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116 Cards in this Set

  • Front
  • Back
What nodes does the proximal 2/3 of the vagina/uterus drain to?
Obturator, external iliac, and hypogastric nodes
What is the round ligament of the uterus?
Connects uterine fundus to labia majora. Derived from the gubernaculum. Travels through the inguinal canal.
Which ligament contains the uterine vessels?
Cardinal ligament (cervix to side wall of pelvis)
3 causes of neurological disease leading to erectile dysfunction?
Autonomic diabetic neuropathy, MS, and damage from radical prostatectomy
Where do the acrosome and the tail of sperm come from?
Acrosome comes from Golgi and tail forms from the centrioles.
What accounts for 90% of male infertility?
Seminiferous tubule dysfunction. Associated with varicocele, Klinefelter's, and orchitis.
What is Leriche syndrome?
Aortoiliac atherosclerosis. Cause of vascular insufficiency leading to ED (decreased penile blood flow, calf claudication, etc)
How does hypothyroidism lead to ED?
Primary hypothyroidism --> increased TRH levels --> increased release of PRL --> shuts down GnRH axis
What does spermiogenesis refer to?
Spermatid to spermatozoa. Involves loss of cytoplasmic contents and gain of acrosomal cap. No change in genetic material (both N).
What happens between the primary and secondary spermatocytes?
Meiosis 1. Primary spermatocyte is 4N. Secondary spermatocyte is 2N.
What does progesterone do to the uterus?
Decreases myometrial excitability/prevents contractions. Stimulates endometrial glandular secretions and spiral artery development.
Potency of 3 estrogens?
Estradiol > estrone > estriol
How is estriol formed?
Fetal zone of the adrenal cortex makes DHEA-S, fetal liver makes 16-OH-DHEA-S, placenta makes estriol, and maternal liver conjugates estriol and excretes it in urine.
4 causes of decreased SHBG?
Androgens, obesity, insulin, and hypothyroid.
What is Mittelschmerz?
Blood from ruptured follicle causes peritoneal irritation that can mimic appendicitis. Mittelschmerz is German for "middle pain" (middle of menstrual cycle).
Most common site of fertilization?
Ampulla (upper end) of fallopian tube.
Site of progesterone production.
Corpus luteum for the 1st trimester (due to stimulation by hCG producted in the syncytiotrophoblast), then the placenta for the 2nd/3rd trimesters.
Best test to confirm menopause?
Increased FSH (due to loss of negative feedback by estrogen).
Main type of estrogen post-menopause?
Estrone. Due to peripheral conversion of androgens.
Cause of thick neck in Turner's syndrome?
Cystic hygroma (lymphangioma often in posterior neck) --> causes webbed neck.
What is a Barr body?
Inactive X chromosome. NOT seen in Turner's syndrome (XO).
Disease? Male with low testosterone and inhibin, eunuchoid body shape, gynecomastia, developmental delay, and presence of Barr body?
Klinefelter's syndrome. (XXY)
Common cause of 2nd trimester recurrent miscarriage?
Bicornuate uterus (incomplete fusion of paramesonephric duct)
Cause of mortality in pre-eclampsia/eclampsia?
Cerebral hemorrhage and ARDS.
Seizure prevention with pre-eclampsia?
Delivery! But otherwise IV magnesium sulfate and diazepam. Also bed rest, salt restriction, treat HTN.
What does 2 sperm + an empty egg cause?
Complete mole! 46XX or 46XY. Increased hCG, uterine size. Risk of conversion to choriocarcinoma. NO fetal parts.
Risk factors for endometrial hyperplasia?
Granulosa cell tumor, PCOS, HRT, anovulatory cycles
Age cutoff for premature ovarian failure?
40 yo w/ signs of menopause
Common causes of anovulation?
PCOS, obesity, HPO axis, premature ovarian failure, hyper-PRL, thyroid disorders, eating disorders, Cushing's syndrome, adrenal insufficiency
Values for oligo and polyhydramnios?
< 0.5 L or > 1.5-2 L
Attachment of placenta to lower uterine segment with occlusion of internal os and painLESS bleeding?
Placenta previa.
Risk for placenta previa?
Multiparity or prior C-section.
Premature detachment of placenta from implantation site with painFUL bleeding in 3rd trimester?
Abruptio placentae.
Risks for abruptio placentae?
Smoking, HTN, cocaine use, AMA, trauma, chorioamnionitis
Defective decidual layer allows placenta to attach to myometrium without separation of placenta after birth?
Placenta accreta.
Risk factors for placenta accreta?
Prior C-section, inflammation, and placenta previa.
Treatment for PCOS?
Weight loss, OCPs, gonadotropin analogs, clomiphene, spironolactone (for hirsutism), surgery
What causes a theca-lutein cyst?
Gonadotropin stimulation (so they're often multiple/bilateral). Associated with choriocarcinoma and moles.
2 hormones that contribute to BPH?
Estradiol (age related increase in sensitization) with DHT (growth promoting effects)
Increased free vs bound PSA?
Total PSA is increased in both BPH and prostate cancer. BPH: greater increase in free PSA. Cancer: decreased free fraction.
What is seen in the transitional vs periurethral zone in BPH?
Transitional zone: glandular hyperplasia.
Periurethral zone: stromal hyperplasia (leads to urethral obstruction)
Lobes of BPH vs prostate cancer?
BPH: lateral and middle (periurethral)
Cancer: posterior (peripheral)
Hallmark of prostate cancer on histology?
Perineural invasion. Also vascular and capsular invasion, etc.
Hormones that contribute to cryptorchidism?
Possible defect in androgen and hCG levels. Most spontaneously descend in 3 mo.
Drugs that can cause gynecomastia?
Spironolactone, Digitalis, Cimetidine, Alcohol, Ketoconazole, Leuprolide, Flutamide
Pathology of lactiferous sinus of breast?
Intraductal papilloma, breast abscess, mastitis
Pathology of nipple?
Paget's disease, breast abscess
Pathology of terminal duct?
Tubular carcinoma
Pathology of breast stroma?
Fibroadenoma, phyllodes tumor
Pathology of lobules of breast?
Lobular carcinoma, sclerosing adenosis
Pathology of major duct in breast?
Fibrocystic change, ductal cancer
Different types of fibrocystic breast disease?
Sclerosing adenosis (intralobular), epithelial hyperplasia (terminal duct lobules), fibrosis (stroma), cystic (ductal dilation)
Drainage of inner and outer breast quadrants?
Inner --> internal mammilary nodes
Outer --> axillary nodes
What is an easy way to distinguish testicular tumors from other testicular masses?
Transillumination (hydrocele and spermatocele). Note: varicocele does not transilluminate.
What is a unique histological finding of Leydig cell tumors?
Reinke crystals: cytoplasmic protein crystals. Golden brown color overall.
Most common testicular cancer in older men?
Testicular lymphoma (non-germ cell tumor)
Name for when the orifice of the prepuce is too small to retract over the head of the penis?
Phimosis. Often associated with infection.
Name for red velvety plaques on the penis and their location?
Erythroplasia of Queyrat/erythroplakia. Usually involves glans.
2 precursors to SCC of the penis?
Bowen's disease and erythroplasia of Queyrat
Gray solitary crusty plaque on shaft of penis or scrotum?
Bowen's disease
Multiple papular lesions on penis of young man?
Bowenoid papulosis (considered CIS but almost never invasive)
Histological lesions that resemble primitive glomeruli?
Schiller-Duval bodies. Seen in yolk sac (endodermal sinus) tumors.
Which testicular cancer is painful?
Embryonal carcinoma. Often have glandular/papillary morphology with bulky hemorrhage and necrosis.
Most common testicular tumor?
Seminoma. See lobules of "fried egg" cells, lymphocytes or granulomas. Very radiosensitive.
Use of exemestane/anastrozole in women?
Treat ER-positive breast cancer (aromatase inhibitor)
What are the two mechanisms of Leuprolide?
Acts as a GnRH agonist when used in a pulsatile manner (ie: for infertility) or as an antagonist when used in a continuous manner (ie: for prostate cancer, uterine fibroids)
Contraindications of estrogen use?
ER positive breast cancer, history of DVT
Estrogen partial agonist on bone?
Raloxifene
Partial estrogen agonist at receptors in hypothalamus?
Clomiphene. Stimulates ovulation (tx for infertility, PCOS)
Finasteride vs Flutamide?
Finasteride (5-alpha-reductase inhibitor) is used in BPH and for male pattern baldness. Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor and is used for prostate cancer.
PGE2 analog used to induce labor?
Dinoprostone
Beta-2 agonists that relax uterus and reduce premature delivery?
Ritodrine and terbutaline.
Alpha 1 receptors on prostate vs vasculature?
Alpha 1 A, D found on prostate (and selectively inhibited by tamsulosin). Alpha 1 B found in vessels.
Grape like mass of vagina with spindle shaped tumor cells that stain desmin positive?
Sarcoma botyroides (rhabdomyosarcoma variant)
Fibroadenoma is common with which medication?
Cyclosporine
Bloody nipple discharge --> think?
Intraductal papilloma. In lactiferous sinus region of breast.
Phyllodes tumor characteristics?
Large bulky mass of connective tissue, leaf-like projections, lobulated. Hypercellular stroma with mitoses.
Meds that cause galactorrhea?
OCPs, phenothiazines, methyldopa, H2 blockers, anxiolytics
What do Paget cells look like?
Large cells in epidermis with clear halo.
Subtype of DCIS with caseous necrosis?
Comedocarcinoma.
Bilateral breast cancer?
Invasive lobular. Orderly rows of cells or concentric circles (bull's eye).
Rock hard breast mass with stellate shape?
Invasive ductal cell carcinoma.
Meigs' syndrome?
Triad of ovarian fibroma or tumor, ascites, and hydrothorax (R pleural effusion)
What is struma ovarii?
Type of ovarian teratoma that contains functional thyroid tissue and can present as hyperthyroidism.
Where are Call-Exner bodies?
Small follicles filled with eosinophilic secretions. Seen in Granulosa cell tumors.
Which ovarian tumor looks like bladder tisue (Walthard's rests: transitional-like epithelium)?
Brenner tumor
Which ovarian tumor has intestine-like tissue?
Mucinous cystadenoma. Multilocular cyst lined by mucus secreting epithelium.
What findings are in mucinous cystadenocarcinoma?
Pseudomyxoma peritonei: intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor. "Beach ball" appearance.
Pulling sensation in groin: which ovarian tumor?
Fibroma (non-germ-cell)
Bilateral ovarian tumors?
Serous cystadenocarcinoma.
Which chromosomes are commonly involved in translocations?
13, 14, 15, 21, 22 (cluster during meiosis)
What happens between a primordial germ cell, an oogonium, and a primary oocyte in prophase?
2 cycles of mitosis
Resting stage of primary oocyte until just before ovulation?
Diplotene stage of prophase 1.
Follicle with primary oocyte surrounded by layer of flat epithelial (follicular) cells?
Primordial follicle
Primary oocyte surrounded by stratified layer of granulosa cells and well defined zona pellucida?
Primary follicle
Oocyte surrounded by zona pellucida where egg is off center and fluid has accumulated within layers of granulosa cells?
Secondary (antral) follicle
Which meiosis involves exchange of genetic material between homologous chromosomes?
Meiosis 1
What happens in the ovary without FSH stimulation?
Primary follicles die and become atretic.
Order of ovarian follicle development?
Primordial, primary, secondary/antral, pre-ovulatory
What happens to the corpus luteum if fertilization does not occur?
The lutean cells degenerate (luteolysis) and form a mass of fibrotic scar tissue (the corpus albicans).
3 phases of fertilization process?
1. Penetration of the corona radiata
2. Penetration of the zona pellucida
3. Fusion of the oocyte and sperm cell membranes
Drainage of distal 1/3 of vagina/vulva/scrotum?
Superficial inguinal lymph nodes
Which ligament contains the ovarian vessels?
Suspensory ligament of the ovary (ovary to lateral pelvic wall)
Which ligament travels through the inguinal canal?
Round ligament of the uterus
Fallopian tube epithelium?
Simple columnar epithelium, ciliated
Uterus epithelium?
Simple columnar epithelium, pseudostratified, with tubular glands
Top causes of seminiferous tubule dysfunction?
Varicocele, Klinefelter's syndrome, orchitis
What cells secrete androgen binding protein (ABP)?
Sertoli cells
- maintains proper levels of testosterone
What produces primary spermatocytes?
Spermatogonia (most primitive germ cells)
Early vs late effects of DHT?
Early: differentiation of penis, scrotum, and prostate

Late: prostate growth, balding, sebaceous gland activity
Estrogen's effect on prolactin?
Estrogen stimulates prolactin secretion but blocks its action at the breast.
Metrorrhagia vs Menometrorrhagia?
Metrorrhagia: frequent but irregular menstruation

Menometrorrhagia: heavy, irregular menstruation at irregular intervals
Hormone changes in Klinefelter's syndrome?
Low testosterone
High LH
High estrogen
Hormone levels in PCOS?
High LH
Low FSH
High testosterone
Common ovarian cyst in pregnancy?
Corpus luteum cyst

- caused by hemorrhage into persistent corpus luteum
Frequency of what type of cyst is increased with choriocarcinoma?
Theca-lutein cyst
- high hCG production