Repro Flashcards
(534 cards)
1
Q
Unilateral, painful cystic lesion in the lower vestibule adjacent to the vaginal canal.
A
Bartholin’s cyst
2
Q
What HPV types cause condyloma?
A
6 & 11
3
Q
What HPV types cause cancer?
A
16, 18. 31, 33
4
Q
Cells with raisin-like nucleus appearance is descriptive of…
A
Koilocytic change - HPV infection
5
Q
HPV infection produces what type of change on histology?
A
Koilocytic change - raisin-like appearance of nucleus
6
Q
What is koilocytic change?
A
Raisin-like appearance of nucleus in HPV
7
Q
<p>Thin, parchment-like vulvar skin</p>
A
<p>Lichen sclerosis - will see leukoplakia</p>
8
Q
Thinning of vulvar epidermis with thickening of dermis and leukoplakia.
A
Lichen sclerosis
9
Q
What is lichen sclerosis?
A
Thin, parchment like vulvar skin with thinning of epidermis and fibrosis of dermis and leukoplakia.
10
Q
What is the prognosis of lichen sclerosis?
A
Benign, but associated with a slightly increased risk of SCC
11
Q
Thickened, leather-like vulvar skin
A
Lichen simplex chronicus - due to chronic irritation/scratching.
12
Q
Hyperplasia of vulvar squamous epithelium with leukoplakia.
A
Lichen simplex chronicus - due to chronic irritation/scratching.
13
Q
What is lichen simplex chronicus?
A
Thickening of vulvar skin due to hyperplasia of vulvar squamous epithelium caused by chronic irritation/scratching.
14
Q
What causes lichen simplex chronicus?
A
Chronic irritation/scratching.
15
Q
What is the prognosis of lichen simplex chronicus?
A
Benign - no increased risk of SCC like with lichen sclerosis.
16
Q
A patient with vulvar leukoplakia can have which 3 disorders?
A
Lichen sclerosis (thinning of skin); Lichen simplex chronicus (hyperplasia of skin due to chronic scratching); Vulvar carcinoma (HPV or non-HPV related due to chronic lichen sclerosis)
17
Q
What are the two pathways to development of vulvar carcinoma?
A
HPV related (16, 18, 31, 33); Non-HPV related (usually due to long-standing lichen sclerosis).
18
Q
Malignant epithelial cell in the epidermis of the vulva
A
Extramammary Paget’s disease
19
Q
Erythematous pruritic, ulcerated vulvar skin
A
Extramammary Paget’s disease
20
Q
How does extramammary Paget’s disease present?
A
Erythematous pruritic, ulcerated vulvar skin
21
Q
What does extramammary Paget’s disease represent?
A
Carcinoma in situ- usually no underlying CA
22
Q
What is seen on biopsy of extramammary Paget’s disease?
A
Malignant epithelial cell in the epidermis of the vulva
23
Q
Biopsy of vulvar cells show PAS + , keratin +, and S100 - cells. Dx?
A
Extramammary Paget’s disease (keratin + because it is a carcinoma, PAS + = cells are secreting mucus, so it must be a carcinoma).
24
Q
Biopsy of vulvar cells show PAS - , keratin -, and S100 + cells. Dx?
A
Melanoma
25
How do you distinguish extramammary Paget's disease from melanoma?
Extramammary Paget's disease: PAS + , keratin +, and S100 - cells; Melanoma : PAS - , keratin -, and S100 + cells
26
Where is the underlying cancer usually located in extramammary Paget's disease?
There is NO underlying cancer. There is only underlying cancer in Paget's disease of the nipple.
27
Persistence of columnar epithelium in the upper 1/3 of vagina
Adenosis - precursor to clear cell adenocarcinoma
28
What is vaginal adenosis?
Persistance of columnar epithelium (from Mullerian duct) in the upper 1/3 of vagina. Precursor to clear cell adenoacarcinoma.
29
What causes vaginal adenosis?
Exposure to DES in utero
30
What lesion is considered a precursor to clear cell adenocarcinoma of the vagina?
Adenosis
31
Malignant vaginal proliferation of glands with clear cytoplasm.
Clear cell adenoarcinoma.
32
Exposure to DES in utero leads to increased risk for what two disorders?
Adenosis - persistence of columnar epithelium in upper 1/3 of vagina. Clear cell adenocarcinoma - malignant vaginal proliferation of glands with clear cytoplasm.
33
Malignant mesenchymal proliferation of immature skeletal muscle
Embryonal rhabdomyosarcoma
34
Bleeding with a grape-like mass protruding from vagina in a young girl
Embryonal rhabdomyosarcoma (Sarcoma botyroides).
35
What is seen on histological examination of sarcoma botryiodes?
Cells with cytoplasmic cross-striations (spindle shaped cells) This is the description of a rhabdomyoblast.
36
Rhabdomyosarcoma (sarcomam botryoides) stains for what IHC marker?
Desmin (IF for a muscle cell)
37
Tumor biopsy shows immature cells with cytoplasmic cross-striations. What cell is seen?
Rhabdomyoblast (also desmin positive)
38
What causes vaginal SCC?
HPV 16, 18, 31, 33
39
Cancer from the lower 2/3 of the vagina drains to which nodes?
Inguinal nodes
40
Cancer from the upper 1/3 of the vagina drains to which nodes?
Regional iliac nodes
41
Anatomically, HPV infects what part of the cervix?
The transformation zone (where columnar and squamous epithelia meet).
42
How does HPV cause cancer?
Produces: E6, which destroys p53 (G1---->S); E7, which destroys Rb (Free E2F allows G1 ---> S)
43
Cervical dysplasia involving only the lowest 1/3 of cells.
CIN I (reversible)
44
Cervical dysplasia involving the lowest 2/3 of cells.
CIN II (reversible)
45
Cervical dysplasia involving most of the epithelium, but not all of it.
CIN III (reversible)
46
Cervical dysplasia involving the entire epithelium.
CIS (irreversible)
47
What is the #1 risk factor for cervical cancer?
Multiple sexual partners (others include smoking, immunodeficiency).
48
Why are HIV patients at a higher risk for cervical cancer?
Immune system can't remove HPV virus (cervical cancer is an AIDS-defining illness)..
49
HPV can cause which type(s) of cervical carcinoma?
BOTH squamous (much more common) and adenocarcinoma (pap smear doesn't screen for adenoCA well)..
50
Typically, how does cervical cancer spread?
Locally - invades anterior uterine wall into bladder, leading to hydronephrosis and post-renal failure.
51
What subtypes are included in the HPV vaccine?
6, 11, 16, 18
52
What is Asherman syndrome?
Secondary amenorrhea due to loss of basalis (regenerative layer) and scarring or due to intrauterine adhesions. Result of overaggressive D & C.
53
What layer of the endometrium is considered the stem cell layer?
Basalis (lost in Asherman syndrome due to overaggressive D&C).
54
What causes Asherman syndrome?
Overaggressive D & C
55
What is the #1 cause of acute endometritis?
Retained products of conception. Retained products in uterus promotes infection by bacterial flora from vagina or intestinal tract
56
What is the treatment for acute endometritis?
Gentamycin + clindamycin with or without ampicillin.
57
What must be seen on biopsy in order to diagnose chronic endometritis?
Plasma cells
58
What is a main cause of endometrial polyps?
Tamoxifen
59
What is endometriosis?
Non-neoplastic Endometrial glands AND stroma misplaced outside the uterine endometrial lining
60
What is the most common site of involvement of endometriosis?
Ovary (causing chocolate cyst)
61
What is a chocolate cyst?
Cystic lesion of the ovary filled with menstrual products as a result of chronic endometriosis.
62
How can endometriosis cause infertility?
Chronic endometriosis of the Fallopian tube can cause scarring.
63
What is adenomyosis?
Endometriosis (presence of glands/stroma) in the myometrium Treat with hysterectomy
64
Endometriosis in the myometrium is called..
Adenomyosis
65
How does andenomyosis typically present?
Menorrhagia, dysmenorrhea, and uterine enlargement.
66
What is endometrial hyperplasia?
Hyperplasia of the endometrial glands relative to stroma
67
What causes endometrial hyperplasia?
excess Estrogen
68
What is the most common cause of postmenopausal uterine bleeding?
Endometrial hyperplasia
69
What is the most important predictor for progression of endometrial hyperplasia to carcinoma?
Cellular atypia
70
What are the 2 pathways leading to endometrial carcinoma?
Hyperplasia pathway - unopposed estrogen leads to cancer with endometrioid appearance. Sporadic pathway - no hyperplasia. Cancer arises from atrophic endometrium. Caused by p53 mutations, shows serous histology with papillae and psammoma bodies.
71
Sporadic (non-hyperplastic) endometrial cancer is driven by...
p53 mutations (papillary serous cancer with psammoma bodies, caused by atrophy)
72
Endometrioid appearance of endometrial biopsy...
Endometrial cancer caused by estrogen (hyperplasia pathway).
73
Serous (papillary) appearance of endometrial biopsy with psammoma bodies...
Endometrial cancer caused by atrophy. Caused by p53 mutations.
74
Name 5 cancers that show psammoma bodies on histology.
Papillary thyroid cancer; Mesothelioma; Papillary (serous) ovarian/endometrial cancer; Meningioma
75
Multiple, well-defined white whorled uterine masses.
Leiomyoma (no progression to leiomyosarcoma, driven by estrogen, completely benign).
76
Do leiomyomas become leiomyosarcomas?
NO! Leiomyosarcomas arise de novo.
77
Describe the gross findings of a leiomyoma vs. a leiomyosarcoma.
Leiomyoma - MULTIPLE, well-defined, white whorled masses. Leiomyosarcoma - SINGLE lesion with necrosis and hemorrhage
78
What is a follicular cyst?
Distension of unruptured Graffian follicle. Multiple follicular cysts are seen in PCOS.
79
What type of cysts are seen in PCOS?
Follicular (unruptured Graffian follicles).
80
LH:FSH >2
PCOS
81
What happens to LH and FSH levels in PCOS?
LH:FSH >2 (LH increases, FSH decreases)
82
What is the underlying cause of PCOS?
Increased LH causes increased production of androgens, which is converted into estrone in adipose tissue. Estrone feeds back to decrease production of FSH. Decreased FSH leads to degeneration of the follicle, causing it to become a cyst.
83
Obese young woman presenting with infertility, oligomenorrhea, and hirsuitism.
PCOS
84
What estrogen is made by adipose tissue?
Estrone (from T by aromatase)
85
What happens to estrogen levels in PCOS?
They increase due to increased testosterone production (secondary to increased LH), which is aromatized in adipose to estrone. Estrone feeds back to inhibit FSH release, which causes degeneration of follicles and formation of cysts.
86
Why are obese women at higher risk for PCOS?
Because adipose aromatizes the excess androgens into estrone, which feeds back to inhibit FSH release, which causes degeneration of follicles and formation of cysts.
87
Patients with PCOS are at a higher risk for what metabolic disorder?
Type II DM
88
Patients with PCOS are at a higher risk for what gynecologic cancer?
Endometrial (secondary to increased estrone)
89
What are the two most common subtypes of ovarian surface epithelial tumors and how are they differentiated?
Serous and mucinous. Both are cystic. Serous tumors are filled with a watery fluid, mucous tumors are filled with a mucinous fluid.
90
BRCA1 mutation increases risk for what non-breast tumors (2)?
Serous cystadenocarcinoma of the ovary and fallopian tube
91
Genetic association with serous cystadenocarcinoma of the ovary
BRCA1
92
CA-125
Ovarian cancer tumor marker. Good for monitoring progression, but not for screening.
93
Ovarian cancer tumor marker
CA-125
94
Ovarian tumor containing urothelium
Brenner tumor
95
What is a Brenner tumor?
Benign tumor of ovary that looks like bladder. H&E shows "coffee bean" nuclei.
96
What are the B's of Brenner tumor?
looks like Bladder, coffee Bean shape nuclei, Benign.
97
What is pseudomyxoma peritonei?
Intraperitoneal accumulation of mucinous material from a mucinous cystadenocarcinmoa of the ovary or an appendiceal tumor. "Full belly of jelly"
98
Patient presents with massive intraperitoneal accumulation of mucous material. What 2 things are at the top of your ddx?
This is pseudomyxoma peritonei. Caused by: Mucinous cystadenocarcinmoa of the ovary or an appendiceal tumor.
99
What is a cystic teratoma?
Cystic ovarian tumor composed of fetal tissue derived from 2 or 3 embryologic layers
100
What is the most common form of immature tissue in an immature teratoma?
Neuroectoderm - highly malignant
101
Teratoma containing functioning thyroid tissue
Struma ovarii
102
What is struma ovarii?
Teratoma containing functioning thyroid tissue (causes hyperthyroidism).
103
What is somatic malignancy and what is the most common one?
Tissue in a teratoma having cancer. #1 cause = skin squamous cell carcinoma of skin in a teratoma.
104
Dysgerminoma is a neoplasm of what cells?
Germ cells (eggs)
105
What is the most common malignant germ cell tumor in females?
Dysgerminoma
106
How is a dysgerminoma treated?
Radiotherapy (responds well).
107
Tumor marker for dysgerminoma
LDH
108
Patient with ovarian mass and increased serum LDH
Dysgerminoma
109
Tumor marker for yolk sac (endodermal sinus) tumor
AFP
110
Patient with testicular/ovarian mass and elevated serum AFP
Yolk sac (endodermal sinus) tumor
111
Yolk sac tumor is AKA...
Endodermal sinus tumor
112
What is the most common germ cell tumor in children?
Yolk sac tumor
113
Child with ovarian/testicular mass - biopsy shows glomerulus-like (glomeruloid) tissue. Dx?
Yolk sac tumor (glomerulus-like tissue = Schiller-Duval bodies).
114
What is a Schiller-Duval body?
Glomerulus-like structure seen in ovarian/testicular yolk sac (endodermal sinus) tumor in kids.
115
Tumor marker for choriocarcinoma
B-hCG
116
Ovarian tumor with large primitive cells
Embryonal
117
Name the 5 ovarian germ cell tumors and some characteristics about each.
Dysgerminoma - most common, formed from eggs. LDH is tumor marker. Yolk sac tumor - most common in kids. Schiller-Duval bodies (primitive glomeruli). AFP is marker. Choriocarcinoma- tumor of trophoblastic tissue with no villi. Very aggressive, spreads hematogenously, poor response to chemo if spontaneous mutation. Responds well if it is a result of pregnancy B-HCG is marker. Teratoma- tumor made of 2 or 3 layers of epithelium. Can contain thyroid tissue (struma ovarii). Usually benign. Embryonal carcinoma- contains large primitive cells, aggressive with early mets.
118
Name the 3 ovarian surface epithelial tumors and some characteristics of each.
Mucinous cystadenocarcinoma - cystic, produces mucin. Can cause pseudomyxoma peritonei (full belly of jelly). Serous cystadenocarcinoma - cystic, produces serous fluid. Increased risk with BRCA-1 mutations. Psammoma bodies on histo. Brunner tumor - looks like bladder, benign, coffee-bean shaped nuclei on histo.
119
Ovarian tumor with psammoma bodies.
Serous cystadenocarcinoma
120
Ovarian tumor presenting with signs of estrogen excess (precocious puberty, abnormal bleeding).
Granulosa-theca cell tumor (produces estrogen).
121
Reinke crystals
Leydig cell tumor
122
Ovarian tumor showing tubules and Reinke crystals
Sertoli (tubes) Leydig (Reinke crystals) cell tumor
123
Ovarian fibroma, pleural effusion, ascites
Meig's syndrome
124
Triad seen with Meig's syndrome
Ovarian fibroma; Ascites; pleural effusion
125
Name 3 sex-cord stromal tumors of the ovary and some characteristics of each.
Granulosa-Theca cell tumor - secretes high estrogen. Call-Exner bodies (small follicles filled with eosinophilic secretions). Sertoli-Leydig cell tumor - secretes androgen, contains tubules (Sertoli) and Reinke crystals (Leydig); Fibroma - fibrous tissue. Produce Meig's syndrome: fibroma + pleural effusion + ascites
126
What are Call-Exner bodies?
Small follicles filled with eosinophilic secretions. Seen in Granulosa-Theca cell tumors.
127
Ovarian tumor biopsy shows small follicles filled with eosinophilic secretions. Dx?
Granulosa-Theca cell tumor. This is a description of a Call-Exner body.
128
What is a Krukenburg tumor?
Metastasis of a gastric signet-ring cell (diffuse type) carcinoma to the ovaries. Produces mucous.
129
What is a signet ring cell and what gynecological tumor is it associated with?
A cell with its nucleus pushed off to the side due to mucous accumulation. Associated with Krukenburg tumor (metastasis of diffuse-type signet ring cell gastric CA to the ovaries).
130
What GI cancer metastasizes to ovaries?
Diffuse type gastric cancer (signet-ring cell) - Krukenberg tumor.
131
What is placenta previa?
Placenta overlying the cervical os. Presents as bright red painless bleeding.
132
Placenta overlying the cervical os.
Placenta previa
133
Separation of placenta from decidua prior to delivery of fetus.
Placental abruption. Present with dark red, painful bleeding in the 3rd trimester.
134
What is placenta accreta?
Placenta implantation into the myometrium. Presents with difficult delivery of placenta and massive post-partum bleeding. (increta is into the wall of uterus, all the way through the myometrium, percreta perforates through the uterus).
135
What will be seen in the vessels of the placenta in pre-eclampsia?
Fibrinoid necrosis
136
What is pre-eclampsia?
HTN + proteinuria + edema
137
What is eclampsia?
HTN + proteinuria + edema (pre-eclampsia) + seizures
138
How do you treat pre-eclampsia?
Magnesium sulfate, deliver ASAP
139
What is HELLP?
Hemolysis, elevated liver enzymes, low platelets. Seen in pregnancy. Schistocytes are seen on peripheral smear.
140
What causes HELLP?
Platelet thrombus in a small vessel in the liver causes hemolysis and production of schistocytes with elevation of liver enzymes.
141
Name 3 risk factors for SIDS.
Sleeping on stomach, smoking in household, prematurity.
142
Uterus larger than gestational age
Molar pregnancy
143
What are the "grape-like" masses in a molar pregnancy?
Edematous villi
144
Snow storm appearance on US
Molar pregnancy
145
Karyotype of a complete mole
46 XX or XY
146
What causes a complete mole?
2 sperm fertilizing an empty ovum (46 XX or XY)
147
What causes a partial mole?
2 sperm fertilizing an egg (69 XXY, XXX or XYY)
148
What type of mole has fetal parts?
PARTial mole
149
Which mole has a greater risk of choriocarcinoma?
Complete mole
150
69 XXY
Partial mole
151
What is measured to ensure complete removal of a molar pregnancy?
B-hCG
152
What are the 2 ways to get a choriocarcinoma and how are they differentiated?
Spontaneous germ cell mutation - does NOT respond to chemotherapy; Result of pregnancy (molar) - responds WELL to chemotherapy
153
Under what circumstances does a choriocarcinoma respond to chemotherapy?
If it arises as a result of a pregnancy. If it arises de novo, it does not respond well to chemo.
154
What causes hypospadias?
Failure of the urethral folds to close
155
Opening of the urethra on the inferior (ventral) | surface of the penis.
Hypospadias
156
Is hypospadias or epispadias more common?
Hypospadias
157
Opening of the urethra on the superior (dorsal) surface of the penis.
Epispadias
158
What causes epispadias?
Abnormal positioning of the genital tubercle
159
Bladder exstrophy is associated with what penile malformation?
Epispadias
160
What serotypes of C. trachomatis causes LGV?
L1-L3
161
What causes SCC of the penis?
High risk HPV - 16, 18, 31, 33; Lack of circumcision
162
In situ carcinoma presenting as leukoplakia of the shaft of the penis
Bowen disease (can invade as SCC)
163
In situ carcinoma presenting as erythroplasia of the glans of the penis
Erythroplasia of Queyrat
164
In situ carcinoma presenting as red papules on the shaft of the penis
Bowenoid papulosis
165
Cryptorchidism increases the risk for...
Seminoma and infertility
166
Painful testicle with absent cremasteric reflex
Testicular torsion
167
What causes infarction in testicular torsion?
The vein is blocked but the artery keeps pumping
168
What causes hydrocele?
Incomplete closure of processus vaginalis (infants) or blockage of lymphatic drainage (adults)
169
What are the two general categories of testicular tumors?
Germ cell or sex cord stromal tumors (no surface epithelial tumors like in ovary)
170
How do you biopsy a testicular tumor?
NEVER biopsy a testicular tumor due to risk of seeding scrotum.
171
How is a seminoma treated?
Radiotherapy. Responds very well.
172
Grossly, what is the appearance of a seminoma?
Homogenous mass with no hemorrhage or necrosis.
173
What happens to testicular embryonal carcinoma when it is treated with chemo?
It can differentiate into a teratoma
174
What is the #1 testicular tumor in children?
Yolk sac tumor
175
In choriocarcinoma, what cells make B-HCG?
Syncytiotrophoblasts (mimics TSH and can cause hyperthyroidism!)
176
Patient with testicular mass and hyperthyroidism. Dx?
Choriocarcinoma. Excess B-HCG produced by tumor mimics TSH.
177
Describe the appearance of the villi in a choriocarcinoma.
Villi are ABSENT. The tumor is only cytotrophoblasts and syncytiotrophoblasts.
178
Describe the behavior of testicular teratomas vs. ovarian teratomas
Malignant in males, benign in females
179
Leydig cell tumors produce...
Androgen
180
How does a Leydig cell tumor present in adults? Kids?
Kids - precosious puberty; Adults - gynecomastia
181
How does a male Sertoli cell tumor usually present?
Usually clinically silent
182
What is the most common cause of testicular mass in males > 60?
Lymphoma - metastasis. Usually DLBCL.
183
What is the #1 and 2 causes of acute prostatitis in young adults?
C. trachomatis and N. gonorrhea
184
What is the #1 and 2 causes of acute prostatitis in older adults?
E. coli and pseudomonas
185
What causes BPH?
DHT (T converted by 5 alpha reductase)
186
Where in the prostate does BPH occur?
The peri-urethral (lateral and middle) zone of the prostate
187
What happens to PSA in BPH?
Elevates slightly (4-10, normal is 0-4).
188
Name 3 treatments for BPH.
Alpha 1 antagonist (terazosin) to relax smooth muscle in hypertensive pts.; Seletive alpha 1A antagonists (tamsulosin) in normotensive patients; 5-alpha reductase inhibitors (finasteride) to reduce DHT
189
What is the gross hallmark of BPH?
Nodularity
190
Where in the prostate does prostatic adenocarcinoma occur and what is the significance of this?
Posterior zone. It is therefore clinically silent, because it occurs away from the urinary zone of the prostate. It is also picked up on DRE because DRE involves palpating the posterior zone.
191
Describe the appearance of the nuclei of prostate cancer cells.
They contain dark nucleoli - characteristic.
192
The Gleason grading system for prostate cancer uses what parameters?
Architecture, not nuclear atypia
193
What type of lesions does prostate cancer produce when metastasizing to spine?
Osteoblastic - causes increased increased alkaline phosphatase, which is indicative of increased osteoblastic activity.
194
What is flutamide?
Androgen receptor blocker used in prostate cancer
195
What is leuprolide?
Continuous GnRH analog used in prostate cancer.
196
What is finasteride?
5 alpha reductase inhibitor used in BPH
197
Describe the genital lesions seen in primary, secondary, and tertiary syphilis.
Primary - painless chancre; Secondary - condyloma lata; tertiary - gumma
198
Describe the changes seen in the uterus with an ectopic pregnancy.
Deciduilization of the uterus (just like in a normal pregnancy), with no embryonic tissue or villi.
199
Karyotype, SSX of Klinefelter syndrome
47 XXY. Testicular atrophy, eunuchoid body shape, tall, long extremities, gynecomastia, female hair distribution, Barr body, low T. Increased FSH due to dysgenesis of seminiferous tubules and decreased inhibin. Increased LH due to abnormal Leydig cell function causing increased LH and increased Estrogen. Note that the estrogen:Testosterone ratio determines the extent feminization
200
Karyotype, SSX of Turner syndrome.
45 XO. Short stature, ovarian dysgenesis (streak ovary with infertility), shield chest, bicuspid aortic valve, webbed neck (defects in lymphatics - cystic hygroma), horseshoe kidney, preductal coarctation of the aorta, NO Barr body. Decreased E leads to increased LH and FSH.
201
Phenotypically female newborn with testes located in the labia majora and normal female genitalia.
Androgen insensitivity syndrome (46 XY)
202
Newborn male presents with decreased development of the penis, prostate, and scrotum.
5 alpha reductase deficiency
203
What causes Kallman syndrome?
Defective migration of GnRH cells and formation of olfactory bulb.
204
SSX of Kallman syndrome?
Anosmia, lack of secondary sex characteristics, decreased GnRH, FSH, LH, testosterone, and sperm count. Due to defective migration of GnRH cells and formation of olfactory bulb
205
Male presents with inability to smell and lack of secondary sex characteristics.
Kallman syndrome. Defective migration of GnRH cells and formation of olfactory bulb.
206
Bent penis due to acquired fibrous tissue formation.
Peryione disease
207
Describe the actions of the sonic hedgehog gene
Produced at the base of limbs in zone of polarizing activity. Involved in patterning along anterior posterior axis. Involved in CNS development
208
What can occur with mutation in the sonic hedgehog gene?
holoprosencephaly
209
Describe the actions of the WNT-7 gene
Produced at apical ectodermal ridge (thickened ectoderm at distal end of each developing limb)
necessary for proper organization along dorsal-ventral axis (so that feet and nose point in the same direction)
210
Describe the FGF gene
Produced at apical ectodermal ridge. Stimulates mitosis of underlying mesoderm, providing for lengthening of limbs
211
What occurs with mutation in FGF receptor 3?
Achondroplasia (short limbs)
212
Describe the Homeobox (HOX) genes
Involved in segmental organization of embryo in a craniosacral direction.
213
What occurs with a HOX mutation?
Appendages in wrong places
Note that retinoic acid can alter HOX gene expression
214
When does hCG secretion begin?
After implantation of the blastocyst.
| Causes the corpus luteum to continue to secrete progesterone to maintain the uterine lining
215
When does the embryo develop into a bilaminar disc?
Within 2 weeks you get the 2 layered disc
| composed of epiblast and hypoblast (yolk sac)
216
What occurs at 3 weeks of fetal development?
Trilaminar disc (3 weeks = 3 layers)
Ectoderm, mesoderm and endoderm
Gastrulation occurs.
The primitive streak, notochord, mesoderm and its organization and neural plate begin to form
217
When does the neural tube close by?
By week 4
218
When is the fetus extremely susceptible to teratogens?
During organogenesis (weeks 3-8)
219
What special thing starts in week 4 of early fetal development?
Heart begins to beat.
| Upper and lower limb buds begin to form (4 weeks = 4 limbs and 4 chamber heart)
220
What occurs in week 8 of the early fetal development?
Fetal movement (Eight = Gait), fetus looks like a baby
221
What occurs in week 10 of early fetal development?
Genitalia have male/female characteristics
222
What is gastrulation?
Process that forms the trilaminar embryonic disc. Establishes the ectoderm, mesoderm and endoderm germ layers. Starts with the epiblast invaginating to form the primitive streak
223
List a bunch of things that develops from surface ectoderm
```
Adenohypophysis (AP)
Lens of eye
Epithelial linings of oral cavity
sensory organs of ear
olfactory epithelium
epidermis
anal canal below the pectinate line
parotid, sweat and mammary glands
```
224
List a bunch of things that develop from the neuroectoderm
Brain (plus PP, CNS neurons, oligodendrocytes, astrocytes, ependymal cells, pineal gland)
retina
optic nerve
spinal cord
225
List a bunch of things that develop from the neural crest
```
PNS (dorsal root ganglia, cranial nerves, celiac ganglion, Schwann cells, ANS)
melanocytes
chromaffin cells of adrenal medulla
Parafollicular C cells of the thyroid
Schwann cells
pia and arachnoid
bones of the skull
odontoblasts
aorticopulmonary septum
cornea
```
226
What is the neural crest derived from?
Ectoderm
227
List a bunch of things that develop from mesoderm
```
Muscle
bone
connective tissue
serous linings of body cavities (peritoneum)
spleen (derived from foregut mesentery)
cardiovascular structures
lymphatics
blood
wall of gut tube
wall of bladder
upper 1/3 vagina
kidneys
adrenal cortex
dermis
testes
ovaries
Notochord induces ectoderm to form neuroectoderm (neural plate). It's only postnatal derivative is the nucleus pulposus of the intervertebral disc
```
228
What is the mnemonic for mesodermal defects?
```
VACTERL
Vertebral defects
Anal atresia
Cardiac defects
Tracheo-Esophageal fistula
Renal defects
Limb defects (bone and muscle)
```
229
List a bunch of things that come from endoderm
Gut tube epithelium (including anal canal above the pectinate line)
luminal epithelial derivatives - lungs, liver, gallbladder, pancreas, Eustachian tube, thymus, parathyroid, thyroid follicular cells
urethra
epithelium of bladder/urethra and lower 2/3 of vagina
230
What is the difference between deformation and malformation?
Deformation: extrinsic disruption; occurs after the embryonic period
Malformation: Intrinsic disruption; occurs during the embryonic period (wks 3-8)
231
What is fetal hydantoin syndrome and what drug can cause it?
Caused by phenytoin
Microcephaly, dysmorphic craniofacial features, hypoplastic nails and distal phalanges, cardiac defects, IUGR, mental retardation
232
What are the teratogenic effects of thalidomide and cyclophosphamide?
Limb defects, limb hypoplasia
233
What are the teratogenic effects of warfarin?
Bone deformities, fetal hemorrhage, abortion, ophthalmologic abnormalities
234
What are the teratogenic effects of aminoglycosides?
CNVIII toxicity (ototoxicity)
235
What are the teratogenic effects of Carbamazepine?
Neural tube defects, craniofacial defects, fingernail hypoplasia, developmental delay, IUGR
236
What are the teratogenic effects of lithium?
Ebstein's anomaly (atrialized right ventricle)
237
What are the teratogenic effects of alcohol?
Alcohol is the leading cause of birth defects and mental retardation, causes fetal alcohol syndrome
238
What are the teratogenic effects of cocaine?
Abnormal fetal development and fetal addiction; placental abruption
cocaine interferes with blood flow to the fetus
239
What are the teratogenic effects of smoking?
Preterm labor, placental problems, IUGR, ADHD
Smoking interferes with blood flow to the fetus
240
What are the teratogenic effects of Maternal diabetes?
Caudal regression syndrome (anal atresia to sirenomelia), congenital heart defects, neural tube defects
241
What are the teratogenic effects of X rays?
Microcephaly, mental retardation
242
What is the possibility with twinning if cleavage occurred on day 4-8?
Monochroionic diamniotic
243
What is the possibility with twinning if cleavage occurred on day 8-12?
Monochorionic monoamniotic
244
What is the possibility with twinning if cleavage occurred on day 13 or after?
Monochorionic monoamniotic, conjoined twins
245
How does twin-twin transfusion syndrome occur?
Only with monochorionicity
can be mono/mono or mono/di twins
Anastamoses leads to shunting of blood
246
What are the stem cells of the fetal component of the placenta?
Cytotrophoblasts
247
What is the outer layer of the chorionic villi called which are multinucleated?
Synciotrophoblasts
248
What do Synciotrophoblasts do?
Secrete hCG which stimulates the corpus luteum to secrete progesterone during the first trimester
249
What happens to the sacrum because of childbirth?
Bilateral sacral flexion
250
What is the decidua basalis?
Derived from the endometrium - maternal component of the placenta.
The maternal blood is located in the lacunae
251
How does the umbilical vein drain?
Drains via ductus venosus into the IVC
252
What are the umbilical arteries and umbilical vein derived from?
Allantois
253
What would you think if you saw a single umbilical artery?
Uh-oh.
a single umbilical artery is associated with congenital (esp renal) and chromosomal anomalies
254
What are the two things that can occur with failure of the urachus to obliterate?
Patent urachus - urine discharges from umbilicus
Vesicourachal diverticulum - outpouching of the bladder
255
What are the two things that can occur with failure of the vitelline duct to close?
Vitelline fistula - meconium discharge from the umbilicus
Meckel's diverticulum - partial closure, with patent portion attached to ileum. May have ectopic gastric mucosa --> melena, periumbilical pain, and ulcer
256
What develops from the first aortic arch?
Part of maxillary artery (branch of external carotid) - 1st arch is maximal
257
What develops from the 2nd aortic arch?
Stapedial artery and hyoid artery
| Second=Stapedial
258
What develops from the 3rd aortic arch?
Common Carotid artery and proximal part of internal Carotid artery
C=3rd letter in the alphabet
259
What develops from the 4th aortic arch?
On left: aortic arch
on right: proximal part of right subclavian artery
4th arch = 4 limbs (systemic circulation)
260
What develops from the 6th aortic arch?
Proximal part of pulmonary arteries and (on left only) ductus arteriosus
6th arch = pulmomonary and the pulmonary-to-systemic shunt (ductus arteriosus)
261
What does the left recurrent laryngeal nerve get stuck on?
Ligamentum arteriosum
262
What is the branchial apparatus?
Same thing as the pharyngeal apparatus
Composed of branchial clefts, arches and pouches
CAP covers outside from inside
Clefts = ectoderm
Arches = mesoderm
Pouches = endoderm
263
What are the branchial clefts?
Derived from ectoderm. Also called branchial grooves
264
What are the branchial arches?
Derived from mesoderm (muscles, arteries) and neural crest (bones, cartilages)
265
What are the bronchial pouches?
Derived from endoderm
266
What is derived from the first branchial cleft?
external auditory meatus
267
What is derived from the 2-4th branchial clefts?
temporary cervical sinuses, which are obliterated by proliferation of 2nd arch mesenchyme
Persistence of cervical sinus = branchial cleft cyst within lateral neck
268
What is the difference between a branchial cleft cyst an a thyroglossal duct cyst?
Branchial cleft cyst: lateral neck, doesn't move with swallowing
Thyroglossal duct cyst: midline neck, moves with swallowing - gets pushed around due to its association with the thyroid cartilage
269
List the cartilage, muscles, and nerves that are derived from the first branchial arch
1st arch = M's and T's
Cartilage: Meckel's cartilage: Mandible, Malleus, incus, sphenoMandibular ligament
Muscles: Muscles of Mastication (Temporalis, Masseter, lateral and Medial pterygoid), Myelohyoid, anterior belly of digastric, Tensor Tympani, Tensor veli palatini
Nerves: CN V2 and V3 - chew
270
What abnormality is seen with development of the first branchial arch?
Treacher Collins syndrome - first arch neural crest fails to migrate leading to mandibular hypoplasia and facial abnormalities
271
List the cartilage, muscles, and nerves that are derived from the second branchial arch
2nd arch = S's
Cartilage: Reichert's cartilages: Stapes, Styloid process, lesser horn of hyoid, Stylohyoid ligament
Muscles: Muscles of facial expression, Stapedisu, Stylohyoid, posterior belly of digastric
Nerves: CN Seven Smile
272
List the cartilage, muscles, and nerves that are derived from the third branchial arch
3rd arch = pharyngeal
Cartilage: greater horn of hyoid
Muscles: stylopharyngeus (think of stylopharyngeus innervated by glossopharyngeal nerve)
Nerve: CN IX (stylopharyngeus) swallow stylishly Glossopharyngeal nerve
273
What is the abnormality seen with poor development of the 3rd branchial arch?
Congenital pharyngocutaneous fistula - persistence of cleft and pouch leading to fistula between tonsillar area, cleft in lateral neck (branchial cleft cyst)
274
List the cartilage, muscles, and nerves that are derived from the 4th - 6th branchial arch
4th and 6th arches = cricothyroid and larynx
Cartilage: thyroid, cricoid, arytenoids, corniculate, cuneiform
Muscles:
4th arch - most pharyngeal constrictors; cricothyroid, levator veli palatini
6th arch - all intrinsic muscles of larynx except cricothyroid
Nerves:
4th arch - CN X (superior laryngeal branch)
6th arch - CN X (recurrent laryngeal branch)
275
What is derived from the 1st branchial pouch?
Develops into the middle ear cavity, Eustachian tube, mastoid air cells
first pouch contributes to endoderm lined structures of the ear
276
What is derived from the 2nd branchial pouch?
Develops into epithelial lining of palatine tonsil
277
What is derived from the 3rd branchial pouch?
Dorsal wings - develops into inferior parathyroids
ventral wings - develops into thymus
The 3rd pouch contributes to 3 structures (thymus, left and right inferior parathyroids)
Note that 3rd pouch structures end up below the 4th pouch structures
278
What is derived from the 4th branchial pouch?
Dorsal wings - develops into superior parathyroids
279
What is the problem in DiGeorge syndrome?
Aberrant development of the 3rd and 4th branchial pouches (no thymus and no parathyroids)
280
What is the mutation in MEN2A and what does it cause?
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 the 4th/5th pharyngeal pouches
281
What has failed that leads to a cleft lip?
Failure of fusion of the maxillary and medial nasal processes (formation of primary palate)
282
What has failed that leads to a cleft palate?
Failuer of fusion of the lateral palatine processes, the nasal septum, and/or the median palatine process (formation of secondary palate)
283
What occurs in female embryology?
Default development - mesonephric duct degenerates and paramesonephric duct develops
284
What 3 things occur in a male to allow for male development?
- SRY gene on Y chromosome produces testis-determining factor
- Sertoli cells secrete Mullerian inhibitory factor that suppresses the development of the paramesonephric duct
- Leydig cells secrete androgens that stimulate the development of mesonephric ducts
285
What develops from the paramesonephric (mullerian) duct?
female internal structures:
fallopian tubes
uterus
upper portion of vagina (lower portion comes from the urogenital sinus)
286
What can the presentation be in a female patient with Mullerian duct abnormalities?
anatomical defects that may present as primary amenorrhea in female with fully developed secondary sexual characteristics (indicator of functional ovaries)
287
What develops from the mesonephric (Wolffian) duct?
```
male internal structures EXCEPT the prostate!
Seminal vesicles
Epididymis
Ejaculatory duct
Ductus deferens
```
288
What causes a Bocornuate uterus?
Incomplete fusion of the paramesonephric ducts.
| Can lead to urinary tract abnormalities and miscarriages
289
What would occur if a patient had no sertoli cells or lacked mullerian inhibitory factor?
Development of both male and female internal genitalia and male external genitalia
290
What would occur with a 5 alpha reductase deficiency?
Male internal genitalia, ambiguous external genitalia until puberty
291
Why is it important to fix hypospadias?
To prevent UTIs
292
What is the male and female remnant of the Gubernaculum (band of fibrous tissue)?
Male - anchors testes within the scrotum
Female - Ovarian ligament + round ligament of the uterus
293
What is the male and female remnant of the processus vaginalis (evagination of peritoneum)?
Male - forms tunica vaginalis
Female - Obliterated
294
What is the gonadal venous drainage?
Left ovary/testis drains to the left gonadal vein then drains to the left renal vein which drains to the IVC
Right ovary/testis drains to the right gonadal vein which drains to the IVC
295
What is the gonadal Lymphatic drainage?
Ovaries/testes drain to the para-aortic lymph nodes
Distal 1/3 of vagina/vulva/scrotum drains to the superficial inguinal nodes
Proximal 2/3 of vagina/uterus drains to the obturator, external iliac and hypogastric ndoes
296
Which testes has higher venous pressure?
Left venous pressure is higher than right venous pressure
this means that varicocele is more common on the left
(Left hands lower)
297
What is the suspensory ligament of the ovaries?
Infundibulopelvic ligament
| connects the ovaries tot he pelvic wall and contains the ovarian vessels
298
What is the cardinal ligament?
Cervix to side wall of pelvis
| contains the uterine vessels
299
What is the round ligament of the uterus?
Uterine fundus to labia majora
contains artery of Sampson
travels through the round inguinal canal
300
What is the broad ligament?
Connects the uterus, fallopian tubes, and ovaries to pelvic side wall
contains the ovaries, fallopian tubes and round ligaments of the uterus
301
What is the ligament of the ovary?
Connects the medial pole of ovary to lateral uterus
302
What is the normal histology of the vagina and ectocervix?
Stratified squamous epithelium, nonkeratinized
303
What is the normal histology of the endocervix?
Simple columnar epithelium
304
What is the normal histology of the uterus?
Simple columnar epithelium, pseudostratified tubular glands
305
What is the normal histology of the fallopian tube?
Simple columnar epithelium, pseudostratified tubular glands
306
What is the normal histology of the fallopian tube?
Simple columnar epithelium, ciliated (to swoop eggs)
307
What is the normal histology of the ovary?
Simple cuboidal epithelium
308
What is the pathway of sperm during ejaculation?
```
SEVEN UP
Seminiferous tubules
Epididymis
Vas deferens
Ejaculatory ducts
nothing
Urethra
Penis
```
309
What is the biochemical pathway that allows for an erection?
Parasympathetics
NO leads to increased cGMP leading to smooth muscle relaxation and vasodilation allowing for the penis to fill with blood and have an erection
310
What is the biochemical pathway that is antierectile?
Sympathetics
Norepinephrine increases intracellular calcium leading to smooth muscle contraction and vasoconstriction and decreased erection
311
What nerves allow for erection, emission and ejaculation?
Erection: Parasympathetic via the pelvic nerve
Emission: Sympathetic via the hypogastric nerve
Ejaculation: visveral and somatic nerves via the pudendal nerves
312
What is the function of spermatogonia?
These are the germ cells, they maintain the germ pool and produce primary spermatocytes
They line the seminiferous tubules
313
Are sertoli germ cells?
NO
314
What is the function of sertoli cells? (6)
- Secrete inhibin which inhibits FSH
- Secrete androgen binding protein to maintain local levels of testosterone
- maintain tight junctions between adjacent sertoli cells to form blood testis barrier which isolates the gametes from autoimmune attack
- Support and nourish developing spermatozoa
- regulate spermatogenesis
- produce anti-mullerian hormone
315
Which cells in the testes are temperature sensitive?
Sertoli cells are temperature sensitive,
| leads to decreased sperm production and decreased inhibin with increased temperature
316
What are leydig cells?
Endocrine cells
Secrete testosterone
Note that testosterone production is not affected by temperature
located in the interstitum
317
When does spermatogenesis occur in men and how long does full development of the sperm take?
Beings at puberty
takes 2 months
"gonium is going to be a sperm, Zoon is Zooming to the egg"
318
What is spermiogenesis?
Loss of cytoplasmic contents and gain of acrosomal cap in order to form a mature spermatozoan
319
What is the function of LH in males?
Stimulates synthesis of testosterone in leydig cells
320
What is the function of FSH in males?
Stimulates sertoli cells to make androgen binding protein and inhibin
and sperm
321
List the order of potency of the male androgens?
DHT > Testosterone > Androstenedione
322
What does aromatase do to Androstenedione and testosterone in a male?
converts andostenedione to estrone
| converts testosterone to estradiol
323
List the functions of Testosterone (5)
- Differentiation od epididymis, vas deferens, seminal vesicles (internal genitalia except prostate)
- Growth spurt (penis, seminal vesicles, sperm, muscle, RBCs)
- Deepening of the voice
- Closing of epiphyseal plates (via estrogen converted from testosterone)
- Libido
324
List the functions of DHT
Early - differentiation of penis, scrotum and prostate (works on urogenital sinus)
late - prostate growth, balding, sebaceous gland activity
325
What is the function of 5 alpha reductase?
Converts Testosterone to DHT
Note that Finasteride INHIBITS 5 alpha reductase!
326
What does exogenous testosterone do to a male?
Exogenous testosterone inhibits the hypothalamic pituitary gonadal axis leading to decreased intratesticular testosterone which leads to decreased testicular size and azoospermia
327
What are the sources and potency of the different types of estrogen?
Estradiol > estrone > estriol
Ovary - 17Beta estradiol
placenta - estriol
adipose tissue - estrone
328
What happens to estrogen during pregnancy?
50-fold increased in estradiol and estrone
| 1000 fold increased in estriol (indicator of fetal well being)
329
List the functions of estrogen (4)
- 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 prolactin secretion (but blocks its action at the breast)
- Increased transport proteins, SHBG; Increased HDL decreased LDL
330
What are the sources of progesterone?
Corpus luteum, placenta, adrenal cortex, testes
331
List the functions of Progesterone (8)
- Stimulation of endometrial glandular secretions and spiral artery development
- Maintenance of pregnancy
- decreased myometrial excitability
- Production of thick cervical mucus, which inhibits sperm entry into the uterus
- Increased body temperature
- inhibition of gonadotropins (LH, FSH)
- Uterine smooth muscle relaxation (preventing contractions)
- decreased estrogen receptor expressivity
332
What happens with the corpus luteum?
Formed after ovulation; produces progesterone and estrogen in the luteal phase; lasts 14 d (luteal phase) - if beta hCG from the placeta is present, the lifespan of the CL will extend to 6-7 weeks until the placenta is able to make its own progesterone
333
List the 5 tanner stages of sexual development
1. Childhood
2. Pubic hair appears (pubarche); breast bud forms (thelarche)
3. Pubic hair darkens and becomes curly; penis size/length increases; breast enlarges
4. Penis width increases, darker scrotal skin, development of glans, raised areolae
5. Adult; areolae are no longer raised
334
How long is the menstrual cycle?
Follicular phase can vary; Luteal phase is always 14 days
| Ovulation + 14 days = menstruation
335
```
Define:
Oligomenorrhea
Polymenorrhea
Metorrhagia
Menometorrhagia
```
Oligomenorrhea: > 35 day cycle
Polymenorrhea: < 21 day cycle
Metorrhagia: Frequent but irregular menstruation
Menometrorrhagia: heavy irregular menstruation at irregular intervals
336
what happens when progesterone levels fall during the menstrual cycle?
Falls in progesterone lead to menstruation (via apoptosis of endometrial cells)
337
List the endometrial layers - which is shed during menses?
Layers are stratum basalis, stratum spongiosum, stratum compactum
Shed during menses: stratum spongiosum and stratum compactum
338
What causes increased temperature during ovulation?
Progesterone
339
What is Mittelschmez?
mid cycle pain associated with ovulation; blood from ruptured follicle or follicular enlargement causes peritoneal irritation that can mimic appendicitis
340
Describe oogenesis
- Primary oocytes being meiosis I during fetal life and complete meiosis I just prior to ovulation
- Meiosis I is arrested in prOphase I for years until Ovulation (primary oocytes)
- Meiosis II is arrested in METaphase II until fertilization (secondary oocytes) "an egg MET a sperm"
If fertilization does no occur within 1 day, the secondary oocyte degenerates
341
What allows for lactation after giving birth?
After labor, the decreased in progesterone disinhibits lactation. Suckling is required to maintain milk production, since increased nerve stimulation increases oxytocin and prolactin
342
What is the function of prolactin?
Induces and maintains lactation and decreases reproductive function
343
What is the function of oxytocin?
Appears to help with milk letdown and may be involved with uterine contractions
344
What needs to be supplemented with breast milk?
Vitamin D
345
Why are LH levels low during pregnancy?
LH levels are low during pregnancy due to progesterone feedback inhibition on the anterior pituitary
346
What is the function of hCG?
Maintains the corpus luteum and therefore progesterone, for the first trimester by acting like LH - otherwise there's no luteal cell stimulation and abortion results
347
What does this mean: Menopause causes HHAVOC
```
Hirsutism
Hot flashes
Atrophy of the Vagina
Osteoporosis
Coronary artery disease
```
348
What is menopause
Decreased estrogen production due to age-linked decline in the number of ovarian follicles. Average age at onset is 51 years (earlier in smokers)
1 year without menses
349
What is the best test to confirm menopause?
INCREASED FSH is the best test to confirm menopause (loss of negative feedback for FSH due to decreased estrogen)
350
What are the lab hormonal changes seen in menopause?
Decreased estrogen, wayy Increased FSH, increased LH (no surge), increased GnRH
351
What is Gravidity? Parity?
Gravidity - # of pregnancies
Parity - # of deliveries over 20 weeks (including stillbirths)
A = abortions; # of deliveries before 20 weeks (medical/spontaneous)
352
What is seen on triple screen with trisomy 21?
Decreased AFP and estriol, increased hCG
353
What is seen on triple screen with trisomy 18?
Decreased AFP, Estriol and hCG
354
What is double Y males?
XYY; phenotypically normal, very tall, severe acne, antisocial behavior
Normal fertility. small percentage diagnosed with autism spectrum disorders
355
What is the diagnosis: Increased Testosterone and increased LH
Defective androgen receptor
356
What is the diagnosis: Increased testosterone and decreased LH
Testosterone secreting tumor, exogenous steroids
357
What is the diagnosis: Decreased testosterone and increased LH
Primary hypogonadism
358
What is the diagnosis: Decreased Testosterone and decreased LH
Hypogonadotropic hypogonadism (kallmann syndrome)
359
What is pseudohermarphroditism?
Disagreement between the phenotypic (external genitalia) and gonadal (ovaries vs testes) sex
360
Describe Female psudohermaphrodite (XX)
Ovaries are present but external genitalia are virilized or ambiguous. Due to excessive and inappropriate exposure to androgenic steroids during early gestation (e.g. congenital adrenal hyperplasia or exogenous administration of androgens during pregnancy)
361
Describe Male pseudohermaphrodite (XY)
Testes present, but external genitalia are female or ambiguous. Most common form is androgen insensitivity syndrome (testicular feminization)
362
Describe True hermaphroditism (46XX or 47XXY)
Both ovary and testicular tissue present (ovotestis); ambiguous genitalia. very rare
363
What is androgen insensitivity syndrome (46, XY)?
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, LH (vs sex chromosome disorders)
364
Describe 5 alpha reductase deficiency?
AR, sex limited to genetic males.
Inability to convert T 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
365
Describe Kallmann syndrome
Defective migration of GnRH cells and formation of olfactory bulb; decreased synthesis of GnRH in the hypothalamus; anosmia; lack of secondary sexual characteristics
Decreased GnRH, FSH, LH, testosterone and sperm count
366
How do you treat Kallmann syndrome?
Hormone replacement
testosterone in M and estrogen-progesterone in F
If patient desires fertility you can give them hCG and FSH to be used to stimulate production of gonadal steroid hormone
367
What is seen with a hydatidiform mole?
Cystic swelling of hydropic/chorionic villi and proliferation of chorionic epithelium (trophoblast) that presents with abnormal vaginal bleeding
368
What is the most common precursor of choriocarcinoma?
Hydatidiform mole (esp complete mole)
369
Honeycombed uterus or cluster of grapes appearance, abnormally enlarged uterus.
Hydatidiform mole
370
Complete moles classically have...
Snowstorm appearance with no fetus during 1st sonogram - "central heterogenous mass with numerous discrete anechoic spaces" = snowstorm
371
What does preeclampsia before 20 weeks gestation suggest?
molar pregnancy
372
When does preeclampsia normally occur?
20 weeks gestation to 6 weeks postpartum
373
What causes preeclampsia?
Placental ischemia due to impaired vasodilation of spiral arteries, resulting in increased vascular tone
374
What can preeclampsia be associated with?
HELLP syndrome
375
What is HELLP syndrome?
Hemolysis, elevated liver enzymes, Low platelets
376
What causes morality from preeclampsia?
cerebral hemorrhage and ARDS
377
What are the clinical features of a patient with preeclampsia?
headache, blurred vision, abdominal pain, edema of face and extremities, altered mentation, hyperreflexia, lab findings may include thrombocytopenia and hyperuricemia
378
What is the treatment for a patient with preeclampsia?
Delivery of fetus as soon as viable.
Otherwise bed rest, monitoring and treatment of hypertension
Treatment: IV magnesium sulfate to prevent and treat seizures of eclampsia
Methyldopa for hypertension
379
What can increase the risk of abruption placentae?
Increased risk with smoking, hypertension and cocaine use
380
What is the immediate cause of Abruptio placentae?
Rupture of maternal vessels in the decidua basalis leading to premature detachment of the placenta from the implantation site
381
What is the Kleihauer Betke test?
Look for fetal red blood cells in moms blood
382
List 3 things that can increase the risk of placenta accreta?
Prior C-section, inflammation, placenta previa
383
What should you start to think if a patient fails to deliver the placenta within 30 minutes of birth?
Placenta accreta
384
What is the pelvic diameter that must be adequate to ensure a safe delivery?
Obstetric conjugate
This is the shortest diameter through which the detal head must pass
385
List 2 things that can increase the risk for placenta previa?
Multiparity and prior C section
386
How does placenta previa present?
Painless bleeding in any trimester
| Note that there will be no signs of fetal distress
387
What is the concern with retained placental tissue after delivery?
May cause postpartum hemorrhage. Increased risk of infection
388
What is seen with ectopic pregnancy?
Pain with or without bleeding - often mimics appendicitis.
| Endometrial biopsy shows decidualized endometrium but no chorionic villi (develop only in intra-uterine pregnancy)
389
What are the risk factors for ectopic pregnancy? (4)
History of infertility
Salpingitis (PID)
Ruptured appendix
Prior tubal surgery
390
What is considered Polyhydraminos? Oligohydraminos?
Polyhydraminos: >1.5-2L
Oligohydraminos: <0.5 L
391
List 4 conditions that are associated with increased fetal urination and therefore polyhydraminos?
High cardiac output due to anemia or twin-twin transfusion syndrome
esophageal/duodenal atresia
anencephaly
392
List 3 conditions that are associated with oligohydraminos
placental insufficiency
bilateral renal agenesis
posterior urethral valves (in males)
393
Where does cervical dysplasia being?
Begins at basal layer of squamo-columnar junction and extends outward
394
What are the 4 risk factors for cervical dysplasia and carcinoma in situ?
due to HPV infection
1. multiple sexual partners is #1
2. smoking
3. early sexual intercourse
4. HIV infection
395
What is invasive carcinoma manifest as?
often as squamous cell carcinoma
396
How does endometriosis clinically manifest?
Severe menstrual related pain, painful intercourse and infertility, menorrhagia, dysmenorrhea, dyspareunia, infertility.
Note that the uterus is NORMAL sized
397
How does Adenomyosis present?
Menorrhagia, dysmenorrhea, pelvic pain
| Note that the uterus is ENLARGED
398
What is the treatment for endometriosis?
Oral contraceptives, NSAIDs, leuprolide (like a chemical menopause), danazol
399
What can endometrial hyperplasia progress into?
Endometrial carcinoma
400
How does endometrial hyperplasia manifest clinically?
postmenopausal vaginal bleeding
401
What are the risk factors for endometrial hyperplasia?
```
XS estrogen....
anovulatory cycles
hormone replacement therapy
polycystic ovarian syndrome
granulosa cell turnover
```
402
What is the most common gynecological malignancy?
Endometrial carcinoma
| typically occurs at 55-65 yo
403
What are the risk factors for endometrial carcinoma?
```
HHONDA
Hyperplasia (endometrial)
HTN
Obesity
Nulliparity
Diabetes
Anovulatory state
```
note that Tamoxifen is also a risk factor!
404
What are the two myometrial tumors?
Leiomyoma (fibroid)
| Leiomyosarcoma
405
What is the most common of all tumors in females?
Leiomyoma (20-40 yo)
406
Are Leiomyomas sensitive to estrogen?
Yes - they increased in size with pregnancy and decreased in size with menopause
407
Ultrasound shows concentric, solid, hypoechoic mass with acoustic shadowing consistent with hypertrophy of myometrial tissue
Leiomyoma
408
What is a Leiomyosarcoma?
Bulky, irregular shaped tumor with areas of necrosis and hemorrhage
Highly aggressive tumor with tendency to recur
- desmin +, contains spindle cells with mitotic figures
409
What is the incidence of Gynecological tumors in the US? worldwide?
US: endometrial> ovarian> cervical
worldwide: cervical is most common
410
What is the worst prognosis of gynecological tumors?
Ovarian >cervical>endometrial
411
What is premature ovarian failure and what are the commonly found lab findings?
Premature atresia of ovarian follicles in women of reproductive age. Patients present with signs of menopause after puberty but before age 40.
Labs: decreased estrogen, increased LH and FSH
412
Describe Polycystic ovarian syndrome?
Increased LH production leads to anovulation and therefore no progesterone, hyperandrogenism due to deranged steroid synthesis by theca cells
413
A patient presents with amenorrhea, infertility, obesity and hirsutism - what is the most likely cause?
Polycystic ovarian syndrome
414
what are patients with PCOS at increased risk for?
Endometrial cancer, secondary to increased in estrogens from the aromatization of testosterone in fat cells without progesterone to oppose
415
List 5 possible treatments for PCOS?
1. weight reduction
2. low dose OCPs or medroxyprogesterone (decreases LH and androgenesis)
3. comiphene (for women who want to get pregnant)
4. metformin (for patients with features of diabetes or metabolic syndrome)
5. spironolactone (treats acne and hirsutism)
416
PCOS patients can be insulin resistant - what is the problem with this?
Increaesd insulin levels and insulin stimulates androgen production in theca cells (theca cells make androstenedione) which is turned into estrogen by granulosa cells
estrogen will then feedback to further decrease FSH levels
417
What are the lab values in PCOS?
Increased LH, decreased FSH, increased testosterone, increased estrogen (from testosterone aromatization)
418
What is the most common ovarian mass in young women and what may it be associated with?
Follicular cyst.
| May be associated with hyperestrinism and endometrial hyperplasia
419
What is a corpus luteum cyst?
Hemorrhage into persistent corpus luteum. Commonly regresses spontaneously
420
What is a theca-lutein ovaria cyst?
Often bilateral/multiple. Due to gonadotropin stimulation (from increased hCG). associated with crhoiocarcinoma and moles
Caused by luteinization and hypertrophy of theca interna layer of ovary
421
What is a hemorrhagic ovarian cyst?
Blood vessel rupture in cyst wall. Cyst grows with increased blood retention. usually self-ersolves
422
What is a dermoid ovarian cyst?
Mature teratoma. Cystic growths filled with various types of tissue such as fat, hair, teeth, bits of bone and cartilage
423
What is an endometrioid ovarian cyst?
Endometriosis within ovary with cyst formation. Varies with menstrual cycle. When filled with dark, reddish brown blood it's called a chocolate cyst
424
Describe the difference between hirsutism and virilization?
Hirsutism: male pattern hair growth, acne, muscle mass, seen in PCOS!
Virilization: male pattern balding, deepening of the voice, clitoromegaly, seen with exogenous testosterone or androgens or androgen tumors!
425
What is the female equivalent to a seminoma?
Dysgerminoma
426
Ovarian germ cell tumor with sheets of uniform cells associated with Turner syndrome
Dysgerminoma
427
Malignancy of trophoblastic tissue and chorionic villi are not present
Choriocarcinoma
428
Rare but malignant ovarian germ cell tumor that can develop during or after pregnancy in mother or baby but it will contain only maternal DNA
Choriocarcinoma
429
A patient has a choriocarcinoma ovarian germ cell tumor, what so they have increased frequency of?
Theca-lutein cysts
430
Where can choriocarcinoma metastasize to?
Early hematogenous spread to lungs
431
Yellow, friable, solid mass that may or may not have Schiller-Duval bodies (resembles glomeruli)
Yolk sac (endodermal) tumor
432
Who can get yolk sac tumors?
Ovaries, testes, and sacrococcygeal area of young children
433
What is the tumor marker for yolk sac (endodermal) tumors?
AFP
434
What is the most common of ovarian germ cell tumors?
Teratoma
435
Describe the difference between Mature teratoma and Immature teratoma in a ovarian germ cell tumor?
Mature teratoma: dermoid cyst; most common ovarian germ cell tumor, mostly benign
Immature teratoma - aggressively malignant
436
What is a struma ovarii?
Teratoma that contains functional thyroid tissue. Can present as hyperthyroidism
437
What is a serous cystadenoma ovarian non germ cell tumor?
Frequently bilateral, lined with fallopian tube-like epithelium. Benign
438
What is a Serous cystadenocarcinoma ovarian non germ cell tumor?
malignant and frequently bilateral. Psammoma bodies seen on histology
439
What is a mucinous cystadenoma ovarian non germ cell tumor?
Multilocular cyst lined by mucus secreting epithelium. Benign. Intestine-like tissue
440
What is a mucinous cystadenocarcinoma ovarian non germ cell tumor?
Malignant.
| Pseudomyxoma peritonei - intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor
441
What is a Brenner tumor ovarian non germ cell tumor?
Benign and unilateral.
Looks like bladder.
Solid tumor that is pale yellow-tan in color and appears encapsulated
"Coffee bean" nuclei on H+E
442
What is a Fibroma ovarian non germ cell tumor?
Bundles of spindle shaped fibroblasts
Presents with Meigs' syndrome: ovarian fibroma, ascities, hydrothorax
Sometimes patients will have a pulling sensation in the groin
443
What is a Granulosa cell tumor ovarian non germ cell tumor?
Secretes estrogen leading to precocious puberty in kids
Can cause endometrial hyperplasia or carcinoma in adults.
Call-Exner bodies - small follicles filled with eosinophilic secretions
May presents with abnormal uterine bleeding
444
What is a Krukenberg tumor ovarian non germ cell tumor?
GI malignancy that metastasizes to ovaries causing a mucin-secreting signet cell adenocarcinoma
445
Describe 3 vaginal tumors
Squamous cell carcinoma - usually secondary to cervical squamous cell carcinoma, Primary vginal carcinoma is rare
Clear cell adenocarcinoma -affects women who had exposure to DES in utero
Sarcoma botryoides - rhabdomyosarcoma variant; affects girls <4yo; spindle shaped tumor cells that are desmin positive
446
Describe the 3 benign breast tumors
Fibroadenoma: small, mobile firm mass with sharp edges. Most common tumor in W projections. Most common in 60 yo, some may become malignant
447
Where do malignant breast tumors commonly arise from?
Terminal duct lobular unit
448
What is the single most important prognostic factor for malignant breast cancer?
involvement of the axillary lymph node
449
Describe comedocarcinoma subtype of ductal carcinoma in situ
Malignant but noninvasive.
| Ductal, caseous necrosis
450
What is the most common breast cancer, and is the worst and most invasive?
Invasive ductal carcinoma
451
Describe invasive ductal carcinoma
Firm, fibrous "rock hard" mass with sharp margins and small, glandular, duct-like cells. Classic stellate morphology
452
Describe Invasive lobular breast cancer
Orderly row of cells (indian file) often bilateral with multiple lesions in the same location.
Due to inactivation of E-cadherin genes
453
Describe medullary invasive breast cancer
Fleshy, cellular, lymphocytic infiltrate. Good prognosis
454
Describe inflammatory invasive breast cancer
Dermal lymphatic invasion by breast carcinoma
Peau d'orange appearance
Neoplastic cells block lymphatic drainage
455
Describe Paget's disease invasive breast cancer
Eczematous patches on nipple . Paget cells = large cells in epidermis with clear halo.
Suggests underlying DCIS
456
What is the pathologic hallmark of Paget's disease?
Presence of malignant, intraepithelial adenocarcinoma cells (paget cells) within the epidermis of the nipple
457
What is fibrocystic disease of the breast?
Most common cause of "breast lumps" from age 25-menopause. Presents with premenstrual breast pain and multiple lesions, often bilateral. Fluctuating in size of mass. Usually does not indicate increased risk of carcinoma.
458
List the 4 histologic types of fibrocystic disease in the breast
Fibrosis - hyperplasia of breast stroma
cystic - fluid filled, blue dome. Ductal dilation
sclerosing adenosis - Increased acini and intralobular fibrosis. Associated with calcifications. Often confused with breast cancer
Epithelial hyperplasia - Increase in number of epithelial cell layers in terminal duct lobule. Increased risk of carcinoma with atypical cells. Occurs in W >30yo
459
What is gynecomastia?
Occurs in males, results from hyperestrogenism (cirrhosis, testicular tumor, puberty, old age), Klinefelters syndrome, or drugs
460
List Drugs that can cause gynecomastia?
Some Drugs Cause Awesome Knockers
```
Spironolactone
Digitalis
Cimetidine
Alcohol
Ketoconazole
```
Others - estrogen, marijuana, heroin, psychoactive drugs
461
How should you treat prostatitis?
Fluoroquinoline like a UTI
| or levofloxacin, TMP-SMX, Ciprofloxacin, doxycycline
462
What is BPH?
Hyperplasia of the prostate gland characterized by a nodular enlargement of the periurethral (lateral and middle) lobes which compress the urethra into a vertical slit
463
What can BPH cause?
distension and hypertrophy of the bladder
hydronephrosis
UTIs
increased free PSA
464
List the 3 treatments you can use for BPH
Terazosin - alpha 1 antagonist
Tamsulosin - alpha 1A,D antagonist - no antihypertensive effects (note that alpha IB is found on blood vessels)
Finasteride - 5 alpha reductase inhibitor which slowly reduces DHT levels which will decreased the prostate volume
465
How is prostatic adenocarcinoma diagnosed?
Increased PSA and subsequent needle core biopsies.
Prostatic acid phosphatase (PAP) and PSA are useful tumor markers (Increased total PSA with decreased fraction of free PSA)
466
What can be seen in prostatic adenocarcinoma?
Osteoblastic metastases in bone may develop in late stages as indicated by lower back pain and an increased in serum alkaline phosphatase and PSA
467
How can you treat prostatic adenocarcinoma?
Flutamide - blocks testosterone at receptor level
| resection
468
Can you have normal testosterone levels with cryptorchidism?
Yes, leydig cells are not affected by increased temperature. But T levels may be decreased in bilateral cryptorchidism but normal in unilateral
Will have decreased sperm because sertoli cells are effected by temperature
Also at risk of germ cell tumors
469
What is the treatment for cryptorchidism?
Prepubertal - orchiplexy (bring down and sew it into the scrotum)
Post-pubertal - may be orchiectomy (removal)
470
What is varicocele?
Dilated veins in pampiniform plexus as a result of increased venous pressure
(usually on the Left side)
bag of worms appearance, DX with US
471
How do you treat varicocele?
Varicocelectomy, embolization by interventional radiologist
472
Are testicular germ cell tumors usually benign or malignant?
Malignant most often
473
Name the testicular germ cell tumor: Malignant, painless, homogenous testicular enlargement; most common testicular tumor mostly affecting males 15-35 yo
Seminoma
474
Name the testicular germ cell tumor: Large cells in lobules with watery cytoplasm and a "fried egg" appearance. Increased placental alkaline phosphatase (PLA). Is radiosensitive, late metastasis and has an excellent prognosis
Seminoma
475
Name the testicular germ cell tumor: Yellow, mucinous. Schiller-Duval bodies resemble primitive glomeruli. Will have increased AFP and can have a honeycomb appearance
Yolk sac (endodermal) tumor
476
Name the testicular germ cell tumor: Malignant, Increased hCG. Disordered synciotrophoblastic and cytotrophoblastic elements. Hematogenous metastasis to lung.
Choriocarcinoma
477
Name the testicular germ cell tumor: May produce gynecomastia as hCG is an LH analog. Or impotence, decreased libido or precocious puberty
Choriocarcinoma
478
Name the testicular germ cell tumor: Malignant, painful, worse prognosis than seminoma
Embryonal carcinoma
479
Name the testicular germ cell tumor: Often glandular/papillary morphology. most commonly mixed with other tumor types. May be associated with increased hCG and normal AFP levels when pure and increased AFP when mixed
Embryonal carcinoma
480
Describe a teratoma in males
Unlike in females, mature teratoma in adult males if more often malignant. Benign in children.
Can have increased hCG and/or AFP in 50% of cases
481
List the testicular non-germ cell tumors
Leydig cell tumor
Sertoli cell tumor
Testicular lymphoma
482
Name the testicular non-germ cell tumor: Contains Reinke crystals
Leydig cell tumor
483
Name the testicular non-germ cell tumor: usually androgen producing, gynecomastia in men, precocious puberty in boys. Golden brown color
Leydig cell tumor
484
Name the testicular non-germ cell tumor: Androblastoma from sex cord stroma.
Sertoli cell tumor
485
Name the testicular non-germ cell tumor: Most common testicular cancer in older men
Testicular lymphoma
486
Name the testicular non-germ cell tumor: Not a primary cancer, arises from lymphoma metastases to testes. Aggressive. will present with fever, night sweats and weight loss
Testicular lymphoma
487
What is a spermatocele?
Tunica vaginalis lesion due to a dilated epididymal duct
488
Describe squamous cell carcinoma of the penis
More common in Asia, Africa, and south America
| Commonly associated with HPV and lack of circumcision
489
Describe Peyroni's disease
Bent penis due to acquired fibrous tissue formation will have pain with erection
inflammation and fibrous tissue of tunica albuginea
490
Describe priapism
Painful sustained erection not associated with sexual stimulation or desire.
Associated with trauma, sickle cell disease, medications (anticoagulants, PDE5 inhibitors, antidepressants, alpha blockers and cocaine)
can lead to ischemia and clotting of blood in the penis
491
What can cause and how do you treat Epididymis?
35 yo: e.coli, pseudomonas, proteus, Klebsiella, TX with fluoroquinolone
492
What is the MOA of leuprolide?
GnRH analog with agonist properties when used in pulsatile fashion; antagonist properties when used in continuous fashion (downregulates GnRH receptor in pituitary leading to decreased FSH/LH)
493
What is the clinical use of leuprolide?
```
Infertility (pulsatile),
prostate cancer (continuous - use with flutamide),
uterine fibroids (continuous),
precocious puberty (continuous)
```
494
What is the toxicity seen with leuprolide?
Antiandrogen, nausea, vomiting
495
What is the MOA of testosterone and methyltestosterone?
Agonist at androgen receptors
496
What is the clinical use of testosterone and methyltestosterone?
Treats hypogonadism and promotes development of secondary sex characteristics;
stimulation of anabolism to promote recovery after burn or injury
497
What is the toxicity seen with testosterone and methyltestosterone?
Causes masculinization in females
reduces intratesticular testosterone in males by inhibiting release of LH (via NF) leading to gonadal atrophy
premature closure of epiphyseal plates
Increased LDL and decreased HDL
498
List 4 anti androgens
Finasteride, Flutamide, Ketoconazole, Spironolactone
499
What is the MOA of Finasteride?
A 5 alpha reductase inhibitor that decrases conversion of T to DHT.
Useful in BPH.
Also promotes hair growth used to treat male pattern baldness
"to prevent male-pattern hair loss, give a drug that will encourage female breast growth"
500
What is the MOA of flutamide?
Nonsteroidal competitive inhibitor of androgens at the testosterone receptor.
Used in prostate carcinoma
501
What is the MOA of ketoconazole?
Inhibits steroid synthesis (inhibits 17,20 desmolase)
used to treat PCOS
side effects include gynecomastia and amennorhea
502
What is the MOA of Spironolactone?
Inhibits steroid binding
used to treat PCOS
side effects include gynecomastia and amennorhea
503
Name 3 estrogen drugs
Ethinyl estradiol, DES, mestranol
504
What is the MOA of estrogens?
Bind estrogen receptors
505
What is the clinical use of estrogen drugs?
Hypogonadism or ovarian failure,
menstrual abnormalities,
HRT in postmenopausal women;
use in men with androgen-dependent prostate cancer
506
What is the toxicity seen with estrogen use?
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 are ER positive breast cancer and a history of DVTs
507
How are estrogens protective against osteoporosis?
Decreased osteoclast activity
508
Name 3 Selective estrogen receptor modulators
Clomiphene, Tamoxifen, Raloxifene
509
What is the MOA of clomiphene?
Partial agonist at estrogen receptors in hypothalamus. Prevents normal feedback inhibition and increases release of LH and FSH from anterior pituitary which stimulates ovulation
510
What is the clinical use of clomiphene?
Used to treat infertility and PCOS
511
What are the side effects that can be seen with clomiphene use?
Hot flashes, ovarian enlargement, multiple simultaneous pregnancies, visual disturbances
512
What is the MOA of Tamoxifen?
Antagonist on breast tissue; used to treat and prevent recurrence of ER positive breast cancer
513
What is the problem with Tamoxifen?
Has an agonist effect in the endometrium which can increase the risk of endometrial cancer
514
What is the MOA of Raloxifene?
Agonist on bone; reduces resoprtion of bone; used to treat osteoporosis
Antagonist in breast and has no effect in the endometrium
515
What is Anastrozole, exemestane, and letrozole?
Aromatase inhibitors used in postmenopausal women with breast cancer.
Inhibits estrogen production but can increase risk of osteoporosis and fractures
516
What is the MOA of progestins?
Bind progesterone receptors, reduce growth and increased vascularization of endometrium
Ovulation suppression, stabilization of endometrium
517
What is the clinical use of progestins?
Used in oral contraceptives and in the treatment of endometrial cancer and abnormal uterine bleeding
518
What is the MOA of Mifepristone (RU-486)?
Competitive inhibitor of progestins at progesterone receptors
519
what is the clinical use of Mifepristone (RU-486)?
Termination of pregnancy, administered with misoprostol (PGE1)
520
What is the toxicity seen with Mifepristone (RU-486)?
Heavy bleeding, GI effects (nausea, vomiting, anorexia), abdominal pain
521
How do oral contraceptives work?
Estrogen and progestins inhibit LH/FSH and thus prevent estrogen surge. No estrogen surge leads to no LH surge which leads to 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
522
Why do you have decreased acne with oral contraceptive use?
Decreased acne due to increased SHBG made in the liver which binds up the free testosterone
523
What are the contraindications for oral contraceptive use?
smokers >35 yo due to increased risk of cardiovascular events
Patients with history of thromboembolism and stroke or history of estrogen dependent tumor
524
What is terbutaline?
Beta 2 agonist that relaxes the uterus; reduces premature uterine contraction
525
What is tamsulosin
Alpha 1 antagonist used to treat BPH by inhibiting smooth muscle contraction.
Selective for alpha1A,D receptors found on the prostate instead of alpha 1B receptors on the vvasculature
526
What is the MOA of sildenafil and vardenafil?
Inhibit phosphodiesterase 5 causing increased cGMP
| which leads to smooth muscle relaxation in the corpus cavernosum, increased blood flow and penile erection
527
What is the clinical use of sildenafil and vardenafil?
erectile dysfunction
528
What is the toxicity associated with sildenafil and vardenafil?
Headache, flushing, dyspepsia, impaired blue-green color vision.
Risk of life-threatening hypotension in patients taking nitrates
blue tint to vision field is due to sildenafil also inhibiting PDE6 which normally transforms light into electrical signals
529
What is the MOA of Danazol?
Synthetic androgen that acts as partial agonist at androgen receptors. (counteracts estrogen)
530
What is the clinical use of danazol?
endometriosis and hereditary angioedema
531
What is the toxicity of danazol?
weight gain, edema, acne, hirsutism, masculinization, decreased HDL levels and hepatotoxicity
532
What do tocolytics do?
stop contractions
| Indomethacin, nifedipine, terbutaline, ridadrine
533
Name some drugs that can be used to induce labor
Dinoprostone (PGE2 analog)
Misprostol (PGE1 analog)
Oxytocin
534
A 28-year-old-male presents with acute onset of pain in his scrotum while playing baseball. Physical examination reveals an absent rise of his scrotum in response to light stroking of his proximal inner thigh. The most likely affected structure is the?
Spermatic cord.
This is a testicular torsion
