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149 Cards in this Set
- Front
- Back
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A 24-year old male develops testicular cancer. Mets spread occurs by what route?
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Para-aortic nodes (remember the descent of the testes during drift)
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A woman with previous cesarean section has a scar in her lower uterus close to the opening of the os. What is she at increased risk for?
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Placenta previa
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An obese woman presents with hirsutism and increased levels of serum testosterone. What is the diagnosis?
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PCOS
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A pregnant woman at 16 weeks of gestation presents with an atypically large abdomen. what is the dx?
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High hCG; hydatidiform mole
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A 55-year-old postmenopausal woman is on tamoxifen therapy. What is she at increased risk of acquiring?
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Endometrial carcinoma
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Trace the venous drainage of the L ovaries/testes.
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L ovary/testes -> L gonadal v -> L renal v -> IVC
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Trace the venous drainage of the R ovaries/testes.
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R ovary/testes -> R gonadal v -> IVC
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Trace the lymphatic drainage of the Ovaries/testes
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ovaries/testes -> para-aortic lymph nodes
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For the following ligament of the uterus, state what that ligament contains: suspensory ligament of the uterus
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contains the ovarian vessels
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For the following ligament of the uterus, state what that ligament contains: Transverse cervical (cardinal) ligamnet
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contains the uterine vessels
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For the following ligament of the uterus, state what that ligament contains: Round ligament of the uterus
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contains no important structures
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For the following ligament of the uterus, state what that ligament contains: broad ligament
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comtains the round ligaments of the uterus and ovaries and the uterine tubules and vessels
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An erection is mediated by which branch of the nervous system?
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Parasympathetic
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Emission from the penis is mediated by which branch of the nervous system?
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Sympathetic
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Ejaculation is mediated by what type of nerves?
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Visceral and somatic
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The acrosome of the sperm is derived from what cellular structure?
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Golgi
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The tail (flagellum) is derived from which cellular structure?
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centrioles
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What is contained in high density in the neck of sperm?
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mitochondria
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What is the food supply of the sperm?
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fructose
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How long does sperm development take?
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2 months (64 days)
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Where does spermatogenesis occur?
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Seminiferous tubules
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Trace the pathway of sperm from the testes to the penis
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Seminiferous Tubules
Epididimys Vas deferens Ejaculatory Ducts (Nothing) Urethra Penis SEVEN UP |
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What is the term for the first cell on the way to becoming a sperm
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spermatagonium
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What is the function of androgen-binding protein (ABP)?
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ensures that testosterone in seminiferous tubule is high
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What is the function of inhibin?
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Inhibits FSH from ant pituitary
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What is the function of testosterone?
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Differentiates male geitalia, anabolic effects of protein metabolism, maintains gametogenesis, libido, inhibits GnRH, fuses epiphyseal plates in bones
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What are the 3 androgens?
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testosterone, dihydrotestosterone (DHT), androstenedione
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From where do DHT and testosterone orginiate?
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Testis
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From where does androstenedione originate?
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adrenal gland
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Trace the order of potency of the androgens
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DHT > testosterone > androstenedione
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Which enzyme converts testosterone to DHT?
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5a-reductase
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Which anti-androgen drug inibits 5a-reductase?
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finasteride
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Which enzyme converts testosterone and androstenedione to estrogen in adipose tissue?
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aromatase
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What are the sources of estrogen?
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Ovary (estradiol), placenta (estriol), blood (aromatization)
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What are the functions of estrogens?
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1. growth of the follicle
2. endometrial proliferation 3. development of genitalia 4. stromal development of the breast 5. female fat distribution 6. hepatic synthesis of transport proteins 7. feedback inhibition of FSH 8. LH surge 9. increased myometrial excitability 10. increased HDL, lower LDL |
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Where are the sources of progesterone?
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corpus luteum, placenta, adrenal cortex, testes
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elevation of progesterone is indicative of which phase of the mestrual cycle?
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start of ovulation
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What is the main function of progesterone?
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maintenance of pregnancy
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At what point in the menstrual cycle is follicular growth the fastest?
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2nd week of the follicular phase
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What causes the LH surge just prior to ovulation?
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estrogen surge stimulates LH and inhibits FSH
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Define Mittelschmerz
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blood from a ruptured follicle causes peritoneal irritation that can mimic appendicitis
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How do oral contraceptives work?
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prevent estrogen surge/LH surge -> no ovulation
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At what phase is the oocyte halted until fertilization?
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Metaphase of meiosis II
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At what phase is the oocyte halted prior to ovulation?
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prophase of meiosis I
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Where is the source of hCG?
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syncytiotrophoblast of the placenta
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What are the functions of hCG?
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1. maintains corpus luteum for 1st trimester by acting like LH
2. detects pregnancy because it appears in the urine 8 days after successful fertilization 3. detects hydatidiform moles or choriocarcinoma |
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What are the hormonal changes associated with menopause?
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decreased estrogen, increased FSH and LH (no surge), increased GnRH
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what are the sx of menopause?
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Hot flashes, Atrophy of the Vagina, Osteoporosis, Coronary artery disease
Menopause causes HAVOC |
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What is the cause of bicornuate uterus?
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incomplete fusion of the paramesonephric ducts (causes of UTI and infertility)
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What is the embryological cause of hypospadius?
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Abnl opening of penile urethra on inferior (ventral) sides of penis due to failure of the urethral folds to close
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What is the embryological cause of epispadius?
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Abnl opening of the penile urethra on superior (dorsal) side of the penis due to faulty positioning of the genital tubercle
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What is the karyotype of Klinefelter's syndrome?
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47 XXY
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What are the sign of Klinefelter's syndrome?
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testicular atrophy, tall, long extremeties, gynecomastia, infertility
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What is the karyotype of Turner's syndrome?
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45XO
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What are the signs of Turner's syndrome?
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short stature, ovarian dysgenesis (streak ovary), webbong of the neck, coarctation of the aorta, most common cause of 1' amenorrhea; no Barr body
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What is the cause of female pseudohermaphroditism?
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excessive and inappropriate exposure to androgenic steroids during gestation (CAH or exogenous administration of androgens during pregnancy)
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What is the cause of male pseudohermaphoditism?
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androgen insenstivity syndrome (testicular feminization)
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What is the definition of true hermaphroditism?
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both ovary and testicular tissue present; ambiguous genitalia.
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What is the karyoptype of an individual with androgen insenstivity syndrome?
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45 XY
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What is the etiology of androgen insensitivity syndrome?
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defect in androgen receptor resulting in normal-appearing female
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What is the physiologic result of 5a-reductase deficiency?
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unable to convert testosterone to DHT -> ambiguous genitalia until puberty
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Hydatidiform mole has what genotype?
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46XX but all from paternal DNA (empty egg - ovum with no DNA)
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What other disease does a hydatidiform mole predipose one to?
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choriocarcinoma
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Which HPV serotypes are associated with cervical carcinoma in situ and high dysplasia?
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HPV 16 and 18
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What is the classification of cerviacal carcinomal in situ?
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CIN 3
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Invasive cervical carcinoma is usually of which cell type?
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squamous cell carcinoma
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Which HPV serotypes are the cause of genital warts?
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HPV types 6,8, and 11
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What is the definition of endometriosis?
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non-neoplastic endometrial glands in a place outside of the uterus
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How does endometrial hyperplasia frequently manifest?
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vaginal bleeding
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What is the most common gynecological malignancy? what typically precedes is?
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endometrial carcinoma; preceded by endometrial hyperplasia
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What are the risk factors for endometrial carcinoma?
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prolonged estrogen use without progestins, obesity, diabetes, htn, nulliparity and late menopause
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What is the most common of all tumors in females?
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leiomyoma
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Which racial group has a higher risk of leiomyoma?
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African Americans
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T/F: leiomyomas progress to leiomyosarcomas.
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False; leiomyosarcomas typically arise de novo
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What are the relative hormone levels of a pt with PCOS?
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high LH, low FSH, high testosterone
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What are the sx in pt with PCOS?
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amenorrhea, infertility, obesity and hirsutism
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Describe a dysgerminoma.
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the malignant equivalent to a male seminoma; sheets of uniform cells; increased hCG
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Describe a yolk sac tumor
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aggressive malignancy in ovaries (testes in boys) and sacrococcygeal area of young children; increased a-fetoprotein (AFP)
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Describe an ovarian choricarcinoma
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rare but malignant; can develop during pregnancy in mother or baby; large hyperchromatic syncytiotrophoblastic cells; increased hCG
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Describe an ovarian teratoma
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90% of all ovarian germ cell tumors; contains cells from 2 or 3 germ layers; mature teratomas are the most frequent benign ovarian tumor; immature teratomas are agressively malignant
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What is struma ovarii
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ovaries containing functional thyroid tissue (high RAI uptake in the ovaries)
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50% of ovarian tumors are of what type?
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Serous cystadenocarcinomas
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Describe the appearance and agressiveness of serous cystadenocarcinomas
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bilateral; malignant
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What is a pseudomyxoma peritonei?
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intraperitoneal accumulation of mucinous material from ovarian or appendectomal tumor
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Describe a Brenner tumor.
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benign tumor that resembles bladder epithelium
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Which type of ovarian non-germ cell tumor causes precocious puberty in kids?
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Granulosa cell tumor - secretes estrogen
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What feature is distinctive to Granulosa cell tumors of the ovaries?
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call-exner bodies: small follicles filled with eosinophilic secretions
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What are the symptoms of prostatitis?
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Dysuria, frequency, low back pain
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What are the causes of acute and chronic prostatitis, respecctively?
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acute: bacterial
Chronic: bacterial or abacterial (most common) |
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Is benign prostatic hyperplasia considered a premalignant lesion?
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No
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What is the proposed etiology of benign prostatic hyperplasia?
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age-related increase in estradiol with possible sensitization of the prostate to the growth promoting effects of DHT
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Where is the most common location for prostatic adenocarcinoma?
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posterior lobe (peripheral zone of the prostate gland
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What does the PSA level look like in a pt with prostatic adenocarcinoma?
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high PSA with a low fraction of free PSA
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Increased serum alk phos in a pt with prostatic adenocarcinoma is suggestive of what?
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osteoblastic metastases
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What causes the lack of spermatogenesis in cryptorchidism?
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increase in body temperature
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Crptorchidism is associated with an increased risk of what complication?
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germ cell tumors
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What are the 5 forms of testicular germ cell tumors?
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1. seminoma
2. embryonal carcinoma 3. yolk sac tumor 4. choriocarcinoma 5. teratoma |
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95% of all testicular tumors are of what general classification?
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germ cell tumors
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What is the most common testicular tumor?
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Seminoma
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what is the age range for a pt with a seminoma?
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15-35
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State the differences between a seminoma and an embryonal tumor
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Seminoma: malignant; painless testicular enlargement
Embryonal: malignant; painful; worse prognosis than seminoma |
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what tumor marker is used to diagnose a yolk sac tumor of the testicles?
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a-fetoprotein
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What tumor marker is used to diagnose a choriocarcinoma?
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hCG (malignant)
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What is the difference in teratomas in men and women?
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mature teratomas are almost always malignant in men
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What are the three main testicular non-germ cell tumors?
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Leydig cell tumor
Sertoli cell tumor Testicular lymphoma |
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Which testicular non-germ cell tumor is likely to cause precocious puberty in boys?
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Leydig 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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What are the 4 main antiandrogen agents?
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Finasteride
Flutamide Ketoconazole Spironolactone |
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what is the category and MOA of Finasteride?
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5a-reductase inhibitor; decreases conversion of testosterone to DHT
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What are the two uses for Finasteride?
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BHP and bladness
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What is the MOA of flutamide?
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nonsteroidal competitive inhibitor of androgens at the testosterone receptor
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What is the use for flutamide?
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prostatic adenocarcinoma
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Ketoconazole and spironolactone bot have what MOA and use?
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inibit steroid synthesis; used in PCOS to prevent hirsutism
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What is the class and MOA of sildenafil and vardenafil?
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phosphodiesterase inhibitor; inibits cGMP phosphodiesterase, causing increased cGMP smooth muscle relaxation in the corpus cavernosum
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What are sildenafil and vardenafil used for?
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erectile dysfunction
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What are some of the adverse effects of phosphodiesterase inhibitors?
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headache, flushing, dyspepsia, blue-green color vision; hypotension in pts taking nitrates
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What is the MOA of clomiphene and what is it used for?
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Partial agonist at androgen receptors in the pit gland. Prevents nl feedback inhibition and increased release of LH and FSH from the pi, stimulating ovulation; treatment for infertility
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What are some of the side effects of clomiphene?
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hot flashes, ovarian enlargement, multiple simulataneous pregnancies, visual disturbances
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What is the MOA of Mifepristone (RU486)
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competitive inhibitor of progestins at progesterone receptors in uterus preventing implantation
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What is the classic triad of preeclampsia?
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HTN, proteinuria, edema
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What is added to the preeclampsia triad to make it eclampsia?
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Seizures
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What are the symptoms of HELLP syndrome?
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Hemolysis, Elevated LFTS, Low Platelets
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What are the symptoms of preeclampsia?
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headache that won't go away, blurred vision, abdominal pain, edema of face and extremities, hyperreflexia
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What is the ideal treatment for preeclampsia?
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Delivery
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What is the treatment for eclampsia?
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Medical emergency
1. IV Magnesium sulfate 2. diazepam |
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What is abruptio placentae?
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premature detachment of placenta from implantation site resulting in painful uterine bleeding and fetal death
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What is placenta accreta?
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defective decidual layer allowing the placenta to attach directly to the myometrium which can result in hemorrhage after delivery
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What are the risks for placenta accreta?
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Prior C-section or inflammation
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What is placenta previa? what are the signs?
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attachment of placenta to the lower uterine segment with possible occlusion of the cervical os; painless bleeding in ANY trimester
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What is an ectopic pregnancy? What is it commonly mistaken for and how could you dx?
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improper implantation in the fallopian tubes with PID as a risk factor; it is commonly mistaken for appedicitis--test hCG levels for dx.
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What is the criteria for polyhydramnios and what the the possible causes?
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> 1.5-2L of amniotic fluid; assoc with esophageal/duodenal atresia (inability to swallow fluid) and anencephaly
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What is the criteria for oligohydramnios and what the the possible causes?
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< 0.5L amniotic fluid; assoc with bilateral renal agenesis or posterior urethral valves (can't excrete urine)
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What is the most common breast tumor in pts < 25 yrs?
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fibroadenoma--not a precursor to breast cancer
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Which breast tumor is in the lactiferous ducts and has pts presenting with serous or bloody discharge?
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intraductal papilloma
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Cystocarcinoma phyllodes is a breast tumor with what type of morphology?
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"leaflike" projections of connective tissue and cysts
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What is the single most important prognostic factor in breast carcinomas?
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lymph node involvement
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Ductal carcinoma in situ is characterized by early malignancy without _____.
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basement membrane penetration
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Which breast carcinoma is the worst and most invasive?
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Invasive ductal, no specific type
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Which breast carcinoma is ductal with cheesy consistency due to central necrosis?
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Comedocarcinoma
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Paget's dz of the breast has what sign on physical exam?
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eczematous patches on the nipple
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What are Paget cells?
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large cells with a clear halo - suggestive of underlying carcinoma
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What are the risk factors for breast carcinoma?
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gender, age, early 1st menarche, delayed first PG, late menopause, FHX
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How does a pt with fibrocystic disease of the breast present?
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diffuse breast pain and multiple bilateral lesions
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What are the 4 types of fibrocystic disease?
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1. Fibrosis - hyperplasia of normal breast stroma
2. Cystic - fluid-filled 3. Sclerosing 4. Epithelial hyperplasia |
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What is the most common pathogen to infect and woman with acute mastitis?
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S. aureus
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What is the cause of fat necrosis of the breast?
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injury
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What are the three main causes of gynecomastia?
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hyperestrogenism, Klinefelter's syndrome, or drug induced
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What are the advantages to oral contraception?
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1. reliable
2. decreased risk of endometrial and ovarian cancer 3. decreased incidence of ectopic pregnancy 4. decreased pelvic infections 5. regulation of menses |
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What are the disadvantages to oral contraception?
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1. daily dosage
2. no protection against STDs 3. increased triglycerides 4. Depression, wt gain, nausea 5. hypercoaguable state |
