Discuss human chorionic gonadotropin levels in normal and abnormal pregnancies. (SIGS Case 7.4b)
Normal: levels double every 48 hours; Abnormal: falling= failed IUP or ectopic; drop >21% = failed IUP; drop < 21% = ectopic pregnancy
Contrast the diagnostic work-up and management for a hemodynamically stable vs. unstable patient with ectopic pregnancy. (SIGS Case 7.4b)
stable: laparoscopic surgery OR methotrexate ; unstable: immediate laparotomy and treatment for hemorrhagic shock
Relate the actions of methotrexate to the underlying pathophysiology of ectopic pregnancy. (SIGS 7.4)
folic acid antagonist that competitively inhibits folate-dependent steps in nucleic acid synthesis. inhibits DNA synthesis/reproduction in proliferating cells
Distinguish fibroadenoma and phyllodes tumor in terms of clinical features, morphology and prognosis. (SIGS 7.6a)
Fibro: most common, benign, <25 years, firm, solitary, rarely malignant; Phy: from intralobular stroma, older pts, massive size, leaf-like appearance, 15% malig
Compare/contrast the clinical presentation and underlying pathophysiology of Sertoli-Leydig cell tumors and polycystic ovary syndrome (PCOS) (Sigs 7.4a)
S-L: neoplasm; hypersecrete testosterone/estrogen; PCOS: not neoplasm, disbalance of hormonal axis-> overgrowth dominant follicle-> hypersecrete horm.
Define the progestin challenge test and relate it to PCOS. (SIGs 7.4a)
progesterone given to test for amenorrhea by attempting to induce menstratuion; + if light bleeding occurs w/in 2 wks-> PCOS; - if no bleeding
List diagnostic criteria for PCOS (SIGs 7.4a)
Rotterham Criteria:2+ of: oligoovulation/anovulation, hyperandrogenism, enlarged/polycystic ovary, ovarian volume>10mL, multiple cystic follicle(string of pearl
Relate the clinical features of intraductal papilloma to the tumor's characteristic morphology. (SIGs 7.6a)
papillary growth of luminal cells into a large duct, bloody nipple discharge; finger-like projections; benign, but if no myoepithelial--> papillary carcinoma
Describe the pathogenesis of the three principal morphologic features of non-proliferative fibrocystic breast changes (SIGs 7.6a)
Apocrine metaplasia, fibrosis, adenosis (see image for details)
Characterize the indications, risks, benefits, and role of screening vs. diagnostic mammography. (Sigs 7.6a)
40-49 if high risk, 50-75 every 2 years; benefits: diagnose early; risks: overdiagnosis, false-positive, radiation
Discuss the role of serum CA-125 levels in the diagnosis and monitoring of ovarian neoplasms (SIGs 7.6b)
biomarker for ovarian cancer; can be used to monitor response to treatment. See image
Explain the pathogenesis and clinical features of torsion and adhesions as sequelae of an ovarian neoplasm. (SIGs 7.6b)
fibroma continues to grow-> twisting of ligaments (suspensory lig)-> compression of ovarian artery and vein-> ischemia-> acute abdominal pain
What is the MOA and indications for medroxyprogesterone acetate (MPA) (Sigs 7.7a)
inhibits production of gonadotropin-> no follicular maturation and ovulation, thins endometrium;heavy menstrual bleeding, contraception, endometrial hyperplasia
Describe the pathways by which synthetic progesterones or progestins act to stabilize the endometrium (Sigs 7.7b)
blocks proliferative effect of estrogen; induces expression of 17beta-hydroxysteroid dehydrogenase type 2 (metabolizes estradiol to less potent estrone)
What are risk factors for progression from endometrial hyperplasia to endometrial carcinoma, including specific genetic mutations (Sigs 7.7a)
See image
