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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
Q

progesterone in menstrual cycle

A

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

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26
Q

estrogen in menstrual cycle

A

proliferative phase

thickened endometrial lining

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27
Q

uterine leiomyoma

A

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

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28
Q

solid, mature teratomas with malignant transformation

A

development of carcinoma in mature teratoma

should be completely excised ASAP

more common in testicular than ovarian

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29
Q

dermoid cysts

A

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

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30
Q

solid mature teratoma

A

benign tumor forming multiple adult like tissues

found in ovaries of all ages

found in testes in prepubertal stage

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31
Q

immature teratomas

A

contain tissues resembling embryonal or fetal tissue

has neuroectoderm components

considered to be potentially clinically malignant

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32
Q

bartholin gland cyst

A

flocculent mass on medial aspect of labia minora

lined by transitional epithelium or metaplastic squamous epithelium

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33
Q

Bowen’s disease

A

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

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34
Q

ectopic pregnancy

A

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

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35
Q

chronic endometritis

A

inflammatory infiltrates of lymphocytes, plasma cells, and histiocytes

vaginal bleeding, pain, infertility

causes include chlamydia, IUD, recent pregnancy, miscarriage, abortion, other foreign bodies

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36
Q

breast carcinoma with estrogen receptors

A

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

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37
Q

preeclampsia

A

HTN, edema, proteinuria

due to impaired remodeling of maternal spiral arteries during placention –> leads to placental hypoperfusion

development of seizures is indication of eclampsia

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38
Q

Pagets disease of the nipple

A

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

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39
Q

breast cancer mets

A

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

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40
Q

androgen insensitivity syndrome

A

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

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41
Q

HER2

A

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

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42
Q

changes a few days before menstruation

A

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

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43
Q

embryonic development week 1

A

hCG secretion begins when blastocyst implants

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44
Q

embryonic development week 2

A

bilaminer disc develops

epibast and hypoblast

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45
Q

embryonic development week 3

A

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

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46
Q

embryonic weeks 3-8

A

embryonic period

neural tube formed by neuroectoderm and closes by week 4

organogenesis

extremely susceptible to teratogens

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47
Q

embryonic week 4

A

heart beat

upper and lower limb buds

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48
Q

embryonic week 6

A

fetal cardiac activity seen on transvaginal ultrasound

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49
Q

embryonic week 8

A

fetal movements begin

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50
Q

embryonic week 10

A

genitalia have male/female characteristics

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51
Q

cytotrophoblasts

A

inner layer of chorionic villi

52
Q

synctiotrophblasts

A

outer layer of chorionic villi

make hCG

stimulate corpus luteum to make progesterone during first trimester

lack MHC 1

53
Q

male genital embryology

A

SRY gene produces testis determining factor

sertoli cells secrete MIF to suppress paramesonephric duct

leydig cells secrete androgen that stimulate mesonephric ducts

54
Q

paramesonephric (mullerian duct)

A

develops into female internal structures:

Fallopian tubes
uterus
upper vagina
appendix testes

55
Q

mullerian agenesis (Mayer-Rokitansky-Kuster-Hauser)

A

presents as primary amenorrhea

no uterine development

females with fully secondary sex characteristics

functional ovaries

56
Q

mesonepheric (wolffian ducts)

A

male internal structures

seminal vesicles
epididymus
ejaculatory duct
ductus deferens

57
Q

septate uterus

A

incomplete resorption of the septum

low fertility

early miscarriage and pregnancy loss

treat with septoplasty

58
Q

bicorunate uterus

A

incomplete fusion of mullerian ducts

increased risk of complicated pregnancy

early pregnancy loss, malpresentation, prematurity

59
Q

uterus didephys

A

complete failure of fusion

double uterus, cervix, vagina

pregnancy possible

60
Q

hypospadias

A

abnormal opening of urethra on ventral surface

failure of urethral folds to fuse

associated with inguinal hernia and cryptocordism

61
Q

epispadias

A

abnormal opening of urethra on dorsal surface

faulty positioning of genital tuberacle

associated with extrophy of the bladder

62
Q

sertoli cells

A

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
Q

leydig cells

A

secrete testosterone in the presence of LH

64
Q

theca cells

A

respond to LH

produce androstenedione from cholesterol

65
Q

granulosa cells

A

respond to FSH

convert androstenedione to estrogen via aromatase

66
Q

physiologic changes in pregnancy

A

increased CO: increased preload, decreased afterload, increased HR

anemia: increased plasma volume more than increased RBCs

hyper-coagulability

hyperventilation to eliminate fetal CO2

67
Q

hCG

A

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
Q

human placental lactogen

A

produced by syncytiotrophoblasts

stimulates insulin production

high insulin resistance due to shunting metabolism to fetus

increased lipolysis due to insulin resistance

69
Q

lactation

A

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
Q

menopause

A

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
Q

testosterone

A

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
Q

DHT

A

early: differentiation of penis, scrotum, prostate
late: prostate growth, balding, sebaceous gland activity

73
Q

turner syndrome

A

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
Q

double Y males

A

phenotypically normal

very tall

normal fertility

may have severe acne, learning disability, autism

75
Q

ovotesticular disorder of sex development

A

more often 46 XX

both ovarian and testicular tissue present

ambiguous genitalia

76
Q

46 XX DSD

A

ovaries present

external genitalia is ambiguous or virulized

caused by exposure to excess androgen in early gestation

77
Q

46 XY DSD

A

testes present

external genitalia are female or ambiguous

most common form is androgen insensitivity

78
Q

placental aromatase deficiency

A

can’t synthesize estrogens from androgens

masculinization of female

increased serum T and androstenedione

can present with maternal virilization during pregnancy

79
Q

kallmann syndrome

A

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
Q

choriocarcinoma

A

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
Q

placenta previa

A

attachment over the cervical os

risk: multiparity, prior C

painless bleeding in 3rd tri

82
Q

placental abruption

A

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
Q

placenta accreta

A

placenta attaches to myometrium without penetrating

84
Q

placenta increta

A

placenta penetrates into the myometrium

85
Q

placenta percreta

A

placenta penetrates through myometrium and into uterine serosa

can result in placenta attachment to rectum or bladder

86
Q

vasa previa

A

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
Q

polyhydramnios

A

too much amniotic fluid

associated with esophageal atresia, duodenal atresia, anencephaly – can’t swallow

maternal diabetes

fetal anemia

multiple gestations

88
Q

oligohydramnios

A

too little amniotic fluid

placental insufficiency

bilateral renal agenesis, posterior urethral valves

inability to excrete urine

can lead to potter syndrome

89
Q

antihypertensives in pregnancy

A

Hydralizine

alpha methyldopa

labetalol

nifedipine

90
Q

brenner tumor

A

looks like bladder

solid tumor that is pale yellow-tan

encapsulated

coffee bean nuclei on H and E

91
Q

fibromas – ovarian

A

bundles of spindle shaped fibroblasts

meigs syndrome

ovarian fibroma, ascites, hydrothorax

pulling sensation in groin

92
Q

thecoma – ovarian

A

may produce estrogen

usually presents as AUB in post menopausal woman

93
Q

dysgerminoma – malignant ovarian

A

most common in adolescents

similar to seminoma in males

sheets of “fried egg” cells

hCG

LDH

94
Q

endometrial polyps

A

well circumscribed

may contain smooth muscle cells

can extend into endometrial cavity

can be asymptomatic or present with AUB

95
Q

adenomyosis

A

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
Q

endometriosis

A

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
Q

fibrocystic breast changes

A

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
Q

sclerosing adenosis of breast

A

subtype of fibrocystic breast changes

acini and stromal fibrosis associated with calcifications

slight increased risk for cancer

99
Q

epithelial hyperplasia of breast

A

subtype of fibrocystic breast changes

cells in terminal ductal or lobular epithelium

increased risk of carcinoma with atypical cells

100
Q

fat necrosis in breast

A

inflammatory

benign, painless, lump

caused by injury

calcified oil cysts on mammography

necrotic fat and giant cells on biopsy

101
Q

lactational mastitis

A

occurs during breast feeding

increased risk of bacterial infection through cracks – s. aureus

treat with antibiotics and continue breast feeding

102
Q

fibroadenoma in breast

A

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
Q

intraductal papilloma in breast

A

benign breast tumor

small papillary tumor within lactiferous ducts

typically beneath areola

most common cause of nipple discharge

slight increase in cancer risk

104
Q

phyllodes tumor in breast

A

benign

large mass of connective tissue and cysts

leaf-like lobulations

most common in fifth decade

some may become malignant

105
Q

malignant breast cancer

A

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
Q

ductal carcinoma in situ

A

non invasive

fills ductal lumen

arises from ductal atypia

often seen as microcalcifications on mammography

early malignancy without BM penetration

107
Q

comedocarcinoma

A

non invasive breast

ductal

central necrosis

type of DCIS

108
Q

invasive ductal carcinoma

A

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
Q

invasive lobular carcinoma

A

orderly row of cells due to low e-cadherin expression

often bilateral with multiple lesions in the same location

110
Q

medullary carcinoma of breast

A

invasive

fleshy, cellular, lymphocytic infiltrate

good prognosis

111
Q

inflammatory breast cancer

A

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
Q

ischemic priapism

A

painful erection lasting over 4 hours

associated with sickle cell disease

blocked venous drainage

treat with corporal aspiration, intracavernosal phenylephrine or surgical decompression

113
Q

erythroplasia of Queyrat

A

cancer of the glans of the penis

presents as erythroplakia

114
Q

Bowenoid papulosis

A

carcinoma in situ of unclear malignant potential

presents as reddish papules on penis

115
Q

embryonal carcinoma

A

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
Q

Leydig cell tumor

A

golden brown color

Reinke crystals (eosinophilic cytoplasmic inclusions)

produces androgens or estrogens

can lead to gynecomastia in men, and precocious puberty in boys

117
Q

Sertoli cell tumor

A

androblastoma from sex cord stroma

118
Q

testicular lymphoma

A

most common testicular cancer in older men

not a primary cancer – arises from metastatic lymphoma

aggressive

119
Q

BPH

A

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
Q

prostatitis

A

dysuria, frequency, urgency, low back pain

warm, tender, enlarged prostate

acute: usually bacterial
chronic: can be bacterial, nerve problems, chemical irritation

121
Q

prostatic adenocarcinoma

A

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
Q

monodermal teratoma

A

secretes thyroid hormone without presence of TSH

123
Q

11 beta hydroxylase deficiency

A

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
Q

PID

A

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
Q

cryptorhidism

A

complications include:

malignancy

testicular infarction secondary to torsion

testicular atrophy and infertility

inguinal hernia

HSR (5 decks)

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