Repro Flashcards
____ and beta HCG bind to the same receptor
LH and hCG have a similar molecular structure and share the same receptors. Injectable hCG causes an LH surge that stimulates ovarian follicular maturation and ovulation and is therefore used to induce ovulation in infertile women
Degarelix
a GnRH antagonist used in adv. prostate cancer
Abiraterone
a CYP17 inhibitor that decreases the formation of testosterone precursors, which reduces the synthesis of androgens in the testes, adrenal glands, and (cancerous) prostate tissue
leuprolide
GnRH agonist used in treatment of adv. prostate cancer (among other indications). Causes initial testosterone flare.
1st line chemo agents for testicular cancer (3)
Bleomycin; Etoposide; Cisplatin
__________typically presents with female external genitalia and male internal genitalia.
androgen insensitivity syndrome
both _______ and _________ present with bloody nipple discharge
intraductal papilloma and papillary carcinoma
upper 1/3 of vagina originates from _____1_ wherease lower 2/3 of vagina originates from___2___
- mullarian ducts
- urogenital sinus
clinical correlate: LN drainage.
top 1/3 goes to iliac nodes
bottom 2/3 goes to inguinal nodes
Each ejaculatory duct is formed by the union of the vas deferens with the duct of the seminal vesicle.
These are ejaculatory ducts.
Each ejaculatory duct is formed by the union of the vas deferens with the duct of the seminal vesicle.
The other opening on the top is the prostatic utricle
name this
rete testis
A network of small tubes in the testicle that helps move sperm cells (male reproductive cells) from the testicle to the epididymis. The epididymis is where the sperm mature and are stored.
which drugs reduce efficacy of oral contraceptives
phenytoin, rifampin, st. johns wart
Rifampin is an inducer of the cytochrome P-450 system, and it causes these enzymes to metabolize drugs such as oral contraceptives at a faster rate.
what voluntary muscles are controlled by the pudendal nerve
The external anal sphincter, along with the external urethral sphincter, levator ani, bulbospongiosus, and ischiocavernosus muscles are motor targets of the pudendal nerve.
the pudendal nerve provides sensory innervation of
Sensory innervation is to the perineum, clitoris, labia, lower vagina, penis, scrotum, and anal canal.
Gestational Age vs Embryonic Age
Length of pregnancy is from the last menstrual period (aka Gestational Age)
Embryonic Age is from time of fertilization i.e. Gestational Age less 2 weeks
list the factors that support the passage of sperm to the ampulla
Sperm transport is aided by contractions of uterus & fallopian tube -stimulated by prostaglandins in seminal fluid and oxytocin from female during orgasm
The cremasteric reflex stimulates contraction of the cremasteric muscle, an extension of the ___________muscle.
internal oblique abdominal
dartos muscle, which creates the rugose (or wrinkled) appearance of the scrotum when contracted, is derived from the __________
superficial fascia.
what is the typical clinical presentation of an Embryonal carcinoma
Embryonal carcinoma is a testicular germ cell tumor described as a hemorrhagic mass with necrosis that is painful. May be associated with elevated hCG and AFP
does adenomyosis cause infertility?
Adenomyosis is endometrial tissue within the myometrium. It is often asymptomatic but may present with menorrhagia, dyspareunia, or dysmenorrhea. However, it does not cause infertility.
Dartos fascia
a continuation of scarpa’s fascia of the abdomina wall –> superficial fascia just underneath the skin. Dartos muscle is reponsible for the rugged appearance of scrotum
what are the layers of the scrotum from outer to inner?
Some Damn Englishman Called It The Testes
use ICE TIE to remember where each part originated from in the abdomen:
Internal spermatic fascia
Cremasteric
external spermatic fascia
came from
Transversalis fascia (NOT the muscle)
Internal oblique
external oblique
what are the classic features of Kartagener syndrome
Kartagener syndrome is an autosomal recessive condition resulting in immotile cilia and subsequent infertility. Kartagener syndrome would also present with situs inversus, conductive hearing loss, recurrent sinusitis, and chronic ear infections.
what is the mechanism of the cremasteric reflex (including what nerves are involved)
The cremaster muscle originates from the internal oblique muscle. The function of the cremaster muscle is to raise and lower the testis for optimal spermatogenesis. The sensory limb of the cremaster reflex is the ilioinguinal nerve (L1 spinal cord level), which supplies the skin of the inner thigh. The motor limb of the reflex is the genitofemoral nerve (also L1). Lightly stroking the inner thigh toward the knee raises the testicle. This is referred to as the cremasteric reflex.
what drug is prescribed for syphilis and what’s the MOA
Penicillin G and related β-lactam antibiotics block cell wall synthesis by inhibiting peptidoglycan cross-linking. Specifically, these drugs inhibit bacterial transpeptidase, a penicillin-binding protein that is required for the formation of the peptide bond that cross-links the glycopeptide polymers to the growing peptidoglycan cell wall.
vasa previa vs placenta previa
Vasa previa refers to the separation of vessels that traverse the amniotic membranes from the placenta, usually occurring between lobes of a multilobed placenta or a velamentous cord insertion. It is a very rare cause of antepartum hemorrhage. Bleeding from vasa previa more commonly occurs during delivery
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. The abdominal and perineal examinations are normal. Semen analyses reveal a reduced sperm count, with abnormal morphology and mobility.
What clinical picture is this?
Mumps
The patient’s infertility and abnormal sperm preceded by a febrile illness with scrotal (orchitis) and facial swelling (parotitis) suggest prior mumps infection complicated by primary hypogonadism. This damage to the testes leads to decreased sperm production
The classic histologic finding of an ovarian fibroma is __________________
the presence of collagen-rich, monomorphic spindle cells.
The patient presents with signs of abdominal pain, weight loss, and adnexal fullness. Computed tomography of the abdomen shows bilateral ovarian masses and stomach wall thickening. Biopsy results of the ovarian masses show round, mucin-secreting cells known as “signet-ring” cells. The physician then palpates the supraclavicular lymph nodes
these findings are diagnostic of Krukenberg tumors, indicative of cancer metastases to the ovaries from the stomach. In up to 70% of cases, the primary site of Krukenberg tumors is cancer of the stomach,
Gastric cancer can spread aggressively to lymph nodes and the liver. A classic sign of metastatic gastric cancer is left supraclavicular lymphadenopathy involving the Virchow lymph node.
____is the most common cause of lactational mastitis.
Staph aureus
what is the karyotype of a complete mole
karyotype of 46,XX or 46,XY
what is the karyotype of a partial mole
69,XXX or 69 XXY
what are the contents of the superficial perineal pouch
superficial transverse perineal muscles
pudendal neurovasculature
ischiocavernosus
corpus spongiosum and corpora cavernosa, bulbospongiosus. (male)
bulbospongiosus muscle, bulb of vestibule, bartholin glands (female)
what are the contents of the deep perineal pouch
The deep perineal pouch is an anatomic space superior (deep) to the perineal membrane in the urogenital triangle of the perineum, anterior to the transverse line between the ischial tuberosities. it is partly bound on the side by the obturator fascia
Contents:
Deep transverse perineal muscle
external urethral sphincter
Urethrovaginal sphincter, compressor urethrae muscle, dorsal n. of clitoris (female)
membranous urethra, Bulbourethral glands, dorsal n. or penis (male)
conjugata vera
aka obstetrical conjugate or diagnoal conjugate
narrowest point in birth canal, bounded by pubic symphysis and sacral proinence
A woman is delivering a breech baby. The obstetrician decides that it is best to perform a mediolateral episiotomy. Which of the following structures should the obstetrician avoid incising
Levator ani
The lateral pelvic walls are made up of
two hip bones, (iliac, pubic and ischium) and muscles (obturator internus)
posterior pelvic wall is made up of
Posterior wall is made up of piriformis muscles, SI joints and ligaments, (sacrospinous and sacrotuberous), sacrum and coccyx in midline
The main muscles of pelvic floor are called pelvic diaphragm and consist of
- levator ani
- coccygeus
attachment points of coccygeus
Coccygeus is attached between the ischial spine, the sacrospinous ligament and sacrum/ coccyx
urogenital diaphragm vs pelvic diaphragm
The urogenital diaphragm consists of the deep transverse perineal muscle with the superior and inferior fascia
the pelvic diaphragm is the pelvic floor muscles (levator ani and coccygeus)
Culdocentesis - what is it and how is it done
Culdocentesis is the procedure that is usually performed for the aspiration of fluid from the cul-de-sac of Douglas (rectouterine pouch) by a needle puncture of the posterior vaginal fornix near the midline between the uterosacral ligaments
Which ligament is most helpful to keep the uterus in its normal pelvic place
cardinal ligament, then next the uterosacral I guess? nausheen
ejaculate is made of
seminal vesicle secretion 70% of the ejaculate (alkaline fluid and fructose)
25% by the prostate (prostate-specific antigen, prostatic acid phosphatase, fibrinolysin (helps to liquefy the semen), and citric acid
5% by testes and bulbourethral glands.
pathway of ductus deferens
- The ductus deferens (vas deferens) is the continuation of the epididymis (45 cm long), which…
- crosses the external iliac vessels, anteriorly, to enter the pelvis, remaining external to the peritoneum
- crosses over the ureter (anteriorly) to reach the base of the bladder where it enlarges to form the ampulla
- its ampulla lies superior to the seminal vesicle
- then narrows into a duct to turn inferiorly
- joins the duct of the seminal vesicle to form the ejaculatory duct.
Neurovascular supply and lymphatic drainage of ductus deferens and seminal vessicles
urethral crest
the epididymus is continuous with the vas deferense via the
tail of epididymis
innervation of the testis
The autonomic nerves of the testes arise as the testicular plexus on the testicular artery. Convey vagal parasympathetic, visceral afferent fibers, and sympathetic fibers from T10-T11 levels
hydrocele vs inguinal hernia
Congenital inguinal hernia (indirect): due persistent entire processus vaginalis
Hydrocele: fluid in persistent middle portion of tunica vaginalis
what are the coverings of the erectile tissues of the penis?
The corpora cavernosa are the paired erectile tissue that forms the crura of the penis. The two corpora cavernosa fuse and form the dorsal portion of the body of the penis inferior to the pubic symphysis. They are surrounded by a thick capsule called tunica albuginea, which extends inward as a septum in the body of the penis. Intermittent openings in the septum allow these two vascular spaces to communicate.
The corpus spongiosum penis is a single erectile mass surrounded by a tunica albuginea that surrounds the spongy urethra. It expands posteriorly to form the bulb of the penis, which anchors to the perineal membrane.
in addition to the individual coverings, all the erectile tissue is also covered by deep penile fascia (bucks fascia) followed by more superficial colles (aka dartos) fascia (which contains some muscle fibers and is continuous with Scarpa’s fascia of the abdominal wall)
bucks fascia is continuous with the deep perineal fascia and aponeurosis of external oblique
for the most part glandular secretions along the reproductive tract are under ______________ control
symp or parasymp?
sympathetic
Visceral afferents conducting pain from structures superior to Pelvic pain line travel along sympathetics retrogradely to _______
eg. fundus of uterus.
dorsal root ganglia (T12 – L2)
Whereas Visceral afferents conducting pain from structures inferior to the pelvic pain line, follow the course of the parasympathetic fibers to the spinal sensory ganglia of S2-4 eg. cervix and vagina.
clinical relevance: epidural during childbirth
how do nabothian cysts form
At puberty, the simple columnar epithelium of the endocervical canal extends onto the ectocervix. •Exposure of the simple columnar epithelium to the acidic (pH = 3) environment of the vagina induces a transformation from columnar to squamous epithelium (i.e., squamous metaplasia) •This can result in entrapment of mucous (Nabothian Cysts)
lymph from the upper 3/4 of the vagina go to ______
upper three-fourths into the internal iliac nodes
how does imperforate hymen occur (aka vaginal atresia)
vaginal lumen is blocked due to a failure of the vaginal plate to canalize and form a lumen
Balanitis xerotica obliterans, also known as ____
lichen sclerosus, are white inflammatory patches that can affect both males and females. In males, the affected areas usually involve the foreskin and penile glans, termed specifically balanitis xerotica obliterans
biochemical failure (in terms of prostate treatment) refers to
Increasing PSA levels despite no evidence of disease recurrence
Koilocytes are pathognomonic of an infection with
human papillomavirus (HPV). Condylomata acuminata, like cervical dysplasia, are caused by an infection with HPV and can therefore present with koilocytes on histopathology. Condylomata acuminata are typically associated with HPV strains 6 and 11.
identify the organ
epididymis
what are those large purple things? (prostate)
Corpora Amylacea - concretions of prostatic fluid in the lumen of some glands in older men.
Often have concentric lamellar appearance.
They gradually increase in number and size with age.
the ________________ nerve can be injured during radical prostatectomy
The cavernous nerve can be injured during radical prostatectomy. The resulting erectile dysfunction is one of the most feared complications of radical prostatectomy, but advances in urological surgery have enabled safer approaches that have significantly reduced the risk of permanent impotence.
classic triad of autoimmune polyendocrine syndrome type 1 (APS1)
hypoparathyroidism, primary adrenal insufficiency, and mucocutaneous candidiasis.
What is Pituitary apoplexy and what causes it?
Pituitary apoplexy is loss of blood supply or hemorrhage to the pituitary gland.
often caused by hemorrhage into the pituitary gland. Intracerebral bleeding increases intracranial pressure, causing sudden, severe headache. The hematoma compresses the oculomotor nerves, which lie adjacent to the pituitary, causing acute onset of double vision. The disruption of pituitary secretion and release of ACTH can cause severe hypotension, as seen in this patient. Hemorrhage into the pituitary gland usually occurs into a previously existing pituitary adenoma b/c tumors have higher blood demand, increasing pressure (e.g., prolactinoma), which explains this patient’s history of amenorrhea, recurrent headaches, and bitemporal hemianopsia.
what are the signs and sx of hypercalcemia
fatigue, hypertension, polyuria (“thrones”), abdominal and lower back pain (“groans, bones”), costovertebral angle tenderness (renal “stones”), constipation, and depression (“psychiatric overtones”)
what are the signs and sx of pheochromocytoma
HTN, paroxysmal headaches, diaphoresis, and palpitations.
d/t hyperplasia of chromaffin cells in the adrenal gland –> site of catecholamine release (e.g., epinephrine and norepinephrine
________________ are the most common cause of ovarian mass in pregnancy.
Corpus luteum cysts
asymptomatic, unilateral cystic ovarian mass differential
- follicular cyst (unilocular cyst without solid components)
- mucinous cystadenona (multilocular cyst with numerous thin septations)
- dermoid cyst (complex cystic mass with calcifications and solid components)
- theca lutein cyst (multiple, multilocular, and seen bilaterally)
- corpus luteum cyst (thick walls with wall vascularity + less common in non-pregnant women)
Non-PTH-mediated hypercalcemia most commonly occurs in ______________
malignancy (so-called hypercalcemia of malignancy) due to the paraneoplastic production of PTHrP (e.g., in squamous cell carcinomas of the lung, head, and neck; renal, bladder, breast, and ovarian cancer; lymphoma and leukemia). Other, less common causes of hypercalcemia of malignancy include osteolytic metastases (e.g., in multiple myeloma) and paraneoplastic production of calcitriol (e.g., in lymphoma).
Parathyroid hormone (PTH) acts to _____________calcium reabsorption from the bones and kidney, and __________ phosphate reabsorption in the kidney
Parathyroid hormone (PTH) acts to increase calcium reabsorption from the bones and kidney, and decrease phosphate reabsorption in the kidney*** but increase phosphate reabsorption from the bones
what is the pathophysiology of hyperparathyroidism secondart to End-stage kidney disease (ESKD)?
End-stage kidney disease (ESKD) causes decreased biosynthesis of active vitamin D, which leads to decreased calcium reabsorption in the intestines and distal convoluted tubule, resulting in hypocalcemia. Hypocalcemia then triggers PTH secretion, causing elevated serum PTH levels (i.e., secondary hyperparathyroidism)
how to differentiate graves disease from toxic nodular goiter?
Graves: Crowded follicular cells with scalloped colloid + diffuse uptake on scintigraphy
toxic Multinodular goiter: Patches of enlarged follicular cells distended with colloid + focal areas of uptake on scintigraphy
cut off for hyponatremia
serum sodium concentration < 135 mEq/L
what are the possible causes of SIADH
mn: “SIADH”
Surgery
Intracranial – Infection, Head injury, CVA
Alveolar – Carcinoma, Pus
Drugs – Opiates, Antiepileptics, Cytotoxics, Anti-psychotics
Hormonal – Hypothyroid, Low corticosteroid level
which female cells are homologous to leydig cells in that they secrete testosterone?
Leydig cells are homologous to the female theca interna cells, which cover the granulosa cell layer of developing ovarian follicles and also secrete testosterone. Theca cells express luteinizing hormone (LH) receptors and, when stimulated, convert cholesterol into androstenedione with the enzyme desmolase. After rupture of the mature ovarian follicle, theca interna cells differentiate into theca-lutein cells, which continue secreting androgens along with progesterone.
Theca vs granulosa cells
Granulosa cells form the immediate cell layer around maturing ovarian follicles. In response to follicle-stimulating hormone (FSH), granulosa cells convert incoming androstenedione into estrogen using aromatase.
Theca cells express luteinizing hormone (LH) receptors and, when stimulated, convert cholesterol into androstenedione with the enzyme desmolase. After rupture of the mature ovarian follicle, theca interna cells differentiate into theca-lutein cells, which continue secreting androgens along with progesterone.
low birthweight classification
Low: <2500 grams
Very low: <1500 grams
Extremely low: <1000 grams
