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72 Cards in this Set

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  • Back
fibroadenoma vs. phyllodes tumor
both mixed stroma and epithelial but phyllodes has more cellular/atypical stroma and may be malignant (esp stromal part)
most common site for initial presentation of breast cancer?
upper outer quadrant
of the 2 sets of genital ducts, which plays significant role in female embryo
paramesonephric (not mesoneprhic)
Gartner duct cysts
cysts of persistent parts of mesonephric ducts, presents as discrete nontender nodule on anterolateral vag wall
"keyhole" pattern
assoc'd with classic presentation of lichen sclerosis
normal pH of vaginal secretioin
3.8-4.2
4 cardinal questions of preggers?
1. are you bleeding? 2.do you have any leaking fluid? 3. contractions? 4. is the baby moving well?
midcycle surge of FSH/LH a)caused by? B) Causes?
a) estradiol switching to pos feedback on pituitary (not hypothal); b)rupture of dominant follicle, primary steroid becomes progesterone
what rescues corpus luteum from nl regression?
if conception, trophoblast cells would secrete chorionic gonadotropin
primary site of GnRH secretion?
arcuate nucleus of hypothalamus
midcycle surge of FSH/LH comes from?
releasable pool (vs reserve pool)
what kind of R on a) theca cells, b)granulosa cells?
a) LH R (produce androstenedione, testosterone), b) FSH R (produce estradiol, estrone
how get estrone/estradiol from androstenedione/testosterone?
aromatization with P450arom
histology of lichen sclerosus
hyperkeratosis of vulvar skin, loss of rete ridges, acellular homogeneous zone in superficial dermis
most common malignancy arising in vulva?
squamous cell carcinoma
verrucous carcinoma assoc'd with infection by what?
HPV, types 6 or 11
how is vulvar Paget dz different from nipple Paget?
vulvar is only rarely assoc'd with underlying adenocarcinoma
most common malignancy of vagina?
squamous cell carcinoma
cambium layer
dense band of tumor cells beneath vag epithelium in sarcoma botryoides
when get microglandular hyperplasia?
during pregnancy, post-partum or with OCP (from progestin stim)
unique metastatic pattern of infiltrating lobular carcinoma
CNS, ovarian, uterine mets
most common sites of breast cancer mets?
skin, lymph, bone, liver
megastrol
anti-progestin
which endometrial adenocarcinomas are non-estrogen dependent?
papillary serous and clear cell variants
Aria-stella reaction
refers to thickened and hypersecretory endometrium that occurs during pregnancy, due to HCG stimulation (get hobnail cells)
endometrial polyps result of what?
focal hypersensitivity of endometrial glands to estrogen (or unresponsive to progesterone)
most important prognostic factor for endometrial hyperplasia?
nuclear atypia
endothelial intraepithelial neoplasia often asso'cd with what mutation?
loss of function of PTEN (tumor suppressor)
most common variant of endometrial adenocarcinoma?
endometroid variant (60%)
most common gyn cancers in US?
#1 endometrial #2 ovarian #3 cervical
US gyn cancer that cuases the most deaths?
ovarian
DDx for menorrhagia?
fibroids (submucosal), adenomyosis, blood dyscrasias (PLT d/o)
when is tissue bx indicated for vaginal bleeding?
1) >40y/o 2) unresponsive to med tx 3) high risk group (obese, HTN, diabetic)
lab definition of menopause
FSH>30mlU/ml
"premature" menopause =
<35 y/o
contraindications to estrogen replacement therapy
1. current breast/endometrial cancer 2. past breas/endometrial cancer 3. unexplained vag bleeding 4. preggers 5. liver dz 6. active VTE
nonhormonal treatment of vasomotor sxs of menopause
clonidine (antiHTN), SSRIs, vit E (herbal estrogen)
underlying abnormality in PCOS?
increased ovarian production of androgens secondary to abnl regulation of 17alpha hydroxylase
Krukenberg tumor
gastric carcinoma that mets to ovary; mucin producing signet ring cells
Schiller-Duval bodies seen in what gyn tumor?
yolk sac tumors (highly malignant, in <30y/o!)
Meigs syndrome
assoc'n of ovarian fibroma with ascites and sometimes pleural effusions
how make diagnosis of preeclampsia?
BP>140.90 (after 20wks gestation), 300mg protein in 24hr collection
effect of smoking on preeclampsia?
decreases risk
preeclampsia prior to 20wks gestation is highly suggestive of what?
molar pregnancy
prostanoid changes in preeclampsia
TXA>PGI (more vasoconstriction)
most common hematologic abnl in preeclampsia?
thrombocytopenia
severe preeclampsia defined by
BP=160/110, proteinuria=5g/24hr
HELLP
hemoslyis, elevated liver enzymes, low plt; variant, probably severe preeclampsia but may present with little or no HTN/proteinuria
when is childhood masturbation "abnormal"
if deliverately done in public after 5-6 years
ductal boob growth stimulated by?
estrogen
boob alveolar hypertrophy stimulated by?
progesterone
what happens to PTH during pregnancy? (and why?)
levels increase progressively (maintains serum calcium levles and allows for transfer to fetus)
effect of estrogen on thryoid?
increase in TBG (hence, check free T4/T3)
effect of estrogen on coagulation?
decreases AT3, increases plasminogen, II, VII, IX, X
what kind of estrogen R more active in reproductive system?
alpha
what kind of estrogen R increase in breast tumors?
alpha
indications for tamoxifen?
metastatic breast cancer, prophylaxis (only SERM for premenopausals!)
how is raloxifene different from tamoxifen?
has estrogen antagonist activity centrally (hot flashes) but also on uterus and breat tissue
indications for raloxifen
postmenopausal osteoporosis (b/c estrogen ag on bone..and lipids and coag)
indications for fulvestrant
treatment of ER + met breast cancer in postmenopausal women
fecundability vs fecundity
fecundability-probability of preggers w/I 1 mentstrual cycle; fecundity--ability to achieve LIVE birth in 1 menstrual cycle
5 tests to check for ovulatory d/o, progesterone
1.regular menses esp w/moliminal sxs; 2. basal body T (midcycle spike). 3. endometrial bx; 4. sr progesterone (day18-22, 15-15ng/ml); 5. urinary LH
MOA of clomiphene
easy to use SERM--ER antag on hypothal. Low estrogen causes increase GnRH pulse amplitude and frequency (but must have intact axis!)
effect of hcG in tx of ovulatory d/o
like natural LH surge, causes dominant follicle to release egg and corpus luteum to produce progesterone
hMG
very potent ovulation drug that stimulates follicular growth and maturation but need also hcg to induce ovulation
why use GnRH antag for tx of ovulatory d/o??
exposes pituitary gl to constant>pulsatile GnRH and somehow this enables better response to hMG
estrogenic component of combo OCP does what?
suprresses FSH (prevents emergence of dominant follicle), stabilizes endometrium
progestational part of combo OCP does what?
suppresses LH (prevents midcycle LH surge), stabilizes endometrium, affects cervical mucous and tubal motility
absolute contraindications to OCP (9)
DVT hx, vascular dz, hyperlipidemia, significant cardiac dz, estrogen-dep cancer, preggers, active liver dz/tumor, unexplained uterine bleeding, uncontrolled HTN
MOA of emergency contraception
delay/inhibt ovulation and alter endometrium to prevent implantation
medical tx of ectopic pregnancy?
MTX
placental abuption vs. previa?
abrptio is PAINFUL; previa is PAINLESS