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155 Cards in this Set

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