Reproductive - First Aid Flashcards
1
Q
Sonic hedgehog gene is produced at the…
A
base of the limbs in the zone of polarizing activity.
2
Q
Sonic hedgehog gene is involved in..
A
patterning along the anterior posterior axis and CNS development.
3
Q
Mutation of the sonic hedgehog gene can cause….
A
holoprosencephaly.
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.
5
Q
Wnt-7 gene is necessary for…
A
proper organization along the dorsal-ventral axis.
6
Q
FGF gene is produced at the….
A
apical ectodermal ridge.
7
Q
FGF gene stimulates….
A
mitotis of the underlying mesoderm providing for lengthening of limbs.
8
Q
Homeobox (Hox) gene is involved in…
A
segmental organization of the embryo in a craniocaudlal direction.
9
Q
Hox mutations lead to…
A
appendages in the wrong locations.
10
Q
Day 0 of fetal development
A
fertilization by sperm, forming zygote, initiating embryogenesis
11
Q
Fetal development within one week
A
hCG secretion begins around the time of implantation of the blastocyst
12
Q
Fetal development within 2 weeks
A
bilaminar disc (epiblast, hypoblast) (2 weeks = 2 layers)
13
Q
Fetal development within 3 weeks
A
trilaminar disc (3 wks = 3 layers) gastrulation primitive streak, notochord, mesoderm, neural plate begin to form
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
15
Q
Fetal development within within wk 4
A
heart begins to beat upper and lower limb buds (week 4 = 4 chambers, 4 limbs)
16
Q
Fetal development within week 6
A
fetal cardiac activity is visible by transvaginal ultrasound
17
Q
Fetal development within week 10
A
genitalia have male/female characteristics
18
Q
Gastrulation is the process that…
A
forms the trilaminar embryonic disc. It establishes the ectoderm, mesoderm and endoderm germ layers.
19
Q
Gastrulation starts with the….
A
epiblast invaginating to form the primitve streak.
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
21
Q
A craniopharyngioma is…
A
a benign Rathke pouch tumor with cholesterol crystals and calcifications. (surface ectoderm derivative)
22
Q
Neuroectoderm derivatives (3)
A
-brain (neurohypophysis, CNS neurons, oligodendrocytes, astrocytes, ependymal cells, pineal gland) -retina and optic nerve -spinal cord
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
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
25
Mesodermal defects =
VACTERL -Vertebral defects -Anal atresia -Cardiac defects -Tracheo-Esophageal fistula -Renal defects -Limb defects
26
Endoderm derivatives
-gut tube epithelium -most of urethra -luminal epithelial derivatives (lung, liver, gallbladder, pancreas, eustachian tube, thymus, parathyroid)
27
Agenesis
absent organ due to absent primordial tissue
28
Aplasia
absent organ despite presence of primordial tissue
29
Hypoplasia
incomplete organ development; primordial tissue present
30
Deformation
extrinsic disruption; occurs after the embryonic period
31
Disruption
secondary breakdown of a previously normal tissue (ex. amniotic band syndrome)
32
Malformation
intrinsic disruption; occurs during the embryonic period
33
Sequence
abnormalities result from a single primary embryological event
34
Before week 3, teratogens cause...
all-or-none effects.
35
After week 8, teratogens affect...
growth and function.
36
ACE Inhibitors cause...
renal damage.
37
Alkylating agents cause...
absence of digits
38
Aminoglycosides cause...
CN VIII toxicity
39
Carbamazepine causes...
neural tube defects\*\*\* craniofacial defects fingernail hypoplasia developmental delay IUGR
40
Diethylstilbestrol (DES) causes...
vaginal clear cell adenocarcinoma congenital Mullerian anomalies
41
Folate antagonists cause...
neural tube defects
42
Lithium causes...
ebstein anomaly (atrialized right ventricle)
43
Methimazole causes...
aplasia cutis congenita
44
Phenytoin causes...
Fetal hydantoin syndrome (microcephaly, dysmorphic craniofacial features, hypoplastic nails and distal phalanges, cardiac defects, IUGR and intellectual disability)
45
Tetracyclines cause...
discolored teeth
46
Thalidomide causes...
limb defects (phocomelia, micromelia)
47
Valproate causes...
inhibition of maternal folate absorption leading to neural tube defects
48
Warfarin causes...
bone deformities, fetal hemorrhage, abortion, and ophthalmologic abnormalities
49
Cocaine causes...
abnormal fetal growth and fetal addiction; placental abruption.
50
Smoking (nicotine, CO) causes...
low birth weight, preterm labor, placental problems, IUGR, and ADHD.
51
Iodine (lack or excess) causes...
congenital goiter or hypothyroidism (cretinism)
52
Maternal diabetes causes...
caudal regression syndrome (anal atreisa to sirenomelia), congenital heart defects and neural tube defects.
53
Excess vitamin A causes...
extremely high risk for spontaneous abortions and birth defects (cleft palate, cardiac abnormalities).
54
X-rays cause...
microcephaly and intellectual disability.
55
Congenital malformations (7) of Fetal Alcohol Syndrome include...
intellectual disability developmental retardation microcephaly holoprosencephaly facial abnormalities limb dislocation heart defects
56
Facial abnormalities of FAS include...
smooth philtrum, thin upper lip, small palpebral fissures and hypertelorism.
57
Dizygotic twins arise from...
2 eggs that are separately fertilized by 2 different sperm and will have 2 separate amniotic sacs and 2 separate placentas.
58
Monozygotic twins arise from...
1 fertilized egg that splits into 2 zygotes early in pregnancy.
59
The degree of separation between monozygotic twins depends on...
when the fertilized egg splits into 2 zygotes. the timing of this separation determines the number of chorions (placentas) and amnions.
60
Fetal components of the Placenta
-cytotrophoblast -syncytiotrophoblast
61
Maternal component of the placenta
decidua basalis
62
The cytotrophoblas is the...
inner layer of chorionic villi that makes cells.
63
The syncytiotrophoblast is the...
outer layer of chorionic villi that secretes hCG.
64
The decidua basalis is derived from the...
endometrium and has maternal blood in lacunae.
65
The umbilical arteries (2) return...
deoxygenated blood from the fetal internal iliac arteries to the placenta.
66
The umbilical vein (1) supplies...
oxygenated blood from the placenta to the fetus and drains into the IVC via the liver or via the ductus venosus.
67
The most oxygenated blood in the fetus is located in the...
umbilical vein.
68
A single umbilical artery is associated with..
congenital and chromosomal anomalies.
69
The umbilical arteries and veins are derived from...
allantois.
70
In the 3rd week, the yolk sac forms the...
allantois which extends into the urogenital sinus.
71
The allantois becomes the...
urachus, a duct between fetal bladder and yolk sac.
72
Failure of the urachus to obliterate results in (3):
1. patent urachus 2. urachal cyst (partial failure) 3. vesicourachal diverticulum
73
A patent urachus allows...
urine discharge from the umbilicus.
74
A urachal cyst is a...
fluid-filled cavity lined with uroepithelium, between the umbilicus and bladder.
75
A urachal cyst can lead to...
infection and adenocarcinoma.
76
A veicourachal diverticulum is...
outpouching of the bladder.
77
The vitelline duct is...
a connection from the yolk sac to the midgut lumen. It is obliterated in the 7th week.
78
Failure of the vitelline duct to close results in (2):
1. vitelline fistula 2. meckel diverticulum
79
Vitelline fistula causes...
meconium discharge from the umbilicus.
80
Meckel diverticulum has partial closure of the vitelline duct with the patent portion...
attached to the ileum (a true diverticulum).
81
A meckel diverticulum may contain...
ectopic gastric mucosa and/or pancreatic tissue leading to melena, periumbilical pain and ulcers.
82
The 1st aortic arch becomes...
part of the maxillary artery.
83
The 2nd aortic arch becomes...
the stapedial artery and hyoid artery.
84
The 3rd aortic arch becomes...
the common carotid artery and the proximal part of the internal carotid artery.
85
The 4th aortic arch becomes..
the aortic arch on the left and the right subclavian.
86
The 6th aortic arch becomes...
the proximal part of the pulmnoary arteries and the ductus arteriosus (on the left).
87
The branchial apparatus is composed of...
branchial clefts, arches and pouches.
88
The branchial clefts (grooves) are derived from...
ectoderm.
89
The branchial arches are derived from...
mesoderm (muslces, arteries) and neural crest (bone, cartilage).
90
The branchial pouches are derived from...
endoderm.
91
The 1st branchial cleft develops into the...
external auditory meatus.
92
the 2nd through 4th branchial clefts form...
temporay cervical sinuses which are obliterated by proliferation of 2nd arch mesenchyme.
93
A persistent cervical sinus leads to...
a branchial cleft syst within the lateral neck.
94
1st branchial arch cartilage derivatives
-meckel cartilage: mandible, malleus, incus, spheno-mandibular ligament
95
1st branchial arch muscle derivatives
-muscles of mastication (temporalis, masseter, lateral and medial pterygoids) -mylohyoid -anterior belly of digastric -tensor tympani -tensor veli palatini
96
1st branchial arch nerves
CN V2 and V3
97
Abnormality of the 1st branchial arch leads to...
Treacher Collins Syndrome (which is when the first arch neural crest fails to migrate leading to mandibular hypoplasia and facial abnormalities)
98
2nd branchial arch cartilage derivatives
Reichert cartilage (stapes, styloid process, lesser horn of the styoid and stylohyoid ligament)
99
2nd branchial arch muscle derivatives
Muscles of facial expression (stapedius, stylohyoid, platysma, belly of digastric)
100
2nd branchial arch nerve derivatives
CN VII (facial expression)
101
Abnormalities of the 2nd branchial arch leads to...
congenital pharyngocutaneous fistula (persistence of the cleft and pouch leads to a fistula between the tonsillar area and lateral neck)
102
3rd branchial arch cartilage derivatives
greater horn of hyoid
103
3rd branchial arch muscle derivatives
stylopharyngeus
104
3rd branchial arch nerve derivative
CN IX
105
4th-6th branchial arch cartilage derivatives
-thyroid -cricoid -arytenoids -corniculate -cuneiform
106
4th branchial arch nerve derivative
CN X (superior laryngeal branch)
107
6th branchial arch nerve derivative
CN X (recurrent laryngeal branch)
108
The 1st branchial pouch develops into...
the middle ear cavity, eustachian tube and mastoid air cells. (endoderm-lined ear structures)
109
The 2nd branchial pouch develops into...
epithelial lining of the palatine tonsil.
110
The 3rd branchial pouch develops into...
dorsal wings --\> inferior parathyroids ventral wings --\> thymus
111
The 4th branchial pouch develops into...
dorsal wings --\> superior parathyroids
112
DiGeorge Syndrome is due to...
aberrant development of the 3rd and 4th branchial pouches which leads to T-cell deficiency (thymic hypoplasia) and hypocalcemia (failure of parathyroid devo).
113
MEN2A is due to a...
mutation of germline RET (neural crest cells).
114
Features of MEN2A (3)
-pheochromocytoma (adrenal medulla) -parathyroid tumor (3rd/4th pouches) -medullary thryoid cancer (4th/5th pouches)
115
Cleft lip is due to...
failure of fusion of the maxillary and medial nasal processes.
116
Cleft palate is due to..
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.
117
Default emryological development is...
female. The mesonephric duct degenerates and the paramesonephric duct develops.
118
The SRY gene is located on the...
Y chromosome and produces testis-determining factor which causes the testes to develop.
119
Sertoli cells secrete...
mullerian inhibitory factor (MIF) that suppresses the development of the paramesonephric ducts.
120
Leydig cells secrete...
androgens taht stimulate the development of the mesonephric ducts.
121
The parapmesonephric (mullerian) ducts develop into...
female internal structures (fallopian tubes, uterus, uppe portion of the vagina).
122
The lower portion of the vagina is from the...
UG sinus.
123
Mullerian duct abnormalities result in...
anatomical defects that may present as primary amenorrhea with fully developed secondary sex characteristics.
124
The mesonephric (wolffian) ducts develop into...
male internal structures (except prostate) - seminal vesicles, epididymis, ejaculatory duct and ductus deferens.
125
A bicornate uterus results from...
incomplete fusion of the paramesonephric ducts. Can lead to recurrent miscarriages.
126
Complete failure of fusion of the paramesonephric ducts leads to...
double uterus and vagina.
127
No sertoli cells or a lack of MIF will lead to...
development of both male and female internal genitalia and male external genitalia.
128
5-alpha reductase deficiency leads to...
inability to convert testosterone into DHT; pts will have male internal genitalia and ambiguous external genitalia until puberty (when increased testosterone levels cause masculinization).
129
In the female, the genital tubercle becomes...
the glans clitoris and vestibular bulbs.
130
In the male, the genital tubercle becomes...
the glans penis and corpus cavernosum/spongiosum.
131
In the female, the urogenital sinus becomes...
the greater vestibular glands (Bartholin) and the urethral/paraurethral glands (Skene).
132
In the male, the urogenital sinus becomes...
the bulbourethral glands of Cowper and the prostate gland.
133
In the female, the urogenital folds become...
the labia minora.
134
In the male, the urogenital folds become...
the ventral shaft of the penis.
135
In the female, the labioscrotal swelling becomes the...
labia majora.
136
In the male, the labioscrotal swelling becomes the..
scrotum.
137
Hypospadias is an...
abnormal opening of the penile urethra on the inferior (ventral) side of the penis due to failure of the urethral folds to close.
138
Fix hypospadias to prevent..
UTIs.
139
Epispadias is...
an abnormal opening of the penile urethra on the superior (dorsal) side of the penis due to faulty positioning of the genital tubercle.
140
Epispadias is associated with...
exstrophy of the bladder.
141
The male remnant of the gubernaculum is...
anchoring the testes within the scrotum.
142
The female remnant of the gubernaculum is...
the ovarian ligament and the round ligament.
143
The male remnant of the processus vaginalis forms...
the tunica vaginalis.
144
The female remnant of the processus vaginalis is...
obliterated.
145
The left ovary/testis is drained via the...
left gonadal vein to the left renal vein to the IVC.
146
The right ovary/testis is drained via the..
right gonadal vein to the IVC.
147
Ovaries and testes lymph drain to the...
para-aortic LNs.
148
The distal vagina/vulva/uterus drain lymph to the...
superficial inguinal nodes.
149
The proximal vagina/uterus drains lymph to the...
obturator, external iliac and hypogastric nodes.
150
The left spermatic vein enters the left renal vein at a 90 degree angle leading to...
increased pressure compared to the right and more common varicoceles on the left.
151
The infundibulopelvic (suspensory) ligament connects...
the ovaries to the lateral pelvic wall.
152
The infundibulopelvic (suspensory) ligament contains...
the ovarian vessels. Need to be ligated during oophorectomy to avoid bleeding.
153
The ureter courses retroperitoneally close to...
the gonadal vessels and thus is at risk of injury during ligation of the ovarian vessels.
154
The cardinal ligament connects...
the cervix to the side wall of the pelvis.
155
The cardinal ligament contains...
the uterine vessels. The ureter is at risk during ligation of the uterine vessels in a hysterectomy.
156
The round ligament connects...
the uterine fundus to the labia majora.
157
The round ligament travels through...
the round inguinal canal above the artery of Sampson.
158
The broad ligament connects...
the uterus, fallopian tubes and ovaries to the pelvic side wall.
159
The broad ligament contains...
the ovaries, fallopian tubes and round ligaments.
160
The components of the broad ligament are the...
mesosalpinx, mesometrium and mesovarium.
161
The ovarian ligament connects the...
medial pole of the ovary to the lateral uterus.
162
Histology of the vagina
stratified squamous epithelium, nonkeratinized
163
Histology of the ectocervix
stratified squamous epithelium, nonkeratinized
164
Histology of the endocervix
simple columnar epithelium
165
Histology of the transformation zone
squamocolumnar juction (most common area for cervical cancer)
166
Histology of the uterus
simple columnar epithelium with long tubular glands
167
Histology of the fallopian tube
simple columnar epithelium, many ciliated cells, a few secretory (peg) cells
168
Histology of the ovary (outer surface)
simple cuboidal epithelium (germinal)
169
Female Sexual Response Cycle
1. phase of excitement (uterus elevates, vaginal lubrication) 2. plateau (expansion of inner vagina) 3. orgasm (contraction of uterus) 4. resolution
170
Female sexual response cycle is mediated by the..
autonomic nervous system.
171
Pathway of sperm during ejaculation
Semniferous tubules - epididymis - vas deferens - ejaclatory ducts - urethra - penis
172
Erection is innervated by the...
PNS (pelvic nerve). NO leads to increased cGMP causes smooth muscle relaxation, vasodilation and it becomes erect.
173
When the pelvic nerve secretes NE, this leads to..
an increase in calcium leading to smooth muscle contraction, vasoconstriction and this is antierectile.
174
Emission is innervated by...
the SNS (hypogastric nerve).
175
Ejaculation is innervated by...
visceral and somatic nerves (pudendal).
176
Spermatogonia (germ cells) maintain the...
germ pool and produce primary spermatocytes. They line the semniferous tubules.
177
Sertoli cells secrete...
inhibin (inhibits FSH) and androgen-binding protein (maintains local testosterone) and MIF.
178
Tight junctions between adjacent sertoli cells form..
the blood-testis barrier which isolates gametes from autoimmune attack.
179
Sertoli cells also support...
developing spermatozoa and regulate spermatogenesis.
180
Sertoli cells are sensitive to...
temperature. Increased temp leads to decreased sperm and increased inhibin.
181
The sertoli cells line...
seminiferous tubules.
182
The sertoli cells convert...
androstenedione to estrogen via aromatase.
183
Increased temperature of the testes is seen in both...
varicocele and cryptorchidism.
184
The Leydig cells secrete..
testosterone in the presence of LH. (unaffected by temp)
185
Estrogen sources
Ovary (17beta-estradiol) Placenta (estriol) Adipose tissue (estrone via aromatization)
186
Potency of the estrogens
estradiol \> estrone \> estriol
187
Estrogen is necessary for development of...
genitalia and breast and female fat distribution.
188
Estrogen is needed for growth of...
the follicle, endometrial proliferation and increased myometrial excitability.
189
Estrogen upregulates...
estrogen, LH and progesterone receptors.
190
Estrogen has feedback inhibition of...
FSH and LH, then an LH surge. It also stimulates prolactin secretion.
191
Estrogen increases...
transport proteins and SHBG; it increases HDL and decreases LDL
192
Estrogen during pregnancy:
50-fold increase in estradiol and estrone 1000-fold increase in estriol (indicator of fetal well-being)
193
Estrogen receptors are expressed in the...
cytoplasm and then translocate to the nucleus when bound.
194
In the theca cells, LH stimulates...
desmolase to convert cholesterol into androstenedione (which travels to the granulosa cells.
195
In the granulosa cells, FSH stimulates...
aromatase to convert androstenedione into estrogens.
196
Sources of progesterone
-corpus luteum -placenta -adrenal cortex -testes
197
Progesterone stimulates...
endometrial glandular secretions and spiral artery development.
198
Progesterone maintains...
pregnancy.
199
Progesterone decreases....
myometrial excitability (causes uterine smooth muscle relaxation) and estrogen receptor expressivity.
200
Progesterone produces...
thick cervical mucus, which inhibits early sperm entry into the uterus.
201
Progesterone increases...
temperature.
202
Progesterone inhibits...
LH and FSH.
203
Progesterone prevents...
endometrial hyperplasia.
204
The fall in progesterone after delivery acts to...
disinhibit prolactin which leads to prolactin.
205
Tanner Stages
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
The phase of the menstrual cycle that can vary in length is the...
follicular phase; luteal phase is usually a constant 14 days. Ovulation day + 14 days = menstruation
207
Decreased progesterone leads to...
decreased fertility.
208
Oligomenorrhea
\> 35 day cycle
209
Polymenorrhea
\< 21 day cycle
210
Metrorrhagia
frequent but irregular bleeding (intermenstrual)
211
Menorrhagia
\> 80 mL blood loss or \> 7 days of menses (heavy menstrual bleeding)
212
Menometrorrhagia
heavy, irregular menstruation at irregular levels
213
Increased estrogen midcycle leads to...
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
Primary oocytes begin...
meiosis I during fetal life and complete meiosis I just prior to ovulation.
215
Meiosis I is arrested in...
prophase I for years until ovulation (primary oocytes).
216
Meiosis II is arrested in...
metaphase II until fertilization (secondary oocytes).
217
If fertilizaiton does not occur within 1 day, then the...
secondary oocyte degenerates.
218
Ovulation is caused when...
increased estrogen and increased GnRH receptors on the anterior pituitary cause LH release leading to ovulation (rupture of the follicle).
219
Temperature during ovulation is...
increased from progesterone.
220
Mittelschmerz refers to...
transient mid-cycle ovulatory pain; classically associated with peritoneal irritation (follicular swelling, fallopian tube contraction). This can mimic appendicitis.
221
Fertilization most commonly occurs in the...
upper end of the fallopian tube (the ampulla). It occurs within one day of ovulation.
222
Implantation within the wall of the uterus occurs...
6 days after fertilization.
223
Syncytiotrophoblasts secrete...
hCG, which is detectable in the blood 1 week after conception and on the home urine test 2 wks after conception.
224
Suckling is required to maintain...
milk production since increased nerve stimulation increases oxytocin and prolactin.
225
Prolactin induces and maintains...
lactation and decreases reproductive fxn (decreases LH/FSH).
226
Oxytocin assists in...
milk letdown and promotes uterine contractions.
227
Breastmilk contains...
maternal Igs, macrophages and lymphocyts.
228
Breastmilk decreases risk for the child to develop....
asthma, allergies, DM and obesity (and infxns).
229
Exclusively breastfed infants require....
vitamin D supplementation.
230
Breastfeeding decreases maternal risk of...
breast and ovarian cancer.
231
hCG maintains...
the corpus luteum (and thus progesterone) for the 1st trimester by acting like LH to stimulate luteal cells.
232
In the 2nd and 3rd trimesters, the placenta synthesizes...
its own estriol and progesterone and the corpus luteum degenerates.
233
The alpha subunit of hCG is structurally....
identical to alpha subunits of LH, FSH, and TSH. The beta subunit is unique.
234
hCG is greatly increased in...
multiple gestations, hydatiform moles, and choriocarcinoma.
235
During menopause, there is decreased...
estrogen production due to age-linked decline in the number of ovarian follicles.
236
The source of estrogen after menopause becomes...
peripheral conversion of androgens. The increase in androgens leads to hirsutism.
237
Test for menopause with...
greatly increased FSH (due to loss of negative feedback on FSH due to decreased estrogen).
238
Hormonal changes during menopause (4)
1. decreased estrogen 2. increased FSH 3. increased LH 4. increased GnRH
239
Menopause causes:
HAVOCS -Hot flashes -Atrophy of the vagina -Osteoporosis -Coronary artery disease -Sleep disturbances
240
Spermatogenesis begins at...
puberty with spermatogonia. Full development takes 2 months. It occurs in the seminiferous tubules.
241
Spermatogenesis produces...
spermatids that undergo spermiogenesis (loss of cytoplasmic contnets, gain of acrosomal cap) to form mature spermatozoon.
242
Sources of Androgens
DHT and testosterone (testis) Androstenedione (adrenal)
243
Potency of the androgens
DHT \> testosterone \> androstenedione
244
Functions of Testosterone (5)
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
Functions of DHT (2)
1. differentiation of penis, scrotum, prostate (early) 2. prostate growth, balding, sebaceous gland activity (late)
246
Testosterone is converted to DHT by...
5alpha-reductase.
247
In the male, androgens are converted to estrogen by...
cytochrome P450 aromatase (mainly in adipose tissue and testis).
248
Exogenous testosterone leads to inhibition of...
the hypothalamic-pituitary-gonadal axis leading to decreased intratesticular testosterone leading to decreased testicular size and azoospermia.
249
Klinefelter Syndrome Features (7)
-XXY (male) -testicular atrophy -eunuchoid body shape -tall -gynecomastia -female hair distribution -presence of inactivated X chromoxome (barr body)
250
In Klinefelter, the dysgenesis of the seminiferous tubules leads to...
decreased inhibin and increased FSH.
251
Turner Syndrome Features (8)
-XO (female) -short stature -ovarian dysgenesis (streak ovary) -shield chest -bicuspid aortic valve -preductal coarctation -lymphatic defects (webbed neck, cystic hygroma) -horseshoe kidney
252
Signs of preductal coarctation
femoral \< brachial pulse notched ribs
253
Double Y males features (XYY) (5)
-phenotypically normal -very tall -severe acne -antisocial behavior -normal fertility
254
True hermaphroditism features
-46 XX or 47 XXY -both ovary and testicular tissue present -ambigous genitalia
255
Increased T, Increased LH
defective andgrogen receptor
256
Increased T, Decreased LH
testosterone secreting tumor or exogenous steroids
257
Decreased T, Increased LH
primary hypogonadism
258
Decreased T, Decreased LH
hypogonadotropic hypogonadism
259
Female Pseudohermaphrodite (XX)
-ovaries are present but external genitalia are virilized or ambiguous -due to excessive exposure to androgenic steroids during early gestation (CAH or exogenous)
260
Male Pseduohermaphrodite (XY)
-testes present but external genitalia are female or ambiguous
261
Aromatase Deficiency Features (3)
-inability to synthetize estrogens from androgens -masculinization of female infants and increased androgens -can present with maternal virilization during pregnancy
262
Androgen Insensitivity Features (5)
-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
5alpha-reductase deficiency features (6)
-autosomal recessive -inability to convert testosterone to DHT -ambiguous genitalia until puberty -testosterone/estrogen levels normal -LH is normal/increased -internal genitalia normal
264
Kallmann syndrome features
-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
A hydatidiform mole is a...
cystic swelling of chorionic villi and proliferation of chorionic epithelium (only trophoblast).
266
Treatment for hydatidiform moles
dilation and curettage and methotrexate (have to monitor beta-hCG after)
267
Karyotype of hydatidiform moles
Complete: 46 XX; 46 XY Partial: 69 XXX; 69 XXY; 69 XYY
268
Uterine size in hydatidiform moles
Complete: increased
269
Conversion to choriocarcinoma in hydatidiform moles
Complete: 2% Partial: rare
270
Fetal parts in hydatidiform moles
Complete: none Partial: Yes
271
Components of the hydatidiform moles
Complete: nucleated egg + single sperm (duplicates paternal DNA) Partial: 2 sperm + 1 egg
272
Symptoms of hydatidiform moles
Complete: vaginal bleeding, enlarged uterus, hyperemesis, pre-eclampsia, hyperthyroidism Partial: vaginal bleeding, abdominal pain
273
Imaging of hydatidiform moles
Compete: honeycombed uterus or "clusters of grapes" or "snowstorm" on U/S Partial: fetal parts
274
Gestational hypertension is defined as...
BP \> 140/90 after the 20th week.
275
Treat gestational HTN with...
antihypertensives (alpha-methyldopa, labetalol, hydralazine, nifedipine) and deliver at 39 weeks.
276
Preeclampsia is defined as...
HTN, proteinuria (\>300 mg/24 hr) after the 20th wk of gestation.
277
End-organ damage from severe preeclampsia results in...
HA, scotoma, oliguria, increased AST/ALT, and thrombocytopenia.
278
Preeclampsia is caused by...
abnormal placental spiral arteries and results in maternal endothelial dysfunction, vasoconstriction or hyperreflexia.
279
The incidence of preeclampsia is increased in pts with...
preexisting HTN, diabetes, chronic renal dz or autoimmune disorders.
280
Complications of preeclampsia (5)
1. placental abruption 2. coagulopathy 3. renal failure 4. uteroplacental insufficiency 5. eclampsia
281
Treatment of preeclampsia
-antihypertensives -deliver at 34 wks if severe -IV magnesium sulfate (to prevent seizure)
282
Eclampsia is...
preeclampsia + maternal seizures.
283
Maternal death in eclampsia is due to...
stroke leading to intracranial hemorrhage or ARDS.
284
Treatment of eclampsia is...
antihypertensives IV magnesium sulfate immediate delivery
285
HELLP Syndrome is...
Hemolysis, Elevated Liver enzymes, and Low Platelets (a manifestation of severe preeclampsia; deliver immediately)
286
Placental abruption is...
premature separation of the placenta from the uterine wall before delivery of the infant. Life threatening for both mother and fetus.
287
Risk factors for placental abruption include (5)...
trauma smoking HTN preeclampsia cocain abuse
288
Presentation of placental abruption
-abrupt, painful bleeding in 3rd trimester -possible DIC -maternal shock -fetal distress
289
Placental accreta, increta and percreta are due to...
defective decidual layers leading to abnormal attachment and separation after delivery.
290
Risk factors for placental accreta/increta/percreta include (3)...
prior C-section inflammation placenta previa
291
Placenta accreta
placenta attaches to the myometrium without penetrating it
292
Placenta increta
placenta penetrates into myometrium
293
Placenta percreta
placenta penetrates through the myometrium adn into the uterine serosa; can result in placental attachment to rectum or bladder
294
Presentation of Placenta accreta/increta/percreta
-no separation of placenta after delivery leading to massive bleeding
295
Placenta previa is...
attachment of the placenta to the lower uterine segment. It lies near, partially covers or completely covers the internal cervical os. (painless)
296
Risk factors for placenta previa (2)
multiparity prior C-section
297
Retained placental tissue may cause...
postpartum hemorrhage and increases risk of infection.
298
Ectopic pregnancy most often occurs in the...
ampulla of the fallopian tube.
299
Ectopic pregnancy should be suspected with a hx of...
amenorrhea, lower-than-expected rise in hCG and sudden lower abdominal pain. (+/- bleeding)
300
Ectopic pregnancy is confirmed with...
ultrasound.
301
Risk factors for ectopic pregnancy (4)
-hx of infertility -salpingitis -ruptured appendix -prior tubal surgery
302
Polyhdramnios (\> 1.5-2 L) is associated with...
fetal malformations (inability to swallow amniotic fluid), maternal diabetes, and multiple gestations.
303
Oligohydramnios (\< .5 L) is associated with...
placental insufficiency, bilateral renal agenesis or posterior urethral valves (inability to excrete urine).
304
Profound Oligohydramnios can cause...
POTTER sequence.
305
Dysplasia/Carcinoma in situ is...
disordered epithelial growth that begins at the basal layer of squamocolumnar junction and extends outward.
306
Dysplasia/Carcinoma in situ is associated with....
HPV 16 and HPV 18 which both produce the E6 gene (inhibits p53) and E7 (inhibits Rb)
307
Dysplasia/Carcinoma in situ is typically...
asymptomatic or presents as abnormal vaginal bleeding. Can progress to invasive carcinoma (catch early with pap smear).
308
Risk factors for dysplasia/carcinoma in situ
-multiple sexual partners -smoking -early intercourse -HIV
309
Invasive carcinoma is often...
squamous cell carcinoma. Lateral invasion can block the ureters, causing renal failure.
310
Endometritis is...
inflammation of the endometrium (with plasma cells and lymphocytes).
311
Endometritis is associated with...
retained products of conception following delivery/miscarriage/abortion or foreign bodies such as an IUD.
312
Retained material in the uterus promotes...
infxn by bacterial flora from the vagina or intestinal tract.
313
Treatment for endometritis
gentamicin + clindamycin (+/- ampicillin)
314
Endometriosis is...
non-neoplastic endometrial glands/stroma outside of the endometrial cavity; most commonly in the ovaries, pelvis adn peritoneum; normal sized uterus.
315
In the ovary, endometriosis appears as...
an endometrioma (blood-filled "chocolate cyst").
316
Endometriosis can be due to...
retrograde flow, metaplastic transformation of multipotent cells or transportation of endometrial tissue via the lymphatic system.
317
Endometriosis is characterized by...
cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia and infertily.
318
Treatment for Endometriosis
NSAIDs OCPs progestins GnRH agonists surgery
319
Adenomyosis is...
extension of the endometrial tissue (glandular) into the uterine myometrium caused by hyperplasia of the basalis layer of the endometrium.
320
Adenomyosis is characterized by....
dysmenorrha, menorrhagia and an enlarged, soft, globular uterus.
321
Treatment for Adenomyosis
hysterectomy
322
Adenomyoma (polyp) is a...
well-circumscribed collection of endometrial tissue within the uterine wall. May contain smooth muscle cells.
323
Endometrial hyperplasia is...
abnormal endometrial gland proliferation caused by excess estrogen stimulation. Give an increased risk for endometrial carcinoma.
324
Endometrial hyperplasia manifests as...
postmenopausal vaginal bleeding.
325
Risk factors for endometrial hyperplasia include...
anovulatory cycles, hormone replacement therapy, polycystic ovarian syndrome, and granulosa cell tumor.
326
Endometrial carcinoma clinically presents with...
vaginal bleeding at ages 55-65.
327
Risk factors for endometrial carcinoma include...
prolonged use of estrogen w/o progestins obesity diabetes HTN nulliparity late menopause (often preceded by endometrial hyperplasia)
328
Leiomyoma (aka fibroid) often presents with...
multiple discrete tumors. Increased incidence in black females from 20-40 yrs old. It is a benign smooth muscle tumor.
329
Leiomyomas are sensitive to...
estrogen so the tumor size increases with pregnancy and decreases with menopause.
330
Leiomyoma manifestations include...
asymptomatic, abnormal uterine bleeding, miscarriage. Severe bleeding may cause iron deficiency anemia.
331
Leiomyomas do not progress to...
leiomyosarcoma.
332
Histology of Leiomyoma
whorled pattern of smooth muscle bundles with well-demarcated borders
333
Polycystic Ovarian Syncrome (PCOS) is...
hyperandrogenism due to deranged steroid synthesis by theca cells and hyperinsulinemia.
334
PCOS results in...
enlarged, bilateral cystic ovaries. It presents with amenorrhea, hirsutism, acne and infertility. Associated with obesity.
335
PCOS has an increased risk for...
endometrial cancer secondary to increased estrogens from aromatization of testosterone and absence of progesterone.
336
Treatment for PCOS
-weight reduction -OCPs -antiandrogens -clomiphene citrate -metformin -cyclic progesterones
337
Lab features of PCOS
-increased LH and FSH (ratio is LH:FSH, 3:1) -increased testosterone -increased estrogen -increased insulin
338
PCOS is the most common cause of....
infertility in women.
339
Follicular cyst is a...
distention of unruptured graafian follicle. May be associated with hyperestrogenism and endometrial hyperplasia.
340
Corpus luteum cyst is...
a hemorrhage into persitent corpus luteum.
341
Theca-lutein cyst
-often bilateral/multiple -due to gonadotropin stimulation -associated with choriocarcinoma and moles
342
Hemorrhagic cyst
-blood vessel rupture in cyst wall -cyst grows with increased blood retention
343
Dermoid cyst
-mature teratoma -cystic growths filled with various types of tissue such as fat, hair, teeth, etc.
344
Endometrioid cyst
-endometriosis within ovary with cyst formation -varies with menstural cycle -when filled with dark, reddish-brown blood, called a "chocolate cyst"
345
Risk of ovarian neoplasm is increased with...
age, infertility, endometriosis, PCOS, genetics (BRCA-1/2, HNPCC, fam hx).
346
Risk of ovarian neoplasm decreases with...
previous pregnancy, hx of breastfeeding, OCPs, tubal ligation.
347
Ovarian neoplasms presetn with...
adnexal mass, abdominal distention, bowel obstruction and pleural effusion.
348
Ovarian neoplasms can be monitored by measureing...
CA-125 levels (not for screening).
349
Serous cystadenoma features (3)
-thin-walled, uni or multi locular -lined with fallopian-like epithelium -often bilateral
350
Mucinous cystadenoma (2)
-multiloculated, large -lined by mucus-secreting epithelium
351
Endometrioma (3)
-mass arising from gorwth of ectopic endometrial tissue -complex mass on U/S -presents with pelvic pain, dysmenorrhea and dyspareunia
352
Mature cystic teratoma (dermoid cyst) (4)
-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
Brenner tumor (2)
-solid tumor that is pale yellow-tan and appears encapsulated (looks like bladder) -coffee bean nuclei
354
Fibromas (3)
-bundles of spindle-shaped fibroblasts -Meigs syndrome -pulling sensation in groin
355
Meigs syndrome is a...
triad of fibroma, ascites and hydrothorax.
356
Thecoma (2)
-like granulosa cell tumors, may produce estrogen -usually present as abnormal uterine bleeding in a postmenopausal woman
357
Immature teratomas (3)
-aggressive -contains fetal (embryonic-like) tissue -neuroectoderm
358
Granulosa cell tumor (4)
-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
Serous cystadenocarcinoma (2)
-frequently bilateral -psammoma bodies
360
Mucinous cystadenoma (2)
-pseudomyxoma pertonei (intraperitoneal accumulatio nof mucinous material from ovarian or appendiceal tumor)
361
Dysgerminoma (3)
-common in adolescents -sheets of uniform "fried egg" cells -tumor markers are hCG and LDH
362
Choriocarcinoma (7)
-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
Yolk sac (endodermal sinus) tumor (5)
-aggressive -in ovaries or testes and sacrococcygeal area in young children -yello, friable, solid mass -Schiller-Duval bodies (resemble glomeruli) -AFP tumor marker
364
Krukenberg tumor (2)
-GI malignancy that metastasizes to the ovaries -causes a mucin-secreting, signet cell adenocarcinoma
365
Vaginal Squamous Cell Carcinoma is usually...
secondary to cervical SCC.
366
Vaginal clear cell adenocarcionma affects...
women who had exposure to DES in utero.
367
Sarcoma botryoides affects...
girls \< 4 yrs old; spindle-shaped tumor cells that are desmin +.
368
Fibroadenoma is a...
small, mobile firm mass with sharp edges most common in those younger than 35.
369
Fibroadenoma increases in size and tenderness with...
estrogen. It is not a precursor to cancer.
370
Intraductal papilloma is a...
small tumor that grows in the lactiferous ducts. Typically beneath the areola.
371
Intraductal papilloma presents with...
serous or bloody nipple discharge. Slight increased risk for carcinoma.
372
Phyllodes tumor is a...
large bulky mass of CT and cysts. "leaf-like" projections. (common in 6th decade)
373
Malignant breast tumors are commonly...
postmenopausal and arise from terminal duct lobular unit.
374
In malignant breast tumors, overexpression of...
estrogen/progesterone receptors or c-erbB2 is common.
375
Breast tumors are more aggressive if they are...
triple negative (ER -, PR -, Her2/Neu -).
376
The single most important prognostic factor for malignant breast cancer is...
axillary LN involvement indicating metastasis.
377
Most common location of malignant breast cancer
upper outer quadrant
378
Risk factors for malignant breast cancer (6)
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
Ductal carcinoma in situ fills...
the ductal lumena and arises from ductal atypia. Seen as microcalcifications.
380
Ductal carcinoma in situ is an early malignancy...
without basement membrane penetration.
381
Comedocarcinoma is a subtype of...
DCIS. It is ductal and has caseous necrosis.
382
Paget Disease results from...
underly DCIS.
383
Paget Disease presents with...
eczematous patches on the nipple. It has Paget cells (large cells in dermis with clear halo.
384
Invasive ductal carcinoma is a...
firm, fibrous, rock-hard mass with sharp margins and small, glandular, duct-like cells. Gross stellate infiltration.
385
Invasive lobular carcinoma is often...
bilateral with multiple lesions in the same location; orderly row of cells (indian file).
386
Medullary breast carcinoma is a...
fleshy, cellular lymphocytic infiltrate.
387
Inflammatory breast carcinoma is a...
dermal lymphatic invasion. Presents with peau d'orange.
388
Proliferative breast disease presents with...
premsentrual breast pain, bilateral, multiple lesions, and fluctuation in mass size.
389
Histologic types of Proliferative breast disease
1. Fibrosis 2. Cystic 3. Sclerosing adenosis 4. Epithelial hyperplasia
390
Fibrosis (proliferative brease disease)
hyperplasia of breast stroma
391
Cystic (proliferative breast disease)
fluid, billed, blue dome, ductal dilation
392
Sclerosing adenosis
increased acini and intralobular fibrosis; associated with calcifications; increased risk of cancer
393
Epithelial hyperplasia
increase in number of epithelial cell layers in terminal duct lobule; increased risk of carcinoma; occurs in women \> 30
394
Acute mastitis is a...
breast abcess caused by cracks in the nipple from breast-feeding that leads to infxn from S. aureus
395
Acute mastitis should be treated with...
dicloxacillin and continued breast feeding.
396
Fat necrosis is a...
benign, usually painless lump that forms as a result of injury to breast tissue.
397
Fat necrosis findings
-calcifications on mammography -biopsy shows necrotic fat, giant cells
398
Gynecomastia results from...
hyperestrogenism (cirrhosis, testicular tumor, puberty, old age), Klinefelter syndrome and drugs.
399
Drugs that cause gynecomastia
-Spironolactone -marijuana -Digitalis -Estrogen -Cimetidine -Alcohol -Heroin -Dopaine D2 antagonists -Ketoconazole
400
Prostatitis usually presents with...
dysuria, frequency, urgency and low back pain.
401
Acute prostatitis is usually due to...
E. coli.
402
Benign prostatic hyperplasia (BPH) is characterized by...
smooth, elastic, firm nodular enlargement of the peiurethral lobes which compress the urethra into a vertical slit.
403
BPH often presesnts with...
increased frequency of urination, nocturia, difficulty stopping and starting stream, dysuria. Increased PSA
404
BPH may lead to...
distention/hypertrophy of the bladder, hydronephrosis, and UTIs.
405
Treatments for BPH
-alpha1 antagonists (terazosin, tamulosin which cause relaxation of smooth muscle) -finasteride
406
Prostatic adenocarcinoma arises most often from the...
posterior lobe (peripheral zone) of the prostate and is diagnosed by increased PSA and needle core biopsies.
407
Tumor markers of prostatic adenocarcinoma include...
PSA and PAP.
408
Prostatic adenocarcinoma may develop into...
osteoblastic metastases in the bone indicated by lower back pain and increased serum ALP.
409
Cryptorchidism is...
undescended testis, with impaired spermatiogenesis. Can have normal testosterone levels (Leydig cells unaffected by heat).
410
Cryptorchidism is associated with...
increased risk of germ cell tumors. Prematurity increases the risk.
411
Lab features of cryptorchidism
-decreased inhibin -increased FSH -increased LH -testosterone decreased in bilateral
412
Varicocele is...
dialted veins in the pampiniform plexus as a result of increased venous pressure. Most common cause of scrotal enlargment in adults.
413
Varicocele is most often on the...
left side because of increased resistance to flow from left gonadal vein drainage into the renal vein.
414
Varicocele appears as...
a "bag of worms" and is diagnosed by U/S w/ doppler.
415
Treatment for varicocele
varicocelectomy embolization
416
Risk factors for testicular germ cell tumors
-cryptorchidism -Klinefelter -young age
417
Seminoma features (5)
-painless, testicular enlargmeent -3rd decade -large cells in lobules with watery cytoplasm and a "fried egg" appearance -increased placental AFP -radiosensitive
418
Yolk sac tumor (testicular) (3)
-yellow, mucinous -schiller-duval bodies -common in boys \< 3
419
Choriocarcinoma (4)
-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
Teratoma (2)
-malignant in males (NOT in females) -increased hCG and/or AFP
421
Embryonal carcionma
-hemorrhagic mass with necrosis -painful -often glandular/papillary -increased hCG and normal AFP when pure
422
Leydig cell tumor (4)
-contains Reinke crystals -usually androgen producing -gynecomastia or precocious puberty -golden brown color
423
Sertoli cell tumor
-androblastoma from sex cord stroma
424
Testicular lymphoma
-arises from lymphoma metastases to testes
425
Tunica vaginals lesions are...
in the serous covering of the testis present as testicular masses that can be transilluminated.
426
Hydrocele
increaed fluid secondary to incomplete obliteration of processus vaginalis
427
Spermatocele
dialted epididymal duct
428
Penile SCC is most common in...
Asia, Africa and South America.
429
Precursor lesions to penile SCC
-Bowen disease -erythroplasia of Queyrat -bowenoid papulosis
430
Bowen Disease is in the...
penile shaft and presents as leukoplakia.
431
Erythroplasia of Queyrat is...
cancer of the glans that presents as erythroplakia.
432
Bowenoid papulosis presents as...
reddish papules.
433
Penile SCC is associated with...
HPV and a lack of circumcision.
434
Priapism is a...
painful, sustained erection.
435
Priapism is associated with...
trauma sickle cell disease (RBCs get trapped in vaculature) medications (anticoagulants, PDE-5 inhibitors, antidepressants, alpha-blockers and cocaine)
436
Leuprolide mechanism
-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
Clinical use of Leuprolide
infertility prostate cancer uterine fibroids precocious puberty
438
Clinical use of estrogens (ethinyl estradiol, DES, mestranol)
-hypogonadism or ovarian failure -mesntrual abnormalities -HRT in postmenopausal women -used in men with androgen dependent prostate cancer
439
Toxicity of estrogens
-increased risk of endometrial cancer -bleeding -clear cell adenocarcionma of vagina (DES) -increased risk of thrombi
440
Estrogens are contraindicated in...
ER + breast cancer and those with a hx of DVTs
441
Selective Estrogen Receptor Modulators (SERMs)
-Clomiphene -Tamoxifen -Raloxifene
442
Clomiphene is an...
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
CLompihene is used to treat...
infertility due to anovulation (PCOS).
444
Clomiphene may cause...
hot flashes, ovarian enlargement, multiple simultaneous pregnancies and visual disturbances.
445
Tamoxifen is an...
antagonist on breat tissue and agonist in bone and the uterus.
446
Tamoxifen is associated with...
endometrial cancer and thromboembolic events.
447
Tamoxifen is primarily used to treat and prevent recurrence of...
ER + breast cancer.
448
Raloxifene is an...
agonist on bone and antagonist at the uterus.
449
Raloxifene increases risk of...
thromboemblic events.
450
Raloxifene is used to treat...
osteoporosis bc it decreases resorption of bone.
451
HRT is used for...
relief of menopausal symptoms and osteoporosis.
452
Unopposed estrogen replacement therapy increases risk of...
endometrial cancer so progesterone is added.
453
Anastrozole/Exemestane are...
aromatase inhibitors used in postmenopausal women with breast cancer
454
Progestins MOA
bind progesterone receptors to decrease growth and increase vascularization of the endometrium
455
Progestins Use
used in oral contraceptives and in treatment of endometrial cancer and abnormal uterine bleeding
456
Mifepristone MOA
competitive inhibitor of progestins
457
Clinical use of mifepristone
termination of pregnancy (administered with misoprostol (PGE1))
458
In OCPs, estrogen and progestins inhibit...
LH/FSH and thus prevent the estrogen surge. No estrogen surge means no LH sruge means no ovulation.
459
In OCPs, progestins cause...
thickening of the cervical mucus (limiting access to sperm) and they inhibit endometrial proliferation making it less suitable for implantation.
460
Contraindications for OCPs
smokers \> 35 hx of thromboembolism, stroke or estrogen-dependent tumors
461
Terbutaline is a...
beta2-agonist that relaxes the uterus; usted to decrease contraction frequency in women during labor.
462
Danazol MOA
synthetic androgen that acts as a partial agonist
463
Use of Danazol
endometriosis and angioedema
464
Toxicity of Danazol
-weight gain -edema -acne -hirsutism -masculinization -decreased HDL -hepatotoxicity
465
MOA of Testosterone and Methyltestosterone
agonist at androgen receptors
466
Use of Testosterone and Mehtyltestosterone
-hypogonadism -promotes development of secondary sex characteristics -stimulation of anabolism to promote recovery after burn or injury
467
Toxicity of testosterone
-masculinization -decrease intratesticular testosterone (gonadal atrophy due to decreased LH) -premature closure of epiphyseal plates -increased LDL, decreased HDL
468
Finasteride is a...
5alpha-reductase inhibitor that decreases the conversion of testosterone to DHT
469
Finasteride uses
-BPH -male pattern baldness
470
Flutamide is a...
nonsteroidal competitive inhibitor of androgens at teh testoterone receptor.
471
Flutamide is used in...
prostate carcinoma.
472
Ketoconazole inhibits...
steroid synthesis (inhibits 17,20-desmolase).
473
Spironolactone inhibits...
steroid binding, 17alpha-hydroxylase and 17,20-desmolase.
474
Ketoconazole and spironolactone are used in the treatment of...
PCOS to prevent hirsutism. Both have side effects of gynecomastia and amenorrhea.
475
Tamsulosin is an...
alpha1-antagonist used to treat BPH by inhibiting smooth muscle contraction. Selective for alpha1A,D receptor found on prostate.
476
Sildenafil and Vardenafil MOA
inhibit phosphodiesterase-5 causing increased cGMP, smooth muscle relaxation, increased blood flow and penile erection
477
Toxicity of Sildenafil and Vardenafil
-dyspepsia -impaired blue-green color vision -risk of life-threatening hypotension in pts taking nitrates (since they block teh breakdown of NO)
