Reproductive Flashcards
1
Q
which HPV strains typically responsible for Condyloma
A
6, 11. Region is the vulva.
2
Q
hallmark of HPV infected cells, i.e. condyloma
A
koilocytes
3
Q
HPV strains responsible for vulvar carcinoma
A
16, 18
4
Q
Dysplastic precursor lesion of vulvar carcinoma that is characterized by koilocytic change
A
Vulvar intraepithelial neoplasia (VIN)
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)
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 -
7
Q
link between keratin and carcinoma
A
Keratin = intermediate filament of Epithelial cells
Malignancy of epithelial cells = Carcinoma
8
Q
DES (estrogen compound) exposure
A
Adenosis–> Clear cell carcinoma
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)
10
Q
Vaginal Carcinoma LN spread
A
lower 1/3 (UGS) –> inguinal
upper 2/3 (Mullerian) –> iliac
11
Q
Vaginal carcinoma precursor lesion
A
related to high-risk HPV. Lesion is VAIN = vaginal intraepithelial neoplasia
12
Q
Cervix epithelium
A
Exocervix: nonkeratinizing squamous
Endocervix: single layer columnar
transformation zone = j(x) btwn
13
Q
Tumor suppressor genes lost due to high risk HPV
A
p53 and Rb. results in increased risk of CIN (cervical intraepithelial neoplasia)
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
15
Q
postcoital vaginal bleeding
A
Cervical carcioma
16
Q
cod in cervical carcinoma
A
Hydronephrosis with postrenal failure –> the tumor invades into the bladder and blocks the ureters
17
Q
what are we trying to catch with pap smear
A
dysplasia (CIN)
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.
19
Q
mucosal lining of the uterus
A
endometrium
20
Q
effect of estrogen on endometrium
A
Growth (proilferative phase)
21
Q
effect of progesterone on endometrium
A
preparation of endometrium for implantation (secretory phase)
Loss of progesterone = shedding (menstrual phase)
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
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
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
25
fever, pelvic pain, abnormal uterine bleeding
EndometrITIS (infection) - Acute
26
Endometritis defintion and cause
Bacterial infection of endometrium. Retained products of conception (post delivery or miscarriage)A
27
Abnormal uterine bleeding, pain, and infertility
Endometritis - CHRONIC!! Acute doesn't present with infertility.
28
Characteristic cells of Chronic endometritis
PLASMA CELLS. Also see lymphocyctes but these are normally found in endometrium so have to see PLASMA CELLS.
29
causes of chronic endometritis
Retained products of conception, PID, IUD, TB
30
plasma cells seen in a women with infertility issues
Chronic Endometritis
31
hyperplastic protrusion of endometrium
Endometrial Polyp --> presents as abnormal uterine bleeding
32
Drug that can cause endometrial polyp/carcinoma
Tamoxifen (remember, has anti-estrogen on breast but pro-estrogen on uterus and bone)
33
Retrograde menstruation causing implantation of endometrial glands/stroma at ectopic site
Endometriosis
34
Dysmenorrhea (pain) + Pelvic pain
Endometriosis. Can sometimes cause infertility
35
Adenomyosis definition
when endometriosis involves myometrium
36
most common site of endometriosis
ovary
37
Unopposed estrogen (obesity, PCOS, hormone replacement)
endometrial hyperplasia (increased glands relative to stroma)
38
Postmenopausal uterine bleeding
Endometrial hyperplasia, Endometrial carcinoma, Granulosa cell tumor (stromal tumor that produces estrogen)
39
Most imporant predictor for endometrial hyperplasia progression --> endometrial carcinoma?
Cellular atypia
40
Most common invasive carcinoma of the female genital tract
Endometrial carcinoma
41
most common tumor in females
Leiomyoma (fibroids)
42
Leiomyoma definition
Benign neoplastic prolif of smooth muscle arising from myometrium. Estrogen sensitive (grows during pregnancy and shrinks after menopause)
43
does leiomyoma progress to leiomyosarcoma?
no, it arises de novo
44
leiomyoma vs leiomyosarcoma
Myoma: multiple lesions, estrogen sensitive so seen in premenopausal. Myosarcoma: single lesions with necrosis/atypia, is malignant, seen in postmenopausal women
45
Granulosa cells respond to ____, Theca cells respond to ____
G- FSH ; T - LH
46
LH acts on theca cells to induce ____ production
Androgen
47
FSH stimulates granulosa cells to:
convert androgen to estradiol(which leads to LH surge which leads to ovulation)
48
whats the corpus luteum?
Residual follicle after ovulation that secretes Progesterone
49
LH and FSH ratio in PCOS
Increased LH, decreased FSH. (LH: FSH>2)
Increased LH causes androgens from theca = hirsutism
50
Where is Androgen (increased LH) in PCOS converted to estrone?
Adipose Tissue. Classically see PCOS in obese women.
| Estrone feedback causes decreases FSH secretion = cystic degeneration of Follicles
51
PCOS presentation
Obese woman, infertile, oligomenorrhea, hirsutism/acne. Can see insulin resistance/excess
52
Mutation causing increased risk for serious carcinoma of ovary and fallopian tube
BRCA1. Carriers often have prophylactic salpingo-oophorectomy
53
bladder-like tumor
Brenner
54
3 locations for ovarian tumors
Surface epithelium (worst prognosis), germ cell, sex cord
55
Surface epithelial tumors
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.
56
Germ Cell Tumors
Cystic Teratoma, Dysgerminoma (oocytes), Choriocarcinoma, Yolk Sac Tumor
57
Struma Ovarii
Teratoma with thyroid tissue
58
female equivalent of seminoma
Dysgerminoma
59
Ovarian tumor with increased LDH
Dysgerminoma
60
Glomeruli-like structures in germ cell tumor
Schiller-Duval bodies --> Yolk Sac Tumor
61
Yolk Sac Tumor aka
Endodermal sinus tumor
62
Germ cell ovarian tumor with increased AFP
Yolk Sac Tumor
63
Malignant tumor of trophoblasts, lacking villi
Choriocarcinoma. High b-HCG is characteristic.
64
increased b-HCG, Hemoptysis, shortness of breath
Choriocarcinoma (hematogenous spread to the lungs)
65
Estrogen producing malignant stromal tumor
Granulosa cell tumor (granulosa-theca cell tumor)
66
sx of granulosa (estrogen producing) cell tumor
piror to puberty = precocious puberty; reproductive age = menorrhagia. postmenopausal = endometrial hyperplasia with postmenopausal uterine bleeding.
67
why do a pregnancy test in pt with Lower quadrant pain a few weeks after missed period?
ectopic pregnancy
68
most common cause of spontaneous abortion?
Chromosomal anomalies
69
third trimester bleeding
Painless: Placenta Previa. req c-section
Painful: Placenta abruption. life threatening for mom and fetus.
70
third trimester bleeding with still birth
placenta abruption
71
difficult delivery of the placenta + postpartum bleeding
placenta accreta. req hysterectomy
72
risk factors for sudden infant death syndrome
Sleeping on stomach, exposure to cigarette smoke, prematurity
73
define Hydatidiform mole
abnormal conception characterized by swollen VILLI with prolif of trophoblasts (grow placental tissue instead of fetus)
(vs choriocarcinoma = no villi, malignant prolif tropho)
74
abortion med thats a prostaglandin agonist
Misoprostol (PG E1)
75
abortion med thats a progesterone antagonist
Mifepristone
76
abortion med thats a folic acid antagonist
Methotrexate
77
Uses for constant GnRH therapy
Precocious puberty, prostate cancer, endometriosis, premenopausal breast cancer
78
define preeclampsia
Gestational HTN + either PROTEINURIA or END ORGRAN DAMAGE
79
ovarian cystic tumor producing androgens
Sertoli-Leydig stromal tumor
80
hormone responsible for physiologic maternal resistance in 2nd/3rd trimester (so theres glucose to cross placenta and go to fetus)
HPL (secreted by synctiotrophoblast)
81
pregnancy changes to thyroid binding globulin
increases = increased total t3/t4; normal free
82
common cause of irregular menstrual cycle/bleeding in first few years after menarche
anovulation
83
median age of carcinoma
60
84
median age of germ cell tumor (teratoma, dysgerminoma, yolk sac tumor, choriocarcinoma)
15-30
85
when intraabdominal pressure exceeds urethral sphincter pressure
Stress incontinence (laugh/cough)
86
Sudden, overwhelming need to empty bladder
Urge incontinence
87
Detrusor overactivity
Urge incontinence
88
Impaired detrusor contractility
Overflow incontinence
89
Bladder outlet obstruction (incontinence)
Overflow incontinence
90
incomplete bladder emptying/involuntary dribbling
Overflow incontinence
91
Incontinence due to pregnancy
Stress incontinence: gravid uterus causes increased intraabdominal pressure
92
Gallstones caused by Pregnancy:
Estrogen causes cholesterol hypersecretion (upreg hepatic HMG CoA reductase; Progesterone causes gallbladder hypomotility and decreased bile acid secretion
Fat, Fertile, Female, Forty
93
Repro cancer thats an AIDS defining illness
Cervical carcinoma --> immune system is important for ridding 90% of HPV infections. immunodeficiency = increased risk
94
Squamous cell carcinoma of cervix or adenocarcinoma of cervix ass. with HPV? which does PAP smear pick up?
both. much better at picking up squamous. Bad for adenocarcinoma (so adenocarcinoma incidence hasnt decreased with advent of pap smear)
95
Pathology in Pre-eclampsia (placental vascular interface btwn mom and baby)
Fibrinoid Necrosis
96
baby dies 1month to 1year: name and risk factors
Sudden Infant death syndrome. Smoking, sleeping on stomach, prematurity.
97
Hytadiform mole
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
US of hytadiform mole
absence of fetal cardiac beat, grape like masses (snowstorm appearance)
99
classification of molar pregnancy
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
tx of molar pregnancy
D and C. as you get rid of mole, b-hcg should go down (so measure...also helps screen for choriocarcinoma).
101
tumor of trophoblast (no villi seen)
Choriocarcinoma
102
2 ways to get choriocarcinoma
1. complication of gestation --> molar pregnancy or spontaneous abortion (great response to chemo)
2. spontaneous germ cell mole (poor response to chemo)
103
first trimester bleeding and uterus that is larger than expected
hytadiform mole
104
most vulnerable to injury during hysterectomy
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
genotype in Androgen Insensitivity Syndrome
46 XY
106
phenotype in Androgen insensitivity Syndrome
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
looks female, but has testes and no uterus/ovary
Androgen Insensitivity Syndrome (46 xy)
108
secondary amenorrhea from obstruction due to scarring of uterine cavity
Asherman --> due to endometritis or D and C
109
hypogonadotropic hypogonadism (hypothalamus)
Kallman
110
defective migration of GnRH cells. Defective olfactory bulb development
Kallman
111
Infertility, anosmia (cant smell), decreased GnRH, LH, FSH, testosterone
Kallman
112
most common cause of primary amennorhea
Turners --> short stature, webbed neck, fibrotic streak ovaries
113
primary amenorrhea, cyclic abdominal/pelvic pain, normal secondary sex characteristics
Imperforate hymen
114
what is a cervical cytology used for?
This is another name for Pap smear. screening test for cervical cancer.
115
addition of KOH when vaginitis:
Whiff test (releases amines that smell). Gardnerella vaginalis: clue cells
116
green frothy discharge vagina, whats the organism and best test
Trichomonas vaginalis. have to do Saline microscopy aka wet mount to visualize the trichomonads.
117
pH in vaginitis
Gardnerella and trichomonas: increased pH (alkaline)
| candida: normal pH
118
tx in vaginitis
Gardnerella and trichomonas: metronidazole (or clindamycin for Gardnerella)
Candida: fluconazole
119
cardiac manifestations of Turners
Bicuspid aortic valve and Coarctation of the aorta
120
renal manifestations of Turners
horseshoe kidney
121
Endometrial hyperplasia (increased gland:stroma ratio): pain? heavy bleeding?
Heavy bleeding, NO PAIN
122
heavy bleeding, irregularly enlarged uterus
Leiomyoma aka FIBROIDS nigga--> prolif of myometrial smooth m cells
123
heavy and painful menstrual bleeding, uniformly enlarged uterus
Adenomyosis (endometrial tissue in myometrium)
124
metronidazole rxn with alcohol
disulfuram like reaction = flushing, cramps, nausea, headache.
125
why does FSH increase in menopause
lack of feedback inhibition from Inhibin (follices are resistant)
126
Vaginitis organism types
Gardnerella: gram variable rod. no inflammation interestingly
Trichomonas: protozoan. inflam
Candida: fungi. inflam
127
Estrogen and Inhibin levels in granulosa cell tumor
both increased (granulosa cell is what makes the estrogen fam)
128
ovarian venous drainage
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
female repro tract: cuboidal cells
ovary
130
female repro tract: columnar cells
fallopian tube, uterus, endocervix
131
female repro tract: strat squam (non-keratin)
vagina, ectocervix
132
epithelial layer of uterus that sloughs during menstruation
stratum functionalis
133
dimpling of breast in breast cancer signals involvement of:
suspensory ligaments of cooper
134
most common LN involved in breast cancer
axillary
135
nipple discharge in breast cancer
lactiferous sinus
136
increased androgens in women with mass
sertoli-leydig tumor
137
concentrically laminated, calcified spherical deposits on ovarian tumor biopsy
psammoma bodies --> Serous cystadenocarcinoma
138
coffee bean nuclei
Granulosa cell tumor. coffe GRounds
139
water under the bridge
water= ureter. bridge = uterine artery
140
Premature sep of placenta from uterine wall (before delivery)
Defective decidual layer (abnormal attach/sep after delivery)
Attachment of placenta to lower segment uterus
Placenta Abruption
Placenta Accreta
Placenta Previa
