DIT repro Flashcards
Layers of penis:
Outer dermis Dartos fascia Deep Buck's Fascia Tunica albuginea then CORPUS CAVERNOSA or OR SPONGIOSA (latter is around urethra)
Nerve for boner?
Pelvic Nerve (parasympthatic)
NO makes more cGMP and sildenafil prevents breakdown
NE causes more Ca++ in the muscle and smooth muscle contraction and vasoconstriction and fight or flight so you don’t want blood to penis then)
Nerve for emission?
Hypogastric nerve
Nerve for ejaculation?
Pudendal nerve (visceral and somatic nerve)
LIgaments for uterus
C for Cervix and Cardinal ligament holding down Cervix
Broad uterus is BIG (everything else to pelvic wall) Uterus, ovary, fallopian tube, cut during hysterectomy)
Suspensory ligament of ovary suspends ovary to pelvic wall
Ovarian ligament is ovary to uterus
Round ligament of uterus is from gubernaculum
Which ligament holds ovarian vessels?
Uterine vessels?
Suspensory ligaemnt
Cardinal ligament
Venous drainage of Left vs right gonadal veins? clinical significance?
Left is to Renal vein to IVC (takes a right angle, so vericocele more common in left b/c 90 degree angle and blood leaves slower)
Right is to IVC directly
Adrenals do the same thing! Q bank damn!
Lymphatic drainage of ovaries/testes?
Howabout distal vag/vulva/scrotum?
Howabout uterus/proximal vagina?
Ovaries/testes to para aortic
Distal vagina/vulva/scrotum to inguinal nodes
Obturator, external iliac and hypogastric nodes
Mnemonic for inguinal hernias?
MDs dont LIe
Medially to inferior epigastric is Direct inguinal hernia (through hasselbach triangle)
Laterally to inferior epigastric artery is Indirect inguinal hernia (Processus vaginalis)
What does 5 alpha RIDEuctase important for in development?
External genitalia. If it is deficient, you have male internal genitalia, and ambiguous or perhaps female external… UNTIL PUBERTY!
What if sertoli cells aren’t making anti mullein factor?
You have female and male internal genitalia
Male external genitalia
Work on homologous gender structures on page 562
ok
What teste cells are affected by temp?
Sertoli.
What spermatogonial cell line cells can’t do meiosis 1?
you get a lot of primary spermatocytes. (makes sense b/c completion of M1 makes secondary spermatocyte, then completion M2 makes spermatid)
Cant do meiosis 2?
lots of secondary spermatocytes. makes sense
FSH action in male?
Sertoli supports for sperm
Also makes inhibin and androgen binding protein
LH action in male?
Testosterone production in Leydig
What is aromatase?
It converts testosterone and androgen to estrogens (especially big in obese, so fat can become adipose deficient)
Lipid affects of exogenous testosterone?
Higher LDL and lower HDL (opposite of what you want)
5 alpha reductase inhibitors? and use?
Finasteride is RIDEuctase inhibitor
used in BPH
male pattern baldness
What is an inhibitor of testosterone receptor? What is it used for?
Flutamide (girly b/c it is blocked)
Prostate carcionma
What is ketoconazole?
Inhibits desmolase (steroid synthesis) (no prenenolone is made from cholesterol)
PCOS to block hair growth and hirsutism
androgen insensitivity syndrome?
look like woman, but inside is male. Genetics is male. Testes often in labia majora (lumps there are often there in test)
High estrogen and LH b/c body not getting feedback
5 alpha reductase insufficiency?
Born with ambiguous or female genitalia, then as you hit puberty, testosterone goes up and you become male
Female pseudo hermaprhodite?
21 beta hydroxylase or 11 beta hydroxylase.
Look like male
Male pseudo hermaphrodite?
Androgen insensitivty syndrome
What is kallmann syndrome?
Low GnRH, so low FSH, LH, so low testosterone
Defect is X-linked KAL chain
Defective smell, amenorrhea? look into it!!!
What is epididymitis caused by? How diagnosed? How treat?
Tender
gonorrhea or chlamydia
Ceftriaxone IM and then doxy
If anal intercourse: enterobacter and do fluoroquine
How do you tell testicular torsion is from epididymitis?
support doesn’t relieve symptom
no cremaster reflex from the tickle
Treat with detorsion within six hours
Old man with tumor of testicle?
lymphoma metastasis
Buzzwords for tumors should be ok fi you got them
13:00 min of repro chapter 4
Schiller duval bodies
Yolk sac tumor
High alpha fetoprotein
Teratoma 50%
BUT REALLY Yolk sac tumor
High hCG
Choriocarcinoma (can be teratoma)
Fried Egg appearance
Seminoma (watery looking, makes sense seminoma)
Normal AFP but high hCG
Embryonal (bad prognosis)
Most common testicular tumor?
Seminoma (responds to radiation
Synciotrophoblasts
Choriocarcionma
Painful testicular tumor?
Embryonal
Most common tumor up to age 3!!! IMPORTANT TO KNOW
Yolk sac tumor!
Estrogen secreting tumor of testicle?
Sertoli tumor
Hydrocele vs spermatocele?
Tunica vaginalis lesions
Both are lesions in serous covering of testes that present as masses that CAN BE TRANSILLUMINATED.
Hydrocele: secondary to inclompete obliteration of processus vaginalis (common in neonates, don’t treat for some time)
Spermatocele is dilated epididymal duct
What is varicocele? Key description?
Dilated veins in pampiniform plexus. Cause of infertility “Bag of worms” MORE COMMON IN LEFT b/c testicular vein goes all the way to renal vein and 90 degree angle)
Reinke rods?
Leydig tumor
Also they are gold cuz you dig for gold
Sildenafil mechanism and use?
Inhibit cGMP phosphodiesterase so more cGMP and more relaxion in corpus callosum and hard
Raynaud
Primary pulmonary HTN
Symptom: blue green color vision (viagra is the blue pill and blue vision)
Life threatening with nitrates
What is Bowen Disease?
Gray crusty plaque on penile shaft and can progress to squamous cell carcinoma (rarely)
What is bowenoid papulosis?
multiple papular lesions of penis and affects younger people
DO NOT become invasive
Priapism is associated with what?
sickle cell and spinal cord
What is balanitis?
Inflammation of glans often from candida
DIABETICs (makes sense b/c candida)
and in uncircumcised
Acute prostatis younger than 35 age?
Older than 35? Tx?
Young: gonorrhea, chlamydia
Older than 35: klebsiella, serratia, enterobacter, proteus (UTI bugs)
Flouroquinolones, TMP SX for 4 weeks (UTI bugs)
BPH tx?
Nonselective alpha 1 blockers (azosins). Decrease smooth muscle tone in prostate. Dizziness, postural hypotension.
TAMSOLUSIN!!!! (SELECTIVE for prostate!) IMPORTANT (alpha 1AD)
5 alpha riductase (finasteride, dutasteride)
How do you remember estrogens?
1, 2, 3. Men, Women, Baby (order of importance ;) )
EstrONE: made in men and women in periphery by aromatase
EstraDIone: (2) so women and ovaries and strongest
EsTRIol: (3) in placenta so way up in preggers
Myometrial excitability affected by what hormones?
estrogen increases it
progesterone decreases it
What hormone increases body temp?
progesterone!
What is menorrhagia?
Metrorrhagia?
Menometrorrhagia?
Oligomenorrhea?
Polymenorrhea?
Memorrhagia: heavy periods
Metrorrhagia: frequent irregular (think like metro bus with lots of stops
Menometrorrhagia: heavy, frequent (combo)
More than 35 day
<21 days in cycle
How long does ti take BhCG to be detected?
2 weeks after conception (smart, that is when period would start anyway)
Serum is a week after conception (implantation time)
Why do OCPs help with acne?
estrogen causes liver to make more steroid binding hormone, so less free and active testosterone
Who is OCP contraindicated for?
Dangers of OCP
Smokers over 35. Patients with aura and migraine! (risk of stroke b/c vasospasm!)
HTN, triglycerides, GI and weight gain.
Problems with medroxyprogesterone?
Might have affect lasting a year (want it to last 3 months) Not good if you want to be pregnant in 6 months.
May cause bone mineral density lost if long term, so use less than 2 years
Irregular bleeding and stuff
Who is IUD contraindicated for?
STD high risk (when you place it, you can push chlamydia or gonnohrea up higher, thats shitty b/c ascending infection and PID risk)
Why hirsuitism in menopause?
change in balance of estrogen/androgen
Allodynia vs hyperalgesia?
allodynia is stimulus that shouldn’t cause pain causes pain
hyperalgesia is over sensitized to pain
What is vaginismus?
cramping of vaginal muscles that happens with touch and it hurts! Makes intercourse difficult
Genes from HPV for tumor?
E6 and E7 and p53 and RB respectively. p53 comes before RB
What do you see with sarcoma botryoides?
Girls less than 4. It is rhabdomyosarcoma and grapes
Desmin positive stain, duh.
Spindle shaped cells
DES exposure?
Clear cell adenocarcinoma of vagina
Koilocytes?
HPV infected cells.
Raison like nuclei with cleared cytoplasm
Tx for endometriosis?
OCPs to control estrogen
Continous GnRH (leuprolide) to prevent more menstruation
Surgery: bilateral salpingo-oophorectomy
What is danazol?
mild androgenic medication that counteracts estrogen but androgenic side effects, so not used anymore
What is adenomyosis? and signs/symptoms?
Dx? Rx?
Endometrial tissue in myometrium
Tender, boggy, enlarged uterus
Heavy periods
Focal pain on exam
Dyspareunia
Dx and Rx: histerectomy
What causes endometrial hyperplasia?
Unopposed estrogen (no progesterone)
It keeps building and building.
Risk factors: Polycysti ovarian syndrome and granulosa cell tumor
Anovulatory cycles
ESPECIALY Worry if postmenopausal bleeding
Risk factors for endometrial cancer?
HHONDA Hyperplasia HTN Obesity Nulliparity Diabetes Anovulatory state
What is leiomyoma (fibroid)? histo? Symptoms?
Benign smooth muscle tumor common in women. COMMON
NO RISK OF CANCER even though they come from single cell
Decreases with menopause b/c estrogen sensitive. So OCP is tx (b/c controlled estrogen), Leuprolide, ablate, myomectomy, Hysterectomy
histo is whorled pattern
ASYMPTOMATIC, OR vaginal bleeding, bulk systems, miscarriage if poor blood supply, can cause PAIN if necrosis (but rare outside of pregnancy)
Who gets leiomysoarcoma?
Middle aged. They are aggressive and reoccur
Hysterectomy
Most common gyn cancers?
endometrial (#4 overall)
Ovarian (#5) poor prognosis b/c late catching it
Cervical farther down list thx to screening
Most common tumor in women? RFF
leiomyoma
Most common gyn malignancy in US? in world? RFF
Endometrial
Cervical
Choclate cyst is what? RFF
endometriosis of ovary
What can cause anovulation in a young woman?
PREGNANCY Thyriod disease hyperprolactinemia cushing disease adrenal insufficiency Premature ovarian failure Stress Starvation (evolution makes sense) Anorexia Obesiy
What are the diagnostic criteria for polycistic ovarian syndrome?
2 of the 3
Oligo- or anovulation
Hyperandrogenism
Polycistic ovaries on US
PCOS is a 4 star topic. so list the three ways it can develop?
High LH:FSH from pituitary/hypothal issue causes theca cell to make a ton of androgen (hirsuitism) which is made to estrogen by granulosa which feedback inhibition stops FSH from being released (and follicles don’t develop) and you get an ovulation.
Or you could: peripheral adipose makes more estrogen
Or you could have insulin resistance causing more insulin to be released which stimulated theca cells and decreases liver synthesis of androgen hormone binding globulin (hirsuitism)
What are the treatments for polycystic ovarian syndrome?
Weight loss
Metformin
PROGESTERONE (to protect endometrium from unopposed estrogen)
Clomiphene (blocks the estrogen negative feedback)
Leuprolide pulses to get back ovulation
Spironolactone (antiandrogen)
Ovarian drilling (a weird thing done surgically and people aren’t sure why it works)
What is clomiphene?
Partial agonist at estrogen receptor in hypothalamus (makes a competitive inhibitor to decrease negative feedback AT HYPOTHALAMUS) so you can increase FSH!
What is CA 125?
A way to monitor progression of ovarian tumors (but terrible for screening b/c non-specific)
20% bilateral, unilocular cyst lined by fallopian tube epithelium (ciliated) is what kind of ovarian tumor?
Serous cystadenoma
What type ovarian tumor is often bilateral with fallopian tube epithelium or potentially anapestic? It can have psammoma bodies.
Mucinous cystadenoma (50% of ovarian tumors)
Psammoma bodies are concentric rings of calcifications
What type of ovarian tumor is unilateral, potentially being multilocular and large and lined by columnar cells that look similar to intestine on pathology?
Mucinous cystadenoma (there is a pic on 582 of first aid, check it out on the PDF)
What ovarian tumor can cause pseudomyxoma peritonea? What else can cause this?
Mucinous cystadenocarcionma. Looks like adenocarcionma of the intestine.
Pseudomyxoma peritonei is intraperitoneal mucinous material (i think joe saw a guy with this in clinic) which can happen with appendices cancers as well)
What tumor looks like transitional cell of the bladder? It has COFFEE BEAN nuclei (first aid mentions this as does DIT)
Brenner tumor (it is encapsulated so it is benign)
The nuclei look like little blue/purple coffee beans)
BrennER is BladdER
What is difference between mature and immature teratomas? One of them can they secrete causing strum ovarii?
95% are mature and benign “Dermoid cysts”
5% are immature with neural elements and in the 1st or 2nd decade of life.
they can have functionally thyroid tissue making a person hyperthyroid and if so, it is more likely to be a mature (benign) teratoma
What type of ovarian tumor has sheets of uniform cells?
dysgeminoma: hCG and LDH are tumor markers
What is dysgerminoma associated with? What are the markers?
Turner syndrome. LDH and hCG
What are sheller duval bodies? if you see it, what is a tumor marker for it?
Endodermal sinus (Yolk sac tumors) have them, they are resembling glomeruli
AFP is the marker
What ovarian tumor differentiates towards trophoblastic structures with only maternal DNA? Is it dangerous?
Ovarian choriocarcionma develops syncytiotrophoblasts and cytotrophoblasts so makes hCG!
Yes metastasize, b/c trophoblastic tissue is designed to be invasive (to be able to do blood exchange in placenta, so they can invade tissues)
What is Meigs syndrome?
Ovarian Fibroma, ascites, pleural effusion (hydrothorax)
pulling sensation in the groin
What are Call-Exner bodies found in? What do they look like? And what findings do you have in serum tests?
Malignant Granulosa cell tumor and they make estrogen/progesterone which makes sense.
Call exner bodies resemble primordial follicles (disarrayed granulosa cells in eosinophilic fluid)
can cause endometrial hyperplasia and breast tenderness
If in kids, can cause precocious puberty,
What is a mucin-secreting signet cell adenocarcionma?
Kruckenberg tumor (nucleus is pushed to one side b/c all the mucoin in the cell)
They are from GI (which makes sense b/c GI makes a lot of mucin)
What is the fetal component of the placenta? What does what?
Cytotrophoblast make Cells and is inner layer of chorionic villi
Syncytiotrophoblast is outer layer and Secretes hCG (stimulates corpus luteum as it is similar to to LH.)
Syncytiotrophoblast Syncs with mother
What is the maternal component of placenta?
Decidua basalis (from endometrium)
Maternal blood is in the lacunae and is around syncytiotrophoblast
G#P#A#?
Gravidity is number preggers
P is number delivery
A is huber of abortions/miscarriage
Why is glucose high in pregnancy?
human placental lactogen is released which is important to allow more nutrients to baby
Quad screen for DownSyndrome?
low AFP high betaHCG low estriol
Easy to remember b/c it is every other if you do it alphabetically and you start down b/c down syndrome
What are the markers for trisomy 18?
low everything, AFP bhCG and estriol (think of it as more severe, so everything is low)
What cause increase in AFP during preggers?
NEURAL TUBE DEFECTS (biggie)
Abdominal wall defects
multiple gestation
What is risk of of amniocentesis?
0.5% risk of fetal loss and risk of of 1-2% of fetal/maternal hemorrhage
What do you see if monozygotic twins split before 4 days?
4-8 days?
8-12 days?
13+ days
0-4 before chorion is made, so dichorionic and diamniotic
4 days is chorion formed, so 4-8 days is monochorionic and diamniotic (shared placenta)
8 days the amnion is formed so they are monochorionic and mono amniotic (floating with nothing separating the two
13 days is when embryonic disc is formed so the twins are conjoined if splitting happens here
What happens with twin-twin transfusion syndrome?
Anastomis in chorion causes shunting of blood.
Donor is growth restricted and anemic
Recipient is polycythemic, overloaded and has heart failure and comes out worse than donor
What do you suspect if uterine rupture in pregnancy?
Complete mole. (complete moles are completely worse)
What is it called when placenta attaches over cervical os? How does it present?
Placenta previa. Partially covers or completely covers it.
PRESENSTS as painless vaginal bleeding
Dx is ultrasound. DO NOT put your finger in and rupture anything
Risk factor: multiparty, makes sense, prior C section b/c scarring
What is vasa previa?
Fetal blood vessels over cervix
3 types of placental invasion into uterus. What are they? How do you tx? How are they caused?
Placenta Accreta ATTACHES to myometrium without penetrating it
Placenta INcreta goes INTO myometrium
Placenta PERCRETA PERForates through myometerium
Life threatening b/c exposed vessels will bleed, need to do hysterectomy.
The mother made a defective dicidual layer so the placenta infiltrates
Prior c section is a risk b/c scar makes for poor basalis
Third trimester has painful vaginal bleeding. What is it?
Placental abruption. Can lead to DIC
Predisposed with trauma (makes sense)
Cocaine
Vasoconstriction can cause it: preeclempsia, cocaine use
Dx: Kleihauer-Betke checks for fetal blood in mom
What can cause oligohydramnios?
Placental insufficiency
Bilateral renal agenesis
Posterior urethral valves
What is preeclempsia defined as?
> 140/90 and proteinuria with 300 mg/24 hours
if seizures, it is eclempsia
What is HELLP syndrome?
Hemolysis
Elevated Liver enzymes
Low Platelet
Anemia, RUQ pain/jaundice, bruising/bleeding
Tx for eclempsia seizure?
Delivery!
IV magnesium and its side effects are:
low reflex, pulmonary edema, altered mental status, cardiac conduction defects
Similarities and differences between gestational diabetes and Type 1/II diabetes in pregnancy?
Similar: Macrosomia and stillbirth (later high sugars, after human placental lactogen kicked in)
Different: Type I/II cause miscarriage or abnormalities (b/c differences diabetes is bad for vessels and high blood sugar doesn’t come up until later in pregnancy normally, but if high in first 20 weeks, it is bad)
Congenital heart defects
Caudal regression syndrome
Nueral tube defects
That doesn’t happen with gestational diabetes b/c that doesn’t happen until after vessel development of baby
Majority of miscarriage is what?
Trisomy 16
PCOS can cause infertility. How do you fix that?
Clomiphene or metformin
What are the different drug categories for pregnancy (if you want an exhaustive list of where drugs fall, page 237 can help you out)
Category A (safety established in human studies)
B: presumed safety from animal studies
C no studies have shown things, uncertain safety
D human risk, but benefit may ouweight risk
X: NEVER OK TO USE
Drugs for HTN in preggers?
Hydralazine (arterial vasodilate)
Methyldopa
Labetalol
Diabetes tx in preggers?
Insulin (important to make sure to take care of it pregestationally)
Tx for epilepsy in preggers?
Anything that helps control seizures b/c seizures are bigger risk EXCEPT avoid valproic acid
Supplement with folic acid b/c NTD risk
Tx for hyperthyroid in preggers?
PTU in first trimester then methimazole in second and third
Anticoag tx during preggers?
Heparin or enoxaparin
NEVER WARFARIN
What are tocolytics? 4 of them
Indomethacin decreases prostaglandins. Risk of closing PDA but if short usage, not bad
Nifedipine: calcium cahnnel blocker causes myometrial relaxation
Terbutaline: beta2 agonist to relax myometrium
Magnesium sulfate seizure prophylaxis also
Drugs for promoting labor?
Prostaglandins. DinoPROSTone is PGE2 and misoPROSTol is PGE1 (cervical relaxation and uterine contractions). Risk of tachysystole that can cut off blood flow or uterine rupture if scarred uterus
Oxytocin
Both can be used to fix atony to stop bleeding after delivery
Chemical abortificants that are approved? Which is specific for ectopic?
Mifepristone: progesterone antagonist
Misoprostol: PGE1 analog to cause uterine contraction to kick out the pregnancy (expulsion)
Methotrexate for ectopics. Folic acid antagonists so cells don’t grow
Gene for fragile x syndrome? What heart issue comes with it?
FRM1 (Fragile mental retardation is mnemonic) is affected by methylation and expression of it.
MVP
What are risks with down syndrome? Quad screen?
Duodenal atresia Endocoardial cushion Risk of ALL/AML (ALL) ALLzheimer disease Polycythemia (65% newborns with down's have it)
ALL fall DOWN (down’s syndrome from that ring around the rosie song)
Down alpha fetoprotein
UP betaHCG
down estriol
Up inhibit A
Ultrasound is more nuchal translucency (also turner syndrome)
What does Edwards syndrome look like?
Trisomy 18. Rocker bottom feet, micrognathia (small jaw), low set Ears (Edwards), clenched han and congenital heart disease. Death within a year. (so it is bad, so in had screen EVERYTHING is low)
Normal inhibin A
What do you see with Patau?
Patua is trisomy 13. P disease
Clef liP/Palate, holoProsencephaly, Polydactyly, microcephaly, mircroPhthalmia
Screening: everything is low but INCREASED nuchal translucency (like down)
No quad screen, but you do see decreased betahCG in first trimester. PAPP-A is decreased
Klinefelter presentation?
Tall, less testosterone (so hips are big and female hair distribution). Infertal, dysgenisis of seminiferous tubules, so less inhibit so more FSH
Inactive X is BARR Body and present
Turner syndrome presentation?? What heart conditions do you have?
Short shield chest webbing of neck gonadal dysfunction (streak ovaries) most common cause of primary amenorrhea Preductal coartation and bicuspid aortic valve
Always rule out Turner if amenorrhea (b/c some people don’t have other symptoms
Double Y?
normal phenotype, very tall, severe acne, and autism or antisocial behavior
Cri du chat? Which chromosome?
5p- (youtube video of kid with retardation who has high pitched voice talking about 5p-
Microdeletion of short arm of chromosome 5
Microsephaly. moderate to severe retardation, MEWING, VSD
Williams sydnrome? Which chromosome?
Will Ferrell in Elf (lucky chromosome number 7 micro deletion of long arm)
Elfin facies, very friendly to strangers, Hypercalcemia from increased sensitivity to vitamin D (makes living in north pole with low Vit D more bearable)
Problems with 22q11 deletions?
CATCH-22
Cleft palate Abnormal facies Thymic aplasia (T cell def) Cardiac defects Hypocalcemia (parathyroid issues) 22q11
Difference of DiGeorge and velocardiaofacial syndrome?
Digeorge is triad of thymic, parathyroid and cardiac issues
Velocardiofacial is palate, facial, and cardiac issues
