Term
| Where does lymphatic drainage from the ovaries/testis go? Distal 1/3 vagina? Proximal 2/3 vagina/uterus? |
|
Definition
Ovaries/Testis = para-aortic LNs
Distal vag = superficial inguinal nodes
Proximal 2/3 = obturator, external iliac and hypogastric nodes |
|
|
Term
| What are the 5 ligaments associated w/ the uterus/ovaries? |
|
Definition
Suspensory lig of ovaries = ovaries --> lat pelvic wall (contains ovarian vessels)
Cardinal lig = cervix to side wall of pelvis (contains uterine vessels)
Round lig of uterus = uterine fundus to labia majora (contains NO structures)
Broad ligament = uterus, fallopian tubes and ovaries to pelvic side wall (contains ovaries, fallopian tubes and round ligaments)
Ligament of the ovary = ovary to lateral UTERUS |
|
|
Term
| What cell types make up the female reproductive tract? |
|
Definition
Cuboidal = ovary
Columnar = fallopian tube, uterus, endocervix
Stratified squamous = ectocervix, vagina |
|
|
Term
| What is the pathway sperm take during ejaculation? |
|
Definition
SEVEN UP
Seminiferous tubules, Epididymis, Vas deferens, Ejaculatory ducts, (Nothing), Urethra, Penis |
|
|
Term
| How does the autonomic nervous system affect the male sexual response? |
|
Definition
Point and Shoot
Parasym = erection
Sympathetic = emission (hypogastric n)
Ejaculation = visceral and somatic nn (pudendal n) |
|
|
Term
| Where are the different sperm parts from? |
|
Definition
Middle piece (neck) from Mitochondria
Acrosome from Golgi
Tail from centrioles
Feeds on Fructose |
|
|
Term
| What do sertoli and leydig cells secrete? |
|
Definition
Sertoli = inhibin (inh FSH), androgen-binding protein (maintains T level) and anti-mullerian hormone
Sertoli cells Support Sperm Synthesis
Leydig = testosterone |
|
|
Term
| What forms the blood-testis barrier? |
|
Definition
| Tight junctions b/w adjacent sertoli cells (isolates gametes from autoimmune attack) |
|
|
Term
| What hormones act on sertoli and leydig cells? |
|
Definition
FSH stimulates sertoli to produce ABP and inhibin
LH stimulates leydig to release testosterone |
|
|
Term
| What would be the difference in hormone levels in a man with just 1 testis? |
|
Definition
| Less sertoli cells so lower inhibin levels --> less feedback on FSH so have increased FSH levels (similar to females in menapause!) |
|
|
Term
| What hormone causes the closing of epiphyseal plates (in both genders)? |
|
Definition
estrogen
(in males is converted from testosteron via aromatase) |
|
|
Term
| What inhibits 5-alpha reductase? |
|
Definition
|
|
Term
| What is the main effect of DHT? |
|
Definition
Early = differentiation of penis, scrotum and prostate
Late = prostate growth, balding and sebaceous gland activity |
|
|
Term
| What is a hormone indicator of fetal well-being? |
|
Definition
| 1000-fold increase in estriol |
|
|
Term
| How does estrogen affect thyroid hormone? |
|
Definition
| causes decreased catabolism of TBG --> causing increased TBG levels so increased total T4/T3 (free T3/T4 is normal) |
|
|
Term
| What do the theca and granulosa cells respond to and produce? |
|
Definition
Theca responds to LH and makes androstenedione (testosterone!)
Granulosa responds to FSH and makes estrogen and progesterone |
|
|
Term
| What effects does progesterone have during the normal cycle? |
|
Definition
| Stim endometrial gland secretions, spiral a devl, thick cervical mucus (inh sperm entry), increased body temp, inh gonadotropins, uterine smooth mm relax, decreased estrogen rec expressivity |
|
|
Term
| What causes the increase in basal body temp w/ ovulation? |
|
Definition
|
|
Term
| When do changes w/ meiosis occur in the dev of an egg? |
|
Definition
Prophase until Ovulation
Meiosis II is arrested in METaphase until fertilization (an egg MET a sperm) |
|
|
Term
| What is the timeline of pregnancy/fertilization? |
|
Definition
Fertilization w/in 1 day of ovulation
Implantation w/in 6 days after fertilization
hCG detectable 1 weeks after conception in blood (urine 2 weeks after conception) |
|
|
Term
What structure produces hCG?
In what states is hCG elevated (over preg levels)? |
|
Definition
Syncytiotrophoblast
hydatidiform moles, choriocarcinoma, gestational trophoblastic tumors |
|
|
Term
| What are the hormonal changes associated with menopause? What are the symptoms? |
|
Definition
decreased estrogen, high FSH, somewhat high LH (no surge), elevated GnRH
HHAVOC: Hirsutism, Hot flashes, Atrophy of Vagina, Osteoporosis, Coronary artery disease |
|
|
Term
| What is the presentation of Klinefelter's? |
|
Definition
XXY male
testicular atrophy, eunuchoid body shape, tall, long extremities, gynecomastia, female hari distribution.
Dev delay
High FSH and LH, increased estrogen and decreased testosterone
Caused by dysgenesis of seminiferous tubules --> decreased inhibin, increased FSH and abnl Leydig cell fxn = decreased testosterone (increased LH and estrogen) |
|
|
Term
| What is the presentation of Turner's? |
|
Definition
Short, dysgenesis of ovary, shield chest, bicuspid aortic valve, webbing of neck, preductal coarctation
Most common cause of primary amenorrhea |
|
|
Term
| What are the causes of pseudohermaphroditism? |
|
Definition
Female = exposure to androgenic steroids during early gestation (congenital adrenal hyperplasia, exogenous androgens during preg)
Male = androgen insensitivity syndrome |
|
|
Term
| What is the usual cause of true hermaphrodites? |
|
Definition
Mutation in SRY
Probs w/ fertilization |
|
|
Term
| What are the hormone findings with androgen insensitivity syndrome? |
|
Definition
| increased testosterone, estrogen and LH |
|
|
Term
| What is the typical presentation of 5alpha-reductase deficiency? |
|
Definition
AR
Ambiguous genitalia until puberty when increased T causes masculinization
T/estrogen levels normal, LH normal or increased
"Penis at 12" |
|
|
Term
| What is Kallmann Syndrome? |
|
Definition
decreased synthesis of gonadotropins from ant pituitary
Anosmia, lack of secondary sexual characteristics
Failure of GnRF neurons to migration from origin in olfactory placode to hypothalamus |
|
|
Term
| What are the 3 major hormones that cause formation of a male? |
|
Definition
anti-mullerian = degen of paramesonephric duct
Testosterone = male internal genitalia (except prostate)
DHT = male external genitalia incl prostate
No sertoli cells/lack anti-mullerian = both F&M internal and male external genitalia
5alpha-reductase def = male internal, ambiguous external genitalia until puberty |
|
|
Term
| What are the findings with a complete hydatidiform mole? |
|
Definition
46XX/XY
VERY high hCG
uterine size increased (not in partial)
2% risk choriocarcinoma
NO fetal parts (yes w/ partial)
2 sperm to an empty egg (ALL Paternal!)
Risk of malignant trophoblastic dz |
|
|
Term
| What is the major cause of 2nd trimester miscarriages? |
|
Definition
| bicornuate uterus (incomplete fusion of paramesonephric ducts) |
|
|
Term
| What is the cause of preeclampsia? |
|
Definition
altered maternal immune response to get lack of maternal spiral a invasion --> poor placental perfusion
Get release of vasoactive substances (preg is nl dilated vasc state) and get altered maternal vascular endothelial fxn |
|
|
Term
| What syndrome may be associated w/ preeclampsia? |
|
Definition
HELLP
Hemolysis, Elevated LFTs, Low Platelets |
|
|
Term
| What are the findings associated w/ gestational choriocarcinoma? |
|
Definition
increased hCG
early hematogenous spread to lungs
responsive to chemo
Preceeded by hydatidiform mole, abortion of ectopic preg or nl term preg |
|
|
Term
| What are the major risk factors for ectopic pregnancy? |
|
Definition
History of infertility
Salpingitis (PID)
Ruptured appendix
Prior tubal surgery |
|
|
Term
| What is the difference b/w Pott's disease and Potter's syndrome? |
|
Definition
Pott's = extrapulmonary TB to vertebrae
Potter's = renal dx that causes clubbed feet, pulmonary hypoplasia and cranial anomalies (pulm prob is cause of death) |
|
|
Term
| What viral proteins from HPV cause the problems? |
|
Definition
| E6 and E7 bind and inactivate gene products of p53 and Rb, respectively (E6 --> p53, E7 --> Rb) |
|
|
Term
| What is the most common gynecological malignancy? |
|
Definition
Endometrial carcinoma
decreased myometrial invasion = worse prognosis |
|
|
Term
| What is the most common tumor of all in females? |
|
Definition
|
|
Term
| What does leiomyosarcoma arise from? |
|
Definition
| NOT leiomyoma! typically arises de novo |
|
|
Term
| What is the relative incidence of gyn tumors? Prognosis? |
|
Definition
Endometrial > ovarian > cervical
Worst prognosis: ovarian > cervical > endometrial |
|
|
Term
| What is Asherman's syndrome? |
|
Definition
| iatrogenic removal of basal layer w/ D&C |
|
|
Term
| What can be used to treat hirsutism (assoc w/ PCOS, etc)? |
|
Definition
|
|
Term
| What are the hormonal findings associated with PCOS? |
|
Definition
Increased LH, decreased FSH, increased testosterone
High freq GnRH pulses cause increased LH, decreased FSH and increased androgens
(No CL, no negative feedback) |
|
|
Term
| What are the different types of ovarian cysts? |
|
Definition
Follicular cyst --> hyperestrinism and endometrial hyperplasia
Corpus luteum cyst (hemorrhage into persistent corpus luteum)
Theca-Lutein cyst = due to gonadotropic stim (assoc w/ choriocarcinoma and moles)
Chocolate cyst = ovarian endometriosis |
|
|
Term
| What are the ovarian germ cell tumors (and markers)? Age of presentation? |
|
Definition
Commonly occur in adolescents
Dysgerminoma = hCG and LDH
Choriocarcinoma = hCG (large, hyperchromatic syncytiotrophoblastic cells)
Yolk Sac (endodermal sinus) = AFP, schiller-duval bodies (resemble glomeruli)
Teratoma (immature = malignant) |
|
|
Term
| What are the ovarian non-germ cell tumors? Marker? |
|
Definition
CA-125
Serous cystadenoma
Serous cystadenocarcinoma
Mucinous cystadenoma
Mucinous cystadenocarcinoma
Brenner tumor (Brenner looks like Bladder)
Fibromas
Granulosa cell tumor (Call-Exner bodies)
Krukenberg tumor = GI malig to ovaries --> signet cell adenocarcinoma |
|
|
Term
|
Definition
Triad of ovarian fibroma, ascites, and hydrothorax
Pulling sensation in groin |
|
|
Term
| What are the types of vaginal carcinoma? |
|
Definition
Squamous Cell (secondary to cervical)
Clear Cell (DES in utero)
Sarcoma botryoides (rhabdomyosarcoma variant) = girls <4yrs, spindle-shaped tumor that are desmin positive "Bunch of grapes" in vagina |
|
|
Term
| What is the most important prognostic indicator of malignant breast tumors? |
|
Definition
| axillary lymph node involvement |
|
|
Term
| What are the types of malignant breast tumors? |
|
Definition
DCIS
Invasive ductal (most invasive)
Invasive lobular (orderly row of cells)
Medullary (fleshy, cellular, lymphocytic infiltrate, good prognosis)
Comedocarcinoma (ductal, CASEOUS NECROSIS, subtype of DCIS)
Inflammatory (dermal lymphatic invasion, peau d'orange --> neoplastic cells block lymphatic drainage)
Paget's disease (cells = lg cells in epidermis w/ clear halo - also seen on vulva) |
|
|
Term
| What breast disease presents with premenstrual breast pain? |
|
Definition
Fibrocystic disease
Most common cause of breast lumps
Multiple lesions, often bilateral
Can be fibrosis, cystic, sclerosing adenosis (calcifications), epithelial hyperplasia (increased risk carcinoma w/ atypical cells) |
|
|
Term
| What drugs can cause gynecomastia? |
|
Definition
Some Drugs Create Awesome Knockers
Spironolactone, Digoxin, Cimetidine, Alcohol, Ketoconazole |
|
|
Term
| What part of the prostate is affected by Benign Prostatic Hyperplasia? |
|
Definition
Lateral and middle lobes (periurethral lobes)
increased free PSA |
|
|
Term
| What can be used to treat BPH? |
|
Definition
alpha-1 antagonists
Finasteride (inh 5-alpha reductase) |
|
|
Term
| Where is prostatic adenocarcinoma found in the prostate? |
|
Definition
| Posterior lobe (peripheral zone) |
|
|
Term
| What are the markers and lab findings w/ prostatic adenocarcinoma? |
|
Definition
Prostatic acid phosphatase (PAP) and PSA (increased total PSA, decreased fraction free PSA)
Increased serum alk phos and PSA w/ osteoblastic metastases |
|
|
Term
| What are the testicular germ cell tumors? |
|
Definition
Seminoma
Embryonal carcinoma
Yolk sac (endodermal sinus)
Chooriocarcinoma
Teratoma |
|
|
Term
| What are the findings/tumor markers of seminoma,, embryonal carcinoma, yolk sac and chriocarcinoma in the testis? |
|
Definition
Seminoma = malignant, painLESS, males 15-35, fried egg appearance, radiosensitive, hCG/LDH
Embryonal carcinoma = malignant, painFUL, glandular/papillary, increased AFP and hCG
Yolk sac = yellow, mucinous, Schiller-Duval bodies, increased AFP
Choriocarcinoma = malignant, increased hCG, hematogenous metastases |
|
|
Term
| What are the testicular non-germ cell tumors? |
|
Definition
Leydig = Reinke crystals, androgen producing
Sertoli cell = androblastoma from sex cord stroma
Testicular Lymphoma = most common testicular cancer in older men |
|
|
Term
| What are the penile carcinomas in situ? |
|
Definition
Bowen's disease = gray, solitary, crusty plaque on shaft or scrotum. 5th decade, progresses in invasive SCC in <10%
Erythroplasia of Queyrat = red velvety plaques on glans (otherwise same as bowen's)
Bowenoid papulosis = wart-like lesions, younger age group, doesn't become invasive |
|
|
Term
| What are the other penile pathologies other than carcinoma in situ? |
|
Definition
SCC = HPV and lack of circumcision, common in Asia, Africa and South America
Peyronie's disease = bent penis due to acquired fibrous tissue formation |
|
|
Term
| What drug is a GnRH analog? |
|
Definition
Leuprolide
Can be used in LIEU of GnRH |
|
|
Term
| What are the antiandrogen drugs? |
|
Definition
Finasteride = 5alpha-reductase inhibitor
Flutamide = non-steroid competitive inhibitor of androgens
Ketoconazole = inh steroid syn (inh desmolase)
Spironolactone = inh steroid binding
Keto and Spirono used to prevent hirsutism --> cause gynecomastia and amenorrhea |
|
|
Term
| What are the estrogen partial agonists? |
|
Definition
Clomiphene - acts on hypothalamus
Tamoxifen - acts on breast
Raloxifene - acts on bone |
|
|
Term
| What are the aromatase inhibitors? |
|
Definition
|
|
Term
| What drug is a competitive inh of progestins at progesterone rec? |
|
Definition
Mifepristone
Termination of preg, used w/ misoprostol (PGE1) |
|
|
Term
|
Definition
PGE2 analog
Causes cervical dilation and uterine contraction |
|
|
Term
| What does Ritodrine/terbutaline do? |
|
Definition
beta-2 agonists that relax the uterus, reduce premature uterine contractions
Ritodrine allows the fetus to "return to dreams" by preventing early delivery |
|
|
Term
|
Definition
alpha-1 antagonist used to treat BPH by inh smooth muscle contr
Selective for alpha-1,A,D rec (on prostate) |
|
|
