Question | Answer |
Testosterone | develops seminal vesicles, epididymis, vas deferens |
Dihydrotestosterone (DHT) | develops prostate and male external genitalia |
Testicular feminization | XR; deficient androgen receptors; MCC male pseudohermaphrodite |
Klinefelter’s syndrome | XXY; 1 Barr body; female secondary sex characteristics |
Herpes genitalis | recurrent painful vesicles; multinucleated squamous cells with intranuclear inclusions |
Human papilloma virus | condyloma acuminata; koilocytosis (wrinkled nuclei surrounded by a halo) |
Chlamydia trachomatis | metaplastic squamous cells with vacuoles containing elementary bodies |
Chlamydia trachomatis S/S | non-specific urethritis, cervicitis, PID, ophthalmia neonatorum |
Neisseria gonorhoeae | urethritis, cervicitis, PID; ophthalmia neonatorum, gram negative diplococcus |
Ophthalmia neonatorum first week | N gonorrhoeae |
Ophthalmia neonatorum second week | C. trachomatis |
Lymphogranuloma venereum | C. trachomatis subtype |
Lymphogranuloma venereum S/S | scrotal/vulva lymphedema; granulomatous microabscesses; rectal strictures in females |
Chancroid | painful ulcer, adenopathy, Hemophilus ducreyi |
Granuloma inguinale | Calymmatobacterium granulomatis; raised ulceration but no lymphadenopathy |
Treponema pallidum | spirochete; produces vasculitis of arterioles (plasma cell infiltrate) |
Primary syphilis | painless chancre |
Secondary syphilis | rash on palms/soles; condyloma lata; generalized adenopathy |
Tertiary syphilis | neurosyphilis (e.g., tabes dorsalis), aortic arch aneurysm, gummas |
RPR/VDRL | reagin antibodies against cardiolipin; ↓ titer with Rx of syphilis |
RPR/VDRL | false positive with anticardiolipin antibodies (common in SLE) |
FTA-ABS | confirmatory test for syphilis; not distinguish active from treated disease |
FTA-ABS | remains positive after Rx |
Trichomonas vaginalis | flagellate protozoan; cervicitis/vaginitis; Rx metronidazole both partners |
Gardnerella vaginalis | vaginal pH >5; bacterial vaginosis; clue cells; Rx metronidazole |
Candida vaginitis | white, curd-like discharge; DM, antibiotics, pregnancy; Rx fluconazole |
Vulvar squamous cancer | MC vulvar cancer; HPV association |
Vulvar leukoplakia | biopsy to R/O squamous dysplasia/cancer |
Lichen sclerosis vulva | epidermal atrophy; slight risk for squamous cancer |
Squamous hyperplasia vulva | leukoplakia; no cancer risk |
Paget’s disease | intraepithelial adenocarcinoma (mucin production) of vulva |
Malignant melanoma | vulva location; similar to Paget cells but not mucin positive |
Gartner’s duct cyst | lateral wall vagina; persistent mesonephric duct |
Embryonal rhabdomyosarcoma | bloody, grape-like vaginal mass young girl |
Vaginal adenosis | maternal exposure to DES; precursor clear cell adenocarcinoma vagina |
Vaginal squamous cancer | usually extension of cervical cancer |
Rokitansky-Kiister-Hauser | absence of vagina and uterus |
Nabothian cysts | endocervical glands covered by metaplastic squamous epithelium |
Pathologic cervicitis | trichomonas, HSV-2, C. trachomatis (follicular cervicitis) |
Cervical Pap | superficial squamous (estrogen), intermediate (progesterone), parabasal (no hormone) |
Normal | 70% superficial, 30% intermediate |
Atrophic | 100% parabasal cells |
Hyperestrinism | 100% superficial cells |
Pregnancy | 100% intermediate cells |
Endocervical cells | sign of adequately performed Pap smear |
Cervical polyp | bleeding after intercourse; non-neoplastic |
Cervical dysplasia | begins in transformation zone; associated with low and high risk HPV |
Risk factors cervical dysplasia/cancer | early onset sexual activity; multiple partners; smoking; OC |
CIN | cervical intraepithelial dysplasia; mild, moderate, severe (in-situ) |
Cervical cancer | ↓ incidence (Pap smear); 45-yr-old; COD renal failure from obstruction of ureters |
Cervical S/S | cervical discharge; bleeding after intercourse |
Sequence to menarche | breast budding, growth spurt, pubic hair, axillary hair, menarche |
Proliferative phase cycle | estrogen-dependent; ↑estrogen inhibits FSH and stimulates LH |
Ovulation | day 14-I6; LH surge; subnuclear vacuoles; ↑body temperature |
Secretory phase cycle | progesterone-dependent |
Menses | drop in estrogen/progesterone stimulates apoptosis; plasmin prevents clotting |
FSH | stimulates follicle and aromatase synthesis in granulosa cells |
LH | stimulates androgen synthesis in proliferative phase and progesterone synthesis in secretory phase |
Embryonic Event on Day 21 | day of implantation of fertilized egg |
Pregnancy | ↑plasma volume > RBC mass; ↑GFR; ↑thyroxine/cortisol (increased binding proteins) |
hCG | LH analogue produced by syncytiotrophoblast |
hCG | stimulates corpus luteum of pregnancy to synthesize progesterone for 8-10 weeks |
Estrone | estrogen of postmenopausal woman; aromatization of adrenal androstenedione |
Estradiol | estrogen of non-pregnant woman in reproductive life; aromatization of testosterone |
Estriol | estrogen of pregnancy |
Menopause | ↑ FSH (best screen; due to ↓estrogen), ↑LH |
Menopause S/S | secondary amenorrhea, hot flushes |
Hirsutism | ↑ hair in normal areas |
Virilization | hirsutism + male secondary sex characteristics (clitoromegaly) |
Test for hirsutism/virilization | ↑ testosterone - ovarian source; ↑DHEA-sulfate - adrenal source |
Polycystic ovarian syndrome (PCOS) | ↑ LH; ↓ FSH; ↑ estrogen and androgens |
Polycystic ovarian syndrome (PCOS) S/S | hirsutism, oligomenorrhea, infertility; enlarged ovaries with subcortical cysts; LH:FSH >2:1 |
Menorrhagia | excess menstrual flow; MCC iron deficiency in women |
Dysmenorrhea | painful menses; 1° PGF2α, 2° endometriosis |
DUB | bleeding related to hormone rather than anatomic causes |
Anovulatory DUB | menarche and perimenopause; estrogen excess without progesterone |
Ovulatory DUB | irregular shedding, inadequate luteal phase |
Primary amenorrhea | no menses by 16 years old |
Secondary amenorrhea | no menses for 3 months |
Amenorrhea-hypothalamic/pituitary dysfunction | ↓ FSH/LH; e.g., hypopituitarism |
Amenorrhea-ovarian dysfunction | ↑FSH/LH; e.g., Turner’s syndrome |
Amenorrhea-end-organ disease | normal FSH/LH; e.g., imperforate hymen |
Asherman syndrome | surgical removal of stratum basalis |
Primary amenorrhea-normal secondary sex characteristics | constitutional delay MCC |
Primary amenorrhea-lack secondary sex characteristics | Turner’s |
Turner’s syndrome | XO; no Barr bodies; XO/XY types have gonadoblastomas; streak gonads (no eggs) |
Turner’s syndrome S/S | newborn with lymphedema hands/feet; cystic hygroma in neck (web); short stature; 1° amenorrhea |
Secondary amenorrhea | pregnancy MCC; prolactinoma; anorexia nervosa; pituitary adenoma |
Asherman syndrome | removal of stratum basalis causing scarring; secondary amenorrhea |
Endometritis | group B streptococcus; intrauterine device (Actinomyces); chronic - plasma cells |
Endometrial polyp | menorrhagia; not a precursor for endometrial cancer |
Adenomyosis | functioning endometrial glands and stroma in myometrium; enlarged uterus |
Endometriosis | functioning glands and stroma outside uterus; reverse menses; ovary MC site |
Endometriosis S/S | dysmenorrhea, painful stooling, bowel obstruction; “powder burn” appearance |
Endometrial hyperplasia | unopposed estrogen; simple/complex types; precursor endometrial cancer |
Causes of endometrial hyperplasia | obesity, estrogen Rx, polycystic ovarian syndrome |
Endometrial cancer | obesity, nulliparity, estrogen Rx, early menarche/late menopause; OC protective |
Endometrial cancer S/S | bleeding in postmenopausal woman |
Leiomyoma uterus | menorrhagia, obstructive delivery; not a precursor for leiomyosarcoma |
Leiomyosarcoma | MC sarcoma |
Ectopic pregnancy | PID MC risk factor; intraperitoneal hemorrhage; screen with ß-hCG |
Follicular cyst | MC ovarian mass in young woman |
Risk factors ovarian tumors | nulliparity and genetic factors; OC protective |
Serous ovarian tumors | surface-derived; ↑ bilaterality; psammoma bodies in malignant type |
Mucinous ovarian tumors | surface-derived; pseudomyxoma peritonei in malignant type |
Endometrioid carcinoma | resembles endometrial cancer; association with endometriosis |
Cystic teratoma | MC benign germ cell tumor (<1% malignant); hair/teeth; calcifications |
Dysgerminoma | MC malignant germ cell tumor; associated with streak gonads of Turners |
Yolk sac tumor | MC germ cell tumor young girl; ↑AFP; Schiller-Duval bodies |
Meigs syndrome | ovarian fibroma, ascites, right-sided pleural effusion |
Granulosa tumor | low grade malignant; hyperestrinism, Call Exner bodies |
Thecoma | benign; yellow color; hyperestrinism |
Leydig cell and Sertoli cell tumors | hyperandrogenism |
Gonadoblastoma | XY phenotype of Turner’s |
Krukenberg tumors | metastatic stomach cancer; signet ring cells |
Single umbilical artery | ↑ incidence congenital defects |
Syncytiotrophoblast | lining of villi; produces hCG and human placental lactogen |
Human placental lactogen | responsible for mild glucose intolerance in pregnancy |
Abruptio placenta | retroplacental clot; painful bleeding; hypertension, cocaine, smoking |
Placenta previa | placenta implanted over cervical os; painless bleeding |
Placenta accreta | direct implantation into myometrium without intervening decidua; hysterectomy |
Twin placenta | monochorionic always identical twins; dichorionic may be identical or fraternal |
Siamese twins | monoamniotic monochorionic twin placenta |
Enlarged placenta | DM, Rh HDN, syphilis |
Complete mole | benign neoplasm of chorionic villi; dilated villi; no embryo; 46 XX (both male) |
Complete mole S/S | preeclampsia in first trimester; ↑ incidence choriocarcinoma |
Partial mole | embryo present; 68 XXY; no transformation into choriocarcinoma |
Choriocarcinoma | malignancy of trophoblastic tissue (syncytiotrophoblast, cytotrophoblast) |
Choriocarcinoma risk factors | complete mole (MC), spontaneous abortion, normal pregnancy |
Choriocarcinoma S/S | ↑hCG; lung metastasis; good prognosis |
Chorioamnionitis | group B streptococcus (S. agalactiae) infection |
Preeclampsia | abnormal placentation causing placental ischemia; ↑ in vasoconstrictors (ATII) |
Preeclampsia S/S | hypertension, proteinuria, pitting edema; begins in third trimester |
Spontaneous abortion | 50% have karyotype deformity (trisomy 16) |
Amniotic fluid | fetal urine |
Polyhydramnios | TE fistula, duodenal atresia, open neural tube defects |
Oligohydramnios | infantile polycystic disease |
↑ Serum AFP | open neural tube defect |
↓ Serum AFP | Down syndrome |
Urine estriol | fetal adrenal, placental, maternal liver involved in its production |
Down syndrome triad | ↑ ß-hCG, ↓ serum AFP, ↓ urine estriol |
Fibrocystic change | MC breast mass <50-yrs-old; atypical hyperplasia cancer risk; lumpy, painful breasts |
Sclerosing adenosis | component of FCC; involves terminal lobules often has microcalcifications |
Fibroadenoma | benign stromal tumor; MC movable mass in women <35-yrs-old |
Intraductal papilloma | benign tumor lactiferous duct/sinus; MCC bloody nipple discharge <50-yr-old |
Invasive ductal cancer | MCC breast mass in woman >50-yrs-old |
Breast cancer risk | unopposed estrogen; family history first-degree relatives |
Breast cancer | painless mass upper outer quadrant in woman >50-yrs-old |
Mammography | screening test to detect non-palpable masses |
Palpable breast mass | order fine needle aspiration (not a mammogram) |
Ductal carcinoma in situ | necrotic centers (comedo); microcalcifications common |
Paget’s disease of breast | invasive ductal cancer into nipple; Paget’s cells similar to vulvar Paget’s |
Medullary carcinoma | bulky tumor with large cells and lymphoid infiltrate; more common in Pt with BRCA 1 mutation |
Inflammatory carcinoma | orange peel appearance; lymphatics blocked by tumor (lymphedema) |
Lobular cancer | MC cancer of terminal lobule; ↑ bilaterality |
Phyllodes tumor | low grade malignant tumor of stroma |
ER-PR positive tumors | tumors responding to hormones; candidate for tamoxifen (anti-estrogen) |
ERB-B2 oncogene positive breast cancer | aggressive breast cancer |
Gynecomastia | estrogen stimulation of male breast |
Gynecomastia | normal in newborn, puberty (no surgery), old age; (micronodular) cirrhosis MC pathologic cause |