Uterine and Ovarian Pathophysiology

Question 1

Menstruation starts because of what hormone?

Answer 1

No hormones

Question 2

What is endometriosis?

Answer 2

Endometrial tissue outside of the uterine cavity

Question 3

Where does endometriosis commonly grow?

Answer 3

Within the pelvic structures but can grow anywhere

Question 4

What causes anatomical changes in endometriosis?

Answer 4

Scaring that can result in infertility and chronic pain

Question 5

What is adenomyosis?

Answer 5

Enlargement of the myometrium d/t presence of endometrial glands, essentially a form of endometriosis

Question 6

Normal PT with prolonged PTT will be seen in labs in women with abnormal uterine bleeding that have what coagulopathy?

Answer 6

Von Willebrand

Question 7

Per ACOG, 20% of women with heavy bleeding have what underlying coagulopathy?

Answer 7

Von Willebrand

Question 8

In anovulatory cycles, there is no spike in LH or no ovulation which results in the lack of production of what?

Answer 8

Corpus Luteum due to the lack of progesterone

Question 9

What is the role of progesterone and why does an increase result in anovulatory cycle?

Answer 9

Proliferation of the endometrium while also keeping the endometrium stable, without this, bleeding can be irregular, proliferation/stability of endometrial lining can vary

Question 10

At the time of puberty, there is likely low levels of LH stimulation which will lead to what kind of cycle?

Answer 10

Anovulatory cycle

Question 11

What is endometrial hyperplasia?

Answer 11

Overgrowth of the endometrial glands

Question 12

When is endometrial hyperplasia more common?

Answer 12

Older patients and obesity

Question 13

How does endometrial carcinoma present?

Answer 13

Abnormal uterine bleeding

Question 14

What are endometrial polyps?

Answer 14

Overgrowth of endometrial glands and stroma, this forms around a vascular bed and will hang in a peduculated fashion

Question 15

What can lead to long-term consequences in pelvic inflammatory disease?

Answer 15

Scaring and inflammation, requires early diagnosis

Question 16

What is the primary microorganism in the vagina?

Answer 16

Lactobacilli

Question 17

What infections are pelvic inflammatory disease most commonly associated with?

Answer 17

Gonorrhea and Chlamydia

E. Coli can be associated in post-menopausal women
Often polymicrobial

Question 18

Do you need to be sexually active for a diagnosis of PID?

Answer 18

Yes

*sure it could be possible to not be but extremely unlikely

Question 19

Chylamydia has an affinity for columnar epithelial cells of mucus membranes, therefore chylamydia infection is common in what locations?

Answer 19

Conjunctiva
Cervix
Lungs (pneumonia)

Question 20

Endometritis is the inflammation of ________, and is most commonly associated with ________.

Answer 20

Intrauterine lining, PID

Question 21

Idiopathic endometritis can lead to chronic disease, which will result in what long term complication?

Answer 21

Decrease in fertility (increased risk of spontaneous abortion, problems with implantation)

Question 22

Salpingitis is inflammation of the _________ and is due to ____________.

Answer 22

Fallopian tube, PID

Question 23

If a patient of child-bearing age presents with syncope what needs to be included in the work-up?

Answer 23

Evaluation of ectopic pregnancy

Question 24

What are ovarian torsions m/c associated with?

Answer 24

Enlarged ovary (from cysts), typically >4cm

Question 25

What ovary is most likely to be torsed?

Answer 25

Right, due to increased ligament length

Question 26

What is the presentation of ovarian torsion?

Answer 26

Severe, sudden onset of adnexal pain, vomiting