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147 Cards in this Set
- Front
- Back
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What is the lymphatic drainage for the distal 1/3 of the vagina/vulva/scrotum
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superficial inguinal nodes
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What is the lymphatic drainage for the ovaries/testes
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para-aortic lymph nodes
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In the female, what is the derivative of the gubernaculum
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round ligament of the uterus
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What does the round ligament of the uterus connect?
What structures does it contain? |
connects the uterine fundus to the labia majora
NO structures are contained it |
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What ligament (in the female) travels through the inguinal canal?
What ligament contains the ovarian vessels? uterine vessels? |
Round ligament of the uterus (travels through Round inguinal canal)
suspensory ligament of the ovaries: ovarian vessels Cardinal ligament: uterine vessels |
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What structures are contained in the broad ligament
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ovaries, fallopian tubes, round ligaments of the uterus
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What is the pathway of sperm during ejaculation
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SEVEN UP
Seminal vesicles epididymis Vas deferens Ejaculatory ducts (Nothing) Urethra Penis |
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What effect does NE have on erection
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antierectile
NE -> increased intracellular Ca -> smooth muscle contraction -> vasoconstriction -> anti-erection |
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By what nerve does emission happen
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hypogastric nerve (sympathetic)
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By what nerve does ejaculation happen
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pudendal nerve (visceral and somatic nerves)
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What is spemiogenesis
What happens during it? |
spermatid -> spermatozoa
loss of cytoplasmic contents, gain of acrosomal cap |
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From what does the sperm flagellum (tail) develop?
How about acrosome? |
centrioles
golgi apparatus |
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What forms the blood-testis barrier
What is its function |
tight junctions b/w adjacent Sertoli cells
Function is to prevent gametes from autoimmune attack |
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What 3 main hormones do the Sertoli cells secrete
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inhibin -> inhibits FSH
Androgen-binding protein (ABP) -> maintain levels of testosterone Anti-Mullerian hormone |
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What kinds of cells are
Spermatogonia Sertoli cells Leydig cells |
Spermatogonia: germ cells
Sertoli: non-germ cells Leydig: endocrine cells |
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What is the composition of sperm
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-60% seminal vesicle products (fructose, prostaglandins)
-20% prostate products (acid phosphatase, zinc) -semen |
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When does spermatogenesis begin?
Where does it occur? How long does it take? |
Begins at puberty w/spermatogonia
Happens in the seminiferous tubule Takes 2 months for full development |
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What is the potency of the 3 androgens in order from highest to lowest
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DHT > testosterone > androstenedione
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What hormone closes the epiphyseal plates?
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via estrogen converted from testosterone
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What are the functions of DHT
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early: differentiation of penis, scrotum, prostate
late: prostate growth, balding, sebeceous gland activity |
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What effect does exogenous testosterone have on the testis
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e.g., steroids
inhibition of HPG axis -> decreased intratesticular testosterone -> decreased testicular size -> azoospermia |
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where is estrogen converted in male tissues?
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adipocytes and SERTOLI CELLS by enzyme aromatase
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What are the sources of estrogens
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ovary: 17-beta estradiol
placenta: estriol blood (from aromatization) |
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What is the potency of the estrogens in order of highest to lowest
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estradiol > estrone > estriol
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What estrogen is an indicator of fetal well-being
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estriol
1000-fold increase during pregnancy |
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How does estrogen affect cholesterol levels
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increases HDL
decreases LDL |
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What are the sources of Progesterone
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corpus luteum, placenta, adrenal cortex, testes
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What is the main placental estrogen
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estriol
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What is Mittelschermz
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blood from ruptured follicle in ovulation causes peritoneal irritation that can mimic appendicitis
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When do primary oocytes begin meiosis I
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during fetal life
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Pirmary oocytes are arrested in what stage and until what time?
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arrested in Prophase of Meiosis I
until ovulation/puberty |
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Secondary oocytes are arrested in what phase and until when?
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arrested in Metaphase of Meiosis II
until fertilization |
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Primary oocytes are arrested in what stage and until what time?
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arrested in Prophase of Meiosis I
until ovulation/puberty |
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When does fertilization occur
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w/in 1 day after ovulation
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When does implantation occur
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w/in wall of uterus 6 days after fertilization
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What is the function of hCG
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to maintain corpus luteum in 1st trimester (acts like LH; and makes progesterone)
in 2nd/3rd trimesters, placenta takes over and makes its own estriol and progesterone (corpus luteum degenerates) |
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when is beta-hCG detected in blood
and what secretes it |
1 week after conception
(and 2 weeks w/a home urine test) syncytiotrophoblasts secrete hCG Also in pathologies (e.g. choriocarcinoma, hydatidiform mole, invasive mole) |
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What is the estrogen and its source after menopause
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estrone from peripheral conversion of androgens
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What is the confirmatory test of menopause
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markedly increased FSH
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What is the hormone profile of menopause
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decreased E
markedly increased FSH increased LH (no surge) increased GnRH |
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What are the Sx of menopause
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HHAVOC
Hirsutism Hot flashes Atrophy of the Vagina Osteoporosis Coronary artery disease |
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What can early menopause indicate
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premature ovarian failure
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What is the most common cause of primary amenorrhea
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Turner's syndrome
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What are the characteristics of Double Y males
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phenotypically NL
very tall, severe acne, antisocial behavior, NL fertility |
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What is the hormone profile in Klinefelter's
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increased FSH (dysgenesis of seminiferous tubules -> decreased inhibin)
increased estrogen (AbNL leydig cell function -> decreased testosterone -> increased LH) |
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What is the hormone profile in Turner's syndrome
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decreased estrogen (-> increased LH and FSH)
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What is this disorder
high Testosterone high LH |
defective androgen receptor
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What is this disorder
high testosterone low LH |
testosterone-secreting tumor
exogenous steroids |
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What is this disorder
low testosterone high LH |
primary hypogonadism
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Kallmann's syndrome
hormone profile? cause? sxs? |
hypogonadotropic hypogonadism (low FSH, LH, testosterone, and sperm count)
maldevelopment of the olfactory bulbs and GnRH producing cells sxs: delayed puberty, anosmia, color blindness |
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What is the most common form of male pseudohermaphroditism
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androgen insensitivity syndrome (most common)
also, 17 alpha hydroxylase deficiency |
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What can cause female pseudo-hermaphroditism
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excessive and inappropriate exposure to androgenic steroids during early gestation (like CAH or exogenous androgens during pregnancy)
21 alpha hydroxylase deficiency |
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What is the hormone profile in androgen insensitivity syndrome
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increased testosterone, estrogen, LH (unlike in sex chromosome disorders
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What causes "Penis at 12"
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5alpha-reductase deficiency
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How does a complete mole look on ultrasound
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"snowstorm" appearance w/no fetus during 1st sonogram
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How do hydatidiform moles present
Describe genetic profile of complete and partial moles. |
AbNL vaginal bleeding
Complete: 46, XX (2 sperms and an empty egg) Partial; 69, XXY (2 sperms and an egg) |
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What are the risks of hydatidiform moles
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choriocarcinoma and uterine rupture
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What is the treatment for hydatidiform moles
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D & C (dilatation and curettage) and methotrexate
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What are the risks of hydatidiform moles
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15-20% risk in complete mole and <5% in partial mole
can lead to invasive mole and choriocarcinoma and uterine rupture |
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tx for seizures of eclampsia?
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MgSO4 and diazepam
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What is the common cause of miscarriage in the 1st weeks of gestation?
1st trimester? 2nd trimester? |
1st week:low progesterone (no response to beta-hCG)
1st trimester: chromosomal abnormalities (e.g. robertosonian translocations) 2nd trimester: bicornuate uterus (incomplete fusion of paramesonephric ducts) |
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HELLP syndrome
association? sxs? |
associated with pregnancy-induced htn (preeclampsia)
sxs: Hemolysis, Elevated LFTs, low platelets |
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What 4 serum markers are tested in the maternal serum during gestation?
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tested during week 16-18
1. AFP 2. Estriol 3. hCG 4. inhibin A |
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What causes painful bleeding in 3rd trimester
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abruptio placentae
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What increases risk of abruptio placentae
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smoking, HTN, cocaine use
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What causes massive painful bleeding after delivery
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placenta accreta (no separation of placenta after birth)
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What can predispose placenta accreta
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prior C-section, inflammation, placenta previa
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What causes painless bleeding in any trimester
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placenta previa (placenta attaches to lower uterine segment and can occlude internal os
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What predisposes to placenta previa
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multiparity and prior C-section
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What are risk factors for ectopic pregnancy
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history of infertility
Salpingitis (PID) ruptured appendix prior tubal surgery |
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What is associated w/polyhydramnios
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esophageal/duodenal atresia (inability to swallow amniotic fluid), anencephaly
>1.5-2 L of fluid |
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What is assoc w/oligohydramnios
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placental insufficiency, bilateral renal agenesis, posterior urethral valves (in males), inability to excrete urine
can give rise to Potter's syndrome |
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What can lateral invasion of cervical CA cause
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can block ureters -> renal failure
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what are the most common causes of anovulation
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Polycystic ovarian syndrome, 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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How does endometriosis manifest clinically
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severe menstrual-related pain (ectopic endometrial tissue undergoes cyclic bleeding -> chocolate cysts)
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What is the most common gynecologic malignancy
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endometrial carcinoma
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What is the most common of all tumors in females
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leiomyoma (fibroids)
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What tumor has whorled pattern of smooth muscle bundles
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leiomyoma (fibroids)
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What are risk factors for endometrial hyperplasia
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anovulatory cycles, HRT, polycystic ovarian syndrome, granulosa cell tumor
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How can fibroids clinically manifest
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abnormal uterine bleeding, miscarriage, or iron deficiency anemia if severe bleeding
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What is the hormone profile of polycystic ovarian syndrome
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increased LH
increased testosterone decreased FSH |
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What is polycystic ovarian syndrome
What is it associated with |
enlarged, bilateral cystic ovaries that manifest as amenorrhea, infertility, obesity, hirsutism
assoc w/insulin resistance and increased risk for endometrial cancer |
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How do you treat polycystic ovarian syndrome
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weight loss, OCPs
gonadotropin analogs, clomiphene(selective estrogen receptor modulator (SERM) that increases production of gonadotropins by inhibiting negative feedback on the hypothalamus), surgery |
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What is a theca-lutein cyst
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often bilateral/multiple
due to gonadotropin stimluation assoc w/choriocarcinoma and moles |
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Follicular cyst
Corpus Luteum cyst |
Follicular: distention of unruptured graafian follicle (assoc w/hyperestrinism and endometrial hyperplasia)
Corpus Luteum: hemorrhage into persistent corpus luteum (spontaneously regresses); most common ovarian mass in pregnancy |
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What are ovarian germ cell tumors
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Dysgerminoma, Choriocarcinoma, Yolk sac (endodermal sinus) tumor, teratoma
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What ovarian germ cell tumor has an increased frequency of theca-lutein cysts
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choriocarcinoma
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What is the female equivalent to the male seminoma
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dysgerminoma
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Increased AFP indicates what ovarian germ cell tumor
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yolk sac (endodermal sinus) tumor
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Schiller-Duval bodies
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in yolk sac tumors
50% of these tumors have these bodies that resemble glomeruli |
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What is the most frequent benign ovarian tumor
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mature teratoma (dermoid cyst)
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What is more aggressively malignant in women: mature or immature teratoma
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immature teratoma
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What is a struma ovarii
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teratoma w/functional thyroid tissue that can present as HYPERthyroidism
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hCG and LDH are tumor markers for what germ cell tumor?
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dysgerminoma
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what is the tumor marker for choriocarcinoma
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hCG
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What is Meig's syndrome
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R-sided hydrothorax, ovarian fibroma, ascites
pulling sensation in groin |
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Granulosa cell tumor
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secretes estrogen -> precocious puberty in kids
can cause endometrial hyperplasia or carcinoma in adults Call-Exner bodies (small follicles filled w/eosinophilic secretions) abNL uterine bleeding |
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what causes clear cell adenocarcinoma
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exposure to DES in utero
vaginal carcinoma |
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rare
pain in labia majora can result from a prior infection What infection? |
Bartholin's gland cyst
Neisseria gonorrhea |
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What vaginal carcinoma is secondary to cervical SCC
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vaginal SCC
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intraductal papilloma
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benign
small tumor that grows in lactiferous ducts, typically beneath areola slight increase in risk for carcinoma serous or BLOODY nipple discharge |
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in ovarian non-germ cell tumors (serous cystadenoma, etc.) what is the single most important risk factor
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significant genetic disposition
other risk factors: BRCA-1, HNPCC |
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Which BRCA gene is assoc w/ovarian non-germ cell tumors
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BRCA-1
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what is the single most important prognostic factor in malignant breast tumors
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axillary lymph node involvement
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what is the most common malignant breast cancer
and what is so characteristic of it |
invasive ductal
it is the worst and most invasive breast cancer |
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What breast cancer is fleshy, cellular, lymphatic infiltrate
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medullary carcinoma
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intraductal papilloma
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benign
small tumor that grows in lactiferous ducts, typically beneath areola slight increase in risk for carcinoma serous or bloody nipple discharge |
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Paget cells
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large cells in epidermis w/clear halo
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what are risk factors for malignant breast tumors
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increase estrogen exposure
increase total number of menstrual cycles older age at 1st live birth obesity (adipose tissue-site of aromatization) |
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Paget's disease
and what does it suggest where can it also be |
eczematous patches on nipple w/Paget cells
suggests underlying carcinoma also seen on vulva |
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Inflammatory breast cancer
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dermal lymphatic invasion by breast carcinoma
Peau d'orange 50% survival at 5 years |
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What is fibrosis (of fibrocystic dz)
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hyperplasia of breast Stroma
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What fibrocystic dz histiologic type has an increased risk of carcinoma
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epithelial hyperplasia (increased number of epithelial cell layers in terminal duct lobule
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what is acute mastitis
what is the most common pathogen assoc w/it |
breast abscess; during breast feeding
increased risk of bacterial infection through cracks in nipple S. aureus most common |
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What 3 main things can cause gynecomastia
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hyperestrogenism (cirrhosis, testicular tumor, puberty, old age)
Klinefelter's drugs |
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What drugs can cause gynecomastia
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estrogen, marijuana, heroin, psychoactive drugs
Spirinolactone Digitalis Cimetidine Alcohol Ketoconazole (Some Drugs Create Awesome Knockers) |
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comedocarcinoma
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ductal, caseous necrosis
subtype of DCIS |
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sclerosing adenosis
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type of fibrocystic change
increased acini and intralobular fibrosis assoc w/calcifications |
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What is the pathogenesis of BPH
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maybe from age-related increase in estradiol w/possible sensitization of prostate to DHT (growth-promoting effects)
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What are the charactersitics of BPH
How does it present |
nodular enlargement of periurethral lobes (lateral and middle) -> compress urethra into a vertical slit
Presents w/increased frequency of urination, nocturia, difficulty starting and stopping stream of urine, dysuria |
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What can BPH lead to
How do you treat BPH |
Can lead to distention and hypertrophy of bladder, hydronephrosis, UTI
treat w/alpha1-antagonist (terazosin, tamsulosin) which causes relaxation of smooth m |
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Where do prostatic adenocarcinomas arise from
What are useful tumor markers |
arise most often from the posterior lobe (peripheral zone)
PAP (prostatic acid phosphatase) and PSA are useful tumor markers (an increase in total PSA, with decreased fraction of free PSA) |
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Compare PSA in BPH and Prostate cancer
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BPH: increase in total free PSA
Cancer: increase in total PSA, but decrease in fraction of free PSA |
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cryptorchidism
what are patients at increased risk for? |
undescended testis
at increased risk for germ cell tumors |
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what process is lacking in cryptorchidism?
What increases the risk for cryptorchidism? |
Lack spermatogenesis b/c of increased body temp
Prematurity increases risk of cryptorchidism |
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What is the most common testicular tumor
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seminoma
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What is the most common testicular cancer in older men
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testicular lymphoma (non-germ cell tumor)
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which teratoma is more malignant (in men): mature or immature
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mature (opposite in women)
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What is a varicocele
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dilated vein in pampiniform plexus
can cause infertility "bag of worms" decreased size in recumbent position b/c blood returns to the systemic circulation tunica vaginalis lesion |
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What is a hydrocele
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tunica vaginalis lesion
increased fluid secondary to incomplete fusion of processus vaginalis |
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What is a spermatocele
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dilated epididymal duct
tunica vaginalis lesion |
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What disease causes a bent penis from acquired fibrous tissue formation
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Peyronie's disease
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Leydig cell tumor
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testicular non-germ cell tumor
contains Reinke crystals usually androgen-producing gynecomastia in men; precocious puberty in boys |
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Leuprolide
MOA? clinical use? |
GnRH analog
agonist property when used in pulsatile fashion antagonist property when used in continuous fashion infertility (pulsatile) prostate cancer, uterine fibrinioids (continuous) |
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Methyltestosterone
toxicities |
causes masculinization in females
gonadal atrophy premature closure of epiphyseal plates increase LDL, decrease HDL |
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Finasterides
class? indication? |
5alpha reductase inhibitor
useful in BPH promotes hair growth |
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flutamide
class? indication? |
a nonsteroidal competitive inhibitor of androgens at the T receptor
used in prostate carcinoma |
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tx of polycystic ovarian syndrome to prevent hirsutism.
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ketoconazone: inhibit steroid synthesis
spironolactone: inhibits steroid binding |
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Clomiphene
MOA? indication? |
partial agonist at Estrogen receptor in hypothalamus -> prevent normal feedback inhibition -> increase release of LH/FSH -> ovulation
to treat infertility and PCOS |
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Which SERM is a partial agonist in the endometrial tissue? can lead to what?
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tamoxifen
can cause endometrial cancer |
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Anastrozole, exemestane
class? indication? |
aromatase inhibitor
used in postmenopausal women with breast cancer |
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Mifepristone
clinical use? co-administered with? |
termination of pregnancy
administered with misoprostol (PGE1 analog), which will induce labor to expel the egg |
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Oral contraceptive
how does it affect risk of endometrial and ovarian cancer? TG? and coagulability? |
decrease risk of endometrial and ovarian cancer
increase TG hypercoagulable state |
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Dinoprostone
class? indication? |
PGE2 analog causing cervical dilation and uterine contraction
induce labor |
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Ritodrine, terbutaline
class? indication? |
Beta-2 agonists that relax uterus
reduce premature uterine contractions |
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Tamsulosin
class? indication? |
alpha1 antagonist used to treat BPH by inhibiting smooth muscle contraction
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sildenafil, vardenafil
indication? toxicities? |
viagra, levitra (respectively)
tx of erectile dysfunction can cause headache, flushing, dyspepsia, impaired blue-green color vision. Risk of life-threatening hypotension in pts taking nitrates |
