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25 Cards in this Set

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PID Casues
– most polymicrobial
– N. gonorrhea most common single, upward migration from mucinous glands gets tubo-ovarian region
– also E. coli, Staph, Strep, Clostridium via lymph or vascular after surgery
– Also Chlamydia, Mycoplasma, Actinomyces (IUDs)
Adenomatoid tumor
benign fallopian tumor of mesothelial origin
Surface epi inclusion cysts of ovaries
small cysts from involution of surface epi, benign
Functional ovarian cysts
follicular and corpus luteal cysts, benign
PCO path
– Increased ovarian production of androgens that act locally to cause premature follicular atresia, multiple follicular cysts, persistent anovulatory state and decreased P
– Excess androgens converted to E in peripheral adipose tissue
Sporadic ovarian cancer
– activation of oncogenes (c-myc, K-ras, HER2/neu)
– Inactivation of tumor suppressor genes (p53, p16)
– Aneuploidy
Hereditary ovarian cancer
– 5-10% in women w/ familial susceptibility to ovarian and/or breast cancer
– Germline mutations in DNA repair genes
– BRCA-1 (chromo 17), BRCA-2 (chromo 13)
Most common germ cell tumor in adults
95% are benign mature cystic teratomas (dermoid cyst)
Ovarian mets
– stomach (Krukenberg tumor) colon, pancreas and appendix
– also breast, endometrium
Ovarian tumor cell markers
– Serous/endometrioid is CA125
– Mucinous is CEA
– Yolk sac tumor is AFP
– Choriocarcinoma is hCG
Imperforate hymen
– no obvious vaginal orifice
– thin, bulging, blue perineal membrane
– fluctuant pelvic
Mullerian agenesis
– Absent vagina, absent/ rudimentary uterus
– 46,XX, – Normal ovaries
– Normal 2o sexual development
– ASx
Transverse vaginal septum/cervical atresia
– Blind vaginal pouch, 46,XX
– Normal ovaries
– Normal 2o sexual development
– Cryptomenorrhea
Asherman Syndrome
– Synechiae
– Dx w/ strong suspicion
– based on hx uterine curettage (retained POC, endometritis)
– hx of IUD infection or PID
– hx of genital TB, schistosomiasis
– Hysterosalpingogram (HSG)
Drugs that could cause amenorrhea
Phenothiazines
Reserpine
Amphetamines
Opiates
Benzos
Butyrophenones
TCA’s
Metaclopramide
Enzyme deficiencies that can cause ammenorhea w/ high FSH
P450c17, aromatase
Evaluation for PCOD
– 1) T (producing neoplasm) > 200 – Transvaginal U/S – Adrenal CT/MRI
– 2) 17-hydroxyP (nonclassical CAH) > 2 – ACTH stim test
– 3) 24 hr cortisol if cushing signs and Sx
Abnormal Uterine bleeding Evlauation
– 1) Exclude pregnancy
– 2) Identify anemia, thrombocyto
– 3) Assess ovulatory function – Menstrual hx, Timed serum P, Endometrial bx (Age > 40 yr – Hx of chronic anovulation – Confusing/suspicious hx)
Hypoestrogenism
– Thin, inactive endometrium
– don’t tx w/ P, b/c it organizes and attenuates bleeding
– Dx if Biopsy yields minimal tissue and there is Attenuated endometrium (Stripe < 4 mm)
– Tx must begin w/ estrogen to build a foundation, then do progestin
Why is nulliparity an RF for endometrial cancer
– Infertility common link
– Anovulation
– high serum levels of androstenedione
– lack of monthly menses more common in this population
Endometrial cancer and ultrasound
– Normal has a very thin lining
– if lining less than 5 mm, possibility of having endometrial cancer is very small
– if asian, less than 3 means you are ok
Endometrial Cancer Staging
– Stage I is Uterus only
– Stage II is Cervical involvement
– Stage III is Ab involvement (tubes/ovaries/washings/nodes) or vaginal involvement
– Stage IV is Bowel, bladder, or mets
First line Tx for ovarian cancer
– Debulking Surgery/Staging
– then Chemotherapy (Platinum + Taxol) every 3 weeks for 6 cycles
– then second look surgery
2nd line Tx for ovarian cancer
– Ovarian cancer recurrence
– then Other chemo? Hormonal treatment? Interval debulking surgery? Radiation
Ovarian Cancer Staging
– Stage I is Ovaries only
– Stage II is Pelvic extension
– Stage III is Abdominal implants or lymph node spread
– Stage IV is Distant METs