Week 3 Flashcards by Anum Samdani

What do fetal testes secrete that cause regression of female related ducts?

Mullerian inhibiting factor

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What part of the prostate is susceptible to BPH?
Infections?
Cancer?
Involved with continence?

Transitional
Central
Peripheral
Anterior Fibromuscular stroma

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What secretion from the male testes induces male phenotype?

Androgens (primarily testosterone)

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What stimulates the burst of m-inhibiting factor and testosterone from the fetal testes?

LH and FSH

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When does the sexual dimorphic change in the brain occur?

Six months-burst of gonadotropins

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How does puberty start in males?

GnRH neurons–>LH & FSH bursts
Increase gonadotropins–>sperm production and steroidogenesis
Androgen secretion–>secondary sex characteristics

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Where is most 5-alpha reductase activity?

Target tissue (there is some in testes though)

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What inhibits gonadotropin secretion?

Prolactin

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Testosterone and growth? How are they related?

1) stimulate increase in GH that stimulates linear growth (IGF1)
2) growth plate closure

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Major stimulator of spermatogenesis

FSH stimulation and local testosterone stimulation

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What cell does LH stimulate?

FSH?

Leydig cell (testosterone and stimulates Sertoli cell)
Sertoli cell (inhibin-inhibits FSH release)

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What is the purpose of ABP?

Increases local testosterone concentration

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What happens if the SRY does not express in a fetus?

Absence of Y chromosome leads to formation of ovaries.
Formation leads to absence of androgens and MIF.
Wolffian ducts regress and Müllerian ducts form.

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After ovulation, what do the cells that remain in the follicle form?

corpus luteum (rich in steroidogenic cells)

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When do the number oogonia peak in the fetal ovary?
How many are there?
How many are present at birth?

6 months of fetal development
7 million
600,000

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What stimulates oogonia production in ovaries?

hCG from placenta

fetal FSH and LH

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What is secreted by the pituitary before the first menstrual cycle?

FSH, LH (induce ovarian function)

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What are the primary secretory products of the ovary?

Which estrogen is usually only found in significant amounts in pregnant women?

Estradiol and estrone

Estriol

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Which gonadal steroids bind mostly albumin?
Which gonadal steroids bind mostly to SHBG?
Which gonadal steroid binds CBG a bit?

Estrogen and androstenedione
Testosterone and DHT
Progesterone (still more to albumin)

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What “wakes up” hypothalamus in girls to produce GnRH (pulsatile)?

Theory: signals from adipose tissue (leptin etc.)

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What do GnRH pulses increase?

FSH and LH

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What happens if hCG is not released by trophoblast into blood?

corpos luteum dies

progesterone and estrogen decrease

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What provides the negative feedback to FSH (and LH)?

estrogen being secreted from dominant follicle

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When does the switch from estrogen inhibiting LH and FSH to stimulating LH occur?

estrogen peak (switch in hypothalamus-pituitary)
Inhibin preferentially inhibits FSH (from ovaries) so smaller surge

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What cells do LH act upon? | FSH?

``` Theca cells (produce androgens) Granulosa cells (stimulate aromatase activity) ```

What stimulates follicular phase of myometrial cycle? | Secretory phase?

Estrogens | Progesterone

When does hCG peak?

first trimester of pregnancy

3 main functions of male reproductive system

1) produce and store male gamete 2) produce male sex hormones (androgens) 3) deliver male gametes to female reproductive tract

Two type of cells in seminiferous tubules

germinal/spermatogenic | sertoli

Three phases of spermatogenesis

spermatocytogenesis spermatocyte (meiosis) spermiogenesis

What drives spermiation?

actin mediated contraction of Sertoli cells

How many cycles of the seminiferous epithelium cycle are needed to form a mature sperm?

four

``` How are the following hormones involved with the testes? FSH LH Testosterone Inhibin B ```

- Maturation of Sertoli and Leydig cells, maintain spermatogenesis - Synthesis and release of testosterone by interstitial cells - Maintains spermatogenesis, male duct morphology/function, accessory sex gland structure/function, secondary sex characteristics - Modulate FSH release

Factors affecting spermatogenesis

``` premature thickening of tunica propria steroid hormones and related meds infections radiation diet deficiency toxic agents elevated testicular temp ```

What mediates smooth muscle relaxation in an erection? | What mediates flaccidity(detumesence)?

NO and PDE2 | PDE5

Aromatase deficiency in men causes what?

Osteoporosis (epiphyses do not close) | Treat with estradiol

Why can't testosterone be given orally?

High first pass effect, catabolized by liver

Side effects of testosterone

acne, gynecomastia, more aggressive sexual behavior, growth plate closure

What drug is good for treating angioedema?

Stanozol 17-alkylated androgens stimulate synthesis of C1-esterase inhibitor

Side effects of steroid abuse

diminished fertility, diminish testicular size, gynecomastia | 17-alkylated androgens-->hepatotoxicity

What are androgen receptor antagonists used in conjunction with?

GnRH analog

What drugs should not be combined with PDE5 inhibitors?

Organic nitrate vasodilators | can cause extreme hypotension

Which of the drugs don't have trouble with avoiding the first padd effect/hepatic metabolism?

17-alpha alkylated testosterones | stanozolol

Most common neoplasm in males in reproductive age

testicular neoplasms

What are the nonseminomatous testicular tumors?

embryonal yolk sac choriocarcinoma teratoma

Second most common germ cell tumor? Most common germ cell tumor in infants? Which is worse: mature or immature teratoma? Which metastasize to brain and lungs?

embryonal yolk sac immature choriocarcinoma

Most common malformation of penis?

hypospadias | ventral surface

Which squamous cell carcinoma in situ does not invade?

bowenoid papulosis

What is the first test you should do with a male with premature puberty? What is the diagnosis if the levels are elevated?

LH | If elevated, GDPP (gonadotropin dependent)

What should you administer if LH levels are not elevated in premature puberty?

GnRH agonist

What nerves provide the sympathetic innervation to the bladder?

hypogastric nerves

What parts of the brain control the micturition reflex?

Pons-facilitative and inhibitory | Cerebral cortex-mainly inhibitory

What can a lesion between the sacral spinal cord and brainstem/pons cause? What can a lesion in the brain above the pons cause? What can a lesion below the sacral spinal cord cause?

- hyperactive bladder or detrusor-sphincter dyssynergia - hyperactive bladder - damages micturition reflex

Host defenses against UTIs?

flow of urine AMPS Tamm-Horsfall protein exfoliating bladder epithelia

Bacteria seen most often in hematogenously spread UTIs?

staph aureus candida mycobacterium tuberculosis

What increases for UTI?

reduced urine flow promote colonization facilitate ascent

What do e.coli pili adhere to in a UTI?

(type 1 pili) mannose in urinary epithelial mucupolysaccharide lining and to PMNs

Mechanical issues the predispose to UTI?

urethral length, completeness of bladder emptying, integrity of natural uretervesical junction valve

Biochemical properties that make bacterial survival difficult in urine?

acid pH, high urea content, high osmolality

Nitrite in urine indicates what type of bacteria in UTI?

gram negative

What (mentioned) drug has the highest concentration in urine? What (mentioned) drug has the lowest?

Cabrenicillin | Nitrofurantoin

In what phase of spermatogenesis does genetic recombination occur?

Pachytene phase

How long does it take for maturation of the sperm?

90 days

What are responsible for the only source of fructose in semen?

seminal vesicles

How many semen analyses should a patient have?

At least two

What should all men with azoospermia or severe oligospermia be offered (test)?

karyotypic and genetic testing, including evaluation of Y chromosome microdeletions

Two more common genetic alterations associated with male infertility

Klinefelter's syndrome, Y chromosome deletions

What is CBAVD typically associated with?

Mutation of CFTR gene

What is usually the cause for CBAVD without genetic deletions?

Insult to the mesonephric (wolffian) duct

What side does a variocecle typically occur on?

left

Exfoliated cells are collected from what area during a PAP smear?

Transformation zone (between simple columnar and stratified squamous epithelium)

Which of the SERMs treats osteoporosis?

Raloxifene

What should be monitored in women taking Drospirenone?

risk for hyperkalemia

Two phases of the menstrual cycle

Follicular: 10-17 days Luteal: 14 days

Contraindications to estrogen containing contraceptives?

history of venous thromboembolic event

How to evaluate ovarian reserve?

- FSH and Estradiol (elevated = diminished) - Antimullerian hormone - Antral follicle counts by ultrasound

Mech of action of aromatase inhibitors in treating infertility

inhibition of E2 production, negative feedback causing increase in FSH levels

How does anovulation occur in AUB?

Chronic exposure of endometrium of estrogen without exposure to postovulatory progesterone

Most common locations of endometriosis

in pelvis and near tubal fimbria: ovaries--cul-de-sac--broad ligament--uterosacral ligaments bowel is most common extragenital location