Glossary of Block VII, WeekV
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- define an uncomplicated UTI.
- cystitis in a nonpregnant woman without an underlying anatomic abnormality or neurologic dysfunction.
- T/F: a male can have an uncomplicated UTI.
every UTI in a male is complicated
- pharmacologically, what are the treatment implications of a complicated UTI vs. an uncomplicated UTI?
- uncomplicated - low risk for treatment failure
complicated - increased risk for treatment failure
- what type of pathogenic organism, causing a UTI, would place this UTI in the "complicated" category?
- urease producing organism
(ie. Proteus mirabalis)
- in diagnosing a UTI - what would a positive nitrite test tell us about the causative organism?
- tells us it is gram negative
(gram negative organisms convert nitrate to nitrite)
- what is a frequent complication of UTIs (as a matter of fact UTIs are the #1 cause of this complication).
- what is the regular "cutoff" in a UC, where, above it, a UTI is diagnosed?
- 10^5 bacteria/mL
- which pathogens cause most uncomplicated UTIs?
- E. coli
(minor: Enterococci, Klebsierlla, P.mirabolis)
- which pathogens cause most complicated UTIs? (6)
- E. coli
- which three antibiotics should you never use to treat a UTI unless the UC shows the pathogen is susceptible?
(high rates of resistance)
- which urinary analgesic agent reduces symptoms of dysuria and colors the urine red/orange?
- phenazopyridine HCL (pyridium)
- which antibiotic is the one of choice in the treatment of complicated UTIs and areas of increased resistance?
(oral or parenteral)
*high urinary concentrations*
- optimal time period to treat acute uncomplicated cystitis?
- 3 days
- 3 treatments of choice for uncomplicated cystitis?
- 1. TMP/SMX
- what 3 conditions must be met before you use TMP/SMX in uncomplicated cystitis?
- 1. no allergy
2. not recently received antibiotics
3. local resistance <15-20%
- treatment indications for asymptomatic bacteriuria?
- *DO NOT TREAT UNLESS:*
- before urologic surgery
- why are pregnant women treated for asymptomatic bacteriuria (UC>10^5)?
- they have:
- a 20x increased risk of pyelonephritis
- an increased risk of stillbirth or premature labor
- what would we use to treat a pregnant woman with asymptomatic bacteriuria?
- why would you not use a urinary antiseptic to treat pyelonephritis?
- poor tissue concentration
- List three urinary antiseptics
- 1. nitrofurantoin
- spectrum of nitrofurantoin?
- basically all urinary pathogens EXCEPT Pseudomonas, Proteus, Serratia
- indications for nitrofurantoin? (2)
- 1. uncomplicated cystitis
2. prophylaxis of recurrent cystitis
- hallmark side effect of nitrofurantoin?
- pulmonary fibrosis
(may not be reversible)
- if therapy for cystitis fails, how should we treat the infection?
- as if it is pyelonephritis
(silent pyelo occurs in ~30% of cystitis cases)
- what is the duration of antibiotic therapy for pyelonephritis?
(unless is a cipro - then 7 days)
- outpatient first line treatment for uncomplicated pyelonephritis?
- outpatient treatment for pyelonephritis when a gram + organism (ie. Enterococcus) is suspected?
- amoxicillin or amox/clavulanate
- inpatient treatment for uncomplicated pyelonephritis?
- IV FQ, aminoglycoside, 3rd gen. ceph
- inpatient treatment for pyelonephritis when a gram + organism (ie. Enterococci) is suspected?
- Amp/sulbactam or ampicillin + aminoglycoside
- what is the most commonly used medication in the prevention of recurrent UTIs?
- what type of patients would be on long-term, low-dose prophylaxis for recurrent UTIs?
- Pediatric population
- what is the ~ seroprevalence for HSV-2?
(many don't know they are infected)
- what is the difference in symptoms seen between a primary and a secondary HSV infection?
- primary - both local and systemic symptoms
secondary - mostly local symptoms, milder
- How long does HSV remain latent and where does it establish latency?
- remains latent indefinitely in neuronal bodies
- in a recurrent HSV infection, when should antiviral treatment be initiated?
- at the onset of prodromal symptoms
(tingling, irritation, pain in buttocks, legs or hips)
- compare the number of lesions seen in a primary vs. a secondary HSV infection.
- primary - 16 lesions on avg.
secondary - 6 on avg.
- which antivirals are effective in treating HSV?
- describe the effects of antiviral treatment on establishing latency in HSV.
- NO effects in establishing latency of HSV
- length of treatment time with acyclovir in primary HSV?
- compare the initiation times of antiviral treatment in a primary vs. secondary HSV infection
- primary - within 48-72 hours of onset
secondary - within 24 hours of lesions
- duration of antiviral treatment of secondary HSV infection?
- 3-5 days
- benefits of daily HSV suppressive therapy? (3)
- 1. decreases recurrences
2. decreases viral shedding
3. reduces risk of infecting uninfected partners
- indications for daily HSV suppressive therapy? (3)
- 1. frequent or severe recurrences
2. HSV discordant couples
- what is the drug of choice for the treatment of all stages of syphillis?
- Benzathine penicillin G (IM)
- what is the Jarisch-Herxheimer rxn?
- self-limited reaction to anti-treponemal therapy
(fever, headache, myalgia, N/V, chills, exacerbation of secondary rash)
- what two "syndromes" is Chlamydia trachomatis associated with?
- 1. Fitz-Hugh-Curtis syndrome (perihepatitis)
2. Reiter's syndrome (urethritis, conjunctivitis, arthritis, mucuocutaneous lesions)
- what is the recommended treatment regimen for an uncomplicated Chlamydia infection?
- azythromycin (single dose)
doxyxycline (BID for 7d)
- Neisseria gonorrhoeae has demonstrated resistance to which two antibiotics?
- 1. penicillin
- what is the recommended regimen to treat an uncomplicated gonorrhea infection?
- cefixime (single dose)
-(or ceftriaxone or FQ)
azithromycin or doxycycline (for Chlamydia tx.)
- if Gonorrhea was acquired in Asia, Hawaii, California or MSM what could it be resistant to (therefore we should not use this to treat these infections)?
- what would we use instead to treat gonorrhea infections acquired in Asia, Hawaii, California or MSM?
- in a PID infection, what pathogen should we worry about that is particularly difficult to get rid of?
- Bacteroides fragilis
- two parenteral regimens to treat PID?
- 1. cefotetan (or cefoxitin) PLUS doxyxycline (for chlamydia)
2. clindamycin PLUS gentamycin PLUS doxycycline
- two oral regimens to treat PID?
- 1. FQ W/ or W/O metronidazole
2. ceftriaxone PLUS doxy W/ or W/O metronidazole
- which three STDs can be treated with a single dose antibiotic?
- 1. chlamydia
- which antibiotic is given in a single dose to treat trichomonas?
- metronidazole (2g)
- in trichomonas infection do you treat the partner?
- in a BV infection do you treat the partner?
- two antibiotics used to treat BV?
- metronidazole (oral or intravaginal)
- topical therapy for vulvovaginal candidiasis? (2)
- oral therapy for vulvovaginal candidiasis?
- fluconazole (single dose)
- two treatment regimens for HPV external warts?
- 1. podofilox
- MOA of imiquimod?
- immune response modifier
- enhances natural cellular immune mechanisms
- no anti-HPV activity
- four provider administered regimens for external HPV warts?
- 1. cryotherapy
2. podphyllin resin
3. trichloroacetic acid (TCA)
4. surgical removal
- describe what a crossection of uterine tube would look like in the:
1. interstitial portion
- 1. narrow lumen rimmed by muscle
2. decidualization, less cilia
3. lots of ciliated epithelium
- gross manifestations of salpingitis isthmica nodosa?
- nodual swelling of the isthmic portion of the uterine tubes
- microscopic manifestations of sapingitis isthmica nodosa?
- 1. thickened wall
2. hypertrophied musculature
3. epithelium line channels running between muscle bundles (channels connect but do not extend to peritoneum)
- Three postulated causes of salpingitis isthmica nodosa?
- 1. inflammation
2. mechanical pressure (diverticula)
3. analagous to adenomyosis
- salpingitis isthmica nodosa is more commonly found in what two groups of women?
- 1. infertile ones
2. ectopic pregnancies
- where does the typical peratubal cyst occur?
- in the broad ligament
- what three things may a peritiubal cyst be derived from?
- 1. mullerian ducts (paramesonephric)
2. wolffian ducts (mesonephric)
3. peritoneal inclusion (mesothelial)
- what are hydatids of Morgagni?
- little cysts found on the fimbriated portion of the uterine tubes and broad ligament
- is an adenomatoid tumor of the uterine tube benign or malignant?
- describe the microscopic characteristics of an adenomatoid tumor
- cleft like spaces of mesothelial epithelium in loose stroma
- which disorder can be present in the fallopian tubes and has the following microscopic characteristics?
hemosiderin laden macrophages
- s/s of acute salpingitis? (5)
- 1. pelvic pain
2. adnexal tenderness
3. pain with cervical motion
4. vaginal discharge
- possible complication of salpigitis?
- destruction of tubal epithelium resulting in formation of a tubo-ovarian absess
- "violin strings" (a complication of salpingitis) is also known as? and is?
- aka. Fitz-Hugh curtis syndrome
*perihepatitis in female with a history of gonococcal or chlamydial salpingitis
- besides STDs, what are some other causes of acute salpingitis?
- infection after:
- describe the gross characteristics of acute salpingitis.
- distended uterine tubes
early fibrinous adhesions
- untreated acute salpingitis may progress to? which may progress to?
- parametritis, which may progress to peritonitis
- gross characteristics of pyosalpinx?
- HUGE distended uterine tube
(pyosalpinx = pus bag)
- four complications of PID?
- 1. peritonitis
2. intestinal obstruction
4. infertility, ectopic pregnancy
- more than 40% of women diagnosed with PID are in what age group?
- 15-24 yrs
- minimum criteria for PID? (3)
- 1. lower abdominal tenderness
2. adnexal tenderness
3. cervical motion tenderness
- besides STDs, what are some other causes of PID? (4)
- 1. appendicitis
3. hematogenous spread
4. transuterine (IUD, D&C)
- why is a ruptured tuboovarian abcess so emergent?
- risk of gram negative endotoxic shock
- what is hydrosalpinx?
- collection of sterile fluid in the lumen of the uterine tubes
also see distended tubes
- in a hydrosalpynx, what microscopic changes are seen in the uterine tube?
- 1. epithelium thin and nonciliated
2. thinned muscular wall, loss of plicae
- hydrosalpynx is usually the sequelae to?
- chronic salpingitis that has been treated or resolved
- granulomatous salpingitis almost always has what origin?
- via what 2 routes is fallopian tube tuberculosis spread?
- hematogenous or lymphatic
- fallopian tube tuberculosis is most commonly seen in what population?
- immigrant population
3rd world countries
post-menopausal women (in US)
- 4 causes of ectopic pregnancy? (given to us by Torgerson)
- in which portion of the uterine tube does an ectopic pregnancy MC occur?
- compare hCG levels in an ectopic pregnancy vs. a normal pregnancy
- ectopic - lower hCG levels, don't see normal doubling rate
normal - see hCG double every 2 days
- compare progesterone levels in an ectopic pregnancy vs. a normal pregnancy
- ectopic pregnancy has lower progesterone levels
- most ectopic pregnancies rupture at what time?
- 10-12 wks
- what is it called when the ectopic pregnancy terminates in the uterine tube and just hangs out there?
- malignant neoplasms of the uterine tube present in what age group of women?
- 6th-7th decades
- clinical presentation of malignant neoplasms of the uterine tube? (3)
- 1. vaginal discharge/bleeding
2. pelvic pain
3. insidious onset of abdominal bloating/ascites
- the majority of malignant uterine tube neoplasms are of what type?
(arise from uterine tube epithelium)
- describe the spread of fallopian tube carcinoma
- - transluminal into peritoneal cavity, implants on peritoneal surfaces
- direct invasion of uterus and ovary
- spread to lymph nodes
- describe the four FIGO stages of fallopian tube carcinoma
- 0. carcinoma in situ
1. limited to uterine tube
2. pelvic extension
3. peritoneal/omental implants outside of pelvis / mets. to retroperitoneal lymph nodes
4. distant mets
- which FIGO stages are considered incurable?
- 2, 3 and 4
(once it has spread)
- describe the number of follicles in a female throughout life.
- newborn - million, then some die off
puberty - less
reproductive years - 450 are ovulated
dissapear at menopause
- embryology: what two things does the mesenchymal stroma give rise to?
- theca and granulosa cells
- describe the sequence from primordial follicle to Graafian follicle (5)
- primordial follicle
early primary follicle
- if pregnant, how long does the corpus luteum secrete progesterone?
- until the 3rd month
(then placenta takes over)
- what maintains the corpus luteum of pregnancy? (ie. why doesn't it die like it does in an unfertilized cycle)
- the developing embryo secretes hCG - this maintains CL.
- what are the three components of the ovary?
- 1. epithelial surface
2. mesenchymal stroma
3. germ cells
- at what developmental age do the germ cells of the ovary cease multiplying?
- third trimester
- ovarian arterial supply?
- ovarian artery
(branch of abdominal aorta)
- ovarian venous drainage?
- drain into utero-ovarian vain
- where do the lymphatics drain?
- lumbar lymph nodes
- describe the surface epithelium of the ovary?
- single layer of columnar cuboidal cells
- which type of cell in the ovary is responsive to hCG?
- Hilus cells
- about how many follicles are mature in each ovulation cycle?
- the corpus luteum is under control of which hormone?
- what is the major estrogen in a menopausal woman? why?
(no more follicular synthesis of estradiol)
- a follicle cyst or a corpus luteum cyst can progress to ?
- a hematoma
- what is the MC site of endometriosis?
- what is the cyst called that is seen in endometriosis?
- chocolate cyst
- stromal hyperplasia and hyperthecosis results in bilateral ovarian enlargement. consequence?
- stromal cells syntheslize androgens.
these androgens are converted peripherally to estrone, this leads to increased incidence of endometrial hyperplasia/carcinoma.
- oophoritis is rare; often it is associated with concurrent inflammation of?
(this could result in a tuboovarian abscess)
- in a patient with chronic oophoritis, the cause could very likely be _____ related.
- what happens during ovarian torsion?
- the ovary twists on its pedicle -> this results in congestion and infarction
- is a serous inclusion cyst of the ovary functional or nonfunctional?
- is a follicle cyst of the ovary functional or nonfunctional?
(high estrogen content in cyst fluid, also causes abnormalities in the release of pituitary gonadotropins)
- what are the characteristics of a corpus luteum cyst?
- - continued progesterone secretion (causes menstrual irregularities)
- complications of an ovarian cyst?
- intraperitoneal rupture
hemorrhage into cyst
- what are the clinical features of PCOS?
- 1. obesity
3. secondary amenorrhea
- what is the hormonal imbalance in PCOS?
- excessive synthesis of androgens - these are converted peripherally to estrone
- what hormonal imbalance are theca-leutein cysts associated with?
- increased circulating gonadotropins
- causes stimulation of theca interna
- causes extensive cyst formation
- what do all these conditions have in common:
- high hCG levels
- what three tissues of derivation can ovarian neoplasms arise from?
- 1. coelomic epithelium (mullerian or surface epithelium)
2. germ cells
3. stroma (sex cords)
- seven neoplasms derived from coelomic (outer) epithelium?
- 1. serous tumors
2. mucinous tumors
3. endometrioid tumors
4. clear cell tumor
5. Brenner tumor
7. mixed mesodermal tumor
- how are/were borderline ovarian tumors distinguished from frankly invasive epithelial cell tumors?
- borderline tumors have no destructive infiltrative growth or stromal invasion
- neoplasms derived from germ cells? (6)
- 1. teratoma
3. embryonal carcinoma
4. endodermal sinus tumor
- four neoplasms derived from specialized gonadal stroma?
- 1. granulosa-theca cell tumors
2. Sertoli-Leydig tumors
4. Lipid cell tumors
- two types of granulosa-theca cell tumors?
- 1. granulosa cell tumor
(derived from gonadal stroma)
- two types of Sertoli-Leydig tumors?
- 1. arrhenoblastoma
2. sertoli cell tumor
- 5 neoplasm locations that commonly metastasize to the ovary?
- 1. GI tract (Kruckenberg)
- what are the top 3 gynecological malignancies?
- what is the deadliest gynecologic malignancy?
- why are ovarian tumors so deadly?
- by the time they are discovered ~75% of them have spread to the pelvis and abdomen.
- 3 risk factors for ovarian CA?
- 1. nulliparity
2. family history (BRCA genes)
3. estrogen? (HRT)
- effect of OCs on ovarian CA risk?
- protective against ovarian CA
- two features in molecular biology that predispose to ovarian CA?
- 1. High levels of HER2-neu
2. mutations in p53 tumor suppressor gene
- if a patient has a BRCA1 or BRCA2 gene, what is their essential risk of ovarian CA?
- 20-60% by age 70
- BRCA1 is highly expressed in what type of ovarian CA?
- borderline ovarian carcinomas
- BRCA2 is highly expressed in what type of ovarian carcinoma?
- serous cystadenocarcinomas
- presence of the BRCA gene also increases risk of what cancers? (besides ovarian)
- four things that decrease the risk of ovarian CA?
- 1. breastfeeding
4. tubal ligation (and ovarian conservation)
- clinical presentations of ovarian CA? (6)
- 1. increase in abdominal girth
2. urinary symptoms
3. ovarian torsion
5. functional endocrinopathies
6. abnormal uterine bleeding *(in about 1/3 of cases)*
- 3 tumor markers used in ovarian CA screening?
- 1. CA-125
3. alpha fetoprotein
- tumors of this origin make up:
60-75% of primary ovarian tumors
90% of malignant ovarian tumors
- surface epithelium
- which type of epithelial ovarian tumor is the most common?
- serous tumor
- which type of epithelial ovarian tumor has the highest malignant potential?
- serous tumor
- what is the most common benign ovarian tumor?
- serous cystadenoma
- what is the malignant equivalent of a serous cystadenoma?
- serous cystadenocarcinoma
- which microscopic feature, when seen in serous cystadenocarcinoma, delivers a poor prognosis?
- psammoma bodies
"tombstones of tumor cells"
- are most mucinous tumors benign or malignant?
- gross characteristics of a mucinous cystadenoma?
cysts filled with thick mucinous contents
- classic micro characteristics of a mucinous adenocarcinoma?
- "picket fence"
single epithelial cells line the cyst
- what is pseudomyxoma peritonei and what is it associated with?
- mucin errupts in to the peritoneal cavity eliciting a fibrous response (get adhesions and bowel obstruction)
*associated with mucinous carcinoma of the ovary or appendix
- are most endometriod tumors benign or malignant?
- endometrioid carcinoma is usally found with which concurrent cancer?
- endometrial adenocarcinomas
- are ovarian clear cell adenocarcinomas benign or malignant?
- are most ovarian clear cell adenocarcinomas unilateral or bilateral?
- unilateral (90%)
- are most Brenner cell tumors benign or malignant?
- characteristic micro of ovarian clear cell adenocarcinoma?
- "hobnail" cells (clear cytoplasm)
*tubes or sheets of clear tubes*
- what does a Brenner tumor resemble?
- Bladder epithelium
- which type of tumor accounts for >90% of all germ cell tumors?
- are most germ cell tumors benign or malignant?
- a germ cell tumor that is derived from neoplastic germ cells is called?
- what is a teratoma derived from?
- embryonic tissues
- what tissues are endodermal sinus tumors and choriocarcinomas derived from?
- extraembryonic tissues
- what is another name for a benign cystic teratoma?
- dermoid cyst
- compare the nature of a mature teratoma vs. an immature teratoma
- mature - benign
immature - malignant, rare
- compare the nature of the cyst in a mature teratoma vs. an immature teratoma
- mature - liquid-like cyst
immature - solid cyst
- what is the part of the immature teratoma that is considered responsible for its agressive nature?
- in what age group are immature teratomas most commonly seen?
- first two decades
- what is the following called?
a monodermal teratoma in which the predominant tissue is thyroid?
- stroma ovarii
- what is the following called?
a monodermal/specialized teratoma that produces carcinoid syndrome (where you must first exclude metastasis from the GI tract)?
- what is the following tumor called?
the female "counterpart" of testicular seminoma?
- two laboratory levels that would be elevated in a patient with dysgerminoma?
- 1. lactic dehydrogenase
- unique feature of dysgerminomas when it comes to treatment?
(therefore good prognosis, respond to radiation treatment)
- yolk sac tumors are MC present in which age group?
- 10-30 yrs
- what do yolk sac tumors produce?
- alpha fetoprotein
- microscopic hallmark characteristics of a yolk sac tumor?
- Schiller-Duval bodies
- prognosis for yolk sac tumors?
- used to be lethal
now most are cured with chemotherapy
- embryonal carcinoma is associated with what elevated laboratory levels? (2)
- elevated hCG
elevated alpha fetoprotien
- choriocarcinoma is associated with what laboratory results?
- elevated hCG
- what is the most common ovarian tumor with estrogenic manifestations?
- granulosa-theca cell tumor
- micro hallmark characteristic of granulosa-theca cell tumors?
- Call-Exner bodies
- describe the manifestations of a granulosa-theca cell tumor in a child.
(secondary sex characteristics)
- which tumor is associated with Meig's syndrome?
- what is Meig's syndrome? (3 manifestations)
- ovarian tumor
- thecomas may be associated with what other type of gynecological change?
- 1. endometrial hyperplasia/carcinoma
2. granulosa cell tumor
- why are fibromas unique when compared to the other ovarian stromal tumors?
- it does not release estrogen, therefore no fat is present.
- a luteoma is associated with what clinical presentation?
- clinical features of a Sertoli-Leydig Cell tumor?
- masculinize (hirsutism, male hair distribution, voice changes, clitoral hypertrophy)
defeminization (breast atrophy, amenorrhea, hair loss)
- are Sertoli-Leydig cell tumors benign or malignant?
- are most tumors that are unclassified benign or malignant?
- a Kruckenberg tumor usually comes from?
- the stomach
(characterized by signet ring cells)
- three treatment modalities for ovarian cancer in general?
- 1. surgery with debulking
- what is the most common type of placental structure seen in twins?
- dichorionic diamnionic (two separate ones)
- when do most spontaneous abortions occur?
- in the first 12 wks of pregnancy
- risk factors for a spontanous abortion?
- 1. increasing maternal age
2. increasing parity
3. increasing paternal age
4. conception w/i 3 months of a live birth
- 50% of spontanous abortions are the result of chromosomal abnormalities. what is the chance of subsequent pregnancies having chromosomal abnormalities as well?
- maternal infections that can result in spontaneous abortion?
- T - Toxoplasmosis
O - Other (Listeria, mycoplasma hominis, ureaplasma urealyticum)
R - Rubella
C - Cytomegalovirus
H - not relevant to spontaneous abortion
- what are some endocrine factors that could result in spontaneous abortion? (3)
- 1. Luteal phase defect (decreased progesterone synthesis)
2. Thyroid disease
- paternal factors increasing risk of a spontaneous abortion? (2)
- 1. chromosomal abnormalities
2. advanced age of sperm
- which two things, if they happen in the first trimester of pregnancy, result in an inevitable abortion?
- 1. rupture of membranes
2. cervical dilation
- what is the treatment for an incomplete abortion?
- suction and curettage
- what is a septic abortion?
- complications of an incomplete abortion. manifests as sepsis, shock, hemorrhage, renal failure
- what is the term for inflammation of the umbilical cord?
- when villitis is present and you see granulomas under the scope, what is the most likely causative organism?
- what is velamentous insertion of the umbilical cord?
- trapping of the cord within the membranes
- what placenta accreta?
- when a defective decidual layer allows the placenta to attach directly to the myometrium. (results in hemorrhage after delivery)
- what is placenta increta?
- when the placenta penetrates the myometrium
- what is placenta percreta?
- when the placenta invades the myometrium and attaches to the peritoneal surface
(may result in rupture of the uterus)
- what is placenta previa?
- when the placenta implants in the lower uterine segment. this may occlude the cervical os.
(causes premature labor, bleeding as the cervix dilates)
- what is abruptio placenta?
- premature separation of the normally implanted placenta from the uterine wall
(results in fetal anoxia and maternal hemorrhage)
- what constitutes HTN in pregnancy?
- systolic >140 mmHg
diastolic > 90 mmHg
- terms for pregnancy induced hypertension?
- 3 clinical s/s of pre-eclampsia?
- 1. HTN
- when is pre-eclampsia more common?
- 1. primigravida
2. extreme ends of reproductive years
- what makes pre-eclampsia eclampsia?
- presence of convulsions
- What does the HELLP syndrome consist of?
- H - Hemolysis
E - Elevated Liver enzymes
L - Low Platelets
- describe the levels of the following in pre-eclampsia/eclampsia:
1. renin/angiotensin II
- 1. increased
- result of pre-eclampsia/eclampsia on fetus?
- "vasospastic changes"
- placenta becomes ischemic
- fetal hypoxia
- results of pre-eclampsia/eclampsia on mother?
- *arterial hypertension leads to:
- endothelial injury
- multi-system failure
- describe gestational trophoblastic disease (GTD)
- abnormal proliferation and maturation of trophoblastic tissue
- MC manifestation of gestational trophoblastic disease?
- hydatidiform mole
- why are we worried about gestational trophoblastic disease (possible complication)?
- malignant transformation
- Why does GTD present clinically as a pregnancy?
- elevated hCG
- what is the major difference between a complete and an incomplete hydatidiform mole?
- complete - no fetus or fetal membranes associated with it
incomplete - presence of a chromosomally abnormal embryo or fetus
- what "invades" what in an invasive hydatidiform mole?
- villious trophoblast invades underlying myometrium
(can spread to distant sites)
- gross appearance of a hydatidiform mole?
- "cluster of grapes"
- possible complication of hydatidiform mole?
- progression to choriocarcinoma
(malignant tumor derived from trophoblast)
~1/140 molar pregnancies
- via what route does choriocarcinoma spread?
- invades the venous sinuses, then metastasizes to the:
lungs, brain, liver, vagina, GI tract
- what laboratory value can be used to follow progression/remission of a choriocarcinoma?
- hCG levels
(tumor produces hCG)
- treatment for a choriocarcinoma?
- aggressive tumor: treat with chemotherapy, hysterectomy, radiation
- what exactly produces hGC?
- syncitiotrophoblasts of the growing placenta
- what is the most common congenital infection in the US?
- what type of virus is CMV?
- describe the genome of CMV
- where does CMV establish a latent infection?
- in lymphocytes and epithelial cells
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