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90 Cards in this Set
- Front
- Back
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causes of hypothalamic amenorrhea
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deficiancy in GnRH secretion eg anorexia nervosa,Kallman's syndrome (congenital GnRH deficiancy)
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pituitary causes of amenorrhea
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destruction of pit such as prolactin adenoma or Sheehan's syndrome (acute necrosis)
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invasive or persistant GTD
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only occurs after pregnancy/mole in endo and myometrium, local invasion, excessive trophoblastic proliferation, villous pattern maintained, metastasis rare, dianosis based on stable or serially rising beta-hCG, will regress with time
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risk for invasive or persistant GTD
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long interval between the pregnancy and evacuation, large theca lutein cysts, mom over 40, history of GTD
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complete molar pregnancy
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hydropic degeneration and swelling of villous stroma, absence of blood vessels
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choriocarcinoma
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gestational trophoblastic neoplasia - sheets of anaplastic (undifferentiated)trophoblast, no chorionic villi seen
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mifepristone 8hrs
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decidua begins to retract from uterine wall, pycnotic nuclei appear in the decidua, small hemmorhagic lakes are seen around the embryo
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mifepristone 10 hrs
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the decidua is necrotic and filled with a polymorphonuclear infiltrate and large areas of hemmorage, embryo partially disorganized
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mifepriston 16hrs
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the decidua is almost completely separated from the uterine wall and the degenerating embryo can be seen floating within hemmorrhagic lakes
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oxytocin
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causes uterine contractions
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prostaglandins for cervical ripening
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prepidil-intracervical with syringe
cervidil-vaginal insert misoprostol-placed in posterior vagina, near cervix |
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E and P in the pill
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E - supresses FSH, stabilizes the endometrium, induces progesterone receptors
P-supresses LH, decidualizes the endometrium, thickens cervical mucous |
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Copper T
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MEch-steril inflammatory process, spermicidal
heavy menses, cramping, irregular bleeding |
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Mirena
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Mech - thickens cervical mucous, atrophy of endometrium
light periods |
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mastitis treatment
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dicloxacillin, hydration, bedrest, acetominophen
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danazol
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decr production of E
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fibrocystic change
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cystic areas may enlarge rapidly, occasional spontaneous nipple discharge, epithelial and fibrous proliferation, fluid retention
treat - premenstrual diuretics, progestins, danazol, bromocriptine, tamoxifen, aspiration or excision of cysts |
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fibroadenoma
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adolescents-20's, solitary, slow growing, mobile, painless, no change w/ menses, etiology may be determined by FNA cytology, imiging
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duct ectasia
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nipple retraction common
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breast cancer - low grade
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forms tubules, ER pos
(lobular tends to be low grade, can metastasize, multifocal/unifocal, risk for bilaterality, 10% lobular) |
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breast cancer - high grade
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no tubules, ER neg
(ductal tends to be high grade, worse prognosis, unifocal, 80% ductal) |
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most imp factor in breast canger prognosis
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stage
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precancerous lesions and squamous carcinomas develop...
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in the transformation zone, including the squamocolumnar jct
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condyloma accuminatum
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branching tree-like proliferation of stratified squamous epi supported by a fibrous stroma
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carcinoma of the vulva
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85% are squamous cell carcinomas, either
1) associated w/ high risk HPV, and frequently coexists with or is preceded by VIN OR 2) associated with squamous cell hyperplasia and lichen sclerosis |
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syphilis
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microaerophilic
2ndary)condyloma lata (moist confluent plaques), mucous patches, 6-8 wks after inital chancre, lasts 2-6wks |
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2 types of vulvar squamous carcinoma
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1)HPV,VIN
2)p53,differntiated type/vulvar dystrophy/symplastic, assoc. w/ lichen sclerosis, worse prognosis |
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vaginal adenosis
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DES, precursor to clear cell adenocarcinoma (vacuolated glycogen-containing cytoplasm), glandular columnar epithelium of mullerian type (endocervical appearance), appears beneath the squamous epi or replaces it
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cambium layer
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hypercellular zone beneath the vaginal epi - present in embryonal rabdomyosarcoma (sarcoma botryoides-spindled striated cells)
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extramammory paget disease
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large mucin-positive tumor cells within the epidermis, most frequently confined to the epidermis, may be accompainied by a palpable submucosal thickening or tumor, large tumor cells ingly or in small clusters within the epidermis, clear separation "halo" from surrounding epithelial cells
PAS, Alcian blue, or mucicarmine positive mucopolysaccharide |
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granuloma ingiunale
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infiltrate of histiocytes and plasma cells, islands of necrosis (small abscesses)
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lymphogranuloma venereum
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LGV - ulcer painful on palpation
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koilocytes
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halo cells (clear zone around hyperchromatic nuclei), seen in condyloma accuminatum
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HPV 18>16
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often associated with CIN - cervical adenocarcinoma
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anovulatory cycles
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prolonged E stimulation w/o following progestational phase.
Common causes:endocrinee disorder, estrogenic ovarian lesion, metabolic disturbance (obesity, malnutrition) |
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OCP
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atrophic/inactive glands and decidualized stroma
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menopause can lead to
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cystic atrophy, atrophic glands, resembles normal basalis, fewif an mitoses
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endometriosis
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infertility, dysmennorhea, pain
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endometrial polyps
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stromal cells clonal w/ 6p21 rearrangemant, funtional/proliferative or hyperplastic endometrium, fibrotic stroma, some associated with tamoxifen
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endometrial carcinoma type I
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herestrogenic, hyperplasia, endometroid, microsattelite instability, PTEN mutations
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endometrial carcinoma type II
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NOT hypperestrogenic, NOT hyperplastic, serous pappilary clear cell, p53 mutations, LOH, grade 3
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endometrial stromal tumors
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Benign: stromal nodule - well circumscribed, endometrail stromal cells in myometrium
Malignant: endometrial stromal sarcoma - invasive, low grade, or high grade, rich in blood vessels, invades myometrium, blood vessels, or lymphatics, t(7;17) |
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mixed epithelial-stromal neoplasms
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adenosarcoma: benign glands and malignant stroma (periglandular cuffing), usually low grade polypoid mass
carcinosarcoma: MMMT, malignant mixed mullerian tumor, malignant glands and malignant stroma, homologous vs heterologous |
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leiomyosarcoma
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arise from myometrium or endometrial stroma, complex karyotype, invade into uterine wall or project into lumen, patchy necrosis, nuclear pleomorphism, high mitotic index, 40-60yr
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proliferative endometrium
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coiling increases progressively, stromal cells with scant indistinct cytoplasm, mitoses
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endometrium in pregnancy
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hypersecretory endometrial glands, decidualized stromal cells
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leiomyoma
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simple chromosomal abnormality, intersecting facies of bland spindle cells, degeneration common, may metastasize (benign metastasizing, disseminated peritoneal leiomyomatosis), variants (symplastic, cellular), edema
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follicular cysts
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graffian follicle origin, multiple, <2cm, may cause increased E
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luteal cysts
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rupture may cause peritoneal inflammation, corpus luteum of pregnancy: may appear as ovarian neoplasm
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stein-leventhal syndrom
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polycystic ovarian disease, enlarged thick smooth capsule
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benign surface epithelial tumors (ovarian)
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cystadenoma, cystadenofibroma
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malignant surface epithelial tumors (ovarian)
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cystadenocarcinoma, adenocarcinoma
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surface epithelial stromal tumors
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not enlarged ovary, ovary pouches in post ovulation
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Brenner
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most common transitional type of surface epithelial stromal tumor
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serous-benign
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pseudostratified, tall cilliated, flat or with few pappilae
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serous-borderline
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more solid, more papillae, more epi proliferation as tufting or multilayered arrangement
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serous-malignant
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more solid, invasion into stroma, more proliferation, cytologic atypia and psammoma bodies (concentric calcifications)
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serous may areise from...
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ovary or ceolomic epi
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mucinous tumors
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endocervical-benign,cystic
intestinal-benign,LMP,or malignant(more solid)...stromal invasion more difficult to detect pseudomyxoma peritonei has extensice mucinous ascites progress along an adenoma-borderline tumor-carcinoma sequence involving mutations in KRAS |
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mucinous cystadenocarcinoma
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lossof glandular architecture, necrosis
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endometroid tumor
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most often carcinoma, grossly solid and cystic neoplasms w/ tubular glands resembling endomerium, 15% show co-existing endometriosis, co-existing endometrial carcinoma in 15-30% of cases
Arise from endometriosis involving mutations of CTNNB1 (b-catenin gene) and PTEN |
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low grade serous carcinoma
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adenoma-borderline tumor-carcinoma sequence ... mutaions in KRAS and BRAF
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high grade serous
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from surface epithelial inclusion glands invloving mutations of TP53, BRACA1 and/or BRACA2
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Teratoma
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Mature (cystic)-benign in ovary, not in testes-all 3 germ layers, dermoid cyst; struma avarii;carcinoid (derived from intestinal epi)
Immature: (soild)generally bulky,may grow rapidly, grading based on ammoutn of immature neuroepithelium |
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dysgerminoma
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ovarian equivalent of seminoma, 90% unliateral, fleshy, 20-40yrs, sheets of large cells with clear cytoplasm, central nucleus
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endodermal sinus
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(yolk sac tumor)agressive, schiller duval body (glomerulous-like structure rich in AFP, A1-AT, forming hyaline droplets
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choriocarcinoma
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agressive, early vascular metastasis, b-HCG, bilaminar combination of syncytiotrophoblasts and cytotrophoblasts, most exist in combination with other germ cell tumors
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granulosa cell tumor
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produle large amounts of E, post-menopausal, usually indolent course
juvenile form call exner bodies- small gland-like spaces filled with eosinophillic material-resembles immature follicle |
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fibroma-thecoma
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composed of fibroblasts(fibroma, plump lipid-containing spindle cells (thecoma), or mixture
90% unliateral solid firm grey white masses Meigs syndrome: fibroma + ascites + R-sided hemothorax |
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proctitis
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NG,CT, T Pallidum, HSV
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Gonorrhea
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sterile pyuria, dissemites with fever, joint pain, rash
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Chlamydia tests
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gorwn in McCoy cells, DFA - direct flourescence antibody, EIA enzyme linked immuno assay, DNA RNA amplification tests by urine
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Jarisch-Herxheimer reaction
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fever, headache, muscle aches
in first 24hrs of syphillis treatment |
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bacterial vaginosis
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malodorous white vaginal discharge, irritation, and itching
can lead to PID and premature labor "clue cells"-vaginal epithelial cells coated with coccobacillary organisms few PMNs in vaginal discharge |
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Hep B to fetus
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transvaginal..prevent by active(hepatavax) and passive (HB immunoglobulin) immunotherapy of infant
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HSV to baby
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transvaginal...mucocutaneous/systemic/CNS disease, death...offered cesarian
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STD highest incidence
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1)HPV 2)Chlamydia
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STD highest prevalence
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HSV
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pneumocystis pneumonia (PCP)
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fungus, pneumocystis jiroveci, non-productive cough, labored breathing, fever, hypoxemia, elevated LDH, CXR bilateral diffuse interstitial infiltrates, CD4 <200
Disgnosis: induced sputum, broncoscopy w/ bronchiaveolar lavage. Prophylaxis:TMP-SMX |
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disseminated MAC
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fever, night sweats, anemia, weight loss abdominal pain, diarrhea, hepatosplenomegaly, intra-abdominal lymphadenopathy, elevated alkaline phosphatase
Diagnosis: bacteremia, AFB culture Prophylaxis: azythromycin |
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Toxoplasma encephalitis
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headache, confusion, lethargy, fever, neuro symptoms
Diagnosis: multifocal ring-enhancing lesions on CT or MRI w/ brain positive toxoplasma serology, response to empiric treatment, rarely biopsy Prophylaxis:TMP-SMX |
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Tuberculosis
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high CD4-upper lobe cavitary disease
low CD4-lower lobe, extrapulmonary, lymphadenopathy |
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cryptococcal meningitis
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headache, stiff neck, confusion, fever, CSF may show lymphocytic pleocytosis, low glucose, or no WBCs
Diagnosis:CSF and serum antigen-titer correlates with prognosis and treatment response |
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CMV
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retinits, enterocolitis, encephalitis, radiculopathy
Diagnosis: plasma DNA PCR suggests, retinits, blood cultire, colitis histopathology, CSF PCR |
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HSV
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esophgitis, proctitis, perianal ulceration
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VZV
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herpes zoster, postherpetic neuralgia, encephalitis/myelitis
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PML - progressive multifocal leukoencephalopathy
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JC virus - ataxia, visual field cuts, multifocal demylenating lesions on brain MRI
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Kaposi's sarcoma
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HHV-associated
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cervical/anorectal carcinoma
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HPV-related
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non-Hodgkin's Lymphoma
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primary CNS lymphoma usually EBV realted, 80% B cell, often polyclonal, extranodal disease is common
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