repro

Question 1

1. Know the definitions and causes of dysmenorrhea, amenorrhea, and DUB (be able to define an anovulatory cycle).

Answer 1

painful periods (1. Primary – due to monthly release of prostaglandins from endometrium 2. Secondary - related to pelvic pathological conditions (e.g., endometriosis) and can occur anytime in cycle)

Lack of menstruation (1. Primary (no menarche) – caused by hypothalamic-pituitaryovarian axis disorder, for e.g. 2. Secondary (cessation of menses for at least 6 months after establishing normal menstrual cycle) – caused by ovarian, pituitary or hypothalamic dysfunction, anorexia nervosa, for e.g.)

Heavy or irregular bleeding in the absence of disease

Question 2

2. Define and describe endometriosis (be able to define retrograde menstruation).

Answer 2

presence of functioning endometrial tissue outside of the uterus (occurs primarily in the abdominal and pelvic cavities.)

not sure of cause (could be retrograde menstruation, remnants from embyonic development, or spread through lymph/blood)

blood goes different direction

Question 3

3. Describe cervical cancer, including its cause, associated risk factors and detection.

Answer 3

Almost exclusively caused by human papillomavirus (HPV) (specifically, the “high-risk” types)

Risk factors are early intercourse/multiple sex partners, a history of STI’s, smoking, immunosuppression.

Slowly progressive disease – about 90% of cervical cancers can be detected early through the use of Pap smears and HPV testing

Question 4

Describe endometrial cancer, including the primary risk factor and what age group is mainly affected

Answer 4

Most prevalent malignancy of female reproductive tract

Primary risk factor is unopposed estrogen exposure (as in anovulatory cycles or estrogen therapy for symptoms of menopause) resulting in hyperplasia.

Mostly occurs in post-menopausal women

Question 5

5. What is the most significant risk factor for ovarian cancer?

Answer 5

length of time when the ovarian cycle is not suppressed by pregnancy (i.e., incidence is lower in countries with multiple births/woman)

Question 6

What is one of the reasons why ovarian cancer causes more deaths than any other cancer of the reproductive system?

Answer 6

Early stages very difficult to detect (only 20% of ovarian cancers are found in the early stage)

Question 7

7. Define galactorrhea, mastitis, ductal disorders and intraductal papillomas.

Answer 7

secretion of breast milk in a nonlactating breast

inflammation of the breast, usually from infection occurring during lactation

Disorders of the milk ducts

benign epithelial tissue tumours that manifest with a bloody nipple discharge

Question 8

8. Describe a fibroadenoma and fibrocystic changes.

Answer 8

A firm, rubbery, sharply defined mass, easily moveable – asymptomatic

Most frequent breast lesion, multiple, mobile, masses and compressible cysts that are more prominent and painful during luteal portion of the cycle - Occurs within both breasts at the same time

Question 9

9. Outline the incidence, from what tissues most breast cancers arise, the metastasis and the initial manifestation of breast cancer.

Answer 9

Most breast cancers arise from the epithelium of the ducts (79%), but can occur in the lobules or in the stroma (connective tissue between ducts).

The edges of the lesion can invade local tissue, which is then followed by malignant cells scattering into the lymph nodes. From there, the cancer can metastasize into other body sites, commonly the lung, liver and bone.

First sign is usually a painless lump, usually in upper outer quadrant, where most of the glandular tissue of the breast is located.

Question 10

What are two mechanisms in which estrogen is thought to play a part in the development of breast cancer?

Answer 10

Estrogen is thought to either cause increased cell proliferation, which increases the possibility of accumulating genetic damage, or break down into toxic compounds that can directly damage DNA.

Question 11

11. What timing (early/late onset) for menarche and menopause increase the risk for breast cancer?

Answer 11

Early menarche + late menopause increases the risk

Question 12

12. What timing for giving birth affects the risk of breast cancer?

Answer 12

Giving birth at less than 18yrs decreases the risk; at more than 35 yrs increases the risk

Question 13

13. Name the two genes that have been linked with an increased risk of breast cancer.

Answer 13

(BRCA1 and BRCA2

Question 14

14. Define lobular involution of the breast. How does this process alter the risk of breast cancer?

Answer 14

the glandular structures and connective tissue between the glands are replaced with fatty tissue

The more involution has occurred, the lower the risk of cancer

Question 15

15. What is the “dense” tissue of breast tissue composed of? How does the amount of dense tissue in a woman’s breast affect her risk for breast cancer?

Answer 15

The denser the tissue (thought to be both glandular and connective tissue between the glands, which appears white on a mammogram), the higher the risk. The more involuted the breast tissue (the fattier), the lower the risk.

Question 16

16. Define cryptorchidism, hydrocele and varicocele.

Answer 16

group of abnormalities in which the testis fails to descend completely (may remain in abdomen, or only partially descend)

excess fluid builds up between tissue layers surrounding the testes. May be congenital, result of injury, infection

varicosities of veins supplying the testes, usually on the left side

Question 17

17. Describe torsion of the testis, its causes and what it can lead to.

Answer 17

when the testis rotates on its axis, interrupting its blood supply

congenital abnormalities of tunica vaginalis or spermatic cord exist that predispose

Causes ischemia

Question 18

18. Define benign prostatic hyperplasia (hypertrophy).

Answer 18

Age related, non-malignant enlargement of the prostate gland

Question 19

19. When and why does it happen?

Answer 19

: >50% men older than 60 have BPH

Normal enlargement that begins around 40-45 yrs of age and continues slowly for remainder of life

Result of a complex interaction between sex hormones, chronic inflammation and growth factors.

Question 20

20. What is the effect of BPH on the frequency of urge to urinate, time required to start urination and strength of force of flow.

Answer 20

if the prostatic urethra is compressed, symptoms occur, including frequent urges to urinate, delay in starting urination and decreased force of flow

With further obstruction, the bladder can’t empty all of the urine, leading to uncontrolled overflow incontinence (involuntary release of urine from an overfull bladder) with any increase in intra-abdominal pressure.

Question 21

21. What occurs with BPH that can lead to incontinence, infection, bladder stones and kidney failure?

Answer 21

There is increased risk for infection and bladder stones.

Back-pressure on the ureters and kidneys can promote hydroureter, hydronephrosis and eventual kidney failure

Question 22

22. Be familiar with risk factors for prostate cancer.

Answer 22

Other risk factors may include inflammation, hormones, genetic factors

diet has an influence on the development of prostate cancer

Question 23

23. What does PSA stand for, where does it come from and what is it used for?

Answer 23

prostate specific antigen

a compound that is secreted by prostate cells (both benign and malignant) – can be used to screen for prostate cancer

Question 24

What is the difference in location within the prostate gland between BPH and a tumour in prostate cancer?

Answer 24

Tumour usually located in periphery of prostate (not around the urethra, as in BPH)

Question 25

25. What are the usual symptoms of early prostate cancer?

Answer 25

If early symptoms are present, they are usually symptoms of bladder outlet obstruction – may be accompanied by rectal obstruction, as well.

Question 26

26. Be familiar with usual symptoms of late prostate cancer.

Answer 26

Symptoms of late disease include bone pain at sites of bone metastasis, enlargement of lymph nodes, liver enlargement, mental confusion associated with brain metastases

Question 27

Know the definitions of complete fracture and the types of complete fractures: comminuted, spiral, transverse, oblique and linear.

Answer 27

– the bone is broken entirely

Comminuted – two or more fragments present

spiral (encircles the bone),

transverse (straight across),

oblique (at an angle),

linear (along the length of the bone

Question 28

2. Know the definitions of incomplete fracture and the types of incomplete fractures: greenstick, torus and bowing.

Answer 28

bone is damaged but still in one piece (tend to occur in children

Greenstick – only one side is broken

Torus – the outer portion of the bone buckles, but doesn’t break

Bowing – in bone pairs (tibia/fibula, radius/ulna) – one bone breaks, but the other only bends. Difficult to treat, as have two different situations

Question 29

3. Define open vs closed fractures

Answer 29

Open (compound) – skin is broken

Closed (simple) – skin is intact

Question 30

4. Define the 3 classifications of fractures, based on cause.

Answer 30

Sudden injury – result of a fall, a blow, or massive muscle contraction, etc.

Pathologic – due to a prior disease that weakens a bone (e.g., tumors, infections, osteoporosis). Can occur spontaneously with little or no stress

Stress - in normal bone (due to repeated stress on the bone, e.g., in a new sport, muscle gains strength before bone, and can get microfractures within bone).

Question 31

5. Describe the steps involved in healing of a fracture, using the terms: fibrocartilaginous callus (procallus) and bony callus.

Answer 31

1. A clot forms in the medullary cavity, under the periosteum, and between the ends of the bone fragments.
2. Adjacent bone tissue dies (necrosis) because the torn blood vessels are unable to perform exchange of nutrients/waste, gases to site.
3. This stimulates inflammation (vasodilation, infiltration of plasma, WBC, growth factors and mast cells)
4. Phagocytic cells move in and remove dead tissue. Fibroblasts and chondroblasts also arrive and lay down collagen fibers and cartilage, respectively on the network formed by the fibrin of the clot. This forms an initial bridge (fibrocartilaginous callus = procallus) between the bone ends
5. Osteoblasts within the procallus (from the periosteum and endosteum) synthesize bone matrix, which then calcifies, forming a bony callus (3).
6. During subsequent months, the callus is remodelled (4) by osteoblasts and osteoclasts (excess callus is resorbed and trabeculae are formed along lines of stress)

Question 32

6. Define dislocation and subluxation and where these are most likely to occur.

Answer 32

Displacement of one or more bones in a joint in which opposing surfaces lose all contact, most often joints of the shoulder (most often), elbow, wrist, finger, hip and knee

Displacement of one or more bones in a joint in which opposing surfaces lose only some contact, same joints as above

Question 33

7. Define kyphosis, lordosis and scoliosis and be familiar with the causes for each.

Answer 33

Increased curvature of upper spine – Brought about through diseases causing loss of bone density in vertebrae (osteoporosis, etc.) or fusion of joints between vertebrae (ankylosing spondylitis, etc.

Excessive curvature of lower spine – Brought about through misaligned vertebrae, for e.g.

Lateral deviation of the spinal column, with/without rotation – Can be idiopathic (perhaps genetic), due to systemic conditions (cerebral palsy), conditions not directly affecting spine (leg length discrepancy), etc.

Question 34

8. Define strain, sprain and avulsion and where these are most likely to occur.

Answer 34

Tearing or stretching of a muscle or tendon – Can occur anywhere in body, but most common in lower back, and neck portion of spine (“whiplash”).

Tearing of ligament. – Most common in ankle, but can occur in wrist, elbow and knee

Complete separation of ligament from bone is called an avulsion.

Question 35

Define osteoporosis, the general process that leads to this condition and identify where in the body it is most likely to occur.

Answer 35

Decrease in mineralized bone mass, leading to fragile bones

General process is that old bone is being reabsorbed faster than new bone is being deposited, resulting in bones losing density (thinner and more porous

Appears to be most severe in femoral neck, thoracic and lumbar spine, and wrist

Question 36

10. At what age does peak bone mass occur?

Answer 36

Peak bone mass occurs at around age 30, and then declines (resorption slowly exceeds formation).

Question 37

11. What hormone is linked to post-menopausal osteoporosis, and what is the main effect of this hormone that affects bone density?

Answer 37

Estrogen

– Estrogen has an osteoclast inhibiting activity by: • directly decreasing the production of cytokines that increase osteoclast formation • increasing the production of cells that release compounds that decrease osteoclast production

Question 38

12. Describe two differences between men and women that result in men developing osteoporosis later in life.

Answer 38

The decrease in bone protecting hormones (testosterone, estrogen) in men is more gradual than in women, so that there is slower loss of bone in men than women during aging.

Men also begin with denser bones, so osteoporotic levels are reached at an older age.

Question 39

13. Be familiar with conditions that can result in secondary osteoporosis (=risk factors). (Name four hormones that can affect bone density and how their influence is possible).

Answer 39

LONG TERM CORTICOSTEROID USE

ENDOCRINE DISORDERS: Hyperparathyroidism (increased bone resorption) – Hyperthyroidism (increased metabolism = increased bone turnover with disruption of osteoblast / osteoclast balance) – Cushing’s syndrome (oversecretion of cortisol leads to increased bone protein breakdown) – Diabetes mellitus : increased porosity & AGEs  brittle bone that doesn’t deform

ALCOHOLISM

Question 40

14. Describe three clinical manifestations of osteoporosis

Answer 40

Kyphosis: hunched back due to vertebral collapse

Loss of height due to compression of spinal column

Fractures very common due to thin and sparse trabeculae in spongy bone and porous compact bone.

Question 41

15. What is osteomyelitis?

Answer 41

Infectious bone disease

Question 42

16. Name and describe the difference between the two types of osteomyelitis.

Answer 42

Exogenous osteomyelitis - most common. Caused by pathogens introduced through direct entry (open fractures, penetrating wounds (bites), surgery).

In hematogenous osteomyelitis, pathogens are carried in the blood from site of infection elsewhere in the body. (usually found in infants, children and elderly

Question 43

17. What is the primary causative organism for osteomyelitis?

Answer 43

Staphylococcus aureus

Question 44

18. Describe the sequence of events that can occur in children upon infection causing osteomyelitis. Know the terms: sequestrum and involucrum.

Answer 44

1. Affects area in metaphyseal region close to the growth plate in long bones (blood flow favours attachment of bacteria)
2. Purulent exudate develops within bone and beneath periosteum. This cuts off blood supply and causes bone in cortex to die = sequestrum.
3. Lifting of periosteum stimulates osteoblasts, which lay down layer of bone on top of sequestrum (involucrum)

Question 45

19. Define osteroarthritis.

Answer 45

An age-related progressive, inflammatory, degenerative disorder of synovial joints. Not autoimmune in nature

Question 46

20. Be familiar with primary and secondary causes.

Answer 46

Primary cause: intrinsic defects in articular cartilage (i.e., natural variation between individuals)

Secondary causes: congenital joint defects, trauma (sports injuries), infection, crystal deposits, excessive life-long wear & tear, inflammatory diseases (including rheumatoid)

Question 47

21. Where in the body does osteoarthritis usually occur?

Answer 47

hands, hips or spine

Question 48

22. What is the primary defect in osteoarthritis?

Answer 48

intrinsic defects in articular cartilage

Question 49

23. Describe the sequence of events in the development of osteoarthritis.

Answer 49

1. Early in disease, articular cartilage changes structure; the surface flakes off and underlying layers develop cracks.
2. Exposed articular bone becomes hardened and may develop cysts.
3. Cartilage coated projections of bone at the edges of the joint (osteophytes) may grow out and alter the anatomy of the joint.
4. Small pieces of these projections may break off (joint mice) and go into the synovial cavity.
5. If the synovial membrane is irritated by these, synovitis and joint effusion develop.
6. The joint capsule becomes thickened and may stick to the underlying bone, therefore restricting movement.

Question 50

24. At what age does osteoarthritis usually appear?

Answer 50

5th or 6th decade of life.

Question 51

25. What are the primary signs of osteoarthritis? When is stiffness present?

Answer 51

Primary signs include pain, stiffness, enlargement (swelling), deformity of joints

Stiffness is usually only in first few minutes of use (uncommon to persist after 30 min)

Question 52

26. What causes the enlargement (swelling) of the joints in osteoarthritis?

Answer 52

due to bone enlargement around the joint

Question 53

27. Why is the range of motion limited?

Answer 53

due to cartilage degeneration and formation of osteophytes. Movement often accompanied by creaking or grating sounds.

Question 54

28. What is inflammatory joint disease characterized by?

Answer 54

inflammatory damage in the synovial membrane or articular cartilage and by systemic signs of inflammation (fever, leukocytosis, malaise, anorexia

Question 55

29. Name and describe the two types of inflammatory joint disease.

Answer 55

Infectious – caused by introduction of pathogens through wound or the bloodstream

Noninfectious – Most common – caused by immune reactions (rheumatoid arthritis and ankylosing spondylitis) or deposition of monosodium urate crystals (gouty arthritis)

Question 56

30. Define rheumatoid arthritis.

Answer 56

Chronic, systemic, inflammatory autoimmune disease distinguished by joint swelling and tenderness and destruction of synovial joint

Question 57

31. What are the most common joints affected by rheumatoid arthritis?

Answer 57

e fingers, wrists, elbows, feet, ankles, knees

Question 58

33. What is an RF factor in the development of rheumatoid arthritis?

Answer 58

“rheumatoid factors” RFs) that react to portions of host antibodies present in the synovial membrane

Question 59

34. Name 3 clinical manifestations of rheumatoid arthritis that differ from osteoarthritis.

Answer 59

inflammation: fatigue, weakness

Stiffness lasts for about 1 hour after rising

– Loss of mobility leads to atrophy of surrounding muscles

Question 60

35. Define ankylosing spondylitis, including how it is manifested and probable cause.

Answer 60

chronic, systemic inflammatory disease of the joints of the vertebral column, typically beginning with the sacroiliac joints then ascending to smaller spinal joints

Manifested by pain, progressive stiffening and fusion of the spinal column due to ossification of disks, joints and ligaments

autoimmune in nature

Question 61

36. Define equinovarus and be familiar with possible causes.

Answer 61

One or both feet turn inward and downward

Can be positional, idiopathic or as a result of another syndrome (e.g., spina bifida)

Question 62

37. Define developmental dysplasia of the hip and be familiar with possible causes and treatment.

Answer 62

– Imperfect development of the hip joint, ranging from unstable (loose) to dislocation.

environment, genetic, associated with other defects

– May be correctable with Pavlik harness (2-3 weeks, if successful) – If not successful, requires surgery and body casting