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58 Cards in this Set
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Mullerian Duct |
Mullerian (paramesonephros): fallopian duct,
Wollfian (mesonephros): epididymis, vas, regresses in females |
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gartner duct cyst,
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mesonephric duct cyst (meso, men. wolffian):
*failure of regression of the mesonephric duct |
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how does sex develop in a baby
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mullerian (paramesonephros) makes female bits, this is default path
wolffian (mesonephros): makes boys parts. this one degenerates in the default setting. **to make a boy sertoli cells make mullerian inhibitory factor to inhibit paramesonephros (mullerian) girl bits from forming |
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what structure develops to make girls girls
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paramesonephros (mullerian) duct: its the vagina tubes and uterus
external genitalia is made from urogenital sinus |
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what is the remnant called if the mesonephric duct fails to regress
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mesonephros is the boy parts. its called gartner duct cyst,
it can occur in the cervix, vagina, or meso-ovarium |
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where do germ cells originate in the embryo, do they remain there
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yolk sac
then migrate to urogenital ridge *8recall its the UG SINUS that makes external female genitalia |
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what does PID present as
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pelvic, adnexal tenderness
discharge fever |
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what are some predisposing conditions for PID
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ascending lower UG infection
sepsis, abortion surgery, IUD |
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what are the complication associated with PID
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tubo-ovarian abcess--> 2 ovarian failure
peritonitis --> adhesions stricture sterility tubal preggo bacteremia- infective endocarditis, septic arthritis |
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how does gonorrhea get to PID
chlamydia |
gono: vulva and then ascends to cervix
chlamydia: can infect the cervix alone **other bugs nad combos of bugs can also cause |
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tell me about gonococcal PID
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common, STI
2-7 days after sex Bartholinitis: swollen volvular gland Vestibuar/Periurethral glands are initially infected nad then ascend. PURULENT- this is why it is caught earlier than a chlamydia infection. this infection causes pain and fever |
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what causes the pain and fever in gonococcal PID
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acute suppurative salpingitis
salpingo-oophritis- ovary infection peritonitis- perihepatitis pyosalpinx- pus in sealed tubule lumen, may resolve to hydrosalpinx |
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can a gonococcal PID progress to septic arthritis?
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you bet!
can also cause tubo-ovarian abcess infetive endocarditis peritonitis etc etc |
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list predisposing factors for PID
list complications |
PREDISPOSOTION:
fallopian stricture endometritis IUD Curettage/abortion organisms form sex: gonococcus, strep, staph, acintomyces, mycoplasma, chlamydia COMPLICATIONS: hydro/pyosalpinx adhesions, frozen pelvis tubo-ovarian abcess infertility- 2 ovarian failure bc of adhesions peritonitis, perihepatitis: intestinal obstruction and adhesions Besteremia: endocarditis, septic arthritis suppurative arthritis tubal preggo |
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• This 39 y/o G2P2 female presented to the ER
c/o / severe pelvic and lower abdominal pain with nausea, vomiting and diarrhea. • She was febrile with a temperature of 101º. • The abdomen was tender to palpation in both lower quadrants but most marked on the left. LMP 2 weeks ago. • Pelvic exam not done. • Diagnosis: Gastroenterits. Rx: tylenol. Patient discharged • The patient was an IV drug user as indicated by extensive tracts that made venipuncture difficult and painful. She admitted to smoking marijuana “whenever I can get it.” She did not smoke tobacco or use alcohol. • Family history: She and a sister were sexually molested by grandfather as children. 1 brother dead of gunshot wound. 2 brothers living and well. Estranged from parents all of adult life • She returned to ER in 1 week, c/o severe pelvic pain for 2 weeks duration with pain on urination and defecation. • Pelvic exam: marked left adnexal tenderness. • Cervical cultures taken. Pelvic ultrasound showed a heterogenous pelvic mass with complex cyst left adnexa 4.5 cm diameter. • Differential diagnosis: diverticular disease, ovarian tumor and pelvic inflammatory disease • Admitted for IV antibiotics. HB low Hct N plate: high • Hepatitis C antibody positive; C RNA negative • Hepatitis BsAg negative; HBcAb positive, HBsAb positive • HIV negative • CT of abdomen 6 days after admission showed persistent pelvic mass with cystic areas. • She had to be placed on methadone due to apparent narcotic withdrawal. • After 9 days of antibiotics with little improvement in pelvic symptoms, she was taken to surgery. Ureteral stents were placed by urologist prior to surgery. • Bilateral salpingo‐oophorectomy/hysterectomy: Acute and chronic cystic cervicitis Bilateral tubo‐ovarian abscesses; adhesions • Culture from ER grew Neisseria gonorrhea |
iniital sx indicate PID. DO A PELVIC
complications of untreated gonogoccal PID 1. tubo-ovarian abcess 2. pyosalpinx |
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is gonococcal infection the only cause od PID
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no way!
chlamydia staph strep **less pus with these infection sos they are often not detected until sterility |
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whats bartholin cyst
cause clinical assocaitation |
caused by
1 blocked gland 2. bartholinitis bc of gonococcal or NG infection clinical: red, enlarged, sore, painful tx w/ excision |
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vulvular vestibulitis clinical features
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inflammation of small glands in post introitus
chronic, RECURRENT, painful tx w/surgery |
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whats the ddx for vulvular leukoplakia
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its NOT cancer,
vitiligo- loss of pigment inflamm carcinoma in situ (VIN) pagets vulvular dystrophy: lichen sclerosis, lichen simplex |
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lichen sclerosis
lichen simplex |
both are types of vulvular dystrophy and can cause leukoplakia
lichen sclerosis: leukoplakia, over time the skin thins and gets parchment, and the epidermis get thick. lichen simplex : hyperkeratosis, thick epidermis, dermis w/mild chronic inflamm infiltrate. LOOKS JUST LIKE CA, biopsy!!!! |
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what disease is when the vaginal skin gets thin and the introitus narrows
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lichen sclerosis
analgous to male balantitis xerotica obliterans lichen simplex: looks like CA. its a thich epidermis |
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benign nodular neoplasm of vulva
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papillary hidradenoma: most common benign of the volvula
can confuse with cancer bc it ulcerates but its benign at micro looks just like intraductualr papilloma of breast |
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what is teh sq precancer of the vulva
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VIN
vulvular intraepithelial neoplasm **related to HPV and lichen sclerosis PAS +, S100 neg |
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what causes vulvular sq cell carcinoma
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1 HPV
2, lichen sclerosis (parchment skin, narrow introitus) |
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what is the PAS and S100 of VIN
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PAS +
S100 neg |
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• This patient is a 39 y/o gravida 5, para 3 female
presented with complaint of vulvar pruritis. On PE, there is a dark, irregular discoloration of the vulva. • She had no other symptoms referable to the genital tract. • She had a long time relationship with the male with whom she lived. • Physical examination revealed mottled irregular hyperpigmentation of the vulva involving parts of each of the labia majora. • A punch biopsy was performed of one of the pigmented sites with the diagnosis of VIN III. • A Pap smear of the cervix obtained at the same time was NILM • The patient underwent subtotal vulvectomy. • There was extensive vulvar intraepithelial neoplasia, VIN I-III with extension to margins. What is the significance of the pap smear result? What is the cause of VIN? |
pigmented VIN- precancer to volvular can
NILM- no intraepithelial lesion PAP- no cervical cacner, or it was past the shedding stage cause of VIN: HPV or lichen sclerosis |
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pagets disease is HIGH YEILD
tell me about extramammary pagets |
red, crusty lesion of the perineum. this is NOT associated with cancer (breast pagets suggested underlying CA)
serived from primitive epithelial progenitors PAS + cytokeratin positive |
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what vulvular lesion is assocation with + PAS and + cytokeratin. its presence is NOT indicitive of CA
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extramammary pagets
melanoma is S100 + and cytokeratin neg |
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melanoma of the vulva. what are the markers
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S100 +
cytokeratin neg **LOW survival |
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what is s100 + and cytogeratin neg
what is PAS + and cytokeratin + what is cytokeratin +, PAS neg, and S100 neg |
melanoma of vulva
extramammary pagets VIN **all are cyto + |
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VIN
pagets melanoma what is cytokeratin, PAS, and S100 |
all are cyto +, PAS is only pagets, S100 is only melanoma
VIN: cyto +, PAS/S100 neg. risk for invasive sq carcinoma. its atypia of cells. Associated with HPV lichen sclerosis Pagets: PAS +, no underlying CA Melanoma: s100+. early mets, lethal |
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complications of female curcumscision
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reproduciton is hard
structures bleed to death cant pee |
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what is teh most common anamoly of the vagina
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imperforate hymen - associated with 1 amenorrhea
can get blood all backed up in the uterus and vagina (hematometra) |
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what are some vaginal anomalies
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imperforate hymen
septate (double) vagina- failure of mullerian fusion garyners duct cyst: wolffian (man) duct doesnt regress and is left behind in the lateral wall of vagina |
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what is vaginal clear cell adenocarcinoma assocaited with
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arises from vaginal adenosis
result of DES exposure in utero **MUST KNOW |
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what is the vaginal malignancy seen in kids
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embyronal rhabdomyoscaroma, aka sarcoma botryoides
polypoid tumor that projects out of the vagina |
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why look at a little girls vagina on PE
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to be sure there is no embryonal rhabdomyosarcoma. the vaginal ca of little girls
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rhabdomyosarcoma
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vaginal ca of little girls
polypoid tumor that projects from vagina |
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from what embryonal structure does the uterus and cervix arise
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mullerian paramesonephros
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what does chronic cervicitis look like
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nabothian cysts
reparative atypia- epithelial cells that kinda mimic CA on pap |
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whats the sx, morph, significance of endocervical polyps
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COMMON
NOT CANCER, inflammatory overgrowth protrude from the os and bleed after sex and other irregular bleeding |
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when are nabothian cysts seen
what about reparative atypia |
both are seen in chronic cervicitis
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an inflammatory overgrowth that is NOT CA can cause irregular bleeding. this thing poke out of the os. what is it
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endovervical polyps
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what cysts are seen in the fallopian tube
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paratubal
hytadid of morgagni- mullerian remnants any tubo-ovarian mass can cause TORISION |
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what is a complication of ovary cyst (and other ovarian masses)
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torsion
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what is the most common ovarian lesion
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follicular cysts: lined by granulosa and make estrogen
corpus luteum- leutal cyst. makes progestone |
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whats a hydatid cyst of morgagni
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mullerian remant, its a fallopian cyst
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ovarian cysts can be
1. follicular 2. luteal **what is secreted by each |
follicular- estrogen. cause endometiral hyperplasia
luteal- progesterone. YELLOW. can cause peritoneal hemorrhage adn menstrual abnormalities |
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does an ovarian luteal cyst or follicular cyst potentially cause hamorrhage
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luteal- THE YELLOW ONE
**the follicular makes estrogen so can cuase endometrial hyperplasia |
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what are some NON cancerous cysts of the ovary
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1 chocolate cyst- endometriosis of the ovary. can lead to infertility. can be hard to distinguish from a hemorrhagic CL
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whats a chocolate cyst
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endometritis of the ovary
non neoplastic |
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tell me about PCOD
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PCOD is HY!!!!! but ALL ovarian cysts end up on the exam
super sommon, causes infertility and increased risk of endometrial cancer the ovary looks like it has a string of pearls TONS of androgens are being secreted |
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whats the pathogenesis of PCOD
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HYPERINSULINEMIA
insulin makes more LH to make more testosterone. also increases aromatase |
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what is the appearance of PCOD
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thick ovarian capsule, with lots of subcapsular follicular cysts lined with granulosa. failure to ovulate
women with this are fat, hairy, and kinda manish from the excess androgen |
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what are some complications of PCOD
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1, infertility
2. endometrial CANCER |
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what are hte clinical features
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its androgen excess so you have
amenorrhea anovulation obses hairy infertile acanthosis nigricans |
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IR is a key feature in what gynecological disease
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PCOD
causes increase in aromatase, increase estrogen, increase androgen, decrease SHBG causes more LH and less FSH |
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does PCOD increase risk of cancer
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yep, increased risk of endometrial cacner bc of the increased estrogen
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