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Repro Flashcards

1
Q

24 y/o male develops testicular cancer. Metastatic spread occurs by what route

A

para-aortic lymph nodes (recall descent of testes during development)

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2
Q

woman with previous cesarean section has a scar in her lower uterus close to the opening of the os. What is she at increased risk for?

A

placenta previa

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3
Q

obese woman presents with hirsuitisma nd increase levels of serum testosterone. What is the dx?

A

Polycystic ovarian syndrome

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4
Q

pregnat woman at 16 weeks of gestation presents with an atypically large abdomen. what is the dx?

A

high hCG; hydatidiform mole

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5
Q

55 y/o postmenopausal woman is on tamoxifen therapy. What is she at increase risk of aquiring

A

endometrial carcinoma

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6
Q

what is the drainage of the left ovary/testes

A

left gonadal vv -> left renal vv -> IVC

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7
Q

what is the drainage of the right ovary/testes

A

right ovary/testis -> right gonadal vein -> IVC

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8
Q

suspensory ligament of ovaries contains these vessels

A

ovarian vessels

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9
Q

transverse cervical (cardinal) ligament contains these vessels

A

uterine vessels

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10
Q

round ligament of uterus contains

A

no important sx

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11
Q

broad ligament contains

A

round ligaments of the uterus and ovaries and the uterine tubules and vessels

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12
Q

erection is mediated by the _______ nervous system

A

parasympathetic

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13
Q

emission is mediated by the _______ nervous system

A

sympathetic

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14
Q

ejaculation is mediated by _____ and _____ nerves

A

visceral and somatic neves

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15
Q

acrosome of the sperm is derived from this

A

golgi apparatus

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16
Q

flagellum (tail) is derived from these

A

centrioles

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17
Q

middle piece (neck) has this

A

mitochondria

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18
Q

sperm food supply

A

fructose

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19
Q

spermatogenesis begins with _______(type A and B). Full development takes 2 mo

A

spermatogonia

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20
Q

spermatogenesis occurs here

A

seminiferous tubules.

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21
Q

type A forms these types of spermatogonia

A

type A & B

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22
Q

spermatogonium is ____, __N

A

dipoloid, 2N

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23
Q

spermatocyte is ____, __N

A

diploid, 4N

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24
Q

primary spermatocyte is ____, __N

A

diploid, 4N

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25
Q

secondary spermatocyte is ____, __N

A

haploid, 2N

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26
Q

spermatid is ____, __N

A

haploid, N

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27
Q

In male spermatogenesis, androgen-binding protein (ABP) functions to

A

ensure that tesetosterone in seminiferous tubule is high

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28
Q

In male spermatogenesis, inhibin functions to

A

inhibits FSH

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29
Q

testosterone functions to

A

differentiate male genitalia, has anabolic effects on protein metabolism, maintains gametogenesis, maintains libido, inhibits GnRH, and fuses epiphyseal plates in bone

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30
Q

FSH stimulates these cells to produce sperm

A

Sertoli cells

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31
Q

LH stimulates these cells to produce testosterone

A

Leydig cells

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32
Q

give some examples of androgens

A

testosterone, dihydrotestosterone (DHT, androstenendione

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33
Q

what is the source of DHT and testosterone

A

testes

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34
Q

what is the source of androstenedione

A

adrenal

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35
Q

rate testosterone, DHT and androstenedione in terms of potency

A

DHT>testosterone>androstenedione

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36
Q

name some targets of androgens

A

skin, prostate, seminal vesicles, epidydymis, liver, muscle, brain

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37
Q

testosterone is converted to DHT by this enzyme

A

5 alpha reductase

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38
Q

testosterone is converted to DHT by 5 alpha reductase which is inhibited by _______

A

finasteride

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39
Q

androgens functions to differentiate the wolffian duct system into these

A

internal gonadal structures

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40
Q

androgens functions to produce these changes in puberty

A

produce secondary sexual characteristics and growth spurt

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41
Q

androgens are required for normal spermatogenis. T or F

A

T

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42
Q

androgens functions for anabolic effects. E.g.,

A

increased mm size, increased RBC production

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43
Q

androgens increase this

A

libido

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44
Q

testosterone and androstenedione are converted to estrogen in adipose tissue by this enzyme

A

aromatase

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45
Q

ovaries produce this version of estrogen

A

estradiol

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46
Q

placenta produces this version of estrogen

A

estriol

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47
Q

list estrone, estradiol, and estriol in terms of potency

A

estradiol > estrone > estriol

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48
Q

give some fxs of estrogen

A

1) growth of follicle
2) endometrial proliferation, myometrial exitability
3) development of genitalia
4) stromal development of breast
5) female fat distribution
6) hepatic synthesis of transport protiens
7) feedback inhibition of FSH
8) LH surge (estrogen feedback on LH secretion switches to positive from negative just before LH surge)
9) increase myometrial exitability
10) incrase HDL, decreae LDL

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49
Q

estrogen hormone replacement therapy after menopause has these effects

A

decreased hot flashes and decreased postmenopauseal bone loss

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50
Q

unopposed estrogen therapy increases the risk of this CA

A

endometrial CA

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51
Q

using this with estrogen therapy can reduce the risk of CA

A

progesterone

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52
Q

what is the source of progesterone

A

corpus luteum, placenta, adrenal cortex, testes

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53
Q

progesterone functions to stimulate this?

A

endometrial glandular secretions and spiral artery development

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54
Q

progesterone functions to maintaine this?

A

pregnancy

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55
Q

progesterone functions to decrease exitability of this?

A

myometrial

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56
Q

progesterone produces thick cervical mucus, which functions to do this?

A

inhibits sperm entry into the uterus

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57
Q

progesterone functions to do this to body temperature?

A

increase

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58
Q

progesterone functions to do this to gonadotropins(LH,FSH)?

A

inhibit

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59
Q

progesterone functions to do this to uterine smooth mm?

A

relax it

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60
Q

follicular growth is fastest during this week of the proliferative phase

A

2nd week

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61
Q

this hormone stimulates proliferation of endometrium

A

estrogen

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62
Q

this hormone maintains endometrium to support implantation

A

progesterone

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63
Q

decreased amounts of this hormone can lead to decreased fertility

A

progesterone

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64
Q

there is a surge of this hormone the day before ovulation

A

estrogen

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65
Q

ovulation has this effect on LH, and this effect on FSH

A

stimulates LH

inhibits FSH

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66
Q

LH surge causes this

A

ovulation (rupture of follicle)

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67
Q

ovulation results in an increase in temperature which is induced by this hormone

A

progesterone

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68
Q

ovulation has this effect on the cervical mucosa

A

ferning

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69
Q

oral contraceptives prevent the surge of this hormone, LH surge -> ovulation does not occur

A

estrogen

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70
Q

this word refers to when blood from a ruptured follicule causes peritoneal irritation that can mimic appendicitis

A

Mittelschmerz

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71
Q

primary oocytes begin this during fetal life and complete it just prior to ovulation

A

meiosis I

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72
Q

Meiosis I is arrested in this phase for years until Ovulation

A

prOphase

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73
Q

Meiosis is arrested in this phase until fertilization

A

METaphase

mneu: an egg MET a sperm

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74
Q

source of hCG

A

syncytiotrophoblast of placenta

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75
Q

hCG functions to maintain this ________ for the 1st trimester by acting like LH.

A

corpus luteum

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76
Q

In the 2nd and 3rd trimester, this synthesizes its own estrogen and progesterone and the corpus luteum degenerates

A

placenta

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77
Q

this hormone is used to detect pregnancy because it appears in the urine 8 days after successful fertilization (blood and urine tests available)

A

hCG

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78
Q

elevated hCG can be seen in woman with these 2 neoplasms

A

hydatiform moles

choriocarcinoma

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79
Q

this is the cessation of estrogen production with age-linked decline in number of ovarian follicles

A

menopause

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80
Q

what is the average age of onset of menopause

A

51 years

81
Q

menopause tends to be earlier in this group of people

A

smokers

82
Q 
what hormonal changes occur in menopause?
estrogen
FSH
LH
GnRH
A

estrogen:↓
FSH:↑↑
LH:↑
GnRH:↑

83
Q

what are some symptoms of menopause

A 
mneu: HAVOC
Hot flashes
Atrophy of the vagina
Osteoporosis
Coronary artery dz
84
Q

bicornuate uturus results from incomplete fusion of thse ducts

A

paramesonephric ducts

85
Q

bicornate uterus is associated with these abnormalities

A

urinary tract abnormalities and infertality

86
Q

this is abnormal opening of penile urethra on inferior (ventral) side of penis due to failure of urethral folds to close

A

hypospadias

87
Q

this is an abnormal opening of penile urethra on superior (dorsal) side of penis due to faulty positioning of genital tubercle

A

epispadias

88
Q

what is more common hypospadias or epispadias

A

hypospadias

89
Q

why should you fix hypospadias.

A

prevent UTI

90
Q

exstrophy of the bladder is associated with this

A

epispadias

91
Q

pt presens for infertility workup with testicular atrophy, eunuchoid body shape, tall, long extemities, gynomastia, female hair distribution.

A

kleinfelter’s syndrome

92
Q

kleinfelter’s syndrome karyotype

A

XXY presence of inactivated X chromosome (Barr body)

93
Q

frequency of kleinfelter’s syndrome

A

1:850

94
Q

pt presents for primary amenorrhea with short stature, ovarian dysgenesis (streak ovary) webbing of neck, coarctation of the aorta.

A

turners syndrome

95
Q

Turner’s syndrome karyotype

A

XO (no barr body)

96
Q

man in penal institution looks normal but is very tall and has severe acne

A

double Y males

97
Q

frequency of double Y male

A

1:1000

98
Q

this is a disagreement between the phenotypic (external genitalia) and gonadal (testes vs. ovaries) sex

A

pseudohermaphroditism

99
Q

In this form of pseudohermaphroditism ovaries are present but external genitalia are virilized or ambiguous

A

female pseudohermaphroditism (XX)

100
Q

what are some causes of female pseudohermaphroditism (XX)

A

excessiva and inappropriate exposure to androgenic steroids during early gestration (i.e., congenital adrenal hyperplasia or exogenous administration of androgens during pregnancy)

101
Q

testes are present, but external genitalia are female or ambiguous.

A

male pseudo-hermaphrodite (XY)

102
Q

what is the most common form of male pseudo-hermaphrodite (XY)

A

androgen insensitivity syndrome (testicular feminization)

103
Q

what is a true hermaphrodite (46 XX, 47 XXY

A

both ovary and testicular tissue present; ambigous genetalia. Very rare.

104
Q

this results when a defect in androgen receptor results in a normal-appearing female. Female external genitalia are present with rudimentary vagina. Uterus and uterine tubes are generally absent.

A

androgen insensitivity syndrome (46 XY)

105
Q

what do you do with the testes in a pt with androgen insensitivity syndrome

A

remove them to prevent malignancy

106
Q

what will the levels of testosterone, estrogen and LH look like in androgen insensitivity syndrome

A

all will be high

107
Q

unable to convert testosterone to DHT. Ambiguous genitalia until puberty, when increased testosterone causes masculinization of genitalia. Testosterone/estrogen levels are normal; LH is normal or increased

A

5alpha reductase deficiency

108
Q

this is common in men >50 y/o. often presents with increased frequency of urination, nocturia, difficulty starting and stopping the stream of urine and dysuria

A

benign prostatic hyperplasia

109
Q

complications of BPH (is it precancerous)

A

may lead to distension and hypertrophy of the bladder, hydronephrosis and UTIs. Not considered a premalignant lesion.

110
Q

BPH is characterized by a nodular enlargement of these lobes of the prostate gland, compressing the urethra into a verticle slit

A

periurethral (lateral and middle) lobes

111
Q

possible etiology of BPH

A

age related increase in estradiodl with possible sensation of the prostate to growth promoting effects of DHT

112
Q

prostatic adenocarcinoma is common in men >50 y/o. It arises most often from this lobe of prostate gland.

A

posterior lobe (peripheral zone.

113
Q

how is prostatic adenocarcinoma frequently diagnosed

A

hard nodule on digital rectal exam and prostate bx.

114
Q

what are two tumor markers for prostatic adenocarcinoma

A

prostatic acid phosphatase and prostate specific antigen (PSA)

115
Q

increase in serum alkaline phosphorus and PSA in pt with prostatic adenocarcinoma may indicate what

A

osteoblastic metastases

116
Q

this is a pathologic ovum (“empty egg”–ovum with no DNA) resulting in cystic swelling of chorionic villi and proliferation of choorionic epithelium (trophoblast). “honeycomed uterus” and clluster of grapes appearance

A

hydatiform mole

117
Q

hydatiform mole produces high levels of this

A

B-hCG

118
Q

what is the genotype of a complete mole? Is it maternal or paternal in origin?is there a fetus?

A

46, XX-completely paternal-no fetus

119
Q

this type of mole is made up of 3 or more parts (triploid or tetraploid; It may contain fetal parts.

A

a partial mole

120
Q

this triad in pregnancy is hypertension, proteinuria, and edema.

A

preeclampsia (pregnancy induced hypertension)

121
Q

the preeclampsia triad + seizures =

A

eclampsia

122
Q

preeclapsia/eclampsia affects what percentage of pregnant women form 20 weeks’ gestation to 6 weeks postpartum

A

7%

123
Q

what are some conditions that predispose a woman to preeclampsia

A

hypertension, dbts, chronic renal dz, autimmune disorders

124
Q

etiology of preeclampsia includes placental ______

A

ischemia

125
Q

preeclampsia can be associated with HELLP syndrome. What does this stand for

A

Hemolysis, Elevted LFTs, Low Platelets

126
Q

What are some of the clinical features of preeclampsia

A

headache, blurred vision, abdominal pain, edema of face and extremities, altered mentation, hyperreflexia

127
Q

lab findings of preeclampsia may inculde

A

thrombocytopenia, hyperuricemia

128
Q

what is the tx of preeclampsia

A

deliver the fetus as soon as viable. Until then bed rest, salt restriction and monitoring and tx of HTN

129
Q

what is the tx of eclapsia

A

medical emergency, IV magnesium sulfate and diazepam

130
Q

this pregnancy complication describes a premature separation of the placenta. It presents with PAINFUL uterine bleeding (usually during 3rd trimester). Fetal death occurs. It may be associated with DIC. there is increased risk in mothers who have HTN, smoke, or use cocaine

A

abruptio placenta

131
Q

this pregnancy complication describes when a defective decidual layer allows the placenta to attach ddirectly to the myometrium. Prior C-section or inflammation predisposes a woman to it. There may be a massive hemorrhage after delivery

A

placenta accreta

132
Q

this pregnancy complication describes the attachment to the placenta to the lower uterine segment. It may occlude the cervical os. PAINLESS bleeding may occur in any trimester

A

placenta previa

133
Q

this pregnancy complication occurs most often in the fallopian tubes. It is predisposed by salpingitis (PID). Suspect it with increased hCG and sudden lower abdominal pain. Confirm with an ultra sound

A

ectopic pregnancies

134
Q

> 1.5-2L of amniotic fluid; associated with esophogeal/duodenal atresa, cauasing inability to swallow amniotic fluid, and with anencephaly

A

polyhydramnos

135
Q

<0.5L of amniotic fluid. Associated with bilateral renal agenesis or posterior urethral valves (in males) and resultant inability to excrete urine

A

oligohydramnios

136
Q

disordered epithelial growth. begins at basal layer and extens outward. classified as I-III depending on extent of disordere.

A

dysplasia and carcinoma in situ

137
Q

carcinoma in situ is associated with what virus

A

HPV 16,18

138
Q

is carcinoma in situ premalignant

A

yes it may progress slowly to invasive carcinoma

139
Q

invasive carcinoma is often this type

A

squamous cell carcinoma

140
Q

papsmear can catch this sign of cervical dysplsia before it progresses to invasive carcinoma

A

koilocytes

141
Q

lateral invasion of invasivve carcinoma can block ureters, causing this

A

renal failure

142
Q

this uterine pathology is characterized by non-neoplastic endometrial glands/ stroma in abnormal location outside the uterus. It is characterized by cylcic bleeding (menstral type) from ectopic endometrial tissue resulting in blood filled “chocolate cysts.” In ovary or peritoneum. It manifests clinically as severe menstrual related pain. It often results in infertility

A

endometriosis

143
Q

this is endometriosis within the myometrium

A

adenomyois

144
Q

this abnormal endometrial gland proliferation is usually caused by excess estrogen stimulation. It most commonly presents clinically as vaginal bleeding. Pts with this are at increased risk for endometrial carcinoma

A

endometrial hyperplasia

145
Q

this is the most common gynecologic malignancy. Peak age is 55-65 y/o. Clinically presetns with vaginal bleeding and is typically preceded by endometrial hyperplasia. Risk factors include prolonged estrogen use, obesity, dbts, and hypertension.

A

endometrial carcinoma

146
Q

this is the most common of all tumors in females. It often presents with multiple tumors. there is an increase incidence in blacks. These tumors are estrogen sensitive and tumor size increases with pregnancy and decreases with menopause. malignant transformation is rare.

A

leiomyoma

147
Q

this is a bulky tumor with areas of necrosis and hemorrhage, dypically arising de novo (not from leiomyoma0. There is an increased incidence in blacks. THis is a highly aggressive tumor with tendency to recur. May protrude from cervix and bleed

A

Leiomyosarcoma

148
Q

increased LH production leads to anovulaiton, hyperandrogenism due to deranged steroid synthesis. It manifests itself clinically by amenorrha, infertility, obesity, and hirsutism. Tx with weight loss, OCPs, gonadotropin analogs, or surgery

A

polycystic ovarian syndrome

149
Q

this ovarian cyst is a distension of unruptured graafian follicle. It may be associated with hyperestrinism and endometrial hyperplasia

A

follicular cyst

150
Q

this ovarian cyst is a results from hemorrhage into persistant corpus luteum. It cfan cause menstral irregularity

A

corpus luteum cyst

151
Q

this ovarian cyst is often bilateral/multiple. It is due to gonadotropin stimulation. It is associated with choriocarcinoma and moles

A

theca-lutein cyst

152
Q

this ovarian cyst is a blood containing cyst from ovarian endometriosis. It varies with the menstral cycle

A

chocolate cyst

153
Q

this is the most common germ cell tumor of the ovaries and testse. It produces incresed hCG and sheets of uniform cells

A

germinomas

154
Q

germinoma of the ovary is called

A

dysgerminoma

155
Q

germinoma of the testes is called

A

seminoma

156
Q

how does seminoma often present

A

with painless testicular enlargment

157
Q

what puts pts at increased risk for seminoma

A

cryptochidism

158
Q

this is an aggressive malignancy in the ovaries, testes, sacrococcygeal are of young children.

A

yolk sac (endodermal sinus) tumor

159
Q

______ bodies and primitive glomeruli are seen in yolk sac (endodermal sinus) tumors

A

Schiller-Duval bodies

160
Q

this lab value is increased with yolk sac (endodermal sinus) tumor

A

AFP

161
Q

this is a rare but malignant germ cell tumor that can develop during pregnancy in mother or baby. Tumor shows large hyperchromatic syncytrotrophoblastic cells

A

choriocarcinoma

162
Q

what lab value is increased in choriocarcinoma

A

hCG

163
Q

this is the 2nd most common testicular germ cell tumor. It presents as a painful mass. Microscopically the tumor is glandular w/ papillary convolutions

A

embryonal carcinoma

164
Q

this constitutes 90% of ovarian germ cell tumor. It contains cells from 3 germ layers.

A

teratoma

165
Q

in woman matuure teratoma (“dermoid cyst”) is _______

immature teratoma is _______

A

benign

malignant

166
Q

In Men, Mature teratomas can present with gynecomastia, they are painful and __________

A

Malignant

167
Q

this form of teratoma contains functional thyroid tissue

A

struma ovarii

168
Q

This ovarian non-germ cell tumor consists of 20% of ovarian tumors. It is frequently bilateral, and lined with fallopian tubbe-like epithelium. It is benign

A

serous cystadenoma

169
Q

This ovarian non-germ cell tumor consists of 50% of ovarian tumors. These are malignant and frequently bilateral

A

serous cystadenocarcinoma

170
Q

This ovarian non-germ cell tumor is benign. It is a multilocular cyst lined by mucus-secreting epithelium

A

mucinous cystadenoma

171
Q

This ovarian non-germ cell tumor is malignant. It can be associated with pseudomyxoma peritonei-intraperitoneal accumulaiton of mucinous material from ovarian or eppendiceal tumor

A

mucinous cystadenocarcinoma

172
Q

This ovarian non-germ cell tumor is a benign tumor that resembles Bladdr epithelium.

A

Brenner tumor

173
Q

This ovarian non-germ cell tumor consists of bundles of spindle-shaped fibroblasts

A

ovarian fibroma

174
Q

what is Meigs syndrome

A

triad of ovarian fibroma, ascites, and hydrothorax

175
Q

This ovarian non-germ cell tumor secretes estrogen which leads to precocious puberty (kids). It can cause endometrial hyperplasia or carcinoma in adults.

A

granulosa cell tumor

176
Q

these “bodies” consisting of small follicles filled with eosinophilic secretions are characteristic of granulosa cell tumors

A

CAll-Exner bodies

177
Q

this testicular non-germ cell tumor is benign. It contains Reinke crystals. It is androgen producing leading to gynecomastia in men and precocious puberty in boys.

A

Leydid cell tumor

178
Q

this testicular non-germ cell tumor is benign. It is an androblastoma from sex cordd stroma.

A

Sertoli cell tumor

179
Q

this testicular non-germ cell tumor is the most common testicular cancer in older men

A

testicular lymphoma

180
Q

this breast dz presents with diffuse breast pain and multiple lesions, often bilateral. Bx shows fibrocystic elements. Usually does not indicate increased risk of carcinoma

A

fibrocystic breast dz

181
Q

this histologic type of fibrocystic breast dz, manifests itself in hyperplasia of the breast stroma

A

fibrosis fibrocystic breast dz

182
Q

this histologic type of fibrocystic breast dz, manifests itself in fluid filled cysts

A

cystic fibrocystic breast dz

183
Q

this histologic type of fibrocystic breast dz, manifests itself in increased acini and intralobular fibrosis

A

sclerosing fibrocystic breast dz

184
Q

this histologic type of fibrocystic breast dz, manifests itself in increased numbers of epithelial cell layers in terminal duct lobule. There is increased risk of carcinoma with atypical cells. it usually occurs in women over 30 y/o

A

epithelial hyperplasia fibrocystic breast dz

185
Q

this benign tumor is the most common tumor of young women under 25 y/o. It is characterized by a small, mobile, firm mass with sharp edges. It may increase size and tenderness with pregnancy. It is not a precursor to breast cancer

A

fibroadenoma

186
Q

this benign tumor is a large, bulky mass of connective tissue and cysts. Tumor may have “leaflike” projections

A

cystosarcoma phyllodes

187
Q

this benign tumor is a tumor of the lactiferous ducts and presents with nipple discharge

A

intraductal papilloma

188
Q

when do malignant tumors of the breast (carcinomas) usually occur in a womans life

A

postmenopausally

189
Q

breast carcinomas can arise from either of these 2 tissues

A

mammary duct epithelium or lobula rglands

190
Q

breast carcinomas may show an overexpression of these receptors which affect therapy and prognosis

A

estrogen/progesterone receptors or

erb-B2 (HER-2, an EGF receptor)

191
Q

this histologic type of breast carcinoma refers to early malignancy without basement membrane penetration

A

ductal carcinoma in situ (DCIS)

192
Q

this histologic type of breast carcinoma is very common. It presents as a firm, fibrous mass

A

invasive ductal, no specific type

193
Q

this histologic type of breast carcinoma is ductal, with a cheesy consistency due to central necrosis

A

comedocarcinoma

194
Q

this histologic type of breast carcinoma has lmphatic involvement and a poor prognosis

A

inflammatory

195
Q

this histologic type of breast carcinoma is often multiple and bilateral

A

invasive lobular

196
Q

this histologic type of breast carcinoma is fleshy, cellular, with lymphocytic infiltrates. It carries a good prognosis

A

medullary

197
Q

this histologic type of breast carcinoma presents with eczematous patches on the nipple. On biopsy there are large cells with a clear halo. This type of malignancy is also seen on the vulva

A

paget’s dz of the breast

198
Q

what are some risk factors for breast carcinoma

A

gender, age, early 1st menarchy (30y/o), late menopause (>50y/o), family hx of 1st degree relative w/ breast cancer at a young age.

199
Q

T or F. Fisk of breast carcinoma is not increased by fibroadenomas or nonhyperplastic cysts

A

T

Step 1 Complete (29 decks)

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