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1
Q

Pudendal nerve block

A

pudendal nerve innervates the perineum

to block: have to go near ichial spine

exits pelvis through greater sciatic foramen

ischial spine is the bony landmark through vagina

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2
Q

spermatogonia

A

located in seminiferous tubes near basal lamina

spermatogonia B go through meiosis to form primary spermatocytes

at the end of meiosis I they form secondary spermatocytes

mitosis to form spermatids

then mature through spermatogenesis to form spermatozoa

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3
Q

CIN – cervical intraepithelial neoplasia– 3

A

high grade dysplasia of the cervix

high nuclear to cytoplasm ratio

confined to epithelium, full thickness

after two years, either persists or progresses to invasive carcinoma

no koilocytes

BM intact

no stromal involvement

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4
Q

First trimester pregnancy loss

A

most commonly due to chromosomal abnormalities

painless vaginal bleeding

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5
Q

amniotic fluid embolism

A

happens when amniotic fluid enters mothers venous system

causes respiratory distress

caused by abdominal trauma, placental abruption, placenta previa, amniocentisis, C section, uterine rupture, instrumental vaginal delivery

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6
Q

chlamydia trachomatis

A

PID can cause scarring of fallopian tubes and type IV hypersensitivity reaction

can lead to ectopic pregnancy

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7
Q

ectopic pregnancy with tubal rupture

A

loss of consciousness

severe lower abdominal pain and nausea

mass in adenaxal and cul-de-sac

hypotension

increased hCG

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8
Q

mullerian inhibitory factor deficiency

A

normally made by sertoli cells

XY with no MIF but otherwise normal will have a male phenotype, but will have mullerian structures

cryptorchidism is common

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9
Q

krukenburg tumors

A

gastric mucinous tumors that can metastasize to ovaries

usually bilateral ovaries

signet ring cells: cytoplasmic mucin droplets push aside nucleus of adenocarcinoma cell

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10
Q

complete hydatid mole

A

no maternal DNA

non viable pregnancy

grapelike masses of dilated chorion villi

can lead to choriocarcinoma

no fetal tissue

higher hCG than expected

larger uterus than expected

no heart beat or fetal movements

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11
Q

partial hydatid mole

A

one set of maternal DNA and two sets of paternal

some fetal tissue

usually more benign and less chance of choriocarcinoma

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12
Q

5 alpha reductase deficiency

A

autosomal recessive

limited to XY

can’t convert testosterone to DHT

ambiguous genitalia until puberty where there is enough T to mature external genitalia

LH and T levels are normal

internal genitalia are normal

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13
Q

congenital adrenal hyperplasia (CAH) – 21 hydroxylase deficiency

A

leads to build up of 17 hydroxyprogesterone

androngenization of XX

blocks cortisol and aldosterone synthesis

17 hydroxyprogesterone is shunted to androgen synthesis

would have ovaries, empty scrotum, and odd phallus

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14
Q

seminoma

A

painless testicular mass

elevated levels of placental alkaline phosphatase

histology: nests or lobules of malignant cells surrounded by lymphocytes

large fleshy masses

fried egg cells

common in males 20-35

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15
Q

follicular phase of menstrual cycle

A

granulosa cells synthesize estradiol from androstendione or testosterone donated by thecal cells

estradiol rises with follicular development –> promotes GnRH section and LH surge for ovulation

than transform and estradiol falls

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16
Q

luteal phase of menstrual cycle

A

estradiol rises again and stimulates expression of progesterone receptors

theca lutein cells produce estradiol

fall with degeneration of corpus luteum

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17
Q

congenital hydrocele

A

failure of the obliteration of processus vaginalis which connects the peritenum with the scrotum

results in peritoneal fluid to build up in the scrotal sac which transluminates

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18
Q

klinefelter’s syndrome

A

XXY phenotypic male

sparse body hair, female body habitus, gynecomastia, small testes, reduced fertility

hyalinized seminiferous tubules without sperm

decreased inhibin and testosterone

increased LH, FSH, estrogen

presence of barr body

abnormal leydig cell function

can have hypothyroidism

high pitched voice

testicular atrophy

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19
Q

PCOS

A

hyperinsulinemia

high LH to FSH ratio

high androgens from theca interna cells

low rate of follicular maturation

subfertility

amenorrhea, oligomenorhea, hirsutism, acne, obesity

increased risk of endometrial cancer due to unopposed estrogen

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20
Q

spironolactone in PCOS

A

has anti androgen effects that can treat hirsutism

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21
Q

congenital syphillus

A

saddle nose

hutchinson’s teeth

mulberry molars

saber shins

interstital keratitis

sensoneural deafness

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22
Q

yolk sac tumor

A

most common testicular cancer in young boys

primitive cells, endodermal sinuses, cytoplasmic granules

positive for alpha fetal protein

yellow-tan mass with areas of hemorrhage and necrosis

scattered structures resembling glomeruli –schiller duval bodies

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23
Q

cystadenocarcinoma

A

most common malignant epithelial tumor of ovary

can be sereous or mucous

often produce CA-125 which can be used to monitor treatment and recurrence

papillary structures and psomomma bodies

common to have bilateral

mucinous can cause pseudomyxoma peritonei-intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor

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24
Q

Granulosa cell tumor

A

solid, yellow ovarian mass

ovarian, sex chord stromal tumor

can produce estrogen and cause precocious puberty in girls

can cause endometrial hyperplasia and abnormal bleeding in reproductive or post menopausal women

increased risk for endometrial carcinoma

call exner bodies: follicular like structures

stain positive for inhibin

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25
progesterone in menstrual cycle
initiates transition from proliferative phase to secretory phase increased glandular activity thick endometrium with long coiled glands lined by columnar epithelium prominent cytoplasmic vacuoles adjacent to gland lumen
26
estrogen in menstrual cycle
proliferative phase thickened endometrial lining
27
uterine leiomyoma
benign masses composed of whorling smooth muscle may cause AUB and anemia, usually in premenopausal patients show immunoreactivity for actin estrogen dependent usually asymptomatic but can cause things like recurrent abortion treat by embolization, myomectomy, or hysterectomy
28
solid, mature teratomas with malignant transformation
development of carcinoma in mature teratoma should be completely excised ASAP more common in testicular than ovarian
29
dermoid cysts
benign, cystic teratoma usually found in ovaries most common ovarian tumor in women 10-30 all three germ layers can present with pain secondary to ovarian enlargement and torsion
30
solid mature teratoma
benign tumor forming multiple adult like tissues found in ovaries of all ages found in testes in prepubertal stage
31
immature teratomas
contain tissues resembling embryonal or fetal tissue has neuroectoderm components considered to be potentially clinically malignant
32
bartholin gland cyst
flocculent mass on medial aspect of labia minora lined by transitional epithelium or metaplastic squamous epithelium
33
Bowen's disease
in situ squamous cell carcinoma full thickness epithelium involvement of atypical cells increased nucleus to cytoplasm ratio cell crowding intact basement membrane gray white plaque on the shaft of penis associated with being uncircumcised and HPV
34
ectopic pregnancy
implantation of developing embryo in a non uterine site most commonly in the ampulla usually results from delayed transit of the blastocyst commonly due to scarring or inflammation of the uterine tube gynecological emergency presents with acute pain and vaginal bleeding risk: prior, history of infertility, salpingitis, PID, ruptured appendix, prior tubal surgery
35
chronic endometritis
inflammatory infiltrates of lymphocytes, plasma cells, and histiocytes vaginal bleeding, pain, infertility causes include chlamydia, IUD, recent pregnancy, miscarriage, abortion, other foreign bodies
36
breast carcinoma with estrogen receptors
arises from mammary gland tissue if positive for estrogen/progesterone receptors they have a better prognosis more likely to respond to tamoxifen grading is based on histology staging is based on distribution HER2 positive forms are treated with trastuzumab
37
preeclampsia
HTN, edema, proteinuria due to impaired remodeling of maternal spiral arteries during placention --> leads to placental hypoperfusion development of seizures is indication of eclampsia
38
Pagets disease of the nipple
individual adenocarcinoma cells within squamous epithelium of the skin many have underlying ductal adenocarcinoma cells stain positive for cytokeratin and negative for S100 burning, itching, or tingling on the breast with erythematous inflamed lesion paget cells are large cells with clear cytoplasm and hyperchromic nuclei mucin positive and PAS positive
39
breast cancer mets
often go to bone create osteolytic and osteoblastic lesions osteolytic: bone destruction by osteoclasts osteoblastic/sclerotic: new bone formation by osteoblasts invasive glands and ducts seen on histology tend to be mucin negative
40
androgen insensitivity syndrome
phenotypic female with XY shallow vagina, no uterus or cervix, amenorrhea palpable masses in labia majora indicating testes secretion of MIF and testosterone still intact --> that's why they do not develop uterus disorder is in the androgen receptor increased T, E, and LH
41
HER2
epidermal growth factor that signals through ras and MAPK many breast cancers have over activation of ras signaling that results in over proliferation of cells
42
changes a few days before menstruation
progesterone and estradiol begin to fall gonadotropin levels are low body temperature falls due to lowered progesterone withdrawal of hormone support causes endometrial degeneration and sloughing mensturation marks the transition luteal phase into the next follicular phase
43
embryonic development week 1
hCG secretion begins when blastocyst implants
44
embryonic development week 2
bilaminer disc develops epibast and hypoblast
45
embryonic development week 3
gastrulation forms trilaminar disc epiblast invaginates to form primitive streak streak froms endoderm, mesoderm, ectoderm notochord arises from midline mesoderm overlying ectoderm becomes neural plate
46
embryonic weeks 3-8
embryonic period neural tube formed by neuroectoderm and closes by week 4 organogenesis extremely susceptible to teratogens
47
embryonic week 4
heart beat upper and lower limb buds
48
embryonic week 6
fetal cardiac activity seen on transvaginal ultrasound
49
embryonic week 8
fetal movements begin
50
embryonic week 10
genitalia have male/female characteristics
51
cytotrophoblasts
inner layer of chorionic villi
52
synctiotrophblasts
outer layer of chorionic villi make hCG stimulate corpus luteum to make progesterone during first trimester lack MHC 1
53
male genital embryology
SRY gene produces testis determining factor sertoli cells secrete MIF to suppress paramesonephric duct leydig cells secrete androgen that stimulate mesonephric ducts
54
paramesonephric (mullerian duct)
develops into female internal structures: Fallopian tubes uterus upper vagina appendix testes
55
mullerian agenesis (Mayer-Rokitansky-Kuster-Hauser)
presents as primary amenorrhea no uterine development females with fully secondary sex characteristics functional ovaries
56
mesonepheric (wolffian ducts)
male internal structures seminal vesicles epididymus ejaculatory duct ductus deferens
57
septate uterus
incomplete resorption of the septum low fertility early miscarriage and pregnancy loss treat with septoplasty
58
bicorunate uterus
incomplete fusion of mullerian ducts increased risk of complicated pregnancy early pregnancy loss, malpresentation, prematurity
59
uterus didephys
complete failure of fusion double uterus, cervix, vagina pregnancy possible
60
hypospadias
abnormal opening of urethra on ventral surface failure of urethral folds to fuse associated with inguinal hernia and cryptocordism
61
epispadias
abnormal opening of urethra on dorsal surface faulty positioning of genital tuberacle associated with extrophy of the bladder
62
sertoli cells
secrete inhibin B which inhibits FSH secretes androgen binding protein produces MIF forms blood testes barrier regulate spermatogenesis temperature sensitive have aromatase that convert androgens to estrogen
63
leydig cells
secrete testosterone in the presence of LH
64
theca cells
respond to LH produce androstenedione from cholesterol
65
granulosa cells
respond to FSH convert androstenedione to estrogen via aromatase
66
physiologic changes in pregnancy
increased CO: increased preload, decreased afterload, increased HR anemia: increased plasma volume more than increased RBCs hyper-coagulability hyperventilation to eliminate fetal CO2
67
hCG
produced by synctiotrophoblasts maintains corpus luteum for first 8-10 weeks of pregnancy used to detect pregnancy identical alpha subunits to LH, FSH, TSH use beta to evaluate preganancy high levels: multiple gestations, hydadiform mole, choriocarcinoma, and down syndrome low levels: ectopic, edward/Patau syndromes
68
human placental lactogen
produced by syncytiotrophoblasts stimulates insulin production high insulin resistance due to shunting metabolism to fetus increased lipolysis due to insulin resistance
69
lactation
after birth, drop in E and P disinhibit lactation suckling increases oxytocin and prolactin prolactin increases lactation and decreases reproductive function oxytocin assists in milk letdown and causes uterine contraction decreases mother's risk of breast and ovarian cancer
70
menopause
amenorrhea for 12 months low estrogen estrogen source becomes peripheral conversion of androgens high FSH is marker due to loss of negative feedback also see high LH and GnRH hot flashes, atrophy of vagina, osteoporosis, CAD, sleep disturbances menopause before age 40 suggests primary ovarian insufficiency
71
testosterone
differentiation of epididymis, vas deferens, seminal vesicles growth spurt: penis, seminal vesicles, sperm, muscles, RBCs deepening of voice closing of epiphyseal plates (via estrogen converted by testosterone) libido
72
DHT
early: differentiation of penis, scrotum, prostate late: prostate growth, balding, sebaceous gland activity
73
turner syndrome
45 XO short stature streak ovary shield chest coartation of aorta webbed neck horseshoe kidney most common cause of primary amenorrhea no barr body low estrogen leading to high LH and FSH pregnancy can be possible in some cases with IVF
74
double Y males
phenotypically normal very tall normal fertility may have severe acne, learning disability, autism
75
ovotesticular disorder of sex development
more often 46 XX both ovarian and testicular tissue present ambiguous genitalia
76
46 XX DSD
ovaries present external genitalia is ambiguous or virulized caused by exposure to excess androgen in early gestation
77
46 XY DSD
testes present external genitalia are female or ambiguous most common form is androgen insensitivity
78
placental aromatase deficiency
can't synthesize estrogens from androgens masculinization of female increased serum T and androstenedione can present with maternal virilization during pregnancy
79
kallmann syndrome
failure to complete puberty hypogonadic hypogonadism defective migration of GnRh releasing neurons failure of olfactory bulbs to develop -- anosmia low GnRH, FSH, LH, T infertility and amenorrhea
80
choriocarcinoma
can develop after pregnancy malignancy of trophoblastic tissue: synctriotrophblasts and cytotrophoblasts no chorionic villi present bilateral theca lutein cysts increased beta hCG SOB, hemoptysis hematogenous spread to lungs -- cannonball mets can be seen in males: can produce gynecomastia and hyperthyroidism
81
placenta previa
attachment over the cervical os risk: multiparity, prior C painless bleeding in 3rd tri
82
placental abruption
premature separation of placenta from uterine wall risk: trauma, smoking, HTN, preeclampsia, cocaine presents as abrupt, painful bleeding bleeding can be concealed complications: DIC, shock, fetal distress, life threatening
83
placenta accreta
placenta attaches to myometrium without penetrating
84
placenta increta
placenta penetrates into the myometrium
85
placenta percreta
placenta penetrates through myometrium and into uterine serosa can result in placenta attachment to rectum or bladder
86
vasa previa
fetal vessels run over the os can result in vessel rupture and fetal death painless vaginal bleeding, fetal bradicardia emergency C assocaited with velamentous umbilical cord (cord inserts in chorioamniotic membrane rather than placenta) -- not protected by wharton jelly
87
polyhydramnios
too much amniotic fluid associated with esophageal atresia, duodenal atresia, anencephaly -- can't swallow maternal diabetes fetal anemia multiple gestations
88
oligohydramnios
too little amniotic fluid placental insufficiency bilateral renal agenesis, posterior urethral valves inability to excrete urine can lead to potter syndrome
89
antihypertensives in pregnancy
Hydralizine alpha methyldopa labetalol nifedipine
90
brenner tumor
looks like bladder solid tumor that is pale yellow-tan encapsulated coffee bean nuclei on H and E
91
fibromas -- ovarian
bundles of spindle shaped fibroblasts meigs syndrome ovarian fibroma, ascites, hydrothorax pulling sensation in groin
92
thecoma -- ovarian
may produce estrogen usually presents as AUB in post menopausal woman
93
dysgerminoma -- malignant ovarian
most common in adolescents similar to seminoma in males sheets of "fried egg" cells hCG LDH
94
endometrial polyps
well circumscribed may contain smooth muscle cells can extend into endometrial cavity can be asymptomatic or present with AUB
95
adenomyosis
extension of endometrial glan tissue into uterine myometrium non focal thickening of the myometrium caused by hyperplasia of basal layer of endometrium pain is due to cyclic breaking down of glands and bleeding into the myometrium presentation: dysmenorrhea, menorrhagia, uniformly enlarged, soft, globular uterus treat: GnRH agonists, hysterectomy or excision of an organized adenomyoma
96
endometriosis
non neoplastic endometrium like glands/stroma outside of endometrial cavity most common sites: ovary, pelvis, peritoneum, chocolate cysts gun powder lesions theories of causes: retrograde flow, metaplastic transformation, transport via lymphatics presentation: pelvic pain, bleeding, dysmenorrhea, dysparenunis, dyschezia, infertility, normal sized uterus treatment: NSAIDs, OCPs, progestins, GnRH, danazol, laparoscopic removal
97
fibrocystic breast changes
most common in premenopausal women over 35 presentation: pre menstrual pain or lumps, often bilateral and multifocal non proliferative lesions include: simple cysts, papillary apocrine changes/metaplasia, stromal fibrosis no increased risk of cancer
98
sclerosing adenosis of breast
subtype of fibrocystic breast changes acini and stromal fibrosis associated with calcifications slight increased risk for cancer
99
epithelial hyperplasia of breast
subtype of fibrocystic breast changes cells in terminal ductal or lobular epithelium increased risk of carcinoma with atypical cells
100
fat necrosis in breast
inflammatory benign, painless, lump caused by injury calcified oil cysts on mammography necrotic fat and giant cells on biopsy
101
lactational mastitis
occurs during breast feeding increased risk of bacterial infection through cracks -- s. aureus treat with antibiotics and continue breast feeding
102
fibroadenoma in breast
benign breast tumor most common in women less than 35 small, well defined, mobile mass increased size and tenderness with estrogen risk of cancer not usually increased
103
intraductal papilloma in breast
benign breast tumor small papillary tumor within lactiferous ducts typically beneath areola most common cause of nipple discharge slight increase in cancer risk
104
phyllodes tumor in breast
benign large mass of connective tissue and cysts leaf-like lobulations most common in fifth decade some may become malignant
105
malignant breast cancer
arises in terminal duct lobular unit over expression of c-erbB2 (HER-2) triple negative is more aggressive (ER, PR, HER2) axillary lymph node involvement is most important prognostic factor early on most often in upper-outer quadrant of breast risk factors: increased E exposure, increased menses, older age at first live birth, obesity, BRCA, African American
106
ductal carcinoma in situ
non invasive fills ductal lumen arises from ductal atypia often seen as microcalcifications on mammography early malignancy without BM penetration
107
comedocarcinoma
non invasive breast ductal central necrosis type of DCIS
108
invasive ductal carcinoma
firm, fibrous, rock hard mass with sharp margins small, glandular, duct like cells, reactive, desmoplastic stroma infiltrating glandular structures positive cytokeratin stain can be ER, PR, and HER2 positive tumor can deform suspensory ligaments and cause skin dimpling stellate infiltration most common type of breast cancer
109
invasive lobular carcinoma
orderly row of cells due to low e-cadherin expression often bilateral with multiple lesions in the same location
110
medullary carcinoma of breast
invasive fleshy, cellular, lymphocytic infiltrate good prognosis
111
inflammatory breast cancer
invasive dermal lymphatic invasion by breast carcinoma orange peel appearance neoplastic cells block lymphatic drainage poor prognosis often mistaken for mastitis or Paget erythema, redness, warm to touch
112
ischemic priapism
painful erection lasting over 4 hours associated with sickle cell disease blocked venous drainage treat with corporal aspiration, intracavernosal phenylephrine or surgical decompression
113
erythroplasia of Queyrat
cancer of the glans of the penis presents as erythroplakia
114
Bowenoid papulosis
carcinoma in situ of unclear malignant potential presents as reddish papules on penis
115
embryonal carcinoma
malignant, hemorrhagic mass with necrosis painful glandular and papillary morphology most commonly a mixed type and not pure embryonal may be associated with hCG, normal or elevated AFP (pure, mixed respectively)
116
Leydig cell tumor
golden brown color Reinke crystals (eosinophilic cytoplasmic inclusions) produces androgens or estrogens can lead to gynecomastia in men, and precocious puberty in boys
117
Sertoli cell tumor
androblastoma from sex cord stroma
118
testicular lymphoma
most common testicular cancer in older men not a primary cancer -- arises from metastatic lymphoma aggressive
119
BPH
smooth, elastic, firm, nodular enlargement of periurethral lobes (latteral and middle) not premalignant increased frequency of urination, nocturia, difficulty starting stopping, dysuria may lead to distention and hypertrophy of the bladder, hydronephrosis, UTIs increased PSA treatment: alpha one antagonists, 5 alpha reductase inhibitors, PDE-5 inhibitors, surgery
120
prostatitis
dysuria, frequency, urgency, low back pain warm, tender, enlarged prostate acute: usually bacterial chronic: can be bacterial, nerve problems, chemical irritation
121
prostatic adenocarcinoma
common in men over 50 arises in posterior lobe (peripheral zone) diagnosed with elevated PSA and needle core biopsies osteoblastic metastases in bone may develop in late stages-- elevated ALP
122
monodermal teratoma
secretes thyroid hormone without presence of TSH
123
11 beta hydroxylase deficiency
elevation of androgens, HTN, viralization, hypokalemia can't produce cortisol, so get high levels of ACTH and adrenal hyperplasia and over production of cortisol precursors excess mineralocorticoids because of buildup of precursor to corticosterone
124
PID
lower abdominal pain, vaginal discharge, adenexal tenderness, with cervical motion can be caused by chlamydia, vaginal anearobes, and other GNR complications: sterility, ectopic, bacteremia, peritonitis, intestinal obstruction
125
cryptorhidism
complications include: malignancy testicular infarction secondary to torsion testicular atrophy and infertility inguinal hernia

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