Repro Flashcards
24 y/o male develops testicular cancer. Metastatic spread occurs by what route
para-aortic lymph nodes (recall descent of testes during development)
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?
placenta previa
obese woman presents with hirsuitisma nd increase levels of serum testosterone. What is the dx?
Polycystic ovarian syndrome
pregnat woman at 16 weeks of gestation presents with an atypically large abdomen. what is the dx?
high hCG; hydatidiform mole
55 y/o postmenopausal woman is on tamoxifen therapy. What is she at increase risk of aquiring
endometrial carcinoma
what is the drainage of the left ovary/testes
left gonadal vv -> left renal vv -> IVC
what is the drainage of the right ovary/testes
right ovary/testis -> right gonadal vein -> IVC
suspensory ligament of ovaries contains these vessels
ovarian vessels
transverse cervical (cardinal) ligament contains these vessels
uterine vessels
round ligament of uterus contains
no important sx
broad ligament contains
round ligaments of the uterus and ovaries and the uterine tubules and vessels
erection is mediated by the _______ nervous system
parasympathetic
emission is mediated by the _______ nervous system
sympathetic
ejaculation is mediated by _____ and _____ nerves
visceral and somatic neves
acrosome of the sperm is derived from this
golgi apparatus
flagellum (tail) is derived from these
centrioles
middle piece (neck) has this
mitochondria
sperm food supply
fructose
spermatogenesis begins with _______(type A and B). Full development takes 2 mo
spermatogonia
spermatogenesis occurs here
seminiferous tubules.
type A forms these types of spermatogonia
type A & B
spermatogonium is ____, __N
dipoloid, 2N
spermatocyte is ____, __N
diploid, 4N
primary spermatocyte is ____, __N
diploid, 4N
secondary spermatocyte is ____, __N
haploid, 2N
spermatid is ____, __N
haploid, N
In male spermatogenesis, androgen-binding protein (ABP) functions to
ensure that tesetosterone in seminiferous tubule is high
In male spermatogenesis, inhibin functions to
inhibits FSH
testosterone functions to
differentiate male genitalia, has anabolic effects on protein metabolism, maintains gametogenesis, maintains libido, inhibits GnRH, and fuses epiphyseal plates in bone
FSH stimulates these cells to produce sperm
Sertoli cells
LH stimulates these cells to produce testosterone
Leydig cells
give some examples of androgens
testosterone, dihydrotestosterone (DHT, androstenendione
what is the source of DHT and testosterone
testes
what is the source of androstenedione
adrenal
rate testosterone, DHT and androstenedione in terms of potency
DHT>testosterone>androstenedione
name some targets of androgens
skin, prostate, seminal vesicles, epidydymis, liver, muscle, brain
testosterone is converted to DHT by this enzyme
5 alpha reductase
testosterone is converted to DHT by 5 alpha reductase which is inhibited by _______
finasteride
androgens functions to differentiate the wolffian duct system into these
internal gonadal structures
androgens functions to produce these changes in puberty
produce secondary sexual characteristics and growth spurt
androgens are required for normal spermatogenis. T or F
T
androgens functions for anabolic effects. E.g.,
increased mm size, increased RBC production
androgens increase this
libido
testosterone and androstenedione are converted to estrogen in adipose tissue by this enzyme
aromatase
ovaries produce this version of estrogen
estradiol
placenta produces this version of estrogen
estriol
list estrone, estradiol, and estriol in terms of potency
estradiol > estrone > estriol
give some fxs of estrogen
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
estrogen hormone replacement therapy after menopause has these effects
decreased hot flashes and decreased postmenopauseal bone loss
unopposed estrogen therapy increases the risk of this CA
endometrial CA
using this with estrogen therapy can reduce the risk of CA
progesterone
what is the source of progesterone
corpus luteum, placenta, adrenal cortex, testes
progesterone functions to stimulate this?
endometrial glandular secretions and spiral artery development
progesterone functions to maintaine this?
pregnancy
progesterone functions to decrease exitability of this?
myometrial
progesterone produces thick cervical mucus, which functions to do this?
inhibits sperm entry into the uterus
progesterone functions to do this to body temperature?
increase
progesterone functions to do this to gonadotropins(LH,FSH)?
inhibit
progesterone functions to do this to uterine smooth mm?
relax it
follicular growth is fastest during this week of the proliferative phase
2nd week
this hormone stimulates proliferation of endometrium
estrogen
this hormone maintains endometrium to support implantation
progesterone
decreased amounts of this hormone can lead to decreased fertility
progesterone
there is a surge of this hormone the day before ovulation
estrogen
ovulation has this effect on LH, and this effect on FSH
stimulates LH
inhibits FSH
LH surge causes this
ovulation (rupture of follicle)
ovulation results in an increase in temperature which is induced by this hormone
progesterone
ovulation has this effect on the cervical mucosa
ferning
oral contraceptives prevent the surge of this hormone, LH surge -> ovulation does not occur
estrogen
this word refers to when blood from a ruptured follicule causes peritoneal irritation that can mimic appendicitis
Mittelschmerz
primary oocytes begin this during fetal life and complete it just prior to ovulation
meiosis I
Meiosis I is arrested in this phase for years until Ovulation
prOphase
Meiosis is arrested in this phase until fertilization
METaphase
mneu: an egg MET a sperm
source of hCG
syncytiotrophoblast of placenta
hCG functions to maintain this ________ for the 1st trimester by acting like LH.
corpus luteum
In the 2nd and 3rd trimester, this synthesizes its own estrogen and progesterone and the corpus luteum degenerates
placenta
this hormone is used to detect pregnancy because it appears in the urine 8 days after successful fertilization (blood and urine tests available)
hCG
elevated hCG can be seen in woman with these 2 neoplasms
hydatiform moles
choriocarcinoma
this is the cessation of estrogen production with age-linked decline in number of ovarian follicles
menopause
what is the average age of onset of menopause
51 years
menopause tends to be earlier in this group of people
smokers
what hormonal changes occur in menopause? estrogen FSH LH GnRH
estrogen:↓
FSH:↑↑
LH:↑
GnRH:↑
what are some symptoms of menopause
mneu: HAVOC Hot flashes Atrophy of the vagina Osteoporosis Coronary artery dz
bicornuate uturus results from incomplete fusion of thse ducts
paramesonephric ducts
bicornate uterus is associated with these abnormalities
urinary tract abnormalities and infertality
this is abnormal opening of penile urethra on inferior (ventral) side of penis due to failure of urethral folds to close
hypospadias
this is an abnormal opening of penile urethra on superior (dorsal) side of penis due to faulty positioning of genital tubercle
epispadias
what is more common hypospadias or epispadias
hypospadias
why should you fix hypospadias.
prevent UTI
exstrophy of the bladder is associated with this
epispadias
pt presens for infertility workup with testicular atrophy, eunuchoid body shape, tall, long extemities, gynomastia, female hair distribution.
kleinfelter’s syndrome
kleinfelter’s syndrome karyotype
XXY presence of inactivated X chromosome (Barr body)
frequency of kleinfelter’s syndrome
1:850
pt presents for primary amenorrhea with short stature, ovarian dysgenesis (streak ovary) webbing of neck, coarctation of the aorta.
turners syndrome
Turner’s syndrome karyotype
XO (no barr body)
man in penal institution looks normal but is very tall and has severe acne
double Y males
frequency of double Y male
1:1000
this is a disagreement between the phenotypic (external genitalia) and gonadal (testes vs. ovaries) sex
pseudohermaphroditism
In this form of pseudohermaphroditism ovaries are present but external genitalia are virilized or ambiguous
female pseudohermaphroditism (XX)
what are some causes of female pseudohermaphroditism (XX)
excessiva and inappropriate exposure to androgenic steroids during early gestration (i.e., congenital adrenal hyperplasia or exogenous administration of androgens during pregnancy)
testes are present, but external genitalia are female or ambiguous.
male pseudo-hermaphrodite (XY)
what is the most common form of male pseudo-hermaphrodite (XY)
androgen insensitivity syndrome (testicular feminization)
what is a true hermaphrodite (46 XX, 47 XXY
both ovary and testicular tissue present; ambigous genetalia. Very rare.
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.
androgen insensitivity syndrome (46 XY)
what do you do with the testes in a pt with androgen insensitivity syndrome
remove them to prevent malignancy
what will the levels of testosterone, estrogen and LH look like in androgen insensitivity syndrome
all will be high
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
5alpha reductase deficiency
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
benign prostatic hyperplasia
complications of BPH (is it precancerous)
may lead to distension and hypertrophy of the bladder, hydronephrosis and UTIs. Not considered a premalignant lesion.
BPH is characterized by a nodular enlargement of these lobes of the prostate gland, compressing the urethra into a verticle slit
periurethral (lateral and middle) lobes
possible etiology of BPH
age related increase in estradiodl with possible sensation of the prostate to growth promoting effects of DHT
prostatic adenocarcinoma is common in men >50 y/o. It arises most often from this lobe of prostate gland.
posterior lobe (peripheral zone.
how is prostatic adenocarcinoma frequently diagnosed
hard nodule on digital rectal exam and prostate bx.
what are two tumor markers for prostatic adenocarcinoma
prostatic acid phosphatase and prostate specific antigen (PSA)
increase in serum alkaline phosphorus and PSA in pt with prostatic adenocarcinoma may indicate what
osteoblastic metastases
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
hydatiform mole
hydatiform mole produces high levels of this
B-hCG
what is the genotype of a complete mole? Is it maternal or paternal in origin?is there a fetus?
46, XX-completely paternal-no fetus
this type of mole is made up of 3 or more parts (triploid or tetraploid; It may contain fetal parts.
a partial mole
this triad in pregnancy is hypertension, proteinuria, and edema.
preeclampsia (pregnancy induced hypertension)
the preeclampsia triad + seizures =
eclampsia
preeclapsia/eclampsia affects what percentage of pregnant women form 20 weeks’ gestation to 6 weeks postpartum
7%
what are some conditions that predispose a woman to preeclampsia
hypertension, dbts, chronic renal dz, autimmune disorders
etiology of preeclampsia includes placental ______
ischemia
preeclampsia can be associated with HELLP syndrome. What does this stand for
Hemolysis, Elevted LFTs, Low Platelets
What are some of the clinical features of preeclampsia
headache, blurred vision, abdominal pain, edema of face and extremities, altered mentation, hyperreflexia
lab findings of preeclampsia may inculde
thrombocytopenia, hyperuricemia
what is the tx of preeclampsia
deliver the fetus as soon as viable. Until then bed rest, salt restriction and monitoring and tx of HTN
what is the tx of eclapsia
medical emergency, IV magnesium sulfate and diazepam
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
abruptio placenta
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
placenta accreta
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
placenta previa
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
ectopic pregnancies
> 1.5-2L of amniotic fluid; associated with esophogeal/duodenal atresa, cauasing inability to swallow amniotic fluid, and with anencephaly
polyhydramnos
<0.5L of amniotic fluid. Associated with bilateral renal agenesis or posterior urethral valves (in males) and resultant inability to excrete urine
oligohydramnios
disordered epithelial growth. begins at basal layer and extens outward. classified as I-III depending on extent of disordere.
dysplasia and carcinoma in situ
carcinoma in situ is associated with what virus
HPV 16,18
is carcinoma in situ premalignant
yes it may progress slowly to invasive carcinoma
invasive carcinoma is often this type
squamous cell carcinoma
papsmear can catch this sign of cervical dysplsia before it progresses to invasive carcinoma
koilocytes
lateral invasion of invasivve carcinoma can block ureters, causing this
renal failure
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
endometriosis
this is endometriosis within the myometrium
adenomyois
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
endometrial hyperplasia
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.
endometrial carcinoma
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.
leiomyoma
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
Leiomyosarcoma
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
polycystic ovarian syndrome
this ovarian cyst is a distension of unruptured graafian follicle. It may be associated with hyperestrinism and endometrial hyperplasia
follicular cyst
this ovarian cyst is a results from hemorrhage into persistant corpus luteum. It cfan cause menstral irregularity
corpus luteum cyst
this ovarian cyst is often bilateral/multiple. It is due to gonadotropin stimulation. It is associated with choriocarcinoma and moles
theca-lutein cyst
this ovarian cyst is a blood containing cyst from ovarian endometriosis. It varies with the menstral cycle
chocolate cyst
this is the most common germ cell tumor of the ovaries and testse. It produces incresed hCG and sheets of uniform cells
germinomas
germinoma of the ovary is called
dysgerminoma
germinoma of the testes is called
seminoma
how does seminoma often present
with painless testicular enlargment
what puts pts at increased risk for seminoma
cryptochidism
this is an aggressive malignancy in the ovaries, testes, sacrococcygeal are of young children.
yolk sac (endodermal sinus) tumor
______ bodies and primitive glomeruli are seen in yolk sac (endodermal sinus) tumors
Schiller-Duval bodies
this lab value is increased with yolk sac (endodermal sinus) tumor
AFP
this is a rare but malignant germ cell tumor that can develop during pregnancy in mother or baby. Tumor shows large hyperchromatic syncytrotrophoblastic cells
choriocarcinoma
what lab value is increased in choriocarcinoma
hCG
this is the 2nd most common testicular germ cell tumor. It presents as a painful mass. Microscopically the tumor is glandular w/ papillary convolutions
embryonal carcinoma
this constitutes 90% of ovarian germ cell tumor. It contains cells from 3 germ layers.
teratoma
in woman matuure teratoma (“dermoid cyst”) is _______
immature teratoma is _______
benign
malignant
In Men, Mature teratomas can present with gynecomastia, they are painful and __________
Malignant
this form of teratoma contains functional thyroid tissue
struma ovarii
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
serous cystadenoma
This ovarian non-germ cell tumor consists of 50% of ovarian tumors. These are malignant and frequently bilateral
serous cystadenocarcinoma
This ovarian non-germ cell tumor is benign. It is a multilocular cyst lined by mucus-secreting epithelium
mucinous cystadenoma
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
mucinous cystadenocarcinoma
This ovarian non-germ cell tumor is a benign tumor that resembles Bladdr epithelium.
Brenner tumor
This ovarian non-germ cell tumor consists of bundles of spindle-shaped fibroblasts
ovarian fibroma
what is Meigs syndrome
triad of ovarian fibroma, ascites, and hydrothorax
This ovarian non-germ cell tumor secretes estrogen which leads to precocious puberty (kids). It can cause endometrial hyperplasia or carcinoma in adults.
granulosa cell tumor
these “bodies” consisting of small follicles filled with eosinophilic secretions are characteristic of granulosa cell tumors
CAll-Exner bodies
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.
Leydid cell tumor
this testicular non-germ cell tumor is benign. It is an androblastoma from sex cordd stroma.
Sertoli cell tumor
this testicular non-germ cell tumor is the most common testicular cancer in older men
testicular lymphoma
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
fibrocystic breast dz
this histologic type of fibrocystic breast dz, manifests itself in hyperplasia of the breast stroma
fibrosis fibrocystic breast dz
this histologic type of fibrocystic breast dz, manifests itself in fluid filled cysts
cystic fibrocystic breast dz
this histologic type of fibrocystic breast dz, manifests itself in increased acini and intralobular fibrosis
sclerosing fibrocystic breast dz
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
epithelial hyperplasia fibrocystic breast dz
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
fibroadenoma
this benign tumor is a large, bulky mass of connective tissue and cysts. Tumor may have “leaflike” projections
cystosarcoma phyllodes
this benign tumor is a tumor of the lactiferous ducts and presents with nipple discharge
intraductal papilloma
when do malignant tumors of the breast (carcinomas) usually occur in a womans life
postmenopausally
breast carcinomas can arise from either of these 2 tissues
mammary duct epithelium or lobula rglands
breast carcinomas may show an overexpression of these receptors which affect therapy and prognosis
estrogen/progesterone receptors or
erb-B2 (HER-2, an EGF receptor)
this histologic type of breast carcinoma refers to early malignancy without basement membrane penetration
ductal carcinoma in situ (DCIS)
this histologic type of breast carcinoma is very common. It presents as a firm, fibrous mass
invasive ductal, no specific type
this histologic type of breast carcinoma is ductal, with a cheesy consistency due to central necrosis
comedocarcinoma
this histologic type of breast carcinoma has lmphatic involvement and a poor prognosis
inflammatory
this histologic type of breast carcinoma is often multiple and bilateral
invasive lobular
this histologic type of breast carcinoma is fleshy, cellular, with lymphocytic infiltrates. It carries a good prognosis
medullary
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
paget’s dz of the breast
what are some risk factors for breast carcinoma
gender, age, early 1st menarchy (30y/o), late menopause (>50y/o), family hx of 1st degree relative w/ breast cancer at a young age.
T or F. Fisk of breast carcinoma is not increased by fibroadenomas or nonhyperplastic cysts
T
