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102 Cards in this Set
- Front
- Back
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Turners
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XO, female pheontype, gonads don't develop, no puberty, infertile, short stature, put on OCPs to cause 2 sex characteristis
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Klinefelter's
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XXY, pheno is male, but with small testes and low test, small phalus, gynecomastia and other female body habitus, unicoid, infertile
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androgen insensitivity
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XY, female phenotype, testes (which don't descend and remain in abdomen) secrete test but body can't respond so it is converted to E which yields female 2 sex charact, neither duct system forms internally (can't respond to T but make AMH)
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congenital adrenal hyperplasia
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excess androgen production, XX with variable phenotype, often masculinized, but have ovaries and are fertile
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5a reductase deficiency
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blocks conversion of T to DHT, XY, phenotype is initially female at birth with the testes descending into the labia majora, at puberty they will start to incr the amount of test and will have growth of the clitoris
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minor side effects of estrogen therapy (5)
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headache, edema, nausea, vomiting, breast tenderness
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CA effects of HRT therapy
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estrogen alone incr risk of endometrial CA and PandE cause incr risk of brease CA
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5 major side effects of estrogen
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1-effects on breast and endometrial CA 2- HTN (incr angiotensin) 3-thromboembolism 4-gallstone formation (incr cholesterol secretion in bile) 5-CV disease
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thromboembolism mechanism in estrogen therapy
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incr synthesis of liver production of clotting factors
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contraindications for estrogen therapy 6
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1- pregnancy 2-breast and endometrial CA 3-hepatic disease 4-undiagnosed genital bleeding 5-thromboembolitic disorder 6-uncontrolled BP
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altered physiology of hot flashes and therapy
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estogen withdrawal leads to incr hypothalamic norepi which stimulates GnRH neurons and resets the central thermoregulatory center, therapy is estrogen for 6-12 months; if contraindicated use medroxyprogesterone or clonadine
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replacement therapy for postmenopausal women to avoid osteoporosis
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if no uterus, give estrogen (no need for prog), if they have an intact uterus give HRT with low dose progest
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raloxifene
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nonsteroidal SERM; is estrogen agonist in bone, antagonist in breast, uterus and hypothalamus, decreases vertebral fractures; used to prevent and treat osteoporosis
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clomiphene
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nonsteroidal; acts as antiestrogen in the hypothalamus and pit to incr secretion of GnRH and FSH and LH and induce ovulation; can be used to help fertility in PCOS
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noncontraception uses of OCPs (5)
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acne or hirsutism, hysmenorrhea/endometriosis, ovarian CA or cysts, endometrial CA, fibrocystic breast disease
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OCP effect on acne and hirsutism
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must be e/p mix, estrogen blocks androgen action in stimulating sebum production or hair growth
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type of OCP used in dysmenorrhea/endometriosis or fibrocystic breast disease
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progestin provides the benifit, can also use e/p mix
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drug interactions with OCPs
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CYP-inducing drugs like antiepileptics (barbituates, carbamazepine), rifampin, St John's Wort; this is because both E and P are metabolized by CYP so these other drugs would decr plasma levels of both e and p; can use a OCP with high E and P levels
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antibiotic interaction with OCPs
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tetracyclin +ampicillin, metronidazole; decreases estrogen levels weakly, causes uterine bleeding problems but not contraception failure, only certain women with genetic susceptibility
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type of OCP to use if patient can use estrogen and has acne
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E/P mix with low androgenic activity
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type of OCP to use if patient can use estrogen and has diabetes
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triphasic E/P with low progestin
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type of OCP to use if patient can use estrogen and has hypercholesteremia
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E/P with low androgen
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clinical uses for testosteone esters
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induction and maintenence of secondary sex characteristics, somatic development, libido; patches or gels are good for maintenence; used for primary hypogonadism of testicular origin (Klenfelters) or secondary hypogonad (hypothalamic/pit)
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clinical uses for anabolic steroids
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not used in androgen replacement; stimulated appetite and muscle mass in chronically ill patients (AIDS)
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clinical uses for Danazol
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used in endometriosis and fibrocystic breast disease
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clinical uses for GnRH/LHRH agonists 3
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prostate/breast cancers, endometriosis, central precocious puberty
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clinical uses for finasteride
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BPH, male alopecia, decr chest hair
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clinical uses for spiranolactone (4)
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hirsutism, alopecia for women, acne, precocioous puberty
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therapy for endometriosis
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start with OCPs, after confirmation give GnRH agonists or Danazol
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effect of oxytocin on the uterus, mechinism, treatment of hyperstimulation
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uterotonic, receptor is g-protein linking to PLC and its activcation causes incr release of Ca stores, also stimulates PG synthesis, can only be used close to time of delivery since the receptors don't appear until late pregnancy; has short 1/2 life so treatment of hyperstimulation is just cessasion
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effect of dinoprotone/misoprostol on the uterus
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uterotonic, PG E analogs, help contribute to cervical ripening in the normal pregnancy, open Ca channels
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effect of mifeprostone on the uterus
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uterotonic, progesterone antagonist, also directly interferes with fetal development
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effect of ergonovine on the uterus, mechanism, primary use, side effect
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uterotonic, acts through seratonin receptors to elevate intracellular Ca or decr cAMP; preferable for treating hemorrhage since they produce a tonic contraction with long duration; side effect is HTN
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effect of ritodrine/terbutaline on the uterus, side effect
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are b-adrenergic agonists, are tocolytic, tachyphylaxis (desensitization by internalalization) limits its efficacy, act by incr cAMP; can cause generalized SM relaxation and decr BP and reflex tachycardia
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effect of indomethacin on the uterus, mechanism, primary use, side effect
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tocolytic, COX inhibitor, COX 2 is esp important in uterus, inhibit PG's; good for menstrual pain; can cause premature closure of fetal ductus arteriosis
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effect of Mg sulfate on the uterus
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tocolytic, non-specific Ca channel block
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effect of nifedipine on the uterus
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tocolytic, specific Ca channel block so less sytemic side effects
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mechanism of uterotonics
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incr intracellular Ca in myometrial muscle which facilitates the phosphorylation of myosin light chain and its associated kinase and inhiting the dephosphorylation by the phosphatase; causes muscular contraction via formation of the actomyosin complex
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mechnism of action of tocolytics
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act by incr cAMP or cGMP levels, this activates the appropriate kinases and inactivates the MLC kinase by phosphorylation; or they block intrauterine elevation of intracellular Ca
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toxic effects of uterotonics
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hyperstimulation in the most important one evidence by high contraction rates, maternal pain or fetal distress
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clinical uses of uterotonics (3)
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indcution of abortion, induction of late labor, arrest of postpartum hemorrhage
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clinical uses of tocolytics (4)
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inhibition of preterm labor, reversal of uterotonic hyperstimulation, east intrauterine surgical and other manipulations and relief of mainful menses
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schiller duval bodies
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found in tolk sac germ cell tumors of the ovary and testis, characteristic rosettes around small veins
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meig syndrome
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associated with thecoma (stromal cell tumor of the ovary); is asites and pleural effusion
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call exner bodies
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found in granulosa tumors (stromal cell tumor of ovary), are solid aggregates of granulosa cells which mimick primordial follicles
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most common type of invasive breast CA
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ductal CA
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type of breast CA associated with bilaeral CA
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LCIS or lobular
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fibrocystic change and breast CA
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ductal hyperplasia either with or without atypia has incr change of breast CA
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which breast CA shows single file line cells
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lobular CA
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2 signs of ductal breast CA
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hard palpable mass due to incr desmoplasia reaction and calcifications
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fibrocystic change histo characteristics; characteristic clinical presentation
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cysts, fibrosis, apocrine metoplasia, sclerosing adenosis, ductal hyperplasia; changes with menstruation
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Reinke crystal is in which tumor
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Leydig cell tumor (of testis)
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seminoma (2)
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large round clear cells; lymphocytic infiltrate
most common germ cell tumor of testis |
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most common group of testicular CA
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germ cell tumors!!
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most common CA of endometrium
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adenoCA
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embryonal CA (2)
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incr AFP, highly malignant
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tolk sac tumor of testis (3)
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incr AFP, often in infants, SD bodies
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chorioCA (5)
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highly malignant; primary may met by the time you catch it and only leave scar in testis; incr b-HCG; malignant trophoblastic cells; hemorrhage
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precursor lesions to penile CA
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Bowden's or erythroplasia of Queyat
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most common group of ovarian CA
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epithelial CA's
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pain on defecation?
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endometriosis
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most common malignancy in the female GU tract
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endothial CA (due to estrogen)
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germ cell tumors in male (5)
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teratoma, yolk sac, seminoma, chorioCA, embryonal CA
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germ cell tumors in female (3)
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dysgerminoma, yolk sac and teratoma
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dysgerminoma
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germ cell tumor of ovary, more common in young women, incr LDH possible, fried egg cells, lymphocytic infiltrate
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yolk sac tumor of ovary
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younger women, AFP incr, SD bodies
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stromal tumors of the ovary
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thecoma, S-L cell tumor, granulosa tumor; more common in older women
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cystadenoma
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another name for epithelilal tumors of ovary
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functions of sertoli cells (5)
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create blood testis barrier, synthesize inhibin, synthesize AMH, convert T to DHT, are phagocytic, create APH
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most important risk factor for placenta acrreta
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previous c-sections
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function of SS and ST ligaments
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prevent upward rotation of coccyx end of sacrum
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pudendal canal contents from superior to inferior
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perineal nerve, internal pudendal artery, dorsal nerve of the clitoris
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branches from which the pudendal nerve comes
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S2-4
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parasymp to male and female
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rectum for defecation, bladder to void, erectile for erection; plus Bartholins for female
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symp for male and female
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rectum and bladder for inhibition, detum for erectile; emission for male
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lymph for testis
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aortic
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lymph for scrotum and penis
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inguinal
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lymph for anus below pectinate line
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inguinal
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lymph for rectum above pectinate
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II and aortic
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lymph for ovary
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aortic
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lymph for cervix
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II
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lymph for uterus
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inguinal
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inhibin
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secreted by the Sertoli cells in men and by the granulosa cells in females; is secreted in response to FSH stimulation and acts to inhibit FSH release from the ant pit
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normal amount of sperm in ejaculation
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50-500 million
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non acrosomal sperm bind to which ZP
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ZP3
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most common cause of prevetable mental retardation
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alcohol
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fetal hydantion syndrome
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teratogen of arene oxidases which are anticonvulsants,
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major teratogen effect of amphetamines
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gastriochisis (opening of abdominal wall and prot of colon)
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what cell type of SRY induce formation of
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sertoli cells
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last part of puberty in girls
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development of _ feedbacl
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adrenarche
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incr in androgen secretion from adrenals in puberty, not stimulated, causes axillary and pubic hair gowth
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antigenicity of sphylis
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causes production of reagin Ab to cardiolipin which is exposed during infection
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reaction occuring in tertiary syph
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tissue damage due to delayed hypersensitivty
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treatment for gonorrhea
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ceftriaxone
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gonorrhea in men and women
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asympt women, not in men, urethritis
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chylmidia in men and women
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often asympt in women and symptomatic in men
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prolactin and estrogen in the breast during preg
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incr estrogen during preg causes an incr prolactin release, this helps prepare the breast by incr estrogen receptors in the breast but inhibiting lactation until baby is born
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reaction occuring in tertiary syph
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tissue damage due to delayed hypersensitivty
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treatment for gonorrhea
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ceftriaxone
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gonorrhea in men and women
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asympt women, not in men, urethritis
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chylmidia in men and women
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often asympt in women and symptomatic in men
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prolactin and estrogen in the breast during preg
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incr estrogen during preg causes an incr prolactin release, this helps prepare the breast by incr estrogen receptors in the breast but inhibiting lactation until baby is born
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