Term
| Müllerian inhibiting factor is produced by what cells |
|
Definition
|
|
Term
| Sex Cord - Stromal Tumors (female) |
|
Definition
6% of ovarian tumors; most are fibromas
a. Granulosa cell tumor
b. Thecoma-fibroma
Arise from the ovarian follicular granulosa and thecal cells. When hormonally active (estrogen producing), they may cause sexual pseudo precocity in a prepubertal girl or endometrial hyperplasia / adenocarcinoma in an older woman.
A rare granulosa cell tumor will behave malignantly, eventually causing tumor encasement of the abdominal viscera.
Fibromas may grow to a very large size. |
|
|
Term
| Sex Cord - Stromal Tumors (male) |
|
Definition
a. Sertoli cell tumor
b. Leydig cell tumor
Tumor may be of a pure cell type or a combination of both.
Seventy to 85% of patients are virilized (amenorrhea, breast atrophy, loss of female body contour, acne, hirsutism, clitoral enlargement, deepening of the voice, temporal hair-line recession).
A rare tumor may behave malignantly. |
|
|
Term
| Metastatic gastrointestinal tract tumor |
|
Definition
|
|
Term
|
Definition
| found in the anterolateral vaginal wall. They are derived from embryologic wolffian duct rests. |
|
|
Term
|
Definition
Also called paratubal cysts, these are common incidental findings. They are embryologic remnants of the wolffian duct. several 0.2 cm translucent fluid-filled cysts near the fimbriated end of the fallopian tubes. called hydatid of Morgagni when it dangles from the fimbria.
May be derived from müllerian or wolffian epithelium, or be lined by undifferentiated pelvic mesothelium. |
|
|
Term
|
Definition
| The most common tumor of the uterus is a leiomyoma. They can be multiple and can lead to abnormal bleeding. May present as an enlarged and nodular uterus. |
|
|
Term
| A 50 year old female has noted increasing abdominal enlargement for the past year. On physical examination, there is a fluid wave, but no tenderness. Bowel sounds are present. She has no vaginal bleeding. An abdominal ultrasound reveals bilateral 10 and 7 cm adnexal masses. At surgery you find bilateral mass lesions of the ovaries which are unilocular, filled with watery fluid, and covered with papillary excresences on all surfaces. These masses are probably: |
|
Definition
| Classic presentation of Bilateral serous cystadenocarcinomas |
|
|
Term
|
Definition
| Intrusions of stratum basalis endometrium (glands and stroma) into the myometrium. May be a cause of pelvic pain and abnormal vaginal bleeding. Causes mild to moderate uterine enlargement with coarse smooth muscle bundles. The adenomyotic glands may, but usually do not, show cyclic changes. |
|
|
Term
|
Definition
| adenomyosis; may be mistaken for a leiomyoma |
|
|
Term
|
Definition
| Benign proliferation of endometrial glands within fibrotic stroma; most common near menopause; may ulcerate and cause clinical bleeding. Rarely may undergo malignant transformation. |
|
|
Term
|
Definition
| Teratoma that produces thyroid tissue and can lead to hyperthyroidism |
|
|
Term
| ENDOMETRIAL AND MYOMETRIAL NEOPLASMS AND NEOPLASTIC-LIKE CONDITIONS |
|
Definition
| Adenomyosis, Endometriosis, Endometrial polyp, Endometrial hyperplasia, Endometrial adenocarcinomas, |
|
|
Term
| Endometrial adenocarcinomas risk factors |
|
Definition
often occurs with chronic estrogenic stimulation.
a. Obesity: Androstenedione is converted in adipose tissue to estrone.
b. Low parity
c. Irregular menses and failure of ovulation
d. Hypertension: Reason for association is not known.
e. Endometrial hyperplasia
f. Exogenous estrogen administration |
|
|
Term
| Clincical stage of endometrial adenocarcinoma |
|
Definition
I Tumor confined to the uterine corpus.
II Tumor has invaded the cervix.
III Tumor has grown beyond the confines of the uterus, but is still within the pelvis.
IV Tumor has spread beyond the confines of the pelvis |
|
|
Term
| Uterine Mesenchymal Tumors |
|
Definition
Smooth muscle tumors: Leiomyoma, Leiomyosarcoma(Greater than 10 mitotic figures per 10 high power fields.)
Endometrial stromal tumors: Endometrial stromal nodule, Endolymphatic stromal myosis / low-grade stromal sarcoma, High-grade stromal sarcoma: May metastasize widely.
Mixed müllerian tumors: Adenofibroma, adenosarcoma, Malignant mixed müllerian tumor . |
|
|
Term
| DISEASES OF THE FALLOPIAN TUBE |
|
Definition
| Salpingitis, Ectopic pregnancy, Paratubal Cysts, Adenocarcinoma, |
|
|
Term
| Tumors of ovary surface epithelium |
|
Definition
1. Serous Tumors: 40% of ovarian tumors; high percentage of serous tumors are bilateral. The majority of these tumors are malignant. Serous cystadenoma, Serous cystadenoma of borderline malignancy, Serous cystadenocarcinoma
2. Mucinous Tumors: 20% of ovarian tumors; have a low incidence of bilaterality; may grow to tremendous size (100 pounds !). The majority of these tumors are benign. Pseudomyxoma peritonei can result if ruptured (similar to ruptured appendiceal mucocele). Mucinous tumors tend to be multiloculated and exhibit a variation in pattern from one area to another (some areas are benign while others are malignant).
3. Endometrioid Tumors: 5% of ovarian tumors; may arise in a focus of ovarian endometriosis, but most arise from the ovarian surface epithelium.
4. Clear Cell Carcinoma: 5% of ovarian tumors; similar to vaginal clear cell carcinoma, but not related to DES exposure. May be associated with ovarian endometriosis or endometrioid carcinoma.
5. Brenner Tumor: 2% of ovarian tumors; contains nests of transitional epithelium in a background of fibrous stroma. Most are benign. |
|
|
Term
|
Definition
A malignant proliferation of primordial germ cells. The tumor is very radiosensitive.
Seminoma is the corresponding tumor in the testis.
The 10-year survival rate is 90%. |
|
|
Term
|
Definition
A malignant proliferation of primordial germ cells. The tumor is very radiosensitive.
Seminoma is the corresponding tumor in the testis.
The 10-year survival rate is 90%. |
|
|
Term
|
Definition
Embryonal carcinoma
Choriocarcinoma
Endodermal sinus tumor
These are all malignant germ cell tumors and may occur concurrently in the same tumor.
The immature teratoma contains embryonic-type tissue. Choriocarcinoma contains malignant placental tissue.
Polyembryoma is a very rare malignant tumor that forms embryoid bodies that exhibit both embryonic and extraembryonic differentiation. |
|
|
Term
|
Definition
| The hydropic chorionic villi invade the myometrium. Evacuation from the uterus is difficult, but metastases do not occur. |
|
|
Term
|
Definition
Malignant proliferation of cyto- and syncytiotrophoblasts. By definition, villi are not present. The tumor is hemorrhagic, focally necrotic and can metastasize widely.
Gestational choriocarcinoma has a better prognosis than choriocarcinoma that arises in a germ cell tumor.
The tumor responds well to methotrexate and actinomycin D |
|
|
Term
| Placental Site Trophoblastic Tumor |
|
Definition
This is a rare tumor that consists of intermediate trophoblasts that invade deeply into the myometrium. These cells make human placental lactogen, not HCG. There is no cytotrophoblast or syncytiotrophoblast.
These tumors are locally invasive but often self-limited to the pregnancy; others can be curetted out. Malignancy can occur. |
|
|
Term
|
Definition
Incomplete fusion of the urethral folds along the ventral aspect of the penis, the scrotal raphe, or perineum.
Caused by inadequate levels of fetal androgens; may be associated with chordee (flexion contracture of the penis during erection). |
|
|
Term
| Menstrual decidua and cramping |
|
Definition
Falling progesterone in the secretary endometrium leads to the local production of prostaglandin by the
decidua (the part of the endometrium which is sloughed each month). Prostaglandin causes vasospasm of
the spiral arterioles, and subsequent ischemia and sloughing of the endometrium is what patients
experience as a "periods.' The uterine cramping associated with the normal ovulatory cycle is caused by this prostaglandin's action and explains the effectiveness of prostaglandin inhibitors (aspirin or ibuprofen) in the treatment of dysmenorrhea. |
|
|
Term
| What did prospective randomized trials of initiating continuous estrogen and progestin in older postmenopausal women show? |
|
Definition
| did not show a health benefit with respect to protection against coronary artery disease, demonstrated a very small increase in the incidence of breast cancer and thromboembolic disease, and showed a decrease in osteoporotic fractures and colon cancer |
|
|
Term
|
Definition
| secrete proteins that are important to spermatogenesis including Androgen Binding Protein. Called the "director cells of spermatogenesis." They comprise the blood-testis barrier. |
|
|
Term
| Difference between spermatogenesis and spermiogenesis |
|
Definition
Spermatogenesis is the process by which spermatogonia reach the haploid, round spermatid stage.
Spermiogenesis transforms early, round spermatids into late, differentiated spermatids, what we recognize as morphological normal sperm. |
|
|
Term
| Disorders of spermatogenesis |
|
Definition
a. Azoospermia including Sertoli cell only syndrome
b. Maturation arrest at one of a number of possible stages
c. Hypospermatogenesis |
|
|
Term
| Disorders of spermiogenesis |
|
Definition
a. Fertilization defects
b. Motility defects
c. Various morphological defects |
|
|
Term
| Epididymis: Caput, Corpus, Cauda |
|
Definition
a. Sperm passage through the epididimus is approximately 14 days.
b. Extensive membrane protein changes.
c. “Natural fertilization” ability is aquired when sperm enter the cauda.
d. Caput (and testicular) sperm can not undergo natural fertilization, but are
fine for ICSI.
e. Marker of epididymal function is carnitine |
|
|
Term
|
Definition
Emission: Movement of semen into the urethra under sympathetic control (adrenergic receptors).
Ejaculation Proper: Propulsion of semen out of urethra under parasympathetic control. |
|
|
Term
|
Definition
Epididymal Fluid: <5% of semen volume
Seminal vesicles: 60-70% of semen volume.
1. Contribute prostaglandins and fructose.
3. Qualitative fructose is useful for verifying presence and the presence of the vas
deferens.
Prostate: 25-30% of semen volume.
1. Contributes acid phosphatase, Zn and citric ac
2. Chronic inflammation may contribute to infertility
3. Many markers including PSA
Bulbourethral and Cowper’s Glands: About 5% of semen volume. |
|
|
Term
|
Definition
a. Acquisition of the ability to acrosome react and gain fertilizing ability.
b. 0-40% of sperm reaching the oocyte capacitate.
c. Influx of Ca++, efflux oh H+, removal of sterols from the membrane |
|
|
Term
| Contributions of Sperm to Embryogenesis |
|
Definition
1. Normal Genetic Complement
2. Centrosome
3. Early Embryonic Gene Regulators |
|
|
Term
| Asthenospermia (azthenozoospermia): |
|
Definition
| The production of an ejaculate in which less than 50% of spermatozoa are motile. |
|
|
Term
|
Definition
| The failure to produce an ejaculate |
|
|
Term
|
Definition
| The production of an ejaculate devoid of spermatozoa. |
|
|
Term
| Oligospermia (oligozoospermia): |
|
Definition
The production of an ejaculate containing less than 20 x 1C~
spermatozoa per milliliter of semen. |
|
|
Term
| Teratospermia (teratozoospermia) |
|
Definition
| The production of an ejaculate in which more than 50% of spermatozoa are of abnormal shape. |
|
|
Term
| Prolactins effect on leydig cells and prostate |
|
Definition
| Prolactin may increase Leydig cell response to LH and/or prostate sensitivity to androgens. |
|
|
Term
| Treatment of hypogonadotropic male infertility |
|
Definition
1. Specific medical
a. Gonadotropins - HCG, Pergonal, Metrodin
b. Other - thyroid, adrenal, etc.
2. Non-specific medical therapy
a. Gonadotropins - 2500 IU HCG 2X weekly - 10 to 12 weeks
b. Testosterone rebound therapy
c. Clomiphene citrate - 25 mg daily for 3 to 4 month |
|
|
Term
|
Definition
Found in about 40% of infertile men, but also found in about 20% of fertile men.
Semen Analysis: Diminished morphology with an increase of tapered sperm. Count and motility may be diminished.
Sperm capacitation ability may be diminished. |
|
|
Term
| Absolute Contraindications to oral contraceptives |
|
Definition
1. Thromboembolic disorder (or history thereof)
2. Cerebrovascular accident (or history thereof)
3. Coronary artery disease (or history thereof)
4. Impaired liver function (current)
5. Hepatic adenoma (or history thereof)
6. Breast cancer, endometrial cancer, other estrogen-dependant malignancies (or history thereof)
7. Pregnancy
8. Undiagnosed vaginal bleeding
9. Cigarettes more than 15 per day (?) over age 35 |
|
|
Term
| Relative Contraindications to oral contraceptives |
|
Definition
1. Migraine headaches, esp. with aura or worsening with pill use
2. Hypertension
3. Diabetes mellitus
4. Surgery with immobilization (suggest 1 - 3 months discontinuation)
5. Seizure disorder, anticonvulsant use
6. Obstructive jaundice in pregnancy
7. Gall bladder disease
8. Heavy smoking in a woman <35yo (15+ cigarettes/day) |
|
|
Term
| Noncontraceptive Benefits of OCPs |
|
Definition
Effective contraception
--less need for therapeutic abortion
--less need for surgical sterilization
Less endometrial cancer (50% reduction)
Less ovarian cancer (40% reduction)
Less benign breast disease
Fewer ovarian cysts (50% to 80% reduction)
Fewer uterine fibroids (31 % reduction)
Fewer ectopic pregnancies
Fewer menstrual problems
--more regular
--less flow
--less dysmenorrhea
--less anemia
Less salpingitis (pelvic inflammatory disease)
Less rheumatoid arthritis (60% reduction)
Increased bone density
Probably less endometriosis
Possibly protection against atherosclerosis |
|
|
Term
| Contraindications for IUD use include |
|
Definition
-Known or suspected pregnancy
-Acute PID, or current behavior suggesting a high risk for PID (woman or partner has multiple
sexual partners)
-Postpartum or postabortal endometritis in the past 3 months
-Distorted uterine cavity from leiomyomata, uterine anomalies, etc.
-Undiagnosed abnormal genital bleeding
-Known or suspected cervical or uterine malignancy, including an unresolved abnormal Pap
-Untreated acute cervicitis or vaginitis
-Conditions associated with increased susceptibility to infection (AIDS, leukemia, IV drug use)
-Previous ectopic pregnancy or condition that would predispose to ectopic pregnancy
-A previously placed IUD that has not been removed |
|
|
Term
| Fertility Awareness Methods |
|
Definition
Typical use failure rates are 25% during
the first year. With perfect use failure rates of 1-9 % occur.
Four indicators may be used to predict periods of fertility.
1. Cervical secretions increase and become clear and stretchy near ovulation.
2. The cervix itself, becomes softer and wider near ovulation.
3. Basal body temperature (BBT) rises under the influence of progesterone after ovulation
4. Calendar calculations may be made based on the length of a women’s menstrual cycle. |
|
|
Term
| Good contraceptive options for lactating women |
|
Definition
barrier methods, progestin only
methods, the IUD, and sterilization. |
|
|
Term
|
Definition
| uterine bleeding, usually not excessive, occurring at irregular intervals. intermenstrual bleeding: uterine bleeding occurring between otherwise regular menstrual periods. |
|
|
Term
| Causes of Secondary dysmenorrhea |
|
Definition
a. adenomyosis: gland-like growth into myometrium
b. endometriosis: ectopic endometrial tissue
c. fibroids: (covered separately)
d. intrauterine devices (IUD)
e. endometritis: chronic infection of uterus
f. congenital uterine anomalies: menstrual flow may lack an outflow tract.
g. other: ovarian cysts, pelvic varicosities |
|
|
Term
| FLOW DIAGRAM FOR TREATMENT OF PMS |
|
Definition
non-steroidal anti-inflammatory agent
no caffeine (forever)
low sodium diet 7-10 days prior to menses
exercise
six feedings a day Q meals, 3 protein/complex carbo snacks)
vitamin B6, calcium
family or marital counselling
prozac
oral contraceptives , hormonal antagonists:
danazol, LHRH analogues |
|
|
Term
|
Definition
| an antibody preparation of anti-Rh factor given to Rh (-) women to prevent Rh isoimmunization |
|
|
Term
|
Definition
| The pregnant patient is best served by having a healthy balanced diet with iron and folate supplementation. Only rarely are other vitamin supplements needed. |
|
|
Term
|
Definition
| condition occurring only during pregnancy characterized by hypertension, edema and proteinuria. |
|
|
Term
|
Definition
| occurrence of convulsions, not caused by any coincident neurologic disease in a woman whose condition fulfills the criteria for preeclampsia |
|
|
Term
| leading cause of maternal death |
|
Definition
|
|
Term
| second leading cause of maternal death |
|
Definition
| Preeclampsia and Eclampsia |
|
|
Term
| Preeclampsia risk factors |
|
Definition
1. First pregnancy – 85% of cases of PE/E occur in first pregnancies.
2. Age-PE/E occurs most frequently in teens and women in their late 30’s and 40’s.
3. Chronic hypertension
4. Renal disease
5. Molar pregnancy
6. Previous pregnancy complicated by severe PE/E |
|
|
Term
| Drug therapy to prevent convulsions and control BP in PIH |
|
Definition
1. Magnesium sulfate-typically administered intravenously, monitoring reflexes, respirations and urine output.
2. Hydralazine (Apersoline) – used to control sever HTN and reduce the maternal risk of intracranial hemorrhage, NOT to achieve normotension which can compromise placental perfusion. Several other antihypertensive drugs can be used in this settin. However, the bulk of experience is with hydralazine. |
|
|
Term
|
Definition
Implantation in the lower uterine segment over or near the cervical
internal os. Placenta previa is uncommon with the first child. In women who have had a previous cesarean section and present with an anterior low-lying placenta previa, up to 25% of these women may have a placenta acreta caused by the absence of Nitabuch’s layer |
|
|
Term
|
Definition
| is a severe obstetric complication involving an abnormally deep attachment of the placenta, through the endometrium and into the myometrium (the middle layer of the uterine wall). |
|
|
Term
| Risk Factors for placenta previa |
|
Definition
1. Multipara
2. Advanced maternal age
3. Previous cesarean section
4. Large placenta such as in multiple gestation and pregnancies complicated by fetal erythroblastosis.
5. Previous D&C or treatment for Asherman’s syndrome |
|
|
Term
| Risk factors for Placental Abruption |
|
Definition
1. Trauma
2. Polyhydramnios
3. Chronic HTN or PIH
4. Short umbilical cord
5. Uterine anomaly or tumor
6. Alcohol or drug use (particularly cocaine) |
|
|
Term
| Initial approach to a patient presenting with third-trimester bleeding |
|
Definition
A. Hospitalization
B. Careful abdominal examination, including Leopold maneuvers
C. No internal vaginal or rectal exams
D. Placement of TV access
E. Type and crossmatch 2 to 4 units of PRBC
F. Ultrasound examinations for placental location
G. Close monitoring of mother and baby |
|
|
Term
| LABORATORY INVESTIGATION OF INFERTILITY |
|
Definition
| Rubella immunity status, chlamydia and gonorrhea cultures are generally pursued on the initial visit. Folate supplementation should be considered if an inadequate diet is ascertained. semen analysis followed by presumptive documentation of ovulation usually by temperature charting, and an hysterosalpingogram (HSG). Depending on outcome possible endometrial biopsies to establish the diagnosis of inadequate luteal phase and, a postcoital test to determine sperm survival and movement within cervical mucus, and lastly, diagnostic laparoscopy. |
|
|
Term
| Female FSH and estradiol in evaluating fertility |
|
Definition
| Both serum FSH and estradiol are obtained on either day 2, 3 or 4 of the cycle. A high FSH indicates the woman’s pituitary is working harder to maintain ovarian function, implying that the “reserve” of the ovaries is low. This correlates highly with a poor pregnancy prognosis. A high estradiol value also has high correlation with a poor prognosis. |
|
|
Term
| Minimum normal values for sperm analysis |
|
Definition
sperm concentration > 20 million per ml, total count > 60 million, ejaculate volume > 1.5 ml, total motile
count > 30 million, viable sperm > 50%, normal shapes (morphology) > 60%. |
|
|
Term
| Presumptive Documentation of Ovulation |
|
Definition
| BBT, serum progesterone, and urinary LH surge testing |
|
|
Term
|
Definition
| clorniphene citrate, human menopausal gonadotropins (hMG), GnRH, glucocorticoids and bromocriptine mesylate |
|
|
Term
|
Definition
Relatively inexpensive, taken by mouth with few side effects (except a multiple
gestation rate of 7% in anovulatory women and the rare possibility of inducing hyperstimulation syndrome). Requires an intact hypothalamic-pituitary-ovarian axis. Mechanism of action is primarily within the hypothalamus as an "antiestrogen". It occupies estrogen receptors and "deceives" the hypothalamus into sensing a low estrogen environment. The hypothalamus in turn signals the pituitary via pulsatile GnRH to increase gonadotropin (FSH and LH) release to produce more follicular development and subsequent estrogen release. |
|
|
Term
| Human menopausal gonadotropins |
|
Definition
| hMG consists of LH and FSH, therefore it can bypass a non-functional hypothalamic-pituitary axis. Overdose can be lifethreatening |
|
|
Term
| Glucocorticoids for anovulation |
|
Definition
| Act by suppressing ACTH and therefore adrenal androgen production. This may occasionally be helpful in facilitating ovulation because circulating androgens cause ovarian follicular atresia. Used primarily in polycystic ovary syndrome with a component of elevated adrenal androgen secretion, and in women with congenital adrenal hyperplasia. |
|
|
Term
| Bromocriptine mesylate for anovulation |
|
Definition
| Anovulatory women with hyperprolactinernia should be treated initially with bromocriptine before considering ovulation induction medications. Excess prolactin inhibits normal hypothalamic pulsatile GnRH release. |
|
|
Term
| Type E (estrogenic) cervical mucus |
|
Definition
| lasts 3-5 days and helps facilitate pregnancy/sperm survival |
|
|
Term
| Type G (progesterone-related) cervical mucus: |
|
Definition
| Minutes to hours. Blocks sperm |
|
|
Term
|
Definition
| Averages 9-10 days in most NFP methods but a female is usually only fertile about 6 days a month. |
|
|
Term
|
Definition
Based on previous menstrual cycles
Fertile days begin on prior shortest cycle minus 19
Fertile days end on prior longest cycle minus 11
Strength: low cost
Weakness: requires cycle regularity
Rarely used correctly! |
|
|
Term
|
Definition
Fertile days are days 8-19 of cycle
Women must have cycles 26-32 days long
Strength: simple, low cost
Weakness: only about 50% of women of reproductive age can use it!
Often used with “cycle beads” |
|
|
Term
|
Definition
If a woman has any vaginal discharge today or yesterday, she considers herself potentially fertile.
Strength: ease of use, can be used by women with irregular cycles or no menstrual bleeding
Weakness: cannot be used if a woman has a continuous vaginal discharge (1-5%) |
|
|
Term
| Billings Ovulation Method |
|
Definition
Women learn to identify changes in types of vaginal discharge from mucus and to identify the peak day- the estimated day of ovulation.
Days with vaginal discharge and three days after the mucus Peak Day are considered fertile
Strength: More flexible and more knowledge than the two-day method
Weakness: Need for personal instruction |
|
|
Term
| Creighton Model FertilityCare |
|
Definition
Standardized adaptation of Billings Ovulation Method
Additional insight into menstrual cycle function
Medical applications
Weakness: Requires more personal instruction |
|
|
Term
|
Definition
Begin fertile phase by mucus or calendar
End of fertile phase by temperature and end of type E mucus
Strength: Multiple symptoms to cross-check
Weakness: Requires adaptation in times of anovulation (no temperature rise)
Optional additional sign: cervix palpation |
|
|
Term
| What factors are considered important in NFP effectiveness |
|
Definition
Personalized instruction
Well-trained teachers
Motivation
Couple communication |
|
|
Term
| What factors are NOT considered important in NFP effectiveness |
|
Definition
Regular cycles
Educational status
Socioeconomic status
Religiosity |
|
|
Term
| Mucus PEAK to identify ovulation |
|
Definition
prospectively identifies approach of ovulation
information about cervical and ovarian function
information about sperm survival |
|
|
Term
| BBT in identifying ovulation |
|
Definition
retrospectively indicates occurrence of ovulation
information about ovarian function only
no information about sperm survival |
|
|
Term
| Urine LH to identify ovulation |
|
Definition
prospectively identifies approach of ovulation within shorter time frame
information about ovulation only
no information about sperm survival |
|
|
Term
|
Definition
Shortening and thinning of the cervix
Expressed as % of original length or length in centimeters |
|
|
Term
|
Definition
Interval between onset of labor and complete cervical dilation.
2 phases: latent and active. |
|
|
Term
|
Definition
Begins with first regular contractions and continues until 3-4 cm dilated.
Slower rate of cervical change |
|
|
Term
|
Definition
Remainder of 1st stage until complete cervical dilation (10 cm)
Acceleration, maximal slope, and deceleration phases |
|
|
Term
| Cardinal Movements of Labor |
|
Definition
Engagement
Flexion and descent
Internal rotation
Extension
External rotation (restitution)
Expulsion (delivery of the anterior and posterior shoulders) |
|
|
Term
|
Definition
Part of the fetus lying over the pelvic inlet or cervical os
Cephalic
Breech
Shoulder |
|
|
Term
|
Definition
| (forehead)- brow presentation |
|
|
Term
| Abnormal Labor: The 3 P’s |
|
Definition
Power (uterine contractions)
Passenger (size, presentation, and position of the fetus)
Passage (pelvis) |
|
|
Term
| Power Problems: Interventions |
|
Definition
Oxytocin augmentation.
Artificial rupture of membranes (AROM).
Assisted vaginal or cesarean delivery. |
|
|
Term
| Passenger/Passage Problems |
|
Definition
Optimize Power
Reposition the fetus if possible
Manual rotation
Forceps rotation
(You can’t fix size issues) |
|
|
Term
| Protracted Active Phase intervention |
|
Definition
1. Rupture of the membranes
2. Oxytocin augmentation |
|
|
Term
Arrest of Dilation in the Active Phase
intervention |
|
Definition
1. Rupture membranes
2. Pitocin
3. Cesarean delivery |
|
|
Term
| Protracted Second Stage intervention |
|
Definition
1. Oxytocin
2. Manuel rotation
3. Assisted delivery |
|
|
Term
| Agents that induce cytochrome P450 enzymes can enhance metabolism and interfere w/ therapeutic actions of estrogens |
|
Definition
rifampin, phenytoin, carbamezepine,
phenobarbital, topiramate, St. John’s Wort. Some antibiotics (penicillin, tetracyclines) may reduce
bioavailability by altering intestinal flora. |
|
|
Term
| Estrogen synthesis inhibitors (aromatase inhibitors) |
|
Definition
| (used in Rx of breast cancer): exemestane, anastrozole and letrozole |
|
|
Term
| CLINICAL USES OF ESTROGENS |
|
Definition
1. As a component of OC; mainly ethinyl estradiol
2. In HRT during menopause (Premarin ® most widely used)
3. HRT for hypogonadism; delayed puberty in women
4. Rx of dysmenorrhea, dysfunctional uterine bleeding (oligomenorrhea)
and some amenorrheic states; perimenopause
5. Rx of acne |
|
|
Term
| CLINICAL USES OF PROGESTINS |
|
Definition
1. As OC alone, or a component of OC; mainly the 19-norT derivatives
2. In HRT during menopause (mainly medroxyprogesterone) for
endometrial protection
3. Rx of oligomenorrhea or amenorrhea
4. Rx of polycystic ovary syndrome
5. Rx of endometriosis |
|
|
Term
|
Definition
mifepristone (RU-486; Mifeprex ®)
1. progestin (and glucocorticoid) receptor antagonist
2. abortifacient in first trimester; regimen includes misoprostol |
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Term
| Adverse Effects of Combination OC’s |
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Definition
a. nausea and vomiting (E)
b. breast tenderness (mastalgia) (E)
c. exacerbation of migraine headache (E or P)
d. melasma, chloasma (E)
e. acne (P)
f. breakthrough bleeding (too low E) |
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Term
| Absolute contraindications to use of combination OCs |
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Definition
a. Past or present history of thromboembolic disease, thrombophlebitis
b. Past or present history of cardiovascular disease, esp. cerebrovascular
disease, coronary artery disease, and MI
c. Heavy smokers (1 pack +) over 35
d. Past or present history of estrogen-dependent neoplasia, esp. carcinoma of
the breast and endometrium
e. Undiagnosed abnormal vaginal bleeding
f. Lactation |
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Term
| Non-contraceptive Benefits of Combination OCs |
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Definition
a. More predictable menses; decreased dysmenorrhea; decreased anemia;
regularizes dysfunctional uterine bleeding
b. Rx symptoms in perimenopausal transition
c. protective against ovarian, endometrial and colorectal carcinoma
d. protective against ovarian cysts
e. protective against fibrocystic and other benign breast disorders |
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Term
| Progestin-only contraceptives |
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Definition
KEY CONCEPT: These are useful when there is a contraindication to use of
estrogen. In addition, progestin only contraceptives are useful in lactation,
where estrogen has been shown to reduce milk volume. |
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Term
|
Definition
| Progesterone implant, 3 yr action, implanon |
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Term
| Adverse effects of progesterones |
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Definition
a. * irregular, unpredictable bleeding; amenorrhea
b. mood changes, esp depression
c. headache |
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Term
| Contraindications to progestin-only contraceptives |
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Definition
| a. Hx of breast cancer or thromboembolic disease |
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Term
| Emergency (post-coital) contraception |
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Definition
a. Yuzpe regimen: double dose of any combined OC taken within 72 hrs of intercourse followed 12 hours later by a second double dose;
b. levonorgestrel-only regimen, e.g., in Plan B®, 0.75 mg levonorgestrel taken asap w/i 72 hr of intercourse and again 12 hr later. Some recommend both doses be taken together |
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Term
| Adverse effects of emergency contraception |
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Definition
a. *nausea and vomiting
b. headache, dizziness
c. mastalgia |
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Term
| Major indications for HRT in menopause |
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Definition
1. vasomotor instability (hot flashes or flushes, night sweats)
2. mood changes
3. urogenital atrophy
4. prevention and Rx of osteoporosis |
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Term
| Why is a progesterone commonly added in HRT? |
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Definition
KEY CONCEPT: A progestin is included only to eliminate risk of endometrial
cancer (see below); not needed after a hysterectomy |
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Term
| Why is a progesterone commonly added in HRT? |
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Definition
KEY CONCEPT: A progestin is included only to eliminate risk of endometrial
cancer (see below); not needed after a hysterectomy |
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Term
| Why is a progesterone commonly added in HRT? |
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Definition
KEY CONCEPT: A progestin is included only to eliminate risk of endometrial
cancer (see below); not needed after a hysterectomy |
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Term
| Common adverse effects of HRT |
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Definition
| KEY CONCEPTS: Biological activities of estrogens used in HRT are generally lower than in OCs. The adverse effects and absolute and relative contraindications to estrogen use are similar to those for OCs. |
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Term
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Definition
1. Endometrial cancer: Unopposed estrogen taken for 5 years increases the risk of endometrial hyperplasia and cancer by 5-fold , and by 8-fold if taken for longer than 5 years. Risk is nearly eliminated by addition of progestin.
2. HRT reduces risk of colorectal cancer
3. Breast Cancer:
a. little or no increased risk for HRT < 5 yrs
b. Women’s Health Initiative reports relative risk (RR) of 1.26 for
approx. 5 years of HRT, and perhaps decreased with ERT
c. HRT for 10-15 yrs RR ~1.3, from U.S. studies
d. Results from the Million Women Study
1. Overall relative risk for breast cancer incidence in current users
vs. never-users was 1.66
2. Risk increases with duration of use
3. No risk for past users
4. Risk was higher in estrogen+progestin vs. estrogen alone;
Progestin component now believed to contribute significantly |
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Term
| Clinical manifestations of different STDs |
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Definition
1. Generalized rash: Initial infection with human immunodeficiency virus, secondary syphilis, disseminated gonorrhea. A rash in an adult should be considered to be syphilis until proven otherwise.
2. Localized ulcer: Syphilis, chancroid, herpes.
3. Localized papules: Warts, molluscum, scabies.
4. Vaginal discharge: Trichomonas, bacterial vaginosis.
5. Mucopurulent cervicitis, post coital bleeding: Gonorrhea, chlamydia.
6. Inguinal lymphadenopathy: Chancroid, syphilis, primary herpes, lymphogranuloma venereum, granuloma inguinale.
7. Pubic pruritus: Pubic lice, scabies.
8. Dysuria: Chlamydia, gonorrhea, trichomonas, herpes. |
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Term
| Management of sexual contacts of those with STDs |
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Definition
5. Test all primary sexual contacts of identified cases, but primary contacts should be treated even if tests are negative.
6. Test all secondary contacts (other sexual partners of primary contacts) and treat if tests are positive or if disease is suspected. |
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Term
| Follow up for those with STDs or high risk for STDs |
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Definition
1. Repeat cultures to test for cure 3 weeks after chlamydia or gonorrhea therapy.
2. Serology should be repeated for syphilis (RPR titer) and for HIV infection (HIV antibody) after 3
to 6 months if initial tests are negative.
3. Annual screening is recommended for the population at risk for syphilis, gonorrhea, chlamydia, cervical dysplasia, and HIV. |
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Term
A 19 year old female gave birth to a healty term male. She has been breast feeding the baby for a month, but now notes that her left breast is swollen and painful to touch. She is febrile. The best diagnosis is:
A Acute mastitis
B Fibrocystic disease
C Fat necrosis
D Intraductal papilloma
E Galactocele |
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Definition
| The organism is most often Staphylococcus aureus or Streptococcus. Antibiotic therapy is usually successful. A |
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Term
A 29 year old female has been taking oral contraceptives for many years. She now has a palpable "lump" in the left breast. Of the following conditions, the one that is most likely to be associated with oral contraceptive use is:
A Acute mastitis
B Fat necrosis
C Galactocele
D Hypertrophy
E Cyst formation |
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Definition
| It occurs secondary to obstruction of lactiferous ducts.C |
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Term
A 41-year-old female has a 9-cm soft, fleshy right breast neoplasm that microscopically demonstrates a lymphoid stroma with little fibrosis surrounding sheets of large vesicular cells with frequent mitoses. This lesion is most likely to be a(an):
A Infiltrating ductal carcinoma
B Paget's disease of breast
C Medullary carcinoma
D Lobular carcinoma
E Cystosarcoma phyllodes |
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Definition
| Medullary carcinoma is often bulky, with pushing margins. It lacks the desmoplasia typical of ductal carcinomas. It accounts for only about 1% of breast cancers |
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Term
While performing a hysterectomy on a 44 year old female found to have uterine leiomyomata as a cause for perimenopausal bleeding, the surgeon notes several 0.2 cm translucent fluid-filled cysts near the fimbriated end of the right fallopian tube. This finding is most consistent with:
A Gartner's duct cysts
B Krukenberg tumors
C Parovarian cysts
D Pelvic inflammatory disease
E Mucinous cystadenomas |
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Definition
| Also called paratubal cysts, these are common incidental findings. They are embryologic remnants of the wolffian duct.C |
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Term
A 33 year old female and her husband have wanted a child, but she has been unable to conceive. Her husband's sperm count is normal. Of the following, which is LEAST likely to be the cause for her infertility:
A Endometriosis
B Prolactinoma
C Pelvic inflammatory disease
D Leydig cell tumor
E Chronic cervicitis |
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Definition
| Many women have some degree of chronic cervicitis.E |
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Term
A 55-year-old female has lower abdominal pain. She had a simple hysterectomy performed 25 years before. On pelvic examination, she has a vagina that ends in a blind pouch, and a large left adnexal mass is palpable and is non-tender. At laparotomy, there is a 9 cm mass involving the left ovary. Microscopic examination reveals malignant glands resembling endometrial glands. What abnormality was the hysterectomy specimen most likely to have shown:
A Endometriosis
B Adenomyosis
C Malignant mixed mullerian tumor
D Chronic endometritis
E Endometrial hyperplasia |
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Definition
| An endometrioid carcinoma can develop in the setting of endometriosis. The processes can occur decades apart.A |
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Term
A 46 year old female has irregular menometrorrhagia for the last two months. Pelvic examination reveals a normal-sized uterus and a normal-appearing cervix. A Pap smear reveals no abnormal cells. An endometrial biopsy is performed and shows a fragment of a polypoid mass covered by columnar cells and containing cystically dilated endometrial glands. Which of the following lesions best accounts for these findings:
A Adenomatous hyperplasia
B Endometritis
C Adenocarcinoma
D Endometrial polyp
E Adenomyosis |
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Definition
| Endometrial polyps are small 0.5 to 2 cm masses that are most common in menopausal women. They can produce abnormal uterine bleeding.. |
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Term
| (55) A 53-year-old female has a bulky, polypoid uterine mass protruding from the vagina |
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Definition
| Malignant mixed mesodermal tumor, Such a tumor arises in uterus and is often large and bulky. It has both malignant epithelial and mesenchymal components. |
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Term
On a routine physical examination of a 70-year-old male, you palpate a firm nodule in the prostate via rectal examination. If the biopsy of this lesion shows the microscopic appearance of small, crowded glands containing cells with prominent nucleoli in the nuclei, the diagnosis is probably:
A Adenocarcinoma of the prostate
B Benign prostatic hyperplasia
C Chronic prostatitis
D Metastatic transitional cell carcinoma
E Recent infarction of prostate |
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Definition
| Such a nodule at that age strongly suggests carcinoma. A |
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Term
| A typical cause for chronic abacterial prostatitis in sexually active 30- to 45-year-old males is: |
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Definition
| This is the most frequent form of prostatitis today. There is typically no history of chronic urinary tract infection. Chlamydia trachomatis |
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Term
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Definition
| (also known as "squamous cell carcinoma in situ"[1]:655) is a neoplastic skin disease, it can be considered as an early stage or intraepidermal form of squamous cell carcinoma. Erythroplasia of Queyrat is a form of squamous cell carcinoma in situ arising on the glans or prepuce, possibly induced by HPV |
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Term
The best way to diagnose infection with Chlamydia trachomatis.
(27) The best way to diagnose infection with Treponema pallidum.
A Darkfield microscopic examination of exudate or secretions
B Cytologic smear
C Tissue biopsy
D ELISA performed on exudate or secretions
E Microbiologic culture |
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Definition
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Term
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Definition
– Primary morphologic defect
– Intrinsically abnormal developmental process
– e.g. cleft lip, omphalocele |
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Term
|
Definition
– Secondary alteration (form, function, position)
– Initially normally formed body part
– Usually occurs in fetal life, as opposed to embryogenesis
– e.g. clubfoot |
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Term
|
Definition
– Secondary morphologic defect
– Extrinsic breakdown of an originally normal developmental process
– e.g. amniotic bands, viral infection |
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Term
|
Definition
– Primary defect involving abnormal organization of cells into tissue
– e.g. hemangioma, neoplasia |
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Term
|
Definition
– Primary defect with its secondary structural changes
– Pierre Robin sequence‐ disorder in which a primary defect in mandibular development produces a small jaw, glossoptosis, cleft palate
– Oligohydramnios sequence |
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Term
|
Definition
– Pattern of multiple primary malformations due to a single etiology
– e.g. trisomy 13 |
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Term
|
Definition
| High glucose due to maternal diabetes |
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Term
| Nuchal translucency (NT) at 10‐14 wk |
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Definition
• Aneuploidy screen
• Association between increased NT and cardiac abnormalities independent of abnormal karyotype |
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Term
| Trichomonas Pathophysiology |
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Definition
• High transmission rate (invades intact skin)
• Vaginal binding sites are estrogen
dependent
• Men are typically asymptomatic carriers
with fewer skin binding sites
• Trichomonas is a disease of the reproductive years
• Trichomonas inhibits NF‐kappa B |
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Term
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Definition
• Warts and dysplasia appear in reactive skin
• A healthy Th1 response eliminates the virus after a few months (50% by 18 months, 95% by 5 years)
• Thumb sucking contributes to warts on the thumb
• Smoking, diabetes, and immunosuppressant drugs inhibit the normal Th1 response
• Interferon injection and Aldara cream improve a deficient Th1 response |
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Term
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Definition
• Skin trauma and a Th1 deficiency contribute to herpes persistence and recurrence
• Vulvar dermatitis therapy may help to prevent recurrence if a Th2 response is eliminated and the normal Th1 response is restored
• Vaccinia (serious widespread infection) after smallpox vaccination is a similar issue in cases of atopic skin (Th2 response that down‐regulates the Th1 response)
• Chronic herpes suppression should only be needed in immunocompromised patients |
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Term
| Molluscum Pathophysiology |
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Definition
• Folliculitis may be secondarily infected with molluscum
• A healthy Th1 response eliminates the virus after a few months
• Curettage spreads the lesions
• Aldara cream activates interferon production that boosts the Th1 response |
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Term
|
Definition
• Generally only infect columnar epithelium
• Purulent endocervical mucus is evident in half of cases
• After the menopause, chlamydia and
gonorrhea may only be found in the female urethra and rectum |
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Term
Risk Factors for Severe Recurrent Yeast
Infection |
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Definition
• Vulvar allergic dermatitis (Th2 response with down‐regulated Th1)
• History of asthma, hay fever, eczema, sinusitis
• Poorly controlled diabetes, lichen sclerosus, possibly hypothyroidism |
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Term
| Therapy for Langerhans Cell Dysfunction |
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Definition
• Injectable Interferon boosts the Th1 response in the skin, mainly used for persistent viral infection
• Aldara Cream activates natural interferon in the skin and is more convenient than injectable agents
• Topical steroid ointment inhibits Th2 response and allows some restoration of Th1 in allergy cases
• Immunosuppressant drugs inhibit excessive Th1 in cases of autoimmune skin disease |
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Term
| Langerhans Cell Th2 Response |
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Definition
• T‐helper cell type 2 response
• Mediates allergy
• Does not effectively eliminate bacteria, yeast, viruses or cancer cells in the skin
• A Th2 response down‐regulates the ability to have a good Th1 response
• A persisting Th2 response increases the risk for viral and yeast infection, as well as skin cancer |
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Term
| Langerhans Cell Th1 Response |
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Definition
• T‐helper cell type 1 response (Th1)
• Stimulated by foreign antigen exposure in the skin
• The appropriate response to help eliminate infection and individual malignant cells
• Auto‐immune skin disease is an excessive Langerhans cell activated Th1 response
• Rejection of a transplanted organ is a Th1 response |
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