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119 Cards in this Set
- Front
- Back
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Outline the general hormone sequence of the female reproductive cycle
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FSH --> Follicle maturation --> Estradiol produc --> LH surge --> Ovulation & progesterone produc (+ estradiol) --> Inhib of SH & LH produc --> Corpus luteum decline --> No produc of estradiol & proges --> Loss of FSH inhib --> Inc FSH
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Which hypothalamic nucleus is involved in ovulation?
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Arcuate nucleus (GnRH)
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What are the layers of the endometrium? Which layers are shed during menstruation?
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- Stratum basalis
- Stratum spongiosum (shed) - Stratum compactum (shed) |
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When does the basal body temp increase occur in relation to ovulation?
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24 hrs after ovulation
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What cells of the corpus luteum secrete progesterone & estrogen?
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- Granulosa lutein cells
- Theca lutein cells |
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What uterine pathology matches the following description?
Excess unopposed estrogen is the main risk factor |
Endometrial hyperplasia & carcinoma
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What uterine pathology matches the following description?
Menorrhagia w/ enlarged uterus & no pelvic pain |
Leiomyoma
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What uterine pathology matches the following description?
Pelvic pain that is present only during menstruation |
Endometriosis
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What uterine pathology matches the following description?
Diagnosed by endometrial biopsy in clinic |
Endometrial hyperplasia & carcinoma
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What uterine pathology matches the following description?
Definitive diagnosis & treatment by laproscopy |
Endometriosis
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What uterine pathology matches the following description?
Menstruating tissue within myometrium |
Adenomyosis
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What uterine pathology matches the following description?
Malignant tumor of the uterine smooth muscle |
Leiomyosarcoma
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What uterine pathology matches the following description?
Most common gynecologic malignancy |
Endometrial carcinoma
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What are the 4 main categories of ovarian tumors?
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1. Epithelial (65% of ovarian tumors, 90% of ovarian cancers)
2. Germ cell 3. Stromal 4. Metastatic (GI, breast, endometrium) 1-3 are ovarian |
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What are the main types of epithelial cell ovarian tumors?
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- Serous!
- Mucinous! - Endometrioid! - Clear cell - Brenner - Mixed {My Med Students Consistently Beat Exams} |
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What are the main types of germ cell ovarian tumors?
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- Teratoma!
- Dysgerminoma! - Endodermal sinus - Choriocarcinoma |
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What are the main types of stromal/sex cord ovarian tumors?
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- Granulosa theca cell
- Sertoli-Leydig cell - Fibroma |
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What ovarian tumor matches the following statement?
Produces AFP |
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What ovarian tumor matches the following statement?
Estrogen secreting --> precocious puberty |
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What ovarian tumor matches the following statement?
Intraperitoneal accumulation of mucinous material |
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What ovarian tumor matches the following statement?
Testosterone secreting --> virilization |
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What ovarian tumor matches the following statement?
Psammoma bodies |
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What ovarian tumor matches the following statement?
Multiple different tissue types |
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What ovarian tumor matches the following statement?
Lined w/ fallopian tube-like epithelium |
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What ovarian tumor matches the following statement?
Ovarian tumor + ascites + pleural effusions |
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What ovarian tumor matches the following statement?
Call Exner bodies |
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What ovarian tumor matches the following statement?
Resembles bladder epithelium |
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What ovarian tumor matches the following statement?
Elevated beta hCG |
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HYQ: An obese woman presents w/ amenorrhea & inc levels of serum testosterone. What is the most likely diagnosis?
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HYQ: A pt w/ polycystic ovarian dz is most @ risk for developing which type of cancer?
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HYQ: Why is progesterone used in combo w/ estrogen during estrogen replacement?
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HYQ: Under what circumstances would you expect to see an elevated LH?
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What are the risk factors for ovarian cancer?
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What are some of the normal physiologic changes that take place during pregnancy?
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1. Inc plasma vol, RBC vol (= Inc preload) --> Inc CO
2. Vasodilatation --> Dec BP (early preggo) --> return to normal by term 3. Inc min vent --> Dec PACO2 & PaCO2 --> mild resp alk --> CO2 transferred more easily from fetus to mother 4. Inc procoag factors --> Hypercoagu state 5. Inc GFR --> Dec Bun & Cr 6. Normal TSH & free T4 7. Inc periph resist to insulin (human placental lactogen) that worsens throughout pregoo --> hyperinsulinemia, hyperglycemia & hyperlipidemia |
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What is the difference btwn placental previa, abruptio & accreta?
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- Previa: Placenta overlies cervical os; Painful vaginal bleeding; Need C section
- Abruptio: Painful +/- vaginal bleeding; A/w trauma or abuse; Life threatening to fetus - Accreta: Placenta doesn't separate from myometrium b/c abnormally attached |
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HYQ: A preggo woman w/ previous c-section is @ increased risk for what?
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- Placenta accreta
- Placenta previa |
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HYQ: A preggo woman @ 16 wks of gestation presents w/ an atypically large abdomen & HTN. What abnormality might be seen on blood test & what is the d/o?
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1. Molar preg/Hydatidiform mole
2. Excessively inc beta hCG |
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HYQ: What substance is present in high levels in cases of hydatidiform moles?
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beta hCG
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HYQ: A 15 yo female patient of yours that normally comes w/ her parents presents alone this time. She states that she is sexually active but that she knows she is not pregnant b/c she has never menstruated. What would be the appropriate next step in managing this pt?
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1. Assess for 2ndary sex character +/- workup for delayed puberty
2. Educate pt she can become preggo before 1st menstrual cycle 3. Educate about STDs 4. Offer birth control |
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HYQ: A 23 yo female who is on rifampin for TB prophylaxis & on birth control (estrogen) gets pregnant. Why?
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Rifampin revs up CP450 --> Inc met of birth control pills.
Birth control less effective w/ Rifampin |
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HYQ: What is the best option for birth control in a mentally retarded pt?
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IM medroxyprogesterone
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Types of benign epithelial lesions
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1. Nonproliferative breast changes (fibrocystic changes)
- Cysts -Fibrosis -Adenosis: Fibroadenoma 2. Proliferative breast dz w/ atypia - Sclerosing adenosis - Epithelial hyperplasia - Complex sclerosing lesion (radial scar) - Papillomas |
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Types of in situ breast carcinoma
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1. Ductal carcinoma in situ (DCIS, intraductal carcinoma)
- Comedocarcinoma - Solid - Cribriform - Papillary - Micropapillary - Paget dz 2. Lobular carcinoma in situ |
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Types of invasive carcinoma
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1. Inflammatory carcinoma
2. Invasive ductal (70-80%) 3. Invasive lobular carcinoma 4. Tubular/cribriform carcinoma 5. Mucinous carcinoma 6. Medullary carcinoma 7. Papillary carcinoma 8. Metaplastic carcinoma |
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What breast pathology fits the following description?
Most common breast tumor in women under 25 |
Fibroadenoma
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What breast pathology fits the following description?
Most common breast mass in postmenopausal women |
invasive ductal carcinoma
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What breast pathology fits the following description?
Most common breast mass in premenopausal women |
Fibrocystic changes
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What breast pathology fits the following description?
Most common form of breast cancer |
invasive ductal carcinoma
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What breast pathology fits the following description?
Small, mobile firm mass w/ sharp edges in 24 yo female |
Fibroadenoma
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What breast pathology fits the following description?
Histological "leaf like" projections |
Phyllodes tumor
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What breast pathology fits the following description?
Signet ring cells |
Lobular carcinomas in situ (invasive lobular carcinoma too)
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What breast pathology fits the following description?
Loss of e-cadherin cell adhesion gene on chrom 16 |
Invasive lobular carcinoma
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What breast pathology fits the following description?
Always ER (+) & PR (+) |
Lobular carcinoma in situ
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What breast pathology fits the following description?
Commonly presents w/ nipple discharge |
Intraductal papilloma
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What breast pathology fits the following description?
Eczematous patches on nipple |
Paget's dz
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What breast pathology fits the following description?
Multiple bilateral fluid filled lesions w/ diffuse breast pain |
Fibrocystic changes of breast
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What breast pathology fits the following description?
Firm, fibrous mass in a 55 yo woman |
Invasive ductal carcinoma
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HYQ: A 58 yo postmenopausal woman is on Tamoxifen. What is she @ inc risk of acquiring?
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Endometrial cancer
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What is the 2 cell theory of estradiol production?
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- Theca cells make androstenedione
- Granulosa cells make estradiol from androstenedione |
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What are the target cells of LH?
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Theca cells, Leydig cells
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What are the target cells of FSH?
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Granulosa cells, Sertoli cells
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What are the pros of oral contraceptive pills?
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- Reliable
- Low fail rate - Dec risk of endometrial & ovarian cancer - Dec risk of preggo & ectopic preggo - Regulate menses - Dec dysmenorrhea - improve acne |
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What are the cons of oral contraceptive pills?
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- Daily dosing
- No STD prevention - Inc TG levels - Nausea - HTN - Induce hypercoagulable state |
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Estrogen or Progesterone?
Production of thick mucus that inhibits entry of sperm into the uterus |
Progesterone
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Estrogen or Progesterone?
Induces LH surge |
Estrogen
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Estrogen or Progesterone?
Uterine smooth muscle relaxation |
Progesterone
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Estrogen or Progesterone?
Follicle growth |
Estrogen
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Estrogen or Progesterone?
Maintenance of pregnancy |
Progesterone
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Estrogen or Progesterone?
Hepatic synthesis of transport proteins |
Estrogen
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Estrogen or Progesterone?
Withdrawal leads to menstruation |
Progesterone
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What drug would you give to inhibit prolactin secretion?
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Dopamine analog (Bromocriptine)
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When does beta hCG appear in the urine during pregnancy?
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4 wks after LMP
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What hormonal changes are seen during menopause?
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- Dec estrogen
- Inc GnRH, FSH, Lh |
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What is the underlying cause of PCOS?
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Inc LH
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What are the clinical manifestations of PCOS?
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- Amenorrhea
- Infertility - Obesity - Hirsutism - Impaired glucose tolerance |
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What is the treatment of PCOS?
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- OCPs
- Wt loss - Metformin - Clomiphene - Leuprolide - Spironolactone |
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What ovarian tumor matches the following statement?
Produces AFP |
Yolk sac (Endodermal sinus)
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What ovarian tumor matches the following statement?
Estrogen secreting --> precocious puberty |
Granulosa theca cells
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What ovarian tumor matches the following statement?
intraperitoneal accumulation of mucinous material |
Mucinous cystadenocarcinoma
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What ovarian tumor matches the following statement?
Testosterone secreting --> virilization |
Sertoli-Leydig cells
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What ovarian tumor matches the following statement?
Psammoma bodies |
Serous cystadenocarcinoma
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What ovarian tumor matches the following statement?
Multiple different tissue types |
Teratoma
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What ovarian tumor matches the following statement?
Lined w/ fallopian tube-like epithelium |
Serous cystadenoma
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What ovarian tumor matches the following statement?
Ovarian tumor + ascites + hydrothorax |
Meig's syndrome (ovarian fibroma)
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What ovarian tumor matches the following statement?
Call Exner bodies |
Granulosa theca cells
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What ovarian tumor matches the following statement?
Resembles bladder epithelium |
Brenner
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What ovarian tumor matches the following statement?
Elevated beta hCG |
Choriocarcinoma (primarily), dysgerminoma
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What are the risk factors for endometrial carcinoma?
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- Inc estrogen (PCOS, obesity, estrogen secreting tumors, unopposed HRT, age, endometrial hyperplasia)
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What are the risk factors for ovarian cancer?
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Ovulation
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What are the risk factors for cervical cancer?
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- Inc HPV risk (STDS, multiple sex partners, partner w/ multiple sexual partners, HIV, not being vaccinated, smoking)
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HYQ: Which cells are responsible for maintaining a high testosterone concentration in the seminiferous tubules?
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- Leydig cells: Secrete testosterone
- Sertoli cells: Secrete ABP, which helps maintain the testosterone concentration in the area |
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What testicular tumor is described by the following statement?
Composed of cytotrophoblasts & syncytiotrophoblasts |
Choriocarcinoma
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What testicular tumor is described by the following statement?
May present initially w/ gynecomastia |
Leydig cell
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What testicular tumor is described by the following statement?
Elevated AFP |
- Yolk sac
- Embryonal carcinoma |
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What testicular tumor is described by the following statement?
Elevated beta hCG |
- Choriocarcinoma
- Embryonal carcinoma |
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What testicular tumor is described by the following statement?
Most common testicular tumor |
Seminoma
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What testicular tumor is described by the following statement?
Most common testicular tumor in infants & children up to 3 years of age |
Yolk sac
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What testicular tumor is described by the following statement?
Most common testicular tumor in men over age 60 |
Testicular lymphoma
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What testicular tumor is described by the following statement?
Histologic appearance similar to koilocytes (cytoplasmic clearing) |
Seminoma
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What testicular tumor is described by the following statement?
Histologically may have alveolar or tubular appearance sometimes w/ papillary convolutions |
Embryonal carcinoma
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What testicular tumor is described by the following statement?
Composed of multiple tissue types |
Teratoma
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What testicular tumor is described by the following statement?
Histologic endodermal sinus structures (Schiller-Duval bodies) |
Yolk sac
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What testicular tumor is described by the following statement?
25% have cytoplasmic rod-shaped crystalloids of Reinke |
Leydig cells
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What testicular tumor is described by the following statement?
Androgen producing & associated w/ precocious puberty |
Leydig cells
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HYQ: A 55 yo man undergoing treatment for BPH has increased testosterone & decreased DHT as well as gynecomastic & edema. What is his medication?
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Finasteride or 5 alpha reductase
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How does flutamide differ from finasteride in relation to MOA & clinical use?
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Flutamide
- Inhib @ testosterone receptor level - Tx: Prostate adenocarcinoma Finasteride - 5 alpha reductase inhib - Prevents conversion of testos to DHT - Used for BPH & male pattern baldness |
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What is the clinical use of clomiphene? How does this drug work?
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- Use: Infertility
- MOA: Agonist @ pituitary estrogen receptor; Induces FSH secretion |
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What are the side effects of sildenafil?
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Causes vasodilation therefore:
- Flushing, HA, Dyspepsia - Impaired blue green color vision - Life threatening hypotension in pts also taking nitrates |
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What is the role of Sertoli cells & Leydig cells in male spermatogenesis?
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- Leydig cells: Stim by LH --> Produce testosterone
- Sertoli cells: Stim by FSH --> Secrete ABP; Maintain [testos] in seminiferous tubules; provides nutrients to spermatocytes |
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What is the difference between androgen insensitivity & 5 alpha reductase deficiency?
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Androgen insensitivity:
- Testicular feminization - Defect in DHT-R (doesn't respond to stim) - Phenotypically normal female - Elevated levels of testosterone, LH & estrogens 5 alpha reductase deficiency: - Can't convert testos to DHT - Early defect: Ambiguous genitalia - Puberty: Normal male genitalia - Normal testosterone, estrogen, LH |
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How many carbon molecules are found on testosterone & on androstenedione?
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19
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What structures develop from the mesonephric duct system?
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- Seminal vesicles
- Epididymis - Ejaculatory duct - Ductus deferens |
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What is the male homologue to the following female structure?
Vestibular bulbs |
Corpus spongiosum
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What is the male homologue to the following female structure?
Labia minora |
Ventral shaft of penis
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What is the male homologue to the following female structure?
Bartholin glands |
Bulbourethral glands
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What is the male homologue to the following female structure?
Urethral & paraurethral glands (of Skene) |
Prostate
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HYQ: To where does testicular cancer first metastasize?
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Para-aortic lymph nodes
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Review quiz Q:
How do CO, BP, GFR & TH change during pregnancy? |
- BP: Dec in early preggo (nadir @ 16-20 wks)
- CO: Inc by 30-50% - GFR: Inc; A/w inc plasma vol & preload --> Dec BUN & Cr - No change in TH; Inc TBG & total T3 and T4; Normal TSH & free T3 and T4 |
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Review quiz Q:
What are the characteristic features of HELLP syndrome? |
H: Hemolysis
E: Elevated L: Liver enzymes L: Low P: Platelets |
