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Goljan ObGyn

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