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598
A casecontrol study
is used to
compare the
exposure of
people with the

disease (cases)
to theexposure
of people
without the
disease
(control). The
measure of
association is
the

exposure
oddratio.
(what
happened?)
Add ration =
odds of
exposure of
people with
disease

(case)Odds of
exposure of
people without
disease
(control)
A crosssectional
study

is used to
compare the
prevalence of a
disease in
different
populationsThe
measure of
association is
the

Prevalence
odd ratio.
(What is
happening?)
Prevalence odd
ratio = total
cases in
population at
a given

timeTotal
population at
risk at a given
time
Cohort study
= (what will
happen?)
Relative Risk
(RR)

Relative Risk =
[a/(a+b)] / [c/
(c+d)]
Anovulation
is common
during the
first
five to seven
years after

menarche and
the
last
ten
yearsbefore
menopause,
and manifests
with

marked
menstrual
cycle
variability
. Therefore, this
adulsents
irregular and
her menses
last seven to

ten days,
is strongly
suggestive of
absence
ovulation.
Granulosa cell
tumors
are estrogensecreting

primary ovarian
tumors. The
hyperestroge
nemic
state that
results can
cause
endometrial
hyperplasia

and abnormal
uterine
bleeding. It
alsopredisposes
to
endometrial
adenocarcino
ma.

SteinLeventhal
Syndrome
= Polycystic
ovarian
syndrome
(PCOS,
unknown
reasons)PCOS

is clinically
characterized
by obesity,
hyperandrogeni
sm,
oligomenorrhea
, infertility, and
enlarge
ovaries with

multiple
cysts.
Theca cell
hyperplasia can
result in excess
androgen
production and
symptoms
ofhyperandroge

nism such as
acne,
hirsutism,
male pattern
balding, and
other forms of
virilzation.Obes
ity, insulin
resistance,

and dyslipidemi
a are also
common
features of
PCOS, which
result
in anincreased
risk of diabetes
and cardiovasc

ular
disease.Patient
with PCOS are
commonly
treated with
weight loss
regimens and
oral contracepti
ves.However,

medication is
used for women
who desire to
be pregnant.
Clomiphene i
sa
selectiveestrog
en receptor
modulator that

prevents
negative
feedback
inhibitor
on the
hypothalamus
by circulating
estrogen, which

results
in increased
gonadotropin
production
(e.g. FSH and
LH) andovulatio
n.
599

Ductal
carcinoma in
situ
(DCIS, known
as
comedocarcin
oma
) is
a precancerous

breast
lesioncharacteri
zed by a usual
single lesion
and malignant
clonal cell
proliferation
contained by
the

surrounding
ductal
basement
membrane.
Paget disease

superficial
DCIS into
nipple skin

without having
cross base
membraneMed
ullary
carcinoma

significant
lymphoplasmac
ytic

infiltratePhyillo
des tumor

similar to
fibroadenomas
(leaflike)When
an injury
occurs, local
neutrophils and

macrophages
release TNF-a,
IL-1, and IL-6
intocirculation.
The three
cytokines
IL-1, IL-6,
and INF-a

mediate
system
inflammatory
response
andstimulate
hepatic
secretion of
acute-phase
proteins (eg

fibrinogen).Hig
h levels of
circulating
fibrinogen
(RBC falling
rate) increase
the erythrocyte
sedimentation
rate(ESR),

which is a nonspecific marker

of
inflammation
.
Bradykinin

is vasodilation
and mediates

painLeukotrien
e B4

metabolite of
arachidonic
acidStimulate
neutrophil
migration
to the site

of inflammation
The gray
discharge
with potassium
hydroxide
(KOH, whiff
test)
produce
a fishy odor

ischaracteristic
of
Gardnerella
vaginalis
(bacterial
vaginosis).
The presence
of
clue cells

on wetmount
microscopy of
the discharge is
also
characteristic.
Trichomonas
- is a
flagellated
protozoan that

causes
vaginitis.Develo
p a yellowgreen foamy,
foul-smelling
discharge
Motile
trophozoites
with flagellae

are seen on
wet
mount microsc
opy
Klinefelter
syndrome
(long body
parts,
gynecomastia

is common)
characterized
by a
karyotypewith
two or more Xchromosome (
47, XXY
is present in
82% of all

cases). The
testis in
thesepatients
reveals some
or all of the
testicular
tubules to be
completely
atrophied and

replaced
bypink,
hyalinized
tissue. This
increased
plasma folliclestimulating
hormone
(FSH) reflects

gonadalfailure
(hypogonadism
) in patients
with klinefelter
syndrome. The
estrogen :
testoterone
ratiodetermines
the extent of

feminization.Pr
olactinomas are
the most
common
pituitary
adenomas
in adult.
The excess
prolactin

producedby
these tumors
can cause
galactorrhea
(white nipple
discharge) and
amenorrhea.
Visual
changesmay

also occur due

to compression
of the optic
chiasm.Fibrocy
stic breast
disease

the breasts to
feel dense and

lumpy in a
waxingIntraduc
tal papilloma

spontaneous
bloody
nipple discharg
eLobular breast
carcinoma


asymptomatic
breast lump
Recall bias
occurs when
people with
adverse events
are more likely
to recall

risk factors
than
600those
without
adverse events.
Pre-eclampsia
is the triad of
hypertension,

proteinuria and
edema
in pregnancy
. Preeclampsiaoccur
s as a
complication in
< 10% of
pregnancies,

with onset
typically after
the 20
th

week
ofgestation. Its
cause is
unknown,
but poor

placental
perfusion is
thought to
contribute.
Release
ofinflammatory
factors from
the hypoxic
placenta causes

endothelial
injury leading
to sings of
thisdisease. It
may also
progress to
HELLP
syndrome

(Hemolytic
anemia,
Elevated Liver
enzymes,
andLow
Platelets)
A

uniformly
enlarged
uterus

with normal
appearing
endometrial
tissue within

the
myometriumind
icates a
diagnosis of
adenomyosis
. Menorrhagia
and
dysmenorrheal
are common

presentingsynd
rome.In
general, the
lymph
drainage
from a
particular
organ follows
the path of the

arterial supply
tothat site.
During fetal
development,
the testes
originate within
the

retroperitone
um

andestablish
their arterial
supply from the
abdominal
aorta. The

testes
subsequently
descend
throughthe
inguinal canals
into the
scrotum, taking
with them their
arterial, venous

and
lymphaticsuppli
es. Thus,
lymph from the
testes drains
through lymph
channels
directly back
to

theretroperito
neal lymph
nodes.Estroge
n
(fetal adrenal
gland) and
progesterone
(placenta)
serve as the

principle
mediator
ofmaternal
breast growth
and
development
during the
prenatal
period, with

prolactin a
secondarycontri
butor.
Prolactin
is prevented
by the high
gestational
levels of
estrogen and

progesteronefr
om
accomplishing
its primary
function,
which is
lactogenesis.
Once the
estrogen

andprogesteron
e levels drop
precipitously
after placental
separation and
expulsion,
however,
theprolactin

stimulates milk
production.

Reproductive
System1. A
pudendal
nerve
(drived from

the S2-S4)
block can be
performed
by
injectingane
sthetic
intravaginall

y in the
region of the
ischial
spine. Blocki
ng the
pudentalnerv
e provides

anesthesia
to the
majority
of perineum;
additional
blockage of
thegenitofe

moral and
ilioinguinal n
erves would
provide
complete
perineal and
genital

anesthesia.T
his nerve
is also
innervates to
the sphincter
urethrrae

and the
external anal