Female Reproductive Pathologies

Question 1

T/F Normally, the only significant source of estrogen in non-pregnant women is the corpus luteum.

Answer 1

1
False
During the follicular phase of the ovarian cycle, maturing follicles release increasing amounts of estrogen. This is before a corpus luteum has even formed. Also, adipose tissue can aromatize androgens into estrogens (though this would happen under the non-normal conditions of high androgen and extra adipose).

Question 2

T/F Normally, the only significant source of progesterone in noon-pregnancy women is the corpus luteum.

Answer 2

2
True
This true because prior to ovulation, maturing follicles do not secrete progesterone. After ovulation, a corpus luteum forms
and it releases both estrogen and progesterone.

Question 3

T/F Estrogen inhibits GnRH & gonadotropin release in typical negative feedback fashion.

Answer 3

3
True
But remember the two caveats regarding negative feedback of estrogen on gonadotropin release from the anterior pituitary:
(1) Estrogen by itself can totally suppress FSH release (and it has pretty much done so by Day 10 or so in the
cycle), but estrogen by itself can only partially suppress LH release (it take estrogen plus progesterone to totally suppress it).
(2) At low levels, estrogen exerts a negative feedback on LH release (it suppresses it partially), but at higher
concentrations estrogen exerts apoistive feedback on LH release- it stimulates it. This is what brings about the LH peak on about Day 14, with ovulation normally following within about 24 hours.

Question 4

T/F After ovulation, the follicular remnants transform into a corpus luteum; the corpus luteum, in turn, degenerates within two weeks if fertilization and implantation have not occurred.

Answer 4

4
True
Furthermore, as the corpus luteum degenerates, progesterone levels plummet, which brings about menstruation.

Question 5

T/F Under certain conditions, adipose tissue can convert androgens into estrogens.

Answer 5

5
True
This is because adipose tissue expresses the aromatase enzyme.

Question 6

T/F FSH is responsible for putting oxidoreductase into the thecae cells (so they can convert cholesterol into androgens) while LH puts aromatase into granulose cells (so they can convert androgens into estrogens)

Answer 6

6
False
The enzymes and cell types are paired properly, but the gonadotropins are switched. LH puts oxidoreductase into thecal cells, while FSH puts aromatase into granulosa cells.

Question 7

T/F The corpus luteum is the major source of estrogen and progesterone throughout all three trimesters of a pregnancy

Answer 7

7
False
The corpus luteum is an extremely important source of estrogen and progesterone during Trimester 1, but in Trimesters 2 & 3 the placenta itself is the major sources of those hormones.

Question 8

T/F The term “venereal infection” is a synonym for “sexually transmitted disease”

Answer 8

8

True

Question 9

T/F Among the triad of cervical cancer/endometrial (uterine) cancer/ovarian cancer, the latter (ovarian cancer) is the most readily detected and hence most easily treated.

Answer 9

9
False
Ovarian cancers are often asymptomatic until they are quite advanced, while the other two are much more easily detected via Pap smears (cervical cancer) or abnormal bleeding (endometrial cancer).

Question 10

The [follicular/luteal/gestational] phase of the ovarian cycle occurs before ovulation from days 1 to about days 14.

Answer 10

10

follicular

Question 11

The [follicular/luteal/gestational] phase of the ovarian cycle occurs after ovulation from about days 14 to 28.

Answer 11

11

luteal

Question 12

In females, [LH and FSH / androgens / GnRH / prolactin / oxytocin] stimulate(s) follicle cells to secrete sex hormones.

Answer 12

12
LH and FSH
Actually, these gonadotropins perform the same function in males, except that the cells they are stimulating are Leydig and Sertoli cells, not follicle cells.

Question 13

The [menstrual/follicular/proliferative/secretory] phase is the only phase (of those four) which is not part of the uterine cycle.

Answer 13

13

follicular

Question 14

When Doris missed her period, her doctor checked Doris’ urine for the presence of [LH / hCG / FSH / estrogen / GH] to see if she was pregnant.

Answer 14

14

HcG

Question 15

The [stratum basalts/stratum functionalism/myometrium] is the portion of the endometrium which is responsible to female sex hormones; every cycle, it proliferates in preparation for implantation, and is shed if conception does not occur.

Answer 15

15

stratum functionalis

Question 16

The [stratum basalts/stratum functionalism/myometrium] is the persistent portion of the endometrium which is not to responsive to female sex hormones, at least in that it does not undergo the monthly cycles of regeneration and degeneration.

Answer 16

16

stratum basilis

Question 17

______ refers to a normal monthly flow.

Answer 17

17

menorrhea

Question 18

_____ refers to the lack of menstruation in a reproductive-aged woman.

Answer 18

18

amenorrhea

Question 19

_____ refers to a difficult or painful monthly flow; pelvic pain during a menstrual period that does not resolve with the onset of menses.

Answer 19

19

dysmenorrhea

Question 20

_____ refers to a monthly flow where the duration is long and/or the amount heavy; aka menorrhagia

Answer 20

20

hypermenorrhea

Question 21

_____ refers to a monthly flow where the duration is short and the amount scant

Answer 21

21

hypomenorrhea

Question 22

_____ refers to excessive uterine bleeding at and between menstrual periods

Answer 22

22

menometrorrhagia

Question 23

____ refers to a menstrual period where the cycle is abnormally short (<22 days)

Answer 23

23

polymenorrhea

Question 24

______ refers to infrequent menstrual periods (36 days to 6 months), usually with scanty flow as well

Answer 24

24

oligomenorrhea

Question 25

_____ refers to a monthly flower wherein, for a variety of reasons, the products of menstruation remain internal

Answer 25

25

cryptomenorrhea

Question 26

A(n) _____ is the cholesterol-packed ovarian structure that develops from a ruptured follicle following ovulation

Answer 26

26

corpus luteum

Question 27

A(n) ____ is a developing oocyte and its surrounding specialized cells.

Answer 27

27
(ovarian) follicle
It is important to realize that those ‘surrounding specialized cells’ are thecal and granulosa cells. They are derived from the ovarian stroma. Why is that important? It explains why some sex cord stromal tumors- such as granulosa and theca cell tumors- secrete hormones.

Question 28

The ____ refers to the initial, funnel-shaped portion of the uterine tube which is open to the peritoneal cavity.

Answer 28

28
infundibulum
It is the infundibulum that bears the fimbriae and is responsible for bringing an ovulated oocyte into the uterine tubes.

Question 29

The ____ refers to the outermost, serious covering of the uterus.

Answer 29

29

perimetrium

Question 30

The ____ refers to the middle, muscular layer of the uterus.

Answer 30

30

myometrium

Question 31

The ____ refers to innermost layer of the uterus; a portion of this layer develops during the initial phases of the uterine cycle, and then is shed during menstruation if fertilization has not occurred.

Answer 31

31

endometrium

Question 32

The ___ refers to the cul-de-sac between the uterus and the rectum; it is often sampled during culdocentesis.

Answer 32

32

rectouterine pouch, or pouch of Douglas

Question 33

The ___ refers to the external female genitalia.

Answer 33

33

vulva or pudenda

Question 34

The ___ is the recess enclosed by the labia minor; 4 structures open into this space’ two Bartholin’s glands, the vagina, and the urethra.

Answer 34

34

vestibule

Question 35

The secretions of the two ____ glands keep the vestibule moist and lubricated.

Answer 35

35

Bartholin’s glands

Question 36

Contractions of the ____ in the endometrium cause/facilitate the shedding of the stratum functionalism during menstruation.

Answer 36

36

spiral arteries

Question 37

Which fetal/placental hormone is responsible for maintaining the corpus luteum during the initial trimester of pregnancy?

Answer 37

37

hCG

Question 38

T/F Herpesvirus is typically spread by aerosolized droplets, or by touching contaminated surfaces such as doorknobs or table tops.

Answer 38

46
False
Herpesvirus is typically spread via sexual contact.

Question 39

T/F Typically herpes simplex virus (HSV) type I causes cold sores while HSV type II causes genital herpes

Answer 39

47
True
but remember that either virus type can cause lesions elsewhere on the body

Question 40

T/F Herpes simplex virus type II causes genital herpes but does not - and cannot - cause cold sores in the perioral areas.

Answer 40

48
False
The genital region is only the preferred site of HSV type II- it can cause lesions elsewhere on the body, including cold sores around the mouth.

Question 41

T/F Herpes simplex virus is only transmitted person-to-person via direct contact with the clear but virus-laden fluid from the herpetic vesicles.

Answer 41

49
False
HSV can also be transmitted via viral shedding, e.g., from saliva or skin moisture

Question 42

T/F After the initial infection of herpes simplex virus, the virus typically enters nerves, where it may remain dormant and asymptomatic for years or decades

Answer 42

50

True

Question 43

T/F Genital herpes is easily resolves after treatment with antibotics such as doxycycline or tetracycline

Answer 43

51
False
Genital herpes is caused by a virus, which will be unaffected by antibiotics. Treatment with anti-virals such as acyclovir can help lessen the intensity of outbreaks and thus provide some relief, but they do not eradicate the virus.

Question 44

T/F Herpesvirus may be associated with Bell palsy.

Answer 44

52

True

Question 45

T/F Presently, genital herpes cannot be cured

Answer 45

53

True

Question 46

T/F Although warts are caused by human papilloma virus (HPV), the strains of HPV causing common skin warts are not the same as the “high risk” strains causing precancerous and cancerous lesions

Answer 46

54
True
Types 16 and 18 are the two biggies for high risk lesions; these two strains cause about 70% of cervical cancers.

Question 47

T/F The HPV types that cause genital warts also cause cervical cancer

Answer 47

55

False

Question 48

T/F The Gardasil vaccine provides protection against infection by all types of HPV

Answer 48

56
False
In fact,it only protects agains four types of HPV.

Question 49

T/F Most HPV infections in young women spontaneously disappear within two years

Answer 49

57
True
70% by one year, 90% by two years.

Question 50

T/F With HPV infections, progression from precancerous lesion to cervical cancer is fairly rapid, typically occurring in two years or less

Answer 50

58
False
This progression is much slower, more like 15 to 20 years. This is fortunate, as it provides pleanty of opportunity for detection and treatment.

Question 51

T/F All women aged 18 to 65 years old should seek out regulate Pap smear testing

Answer 51

59
False
Most women should, but there is little benefit in Pap screening women who have not had sex (since HPV is spread via sexual contact).

Question 52

T/F Gonococcus and Chlamydia trachoma’s are two pathogens that are common causes of pelvic inflammatory disease

Answer 52

60

True

Question 53

Vulvovaginitis accompanied by a curd-like vaginal discharge (lacking clue cells) is typical of infection by [C. albicans / C. trachomatis / T. vaginalis / G. vaginalis].

Answer 53

61

C. albicans

Question 54

____ refers to inflammation of the inner lining of the uterus.

Answer 54

62

Endometritis

Question 55

____ refers to inflammation of the entire female reproductive system

Answer 55

63

Pelvic inflammatory disease (PID)

Question 56

____ refers to inflammation of the uterine (fallopian) tubes

Answer 56

64

Salpingitis

Question 57

____ refers to inflammation of of the ovaries

Answer 57

65

Oophoritis

Question 58

____ refers to difficult or painful sexual intercourse

Answer 58

66

Dyspareunia

Question 59

____ refers to inflammation of the uterus

Answer 59

67

Metritis

Question 60

____ refers to inflammation of the cervical canal

Answer 60

68
Endocervicitis
The endocervix refers to the cervical canal.

Question 61

____ refers to inflammation of the vagina; aka vaginitis

Answer 61

69

Colpitis

Question 62

____ refers to an infectious eye disease caused by chlamydial bacteria; it is a leading cause of blindness worldwide

Answer 62

70
Trachoma
Caused by the bacterium Chlamydia trachomatis. Globally, 41 million people suffer from active infection and nearly 8 million people are visually impaired as a result of this disease.

Question 63

_____, seen on dentists and health care workers, produces herpetic vesicles on the thumbs or fingers

Answer 63

71

Herpetic whitlow

Question 64

____ are also known as anogenital genital, or venereal warts

Answer 64

72

Condylomata acuminatum

Question 65

Medically, warts are known as ____

Answer 65

73

verrucae

Question 66

____, otherwise known as Flayl, is the drug typically used to treat trichomoniasis

Answer 66

74

Metronidazole

Question 67

A nonbacterial pathogen that typically causes vesicles in the anogenital or peritoneal areas; these vesicles then rupture, giving rise to shallow ulcers

Answer 67

77a
D
Herpesvirus

Question 68

The bacterium responsible for syphilis

Answer 68

77b
I
Treponema pallidum

Question 69

The bacterium responsible for gonorrhea

Answer 69

77c
G
Neisseria gonorrhoeae

Question 70

The bacterium responsible for many cases of cervicitis and non-gonorrheal urethritis it is an important pathogen causing PID in women, an an important cause of blindness due to eye infections passed from mother to child during delivery

Answer 70

77d
B
Chlamydia trachomatis

Question 71

A pathogen, usually spread via the hematogenous route, which is a common cause of orchitis in males and an occasional cause of oophoritis in female

Answer 71

77e
F
Mumps virus

Question 72

A yeast that typically causes vulvovaginitis

Answer 72

77f
A
Candida albicans

Question 73

A bacteria that typically causes vaginitis; this infection is characterized by the presence of “clue cells” and a vaginal discharge with a fishy color

Answer 73

77g
C
Gardnerella vaginalis

Question 74

Also known as gonococcus

Answer 74

77h
G
Neisseria gonorrhoeae

Question 75

A virus that causes warts (common and genital) and is associate with cervical cancer

Answer 75

77i
E
Human papilloma virus

Question 76

A widespread bacterium (e.g. it is usually found in the human mouth or on human skin) that may cause genital infections via either the ascending or descending routes

Answer 76

77j
H
Staphylococcus aureus

Question 77

A protozoan which, in women, proceeds a greenish, frothy vaginal discharge accompanied by itching

Answer 77

77k
J
Trichomonas vaginalis

Question 78

T/F In a grade 2 cystocele, the bladder sinks far enough to reach the introitus

Answer 78

78
True
Students should also know what a grade 1 and grade 3 cystocele is, as on an exam I might switch this question to one of the other grades.

Question 79

T/F Chronic constipation and straining to pass bowel movements are two potential causes rectocele

Answer 79

79
True
Episiotomy and large baby deliveries are two others.

Question 80

A(n) _____ is a herniation of the urinary bladder through the pubocervical fascia and into the vagina

Answer 80

80
cystocele
Pubocervical fascia is another name for the vesicovaginal septum.

Question 81

A(n) _____ is a herniation of the rectum through the rectovaginal septum and into the vagina

Answer 81

81

rectocele

Question 82

A bladder that has dropped down from its normal position (e.g. because of a cystocele) may cause two kinds of problems: ______ and ______

Answer 82

82

unwanted urine leakage and incomplete emptying of the bladder

Question 83

A(n) _____ is a medical procedure to suture the vagina, usually to close an incision made during surgery

Answer 83

83

colporrhaphy

Question 84

A(n) _____ is a small plastic or silicone medical device that is inserted into the vagina and held in place by the pelvic floor musculature; therapeutic versions are used to support the uterus, vagina, urinary bladder, or rectum

Answer 84

84

pessary

Question 85

The ____ refers to the vaginal orifice – the outer or vestibular opening to the vagina

Answer 85

85

introitus

Question 86

T/F NSAIDs often work well in resolving primary dysmenorrhea

Answer 86

87
True
Recall that prostaglandins stimulate myometrial contraction and that primary dysmenorrhea is usually due to overproduction of prostaglandins. NSAIDs like aspirin provide relief by inhibiting prostaglandin synthesis

Question 87

T/F The most common cause of secondary dysmenorrhea is excessive prostaglandin secretion

Answer 87

88
False
Recall that secondary dysmenorrhea is due to a cause other than pelvic congestion, e.g., endometriosis, or fibroids.
Prostaglandin overproduction is not the issue in this case.

Question 88

T/F Primary dysmenorrhea refers to dysmenorrhea where the problems lies with the ovaries

Answer 88

89
False
Primary dysmenorrhea is usually due to overproduction of prostaglandins

Question 89

T/F Common causes of secondary dysmenorrhea include endometriosis, fibroids, PID, and IUD problems

Answer 89

90
True
these and a few other causes were listed in the lecture notes

Question 90

T/F Dysmenorrhea presents as excessive low pelvic pain, which may be sharp, throbbing, or dull, and may extend into the back or legs

Answer 90

91

True

Question 91

T/F Some women experience nausea and vomiting with dysmenorrhea

Answer 91

92

True

Question 92

T/F Dysmenorrhea affects about 10% of all women, and it affects about 10% of those (i.e. about 1% of all women) severly

Answer 92

93
False
The numbers are higher than this: half to three-quarters of women are affected by this condition, 5-10% severely enough to loose time at work or school.

Question 93

T/F Primary amenorrhea refers to amenorrhea where the problems lies with the uterus

Answer 93

94
False
I tried to trick you with this one. Here ‘primary’ is used a little differently than you might be accustomed to, since primary amenorrhea refers to a condition where a women has never started menstruating. Compare that to secondary amenorrhea, where she has stopped menstruating (during her reproductive years).

Question 94

T/F Amenorrhea is normal for some variable number of months following a pregnancy

Answer 94

95

True; it has to do with prolactin inhibiting GnRH release from the hypothalamus.

Question 95

T/F A woman misses 2 cycles in a row – this qualifies for amenorrhea

Answer 95

96
False; Although the actual definition varies from authority to authority, three missed cycles in a row seems to be an accepted
minimum to qualify a amenorrhea.

Question 96

____ refers to spontaneous milk production unrelated to pregnancy

Answer 96

97

Galactorrhea. Usually hyperprolactinemia will be present as well.

Question 97

A(n) ____ should always be the first workup for a patient with secondary amenorrhea

Answer 97

98

pregnancy test; the answer to this question should be obvious

Question 98

A(n) ____ refers to a condition where a woman ovulates, but the residual follicular cells fail to develop into a proper corpus luteum; thus her cycle does not evolve into a normal luteal phase

Answer 98

99
Inadequate luteal phase; Without an adequate luteal phase, progesterone is not secreted, so that the uterus does not become fully receptive for implantation, and without progesterone withdrawal, menstruation does not begin. The net effect is that estrogen just continues to stimulate the endometrium, and it grows and grows and grows.

Question 99

T/F A woman with hirsutism and elevated testosterone levels most likely has an adrenal problem

Answer 99

101
False; There is an outside chance that she has an adrenal problem, but remember: if the elevated androgen is testosterone, she most likely has an ovarian problem. If the elevated androgen is DHEA sulfate, then she most likely has an adrenal problem.

Question 100

T/F A woman with hirsutism and elevated DHEA sulfate levels most likely has an adrenal problem

Answer 100

102

True; in a woman, elevated testosterone levels- ovarian problem; elevated DHEA sulfate- adrenal problem.

Question 101

____ refers to an excess of hair in normal hair-bearing areas

Answer 101

103

Hirsutism

Question 102

____ refers to an excess of hair in normal hair-bearing areas plus secondary male sex characteristics, esp. clitoromegaly

Answer 102

104

Virilization

Question 103

T/F Anovulation is common in pubertal girls in whom the normal cycle of the hypothalamus has not yet been established

Answer 103

106
True; The menstrual cycle is often somewhat irregular in teenaged women, especially if they are also athletically active. The cycles will usually settle down by the time a woman enters her 20’s.

Question 104

T/F Anovulatory cycles often result in endometrial hyperplasia

Answer 104

107

True; it is that unopposed estrogen thing again.

Question 105

T/F NSAIDs often work well in resolving anovulatory cycles

Answer 105

108
False; NSAIDs suppress prostaglandin synthesis, and that will do nothing to resolve an anovulatory cycle. Progesterone- a birth control pill- is what is needed to break the anovulatory cycle and bring on menstruation and a new cycle.

Question 106

T/F Anovulatory cycles and inadequate luteal phase are examples of functional causes of menometrorrhagia

Answer 106

109
True; Recall that a functional cause refers to a cause that has no organic component and usually involves hormones. The continual high estrogen levels found in both of these conditions will certainly have an effect on the uterus, causing endometrial hyperplasia and ultimately, bleeding

Question 107

T/F High LH levels coupled with low FSH levels will cause high androgen levels in an otherwise healthy woman

Answer 107

110
True; LH puts the oxidoreductase into the thecal cells so they readily convert cholesterol into androgen, and FSH puts aromatase into granulosa cells so they readily convert androgens into estrogens. Without FSH, a woman will produce plenty of androgen without her granulosa cells being able to convert them to estrogen.

Question 108

T/F Normally, granulose cells convert cholesterol into androgens while thecae cells convert androgens into estrogens

Answer 108

111
False; It is backwards. Thecal cells convert cholesterol into androgens, and granulosa cells convert androgens into estrogens.

Question 109

T/F Inadequate luteal phase results in high progesterone levels unopposed by estrogen

Answer 109

112
False; Normal ovarian secretion of progesterone requires a properly functioning corpus luteum. If the corpus luteum is inadequate, then obviously the progesterone levels will be inadequate (i.e., low) as well.

Question 110

T/F For many women, the first symptoms to appear from anovulatory cycles or inadequate luteal phase are fertility issues

Answer 110

113
True; It is surprising that, in spite of all these hormonal disruptions, many women with either of these conditions still have semi-regular periods.

Question 111

During the early part of the follicular phase of the ovarian cycle, serum estrogen levels are [high / low] and serum progesterone levels are [high / low]

Answer 111

114
low, low
See slide 75ish

Question 112

During the late part of the follicular phase of the ovarian cycle, serum estrogen levels are [high / low] and serum progesterone levels are [high / low]

Answer 112

115
high, low
See slide 75

Question 113

During the middle part of the luteal phase of the ovarian cycle, serum estrogen levels are [high / low] and serum progesterone levels are [high / low]

Answer 113

116

high, high

Question 114

During the proliferative phase of the uterine cycle, the hormone(s) [estrogen / progesterone / estrogen & progesterone / LH / FSH] act on the endometrium and signal it to grow (proliferate).

Answer 114

117
estrogen alone; There is very little progesterone around at this time, and uterine tissue is not responsive to LH and FSH.

Question 115

During the secretary phase of the uterine cycle, the hormone(s) [estrogen / progesterone / estrogen & progesterone / LH / FSH] act on the endometrium, signaling it to (1) continue growing (proliferating), (2) become edematous so that it forms a soft medium ideal for implantation, and (3) transform its uterine glands into secretory structures

Answer 115

118
estrogen and progesterone; The two act together. Estrogen continues the proliferation of the endometrial tissue, while progesterone transforms the endometrium into a tissue receptive to- and ideal for- implantation. Note that in this question, as
worded, neither estrogen not progesterone alone would completely answer the question- both are required to effect all the changes mentioned in the stem of the question.

Question 116

_____ are the most common cause of abnormal bleeding in a young woman from menarche to about 20 years of age

Answer 116

119

Anovulatory cycles. Anovulatory cycles and inadequate luteal phase are common causes of dysfunctional uterine bleeding.

Question 117

_____ - marked thickening of the inner uterine mucosa - is the result of continued stimulation of this tissue by estrogen unopposed by progesterone.

Answer 117

120

Endometrial hyperplasia

Question 118

___ occurs when a properly functioning corpus luteum fails to form from the follicular remnants after ovulation; as a result, progesterone levels remain abnormally low.

Answer 118

121

Inadequeate luteal phase.

Question 119

T/F Endometrial polyps occur most frequently in teenaged women

Answer 119

126

False; They are usually seen in women in the 40’s or 50’s.

Question 120

T/F Tamoxifen, an anti-estrogen drug used to treat some breast cancers, appears to encourage the growth of endometrial polyps in some women

Answer 120

127
True; Remember that tamoxifen is an estrogen antagonist in breast tissue, but a weak estrogen agonist in endometrial tissue. Thus tamoxifen discourages the growth of some breast tumors but encourages the growth of endometrial tissue.

Question 121

_____ are exophytic masses of variable size that project into the endometrial cavity

Answer 121

128

Endometrial polyps

Question 122

A(n) _____ polyp is borne at the end of a stalk

Answer 122

129

pedunculated

Question 123

A(n) ______ polyp arises directly off the underlying tissue, without an intervening stalk

Answer 123

130

sessile

Question 124

T/F Endometrial hyperplasia is the result of uterine overstimulation by unopposed progesterone

Answer 124

131
False; endometrial hyperplasia is due to uterine overstimulation by estrogen unopposed by progesterone. The hyperplasia
is NOT due to stimulation by progesterone alone, but by estrogen alone.

Question 125

T/F The rate of progression from endometrial hyperplasia to endometrial cancer ranges from about 1% to 25% depending on the type hyperplasia

Answer 125

132
True; Simple hyperplasia progresses to cancer ~1% of the time, complex hyperplasia 3%, and complex hyperplasia with atypia 25%.

Question 126

T/F Endometriosis progresses to cancer with relatively high frequency (>25%)

Answer 126

138

False; endometriosis progresses to cancer maybe 2% of the time- certainly not 25% of the time

Question 127

T/F Adenomyosis is a common cause of hysterectomy, since the uterus is often enlarged.

Answer 127

139
True; Recall that in adenomyosis the myometrium may be so riddled with nests of endometrial tissue (and chocolate cysts) that hysterectomy seems the only option.

Question 128

T/F The incidence of endometriosis in reproductive-aged women is less than 2%

Answer 128

140

False; the incidence in reproductive aged women is much higher than this- perhaps as high as one in five women

Question 129

T/F Supression of menstruation (i.e. contraceptive pills) may alleviate the pain and discomfort of endometriosis

Answer 129

141
True; Since the tissue of endometriosis swells and involutes with the changing levels of ovarian hormones (we’re talking estrogen here), then it makes sense that suppressing the high levels of unopposed estrogen will reduce the size of the endometriotic tissue. This alone may alleviate some of the pain and discomfort.

Question 130

T/F In stage II endometriosis, only superficial lesions are present, possibly with a few adhesion as well, but deep lesions are not present

Answer 130

142
False; In stage II endometriosis the superficial lesions are present but so are some deep lesions in the pouch of Douglas (the cul-de-sac).

Question 131

T/F In stage IV endometriosis, superficial and deep lesions are present as well as large endometriomas on the ovaries, accompanied by extensive adhesions

Answer 131

143

True

Question 132

_____ refers to the presence of endometrial glands and stroma within the uterus (i.e. within the myometrium)

Answer 132

144

Adenomyosis.

Question 133

____ refers to the presence of endometrial glands and stroma outside the uterus

Answer 133

145

Endometriosis

Question 134

A(n) _____ is another name for a chocolate cyst found on an ovary in cases of moderate to severe endometriosis

Answer 134

146

Endometrioma

Question 135

____ are foreign estrogens or chemicals having estrogenic effects on the body

Answer 135

147

Xenoestrogens

Question 136

T/F Follicular cysts provide an example of functional ovarian cysts

Answer 136

152
True; they are functional in the sense that they usually secrete sex hormones, which may disrupt the HPO axis and cause other hormonal problems.

Question 137

T/F Luteal cysts provide an example of functional ovarian cysts

Answer 137

153
True; they are functional in the sense that they usually secrete sex hormones, which may disrupt the HPO axis and cause other hormonal problems.

Question 138

T/F The chocolate cysts of endometriosis provide an example of a non-functional ovarian cyst

Answer 138

154

True

Question 139

T/F The main complication of follicular cysts is that they cause endometrial hyperplasia

Answer 139

155
False; follicular cysts may cause endometrial hyperplasia if they are secreting lots of estrogen, but the MAIN complication is mild intraperitoneal bleeding and pain.

Question 140

T/F Luteal cysts are typically filled with solid, progesterone-secreting tissue

Answer 140

156
False; While luteal cysts certainly may secrete progesterone, they are CYSTS, and the definition of a cyst is a sac filled with fluid or semi-fluid material. Thus cysts are not filled with solid material.

Question 141

____ cysts are derived from unruptured ovarian follicles that enlarge and become cystic; these are extremely common

Answer 141

157

Follicular

Question 142

____ cysts are derived from ruptured ovarian follicles that fail to become normal corpora luteal; instead the structure seals, enlarges as it fills with fluid, and becomes cystic

Answer 142

158

Luteal

Question 143

A(n) ____is any collection of fluid, surrounded by a very thin wall, within an ovary.

Answer 143

159

ovarian cyst

Question 144

T/F As a group, women with polycystic ovarian syndrome show higher incidences of endometrial adenocarcinoma

Answer 144

160
True; Polycystic ovarian syndrome is accompanied by high levels of estrogen; this, in turn, results in endometrial hyperplasia, which can then lead to cancer.

Question 145

T/F In essence, polycystic ovarian syndrome is due to high levels of estrogen which, in turn, results in high LH and low FSH levels; clearly such a woman is hormonally out of balance

Answer 145

161

True

Question 146

T/F Polycystic ovarian syndrome is perhaps the most common cause of hirsutism

Answer 146

162
True; The high estrogen levels totally suppress FSH secretion by the anterior pituitary. Without FSH, granulosa cells do not aromatize androgens to estrogens. Instead, the androgens are secreted into the blood, where they cause hirsutism. If a woman
has a little extra adipose tissue, the fat cells can aromatize androgens to estrogen, in which case she will have high serum levels of BOTH androgens and estrogens.

Question 147

T/F The cycle of polycystic ovarian syndrome can usually be broken by administration of progestin (birth control pill)

Answer 147

163
True; Recall that the root of the problem is an abundance of LH and no FSH. LH puts oxidoreductase into the theca cells, so they are quite capable of converting cholesterol into androgens. However, without FSH, the granulosa cells are unable to convert androgen to estrogen. Recall also that estrogen alone can totally suppress FSH release from the anterior pituitary, but both estrogen AND progesterone are required to suppress LH. By supplying the progesterone in a birth control pill, then both LH and FSH will be suppressed, androgen synthesis will be inhibited, and hopefully the woman’s body can reset itself and resume a normal cycle.

Question 148

T/F The cysts of polycystic ovarian syndrome are derived from ovarian follicles which, after ovulation, enlarge as they accumulate fluid and become cystic

Answer 148

164
False; Recall that in polycystic ovarian syndrome FSH levels are very low (suppressed by the high estrogen). Without FSH, there will be no mature follicles, and hence no ovulation. Without FSH, the hormonal environment does not allow follicles to develop and mature. Thus, the logic of the question is screwy since there would be no mature follicles and no ovulation.

Question 149

T/F Leiomyomas are seldom found in prepubertal girls, and they seldom develop in post-menopausal women

Answer 149

167

True; In either case they are deprived of their estrogen support.

Question 150

T/F Leiomyomas are exclusively tumors of uterine smooth muscle; they do not occur elsewhere in the body

Answer 150

168
False; Leiomyomas can and do occur in smooth muscle elsewhere in the body- e.g., the arrector pili muscles associated with hair follicles, the smooth muscles associated with blood vessels, etc.

Question 151

T/F Fibroid symptoms range from asymptomatic to almost debilitating, and are a common source of infertility

Answer 151

169
True; Small fibroids may produce no symptoms whatsoever. But think about the effects of an abdominal fibroid the size of a softball!

Question 152

T/F Leiomyomas have a tendency to progress to their cancerous form, leiomyosarcomas

Answer 152

170
False; Very rarely leiomyosarcomas may arise within a leiomyoma, but this is very rare. Typically, leiomyomas do not evolve into cancer.

Question 153

T/F Fibroids are a rather rare form of uterine tumor

Answer 153

171
False; Fibroids (leiomyomas) are the most common of uterine tumors. Approximately 20% of reproductive age women have them.

Question 154

T/F Leiomyomas tend to regress after menopause

Answer 154

172
True; after their estrogen support is withdrawn, the uterine smooth muscle component atrophies, leaving behind the fibrous stroma.

Question 155

T/F Leiomyomas are the third most common uterine tumor

Answer 155

173

False; fibroids are the most common type of uterine tumor and thankfully they are benign.

Question 156

T/F Leiomyomas are sensitive to, and also caused by, estrogen

Answer 156

174
False; Fibroids are definitely sensitive to estrogen levels, but apparently they are not caused by- not initiated by- estrogen.
Frankly, we don’t know what causes fibroids.

Question 157

T/F Fibroids evolve along a dangerous path and should be removed promptly when discovered

Answer 157

175
False; most fibroids are asymptomatic and don’t require treatment. They do not, as the question implies, evolve along a dangerous path, in that cancer very seldom develops within them.

Question 158

A(n) _____ fibroid dangles or projects from a stalk.

Answer 158

176
pedunculated; ‘peduncle’ means ‘little foot,’ so pedunculated fibroids sit on a stalk. The opposite condition- sessile- means there is no stalk and the fibroid rises right up out of the underlying tissue.

Question 159

A(n) _____ is another name for a uterine leiomyoma

Answer 159

177
fibroid. During a woman’s reproductive years fibroids usually have lots of smooth muscle in them, but after menopause, the muscles regresses (no estrogen) and then fibroids become mostly a mass of connective tissue stroma (i.e., FIBROUS tissue).

Question 160

A(n) _____ refers to the surgical removal of a muscle tumor, but especially to fibroids in the uterus

Answer 160

178

myomectomy; ‘myoma’, muscle + ‘ectomy’, to cut out.

Question 161

A(n) _____ leiomyoma develops just beneath (just deep to) the perimetrium

Answer 161

179
subserosal; The perimetrium is, of course, the serosa of the uterus, but if I had said ‘beneath the serosa’ that would have made the question way too easy.

Question 162

A(n) _____ leiomyoma develops within the myometrium itself

Answer 162

180

intramural; Meaning literally ‘within the wall’.

Question 163

T/F The mortality rates from cervical cancer have been steadily on the rise over the last 40 years, peaking in 2008 in the US.

Answer 163

183
False; In fact, cervical cancer mortality rates have been declining, due to better detection (Pap smear) and better treatment options.

Question 164

T/F Many authorities consider carcinoma of the cervix to be an infectious disease transmitted by intercourse and caused by viruses

Answer 164

184

True; Although the conclusive proof of this viral relationship still is elusive.

Question 165

T/F Cigarette smoking and chlamydial infection are known risk factors for cervical cancer

Answer 165

185

True; The viral connection is probably the big one, but these non-viral risk factors are pretty well established.

Question 166

T/F Most cervical cancers arise in the transformation zone, where the endocervix and exocervix meet

Answer 166

186

True; Also, this area is visible via colposcopy, which facilitates easier detection.

Question 167

T/F Having intercourse at an early age increases a woman’s risk of developing cervical cancer

Answer 167

187
True; Do you see the connection- it increases her risk of contracting a viral (HPV) or bacterial (e.g., syphilis or chlamydia) infection.

Question 168

T/F Having many sex partners increases a woman’s risk of developing cervical cancer

Answer 168

188
True again; Same connection- it increases her risk of contracting a viral (HPV) or bacterial (e.g., syphilis or chlamydia) infection.

Question 169

T/F Once cervical dysplasia crosses the basement membrane, it is known as carcinoma in situ, or CIS

Answer 169

189
False; This is wrong. Dysplasia won’t cross the basement membrane- that requires cancer. CIS is early cancer- it means that the cancer has NOT yet crossed the basement membrane- it is a cancer but it is still confined to the epithelial layer in which it arose. When it finally does cross the basement membrane, then we call it invasive carcinoma.

Question 170

T/F Cervical dysplasia and CIS (carcinoma in situ) are collectively known as cervical intraepithelial neoplasia, or CIN

Answer 170

190
True; Note that this means that the earlier stages of CIN coincide with dysplasia, while late CIN III is synonymous with carcinoma in situ. In this scheme, we have normal cervical structure, CIN, and invasive carcinoma.

Question 171

T/F All types of HPV are associated with cervical cancer

Answer 171

191
False; The two big HPV types associated with cervical cancer are types 16 and 18, and to a lesser extent, a few others I named in lecture. The remainders may cause warts, but they are not associated with cancer.

Question 172

T/F Histologically, carcinoma of the cervix is a squamous cell carcinoma

Answer 172

192

True; This makes sense, since the exocervixis lined by a squamous epithelium.

Question 173

T/F The median age of women diagnosed with CIN is 35 years, and usually invasive carcinoma develops within 1 or 2 years of this

Answer 173

193
False; The median age of women diagnosed with CIN is 35 years, but invasive carcinoma doesn’t usually follow for another 15 years or so. This gives a woman a decade and a half to be diagnosed and treated before the invasive cancer develops.

Question 174

T/F When found, CIN is usually resected via several techniques, including laser ablation, cryotherapy, of electrocautery

Answer 174

194

True

Question 175

T/F Early (Stage 0) cervical carcinoma is curable

Answer 175

195

True; this means cure rates approach (or are) 100%.

Question 176

T/F Even advanced (Stage IV) cervical carcinoma has a good prognosis, with 5-year survival rates exceeding 70%

Answer 176

196

False; 5-year survival rates for advanced cervical carcinoma are in the 10-15% range, not 79%.

Question 177

T/F Cervical carcinoma is the most common malignant tumor of the female reproductive tract

Answer 177

197

False; this ‘honor’ falls to endometrial cancer.

Question 178

T/F The occurrence of endometrial cancer rises with increasing age

Answer 178

198

True; The average age of diagnosis is 63, with 7-fold more diagnoses at 60 than at 40.

Question 179

T/F Histologically, endometrial cancer is a squamous cell carcinoma, as with cervical cancer

Answer 179

199
False; Endometrial cancer is an adenocarcinoma. This makes sense if you think about it. The endometrium is a secretory layer- i.e., a glandular layer. It is typical of cancer of this kind of glandular tissue will present as an adenocarcinoma.

Question 180

T/F Benign endometrial tumors - endometrial adenomas - are even more frequent than endometrial adenocarcinoma

Answer 180

200
False; In fact, benign endometrial tumors are not recognized clinically. This does not necessarily mean that endometrial adenomas do not form. Perhaps they are indistinguishable from endometrial hyperplasia. Perhaps the adenomas get flushed out with the menstrual blood each period.

Question 181

T/F Because of their invasive growth, endometrial carcinomas penetrate into the myometrium and may extend all the way to the serosa

Answer 181

201

True

Question 182

T/F The most common endometrial adenocarcinoma is a type II tumor

Answer 182

202

False; Endometrioid tumors are far more common than the type II tumors.

Question 183

T/F Non-endomterioid, or type II, adenocarcinomas of the endometrium usually are found in older women and typically do not arise in the context of hyperestrinism

Answer 183

203

True

Question 184

T/F Pap smears are as effective at detecting endometrial cancer as they are for cervical cancer

Answer 184

204
False; Although endometrial cancer cells do show up in vaginal/cervical Pap smears, the test is not as reliable for endometrial cancers. Still useful, but not as efficient.

Question 185

T/F The treatment for endometrial cancer usually involves laser ablation or curettage to remove the tumor

Answer 185

205

False; Treatment for endometrial cancer usually necessitates a hysterectomy.

Question 186

____ refers to elevated levels of estrogen in the blood

Answer 186

206

Hyperestrinism

Question 187

____ pertains to a woman who has born more than one child

Answer 187

207

Multiparous

Question 188

____ pertains to a woman who has not borne any children

Answer 188

208

Nulliparous

Question 189

____, or type I endometrial carcinoma, contain structures resembling endometrial glands; these tumors typically arise in the settings of endometrial hyperplasia and hyperesterinism

Answer 189

209

Endometrioid

Question 190

___ is the most common presenting symptom of endometrial adenocarcinoma

Answer 190

210

Vaginal bleeding

Question 191

T/F Although ovarian cancer ranks third in frequency among cancers of the female reproductive tract, they account for more deaths than any other gynecological cancer

Answer 191

212
True; This is due to a great extent to the fact that ovarian cancers are often clinically silent until they become advanced tumors, by which time they have already spread locally and to distant sites.

Question 192

T/F Because the ovaries are endocrine organs, most ovarian tumors are functional (i.e. they release hormones)

Answer 192

213

False

Question 193

T/F Although benign ovarian tumors (and some malignant tumors) may be asymptomatic, common symptoms of malignant tumors include pain and abdominal distension

Answer 193

214
True; Also, mass effects- compression, etc., due to the bulk of a tumor- may also occur. Such bulk effects would include bowel obstruction and urinary urgency.

Question 194

T/F Endometrioid tumors are cystic, while serous and mutinous tumors are solid

Answer 194

215
False; This is backwards. Endometrioid tumors are solid. Serous and mucinous tumors are cystic and filled with watery fluid and jelly-like material, respectively. How could you be filled with fluid if you were a solid tumor?

Question 195

T/F Most endometrioid tumors are malignant

Answer 195

216

True; But serous and mucinous tumors may be benign, borderline malignant, or malingant.

Question 196

T/F Endometrioid tumors are the most common type of surface epithelial tumor

Answer 196

217

False; Serous tumors are the most common

Question 197

T/F Serous tumors often consist of several cysts lumped together within a common outer capsule

Answer 197

218

True; See the photo on or about Slide 174.

Question 198

T/F The cavity of mutinous tumors is filled with thick, yellowish or white, jelly-like mucus

Answer 198

219

True; If the tumor ruptures, the jelly-like material fills the peritoneum and leads to a condition called ‘jelly belly’.

Question 199

T/F Quite frequently, mutinous tumors are accompanied by uterine tumors, suggesting some sort of special relationship between the two

Answer 199

220
False; But the statement is true of endometrioid tumors- endometrioid tumors of the ovary are often associated with endometrioid (type I) tumors of the endometrium.

Question 200

T/F High estrogen levels, unopposed by progesterone, support the development of endometrioid tumors

Answer 200

221

True

Question 201

T/F Patients being treated for endometrioid carcinomas that have not yet spread outside the ovary have a 5 year survival rate in excess of 80%

Answer 201

222

True

Question 202

T/F In the ovaries, germ cell tumors arise from virus or bacteria infected ovarian cells

Answer 202

223
False. ‘Germ cell’ does not have anything to do with microbes. Germ cells are cells that have the ability, or are in the process of, forming gametes. The correct statement here is that germ cell tumors arise from activated oocytes.

Question 203

T/F Although teratomas are benign tumors, they can, if left in place for too long, undergo malignant transformation

Answer 203

224
True; That is why they should be resected once they are found. BTW, the malignant transformation usually only happens in older patients.

Question 204

T/F The presence of serum hCG in a man strongly suggests the presence of testicular cancer - a teratocarcinoma or one of its derivatives (e.g. choriocarcinoma)

Answer 204

225

True; hCG in a man is a pretty sure sign that he has testicular cancer.

Question 205

T/F The presence of elevated serum hCG in a woman strongly suggests the presence of ovarian cancer - a teratocarcinoma or one of its derivatives

Answer 205

226
False; Or more properly, Not Necessarily. She could have a teratocarcinoma, but the most likely reason her hCG is elevated is that she is pregnant.

Question 206

T/F Both teratomas and teratocarcinomas secrete hCG and AFP, which thus serve as serologic markers for the presence of either of these tumors

Answer 206

227
False; Teratomas consist only of SOMATIC cells, which do not secrete hCG or alpha fetoprotein. Teratocarcinomas, on the other hand, may very well contain placental tissue or extra-embryonic tissue, and may thus secrete hCG and/or AFP.

Question 207

T/F Most germ cell tumors secrete sex hormones

Answer 207

228

False; Germ cell tumors don’t secrete sex hormones (tho some of them secrete human chorionic gonadotropin).

Question 208

T/F Most sex cord stromal tumors secrete sex hormones

Answer 208

229
True; If they secrete estrogens and/or progesterone, they can easily disrupt a woman’s menstrual cycle. If they secrete androgens, they may virilize her.

Question 209

Benign, _____, and malignant are the three categories of ovarian tumors; the first is not cancerous, the second is low-grade cancer, while the third is high-grade cancer

Answer 209

230

border line

Question 210

Most tumors of the ovary ultimately arise from one of the three ovarian tissues. List these resulting three types of ovarian tumors: _____, _____, and ______.

Answer 210

231
Surface epithelium, germ cell, and sex cord stromal tumors; Of course, each of these has several associated subtypes, and there are two other groups of ovarian tumors: those that defy classification, and metastases from other organs.

Question 211

Surface epithelial tumors of the ovary are usually subdivided into three subtypes; list those three subtypes: _____, _____, and ______.

Answer 211

232

Serous, mucinous, and endometrioid.

Question 212

____ tumors are solid tumors composed of glands resembling endometrial glands.

Answer 212

233

Endometrioid

Question 213

The term ____ refers to a cell that produces gametes - either an oocyte or a spermatocyte.

Answer 213

234

gonocyte

Question 214

_____ and _____ are germ cell tumors of the ovaries and testes whose malignant cells retain their resemblance to gonocytes.

Answer 214

235

Dysgerminomas and seminomas

Question 215

T/F The most common place for an exotic pregnancy is on the ovaries themselves.

Answer 215

240

False; 95% of ectopic pregnancies are tubal pregnancies- implantation in the fallopian tubes.

Question 216

T/F Complications of PID or endometriosis are common causes of tubal pregnancies

Answer 216

241

True

Question 217

T/F Abruptio placentae, placenta accrete, hydatidiform mole, and choriocarcinoma are all examples of gestational trophloblastic disease

Answer 217

242
False; GTD describes abnormal conditions of the placental trophoblastic cells- they proliferate or mature abnormally, or they undergo malignant transformation. Only hydatidiform mole and choriocarcinoma fit this definition.

Question 218

T/F Molar pregnancies are most common in the middle of a woman’s reproductive years, specifically in the 25 to 35 age group

Answer 218

243
False; Molar pregnancies are most common and the ends of a woman’s reproductive years- either just after menarche, or just before menopause.

Question 219

T/F Partial hydatidiform moles feature triploid cells, usually the result of the fertilization of on haploid egg by two haploid sperm

Answer 219

244

True; another possibility is the fusion of a haploid egg with a single abnormal but diploid sperm.

Question 220

T/F The most important complication of a complete hydatidiform mole is the development of PID

Answer 220

245
False; Moles are not infectious conditions and don’t naturally progress to PID. Complete moles do progress to cancer- to be exact, choriocarcinomas about 2% of the time. Partial moles do not progress to choriocarcinoma.

Question 221

T/F In a complete hydatidiform mole, all the genetic material in the nucleus is paternal in origin

Answer 221

246

True; The nuclear DNA all comes from dad and, oddly enough, the egg has totally lost its nucleus.

Question 222

T/F The cells of complete hydatidiform moles posses the normal number of chromosomes (46), while those of incomplete moles possess and abnormal number (69) of chromosomes

Answer 222

247
True; In the complete moles, all the chromosomes come from dad, while in the partial moles, 2 sets come from dad and one set from mom.

Question 223

T/F Like trophoblastic cells themselves, choriocarcinoma cells are highy invasive and secrete hCG

Answer 223

248

True; The elevated hCG levels serves as a serologic marker for this tumor.

Question 224

T/F Most commonly, choriocarcinomas arise from pre-existing complete hydatidiform moles

Answer 224

249

True

Question 225

T/F Although choriocarcinoma is an aggressive tumor, it responds well to methotrexate chemotherapy

Answer 225

250

True; If treated early, cure rates are in the 80-100% range. These tumor melt with chemo, even if they’ve metastasized.

Question 226

T/F Eclampsia and pre-eclampsia are both marked by the triad of hypertension, edema, and proteinuria

Answer 226

251

True

Question 227

T/F Pre-eclampsia presents with seizures which may be life-threatening

Answer 227

252

False; It is eclampsia, not pre-eclampsia, that is marked by seizures.

Question 228

[Complete / Partial / Molar / Trophoblastic] hydatidiform mole refers to a placenta that has grossly swollen chorionic villi-resembling bunches of grapes - in which there are varying degrees of trophoblastic proliferation but no recognizable fetus

Answer 228

253

Complete; Partial moles also exist, but I just made up the last two.

Question 229

[Complete / Partial / Molar / Trophoblastic] hydatidiform mole refers to a placenta that has grossly swollen chorionic villi-resembling bunches of grapes - in which there are varying degrees of trophoblastic proliferation and usually recognizable fetal parts

Answer 229

254

Partial; Complete moles also exist, but I just made up the last two.

Question 230

A(n) ______ refers to implantation of a zygote anywhere but the normal location in the uterus

Answer 230

255

ectopic pregnancy; ‘ecto’=out + ‘topo’=place, location. ectopic=’out of place’.

Question 231

______ refers to deep penetration of the placental villi into the uterine wall (at least to and possibly through the endometrium)

Answer 231

256

Placenta accreta

Question 232

_____ refers to the implantation of the zygote in the lower segment of the uterus, with consequent positioning of the placental disk over the internal orifice of the cervix

Answer 232

257

Placenta previa

Question 233

____ refers to a complication of pregnancy, where the placental lining has separated from the uterus

Answer 233

258

Abruptio placentae

Question 234

____ is an umbrella term embracing the spectrum of trophoblastic disorders that exhibit abnormal proliferation and maturation of trophoblastic cells as well as neoplasms derived from the trophoblast

Answer 234

259

Gestational trophoblastic disease

Question 235

_____ refers to a cystic swelling of the chorionic villi, accompanied by variable trophoblastic proliferation

Answer 235

260

Hydatidiform mole; this definition applies whether the mole is complete or partial.

Question 236

____ is a malignant tumor derived from trophoblastic cells, i.e. a cancer of the placenta

Answer 236

261

Choriocarcinoma