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Exam 4 Summer 2025 Adv Pathophysiology
MARK YOUR CALENDARS: Exam 4 opens Tuesday, August 19, at 8 am CENTRAL TIME; it closes Friday, August
22, at 8 am CENTRAL TIME. Scores will be posted the following day after the exam closes.
NOTE: I include MOST of these concepts in the Kaltura voiceovers housed in the announcements of your Canvas
course, but I may not touch on some of them if they are pretty straightforward. – PLEASE REACH OUT TO YOUR
COURSE FACULTY IF YOU HAVE ANY QUESTIONS!!! This exam covers weeks 12, 13, 14, and 15 content. Chapters
25, 26, 27, 35, 36, 38, 39, 41, 42.
REMINDER: Must earn an average score on all exams of 79.5% to pass the course. If a 79.5% is earned on the
average exam score, all other points from assignments and discussions will be added to calculate the final grade.
Alterations in the Reproductive Systems
Modifications in the Female Reproductive System
Hormonal and Menstrual Alterations
Primary dysmenorrhea is attributed to excessive endometrial prostaglandin production. Painful periods produce
more prostaglandin, a potent myometrial stimulant and vasoconstrictor, than in asymptomatic women. Elevated
levels of prostaglandins cause uterine hypercontractility, decreased blood flow to the uterus, and increased nerve
hypersensitivity, thus resulting in pain. Secondary dysmenorrhea results from disorders in the presence of pelvic
pathologic conditions such as endometriosis (the most common cause), endometritis (infection), pelvic
inflammatory disease, uterine fibroids (leiomyomas), polyps, tumors, ovarian cysts, or intrauterine devices (IUDs).
Endometriosis is the presence of functioning endometrial tissue or implants outside the uterus. Like normal
endometrial tissue, the ectopic (out-of-place) endometrium responds to the hormonal fluctuations of the menstrual
cycle. Common implantation sites include the pelvic peritoneum, ovaries, and uterosacral ligaments. Implants can
also be found outside the pelvic locations: the GI tract, lungs, diaphragm, abdomen, and pericardium. The exact
cause of endometriosis is not known. The clinical manifestations of endometriosis can mimic other disease
processes (i.e., PID, irritable bowel syndrome, ovarian cysts). Symptoms are variable in frequency and severity,
and most commonly include pain and infertility. Women with endometriosis report progressive dysmenorrhea,
dysuria, and dyspareunia (pain on intercourse); they may also report constipation and abnormal vaginal bleeding—
high risk for infertility and cancers, especially ovarian.
Polycystic Ovarian Syndrome (PCOS). Although the underlying cause of PCOS is unknown, a genetic basis is
suspected. No single factor fully accounts for the abnormalities of PCOS, and it is a leading cause of infertility in
the United States. Although PCOS presents in a variety of ways, it is defined as having at least two of the following
three features: Irregular ovulation, elevated levels of androgens (e.g., testosterone), and the appearance of
polycystic ovaries on ultrasound. Polycystic ovaries do not have to be present to diagnose PCOS, and conversely,
their presence alone does not establish the diagnosis. A hyperandrogenic state and ovulatory dysfunction are the
cardinal features in the pathogenesis of PCOS. Excessive androgens affect follicular growth. Follicle-stimulating
hormone (FSH) is decreased (note: FSH regulates the menstrual cycle and stimulates egg production in the
ovaries). Glucose intolerance/insulin resistance (IR) often runs parallel and markedly aggravates the
hyperandrogenic state, thus contributing to the severity of signs and symptoms of PCOS. Obesity adds to and
worsens IR.
Pelvic Inflammatory Disease (PID) is an acute inflammatory process caused by infection. Infection of the upper
genital tract leads to inflammatory damage, including scarring, adhesions, and partial or total obstruction of the
fallopian tubes. Scarring increases the risk of a later ectopic pregnancy because damaged cilia slow the mobility of
an egg through the fallopian tubes. Loss of the ciliated epithelial cells along the fallopian tube lining results in
impaired ovum transport and increases the risk for infertility and ectopic pregnancy.
Scarring and adhesions can also result in chronic pelvic pain. Increased risk of uterine cancer
, Page 2 of 14
Two sexually transmitted infections that cause PID are gonorrhea and chlamydia.
Bacterial vaginosis (BV) is a noninflammatory condition resulting from an overgrowth of anaerobic bacteria.
The overgrowth causes a shift in the composition of the vaginal flora and produces a malodorous vaginal
discharge. Pain and itching are common manifestations. BV is present in up to 66% of PID.
Pelvic Organ Prolapse (POP) is the descent of one or more of these structures: the vaginal wall, uterus, or apex of
the vagina (after a hysterectomy). Although more than 50% of women have some version of POP on physical
examination, most women have no symptoms. When prolapse becomes severe, the function of the surrounding
organs can be altered. POP is thought to be caused by direct trauma (e.g., childbirth), pelvic floor surgery, obesity,
constipation, pelvic organ cancers, or damage to the pelvic innervation, particularly the pudendal nerve. However,
risk factors in nulliparous women include occupational activities that require heavy lifting or chronic medical
conditions, such as chronic lung disease or refractory constipation (chronically increased intra-abdominal
pressure). The most frequently cited risk factors are aging, obesity, and hysterectomy. Other risk factors include a
strong familial tendency (from family and twin studies) and possibly a multifactorial genetic component. Prolapse
of the bladder, urethra, rectum, or uterus may occur many years after an initial injury to the supporting structure.
The “Cele’s”
Cystocele is the descent of a portion of the posterior bladder wall and trigone into the vaginal canal and is usually
caused by the trauma of childbirth. Usually, symptoms are insignificant in mild to moderate cases. Increased
bulging and descent of the anterior vaginal wall and urethra can be aggravated by vigorous activity, prolonged
standing, sneezing, coughing, or straining. They can be relieved by rest or assumption of a recumbent or prone
position. Signs and symptoms:
Urination issues: Difficulty starting urination, a slow urine stream, urinary incontinence, urine leakage,
especially when coughing, sneezing, or exercising.
Pelvic discomfort: A feeling of fullness, heaviness, pain in your pelvic area, or lower back pain.
Other symptoms: Frequent urinary tract infections (UTIs), or discomfort or numbness during sex.
Rectocele is the bulge of the rectum and posterior vaginal wall into the vaginal canal. Childbirth may increase
damage. Lifelong constipation.
An enterocele is a herniation of the rectouterine pouch into the rectovaginal septum (between the rectum and
posterior vaginal wall). Most large enteroceles are found in grossly obese and older adults and can be complicated
by rupture or complete eversion of the vagina with trophic ulceration, edema, and fibrosis. Treatment is surgical.
Spermatoceles (epididymal cysts) are benign cystic collections of fluid of the epididymis located between the head
of the epididymis and the testis. Spermatoceles are filled with milky fluid that contains sperm. Spermatocele is
differentiated from a hydrocele in that aspiration of the hydrocele recovers a clear, yellow liquid, and, unlike a
hydrocele, a spermatocele does not cover the entire anterior surface of the testis.
Malignancies
Ovarian cancer is commonly asymptomatic until the tumors have grown very large, and is most commonly
diagnosed after metastasis has occurred. Consequently, ovarian cancer is often termed the “silent killer”. The
pathogenesis of ovarian cancer is not fully understood. A genetic predisposition is found in 10% to 15% of cases.
There is an association with the breast cancer susceptibility gene 1 (BRCA1) and a smaller number with mutations
of BRCA2. Difficult to classify: In the past, ovarian cancers were thought to arise from just epithelial cells. Ovarian
cancer is not easily classified. Newer evidence suggests that tumors can arise from: the fimbriae of the fallopian
tubes, deposits of endometriosis, or stromal cells.
Breast Cancer Inheritance factors of the cancerous genes BRCA1 and BRCA2 play a role in the development of
breast cancer. BRCA1 (breast cancer one gene) is a tumor-suppressor gene; therefore, any mutation in the gene
may inhibit or alter its suppressor function, leading to uncontrolled cell proliferation. BRCA2 (breast cancer two
gene) helps repair damaged DNA and maintain the stability of a cell's genetic information. Males who develop
breast cancer are more likely to have a BRCA2 mutation than a BRCA1 mutation. Risk factors and possible causes
Exam 4 Summer 2025 Adv Pathophysiology
MARK YOUR CALENDARS: Exam 4 opens Tuesday, August 19, at 8 am CENTRAL TIME; it closes Friday, August
22, at 8 am CENTRAL TIME. Scores will be posted the following day after the exam closes.
NOTE: I include MOST of these concepts in the Kaltura voiceovers housed in the announcements of your Canvas
course, but I may not touch on some of them if they are pretty straightforward. – PLEASE REACH OUT TO YOUR
COURSE FACULTY IF YOU HAVE ANY QUESTIONS!!! This exam covers weeks 12, 13, 14, and 15 content. Chapters
25, 26, 27, 35, 36, 38, 39, 41, 42.
REMINDER: Must earn an average score on all exams of 79.5% to pass the course. If a 79.5% is earned on the
average exam score, all other points from assignments and discussions will be added to calculate the final grade.
Alterations in the Reproductive Systems
Modifications in the Female Reproductive System
Hormonal and Menstrual Alterations
Primary dysmenorrhea is attributed to excessive endometrial prostaglandin production. Painful periods produce
more prostaglandin, a potent myometrial stimulant and vasoconstrictor, than in asymptomatic women. Elevated
levels of prostaglandins cause uterine hypercontractility, decreased blood flow to the uterus, and increased nerve
hypersensitivity, thus resulting in pain. Secondary dysmenorrhea results from disorders in the presence of pelvic
pathologic conditions such as endometriosis (the most common cause), endometritis (infection), pelvic
inflammatory disease, uterine fibroids (leiomyomas), polyps, tumors, ovarian cysts, or intrauterine devices (IUDs).
Endometriosis is the presence of functioning endometrial tissue or implants outside the uterus. Like normal
endometrial tissue, the ectopic (out-of-place) endometrium responds to the hormonal fluctuations of the menstrual
cycle. Common implantation sites include the pelvic peritoneum, ovaries, and uterosacral ligaments. Implants can
also be found outside the pelvic locations: the GI tract, lungs, diaphragm, abdomen, and pericardium. The exact
cause of endometriosis is not known. The clinical manifestations of endometriosis can mimic other disease
processes (i.e., PID, irritable bowel syndrome, ovarian cysts). Symptoms are variable in frequency and severity,
and most commonly include pain and infertility. Women with endometriosis report progressive dysmenorrhea,
dysuria, and dyspareunia (pain on intercourse); they may also report constipation and abnormal vaginal bleeding—
high risk for infertility and cancers, especially ovarian.
Polycystic Ovarian Syndrome (PCOS). Although the underlying cause of PCOS is unknown, a genetic basis is
suspected. No single factor fully accounts for the abnormalities of PCOS, and it is a leading cause of infertility in
the United States. Although PCOS presents in a variety of ways, it is defined as having at least two of the following
three features: Irregular ovulation, elevated levels of androgens (e.g., testosterone), and the appearance of
polycystic ovaries on ultrasound. Polycystic ovaries do not have to be present to diagnose PCOS, and conversely,
their presence alone does not establish the diagnosis. A hyperandrogenic state and ovulatory dysfunction are the
cardinal features in the pathogenesis of PCOS. Excessive androgens affect follicular growth. Follicle-stimulating
hormone (FSH) is decreased (note: FSH regulates the menstrual cycle and stimulates egg production in the
ovaries). Glucose intolerance/insulin resistance (IR) often runs parallel and markedly aggravates the
hyperandrogenic state, thus contributing to the severity of signs and symptoms of PCOS. Obesity adds to and
worsens IR.
Pelvic Inflammatory Disease (PID) is an acute inflammatory process caused by infection. Infection of the upper
genital tract leads to inflammatory damage, including scarring, adhesions, and partial or total obstruction of the
fallopian tubes. Scarring increases the risk of a later ectopic pregnancy because damaged cilia slow the mobility of
an egg through the fallopian tubes. Loss of the ciliated epithelial cells along the fallopian tube lining results in
impaired ovum transport and increases the risk for infertility and ectopic pregnancy.
Scarring and adhesions can also result in chronic pelvic pain. Increased risk of uterine cancer
, Page 2 of 14
Two sexually transmitted infections that cause PID are gonorrhea and chlamydia.
Bacterial vaginosis (BV) is a noninflammatory condition resulting from an overgrowth of anaerobic bacteria.
The overgrowth causes a shift in the composition of the vaginal flora and produces a malodorous vaginal
discharge. Pain and itching are common manifestations. BV is present in up to 66% of PID.
Pelvic Organ Prolapse (POP) is the descent of one or more of these structures: the vaginal wall, uterus, or apex of
the vagina (after a hysterectomy). Although more than 50% of women have some version of POP on physical
examination, most women have no symptoms. When prolapse becomes severe, the function of the surrounding
organs can be altered. POP is thought to be caused by direct trauma (e.g., childbirth), pelvic floor surgery, obesity,
constipation, pelvic organ cancers, or damage to the pelvic innervation, particularly the pudendal nerve. However,
risk factors in nulliparous women include occupational activities that require heavy lifting or chronic medical
conditions, such as chronic lung disease or refractory constipation (chronically increased intra-abdominal
pressure). The most frequently cited risk factors are aging, obesity, and hysterectomy. Other risk factors include a
strong familial tendency (from family and twin studies) and possibly a multifactorial genetic component. Prolapse
of the bladder, urethra, rectum, or uterus may occur many years after an initial injury to the supporting structure.
The “Cele’s”
Cystocele is the descent of a portion of the posterior bladder wall and trigone into the vaginal canal and is usually
caused by the trauma of childbirth. Usually, symptoms are insignificant in mild to moderate cases. Increased
bulging and descent of the anterior vaginal wall and urethra can be aggravated by vigorous activity, prolonged
standing, sneezing, coughing, or straining. They can be relieved by rest or assumption of a recumbent or prone
position. Signs and symptoms:
Urination issues: Difficulty starting urination, a slow urine stream, urinary incontinence, urine leakage,
especially when coughing, sneezing, or exercising.
Pelvic discomfort: A feeling of fullness, heaviness, pain in your pelvic area, or lower back pain.
Other symptoms: Frequent urinary tract infections (UTIs), or discomfort or numbness during sex.
Rectocele is the bulge of the rectum and posterior vaginal wall into the vaginal canal. Childbirth may increase
damage. Lifelong constipation.
An enterocele is a herniation of the rectouterine pouch into the rectovaginal septum (between the rectum and
posterior vaginal wall). Most large enteroceles are found in grossly obese and older adults and can be complicated
by rupture or complete eversion of the vagina with trophic ulceration, edema, and fibrosis. Treatment is surgical.
Spermatoceles (epididymal cysts) are benign cystic collections of fluid of the epididymis located between the head
of the epididymis and the testis. Spermatoceles are filled with milky fluid that contains sperm. Spermatocele is
differentiated from a hydrocele in that aspiration of the hydrocele recovers a clear, yellow liquid, and, unlike a
hydrocele, a spermatocele does not cover the entire anterior surface of the testis.
Malignancies
Ovarian cancer is commonly asymptomatic until the tumors have grown very large, and is most commonly
diagnosed after metastasis has occurred. Consequently, ovarian cancer is often termed the “silent killer”. The
pathogenesis of ovarian cancer is not fully understood. A genetic predisposition is found in 10% to 15% of cases.
There is an association with the breast cancer susceptibility gene 1 (BRCA1) and a smaller number with mutations
of BRCA2. Difficult to classify: In the past, ovarian cancers were thought to arise from just epithelial cells. Ovarian
cancer is not easily classified. Newer evidence suggests that tumors can arise from: the fimbriae of the fallopian
tubes, deposits of endometriosis, or stromal cells.
Breast Cancer Inheritance factors of the cancerous genes BRCA1 and BRCA2 play a role in the development of
breast cancer. BRCA1 (breast cancer one gene) is a tumor-suppressor gene; therefore, any mutation in the gene
may inhibit or alter its suppressor function, leading to uncontrolled cell proliferation. BRCA2 (breast cancer two
gene) helps repair damaged DNA and maintain the stability of a cell's genetic information. Males who develop
breast cancer are more likely to have a BRCA2 mutation than a BRCA1 mutation. Risk factors and possible causes
