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185 Cards in this Set

  • Front
  • Back
Where is FSH produced in males?
F[S]H = [S]ertoli cells -> [S]perm production
Where is LH produced in males?
[L]H = [L]eydig cells
What are the three androgens?
In order of potency:

[1] Dihydrotestosterone (DHT)
[2] Testosterone
[3] Androstenedione

(They make a great band!)
Where are each of the androgens produced?
DHT & Testosterone -> Testis

Androstenedione -> Adrenal
How do you get DHT from Testosterone?
5alpha-reductase converts DHT to testosterone. It is inhibited by finasteride.
What are the targets for androgens?
[] skin
[] prostate
[] seminal vesicles
[] epididymis
[] liver
[] muscle
[] brain
What is the function of androgens?
[A hairy wolf with a low voice and lots of muscles wants to swim and have sex]

[] Differentiation of wolffian duct system into internal gonadal structure
[] Secondary sexual characteristics & pubertal growth spurt
[] Spermatogenesis
[] Anabolism [+]muscle size [+] RBC production
[] [+] Libido
How do you get estrogens from androgens?
Aromatase found in adipose tissue converts testosterone & androstenedione into estrogen.
What are the different potencies of various estrogens?
Estradiol > Estrone > Estriol
What is the sources of estrogens?
Ovary -> estradiol
Placenta -> Estriol
Blood -> Aromatization
What are the functions of estrogens?
[Things that change with puberty: 'Hair', 'Skin', Genitals, Breast, Fat, Liver, Hormones (FSH&LH), Excitement, Cholesterol]

[] Growth of follicle
[] Endometrial proliferation
[] Development of genitalia
[] Stromal development of breast
[] Female fat distribution
[] Hepatic synthesis of transport proteins
[] Feedback inhibition of FSH
[] LH surge (feedback changes from negative -> positive just before surge)
[] [+] myometrial excitability
[] [+] HDL, [-] LDL
What's the deal with estrogen hormone replacement therapy?
After menopause, estrogen -> [-] hot flashes, [-] bone loss BUT [+]endometrial cancer unless opposed by progesterone
What can lead to increased risk of endometrial cancer?
unopposed estrogen:

[] ERT
[] Early Menarche
[] Late Menopause
What enzyme in which cell does LH act upon?
Desmolase in the Theca cell converts Cholesterol to Androstenedione.
What enzyme in which cell does FSH act upon?
Aromatase in the Granulosa cell converts Androstenedione to Estrogen.
What is the pathway from Cholesterol to Estrogen?
Cholesterol -> Androstenedione (via Desmolase in Theca cell)
Androstenedione -> Estrogen (via Aromatase in Granulosa cell)
What is the source of progresterone?
[] Corpus luteum
[] placenta
[] adrenal cortex
[] testes
What is indicated by elevation of progesterone?
What are the functions of progesterone?
[What happens when you're pregnant: secretions, varicosities (arteries), less sex (excitability), more mucus, feel hot, don't eat FiSH and then you try to relax)

[] Maintenance of pregnancy
[] Stimulate endometrial glandular secretions
[] Stimulate spiral artery development
[] [-] myometrial excitability
[] Production of thick cervical mucus
[] [+] body temp
[] Inhibits gonadotropins [LH, FSH]
[] Relax uterine smooth muscles
What are the two phases of the menstrual cycle called?
[] Proliferative phase
[] Secretory phase
During what part of the menstrual cycle is follicular growth fastest?
second week of proliferative phase
What stimulates endometrial proliferation?
What maintains endometrium to support implantation?
What happens with decreased progesterone?
decreased fertility
What is Mittelschmerz?
blood from ruptured follicle causes peritoneal irritation ('feeling' ovulation)
What are the steps that cause ovulation?
[1] Estrogen surge day before ovulation
[2] Stimulates LH, inhibits FSH
[3] LH surge causes ovulation
[4] Progesterone induces temp increase
[5] Ferning of cervical mucosa
How do oral contraceptives work?
They prevent estrogen surge so no LH surge so no ovulation.
What stage would you find oocytes during childhood?
Meiosis I is arrested in pr[O]phase until [O]vulation
What stage would you find oocytes in the fallopian tubes?
Meiosis II is arrested in [MET]aphase until the egg [MEETS] a sperm.
What is the source of hCG?
Syncytiotrophoblast of placenta?
What does the syncytiotrophoblast produce?
What is the function of hCG?
[] Maintains corpus luteum for 1st trimester by acting like LH. Placenta takes over in 2nd trimester
[] Detects pregnancy in urine 8 days after fertilization
[] Elevated hCG also occurs in hydatidiform moles or choriocarcinoma
What hormonal changes occur in menopause?
[-] estrogen
[++] FSH
[+] LH (no surge)
[+] GnRH
What is the average age of onset of menopause?
51 y/o. Earlier in smokers
What havoc does menopause cause?

[H]ot flashes
[A]trophy of the [V]agina
What is a bicornuate uterus?
"Two horned" uterus.

Results from incomplete fusion of the paramesonephric ducts.

Associated with urinary tract abnormalities and infertility.
What are the two types of congenital penile abnormalities?
Hypo[s]padias (pee on your [s]hoes; ventral side; more common)

[E]pispadias (pee on in your [e]ye; dorsal side)
What causes hypospadias?
failure of urethral folds ot close. Associated with UTIs.
What causes epispadias?
Faulty positioning of genital tubercle. Associated with exstrophy of bladder.
What are the different kinds of sex chromosome disorders?
[XXY] Klinefelter Syndrome (male) 1:850

[XO] Turner Syndrome (female) 1:3000

[XYY] Double Y males (male) 1:1000
What are the clinical findings associated with Klinefelter Syndrome?
[] Testicular atrophy
[] eunuchoid body shape
[] long extremities
[] gynecomastia
[] female hair distribution
[] barr body
[] hypogonadism and infertility
<Male with Barr body>
Klinefelter Syndrome
What are the clinical findings associated with Turner Syndrome?
[] Short stature
[] Menopause before menarche (streak ovary)
[] Webbing of neck
[] Coarctation of aorta
[] common cause of primary amenorrhea
[] no barr body
[] "nuckle, nuckle, dimple, nuckle"
<Female with no barr body>
Turner syndrome
What is the clinical findings of Double Y males?
[Why] are so many seen as inmates of penal institutions?

[] Phenotypically normal
[] Very Tall
[] Severe Acne
[] Antisocial behavior
What is pseudohermaphroditism?
Disagreement between the phenotypic (external genitalia) and gonadal (testes vs. ovaries) sex.
What are the clinical findings in female pseudohermaphroditism?
Ovaries present but external genitalia are virilized or ambiguous. 46, XX
What causes female pseudohermaphroditism?
Excessive or inappropriate exposure to androgenic steroids during early gestation:

[] Congenital adrenal hyperplasia
[] Exogenous administration of androgens during pregnancy
What is the clinical presentation of male pseudohermaphroditism?
Testes present, but external genitalia are female or ambiguous.

Most common form is androgen insensitivity syndrome. 46, XY
What is the clinical presentation of a true hermaphrodite?
Both ovary and testicular tissue is present; ambiguous genitalia. Very rare. (46,XX or 47,XXY)
What is the clinical presentation of a person with Androgen insensitivity syndrome?
[] Normal appearing female with defect in androgen receptor.
[] Female external genitalia with rudimentary vagina
[] Uterus and uterine tubes absent
[] Develops testes (often found in labia majora)
[] High levels of testosterone, estrogen & LH
[] 46,XY
What is the clinical presentation of a person with 5alpha-reductase deficiency?
Unable to convert testosterone to DHT.

[] Ambiguous genitalia until puberty
[] At puberty, [+] testosterone causes masculinization of genitalia
[] Testosterone/Estrogen levels normal
[] LH may be high.
What causes benign prostatic hyperplasia?
Men > 50 years of age.
Age-related increase in estradiol sensitizes prostate to growth-promoting effects of DHT.
What are the clinical findings associated with benign prostatic hyperplasia?
[] Men > 50 years of age.
[] Nodular enlargement of periurethral (lateral & middle) lobess of prostate
[] Compression of urethra into a verticla slit
[] [+] frequency of urination, nocturia, dysuria & difficulty stopping & starting stream of urine.
What are the complications associated with benign prostatic hyperplasia?
[] distention and hypertrophy of the bladder
[] hydronephrosis
[] UTI
What are the clinical presentations of prostatic adenocarcinoma?
[] Men > 50 y/o
[] Posterior lobe of prostate gland
[] diagnosed as hard nodule on digital rectal exam
[] elevated prostatic acid phosphate and PSA
What tumor markers are available for prostatic adenocarcinoma?
PSA & Prostatic acid phosphatase
<Elevated serum alkaline phosphatase & PSA>
Osteoblastic metastases on prostatic adenocarcinoma
<Honeycombed uterus>
Hydatidiform mole
What is a Hydatidiform mole?
A pathologic ovum ("empty egg") resulting in cystic swelling of chorionic villi and proliferation of chorionic epithelium (trophoblast).
What is the clinical findings of a Hydatidiform mole?
[] "Honeycombed uterus" or "cluster of grapes" appearance.
[] High Beta-hCG
[] Common precursor of choriocarcinoma
What is a common precursor of choriocarcinoma?
hydatidiform mole
What is the difference between a complete and a partial hydatidiform mole?
Genotype of [complete] mole is 46,XX and is [completely] paternal in origin with no associated fetus.

[Part]ial mole is made up of 3 or more [Parts] (triploid/tetraploid) with fetal [Parts]
What is the difference between preeclampsia and eclampsia?
preeclampsia is a triad of findings:

[] hypertension
[] proteinuria
[] edema

eclampsia adds:
[] seizures
When does preeclampsia/eclampsia manifest itself?
7% of pregnant women from 20 weeks' gestation to 6 weeks postpartum.
What factors increase the risk of preeclampsia/eclampsia?
[] preexisting hypertension
[] diabetes
[] chronic renal disease
[] autoimmune disorders
What is teh HELLP syndrome?
Associated with preeclampsia/eclampsia:

[E]levated [L]FTs
[L]ow [P]latelets
What are the clinical features of preeclampsia/eclampsia?
[] Headache
[] Blurred vision
[] abdominal pain
[] edema of face and extremities
[] altered mentation
[] hyperrelexia
[] thrombocytopenia
[] hyperuricemia
What is the treatment for preeclampsia?
Delivery of fetus as soon as viable. Otherwise bed rest, salt restriction and monitering and treatment of hypertension.

For eclampsia, a medical emergency, IV magnesium sulfate & diazepam.
What is abruptio placentae?
Premature separation of placenta. PAINFUL uterine bleeding (3rd trimester). Fetal death.
What factors increase the risk of abruptio placentae?
[] DIC
[] smoking
[] hypertension
[] cocaine use
What is placenta accreta?
Defective decidual layer allows placenta to attach directly to myometrium. Massive hemorrhage after delivery.
What factors increase the risk of placenta accreta?
[] prior C-section
[] inflammation
What is placenta previa?
Attachment of placenta to lower uterine segment. May occluse cervical os.
What are the clinical findings assocaited with placenta previa?
PAINLESS bleeding in any trimester
What is an ectopic pregnancy?
A fertalized egg outside the uterus. Most often in fallopian tubes.
What are the clinical findings associated with ectopic pregnancy?
[] Salpingitis (PID)
[] [+] hCG w/ lower abdominal pain
What are the two types of amniotic fluid abnormalities?
Polyhydramnios > 1.5-2 L amniotic fluid

Oligohydramnios < 0.5 L amniotic fluid
What causes polyhydramnios?
An inability to swallow amniotic fluid due to esophageal/dudoenal atresia. Also associated with anencephaly.
What causes oligohydramnios?
An inability to exrete urine due to bilateral renal agenesis or posterior urethral valves in males.
What different kinds of cervical pathology are found?
[] Dysplasia & CIS = Disordered epithelial growth associated with HPV 16,18. May progress to invasive carcinoma.
[] Invasive carcinoma = Often squamous cell carcinoma.
How can you prevent invasive cervical carcinoma?
Pap smear can catch cervical dysplasia before it progresses to invasive carcinoma.
What complications can arise from invasive cervical carcinoma?
Lateral invasion can block uereters casuing renal failure.
What are six different types of uterine pathology?
[1] Endometriosis
[2] Adenomyosis
[3] Endometrial hyperplasia
[4] Endometrial carcinoma
[5] Leiomyoma
[6] Leiomyosarcoma
What is endometriosis?
Non-neoplastic endometrial glands/stroma in abnormal locations OUTSIDE the uterus.
<"Chocolate cysts">
blood-filled ovarian cysts indicative of endometriosis of ovaries.
What are the clinical manifestations of endometriosis?
[] cyclic bleeding from ectopic endometrial tissue.
[] found in ovary & on peritoneum
[] severe menstrual-related pain
[] results in infertility
What is adenomyosis?
endometriosis within the myometrium
What causes endometrial hyperplasia?
Excess estrogen stimulation causes endometrial gland proliferation.
What are the clinical presentations of endometrial hyperplasia?
[] vaginal bleeding
[] [+] risk of endometrial carcinoma
What is the most common gynecological malignancy?
endometrial carcinoma
What is the peak age for endometrial carcinoma?
55-65 years old
What are the clinical manifestations of endometrial carcinoma?
[] vaginal bleeding
[] often preceeded by endometrial hyperplasia
What risk factors contribute to a greater risk of endometrial carcinoma?
[] prolonged estrogen use
[] obesity
[] hypertension
What is the most common of all tumors in females?
Leiomyoma = fibroid of myometrium.
Does leiomyoma progress to leiomyosarcoma?
Nope. Separate processes.
What factors increase or decrease the size of a leiomyoma?
Estrogen size -> [+] pregnancy, [-] menopause
Who is at an increased risk for developing leiomyoma and leiomyosarcoma?
[+] African americans
What are the clinical findings of a leiomyosarcoma?
[] Bulky tumor with areas of necrosis & hemorrhage.
[] Agressive (recurs)
[] May protrude from cervix and bleed
<a single recurrant leiomyoma>
It's probably not a leiomyoma, but rather a leiomyosarcoma
What causes polycystic ovarian syndrome?
[+] LH production leads to anovulation and hyperandrogenism due to deranged steroid synthesis. (aka high estrogens & high androgens)
What are the clinical features of polycystic ovarian syndrome?
[] amenorrhea
[] infertility
[] obesity
[] hirsutism
What is the treatment for polycystic ovarian syndrome?
[] Weight loss
[] OCPs
[] Gonadotropin analogs
[] Surgery
What are four different types of ovarian cysts?
[1] Follicular cyst
[2] Corpus luteum cyst
[3] Theca-lutein cyst
[4] Chocolate cyst
What is a follicular cyst?
Distention of unruptured graafian follicle. Associated with hyperestrinism & endometrial hyperplasia.
What is a corpus luteum cyst?
Hemorrhage into persistent corpus luteum. Presents with menstrual irregularity.
What is a theca-lutein cyst?
Often bilateral/multiple. Due to gonadotropin stimulation. Associated with choriocarcinoma and moles.
What is a "chocolate cyst"?
blood containing cyst from ovarian endometriosis. Varies with menstrual cycle.
What kind of ovarian cyst is associated with hyperestrinism and endometrial hyperplasia?
Follicular cyst
What kind of ovarian cyst is associated with choriocarcinoma and moles?
Theca-lutein cyst
What kind of ovarian cyst varies with menstrual cycle?
"Chocolate cyst"
What kind of ovarian cyst is associated with menstrual irregularity?
Corpus luteum cyst
What are the five types of germ cell tumors?
[1] Germinomas
[2] Yolk sac tumors
[3] Choriocarcinoma
[4] Embryonal carcinoma
[5] Teratomoa
What is the most common malignant germ cell tumor of the ovaries and testes?
Germinomoa. Dysgerminoma in ovaries, Seminoma in testes
What is the clinical presentation of a dysgerminoma?
Common malignant germ cell tumor of the ovary. Sheets of uniform cells with [+] hCG
What is the clinical presentation of a seminoma?
Common malignant germ cell tumor of the testes. Presents with painless testicular enlargement. Increased risk with cryptorchidism.
What factors increase the risk for seminoma?
Where are yolk sac tumors found?
Aggressive malignancy in ovaries, testes & sacrococcygeal area of young children.
What are the clinical findings associated with yolk sac tumors?
Schiller-Duval bodies with primitive glomeruli and [+] AFP.
<Schiller-Duval bodies>
yolk-sac tumor
What is a choriocarcinoma?
[] rare but malignant
[] large hyperchromatic syncytiotrophoblastic cells.
[] develops during pregnancy in mother or baby.
[] [+] hCG
<hyperchromatic syncytiotrophoblastic cells>
What is the second most common testicular germ cell tumor?
embryonal carcinoma
What is the clinical presentation of an embryonal carcinoma?
[] painful testicular mass
[] glandular with papillary convolutions
How do teratomas present in females?
[] contain cells from 3 germ layers.
[] mature teratoma is benign while immature form is aggressively malignant
How do teratomas present in males?
[M]en, [M]ature teratomas are [M]alignant and painful. Can present with gynecomastia.
What is struma ovarii?
ovarian teratoma containing thyroid tissue
What are the seven types of ovarian non-germ cell tumors?
[1] Serous cystadenoma
[2] Serous cystadenocarcinoma
[3] Mucinous cystadenoma
[4] Mucinous cystadenocarcinoma
[5] Brenner tumor
[6] Ovarian fibroma
[7] Granulosa cell tumor
What are the two most common non-germ cell tumors of the ovary? (Hint: They often present bilaterally)
[1] Serous cystadenoma (20%) Benign.
[2] Serous cystadenocarcinoma (50%) Malignant.
What two types of non-germ cell ovarian tumors are lined by mucous-secreting epithelium?
[1] Mucinous cystadenoma
[2] Mucinous cystadenocarcinoma
What is pseudomyxoma peritonei?
Intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor
What is a Brenner tumor?
benign non-germ cell tumor of the ovary that resembles [B]ladder epithelium
What is Meigs' syndrome?
Triad of: Ovarian fibroma, ascites & hydrothorax
<Ovarian fibroma, ascites & hydrothorax>
Meigs' syndrome
What are Call-Exner bodies?
small follicles filled with eosinophilic secretions
What does granulosa cell tumors secrete?
Estrogen (Granulosa cell!) -> precocious puberty in kids.
What are the three types of testicular non-germ cell tumors?
[1] Leydig cell
[2] Sertoli cell
[3] Testicular lymphoma
What is a Leydig cell tumor?
Benign non-germ cell testicular tumor containing Reinke crystals. Produces androgens -> gynecomastia / precocious puberty in boys
What tumors are associated with precocious puberty?
Girls: Granulosa cell tumors -> Estrogen

Boys: Leydig cell tumors -> Androgens
What is a sertoli cell tumor?
Benign non-germ cell testicular tumor from sex cord stroma.
What is a the most common testicular cancer in older men?
testicular lymphoma
What type of breast disease is often bilateral?
Fibrocystic disease
What are the four histologic types of fibrocystic disease?
[1] Fibrosis = stromal hyperplasia
[2] Cystic = fluid filled
[3] Sclerosing = [+]acini
[4] Epithelial hyperplasia = [+] # epithelial cell layers in terminal duct lobule. [+] carcinoma risk with atypical cells. > 30y/o
What are the three types of benign breast tumors?
[1] Fibroadenoma
[2] Cystosarcoma phyllodes
[3] Intraductal papilloma
What is the most common breast tumor in women under 25?
What is the clinical presentation of a fibroadenoma of the breast?
Benign. Small, mobile, firm mass with sharp edges. [+] size and tenderness with period/pregnancy. <25 y/o
What is the clinical presentation of cystosarcoma phyllodes?
Benign tumor of the breast. Large, bulky mass of connective tissue and cysts. Tumor may have "leaflike" projections.
<Tumor with "leaflike" projections>
Cystosarcoma phyllodes of the breast
What is the clinical presentation of an intraductal papilloma?
Benign breast tumor of lactiferous ducts. Presents with nipple discharge.
<Bleeding from single hole when pressing on nipple>
Intraductal papilloma
Where does breast carcinoma arise from?
mammary duct epithelium or lobular glands
What receptors are frequently overexpressed in breast carcinoma?
estrogen/progesterone receptors or erb-B2 / HER-2
What are the seven histologic types of breast carcinomas?
[1] Ductal carcinoma in situ (DCIS)
[2] Invasive ductal
[3] Comedocarcinoma
[4] Inflammatory
[5] Invasive lubular
[6] Medullary
[7] Paget's disease of the breast
<breast tumor with cheesy consistency>
Comedocarcinoma (think popping a zit)
<bilateral breast carcinoma>
Invasive lobular
<Large cells with clear halo>
Paget cells suggestive of underlying carcinoma
What is DCIS?
Ductal carcinoma in situ an early malignancy without basement membrane penetration.
What does DCIS grow up to become?
Invasive ductal carcinoma (that's why you need to catch DCIS fast)
What is the breast carcinoma with the worst prognosis?
Inflammatory = lymphatic involvement.
What is unique about the presentation of invasive lobular carcinoma?
It is often multiple and bilateral
<Eczematous patches on nipple>
Paget's disease
What are the risk factors for breast disease?
[] Gender
[] Age
[] Early menarche <12 y/o
[] Late menopause >50 y/o
[] delayed 1st pregnancy > 30 y/o
[] family history of 1st-degree relative with breast cancer at a young age

[] NOT fibroadenoma or nonhyperplastic cysts
What is the clinical use of Finasteride?
[Fin]asteride = [Five]alpha reductase inhibitor
[-] conversion of testosterone to DHT
[] treat BPH
[] treat Male pattern baldness
What is the clinical use of Flutamide?
Nonsteroidal competitive inhibitor of androgens at the testosterone receptor. Used in prostate carcinoma
What is the clinical use of Ketoconazole & spironolactone?
[] Inhibit steroid synthesis
[] Treat polycystic ovarian syndrome
What is the clinical use for sildenafil/vardenafil?
[Fill] the penis (Erectile dysfunction)
What is the mechanism of sildenafil/vardenafil action?
[1] Inhibit cGMP phosphodiesterase,
[2] [+] cGMP
[3] smooth muscle relaxation in the corpus cavernosum
[4] [+] blood flow & penile erection
What is the toxicity of sildenafil/vardenafil?
[!] Life threatening hypotension if takin nitrates.

[] Headache
[] flushing
[] dyspepsia
[] blue-green color vision
What is the clinical use of Leuprolide?
Pulsatile - Infertility
Continuous w/ flutamide - prostate cancer / uterine fibroids
What is the mechanism of action of Leuprolide?
GnRH analog acts as agonist when used pulsatile, but antagonist when used continuously.
What is the toxicity of Leuprolide?
[] antiandrogen
[] nausea
[] vomiting
{BPH or Male Pattern Baldness}
{Prostate carcinoma}
Flutamide + continuous Leuprolide
{Polycystic ovarian syndrome}
Ketoconazole + Spironolactone
{Erectile Dysfunction}
Sildenafil / Vardenafil (Fill the penis)
Pulsatile use of Leuprolide
{Uterine fibroids}
continuous Leuprolide
Mifepristone (RU-486)
What is the clinical use of Clomiphene?
Treatment of infertility
What is the mechanism of action for Clomiphene?
[+] LH/FSH via partial agonist at estrogen receptors in the pituitary gland. Prevents normal feedback inhibition.
What are the toxicities associated with Clomiphene?
Think estrogen toxicity:

[] Hot flashes
[] Ovarian enlargement
[] multiple pregnancies
[] visual disturbances
What is the clinical use for Mifepristone?
aka RU-486

[] Abortifacient (prevents implantation)
What is the mechanism of action for Mifepristone?
Competitive inhibitor of progestins at progesterone receptors.
What is the toxicities associated with Mifepristone?
[] Heavy bleeding
[] GI effects (nausea, vomiting, anorexia)
[] abdominal pain
What are the advantages & disadvantages of oral contreception use?
[] Reliable
[-] endometrial/ovarian cancer risk
[-] ectopic pregnancy risk
[-] pelvic infections
[] regulation of menses

[] Taken daily
[] No STD protection
[+] triglycerides
[] Depression, weight gain, nausea, hypertension
[] hypercoagulable state