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155 Cards in this Set
- Front
- Back
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Herpes genitalis
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recurrent painful vesicles; multinucleated squamous cells with intranuclear inclusions
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Human papilloma virus
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condyloma acuminata; koilocytosis (wrinkled nuclei surrounded by a halo)
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Chlamydia trachomatis
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metaplastic squamous cells with vacuoles containing elementary bodies
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S/S of Chlamydia
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non-specific urethritis, cervicitis, PID, ophthalmia neonatorum
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Neisseria gonorrhoeae
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urethritis, cervicitis, PID; ophthalmia neonatorum, gram negative diplococcus
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Ophthalmia neonatorum first week
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N. gonorrhoeae
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Ophthalmia neonatorum second week
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C. trachomatis
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Lymphogranuloma venereum
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C. trachomatis subtype
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Lymphogranuloma venereum S/S
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scrotal/vulva lymphedema; granulomatous micrcabscesses; rectal strictures in females
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Chancroid
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painful ulcer, adenopathy, Hemophilus ducreyi
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Granuloma inguinale
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Calymmatobacterium granulomatis; raised ulceration but no lymphadenopathy
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Treponema pallidum
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spirochete; produces vasculitis of arterioles (plasma cell infiltrate)
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Primary syphilis
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painless chancre
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rash on palms/soles; condyloma lata; generalized adenopathy
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Secondary syphilis
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Tertiary syphilis
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neurosyphilis (e.g., tabes dorsalis), aortic arch aneurysm, gummas
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RPR/VDRL positive
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reagin antibodies against cardiolipin; • titer with Rx of syphilis
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false positive RPR/VDRL
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with anticardiolipin antibodies (common in SLE)
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FTA-ABS positive
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confirmatory test for syphilis; not distinguish active from treated disease, remains positive after Rx
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Trichomonas vaginalis
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flagellate protozoan; cervicitis/vaginitis; Rx metronidazole both partners
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Gardnerella vaginalis
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vaginal pH > 5; bacterial vaginosis; clue cells; Rx metronidazole
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Candida vaginitis
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white, curd-like discharge; DM, antibiotics, pregnancy; Rx fluconazole
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Vulvar squamous cancer
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MC vulvar cancer; HPV association
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Vulvar leukoplakia
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biopsy to R/O squamous dysplasia/cancer
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Lichen sclerosis vulva
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epidermal atrophy; slight risk for squamous cancer
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Squamous hyperplasia vulva
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leukoplakia; no cancer risk
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Paget's disease
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intraepithelial adenocarcinoma (mucin production) of vulva
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Malignant melanoma of the vulva
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vulva location; similar to Paget cells but not mucin positive
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Gartner's duct cyst
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lateral wall vagina; persistent mesonephric duct
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Embryonal rhabdomyosarcoma
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bloody, grape-like vaginal mass young girl
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Vaginal adenosis
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maternal exposure to DES; precursor clear cell adenocarcinoma vagina
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Vaginal squamous cancer
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usually extension of cervical cancer
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Rokitansky-Koster-Hauser
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absence of vagina and uterus
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Nabothian cysts
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endocervical glands covered by metaplastic squamous epithelium
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Pathologic cervicitis
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trichomonas, HSV-2, C. trachomatis (follicular cervicitis)
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Cervical Pap
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superficial squamous (estrogen), intermediate (progesterone), parabasal (no hormone)
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Normal Pap Smear
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70% superficial, 30% intermediate
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Atrophic pap smear
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100% parabasal cells
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Pap smear in Hyperestrinism
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100% superficial cells
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Pap smear in pregnancy
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100% intermediate cells
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Endocervical cells in Pap smear
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sign of adequately performed Pap smear
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Cervical polyp
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bleeding after intercourse; non-neoplastic
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Cervical dysplasia
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begins in transformation zone; associated with low and high risk HPV
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Risk factors of cervical dysplasia/cancer
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early onset sexual activity; multiple partners; smoking; OC
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CIN
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cervical intraepithelial dysplasia; mild, moderate, severe (in-situ)
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Cervical cancer
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dec incidence (Pap smear); 45-yr-old; COD renal failure from obstruction of ureters
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S/S of Cervical cancer
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cervical discharge; bleeding after intercourse
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Sequence to menarche
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breast budding, growth spurt, pubic hair, axillary hair, menarche
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Proliferative phase cycle
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estrogen-dependent; inc estrogen inhibits FSH and stimulates LH
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Ovulation
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day 14-16; LH surge; subnuclear vacuoles; inc body temperature
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Secretory phase cycle
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progesterone-dependent
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Menses
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drop in estrogen/progesterone stimulates apoptosis; plasmin prevents clotting
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FSH action
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stimulates follicle and aromatase synthesis in granulosa cells
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LH action
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stimulates androgen synthesis in proliferative phase and progesterone synthesis in secretory phase
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Day 21 of cycle
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day of implantation of fertilized egg
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Pregnancy effects
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inc plasma volume > RBC mass; inc GFR; inc thyroxine/cortisol (increased binding proteins)
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hCG
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LH analogue produced by syncytiotrophoblast
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hCG
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stimulates corpus luteum of pregnancy to synthesize progesterone for 8-10 weeks
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Estrone
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estrogen of postmenopausal woman; aromatization of adrenal androstenedione
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Estradiol
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estrogen of non-pregnant woman in reproductive life; aromatization of testosterone
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Estriol
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estrogen of pregnancy
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Menopause
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inc FSH (best screen; due to dec estrogen), inc LH
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S/S of Menopause
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secondary amenorrhea, hot flushes
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Hirsutism
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inc hair in normal areas
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Virilization
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hirsutism + male secondary sex characteristics (clitoromegaly)
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Test for hirsutism/virilization
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inc testosterone- ovarian source; inc DHEA-sulfate- adrenal source
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Polycystic ovarian syndrome (PCOS)
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inc LH; dec FSH; inc estrogen and androgens
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S/S of PCOS
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hirsutism, oligomenorrhea, infertility; enlarged ovaries with subcortical cysts; LH:FSH > 2:1
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Menorrhagia
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excess menstrual flow; MCC iron deficiency in women
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Dysmenorrhea
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painful menses; primary PGF2a, secondary endometriosis
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DUB
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bleeding related to hormone rather than anatomic causes
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Anovulatory DUB
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menarche and perimenopause; estrogen excess without progesterone
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Ovulatory DUB
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irregular shedding, inadequate luteal phase
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Primary amenorrhea
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no menses by 16 years old
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Secondary amenorrhea
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no menses for 3 months
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Amenorrhea-hypothalamic/pituitary dysfunction
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dec FSH/LH; e.g., hypopituitarism
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Amenorrhea-ovarian dysfunction
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inc FSH/LH; e.g., Turner's syndrome
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Amenorrhea-end-organ disease
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normal FSH/LH; e.g., imperforate hymen
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Asherman syndrome
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surgical removal of stratum basalis
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Primary amenorrhea-normal secondary sex characteristics
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constitutional delay MCC
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Primary amenorrhea-lack secondary sex characteristics
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Turner's
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Turner's syndrome
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XO; no Barr bodies; XO/XY types have gonadoblastomas; streak gonads (no eggs)
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S/S of Turner's syndrome
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newborn with lymphedema hands/feet; cystic hygroma in neck (web); short stature; primary amenorrhea
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Secondary amenorrhea
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pregnancy MCC; prolactinoma; anorexia nervosa; pituitary adenoma
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Asherman syndrome
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removal of stratum basalis causing scarring; secondary amenorrhea
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Endometritis
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group B streptococcus; intrauterine device (Actinomyces); chronic- plasma cells
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Endometrial polyp
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menorrhagia; not a precursor for endometrial cancer
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Adenomyosis
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functioning endometrial glands and stroma in myometrium; enlarged uterus
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Endometriosis
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functioning glands and stroma outside uterus; reverse menses; ovary MC site
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S/S of Endometriosis
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dysmenorrhea, painful stooling, bowel obstruction; "powder burn" appearance
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Endometrial hyperplasia
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unopposed estrogen; simple/complex types; precursor endometrial cancer
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Causes of endometrial hyperplasia
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obesity, estrogen Rx, polycystic ovarian syndrome
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Endometrial cancer
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obesity, nulliparity, estrogen Rx, early menarche/late menopause; OC protective
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S/S of Endometrial cancer
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bleeding in postmenopausal woman
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Leiomyoma uterus
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menorrhagia, obstructive delivery ; not a precursor for leiomyosarcoma
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Leiomyosarcoma
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MC sarcoma: necrosis + atypical mitotic spindles
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Ectopic pregnancy
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PID MC risk factor; intraperitoneal hemorrhage; screen with (Beta-hCG)
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Follicular cyst
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MC ovarian mass in young woman
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Risk factors for ovarian tumors
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nulliparity and genetic factors; OC protective
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Serous ovarian tumors
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surface-derived; l' bilaterality; psammoma bodies in malignant type
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Mucinous ovarian tumors
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surface-derived; pseudomyxoma peritonei in malignant type
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Endometrioid carcinoma
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resembles endometrial cancer; association with endometriosis
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Cystic teratoma
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MC benign germ cell tumor (<1% malignant); hair/teeth; calcifications
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Dysgerminoma
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MC malignant germ cell tumor; associated with streak gonads of Turners
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Yolk sac tumor
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MC germ cell tumor young girl; TAFP; Schiller-Duval bodies
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Meigs syndrome
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ovarian fibroma, ascites, right-sided pleural effusion
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Granulosa tumor
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low grade malignant; hyperestrinism, Call Exner bodies
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Thecoma
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benign; yellow color; hyperestrinism
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Leydig cell and Sertoli cell tumors
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hyperandrogenism
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Gonadoblastoma
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XY phenotype of Turner's
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Krukenberg tumors
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metastatic stomach cancer; signet ring cells
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Single umbilical artery
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inc incidence of congenital defects
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Syncytiotrophoblast
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lining of villi; produces hCG and human placental lactogen
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Human placental lactogen
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responsible for mild glucose intolerance in pregnancy
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Abruptio placenta
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retroplacental clot; painful bleeding; hypertension, cocaine, smoking
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Placenta previa
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placenta implanted over cervical os; painless bleeding
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Placenta accreta
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direct implantation into myometrium without intervening decidua; hysterectomy
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Twin placenta
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monochorionic always identical twins; dichorionic may be identical or fraternal
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Siamese twins
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monoamniotic monochorionic twin placenta
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Enlarged placenta found in
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DM, Rh HDN, syphilis
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Complete hydatiform mole
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benign neoplasm of chorionic villi; dilated villi; no embryo; 46 XX (both male)
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S/S of a complete hydatiform mole
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preeclampsia in first trimester; inc incidence choriocarcinoma
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Partial mole
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embryo present; 68 XXY; no transformation into choriocarcinoma
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Choriocarcinoma
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malignancy of trophoblastic tissue (syncytiotrophoblast, cytotrophoblast)
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risk factors for Choriocarcinoma
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complete mole (MC), spontaneous abortion, normal pregnancy
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S/S of choriocarcinoma
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inc hCG; lung metastasis; good prognosis
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Chorioamnionitis
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group B streptococcus (S. agalactiae) infection
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Preeclampsia
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abnormal placentation causing placental ischemia; inc in vasoconstrictors (ATII)
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S/S of Preeclampsia
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hypertension, proteinuria, pitting edema; begins in third trimester
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Spontaneous abortion
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50% have karyotype deformity (trisomy 16)
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Amniotic fluid
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fetal urine
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Polyhydramnios
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TE fistula, duodenal atresia, open neural tube defects
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Oligohydramnios
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infantile polycystic disease
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inc Serum AFP in pregnancy
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open neural tube defect
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dec Serum AFP in pregnancy
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Down's Syndrome
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Urine estriol
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fetal adrenal, placental, maternal liver involved in its production
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Down syndrome triad
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inc beta-hCG, dec serum AFP, dec urine estriol
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FCC
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MC breast mass < 50-yrs-old; atypical hyperplasia cancer risk; lumpy, painful breasts
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Sclerosing adenosis
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component of FCC; involves terminal lobules often has microcalcifications
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Fibroadenoma
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benign stromal tumor; MC movable mass in women < 35-yrs-old
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Intraductal papilloma
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benign tumor lactiferous duct/sinus; MCC bloody nipple discharge < 50-yr-old
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Invasive ductal cancer
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MCC breast mass in woman > 50-yrs-old
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Breast cancer risks
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unopposed estrogen; family history first-degree relatives
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Breast cancer
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painless mass upper outer quadrant in woman > 50-yrs-old
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Mammography
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screening test to detect non-palpable masses
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Palpable breast mass
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order fine needle aspiration (not a mammogram)
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Ductal carcinoma in situ
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necrotic centers (comedo); microcalcifications common
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Paget's disease of breast
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invasive ductal cancer into nipple; Paget's cells similar to vulvar Paget's
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Medullary carcinoma
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bulky tumor with large cells and lymphoid infiltrate
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Inflammatory carcinoma
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orange peel appearance; lymphatics blocked by tumor (lymphedema)
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Lobular cancer
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MC cancer of terminal lobule; inc bilaterality
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Phyllodes tumor
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low grade malignant tumor of stroma
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ERA-PRA positive tumors
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tumors responding to hormones; candidate for tamoxifen (anti-estrogen)
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ERB-B2 oncogene positive breast cancer
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aggressive breast cancer
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Gynecomastia
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estrogen stimulation of male breast
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Gynecomastia
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normal in newborn, puberty (no surgery), old age; cirrhosis MC pathologic cause
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