Terms in this set (337)
**28 y. F has severe abdominal pain in right lower quad and vaginal bleeding. last menstrual period was 7 weeks ago, she has had PID, hypothyroidism, and appendectomy. low BP and pulse is 130. Extremities are cold and clammy and she is pale. what would D and C show?
what does the px have?
ruptured ectopic pregnancy
how does it present summary?
abd pain, vag bleeding, hemorrhagic shock, amenorrhea
-decidual (gestation) cahgnes in endometrium but no chorionic vili
where is MC site for ectopic pregnancy?
what is main risk factor for ectopic pregnancy
history of PID
what is important in history to make diagnosis of ectopic pregnancy?
decidualized endometriu, chorionic villi, embryonic tissue seen in?
inflmx endometrial infiltrate?
atypical endometrial cx that form glands?
endometrial adenocarcinoma (postmenopausal malignancy women and has vaginal bleeding)
short, straight endometrial glands and compact stroma?
early proliferative phase of menstrual cycle (4-7 days after onset of menses)
***semen analysis shows normal sperm count but immobile sperm due to abnormal tail fxn. what other finding is seen?
persistent bronchial dilation (impaired mucociliary clearance)
what is this condition?
primary ciliary dyskinesia
what does it result from?
AR mutation in px for normal flagellar and cilairiy structure and fxn (dynein, assembly px)
what are clinical manifestations?
situs inversus, chronic sinusitis, bronchiectasis, infertility (Kartagener syndrome)
what causes infertility?
-men: impaired fxn of sperm flagella
-women: immobility of fallopian tube cilia
infertility in males with CF vs. Kartagener?
-CF: bilateral absence of vas deferns (azoospermia)
**left sided mass compresses renal vein, what else would you find?
what drains into left renal vein?
left gonadal (testicular or ovarian) vein
what does the left renal vein drain?
left suprarenal gland and left gonad
are renal veins part of portal system?
what are portal HTN sx
eso varices, rectal varices, periumbilical venous distension
**32 y. F has infertility, 2-3 periods per year, moderate obesity, and excessive facialhair growht. what is px at increased risk for?
waht is PCOS associated with?
oligomenorrhea, obesity, hirsutis, polycistc ovaries
what are px at increased risk of devo?
**22y. F has bloody vaginal discharge and crampy abdominal pain with positive pregnancy test. D/C and edematous villi are found with 69 XXX karyotype. what is diagnosis
partial hydatiform moel
does complete or partial mole have fetal tissue?
karyotype of complete vs. partial mole?
-complete: 46 XX or XY (of paternal origin)
-69 XXX or XXY
what is key diff btwn the 2
complete ha super enlarged uterus
how does choriocarcinoma present?
-sx of metastatic dx (cough with lung metastases)
what is missed abortion
embryonic death in utero
-vaginal bleedign with a closed cervical os, small uterus, absence of fetal heart tones, low hcG
are fetus and trophoblast seen in ruptured tubal pregnancy?
sx of complete mole
**21 y. M has scrotum lacking testes and bilateral inguinal masses. Secondary sex chx are well-devo and denies any impairment in sexual drive. Low sperm count. what is decreased
decreased inhibin levels
what does px have
seminiferous tubules become atrophic and hyalinized from temperature-induced damage --> decreased sperm count and decreased inhibin levels
in cryptorchidism, are leydig cx impaired?
NO --> normal secondary sex chx and sex performance
only sertoli cx are temperature sensitive
what are in seminiferous tubules
sertoli cx which secrete inhibin
so as seminiferous tubules degenerate from temp-damage,
inhibin decreases, FSH elevated due to loss of negative inhibition by inhibin
what do px with cryptorchidism have increased risk for?
**what creates sig risk factor for devo of squamous cx carcinoma of cervix?
history of multiple sex partners!!
increaed risk of transmission of carcinogenic strains of HPV (16, 18, 31, 33)
what are other risk factors
-lower socioeconomic status
what does family history of cancer RF for
breast and ovarian cancer
what is early menarche and increased E exposure risk factor for
what does BC pills decrease
risk of ovarian and endometrial cancer
does OCP decrease risk of cervical cancer?
NO --> increased promiscuity an dincreased HPV transmission
**what should affect your decision to prescribe OCP?
what are absolute contraindications for OCP use
-prior history of thromboembolic event or stroke
-hx of E-dependent tumor
-women over 35 who smoke heavily
-decompensated or active liver dx (would impair steroid metabolism)
what does E in OCP due
suppress midcycle gonadotropin surge to block ovulation
what does P added do?
-enhance contraceptive by decreasing permeability of cervical mucus to sperm
-counterat increased risk of endometrial cancer
is the guideline for OCP use in px with hypercholesterolemia based on LDL or HDL levels
**woman with T1DM goes into labor but her blood glucose levels were poorly controlled throughout pregnancy. Infant delivered via C-section and infant is large for gestational age but otherwise normal. what is most likely to devo in infant
what are neonates born to mothers with poorly controlled diabetes exposed to
high maternal glucose levels --> excessive fetal insulin proudction and iselt hyperplasia
what does this create
fetal hyperinsulinemia --> transient hypoglycemia
can maternal insulin cross placneta?
can maternal thyroid-stimulating antibodies cross placenta?
**vaginal discharge, wet mount shows few leukocytes, applying KOH yields strong fishy odor (positive "whiff" test)
what are chx cx?
why fishy odor?
-odor from volatilization of amines made by gardnerella vaginalis
what is trichomonas vs. gardnerella
-trich: flagellated protozoan
-gardnerella: gram variable rod
what do trich px devo?
yellow-green foamy foul-smelling discharge and motile trophozoites with flagellae
**woman has palpale nodularity in right breast and lesion is made of ducts distended by pleomorphic cx with prominent central necrosis. lesion doesn't extend beyond ductal basal membrane. what is cause?
what is comedocarcinoma
-solid sheets of pleomorphic high-grade cx with central necrosis
why can DCIS be detected on mammography
as malignant cx membrane become necrotic, they calcify
what is Paget
malignant cx spread from DCIS into nipple skin witout crossing BM
what are phyllodes tumors similar to
fibroadenomas with increased cytological atypia and stromal cellularity and overgrowth --> "leaflike"
**32 y. F has abnormal uterine bleedign. pregnancy test negative. Endometrial hyperplasia + right-sided adnexal mass. Adnexal mass is most likely?
granulosa cx tumor
what are granulosa cx tumor
E-secreting primary ovarian tumros
what causes endometrial hyperplasia and abnormal uterine bleeding
hyperestrogenemic state --> predisposes to endometrial adenocarcinoma
what are these tumor chx by?
Call-Exner bodies, small follicle structures filled with eosinophilic secretions
what can mucinous cystadenocarcinoma progress to
do dysgerminomas secrete estrogen?
what are MC germ cx tumors
where do fallopian tube cancers come from
**female with history of amenorrhea devo white nipple discharge. she is not sexually active. family history sig for mother dying of breast cancer at 50
what is MC pituitary adenoma
-can also cause vision changes
what is MCC of spontaneous nipple discharge
intraductal papilloma (benign tumor within mammary duct)
-discharge is bloody or serosanguinous
what can lobular breast carcinoma create
-nipple discharge but not amenorrhea
what can follicular thyroid carcinoma cause
asx neck mass, voice changes inif larynx or recurrent laryngeal nerve involved
**23 y. M with bilateral breast enlargement. Tall stature and little body hair. Testicles are small and firm. What would you find?
increased plasma FSH
What reflects gonadal failure in px with Klinefelter syndrome?
increased plasma FSH
what determnes extent of feminization?
E: T ratio
what does Klinefelter cause
hypogonadism, sreduced spermatogenesis, male infertility
what has testis been replaced with?
atrophied and replaced by pink, hyalinized tissue
**what is ovary lined with?
simple (pseudostratified columnar)
-endocervix: simple columnar
-ectocervix: stratified squamous
stratified squamous non-keratinized
what is germinal epithelium?
simple cuboidal in ovary
associated epi tumors
what are cx found in fallopian tubes
-ciliated cx: transport egg/embryo
-peg cx: secrete nutrients
associated tumors with fallopian tube?
associated tumors with uterus
layers of uterus
functional and basal layers
what do cervix glands to?
secrete viscous mucous at time of ovulation
epi tumors with cervix?
-squamous cx carcinoma
where is glycogen?
what is epi tumor of vagina?
squamous cx CA
**23 y. F at 35th gestation has serum prolactin level higher than preconception. WHat hx blocks lactation?
what do high levels of E and P do in relation to breast during pregnancy?
-promote breast growth and devo
during first trimester of pregnancy, what produces P and E?
2nd and third trimesters?
placenta makes P and fetal adrenal gland + placenta makes E
so prolactin is around?
YES but E and P blocks it
when is hCG highest?
what does hCG do
maintain CL until placenta can assume responsibility for E and P synthesis
what happens to hCG once CL degenerates?
serum hCG also drops
does hCG have a role in late pregnancy?
why is LH low durin gpregnancy
role of thyroxine and inuslin
contribute to normal genstational mammary gland hypertrophy
**endometrial sampling shows coiled glands filled with carb-rich mucus, edematous stroma, and tortuous spiral arteries, what controls this?
**when does secretory phase of menstrual cycle occur?
15-28 day (btwn ovulation and menses)
what does P released by CL cause?
uterine glands to coil and secrete glycogen-rich mucus
what is proliferate phase chx?
nonbranching, nonbudding uniform glands evenly distributed in a uniform stroma
-straight glands are tubular, narrow, lined with pseudostratified, elongated, mitotically acitve epi cx
what does proliferative phase begin and end?
begins with menses and ends with ovulation
at LH surge?
coiled glands and occasional cytoplasmic vacuoles in late proliferative endometrium
why does mensturation happen
no hCG to support CL in its secretin of progesterone --> sheds
**Right testicular swelling with a solid testicular mass. Where is tumor most likely to spread?
where does lymph from testes drain?
through lymph channels back to para-aortic LN
where does lymph from scrotum go?
superficial inguinal LN
where does lymph generally go
path of arterial supply
where do testes originate during devo?
originate in retroperitoneum --> descend through inguinal canal into scrotum
--> para-aortic (retroperitoneal)
where are superficial inguinal LN located
anterior thigh inferior to inguinal ligament
what do these drain
all cutaneous strucutres inferior to umbilicius, external genitalia and anus up to pectinate line
where are deep inguinal nodes
under fascia lata on medial side of femoral vein
what do these receive?
afferents from superficial inguinal nodes and deep lymphatic trunks along femoral vessels
-glans penis/clit drain here
what do external iliac nodes drain
superficial and deep inguinal nodes and deep lx of abdominal wallb elow umbilicus
what do common iliac nodes drain?
internal and external iliacnodes
common iliac node associated with
common iliac artery
what do inferior mesneteric nodes drain
branches of inferior mesenteric artery!!
-left colic, sigmoid, superior rectal arteries
where do these efferents go?
**female has been trying to conceive one year without success. Partner has adequate sperm count and motility, she has 15 years of OCP use, purulent urethritis 5 years ago tx ith ceftriaxone and HTN controlled by methyldopa. What contributes to infertility
inappropriate antibiotic therapy
what causes the purulent urethritis (+cervical motion tenderness)?
PID --> N. gonorrhoeae and C trachomatis
-urethritis and then can ascend
what if lef tuntreated?
scar fallopian tubes, infertility or ectopic pregnancy
so if you treat gonococcal infxn, must also always treat..chlamydia!!
what is MCC of tubal factor infertility?
what are conditions associated with ascension of N. gonorrhoeae and chlamydia?
-PID (purulent cervical discharge and cervical motion tenderness)
-salpingitis and tubo-ovarian abscess
-peritoneal inflmx incl Fitz-Hugh-Curtis syndrome from inflmx of hepatic capsule
when does age create infertility?
what is first-line drug in treating pregnancy HTN?
how long should try to conceive before see doctor?
**23 y. F infertile. Normal rise in blood estradiol during first phase of menstrual cycle. Androgens --> estradiol in which cx type?
granulosa with aromatase (under FSH)
what produces androgens in ovarian follicle?
LH stimulation of thec a interna
role of theca externa?
CT support for follicle
how are androgens and P made in theca interna cx?
made from choleseterol under LH
female oocytes in embryognesis are arrested in
prophase I till ovulation
at ovulation, oocyte completes?
when does meiosis II occur?
what are analogous to theca interna cx in males?
**1 month baby only breastfed. Mother has good diet, no meds, no alcohol. Boy is at 56th percentile for weight and heigh. Infant requires what?
what is gold standard of infant nutrition
what doesn't it have
vitamins D and K
how is vit K given
intramuscular injection to block hemorrhagic disease of newborn
why is vitamin D an issue?
infants don't see a log of sunlight
what is issue with dark skin pigmentation?
require more sunliht exposure to make enough vitamin D since melanin is natural sunblock
does human breast milk normally provide enough folic acid, Fe, riboflavin, and thiamine for full-term infants?
**32 y. F with grayish white vag discharge and fishy odor. What is responsible?
what are clue cells
squam epi cx covered by bacterial organisms
how is bacterial vaginosis dif't from trichomoniasis or candida vulvovaginitis?
NO vag inflmx!!
how is bacterial vaginosis tx
what causes it?
alterations in normal vaginal flora (loss of lactobacilli)
what causes labial erythema
what can progress to PID?
neisseria and chlamydia (purulent discharge)
multinucleated giant cx?
yellow-green, foamy, foul-smelling discharge
trichomonas vaginalis protozoans
**29 y. M has painless scrotal mass and has increased sweating and heat intolerance. Enlarged nontender right testicle and increased serum T4/T3 with hypoechoic mass in right testicle. What serum marker is elevated
human chorionic gonadotropin
what is alpha/beta subunit of hcG similar to?
TSH TSH TSH
-LH AND FSH TOO!!!what
what creates high hCG concentrations?
px with testicular germ cx tumors or gestational trophoblastic disease
what can high hCG do
stimulate TSH rx and cause hyperthyroidism
what does this px have?
nonseminomatous germ cx tumor
what is LDH?
-can increase in seminomatous and nonsem tumors of testes
**23 y. F is delivering baby. Intravaginally, he injects lidocaine near tipe of ischial spine. What nerve is blocked
what does block of pudendal nerve create
anesthesia to majority of perineum
what creates complete perineal and genital anesthesia?
additional blockade of genitofermoal and ilioinguinal nerves
where is pudendal nerve derived from/
what does it do
sensory innervation to perineum and genitals (of both sexes) as well as motor innervation to sphincter urethrae and external anal sphincter
what does genitofermoal nerve innervate?
-scrotum/labia majora /femoral triangle
where does it originate?
L1-L2 and courses on anterior surface of psoas
what does iliohypogastric nerve do?
innervates skin overlying iliac crests
where is it derived from
what does lateral femoral cutaneous nerve innervate
skin on anterolateral thigh
where is it derived from?
L2 and L3
what does obturator nerve do?
provide motor innervation to medial thigh
where is it derived?
L3 to L4
what does inferior gluteal nerve do?
motor innervation to gluteus maximsu
where is it derived?
**During first trimester of pregnancy, 22 y. F from middle east has low-grade fever and maculopapular rash that spreads to face, chest, trunk and extremities. She has postauricular lymphadenopathy. What is fetus and mother at risk for?
what does mother have?
how does rubella present
low-grade fever, maculopapular rash with cephalocaudal progression
-posterior auricular and suboccipital lymphadenopathy
what do most women devo as a result?
what is congenital rubella syndrome associated with?
-cardiac malformations (PDA)
what are the 2 viral infxns where maculopapular rash start at head and neck and spread downwrad?
-german measles (rubella)
**what increases in follicular phase
estradiol --> positive LH surge
what increases after ovulation
progesterone with formation of CL
4 menstrual cycles
what does FSH stimulate
-one dominant follicle
-estrogen from ovaries
when does progesterone peak
**37 y. F at 12 weeks gestation has routine prenatal exam and only takes prenatal vitamin. uterine is a size of date. Glucose 210 mg/dL and triG 232 mg/dL. what causes this
human placental lactogen 9placental GH)
what does hPL do
-increase insulin R
-stimulate proteolysis and lipolysis
what does maternal insulin R result from?
increased secretion of hPL, placental GH, E, P, glucocorticoids
when does gestational DM occur?
woman's pancreatic fxn can't overcome pregnancy-related increase in insulin R
What changes occur in maternal metabolism?
-carb metabolism shunted to supply glucose and a.a. to fetus
-excess free f.a., ketones, glycerol provide energy to mother
what does this?
where is hPL secreted and what is it similar to?
-secreted from synctiotrophoblast
-similar to prolactin and GH
when do hPL levels plateua?
when at term
how does pregnancy affect levels of TBG?
increases!! increased total circulating T3 and T4 but free thyroid hx are still normal
**22 y. F at 14 weeks gestation has larger than expected abdomen and has twins (one male, one female). What type of twin placentation?
how to create dizygotic twins?
fertilization of 2 oocytes by 2 different sperma --> 2 amnions and 2 chorions
why one male, one female?
fertilization of 2 different ooxcytes by 2 different sperm
what causes monozygotic twins
fertilization of a single oocyte and devo from 1 zygote
monozygotic twins are of same/different sex?
same sex, geneitcally identical, similar in appearance
how to tell if twins are monozygotic or dizygotic?
other chx devo or if blood groups differ
what is a monochorionic, monoamniotic pregnancy associated with?
high fetal fatality rate via increased umbilical cord entanglement
do dichorionic, monoamniotic twins exist?
**autopsy on 17 yr. F with ovaries that are small and underdeveloped. Ovaries made of CT with no follicles. what additional problems will be seen?
bicuspid aortic valve
what are gyn problems of Turner
short stature, webbed neck, shield chest, low posterior hairlines
what is MCC cardiac issue in turner
bicuspid aortic valve
what chx premature ovarian failure
high LH and FSH
Turner vs. Marfan
-Turner: bicuspid aortic valve, aorta coarctation
-Marfin: MVP, aortic root dilation, aortic dissection
**10 y. F has no breast buds, no axillary or pubic hair, low hairlines, short and wide neck, broad chest and widely-space nipples. what cuases this?
what is mosaic Turner
(45X, 46 XX)
what does loss of X chromo create?
missing SHOX gene (long bone growth)
what does meiotic nondisjunction also cause?
klinefelter syndrome and trisomies 13, 18, 21
what is associated with frameshift mutations
is a balanced reciprocal translocation bad?
NO --> jsut creates risk of having child with unbalanced when having child
in what dx are trinucleotide repeat expansions present?
-fragile X (CGG)
-myotonic dystrophy (CTG)
-Prader-Willi and Angelman
-inherit 2 copies of chromo from one parent and none from other
-Prader (all from mom)
-Angel (allf rom dad)
**what causes down's syndrome?
nondisjunction!! failure to separate during cx division
(esp during maternal meiosis I)
what can create this?
failure of homologous chromo to separate in meiosis I or failure of sister chromatids to separate during meiosis II or mitosis
meiosis I vs. II
-meiosis I - 3 bands (one from dad, 2 from mom)
-meiosis II - 2 bands (one from dad, one extra dark from mom to mean 2 sister chromatids)
child has 2 same bands as mom and 1 same band as father?
got it form his mama
**73 y. F has lower abdominal discomfort and adnexal mass on R. What levels are elevated?
what is MC adnexal mass in elderly female?
ovarian malignancy (esp from ovary's surface epi)
what is made by malignant ovarian epi tumors?
colorectal and pancreatic cancers
-yolk sac tomors
-gestational trophoblastic tumors
excess adrenal androgens (adrenal neoplasia)
**fetus has 46 XY, testes with normal Leydig cx but no sertoli. what is phenotype
both female and male internal genitalia and male external genitalia
what does SRY gene on Y chromo code for
testes determining factor --> gonadal differentiation in testes containing Sertoli and Leydig cx
what do Sertoli make
Mullerian inhibitinr factor that prevent devo of female internal genitalia
what do Leydig make
T necessary for male internal genitalia
where do primitive gonads develop from?
genital ridges near adrenal glands --> either male testes or female ovaries
What induces devo of male gonads
what does absence of Y chromo mean
default female pattern
which belongs to female? paramesonephric or mesonephric?
what causes female pseudohermaphrotidisim?
-androgen excess during gestation
-21 hydroxylase of 11-hydroxylase deficiency (congenital adrenal hyperplasia)
**complete moles have 46 XX genotype from?
from father only!!
when does complete mole occur
ovum loses maternal chromo and then becomes fertilized by haploid sperm
-subsequent duplication of paternal geentic info = 46 XX
what are partial moels?
69XXY or 69 XXX
what happens with Y-sperm fertilization?
non-viable tissue due to lack of X-chromo
"size greater than dates" uterus
pouch of douglas
**16 y. F has crampy abdominal pain every 28 days that resolve in a day or two. NEver had menstrual period, has secondary sex chx. Rectal exam shows palpable mass anterior to rectum. serum b-HCG neg. what causes this
what does primary amenorrhea in a px with fully devo scndary sex chx suggest?
anatomic defec tin genital tract (imperforate hymen or mullerian duct anomaly)
how do these girls present
cyclic abdominal or pelvic pain and physical exam suggestive of hematocolpos
accumulation of blood invaginal canal (back pain, difficulties poop/pee)
-mass anterior to rectum
how does imperforate hymen occur?
at birth, vag secretions from mothers E level cause mucocolpos (mucus in vaginal canal) -->
what if diagnosis is not made
child asx until menarche
what is testicular feminization syndrome
complete androgen insensitivity
what will they have
-normal breast devo
-sparse pubic and axillary hari devo
**primary oocytes in female embryos are arrested in?
prophase of meiosis I
at ovulation prior to fertilization, secondary oocytes are arrested in?
metaphase of meiosis II
where do primordial germ cx migrate from?
yolk sac to region of developing gonad
progress of chromo?
(46, 4N) --> (23, 2N)
**when are serum b-hCG levels detectable?
eighth day after ovulation (1IU/L)
how about in urine?
14 days after ovulation (20 IU/L)
how does zygote enter uterus?
2-8 cx morula 3-4 days after ovulation
what does morula devo intO/
blastocyst (5.5-6 days after ovulation)
when does implantation occur?
6-12 days after fertilization
most sensitive detector of pregnancy?
**14 y. F has bump on chest and becomes tender before menses. NO other issues except for a soft, raised, hyperpigmented 0.5 cm nontender lesion below right breast. what causes this
what are the MC congenital breast anomaly
--> often confused with nevi
chx of accessory nipples aka polythelia
bilateral, asx, no excision
what causes this
inappropriate involution of mammary ridge
what are ephelides
what are the MC skin lesions that are confused with accessory nipples?
what are cutaneous neurofibromas made of (button-hole sign)?
Schwann cx and neural fibrolbasts
**15 y. F has never menstruated, has secondary sex chx, shortened vaginal canal with rudimentary uterus.
duct regression in females vs. males?
-females: massive wolffian duct regression
-males: active mullerian duct regression
px with vaginal agenesis have?
-Mayer-Rokitansky-Kuster-Hauser syndrome with no upper vagina (short vagina) and variable uterine devo
do these px have chromo issues?
NO --> XX
para vs. mesonephric
what do mullerian ducts create
fallopian tubes, uterus, cervix, upper vagaina
why do px with Rokitansky-Kuster-Hauser have secondary sex chx?
normal ovaries --> secrete E normally
what should all females with mullerian defects be screened for?
unilateral renal agenesis
47 XXX px have
what do px with 47 XY androgen insensitivity have?
-cryptorchid testes (secretes T)
-no axillary/pubic hair
-free T --> E to create breast devo
do AIS px have ovaries?
**px w/ amenorrhea has high arched palate and Tanner stage 1 breasts with inverted and widely spaced nipples, what else would be found
atrophic, streak ovaries
what does this lead to
what is primary amenorrhea
-absence of menses by age 15 in someone who has normal growth and secondary sex chx
-absence of menses by age 13 in girls w/0 secondary sex chx
do turner px have uterus?
when is uterus absent + primary amenorrhea?
Mullerian agenesis and androgen insensitivity syndrome
how do external genitalia of turner look
when are ambigous external genitalia seen
46 XX px with CAH
will px with mullerian agenesis have normal palaate and breast devo?
**px has irregular menstrual periods, no meds, obese, facial acne and excessive hair growth. what causes this
enlarged ovaries with multiple cysts
obestiy, hyperandrogenism, oligomenorrhea, infertility, enlarged ovaries with multiple cysts
how to tx PCOS px
extrogen rx modulation
px with PCOS who desire fertility are tx with?
what does that do?
E-rx modulator htat decreases neg feedback inhibiition on hypo by circulating E and increases gonadotropin production
what is spironolactone for?
androgen rx antagonist to tx acne and hirsutism
what does progesterone block?
protect against endometrial hyperplasia from unopposed E
**greatest risk factor for cervical cancer?
multiple sex partners
what are the virus associated
HPV 16, 18 (strongest, nono-social factor)
cervical carcinoma is very rare in?
so CIN/cervical CA is mostly a ?
risk factors for CN/cervical CA
-low socioeco status
**37 y. F has lower abdominal discomfort with enlarged uterus. Normal endometrial glands within myometrium. what is diagnosis
uniformly enlarged uterus + normal endometrial tissue within myometrium
-causes menorrhagia and dysmenorrhea
what is adenomyosis
endometrial glandular tissue within myometrium
what is MC type of endometrial carcinoma
-abnormal uterine bleeding in postmenopausal owman
what does endometriosis cause
cyclic pelvic pain (dysmenorrhea)
is uterus invovled in ectopic pregnancy?
**32 y. F in 30th week of pregnancy has leg swelling, heartburn. Elevated BP, what else does she have
triad of pre-eclampsia?
what are women who devo gestational diabetes at pregnancy at an increased risk for?
devo T2DM later
**14 y. F doesn't have regular periods, has heavy periods when she does. what is diagnosis
what creates anovulation
menstrual cycle variability!!
-absence of ovulation, ovarian follicle does no tegenerate to become CL. N P is produced and E remains high to cause endometrium to remain in proliferative phase
-chronically prolifeartive endo becomes disorganized and fragile to create heavy bleeding
when does anovulation occur
first several years after menarche (immature HPA) axis
-last few years before menopause
when is endometrial atrophy seen
what is highest hx at the end of menses?
when does increased FSH occur
-premature ovarian failure when no E to provide negative feedback
what creates complex atypical hyperplasia
prolonged exposure to E without opposing P
**granulosa-theca cx (sex-cord)tumor makes?
how does it look
-small, cuboidal cx that grow in cords or sheets
-Call-exner bodies (small, gland-like structures with acidophilic material)
can CA125 be used for screening?
NO --> nonspecific
-only for tx response