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166 Cards in this Set
- Front
- Back
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where do the left ovary/testes drain into
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left renal vein via left gonadal vein
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which side is a varicocele more common
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left - because drains into left renal vein
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where is the lymph drainage for the ovaries/testes
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para-aortic lymph nodes
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where does the distal 1/3 vs. the proximal 2/3 of vagina/uterus lymph drain
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distal 1/3 - superficial inguinal nodes
proximal 2/3 - deep inguinal nodes |
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this ligament contains the ovarian vessels
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suspensory ligament of the ovaries
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this ligament contains the uterine vessels
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cardinal ligement
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this ligament is a derivative of gubernaculum and travels through the inguinal canal
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round ligament of the uterus
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this ligament contains the ovaries, fallopian tubes, and round ligament of uterus
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broad ligament
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pathway of sperm during ejaculation
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SEVEN UP
seminiferous tubules epididymis vas deferens ejeaculatory ducts - urethra penis |
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what causes an erection
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parasympathetic nervous system
NO causes increased cGMP to cause vasodilation |
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what two drugs inhibit cGMP breakdown and allow erection to occur
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sildenafil
verdenafil |
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where are the acrosome and flagellum of sperm derived from respectively
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acrosome - golfi apparatus
flagellum - centrioles |
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what does the middle piece of sperm contain
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mitochondria
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what is the source of energy for sperm
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fructose
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these cells secrete inhibin, anti-mullerian hormone, and androgen-binding protein; as well as support sperm synthesis
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Sertoli cells
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these cells secrete testosterone
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Leydig cells (endocrine cells)
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where are spermatogonia, Sertoli cells, and Leydig cell found respectively
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spermatogonia and Sertoli cells line seminiferous tubules
Leydig cell found in interstitium below the basal lamina |
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what does inhibin do
secrete by what |
inhibits FSH secretion by anterior pituitary
Sertoli cells secrete inhibin |
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what forms the blood-testis barrier
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tight junctions between adjacent Sertoli cells
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when does spermatogenesis begin in male
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puberty
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N of spermatogonium, primary spermatocyte, secondary spermatocyte, spermatid/spermatozoan
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spermatogonium - 2N
primary spermatocyte - 4N secondary spermatocyte - 2N spermatid/spermatozoan - N |
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how does spermatid become spermatozoan
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undergoes spermiogenesis - loss of cytoplasmic contents and gains acrosomal cap
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what does FSH and LH do in male
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FSH stimulates Sertoli cells to activate sperm production
LH stimulates Leydig cells to produce testosterone |
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what two things does FSH stimulate Sertoli cells to produce
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Androgen Binding Protein
Inhibin |
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source and potency of androgens: DHT, Testosterone, androstenedione
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DHT and T - testis
Androstenedione - adrenal DHT > T > Androstenedione |
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converts T --> DHT
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5a-reductase
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what does finasteride inhibit
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5a-reductase
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what can be converted to estrogen in adipose tissue and Sertoli cells by aromatase
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Testosterone
Androstenedione |
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functions of DHT early vs. late
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early - differentiation of penis, scrotum, prostate
late - prostate growth, balding, sebaceous gland activity |
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associated with differentiation of epididymis, vas deferens, and seminal vesicles
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testosterone (internal genitalia except prostate)
*DHT does external genitalia |
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source and potency of estrogen: 17B-estradiol, estriol, estrone
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17B-estradial - ovary
estriol - placenta estreon - aromatization in adipose tissue estradiol > estrone > estriol |
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what estrogen compound increases 1000 fold during pregnancy and is a good indicator of fetal well-being
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estriol
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functions of desmolase and aromatase and location of each
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desmoalse (theca cell) - converts cholesterol to androstenedione
aromatase (granulosa cell) - converts androstenedione to estrogen |
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which hormones stimulate desmolase and aromatase respectively
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desmolase - LH
aromatase - FSH *both from pulsitile GnRH |
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what does elevation of progesterone indicate
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ovulation
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functions of progesterone (4)
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1. stimulate endometrial glandular secretion and spiral artery development
2. maintains pregnancy 3. inhibits LH and FSH 4. decreases estrogen receptor expressivity |
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which phase of menstrual cycle is a constant 14 days
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luteal, secretory phase
*proliferative phase can vary from the usual 14 days |
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this hormone upregulates progesterone receptors
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estrogen
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which hormone stimulates endometrial proliferation and which one maintains endometrium to support implantation
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estrogen stimulates proliferation
progesterone maintains endometrium |
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what hormone does corpus luteum secrete
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progesterone
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what is menstruation
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apoptosis of endometrial cells
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what causes increased temperature during ovulation
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progesterone
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blood from ruptured follicle causes peritoneal irritation that can mimic appendicitis
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Mittelschmerz
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positive feedback of this hormone causes increased GnRH receptor on anterior pituitary to eventually stimulate LH surge
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estrogen - estrogen surge stimulates LH surge at day 13
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what does LH surge do
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causes ovulation and rupture of follicle
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in what stages are Meiosis I and II arrested in in oogenesis
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Meiosis I - prophase until ovulation (primary oocytes)
Meiosis II - metaphase until fertilization (secondary oocytes) |
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when do primary oocytes begin and finish Meiosis I
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begin during fetal life
finish just prior to ovulation |
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what completes Meiosis II in secondary oocyte
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fertilization
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N number in: oogonium, primary oocyte, secondary oocyte, ovum
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oogonium - 2N
primary - 4N secondary - 2N ovum - N |
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unlike spermatogenesis, how many ovums are derived from one primary oocyte
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ONE
*4 spermatids from 1 primary spermatocyte |
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where does fertilization most commonly occur
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upper end of fallopian tube (ampulla)
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when does implantation occur
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6 days after fertilization
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decrease in which hormone after labor induces lactation
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progesterone
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source of B-hCG secretion
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synctiotrophoblast of placenta
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function of B-hCG
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1. maintain corpus luteum and therefore progesterone secretion for first trimester
2. used to detect pregnancy |
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what do extreme elevated levels of hCG indicate
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hydatiform moles
choriocarcinoma gestational trophoblastic tumor |
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when does the corpus luteum degenerate
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2nd trimester because placenta synthesizes its own estriol and progesterone
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what is the best test to confirm menopause
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super elevated levels of FSH
*loss of negative feedback from estrogen |
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young male presents with testicular atrophy, tall, long extremities, gynecomastia, female body shape, and increased levels of FSH and LH
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Klinefelter's syndrome (XXY)
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characteristics of Turner syndrome (XO)
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short stature
ovarian dysgenesis (streak ovary) webbing of neck bicuspid aortic vavlve preductal coarcatation |
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most common cause of primary amenorrhea
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Turner's syndrome
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male presents with severe acne and is very tall, antisocial behavior as well
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XYY male
*normal fertility |
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associated with both increased testosterone and LH
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defective androgen receptor
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associated with increased Testosterone and decreased LH
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exogenous steroids
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associated with increased LH but decreased T
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primary hypogonadism
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associated with both decreased LH and T
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hypogonadotropic hypogonadism
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disagreement between phenyotypic and gonadal sex
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pseudo-hermaphroditism
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cause of pseudo-hermaphroditisim
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female (XX) - inappropriate expsosure to endrogenic steroids during early gestation
male (XY) - androgen insensitivity syndrome |
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normal-appearing female with external genitalia presents with mass in labia majora and increased testosterone, estrogen, and LH
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androgen insensitivity syndrome
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male presents with ambiguous genitalia until puberty when testosterone causes masulinization and growth of external genitalia
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5a-reductase deficiency
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decreased synthesis of gonadotropin in anterior pituitary results in anosmia and lack of secondary sexual characteristics
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kallmann sydnrome
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deficiency in this hormone in a male would develop both male and female internal genitalia with male external genitalia
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anti-mullerian hormone secreted by Sertoli cell
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this gene on the Y chromosome is responsible for testis-determining factor
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SRY gene
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associated with abnormal vaginal bleeding, increased B-hCG, abnormally enlarged uterus, and snowstorm appearance with no fetus during 1st sonogram
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hydatidiform mole
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differentiate complete and partial mole
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complete - 46XX, XY (2 sperm + empty egg)
partial - 69XXY (2 sperm + 1 egg) |
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which hydratidiform mole is a more likely precursor for choriocarcinoma
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complete mole
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what is associated with recurrent miscarriages during 2nd trimester
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bicornuate uterus (incomplete fusion of paramesopnephric ducts)
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differentiate preeclampsia and eclampsia
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preeclampsia - HTN, proteinuria, edema
eclampsia - preeclampsia + seizures |
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what causes preeclampsia
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plancental ischemia due to impaired vasodilation of spiral arteries resulting in increased vascular tone
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HELLP syndrome
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hemolysis
elevated LFTs Low Platelets |
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what can the HELLP syndrome be associated with
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preeclampsia
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pregnant woman presents with headache, blurred vision, abdominal pain, altered mentation, and edema
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preeclampsia
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painful bleeding during 3rd trimester of pregnancy, associated with smoking, HTN, and cocaine use
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abruptio placentae
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associated with massive bleeding after delivery due to placenta attachment to myometrium, placenta cannot separate after birth
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placenta accreta
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predispositions of placenta accreta
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prior C-section
inflammation placenta previa |
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attachment of placenta to lower uterine segment, associated with painless bleeding in any trimester
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placenta previa
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where does ectopic pregnancy most commonly occur
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fallopian tubes
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what do you suspect with increased hCG and sudden lower abdominal pain
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ectopic pregnancy
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associated with esophagea/duodenal atresia and anencephaly
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polyhydramnios > 1.5-2 L of amniotic fluid
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this can give rise to Potter's syndrome due to bilateral renal agenesis or posterior urethral valve
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oligohydramnios
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risk factors of cervical dysplasia and carcinoma in situ
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multiple sexual partners (#1)
smoking HIV infection |
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what can lateral invasion of invasive cervical carcinoma block
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ureters causing renal failure
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where does cervical dyslplasia/carcinoma in situ begin
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basal layer of squamo-colojmnar junction
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what is a koilocytic change typically a sign of in the cervix
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HPV infection
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non-neoplastic endometrial tissue in abnormal locations outside the uterus
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endometriosis
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associated with cyclic bleeding (mestrual type) and chocolate cysts in ovary of peritoneum
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endometriosis
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endometrium within the myometrium
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adenomyosis
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clinically presents as postmenopausal vaginal bleeding due to excess estrogen stimulation
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endometrial hyperplasia
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risk factor for endometrial hyerplasia
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anovulatory cycles
hormone replacement therapy polycystic ovarian syndrome granulosa cell tumor |
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most common gynecologic malignancy
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endometrial proliferation
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what is associated with poor prognosis in endometrial carcinoma
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myometrial invasion
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risk factors for endometrial carcinoma
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prolonged use of estrogen with progestins
obesity diabetes HTN nullparity late menopause |
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this female tumor increases in size with pregnancy and decreases with menopause, estrogen sensitive
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leiomyoma (fibroid)
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most common female tumor, associated with whorled pattern of smooth muscle bundles
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leiomyoma
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myometrial tumor that is bulky, irregularly shaped with areas of necrosis and hemorrhage
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leiomyosarcoma
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differentiate incidence vs. prognosis or gyncologic tumors
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incidence - endometrial > ovarian > cervical
prognosis (worst) - ovarian > cervical > endometrial |
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associated with increased LH leading to anovulation and hyperandorogenism; increased LH and testosterone with decreased FSH
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polycystic ovarian syndrome
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woman clinically presents with amenorrhea, infertility, obesity, hirsutism and insulin resistance
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polycystic ovarian syndrome
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cyst associated with choriocarcinoma and moles
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theca-lutein cyst
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distention of unruptured graafian follicle, associated with hyperestrinism and endometrial hyperplasia
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follicular cyst
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malignant ovarian germ cell tumor that is equivalent to male seminoma
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dysgerminoma
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tumor makers for dysgeminoma
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hCG and LDH
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malignant ovarian germ cell tumor that develops during pregnancy with large, hyperchromatic synctiotrophoblastic cells
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choriocarcinoma
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aggressive malignancy in ovaries with yellow, solid masses associated with a-FP
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yolk sac tumor
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90% of ovarian germ cell tumors
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teratoma
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three different teratomas of ovarian germ cell tumors
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mature teratoma - dermoid cyst
immature teratoma - malignant struma ovarii - contains functional thryoid tissue |
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CA-125
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general ovarian cancer marker
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genetic risk factors for ovarian carcinoma
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BRCA-1
HNPCC (hereditary nonpolyposis colorectal cancer) |
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this ovarian tumor secretes estrogen and can lead to precocious puberty and endometrial hyperplasia or carcinoma
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granulosa cell tumor
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GI malignancy that metastsizes to ovaries causing mucin-secreting signet cell adenocarcinoma
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Krukenberg tumor
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bundles of spindle-shaped fibroblasts in ovaries
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fibromas
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Meigs syndrome
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benign ovary fibromas
ascites pleural effusion |
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two general types of cystadenomas/adenocarcinomas
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serous
mucinous |
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3 types of vaginal carcinoma
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1. SCC
2. clear cell adenocarcinoma 3. sarcoma botryoides (rhabdomyosarcoma variant) |
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carcinoma associated with in utero exposure to diethylstilbestrol
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clear cell adenocarcinoma of vagina
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spindle-shaped vaginal tumor cells that are desmin positive
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sarcoma botryoides
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this breast tumor increases in size and tenderness with estrogen (pregnancy and menstruation)
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fibroadenoma
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small tumor that grows in lactiferous ducts associated with bloody nipple discharge
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intraductal papilloma
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large bulky mass of CT in breast with leaf-like projections
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phyllodes tumor
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single most important prognostic factor in breast carcinoma
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axillary lymph node involvement
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overexpression of what two things is associated with breast carcinoma
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erb-B2 (HER-2)
estrogen receptors |
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risk factor for breast carcinoma
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increased estrogen exposure: increased number of menstrual cycles and obesity
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most common, worst, most invasive breast carcinoma
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invasive ductal carcinoma
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associated with bilateral breast invovlement with orderly rows of cells
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invasive lobular carcinoma
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subtype of ductal carcinoma in situ with caseous necrosis centrally
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comedocarcinoma
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breast carcinoma with dermal lymphatic invasion causing peau d'orange
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inflammatory carcinoma
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eczematous patches on nipple suggesting underlying carcinoma
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Paget's disease
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firm, fibrous, rock-hard mass found on breast exam
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invasive ductal carcinoma
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breast carcinoma with good prognosis with lymphocytic infiltrate
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medullary carcinoma
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most common cause of breast lumps, presents with premenstrual breast pain and multiple lesions
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fibrocystic disease
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breast abscess that occur during breast-feeding due to S. aureus
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acute mastitis
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results from injury to breast tissue, presents as benign painless lump
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fat necrosis
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two breast tumors involving breast stroma
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fibroadenoma
phyllodes tumor |
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causes of gynecomastia in men
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cirrhosis
testicular atrophy puberty Klinefelter's syndrome drugs |
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drugs associated with causing gynecomastia in men
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Some Drugs Create Awesome Knockers:
spironolactone Digitalis Cimetidine Alcohol Ketoconazole |
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dysuria, frequency, urgency, and low back pain in male
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prostatitis
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man presents with frequency, nocturia, difficulty starting and stopping stream or urine, and dysuria
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BPH
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what is elevated in blood and useful marker for BPH
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PSA
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what lobes are involved in BPH vs. adenocarcinoma
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BPH - middle and lateral
adenocarcinoma - posterior |
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easiest test to screen for adenocarcinoma of the prostate
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DRE
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two useful tumor markers for prostatic adenocarcinoma
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PSA (increase in total PSA with decrease fraction of free PSA)
PAP (prostatic acid phosphatase) |
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prostatic adenocarcinoma associated with lower back pain and increased serum alkaline phosphatase
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metastases to bone
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associated with increased risk of germ cell tumor in male
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cryptoorchidism
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most common testicular tumor that presents as painless mass; fried egg appearance and malignant
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seminoma
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malignant and painful germ cell tumor of the testes, associated with increased AFP and hCG
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embryonal carcinoma
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yellow, mucinous testicular germ cell tumor with increased AFP
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yolk sac tumor
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differentiate mature teratoma in males vs. female
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male - malignant
female - benign |
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this testicular tumor is androgen producing and is associated with gynecomastia and precocious puberty
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Leydig cell
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Androblastoma from sex cord stroma
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sertoli cell tumor
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most common testicular cancer in older men
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testicular lymphoma
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3 DDX of transilluminated testicular mass
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1. varicocele
2. hydrocele 3. sptermatocele |
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increased fluid in scrotum secondary to incomplete fusion of processus vaginalis
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hydrocele
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dilated epidiymal duct
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spermatocele
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gray, solitary, crusty plaque on the shaft of the penis or scrotum in older men
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Bowen's disease
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bent penis due to acquired fibrous tissue formation
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Peyronie's disease
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penile cancer associated with HPV and lack of circumcision
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SCC
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