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237 Cards in this Set
- Front
- Back
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Bartholin gland's infection most commonly caused by
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N. gonorrhea
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Gram - diplococci that causes granuloma inguinale
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Calymmatobacterium granulomatis
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Yeasts and psuedohyphae part of normal vaginal flora
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Candida Albicans
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Second most common cause of vaginitis in US
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Candida Albicans
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Risk factors for Candida Albicans
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DM, Antibiotics, OCP, and pregnancy
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Puritic vaginitis with white discharge and fiery red mucosa
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Candida Albicans
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Tx for Candida Albicans
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Fluconazole
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Sterile pyuria, epididmytitis, proctatitis
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C. trahomatis
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Cervicitis, PID, periheptitis
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C.trachomatis
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Conjuctivitis in newborn
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C.trahomatis
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Tx for C.trachomatis
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Azithromycin 1g single dose; or doxcycline
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Gram - rod that causes vaginitis
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Gardenella vaginalis
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Most common cause of vaginitis
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Gardenella vaginalis
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Clue cells in vaginal smear
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Gardenella vaginalis; cells cling to to squamous cells of vagina
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Tx for Gardenella vaginalis; during pregnancy
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Metronidazole; same
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Gram - rod that causes chancroid, STD
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Haemophilus ducreyi
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Male dominant disease 10:1 high incidence of HIV
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Haemophilus ducreyi
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Signs of Haemophilus ducreyi infection
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painful genital and perianal ulcers with suppurative inguinal lymph nodes
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School of fish appearance on Gram stain
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Haemophilus ducreyi
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Tx for Haemophilus ducreyi
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Ceftriaxone or azithromycin 1 g
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HSV-2 infection is best seen on
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Tzanck preparation
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What does HSV-2 look like on Tzanck preparation?
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Multinucleated squamous cells with eonsinophilic intranuclear inclusions
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Tx for HSV-2
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Acyclovir
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Assoc with condylommata venerum
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HPV
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Which types of HPV are low risk
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6 and 11
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Most common overall STD;
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HPV; 80% of women will have aquired it by age 50
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Which types of HPV are cancerous?
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16 and 18
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What does HPV look like under the microscope?
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Koilocytic change in squamous epi:
Nuclear enlargement (two to three times normal size) Irregularity in the nuclear contour (occasionally) Hyperchromasia (occasionally) Perinuclear clearing |
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These cells have wrinkled pyknotic nuclei surrounded by clear halo
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HPV
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Tx for HPV
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topical= podophyllin
alpha-IFN imiquimod |
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STD gram - diplococci infects glandular tissue
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N.gonorrhea
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Tx for N.gonorrhea
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Ceftriaxone
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Complications of N. gonorrhea
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Ectopic pregnancy, male sterility, Dissemianted gonococcemia C6-C9 deficiency, septic arthritis,
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Main cause of FHC syndrome, Fitz-Hugh-Curtis Syndrome,
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C.trachomatis
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The second main cause of FHC syndrome
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N.gonorrhea
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What is FHC syndrome, Fitz-Hugh-Curtis
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Scar tissue between the peritoneum and surface of the liver from PUS
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STD: Gram- spirochete that causes syphilis
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Treponema pallidum
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Solitary painless indurated chancre on penis, labia and mouth
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Primary syphilis
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Maculopapular rash on trunk. palms, soles, generalized lymphadenopathy; condylomata lata
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Secondary syphilis
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Condylomata lata
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Secondary syphilils
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Screening Test for Syphilis
Confirmatory Test |
Screen:RPR or VDRL
Confirm: FTA-ABS |
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Jarish Herxheimer rxn:
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Syphillis; occurs after Tx b/c of proteins released form dead organisms
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Tx of Syphillis
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Penicillin
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STD: flagellated protozoan with jerk like motility
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Trichomonas Vaginalis
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Produces vaginitis, cervicitis, and urethritis; strawberry colored cervix; greenish frothy discharge
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Trichomonas Vaginalis
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Tx. Trich. Vaginalis
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Metronidazole both partners
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Most common cancer of vagina
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Squamous cell carcinoma
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VIN; Vulvar intraepithelial neoplasia risk factors
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Strong HPV 16 assoc
Smoking Immunodeficiency ie AIDS |
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Red, crusted vulvar lesion, PAS positive cells
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Extramammary Paget's disease
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What is the difference between malignant melanoma and Extramammary Paget's disease
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Melonoma cells are PAS + whereas Paget's cells are PAS+
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Absence of upper vagina and uterus
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RKH syndrome; Rokitanksy-Kuster-Hauser syndrome
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Cause of Clear Cell adenocarcinoma
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DES, diehtylstilbestrol
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DES inhibits the formation of these structures in newborns
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Mullerian structures: uterus, cervix, upper 1/3 of vagina
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Vaginal Adenosis
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Term used specifically with DES, vagina is red, superficial ulcerations
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Other DES abnormalities
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Incompetent cervix, abnormal uterine shape
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Cervix; name the site where squamous dysplasia and cancer develop
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Transformation zone:
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The exocervix begins at the
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cerivcal OS
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Exocervix is lined by
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Squamous Epithelium
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Endocervix is lined by
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mucus secreting columnar glands
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Nabothian cyst are found
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A normal finding in adult women
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Presents a cyst on the lateral wall of the vagina; remnant of wolffian duct
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Gartner's duct cyst
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Benign tumor of skeletal muscle in vagina
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Rhabdomyoma
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Necrotic grape-like mass protrudes from the vagina; in girls younger than 5
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Embryonal Rhabdomyosarcoma
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The transformation zone is site where
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squamous cell dysplasia and cancer develop
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Reticulate bodies of cervix are caused by
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Chlamydia
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What do reticulate bodies look like?
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Cells with vacoules and red inclusions
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What are Elementary bodies?
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Produced by reticulate bodies. Elementary bodies are the infective agent
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What is the most common cause of acute cervicitis?
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C. trachomatis and N. gonorrhea occur together 50% of the time
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What is chief complaint of acute cervicitits?
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Vaginal discharge
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How do you know if proper sampling of transformation was done?
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Presence of metaplastic squamous cells or mucus-secreting columnar cells
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The pap smear not screens for cervical dysplasia but also
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hormonal status
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Interpretation of Pap Smear: Superficial squamous cells
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indicate adequate estrogen
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Interpretation of Pap Smear:Intermediate squamous cells
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adequate progesterone
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Interpretation of Pap Smear:Parabasal cells indicate
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lack of estrogen and progesterone
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Normal nonpregnant adult women Pap:
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70% superficial squamous
30% intermediate squamous |
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Pregnant women Pap
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100% intermediate squamous from progesterone
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Elderly women Pap
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Atrophic smear with parabasal and inflammation
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Are cervical polyps cancerous?
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No not precancerous
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CIN, Cervical Intraepithelial neoplasia, are assoc with
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HPV
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Low risk HPV
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types 6,11
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The pap smear not screens for cervical dysplasia but also
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hormonal status
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Interpretation of Pap Smear: Superficial squamous cells
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indicate adequate estrogen
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Interpretation of Pap Smear:Intermediate squamous cells
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adequate progesterone
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Interpretation of Pap Smear:Parabasal cells indicate
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lack of estrogen and progesterone
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Normal nonpregnant adult women Pap:
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70% superficial squamous
30% intermediate squamous |
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Pregnant women Pap
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100% intermediate squamous from progesterone
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Elderly women Pap
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Atrophic smear with parabasal and inflammation
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Are cervical polyps cancerous?
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No not precancerous
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CIN, Cervical Intraepithelial neoplasia, are assoc with
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HPV
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Low risk HPV
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types 6,11
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High risk HPV
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types 16,18
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HPV produces these type of cell
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Koilocytosis; clear halo containing a wrinkled, pyknotic nucleus
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What are the risk factors of CIN?
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1. Ealry age of sexual activity
2. Multiple partners 3. High-risk biopsy types 16,18 4. Smoking, OCP, immuno |
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What are the classifications of CIN?
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CIN1: Mild dysplasia lower 1/3 of epithelium
CIN2: moderate dysplasia; lower 2/3 CIN3: Severe dysplasia full thickness |
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CIN1 to CIN3 takes how long?
CIN3 to cancer takes how long? |
Both are require 10 years
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What is the average age of cervical cancer?
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45
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The majority of cervical caners are
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Squamous cell carcinoma ~75%
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What are the clinical findings of Cervical cancer?
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Malodorous discharge
Postcoital bleeding |
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What is the most common cause of death in cervical cancer?
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Renal failure; post renal azotemia, b/c the cancer infiltrates the bladder wall and obstruct the ureters
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What is the sequence to menarche?
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Breast budding
Growth spurt Pubic hair Axillary hair Menarche |
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The most variable phase of the menstraul cycle
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Estrogen-mediated PROLIFERATION PHASE
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How does ovulation occur?
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Estrogen surge causes LH and FSH release but affect is LH>FSH
LH surge intiates ovulation |
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Subnuclear vacuoles in endometrial cells indicates
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Ovulation
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Peritoneal irritation from blood from the ruptured follicle
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Mittelshmerz
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What is the least variable phase of the cycle
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Progesterone-mediated SECRETORY PHASE
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Endometrial biopsies are commonly performed on day 21 in fertility clinics
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to confirm ovulation; secretory endo confirms
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An exaggerated secretory phase occurs in pregnancy called
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Arias-Stella phenomenon
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Why during menses is the blood fresh?
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Plasmin prevents clotting
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Excess clotting during menses is a sign of
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Menorrhagia
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Increases aromatase synthesis in the granulosa cells
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FSH
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Increases the synthesis of 17KS in the theca interna
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LH-proliferative phase
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Testosterone enters _____cells and is aromatized to _____ during the proliferative
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Granulosa cell from the theca interna
Aromatized to estradiol |
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What changes in the theca interna during secretory phase?
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Theca interna synthesizes 17-hydroxyprogesterone
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During pregnancy, where is hCG made?
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SYNCYTIOTROPHOBLAST lining the chorionic villi
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After pregnancy occurs how long does the corpus leutum synthesize progesterone?
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~8-10 weeks
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What structure takes over the synthesis of progesterone after corpus luteum?
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Placenta
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What is the goal of OCP?
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Prevent surge of LH and ovulation
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Primary estrogen in nonpregnant women
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Estradiol
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Weak estrogen produced during menopause
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Estrone
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Primary estrogen of pregnancy
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Estriol
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Estriol is derived from
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fetal adrenals, placenta, and maternal liver
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DHEAS is synthesized
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almost entirely in Adrenal cortex
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SHBG is synthesized, in both men and women in
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the liver
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_______ increases the synthesis of SHBG in the liver
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Estrogen
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What decrease SHBG synthesis?
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Androgens
Obesity Hypothyroidism |
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SHBG has a greater affinity for
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testosterone > estrogen
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Increased SHBG will have what affect on testosterone?
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Increased SHBG will Decrease free testosterone
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Decreased SHBG is common cause of
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Hirsutism in women
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Testosterone synthesis occurs where in females
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ovaries and small in adrenals
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What happens to the plasma volume and RBC mass during pregnancy?
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Both are increased; but PV> RBC mass leads to a drop in Hb, 1g/dL
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What affect does pregnancy have on kidneys?
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CCr is increased
Urea and creatinine are clearance increase; so serum levels are lower |
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Why do pregnant women have respiratory alkalosis?
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Estrogen and progesterone stimulate resp. center
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Why do pregnant women have higher levels of cortisol and T4?
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Estrogen increases synthesis of TBG, thyroid binding globulin, and transcortin
Free levels should be normal |
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Menopause is defined
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as no menses for 1 yr after 40
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What is the best marker for menapause?
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Increase serum FSH
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Excess hair in normal hair bearing areas in women is called
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Hirsutism
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What is virilization?
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Hirsutism + male secondary sex characteristics
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What is the most important finding for virlization?
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Enlarged clitoris
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What is the cause of hirsutism or virlization?
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Both are caused by excess androgens from ovaries or adrenals
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The most common cause of hirsutism is
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polycystic ovarian syndrome
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Polycystic Ovarian Disease affects on LH and FSH
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Increases LH: ↑ Estrogen has + feedback on LH and - feedback on FSH
Decreases FSH Ratio 2:1 |
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The most common complain of POS is
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Oligomenorrhea
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What are the clinical findings for POS
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Hirsutism, infertility, obesity
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What are the Lab findings for POS
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1. LH:FSH 2:1
2. Increased Testosterone and Androstenedione 3. Increased Estrogen |
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How does hypothyroidism cause hirsutism and virilization?
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Decreased SBHG causes an increase in free testosterone
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What is Menorrhagia?
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Loss of blood greater than 80ml
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What is dysmenorrhea?
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Painful menses
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Primary dysmenorrhea is caused by
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Increase PGF2α; increases uterine contractions
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Secondary dysmenorrhea is caused by
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Endometriosis;most common
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Most common type of DUB, dysfunctional uterine bleeding
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Anovulatory DUB
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Primary amenorrhea most cases are due to
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Constitutional delay; family hx of delayed onset
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Most common causes of Abnormal Bleeding in Prepubertal Ages
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Vulvovaginitis; poor hygiene, infection, abuse, foreign bodies
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Most common cause of Abnormal bleeding in Menarche to 20
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1. Anovulatory DUB
2. Von Willebrand's disease |
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DUB by definition is
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unrelated to anatomy but caused by hormone imbalance
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Most common cause of Abnormal Bleeding 20 to 40
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1 Pregnancy and complications
2. Ovulatory DUB 3. PID 4. Hypothyrodism 5. Submucosal Leiomyomas 6. Adenomyosis 7.Endometrial Polyp 8. Endometriosis |
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Causes of abnormal bleeding in 40 years and older
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1. Anovulatory DUB
2. Endometrial hyperplasia/cancer; most common menopause |
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Seconday amenorrhea is defined as
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Absences of menses for 3 months
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Most common cause of secondary amenorrhea
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Pregnancy
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What is the Ddx for amenorrhea?
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Hypothalamus/Pituitary dys
Ovarian dis End-organ defect Constitutional Delay |
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Cause of Amenorrhea with :
FSH ↓ LH ↓ Estrogen ↓ |
Think Hypothalamus/Pituitary b/c FSH/LH are decreased
Hypopituitarism Anorexia, Prolactinoma |
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Cause of Amenorrhea with:
FSH ↑ LH ↑ Estrogen ↓ |
Ovarian disorder
Turner's Syndrome most likely |
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Primary Amenrrohea + poor female secondary sex characterisics
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Most likely Tuners syndrome
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Cause of Amenorrhea:
FSH Norm LH Norm Estrogne Normal |
End-organ Defect
Imperforate hymen's Asherman's syndrome |
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Cause of Amenorrhea with:
FSH/LH normal Estrogen Normal |
Constituitional Delay, if not end-organ,
Family hx of delayed onset |
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Most common cause of acute endometritis
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Grp B streptococcus
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Most common cause of Chronic Endometritis
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1. Retained Placenta
2. Gonorrhea, or IUD |
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IUD cause of endometritis
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Actinomyces israeli
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What is adenomyosis
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Invagination of stratum basalis into myometrium
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Functioning glands and stroma are outside the uterus
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Endometriosis
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The most common cause of endometriosis
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Reverse menses thru fallopian tubes
|
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Other causes of Endometriosis
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Coelomic metaplasia, vascular or lymph spread
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The most common sites for Endometriosis
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1.Ovaries most common
2. Rectal Pouch 3. Fallopian tube 4. Intestine |
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What are the clinical findings for Endometriosis?
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Dysmenorrhea
Painful stooling during menses; implants in rectal pouch |
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Cause of endometrial hyperplasia
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Prolonged estrogen stimulation
|
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Risk factors for endometrial hyperplasia
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Early Menses and late Menses
Nullparity Obesity POS, with out porgesterone |
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Classify endometrial hyperplasia:
Increased # of cystically dilated glnas NO glandular crowding |
Simple hyperplasis
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Classify endometrial hyperplasia:
Increased number of dilated glands with branching Glandular crowding |
Complex hyperplasia
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Classify endometrial hyperplasia:
Glandular crowding and dysplastic epi Increased risk for endometrial cancer |
Atypical hyperplasia
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Most common gyn onc cancer
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Endometrial carcinoma
|
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Most common risk factor for Endometrial Carcinoma
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Prolonged Estrogen Stimulation
|
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Most common type of endometrial cancer
|
Well-differentiatied adenocarcinoma
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Highly aggressive endometrial cancer
|
Papillary adenocarcinoma
|
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Most common metastasis for endometrial cancer
|
Lung
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How does the endometrial cancer spread
|
Down into endocervix
Spreads out into uterine wall |
|
|
Most common benign connective tissue tumor in women
|
Leiomyoma
|
|
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Why are leiomyoma called fibroids?
|
B/c of hyalinization
|
|
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What are the clinical signs of leiomyoma?
|
Menorrhagia
Obstructive Delivery |
|
|
Most common sarcoma of the uterus
|
Leiomyosarcoma
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|
|
Multiple well-circumscribed. gray white nodules dispersed thru myometrium
|
Leiomyomas
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|
|
Numerous atypical mitoses and foci of necrosis in uterus
|
Leiomyosarcoma
|
|
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Endometrial adenocarcinoma + malignant mesenchymal tumor
|
Carcinosarcomas
|
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Carcinosarcomas occur in
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postmenopausal women
|
|
|
This cervical tumor is associated with previous irradiation
|
Carcinosarcoma, ( Malignant Mixed mullerian tumors
|
|
|
OCP's decrease the risk for
|
Endometrial cancer and ovarian cancer
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|
Most common group of ovarian tumors
|
Surface dervied tumors
|
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Most common ovarian cancer; bilaterally with psommoma bodies
|
Serous cytsadenocarcinoma
|
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Most common ovarian tumor that is bilateral
|
cystadenocarcinoma
|
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Ovarian tumor with signet ring cell from hematogenous sources
|
Krukenberg tumor
|
|
|
Most common ovarian tumor in girls less than 4
|
Yolk sac tumor
|
|
|
Contain SCHILLER-DUVAL bodies
|
Yolk sac tumor
|
|
|
What would you check for to confirm yolk sac tumor?
|
Alpha fetal protein
|
|
|
Ovarian malignant tumor assoc with endometrial cancer 15-30%
|
Endometroid ( surface tumor)
|
|
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What are the germ cell tumos for ovarian
|
Cystic teratome
Dysgerminoma Yolk Sac Tumor |
|
|
Most of these tumor are found in a nipple like structure in the cyst wal- Rokintansky tubercle
|
Cystic teratoma
|
|
|
Struma ovarii has thyroid tissue
|
Cystic teratoma
|
|
|
What are the surface derived tumors of ovary?
|
Serous
Mucinous Endometroid Brenner |
|
|
What are the sex-cord tumors of ovary
|
Thecoma-fobroma
Granulosa-thecal cell tumor Sertoli-leydig cell Gonadoblastoma |
|
|
Malignant ovarian tumor with mixture of germ cell tumor, dysgerminoma, and sex-cord tumor
|
Gonadoblastoma
|
|
|
Associated with abnormal sexual development in 80% of cases
|
Gondablastoma
|
|
|
Benign tumor assoc with Meig's syndrome; removal of tumor removes effussion
|
Thecoma-fibroma
Meigs syndrome; ascites, right-sided Pleural effusion |
|
|
Most common malignant germ cell tumor; increase in LDH
|
Dysgerminoma
|
|
|
Same histology as testis sminoma
|
Dysgerminoma
|
|
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Assocaited with streak gonads of Turner's syndrome
|
Dysgerminoma
|
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Contain Walthard's rest, transitional like epithelium
|
Brenner tumor ( surface derived ovarian tumor)
|
|
|
Peutz-Jegher's is associated with this ovarian cancer
|
Sex cord tumor with annular tubules
|
|
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Synthesis of hCG in pregnant mother
|
Syncytiotrophoblast
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|
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Cell that synthesis of human placental lactogen
|
Syncytiotrophoblast
|
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|
This directly correlates with placental size and anti-insulin activity
|
Human placental lactogen
|
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|
Endometrial hyperplasia is greatest risk for
|
endometrial cancer
|
|
|
OCPs decrease the risk of
|
Endometrial Ca
|
|
|
Most common gyne Cancer?
|
Endometrial; best prognosis
|
|
|
What causes endometrial hyperplasia?
|
Unopposed prolonged estrogen stimulation
|
|
|
Cervical motion, Adenexal and Uterine tendernerness is possibly
|
PID
|
|
|
Rx for PID
|
Ceftriaxon ( N. gonnorrhea)
Doxycycline ( C. Trachomatis) |
|
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Vaginal bleeding, pelvic pain, adnexal mass
|
Ectopic Pregnancy
|
|
|
Most common cause of hamtosalpinx
|
Ectopic Pregnancy
|
|
|
Knuckle-knuckle-dimble knuckle
|
Tuners
|
|
|
Most common ovarian mass
|
Follicular cyst; non-neoplastic
|
|
|
Most common ovarian mass in a pregnant women
|
Corpus Letum Cyst
|
|
|
Oophoritis
|
Mumps or PID
|
|
|
Hirsutism/Virilization, hypertension, insulin resistance
|
Stromal hyperthecosis
|
|
|
Most common ovarian cancer; occurs bilaterally
|
Serous Cystadenocarcinoma; psammoma bodies
|
|
|
Most common group of ovarian cancers
|
Serous-derived tumors
|
|
|
Hormone producing tumors
|
Sex cord tumors
|
|
|
Abdominal enlargement due to fluid is
|
Most likely Ovarian Cancer
|
|
|
Palpable ovaries in a post-menapausal women is
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Cancer until proven otherwise
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CA-125 is marker found increased in
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Surface-derived tumors
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