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84 Cards in this Set
- Front
- Back
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Nerves erection, emission, ejaculation
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Erection - PNS via pelvic nerve
Emission - SNS via hypogastric nerve Ejaculation - visceral and somatic via pudendal nerve |
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Developmental role of testosterone vs DHT
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Testosterone - Differentiation of epididymis, vas deferens, seminal vesicles. Growth of things at puberty, deep voice, close plates, libido
DHT - early differentiation of external sex organs and prostate. Late growth of prostate, balding and sebaceous glands |
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Kartagener's syndrome
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Dysfunction in ciliary movement
Leads to infertility |
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Estrogen potency
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Estradiol > estrone (menopause) > Estriol (pregnancy)
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Oogenesis arrest
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Prophase I till ovulation
Metaphase II till fertilization |
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What starts lactation after labor
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Drop in progesterone and estrogen
Estrogen enhances prolactin levels but inhibits milk expression |
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hCG source and function, pathogenic increase cause
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Syncytiotrophoblasts of placenta. Used to fertilize 6 days after fertilization
Maintains corpus luteum after progesterone drop for 1st trimester (placenta synthesizes own estriol and progesterone in 2nd and 3rd trimester) Pathologic - hyaditiform moles, choriocarcinoma, gestational trophoblastic tumors |
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Confirming menopause, Signs
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INCREASED FSH (LH and GnRH also rise)
Estrogen drop Signs: HHAVOC Hirsutism Hot flashes Atrophy of Vagina Osteoporosis Coronary Artery Disease |
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Kleinfelters
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47XXY
Testicular atrophy, long extremities (growth plates), gynecomastia, female hair pattern. Infertility Dysgenesis of seminiferous tubules, less inhibin and more FSH, Low T, high LH, high estrogen |
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Turner Syndrome
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45 XO
Short stature, ovarian dysgenesis, shield chest, bicuspid aqortic valve, webbing of neck (cystic hygroma), lymphadema, coarctation of aorta, horeshoe kidney, dysgerminoma. No Barr body Menopause before menarche, low estrogen and high LH and FSH |
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Most common cause of female pseudohermaphroditism
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Androgen exposure (CAH or exogenous)
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Most common cause of male pseudohermaphroditism
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Androgen insensitivity syndrome
High T and LH |
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Androgen Insensitivity Syndrome
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46XY, HIGH T, blind end vagina. No sexual hair. Testes in labia majora, remove to prevent malignancy
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5 alpha reductase def
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Externally female, internally male, Ambiguous till puberty then get virilization, deep voice, hair, etc. NORMAL T levels and LH. "Penis at 12"
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Kallmann Syndrome
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GnRH and olfactory neurons don't migrate, low synthesis of GnRH and anosmia. Hypogonadotropic hypogonadism
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Partial vs complete mole
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Complete - 46 XX or 46XY, HIGHER hCG, 2% to choriocarcinoma
Partial - 69XXX, 69XXY, 69XYY. Some fetal parts, lower risk of malignancy |
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Preeclampsia
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Hypertension, proteinuria, edema
Seizures = eclampsia Risk of placental ischemia and fetal death Treat with bed rest, salt restriction and monitoring, Diazepam and MgSulfate to prevent seizure |
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HELLP syndrome
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Hemolysis, Elevated LFTs, Low Platelets
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a) Abruptio placentae
b) Placenta accreta c) Placenta previa d) Ectopic pregnancy |
a) Abruptio placentae - premature placenta detachment and fetal death. DIC, SMOKING, HTN and COCAINE cause.
b) Placenta accreta - Defective decidual layer (D&C history), placenta attaches to myometrium, massive bleeding at delivery c) Placenta previa - Attachment to lower uterine segment, Multiparity and C-section raise risk d) Ectopic pregnancy - Usually fallopian tubes, high hCG, painful, mistaken for appendicitis, decidualized endometrium but no chorionic villi. RF include infertility, salpingitis, ruptured appendix, tubal surgery |
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Polyhydramnios
Oligohydramnios |
Polyhydramnios - HIGH (>1.5-2L) of amniotic fluid. May mean esophageal/duodenal atresia, or ancephaly
Oligohydramnios - LOW (<0.5L) amniotic fluid, placental insufficiency, renal agenesis, posterior urethral valves, can't excrete urine. Can lead to Potter's |
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Endometriosis vs Adenomyosis
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Endometrial tissue is in myometrium in adenomyosis. Uterus enlarged (not in normal endometriosis)
Both cyclic, menorrhagia, dysmenorrhea, |
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Endometrial Carcinoma Presentation
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Old, postmenopausal bleeding
Prolonged unopposed estrogen, PCOS, anovulatory cycles, HRT, granulosa tumor, obesity |
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Leiomyoma presentation
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Fibroid, middle age, AUB, miscarriages, iron def. anemia. Rarely transforms. NOT associated with leiomyosarcoma
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GYN tumor incidence and prognosis
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Incidence - endometrial > ovarian > cervical
Prognosis - ovarian > cervical > endometrial |
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Anovulation causes
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PCOS
Obesity Asherman's syndrome HPO axis abnormalities Premature ovarian failure Hyperprolactinemia Thyroid disorder Eating disorder Cushing's syndrome Adrenal insufficiency |
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Most common ovarian mass in young women
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Follicular cyst
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Tumor marker
a) Dysgerminoma b) Choriocarcinoma c) Yolk sac tumor |
a) Dysgerminoma - hCG, LDH, similar to seminoma but rare. Turner's association
b) Choriocarcinoma - hCG, trophoblast malignancy (NOT villi like moles), increases theca-lutein cysts. Spreads to lungs c) Yolk sac tumor - aFP, yellow, friable, solid masses. Schiller duval bodies |
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Teratoma types
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Mature - mostly benign, all 3 germ layers and developed
Immature - aggressively malignant, neural tissue Struma ovarri - thyroid tissue, can have hyperthyroidism |
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Brenner tumor
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Benign, UNIL tumor looks like bladder, solid and appears yellow and encapsulated
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Meig's syndrome
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Triad of ovarian fibroma, ascites and hydrothorax, pulling sensation in groin
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Granulosa cell tumor
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Estrogen secretion, precocious puberty
Call-Exner bodies and AUB |
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Krukenberg tumor
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GI malignancy (stomach) that goes to ovary
Signet rings |
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DES exposure
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clear cell adenocarcinoma of vagina
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Breast tumors
a) Fibroadenoma b) Intraductal papilloma c) Phyllodes tumor d) DCIS e) Comedocarcionoma f) Invasive ductal g) Invasive lobular h) Medullary i ) Inflammatory j) Paget's |
a) Fibroadenoma - benign, small, mobile, firm, size changes with estrogen. NO carcinoma risk
b) Intraductal papilloma - small, underneath areola, bloody discharge. slight carcinoma risk c) Phyllodes tumor - "leaf like", BULKY, rarely malignant d) DCIS - fills ductal lumen, no BM penetration e) Comedocarcionoma - DCIS with necrotic caseating center f) Invasive ductal - most common invasive, firm, fibrous "rock hard", "stellate" morphology g) Invasive lobular - orderly row of cells, OFTEN BIL h) Medullary - older pts, good prognosis i ) Inflammatory - peau d orange from lymphatic blockage, dermal lymphocytic invasion j) Paget's - eczematous patches on nipple, paget cells, signals underlying carcinoma, also seen on vulva |
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Gynecomastia causes
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hyperestrogenism (cirrhosis, testicular tumor, puberty, old age), Kleinfelter's, drugs (estrogen, marijuana, heorin, psychoactive)
SDCAK Spironolactone, Digitalis, Cimetidine, Alcohol, Ketoconazole |
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BPH signs, causes, treatments
Adenocarcinoma location |
Dysuria, frequency, urgency, low back pain
Hyperplasia in middle and lateral lobes, elevated PSA seen Treat 1) A1 antagonists (terazosin, tamsulosin) - relax muscle 2) Finasteride - block DHT production Adenocarcinoma in POST lobe, high PSA with lower fraction of free PSA, may have elevated alk phos from bone) |
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Transillumination and testicular mass
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NO illumination = cancer
Illumination = hydrocele, spermatocele, varicocele, etc |
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Testicular tumors
a) Seminoma b) Embryonal carcinoma c) Yolk sac d) Choriocarcinoma e) Teratoma f) Leydig cell |
Testicular tumors
a) Seminoma - most common, "fried egg", RADIOSENSITIVE b) Embryonal carcinoma - aggressive, painful, usually mixed. High hCG and aFP c) Yolk sac - high aFP, usually mixed, yellow, mucionous, schiller duval d) Choriocarcinoma - high hCG, usually mixed, may get gynecomastia because hCG is LH analog e) Teratoma - malignant (unlike females), high hCG and AFP f) Leydig cell - REINKE crystals, gynecomastia, precocious puberty |
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Flutamide, cyproterone, spironalactone
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Block androgen receptor complex, to treat BPH
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Anastrozole
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Block aromatase - lowers estrone and estrogen
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Ketoconazole
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Blocks P450 Scc (cholesterol desmolase)
For CAH or to lower androgens |
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Clomiphene
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Promotes anterior pituitary LH, FSH release via activating estrogen receptors
Used for infertility, PCOS Can cause hot flashes, ovarian enlargement, multiple pregnancy |
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GnRH antagonists use
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Pulse - promote cycles for infertility pts
Constant (leuprolide) - inhibit cycles for precocious puberty, prostate cancer inhibition, uterine fibroids |
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Fulvestrant
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Blocks estrogen expression in responsive cells to lower effect
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SERMS
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Tamoxifen and Raloxifene
Some tissues inhibits estrogen effect (breast cancer) but in some stimulates (bone resorption inh) |
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Finastride
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Blocks 5a reductase conversion of T to DHT to lower prostatic growth
Promotes hair growth too |
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Testosterone use
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Hypogonadism and promote 2ndary sex characteristics. Anabolism to promote recovery
Can lead to gonadal atrophy |
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Progestins use
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Bind progesterone receptors, reduce growth, increase vascularization of endometrium
Oral contraceptives |
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Ru486
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Mifepristone
Competitive inh of progestins at receptor Terminates pregnancy, given with misoprostal (PGE1) Can cause heavy bleeding, GI effect |
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Oral Contraceptives Contraindications
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Smokers > 35 years old (CV risk)
PTE, stroke or estrogen tumor history |
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Ritodrine/Terbutaline
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B2 agonists, relax uterus and reduce premature uterine contractions
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Danazol
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Synthetic androgen partial agonist
Used for endometriosis and hereditary angioedema Causes androgen excess symptoms |
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Estrogen effects on CV system
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Lowers LDL, raises HDL
Vasodilator and antioxidant to LDL to prevent atheroslcerosis IN developed plaques causes MMPs expression and risk of thrombus ONLY start on HRT at beginning of menopause, not over age 62 |
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Ligaments of female system
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Round Ligament and Ligament of Ovary - Gubernaculum remnants
Cardinal Ligament - vessels to uterus Suspensory Ligament of Ovary - vessels to ovary |
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Complete genital and perineal anesthesia
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Pudendal - under ischial spine
Genitofemoral (on psoas) - scrotum and labia major only Ilioinguinal |
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Most common hemorrhagic cystitis in kids
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Adenovirus
E.coli O157 after antibiotics |
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Most common cystitis and pyelonephritis cause
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E. coli and staph saprophyticus
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Ceftriaxone failure in cervicitis
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Usually due to C. trachomatis or U. urealyticum
Both lack peptidoglycan so has no effect. Chlamydia anomaly is that it makes penicillin binding proteins though for no reason |
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Earliest bHCG detected
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At least 6 days
Made by syncytiotrophoblasts |
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Causes of repeated N. gonorrhea
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Terminal complement deficiency
Antigenic variation of pili |
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Male lymphatic drainage
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Testes - para-aortic nodes
Scrotum and all down to feet including anus to dentate line, external genitalia. Except posterior calf goes to superficial inguinal) Glans penis - Deep inguinal |
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COCs action
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Stop pregnancy by
1) Stopping gonadotrophins (PRIMARY) 2) Thicken mucus 3) Make endometrium inhospitable |
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Lymphogranuloma venereum
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Due to Chlamydia trachomatis
Starts with small. painless ulcer Then lymphadenopathy, buboes, fistulas, strictures, granulomas |
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Tissue epithelium along female repro tract
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Ovary - simple cuboidal
Fallopian - simple columnar Uterus - simple/pseudostratified columnar Cervix - simple columnar or stratified squamous (endo vs ectocervix) Vagina - Stratified squamous non-keratinized |
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Embryology Genes
a) Shh b) Wnt-7 c) FGF d) Homeobox |
a) Shh - Polarzing along AP axis, mutated in holoprosencephaly
b) Wnt-7 - Apical ectoderm ridge, organizes DV axis c) FGF - Apical ectoderm ridge, stimulates mitosis of mesoderm underneath for limbs d) Homeobox - TF's involved in organization of craniocaudal direction, appendages in wrong locatiosn in mutation |
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Teratogen: ACEi
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Renal damage
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Teratogen: Alkylating agents
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Absence of digits, others
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Teratogen: Carbamazepine
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Neural tube defects, craniofacial defects, fingernail hypoplasia, developmental delay
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Teratogen: Lithium
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Ebstein's anomaly (atrialized right ventricle)
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Teratogen: Phenytoin
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Fetal hydantoin syndrome: microcephaly, dysmorphic craniofacial features, hypoplastic nails and distal phalanges, cardiac defects, IUGR, mental retardation
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Teratogen: Thalidomide
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Limb defects
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Teratogen: Valproate
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Inhibition of folate absorption in mother (neural tube)
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Teratogen: WArfarin
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Bone deformities, fetal hemorrhage, abortion, ophthalmologic
Switch to heparin |
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Teratogen: Alcohol
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Fetal alcohol syndrome (microcephaly, holoprosencephaly, facial abnormalities, limb dislocatoin, heart and lung fistulas, MR
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Teratogen: Cocaine
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Abnormal development, Placental abruption
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Teratogen: Smoking
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Preterm labor, placental problems, IUGR, ADHD
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Teratogen: Maternal diabetes
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Caudal regression syndrome, congenital heart defects, neural tube defects
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Monozygotic vs Dizygotic twins
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Monozygotic - One egg, splits, usually share amnion, risk of cord tangling
Dizygotic - two eggs, two amnions, may have two placentas |
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Aortic arch derivatives
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1st - Maxillary artery part
2nd - Stapedial artery and hyoid artery 3rd - Common Carotid artery, proximal internal carotid 4th - aortic arch on left, proximal subclavian on right 6th - Proximal part of pulm. arteries and on left only ductus arteriosus |
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Branchial apparatus parts by cell line of origin
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CAP
Clefts = ectoderm Arches = mesoderm and neural crest Pouches = endoderm |
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Brachnial cleft derivatives
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1st - external auditory meatus
2nd-4th - temporary cervical sinus, 2nd arch replace or you have a branchial cleft cyst |
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Branchial arch derivatives
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1st - Meckel's carticlage (Mandible, Malleus, incus, spheno-Mandibular lig); Muscles of Mastication (temporalis, Masseter, lateral and medial pterygoids, mylohyoid, anterior digastric, tensor tympani, tensor veli palatini). CN V2 and 3,
2nd _ Reichert's cartilage (Stapes, Styloid process, lesser horn hyoid, stylohyoid lig; muscles of facial expression, stapedius, stylohyoid, posterior digastric, CN VII) 3rd - Greater horn of hyoid, stylopharyngeus, Glossopharyngeal nerve 4th - Thyroid and cricoid cartilages Most pharyngeal constrictors, cricothyroid, levator veli palatini. CN X, 5th - NONE, degenerates 6th - Cartilages, all intrinsic muscles of larynx except cricothyroid, CN X |
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Brachial pouch derivatives
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1st - Middle ear cavity, ET tube, mastoid air cells,
2nd - Epithelial lining of palatine tonsil 3rd - Dorsal wings (INFERIOR parathyroid), Ventral wings (THYMUS); 4th - Dorsal wings (SUPERIOR parathyroids) |
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Cleft lip vs cleft palate
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Cleft lip - failure of fusion of maxillary and medial nasal processes
Cleft palate - failure of fusion of the lateral palatine processes, nasal septum and/or medial palatine processes Occur together, distinct causes |
