Repro (male + female + OBGYN) Flashcards
(158 cards)
1
Q
Pathogenesis of endometriosis + most common site
A
Endometriosis is a condition characterized by the presence of endometrial glands and stroma outside the uterine cavity, most commonly on the ovaries. The tissue continues to respond to normal hormonal cycles, proliferating and shedding with each cycle.
However, lacking an outlet, this cyclic shedding leads to local inflammation, accumulation of blood, and formation of endometriomas—cystic ovarian masses filled with old blood. Chronic inflammation contributes to pelvic adhesions and fibrosis, often causing pain and infertility. Macrophages ingest the breakdown products like hemosiderin, appearing as hemosiderin-laden macrophages.
2
Q
What is post-partum endometritis?
A
Postpartum endometritis is a polymicrobial infection of the uterine lining that occurs most commonly after a cesarean delivery.
Clinically, it presents with fever, lower abdominal pain, uterine tenderness, malodorous lochia (purulent vaginal discharge), and leukocytosis. If untreated, it can lead to peritonitis and sepsis due to spread of the infection.
3
Q
What are the predisposing factors and pathophysiology behind postpartum endometritis?
A
Postpartum endometritis occurs when the normally sterile upper genital tract becomes contaminated with cervicovaginal flora during labor and delivery, especially in cases of prolonged labor or ruptured membranes. After a cesarean section, the risk increases due to foreign bodies like suture material and hematomas, which can serve as sites for polymicrobial infection. Additionally, suturing of the uterine incision may lead to myometrial necrosis, further predisposing the tissue to infection.
4
Q
What is a craniopharyngioma?
A
Craniopharyngioma is a benign, slow-growing brain tumor derived from Rathke’s pouch remnants.
It commonly occurs in children and can cause:
Bitemporal hemianopsia (due to optic chiasm compression)
Growth retardation or hypopituitarism (if it compresses the pituitary)
Imaging often shows a calcified, cystic suprasellar mass with “motor oil”-like fluid.
5
Q
When are fetuses most susceptible to teratogens?
A
Before 8 weeks of development - organogenesis
6
Q
What is the teratogenic effect of aminoglycosides on the fetus?
A
Ototoxicity. Mnemonic: ‘A mean guy hit the baby in the ear.’
7
Q
What is the teratogenic effect of lithium on the fetus?
A
Ebstein anomaly (a congenital heart defect).
8
Q
What is the teratogenic effect of warfarin on the fetus?
A
Bone and cartilage deformities (stippling of epiphyses, nasal and limb hypoplasia), optic nerve atrophy, cerebral hemorrhage. Mnemonic: ‘In war, you need strong bones to march and optics to see the enemy.’
9
Q
What is the teratogenic effect of maternal diabetes on the fetus?
A
Caudal regression syndrome, cardiac defects (e.g., transposition of great arteries, VSD), neural tube defects, macrosomia, neonatal hypoglycemia, polycythemia, respiratory distress syndrome.
10
Q
What is the teratogenic effect of ACE inhibitors on the fetus?
A
Renal failure
Oligohydrammnios
Hypocalvaria
11
Q
What is the teratogenic effect of antiepileptics on the fetus?
A
Neural tube defects
Cardiac defects
Cleft palate
Skeletal anomalies
12
Q
Which antiepileptics are the most teratogenic?
A
Valproate
Carbamazepine
Phenytoin
Phenobarbital
13
Q
What is the teratogenic effect of isotretinoin on the fetus?
A
Craniofacial dysmorphisms, CNS, cardiac and thymic defects. Contraception mandatory
14
Q
What is the teratogenic effect of alcohol on the fetus?
A
Fetal alcohol syndrome
Developmental anomalies
Facial anomalies
Limb dislocation
Heart defect
Holoprosencephaly in severe cases
15
Q
What is neonatal abstinence syndrome (NAS)?
A
Neonatal abstinence syndrome is a withdrawal syndrome in newborns caused by in utero exposure to opioids or other substances.
Symptoms include:
* Irritability, tremors, high-pitched crying
* Poor feeding, vomiting, diarrhea
* Sweating, sneezing, yawning
Management includes supportive care and sometimes opioid weaning protocols (e.g., morphine or methadone).
16
Q
What is agenesis in morphogenesis?
A
Absent organ due to absent primordial tissue.
17
Q
What is aplasia in morphogenesis?
A
Absent organ despite presence of primordial tissue.
18
Q
What is hypoplasia in morphogenesis?
A
Incomplete organ development with primordial tissue present.
19
Q
What is disruption in morphogenesis?
A
Secondary breakdown of normal tissue with normal developmental potential (e.g., amniotic band syndrome).
20
Q
What is deformation in morphogenesis?
A
Extrinsic mechanical distortion (e.g., congenital torticollis), usually occurring during the fetal period.
21
Q
What is malformation in morphogenesis?
A
Intrinsic developmental defect (e.g., cleft lip/palate), typically occurring during the embryonic period.
22
Q
What is a sequence in morphogenesis?
A
Multiple abnormalities resulting from a single primary embryologic event (e.g., oligohydramnios → Potter sequence).
23
Q
What is the difference between disruption and deformation?
A
Disruption is a breakdown of previously normal tissue due to external factors, while deformation is a mechanical distortion of normally developing tissue due to external pressure or constraint.
24
Q
Do syncytiotrophoblast cells express MHC class I, and why?
A
No, syncytiotrophoblasts do not express classical MHC class I or class II molecules.
This helps prevent maternal immune rejection of the fetus by avoiding recognition and attack by maternal T cells, thus promoting immune tolerance at the maternal-fetal interface.
25
What synthesizes human chorionic gonadotropin (hCG)?
hCG is synthesized by the syncytiotrophoblast cells of the placenta.
Its primary role is to maintain the corpus luteum in early pregnancy, promoting progesterone production until the placenta takes over.
26
Which vessel brings oxygen-rich blood to the fetus, and which vessel carries deoxygenated blood away?
The umbilical vein carries oxygen-rich blood from the placenta to the fetus.
The umbilical arteries carry deoxygenated blood from the fetus to the placenta.
27
How is amniotic fluid produced and cleared?
Produced: urine and expelled lung fluid
Cleared: fetal swallowing
28
Causes of polyhydramnios:
Fetal: impaired swallowing:
* Esophageal/duodenal atresia
* Anencephaly
Fetal anemia
Maternal: multiple gestation, diabetes
29
Causes of oligohydramnios
Fetal: inability to produce:
* Bilateral renal agenesis
* Posterior urethral valves in males
30
Most common chorionicity and amnionicity
Monochorionic
Diamniotic
The twins share one placenta (same chorion), but each have their own amniotic sac
31
When does the splitting happen for each chorionicity and amnionicity?
32
Are fraternal (dizygotic) twins always dichorionic diamniotic (di-di)?
Yes. Fraternal (dizygotic) twins result from fertilization of two separate eggs by two separate sperm, leading to:
Two placentas (dichorionic)
Two amniotic sacs (diamniotic)
33
When does embryo splitting occur for each chorionicity and amnionicity in monozygotic twins?
34
Do monozygotic twins arise from 1 egg and 1 sperm or 1 egg and 2 sperm?
Monozygotic (identical) twins arise from 1 egg fertilized by 1 sperm, which then splits into two embryos.
35
What is a cleft lip and how does it occur?
A cleft lip is a congenital malformation caused by failure of fusion between the maxillary and medial nasal processes during embryonic development.
36
What is a cleft palate and how does it occur?
A cleft palate is a congenital defect caused by failure of fusion of the two lateral palatine shelves, or failure of fusion with the nasal septum and/or median palatine shelf.
37
What are the roles of Sertoli and Leydig cells in male sexual differentiation?
Leydig cells: Secrete testosterone, which promotes development of male internal genitalia (Wolffian ducts) and, via DHT, external genitalia.
➤ Mnemonic: "Leydig Leads" to male differentiation.
Sertoli cells: Secrete Müllerian inhibiting substance (MIS), which prevents female (Müllerian) structures from forming.
➤ Mnemonic: "Sertoli Shuts down" female internal differentiation.
38
Which ducts are associated with male vs female reproductive development?
Mesonephric (Wolffian) ducts → Male internal genitalia:
* Epididymis, vas deferens, seminal vesicles, ejaculatory ducts
* Maintained by testosterone
Paramesonephric (Müllerian) ducts → Female internal genitalia:
* Fallopian tubes, uterus, upper vagina
* Regress in males due to Müllerian inhibiting substance (MIS) from Sertoli cells
39
What are the two main congenital penile anomalies, which is most common, and how do they arise?
**Hypospadias (most common)**:
* Urethral opening on the ventral (underside) of the penis
* Caused by incomplete fusion of the urethral (urogenital) folds
* Associated with inguinal hernias and cryptorchidism
**Epispadias**:
* Urethral opening on the dorsal (top) side of the penis
* Caused by abnormal positioning of the genital tubercle
* Often associated with bladder exstrophy
40
What is the gubernaculum and what does it become in the female genital tract?
The gubernaculum is an embryologic structure that guides gonadal descent.
In males, it helps the testes descend into the scrotum.
In females, it becomes:
* The ovarian ligament (connecting ovary to uterus)
* The round ligament of the uterus (connecting uterus to labia majora via the inguinal canal)
41
What is the lymphatic drainage of the genitourinary (GU) system?
42
Which uterine ligament contains the vasculature of the ovaries?
The suspensory ligament of the ovary (also called the infundibulopelvic ligament) contains the ovarian artery, vein, lymphatics, and nerves.
It connects the ovary to the lateral pelvic wall and must be ligated during oophorectomy to prevent bleeding.
43
What happens in ovarian (adnexal) torsion?
Ovarian torsion is the twisting of the ovary around the infundibulopelvic (suspensory) ligament, which contains the ovarian vessels.
This leads to:
* Reduced venous and lymphatic outflow
* Ovarian edema, and potentially
* Arterial obstruction → ischemia and necrosis
Symptoms: Sudden-onset unilateral pelvic pain, nausea, vomiting. It’s a **gynecologic emergency** requiring prompt surgical intervention.
44
Which ligament of the uterus goes through the inguinal canal?
The round ligament of the uterus travels through the inguinal canal and attaches to the labia majora.
It is a remnant of the gubernaculum and helps maintain anteversion of the uterus.
45
What is the histological lining of the vulva and vagina (lower 1/3)?
Stratified squamous epithelium, non-keratinized (vagina) and keratinized (vulva).
46
What is the histological lining of the ectocervix?
Stratified squamous epithelium, non-keratinized.
47
What is the histological lining of the endocervix?
Simple columnar epithelium.
48
What is the histological lining of the uterus?
Simple columnar epithelium with tubular glands in the proliferative phase and coiled glands in the secretory phase.
49
What is the histological lining of the fallopian tubes?
Ciliated simple columnar epithelium.
50
What is the histological lining of the ovary (surface epithelium)?
Simple cuboidal epithelium (also called germinal epithelium).
51
ID corpus spongiosum and cavernosum
52
Which part of the penis becomes engorged during erection?
The corpora cavernosa become engorged with blood during erection due to parasympathetic stimulation, leading to vasodilation and blood trapping.
The corpus spongiosum also engorges slightly but remains more compliant to keep the urethra open for ejaculation (contains the urethra).
53
Which cells inhibit FSH in the male genital tract and how?
Sertoli cells inhibit FSH by secreting inhibin B, which exerts negative feedback on the anterior pituitary to decrease FSH secretion.
This helps regulate spermatogenesis.
54
Is spermatozoa tail mobility normal in CF?
Yes!! The infertility is due to absence of the vas deferens.
It is in PCD that the motility is impaired.
55
What are the 3 types of estrogens, their sources, and their potency?
**Estradiol (E2)**
Source: Ovaries
Most potent estrogen
**Estrone (E1)**
Source: Adipose tissue (via aromatization of androstenedione)
Intermediate potency
**Estriol (E3)**
Source: Placenta (requires maternal and fetal adrenal precursors)
Least potent
56
What is the relationship between theca and granulosa cells in estrogen production?
Theca cells (stimulated by LH) convert cholesterol → androgens (e.g., androstenedione).
Granulosa cells (stimulated by FSH) take those androgens and use aromatase to convert them into estrogens (e.g., estradiol).
57
What is the effect of estrogen on HDL, LDL, and SHBG?
Estrogen has the following effects:
↑ HDL (high-density lipoprotein) → cardioprotective
↓ LDL (low-density lipoprotein)
↑ SHBG (sex hormone–binding globulin) → binds and reduces free androgens and estrogens in circulation
These changes contribute to the favorable lipid profile and hormone regulation seen in premenopausal women.
58
What becomes the corpus luteum?
The corpus luteum forms from the ruptured dominant follicle after ovulation.
Under the influence of LH, granulosa and theca cells luteinize and start producing progesterone (and some estrogen)
The corpus luteum supports the endometrium for potential implantation
If pregnancy occurs, hCG maintains the corpus luteum; otherwise, it degenerates into the corpus albicans.
59
What are the main sources of progesterone in the body?
1. Corpus luteum – main source during the luteal phase of the menstrual cycle
1. Placenta – after the first trimester of pregnancy (takes over from the corpus luteum)
1. Adrenal cortex – minor source
1. Testes – small amount in males
60
What are the roles of progesterone during the menstrual cycle?
* Maintains the endometrium after ovulation (secretory phase)
* Prepares the uterus for implantation (stimulation of spiral artery development)
* Decreases estrogen receptor expression
* Inhibits LH and FSH (via negative feedback) to prevent another ovulation
* Increases body temperature
* Thickens cervical mucus to block sperm entry
* Reduces uterine contractility to support early pregnancy
61
What are the roles of progesterone during pregnancy?
* Maintains the uterine lining (decidua) to support the implanted embryo
* Suppresses uterine contractions to prevent preterm labor
* Inhibits FSH and LH to prevent new ovulation
* Relaxes smooth muscle, including GI tract → can cause constipation
* Stimulates growth of mammary glands (but inhibits milk letdown until after delivery)
62
Which phase of the menstrual cycle is fixed at 14 days, and which is variable in length?
The luteal phase (post-ovulation) is fixed at ~14 days in most women.
The follicular phase (pre-ovulation) is variable in length, accounting for differences in total cycle length.
63
Mnemonic for abnormal uterine bleeding
PALM COEIN
Structural: polyp, adenomyosis, leiomyoma, malignancy/hyperplasia
Nonstructural: coagulopathy, ovulatory, endometrial, iatrogenic, Not yet classified
64
At which point in gestation does hCG peak?
8-10 weeks in
65
How can increased hCG states cause hyperthyroidism?
hCG has a structural similarity to TSH and can weakly stimulate the TSH receptor on the thyroid.
In conditions with markedly elevated hCG (e.g., molar pregnancy, choriocarcinoma, multiple gestation), this can lead to:
Increased thyroid hormone production
Signs of transient hyperthyroidism (low TSH, elevated free T₄)
66
What is the differential diagnosis (DDx) of abnormally high hCG levels in pregnancy?
Multiple gestation
Hydatidiform mole (complete or partial molar pregnancy)
Choriocarcinoma
Down syndrome (Trisomy 21)
67
What is the differential diagnosis (DDx) of decreased hCG levels in pregnancy?
Ectopic pregnancy
Threatened abortion (impending miscarriage)
Incomplete or missed abortion
Fetal demise
Incorrect gestational dating (earlier than expected)
68
components of the APGAR score
69
What hormonal changes trigger the initiation of lactation after birth?
A rapid decrease in estrogen and progesterone after delivery of the placenta disinhibits prolactin, initiating lactation.
70
What maintains milk production and ejection during lactation?
Suckling stimulates nerve endings → ↑ oxytocin and prolactin. Prolactin maintains milk production; oxytocin promotes milk letdown.
71
What are the functions of prolactin and oxytocin in lactation?
Prolactin induces and maintains lactation and decreases reproductive function. Oxytocin assists in milk letdown and promotes uterine contractions.
72
What are the benefits of breast milk for infants?
Ideal nutrition <6 months; contains IgA, macrophages, lymphocytes; reduces infections, asthma, allergies, diabetes, and obesity.
73
What supplementation is recommended for exclusively breastfed infants?
Exclusively breastfed infants should receive vitamin D and possibly iron supplementation.
74
What are the maternal benefits of breastfeeding?
Breastfeeding reduces the risk of breast and ovarian cancer and promotes mother-child bonding.
75
What hormonal changes are seen in menopause?
Decreased etrogen
Largely increased FSH (marker)
Increased LH (no more surge)
Increased GnRH
76
Symptoms of menopause
HAVOCS:
Hot flashes
Atrophy of the vagina
Osteoporosis
Coronary artery disease
Sleep disturbances
77
Classify the androgens in order of potency
DHT > testosterone > androstenedione > DHEA
78
When to suspect exogenous steroid use
Change in behavior (e.g. aggression)
Acne
Gynecomastia
Small testes (HPA inhibition = decreased intratesticular testosterone)
79
What is Turner syndrome
Turner syndrome is a chromosomal disorder affecting females with a 45,XO karyotype (missing one X chromosome).
80
Manifestations of Turner syndrome
81
What is Klinefelter syndrome
Klinefelter syndrome is a genetic condition in males with an extra X chromosome (47,XXY).
82
Manifestations of Klinefelter syndrome
83
What is the placenta accreta spectrum?
84
What is placenta accreta?
Attaches to myometrium directly instead of overlying the decidua basalis without invading it. Most common type.
85
Why is placenta accreta spectrum dangerous, and what is the treatment?
Placenta accreta spectrum (includes accreta, increta, percreta) is dangerous because the placenta abnormally adheres to or invades the uterine wall, preventing normal separation after delivery.
Complications include:
* Massive postpartum hemorrhage
* Disseminated intravascular coagulation (DIC)
* Shock and maternal death
Treatment:
* Often requires planned cesarean hysterectomy (removal of uterus with placenta in situ)
* Attempting manual removal can lead to life-threatening bleeding
86
What is vasa previa, and why is it dangerous?
Vasa previa is a condition where fetal blood vessels run through the membranes close to the cervical os, beneath the presenting part of the fetus and unprotected by the placenta or umbilical cord.
Risk of fetal vessel rupture during membrane rupture or labor → painless vaginal bleeding and fetal bradycardia
Can lead to fetal exsanguination and death
Management: Emergency C-section if diagnosed
87
What is placenta previa, and what are 2 risk factors?
Placenta previa is when the placenta implants over or near the internal cervical os, causing painless third-trimester bleeding.
Risk factors include:
* Previous cesarean section
* Multiparity or multiple gestations
Management often requires C-section at term or if bleeding is severe.
88
What is placental abruption?
Placental abruption is the premature separation of the placenta from the uterine wall before delivery.
Key features:
* Painful vaginal bleeding in the third trimester
* Uterine tenderness, contractions, or a rigid uterus
* Can cause fetal distress or demise and maternal hemorrhage
Risk factors: Trauma, hypertension, smoking, cocaine use, previous abruption
It is a medical emergency requiring prompt delivery.
89
What are the 4 causes of PPH (4 Ts)
Tone: uterine atony
Trauma: lacerations, incisions, uterine rupture
Tissue: retained products of conception
Thrombin (coagulopathy)
90
What is the leading cause of maternal death?
PPH
91
What is a molar pregnancy?
A molar pregnancy is a form of gestational trophoblastic disease caused by abnormal fertilization, leading to proliferation of trophoblastic tissue.
92
How does a molar pregnancy typically present?
First-trimester vaginal bleeding
Uterus larger than expected for gestational age
Very high hCG levels and its sequelae: severe nausea and vomiting (hyperemesis gravidarum), early-onset preeclampsia (<20 weeks), hyperthyroidism symptoms (due to hCG cross-reactivity with TSH receptor)
93
What is the pathogenesis of a complete molar pregnancy?
A complete mole occurs when an empty ovum (no maternal DNA) is fertilized by:
One sperm that duplicates → 46,XX (most common)
Or two sperm → 46,XX or 46,XY
94
What is the result of a complete molar pregnancy?
No fetal tissue
Diffuse trophoblastic proliferation
Very high hCG levels
Risk of progression to choriocarcinoma (<2%)
95
Appearance of complete mole
Honeycombed uterus, "cluster of grapes"
Snowstorm pattern on ultrasound
96
Which type of molar pregnancy contains fetal parts?
Partial mole
97
What is p57, and which type of molar pregnancy is positive for it?
p57 is a maternally expressed, paternally imprinted gene.
It is used as an immunohistochemical marker to distinguish between complete and partial moles.
Partial moles are p57-positive because they contain maternal DNA.
Complete moles are p57-negative because they lack maternal genetic material.
98
What is the pathophysiology of a partial molar pregnancy?
A partial mole results from fertilization of a normal ovum by two sperm or one sperm that duplicates, leading to a triploid karyotype (e.g., 69,XXY or 69,XXX)
99
What is a choriocarcinoma?
Choriocarcinoma is a highly malignant tumor of trophoblastic tissue, often following:
* Molar pregnancy (complete > partial)
* Normal pregnancy, miscarriage, or ectopic pregnancy
Can also occur non-gestationally in gonads.
100
What is the most common cause of spontaneous abortion?
The most common cause of spontaneous abortion (especially in the first trimester) is chromosomal abnormalities, particularly:
* Trisomy 16 (nonviable)
* Other aneuploidies (e.g., Turner syndrome, trisomies 13, 18, 21)
Other causes include:
* Maternal infections
* Uterine abnormalities
* Thrombophilias
* Hormonal insufficiency
101
What is primary ovarian failure and what are its etiologies?
Primary ovarian failure (also called primary ovarian insufficiency) is a condition where the ovaries stop functioning properly before the age of 40, leading to amenorrhea, estrogen deficiency, and elevated gonadotropins (FSH/LH).
102
What is gestational hypertension?
Gestational hypertension is new-onset hypertension (≥140/90 mmHg) after 20 weeks of gestation in a previously normotensive woman **without proteinuria or signs of end-organ damage**. It typically resolves postpartum.
103
What is preeclampsia in relation to gestational hypertension?
Preeclampsia is gestational hypertension with proteinuria (≥300 mg/day) or signs of end-organ dysfunction (e.g., elevated liver enzymes, thrombocytopenia, renal insufficiency, cerebral/visual symptoms). It represents a progression from simple gestational hypertension.
104
What causes preeclampsia?
Abnormal placental spiral arteries = endothelial dysfunction, vasoconstriction and ischemia
105
Complications of preeclampsia
Placental abruption
Coagulopathy
Renal failure
Pulmonary edema
Uteroplacental insufficiency
Eclampsia
HELLP
106
What is eclampsia?
Eclampsia is preeclampsia with seizures. It is a life-threatening complication of hypertensive disorders of pregnancy and requires immediate management with magnesium sulfate (prevents seizures) and delivery.
107
Why do patients die from eclampsia?
Deaths from eclampsia occur due to:
* Intracerebral hemorrhage (stroke)
* Status epilepticus
* Aspiration pneumonia
* Placental abruption leading to fetal/maternal compromise
108
What is HELLP syndrome?
HELLP syndrome is a severe form of preeclampsia with:
**Hemolysis
Elevated Liver enzymes
Low Platelets**
It can present with right upper quadrant pain, nausea, vomiting, and is associated with a high risk of maternal and fetal morbidity. Prompt delivery is often required.
109
Complications of HELLP
DIC
Subscapular hematomas
110
What is PCOS?
PCOS is an endocrine disorder characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries on imaging. It is associated with insulin resistance, obesity, and increased risk of infertility, endometrial hyperplasia, and type 2 diabetes.
111
Why is there increased risk of endometrial cancer in PCOS?
Anovulatory cycles = unopposed estrogen
112
What is functional hypothalamic amenorrhea?
Functional hypothalamic amenorrhea is a reversible cause of secondary amenorrhea due to suppression of the hypothalamic-pituitary-ovarian axis from stress, weight loss, excessive exercise, or eating disorders.
Pathophysiology:
↓ Energy availability → ↓ GnRH secretion → ↓ FSH & LH → ↓ Estrogen → Amenorrhea
113
Which HPV viruses are associated with cervical cancer and which mutations do they cause?
HPV16 and HPV18
E6 gene inhibits TP53
E7 gene inhibits pRb
114
Histological findings pathognomonic for HPV infection?
Koilocytes: cells with raisinoid nucleus and perinuclear halo
115
What is Lynch syndrome?
Lynch syndrome (Hereditary Nonpolyposis Colorectal Cancer, HNPCC) is an autosomal dominant disorder caused by mutations in DNA mismatch repair genes (e.g., MLH1, MSH2, MSH6, PMS2), leading to microsatellite instability.
Key features:
* Increased risk of colorectal cancer (especially right-sided, early onset)
* Increased risk of endometrial cancer (most common extracolonic cancer)
* Also associated with: ovarian, stomach, small bowel, hepatobiliary, urinary tract, brain, and skin cancers
116
What are the 3 kinds of ovarian tumors and which portion of the ovary gives rise to each?
Epithelial tumors
Germ cell tumors
Sex cord stromal tumors
117
What are the 4 kinds of germ cell tumors?
1) Mature cystic teratoma
2) Immature teratoma
3) Dysgerminoma
4) Yolk sac tumor
118
What is the most common ovarian tumor in young females? + tell me about it
Mature cystic teratoma
Benign
elements from all 3 germ layers
Painful secondary to ovarian enlargment with torsion
119
Markers of dysgerminoma
Increased hCG
Increased LDH
120
Markers of yolk sac tumor
Increased AFP
121
Which ovarian cancer is this?
Dysgerminoma
122
Which ovarian cancer is this?
Yolk sac tumor
123
What is adenomyosis?
Adenomyosis is a benign condition where endometrial glands and stroma are present within the myometrium, causing a diffusely enlarged, tender uterus.
Clinical features:
* Heavy menstrual bleeding (menorrhagia)
* Painful menstruation (dysmenorrhea)
* Chronic pelvic pain
Symptoms often worsen with age and after childbirth
124
What is endometriosis?
Endometriosis is a condition where endometrial-like tissue is found outside the uterus, typically in the pelvis. This ectopic tissue responds to hormonal cycles, leading to chronic inflammation, scarring, and pain.
125
How does endometriosis present?
* Cyclic pelvic pain (worsens around menstruation)
* Dysmenorrhea (painful periods)
* Dyspareunia (pain during deep vaginal penetration)
* Infertility (due to inflammation and adhesions)
* Dyschezia (painful bowel movements), especially during menses
* Possible chronic pelvic pain
* May also have spotting or irregular bleeding
126
What is endometrial hyperplasia?
Endometrial hyperplasia is excessive proliferation of endometrial glands relative to stroma, often due to prolonged unopposed estrogen stimulation (e.g., anovulation, obesity, estrogen therapy without progesterone).
Clinical presentation:
* Abnormal uterine bleeding (especially postmenopausal bleeding)
* May be asymptomatic in early stages
127
Risk factors for endometrial hyperplasia
* Obesity
* PCOS
* Estrogen-only hormone therapy
* Early menarche / late menopause
* Nulliparity
* Tamoxifen use
128
What is endometritis?
Endometritis is inflammation of the endometrium, typically due to infection. It can be acute or chronic.
Types:
* Acute endometritis: Often due to polymicrobial infection after delivery (especially C-section), miscarriage, or instrumentation (e.g., D&C)
* Chronic endometritis: Associated with retained products, IUDs, PID, or tuberculosis (especially in endemic areas)
129
What is a leiomyoma?
A leiomyoma (also called a uterine fibroid) is a benign smooth muscle tumor of the myometrium. It is the most common tumor in women of reproductive age.
130
What are the subtypes of leiomyomas?
Types based on location:
Submucosal (beneath endometrium)
Intramural (within myometrium)
Subserosal (beneath outer serosa)
Pedunculated (on a stalk)
131
Are leiomyomas estrogen sensitive and what would that imply?
Yes; they increase in size with pregnancy and decrease with menopause.
132
Which breast cancers or conditions occur in the lactiferous duct?
Intraductal papilloma
Abscess/mastitis
Mammary duct ectasia
Paget disease
133
Which breast cancers or conditions occur in the terminal duct/lobular unit?
Fibrocystic changes
Ductal cardinoma in situ
Lobular carcinoma in situ
Ductal carcinoma
Lobular carcinoma
134
Which breast cancers or conditions occur in the stroma?
Fibroadenoma
Phyllodes tumor
135
What are breast fibrocystic changes?
Fibrocystic changes are benign, non-cancerous changes in the breast tissue, commonly seen in premenopausal women, especially between 20-50 years old.
Key features:
* Fluctuate with menstrual cycle (often worse before menses)
* Bilateral breast pain or tenderness
* Palpable lumps or nodularity, often in the upper outer quadrant
* Cysts may feel smooth, mobile, and tender
136
What are fibroadenomas of the breast?
Fibroadenomas are benign breast tumors composed of both stromal and epithelial tissue. They are the most common breast mass in women under 30.
* Well-circumscribed, round, mobile, firm, rubbery, and non-tender
* Hormone-sensitive: may enlarge during pregnancy or with estrogen therapy
* Typically solitary and unilateral, but can be multiple or bilateral
* Do not increase the risk of breast cancer
137
Does LCIS increase cancer risk in one breast or both?
Lobular Carcinoma In Situ (LCIS) increases the risk of developing invasive breast cancer in either breast (bilateral risk), not just the affected side.
138
Does DCIS increase cancer risk in one breast or both?
Ductal Carcinoma In Situ (DCIS) increases the risk of invasive breast cancer in the same breast (ipsilateral), particularly in the same quadrant.
139
Do BRCA mutations increase the risk of invasive ductal or lobular breast cancer?
BRCA mutations—especially BRCA1 and BRCA2—are primarily associated with an increased risk of invasive ductal carcinoma.
* Invasive ductal carcinoma is the most common type of breast cancer in BRCA carriers
* Invasive lobular carcinoma can occur but is less commonly associated with BRCA mutations
140
What is Paget disease of the breast?
Paget disease of the breast is a rare form of breast cancer that involves the skin of the nipple and areola, often associated with an underlying ductal carcinoma in situ (DCIS) or invasive ductal carcinoma.
Clinical features:
* Eczematous, scaly, red lesion of the nipple
* May have itching, burning, oozing, or ulceration
* Unilateral and persistent
* May be mistaken for dermatitis but does not improve with topical steroids
141
What is Peyronie disease?
Peyronie disease is a fibroproliferative disorder of the tunica albuginea of the penis, leading to abnormal curvature, pain, and erectile dysfunction.
* Results in painful erections and curved penis during erection
* May lead to difficulty with sexual intercourse
* Often occurs in middle-aged or older men
* Microtrauma during intercourse
142
Lab findings in bilateral cryptorchidism vs unilateral
Unilateral cryptorchidism:
* Usually normal hormone levels (if contralateral testis is functional)
* May still pose a fertility and cancer risk for the undescended testis
Bilateral cryptorchidism:
* Low testosterone (especially after hCG stimulation test)
* Elevated LH and FSH due to impaired Leydig and Sertoli cell function
* Decreased Inhibin B (Sertoli cells)
* Suggests primary testicular failure (hypergonadotropic hypogonadism)
143
What are extragonadal germ cell tumors?
Extragonadal germ cell tumors (EGGCTs) are germ cell-derived tumors that arise outside the gonads, typically along the midline of the body.
Common locations:
* Mediastinum (most common in males)
* Retroperitoneum
* Pineal gland (intracranial)
* Sacrococcygeal region
144
What is an hCG stimulation test?
The hCG stimulation test assesses Leydig cell function in the testes by measuring testosterone production in response to human chorionic gonadotropin (hCG), which mimics LH.
145
What is the Prehn sign and what does positive vs negative test indicate?
Prehn sign is a physical exam maneuver used to help distinguish between epididymitis and testicular torsion. **Elevate the testis**.
Positive Prehn sign: Pain improves with elevation → suggests epididymitis
Negative Prehn sign: Pain persists or worsens with elevation → suggests testicular torsion
146
Which testicular lesions transilluminate?
Testicular lesions that transilluminate are usually fluid-filled, allowing light to pass through the scrotum. These include:
* Hydrocele – most common transilluminating lesion
* Spermatocele – cystic dilation of the epididymal duct
* Epididymal cyst
147
What is the difference between congenital and acquired hydroceles?
Congenital Hydrocele:
* Caused by a patent processus vaginalis
* Peritoneal fluid flows into the tunica vaginalis
* Common in infants and newborns
* Usually resolves spontaneously by 1 year of age
* May be communicating (fluctuates in size with position)
Acquired hydrocele:
* Non communicating with peritoneal cavity
* Due to infectino, trauma, tumor.
148
What is a spermatocele?
A spermatocele is a benign, cystic mass that arises from the epididymis, typically at the head, and contains clear or milky fluid with sperm.
149
What is a varicocele and where is it more likely to arise?
A varicocele is a dilated network of veins (pampiniform plexus) in the scrotum due to impaired venous drainage from the testicle.
Key features:
Feels like a "bag of worms" on palpation
Often painless, but may cause dull discomfort or infertility
**More common on the left side due to**:
Left testicular vein drains into left renal vein, which has higher pressure
Possible compression by SMA → "nutcracker effect"
150
Which types of tumors account for 95% of all testicular tumors?
Germ cell tumors
151
2 risk factors for testicular tumors
Klinefelter syndrome
Cryptorchidism
152
Which types of testicular tumors make up the other 5%? Which cells do they arise from?
Sex cord stromal tumors
Arise from sertoli and leydig ceells
usually benign
153
Are germ cell tumors biopsied?
No, testicular germ cell tumors are typically not biopsied preoperatively. Risk of testicular seeding.
154
What is the most common testicular tumor?
Seminoma:
* Malignant
* Excellent prognosis
* Analogous to ovarian dysgerminoma *fried egg appearance*
* increased PLAP
155
How does teratoma malignancy differ in females vs. males?
Females: immature = malignant; mature = benign
Males = mature and immature are both malignant
156
Hormone changes in yolk sac tumor
Increased AFP
Increased beta hCG
157
Which zone of the prostate is affected by benign prostatic hyperplasia (BPH)?
BPH primarily affects the transitional zone of the prostate.
158
Which zone of the prostate is affected by prostatic adenocarcinoma?
Prostatic adenocarcinoma most often arises in the peripheral zone of the prostate.
