Female Reproduction Flashcards
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
molar pregnancy
complete mole, no, 46XX
partial
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 __________)
CA-125
Beta hCG, AFP
Estrogen, Androgens
prostaglandin E1 agonist =
progesterone and glucocorticoid antagonist
folic acid antagonist
all used for pregnancy ______
misoprostol
mifepristone
methotrexate
termination 1st tri
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)
SERM
osteoporosis
endometrial hyperplasia and carcinoma
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 _______
15-28
Proliferative
functionale
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 _______
LH surge
_______ 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
Progesterone
apoptosis
small, underdeveloped ovaries composed primarily of connective tissue with no follicles =
additional findings include coarctation of the aorta, horseshoe kidney, _______ valve
Turner syndrome
bicuspid aortic
menopause occurs on average at age 51 and is diagnosable retrospectively after 12 months of amenorrhea. An elevated serum _____ confirms diagnosis
FSH
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 ______________
16, 18
lack of barrier protection
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
PCOS
ovaries
Estrogen receptor modulator
oral contraceptives, multiparity, and breastfeeding are ________ against epithelial ovarian cancer by decreasing the frequency of ovulation
protective
E6 and E7 of HPV inhibit p53 and Rb respectively, which are _______ proteins
cell cylce regulatory
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 =
imperforate hymen
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
Koilocyte
HPV, ds
adnexal mass with hair follicles, sebaceous glands, skin, teeth =
mature teratoma (cell lines of more than 1 germ layer)
short, high arched palate, broad chest, widely spaced nipples, primary amenorrhea =
will show ________
due to
Turner syndrome
atrophic ovaries
meiotic nondysjunction (45X)
purulent discharge, friable cervix, spotting, sexually active, + NAT =
treatment =
can result in PID which can cause ______ due to scarring of fallopian tubes
Gonococcal cervicitis
3rd gen cephalosporin + azithromycin or doxycycline
infertility
candida vaginitis will exhibit __________ due to antibiotic suppression but a normal vaginal pH
decreased numbers of G+ bacteria
_____ 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
Gap Junctions
vaginal burning, itching, urinary discomfort, green frothy vaginal discharge =
best diagnosed by
Trichomonas vaginalis
Saline microscopy (wet mount)
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
infertility
suppresses
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
gonadotropin secretion == inhibits ovulation
thicken cervical mucus to impair sperm penetration
cytotoxic inflammatory
_________ is the most common cause of bloody nipple discharge and typically presents without breast masses or skin changes. This lesion has a fibrovascular core
intraductal papilloma
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
suspensory ligaments
postpartum hemorrhage is an emergency. bilateral ligation of the _____ can decrease uterine blood flow and control the hemorrhage that is unresponsibe to medical management
internal iliac artery
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
Theca interna
granulosa cells
theca externa cells
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
suspensory ligament of the ovary
ligated
incomplete ______ of the paramesonephric ducts results in a bicornuate uterus characterized by an indentation in the center of the fundus
lateral fusion
heavy and painful menstrual bleeding witha uniformly enlarged uterus =
characterized as ___________
adenomyosis
benign myometrial smooth muslce cell proliferation
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
pudendal
______ using a donated ovum is the most promising means of achieving pregnancy in a woman with Turner Syndrome
In vitro fertilization
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
leiomyomas (fibroids)
stress urinary incontinence is defined as involuntary urine loss with increased IAP. Kegel exercises target the ______ to improve support around the urethra and bladder
levator ani
_______ 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 _________.
Endometriosis
retroverted uterus
painful intercourse
grayish white vaginal discharge with fishy odor =
anaerobic gram ____ rod
____cells on wet mount
Gardnerella vaginalis
variable
clue
fever, abdominal pain, uterine tenderness, foul smelling discharge after pregnancy termination =
common offending pathogens are ______ and E coli
Septic abortion
S aureus
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 =
Mullerian aplasia
Androgen insensitivity syndrome
Kallmann
Klinefelter
47XXX
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
ureter
patients receiving __________ for Trichomonas vaginitis can develop disulfiram like reaction (face flushing, HA, nausea, vomit, abdominal cramps) shortly after alcohol consumption due to _________ accumulation
metronidazole
acetaldehyde
______ 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
PID
inadequate
pregnant, abdominal pain, vaginal bleeding, hemodynamic instability, previous STI =
due to
ruptured ectopic pregnancy
PID
_______ 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.
Granulosa cell
hyperplasia
_______ 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
Sertoli Leydig
______ 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
Fibroadenomas
lymphedema bilateral and cystic hygromas (posterior neck mass in this patient) in a neonate is indicative of
Turner syndrome
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
perineal body
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
Krukenberg tumor
metastasized
signet ring cells
mucin
_____ is common in the first several years after menarche and the last few years before menopause. It manifests with marked menstrual cycle ________
Anovulation
variability (spotting, spotting, heavy bleeding)
________ increases the most after ovulation due to secretion from the corpus luteum
progesterone
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
thrombosis
IVC
fever and painful vesicular genital rash =
infects the ___________
HSV2
____________ results in a mixture of normal and mutated somatic cells (some X, some XX), often leading to a milder form of disease
Somatic mosaicism
high grade CIN is characterized by expansion of ___________
immature basal cells to the epithelial surface
The____ is covered by simple cuboidal epithelium involved in surface repair or defects from ovulation
ovary
PCOS patients are at risk for endometrial
hyperplasia/carcinoma
HIV coinfection allows _____ to persist and enhances expression of oncogenes, increasing risk for cervical dysplasia/cancer
HPV
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
torsion
infundibulopelvic
