6.4 Reproduction

Front 1

1. Which nerve is responsible for erection and which is responsible for ejaculation?

2. From what cellular structure is the acrosome derived?

3. What is Bowenoid Papulosis? Who is it most often seen in?

Back 1

1. erection: pelvic; ejaculation: pudendal

2. golgi

3. pre-malignant condition that appears like HPV warts; seen in younger men

Front 2

1. Describe the stages of spermatogenesis, their chromosome status (4N, 2N, N) and their ploidy?

2. Penile SCC is associated with what virus?

3. Compare prostate adenocarcinoma and BPH with respect to the free PSA/total ratio?

Back 2

1. spermatogonia (2N diploid) → 1⁰ spermatocyte (4N diploid) →2⁰ spermatocyte (2N haploid) → spermatid (N haploid)

2. HPV

3. BPH: ↑Free(9/10), Cancer: ↓Free (1/10)

Front 3

1. WHat is the difference between spermatogenesis and spermeogenesis?

2. Which testicular cell layer forms the blood/testes barrier?

3. What is the interplay between E1, E2, and E3 (also akas?)

Back 3

1. spermato: spermatogonium → spermatid; spermeogenesis: spermatid → spermatazoa

2. Sertoli cells

3. E2(estradiol)⇋E1(estrone)→E3(Estriol)

Front 4

1. Where are sertoli and leydig cells located within the testes?

2. Moving from Exterior to Interior in the lumen of the seminiferous tubules, which cells (nuclei) will you encounter?

3. Where is estradiol produced (and from what)? Where is estrone produced (and from what?)?

Back 4

1. Sertoli: seminiferous tubules, Leydig: interstitium

2. Primary spermatogonium, Sertoli, Primary Spermatocyte

3. Estradiol: ovary (from testosterone), Estrone: adrenal (from androstenedione)

Front 5

1. What products are secreted by the Sertoli cells and by the Leydig cells?

2. What portion of the prostate is most often effected by adenocarcinoma?

3. Give two situations that would cause an increase in total PSA?

Back 5

1. Sertoli: ABP and inhibin; Leydig: testosterone

2. Posterior peripheral prostate

3. BPH and prostate adenocarcinoma

Front 6

1. What type of tumors are males susceptible for with cryptorchidism?

2. Describe this gonadal tumor: "Watery cytoplasm with fried egg appearance?"

3. What does a testicular mass that can be transilluminated versus not transilluminated mean?

Back 6

1. germ cell tumors

2. Seminoma

3. -transillumination: tumor

Front 7

1. Schiller Duval bodies are pathognomonic for what cancer? What marker is seen?

2. Who most often gets testicular lymphoma?

3. Exstrophy of the bladder is associated with hypospadias or epispadias?

Back 7

1. Endodermal sinus (yolk sac); AFP

2. old men

3. epispadias

Front 8

1. Which testicular tumor is painful?

2. Most common female germ cell tumor? Most common male germ cell tumor?

3. Which is Wolfian and which is Mullerian?

Back 8

1. Embryonal Carcinoma

2. Female: teratoma; male: seminoma

3. Wolf: Mesonephric, Mullerian: Paramesonephric

Front 9

1. Compare the prognosis of teratomas in males and in females?

2. Reinke crystals are pathognomonic for what type of testicular tumor?

3. What structures does the wolfian duct become?

Back 9

1. male teratoma is more often malignant; females more often benign

2. Leydig tumor

3. SEED: Seminiferous Tubules, Ejac Duct, Epidydymis, Seminal Vesicles

Front 10

1. Primitive glomeruli are pathognomonic for what type of gonadal tumor?

2. What structures do the Mullerian ducts become?

3. Which is more common: epispadias or hypospadias?

Back 10

1. endodermal sinus tumor

2. upper 1/3 of vagina and north

3. Hypospadias

Front 11

1. What do the urogenital folds become in a female and in a male?

Back 11

1. female: labia minora, male: ventral penis

Front 12

1. What do the urogenital sinuses become in a male and a female?

Back 12

1. female glands/male glands (prostate)

Front 13

1. Draw the internal female ligaments and what they connect?

2. What HPV viruses are associated with SCC and which are associated with papillomas?

3. First thing to suspect with post-menopausal bleeding?

Back 13

1. SEE SHEET

2. SCC: HPV16, 18 Papilloma: 6, 11

3. endometrial carcinoma

Front 14

1. What ligament contains the uterine vessels?

2. What is the difference between adenomyosis and endometriosis?

3. What is the best prognostic indicator for endometrial carcinoma?

Back 14

1. transverse cervical ligament

2. Adenomyosis: glandular tissue into the myometrium; Endometriosis: glandular tissue outside of the uterus

3. myometrial invasion is a bad prognosis

Front 15

1. What ligament contains the ovarian vessels?

2. What hormone is responsible for endometrial hyperplasia/carcinoma?

3. Does leiomyosarcoma arise from a leiomyoma?

Back 15

1. suspensory ligament of the ovaries

2. unopposed estrogen

3. no

Front 16

1. What does the round ligament connect?

2. Most likely cause of abnormal uterine bleeding at (a) age 55-65 (b) age 20-40

3. Describe typical hormone levels in premature ovarian failure?

Back 16

1. uterus to labia majora

2. (a) endometrial carcinoma (b) leiomyoma

3. ↑LH/↑FSH, ↓estrogen (just like menopause)

Front 17

1. Describe endometrial, ovarian, and cervial tumors with respect to prognosis and frequency?

2. Describe hormone levels in polycystic ovarian syndrome?

3. Theca-Lutein cysts are associated with what condition?

Back 17

1. frequency: E>O>C, worst prognosis: O>C>E

2. ↑LH/Testosterone, ↓FSH/estrogen

3. Choriocarcinoma

Front 18

1. What is a follicular cyst?

2. hCG is eleveated in a choriocarcinoma. What other female gonadal tumor is hCG elevated in?

3. Which has a better prognosis: mature teratoma or immature teratoma?

Back 18

1. unruptured Graffian follicle

2. dysgerminoma

3. mature is bettter

Front 19

1. What is a corpus luteum cyst?

2. What is a struma ovarii?

3. Diagnose: benign ovarian tumor that appears like bladder transitional cells?

Back 19

1. hemorrhage into corpus luteum

2. ovarian tumor with functional thyroid tissue

3. Brenner tumor

Front 20

1. What type of tumor is involved in Meig's syndrome and what does it look like histologically?

2. Most common cause of vaginal SCC?

3. What ages are associated with fibroadenoma and fibrocystic change?

Back 20

1. fibroma; spindle shaped cells

2. cervical SCC spread

3. fibroadenoma: <25, fibrocystic: 25-menopause

Front 21

1. What type of female gonadal tumor would cause precocious puberty and why?

2. Is Phyllodes tumor benign or malignant? Risk for malignancy?

3. Most important prognostic factor for malignant breast tumors?

Back 21

1. Granulosa cell tumor; secretes estrogen

2. benign, 1-2x chance for malignancy

3. axillary node involvement

Front 22

1. In utero exposure to DES causes what cancer in a woman?

2. Is Intraductal papilloma benign or malignant? Risk for malignancy?

3. What is the most common type of malignant breast cancer?

4. Peau d'orange is caused by what?

Back 22

1. clear cell adenocarcinoma of the vagina

2. benign; can become malignant

3. invasive ductal carcinoma

4. lymphatic obstructure and edematous swelling of breast

Front 23

1. Most common pathogen of acute mastitis?

2. What are the three histologic characteristic changes in fibrocystic breast disease?

3. Is the H in BPH hyperplasia or hypertrophy?

Back 23

1. s. aureus

2. (a) fibrosis (b) cysts (c) epithelial gland changes (apocine metaplasia/hyperplasia)

3. hyperplasia

Front 24

1. What drugs cause gynecomastia?

Back 24

1. "Some Drugs Create Awesome Knockers" Spironolactone, Digitalis, Cimetidine, Alcohol, Ketoconazole

Front 25

1. Compare potency of DHT, testosterone, and androstenedione?

2. Estriol arises from what tissue?

3. Compare cervical mucus caused by estrogen and progesterone?

Back 25

1. D>T>A

2. Placenta

3. estrogen: thin, progesterone: thick

Front 26

1. Which hormone is responsible for balding?

2. What is mittelschmerz?

3. Describe estrogen's effects on LH before and after ovulation?

Back 26

1. DHT

2. ruptured blood from follicle that irritates peritoneum and mimics appendicitis

3. Before, estrogen is negative feedback on LH; at ovulation, turns to positive feedback and causes LH surge

Front 27

1. Compare the role of DHT and Testosterone in sexual development?

2. What is the function of hCG?

3. Which phase of the menstrual cycle is constant and which can vary?

4. What type of damage does excess vitamin A cause during pregnancy?

Back 27

1. DHT: penis, scrotum, prostate; Testosterone: everything else

2. hCG maintains corpus luteum to keep progesterone going.

3. follicular phase varies, luteal phase is always 14 days (from ovulation to menstruation)

4. spontaneous abortion

Front 28

1. Compare the actions of estrogen and testosterone on HDL and LDL?

2. Where does progesterone come from at different times in the pregnancy?

3. A female is born with all her eggs in what stage?

Back 28

1. Estrogen: ↑HDL/↓LDL; Testosterone: ↓HDL/↑LDL

2. 1st trimester: corpus luteum; 2nd/3rd trimester: placenta

3. stage I of prophase (1⁰ oocyte)

Front 29

1. Describe the two cell production of estrogen by the female cells? Include enzymes involved and instigating hormones?

2. What two hormones maintain the coprus luteum during its life?

3. When a woman ovulates, what stage of egg is released?

Back 29

1. LH acts on Theca cell (Converts cholesterol to androstenedione via Desmolase); FSH acts on granulosa cells (Converts androstenedione to estrogen via aromatse)

2. LH at first, then hCG

3. 2⁰ oocyte

Front 30

1. What phase is the 2⁰ oocyte that is released at ovulation in before fertilization?

2. What is the sonic hedgehog gene responsible for?

3. Where does fertilization occur?

Back 30

1. Metaphase II

2. A-P organization

3. Distal fallopian tube

Front 31

1. What is the Wnt-7 gene responsible for?

2. By what week of development are genitals apparent?

3. What important events occur during the 3rd week of development?

Back 31

1. Dorsal-Ventral organization

2. Week 10

3. 3 layers (endo, meso, ecto)

Front 32

1. What two important events occur during the fourth week of embryonal development?

2. What is the homeobox gene responsible for?

3. How long after fertilization does implantation take place and at what stage is the embryo during implantation?

Back 32

1. (a) heart develops (b) limbs develop (think 4!!)

2. segmental organization

3. 1 week: blastocyst

Front 33

1. What important events occur during the 2nd week of development?

2. During what weeks of pregnancy is the fetus most susceptible to teratogens?

3. What type of damage do ACE inhibitors cause during pregnancy?

4. What are the two parts of the trophoblast? Which is the inner/outer layer? Which produces hCG*?

Back 33

1. 2 layers (epiblast/hypoblast), 2 cavities (amnion/yolk), 2 parts of placenta (syncyto, cytotrophoblast)

2. weeks 3-8 (during organogenesis)

3. renal damage

4. cytotrophoblast (inner), syncytotrophoblast (outer)*

Front 34

1. What type of damage does thalidomide do during pregnancy?

2. S/S of fetal alcohol syndrome?

3. Which is the fetal component and which is the material component: trophoblast and decidua?

Back 34

1. limb defects

2. FAS: facies, forebrain, arthritis, adhd, short, septal, stupid

3. trophoblast:fetus, decidua: maternal

Front 35

1. What are lacunae?

2. What does it mean if there is only 1 umbillical artery?

Back 35

1. Lacks of maternal blood that bath fetal villi

2. congenital anomalies

Front 36

1. Does Klinefelters have a Barr body? Does Turner's have a Barr body?

2. Most common cause of female pseudohermaphroditism?

3. Most common cause of spontaneous abortion in 1st trimester?

Back 36

1. Klinefelters: yes, Turner's: no

2. congenital adrenal hyperplasia

3. chromosomal abnormalities

Front 37

1. What auto-antibody condition is associated with Turner's syndrome?

2. Most common cause of male pseudohermaphroditism?

3. Most common cause of spontaneous abortion in 2nd+ trimester?

Back 37

1. hypothyroid

2. testicular feminization (androgen insensitivity)

3. bicornate uterus

Front 38

1. What are ovarian streaks and what condition are they seen in?

2. Most common cause of spontaneous abortion in first weeks of pregnancy?

3. How does 5α reducatase deficiency in XY patient appear?

Back 38

1. Ovary replaced with fibrous tissue; Turner's

2. low progesterone

3. ambiguous genitalia until puberty

Front 39

1. What effect does progesterone have on the gonadotropins?

2. Compare karyotypes in a complete mole and a partial mole?

3. What is placenta accreta? What puts patient at risk for it?

Back 39

1. negative feedback

2. complete: 46, XY/XX partial: 69:XXY

3. defective decidua allows placenta to invade myometrium; C-sections

Front 40

1. What is the difference between pseudohermaphroditism and hermaphroditism?

2. Which type of mole more commonly converts to choriocarcinoma and at what rate?

3. What is placenta previa? What puts patient at risk for it?

Back 40

1. Pseudo has expected gonads but opposite external genitalia; Hermaphroditism has both sets of gonads

2. complete: 2%

3. placental attachment near cervical os; C-sections

Front 41

1. What drug is used to treat moles?

2. Compare abruptio, accreta, and previa with respect to timing and pain?

3. What is the difference between pre-eclampsia and eclampsia?

Back 41

1. MTX

2. abruptio: 3rd tri/painful, accreta: painless/after delivery, previa:painless/anytime during pregnancy

3. pre: edema, HTN, proteinuria; eclampsia adds seizures

Front 42

1. What is HELLP syndrome and what is it associated with?

2. What is polyhydramnios associated with?

Back 42

1. pre-eclampsia related; Hemolysis, Elevated LFTs, Low Platelets

2. esophageal atresia, or anencephaly (lose swallowing center)

Front 43

1. What is oligohydramnios associated with?

2. Unopposed estrogen HRT puts patients at risk for what? What is done to counteract this?

Back 43

1. renal agenesis

2. endometrial carcinoma; add progesterone