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227 Cards in this Set
- Front
- Back
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what is the venous drainage of the left ovary/testis?
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left gonadal vien - left renal vein - IVC
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what is the venous drainage of the right ovary/testis?
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right gonadal vien - IVC
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what is the lymphatic drainage of the ovaries/testes?
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para-aortic lymph nodes
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what is the lymphatic drainage of the vulva/scrotum?
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supericial inguinal nodes - this also drains the distal 1/3 of the vagina
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what is the lymphatic drainage of the proximal 2/3 of the vagina/uterus?
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obturator, external iliac and hypogastric nodes
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what does the suspensory ligament of the ovaries connect?
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ovaries to the lateral pelvic wall
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what does the suspensory ligament of the avoaries contain?
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ovarian vessels
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what does the cardinal ligament connect?
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cervix to the side wall of the pelvis
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what does the cardinal ligament contain?
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uterine vessels
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what does the round ligament of the uterus connect?
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uterine fundus to labia majora; (travels through the round inguinal canal, and is derived from the gubernaculum)
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what does the broad ligament connect?
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uterus, fallopian tubes and ovaries to the pelvic side walls
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what does the broad ligament contain?
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ovaries, fallopain tubes and round ligaments of the uterus
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what does the ligament of the ovary connect?
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ovary to the uterus
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what is the pathway of sperm during ejaculation?
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SEVEN UP: Seminiferous tubules, Epididymis, Vas deferens, Ejacualtory ducts (Nothing), Urethra, Penis
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what is the automonic innervation of erection?
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PNS - NO increases cGMP = vasodilation
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What is the autonomic innervation of emission in the male sexual response?
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SNS - hypogastric nerve
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what is the autonomic innervation of ejaculation of the male sexual response?
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SNS viceral and somatic nerves - pudendal nerve
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what is the acrosome of sperm derived from?
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golgi apparatus
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what is the falgellum of sperm derived from?
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one of the centrioles
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what is the middle piece (neck) of sperm derived from?
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mitochondria
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what energy source do sperm use?
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fructose
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what is the function of spermatogonia?
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they are germ cells - maintain the germ pool and product primary spermatocytes
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what is the function of sertoli cells?
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secrete inhibin - inhibits FSH; secrete androgen binding protein - maintain levels of testosterone; form the blood testis barrier; support and nourish developing spermatozoa, regulate spermatogenesis and produce anti-mullerian hormone
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what is the function of leydig cells?
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secrete testosterone
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what is contained in the seminal vesicle product?
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accounts for 60% of total volume - fructose, ascorbic acid, porstaglandins, phophorylcholine, flavins
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what is contained in prostate procuts?
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zinc, citric acid, phospholipids, acid phosphatase and fibrinolysin
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what is the sequence of sperm maturation?
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1. spermatogonium, 2. primary spermatocytes, 3. secondary spermatocytes, 4. spermatid, undergo spermiogenesis - 5. spermatozoan
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what cell is stimulated by FSH in spermatogenesis?
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FSH stimulates Sertoli = sperm production
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what cell is stimulated by LH in spermatogenesis?
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LH stimulates Leydig cells = testosterone production
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what is the function of testosterone?
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1. differentiation of the epididymis, vas deferens, seminal vesicles; 2. growth spurt, 3. deepening of voice, 4. closing of epiphyseal plates, 5. libido
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what is the function of DHT?
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early = differentiation of penis, scrotum, prostate; late = prostate growth, balding, sebaceous gland activity
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what is the effect of exogenous testosterone on spermatogenesis?
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exgoenous testosterone inhibits HPG axis = decreased intratesticular testosterone = decreased testicular size = azoospermia
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what is the funciton of estrogen?
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1. development of genitalai and breast, female fat distribution, 2. growth of follicle, endometrial proliferation, increased myometrial excitability, 3. upregualtion of E, LH, P receptors, feedback inhibition of FSH and LH, LH surge, stimulation of prolactin (but it BLOCKS its action at the breat = prevents lactation), 4. increased transport proteins, SHBG, increases HDL, decreases LDL
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what are the sources of estrogen?
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ovary - 17β-estradiol; placenta - estriol, blood (aromatization)
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what are the potencies of the 3 estrogens?
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estradiol > estrone > estriol
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what are the sources of testosterone?
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DHT and T - testes; androstenedion - adrenal gland
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what are the potencies of the 3 testosterones?
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DHT > T > androstenedione
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where is estrogen made in the ovary?
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in the granulosa cell
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which cell in the ovary is stimulated by FSH?
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granulosa cell to produce estrogen
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what cell in the ovary is stimulated by LH?
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theca cell to produce androstenedione
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where are the sources of progesterone?
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corpus luteum, placenta, adrenal cortex and testes
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what are the functions of progesterone?
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1. stimulation of endometrial glandular secretiosn and spiral artery development; 2. maintain preganncy, 3. decreased myometrial excitability, 4. production of thick cervical mucus - inhibits sperm entry into uterus; 5. increased body temp, 6. inhibit LH/FSH, 7. uterine smooth muscle relaxation, 8. decrease E receptors
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which part of the menstrual cycle is stimulated by estrogen?
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Proliferative (follicular) phase = 1st two weeks
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which part of the menstrual cycle is stimulated by progesterone?
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secretory phase (luteal) phase - 2nd two weeks
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define oligomenorrhea
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> 35 day cycle
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define polymenorrhea
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< 21 day cycle
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define metrorrhagia
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frequent but irregular menstration
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define menometrorrhagia
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heavy menstruation
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what causes ovulation?
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E surge that stimulates LH release causing ovulation (rupture of follicle); estrogen increases GnRH recetpors on the anterior pituitary
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what is Mittelschmerz?
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blood from the ruptured follicle that causes peritoneal irritation - can miic appendicitis
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when does oocyte meiosis I begin?
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during fetal life - arrested in prophase until ovulation
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when does oocyte meiosis I complete?
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just prior to ovulation
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at what stage is meiosis II arrested in?
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meiosis II is arrested in metaphase until fertilization
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where does fertilization occur?
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in the amuplla of the upper end of the fallopian tube - occurs within 1 day after ovulation
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when does implantation occur?
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6 days after fertilization
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what induces lactation?
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decrease in maternal steroids, suckling is required to maintain milk production - increased nerve stimulation increases oxytocin and prolactin
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what is the function of prolactin?
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induces and maintains lacationa nd decreases reproductive function
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what is the funciton of oxytocin?
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appears to help with milk letdown and may be involved with uterine contractions
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where is the source of hCG?
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syncytiotrophoblasts of the placenta
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what is the function of hCG?
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1. maintian the corpus luteum (acts like LH), 2. used to detect pregnancy, 3. elevated hCG in pathologic states - hydatidiform moles, choriocarcinoma, gestational trophoblastic tumors
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what are the hormonal changes in menopause?
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↓Estrogen, ↑FSH, LH and GnRH
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what are the symptoms of menopause?
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HHAVOC: hirsutism, hot flashes, atrophy of the vagina, osteoporosis, coronary artery disease
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where is the source of estrogens after menopause?
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peripheral conversion of androgens - increased androgens cause hirsutism
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what disease has a genotype of XXY
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klinefelter's syndrome
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what are the symptoms of klinefeleter's syndrome?
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testicular atrophy, eunuchoid body shpae, tall, long extremities, gynecomastia, female hair distribution, may have developmental delay
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what disease presents with a male that has a barr body?
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klinefelter's syndrome
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what hormonal changes are present in klinefelter's syndrome?
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dysgenesiss of siminiferous tubules - ↓ inhibin = ↑ FSH; abnromal leydig cell function = ↓ T, ↑ LH and estrogen
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what are the symptoms of Turner's syndrome?
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short stature, ovarain dysgenesis (streak ovary), shield chest, bicuspid aortic valve, webbing of neck (cystic hygroma), preductal coarctation of the aorta
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what disease causes a female to have 0 barr bodies?
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turner's syndrome
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what is the primary cause of amenorrhea?
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turner's syndrome
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what are the hormonal changes seen in turner's syndrome?
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↓ estrogen = ↑ LH and FSH
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how do XYY males present?
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phenotypically normal, very tall, severe acne, antisocial behavior (1-2% of XYYs); normal fertility
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what is the diagnosis if you have elevated T and LH levels?
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defective androgen receptor
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what is the diagnosis if you have elevated T and low LH levels?
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testosterone secreting tumor, exogenous steroids
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what is the diagnosis if you have low T and high LH?
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primary hypogonadism
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what is the diagnosis if you have low T and low LH?
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hypogonadotropic hypogonadism
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define pseudohermaphroditism
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disagreement between phenotypic and gonadal sex
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how does female pseudohermaphroditism present?
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ovaries are present, external genitalia are virilized or ambiguous
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what causes femal pseudohermaphroditism?
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due to excessive and inappropriate exposure to androgenic steroids during early gestation (congential adrenal hyperplasia or exogenous administration of androges during pregnancy)
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how does male pseudohermaphroditism present?
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testes present but external genitalia are femal or ambiguous
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what is the most common cause of male pseudohermaphroditism
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adnrogen insensitivity syndrome (testicular feminization)
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define true hermaphrodite
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both ovary and testicular tissue present; ambiguous genitalia - very rare
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define androgen insensitivity syndrome
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defect in androgen receptor results in noraml appearing female, femal external genitalia with rudimentary vagina; uterus and uterine tubes ususall absent; presents with no sexual hair; testes often found in the labia major (removed to prevent malignancy)
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what are the hormonal changes seen in androgen sensitivity syndrome?
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increased T, E and LH
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define 5α-reductase deficiency
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inability of males to convert testosterone to DHT
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how does 5α-reductase deficiency present?
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ambiguous genitalia until puberty when increased T causes masculinization and increased growth of external genitalia; "penis at 12"; internal organs are normal
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what are the hormonal changes seen with 5α-reductase deficiency?
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T and E are normal; LH is normal or high
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define hydatidiform mole
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cystic swelling of chorionic villi and prolifreation of chorionic epithleium (trophoblast), that presents with abnormal vaginal bleeding, can lead to uterine rupture
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what is the most common precursor of choriocarcinoma?
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hydatidiform mole
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what disease causes "honeycombed uterus" or cluster of grapes appearance of an abnormally enlarged uterus?
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hydatidiform mole
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what causes "snowstorm" apperaence of the uterus with no fetus during the 1st sonogram?
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hydatidiform mole
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what is the karyotype of a complete mole vs. partial mole?
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complete = 46 XX or XY all from the father; parital = 69XXX 2 sperm + 1 egg
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which mole is more likely to conver to a choriocarcinoma?
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complete - 2% conversion rate; parital - rare
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which mole contains fetal parts?
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partial
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which mole has a greater risk of complications?
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complete - 15-20% malignant trophoblastic disease; partial - rare
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what is a common cause of recurrent miscarriages during the 1st weeks?
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low P (no response to hCG)
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what is a common cause of recurrent miscarriages during the 1st trimester?
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chromosomal abnormalities
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what is a common cause of recurrent miscarriages during the 2nd trimster?
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bicornuate uterus (incomplete fusion of paramesonephric ducts)
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define pre-eclampsia
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HTN, proteinuria and edema
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define eclampsia
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preeclampsia + seizures
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when does pre-eclampsia occur?
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20 weeks gestation to 6 weeks postpartum (before 20 weeks suggests a mole)
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what are the risk factors for pre-eclampsia?
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increased risk in pts with preexisting HTN, diabetes, chronic renal disease and autoimmune disorders
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what causes pre-eclampsia?
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placental ischemia due to impaired vasodilation of spiral arteries, resulting in increased vascular tone
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define HELLP syndrome
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Hemolysis, Elevated Liver enzymes, Low Platetes
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what are the clinical symptoms of pre-eclampsia?
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headache, blurred vision, abdominal pain, edema of the face and extremities, altered mentation, hyperreflexia; lab - thrombocytopenia, hyperuricemia
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define abruptio placentae
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premature detachment of the palcenta from the implantation site - fetal death
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what is associated with abruptio placentae?
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DIC; and increased risk with smoking, HTN and cocaine use
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define placenta accreta
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defective decidual layers allows the placenta to attach to the myometrium - no sepration of the placenta after birth
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what are the risk factors for placenta accreta?
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prior C-section, inflammation, and palcenta previa
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define placenta previa
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attachement of the placenta to lower uterine segment - may occlude the internal os
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what predisposes to placenta previa?
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multiparity and prior C-section
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define ectopic pregnancy
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implantation in a place other than the uterus - most often in the fallopian tube
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how does an ectopic pregnancy present?
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increased hCG, sudden lower abdominal pain; confirmed with ultrasound
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define retained placenta tissue
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may cause postpatum hemorrhage
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what pregnancy complication causes massive bleeding after delivery?
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placenta accreta
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what pregnancy complication causes painless bleeding in any trimester?
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placenta previa
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what are the risk factors for ectopic pregnancy?
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1. history of infertility, 2. salpingitis (PID), 3. ruptured appendix, 4. prior tubal surgery
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define polyhydramnios
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>1.5-2 L of amniotic fluid
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what is associated with polyhydramnios?
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1. esophageal/duodenal atresia, 2. anencephaly
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define oligohydramnios
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<0.5 L of amniotic fluid
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what causes oligohydramnios?
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placental insufficiency, bilateral renal agenesis, posterior urethral valves (males); can give rise to potter's syndrome
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define cervical dysplasia and carcinoma in situ
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disordered epithelial growth - begins at the basal layer of the squamo-columnar junction and extends outward; calssified as CIN1, 2 or 3; associated with HPV 16 and 18; progresses if untreated
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define invasive cervical carcinoma
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often SCC, lateral invasion can block ureters, causing renal failure
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define endometriosis
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non-neoplastic endometrial glands/storma in abnormal locations
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what characterizes endometriosis?
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cyclic bleeding resulting in 'chocolate cysts' in the ovaries; causes severe menstrual related pain
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what are the complications of endometriosis?
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often results in infertility, can be due to retrograde menstrual flow or ascending infection
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define adenomyosis
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endometrium within the myometrium
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define endometrial hyperplasia
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abnormal endometrial gland prliferation susually caused by excess estrogen stimulation - increased risk for endometrial carcinoma
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how does endometrial hyperplasia present?
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postmenopausal vaginal bleeding
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what are the risk factors for endometrial hyperplasia?
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anovulatory cycles, HRT, PCOS, granulosa cell tumor
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what is the most common gynecologic malignancy?
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endometrial carcinoma; often preceeded by endometrial hyperplasia
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how does endometrial carcinoma present?
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vaginal bleeding usually occurs between 55-65 yoa; increased myometrial invasion - decreased prognsis
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what are the risk factors for endometrial carcinoma?
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prolonged use of estrogen without progestins, obesity, diabetes, HTN, nulliparity, and late menopause
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what is the most common tumor in females?
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leiomyoma (fibroid)
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what are the characteristics of leiomyomas of the uterus?
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mutliple tumors with well demarcated borders, increased incidence in blacks; estrogen sensitive - increases size with pregnancy, decreases with menopause
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what tumor has whorled pattern of smooth muscle bundles?
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leiomyoma (fibroid)
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what are the complications of leiomyomas of the uterus?
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may be asymptomatic, cause abnoraml bleeding or result in miscarriages; severe bleeding can lead to iron deficiency anemia; does NOT progress to leiomyosarcoma
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what are the characteristics of leiomyosarcoma of the uterus?
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bulky, irregularly shaped tumor with areas of necrosis and hemorrhage, increased incidence in blacks; aggressive and recur; common in middle age
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define premature ovarina failure
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prematurea atresia of ovarian follicles in women of reproductive age; presents with signs of menopause before 40; decreased E, increased LH/FSH
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what are the common causes of anovulation
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PCOS, obesity, Asherman's syndrome (adhesions), HPO axis abnormalities, premature ovarian failure, hyperprolactinemia, thyroid disorders, eating disorders, cushing's syndrome, adrenal insufficiency
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what is PCOS?
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increased LH production leads to anovulation, hyperandrogenism and enlarged bilartarl cystic ovaries
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how does PCOS present?
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amenorrhea, infertility, obesity and hirsutism; associated with insulin resistance; and increased risk of endometrial cancer
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define follicular cyst
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distention of unruptured graafian follcile; may be assciated with hyperestrinism an dendometrial hyperplasia
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define corpus luteum cyst
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hemorrhage into persistent coprus luteum, commonly regresses spontaneously
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define theca-lutein cyst
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often bilateral and multiple; due to gonadotropin stimulation, associated with choriocarcinoma and moles
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define chocoloate cyst
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blood containing cyst from ovarian endometriosis, varies with menstrual cycle
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define ovarian dysgerminoma
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malignant, equivlaent ot male seminoma but rare; sheets of uniform cells
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what tumor has markers: hCG and LDH?
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ovarian dysgerminoma
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define choriocarcinoma
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rare, but malignant; can develop during preganncy; large, hyperchromatic syncytiotrophoblastic cells, increased theca-lutein cysts
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what tumor has a marker of hCG?
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choriocarcinoma
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define yolk sac tumor
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aka endodermal sinus; aggressive malgianncy in ovaries (testes in boys) and sacrococcygeal area of young children; yellow, friables an solid
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what gonadal tumor has Schiller-Duval bodies?
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yolk sac (endodernal sinus) tumor
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what gonadal tumor has a marker of AFP?
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yolk sac (endodernal sinus) tumor
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what is the most common ovarian germ cell tumor?
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teratoma - contains cells from 2 or 3 germ layers
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what is struma ovarii?
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teratoma that contains functional thyroid tissue, can present with hyperthyroidism
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which non-germ cell ovarian tumor is lined with fallopian tube-like epithelium?
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serious cystadenoma; often bilateral; 20% of ovarian tumors
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what are the characteristics of non-germ cell tumors?
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50% of ovarian tumors, malignant and frequently bilateral
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what non-germ cell ovarian tumor is lined by mucus screting epithelium?
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mucinous cystadenoma; contains intestinal like tissue
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what ovarian tumor cauess pseudomyxoma peritonei?
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mucinous cystasenocarcinoma
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what ovarian tumor is lined by transitional cells?
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Brenner tumors - looks like the bladder
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what is Meig's syndrome?
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triad: ovarian fibroma, ascites and hydorthorax; causes a pulling sensation in the groin
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what ovarian tumor has spindle shaped fibroblasts?
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fibromas
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which ovarian tumor secretes estrogen?
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granulosa cell tumor - can cause endometrial hyperplasia or carcinoma in adults
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what tumor has Call-Exner bodies?
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granulosa cell tumor - they are small follicles filled with eosinophilic secretions
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what is Krukenberg tumor?
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GI malignancy that metastasizes to ovaries causing a mucin secreting signet cell adenocarcinoma
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what is the marker for ovarian cancer?
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CA-125
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what are the risk factors for ovarian cancer?
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BRCA-1 and HNPCC
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what causes SCC of the vagina?
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it is secondary to cervical SCC
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what causes clear cell adenocarcinoma of the vagina?
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women exposed to DES in utero
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what vaginal tumor has spindle shpaed tumor cells that are desmin positive?
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sarcoma botryoides
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what is bartholin's gland cyst?
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pain in the labia majora, can result form previous infection
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what breast tumor is small, mobile and firm with shapr edges
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fibroadenoma
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what breast tumor is small and grows in lactiferous ducts typically beneath the areola
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intraducatl papilloma
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what breast tumor is large, bulky mass of CT and cysts?
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Phyllodes tumor
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which breast tumor has 'leaf-like' projections?
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Phyllodes tumor
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which breast tumor increases size and tenderness with increased estrogen?
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fibroadenoma
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which breat tumor causes serous of bloody nipple discharge?
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intraductal papilloma
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what is the most imporatnt prognostic factor in breast cancer?
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axillary lymph node involvement
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what are the risk factors for malignant breast tumors?
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increased estrogen exposure, increased total number of menstrual cycles, older age at first liver birht, obesity - increased E
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what breast tumor fills ductal lumen and arises from ductal hyperplasia?
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DCIS = early malignancy without BM penetration
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what breast tumor is firm, fibrous and 'rock-hard' mass with sharp margins and small, galndular duct-like cells
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invasive ductal carcinoma
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which breast tumor has orderly rows of cells?
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invasive lobular
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what is the most common malignant breast tumor?
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invasive ductal carcinoma
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which malignant breast tumor is often bilateral?
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invasive lobular
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which malignant breast tumor is fleshy, cellular and has lymphotic infiltrates?
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medullary - good prognosis
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which malignant breast tumor has ductual caseous necrosis?
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comedocarcinoma - subtype of DCIS
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which malignant breast tumor has dernal lymphatic invasion by breast carcinoma?
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inflammatory - often has peau d'orange
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what breast tumor has eczematous patches on the nipple?
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Paget's disease - suggests underlying carcinoma
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which breast tumor has large cells in the epidermis with clear halos?
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Paget's disease - suggests underlying carcinoma
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what are the subtypes of fibrocystic change?
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1. fibrosis, 2. cystic, 3. sclerosing adenosis, 4. epithelial hyperplasia
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what breast condition has hyperplasia of breast stroma?
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fibrosis - part of fibrocystic change
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what breast condition has fluid filled, blue domed cysts and ductal dilation?
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cystic change - part of fibrocystic change
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what breast condition has increaed acini and intralobular fibrosis and is associated with calcification?
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sclerosing adenosis
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what breast condition has increased number of epihtelial cell layers in the terminal duct lobule?
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epithelial hyperplasia = increased risk of carcinoma
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define acute mastitis
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breast abscess, during breast-feeding; increased risk of bacterial infection - S. aureus MC pathogen
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define fat necrosis
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a benign painless that is a result of injury to breast tissue
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define gynecomastia
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increased in breast tissue caused by hyperestrogenism = cirrhosis, testicular tumor, puberty, old age; klinefelter's syndrome or drugs
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what drugs can cause gynecomastia?
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Spirolactone, digitalis, cimetidine, alcohol, ketoconazole; estrogen, MJ, heroin, psychoactive drugs
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what 2 breast pathologies arise from the nipple?
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Paget's disease and breast abcesses
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what 3 breast pathologies arise from the lactiferous sinus?
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1. intraductal papilloma, 2. breast abscesses, 3. mastitis
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what 2 breast pathologies arise from the major duct?
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fibrocystic change and ductal cacner
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what breast pathology arises from the terminal duct?
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tubular carcinoma
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what 2 breast pathologies arise from the lobules?
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1. lobular carcinoma, 2. sclerosing adenosis
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what 2 breast pathologies arise from the stroma?
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fibroadenoma and phyllodes tumor
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how does prostatits present?
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dysuria, frequentcy, urgency and low back pain
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what occurs in BPH, hyperplasia or hypertophy?
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hyperplasia
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what pathology has nodular enlargement of the periurethral lobes of the prostate which can compress the urethra?
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BPH
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what marker is increased in BPH?
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PSA
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which lobe is affected by prostatic adenocarcinoma?
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posterior lobe (peripheral zone)
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what are markers for prostatitc adenocarcinoma?
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Prostatic acid phophatase (PAP) and PSA - decreased fraction of free PSA and increased total PSA
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what is cryptochidism?
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undesecnded testis, lack of spermatogenesis due to increaed temperature; associated with increased risk of germ cell tumors in both testes; prematurity increases the risk of cryptochidism
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which testicular tumor presents as a painless, homongenous testicular enlargement?
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seminoma
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what is the most common testicular tumor?
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seminoma - affects males 15-35
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which testicular tumor has large cells in lobules with watery cytoplasm and a fried egg appeareance?
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seminoma - radiosenstiive; late mestatasis
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which testicular tumor is painful?
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embryonal carcinoma - worse prognosis than seminoma
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which testicular tumor is yellow and mucinous and has Schiller duval bodies?
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yolk sac (endodernal sinus) tumor
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which testicular tumor has hematogenous meastases?
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choriocharcinoma
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which testicular tumor has Reinke crystals?
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Leydig cell tumor
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which testicular tumor produces androgens?
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Leydig cell tumor
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which testicular tumor is a androblastoma from sex cord stroma?
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Sertoli cell tumor
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what is the most common testicular cancer in older men?
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testicular lymphoma
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which testicular lesions present as masses that can be transilluminated?
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tunica vaginalis lesions - 1. varicocele (dilated veins in pampiniform plexus), 2. hydrocele (incomplete fusion of processus vaginalis), 3. spermatocele (dilated epididymal duct)
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what penile pathology has gray, solitary, crusty plaque usually on the shaft of the penis or on the scrotum?
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bowen's disease - processes to SCC; 50 yoa
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what penile pathology has red velvety plaques on the glans?
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erythroplasia of Queyrat
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what penile pathoogy multiple papular lesions, that is usually seen on younger pts than other pathologies?
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bowenoid papulosis
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where is SCC of the penis common?
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Asia, Africa, S. america; associated with HPV and lack of circumcision
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define peyronie's disease?
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bent penis due to acquired fibrous tissue formation
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