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Path 22 Female Gens


Painful genital ulcerations on cervix, vag/vulv d/t DNA viruses (1 is oropharyngeal, 2 is genital mucosa/skin). Initial lesions, red papule->vesicle->ulcer w fever, malaise, tender inguinal nodes at 3-7 days. heal 1-3 wks, virus migrates to lumbosacral Herpes Simplex Virus 2 (HSV-2)
Poxvirus skin/mucous memb infx (4 types: 1 is most prevalent [kids, infx on trunk, arms, legs]; 2 is most often sex transmit [adult, infx on gens, low abdomen, butt, inner thigh]). Pearly, dome shaped papules w dimpled center and viral inclusions. Molluscum contagiosum
DM, antibiotics, preg, immunosuppress predispose to vulvovag pruritis, erythema, swelling, curd-like discharge. Candida
Large, flagellated ovoid protozoan has yellow, frothy vaginal discharge, vulvovag discomfort, dysuria, dyspareunia. Fiery red vaginal and cervical mucosa (strawberry cervix) Trichomonas vaginalis
Gram neg bacillus is main cause of bacterial vaginosis (vaginitis). thin, green-gray, fishy vaginal discharge. can cause premature labor Gardnerella vaginalis
Gram neg diplococcus. Endocervix initially involved, spreads to fallopian tubes along the mucosal surface-> salpingo-oophoritis, tubo-ovarian abscess, pyosalpinx-> hydrosalpinx. PID and infertility. Gonococcus
causes cervicitis and PID (sequelae of PID include infertility, tubal obstruction, ectopic preg, pelvic pain, intestinal obstruct from adhesions b/w bowel and pelvic organs) Chlamydia trachomatis
THIN epidermis and disappearance of rete pegs, hydropic degen of basal cells, superficial hyperkeratosis, dermal fibrosis w scant perivasc mononuc inflamm cell infiltrate. smooth, white plaques. Labia can become atrophic and stiff. postmenopause Lichen sclerosus
nonspecific condition resulting from rubbing/scratching of skin to relieve pruritis. THICK epithel expansion of stratum granulosum and hyperkeratosis. area of leukoplakia. Squamous cell Hyperplasia
benign lesions w verrucous gross appearance and branching, treelike cores of stroma w viral cytopathic changes (Koilocytic Atypia). D/t low risk HPV (types 6 and 11) Condyloma Acuminatum
Most common vulvar cancer. warty, from VIN (HPV 16), are related to high oncogenic HPV, keratinizing (70%) are not related to HPV Squamous cell carcinoma - HPV 16->Vulvar Intraepithelial Neoplasia-> Vulvar CA - Lichen Sclerosus/Squamous Cell Hyperplasia-> Differentiated VIN-> Keratinizing Squamous Cell Carcinoma
Sharply circumscribed nodule on labia majora or interlabial folds, tendency to ulcerate. Identical in appearance to intraductal papillomas of the breast. Columnar secretory epithel and underlying Myoepithel Papillary Hidradenoma
Pruritic, red, crusted, sharply demarcated, maplike area, on labia majora. Large tumor cells lying singly or in small clusters w/in the epidermis, distinguished from the surrounding epithel by a halo Extramammary Paget Disease - reacts to anti-cytokeratin - has mucopolysaccharides
Septate vagina (w Uterus Didelphys) arises from ... failure of total fusion of mullerian ducts
Gartner duct cysts are derived from ... Wolffian (Mesonephric) duct rests
<5 y/o tumors grow as polypoid, rounded, bulky masses that sometimes fill and project out of the vagina. Grapelike clusters Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)
Risk factors for Cervical Cancer 1. Multi sex partners 2. Male partner w previous multi sex partners 3. Young age at first intercourse 4. High parity 5. Infx w high onco risk HPV (16, 18) 6. Immunosuppression 7. Some HLA subtypes 8. Oral Contraceptives 9. Nicotine
Most common cause of dysfunctional uterine bleeding, results in excessive and prolonged estrogenic stimulation w/o counteractive effect of progestational phase Anovulatory Cycle
Bacterial infx after delivery or miscarriage. often group A strep and staph Acute Endometritis
Presence of endometrial tissue outside the uterus, frequently ovaries. causes infertility, dysmenorrhea, pelvic pain. High levels of PGE2, IL1Beta, TNF, IL6, estrogen upregulated by high aromatase. red-blue/yellow-brown nodules and chocolate cysts. Endometriosis
Endometrial nests w/in myometrium-> hemorrhagic cysts w/in the uterine wall and menometrorrhagia, colicky dysmenorrhea, dyspareunia, pelvic pain Adenomyosis
Exophytic masses that project into the endometrial cavity, can ulcerate and undergo necrosis and cause abnorm bleeding. glands are hyperplastic or atrophic. assoc w tamoxifen and rearrangements of HMGIY gene Endometrial Polyps
Inc prolif of endometrial glands relative to the stroma d/t prolonged estrogen stim from anovulation, inc endog or exog estrogen (obesity, menopause, polycystic ovarian disease, ERT). asso w endometrial carcinoma and inactive PTEN (can cause Cowden synd) Endometrial Hyperplasia - Simple w/o atyp: various size glands, irreg shapes w cystic dilation - Simple w atyp: uncommon, loss of polarity, vesicular nuclei, prominent nucleoli - Complex w/o atyp: inc number, size of glands->crowding - Complex w a
Most common invasive cancer of female gen tract, usually in postmenopausals (cause postmenopausal bleeding). Endometrial Carcinoma
Most common type of endomet carc, typically from endomet hyperplasia (asso w obesity, diabetes, HTN, infertility, unopposed estrogen stim; also PTEN mut). Type 1 endomet carcinoma - and most of these are Endometrioid Adenocarcinoma
Type of Endomet Carc that arises 10 yrs later and in the setting of endomet atrophy. Poorly differentiated (grade 3) tumors. p53 mut. precursor is Endomet Intraepithel Carcinoma (EIC). Type 2 endomet carcinoma - most common of these is Serous Carcinoma: large, bulky tumor, deeply invasive into myometrium
Endometrial Adenocarcinomas w malignant changes in stroma. Fleshy, bulky, polypoid, can protrude through cervical os. Malignant Mixed Mullerian Tumor
Large broad-based endomet polypoid growths that may prolapse through cervical os. has malignant stroma w benign but abnorm shaped endomet glands. 30-40 y/o. Adenosarcomas
Most common tumor in women, benign smooth muscle neoplasms, multiple. Whorled pattern of smooth muscle bundles. Leiomyoma
Bulky fleshy masses that invade uterine wall or Polypoid masses that project into uterine lumen. w nuclear atypia, mitotic index, zonal necrosis Leiomyosarcoma
Most common cause of suppurative salpingitis Gonnococcus
Cystic follicles w oligomenorrhea, persistent anovulation, obesity, hirsutism, virilism. ovaries are double sized w smooth, gray-white outer cortex studded w subcortical cysts Polycystic Ovarian Disease (PCOD) - Stromal hyperthecosis: uniform enlargement of ovaries w white-tan cut section. heavy virilization
Most common malignant ovarian tumor. lined by tall, columnar, ciliated and nonciliated epithel cells, filled w clear fluid Serous Ovary Tumors - Low-grade: KRAS and BRAF muts - High-grade: p53 muts
less common ovarian tumor, larger cystic masses w rarity of surface involvement, filled w sticky, gel fluid rich in glycoprots. asso w smoking and KRAS muts. Mucinous Ovary Tumors
Ovarian tumors w presence of tubular glands bearing close resemblance to benign or malignant endometrium. can coexist w endometriosis. asso w PTEN, KRAS, Beta-catenin, p53 muts and microsatellite instability. Endometrioid Ovary Tumors (Endometrioid Adenofibromas)
Large epithel cells w abundant clear cytoplasm in the ovaries Clear Cell Adenocarcinoma
Adenofibromas in which epithel component consists of nests of transitional-type Ovarian epithel cells resembling those lining bladder, nests of epithel cells resembling UT epithel. usually unilateral Brenner Tumors
HPV 16 and HPV 18 Viral E6 affects ... Viral E7 affects ... most important (esp HPV 16) for cervical oncogenesis E6 binds to and degrades p53 and upregulates telomerase E7 binds to RB and upregulates cyclin E
cysts containing hair, teeth, areas of calcification, mixtures of tissues, and cheesy sebaceous material. Teratoma - Most are benign (mature). 46 XX - Struma ovarii is all mature thyroid tissue->hyperthyroidism - Malignant (immature) resemble embryonal and immature fetal tissue, like primitive neuroepithel
Most common malignant germ cell tumor of ovary, ovarian counterpart of testicular seminoma. composed of large vesicular cells having a clear cytoplasm, defined borders, and central regular nuclei. Teens and 20s. Express Oct3, Oct4, Nanog, cKIT. Dysgerminoma - responds to chemo, 1/3 are aggressive, >80% survival
Tumor is rich in Alpha-fetoprotein and Alpha1-antitrypsin. Glomerulus-like central blood vessel enveloped by germ cells w/in space lined by germ cells (Schiller-Duval body). Children/young women w ab pain and rapidly developing pelvic mass. Endodermal Sinus (Yolk Sac) Tumor
yellow coloration to cut surface d/t intracell lipids, tumor cells are arranged in sheets punctuated by small follicle-like structures (Call-Exner bods). can elaborate large amounts of estrogen and elevate inhibin, asso w precocious puberty, endomet CA. Granulosa-Theca cell Tumors
Ovarian Tumor, Hydrothorax, Ascites = Meigs syndrome - Fibromas, Thecomas, Fibrothecomas
Most common site of ectopic preg ... Most important predisposing condition ... Presentation of ectopic preg ... Fallopian tubes PID -> Fallopian tube scarring Severe ab pain, pelvic hemorrhage->shock
HTN, edema, proteinuria = ? + convulsions = ? 10% develop HELLP = ? Preeclampsia (usually in last trimester) Eclampsia Hemolysis, Elevated Liver enzymes, Low Platelets
Cystic swelling of chorionic villi w vaiable trophoblastic prolif. inc risk of choriocarcinoma. HCG levels far exceeding normal pregnancy (higher in Choriocarcinoma) Hydatidaform Mole - Complete: fertilization of an egg w/o genetic material, most are 46XX (duplication of sperm genes). Enlarged scallop shaped villi w cisterns and extensive trophoblast prolif involving entire circumference of villi - Partial: has p5
Created by: Jakphooey