Female Reproductive System

A comprehensive set of practice flashcards covering BRCA risk, breast and ovarian cancer screening, ectopic pregnancy, inflammatory breast cancer, cervical health and screening, Pap/HPV testing, colposcopy, endometriosis, contraception, pelvic organ prolapse, reproductive physiology, menopause, and common vaginal infections.

What is the inheritance pattern of BRCA1 and BRCA2 mutations?

Autosomal dominant.

Approximately what percentage of breast cancer and ovarian cancer cases are caused by BRCA1/BRCA2 mutations?

Up to 6% of breast cancer and 20% of ovarian cancer.

For women with a high lifetime risk of breast cancer (risk ≥20%), what screening is recommended and when should it start?

Annual screening mammogram, annual breast MRI, and clinical breast exam every 6–12 months beginning 10 years prior to the age at diagnosis of the youngest affected family member.

Describe the typical features of a dominant breast mass that suggests breast cancer.

A mass that is hard, irregular in shape, possibly attached to skin or surrounding tissue, often in the tail of Spence; may have peau d’orange, dimpling, or retraction.

What are common sites of breast cancer metastasis?

Bone, liver, lungs, and brain.

What is the definitive diagnostic test for breast cancer?

Tissue biopsy.

Where do most ectopic pregnancies occur, and how is definite diagnosis made?

Most occur in the fallopian tube; definite diagnosis by serum quantitative hCG and transvaginal ultrasonography.

What is the typical presentation of an ectopic pregnancy?

Pelvic pain (early in the first trimester) with possible vaginal bleeding; pain may radiate; amenorrhea; risk factors include prior ectopic, IUD use, tubal ligation, IVF.

What characterizes inflammatory breast cancer (IBC)?

Rapid onset of a red, swollen, warm breast with quick progression; may lack a distinct lump; peau d’orange; commonly with lymph node metastases and sometimes distant metastases; more common and earlier in African Americans; very aggressive.

What are common symptoms and prognosis factors for ovarian cancer?

Vague symptoms (abdominal bloating, discomfort, early satiety, GI reflux-type symptoms, back/pelvic pain, dyspareunia); most are diagnosed after spread; 5-year survival is poor with distant metastases; CA-125 lacks specificity for screening.

Which genetic testing is recommended for women with a high-risk family history of ovarian cancer?

Genetic counseling and testing (BRCA1/BRCA2, Lynch syndrome).

What is Paget’s disease of the breast and its typical presentation?

A red, scaly rash starting at the nipple and spreading to the areola; itching, pain, or burning; may be associated with a breast mass; rare in men.

Where is the majority of breast cancer located in the breast anatomy?

In the upper outer quadrant (tail of Spence).

What is a fibroadenoma and how is it usually evaluated?

A benign solid breast tumor; ultrasound is imaging of choice; needle biopsy may be needed for confirmation; may enlarge with estrogen and shrink after menopause; usually not associated with increased breast cancer risk except for complex fibroadenomas.

What is the estimated lifetime risk of breast cancer for BRCA1/BRCA2 mutation carriers?

Up to about 72%.

What are some risk factors for male breast cancer?

Cryptorchidism, positive family history, BRCA1/BRCA2 mutations.

What is the diagnostic test for breast cancer or any solid tumor?

Tissue biopsy.

What is cervical ectropion and why is sampling the transformation zone (TZ) important during Pap tests?

A benign red, friable area around the os made of glandular cells; TZ sampling is important because abnormal cells are more likely to develop where the TZ transitions to the squamous surface.

What is the typical pattern of cervical mucus across the menstrual cycle?

After menses: scant mucus; midcycle: large amounts of clear, runny mucus (egg white); mucus changes with hormonal contraception (thickened by hormones).

What are the major components of the uterus and endometrium?

The uterus consists of the uterine corpus and cervix; the endometrium is made of glandular epithelium and stroma.

What are fibroids (leiomyomas), their symptoms, and their potential to become malignant?

Benign tumors that can enlarge the uterus, causing heavy menstrual bleeding, pelvic pain, or abnormal bleeding between periods; rarely can be malignant (leiomyosarcoma).

What hormones are produced by the ovaries and what PCOS-related changes occur?

Ovaries produce estrogen, progesterone, and small amounts of testosterone; PCOS causes higher estrogen and higher androgens (leading to acne, hirsutism, oligomenorrhea) and insulin resistance.

What is a common anatomic variant (benign) related to nipples?

Supernumerary nipples forming a V-shaped line on chest and abdomen.

Name the major phases of the typical 28-day menstrual cycle and the key hormonal changes in each phase.

Follicular/Proliferative (Days 1–14): FSH stimulates follicle maturation; estrogen predominates and thickens the endometrium. Ovulatory (Day 14): LH surge triggers ovulation. Luteal (Days 14–28): Progesterone predominates and stabilizes the endometrium.

What defines menopause and perimenopause, and what are common symptoms?

Menopause is the cessation of menses for 12 consecutive months; average age is ~51. Perimenopause lasts about 10 years with vasomotor symptoms and changes in lubrication; postmenopausal symptoms include vaginal dryness and decreased libido.

What did the Women’s Health Initiative (WHI) and USPSTF report regarding combined estrogen–progestin therapy and unopposed estrogen?

WHI found increased risks (stroke, heart disease, VTE, breast cancer, pulmonary embolism); USPSTF does not recommend routine use of combined estrogen–progestin or unopposed estrogen for chronic disease prevention; duration generally <5 years; estrogen + progesterone is used when the uterus is present to reduce endometrial cancer risk.

What is the fertile time period for conception and what signs indicate it?

Sexual intercourse 1–2 days before ovulation; fertile period marked by copious clear mucus that is thin and elastic.

Describe conception and early pregnancy development milestones.

Fertilization occurs, the zygote travels through the fallopian tube becoming a blastocyst; implantation into the endometrium occurs; placenta forms by 18–20 weeks; pregnancy lasts about 280 days (40 weeks).

What is liquid-based cervical cytology (ThinPrep) and how does it differ from conventional Pap testing?

Liquid-based cytology is processed by computer (ThinPrep) and is more common in the US; it has a higher yield and allows standardized processing; conventional Pap uses a glass slide.

What is the Bethesda System used for in cervical cytology?

A standardized reporting system for cervical cytology results, including categories like ASC-US, LSIL, HSIL, AGC, and references for follow-up.

What is ASC-US and how is it managed by age group?

Atypical Squamous Cells of Undetermined Significance; management varies by age: under 21 no Pap; 21–24 repeat Pap in 12 months (or reflex HPV); 25–29 reflex HPV; 30+ cotesting for high-risk HPV with colposcopy if HPV positive.

What is HSIL and how is it managed?

High-grade squamous intraepithelial lesion; management: 21–24 years: refer for colposcopy; 25+ years: immediate excisional treatment or colposcopy (LEEP, cone) due to higher cancer risk.

What is AGC and why is follow-up important?

Atypical Glandular Cells; associated with premalignancy or malignancy in about 30% of cases; follow-up may include colposcopy, endocervical sampling, and endometrial sampling.

What is the role of an HPV DNA test in cervical cancer screening?

HPV types 16 and 18 cause nearly all cervical cancers; reflex or primary testing is used in co-testing strategies.

What is Gardasil and what is its recommended age range and dosing schedule?

HPV vaccine; recommended ages 9–45; if given before age 15, a two-dose series is used (0, 6–12 months); if at 15 or older, a three-dose series (0, 1–2, 6 months).

What is a colposcopy and what does it involve?

A procedure using a colposcope to visualize the cervix, obtain cervical biopsies, and access the cervix for cryotherapy or laser therapy.

What is acetowhitening and how is it used in colposcopy?

Application of 3–5% acetic acid causes abnormal cervical areas to turn bright white, guiding biopsy from acetowhitened areas.

What additional steps follow a colposcopy?

Biopsy samples from acetowhitened areas, ectocervix, endocervical canal, and squamocolumnar junction; post-procedure cramping and spotting are common.

What are the common laboratory procedures used to treat abnormal cervical cells (ablative and excisional options)?

Cryotherapy or laser therapy (ablative) and loop electrosurgical excision procedure (LEEP) or conization (excisional).

What is a KOH (potassium hydroxide) test used for?

Helpful for diagnosing fungal infections (hair, nails, skin); vaginal specimens usually do not require KOH for Candida.

What is a Whiff test and what does a positive result indicate?

Adding KOH to vaginal discharge produces a fishy odor indicating bacterial vaginosis (BV).

What is a Tzanck smear used for and what would a positive result show?

Adjunct test for evaluating herpes infections; shows giant multinucleated cells with abnormal nuclei.

What are the CDC/ACOG guidelines regarding Pap testing before age 21?

Pap testing and HPV testing are not recommended before age 21, regardless of risk factors.

What are the major categories of contraception and their relative effectiveness?

Least effective: fertility awareness, spermicide, condoms, withdrawal; moderate: pill, patch, ring, diaphragm; most effective: implant, IUD, vasectomy, tubal/hysterectomy.

What are absolute contraindications to combined hormonal contraception (CHC)?

Conditions increasing thromboembolic or stroke risk (e.g., history of DVT/PE, factor V Leiden, major surgery with immobilization, smoking ≥15 cigarettes/day if age ≥35, hypertension with SBP ≥160 or DBP ≥100, certain cardiovascular diseases, liver disease with abnormal LFTs, estrogen-dependent tumors, known pregnancy, etc.).

What mnemonic helps remember absolute contraindications to CHC, and what does it stand for?

My CUPLETS: Migrations? My—migraines with aura; C—CAD or CVA; U—undiscovered genital bleeding; P—pregnant or suspected pregnancy; L—liver tumor or active liver disease; E—estrogen-dependent tumor; T—thrombus or emboli; S—smoker 35 or older.

What are some common contraindications and cautions for progestin-only methods like the mini-pill?

Safer in breastfeeding; must be taken at the same time daily; missed doses require backup contraception; slightly less effective than combined pills; no placebo week.

What is the Depo-Provera (DMPA) contraception and what are its cautions?

Intramuscular injection every 3 months; highly effective; can cause amenorrhea with long-term use; boxed warning for potential long-term bone density loss; not ideal if pregnancy is desired within 12 months.

What is Nexplanon/Nexplanon II and how long is it effective?

A subdermal implant containing etonogestrel; effective up to 3–5 years (Nexplanon up to 3 years; Norplant up to 5). Unscheduled bleeding often occurs initially; removal may require surgery.

What are the features and risks associated with copper IUD (Paragard) vs LNG IUS (Mirena)?

Copper IUD: non-hormonal, effective up to 10 years; may cause heavier menses and cramping initially. LNG IUS: hormonal, reduces bleeding; effective up to 5 years; may cause lighter periods; generally more effective at reducing bleeding.

What are common barrier methods and important cautions about spermicides containing nonoxynol-9 (N-9)?

Diaphragm, cervical cap, condoms, vaginal spermicides; N-9 increases risk of vaginal/cervical irritation and HIV transmission; avoid oil-based lubricants with silicone devices.

What is the management of atrophic vaginitis in postmenopausal women with vaginal estrogen?

Nonhormonal moisturizers and lubricants for mild symptoms; moderate-to-severe symptoms: topical estrogen preparations (creams, tablets, vaginal rings) with the need for progesterone if the uterus is intact to prevent endometrial hyperplasia; periodic Pap rechecks.

What are the pelvic organ prolapse types and basic management options?

Cystocele (bladder), rectocele (rectum), uterine prolapse (uterus), enterocele (small bowel); manage with pelvic floor exercises, pessary, or surgical repair (urogynecologist).

What is the classic clinical picture of endometriosis and its common treatments?

Reproductive-aged woman with dysmenorrhea, heavy cramps, and dyspareunia; nodules or masses may be found; treat with NSAIDs, hormonal therapies (combined OCs, GnRH analogues like leuprolide, aromatase inhibitors for severe cases), and weight management; infertility is possible.

What is the typical description and findings of fibrocystic breast changes?

Cyclic breast pain and lumpiness with breast tenderness; lumps are mobile and rubbery; may be worse premenstrually; caffeine reduction and vitamin E/ evening primrose may help; avoid receptor-specific guidance.

What is the standard approach to evaluating pelvic organ prolapse during exam?

Bimanual and speculum exam with Valsalva; identify cystocele, rectocele, uterine prolapse, and enterocele; refer for pessary or surgical repair as indicated.

What are common presentations and essential management steps for bacterial vaginosis (BV)?

Fishy vaginal odor with a thin, gray-white discharge; clue cells; positive Whiff test; pH >4.5; treat with metronidazole (oral or vaginal gel); avoid sex until treated; partners do not require treatment.

What are the common presentations and treatments for candidiasis (yeast infection)?

Cheesy white discharge with vulvar/vaginal itching; microscopy with pseudohyphae and spores; treat with azoles (miconazole, clotrimazole) or single-dose fluconazole (avoid in pregnancy).

What are the key features of Trichomoniasis and its treatment?

Pruritus, burning, dysuria, and copious gray-green frothy discharge; strawberry cervix; treat with metronidazole (2 g PO × 1 dose) or tinidazole (2 g PO × 1 dose); treat sexual partners.

What is the “strawberry cervix” sign associated with Trichomonas infection?

punctate hemorrhages on the cervix seen during exam.

What are common causes and management strategies for endometriosis-related infertility?

Ectopic endometrial implants; treat with hormonal suppression for pain; GnRH analogues or aromatase inhibitors for severe cases; consider assisted reproduction if infertility persists.

What risk factors are commonly cited for ovarian cancer screening in high-risk women with BRCA mutations?

BSO (risk-reducing salpingo-oophorectomy) between ages 35–40 after childbearing; screening with transvaginal ultrasound and CA-125 if done, but routine screening is not generally recommended for the general population.

What are the key types of cervical cancer screening guidelines mentioned (USPSTF and ACOG) for average-risk women?

USPSTF: 21–29 years cytology alone; 30–65 years cytology with HPV co-testing every 5 years or cytology alone every 3 years; stop at 65 or after hysterectomy with no cervix. ACOG: more frequent screening for certain high-risk groups (e.g., HIV+, DES exposure).

What is the first-line diagnostic test for cervical cancer?

Colposcopy with directed cervical biopsy.

What is the role of a Pap test in pregnancy?

Pap tests may be performed during pregnancy if needed, but some guidelines advise delaying non-urgent cytology; most screening can be continued after delivery depending on risk.