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83 Cards in this Set
- Front
- Back
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What cells are responsible for the blood-testis barrier?
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Sertoli cells
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What do the seminal vesicles contribute to semen?
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80% of semen volume: fructose, ascorbic acid, prostaglandins, phosphorylcholine, flavins
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What does the prostate contribute to semen?
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20% of semen volume: zinc, citric acid, phospholipids, acid phosphatase, fibrinolysin
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What does 5-alpha-reductase do?
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Converts testosterone to DHT (required for differentiation of penis, scrotum, prostate; later in life contributes to prostate growth, balding, and sebaceous gland activity)
- Inhibited by finasteride |
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What does aromatase do?
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Converts testosterone and androstenedione to estrogen
- Located in gonads and in extragonadal tissues (adipose tissue, blood vessels, etc.) |
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Where is 17-beta-estradiol produced?
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Mostly in the ovary (granulosa cells), small amounts in other tissues
- Made from testosterone by aromatase |
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What is estriol, and where is it produced?
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Weak estrogen, produced in the placenta in pregnancy (1000-fold increase in estriol during pregnancy indicates fetal well-being)
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What is estrone, and where is it produced?
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Weak estrogen, produced in ovary and adipose tissue
- Made from androstenedione by aromatase |
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What is Mittelschmerz?
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Peritoneal irritation--mimicking appendicitis--that occurs due to blood from a ruptured ovarian follicle (post-ovulation)
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When do oocytes undergo meiosis I?
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1) Primary oocytes begin meiosis I during fetal life...
2) They're arrested in prOphase for years until Ovulation... 3) Then complete mieosis I just prior to ovulation |
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When do oocytes undergo meiosis II?
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1) The secondary oocyte begins meiosis II at ovulation
2) It's arrested in METaphase until fertilization ("the egg MET a sperm") 3) It completes meiosis II after fertilization; if no fertilization, the secondary oocyte degenerates |
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Where does fertilization most commonly occur?
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In the ampulla (upper end) of the fallopian tube, within 1 day after ovulation
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Where is hCG made and when is it detectable in blood and urine?
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Syncytiotrophoblast of placenta
- Detectable in blood 1 week after conception - Detectable in urine 2 weeks after conception |
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In what pathologic states do you see an elevated hCG?
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Hydatidiform moles
Choriocarcinoma Gestational trophoblastic tumors |
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Male with testicular atrophy, eunuchoidal proportions, tall, long extremities, gynecomastia, female hair distribution... what is it?
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Klinefelter's syndrome (47,XXY)
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Female with short stature, streak ovaries, shield chest, bicuspid aortic valve, webbing of neck, preductal coarctation of the aorta... what is it?
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Turner's syndrome (45,XO)
- Most common cause of primary amenorrhea |
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What causes female pseudo-hermaphroditism (pts w/ XX genotype)?
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Inappropriate exposure to androgens during early gestation --> external genitalia are virilized or ambiguous
- Ovaries present - Caused by congenital adrenal hyperplasias and exogenous admin of androgens during pregnancy |
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What causes male pseudo-hermaphroditism (pts w/ XY genotype)?
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- Most common cause is androgen insensitivity syndrome --> testes are present, but external genitalia are female or ambiguous
- Should remove undescended testes surgically to avoid cancer risk |
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How does 5-alpha-reductase deficiency in males manifest?
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Inability to convert testosterone to DHT --> ambiguous genitalia until puberty
- Puberty --> increased testosterone --> masculinization and increased growth of external genitalia - Testosterone/estrogen levels are normal - Internal genitalia are normal |
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How would a pt with a hydatidiform mole present?
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Vaginal bleeding, elevated hCG, abnormally enlarged uterus, "snowstorm" appearance on sonogram
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What is pre-eclampsia?
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HTN, proteinuria, and edema during pregnancy (>20 weeks gestation; <20 weeks suggests mole)
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What is eclampsia?
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Preeclampsia + seizures
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What is the HELLP syndrome?
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Variant of preeclampsia
= Hemolysis, Elevated Liver enzymes, and Low Platelets |
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How do you treat eclampsia?
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IV magnesium sulfate + diazepam
(and deliver fetus as soon as possible) |
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What factors predispose to placenta accreta?
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Prior C-section, endometrial inflammation, placenta previa
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What are the major risk factors for cervical neoplasia?
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Multiple sexual partners, smoking, early sexual intercourse, HIV infection
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What is menorrhagia?
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Profuse/prolonged menstrual bleeding
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What is metrorrhagia?
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Irregular bleeding between periods
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What are koilocytes?
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Atypical cells seen in cervical dysplasia (CIN, cervical intraepithelial neoplasia)--precursors to invasive ca
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What are "chocolate cysts" and what disorder are they seen in?
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Blood-filled cysts due to cyclic bleeding from ectopic endometrial tissue; seen in endometriosis
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What is adenomyosis?
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Islands of endometrium within the myometrium
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What causes endometrial hyperplasia?
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Excess estrogen stimulation
- Manifests as postmenopausal vaginal bleeding |
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What's the most common gynecologic malignancy?
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Endometrial carcinoma
- Seen in women age 55-65 (not younger than 40) - Preceded by endometrial hyperplasia - Risk factors assoc. w/ increased estrogen |
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What's the most common tumor in women?
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Leiomyoma (uterine fibroid)
- Usually multiple tumors, estrogen sensitive, rarely progress to malignancy |
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How do leiomyosarcomas arise?
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De novo from myometrium (NOT from leiomyomas)
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What are the key hormonal changes signaling menopause?
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Decreased estrogen, increased FSH > LH
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What hormonal abnormalities are seen in polycystic ovarian syndrome (PCOS)?
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Increased LH relative to FSH, increased testosterone
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What is a follicular cyst?
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Distention of an unruptured graafian follicle
- Can be assoc. w/ hyperestrinism |
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What is a corpus luteum cyst?
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Results from hemorrhage into a persistent mature corpus luteum
- Pts present w/ menstrual irregularity, sometimes with intraperitoneal hemorrhage |
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What is a theca-lutein cyst?
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Results from gonadotropin stimulation
- Can be assoc. w/ choriocarcinoma and hydatidiform mole - Often multiple, bilateral, and lined by luteinized theca cells |
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What's the most frequent site of endometriosis?
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The ovary
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What's the female equivalent of male seminoma?
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Dysgerminoma (much more rare than seminoma)
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What tumor marker is used for choriocarcinoma?
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hCG
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What tumor marker is used for dysgerminoma?
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hCG & lactate dehydrogenase (LDH)
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What tumor marker is used for yolk sac (endodermal sinus) tumors?
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Alpha-fetoprotein (AFP)
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What's the most common ovarian germ cell tumor?
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Teratoma (90%)- contain cells from 2 or 3 germ layers
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What's an immature teratoma?
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Aggressively malignant teratoma
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What's a struma ovarii?
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Ovarian teratoma containing functional thyroid tissue
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Large, hyperchromatic syncytiotrophoblastic cells, lots of theca-lutein cysts... what is it?
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Choriocarcinoma
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Young child with gonadal or sacrococcygeal mass that's yellow, friable, solid, with Schiller-Duval bodies (resemble glomeruli)... what is it?
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Yolk sac (endodermal sinus) tumor
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Benign ovarian tumor, often bilateral, lined with fallopian tube-like epithelium... what is it?
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Serous cystadenoma
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Malignant ovarian tumor, often bilateral, lined with fallopian tube-like epithelium... what is it?
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Serous cystadenocarcinoma (50% of ovarian tumors)
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What marker is commonly used for ovarian cancer?
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CA-125
- Most useful in monitoring response to therapy - Useful as screening test in asymptomatic postmenopausal women |
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What are the genetic risk factors for ovarian non-germ cell tumors?
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Family history, BRCA-1, HNPCC
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Benign ovarian tumor: multilocular cyst lined by mucus-secreting epithelium, with intestine-like tissue... what is it?
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Mucinous cystadenoma
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Malignant ovarian tumor: multilocular cyst lined by mucus-secreting epithelium, associated with pseudomyxoma peritonei... what is it?
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Mucinous cystadenocarcinoma
- Pseudomyxoma peritonei = intraperitoneal accumulation of mucinous material from ovarian (or other mucinous, incl. appendiceal) tumor |
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What is pseudomyxoma peritonei?
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Intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor (any mucinous tumor)
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Benign ovarian tumor, with islands of epithelial cells resembling bladder transitional epithelium... what is it?
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Brenner tumor
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What is Meigs' syndrome?
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Triad of ovarian fibroma, ascites, and hydrothorax
- Seen in pts w/ ovarian fibromas, for unclear reasons |
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Ovarian tumor with bundle of spindle-shaped fibroblasts, + Meigs' syndrome... what is it?
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Ovarian fibroma
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Estrogen-secreting ovarian tumor with abnormal uterine bleeding and Call-Exner bodies... what is it?
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Granulosa cell tumor
- Can cause endometrial hyperplasia or carcinoma; in kids, can cause precocious puberty - Call-Exner bodies = small follicles filled w/ eosinophilic secretions |
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What is a Krukenberg tumor?
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GI malignancy that metastasizes to ovaries, causing a mucin-secreting signet cell adenocarcinoma
- Usually of gastric origin |
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Women whose mothers took diethylstilbestrol (DES) during pregnancy--what cancer are they more at risk for?
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Clear cell adenocarcinoma of vagina
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Vaginal carcinoma with spindle-shaped tumor cells that are desmin-positive, with polypoid masses projecting into the vagina resembling "bunches of grapes", in girls <4... what is it?
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Sarcoma botryoides (rhabdomyosarcoma variant)
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Pain in the labia majora... what is it?
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Bartholin's gland cyst
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What drugs can cause gynecomastia?
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Any drugs that cause increase in estrogen levels
- "Some Drugs Create Awesome Knockers": Spironolactone, Digitalis, Cimetidine, Alcohol, Ketoconazole - Also: estrogen, marijuana, heroin, psychoactive drugs |
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What is acute mastitis, and what is the most common implicated pathogen?
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Acute mastitis = breast abscess
- S aureus is most common pathogen - During breast-feeding, increased risk of bacterial infection through cracks in nipple |
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Gray, solitary, crusty plaque on penis or scrotum, in uncircumcised men in 40s, progressing to invasive squamous cell ca in <10%... what is it?
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Bowen's disease (carcinoma in situ)
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Red velvety plaques on penis usually involving the glans, in middle-aged men... what is it?
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Erythroplasia of Queyrat (carcinoma in situ)
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Multiple papular lesions of squamous carcinoma in situ on penis, affecting younger men, usually transient and usually doesn't become invasive... what is it?
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Bowenoid papulosis
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What factors are associated with squamous cell carcinoma of the penis?
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Lack of circumcision, HPV 16 & 18
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What is Peyronie's disease?
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Bent penis due to acquired fibrous tissue formation
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What is leuprolide?
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GnRH analog (agonist with pulsatile admin; antagonist with continuous admin)
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What is ketoconazole used for (aside from anti-fungal activity)?
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Inhibits desmolase --> inhibition of steroid hormone synthesis
- Used to treat Cushing's disease, prevent hirsutism in PCOS - Side effects: gynecomastia, amenorrhea |
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What is finasteride?
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5-alpha-reductase inhibitor
- Used to treat BPH, male pattern baldness |
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What is flutamide?
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Nonsteroidal competitive inhibitor of androgens at the testosterone receptor
- Used in prostate ca |
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What are anastrozole and exemestane?
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Aromatase inhibitors
- Used in postmenopausal women w/ breast ca |
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What is mifepristone?
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= RU 486
- Causes termination of pregnancy - Given with misoprostol |
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What is dinoprostone?
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PGE2 analog
- Causes cervical dilation and uterine contraction |
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What are ritodrine and terbutaline?
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Beta-2 agonists used to delay premature labor
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What is tamsulosin?
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Alpha-1 antagonist used to treat BPH (inhibits smooth muscle contraction)
- Selective for alpha-1 receptors on prostate |
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What's the most common testicular tumor in men >50?
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Malignant lymphoma
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What can cause an abnormally low AFP in a pregnant woman?
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Down's syndrome (trisomy 21)
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