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Pathophys Final Exam (semester 2) > Female Reproductive Tract- Witwer > Flashcards

Female Reproductive Tract- Witwer Flashcards

1
Q

Menstrual Cycle is required for:

  • production of ______
  • Preparation of the ______
A
  • **ovocytes

- uterus for pregnancy

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2
Q

Menarche=

A

first period

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3
Q

avrg period=

A

28 days

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4
Q

Sx associated with Menstrual cycle:

A

-Premenstrual symptoms are common, acne, tender breasts, bloating, malaise, iritability, mood changes.

  • **If these interfere with normal activities = Premenstrual Syndrome
  • -Severe in 3-8%
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5
Q

Menopause: women ____ yo

A

45-55 yo

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6
Q 
Menstrual cycle: 
Three Components (list)
A
  1. Hypothalamus/Pituitary Cycle
  2. Ovarian cycle
  3. Uterine cycle
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7
Q

Describe the Hypothalamus/Pituitary Cycle (hormones)

A
  • Hypothalamic Gonadotropin Releasing Hormone
  • Follicle Stimulating Hormone
  • Luteinizing Hormone
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8
Q

Describe the Ovarian Cycle:

A

Follicular Phase
Ovulation
Luteal Phase

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9
Q

Describe the uterine cycle

A

Menstruation
Proliferative Phase
Secretory Phase

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10
Q

Hypothalamus-Pituitary-Ovarian Axis

A
  • Precise signalling b/w hypothalamus and ovary.
  • Primary Signal is Hypothalamic GnRH (stimulating the release of FSH and LH from the anterior pituitary) feedback loop with ovarian androgen and estrogen steroids regulating the GnRH.
  • FSH and LH act in concert to stimulate gamete (ovum) maturation and hormone production
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11
Q

Gametes are _____ cells

A
  • *haploid

- -ovum or sperm cells

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12
Q

Slide 8

A

draw out

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13
Q

Menstrual cycle:
Three Ovarian phases–>
Follicular=

Ovulatory=

Luteal=

A

Follicular–> Granulosa cells proliferate in response to Follicle Stimulating Hormone (FSH) and produce estradiol
-Luteinizing Hormone (LH) stimulates Theca
cells to produce androgens > estradiol in
granulosa cells
-Estradiol and progestins stimulate Gonadotropin Releasing Hormone (GnRH) which stimulates FSH and LH and induces ovulation

-Ovulatory –

Luteal–> after ovulation, follicular cells transform into Corpus Luteum in response to Luteinizing Hormone and produce progesterone and estrodiol and these along with Inhibin produced by granulosa cells suppresses LH and FSH.
Without fertilization, corpus luteum regresses
and cycle starts again.

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14
Q

Hormonal Regulation of Menstrual Cycle

A

GnRH = Gonadotropin Releasing Hormone

Granulosa cells = follicle cells – produce sex hormones in ovary.

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15
Q

Fertilization= ____ hours

A

12-24

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16
Q

Zygote (2-cell stage) approx. ____ hrs

A

30

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17
Q

Four cell stage=

A

40 hrs

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18
Q

**Early Morada= ____ hrs

A

80 hrs**

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19
Q

Blastocyst approx __ days

A

5 days

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20
Q

Early implantation approx. __ days

A

6

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21
Q

Vaginal Developmental Variants (list ex’s)

A
  • Double Vagina
  • Absence of Vagina
  • Rudimentary second vagina without external opening forming a cyst

(these are rare)

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22
Q

Uterine Developmental Variants (ex’s)

A

Uterus Didelphys= 2 uteruses

Uterus Duplex bicornis= this means a horned uterus (not uncommon)

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23
Q

Normal Variations of the uterus:

A

retroverted, anteverted, retroflexed, anteflexed

Retrocession= whole uterus moves posteriorly

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24
Q

Vulvar Disease - Benign

-list Ex’s

A

varicose veins, Angioneurotic edema, Bartholin cyst, Sebaceous cyst, Lipoma, fibroma

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25
Q

Vulvar Disease – “Inflammatory”

-list Ex’s

A

Furunculosis= inflammatory infxn of the hair follicle (common w shaving)

Herpes genitalis (HSV)

Intertrigo= inflame. Condition in folds of tissue

Tinea cruris= fungal infxn

Psoriasis
Diabetic vulvitis, Tichomoniasis, Candidiasis, Acute urethritis, Bartholin abscess

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26
Q

Vulvar Disease - Malignancies

-list ex’s

A

carcinoma of the clitoris, Carcinoma on leukoplakia, Sarcoma of the labium, metaplastic hypernephroma (=kidney cancer, rare)

Leukoplakia tends to be pre cancerous condition**

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27
Q

Sexually Transmitted Disease:

  • Chancroid
  • bubo=
A

Chancroid= there will be a bubo (= inflamed lymph node, that can break down and form an abscess)

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28
Q

Sexually Transmitted Disease:

-list ex’s

A
  • Chancre with inguinal adenopathy

- Condylomata lata or acuminata

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29
Q

____ is the MCC of female infertility and ectopic pregnancy

A

**PID

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30
Q

PID:

-risk factors

A
  • Multiple partners
  • Vaginal douching
  • Previous episodes of PID
  • Unprotected sex
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31
Q

Most, but not all cases of PID are ____

A

STDs

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32
Q

PID: causes?

A
  • **Most often Neisseria gonorrhea or Chlamydia trachomatis
  • Coexisting infection in 45%
  • Without treatment, 40% with gonorrhea and 10% with Chlamydia will get PID
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33
Q

PID:

-other non-STD pathogens ?

A
  • Bacteroides fragilis
  • Streptococci
  • Clostridium perfringens (gas gangrene)
  • Mycobacterium tuberculosis
  • Cytomegalovirus
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34
Q

PID:

-findings?

A
  • Fallopian tubes filled with pus
  • MCC of hydrosalpinx, the result of pus resorption
  • Tuboovarian Abscess - TOA
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35
Q

PID:

-clinical Sx?

A
  • Fever
  • Lower abd pain
  • Pain with cervical motion, palpation of adnexa and uterus
  • Abnormal uterine bleeding
  • Vaginal discharge
  • Mucopurulent cervical os discharge
  • RUQ pain in 5% > FitzHugh-Curtis Syndrome, inflammatory adhesions around liver secondary to Chlamydia or GC infection
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36
Q

PID: dx

A

**Pelvic Ultrasound

MRI

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37
Q

Cul-de-sac abscess–>

A

In Pt with PID, Culposcopy= scope in there and draining the abscess

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38
Q

tuboOvarian abscess can develop in Pts with ____

A

PID

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39
Q

If the patient’s beta-HCG level is >1000 IU/mL (2IS Standard) or >2000 IU/mL (IRP Standard), an _____ _____ _____should be identifiable on a Transvaginal Sonogram.

A

**intrauterine gestational sac

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40
Q

**An intrauterine gestational sac should be present by __ weeks and also show embryonic cardiac activity by ___ weeks on a Transvaginal Sonogram when the sac is at least 16mm long or embryonic crown rump length is at least 5mm.

A
  • **5 weeks

- 5+

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41
Q

If none of the above are evident (ie gestational sac at 5 weeks), strongly suspect an Ectopic Pregnancy. Additional criteria for ectopic pregnancy:

A

If no intrauterine gestational sac is seen at all
If a live, extrauterine embryo is identified
There is free fluid in the pelvis or peritoneum
There is an adnexal mass
There is a hematosalpinx

42
Q

Ectopic pregnancy:
___% of pregnancies
-___% of maternal deaths, MCC of death in early pregnancy

A
  • 1-2%

- 13%

43
Q

Ectopic Pregnancy:

-risk factors=

A 
Scarring from previous PID
	Endometriosis
	Altered tubal motility
	Progestin only pill
	Previous tubal ligation
44
Q

Ectopic Pregnancy:

-MC location?**

A

fallopian tubes*

45
Q

Ectopic Pregnancy:
clinical Sx ?
-complications?

A 
Pain 95%
About six (6) weeks from LMP 
Adnexal tenderness 90+%
-Peritoneal signs 70+%
-Abnormal uterine bleeding 75%

-Complications:
Rupture with intra-abdominal bleeding

46
Q

Ectopic pregnancy:

-dx?

A

Beta HCG with Ultrasound
-Positive Pregnancy Test
No Intrauterine Pregnancy

(also note fluid in the adnexa)

47
Q

Vaginal conditions:

-ex’s

A
  • foreign body
  • Chemical vaginitis
  • Adhesions after severe chemical erosion
  • irritation from prolonged use of pessary and poor hygeine
48
Q

Vaginal Cancer (ex’s)

A
  • sarcoma
  • melanoma
  • Squamous cell carcinoma
49
Q

Simple Ovarian Cysts:

  • how common
  • 2 types=
A
  • Common, majority of no clinical significance, can be large.
  • Related to ovulation

-2 Types:
Follicular cysts
Corpus Luteum cysts

50
Q

Simple Ovarian Cysts:
-Clinical sx=

Dx=

A 
Bloating, lower abdominal pain, lower back pain
May rupture > pain, usually self limiting
May volve (twist, torsion)  > pain

Dx: Ultrasound, CT, or MRI

51
Q

REMEMBER: Endometriosis, dermoid cysts, polycystic ovarian syndrome, cystadenomas and cystadenocarcinoma can form cysts. These are NOT _____ cysts

A

simple

52
Q

“blue” mass in ovary=

A

= cyst

53
Q

Ovarian Torsion

A
  • large ovary w large follicles

- large ovary w/out doppler flow

54
Q

Polycystic Ovary Disease=

A

**PCOD - Enlarged ovaries with thick sclerotic capsules and an abnormally high number of follicles

55
Q

Stein-Levanthal Syndrome=

-4 things**

A

amenorrhea, infertility, hirsutism and enlarged polycystic ovaries

56
Q

Ovarian Epithelial-Stromal Tumors

- benign or malignant?

A
  • May be benign: MC forms are Cystadenomas, Serous and Mucinous tumors
  • May be malignant, Cystadenocarcinoma
57
Q

Ovarian Germ Cell tumors – about 30%:

A

are benign, occur in young females

58
Q

Ovary - Serous Cystadenoma:

  • demographic?
  • benign or malignant
A

Tumors <45 yrs tend to be benign

75% of serous tumors benign, 25% malignant

-Ovarian tumors may be bilateral in significant percent, especially
malignant tumors 66%

59
Q

Ovary Cystadenoma - Mucinous tumors ___% are ovarian tumors

A

25%

-**Very large masses can occur.

60
Q

Ovary: Teratoma/Dermoid Cyst

  • describe
  • benign or malignant
  • teratoma=
A
  • Germ Cell tumors 20% -tend to be **Benign
  • Note hair and teeth and skin
  • Teratoma= can be benign or malignant ,tumors of germ cell origin, and often has differentiated structures within it

These can be nasty and are benign

61
Q

Carcinoma of the Ovary:

  • risk of malignancy increases with ____
  • majority derived from _____
A
  • *age
  • -Median age 61 yrs
  • Peaks in late 70s
  • 60% present with advanced disease
  • Majority derived from surface cells – Epithelial-stromal tumors
62
Q

Carcinoma of the Ovary:

-risk factors?

A

Nulliparity – greater menstrual cycles increases risk, oral contraceptives

  • *and pregnancy decreases risk
  • **Genetic factors: BRCA 1 and 2
  • Lynch Syndrome: Hereditary Non-Polyposis Colorectal Cancer
  • History of Breast Cancer
  • Postmenopausal estrogen therapy
  • Obesity
63
Q

Carcinoma of the Ovary:

Serous Cystadenocarcinoma – ___% carcinomas

A

40%

64
Q

Carcinoma of the Ovary:
-Metastases seed omentum and ________
-Other malignancies may metastasize to
the ovaries, from uterus, breast, ___

A

peritoneum

-and GIT

65
Q

Carcinoma of the Ovary:

-Clinical Sx: (hint: which sign, and which tumor marker**)

A
  • Malignant ascites common
  • Palpable ovarian mass in postmenopausal
  • Malignant pleural effusion
  • **Sister Mary Joseph Sign

-***Tumor markers: CA125

66
Q

Abnormal Uterine Bleeding:
menorrhagia=

Metorrhagia=

A

=heavy or prolonged flow

=spotting or between menstrual flow

67
Q

AUB:

Think–>

A 
Uterus and Cervix:
	Menstruation disorders
	Pregnancy Disorders
	Tumors
	Infection

-Ovary or Adnexa:
Tumors
Endometriosis
PID

Hormonal Disorders: Pituitary, Ovarian, Exogenous

Systemic conditions

1 thing to be careful about= POST menopausal woman w uterine bleeding MUST R/O malignancy

68
Q

Carcinoma of the Cervix:

  • how common?
  • majority are ____ cell carcinoma
A
  • Least common Gynecologic cancer
  • Higher incidence in developing countries
  • **Squamous Cell Carcinoma
69
Q

Carcinoma of the Cervix:

-risk factors for Types 16 and 18=

A

**-HPV–> Types 16 and 18 have high risk

70
Q

Carcinoma of the Cervix:
other risk factors?
-clinical sx?

A

Early onset of sexual intercourse

  • Multiple, high risk partners
  • Smoking, OCP, immunodeficiency
  • *Abnormal vaginal bleeding MC
  • Malodorous discharge
  • Obstructs ureters leading to renal failure and death
71
Q

Leiomyoma -Uterine Fibroids = _____ ____ _____ tumor

A

**Benign smooth muscle tumor

72
Q

Leiomyoma - Uterine Fibroids:

-how common?

A
  • Most frequently diagnosed gynecologic tumor
  • Occurs in 20-50% women over 30 yrs
  • Blacks > whites
  • Estrogen sensitive – larger in pregnancy

-Will undergo degeneration, dystrophic calcification, hyalinization (fibroid)

73
Q

Leiomyoma - Uterine Fibroids:

-clinical Sx?

A

Menorrhagia
Obstructive delivery
Pressure on colon with constipation
Pressure on bladder with frequency, urgency, and incontinence

74
Q

Leiomyoma - Uterine Fibroids:

dx?

A

Ultrasound

MRI

75
Q

Leiomyoma - Uterine Fibroids:

Surgery?

A

Myotomy, hysterectomy

76
Q

Uterine Adenomyosis=

A

Endometrial glandular tissue within the myometrium

–leads to enlarged uterus

77
Q

Uterine Adenomyosis:

  • MC age?
  • Clinical sx:
  • Dx?
A

Mid to late 40s

  • Pelvic pain
  • Menorrhagia
  • Dysmenorrhea

-Myometrial Biopsy**

78
Q

Uterine Adenomyosis:

tx?

A

hysterectomy

79
Q

**NOTE:
Although different conditions, Uterine Adenomyosis and Endometriosis are both
caused by the SAME estrogen sensitive ectopic endometrial glandular tissue.

A

endometriosis= tissue that normally lines the inside of your uterus= the endometrium — instead it grows OUTSIDE your uterus.

80
Q

Endometrial Carcinoma of the Uterus= the MC _____

A
  • *malignant gynecologic tumor
  • Median age, 60 yrs
  • **Post menopausal bleeding
81
Q

Endometrial Carcinoma of the Uterus:

-Pathogenesis=

A

prolonged estrogen stimulation

-**OCPs decrease risk

82
Q

Endometrial Carcinoma of the Uterus:
Types–>
-Dx?

A

-Well differentiated adenocarcinoma= MC
-Adenosquamous has squamous elements
=Papillary Adenocarcinoma

dx= Endometrial biopsy

83
Q

Endometrium: Other Disorders

-list Ex’s

A
  • endometrial hyperplasia
  • Tuberculous endometritis
  • multiple endometrial polyps
84
Q

Endometriosis= functioning uterine glands and _____ located ______

-characterized by=

A

stroma**
-located outside of the uterus

  • *cyclic bleeding of glandular and stromal elements
  • MC Sx= Dysmenorrhea***
  • other Sx: Infertility, endometrial cysts (aka chocolate covered cysts)
85
Q

Endometriosis:

-very high in women with ______

A
  • *dysmenorrhea (pain) (40-60%)

- 25-29 yo

86
Q

Endometriosis:

-MC site?

A

ovaries

87
Q

**ALTHOUGH different conditions, Adenomyosis and Endometriosis are both:

A

** caused by the same estrogen sensitive ectopic endometrial glandular tissue.
(KNOW)

88
Q

Endometriosis:

-Diagnosis made by?

A
  • Laparoscopy*

- Increased CA 125

89
Q

Gestational Trophoblastic Neoplasms:

-Hydatidiform mole=

A

clump of growing tissue, aka molar pregnancy
=An abnormal form of pregnancy, the fertilized egg does not have a maternal DNA and does not develop into fetal tissue. The tissue grows from the chorion and placenta
-a benign tumor** of the chorionic villus

90
Q

“dilated, “Grape-like,” swollen villi without fetal blood vessels or parts” =

A

Hydatidiform mole= Molar pregnancy!!**

  • May develop into choriocarcinoma in 20%
  • Dx: US/CT/MRI
91
Q

Gestational Trophoblastic Neoplasms:

-Key clinical sx=

A
  • Vaginal bleeding at 6-16 weeks
  • Severe vomiting= hyperemesis gravidarum-10%
  • MARKEDLY increased Beta hcg
92
Q

Gestational Trophoblastic Neoplasms:

-Tx?

A
  • dilation and curettage

- follow beta hCG levels

93
Q

Gestational Trophoblastic Neoplasms:

-Choriocarcinoma=

A

=Malignant tumor–> Chorionic villi are not present, tumor arises from trophoblastic cells

  • 50% arise from molar pregnancy
  • 25% from spontaneous abortion
  • 20% from full term pregnancy
94
Q

Gestational Trophoblastic Neoplasms:
-Choriocarcinoma:
Sx?

tx: ?

A
  • lesions are hemorragic, vaginal bleeding
  • Chest pain, elevated b hCG
  • Mets: lungs/vagina/brain

excellent response to chemotherapy*****

95
Q

Supporting structures of uterus: list 3

A
  1. Pelvic Diaphragm (Pelvic Floor)= Levator Ani, Coccygeus Muscle, And associated fascia
  2. Urogenital diaphragm/perineal membrane
  3. Perineal body
96
Q

Note: the Broad Ligament, Round Ligament, suspensory ligament of the ovary, and peritoneal folds associated with the uterus are ______

A

**NOT considered to be true uterine support structures

97
Q

“Ligamentous Supporting” Structures of the Uterus:

A

Cardinal (=Transverse cervical, Mackenrodt) – fibromuscular fascia from either side of cervix to the pelvic walls

Uterosacral ligaments–from posterior cervix to the sacrum–comprised of the Recto-uterine folds – comprised of fibrous tissue and muscular fibers attached to front of sacrum

Anterior Pubocervical ligament - from the uterus to the pubic symphysis

98
Q

Cul de sac=

A

rectouterine pouch, rectovaginal pouch/space, aka pouch of douglas

=a deep pouch posterior to the uterus and anterior to the rectum

99
Q

Peritoneal folds associated with the Uterus=

A

Broad Ligament, Mesovarium, Mesosalpinx, Round Ligament

100
Q

Supporting structures of the ovary= (list 3)

A

Mesovarium – a fold of peritoneum off of the Broad Ligament
Suspensory Ligament of Ovary – a fold of peritoneum from superiolateral pelvic wall and contains arteries, veins, lymphatics
Ligament of Ovary – continuous with Round Ligament of Uterus. Attached to lower pole of ovary to Uterus

101
Q

the ______ fascia supports the bladder

-when this fascia weakens, often 2/2 childbirth, then the support of the _____ weakens and ______ occurs

A

**pubocervical

-bladder support weakens–> cystocele (prolapse)

Pathophys Final Exam (semester 2) (5 decks)

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