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