11 - Female Reproductive System, Breast and Skin

Question 1

Three examples of developmental abnormalities of female reproductive system?

Answer 1

1. agenesis of vagina
2. agenesis of uterus
3. abnormality of uterus

Question 2

Define the difference btwn true hermaphroditism, male and female pseudohermaphroditism

Answer 2

True: person has both male and female gonads (hormone makers)
Male pseudo: genotypically male, phenotypically female
Female pseudo: genotypically female, phenotypically male

Question 3

What are the 2 pathogenic and 5 anatomic classifications

Answer 3

Pathogenic:
1. descending infections (TB, hematogenouos)
2. Ascending infection (STI)

Anatomic classification:
1. salpingitis: fallopian tube
2. endometritis: endometrium
3. cervicitis: cervix
4. vaginitis: vagina
5. vulvitis: vulva

Question 4

What are the main characteristics of diseases caused by genital herpes (3)? Why is it important?

Answer 4

• majority are asymptomatic
• vesicle rupture can lead to ulcerations
• no cure, virus remains dormant in neural ganglion

Important because don’t want vaginal delivery if active lesions

Question 5

What are the main characteristics of diseases caused by HPV (3)?

Answer 5

• labial, vaginal, and cervical warts (condyloma)
• certain types associated with carcinoma
• condyloma acuminatum: anogenital warts, usually caused by HPV 6,11 and transmitted through skin contact

Question 6

Describe bacteria and diseases caused by chlamydia, gonorrhea, and syphilis

Answer 6

Chlamydia:
- chlamydia trachomatis
- causes urethritis, cervicitis with discharge, and PID

Gonorrhea:
- neisseria gonorrheae
- causes urethritis, cervicitis with discharge, and PID

Syphilis:
- treponema pallidum
- causes vulvar ulcers

Question 7

Characteristics of PID? What are 3 other diseases it can cause and 3 complications?

Answer 7

• infection of reproductive tract, usually secondary to an ascending infection of STI

Causes: salpingitis, tubo-ovarian abscess, peritonitis

Complications: infertility, ectopic pregnancy, spread of infection

Question 8

What are the three main infectious and non-infectious causes of vaginitis

Answer 8

Infectious:
1. bacterial vaginosis (bacteria, not STI)
2. candidiasis (fungus, not STI)
3. Trichomonas (trichomonas vaginalis, STI)

Non-infectious:
1. atrophic vaginitis
2. foreign body
3. allergen or irritant

Question 9

What is endometriosis characterized by (2)? Pathogenesis? What’s a specific example

Answer 9

Characterized by:
- when endometrial tissue, which is normally lines the inside of the uterus, is found on the outside of the uterus
- benign condition that may cause pain and infertility

Pathogenesis:
- retrograde menstrual flow theory
- traumatic implantation
- embryonic rests (part of embryonic tissue remains after embryonic development period)

Example: **Ovarian endometriosis **-> ovarian cyst

Question 10

What is endometrial hyperplasia?

Answer 10

thickening of endometrial mucosa due to hormonal imbalances

Question 11

What are the 5 main steps of the anovulatory cycle? What are the functional and organic causes? What disease is this cycle relevant to?

Answer 11

1. no ovulation
2. no progesterone secretion
3. unopposed estrogenic stimulation
4. proliferation
5. endometrial hyperplasia

Functional: puberty, anorexia, anxiety, nervosa, bulima, athletes
Organic: excess estrogen

Endometrial Hyperplasia

Question 12

Describe characteristics of vulva (4) carcinoma and vaginal carcinoma (2)

Answer 12

Vulva
- squamous cell carcinoma
- raised wart-like or ulcerated regions
- may result in leukoplakia or erythroplakia
- biopsy to assess, surgical excision w/ or w/o adjuvant therapy to treat

Vagina
- squamous cell carcinoma
- clear cell carcinoma due to women born to mothers on DES during pregnancy

Question 13

What are 4 characteristics of carcinoma of cervix?

Answer 13

1. cause is unknown
2. most commonly squamous cell carcinoma
3. occurs at transition zone of exocervic and endocervix
4. cells may shed into vagina (hence pap test)

Question 14

What are 2 risk factors of carcinoma of cervix?

Answer 14

1. sexual intercourse at young age/multiple partners/HPV infections type 16 and 18
2. Environmental factors (tobacco)

Question 15

What type of neoplasm is cervical intra-epithelial neoplasia (CIN) associated with? What does CIN I, II, III mean in terms of severity?

Answer 15

Carcinoma of cervix

CIN I = mild
CIN II = moderate
CIN III = severe

Question 16

Describe leiomyoma (3) and leiomyeosarcoma (2)

Answer 16

Leiomyoma:
- benign neoplasm of uterus derived from smooth muscle of uterus wall
- response to estrogen, usually asymptomatic
- may produce symptoms due to bleeding

Leiomyosarcoma:
- malignant neoplasm derived from smooth muscle in uterus wall
- very rare

Question 17

What is endometrial adenocarcinoma? What is a risk factor? Diagnosis and treatment?

Answer 17

Malignant neoplasm derived from epithelial cells in endometrium

Risk factors are related to increased estrogen

Diagnosis: endometrial biopsy, dilation, curettage

Treatment: hysterectomy (surgical removal of uterus) with or without adjuvant therapy

Question 18

Name an example of a disease with ovarian cysts and state 4 characteristics

Answer 18

Polycystic ovary syndrome
1. multiple cysts in both ovaries
2. presents with menstrual irregularities
3. patients don’t ovulate
4. cause of infertility

Question 19

What are the three major ovarian neoplasm groups? Pathogenesis (3)?

Answer 19

Three Major Groups:
1. surface epithelial tumors
2. Germ cell tumors
3. Sex Cord stromal tumors

Pathogenesis
1. after ovulation, ovarian surface epithelium ruptures
2. heals by proliferation
3. proliferative surface epithelial cells have increased risk of transformation

Question 20

What are the three main surface epithelial tumors? Describe their characteristics and whether they’re generally benign or malignant

Answer 20

Serous epithelial tumors
- typically cystic and filled with clear fluid
- 30% benign 60% malignant

Mucinous epithelial tumors
- typically cystic and filled with vicsous fluid
- more likely to be benign compared to serous

Endometriod epithelial tumors
- typically solid
- usually malignant

Question 21

Characteristics of teratoma (4)?

Answer 21

• aka dermoid cyst, often cystic and contains hair + sebaceous material
• may contain teeth and bone cartilage
• benign but should be resected to avoid malignant transformation
• immature teratomas contain immature neural tissue and may behave malignantly

Question 22

What disease is a risk of excess estrogen

Answer 22

Endometrial carcinoma

Question 23

Where do ovarian sex cord neoplasms originate from? What are the 4 types?

Answer 23

Originates from ovarian stromal cells

1. Fibroma: benign neoplasm of fibroblasts
2. thecoma: benign neoplasm of theca cells, can produce estrogen
3. Granulosa cell tumor: benign or malignant neoplasm of granulosa cell, can produce estrogen
4. Sertoli-leydig cell tumor: secretes androgens -> virilization

Question 24

What are 4 factors leading to infertile pregancies?

Answer 24

Ovum related:
- immature ovum, incomplete meiotic division

Sperm related:
- azospermia (no sperm)
- oligospermia (low sperm)
- immotile sperm

Genital organ factors:
- PID
- Asherman’s syndrome: scar tissue in uterus or cervix

Systemic Factors:
- immune mechanisms

Question 25

Describe ectopic pregnancy and why it's dangerous (3)?

Answer 25

- implantation of fertilzied ovum outside of uterine cavity, usually in the fallopian tube - adhesions prevent normal passage of zygote so it implants and penetrates in the fallopian tube - may erode through wall and rupture, leading to massive blood loss

Question 26

Difference btwn placenta accreta and previa?

Answer 26

**Accreta**: - abnormally deep peneration of placental villi into uterus wall - risk of retaining placenta after delivery and post-partum hemorrhage **Previa**: - abnormal placental implantation site in lower uterine segment - prone to bleeding and risk of premature delivery

Question 27

What is the difference btwn complete, incomplete, missed, threatened, and inevitable abortion?

Answer 27

**Complete**: fetus and placenta expelled, normal function **Incomplete**: retention of some fetal and placental material **Missed**: death of fetus in uterus, expelled weaks later **Threatened**: cervix closed, spotting blood, fetus still in uterus **Inevitable**: cervix is dilated, but products of conception not expeleld

Question 28

What are gestational trophoblastic diseases? What are the two cell types? Name a benign and malignant GTD.

Answer 28

Group of abnormalities of placentation resulting in tumor-like changes or malignant transformation Cytotrophoblasts and synctiotrophoblasts which proliferate in GTD **Benign**: hydatid mole **Malignant**: choriocarcinoma

Question 29

What are some characteristics of hydatid form moles? Difference btwn complete and incomplete moles?

Answer 29

- trophoblastic proliferation, degeneration of chorionic villi - features enlarged uterus with no fetal movement, looks like cluster of grapes on ultrasound **Complete mole**: - more common, no fetus (empty ovum), abnormal fertilization (all chromosomes from one parent, but normal amount) **Incomplete mole**: - some fetal parts in ovum, abnormal fertilization (abnormal number of chromosomes)

Question 30

Characteristics of choriocarcinoma?

Answer 30

rare highly malignant tumor of gestational trophoblasts, arises from pre-existing complete mole

Question 31

What is the difference btwn preeclampsia and eclampsia? What disease do they describe?

Answer 31

**Preeclampsia**: - triad: HTN, edema, proteinuria - typically occurs in third trimester - can lead to eclampsia **Eclampsia**: - triad + seizure, life threatning to both mother and baby - requires treatment of seizure before delivering baby **Toxemia of pregnancy**

Question 32

What is mastitis? Difference btwn acute and chronic mastitis?

Answer 32

Mastitis = inflammation of breast **Acute**: - warm, red, edema, painful - bacterial infection through milk ducts and breastfeeding - may develop abscess **Chronic**: mimics breast cancer, requires biopsy

Question 33

Describe fibrocystic change. What are some clinical features? Pathological findings?

Answer 33

Benign change in bobs due to hormones and age **Clinical findings**: pain, nodularity, sensitivity on palpation **Pathological findings**: - *fibrosis* on intralobular stroma - *cystic dilation* of epithelial ducts - epithelial *hyperplasia*

Question 34

Describe gynecomastia

Answer 34

Increased proliferation of excretory ducts and stroma, leading to enlarged man breasts, usually due to hormonal changes

Question 35

Name a benign breast neoplasm and what causes it to occur

Answer 35

Fibroadenema - Proliferation of stromal elements (fibro) and epithelial elements (adenoma) - Believed to be abnormal exaggerated response of breast to hormones (puberty, pregnancy)

Question 36

Name a malignant breast neoplasm and what causes it to occur

Answer 36

**Breast cancer, most common type is ductal carcinoma** - hormonal, environmental, and genetic influences (e.g. familial breast cancers = mutation in BRCA-1 and BRCA-2 tumor suppressor genes)

Question 37

What are some non-modifiable and modifiable risk factors of breast cancer?

Answer 37

**Non-modifiable**: - age, race, female sex - genetic predisposition, personal history - hormones - dense breasts **Modifiable**: - alcohol intake - smoking - maintaining healthy body weight - breastfeeding - hormone replacement therapy - radiation exposure (unnecessary)

Question 38

Describe the three types of external skin injuries

Answer 38

**Mechanical**: - blunt force - sharp force **Electrical**: - inadequately isolated electrical wiring/lightening - can cause burns - can interfere with heart conduction **Radiation injury** - non-ionizing (UV) - ionizing

Question 39

Describe the 4 degrees of burn

Answer 39

**First degree**: epidermis only, erythema, swelling, pain **Second degree**: involves dermis, superficial or deep partial thickness, blisters/pain **Third degree**: full thickness dermis, charred and black, no pain **Fourth degree**: underlying soft tissue, muscle and bone

Question 40

Describe eczema and urticaria

Answer 40

**Eczema** - chronic inflammatory disorder characterized by red, dry, scaly. itchy skin - type I HSR - often associated with asthma and allergic rhinitis **Urticaria (hives, welts, wheals)** - acute, transient, intensely itchy red raised plaques - mast cell degranulation - allerigic triggers (meds, food, bite) and non-allergic triggers (infections, cold temperature)

Question 41

What is seborrheic dermatitis

Answer 41

- chronic relapsing mild dermatitis - infants -> cradle cap - severity varies

Question 42

What is psoriasis

Answer 42

Papules and patches covered by scale extensor surfaces (elbows, knees)

Question 43

What are the 4 types of skin neoplasms?

Answer 43

1. **epithelial** (basal cell carcinoma, squamous cell carcinoma) 2. **melanocytic** (nevus/mole, melanoma) 3. **dermal connective tissue** 4. **metastasis**

Question 44

Describe basal and squamous cell carcinoma

Answer 44

**Basal**: - good prognosis, doesn't metastasize - nodule with red thread-like veins **Squamous**: - good prognosis, <2% metastasize - firm, scaly nodules

Question 45

Describe nevus and melanoma

Answer 45

**Nevus**: benign neoplasm of melanocyte **Melanoma**: malignant neoplasm of melanocyte - refer to the ABC's: - Asymmetry - Border irregularity - Colour irregularity - Diameter > 6 mm - Evolution (shape, colour, size, etc.)