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149 Cards in this Set

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Follicular growth if fastest during which week of mentrual cycle?
Second week of proliferative phase
Hormone that Simulates endometrial proliferation?
Estrogen- endometrial proliferation
Hormone that maintains endometrium for implantation?
Progesterone- maintains endometrium
Which phase of menstrual cycle can vary in length?
Follicular phase can vary
Which phase is usually a constant 14 days?
Luteal phase is constant
Ovulation is caused by what hormone?
LH surge
Estrogen surge effect on other hormones?
Stimulates LH and inhibits FSH
What is Mittelschmerz?
Blood from ruptured follicles causing peritoneal irriation and mimicing appendicitis
What is the Mechanism of Oral contraceptions?
Prevent estrogen surge and subsequent LH surge preventing ovulation
When do primary oocytes begin and complete meiosis?
Begins meiosis I during fetal life and complete prior to ovulation
What phase is Meiosis I is arrested in and until what time?
Arrested in prophase until ovulation
What phase is Meiosis II is arrested in and until what time?
Arrested in Metaphase until fertiliation
What is the most common location and time of fertilization?
Upper end of the oviduct within one day of ovulation
How long after fertilization does implantation?
Implantation occurs 6 days after fertilization
Which hormones are elevated at term of pregnancy?
Estrogen, Progesterone, Oxytocin and prolactin
What is the Mechanism of lactation?
decrease in Maternal estrogen induces Lactation
How Suckling maintain milk Production?
Suckling increases nerve stimulation and oxytocin
Human Chorionic Gonadotropin secreted by which cells?
Syncytiotrophoblast of the placenta
What is function of hCG?
Maintains the corpus luteum for the first trimester
What two diseases can cause elevated hCG?
Hadatidiform mole and Choriocarcinoma
Which trimesters does the placenta synthesize its own estriol and progestone?
Second and third trimester
Which hormone is measured to detect pregnancy?
Elevated hCG at one week after conception
What causes the cessation of estrogen at menopause?
Decline in number in ovarian follicles
What hormonal changes occur in Menopause?
Decreased Estrogen Increased FSH, LH and GnRH
What can cause Menopause to occur at an earlier age?
Smokers have earler menopause
Early menopause can indicate premature ovarian failure
What are Four symptoms or consequences of menopause?
Hot flashes, Vaginal atrophy, Osteoporosis, Coronary artery disease
What are the clinical characteristics of Klinefelter's Syndrome?
Male (XXY) with testicular atrophy, eunuchoid body shape, tall, long extremities, gynecomastia, and female hair distribution. Common cause of hypogonadism in infertility workup. Barr body present.
What are the clinical characteristics of Turner's Syndrome?
Female (XO) short stature, ovarian dysgenesis (streak ovary), webbing of the neck, preductal coarctation of the aorta, and is the most common cause of primary amenorrhea. No barr body present.
What are the clinical characteristics of Double Y males?
Male (XYY) phenotypically normal, very tall, severe acne, antisocial behavior, and normal fertility. May be a higher frequency among inmates of penal institutions.
What are the clinical characteristics of female pseudohermaphrodite?
Female (XX) ovaries present but external genitalia are virilized or ambiguous due to excessive and inappropriate exposure to androgenic steroids during early gestation.
What are the clinical characteristics of male pseudohermaphrodite?
Male (XY) Testes present but external genitalia are female or ambiguous, most common form is due to androgen insensitivity syndrome (testicular feminization).
What are the clinical characteristics of a true hermaphrodite?
46 XX, or 47 XXY both ovary and testicular tissue are present with ambiguous genitalia. Very rare.
How would a female patient present with Androgen insensitivity syndrome, and what is it caused by?
Defect in androgen receptor resulting in normal appearing female (46 XY) (female external genitalia with rudimentary vagina), uterus and uterine tubes generally absent, and has testes. Levels of testosterone, estrogen, and LH are all high.
What enzyme is needed to convert testosterone to DHT, and what is the patient presentation in someone deficient in that enzyme?
5alpha-reductase. Deficient patient has ambiguous genitalia until puberty when increase in testosterone causes masculinization of genitalia. Testosterone and estrogen levels are normal, LH is normal or increased. The patient has a penis at 12 once puberty begins.
What is a hydatidiform mole?
A pathologic ovum -an empty egg without any DNA- resulting in cystic swelling of chorionic villi and proliferation of chorionic epithelium (trophoblast). It is the most common precursor of choriocarcinoma with high levels of beta-hCG. Is said to be a :honeycomb uterus, cluster of grapes in appearance. Moles can lead to uterine rupture. Treat with dilation and curettage and methotrexate.
Complete hydatidiform mole vs partial?
Complete mole is 46xx and is completely paternal in origin. There is no fetus and leads to an enlarged uterus. A Partial mole is typically a triploid karyotype or tetraploid, and contains fetal parts. They are less likely to be associated with uterine enlargement.
What are the symptoms of preeclampsia?
Preeclampsia is the triad of hypertension, proteinuria, and edema. Headache, blurred vision, abdominal pain, edema of face and extremities, altered mentation, hyperreflexia, thrombocytopenia, and hyperuricemia.
What is HELLP syndrome?
HELLP is hemolysis, elevated LFT's, low platelets
What is abruptio placentae?
Premature detachment of placenta from implantation site resulting in painful bleeding usually occurs during 3rd trimester. Increased risk with smoking, cocaine, hypertension. May be associated with DIC.
What is placenta accreta?
Defective decidual layer allows placenta to attach directly to myometrium. Predisposed by prior C-section or inflammation may have massive hemorrhage after delivery
What is placenta previa?
Attachment of the placenta to lower uterine segment, may occlude internal os. Painless bleeding in any trimester. Prior C-section predisposes
What is ectopic pregnancy?
Most often in the fallopian tubes, predisposed by salpingitis (PID). Suspect if increased hCG with sudden lower abdominal pain often mistaken for appendicitis
What is polyhydramnios, and what is it associated with?
Greater than 1.5-2L of amniotic fluid associated with esophageal/duodenal atresia, causing inability to swallow amniotic fluid, and with anencephaly
What is oligohydramnios and what is it associated with?
less than 0.5 L of amniotic fluid associated with bilateral renal agenesis or posterior urethral valves (in males) and resultant inability to excrete urine. Can give rise to Potter's syndrome.
What virus and strain is most associated with cervical dysplasia, and what is cervical dysplasia?
HPV 16, 18 Cervical dysplasia is disordered epithelial growth that begins at the basal layer of squamous-columnar junction and extends outward.
What is the most common type of invasive carcinoma of the cervix?
squamous cell carcinoma
What is endometriosis?
Non-neoplastic endometrial gland/stroma in abnormal locations outside the uterus. Characterized by cyclic bleeding from ectopic endometrial tissue resulting in blood-filled chocolate cysts in ovary or peritoneum
What is adenomyosis?
Endometriosis within the myometrium.
What is the most common cause of endometrial hyperplasia what is it a risk factor for?
Usually caused by excess estrogen stimulation, and leads to an increased risk for endometrial carcinoma
What are the risk factors for endometrial carcinoma?
Prolonged use of estrogen without progestins, obesity, diabetes, hypertension, mulliparity, and late menopause.
What is the most common gynecologic malignancy and what is its prognosis?
Endometrial carcinoma and its prognosis correlates with the degree of myometrial invasion.
What is a leiomyoma?
Most common of all tumors in females with an increased incidence in blacks. Benign smooth muscle tumor that is estrogen sensitive and decreases in size after menopause.
What is a leiomyosarcoma?
Bulky irregularly shaped tumor with areas of necrosis and hemorrhage typically arising de novo. Increased incidence in blacks, highly aggressive tumor with tendency to recur. May protrude from the cervix and bleed
What is the hormone profile of polycystic ovarian syndrome?
increased LH, decreased FSH, and increased testosterone. Increased LH leads to anovulation, and hyperandrogenism.
What is the patient presentation with polycystic ovarian syndrome and how do you treat it?
Patient presents with enlarged bilateral cystic ovaries with amenorrhea, infertility, obesity, and hirsutism. Treated with weight loss, OCP's, gonadotropin analogs, clomiphene, or surgery.
What is a chocolate cyst?
blood containing cyst from ovarian endometriosis
what is a theca lutein cyst?
often bilateral/multiple due to gonadotropin stimulation.
What is the presentation of a follicular cyst?
Distention of unruptured graafian follicle, may be associated with hyperestrinism and endometrial hyperplasia.
Describe dysgerminoma and what is its tumor marker?
Malignancy equivalent to male seminoma, sheets of uniform cells. Tumor marker hCG.
Describe choriocarcinoma and what is its tumor marker?
Rare but malignant can develop during pregnancy in mother or baby, large hyperchromatic syncytiotrophoblastic cells and increased frequency of theca-luetin cysts. Tumor marker hCG
Describe yolk sac tumor and what is its tumor marker?
Aggressive malignancy in ovaries testes in boys and sacrococcygeal area of young children. Tumor marker is AFP
What is a teratoma?
Germ cell tumor with cells from 2 or 3 germ layers.
Mature vs immature teratoma?
Mature is the most frequent benign ovarian tumor. Immature is aggressively malignant.
Mifepristone
•Mechanism- Competitive inhibitor of progestins at progesterone receptors. •Use: Termination of pregnancy. Administered with misoprostol (PGE1). •Toxic: Heavy bleeding, GI Effects (Nausea, vomiting, Anorexia), abdominal pain
Oral Contraception (synthetic Progestins and estrogen) Advantages
Reliable
Decreased risk of endometrial and ovarian cancer
Decreased incidence of ectopic pregnancy
Decreased pelvic infections
Regulation of Menses
Oral Contraception (synthetic Progestins and estrogen) Disadvantages
Taken Daily
No protection against STDs
Increase triglycerides
Depression, Weight Gain, Nausea, Hypertension
Hypercoagulable state
Hormone replacement therapy
Used for relief or prevention of menopausal symptoms like:
Hot flashes, vaginal atrophy
Osteoporosis (due to decreased estrogen levels)
Unopposed estrogen replacement therapy increases the risk of endometrial cancer, so progesterone is added.
Increased CV risk maybe!
Dinoprostone
Mechanism: PGE2 analog causing cervical dilation and uterine contraction.
Use: Induce labor
Ritodine/Terbutaline
Beta two agonists
Relax uterus
Anastrazole
Aromatase inhibitor used in postmenopausal women with breast cancer
Testosterone(methyltestosterone)
MOA: Agonist at androgen receptors Use: Treat hypogonadism and promote development of secondary sex characteristics; stimulation of anabolism to promote recovery after burn or injury; treat ER positive breast cancer (Exemestane) Toxic: masculinization in females; reduces intratesticular testosterone in males by inhibiting Leydig cells; Leads to gonadal atrophy, Premature closer of Epiphyseal plates. Increased LDL, Decreased HDL
Estrogen (ethinyl estradiol, DES, mestranol)
MOA: Bind estrogen receptors Use: Hypogonadism or ovarian failure, menstrual abnormalities, HRT in postmenopausal women, use in men w/ androgen dependent prostate cancer Toxic: Increased risk of endometrial carcinoma, bleeding in postmenopausal women, clear cell adenocarcinoma of vagina in females exposed to DES in utero, Increased thrombi. DON’T USE IN ER POSITIVE BREAST CANCER
Progestins
MOA: Bind progesterone receptors, reduce growth, increase vasularization of endometrium Use: Oral contraceptives and treatment of endometrial cancer and abnormal uterine bleeding
Clomiphene
SERMs: Estrogen partial agonist in pituitary gland. Prevents normal feedback inhibition and increased release of LH and FSH, stimulating ovulation Treat infertility and PCOS. Hot flashes, ovarian enlargement, multiple simultaneous pregnancies, visual disturbances
Tamoxifen
SERMs: Antagonist on breast tissue ER - used to treat and prevent recurrence of ER-positive breast cancer
Raloxifene
SERMs: Agonist on bone estrogen receptors. Reduces reabsorption of bone. Treat osteoporosis
What hormone most directly stimulates spermatogenesis, and where is it produced?
Testosterone, Leydig cells of seminiferous tubule
Starting with hypothalamus, name pathway to stimulate testosterone production in Leydig cells, how is it regulated?
Hypothalamus releases GnRH => Ant pituitary releases LH => Leydig cells release testosterone => testosterone downregulates GnRH release
What stimulates ABP (androgen binding protein), what cells produce ABP, and what does it do?
FSH stimulates Sertoli cells to produce ABP. ABP ensures that testosterone in seminiferous tubule is high.
What stimulates inhibin, what cells produce inhibin, what does it do?
FSH stimulates Sertoli cells to produce inhibin. Inhibin simply provides negative feedback on FSH release from ant pituitary.
What 2 hormones does FSH stimulate in Sertoli cells?
ABP and inhibin
What 2 androgens are produced in testis, what 1 in adrenal? Which is most potent?
Testis: DHT and testosterone, Adrenal: androstenedione. DHT is most potent.
What enzyme converts testosterone to DHT, and what inhibits it?
5a-reductase converts to DHT, finasteride inhibits
Which 2 androgens get converted to estrogen? What enzyme? Name the 2 locations where this occurs in men.
Testosterone and androstenedione. Aromatase. Adipose tissue and Sertoli cells of seminiferous tubule.
Estriol is produced in what structure?
Placenta
17B-estradiol is produced in what structure?
Ovary
Which type of estrogen most potent?
Estradiol > estrone > estriol
What type of estrogen increases most in pregnancy?
Estriol increases 1000-fold, is indicator of fetal well-being. (Estradiol and estrone increase 50-fold)
What cell in ovaries is most similar in function to Leydig cells in testes?
Theca cells, produce androgen
What enzyme produces androstenedione in Theca cells, what hormone stimulates?
Desmolase converts cholesterol to androstenedione, stimulated by LH
What cell in ovaries produces estrogen? Which cell does this in testes?
Granulosa cells in ovaries, Sertoli in testis
What enzyme produces estrogen in Granulosa cells and what hormone stimulates this enzyme?
Aromatase converts Androstenedione to Estrogen, stimulated by FSH
Elevation of what hormone indicates ovulation has just occurred?
Progesterone
Name the 4 structures where progesterone can be produced:
corpus luteum, placenta, adrenal cortex, and testes
What hormone stiumulates endometrial glandular secretions and spiral artery development?
Progesterone
What hormone produces a thick cervical mucus, inhibiting sperm entry to uterus?
Progesterone
Describe estrogen's effect on LH secretion.
Usually negative feedback, but switches to postive just before LH surge.
How does estrogen affect cholesterol levels?
Increases HDL, lowers LDL
Estrogen has what effect on myometrium? What about progesterone?
Estrogen increases myometrial excitability, progesterone decreases excitability.
Ovarian Cancer Marker
CA-125
Ovarian Cancer Genetic Risk Factors
BRCA-1, HNPCC
Number one type of ovaria non-germ cell tumor
Serous Cystadenocarcinoma
Complication of Mucinious Cystadenocarcinoma
Jelly Belly' Pseudomyxoma Peritonei
Two examples of sex cord type ovarian non-germ cell tumors
Fibromas and Granulosa
The two B's associated with Brenner's Tumor
Benign and looks like bladder
Fibromas are associated with
Meig's Syndrome
Meig's Syndrome consists of the following triad
Ovarian Fibromas, ascites, and hydrothorax
Granulosa cell tumors secrete
estrogen and thus are associated with Precocious puberty
Granulosa cell tumors have this histological feature
Call Exnler bodies- small follicle filled with eosinophils (Memo: Call Granny)
A metastatic tumor from the GI that produces a mucin secreting adenocarcinoma in the ovaries
Krukenberg Tumor
Histological feature of Krukenberg tumor
Signet Ring- nucleus pushed to one side
Squamous cell carcinoma of the vagina is secondary to
cervical SCC
Clear cell adenocarcinoma of the vagina is caused by
DES (Diethylstilbesterol) exposure- synthetic estrogen
Highly aggressive tumor that produces grape-like masses that protrude out of the vagina of <4 year old girls
Rhabdomyosarcoma/ Sarcoma Butyroides (Memo: But out/ Oh my)
#1 Tumor of <25 year old females
Fibroadenoma of the breast (benign)
A benign breast tumor that is a small, mobile, firm mass with sharp edges and which increases in size and tenderness with pregnancy
Fibroadenoma of the breast
Tumor of the lactiferous ducts that presents with bloody discharge
Intraductal papilloma (benign)
Large, bulky mass of connective tissue and cysts that has 'leaflike projections'
Phyllodes Tumor (benign)
T/F: The prevelance of malignant breast tumors increase in post-menopausal years
TRUE
Malignant breast tumors overexpress these receptors
ER/PR
Recommended treatment for ER/PR positive breast CA
Tamoxifen (SERM)
Most important prognostic factor in malignant breast CA
Axillary lymph node involvement
Noninvasive (histologically) malignant breast CA
DCIS (ductal carcinoma in situ)
#1 type of invasive malignant breast cancer
Invasive ductal, no specific type
Worst prognosis and most invasive of invasive malignant breast cancer
Invasive ductal, no specific type
Eczematous patches on the nipple with large cells + clear halo
Paget's Disease of Breast
Risk factors for malignant breast cancer
Gender, age, early 1st menarche, delayed first preg, late menopause, and family history of breast CA
#1 cause of 'breast lumps' in age 25 to menopause that presents with breast pain and multiple leshions
Fibrocystic dx
T/F: Atypical cells in epithelial hyperplasia type of fibrocystic disease have an increased risk of carcinoma
TRUE
Acute Mastitis is a breast abscess that occurs during breast feeding. What type of bacterial infection can occur
S. aureus
A benign painless lump that results from trauma to the breast tissue
Fat Necrosis
Gynecomastia results from
Hyperestrogenism, Klinefelters, or Drugs
What are the drugs that result in gynecomastia
Spironolactone, Digitalis, Cimetidine, Alcohol, Ketoconazole (Memo: Alcohol cements digits on lactators)
A dilated epididymal duct
spermatocele
A 50 yo man presents with a crusty placque on the shaft of his penis.
Bowen's disease (CIS)
Red velvety placque on glans
Erythroplasia of Queyat
Multiple papular lesions on penis
Bowenoid papulosis
This Ca is more common in uncircumsized men. (Asia, Africa, SA. Associated with HPV
sqamous cell carcinoma of penis
Bent penis due to fibrous tissue
Peyronie's desease
How does spironolactone cause gynecomastia?
inhibit testosterone release from testis, block androgen receptor
When is progesterone released from the ovary?
luteal phase
If a bodybuilder was growing man-boobs, what's one drug you could give him?
anastrozole
How does ketoconazole cause gynocomastia?
inhibit testosterone synthesis
How would you give leuprolide to treat infertility?
in a pulsatile manner
How would you give leuprolide to treat prostate cancer
continuous
Antiandrogens used in the tx of polycystic ovarian syndrom to prevent hirsutism.
ketoconazole, spironolactone
A 50 yo man wants to hit the bar scene again. Unfortunately, he is bald and has BPH. What can he take so he can get his mojo back?
finasteride
Sildenafil and Vardenafil exert their action of increasing cGMP in what part of the penis?
Corpus cavernosum
SE of sildenafil and vardenafil
Risk of hypotension in pt on nitrates. Impaired blue-green vision