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Step 1 Exam > Reproductive - First Aid > Flashcards

Reproductive - First Aid Flashcards

1
Q

Sonic hedgehog gene is produced at the…

A

base of the limbs in the zone of polarizing activity.

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2
Q

Sonic hedgehog gene is involved in..

A

patterning along the anterior posterior axis and CNS development.

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3
Q

Mutation of the sonic hedgehog gene can cause….

A

holoprosencephaly.

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4
Q

The Wnt-7 gene is produced at…

A

the apical ectodermal ridge (a thickened ectoderm at the distal end of each developing limb.

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5
Q

Wnt-7 gene is necessary for…

A

proper organization along the dorsal-ventral axis.

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6
Q

FGF gene is produced at the….

A

apical ectodermal ridge.

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7
Q

FGF gene stimulates….

A

mitotis of the underlying mesoderm providing for lengthening of limbs.

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8
Q

Homeobox (Hox) gene is involved in…

A

segmental organization of the embryo in a craniocaudlal direction.

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9
Q

Hox mutations lead to…

A

appendages in the wrong locations.

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10
Q

Day 0 of fetal development

A

fertilization by sperm, forming zygote, initiating embryogenesis

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11
Q

Fetal development within one week

A

hCG secretion begins around the time of implantation of the blastocyst

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12
Q

Fetal development within 2 weeks

A

bilaminar disc (epiblast, hypoblast) (2 weeks = 2 layers)

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13
Q

Fetal development within 3 weeks

A

trilaminar disc (3 wks = 3 layers) gastrulation primitive streak, notochord, mesoderm, neural plate begin to form

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14
Q

Fetal development during wks 3-8 (embryonic period)

A

neural tube formed by neuroectoderm and closes by wk 4; organogenesis **extremely susceptible to teratogens

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15
Q

Fetal development within within wk 4

A

heart begins to beat upper and lower limb buds (week 4 = 4 chambers, 4 limbs)

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16
Q

Fetal development within week 6

A

fetal cardiac activity is visible by transvaginal ultrasound

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17
Q

Fetal development within week 10

A

genitalia have male/female characteristics

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18
Q

Gastrulation is the process that…

A

forms the trilaminar embryonic disc. It establishes the ectoderm, mesoderm and endoderm germ layers.

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19
Q

Gastrulation starts with the….

A

epiblast invaginating to form the primitve streak.

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20
Q

Surface ectoderm derivatives (8)

A

-adenohypophysis -lens of eye -epithelial linings of oral -sensory organs of the ear -olfactory epithelium -epidermis -anal canal below pectinate line -parotid, sweat and mammary glands

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21
Q

A craniopharyngioma is…

A

a benign Rathke pouch tumor with cholesterol crystals and calcifications. (surface ectoderm derivative)

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22
Q

Neuroectoderm derivatives (3)

A

-brain (neurohypophysis, CNS neurons, oligodendrocytes, astrocytes, ependymal cells, pineal gland) -retina and optic nerve -spinal cord

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23
Q

Neural Crest derivatives (8)

A

-PNS (DRG, cranial nerves, celiac ganglion, Schwann cells, ANS) -melanocytes, -chromaffin cells of adrenal medulla -parafollicular cells of thyroid -pia and arachonid -bones of the skull -odontoblasts -aorticopulmonary septum

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24
Q

Mesoderm derivatives (15)

A

-muscle -bone -CT -serous linings -spleen -CV structures -lymphatics -blood -wall of gut tube -vagina -kidneys -adrenal cortex -dermis -testes -ovaries

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25
Q

Mesodermal defects =

A

VACTERL -Vertebral defects -Anal atresia -Cardiac defects -Tracheo-Esophageal fistula -Renal defects -Limb defects

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26
Q

Endoderm derivatives

A

-gut tube epithelium -most of urethra -luminal epithelial derivatives (lung, liver, gallbladder, pancreas, eustachian tube, thymus, parathyroid)

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27
Q

Agenesis

A

absent organ due to absent primordial tissue

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28
Q

Aplasia

A

absent organ despite presence of primordial tissue

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29
Q

Hypoplasia

A

incomplete organ development; primordial tissue present

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30
Q

Deformation

A

extrinsic disruption; occurs after the embryonic period

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31
Q

Disruption

A

secondary breakdown of a previously normal tissue (ex. amniotic band syndrome)

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32
Q

Malformation

A

intrinsic disruption; occurs during the embryonic period

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33
Q

Sequence

A

abnormalities result from a single primary embryological event

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34
Q

Before week 3, teratogens cause…

A

all-or-none effects.

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35
Q

After week 8, teratogens affect…

A

growth and function.

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36
Q

ACE Inhibitors cause…

A

renal damage.

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37
Q

Alkylating agents cause…

A

absence of digits

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38
Q

Aminoglycosides cause…

A

CN VIII toxicity

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39
Q

Carbamazepine causes…

A

neural tube defects*** craniofacial defects fingernail hypoplasia developmental delay IUGR

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40
Q

Diethylstilbestrol (DES) causes…

A

vaginal clear cell adenocarcinoma congenital Mullerian anomalies

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41
Q

Folate antagonists cause…

A

neural tube defects

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42
Q

Lithium causes…

A

ebstein anomaly (atrialized right ventricle)

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43
Q

Methimazole causes…

A

aplasia cutis congenita

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44
Q

Phenytoin causes…

A

Fetal hydantoin syndrome (microcephaly, dysmorphic craniofacial features, hypoplastic nails and distal phalanges, cardiac defects, IUGR and intellectual disability)

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45
Q

Tetracyclines cause…

A

discolored teeth

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46
Q

Thalidomide causes…

A

limb defects (phocomelia, micromelia)

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47
Q

Valproate causes…

A

inhibition of maternal folate absorption leading to neural tube defects

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48
Q

Warfarin causes…

A

bone deformities, fetal hemorrhage, abortion, and ophthalmologic abnormalities

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49
Q

Cocaine causes…

A

abnormal fetal growth and fetal addiction; placental abruption.

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50
Q

Smoking (nicotine, CO) causes…

A

low birth weight, preterm labor, placental problems, IUGR, and ADHD.

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51
Q

Iodine (lack or excess) causes…

A

congenital goiter or hypothyroidism (cretinism)

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52
Q

Maternal diabetes causes…

A

caudal regression syndrome (anal atreisa to sirenomelia), congenital heart defects and neural tube defects.

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53
Q

Excess vitamin A causes…

A

extremely high risk for spontaneous abortions and birth defects (cleft palate, cardiac abnormalities).

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54
Q

X-rays cause…

A

microcephaly and intellectual disability.

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55
Q

Congenital malformations (7) of Fetal Alcohol Syndrome include…

A

intellectual disability developmental retardation microcephaly holoprosencephaly facial abnormalities limb dislocation heart defects

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56
Q

Facial abnormalities of FAS include…

A

smooth philtrum, thin upper lip, small palpebral fissures and hypertelorism.

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57
Q

Dizygotic twins arise from…

A

2 eggs that are separately fertilized by 2 different sperm and will have 2 separate amniotic sacs and 2 separate placentas.

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58
Q

Monozygotic twins arise from…

A

1 fertilized egg that splits into 2 zygotes early in pregnancy.

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59
Q

The degree of separation between monozygotic twins depends on…

A

when the fertilized egg splits into 2 zygotes. the timing of this separation determines the number of chorions (placentas) and amnions.

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60
Q

Fetal components of the Placenta

A

-cytotrophoblast -syncytiotrophoblast

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61
Q

Maternal component of the placenta

A

decidua basalis

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62
Q

The cytotrophoblas is the…

A

inner layer of chorionic villi that makes cells.

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63
Q

The syncytiotrophoblast is the…

A

outer layer of chorionic villi that secretes hCG.

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64
Q

The decidua basalis is derived from the…

A

endometrium and has maternal blood in lacunae.

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65
Q

The umbilical arteries (2) return…

A

deoxygenated blood from the fetal internal iliac arteries to the placenta.

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66
Q

The umbilical vein (1) supplies…

A

oxygenated blood from the placenta to the fetus and drains into the IVC via the liver or via the ductus venosus.

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67
Q

The most oxygenated blood in the fetus is located in the…

A

umbilical vein.

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68
Q

A single umbilical artery is associated with..

A

congenital and chromosomal anomalies.

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69
Q

The umbilical arteries and veins are derived from…

A

allantois.

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70
Q

In the 3rd week, the yolk sac forms the…

A

allantois which extends into the urogenital sinus.

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71
Q

The allantois becomes the…

A

urachus, a duct between fetal bladder and yolk sac.

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72
Q

Failure of the urachus to obliterate results in (3):

A
  1. patent urachus 2. urachal cyst (partial failure) 3. vesicourachal diverticulum
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73
Q

A patent urachus allows…

A

urine discharge from the umbilicus.

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74
Q

A urachal cyst is a…

A

fluid-filled cavity lined with uroepithelium, between the umbilicus and bladder.

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75
Q

A urachal cyst can lead to…

A

infection and adenocarcinoma.

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76
Q

A veicourachal diverticulum is…

A

outpouching of the bladder.

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77
Q

The vitelline duct is…

A

a connection from the yolk sac to the midgut lumen. It is obliterated in the 7th week.

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78
Q

Failure of the vitelline duct to close results in (2):

A
  1. vitelline fistula 2. meckel diverticulum
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79
Q

Vitelline fistula causes…

A

meconium discharge from the umbilicus.

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80
Q

Meckel diverticulum has partial closure of the vitelline duct with the patent portion…

A

attached to the ileum (a true diverticulum).

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81
Q

A meckel diverticulum may contain…

A

ectopic gastric mucosa and/or pancreatic tissue leading to melena, periumbilical pain and ulcers.

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82
Q

The 1st aortic arch becomes…

A

part of the maxillary artery.

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83
Q

The 2nd aortic arch becomes…

A

the stapedial artery and hyoid artery.

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84
Q

The 3rd aortic arch becomes…

A

the common carotid artery and the proximal part of the internal carotid artery.

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85
Q

The 4th aortic arch becomes..

A

the aortic arch on the left and the right subclavian.

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86
Q

The 6th aortic arch becomes…

A

the proximal part of the pulmnoary arteries and the ductus arteriosus (on the left).

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87
Q

The branchial apparatus is composed of…

A

branchial clefts, arches and pouches.

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88
Q

The branchial clefts (grooves) are derived from…

A

ectoderm.

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89
Q

The branchial arches are derived from…

A

mesoderm (muslces, arteries) and neural crest (bone, cartilage).

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90
Q

The branchial pouches are derived from…

A

endoderm.

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91
Q

The 1st branchial cleft develops into the…

A

external auditory meatus.

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92
Q

the 2nd through 4th branchial clefts form…

A

temporay cervical sinuses which are obliterated by proliferation of 2nd arch mesenchyme.

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93
Q

A persistent cervical sinus leads to…

A

a branchial cleft syst within the lateral neck.

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94
Q

1st branchial arch cartilage derivatives

A

-meckel cartilage: mandible, malleus, incus, spheno-mandibular ligament

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95
Q

1st branchial arch muscle derivatives

A

-muscles of mastication (temporalis, masseter, lateral and medial pterygoids) -mylohyoid -anterior belly of digastric -tensor tympani -tensor veli palatini

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96
Q

1st branchial arch nerves

A

CN V2 and V3

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97
Q

Abnormality of the 1st branchial arch leads to…

A

Treacher Collins Syndrome (which is when the first arch neural crest fails to migrate leading to mandibular hypoplasia and facial abnormalities)

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98
Q

2nd branchial arch cartilage derivatives

A

Reichert cartilage (stapes, styloid process, lesser horn of the styoid and stylohyoid ligament)

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99
Q

2nd branchial arch muscle derivatives

A

Muscles of facial expression (stapedius, stylohyoid, platysma, belly of digastric)

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100
Q

2nd branchial arch nerve derivatives

A

CN VII (facial expression)

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101
Q

Abnormalities of the 2nd branchial arch leads to…

A

congenital pharyngocutaneous fistula (persistence of the cleft and pouch leads to a fistula between the tonsillar area and lateral neck)

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102
Q

3rd branchial arch cartilage derivatives

A

greater horn of hyoid

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103
Q

3rd branchial arch muscle derivatives

A

stylopharyngeus

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104
Q

3rd branchial arch nerve derivative

A

CN IX

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105
Q

4th-6th branchial arch cartilage derivatives

A

-thyroid -cricoid -arytenoids -corniculate -cuneiform

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106
Q

4th branchial arch nerve derivative

A

CN X (superior laryngeal branch)

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107
Q

6th branchial arch nerve derivative

A

CN X (recurrent laryngeal branch)

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108
Q

The 1st branchial pouch develops into…

A

the middle ear cavity, eustachian tube and mastoid air cells. (endoderm-lined ear structures)

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109
Q

The 2nd branchial pouch develops into…

A

epithelial lining of the palatine tonsil.

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110
Q

The 3rd branchial pouch develops into…

A

dorsal wings –> inferior parathyroids ventral wings –> thymus

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111
Q

The 4th branchial pouch develops into…

A

dorsal wings –> superior parathyroids

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112
Q

DiGeorge Syndrome is due to…

A

aberrant development of the 3rd and 4th branchial pouches which leads to T-cell deficiency (thymic hypoplasia) and hypocalcemia (failure of parathyroid devo).

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113
Q

MEN2A is due to a…

A

mutation of germline RET (neural crest cells).

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114
Q

Features of MEN2A (3)

A

-pheochromocytoma (adrenal medulla) -parathyroid tumor (3rd/4th pouches) -medullary thryoid cancer (4th/5th pouches)

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115
Q

Cleft lip is due to…

A

failure of fusion of the maxillary and medial nasal processes.

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116
Q

Cleft palate is due to..

A

failure of fusion fo the two lateral palatine processes or failure of fusion of lateral palatine processes with the nasal septum and/or median palatine process.

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117
Q

Default emryological development is…

A

female. The mesonephric duct degenerates and the paramesonephric duct develops.

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118
Q

The SRY gene is located on the…

A

Y chromosome and produces testis-determining factor which causes the testes to develop.

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119
Q

Sertoli cells secrete…

A

mullerian inhibitory factor (MIF) that suppresses the development of the paramesonephric ducts.

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120
Q

Leydig cells secrete…

A

androgens taht stimulate the development of the mesonephric ducts.

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121
Q

The parapmesonephric (mullerian) ducts develop into…

A

female internal structures (fallopian tubes, uterus, uppe portion of the vagina).

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122
Q

The lower portion of the vagina is from the…

A

UG sinus.

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123
Q

Mullerian duct abnormalities result in…

A

anatomical defects that may present as primary amenorrhea with fully developed secondary sex characteristics.

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124
Q

The mesonephric (wolffian) ducts develop into…

A

male internal structures (except prostate) - seminal vesicles, epididymis, ejaculatory duct and ductus deferens.

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125
Q

A bicornate uterus results from…

A

incomplete fusion of the paramesonephric ducts. Can lead to recurrent miscarriages.

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126
Q

Complete failure of fusion of the paramesonephric ducts leads to…

A

double uterus and vagina.

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127
Q

No sertoli cells or a lack of MIF will lead to…

A

development of both male and female internal genitalia and male external genitalia.

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128
Q

5-alpha reductase deficiency leads to…

A

inability to convert testosterone into DHT; pts will have male internal genitalia and ambiguous external genitalia until puberty (when increased testosterone levels cause masculinization).

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129
Q

In the female, the genital tubercle becomes…

A

the glans clitoris and vestibular bulbs.

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130
Q

In the male, the genital tubercle becomes…

A

the glans penis and corpus cavernosum/spongiosum.

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131
Q

In the female, the urogenital sinus becomes…

A

the greater vestibular glands (Bartholin) and the urethral/paraurethral glands (Skene).

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132
Q

In the male, the urogenital sinus becomes…

A

the bulbourethral glands of Cowper and the prostate gland.

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133
Q

In the female, the urogenital folds become…

A

the labia minora.

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134
Q

In the male, the urogenital folds become…

A

the ventral shaft of the penis.

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135
Q

In the female, the labioscrotal swelling becomes the…

A

labia majora.

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136
Q

In the male, the labioscrotal swelling becomes the..

A

scrotum.

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137
Q

Hypospadias is an…

A

abnormal opening of the penile urethra on the inferior (ventral) side of the penis due to failure of the urethral folds to close.

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138
Q

Fix hypospadias to prevent..

A

UTIs.

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139
Q

Epispadias is…

A

an abnormal opening of the penile urethra on the superior (dorsal) side of the penis due to faulty positioning of the genital tubercle.

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140
Q

Epispadias is associated with…

A

exstrophy of the bladder.

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141
Q

The male remnant of the gubernaculum is…

A

anchoring the testes within the scrotum.

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142
Q

The female remnant of the gubernaculum is…

A

the ovarian ligament and the round ligament.

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143
Q

The male remnant of the processus vaginalis forms…

A

the tunica vaginalis.

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144
Q

The female remnant of the processus vaginalis is…

A

obliterated.

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145
Q

The left ovary/testis is drained via the…

A

left gonadal vein to the left renal vein to the IVC.

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146
Q

The right ovary/testis is drained via the..

A

right gonadal vein to the IVC.

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147
Q

Ovaries and testes lymph drain to the…

A

para-aortic LNs.

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148
Q

The distal vagina/vulva/uterus drain lymph to the…

A

superficial inguinal nodes.

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149
Q

The proximal vagina/uterus drains lymph to the…

A

obturator, external iliac and hypogastric nodes.

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150
Q

The left spermatic vein enters the left renal vein at a 90 degree angle leading to…

A

increased pressure compared to the right and more common varicoceles on the left.

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151
Q

The infundibulopelvic (suspensory) ligament connects…

A

the ovaries to the lateral pelvic wall.

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152
Q

The infundibulopelvic (suspensory) ligament contains…

A

the ovarian vessels. Need to be ligated during oophorectomy to avoid bleeding.

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153
Q

The ureter courses retroperitoneally close to…

A

the gonadal vessels and thus is at risk of injury during ligation of the ovarian vessels.

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154
Q

The cardinal ligament connects…

A

the cervix to the side wall of the pelvis.

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155
Q

The cardinal ligament contains…

A

the uterine vessels. The ureter is at risk during ligation of the uterine vessels in a hysterectomy.

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156
Q

The round ligament connects…

A

the uterine fundus to the labia majora.

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157
Q

The round ligament travels through…

A

the round inguinal canal above the artery of Sampson.

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158
Q

The broad ligament connects…

A

the uterus, fallopian tubes and ovaries to the pelvic side wall.

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159
Q

The broad ligament contains…

A

the ovaries, fallopian tubes and round ligaments.

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160
Q

The components of the broad ligament are the…

A

mesosalpinx, mesometrium and mesovarium.

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161
Q

The ovarian ligament connects the…

A

medial pole of the ovary to the lateral uterus.

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162
Q

Histology of the vagina

A

stratified squamous epithelium, nonkeratinized

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163
Q

Histology of the ectocervix

A

stratified squamous epithelium, nonkeratinized

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164
Q

Histology of the endocervix

A

simple columnar epithelium

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165
Q

Histology of the transformation zone

A

squamocolumnar juction (most common area for cervical cancer)

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166
Q

Histology of the uterus

A

simple columnar epithelium with long tubular glands

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167
Q

Histology of the fallopian tube

A

simple columnar epithelium, many ciliated cells, a few secretory (peg) cells

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168
Q

Histology of the ovary (outer surface)

A

simple cuboidal epithelium (germinal)

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169
Q

Female Sexual Response Cycle

A
  1. phase of excitement (uterus elevates, vaginal lubrication) 2. plateau (expansion of inner vagina) 3. orgasm (contraction of uterus) 4. resolution
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170
Q

Female sexual response cycle is mediated by the..

A

autonomic nervous system.

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171
Q

Pathway of sperm during ejaculation

A

Semniferous tubules - epididymis - vas deferens - ejaclatory ducts - urethra - penis

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172
Q

Erection is innervated by the…

A

PNS (pelvic nerve). NO leads to increased cGMP causes smooth muscle relaxation, vasodilation and it becomes erect.

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173
Q

When the pelvic nerve secretes NE, this leads to..

A

an increase in calcium leading to smooth muscle contraction, vasoconstriction and this is antierectile.

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174
Q

Emission is innervated by…

A

the SNS (hypogastric nerve).

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175
Q

Ejaculation is innervated by…

A

visceral and somatic nerves (pudendal).

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176
Q

Spermatogonia (germ cells) maintain the…

A

germ pool and produce primary spermatocytes. They line the semniferous tubules.

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177
Q

Sertoli cells secrete…

A

inhibin (inhibits FSH) and androgen-binding protein (maintains local testosterone) and MIF.

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178
Q

Tight junctions between adjacent sertoli cells form..

A

the blood-testis barrier which isolates gametes from autoimmune attack.

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179
Q

Sertoli cells also support…

A

developing spermatozoa and regulate spermatogenesis.

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180
Q

Sertoli cells are sensitive to…

A

temperature. Increased temp leads to decreased sperm and increased inhibin.

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181
Q

The sertoli cells line…

A

seminiferous tubules.

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182
Q

The sertoli cells convert…

A

androstenedione to estrogen via aromatase.

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183
Q

Increased temperature of the testes is seen in both…

A

varicocele and cryptorchidism.

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184
Q

The Leydig cells secrete..

A

testosterone in the presence of LH. (unaffected by temp)

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185
Q

Estrogen sources

A

Ovary (17beta-estradiol) Placenta (estriol) Adipose tissue (estrone via aromatization)

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186
Q

Potency of the estrogens

A

estradiol > estrone > estriol

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187
Q

Estrogen is necessary for development of…

A

genitalia and breast and female fat distribution.

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188
Q

Estrogen is needed for growth of…

A

the follicle, endometrial proliferation and increased myometrial excitability.

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189
Q

Estrogen upregulates…

A

estrogen, LH and progesterone receptors.

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190
Q

Estrogen has feedback inhibition of…

A

FSH and LH, then an LH surge. It also stimulates prolactin secretion.

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191
Q

Estrogen increases…

A

transport proteins and SHBG; it increases HDL and decreases LDL

192
Q

Estrogen during pregnancy:

A

50-fold increase in estradiol and estrone 1000-fold increase in estriol (indicator of fetal well-being)

193
Q

Estrogen receptors are expressed in the…

A

cytoplasm and then translocate to the nucleus when bound.

194
Q

In the theca cells, LH stimulates…

A

desmolase to convert cholesterol into androstenedione (which travels to the granulosa cells.

195
Q

In the granulosa cells, FSH stimulates…

A

aromatase to convert androstenedione into estrogens.

196
Q

Sources of progesterone

A

-corpus luteum -placenta -adrenal cortex -testes

197
Q

Progesterone stimulates…

A

endometrial glandular secretions and spiral artery development.

198
Q

Progesterone maintains…

A

pregnancy.

199
Q

Progesterone decreases….

A

myometrial excitability (causes uterine smooth muscle relaxation) and estrogen receptor expressivity.

200
Q

Progesterone produces…

A

thick cervical mucus, which inhibits early sperm entry into the uterus.

201
Q

Progesterone increases…

A

temperature.

202
Q

Progesterone inhibits…

A

LH and FSH.

203
Q

Progesterone prevents…

A

endometrial hyperplasia.

204
Q

The fall in progesterone after delivery acts to…

A

disinhibit prolactin which leads to prolactin.

205
Q

Tanner Stages

A

I = childhood II = pubic hair appears (pubarche); breast buds (thelarche) III = pubic hair darkens, becomes curly; penis size/length increases; breasts enlarge IV = penis width increases; darker scrotal skin; development of glans; raised areolae V = adult; areolae no longer raised

206
Q

The phase of the menstrual cycle that can vary in length is the…

A

follicular phase; luteal phase is usually a constant 14 days. Ovulation day + 14 days = menstruation

207
Q

Decreased progesterone leads to…

A

decreased fertility.

208
Q

Oligomenorrhea

A

> 35 day cycle

209
Q

Polymenorrhea

A

< 21 day cycle

210
Q

Metrorrhagia

A

frequent but irregular bleeding (intermenstrual)

211
Q

Menorrhagia

A

> 80 mL blood loss or > 7 days of menses (heavy menstrual bleeding)

212
Q

Menometrorrhagia

A

heavy, irregular menstruation at irregular levels

213
Q

Increased estrogen midcycle leads to…

A

the LH surge leads to ovulation leads to progesterone release from the corpus luteum. Then, progesterone levels fall (if no implantation) leading to menstruation via apoptosis of endometrial cells.

214
Q

Primary oocytes begin…

A

meiosis I during fetal life and complete meiosis I just prior to ovulation.

215
Q

Meiosis I is arrested in…

A

prophase I for years until ovulation (primary oocytes).

216
Q

Meiosis II is arrested in…

A

metaphase II until fertilization (secondary oocytes).

217
Q

If fertilizaiton does not occur within 1 day, then the…

A

secondary oocyte degenerates.

218
Q

Ovulation is caused when…

A

increased estrogen and increased GnRH receptors on the anterior pituitary cause LH release leading to ovulation (rupture of the follicle).

219
Q

Temperature during ovulation is…

A

increased from progesterone.

220
Q

Mittelschmerz refers to…

A

transient mid-cycle ovulatory pain; classically associated with peritoneal irritation (follicular swelling, fallopian tube contraction). This can mimic appendicitis.

221
Q

Fertilization most commonly occurs in the…

A

upper end of the fallopian tube (the ampulla). It occurs within one day of ovulation.

222
Q

Implantation within the wall of the uterus occurs…

A

6 days after fertilization.

223
Q

Syncytiotrophoblasts secrete…

A

hCG, which is detectable in the blood 1 week after conception and on the home urine test 2 wks after conception.

224
Q

Suckling is required to maintain…

A

milk production since increased nerve stimulation increases oxytocin and prolactin.

225
Q

Prolactin induces and maintains…

A

lactation and decreases reproductive fxn (decreases LH/FSH).

226
Q

Oxytocin assists in…

A

milk letdown and promotes uterine contractions.

227
Q

Breastmilk contains…

A

maternal Igs, macrophages and lymphocyts.

228
Q

Breastmilk decreases risk for the child to develop….

A

asthma, allergies, DM and obesity (and infxns).

229
Q

Exclusively breastfed infants require….

A

vitamin D supplementation.

230
Q

Breastfeeding decreases maternal risk of…

A

breast and ovarian cancer.

231
Q

hCG maintains…

A

the corpus luteum (and thus progesterone) for the 1st trimester by acting like LH to stimulate luteal cells.

232
Q

In the 2nd and 3rd trimesters, the placenta synthesizes…

A

its own estriol and progesterone and the corpus luteum degenerates.

233
Q

The alpha subunit of hCG is structurally….

A

identical to alpha subunits of LH, FSH, and TSH. The beta subunit is unique.

234
Q

hCG is greatly increased in…

A

multiple gestations, hydatiform moles, and choriocarcinoma.

235
Q

During menopause, there is decreased…

A

estrogen production due to age-linked decline in the number of ovarian follicles.

236
Q

The source of estrogen after menopause becomes…

A

peripheral conversion of androgens. The increase in androgens leads to hirsutism.

237
Q

Test for menopause with…

A

greatly increased FSH (due to loss of negative feedback on FSH due to decreased estrogen).

238
Q

Hormonal changes during menopause (4)

A
  1. decreased estrogen 2. increased FSH 3. increased LH 4. increased GnRH
239
Q

Menopause causes:

A

HAVOCS -Hot flashes -Atrophy of the vagina -Osteoporosis -Coronary artery disease -Sleep disturbances

240
Q

Spermatogenesis begins at…

A

puberty with spermatogonia. Full development takes 2 months. It occurs in the seminiferous tubules.

241
Q

Spermatogenesis produces…

A

spermatids that undergo spermiogenesis (loss of cytoplasmic contnets, gain of acrosomal cap) to form mature spermatozoon.

242
Q

Sources of Androgens

A

DHT and testosterone (testis) Androstenedione (adrenal)

243
Q

Potency of the androgens

A

DHT > testosterone > androstenedione

244
Q

Functions of Testosterone (5)

A
  1. differentiation of epididymis, vas deferns, seminal vesicles 2. growth spurt 3. deepening voice 4. closing of epiphyseal plates (via estrogen conversion) 5. libido
245
Q

Functions of DHT (2)

A
  1. differentiation of penis, scrotum, prostate (early) 2. prostate growth, balding, sebaceous gland activity (late)
246
Q

Testosterone is converted to DHT by…

A

5alpha-reductase.

247
Q

In the male, androgens are converted to estrogen by…

A

cytochrome P450 aromatase (mainly in adipose tissue and testis).

248
Q

Exogenous testosterone leads to inhibition of…

A

the hypothalamic-pituitary-gonadal axis leading to decreased intratesticular testosterone leading to decreased testicular size and azoospermia.

249
Q

Klinefelter Syndrome Features (7)

A

-XXY (male) -testicular atrophy -eunuchoid body shape -tall -gynecomastia -female hair distribution -presence of inactivated X chromoxome (barr body)

250
Q

In Klinefelter, the dysgenesis of the seminiferous tubules leads to…

A

decreased inhibin and increased FSH.

251
Q

Turner Syndrome Features (8)

A

-XO (female) -short stature -ovarian dysgenesis (streak ovary) -shield chest -bicuspid aortic valve -preductal coarctation -lymphatic defects (webbed neck, cystic hygroma) -horseshoe kidney

252
Q

Signs of preductal coarctation

A

femoral < brachial pulse notched ribs

253
Q

Double Y males features (XYY) (5)

A

-phenotypically normal -very tall -severe acne -antisocial behavior -normal fertility

254
Q

True hermaphroditism features

A

-46 XX or 47 XXY -both ovary and testicular tissue present -ambigous genitalia

255
Q

Increased T, Increased LH

A

defective andgrogen receptor

256
Q

Increased T, Decreased LH

A

testosterone secreting tumor or exogenous steroids

257
Q

Decreased T, Increased LH

A

primary hypogonadism

258
Q

Decreased T, Decreased LH

A

hypogonadotropic hypogonadism

259
Q

Female Pseudohermaphrodite (XX)

A

-ovaries are present but external genitalia are virilized or ambiguous -due to excessive exposure to androgenic steroids during early gestation (CAH or exogenous)

260
Q

Male Pseduohermaphrodite (XY)

A

-testes present but external genitalia are female or ambiguous

261
Q

Aromatase Deficiency Features (3)

A

-inability to synthetize estrogens from androgens -masculinization of female infants and increased androgens -can present with maternal virilization during pregnancy

262
Q

Androgen Insensitivity Features (5)

A

-defect in androgen receptor resulting in normal looking female -uterus and fallopian tubes absent -scant sexual hair -testes often in labia majora (remove to prevent malignancy) -increased T, E, and LH

263
Q

5alpha-reductase deficiency features (6)

A

-autosomal recessive -inability to convert testosterone to DHT -ambiguous genitalia until puberty -testosterone/estrogen levels normal -LH is normal/increased -internal genitalia normal

264
Q

Kallmann syndrome features

A

-failure to complete pubery -defective migration of GnRH cells and formation of olfactory bulb -decreased synthesis of GnRH -anosmia -decreased GnRH, FSH, LH, testosterone -infertility

265
Q

A hydatidiform mole is a…

A

cystic swelling of chorionic villi and proliferation of chorionic epithelium (only trophoblast).

266
Q

Treatment for hydatidiform moles

A

dilation and curettage and methotrexate (have to monitor beta-hCG after)

267
Q

Karyotype of hydatidiform moles

A

Complete: 46 XX; 46 XY Partial: 69 XXX; 69 XXY; 69 XYY

268
Q

Uterine size in hydatidiform moles

A

Complete: increased

269
Q

Conversion to choriocarcinoma in hydatidiform moles

A

Complete: 2% Partial: rare

270
Q

Fetal parts in hydatidiform moles

A

Complete: none Partial: Yes

271
Q

Components of the hydatidiform moles

A

Complete: nucleated egg + single sperm (duplicates paternal DNA) Partial: 2 sperm + 1 egg

272
Q

Symptoms of hydatidiform moles

A

Complete: vaginal bleeding, enlarged uterus, hyperemesis, pre-eclampsia, hyperthyroidism Partial: vaginal bleeding, abdominal pain

273
Q

Imaging of hydatidiform moles

A

Compete: honeycombed uterus or “clusters of grapes” or “snowstorm” on U/S Partial: fetal parts

274
Q

Gestational hypertension is defined as…

A

BP > 140/90 after the 20th week.

275
Q

Treat gestational HTN with…

A

antihypertensives (alpha-methyldopa, labetalol, hydralazine, nifedipine) and deliver at 39 weeks.

276
Q

Preeclampsia is defined as…

A

HTN, proteinuria (>300 mg/24 hr) after the 20th wk of gestation.

277
Q

End-organ damage from severe preeclampsia results in…

A

HA, scotoma, oliguria, increased AST/ALT, and thrombocytopenia.

278
Q

Preeclampsia is caused by…

A

abnormal placental spiral arteries and results in maternal endothelial dysfunction, vasoconstriction or hyperreflexia.

279
Q

The incidence of preeclampsia is increased in pts with…

A

preexisting HTN, diabetes, chronic renal dz or autoimmune disorders.

280
Q

Complications of preeclampsia (5)

A
  1. placental abruption 2. coagulopathy 3. renal failure 4. uteroplacental insufficiency 5. eclampsia
281
Q

Treatment of preeclampsia

A

-antihypertensives -deliver at 34 wks if severe -IV magnesium sulfate (to prevent seizure)

282
Q

Eclampsia is…

A

preeclampsia + maternal seizures.

283
Q

Maternal death in eclampsia is due to…

A

stroke leading to intracranial hemorrhage or ARDS.

284
Q

Treatment of eclampsia is…

A

antihypertensives IV magnesium sulfate immediate delivery

285
Q

HELLP Syndrome is…

A

Hemolysis, Elevated Liver enzymes, and Low Platelets (a manifestation of severe preeclampsia; deliver immediately)

286
Q

Placental abruption is…

A

premature separation of the placenta from the uterine wall before delivery of the infant. Life threatening for both mother and fetus.

287
Q

Risk factors for placental abruption include (5)…

A

trauma smoking HTN preeclampsia cocain abuse

288
Q

Presentation of placental abruption

A

-abrupt, painful bleeding in 3rd trimester -possible DIC -maternal shock -fetal distress

289
Q

Placental accreta, increta and percreta are due to…

A

defective decidual layers leading to abnormal attachment and separation after delivery.

290
Q

Risk factors for placental accreta/increta/percreta include (3)…

A

prior C-section inflammation placenta previa

291
Q

Placenta accreta

A

placenta attaches to the myometrium without penetrating it

292
Q

Placenta increta

A

placenta penetrates into myometrium

293
Q

Placenta percreta

A

placenta penetrates through the myometrium adn into the uterine serosa; can result in placental attachment to rectum or bladder

294
Q

Presentation of Placenta accreta/increta/percreta

A

-no separation of placenta after delivery leading to massive bleeding

295
Q

Placenta previa is…

A

attachment of the placenta to the lower uterine segment. It lies near, partially covers or completely covers the internal cervical os. (painless)

296
Q

Risk factors for placenta previa (2)

A

multiparity prior C-section

297
Q

Retained placental tissue may cause…

A

postpartum hemorrhage and increases risk of infection.

298
Q

Ectopic pregnancy most often occurs in the…

A

ampulla of the fallopian tube.

299
Q

Ectopic pregnancy should be suspected with a hx of…

A

amenorrhea, lower-than-expected rise in hCG and sudden lower abdominal pain. (+/- bleeding)

300
Q

Ectopic pregnancy is confirmed with…

A

ultrasound.

301
Q

Risk factors for ectopic pregnancy (4)

A

-hx of infertility -salpingitis -ruptured appendix -prior tubal surgery

302
Q

Polyhdramnios (> 1.5-2 L) is associated with…

A

fetal malformations (inability to swallow amniotic fluid), maternal diabetes, and multiple gestations.

303
Q

Oligohydramnios (< .5 L) is associated with…

A

placental insufficiency, bilateral renal agenesis or posterior urethral valves (inability to excrete urine).

304
Q

Profound Oligohydramnios can cause…

A

POTTER sequence.

305
Q

Dysplasia/Carcinoma in situ is…

A

disordered epithelial growth that begins at the basal layer of squamocolumnar junction and extends outward.

306
Q

Dysplasia/Carcinoma in situ is associated with….

A

HPV 16 and HPV 18 which both produce the E6 gene (inhibits p53) and E7 (inhibits Rb)

307
Q

Dysplasia/Carcinoma in situ is typically…

A

asymptomatic or presents as abnormal vaginal bleeding. Can progress to invasive carcinoma (catch early with pap smear).

308
Q

Risk factors for dysplasia/carcinoma in situ

A

-multiple sexual partners -smoking -early intercourse -HIV

309
Q

Invasive carcinoma is often…

A

squamous cell carcinoma. Lateral invasion can block the ureters, causing renal failure.

310
Q

Endometritis is…

A

inflammation of the endometrium (with plasma cells and lymphocytes).

311
Q

Endometritis is associated with…

A

retained products of conception following delivery/miscarriage/abortion or foreign bodies such as an IUD.

312
Q

Retained material in the uterus promotes…

A

infxn by bacterial flora from the vagina or intestinal tract.

313
Q

Treatment for endometritis

A

gentamicin + clindamycin (+/- ampicillin)

314
Q

Endometriosis is…

A

non-neoplastic endometrial glands/stroma outside of the endometrial cavity; most commonly in the ovaries, pelvis adn peritoneum; normal sized uterus.

315
Q

In the ovary, endometriosis appears as…

A

an endometrioma (blood-filled “chocolate cyst”).

316
Q

Endometriosis can be due to…

A

retrograde flow, metaplastic transformation of multipotent cells or transportation of endometrial tissue via the lymphatic system.

317
Q

Endometriosis is characterized by…

A

cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia and infertily.

318
Q

Treatment for Endometriosis

A

NSAIDs OCPs progestins GnRH agonists surgery

319
Q

Adenomyosis is…

A

extension of the endometrial tissue (glandular) into the uterine myometrium caused by hyperplasia of the basalis layer of the endometrium.

320
Q

Adenomyosis is characterized by….

A

dysmenorrha, menorrhagia and an enlarged, soft, globular uterus.

321
Q

Treatment for Adenomyosis

A

hysterectomy

322
Q

Adenomyoma (polyp) is a…

A

well-circumscribed collection of endometrial tissue within the uterine wall. May contain smooth muscle cells.

323
Q

Endometrial hyperplasia is…

A

abnormal endometrial gland proliferation caused by excess estrogen stimulation. Give an increased risk for endometrial carcinoma.

324
Q

Endometrial hyperplasia manifests as…

A

postmenopausal vaginal bleeding.

325
Q

Risk factors for endometrial hyperplasia include…

A

anovulatory cycles, hormone replacement therapy, polycystic ovarian syndrome, and granulosa cell tumor.

326
Q

Endometrial carcinoma clinically presents with…

A

vaginal bleeding at ages 55-65.

327
Q

Risk factors for endometrial carcinoma include…

A

prolonged use of estrogen w/o progestins obesity diabetes HTN nulliparity late menopause (often preceded by endometrial hyperplasia)

328
Q

Leiomyoma (aka fibroid) often presents with…

A

multiple discrete tumors. Increased incidence in black females from 20-40 yrs old. It is a benign smooth muscle tumor.

329
Q

Leiomyomas are sensitive to…

A

estrogen so the tumor size increases with pregnancy and decreases with menopause.

330
Q

Leiomyoma manifestations include…

A

asymptomatic, abnormal uterine bleeding, miscarriage. Severe bleeding may cause iron deficiency anemia.

331
Q

Leiomyomas do not progress to…

A

leiomyosarcoma.

332
Q

Histology of Leiomyoma

A

whorled pattern of smooth muscle bundles with well-demarcated borders

333
Q

Polycystic Ovarian Syncrome (PCOS) is…

A

hyperandrogenism due to deranged steroid synthesis by theca cells and hyperinsulinemia.

334
Q

PCOS results in…

A

enlarged, bilateral cystic ovaries. It presents with amenorrhea, hirsutism, acne and infertility. Associated with obesity.

335
Q

PCOS has an increased risk for…

A

endometrial cancer secondary to increased estrogens from aromatization of testosterone and absence of progesterone.

336
Q

Treatment for PCOS

A

-weight reduction -OCPs -antiandrogens -clomiphene citrate -metformin -cyclic progesterones

337
Q

Lab features of PCOS

A

-increased LH and FSH (ratio is LH:FSH, 3:1) -increased testosterone -increased estrogen -increased insulin

338
Q

PCOS is the most common cause of….

A

infertility in women.

339
Q

Follicular cyst is a…

A

distention of unruptured graafian follicle. May be associated with hyperestrogenism and endometrial hyperplasia.

340
Q

Corpus luteum cyst is…

A

a hemorrhage into persitent corpus luteum.

341
Q

Theca-lutein cyst

A

-often bilateral/multiple -due to gonadotropin stimulation -associated with choriocarcinoma and moles

342
Q

Hemorrhagic cyst

A

-blood vessel rupture in cyst wall -cyst grows with increased blood retention

343
Q

Dermoid cyst

A

-mature teratoma -cystic growths filled with various types of tissue such as fat, hair, teeth, etc.

344
Q

Endometrioid cyst

A

-endometriosis within ovary with cyst formation -varies with menstural cycle -when filled with dark, reddish-brown blood, called a “chocolate cyst”

345
Q

Risk of ovarian neoplasm is increased with…

A

age, infertility, endometriosis, PCOS, genetics (BRCA-1/2, HNPCC, fam hx).

346
Q

Risk of ovarian neoplasm decreases with…

A

previous pregnancy, hx of breastfeeding, OCPs, tubal ligation.

347
Q

Ovarian neoplasms presetn with…

A

adnexal mass, abdominal distention, bowel obstruction and pleural effusion.

348
Q

Ovarian neoplasms can be monitored by measureing…

A

CA-125 levels (not for screening).

349
Q

Serous cystadenoma features (3)

A

-thin-walled, uni or multi locular -lined with fallopian-like epithelium -often bilateral

350
Q

Mucinous cystadenoma (2)

A

-multiloculated, large -lined by mucus-secreting epithelium

351
Q

Endometrioma (3)

A

-mass arising from gorwth of ectopic endometrial tissue -complex mass on U/S -presents with pelvic pain, dysmenorrhea and dyspareunia

352
Q

Mature cystic teratoma (dermoid cyst) (4)

A

-germ cell tumor (common in women 20-30) -contains elements form all 3 germ layers -presents with pain seoncdary to ovarian enlargement or torsion -can contain functional thyroid tissue and present as hyperthyroidism (struma ovarii)

353
Q

Brenner tumor (2)

A

-solid tumor that is pale yellow-tan and appears encapsulated (looks like bladder) -coffee bean nuclei

354
Q

Fibromas (3)

A

-bundles of spindle-shaped fibroblasts -Meigs syndrome -pulling sensation in groin

355
Q

Meigs syndrome is a…

A

triad of fibroma, ascites and hydrothorax.

356
Q

Thecoma (2)

A

-like granulosa cell tumors, may produce estrogen -usually present as abnormal uterine bleeding in a postmenopausal woman

357
Q

Immature teratomas (3)

A

-aggressive -contains fetal (embryonic-like) tissue -neuroectoderm

358
Q

Granulosa cell tumor (4)

A

-often produce estrogen and/or progesterone -present with abnormal uterine bleeding, xexual precocity, breast tenderness -usually in women in 50s -Call-Exner bodies (resemble primordial follicles)

359
Q

Serous cystadenocarcinoma (2)

A

-frequently bilateral -psammoma bodies

360
Q

Mucinous cystadenoma (2)

A

-pseudomyxoma pertonei (intraperitoneal accumulatio nof mucinous material from ovarian or appendiceal tumor)

361
Q

Dysgerminoma (3)

A

-common in adolescents -sheets of uniform “fried egg” cells -tumor markers are hCG and LDH

362
Q

Choriocarcinoma (7)

A

-develops during/after pregnancy in mother or baby -malignancy of trophoblastic tissue -no chorionic villi -increased frequency of theca-lutein cysts -presents with abnormal beta-hCG, SOB and hemoptysis -hematogenous spread to lungs -responds to chemo

363
Q

Yolk sac (endodermal sinus) tumor (5)

A

-aggressive -in ovaries or testes and sacrococcygeal area in young children -yello, friable, solid mass -Schiller-Duval bodies (resemble glomeruli) -AFP tumor marker

364
Q

Krukenberg tumor (2)

A

-GI malignancy that metastasizes to the ovaries -causes a mucin-secreting, signet cell adenocarcinoma

365
Q

Vaginal Squamous Cell Carcinoma is usually…

A

secondary to cervical SCC.

366
Q

Vaginal clear cell adenocarcionma affects…

A

women who had exposure to DES in utero.

367
Q

Sarcoma botryoides affects…

A

girls < 4 yrs old; spindle-shaped tumor cells that are desmin +.

368
Q

Fibroadenoma is a…

A

small, mobile firm mass with sharp edges most common in those younger than 35.

369
Q

Fibroadenoma increases in size and tenderness with…

A

estrogen. It is not a precursor to cancer.

370
Q

Intraductal papilloma is a…

A

small tumor that grows in the lactiferous ducts. Typically beneath the areola.

371
Q

Intraductal papilloma presents with…

A

serous or bloody nipple discharge. Slight increased risk for carcinoma.

372
Q

Phyllodes tumor is a…

A

large bulky mass of CT and cysts. “leaf-like” projections. (common in 6th decade)

373
Q

Malignant breast tumors are commonly…

A

postmenopausal and arise from terminal duct lobular unit.

374
Q

In malignant breast tumors, overexpression of…

A

estrogen/progesterone receptors or c-erbB2 is common.

375
Q

Breast tumors are more aggressive if they are…

A

triple negative (ER -, PR -, Her2/Neu -).

376
Q

The single most important prognostic factor for malignant breast cancer is…

A

axillary LN involvement indicating metastasis.

377
Q

Most common location of malignant breast cancer

A

upper outer quadrant

378
Q

Risk factors for malignant breast cancer (6)

A
  1. increased estrogen 2. increased total number of menstrual cycles 3. older age at 1st live birth 4. obesity 5. BRCA1 and BRCA2 mutations 6. African Amerian ethnicity
379
Q

Ductal carcinoma in situ fills…

A

the ductal lumena and arises from ductal atypia. Seen as microcalcifications.

380
Q

Ductal carcinoma in situ is an early malignancy…

A

without basement membrane penetration.

381
Q

Comedocarcinoma is a subtype of…

A

DCIS. It is ductal and has caseous necrosis.

382
Q

Paget Disease results from…

A

underly DCIS.

383
Q

Paget Disease presents with…

A

eczematous patches on the nipple. It has Paget cells (large cells in dermis with clear halo.

384
Q

Invasive ductal carcinoma is a…

A

firm, fibrous, rock-hard mass with sharp margins and small, glandular, duct-like cells. Gross stellate infiltration.

385
Q

Invasive lobular carcinoma is often…

A

bilateral with multiple lesions in the same location; orderly row of cells (indian file).

386
Q

Medullary breast carcinoma is a…

A

fleshy, cellular lymphocytic infiltrate.

387
Q

Inflammatory breast carcinoma is a…

A

dermal lymphatic invasion. Presents with peau d’orange.

388
Q

Proliferative breast disease presents with…

A

premsentrual breast pain, bilateral, multiple lesions, and fluctuation in mass size.

389
Q

Histologic types of Proliferative breast disease

A
  1. Fibrosis 2. Cystic 3. Sclerosing adenosis 4. Epithelial hyperplasia
390
Q

Fibrosis (proliferative brease disease)

A

hyperplasia of breast stroma

391
Q

Cystic (proliferative breast disease)

A

fluid, billed, blue dome, ductal dilation

392
Q

Sclerosing adenosis

A

increased acini and intralobular fibrosis; associated with calcifications; increased risk of cancer

393
Q

Epithelial hyperplasia

A

increase in number of epithelial cell layers in terminal duct lobule; increased risk of carcinoma; occurs in women > 30

394
Q

Acute mastitis is a…

A

breast abcess caused by cracks in the nipple from breast-feeding that leads to infxn from S. aureus

395
Q

Acute mastitis should be treated with…

A

dicloxacillin and continued breast feeding.

396
Q

Fat necrosis is a…

A

benign, usually painless lump that forms as a result of injury to breast tissue.

397
Q

Fat necrosis findings

A

-calcifications on mammography -biopsy shows necrotic fat, giant cells

398
Q

Gynecomastia results from…

A

hyperestrogenism (cirrhosis, testicular tumor, puberty, old age), Klinefelter syndrome and drugs.

399
Q

Drugs that cause gynecomastia

A

-Spironolactone -marijuana -Digitalis -Estrogen -Cimetidine -Alcohol -Heroin -Dopaine D2 antagonists -Ketoconazole

400
Q

Prostatitis usually presents with…

A

dysuria, frequency, urgency and low back pain.

401
Q

Acute prostatitis is usually due to…

A

E. coli.

402
Q

Benign prostatic hyperplasia (BPH) is characterized by…

A

smooth, elastic, firm nodular enlargement of the peiurethral lobes which compress the urethra into a vertical slit.

403
Q

BPH often presesnts with…

A

increased frequency of urination, nocturia, difficulty stopping and starting stream, dysuria. Increased PSA

404
Q

BPH may lead to…

A

distention/hypertrophy of the bladder, hydronephrosis, and UTIs.

405
Q

Treatments for BPH

A

-alpha1 antagonists (terazosin, tamulosin which cause relaxation of smooth muscle) -finasteride

406
Q

Prostatic adenocarcinoma arises most often from the…

A

posterior lobe (peripheral zone) of the prostate and is diagnosed by increased PSA and needle core biopsies.

407
Q

Tumor markers of prostatic adenocarcinoma include…

A

PSA and PAP.

408
Q

Prostatic adenocarcinoma may develop into…

A

osteoblastic metastases in the bone indicated by lower back pain and increased serum ALP.

409
Q

Cryptorchidism is…

A

undescended testis, with impaired spermatiogenesis. Can have normal testosterone levels (Leydig cells unaffected by heat).

410
Q

Cryptorchidism is associated with…

A

increased risk of germ cell tumors. Prematurity increases the risk.

411
Q

Lab features of cryptorchidism

A

-decreased inhibin -increased FSH -increased LH -testosterone decreased in bilateral

412
Q

Varicocele is…

A

dialted veins in the pampiniform plexus as a result of increased venous pressure. Most common cause of scrotal enlargment in adults.

413
Q

Varicocele is most often on the…

A

left side because of increased resistance to flow from left gonadal vein drainage into the renal vein.

414
Q

Varicocele appears as…

A

a “bag of worms” and is diagnosed by U/S w/ doppler.

415
Q

Treatment for varicocele

A

varicocelectomy embolization

416
Q

Risk factors for testicular germ cell tumors

A

-cryptorchidism -Klinefelter -young age

417
Q

Seminoma features (5)

A

-painless, testicular enlargmeent -3rd decade -large cells in lobules with watery cytoplasm and a “fried egg” appearance -increased placental AFP -radiosensitive

418
Q

Yolk sac tumor (testicular) (3)

A

-yellow, mucinous -schiller-duval bodies -common in boys < 3

419
Q

Choriocarcinoma (4)

A

-increased hCG -disordered syncytiotrophoblastic and cytotrophoblastic elements -hematogenous metastases to lungs and brain -may produce gynecomastia or hyperthyroid symptoms (hCG is an LH and TSH analog)

420
Q

Teratoma (2)

A

-malignant in males (NOT in females) -increased hCG and/or AFP

421
Q

Embryonal carcionma

A

-hemorrhagic mass with necrosis -painful -often glandular/papillary -increased hCG and normal AFP when pure

422
Q

Leydig cell tumor (4)

A

-contains Reinke crystals -usually androgen producing -gynecomastia or precocious puberty -golden brown color

423
Q

Sertoli cell tumor

A

-androblastoma from sex cord stroma

424
Q

Testicular lymphoma

A

-arises from lymphoma metastases to testes

425
Q

Tunica vaginals lesions are…

A

in the serous covering of the testis present as testicular masses that can be transilluminated.

426
Q

Hydrocele

A

increaed fluid secondary to incomplete obliteration of processus vaginalis

427
Q

Spermatocele

A

dialted epididymal duct

428
Q

Penile SCC is most common in…

A

Asia, Africa and South America.

429
Q

Precursor lesions to penile SCC

A

-Bowen disease -erythroplasia of Queyrat -bowenoid papulosis

430
Q

Bowen Disease is in the…

A

penile shaft and presents as leukoplakia.

431
Q

Erythroplasia of Queyrat is…

A

cancer of the glans that presents as erythroplakia.

432
Q

Bowenoid papulosis presents as…

A

reddish papules.

433
Q

Penile SCC is associated with…

A

HPV and a lack of circumcision.

434
Q

Priapism is a…

A

painful, sustained erection.

435
Q

Priapism is associated with…

A

trauma sickle cell disease (RBCs get trapped in vaculature) medications (anticoagulants, PDE-5 inhibitors, antidepressants, alpha-blockers and cocaine)

436
Q

Leuprolide mechanism

A

-GnRH analog with agonist properties when used in a pulsatile fashion; antagonist properties when used continuously (downregulates GnRH receptor in the pituitary leading to decreased FSH/LH)

437
Q

Clinical use of Leuprolide

A

infertility prostate cancer uterine fibroids precocious puberty

438
Q

Clinical use of estrogens (ethinyl estradiol, DES, mestranol)

A

-hypogonadism or ovarian failure -mesntrual abnormalities -HRT in postmenopausal women -used in men with androgen dependent prostate cancer

439
Q

Toxicity of estrogens

A

-increased risk of endometrial cancer -bleeding -clear cell adenocarcionma of vagina (DES) -increased risk of thrombi

440
Q

Estrogens are contraindicated in…

A

ER + breast cancer and those with a hx of DVTs

441
Q

Selective Estrogen Receptor Modulators (SERMs)

A

-Clomiphene -Tamoxifen -Raloxifene

442
Q

Clomiphene is an…

A

antagonist at estrogen receptors in the hypothalamus that prevents normal feedback inhibition leading to increaed release of LH and FSH from the pituitary which stimulates ovulation.

443
Q

CLompihene is used to treat…

A

infertility due to anovulation (PCOS).

444
Q

Clomiphene may cause…

A

hot flashes, ovarian enlargement, multiple simultaneous pregnancies and visual disturbances.

445
Q

Tamoxifen is an…

A

antagonist on breat tissue and agonist in bone and the uterus.

446
Q

Tamoxifen is associated with…

A

endometrial cancer and thromboembolic events.

447
Q

Tamoxifen is primarily used to treat and prevent recurrence of…

A

ER + breast cancer.

448
Q

Raloxifene is an…

A

agonist on bone and antagonist at the uterus.

449
Q

Raloxifene increases risk of…

A

thromboemblic events.

450
Q

Raloxifene is used to treat…

A

osteoporosis bc it decreases resorption of bone.

451
Q

HRT is used for…

A

relief of menopausal symptoms and osteoporosis.

452
Q

Unopposed estrogen replacement therapy increases risk of…

A

endometrial cancer so progesterone is added.

453
Q

Anastrozole/Exemestane are…

A

aromatase inhibitors used in postmenopausal women with breast cancer

454
Q

Progestins MOA

A

bind progesterone receptors to decrease growth and increase vascularization of the endometrium

455
Q

Progestins Use

A

used in oral contraceptives and in treatment of endometrial cancer and abnormal uterine bleeding

456
Q

Mifepristone MOA

A

competitive inhibitor of progestins

457
Q

Clinical use of mifepristone

A

termination of pregnancy (administered with misoprostol (PGE1))

458
Q

In OCPs, estrogen and progestins inhibit…

A

LH/FSH and thus prevent the estrogen surge. No estrogen surge means no LH sruge means no ovulation.

459
Q

In OCPs, progestins cause…

A

thickening of the cervical mucus (limiting access to sperm) and they inhibit endometrial proliferation making it less suitable for implantation.

460
Q

Contraindications for OCPs

A

smokers > 35 hx of thromboembolism, stroke or estrogen-dependent tumors

461
Q

Terbutaline is a…

A

beta2-agonist that relaxes the uterus; usted to decrease contraction frequency in women during labor.

462
Q

Danazol MOA

A

synthetic androgen that acts as a partial agonist

463
Q

Use of Danazol

A

endometriosis and angioedema

464
Q

Toxicity of Danazol

A

-weight gain -edema -acne -hirsutism -masculinization -decreased HDL -hepatotoxicity

465
Q

MOA of Testosterone and Methyltestosterone

A

agonist at androgen receptors

466
Q

Use of Testosterone and Mehtyltestosterone

A

-hypogonadism -promotes development of secondary sex characteristics -stimulation of anabolism to promote recovery after burn or injury

467
Q

Toxicity of testosterone

A

-masculinization -decrease intratesticular testosterone (gonadal atrophy due to decreased LH) -premature closure of epiphyseal plates -increased LDL, decreased HDL

468
Q

Finasteride is a…

A

5alpha-reductase inhibitor that decreases the conversion of testosterone to DHT

469
Q

Finasteride uses

A

-BPH -male pattern baldness

470
Q

Flutamide is a…

A

nonsteroidal competitive inhibitor of androgens at teh testoterone receptor.

471
Q

Flutamide is used in…

A

prostate carcinoma.

472
Q

Ketoconazole inhibits…

A

steroid synthesis (inhibits 17,20-desmolase).

473
Q

Spironolactone inhibits…

A

steroid binding, 17alpha-hydroxylase and 17,20-desmolase.

474
Q

Ketoconazole and spironolactone are used in the treatment of…

A

PCOS to prevent hirsutism. Both have side effects of gynecomastia and amenorrhea.

475
Q

Tamsulosin is an…

A

alpha1-antagonist used to treat BPH by inhibiting smooth muscle contraction. Selective for alpha1A,D receptor found on prostate.

476
Q

Sildenafil and Vardenafil MOA

A

inhibit phosphodiesterase-5 causing increased cGMP, smooth muscle relaxation, increased blood flow and penile erection

477
Q

Toxicity of Sildenafil and Vardenafil

A

-dyspepsia -impaired blue-green color vision -risk of life-threatening hypotension in pts taking nitrates (since they block teh breakdown of NO)

Step 1 Exam (32 decks)

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