Reproductive System Flashcards
Which ligament contains the ovarian vessels?
Which contains the uterine vessels?
Which ligament contains the ovarian vessels?
- Suspensory ligament/infundibulopelvic ligament
Which contains the uterine vessels?
- Cardinal ligament
What nerve controls erection?
What nerve controls emission (movement of sperm to penis)?
What nerve controls ejaculation?
Erection: Pelvic nerve (PNS)
Emission: Hypogastric nerve (SNS)
Ejaculation: Pudendal nerve (Visceral and somatic nerves)
What landmark is used for the pudendal nerve block?
Ischial spine
What is the purpose of androgen binding protein secreted by the Sertoli cells (which also secrete antimullerian hormone and inhibin)?
Maintains the level of testosterone in the seminiferous tubules
Name the corresponding female structures for each male structure... Glans penis Corpus spongiosum/corpus cavernosum Bulbourethral glands Prostate gland Ventral shaft of penis Scrotum
Name the corresponding female structures for each male structure…
Glans penis - Glans clitoris
Corpus spongiosum/corpus cavernosum - Vestibular bulbs
Bulbourethral glands - Greater vestibular glands (Bartholin glands)
Prostate gland - Urethral/paraurethral glands (Skene glands)
Ventral shaft of penis - Labia minora
Scrotum - Labia majora
What are the testicular germ tumors?
Seminoma Yolk Sac Choriocarcinoma Teratoma Embryonal carcinoma
Which testicular germ cell tumor is associated with increased hCG, hematogenous metastasis to lungs and brain, and synctiotrophoblasts?
Choriocarcinoma
Which testicular germ cell tumor has Schiller-Duval bodies and increased AFP?
Yolk Sac tumor
Which testicular germ cell tumor is painful and has normal AFP and increased hCG?
Which testicular germ cell tumor has a fried egg appearance?
Which testicular germ cell tumor is painful and has normal AFP and increased hCG? Embryonal
Which testicular germ cell tumor has a fried egg appearance?
Seminoma
Which non-germ cell testicular tumor secretes estrogen?
Sertoli cell tumor
What do you give to treat BPH and why?
Alpha 1 antagonists (Terazosin, Tamulosin, Prazosin) - because they cause relaxation of smooth muscle
Tamsulosin does not block Alpha1b receptors so does not cause hypertension
What are the SE of non-selective Alpha-1 blockers?
Dizziness, Postural hypotension, Fatigue
What is the order of incidence of gynecologic tumors from most common to least common?
What is the order of prognosis from worst to best?
Incidence: Endometrial > Ovarian > Cervical
Worst prognosis: Ovarian > Cervical > Endometrial
What is Meigs syndrome? (Triad)
Type of fibroma
Triad of Ovarian fibroma, ascites, and hydrothorax
What pattern is seen in a granulosa theca cell tumor? What is produced?
Cal-Exner bodies: Granulosa cells in eosinophilic fluid
Produces Estrogen, Progesterone, and Inhibin
What is a Krukenberg tumor?
Metastasis to the ovary by a gastric carcinoma
Signet ring cells
What type of ovarian tumor presents with an intraperitoneal accumulation of mucinous material (pseudomyxoma peritonei)?
Mucinous cystadenocarcinoma
- Due to mucinous tumor of the appendix with metastasis to the ovary
What ovarian tumor is testosterone-secreting?
Sertoli-Leydig cell tumor
What ovarian tumor contains Psammoma bodies?
serous cystadenocarcinoma
Which ovarian tumor resembles bladder epithelium?
Brenner tumor
Explain the changes to the following during pregnancy…
Plasma volume (as compared to RBC volume):
BP:
GFR:
Plasma volume increases 50% and RBC volume increases 30% (decreases risk of anemia with post partum bleeding)
BP decreases early in pregnancy but then peaks at 16-20 weeks (accomodation by blood vessels prior to increase in volume)
GFR is increased (with decreased BUN and Cr)
What happens to ventilation during pregnancy? How does this affect PACO2 and PaCO2?
What happens to TSH?
Increased minute ventilation with decreased PACO2 and PaCO2 as well as mild respiratory alkalosis - this creates a gradient so CO2 can be more easily transferred from fetus to mother
Normal TSH and free T4
What are the levels of AFP, hCG, and estriol in maternal screen of trisomy 21?
Decreased AFP
Decreased estriol
Increased hCG
What are the levels of AFP, hCG, and estriol in maternal screen of trisomy 18?
Decreased AFP, estriol, and hCG
Describe the level of monozygotic twinning if it occurs at the following dates of pregnancy...(which is most common?) 0-4 days: 4-8 days: 8-12 days: >13 days:
0-4 days: Dichorionic, diamniotic
4-8 days: Monochorionic, diamniotic (75%)
8-12 days: Monochorionic, monoamniotic
>13 days: Conjoined twin
What screen markers are used to diagnose trisomy 13?
Decreased hCG
Decreased PAPP-A
Nuchal translucency
What gene is affected in Fragile X syndrome?
What are features of individuals with this disorder?
Gene: FMRI1 gene
Features: Autism, Large jaw, Elongated face, Everted ears, Mitral valve prolapse
What drugs can cause gynecomastia? (STACKED)
Spironolactone THC Alcohol Cimetidine Ketoconazole Estrogens Digoxin
What are the types of proliferative breast disease?
Fibrosis
Cystic
Sclerosing adenosis
Epithelial hyperplasia
What is hyperplastic in fibrosis of the breast?
Breast stroma
Describe a cystic form of proliferative breast disease
Fluid filled, blue dome
Where does the increase in epithelial layers occur in epithelial hyperplasia of the breast?
Terminal duct lobule
What is increased in sclerosing adenosis?
Increased acini and intralobular fibrosis
What type of cell is seen in lobular carcinoma in situ?
What receptors are expressed in this condition?
Signet ring cells
ER and PR positive
What is the same and what is different between invasive ductal carcinoma and fibroadenoma?
Both contain firm, rock hard mass with sharp edges
Invasive ductal carcinoma is fixed and immobile whereas fibroadenoma (
What happens with dermal lymphatic invasion by breast carcinoma?
Peau d’orange (Inflammatory carcinoma)
What breast pathology is associated with loss of e-cadherin cell adhesion gene on chromosome 16?
Invasive lobular carcinoma
Which breast pathology commonly presents with nipple discharge?
Eczematous patches on the nipple?
Nipple discharge - Intraductal papilloma
Eczematous patches on the nipple - Paget disease
What is the most common malignant breast tumor?
Infiltrating ductal carcinoma
Name the origin and main activity of the following genes... Sonic hedgehog gene: Wnt-7 gene: FGF gene: Hox genes:
Sonic hedgehog gene: Produced at base of limbs in zpa; Patterning along anterior-posterior axis
Wnt-7 gene: Produced at apical ectodermal ridge; proper organization along dorsal-ventral axis
FGF gene: Produced at apical ectodermal ridge; lengthening of limbs
Hox genes: Involved in segmental organization of embryo in craniocaudal direction
During which week of fetal development does gastrulation (epiblast invagination to form primitive streak) and neural plate formation begin?
Week 3 (formation of trilaminar embryonic disc)
What are the mesodermal defects during fetal development?
VACTERL
Verterbral defects Anal atresia Cardiac defects Tracheo-Esophageal fistula Renal defects Limb defects (bone and muscle)
What is the embryologic derivative of the following... Melanocytes: Gut tube epithelium: Parafollicular cells of the thyroid: Thyroid follicular cells: Bones of the skull:
Melanocytes: Neural crest Gut tube epithelium: Endoderm Parafollicular cells of the thyroid: Neural crest Thyroid follicular cells: Endoderm Bones of the skull: Neural crest
Limb defects in a child (phocomelia, micromelia, “flipper” limbs) are most likely due to which maternal medication?
Thalidomide
What are the two layers of the chorionic villi? Which secretes hCG?
Inner layer: Cytotrophoblast (makes cells)
Outer layer: Synctiotrophoblast - secretes hCG
What are the three complications from failure of the urachus to obliterate? Which one can lead to adenocarcinoma?
Patent urachus: urine discharge from umbilicus
Urachal cyst: Fluid filled cavity between umbilicus and bladder; can lead to infection and adenocarcinoma
Vesicourachal diverticulum: Outpouching of bladder
In the branchial/pharyngeal apparatus, what are the derivatives of the following?
Clefts:
Arches:
Pouches:
Clefts: ectoderm
Arches: mesoderm
Pouches: endoderm
“Cap covers outside to inside”
Which branchial cleft persists? What does it form?
What happens if the other branchial clefts persist?
1st cleft develops into external auditory meatus
Persistence of 2nd-4th clefts = cervical sinus (branchial cleft cyst within lateral neck)
What occurs with failure of 1st arch neural crest cells to migrate?
Treacher Collins syndrome: mandibular hypoplasia, facial abnormalities (meckel cartilage)
Which branchial arches form the posterior 1/3 of the tongue?
Which arch forms Reichert cartilage (stapes, styloid process, lesser horn of hyoid)?
Posterior 1/3 of the tongue is from arches 3 and 4
Reichert cartilage is from the 2nd arch
*Greater horn of hyoid is 3rd arch
______ cells secrete MIF that suppresses development of the _______________ ducts
Sertoli cells secrete MIF that suppresses development of the paramesonephric ducts
What is the female remnant of the Gubernaculum (which anchors the testes within the scrotum)?
Ovarian ligament + round ligament of the uterus
Which ligament connects the ovaries to the lateral pelvic wall:
Which connects the cervix to the side wall of the pelvis:
Which connects the uterine fundus to the labia majora:
Ovaries to lateral pelvic wall: Suspensory ligament
Cervix to side wall of pelvis: Cardinal ligament
Fundus to labia majora: Round ligament (of the uterus)
What two cells line the seminiferous tubules?
Spermatogonia and Sertoli cells
What is the progression of sperm cell development?
How long does full development take?
Spermatogonia → Primary spermatocyte → Secondary spermatocyte → Spermatids → Spermatozoon → Sperm
Takes 2 months
What is the order of potency of the different estrogen types? Which is an indicator of fetal well-being?
Estradiol > Estrone > Estriol (increased 1000 fold in pregnancy - fetal well-being)
How do estrogen and progesterone affect prolactin release?
Estrogen stimulates prolactin secretion and progesterone inhibits prolactin secretion (fall in progesterone after deliver disinhibits prolactin)
What stage is the oocyte in prior to ovulation?
What stage is the oocyte in between ovulation and fertilization?
Prophase I until ovulation (meiosis I)
Metaphase II until fertilization (meiosis II)
Which hormones share the α subunit with hCG
LH, FSH and TSH
Which sex chromosome disorder presents with dysgenisis of seminiferous tubules and the presence of a Barr body (inactivated X chromosome)?
Klinefelter syndrome
What types of error can lead to Turner syndrome? What is needed to allow pregnancy in these patients?
Error: Mitotic or meiotic error (can be complete monosomy or mosaicism)
For pregnancy: Oocyte donation, exogenous estradiol-17β and progesterone
Which sex hormone disorder in a 46XY individual presents with a normal appearing female with an absent uterus and fallopian tubes? (testes often found in labia majora)
Androgen insensitivity syndrome (Male pseudohermaphrodite)
What causes a female pseudo-hermaphrodite?
How does aromatase deficiency of the fetus affect the mother?
Female pseudohermaphrodite due to excessive and inappropriate exposure to androgenic steroids during early gestation
Aromatase deficiency: maternal virilization during pregnancy (fetal androgens cross the placenta)
How is gestational hypertension treated?
α-methyldopa, labetalol, hydralazine, nifedipine
What are the findings in pre-eclampsia? (what causes it?)
How is seizure prevented in preeclampsia (drug)?
Hypertension, proteinuria, and edema (caused by abnormal placental spiral arteries)
IV magnesium sulfate
Describe the layer of attachement for the following placental complications…
Placenta accreta:
Placenta increta:
Placenta percreta:
Placenta accreta: placenta attaches to myometrium without penetrating it
Placenta increta: Placenta penetrates into myometrium
Placenta percreta: Placenta penetrates through myometrium into uterine serosa
What are the gene products of HPV 16 and 18 and what are their functions?
E6 gene inhibits p53 suppressor gene
E7 gene inhibits RB suppressor gene
How is endometritis treated?
Gentamicin + clindamycin
Where is endometrial tissue (glandular) in an adenomyosis? How is this distinguished from endometriosis upon observation?
Uterine myometrium
Adenomyosis has uniformly enlarged uterus whereas uterus in endometriosis is normal-sized
How is a leiomyoma different from a leiomyosarcoma?
Leiomyoma: Benign; Whorled pattern of smooth muscle bundles with well-demarcated borders, peak incidence 20-40 years old - in myometrium
Leiomyosarcoma: do not arise from leiomyomas - necrosis and hemmorhage in the myometrium - peak incidence in postmenopausal females
What are the findings in PCOD?
How does it present?
Increased LH, Decreased FSH, Increased testosterone and estrogen (aromatization)
Presentation: obesity, hirsutism, amenorrhea, acne, infertility
Endometrial hyperplasia involves hyperplasia of _______ relative to ________
glands relative to stroma
What are the benign ovarian neoplasms?
Serous cystadenoma Mucinous cystadenoma Endometrioma Mature cystic teratoma Brenner tumor Fibroma Thecoma
What are the malignant ovarian neoplasms?
Immature teratoma Granuosa cell tumor Serous and mucinous cystadenocarcinoma Dysgerminoma Choriocarcinoma Yolk sac tumor
Which tumors are surface epithelial tumors and which are germ cell tumors?
Surface epithelium: Mucinous and serous tumors
Germ cell tumors: Teratoma, Dysgerminoma, Endodermal sinus tumor (yolk-sac), choriocarcinoma, embryonal carcinoma
Whar variation of cystic teratoma can cause hyperthyroidism?
Struma ovarri - a teratoma composed primarily of thyroid tissue
What are the sex-cord stromal tumors?
Granulosa-theca cell tumor
Sertoli-Leydig cell tumor (can be in the ovaries)
Fibroma
Which type of cancer affects women who had exposure to DES in utero?
Clear cell adenocarcinoma
What pathogen is associated with acute mastitis and how is this treated?
S. Aureus
Treat with dicloxacillin and continued breast feeding
What is comedocarcinoma?
Subtype of DCIS with ductal caseous necrosis
What distinguishing characteristic is found in leydig cell tumors?
Reinke crystals; golden brown color
What is the difference between a mature teratoma in males and females?
A mature teratoma in males may be malignant
