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224 Cards in this Set
- Front
- Back
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venous drainage of L gonadal vein
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L renal vein
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venous drainage of R gonadal vein
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IVC
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MOST common side of varicocele
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Left
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lymphatic drainage for gonads
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para-aortic (lumbar) nodes
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lymphatic drainage for distal 1/3 of genitals
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superficial inguinal nodes
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lymphatic drainage for proximal 2/3 of genitals
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obturator, external iliac, and hypogastric nodes
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lymphatic drainage for the glans
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deep inguinal nodes
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the suspensory ligament of the ovary connects what
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ovaries to lateral pelvic wall
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the cardinal ligament (aka lateral cervical lig.) connects what
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cervix to pelvis
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the round ligament connects what
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uterus to labia majora
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the broad ligament connects what
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the pelvis to the uterus, fallopian tubes, and ovaries
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the ovarian ligament connects what
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ovary to uterus
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structures contained in the suspensory ligament of the ovary
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ovarian vessels
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structures contained in the cardinal ligament
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uterine vessels
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structures contained in the round ligament
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NONE
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structures contained in the broad ligament
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ovaries, fallopian tubes, and round ligament
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derivatives of the gubernaculum
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ovarian and round ligaments
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ligament that travels through the inguinal canal
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round ligament
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what epithelium makes up the endocervix vs. the ectocervix
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endocervix: simple columnar
ectocervix: stratified squamous |
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epithelium of the vagina
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stratified squamous
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epithelium of the ovary
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simple cuboidal
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pathway of sperm from formation to ejaculation
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seminferous tubules (where it's made)
epididymis (where it's matures) vas deferens (where it's stored) ejaculatory ducts urethra ejaculation out the penis |
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pathogenesis of an erection
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nitric oxide increases cGMP which causes smooth muscle relaxation leading to vasodilation in the penis and erection
(*parasympathetics) |
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main form of energy for sperm
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fructose
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location of mitochondria in sperm
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middle neck
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initial precursor to sperm
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spermatogonia
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which cells in the seminiferous tubules secrete inhibin and androgen-binding protein
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sertoli cells
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which cells in the seminiferous tubules form the blood-testis barrier
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sertoli cells
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which cells in the seminiferous tubules regulate spermatogenesis
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sertoli cells
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which cells in the seminiferous tubules secrete testosterone
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leydig cells
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when does spermatogenesis begin
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puberty
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how long does it take for a sperm to fully develop
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2 months
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where does spermatogenesis occur
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seminiferous tubules
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steps of spermatogenesis
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spermatogonium (2N) -> primary spermatocyte (4N) -> secondary spermatocyte (2N) -> spermatids (N) -> spermatozoa (N)
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what is a fully mature sperm called
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spermatozoan
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FSH acts on which cells in the seminiferous tubules
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sertoli cells
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LH acts on which cells in the seminiferous tubules
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leydig cells
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effect of inhibin
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directly inhibits FSH
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enzyme that converts testosterone into estradiol
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aromatase
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MOST potent androgen
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DHT
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where is DHT formed
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prostate
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what enzyme coverts testosterone into DHT
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5-alpha-reductase
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enzyme deficiency in male pseudohermaphroditism
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17-alpha-hydroxylase deficiency
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enzyme deficiency in female pseudohermaphroditism
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21-hydroxylase deficiency
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enzyme deficiency in female sexual infantilism
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17-alpha-hydroxylase deficiency
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major source of estrogen
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ovaries
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functions of estrogen vs. progesterone
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estrogen: development of genitalia and breasts, endometrial proliferation, feedback inhibition of FSH/LH, cardioprotective
progesterone: endometrial gland secretions, spinal artery development, maintenance of pregnancy, increase body temperature, uterine smooth muscle relaxation, maintains corpus luteum |
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major source of progesterone
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corpus luteum
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what day of the menstrual cycle does ovulation occur
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day 14 regardless of how long the woman's cycle lasts
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what causes ovulation
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LH surge
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what cause LH surge
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sudden drop in estrogen levels
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when are progesterone levels highest
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from ovulation to menstruation
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when are estrogen levels highest
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before ovulation
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when are primary oocytes formed
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during embryogenesis before birth
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which phase are primary oocytes frozen in
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prophase of meiosis I
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when do primary oocytes that are frozen continue oogenesis
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prior to ovulation
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which phase are secondary oocytes frozen in
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metaphase of meiosis II
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when do secondary oocytes that are frozen continue oogenesis
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after fertilization
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how many polar bodies are made from a single oogonium
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3 polar bodies (and 1 ovum)
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where does fertilization occur
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ampulla of fallopian tube
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cells that secrete B-hCG
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syncytiotrophoblasts
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what initially induces lactation after giving birth
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sudden drop in progesterone
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trigger for oxytocin and prolactin for breastfeeding
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positive feedback mechanism elicited by infant suckling
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function of prolactin in breastfeeding
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induces and maintains lactation
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function of oxytocin in breastfeeding
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causes milk letdown
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when does B-hCG peak
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10 weeks into the pregnancy
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when is B-hCG first noticeable in the urine during a pregnancy test
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1 week after fertilization
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function of B-hCG
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maintains corpus luteum along with progesterone for the 1st trimester
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2 important lab values at the beginning of menopause
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decreased estrogen, increased FSH, increased LH, increased GnRH
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symptoms of menopause
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hot flashes
atrophy of the vagina osteoporosis CAD hirsutism |
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XXY
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Klinefelter's
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what's a barr body
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inactivated X chromosome
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in what disease will a male have a barr body
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Klinefelter's
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what WBC are barr bodies found in
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neutrophils
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symptoms of Klinefelter's
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testicular atrophy
eunuchoid body shape tall stature long extremities gynecomastia female hair distribution patterns hypogonadism |
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lab values in Klinefelter's
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decreased testosterone
increased LH increased FSH increased estrogen decreased inhibin |
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lab values in Turner's
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decreased estrogen
increased LH increased FSH |
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symptoms of Turner's
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short stature
webbed neck shield chest wide-spaced nipples ovarian dysgenesis |
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MOST common cause of primary amenorrhea
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Turner's
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2 heart condition linked to Turner's
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bicuspid aortic valve and preductal coarctation
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kidney condition linked to Turner's
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horseshoe kidney
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chromosomal abnormality in Turner's
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X-
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what disease will a female have no barr bodies
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Turner's
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15 y/o genetic male (XY) presents with female external genitalia (rudimentary vagina), but there is no evidence of a uterus or fallopian tubes; he has little to no pubic hair; he appears to have miniature testes within the labia majora; lab values reveal increased testosterone, increased estrogen, and increased LH
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androgen insensitivity syndrome
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it's noted during a routine physical of a 10 y/o male that his penis has still not developed at all and considers him to have ambiguous genitalia; screenings for 21, 17, and 11 hydroxylase are all within range; labs reveal normal testosterone but increased LH; 2 years (now age 12), the child begins puberty, and his genitals finally start developing into that of a normal male
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5-alpha reductase deficiency
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16 y/o male presents for delayed puberty; it's noted during the PE that he has anosmia and red-green color blindness; he is not on any medications; labs reveal decreased FSH and decreased LH
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Kallmann syndrome
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gene on Y chromosome that favors development of male genitalia
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SRY gene
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parents bring their 1 y/o son in for a checkup citing abnormally looking genitalia for a male; it's noted that he has ambiguous genitalia; labs reveal hypotension and genetic studies reveal XX
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21-alpha hydroxylase deficiency (female pseudohermaphroditism)
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parents bring in their 3 y/o daughter for a routine annual checkup; 2 separate BP readings reveal hypertension; labs reveal decreased testosterone, decreased estrogen; genetic studies reveal XY
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17-alpha hydroxylase deficiency (male pseudohermaphroditism)
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15 y/o comes in for a routine annual physical; her external genitalia appear normal, but she lacks secondary sexual characteristics including pubic hair and breast development; genetic studies reveal XX with no chromosomal abnormalities; she is initially started on estrogen therapy but it has no effect
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17-alpha-hydroxylase deficiency (sexual infantilism)
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8 y/o presents for a routine annual physical; PE reveals early puberty and excessive masculinization for a male this old; genetic studies reveal normal XY with no chromosomal abnormalities; labs reveal increased testosterone, increased estrogen; 2 separate BP readings reveal HTN presumably related to his condition
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11-B-hydroxylase deficiency
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pregnant female presents in 3rd trimester with abnormal vaginal bleeding; B-hCG levels are 5x greater than normal; the uterus is enlarged
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COMPLETE hydatidiform mole
(*note, in partial hydatidiform moles, B-hCG is only slightly elevated whereas in complete moles, it is drastically elevated between 4-6x normal) |
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"honeycombed uterus" appearing as a "cluster of grapes"
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hydatidiform mole
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pregnant females comes in for her first sonogram of the pregnancy; the sonogram reveals a "snowstorm" appearance an absence of a fetus
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COMPLETE hydatidiform mole
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treatment for hydatidiform moles
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dilation/curettage with methotrexate
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MOST common precursor of hydatidiform moles
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choriocarcinoma
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karyotype of complete vs. partial hydatidiform mole
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complete: 46,XX or 46,XY
partial: 69,XXY |
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which form of hydatidiform mole does the uterus NOT change in size
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partial mole
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which hydatidiform mole has various fetal parts as opposed to an absent fetus completely
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partial moles: contain various fetal parts
complete moles: completely absent fetus |
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which hydatidiform mole is malignant
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complete moles are malignant (20%)
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MOST common cause of miscarriage in 1st week of pregnancy
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low progesterone
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MOST common cause of miscarriage throughout 1st trimester
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chromosomal abnormalities
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MOST common cause of miscarriage throughout 2nd trimester
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bicornuate uterus
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clinical triad of preeclampsia
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proteinuria
edema HTN (*you MUST have all 3 to be considered in preeclampsia) |
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what symptoms differentiates preeclampsia from eclampsia
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eclampsia has seizures along with edema, proteinuria, and HTN
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cause of preeclampsia
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placental ischemia secondary to impaired vasodilation of spiral arteries
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what is HELLP syndrome and what pregnancy condition is it associated with
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HELLP syndrome:
H- hemolysis E- elevated L- LFTs LP- low platelets **associated with preeclampsia and eclampsia |
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DOC to prevent seizures of preeclampsia and slow progression if it happens postpartum
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magnesium sulfate and diazepam
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treatment for preeclampsia
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termination of pregnancy
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time frame when preeclampsia occurs
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week 20 of the pregnancy to 6weeks-postpartum
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painful bleeding in 3rd trimester
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abruptio placentae
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massive bleeding after pregnancy; drastic measures are taken and the patient is stabilized
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placenta accreta
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painless bleeding during any trimester
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placenta previa
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patient presents with sudden, severe pain that started in the LRQ; labs reveal increased B-hCG; ultrasound confirms diagnosis
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ectopic pregnancy
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MOST common location of ectopic pregnancy
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ampulla of fallopian tubes
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major risk factor for ectopic pregnancy
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PID
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massive bleeding after pregnancy; despite drastic measures, bleeding can't be stopped and patient dies within minutes
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placenta increta
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difference between placenta accreta and placenta increta
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placenta accreta: placenta attaches to myometrium
placenta increta: placenta invades through the myometrium |
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illicit drug linked to abruptio placentae
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cocaine
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attachment of placenta to lower uterine segment
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placenta previa
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prior C-sections are risk factors for what pregnancy complications
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placenta accreta and placenta previa
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GI condition linked to polyhydramnios
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esophageal/duodenal atresia
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kidney condition linked to oligohydramnios
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bilateral renal agenesis
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location of cervical cancer
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squamo-columnar junction
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virus and serotypes linked to cervical cancer
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HPV 16,18
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risk factors for cervical cancer
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multiple sexual partners
smoking sex at early age HIV |
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prevention of cervical cancer
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Gardisil vaccine
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cyclic bleeding and chocolate cysts
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endometriosis
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consequence of endometriosis
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infertility
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MOST common gynecologic cancer
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endometrial cancer
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drug with risk factor of endometrial cancer
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estrogen therapy and tamoxifen
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benign gyencologic tumor with a "whorled pattern" of smooth muscle bundles
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Leiomyoma
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hormonal cause of anovulation in polycystic ovarian syndrome
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increased LH
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lab values in polycystic ovarian syndrome
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increased LH
decreased FSH increased testosterone |
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symptoms of polycystic ovarian syndrome
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amenorrhea
infertility obesity hirsutism insulin resistance |
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specific ovarian cyst associated with choriocarcinoma and hydatidiform moles
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theca-lutein cysts
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specific ovarian cyst that is formed from an unruptured graafian follicle
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follicular cysts
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tumor markers for dysgerminomas
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hCG and LDH
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ovarian germ cell tumor that usually develops during pregnancy and is characterized by hyperchromatic syncytiotrophoblasts
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choriocarcinoma
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tumor markers for choriocarcinoma
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hCG
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tumor markers for yolk sac tumors
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AFP
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morphologic feature of yolk sac tumors
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Schiller-Duval bodies
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is a mature teratoma malignant? what about an immature teratoma?
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mature teratomas: benign
immature teratomas: malignant |
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ovarian tumor containing thyroid tissue (presents as hyperthyroidism)
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struma ovarii
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general tumor markers for ovarian cancers
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increased CA-125
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gene mutations linked to ovarian cancer
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BRCA-1 and HNPCC
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female patient presents with suprapubic pain and trouble breathing; PE reveals smooth, well circumscribed tumors overlying the ovaries; her shortness of breath is attributed to hydrothorax and ascites; what's the underlying condition
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Meigs syndrome
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what is pseudomyxoma peritonei and what ovarian tumor is it associated with
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pseudomyxoma peritonei is an intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumors
it's associated with mucinous cystadenocarcinoma) |
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benign ovarian tumor whose histology is like that of the bladder
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Brenner's tumor
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GI malignancy that metastasizes to the ovaries
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Krukenberg tumor
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granulosa cell tumors express what hormone
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estrogen
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morphologic feature of granulosa cell tumors
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Call-Exner bodies
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this ovarian tumor is known for causing precocious puberty when occuring in kids
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granulosa cell tumors
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cancer linked to DES
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clear cell adenocarcinoma
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desmin-positive vaginal tumor in young girls
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Sarcoma botryoides
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|
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MOST common breast tumor in teens and young adults
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fibroadenoma
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benign breast tumor that causes serous/bloody discharge from the nipple and grows within the lactiferous ducts
|
intraductal papilloma
|
|
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breast tumor characterized by a bulky mass of connective tissue and cysts with "leaf-like" projections
|
Phyllodes tumor
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|
|
MOST important prognostic factor for breast cancers
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axillary lymph node involvement
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when saying a patient has a "family history" of breast cancer, how far back in their family lineage is considered prognostic for your patient
|
ONLY a 1st degree relative is a risk
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risk factors for breast cancer
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increased estrogen exposure
increased total number of menstrual cycles old age at first live birth obesity 1st degree relative with breast cancer |
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malignant breast tumor arising in the ducts without penetration of the basement membrane
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ductal carcinoma in situ (DCIS)
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MOST common and MOST serious form of breast cancer
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invasive ductal carcinoma
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|
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malignant breast cancer usually occuring bilaterally
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Invasive lobular carcinoma
|
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subtype of DCIS that undergoes caseous necrosis
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comedocarcinoma
|
|
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eczematous patches on nipple made from clear halo cells
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Paget's disease
|
|
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CE sign of dermal invasion of inflammatory breast cancer
|
Peau d'orange
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|
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breast disease associated with menstrual cycle
|
fibrocystic disease
|
|
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breast condition linked to breast-feeding
|
acute mastitis
|
|
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MOST common cause of acute mastitis
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S. aureus
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breast lump linked to trauma of the breast tissue
|
fat necrosis
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|
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drugs (4) that cause gynecomastia
|
spironolactone
digitalis cimetidine ketoconazole |
|
|
MOST common cause of acute prostatitis
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E.coli
|
|
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is BPH a precursor to cancer
|
NO
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tumor marker for prostate cancer and BPH
|
PSA
|
|
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DOC (2) for BPH
|
tamsulosin or finasteride
|
|
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BPH affects all zones of the prostate EXCEPT which one
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peripheral zone
|
|
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which zone of the prostate does cancer usually occur in
|
peripheral zone
|
|
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gold standard diagnostic test for prostate cancer
|
DRE with biopsy
|
|
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tumor markers that suggests metastasis of prostate cancer
|
prostatic acid phosphatase (PAP) and alkaline phosphatase (ALP)
|
|
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MOST common site of metastasis of prostate cancer
|
vertebrae (osteoblastic bone lesions)
|
|
|
special hematogenous route that prostate cancer uses to metastasize
|
Batson's plexus
|
|
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how can you tell the difference between BPH and prostate cancer using PSA
|
prostate cancer: increased bound PSA
BPH: increased free PSA |
|
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what binds to PSA
|
alpha-antichymotrypsin
|
|
|
what is cryptorchidism
|
undescended testes; lack of spermatogenesis due to increased temperature
|
|
|
malignant testicular tumor that has a "fried-egg" appearance and watery cytoplasm
|
seminoma
|
|
|
tumor markers of embryonal carcinoma of the testes
|
increased AFP and hCG
|
|
|
are teratomas usually malignant in men? what about in women?
|
usually malignant in males
usually benign in females |
|
|
are seminomas painful or painless
|
painless
|
|
|
male presents complaining of a lump in his testicle; it's noted that he also has gynecomastia; he is on no medications; upon biopsy, it's noted that it's golden brown in color and has reinke crystals
|
Leydig cell tumor
|
|
|
MOST common form of testicular cancer
|
testicular lymphoma
|
|
|
scrotum looks like a bag of worms
|
varicocele
|
|
|
dilation of veins in the pampiniform plexus
|
varicocele
|
|
|
fluid buildup in the processus vaginalis
|
hydrocele
|
|
|
fluid buildup in epididymal duct
|
spermatocele
|
|
|
penis cancer characterized by red plaques on the glans
|
Erythroplasia of Queyrat
|
|
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penis cancer characterized by gray plaques of the shaft near the scrotum
|
Bowen's disease
|
|
|
penis cancer characterized by multiple papular lesions usually affecting a younger age group
|
Bowenoid papulosis
|
|
|
virus linked to squamous cell carcinoma of the penis
|
HPV 16,18
|
|
|
painful bend in penis secondary to acquired fibrous tissue formation (due to trauma)
|
Peyronie's disease
|
|
|
MOA of clomiphene
|
GnRH agonist (estrogen receptors)
|
|
|
how does birth control work
|
supplementing constant large doses of estrogen and progesterone will inhibit the secretion of FSH and LH thus preventing follicle stimulation and ovulation
|
|
|
anti-fungal which inhibits the formation of androgens
|
ketoconazole
|
|
|
MOA of anastrozole
|
aromatase inhibitor
|
|
|
MOA of leuprolide
|
GnRH agonist
|
|
|
clinical uses of leuprolide
|
infertility, prostate cancer, uterine fibroids
|
|
|
MOA of finasteride
|
5-alpha-reductase inhibitor
|
|
|
clinical uses of finasteride (Propecia)
|
BPH and male pattern baldness
|
|
|
MOA of flutamide
|
androgen receptor antagonist
|
|
|
DOC for prostate cancer
|
flutamide
|
|
|
SE of estrogen therapy
|
thromboembolisms
|
|
|
DOC for estrogen positive breast cancer
|
tamoxifen
|
|
|
clinical uses of raloxifene
|
breast cancer and osteoporosis
|
|
|
DOC for polycystic ovarian syndrome
|
clomiphene
|
|
|
MOA of mifepristone (RU486)
|
glucocorticoid antagonist and blocks progesterone receptors
|
|
|
DOC for medical abortion
|
mifepristone (RU486)
|
|
|
SE of taking birth control
|
increased triglycerides
depression weight gain nausea HTN hypercoagulable state liver adenomas thromboembolisms |
|
|
advantages of taking birth control other than preventing pregnancy
|
decreases risk of endometrial and ovarian cancer
decreases risk of ectopic pregnancy decreases risk of pelvic infection can treat acne |
|
|
PGE2 analog that can induce labor
|
Dinoprostone
|
|
|
B2 agonist that relaxes the uterus and reduces premature uterine contractions
|
Ritodrine
|
|
|
MOA of tamsulosin
|
alpha-1-antagonist selective for 1A and 1D receptors on the prostate
(*note that most alpha-1-antagonists act on 1B receptors on blood vessels and do not affect the prostate) |
|
|
50 y/o patient presents complaining of ED; psychiatric evaluation is unremarkable; he has no chronic diseases, and is not taking any medication; what is the MOA of the drug you will prescribe him
|
Viagra inhibits cGMP phosphodiesterase causing increased cGMP leading to smooth muscle relaxation
(*phosphodiesterase normally breaks down cGMP) |
|
|
you can NEVER combine sildenafil with what class of drugs and why
|
can NEVER combine sildenafil with nitrates for risk of life-threatening hypotension
|
|
|
DOC for breast cancer that expresses HER2/neu receptors
|
trastuzumab
|
