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88 Cards in this Set
- Front
- Back
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Blood supply to the uterus?
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Aorta - ovarian a - uterine a - internal iliac a
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Suspensory lig - connects, structures contained?
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ovaries to lat pelvic wall, ovarian a and some nerves
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Cardinal lig (aka transverse cervical lig) - connects, structures contained?
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cervix to side wall of pelvis, uterine a
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Round lig - connects, remnant of, runs thru?
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uterine fundus to labia majora, remnant of gubernaculum, runs thru inguinal canal, artery of Sampson
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Broad lig - connects, structures contained?
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everything to side wall, uterus/ fallopian tube/ round lig
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Lig of ovary - connects?
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ovary to lat uterus
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Epithelium of these structures?
ovary fallopian tube uterus endocervix ectocervix vagina |
ovary - simple cuboidal
fallopian - simple columnar, ciliated uterus - simple columnar with tubular glands, pseudostrat endocervix - simple columnar ectocervix - stratified squamous vagina - NKSSE |
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Innervation of erection - up and down?
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Up - parasym - NO relax smc, vasodil, penis fills with blood.
Down - sym - NE contracts smc, vasocon, blood out of penis |
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Innervation of emission, ejaculation?
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Emission - sym, hypogastric n.
Ejac - visceral and somatic, pudendal n. |
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What are the acrosome and flagella of sperm derived from?
What does the middle piece hold? When do these go away? When does this happen? |
Acrosome - Golgi
Flagella - centriole Middle piece - houses mitos that are lost during fertilization, feeds on fructose (sorbitol DH) **during final phase, spermatid to spermatozoa (spermiogenesis) |
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Sertoli cells - fxn, location?
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secrete inhibin and FSH
secrete ABP - maintain testo levels secrete AMH/MIF tight jxns, form blood-testes barrier support/nourish spermatogen regulate spermatogen **seminiferous tubules |
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Leydig cells - fxn, location?
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make testosterone
**interstitium |
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Progression in spermatogenesis and spermiogenesis?
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spermatogonium
primary spermatocyte (4N) secondary spermatocyte (2N) spermatids (N) spermatozoans (N) |
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How do LH and FSH support spermatogenesis?
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FSH - sertoli cells - spermatogen, and ABP/inhibin production
LH - Leydig - testo to support it |
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Name the androgens, source?
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DHT, testo - testes
androstenedione - adrenals |
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What are testo and androstenedione converted to, where?
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Estrogens in adipose and Sertoli cells by aromatase.
Testo to DHT by 5alpha-reductase |
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Testo - 5 fxns?
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-Differentiation of epididymis, vas, seminal vesicles (NOT prostate)
-Growth (penis, sem vesicles, sperm, muscle, RBC) -deep voice -libido -testo to E closes epiphyseal plates |
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DHT - fxn?
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-differentiation of penis, scrotum, prostate
-prostate growth, balding, sebaceous gland activity |
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Source of E, potency?
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Ovary - estradiol
Placenta - estriol Blood aromatization - estrone estradiol>estrone>estriol |
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Estrogen - 6 fxns?
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-development of genitalia/breast and fat distribution
-growth of follicle, endometrial prolif, myometrial excitability -upregulates estrogen, LH, progesterone receptors -stim of prolactin secretion BUT blocks action at breast -increase SHBG -increase HDL, decrease LDL |
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What happens to estradiol, estrone, and estriol levels in preg?
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Estradiol, estrone - 50x
estriol - 1000x (fetal wellbeing) |
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Synthesis of estrogen?
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LH - theca cell, chol to androstenedione via desmolase
FSH - granulosa cell, androstenedione to estrogen via aromatase. |
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Progesterone - source?
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Corpus luteum, placenta, adrenal cortex, testes
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Progesterone - 7 fxns?
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-maintains preg
-stimulates endometrial glandular secretions, spiral artery dev -thick cervical mucus -increase body temp -decreases E receptor sensitivity -inhibits LH/FSH -uterine smc relaxation, decrease myometrial excitability (prevents ctx) |
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Menstrual Cycle - phases, hormones
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Prolif/follicular phase
Secretory/luteal phase (14d) Estrogen, LH surge, ovulation, progesterone, menses (apoptosis) |
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Define oligo, polymenorrhea.
Metrorrhagia, menometrorrhagia. |
Oligo - >35d btwn cycle
Poly - <21 d btwn cycle Metrorhaggia - frequent but irreg cycles Menometro - frequent, irreg, heavy cycles |
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How does ovulation happen?
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Increase estrogen, upreg GnRH receptors on ant pit, LH surge, ovulation.
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Oogenesis - progression?
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Oogonium (2N)
primary oocyte (4N) - arrested prophase I until ovulation (pro for premature) secondary oocyte (2N) - arrested in metaphase II until fertilization (meta for meet the sperm) ovum (1N) and 3 polar bodies |
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hCG - site of synthesis, fxn in diff trimesters?
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Syncytiotrophoblast of placenta
1st tri: hCG maintains corpus lutuem to secrete progesterone. 2nd/3rd tri: placenta secretes its own progesterone, estriol |
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Source of progesterone in diff tri?
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1st - corpus luteum
2nd/3rd - placenta |
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Best test to confirm menopause?
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Increase FSH! (No E for neg feedback)
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Why do you get feminization and hypogonadism in Klinefelter's?
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-Dysgenesis of sem tubules causes Sertoli cell to release less inhibin, increase FSH
-Abnl Leydig cells, low testo, increase LH, high E. |
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Turner's - hormonal findings?
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Low estrogen from streak ovaries, high LH/FSH
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What do these findings tell you:
High T, high LH High T, low LH Low T, high LH Low T, low LH |
High T, high LH - androgenR def
High T, low LH - exogenous T, tumor Low T, high LH - primary hypogonadism Low T, low LH - hypogonadotropic hypogonadism |
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Pseudohermaphrodite vs true hermaphrodite?
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Pseudo - ext genitalia don't match gonads.
True - both types of gonads present. |
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Female pseudohermaphrodite (46XX)
Male pseudohermaphrodite (46XY) |
Female - CAH, exog androgens during preg
Male - androgen insen syndrome |
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Androgen insen syndrome
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46XY, defective androgen receptor. Phenotypic female, no pubic hair, blind vagina, testes that need to be removed, increase LH, T, E.
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5alpha-reductase def
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AR, 46XY, no ext male genitalia until puberty when increase T (penis at 12), hormone levels normal.
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Partial mole vs Complete mole
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Partial - 69XXY, 2 sperm+1 egg, fetal parts, low risk malig.
Complete - 46XX/XY, 2 sperm+empty egg, S>D, HIGH hCG, no parts, higher risk malig. |
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Recurrent SAB's:
1st weeks 1st tri 2nd tri |
weeks- low progesterone (no hCG)
1st tri - chr abnl (trisomy) 2nd tri - bicornuate uterus |
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Pathogenesis of preE?
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Vasospasm of spiral arteries, causing increased vasc tone and placental ischemia.
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Polyhydramnios
Oligohydramnios |
Poly - >1.5 L, duo atresia, anencephaly
Oligo - <.5 L, placental insuff, bilat renal agenesis |
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Endometriosis vs adenomyosis
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Endometriosis - glandular endometrial tissue outside uterus
Adenomyosis - glandular endometrium grows in to myometrium |
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Leiomyoma - sensitive to what hormone?
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Estrogen sensitive - grow with preg, shrink with menopause
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PCOS - cause, tx?
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Increase LH causes anovulation, deranged steroid syn by theca cells with hyperandrogenism.
OCP - regulate cycle to prevent endometrial hyperplasia, increase SHBG to decrease androgens. Weight loss, metformin, and clomiphene if want to get preg. |
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Corpus luteum cyst
Theca-lutein cyst |
Corpus luteum - hemorrhage in corpurs lutuem, pregnancy/bleeding disorders. Abd pain, hemoperitoneum.
Theca-lutein cyst - due to increase GnRH, assoc with choriocarcinoma/moles. |
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Dysgerminoma
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Malig, sheets of uniform cells, equiv to male seminoma but way less common. hCG.
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Choriocarcinoma
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Malig, hyperchromatic syncytiotrophoblast cells, assoc theca-lutein cysts, hCG.
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Yolk sac (endodermal sinus) tumor
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AFP, Schiller-Duval bodies (glom), yellow/solid/friable mass. Found in ovaries/testes and sacrococcygeal area of young kids.
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Teratoma
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MC germ cell tumor. Mature benign, immature malig.
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Serous cystadenoma
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Benign, simple columnar ciliated epi (like fallopian tube), bilat. 20% of ovarian tumors.
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Serous cystadenocarinoma
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Malig, freq bilat, 45% of malig ovarian tumors.
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Mucinous cystadenoma
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Benign, multilocular cyst lined with mucus-secreting epithelium. Intestine-like.
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Mucinous cystadenocarcinoma
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Malig, mucinous cells, pseudomyxoma peritonei
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Brenner tumor
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Bening, looks like bladder
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Meigs' Syndrome
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Ovarian fibroma (fibroid)
Ascites Hydrothorax pulling sensation in groin |
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Granulosa-theca cell tumor, path finding?
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Secretes E, precocious puberty, abnl uterine bleeding, Call-Exner bodies (small follicles with red secretions)
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Sarcoma botryoides (rhabdomyosarcoma)
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Girls<4yo, grapes out of vagina, desmin pos spindle cells
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Intraductal papilloma
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Small tumor in lactiferous ducts, serous/blood nipple discharge, only slight risk malig transformation.
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Phyllodes tumor
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Age>65, LARGE bulky mass with leaf-like projections, risk malig.
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Fibroadenoma
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MC breast tumor<35yo, small/firm/mobile, increase size/tenderness with E. Benign!
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DCIS, comedocarcinoma
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DCIS - ductal hyperplasia fills ductal lumen
Comedocarcinoma - ductal caseous necrosis |
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Invasive ductal carcinoma
Invasive lobular carcinoma |
IDC - most common, worst prog, small/glandular/duct-like cells.
ILC - bilat, orderly row of cells |
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Medullary breast carcinoma
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Better prognosis, lymphocytic infiltrate/fleshy/cellular
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Inflammatory breast carcinoma
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Dermal lymphatic invasion, peau d'orange.
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Page'ts disease of breast/vulva
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Eczematous, scaly lesion with Paget's cells (large cells in epidermis with halo). Suggests underlying carcinoma.
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Types of fibrocystic disease
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Fibrosis - hyperplasia of stroma
Cystic - fluid filled, blue dome, ductal dilation. Sclerosing adenosis - increased acini, intralobular fibrosis, calcs Epithelial hyperplasia - increase number of epi cell layes in terminal duct lobule, atypia risk of carcinoma. |
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Locations of breast diseases:
Nipple Lactiferous sinus Major duct Terminal duct Lobules Stroma |
Nipple - Paget's, abscess
Lactiferous sinus - intraductal papilloma, abscess, mastitis Major duct - DIC, IDC, cytic fibrocystic disease Terminal duct - tubular carcinoma Lobules - ILC, sclerosing adenosis and epithelial hyperplasia fibrocystic change Stroma - fibroadenoma, Phyllodes, fibrosis fibrocystic change. |
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Benign Prostatic Hyperplasia - location?
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Ant, lat, middle lobes (periurethral), increase free PSA.
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Prostatic adenocarcinoma - location?
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Post lobe (periph zone), decrease free PSA.
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Seminoma
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Malig, painless, radiosen, large cells in lobules with watery cyto and fried-egg appearance.
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Embryonal carcinoma of testis
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Malig, PAINFUL, glandular/papillary, can differentiate to other tumors, assoc hCG and AFP.
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Yolk sac (endodermal sinus tumor) of testis
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Yellow, mucinous, Schiller-Duval bodies, AFP.
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Teratoma of testis
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Mature teratomas are malig in males!
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Leydig cell tumor
Sertoli cell tumor Testicular lymphoma |
Leydig - androgen producing, Reinke crystals, causes gynecomastia in men and precocious puberty in boys, golden brown color.
Sertoli - androblastoma from sex cord stroma Testicular lymphoma - older men |
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Bowen's disease
Bowenoid papulosis |
Bowen's - Gray single crusty plaque on shaft/scrotum, malig transform 10%.
Bowenoid - multiple lesions, no risk malig, younger |
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Erythroplasia of Querat
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red velvety plaque on glans
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Leuprolide - pulsatile and continuous, tox
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Pulsatile - GnRH agonist (infertility)
Cont - GnRH antag (prostate ca) antiandrogen, N/V |
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Testo - tox, use
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Can stimulate anabolism to promote recovery after burn of injury!
ER pos breast cancer (exemstane) Hypogonadism, secondary sex characteristics Increase LDL, decrease HDL polycythemia testicular atrophy premature closure of epiphyseal plates when converted to E |
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Flutamide - MOA, use
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Nonsteroidal androgen receptor blocker.
Use - prostate ca (flutamide+leuprolide cont) |
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Clomiphene - MOA, tox
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Partial E agonist blocks neg feedback at hypothal to increase GnRH. Hot flashes, visual change, multiples.
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Tamoxifen and raloxifene - MOA, tox
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Tamox - Antag E at breast but stimulates endometrium.
Ralox - agonist at bone, no endometrial hyperplasia. |
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Anastrazole, exemetane
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Inhibits aromatase, no conversion of androgens to E. Postmenopausal breast ca.
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Mifipristone (RU-486) - MOA, tox
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Blocks progesterone receptors - abortion.
Heavy bleeding, GI, abd pain. |
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OCP - neg side effects?
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hypercoag state
increase TG HTN depression wt gain |
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Misoprostol
Dinoprostone |
Misoprostol - PGE1
Dinoprostone - PGE2 Both induce ctx and cervial dil. |
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Tamsulosin - MOA
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specific to alpha1d receptors on prostate, not as much ortho hypotension
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Sildenafil, vardenafil - tox?
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impaired blue-green color vision
HA, flushing (vasodilator) heartburn |
