Female Reproductive Pathologies Flashcards
(236 cards)
1
Q
T/F Normally, the only significant source of estrogen in non-pregnant women is the corpus luteum.
A
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).
2
Q
T/F Normally, the only significant source of progesterone in noon-pregnancy women is the corpus luteum.
A
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.
3
Q
T/F Estrogen inhibits GnRH & gonadotropin release in typical negative feedback fashion.
A
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.
4
Q
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.
A
4
True
Furthermore, as the corpus luteum degenerates, progesterone levels plummet, which brings about menstruation.
5
Q
T/F Under certain conditions, adipose tissue can convert androgens into estrogens.
A
5
True
This is because adipose tissue expresses the aromatase enzyme.
6
Q
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)
A
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.
7
Q
T/F The corpus luteum is the major source of estrogen and progesterone throughout all three trimesters of a pregnancy
A
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.
8
Q
T/F The term “venereal infection” is a synonym for “sexually transmitted disease”
A
8
True
9
Q
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.
A
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).
10
Q
The [follicular/luteal/gestational] phase of the ovarian cycle occurs before ovulation from days 1 to about days 14.
A
10
follicular
11
Q
The [follicular/luteal/gestational] phase of the ovarian cycle occurs after ovulation from about days 14 to 28.
A
11
luteal
12
Q
In females, [LH and FSH / androgens / GnRH / prolactin / oxytocin] stimulate(s) follicle cells to secrete sex hormones.
A
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.
13
Q
The [menstrual/follicular/proliferative/secretory] phase is the only phase (of those four) which is not part of the uterine cycle.
A
13
follicular
14
Q
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.
A
14
HcG
15
Q
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.
A
15
stratum functionalis
16
Q
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.
A
16
stratum basilis
17
Q
______ refers to a normal monthly flow.
A
17
menorrhea
18
Q
_____ refers to the lack of menstruation in a reproductive-aged woman.
A
18
amenorrhea
19
Q
_____ refers to a difficult or painful monthly flow; pelvic pain during a menstrual period that does not resolve with the onset of menses.
A
19
dysmenorrhea
20
Q
_____ refers to a monthly flow where the duration is long and/or the amount heavy; aka menorrhagia
A
20
hypermenorrhea
21
Q
_____ refers to a monthly flow where the duration is short and the amount scant
A
21
hypomenorrhea
22
Q
_____ refers to excessive uterine bleeding at and between menstrual periods
A
22
menometrorrhagia
23
Q
____ refers to a menstrual period where the cycle is abnormally short (<22 days)
A
23
polymenorrhea
24
Q
______ refers to infrequent menstrual periods (36 days to 6 months), usually with scanty flow as well
A
24
oligomenorrhea
25
_____ refers to a monthly flower wherein, for a variety of reasons, the products of menstruation remain internal
25
| cryptomenorrhea
26
A(n) _____ is the cholesterol-packed ovarian structure that develops from a ruptured follicle following ovulation
26
| corpus luteum
27
A(n) ____ is a developing oocyte and its surrounding specialized cells.
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.
28
The ____ refers to the initial, funnel-shaped portion of the uterine tube which is open to the peritoneal cavity.
28
infundibulum
It is the infundibulum that bears the fimbriae and is responsible for bringing an ovulated oocyte into the uterine tubes.
29
The ____ refers to the outermost, serious covering of the uterus.
29
| perimetrium
30
The ____ refers to the middle, muscular layer of the uterus.
30
| myometrium
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.
31
| endometrium
32
The ___ refers to the cul-de-sac between the uterus and the rectum; it is often sampled during culdocentesis.
32
| rectouterine pouch, or pouch of Douglas
33
The ___ refers to the external female genitalia.
33
| vulva or pudenda
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.
34
| vestibule
35
The secretions of the two ____ glands keep the vestibule moist and lubricated.
35
| Bartholin's glands
36
Contractions of the ____ in the endometrium cause/facilitate the shedding of the stratum functionalism during menstruation.
36
| spiral arteries
37
Which fetal/placental hormone is responsible for maintaining the corpus luteum during the initial trimester of pregnancy?
37
| hCG
38
T/F Herpesvirus is typically spread by aerosolized droplets, or by touching contaminated surfaces such as doorknobs or table tops.
46
False
Herpesvirus is typically spread via sexual contact.
39
T/F Typically herpes simplex virus (HSV) type I causes cold sores while HSV type II causes genital herpes
47
True
but remember that either virus type can cause lesions elsewhere on the body
40
T/F Herpes simplex virus type II causes genital herpes but does not - and cannot - cause cold sores in the perioral areas.
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.
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.
49
False
HSV can also be transmitted via viral shedding, e.g., from saliva or skin moisture
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
50
| True
43
T/F Genital herpes is easily resolves after treatment with antibotics such as doxycycline or tetracycline
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.
44
T/F Herpesvirus may be associated with Bell palsy.
52
| True
45
T/F Presently, genital herpes cannot be cured
53
| True
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
54
True
Types 16 and 18 are the two biggies for high risk lesions; these two strains cause about 70% of cervical cancers.
47
T/F The HPV types that cause genital warts also cause cervical cancer
55
| False
48
T/F The Gardasil vaccine provides protection against infection by all types of HPV
56
False
In fact,it only protects agains four types of HPV.
49
T/F Most HPV infections in young women spontaneously disappear within two years
57
True
70% by one year, 90% by two years.
50
T/F With HPV infections, progression from precancerous lesion to cervical cancer is fairly rapid, typically occurring in two years or less
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.
51
T/F All women aged 18 to 65 years old should seek out regulate Pap smear testing
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).
52
T/F Gonococcus and Chlamydia trachoma's are two pathogens that are common causes of pelvic inflammatory disease
60
| True
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].
61
| C. albicans
54
____ refers to inflammation of the inner lining of the uterus.
62
| Endometritis
55
____ refers to inflammation of the entire female reproductive system
63
| Pelvic inflammatory disease (PID)
56
____ refers to inflammation of the uterine (fallopian) tubes
64
| Salpingitis
57
____ refers to inflammation of of the ovaries
65
| Oophoritis
58
____ refers to difficult or painful sexual intercourse
66
| Dyspareunia
59
____ refers to inflammation of the uterus
67
| Metritis
60
____ refers to inflammation of the cervical canal
68
Endocervicitis
The endocervix refers to the cervical canal.
61
____ refers to inflammation of the vagina; aka vaginitis
69
| Colpitis
62
____ refers to an infectious eye disease caused by chlamydial bacteria; it is a leading cause of blindness worldwide
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.
63
_____, seen on dentists and health care workers, produces herpetic vesicles on the thumbs or fingers
71
| Herpetic whitlow
64
____ are also known as anogenital genital, or venereal warts
72
| Condylomata acuminatum
65
Medically, warts are known as ____
73
| verrucae
66
____, otherwise known as Flayl, is the drug typically used to treat trichomoniasis
74
| Metronidazole
67
A nonbacterial pathogen that typically causes vesicles in the anogenital or peritoneal areas; these vesicles then rupture, giving rise to shallow ulcers
77a
D
Herpesvirus
68
The bacterium responsible for syphilis
77b
I
Treponema pallidum
69
The bacterium responsible for gonorrhea
77c
G
Neisseria gonorrhoeae
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
77d
B
Chlamydia trachomatis
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
77e
F
Mumps virus
72
A yeast that typically causes vulvovaginitis
77f
A
Candida albicans
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
77g
C
Gardnerella vaginalis
74
Also known as gonococcus
77h
G
Neisseria gonorrhoeae
75
A virus that causes warts (common and genital) and is associate with cervical cancer
77i
E
Human papilloma virus
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
77j
H
Staphylococcus aureus
77
A protozoan which, in women, proceeds a greenish, frothy vaginal discharge accompanied by itching
77k
J
Trichomonas vaginalis
78
T/F In a grade 2 cystocele, the bladder sinks far enough to reach the introitus
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.
79
T/F Chronic constipation and straining to pass bowel movements are two potential causes rectocele
79
True
Episiotomy and large baby deliveries are two others.
80
A(n) _____ is a herniation of the urinary bladder through the pubocervical fascia and into the vagina
80
cystocele
Pubocervical fascia is another name for the vesicovaginal septum.
81
A(n) _____ is a herniation of the rectum through the rectovaginal septum and into the vagina
81
| rectocele
82
A bladder that has dropped down from its normal position (e.g. because of a cystocele) may cause two kinds of problems: ______ and ______
82
| unwanted urine leakage and incomplete emptying of the bladder
83
A(n) _____ is a medical procedure to suture the vagina, usually to close an incision made during surgery
83
| colporrhaphy
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
84
| pessary
85
The ____ refers to the vaginal orifice -- the outer or vestibular opening to the vagina
85
| introitus
86
T/F NSAIDs often work well in resolving primary dysmenorrhea
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
87
T/F The most common cause of secondary dysmenorrhea is excessive prostaglandin secretion
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.
88
T/F Primary dysmenorrhea refers to dysmenorrhea where the problems lies with the ovaries
89
False
Primary dysmenorrhea is usually due to overproduction of prostaglandins
89
T/F Common causes of secondary dysmenorrhea include endometriosis, fibroids, PID, and IUD problems
90
True
these and a few other causes were listed in the lecture notes
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
91
| True
91
T/F Some women experience nausea and vomiting with dysmenorrhea
92
| True
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
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.
93
T/F Primary amenorrhea refers to amenorrhea where the problems lies with the uterus
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).
94
T/F Amenorrhea is normal for some variable number of months following a pregnancy
95
| True; it has to do with prolactin inhibiting GnRH release from the hypothalamus.
95
T/F A woman misses 2 cycles in a row -- this qualifies for amenorrhea
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.
96
____ refers to spontaneous milk production unrelated to pregnancy
97
| Galactorrhea. Usually hyperprolactinemia will be present as well.
97
A(n) ____ should always be the first workup for a patient with secondary amenorrhea
98
| pregnancy test; the answer to this question should be obvious
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
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.
99
T/F A woman with hirsutism and elevated testosterone levels most likely has an adrenal problem
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.
100
T/F A woman with hirsutism and elevated DHEA sulfate levels most likely has an adrenal problem
102
| True; in a woman, elevated testosterone levels- ovarian problem; elevated DHEA sulfate- adrenal problem.
101
____ refers to an excess of hair in normal hair-bearing areas
103
| Hirsutism
102
____ refers to an excess of hair in normal hair-bearing areas plus secondary male sex characteristics, esp. clitoromegaly
104
| Virilization
103
T/F Anovulation is common in pubertal girls in whom the normal cycle of the hypothalamus has not yet been established
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.
104
T/F Anovulatory cycles often result in endometrial hyperplasia
107
| True; it is that unopposed estrogen thing again.
105
T/F NSAIDs often work well in resolving anovulatory cycles
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.
106
T/F Anovulatory cycles and inadequate luteal phase are examples of functional causes of menometrorrhagia
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
107
T/F High LH levels coupled with low FSH levels will cause high androgen levels in an otherwise healthy woman
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.
108
T/F Normally, granulose cells convert cholesterol into androgens while thecae cells convert androgens into estrogens
111
False; It is backwards. Thecal cells convert cholesterol into androgens, and granulosa cells convert androgens into estrogens.
109
T/F Inadequate luteal phase results in high progesterone levels unopposed by estrogen
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.
110
T/F For many women, the first symptoms to appear from anovulatory cycles or inadequate luteal phase are fertility issues
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.
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]
114
low, low
See slide 75ish
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]
115
high, low
See slide 75
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]
116
| high, high
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).
117
estrogen alone; There is very little progesterone around at this time, and uterine tissue is not responsive to LH and FSH.
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
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.
116
_____ are the most common cause of abnormal bleeding in a young woman from menarche to about 20 years of age
119
| Anovulatory cycles. Anovulatory cycles and inadequate luteal phase are common causes of dysfunctional uterine bleeding.
117
_____ - marked thickening of the inner uterine mucosa - is the result of continued stimulation of this tissue by estrogen unopposed by progesterone.
120
| Endometrial hyperplasia
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.
121
| Inadequeate luteal phase.
119
T/F Endometrial polyps occur most frequently in teenaged women
126
| False; They are usually seen in women in the 40's or 50's.
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
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.
121
_____ are exophytic masses of variable size that project into the endometrial cavity
128
| Endometrial polyps
122
A(n) _____ polyp is borne at the end of a stalk
129
| pedunculated
123
A(n) ______ polyp arises directly off the underlying tissue, without an intervening stalk
130
| sessile
124
T/F Endometrial hyperplasia is the result of uterine overstimulation by unopposed progesterone
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.
125
T/F The rate of progression from endometrial hyperplasia to endometrial cancer ranges from about 1% to 25% depending on the type hyperplasia
132
True; Simple hyperplasia progresses to cancer ~1% of the time, complex hyperplasia 3%, and complex hyperplasia with atypia 25%.
126
T/F Endometriosis progresses to cancer with relatively high frequency (>25%)
138
| False; endometriosis progresses to cancer maybe 2% of the time- certainly not 25% of the time
127
T/F Adenomyosis is a common cause of hysterectomy, since the uterus is often enlarged.
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.
128
T/F The incidence of endometriosis in reproductive-aged women is less than 2%
140
| False; the incidence in reproductive aged women is much higher than this- perhaps as high as one in five women
129
T/F Supression of menstruation (i.e. contraceptive pills) may alleviate the pain and discomfort of endometriosis
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.
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
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).
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
143
| True
132
_____ refers to the presence of endometrial glands and stroma within the uterus (i.e. within the myometrium)
144
| Adenomyosis.
133
____ refers to the presence of endometrial glands and stroma outside the uterus
145
| Endometriosis
134
A(n) _____ is another name for a chocolate cyst found on an ovary in cases of moderate to severe endometriosis
146
| Endometrioma
135
____ are foreign estrogens or chemicals having estrogenic effects on the body
147
| Xenoestrogens
136
T/F Follicular cysts provide an example of functional ovarian cysts
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.
137
T/F Luteal cysts provide an example of functional ovarian cysts
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.
138
T/F The chocolate cysts of endometriosis provide an example of a non-functional ovarian cyst
154
| True
139
T/F The main complication of follicular cysts is that they cause endometrial hyperplasia
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.
140
T/F Luteal cysts are typically filled with solid, progesterone-secreting tissue
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.
141
____ cysts are derived from unruptured ovarian follicles that enlarge and become cystic; these are extremely common
157
| Follicular
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
158
| Luteal
143
A(n) ____is any collection of fluid, surrounded by a very thin wall, within an ovary.
159
| ovarian cyst
144
T/F As a group, women with polycystic ovarian syndrome show higher incidences of endometrial adenocarcinoma
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.
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
161
| True
146
T/F Polycystic ovarian syndrome is perhaps the most common cause of hirsutism
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.
147
T/F The cycle of polycystic ovarian syndrome can usually be broken by administration of progestin (birth control pill)
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.
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
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.
149
T/F Leiomyomas are seldom found in prepubertal girls, and they seldom develop in post-menopausal women
167
| True; In either case they are deprived of their estrogen support.
150
T/F Leiomyomas are exclusively tumors of uterine smooth muscle; they do not occur elsewhere in the body
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.
151
T/F Fibroid symptoms range from asymptomatic to almost debilitating, and are a common source of infertility
169
True; Small fibroids may produce no symptoms whatsoever. But think about the effects of an abdominal fibroid the size of a softball!
152
T/F Leiomyomas have a tendency to progress to their cancerous form, leiomyosarcomas
170
False; Very rarely leiomyosarcomas may arise within a leiomyoma, but this is very rare. Typically, leiomyomas do not evolve into cancer.
153
T/F Fibroids are a rather rare form of uterine tumor
171
False; Fibroids (leiomyomas) are the most common of uterine tumors. Approximately 20% of reproductive age women have them.
154
T/F Leiomyomas tend to regress after menopause
172
True; after their estrogen support is withdrawn, the uterine smooth muscle component atrophies, leaving behind the fibrous stroma.
155
T/F Leiomyomas are the third most common uterine tumor
173
| False; fibroids are the most common type of uterine tumor and thankfully they are benign.
156
T/F Leiomyomas are sensitive to, and also caused by, estrogen
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.
157
T/F Fibroids evolve along a dangerous path and should be removed promptly when discovered
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.
158
A(n) _____ fibroid dangles or projects from a stalk.
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.
159
A(n) _____ is another name for a uterine leiomyoma
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).
160
A(n) _____ refers to the surgical removal of a muscle tumor, but especially to fibroids in the uterus
178
| myomectomy; 'myoma', muscle + 'ectomy', to cut out.
161
A(n) _____ leiomyoma develops just beneath (just deep to) the perimetrium
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.
162
A(n) _____ leiomyoma develops within the myometrium itself
180
| intramural; Meaning literally 'within the wall'.
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.
183
False; In fact, cervical cancer mortality rates have been declining, due to better detection (Pap smear) and better treatment options.
164
T/F Many authorities consider carcinoma of the cervix to be an infectious disease transmitted by intercourse and caused by viruses
184
| True; Although the conclusive proof of this viral relationship still is elusive.
165
T/F Cigarette smoking and chlamydial infection are known risk factors for cervical cancer
185
| True; The viral connection is probably the big one, but these non-viral risk factors are pretty well established.
166
T/F Most cervical cancers arise in the transformation zone, where the endocervix and exocervix meet
186
| True; Also, this area is visible via colposcopy, which facilitates easier detection.
167
T/F Having intercourse at an early age increases a woman's risk of developing cervical cancer
187
True; Do you see the connection- it increases her risk of contracting a viral (HPV) or bacterial (e.g., syphilis or chlamydia) infection.
168
T/F Having many sex partners increases a woman's risk of developing cervical cancer
188
True again; Same connection- it increases her risk of contracting a viral (HPV) or bacterial (e.g., syphilis or chlamydia) infection.
169
T/F Once cervical dysplasia crosses the basement membrane, it is known as carcinoma in situ, or CIS
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.
170
T/F Cervical dysplasia and CIS (carcinoma in situ) are collectively known as cervical intraepithelial neoplasia, or CIN
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.
171
T/F All types of HPV are associated with cervical cancer
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.
172
T/F Histologically, carcinoma of the cervix is a squamous cell carcinoma
192
| True; This makes sense, since the exocervixis lined by a squamous epithelium.
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
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.
174
T/F When found, CIN is usually resected via several techniques, including laser ablation, cryotherapy, of electrocautery
194
| True
175
T/F Early (Stage 0) cervical carcinoma is curable
195
| True; this means cure rates approach (or are) 100%.
176
T/F Even advanced (Stage IV) cervical carcinoma has a good prognosis, with 5-year survival rates exceeding 70%
196
| False; 5-year survival rates for advanced cervical carcinoma are in the 10-15% range, not 79%.
177
T/F Cervical carcinoma is the most common malignant tumor of the female reproductive tract
197
| False; this 'honor' falls to endometrial cancer.
178
T/F The occurrence of endometrial cancer rises with increasing age
198
| True; The average age of diagnosis is 63, with 7-fold more diagnoses at 60 than at 40.
179
T/F Histologically, endometrial cancer is a squamous cell carcinoma, as with cervical cancer
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.
180
T/F Benign endometrial tumors - endometrial adenomas - are even more frequent than endometrial adenocarcinoma
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.
181
T/F Because of their invasive growth, endometrial carcinomas penetrate into the myometrium and may extend all the way to the serosa
201
| True
182
T/F The most common endometrial adenocarcinoma is a type II tumor
202
| False; Endometrioid tumors are far more common than the type II tumors.
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
203
| True
184
T/F Pap smears are as effective at detecting endometrial cancer as they are for cervical cancer
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.
185
T/F The treatment for endometrial cancer usually involves laser ablation or curettage to remove the tumor
205
| False; Treatment for endometrial cancer usually necessitates a hysterectomy.
186
____ refers to elevated levels of estrogen in the blood
206
| Hyperestrinism
187
____ pertains to a woman who has born more than one child
207
| Multiparous
188
____ pertains to a woman who has not borne any children
208
| Nulliparous
189
____, or type I endometrial carcinoma, contain structures resembling endometrial glands; these tumors typically arise in the settings of endometrial hyperplasia and hyperesterinism
209
| Endometrioid
190
___ is the most common presenting symptom of endometrial adenocarcinoma
210
| Vaginal bleeding
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
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.
192
T/F Because the ovaries are endocrine organs, most ovarian tumors are functional (i.e. they release hormones)
213
| False
193
T/F Although benign ovarian tumors (and some malignant tumors) may be asymptomatic, common symptoms of malignant tumors include pain and abdominal distension
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.
194
T/F Endometrioid tumors are cystic, while serous and mutinous tumors are solid
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?
195
T/F Most endometrioid tumors are malignant
216
| True; But serous and mucinous tumors may be benign, borderline malignant, or malingant.
196
T/F Endometrioid tumors are the most common type of surface epithelial tumor
217
| False; Serous tumors are the most common
197
T/F Serous tumors often consist of several cysts lumped together within a common outer capsule
218
| True; See the photo on or about Slide 174.
198
T/F The cavity of mutinous tumors is filled with thick, yellowish or white, jelly-like mucus
219
| True; If the tumor ruptures, the jelly-like material fills the peritoneum and leads to a condition called 'jelly belly'.
199
T/F Quite frequently, mutinous tumors are accompanied by uterine tumors, suggesting some sort of special relationship between the two
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.
200
T/F High estrogen levels, unopposed by progesterone, support the development of endometrioid tumors
221
| True
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%
222
| True
202
T/F In the ovaries, germ cell tumors arise from virus or bacteria infected ovarian cells
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.
203
T/F Although teratomas are benign tumors, they can, if left in place for too long, undergo malignant transformation
224
True; That is why they should be resected once they are found. BTW, the malignant transformation usually only happens in older patients.
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)
225
| True; hCG in a man is a pretty sure sign that he has testicular cancer.
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
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.
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
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.
207
T/F Most germ cell tumors secrete sex hormones
228
| False; Germ cell tumors don't secrete sex hormones (tho some of them secrete human chorionic gonadotropin).
208
T/F Most sex cord stromal tumors secrete sex hormones
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.
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
230
| border line
210
Most tumors of the ovary ultimately arise from one of the three ovarian tissues. List these resulting three types of ovarian tumors: _____, _____, and ______.
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.
211
Surface epithelial tumors of the ovary are usually subdivided into three subtypes; list those three subtypes: _____, _____, and ______.
232
| Serous, mucinous, and endometrioid.
212
____ tumors are solid tumors composed of glands resembling endometrial glands.
233
| Endometrioid
213
The term ____ refers to a cell that produces gametes - either an oocyte or a spermatocyte.
234
| gonocyte
214
_____ and _____ are germ cell tumors of the ovaries and testes whose malignant cells retain their resemblance to gonocytes.
235
| Dysgerminomas and seminomas
215
T/F The most common place for an exotic pregnancy is on the ovaries themselves.
240
| False; 95% of ectopic pregnancies are tubal pregnancies- implantation in the fallopian tubes.
216
T/F Complications of PID or endometriosis are common causes of tubal pregnancies
241
| True
217
T/F Abruptio placentae, placenta accrete, hydatidiform mole, and choriocarcinoma are all examples of gestational trophloblastic disease
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.
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
243
False; Molar pregnancies are most common and the ends of a woman's reproductive years- either just after menarche, or just before menopause.
219
T/F Partial hydatidiform moles feature triploid cells, usually the result of the fertilization of on haploid egg by two haploid sperm
244
| True; another possibility is the fusion of a haploid egg with a single abnormal but diploid sperm.
220
T/F The most important complication of a complete hydatidiform mole is the development of PID
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.
221
T/F In a complete hydatidiform mole, all the genetic material in the nucleus is paternal in origin
246
| True; The nuclear DNA all comes from dad and, oddly enough, the egg has totally lost its nucleus.
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
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.
223
T/F Like trophoblastic cells themselves, choriocarcinoma cells are highy invasive and secrete hCG
248
| True; The elevated hCG levels serves as a serologic marker for this tumor.
224
T/F Most commonly, choriocarcinomas arise from pre-existing complete hydatidiform moles
249
| True
225
T/F Although choriocarcinoma is an aggressive tumor, it responds well to methotrexate chemotherapy
250
| True; If treated early, cure rates are in the 80-100% range. These tumor melt with chemo, even if they've metastasized.
226
T/F Eclampsia and pre-eclampsia are both marked by the triad of hypertension, edema, and proteinuria
251
| True
227
T/F Pre-eclampsia presents with seizures which may be life-threatening
252
| False; It is eclampsia, not pre-eclampsia, that is marked by seizures.
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
253
| Complete; Partial moles also exist, but I just made up the last two.
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
254
| Partial; Complete moles also exist, but I just made up the last two.
230
A(n) ______ refers to implantation of a zygote anywhere but the normal location in the uterus
255
| ectopic pregnancy; 'ecto'=out + 'topo'=place, location. ectopic='out of place'.
231
______ refers to deep penetration of the placental villi into the uterine wall (at least to and possibly through the endometrium)
256
| Placenta accreta
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
257
| Placenta previa
233
____ refers to a complication of pregnancy, where the placental lining has separated from the uterus
258
| Abruptio placentae
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
259
| Gestational trophoblastic disease
235
_____ refers to a cystic swelling of the chorionic villi, accompanied by variable trophoblastic proliferation
260
| Hydatidiform mole; this definition applies whether the mole is complete or partial.
236
____ is a malignant tumor derived from trophoblastic cells, i.e. a cancer of the placenta
261
| Choriocarcinoma
