Reproduction Flashcards by geet baghel

Cancers of pelvis, including prostate, spread to lumbar spine via the

Vertebral venous plexus (including prostatic venous plexus in men)

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breast and lung cancers metastasize to spine via

Vertebral venous plexus (communicates with azygos vein)

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Venous drainage from testis, epididymis and ductus deferences. Drains into testicular veins

Pampiniform plexus

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Classic triad of congenital rubella

Cataracts, sensory-neural deafness and PDA

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How do progestin-only (norethindrone) and levonorgestrel IUD work as contraceptives

Thicken cervical mucus to impair sperm motility

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How do combined hormonal contraceptives and progestin implant/injection function as contraceptives

Suppress GnRH and gonadotropin secretion to inhibit ovulation

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How does Copper IUD function

Cytotoxic inflammatory response in uterus to impair sperm migration

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Which hormone causes increased insulin resistance in pregnancy during second and third trimester

Human placental lactogen (Secreted by synctiotrophoblast)

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Bulk-related symptoms like pressure and constipation that are relieved by “splinting” to defecate (manual deflection of obstruction) likely indicate

Posterior subserosal uterline leiyomyoma (fibroid)

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How does progesterone withdrawal cause menses

Loss of progesterone leads to increased prostaglandin, which vasoconstricts spiral arteries. Increased metalloproteases by endometrial stromal cells degrade ECM and endometrial epithelium undergoes apoptosis, thus leading to menstruation

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Which arteries can be ligated during postpartum hemorrhage to stop bleeding and maintain fertility?

Internal iliac arteries (Uterine is branch of them); blood flow maintained by ovarian anastamoses

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Which blood pressure medications are teratogens that can lead to renal agenesis/malformation (oligohydramnios) and hypoplasia of skull?

ACE inhibitors or ARBs (Angiotensin II is needed for renal function in babies)

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Peyronie disease

Fibrotic plaque of tunica albuginea causes abnormal curvature of penis and erectile dysfunction

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Bowen disease

In situ carcinoma of penile shaft that presents as leukoplakia

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Erythroplasia of Queyrat

In situ carcinoma of glans that presents as erythroplakia

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Bowenoid papulosis

In situ squamous cell carcinoma of penis that presents as reddish papules

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HPV causes which cancer in males

Penile squamous cell carcinoma

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Cause of hypospadias (opening of urethra on inferior fold)

Failure of urethral folds to close

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Cause of epispadias (opening of urethra on superior surface of penis)

Abnormal positioning of genital tubercle. Associated with bladder exstrophy

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Which HPV strains cause condyloma acuminatum

6 and 11

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Necrotizing granulomatous inflammation of inguinal lymphatics and lymph nodes caused by

Chlamydia trachomatis

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Fibrotic healing of lymphogranuloma venerum can involve perianal area with

rectal strictures

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Cryptorchidism increases risk of which condition

Germ cell tumors (seminomas)

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Common cause of orchitis in older adults

E. Coli or Pseudomonas

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Non-necrotizing granulomas involving seminiferous tubules suggest

Autoimmune orchitis

Can occur due to failure of testes to attach to inner lining of scrotum via processus vaginalis

Testicular torsion

An adolescent male presenting with sudden, unilateral testicular pain, absent cremasteric reflex, nausea/vomiting and fever likely has

Testicular torsion

Left scrotum with "bag of worms" appearance is associated with increased risk of

Left-sided renal cell carcinoma

Scrotum that is "bag of worms" in appearance occurs due to

Dilation of spermatic vein due to impaired drainage (varicocele)

Common cause of hydroceles

Incomplete closure of processus vaginalis

Scrotal swelling that can be transilluminated is likely

Hydrocele

Cyst due to dilated epididymal duct or rete testes is a

Spermatocele

Lymph drainage of testes and epididymis

Para-aortic and lumbar lymph nodes

Small nodule on testes with elevated beta-hCG, symptoms of hyperthyroidism (weight loss, heat intolerance, lack of sleep) and gynecomastia are suggestive of what in a male?

Choriocarcinoma

Choriocarcinoma is a malignant tumor of which origin

Synctiotrophoblasts and cytotrophoblasts

Teratomas in males vs females

Malignant in males if found in 20s-40s; benign in females

Most common testicular tumor in male infants, characteristically elevated AFP

Yolk sac tumor

Testicular tumor with poorest prognosis ; chemo can cause differentiation into different type of tumor

Embryonic carcinoma

Characterized by immature, primitive cells organized in irregular patterns that may produce glands and sites of necrosis and hemorrhage

Embryonic carcinoma

Rapidly metastasize, variable response to cancer therapy

Non-seminoma germ cell tumors

Slow to metastasize, excellent response to therapy

Seminoma

Tumor of maternal fetal tissue composed of elements from 2-3 germ layers

Teratoma

Increased placental ALP

Seminoma

Hemategnous mets to lungs and brain in male

Choriocarcinoma

Presents as painful hemorrhagic testicular mass; usually mixed with other tumor types (increased AFP when mixed)

Embryonic carcinoma

Which male organ is located below bladder and anterior to rectum?

Prostate

Which two lobes tend to undergo hyperplasia in BPH?

Lateral and middle lobes

Increased risk of bladder diverticuli, hydronephrosis and UTIs associated with which condition?

BPH

Side effects of 5-alpha-reductase inhibitors

Sexual dysfunction (decreased libido), gynecomastia

Treatment for BPH

alpha-1-receptor antagonists (Terazosin) to relax smooth muscle; 5-alpha-reductase inhibitors (finasteride) to decrease DHT production

treatment for prostate cancer

Leuprolide (continuous GnRH to shut down FSH and LH) | Flutamide (competitive androgen receptor antagonist)

Injury to which nerve can cause erectile dysfunction after prostatectomy

Prostatic plexus

This nerve innervates the external urethral and anal sphincters and provides sensory innervation of external gnitalia

Pudendal

Injury to this nerve can cause fecal incontinence, decreased penile sensation or external urethral sphincter paralysis

Pudendal

Which nerve mediates the cremasteric reflex

Genitofemoral (L1-L2)

Gonadal arteries and veins are branches of

abdominal aorta, slightly below renal arteries

This artery travels in front of IVC and behind ileum

Right gonadal artery

This artery travels behind left colic and sigmoid arteries and iliac colon

Left gonadal artery

Arises off common iliac artery and becomes femoral artery

External iliac artery

Arises off common iliac artery and supplies pelvic wall/viscera, buttock, female repro organs, bladder and medial thigh

Internal iliac artery

Branch of internal iliac that provides blood to anal canal, scrotum and penis

Pudendal

Small/firm testes, azoospermia, tall stature and gynecomastia suggest

Klinefelter syndrome (XXY)

Levels of testosterone, LH and FSH and estradiol in Klinefelter

Decreased testosterone, increased LH and FSH,, increased estradiol

Lymph drainage of glans penis and superficial nodes

Deep inguinal nodes

Triad of Kartagener syndrome (primary ciliary dyskinesia)

Situs inversus, chronic sinusitis, bronchiectasis (persistent bronchial dilation)

Most common causative pathogen for acute mastitis

S. Aureus (Tx: Dicloxacillin)

Erythematous nipple with purulent discharge in a breast-feeding woman suggets

Acute mastitis

Subareolar mass with nipple retraction in a female smoker suggests

Periductal mastitis

What causes periductal mastitis

Vitamin A deficiency results in squamous metaplasia of lactiferous ducts, producing some degree of keratin that plug/block ducts leading to inflammation

Periareolar mass (inverted nipple) with green-brown nipple discharge in multi-parous post-menopausal woman

Mammary duct ectasia

Biopsy of Mammary duct ectasia would show

Inflammation with plasma cells

50% of cases are the result of trauma. Biopsy reveals giant cells and calcifications

Fat necrosis of breast

Risk of invasive cancer with fibrosis, cysts and apocrine metaplasia

No risk

Risk of invasive breast cancer with ductal hyperplasia and sclerosing adenosis

2x increased risk

Risk of invasive breast cancer with atypical hyperplasia (dark nuclei that fill acini space)

5x increased risk

Inner layer of lobules and ducts

Luminal cell layer (produces milk)

Outer layer of ducts and lobules

Myoepithelial cell layer (pushes milk forward)

What causes nipple retraction in periductal mastitis?

Myofibroblasts contract during healing process (fibrosis) of breast tissue, pulling in nipple tissue

Two characteristics of mammary duct ectasia

green-brown nipple discharge and plasma cells on biopsy

Unilateral bloody nipple discharge in a premenopausal woman. Biopsy reveals papillae with two cell layers.

Intradutal papilloma

Papillary carcinoma vs adenoma

Papillary carcinoma is more common in older women (post-menopausal). Both have bloody nipple discharge due to fibrovascular papillae, but the papillae in carcinoma do not have myoepithelial layer

Well-circumscribed, mobile marble-like mass in pre-menopausal woman likely suggests

Fibroadenoma (most common benign tumor in pre-meni females. no risk of carcinoma. Estrogen sensitive)

Difference between fibroadenoma and Phylloides tumor

Both are tumor of fibrous tissue and glands but Phyllodes has OVERGROWTH of fibrous component and is found in post-menopausal women

"Leaf-like" projections seen on biopsy suggest

Phyllodes tumor (can be malignant in some cases), seen in post-menopausal women; suggestive of genetic inheritance of breast cancer

6 risk factors for breast cancer

female gender, age, early menarche/late menopause, obesity, atypical hyperplasia, first-degree relative (sister, mother, daughter)

Which part of breast do most malignant tumors arise from?

Duct lobular unit

Which test distinguishes benign from malignant breast pathologies

Biopsy

High grade cells with necrosis and dystrophic calcification inc enter of ducts is what type of DCIS

Comedo type

Define Paget disease of breast

DCIS that moves up to skin of nipple. Presents with nipple ulceration and erythema

Detection of Paget disease of breast is important because

It is almost always associated with ductal carcinoma of breast (malignant breast cancer)

Appearance of Paget disease on biopsy

Scattered "fried egg" appearance cells

Most common type of malignant breast cancer

Invasive ductal carcinoma

How does DCIS present on mammography

calcifications in breast (no mass)

How does Invasive ductal carcinoma present on mammography

Mass greater than 1cm)

Appearance of invasive ductal carcinoma on biopsy

Duct-like structures in connective tissue stroma

Biopsy of Tubular carcinoma (Invasive ductal carcinoma)

You see a lot of ducts, but they lack myoepithelial cells also see stromal background good prognosis

Biopsy of Mucinous carcinoma (Invasive ductal carcinoma subtype)

Ductal cells floating in mucus pool (light-lavendar background)

Prognosis of tubular and mucinous carcinoma

Excellent

Average age of occurrence for mucinous caricnoma

70 years

Highly erythematous and inflamed breast that does not resolve with antibiotics is suggestive of

Inflammatory carcinoma

Biopsy of Inflammatory carcinoma (subtype of Invasive Ductal carcinoma)

Hyperplasia of cells in dermal lymphatics, decreasing their drainage and causing inflammation (filled circle of purple cells in pink stromal tissue)

Prognosis of inflammatory carcinoma

Very poor (double negative, ER-/PR-)

Inflammatory carcinoma is more common in

African American women around 50 years, higher BMI (obese)

Well circumscribed mass that mimics fibroadenoma on mammography. Biopsy characterized by large, high-grade cells growing in sheets with lymphocytes and plasma cells

Medullary carcinoma (Invasive duct carcinoma

Patients with BRCA1 mutations have an increased risk of which type of Invasive Duct Carcinoma subtype?

Medullary carcinoma

Multifocial and bilateral masses that have been incidentally found on mammography suggest

Lobular carinoma in situ (mutation in E-cadherin so cells are not attached to one another)

Treatment for lobular carcinoma in situ

Tamoxifen (estrogen antagonist)

Risk of progression to invasive carcinoma for LCIS

Low

Biopsy showing cells in single-file pattern and E-cadherin mutations suggest

Invasive lobular carcinoma

Most useful prognostic factor in breast cancer

Spread to axillary lymph nodes

ER and PR associated breast cancers are treated with

Tamoxifen (antiestrogenic agents)

Her2/neu (c-erbB2) amplication is treated with

Traztuzumab (anti-Her2/neu)

What is Her2/neu

Cell membrane growth receptor (oncogene)

Which population is susceptible to triple negative breast carcinoma?

African American womoen

Gene responsible for breast cancer in males

BRCA2

Gene associated with familial breast and ovarian cancers

BRCA1

Where is the highest density of breast tissue in males

Underneath nipple (subareolar) ; may produce discharge

In pregnancy, DIC is mediated by which factor

Tissue factor produced by placental trophoblast