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Step 1 > Reproductive > Flashcards

Reproductive Flashcards

1
Q

which HPV strains typically responsible for Condyloma

A

6, 11. Region is the vulva.

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2
Q

hallmark of HPV infected cells, i.e. condyloma

A

koilocytes

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3
Q

HPV strains responsible for vulvar carcinoma

A

16, 18

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4
Q

Dysplastic precursor lesion of vulvar carcinoma that is characterized by koilocytic change

A

Vulvar intraepithelial neoplasia (VIN)

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5
Q

non-HPV related vulvar carcinoma

A

Due to Lichen sclerosis (thinning and increased cancer risk, vs lichen planus is thickening with no increased risk)

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6
Q

Erythematous, pruritic, ulcerated vulvar skin. Have to diff btwn Melanoma and Carcinoma(extramammary paget disease)

A

Melanoma: PAS and keratin -, S100+

Paget cells - Carcinoma: PAS and keratin +, S100 -

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7
Q

link between keratin and carcinoma

A

Keratin = intermediate filament of Epithelial cells

Malignancy of epithelial cells = Carcinoma

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8
Q

DES (estrogen compound) exposure

A

Adenosis–> Clear cell carcinoma

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9
Q

Vaginal canal embryo (upper 2/3 vs lower 1/3)

A

upper 2/3 starts as Mullerian duct-derived columnar cells
Lower 1/3 urogenital sinus derived strat squam, which ultimately spreads and takes over normally (lack of this = adenosis)

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10
Q

Vaginal Carcinoma LN spread

A

lower 1/3 (UGS) –> inguinal

upper 2/3 (Mullerian) –> iliac

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11
Q

Vaginal carcinoma precursor lesion

A

related to high-risk HPV. Lesion is VAIN = vaginal intraepithelial neoplasia

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12
Q

Cervix epithelium

A

Exocervix: nonkeratinizing squamous
Endocervix: single layer columnar
transformation zone = j(x) btwn

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13
Q

Tumor suppressor genes lost due to high risk HPV

A

p53 and Rb. results in increased risk of CIN (cervical intraepithelial neoplasia)

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14
Q

proteins produced by high-risk HPV

A

E6 protein: knocks out p53 tumor suppressor gene

E7 protein: knocks out Rb tumor suppressor gene

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15
Q

postcoital vaginal bleeding

A

Cervical carcioma

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16
Q

cod in cervical carcinoma

A

Hydronephrosis with postrenal failure –> the tumor invades into the bladder and blocks the ureters

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17
Q

what are we trying to catch with pap smear

A

dysplasia (CIN)

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18
Q

Difference btween CIN and CIS

A

Cervical Intraepithelial Neoplasia doesn’t involve the entire thickness of the epithelium (I, II, and III)
Carcinoma in situ involves entire thickness and is irreversible now.

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19
Q

mucosal lining of the uterus

A

endometrium

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20
Q

effect of estrogen on endometrium

A

Growth (proilferative phase)

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21
Q

effect of progesterone on endometrium

A

preparation of endometrium for implantation (secretory phase)

Loss of progesterone = shedding (menstrual phase)

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22
Q

functionalis and basalis of endometrium

A

functionalis is layer that is grown with each cycle. basalis is regenerating layer/stem cells. basalis is lost in asherman syndrome

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23
Q

Loss of the regenerative layer of the endometrium resulting in secondary ammenorrhea

A

Asherman syndrome (loss of basalis). Results from overaggressive Dilation and Curettage

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24
Q

Estrogen-driven proliferative phase without a subsequenct progesterone-driven secretory phase

A

Anovulatory cycle. Keeps growing = overgrowth relative to blood supply = degeneration= BLEEDING

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25
Q

fever, pelvic pain, abnormal uterine bleeding

A

EndometrITIS (infection) - Acute

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26
Q

Endometritis defintion and cause

A

Bacterial infection of endometrium. Retained products of conception (post delivery or miscarriage)A

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27
Q

Abnormal uterine bleeding, pain, and infertility

A

Endometritis - CHRONIC!! Acute doesn’t present with infertility.

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28
Q

Characteristic cells of Chronic endometritis

A

PLASMA CELLS. Also see lymphocyctes but these are normally found in endometrium so have to see PLASMA CELLS.

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29
Q

causes of chronic endometritis

A

Retained products of conception, PID, IUD, TB

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30
Q

plasma cells seen in a women with infertility issues

A

Chronic Endometritis

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31
Q

hyperplastic protrusion of endometrium

A

Endometrial Polyp –> presents as abnormal uterine bleeding

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32
Q

Drug that can cause endometrial polyp/carcinoma

A

Tamoxifen (remember, has anti-estrogen on breast but pro-estrogen on uterus and bone)

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33
Q

Retrograde menstruation causing implantation of endometrial glands/stroma at ectopic site

A

Endometriosis

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34
Q

Dysmenorrhea (pain) + Pelvic pain

A

Endometriosis. Can sometimes cause infertility

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35
Q

Adenomyosis definition

A

when endometriosis involves myometrium

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36
Q

most common site of endometriosis

A

ovary

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37
Q

Unopposed estrogen (obesity, PCOS, hormone replacement)

A

endometrial hyperplasia (increased glands relative to stroma)

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38
Q

Postmenopausal uterine bleeding

A

Endometrial hyperplasia, Endometrial carcinoma, Granulosa cell tumor (stromal tumor that produces estrogen)

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39
Q

Most imporant predictor for endometrial hyperplasia progression –> endometrial carcinoma?

A

Cellular atypia

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40
Q

Most common invasive carcinoma of the female genital tract

A

Endometrial carcinoma

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41
Q

most common tumor in females

A

Leiomyoma (fibroids)

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42
Q

Leiomyoma definition

A

Benign neoplastic prolif of smooth muscle arising from myometrium. Estrogen sensitive (grows during pregnancy and shrinks after menopause)

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43
Q

does leiomyoma progress to leiomyosarcoma?

A

no, it arises de novo

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44
Q

leiomyoma vs leiomyosarcoma

A

Myoma: multiple lesions, estrogen sensitive so seen in premenopausal. Myosarcoma: single lesions with necrosis/atypia, is malignant, seen in postmenopausal women

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45
Q

Granulosa cells respond to ____, Theca cells respond to ____

A

G- FSH ; T - LH

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46
Q

LH acts on theca cells to induce ____ production

A

Androgen

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47
Q

FSH stimulates granulosa cells to:

A

convert androgen to estradiol(which leads to LH surge which leads to ovulation)

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48
Q

whats the corpus luteum?

A

Residual follicle after ovulation that secretes Progesterone

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49
Q

LH and FSH ratio in PCOS

A

Increased LH, decreased FSH. (LH: FSH>2)

Increased LH causes androgens from theca = hirsutism

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50
Q

Where is Androgen (increased LH) in PCOS converted to estrone?

A

Adipose Tissue. Classically see PCOS in obese women.

Estrone feedback causes decreases FSH secretion = cystic degeneration of Follicles

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51
Q

PCOS presentation

A

Obese woman, infertile, oligomenorrhea, hirsutism/acne. Can see insulin resistance/excess

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52
Q

Mutation causing increased risk for serious carcinoma of ovary and fallopian tube

A

BRCA1. Carriers often have prophylactic salpingo-oophorectomy

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53
Q

bladder-like tumor

A

Brenner

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54
Q

3 locations for ovarian tumors

A

Surface epithelium (worst prognosis), germ cell, sex cord

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55
Q

Surface epithelial tumors

A

Serous/Mucinous.
Cystadenoma (benign, single cyst, PREMENOPAUSAL) or
Cystadenocarcinoma (malignant, complex, POSTMENOPAUSAL).
Also includes endometroid (malignant tumor from endometriosis) and Brenner. Monitor tx response and recurrence with CA-125.

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56
Q

Germ Cell Tumors

A

Cystic Teratoma, Dysgerminoma (oocytes), Choriocarcinoma, Yolk Sac Tumor

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57
Q

Struma Ovarii

A

Teratoma with thyroid tissue

58
Q

female equivalent of seminoma

A

Dysgerminoma

59
Q

Ovarian tumor with increased LDH

A

Dysgerminoma

60
Q

Glomeruli-like structures in germ cell tumor

A

Schiller-Duval bodies –> Yolk Sac Tumor

61
Q

Yolk Sac Tumor aka

A

Endodermal sinus tumor

62
Q

Germ cell ovarian tumor with increased AFP

A

Yolk Sac Tumor

63
Q

Malignant tumor of trophoblasts, lacking villi

A

Choriocarcinoma. High b-HCG is characteristic.

64
Q

increased b-HCG, Hemoptysis, shortness of breath

A

Choriocarcinoma (hematogenous spread to the lungs)

65
Q

Estrogen producing malignant stromal tumor

A

Granulosa cell tumor (granulosa-theca cell tumor)

66
Q

sx of granulosa (estrogen producing) cell tumor

A

piror to puberty = precocious puberty; reproductive age = menorrhagia. postmenopausal = endometrial hyperplasia with postmenopausal uterine bleeding.

67
Q

why do a pregnancy test in pt with Lower quadrant pain a few weeks after missed period?

A

ectopic pregnancy

68
Q

most common cause of spontaneous abortion?

A

Chromosomal anomalies

69
Q

third trimester bleeding

A

Painless: Placenta Previa. req c-section
Painful: Placenta abruption. life threatening for mom and fetus.

70
Q

third trimester bleeding with still birth

A

placenta abruption

71
Q

difficult delivery of the placenta + postpartum bleeding

A

placenta accreta. req hysterectomy

72
Q

risk factors for sudden infant death syndrome

A

Sleeping on stomach, exposure to cigarette smoke, prematurity

73
Q

define Hydatidiform mole

A

abnormal conception characterized by swollen VILLI with prolif of trophoblasts (grow placental tissue instead of fetus)

(vs choriocarcinoma = no villi, malignant prolif tropho)

74
Q

abortion med thats a prostaglandin agonist

A

Misoprostol (PG E1)

75
Q

abortion med thats a progesterone antagonist

A

Mifepristone

76
Q

abortion med thats a folic acid antagonist

A

Methotrexate

77
Q

Uses for constant GnRH therapy

A

Precocious puberty, prostate cancer, endometriosis, premenopausal breast cancer

78
Q

define preeclampsia

A

Gestational HTN + either PROTEINURIA or END ORGRAN DAMAGE

79
Q

ovarian cystic tumor producing androgens

A

Sertoli-Leydig stromal tumor

80
Q

hormone responsible for physiologic maternal resistance in 2nd/3rd trimester (so theres glucose to cross placenta and go to fetus)

A

HPL (secreted by synctiotrophoblast)

81
Q

pregnancy changes to thyroid binding globulin

A

increases = increased total t3/t4; normal free

82
Q

common cause of irregular menstrual cycle/bleeding in first few years after menarche

A

anovulation

83
Q

median age of carcinoma

A

60

84
Q

median age of germ cell tumor (teratoma, dysgerminoma, yolk sac tumor, choriocarcinoma)

A

15-30

85
Q

when intraabdominal pressure exceeds urethral sphincter pressure

A

Stress incontinence (laugh/cough)

86
Q

Sudden, overwhelming need to empty bladder

A

Urge incontinence

87
Q

Detrusor overactivity

A

Urge incontinence

88
Q

Impaired detrusor contractility

A

Overflow incontinence

89
Q

Bladder outlet obstruction (incontinence)

A

Overflow incontinence

90
Q

incomplete bladder emptying/involuntary dribbling

A

Overflow incontinence

91
Q

Incontinence due to pregnancy

A

Stress incontinence: gravid uterus causes increased intraabdominal pressure

92
Q

Gallstones caused by Pregnancy:

A

Estrogen causes cholesterol hypersecretion (upreg hepatic HMG CoA reductase; Progesterone causes gallbladder hypomotility and decreased bile acid secretion

Fat, Fertile, Female, Forty

93
Q

Repro cancer thats an AIDS defining illness

A

Cervical carcinoma –> immune system is important for ridding 90% of HPV infections. immunodeficiency = increased risk

94
Q

Squamous cell carcinoma of cervix or adenocarcinoma of cervix ass. with HPV? which does PAP smear pick up?

A

both. much better at picking up squamous. Bad for adenocarcinoma (so adenocarcinoma incidence hasnt decreased with advent of pap smear)

95
Q

Pathology in Pre-eclampsia (placental vascular interface btwn mom and baby)

A

Fibrinoid Necrosis

96
Q

baby dies 1month to 1year: name and risk factors

A

Sudden Infant death syndrome. Smoking, sleeping on stomach, prematurity.

97
Q

Hytadiform mole

A

edematous villi with excessive prolif of cells surrounding (trophoblast). Basically growth of placenta instead of fetus. Uterus is bigger than normal, b-HCG is higher than what youd expect. Women will pass grape like masses: edematous villi.

98
Q

US of hytadiform mole

A

absence of fetal cardiac beat, grape like masses (snowstorm appearance)

99
Q

classification of molar pregnancy

A

complete (2 sperm into empty ovum…all genetic material is completely from dad: 46 chrom.
no fetal tissue, completely a mole.
completely edematous villi (all).
Excess trophoblast completely surrounds the villus. Complete mole has higher b-hcg because it comes from synctiotrophoblast.
Complete mole has the complete risk of choriocarcinoma (higher risk).

vs Partial (opposite): fetal tissue present etc.

100
Q

tx of molar pregnancy

A

D and C. as you get rid of mole, b-hcg should go down (so measure…also helps screen for choriocarcinoma).

101
Q

tumor of trophoblast (no villi seen)

A

Choriocarcinoma

102
Q

2 ways to get choriocarcinoma

A
  1. complication of gestation –> molar pregnancy or spontaneous abortion (great response to chemo)
  2. spontaneous germ cell mole (poor response to chemo)
103
Q

first trimester bleeding and uterus that is larger than expected

A

hytadiform mole

104
Q

most vulnerable to injury during hysterectomy

A

URETER. Can still have normal urinary voiding with unilateral injury. Presents with fever and back pain

Water under the bridge. The ureter passes below and lateral to uterine artery prior to entering bladder.

105
Q

genotype in Androgen Insensitivity Syndrome

A

46 XY

106
Q

phenotype in Androgen insensitivity Syndrome

A

no penis/scrotum; no axillary pubic hair; cryptorchidism…testes do secrete testosterone, which is chilling free in the serum and thus converted to estrogen by perip tissue = breast formation

107
Q

looks female, but has testes and no uterus/ovary

A

Androgen Insensitivity Syndrome (46 xy)

108
Q

secondary amenorrhea from obstruction due to scarring of uterine cavity

A

Asherman –> due to endometritis or D and C

109
Q

hypogonadotropic hypogonadism (hypothalamus)

A

Kallman

110
Q

defective migration of GnRH cells. Defective olfactory bulb development

A

Kallman

111
Q

Infertility, anosmia (cant smell), decreased GnRH, LH, FSH, testosterone

A

Kallman

112
Q

most common cause of primary amennorhea

A

Turners –> short stature, webbed neck, fibrotic streak ovaries

113
Q

primary amenorrhea, cyclic abdominal/pelvic pain, normal secondary sex characteristics

A

Imperforate hymen

114
Q

what is a cervical cytology used for?

A

This is another name for Pap smear. screening test for cervical cancer.

115
Q

addition of KOH when vaginitis:

A

Whiff test (releases amines that smell). Gardnerella vaginalis: clue cells

116
Q

green frothy discharge vagina, whats the organism and best test

A

Trichomonas vaginalis. have to do Saline microscopy aka wet mount to visualize the trichomonads.

117
Q

pH in vaginitis

A

Gardnerella and trichomonas: increased pH (alkaline)

candida: normal pH

118
Q

tx in vaginitis

A

Gardnerella and trichomonas: metronidazole (or clindamycin for Gardnerella)
Candida: fluconazole

119
Q

cardiac manifestations of Turners

A

Bicuspid aortic valve and Coarctation of the aorta

120
Q

renal manifestations of Turners

A

horseshoe kidney

121
Q

Endometrial hyperplasia (increased gland:stroma ratio): pain? heavy bleeding?

A

Heavy bleeding, NO PAIN

122
Q

heavy bleeding, irregularly enlarged uterus

A

Leiomyoma aka FIBROIDS nigga–> prolif of myometrial smooth m cells

123
Q

heavy and painful menstrual bleeding, uniformly enlarged uterus

A

Adenomyosis (endometrial tissue in myometrium)

124
Q

metronidazole rxn with alcohol

A

disulfuram like reaction = flushing, cramps, nausea, headache.

125
Q

why does FSH increase in menopause

A

lack of feedback inhibition from Inhibin (follices are resistant)

126
Q

Vaginitis organism types

A

Gardnerella: gram variable rod. no inflammation interestingly
Trichomonas: protozoan. inflam
Candida: fungi. inflam

127
Q

Estrogen and Inhibin levels in granulosa cell tumor

A

both increased (granulosa cell is what makes the estrogen fam)

128
Q

ovarian venous drainage

A

Left ovarian into L renal into IVC.
R ovarian directly into IVC
–> think IVC goes into RA so left side takes longer route, r side more sehlu

129
Q

female repro tract: cuboidal cells

A

ovary

130
Q

female repro tract: columnar cells

A

fallopian tube, uterus, endocervix

131
Q

female repro tract: strat squam (non-keratin)

A

vagina, ectocervix

132
Q

epithelial layer of uterus that sloughs during menstruation

A

stratum functionalis

133
Q

dimpling of breast in breast cancer signals involvement of:

A

suspensory ligaments of cooper

134
Q

most common LN involved in breast cancer

A

axillary

135
Q

nipple discharge in breast cancer

A

lactiferous sinus

136
Q

increased androgens in women with mass

A

sertoli-leydig tumor

137
Q

concentrically laminated, calcified spherical deposits on ovarian tumor biopsy

A

psammoma bodies –> Serous cystadenocarcinoma

138
Q

coffee bean nuclei

A

Granulosa cell tumor. coffe GRounds

139
Q

water under the bridge

A

water= ureter. bridge = uterine artery

140
Q

Premature sep of placenta from uterine wall (before delivery)

Defective decidual layer (abnormal attach/sep after delivery)

Attachment of placenta to lower segment uterus

A

Placenta Abruption

Placenta Accreta

Placenta Previa

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