Life Cycles

Question 1

LH acts on…to produce FSH acts on…to produce (in males)

Answer 1

• LH –> Leydig cells to produce Testosterone, StAR, SCP
• FSH –> Sertoli cells to produce Androgen Binding Protein (ABP), Aromatase (convert androgen to estrogen), increase spermatogenesis, increase inhibin

Question 2

first sign of puberty in boys and girls and at what age?

Answer 2

Boys: testicular enlargement (>3ml) age 9-14

Girls: breast bud development age 8-13 in caucasian girls

*African Americans and Hispanic girls start puberty on average 1 year earlier*

Question 3

McCune-Albright syndrome

Answer 3

due to mutation affecting G-protein signaling. Presents with unilateral café-au-lait spots, polyostotic
fibrous dysplasia,precocious puberty, multiple endocrine abnormalities. Lethal if mutation occurs before fertilization (affecting all cells), but survivable in patients with mosaicism

Tx: girls can be treated with aromatase inhibitor to block conversion of androgens to estrogen.

boys: treated with ketoconazole or combo of androgen blocker and aromatase inhibitor

Question 4

Branchial (pharyngeal) apparatus

Answer 4

Branchial clefts: derived from ectoderm (also called grooves)

Branchial arches: derived from mesoderm (muscles, arteries), and neural crest (bones, cartilage)

Branchial pouches: derived from endoderm

CAP covers outside to inside

Clefts=ectoderm

Arches=mesoderm + neural crest

Pouches= endoderm

Question 5

Branchial cleft derivatives

Answer 5

1st: external auditory meatus

2nd-4th: temporary cervical sinus (obliterated by proliferation of 2nd arch mesenchyme)

Question 6

What is the result of Mullerian agenesis?

Answer 6

presents as primary amenorrhea (due to lack of uterine development, because mullerian develops into uterus, fallopian tubes, upper 2/3 of vagina (columnar epithelium))

-have fully developed secondary sexual characteristics (like functional ovatres)

Question 7

Mesonephric ducts also known as….

Paramesonephric ducts also known as…

Answer 7

mesonephric=wolffian

paramesonephric= mullerian

-incomplete fusion of the paramesonephric ducts results in bicornuate uterus (uterus has two horns with communicating ducts

Picture shows partial failure of fusion of paramesonephric ducts

Question 8

mesonephric duct becomes…in males

Answer 8

male internal structures (except prostate)

1. Seminal Vesicle
2. Epididymus
3. Ejactulatory Duct
4. Ductus Deferens

SEED

Question 9

pathway of sperm during ejactulation

Answer 9

SEVEN UP

S: seminiferous tubules

E: epididymus

V: Vas deferens

E: ejaculatory ducts

N: NOTHING

U: urethra

P: penis

Question 10

In females, FSH acts on… and LH acts on…

Answer 10

FSH–> Granulosa cells to convert androgens to estrogens via aromatase

LH –> Theca cells to convert cholesterol to androgens via desmolase

Question 11

Actions of progesterone (9)

Answer 11

1. stimulation endometrial glandular secretions
2. maintain pregnancy
3. decrease myometrial excitability
4. produce cervical mucus to inhibit sperm entry
5. increase body temp
6. inhibit gonadotropins (LH, FSH)
7. uterine smooth muscle relaxation (prevent contraction)
8. decrease estrogen receptor expression
9. prevent endometrial hyperplasia

Question 12

phases of miosis that egg is suspended in

Answer 12

Primary oocyte begin meiosis 1 during fetal life and complete miosis 1 just prior to ovulation

Meiosis I is arrested in prOphase 1 for years until Ovulation (1⁰ oocyte)

Meiosis II is arrested in metaphase II until fertilization (2⁰ oocyte) “an egg MET a sperm”

Question 13

Mittelschmerz

Answer 13

transient mid-cycle ovulatory pain (Middle Hurts); classically associated with peritoneal irritation (follicular swelling/rupture, fallopian tube contraction)

-can mimic appendicitis

Question 14

Menorrhea Terms

1. Dysmenorrhea
2. Oligomenorrhea
3. Polymenorrhea
4. Metrorrhagia
5. Menorrhagia
6. Menometrorrhagia

Answer 14

1. Dysmenorrhea: pain with menses, often associated with endrometriosis
2. Oligomenorrhea: > 35 day cycle
3. Polymenorrhea: <21 day cycle
4. Metrorrhagia: Frequent or irregular menstruation
5. Menorrhagia: Heavy menstrual bleeding >80ml blood loss or >7 days of menses

Menometrorrhagia: Heavy, irregular menstruation

Question 15

hCG fun facts (source, function)

Answer 15

Source is syncytiotrophoblast of placenta

• maintain corpus luteum (and thus progesterone) for first 8-10 weeks by acting like LH
• Used to detect pregnancy (appears in urine 2 weeks, appears in blood 1 week)
• Identical alpha subunits to LH, FSH, TSH (unique Beta subunit, what test)

Question 16

Klinefelter syndrome

Answer 16

male 47, XXY

Testicular atrophy, eunuchoid body shape, tall, long extremities, gynecomastia, female hair distribution.

• Presence of inactivated X-chromosome (Barr Body)
• Dysgenesis of seminiferous tubules –> decresed inhibin B –> increased FSH
• Abnormal leydig cell function –> decreased testosterone and Increased LH –> increased estrogen

Question 17

struma ovarii

Answer 17

cystic ovarian mass in combination with signs of excessive thyroid hormone

• a thyroid hormone secreting teratoma
• manifests as unilateral, cystic, pelvic masses with concomminant hyperthyroid sx

Question 19

What hormone is responsible for development of external male genetalia (prenatally)

Answer 19

DHT (prenatally)

Later it is involved in development of secondary sexual characteristics such as hair distribution, increased statue, increased sweat gland secretion. Also causes an increase in the size of the prostate and epididymus

Question 20

A positive transillumination test of the testes suggests…

Answer 20

A cystic mass, a testicular hydrocele is the most common cause of painless scrotal enlargement

Question 21

orchitis and what are the cuases

Answer 21

testicular inflammation

• usually caued by viral infection (rubella, mumps) or bacterial infection
• pain, tenderness and erythema are common sx

Question 22

hydrocele

Answer 22

fluid collection in the space between the visceral and parietal layer of the tunica vaginalis of the scrotum

Question 23

Pseudomyxoma peritonei

Answer 23

intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor.

Question 24

wehre do sperm achieve motility and what is the lining of this structure

Answer 24

Spermatogenesis takes place in the seminal vesicle.

Some maturation does occur in the epididymus with enhancement of motility.

The epididymus is lined with pseudostratified columnar epithelium with stereocilia

Question 25

α-fetoprotein tumor marker

Answer 25

-Seen in Hepatocellular carcinoma, hepatoblastoma, yolk sac (endodermal sinus) tumor, mixed germ cell tumor. Normally made by fetus. Transiently elevated in **pregnancy**; **High** levels associated with "open" **neural tube** and abdominal wall defects (meningocele, myelomeningocele, encephalocele) **Low** levels associated with Down syndrome (Edwards, 18 too)

Question 26

cryptorchidism

Answer 26

absence of one or more testes from the scrotum -these pts have an increased risk of developing testicular cancer, even if they are surgically descended

Question 27

Two most common causes of urethritis in men and the abx of choice for each

Answer 27

1. Chlamydia trachomatis --\> azithromycin (macrolide) or doxycycline 2. Neisseria Gonococci --\> treat with cephtriaxone

Question 29

Medically induced abortion meds

Answer 29

1. Mifepristone: a progesterone antagonist, makes the uterus uninhabitable A few days later.... 2. Misoprostol a prostaglandin E1 analog that causes uterine contraction and expulsion of the fetus

Question 30

Breast cancer in men is increased in what pts?

Answer 30

Klinefelter (47, XXY) have a 19 fold increase risk in breast cancer. The reason is the increased risk of estrogen in these pts. -These pts are also at risk for an increase in mediastinal germ cell tumors

Question 31

Risk factor for developing endometrial cancer

Answer 31

Obesity increases the risk 5-10x due to higher levels of estrogen (because testosterone is converted into estrogen in fat cells) - higher levels of estrogen lead to greater risk of dysplasia - NOT having children (nulliparity) is a risk for endometrial cancer (because having children gives endometrium a rest) Early sex increases the risk for cervical cancer due to exposure to HPV

Question 32

Trichomonas vaginalis

Answer 32

Vaginitis—foul-smelling, greenish discharge; itching and burning; do not confuse with Gardnerella vaginalis, a gram-variable bacterium associated with bacterial vaginosis Diagnosis: Trophozoites (motile) on wet mount; “strawberry cervix” Tx: Metronidazole for patient and partner (prophylaxis)