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WorksheetsPathophysiology III Reproductive Systems 2 & 3
Total questions: 114
Worksheet time: 57mins
Abdominal pain that occurs during menses is called?
Amenorrhea
Dysmenorrhea
Dyspareunia
Crampy, lower abdominal pain that occurs during menses due to protaglandin induced (PGF-2alpha) uterine contractions?
Primary Dysmenorrhea
Secondary Dysmenorrhea
Tertiary Dysmenorrhea
What are leiomyomas?
Lipomas
Fibroids
Squamous Cell Carcinomas
Presentation of dysmenorrhea?
Symptoms first appear 6-12 months post menarche
Last Up to 72 hours
Normal Physical Exam
What happens if uterine pressure increases greater than arterial pressure?
Uterine Ischemia = metabolites that activate type c neural pain fibers
Prostatic ischemia = activation of type c neural pain fibers
Midcycle pain (Mittelschmerz), what is it?
Pain that manifests beginning of menstrual cycle due to ovulation, enlargement and rupture of follicular cyst = colitis
Pain that manifests at end of menstrual cycle due to ovulation, enlargement and rupture of follicular cyst = appendicitis
Pain that manifests mid menstrual cycle due to ovulation, enlargement and rupture of follicular cyst = peritoneal inflammation
Primary amenorrhea presentation?
absence of menses by age <15 with NORMAL sex characteristics/growth.
If >13 years old with absence of secondary sex characteristics = Attributable to other causes (Turner's, Mullerian Agenesis, Hypopituitarism)
absence of menses by age >15 with NORMAL sex characteristics/growth.
Asherman syndrome?
Intrauterine adhesions or intrauterine synechiae (hold together)
Extrauterine adhesions or extrauterine synechiae (hold together)
Causes of Asherman syndrome?
Scarring after dilation and curettage
Post Leiomyomectomy
Placenta left in uterus post partum
Presentation of Asherman syndrome?
abnormal uterine bleeding
Asymptomatic
infertility
dysmenorrhea
Abnormal uterine bleeding (AUB)?
abnormal menstrual bleeding in non pregnant patient
bleeding that occurs as a normal part of pregnancy
Pathogenesis of AUB?
result of anovulation (corpus luteum not forming) = absence of progesterone = unopposed estrogen function leading to continuous endometrium proliferation
result of polyovulation = too much progesterone = opposed estrogen leads to continuous endometrium proliferation
SYmptoms of AUB?
Variations in menstrual cycle
anemia, lightheadedness
Shortness of Breath
Physical exam of abnormal uterine bleeding?
Obesity
hirsutism
acanthosis nigricans (PCOS likely)
Leiomyoma
What is Polycystic ovarian syndrome?
acquired endocrine disorder characterized by ovarian failure, hyperandrogenism + polycystic ovaries
acquired endocrine disorder characterized by testicular failure, hyperandrogenism + polycystic testicles
acquired endocrine disorder characterized by ovarian failure, hypOandrogenism + polycystic ovaries
Pathogenesis of PCOS?
Insulin resistance = hyperinsulinemia = insulin promotes androgen synthesis from ovary and adrenals
Insulin resistance = hyperinsulinemia = insulin suppresses hepatic production of sex hormone binding globulin
RESULT in increased LH = abnormal ovarian stimulation of theca cells = excess androgen prod. = increased aromatase activity = estrogen elevation = Endometrial Hyperplasia
RESULT in Increased androgens = acne + hirsutism
Labs for PCOS (TST, LH and FSH)?
Elevated TST & LH:FSH ratio of >3
Decreased TST and LH:FSH ratio <2
Presentation of PCOS?
menstrual dysfunction and infertility
asymptomatic
echolalia and apraxia
Physical exam of PCOS?
Obesity
Hirsutism
Acne/Acanthosis Nigricans
Bilateral Enlarged Ovaries
Premenstrual syndrome occurs during?
Luteal Phase of menstrual cycle
Follicular Phase of menstrual cycle
Secretory phase of menstrual cycle
Approximately what day of the menstrual cycle is the luteal phase and what is another name for it?
14th day/ Secretory Phase
7th day / Proliferative Phase
Mechanism of premenstrual syndrome?
hormonal alterations lead to dysregulation of CNS neurotransmitters (GABA/Serotonin)
hormonal alterations lead to dysregulation of CNS leading to seizures and possible status epillipticus
It is a normal manifestation in the male gender
Pelvic organ prolapse?
Herniation of pelvic organs leading to another type of herniation known as an uncal herniation
herniation of transverse colon into the thoracic cavity
Herniation of pelvic organs to or beyond vaginal walls
Pathogenesis of pelvic organ prolapse?
Thoracic floor musculature becomes unable to support the pelvic cavity and causes herniation/prolapse of pelvic organs
Unknown
Pelvic floor musculature becomes unable to provide adequate support = ligament stretches and weakens
Most important ligament in preventing pelvic organ prolapse?
Inguinal Ligament
ACL
MCL
Uterosacral Ligament
Presentation of uterine prolapse?
Heaviness/Pressure in pelvis
Pelvic pain and Urinary Incontinence
Protrusion of tissue
Incomplete prolapse description?
Breast enlargement with bone weakness and decreased estradiol
Uterus drops part way down into vagina
Complete prolapse description?
uterus drops part way into the vagina
uterus slips down and protrudes out of vagina
small intestine protrusion
Cervical cancer is 85% due to? (15% is Adeno)
Squamous Cell Carcinoma
Adenocarcinoma
Unknown
Risk factors for cervical cancer?
HPV infection especially types 16 & 18
Multiple Sex Partners
Asian Descent
HPV 16 & 18 produce what?
E6 Gene Products which inhibit p53 (Tumor Suppressor Gene)
E7 Gene Products which inhibit Rb Suppressor Gene
Presentation of cervical cancer patients?
Postcoital Bleeding
Malodorous discharge, pelvic pain
Ulceration
Cervical cancer may invade?
Rectum
Bladder
Ureters
Lungs
Endometrial cancer is dependent on?
Testosterone dependent malignancy and affects mainly postmenopausal Women
DHEA dependent malignancy and affects mainly postmenopausal Women
DHT dependent malignancy and affects mainly postmenopausal Women
Estrogen dependent malignancy and affects mainly postmenopausal Women
Endometrial cancer may present with?
Abnormal Uterine Bleeding or Postmenopausal Bleeding
Green Discharge
Gray Discharge and Clue Cells
Reed Sternberg Cells
Females with which syndrome are at high risk of acquiring endometrial cancer?
Lynch Syndrome
Peutz Jeghers Syndrome
Turner's Syndrome
Ovarian Cancer is usually presenting with ?
AUB
Chest Pain
SOB
Asymptomatic
Findings in ovarian cancer include?
Ascites, distension
SOB
Hyperestrinism
Early satiety
Associated conditions with ovarian cancer?
BRCA1/BRCA2
Lynch Syndrome
Peutz-Jeghers
Turner's Syndrome
Peutz Jeghers Breakdown?
Polyps
Melanocytic Macules
STK11 Mutation
CEA Marker
CA 19-9, CA125
Germ cell tumors in teenagers are usually due to?
Zenker's Diverticulum
Meckel's DIverticulum
Remnants of embryonic tissues
Dysgerminoma labs?
Turner's Syndrome (Increased HCG and LDH)
Increased AFP and LDH
Teratoma germ cell tumor contains?
Teeth
Hair
Muscle
Yolk Sac embryonic remnants labs?
Decreased AFP and Decreased LDH
Decreased AFP and Increased LDH
Increased AFP and LDH
Sex cord stromal tumor?
Benign; Hormone producing
Sertoli and Leydig = Androgens = Virilization
Granulosa = Hyperestrinism
Surface derived tumors?
Most common Ca125
May metastasize to peritoneum and stomach
Breast cancer is?
most common cancer and second most common cause of death in adult females
most common cancer and second most common cause of death in adult males
Risk factor for breast cancer in females?
BRCA1/BRCA2
RAS Oncogene
Breast cancer physical exam?
Skin changes (retraction) (Dimpling)
Peau d'orange ; skin resembling orange peel
Palpable mass (single nontender firm mass, poorly demarcated margins, and Upper Outer Quadrant Position)
Most frequent type of breast cancer? (2nd most common = Lobular Carcinoma in Situ (LCIS))
Ductal Carcinoma in Situ (DCIS)
Lobular Carcinoma in Situ (LCIS)
Presentation of DCIS? Remember (DUCTAL CARCINOMA IN SITU)
Ductal Hyperplasia, Seen as microcalcification
xx
Paget's Disease is?
Extension of DCIS into lactiferous ducts and skin of nipple
Ductal hyperplasia only
Invasive/Infiltrating ductal carcinoma is the?
worst and most invase
most benign form of ductal carcinoma
Fibroadenomas, what are they and their mechanisms?
Benign solid tumor of breast with epithelial and stromal components
Unclear mechanisms but partially hormone dependent
Fibroadenomas presentation?
female of reproductive age
Nonstender small MOBILE palpable mass
Nontender small NONMOBILE
Fibrocystic breast disease creates a risk factor for? And description?
Risk factor for future Breast Cancer
Non-Proliferative
Cysts, Bilateral, and May have discharge
Presence of varicose veins in scrotum is known as?
Varicocele
Hydrocele
Epididymitis
Varicocele mechanism?
Decreased venous pressure = varicose veins in pampiform plexus
Increased venous pressure = varicose veins in pampiform plexus
Decreased venous pressure = varicose veins in enteric plexus
Why do varicoceles usually occur on the left side?
increased resistance to blood flow from left gonadal vein into left renal vein
increased resistance to blood flow from right gonadal vein into right renal vein
Difference between primary and secondary varicoceles?
Primary = Venous Reflux
Secondary = Neoplasm/renal cell carcinoma compressing veins
Primary = Neoplasm/renal cell carcinoma compressing veins
Secondary = Venous Reflux
Varicocele presentation?
Asymptomatic
Can present with dull ache/heaviness in scrotum
No radicular pain
Infertility (due to testicular atrophy)
Physical exam of varicocele?
Valsalva Maneuver = Distension on inspiration
Bag of worms on palpation
Negative Transillumination
(+) transillumination, decreased resistance with valsalva
Compression of renal vein can cause what syndrome/triad?
Nutcracker syndrome (collateral vein development due to elevated left renal vein pressure)
Hematuria/Flank Pain/Varicocele
Allergic Rhinitis, Asthma, Eczema
Hydrocele characteristics?
Scrotal swelling due to fluid accumulation between parietal and visceral layers of tunica vaginalis
Penile swelling due to fluid accumulation between parietal and visceral layers of tunica vaginalis
Communicating vs Non-Communicating hydrocele?
incomplete closure of processus vaginalis vs complete closure
X
Clinical Presentation of hydrocele?
Painless scrotal bulging
(+) Transillumination
Painful scrotal bulging
(-) Transillumination
Spermatocele Characteristics?
(+) Transillumination
( - ) Transillumination
Malignant Cystic accumulation of LDH arising from head of epididymis
Benign Cystic accumulation of sperm arising from head of epididymis
Spermatocele vs Hydrocele locations?
Hydrocele = Anterior Lateral
Hydrocele = Posterior Lateral
Spermatocele = Posterior Superior
Spermatocele = Posterior Inferior
Testicular torsion = urological emergency due to?
torsion of scrotum itself = ischemia
unable to have sex
torsion of spermatic cord and loss of blood supply = ischemia
Mechanism for testicular torsion?
defective attachment of processus vaginalis allowing abnormal mobility of spermatic cord
defective attachment of parietal and visceral peritoneum allowing abnormal mobility of spermatic cord
defective attachment of tunica vaginalis allowing abnormal mobility of spermatic cord
Physical exam for testicular torsion?
Erythema, Swelling
Tender
Absent Cremasteric Reflex
(+) Cremasteric Reflex
Clinical presentation of testicular torsion?
Severe scrotal pain, nausea/vomit
Blue/Firm unilateral scrotal mass in neonates
Difference between epididymitis and testicular torsion?
epididymitis = (+) cremasteric reflex
testicular torsion = (-) cremasteric reflex
epididymitis = (-) cremasteric reflex
testicular torsion = (+) cremasteric reflex
Physical exam of benign prostatic hyperplasia?
Nontender, smooth, elastic and firm enlarged prostate
tender, irregular , elastic and firm enlarged prostate
What are some modifiable risk factors of BPH?
Obesity/Metabolic Syndrome
Caffeine/Low Physical Activity
3 or more drinks QD
Vitamin C Increases risk
What can help Decrease the risk of BPH?
Citrus
Antioxidants
Pathophysiology of BPH?
Hyperinsulinemia
Increased IGF-1
Fetal Exposure to excess estrogen
What does insulin resistance do to cause BPH?
Sympathetic nervous system activation = increased prostate smooth muscle tone
xx
Prostatic adenocarcinoma arises from?
DHT dependent hyperplasia + posterior lobe
DHT dependent hyperplasia + anterior lobe
Most common cancer in makes and second most common cause of cancer death?
Prostatic Adenocarcinoma
Ductal Carcinoma in Situ
Clinical presentation of prostatic adenocarcinoma?
Asymptomatic
Rarely nonspecific urinary symptoms
Klinefelters
Metastatic prostatic cancer presentation?
Back Pain
Fractures
Weight Loss
Signs of prostatic cancer?
ABnormal Prostate Exam
Increased PSA
Elevated Alk. Phos = Metastasis
Testicular tumors that are mostly malignant?
Germ cell tumors
xx
Most common type of germ cell tumor?
Seminoma (metastasize to para aortic lymph nodes)
Embryonal
NO RIGHT ANSWER
Embryonal germ cell tumors carry worse prognosis than seminoma. Hematogenous.
What germ cell tumor has the worst prognosis ?
Choriocarcinoma
Embryonal
Seminoma
Yolk sac germ cell tumors are seen?
In age <4
In age >65
Non Germ Cell Tumors?
Leydig and Sertoli
Testicular Lymphoma (Bilateral in Older Males)
Presentation of testicular tumors?
Painful unilateral enlargement on testis + transillumination (+) mass
No PE Findings
Painless unilateral enlargement on testis + solid mass
Embryonal germ cell tumors can be painful with elevation in which labs?
Elevated AFP and hCG
Decreased AFP and hCG
Choriocarcinoma produces?
Gynecomastia, (+) hCG= LH Analogous
Gluteal Cellulite , (+) hCG= LH Analogous
Yolk sac tumor in young children labs?
Increased AFP
Decreased AFP
Leydig cell tumor presentation?
Delayed puberty in young and gynecomastia in older
Precocious puberty in young and increased libido in older
Precocious puberty in young and gynecomastia in older
Sexual response cycle steps?
Desire, Excitement, Orgasm and Resolution
Excitement, Orgasm, Desire, and Resolution
Love is all you need (okaayyyy)
Population in which sexual dysfuntion is most prevalent?
Males
Females
Trans
Most common problems causing sexual dysfunction in WOMEN?
lack of desire (47%)
infrequent orgasm (42%)
Dry vagina (37%)
Penile Erectile Dysfunction
Causes of disorders of sexual DESIRE? SOOOO MANY
Chronic stress anxiety, depression
Prolonged abstinence, previous BAD SEX experience
Childhood sexual abuse, religious taboos
Biological Drive Low
Disorders of arousa in females?
failure to lubricate
decreased clitoris enjoyment
decreased penis length
Anorgasmic disorder may lead to?
Anorgasmia may lead to increased desire or no kind of arousal abnormalities
Anorgasmia may lead to decreased desire or arousal disorder
Anorgasmia may lead to increased desire or arousal disorder
Dyspareunia definition?
Superficial Pain = with attempted penetration
Recurrent or persistent genital pain before, during and after
Vaginal Pain = Related to friction
Deep Pain = Thrusting related and associated with pelvic disease
What is vaginismus?
recurrent or persistent involuntary spasm of musculature surrounding lumbar spine ; Interferes with penetration
recurrent or persistent voluntary spasm of musculature surrounding vaginal outlet ; Helps with penetration
XX
recurrent or persistent involuntary spasm of musculature surrounding vaginal outlet ; Interferes with penetration
Most common cause of sexual pain in females?
Hypoestrogenism (usually a syndrome after menopause)
Hyperestrogenism (usually after menopause)
Hyperprolactinemia
Low circulating estradiol and androgen can lead to what in females?
poor lubrication, dryness, and inflammation
can be caused by estrogen-progestin contraceptives or progestin only contraceptives
Sexual dysfunction in males includes?
Vaginal Dryness
Erectily Dysfunction
Decreased Libido
Abnormal Ejaculation
Decreased Clitoris Enjoyment
What drugs/Neurotransmitters cause a decrease in nNos?
GABA
Opioids
Endocannabinoids
Penis cancer most commonly occurs as?
Carcinoma in Situ or Squamous Cell Carcinoma
xx
Bowen's Disease is associated with?
HPV33
HPV 16
Bowen's disease presentation?
Leukoplakia on shaft or scrotum
Leukoplakia on glans penis
Bowen's Disease patients may progress to?
Squamous Cell Carcinoma (indurated and ulcerated, sun exposure)
Adenocarcinoma
Basal Cell Carcinoma (rolled edges, telangiectasias and pearly)
Erythroplasia of Queyrat is found?
glans penis or prepuce
shaft of penis or scrotum
Bowenoid papulosis presentation?
single macular lesion + affects younger age
multiple papular lesions + affects younger age
Bowenoid papulosis is associated with?
HPV 18
HPV 16
HPV 31
Penile squamous cell carcinoma is associated with?
HPV 16
HPV 18
HPV 16 and 18
HPV 33
