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Tim's Cards > Reproduction II > Flashcards

Reproduction II Flashcards

1
Q

What is defined as the abnormal presence of neutrophils in the endometrium?

A

Acute Endometritis

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2
Q

What are 3 causes of Acute Endometritis?

A

Ascending Infection due to Abortion

Delivery

Medical Instrumentation

**specific cause rare

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3
Q

What must Acute Endometritis be distinguished from?

A

Normal PMN’s due to menstruation

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4
Q

The presence of plasma cells, lymphocytes, and the occasional lymph nodule within normal Endometrium indicates what?

A

Chronic Endometritis

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5
Q

What is Chronic Endometritis often associated with?

3 things

A

IUD’s

PID

Abortion/Delivery substances (that have been retained)

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6
Q

Bleeding, Pelvic pain, IUD…

A

Chronic Endometritis

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7
Q

Pus in the Endometrial Cavity is defined as…

A

Pyometria

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8
Q

Anything that causes cervical stenosis (narrowing) will be associated with what condition?

*due to tumor, scarring, etc

A

Pyometria

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9
Q

Long standing pyometria may be associated with what?

How often does this occur?

A

Endometrial Squamous Cell Carcinoma

**Rare

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10
Q

Endometrial tissue that forms tumor-like nodules outside the uterus is known as…

A

Endometriosis

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11
Q

What are 3 places Endometriosis is often found?

A

Ovary

Fallopian tube

Pelvic peritoneum

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12
Q

Endometrial foci are composed of what?

A

Endometrial glands and stroma

***responds to estrogenic stimulation/cycle

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13
Q

Why can’t the blood be cyclically discharged in endometriosis?

A

Foci encased in CT/Peritoneum

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14
Q

Endometriosis primarily happens in the 3rd to 4th decade of life, and has a higher incidence in….

A

Higher socio-economic groups

*marry later

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15
Q

T/F

The most popular theory of Endometriosis pathogenesis is the Regurgitation Theory, but is not clearly understood

A

True

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16
Q

What color are the nodules/plaques in Endometriosis?

A

Red-Brown

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17
Q

Where are most foci in Endometriosis found?

A

Orifice of Fallopian Tubes

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18
Q

What percentage of women of reproductive age have Endometrial foci?

A

15-20%

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19
Q

T/F

Endometriosis does not progress to cancer

A

True

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20
Q

Where are Chocolate Cysts found?

How big are they?

A

Ovarian endometriosis

1-5 cms

*filled with brown red viscous fluid

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21
Q

If endometrial glands and stroma enter the myometrium, it can cause what?

A

Adenomyosis

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22
Q

T/F
The deeper the Adenomyosis penetration, the more likely symptomatic with dysmenorrhea (painful menstruation) or menorrhagia (heavy bleeding menstruation)

A

True

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23
Q

Adenomyosis is most often seen in what demographic?

A

Parous - have had children

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24
Q

Small, soft, tan, partially cystic masses in the myometrium is what?

*also mildly proliferative endometrial glands surrounded by stroma of varying fibrotic states

A

Adenomyosis

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25
Q

Adenomyosis is often asymptomatic, what percentage of removed uteri have some degree of this?

A

1/5

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26
Q

Benign tumors of the Myometrial smooth muscle are called what?

A

Leiomyomas

*Fibroids

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27
Q

Leiomyomas are ____ % benign and _____ % malignant and are then called ______

A

98%

1-2%

Leiomyosarcomas

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28
Q

What is the most common uterine tumor?

What % of reproductive-aged women have them?

A

Leiomyoma

20%

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29
Q

In connective tissue, ….oma is ______ and …sarcoma is ______.

A

Benign

Malignant

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30
Q

T/F

Leiomyomas aren’t seen before puberty or after menopause

A

True

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31
Q

Leiomyomas are more commonly seen in what ethnic group?

A

Blacks

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32
Q

Describe the histology of Leiomyoma:

A

Smooth muscle cells in fascicles

*unencapsulated, white-tan whorled masses

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33
Q

What are the 3 types of Leiomyoma fibroids?

A

Intramural - within myometrium

Subserosal - beneath uterine serosa

Submucosal - in endometrial cavity

**size and location determine symptoms

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34
Q

What type of Leiomyoma often compresses the rectum, and can cause abdominal heaviness, urinary urgency, and constipation?

A

Subserosal

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35
Q

What type of Leiomyoma can cause menstrual irregularities, bleeding, and Infertility?

A

Submucosal

*interfere with embryonic implantation

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36
Q

Submucosal fibroid (Leiomyoma) are treated how?

A

Surgically

small, myomectomy

large, hysterectomy

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37
Q

Excessive estrogen can cause what in the endometrium?

A

Endometrial Hyperplasia

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38
Q

Endometrial hyperplasia is mostly what type of tissue?

A

Glandular

*not much stroma

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39
Q

What are the 3 types of Endometrial Hyperplasia?

A

Simple - minimal glandular complexity, no cell atypia

Complex - multi-layered glandular complexity, no atypia

Atypical Hyperplasia - glandular complexity, cell atypia

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40
Q

What are the chances of progression to carcinoma/adenocarcinoma in the 3 types of Endometrial Hyperplasia?

A

Simple - 1% - carcinoma

Complex - 3% - adenocarcinoma

Atypical - 25% - adenocarcinoma

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41
Q

Estrogen -producing tumors, Polycystic Ovarian Syndrome, exogenous estrogen, an Obesity can all cause what?

A

Endometrial Hyperplasia

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42
Q

What is the treatment for Endometrial Hyperplasia?

A

Progestins (high dose)

*synthetic progesterone

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43
Q

What are the benign projections of the endometrial surface called?

A

Endometrial Polyps

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44
Q

What 2 things may cause endometrial foci to produce polyps?

Do polyps slough during menstruation?

A

Hypersensitive to Estrogen

Unresponsive to Progesterone

NO

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45
Q

Where are Endometrial Polyps usually found?

A

Fundus

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46
Q

What bleeds inter-menstually and has a high degree of endomentrial glands and stroma?

A

Endometrial Polyps

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47
Q

Endometrial Polyps aren’t considered neo-plastic, but _____ harbor Adenocarcinomas.

A

0.5%

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48
Q

What is the most common malignant tumor of the female genital tract?

It accounts for what % of GYN malignancies?

A

Endometrial Adenocarcinoma

50%

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49
Q

Endometrial Adenocarcinoma arises from what cells?

Associated with?

A

Epithelial cells lining endometrial glands

More estrogen exposure

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50
Q

What are 4 risk factors for Endometrial Adenocarcinoma?

A

Exogenous estrogen

Estrogen producing tumors

Obesity

Nulliparous (or early menarche/late menopause)

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51
Q

What gives the endometrium breaks from proliferation?

A

Progesterone

*Estrogens stimulate endometrium

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52
Q

What is the most important benefit to estrogen supplements?

A

Prevents bone loss

*but increases carcinoma

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53
Q

T/F

The risks outweigh the rewards for estrogen supplements

A

True

*bone loss more important to address, cancer can be detected early

**15,000 deaths/yr related to osteoporotic bone fractures

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54
Q

What is it about endometrial cancers (adenocarcinoma) that justifies estrogen supplementation?

A

80% confined to uterus.

Excellent prognosis

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55
Q

What 2 cancers, other than Endometrial Adenocarcinoma, are also estrogen dependent and have an increased risk for upon diagnosis?

A

Breast

Ovarian

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56
Q

How do most endometrial adenocarcinomas grow?

A

Exophytic - grow into endometrium

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57
Q

Describe the 4 Stages of Endometrial Carcinoma

A

I - Endometrium only

II - Endometrium, cervix, myometrium

III - Breaches uterus (but not outside pelvis)

IV - Bladder, rectum (outside pelvis)

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58
Q

T/F

Endometrial cancer is rare before 35, presents with inter-menstrual bleeding.

A

True

*mostly diagnosed through irregular bleeding

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59
Q

What is the treatment for Endometrial Cancer?

If advanced (or incomplete resection/undetected)?

If inoperable?

A

Hysterectomy
(with or without ovaries)

Radiation

Chemo

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60
Q

What are the most common primary lesions of the Fallopian Tubes?

A

Benign Paratubal Cysts

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61
Q

Describe Benign Paratubal Cysts?

A

0.1-2.0 cm

Translucent

Clear, serous fluid

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62
Q

Where are the largest Benign Paratubal Cysts found?

A

Fimbrae

Broad Ligament

*little clinical significance

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63
Q

Where do Ectopic Pregnancies most often implant?

3 places

A

Ovary

Abdominal cavity

Fallopian tubes (95%)

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64
Q

Ectopic Pregnancy incidence?

A

1/150

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65
Q

What is the greatest risk factor for Ectopic Pregnancy?

3 additional factors?

A

Chronic Salpingitis

Endometrial peritubular adhesions, Previous surgery, Leiomyoma

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66
Q

What usually happens in Ectopic Pregnancy 2-6 weeks after fertilization?

A

Rupture/Intraperitoneal hemorrhage

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67
Q

T/F

Decidual reaction of endometrium and no chorionic villi are indicative of Ectopic Pregnancy

A

True

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68
Q

PID ascends due to a variety of microorganisms

A

True

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69
Q

The ascent of PID can result in what 3 acute conditions?

A

Salpingitis

Pyosalpinx

Tuboovarian abscess

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70
Q

List 5 species that cause PID starting with the most common.

A

Gonorrhea

Chlamydia

Staph, Strept, Mycoplasma

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71
Q

What procedure/conditions may cause PID?

2 things

A

Septic Abortion

Postpartum endometritis

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72
Q

Cervicitis is usually due to what 2 bugs and has what symptoms?

A

Chlamydia/Gonococcus

Cervix red/swollen - yellow mucopurulent discharge

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73
Q

What is the most common symptom in Cervicitis/PID?

A

Lower abdominal pain

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74
Q

T/F

Gonococcal urethritis is more painful in men, and often asymptomatic in women

75
Q

T/F

Dyspareunia (painful intercourse) and purulent discharge is common in PID

76
Q

PID caused by what organism can be especially consequential (leading to infertility) because of mild symptoms?

A

Trachomatis

77
Q

Name 4 Complications of PID:

A

Sterility - scars fallopian tubes

Ectopic Pregancy

Abscesses- in Fallopian Tubes, ovaries, peritoneum

Peritonitis - bacterial spread out fallopian tubes/ovaries

78
Q

Increase risk of PID due to IUD is due to what organism?

A

Actinomyces israelii

79
Q

Actinomyces israelii is found in what % of genital tracts?

What does it produce?

How does it enter the Uterine Cavity?

A

4%

Sulfur Granules

IUD tail

**G+ Rod

80
Q

Actinomyces israelii PID by IUD can result in what?

A

Extensive scarring

81
Q

T/F

Tumors of the Fallopian Tubes are rare because epithelium does not shed cyclically and isn’t under estrogenic control

82
Q

Of Fallopian Tube cancers, what is the most common?

Account for what % of GYN malignancies?

A

Adenocarcinomas

1%

83
Q

Ovarian Neoplasms come in what 4 subtypes based on their cells of origin?

What % of ovarian tumors do each make up?

A

Surface tumors (70%)

Germ Cell tumors (20%)

Sex cord stromal tumors (10%)

Ovarian metastases

(1st 3 embryological)

84
Q

T/F

The benign Ovarian tumors are more common than malignant ones.

85
Q

What is the 2nd most common GYN cancer?

What does it rank 1st for?

A

Ovarian

Deaths

*causes more deaths than all other GYN tumors

86
Q

How many patients die from Ovarian cancer/year?

A

12,000

*19k new cases

87
Q

The most common Ovarian Neoplasms are derived from what?

How do they act cyclically?

A

Surface Epithelial Cells

Rupture every month

  • proliferating cells heals each month - increases cancer risk
  • *BCP’s suppress
88
Q

What are the four types of Ovarian Surface Epithelial Tumors?

*comprises 70% ovarian tumors

A

Serous

Mucinous

Brenner

Endometroid

*1st 2 cystic, latter 2 solid

89
Q

T/F

All surface tumors of the Ovary are Adenomas

A

False

Adenomas and Adenocarcinomas

90
Q

How are the Serous and Mucinous Epithelial tumors of the Ovary classified?

A

Benign

Borderline

Malignant

91
Q

What are the most common surface tumors of the Ovary?

92
Q

Serous Tumors of the Ovary epithelium consist of what?

What do they mimic?

A

Several encapsulated cysts

Fallopian tube epithelium

93
Q

In Serous Tumors of Ovarian epithelium, what % are benign?

% borderline?

% malignant?

A

60%

15%

25%

94
Q

60% of malignant Serous Tumors of the Ovarian epithelium are bilateral. 30% benign as well. Suggest?

A

Genetic component

95
Q

What do the malignant tumors of the Serous type of Ovarian epithelial cancers form?

A

Papillary projections

96
Q

Mucinous - type Ovarian Epithelial tumors have what ratio of benign:malignant?

What % are bilateral?

A

7:1

10-30%

97
Q

Describe a Mucinous-type Ovarian Epithelial tumor.

A

Thick yellowish or clear jelly-like material

98
Q

If a Mucinous-type Ovarian Epithelial tumor invades the peritoneum, what happens and what is it called?

A

Entire belly filled with mucous

Pseudomyxoma peritonei

99
Q

What type of tumor mimics Endocervical Epithelium?

A

Mucinous tumors (Ovarian epithelium)

100
Q

Describe Endometroid Ovarian Surface Epithelial tumors.

A

Solid, glandular

*resembles endometrial glands

101
Q

What % of Endometroid Ovarian Surface Epithelial tumors have carcinoma of endometrium?

What % have benign endometriosis?

A

15-30%

15%

102
Q

What type of malignancies are Brenner Tumors?

A

Transitional Cell Carcinomas

*Ovarian surface epithelial tumor

103
Q

What type of tumor is solid with dense fibrous stroma and scattered nests of Transitional epithelium?

A

Brenner Ovarian Surface Epithelial tumors

*2%

104
Q

T/F

The vast majority of ovarian tumors are hormonally non-functional

105
Q

What antibody is detected in 50% epithelial tumors confined to the Ovary, and 90% that have spread?

106
Q

What is the survival rate of the progression-types of Surface Epithelial Tumors?

A

Benign - 100% (5 yr)

Borderline - 80%

Malignant - 10-40% (depends on stage)

107
Q

What type of tumor accounts for 20% of Ovarian cancers and is predominately seen in women before age 25?

A

Germ Cell Tumors

108
Q

What is the most common type of Germ Cell Tumor?

most common ovarian tumor in women less than 25

A

Benign Cystic Teratoma
(Dermoid Cyst)

*95%

109
Q

How does Benign Cystic Teratoma present?

A

Cyst, hairy skin, teeth, etc.

  • potentially metastatic but benign in this form
  • *needs removal
110
Q

What is the ovarian counterpart to male Seminoma?

A

Dysgerminoma

111
Q

Describe Dysgerminoma

Treatment?

When does it occur?

A

large and firm

Surgical

Childhood

112
Q

Dysgerminomas are sensitive to what

A

Radiosensitive

113
Q

Dysgerminoma is homologous to what male tumor?

A

Seminoma of testes

114
Q

What is the ovarian counterpart to of the Yolk Sac Tumor of the male testes?

A

Endodermal Sinus Tumor

115
Q

Endodermal Sinus Tumor is rich in what?

Predominantly seen in what age group?

Describe growth

A

AFP - alpha feto protein

Children/young adults

Agressive/rapid

116
Q

What tumor is histologically identical to Placenta?

What does it excrete? (the Tumor Marker)

A

Choriocarcinoma

HCG

117
Q

T/F

Choriocarcinomas usually exist in combo with teratocarcinomas (other germ cell tumors)

118
Q

T/F

Choriocarcinomas are highly lethal because they get into the bloodstream/liver/lungs/bones at time of diagnosis

119
Q

What accounts for 5% of all Ovarian tumors and originate from cells forming the Follicles?

A

Sex Cord Stromal Tumors

120
Q

What are the 3 variants of Sex Cord Stromal Tumors?

A

Theocomas - solid/estrogen secreting/benign

Granulosa - solid/estrogen producing/small are benign/large malignant

Sertoli-Leydig Cell Tumors - solid/Androgen secreting

121
Q

What can Granulosa Sex Cord Stromal tumors cause in the young?
Older?

A

Precocious puberty

Breast/endometrial cancer

122
Q

What does Sertoli-Leydig tumors cause?

What type of tumor is it?

A

Deep voice, hypertrophy clitoris (micropenis), baldness, etc.

Sex Cord Stromal Tumor

*can be benign/malignant

123
Q

Where do Metastatic Ovarian Tumors most often originate?

What explains this?

A

Carcinomas of Endometrium and Breast

Tumors have estrogen receptors

124
Q

What is the most common tumor of the GI tract that metastasizes on the ovary?

A

Krukenberg tumors

***Stomach carcinoma

125
Q

Describe the maternal surface of Normal Placenta

Describe the fetal surface of a Normal Placenta

A

Dark red, lobules (cotyledons)

Shiny, gray, translucent

126
Q

Out of the syncytiotrophoblast, cytotrophoblast, connective tissue, and endothelium of fetal capillaries that make up the Placenta early in pregnancy, what degenerates in late pregnancy?
What is displaced?
What remains?

A

Cytotrophoblast

Connective tissue displaced by fetal capillaries

Syncytiotrophoblast/fetal capillary endothelium

127
Q

How does the blastocyst stimulate the endometrium for implantation?

A

Decidual Reaction

*stimulates Stroma to thicken and vascularize

128
Q

T/F

The placenta produces both steroid and protein hormones

129
Q

Name 2 hormones secreted by the Placenta

A

Human chorionic gonadotropin (hCG)- stimulated progesterone production by corpus luteum

Human placental lactogen (hPL) - induces lypolysis

130
Q

What hormone is considered the Growth Hormone for the fetus?

A

hPL - Human Placental Lactogen

131
Q

T/F

Estrone, Etstradiol, and Estriol are all steroid hormone of unknown function secreted by the Placenta

132
Q

What hormone is used by the fetal adrenal cortex as a precursor for other hormones?

A

Progesterone

“seeds” cortex

133
Q

What placental variation presents as a thick ring that is over the fetus rather than around the placenta?

A

Circumvallate Placenta

134
Q

T/F

Placenta can have accessory lobes and are usually of no clinical importance

135
Q

What variation of Placenta has small gray or yellowish nodules on the fetal surface associated with oligohydramnios and Potters syndrome (renal agenesis)?

A

Amnion Nodosa

136
Q

What are the contents of the Umbilical cord?

A

Right and Left arteries

Vein

Wharton’s Jelly

137
Q

What blood is in the Right and Left umbilical arteries?

What blood is in the Umbilical vein?

A

Deoxygenated blood from fetus to placenta

Oxygenated blood from placenta to fetus

138
Q

T/F

Presence of only on Umbilical artery suggests CV abnormalities

139
Q

If the umbilical cord is inserted into the fetal membranes and not the placenta, this suggests what?

A

Velamentous Insertion

*longer cord - 1%

140
Q

T/F

True knots are found more often in males

A

True

*false knot is Wharton’s jelly accumulation

141
Q

What is it called if the umbilical cord becomes wrapped around the neck?

A

Nuchal cords

142
Q

T/F

15-20% of pregnancies have one-loop nuchal cords

143
Q

T/F

The amniotic fluid increases through the 7th month and decreases in last 2

144
Q

What is the volume of amniotic fluid at birth?

What is the exchange rate?

A

1 liter

400-500mL/HOUR

145
Q

How much amniotic fluid will the term fetus swallow daily?

How much urine excrete daily?

A

400 mL

500 mL

146
Q

What is produced in fetal hepatocytes?

Elevated levels associated with what?

Reduced levels associated with what?

A

AFP - alpha fetoprotein

Neural tube defects (spina bifida) or Esophageal problems

Down syndrome

147
Q

Fetal swallowing defects or absorption defects (duodenal) result in what?

What is this associated with?

A

Polyhydramnios

(too much amniotic fluid)

Diabetes

148
Q

What is a low amount of amniotic fluid called?

Caused by?

Causes what congenital malformations?

A

Oligohydraminios

Inability to excrete urine

Potter’s syndrome/hypoplastic lungs

149
Q

Placenta implanting over the cervix is called what?

It is often caused by?

A

Placenta previa

Decidua deficiency

**old cesarean scars also have difficulty implanting

150
Q

5 contributing factors for Placenta Previa

A

C-section

Advanced maternal age

multiparity

Cocaine

Cigarettes

151
Q

What placental condition is marked by the absence of decidua and inability to separate from wall?

A

Placenta Accreta

152
Q

Placenta Accreta is subclassified according to what?

A

Depth of villous invasion to myometrium

153
Q

What are the 3 types of Placenta Accreta?

A

Placenta Accreta - villi to myometrium

Placenta Increta - villi to underlying myometrium

Placenta Percreta - villi across uterine wall

**normal villi

154
Q

What is the most common presentation of Placenta Accreta?

A

3rd trimester bleeding

155
Q

T/F

Postpartem hemorrhage from Placenta Accreta requires emergency hysterectomy

156
Q

Placenta accreta has a maternal death rate of what?

157
Q

Blood between the basal plate of the placenta and uterine wall is what?

Accounts for what % of perinatal deaths?

A

Retroplacental Hematoma

8%

158
Q

T/F

smoking, advanced age, cocaine, and acute chorioamnionitis are all associated with Retroplacental Hemotama

159
Q

What is the term for infection/inflammation of the placental amnion, chorion, and extraplacental membranes?

A

Chrioamnionitis

160
Q

T/F

Chorioamnionitis can spread to the umbilical cord (funisitis)

161
Q

5 Bacteria responsible for Chorioamnionitis starting with the most common

A

Mycoplasma

Bacteroides

B strep

E. coli

Gardnerella vaginalis

162
Q

These bacteria responsible for chorioamnionitis are found in what % of placentas?

163
Q

Infection of the placental villi can come from what 2 sources?

A

Endometritis

Transplacental from maternal circulation

*syphilis, rubella, HSV, etc.

164
Q

T/F

Meconium stained placentas occur 18% of the time and are usually in pregnancies that go longer than 42 weeks

165
Q

Thick meconium aspiration causes what?

A

Fetal chemical pneumonitis

166
Q

T/F

There are macrophage within fetal membranes of meconium stained placenta

167
Q

What are the 3 most common sites of Ectopic pregnancy?

A

Tubal - 95%

Ovarian

Peritoneal

168
Q

T/F

The aspiration of fresh blood from the Pouch of Douglas (posterior fornix) denotes ectopic rupture

169
Q

What disease involves the trophoblastic epithelium?

A

Gestational Trophoblastic Disease

170
Q

Trophoblastic proliferation and degeneration of chorionic villi suggest what placental abnormality?

A

Hydatidiform Mole

171
Q

Complete Hydatidiform Mole is caused by what?

A

All chromos paternal

Androgenesis 23 X to 46

172
Q

T/F

Without maternal chromos the embryo can’t develop and the placenta undergoes hydropic degeneration

173
Q

2 Sperm fertilizing an ovum will result in what?

A

Incomplete Hydatidiform Mole

  • 69 chromos
  • *fatal but not immediate
174
Q

What is the incidence of H. moles in the US?

Diagnosis based on what?

A

1/2000 pregnancies

Enlarged uterus - no fetus

175
Q

What hormone is found in Hydatidiform Mole in high levels?

176
Q

T/F

Hydatidiform Mole pregnancies are aborted spontaneously mid-pregnancy

177
Q

Why is it important to remove Hydatidiform Mole completely upon miscarriage?

Grossly, what does H. Mole look like

A

Trophoblastic cells are potential malignancies (chorio)

Grape-like clear vesicles

178
Q

The malignant tumor composed of trophoblastic cells is called what?

A

Choriocarcinoma

179
Q

T/F
50% of Choriocarcinomas arise from a preexisting complete mole
25% retained abortive tissue
25% normal placenta

180
Q

Describe the nature of choriocarcinoma and what its marker is

A

Highly invasive

hCG

181
Q

T/F
Choriocarcinoma forms bulky hemorrhagic nodules in the placental bed
Invades through uterus, often implants in vagina

182
Q

Where does Choriocarcinoma often metastasize to once it invades the veins?

A

Lung, liver, and brain

183
Q

What does Choriocarcinoma respond well to if it hasn’t yet metastsized?

A

Chemo with Methotrexate

80-100% cure rates

Tim's Cards (140 decks)

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