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106 Cards in this Set
- Front
- Back
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Left ovary/testis venous drainage:
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L gonadal v. --> left renal v. --> IVC
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Suspensory ligament holds:
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ovarian vessels
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Transverse cervical ligament (cardinal ligament) holds:
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uterine vessels
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Round ligament of the uterus holds:
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nothing important (yay! less to remember)
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Broad ligament holds:
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- round ligament
- ovaries - fallopian tubes - uterine vessels |
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How long does it take for sperm to fully develop?
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2 months
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Where does spermatogenesis take place?
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seminiferous tubules
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Spermatogonium are:
- haploid/diploid - N/2N/4N |
diploid, 2N
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Primary spermatocytes are:
- haploid/diploid - N/2N/4N |
diploid, 4N
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Secondary spermatocytes are:
- haploid/diploid - N/2N/4N |
haploid, 2N
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Spermatids are:
- haploid/diploid - N/2N/4N |
haploid, N
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Tight junctions between ___ cells maintains the blood-testis barrier.
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Sertoli
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GnRH from the hypothalamus causes anterior pituitary to release:
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LH, FSH
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What does LH do?
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stimulates Leydig cells to release testosterone
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What does FSH do?
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stimulates Sertoli cells to make (1) androgen binding protein (2) inhibin, which inhibits FSH
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Spermatogonium are found in the basal/adluminal compartment of the seminiferous tubule.
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basal
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What does Testosterone do? (6)
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- differentiates male genitalia
- builds protein - maintains spermatogenesis - maintains libido - inhibits GnRH - fuses epiphyseal growth plates |
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What does androgen binding protein do?
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ensures Testosterone level in seminiferous tubules is high, needed for spermatogenesis and maturation
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Where are testosterone & DHT made?
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testes
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Where is androstenedione made?
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adrenal
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What are the targets of androgens androstenedione, testosterone, and DHT? (7)
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- skin
- prostate - seminal vesicles - epididymis - liver - muscle - brain |
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What are the functions of androgens? (5)
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- differentiate wolffian ducts into internal gonadal structures
- 2ndary sex characteristics, growth spurt - spermatogenesis - anabolic effects on muscle and hematocrit - increase libido |
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Which androgen is the most potent?
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DHT > testosterone > androstenedione (backwards order from the way they are made)
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Testosterone and androstenedione are coverted to ___ and ___, respectively, by the adipose enzyme Aromatase.
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estradiol, estrone
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Finasteride inhibits the enzyme, ___, which is needed to convert testosterone into ___.
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5-a-reductase, DHT
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Which is the most potent estrogen?
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estradiol (from ovary) > estrone > estriol (from placenta)
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What is the laundry list of estrogen functions?
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1) growth of follicle
2) endometrial proliferation 3) genital development 4) breast development 5) female fat distribution 6) liver synthesis of transport proteins 7) inhibit FSH 8) LH surge 9) inc. myometrial excitability 10) raise HDL, lower LDL |
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LH stimulates the enzyme ___ to convert cholesterol to androstenedione in Theca cells.
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desmolase
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FSH stimulates the enzyme ___ to convert androstenedione to estrogen in Granulosa cells.
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aromatase
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Androstenedione is made in the ___ cell, then moved into the ___ cell for conversion into estrogen.
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theca, granulosa
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Which tissues can make progesterone?
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- corpus luteum
- placenta - adrenal cortex (zona reticularis) - testes |
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Elevated level of ___ indicates a woman has ovulated.
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progesterone
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What does progesterone do?
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- stimulate endometrial secretions, spiral artery development
- maintains pregnancy - decrease myometrial excitability - produce thick cervical mucus - raise body Temp - inhibit LH, FSH - relax uterus smooth muscle |
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Which day of the menstrual cycle is progesterone the highest?
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~ Day 21 (after that, corpus luteum regresses and endometrial lining starts degenerating)
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When do you see the estrogen surge?
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a day before ovulation
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What does the LH surge cause?
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rupture of follicle = ovulation
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Oral contraceptives prevent which part of the menstrual cycle?
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prevent estrogen & LH surge = no ovulation
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Mittelschmerz =
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blood from ruptured follicle irritates peritoneum and mimics appendicitis (weird)
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A female newborn has primary oocytes arrested in which phase of the cell cycle?
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prophase of meiosis 1
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Let's say an oocyte is ovulated and now waiting for a lucky sperm to find it. What phase of the cell cycle is it currently stuck in?
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metaphase of meiosis 2
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Which cells make hCG?
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syncytiotrophoblasts of placenta
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What are some uses of hCG?
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- maintain corpus luteum for the 1st trimester (acts like LH)
- used to detect pregnancy because appears in urine 8 days after fertilization - detect hydatidiform moles or choriocarcinoma (elevated) |
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What is average age of menopause onset?
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51 yrs - earlier in smokers
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What hormonal changes are seen in menopause?
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- estrogen goes down
- FSH goes uuuuupppp - LH goes up - GnRH goes up |
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What are sxs of menopause?
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- hot flashes
- vaginal atrophy - osteoporosis (low estrogen) - CAD (recall: estrogen raised HDL lowered LDL) |
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Incomplete fusion of paramesonephric ducts -->
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bicornate uterus (associated with UTI, infertility)
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Failure of urethral folds to close -->
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HYPOspadias - urethral opening on inferior side (more common than epispadias)
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Faulty positioning of genital tubercle -->
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EPIspadias - opening on superior side of penis (associated with bladder exstrophy)
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A male patient goes to a fertility clinic because of infertility. He is tall with long arms and legs, has testicular atrophy, and a female hair and body fat distribution. You suspect he has:
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Klinefelter's syndrome - male (XXY), presence of inactivated X chromosome (Barr body)
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A female patient goes to a fertility clinic complaining of amenorrhea and infertility. She is very short with a webbed neck, and a congenital heart defect that causes HTN of upper limbs but hypotension of lower limbs. She has:
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Turner's syndrome - female (XO), most common cause of primary amenorrhea; ovary dysgenesis, coarctation of Ao, no Barr body.
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What do double Y males (XYY) look like?
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phenotypically normal, very tall, bad acne, antisocial behavior
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Someone who is 46XX, has ovaries but virilized external genitalia is:
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female pseudohermaphrodite (usually due to excessive steroid exposure in utero)
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Someone who is 46XY, has testes, and female external genitalia is:
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male pseudohermaphrodite (usually due to androgen insensitivity syndrome)
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A true hermaphrodite has karyotype ___ or ___, and has both ovaries and testes with ambigious external genitalia.
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46XX, 47XXY
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A male with androgen insensitivity syndrome looks like normal female but has (or does not have):
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- incomplete vagina
- no uterus, no fallopian tubes - develops testes - high testosterone, estrogen, LH |
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If a male is missing 5-a-reductase:
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Cannot convert testosterone to DHT. Will have ambiguous genitalia until puberty when rise in testosterone masculinizes everything.
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Signs of prostatic adenocarcinoma:
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- hard nodule of posterior lobe (digital rectal exam)
- high PSA - high ALP (osteoblastic marker) |
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What is a hydatidiform mole?
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pathologic ovum - no DNA - makes beta-hCG, can lead to choriocarcinoma, looks like a bunch of grapes
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A complete hydatidiform mole has karyotype ___ and is ___ in origin.
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46XX, paternal
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What is the triad of preeclampsia?
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1) HTN
2) proteinuria 3) edema |
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When can a pregnant women develop eclampsia?
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20 weeks gestation --> 6 weeks postpartum
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What increases a woman's chance of getting eclampsia during pregnancy?
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- preexisting HTN!!
- diabetes - chronic renal dz - autoimmune dz |
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What is the cause of preeclampsia-eclampsia?
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placental ischemia
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What is the "HELLP" syndrome often associated with preeclampsia-eclampsia?
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hemolysis
elevated LFTs low Platelets |
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A pregnant patient in her 3rd trimester who is a known diabetic suddenly develops a bad headache and blurry vision with facia puffing and abdominal pain. You think she might have:
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preeclampsia - HTN, proteinuria, edema
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How do you Tx eclampsia?
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- magnesium sulfate
- diazepam (benzodiazepine) |
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How do you Tx preeclampsia?
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- deliver baby if possible
- bed rest - salt restriction - treat HTN |
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Painful bleeding during 3rd trimester should make you suspect:
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abruptio placenta - premature separation of placenta, fetal death, DIC, risk increased with cocaine use, smoking, HTN
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Massive hemorrhage after vaginal delivery in a woman who's had previous C-section makes you suspect:
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placenta accreta - placenta attached directly to myometrium
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Painless bleeding in a pregnant woman makes you suspect:
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placenta previa - placenta attached to lower uterine segment might have occluded cervical os
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Sudden lower abdominal pain in a women who has PID and high hCG levels =
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ectopic pregnancy
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What abnormality of the fetus should you consider if there is polyhydramnios (> 1.5L)?
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esophageal/duodenal atresia, with anencephaly
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What abnormality of the fetus should you suspect in oligohydramnios (< 0.5L)?
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bilateral renal agenesis, or posterior urethral valves (in males)
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Severe menstrual-related pain, chocolate cysts, infertility =
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endometriosis - nonneoplastic endometrial glands outside the uterus causing problems, often in ovary or on peritoneum
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Adenomyosis =
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endometriosis in the smooth muscle of uterus
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Endometrial hyperplasia =
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due to excess Estrogen stimulation, higher risk for endometrial carcinoma, see vaginal bleeding
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What is the most common gynecologic malignancy?
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endometrial carcinoma - vaginal bleeding, prolonged estrogen use, obesity, diabetes, HTN
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What is the peak age of women who get endometrial carcinoma?
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55-65 yrs
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What is the most common tumor in females?
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leiomyoma - higher incidence in blacks, estrogen sensitive, does not progress to leimyosarcoma
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Leiomyosarcoma arises...
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de novo! highly aggressive, tends to recur, can protrude from cervix and bleed, bulky necrotic & hemorrhagic
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Polycystic ovaries has high level of ___, leading to anovulation and hyperadrogenism.
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LH - patients have hirsutism, infertility, obesity, amenorrhea
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Name 4 ovarian cysts (very boring, I know, but do it anyway):
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1) follicular - unruptured Graafian follicle
2) corpus luteum cyst - bleeding into persistent corpus luteum 3) theca-lutein - bilateral and multiple, associate with choriocarcinoma and moles 4) chocolate - endometriosis |
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What is the most common malignant germ cell tumor of the ovaries and testes?
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germinona (dygerminoma, seminoma) - make hCG, seminoma presents as painless testicular enlargement
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Which germ cell tumor is common in young children, makes AFP, is agressive, and has Schiller-Duval bodies?
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yolk sac (endodermal sinus) tumor
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What is a malignant germ cell tumor of syncytiotrophoblasts making hCG?
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choriocarcinoma - in mother or baby during pregnancy
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What is a germ cell tumor that presents as a painful testicular mass?
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embryonal carcinoma
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How do teratomas present in men?
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- mature teratoma
- painful - malignant - gynecomastia |
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Struma ovarii =
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monodermal teratoma with function thyroid tissue
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In females, mature teratomas are malignant/benign, and immature ones are malignant/benign.
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benign (dermoid cyst), malignant
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Which ovarian non-germ cell tumor is malignant, common (50%), often bilateral, and has psammoma bodies?
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serous cystadenocarcinoma
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Which ovarian non-germ cell tumor is benign and lined with fallopian tube-like epithelium?
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serous cystadenoma
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Where is the primary tumor in a patient with pseudomyxoma peritonei?
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ovary or appendix (if from ovary, came from mucinous cystadenocarcinoma)
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Benign tumor that looks like bladder epithelium =
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Brenner tumor (ovarian non-germ cell tumor)
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Meigs' syndrome =
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1) ovarian fibroma (spindle-shaped fibroblasts)
2) acites 3) hydrothorax |
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Granulosa cell tumor secretes:
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estrogen --> precocious puberty, endometrial hyperplasia, endometrial CA, Call-Exner bodies
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Which testicular, non-germ cell tumor presents as precocious puberty in boys, gynecomastia in men, and has intracytoplasmic rod-shaped, eosinophilic crystals?
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Leydig cell - benign, Reinke crystals
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What is the most common testicular CA in OLD MEN?
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testicular lymphoma
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Breast epithelial hyperplasia with atypical cells increases a woman's risk of ___. It usually presents in what age women?
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carcinoma; women > 30 yrs
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What is the most common tumor in young women < 25?
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breast fibroadenoma - small, mobile, firm, gets bigger during pregnancy, NOT a breast cancer precursor!
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Which breast tumor has "leaflike" pattern of connective tissue and cysts?
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cystosarcoma phyllodes - benign!!
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Which malignant breast tumor has a cheesy consistency due to central necrosis?
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comedocarcinoma - ductal
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Which malignant breast tumor has lymphatic involvement and poor Px?
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inflammatory!!!
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Malignancy breast tumors are more common in women of which stage in life?
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post-menopausal
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Which malignant breast tumor has lymphatic involvement but a good Px?
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medullary - fleshy & cellular
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A woman with itchy, scaling patches of skin around the areola and nipple, with nipple retraction, has:
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Paget's disease of breast - large, clear haloed cells in epidermis, suggest underlying carcinoma (DCIS?), look for vulva involvement
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Risk factors for breast cancer:
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1) early menarche & late menopause
2) delayed 1st pregnancy 3) family Hx of 1st degree relative |
