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1
Q

Complete mole

A

46 XX or 46 XY - 1 sperm divides and fertilizes empty egg

  • VERY high beta-hCG
  • increased uterine size
  • NO fetal parts

Risk: 2% choriocarcinoma, 15-20% malignant trophoblastic disease (invades through uterine wall)
- Monitor beta-hCG after evacuation

Tx: dilation currettage, methotrexate

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2
Q

Partial mole

A

69 XXX, 69 XXY, 69 XYY

  • 2 sperm and 1 egg
  • slight increase in beta-hCG
  • Fetal parts

Risk: low risk of malignancy (<5%)

Tx: dilation currettage, methotrexate

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3
Q

Preeclampsia

A

Preeclampsia= HTN, proteinuria, edema

  • Occurs in 7% women from 20 weeks gestation to 6 weeks postpartum
  • Before 20 weeks= molar pregnancy likely

Eclampsia= preeclampsia + seizures

Etiology:

  • Increased incidence in pre-existing HTN, diabetes, chronic renal disease, autoimmune disorders
  • Defect in uterine vasculature–> increased vascular tone

HELLP syndrome= Hemolysis, Elevated Liver enzymes, Low Platelets

Mortality: cerebral hemorrhage, adult respiratory distress syndrome

Treatment:
- IV magnesium sulfate: prevention and treatment for seizures

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4
Q

Abruptio placentae

A

Premature detachment of placenta

  • Associated with DIC?
  • Increased risk with smoking, HTN, cocaine

Symptoms:
- Painful bleeding in 3rd trimester (Abrupt detachment)–> life threatening to fetus and mother

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5
Q

Placenta accreta

A

Scar tissue in myometrium–> defects in decidual layer–> allows placenta to adhere to tissue
- increased bleeding risk after delivery

    • Retained placental tissue: increased risk of infection
  • Bacteroides= most commonly isolated (mixed flora infection)
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6
Q

Placenta previa

A

Placenta attaches to lower uterine segment
- Increased risk with multiparity, C-section

Symptoms:
- PainLESS bleeding in any trimester

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7
Q

Ectopic pregnancy

A

** Lower than expected beta-hCG

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8
Q

Polyhydramnios

A

> 1.5-2 L amniotic fluid–>
Due to:
- esophageal/duodenal atresia: Can’t swallow amniotic fluid
- Anencephaly (can’t swallow w/o brain

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9
Q

Cervical dysplasia/CIN

A

HPV 16–> E6–> inhibit p53
HPV 18–> E7–> inhibit Rb

  • Increased risk with multiple sexual partners (#1), smoking, early debut, HIV infection
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10
Q

Gynecologic tumor epidemiology

A

Worldwide: Cervical cancer most common

Incidence (US):

  1. endometrial
  2. ovarian
  3. cervical

Highest mortality:

  1. ovarian
  2. Cervical
  3. Endometrial
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11
Q

Clear cell adenocarcinoma of vagina

A

DES exposure in utero–> seen in adulthood

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12
Q

Sarcoma botyoides

A

Rhabdomyosarcoma

  • girls < 4 years of age
  • Spindle-shaped tumor cells= desmin positive
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13
Q

CA-125

A

Cancer antigen elevated in serous, endometrioid, clear cell carcinoma of ovary
- Used to monitor therapeutic response

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14
Q

Malignant breast cancer

A

Common post-menopause
Usually arise from terminal duct lobular unit

Overexpression of:

  • Estrogen/progesterone receptors
  • c-erbB2 (HER-2= EGF receptor)
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15
Q

Leuprolide

A

GnRH analog:

  • Agonist when used in pulsatile dosing (infertility drug)
  • Antagonist when used continuously (prostate cancer, uterine fibroids, precocious puberty treatment)

Tox:
- Antiandrogen, N/V

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16
Q

Testosterone

A

MOA: Agonist at androgen receptors

Use: Treats hypogonadism

  • Promotes secondary sex characteristics
  • Anabolic steroid- burn or injury recovery

Tox:

  • Masculinization in famles
  • Inhibits LH release (negative feedback)–> gonadal atrophy
  • Premature epiphyseal plate closure
  • Increased LDL, decreased HDL
17
Q

Finasteride

A

MOA: 5-alpha-reductase inhibitor
- Decreases conversion of T–> DHT

Use:

  • BPH
  • Male-pattern baldness
18
Q

Flutamide

A

MOA: nonsteroidal inhibtor of androgens at testosterone receptor

Use: prostate cancer

19
Q

Ketoconazole

A

MOA: inhibits steroid synthesis (inhibits 17,20-desmolase)

Use:
- PCOS (prevent hisutism)

Tox: gynecomastia, amenorrhea

20
Q

Spironolactone

A

MOA: inhibits steroid binding

Use:
- PCOS (prevent hisutism)

Tox: gynecomastia, amenorrhea

21
Q

Ethinyl estradiol, DES, Mestranol

A

MOA: bind estrogen receptors

Use:

  • Hypogonadism, ovarian failure
  • Menstrual abnormalities
  • HRT in post-menopauseal women
  • Androgen-dependent prostate cancer

Tox:

  • Increased endometrial cancer risk
  • Bleeding in post-menopausal women
  • DES in utero exposure–> clear cell adenocarcinoma of vagina
  • Thrombosus
    • Avoid in ER-positive breast cancer, previous history of DVT
22
Q

Clomiphene

A

MOA: SERM

  • Partial agonist at estrogen receptors in hypothalamus (prevents normal feeback inhibition)
  • Increases LH, FSH release

Use: infertility, PCOS

Tox:

  • Hot flashes
  • Ovarian enlargement
  • Multiple simultaneous pregnancies
  • Visual disturbances (enlarged pituitary)
23
Q

Tamoxifen

A

MOA: SERM
- Antagonist on breast tissue, agonist of endometrium

Use: treat, prevent recurrence of ER-positive breast cancer

24
Q

Raloxifene

A

MOA: SERM
- Agonist on bone–> reduces resorption

Use: Osteoporosis

25
Anastrozole, Exemestane
Aromatase inhibitors Use: postmenopausal breast cancer (estrogen-sensitive cancer)
26
Progestin
MOA: bind progesterone-R, reducing growth and decreasing vascularization of endometrium Use: - oral contraceptives - Endometrial cancer - AbnL uterine bleeding
27
Mifepristone (RU-486)
MOA: competitive inhibitor of progestins at progesterone-R Use: terminate pregnancy (administered with misoprostol= PGE1) Tox: Heavy bleeding, GI effects (N/V/A), abdominal pain
28
Oral contraceptives (progestin + estrogen)
MOA: inhibit LH/FSH release--> prevent estrogen surge--> no LH surge--> no ovulation - Progestins= thicken cervical mucus (barrier); inhibit endometrial proliferation (no implantation)
29
Terbutaline
MOA: beta-2 agonist, relaxes uterus Use: reduce premature contractions
30
Tamulosin
MOA: alpha-1 antagonist, inhibits smooth m. contraction (selective for alpha 1A,D receptors in prostate vs alpha 1B in vasculature) Use: BPH
31
Sildenafil, Vardenafil
MOA: inhibit PDE-5--> increased cGMP--> smooth muscle relaxation in corpus cavernosum (increased blood flow--> erection) Use: Treat ED Tox: H/A, flusing, dyspepsia, impaired blue-green color vision - Avoid in patients taking nitrates--> hypotension
32
Danazol
MOA: synthetic androgen; partial agonist at androgen receptors Use: endometriosis, hereditary angioedema Tox: - Weight gain, edema - Acne, hirsutism, masculinization - Decreased HDL, hepatotoxic
33
Sources of estrogen in female
Ovary (17-beta estradiol), placenta (estriol), adipose tissue (estrone via aromatization) - GnRH--> LH--> desmolase in Theca cell - -> Cholesterol converted to androstenedione - GnRH--> FSH--> aromatase in Granulosa cell - --> Androstenedione converted to astrogen Estrogen--> increased transport proteins, SHBG; increased HDL, lowered LDL; causes LH surge--> ovulation ** Potency: estradiol > Estrone > estriol
34
Oogenesis
Meiosis I= prophase I; primary oocyte (until ovulation) | Meiosis II= Metaphase II; secondary oocyte (until fertilization)
35
Lactation
Progesterone decreases at birth--> lactation begins - Prolactin= binds JAK-STAT pathway--> induce and maintain lactation, prevent ovulation - Oxytocin= milk letdown
36
hPL
Human placental lactogen - Secreted from syncytiotrophoblast - Similar to prolactin, GH - Increases maternal insulin resistance, decreases maternal glucose utilization, increases blood glucose - -> increased lipolysis, proteolysis (energy for mom as baby uses glucose) * * Maternal insulin resistance d/t: hPL, GH, estrogens, progesterone, glucocorticoids - Gestational diabetes= unable to overcome insulin resistance
37
Alpha-fetoprotein (AFP)
Synthesized in liver, GI tract, yolk sac - Serum AFP low in: Down's syndrome, increased gestational age - Elevated AFP: dating error (most common cause), neural tube defects, gastro wall defects, multiple gestations
38
Endometritis
Inflammation of endometrium d/t: - Retained products of conception following delivery - Miscarriage/abortion - Foreign body (IUD) Bacteroides= common infection Treatment: - Gentamycin + Clindamycin +/- Ampicillin
39
Fibrocystic change in breast
Most common cause of breast lumps from 25- menopause - Premenstrual breast pain, bilateral, multiple lesions - Fluctate in size, mass - Does NOT indicate increased risk of carcinoma Fibrosis= hyperplasia of stroma Cystic= fluid-filled blue dome (ductal dilation) Sclerosing adenosis= increased acini, intralobular fibrosis; associated with calcifications (confused with cancer) Epithelial hyperplasia= increased epithelial cells in terminal duct lobule (increased risk of cancer if atypical cells)

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