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Goljan ObGyn
| 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 |
Created by:
megankirch
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