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63 Cards in this Set

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The left ovary/testis drains to the left gonadal vein --> X --> IVC
x = left renal vein
The right ovary/testis drains to the right gonadal vein --> y
y = IVC
The ovaries and testes have lymphatic drainage into which set of lymph nodes?
para-aortic lymph nodes
Spermatogonium:
Diploid (2N)
46 single chromatids
maintains germ pool and produces primary spermatocytes
sits on basal lamina within seminiferous tubules
primary spermatocyte:
Diploid (2N)
46 sister chromatids
divides to become secondary spermatocyte (haploid with sister chromatids)
secondary spermatocyte:
haploid with sister chromatids
either XX or YY, but not both (unless secondary non-disjunction occurs)
Spermatid:
haploid (N) with single chromosomes
forms as a result of meiosis II
FSH stimulates sertoli cells to produce:
-androgen binding protein
-inhibin: which inhibits FSH release
enzyme that converts testosterone to DHT:
5-alpha-reductase
drug that inhibits 5-alpha-reductase:
finasteride
enzyme in adipose tissues and sertoli cells that converts testosterone and androstenedione to estrogen:
aromatase
enzyme in theca cells that converts cholesterol to andostenedione:
desmolase
during which phase of the menstrual cycle is estrogen highest?
During which phase is progesterone highest?
Proliferative (follicular) phase- estrogen peaks- estrogen is responsible for endometrial growth

secretary (luteal) phase- progesterone peaks because progesterone maintains endometrium to support implantation

Note: ovulation occurs in between proliferative and secretory phases
Oogonium:
diploid (2N)
contains 46 single chromosomes
1 oocyte:
when does it begin meiosis I? what phase is it arrested in?
1 oocyte is diploid (2N) with 46 sister chromatids
1 oocyte begins meiosis during fetal life, where it becomes suspended in prophase 1 until just prior to ovulation
when do 1 oocytes become 2 oocytes?
prior to ovulation. They are suspended in prophase 1 from fetal life and become 2 oocytes before ovulation. Meiosis I occurs prior to ovulation
hCG:
source and function?
secreted by synctiotrophoblasts of the placenta and trophoblasts 6 days after fertilization

hCG maintains corpus luteum (thus maintaining progesterone--> maintaining endometrial lining)
Symptoms of menopause:
Hot flashes, Atrophy of the Vagina, Osteoporosis, increased risk for coronary artery disease (remember that estrogen increases HDL, decreases LDL)
Diagnosis:
testicular atrophy, eunochoid body shape, tall, long extremities, gynecomastia, female hair distribution
Klinefelter's syndrome: XXY [male]

Result:
-hypogonadism
-dysgenesis of seminiferous tubules--> decreased inhibin--> increased FSH
-abnormal leydig cell function --> decreased testosterone --> increased LH --> increased estrogen
Diagnosis:
short stature, ovarian dysgenesis, webbing of neck, preductal coarctation of the aorta, amenorrhea
Turner's syndrome: XO [female]
decreased estrogen leads to increased LH and FSH

most common cause of primary amenorrhea
Diagnosis:
Tall male with severe acne displays antisocial behavior. Overall, he is phenotypically normal
Double Y males: XYY
these males have normal fertility
Pre-eclampsia triad

eclampsia
hypertension, proteinuria, and edema

pre-eclampsia + seizures
Diagnosis:
patient presents with blurred vision, abdominal pain, edema of the face and extremeties, altered mentation and hyperreflexia
Labs reveal thrombocytopenia and hyperuricemia
pre-eclampsia

deliver fetus as soon as posible
give IV magnseium sulfate and diazepam to prevent and treat seizures of eclampsia
abruptio placentae:
premature detachment of placenta from implantation site, resulting in fetal death.

Painful bleeding in 3rd trimester

Associated with DIC. and an increased risk with smoking
Nat Turner
American slave who led a slave rebellion in Virginia. This revolution killed 5 white people and lead to less rights to black people.
led a slave rebellion
placenta accreta:
attachment of the placentat to lower uterine segments.

prior c-section predisposes

causes painless bleeding any trimester
Ectopic pregnancy:
implantation in fallopian tube
predisposed by salpingitis (PID)

there will be an increase in hCG with sudden lower abdominal pain
(1) polyhydramnios
(2) oligohydramnios
(1) more than 1.5-2 L of amniotic fluid;
associated with duodenal/esophageal atresia
(2) less than 0.5 L of amniotic fluid; associated with bilateral adrenal agenesis. can give rise to potter's syndrome
Chocolate cysts are associated with what condition?
endometriosis- endometrial glands/stroma planted any other location outside of the uterus.
causes cyclic menstral-like bleeding and pain
DX:
most comon of all tumors in females which increases in size with pregnancy and decreases with menopause
Leiomyomas (fibroids)

contain whorled patter of smooth muscle bundles

severe bleeding may result in iron deficiency anemia
DX:
aggressive myometrial tumor with areas of necrosis and hemorrhage
Leiomyosarcoma

high incidence in blacks
tendency to recur
which hormone leads to anovulation and hyperandrogenism in Polycistic ovarian disease?
LH

POD is associated with in increased risk for endometrial carcinoma
Tumor marker of dysgerminoma:
hCG
Tumor marker for choriocarcinoma:
hCG
hyperchromatic synctiotrophoblastic cells
Tumor carcinoma for yolk sac endodermal sinus tumor
AFP
most common form of breast cancer?
Invasive ductal carcinoma

most common, most invasive
DX:
multiple, bilateral orderly row of cells of the breast
invasive lobular
DX:
fleshy, cellular, lymphatic infiltrate of the breasts
medullary breast carcinoma
DX: Peau d'orange- breast skin resembles orange peel
inflammatory breast cancer

50% survive at 5 years
dermal lymphatic invasion by breast carcinoma
Paget's disease
Paget's disease:
Eczematous patches on nipple
Paget cells = large cells in epidermis with clear halo
krukenberg tumor
tumor of the GI tract metastasizes to ovaries, causing a mucin-secreting (signet cell) adenocarcinoma
Drugs that cause gynecomastia:
"some drugs create awesome knockers:"
some drugs create awesome knockers:
Spironolactone
Digitalis
Cimetidine (histamine H2 receptor blocker, prevents secretion of gastric acid)
alcohol
ketoconazole
DX:
increased total PSA, with low fraction of free PSA
prostatic adenocarcinoma

osteoblastic metastases to bone--> increase in serum alkaline phosphatase and PSA, lower back pain
DX:
common in uncircumcised men, associated with HPV
squamous cell carcinoma of the penis
DX:
gray, solitary, crusty plaque located on the shaft of the penis or scrotum; peak incidence 50+; often progresses to SCC
Bowen's disease
Flutamide:
Used for prostate cancer

nonsteroidal competitive inhibitor of androgens at the testosterone receptor;
Leuprolide:
GnRH analog- agonist-pulsatile
antagonist-continuous

used for infertility (pulsatile fashion)
prostate cancer and uterine fibroids(coninuous use)
Sildenafil, vardenafil:
erectile dysfunction

inhibits cGMP phosphodiesterase, increasing levels of cGMP

Risk: life-threatening hypotension in patients also taking nitrates
Mifepristone:
used to terminate pregnancies

inhibitor of progesterone and progestins- (endometrium no longer maintained)

tox: heavy bleeding, GI effects (nausea, vomiting, anorexia)
Synthetic progestins, estrogens
these oral contraceptives prevent estrogen surge, so LH surge does not occur
unopposed estrogen replacement therapy increases the risk for what cancer?

what is added to prevent this cancer?
endometrial carcinoma

progesterone is added to oppose estrogen
dinoprostone:
PGE2 analogue labor inducer
cervical dilation, uterine contraction
Ritodrine/terbutaline
beta2 agonists that relax the uterus to reduce premature uterine contractions
estrogens: risks
increased risk of endometrial carcinoma

increase risk of clear cell adenocarcinoma of the vagina in females exposed to DES in utero
clomiphene
Used to treat infertility

partial agonist to estrogen receptors, decreasing negative feedback on pituitary--> LH and FSH surge

may result in multiple simultaneous pregnancies, hot flashes
tamoxifen:
estrogen antagonists on breast tissue
used to treat and prevent recurrence of estrogen-responsive breast cancer
raloxifen
estrogen agonist on bone, reduces resorption of bone; used to treat osteoporosis
AFP is a tumor marker for:?
hepatocellular carcinoma
testicular carcinomas
ovarian carcinomas

APF is normally produced by the fetal liver and yolk sac
CA-125:
found on the surface of malignant ovarian epithelials in serous, endometrioiud, and clear cell carcinomas of the ovary
Dx:
solid sheets of pleomorphic, high-grade cells with central necrosis.
comedocarcinoma
Dx:
solid sheets of vesicular, pleomorphic, mitotically active cells with lymphatic infiltrate
medullary duct cell carcinoma in situ
Dx:
dermal lymphatic invasion by breast carcinoma
breast skin resembles orange peel
inflammatory ductal cell carcinoma in situ
Dx:
exzematous, scale crust patches on nipple
paget's disease
paget cells= large cells in epidermis with clear halo
suggestive of underlying carcinoma