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Anatomy and Clinical Flashcards

1
Q

The lesser vestibular gland in women is analogous to what male structure? what’s another name for this gland?

A

Prostate

aka paraurethral gland

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2
Q

The greater vestibular gland in women is analogous to what male structure? what’s the name of the anatomic pouch its contained in and how is this different than it’s male counterpart?

A

Bulbourethral gland

The superficial perineal pouch whereas the bulbourethral gland is in the deep perineal pouch

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3
Q

The clitoris has two leg like extensions similar to the glans penis, what are they called?

A

crus

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4
Q

What’s a hysterosalpingography and when is it indicated?

A

Injection of contrast agent into the uterus to determine the patiency of the fallopian tubes.

Used to diagnose Ashermans syn, malformations, tubal occlusions, PID.

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5
Q

The peritoneal covering of the uterus called the broad ligament is made up of what structures?

A

mesosalpinx, mesovarium, and the mesometrium

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6
Q

The genitourinary system is derived from what embryologic portions of the tri-laminar disk? When does this disk become tri-laminar?

A

intermediate mesoderm (the rest) and endoderm (prostate, cowpers gland m; lower vagina f).

week 3 bi to tri laminar.

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7
Q

What happens following the migration of primordial germ cells to the gonadal ridge leading to the formation of primitive sex cords?

A

Cell clusters are formed from these primitive germ cells and later degenerate, next cortical cords develop from the surface epithelium and separate into primary oocytes (follicular cells surrounding an oogonium).

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8
Q

When does the indifferent stage end?

A

week 6

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9
Q

Which gender develops medullary cords?

A

men

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10
Q

Which anatomic structures are derived from the UG sinus in women?

A

Inferior vagina, greater vestibular glands, paraurethral glands, urethra and bladder.

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11
Q

Which anatomic structures are derived from the paramesonephric ducts (mullerian ducts) in women?

A

superior vagina, cervix and uterus

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12
Q

What gene is responsible for female ovarian development and subsequent mullerian duct development? Which hormones are involved in this process?

A

WNT4

Estrogens help develop the mullerian duct and a lack of testosterone causes the mesonephric duct to degenerate

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13
Q

Which structures are part of the unfused part of the mullerian ducts?

A

uterine tubes

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14
Q

What condition can result from the incomplete fusion of the mullerian duct (pathologic not physiologic)?

A

bicornate uterus

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15
Q

Genital swellings in women and men give rise to which complementary yet different structures?

A

scrotum

labia majora

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16
Q

The urethral folds in men close yet in women stay open and become what structure? Name the condition that occurs in men if they have a partial closure of these folds

A

labia minora

hypospadia

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17
Q

What is the first line treatment in endometriosis other than NSAIDs? Name an additional treatment.

A

OCP- They must be taken continuously (skip placebo wk). This will help with dysmenorrhea and the building up of the endometrium that can lead to endometriosis.

GnRH agonists like leuprolide can induce menopause but is limited to 6 month therapy due to bone loss.

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18
Q

How do you diagnose endometriosis

A

TVUS or diagnostic laparoscopy

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19
Q

Which uterine condition leading to dysmenorrhea is characterized by an enlarged uterus, pain, and heavy bleeding; unrelated to tumor growth? How do you diagnose and treat?

A

Adenomyosis
Dx TVUS, MRI
Tx total hysterectomy

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20
Q

Patient presents with pelvic pain and pressure worse during her period that she describes as heavy. She’s been trying to get pregnant without success and is nulligravida. You can palpate an adnexal mass; whats the likely diagnosis and treatment?

A

Leiomyomata

Dx US, hysteroscopy, MRI
Tx manage to surgery

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21
Q

What surgical interventions are common with dysmenorrhea patients?

A

endometrial biopsy
D&C sampling
Laparoscopy-Dx and Tx

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22
Q

When might a laparoscopy be preformed?

A

LUNA, Ectopic preg, adhesions, cyst drainage

23
Q

Hysteroscopies can be used for what?

A

Eval of interior of uterus, biopsy, sterilization, lysis of septa.
Dx and Tx

24
Q

Patient presents with an adnexal mass and hx of endometriosis. Neg for guitar string texture of rectovaginal exam. US reveals an enlarged ovary; whats the Dx?

A

endometrioma

25
Q

You patient has a hx of ovarian cysts that have been drained in the past via laparoscopy. They present to the ER c/o pain and they start vomiting. Adnexal mass is palpated and TVUS with doppler reveals decreased blood flow in the area of the ovary. Dx?

A

ovarian torsion

26
Q

A young woman you know has been trying to get pregnant tells you that she hasn’t had a period in 2 months but has had some pain and spotting. You’re only experience with this patient was treating her N. gonorrhea infection a little while back. TVUS may reveal what pathology?

A

ectopic pregnancy

27
Q

You begin performing OPP on a patient that’s getting over a pelvic infection and notice she has limited organ mobility in her lower abdomen around her uterus, what’s a possible Dx and Treatment plan?

A

adhesions

laparoscopy to confirm and treat

28
Q

One of your OPP patients is complaining of lower pelvic pain that you attempted to treat with a pelvic diaphragm release the tissue feels hypercontractile. She tells you that her pain feels better after she urinates which she does frequently. All other findings and work up are neg. What is her diagnosis?

A

interstital cystitis, or possible pelvic floor muscle spasm, or strain.

MRI or X-ray to r/o MSK

29
Q

What’s the parasympathetic and sympathetic innervation of the descending sigmoid and colon

A

L1-2 and S2-4

30
Q

Blood drains out of the penis via which vessels following ejaculation?

A

deep dorsal vein of the penis, prostatic plexus (of veins), the internal iliac vein

31
Q

The corpus spongiosum makes up which structures at either end of the penis?

A

posterior bulb, anterior glans

32
Q

S2-S4 keeps the penis off the floor via which nerves?

A

pelvic splanchnic nerve, cavernous nerve, and the pudendal nerve.

33
Q

Neves of which autonomic branch supply the epididymus?

A

sympathetics

34
Q

NO facilitates what process in the penis; via what mechanism; where does sidenafil come into play?

A

Relaxation of smooth muscle leading to vasodilation and errection.

This process can be stimulated via touch or thoughts and as such NO is released by endothelial cells and parasympathetic axons. This NO activates guanylate cyclase, CGMP, and MLCPtase which dephosphorylates Myosin to cause relaxation. cGMP is broken down by PGE5 to end an errection; PGE5 is broken down by viagra to prevent this from happening.

35
Q

Your patient is complaining that he can’t get it up, even when a hot ass blonde is taking off his pants. Other than the obvious problem what else are you concerned about with this patient?

A

His ED could be an indication of cardiac disease, DM, Hyperlipidemia, or hypogonadism (even secondary to something else).

36
Q

Your ED patient has high blood pressure and smokes 2 packs a day. He’s 55 over weight and says viagra doesn’t work for him. You’re worried the statin he’s on is just making things worse. What’s the best long term plan for this patient?

A) quit smoking
B) loose weight
C) penis injections of aloprostadil
D) a hotter date

A

B) loosing weight. Although a penis injection would be great short term, loosing weight will decrease the peripheral conversion of testosterone to estrogen, help his hyperlipidemia, and may even get him off a statin which will also help his ED.

Smoking will help with circulation and is important but I think is the next best choice

37
Q

In the female artery system the uterine branches into what artery? What gives rise to the uterine artery?

A

vaginal

internal iliac

38
Q

The internal pudendal artery is superior or inferior to the vaginal artery? Which embryologic structure does this supply?

A

inferior

GU sinus that makes up the lower vagina

39
Q

What’s the name of the angle at which a physician does a female pelvic exam?

A

lithotomy position

40
Q

The pudendal nerve is a parasympathetic nerve that has what function general function? Where does it originate in the spine? Which muscles does it innervate; can you identify them?

A

motor and sensory
S2-S4
bulbospongiosus and ischiocavernosus

41
Q

where would a physician attempt to block the pudendal nerve during childbirth?

A

Ischial spine

42
Q

Describe the pathway of the pudendal nerve and artery in the pelvis

A

S2-4 travels into the greater sciatic foramen and underneath the sacrospinous ligament (covered by the coccygeus muscle), then into the lesser static foramen within the pudendal canal (fascial sheath of the obturator internus), then travels along the ischial pubic ramus in the perineum. The pudendal artery then branches into the dorsal and deep artery of the penis.

43
Q

You have a 51 y/o menopausal patient looking to take HRT and she wants your advice. She has no hx of hysterectomy and wants to know the risks of HRT; what’s your advice and what are the risks? How would this change if she had a hysterectomy with salpingo-oophrectomy

A

Increases risk of breast cancer, stroke, DVT, and cholecystitis.

Benefit other than helping with symptoms of menopause: Decrease in CHD, mortality, fracture, DM, and colorectal cancer

Advice- 5 year Estrogen and progesterone therapy (low dose). Femhrt over prempro due to its more negative effects in the WHI study.

No progesterone for women with hysterectomy and no increase risk of breast cancer

44
Q

The uterine cycle is defined by what criteria?

A

day 1-5 menstrual
day 6-14 proliferative
15-26 secretory
27-28 pre-menstrual

45
Q

How does LH affect the theca cells?

A

Activates desmolase which facilitates the production of androgens from LDL. Theca cells can produce testosterone from androstenedione but not estrone (E1), b/c they lack aromatase.

46
Q

How does FSH affect granulosa cells?

A

FSH activates aromatase to facilitate the conversion of androstenedione coming from theca cells into estrone which can be converted to estradiol.

Granulosa cells also lack 17-alpha hydroxylase and thus can’t convert progesterone which then supports the uterine lining or diffuses to the theca cells.

47
Q

How do the levels of the following hormones look in menopause: AMH, inhibin, estradiol, FSH, GnRH

A

AMH decreased
inhibit decreased
Estradiol decreased

FSH and GnRH increased

48
Q

Estrone is more or less common in menopause? What are some negative effects of this hormone?

A

More; estradiol pre-menopause

Increase body fat

49
Q

Lack of estrogen leads to three major complications menopausal and post menopausal women

A

osteoporosis
Heart disease
Collagen breakdown-uterinovaginal prolapse, wrinkles, immobility

50
Q

What are the two mechanisms by which a lack of estrogen increases a woman risk for osteoporosis?

A

T-cells increase release of pro-inflammatory cytokines, this increases expression of RANK ligand expression on osteoblasts; concomitantly CCR2 increases expression of RANK on osteoclast precursor cells. The subsequent binding of osteoblasts with osteoclast precursors produces mature osteoclasts.

51
Q

What monoclonal antibody is approved for treatment of post menopausal women for osteoporosis prevention?

A

denosumab binds RANK L

52
Q

What are the vascular effects of estradiol?

A

smooth muscle relaxation

53
Q

The major effects of prostaglandins that lead to uterine cramping and pain during menstruation are what?

A

Uterine contractions
vascular-constriction
hypersensitivity of pain receptors

GU (5 decks)

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