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200 Cards in this Set
- Front
- Back
|
what is an XXY person? XO?
|
Klinefelter's = XYY
Turner's = XO |
|
Sx's of Klinefelter's?
|
Testicular Atrophy
Eunochoid body shape Tall Long limbs Gynecomastia Female hair distribution Common cause of hypogonadism in infertility workup |
|
What happens w/ the seminiferous tubules and leydig cells in Klinefelter's?
|
Dysgenesis of Seminiferous Tubules---> dec inhibin---> Inc FSH
Abnormal Leydig's-->dec testosterone---> Inc LH---> Inc Estrogen |
|
Sx's of Turner's?
|
Short
Ovarian dysgenesis Webbing of neck Preductal Coarctation Most common cause of primary amenorrhea No barr body |
|
Hormone levels in Turner's?
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dec estrogen---> Inc LH and FSH
|
|
What's up with an XYY guy?
|
Phenotypicall normal
Very Tall Severe Acne Antisocial Behavior in 1-2% (wouldn't that be the norm for XY guys?) Normal Fertility |
|
What is going on w/ Female Pseudohermaphroditism?
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Ovaries present, but external genitalia is virilized or ambiguous
|
|
Etiology of Female Pseudohermaphroditism?
|
Excessive or inappropriate exposure to androgenic steroids during early gestation
ex: congenital adrenal hyperplasia or exogenous administration of androgens during preggers |
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What's going on w/ Male Pseudohermaphroditism?
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Testes present, but external genitalia are female or ambiguous
|
|
Most common etiology of Male Pseudohermaphroditism?
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Androgen Insensitivity Syndrome
|
|
What is True Hermaphrodite then?
|
46, XX or 47,XXY
Both ovary and testicular tissue present Ambiguous genitals VERY RARE |
|
What about the uterus, testes, and hormone levels in Androgen Insensitivity syndrome?
|
No uterus or uterine tubes
Testes usually show up in labia majora and removed to prevent malignancy Testosterone, estrogen, and LH are all HIGH |
|
What happens w/ a 5alpha reductase def?
|
Unable to convert testosterone to DHT
Ambiguous genitals till puberty when inc testosterone--->masculinization and growth of external genitals "penis at 12" |
|
Hormone levels in 5-alpha reductase def?
|
Inc Testosterone and Estrogen
LH is normal or elevated |
|
What is a Hydatidiform Mole?
|
Cystic Swelling of Chorionic Villi and proliferation of chorionic Epithelium (trophoblast)
|
|
What can a Hydatidiform Mole lead to?
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Choriocarcinoma
|
|
Hormone levels w/ a Hydatidiform Mole?
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Inc Beta-hCG
|
|
Appearance of a Hydatidiform Mole
|
Honeycomb uterus
Cluster of Grapes Abnormally enlarged uterus (can lead to rupture) |
|
Rx for Hydatidiform Mole?
|
Dilatation and Curettage
Methotrexate |
|
Complete vs Partial Hydatidiform Mole: karyotype
|
Complete: 46,XX or XY
Partial: 69,XXY |
|
Complete vs Partial Hydatidiform Mole: Beta-hCG levels?
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C: very very veryhigh
P: elevated but not crazy high |
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Complete vs Partial Hydatidiform Mole: Uterine size?
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C: enlarged
P: normal |
|
Complete vs Partial Hydatidiform Mole: % converting to choriocarcinoma?
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C: 2%
P: rare |
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Complete vs Partial Hydatidiform Mole: Fetal parts?
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C: No
P: yes |
|
Complete vs Partial Hydatidiform Mole: gamete components?
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C: 2 sperm + 1 empty egg
P: 2 sperm + 1 egg |
|
common causes of recurrent, 1st weeks miscarriages?
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Low Progesterone levels (no response to b-hCG
|
|
common causes of recurrent 1st trimester miscarriages?
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Chromosomal Abnormalities (e.g. roberstonian translocation)
|
|
common causes of recurrent 2nd trimester miscarriages?
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Bicornuate uterus
|
|
what is preeclampsia?
|
Triad of HTN, Proteinuria, and Edema
|
|
So what is Eclampsia?
|
addition of seizures to triad
|
|
% of women who get it?
|
7%
|
|
time period when preeclampsia arises?
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20 weeks gestation to 6 weeks postpartum
|
|
What inc risk of preeclampsia?
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Preexisting HTN
diabetes Chronic Renal Disease, Autoimmune disorders |
|
Etiology of preeclampsia?
|
Involves placental ischemia (messed up spiral artery invasion)
---> lots of factors causes altered maternal endothelial cell fxn (inc vasc tone, inc vasc perm, coagulopathy) |
|
Syndrome association for preeclampsia
|
HELLP Syndrome
Hemolysis Elevated LFT's Low Platelets |
|
How does preeclampsia kill you?
|
Cerebral hemorrhage
ARDS |
|
what is Abruptio Placentae?
|
Premature detachment of placenta from implantation site
|
|
Sx's of Abruptio Placentae? outcome?
|
Painful bleeding in 3rd trimester
Fetal Death |
|
Risk factors and associations w/ Abruptio Placentae?
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Maybe ass w/ DIC
Inc Risk w/ smoking, HTN, and cocaine use |
|
What is Placenta Accreta?
|
Defective decidual layer allows placenta to attach to myometrium
|
|
How does Placenta Accreta Present?
|
massive bleeding after delivery
|
|
Predisposing factors for Placenta Accreta?
|
Prior C-Section or inflammation
|
|
What is Placenta Previa?
|
Attachment of placenta to lower uterine segment
Can occlude internal os |
|
Presentation of Placenta Previa?
|
painless bleeding during any trimester
|
|
Predisposing factors for Placenta Previa?
|
prior c-section
|
|
Predisposing factors for ectopic pregnancy?
|
Salpingitis (PID)
|
|
Presentation of ectopic Pregnancy?
|
pain w/o bleeding
may mimic appendicitis inc hCG and sudden lower abd pain |
|
Definition of poly and oligo-hydramnios?
|
Poly > 1.5-2 L
Oligo < 0.5 L |
|
What is Polyhydramnios associated w/?
|
Esophageal/Duodenal atresia
Anencephaly |
|
What is oligohydramnios associated w/?
|
Bilateral Renal Agenesis
Posterior Urethral Valves in males and subsequent inability to excrete urine |
|
what can oligohydramnios lead to?
|
Potter's Syndrome
|
|
HPV strains associated w/ CIN?
|
16 and 18
|
|
Common invasive cervical malignancy?
|
Squamous Cell Carcinoma
|
|
What can lateral invasion of SCC of cervix lead to?
|
Blocked ureters and RF
|
|
What is Endometriosis?
|
Non-neoplastic endometrial glands/stroma in abnormal locations outside uterus
|
|
Key presentation for Endometriosis?
|
Cyclic Bleeding resulting in blood-filled, chocolate cysts
Severe menstrual pain |
|
What is the ectopic endometrium usually?
|
ovary
peritoneum |
|
Possible outcome of endometriosis?
|
infertility
|
|
What is Adenomyosis?
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Endometrium w/in the myometrium
|
|
Typical Etiology of Endometrial Hyperplasia?
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Excess estrogen stimulation
|
|
Typical clinical manifestation of endometrial hyperplasia?
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Post-menopausal vaginal bleeding
|
|
Risk factors for Endometrial hyperplasia?
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anovulatory cycles
HRT Polycystic ovarian syndrome Granulosa cell tumor |
|
What is the most common gynecologic malignancy?
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Endometrial Carcinoma
|
|
Peak age for Endometrial Carcinoma?
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55-65
|
|
presentation of Endometrial Carcinoma?
|
vaginal bleeding
|
|
Risk factors for Endometrial Carcinoma?
|
endometrial hyperplasia
Prolonged use of estrogens w/o progestins Obesity Diabetes HTN Nulliparity Late menopause |
|
What is Endometrial Carcinoma prognosis related to?
|
degree of myometrial invasion
|
|
Types of Myometrial Tumors?
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Leiomyoma (fibroid)
Leiomyosarcoma |
|
Most common of all tumors in females?
|
Fibroid (leiomyoma)
|
|
Typical presentation of leiomyomas?
|
Multiple tumors w/ well-demarcated borders
|
|
What is a fibroid?
|
benign, smooth muscle tumor
|
|
who normally gets Fibroids?
|
more common in blacks
20-40 |
|
Hormone sensitivity of Fibroids? so?
|
Estrogen sensitive---> inc tumor size w/ pregnancy and dec size w/ menopause
|
|
Histo of Leiomyomas?
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Whorled pattern of smooth muscle bundles
|
|
Origin of Leiomyosarcoma?
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typically de novo
|
|
race and leiomyosarcomas?
|
more common in blacks
|
|
Course for Leiomyosarcoma?
|
highly aggressive
tendency to recur May protrude from cervix-->bleeding |
|
Incidence of main gynecological tumors?
|
endometrial > ovarian > cervical
|
|
Worst Px of gyn tumors?
|
Ovarian > cervical > endometrial
|
|
What is premature ovarian failure? hormone levels?
|
pt presents w/ menopause sx's after puberty but before 40
dec estrogen inc LH and FSH |
|
Polycystic Ovarian Syndrome presentation?
|
Amenorrhea
Infertility Obesity Hirsutism |
|
Hormone levels for Polycystic Ovarian Syndrome? so?
|
Inc LH--> anovulation
Dec FSH Inc Testosterone |
|
Inc incidence of what w/ Polycystic Ovarian Syndrome?
|
ass w/ insulin resistance
inc risk of endometrial cancer |
|
Rx for Polycystic Ovarian Syndrome
|
Wt loss
OCP's Gonadotropin analogs Clomiphene Surgery |
|
Types of Ovarian Cysts/
|
Follicular
Corpus Luteum Theca-lutein Chocolate |
|
What is a follicular cyst?
|
Distention of unruptured graafian follicle
|
|
what's up w/ Corpus Luteum cysts?
|
hemorrhage into persistent corpus luteum
menstrual irregularity |
|
Presentation of Theca-lutein cysts?
|
Often bilateral/multiple
|
|
Etiology of Theca-lutein cysts?
|
due to gonadotropin stimulation
|
|
Disease ass for Theca-lutein cysts?
|
choriocarcinoma and moles
|
|
Who are the Ovarian Germ Cell Tumors?
|
Dysgerminoma
Choriocarcinoma Yolk Sac (endodermal sinus tumor) Teratoma |
|
Tumor markers for Ovarian Germ Cell Tumors?
|
Dysgerminoma: hCG
Choriocarcinoma: hCG Yolk Sac Tumor: AFP |
|
What's up with Dysgerminoma?
|
malignant
= to male seminoma |
|
Morphology of Choriocarcinoma?
|
Large
Hyperchromatic syncytiotrophoblastic cells |
|
Location and course for Yolk Sac tumors?
|
Aggressive malignancy in ovaries (testes in boys) and sacrococcygeal area in kids
|
|
% of ovarian germ cell tumors that are Teratomas? what is it?
|
90%
|
|
Most frequent benign ovarian tumor?
|
Mature Teratoma (dermoid cyst)
|
|
Key for immature teratomas?
|
aggressively malignant
|
|
What is Struma ovarii?
|
contains functional thyroid tissue
can present like hyperthryoidism |
|
Who are 8 Ovarian Non-Germ Cell Tumors?
|
Serous Cystadenoma
Serous Cystadenocarcinoma Mucinous Cystadenoma Mucinous Cystadenocarcinoma Brenner Tumor Fibromas Granulosa Cell Tumor Krukenberg Tumor |
|
Prevalence of the 2 types of Serous tumors?
|
The cystadenoma makes up 20% of ovarian tumors
The cystadenocarcinoma makes up 50% |
|
Location, lining, and px for Serous Cystadenomas?
|
Frequently bilateral
Lined w/ fallopian-tube-like epithelium Benign |
|
Common Ovarian Cancer marker?
|
Inc CA-125
|
|
Location for lots of Serous Cystadenocarcinomas?
|
Frequently bilateral
|
|
Risk factors for Serous Cystadenocarcinomas?
|
BRCA-1
HNPCC |
|
What is a Mucinous Cystadenoma?
|
Multiocular cyst lined by mucus-secreting epithelium
|
|
Complication w/ Mucinous Cystadenocarcinoma?
|
Pseudomyxoma peritonei
|
|
What is Pseudomyxoma peritone
|
intraperitoneal accumulation of mucus from ovarian or appendiceal tumor (can compress stuff)
|
|
Kickers for Brenner Tumor?
|
Benign
looks like Bladder |
|
What does a Fibroma look like?
|
Bundles of Spindle-shaped fibroblasts
|
|
What is Meig's Syndrome?
|
Triad of ovarian fibroma
ascites hydrothorax |
|
Sx of Fibroma?
|
Pulling sensation in groin
|
|
Kicker for Granulosa Cell Tumor in kids?
|
Can cause precocious puberty since it secretes estrogen
|
|
What can Granulosa Cell Tumors cause in adults?
|
Endometrial hyperplasia or carcinoma
|
|
Morphological kicker for Granulosa Cell Tumor
|
Call-Exner Bodies =
small follicles filled w/ eosinophilic secretions |
|
What is a Krukenberg Tumor?
|
GI malignancy that metastasizes to ovaries---> mucin-secreting signet cell adenocarcinoma
|
|
3 Types of Vaginal Carcinoma?
|
Squamous Cell
Clear Cell Adenocarcinoma Sarcoma Botryoides |
|
What causes SCC of vagina?
|
its comes secondary to cervical SCC
|
|
Who gets Clear Cell Adenocarcinoma of vag?
|
women who were exposed to DES in utero
|
|
Who gets Sarcoma botryoides?
|
girls < 4
|
|
Histo of Sarcoma botryoides?
|
spindle-shaped tumor cells
desmin-positive |
|
3 Benign Breast Tumors?
|
Fibroadenoma
Intraductal Papilloma Phyllodes Tumor |
|
Characteristics of Fibroadenomas?
|
Small
Mobile Firm Sharp edges |
|
Characteristics of Intraductal Papilloma?
|
Small
Grows in lactiferous ducts Typically beneath areola |
|
Characteristics of Phyllodes tumor?
|
Large, bulkly mass
Made of connective tissue and cysts Leaf-like projections |
|
Epidemiological kickers for Fibroadenoma and Phyllodes?
|
Fibroadenoma is most common tumor in < 25 crowd
Phyllodes is most commonly seen in 6th decade |
|
Typical changes in Fibroadenomas?
|
Inc size and tenderness w/ inc estrogen (preggers, period)
NOT a precursor for cancer |
|
possible presenting sx of intraductal papilloma?
|
serous or bloody nipple discharge
|
|
Progression of intraductal papilloma and phyllodes
|
Slight risk of progression to malignancy
|
|
7 types of malignant breast cancer?
|
Ductal Carcinoma in Situ (DCIS)
Invasive Ductal Invasive Lobular Medullary Comedocarcinoma Inflammatory Paget's Disease |
|
Common time period when malignant breast cancer shows up?
|
Postmenopause
|
|
Origin of malignant breast cancer?
|
mammary duct epithelium or lobular glands
|
|
What is the single most important prognostic factor for breast cancers?
|
Axillary LN involvement
|
|
Characteristics of DCIS?
|
fills ductal lumen
|
|
Characteristics of Invasive Ductal?
|
Firm, fibrous mass
Small, glandular, duct-like cells |
|
Characteristics of invasive lobular?
|
Orderly rows of cells
|
|
Characteristics of Medullary?
|
Fleshy, Cellular, Lymphatic infiltrate
|
|
Characteristics of Comedocarcinoma?
|
Ductal
Caseous Necrosis |
|
Characteristics of Inflammatory Breast cancer?
|
dermal lymphatic invasion by breast carcinoma
Peau d'orange |
|
Characteristics of Paget's of boob?
|
Eczematous patches on nipple
Paget Cells = large cells in epidermis w/ clear halo |
|
what does in situ mean in DCIS?
|
No Basement membrane penetration
|
|
Which breast cancer is the worst?
|
Invasive ductal is the worst and most invasive
|
|
Which breast cancer is the most common?
|
Invasive Ductal (76%)
|
|
Typical location of Invasive Lobular?
|
Often Multiple and Bilateral
|
|
Px for Medullary Breast Cancer?
|
GOOD
|
|
5 year survival rate of Inflammatory breast cancer?
|
50%
|
|
Where else can Paget's be seen?
|
vulva
|
|
4 other common pathological breast conditions?
|
Fibrocystic Disease
Acute Mastitis Fat Necrosis Gynecomastia |
|
Fibrocystic Disease's claim to fame?
|
most common cause of lumps from 25-menopause
|
|
Typical Presentation of Fibrocystic Disease?
|
Premenstrual breast pain
Multiple Lesions Often bilateral Fluctuation in size of mass |
|
4 Histological types of fibrocystic disease?
|
1. Fibrosis (hyperplasia of breast stroma)
2. Cystic (fluid filled, blue dome) 3. Sclerosing adenosis (inc acini and intralobular fibrosis) 4. Epithelial hyperplasia (inc number of epithelial layers in terminal duct lobule |
|
2 other kickers for Epithelial Hyperplasia type?
|
Inc risk of carcinoma if atypical cells present
Occurs in women > 30 |
|
What is Acute Mastitis?
|
Breast Abscess
|
|
When does Acute Mastitis usually occur? why?
|
During breast feeding
Inc risk of bacterial infection through cracks in nipple |
|
Most common bug causing Acute Mastitis?
|
staph aureus
|
|
What causes fat necrosis?
|
Injury to breast tissue--->benign painless lump
|
|
Causes of Gynecomastia?
|
Hyperestrogenism (cirrhosis, testicular tumor, puberty, old age)
Klinefelter's Drugs (estrogen, weed, heroin, psychoactive drugs, and...) |
|
Who are the 5 big drugs that can cause Gynecomastia?
|
Spironolactone
Digitalis Cimetidine Alcohol Ketoconazole |
|
Sx's of Prostatitis?
|
Dysuria
Frequency Urgency Low back pain |
|
causes of prostatitis?
|
Acute: bacterial (e.coli)
Chronic: bacterial or abacterial (most common) |
|
what does the H in BPH stand for?
|
HyperPLASIA, not hyperTROPHY
|
|
How does the prostate enlarge in BPH?
|
Nodular enlargement of Periurethral lobes (lateral and middle)--->compression of urethra
|
|
Typical Presentation of BPH?
|
Inc Frequency
Nocturia Difficulty starting or stopping Dysuria |
|
Possible complications of BPH?
|
Distention and hypertrophy of bladder
Hydronephrosis UTI's |
|
Sign of BPH?
|
Inc free PSA
|
|
Origin of Prostate Cancer?
|
Posterior Lobe (peripheral zone)
|
|
Typical Dx of Prostate cancer?
|
DRE finds a hard nodule
Bx it |
|
Markers for prostate cancer?
|
Prostatic Acid Phosphatase (PAP)
PSA (esp inc in total PSA, w/ dec fraction of free PSA) |
|
What does an inc in serum Alkaline Phosphatase indicate in a prostate cancer pt?
|
Metastases to bone (esp likes lower back)
|
|
What happens as a result of Cryptorchidism?
|
no spermatogenesis from inc body temp
|
|
what inc Risk of Cryptorchidism?
|
Prematurity
|
|
what can cryptorchidism inc your risk of?
|
Inc risk of germ cell tumors
being made fun of in high school |
|
5 Testicular Germ Cell Tumors? prevalence of germ cell tumors as a whole?
|
Seminoma
Embryonal Carcinoma Yolk Sac Choriocarcinoma Teratoma they all make up 95% of testicular tumors |
|
Which is the most common testicular tumor? age?
|
Seminoma
15-35 |
|
Sx's of Seminoma?
|
Painless testicular enlargement
|
|
Histo of Seminoma?
|
Large cells in lobules w/ watery cytoplasm and "fried egg" appearance
Radiosensitive |
|
Px for Seminomas?
|
Excellent
only has Late metastases |
|
Sx's of Embryonal Carcinoma? Px?
|
Painful
Worse Px |
|
Histo of Yolk Sac Tumor?
|
Schiller-Duval Bodies
Primitive Glomeruli (inc AFP) |
|
Marker for Choriocarcinoma of nuts?
|
inc hCG
|
|
How do teratomas in females and males differ?
|
Mature teratomas in males are most often malignant
|
|
Who are the Non-Germ Cell Testicular Tumors? general Px?
|
Leydig Cell
Sertoli Cell Testicular Lymphoma mostly benign |
|
What is the most common testicular cancer in old guys?
|
testicular Lymphoma
|
|
Histo of Leydig Cell Tumor?
|
Reinke crystals
|
|
Sx's of Leydig Cell Tumor?
|
Gynecomastia in men or precocious puberty in boys b/c its Androgen Producing
|
|
Origin of sertoli cell tumor?
|
Andromblastoma from sex cord stroma
|
|
What are Tunica Vaginalis Lesions?
|
Lesions in serous covering of testis that present as masses
|
|
Difference between Tunica Vaginalis lesions and testicular tumors?
|
Tunica Vaginalis lesions can be transilluminated
|
|
3 types of Tunica Vaginalis lesions
|
Varicocele
Hydrocele Spermatocele |
|
What is varicocele?
|
Dilated vein in pampiniform plexus--> bag of worms
|
|
what is hydrocele?
|
Inc fluid secondary to incomplete fusion of processus vaginalis
|
|
What is spermatocele?
|
dilated epididymal duct
|
|
Types of Carcinoma in Situ of the wiener?
|
Bowen's Disease
Erythroplasia of Queyrat Bowenoid papulosis |
|
What is Bowen's Disease?
|
Gray, solitary, crusty plaque
Usually on shaft or scrotum |
|
Ages for Bowen's? Px?
|
peak incidence in 5th decade
progresses to SCC in < 10% |
|
What is up with Erythroplasia of Queyrat?
|
Red, velvety plaques
usually involves glans otherwise similar to bowen's |
|
What is Bowenoid Papulosis?
|
Multiple papular lesions
|
|
Age and Px for Bowenoid papulosis?
|
Younger age group
Doesn't become invasive |
|
Risk factors for Squamous Cell Carcinoma of wiener?
|
Uncircumcised
HPV |
|
What is Peyronie's Disease?
|
Bent penis due to acquired fibrous tissue formation
|
