinuria
Eclampsia = Preeclampsia + seizures

MECH = PLACENTAL ISCHEMIA due to vasodilation of spiral arteries.

RF:

  • Pre-existing Htn
  • Diabetes
  • Renal dz
  • Autoimmune disorders

ASSOC: “HELLP”

  • Hemolysis
  • Elevated Liver enz
  • Low Platelets

PRES: 7% of pregnant women

  • 20 wks gestation - 6 wks postpartum
  • Triad:
    1. Htn (-> visual abnormalities, headache, altered mentation)
    2. Edema (face + extremities)
    3. Proteinuria
  • Hyperreflexia
  • Ab pain

BLOOD:

  • Hemolysis
  • Thrombocytopenia

LABS:

  • Hyperuricemia
  • Liver enz ↑

COMP: Mortality due to…

  • ARDS
  • Cerebral hemorrhage
28
Q

Endometrial Carcinoma

Def’n, Causes / RF (7), Pres (Epi + 1), Prog?

A

Malignant proliferation of endometrial glands.

CAUSES / RF: ↑Estrogen exposure

  • Endometrial hyperplasia (however can also be sporadic)
  • Early menarche / Late menopause
  • Nulliparity
  • Prolonged use of Estrogens WITHOUT Progestins
  • Obesity
  • Htn
  • Diabetes

PRES: MC at 55-65
- Vaginal bleeding

PROGNOSIS:↓with↑myometrial invasion

29
Q

Leiomyoma (Fibroid)

Def’n, Causes, Pres (2 Epi + 3), Micro Finding (CLUE), Comp?

A

Benign proliferation of smooth muscle arising from myometrium.

CAUSES = *↑Estrogen exposure *

PRES: Blacks, 20-40 yrs. May be asymptomatic

  • Pelvic mass
  • Abnormal uterine bleeding
  • Infertility / Miscarriage

FINDINGS:
- “White whorled pattern of smooth muscle bundles”

COMP:
- Severe bleeding -> Iron-Def Anemia

30
Q

Leiomyosarcoma

Def’n (origin + appearance + features),
Pres (2 Epi + 1), Histo (3),
Prog?

A
  • Aggressive tumor*
  • Arises DE NOVO
  • Bulky + irregularly-shaped SINGLE lesion
  • Areas of hemorrhage + necrosis

PRES:↑incidence in Blacks + Post-Menopausal women
- May protrude from cervix and bleed

HISTO:

  • Cellular atypia
  • Mitotic activity
  • Hemorrhage + Necrosis

PROG: Highly aggressive tumor with tendency to recur

31
Q

Premature Ovarian Failure

Def’n, Pres (CLUE), Labs (2)?

A

Premature atresia of ovarian follicles in women of reproductive age.

PRES = “Menopause before 40”

LABS:

  • ↑FSH + LH
  • ↓Estrogen
32
Q

Polycystic Ovarian Failure (PCOS)

Def’n, Mech, Pres (Epi + 4), Labs (3), Comp (2), RX (5)?

A

Multiple FOLLICULAR ovarian cysts due to HORMONE IMBALANCE.

↑LH -> Anovulation
-> Excess Androgen production by Theca cells
-> Hirsutism
-> Testosterone aromatization in adipose tis
-> ↑Estrogen/Estrone -> (- feedback) ->↓FSH ->
Cystic degeneration of follicles.

PRES: Women of repro age

  • Amenorrhea / Oligomenorrhea
  • Infertility
  • Hirsutism
  • Obesity

LABS:

  • ↓FSH +↑LH (LH:FSH > 2)
  • ↑Estrogen
  • ↑Testosterone

COMP:

  • Insulin resistance
  • ↑risk of Endometrial Cancer (due to↑Estrogen)

RX:

  • Weight loss
  • Low-dose OCPs
  • Medroxyprogesterone (↓LH ->↓androgenesis)
  • Clomiphene (for women who want to get pregnant)
  • Spironolactone (for hirsutism + acne)
33
Q

Follicular Ovarian Cyst

Def’n, Assoc (2)?

A

Distention of unruptured GRAFFIAN FOLLICLE.

ASSOC:

  • Hyperestrinism
  • Endometrial Cancer
34
Q

Corpus Luteal Ovarian Cyst

Def’n?

A

HEMORRHAGE into PERSISTENT corpus luteum.

* Commonly regresses spontaneously *

35
Q

Theca-Luteal Ovarian Cyst

Mech (2), Assoc (2), Pres (general)?

A

MECH:

  • Gonadotropin stim
  • ↑Hcg

ASSOC:

  • Moles
  • Choriocarcinoma

PRES = Often bilateral + multiple.

36
Q

Hemorrhagic Ovarian Cyst

Def’n / Mech?

A

Cyst grows with↑blood retention ->
Blood vessel rupture in cyst wall.
* Usually self-resolves *

37
Q

Dermoid Cyst / Mature Teratoma

Def’n, Malignant Indicators (2 options)?

A

Cystic growths filled with various types of tis-
fat, cartilage, bits of bone, hair + teeth.

Malignant Indicators:

  • Immature tissue (usually neural) OR
  • Somatic malignancy (usually SCC of skin)
38
Q

Endometrioid Cyst

Def’n?

A

Endometriosis within ovary with cyst formation.
Varies with menstrual cycle.

Called a “chocolate cyst” when filled with dark reddish-brown blood.

39
Q

Yolk Sac / Endodermal Sinus Tumor

Locations (2), Tumor Marker,
Pres (Epi), Micro Findings (2 CLUES)?

A
  • Aggressive malignancy in young children*
  • Ovaries / Testes
  • Sacrococcygeal area

TM = AFP

PRES: Young children.

FINDINGS:

  • “Yellow, solid, friable masses”
  • “Schiller-Duval bodies” (in 50% of cases)
40
Q

Struma Ovarii (a Teratoma)

Def’n, Pres (CLUE)?

A

Contains functional thyroid tis.

PRES = Hyperthyroidism.

41
Q

Dysgerminoma

Tumor Markers (2), Assoc, Micro Findings (2), RX?

A

TM:

  • HCG
  • LDH

ASSOC with Turner Sx.

FINDINGS:

  • Sheets of uniform cells
  • Large cells w clear cytoplasm + central nuclei resemble oocytes

RX = Radiotherapy (responsive to).
Good prognosis for this reason

42
Q

Endometrial Carcinoma- Sporadic Pathway

Def’n, Genetics, Pres (Epi), Histo (2)?

A

Aggressive tumor
Endometrial carcinoma that arises in ATROPHIC endometrium.

p53 mutation common.

PRES: ~70 yrs

HISTO:

  • Papillary + serous structures
  • Psammoma bodies
43
Q

Asynchronous Secretory Endometrium

Def’n, Mech, Pres (Epi +1)?

A

Secretory endometrium that has MISMATCH OF 2+ DAYS in development / evolution of glands + stroma.

MECH = Inadequate LUTEAL PHASE
(corpus luteum not producing enough progesterone)

PRES: Women taking Oral-Contraceptives
- Infertility

45
Q

Krukenberg Tumor

Def’n, Micro Findings (2: CLUE + General)?

A

Diffuse Stomach Cancer -> Bilateral Mets to Ovaries.

FINDINGS:

  • “Signet Ring” cells
  • Abundant mucus
46
Q

Paget Disease of Breast

Pres, Significance?

A

PRES = “Red, swollen + itchy rash of nipple / areola”

** Sign of underlying neoplasm **

46
Q

Endometriosis

Def’n, MC Location, Mech,
Pres (6, incl MICRO CLUE),
Comp, RX?

A

Endometrial glands/stroma in ABNORMAL LOCATIONS outside the uterus.

MC Location = Ovaries.

MECH = Retrograde menstrual flow + implantation at ectopic site

PRES: Uterus is NORMAL-SIZED

  • Menorrhagia + Dysmenorrhea
  • Menstrual-type cyclic bleeding from ectopic endometrial tis ->
  • Blood-filled “chocolate cyst(s)” of ovaries (frequently involves BOTH ovaries) or on peritoneum
  • Infertility
  • Pelvic / Ab / Urinary / Defecatory pain
  • Painful intercourse

COMP:
- ↑risk of carcinoma at site of endometriosis

RX:
- Danazol

46
Q

Granulosa-Theca Cell Tumor of Ovary

Micro Finding?

A

FINDING:

- Call-Exner Bodies

46
Q

Fibrocystic Change of Breast

Micro Finding?

A

FINDING:

- Mammary gland “blue domed” cyst

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