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181 Cards in this Set

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what is the difference in venous drainage from the left ovary/testis vs. the right ovary/testis?
left ovary/ testis --> left gonadal vein --> left renal vein --> IVC

right ovary/testis --> right gonadal vein --> IVC
what lymph nodes do the ovaries/ testis drain to?
para-aortic lymph nodes
what does the round ligament connect? what structures are contained?
connects the uterus to the labia majora; contains 0 structures
what does the broad ligament contain?
uterus, fallopian tubes, and ovaries to the pelvic side wall
what is the pathway of sperm during ejaculation?
Seminiferous tubules --> epididymis --> vas deferens --> ejaculatory ducts --> (nothing) --> urethra --> penis
SEVEN UP
is erection parasymp or sympathetic?
parasympathetic
point and shoot
what drugs cause smooth muscle relaxation leading to vasodilation and erection?
NO, sildenafil, vardenafil
what is the effect of NE on erection?
causing smooth muscle contraction and vasoconstriction leading to antierection
what nerve controls ejaculation?
pudendal (visceral and somatic nerves)
what nerve controls emission?
hypogastric nerve (sympathetic nervous system)
where are mitochondria located in the sperm? what powers?
middle piece; fructose (feeds on fructose)
what is the sperm acrosome and flagellum derived from?
acrosome is derived from the golgi apparatus

flagellum is derived from one of the centrioles
what types of cells are contained in the seminiferous tubules?
spermatogonia (germ cells), sertoli cells, leydig cells (endocrine cells)
what do spermatogonia produce?
primary spermatogonia
what is the main function of sertoli cells? what do they secrete?
sertoli cells support sperm synthesis

secrete inhibin (inhibits FSH), androgen-binding protein to maintain testosterone levels, form blood-testis barrier
what do leydig cells secrete?
testosterone
where does sperm development occur?
seminiferous tubules
what cell do LH and FSH target in the male? what is the effect?
LH - targets leydig cells causing testosterone release

FSH - targets sertoli cells to produce androgen binding protein and inhibin which feedbacks to inhibit FSH release from the anterior pituitary
what are the three forms of androgens in order of potency?
DHT > testosterone > androstenedione
what enzyme converts testosterone to DHT? what inhibits this enzyme?
5-alpha reductase

inhibited by finasteride
what are the four primary functions of DHT?
1. differentiation of PENIS, SCROTUM, PROSTATE
2. balding
3. increase sebaceous gland activity
4. increase prostate growth
what are the three types of estrogen in order of potency?
estradiol (ovary) > estrone > estriol (placenta)
what cells do LH and FSH act on in the female and what is there function?
LH - stim. desmolase in the theca cell to produce androstenedione

FSH - stim. aromatase in the granulosa cell to convert androstenedione from the theca cell to estrogen
what form of estrogen increased most markedly in pregnancy?
estriol (released from the placenta)
what does an elevation of progesterone in the female indicate?
ovulation - secretory phase
what are the sources of progesterone?
corpus luteum, placenta, adrenal cortex, testes
estrogen and progesterone are elevated during which phases of the menstrual cycle, respectively?
proliferative phase (follicular) and secretory phase (luteal)
when does ovulation occur in the menstrual cycle?
after the proliferative phase and at the beginning of the secretory phase
what is the effect of progesterone on the endometrium?
maintains to support implantation
when is follicular growth fastest during the menstrual cycle?
2nd week of the proliferative phase
how long is the luteal phase?
14 days
how long is menstration?
ovulation day + 14 days (luteal phase) = menstration
during menstration, what is the source of the rise in progesterone?
the corpus luteum
what occurs the day before ovulation which leads to ovulation?
estrogen surge stimulates the release of LH (estrogen changes from having a negative feedback on LH release to a positive feedback) --- this results in rupture of the graafian follicle (ovulation)
what is mittelschmerz?
blood from the ruptured follicle after ovulation causes peritoneal irritation that can mimic appendicitis
in oogenesis, when do primary oocytes begin and complete meiosis I?
meiosis I is started during fetal life and completed just prior to ovulation
meiosis I is arrested in what phase of the cell cycle for years until ovulation?
meiosis I is arrested in prOphase until Ovulation
what phase of the cell cycle is meiosis II arrested in until fertilization?
meiosis II is arrested in METaphase until fertilization
a egg MET a sperm
what happens to the secondary oocyte if fertilization does not occur?
degenerates
each oogonium gives rise to how many eggs?
one
where does fertilization most commonly occur?
upper end of the fallopian tube
how many days after fertilization does implantation occur?
6 days
what secretes hCG? when is it detectable in blood and urine?
trophoblasts -- detectable in blood 1 week after conception and in urine 2 weeks after conception
what induces lactation after labor and what maintains lactation?
decrease in maternal steroids induces; suckling is required to maintain milk production
what hormone is responsible for inducing and maintaining lactation?
prolactin
what is the function of oxytocin?
milk letdown and may be involved in uterine contraction
what cells of the placenta release hCG?
syncytiotrophoblast
what is the function of hCG?
1. maintains the corpus luteum for the 1st trimester

2. used to detect pregnancy because can be found in urine 2 weeks after conception

3. there is elevated hCG in pathologic states
what is the average age of onset for menopause? what environmental influence decreases the age of onset?
51 -- smoking decreases
what hormone decreases during menopause and why?
estrogen because there is an age-linked decline in the number of ovarian follicles
what are the hormonal changes that accompany menopause?
decreased estrogen, markedly increased FSH, increased LH (but no surge) and increase GnRH
what health problems does menopause cause?
Hot flashes, Atrophy of the Vagina, Osteoporosis, Coronary artery disease
HAVOC
what is the chrom. abn in klinefelter's syndrome?
XXY
what does klinefelter's show in the infertility workup?
HYPOGONADISM, tall long extremities, gynecomastia, female hair distribution
what is the chrom. abn in turner's syndrome?
XO
"Hugs and Kisses" from tina Turner
what is the most common cause of primary amenorrhea?
turner's
does XYY males have nl fertility?
yes
what is traditionally assoc. with XYY males?
antisocial behavior (but seen in only 1-2% of XYY males)
what is a female pseudohermaphrodite? how does this result?
XX - ovaries are present, but external genitalia are virilized or ambiguous

results from excessive exposure to androgenic steroids during early gestation
what is a male pseudohermaphrodite?
XY - testes are present but external genitalia are female or ambiguous
what is a true hermaphrodite?
(46, XX or 47 XXY) both ovary and testicular tissue are present with ambiguous genitalia
what are the sex chromosomes present in an individuals who appears to be female?
46, XY
what is the problem in androgen insensitivity syndrome?
defect in androgen receptor resulting in normal appearing female

uterus and uterine tube are generally absent; develops testes (in labia majora)
what results from 5alpha-reductase deficiency?
unable to convert testosterone to DHT

individuals have an ambiguous genitalia until puberty when there is an increase in testosterone that leads to masculinization
what is a hydatidiform mole?
cystic swelling of the chorionic villi and proliferation of the chorionic epithelium
identify the following differences betwee a complete and partial mole:

karyotype; hCG levels, uterine size, % that convert to choriocarcinoma, fetal parts?, components
complete mole: 46, XX or 46, XY; markedly increased hCG levels; increase in uterine size; 2% convert to choriocarcinoma; no fetal parts; 2 sperm + empty egg

partial mole: 69, XXY; increase in hCG; no change in uterine size; rare conversion to choriocarcinoma; partial has fetal parts; 2 sperm + 1 egg
what is the most common cause of recurrent miscarriages in the first week of pregnancy? first trimester? second trimester?
first weeks - low progesterone

first trimester - chromosomal abnormalities

second trimester - bicornuate uterus
what is the triad of preeclampsia?
hypertension, proteinuria, edema
what is added to the preeclampsia triad to call it eclampsia?
(triad includes hypertension, proteinuria, edema) + seizures
what factors increase the incidence of preeclmapsia-eclampsia?
preexisiting hypertension, diabetes, chronic renal disease, and autoimmune disorders
what syndrome is associated with preeclampsia-eclampsia?
HELLP syndrome - Hemolysis, Elevated LFTs, Low Plateletes
HELLP
what is the treatment for exclampsia-preeclampsia?
deliver fetus as soon as viable; bed rest, salt restriction, treatment of hypertension; for seizures use IV magnesium sulfate and diazepam
what is abruptio placentae? what increases the risk?
premature detachment of placenta from the implantation site

increased risk with smoking, hypertension, cocaine use
what is placenta accreta? what predisposes?
defective decidual layer allow placenta attachment to myometrium; poses difficulty at birth when placenta cannot be delivered and vessels remain dilated resulting in massive bleeding after delivery

predisposed in those with prior C section or inflammation
what is placenta previa? what predisposes?
attachment of the placenta to the lower uterine segment which may obstruct the internal os

prior C section predisposes
what is the difference in the type of bleeding experienced in placenta previa vs. abruptio placenta?
placenta previa - painless bleeding in any trimester

abruptio placenta - painful bleeding int he 3rd trimester
what is the most common site of ectopic pregnancy? what predisposes?

what is seen clinically? what is it often confused for?
fallopian tubes; predisposed by PID

clinically you see lower ab pain with increase in serum hCG; often confused with appendicitis
what HPV serotypes are assoc. with cervical intraepithelial neoplasia?
HPV 16, 18
what is the typical change you see in cells infected with HPV? (these cells are detected with a pap smear)
koilocytic change
in what cells does cervical dysplasia begin?
begins at basal layer of squamo-columnar junction and extends outward
CIN can give rise to what type of invasive carcinoma?
squamous cell carcinoma
what is endometriosis?
endometrial glands and stroma in locations outside the uterus (not neoplastic)
what are chocolate cysts and how do they result?
these are blood filled cysts that result from the cyclic bleeding of ectopic endometrial tissue in endometriosis
where does endometriosis commonly occur and how does it manifest clinically?
commonly occurs on ovaries or peritoneum

manifests as severe menstrual-related pain
what is adenomyosis?
endometrial tissue within the myometrium
excess stimulation by what hormone leads to endometrial hyperplasia?
estrogen
endometrial hyperplasia puts you at risk for what?
endometrial carcinoma
how does endometrial hyperplasia manifest clinically?
postmenopausal vaginal bleeding
what is the most common gyn malignancy?
endometrial carcinoma
how does endometrial carcinoma usually present?
vaginal bleeding
what is the age of peak occurance for endometrial carcinoma?
55 - 65 years
what are the two types of myometrial tumors?
leiomyoma (fibroids)

leiomyosarcoma
what is the most common tumor in females? what race is at a particular risk?
leiomyoma; blacks
what happens to the size of a leiomyoma with pregnancy and menopause?
estrogen sensitive therefore size increases with pregnancy and decreases with menopause
does leiomyoma progress to leiomyosarcoma?
no
what does a leiomyoma look like grossly?
usually multiple; whorled pattern of smooth muscle bundles
how does a leiomyosarcoma usually arise? is it benign of malignant?
de novo; malignant - high aggressive tumor with tendency to recur
rank ovarian, cervical and endometrial tumors in order or incidence and worst prognosis
incidence: endometrial > ovarian > cervical

worst prognosis: ovarian > cervical > endometrial
when does premature ovarian failure present?
signs of menopause after puberty but before age 40
increase production of what hormone leads to anovulation in polycystic ovarian syndrome?
LH
how does polycystic ovarian syndrome manifest clinically?
enlarged, bilateral cystic ovaries with amenorrhea, infertility, obesity and hirsutism

also, insulin resistance
polycystic ovarian syndrome puts you at a higher risk of developing which type of cancer?
endometrial cancer
what is a follicular cyst?
distention of an unruptured graafian follicle
what is a corpus luteum cyst?
hemorrhage into a persistent corpus luteum
what is a theca-lutein cyst?
often bilateral and multiple assoc with gonadotrophin stimulation
what are the ovarian germ cell tumors? (4)
dysgerminoma, choriocarcinoma, yolk sac (endodermal sinus tumor), teratoma
what is the male equivalent of dysgerminoma? what marker is elevated?
male equiv is seminoma

hCG is marker
is choriocarcinoma benign? what cell abnormality do you see with choriocarcinoma? what is the marker?
no, rare but malignant

cell abn: large hyperchromatic syncytiotrophoblastic cells

marker: hCG
what is a yolk sac tumor? what is the tumor marker?
aggressive malignancy in ovaries of female and testes of boys

marker: AFP
what type of tumor comprises the vast majority of ovarian germ cell tumors?
teratoma (90% of ovarian germ cell tumors)
what is the most frequent benign ovarian tumor?
mature teratoma or "dermoid cyst"
what ovarian teratoma can present as hyperthyroidism?
struma ovarii
what are the ovarian non-germ cell tumors?
serous cystadenoma

serous cystadenocarcinoma

mucinous cystadenoma

mucinous cystadenocarcinoma

Brenner tumor

Fibromas

Granulosa cell tumor

Krukenberg tumor
what type of epithelium lines a serous cystadenoma?
fallopian tube-like epithelium
what is a general ovarian cancer marker that is increased in serous cystadenomas?
CA-125
is serous cystadenocarcinoma malignant?
yes, and freq. bilateral
what are 2 risk factors for the development of serous cystadenocarcinoma?
BRCA-1 and HNPCC
what condition can result from mucinous cystadenocarcinoma?
pseduomyxoma peritonei
is a brenner tumor benign or malignant? what does it look like?
benign; looks like bladder
fibromas are made up of what cell type?
bundles of spindle shaped fibroblasts
what is meigs' syndrome?
triad of ovarian fibroma, ascites and hydrothorax
what does a granulosa cell tumor secrete?

what can it lead to in children? adults?

what bodies are characteristic?
estrogen

precocious puberty in children; endometrial hyperplasia or carcinoma in adults

Call-Exner bodies which are small follicles filled with eosinophilic secretions
what is a Krukenberg tumor?
GI (often stomach) mets to ovaries causing a mucin-secreting signet cell adenocarcinoma
what are the three types of vaginal carcinoma?
sqaumous cell carcinoma

clear cell adenocarcinoma

sarcoma botryoides (rhabdomyosarcoma variant)
what is clear cell adenocarcinoma of the vagina assoc. with?
affects women who had exposure to DES in utero
what age is affected by sarcoma botryoides?
< 4 years
what clinical symptoms are seen with prostatitis?
dysuria, frequency, urgency, low back pain
what is the hormonal cause of benign prostatic hyperplasia?
age-related increase in estradiol with possible sensitization of the prostate to DHT (promotes growth)
which lobes of the prostate are enlarged in BPH? what occurs as a result?
periurethral lobes - lateral and middle

compresses the urethra into a verticle slit
is benign prostatic hyperplasia a precancer?
no
what marker is increased with benign prostatic hyperplasia?
increase in free prostate specific antigen
how does the location of prostate adenocarcinoma differ from BPH?
prostate cancer is more posterior while BPH is more central
how is prostate adenocarcinoma most commonly diagnosed?
a hard nodule is felt on digital rectal exam and through prostate biopsy
what are the prostate adenocarcinoma tumor markers?
prostatic acid phosphatase (PAP) and PSA (increase in total PSA but decreased fraction of free PSA)
what is the most common site of prostate cancer metastasis?
osteoblastic tumor on the spine
what is cryptorchidism?
undescended testis
if you have cryptorchidism, what type of tumor are you at a higher risk of developing?
germ cell tumors
what are the testicular germ cell tumors?
seminoma, embryonal carcinoma, yolk sac (endodermal sinus) tumor, choriocarcinoma, teratoma
are testicular germ cell or non-germ cell tumors more common?
germ cell (about 95% of all testicular tumors)
what is the most common testicular tumor?
seminoma
which testicular germ cell tumor displays painless testicular enlargement?
seminoma
what is the histo buzz word for a seminoma?
"fried egg" appearance
are seminomas readiosensitive?
yes
which has a worse prognosis: seminoma or embryonal carcinoma? how does their presentation differ?
embryonal carcinoma has a worse prognosis

presentation differs in that embryonal carcinomas are painful
what characteristic bodies do yolk sac tumors show on histology?
Schiller-Duval bodies, primative glomeruli
what marker is increased with a testicular choriocarcinoma?
hCG
what is the difference between a teratoma in males vs. females?
in males: often malignant

in females: often benign
what are the testicular non-germ cell tumors?
leydig cell, sertoli cell, testicular lymphoma
what hormone do leydig cell tumors usually produce?
androgen (gyecomastia in men, precocious puberty in boys)
which testicular non-germ cell tumor displays Reinke cystals?
leydig cell
what is the most common testicular cancer in older men?
testicular lymphoma
what are tunica vaginalis lesions?
lesions in the serous covering of testis
what is a varicocele?
dilated vein in pampiniform plexus
what is a hydrocele?
increase fluid secondary to incomplete fusion of processus vaginalis
what is a spermatocele?
dilated epidymal duct?
what is bowen's disease?
gray solitary gray plaque on the shaft of the penis
what is erythroplasia of Queyrat?
red velvety plaques, usually involving the glans
what is bowenoid papulosis?
multiple papular lesions -- occurs earlier than other subtypes
where is squamous cell carcinoma of the penis more common? what group of people?
asia, africa, s. america

uncircumsized men
what is peyronie's disease?
bent penis due to acquired fibrous tissue formation
what is the most breast tumor in those under 25?
fibroadenoma
is fibroadenoma a precursor lesion to breast cancer?
no
what are 3 benign breast tumors?
fibroadenoma, intraductal papilloma, Phyllodes tumor
which of the benign breast tumors responds to estrogen?
fibroadenoma
by how much does an intraductal papilloma increase the risk for carcinoma?
1.5-2X increase
what is seen clinically in a intraductal papilloma?
serous or bloody nipple discharge because they typically occur beneath the areola
what is characteristic of a Phyllodes tumor?
LARGE mass of connective tissue and cysts

"leaf-like" projections
when does a Phyllodes tumor typically occur?
6th decade of life
when are malignant breast cancers most common?
postmenopause
what is the most important prognostic factor in malignant breast cancer?
axillary lymph node involvement
what type of breast cancer exhibit peau d'orange?
inflammatory type -- dermal lymphatic invasion by breast cancer
what is the worst, most invasive, and most common type of malignant breast cancer?
invasive ductal
what is clinically characteristic of Paget's disease?
eczematous patches on nipple suggesting underlying carcinoma
what are paget cells?
large cell in the epidermis with a clear halo
what is the most common cause of lumps in the breast from age 25 to menopause?
fibrocystic disease
what are the four histologic types of fibrocystic disease?
fibrosis, cystic, sclerosing adenosis, epithelial hyperplasia
what is the most common pathogen in acute mastitis?
S. aureus
fat necrosis occurs as a result of what?
injury to breast tissue
does fat necrosis form a lump that is painful or painless?
painless
gynecomastia results from elevations in what hormone?
estrogen
what drugs can cause gynecomastia?
spironolactone, digitalis, cimetidine, alcohol, ketoconazole
some drugs create awesome knockers