Key concepts REPRO Flashcards
GnRH
GnRH works via Gq
Hormones that share similar structure(4)?
-What makes them diffrent?
-Mecanism of action
-FSH,LH,TSH,hCG. Heterodimers
-Same alpha,diffrent Beta chain
-All function** cAMP**
Male penile nerve involment:
1.Erection
2.Emmision
3.Expulsion.
1.Erection parasympathetic nervous system (pelvic splanchnic nerves,S2-S4):
* NO–>Incr cGMP–>smooth muscle relaxation–> vasodilation–> pro-erectile.
*Norepinephrine–>Incr[Ca2+] –>in smooth muscle contraction–> vasoconstriction –>antierectile.
2.Emission—sympathetic nervous system (hypogastric nerve,T11-L2).
3.Expulsion—visceral and somatic nerves (pudendal nerve).
Where is your Sertoli cells found and what do they form??
**-Edges of semineforous tubules and form Blood-Testis Barrier. **
GONORHEA
Chlamydia
-Only see inflamatory cell, NO bacteria—> no muramic acid makes the peptidoglygan wall
Differential diagnosis of rash on palms and soles??(3 types)
Maculopapulo rash–>Syphylis, TSS(S.Aureus),S.Pyeogenes
Vesicular–>Cocksackie Hand-Mouth and Fouth syndrome
Petechial–>Ricketsia in wrist and ankles
In Inguinal hernia surgeries what structure superior to spermatic cord should we isolate first>
Ilio-ingunal nerve (L1)–>supplies sensation to inner thigh and scrotum.
What nerves are involved in cremasteric reflex and what abd muscle does it originate from?
Afferent:Ilio-inginal nerve (L1)
Efferent: Genitofemoral (L1-L2)
-Internal oblique muscle.
What muscle contarcts and causes wrinkle app of scrotum
What muscle contributes to inguinal canal
-Dartos muscle
-External obligue muscles
Complication of MUMP virus
-Pancreatitis, Parotid inflam.Orchitis–>Infertility and Aseptic meningitis.
-Can also lead to HYPOGONADISM–>Infertility (LOW testosterone,High LH and FSH)
A 22-year-old man comes to the infertility clinic because he and his wife have been trying to conceive for the past year without success. Three years ago he had an illness marked by fever, and swelling in his face, followed by tender swelling of his testicles. He immigrated from a developing country two years ago and did not receive routine medical care as a child. His** breasts are enlarged and mildly tender. **
Whats the infection?
Mumps infection.
How does cortisol causes irregular menstruation ans where?
-Messing with GnRH
-Seen in Cushions
What does haloperidol and risperidone do?
-Anti-psycotics will inhibits Dopamine–>incr Prolactin.
Craniopharingioma app microscopy?
-Motor oily app.
What type of hypothyroidism?
-1* hypothyrodism–> you see incr TSH
Female present with abnormal white plaques… Microscopy was done and are neoplastic vulvar disorders. Identify
Left: HPV ass SCC
Right: Non-HPV ass SCC of culva.You see hyper keratosis
Multiple sexual partner female, over 20 yrs progression lesion on cervix
HPV SCC
Synonym of posterior zone in lobe?
**Peripheral zone. **
How do you differentiate between
Lichen Sclerosus
Lichen Simplex Chronicus
Bartholian cyst
-Ass conditions that may present similar as vulvar pathology?
-Autoimmune dis (T cell infiltration)–> Atrophic vaginitis (Epi is thin and DERMIS is SCLEROSIS). Ass post-menopuasal (decr estrogen).INCR risk of SCC.Porcenian white/purple plaques.
-Chronic scrating due to pruritis–>HYPERPLASIA of tissues. Described as leukplaquia ( whites leathery skin)
-Bartholian cyst: fluid filled space due to obstruction of Bartholian gland–>can lead to abscess (due to Gonorrhea–>inflam. –>ass reproductive females)
-Poriasis, Lichen Planus, SCC.
Differentiate between:
SCC of vulva HPV and NON-HPV related
Extra-mamary Paget dis.
HPV: younge age, RF: sexually active, multiple sexual partners and early coiter
NON-HPV: Chronic Lichen Sclerosus: >70 yrs.
-Erythema, Pruritis and ulcer.
What are your vaginal tumors?
SCC of vagina (ass??)
Sarcoma Boytroides (age)
Vaginal Adenocarcinoma (ass?)
Vesiculo-uretral reflex
Most common cause in males
Most common cause in children
-Anything that causes reflux of urine up to kidneys.
Most commonly due to** prostatic urethral valve remmanat–> leads to backflow (vesiculo-uretral reflux)–>BILATERAL Hydronephrosis and recurrent UTI**
Most comm cause in children is **ureter-pelvic junction abnormality. **–>abn ureter opening in bladder–>when it fills it dosent close complely.
What causes a mother complaining that her child has urine coming out of the umbilicus?
-Urachus remmanant (persistent urachus)–>umbilicus remains connected to bladder
RF for
-Urothelial carcinoma
TYPES
-SCC of bladder
Painless hematuria,NO cast
-Phenacetin, Smoking, Amine dyes, Cyclophosphomide (Pee SAC)
-TP53 depended(invasive) and **non-dependet **(less malignant)
-4’s–> Smoking, Schisotoma, Recurrent stones,Chronic cystitis.–>chronic irritation.
Hypospadias
Epispadias
Phymosis
Para-Phymosis
Peyroni (How do you ge it?)
-Openning urethra on top of penis–>ass. with cryptochidism,inguinal hernias.Faliure of urethral folds.
-Openning lower portion–> ass with bladder extrophy.**Faliure of penis tubercle **
-Cannot pull foreskin back->Incr risk 2* infections
-The opposite
-Microtrauma (lot’s of sex)–>activates fibroblast causing fibrosis.
2 disease ass with Testicular cancer?
Patchy testicular inflamation??
-Klinefter syndrome and Cryptochidism
-Mumps infections–>not severe enough to cause infertility.
What are the lesions ass with Penile SCC?
-BOWEN disease–>**Pre-cursor lesion of Penile SCC with whole thickness with dysplasia. **
-erythroplasia of Queyrat–>present as erythroplakia
-Bowenoid papulosis–>pre cursor lesion with* papules* as with Viral infections.
SCC RF are HPV 16 and no circumcisition–>chronic inflamation. Mostly present in South America,Africa….
How do you diff between uni-lateral and bi-lateral cryptochidism?
-Testosterone levels are normal in uni-lateral, decr in bi-lateral.
Test of choice in diagnosis of Chlamydia and Gonorrhea?
NAAT
What infet is ass with Acquired Hydrocele?
Wucheria Bancrofti ( blocks lymph drainage)
What test will help you get a diagnose of srotal enlargement chief complain? (4)
Translumination–>Hydrocele,Spermatocele
Phrenic Test–>positive epidymitis
Cremasteric Relex–>absent in Torsion
Valsalva–> Augmantates Varicocele
Oligospermia
Athenospermia
Teratospermia
- <10M/mL of sperm.Check H (LH,FSH, Test, and Prolactin)
- Abn motility–>flagellum abn.
- Incr # Germ cells–>issues with spermatogenesis.
Menorrhagia
Metrorrhagia
Oligomenorrhea
Amenorrhea
Dysmenorrhea
Ano-ovulation
Oligo-ovulation
-Excessive bleeding (>85mL per month)
-Between menstrual cycle bleeding
-Irregular cycles (>42 days)
-NO bleeding (Menarche or with established period)
-Excessive pain in uterine cycle
-Irregular avulation–>seen in perimenopause
Ano-ovulatory cycle cause and ass disorders?
-Hormonal imbalance–>excessive estrogen (excessive endometrium hyperplasia–> due to faliure of ovulation)
-Ovarian disorders –> Granulosa cell tumors + PCOS
Generic: obesity (aromatase in adipose tissues)+ Malnutrition
Diagnosis
Testicular enlargement Bi-lateral after a trip to Mexico?
-Transulination test positive
-Hydrocele (Wucheria Trichonoma)
BPH cause??
-PSA value?
-Complications
-NOT by incr in DHT (actually test reduces with age–>by** INCR in DHT recepteros=androgen recep.)**
- <10ng/mL–>gland hypertophy (in adenocarcinoma is much more)
- Recurrent UTI, Bladder hyperthrophy and TRABECULATION, Post-Renal Azotemia **Diverticulum Bladder **
Prostatic Adenocarcinoma histological description?
-Values of PSA
-Glandular tissues is losed (difficult to identify it), tumor cells forming cords (like smooth muscle app).
-PSA >10ng/mL and** FREE PSA decr because cancer cells make BOUND PSA.Total PSA incr**
-Incr ALP
Diagnosis
Alterations of the glutathione S-transferase (GSTP1)
gene allow damage from carcinogens. TMPRSS2-ETS fusion
gene and PTEN mutations are common.
-Prostatic Adenocarcinoma
Which testicular tumor aside from mixed has elevated AFP and HCG?
Teratoma
postmenopausal bleeding is considered what until proven otherwise?
Cancer
Diagnosis
Low test w/ Low/Normal FSH and LH
High testosterone w/ High LH and Normal FSH
Low testosterone w/ High LH
Normal testosterone w/ Normal LH and FSH–>patient infertile
-Variable testosterone w/ Low LH + patient is muscular
-2* Hypogonadism (TSH and Prolactin)
-Androgen resistance
-1* Hypogonadism–>klinefter
-Azoospermia, CFTR gene mutation (without CF presentation)
-Androgen abuse
What type of description will you give in Endometriosis to the outside tissues?
Choristoma
Presentation of Leiomyomas
Treat.
-Abnormal vaginal bleeding+ Pelvic pain+Bloating
-OCP first line, and Leurpolide
What the classical traid of Endometriosis?
-Infertility+Dysmenorrhea+Dyspareunia
Young female with amenorrhea + pain in pelvis+ Sudden onset of tachycardia and loss BP + Bleeding
Ectopic Pregnancy
-HCG should incr every day doubling.
Fetal Bradycardia+Painless vaginal bleeding+Membrane rupture?
Vasa previa
Diagnosis
-3 trimester painfull vaginal bleeding+ fetal compromise]
-3 trimester painless vaginal bledding + fetal compromise
-3 trimester High BP+ protenuria+edema
-1 trimester of pelvic pain with high HCG–>will go down.
-Post-menopausal bleeding
-Painfull vaginal bledding+Emesis at 1 trimester+absence fetal heart sound (absence fetal tissues)
-3 trimester when female lies down gets palpitations
-Placental Abruption (smoking,cocaine,Pre-eclampsia,trauma)** DIC**
-Placental previa (C-section,Multiparity)
-Pre-Eclampsia
-Ectopic pregnancy
-Endometrial carcinoma/Hyperplasia or Accreta/Increta/Pacreta
-Complete mole (elevated HCG,snowstorm app in ultrasound)
-Supine Hypotensive syndrome–>placental hypoperfusion–>fetus loss + relieved by left lateral decubitus.
Early (<20 week) Pre-Eclampsia,most likely indicates what??
-Complete mole
Which hormone is responsible for the development of Gestational Diabetus?
Human Placental Lactogen (HPL)
What does patient being treated for complete mole shows lowering of HCG but then plateus mean?
Choricarcinoma,expect respiratory symptoms.
Enlarged soft tender globular uterus with menorrhagia ?
-Adenomyosis
What 2 markers will you use for Sarcoma Boytroides to identify?
-Desmin and Myogin
Resemble epithelium of endocervix or
intestinal type
Mucinous ovarian cancer (Tall columnar cells).
Ass malignancy
Anaplastic cyrtotoboblast?
-Choricarcinoma
Will a pregnancy be + for which of the following
Choricarcinoma,Ectopic pregnancy, mole?
-Causes of abortion late and early?
ALL will be positive due to massive HCG secretion.
-Early–>Fetal problems (trisomies 16),,Late (maternal problems)
Cystadenocarcinomas are common ovarian tumors
that are often bilateral. The serous type occurs more frequently than the mucinous type and is typically unilocular,
whereas mucinous tumors are multilocular. Serous cystadenocarcinomas account for more than half of ovarian cancers. As the name indicates, they are cystic in appearance.
They may be benign, borderline, or malignant. Benign
tumors have a smooth cyst wall with small or absent papillary projections. Borderline tumors have increasing amounts
of papillary projections. Endometrioid tumors resemble
endometrial carcinomas and may arise in foci of endometriosis.
Immature teratoma
-Presence of all mature embryological tissues,except one–>usually is nerual tissues (explains the name).
Immature teratoma
CA-125 is specific for what type of ovarian tumor and how is the commonest way to present?
-Where does gonads (both sexes) drain?
-Presence of all mature embryological tissues,except one–>usually is nerual tissues (explains the name).
-Epithelial ovarian tumors+ with ascitis
-Para-Aortic lymph nodes–>first site of metastasis of ovarian and testicular cancer. They develop in abdominal cavity.
Mitterlschmerz
Mittelschmerz is a unilateral, dull achy pain (seldom severe), initiated after rupture of the mature follicle during ovulation in the middle of the menstrual cycle.
The rupture of the mature follicle during ovulation may cause bleeding and release of prostaglandins that, in turn, irritates the peritoneum, causing pain
-Everything else should be normal
What breast conditions do you see calcification?
-DCIS, Sclerosing adenosing, Fat necrosis
-All resemble carcinoma
Patient in peptic ulcer treat develops Gynecomastia??
-Cimetidine (H2 antagonist)
Inhibits metabolism estrogen liver.
Linear cells
Solid pattern central necrosis
Lymphatic involment
Lobular Carcinoma In Situ
DCIS with central necrosis
Medullary Ductal carcinoma
