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373 Cards in this Set
- Front
- Back
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What guides the decision for Anastrazole vs Tamoxifen?
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Anastrozole, and aromatase inhibitor, is used in postmenopausal breast cancer only. Tamoxifen can be either.
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What is exemestane?
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Anastrozole like aromatase inhibitor
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What is a major adverese effect of Tamoxifen?
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Increased uterine cancer (agonist in uterus, antag in breast)
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What is Raloxifene used for?
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Agonist on bone- prevent osteoperosis in post-meno women (who have increased risk for breast cancer)
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What is Leuprolide used for?
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In lieu of GnRH. Depends on if you use it pulsatile (for infertility) or constant high dose(get rid of androgens and estrogens)- no pulsatile secretion of LH and FSH
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Whats Traztuzumab?
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Her 2 antibody. Targeted for breast cancer with her2 amplification
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Whats the normal histology of the duct and acini?
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Basement membrane, Myoepithelium, and Epithelium on top closest to lumen
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What area of the breast has te most dense breast tissue?
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Upper outer quadrant
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Whats the most common gross anatomical location for breast cancer?
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Upper outer quadrant
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Estrogen stimulates (ductal/alveolar/both) (growth/differentiation.)
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Both; Growth
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Progesterone stimulates (Alveolar/ductal) (growth/differentiation)
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Alveolar Differentiation
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Where do outer quadrant cancers drain to?
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Axillary lymph nodes
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Where do inner quadrant cancers drain to?
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Internal mammary nodes
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Where does Paget's disease of breast occur histologically?
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nipple/areola complex (halo cells come out into epidermis)
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Where do breast abcesses occur histologically?
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Nipple/areola complex and Lactiferous sinus
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Where do intraductal papillomas occur histologically?
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Lactiferous sinus
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Where does Fibrocystic change normally occur histologically?
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Major duct
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Where does Invasive ductal cancer usually occur histologically?
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Major duct
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Where does tubular carcinoma normally occur histologically?
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Terminal duct
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Where does sclerosing adenosis occur histologically?
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Lobule
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Where does lobular carcinoma occur histologically?
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Lobule
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Where does phyllodes tumor occur histologically?
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Stroma
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Where do Fibroadenomas occur histologically?
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Stroma
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Whats the most common pathologic cause for galactorhea?
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Prolactinoma
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Does hypo/hyperthyroidsm lead to galctohrrhea?
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Hypo- stimulates TRH, which also release prolactin
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Whats the most common cause for a bloody nipple discharge?
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Intraductal papilloma
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Whats the cause of a purulent nipple discharge?
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Acute mastitis-
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What causes Acute mastitis?
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S. Auerus gets through cracks in the skin near nipple
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Whats the most common cause for breast lumps from age 25 to menopause?
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Fibrocystic change
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Fibrocystic change has pain and size that (does/does not) vary with menstruel cycle.
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Does vary
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Fibrocystic change is usually unilateral/bilateral.
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Bilateral
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What disease is characterized by lumpy, bumpy breasts on exam?
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Fibrocystic change
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What are the main types of fibrocystic breast change?
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1. Cysts 2. Fibrosis 3. Sclerosing Adenosis 4. Epithelial hyperplasia
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Why are blue-domed cysts blue?
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They have hemorrhage in them
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What is scelerosing adenosis characterized by?
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Proliferation of small ductures/acini and microcalcifications, also intralobular fibrosis
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What is the significance of epithelial/ductal hyperplasia in fibrocystic change?
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Degree of Atypia determines cancer risk
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Are the ducts of fibrocystic change sensitive to estrogen?
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Yes
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What is apocrine metaplasia and what disease process is it part of?
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Presence of large, pink staining cells in ductal hyperplasia in fibrocystic change
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Does sclerosing adenosis have an increased risk for cancer?
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yes, very slightly though. Like fibroadenoma
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What type of breast lesion is characterized by a green brown nipple discharge?
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Mamillary duct ectasia- dilaton and rupture of ducts that wre full of debris
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What is Fat necrosis caused by?
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Trauma to breast
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What is a benign painless lump in the breast that formed as a result of injury?
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Fat necrosis
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Whats the most common breast tumor in younger women (<35)?
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Fibroadenoma
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What develops in half of the women who receive cyclosporine after renal transplant?
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Fibroadenoma
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What kind of drug are Fibroadenomas closely associated with?
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Cyclosporine after renal transplant
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What is the most common cause of a freely movable mass in the breast in a young woman?
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Fibroadenoma
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What is the tumor derived from in fibroadenomas, ducts or stroma?
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Stroma
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Are fibroadenomas estrogen sensitive?
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Yes, they grow during pregnancy
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True/False. Fibroadenomas are not estrogen sesntive and do not change cyclically.
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False, they are estrogen sensitive
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A path image shows proliferation of stroma compressing ducts into slit like spaces. Whats the most likely cause?
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Fibroadenoma
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The breast has large bulky mass of connective tissue and cysts with leaf like projections. Whats the diagnosis?
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Phyllodes Tumor
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Are Phyllodes tumors ever malignant?
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Yes, they may become malignant
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What type of cells are Phyllodes tumors derived from. Ductal or Stroma?
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Stromal
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What develops in the lactiferous duct and causes bloody nipple discharge?
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Intraductal papilloma
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True/False. Intraductal papilloma has no increased risk for carcinoma.
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False, it has a slightly increased risk for carcinoma
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True/False. Increasing age decreases risk of breast cancer because of falling estrogen levels.
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False, age is a risk factor for breast cancer. Increasing age predisposes
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Whats the most common cancer death in women?
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Lung, 2nd is breast
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Whats the most common prognostic factor in breast cancer mortality?
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Axillary lymph node involvement (except for distal metastasis)
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What seems to be a common risk factor for the development of breast cancer?
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Prolonged estrogen exposure (early menarche, nullparity, OCPs, etc)
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True/False. Breast cancer has a huge genetic component. 50% are due to BRCA1 or 2 mutations.
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False, less than 10% are due to BRCA1 (chrom17) or BRCA2 (chrom13) mutations
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True/False. Obesity leads to increased breast cancer.
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True, androgens are converted to estrogen in fat
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What does a painless mass in the breast with nipple retraction in a postmenopausal woman indicate ?
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Breast cancer
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What does mammography detect?
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Microcalcifications and spiculated masses (cant distinguish benign from malignant)
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At what age does screening for breast cancer usually begin?
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40 and 50-69 it is annually
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What condition that isnt cancer has microcalcificatiosn that makes it appear on mammography?
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Sclerosig adenosis
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Whats the most common nerve injury in radical mastectomy?
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long thoracic nerve (winged scapula)
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Is the prognosis of medullary invasive carcinoma of the breast good or bad?
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Good, there is a large lymphoid infiltrate
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What manifestation of breast cancer has large cells wih clear halo that cause an itchy , crusty scale like eczema on the breast?
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Paget's disease of nipple.
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What breast cancer is peu- de orange and blockage of dermal lymphatics most common in ?
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Inflammatory carcinoma
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What kind of prognosis does inflammatory carcinoma of breast have?
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Bad
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What type of breast cancer has an orderly row of cells "linear indian file pattern"?
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Invasive Lobular carcinoma
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Are invasive lobular carcinomas usually (bilateral or unliateral) (single or mutiple)
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Bilateral and multiple
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What type of breast cancer is found incidentally during biopsy?
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lobular carcinoma in situ
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What do lobular carcinomas in situ indicate?
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Increased chance for getting breast cancer in either breast
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What type of breast cancer is described as fleshy and cellular with lymphocytes?
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Medullary carcinoma
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What type of breast cancer fills the duct lumen and sometimes has a necrotic center, but does not invade?
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DCIS
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What type of breast cancer is a firm, fibrous rockhard mass and small glandular duct like cells
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Invasive ductal carcinoma
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What type of breast cancer has the worst prognosis?
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Invasive ductal carcinoma
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What type of breast cancer hs a stellate shaped scar and breaks through basement membrane?
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Invasive ductal carcinoma
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What types of breast cacner are Ecadherin negative?
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lobular in situe or invasive lobular
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What type of breast cacner is ductal and caseous necrois in the center?
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Comedocarcinoma (DCIS)
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What does amplification of Erb2 indicate In breastcancer prognosis?
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bad
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Where and when does fertilization normally occur in the female reprod. Tract?
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1 day after ovulation Upper end of fallopian tube (ampulla)
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B-Hcg, which share an alpha subunit with _______, is secreted by ________, and is detectable in blood on day ______ post conception.
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Lh,Fsh, Tsh ; syncitiotrophoblast , day 8 (1 week)
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When are home pregnancy tests going to pick up B-Hcg?
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2 weeks to get to urine
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On what day does implantation of blastocyst occur?
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Day 5
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True or False. B-Hcg rises from conception to week 11 and 12, pretty much in a linear fashion.
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False, it doubles every 48 hours until 9 weeks, Exponential rise
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What is the function of Hcg for the baby?
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Needs to maintain corpus luteum which makes progesterone which keeps endometrium alive
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How long is the corpus luteum needed post conception?
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Until the end of the first trimester, after that, placenta makes its own progesterone and estriol
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What are the arteries that provide the placenta?
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Spiral arteries
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What change do the spiral arteries undergo that makes them resistant to maternal BP control?
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Destruction of their media by trophoblasts= no smooth muscle, so fetal always has blood coming in
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What is the pathologic significance of the alterations to the spiral arteries?
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Improper trophoblast migration and denuding of arterial media is thought to cause pre-eclampsia
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What is Human placental Lactogen (Hpl) secrete by and what does it mediate?
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Syncitiotropho, it stimulate IGF type I, stimulates insulin resistance so there is enough glucose for everyone
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What is Hpl linked to pathologically in the mother?
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Gestational diabetes if HPL is de-regulated
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How long is a full term pregnancy?
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40 weeks (from last menstruel period)
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What happens to plasma volume in pregnancy?
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Goes up
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What happens to blood pressure in pregnancy?
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Drops
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What happens to red cell mass in pregnancy?
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goes up
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What happens to Hgb in pregnancy?
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drops artificially, increased volume and rbcs, but more volume so diluted
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What happens to peripheral vascular resisitance in pregnancy/
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drops
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IS pregnancy a pro or anti-thrombotic state, what mediates this, and why?
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Pro-thromnotic, estrogen mediated, to prevent hemorrhage at childbirth
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What happens to GFR in pregnancy?
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Goes up
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What happens to GI sphincters and motility in pregnancy?
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The sphincters get looser heartburn, and motility drops leadin to constipation- due to progesterone
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What skin changes occur in pregancy?
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Melasma, spider angiomas, stretch marks
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Why do women lose hair after pregnancy?
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More hair follicles were in growth phase(anagen) than rest phase(telogen) during pregnancy
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How is labor defined?
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Uterine contractions that produce a Cervical change- dilation from 0 to 10 cm
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What hormone change allows prolactin to stimulate lactation postpartum?
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Progesterone and estrogen drop (it was inhibiting)
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Whats the advantage of breastfeeding for a longer time?
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Natural birth control via prolactin release, and less likely to get breast/uterine cancer (less estrogen exposure)
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What is the function of the theca cell in the ovary?
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To make testosterone, progesterone, adrastinedione
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What stimulates the Theca cell in the ovary?
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LH
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What product of the theca cell diffuses to the granulosa cells in the ovary?
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Testosterone
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What is the function of the granulosa cells in the ovary?
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Aromatase- To convert testosterone to 17 Beta Estradiol
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What does FSH stimulate in the granulosa cells?
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Aromatase- To convert testosterone to 17 Beta Estradiol
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Sex hormone: What helps development of breasts and secondary sex characteristics?
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Estrogen
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Sex hormone: What causes upregulation of LH, progesterone, and estrogen receptors on follicle and uterus?
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Estrogen
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Sex hormone: What increases myometrial excitability?
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Estrogen
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Sex hormone: What decreases myometrial excitability?
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Progesterone
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Sex hormone: What causes stimulation of prolactin secretion, but then blocks the receptor at the breast
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estrogen
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Sex hormone: What causes proliferation, not secretion, of the uterus?
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Estrogen
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Sex hormone: What increases coagulation factors?
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Estrogen
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Sex hormone: What causes an LH surge in the cycle?
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Increased estrogen (midcylce- estrogen is stimulating to Anterior pituitary)
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Sex hormone: What hormone is increased in the luteal phase only
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Progesterone
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Sex hormone: What hormone maintains secretory activity, not proliferation, in the luteal phase/
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Progesterone
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Sex hormone: What is responsible for temperature increase?
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Progesterone
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Sex hormone: What increases cervical mucous thickness, decreasing sperm entry?
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Progesterone
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Sex hormone: What suppresses ovarian function during pregnancy?
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Both Progesteron and estrogen
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Sex hormone: What keeps the Corpus luteum alive?
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HCG
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Sex hormone: What works through IGF-1 to increase insulin insensitivity?
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HpL
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Sex hormone: What hormone inhibits T-cell immunity against fetus?
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Progesterone
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Sex Hormone: What hormone supplies Fetal adrenal gland with precursors?
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Progesterone from placenta
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Sex Hormone: What hormone blocks prolactin's affect at the breast?
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Both Progesteron and estrogen
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Sex Hormone: What is stimulated by suckling?
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prolactin and Oxytocin
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Once the corpus luteus is gone, what makes progesterone?
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The placenta
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Once the corpus luteus is gone, how is estrogen made?
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The fetal adrenal gland takes placental progesterone, makes DHEA-s, hydroxylates in liver, and placenta removes Sulfate, and aromatizes to estriol
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What hormone is responsible for the termperature rise at ovulation?
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Progesterone
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What is Mittelschmerz?
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Blood from ruptured follicle caues intraperitoneal irritations leading to pain mimiccing apendicitis
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The egg that is released is (primary/secondary) oocyte
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secondary Diplod 2n
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How many umbillical arteries and veins are there?
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2 arteries, 1 vein
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What does only 1 umbillical artery indicate?
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Congenital RENAL anomalies are more frequent
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What are most placental infections due to?
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Ascending infections usually Group B strep
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What is a placental abnormality that has implantation near the cervical os or over it
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Placenta Previa
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What pregnancy complication does a previous C-section or many pregnancies put a woman at risk for?
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Placenta Previa
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What is commonly the cause of painless bleeding in 2nd or 3rd trimester (really any)?
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Placenta Previa
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What is the solution to Placenta Previa?
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Deliver by C-section
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How is placenta previa confirmed?
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Transabdominal Ultrasound
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What exam should not be done on a woman with placenta previa?
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Pelvic exam
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What is the complication of placenta previa to the fetus?
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Premature separation and death from hypoxia
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What is the most common cause for painful bleeding in late pregnancy?
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Placenta Abruptio- premature detachment of placenta from attachment site
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What is the term for premature detachement of placenta from attachment site?
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Placent Abruptio
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What separates the placenta from its implantation site in placenta abruptio?
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A retroperitoneal clot
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Whats the most significant factor for placenta abruptio?
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Hypertension (50% of cases), cocaine use, cigarrete smoking
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What condition is associated to attachment of placenta to myometrium due to a defective decidua?
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Placenta Accreta
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What does Placenta Accreta predispose the mother to?
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Hemorrhage during delivery, and failure to detach placenta
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What procedure often has to be performed due to placenta accreta?
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Hysterectomy to stop bleeding
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What is a more severe form of placenta accreta which goes to the serosa?
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Placenta percreta
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What is placenta increta?
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Placenta goes deeper into the muscle layer than in accreta
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What do prior C section, inflammation, and placenta previa predispose someone to?
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Placent accreta
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Can monochorionic twins ever be non-identical?
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no
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Can dichorionic twins be identical?
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Yes, if the zygote separated before day 3.
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If a zygote, splits between days 3 and 8, what kind of babies will form?
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Monochorionic, diamniotic
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If a zygote splits after day 8, what kind of babies will form?
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Monochorionic, monoamniotic
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What are the risks of being a monochorionic, monoamniotic twin?
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Conjoinined twins, extremely high death rate due to intertangled cords
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What is hypertension, edema, and proteinuria in pregnancy characterized by after 20 weeks?
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Pre-eclampsia
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What is preeclampsia when it occurs with seizures?
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Eclampsia
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What is hypertension, edema and proetinuria in pregnancy before 20 weeks?
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Hydatidiform mole
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In what percent of pregnancies does pre-eclampsia occur?
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7 percent (very high)
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What is the main pathogenetic factor in pre-eclampsia (the thing that starts everything off)?
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Fetal hypoperfusion
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Why does fetal hypoperfusion and placental infarct occur in pre-eclampsia?
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Due to failure of trophoblast to migrate out and replace all of spiral artery media
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What do multiple placental infarctions and spiral artery atherosclerosis indicate?
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Pre-eclampsia
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What complication of pregnancy is associated with HELLP syndrome and DIC?
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Pre-eclampsia
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What are the seizures is Eclampsia treated with?
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Magnesium
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Whats the only treatment for preeclampsia?
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Deliver if viable
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What is death in the mother usually due to in pre-eclampsia/eclampsia?
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DIC can cause multisystem failure like Cerebral Hemorrage or ARDS
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What disease predispose someone to preeclampsia?
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Diabetes, Kidney disease, auto-immune disease, Pre existing HTN
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Whats the classic signof preeclampsia?
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Third trimester HTN, edema, and Proteinuria
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What are the Sx felt by the patient in pre-eclampsia?
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Blurry vision, headache, abdominal pain, edema, hyperreflexia
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What happens to angiotensin II, thromboxane A2, Pge2, and No in preeclampsia?
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ANG 2 and TXA2 go up, and NO and pGE2 go down. Vasoconstrictors go up, and Vasodilators go down
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Which antihypertensives are safe to use in preeclampsia?
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Hydralizine, Nifedipine, and labetalol (NOT ACE-inhibtors)
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Whats the number one cause of death in first trimester?
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Ectopic pregnancy
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What do scarring from PID, endometriosis, IUDs, and previous tubal surgery predispose to?
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Ectopic pregnancy
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True of False. Endometriosis predisposes to Ectopic Pregnancy,
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True, anything that makes it hard to get from ovary to uterus does this
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Where do most ectopic pregnancies occur?
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Fallopia tube ampulla
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Put these in order from greatest to least incidence. Ampulla, insthmus, fimbriae, interstitium
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Ampulla>Fimbriae>isthmus>interstitium
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True or False. Ectopic pregnancy occurs in women who have had tubal ligation surgery.
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Yes this surgery predisposes
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True or False. DES predisposes to Ectpoc Pregnancy.
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Yes this drug predisposes. It makes uterine abnormalities. T shaped uterus and hypoplastic uterus.
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Woman has sudden abdominal pain, bleeding, and adnexal tenderness. Whats the cause?
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Ectopic pregnancy
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What is the most common cause of hematosalpinx?
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Ectopic pregnancy
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What is the screning test for Ectopic pregnacny?
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Serum HCG, confirm with ultrasound
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What is used to terminate the fetus if there is no bleeding in ectopic pregnancy?
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Methotrexate
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IF there is bleeding in ecotpic pregnancy, you can use methotrexate. (true/false)
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False, you have to remove the fallopian tube-
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What condition is ectopic pregnancy often confused with?
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appendicitis
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True/False. Ectopoc pregnancies don’t usually have any complications after the baby is aborted.
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false, these women are at high risk for another ectopic and for spontaneous abortion. In fact, only 55% can conceive after one ectopic.
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Does the outer or inner cell mass give rise to the amnion?
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inner
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Is the umbillical cord covered by amnion?
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Yes
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Whats a common Sx of having a bicornuate uterus?
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Misscarriage in 2nd trimester
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What condition appears as painless bleeding in 4-5 month of pregnancy with a snowstorm appearance on ultrasound?
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Complete mole
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What is the genetic makeup of a complete hydatidiform mole?
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No egg, and 2 sperms XX (46XX)
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What is a hydatidiform mole?
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A tumor of the chorionic villus
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Which type of mole has no fetal elements present?
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A complete hydatidiform mole
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Which type of mole has a genetic make up of 69XXY?
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A partial mole (2 sperms, 1 egg)
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In which type of mole are HCG levels really high?
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A complete hydatidiform mole
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What marker indicates a complete mole?
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HCG too high for stage of pregnancy
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What is inidicated by dilated swollen villi without fetal blood vessels?
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A complete hydatidiform mole
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Which type of mole has an increased risk for choriocarcinoma?
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A complete hydatidiform mole
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What are the risks of a complete hydatidiform mole?
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Choriocarinoma in 20%
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What is a local complication of a mole?
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Uterine rupture
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Which type of mole has fetal parts?
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Partial mole
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What type of tumor is composed of synctiotrophoblasts and cytotrophoblasts, and no chorionic villi?
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Choriocarinoma
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Where do choriocarcinomas metastasize to and what is the danger?
|
Lung and vagina, they are hemorrhagic
|
|
|
True or False. Choriocarcinomas derived from pregnancy have an excellent response to chemo even after distant metastasis.
|
True, they respond to methotrexate. Low mortality
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|
True or False. Choriocarcinomas not derived from pregancy also have an excellent response to chemo.
|
False, they are not a good prognosis
|
|
|
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|
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|
What do Tracheoesophageal fistulas, maternal diabetes( and therefore fetal hyperglycemia), and Duodenal atresia, and anencephaly do to the amniotic fluid?
|
Increase it = Polyhydraminos
|
|
|
What do Juvenile Polycystic kidney disease, fetal genitourinary malformation, uteroplacental insufficiency, and premature rupture of membranes cause in the amniotic sac?
|
Decrease it-- oligohydraminos
|
|
|
What is amniotic fluid made of?
|
Fetal piss
|
|
|
What does the fetus do with the amniotic fluid?
|
Swallows it and recycles it
|
|
|
What does an increase in Alphafetoprotein indicate in the mother during pregnancy?
|
The fetus has a nueral tube defect
|
|
|
What does a decrease in Alphafetoprotein indicate in the mother?
|
Edwards, Downs, etc
|
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|
The ratio of ___________ in the amniotic fluid is used to determine if there is enough surfactant.
|
Lecithin/Sphingomyelin has to be above 2 in amniotic fluid
|
|
|
What can be administered in the mother to increase surfactant?
|
Corticosteroids or Tydroxine
|
|
|
What, if given to the mother, will decrease surfactant in the baby?
|
Insulin
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|
|
|
|
|
|
What disorder is indicated when LH and testosterone are high, and FSH is low?
|
PCOS
|
|
|
A woman presents with amenorrhea, infertility, and obesity. What other finding is likely to be present?
|
Hirsuitism - this is PCOS
|
|
|
What is the main pathogenetic factor in PCOS?
|
Insulin resistance. High insulin causes deranged producton of androgens from Theca cells
|
|
|
What is a common cause of infertility in obese women?
|
PCOS
|
|
|
What are some longer term complications for PCOS?
|
Endometrial and breast carcinoma due to high estrogen levels (androgens are converted in the fat)
|
|
|
Why is FSH suppressed in PCOS?
|
due to high estrogen levels (from conversion of androgens)
|
|
|
A really fat woman has hirsuitism and oliggomenorhea. Whats the cause?
|
Polycystic ovarian Syndrome
|
|
|
Whats the treatment for PCOS for a woman who wants to get pregnant?
|
Clomiphene - selective estrogen antagonist at the hypothalamus
|
|
|
What effect is clomiphene known to cause?
|
Multple gestatiosn
|
|
|
What can you treat PCOS with in a woman who does not want to get pregnant?
|
OCPs or a Gonadotropin agonist. Or just weight loss
|
|
|
|
|
|
|
What do women with painful periods, painful sex, and infertility often have?
|
Endometriosis
|
|
|
What is endometriosis?
|
Non-neoplastic implantation of endometrial glands in ovary, peritonuem, intestines, etc
|
|
|
True or false. Endometriosis presents with non-cyclic random bleeding and pain.
|
False, endometriosis is sensitive to estrogen, and presents cyclicly.
|
|
|
What is thought to be the mechanism behind endometriosis?
|
Retrogade menstruation implants viable glands
|
|
|
What is the most common site of implantation in endometriosis?
|
Ovaries
|
|
|
A woman has painful shits during her period, has not been able to get pregnant, and has enlargment of her ovaries. What is it?
|
Endometriosis- (Ovaries big due to Chocolate cysts - blood filled cysts in ovary)
|
|
|
What is endometriosis in the myometrium?
|
Adenomyosis
|
|
|
Where in the peritoneum does the blood from endometriosis often collect?
|
Pouch of Douglas
|
|
|
How does endometriosis lead to infertility?
|
Causes adhesions in the peritoneum and may prevent egg from reaching fibrie, or may damage the ovarys
|
|
|
How is endometriosis treated?
|
OCPs or surgery
|
|
|
Whats a tumor common in black women that enlarges during pregnancy, and may cause obstructive deilvery?
|
Fibroids- leiomyomas of the endometrium
|
|
|
True or False. Leiomyomas, or fibroids, are not sensitve to estrogen.
|
False, they enlarge during pregnancy
|
|
|
Leiomyomas are (benign/malignant) tumors that (Do/don't) cause bleeding.
|
benign, do cause bleeding
|
|
|
True or False. Leiomyomas often progress to cancer.
|
False, leiomyosarcomas do not arise from leiomyomas
|
|
|
What growth can cause cramping during menses, pressure on colon and bladder, and excessive bleeding?
|
Fibroids- leiomyomas of the endometrium
|
|
|
|
|
|
|
What is by far the most common cause of femal infertility and of ectopic pregnancy?
|
Pelvic inflammatory Disease
|
|
|
True or false. PID is always caused by Stds.
|
False, but most cases are caused by gonorrhea or Chlmidia
|
|
|
What is the treatment for PID?
|
Ceftriaxone and Doxycyclien to cover both
|
|
|
When Right upper quadrant pain is present in PID what is suspected?
|
Fitz-Hugh-Curtis syndrome, Which is inflammation and scar tissue between peritoneum and surface of liver
|
|
|
A woman has uterine and adnexal tenderness, with a fever. She also complains of lower abdominal pain. Whats the diagnosis?
|
most likely PID. Check for mucopurulent discharge or cervical motion tenderness
|
|
|
What becomes full of pus in PID?
|
Fallopian tubes- they then become hollowed out and scarred- hence ectopic pregnancy
|
|
|
What is tubal diverticulosis called and caused by?
|
Postinfectious and its alled Salpingitis isthmica Nodosa
|
|
|
|
|
|
|
What kind of infeciton often follows deilvery or abortion?
|
Acute endometritis by group B strep, or GAS, staph, others
|
|
|
What kind of infection of the endometrium is characterized by the presence of plasma cells?
|
Chronic endometritis by gonorrhea or an IUD- A. isreali
|
|
|
What are bilateral multiple cysts associated with moles and choriocarcinoma?
|
Theca-lutein cyst
|
|
|
What is the most common ovarian mass?
|
Follicular cyst -distension of upruptred graffian follicle
|
|
|
What is a mass in the ovary that is due to the distension of an unruptured graffian follicle?
|
Follicular cyst -distension of upruptred graffian follicle
|
|
|
Whats the most common ovarian mass during pregnancy?
|
Corpus luteum cyst
|
|
|
What kind of mass is due to hemorrhage into a persisent corpus luteum?
|
Corpus luteum cyst -most common mass during pregnancy
|
|
|
Whats the outcome of a corpus luteum cyst?
|
Regress sponataneously
|
|
|
What is oophoritis normally a complication of?
|
Mumps or PID
|
|
|
What ovarian syndrome causes bilateral enlargement with vacoular hilar cells that overproduce androgens?
|
Stromal hyperthecosis- associated with acanthosis nigricans/Insuli resistance
|
|
|
What is Stromal hyperthecosis associated with?
|
Insulin resistance- It causes virilism due to production of androgens
|
|
|
In general, are ovarian tumors likely to be benign or malignant in women under 45?
|
benign
|
|
|
What are three major categories of ovarian tumors?
|
Surface, stromal (sex cord), and germ cell Also- metastasis-krukenberg
|
|
|
Whats the general disposing factor to ovarian cancer?
|
Increased number of ovulations (also genetics BRCA1, 2 and HNPCC)
|
|
|
What are the most common to least common ovarian tumors: surface, germ, stromal?
|
Surface (75%) >Germ(20%), >Stromal (5%)
|
|
|
What general type are most of the malignant ovarian tumors?
|
Surface derived
|
|
|
What disease are palpable ovaries in a post-menopausal woman?
|
Cancer until proven otherwise
|
|
|
Whats the most common sign for ovarian cancer?
|
Abdominal enlargement due to malignant ascites due to seeding
|
|
|
What is Ca125 a marker of?
|
Surface derived ovarian tumors (sensitive not specific)
|
|
|
Are serous cyst tumors of the ovary more likely to be bilateral or unilateral?
|
Serous cystadeomas or serous cystadenocarinomas are Bilateral, and together account for most ovarian tumors
|
|
|
Sereous Cystadenomas are (bilateral/unilateral) and _________ like epithelium.
|
Bilateral with fallopian tube like epithelium- benign
|
|
|
What is the most common malignant tumor in the body that is bilateral?
|
Serous Cystadenocarcinoma
|
|
|
What kind of ovarian tumor has psammoma bodies?
|
Serous Cystadenocarcinoma
PSmomma bodies are serious (serous) |
|
|
Are mucinous ovarian tumors bilateral/unilateral?
|
Unilateral
|
|
|
What kind of epithelium are mucinous cystadenomas lined by?
|
Mucous secreting epithelium. Benign
|
|
|
What kind of Ovarian tumor is related to Psuedomyxoma Peritonei?
|
Mucous cystadenocarcinoma (intraperitoneal accumulation of mucinous material- psuedomyxoma)
|
|
|
What is an intraperitoneal accumulation of mucinous material related to an ovarian or appindeceal tumor/
|
Psuedomyxoma Peritonei
|
|
|
What ovarian tumor has transitional cell epithelium?
|
Brenner Tumor
|
|
|
Is Brenner Tumor usually malignant or benign?
|
Benign Bladder Brenner
|
|
|
What category of tumors are Teratomas, yolksack tumors, Dysgerminomas, and Choriocarcinomas?
|
Ovarian Germ cell tumors
|
|
|
What is the most common of the germ cell tumors and is it benign/malignant?
|
Teratoma - 90%
|
|
|
What determines if a teratoma is benign or malignant?
|
Boys- Teratomas always mailgnant. Girls- depends on amount of maturation (low maturation -neuroepithelium is a bad sign)
|
|
|
Of the three germ layers a teratoma can turn into, which one is most prominent?
|
Ectodermal
|
|
|
When a teratoma does become malignant, what type of cancer does it form?
|
Sqaumous cell
|
|
|
What is a woman presenting with hyperthyroidsm and an adnexal mass most likely have/
|
A teratoma called struma ovarii- thyroid producing tumor
|
|
|
What are the malignant types of germ cell ovarian tumors?
|
Dysgerminomas, choriocarcinomas, Yolk-sac tumors
|
|
|
What is the most common malignant germ cell tumor?
|
Dysgerminoma
|
|
|
What is the parallel for a dysgerminoma in a man?
|
Seminoma of testses (seminoma is way more common though (of the germ cell tumors in men))
|
|
|
What type of germ cell tumor of the ovary is related to Turner syndrome?
|
Malignant Dysgerminoma (associated to streak gonads in Turners)
|
|
|
What type of ovarian tumor is categorized by sheets of uniform cells?
|
Malignant Dysgerminoma
Germs never are uniform, so it must be a dysgerminoma |
|
|
What do increased LDH and HCg in a woman with an adnexal mass make you worry about?
|
Malignant Dysgerminoma
|
|
|
What age group are the germ cell tumors of the ovary most common in?
|
Adolescents
|
|
|
What type of ovarian or testicular mass has an increased alpha fetoprotein level?
|
Yolk-sac tumor =endodermal sinus tumor
|
|
|
What is an endodermal sinus tumor otherwise known as?
|
Yolk-sac tumor
|
|
|
What are yellow friable solid masses in the ovary most likely to show on blood test?
|
Increased Alpha-fetoprotein (Yolk-sac Tumor- malignant)
|
|
|
What is the most likely histological entity noticeable on an ovarian mass that has a yellow friable solid mass?
|
Schiller-Duval Bodies -(Yolk Sac Tumor- malignant)
|
|
|
What do shiller duvall bodies look like?
|
Glomeruli
|
|
|
What is the most common ovarian cancer in girls under 4 yrs old?
|
Yolk- sac tumor
|
|
|
What type of ovarian tumor is associated with increased bilateral multiple theca-lutein cysts?
|
Choriocarcinoma malignant
|
|
|
What type of ovarian tumor is characterized by large hyperchromatic synctiotrophoblastic cells?
|
Choriocarcinoma malignant
|
|
|
Whe do Choriocarcinomas develop?
|
usually in pregnancy (with or without a mole- mole is higher chance)
|
|
|
Do choricarcinomas usually have chorionic villi or no?
|
no
|
|
|
What are the types of stromal cell tumors?
|
Thecoma-fibroma, Graunolosa-theca cell tumor, sertoli-leydig tumor
|
|
|
What type of ovarian tumor has Call-exener bodies and is related to precocious puberty?
|
Granulosa cell tumor (makes estrogen)
|
|
|
What type of ovarian tumor increases the chance to develop endometrial tumors?
|
Granulosa cell tumor (makes estrogen)
|
|
|
What type of ovarian tumor resembles endometrial tissue and is associated to HNPCC?
|
Endometriod ovarian cancer- often bilateral
|
|
|
What type of ovarian cancer has to do with bundles of spindle shaped fibroblasts?
|
Fibroma (theca-fibroma)
|
|
|
What type of ovarian cancer has right-sided pleural effusions and ascites?
|
Theca-fibroma
|
|
|
What is Meig's syndrome?
|
Triad of ovarian Theca-fibroma, plerual effusion, and ascities
|
|
|
What type of tumor metasizes the the ovary from gastric adenocarcinoma (mucin-secreting signet cell)?
|
Krukenberg
|
|
|
|
|
|
|
Whats the most common risk factor in endometrial hyperplasia and cancer?
|
Prolonged estrogen stimulation
|
|
|
What are some conditions that increase the risk for uterine cancer?
|
PCOS, granulosa cell tumor of ovary, obesity, Tamoxifen, Nulliparity
|
|
|
What is abormal endometrial gland prolerferation caused by?
|
Excess estrogen stimulation
|
|
|
What is the precursor lesion to endometrial cancer?
|
Endometrial hyperplasia
|
|
|
What does post-menopausal bleeding a sign for?
|
Endometrial hyperplasia or Carcinoma
|
|
|
What type of endometrial hyperplasia is likely to proceed to carcinoma?
|
Atypical complex with glands all intermingling
|
|
|
True or false. Most endometrial hyperplasia lesions regress.
|
True. Only a few of them go to cancer
|
|
|
How can endometrial hyperplasia be treated?
|
OCPs ( they have progesterone in them too)
|
|
|
Why do OCPs reduce the risk of endometrial cancer?
|
Progesterone has an anti-estrogen effect in the endometerium (decreases sensitivity)
|
|
|
What is the most common gynecological tumor?
|
Endometrial carcinoma
|
|
|
What is a common cause for abnormal bleeding in 20-40 yr old women that has no risk for proceeding to carcinoma?
|
Enometrial polyp
|
|
|
Are endometrial polyps sensitive to estrogen?
|
Yes
|
|
|
What are the symptoms of menopause?
|
HHAVOC- hirusitism, hot flashes, Atrophy of vagina, osteoperosis, and coronary artery disease
|
|
|
True or False. Smokers reach menopause before non-smokers.
|
True. Smoking brings menopause closer
|
|
|
True or False. Menopause is very abrupt.
|
false. It’s a gradual change preceded by 4-5 yrs of abnormal cycles
|
|
|
|
|
|
|
Whats the most common cause of death in Cervical cancer?
|
Post-renal azotemia due to involvement of ureter
|
|
|
Whats the most common risk factor for Cervical cacner?
|
HPV 16 and 18, also smoking and OCPs
|
|
|
True or False. Cervican intraepithelial Neoplasia 1 involves dysplasia of top 1/3 of epithelium?
|
False. Bottom 1/3
|
|
|
Do most CIN1's regress to normal or proceed to cervical cancer?
|
Regress to normal
|
|
|
What is one cause for post-sex bleeding and malodorous discharge?
|
Cervical cancer
|
|
|
What does a pap smear look for?
|
Koilocytes and dysplastc cells. Must be at the squamocolumnar junction.
|
|
|
What kind of cacner is cervical cancer?
|
Sqaumous cell carcinoma at the transitional zone between cervix and vagina
|
|
|
True or false. Endocervix cells migrate into vagina and undergo metaplasia. This is where cervical cancer occurs.
|
True, the squamocolumnary junction. The squamous cells are actually metaplastic columnar cells
|
|
|
What are nabothian cysts in the cervix?
|
Squamous metaplasia blocks the old mucous columnar cells beneath it making cysts
|
|
|
What are most cases of acute cervicitis caused by?
|
Gonorrhea and Chylmidia
|
|
|
|
|
|
|
What is a thinning of the vulva epidermis that looks like parchment and has a small risk for developing into Squamou cell carcinoma?
|
Lichen sclerosis
|
|
|
What is a white plaque like lesion on the vulva due to squamou cell hyperplasia that has a small risk for turning into squamosu cell cancer?
|
Lichen simplex leukoplakia
|
|
|
What is a benign tumor of the vulva from apocrine sweat glands that presents as a painful nodule on the labia majora?
|
Papillary hidradenoma
|
|
|
What can vulvar neoplasm can present as a painful nodule on the labia majora
|
Papillary hidradenoma
|
|
|
What intraepithelial halo like cells cause a red crusted vulvar lesion?
|
Extramaillary Paget's disease
|
|
|
How do you tell the difference between mailgnant melanoma of the vulva and paget's disease of vulva?
|
Pagets disease is pas positive
|
|
|
What is rotinsky kuster hauser syndrome?
|
Absence of Vagina
|
|
|
What can exposure to DES in utero cause?
|
Clear cell carcinoma of vagina
|
|
|
What is a tumor of the vagina in girls under 4 years?
|
Rhabdomyosarcoma (Sarcoma botryoides)=embryonal
|
|
|
A 4 year old girl has a necrotic grapelike mass protuding from her vagina. Likely diagnosis?
|
Sarcoma Botryoides- embryonal rhabdomyosarcoma
|
|
|
What post-infectious entity can cause pain in the labia majora
|
Bartolin's gland cyst post- gonorrhea
|
|
|
What type of tumor is characterized by spindle shaped tumor cells that are desmin positve?
|
Rhabdomyosarcoma (Sarcoma botryoides)=embryonal
|
|
|
What does Vaginal Squamou cell carcinoma usually caused by?
|
Secondary to Cervical which is caused by HPV
|
|
|
True or False. Smoking is a factor for Cervical carcinoma.
|
True, it is.
|
