Female Reproduction

Question 1

patient with many previous first trimester losses, uterus that is larger than expected for gestation age, >100,000 Beta hCG, multiple small cysts uterine =

______has ____ fetal structures and typically only has paternal DNA resulting in dipliod ________ DNA due to fertilized empty ovum by single sperm

_____ molar pregnancies have 69 XXX or 69XXY and contains fetal tissue and normal placenta villi intermixed with hydropic villi. results from fertilization of ovum by 2 sperm

Answer 1

molar pregnancy

complete mole, no, 46XX

partial

Question 2

ovarian cancer has three histologic types: Epithelial germ cell, and sex cord stroma

Epithelial: Serous (bilateral, psammoma bodies) or Mucinous (pseudomyxoma peritonei, mucin cells) cystadenocarcinomas associated with increased levels of _________. Risk factors include age, nulliparity

Germ cell: dysgerminoma (fried egg cells, adolescents, increased ______ and LDH levels) or Endodermal sinus yolk sac (increased ______, aggressive, schiller duval bodies resemble glomeruli)

Sex cord Stroma: granulosa (increased ______, inhibin, call Exner bodies, coffee bean nuclei) or sertoli-leydig (increased __________)

Answer 2

CA-125

Beta hCG, AFP

Estrogen, Androgens

Question 3

prostaglandin E1 agonist =

progesterone and glucocorticoid antagonist

folic acid antagonist

all used for pregnancy ______

Answer 3

misoprostol

mifepristone

methotrexate

termination 1st tri

Question 4

tamoxife and raloxifene are ______ that competitively inhibit estrogen binding with mixed agonist/antagonist action and are indicated in the prevention of breast cancer in high risk patients. Tamoxifen is an adjuvant treatment of breast cancer, while raloxifene is used for postmenopausal __________. Adverse effects include hot flashes, VTE, and ___________ (tamoxifen only)

Answer 4

SERM

osteoporosis

endometrial hyperplasia and carcinoma

Question 5

the secretory phase of the menstrual cycle occurs from days _______. Progesterone from the corpus luteum causes the uterine glands to coil and secrete glycogen rich mucus. The stroma is completely traversed by tortuous spiral arteries that extend from the deep layers of the uterine lumen. THe ________ is the first half of the cycle, during this time estrogen stimulates the proliferation of the stratum _______

Answer 5

15-28

Proliferative

functionale

Question 6

anovulation is a common infertility cause. Menotropin is a treatment that acts like FSH and triggers the formationation of a dominant ovarian follicle. Ovulation is then induced by administration of hCG, which mimics the _______

Answer 6

LH surge

Question 7

_______ is the primary hormone responsible for stimulating the endometrium so that it is suitable for implantation. Withdrawal causes endometrial cells to undergo ________, resulting in menstrual bleeding

Answer 7

Progesterone

apoptosis

Question 8

small, underdeveloped ovaries composed primarily of connective tissue with no follicles =

additional findings include coarctation of the aorta, horseshoe kidney, _______ valve

Answer 8

Turner syndrome

bicuspid aortic

Question 9

menopause occurs on average at age 51 and is diagnosable retrospectively after 12 months of amenorrhea. An elevated serum _____ confirms diagnosis

Answer 9

FSH

Question 10

HPV strains __ and ___ cause cervical, vaginal, vulvar and anal neoplasia and lead to overexpression of oncogenes E6 and E7. CIN precedes SCC. The most significant risk factor for CIN is a history of multiple sexual partners and a ______________

Answer 10

16, 18

lack of barrier protection

Question 11

hirsutism, acne, ovarian dysfunction, insulin resistance, obesity =

exhibits enlarged ____
treat with weight loss, combination hormonal contraceptives, and metformin

patients who desire fertility can be treated with Clomiphene, which is an __________ that increases gonadotropic production

Answer 11

PCOS

ovaries

Estrogen receptor modulator

Question 12

oral contraceptives, multiparity, and breastfeeding are ________ against epithelial ovarian cancer by decreasing the frequency of ovulation

Answer 12

protective

Question 13

E6 and E7 of HPV inhibit p53 and Rb respectively, which are _______ proteins

Answer 13

cell cylce regulatory

Question 14

teenage, non sexually active female with normal secondary sex characteristics, primary amenorrhea with cyclic abdominal or pelvic pain and a vaginal bulge or mass palpated anterior to the rectum =

Answer 14

imperforate hymen

Question 15

a ______ is an immature squamous cell with dense, irregularly staining cytoplasm and perinuclear clearing, resulting in a halo. It has an enlarged pyknotic nucleus where the chromatin has condensed, giving it a raisinoid appearance

typical of ______, which is a _____ DNA non enveloped virus

Answer 15

Koilocyte

HPV, ds

Question 16

adnexal mass with hair follicles, sebaceous glands, skin, teeth =

Answer 16

mature teratoma (cell lines of more than 1 germ layer)

Question 17

short, high arched palate, broad chest, widely spaced nipples, primary amenorrhea =

will show ________

due to

Answer 17

Turner syndrome

atrophic ovaries

meiotic nondysjunction (45X)

Question 18

purulent discharge, friable cervix, spotting, sexually active, + NAT =

treatment =

can result in PID which can cause ______ due to scarring of fallopian tubes

Answer 18

Gonococcal cervicitis

3rd gen cephalosporin + azithromycin or doxycycline

infertility

Question 19

candida vaginitis will exhibit __________ due to antibiotic suppression but a normal vaginal pH

Answer 19

decreased numbers of G+ bacteria

Question 20

_____ facilitate communication and coordiantion between cells in labor contractions. Connexins are proteins that assemble these and their density incrases in the uterus before delivery in response to rising Estrogen levels

Answer 20

Gap Junctions

Question 21

vaginal burning, itching, urinary discomfort, green frothy vaginal discharge =

best diagnosed by

Answer 21

Trichomonas vaginalis

Saline microscopy (wet mount)

Question 22

pulsatile administration of GnRH stimulates FSH and LH release and is useful in the treatment of _______. Constant infusion of GnRH or a long acting analog ___________ FSH and LH release and subsequently suppresses gonadal function

Answer 22

infertility

suppresses

Question 23

the primary mechanism of action of combined oral contraceptives is reduction of ____________.

primary MOA of progestin only pill or levonorgestrel IUD (Locally acting progestins) is __________

the primary MOA of copper IUD is to create a chronic ________ response in uterus to impair sperm migration

Answer 23

gonadotropin secretion == inhibits ovulation

thicken cervical mucus to impair sperm penetration

cytotoxic inflammatory

Question 24

_________ is the most common cause of bloody nipple discharge and typically presents without breast masses or skin changes. This lesion has a fibrovascular core

Answer 24

intraductal papilloma

Question 25

Invasive breast carcinoma typically presents as an irregularly shaped adherent breast mass, most commonly in the upper outer quadrant. Malignant infiltration of _______ of the breast causes dimpling of the overlying skin

Answer 25

suspensory ligaments

Question 26

postpartum hemorrhage is an emergency. bilateral ligation of the _____ can decrease uterine blood flow and control the hemorrhage that is unresponsibe to medical management

Answer 26

internal iliac artery

Question 27

LH stimulates the ____ of the ovarian follicle to produce androgens. Aromatase within the follicles ________ subsequently converts these androgens to estradiol under FSH stimulation. The ______ serve as connective tissue support structure for the follcile

Answer 27

Theca interna granulosa cells theca externa cells

Question 28

the _________ contains the ovarian artery, vein, lymph, and nerves. The ovarian artery is the major blood supply to the ovary and must be _____ during an oophorectomy to prevent heavy bleeding

Answer 28

suspensory ligament of the ovary ligated

Question 29

incomplete ______ of the paramesonephric ducts results in a bicornuate uterus characterized by an indentation in the center of the fundus

Answer 29

lateral fusion

Question 30

heavy and painful menstrual bleeding witha uniformly enlarged uterus = characterized as ___________

Answer 30

adenomyosis benign myometrial smooth muslce cell proliferation

Question 31

a _____ nerve block is performed by injecting an anesthetic intravaginally, medially to the ischial spine, through the sacrospinous ligament. This provide anesthesia to most of the perineum

Answer 31

pudendal

Question 32

______ using a donated ovum is the most promising means of achieving pregnancy in a woman with Turner Syndrome

Answer 32

In vitro fertilization

Question 33

posterior subserosal surface ________ cause irregular uterine enlargement and constipation in young women despite normal rectal tone. Patients can relieve this pressure by splinting to defecate

Answer 33

leiomyomas (fibroids)

Question 34

stress urinary incontinence is defined as involuntary urine loss with increased IAP. Kegel exercises target the ______ to improve support around the urethra and bladder

Answer 34

levator ani

Question 35

_______ or ectopic endometrium refers to the prescence of endometrial glands and stroma outside the uterus. It may be asymptomatic or present with dysmenorrhea, abdominal pain with menses, dyspareunia, and infertility. Implants and adhesions involving the uterosacral ligament can result in a fixed _________ . Infiltration of the posterior cul de sac can result in _________.

Answer 35

Endometriosis retroverted uterus painful intercourse

Question 36

grayish white vaginal discharge with fishy odor = anaerobic gram ____ rod ____cells on wet mount

Answer 36

Gardnerella vaginalis variable clue

Question 37

fever, abdominal pain, uterine tenderness, foul smelling discharge after pregnancy termination = common offending pathogens are ______ and E coli

Answer 37

Septic abortion S aureus

Question 38

patients with ________ have no upper vagina (short vagina) and variable uterine development. These patients are XX females with normal ovaries and secondary sexual characteristics patient with ____ are 46XY males who are phenotypically female, have minimal axillary or pubic hair, and have crytorchid testes and no uterus or ovaries primary amenorrhea, no secondary sexual characteristics, olfactory sensory defect = males with tall stature, poor secondary sex development, atrophic testes, infertility = females with normal development, tall stature, decreased IQ =

Answer 38

Mullerian aplasia Androgen insensitivity syndrome Kallmann Klinefelter 47XXX

Question 39

the ____ can be injured during hysterectomy due to its close proximity to the uterine structures. It passes inferior and lateral to the uterine artery at the level of the internal cervical os prior to entering the bladder

Answer 39

ureter

Question 40

patients receiving __________ for Trichomonas vaginitis can develop disulfiram like reaction (face flushing, HA, nausea, vomit, abdominal cramps) shortly after alcohol consumption due to _________ accumulation

Answer 40

metronidazole acetaldehyde

Question 41

______ is most frequently caused by N gonorrhoeae and C trachomatis. Severe disease or _________ treatment can result in fallopian tube scarring. Treatment must cover both organisms

Answer 41

PID inadequate

Question 42

pregnant, abdominal pain, vaginal bleeding, hemodynamic instability, previous STI = due to

Answer 42

ruptured ectopic pregnancy PID

Question 43

_______ tumors are sex cord stromal tumors of the ovary (yellow, gland like due to lipid content) that secrete estrogen and cause endometrial ______. Call Exner bodies (cells arranged in a microfollicular or rosette pattern) are seen.

Answer 43

Granulosa cell hyperplasia

Question 44

_______ cell tumors of the ovary arise from the sex cord stroma and secrete testosterone. Typical features include a large ovarian mass and signs of virilization. Tubular structures lined by round cells and surrounded by fibrous stroma are seen on pathology

Answer 44

Sertoli Leydig

Question 45

______ are the most common benign tumor of the breast. Characterized by cellular or myxoid stroma that encircles and sometimes compresses epithelium glandular and cystic spaces

Answer 45

Fibroadenomas

Question 46

lymphedema bilateral and cystic hygromas (posterior neck mass in this patient) in a neonate is indicative of

Answer 46

Turner syndrome

Question 47

the ______ is a fibromuscular tissue between the urogenital and anal triangle. A midline episiostomy is a vertical incision from the posterior vaginal opening to the perineal body. It transects the vaginal submucosal tissue but not the external anal sphincter or the rectal mucosa

Answer 47

perineal body

Question 48

unintentional weight loss, early satiety, gastric thickening on CT, lower abdominal pressure and adnexal masses = primarily a gastric cancer that has ______ to the ovaries. The cardinal feature is nests of __________ with large amounts of _____ displacing the nucleus

Answer 48

Krukenberg tumor metastasized signet ring cells mucin

Question 49

_____ is common in the first several years after menarche and the last few years before menopause. It manifests with marked menstrual cycle ________

Answer 49

Anovulation variability (spotting, spotting, heavy bleeding)

Question 50

________ increases the most after ovulation due to secretion from the corpus luteum

Answer 50

progesterone

Question 51

venous stasis and hypercoagulability from pregnancy in addition to endothelial damage from delivery can cause ovarian vein ________ in the peurperium. Symptoms include fever and localized abdominal or flank pain. Most of these are right sided and can extend to the ______, left sided will extend to the left renal vein

Answer 51

thrombosis IVC

Question 52

fever and painful vesicular genital rash = infects the ___________

Answer 52

HSV2

Question 53

____________ results in a mixture of normal and mutated somatic cells (some X, some XX), often leading to a milder form of disease

Answer 53

Somatic mosaicism

Question 54

high grade CIN is characterized by expansion of ___________

Answer 54

immature basal cells to the epithelial surface

Question 55

The____ is covered by simple cuboidal epithelium involved in surface repair or defects from ovulation

Answer 55

ovary

Question 56

PCOS patients are at risk for endometrial

Answer 56

hyperplasia/carcinoma

Question 57

HIV coinfection allows _____ to persist and enhances expression of oncogenes, increasing risk for cervical dysplasia/cancer

Answer 57

HPV

Question 58

Ovarian _____ typically involves twisting of the _________ often due to the weight of a large adnexal mass. The resulting occlusion of the blood and nerve supply to the ovary results in severe, acute pelvic pain and ovarian ischemia

Answer 58

torsion infundibulopelvic