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*First Aid in Brainscape* > Steve Avery's Reproductive Lockup > Flashcards

Steve Avery's Reproductive Lockup Flashcards

1
Q

Sonic headgehog gene

A

Produced at the base of the limbs in zone of polarizing activity;
involved in patterning along anterior-posterior axis;
Involved in CNS development;
Mutation can cause holoprosencephaly

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2
Q

Wnt-7 gene

A

Produced at the apical ectodermal ridge (thickened ectoderm at distal end of each developing limb);
Necessary for proper organization along dorsal-ventral axis

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3
Q

FGF gene

A

Produced at the apical ectodermal ridge;
stimulates mitosis of underlying mesoderm;
providing for lengthening of limbs

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4
Q

Homeobox (Hox) genes

A

Involved in segmental organization of embryo in a craniocaudal direction. Hox mutations lead to appendages in wrong locations

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5
Q

Early fetal development: day 0

A

Fertilization of egg by sperm forming the zygote, initiating embryogenesis

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6
Q

Early fetal development: within 1 week of fertilization

A

hCF secretion begins around the time of implantation of the blastocyst

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7
Q

Early fetal development: within 2 weeks of fertilization

A 
bilaminar disc (epiblast and hypoblast);
2 weeks= 2 layers
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8
Q

Early fetal development: within 3 weeks of fertilization

A

trilaminar disc, 3 weeks=3 layers;
gastrulation;
primitive streak, notochord, mesoderm and its organization, and neural plate begin to form

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9
Q

Early fetal development: weeks 3-8 post fertilization

A

Embryonic period;
neural tube formed by neuroectoderm and closes by week 4;
organogenesis;
extremely susceptible to teratogens

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10
Q

Early fetal development: Week 4

A

Heart begins to beat;
upper and lower limb buds begin to form;
4 weeks= 4 limbs

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11
Q

Early fetal development: week 6

A

Fetal cardiac activity visible by transvaginal ultrasound

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12
Q

Early fetal development: week 10

A

Genitalia have male/female characteristics

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13
Q

Grastrulation

A

Process that forms the trilaminar embryonic disc;
Establishes the ectoderm, mesoderm, and endoderm germ layes;
starts with the epiblast invaginating to form primitive streak

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14
Q

Surface ectoderm leads to what notable structures

A 
Adenohypophysis (from Rathke pouch);
lens of the eye;
epithelial lining of the oral cavity, sensory organs of ear, and olfactory epithelium;
Epidermis;
anal canal below the pectinate line;
parotid, sweat, and mammary glands
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15
Q

Craniopharyngioma

A

Benign Rathke pouch tumor with cholesterol crystals, calcifications

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16
Q

Neuroectoderm leads to what notable structures

A

Brain (neurohypophysis, CNS neurons, oligodendrocytes, astrocytes, ependymal cells, pineal gland), retina, optic nerve, spinal cord;
Just think CNS

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17
Q

Neural crest leads to what notable structures

A 
PNS (dorsal root ganglia, cranial nerves, celiac ganglion, Schwann cells, ANS); 
Melanocytes;
chromaffin cells of adrenal medulla;
Parafollicular C cells of thyroid;
pia and arachnoid;
bones of the skull;
Odontoblasts;
aorticopulmonary septum
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18
Q

Mesoderm leads to what structures

A

Muscle, bone, connective tissue, serous linings of body cavities(e.g. peritoneum), spleen (from foregut mesentery), cardiovascular structures, lymphatics, blood, wall of gut tube, vagina, kidneys, adrenal cortex, dermis, testes, ovaries;

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19
Q

Notochord induces ectoderm to form neuroectoderm (neural plate). Its post natal structures are

A

Nucleus pulposus of the intervertebral disc. That is it.

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20
Q

Endoderm

A

Gut tube epithelium (including anal canal above the pectinate line), most of urethra (derived from urogenital sinus), luminal epithelium derivatives (e.g. lungs, liver, gall bladder, pancreas, eustachian tubes, thymus, parathyroid, thyroid follicular cells)

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21
Q

Errors in morphogenesis: agenesis

A

Absent organ due to absent primordial tissue

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22
Q

Errors in morphogenesis: aplasia

A

Absent organ despite presence of primordial tissue

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23
Q

Errors in morphogenesis: Hypoplasia

A

Incomplete organ development;

primordial tissue present

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24
Q

Errors in morphogenesis: Deformation

A

extrinsic disruption;

occurs after the embryonic period

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25
Q

Errors in morphogenesis: Disruption

A

secondary breakdown of a previously normal tissue or structure (e.g. amniotic band syndrome)

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26
Q

Errors in morphogenesis: malformation

A

Intrinsic disruption;

occurs during embryonic period (weeks 3-8)

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27
Q

Errors in morphogenesis: sequence

A

Abnormalities result from single primary embryologic event (e.g. oligohydramnios leads to potter sequence)

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28
Q

Teratogen and its effect: ACE inhibitors

A

Renal damage

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29
Q

Teratogen and its effect: Alkylating agents

A

absence of digits, multiple abnormalities

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30
Q

Teratogen and its effect: Aminoglycosides

A

CN VIII toxicity;

a mean guy hit the baby in the ear

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31
Q

Teratogen and its effect: Carbamazepine

A

Neural tube defects, craniofacial defects, fingernail hypoplasia, developmental delay, IUGR

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32
Q

Teratogen and its effect: Diethylstilbestrol (DES)

A

Vaginal clear cell adenocarcinoma, congenital Mullerian anomalies; Adenosis (persistance of columnar cells in upper 2/3 of vagina, should be replaced by squamous cells) which leads to Vaginal clear cell adenocarcinoma

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33
Q

Teratogen and its effect: Folate antagonists

A

Neural tube defects

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34
Q

Teratogen and its effect: Lithium

A

Ebstein anomaly (atrialized right ventricle)

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35
Q

Teratogen and its effect: Methimazole

A

Aplasia cutis congenita (“Congenital absence of skin”)

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36
Q

Teratogen and its effect: Phenytoin

A

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

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37
Q

Teratogen and its effect: Tetracyclines

A

Discolored teeth; Teethracyclines

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38
Q

Teratogen and its effect: Thalidomide

A 
Limb defects (phocomelia, micromelia-flipper limbs;
limb defects with tha-limb-domide
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39
Q

Teratogen and its effect: valproate

A

Inhibition of maternal folate absorption leading to neural tube defects;
Valproate inhibits folate absorption

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40
Q

Teratogen and its effect: warfarin

A

Bone deformities, fetal hemorrhage, abortion, opthalmologic abnormalities;
Do not wage war on the baby, keep it heppy with heparin (does not cross placenta)

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41
Q

Teratogen and its effect: Alcohol

A

Common cause of birth defects and intellectual disability; fetal alcohol syndrome

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42
Q

Teratogen and its effect: cocaine

A

Abnormal fetal growth and fetal addiction; placental abruption

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43
Q

Teratogen and its effect: Smoking (nicotine, CO)

A

A leading cause of low birth weight in developed countries;

Associated with preterm labor, placental problems, IUGR, ADHD

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44
Q

Teratogen and its effect: Iodine (lack of or excess)

A

Congenital goiter or hypothyroidism (cretinism)

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45
Q

Teratogen and its effect: Maternal diabetes

A

Caudal regression syndrome (anal atresia to sirenomelia);
congenital heart defects;
neural tube defects

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46
Q

Teratogen and its effect: Vitamin A excess

A

Extremely high risk for spontaneous abortions and birth defects (Cleft palate, cardiac abnormalities)

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47
Q

Teratogen and its effect: X-rays

A

Microcephaly, intellectual disability

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48
Q

Fetal alcohol syndrome

A

One of the leading causes of congenital malformations in the US;
Increased risk for: intellectual disability, pre and postnatal developmental retardation, microcephaly, holoprosencephaly, facial abnormalities (smooth philtrum, thin upper lip, small palpebral fissures, hypertelorism), limb dislocation, and heart defects

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49
Q

Dizygotic twins arise from

A

Arise from 2 separate eggs fertilized by 2 separate sperm;
have 2 separate amniotic sacs;
2 separate placents (chorions).

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50
Q

Monozygotic twins arise from

A

arise from 1 fertilized egg that splits into 2 zygotes in early pregnancy

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51
Q

Monozygotic twins that separate in the first 4 days

A

before morula forms;
cleavage can cause fused or separate placenta;
either way you get dichrorionic and diamniotic placenta;

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52
Q

Monozygotic twins that separate in the 4-8 day range

A

(after morula forms, but before blastocyte);

Cleavage leads to monochorionic diamniotic twins

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53
Q

monozygotic twins that separate in the 8-12 day range

A

After blastocyst forms;

get monochorionic monoamniotic twins

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54
Q

Monozygotic twins that separate after 12 days

A

Cleavage leads to monochorionic monoamniotic conjoined twins

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55
Q

Fetal component of placental: cytotrophoblast

A

inner layer of chorionic villi;

Cytotrophoblast makes Cells

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56
Q

Fetal component of placental: Syncytiotrophoblast

A 
Outer layer of chorionic villi; 
secretes hCG (structurally similar to LH; stimulates corpus luteum to secrete progesterone during first trimester)
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57
Q

Maternal component of placental: Decidua basalis

A

Derived from the endometrium, the maternal blood would be in the lacunae

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58
Q

Umbilical cord

A

contains 2 umbilical arteries (look like the eyes): return deoxygenated blood from fetal internal iliac arteries to placenta;
Contains 1 umbilical vein (looks like the mouth): supplies oxygenated blood from placenta to fetus, drains into IVC via liver or ductus venosus;
Arteries and veins are derived from allantois

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59
Q

Urachus

A

In the 3rd week the yolk sac forms the allantois, which extends into the urogenital sinus. Allantois becomes the urachus, a duct between fetal bladder and yolk sac

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60
Q

Failure of urachus to obliterate causes

A

Patent urachus- urine discharge from umbilicus;
Urachal cysts- partial failure of urachus to obliterate, fluid-filled cavity lined with uroepithelium, between umbilicus and bladder, can lead to infection and adenocarcinoma;
Vesiourachal diverticulum- outpouching of bladder

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61
Q

Vitelline duct

A

7th week-obliteration of vitelline duct (omphalo-mesenteric duct), which connects yolk sac to midgut lumen;

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62
Q

Failure of the vitelline duct to obliterate causes

A

Vitelline fistula- meconium discharge from umbilicus;
Meckel diverticulum- Partial closure, with patent portion attached to ileum (true diverticulum). May have ectopic gastric and pancreatic tissue leading to melena, periumbilical pain, and ulcers

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63
Q

What arterial system does this aortic arch develop into: 1st arch

A

Part of the maxillary artery (branch of external carotid);

1st arch is the max

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64
Q

What arterial system does this aortic arch develop into: 2nd arch

A

Stapedial artery and hyoid artery;

Second=Stapedial

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65
Q

What arterial system does this aortic arch develop into: 3rd arch

A

Common Carotid artery and proximal part of internal Carotid artery;
C is 3rd letter

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66
Q

What arterial system does this aortic arch develop into: 4th arch

A

on left-aortic arch;
on right-proximal part of right subclavian artery;
4th arch=4 limbs=systemic

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67
Q

What arterial system does this aortic arch develop into: 6th arch

A

Proximal part of the pulmonary arteries and ductus arteriosis (on left only);
6th=pulmonary and pulmonary to systemic shunt

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68
Q

Branchial apparatus

A

AKA pharyngeal apparatus;
composed of clefts, arches, pouches;
Clefts-derived from ectoderm, AKA branchial grooves;
Arches-derived from mesoderm (muscles, arteries) and neural crest (bones, cartilage);
Pouches- derived from endoderm;
CAP covers inside to outside= Clefts, Arches, Pouches

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69
Q

Branchial cleft derivates

A

1st cleft develops into external auditory meatus;
2nd through 4th clefts form temporary cervical sinuses, which are obliterated by proliferation of 2nd arch mesenchyme;
Persistent cervical sinus leads to branchial cleft cyst within lateral neck (remnant of 2nd cleft)

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70
Q

Branchial arch derivatives of 1st arch

A

Cartilage: Meckel cartilage (Mandible, Malleus, incus, spheno-Mandibular ligament;
Muscles: Muscles of Mastication (temporalis, Masseter, lateral and medial pterygoids), Mylohyoid, anterior belly of digastric, tensor tympani, tensor veli palatini;
Nerves: CN V2, V3 (chew);

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71
Q

Branchial arch derivatives of 2nd arch

A

Cartilage: Reichert cartilage (Stapes, Styloid process, lesser horn of hyoid, Stylohyoid ligament);
Muscles: Muscle of facial expression )Stapedius, Stylohyoid, platySma), belly of digastic;
Nerves: CN VII (facial expression);

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72
Q

Abnormalities in 1st branchial arch development

A

Treacher collins syndrome (failure of 1st arch neural crest cells to migrate leading to mandibular hypoplasia, facial abnormalities)

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73
Q

Abnormalities in 2nd branchial arch development

A

Congenital pharyngo-cutaneous fistula: persistance of cleft and pouch leading to fistula between tonsillar area and lateral neck

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74
Q

Branchial arch derivatives of 3rd arch

A

Cartilage: greater horn of hyoid;
Muscles: Stylopharyngeus (think of stylopharyngeus innervated by the glossopharyngeal nerve);
Nerves: CN IX (stylo-pharyngeus), swallow stylishly

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75
Q

Branchial arch derivatives of 4th and 6th arch

A

Cartilage: thyroid, cricoid, arytenoids, corniculate, cuneiform;
Muscles: 4th-Most pharyngeal constrictors, cricothyroid, levator veli palatini, 6th- all intrinsic muscles of larynx except crycothyroid;
Nerves: 4th- CN X (superior laryngeal branch, simply swallow), 6th- CN X (recurrent laryngeal branch, speak)

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76
Q

Branchial arches 3 and 4 create what together

A

the posterior 1/3 of tongue

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77
Q

What is derived from this branchial pouch: 1st

A

Develops into the middle ear cavity, eustachian tube, mastoid air cells;
1st pouch contributes to endoderm-lined structures of ear

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78
Q

What is derived from this branchial pouch: 2nd

A

Develops into the epithelial lining of the palatine fossa

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79
Q

What is derived from this branchial pouch: 3rd

A

Dorsal wings-develops into the inferior parathyroids;
Ventral wings-develops into the thymus;
3rd pouch= 3 structures (thymus, left and right parathyroid);
3rd pouch ends up below the 4th

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80
Q

What is derived from this branchial pouch: 4th

A

Dorsal wings-develops into superior parathyroids

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81
Q

DiGeorge syndrome

A

Aberrant development of 3rd and 4th pouches leads to T cell deficiency (thymic aplasia) and hypocalcemia (failure of parathyroid development). Associated with cardiac defects (conotruncal anomalies)

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82
Q

MEN 2A

A

Mutation of Germline RET (neural crest cells);
Adrenal medulla (pheochromocytoma);
Parathyroid (tumor): 3rd and 4th pharyngeal pouch;
Parafollicular cells (medullary thyroid cancer): derived from neural crest cells: associated with 4th and 5th pharyngeal pouches

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83
Q

Cleft lip

A

Failure of fusion of the maxillary and medial nasal processes (formation of primary palate)

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84
Q

Cleft palate

A

Failure of fusion of the two lateral palatine processes or failure of fusion of lateral palatine processes with the nasal septum and/or median palatine process (formation of secondary palate)

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85
Q

Genital embryology: males and the SRY gene

A

SRY gene on chromosome Y produces testis determining factor (testes development)

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86
Q

Genital embryology: Male Sertoli cells make what

A

Secrete Mullerian inhibitory factor (MIF);

suppresses development of paramesonephric ducts

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87
Q

Genital embryology: Male leydig cells do what

A

Secrete androgens that stimulate development of mesonephric ducts

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88
Q

Mesonephric (wolffian) duct develops into

A 
male internal structures (Except prostate): SEED;
Seminal vesicles;
Epididymis;
Ejaculatory Duct;
Ductus deferens
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89
Q

Bicornuate uterus

A

Results from incomplete fusion of the paramesonephric ducts (vs. complete failure of fusion, resulting in double uterus and vagina). Can lead to anatomic defects such as recurrent miscarriages

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90
Q

Lets say you have a male with SRY gene on his Y chromosome (normal), but he has no sertoli cells or no mullerian inhibitory factor

A

Develop both male and female internal genitalia and male external genitalia

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91
Q

What if you have a XY male that has a defect in 5alpha reductase

A

can’t convert testosterone into dihydrotestosterone;
Male internal genitalia, ambiguous external genitalia until puberty (then increased testosterone will cause manly development)

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92
Q

What does this structure grow into when exposed to dihydrotestosterone (male) vs Estrogen (female): Genital tubercle

A

Men: glans penis, Women: Glans clitoris;
Men: Corpus cavernosum and spongiosum, women: vestibular bulbs

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93
Q

What does this structure grow into when exposed to dihydrotestosterone (male) vs Estrogen (female): urogential sinus

A

Men: bulbourethral glands of Cowper, Women: Greater vestibular glands of Bartholin;
Men: prostate gland, Women: Urethral and paraurethral glands of Skene

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94
Q

What does this structure grow into when exposed to dihydrotestosterone (male) vs Estrogen (female): Labioscrotal swelling

A

Men: scrotum, Women: Labia majora

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95
Q

Hypospadias

A

Abnormal opening of the urethra on inferior (ventral) side of penis due to failure of urethral folds to close;
More common than epispadius;
Fix to prevent UTIs and infertility;
Hypo is below

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96
Q

Epispadias

A

Abnormal opening of penile urethra on superior (dorsal) side of penis due to faulty positioning of genital tubercle;
Exstrophy of bladder is associated with epispadias;

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97
Q

What are the female and male remnants of: Gubernaculum

A

males: anchors testes within scrotum;
Females: ovarian ligament + round ligament of uterus.

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98
Q

What are the female and male remnants of: Processus vaginalis

A

Males: forms tunica vaginalis;
Female: obliterated

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99
Q

Venous drainage of gonads

A

Left ovary/testes drains into left gonadal vein into the left renal into the IVC;
Right ovary/testes drains into the right gonadal vein into the IVC

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100
Q

Lymphatic drainage of gonads

A

Ovaries/testes drain into the para-aortic lymph nodes;
Distal vagina/vulva/scrotum drain into the inguinal nodes;
Proximal vagina/uterus drains into the obturator, external iliac and hypogastric

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101
Q

Infundibulopelvic ligament (suspensory ligament of the ovaries): does what, contains what

A

Connects ovaries to lateral pelvic wall;
Contains the ovarian vessels;
Ligate vessels during oophorectomy to avoid bleeding;
Ureter courses retroperitoneally, close to gonadal vessels. At risk of injury during ligation of ovarian vessels

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102
Q

Cardinal ligament: does what, contains what

A

Connects cervix to side wall of pelvis;
contains uterine vessels;
Ureter at risk of injury during ligation of uterine vessels in histerectomy;

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103
Q

Round ligament of the uterus: does what

A

Uterine fundus to labia majora;

Derivative of gubernaculum. Travels through round inguinal canal; above the artery of sampson

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104
Q

Broad ligament: connects what, contains what

A

Connects uterus, fallopian tubes, and ovaries to pelvic side wall;
Ovaries, fallopian tubes, and round ligaments of uterus;
Mesosalpinx, mesometrium, and mesovarium are the components of the broad ligament

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105
Q

Ovarian ligament: connects what

A

Connects the medial pole of ovary to lateral uterus;
a derivative of the gubernaculum;
Ovarian Ligament Latches to Lateral uterus

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106
Q

Female epithelial histology that makes up the: vagina

A

Stratified squamous epithelium, nonkeratinized

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107
Q

Female epithelial histology that makes up the: Ectocervix

A

Stratified squamous epithelium, nonkeratinized

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108
Q

Female epithelial histology that makes up the: Endocervix

A

Simple columnar epithelium

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109
Q

Female epithelial histology that makes up the: Transformation zone

A

squamocolumnar junction (most common area for cervical cancer

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110
Q

Female epithelial histology that makes up the: Uterus

A

Simple columnar epithelium with long tubular glands

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111
Q

Female epithelial histology that makes up the: Fallopian tube

A

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

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112
Q

Female epithelial histology that makes up the: Ovary, outer surface

A

Simple cuboidal epithelium (germinal epithelium covering surface of ovary)

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113
Q

Female sexual response cycle

A

Most commonly describe as phase of excitement (uterus elevates, vaginal lubrication), plateau (expansion of inner vagina), orgasm (contraction of uterus), and resolution;
mediated by autonomic nervous system;
also causes tachycardia and skin flushing

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114
Q

Male reproductive anatomy: pathway of sperm during ejaculation

A

SEVEN UP;

Semininferous tubules, Epididymis, Vas deferens, Ejaculatory ducts, Nothing, Urethra, Penis

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115
Q

Autonomic innervation of the male sexual response

A

Erection is parasympathetic (via pelvic nerve);
NO leads to increased cGMP causing smooth muscle relaxation leading to vasodilation causing proerectile force;
NE leads to increased Calcium leading to smooth muscle contraction leading to vasoconstriction leading to antierectile force;
Emission is by sympathetic (via hypogastric nerve);
Ejaculation visceral and somatic nerves (pudendal nerve)

116
Q

Seminiferous tubules: Spermatogonia (germ cells)

A

Maintain germ pool and produce primary spermatocytes;

They line the seminiferous tubules

117
Q

Seminiferous tubules: sertoli cells

A

Secrete inhibit leading to inhibition of FSH;
Secrete androgen binding protein leading to maintenance of local levels of testosterone;
Tight junctions between sertoli cells form blood testis barrier helping to isolate gametes form autoimmune attacking;
Support and nourish developing spermatozoa;
regulate spermatogenesis;
Produce MIF;
Temperature sensitive: decrease sperm production, and decreased inhibin with increase in temperature;
Lines seminiferous tubules;
Converts testosterone and androstenedione to estrogen via aromatase

118
Q

Seminiferous tubules: Leydig cells

A

Secrete testosterone in the presence of LH;
Testosterone production unaffected by temperature;
Located in interstitium;
Also contain aromatase

119
Q

Estrogen: souce

A

Ovary (17beta-estradiol), Placenta (estriol), adipose tissue (estrone via aromatization);
Potency: estradiol > estrone > estriol

120
Q

Estrogen: function

A

Development of genitalia and breast, female fat distribution;
Growth of follicle, endometrial proliferation, increased myometrial excitability;
upregulation of estrogen, LH, and progesterone receptors; feedback inhibition of FSH and LH, then LH surge; stimulation of prolaction secretion;
estrogen receptors in the cytoplasm, go to nucleus once bound

121
Q

Progesterone

A

Source: Corpus leteum, placenta, adrenal cortex, testes;
Function: Stimulation of endometrial glandular secretion and spiral artery development;
Maintenance of pregnancy;
Decreases myometrial excitability;
Production of thick cervical mucus, which inhibits sperm entry into the uterus;
increases body temperature;
Inhibition of FSH and LH;
Uterine smooth muscle relaxation (preventing contractions);
Decreases estrogen receptor expressivity;
Prevents endometrial hyperplasia;
Fall in progesterone after delivery disinhibits prolactin leading to lactation;
Increased progesterone is indicative of ovulation
PRO-GESTerone is PRO-GESTation

122
Q

Tanner stages of sexual development

A

Stage is assigned independently to genitalia, pubic hair, and breast;

1: Childhood (prepubertal);
2: Pubic hair appears (pubarche); breast buds form (thelarche);
3: Pubic hair darkens and becomes curly, penis size/length increases, breasts enlarge;
4: Penis width increases, darker scrotal skin, development of glans, raised areolae;
5: Adult, areolae are no longer raised

123
Q

Menstrual cycle: Follicular and luteal phase length

A

Follicular can be variable;
luteal phase is always 14 days;
Ovulation to 14 days=menstruation (usually you count back 14 days from menstruation)

124
Q

Menstrual cycle: What stimulates endometrial proliferation

A

estrogen

125
Q

Menstrual cycle: what hormone maintains the endometrium to support implantation

A

Progesterone

126
Q

Define oligomenorrhea

A

> 35 day cycle

127
Q

Define polymenorrhea

A
128
Q

Metrorrhagia

A

Intermenstrual bleeding;

Frequent but irregular menstruation;

129
Q

Menorrhagia

A

Heavy menstrual bleeding;

>80 ml blood loss or >7 days menses

130
Q

Menometrorrhagia

A

Heavy, irregular menstruation at irregular intervals

131
Q

Oogenesis

A

Primary oocytes begin meiosis I during fetal life and complete meiosis I prior to ovulation;
Meiosis I is arrested in prOphase I for years until Ovulation (primary oocyte);
Meiosis II is arrested in metaphase II until fertilization (secondary oocytes);
If fertilization does not occur within 1 day, the secondary oocyte degenerates

132
Q

Steps of ovulation

A 
Increased estrogen, increased GnRH receptors on anterior pituitary. Estrogen then stimulates LH release (surge) leading to ovulation (rupture of follicle);
Increased temperature (progesterone induced)
133
Q

Mittelschmerz

A

Refers to transient mid cycle ovulatory pain; classically associated with peritoneal irritation (e.g. follicular swelling/rupture, fallopian tube contraction);
Can mimic appendicitis

134
Q

Where does fertilization commonly occur

A

Upper end of the fallopian tube (ampulla);

Occurs within first day of ovulation;

135
Q

After fertilization of egg in ampulla, what happens

A

Implantation within the wall of the uterus occurs 6 days after fertilization;
Syncytiotrophoblasts secrete hCG, which is detectable 1 week after conception and on home test in urine 2 weeks after conception

136
Q

Lactation after labor

A

After labor, the decreased progesterone and estrogen disinhibits lactation. Suckling is required to maintain milk production since increase nerve stimulation increases oxytocin and prolactin

137
Q

Lactation: Prolactin’s role

A

Induces and maintains lactation and decreased reproductive function

138
Q

Lactation: Oxytocin’s role

A

Assists in milk letdown;

promotes uterine contractions

139
Q

Breast milk contains and has what benefits

A

Maternal immunoglobulins (mostly IgA);
Macrophages;
lymphocytes;
Still need to give vitamin D to baby;
Decreases child’s chance of: asthma, allergies, diabetes, obesity;
decreases maternal risk of breast and ovarian cancer

140
Q

hCG: source of it

A

Syncytiotrophoblasts of the placenta

141
Q

hCG: function

A

Maintains the corpus luteum (and thus progesterone) for the 1st trimester (otherwise no luteal cell stimulation and abortion happens);
in the 2nd and 3rd trimester the placenta synthesizes its own estriol and progesterone and corpus luteum degenerates;
Used to detect pregnancy because it appears early in the urine;
alpha subunit of hCG is same as LH, FSH, and TSH so beta subunit is how it is distinguished;
hCG increased in multiple gestations and in pathologic states (e.g. hydatidiform mole, choriocarcinoma)

142
Q

menopause

A

Decreased estrogen production due to age linked decline in number of ovarian follicles;
Average age of onset is 51 (earlier in smokers);
Usually preceded by 4-5 years of abnormal menstrual cycles;
source of estrogen (estrone) after menopause become peripheral conversion of androgens (increased androgens leads to hirsutism);
Massively increased FSH is specific for menopause (loss of estrogen’s negative feedback), decreased Estrogen, increased LH, increased GnRH

143
Q

Menopause causes HAVOCS

A 
hot flashes;
Atrophy of vagina;
Osteoporosis;
Coronary artery disease;
Sleep disturbances
144
Q

Spermatogenesis

A

Spermatogenesis begins at puberty with spermatogonia;
Full development takes 2 months;
Occurs in seminiferous tubules;
Produces spermatids that undergo spermiogenesis (loss of cytoplasmic contents, gain of acrosomal cap) to form mature spermatozoon;
Gonium is going to be sperm;
Zoon is Zooming to egg

145
Q

Androgens: name them

A

Testosterone, Dihydrotestosterone (DHT), Androstenedione

146
Q

Androgens: source

A

DHT and testosterone (testis, AnDrostenedione (ADrenal)

147
Q

Androgens: potency

A

DHT > testosterone > androstenedione

148
Q

Androgens: function of testosterone

A

Differentiation of epididymis, vas deferens, seminal vesicles (genitalia, except prostate);
Growth spurt: penis, seminal vesicles, sperm, muscle, RBCs;
Deepening of voice;
Closing of epiphyseal plates (via estrogen converted from testosterone);
libido

149
Q

Androgens: Functions of DHT

A

Early- Differentiation of penis, scrotum, prostate;

Late-prostate growth, balding, sebaceous gland activity

150
Q

How to convert testosterone to DHT

A

5 alpha reductase enzyme;

151
Q

Androgens are converted to estrogens in males by

A

cytochrome p-450 aromatase (primarily in adipose tissue and the testis);

152
Q

Exogenous testosterone

A

leads to inhibition of hypothalamic pituitary gonadal axis leading to decreased intratesticular testosterone leading to decreased testicular size and azoospermia (absence of motile sperm)

153
Q

10-OH progesterone

A

Rises in the first semester like hCG, then falls off like hCG;
Made by the corpus luteum because placenta lacks 17 alpha hydroxylase;

154
Q

Klinefelter Syndrome

A

XXY Male, 1:850;
See: testicular atrophy, eunuchoid body shape, tall, long extremities, gynecomastia, female hair distribution, may present with developmental delay;
Presence of Barr body (inactivated X chromosome);
Common cause of hypogonadism see in infertility workup;
Dysgenesis of seminiferous tubules leading to decreased inhibit and therefore increased FSH;
Abnormal leydig cell function leads to decreased testosterone causing increased LH and therefore increased estrogen

155
Q

Turner syndrome

A

XO Female;
Short stature if untreated, ovarian dysgenesis (streak ovary), shield chest, bicuspid aortic valve, preductal coarctation (femoral

156
Q

Double Y males

A

XYY, 1:1000;
Phenotypically normal;
very tall, severe acne, antisocial behavior (1-2%), Normal fertility, small percentage diagnosed with autism spectrum disorders

157
Q

True hermaphroditism

A

46XX or 47 XXY, Very rare;
Also called ovotesticular disorder of sex development;
both ovary and testicular tissue are present (ovotestis);
ambiguous genitalia;

158
Q

Trisomy 16

A

Never born, always die in utero;

most common genetic reason for death of fetus

159
Q

Diagnosing disorders of sex hormones: increased LH and increased testosterone

A

Think defective androgen receptor

160
Q

Diagnosing disorders of sex hormones: increased Testosterone and decreased LH

A

Testosterone secreting tumor, exogenous steroids

161
Q

Diagnosing disorders of sex hormones: Decreased testosterone, increased LH

A

primary hypogonadism

162
Q

Diagnosing disorders of sex hormones: Decreased testosterone, decreased LH

A

Hypogonadotropic hypogonadism

163
Q

Female pseudohermaphrodite (XX)

A

Ovaries present but external genitalia are virilized or ambiguous;
Due to excessive and inappropriate exposure to androgenic steroids during early gestation (congenital adrenal hyperplasia or exogenous administration of androgens during pregnancy)

164
Q

Male pseudohermaphrodite (XY)

A

Testes present, but external genitalia are female or ambiguous;
most common form is androgen insensitivity syndrome (testicular feminization)

165
Q

Aromatase deficiency

A

inability to synthesize estrogens from androgens;
Masculinization of female (46,XX) infants (ambiguous genitalia);
increased serum testosterone and androstenedione;
can present with maternal virilization during pregnancy (fetal androgens cross the placenta)

166
Q

Androgen insensitivity syndrome (46XY)

A

Defect in androgen receptor resulting in normal appearing female;
female external genitalia with rudimentary vagina;
uterus and fallopian tubes generally absent;
presents with scant sexual hair;
develops testes (often found in labia majora; surgically removed to prevent malignancy);
increased testosterone, estrogen, and LH (vs. sex chromosome disorders)

167
Q

5alpha reductase deficiency

A 
Autosomal recessive;
sex limited to genetic males (46XY);
inability to convert testosterone to DHT;
Ambiguous genitalia until puberty;
when increased testosterone causes masculinization/ increased growth of external genitalia;
testosterone/estrogen levels are normal;
LH is normal or increased;
internal genitalia are normal
168
Q

Kallman syndrome

A

Failure to complete puberty;
a from of hypogonadotropic hypogonadism;
defective migration of GnRH cells and formation of olfactory bulb;
decreased synthesis of GnRH in the hypothalamus;
anosmia;
Decreased GnRH, FSH, LH, testosterone, and infertility (low sperm count or amenorrhea)

169
Q

Hydatitdiform mole

A

Cystic swelling of chorionic villi and proliferation of chorionic epithelium (only trophoblast);
Treatment: dilation and curettage and methotrexate;
Monitor beta hCG

170
Q

Complete Hydatidiform mole

A

Karyotype- 46,XX or 46,XY;
Massively increased hCG;
Increased uterine size;
2% convert to choriocarcinoma;
No fetal parts;
Enucleated egg + single sperm (subsequently duplicates paternal DNA), empty egg + 2 sperm is rare;
15-20% have complication of malignant trophoblastic disease (choriocarcinoma);
Symptoms- Vaginal bleeding, enlarged uterus, hyperemesis, pre-eclampsia, hyperthyroidism;
Imaging-honeycombed uterus or cluster of grates, snowstorm on ultrasound

171
Q

Partial hydatidiform mole

A

Karyotype- 69,XXX or 69,XXY or 69,XYY;
increased hCG;
normal uterine size;
Rare for it to convert to choriocarcinoma;
Fetal parts are present (partial parts present);
Components- 2 sperm + 1 egg;
Low risk of malignancy (

172
Q

Gestational HTN (pregnancy induced HTN)

A

BP > 140/90 mmHg after the 20th week of gestation;
no pre-existing HTN;
No proteinuria or end organ damage;
Treat: antihypertensives (alpha methyldopa, labetalol, hydralazine, nifedipine), deliver at 39 weeks;

173
Q

Preeclampsia: presentation

A

Defined as HTN and proteinuria after 20th week of gestation to 6 weeks (160/100, with or without end organ damage, e.g. headache, scotoma, oliguria, increased AST/ALT, thrombocytopenia

174
Q

Preeclampsia: Causes

A

Caused by abnormal placental spiral arteries, results in maternal endothelial dysfunction, vasoconstriction, or hyperreflexia

175
Q

Preeclampsia: who is more likely to get it

A

Patients with preexisting: HTN, diabetes, chronic renal disease, or autoimmune disorders

176
Q

Preeclampsia: Complications

A

Placental abruption, coagulopathy, renal failure, uteroplacental insufficiency, or eclampsia

177
Q

Preeclampsia: treatment

A

Antihypertensives, deliver at 34 weeks if severe, 37 weeks if mild, IV magnesium sulfate to prevent seizure

178
Q

Eclampsia

A

Preeclampsia + seizures in mom;
Maternal death due to stroke due to intracranial hemorrhage or ARDS;
Treat with antihypertensives, IV magnesium sulfate, immediate delivery

179
Q

HELLP syndrome

A

Hemolysis, Elevated liver enzymes, Low Platelets;
A manifestation of severe preeclampsia, although may occur without HTN;
Treat by immediate delivery

180
Q

Placental abruption (abruptio placentae)

A

Premature separation (separate or complete) of placenta form uterine wall before delivery of baby;
Risk factor: trauma, smoking, HTN, preeclampsia, cocaine abuse;
Presents as abrupt, painful bleeding (concealed or apparent) in 3rd trimester, Possible DIC, maternal shock, fetal distress;
Life threatening for mom and baby

181
Q

Placenta accreta

A

Placenta attaches to myometrium without penetrating it, most common type;
Defective decidual layer leading to abnormal attachment and separation after delivery;
Risk factor: prior C section, inflammation, placenta previa
Presents as no separation of placenta after delivery of baby leading to massive bleeding, life threatening for mom

182
Q

Placenta increta

A

Placenta penetrates into myometrium and attaches;
Defective decidual layer leading to abnormal attachment and separation after delivery;
Risk factor: prior C section, inflammation, placenta previa
Presents as no separation of placenta after delivery of baby leading to massive bleeding, life threatening for mom

183
Q

Placenta Percreta

A 
Placent penetrates (perforates) through the myometrium and into uterine serosa (invades entire uterine wall); can result in placental attachment to rectum or bladder;
Defective decidual layer leading to abnormal attachment and separation after delivery;
Risk factor: prior C section, inflammation, placenta previa
Presents as no separation of placenta after delivery of baby leading to massive bleeding, life threatening for mom
184
Q

Pregnancy complications: Retained placental tissue

A

May cause postpartum hemorrhage;

increased risk of infection

185
Q

Ectopic pregnancy

A

Most often in ampulla of fallopian tube;
suspect with Hx of amenorrhea, lower than expected hCG based on dates, and sudden lower abdominal pain, Hx of infertility, pelvic inflammatory disease;
confirm with ultrasound;
often mistaken as appendicitis;

186
Q

Polyhydramnios

A

> 1.5 to 2 liters of amniotic fluid; Associated with fetal malformations (e.g. esophageal/duodenal atresia, anencephaly, both result in inability to swallow amniotic fluid), maternal diabetes, fetal anemia, multiple gestations

187
Q

Oligohydramnios

A
188
Q

Cervical pathology: dysplasia and carcinoma in situ

A

Disordered epithelial growth;
Begins at basal layer of squamocolumnar junction (transition zone) and extends outward;
Classified as CN I, 2, or 3 depending on extent of dysplasia;
associated with HPV 16 and 18 which produce both the E6 gene product (inhibits p53 suppressor gene) and E7 gene product (inhibits RB suppressor gene);
May slowly progress to invasive carcinoma if left untreated;
Typically asymptomatic (PAP smear detects it);
Can have vaginal bleeding (often post coital);
Risk factors- multiple sexual partners (#1), smoking, early sexual intercourse, HIV infection

189
Q

Cervical pathology: invasive carcinoma

A

Often squamous cell carcinoma;
Pap smear can catch cervical dysplasia (koilocytes) before it progresses to invasive carcinoma;
lateral invasion can block ureters, causing renal failure

190
Q

Endometritis

A

Inflammation of the endometrium (with plasma cells and lymphocytes);
associated with retained products of conception post delivery or foreign body such as an IUD;
Retained material promotes infection by bacterial flora from vagina or intestinal tract;
Treatment: gentamicin + clindamycin with or without ampicillin

191
Q

Endometriosis: what is it?

A

Non-neoplastic endometrial glands/stroma outside of the endometrial cavity;
Can be found anywhere but most common in ovary, pelvis, and peirtoneum;
In ovary, appears as an endometrioma (chocolate cysts);
Can be due to retrograde flow, metastatic transformation of multipotent cells or transportation of endometrial tissue via lymphatic system

192
Q

Endometriosis: Symptoms that bring patient into office

A

Characterized by cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia (pain with pooping), infertility;
normal sized uterus

193
Q

Endometriosis: Treatment

A

Treatment- NSAIDs, OCPs, progesterone, GnRH agonists, surgery

194
Q

Adenomyosis

A

Extension of endometrial tissue (glandular) into the uterine myometrium;
Caused by hyperplasia of the basalis layer of the enodmetrium;
Dysmenorrhea, menorrhagia;
Uniformly enlarged, soft, globular uterus;
Treatment is hysterectomy

195
Q

Adenomyoma

A

polyp;
Well circumscribed collection of endometrial tissue within the uterine wall;
may contain smooth muscle cells;
Can extend into the endometrial cavity in the form of a polyp

196
Q

Endometrial hyperplasia

A

abnormal endometrial gland proliferation usually caused by excess estrogen stimulation;
increased risk for endometrial carcinoma;
Clinically manifests as postmenopausal vaginal bleeding;
risk factors include anovulatory cycles, hormone replacement therapy, polycystic ovarian syndrome, and granulosa cell tumor

197
Q

Endometrial carcinoma

A

Most common gynecologic malignancy;
peak occurrence at 55-65;
clinically presents as vaginal bleeding;
typically preceded by endometrial hyperplasia;
risk factors include prolonged use of estrogen without progestins, obesity, diabetes, HTN, nulliparity, and late menopause (any situation that raises estrogen);
Increased myometrial invasion leading to worse prognosis

198
Q

Leiomyoma

A

fibroid;
Most common tumor in females;
Often presents as multiple discrete tumors;
increase incidence in blacks;
benign smooth muscle tumor;
malignant transformation rare;
Estrogen sensitive- tumor size will increase with pregnancy and decrease with menopause;
Peak occurrence is 20-40;
may be asymptomatic, cause bleeding or miscarriage;
does not progress to leiomyosarcoma!;
whorled pattern of smooth muscle with well-demarcated borders

199
Q

Gynecologic tumor epidemiology: what is most common in US, what is most deadly

A

Incidence: endometrial > ovarian > cervical;

Worst prognosis: Ovarian > cervical > endometrial

200
Q

Premature ovarian failure

A

Premature atresia of ovarian follicles in women of reproductive age;
Patients present with signs of menopause after puberty but before age 40;
Decreased estrogen, increased LH and FSH

201
Q

Most common causes of anovulation

A

Pregnancy, polycystic ovarian syndrome, obesity, HPO axis abnormalities, premature ovarian failure, hyperprolactinemia, thyroid disorders, eating disorders, female athletes, Cushing syndrome, adrenal insufficiency

202
Q

Polycystic Ovarian Syndrome: physiology

A

Hyperandrogenism due to deranged steroid synthesis by theca cells, hyperinsulinemia;
Estrogen increases steroid hormone-binding globulin and decreases LH, leading to decreased free testosterone;
Insulin and testosterone decrease SHBG leading to increased free testosterone;
Increased LH due to pituitary/hypothalamus dysfunction;
Results in enlarged, bilateral cystic ovaries;

203
Q

Polycystic Ovarian Syndrome: presentation

A

Presents with amenorrhea/oligomenorrhea, hirsutism, acne, infertility;

204
Q

Polycystic Ovarian Syndrome: Associated with

A

Associated with obesity;
Increased risk of endometrial cancer secondary to increased estrogens from aromatization of testosterone and absence of progesterone;

205
Q

Polycystic Ovarian Syndrome: treatment for Hirsutism, acne:

A

weight reduction, OCPs (estrogen increases SHBG and decreased LH leading to decreased free testosterone), antiandrogens;

206
Q

Polycystic Ovarian Syndrome: treatment for infertility:

A

clomiphene citrate (block negative feedback of estrogen, decreased FSH and LH), metformin (increases insulin sensitivity, decreases insulin levels, results in decreased testosterone, enables LH surge);

207
Q

Polycystic Ovarian Syndrome: treatment for endometrial protection:

A

Cyclic progesterone (antagonizes endometrial proliferation)

208
Q

Follicular ovarian cyst

A

distention of unruptured graafian follicle;
may be associated with hyperestrogenism and endometrial hyperplasia;
Most common ovarian mass in young women

209
Q

Ovarian cyst: Corpus Leteum cyst

A

Hemorrhage into persistent corpus luteum;

commonly regresses spontaneously

210
Q

Ovarian cyst: Theca-lutein cysts

A

Often bilateral/multiple;
Due to gonadotropin stimulation;
Associated with choriocarcinoma and moles;

211
Q

Ovarian cyst: hemorrhagic cysts

A

blood vessel rupture in cyst wall;
cyst grows with increased blood retention;
Usually self-resolves

212
Q

Ovarian cysts: Dermoid cyst

A

Mature teratoma;

Cystic growths filled with various types of tissue such as fat, hair, teeth, bits of bone, and cartilage

213
Q

Ovarian cysts: Endometrioid cysts

A

Endometriosis within ovary with cyst formation;
varies with menstrual cycle;
when filled with dark, reddish-brown blood it is called a “chocolate cyst”

214
Q

Serous cystadenoma

A

most common benign ovarian neoplasm;
thin walled, uni or multilocular;
lined with fallopian like epithelium;
often bilateral

215
Q

Mucinous Cystadenoma

A

benign ovarian neoplasm;
Multiloculated;
large;
Lined by mucus secreting epithelium

216
Q

Endometrioma

A

benign ovarian neoplasm;
Mass arising from from growth of ectopic endometrial tissue;
Complex mass on ultrasound;
presents with pelvic pain, dysmenorrhea, dyspareunia

217
Q

Mature cystic teratoma (dermoid cyst)

A

benign ovarian Germ cell tumor;
most common ovarian tumor in 20-30 year olds;
can contain elements from all 3 germ layers (teeth, hair, sebum are common);
Can present as pain due to secondary ovarian enlargement or torsion;
Can also contain functional thyroid tissue and present as hyperthyroidism (struma ovarii)

218
Q

Brenner tumor

A

benign ovarian neoplasm;
Looks like bladder;
Solid tumor that is pale yellow-tan in color and appears encapsulated;
“coffee bean” nuclei on H&E stain

219
Q

Fibromas of ovary

A

benign ovarian neoplasm;
bundles of spindle shaped fibroblasts;
Meigs Syndrome-triad of ovarian fibroma, ascites, and hydrothorax;
pulling sensation in groin

220
Q

Thecoma in ovary

A

benign ovarian neoplasm;
Like granulosa cell tumors, may produce estrogen;
usually present as abnormal uterine bleeding in a postmenopausal woman.

221
Q

Immature teratoma

A

Malignant ovarian neoplasm;
aggressive, contains fetal tissue, neuroectoderm;
typically has immature/embryonic like neural tissue (mature teratoma more likely to contain thyroid tissue)

222
Q

Serous cystadenocarcinoma

A

most common malignant ovarian neoplasm;
frequently bilateral;
Psammoma bodies;

223
Q

Mucinous cystadenocarcinoma

A

Malignant ovarian neoplasm;

Pseudomyxoma peritonei- intraperitoneal accumulation of musinous material from ovarian or appendiceal tumor

224
Q

Dysgerminoma

A 
Malignant ovarian neoplasm;
Most common in adolescents;
equivalent to male seminoma but rarer;
1% of all ovarian tumors;
30% of all germ cell tumors;
sheet of uniform "fried egg" cells;
hCG, LDH=tumor markers
225
Q

Choriocarcinoma

A

Rare Malignant ovarian neoplasm;
Can develop after pregnancy in mother or baby;
malignancy of trophoblastic tissue (crytotrophoblasts, syncytiotrophoblasts);
no chorionic villi present;
increased frequency of theca-lutein cysts;
Presents with abnormal beta-hCG, SOB, hemoptysis;
Hematogenous spread to lungs;
very responsive to chemo

226
Q

Yolk sac (endodermal sinus) tumor

A

Aggressive Malignant ovarian neoplasm;
in ovaries or testes and sacrococcygeal area in young children;
most common tumor in male infanats;
yellow, friable (hemorrhagic), solid mass;
50% have Schiller-Duval bodies (resemble glomeruli;
AFP=tumor marker

227
Q

Krunkenberg tumor

A

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

228
Q

Vaginal tumor: squamous cell carcinoma

A

Usually secondary to cervical clear cell carcinoma;

primary vaginal carcinoma rare

229
Q

Vaginal tumor: Clear cell adenocarcinoma

A

Affects women who had exposure to DES in utero

230
Q

Vaginal tumor: sarcoma botryoides (rhabdomyosarcoma variant)

A

Affects girls

231
Q

Breast tumor: Fibroadenoma

A

Benign tumor;
Small, mobile, firm mass with sharp edges;
most common tumor in those

232
Q

Breast tumor: Intraductal papilloma

A

Benign tumor;
Small tumor that grows in lactiferous ducts;
Typically beneath areola;
Serous or bloody nipple discharge;
Slight (1.5-2x) increase in risk for carcinoma

233
Q

Breast tumor: Phyllodes tumor

A

Benign tumor;
Large bulky mass of connective tissue and cysts. Leaf-like projections;
Most common in 6th decade;
Some may become malignant

234
Q

Overview of malignant breast tumors

A

Commonly postmenopausal;
usually arise from terminal duct lobular unit;
overexpression of estrogen/progesterone receptors or c-erbB2 (HER-2, an EGF receptor) is common;
Triple negative (ER-, PR-, and Her2/Neu-) more aggressive;
type affects therapy and prognosis;
Axillary lymph node involvement indicating metastasis is the single most important prognostic factor;
Most often located in upper-outer quadrant of breast;

235
Q

Risk factors for malignant breast tumors

A

increased estrogen exposure;
Increase total number of menstrual cycles;
older age at 1st live birth;
obesity (increased estrogen exposure as adipose tissue has aromatase to convert androstenedione to estrone);
BRCA1 and BRCA2 gene mutations;
African American ethnicity (increases risk for triple negative breast cancer)

236
Q

Breast tumor: Ductal carcinoma in situ

A

noninvasive;
Fills ductal lumen;
arises from ductal atypia;
Often seen early as microcalcification on mammography;
Early malignancy without basement membrane penetration

237
Q

Breast tumor: Comedocarcinoma

A

noninvasive;
Ductal, caseous necrosis;
Subtype of DCIS

238
Q

Breast tumor: paget disease

A

noninvasive;
Results from underlying DCIS;
exzematous patches on nipple;
paget cell=large cells in epidermis with clear halo;
Nipple inflammation, pigmentation;
PAS + (stains carbohydrate macromolecules like mucin);
Burning and itching of breast;
Suggests underlying DCIS;
also seen in vulva, though does not suggest underlying malignancy

239
Q

Breast tumor: Invasive ductal

A

Invasive;
firm, fibrous, “rock-hard” mass with sharp margins and small, glandular, duct like cells;
Grossly, see classic “stellate” infiltration;
Worst and most invasive;
most common (76%) breast cancer

240
Q

Breast tumor: Invasive lobular

A

Invasive;
Orderly row of cells (indian file);
often bilateral with multiple lesions in the same location

241
Q

Breast tumor: Medullary

A

Invasive;
Fleshy, cellular lymphocytic infiltrate;
Good prognosis

242
Q

Breast tumor: inflammatory

A

Invasive;
Dermal lymphatic invasion by breast carcinoma;
Peau d’orange (breast skin looks like orange peel);
neoplastic cells block lymphatic drainage;
50% survival at 5 years

243
Q

Mullerian inhibitory factor: what does it do in development

A

In men, in utero, mullerian inhibitory factor is a requirement to block the development of female structures (if missing you can get a normal external fertile adult dude, but inside he will have a uterus)

244
Q

mixed testicular tumor

A

Shows differentiation consistent with multiple types of tumors

245
Q

Proliferative breast disease: overview and types

A

Most common cause of breast lumps from age 25 to menopause;
presents with pre-menstrual breast pain and multiple lesions, often bilateral;
Fluctuation in size and mass;
Usually does not indicate an increase risk of carcinoma;
4 types are Fibrosis, Cystic, Sclerosing adenosis, Epithelial hyperplasia

246
Q

Proliferative breast disease: fibrosis type

A

Hyperplasia of breast stroma

247
Q

Proliferative breast disease: Sclerosing adenosis

A

Increased acini and intralobular fibrosis;
Associated with calcifications;
Often confused with cancer;
Increased risk (1.5-2x) of cancer

248
Q

Proliferative breast disease: Cystic type

A

Fluid filled, blue dome;

Ductal dilation

249
Q

Proliferative breast disease: Epithelial hyperplasia

A

Increased number of epithelial cell layers in terminal duct lobule. Increased risk of carcinoma with atypical cells;
Occurs in women>30 years old

250
Q

Acute mastitis

A

Breast abscess;
during breast feeding, increased risk of bacterial infection through cracks in the nipple;
S. auereus is the most common pathogen;
Treat with dicloxacillin and continued breast-feeding

251
Q

Fat necrosis of breast

A 
A benign, usually painless lump;
forms as a result of breast trauma;
abnormal calcifications on mammography;
biopsy shows necrotic fat, giant cells;
Up to 50% of patients may not report trauma
252
Q

Gynecomastia

A

Occurs in males;
results from hyperestrogenism (cirrhosis, testicular tumor, puberty, old age), klinefelter syndrome, or drugs (spironolactone, Dope (marijuana), Digitalis, Estrogen, Cimetidine, Alcohol, Heroin, Dopamine D2 antagonists, Ketoconazole, Some Dope Drugs Easily Create Awkward Hairy DD Knockers)

253
Q

Benign prostatic hyperplasia

A

Common in men >50;
Hyperplasia (not hypertrophy);
characterized by a smooth elastic, firm nodular enlargement of the periurethral lobes which compress the urethra into a vertical slit;
Not pre-malignant;
Will increase PSA;
Treatment: alpha1 antagonists (terazosin, tamsulosin), which cause relaxation of smooth muscle, Finasteride

254
Q

Prostatic adenocarcinoma

A

Common in men >50;
arises most often from the posterior lobe (peripheral zone) of the prostate gland;
Increased PSA followed by needle core biopsy;
Prostatic acid phosphatase (PAP) and PSA are useful tumor markers (increased total PSA with decreased fraction of free PSA);
Obsteoblastic metastases in bone may develop in late stages, as indicated by lower back pain and an increase in serum ALP and PSA

255
Q

Cryptorchidism

A 
Undescended testis (one or both);
impaired spermatogenesis (since sperm develop best at temperatures
256
Q

Varicocele

A

Dilated veins in pampiniform plexus as a result of increased venous pressure;
most common cause of scrotal enlargement in adult males;
most often on the left side (left vein drains into left renal vein);
Can cause infertility due to increased temperature;
Bag of worms appearance;
Diagnosed by ultrasound Doppler;
Treatment- Varicocelectomy, embolization by interventional radiology

257
Q

Testicular germ cell tumors: overview

A

95% of all testicular tumors;
most often occur in young men;
risk factor: cryptorchidism, Klinefelter syndrome;
Can present as a mixed germ cell tumor;
Differential diagnosis for testicular mass that does not transilluminated is cancer

258
Q

Testicular germ cell tumors: Seminoma

A

Malignant;
Painless, homogenous testicular enlargement;
most common testicular tumor, most common in 3rd decade, never in infancy;
Large cells in lobules with watery cytoplasm and a fried egg appearance;
Increased placental AL;
Radiosensitive;
Late metastasis, excellent prognosis

259
Q

Testicular germ cell tumors: Yolk sac (endodermal sinus) tumor

A

Yellow, mucinous;
aggressive malignancy of testes, analogous to ovarian yolk sac tumor;
Schiller Duval bodies resemble primitive glomeruli;
Most common testicular tumor in boys

260
Q

Testicular germ cell tumors: Choriocarcinoma

A

Malignant;
Increase in hCG;
Disordered syncytiotrophoblastic and Cytotrophoblastic elements;
Hematogenous metastases to lungs and brain (may present with hemorrhagic stroke due to bleeding into the metastasis. may produce gynecomastia or symptoms of hyperthyroidism (hCG is an LH and TSH analog)

261
Q

Testicular germ cell tumors: Teratoma

A

Unlike in females, mature teratoma in adult males may be malignant;
benign in children;
increased hCG and/or AFP in 50% of cases

262
Q

Testicular germ cell tumors: Embryonal carcinoma

A

malignant, hemorrhagic mass with necrosis;
painful;
worse prognosis than seminoma;
Often glandular/papillary morphology;
“Pure” embryonal carcinoma is rare, most commonly present as mixed tumor;
When “Pure” may present with increased hCG and normal AFP

263
Q

Testicular non-germ cell tumors: Leydig cell

A

Contains Reinke crystals;
usually androgen producing, gynecomastia in men, precocious puberty in boys;
Golden brown color

264
Q

Testicular non-germ cell tumors: Sertoli cell

A

Androblastoma from sex cord stroma

265
Q

Testicular non-germ cell tumors: Testicular lymphoma

A

Most common testicular cancer in older men;
not a primary cancer, arises form lymphoma metastases to testes;
Aggressive

266
Q

Tunica Vaginalis Lesions

A

Lesions in the serous covering of testis present as testicular masses that can be transluminated (vs. testicular tumors);
Hydrocele-increased fluid secondary to incomplete obliteration of processus vaginalis;
Spermatocele-Dilated epididymal duct

267
Q

Penile Pathology-Squamous cell carcinoma

A

Most common in Asia, Africa, and South America;
Precursor in situ lesions- Bowen disease (in penile shaft, presents as leukoplakia), erythroplasia of Queyrat (cancer of glans, presents as erythroplakia), Bowenoid papulosis (presents as reddish papules);
Associated with HPV and lack of circumcision

268
Q

Penile pathology- Priapism

A

Painful sustained erection not associated with sexual stimulation or desire;
Associated with trauma, sickle cell disease, medications (anticoagulants, PDE-5 inhibitors, antidepressants, alpha blockers, cocaine)

269
Q

Leuprolide

A

GnRH analog with agonist properties when used in pulsatile fashion, antagonist when used continuously (down-regulates GnRH receptors in anterior pituitary);
Used for: infertility (pulsatile), prostate cancer (continuous), uterine fibroids (continuous), Precocious puberty (continuous);
Toxicity: antiandrogen, nausea, vomiting

270
Q

Estrogen Agonists

A

Ethinyl estradiol, DES, Mestranol;
Estrogen receptor agonists;
Used for hypogonadism or ovarian failure, menstrual abnormalities, HRT in postmenopausal women, used men for androgen-dependent prostate cancer;
Toxicity is increased risk of endometrial cancer, bleeding in postmenopausal women, clear cell adenocarcinoma of vagina in females exposed to DES in utero, increased risk of thrombi;
Contraindications would be ER + breast cancer, history of DVTs

271
Q

Clomiphene

A

Selective Estrogen Receptor Modulators (SERMs);
Antagonist at estrogen receptor in hypothalamus, prevents normal feedback inhibition and increased release of LH and FSH from pituitary, which stimulates ovulation;
Used to treat infertility due to anovulation (e.g. PCOS);
May cause hot flashes, ovarian enlargement, multiple simultaneous pregnancies, and visual disturbances

272
Q

Tamoxifen

A

Selective Estrogen Receptor Modulators (SERMs);
Antagonist at breast, agonist at uterus and bone;
Associated with endometrial cancer, thromboembolic events;
Primarily used to treat and prevent recurrence of ER + breast cancer

273
Q

Raloxifene

A

Agonist on bone;
Antagonist at uterus;
also increase risk of thromboembolic events and decreased resorption of bone so it is used in osteoporosis

274
Q

Hormone replacement therapy

A

Used for relief or prevention of menopausal symptoms (e.g. hot flashes, vaginal atrophy) and osteoporosis (increased estrogen, decreased osteoclast activity);
Unopposed estrogen replacement therapy increases the risk of endometrial cancer, so progesterone is added;
possible increased cardiovascular risk

275
Q

Anastrozole and exemestane

A

aromatase inhibitors used in postmenopausal women with breast cancer

276
Q

Progestins

A

Mechanism: bind progesterone receptors, decreased growth and increased vascularization of endometrium;
Used for oral contraceptives and in the treatment of endometrial cancer and abnormal uterine bleeding

277
Q

Mifepristone (RU-486)

A

Mechanism: Competitive inhibitor of progestins at progesterone receptors;
Used for termination of pregnancy, administered with misoprostol (PGE1);
Toxicity is heavy bleeding, GI effects (nausea, vomiting, anorexia), abdominal pain

278
Q

Oral contraceptin

A

Estrogen and progestins inhibit FSH/LH and thus prevent estrogen surge;
No estrogen surge then no LH surge then no ovulation;
Progestins cause thickening of the cervical mucus, thereby limiting access of sperm to uterus;
Progestins also inhibit endometrial proliferation, thus making endometrium less suitable for the implantation of an embryo;
Contraindications- smokers>35 years old, patients with Hx of thromboembolism and stroke or history of estrogen-dependent tumor

279
Q

Terbutaline

A

Beta 2 agonist that relaxes the uterus;

used to decrease contraction frequency in women in labor

280
Q

Danazol

A

Mechanism: synthetic androgen that acts as partial agonist at androgen receptors;
Used for- endometriosis and hereditary angioedema;
Toxicity- weight gain, edema, acne, hirsutism, masculinization, decreased HDL levels, hepatotoxicity

281
Q

Testosterone, methyltestosterone

A

Mechanism: agonist at androgen receptor;
used for-treats hypogonadism and promotes development of secondary sex characteristics, stimulation of anabolism to promote recovery after burn or injury;
Toxicities are masculinization of females, decreased intratesticular testosterone in males by inhibiting LH via negative feedback leading to gonadal atrophy, Premature closure of epiphyseal plates, Increased LDL and decreased HDL

282
Q

Finasteride

A

A 5 alpha reductase inhibitor (decreased testosterone to DHT);
Useful in BPH;
Also promotes hair growth-used to treat male pattern baldness;

283
Q

Flutamide

A

A non-steroidal competitive inhibitor of androgens at testosterone receptor;
used in prostate carcinoma

284
Q

Ketoconazole

A

Inhibits steroid synthesis (inhibits 17,20 desmolase);
used in the treatment of PCOS to prevent hirsutism;
side effects of gynecomastia and amenorrhea

285
Q

Sprionolactone

A

Inhibits steroid binding, inhibits 17alpha hydroxylase, inhibits 17,20 desmolase
used in the treatment of PCOS to prevent hirsutism;
side effects of gynecomastia and amenorrhea

286
Q

Tamsulosin

A

alpha1 antagonist used to treat BPH by inhibiting smooth muscle contraction;
selective for alpha1A,D receptors found on prostate vs vascular alpha1B receptors

287
Q

Sildenafil, vardenafil, tadalafil

A

Mechanism-inhibit phosphodiesterase 5, causing increased cGMP, smooth muscle relaxation in the corpus cavernosum, increased blood flow, and penile erection;
Uses: treatment of erectile dysfunction;
Toxicity- headache, flushing, dyspepsia, impaired blue-green color vision. Risk of Life threatening hypotension in patients taking nitrates

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