Reproductive System

Question 1

Endometriosis

Answer 1

A condition in which endometrial tissue implants in aberrant (not normal) pelvic locations or multiple cystic masses that are present outside the uterus

Question 2

Mastalgia

Answer 2

Breast pain

Question 3

Mastitis

Answer 3

Inflammation of the breast, most often caused by Staphylococcus bacteria

Question 4

Bicornuate uterus

Answer 4

A uterus with paired uterine horns extending to the uterine tubes

Question 5

Unicornuate uterus

Answer 5

A uterus whose uterine cavity is elongated and has a single uterine tube emerging from it

Question 6

Uterus didelphys

Answer 6

Complete duplication of the uterus, cervix, and vagina

Question 7

Gynecomastia

Answer 7

Abnormal breast tissue development in males as a result of a hormone imbalance

Question 8

Nulliparous

Answer 8

never given birth to a live baby

Question 9

Nongravid

Answer 9

Not pregnant

Question 10

Gravid

Answer 10

pregnant

Question 11

Obstetrics

Answer 11

relating to childbirth and the processes associated with it

Question 12

Gynecology

Answer 12

branch of medicine which deals with functions and diseases specific to females, especially those affecting the reproductive system

Question 13

HYSTEROSALPINGOGRAM (HSG)
● What information can be ascertained from this procedure?
● Describe the HSG procedure:
● What is/ are indication(s) for this procedure?
● HSG is a(n) diagnostic/ therapeutic procedure. (identify the correct answer)
● Define SHG and what modality is used for this exam?

Answer 13

● What information can be ascertained from this procedure? to check if the fallopian tubes are patent(open) or not
● Describe the HSG procedure: Injection of approximately 10 to 30 mL of contrast medium into the uterine cavity done slowly to avoid causing spasms and discomfort. Spillage of the contrast medium from the fallopian tubes indicates the patency of the tubes.
● What is/ are indication(s) for this procedure? possible infertility
● HSG is a(n) diagnostic/ therapeutic procedure: Both
● Define SHG and what modality is used for this exam? This examination is similar to HSG in its procedural approach; however, with Sonohysterography, normal saline, instead of an iodinated contrast agent, is injected into the uterus. Sonography is used for this exam.

Question 14

MAMMOGRAPHY
● Identify DBT and explain how it can be used in mammography:
● Which mammographic procedure may be used to direct the surgeon to the breast abnormality to be removed or biopsied?
● Differentiate between a screening & diagnostic mammogram:

Answer 14

● Identify DBT and explain how it can be used in mammography: Digital breast tomosynthesis (DBT) is emerging as the standard of care for breast imaging based on improvements in both screening and diagnostic imaging outcomes. The additional information obtained from the tomosynthesis acquisition decreases the effect of overlapping tissue, allowing for improved lesion detection, characterization, and localization. In addition, the three-dimensional (3-D) information obtained from the reconstructed DBT data allows a more efficient imaging workup than imaging with two-dimensional (2-D) full-field digital mammography alone.
● Which mammographic procedure may be used to direct the surgeon to the breast abnormality to be removed or biopsied? Needle guidewire localization
● Differentiate between a screening & diagnostic mammogram: screening mammograms are done on patients with no symptoms to detect early signs of breast cancer, while diagnostic mammograms are done on patients who do have some kind of sign or symptom

Question 15

CONGENITAL ANOMALIES

● What is the most serious complication related to congenital anomalies of the female reproductive system?
● Identify the “normal” position of the uterus:
● Define the following “abnormal” positions of the uterus:
-Retroverted:
-Retroflexed:
-Anteflexed:

Answer 15

● What is the most serious complication related to congenital anomalies of the female reproductive system? problems with reproduction, although various surgical corrections can be performed
● Identify the “normal” position of the uterus: the fundus of the uterus lies anterior to the cervix and away from the rectum and is said to be anteverted(inclined forward)
● Define the following “abnormal” positions of the uterus:
-Retroverted: the uterus is more vertical than normal and points backward toward the bowel
-Retroflexed: the uterus is completely bent back and lies against the rectosigmoid region of the bowel
-Anteflexed: uterus that is tilted vertically forward and it lies on top of the urinary bladder

Question 16

Pelvic Inflammatory Disease (PID)
● What is it?
● Identify the etiology of PID:
● What structures may be affected by PID?
● List the complications & potential complications associated with PID in there is no treatment.
● Identify the signs & symptoms related to PID:

Answer 16

● What is it? a bacterial infection of the upper female reproductive system
● Identify the etiology of PID: 1/3rd of cases are caused by Gonococcus, 1/3rd are caused by a mixture of infections, and 1/3rd of cases are caused by Staphylococcus or Streptococcus
● What structures may be affected by PID? fallopian tubes, endometrium, ovaries, or pelvic peritoneum
● List the complications & potential complications associated with PID if there is no treatment: the infection spreads to the peritoneum, resulting in bacteremia
● Identify the signs & symptoms related to PID: pelvic pain, tenderness, guarding, rebound tenderness, or both. Individuals often have fever, chills, elevated white blood cell (WBC) count, nausea, vomiting, and purulent cervical discharge

Question 17

What is Mastitis? What is the etiology?

Answer 17

•Inflammation of the breast, or mastitis, is most often caused by Staphylococcus aureus, although fungal infections are possible as well.
•Acute mastitis begins when bacteria gain access to breast tissue via the ducts. This bacterial route of infection occurs because of cracks or fissures in the nipple that may develop during the first weeks of lactation and the subsequent nursing of an infant

Question 18

Ovarian Cystic Mass

● Identify two types of cysts that are part of the normal menstrual cycle?
● What causes endometriosis?
● Identify the complications associated with longstanding endometriosis:
● List the signs & symptoms of endometriosis:
● What are polycystic ovaries?
● Identify the most common ovarian tumor in females of reproductive age:
● What might be contained in these types of tumors?

Answer 18

● Identify two types of cysts that are part of the normal menstrual cycle? follicular ovarian cysts and corpus luteum ovarian cysts
● What causes endometriosis? lymphatic spread, seeding from retrograde menstruation, or from direct surgical spread
● Identify the complications associated with longstanding endometriosis: the development of fibrosis, adhesions, scarring, and eventually sterility
● List the signs & symptoms of endometriosis: pelvic and low-back pain, dysmenorrhea, intermittent constipation and diarrhea, and infertility
● What are polycystic ovaries? consist of enlarged ovaries containing multiple small cysts
● Identify the most common ovarian tumor in females of reproductive age: Benign cystic teratomas aka dermoid cyst
● What might be contained in these types of tumors? Hair, thyroid tissue, keratin, sebaceous secretions, and occasionally teeth.

Question 19

Ovarian Cancer

● Describe the prognosis of patients with an ovarian cancer diagnosis:
● What is the etiology of ovarian cancer?
● Summarize the signs & symptoms related to ovarian cancer:
● What treatment plan is generally employed for ovarian cancer patients?

Answer 19

● Describe the prognosis of patients with an ovarian cancer diagnosis: the most lethal gynecologic malignancy because they tend to be asymptomatic in the early stages and the prognosis depends on the stage at which the tumor is discovered. Late-stage tumors that have broken through the capsule of the ovary carry a very poor prognosis.
● What is the etiology of ovarian cancer? unknown but risk factors include a history of late childbearing or nulliparity, delayed menopause, a family history of cancers of the endometrium, breast, or colon, and the presence of an inherited autosomal dominant gene known as the BRCA1 or BRCA2 gene.
● Summarize the signs & symptoms related to ovarian cancer: urinary bladder or rectal pressure, back pain, unexpected weight loss, change in bowel habits, abdominal pain, and bloating. In many cases it is asymptomatic.
● What treatment plan is generally employed for ovarian cancer patients? a hysterectomy and bilateral salpingo-oophorectomy in combination with chemotherapy

Question 20

Cervical Carcinoma (Carcinoma of the Cervix)

● Briefly describe how cervical carcinoma is acquired:
● What is the relationship between HPV and cervical cancer:
● Identify the risk factors associated with cervical carcinoma:

Answer 20

● Briefly describe how cervical carcinoma is acquired: essentially a sexually transmitted disease, as a history of multiple sexual partners or prior sexually transmitted infections predisposes females to this disease. The development of cervical cancer is strongly associated with infection with human papillomavirus (HPV)
● What is the relationship between HPV and cervical cancer: HPV types 16 and 18 are responsible for approximately 70% of all cervical cancers, with types 31, 33, 45, 52, and 58 accounting for another 20%.
● Identify the risk factors associated with cervical carcinoma: cigarette smoking and immunodeficiency

Question 21

Leiomyomas (Uterine Fibroids)
● The most common benign tumor of the female reproductive system is a(n):
● Discuss the symptoms associated with this condition:
● What is the etiology of this condition?
● It is rare that these masses will transform into a malignancy. TRUE OR FALSE?

Answer 21

● The most common benign tumor of the female reproductive system is a(n): Uterine fibroid
● Discuss the symptoms associated with this condition: usually asymptomatic but can cause uterine enlargement and distortion, low-back pain, pressure on the bowel and bladder, intermenstrual bleeding, and acute pain. They may also result in heavy or prolonged menstrual bleeding resulting in anemia
● What is the etiology of this condition? unknown but leiomyomas tend to grow under the influence of estrogen, may enlarge during pregnancy, and stop growing at menopause
● It is rare that these masses will transform into a malignancy. TRUE OR FALSE? True

Question 22

Adenocarcinoma of the endometrium (Endometrial Carcinoma)

● What is the prevalence of endometrial carcinoma?
● Which patient population is most at risk for this condition?
● Identify other risk factors associated with this pathology:

Answer 22

● What is the prevalence of endometrial carcinoma? has remained fairly static; the disease ranks as the fourth most common malignancy occurring in females in the United States
● Which patient population is most at risk for this condition? mainly in those who are postmenopausal, and the incidence increases with age
● Identify other risk factors associated with this pathology: Obesity, tamoxifen use, late menopause, a family history of breast or ovarian cancer, diabetes mellitus, or a history of previous pelvic radiation therapy.

Question 23

The most common malignancy of the uterus is

Answer 23

Adenocarcinoma of the endometrium

Question 24

Breast fibroadenoma
● Fibroadenomas are benign or malignant?
● Identify two treatment options that may be employed for fibroadenomas:

Answer 24

● Fibroadenomas are benign or malignant? benign
● Identify two treatment options that may be employed for fibroadenomas: Surgical removal of the lesion is curative, Ultrasound-guided cryoablation is a new technique that has proven successful in localized detection and destruction of fibroadenomatous tissue

Question 25

Fibrocystic Breasts ● Describe the condition, of fibrocystic breasts: ● Based on the description, how might fibrocystic breasts appear on a mammogram:

Answer 25

**● Describe the condition, of fibrocystic breasts:** An overgrowth of fibrous tissue or cystic hyperplasia results in fibrocystic breasts. This is the most common disorder of the female breast and occurs to some degree in 60% to 75% of all females. This condition is most frequently bilateral, with variably sized cysts located throughout the breasts. The texture of the breast tissue is ropy and thick, especially in the upper outer quadrant of the breast. **● Based on the description, how might fibrocystic breasts appear on a mammogram:** white spots or irregular lumpy tissue

Question 26

Breast Carcinoma ● What is the prevalence of breast carcinoma? ● Summarize risk factors believed to be associated with this condition: ● Describe the signs/ symptoms associated with this condition: ● List treatment options related to breast cancer:

Answer 26

**● What is the prevalence of breast carcinoma?** 1 of every 8 females in the United States will develop invasive breast cancer during her lifetime **● Summarize risk factors believed to be associated with this condition:** Heredity, endocrine influence, oncogenic factors (such as viruses), and environmental factors (such as chemical carcinogens) appear to play a role in the development of this disease. The amount of biologically available estrogen and progesterone is a key endocrine factor in the development of breast cancer. Those individuals with an early onset of menstruation (menarche) or late menopause and females with a first pregnancy after age 30 years are at a higher risk for developing breast cancer. Females using oral contraceptives or estrogen replacement therapy over a 10-year period also have a very small increase in the risk of developing breast cancer. **● Describe the signs/ symptoms associated with this condition:** a lump in the breast by the individual. With the exception of inflammatory breast cancer, which is very virulent and associated with diffuse inflammation and breast enlargement, most begin as slow-growing, relatively painless masses, but as they grow they may infiltrate the suspensory ligaments, causing them to shorten and retract the overlying skin. Physical signs of advanced breast cancer include nipple retraction and distorted breast contour **● List treatment options related to breast cancer:** (1) modified radical mastectomy and (2) breast-conserving surgery followed by radiation therapy, Treatment with an established combination of chemotherapeutic drugs is considered the standard care for premenopausal females who have lymph node involvement.

Question 27

Ectoptic Pregnancy ● What is an ectopic pregnancy? ● Where does this most commonly occur? ● Identify two potential outcomes for this condition: ● Modality of choice:

Answer 27

**● What is an ectopic pregnancy?** the development of an embryo outside of the uterine cavity **● Where does this most commonly occur?** the fallopian tube **● Identify two potential outcomes for this condition:** may produce serious internal hemorrhage and can be life-threatening or if a tubal pregnancy goes untreated, or the embryo will develop and survive for only 2 to 6 weeks. **● Modality of choice:** transvaginal ultrasonography

Question 28

Placenta Previa ● What is it? ● What might occur (to the mother and fetus) as a result of this condition? ● How is delivery approached in the presence of placenta previa?

Answer 28

**● What is it?** condition in which the placenta completely or partially covers the opening on the uterus (cervix) **● What might occur (to the mother and fetus) as a result of this condition?** Hemorrhage may occur and this condition can be life-threatening to both mother and fetus **● How is delivery approached in the presence of placenta previa?** Normal delivery cannot occur in individuals with placenta previa, so a cesarean section is routinely performed.

Question 29

Hydatiform Mole/ Molar Pregnancy

Answer 29

an abnormal conception in which usually no fetus is present. Instead of a fertilized egg progressing to a viable pregnancy, the placenta develops into an abnormal mass of cysts

Question 30

Cryptorchidism ● Describe this condition: ● List three conditions that may result from this congenital anomaly: ● Which modality is most useful in detecting the undescended testicle?

Answer 30

**● Describe this condition:** undescended testes **● List three conditions that may result from this congenital anomaly:** higher risk of testicular malignancy, inguinal hernia, and infertility **● Which modality is most useful in detecting the undescended testicle?** MRI

Question 31

Benign Prostatic Hyperplasia (BPH) ● Describe this condition: ● What is the etiology of this condition? ● List the symptoms associated with BPH: ● Which radiographic exam might demonstrate this condition, and how will it appear?

Answer 31

**● Describe this condition:** a common benign enlargement of the prostate gland, is caused by cellular proliferation leading to the development of discrete nodules within the gland and is palpable through the rectum **● What is the etiology of this condition?** unknown, but the condition is thought to be caused by hormonal changes associated with aging, as it generally affects males after age 50 years **● List the symptoms associated with BPH:** difficulty starting, stopping, and maintaining the flow of urine and inability to completely empty the bladder **● Which radiographic exam might demonstrate this condition, and how will it appear?** intravenous urographic examination as a filling defect at the base of the bladder

Question 32

Carcinoma of the prostate ● What is the prevalence of this disease compared to lung cancer? ● What is the etiology of this condition? ● Identify two common tests that may be used to diagnose this condition: ● Which test can offer a definitive diagnosis?

Answer 32

**● What is the prevalence of this disease compared to lung cancer?** It is the second leading cause of cancer death in American males, behind lung cancer **● What is the etiology of this condition?** unknown, but there is evidence of a potential inherited or genetic link **● Identify two common tests that may be used to diagnose this condition:** blood tests screening for PSA(prostate specific antigen) or digital rectal examinations **● Which test can offer a definitive diagnosis?** prostate biopsy

Question 33

Testicular Torsion ● Describe this condition: ● What symptoms might the patient notice with this condition? ● Critical thinking: what may result if testicular vascularity is compromised too long without treatment?

Answer 33

**● Describe this condition:** occurs if a testicle twists on itself, inducing severe pain and swelling. Failure to correct this surgically in an immediate fashion may result in severe compromise of testicular vascularity **● What symptoms might the patient notice with this condition?** severe pain and swelling **● Critical thinking: what may result if testicular vascularity is compromised too long without treatment?** need surgical removal of the testicle

Question 34

Testicular Masses ● Identify two benign testicular masses: ● Define a hydrocele: ● Define a spermatocele: ● What is the suspected etiology of malignant testicular tumors? ● Identify the common sign for malignant testicular tumors: ● Identify the four types of malignant testicular tumors:

Answer 34

**● Identify two benign testicular masses:** hydroceles and spermatoceles **● Define a hydrocele:** common intrinsic scrotal masses, sometimes congenital in nature, caused by a collection of fluid in the testis or along the spermatic cord **● Define a spermatocele:** aka spermatic cysts, are fluid-filled, painless scrotal masses within the testis adjacent to the epididymis **● What is the suspected etiology of malignant testicular tumors?** unknown, but research has shown a strong hereditary association **● Identify the common sign for malignant testicular tumors:** enlargement or palpable hardness of the testis **● Identify the four types of malignant testicular tumors:** seminomas, embryonal carcinomas, teratomas, and choriocarcinomas

Question 35

Breast cancer in males ● Describe the prevalence of breast cancer in males: ● What is the etiology of breast cancer in males?

Answer 35

**● Describe the prevalence of breast cancer in males:** 1 in 1000 **● What is the etiology of breast cancer in males?** unknown, but risk factors include: age, family history, inherited gene mutations, estrogen treatment, liver disease, and high alcohol intake

Question 36

Acute scrotal pain that may be caused by a lack of blood flow to the testicle requires an emergent imaging examination. Which modality is most highly recommended?

Answer 36

Sonography