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Step 1 > Reproductive > Flashcards

Reproductive Flashcards

1
Q

Suspensory ligament of the ovaries

A

Contains ovarian vessels. Ovaries to lateral pelvic wall. Ureter at risk of injury during ligation of these vessels

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2
Q

Cardinal ligament

A

Contains uterine vessels. Ureter at risk of injury during ligation of these vessels in hysterectomy

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3
Q

Round ligament of the uterus

A

Nothing contained in this. Connects uterine fundus to labia majora

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4
Q

Broad ligament

A

Contains ovaries, fallopian tubes, and round ligaments of uterus. Mesosalpinx, mesometrium, and mesovarium are components of the broad ligament

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5
Q

Ligament of the ovary

A

Attaches ovary to lateral uterus

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6
Q

Histology of the ovary and fallopian tube respectively

A

Ovary - simple cuboidal, tube - simple columnar ciliated

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7
Q

Pathway of sperm

A

SEVEN UP. Seminiferous tubules, Epididymis, Vas deferens, Ejaculatory ducts, (nothing), Urethra, Penis

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8
Q

What nerves are responsible for erection, emission and ejactulation repsectively?

A

Erection - pelvic (parasympathetic), Emission - hypogastric (sympathetic), Ejaculation - pudendal (visceral and somatic)

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9
Q

What do sertoli cells and leydig cells respectively respond to and secrete?

A

Sertoli - respond to FSH, secrete inhibin. Leydig - respond to LH, secrete testosterone

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10
Q

Besides secreting inhibin, what are 4 other functions of sertoli cells

A

1) Secrete androgen binding protein, 2) Produce anti-mullerian hormone, 3) Isolate gametes with tight junctions, 4) Support and regulate spermatogenesis

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11
Q

What happens to inhibin levels at high temperatures?

A

They go down (sertoli cells are temp sensitive)

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12
Q

What happens to testosterone levels at high temperatures?

A

Nothing. Leydig cells are not temp sensitive like Sertoli cells are

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13
Q

Give cells in spermatogenesis in order and indicate chromosome status at each step

A

Spermatogonium (2N), Primary spermatocyte (4N), Secondary spermatocyte (2N), Spermatid (N), Spermatozoon (N)

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14
Q

Potency of androgens

A

DHT more potent than Testosterone more potent than Androstenedione

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15
Q

Where is androstenedione made?

A

Adrenal glands

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16
Q

Potency of estrogens

A

Estradiol more potent than estrone more potent than estriol

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17
Q

What hormone is used as an indicator of fetal well being?

A

Estriol (increases 1000 fold in pregnancy)

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18
Q

What is the primary product of the granulosa cell and the theca cell respectively and to which hormone does each respond?

A

Theca - responds to LH and makes androstenedione, Granulosa - responds to FSH and makes estrogen (from androstenedione)

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19
Q

In which menstrual phase will you see straight glands in the endometrium and in which phase will you see tortuous glands?

A

Proliferative phase - straight glands and arteries, Secretory phase - tortuous glands and arteries

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20
Q

What happens to endometrial cells during menstruation?

A

Apoptosis

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21
Q

Mittelschmerz

A

Blood from a ruptured follicle causing peritoneal irritation that can mimic appendicitis

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22
Q

At what stage is the oocyte arrested until ovulation

A

Prophase of Meiosis I

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23
Q

At what stage is an oocyte arrested between ovulation and fertilization?

A

Metaphase of Meiosis II

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24
Q

Cells in oogenesis and the chromosome status of each

A

Oogonium (2N), Primary Oocyte (4N), Secondary Oocyte (2N), Ovum (N)

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25
Q

Prolactin, progesterone, and estriol more or less increase linearly during pregnancy. What hormone does not follow this pattern and what pattern does it follow?

A

hCG. Peaks early (10 weeks) and declines significantly after that

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26
Q

Test of choice to confirm menopause

A

FSH (will be greatly increased due to loss of negative feedback from declining estrogen levels)

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27
Q

Symptoms of menopause

A

HHAVOC. Hirsutism, Hot flashes, Atrophy of the Vagina, Osteoporosis, Coronary artery disease

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28
Q

Genetics and findings of Klinefelters

A

XXY. Testicular atrophy, tall, long extremities, gynecomastia, female hair distribution.

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29
Q

Lab findings in Klinefelters

A

FSH - low or normal, LH - elevated, Testosterone - usually elevated, Estrogens - normal or elevated

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30
Q

What will testicular biopsy show in Klinefelters?

A

Sparse, hyalinized seminiferous tubules

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31
Q

Genetics and findings in Turners

A

XO. Short, streak ovary, shield chest, bicuspid aortic valve, webbing of neck (cystic hygroma), lypmhedema in feet and hands, coarctation, horshoe kidney, dysgerminoma

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32
Q

Lab findings in Turners

A

Decreased estrogen, Increased LH and FSH

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33
Q

Most common cause of primary amenorrhea

A

Turner syndrome

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34
Q

Most common cause of female pseudo-hermaphrodite (XX with virilized external genitalia)

A

CAH, Exogenous androgens during pregnancy, or other cause of exposure to androgens during gestation

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35
Q

Most common cause of male pseudo-hermaphrodite (XY but ambiguous or female external genitalia)

A

Androgen insensitivity syndrome (testicular feminization)

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36
Q

Lab findings in androgen insensitivity syndrome

A

Increased testosterone, estrogen, and LH

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37
Q

5-alpha-reductase deficiency

A

AR (but only males can have it). Normal labs. Ambiguous genital until puberty (penis at 12). Otherwise normal

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38
Q

Kallman syndrome

A

Defective development of GnRH cells and olfactory placode. Anosmia, lack of secondary sexual characteristics. AD. Low GnRH, FSH, LH, Testosterone, and sperm count

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39
Q

Main features of preeclampsia

A

HTN, proteinuria, edema

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40
Q

Most common cause of death in preeclampsia

A

Cerebral hemorrhage or ARDS

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41
Q

Headache, blurred vision, abdominal pain, edema, altered mentation, hyperreflexia in pregnant woman

A

Preeclampsia

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42
Q

Treatment for eclampsia

A

Magnesium sulfate and diazepam

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43
Q

What increases risk of placental abruption?

A

Smoking, HTN, cocaine use

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44
Q

What increases risk of placenta accreta (failure of placental detachment after delivery)?

A

Prior c-section, inflammation, and placenta previa

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45
Q

What increases risk of placenta previa (attachment of placenta to lower uterine segment)?

A

Multiparity and prior c-section

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46
Q

What is the main difference in presentation of placenta previa and placental abruption?

A

Placenta previa creates bleeding in ANY trimester, placental abruption only occurs in the third trimester

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47
Q

Risk factors for ectopic pregnancy

A

History of infertility, salpingits (PID), ruptured appendix, prior tubal surgery

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48
Q

At what point does maternal age become a factor in infertility?

A

Age greater than or equal to 35

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49
Q

What is seen histologically in invasive SCC of the cervix?

A

Pyknotic nuclei, dense cytoplasm, and perinuclear clearing

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50
Q

Treatment for endometritis (inflammation due to retained products of conception, abortion, or foreign body)

A

Cefoxitin, ticarcillin-clavulanate, ampicillin-sulbactam

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51
Q

How do you distinguish between endometriosis and adenomyosis?

A

Ultrasound. Uterus is normal sized in endometriosis and is large in adenomyosis

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52
Q

Treatment for endometriosis

A

Danazol

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53
Q

Menorrhagia, dysmenorrhea, dyspareunia, pelvic pain.

A

May be endometriosis or adenomyosis. Do ultrasound to distinguish the to (uterine size)

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54
Q

Whorled pattern of smooth muscle bundles

A

Leimyoma (fibroid)

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55
Q

Lab findings in PCOS

A

Increased LH, Testosterone, and Estrogen. Decreased FSH

56
Q

Treatment for PCOS

A

Weight loss, low-dose OCPs or medroxyprogesterone, spironolactone, clomiphene (if woman wants to get pregnant)

57
Q

OCPs reduce the risk of which cancer and how?

A

Ovarian cancer by reducing total ovulations

58
Q

Dermoid cyst

A

Mature teratoma (various types of tissue like hair, teeth, etc)

59
Q

Struma ovarii

A

Teratoma containing functional thyroid tissue in the ovary. Can present as hyperthyroidism

60
Q

Brenner tumor

A

Benign and unilateral ovarian tumor. Looks like bladder. Pale yellow-tan and appears encapsulated. Coffee bean nuclei on H and E

61
Q

What type of tumor is responsible for pseudomyxoma peritonei?

A

Mucinous cystadenocarcinoma of the ovary. Appendiceal tumors can also do it

62
Q

Meigs syndrome

A

Ovarian fibroma, ascites, hydrothorax. Pulling sensation in the groin

63
Q

What does a granulosa cell tumor secrete and what are two functional consequences of this?

A

Estrogen. Can present with precocious puberty, also can cause endometrial hyperplasia or carcinoma

64
Q

Call-Exner bodies

A

Small follicles filled with eosinophilic secretions associated with granulosa cell tumors

65
Q

Vaginal carcinoma in girls under 4

A

Sarcoma botryoides (rhabdomyosarcoma variant). Spindle shaped tumor cells that are desmin positive

66
Q

Give the pathology associated with each of the following parts of the breast: nipple, lactiferous sinus, major duct, terminal duct, lobule, and stroma

A

Nipple - Pagets, abcess. Lactiferous sinus - intraductal papilloma, abscess, mastitis. Major duct - fibrocystic change, ductal cancer. Terminal duct - tubular carcinoma. Lobule - lobular carcinoma, sclerosing adenosis. Stroma - fibroadenoma, phyllodes tumor

67
Q

What is the most common breast tumor in women under 35?

A

Fibroadenoma

68
Q

What breast tumor is increasingly tender at high estrogen times (pregnancy, menstruation, etc)

A

Fibroadenoma

69
Q

Outcome of fibroadenoma

A

Not a precursor of breast cancer

70
Q

List the benign breast tumors

A

Fibroadenoma (no progression), intraductal papilloma (may mean increased risk of cancer), phyllodes tumor (some may become malignant)

71
Q

Where are intraductal papillomas typically found?

A

Beneath areola

72
Q

Characteristics of breast fibroadenomas

A

Small, mobile, firm mass with sharp edges

73
Q

Characteristics of phyllodes tumors

A

Large bulky mass of connective tissue and cysts with leaf like projections

74
Q

Where do malignant breast tumors arise from?

A

Mammary duct epithelium or lobular glands

75
Q

Risk factors for malignant breast cancer

A

Increased estrogen exposure (and all the things that cause this)

76
Q

Ductal carcinoma in situ

A

Fills duct lumen, arises from ductal hyperplasia

77
Q

Comedocarcinoma

A

Ductal malignancy with caseous central necrosis. Subtype of DCIS. If you see something with a center that looks very different, pick this one

78
Q

What is the appearance of invasive ductal breast cancer and what is this appearance due to?

A

Firm, fibrous, rock hard mass with sharp margins and small glandular duct like cells. Stellate morphology. This is due to suspensory ligament infiltration

79
Q

Worst and most invasive breast cancer

A

Invasive ductal. Also the most common

80
Q

Which breast cancer looks like an orderly row of cells?

A

Invasive lobular

81
Q

Which breast cancer is often multiple and bilateral?

A

Invasive lobular

82
Q

Appearance of medullary breast cancer

A

Fleshy, cellular, lymphocytic infiltrate. Good prognosis

83
Q

Which breast cancer is associated with peau d orange?

A

Inflammatory. Neoplastic cells block lymphatic drainage

84
Q

Appearance of Pagets disease of the breast

A

Eczematous patches on the nipple. Paget cells are large cells in epidermis with a clear halo

85
Q

Premenstrual breast pain, multiple often bilateral lesions, fluctuation in size of mass.

A

Fibrocystic disease of the breast

86
Q

Histologic types of fibrocystic disease of the breast

A

Fibrosis, cystic, sclerosing adenosis (increased acini and intralobular fibrosis with calcifications), epithelial hyperplasia (inc risk of carcinoma if atypical)

87
Q

What is the most common pathogen in acute mastitis?

A

Staph aureus

88
Q

Benign painless breast lump following trauma

A

Fat necrosis. 50 percent do not report trauma

89
Q

Drugs that cause gynecomastia

A

Estrogen, marijuana, heroin, psychoactive drugs, spironolactone, digitalis, cimetidine, alcohol, ketoconazole

90
Q

Where in the prostate do BPH and prostate cancer respectively tend to develop?

A

BPH - centrally (middle and anterior lobes), Cancer - posterior lobe

91
Q

Lower back pain, increased alk phos, increased PSA and/or PAP

A

Suspect metastatic prostate adenocarcinoma. Will also present with urinary symptoms if very advanced

92
Q

Why might a left varicocele accompany nephrotic syndrome?

A

Loss of antithrombin 3 in urine leads to thrombus in left renal vein, increases pressure in left scrotum

93
Q

What remote symptom can you get in choriocarcinoma and teratoma and why?

A

Hyperthyroidism. hCG is similar to TSH and may stimulate T3 and T4 production

94
Q

How can you tell a pure embryonal carcinoma apart from a mixed embryonal carcinoma

A

Mixed - increased AFP, pure - normal AFP

95
Q

Histologic appearance of seminoma

A

Large cells in lobules with watery cytoplasm and fried egg appearance

96
Q

Which testicular tumor resembles primitive glomeruli and what is its tumor marker?

A

Yolk sac tumor. AFP

97
Q

Difference between mature teratoma in women and in men

A

In men it is most often malignant

98
Q

Hydrocele is contained by what structure?

A

Tunica vaginalis

99
Q

Leuprolide

A

GnRH analog (agonist when given pulsatile, antagonist when given continuously). Use for infertility, prostate cancer, fibroids

100
Q

Exemestane

A

Aromatase inhibitor, used to treat ER-positive breast cancer

101
Q

Finasteride

A

5a-reductase inhibitor. Use in BPH. Promotes hair growth but may cause gynecomastia

102
Q

Flutamide

A

Competitive inhibitor at testosterone receptor. Use in prostate cancer

103
Q

Ketoconazole

A

Inhibits steroid synthesis

104
Q

Spironolactone (repro)

A

Inhibits steroid binding to receptor

105
Q

List 3 pharmaceutically used estrogens

A

Ethinyl estradiol, DES, mestranol

106
Q

Menotropin

A

Human menopausal gonadotropin. Acts like FSH to stimulate primary follicle. Use in infertility

107
Q

What is given to induce ovulation in infertility treatment?

A

A large dose of hCG (simulates LH surge)

108
Q

Clomiphene

A

SERM (agonist in hypothal). Stimulates ovulation, use to treat infertility in PCOS

109
Q

Raloxifene

A

SERM. Agonist on bone, used to treat osteoporosis

110
Q

Anastrozole and Exemestane

A

Aromatase inhibitors used in postmenopausal women with breast cancer

111
Q

Mifepristone

A

Competitive inhibitor at progesterone receptor. Abortion.

112
Q

Ritodrine and terbutaline

A

B2 agonists that relax the uterus and reduce premature contractions

113
Q

Tamsulosin

A

Alpha-1 antagonist. Use in BPH. Selective targets receptors in prostate (alpha 1-a,d)

114
Q

Sildenafil and vardenafil

A

PDE inhibitors. Use in erectile dysfunction

115
Q

Danazol

A

Synthetic androgen. Use in endometriosis and hereditary angioedema

116
Q

Where are the two main androgens in women made?

A

Testosterone - ovary, DHEA sulfate - adrenals. So if you have virilization, check those two levels and it will tell you which organ is the problem

117
Q

Most common cause of hirsutism

A

PCOS

118
Q

Levels of androgens and estrogens in PCOS and effects on FSH and LH

A

Both high. Excess production of androgens and aromatization to estrogens. High estrogen levels suppress FSH and increase LH (which causes theca cells to make more testosterone, repeating cycle)

119
Q

What breaks the cycle of PCOS and how?

A

OCPs. They suppress LH (which is inciting testosterone production, which gets aromatized to estrogens, which leads to high LH levels)

120
Q

Most common primary and secondary causes of dysmenorrhea

A

Primary - too much PGF (prostaglandin that increases contraction). Secondary - endometriosis

121
Q

Most common cause of anovulatory bleeding

A

Sufficient estrogen stimulation without sufficient progesterone stimulation

122
Q

Pain on defecation during period but no pain on defecation the rest of the time

A

Endometriosis to the pouch of douglas

123
Q

GYN cancer ages

A

Cervical - 45, Endometrial - 55, Ovarian - 65

124
Q

Most common cause of ovarian mass in a young woman

A

Follicular cyst. Not neoplastic. May cause peritonitis and suddent pain

125
Q

Most common primary malignant ovarian tumor

A

Serous cystadenocarcinoma. PSAMMOMA BODIES

126
Q

Causes of choriocarcinoma

A

15 percent from preexisting hydatidiform mole. 25 pct from spontaneous abortion, 25 pct from normal preggers

127
Q

Where do choriocarcinomas tend to metastasize to?

A

Lungs

128
Q

Most common cause of bloody nipple discharge of a woman under 50

A

Intraductal papilloma (benign)

129
Q

Where do most breast cancers arise from

A

Major ducts

130
Q

What tumors of the breast and ovary respectively are classically bilateral?

A

Breast - lobular carcinoma. Ovary - serous tumors

131
Q

What type of breast cancers dont get picked up by mammography?

A

Lobular

132
Q

Most common cause of mass in breast of a woman over 50

A

Infiltrating ductal carcinoma (mammography not sensitive to pick it up when it is simply intraductal)

133
Q

Ductal hyperplasia a precusor lesion for breast cancer. What are these hyperplastic cells sensitive to?

A

Estrogen

134
Q

When cancers present as a palpable mass, is the mass typically painful or painless?

A

Painless. Painful masses are more characteristic of an inflammatory process

135
Q

First step in the management of a palpable breast mass

A

Fine needle aspiration (same as for a nodule in thyroid)

136
Q

Do women who are premenopausal or postmenopausal tend to ER PR positivity in their breast cancer?

A

Postmenopausal have more ER PR positivity. This is because presence of estrogen (in premenopausal women) leads to receptor downregulation

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