Female Path And Pharm

Front 1

Clomiphene

Back 1

partial ag at estrogen receptors in pit gland; prevent nl feedback inhib and incr release of LH and FSH from pit which stim ovulation

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Clomiphene use/tox

Back 2

tx of infertility, PCOS
tox: hot flashes, ovarian enlargement, multiple pregn, visual dist

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Mifepristone (RU-486)

Back 3

comp inhib of progestins at progestin receptors
used for abortion
tox: heavy bleeding, n/v/anorexia, ab pain

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Tamoxifen

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increases risk of endomitrial carc

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Advantages of OC

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reliable, decr risk of endomit/ovarian cnacer, decr ectopic preg, decr pelvic infections (mucus change), regulation of menses, dysmenorrhea

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disadvantages of OC

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taken daily, no protection against STDs, incr TG, depression, weight gain, nausea, HTN, hepatic adenoma, hypercoag state

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HRT

Back 7

used for relief or prevention of meno sxs (hot flashes, vag atrophy) and OP (due to diminished estrogen levels)
unopposed ERT incr risk of endomitrial cancer must add progesterone

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IUD

Back 8

risk of PID, perforation, infertility
copper- 10 yr
progesteron- 5 yr
good for stable monogamous relationships

Front 9

Medroxyprogesterone (depo)

Back 9

assoc with bone mineral density loss esp if long term
ideal if > 2yrs
good choice in pt with MR

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bicornate uterus

Back 10

results from incomplete fusion of paramesonephric ducts
assoc with UT abnl and infertility

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hypospadias

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abnl opening of penile urethra on infr side of penis due to failure of urethral folds to close

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epispadias

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abnl opening of penile urethra on superior side of penis due to faulty positioning of genital tubercle
extropy of bladder assoc

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Klinefelters

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XXY: testicular atrophy, eunuchoid body shape, tall long extremities, gynecomastia, female hair dist

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incr FSH in Klinefelters

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dysgenesis of semiferous tublues--> decr inhibin

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incr estrogen in Klinefelters

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abnl Leydig cell function-->decr testo-->incr LH

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Turners

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XO: short stature, ovarian dysgenesis (streak ovary), webbing of neck, coarc of aorta, primary amenorrhea

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double males XYY

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phenotypically nl; very tall, severe acne, antisocial behavior
nl fertility

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Pseudohermaphrodism

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disagreement between phenotypic and gonadal sex

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female pseudoherm (XX)

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ovaries present, but ext genitalia virilized/ambiguous
due to excessive and inappropirate exps to androgenic steroids during early gestation (21B hydroxylase def, 11b hydroxylase def)

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male pseudoherm (XY)

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testes present, but ext genitalia are female/ambig
most common: androgen insensitivty snydrome

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True hermaphrodite (XX or XXY)

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both ovary and testicular tissue present
ambig genitalia

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AIS (XY)

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defect in androgen receptor resulting in nl appearing female; female ext genitalia, no uterus, testes present (often removed)
levels of testo, estrogen, LH all high

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5alpha reductase def

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unable to convert testo to DHT, ambig genitalia until puberty when incr testo causes masculinization of genitalia
testo/estrogen levels nl, LH nl or high

Front 24

abruptio placentae

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premature detachment of placenta from implanation site
painful uterine bleeding (3rd trimester), fetal death
assoc with DIC
incr risk with smoking, HTN, cocaine

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placenta accreta

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defective decidual layer allows placenta to directly attach to myomitrium
predisposed by prior C section or inflam; massive hemorrhage after delivery
tx: hysterectomy

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placenta previa

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attachement of placenta to lower uterine segment
may occlude cervical os; painless bleeding in any trimester

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ectopic preg

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most often in fallopian tube, predisposed by salpingitis
suspect with incr HCG and sudden lower ab pain
confirm w/ U/S
tx: MTX, surgical

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polyhydraminos

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lots of amniotic fluid; assoc with eso/duodenal atresia, causing inability to swallow amniotic fluid and anencephaly

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oligohydraminos

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less amniotic fluid; assoc with bilateral renal agenesis or posterior urethral valves (in males), resultant inability ot excrete urine

Front 30

cervical dysplasia

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disordered epithelial growht; assoc with HPV 16, 18
may progress slowly to invasive carcinoma

Front 31

invasive cervical carc

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often sq cell carc; pap smear can catch cervical dysplasia (kiolocytes) before it progresses to invasive carc
lateral invasion can block ureters causing renal failure

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risk factors for cerv carc

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sex, HPV, smoking

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endomitrosis

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nonneoplastic endomitrial glands/stroma in abnl locations outside uterus
cyclic bleeding (menstrual type) from ectopic endomitrial tissue "chocolate cysts"
severe menstrual related pain, often results in infertility

Front 34

adenomyosis

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endomitriosis within myomitrium

Front 35

endomitrial hyperplasia

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abnl endomtiral gland prolif usually caused by excess estrogen stim
incr risk for endomitrial carc
most commonly presents as vag bleeding

Front 36

endomitrial carc

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most common gyn malignancy; peak age 55-65 y/o; clinically presents w/ vag bleeding
preceded by endomitrial hyperplasia

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r/f for endomitrial carc

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prolonged use of estrogen without progestins, obesity (PCOS, estrone), HTN, diabetes, nulliparity, late menopause, early menarche
tx: hysterectomy

Front 38

leiomyoma (fibroids)

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most common tumor in females; often presents with multiple tumors with well demarcated borders
benign SM tumor
malig transformation is rare
estrogen sens- incr size with preg, decr with meno
tx: leuprolide
infertility if obstruct fallopian tube

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leiomyosarcoma

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bulky irreg shaped tumor with areas of necrosis and hemorrhage, typically arising de novo (not from leiomyoma); highly aggressive with tendency to recur
may protrude from cx and bleed

Front 40

PCOS

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incr LH, decr FSH, incr testo
anovulation, hyperandreogenism
c/f: amenorrhea, infertility, obesity, hirsutism
tx: weight loss, OCP, gonadotropin analogs, surgery, metformin, clomiphene

Front 41

PCOS hormones

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incr LH-->incr ovarian stromal stim-->incr ovarian androgens-->incr estrogen-->incr pit sensitivty to LRF-->incr LH release

Front 42

follicular cyst

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distention of unruptured graafian follicle
may be assoc with hyperestrinism and endomitrial hyperplasia

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CL cyst

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hemorrhage into persistent CL; menstrual irreg

Front 44

Theca-lutein cyst

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often bilateral/multiple; due to gonadotropin stim
assoc with choriocarc and moles

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chocolate cyst

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blood containing cyst from ovarian endomitrosis
varies with menstrual cycle

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dysgerminoma

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malignant; eq to male seminoma
sheets of uniform cells
incr hgc

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yolk sac (endodermal sinus tumor)

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aggressive malignancy in ovaries (testes in boys) and sacrococcygeal area of young children
incr AFP
Schiller Duval bodies (looks like a glomerulus)

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choriocarc

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rare but malignant; can develop during preg in mother or baby; large, hyperchromatic syncytiotrophoblastic cells
incr hCG

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teratoma

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contains 2-3 germ layers
mature- most freq benign ovarian tumor
immature- aggressively malignant
struma ovarii- contains functional thyroid tissue

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serous cystadenoma

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freq bilat; lined with fallopian tube like epithelium
benign
20% of ovarian tumors

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serous cystadenocarcinoma

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malig, freq bilat
psammoma bodies
50% of ovarian tumors

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mucinous cystadenoma

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multilocular cyst lined by mucus secreting epithelium, benign

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mucinous cystadenocarcinoma

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malignant; pseduomyxoma peritonei- intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor

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Brenner tumor

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benign tumor that resembles bladder epithelium

Front 55

ovarian fibroma

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bundles of spindle shaped fibroblasts, Meig's syndrome- triad of ovarian fibroma, ascites, hydrothorax

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granulosa cell tumor

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secretes estrogen-->precocious puberty (kids)
can cause endomitiral hyperplasia or carcinoma in adults
Call-Exner bodies-small follicles filled with eosinophilic inclusions

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Sertoli Leydig cell tumor

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produces androgens (hirsutism)

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ovarian cancer R/F

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ovulation, no OCP, no early preg, no breast feeding

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germ cell tumors

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dysgerminoma, yolk sac (endodermal sinus tumor), choriocarc, teratoma

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epithelial tumors

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serous, mucinous, brenner

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ovarian stromal tumors

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ovarian fibroma, granulosa cell tumor, sertoli Leydig cell tumor

Front 62

fibrocystic disease

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most common cause of breast lumps ages 25-meno
presents with diffuse breast pain and multiple lesions, often bilat
no incr risk of carcinoma

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acute mastitis

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breast abscess, during breast feeding
incr risk of bacterial infection through cracks in nipple
staph aureus is most common pathogen

Front 64

fat necrosis

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benign painless lump
forms due to injury to breast tissue

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gynecomastia

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results from hyperestrinism (cirrhosis, testicular tumor, puberty, old age), Klinefelters, drug induced (cimetidine, alcohol abude, marijuana, heroin, haloperidol, spironolactona, ketoconazole, dig)

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fibroadenoma

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benign- most common tumor <25 yrs; small mobile firm mass with sharp edges, incr size and tenderness with preg
not a precursor to breast cancer
worsen with estrogen and caffeine

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intraductal papilloma

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tumor of lactiferous ducts; presents with serous or bloody nipple dischage

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cystosarcoma phyllodes

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large bulky mass of CT and cysts; tumor may have leaflike projections
some are malignant

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malignant breast tumors (general)

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common postmeno
arise from duct epithelium or lobular glands
overexpression of E/P receptors or erb-B2 (HER-2)
LN involvement is most improtant prognostic factor
see nipple retraction, lactiferous duct involvement, dimpling

Front 70

DCIS

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early malignancy without BM penetration

Front 71

invasive ductal, NST

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firm fibrous mass, MOST common
worst and most invasive

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comedocarc

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ductal with cheesy consistency due to central necrosis

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inflammatory

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lymphatic involvement, poor prognosis
peau d'orange

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invasive lobular

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often multiple, bilateral
loss of e-cadherin on chromo 16
signet ring cells

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medullary

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fleshy, cellular lymphocytic infiltrate
good prognosis

Front 76

Paget's disease of the breast

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eczematous patches on nipple; Paget's cells- large cells with clear halo; suggest underlying carc, also seen on vulva
any brca can present this way

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R/F

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gender, age, early 1st menarche, delayed first preg, late meno, fam hx
not incr with fibroadenoma or nonhyperplastic cells

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LCIS

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ER and PR +
mets to peritoneum