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107 Cards in this Set

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suspensory ligament of the ovaries
carries ovarian vessels
cardinal ligament
carries uterine vessels
round ligament
carries 0 vessels.

round # like round.
from gubernaculum. travels thru inguinal canal
anti-erection
NE-->incr Ca-->smooth muscle contraction-->vasoconstriction
sertoli
line seminiferous tubules
leydig
interstitium
spermatogonium
outside blood-testis barrier. 2N diploid.
primary spermatocyte
diploid 4N
androstenedione
comes from adrenal
testosterone and androstenedione are converted to
estrogen by fat cells and sertoli cells by aromatase
DHT
early differentiation of penis, scrotum, prostate
late: prostate growth, balding, sebaceous glands
pregnancy hormones
50x increase in estradiol and estrone (most potent)
1000x increase in estriol (least potent)
estrogen transport proteins
increases SHBG, HDL, decr LDL
theca cell
LH-->desmolase, which turns cholesterol into androstenedione
granulosa cell
FSH stimulates aromatase, which turns androstenedione from theca into estrogen
mittelschmerz
blood from ruptured follicle causes peritoneal irritation that can mimic appendicitis
lactation
after labor, decrease in progesterone induces lactation
syncytiotrophoblast
maintains corpus luteum (and thus progesterone) during first trimester by acting like LH, then placenta makes its own estriol and progesterone and corpus luteum degens
menopause dx test
high FSH
Klinefelters
testicular atrophy, eunuchoid body, tall, long extremities, gynecomastic, female hair distrubution, sometimes developmental delay.
Barr body (inactivated x). primary hypogonadism. dysgenesis of seminiferous tubules-->decr inhibin and incr FSH. abnormal leydig--> decr testosterone, incr LH, incr estrogen
Turner
short, ovarian dysgenesis (streak ovary), shield chest, BICUSPID aortic valve, webbed neck (cystic hygroma), preductal COARCTATION of aorta
no barr body. most common cause of primary amenorrhea. incr LH and FSH because no estrogen
double Y males
very tall, severe acne, antisocial (1-2%). normal fertility
androgen insensitivity syndrome
defect in androgen receptor resulting in normal-appearing female (no uterus/fallopian)
no sex hair, develops testes (in labia majora). increased T, E, LH
5 alpha reductase def
AR. ambig genit til puberty
T/E norm, LH norm or incr
kallman syndrome
decr synth of gonadotropin in ant pit
anosmia, lack of sec sex char
SRY gene
testis-determining factor. tells sertoli to make anti-mullerian and thus parameso (mullerian) degenerates. if no anti-mullerian, than develop both male and female internal genitalia and male external
hyaditiform mole
cystic swelling of chorionic villi and prolif of chorionic epithelium (trophoblast). complete moles have snowstorm appearance with no fetus on US. can lead to uterine rupture. tx: D/C or MTX
abnormal vaginal bleeding. most common precursor to choriocarcinoma. high hCG. honeycombed uterus, cluster of grapes, abnormally large uterus
complete mole
46, XX or 46 XY. TONS of hCG, no fetal parts, empty egg. 20% malignant trophoblastic dz
partial mole
69XXY, less hCG than complete, less big uterus, choriocarcinoma rarer. fetal parts, maternal DNA, lower risk of malignancy
causes of recurrent miscarriages
1st weeks - low progesterone (no response to hCG)
1st trimester - chromosomal abnormalities
2nd trimester - bicornuate uterus
HTN before 20 weeks
molar pregnancy
ecclampsia
placental ischemia due to impaired vasodilation of spiral arteries, resulting in increased vascular tone
cerebral hemorrhage, ARDS
tx: IV Mg and diazepam
HELLP syndrome
ecclampsia. hemolysis, elevated LFTs, Low Platelets
abruptio placentae
detachment of placenta. fetal death. DIC.
smoking, HTN, cocaine

painful bleeding in 3rd trimester
placenta accreta
defective decidual layer allows placenta to attach to myometrium. no separation of placenta after birth
prior c-section, inflammation, placenta previa risk factors

massive bleeding after delivery

placenta previa
attachment of placenta to lower uterine segment. may occlude internal os.
multiparity and prior c section predispose

painless bleeding in any trimester
ectopic preg
incr hCG and sudden LQ pain
retained placental tissue
postpartum hemorrhage
polyhydramniosis
>1.5L fluid. esophageal/duodenal atresia. unable to swallow amniotic fluid. anencephaly.
oligohydramnios
<0.5L fluid. placental insuffic, bilateral renal agenesis, or posterior urethral valves (males), no urine. potters.
endometrial proliferation
postmenopausal vaginal bleeding
risk: anovulatory cycles, HRT, PCOS, granulosa cell tumor
leiomyoma
whorled pattern of smooth muscle bundles
Asherman's syndrome
anovulation due to adhesions
PCOS
High LH leads to anovulation. deranged steroid synthesis by theca
spironolactone can treat hirsutism

high LH, low FSH, high T
ovarian germ cell tumors
adolescents
dysgerminoma (germ cell)
malignant, equal to seminoma but rarer. sheets of uniform cells
hCG, LDH
choriocarcinoma (germ cell)
rare, malignant, in preg can be in mom or baby. large hyperchromatic syncytiotrophoblasts. incr freq of theca-lutein cysts.
hCG

a gestational trophoblastic neoplasia
yolk sac (endodermal sinus) tumor (germ cell)
aggressive malignancy in ovaries (testes in boys) and sacrococcygeal area of young kids. yellow, friable, solid masses. 50% have Schiller-Duval bodies (look like glomeruli)
AFP
teratoma (germ cell)
90% of ovarian germ cell tumors. dermoid cyst (mature) is most freq benign. immature malig. struma ovarii is thyroid.
serious cystadenoma (non-germ)
20% of ovarian tumors. freq bilat, lined with fallopian tube-like epithelium. benign.
CA-125
general ovarian CA marker
serous cystadenocarcinoma
50% of ovarian tumors, malig, can be bilat
BRCA1 and HNPCC risks
mucinous cystadenoma
multilocular cyst lined by mucus-secreting epithelium. benign. intestine-like tissue
muscinous cystadenocarcinoma
malig. pseudomyxoma peritonei is intraperit acc of mucin
Brenner tumor
benign, looks like bladder
fibromas
spindle-shaped fibroblasts.
Meig's syndrome
ovarian fibroma, ascites, hydrothorax. pulling sensation in groin
granulosa cell tumor
secretes estrogen. can lead to precoc puberty. can cause endometrial hyperplasia/carcinoma in adults. abnormal uterine bleeding
Call-Exner bodies
small follicles filled with eosinophilic secretions. granulosa cell tumor
Krukenberg tumor
GI malig mets to ovaries. mucin-secreting signet cell adenocarcinoma
sarcoma botryoides (rhabdomyosarcoma variant)
affects girls <4, spindle-shaped tumor cells desmin positive
fibroadenoma
benign. small, mobile, firm mass with sharp edges. most common tumor <25yo
incr size and tender with E
intraductal papilloma
benign. small tumor in lactiferous ducts. beneath areola
serous or blood nipple discharge. slight incr in risk for carcinoma
phyllodes tumor
benign. large bulky mass of connective tissue and cysts. leaf like projections. most common in 6th decade.
some can be malig
malig breast tumors
common post-meno. from mammary duct epi or lubular glands.
risks: incr E, incr menstrual cycles, older age at first birth, obesity
ductal carcinoma in situ
malig. fills ductal lumen. from hyperplasia
no BM penetration
invasive ductal
firm, fibrous, rock hard mass with sharp margins and small, glandular, duct-like cells
worst, most invasive. most common (76%) breast cancer
invasive lobular
orderly row of cells
multiple, bilateral
medullary
fleshy, cellular, lymphocytic infiltrate
good prog
comedocarcinoma
ductal, caseous necrosis, DCIS subtype
inflammatory
dermal lymphatic invasion by breast carcinoma. peau d'orange. lymph drain blocked
50% survival at 5 years
paget's dz
eczematous patches on nipple. large cells in epidermis with clear halo
suggest underlying carcinoma. also on vulva
fibrocystic dz
most common cause of breast lumps from age 25 to menopause. premenstrual pain, bilateral, size changes.
types: fibrosis (hyperplasia of stroma), cystic (fluid filled blue dome, ductal dilation), sclerosing adenosis (incr acini and intralob fibrosis. calcifications), epithelial hyperplasia (incr # epi cell layers in terminal duct lobule. incr risk carcinoma, >30)
acute mastitis
breast abscess (feeding), s aureus can infect
far necrosis
benign painless lump from injury
gynecomastia
hyperE (cirrhosis, testes tumor, puberty, old), Klinefelters, drugs (E, THC, heroin, psychoactive) Spironolactone, Digitalis, Cimetidine, Alcohol, Ketoconazole
Some Drugs Create Awesome Knockers
BPH
hyperplasia
prostatic adenocarcinoma
peripheral zone. decr fraction of free PSA
cryptorchidism
prematurity a risk
testicular germ cell tumors
95% of testicular tumors
seminoma (germ)
malig, painless, homogeneous enlargement, most common 15-35. large cells in lobules with watery cytoplasm. fried egg.
radiosens. late mets, good prog
embryonal carcinoma (germ)
malig, pain, worse prog than seminoma. glandular/papillary morphology. high AFP, hCG
yolk sac (endodermal sinus) tumor (germ)
yellow, mucin. Schiller-Duval bodies. incr AFP
choriocarcinoma (germ)
malig, incr hCG. disorder syncytio and cytotropho elements. hematog mets
teratoma
mature malig
testic non-germ
5% of test tumors, most benign
leydig cell tumor
benign. contains reinke crystals, usu androgen producing. golden brown color
gynecomastia or prec pub
sertoli cell tumor
androblastoma from sex cord stroma
testicular lymphoma
older men
tunica vaginalis lesions
varicocele (dilated pampiniform plexus, bag of worms, can cause infert). hydrocele (fluid from incomplete fusion of processus vaginalis) spermatocele (dilated epididymal duct)
Bowen's dz
CIS. gray, solitary, crusty plaque on shaft
5th decade, invades <10%
erythroplasia of queyrat
red velvey plaques of glans
like bowens
bowenoid papulosis
papular lesions
younger, less invasive
SCC of penis
Asia, Africa, S Am.
HPV, lack of circumcision
Peyronies
fibrous tissue
ketoconazole
inhibits p450
anastrozole
inhibits aromatase
leuprolide
use for prostate ca, fibroids
tox: antiandrogen, N/V
Testosterone
stim anabolism after burns, ER+ breast CA
tox: premature close of epiphys, incr LDL, decr HDL
flutamide
nonsteroidal comp inhib at T receptor. prostate CA
ketoconazole, spironolactone
inhibit steroid synth (K), binding (S)
prevent hirsutism in PCOS. cause amenorrhea and gynecomastia
estrogen use in men
androgen-dep prostate CA
clomiphene
SERM. partial agonist.
can cause hot flash, ovarian enlarge, multiple simult preg, vision prob
anastrozole/exemestane
used in post-meno breast CA
ritodrine/terbutaline
beta agonists relax uterus, reduce premature contractions
tamsulosin
alpha 1 antag for BPH by inhib SM contract
viagra
inhibit cGMP phophodiesterase
tox: HA, flush, dyspepsia, impaired blue-green vision, hypotension if nitrates