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97 Cards in this Set
- Front
- Back
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What ligament contains the ovarian vessels?
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Suspensory ligament of the ovaries
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What ligament contains the uterine vessels?
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Cardinal ligament
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What nerve causes penile erection?
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Pelvic nerve - parasympathetic
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What nerve causes emission?
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Hypogastric nerve - sympathetic
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What nerve causes ejaculation?
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Pudendal nerve - visceral and somatic
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The acrosome of the sperm is derived from what organelle?
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Golgi apparatus
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What is the nutritional source for sperm?
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Fructose - found in seminal vesicle products
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What are the functions of Sertoli cells?
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Secrete inhibin - inhibits FSH
Secrete androgen binding protein (ABP) - maintains high levels of testosterone Tight junctions form blood teste barrier - protects sperm from antibodies Produce anti-mullerian hormone |
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What does 5 alpha reductase do?
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Converts testosterone to DHT, which is more potent.
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What effect does estrogen have on prolactin?
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Stimulates prolactin secretion, but blocks its action at the breast.
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What estrogen is expressed by the placenta?
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Estriol
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What effect does estrogen have on carrier proteins?
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Increases sex hormone binding globulin
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What effect does estrogen have on lipid profile? What effect does testosterone have?
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Estrong increases HDL, decreases LDL (good effect)
Testosterone increases LDL, decreases HDL (bad effect) |
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What causes the increase in temperature seen during ovulation?
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Progesterone being to increase 24 hours before ovulation, increasing body temperature. It takes sperm about 24 hours to reach the egg, so the temperature indicates the best time for conception.
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What is mittelschmerz?
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Blood from the ruptured follicle causes peritoneal irritation that can mimic appendicitis.
Most women, however, don't notice anything when they ovulate. |
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What causes lactation after labor? What maintains milk production?
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The decrease in maternal progesterone induces lactation.
Suckling is required to maintain milk production, since increased nerve stimulation increases prolactin and oxytocin. |
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What effect does prolactin have postpartum?
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Induces and maintains lactation and decreases reproductive function.
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What effect does oxytocin have postpartum?
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Appears to help with milk letdown and may be involved with uterine contractions (function not yet entirely understood).
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In what pathologic states is hGC elevated?
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Molar pregnancy, choriocarcinoma, and gestational trophoblastic tumors
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What causes menopause?
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A decrease in estrogen due to decline in the number of ovarian follicles. Usually preceeded by 4-5 years of abnormal menstrual cycles.
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What hormonal changes are seen in pregnancy?
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Decrease in estrogen, big increase in FSH (no more estrogen feedback inhibition), increase in LH (no more estrogen feedback inhibition), increase in GnRH
Increased FSH can be used as a confirmatory test, although this is typically not done. |
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What states can menopause cause?
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HHAVOC - Hirsutism, hot flashes, atrophic vaginitis, osteoporosis, and coronary artery diesase
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What hormone profile is seen in Klinefelter's syndrome?
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Dysgenesis of seminiferous tubules leads to decreased inhibin and increased FSH.
Abnormal Leydig cell function leads to decreased testosterone, increased LH, and increased estrogen. |
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What characteristics are seen in Turner's syndrome?
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Short stature, ovarian dysgenesis (streak ovary), shield chest, bicuspid aortic valve, webbing of neck (cystic hygroma), preductal coarctation of the aorta and no barr body. Turner's is the most common cause of amenorrhea.
45 XO Decreased estrogen leads to increased LH and FSH. |
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Androgen insensitivity syndrome
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(46XY) Defect in androgen receptor resulting in normal-appearing female; female external genitalia with rudimentary vagina; uterus and uterine tubes generally absent; presents with no sexual hair; develops testes (often found in labia majora; surgically removed to prevent malignancy). Increased testosterone, estrogen, and LH.
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5 alpha reductase deficiency
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Inability of males to convert testosterone to DHT. Ambiguous genitalia until puberty, when increased testosterone causes masculinization and increased growth of external genitalia. Testosterone/estrogen levels are normal; LH is normal or elevated. Internal genitalia are normal.
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What is a hydatidiform mole?
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Cystic swelling of chorionic villi and proliferation of chorionic epithelium (trophoblast). Most common precursor to choriocarcinoma
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What are common causes of recurrent miscarriages in the 1st weeks, 1st trimester, and 2nd trimester?
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1st weeks - low progesterone levels (no response to hCG)
1st trimester - chromosomal abnormalities 2nd trimester - bicornuate uterus (incomplete fusion of paramesonephric ducts) |
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What causes preeclampsia?
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Placental ischemia due to impaired vasodilation of spiral arteries, resulting in increased vascular tone.
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What causes mortality in women with preeclampsia?
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Cerebral hemorrhage and ARDS
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What is the treatment for preeclampsia?
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Magnesium sulfate; Diazepam for seizures is controversial.
Treatment of seizures does NOT reduce the chances of developing seizures (eclampsia). |
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What are the symptoms of magnesium toxicity?
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Hyporeflexia, pulmonary edema, and decreased respiratory drive.
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What is Potter's syndrome?
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Bilateral renal agenesis due to malformation of the ureteric bud, causing oligohydraminos, limb deformities, facial deformities, and pulmonary hypoplasia.
Death after birth in these newborns is normally due to lung immaturity. |
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What is blood filled "chocolate cysts" a symptom of?
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Endometriosis
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Where are you most likely to find ectopic endometrial tissue in endometriosis?
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Ovary or on peritoneum
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What causes endometrial hyperplasia? How does endometrial hyperplasia normally present?
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Excess estrogen stimulation.
Endometrial hyperplasia normally presents as postmenopausal vaginal bleeding. |
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What is the most common gynecologic malignancy?
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Endometrial carcinoma
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What is the most common tumor in females?
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Leiomyoma (fibroid)
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How does leiomyoma present histologically?
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Whorled pattern of smooth muscle bundles.
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What is the treatment of leiomyoma?
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Leiomyoma is estrogen sensitive. Its size increases with pregnancy and decreases with menopause. It can be treated by inducing a menopausal state with leuprolide.
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What is Asherman's syndrome?
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Endometrial fibrosis, often due to a surgical procedure like a d & c. Will cause amenorrhea, but not anovulation.
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What hormone abnormality is primary one found in polycystic ovarian syndrome?
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Increased LH production, which leads to anovulation and hyperandrogenism due to deranged steroid synthesis by theca cells.
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What type of cancer has an increased incidence in patients with PCOS?
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Endometrial cancer
OCPs decrease the risk of endometrial cancer in these patients. |
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What are the treatment options for PCOS?
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Weight loss, oral contraceptive pills (suppress LH and decrease production of androgens and estrone), gonadotropin analogues, clomiphene, metformin (treats insulin resistance and it can reinstitute an ovulatory cycle), spironolactone (antiandrogen), or surgery.
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Follicular cyst
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Distention of unruptured graafian follicle. May be associated with hyperestrinism and endometrial hyperplasia.
Can be a physiologic condition |
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Theca-lutein cyst
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Often bilateral/multiple. Due to gonadotropin stimulation. Associated with choriocarcinoma and moles.
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Struma ovarii
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Teratoma containing functional thyroid tissue. Can present as hyperthyroidism.
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hCG and LDH turmor markers are associated with which tumor in women?
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Dysgerminoma
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Which tumor is associated with increased hCG and Schiller-Duval bodies in women?
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Yolk sac (endodermal sinus) tumor
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Whats the most common ovarian tumor?
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Serous cystadenocarcinoma
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Pseudomyxoma peritonei
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Intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor. In the case of ovarian tumors, often caused by mucinous cystadenocarcinoma.
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Krukenberg tumor
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GI malignancy that metastasizes to ovaries, causing a mucin-secreting signet cell adenocarcinoma.
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What is Meigs' triad?
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Triad of ovarian fibroma, ascites, and hydrothorax
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Which ovarian non-germ cell tumor is associated with Call-Exner bodies?
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Granulosa cell tumor
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Sarcoma botryoides
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Rhabdomyosarcoma variant; affects girls less than 4 years of age; spindle shaped tumor cells that are desmin positive.
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Phyllodes tumor of the breast
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Large bulky mass of connective tissue and cysts. "Leaf like" projections. Most common in 6th decade. Some may become malignant.
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What is the most common breast tumor in women younger than 25?
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Fibroadenoma
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What is the single most important prognostic factor for malignant breast cancer?
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Axillary lymph node involvement
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What is Paget's disease?
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Eczematous patches on nipple. Paget cells = large cells in epidermis with clear halo. Suggests underlying carcinoma. Also seen on the vulva.
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What is the general ovarian cancer marker?
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CA-125
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What is the most common cause of breast lumps in women from age 25 to menopause?
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Fibrocystic disease
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Which type of malignant breast cancer often presents with multiple, bilateral lesions?
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Invasive lobular
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Which type of breast cancer presents as caseous necrosis?
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Comedocarcinoma (subset of ductal carcinoma in situ)
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What drugs can cause gynecomastia?
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Spironolactone, Digitalis, Cimetidine, Alcohol, Ketoconazole (Some Drugs Create Awesome Knockers)
Also marijuana, heroin, and psychoactive drugs. |
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What causes benign prostatic hyperplasia?
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May be due to an age related increase in estradiol with possible sensitization of the prostate to the growth-promoting effects of DHT.
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Which lobes of the prostate are enlarged in BPH? Which lobe affected in postatic cancer?
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Periurethral lateral and middle lobes are enlarged in BPH.
The posterior lobe is most frequently involved in prostatic cancer. |
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Is BPH considered a premalignant lesion?
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No
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What is the treatment for BPH?
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alpha 1 antagonists (terazosin, tamsulosin) which cause relaxation of smooth muscle, or finasteride (5 alpha reductase inhibitor).
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What tumor markers are useful in BPH?
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Prostatic acid phosphatase (PAP) and PSA are useful tumor markers. Total PSA will be increased but the fraction of FREE PSA will be decreased).
Osteoblastic metastases in bone may develop in late stages, as indicated by lower back pain and an increase in serum alkaline phosphatase and PSA. |
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What type of tumors are patients with cryptorchidism are an increased risk of getting?
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Germ cell tumors
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What is the most common testicular germ cell tumor?
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Seminoma
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What tumor in men is associated with an increased alpha fetal protein and hCG?
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Embryonal carcinoma
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Which testicular tumor contains Reinke crystals?
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Leydig cell tumor
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Why would a leydig cell tumor, which produces androgens, cause gynecomastia in adult men?
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Peripheral conversion of androgens to estrogen
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What is the most common testicular cancer in older men?
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Testicular lymphoma
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What is Bowen's disease?
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Gray, solitary, crust plaque on the shaft of the penis or on the scrotum; peak incidence in 5th decade of life; progresses to SCC in < 10% of cases. Can also be found on vulva of females.
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Erythroplasia of Queyrat
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Red velvety plaques, usually involving the glans. A form of Bowen's disease.
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Bowenoid papulosis
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Multiple papular lesions; affects younger age group than other Bowen's disease subtypes. Usually does not become invasive.
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Peyronie's disease
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Bent penis due to aquired fibrous tissue formation.
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Which hypothalamic nucleus is involved in ovulation?
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Arcuate nucleus of the hypothalamus (produced GnRH)
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What is the treatment for menopausal hot flashes?
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Estrogen replacement (most effective), SNRI (venlafaxine), then clonidine (alpha blocker) or gabapentin
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What is the birth control of choice for patients with mental retardation?
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Medroxyprogesterone
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An obese woman presents with amenorrhea and increased levels of serum testosterone. What is the most likely diagnosis?
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PCOS
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Why is progesterone used in combination with estrogen during estrogen replacement?
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Reduce the risk of endometrial cancer
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Under what circumstances would you expect to see an increased LH?
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Ovulation, menopause, PCOS, androgen insensitivity syndrome, Turner's syndrome, and Klinefelter's syndrome
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What causes morning sickness in pregnancy?
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Decreased blood pressure and increased beta-hCG
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What type of acid base disturbance is seen physiologically in pregnancy?
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Mild respiratory alkalosis
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A 23 year old patient that is on rifampin for TB prophylaxis and on birth control gets pregnant. Why?
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Rifampin increased P450 metabolism, decreased the birth control's effect.
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Which breast cancer presents with signet ring cells and is always estrogen and progesterone sensitive?
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Lobular carcinoma in situ (LCIS)
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Which breast cancer presents with the loss of the e-cadherin cell adhesion gene on chromosone 16?
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Invasive lobular carcinoma
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Where does invasive lobular carcinoma most commonly metastasize?
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Peritoneum
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What would you give to inhibit prolactin secretion?
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A dopamine agonist, like bromocriptine
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Which cells are responsible for maintaining a high testosterone concentration in the seminiferous tubules?
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Sertoli cells secrete androgen binding protein, which is responsible for the high level of testosterone (Leydig cells are the ones that actually produce the testosterone)
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How do you differentiate testicular torsion from epididymitis?
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If support the testis offers some relief, it is epididymitis. If not, it is torsion.
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A 55 year old man undergoing treatment for BPH has increased testosterone and decreased DTH as well as gynecomastia and edema. What is his medication?
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Finasteride
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How many carbon molecules are there in testosterone and andostenedione?
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19
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To where does testicular cancer first metastasize?
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Para-aortic lymph nodes
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