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238 Cards in this Set

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What are the characteristics of Leiomyoma?
Benign tumor of smooth muscles of the uterus increasing in size under the stimulation of estrogen, and regressing spontaneously after menopause.
At what age is Leiomyoma most common? Gender?
Females 35 y/o or older.
What are the three classifications of Leiomyoma?
Submucosal, intramural, subserosal.
Which classification of Leiomyoma is most common?
Intramural
Which classification of Leiomyoma causes more abnormal bleeding, necrosis, and infection?
Subserosal
What are the manifestations of Leiomyoma?
Abnormal uterine bleeding or prolonged, excessive menstrual flow.
What is the definition of pelvic inflammatory disease (PID)?
Inflammation of the upper reproductive tract.
What are the risk factors of PID?
- age 16-24 unmarried with multiple sex partners

- history of STD

-history of IUD
What are the six manifestations of PID?
fever, lower abdominal pain which may start after menses, purulent discharge, adnexal tenderness, exquisitely painful cervix, blood test: ESR increases, WBC> 10,000/ mcl
What is the definition of ectopic pregnancy?
A fertilized ovum implants outside of uterine cavity
What is the incidence of ectopic pregnancies?
4.5 - 16.8/ 1,000 pregnancies
What are the seven predisposing factors of ectopic pregnancies?
PID, therapeutic abortion, tubal ligation or reversal, previous ectopic pregnancy, intrauterine exposure to DES, use of fertility drug to induce ovulation, and morning after pills
What is the mechanism of ectopic pregnancies?
Stricture of fallopian tube or localized to one side
What are the five manifestations of ectopic pregnancies?
Mostlyoccurs in the fallopian tube, lower abdominal discomfort, spotting, referred shoulder pain, and excruciating pain followed by syncope
How do you diagnose ectopic pregnancies?
Pelvic ultrasound 5th week, definitive laparoscopy, culdocentesis
Most ovarian cysts are _____
benign
What are the five classifications of ovarian cysts?
Follicular cyst, luteal cyst, polycystic ovary disease, endometrioma, cystic teratoma
What is the incidence of ovarian cancer? (Age)
Increases with age (65-84 y/o)
What is the pathology of ovarian cancer?
epithelial tumor, germ cell tumor, gonadal stromal tumor
What are the manifestations of ovarian cancer?
no sx or so vague that women seldom seeks care until disease is far advanced, abdominal distress, discomfort, flatulence, bloating
How do you diagnose ovarian cancer?
Blood test- CA 125 lacks sensitivity

TVS

Gene of chromsome 17 is affected
What is the definition of a cystocele?
Herniation of the bladder into the vagina
What is the mechanism of cystocele?
Weakness of muscles to support the bladder
What is the mode of herniation of a cystocele?
Through the anterior vaginal wall
What are the 4 manifestations of cystocele?
Bearing- down sensation, difficulty of urination ( frequency and urgency also), recurrent cystitis, stress incontinence
What is the definition of uterine prolapse?
Bulging of the uterus into the vagina
What is the cause of uterine prolapse?
Weakness of cardinal alignment
What is the 1st degree of uterine prolapse?
Cervix doesn't reach the introitus
What is the 2nd degree of uterine prolapse?
Cervix passes through the introitus
Xi-Cleft of ST
Liangqiu ST 34
What is the definition of mastitis?
Inflammation of the breast
What are the risk factors of mastitis?
lactating women, trauma, skin infection
What are the manifestations of mastitis?
Abscess, tenderness, warmth
What is fibroadenoma?
Benign, well demarcated, mostly single and unilateral
When does fibroademoma enlarge?
During pregnancy
When does fibroadenoma cease to grow?
After menopause
What age does fibrocystic change occur?
Women of all ages
What is the cause of fibrocystic change?
Unknown
What are the two classifications of fibrocystic change?
Non-proliferative and proliferative
Describe non-proliferative fibrocystic change
Cystic dilation of terminal ducts and increase in fibrous stroma
Describe proliferative fibrocystic change
Ductal epithelial hyperplasia and increased risk of cancer
What are the manifestations of fibrocystic change?
Grandular breast masses. Dull, aching pain, heaviness in luteal phase
Breast cancer is uncommon before what age?
35
What are the five risk factors of breast cancer?
Genetic, hormonal status (early menarche, late menopause, first pregnancy after 35), diet (high in saturated fat), fibrocystic change, and previous breast cancer
What is the pathology of breast cancer?
adenocarcinoma
What are the four risk factors of breast cancer?
Irregular mass, thickening of breast contour, unusual discharge, nipple retraction
How do you diagnose breast cancer?
BSE, phsyical exam every 3 years, mammograpght, excisional biopsy
Define infertility
Unable to conceive a child after 1 year of unprotected sex
Define primary infertility
there has been no prior conception
Define secondary infertility
there has been one or more pregnancies
Define sterility
Inability to father or to become pragnant
What are the five causes of male infertility?
Varicocele (quality of sperm cells), ejactulatory dysfunction, infection, obstruction, congenital anomalies
What are the manifestations of male infertility?
Azoospermia, oligospermia, asthenospermia
Define azoospermia
No sperm
Define oligiospermia
Small amount of sperm
Define asthenospermia
Sperm isn't moving
What are the five female factors of infertility?
Anolulatory cycle, luteal phase effect, cervical mucus problem, uterine abnormalities, and tubal factor, (10-15% unknown cause)
How to you manage female infertility?
IVF, GIFT, ZIFT, TET
What is condylomata acuminata?
Genital Warts
What are the types of genital warts?
Condylomata acuminate (cauliflower shapes), keratotic warts (thick and horny layer), popular warts (smooth surface), flat warts (macular)
What is the pathology of condylomata acuminata?
Innoculation of HPV into the stratified squamous epithelium leading to infection that replicates squamous epithelium (get bigger)
What is the incubation period of condylomata acuminata?
6 weeks to 8 months
What is the subclinical manifestation of condylomata acuminata?
No visible warts (more common)
What is a manifestation od condylomata acuminata?
Warts
How do you diagnose condylomata acuminata?
Slide examination and abnormal pap smear. Also vulvar pruritus
How do you treat and prevent condyloma acuminata?
Burn, surgical removal, vaccine
What is the main causative agent of genital herpes?
HSV2
What is the pathology of genital herpes?
vescicular lesion of dermis infecting local nerves; hiding in dorsal root of sacral regions
What ia the incubation period of genital herpes?
2-10 days
What is the prodomal sign of genital herpes?
local itching, burning, tingling, flu like symptoms
Describe the acute phase of genital herpes
Rupturing of vesicles on 5th day resulting in painful ulcers, swollen lymph nodes
How do you diagnose genital herpes?
S/X, ID of virus taken from lesion, serologic test (ID antibodies)
How do you prevent and treat genital herpes?
No cure.... good hygiene
What is the causative agent of chanchroid?
Haemophilus ducreyi
What is the pathology of chanchroid?
Acute ulcerative lesions with pustular discharge of the genitalia and lymph nodes
What are the manifestations of chancroid?
Macules--> pustules --> rupturing pustules --> painful ulcers
How do you diagnose chancroid?
Specific lesions, culture and PCR
How do you treat chancroid?
Antibiotic
Lymphogranuloma venereum is caused by what?
Chlamydia trachomatis
What is the pathology of acute Lymphogranuloma venereum?
Swollen and tender inguinal lymph nodes
What is the pathology for chronic Lymphogranuloma venereum?
Cervicitis and elephantitis
How do you diagnose and treat Lymphogranuloma venereum?
Clinical signs and serology test. Antibiotic treatment
What is the causative agent of candidiasis (yeast infection)?
candida albicans
What are the risk factors for candidiasis (yeast infection)?
BCP, indiscrimate use of antibiotic, underwear material and style, obesity, diabetes, systemic steroid use, and immunocompromised condition
What is the pathology of candidiasis (yeast infection)?
Local irritation and inflammation
What are the manifestations of candidiasis (yeast infection)?
Vulvar pruritis, dysuria, cheesy vaginal discharge
How do you diagnose candidiasis (yeast infection)?
clinical signs, wet mount slide with KOH, and culture
What is the treatment for candidiasis (yeast infection)?
Antifungal, sodium bicarbonate bath
What is the causative agent for trichmonas?
Trichomonas vaginalis
What is the pathology of trichmonas?
Organism feeds on the mucosa and white cells (local infection)
What are the manifestations of trichmonas?
Asymptomatic in male, copious and nasty discharge, local pruritis, strawberry spot of vagina or cervix, and increase vaginal pH
How do you diagnose and treat trichmonas?
Clinical signs and positive wet mount slide. Treatment is metronidazole
What is the most prevalent vaginitis?
Bacterial vaginosis
What is the pathology of bacterial vaginosis?
presence of anaerobic bacteria, sexual activity (gardnerella vaginosis), minimal inflammation
What are the manifestations of bacterial vaginosis?
Thin and gray and fishy discharge, no local irritation
What is the diagnosis of bacterial vaginosis?
fishy vaginal discharge (KOH), vaginal pH increases, presence of "clue cell"
What is the treament of bacterial vaginosis?
metronidazole
What is the most prevalent STD in the US?
chlamydial infection
The coexistence of chlamydia and ____ is common
gonorrhea
What is the pathology of chlamydia?
PID, pneumonia, trachoma,
What are the manifestations of chlamydia?
dysuria, mucopurulent cervical discharge, 75% of women and 50% of men are asymptomatic, untreated in women can lead to PID --> infertility
How do you diagnose chlamydia?
clinical signs, routine screening, flourescent antibody test, NAAT
How do you treat chlamydia?
Antibiotic
At what age is gonorrhea most prevalent?
15-44
Gonorrhea most of the time is following a single or multiple exposure?
Single
What is the pathology of gonorrhea?
Infection of mucus secreting epithelia, start from urethra and accessory glands, systemic infection
Are men more likely to be symptomatic than women? (gonorrhea)
Yes
How do you diagnose gonorrhea?
Hx of sexual exposure and symptoms, + Gram stain of vaginal discharge, culture if asymptomatic, detection of gonococcal enzyme, and testing for other STDs
How do you treat gonorrhea?
Antibiotic
How is syphyllis transmitted?
Sex
Describe stage 1 of syphyllis
Highly contagious, painless chancre of genitalia, swollen inguinal lymph nodes, healing within 2-12 weeks with or without tx
Describe stage 2 of syphyllis
6 weeks to 6 months after stage 1, rash of palms and soles, genital condyloma, alopecia... fever.. loss of appetite, lesions resolve in 2-6 weeks
Describe stage 3 of syphyllis
gummas, cardiovascular lesions, cns lesions
how do you diagnose syphyllis?
dark field exam (1 and 2 stages), non-specific test (VDRL, RPR), specific test (FTA-Abs, MHA-TP)
How do you treat syphyllis?
Antibiotic penicillin
The testes develop by which months of gestation?
7-9 months
What does the dartos muscle do?
Separates the two testes and responds to temperature change
The tunica albuginea does what to the testes?
Gives shape
The spermatic cord includes what structures?
Testicular artery, pampiniform plexus, nerve, ductus deferens, cremaster muscle
What does the pampiniform plex do?
Regulates temperature in testes
The two seminal vesciles secrete a fluid containing what three properties?
Fructose, prostaglandin, protein
Prostate secretes what three properties ?
Calcium, acid phosphate, and clotting enzyme
What are the erectile tissues of the penis?
lateral copora cavernose and ventral corpus spongiosum
Whe hypothalamus excretes which hormone?
GnRH
GnRH controls which gland?
Pituitary
LH produces which hormone (male)?
Testosterone
FSH is responsible for what action in males?
Initation of spermatogenesis
Spermatogenesis occurs in the ____ tubules and initiated by ____ cells
seminiferous.... sertoli
Sperm cells can survive how many days within the female genital tract?
1-2
Which nerves are responsible for emission and ejaculation?
Sympathetic
Where are the parasympathetic nerves located?
Sacral spinal cord
What is hyposadias?
Termination of the ventral surface of the penis
What is episadias?
Opening of urethra on the dorsal surface of the penis
What is phimosis?
Tightening of the penile foreskin that prevents retraction over the glans
What is paraphimosis?
Ischemia of the glans
What is a priapsim?
Involuntary erection that may last over 24 hours
When does the incidence of priapism peak?
5-10 y/o and 20-50 y/o
What are the two mechanisms of priapism?
Stasis of blood (Low flow) in the corpus cavernosum

And high flow
What is the primary and secondary classifcations of priapism?
Primary- Trauma, infection

Secondary- Hemetologic disorders
When is the onset of peyronie's disease?
Middle-aged and elderly
What is peyronies disease?
Progressive fibrosis of the tunica albuginea of the corpus.... painful and difficult intercourse
What is balantis?
acute of chronic inflammation of the glans penis
What balanoposthitis?
Inflammation of glans and prepuce
What are the causes of blanitis and balanosthitis?
Mainly overgrowth of bacteria

Trauma and infection
What are the cause and manifestation of penile cancer?
Poor hygeine. Lumps and swollen lymph nodes
What is cryptochidism?
Failure of one or two testes
What is the incidence of cryptochidism?
Directly related to birth weight
What is the manifestation of cryptochidism?
Non-palpable testes
What complications can arise from cryptochidism?
cancer and infertility
How do you diagnose cryptochidism?
Ultrasound
How do you treat cryptochidism?
hormonal therapy
What is hyrdocele?
Excess of fluid in the visceral and parietel layers of the tunica vaginalis
What is the incidence of hyrdocele?
Greater than 40
What are the causes of hyrdocele?
Congenital.. local injury
What are the manifestations of hydrocele?
Papable cysts and ultasound
What is the incidence of varicocele? age
15-35
Why can varicocele lead to infertiliy?
Retrograde blood flow can affect sperm prodction
What are the manifestations of varicocele?
Heavy feeling in scrotum, feels liek a bag of worms, straining valsalvar maneuver
What are the manifestations of epididymitis?
Pain, fever, dysuria, increase in WBC
What are the causes of scrotal cancer?
Poor hygeine, HPV
What is the age of scrotal cancer?
60 or older
What is the manifestation of scrotal cancer?
Wartlike growth that eventually ulcaerates
What is the incidence of tesicular cancer?
15-35
What is the manifestation of testicular cancer?
Enlargment of testicle with some aching
How do you diagnose tesicular cancer?
Self exam, biopsy, ultrasound
What are the manifestation of acute prostatis?
High fever, frequent and urgent urination, dysuria, dull pain in scrotum
How do you treat acute prostatis?
antibiotic
Chronic prostatis symptoms are mild or severe? they are easy or hard to treat?
Mild... hard
What age is benign prostatic hyperplasia most common?
60-69
What is a possible cause for benign prostatic hyperplasia?
increased estrogen
What is the main manifestation of benign prostatic hyperplasia? Seconary?
Compression of urethra.Recurrent UTI, hypertrophy of UB, kidney infection
How do you diagnose benign prostatic hyperplasia?
blood tests, ultrasound, perform DRE
How do you treat benign prostatic hyperplasia?
Watch and wait... antiandrogen.. surgery
What are the causes of prostate cancer?
high testosterone, high fat diet, genetic
How do you diagnose prostate cancer?
DRE, PSA, ultrasound, biopsy
How do you treat prostate cancer?
Surgery and radiotherapy
Describe the vesitbule
Area between labia minora.. includes urethral and vaginal opening of bartholins glands
The vagina is fermented by which bacilli?
Doderlins
What is the approximate pH of the vagina?
3.8-4.2
The uterus and cervix are held by which ligaments?
uteralsacral and cardinal
The ovaries are fully developed at which month of fetal life?
3rd
FSH in women stimulates what?
Ovaries and estrogen
LH in women stimulates what?
ovulation and progesterone
Estrogen is produced by which glands?
Ovary and adrenal
What are the functions of estrogen?
Develops secondary sexual characteristics, promote reproduction process, decrease bone resorption, increases HDL and reduces LDL
Progestrone is secreted by what?
corpus luteum
What are the functions of progesterone?
Glandular development of breast and endometrium.. relaxes smooth muscle
FSH does what to the ovaries?
Enlarges
Progesterone makes the body temp high or low?
High
The proliferative phase is stimulated by ____ and secretory phase is stimulated by _____
Estrogen.. progesterone
___% of dysfunctional menstrul cycles are anovulatory in nature
90
What are two manifestations of dysfunctional menstrual cycle?
heavy bleeding at irregular interval, prolonged flow, no cramps
Describe physiologic amenorrhea
Teenage, prior or right after menarche, pregnancy, menopause
Desrcibe pathologic amenorrhea
absence of both menstruation and secondary sexual characteristics at 14 y/o, absence of menstruation at 16y/o regardless if there are secondary sexual characterisitcs, any age when menses ceased in a woman who had normal menstruation before
What are acquired causes of amenorrhea?
nutrition deficiency, emotional stress, too much exercise, intrauterine adhesion
Describe primary dysmenorrhea
Painful menstruation in absence of pelvic lesions, associated with ovulatory cycle, pain is spasmotic
What is secondary dysmenorrhea?
Painful menses in presence of organic disease
What causes secondary dysmenorrhea?
PID, endometriosis, tumor of eterus
What age is PMS most prevalent?
Mid 30s
What are some manifestations of PMS?
Psychological, GI, weight gain, neuromuscular
What is the definition of menopause?
Cessation of menstrual cycle of a year
What are the manifestations of menopause?
Depression, decreased estrogen and increased FSH, degradation of seconary sexual characteristics
What lactiferous duct is located where?
Nipple
During pregnancy which hormone is responsible for the vascularity and heaviness of breasts?
Estrogen
During pregnancy which hormone buds and grows alveolar structures (lactation state)
Progesterone
Which hormone is responsible for milk ejection?
oxytocin
What are the causes of vulvitis?
candida albicans, STD, menopause
What age is carcinoma of the vulva most prevalent?
greater than 60 y/o
What is the causes of carcinoma of the vulva in the elderly? adults?
elderly- hormonal imbalance

adults- STD
What is the pathology of carcinoma of the vulva?
dysplasia of the epithelium tissue
What are manifestations of carcinoma of the vulva?
Late stage is swelling of ingunal lymph nodes.. persistent pruritis
What are the causes of vaginitis ofa premenarchal girl? sexually active population? postmenopausal?
premarche- poor hygeine

Sexually active- bacteria, yeast

postmeno- atrophic vaginitis (estrogen deficiency)
What are the manifestations of vaginitis?
Yucky vaginal discharge, redness and sweeling of vaginal tissues, pain during urination
What is the incidence of cancer of the vagina?
Rare.. mostly in elderly
What are the causes of cancer of the vagina?
Prolonged local irritation

metastasis
What are the manifestations of cancer of the vagina?
abnormal bleeding, vaginal discharge, pelvic pain, dysuria
What are the causes of cervicitis?
Direct infection by yeast, bacteria or parasite. Secondary to viginal infection
What are the manifestations of cervicitis?
Red and edmatous cervix. Purulent itching and malodorous leukorrhea
How do you manage cervicitis?
ID the causative agent and then antibiotherapy accordingly
What is the age range of cervical polyps?
most during reproductive years
What are the manifstations of cervical polyps?
mostly asymptomatic
What are the risk factors of cervical cancer?
early age of intercourse, multiple sex partners, smoking
What is the pathology of cervical cancer?
Begins with squamos cels, then dysplastic period, carcinoma in situ has a long latent period (7-10) before transformng into the invasive period
What is the manifestation cervical cancer?
abnormal uterine bleeding
What is the most definitive diagnosis of cervical cancer? what are the others?
pap smear most definitive. Coloonoscopy and cervicography
What are the risk factors of endometritis?
post partum, post laboral, IUD
What are the manifestations of endometritis?
fever, abnormal uterine bleeding
What is the definition of endometriosis?
Endometrial tissue is found outside the uterus
What is the incidence of endometriosis?
Mostly western countries.. high in women with infertiliy or young women with chronic pelvic pain
What are the risk factors in endometriosis?
early menarche, regulary periods with shorter or longer cycles
What is the pathology of endometriosis?
Lesions and blood found in ovaries and pelvis
What are the manifestations of endometriosis?
dysmenorrhea, dyspaeunia, infertility
How do you manage endometriosis?
antiinflammatory, hormonotherapy, laparoscopy
What age does endometrial cancer peak at?
55-65 y/o
What are risk factors to endometrial cancer?
Obesity, anovulatory cycles, perimenopause, diabetes
Orplonged use of progesterone (or unapposed estrogen therapy) causes hyperplasia of the ____
endometrium
What are the manifestations of endometrial cancer?
Abnormal painless bleeding or prolonged nestrual flow.. late stage is cramping pelvic pain and enlarged lymph nodes
How do you diagnose endometrial cancer?
endometrial biopsy or ultrasound