SEX Flashcards
What codes for Anti-mullerian hormone?
SRY gene just outside the pseudoautosomal region of the short arm of the Y chromosome
The Mullerian duct is also called the _____ duct and will become
Paramesonephric duct
Fallopian tubes and the body of the uterus
The Wolffian duct is also called the ____ duct and will become
Mesonephric duct
Epididymous, vas deferens, and the prostatic urethra
What happens in the absence of anti-mullerian hormone?
The wolffian duct will degenerate and you will develop as a female
What does testosterone determine?
It determines what sex you look like, but not what sex you ARE
Maturation of sperm occurs here
Epididymous and vas deferens
Where are mature sperm located?
The ampulla of the vas deferens
These glands create most of the volume of seminal fluid
Seminal vesicles
Prostate
Bulbourethral (Cowper’s) glands
Sperm does not travel through these glands, they just add fluid to the semen along their mystical journey.
Cells of the testicles
1) Leydig Cells- interstitial cells between the tubules that produce testosterone! Fat blobs in these cells for steroid (testosterone) production. LH will act on Leydig cells to create testosterone.
2) Sertoli cells- FSH activates these cells to provide nutrients and growth factors for developing sperm cells
3) Spermatogonia- STEM CELLS of sperm
These are two immune privileged sites
Testes and ovaries, because these organs don’t mature until puberty
How are the testes immune privileged?
A blood-teste barried formed by the tight junction of sertoli cells
Why does exogenous testosterone cause testicular atrophy?
Testosterone acts on the hypothalamus to decrease GnRH release. This decreases LH and FSH, decreases stimulation of the leydig and sertoli cells, causing atrophy of these cells, and thus the testicles.
How can you prevent testicular atrophy if taking exogenous testosterone?
Take hCG (human chorionic gonadotropin). This has a similar structure to LH, and will bind to leydig cells, stimulating them, and increasing testosterone production.
What do sertoli cells need in order to support sperm production.
FSH AND testosterone
What are two male friends also known as?
Besties with testes
Does BPH predispose you to cancer?
Nope! It’s just super annoying.
When could BPH become an emergency?
If urine flow is halted all together. Urine could back up and cause pyelonephritis.
Why is prostate cancer often detected late?
It starts to grow on the periphery of the prostate, making urine obstruction a late symptom. Plus, prostate CA is a slow growing CA.
Does an elevated PSA mean you have prostate cancer?
Not necesarily. PSA will increase in both prostate CA and BPH. However, a large rapid elevation could indicate prostate CA
BPH usually starts in this zone, while prostate CA will start in this zone
BPH- central zone of prostate
Prostate CA- peripheral zone
This type of herpes causes cold sores
HSV 1
HSV2 is also known as
HHV 2
Sites of prostate CA mets
BONE
Also liver and lungs (like a lot of other cancers)
These STDs cause ulcerations on your pee pee
Herpes
Syphilis
Chancroid
Top to bottom increasing in depth and width of the ulcers :D
Syphilis is caused by this bacteria
Treponema pallidum (spirochete bacteria that causes small, painless ulcerations)
How many total strains of HSV exist that infect humans?
8
When do people get flare-ups of genital herpes?
When the person is immunocompromised (in stress or illness).
HSV lives in neurons. When it escapes, our immune system is able to destroy it. But if immunocompromised, it escapes, and we can’t destroy it. It causes painful, superficial vesicles on the genitals.
Chancroid is caused by this bacteria
H. ducreyi. I do declare, this is an ugly lesion on your penis!
Causes wide, deep, and painful ulcerations.
This is the second leading cause of infertility in women
Chlamydia
This is the first leading cause of infertility in women
PCOS
How does chlamydia cause infertility
Chronic infections in the fallopian tubes cause scarring and eggs can’t get through. Also, it is often asymptomatic, so women may go on for a long time not knowing they have it.
Why is chlamydia difficult to test for?
It’s an intracellular bacteria
Genital warts are also known as
Condylomata acuminata (caused by HPV)
HPV 1 causes _____ and HPV 2 causes ____ and others like 6 & 11 cause _____
1 = plantar warts
2 = warts on hands
6 & 11 = genital warts
Do genital warts become cancerous?
No
Gonorrhea is caused by
Nisseria gonorrhoeae (gram - diplococci) Pain and burning on urination, white/yellow discharge from penis. Basically, it's a bacterial infection of the urethra and can be treated with penicillin!
How was trichomonas vaginalis cause problems?
It is a protozoan that raises the pH of the vagina from 3 to 5 or 6, allowing opportunistic infections like E coli. or candida albicans to thrive).
The problem isn’t really the trichomonas, it’s the opportunistic infections it leads to.
Where does scabies usually infest?
Warm, moist environments. Underarms, groin, butt crack, or wrist (if you wear a watch for example).
These infections are caused by ectoparasites
Scabies and crabs
These are the cells surrounding the egg even after it’s release.
Cumulus oophorus
(cells are cumulated around the oocyte)
These cells are an extension of the granulosa cells.
If fertilization does not occur, the corpus luteum degenerates into the
corpus albicans
goes from yellow to white!
At what point in the cycle does an estrogen spike and follicle rupture occur?
Mid-cycle
In the female, LH and FSH do these functions
LH= stimulates the theca interna to produce androgens
FSH = stimulates the granulosa cells to convert androgens to estrogens and to support egg development
What does the corpus luteum do after ovulation?
Produces progesterone as long as LH is high and supports the endometrium. If no implantation, the corpus luteum becomes the corpus albicans, stops making progesterone, the endometrium is no longer supported and begins to slough off.
What happens if implantation occurs?
The placenta starts making hCG, which acts like LH, and causes the corpus luteum to continue making progesterone and supporting the endometrium.
Each month, about how many primordial follicles start growing?
2 dozen
What causes the mid-cycle spike?
Positive feedback loop. Estrogen from the granulosa causes increased released of GnRH from the hypothalamus, increased LH and FSH from the pituitary, which increases estrogen production. Continues until the Graafian follicle EXPLODES!!!!!
This is the outside layer of the cell that the sperm has to use digestive enzymes to get through
Zona pellucida
Why is TSH usually low during pregnancy?
In addition to looking like LH, hCG also looks like TSH and stimulates the thyroid. Because of this, actual TSH levels fall.
In the glycoprotein hormones (LH, FSH, TSH, hCG), what strands are different.
The alpha strands are exactly the same.
The beta strands are what differ. In pregnancy tests, we are looking for the beta strand of hCG
Why are LH and FSH levels high in utero and early after birth?
To support sexual differentiation. Remember that testosterone is what determines what you look like!
The uterus has these cells while the vagina has these cells
Uterus = columnar Vagina = Stratified squamous
A transition between these cell types occurs at the level of the cervix (squamocolumnar junction)
HPV strains that cause cervical cancer and how they do it
HPV 16, 18, and others
These neutralize p53 and retinoblastoma protein, which are our major tumor suppressor genes.
HPV 6 & 11 cause warts but do not lead to cancer.
HPV is responsible for almost __% of cervical cancers
100%
Why is the squamocolumnar junction at risk for HPV related cancer?
Because a lot of metaplasia is occurring here, especially in the young adult of child-bearing age.
How does endometrial tissue spread?
Usually retrograde through the fallopian tubes
rarely the tissue can spread via the blood or lymphatics
What are the adnexa?
Everything next to and everything attached to the uterus (fallopian tubes/ligaments/ovaries, etc)
How to treat endometriosis
Birth control pills (reduce production of the endometrium). Don’t take the placebos, and this will prevent menstruation.
Uterine fibroids are also known as
leiomyomas. They are benign tumors of the smooth muscle, and do NOT lead to cancer! Many women (30-50%) will have these at some point. They are uncomfortable and have a tendency to bleed. More common with age.
MALIGNANT tumors of the uterine smooth muscle are known as
leiomyosarcomas
Why is endometrial cancer not deadly?
Because of early detection. Usually the first sign is bleeding, and women will get this checked out (especially since it’s more common in post-menopausal women)
Common causes of salpingitis
Chlamydia, endometriosis, gonorhea, and TB infections
Salpingitis is almost always a component of this disease
PID (pelvic inflammatory disease)
What is PID (pelvic inflammatory disease)
Inflammation of the fallopian tubes and/or the ovaries. Clumped together as PID because they are often difficult to distinguish. Also, one will often cause the other.
What causes PCOS?
High LH but low FSH. Unknown cause of why. However, high LH causes excess androgen production (adrostenedione). Low FSH means that these androgens are not being converted to estradiol. Instead, some of the androgens are converted to estrone in the peripheral fat, telling the pituitary to make even less FSH (LH and FSH are independently regulated). Thus, the imbalance continues.
Excess androgens cause facial hair growth, irregular or no menstruation, and enlarged ovaries with multiple cysts.
Mature follicles fail to rupture, causing a collection of mature follicles, leading to cyst formation.
This disease is more common in obese women with blood sugar issues.
Why is there a high death rate with ovarian tumors?
D/t late detection. Takes a long time for the tumor to grow large enough to be palpable.
Women with this gene have an increased risk for ovarian cancer?
BRCA 1 (causes 30% risk as apposed to a 2% risk in the general population)
Where do teratomas usually occur?
Near the gonads! Remember, these are innocent benign tumors who just want to grow up to be a person on their own (how cute!). The gonads are where people begin.
Ectopic pregnancy is sometimes misdiagnosed as
appendicitis.
Ectopic pregnancy usually causes RLQ or LLQ pain, and can be misdiagnosed as this.
Difference between complete and partial molar pregnancy
Complete: NO maternal DNA in the egg. Two sperm entered and supplied all the father, resulting in diploid DNA. No fetus or embryonic tissue. All chorionic villi are vesicular. These create a lot of hCG and can grow quite large. Looks like a snowstorm on ultrasound.
Partial: Normal egg, but two sperm get in, causing a triploid fetus. Fetus is present, but not viable. Some of the chorionic villi are vesicular.
Cause of pre-eclampsia
Shallow implantation of the placenta into the uterus. Causes inadequate blood flow to the developing fetus.
The mother develops hypertension to improve blood flow to the fetus. Also develops proteinuria and edema (unrelated to the HTN b/c the BP isn’t high enough to cause this). Syndrome develops during the third trimester when the fetus is growing rapidly.
Triad involved in pre-eclampsia
HTN, proteinuria, and edema
Eclampsia
Progression of pre-eclampsia and involves seizures and can be fatal.
If 35 weeks along or greater, the solution is premature delivery. If not, we give them mag and put them on bed rest.
Pre-eclampsia should never advance this far!! We should treat pre-eclampsia early and prevent it from reaching this stage.
Why don’t we want to leave a molar pregnancy intact?
Because it’s cells are all fucked up and has a high rate of leading to cancer.
Treatment for PCOS
Birth control to get LH and FSH levels in check
Treatment of eclampsia
If > 35 weeks gestation- early delivery
If <35 weeks gestation- mag and bedrest
