Medical Quiz on Reproductive Health

Learning Objectives

• Students will be able to discuss the fundamental anatomical structures of the male and female reproductive systems.
• Students will be able to explain the roles of general radiography, mammography, diagnostic medical sonography, computed tomography, and magnetic resonance imaging in diagnosing and treating reproductive system disorders.
• Students will be able to compare and contrast breast imaging modalities, including diagnostic and screening mammography, localization techniques, and sonography.
• Students will be able to differentiate between major congenital anomalies affecting the female reproductive system.
• Students will be able to describe neoplastic diseases affecting both female and male reproductive systems, including causes, incidence rates, signs, symptoms, treatment options, and prognosis.
• Students will be able to identify and distinguish common disorders during pregnancy, and explain the role of diagnostic medical sonography in managing pregnant individuals.

Anatomy and Physiology of the Female Reproductive System

• The female reproductive system consists of ovaries, fallopian tubes, uterus, vagina, and breasts.
• The primary function is to produce ova, hormones, and provide a site for the development of the fertilized egg (zygote).

External Genitalia (Vulva)

• Components include the mons pubis, labia majora and minora, clitoris, urethral and vaginal openings, and the perineum.
• The vagina connects the external genitalia to the uterus, acting as an exit for menstrual fluids and conception products.

Uterus

• A pear-shaped organ in the pelvic cavity.
• Divided into fundus, body, and cervix.
• The cervix connects the uterine cavity to the upper vagina.
• The uterus has three layers: endometrial, myometrial, and parietal peritoneum.
• Supported by eight ligaments.
• A pessary can support the uterus for cases of lack of proper support and treat pelvic organ prolapse.

Fallopian Tubes

• Extend from the upper edges of the uterus.
• Act as passageways for mature ova (eggs).
• Fertilization typically occurs within the fallopian tubes.
• The fertilized egg travels to the uterus for implantation.

Ovaries

• Primary reproductive glands responsible for ovulation.
• Produce estrogen and progesterone.
• Contain Graafian follicles enclosing ova.
• One follicle matures each month leading to ovulation.

Breasts

• Considered secondary sex organs.
• Composed of lobes separated by connective tissue.
• Hormonal changes during pregnancy prepare them for lactation.
• Lactogenic hormones stimulate milk secretion after delivery.
• Changes with age, with fatty tissue replacing fibroglandular tissue.
• Mastalgia (breast pain) is associated with architectural changes in breast tissue.

Breast Structure

• Attached to pectoral muscles via Cooper ligaments.
• Divided into lobules clustered around small ducts.
• Ducts join to form larger ducts terminating at the nipple.
• Accessory reproductive glands secreting milk for newborns.

Imaging Considerations: Hysterosalpingography (HSG)

• A radiographic study for non-pregnant women, especially for infertility screening.
• Used to evaluate fallopian tube patency and uterine shape.
• Contrast medium is injected into the uterine cavity to visualize the reproductive organs.
• Spillage of contrast from the fallopian tubes indicates tube patency.

Imaging Considerations: Sonohysterography (SHG)

• An alternative to HSG, using saline instead of iodinated contrast.
• Uses transvaginal sonography for real-time images, without radiation.
• Used for evaluating tubal disease and abnormalities within the uterus.

Mammography

• Used for diagnosing breast-related symptoms and screening.
• Detects breast masses, pain, nipple discharge, and abnormalities in skin and lymph nodes.
• Modern equipment minimises radiation exposure.
• Screening is recommended for women over 50, due to reduced breast tissue sensitivity to radiation and increased cancer risk with age.
• Useful in evaluating breast augmentation cases to visualize native breast tissue.
• Techniques like the Eckland maneuver assist in imaging.

Needle Guidewire Localization

• A procedure to identify nonpalpable breast abnormalities detected by mammography.
• Helps guide surgeons for biopsy with minimal morbidity.
• Other biopsy techniques, like fine-needle and large-core biopsy, are also used.

Sonography

• Used to differentiate cystic from solid breast masses.
• Limited in diagnosing solid malignant breast diseases.
• Highly recommended for evaluating suspected gynecologic adnexal masses.

Magnetic Resonance Imaging (MRI)

• Used in conjunction with sonography for evaluating the female pelvis (uterine and ovarian masses).
• Also used to assess breast tissue, differentiating malignant from benign lesions.

Computed Tomography (CT)

• Used for diagnosing reproductive system diseases, especially staging cancer.
• Used to assess neoplastic growth, abscess formation, and anomalies.
• CT-PET fusion studies are valuable for diagnosing and staging neoplastic diseases.
• Indicated for non-pregnant women in the reproductive age group with complex or solid masses developing in short term.

Congenital Anomalies

• Bicornuate Uterus: Paired uterine horns extending into the fallopian tubes, creating a heart-shaped appearance.
• Unicornuate Uterus: Single uterine cavity with one fallopian tube and often kidney on same side is absent.
• Uterus Didelphys: Complete duplication of the uterus, cervix, and vagina.
• These anomalies can cause problems with reproduction.

Abnormal Uterine Positions

• Normal position (anteverted): Fundus anterior to the cervix and away from the rectum.
• Retroverted: Uterus more vertical and points backward towards bowel.
• Retroflexed: Uterus completely bent back and lies against the rectosigmoid region of the bowel.
• Anteflexed: Uterus tilted vertically forward and lies on top of the bladder.
• While abnormal, these positions are often of little clinical significance.

Pelvic Inflammatory Disease (PID)

• A bacterial infection primarily affecting the fallopian tubes.
• Causes can include Gonococcus, mixed infections, Staphylococcus, or Streptococcus.
• Unsterile abortion or pathogen introduction from other sources may cause PID.
• Without treatment, it can spread to the peritoneum, leading to bacteremia.
• Tubo-ovarian abscess formation is a complication, potentially causing sterility.

Mastitis

• Inflammation of breast tissue, often due to Staphylococcus aureus.
• Commonly occurs during lactation when bacteria enter breast tissue through nipple cracks.
• Symptoms include breast pain, redness, swelling, elevated temperature, and potential for abscess formation.
• Treatment involves antibiotic therapy and heat application.
• Risk factors include diabetes, steroid use, cigarette smoking, and inverted nipples.

Ovarian Cystic Masses

• Simple ovarian cysts are common in reproductive-age women.
• They can cause abdominal discomfort, but are usually asymptomatic.
• Follicular and corpus luteum cysts are normal parts of the menstrual cycle.
• Follicular cysts arise from fluid reabsorption issues in underdeveloped follicles.
• Corpus luteum cysts arise from blood reabsorption after ovulation.
• These cysts may change size during the menstrual cycle and cause discomfort or pressure, but treatment is often unnecessary as they resolve spontaneously.

Endometriosis

• A condition where endometrial tissue or glands are found outside the uterus in the pelvic region.
• May affect ovaries, causing symptoms like pelvic and back pain, dysmenorrhea, constipation, diarrhea, and infertility.
• Diagnosis often involves sonography, but laparoscopy is frequently used for confirmation.
• Mild cases may be treated with hormone therapy, while severe cases require surgery.

Polycystic Ovaries

• Enlarged ovaries containing multiple small cysts.
• Associated with Stein-Leventhal syndrome, leading to irregular ovulation, amenorrhea, and sterility.
• Treatment typically involves medications to induce ovulation.

Cystic Teratomas (Dermoid Cysts)

• Benign ovarian tumors composed of various tissue types.
• The most common type of germ cell tumor.
• Complications include torsion and rupture, potentially requiring surgical removal.

Cystadenocarcinoma

• A malignant ovarian tumor primarily affecting perimenopausal and postmenopausal women.
• Poor prognosis if diagnosed at an advanced stage.
• Risk factors include genetics, diet, and late childbearing.
• CA 125 (lab test) and PET-CT are used for diagnosis and surveillance.
• Treatment involves surgery, chemotherapy, and radiation therapy.

Cervical Carcinoma (Dysplasia)

• A common malignancy of cervical epithelial cells often associated with HPV infection.
• Third most common carcinoma of female genital organs and eighth most common malignancy in American women.
• Symptoms include abnormal bleeding and ureteral obstruction.
• Early detection through Pap tests improves cure chances.
• Treatment options vary by stage, potentially including radiation therapy, surgery, and chemotherapy.
• Vaccines like Gardasil prevent some HPV-related cancers.

Uterine Masses: Leiomyomas (Uterine Fibroids)

• Benign, solid masses developing from uterine smooth muscle overgrowth.
• Common, present in 30-50% of women over 50.
• Symptoms may include uterine enlargement, back pain, pressure on bowel/bladder, intermenstrual bleeding, and acute pain.
• Unknown cause, but influenced by estrogen, grow during pregnancy, and stop growing at menopause.
• Diagnostic imaging (sonography, CT, MRI) confirms presence.
• Treatments range from no treatment to surgical removal or uterine artery embolization.

Adenocarcinoma of the Endometrium

• Most common endometrial malignancy (over 80% of endometrial cancers).
• Primarily affects postmenopausal women.
• Risk factors include hormonal changes, obesity, tamoxifen use, late menopause, family history of breast/ovarian cancer, or previous pelvic radiation.
• Starts with endometrial hyperplasia, often filling the uterine cavity.
• Symptoms commonly include irregular or postmenopausal bleeding.
• Treatment varies based on stage, with curative treatment for stage 0 involving hysterectomy and stages I&II treated with surgery and radiation therapy, and stage III&IV treated with chemotherapy.

Fibroadenoma

• A common benign breast tumor often found in women under 30.
• Solid, well-defined mass, typically in the upper outer quadrant of the breast.
• Estrogen-dependent, may grow during pregnancy.
• Generally painless, movable within the breast.
• Diagnosed via mammography, physical exam, and sonography.
• Surgical removal is curative.

Fibrocystic Breasts

• Result from overgrowth of fibrous tissue or cystic hyperplasia, affecting 60-75% of women.
• Symptoms include palpable masses, tender before menstruation, and thick, ropy breast tissue, with breast pain.
• Sonography differentiates solid and cystic masses.
• Large cysts may be aspirated for cytologic evaluation.
• Treatment is largely symptomatic, including breast self-exam and support.

Breast Carcinoma

• A common malignancy in women, with increased risk between 30-50 years old.
• Factors contributing to breast cancer include heredity, hormonal influence, oncogenic factors, and environmental factors.
• Biologically active estrogen and progesterone contribute to breast cancer development.
• Early detection via mammography reduces mortality.
• Radiographically, appear as dense, irregular, stellate masses.

Identifying Breast Cancer

• Fine-needle aspiration, core needle biopsy, or incisional biopsy aid diagnosis.
• Needle localization helps in surgical removal of non-palpable cancerous lesions.
• ER and PR receptor status assists in treatment planning.
• Treatment options include mastectomy, breast conserving surgery followed by radiation, chemotherapy, and radiation therapy.

Disorders During Pregnancy

• Diagnostic medical sonography confirms pregnancy and diagnoses multiple and ectopic pregnancies.
• Transvaginal sonography visualizes the sac and early fetal pole as early as 3 weeks of gestation.
• Sonography assesses abnormally sized pregnant uteruses.
• Screening fetal anomalies using sonography is typically done between 6 and 8 weeks of gestation.
• Additional lab tests like amniocentesis, chorionic villus sampling, and DNA analysis are conducted for suspected congenital anomalies.

Amniotic Fluid

• Produced by physiological functions in mother and fetus, amount varies during pregnancy.
• Oligohydramnios (too little fluid) vs polyhydramnios (excess).
• Fetal swallowing and urine production are essential to maintain fluid volume.
• Oligohydramnios can arise from poor fetal kidney function or urinary system blockage, while polyhydramnios can originate from certain fetal conditions.
• Essential for fetal development and protection.

Ectopic Pregnancy

• Embryo develops outside the uterine cavity, often in the fallopian tube.
• Symptoms include abdominal pain, tenderness, vaginal bleeding, fainting, and shock.
• Tubal pregnancy can lead to life-threatening internal hemorrhage.
• More common in women with PID or uterine tube obstructions.
• Diagnosis via laparoscopy with surgical removal of the embryo and affected tube is standard.
• MRI can provide additional information for ectopic pregnancies located in the cervix or interstitial area of the fallopian tubes.

Disorders of the Placenta

• The placenta is a temporary organ facilitating nutrient and oxygen exchange between the mother and fetus.
• Placenta previa: Placenta covers the cervical os to cause painless vaginal bleeding.
• Placental abruption: Premature separation of the placenta from the uterine wall, potentially life-threatening.
• Placental percreta: Placenta extends into the myometrium.
• Sonography and Doppler ultrasound are used to diagnose and distinguish placental pathologies.

Hydatidiform Mole

• Abnormal conception with no fetus present, uterus filled with dilated chorionic villi (like a bunch of grapes).
• Characterized by swelling of villi and absence of fetal heart sounds.
• Often spontaneously aborts; suction curettage may be necessary.
• Some moles can develop invasive disease.

Anatomy and Physiology of the Male Reproductive System

• The male reproductive system produces and delivers sperm for fertilization of the female egg.
• Primarily functions to produce testosterone, which plays a crucial role in the development of secondary sexual characteristics and regulates various physiological processes.

Glands of the Male Reproductive System

• Testes: Produce sperm (spermatogenesis) and hormones (primarily testosterone).
• Seminal Vesicles: Produce seminal fluid with nutrients and enzymes to support sperm.
• Bulbourethral Glands (Cowper's Glands): Secrete a clear, viscous fluid that lubricates the urethra and neutralizes acidity.
• Prostate Gland: A single gland inferior to the bladder, secreting the majority of seminal fluid, crucial for sperm motility and viability.

Ducts of the Male Reproductive System

• Epididymides: Coiled tubes superior and lateral to the testes, mature and move sperm.
• Vas Deferentia (Ductus Deferens): Extend from the epididymides, pass above the bladder, and then descend, transporting seminal fluid.
• Ejaculatory Ducts: Formed by the junction of vas deferens and seminal vesicle ducts, responsible for transporting seminal fluid into the urethra.
• Urethra: Single tube carrying both urine from the bladder and seminal fluid from reproductive glands to the exterior of the body.

Imaging Considerations: Testicular Imaging

• Scrotal sonography assesses testicular masses, pain, and scrotal enlargement.
• Diagnoses epididymitis, orchiditis, and testicular torsion.
• MRI evaluates testicular masses, detects and stages testicular cancer, and determines if the cancer is unilateral or bilateral.

Imaging Considerations: Prostate Imaging

• Transrectal sonography evaluates the prostate gland by identifying nodules and aiding biopsies.
• MRI of the pelvis assesses the prostate gland and seminal vesicles, identifying prostate cancer and determining the stage, particularly when prostate specific antigen (PSA) levels are elevated.
• Specialized rectal coils enhance prostate imaging quality.

Congenital Anomalies: Cryptorchidism

• Condition where one or both testes fail to descend into the scrotum before birth.
• Associated with an increased risk of testicular cancer.
• Treatment options include surgery to bring the testicle down and fix it.
• Sonography localizes undescended testicles.
• MRI is valuable for tissue differentiation capabilities.

Neoplastic Diseases: Prostatic Hyperplasia

• Benign enlargement of the prostate gland, frequently occurring with age.
• Characterized by discrete nodules in the gland.
• Diagnosis usually involves digital rectal examination and a PSA blood test.
• Believed to be associated with hormonal changes in men over 50.
• Prostate enlargement often compresses the urethra, causing urinary obstruction and symptoms like urinary difficulties and incomplete bladder emptying.
• Residual urine may cause infections (even affecting kidneys).
• Treatment can include partial excision (transurethral resection of the prostate or TURP) or non-surgical approaches.
• CT and MRI may be used for evaluation.

Carcinoma of the Prostate

• Common cancer in older men, incidence increases with age.
• Diagnosis often made through physical exam and elevated acid phosphatase levels in the blood.
• MRI and sonography help determine tumor location and extent.
• Common symptoms include urinary tract obstructions, enlarged prostate, and low back pain.
• Treatment options involve surgical removal, hormone therapy, or radioactive seed implantation.
• Prostate cancer staging and grading guide treatment decisions, monitoring recurrence through bone scans and CT.

Testicular Masses

• Testicular torsion occurs when a testicle twists on itself, causing severe pain and swelling.
• Doppler ultrasound and nuclear medicine scans assess blood supply to the testicle.
• Inflammation and infection can also cause scrotal swelling.
• Benign masses like hydroceles and spermatoceles (fluid-filled, painless scrotal masses) may need differentiation from malignant neoplasms.
• Sonography differentiates benign masses from malignant neoplasms.

Malignant Testicular Tumors

• While rare, malignant testicular tumors are usually treated with surgical resection, chemotherapy, or radiation therapy.
• The four primary types are seminomas, embryonal carcinomas, teratomas, and choriocarcinomas.
• Gynecomastia (breast tissue proliferation in males) can sometimes present with palpable lumps, possibly with nipple discharge.
• Breast ultrasonography aids in diagnosing gynecomastia.
• Breast cancer in men is rare, often presenting in ducts and requiring mammography for imaging.

Test your knowledge on various aspects of reproductive health including conditions like prostatic hyperplasia, gynecomastia, and endometriosis. This quiz covers diagnostic methods, treatment options, and associated symptoms related to male and female reproductive systems. Challenge yourself with questions on imaging techniques and tumor types.