Day 11.1 Repro Flashcards Preview

* DIT each session > Day 11.1 Repro > Flashcards

Flashcards in Day 11.1 Repro Deck (85):
1

Innervation of male sex response

Erection- pelvic nerve (PNS)
Emission- hypogastric nerve (SNS)
Ejaculation- pudendal nerve (Visceral and somatic nerves)

2

What PNS substances are proerectile and antierectile?

NO --> increased cGMP --> smooth musc relaxation --> vasodilation --> proerectile

NE --> increased intracellular Ca2+ --> smooth musc contraction --> vasoconstriction --> antierectile

3

What is the location and fn of spermatogonia?

Spermatogonia are the germ cells.
They line the seminiferous tubules
They maintain the germ pool and produce primary spermatocytes

4

What is the location and fn of Sertoli cells?

Sertoli cells line the seminiferous tubules (like spermatogonia, altho Sertoli are not germ cells)
They secrete inhibin (which binds FSH)
They secrete ABP androgen-binding protein (which helps maintain levels of testosterone in the seminiferous tubule)
They produce anti-Mullerian hormone (mullarian inhibiting factor)
They support and nourish developing sermatozoa
Sertoli cells Support Sperm Synthesis

5

What forms the blood-testis barrier?

Tight jns bt Sertoli cells (which line the seminiferous tubules)
The blood-testis barrier helps isolate gametes from autoimmune attack.

6

What is the location and function of Leydig cells

Located in the interstitium
Leydig cells are endocrine cells- they secrete testosterone
The testosterone is kept in the tubules by the ABP that comes from Sertoli cells.

7

What are the relative levels of Inhibin B and FSH in pt w one testicle?

If only one testicle, the overall amt of Sertoli cells lining the seminiferous tubules will be greatly reduced. Less Sertoli means less inhibin B is made. And since there is not as much neg fdbk from inhibin on FSH production, FSH will be high.

8

What is the composition of semen?

60% seminal vesicle products (fructose, ascorbic acid, prostaglandins (which cause uterine contractions), phosphorylcholine, flavins)
20% Prostate products (zinc, citric acid, phospholipids, acid phosphotase, fibrinolysin)
Sperm

So if vasectomy, will still have sem fluid, just no sperm in it.

9

When does spermatogenesis being, how long does it last?

Starts in puberty
Full devt of sperm takes 2 months

10

Where does spermatogenesis take place?

Seminiferous tubules

11

What is the product of spermatogenesis?

Spermatids (Haploid, N) that undergo spermiogenesis- loss of cytoplasm, gain of acrosomal cap- to form mature spermatozoan.

12

What are the stages (with -ploid and N) of spermatogenesis?

Spermatogonium (diploid, 2N)
Primary spermatocyte (diploid, 4N)
Secondary spermatocyte (haploid, 2N)
Spermatid (haploid, N)

Spermiogenesis:
Spermatid --> Spermatozoan

13

How many chromosomes do spermatogonium have?

46 single chromosomes
Sex = XY

14

How many chromosomes do primary spermatocytes have?

46 sister chromatids
Sex = XX or YY

15

How many chromosomes do secondary spermatocytes have?

23 sister chromatids in each
one of the two secondary spermatocytes has X-X, the other one has Y-Y

16

How many chromosomes do the spermatids have?

23 single chromatids
there are 4, so the sex in 2 of them is X, and the sex in the other 2 is Y

17

How are Leydig cells stimulated, and what do they produce?

GnRH --> Ant Pit --> Leydig cells --> Testosterone

The testosterone feeds back to inhibit both LH and GnRH
It is kept in the seminiferous tubules by ABP, which comes from Sertoli cells

18

How are Sertoli cells stimulated, and what do they produce?

GnRH --> Ant Pit --> FSH --> Sertoli cells --> Inhibin and ABP
Sertoli cells support sperm production.

The inhibin feeds back to inhibit FSH.
ABP keeps testosterone (which comes from Leydig cells) around.

19

Mechanism of sildenafil, vardenafil, tadalafil

aka viagra
Inhibit cGMP phophodiesterase, causing increased cGMP. This causes smth musc relaxation in the corpus cavernosum, increased blood flow, and penile erection

20

Clinical use of sildenafil, vardenafil, tadalafil

Treatment of ED
Raynaud's (helps vasodilate)
Primary pulm HTN

21

Toxicity of sildenafil, vardenafil, tadalafil

Headache, flushing, dyspepsia, impaired blue-green color vision
Risk of life-threatening hypotension in pts taking nitrates.

Hot and sweaty, but then Headache, Heartburn, Hypotension.

22

At what phase of spermatogenesis do the cells go thru the blood-testes barrier

When they are undergoing replication (spermatogonium --> primary spermatocytes), they pass through the tight jns bt Sertoli cells

23

What accumulates if Meiosis I is lost in spermatogenesis?

Primary spermatocytes (46 sister chromatids, 4N)

24

What accumulates if Meiosis II is lost in spermatogenesis?

Secondary spermatocytes (each of the 2 cells has 23 sister chromatids, one cell is X-X and one is Y-Y). Cells are 2N

25

List the androgens and where they are made

Testosterone - Testis
Dihydrotestosterone (DHT) - Testis
Androstenedione - Adrenal

Potency: DHT > Testosterone > Androstenedione

26

What enz converts Testosterone to DHT?

5a-reductase

27

What drug inhibits 5a-reductase?

Finasteride

28

What are the 5 functions of testosterone?

1. Differentiation of epididymis, vas def, sem vesicles (all internal genitalia except prostate)
2. Growth spurt (Penis, Sem Vesicles, Sperm, Muscle, RBCs)
3. Deepening of voice
4. Closure of epiphyseal plates (via estrogen converted from testosterone)
5. Libido (in both M and F)

29

What are the early and late fns of DHT?

Early: differentiation of penis, scrotum, prostate
Late: prostate growth (BPH), balding, sebaceous gland activity

30

Where are how are testosterone and androstenedione converted to estrogen?

Converted in adipose tsu and Sertoli cells
Enz is aromatase.

31

What does exogenous testosterone cause wrt gonads?

Inhibits the Hypothal-Gonadal-Pit axis, which causes decreased intratesticular testosterone. This leads to decreased testicular size and to azoospermia.

32

Mechanism and clinical use of exog testosterone

Mech: Agonist at androgen receptors
Used to Rx hypogonadism and promote devt of secondary sex characteristics
Stim's anabolism to promote recovery after burn or injury
Treats ER-positive breast cancer (Exemestane)

33

Toxicity of exog testosterone

Causes masculinization in females
Reduces intratesticular testosterone in males by inhibiting rls of LH (via neg fdbk), leading to gonadal atrophy
Premature closing of epiphyseal plates
Bad for lipids: increased LDL and decreases HDL

34

BPH

Benign prostatic hyperPLASIA.
Common in men >50yo
May be d/t age-related increase in estradiol w possible sensitization of the prostate to the growth-promoting effects of DHT.

Nodular enlgmt of the periurethral (lateral and middle) lobes, which compress urethra into a vertical slit. Not pre-malignant.

Increased free PSA.

35

Px of BPH

Increased freq of urination, nocturia, difficulty starting and stopping stream of urine, dysuria. Can lead to distention and hypertrophy of the bladder, hydronephrosis, and UTIs.

36

Rx for BPH

a1 antagonists (terazosin, tamulosin)- these cause relaxation of smth muscle, but do not change size of prostate

Finasteride (5a-reductase inhibitor) does decrease it.

37

List the anti-androgens

Finasteride (propecia)
Flutamide
Ketoconazole
Spironolactone

38

How does finasteride work?

Testosterone is converted to the more potent form DHT by 5a-reductase. Finasteride is a 5a-reductase inhibitor, so it decreases this conversion.
Useful in BPH, since DHT causes prostate enlargement later in life.
Since DHT also causes baldness, finasteride (propecia) can also be used to promote hair growth for pts w male patterb baldness.
Can cause impotence, gynecomastia

39

What is flutamide?

non-steroidal competitive inhibitor of androgens at the testosterone receptor.
Used in prostate carcinoma.

40

What anti-androgenic effects do ketoconazole and spironolactone have?

Ketoconazole- inhibits steroid synthesis (inhib's desmolase)
Spironolactone - inhibs steroid binding.
Both are used to treat the hirsutism of PCOS; both have side effects of gynecomastia and amenorrhea.

41

Tamsulosin

a1-antagonist used to treat BPH bc it inhibits smooth musc contraction.
Selective for a1-A,D receptors, which are in urethral smooth musc
(So does not affect the a1-B receptors, which are vascular- so it does not have an effect on the BP)

42

Prostatic adenocarcinoma

Common in men >50
In posterior lobe (peripheral zone) of the prostate
Most freq dx's by digital rectal exam- feel hard nodule, and prostate biopsy
PAP and PSA are useful tumor markers (PAP is prostatic acid phosphatase)
Osteoblastic mets to bone may devp in later stgs- get lower back pain and incrsd serum alk phos and PSA

43

Rx for prostatic adenocarcinoma

Flutamide
Resection of prostate

44

What happens to the PSA level in prostatic adenocarcinoma

Increased total PSA
Decreased(!) fraction of free PSA

45

Child w testicular and parotid gland swelling

Mumps

46

Cryptorchidism

Undescended testis (one or both)
Lack of spermatogenesis d/t increased body temp.
A/w increased risk of germ cell tumors
Prematurity increases risk of cryptorchidism.
Rx: Orchioplexy

47

Testicular torsion

Twisting of spermatic cord -->ischemia
Dx w US, but also: supporting testes gives no relief (vs epididymis, which it does give relief)
Rx: Surgical detorsion w bilateral orchioplexy w/in 6 hrs (or will have perm dmg)

48

Epididymitis

Inflam of epididymis
Dx: support of testes gives relief
If 35 or hx of anal, prob enterobacteriaceae (UTI bugs)- Rx is fluroquinolone

49

What is orchioplexy?

Suture testes to scrotum
Done for cryptorchidism, testicular torsion

50

Prostatitis

Inflam of prostate, px'g w dysuria, freq, urgency, low back pain. (like a UTI)
If acute and 35yo: UTI bugs- e coli, kleb, proteus, enterobacter, serratus
If chronic can be abacterial (most common) or bacterial (UTI bugs)
Rx fluroquinolones, TMP-SMX for one month!

51

List the testicular germ cell tumors

95% of all tumors are germ cell! they can be:
Seminoma
Embroyonal carcinoma
Endodermal sinus (yolk sac) tumor
Choriocarcinoma
Teratoma

52

List the testicular non-germ cell tumors

5% of all testicular tumors, mostly benign
Leydig cell tumor
Sertoli cell tumor
Testicular lymphoma

53

Seminoma

Testicular germ cell tumor.
Malignant
Painless, homogenous testicular enlgmt
Most common testicular tumor 15-35yo
Lg cells in lobules w watery cytoplasm and fried egg appearance.
Radiosensitive
Late mets, excellent pgx.

54

Embryonal carcinoma

Testicular germ cell tumor
Malignant
Painful
Worse pgx than seminoma
Glandular/papillary morphology.
Can differentiate to other tumors
May be a/w increased AFP, hCG

55

Endodermal sinus/Yolk sac tumor

Testicular germ cell tumor
Yellow, mucinous
Analagous to ovarian yolk sac tumor
Schiller-duval bodies resemble primitive glomeruli
Increased AFP

56

Choriocarcinoma

Testicular germ cell tumor
Malignant
Increased B-hCG.
Disordered synctiotrophoblastic and cytotrophoblastic elements.
Hematogenous mets.

57

Teratoma

Testicular germ cell tumor
Mature teratoma in males is often malignant (vs benign in females)

58

Leydig cell tumor

Testicular, non-germ cell tumor
Contains Reinke crystals
Usu androgen producing (excess testosterone)- causes gynecomastia in men (bc of periph conversion of testosterone to estrogen), precocious puberty in boys
Golden brown color

59

Sertoli cell tumor

Testicular, non-germ cell tumor
Androblastoma from sex cord stroma

60

Testicular lymphoma

Testicular non-germ cell
Most common testicular cancer in older men.

61

Testicular cancer in young men? In old men? In young children up to 3yo?

Young men (15-35): Seminoma
Old men: Testicular lymphoma
Up to 3yo: Yolk sac tumor (endodermal sinus)

62

What is the female equivalent of a seminoma?

Ovarian dysgerminoma

63

What other tumors are similar to seminomas in appearance?

Seminoma has a fried egg appearance, similar to koilocytes of HPV and oligodendrogliomas (adult primary brain tumor)

64

Testicular tumor md of cytotrophoblasts and syncytiotrophoblasts

Choriocarcinoma

65

Testicular tumor that px's w gynecomastia initially

Leydig cell tumor

66

Testicular tumor w elevated AFP

Yolk sac tumor
Embryonal carcinoma

67

Testicular tumor w elevated hCG

Choriocarcinoma
Embryonal carcinoma

68

Testicular tumor w cytoplasmic clearing (similar appearance to koilocytes

Seminoma

69

Testicular tumor that can have alveolar or tubular appearance, sometimes w papillary convolutions (on histo)

Embryonal carcinoma

70

Testicular tumor composed of multiple tsu types

Teratoma

71

Testicular tumor w histological endodermal sinus structures (Schiller-Duval bodies)

Yolk sac tumor

72

25% of this kind of testicular tumors have cytoplasmic rod-shaped crystalloids of Reinke

Leydig cell tumor

73

Testicular tumor that makes androgen and is a/w precocious puberty

Leydig cell tumor

74

Man w BPH undergoing treatment, has increased testosterone, decreased DHT, gynecomastia and edema. What's his med?

5a-reductase inhibitor (finasteride)

75

Tunica vaginalis lesions

Lesions in the serous covering of testis- px as testicular masses that can be transilluminated (vs testicular tumors, which can't be).
1. Varicocele- dilated vein in pampiniform plexus; a/w infertility. "bag of worms"
2. Hydrocele- increased fluid secondary to incomplete fusion of processus vaginalis
3. Spermatocele- dilated epididymal duct

76

List the possible pathologies of the penis

Carcinoma in situ (Bowen's, Queyrat, Bowenoid)
Sq Cell Carcinoma
Peyronie's dz
Balanitis
Priapism

77

Bowen's dz

Carcinoma in situ of the penis
Gray, solitary, crusty plaque
Usu on shaft of penis or on scrotum
Peak incidence in 50-60yo
Progressive to invasive SCC in <10%

78

Bowenoid papulosis

Carcinoma in situ of the penis
Multiple papular lesions
affects younger age group than other penile cancers
Usu does not become invasive

79

Erythroplasia of Queyrat

Carcinoma in situ of the penis
Red velvety plaques
Usu involves glands
Other than location, similar to Bowen's- peak incidence at 50-60

80

Sq Cell Carcinoma of the penis

Commonly assoc w HPV, lack of circumcision
More common in Asia, Africa, S America

81

Peyronie's dz

Bent penis d/y acquired fibrous tsu formation

82

T/F Bowen's dz is a carcinoma of both men and women

True
Usu on shaft of penis or on scrotum, but can also be on female genitalia

83

Types of HPV a/w SCC

16, 18, 31

84

Balanitis

Infection of foreskin
Often fungal; 40% candidiasis
Rx: topical antifungal or 1 dose fluconazole

85

Priapism

Persistent penile erection
Caused by:
Trazodone (anti-depressant med)
Sickle cell dz
Trauma to the spinal cord