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First Aid > REPRO > Flashcards

REPRO Flashcards

1
Q

The Right testes and ovary drain into the Right Gonadal vein which goes to?

A

directly to ICV

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2
Q

the Left testes / ovary drain to Left gonadal vein then to?

A

LEFT RENAL VEIN

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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

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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

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5
Q

where do the ovaries and testes

lymphatics drain to

A

para-aortic nodes​

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6
Q

what lymphatics do the

body of uterues, cervix, superior bladder )

drain to

A

external iliacs

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7
Q

the prostate/ cervix / corpus cavernosum / proximal upper 2/3 vagina

lymphatic drain to

A

internal iliaic nodes

(hypogastric nodes)

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8
Q

distal vagina

vulva

scrotum*

distal anus

lymphatics t​drain into

A

Superficial inguinal nodes

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9
Q

where does the glans of the penis lymphatics drain to

A

deep inguinal nodes

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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

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11
Q

what hernia occurs lateral tot epigastric vessels and goes into the inguinal ring into scrotum

A

indirect

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12
Q

what herniation goes through the inguinal (hesselbach traingle).

medial to inferior epigastric vessels

A

direct

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13
Q

what hernia is due to acquired weakness in transversalis fascia?

who gets this hernia

A

direct

common in older males

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14
Q

what makes up the hesselbachs triangle

A

inferior epigastric vessels (lateral)

inguinal ligment

lateral border of rectur abdominus (medial)

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15
Q

which hernia is more common in women?

A

femoral

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16
Q

what hernia

protrudes BELOW inguinal ligament

through the femoral canal below and lateral to pubic tubercle

A

femoral hernia

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17
Q

which hernia is more likely to present with

incarceration (irreducible hernia)

or strangulation ( contents of hernia undergo necrosis)

A

femoral hernia

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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)

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19
Q

what forms the lower vagina

A

urogenital sinus –> sinovaginal bulbs –> lower vag.

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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

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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

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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

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23
Q

what do sertoli cells secrete

A

inhibiin B that inhibits FSH

androgen-binding protein –> maintain local levels of testosterone.

MIF

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24
Q

sertoli cells form tight junctions that forms blood testis barrier that functions to

A

isolate gametes from autoimmune attack

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25
Q

varicocele and cryptorchidism

both can cause increase in temp to teste what does this do

A

dec sperm production

dec inhibin B

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26
Q

what do leydig cells do?

A

secrete testosterone in presence of LH

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27
Q

FSH –> serotoli cells –> ?

LH –> leydig cells –> /

A

sperm production

\testosterone

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28
Q

dihydrostestosterone is responsible for development of?

it can treat

A

penis, scrotum protstate

its responsible for prostate growth

sebaceous gland activity

it can cause male pattern hair loss?

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29
Q

an OBESE pt can become testosterone deficient how?

A

bc of aromatase

testosterone –> estrogen

aromatase can be found in high concentrations in adipose tissue.

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30
Q

disorders of sex hormone

inc T

inc LH

A

defective androgen receptor

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31
Q

inc testosterone

dec LH

what the cause

A

testosteroe - secreting tumor,

exogenous steroids

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32
Q

primary hypogonadism

you will see what on labs

A

DEC TESTOSTERONE

INC LH

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33
Q

diagnosing diosrders of sex hormones

dec testosterone

DEC LH

What syndrome is associated with this?

A

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!)

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34
Q

female w/ primary amenorrhea or delayed puberty that cant smell.

A

kallmann syndrome

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35
Q

=25 yo that has tried to have kids with his wife. on further questioning cant smell.

what is the diagnosis

A

hypopgonadotropic hypogonadism

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36
Q

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

A

androgen receptor insensitivity

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37
Q

whats the cause?

early defect is ambiguous genitalia

at puberty he developed normal male genitalia.

NORMAL T, Estrogen LH

A

5a- reducatse def

cant convert testo –> DHT

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38
Q

malignant

painless,

homogenous testicular enlargement.

most common testicular tumor.

describe the histo ?

whats diagnosis?

A

large cells in lobules with watery cytoplasm and FRIED EGG appearance

Seminoma.

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39
Q

whats the main difference bw seminoma and embryonal carcinoma?

A

seminoma : NO hemorrhage or necrosis

painless

embryonal carcinoma: necrosis, hemorrhagic mass, painful

inc hCG!

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40
Q

What malignant testicular tumor has hemorrhagic mass w/ necrosis and painful.

describe the histo

A

embryonal carcinoma

glandular papillary morphology

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41
Q

2 yo presents with a testicular mass

you biopsy and see schiller Duval bodies, resembling primitive glomeruli

labs you find inc AFP.

diagnosis ?

A

yolk sac (endodermal sinus) tumor

know the histo

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42
Q
A
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43
Q

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?

A

disorder of syncytiotrophoblast (increases hCG) and Cytotrophoblast.

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44
Q

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

A

leydig tumor.

you get increase testosterone secretion which undergoes peripheral conversion to estrogen –> gynecomastia

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45
Q

what is the most common testicular tumor of older men?

A

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.

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46
Q

schiller duval bodies are most associated with what testicular tumor

A

yolk sac tumor

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47
Q

inc AFP are most associated with what testicular tumor

A

yolk sac

50% teratomas can have it

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48
Q

inc hCG? are most associated with what testicular tumor

A

choriocarcinoma

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49
Q

fried egg appearance

watery cytoplasm

are most associated with what testicular tumor

A

seminoma

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50
Q

normal AFP

inc hCG

A

embryonal

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51
Q

syncytiotrophoblast are most associated with what testicular tumor

A

choriocarcinoma

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52
Q

poor prognosis

painful tumor

A

painful tumor

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53
Q

most common up to age 3 is most associated with what testicular tumor

A

YOLK SAC tumor***

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54
Q

pt with BPH.

Describe what you would see on histo.

A

*hyperplasia of prostate stromal and glandular epithelial cells

in the lateral and medial lobes

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55
Q

during oogenesis

when is the primary oocyte arrested?

A

meiosis 1 is arrrested in prophase 1

for years until Ovulation

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56
Q

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??

A

metaphase II until fertilization

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57
Q

name all the effects of estrogen

(think growth)

A

growth of female reproductive organs

growth of breasts

stimulates endometrial proliferation

inhibits osteoclasts in bone

inc HDL, dec LDL

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58
Q

what are the functions of PROGESTRONE

A

inhibits proliferation but promotes secretory changes in endometrium

prepares breasts for milk production

thickens cervical mucus

inhibits uterine contractions

relaxes smooth muscle.

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59
Q

what produces thick cervical mucus that inhibits entry of sperm into uterus

A

progesterone

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60
Q

induces LH surge

A

Estrogen

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61
Q

what hormone relaxes uterine smooth muscle to prevent miss carriage

A

progesterone

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62
Q

what hormone stimulates endometrial proliferation

hince inc risk for endometrial cancer

A

estrogen

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63
Q

hCG has an Alpha subunit identical to

what other hormoens

A

FSH

LH9

TSH (presents with hyperthyroidiism)

hCG

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64
Q

what can Combined estrogen progestin cause besodes VTE, HTN, MI and stroke?

A

HEPATIC ADENOMA***

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65
Q

what vaginal tumor are found in women who had exposure to DES in utero. *******\

(diethylstilbestrol exposure)

A

Clear cell adenocarcinoma

66
Q

what is DES exposure in uterto associate with?

A

clear cell adenocarcinoma of vagina

mullerian duct anomalies (T shaped uterus)

vaginal adenosis (patches of columnar on the ectocerix)

67
Q

what vaginal tumor presents with clear, grape-like (bunch of grapes), polypoid mass EMERGING from vagina

affects girls < 4 yo;

what would you see on histo?

what marker is positive in this patient?

A

embryonal Rhabdomyosarcoma

see spindle shaped cells

desmin +, myogenin

show pic of 5 yo girl w/ this mass protruding from vagina.

68
Q

risk factors for cervical dysplasia and cancer

A

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
Q

how does HPV 16,18 cause cancer

A

E6 binds to P53 –> degradation (cant tell cell to undergo apoptosis when dna damage).

E7 product binds and inactivates Rb (no G1-S reg)

70
Q

look at image for carcinoma in situ

71
Q

what has had the msot impact on dec in incidence rate of cervical carcinoma?

A. HPV vac

B. cervical cytology

A

Cervical cytology (pap smear)

this is combank

72
Q

what does this histo of a biopsy from cervix show?

A

CN3 cells (large nuclei, scant cytoplasm) next to his hand

top left is a normal squamous cell. (small nucleus large cytoplasm)

73
Q

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

A

cervical cancer.

this is the most common presentation

74
Q

what epithelium covers the

ECTOcervix

ENDOcevix

Fallopian tube

A

Ectocervix: nonkeratinized stratified squamous

Endocervix: mucus secretign simple columnar

fallopian tube; ciliated simple columnar

75
Q

grape like vaginal tumor

A

sarcoma botryoides

76
Q

cells biopsied from cervix with perinuclear halo

what is this describing

A

koilocytes (HPV)

77
Q

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?**

A

cytoplasmic cross striations

78
Q

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
Q

why does anovluation lead to inc endometrial hyperplasia?

A

because you need ovulation to produce corpus luteum which produces progestrone that inhibits endometrial proliferation

80
Q

most common benign tumor in women?

usually multiple round circumscribed tumors.

what will histo show?

can lead to ?

A

leiomyoma uteri (fibroid)

histo: whorled pattern of smooth muscle bundles

usually asymp but if severe bleeding can lead to iron def anemia

81
Q

leuprolide can be given in a pulsatile fashion to tx?

A

inferility

82
Q

menorrhagia + NON tender, enlarged uterus with irregular contours?

83
Q

menorrhagia + tender, enlarged, globular uterus

A

adenomyoysis

84
Q

malignant tumor that arises de novo from the smooth muscle of the uterus

A

leiomyosarcoma

85
Q

powder burn lesions?

A

endometriosis

86
Q

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)

87
Q

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

88
Q

PCOS pts are at an inc risk for?

A

endometrial hyperplasia.

endometrial cancer

89
Q

how does clomiphene work

its a SERM

A

binds estrogen receptos in hypothalamus –> blocks neg feedback of endogenous estrogens –> inc release of fsh and lh –> follicle maturation and ovulation

90
Q

what are some causes of infertility?

A

PCOS

endometriosis

ASHERMAN syndrome (post opt intrauterine adhesions)

PID*

uterine fibroids

chromosomal abnormalities

- turner syndrome

91
Q

midcycle pelvic pai associated with ovulation.

classically associated with peritoneal irritation( follicular swelling/rupture, fallopian tube contraction)

mimics appendicitis

A

mittelschemerz

(Middle hurts)

92
Q

most common cause of infertility in women

93
Q

psammoma bodies in ovary

A

serous cystadenocarinoma

94
Q

most common malignant ovarian neoplasm, usually bilateral

A

serous cystadenocarcinoma.

95
Q

what tumor is associated with tubular glands

A

endometrioid tumor

bc it looks like endometrium which has tubular glands

96
Q

benign tumor of ovary that has

bladder/urinary tract-like epithelium

A

brenner tumor

97
Q

what teratoma contaisn functional thyroid tissue that can cause hyperthyroidism.

pt with ovarian mass and hyperthyroidism.b

A

struma ovarii

98
Q

malignant ovary

most common adolescents.

.hCG, LDH are increased

sheets of uniform Fried egg cells like seminoma

A

dysgerminoma

99
Q

this tumor can metastasize to lungs

inc hCG

A

choriocarcinomas

100
Q

sex cord stromal tumors:

bilat or uni

what age

A

unilateral

all ages

produce hormones

good prognosis

101
Q

what sex cord tumor produces

estrogen –> post menopausal bleeding, abnormal vag bleeding, endometrial hyperplasia, cancer

in child: prcocious puberty

A

granulosa cell tumor

102
Q

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)

A

granulosa cell tumor

103
Q

tumor chart

104
Q

contains fallopian tube like epithelium

A

serous tumor of ovary

105
Q

historically associated w/ pseudomyxomma peritonei

A

mucinous tumor

106
Q

tumor marker AFP

A

yolk sac tumor

107
Q

hCG

A

choriocarcinoma

dysgerminoma

108
Q

LDH tumor marker

A

dysgerminoma

109
Q

ovarian tumor + ascite + hydrothorax

A

meigs syndrome

110
Q

teratoma + hyperthyroidism

A

struma ovarii

111
Q

Estriol dec

alpha-fetoprotein: DEC

hCG: inc

inhibin A: inc

this quad screening during second trimester corralates wth what trisomy

A

trisomy 21

112
Q

estriol: dec

hCG: dec

Alpha feto protein: dec

Inhibin A: normal or slight dec

this quad screen is indicative of?

A

trisomy 18

113
Q

amniocentesis is used for?

chorionic villus sampling is used for? and done when

A

amniocentesis: genetic, NTD

chorionnic villus sampling : genetic, 10-13 weeks.

114
Q

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?

A

BSM: inc

PV: inc, RBC inc thus (greater inc in PV than RBC –> physiological anemia)

CO: inc

HR: inc

GFR inc

hypercoaguable.

115
Q

failure of what embryonic structure results in

drainage of urine from the umbilicus

116
Q

failure of what embryonic structure results in

drainage of .meconium from the umbilicus

A

vitelline (ommphalomesenteric) duct

117
Q

a snow storm appearance on US

A

hydadtiform mole

119
Q

diagnosis?

placenta overlies internal cervical os

whats the biggest risk factor?

A

placenta previa

HX of C-section!

others inc maternal age, multiparity

120
Q

presents as PAINLESS vaginal bleeding

usually in second half of pregnancy (3rd trimester)

how would you diagnosis

A

Placenta PREVIA

get .US (before! digital exam)

121
Q

placenta attaches to MYOmetrium without

penetrating it.

(most common)

A

placcenta ACCRETA

122
Q

placenta invades/penetrates into myometrium

A

placenta increta

123
Q

placenta penetrations (perforates) through myometrium into UTERUS serosa (invades entire uterinewall)

A

placenta percreta

124
Q

placenta accreta/increta/percreta

are associated w/ __________ and _____

whats the risk with these?

DIagnosis US

TX?

A

associated with placenta previa and prior C sections

tx: C section followed by hysterectomy*

125
Q

women in 3rd trimester presents with

PAINFUL BLEEDING.

what is the cause.

the mom can possibly develop?

A

placenta ABRUPTION

Premature separation (partial or comple) of placenta from uterine wall before delivery

DIC,maternal shock fetal distress.

126
Q

in placental abruption. what would you expect to see on US.

COMBANK

A

us shows hyperechoic hemorrhage

incomparison to the placenta

127
Q

sudden onset of painful bleeding in 3rd trimester.

what is the big risk factor to know for this?

A

cocaine use!

(placental abruption)

tx: emergency C section

128
Q

you suspect your sugar momma has preeclampsia

how could you tell this apart from molar pregnancy

A

pre-eclampsia: new onset HTN AFTER 20 wks

molar pregnancy: before 20 weeks.

129
Q

what does HELLP syndrome stand for

A

Hemolysis

Elevated Liver enzymes

Low Platelets

130
Q

what are tocolytics used for?

Terbutaline B2 and B1 agonist

Ritodrine: B2 agonist

A

selective B2 agonist. used to cause uterine relaxation

thus causing dec inc contraction frequency. in women during labor

used to administer steriods

131
Q

what drug is this?

cauuse cervical dilation and uterine contractions

early pregnancy –> termination

late pregnancy –> labor induction

A

prostaglandins

Dinoprostone: prostaglandin E2 analog

misoprostol: prostaglandin E1 analog.

132
Q

what syndrome is caused by

maternal nondisjunction of homologous chromsomes during anaphase of meiosis 1

A

downs syndrome

high yield

133
Q

baby with

microcephaly

mod/severe intellectual disability

HIGH PITCHED crying and mewing

epicanthal fold

cardiac abnormalities (VSD)

A

high yield

cri du chat syndrome

(chromosome 5p deletion)*

chromomsome 5 (46, xx or xy, 5p-)

134
Q

hypercalcemia (inc sensitivity to Vit D)

elfin facies

well developed verbal skills

extreme friendliness with strangers

cardiovascular problems

whats the cause and diagnosis

A

microdeletion of long arm of chromosome 7

(deleted region includes elastin gene)

136
Q

what might a prenatal US show in a pt with Downs syndrome

A

nuchael translucency

137
Q

associated with floppy mitral valve, dissecting aortic aneurysm

138
Q

what disease is associated with

mitral valve prolapse

liver disease

berry aneurysms

A

ADPCK

(autosomal dom polycystic kidney disease)

139
Q

what disease has neural tumors and pigmented iris hamartomas****

140
Q

what disease would you see a MI before age 20

A

familial hypercholesterolemia

141
Q

what disease?

hemangioblastomas of retina/cerebellum/ medulla

highly vascular foamy cels with hyperchromatic nuclei

A

.von hippel lindau

142
Q

what disease?

facial lesions

seizure disorder

cancer risk

A

tuberous sclerosis

143
Q

caudate atrophy, dementia

A

huntington disease

144
Q

***question

cystic medial necrosis of the aorta

can cause dissection

145
Q

defect of fibroblast growth factor (FGF) 3

A

Achondrolplasia

dont forget its parental inherited

146
Q

most common breast tumor in

women under 25

A

fibroadenoma

147
Q

most common breast mass in

postmenopausal women

A

invasive DUCTAL carcinoma

148
Q

most common breast mass

in premenopausal women

A

non proliferative

fibrocystic change

149
Q

most common form of breast cancer

A

invasive ductal carcinoma

150
Q

small, mobile, firm mas w/ sharp edge in 24 yo women

A

fibroadenoma

151
Q

hstiological leaf like projections

A

Phyllodes tumor

152
Q

signet ring cells in breast

A

LCIS,

sometimes in invasive lobular carcinoma (lobular cells in lines)

153
Q

loss of e-cadherin cell adhesion gene

on chromo 16

A

invasive lobular carcinoma

154
Q

always ER+ and PR+

A

LCIS, Invasive lobular carcinoma

155
Q

commonly presents with nipple discharge

A

intraductal papilloma

156
Q

Eczematous patchese .on nipple

A

paget disease

157
Q

multiple bilateral fluid filled lesions with

diffuse breast pain especially right before menses

A

fibrocystic change

158
Q

firm fibrous mass in a 55 yo women in breast

A

invasive ductal carcinoma

159
Q

blue dome cyst in the breast

A

fibrocystic change.

160
Q

tx for ER+ breast cancer

A

tamoxifen.

161
Q

want cancers can you see psammoma bodies?

A

papillary serous carcinoma (endometrial carcinoma (sporadic form) , or ovary) papillary carcinoma of thyroid

meningioma

*mesothelioma

First Aid (15 decks)

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