Step 1 - Reproductive Diseases

Front 1

Gonadal venous and lymphatic drainage

Back 1

Left gonadal vein -> left renal vein -> IVC
Right gonadal vein -> IVC
Lymphatics -> para-aortic lymph nodes

Front 2

Suspensory ligament of the ovaries

Back 2

Ovaries to lateral pelvic wall
Contains ovarian vessels

Front 3

Transverse cervical (cardinal) ligament

Back 3

Cervix to side wall of pelvis
Contains uterine vessels

Front 4

Round ligament of uterus

Back 4

Uterus to labia majora
Derivative of gubernaculum - travels through inguinal canal

Front 5

Ligament of the ovary

Back 5

Ovary to uterus

Front 6

Pathway of sperm

Back 6

Seminal vesicles
Epididymis
Vas deferens
Ejaculatory ducts
Urethra
Penis

Front 7

Erection

Back 7

Parasympathetic (pelvic nerve)
NO, sildenafil, vardenafil -> smooth muscle relaxation -> vasodilation -> erection
NE -> smooth muscle contraction -> vasoconstriction -> antierectile

Front 8

Emission

Back 8

Sympathetic (hypogastric nerve)

Front 9

Ejaculation

Back 9

Visceral and somatic nerves (pudendal nerve)

Front 10

Derivation of sperm parts

Back 10

Golgi apparatus -> acrosome
Centriole -> flagellum
Mitochondria -> middle
Fructose -> energy

Front 11

Sertoli cells

Back 11

GnRH -> FSH -> Sertoli cells -> inhibin -| FSH
Secretes androgen binding protein
Form blood-testis barrier - isolates gametes from autoimmune attack
Support and nourish spermatozoa
Regulate spermatogenesis

Front 12

Leydig cells

Back 12

GnRH -> LH -> Leydig cells -> testosterone -| GnRH

Front 13

Spermatogenesis

Back 13

Spermatogonium (2N diploid) -> primary spermatocyte (4N diploid) -> secondary spermatocyte (2N haploid) -> spermatid (1N haploid)

Front 14

Oogenesis

Back 14

Oogonoium (2N diploid) -> primary oocyte (4N diploid) -> prophase arrest until ovulation -> secondary oocyte (2N haploid) -> metaphase arrest until fertilization -> ovum (1N haploid)
Polar bodies produced as byproduct

Front 15

Dihydrotestosterone

Back 15

Most potent androgen
Converted from testosterone by 5a-reductase (inhibited by finasteride)
Function: differentiation of penis, scrotum, and prostate, balding, sebaceous gland activity, prostate growth

Front 16

Testosterone

Back 16

Converted to estrogen in Sertoli cells and adipose tissue by aromatase
Differentiates epididymis, vas deferens, and seminal vesicles
Increase muscle
Increase growth spurt
Increase growth of penis and seminal vesicles
Increase libido
Spermatogenesis
Closing of epiphyseal growth plate (estrogen)
Increase RBC production
Deepens voice

Front 17

Estrogen - forms

Back 17

Estradiol (ovary)
Estrone (increased 1000x in pregnnacy, indicates fetal well-being)
Estriol (placenta

Front 18

Functions of estrogen

Back 18

Growth of follicle
Endometrial proliferation
Development of genitalia
Stromal development of breast
Female fat distribution
Hepatic synthesis of sex hormone-binding globulin
Feedback inhibition of FSH and LH
LH surge
Myometrial excitability
Increase HDL, decrease LDL

Front 19

Synthesis of estrogen

Back 19

GnRH -> LH -> theca cell -> cholesterol to androstenedione
GnRH -> FSH -> granulosa cell -> androstenedione to estrogen

Front 20

Progesterone

Back 20

Source: corpus luteum, placenta, adrenal cortex, testes
Stimulates endometrial glandular secretion and spiral artery development
Maintains pregnancy
Decrease myometrial excitability
Produce thick cervical mucus
Increase body temperature
Inhibit FSH and LH
Uterine smooth muscle relaxation

Front 21

Ovulation

Back 21

Estrogen -> LH surge -> ovulation
Increase in temperature (progesterone)

Front 22

Mittelschmerz

Back 22

Symptoms: appendicitis symptoms
Pathogenesis: blood from ruptured follicle causes peritoneal irritation

Front 23

Menstrual cycle

Back 23

Menses
Follicular phase - thickening of endometrium (estrogen), varies in length
Ovulation - LH surge
Secretory phase - maintenance of endometrium (progesterone)

Front 24

Pregnancy

Back 24

Fertilization at upper end of fallopian tube - 1 day after ovulation
Implantation in wall of uterus - 6 days after fertilization
b-hCG within 1 week in blood, 2 weeks in urine

Front 25

Lactation

Back 25

Induced by decrease in maternal steroids after labor
Suckling -> nerve stimulation -> oxytoxin and prolactin

Front 26

Prolactin

Back 26

Induces and maintains lactation
Negative feedback on GnRH

Front 27

Oxytocin

Back 27

Helps milk letdown
Uterine contractions

Front 28

hCG

Back 28

Source: syncytiotrophoblast of placenta
Maintains corpus luteum during first trimester (placenta generates estriol and progesterone in second and third trimesters)
Used to detect pregnancy
Elevated in pathology

Front 29

Menopause

Back 29

Symptoms: decreased estrogen, increased GnRH, FSH, and LH, hot flashes, atrophy of vagina, osteoporosis, CAD
Pathogenesis: decreased estrogen due to decline in ovarian follicles (earlier age in smokers)

Front 30

Klinefelter's syndrome

Back 30

Symptoms: testicular atrophy, tall and long extremities, female hair distribution, gynecomastia, abnormal Sertoli (increased FSH) and Leydig (increased LH and estrogen) function
Pathogenesis: XXY male with inactivated X chromosome (Barr body)

Front 31

Turner's syndrome

Back 31

Symptoms: short stature, ovarian dysgenesis, webbed neck, preductal coarctation of aorta, increased FSH and LH due to decreased estrogen
Pathogenesis: XO female

Front 32

Double Y male

Back 32

Symptoms: very tall, severe acne, antisocial behavior, normal fertility
Pathogenesis: XYY male

Front 33

Female pseudohermaphroditism

Back 33

Symptoms: virilized or ambiguous external genitalia
Pathogenesis: excessive or inappropriate androgen exposure during gestation (CAH, exogenous androgens)

Front 34

Male pseudohermaphroditism

Back 34

Symptoms: female or ambiguous external genitalia with testes
Pathogenesis: androgen insensitivity

Front 35

Androgen insensitivity syndrome

Back 35

Symptoms: female external genitalia with vagina, no uterus, testes (can lead to malignancy), high levels of testosterone, estrogen, and LH
Pathogenesis: defect in androgen receptor in XY male

Front 36

5a-reductase deficiency

Back 36

Symptoms: ambiguous genitalia until puberty, growth of external genitalia via testosterone, normal testosterone, LH, and estrogen
Pathogenesis: can't convert testosterone to DHT

Front 37

Complete hydatidiform mole

Back 37

Symptoms:increased b-hCG, honeycomb uterus (abnormally enlarged)
Pathogenesis: 2 sperm fertilize empty egg (46,X?, cystic swelling of chorionic villi, proliferation of chorionic trophoblasts, precursor to choriocarcinoma
Treatment: D&C, methotrexate

Front 38

Partial hydatidiform mole

Back 38

Symptoms: increased b-hCG, can contain fetal parts
Pathogenesis: 2 sperm fertilize an egg (69,XXY)
Treatment: D&C, methotrexate

Front 39

Causes of miscarriage

Back 39

First weeks - low progesterone due to lack of response to b-hCG
First trimester - chromosomal abnormalities
Second trimester - bicornate uterus

Front 40

Pre-eclampsia

Back 40

Symptoms: HTN, proteinuria, edema, headache, blurred vision, abdominal pain, hyperreflexia, thrombocytopenia, hyperuricemia, altered mental status
Pathogenesis: 20 weeks to 6 weeks postpartum, more with pre-existing HTN, diabetes, renal disease, autoimmune, placental ischemia -> increased vascular permeability and coagulopathy
Treatment: deliver fetus, IV MgSO4 or diazepam

Front 41

Eclampsia

Back 41

Symptoms: HTN, proteinuria, edema, seizures
Treatment: deliver fetus

Front 42

HELLP syndrome

Back 42

Symptoms: hemolysis, eelevated LFTs, low platelets
Pathogenesis: pre-eclampsia associated

Front 43

Abruptio placentae

Back 43

Symptoms: painful bleeding in 3rd trimester, fetal death
Pathogenesis: premature detachment of placenta, associated with DIC< smoking, HTN, cocaine

Front 44

Placenta accreta

Back 44

Symptoms: massive bleeding after delivery
Pathogenesis: defective decidual layer allows placenta to attach to myometrium, prior C-section or inflammation

Front 45

Placenta previa

Back 45

Symptoms: painless bleeding in any trimester, occlusion of cervical os
Pathogenesis: attachment of placenta ot lower uterine segment, prior C-section predisposes

Front 46

Ectopic pregnancy

Back 46

Symptoms: pain without bleeding, sudden lower abdominal pain with increased hCG, diagnose with ultrasound
Pathogenesis: mostly in fallopian tubes, PID

Front 47

Polyhydramnios

Back 47

Symptoms: esophageal/duodenal atresia, anencephaly
Pathogenesis: too much amniotic fluid

Front 48

Oligohydramnios

Back 48

Symptoms: bilateral renal agenesis, posterior urethral valves, inability to excrete urine, Potter's syndrome
Pathogenesis: too little amniotic fluid

Front 49

Cervical dysplasia

Back 49

Symptoms: disordered epithelial growth starting at basal layer, koilocytes
Pathogenesis: HPV 16&18

Front 50

Invasive cervical carcinoma

Back 50

Symptoms: block ureters -> renal failure
Pathogenesis: progress from cervical dysplasia, usually squamous cell

Front 51

Endometriosis

Back 51

Symptoms: cyclic menstrual bleeding, blood-filled chocolate cysts, severe menstrual-related pain (ectopic), infertility
Pathogenesis: non-neoplastic endometrial glands and stroma in locations outside the uterus

Front 52

Endometrial hyperplasia

Back 52

Symptoms: postmenopausal vaginal bleeding
Pathogenesis: excess estrogen stimulation causes abnormal endometrial gland proliferation, anovulatory cycles, HRT, PCOS, granulosa cell tumor

Front 53

Endometrial carcinoma

Back 53

Symptoms: vaginal bleeding, myometrial invasion (poor prognosis)
Pathogenesis: 55-65, preceded by endometrial hyperplasia, prolonged estrogen use, obesity, diabetes, HTN, nulliparity, late menopause

Front 54

Leiomyoma

Back 54

Symptoms: tumor that increases in size with pregnancy and decreases in menopause, abnormal uterine bleeding, iron deficiency anemia, whorled smooth muscle bundles
Pathogenesis: well-demarcated benign smooth muscle tumor, more in blacks

Front 55

Leiomyosarcoma

Back 55

Symptoms: bulky irregularly shaped tumor with areas of necrosis and hemorrhage, protrusion from cervix, bleeding
Pathogenesis: de novo, increased in blacks

Front 56

Gynecologic tumor epidemiology

Back 56

Incidence - endometrial > ovarian . cervical
Prognosis (worst) - ovarian > cervical > endometrial

Front 57

Premature ovarian failure

Back 57

Symptoms: signs of menopause before age 40, decreased estrogen, increased LH and FSH
Pathogenesis: premature atresia of ovarian follicles

Front 58

Polycystic ovarian syndrome

Back 58

Symptoms: anovulation, hyperandrogenism, enlarged bilateral cystic ovaries, infertility, amenorrhea, obesity, hirsutism
Pathogenesis: insulin resistance, increased LH (anovulation), increased testosterone (hirsutism)
Treatment: weight loss, oral contraceptives, gonadotropins, clomiphene, surgery

Front 59

Ovarian follicular cyst

Back 59

Symptoms: hyperestrinism, endometrial hyperplasia
Pathogenesis: distention of unruptured grafian follicle

Front 60

Corpus luteum cyst

Back 60

Symptoms: hemorrhage with menstrual irregularity
Pathogenesis: hemorrhage into persistent corpus luteum

Front 61

Theca-lutein cyst

Back 61

Symptoms: multiple or bilateral cysts associated with moles and choriocarcinoma
Pathogenesis: gonadotropin stimulation

Front 62

Chocolate cyst

Back 62

Symptoms: blood-containing cyst that varies with menstrual cycle
Pathogenesis: ectopic ovarian endometriosis

Front 63

Ovarian dysgerminoma

Back 63

Symptoms: sheets of uniform cells
Markers: hCG

Front 64

Ovarian choriocarcinoma

Back 64

Symptoms: large hyperchromatic syncytiotrophoblastic cells, increased frequency of theca-lutein cysts
Markers: hCG

Front 65

Ovarian yolk sac tumor

Back 65

Symptoms: aggressive malignancy in ovaries and sacrococcygeal area of young children
Markers: AFP

Front 66

Ovarian teratoma

Back 66

Symptoms: cells from many germ layers, functional thyroid tissue (struma ovarii, hyperthyroidism)

Front 67

Ovarian cancer markers

Back 67

Increase in CA-125
BRCA-1 and HNPCC are risk factors

Front 68

Serous cystadenoma

Back 68

Frequently bilateral
Lined by fallopian tube-like epithelium
Benign

Front 69

Serous cystadenocarcinoma

Back 69

Malignant
Frequently bilateral

Front 70

Mucinous cystadenocarcinoma

Back 70

Pseudomyxoma peritonei (intraperitoneal accumulation of mucin from ovarian or appendiceal tumor)
Malignant

Front 71

Mucinous cystadenoma

Back 71

Multilocular cyst lined by mucus-secreting epithelium
Benign

Front 72

Brenner tumor

Back 72

Benign
Looks like bladder

Front 73

Fibroma

Back 73

Bundle of spindle-shaped fibroblasts
Meigs' syndrome (ovarian fibroma, ascites, hydrothorax, pulling sensation in groin)

Front 74

Granulosa cell tumor

Back 74

Secretes estrogen (precocious puberty)
Endometrial hyperplasia or carcinoma
Call-Exner bodies (small follicles filled with eosinophilic secretions)

Front 75

Krunkenberg tumor

Back 75

GI malignancy metastatic to ovaries
Mucin-secreting signet cell adenocarcinoma

Front 76

Vaginal carcinoma

Back 76

Squamous cell - secondary to cervical SCC
Clear cell - exposure to DES in utero
Sarcoma botryoides - girls <4 years, spindle-shaped, desmin positive

Front 77

Breast fibroadenoma

Back 77

Small, mobile, firm mass with sharp edges
Most common in <25
Increased size and tenderness with estrogen

Front 78

Breast intraductal papilloma

Back 78

Small tumor that grows in lactiferous ducts beneath areola
Serous or bloody nipple discharge

Front 79

Breast phyllodes tumor

Back 79

Large bulky CT and cystic mass
Leaf-like projections
6th decade

Front 80

Malignant breast tumors

Back 80

Common postmenopause
Pathogenesis: from mammary duct epithelium or lobular glands, overexpression of estrogen/progesterone receptors or erb-B2
Prognosis: worse with axillary node involvement

Front 81

Ductal carcinoma in situ

Back 81

Early malignancy that fills ductal lumen without BM penetration

Front 82

Invasive ductal carcinoma

Back 82

Firm, fibrous mass
Small glandular duct-like cells
Most invasive

Front 83

Invasive lobular breast carcinoma

Back 83

Orderly row of cells
Multiple, bilateral

Front 84

Medullary breast carcinoma

Back 84

Fleshy, cellular, lymphatic infiltrate

Front 85

Comedocarcinoma

Back 85

Ductal with caseous necrosis

Front 86

Inflammatory carcinoma

Back 86

Dermal lymphatic invasion with peau d'orange

Front 87

Paget's disease

Back 87

Eczematous patches on nipple
Large cells in epidermis with clear halo

Front 88

Fibrocystic breast disease

Back 88

Symptoms: premenstrual breast pain, multiple bilateral lesions with fluctuating size
Types: fibrotic (hyperplasia of breast stroma), cystic (fluid-filled), sclerosing adenosis (acinar and intralobular fibrosis), epithelial hyperplasia (increase in number of epithelial cell layers in terminal duct lobule)

Front 89

Acute mastitis

Back 89

Breast abscess during breast feeding
Staph aureus

Front 90

Fat necrosis of breast

Back 90

Benign painless lump
Due to injury of breast tissue

Front 91

Gynecomastia

Back 91

Hyperestrogenism
Klinefelter's syndrome
Drugs (estrogen, marijuana, heroi, spironolactone, digitalis, cimetidine, alcohol, ketoconazole)

Front 92

Prostatitis

Back 92

Symptoms: dysuria, frequency, urgency, low back pain
Pathogenesis: bacteria (acute), abacterial (chronic)

Front 93

Benign prostatic hyperplasia

Back 93

Smptoms: increased urinary frequency, nocturia, difficulty starting and stopping, dysuria, hypertrophy of bladder, UTIs, hydronephrosis, increased free PSA
Pathogenesis: hyperplasia of prostate gland, increased estradiol, sensitization ot DHT, nodular enlargement of periurethral lobes, compression of urethra

Front 94

Prostatic adenocarcinoma

Back 94

Symptoms: hard mobile mass on DRE, osteoblastic metastases (low back pain, increased serum alkaline phosphatase and PSA), increased prostatic acid phosphatase, increased total PSA, decreased free PSA
Pathogenesis: posterior lobe cancer

Front 95

Cryptorchidism

Back 95

Undescended testes
Lack of spermatogenesis (high body temp)
Risk of germ cell tumors
Increased with prematurity

Front 96

Testicular seminoma

Back 96

Malignant
Painless testicular enlargement
Large cells in lobules with watery cytoplasm and fried egg appearance

Front 97

Embryonal carcinoma

Back 97

Malignant
Painful
Glandular or papillary morphology

Front 98

Yolk sac tumor of testis

Back 98

Schiller-Duval bodies
Primitive glomeruli
Increased AFP

Front 99

Choriocarcinoma (testicular)

Back 99

Malignant
Increased hCG

Front 100

Teratoma (testicular)

Back 100

Mature teratoma is most malignant

Front 101

Leydig cell tumor

Back 101

Contains Reinke crystals
Produce androgens
Gynecomastia in men, precocious puberty in boys

Front 102

Sertoli cell tumor

Back 102

Androblastoma from sex cord stroma

Front 103

Testicular lymphoma

Back 103

Most common testicular cancer of older men

Front 104

Tunica vaginalis lesion

Back 104

Lesion in serous covering of testis (testicular mass)
Varicocele - dilated vein in pampiniform plexus (bag of worms)
Hydrocele - fluid due to incomplete fusion of processus vaginalis
Spermatocele - dilated epididymal duct

Front 105

Bowen's disease

Back 105

Gray, solitary crusty plaque on shaft of penis or scrotum
Progresses to SCC

Front 106

Erythroplasia of Queyrat

Back 106

Red velvety plaques involving glans of penis

Front 107

Bowenoid papulosis

Back 107

Multiple papular lesions on penis
Affects younger age group

Front 108

Squamous cell carcinoma of penis

Back 108

Associated with HPV

Front 109

Peyronie's disease

Back 109

Bent penis due to acquired fibrous tissue formation