REPRO Flashcards
1
Q
The Right testes and ovary drain into the Right Gonadal vein which goes to?
A
directly to ICV
2
Q
the Left testes / ovary drain to Left gonadal vein then to?
A
LEFT RENAL VEIN
3
Q
why are varicoceles more common on left?
A
bc the left gonadal vein is longer and has the make the 90 degree turn at the the Renal vein it has higher pressure.
is enlarged pampinoform plexus n
4
Q
where does most of the blood supply to the pelvic region come from ?
whats the exception?
A
branch off the INTERNAL iliac arteries
and the exception
the .gonadal arteries off the aorta
5
Q
where do the ovaries and testes
lymphatics drain to
A
para-aortic nodes
6
Q
what lymphatics do the
body of uterues, cervix, superior bladder )
drain to
A
external iliacs
7
Q
the prostate/ cervix / corpus cavernosum / proximal upper 2/3 vagina
lymphatic drain to
A
internal iliaic nodes
(hypogastric nodes)
8
Q
distal vagina
vulva
scrotum*
distal anus
lymphatics tdrain into
A
Superficial inguinal nodes
9
Q
where does the glans of the penis lymphatics drain to
A
deep inguinal nodes
10
Q
what hernia
is more common in children.
due to failure of processsus vaginalis to close
which can also cause?
A
INDIRECT
can form hydrocele
11
Q
what hernia occurs lateral tot epigastric vessels and goes into the inguinal ring into scrotum
A
indirect
12
Q
what herniation goes through the inguinal (hesselbach traingle).
medial to inferior epigastric vessels
A
direct
13
Q
what hernia is due to acquired weakness in transversalis fascia?
who gets this hernia
A
direct
common in older males
14
Q
what makes up the hesselbachs triangle
A
inferior epigastric vessels (lateral)
inguinal ligment
lateral border of rectur abdominus (medial)
15
Q
which hernia is more common in women?
A
femoral
16
Q
what hernia
protrudes BELOW inguinal ligament
through the femoral canal below and lateral to pubic tubercle
A
femoral hernia
17
Q
which hernia is more likely to present with
incarceration (irreducible hernia)
or strangulation ( contents of hernia undergo necrosis)
A
femoral hernia
18
Q
what does the paramesonephric (Mullerian) duct form
A
fallopian tubes
uterus
UPPER portion of vagina.
(the lower part of vag is from the urogenital sinus)
19
Q
what forms the lower vagina
A
urogenital sinus –> sinovaginal bulbs –> lower vag.
20
Q
what does the mesonephric (Wolffian) duct
not form.
Seminal vesicles
Epididnmis
Ejaculatory duct
Ductus deferens
Prostate
A
it does not form the prostate
21
Q
what can
leydig cell hypoplasia (leydig cell agenesis) cause?
A
no development of mesonephric duct.
bc cant respond to LH thus no testosterone thus no mesonephric duct thus no (SEED) structures
22
Q
what does the paramesonephric mullerian duct form in a male.
what does the mesonephric wolffian duct form in a female
A
male - remnant is appendix testis
female: gartner duct
23
Q
what do sertoli cells secrete
A
inhibiin B that inhibits FSH
androgen-binding protein –> maintain local levels of testosterone.
MIF
24
Q
sertoli cells form tight junctions that forms blood testis barrier that functions to
A
isolate gametes from autoimmune attack
25
**varicocele and cryptorchidism**
both can cause **increase in temp to teste** what does this do
**dec sperm production**
**dec inhibin B**
26
what do **leydig cells do?**
secrete **testosterone** in presence of **LH**
27
FSH --\> serotoli cells --\> ?
LH --\> leydig cells --\> /
sperm production
\testosterone
28
dihydrostestosterone is responsible for development of?
it can treat
**penis, scrotum protstate**
its responsible for prostate growth
sebaceous gland activity
it can cause male pattern hair loss?
29
an OBESE pt can become testosterone deficient how?
bc of **aromatase**
**testosterone --\> estrogen**
aromatase can be found in high concentrations in adipose tissue.
30
disorders of sex hormone
## Footnote
**inc T**
**inc LH**
**defective androgen receptor**
31
**inc testosterone**
**dec LH**
what the cause
**testosteroe - secreting tumor,**
**exogenous steroids**
32
primary hypogonadism
you will see what on labs
**DEC TESTOSTERONE**
**INC LH**
33
diagnosing diosrders of sex hormones
**dec testosterone**
**DEC LH**
What syndrome is associated with this?
**HYPOGONADOTROPIC HYPOGONADISM**
**Kallmann syndrome**
**- low GnRH --\> low LH** and **FSH**
**-** due to defect of **X-linked KAL chain**
defect of olfactory bulb --\> **ANOSMIA** (CANT SMELL!)
34
female w/ primary amenorrhea or delayed puberty that cant smell.
**kallmann syndrome**
35
=25 yo that has tried to have kids with his wife. on further questioning cant smell.
what is the diagnosis
**hypopgonadotropic hypogonadism**
36
**genetically male** but phenotypically female.
have lower part of vagina
NO uterus or ovaries
**have testes (in labia majora)**
**inc testo, estrogen, LH**
whats the cause
androgen receptor insensitivity
37
whats the cause?
**early defect is ambiguous genitalia**
at puberty he developed normal male genitalia.
**NORMAL T, Estrogen LH**
5a- reducatse def
cant convert testo --\> DHT
38
**malignant**
**painless,**
homogenous testicular enlargement.
most common testicular tumor.
describe the histo ?
whats diagnosis?
**large cells** in **lobules** with **watery cytoplasm** and **FRIED EGG** appearance
**Seminoma.**
39
whats the main difference bw **seminoma** and **embryonal carcinoma?**
**seminoma : NO hemorrhage** or **necrosis**
**painless**
**embryonal carcinoma: necrosis, hemorrhagic mass, painful**
**inc hCG!**
40
What malignant testicular tumor has hemorrhagic mass w/ necrosis and painful.
describe the histo
**embryonal carcinoma**
**glandular papillary morphology**
41
2 yo presents with a testicular mass
you biopsy and see sc**hiller Duval bodies,** resembling **primitive glomeruli**
labs you find **inc AFP**.
diagnosis ?
**yolk sac** (endodermal sinus) tumor
know the histo
42
43
pt with a testicular lump. you do labs and see an **inc hCG**
you biopsy and get the histo in the exhibit.
you patient is complaining of gynecomastia, symptoms of **hyperthroidism**.
the tumor is a disorder of?
disorder of **syncytiotrophoblast** (increases hCG) and **Cytotrophoblast.**
44
diagnosis?
most common nongerm cell tumor
Tumor is Golden brown in color
histo: **reinke crstals (eosinophilc cytoplasmic inclusion)**
this tumor produces **androgens** or **estrogens** --\> **gynecomastia** in men, **precocious puberty** in boys
**leydig tumor.**
you get increase testosterone secretion which undergoes peripheral conversion to estrogen --\> gynecomastia
45
what is the most common testicular tumor of older men?
**testicular lymphoma**
not a primary cancer, arises from metastatic lympoma --\> testes. **(diffuse large B cell lymphoma)**
pt didnt have pain, but had a ferver, night sweats, wt loss, 75 yo man. **extranodal** manifestations.
46
**schiller duval bodies** are most associated with what testicular tumor
**yolk sac tumor**
47
**inc AFP** are most associated with what testicular tumor
**yolk sac**
50% teratomas can have it
48
**inc hCG?** are most associated with what testicular tumor
**choriocarcinoma**
49
**fried egg appearance**
**watery cytoplasm**
are most associated with what testicular tumor
seminoma
50
**normal AFP**
**inc hCG**
**embryonal**
51
**syncytiotrophoblast** are most associated with what testicular tumor
**choriocarcinoma**
52
poor prognosis
painful tumor
**painful tumor**
53
**most common** up to **age 3 is** most associated with what testicular tumor
**YOLK SAC tumor\*\*\***
54
pt with BPH.
Describe what you would see on histo.
**\*hyperplasia** of prostate **stromal** and **glandular** epithelial cells
in the **lateral** and **medial lobes**
55
during oogenesis
when is the **primary oocyte** arrested?
meiosis 1 is arrrested in **prophase 1**
for years until **Ovulation**
56
at puberty the oocyte finished meiosis one forming and cell devision occurs forming a haploid oocyte which goes into meiosis II and arrested in what phase??
**metaphase II** until **fertilization**
57
name all the effects of estrogen
| (think growth)
growth of female reproductive organs
growth of breasts
stimulates endometrial proliferation
inhibits osteoclasts in bone
**inc** HDL, **dec** LDL
58
what are the functions of PROGESTRONE
**inhibits** proliferation but **promotes secretory changes in endometrium**
prepares breasts for milk production
**thickens cervical mucus**
**inhibits uterine contractions**
**relaxes smooth muscle.**
59
what produces thick cervical mucus that inhibits entry of sperm into uterus
progesterone
60
induces LH surge
Estrogen
61
what hormone relaxes uterine smooth muscle to prevent miss carriage
progesterone
62
what hormone stimulates endometrial proliferation
hince inc risk for endometrial cancer
estrogen
63
hCG has an Alpha subunit identical to
what other hormoens
**FSH**
**LH9**
**TSH (**presents with hyperthyroidiism)
hCG
64
what can Combined estrogen progestin cause besodes VTE, HTN, MI and stroke?
**HEPATIC ADENOMA\*\*\***
65
what vaginal tumor are found in women who had exposure to DES in utero. \*\*\*\*\*\*\*\
(diethylstilbestrol exposure)
**Clear cell adenocarcinoma**
66
what is **DES exposure** in uterto associate with?
**clear cell adenocarcinoma** of vagina
**mullerian duct anomalies** (T shaped uterus)
**vaginal adenosis** (patches of columnar on the ectocerix)
67
what vaginal tumor presents with c**lear, grape-li**ke (bunch of grapes), p**olypoid mass EMERGING** from vagina
affects girls \< **4 yo;**
what would you see on histo?
what marker is positive in this patient?
**embryonal Rhabdomyosarcoma**
see spindle shaped cells
**desmin +, myogenin**
show pic of 5 yo girl w/ this mass protruding from vagina.
68
risk factors for cervical dysplasia and cancer
High risk HPV (16,18)
smoking/immunosupression (bc smoking also dec immune)
multiple partners, early coitarche (early first intercourse)
OCP use
HX of other STD
69
how does HPV 16,18 cause cancer
**E6** binds to **P53 --\> degradation** (cant tell cell to undergo apoptosis when dna damage).
**E7** product binds and i**nactivates Rb (**no G1-S reg)
70
look at image for carcinoma in situ
71
what has had the msot impact on dec in incidence rate of cervical carcinoma?
A. HPV vac
B. cervical cytology
**Cervical cytology (pap smear)**
this is combank
72
what does this histo of a biopsy from cervix show?
CN3 cells (large nuclei, scant cytoplasm) next to his hand
top left is a normal squamous cell. (small nucleus large cytoplasm)
73
pt that doesnt undergo regular screening presents with abnormal vaginal bleeding usually **post coidal bleeding**
less likely presentation: vaginal discharge, pelvic or low back pain, bowel or bladder symptoms, ureteral obstruction (pyelonephritis, uremia, renal failure)
diagnosis
cervical cancer.
## Footnote
**this is the most common presentation**
74
what epithelium covers the
## Footnote
**ECTOcervix**
**ENDOcevix**
**Fallopian tube**
Ectocervix: **nonkeratinized stratified squamous**
Endocervix: **mucus secretign simple columnar**
fallopian tube; **ciliated simple columnar**
75
grape like vaginal tumor
**sarcoma botryoides**
76
cells biopsied from cervix with **perinuclear halo**
what is this describing
**koilocytes (HPV)**
77
3 yo with grape like mass in vagina opening . you diagnose sarcoma botryoides
you know its an embryonal rhabdomyosarcoma variant.
biopsy of a **rhabdomyoblast .**would show?\*\*
**cytoplasmic cross striations**
78
histo changes during mentrual cycle
proliferative phase: straight tubular galnds w/ dense stroma
secretory : galndes dilated and kinda corkscrewe shaped. stroma not as densa
menses : fragmentation of glands
79
why does anovluation lead to inc endometrial hyperplasia?
because you need ovulation to produce corpus luteum which produces progestrone that inhibits endometrial proliferation
80
most common benign tumor in women?
usually multiple round circumscribed tumors.
what will histo show?
can lead to ?
**leiomyoma uteri (fibroid)**
**histo: whorled pattern** of **smooth muscle bundles**
usually asymp but if severe bleeding can lead to **iron def anemia**
81
leuprolide can be given in a pulsatile fashion to tx?
inferility
82
menorrhagia + NON tender, enlarged uterus with irregular contours?
leiomyoma
83
menorrhagia + **tender, enlarged, globular uterus**
**adenomyoysis**
84
malignant tumor that arises *de novo* from the smooth muscle of the uterus
**leiomyosarcoma**
85
powder burn lesions?
endometriosis
86
inc **LH:** FSH (\>2:1)
**inc LH**
inc **Androgens**
**inc insulin** (insulin resistance)
**inc estrogen (estrone)** -
- prevents normla ovulatory cycles
**dec hormone bindng globulin (SHBG)**
bc androgens and insulin supresses the liver production of it. thus allowing for inc free hormones.
inc in estrone --. inc LH secretion , dec FSH secretion (- feedback)
PCOS
87
2/3 to make diagnosis of?
**1. oligo-ovulation or anovulation**
* menstrual irregularities
* infferitility
**2. hyperandrogenism**
* acne, Hirsutism, (dont see virulization)
**3. U.S.**
* enlarged with bunch of little follicles around peripheri (**string of pearls)**
also associated with **obesity, insulin resistance, inferility**
PCOS
88
PCOS pts are at an inc risk for?
**endometrial hyperplasia.**
**endometrial cancer**
89
how does **clomiphene** work
its a SERM
binds estrogen receptos in hypothalamus --\> **blocks neg feedback of endogenous estrogens** --\> inc release of **fsh** and **lh** --\> **follicle maturation** and **ovulation**
90
what are some causes of infertility?
**PCOS**
**endometriosis**
**ASHERMAN syndrome (post opt intrauterine adhesions)**
**PID\***
**uterine fibroids**
chromosomal abnormalities
**- turner syndrome**
91
midcycle pelvic pai associated with ovulation.
classically associated with **peritoneal irritation**( follicular swelling/rupture, fallopian tube contraction)
**mimics appendicitis**
**mittelschemerz**
| (**M**iddle hurts)
92
most common cause of infertility in women
PCOS
93
psammoma bodies in ovary
serous cystadenocarinoma
94
most common malignant ovarian neoplasm, usually bilateral
**serous** cystadenocarcinoma.
95
what tumor is associated with **tubular glands**
**endometrioid tumor**
bc it looks like endometrium which has tubular glands
96
benign tumor of ovary that has
bladder/urinary tract-like epithelium
**brenner tumor**
97
what teratoma contaisn functional thyroid tissue that can cause **hyperthyroidism.**
pt with ovarian mass and hyperthyroidism.b
**struma ovarii**
98
malignant ovary
most common adolescents.
.**hCG, LDH are increased**
sheets of uniform Fried egg cells like seminoma
**dysgerminoma**
99
this tumor can metastasize to lungs
## Footnote
**inc hCG**
choriocarcinomas
100
sex cord stromal tumors:
bilat or uni
what age
unilateral
all ages
produce hormones
good prognosis
101
what sex cord tumor produces
estrogen --\> post menopausal bleeding, abnormal vag bleeding, endometrial hyperplasia, cancer
in child: prcocious puberty
**granulosa cell tumor**
102
what ovarian tumor appear
**yellow grossly** due to .**choelsterol**
histo: **Call-Exner bodies :**
(granulosa cells arranged haphazardly around collections of **eosinophilic fluid**, resembling primordial follicles)
**granulosa cell tumor**
103
tumor chart
104
contains fallopian tube like epithelium
serous tumor of ovary
105
historically associated w/ pseudomyxomma peritonei
mucinous tumor
106
tumor marker AFP
yolk sac tumor
107
hCG
choriocarcinoma
dysgerminoma
108
LDH tumor marker
dysgerminoma
109
**ovarian tumor + ascite + hydrothorax**
**meigs syndrome**
110
teratoma + hyperthyroidism
struma ovarii
111
Estriol **dec**
alpha-fetoprotein: **DEC**
hCG: **inc**
inhibin A: **inc**
this quad screening during second trimester corralates wth what trisomy
**trisomy 21**
112
estriol: **dec**
hCG: **dec**
Alpha feto protein: **dec**
Inhibin A: normal or slight dec
this quad screen is indicative of?
trisomy **18**
113
amniocentesis is used for?
chorionic villus sampling is used for? and done when
**amniocentesis:** genetic, NTD
**chorionnic villus sampling** : genetic, 10-13 weeks.
114
physiologic changes in pregnancy (inc or dec)
**basal meetabolic rate\_\_\_\_**
**plasma volume inc\_\_\_\_**
**RBC volume \_\_\_**
**CO\_\_**
**HR\_\_**
BP,: initial dec, then 24-26 wks = nadir, return to pre preg at term
GFR\_\_
coagulable state?
BSM: **inc**
PV: inc, RBC **inc** thus (greater inc in PV than RBC --\> physiological anemia)
CO: **inc**
HR: **inc**
GFR **inc**
**hypercoaguable.**
115
failure of what embryonic structure results in
**drainage of urine** from the **umbilicus**
**urachus**
116
failure of what embryonic structure results in
drainage of .**meconium** from the **umbilicus**
**vitelline (ommphalomesenteric**) duct
117
a snow storm appearance on US
**hydadtiform mole**
118
119
diagnosis?
**placenta overlies internal cervical os**
whats the biggest risk factor?
placenta **previa**
**HX** of **C-section!**
others inc maternal age, multiparity
120
presents as **PAINLESS vaginal bleeding**
usually in second half of pregnancy (3rd trimester)
how would you diagnosis
**Placenta PREVIA**
get .**US** (before! digital exam)
121
placenta attaches to **MYOmetrium** without
penetrating it.
(most common)
placcenta **ACCRETA**
122
placenta **invades/**penetrates **into** myometrium
placenta **increta**
123
placenta penetrations (perforates) through myometrium into **UTERUS** serosa (invades entire uterinewall)
placenta **percreta**
124
placenta accreta/increta/percreta
are associated w/ __________ and \_\_\_\_\_
whats the risk with these?
DIagnosis US
TX?
associated with **placenta previa** and **prior C sections**
tx: **C section** followed by **hysterectomy**\*
125
women in 3rd trimester presents with
**PAINFUL BLEEDING.**
what is the cause.
the mom can possibly develop?
**placenta ABRUPTION**
Premature separation (partial or comple) of placenta from uterine wall before delivery
**DIC,**maternal shock fetal distress.
126
in placental abruption. what would you expect to see on US.
COMBANK
us shows **hyperechoic hemorrhage**
## Footnote
**incomparison to the placenta**
127
sudden onset of painful bleeding in 3rd trimester.
what is the big risk factor to know for this?
**cocaine use!**
**(**placental abruption)
tx: emergency C section
128
you suspect your sugar momma has preeclampsia
how could you tell this apart from molar pregnancy
**pre-eclampsia: new onset HTN AFTER 20 wks**
molar pregnancy: **before 20 weeks.**
129
what does HELLP syndrome stand for
**H**emolysis
**E**levated **L**iver enzymes
**L**ow **P**latelets
130
what are tocolytics used for?
**Terbutaline B2** and B1 agonist
**Ritodrine**: B2 agonist
**selective B2 agonist. used to cause uterine relaxation**
thus causing **dec inc contraction frequency.** in women during labor
used to administer steriods
131
what drug is this?
cauuse **cervical dilation** and **uterine contractions**
early pregnancy --\> termination
late pregnancy --\> **labor induction**
**prostaglandins**
**Dinoprostone**: prostaglandin E2 analog
**misoprostol**: prostaglandin E1 analog.
132
what syndrome is caused by
maternal **nondisjunction** of **homologous chromsomes** during **anaphase** of **meiosis** **1**
**downs syndrome**
high yield
133
baby with
**microcephaly**
**mod/severe intellectual disability**
**HIGH PITCHED crying** and **mewing**
epicanthal fold
cardiac abnormalities (**VSD)**
high yield
**cri du chat syndrome**
**(chromosome 5p deletion)\***
chromomsome **5** (46, xx or xy, 5p-)
134
**hypercalcemia** (inc sensitivity to Vit D)
**elfin facies**
**well developed verbal skills**
**extreme friendliness** with **strangers**
**cardiovascular problems**
whats the cause and diagnosis
**microdeletion** of **long arm** of **chromosome 7**
**(deleted** region includes **elastin gene)**
136
what might a prenatal US show in a pt with Downs syndrome
**nuchael translucency**
137
associated with floppy mitral valve, dissecting aortic aneurysm
marfans
138
what disease is associated with
## Footnote
**mitral valve prolapse**
**liver disease**
**berry aneurysms**
**ADPCK**
**(autosomal dom polycystic kidney disease)**
139
what disease has neural tumors and **pigmented iris hamartomas\*\*\*\***
**NF type 1**
140
what disease would you see a MI before age 20
**familial hypercholesterolemia**
141
what disease?
**hemangioblastomas** of **retina/cerebellum/ medulla**
**highly vascular foamy cels** with hyperchromatic nuclei
.**von hippel lindau**
142
what disease?
## Footnote
**facial lesions**
**seizure disorder**
**cancer risk**
**tuberous sclerosis**
143
caudate atrophy, dementia
huntington disease
144
\*\*\*question
**cystic medial necrosis of the aorta**
can cause dissection
marfans
145
defect of fibroblast growth factor (FGF) 3
Achondrolplasia
dont forget its parental inherited
146
most common breast tumor in
women **under 25**
**fibroadenoma**
147
most common breast mass in
**postmenopausal women**
**invasive DUCTAL carcinoma**
148
most common breast mass
in **premenopausal women**
non proliferative
## Footnote
**fibrocystic change**
149
most common form of breast cancer
**invasive ductal carcinoma**
150
small, mobile, firm mas w/ sharp edge in **24** yo women
**fibroadenoma**
151
hstiological **leaf like projections**
**Phyllodes tumor**
152
**signet ring cells** in breast
**LCIS,**
sometimes in invasive lobular carcinoma (lobular cells in lines)
153
loss of **e-cadherin** **cell adhesion gene**
on **chromo 16**
**invasive lobular carcinoma**
154
always **ER+** and **PR+**
**LCIS, Invasive lobular carcinoma**
155
commonly presents with nipple discharge
**intraductal papilloma**
156
**Eczematous patchese .**on **nipple**
paget disease
157
**multiple bilateral fluid filled lesions with**
**diffuse breast pain** especially **right before menses**
**fibrocystic change**
158
firm fibrous mass in a 55 yo women in breast
invasive ductal carcinoma
159
**blue dome cyst** in the breast
**fibrocystic change.**
160
tx for **ER+** breast cancer
**tamoxifen.**
161
want cancers can you see psammoma bodies?
**papillary serous carcinoma (**endometrial carcinoma (sporadic form) , or ovary) **papillary carcinoma of thyroid**
## Footnote
**meningioma**
**\*mesothelioma**
