FEMALE GENITAL TRACT 3/6/19

PLEASE KNOW THE EMBRYOLOGY TO RELATE WITH CANCERS

WHY IS THERE NO VACCINE FOR GONORRHEA BUT THERE ARE 4 FOR MENINGITIDIS
HSV WILL NOT
MOST COMMON CAUSE OF STD IN USA - CHLAMYDIA
MOLLUSCUM IS A DNA POX VIRUS
DENDRIFORM ULCER
 HSV (CROSS REFERENCE WITH INFECTIOUS DISEASE
 VESICLE LIKE LESIONS IN HSV
 TENDER/PAINFUL INGUINAL LYMPH NODES, FEVER, MALAISE
 MOLLUSCUM CONTAGIOSUM
 AFFECTS GENITALS, LOWER ABD, BUTTOCKS, INNER THIGHS
 CENTRAL UMBILICATION OF LESIONS (CELLSW/ CYTOPLASMIC VIRAL, PEARLY - DOME
SHAPED, 1-5 MM N DIAMETER

 VAGINITIS
 CLUE CELLS IN GARRDNERELLA V.; >4.5 pH; FISHY ODOUR
 FROTHY YELLOW-GREEN ODOUROUS DISCHARGE IN TRICHOMONAS V.; >4.5 pH
 NORMAL VAGINAL IS NORMAL IN CANDIDA ALBICANS; COTTAGE CHEESE DISCHANGE; 3.8 -
4.2 pH;
 CHLAMYDIA TRACHOMATIS
 CAUSES REACTIVE ARTHRITIS (REITER SYNDROME)
 WHAT IS IT CALLED IN NEONATES (OPTHALMIA NEUROTORUM); GONORRHEA CAN ALSO
CAUSE THIS (HOW TO DIFFERENTIATE FROM CHLAMYDIA AND WHICH OINTMENT IS GIVEN
TO THE CHILD)
 TYPES D-K: RESPONSIBLE FOR PID/URETHRITIS, ECTOPIC PREGNANCY, NEONATAL
PNEUMONIA (STACCATO COUGH - describe this), NEONATAL CONJUNCTIVITIS 1-2 WEEKS
AFTER BIRTH
 TYPES L1,L2&L3: PAINLESS ULCERS WITH PAINFUL LYMPH NODE THAT ULCERATES
 PID
 PAIN BEGINS IN THE VULVA OR VAGINA AND SPREADS TO INVOLVE MOST OF THE
STRUCTURES IN THE FGS
 PELVIC PAIN, ADNEXAL TENDERNESS, FEVER AND VAGINAL DISCHARGE
 NEISSERIA GONORRHEA IS COMMON CAUSE
 ENDOMETRIUMIS NOT AFFECTED
 FITZ-HUGH-CURTIS SYNDROME (COMPLICATION OF WHICH ORGANISM AND WHAT DOES IT
CAUSE); RELATED TO PID
 GENITAL ULCERS
 H, DUCRYETI, HERPES, KLEBSIELLA INGUINALE, SYPHILIS, CHLAMYDIA TRACHOMATIS
(KNOW THEIR DESCRIPTION AND CLINICAL MANIFESTATION)
 VULVA
 COMPOSED OF LABIA MAJORA &MINORA
 BARTHOLIN CYST
 MOSTLY UNILATERAL
 ARISES DUE TO INFLAMMATION AND OBSTRUCTION OF GLAND
 IN WOMAEN OF REPRODUCTIVE AGE
 HAS TO BE DRAINED
 CONDYLOMA
 WARTY ENEOPLASM OF VULVAL SKIN MADE UP OF SQUAMOUS EPITHELIUM
 COMMONLY DUE TO HSV TYPE 6 OR 11 (LOW RISK; CONDYLOMA ACUMINATUM); LESS
LIKELY CAUSED BY SECONDARY SYPHILIS (CONDYLOMA LATUM)
 KOILOCYTES ARE PRESENT IN HPV
 CAULIFLOWER- LIKE LESION IN CONDYLOMA ACUMINATUM
 ELEVATED PLAQUES/PEARLS IN COMDYLOMA LATA
 LICHEN SCLEROSIS
 THINNING OF EPIDERMIS
  WHITE PATCH/LEUKOPLAKIA WITH PARCHMENT-LIKE VULVAR SKIN
 BENIGN BUT INCREASED RISK OF SQUAMOUS CELL CARCINOMA
 LICHEN SIMPLEX CHRONICUS
 LEUKOPLAKIA THICK VULVAR SKIN (HYPERPLASIA)
 ASSOC WITH CHRONIC IRRITATION AND ITCHING
 BENIGN
 VULVAR CARCINOMA
 DO A PUNCH DIAGNOSIS TO RULE OUT CARCINOMA
 CAN BE CAUSED BY HPV (TYPES 16 & 18, HIGH RISK) AND NON-HPV
 PERSONIN 70s WILL BE NON-HPV RELATED AS OPPOSED TO PERSON IN REPRODUCTIVE AGE
 EXTRAMAMMARY PAGET DISEASE
 MALLIGNANT EPITHELIAL CELLS IN THE EPIDERMIS OF THE VULVA
 ERYTHEMATOUS, PRURITIC, ULCERATED VULVAL SKIN
 UNDERLYNG CARCINOMA IF RELATED TO THE NIPPLE WITH A BREAST CARCINOMA
 PAGET CELLS ARE PAS+, (CYTO-)KERATIN+ AND S100-
 DISTINGUISH FROM MELANOMA AS ITS LAB RESULTS ARE PAS-, (CYTO-)KERATIN- AND
S100+
 MESENCHYMAL ORIGIN IS DESMIN+
 VAGINA
 NKSSE
 VAGINA ADENOSIS
 FOCAL PERSISYENCE OF COLUMNAR EPITHELIUM IN THE UPPER 1/3 RD OF VAGINA
 CLEAR CELL ADENOCARCINOMA
 MUCIN-FILLED, CLEAR CCYTOPLASM
 EMBRYONAL RHABDOMYOSARCOMA
 BLEEDING, GRAPE-LIKE LESION PROTRUDINGFROM VAGINA OR PENIS OF CHILD
 MALIGNANT MESENCHYMAL PROLIFERATION OF IMMATURE SKELETAL MUSCLE
 AKA SARCOMA BOTRYOIDES
 SEEN IN CHILD, >5 YEARS OF AGE
 VAGINAL CARCINOMA
 UTERUS
 ENDOMETRIUM COMPOSED OF GLANDS EMBEDED IN A CELLULAR STROMA
 MENSTRUAL CYCLE LAST FOR 21-35 DAYS; FOLLICULAR PHASE IS 14 DAYS AND DETERMINES THE
CYCLE
 PLEASE REVISE THE MENTRUAL CYCLE IN DETAIL (REFER TO EMBRYOLOGY)
 ACTION OF FSH, LH, PROGESTERONE, ESTROGEN
 NOTE LEVELS OF EACH IN THE MENSTRUAL CYCLE AND WHY IT OCCURS
 ENDOMETRIUM APPEARS HISTOLI THE GALNDS ARE SHORT, NARROW AND SLIGHTLY WAVY IN
THE FOLLICULAR PHASE
 PREOVULATORY PHASE IN LH SURGE PRODUCES PROSTAGLNADINS AND PROGESTERONE
 PG 642 IN FIRST AID FOR MENSTRUAL CYCLE
 LUTEAL PHASE: NEGATIVE FEED BACK OF ESTROGEN AND PROGESTROGEN CAUSES FALL IN FSH
AND LH; CORPUS LUTEUM (PRODUCES ESTROGEN AND PROGESTERONE) DEGENERATES IN A
FIXED 2 WEEKS FOLLOWED BY CORPUS ALBICANS;
 ENDOMETRIAL CANCER SEEN WITH WOMAN IN POSTMENOPAUSAL AGE PRESENTING WITH
BLEEDING
 ANOVULATORY CYCLE
 RESULTS FROM ENDOCRINE DISORDERS, OVARIAN LESIONS (GRANULOSA CELL TUMORS)
AND METABOLIC DISTURBANCES (OBESITY, ANOREXIA NERVOSA [EXPLAIN IN THIS PTS])
 EXCESSIVE ENDOMETRIAL STIMULATION BY ESTROGEN THAT IS UNOPPOSED BY
PROGESTERONE
 MAY PROMPT ENDOMETRIAL BIOPSY: STROMAL CONDENSATION & EOSINOPHILE
EPTHELIAL METAPLASIA LACKS PROGESTERONE-DEPENDENT MORPHOLOGIC FEATURES
(GLANDULAR SECRETORY SCHANGES AND STROMAL PRE-DECIDULIZATION) AS THERE IS NO
CORPUS LUTEUM
 ASHERMAN SYNDROME
 ADHESIONS AND/OR FIBROSIS OF THE ENDOMETRIUM
  DECREASED FERTILITY, RECURRENT PREGNANCY LOSS, ABNORMAL UTERINE BLEEDING,
PELVIC PAIN
 ASSOC WITH C/D
 ACUTE ENDOMETRITIS
 NOT COMMON
 POLYMICROBIAL CAUSES: AGALATESIA/GROUP A HEMOLYTIC STREPTOCOCCI (WHAT IS
THIS DISEASE CALLED IN NEONATE? MENINIGITIS), STAPHYLOCOCCAL
 CHRONIC ENDOMETRITIS
 ASSOC WITH PID, ABORTION, INTRAUTERINE CONTRACEPTIVE DEVICE,
 PLASMA CELLS IN THE STROMA
 ENDOMETRIOSIS
 PRESCNECE OF ECTOPIC ENDOMETRIAL TISSUE OUTSIDE OF UTERUS COMMONLY SEE AT
OVARY
 CAUSES INFERTILITY, DYSMENORRHEA, PELVIC PAIN, DYSPAREUNIA, PAIN DURING
DEFECATION, DYSURIA
 CHOCOLATE CYST OR DUST AROUND CUL-DA-SAC
 ETIOLOGIC THEORIES: REGURGITATION, BENIGN METASTASES, METAPLASTIC,
EXTRAUTERINESTEM/PROGENITOR CELL
 VULVONIMYA, VAGINOSMOS, DYSPAREUNIA
 ADENOMYOSIS
 HEAVY MENSES AND CRAMPS AND PROGRESSIVELY WORSENS, ENLARGED UTERUS WHICH
IS SMOOTH, BOGGY AND TENDER, ECTOPIC ENDOMETRIAL TISSUE IS WITHIN UTERUS
 ENDOMETRIAL POLYP (PG 141 IN PATHOMA); TAMOXIFEN
 ENDOMETRIAL HYPERPLASIA
 ENDOMETROID CARCINOMA AKA TYPE 1 ENDOMETRIAL CARCINOMA
 IMPORTANT CAUSE OF ABNORMAL MENSTRUAL BLEEDING
 OBESITY, HORMONE REPLACEMENT THERAPY CAN PUT PERSONS AT RISK FOR THIS
 DIFFERENCE BETWEN TAMOXIFEN AND RALOXIFEN?
 GAIN OF FUNCTION MUTATION AND GENES THAT ARE TUMOR SUPPRESSORS
 HYPERPHOSPHORYLATION MAKE S ACELL MORE ACTIVE HENCE THE HYPERPLASIA
 NONTYPICAL HYPERPLASIA
 CYSTIC DILATION OF GLANDS
 ATYPICAL HYPERPLASIA
 ENDOMETRIAL CARCINOMA
 RELATE TO GI CANCERS IN TERMS OF GENES THAT PROMOTE GROTH OR ACTIVITY OF CELLS
WITH THIS UTERINE CARCINOMA
 TYPE 2 FOR PERSONS AGED >=60 YO; GRADE 3; ELE MUTATION?
 TYPE 1: POLYPOID LOOK; GRADE 1 OR 2K; FGFR2?; LATE TP53 MUTATION SEEN: PIK3CA IS IT
GAIN OF FUNCTION OR LOSS OF FUNCTION; REVISE GAIN AND LOSS OF FUNCCTION GENES;
 TYPE II CARCINOMA
 CAUSED BY ATROPHY
 EARLY P53 MUTATION
 SLIDE 33 IS GRADE 1
 SLIDE 34 IS GRADE 2

PRESENTATION #3 UGT
 LEIOMYOMA/FIBROID (PATHOMA + SLIDES+ ROBBINS [CHECK CHROMOSOMES])
 OCCURS W/I INTRAMURAL, SUBMUCOSAL, SUBSEROSAL, PEDUNCULATED (FIRST SET
CAUSE SPONTANEOUS ABORTION0
 MULTIPLE WEL-DEFINED, WHITE, WHORLED, LOOK LIKE NORMAL MYOMETRIAL CELLS ON
BIOPSY
 PATIENTS USING OCP CANBE AT RISK OF THIS
 LEIOMYOSARCOMA (ROBBINS+SLIDES)
 MONOCLONALITY, PLEOMORPHIC
 HAPHAZARD ARRANGMENT ON HISTOLOGIC SLIDES
 WHICH CARCINOMA METASTATIZES
 GESTATIONAL PATHOLOGY
  WHAT CHANGES OCCUR IN PREGNANCY? SYSTEMIC ETC
 ABORTION (ROBBINS)
 PREGNANCY LOSS BEFORE 20 WEEKS OF GESTATION
 INTRAUTERINE FETAL DEMISE (AFTER 20 WEEKS GESTATION THE FETUS IS EXPELLED
FROM THE UTERUS)
 LOOK AT THE DIFFERENT TYPES OF ABORTION
 MITESHMEZ (PAIN DURING OVULATION)
 HCG: SERUM IS 6-10 DAYS; URINE TESTING IS 2-3 WEEKS
 PLACENTA PREVIA
 LOW LYING PLACENTA > 2CM
 PAINLESS, BRIGHT-RED HEMORRHAGE
 PARTIAL OR TOTAL PLACENTA PREVIA REQUIRES C-SECTION; TO PREVENT EARLY
PARTUITION USE STEROIDS
 MULIPARITY RESULTS IN MULTIPLE SCARRING OF UTERINE WALL HENCE PALCENTA “FINDS”
A PLCE TO STAY AND MAY END UP AT THE CERVICAL POSTITION
 PLACENTA ABRUPTIO
 SEPARATION OF PLACENTA FROM UTERINE PREMATURELY
 COCAINE ABUSE (WHICH GI ABNORMLITY DOES THIS PUT THE BABY AT RISSK OF?),
TRAUMA, SMOKING, HTN, PREECLAMSIA
 ABRUPT, PAINFUL, DARK HEMORRAGE
 CHECK LAB FINDINGS OF DIC IN THIS PATIENT
 MORBIDITY ADHERENT PLACENTA
 OCCURS AFTER DELIVERY
 PLACENTA ACCRETA - ATTACHED TO MYOMETRIUM
 PITUITARY HYPOPLEXY VS SHEEHAN SYNDROME
 VASA PREVIA
 TRIAD PRESENTATION: MEMBRANE RUPTURE, PAINLESS VAGINAL BLEEDING, FETAL
BRADYCARDIA (<110 BEATS/MIN)
 POST PARTUM HEMORRAGE
 4 T’s: TONE, TRAUMA, THROMBIN, TISSUE
 HYPERTENSION IN PREGNANCY
 ESSENTIAL HYPERTENSION IS HTN BEFORE THE 20TH WEEK OF GESTATION
 GESTATIONAL HTN IS BP> 140/90 mmHg AFTER 20TH WEEK OF GESTATION
 REMEMBER DRUGS CONTRINDICATED IN PREGNANCY
 NO PROTEINURIA
 PREECLAMPSIA
 NEW-ONSET HTN W/ EITHER PROTEINURIA OR END ORGAN DYSFUNCTION AFTER 20 TH
WEEK GESTATION (< 20 WEEKS SUGGESTS MOLAR PREGNANCY)
 VERY OLD OR VERY YOUNG MATERNAL AGE IS A RISK FACTOR
 WHAT IS SIGN OF MAGNESIUM SULFATE OVERDOSE
 HELLP SYNDROME
 GIVE AMOXYCILLIN INSTEAD OF TETRA CYCLE TO A PREGNANT WOMAN OR A CHILD <8
WEEKS
 IUGR - INTRAUTERINE GROWTH RESTRICTION (RETARDATION)
 HYDATIDIFORM MOLE
 TROPHOBLAST ONLY AFFECTED
 UTERINE PAIN; VAGINAL BLEEDING
 MULTIPLE GESTATION CAN BE A DIFFERENTIAL DIAGNOSIS
 ELEVATED hCG
 DO ULTRASOUND: SHOWS SNOW STORM APPEARANCE/CLUSTER OF GRAPES
 WHICH IS MORE COMMON/ COMPLETE VS PARTIAL? EXPLAIN THEIR KAROTYPE NUMBER
 DUPLICATION OF PATERNAL DNA + ENUCLEATD EGG AN SINGLE SPERM IN COMPLETE
MOLE
 CHORIOCARCINOMA
 OCCURS AFTER A PREVIOUSLY NORMAL AND ABNORMAL PREGNANCY
 GTD, GTN?
 CHEST X-RAY: MULTIPLE LESIONS
  BLOODY BROWN DISCHARGE
 LOCHIA: FINDDIFFERENT TYPES
 RENAL, SERO, CHORIOCARCINOMA, PAPILLIARY (CARCINOMAS)
 SAMOMA BODIES
 PLACENTAL SITES TROPHOBLASTIC TUMOR
 ROLE OF LACTOGEN
 TEST FOR GESTATIONAL DIABETES IS TESTED AT 28 TH WEEK OF GESTATION; TEST MODY,
PREVIOUS DIAGNOSIS OF GESTATIONAL DIABETES, FAMILY HISTORY
 READ RELATION TO TSH, THYROID HORMONE AND beta-hCG

PRESENTATION #4 UGT
 OVARIES
 PREMATURE/PRIMARY OVARIAN INSUFFICIENCY: IRREGUAL MENSES, ATROPHOC VAGINA,
LOW ESTRADIOL, HIGH FSH
 OVARIAN TUMORS: SURFACE EPITHELIA (MOST COMMON; DIVIDED INTO SEROUS AND
MUCIOUS), SEX CORD STROMAL TISSUE, GERM CELL (2ND MOST COMMON)
 PROGESTIN/ESTROGEN COMBINATION OCP OR PROGESTIN ONLY OCP PREVENTS OVARIAN
TUMORS
 CILATED COLUMNAR EPITHELIUM (FALLOPIAN TUBE)
 ONCOGENES = GAIN OF FX GENES
 SEROUS MORE COMMON THAN MUCIOUS TUMORS
 LOW GRADE SEROIS CARCINOMA
 PLACENTAL TISSUE - CHORIOCARCINOMA IN GERM CELL TUMOR DOES NOT RESPOND TO
CHEMOTHERAPY
 OLIGODENDROGLIOMA IN BRAIN AND DYSGERMINOMA BOTH HAVE FRIED EGG APPEARANCE
 ALPHA-FETAL PROTEIN (AFP)
 CHORIOCARCINOMA (WHAT LAB VALUES ARE SEEN)
 REINKE CRYSTALS