Female Reproductive

Question 1

Oogenesis

Answer 1

Oogonium (one 2N) -->
Primary oocyte (one 2N) arrested in prophase I until ovulation

OVULATION
Secondary oocyte (one 1N, one polar body) arrested in Metaphase II until fertilization

FERTILIZATION
Ovum (one 1N and one polar body)

Question 2

Draw Two cell theory of estradiol production

Answer 2

page 272

Pulsatile GnRH –> FSH and LH secretion

LH stimulates theca cells… Cholesterol converted by desmolase to androstenedione

Androstenedione crosses basement membrane, enters granulosa cell

Granulosa cell is stimulated by FSH
Aromatase converts androstenedione to estrone
Estrone –> estradiol

Question 3

Steps of female reproductive cycle

Answer 3

1. increased FSH
2. follicle maturation
3. increased estrogen
4. negative feedback –> positive feedback
5. LH surge triggers ovulation
6. Formation of corpus luteum
7. increases progesterone (and estrogen) –> negative feedback
8. decreased FSH and LH
9. Degeneration of corpus luteum
10. decreased progesterone and estrogen
11. Menstruation, decreased inhibition of FSH
12. increased FSH - starts over

Question 4

Draw reproductive cycle

Answer 4

page 273

Question 5

Pregnancy steps

Answer 5

Fertilization w/in 1 day of ovulation in ampulla of tube

Implantation 6 days after fertilization

Syncytiotrophoblasts secrete hCG

• corpus luteum maintained
• hCG has same alpha subunit as LH, FSH, TSH - acts like LH on follicle
• hCG in blood 1 week after fertilization, in urine 2 weeks after

Question 6

Location steps

Answer 6

alveoli –> lobule –> ducts

Suckling stimulates release of:
Prolactin - anterior pituitary –> milk production (secretion)
Oxytocin - posterior pituitary –> milk ejection - alveoli –> ducts

Estrogen and progesterone inhibit milk production

Question 7

Average age of menarche

Answer 7

just under 12.5 years

Question 8

Treatment of anovulatory cycles

Answer 8

OCPs

Question 9

Menorrhagia

Answer 9

heavy, prolonged periods

Question 10

Metrorrhagia

Answer 10

Frequent, irregular periods

Question 11

menometrohhagia

Answer 11

heavy, frequent, irregular periods

Question 12

Oligomenorrhea

Answer 12

more than 35 day cycle, infrequent periods

Question 13

polymenorrhea

Answer 13

less than 21 day cycles, frequent periods

Question 14

primary dysmenorrhea

Answer 14

no cause

tx: NSAIDs +/- hormone contraceptives

Question 15

Progestins

Answer 15

birth control
abnormal uterine bleeding
oppose proliferative effect of estrogen on endometrium

adverse effect - irregular bleeding, wt gain, mood changes
decreased bone mineral density

Question 16

Estrogens side effects

Answer 16

endometrial hyperplasia
growth of estrogen-responsive cancers
increased risk of DVT, PE
metabolized by P450 - caution with inducers

Question 17

Side effects of combined estrogen-progestin contraceptives

Answer 17

venous thromboembolism
HTN
MI and stroke
Hepatic adenoma

Question 18

Risks of paraguard (copper IUD)

Answer 18

uterine perforation

increased risk of PID w/in 3 weeks of insertion

Question 19

Menopause

Answer 19

avg 51.4 years
under 40 yo = primary ovarian insufficiency

cause: depletion of ovarian follicles

12 mo amenorrhea

Ovaries stop: decreased estradiol, decreased inhibin

no negative feedback: increased GnRH, FSH, LH

Estrone becomes main estrogen

Question 20

Symptoms of low estrogen levels

Answer 20

“Menopausal Symptoms wreak HAVOC”

Mood change - depression
Sleep disturbances
Hot flashes - vasomotor sx
Atrophy of vagina
Vaginal dryness
Osteoporosis
Coronary artery dz

Question 21

Menopausal hot flashes

Answer 21

Occur in 75% of menopausal women

Starts in face/chest then generalizes
associated w/ diaphoresis and palpitations, followed by chills and shivering
lasts 2-4 minutes

May cause sleep disturbances

Tx: estrogen replacement > SSRI, SNRI, gabapentin

Herbal tx: soy isoflavones, red clover, black cohosh, vitamin E

Question 22

Hormone replacement therapy for menopause

Answer 22

Use estrogen + progesterone if uterus present
-unopposed estrogen increases risk of endometrial cancer

For relief of sx, not to prevent chronic dz (CAD, osteoporosis)

Use for only shortest about of time and at lowest dose needed

Avoid if:
Coronary heart dz
active liver dz
Hx of breast cancer, stroke, venous thromboembolism

Question 23

Vulva cell type

Answer 23

stratified squamous
Labia majora - keratinized
labia minora - nonkeratinized

Question 24

Vagina cell type

Answer 24

stratified squamous, non keratinized

Question 25

Ectocervix cell type

Answer 25

nonkeratinized stratified squamous

Question 26

Endocervix cell type

Answer 26

simple columnar epithelium - mucus secreting

Question 27

Transformation zone

Answer 27

squamo-columnar junction metaplastic cells transform columnar --> squamous depending on age and hormonal status immature squamous cells vulnerable to HPV majority of cervical cancers arise at squamocolumnar junction

Question 28

Body of uterus cell type

Answer 28

simple columnar ciliated, secretory | long tubular glands

Question 29

Fallopian tube cell type

Answer 29

simple columnar, ciliated, secretory | peg cells - resting

Question 30

ovary cell type

Answer 30

simple cuboidal

Question 31

Sarcoma botryoides

Answer 31

aka embryonal rhabdomyosarcoma infants and kids under 5 grape like mass out of vagina

Question 32

Clear cell adenocarcinoma

Answer 32

rare DES exposure in utero mullerian duct anomalies - T shaped uterus Vaginal adenomas - patches of columnar epithelium in vagina

Question 33

Squamous cell carcinoma of vagina

Answer 33

HPV 16, 18, 31

Question 34

Lichen sclerosus

Answer 34

Prepuberty/postmenopausal Inflammatory condition of vulva - thinning of epidermis smooth white plaques lead to shrinking of introits, fusion of labia majora and minora Sx: pain, pruitis, dyspareunia dx via bx Tx: topical corticosteroids assoc w/ increased risk of squamous cell carcinoma of vulva

Question 35

Squamous cell carcinoma of vulva

Answer 35

chronic inflammatory condition HPV infection 16*, 18, 31 --> koilocytosis coexist w/ cervical cancer

Question 36

Paget dz of vulva

Answer 36

intraepithelial cancer adenocarcinoma 10-20% underlying malignancy (100% in breast Pagets)

Question 37

Cervical dysplasia

Answer 37

``` can lead to cancer Risk: persistent high risk HPV 16, 18 early coitarche multiple sex partners immunosuppression smoking -impairs immune system OCP use - not protecting against STDs Hx of STDs ``` ``` Sx: abnormal bleeding esp postcoital vaginal discharge pelvic or LBP bowel and bladder sx ureteral obstruction --> pyelo, uremia, renal failure ```

Question 38

HPV mechanisms --> cancer

Answer 38

E6 binds p53 - degrades it E7 binds Rb, inactivates it Most squamous cell but some adenocarcinoma

Question 39

Screening for cervical cancer

Answer 39

Pap - transformation zone HPV - koilocytes darkening of cell HPV DNA testing

Question 40

CIN 1

Answer 40

mild dysplasia low grade SIL bottom 1/3 epithelium

Question 41

CIN2

Answer 41

Moderate dysplasia high grade SIL precancerous bottom 2/3 epithelium

Question 42

CIN3

Answer 42

severe dysplasia high grade SIL precancerous throughout epithelium

Question 43

CIS

Answer 43

full thickness of epithelium involved | next step invasion

Question 44

Risk of endometrial hyperplasia

Answer 44

Too much estrogen anovulation - stuck in estrogen dominant phase - PCOS increaed estrogen production - obesity, granulosa cell tumor --> endometrial carcinoma

Question 45

Endometrial carcinoma

Answer 45

MC in US post menopausal 55-65 yo prognosis stage 1 80-90% Present: irregular bleeding or post menopausal bleeding dx: endometrial bx

Question 46

Endometritis

Answer 46

inflammation of endometrium ascending infection acute: postpartum Chronic: PID, retained FB **Plasma cells in endometrium TX: broad spectrum Abx - gentamycin, clindamycin

Question 47

Adenomyosis

Answer 47

endometrium extends into myometrium -enlarged globular uterus tender to palpation Sx: menorrhagia, dysmenorrhea, dysparenia, pelvic pain Tx: hysterectomy

Question 48

Endometriosis

Answer 48

Endometrial tissue found outside uterus - functional - -> fibrosis and adhesions - pain Sx: dysmenorrhea, pelvic pain, dyspareunia, infertility, dysuria, dyschezia - bowel involved MC site: ovaries - ovarian cysts filled with old blood - Chocolate cyst ``` Uterine ligaments bowel bladder lungs bone heart ``` powder burn implants

Question 49

Treatment of Endometriosis

Answer 49

NSAIDs, OCPs, progestine leuprolide - continuous GnRH agonist Danazol - synthetic androgen --> negative feedback - Use in endometriosis, fibrocystic breast dz, hereditary angioedema - SE: acne, hirutism, deepening of voice, wt gain, hot flashes, decreased HDL, hepatotoxicity

Question 50

Leiomyosarcoma

Answer 50

rare malignant tumor arising de novo from myometrium rapidly enlarging uterus

Question 51

Uses of leuprolide

Answer 51

GnRH analog binds GnRH receptors initial release of FSH, LH, estrogen Continuous administration down regs GnRH receptors --> decreased FSH, LH, estrogen --> hypogonadotrophic state Leiomyomas - shrink prior to surgery -short term Endometriosis Central precocious puberty Advanced prostate cancer Infertility - continuously to suppress intrinsic hormone production during IVF - given once to induce ovulation SE: amenorrhea, hot flashes, decreased libido, depression, bone loss

Question 52

Leiomyomas (Leiomyomata uteri)

Answer 52

MC - 70-80% Benign tumor of sm.m. of myometrium Monoclonal hormonally sensitive - shrink after menopause Multiple well circumscribed tumors Histo: whorled pattern of sm.m. Sx: most asx - menorrhagia - dysmenorrhea - pelvic pressure/discomfort - acute pelvic pain - twisted on stalk or outgrow blood supply --> degeneration - infertility - miscarriage - urinary frequency Dx: PE followed by US -nontender enlarged uterus w/ irregular contours Tx: hysterectomy or myomectomy Leuprolide pre-op to shrink