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566 Cards in this Set
- Front
- Back
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Describe the venous drainage of the gonads from the left ovary/testis to the inferior vena cava.
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From the left ovary/testis to the left gonadal vein, then to the left renal vein, then to the inferior vena cava
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Describe the venous drainage of the gonads from the right ovary/testis to the inferior vena cava.
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From the right ovary/testis to the right gonadal vein, then to the inferior vena cava
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The _____ (left/right) gonadal vein drains directly into the inferior vena cava, whereas the _____ (left/right) gonadal vein first drains into the _____ (left/right) renal vein before draining into the inferior vena cava.
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right; left; left
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Into which lymph nodes do the ovaries and testes drain?
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The para-aortic lymph nodes
(since the testes descended from the abdomen) |
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Which other bilateral organ has similar venous drainage to the gonads (i.e., the left organ drains to the left renal vein and the right organ drains to the IVC)?
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The adrenal glands
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The suspensory ligament of the ovaries contains the _____ (ovarian/uterine) vessels.
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Ovarian
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The transverse cervical (cardinal) ligament contains the _____ (ovarian/uterine) vessels.
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Uterine
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True or False: The round ligament of the uterus contains no important structures.
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True; Remember: Round like the number zero
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What structures are contained within the broad ligament of the uterus?
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The round ligament of the uterus, the fallopian tubes, and the ovaries
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What is the name of the ligament that connects the uterus, fallopian tubes and ovaries to the pelvic side wall?
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Broad ligament
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Name the ligament that attaches the ovary to the uterus.
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The ligament of the ovary
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Name the ligament that attaches to the superior aspect of the uterus, travels through the inguinal canal, and attaches distally to the labia majora.
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Round ligament of the uterus
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Name the ligament that attaches the ovaries to the lateral pelvic wall.
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The suspensory ligaments of the ovaries
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What ligament is a derivative of the gubernaculum?
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The round ligament of the uterus
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What ligament attaches the cervix to the side wall of the pelvis?
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The transverse cervical (cardinal) ligament
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Through which structures do sperm travel during ejaculation?
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Seminiferous tubules, Epididymis, Vas deferens, Ejaculatory ducts, Nothing, Urethra, Penis (remember: SEVEN UP)
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Erection is mediated by the _____ (sympathetic/parasympathetic) nervous system.
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Parasympathetic (remember Point & Shoot)
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The emission of sperm is mediated by the _____ (sympathetic/parasympathetic) nervous system.
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Sympathetic (remember Point & Shoot)
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True or False: Ejaculation is mediated by both visceral and somatic nerves.
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True
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Nitric oxide plays a role in smooth muscle _____ (relaxation/contraction) and _____ (vasoconstriction/vasodilation) in the penis leading to erection.
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Relaxation, vasodilation
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Name two drugs that are proerectile and work via the NO pathway.
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Sildenafil, vardenafil
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NE works as an antierectile agent by causing smooth muscle _____ (relaxation/contraction) and _____ (vasoconstriction/vasodilation).
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Contraction, vasoconstriction
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What specific nerve is responsible for emission?
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The hypogastric nerve
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What specific nerve is responsible for ejaculation?
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The pudendal nerve (Pudenal Pushes out the splooge)
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The acrosome of the sperm is derived from what organelle?
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golgi apparatus
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The flagellum (tail) of the sperm is derived from what organelle.
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One of the centrioles
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The middle piece (neck) of the sperm contains what organelle?
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The mitochondria (remember: Middle piece has Mitochondria)
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What is the sperm's food supply ?
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Fructose
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What is the final phase of spermatogenesis called?
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Spermiogenesis
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Are spermatogonia germ cells or non-germ cells?
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Germ cells
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What are the two functions of the spermatogonia?
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Maintain the germ pool and production of primary spermatocytes
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Where are spermatogonia found?
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Lining the seminiferous tubules
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Are Sertoli cells germ cells or non-germ cells?
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Non-germ cells
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What are 5 general functions of sertoli cells?
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Secretion of inhibin, secretion of androgen-binding protein, formation of the blood-testis barrier, support and nourishment of developing sperm, regulation of spermatogenesis (remember: Sertoli cells Support Sperm Synthesis)
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The junctional complex (tight junction) between what type of cells form the blood-testis barrier.
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Sertoli cells
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What is the effect of inhibin released by Sertoli cells?
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Inhibition of FSH release
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What is the effect of androgen-binding protein (ABP) released by Sertoli cells?
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ABP maintains testosterone levels that are required for spermatogenesis
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Why is a blood-testis barrier important?
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It isolates genetically unique sperm from the immune system, preventing autoimmune attack
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Where are Sertoli cells located?
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Lining the seminiferous tubules
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What general type of cells are Leydig cells?
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Endocrine/interstitial cells
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What is the function of Leydig cells?
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Secretion of testosterone
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Where are Leydig cells located?
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In the interstitium/ between semiferous tubules
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How long is required for the development of a mature spermatid?
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2 months
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Where does spermatogenesis occur in the testis?
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In the seminiferous tubules
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Put the following in order of their development during spermatogenesis: spermatozoan, primary spermatocyte, secondary spermatocyte, spermatid, and spermatogonium.
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Spermatogonium, primary spermatocyte, secondary spermatocyte, spermatid then spermatozoan
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Spermatogonium are located in the _____ (basal/adluminal) compartment.
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Basal
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A spermatogonium has _____ chromosomes, is _____ (diploid/haploid), and is _____ (4N/2N/N).
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46; diploid; 2N
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A primary spermatocyte has ____ chromosomes, is _____ (diploid/haploid), and is _____ (4N/2N/N).
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46; diploid; 4N
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A secondary spermatocyte has ____ chromosomes, is _____ (diploid/haploid), and is _____ (4N/2N/N).
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23; haploid; 2N
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A spermatid has ____ chromosomes, is _____ (diploid/haploid), and is _____ (4N/2N/N).
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23; haploid; N
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Which types of spermatic precursors contain the genetic material needed to make both male and female embryos?
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Spermatogonium which contain both an X and a Y chromosome and primary spermatocytes which contain two X chromosomes and two Y chromosomes
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In male spermatogenesis, follicle-stimulating hormone stimulates what type of cells to produce androgen binding protein and inhibin?
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Sertoli cells
(fSh stimulates Sertoli cells) |
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In male spermatogenesis, luteinizing hormone stimulates what type of cells to release testosterone?
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leydig cells
(Lh stimulates Leydig cells) |
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In male spermatogenesis, inhibin is released by Sertoli cells, and it provides negative feedback against the release of what hormone by the anterior pituitary?
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Follicle-stimulating hormone
(FSH stimulates sertoli cells to produce inhibin so it makes sense that inhibin would provide negative feedback to FSH) |
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In male spermatogenesis, androgen-binding protein is released by Sertoli cells, and it ensures that testosterone is high in what anatomic area?
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Seminiferous tubules
- where it necessary for sperm development |
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Testosterone in the bloodstream inhibits the release of what hormone from the hypothalamus?
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Gonadotropin-releasing hormone
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In males, what androgen is associated with the maintenance of gametogenesis?
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Testosterone
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True or False: The presence of testosterone increases sperm production.
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True
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Follicle-stimulating hormone stimulates Sertoli cells to produce which two substances?
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Androgen-binding protein and inhibin
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Luteinizing hormone stimulates Leydig cells to produce what substance?
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testosterone
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Inhibin feeds back to the anterior pituitary to decrease _____ _____ _____ production.
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Follicle-stimulating hormone
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GnRH from the hypothalamus stimulates the release of what two hormones from the anterior pituitary?
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LH and FSH
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How can one remember the functions of the LH and FSH?
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FSH causes Sertoli cells to aid in Sperm production, while LH causes Leydig cells to release testosterone
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Rank the following three androgens in order of potency: androstenedione, dihydrotestosterone, and testosterone.
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Dihydrotestosterone > testosterone > androstenedione
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What is the major source of dihydrotestosterone and testosterone in men?
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The testis
(testosterone is converted to DHT by 5alpha reductase) |
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What is the major source of androstenedione in men?
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What is the major source of androstenedione in men?
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What enzyme converts testosterone to dihydrotestosterone?
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5α-Reductase
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What medicine inhibits 5α-reductase?
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Finasteride
(used for BPH since DHT promotes growth of the prostate) |
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Testosterone and androstenedione are converted to _____ in adipose tissue and sertoli cells by the enzyme _____.
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Estrogen; aromatase
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What are nine important functions of testosterone in males?
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Differentiation of internal reproductive organs, increases muscle, stimulate growth spurt, stimulate growth of penis and seminal vesicles, increase libido, spermatogenisis, closing of epiphyseal plates, increase RBC production and deepening of voice
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Name three structures in which differentiation is dependent on testosterone.
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The epididymis, the vas deferens and the seminal vesicles
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What derivative of testosterone causes epiphyseal plate closure?
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Estrogen
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Name four functions of DHT.
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Differentiation of the penis, scrotum, and prostate; balding; increased sebaceous gland activity; and increased prostate growth
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Name four places in female body where estrogen is produced.
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The ovaries (17β-estradiol), the placenta (estriol), the blood (aromatization), and the adipose tissue
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Rank the following three forms of estrogen in order of potency: estradiol, estriol, and estrone.
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Estradiol > estrone > estriol
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What major hormone is produced by the granulosa cells?
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Estrogen
(granulosa cells are inside the follicle and are stimulated by FSH to produce estrogen) |
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What major hormone is produced by the theca cells?
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Androstenedione
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In granulosa cells, follicle-stimulating hormone promotes the conversion of androstenedione to estrogen via what enzyme?
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Aromatase
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In theca cells, luteinizing hormone promotes the conversion of cholesterol to androstenedione via what enzyme?
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Desmolase
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What is the effect of estrogen on follicle growth?
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Stimulates follicle growth
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What is the effect of estrogen on the endometrium?
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Increases endometrial proliferation
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What is the role of estrogen on physical development during puberty?
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Genital and breast development and creation of female fat distribution
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What is the effect of estrogen on the liver?
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Increased synthesis of binding globulins and transport proteins
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What is the effect of estrogen on the lipid profile?
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Increased HDL, decreased LDL
-- why women of reproductive age have a lower incidence of CAD |
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What is the effect of estrogen on the breast tissue?
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Increased stromal development
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What is the effect of estrogen on FSH?
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Negative feedback
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Describe the "switch" in estrogen feedback on LH that occurs near ovulation.
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The effect of estrogen on LH switches from negative feedback to positive just prior to LH surge
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What is the effect of estrogen on myometrial excitability?
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Increased myometrial excitability
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Estrogen causes what changes in blood lipid levels?
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Increased high-density lipoprotein cholesterol and decreased low-density lipoprotein cholesterol
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During pregnancy there is a 50-fold increase in _____ (estradiol/estriol) and a 1000-fold increase in _____ (estradiol/estriol).
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Estradiol, estriol
(the weaker estrogen needs to be increased more!) |
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Which is an indicator of fetal well being during pregnancy, an increase in estradiol or estriol?
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Estriol- since this produced by the placenta
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What causes the release of FSH and LH that is ultimately responsible for the production of estrogen?
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Pulsatile GnRH secretion by the hypothalamus
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Name four places in the human body where progesterone is produced.
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Corpus luteum, placenta, adrenal cortex, and testes
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Progesterone causes what changes in the endometrium?
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Spiral artery development and increased glandular secretions
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How can one remember that progesterone maintains pregnancy?
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PROGESTerone is PRO-GESTation
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Progesterone _____ (increases/decreases) myometrial contractility while estrogen _____ (increases/decreases) myometrial contractility.
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Decreases, increases
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What is the effect of progesterone on cervical mucus?
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Progesterone thickens cervical mucus to prevent sperm entry
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Progesterone causes what effect on body temperature?
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Increases body temperature
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What effect does progesterone have on FSH and LH secretion?
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Inhibition
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Does progesterone cause uterine smooth muscle relaxation or contraction?
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Relaxation
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True or False: Increases in progesterone are indicative of menstruation.
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False; increases in progesterone indicate that the secretory phase of the cycle is occurring
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During which week of the proliferative phase of the menstrual cycle is follicular growth the fastest?
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The second week
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What hormone stimulates endometrial proliferation during the menstrual cycle?
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Estrogen
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What hormone maintains endometrium to support implantation?
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Progesterone
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True or False: Decreased progesterone levels lead to increased fertility.
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False; decreased progesterone leads to decreased fertility
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When do luteinizing hormone levels peak?
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Luteinizing hormone levels peak just before ovulation
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Which phase of the menstrual cycle, the follicular phase or the luteal phase, can be variable in length?
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The follicular phase
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Which phase of the menstrual cycle, the follicular phase or the luteal phase, is constant in length?
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The luteal phase
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How long does the luteal phase of the menstrual cycle typically last?
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14 days
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Estrogen levels peak _____ (after/before) ovulation, while progesterone levels peak _____ (after/before) ovulation.
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Before; after
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When does the peak of follicle-stimulating hormone production occur?
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At ovulation
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Is the endometrial lining thicker during the proliferative (follicular) phase or secretory (luteal) phase?
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Luteal phase
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Does the graafian follicle mature during the follicular or luteal phase?
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Follicular phase
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Is the corpus luteum present during the follicular or luteal phase?
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Luteal phase
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Regression of the corpus luteum leads to what event?
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Menstruation; when progesterone levels decrease the endometrial lining sloughs off
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Is the endometrial lining thicker in the presence of a maturing Graafian follicle or the corpus luteum?
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Corpus luteum
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Put these events of the menstrual cycle in order: progesterone release from the corpus luteum, increase in LH secretion, menstruation, ovulation and increase in estrogen secretion.
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Increase in estrogen secretion, increase in LH secretion, ovulation, progesterone release from the corpus luteum and menstruation
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What is mittelschmerz?
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Peritoneal irritation that can mimic appendicitis, caused by blood from a ruptured follicle at ovulation
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What hormone surges on the day before ovulation?
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Estrogen
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What are two signs (one lab, one clinical) of ovulation?
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The ferning of cervical mucosa (less acidic, more watery mucous to help out the sperm) and increased temperature (progesterone)
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The LH surge that causes ovulation is triggered by a surge of what the day before ovulation?
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Estrogen
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What causes the rupture of a follicle that constitutes ovulation?
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A surge of LH
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When do primary oocytes begin meiosis I?
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During fetal life
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When do primary oocytes complete meiosis I?
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Right before ovulation
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In what stage of meiosis I is an oocyte arrested in between fetal life and ovulation?
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Prophase (remember that meiosis I is in prOphase until Ovulation)
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In what stage of meiosis II is a secondary oocyte arrested in between ovulation and fertilization?
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METaphase (remember that an egg MET a sperm)
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What happens to a secondary oocyte if fertilization does not occur?
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The oocyte degenerates
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The interphase stage of oogenesis is also known as what?
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Replication
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An oogonium is _____ (diploid/haploid) , _____ (2N/4N) and contains _____ (23/46) _____ (single chromosomes/sister chromatids/single chromatids).
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Diploid, 2N, 46, single chromosomes
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A primary oocyte is _____ (diploid/haploid), _____ (2N/4N) and contains _____ (23/46) _____ (single chromosomes/sister chromatids/single chromatids).
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Diploid, 4N, 46, sister chromatids
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A secondary oocyte is _____ (diploid/haploid), _____ (2N/4N) and contains _____ (23/46) _____ (single chromosomes/sister chromatids/single chromatids).
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Haploid, 2N, 23, sister chromatids
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An ovum is _____ (diploid/haploid), _____ (N/2N) and contains _____ (23/46) _____ (single chromosomes/sister chromatids/single chromatids).
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Haploid, N, 23, single chromatids
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What stage of oogenesis begins with an oogonium and ends with a primary oocyte?
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Replication (interphase)
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What stage of oogenesis begins with a primary oocyte and ends with a secondary oocyte and a polar body?
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Meiosis I
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What stage of oogenesis begins with a secondary oocyte and ends with an ovum and a polar body?
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Meiosis II
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Which is the first stage of oogenesis that results in a polar body?
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Meiosis I
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The polar body that is created during meiosis I has what two possible fates?
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Degeneration or division to form 2 daughter polar bodies
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What are the two products of a secondary oocyte that undergoes meiosis II?
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An ovum and a polar body
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Where does fertilization most commonly occur?
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In the upper end of the oviduct
(the ampulla of the fallopian tube) |
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When does fertilization most commonly occur in relation to ovulation?
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Fertilization commonly occurs within one day of ovulation
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When does implantation most commonly occur in relation to fertilization?
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Implantation occurs 6 days after fertilization
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Trophoblasts secrete what hormone that is detectable in the bloodstream 1 week after conception?
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β-Human chorionic gonadotropin
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How long after conception is β-human chorionic gonadotropin detectable in the urine on a home pregnancy test?
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2 weeks
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In which trimester does the β-human chorionic gonadotropin level peak?
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In the first trimester
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In pregnancy when do progesterone, estriol, and prolactin levels peak?
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At term
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After labor, the _____ (decrease/increase) in maternal progesterone induces lactation.
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decrease
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By what mechanism does suckling maintain milk production.
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Nerve stimulation increases oxytocin and prolactin levels
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What are two functions of prolactin?
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Induction and maintenance of milk production and decrease in reproductive function
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What are two functions of oxytocin?
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Increasing milk letdown, involvement with uterine contractions
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In the placenta, what type of cell is the source of human chorionic gonadotropin?
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Syncytiotrophoblasts
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hCG levels are abnormally elevated in what three pathologic conditions?
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Hydatidiform moles, choriocarcinoma and gestational trophoblastic tumors
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Why is hCG used to detect pregnancy?
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Because is appears in the urine early in pregnancy
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What hormone maintains the corpus luteum, and thus progesterone, for the first trimester of pregnancy?
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Human chorionic gonadotropin
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During the first trimester, hCG maintains the corpus luteum and progesterone production by acting like what other hormone?
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LH
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During the first trimester, where is progesterone produced?
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The corpus luteum; hCG acts like LH to cause the corpus luteum to continue secreting progesterone until the placenta produces its own progesterone
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During the second and third trimesters, where are hCG, estriol and progesterone produced?
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The placenta
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What happens to the corpus luteum after the first trimester?
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It degenerates
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What is menopause?
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The cessation of estrogen production due to the decline of the number of ovarian follicles with age
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What two diseases are commonly associated with menopause?
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Osteoporosis and coronary artery disease (estrogen is protective against both)
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Do levels of estrogen increase, decrease, or stay the same during menopause?
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decrease
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Do levels of follicle-stimulating hormone increase, decrease, or stay the same during menopause?
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They greatly increase- due to decreased estrogen production-- this is great laboratory confirmation of menopause
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Do levels of luteinizing hormone increase, decrease, or stay the same during menopause?
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Increase
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Do levels of gonadotropin-releasing hormone increase, decrease, or stay the same during menopause?
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Increase
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What is the average age for the onset of menopause in nonsmokers?
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51 years
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True or False: Menopause usually occurs later in smokers than in nonsmokers.
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False; menopause usually occurs earlier in smokers
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What is the primary cause of the cessation of estrogen production at menopause?
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There is an age-linked decline in the number of ovarian follicles
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Early menopause can indicate what condition?
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Early menopause can indicate premature ovarian failure
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How can one remember the clinical effects of menopause?
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Remember that menopause causes HAVOC: Hot flashes, Atrophy of the Vagina, Osteoporosis, Coronary artery disease
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What is the incidence of double Y males (XYY): 1:850, 1:1000, or 1:3000?
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1:1000
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What is the incidence of Turner's syndrome (XO): 1:850, 1:1000, or 1:3000?
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1:3000
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What is the incidence of Klinefelter's syndrome (XXY): 1:850, 1:1000, or 1:3000?
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1:850
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Which sex chromosome disorder is marked by testicular atrophy, eunuchoid body shape, tall, long extremities, gynecomastia, and female hair distribution?
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Klinefelter's syndrome (XXY)
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Which sex chromosome disorder is marked by the presence of an inactivated X chromosome (Barr body) in a male?
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Klinefelter's syndrome (XXY)
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What sex chromosome disorder is a common cause of male hypogonadism and is part of most infertility workups?
|
Klinefelter's syndrome (XXY)
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Which sex chromosome disorder is marked by short stature, webbing of the neck, and coarctation of the aorta in a female?
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Turner's syndrome (XO)
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What is the most common cause of primary amenorrhea?
|
Turner's syndrome (XO)
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Which sex chromosome disorder is associated with individuals who are phenotypically normal, who tend to be very tall, who have severe acne, and who are known for antisocial behavior (in 1%-2% of cases)?
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Double Y males (XYY)
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True or False: Double Y males are infertile.
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False, double Y males have normal fertility
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In Turner's syndrome, the decrease in estrogen leads to a(n) _____ (decrease/increase) of follicle-stimulating hormone and a(n) _____ (decrease/increase) of luteinizing hormone.
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Increase; increase
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How many Barr bodies are seen when the cells of a patient with Turner's syndrome are examined under the microscope?
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None
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How can one remember the genotype of Turner's syndrome?
|
"Hugs and kisses" (XO) from Tina Turner (a female singer)
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In Klinefelter's syndrome, dysgenesis of the seminiferous tubules leads to a/an _____ (increase/decrease) in inhibin production, leading to a/an _____ (increase/decrease) in FSH levels.
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Decrease, increase
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In Klinefelter's syndrome, abnormal Leydig cell function leads to a/an _____ (increase/decrease) in testosterone production, leading to a/an _____ (increase/decrease) in LH production which results in a/an _____ (increase/decrease) in estrogen levels.
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Decrease, increase, increase
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True or False: In cases of pseudohermaphroditism, both ovarian and testicular tissue are present.
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False; pseudohermaphroditism is a disagreement between the phenotypic (external genitalia) and the gonadal sex; only one type of gonad (either ovaries or testicles) is present
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What type of internal and external sex organs are present in cases of male pseudohermaphroditism?
|
The testes are present, but the external genitalia are female or ambiguous
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What type of internal and external sex organs are present in cases of female pseudohermaphroditism?
|
The ovaries are present, but the external genitalia are virilized or ambiguous
|
|
|
What are the sex chromosomes in someone with female pseudohermaphroditism?
|
XX
|
|
|
What are the sex chromosomes in someone with male pseudohermaphroditism?
|
XY
|
|
|
What is the endocrine problem during gestation that causes female pseudohermaphroditism?
|
Excessive and inappropriate exposure to androgenic steroids during early gestation (ie, congenital adrenal hyperplasia or exogenous androgens)
|
|
|
What is the most common endocrine problem during gestation that causes male pseudohermaphroditism?
|
Androgen insensitivity syndrome (testicular feminization)
|
|
|
True or False: In cases of true hermaphroditism, both ovarian and testicular tissue are present.
|
True
|
|
|
What are the two possible karyotypes of true hermaphroditism, a rare condition in which both ovarian and testicular tissue are present and the genitalia are ambiguous?
|
46,XX and 47,XXY
|
|
|
Which is more common: pseudohermaphroditism or true hermaphroditism?
|
Pseudohermaphroditism, true hermaphroditism is very rare
|
|
|
A normal-appearing female with 46,XY sex chromosomes and a defective androgen receptor may have what condition?
|
Androgen insensitivity syndrome = testicular feminization
|
|
|
In someone with androgen insensitivity syndrome, will the levels of testosterone, estrogen, and luteinizing hormone be high, low, or normal?
|
The levels of all three will be high
|
|
|
True or False: In cases of true hermaphroditism, both ovarian and testicular tissue are present.
|
True
|
|
|
What are the two possible karyotypes of true hermaphroditism, a rare condition in which both ovarian and testicular tissue are present and the genitalia are ambiguous?
|
46,XX and 47,XXY
|
|
|
Which is more common: pseudohermaphroditism or true hermaphroditism?
|
Pseudohermaphroditism, true hermaphroditism is very rare
|
|
|
A normal-appearing female with 46,XY sex chromosomes and a defective androgen receptor may have what condition?
|
Androgen insensitivity syndrome = testicular feminization
|
|
|
In someone with androgen insensitivity syndrome, will the levels of testosterone, estrogen, and luteinizing hormone be high, low, or normal?
|
The levels of all three will be high
|
|
|
In someone with androgen insensitivity syndrome, why are the testes often removed?
|
To prevent malignancy
|
|
|
In someone with androgen insensitivity syndrome, where in the body are the testes often found?
|
Labia majora
|
|
|
Describe the general physical characteristics of an individual with androgen insensitivity syndrome.
|
Normal-appearing female
- supermodel like-- (the perfect woman is actually genetically male) |
|
|
What is the genotype and phenotype for someone with androgen insensitivity syndrome?
|
The genotype is (46,XY), and the phenotype is externally female
|
|
|
Why does androgen insensitivity syndrome occur?
|
Because androgen receptors do not respond to androgens, and male sex characteristics fail to develop
|
|
|
In someone with androgen insensitivity syndrome, why are the testes often removed?
|
To prevent malignancy
|
|
|
In someone with androgen insensitivity syndrome, where in the body are the testes often found?
|
Labia majora
|
|
|
Describe the general physical characteristics of an individual with androgen insensitivity syndrome.
|
Normal-appearing female
- supermodel like-- (the perfect woman is actually genetically male) |
|
|
What is the genotype and phenotype for someone with androgen insensitivity syndrome?
|
The genotype is (46,XY), and the phenotype is externally female
|
|
|
Why does androgen insensitivity syndrome occur?
|
Because androgen receptors do not respond to androgens, and male sex characteristics fail to develop
|
|
|
Describe the anatomy of the reproductive tract in an individual with androgen insensitivity syndrome.
|
Female external genitalia, rudimentary vagina; uterus and uterine tubes absent; possibly testes in labia
|
|
|
What is the phenotype of the external genitalia of someone with 5α-reductase deficiency?
|
It is ambiguous until puberty
|
|
|
Are the testosterone and estrogen levels of someone with 5α-reductase deficiency high, low, or normal?
|
normal
|
|
|
Why do individuals with 5α-reductase deficiency undergo genital growth at puberty?
|
Increased levels of testosterone present at puberty trigger growth of the external genitalia
|
|
|
Are the luteinizing hormone levels of someone with 5α-reductase deficiency high, low, or normal?
|
Normal or high
|
|
|
A patient with 5α-reductase deficiency is unable to convert _____ to _____.
|
testosterone to DHT
|
|
|
What is a hydatidiform mole?
|
A pathologic ovum that results in the cystic swelling of the chorionic villi and the proliferation of the chorionic epithelium (trophoblast)
|
|
|
A hydatidiform mole is the most common precursor of what malignancy?
|
Choriocarcinoma
|
|
|
Is the genotype of a complete hydatidiform mole 23,X, 46,XX, or 69,XXX?
|
46,XX (or 46,XY)
|
|
|
What is a common marker of hydatidiform mole?
|
High β-human chorionic gonadotropin level
|
|
|
Which type of hydatidiform mole has chromosomes that are triploid or tetraploid: a partial mole or a complete mole?
|
A partial mole
|
|
|
Which type of hydatidiform mole may contain fetal parts: a partial mole or a complete mole?
|
A partial mole (remember: PARTial mole contains PARTS)
|
|
|
Which type of hydatidiform mole is more strongly associated with enlarged uterine size, a complete or a partial mole?
|
A complete mole
|
|
|
True or False: A complete hydatidiform mole has genetic material that is completely derived from the mother.
|
False; the genetic material of this type of mole is completely from the father; 2 sperm fertilize an empty egg
|
|
|
True or False: A partial hydatidiform mole has genetic material that is completely derived from the father.
|
False; the genetic material of this type of mole is from both the mother and the father, and it can be 69,XXX or 69,XXY
|
|
|
A "honeycombed uterus" with a "cluster of grapes" appearance, an abnormally enlarged uterus, and a positive β-human chorionic gonadotropin test are associated with what condition?
|
Hydatidiform mole
|
|
|
What are the two treatments for hydatidiform mole?
|
Dilatation and curettage; methotrexate if choriocarcinoma is suspected
|
|
|
Which are more likely to progress to choriocarcinoma: complete or partial hydatidiform moles?
|
Complete moles, which progress about 2% of the time; partial moles rarely convert
Complete moles, which progress about 2% of the time; partial moles rarely convert |
|
|
Which is associated with a larger increase in β-human chorionic gonadotropin levels, complete or partial hydatidiform moles?
|
Complete moles, although partial moles also cause an increase
|
|
|
Levels of what hormone are monitored in patients with hydatidiform moles?
|
β-Human chorionic gonadotropin is monitored to track recurrence of choriocarcinoma
|
|
|
What is the most common cause of recurrent miscarriages in the first weeks of pregnancy?
|
Low progesterone levels associated with no response to β-human chorionic gonadotropin
|
|
|
What is the most common cause of recurrent miscarriages in the 1st trimester?
|
Chromosomal abnormalities
|
|
|
What is the most common cause of recurrent miscarriages in the 2nd trimester?
|
Bicornuate uterus
|
|
|
What is an example of a chromosomal abnormality that leads to recurrent miscarriages in the first trimester?
|
A robertsonian translocation
|
|
|
Preeclampsia involves what triad of symptoms?
|
Hypertension, proteinuria, and edema
|
|
|
Eclampsia involves the addition of what condition to the triad of symptoms that define preeclampsia?
|
Seizures (the triad of hypertension, proteinuria, and edema define preeclampsia)
|
|
|
What percentage of pregnant women are affected by preeclampsia?
|
Approximately 7%
|
|
|
During what part of pregnancy are women affected by preeclampsia?
|
From 20 weeks' gestation to 6 weeks postpartum
|
|
|
What conditions predispose a woman to preeclampsia or eclampsia?
|
Hypertension, chronic renal disease, diabetes, and autoimmune disorders
|
|
|
What is the HELLP syndrome that is associated with preeclampsia?
|
Hemolysis, Elevated Liver function tests, and a Low Platelet count
|
|
|
Describe the etiology of preeclampsia.
|
Placental ischemia, with a lack of trophoblastic invasion of spiral arteries leading to increased vascular tone and vascular permeability
|
|
|
Certain "at-risk" pregnant women are monitored for thrombocytopenia, hyperuricemia, and proteinuria, as these may be signs of what conditions?
|
Preeclampsia or eclampsia
|
|
|
What is the only definitive treatment for preeclampsia?
|
Delivery of the fetus
|
|
|
A pregnant woman with proteinuria who develops headache, blurred vision, and hyperreflexia should be monitored for what conditions?
|
Preeclampsia or eclampsia
|
|
|
A pregnant woman with hypertension who develops abdominal pain, edema of the face and extremities, and altered mentation should be monitored for what conditions?
|
Preeclampsia or eclampsia
|
|
|
In a stable mother with a preterm fetus that is not yet viable, what is the treatment for preeclampsia?
|
Bed rest, salt restriction, and treatment of hypertension
|
|
|
What two drugs can be used for seizure prophylaxis and treatment in pregnant women?
|
Magnesium sulfate and diazepam
|
|
|
Pregnancy-induced hypertension before 20 weeks' gestation suggests what type of pregnancy?
|
Molar pregnancy
|
|
|
The mortality associated with pregnancy-induced hypertension is most often due to what two conditions?
|
Cerebral hemorrhage and adult respiratory distress syndrome
|
|
|
What condition involves the premature nontraumatic separation of the placenta during pregnancy?
|
Abruptio placentae
|
|
|
What happens during abruptio placentae?
|
The placenta separates from the uterus prematurely and causes painful uterine bleeding; fetal death and disseminated intravascular coagulation sometimes result
|
|
|
In placenta accreta, placental attachment to what increases the risk of hemorrhage after delivery?
|
A defective decidual layer allows the placenta to attach directly to myometrium in the uterus, which can result in massive hemorrhage after delivery
|
|
|
What happens in placenta previa?
|
Attachment of the placenta to the lower uterine segment- may PREVent the baby from being delivered vaginally
|
|
|
Where is the placenta located in a woman with placenta previa?
|
The lower uterine segment, occluding the cervical os
|
|
|
What condition occurs most often in the fallopian tubes and may result from salpingitis?
|
Ectopic pregnancy
|
|
|
The inflammation of what structure as a result of pelvic infection predisposes women to ectopic pregnancy?
|
Fallopian tubes (salpingitis)
|
|
|
Where do ectopic pregnancies most often occur?
|
The fallopian tubes, although they can also occur in the abdomen, cervix, or ovaries
|
|
|
A sexually active 20-year-old woman presents with sudden lower abdominal pain and a history of pelvic inflammatory disease. If tests reveal an increased human chorionic gonadotropin level, what diagnosis is likely?
|
Ectopic pregnancy
|
|
|
What diagnostic test can be used to confirm the suspicion of an ectopic pregnancy?
|
Ultrasound
|
|
|
What condition presents with painless bleeding during any trimester, and is more common in women with a prior cesarean section?
|
Placenta previa
|
|
|
What condition in pregnancy that can lead to post-partum hemorrhage often occurs after a prior cesarean section?
|
Placenta accreta-- placenta attached to myometrium
|
|
|
What condition in pregnancy may lead to massive hemorrhage after delivery?
|
Placenta accreta--placenta attached to myometrium
|
|
|
What condition in pregnancy presents with painful uterine bleeding, usually during the third trimester?
|
Abruptio placentae
|
|
|
What condition in pregnancy can result in fetal death and may be associated with disseminated intravascular coagulation?
|
Abruptio placentae
|
|
|
What condition in pregnancy is associated with smoking, hypertension and cocaine use?
|
Abruptio placentae
|
|
|
What condition early in pregnancy results in abdominal pain without bleeding and is frequently misdiagnosed as appendicitis?
|
Ectopic pregnancy
|
|
|
How much amniotic fluid is associated with polyhydramnios?
|
>1.5-2 L of amniotic fluid
|
|
|
How much amniotic fluid is associated with oligohydramnios?
|
<0.5 L of amniotic fluid
|
|
|
During pregnancy, what condition is associated with esophageal or duodenal atresia: polyhydramnios or oligohydramnios?
|
Polyhydramnios
|
|
|
During pregnancy, what condition is associated with anencephaly: polyhydramnios or oligohydramnios?
|
Polyhydramnios- no head-- cannot swallow amniotic fluid
|
|
|
During pregnancy, why are anencephaly and esophageal or duodenal atresia associated with polyhydramnios?
|
Both result in the inability to swallow, which results in increased levels of amniotic fluid
|
|
|
During pregnancy, what condition is associated with posterior urethral valves in males: polyhydramnios or oligohydramnios?
|
Oligohydramnios, as a result of decreased urine excretion
|
|
|
During pregnancy, what condition is associated with bilateral renal agenesis: polyhydramnios or oligohydramnios?
|
Oligohydramnios, as a result of decreased urine excretion
|
|
|
During pregnancy, why is renal agenesis often associated with oligohydramnios?
|
Decreased urine production results in lower levels of amniotic fluid
|
|
|
True or False: Polyhydramnios can give rise to Potter's syndrome.
|
False; oligohydramnios can give rise to Potter's syndrome-- baby gets smushed face and lungs may not develop properly
|
|
|
In cervical pathology, what condition is defined as "disordered epithelial growth"?
|
Dysplasia/carcinoma in situ
|
|
|
True or False: In cervical pathology, dysplasia begins at the outer epithelial layer and progresses toward the basal layer of the squamocolumnar junction.
|
False; dysplasia begins at the basal layer of the squamocolumnar junction and extends outward
|
|
|
In cervical pathology, what determines the classification of lesions as cervical intraepithelial neoplasia I, II, or III?
|
The extent of dysplasia
|
|
|
What viruses are often associated with cervical dysplasia?
|
Human papillomaviruses 16 and 18-- the ones that can cause cervical cancer
|
|
|
Is the progression to invasive cervical carcinoma from dysplasia or carcinoma in situ usually a slow or rapid process?
|
Slow
|
|
|
What type of carcinoma is usually associated with invasive cervical carcinoma?
|
Squamous cell carcinoma
|
|
|
Why are Pap smears performed?
|
To catch cervical dysplasia (koilocytes) before it progresses to invasive carcinoma
|
|
|
Cervical cancer that invades laterally can cause renal failure via what mechanism?
|
Postrenal failure/obstruction of the ureters
|
|
|
What type of vaccine is available to decrease the risk of cervical cancer?
|
A vaccine against certain types of HPV, a virus that is associated with cervical cancer
A vaccine against certain types of HPV, a virus that is associated with cervical cancer A vaccine against certain types of HPV, a virus that is associated with cervical cancer A vaccine against certain types of HPV, a virus that is associated with cervical cancer A vaccine against certain types of HPV, a virus that is associated with cervical cancer |
|
|
Endometriosis is characterized by the formation of _____ (neoplastic/non-neoplastic) endometrial glands/stroma in _____ (normal/abnormal) locations.
|
Non-neoplastic; abnormal
|
|
|
How are the cysts caused by cyclical bleeding in endometriosis described?
|
Blood filled "chocolate cysts"
|
|
|
Name two locations where "chocolate cysts" are frequently found.
|
On the peritoneum or in the ovary
|
|
|
What is the most common clinical presentation of endometriosis?
|
Severe menstrual pain
|
|
|
What condition is a frequent outcome of endometriosis?
|
Infertility
|
|
|
What is one cause of endometriosis?
|
Retrograde menstrual flow
|
|
|
What is adenomyosis?
|
Adenomyosis occurs when endometrial tissue develops within the myometrium- note this is not a type of endometriosis since it occurs within the uterus
|
|
|
What is the most common cause of endometrial hyperplasia?
|
Excessive estrogen stimulation
|
|
|
Patients with endometrial hyperplasia are at risk of developing what pathologic condition?
|
Endometrial carcinoma
|
|
|
What is the most common clinical presentation of endometrial hyperplasia?
|
Postmenopausal vaginal bleeding
|
|
|
Name four risk factors for endometrial hyperplasia.
|
Hormone replacement therapy (estrogen without progesterone), anovulatory cycles, granulosa cell tumors (secrete estrogen) and polycystic ovarian syndrome
|
|
|
True or False: Endometrial carcinoma is the second most common gynecologic malignancy, next to ovarian cancer.
|
False; endometrial carcinoma is the most common gynecologic malignancy
|
|
|
What is the peak age of occurrence from endometrial carcinoma?
|
55-65 years old
|
|
|
What is the most common clinical presentation of endometrial carcinoma?
|
Vaginal bleeding--especially if postmenopausal--consider endometrial carcinoma
|
|
|
What condition commonly precedes endometrial carcinoma?
|
Endometrial hyperplasia
|
|
|
Name six risk factors for endometrial carcinoma.
|
Late menopause, nulliparity, hypertension, diabetes, obesity and prolonged estrogen without progestins
|
|
|
Name one sign of poor prognosis in endometrial carcinoma.
|
Deep myometrial invasion
|
|
|
Leiomyomas frequently present with _____ (single/multiple) tumors with _____ (well/poorly) demarcated borders.
|
Multiple, well
|
|
|
Which are more common, leiomyomas or endometrial carcinoma.
|
Leiomyomas; they are the most common of all tumors in women
|
|
|
Leiomyomas and leiomyosarcomsa are most common in what population?
|
African-Americans
|
|
|
On average how long does it take for a leiomyoma, which is benign, to progress to leiomyosarcoma?
|
Never; leiomyomas do not progress to leiomyosarcoma or undergo malignant transformation
|
|
|
What is the typical pathologic description of leiomyomas?
|
Bundles of smooth muscle in a whorled pattern--whorled pattern indicates benign--going to stay in the world longer
|
|
|
Leiomyomas are sensitive to what hormone? What is the clinical significance?
|
Estrogen, meaning leiomyomas grow with pregnancy and shrink with menopause
|
|
|
When is the peak occurrence of leiomyomas?
|
20-40 years of age
|
|
|
What are the common presentations of leiomyomas?
|
Abnormal uterine bleeding that can be so severe it causes iron deficiency anemia, or they can by clinically asymptomatic
|
|
|
What is the common description of leiomyosarcomas?
|
They are irregularly shaped, bulky tumors, frequently with hemorrhagic or necrotic areas
|
|
|
Leiomyosarcomas are _____ (aggressive/slow growing) tumors that _____ (do/do not) arise de novo, and have _____ (high/low) rates of recurrence.
|
Aggressive, do, high
|
|
|
Name the two most common myometrial tumors.
|
Leiomyoma and leiomyosarcoma
|
|
|
True or False: Leiomyosarcomas may protrude from the cervix and bleed.
|
True
|
|
|
Rank the following types of gynecological tumors according to their incidence, from most common to least: ovarian, cervical, endometrial.
|
Endometrial > ovarian > cervical
|
|
|
Rank the following types of gynecological tumors according to their prognosis, from worst to best: endometrial, ovarian, cervical.
|
Ovarian > cervical > endometrial
(it is a good thing the most common also has the best prognosis!) |
|
|
Premature ovarian failure is caused by premature atresia of what?
|
The ovarian follicles
|
|
|
What is the age range in which premature ovarian failure can occur?
|
After puberty but before the age of 40
|
|
|
In a patient with premature ovarian failure, lab results would reveal _____ (increased/decreased) estrogen, _____ (increased/decreased) LH and _____ (increased/decreased) FSH.
|
Decreased, increased, increased
|
|
|
Patients with premature ovarian failure present with what types of signs.
|
Signs of menopause
(HAVOC- Hot flashes, atrophy of vagina, osteoporosis and coronary artery disease -- form dec HDL) |
|
|
What syndrome involves enlarged bilateral cystic ovaries manifesting clinically with amenorrhea, infertility, obesity, and hirsutism?
|
Polycystic ovarian syndrome
|
|
|
Name five treatments for polycystic ovarian syndrome.
|
Weight loss, oral contraceptives, gonadotropin analogs, clomiphene (selective estrogen receptor modulator-inhibits the action of estrogen on the pituitary), and surgery
|
|
|
In women with polycystic ovarian syndrome, luteinizing hormone levels are _____ (high/low/normal), follicle-stimulating hormone levels are _____ (high/low/normal) and testosterone levels are _____ (high/low/normal).
|
High, low, high (estrogen stimulates release of LH--inc testosterone, and inhibits the release of FSH)
|
|
|
Polycystic ovarian syndrome is associated with resistance to what hormone?
|
Insulin
|
|
|
Polycystic ovarian syndrome is associated with an increased risk of what type of cancer?
|
Endometrial cancer-- excess testosterone is aromatized to estrogen
|
|
|
The anovulation associated with polycystic ovarian syndrome is caused by increased levels of what hormone?
|
LH
|
|
|
The deranged steroid synthesis associated with polycystic ovarian syndrome includes increased levels of what type of hormone?
|
Androgens
|
|
|
What is the ratio of LH:FSH seen in PCOS?
|
LH: FSH > 2
|
|
|
What is a follicular cyst?
|
A distended and unruptured graafian follicle
|
|
|
What is a corpus luteum cyst?
|
A persistent corpus luteum that has hemorrhaged and can result in menstrual irregularity
|
|
|
What causes theca-lutein cysts?
|
Theca-lutein cysts are caused by gonadotropin stimulation
|
|
|
What is a chocolate cyst?
|
A blood-containing cyst that results from ovarian endometriosis
|
|
|
What two conditions are follicular cysts associated with?
|
Hyperestrinism and endometrial hyperplasia
|
|
|
What type of cysts are associated with choriocarcinoma and moles?
|
Theca-lutein cysts
|
|
|
What symptoms are associated with chocolate cysts?
|
Pain, often in conjunction with the menstrual cycle
|
|
|
Name a rare but malignant germ cell tumor that has large hyperchromatic syncytiotrophoblast cells on pathology.
|
Choriocarcinoma (synctiotrophoblasts produce HCG and this is elevated in choriocarcinoma)
|
|
|
True or False: Choriocarcinoma can develop during pregnancy in either the mother or the baby.
|
True
|
|
|
Which two ovarian germ cell tumors produce human chorionic gonadotropin as a tumor marker?
|
Dysgerminoma and choriocarcinoma
|
|
|
Which ovarian germ cell tumor is associated with an increased frequency of theca-lutein cysts?
|
Choriocarcinoma
|
|
|
What type of tumor makes up 90% of ovarian germ cell tumors?
|
Teratoma
|
|
|
What type of tumor contains cells from 2 or 3 germ layers?
|
Teratoma
|
|
|
What is the most common benign ovarian tumor?
|
Mature teratoma ("dermoid cyst")
|
|
|
In females, a mature teratoma is _____ (benign/malignant), whereas an immature teratoma is _____ (benign/malignant).
|
Benign; malignant (aggressively)
|
|
|
Name a special type of teratoma that contains functional thyroid tissue.
|
Struma ovarii
|
|
|
What type of ovarian tumor can present with hyperthyroidism?
|
Struma ovarii
|
|
|
What type of tumor contains cells from 2 or 3 germ layers?
|
Teratoma
|
|
|
What is the most common benign ovarian tumor?
|
Mature teratoma ("dermoid cyst")
|
|
|
In females, a mature teratoma is _____ (benign/malignant), whereas an immature teratoma is _____ (benign/malignant).
|
Benign; malignant (aggressively)
|
|
|
Name a special type of teratoma that contains functional thyroid tissue.
|
Struma ovarii
|
|
|
What type of ovarian tumor can present with hyperthyroidism?
|
Struma ovarii
|
|
|
In females, a mature teratoma is a benign neoplasm that is also known as a _____ _____.
|
Dermoid cyst
|
|
|
Name an aggressive malignancy found in the ovaries, testes, and sacrococcygeal areas of young children.
|
Yolk sac (endodermal sinus) tumors
|
|
|
_____ is a tumor marker for yolk sac (endodermal sinus) tumors.
|
α-Fetoprotein
|
|
|
Dysgerminoma in women, equivalent to the male seminoma, is _____ (benign/malignant).
|
Malignant
|
|
|
Which type of ovarian germ cell tumor is made up of sheets of uniform cells on pathology?
|
Dysgerminoma
|
|
|
What hormone is a tumor marker for dysgerminoma?
|
Human chorionic gonadotropin
|
|
|
Are dysgerminomas benign or malignant?
|
malignant
|
|
|
Which benign ovarian non-germ cell tumor represents 20% of ovarian tumors and is frequently bilateral?
|
Serous cystadenoma
|
|
|
Which benign ovarian tumor has fallopian-tube-like epithelium on histopathology?
|
Serous cystadenoma
|
|
|
Which malignant ovarian non-germ cell tumor represents 50% of ovarian tumors and is frequently bilateral?
|
Serous cystadenocarcinoma
|
|
|
Which benign ovarian non-germ cell tumor is a multilocular cyst lined with mucus-secreting epithelium?
|
Mucinous cystadenoma
|
|
|
Which malignant ovarian non-germ cell tumor can progress to pseudomyxoma peritonei?
|
Mucinous cystadenocarcinoma
|
|
|
What is pseudomyxoma peritonei?
|
An intraperitoneal accumulation of mucinous material from an ovarian or appendiceal tumor
|
|
|
Which benign ovarian non-germ cell tumor resembles bladder epithelium?
|
Brenner tumor (remember: Brenner is Benign and looks like Bladder)
|
|
|
Which benign ovarian non-germ cell tumor contains bundles of spindle-shaped fibroblasts and can cause Meigs' syndrome?
|
Ovarian fibroma
|
|
|
An ovarian fibroma can present with a pulling sensation in what area?
|
The groin
|
|
|
What triad is associated with Meigs' syndrome?
|
Ovarian fibroma, ascites, and hydrothorax
|
|
|
What is the name for the syndrome which includes ascites, hydrothorax and ovarian fibroma?
|
Meigs' syndrome
|
|
|
What type of benign ovarian non-germ cell tumor contains Call-Exner bodies?
|
Granulosa cell tumor
|
|
|
As they pertain to granulosa cell tumors, what are Call-Exner bodies?
|
Small follicles filled with eosinophilic secretions
|
|
|
Which benign ovarian non-germ cell tumor can be associated with estrogen secretion, which can cause precocious puberty in children?
|
Granulosa cell tumor
|
|
|
What type of benign ovarian non-germ cell tumor can be associated with estrogen secretion, which can cause endometrial hyperplasia or carcinoma in adults?
|
Granulosa cell tumor
|
|
|
What is the name for a gastrointestinal malignancy that metastasizes to the ovaries, causing a mucin-secreting signet cell adenocarcinoma?
|
Krukenberg tumor
|
|
|
What is the key histologic appearance of a Krukenberg tumor of the ovary?
|
Signet cell
|
|
|
Krukenberg tumor is an ovarian tumor that has its origin in what organ system?
|
Gastrointestinal system
(usually the stomach) |
|
|
What protein serves as a general marker for ovarian cancers?
|
CA-125
|
|
|
Name two genetic risk factors for developing ovarian tumors with a non-germ cell origin.
|
Being positive for BRCA-1 and HNPCC genes
|
|
|
Vaginal squamous cell carcinoma is usually secondary to what?
|
Cervical squamous cell carcinoma
|
|
|
Diethylstilbestrol (DES) exposure can lead to what type of vaginal carcinoma?
|
Clear cell adenocarcinoma
|
|
|
Sarcoma botryoides, a rhabdomysarcoma variant, affects females of what age?
|
<4 years
|
|
|
How do tumor cells in sarcoma botryoides appear under the microscope?
|
As spindle-shaped cells
|
|
|
Sarcoma botryoides has tumor cells that are positive for what marker?
|
Desmin
|
|
|
Sarcoma botryoides is a variant of what type of malignancy?
|
Rhabdomyosarcoma
|
|
|
What is the most common breast tumor among women <25 years old?
|
Fibroadenoma
|
|
|
How do fibroadenomas usually present during the physical examination?
|
As small, mobile, firm masses with sharp edges that increase in size and tenderness with pregnancy and the menstrual cycle
|
|
|
True or False: Fibroadenomas are precursors to malignant breast cancers.
|
False; fibroadenomas are benign
|
|
|
What is a phyllodes tumor and how does it present?
|
A benign breast tumor that presents with a large, bulky mass of connective tissue and cysts and that sometimes has "leaf-like" projections
|
|
|
Are phyllodes tumors benign or malignant?
|
Usually benign, though some may be malignant (cystosarcoma phyllodes)
|
|
|
What type of benign breast tumor is a tumor of the lactiferous ducts?
|
Intraductal papilloma
|
|
|
What type of breast tumor most commonly presents with serous or bloody nipple discharge?
|
Intraductal papilloma
|
|
|
Intraductal papillomas increase the risk of developing breast cancer by what factor?
|
1.2-2 times the risk
|
|
|
Where on the breast are intraductal papillomas typically found?
|
Beneath the areola
|
|
|
In what decade do phyllodes tumors most frequently present?
|
The 6th decade
|
|
|
When do breast carcinomas usually occur in women?
|
After menopause
|
|
|
What are the two types of breast tissue from which breast carcinoma can arise?
|
Mammary duct epithelium or lobular gland
|
|
|
In breast carcinoma, why is knowledge of the expression of estrogen/progesterone receptors or erb-B2 (HER-2, an epidermal growth factor receptor) important?
|
The tumor's hormone receptor and HER-2 status affect the prognosis of the patient and dictate the type of treatment that should be used
|
|
|
What is the single most important prognostic factor in malignant breast cancer?
|
Axillary lymph node involvement
|
|
|
What type of breast carcinoma is an early malignancy that fills the ductal lumen without basement membrane penetration?
|
Ductal carcinoma in situ
|
|
|
Which type of breast carcinoma demonstrates a firm fibrous mass composed of small, duct-like glandular cells?
|
Invasive ductal- most common, worst and most invasive
|
|
|
What type of malignant breast tumor has the worst prognosis and is most invasive type of breast cancer?
|
Invasive ductal
|
|
|
Which histologic type of breast carcinoma is derived from ductal tissue and demonstrates caseous necrosis?
|
Comedocarcinoma
|
|
|
Which histologic type of breast carcinoma demonstrates lymphatic involvement and red, swollen, peau d'orange (skin resembling an orange) skin?
|
Inflammatory
|
|
|
Which histologic type of breast carcinoma often presents bilaterally and with multiple tumors?
|
Invasive lobular
|
|
|
Which histologic type of breast carcinoma is a fleshy tumor with lymphocytic infiltration and a good prognosis?
|
Medullary
|
|
|
What condition related to breast carcinoma presents with eczematous patches on the nipple and is suggestive of underlying carcinoma?
|
Paget's disease of the breast
|
|
|
What is the name of the large cells with clear halos seen in Paget's disease of the breast?
|
Paget cells
|
|
|
Paget's disease with eczematous patches is found on the nipple and what other area of the body?
|
Vulva
|
|
|
Invasive ductal carcinoma makes up about what fraction of breast cancer?
|
3/4 (76%)
|
|
|
Pathologic examination of invasive lobular carcinoma would reveal what?
|
Orderly rows of cells
|
|
|
What is the 5-year survival rate for patients with inflammatory breast cancer?
|
50%
|
|
|
What is meant by peau d'orange skin with respect to breast cancer?
|
The breast skin resembles the peel of an orange
|
|
|
On mammography breast cancer generally appears as a _____ (dense/transparent) _____ (regularly/irregularly) shaped mass.
|
Dense, irregular
|
|
|
What is suggested by Paget's disease of the breast?
|
Underlying carcinoma
|
|
|
Name four histologic types of fibrocystic breast disease.
|
Fibrotic, cystic, sclerosing adenosis, and epithelial hyperplasia
|
|
|
How many more times likely is a woman with fibrocystic breast disease to develop breast cancer?
|
In general (other than epithelial cell hyperplasia with atypical cells), women with fibrocystic disease have no increased risk of breast cancer
|
|
|
Which common breast disease presents with premenstrual breast pain and multiple lesions that are often bilateral?
|
Fibrocystic disease
|
|
|
How does the fibrotic type of fibrocystic disease appear on histopathology?
|
Hyperplasia of the breast stroma
|
|
|
How do cysts appear on histopathology in fibrocystic breast disease?
|
Fluid-filled, blue dome cysts
|
|
|
How does sclerosing adenosis appear on histopathology in fibrocystic breast disease?
|
Increased acini and intralobular fibrosis-- may be calcifications
|
|
|
Name one major exception to the rule that women with fibrocystic breast disease are not at higher risk of cancer.
|
Women with atypical epithelial hyperplasia are at higher risk
|
|
|
How does epithelial hyperplasia appear on histopathology in fibrocystic breast disease?
|
Increased number of cell layers in the terminal duct lobule
|
|
|
What is acute mastitis?
|
Formation of abscesses in the breast tissue during breast feeding
|
|
|
What organism most commonly causes acute mastitis?
|
Staphylococcus aureus
|
|
|
What condition causes nursing women to be more prone to acute mastitis?
|
Cracks in the nipple caused by breast feeding, which make bacterial entry easier
|
|
|
What is fat necrosis in the breast?
|
A painless, benign lump in the breast that forms after breast injury
|
|
|
What is gynecomastia?
|
The development of breast tissue in males
|
|
|
What is the most common cause of "breast lumps" in women age 25 years to menopause?
|
Fibrocystic disease
|
|
|
In what aged women does fibrocystic disease with epithelial hyperplasia generally occur?
|
Over the age of 30
|
|
|
Name five conditions that can cause gynecomastia due to hyperestrogenism.
|
Puberty, old age, testicular tumors, cirrhotic liver disease, estrogen therapy
|
|
|
Name a genetic abnormality that can result in gynecomastia.
|
Klinefelter's syndrome
|
|
|
Name nine drugs or substances that cause gynecomastia.
|
Spironolactone, Digitalis, Cimetidine, Alcohol, Ketoconazole (remember: Some Drugs Create Awesome Knockers) along with marijauna, estrogen, heroin and psychoactive drugs
|
|
|
Which of the following street drugs is not known to cause gynecomastia: heroin, cocaine or marijuana?
|
cocaine
|
|
|
What is prostatitis and how does it present?
|
An inflammatory state of the prostate that may be bacterial or abacterial that presents with dysuria, frequency, urgency, and low back pain
|
|
|
Is acute prostatitis most commonly bacterial, abacterial, or either?
|
Bacterial (eg, Escherichia coli
|
|
|
Is chronic prostatitis most commonly bacterial or abacterial?
|
Abacterial
|
|
|
Benign prostatic hyperplasia is common among men in what age group?
|
>50 years
|
|
|
Benign prostatic hyperplasia may be caused by an age-related increase in _____ with possible sensitization of the prostate to the growth-promoting effects of _____.
|
Estradiol; dihydrotestosterone
|
|
|
A 65-year-old man presents with increased frequency of urination, nocturia, and difficulty starting and stopping his urine stream. What common benign urologic condition is high on the differential diagnosis?
|
Benign prostatic hyperplasia
|
|
|
One symptom of benign prostatic hyperplasia is _____ (decreased/increased) frequency of urination.
|
Increased
|
|
|
A 60-year-old man presents with increased frequency of urination and dysuria as a result of chronic urinary tract infection. What common benign urologic condition is likely?
|
Benign prostatic hyperplasia
|
|
|
True or False: Benign prostatic hyperplasia is considered a premalignant lesion.
|
False; benign prostatic hyperplasia is not considered a premalignant lesion
|
|
|
Benign prostatic hyperplasia is characterized by the nodular enlargement of which two nodes of the prostate gland?
|
The lateral and middle/periurethral nodes
|
|
|
The urinary complaints that are commonly associated with benign prostatic hyperplasia are caused by the compression of what structure?
|
The urethra (into a vertical slit)
|
|
|
What are the more serious complications of benign prostatic hyperplasia?
|
Distention or hypertrophy of the bladder, hydronephrosis, and urinary tract infection
|
|
|
Prostate-specific antigen can be elevated in men with what two conditions?
|
BPH and prostate cancer
|
|
|
Prostatic adenocarcinoma is common among men in what age group?
|
>50 years
|
|
|
Prostatic adenocarcinoma is characterized by nodular enlargement of which lobe of the prostate gland?
|
Posterior node (peripheral zone)
- can be felt on digital rectal exam |
|
|
Benign prostatic hyperplasia is often more likely located in the _____ (periurethral/posterior) lobe, whereas prostatic adenocarcinoma is more likely located in the _____ (periurethral/posterior) lobe.
|
Periurethral; posterior
|
|
|
What are the two most common ways to diagnose prostatic adenocarcinoma?
|
Digital rectal exam (hard nodule) and biopsy
|
|
|
In prostatic adenocarcinoma, what are the typical findings on digital rectal examination?
|
A hard nodule located on the posterior lobe (peripheral zone) of the prostate
|
|
|
Name two useful tumor markers for prostatic adenocarcinoma.
|
Prostatic acid phosphatase and prostate-specific antigen
|
|
|
What are common markers for the osteoblastic metastases that may develop during later stages of prostatic adenocarcinoma?
|
Increased serum alkaline phosphatase and increased prostate-specific antigen levels
|
|
|
True or False: Low back pain may be caused by osteoblastic metastases from prostatic adenocarcinoma.
|
True
|
|
|
Lab work in a patient with prostatic adenocarcinoma would reveal _____ (increased/decreased) total PSA and a/an _____ (increased/decreased) fraction of free PSA.
|
Increased, decreased
(if you have increased FREE PSA you are FREE of cancer) |
|
|
What is a common histologic description of prostatic adenocarcinoma?
|
Small infiltrating glands in the prostate with prominent nucleoli
|
|
|
Define cryptorchidism.
|
Undescended testes (one or both)- testes are cryptic
|
|
|
True or False: Cryptorchidism does not affect spermatogenesis
|
False; the increased temperature of the testes when they are close to the body leads to a lack of spermatogenesis
|
|
|
True or False: Cryptorchidism increases the risk of germ line cancers.
|
True
|
|
|
Prematurity _____ (decrease/increases) the risk of cryptorchidism.
|
Increases
|
|
|
Germ cell tumors make up roughly what percent of all testicular tumors?
|
About 95%
|
|
|
What is the most common testicular tumor?
|
Seminoma
|
|
|
Seminoma is a _____ (malignant/benign) testicular tumor which is _____ (painful/painless).
|
Malignant, painless
|
|
|
Seminoma is a testicular germ cell tumor affecting males 15-35 years old with _____ (early/late) metastasis and _____ (excellent/poor) prognosis.
|
Late; excellent
|
|
|
What testicular germ cell tumor has large cells in lobules with watery cytoplasm and a "fried egg" appearance on histopathology?
|
Seminoma
|
|
|
True or False: Seminoma is a testicular germ cell tumor that is very radiosensitive.
|
True
|
|
|
What malignant testicular germ cell tumor can differentiate to other tumors?
|
Embryonal carcinoma (like an embryic stem cells it has the greatest potential to differentiate in many ways)
|
|
|
In males, seminoma presents with a _____ (painful/painless) testicular mass, whereas embryonal carcinoma presents with a _____ (painful/painless) mass.
|
Painless; painful
|
|
|
True or False: Seminoma has a worse prognosis than embryonal carcinoma.
|
False; embryonal carcinoma has a worse prognosis
|
|
|
What is the malignant testicular germ cell tumor, which presents with glandular/papillary morphology on pathology?
|
Embryonal carcinoma
|
|
|
What germ cell tumor has Schiller-Duval bodies on histopathology?
|
Yolk sac (endodermal sinus) tumor
|
|
|
What tumor of the testis has primitive glomeruli on histopathology?
|
Yolk sac tumor
|
|
|
What tumor marker is associated with yolk sac (endodermal sinus) tumors?
|
Increased α-fetoprotein
|
|
|
Name a rare but malignant germ cell tumor of the testis that presents with increased β-human chorionic gonadotropin levels.
|
Choriocarcinoma
|
|
|
Choriocarcinoma is a _____ (benign/malignant) germ cell tumor that presents with increased levels of _____ (α-fetoprotein/human chorionic gonadotropin).
|
Malignant; human chorionic gonadotropin
|
|
|
In men, mature teratomas are _____ (benign/malignant) and in women, mature teratomas are _____ (benign/malignant).
|
Malignant; benign
|
|
|
What malignant testicular tumor is analogous to an ovarian yolk sac tumor?
|
Endodermal sinus (yolk sac) tumor
|
|
|
What benign testicular non-germ cell tumor is associated with Reinke's crystals?
|
Leydig cell tumor
|
|
|
What is a Sertoli cell tumor?
|
A benign testicular non-germ-cell tumor that is an androblastoma derived from sex cord stroma
|
|
|
Tunica vaginalis lesions often present as testicular masses that _____ (can/cannot) be transilluminated, while testicular tumors _____ (can/cannot) be transilluminated.
|
Can; cannot
|
|
|
What is the most common testicular cancer among older men?
|
Testicular lymphoma
|
|
|
Testicular non-germ cell tumors make up approximately what percentage of testicular tumors?
|
About 5%
(most testicular/male cancers are germ cells because men have lots of germs) |
|
|
Testicular non-germ cell tumors are typically _____ (benign/malignant).
|
Benign
|
|
|
What benign testicular non-germ cell tumor is associated with androgen secretion, prompting precocious puberty in children and gynecomastia in adults?
|
Leydig cell tumor- produces testosterone which can then be aromatized to estrogen
|
|
|
What are tunica vaginalis lesions?
|
Lesions in the serous covering of the testis
|
|
|
What is a varicocele?
|
A dilated vein in the pampiniform plexus
|
|
|
True or False: A varicocele can cause infertility.
|
True
|
|
|
What is a hydrocele?
|
A collection of fluid within the scrotum
|
|
|
What embryological abnormality causes a hydrocele?
|
Incomplete fusion of processus vaginalis
|
|
|
What is a spermatocele?
|
A dilated epididymal duct
|
|
|
A varicocele is a dilated vein in the _____ plexus.
|
Pampiniform
|
|
|
What type of tunica vaginalis lesion is described as looking like "a bag of worms?"
|
A varicocele- dilate veins
|
|
|
What are the clinical manifestations of Bowen's disease?
|
A single, gray crusty plaque that forms on the scrotum or shaft of the penis during the fifth decade of life
|
|
|
True or False: If untreated, Bowen's disease of the penis usually progresses to squamous cell carcinoma.
|
False; only about 10% of untreated lesions progress to squamous cell carcinoma
|
|
|
What are the clinical manifestations of erythroplasia of Queyrat?
|
Red, velvety plaques on the glans of the penis that form during the fifth decade of life
|
|
|
Is penile squamous cell carcinoma more or less common in uncircumcised men?
|
More common
- they have more skin on which to develop it and stuff gets caught in there predisposing to infection and neoplastic changes |
|
|
Geographically, where is penile squamous cell carcinoma most common?
|
The condition is uncommon in Europe and the United States and more common in Asia, Africa and South America
|
|
|
Human papillomavirus causes what pathology in uncircumcised males?
|
Penile squamous cell carcinoma
|
|
|
What condition results in a bent penis due to an acquired fibrous tissue formation?
|
Peyronie's disease
|
|
|
What type of penile pathology is characterized by multiple papular lesions in younger men that generally do not become invasive?
|
Bowenoid papulosis
|
|
|
Squamous cell carcinoma of the penis is associated with infection with which virus?
|
HPV
|
|
|
Where is GnRH released from and where does it have its effect?
|
It is released from the hypothalamus and affects the anterior pituitary
|
|
|
What effect do GnRH agonists have on the reproductive HPA axis?
|
GnRH agonists are stimulatory if given as pulses, inhibitory if given continuously
|
|
|
In women, what two reproductive hormones are released by the anterior pituitary and where do they have their effect?
|
FSH and LH stimulate the ovaries
|
|
|
In women, does clomiphine increase or decrease reproductive hormone release from the anterior pituitary?
|
Increase
|
|
|
In women, do oral contraceptives increase or decrease reproductive hormone release from the anterior pituitary?
|
Decrease
|
|
|
Does ketoconazole increase or decrease the testosterone and androstenedione release from the ovaries?
|
Decrease
|
|
|
What effect does anastrozole have on the female HPA axis?
|
It is an aromatase inhibitor that prevents estrogen formation from androgens
|
|
|
What effect do ketoconazole and spironolactone have on the male reproductive hormone axis?
|
They block testosterone release from the testis
|
|
|
What is the mechanism of action and result of finasteride administration?
|
It is an 5α-reductase inhibitor that blocks the conversion of testosterone to dihydrotestosterone
|
|
|
What effect do flutamide and spironolactone have on the male reproductive hormone axis?
|
Block the effect of testosterone and dihydrotestosterone on androgen-receptor complexes
|
|
|
What 5α-reductase inhibitor is useful for treating benign prostatic hyperplasia and also promotes hair growth in patients with male pattern baldness?
|
Finasteride
|
|
|
The mechanism of action of 5α-reductase inhibitors is to decrease the conversion of _____ to _____, a more potent androgen, by inhibiting the enzyme _____.
|
Testosterone; dihydrotestosterone; 5α-reductase
|
|
|
What is the mechanism of action of flutamide?
|
Competitive testosterone receptor antagonist
|
|
|
Which two drugs inhibit steroid synthesis and steroid binding, respectively, and are both used in patients polycystic ovarian syndrome to prevent hirsutism?
|
Ketoconazole and spironolactone
|
|
|
What are two adverse effects common to both ketoconazole and spironolactone?
|
Gynecomastia and amenorrhea
|
|
|
Flutamide is used to treat what condition?
|
Prostate carcinoma
|
|
|
Which is more potent: testosterone or DHT?
|
DHT
|
|
|
What are the primary clinical uses of leuprolide?
|
Infertility (pulsatile), prostate cancer (continuous, used with flutamide), or uterine fibroids
|
|
|
What adverse effects are associated with leuprolide use?
|
Antiandrogenic actions, nausea, and vomiting
|
|
|
Leuprolide demonstrates _____ (agonist/antagonist) properties when used in a pulsatile fashion and _____ (agonist/antagonist) properties when used in a continuous fashion.
|
Agonist; antagonist
|
|
|
Leuprolide is an analog of what hormone?
|
GnRH (remember: Leuprolide is used in lieu of GnRH
|
|
|
What is the primary clinical use for sildenafil and vardenafil?
|
The treatment of erectile dysfunction
|
|
|
What five adverse effects are associated with sildenafil or vardenafil use?
|
Impaired blue-green vision, dyspepsia (heartburn), flushing, headache, and life-threatening hypotension
|
|
|
Sildenafil and vardenafil should not be used in patients taking what other class of drug?
|
Nitrates-- may cause an unsafe drop in blood pressure
|
|
|
What is the mechanism of action of sildenafil and vardenafil and what is the result of their administration?
|
They inhibit cGMP phosphodiesterase, thereby causing increased cGMP, smooth muscle relaxation in the corpus cavernosum, and increased blood flow and erection (remember: sildenafil and vardenafil fill the penis)
|
|
|
What is the mechanism of action of mifepristone (RU-486)?
|
It is a competitive inhibitor of progestins at progesterone receptors
|
|
|
What is the primary clinical use of mifepristone?
|
Termination of pregnancy
|
|
|
What are the known toxicities of mifepristone?
|
Heavy bleeding, gastrointestinal effects (nausea, vomiting, anorexia), and abdominal pain
|
|
|
Mifepristone is frequently administered in conjunction with what other drug?
|
Misoprostol (PGE1)-- both given to abort baby
|
|
|
What are 5 advantages or oral contraceptives?
|
Reliability (<1% failure), regulation of menses, and lower risks of endometrial and ovarian cancer, pelvic infections and ectopic pregnancy
|
|
|
Name 7 disadvantages of oral contraceptives.
|
Must be taken daily, no protection against STDs, hypercoagulable state, increase in triglycerides, depression, hypertension and weight gain
|
|
|
How do oral contraceptives work?
|
They work by preventing an estrogen surge and thus the LH surge that precedes ovulation-- thus no ovulation
|
|
|
What are indications for hormone replacement therapy?
|
Menopausal symptoms (eg, hot flashes, vaginal atrophy) and osteoporosis that is caused by decreased estrogen levels
|
|
|
In terms of hormone replacement therapy, unopposed estrogen can increase the risk of what disease?
|
Endometrial cancer
|
|
|
Why is progesterone added to hormone replacement therapy?
|
To reduce the risk of endometrial cancer- unopposed estrogen causes endometrial proliferation
|
|
|
True or False: There is a possible increase in cardiovascular risk with the use of hormone replacement therapy.
|
True
|
|
|
Dinoprostone is an analogue of what?
|
PGE2
|
|
|
Dinoprostone induces labor by causing cervical _____ (contraction/dilation) and uterine _____ (contraction/dilation).
|
Dilatation; contraction
|
|
|
Ritodrine and terbutaline are β2 _____ (agonists/antagonists) that _______(relax/contract) the uterus.
|
Agonists, relax
|
|
|
In what clinical scenario are ritodrine and terbutaline used?
|
Premature labor
|
|
|
Anastrozole is an aromatase _____ (inducer/inhibitor).
|
Inhibitor
|
|
|
In what clinical scenario is anastrozole/exemestane used?
|
In postmenopausal women with breast cancer
|
|
|
Testosterone is an _____ (agonist/antagonist) at androgen receptors.
|
Agonist
|
|
|
True or False: Testosterone is used to treat hypogonadism and promote the development of secondary sex characteristics.
|
True
|
|
|
Testosterone stimulates _____ (anabolism/catabolism) to _____ (promote/prevent) recovery after burn or injury.
|
Anabolism; promote
|
|
|
True or False: Testosterone is contraindicated in the treatment of estrogen-receptor positive breast cancer.
|
False; testosterone can be used to treat estrogen-receptor positive breast cancer
|
|
|
Exogenous testosterone _____ (increases/reduces) intratesticular testosterone in males.
|
Reduces- feedback inhibition on the pituitary
|
|
|
Exogenous testosterone _____ (induces/inhibits) Leydig cells, leading to gonadal _____ (atrophy/hypertrophy).
|
Inhibits; atrophy
|
|
|
Exogenous testosterone can cause ______ (delayed/premature) closure of epiphyseal plates.
|
Premature
|
|
|
Testosterone increases _____ (low-density lipoprotein/high-density lipoprotein) and decreases _____ (low-density lipoprotein/high-density lipoprotein) levels.
|
Low-density lipoprotein; high-density lipoprotein (all the bad things)
|
|
|
What are the mechanisms of action of ethinyl estradiol, diethylstilbestrol, and mestranol?
|
Binding to estrogen receptors and acting as agonists
|
|
|
Name four conditions in women that are treated with estrogens.
|
Hypogonadism, ovarian failure, menstrual abnormalities; and hormone replacement therapy in postmenopausal women
|
|
|
Name a condition in elderly men that can be treated with estrogens
|
Androgen-dependent prostate cancer
|
|
|
Estrogens are associated with a(n) _____ (decreased/increased) risk of endometrial carcinoma, a(n) ______ (decreased/increased) risk of bleeding in postmenopausal women, and a(n) _____ (decreased/increased) risk of thrombi.
|
Increased; increased; increased
|
|
|
Clear cell adenocarcinoma of the vagina is more common in women exposed to what substance in utero?
|
Diethylsilbestrol (DES)
|
|
|
Name a condition for which estrogens are contraindicated in women.
|
Estrogen receptor-positive breast cancer
|
|
|
Progestins bind progestin receptors, _____ (increasing/reducing) growth, and _____ (increasing/decreasing) vascularization of the endometrium.
|
Reducing; increasing
|
|
|
True or False: Progestins are used in oral contraceptives.
|
True
|
|
|
True or False: Progestins are contraindicated in women with endometrial cancer.
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False; progestins are used to treat endometrial cancer
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True or False: Progestins are used to treat abnormal uterine bleeding.
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True
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Which drug acts as a partial agonist at the estrogen receptors in the hypothalamus and prevents normal feedback inhibition, thereby increasing the release of luteinizing hormone and follicle-stimulating hormone, which stimulates ovulation?
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Clomiphene
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What are two primary clinical uses for clomiphene?
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The treatment of infertility and polycystic ovarian syndrome
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What are four adverse effects associated with clomiphene use?
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Hot flashes, ovarian enlargement, multiple simultaneous pregnancies, and visual disturbances
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Tamoxifen is an _____ (agonist/antagonist) on breast tissue.
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Antagonist
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Tamoxifen used to treat women with and recurrences of estrogen receptor_________(negative/positive) breast cancer).
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Positive
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Raloxifene is an _____ (agonist/antagonist) on bone.
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Agonist
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Which selective estrogen receptor modulator reduces the resorption of bone and is used to treat osteoporosis?
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Raloxifene
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