Reproductive + Urogenital Flashcards
Functional Hypothalamic Amenorrhea
what is it? causes? complications?
a SECONDARY amenorrhea due to LOW LEPTIN via low adipose tissue
causes: excess weight loss, exercise, chronic illness and eating disorders
decr. leptin > decr. pulsatile GnRH secretion > decr. FSH/LH > low estrogen
also causes OSTEOPOROSIS
Granulosa Cell Tumor
type, histo (2 special features)
macro - color, size, location
sex cord stromal tumor
cuboidal cells in sheets/cords with COFFEE-BEAN nuclei and CALL-EXNER BODIES (follicle/rosette-like) with pink center
high lipid content = YELLOW/firm macro
mostly unilateral + large in post-menopausal women (but can cause precocious puberty in young pt)
Small underdeveloped ovaries primarily composed of CT with no follicles.
What is this, what disease is it assoc. with + what are the other features?
“Streak ovaries” ofTurner Syndrome
45, X- lack of paternal X causes loss of ovarian follicles by age 2 > high FSH and LH
withamenorrheaandinfertility
short stature, shield chest, webbed neck, low posterior hairline
lymphedema,bicuspid aortic valve(25%) oraortic coarctation(5%)
Newborn girl with posterior neck mass, bilateral nonpitting edema of hands and feet, diminished femoral pulse.
Neck US > cystic spaces separated by CT
What is the mass, why is it there, what causes the condition + explain other findings?
Turner syndrome
45, X due to loss of paternal X
cystic hygromaon neck due to abnormal lymph flow
edema common to Turner’s, diminished femoral pulse due toaorctic coarcation(2nd commonest CV abn in Turner’s after bicuspid aortic valve)
14 yr old with soft, hyperpigmented non-tender bump below rt breast; has always been there, but got bigger at puberty; becomes tender just before menses
what is it?
accessory nippleAKApolythelia / supernumerary nipple
failed involution ofmammary ridge; histo same as normal nipple; may swell / be tender during menses, pregnancy or lactation
Spina bifida - type of inheritance?
Multifactorial
- many genesplay role in neurulation; folic acid deficiency is major factor
- common in first-degree relatives of those affected
1 cause of pathological
physiological vs. patho nipple discharge
1 =intraductal papilloma- usually no mass or skin change, bloody/serosanguinous dischargeunilaterally due to proliferation of papillary cells in duct/cyst wall withfibrovascularcore (twisting of stalk > bleed), with foci of atypia orductal carcinoma in situ
physio = bilateral, nonbloody / milky without masses or skin changes
patho = bloody or serosanguinous w/ or w/o mass or skin change
Differential dx of abnormal menstrual bleeding
3 diagnoses + their features
Fibroids - heavy menses; constipation, polyuria, pelvic pain/heaviness; ENLARGED uterus
Adenomyosis - dysmenorrhea, pelvic pain; heavy menses; “bulky, globular + tender uterus” (endometrial tissue in myometrium)
Endometrial cancer/hyperplasia - history of obesity, nulliparity, chronic anovulation; irregular, intermenstrual or postmenopausal bleed; NONTENDER uterus
Endometriosis
risk factors? protective factors?
Risk - nulliparity, early menarche or prolonged menses
Protective - multiparity, extended lactation, late menarche
less frequent menstrual cycles > less opportunity for endometrium to disseminate out of uterus
Endometriosis
s/s? (uterine position, menstrual changes)
locations + associated complications?
responds to menstrual hormonal changes > bleeding + shedding > collections of blood in ectopic loci > hemolysis can cause inflammation + adhesions
Infertility - adhesions interfere with ovulation + Fallopia
Fixed, RETROVERTED uterus - adhesions on uterosacral ligament
PAINFUL SEX - infiltration of Douglas pouch; tender palpation of posterior vaginal fornix
DYSMENORRHEA - shedding of ectopic tissues
Estrogen deficiency
causes? vaginal changes? sx?
premature ovarian failure or menopause
glycogen-deficient epithelium; flattened labial folds + vaginal rugae > DYSPAREUNIA + menstrual irregularity
Congenital Torticollis
causes? associated issues?
Causes include…
BIRTH TRAUMA - breech delivery, etc.
IN UTERO MALPOSITION - fetal macrosomia or oligohydramnios
(cervical spine deformities)
cause SCM injury + fibrosis
May also have…
hip dysplasia
metatarsus adductus - forefoot adduction
clubfoot - “talipes equinovarus”
Congenital Torticollis
presentation? dx?
develops by 2-4 WEEKS of age
HEAD TILT TOWARDS affected side, with CHIN POINTED AWAY
Soft tissue mass palpable in inferior 1/3 of SCM
Plagiocephaly - “flat head syndrome” skull malformation sometimes seen
Facial asymmetry - sometimes
Maternal hypertension during gestation
can cause what?
asymmetric intrauterine growth restriction
normal/near-normal head size with REDUCED ABDOMINAL CIRCUMFERENCE
Hypertension in pregnancy
Chronic htn vs. gestational htn?
Chronic - greater than/equal to 140/90 PRIOR TO CONCEPTION or 20 WEEKS
Gestational - new-onset high BP AFTER 20 WEEKS (with no proteinuria or end-organ damage)
Pre-eclampsia vs. eclampsia
Pre-eclampsia - new-onset high BP AFTER 20 WEEKS plus PROTEINURIA or END-ORGAN DAMAGE
Eclampsia - pre-clampsia plus new-onset GRAND MAL SEIZURE
Pre-eclampsia
risks + pathophys
nulliparity, personal/fam history, obesity + chronic htn
abnormal placental vasculature > placental hypoxia + ischemia > ANTIANGIOGENIC FACTORS into maternal circ > endothelial injury with permeability increase and PROTEINURIA
end-organ damage includes HA, visual changes, and abdominal pain from liver damage
HELLP syndrome
acronym?
cause?
Hemolysis
Elevated Liver enzymes
Low Platelets
manifestation of severe pre-eclampsia
Adenomyosis
what? in whom?
endometrial glandular tissue in the myometrium
common in MIDDLE-AGED PAROUS women
Adenomyosis
s/s? definitive dx?
heavy menstruation
dysmenorrhea
UNIFORMLY ENLARGED uterus
definitive dx is by HYSTERECTOMY BIOPSY bc normal endometrial biopsy doesn’t reach myometrium
Endometrial polyps
what? how? s/s?
benign projections of uterine lining
hyperplastic growth of endometrial glands + stroma
abnormal bleeding
NO uterine enlargement
Endometrial hyperplasia
what? s/s?
greater increase in gland proliferation as compared to stroma (polyps are both glands + stroma)
irregular menstrual bleeding that is NOT painful
Uterine Leiomyoma
what? s/s?
proliferation of myometrial SM
heavy menstrual bleeding
uterus is IRREGULARLY ENLARGED
Urachal abnormalities (3)
urachus is a remnant of the allantois
- Patent urachus - all the way open
- Urachal sinus - adjacent to umbilicus
- Urachal cyst - midway btwn bladder + umbilicus
Straw-colored discharge at umbilicus, worsened by crying, straining or lying prone
local skin irritation + erythema
Patent Urachus
Periumbilical tenderness
Purulent umbilical discharge
Urachal sinus
periumbilical sinus is prone to persistent and recurrent infections
Menopause
hormonal changes
FSH increases, due to…
- resistant ovarian follicles
- lack of inhibin
low estrogen also > less feedback inhibition on GnRH and pituitary (ESTRONE, not estradiol, produced outside ovary becomes major estrogen)
progesterone decreases as well
Sertoli-Leydig cell ovarian tumor
presentation? who? histo?
SEX CORD-STROMAL tumor in YOUNG WOMEN with adnexal mass, amenorrhea and VIRILIZATION
hollow/solid tubes lined by round Sertoli cells w/ fibrous stroma
what is VACTERL association?
syndrome of birth defects with at least 3 of:
vertebral anomalies anal atresia cardiac defects tracheoesophageal fistula renal defects limb defects
Maternal Serum AFP Screening
Increased in?
Decreased in?
Increased:
Open NT Defects (anencephaly, open spina bifida)
Ventral Wall Defects (omphalocele, gastroschisis)
Multiple Gestation
Decreased:
Aneuploidy (trisomy 18, 21 etc.)
AFP
Where is it made? How/when does it change? Clinical consequence of this?
Fetal liver, GI tract and yolk sac (early gestation)
Increases with gestational age
Correct gestation aging is important in determining what normal AFP levels should be. In mothers with previously irregular menses this can be hard, and may require ultrasound.
dizygotic twins
how do they form? how many chorions/amnions? how many placentas?
2 oocytes + 2 sperm > twins’ sex may differ
2 amnions + 2 chorions (dichorionic, diamniotic)
chorions may fuse if close > 1 or 2 placentas
monozygotic twins
most common time it starts? most common amniotic/chorionic situation?
usually occurs at END OF 1st WEEK > 2 embryos, each with their own amnion, but a SINGLE CHORION and COMMON PLACENTA
monochorionic, diamniotic
monozygotic twins
early separation > what chorionic/amniotic situation
separation at days 0-4
similar to dizygotic twins > 2 chorions, 2 amnions and 2 placentae +/- placental fusion
monozygotic twins
late separation > what chorionic/amniotic situation
separation at 8-12 days
1 amniotic sac + 1 chorion > high fetal fatality rate via umbilical cord entanglement
what is the cause of conjoined twins?
monozygotic twins separating LATER THAN 13 DAYS after fertilization
monoamniotic, monochorionic
most common site of ectopic pregnancy? imaging?
risk factors?
FALLOPIAN AMPULLA, will appear as an ADNEXAL MASS on US
Any tubal pathology, such as…
Previous infection
Surgery - eg, TUBAL LIGATION (pregnancy rare after ligation, but 1/3 are ectopic if they implant!)
ectopic pregnancy
Treatment
Dx including endometrial histo
Tx - surgical removal and hemostatic maintenance
Dilation + curettage of uterus - can stop bleeding and determine ectopia vs. normal preg
Histo - “decidualized endometrium” with DILATED, COILED GLANDS and VASCULAR EDEMATOUS STROMA (normal changes for the “luteal” phase of cycle via progesterone)
Urethral injury in men
most common site?
Membranous part
less supported/protected than prostatic or penile parts
pelvic fracture often injures it
Mechanism for formation of a COMPLETE MOLE?
most common mech, less common mech
most common - fertilization of an “empty” ovum with NO MATERNAL CHROMOSOMES by a single 23, X sperm > duplicates its chroms. to form 46, XX complete mole
(46, YY have not been observed b/c they just die)
less common - fertilization of empty ovum with 2 DIFFERENT SPERM > can be 46, XX or 46, XY
Mechanism of formation of PARTIAL MOLE?
an egg WITH ITS CHROMOSOMES (23, X) is fertilized by TWO SPERM resulting in 3 possibilities…
69, XXX
69, XXY
69, XYY
Risk factors for molar pregnancy (4)
Advanced maternal age
Prior molar pregnancy
Prior miscarriage
Infertility
Complete molar pregnancy
gross morpho? ultrasound? histo?
NO FETAL STRUCTURES, with large edematous disorded “bunch of grapes” chorionic villi
US shows “swiss cheese” or “snowstorm” - a central heterogenous mass with MULTIPLE CYSTIC areas
histo - trophoblastic hyperplasia
Complete molar pregnancy
s/s? labs?
pelvic pain + vaginal bleeding
uterus larger than expected for gestational age
HIGH beta-hCG!!! (via trophoblastic hyperplasia)
two drugs used in tx of infertility
for 2 phases of menstrual cycle
MENOTROPIN (human menopausal gonadotropin) - mimics FSH to form dominant follicle
hCG - mimics LH > surge causes ovulation
(alpha subunit of hCG is similar to LH)
Gestational choriocarcinoma
from what cells? when? s/s?
malignant TROPHOBLAST tumor
preceded by NORMAL PREGNANCY usually, but can be after molar, ectopic or aborted preg
vaginal bleeding, uterine enlargement and VERY HIGH BETA-hCG!!
Gestational choriocarcinoma
spread? macro? histo?
1 site is LUNGS
hematogenous spread after uterine wall invasion
bulky mass in uterus that is SOFT, YELLOW-WHITE and with NECROSIS + HEMORRHAGE
may or may not have fetal tissue
histo - proliferation of mononuclear CYTOTROPHOBLASTS and multinuclear SYNCYTIOTROPHOBLASTS with NO VILLI
what is the difference in chorionic villi in a PARTIAL vs. COMPLETE vs. INVASIVE mole?
partial - FOCALLY enlarged + hydropic villi
complete - DIFFUSELY enlarged + hydropic
invasive - same as complete, but TROPHOBLASTS INVADE MYOMETRIUM (thus is malignant)
Aromatase deficiency
inheritance? fetal effect? maternal effect?
AR inheritance
high androgens, low estrogens in fetus
maternal virilization - later in preg
fetus has NORMAL INTERNAL but AMBIGUOUS EXTERNAL genitalia
later, primary amenorrhea, OSTEOPOROSIS with TALL STATURE (late epi plate closure)
Nicotine use during pregnancy
what baby effects?
what pregnancy effects?
increased prematurity / low birth weight risk
placenta previa + abruption risk
Phenytoin during pregnancy
what anomalies can result? 3 things
cardiac defects
cleft lip/palate
hypoplastic nails
Congenital Rubella Syndrome
basic triad… i think Sketchy has much more, so make another card on that
hearing loss
cataracts
cardiac defects
Indirect Inguinal Hernia
cause? presentation? in whom?
failed obliteration of processus vaginalis (as in hydrocele)
indirect inguinal hernia (and hydrocele) can present as an asymptomatic scrotal mass that INCREASES WITH VALSALVA
seen in children (as they are a developmental abnormality and not acquired)
Indirect Inguinal Hernia
pass through? covered by? locational landmark?
thru deep inguinal ring
covered by INTERNAL SPERMATIC FASCIA (continuation of transverse fascia) … so intestine is INSIDE the spermatic cord
LATERAL to the INFERIOR EPIGASTRIC VESSELS
Direct Inguinal Hernia
cause? location (triangle)?
ACQUIRED protrusion of abdominal contents through a weak portion of abdominal wall
does NOT pass through inguinal canal or within spermatic cord
HESSELBACH’S TRIANGLE - medial to inf. epigastric vessels; lateral to rectus abdominis; superior to inguinal ligament
another name for the infundibulopelvic ligament?
what does it contain?
suspensory ligament of the ovary
ovarian artery, vein and nerve plexus
ovarian torsion
main risk factor
presentation
dx
large ovarian masses (cyst or tumor) - weight of mass can cause ovary to twist around suspensory ligament + cut off its own blood supply
sudden-onset unilateral pelvic pain and nausea (sometimes vomiting, fever)
pelvic US for dx; doppler shows low/no flow
hormonal changes in anovulatory cycles
immature hypothalamic-pituitary-ovarian axis in early puberty leads to…
anovulation > no corpus luteum > no progesterone and persistently high estrogen
endometrium remains in PROLIFERATIVE phase > disorganized + fragile tissue with irregular, often heavy bleeding
What is “complex atypical hyperplasia of the endometrium”?
what causes it? in whom?
Prolonged exposure to estrogen without opposing progesterone
Chronic anovulation can cause it, as may be seen in OBESE OLDER WOMEN or ESTROGEN-ONLY hormone therapy
Progesterone secretion throughout pregnancy
how does it change?
1st trimester - via corpus luteum, stimulated by beta-hCG
2nd/3rd trimester - progesterone from placenta; (b-hCG drops to very low levels)
What inhibits lactation during pregnancy, despite rising prolactin levels?
Progesterone
Adenomyosis
what is it? who gets it?
endometrial glandular tissue in the myometrium
middle-aged parous women
Adenomyosis
s/s?
dx?
heavy menstrual bleeding
dysmenorrhea
UNIFORMLY enlarged uterus
endometrial biopsy is normal; must to MICROSCOPY HYSTERECTOMY for definitive dx
amniotic fluid analysis in NEURAL TUBE DEFECTS
failure of either neural pore to fuse (rostral > anencephaly; caudal > spina bifida) causes leakage + thus HIGH levels of…
ALPHA-FETOPROTEIN, and…
ACETYLCHOLINESTERASE
GI cause of polyhydramnios
duodenal atresia
amniotic fluid analysis in DOWNS SYNDROME
shows LOW ALPHA-FETOPROTEIN
normal acetylcholinesterase
On which side is varicocele more common and why?
left
left renal vein is often compressed between aorta and SMA as it courses from the kidney to the IVC
left gonadal vein branches off the left renal vein + this compression can cause stasis and backwards flow to the pampiniform plexus
What muscle do Kegel exercises strengthen?
How does this help stress incontinence?
LEVATOR ANI (iliococcygeus, pubococcygeus + puborectalis)
levator ani holds bladder and urethra in correct position… injury during childbirth causes URETHRAL HYPERMOBILITY and/or pelvic organ prolapse
when urethra is hypermobile, incomplete closure of urethra + bladder neck against anterior vaginal wall causes stress incontinence
1 cause of bloody or “serosanguinous” (blood-tinged) nipple discharge
other aspects of presentation? histo?
intraductal papilloma
presents WITHOUT a mass or skin changes
papillary cells in duct/cyst wall with FIBROVASCULAR core +/- foci of atypia or DCIS
what causes nipple bleeding in intraductal papilloma?
twisting of fibrovascular core
what causes Paget disease of nipple?
DUCTAL spread of malignant cells to nipple surface
eczematous exudate on nipple/areola
CYCLIC breast pain without nipple discharge
cause? histo?
FIBROCYSTIC changes in breast
DIFFUSE small cysts +/- metaplasia
Local trauma to breast later develops an irregular mass without discharge
what is it? histo?
FAT NECROSIS
liquefactive adipocyte necrosis + hemorrhage
Fibroadenoma of breast
proliferation of what? causing what in histo?
presentation?
proliferation of stroma + ducts
small, mobile, firm mass
COMPRESSES DUCTS into slits on histo
What occurs in vagina of daughter of pt exposed to DIETHYLSTILBESTROL?
precursor to what?
Vaginal adenosis - replacement of squamous epi with columnar glandular epi
precursor to CLEAR CELL ADC of vagina
Maternal Serum Quadruple Screen
when + what does it test for?
second trimester
AFP, estriol, b-hCG, inhibin A
How does AFP change as pregnancy progresses? Why is this important in serum + amniotic fluid testing?
where is it made in the fetus?
it INCREASES with gestational age
requires ACCURATE DATING of gestational age, which can be difficult in patients with irregular menses prior to pregnancy
made by LIVER, GI TRACT and YOLK SAC (early gestation)
Which 3 things can cause INCREASED AFP in maternal serum testing (quadruple screen in 2nd trimester)?
- Neural tube defects - spin bif, anenceph
- Ventral midline defects - omphalo, gastrosch.
- Multiple gestation
What can DECREASE AFP in maternal serum testing?
Aneuploidies (trisomy 18, 21)
Exclusively breastfed infant not receiving post-natal care is at risk of deficiency of what? why?
Vitamin K
poor placental transfer, sterile gut and low content in breast milk
results in low levels of carboxylated clotting factors
Presentation of complications in vitamin K dependent infant?
intracranial, GI, cutaneous, UMBILICAL and surgical site bleeding in exclusively breastfed infant without postnatal care
Signs of increased ICP in infant (4)
- Altered mental status
- ENLARGED HEAD circumference
- BULGING FONTANEL
- “sunset eyes” DOWNWARD-DRIVEN + can’t look up
when is intracranial hemorrhage from birth injury common?
presents SHORTLY AFTER BIRTH when the birth was operative and involved VACUUM or FORCEPS
INTRAVENTRICULAR hemorrhage in newborn
caused by what? in whom?
GERMINAL MATRIX FRAGILITY in a PREMATURE infant
germinal matrix involutes from week 28 to birth
estrogen levels in PCOS? result?
also INCREASED (along with testo)
LH affects THECAL cells and is increased, so affects both testo and estrogen precursor synth
endometrial hyperplasia with INCREASED ENDOMETRIAL CANCER RISK due to unopposed estrogen effects
Female equivalent of Leydig cell?
Female equivalent of Sertoli cell?
leydig > THECA
sertoli > GRANULOSA
SGLT … like SGLT2 in kidney…
Genes involved in sertoli cell dysfunction and genital malformations in males?
SF-1 / NR5A1
SF-1 = steroidogenic factor
result in decreased inhibin > increased FSH
genital malformation includes micropenis
Symptoms (other than mass effects) in male with FSH-secreting pituitary adenoma?
usually none, because FSH adenomas usually only produce the inactive alpha subunit (FSH is a glycoprotein hormone with inactive alpha and active beta subunits)
few will have testicular enlargement
Bone lesions in prostate cancer…
clastic or blastic?
osteoBLASTIC
stridor in newborn of mother with Graves
cause?
enlargement of infant’s thyroid by anti-TSH-R IgG transfer transplacentally
PCOS - other name and general pathogenesis
Stein-Leventhal
hyperinsulinemia / insulin resistance thought to alter hypothalamic hormone feedback responses…
high LH:FSH ratio
high androgens from theca interna
low rate of follicle maturation > unruptured follicles form cysts
PCOS tx
for 1) cycle regulation, and 2) endometrial hyperplasia
- cycle reg by WEIGHT LOSS (decr. peripheral ESTRONE formation in adipose)
- OCPs - opposes estrogen excess
PCOS tx
for 1) ovulation induction, and 2) hirsutism
- Clomiphene + metformin - induce ovulation (and control glucose)
- Ketoconazole - antiandrogenic for hair
fever, chills, dysuria and tender, large prostate
most common organism?
E. coli
Structure at greatest risk of injury during radical prostatectomy
Pelvic parasympathetic nerves
> erectile dysfunction
What are the TWO GENERAL causes of polyhydramnios?
And examples of things that contribute to these two causes?
- IMPAIRED FETAL SWALLOWING - any GI obstruction; esophageal, duodenal or intestinal atresia; ANENCEPHALY
- INCREASED FETAL URINATION - anything causing high fetal cardiac output: a) alloimmunization, b) parvovirus, c) fetomaternal hemorrhage, d) twin-twin transfusion syndrome
(milder cases can be caused by MATERNAL DM or MULTIPLE GESTATION)
What are FOUR COMPLICATIONS of polyhydramnios?
- preterm labor
- placental abruption
- uterine atony - via distension
- maternal respiratory compromise
Postpartum Ovarian Vein Thrombosis
3 risk factors, all related to pregnancy
- VENOUS DILATION - stasis in the ovarian v.
- HYPERCOAGULABILITY - preg. causes incr. clotting factors
- INTRAPARTUM VASCULAR INJURY - endothelial damage
Postpartum Ovarian Vein Thrombosis
1 non-specific feature with a more specific characteristic to it
1 other feature
- PERSISTENT FEVER after delivery that DOES NOT RESPOND TO ABX - usually hospitalized for presumed infection and ct/mri confirms thrombosis
- FLANK / ABD. PAIN
Prostatic plexus
injury during what + causing what? from what (1 + 3) and innervates what?
can be injured during prostatectomy > erectile dysfunction
from 1) INFERIOR HYPOGASTRIC PLEXUS…
which has inputs from a) HYPOGASTRIC N., b) PELVIC SPLANCHNIC N. (S2-S3) and c) SACRAL SPLANCHNIC N.
innervates penis via CAVERNOUS NERVES
Pudendal nerve
from what? innervates what?
injury causes what?
S2-S4
innervates external anal + urethral sphincters and sensory innervation to genitals
injury > fecal incontinence, decreased penile sensation, external urethral sphincter paralysis
Cremasteric reflex
what nerve mediates (+ roots) ?
lost in what 2 conditions?
Genitofemoral nerve (L1-L2)
1) testicular torsion
2) L1-L2 injury
Detrusor muscle
innervated by what?
dysfunction causes what?
PSNS fibers from PELVIC SPLANCHNIC and INFERIOR HYPOGASTRIC PLEXUS
overactivity > URGE incontinence (mostly women)
Adolescent girl with primary amenorrhea with normal secondary sex char.
Cyclic abdominal/pelvic pain +/- back pain and defecation issues
Dx?
Examination signs? (2)
Imperforate Hymen
exam shows…
- Vaginal bulge - the “hematocolpos” (blood in uterus + vagina) bulges out of the vaginal orifice
- Anterior rectal mass - can palpate the hematocolpos transrectally
Asherman syndrome
what is it? how does it happen (2)?
SECONDARY amenorrhea via obstruction due to scarring of uterus
- INFECTION - eg, postpartum endometritis
- PROCEDURES - eg, dilation + curettage
Androgen Insensitivity Syndrome
karyotype? phenotype? defect?
46, XY
phenotypically female
androgen receptor defect
Androgen Insensitivity Syndrome
Internal + external genitalia?
Secondary sex char?
46, XY phenotypically female with…
Internal - CRYPTORCHID testes; no uterus/ovaries
External - no penis/scrotum
Secondary - no axillary/pubic hair; breast development (due to aromatized androgens)
Characteristic cell on HPV pap smear (name + 3 features)
Koilocyte
immature squamous cell with..
- DENSE, irregular cytoplasm
- PERINUCLEAR HALO
- RAISIN NUCLEUS - large + pyknotic
Incidental finding in Pap of pt with IUD
Actinomyces like organisms
clusters of basophilic thin filaments like cotton candy
Cell that may be seen on Pap during menses
endometrial cell
look like histiocytes; very SMALL DARK NUCLEI and homogenous light cytoplasm (no perinuclear clearing)
Cell type on Pap whose presence indicates ADEQUATE SAMPLING
glandular endocervical cell
columnar cells with vacuolated/granular cytoplasm + prominent borders
clump together into HONEYCOMB pattern
Cell type seen in Pap of POSTMENOPAUSAL / POSTPARTUM women
PARABASAL cell
round with basophilic cytoplasm
finely granular chromatin
FRIED EGG WITH LARGE CENTRAL YOLK
Progestin challenge
what is it + why is it used?
tests for reason for amenorrhea
- Progestin given either IM or oral
- Watch for bleeding within 2-7 days (“withdrawal bleeding”)
3a. If bleeding occurs > ESTROGEN IS SUFFICIENT
and ANOVULATION is issue
3b. if no bleed > either LOW ESTROGEN, HPA axis
dysfunction, nonreactive endometrium, or
outflow tract issues
If NO WITHDRAWAL BLEEDING occurs on progestin challenge, how can the different causes of amenorrhea be differentiated?
causes can be 1) low estrogen, 2) HPA axis dysfunction, 3) nonreactive endometrium or 4) outflow tract issues
can give ESTROGEN followed by PROGESTIN and then watch again for withdrawal bleeding >
- if bleeding, issue was low E
- if no bleeding issue is nonreactive endometrium or outflow issue
What are two possible OUTFLOW TRACT issues that can cause AMENORRHEA?
- Asherman syndrome - “uterine synechiae” intrauterine fibrous scarring (via procedures, infections, obesity, etc.)
- Cervical stenosis
Cervical lymph drainage goes where first?
Internal iliac nodes
Bartholin cyst / abscess
description? cause?
PAINFUL swelling in the posterior part of labia majora
blockage of Bartholin gland duct + fluid accumulation; may lead to abscess via obstruction/inflammation
Bartholin cyst / abscess
in whom? associations?
reproductive-age females (but not necessarily sexually active!)
assoc. with N. gonorrhoeae infection
Vulvar lichen sclerosus
how is epidermis + dermis affected?
derma description?
epidermis is THINNER
dermis is FIBROTIC / SCLEROTIC
“PORCELAIN-white” plaques with RED/VIOLET border
skin fragility with erosions
Vulvar lichen sclerosus
in whom? increased risk for?
in POSTMENOPAUSAL women
incr. risk for SCC
Vulvar lichen simplex chronicus
how is epidermis affected?
derma description?
increased risk for?
HYPERPLASIA of vulvar squamous epi
LEATHERY thick vulvar skin with markins from rubbing / scratching
totally benign… NO increased scc risk (diff from lichen sclerosus)
Vulvar carcinoma
HPV-related vs. non-HPV-related
in whom?
HPV - types 16/8; multiple partners + early “coitarche” in reproductive age females
non-HPV - via long-standing lichen sclerosus in women >70
both have LEUKOPLAKIA
What breast disease can also present in the vulva?
“Extramammary” Paget disease
an intraepithelial ADC - is in situ and low risk of invasion
pruritus, redness, crusting + ulcers
What main gestational issue can arise from cocaine use during pregnancy?
PREMATURITY
HELLP syndrome
smear?
complications (2, one hemo one GI)
tx?
SCHISTOCYTES
- DIC
- HEPATIC SUBCAPSULAR HEMATOMA - may rupture and cause severe hypotension
tx is immediate delivery
US incidence of gynecologic tumors in descending order
3 tumors, by organ not specific subtype; how is it different in worldwide?
endometrial > ovarian > cervical
cervical more common worldwide due to lack of screening + HPV vacc.
Gynecological tumor prognosis in worsening order
3 tumors, by organ not specific subtype
- Cervical - best progno; dx < 45 yrs old
- Endometrial - dx at middle-age; ~55 yrs
- Ovarian - worst progno; dx > 65 yrs
(“CEOs go from good to bad as they get older”)
Histo of proliferative endometrium (glands + stroma)
- STRAIGHT + SHORT glands
- COMPACT stroma
(1st half of menstrual cycle, as estrogen causes endometrial proliferation 4-7 days after menses onset until ovulation)
Endometritis
infection of what?
presentation (3)?
histo?
infection of DECIDUA (term for endometrium during preg)
- uterine tenderness
- fever
- tachycardia
- inflammatory infiltrate of endometrium
Uterine curettage (histo) finding in…
either MOLAR PREG or SPONTANEOUS ABORTION
(2 things)
- enlarged CHORIONIC VILLI
2. AVASCULAR EDEMATOUS stroma
Histo in ENDOMETRIAL ADC (3 things)
in whom? primary symptom?
- ATYPICAL endometrial cells that…
- form DISORGANIZED GLANDS, and have…
- … many MITOSES
in POSTMENOPAUSAL women with VAGINAL BLEEDING
Effect of estrogen on hypothalamus and pituitary secretion throughout menstrual cycle
Most of the time it is INHIBITORY
but MID-CYCLE high estrogen levels STIMULATE the LH + to lesser extent FSH surge
Granulosa Cell Tumor
secretes what (2)? which causes what?
causes what special sign in whom?
increases risk of what other tumor?
- ESTROGEN > endometrial hyperplasia (thick on US) and/or precocious puberty in young pt
- INHIBIN - inhibits FSH
postmenopausal bleeding - occur mostly in older women
endometrial carcinoma risk due to unopposed estrogen stimulation
CA-125 differentiates what two categories of ovarian tumor?
epithelial tumors (serous, endometrioid, clear cell) DO SECRETE ca-125
stromal tumors (granulosa etc.) do not
