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78 Cards in this Set

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Clomiphene
partial ag at estrogen receptors in pit gland; prevent nl feedback inhib and incr release of LH and FSH from pit which stim ovulation
Clomiphene use/tox
tx of infertility, PCOS
tox: hot flashes, ovarian enlargement, multiple pregn, visual dist
Mifepristone (RU-486)
comp inhib of progestins at progestin receptors
used for abortion
tox: heavy bleeding, n/v/anorexia, ab pain
Tamoxifen
increases risk of endomitrial carc
Advantages of OC
reliable, decr risk of endomit/ovarian cnacer, decr ectopic preg, decr pelvic infections (mucus change), regulation of menses, dysmenorrhea
disadvantages of OC
taken daily, no protection against STDs, incr TG, depression, weight gain, nausea, HTN, hepatic adenoma, hypercoag state
HRT
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
IUD
risk of PID, perforation, infertility
copper- 10 yr
progesteron- 5 yr
good for stable monogamous relationships
Medroxyprogesterone (depo)
assoc with bone mineral density loss esp if long term
ideal if > 2yrs
good choice in pt with MR
bicornate uterus
results from incomplete fusion of paramesonephric ducts
assoc with UT abnl and infertility
hypospadias
abnl opening of penile urethra on infr side of penis due to failure of urethral folds to close
epispadias
abnl opening of penile urethra on superior side of penis due to faulty positioning of genital tubercle
extropy of bladder assoc
Klinefelters
XXY: testicular atrophy, eunuchoid body shape, tall long extremities, gynecomastia, female hair dist
incr FSH in Klinefelters
dysgenesis of semiferous tublues--> decr inhibin
incr estrogen in Klinefelters
abnl Leydig cell function-->decr testo-->incr LH
Turners
XO: short stature, ovarian dysgenesis (streak ovary), webbing of neck, coarc of aorta, primary amenorrhea
double males XYY
phenotypically nl; very tall, severe acne, antisocial behavior
nl fertility
Pseudohermaphrodism
disagreement between phenotypic and gonadal sex
female pseudoherm (XX)
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)
male pseudoherm (XY)
testes present, but ext genitalia are female/ambig
most common: androgen insensitivty snydrome
True hermaphrodite (XX or XXY)
both ovary and testicular tissue present
ambig genitalia
AIS (XY)
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
5alpha reductase def
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
abruptio placentae
premature detachment of placenta from implanation site
painful uterine bleeding (3rd trimester), fetal death
assoc with DIC
incr risk with smoking, HTN, cocaine
placenta accreta
defective decidual layer allows placenta to directly attach to myomitrium
predisposed by prior C section or inflam; massive hemorrhage after delivery
tx: hysterectomy
placenta previa
attachement of placenta to lower uterine segment
may occlude cervical os; painless bleeding in any trimester
ectopic preg
most often in fallopian tube, predisposed by salpingitis
suspect with incr HCG and sudden lower ab pain
confirm w/ U/S
tx: MTX, surgical
polyhydraminos
lots of amniotic fluid; assoc with eso/duodenal atresia, causing inability to swallow amniotic fluid and anencephaly
oligohydraminos
less amniotic fluid; assoc with bilateral renal agenesis or posterior urethral valves (in males), resultant inability ot excrete urine
cervical dysplasia
disordered epithelial growht; assoc with HPV 16, 18
may progress slowly to invasive carcinoma
invasive cervical carc
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
risk factors for cerv carc
sex, HPV, smoking
endomitrosis
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
adenomyosis
endomitriosis within myomitrium
endomitrial hyperplasia
abnl endomtiral gland prolif usually caused by excess estrogen stim
incr risk for endomitrial carc
most commonly presents as vag bleeding
endomitrial carc
most common gyn malignancy; peak age 55-65 y/o; clinically presents w/ vag bleeding
preceded by endomitrial hyperplasia
r/f for endomitrial carc
prolonged use of estrogen without progestins, obesity (PCOS, estrone), HTN, diabetes, nulliparity, late menopause, early menarche
tx: hysterectomy
leiomyoma (fibroids)
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
leiomyosarcoma
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
PCOS
incr LH, decr FSH, incr testo
anovulation, hyperandreogenism
c/f: amenorrhea, infertility, obesity, hirsutism
tx: weight loss, OCP, gonadotropin analogs, surgery, metformin, clomiphene
PCOS hormones
incr LH-->incr ovarian stromal stim-->incr ovarian androgens-->incr estrogen-->incr pit sensitivty to LRF-->incr LH release
follicular cyst
distention of unruptured graafian follicle
may be assoc with hyperestrinism and endomitrial hyperplasia
CL cyst
hemorrhage into persistent CL; menstrual irreg
Theca-lutein cyst
often bilateral/multiple; due to gonadotropin stim
assoc with choriocarc and moles
chocolate cyst
blood containing cyst from ovarian endomitrosis
varies with menstrual cycle
dysgerminoma
malignant; eq to male seminoma
sheets of uniform cells
incr hgc
yolk sac (endodermal sinus tumor)
aggressive malignancy in ovaries (testes in boys) and sacrococcygeal area of young children
incr AFP
Schiller Duval bodies (looks like a glomerulus)
choriocarc
rare but malignant; can develop during preg in mother or baby; large, hyperchromatic syncytiotrophoblastic cells
incr hCG
teratoma
contains 2-3 germ layers
mature- most freq benign ovarian tumor
immature- aggressively malignant
struma ovarii- contains functional thyroid tissue
serous cystadenoma
freq bilat; lined with fallopian tube like epithelium
benign
20% of ovarian tumors
serous cystadenocarcinoma
malig, freq bilat
psammoma bodies
50% of ovarian tumors
mucinous cystadenoma
multilocular cyst lined by mucus secreting epithelium, benign
mucinous cystadenocarcinoma
malignant; pseduomyxoma peritonei- intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor
Brenner tumor
benign tumor that resembles bladder epithelium
ovarian fibroma
bundles of spindle shaped fibroblasts, Meig's syndrome- triad of ovarian fibroma, ascites, hydrothorax
granulosa cell tumor
secretes estrogen-->precocious puberty (kids)
can cause endomitiral hyperplasia or carcinoma in adults
Call-Exner bodies-small follicles filled with eosinophilic inclusions
Sertoli Leydig cell tumor
produces androgens (hirsutism)
ovarian cancer R/F
ovulation, no OCP, no early preg, no breast feeding
germ cell tumors
dysgerminoma, yolk sac (endodermal sinus tumor), choriocarc, teratoma
epithelial tumors
serous, mucinous, brenner
ovarian stromal tumors
ovarian fibroma, granulosa cell tumor, sertoli Leydig cell tumor
fibrocystic disease
most common cause of breast lumps ages 25-meno
presents with diffuse breast pain and multiple lesions, often bilat
no incr risk of carcinoma
acute mastitis
breast abscess, during breast feeding
incr risk of bacterial infection through cracks in nipple
staph aureus is most common pathogen
fat necrosis
benign painless lump
forms due to injury to breast tissue
gynecomastia
results from hyperestrinism (cirrhosis, testicular tumor, puberty, old age), Klinefelters, drug induced (cimetidine, alcohol abude, marijuana, heroin, haloperidol, spironolactona, ketoconazole, dig)
fibroadenoma
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
intraductal papilloma
tumor of lactiferous ducts; presents with serous or bloody nipple dischage
cystosarcoma phyllodes
large bulky mass of CT and cysts; tumor may have leaflike projections
some are malignant
malignant breast tumors (general)
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
DCIS
early malignancy without BM penetration
invasive ductal, NST
firm fibrous mass, MOST common
worst and most invasive
comedocarc
ductal with cheesy consistency due to central necrosis
inflammatory
lymphatic involvement, poor prognosis
peau d'orange
invasive lobular
often multiple, bilateral
loss of e-cadherin on chromo 16
signet ring cells
medullary
fleshy, cellular lymphocytic infiltrate
good prognosis
Paget's disease of the breast
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
R/F
gender, age, early 1st menarche, delayed first preg, late meno, fam hx
not incr with fibroadenoma or nonhyperplastic cells
LCIS
ER and PR +
mets to peritoneum