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Repro > Female anatomy, physiology, and pathology > Flashcards

Female anatomy, physiology, and pathology Flashcards

1
Q

Which hypothalamic nucleus is involved in ovulation

A

GnRH comes from the arcuate nucleus

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2
Q

What are the layers of the endometrium? Which layers are shared during menstruation?

A

Bottom to top: stratum basalis -> stratum spongiosum -> stratum compactum. Spongiosum and compactum are shed during menstartion while basalis is left.

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3
Q

When does the basal body temperature increase occur in relation to ovulation

A

24 hours prior to ovulation as progesterone begins to increase

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4
Q

Which uterine pathology? excess unopposed estrogen is the main risk factor

A

Endometrial hyperplasia and endometrial carcinoma

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5
Q

Which uterine pathology? Menorrhagia with an enlarged uterus and no pelvic pain

A

Uterine leiomyoma

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6
Q

Which uterine pathology? Pelvic pain that is present only during mestruation

A

Endometriosis

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7
Q

Which uterine pathology? diagnosed by endo metrial biopsy in clinic

A

Endometrial hyperplasia and carcinoma

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8
Q

Which uterine pathology? definitive diagnose and treatment is by laproscopy

A

Endometriosis

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9
Q

Which uterine pathology? menstruating tissue within the myometrium

A

Adenomyosis

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10
Q

Which uterine pathology? malignant tumor of the uterine smooth muscle

A

Leiomyosarcoma

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11
Q

Which uterine pathology? most common gynecologic malignancy

A

endometrial carcinoma

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12
Q

Which ovarian tumor? produces AFP

A

Yolk sac tumor (endodermal sinus tumor)

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13
Q

Which ovarian tumor? Estrogen secreting -> percocious puberty

A

Granulosa thecal cell tumor

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14
Q

Which ovarian tumor? intraperitoneal accumulation of mucinous material

A

Mucinous cystadenocarcinoma

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15
Q

Which ovarian tumor? testosterone secreting -> virilization

A

Sertoli-Leydig tumor

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16
Q

Which ovarian tumor? Psammoma bodies

A

Serous cystadenocarcinoma

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17
Q

Which ovarian tumor? Multiple different tissue types

A

Mature teratoma

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18
Q

Which ovarian tumor? Lined with fallopian tube-like epithelium

A

Serous cystadenoma

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19
Q

Which ovarian tumor? Ovarian tumor + ascites + pleural effusions

A

Meig’s syndrome of ovarianfibroma

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20
Q

Call Exner bodies (follicles filled with eosinophilic material)

A

Granulosa theca cell tumor

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21
Q

Which ovarian tumor? resembles bladder epithelium

A

Brenner tumor

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22
Q

Which ovarian tumor? elevated hCG

A

Choriocarcinoma > dysgerminoma

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23
Q

An obese woman presents with amenorrhea and increased levels of serum testosterone -> what is the most likely diagnosis?

A

PCOS (polycystic ovarian syndrome)

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24
Q

A patent with polycystic ovarian disease is most at risk for developing which type of cancer?

A

Endometrial carcinoma

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25
Q

Why is progesterone used in combination with estrogen during estrogen replacement

A

reduces incidence of endometrial hyperplasia and endometrial carcinoma

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26
Q

Under what circumstances would you expect to see elevated leutinizing hormone?

A

Menopause (along with FSH), PCOS, in normal females just prior to ovulation (LH surge), androgen insensitivity syndrome (LH and FSH elevated)

27
Q

What are the risk factors for ovarian cancer?

A

Lack of ovulation is protective, so the more you ovulate the higher your risk. Protective = pregnancy, breast feeding, OCPs.

28
Q

What is the difference between placental previa, abruptio, and accretia?

A

Previa is when the placenta overlies the cervical os and causes PAINLESS vaginal bleeding. Necessitates a C-section. Abrubtio is when the placenta separates from the endometrium causing a hematoma. This is PAINFUL and usually bleeds. Associated with cocaine, tobacco, trauma and physical abuse. Life threatening to baby and mom (DIC). Accretia is where the placenta does not detach during delivery because it is abnormally attached to the myometrium. This requires a hysterectomy because it is the only way to get the placenta out.

29
Q

Pregnant woman with a previous C-section is at increased risk for what?

A

Scarring in the endometrium increases risk for placenta previa and accretia.

30
Q

A pregnant woman at 16 weeks gestation presents with an atypically large abdomen and hypertension -> what abnormality might be seen on blood test and what is the disorder?

A

Classic molar pregnancy (hydatidiform mole). You would have an excessively elevated beta hCG.

31
Q

What substance is present in high levels in cases of hydatidiform moles?

A

beta hCG (especially in complete hydatidiform moles)

32
Q

A 15 year old female patient of yours normally comes with her parents, but presents alone this time. She states that she is sexually active but that she knows she is not pregnant because she never menstruated. What would be the appropriate next step in managing this patient?

A

Normal menarchy is around 13 years of age. Assess delayed puberty based on other signs. Normal breast development? If she has developed breast and is been a couple years, may need to do a workup for delayed puberty. Need to be educated that she can get pregnant before her first period. May need to be offered birth control. May need to be educated about STDs. Lots of possible answers here.

33
Q

A 23 year old female who is on rifampin for TB prophylaxis and on birth control (estrogen) gets pregnant. Why?

A

Rifampin revs up P450 system. This increases the metabolism of the birth control pills and makes them less effective.

34
Q

What is the best option for birth control in a mentally retarded patient?

A

IM medroxyprogesterone.

35
Q

Most common breast tumor in women under 25

A

Fibroadenoma

36
Q

Most common breast mass in post menopausal women

A

Invasive ductal carcinoma

37
Q

Most common breast mass in premenopausal women

A

Fibrocystic disease

38
Q

Most common form of breast cancer

A

Invasive ductal carcinoma

39
Q

small mobile firm breast mass with sharp edges in a 24 year old woman

A

Fibroadenoma

40
Q

Histological leaflike projections

A

Phylloides tumor

41
Q

Signet ring cells

A

Lobular carcinoma in situ (and therefore also invasive lobular carcinoma)

42
Q

Loss of E-cadherin cell adhesion gene on chromosome 16

A

Invasive lobular carcinoma

43
Q

Always ER+ and PR+

A

Lobular carcinoma in situ

44
Q

Commonly presents with nipple discharge

A

Intraductal papilloma

45
Q

Eczematous patches on nipple

A

Paget’s disease of the nipple

46
Q

Multiple bilateral fluid-filled lesions with diffuse breast pain

A

Fibrocystic change

47
Q

Firm, fibrous mass in a 55 year old woman

A

Invasive ductal carcinoma

48
Q

A 58 year old post menopausal woman is on Tamoxifen -> what is she at increased risk of acquiring?

A

Endometrial carcinoma

49
Q

What is the two cell theory of estradiol production?

A

The theca cell is stimulated by LH and has desmolase (17 alpha hydroxylase) so it can make andrestenodione. Granulosa cell is stimulated by FSH and needs the andrestenodione from theca cells. It converts andrestenodione to estradiol (E2) via aromatase. (Each of these cell types lacks the enzyme of the other and therfor two cells are needed -> two cell theory).

50
Q

What are the target cells of LH?

A

Theca cells and Leydig cells

51
Q

What cells respond to FSH?

A

Granulosa cells and Sertoli cells

52
Q

Pros and cons or OCP use

A

Pros- reliable, low failure rate, decrease the risk of ovarian cancer, decrease risk of pregnancy and ectopic pregnancy, regulate menses, improve dysmenorrhea, improve acne
Cons- daily dosing unless you are going to use the ring or the patch. No STD prevent. Can elevate Trigs, cause nausea, hypertension, hypercoaguable state (incr risk for DVTs)

53
Q

Estrogen or progesterone? Production of thick mucous that inhibits entry of sperm into the uterus

A

Progesterone

54
Q

Estrogen or progesterone? induces LH surge

A

Estrogen

55
Q

Estrogen or progesterone? uterine smooth muscle relaxation

A

Progesterone

56
Q

Estrogen or progesterone? follicle growth

A

Estrogen

57
Q

Estrogen or progesterone? Maintenance of pregnancy

A

Progesterone

58
Q

Estrogen or progesterone? Hepatic synthesis of transport proteins

A

Estrogen

59
Q

Estrogen or progesterone? withdrawal leads to menstruation

A

Progesterone

60
Q

What drug would you give to prohibit prolactin secretion

A

Dopamine analog like bromocriptine

61
Q

When does beta hCG appear in the urine in pregnancy

A

In urine- 2 weeks post fertilization (= 4 weeks after last menstrual period = estimated gestational age of 4 weeks); in blood- 1 week post fertilization

62
Q

What hormonal changes are seen in menopause

A

Decreased estrogen causes increases in GnRH, FSH and LH (loss of negative feedback)

63
Q

What is the underlying cause of PCOS? What are the clinical manifestations? What is the treatment?

A

PCOS is caused by increased LH. -> amenorrhea, infertility, obesity, hirsutism, impaired glucose tolerance. OCPs, weight loss, metformin, clomiphene or leuprolide in pulsatile fashion in trying to get pregnant, spironolactone for hirsutism

64
Q

What are the risks for endometrial cancer? for ovarian cancer? for cervical cancer?

A

Endometrial- estrogen. -> PCOS, obesity, estrogen secreting tumors (granulosa theca cell tumor), HRT (especially when unopposed by progesterone), age, endometrial hyperplasia.

Ovarian- increased number or menstrual cycles (ovulation), late menopause, early menarche. Risk reducers -> oral contraceptives for longer time and earlier start time, being pregnant early in life, breast feeding.

Cervical- HPV 16/ 18/ 31/ 33. STDs, multiple sexual partners, HIV, not being vaccinated, smoking.

Repro (4 decks)

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