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Step 1 First Aid 16: Reproductive

Step 1 First Aid 16: Reproductive

by rhymenoceros, Apr. 2011

Subjects: 1 16 aid first reproductive step

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253 Cards in this Set

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	varicocele is more common on left/right this is because ___	left L gonadal drains into L renal vein (instead of IVC) -> smaller caliber -> higher resistance
	ovaries/testes drain to the ___ LNs	para-aortic
	vulva drains to the ___ LNs	superficial inguinal
	distal 1/3 of vagina drains to the ___ LNs	superficial inguinal
	proximal 2/3 of vagina and all of uterus drains to the ___ (3) LNs	obturator external iliac hypogastric
	scrotum drains to the ___ LNs	superficial inguinal
	5 ligaments of the uterus and adnexa	suspensory l of the ovaries cardinal l round l broad l l of the ovary
	suspensory l of the ovaries connects ___ to ___ it contains ___	ovary lateral pelvic wall ovarian vessels
	cardinal l connects ___ to ___ it contains ___	cervix lateral pelvic wall (at ischial spine) uterine vessels
	round l connects ___ to ___ it contains ___	uterine fundus labia majora (via inguinal canal) nothing
	round l is derived from ___	gubernaculum
	broad l connects ___ (3) to ___ it contains ___ (3)	uterus fallopian tubes ovaries lateral pelvic wall ovaries fallopian tubes round ligaments
	ligament of ovary connects ___ to ___	ovary uterus
	emission means ___ it is triggered by ___ n. under ___ stimulation	semen moving to ejeculatory ducts hypogastric SYM
	ejaculatory ducts run from junction of ___ (2) to ___ through ___	seminal vesicles vas deferens urethra prostate
	ejaculation means contraction of ___ (2) it is triggered by ___ under ___ stimulation	bulbospongiusus ischiocavernosus pudendal n. SYM
	sperm acrosome is derived from ___	Golgi
	sperm flagellum is derived from ___	centriole
	sperm has mitochondria in its ___	neck
	3 kinds of cell in seminiferous tubule	Leydig Sertoli germ cells
	Leydig cells are stimulated by ___ and make ___	LH testosterone
	Leydig cells are separated from ___ by ___ (2)	seminiferous epithelium myoid cells basal lamina
	Sertoli cells are stimulated by ___ and make ___ (4)	FSH ABP AMH inhibin sperm (indirectly)
	2 structural functions performed by Sertoli cells	blood-testis barrier support developing spermatozoa
	blood-testis barrier is formed by ___ its purpose is ___	tight junctions between Sertoli cells prevent autoimmunity against gametes
	___ is the least differentiated male germ cell its ploidy is ___	spermatogonium 46XY
	spermatogonia are inside/outside of BTB	outside
	in meiosis, spermatogonia become ___	1' spermatocyte
	ploidy of 1' spermatocyte	replicated 46XY
	1' spermatocyte becomes ___	2' spermatocyte
	ploidy of 2' spermatocyte	replicated 23X or replicated 23Y
	2' spermatocyte becomes ___	spermatid
	spermatid ploidy is ___	23X or 23Y
	3 androgens strongest is ___ weakest is ___	testosterone DHT androstenedione DHT androstenedione
	androstenedione is made by ___	adrenal
	T causes differentiation of ___ (3) DHT causes differentiation of ___ (3)	epididymis vas deferens seminal vesicles penis scrotum prostate
	T causes closure of growth plates via ___	conversion to E
	3 changes caused by DHT	prostate hypertrophy balding sebaceous secretion
	3 estrogens strongest is ___ weakest is ___	estrone estradiol estriol estradiol estriol
	estriol comes from ___	placenta
	3 sources of E	ovary placenta blood (aromatization)
	in ___ phase, ___ causes theca cells to ___, causing elevated ___	proliferative LH upregulate androgenic enzymes (e.g. desmolase) high androgens
	in ___ phase, ___ causes granulosa cells to ___, causing elevated ___	proliferative FSH upregulate aromatase E
	normally, LH/FSH is higher	LH
	in PCOS, LH/FSH ratio is high/low	high
	E does ___ to endometrium ___ to myometrium, ___ to Gns, and ___ to E receptor expression	proliferation increased contractility negative feedback EXCEPT when E>P before LH surge increase
	P does ___ (2) to endometrium ___ to myometrium, ___ to Gns, and ___ to E receptor expression	stimulated secretions spiral artery development decreased contractility negative feedback decrease
	4 receptors upregulated by E	GnRH (ant. pituitary) LH (theca cells) E P
	E does ___ to PRL secretion and ___ to PRL action at breast	increase blocks
	4 sources of P	corpus luteum placenta adrenal cortex testes
	P does ___ to cervical mucus and ___ to body temp	thickens increase
	proliferative phase is aka ___	follicular
	secretory phase is aka ___	luteal
	___ menstrual phase can vary in length ___ phase is constant at ___	follicular secretory 14 days
	oligomenorrhea is ___ polymenorrhea is ___	cycle>35 days cycle<21 d
	mittelschmerz is caused by ___ which does ___	blood from ruptured follicle peritoneal irritation
	___ is least differentiated female germ cell its ploidy is ___	oogonium 46XX
	oogonia differentiate into ___s during ___	1' oocyte fetal life
	1' oocytes enter ___ during ___ and stop at ___	meiosis I fetal life prophase I
	1' oocytes stay at ___ phase until ___.	prophase I ovulation
	at ovulation, ___s complete ___ and become ___ (2)	1' oocyte meiosis I 1 2' oocyte 1 first polar body
	at ovulation, 2' oocytes begin ___ but stop at ___	meiosis II metaphase II
	ploidy of 2' oocyte ploidy of first polar body	2N (replicated 23X) 2N (replicated 23X)
	2' oocytes are arrested at ___ until ___	metaphase II fertilization
	at fertilization, ___s complete ___ and become ___ (2)	2' oocyte meiosis II ovum second polar body
	ploidy of ovum ploidy of 2nd polar body	N (23X) N (23X)
	zygote typically implants ___ days after fertilization	6
	bhCG is detectable in blood ___ after fertilization and in urine ___ after fertilization it peaks at ___ weeks	1 week 2 weeks 10 weeks
	oxytocin does ___ (2)	milk letdown uterine contraction
	bhCG maintains pregnancy during ___ by ___ing	1st trimester acting like LH
	3 effects of E on serum lab values	high HDL low LDL high hormone-binding proteins (SHBG, TG, etc)
	marker for menopause	high FSH
	FSH rises more than LH in menopause because ___	it's released from inhibition of E, P and inhibin (LH only released from 1st 2)
	microscopic anomaly in Klinefelter's	Barr body
	5 serum markers for Klinefelters	high LH high FSH low androgens low inhibin high E
	microscopic anomaly in Turner's	no Barr body
	if T is high and LH is high, dx is ___	androgen R defect
	if T is high and LH is low, dx is ___	ectopic or exogenous T
	pseudo-hermaphroditism means ___	gonads don't match external genitalia
	in female pseudo-hermaphroditism, genotype is ___, gonads are ___, external genitalia are ___	XX ovaries ambiguous or virilized
	2 causes of female pseudo-hermaphroditism	CAH in utero exposure to exogenous androgens
	in male pseudo-hermaphroditism, genotype is ___, gonads are ___, external genitalia are ___	XY testes ambiguous or female
	3 causes of male pseudo-hermaphroditism ___ is most common	androgen insensitivity Swyer syndrome 5a reductase deficiency androgen insensitivity
	true hermaphroditism has genotype ___ or ___ it means ___	46XX 47XXY both ovary and testicular tissue present
	Swyer syndrome is caused by ___ this causes absence of ___	SRY mutation AMH
	in androgen insensitivity, gonads are ___ vagina is ___ uterus is ___ body habitus is ___ 2' sex characteristics are ___	testes present (rudimentary) absent (AMH) tall female (from aromatization of T)
	in Swyer syndrome, gonads are ___ vagina is ___ uterus is ___ body habitus is ___ 2' sex characteristics are ___	streak gonads present (no AMH) present (no AMH) tall absent
	in 5a reductase deficiency, T levels are ___ E levels are ___ LH levels are ___	normal normal normal or high
	benign GTD is aka ___	hydatidiform mole
	2 kinds of mole	complete partial
	___% of all moles are complete	90
	4 RFs for molar pregnancy	nulliparity prior molar pregnancy extremes of age asian
	in complete mole, a ___ sperm fertilizes a ___ ovum the resulting cell then ___s	normal enucleate replicates paternal chromosomes
	in partial mole, ___ sperm fertilizes a ___ ovum	2 (or 1 with subsequent duplication) normal
	in complete mole, karyotype is ___ bhCG is ___ uterine size is ___ chorioca risk is ___ fetal parts are ___ malignancy risk is ___	46XX or 46XY very high enlarged 2% absent 15-20%
	in partial mole, karyotype is ___ bhCG is ___ uterine size is ___ chorioca risk is ___ fetal parts are ___ malignancy risk is ___	69XXX or 69XXY high (not as high as complete) normal low present low
	6 sx of complete mole	vaginal bleeding uterus LGA theca-lutein cysts pre-eclampsia HG hyperthyroidism
	workup for molar pregnancy (2)	bhCG US
	tx for molar pregnancy (4)	D&C oxytocin MTX anti-D if Rh-
	followup for molar pregnancy (2)	serial bhCG (until 0) contraception during followup
	3 kinds of malignant GTD	invasive/persistent mole chorioca placental site trophoblastic tumor (PSTT)
	tx for invasive mole	single agent chemo
	tx for chorioca	single agent chemo
	tx for PSTT	hysterectomy
	common cause of recurrent miscarriage during 1st week(s)	low P
	common cause of recurrent miscarriage during 1st semester	chromosomal abnormality
	common cause of recurrent miscarriage during 2nd semester	bicornuate uterus
	preeclampsia is ___ (3) occuring between ___ and ___ weeks gestation	HTN proteinuria edema 20 6 weeks postpartum
	new onset HTN + proteinuria before 20 weeks suggests ___	molar pregnancy
	preeclampsia is caused by ___ due to ___	placental ischemia insufficient vasodilation of spiral a.s
	preeclampsia is associated with ___	HELLP syndrome
	HELLP syndrome is ___	Hemolysis Elevated Liver enzymes Low Platelets
	mortality in preeclampsia is from ___ (2)	cerebral hemorrhage ARDS
	preeclampsia tx: (4)	deliver baby as early as possible bed rest salt restriction seizure prophylaxis
	seizure prophylaxis for preeclampsia (2)	IV mag sulfate diazepam
	bleeding in abruptio placentae is painful/painless bleeding in placenta previa is painful/painless	painful painless
	abruptio placentae is associated with ___ it occurs in the ___ trimester ___ (3) are RFs	DIC 3rd smoking cocaine HTN
	most common location for ectopic pregnancy	fallopian tube
	cervical dysplasia happens at ___ it begins at ___ layer	squamo-columnar junction basal
	4 HPV types associated with cervical ca	16 18 31 45
	microscopic sign of cxal dysplasia	koilocyte
	lateral expansion of cervical tumor can cause ___, in turn causing ___	ureteral obstruction renal failure
	top 3 gynecological malignancies IDOOF	endometrial ovarian cervical
	unopposed E can cause ___ 4 causes of unopposed E	endometrial hyperplasia anovulatory cycle HRT PCOS granulosa cell tumor
	endometrial ca pw	vaginal bleeding
	___ is most common tumor in females	leiomyoma
	leiomyoma pw ___ (2)	bleeding miscarriage
	T/F: leiomyoma can progress to leiomyosarcoma	false
	leiomyomas are sensitive to ___	E
	80% of cxal ca is ___ 20% is ___	SCC adenoca
	___ is a cxal adenoca associated with in utero DES exposure	clear cell adenoca
	most common sign of cxal cancer is ___, especially ___.	abnormal vaginal bleeding postcoital bleeding
	2 morphological kinds of ovarian tumors	cystic solid
	3 kinds of cystic ovarian tumors	functional neoplastic endometrioma
	T/F: functional cysts can be malignant T/F: neoplastic cysts can be malignant T/F: endometriosis cysts can be malignant T/F: solid tumors cysts can be malignant	F T F T
	3 kinds of functional ovarian cysts	follicular corpus luteum theca lutein
	functional cysts are common/rare they are related to ___	common ovulation
	follicular cysts are lined by ___ cells	granulosa
	usual follicular cyst outcome	spontaneous resolution within 2 weeks
	___ is one kind of corpus luteum cyst	hemorrhagic corpus luteum
	menstrual abnormality associated with corpus luteum cyst this can cause confusion with ___	delay of menses ectopic pregnancy
	usual outcome of corpus luteum cyst in the absence of pregnancy usual outcome of corpus luteum cyst in the presence of pregnancy	resolution within 8 weeks resolution at development of yolk sac
	corpus luteum cysts present with ___ they are more common on L/R	sudden pain R
	compared with follicular cysts, CL cysts are ___ (2)	more likely to cause pain larger
	theca lutein cysts and ___ are caused by ___, e.g. from ___ (2)	luteoma of pregnancy hCG molar pregnancy chorioca
	4 ovarian germ cell tumors	dysgerminoma chorioca yolk sac tumor teratoma
	dysgerminoma is the female equivalent of ___ it is relatively rarer/more common it is benign/malignant	seminoma rarer malignant
	dysgerminoma histology	sheets of uniform cells
	2 markers for dysgerminoma	hCG LDH
	chorioca is derived from ___ it is benign/malignant	syncitiotrophoblast malignant
	marker for chorioca	hCG
	chorica is associated with ___	theca-lutein cysts
	marker for yolk sac tumor gross histopath of yolk sac tumor	AFP yellow friable mass
	50% of yolk sac tumors have ___ on micro histopath	Schiller-Duval bodies
	Schiller-Duval bodies resemble ___	glomeruli
	teratomas are ___% of all germ cell tumors they contain ___ germ layers	90 2 or 3
	mature teratomas are aka ___ (2)	benign cystic teratoma dermoid cyst (most frequent benign ovarian tumor)
	immature teratomas are benign/malignant	malignant
	struma ovarii is a kind of ___ it contains ___ tissue and can cause ___	mature teratoma thyroid hyperthyroidism
	3 benign epithelial tumors	serous cystadenoma mucinous cystadenoma brenner tumor
	benign tumor of sex cord stroma	fibroma
	serous/mucinous cystadenoma is more common serous/mucinous cystadenoma is bigger serous/mucinous cystadenoma is associated with psammoma bodies	serous mucinous serous
	___ is a complication of mucinous cystadenoma	pseudomyxoma peritonei
	meigs syndrome includes (3) chief complaint is ___	ascites pleural effusion ovarian fibroma pulling sensation in groin
	4 parameters distinguishing benign from malignant ovarian tumors	size laterality structure ascites
	tumors below ___ are benign tumors above ___ are malignant	8 cm 10 cm
	benign tumors are usually uni/bilateral	uni
	structure of benign tumors (3)	cystic unilocular thin septations
	structure of malignant tumors (3)	solid elements present multilocular thick septations
	___ is 50% of all ovarian tumors ___ is 20% both of these are frequently ___	serous cystadenocarcinoma serous cystadenoma bilateral
	serous cystadenoma has ___ epithelium	fallopian tube-like
	mucinous cystadenoma has ___ epithelium	intestine-like
	brenner tumor has ___ epithelium	transitional (bladder)
	granulosa cell tumor pw ___ (2)	precocious puberty abnormal uterine bleeding
	micro histopath finding in granulosa cell tumor	call-exner bodies
	ovarian ca marker	CA-125
	most important RF for ovarian ca	family hx
	sarcoma botyroides is a kind of ___ it occurs at age ___ it stains + for ___	rhabdomyosarcoma <4 desmin
	bartholin's gland cyst pw ___	pain in labia majora
	3 benign breast tumors	fibroadenoma intraductal papilloma phyllodes tumor
	___ is most common tumor in women < 25	fibroadenoma
	fibroadenomas are sensitive to ___ they are ___ (2) masses with ___ edges	E firm mobile sharp
	intraductal papilloma pw ___ (2)	serous nipple discharge bloody nipple discharge
	intraductal papilloma grows in ___ it is typically located ___ly	lactiferous ducts sub areolar
	phyllodes tumors are most common in ___th decade	6
	T/F: phyllodes tumors can undergo malignant transformation	true
	T/F: intraductal papilloma has elevated risk of carcinoma	true
	most important prognostic factor in breast ca	axillary LN mets
	earlier/later first delivery is RF for breast ca	later (esp nulliparity)
	2 histological types of breast ca	ductal lobular
	2 kinds of ductal breast ca	invasive DCIS (noninvasive)
	2 kinds of DCIS	low grade high grade
	2 kinds of low grade DCIS	cribriform comedocarcinoma
	2 kinds of high grade DCIS	solid papillary
	___ is most common invasive breast cancer prognosis is ___	ductal (50-70%) bad
	invasive ductal ca pw ___ mass and ___ (3) cells	rock-hard small glandular duct-like
	unlike DCIS, LCIS is ___ because ___, it is usually found ___ly	not considered cancerous it doesn't calcify incidentally
	histopath of invasive lobular ca	orderly row of cells
	invasive lobular ca is commonly ___	bilateral
	medullary breast ca is rare/common prognosis is good/bad	rare good
	Paget's disease of the breast has ___ on ___	eczemetous patch nipple
	Paget cells are ___ with ___ located in ___	large cells clear halo epidermis
	acute mastitis mainly occurs during ___ main pathogen is ___	breast feeding SA
	5 drugs which cause gynecomastia	Spironolactone Digitalis Cimetidine Alcohol Ketoconazole (Some Drugs Create Awesome Knockers)
	prostate ca happens in ___ lobe BPH happens in ___ (2) lobes	posterior lateral middle
	RF for cryptorchidism	prematurity
	2 kinds of testicular tumors	germ cell non-germ cell
	95% of all testicular tumors are ___	germ cell
	5 kinds of testicular germ cell tumors	seminoma embryonal ca yolk sac tumor chorioca teratoma
	___ are most common testicular tumor	seminoma
	seminomas are painful/painless	painless
	age range for seminoma	15-35
	micro histopath for seminoma	large cells with watery cytoplasm "fried egg" appearance
	prognosis for seminoma is ___	excellent
	seminoma is sensitive to ___	radiation
	embryonal ca is painful/painless	painful
	embryonal ca morphology (2)	glandular papillary
	2 markers for embryonal ca	AFP hCG
	unlike in females, in males teratoma is ___	usually malignant
	3 testicular non germ-cell tumors	leydig cell sertoli cell testicular Ly
	leydig cell tumor pw ___ in men, and ___ in boys	gynecomastia precocious puberty
	leydig cell tumor is ___ in color and has ___	brown Reinke crystals
	___ is most common testicular tumor in older men	testicular Ly
	___ is a layer covering the testis derived from periteoneum	tunica vaginalis
	3 lesions of tunica vaginalis finding common to all 3	varicocele hydrocele spermatocele they transilluminate (unlike tumors)
	varicocele is ___ it can cause ___	dilated pampiniform plexus infertility
	hydrocele is caused by ___	incomplete fusion of processus vaginalis
	2 lesions which can progess to penile SCC	Bowen's disease erythroplasia of Queyrat
	Bowen's disease pw ___ located on ___	solitary crusty plaque shaft
	Bowen's disease has peak incidence in ___ decade ___% become SCC	5th 10
	erythroplasia of Queyrat usually affects ___	glans
	2 RFs for penile SCC	HPV lack of circumcision
	Peyronie's disease is ___ 2/2 ___	bent penis fibrosis
	leuprolide is a ___ it can be used for ___ or ___, depending on ___	GnRH agonist promoting LH/FSH release inhibiting LH/FSH release whether it's given tonically or in pulses
	2 leuprolide SEs	nausea vomiting
	oncological indication for leuprolide	prostate ca
	oncological indication for T	ER-positive breast ca (see exemestane)
	finasteride does ___	blocks 5a reductase
	2 finasteride indications	BPH balding (propecia)
	spironolactone does ___	competitive androgen R inhibition
	flutamide does ___ unlike spironolactone, ___	competitive androgen R inhibition it's not a steroid
	oncological indication for flutamide	prostate ca
	ketoconazole does ___	decreased steroid synthesis
	3 SERMs	clomiphene tamoxifen raloxifene
	clomiphene does ___ it is used for ___ (2)	increased LH/FSH release infertility PCOS
	3 clomiphene risks	multiple ovulation -> multiple pregnancy ovarian enlargement visual disturbance
	tamoxifen does ___ it is used for ___	E antagonist at breast ER-positive breast ca
	raloxifene does ___ it is used for ___	E agonism at bone osteoporosis
	anastrozole does ___ so does ___ they are used for ___	aromatase inhibition exemestane breast ca in postmenopausal women
	mifepristone does ___ it is used for ___	P antagonism abortion (RU-486)
	dinoprostone does ___ it is used for ___	PGE2 agonism labor induction: cervical dilation + uterine contraction
	terbutaline does ___ so does ___ they are used for ___	beta_2 agnonsim ritodrine tocolysis
	tamsulosin does ___ it is used for ___	alpha_1 blocker (selective for prostate) BPH

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