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119 Cards in this Set
- Front
- Back
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Lymphatic drainage
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Ovaries/testes: para-aortic LNs
Distal 1/3 vagina/vulva/scrotum --> superficial inguinal nodes Proximal 2/3 vagina/uterus --> obturator, external iliac and hypogastric nodes |
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Suspensory ligament of ovaries
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contains ovarian vessels
connects ovaries to lateral pelvic wall |
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Cardinal ligament
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C for Cervix
contains uterine vessels connects cervix to side wall of pelvis |
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Broad ligament
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contains ovaries, fallopian tubes, and round ligament of uterus
connects uterus, fallopian tubes, and ovaries to pelvic side wall |
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Round ligament
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NO STRUCTURES contained
connects uterine fundus to labia majora *derivative of gubernaculum; travels through round inguinal canal |
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Ligament of the ovary
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NO VESSELS contained
connects ovary to lateral uterus |
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Female histo
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ovary: simple cuboidal
fallopian tube: simple columnar uterus: simple columnar, pseudostratified, tubular glands endocervix: simple columnar ectocervix: stratified squamous vagina: stratified squamous, nonkeratinized |
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Pathway of sperm
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SEVEN UP
Seminiferous tubules Epididymis Vas deferens Ejaculatory ducts (Nothing) Urethra Penis |
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Erection/Ejaculation
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Point
Parasympathetic Pelvic n. NO --> cGMP --> vasodilation NE --> Ca --> vasoconstriction Emission: Sympathetic nervous system hypogastric n. sperm travel to prostatic urethra Ejaculation: visceral and somatic nerves pudendal n. |
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Sperm
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Acrosome: from golgi
Flagellum: from centriole Middle piece (neck): has mitochondria Feeds on Fructose |
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Sertoli Cells
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Stimulated by FSH to produce:
1. Inhibin: negative feedback on FSH 2. ABP: maintains levels of testosterone in seminiferous tubules to support sperm synthesis **Blood-testis barrier: tight junctions between adjacent sertoli cells *produce anti-mullerian hormone *regulate spermatogenesis |
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Androgens
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Testis: testosterone and DHT
Adrenal: Androstenedione potency: DHT > test > androstenedione Testosterone: -differentiation of internal genitalia except prostate -growth spurt: penis, seminal vesicles, sperm, muscle, RBCs -deepening of voice -closing of epiphyseal plates (test --> estrogen) -libido DHT: early: external genitalia - penis, scrotum, prostate late: prostate growth, balding, sebaceous gland activity |
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Estrogen
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Ovary: estradiol
Blood: estrone (aromatization from fat) Placenta: estriol Potency: DIOL ONE for O.B. estradiol > estrone > estriol -development of genitalia and breast, fat distribution -growth of follicle, endometrial proliferation -upregulation of estrogen, LH, and progesterone receptors; feedback inhibition of FSH and LH, then LH surge; stimulate PRL secretion (but blocks its action at breast) -increases transport of proteins, SHBG; increase HDL, decrease LDL Pregnancy: 50x increase in estradiol and estrone 1000x increase in estriol (indicator of fetal well-being!!) |
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Granulosa & Theca Cells
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FAGs make estrogen:
FSH Aromatase converts Androstenedione to estrogen Granulosa Cell LH stimulates Theca cell Desmolase converts cholesterol to Androstenedione (transferred to granulosa cell) |
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Progesterone
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PRO-Gestation
Source: corpus luteum, placenta, adrenal cortex, testes -stimulate endometrial gland secretions, spiral artery development -maintenance of PREGNANCY -decrease myometrial excitability -thick cervical mucus (inhibit sperm entry while pregnant) -increase body temp -inhibit LH, FSH -uterine SMC relaxation -decrease estrogen receptor expressivity PGs: cause menstrual cramping |
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Menstrual Cycle
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Follicular growth fastest during 2nd week of proliferative pahse
*estrogen stimulates endometrial proliferation *progesterone maintains endometrium to support implantation *Follicular phase: length varies *Luteal phase: after ovulation; constant 14 days |
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Oligomenorrhea
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>35 day cycle
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Polymenorrhea
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<21 day cycle
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Metrorrhagia
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frequent but irregular menstruation
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Menometrorrhagia
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heavy and irregular; at irregular intervals
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Ovulation
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increase in estrogen, increase in GnRH receptors on anterior pituitary
Estrogen surge then stimulates LH release --> OVULATION! temp increases 24h after (progesterone induced) |
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Oogenesis
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prOphase until ovulation
METaphase until an egg MET a sperm Meiosis I: primary oocytes begin during fetal life **Meiosis I arrested in prOphase for years until Ovulation (primary oocytes) Meiosis II arrested in METaphase until fertalization (secondary oocytes) |
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Pregnancy
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Fertilization: upper end of fallopian tube (ampulla); 1 day after ovulation
Implantation: in wall of uterus 6 days after fertilization (3 weeks after LMP); trophoblasts secrete hCG (detectable in blood 1 week after conception; on urine test 2 weeks after conception) Lactation: drop in progesterone after labor induces lactation; need suckling to maintain (nerve stimulation increases oxytocin and PRL) |
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PRL
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induces and maintains lactation and decreases reproductive function
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Oxytocin
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helps with milk letdown; uterine contractions
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hCG
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Secreted by syncytiotrophoblast of placenta
Acts like LH to maintain corpus luteum, which maintains progesterone for 1st trimester (doubles every 2 days) -after 1st trimester, placenta synthesizes its own estriol and progesterone and corpus luteum degenerates |
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Menopause
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drop in estrogen due to age-related decline in # of follicles (~51yo)
-often preceded by 4-5yrs of abnl cycles, oligomenorrhea -source of estrogen after menopause = peripheral conversion **best test to confirm: INCREASE IN FSH!!! decrease estrogen huge increase in FSH increase in LH, GnRH, inhibin |
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Klinefelter's
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XXY
testicular atrophy, eunuchoid body shape, tall, long extremities, gynecomastia, female hair distribution *barr body present Increase in FSH (bc dysgenesis of seminiferous tubules and no inhibin) Increase in LH and estrogen (bc no testosterone) |
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Turner's
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XO
short, ovarian dysgenesis (streak ovary), shield chest, bicuspid aortic valve, cystic hygroma, webbed neck, preductal coarct **MCC primary amenorrhea no barr body decreased estrogen --> increase LH and FSH |
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Double Y males
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XYY
phenotypically normal, very tall, severe acne, may have antisocial behavior normal fertility |
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True hermaphrodite
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46XX or 47XXY
both ovary and testicular tissue present (ovotestis); ambiguous genitalia very rare |
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Androgen insensitivity syndrome
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Testicular feminization
46, XY defect in androgen reecptor results in normal-appearing female with rudimentary vagina (absent uterus and tubes) *no sexual hair; develops testes in labia majora Increase in testosterone, estrogen, LH |
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5-alpha reductase def
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Auto recessive, only in genetic males
inability to convert testosterone --> DHT ambiguous genitalia until puberty, when testosterone increases --> masculinization normal T and E; LH nl or increased "PENIS at 12" normal internal genitalia |
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Kallmann's
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hypogonadism and anosmia
decreased synthesis of GnRH in the hypothalamus (defective migration of GnRH secreting neurons from olfactory placode) **KAL-1 gene or FGF rec-1 gene no secondary sex characteristics, delayed puberty |
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Lack of sertoli cell or anti-mulllerian hormone
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develop male and female internal genitalia; develop male external genitalia
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Hydatidiform mole
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cystic swelling of chorionic villi; prolif of trophoblast
-abnl vaginal bleeding **MC precursor to choriocarcinoma **increase in beta-hCG -see theca lutein cysts -assoc with preeclampsia in 1st trimester -snowstorm appearance with no fetus on sonogram tx: D&C + MTX; monitor beta-HCG |
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Complete mole
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46XX or 46 XY
2 sperm + empty egg massive increase in hCG increase in uterine size no fetal parts 15-20% risk malignant trophoblastic disease |
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Partial mole
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69XXY
2 sperm + 1 egg increase hCG, no increase in uterine size low risk malignancy |
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Recurrent Miscarriage
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1st trimester: low progesterone; chr abnormalities (robertsonian)
2nd: bicornuate uterus; maternal health, autoimmune 3rd: placental problems |
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Preeclampsia
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HTN, proteinuria
Eclampsia: HTN, proteinuria + SEIZURES starts >20 weeks gestation (before, suspect mole) -cause: immune response from mom against paternal antigens in placenta --> vascular rxn sxs: HA, blurry vision, RUQ pain (capsular hematoma) ,edema, AMS, hyperreflexia Tx: delivery if viable; otherwise bed rest, salt restriction, monitoring and treatment of HTN IV Mg sulfate and diazepam |
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Ectopic pregnancy
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most often in fallopian tubes
*increase hCG (but lower than in nl pregnancy) and sudden abd pain; can look like appendicitis dx: u/s RFs: hx of infertility, PID, ruptured appendix, prior tubal surgery, IUD (decrease rate, but if pregnant, more likely ectopic) |
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Abrutio placentae
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premature detachment of placenta from implantation site, fetal death
*painful bleeding 3rd trimester *may be associated with DIC, increased risk with smoking, HTN, cocaine *can be due to trauma, abuse |
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Placenta previa
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attachment of placenta to lower uterine segment; may occlude internal os
-painless bleeding any trimester RFs: multiparity and prior C-section |
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Placenta accreta
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defective decidual layer allows placenta to attach to myometrium
-no separation of placenta after birth *massive bleeding AFTER delivery RFs: prior c-section, inflammation, placenta previa (percreta: grows outside uterine wall) |
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Retained placental tissue
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may cause postpartum hemorrhage
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HELLP syndrome
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Hemolysis
Elevated LFTs Low PLTs can be associated with preeclampsia |
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Polyhydramnios
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>1.5-2L
esophageal/duodenal atresia; anencephaly **can't SWALLOW fluid also can be with twin-twin transfusion; increased CO due to anemia (increase fetal urination) |
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Oligohydramnios
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<0.5L
placental insufficiency, bilateral renal agenesis, posterior urethral valves **can't excrete urine |
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Endometriosis
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non-neoplastic endometrial glands/stroma in abnl location outside uterus
-cyclic bleeding, blood-filled chocolate cysts **severe menstrual-related pain adenomyosis: endometrium within the myometrium |
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Endometrial hyperplasia
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proliferation caused by excess ESTROGEN stimulation
*increase risk for cancer *usually postmenopausal vaginal bleeding dx: biopsy RFs: anovulatory cycles, HRT, PCOS, granulosa cell tumor (secretes estrogen) |
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Endometrial carcinoma
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MC gyn malignancy
55-65yo vaginal bleeding RFs: HONDA HTN obesity nulliparity DM anovulatory + estrogen tx: hysterectomy |
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Leiomyoma
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fibroid
MC tumor in females; esp blacks benign smooth muscle tumor estrogen sensitive (will grow in pregnancy) ***whorled pattern of smooth muscle bundles tx: resection, leuprolide |
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Leimyosarcoma
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bulky, irregular tumor with areas of necrosis and hemorrhage
-blacks aggressive, recur desmin + stain |
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Premature ovarian failure
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premature atresia of ovarian follicles
signs of menopause after puberty before 40yo decrease estrogen, increase LH, FSH |
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Anovulation
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PCOS, obesity, HPO axis abnormalities, premature ovarian failure, hyperPRL, thyroid disorders, eating disorders, Cushing's, adrenal insufficiency
tx: menotropins (human menopausal gonadotropin); acts like FSH to form follicle then give HCG: stimulate LH surge |
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Asherman's
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endometrial fibrosis that can cause amenorrhea
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PCOS
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***increase in LH
increase T & E decrease FSH dx: 1. Androgen excess (from theca cells): acne, hirsutism 2. Ovulatory dysfunction: amenorrhea 3. polycystic ovaries 4. obesity & insulin resistance *increase risk endometrial cancer tx: weight loss, OCPs (increase progesterone and decrease LH), clomiphene, spironolactone (tx hirsutism) |
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Ovarian cysts
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Follicular: distention of unruptured graafian follicle; may be associated with hyperestrinism and endometrial hyperplasia
Corpus luteum cyst: hemorrhage into persistent corpus luteum; regresses spontaneously Theca-lutein cyst: often bilat/multiple; due to gonadotropin stimulation; associated with choriocarcinoma and moles (bc increase in HCG) |
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Anorexia & amenorrhea
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decrease in body fat --> los pulsatile GnRH from hypothalamus --> decrease LH & FSH --> decrease estrogen
tx: give pulsatile GnRH |
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Dysgerminoma
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malignant, equivalent to male seminoma but rarer
-sheets of uniform cells ***hCG, LDH |
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Choriocarcinoma
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malignant; can develop during pregnancy in mom or baby
-large, hyperchromatic syncytiotrophoblastic cells -increase freq of theca-lutein cysts **hCG |
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Yolk sac (endodermal sinus) tumor
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Duval's Egg Yolk:
Aggressive malignancy in ovaries and sacrococcygeal area of young children yellow, friable, solid masses Schiller-Duval bodies: blood vessels enveloped by germ cells resemble glomeruli **AFP |
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Female Teratoma
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90% of ovarian germ cell tumors
-cells from 2 or 3 germ layers Mature: dermoid cyst; benign Immature: aggressive, malignant, anaplastic Struma ovarii: functional thyroid tissue!! |
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Serous cystadenoma
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MC benign ovarian tumor
freq bilateral, lined with FALLOPIAN tube-like epithelium |
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Serous cystadenocarcinoma
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**psammoma bodies
malignant, freq bilateral |
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Mucinous cystadenoma
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benign; multilocaular cyst lined by mucus-secreting epithelium
*INTESTINE-like tissue |
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Mucinous cystadenocarcinoma
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malignant; pseudomyxoma peritonei: intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor
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Brenner tumor
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Benign
BLADDER-like |
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Ovarian Fibroma
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bundles of spindle-shaped fibroblasts
Meigs' syndrome: ovarian fibroma, ascites, hydrothorax *pulling sensation in groin |
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Granulosa cell tumor
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secretes estrogen --> precocious puberty; endometrial hyperplasia/ carcinoma
Call-Exner: small follicles filled with eosinophilic secretions |
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Krukenberg tumor
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GI mets to ovaries
mucin-secreting SIGNET cell adenocarcinoma |
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Sertoli-Leidig cell tumor
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increase androgens
hirsutism, virulization |
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Vaginal carcinoma
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1. SCC: 2/2 cervical
2. Clear cell adenocarcinoma: women who had exposure to DES in utero 3. Sarcoma botryoides: rhabdomyosarcoma variant; <4yo; spindle shaped tumor cells that are desmin+ |
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Phyllodes tumor
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large bulky mass of connective tissue and cysts
"leaf-like" projections may become malignant |
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Intraductal papilloma
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grows in lactiferous ducts, benath areola
**serous or bloody nipple discharge slight increase risk for CA |
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Most important prognostic factor in breast CA
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axillary LN involvement
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DCIS
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fills ductal lumen; from ductal hyperplasia
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Comedocarcinoma
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subtype of DCIS
ductal caseous necrosis |
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Invasive ductal carcinoma
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firm, fibrous, "rock-hard" with sharp margins
small, glandular, duct-like cells ****MC breast CA (76%); worst and most invasive |
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LCIS
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can have signet ring cells
always ER and PR+ |
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Invasive lobular carcinoma
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orderly row of cells; mets to peritoneum
inactivation of E-cadherin gene |
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Medullary carcinoma
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fleshy, cellular, lymphocytic infiltrate
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Inflammatory breast CA
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can be presentation of invasive CA
dermal lymphatic invasion by breast carcinoma peau d'orange: neoplastic cells block lymphatic drainage |
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Paget's disease of the breast
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eczematous patches on nipple
paget cells: large cells in epidermis with clear halo *suggest underlying carcinoma *may be seen with DCIS |
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Fibrocystic disease of breast
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MCC breast lumps in premenopausal (25-menopause)
premenstrual breast pain and multiple lesions, often bilateral non-proliferative breast changes: 1. fibrotic 2. cystic 3. adenosis: increase acini per lobule; can lead to fibroadenoma |
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Proliferative breast disease without atypia
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1. sclerosing adenosis: increased acini and intralobular fibrosis
*calcifications 2. epithelial hyperplasia: increase in # of epithelial cell layers in terminal duct lobule; increase risk of carcinoma with atypical cells (>30yo) 3. complex sclerosing lesion = radial scar; no prior trauma/surg; similar to fat necrosis; scar with irregular shape; can look like cancer on mammagram 4. Papilloma (bloody/serous nipple discharge) |
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Acute mastitis
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breast abscess; during breast feeding
S. aureus tx: abx, keep breastfeeding |
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Fat necrosis
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benign painless lump; result of injury
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Gynecomastia
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hyperestrogenism: cirrhosis, testicular tumor, puberty, old age
Klinefelter's Drugs: Spironolactone Digitalis Cimetidine Alcohol Ketaconazole marijuana |
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BPH
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HyperPLASIA
increase in estradiol; sensitization to DHT increase PSA tx: alpha1-antag: -zosins (cause 1st dose hypotension) tamsulosin (specific to prostate); finasteride |
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Seminoma
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MC testicular tumor
15-35yo malignant; painless, homogeneous enlargement -large cells in lobules with watery cytoplasm "Fried egg": like koilocytes radiosensitive late mets, good prognosis |
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Embryonal carcinoma
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malignant, painful
glandular/papillary morphology can differentiate to other tumors may have increase AFP, hCG |
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Teratoma in males
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unlike in females, mature teratoma in males is most often MALIGNANT
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Testicular Non-germ cell tumors
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5% of testicular tumors
Leydig cell: contains Reinke crystals; androgen producing, gynecompastia in men (T --> E conversion), precocious puberty in boys -golden brown color Sertoli cell: androblastoma from sex cord stroma; usually benign Testicular lymphoma: MC testicular CA in older men |
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Varicocele
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dilated vein in pampiniform plexus; can cause infertility
does NOT transilluminate |
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Hydrocele
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increase fluid 2/2 incomplete fusion of processus vaginalis
transilluminates |
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Spermatocele
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dilated epididymal duct
transilluminates |
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Bowen's disease
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gray, solitary, crusty plaque
on shaft or scrtum 5th decade progresses to invasive SCC in <10% |
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Erythroplasia of Queyrat
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red velvety plaques, usually involves glans
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Bowenoid papulosis
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multiple papular lesions; young age; not invasive
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SCC of penis
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assoc with HPV, lack of circumcision
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Peyronie's
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bent penis due to acquired fibrous tissue formation
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Balanitis
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infxn of foreskin
usually fungal: candida tx: topical or PO fluconazole |
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Priapism
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cuases:
trazodone SCA spinal cord trauma |
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Leuprolide
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goserelin, naferelin, histrelin
GnRH analogs: agonist when pulsatile antagonist when continuous use: infertility prastate CA (continuous, with flutamide), fibroids tox: antiandrogen, N/V |
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Testosterone
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Use:
1. promote secondary sex characteristics; hypogonadism (increase libido) 2. stimulate anabolism after burn/injury 3. ER+ breast CA (exemestane) |
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Finasteride
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5alpha reductase inhibitor
use: BPH, male pattern baldness decrease PSA by ~50% SE: impotence, decrease libido |
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Flutamide
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nonsteroidal competitive inhibitor of androgens at testosterone receptor
use: prostate CA blocks stimulatory effect of androgens on tumor/mets *also give GnRH agonist to inhibit LH and FSH synthesis |
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Ketoconazole & Spironolactone
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Keto: inhibits steroid synthesis (desmolase)
Spiron: inhibits steroid binding tx: PCOS and prevent hirsutism sex: gynecomastia, amenorrhea |
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Clomiphene
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a SERM:
partial agonist at E receptors in hypothalamus; prevents nl feedback inhibition and increases release of LH and FSH from pituitary, which stimulates ovulation use: tx PCOS (bc has high LH and no FSH) SE: hot flashes, ovarian enlargement, multiple pregnancies, visual disturbance |
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Tamoxifen/Raloxifene
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Tamoxifen:
antag on breast tissue tx: ER+ breast CA (LCIS) also agonist on endometrial tissue Raloxifene: agonist on bone; reduces bone resorption tx: osteoporosis |
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Anastrozole/exemestane
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Aromatase inhibitors
use: postmenopausal women with breast CA |
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Progestins
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bind progesterone receptors, reduce growth
increase vascularization of endometrium use: in OCPs and tx of endometrial CA and abnl uterine bleedgin |
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Mifepristone (RU-486)
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competitive inhibitor of progestins at progesterone receptors
Use: terminate pregnancy *given with misoprostol (PGE1) for uterine contraction tox: heavy bleeding, GI, abd pain |
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OCPs
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prevent estrogen surge --> no LH surge --> no ovulation
benefits: decrease risk endometrial and ovarian CA -decrease pelvic infxns regulate menses acne disadvantages: increase TGs depression, weight gain, nausea, HTN hypercoagulable state CI: smokers >35; migraines with aura, hx of DVT or stroke |
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Dinoprostone
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PGE2 analog: causes cervical dilation and uterine contraction, inducing labor
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Ritodrine/Terbutaline
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Beta-2 agonist
relaxes the uterus reduce premature uterine contractions |
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Tamsulosin
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alpha1A,D receptor antagonist on prostate to inhibit smooth muscle contraction
tx BPH, won't cause hypotension |
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Sildenafil
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inhibit cGMP phosphodiesterase to increase cGMP --> SMC relaxation in corpus cavernosum
Tox: HA, flushing, dyspepsia, blue-green vision, risk of hypotension if taking nitrates!!! |
