FA Repro I Flashcards
1
Q
What is the venous drainage of the left ovary/testis?
A
left gonadal vein, left renal vein, IVC
2
Q
What is the right venous drainage of the ovary/testis
A
right gonadal vein, IVC
3
Q
What is the lymphatic drainage the ovaries/testis
A
para-aortic lymph nodes
4
Q
What is the lymphatic drainage of the distal 1/3 of the vagina/scrotum/vulva
A
superficial inguinal lymph nodes
5
Q
What is the lymphatic drainage of the proximal 2/3 of the vagina/uterus
A
obdurator, exterinal iliac, hypogastic nodes
6
Q
Which side is varicocele more common on
A
left
7
Q
Connects ovaries to lateral pelvic wall, contains ovarian vessels
A
suspensory ligament of ovaries
8
Q
connects cervix to side wall of pelvis, contains uterine vessels
A
cardinal ligament
9
Q
Uterin fundus to labia majora
A
Round ligament of uterus
10
Q
Connects uterus, fallopian tubes and ovaries to pelvic side wall, contains ovaries, fallapian tubes, and round ligaments of uterus
A
Broad ligament
11
Q
Connects ovary to lateral uterus
A
Ligament of the ovary
12
Q
Which ligament is the derivative of the gubernaculum and travels through the inguinal canal
A
Round ligament of the uterus
13
Q
histo: simple cuboidal epithelium
A
ovary
14
Q
histo: simple columnar epithelium, ciliated
A
fallopian tube
15
Q
histo: simple columnar epithelium, pseudostratified tubular glands
A
uterus
16
Q
histo: simple columnar epithelium
A
endocervix
17
Q
histo: stratified sqamous epithelium
A
ectocervix
18
Q
histo: stratified squamous epithelium, nonkeratinized
A
vagina
19
Q
What does SEVEN UP stand for in regards to the pathway of sperm
A
seminiferous tubules, epididymis, vas deferens, ejaculatory ducts, nothing, urethra, penis
20
Q
Which system and nerve allow for erection in the male?
A
PANS, pelvic nerve
21
Q
What effect does NO have on smooth muscle in erectile tissues
A
inc cGMP, smooth muscle relax, vasodltn, proerectile
22
Q
What effect does NE have on smoothe muscle in the erectile tissues
A
inc Ca in, smooth muscle contraction, vasocxn, antierectile
23
Q
Which system and nerve are responsible for emission
A
SANS, hypogastric nerve
24
Q
Which nerve and nerve fibers control for ejaculation
A
visceral, somatic nerves in pudendal
25
What do sildenafil and vardenafil do?
inhibit cGMP breakdown
26
What cellular structure is the acrosome derived from?
golgi
27
Between what two phases does the sperm acquire the acrosome, flagellum, and middle piece
final stage of spermatogenesis, spermiogenesis, spermatid to spermatozoa
28
What is the flaggelum derived from
one of the centrioles
29
what structures supplies the energy to the middle piece (neck)
mitochondria
30
What is the main source of energy for spermatozoa
fructose
31
what does the tail go onto to form
the centrioles
32
Which cells line the seminiferous tubules and maintain germ pool and produce primary spermatocytes
spermatogonia (germ cells)
33
Which cells line the seminiferous tubules and secrete inhibin
sertoli cells
34
What does inhibin do?
inhibit FSH
35
What substances other than inhibin do sertoli cells produce?
andogren binding protein, anti mullerian hormone
36
What forms the blood testis barrier?
tight junctions between sertoli cells
37
What do leydig cells secrete?
testosterone
38
When does spermatogenesis begin?
puberty
39
How long does it take for sperm to fully develop
2 months
40
How many functional sperm does 1 germ cell creat?
4
41
What hormones regulate sperm creation?
GnRH from hypoTh, LH and FSH from ant pituitary
42
What does LH do
stimulates testosterone release from leydig cells
43
What does FSH do
stimulates sertoli cells to produce ABP and inhibin
44
What structures does testosterone negatively feedback on?
the anterior pituitary and hypothalamus
45
Where is testosterone secreted into?
the semiT and the blood vessels
46
What are the 3 androgens
testosterone, DHT, androstenedione
47
Where is androstenedione made?
adrenal gland
48
Which androgen is responsible for differentiation of epididymis, vas deferens, seminal vesicles, internal genitalia (except prostate)
testosterone
49
Which androgens are responsible for the growth spurt of the penis, seminal vesicles, sperm, muscle, RBCs
testosterone
50
Which androgen is responsible for the deepening of the voice
testosterone
51
Which androgen is responsible for the closing of the epiphyseal plate
testosterone
52
Which androgen is responsible for libido
testosterone
53
What is DHT responsible for in early development?
differentiation of penis, scrotum and prostate
54
What is DHT responsible for in late development
prostate growth, balding, and sebaceous gland activity
55
Arrange the androgens in order of most potent to least potent
DHT, testosterone, androstenedione
56
What converts testosterone to DHT
5 alpha reductase, inhibited by finesteride
57
Where is testosterone converted to estrogen
sertoli cells, and adipose tissue via aromatase
58
How does exogenous testosterone create azoospermia
inhibition of HCG access
59
What estrogen does the ovary secrete
17beta estradiol
60
What estrogen does the placenta secrete
estradiol
61
What are the four functions of estrogen
development of genitalia and breast, growth of follicle, hormonal interactions with HPG accesss, and inc transport proteins like SHBG inc HDL and dec LDL
62
What does estrogen do to estrogen, LH and progesterone recepotrs
upregulation
63
what does estrogen do to FSH and LH
feedback inhibition
64
what does estrogen to do prolaction
stimulation of secretion, but blocks its action at the breast
65
List the estrogens in order of decreasing potency
estradiol > estrone > estriol
66
What is the expected increase of estradiol and estrone in pregnancy
50 times
67
What increase in estriol is an indicator offetal well being in pregnancy
1000 times
68
Where does LH work, what enzyme works there and what product is secreted
theca cell, desmolase, androstenedione
69
Where does FSH work, what enzyme works there, what substrate comes in and what leaves
granulosa cell, aromatase, androstenedione, estrogen
70
What are the 4 sources of progesterone
corpus luteum, placenta, adrenal cortex, testes
71
What does progesterone do in the endometrium
stimulate glandular secretions, and spiral artery development
72
What does progesterone do for pregnancy
maintenance
73
What does progesterone do to myometrial excitability
decrease
74
How does progesterone inhibit sperm entry to uterus
production of a thick cervical mucus
75
What does progesterone do to body temp
increase
76
What does progesterone do to gonadotropins
inhibition LH and FSH
77
What does progesterone do to smooth muscle in the uterus
relaxation
78
What does progesterone do to estrogen receptors
down regulation
79
When is follicular growth the fastest?
2nd week of proliferative phase
80
What does estrogen stimulate in the endometrium
proliferation
81
Which phase varies and in length and which is usually 14 days (menstrual cycle)
follicular phase varies, luteal phase is 14
82
> 35 day cycle
oligomenorrhea
83
< 21 day cycle
polymenorrhea
84
frequent bu irregular cycles
metrorrhagia
85
heavy, irregular menstruation at irregular intervals
menometrorrhagia
86
What is the order of events in the menstrual cycle
estrogen, LH surge, ovulation, progesterone from CL, menstruation
87
What does increasing estrogen do to GnRH receptors on ant pit, and what does this lead to
upregulation, LH surge, ovulation
88
blood from ruptured follicle causing peritoneal irritation that can mimic appendicitis
mittelschmerz syndrome
89
when do primary oocytes begin meiosis I
during fetal life
90
when do primary oocytes complete meiosis I
just prior to ovulation
91
In what phase is meiosis I arrested
prophase
92
In what phase is meiosis II arrested
Metaphase
93
When does the secondary oocyte complete meosis II
fertilization "an egg met a sperm"
94
What is the genetic material in the primary oocyte?
diploid, 4N, 46 sister chromatids
95
What is the genetic material in the secondary oocyte?
haploid, 2N, 23 sister chromatids
96
What is the genetic material in the ovum
haploid, N, 23 single chromatids
97
Where does fertilization most commonly occur?
the ampulla, occurs within 1 day of ovulation
98
How many days after fertilization does implantation occur?
6
99
Which cells secrete beta hCG
trophoblasts
100
how is beta hCG detectable in blood or urine for a home pregnancy test
1 week, 2 weeks
101
What stimulation after labor induces lactation
decreasing progesterone
102
what stimulation is required to maintain milk production and what is the pathway
suckling, inc oxytocin, prolactin
103
what are the effects of prolactin?
induces and maintains lactation, decreases reproductive function
104
what are the functions of oxytocin, maybe
milk letdown, uterine contractions?
105
What becomes the main source of hCG
syncytiotrophoblasts of placenta
106
What does hCG do in the first trimester to maintain the corpus luteum
mimics LH
107
What pathologic states cause increases in hCG
hydatidiform moles, choriocarcinoma, gestational trophoblastic tumors
108
decreased estrogen production due to age linked decline in the number of ovarian follices
menopause
109
What is the average age of onset for menopause
51 yo
110
what is the source of estrogen after menopause
peripheral conversion of androgens
111
What is the best test to confirm menopause
increased FSH
112
What does HHAVOC stand for in menopause
hirsutism, hot flashes, atrophy of the vagina, osteoporosis, coronary artery disease
113
What is a concern of early menopause
Premature ovarian failure (POF)
114
testicular atrophy, eunochoid body shape, tall, long extremities, gynecomastia, inactivated X chromosome, dysgenesis of seminiferous tubules, decreased inhibin, abnormal leydig cell function
Klinefelter's, XXY
115
Short stature, ovarian dysgenesis, shield chest, no barr body, webbing of the neck
Turner's XO
116
What common valvular abnormality is common in Turner's
aortic bicuspid valve
117
What changes in the aorta are common in Turner's?
preductal coarctication
118
Is fertility compromised in double Y males?
no
119
dx with increased testosterone and inc LH
defective androgen receptor
120
dx with increased testosterone and dec LH
testosterone secreting tumor, exogenous steroids
121
dx with decreased testosterone, increased LH
primary hypogonadism
122
dx with decreased testosterone and decreased LH
hypogondadotropic hypogonadism
123
disagreement between the phenotypic and gonadal sex
pseudohermaphroditism
124
ovaries plus virilized external genitalia due to excessive and inappropriate exposure to androgenic steroids during early gestation
female pseudoHerm
125
What are causes of female pseudoHerm
congenital adrenal hyperplasia, exogenous administration of steroids
126
testes present with non male external genitals
male pseudoHerm
127
What is the most common form of male pseudoHerm
androgen insensitivity syndrome
128
What is a true hermaphrodite
both ovary and testicular tissue present, ambiguous genitals, rare 46 XX, 47XXY
129
defect in androgen receptor resulting in normal appearing female, rudimentry vagina, no uterus or uterine tubes
androgen insensitivity syndrome, 46 XY
130
Testosterone and estrogen in androgen insensitivity syndrome
increase (and LH)
131
inability to convert testosterone to DHT, limited to genetic males, penis at 12
5 alpha reductase def
132
decreased synthesis of gonadotropin in the ant pit, anosmia, lack of secondary sex characteristics
kallman
133
What can happen with no sertoli cell or lack of anti mullerian hormone
develop both male and female internal genitalia and male external genitalia
134
What does the SRY gene do
testis determining factor
135
cystic swelling of chorionic villi and proliferation of chorionic epithelium that presents with abnormal vaginal bleeding
hydatidiform mole
136
What is hydatidiform mole and precurosor of
choriocarcinoma
137
What is the treatment for hydatidiform mole
dilation and curettage and methotrexate
138
what is the karyotype of a complete mole
46 xx
139
what is the karyotype of a partial mole
69 xxy
140
marked increased hCG, complete or partial
complete
141
2 sperm + empty egg
complete
142
2 sperm + 1 egg
partial
143
Which hydatidiform mole has the greater risk for malignancy
complete
144
common cause of recurrent miscarriage in the 1st week
low progesterone
145
common cause of recurrent miscarriage in 1st trimester
chromosomal abnormalities
146
common cause of recurrent miscarriage in 2nd trimester
bicornute uterus
147
HTN, proteinuria and edema
preeclampsia
148
eclampsia
preeclampsia + siezures
149
What causes preeclampsia
placental ischemia due to impaired vasodltn of spiral arteries resulting in increased vasc tone
150
What is HELLP syndrome
hemolysis, elevated liver enzymes, low platelets
151
What is mortality due to in preeclampsia
cerebral hemorrhage and ARDS
152
headache, blurred vision, abdominal pain, edema of face and extremeties, altered mentation, hyperreflexia in pregnancy
preeclampsia clinical
153
What is the treatment for preeclampsia
delivery of fetus
154
Prevention of seizures and in preeclampsia
IV mag sulfate, diazepam
155
premature detachment of placenta from implantation site leading to fetal death
abruptio placentae
156
What hematologic condition is associated with abruptio placentae
DIC
157
What are risk factors for abruptio placentae?
smoking, HTN, cocaine
158
defective decidual later allows placenta to attach to myometrium, massive bleeding after delivery
placenta acreta
159
What are risk factors for placenta acreta
prior c section, inflammation, placenta previa
160
attachment of palceta to lower uterine segment that may occlude internal os, painless bleeding in any trimester
placenta previa
161
What are predisposing factors for placenta previa
prior c section, multiparity
162
pain with or without bleeding, inc in hCG, sudden lower abdominal pain, mistaken for appendicitis
ectopic preg
163
Complication of retained placental tissue
hemorrhage
164
Risk factors for ectopic pregs
history of infertility, salpingitis, ruptured appendix, prior tubal surgery
165
>1.5 -2 L of amniotic fluid
polyhydramnios
166
What complications are associated with polyhydramnios
esophogeal/duodenal atresia, can't swallow, anencephaly
167
<0.5 L of amniotic fluid
oligohydramnios
168
What complications are associated with oligohydramnios
placental insufficiency, bilateral renal agenesis, posterior urethral valves, potter's syndrome
169
Wher does dysplasia and carcinoma in situ of the cervix usually begin
squamo-columnar jxn
170
How is dyslpasi and carcinoma in situ of the cervix classified
CIN 1, 2, 3
171
What virus is dyslapsia and carcinoma in situ of the cervix associated with
HPV 16, 18
172
What is the number 1 risk factor for cervical dysplasia or carcinoma in situ
multiple sexual partners, also HIV and early sexual intercourse
173
Invasive carcinoma of the cervix is usually caused by what kind of malignancy
squamous cell carcinoma
174
What is a complication of invasive carcinoma
lateral invasion can block ureters causing renal failure
175
What is the typical cell change in HPV infection
koilocytitic
176
non neoplastic endometrial glands/stroma in abnormal locations outsdie the uterus
endometriosis
177
Endometriosis is characterized by what clinical picture?
cyclic bleeding, chocolate cysts, severe menstrual related pain, infertility
178
How does endometriosis cause infertility
retrograde mentrual flow or ascending infection
179
endometrium within the myometrium
adenomyosis
180
what usually causes endometrial hyperplasia
estrogen overstimulation
181
what is a potential complication of endometrial hyperplasia
endometrial carcinoma
182
How does endometrial hyperplasia manifest clinically
post menopausal bleeding
183
What are the risk factors for endometrial hyperplasia
anovulatory cycles, hormone replacement therapy, PCOS, granulosa cell tumor
184
What is the most common gynecologic malignancy
endometrial carcinoma
185
When does endometiral carcinoma usually occur
55-65
186
What increases risk for endometrial carcinoma
unopposed estrogen, obesity, diabetes, HTN, nulliparity, late menopause
187
What is indicative of a poor prognosis for endometrial carcinoma
myometrial invasion
188
What are the most common tumors in all females?
myometrial tumors
189
A leimyoma is overgrowth of what cell
smooth muscle
190
What is the pattern seen in leiomyoma
whorled pattern of smooth muscle bundles
191
When is the peak occurrence of leiomyoma
20 to 40
192
What happens to a leiomyoma in pregs and menopause and why
increase in size in pregs, decrease in size meno, estrogen sens
193
What sequelae are associated with leiomyoma
severe bleeding iron def anemia, miscarriage
194
Does a leiomyoma progress to leiosarcoma
no
195
leiomyoma and leiosarcoma have an increased incidence in which ethnic group
blacks
196
what are the pathologic features of leiosarcoma
necrosis, hemorrhage, can protrude from the cervix and bleed, tendency to recur
197
gynecological tumors from highest incidence to lowest
endometrial > ovarian> cervical (in US)
198
Which gynecologic tumors have the worst prognosis?
ovarian > cervical > endometrial
199
decreased estrogen, inc FSH, LH, signs of menopause after puberty but before 40
Premature ovarian failure (POF)
