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1

Pathogenesis of Klinefelters

Seminiferous tubule destruction and hyalinization -> small, firm testes; Leydig cell damage

2

Klinefelters hormone levels

Serum inhibin low (S tubule dygenesis), low testosterone (Leydig dysfunction), high LH and FSH

3

Cryptorchidism hormone levels

Seminiferous tubules dmg'd but NOT leydig cells; Low inhibin levels and high FSH lvls; but LH and testosterone levels normal

4

Klinefelters clinical characteristics

Testicular atrophy, long extremities, gynecomastia, female hair distribution, presence of Barr bodies, mild ID

5

Cells of seminiferous tubules and functions

Spermatogonia (germ cells) - produce primary spermatocytes. Sertoli cells (non-germ) - secrete inhibin (-| FSH), androgen-binding protein (maintain local testosterone lvl), blood-testis barrier (via tight junctions), support spermatozoa, produce MIF. Leydig cells (endocrine) - secrete testosterone in presence of LH.

6

Temperature affects production of what in semineferous tubules?

Sertoli cells affected - decreased sperm production and decreased inhibin. Leydig cells NOT affected (testosterone levels okay)

7

Three main categories of drugs for BPH?

Alpha-adrenergic antagonists (terazosin, tamsulosin), 5-alpha-reductase inhibitors (finasteride, dutasteride), antimuscarinics (tolterodine)

8

Four possibilities when the urachus doesn't obliterate

Patent urachus (urine from umbilicus), vesicourachal diverticulum (out pouching of bladder), urachal sinus (adj to umbilicus), urachal cyst (often asymptomatic but can be infectious, adenoca)

9

Sertoli v. Leydig. What makes MIF?

Sertoli

10

Fetal anomalies associated with polyhydramnios?

Anencephaly, GI atresia

11

Turner's syndrome presentation

In neonate, lymphedema, cystic hygromas. Primary amenorrhea (streak ovaries), short statue, Coarctation of the aorta. Webbed neck, low hairline. Low estrogen, high LH and FSH.

12

Hydrocele

Serous fluid in tunica vaginalis. See fluid in sac. Communicating if processus vaginalis (diverticulum from peritoneum) remains patent.

13

Complete mole vs. partial mole?

Complete - bleeding, enlarged uterus, PEC, Theca-lutein cysts, trophoblast only, no fetal tissue, 46 XX or XY (both paternal), with 15-20% risk of malignancy. Partial mole - bleeding, pain, fetus, cord, some enlarged villi, 69 XXX or XXY, with low risk malignancy.

14

Kallmann syndrome

Delayed pubery + anosmia. Etio - failure of GnRH-seceting neuron migration from olfactory placode to hypothalamus. Central hypogonadism and anosmia.

15

Male gonadotropin regulation

Hypothalamus secretes GnRH pulsatile which POS pituitary. Pituitary releases FSH and LH (ant. pituitary). LH stimulates release of testosterone from Leydig, which negatively feedbacks to LH.. FSH stimulates release of inhibin B from sertoli, which negatively feedback for FSH. Lute for Leydig for L'testosterone. FSH to Sertoli to inhibin B.

16

Metabolic effects of human placental lactogen?

Increases insulin resistance, stimulates proteolysis and lipolysis, inhibits gluconeogenesis.

17

What control breast development during pregnancy?

1st TM - corpus produces progesterone and estradiol. By 2nd TM, placenta produces progesterone and estradiol, while fetal adrenal helps w/ estradiol. Prolactin increases (ant. pituitary) but is prevented from lactogenesis b/c of high estrogen and progesterone levels. Once placenta separates, prolactin stimulates milk production.

18

Urge incontinence

Uninhibited bladder contractions (detrusor instability). M3 antagonists (e.g. oxybutynin) -> smooth muscle relaxation. (M3 is a Gq pathway, so drug dec. IP3 production).

19

Sheehan's syndrome

If significant hypotension occurs while pituitary is still enlarged (2/2 to high estrogen lvls, e.g. PPH) --> ischemic necrosis of pituitary --> panhypopituitarism -> prolactin deficiency for example

20

What day of separation leads to fetal membrane organization for monozygotic twins?

4,8,12. 4 Twins. FOUR is magic number. 0-4: di/di. 4-8:monochorionic/diamniotic; 8-12: mono/mono; >13: mono/mono conjoined

21

Histology changes in menstrual cycle

First half (proliferative phase). Estrogen stimulates proliferation of stratum FUNCTIONALE. Non-branching, non-budding EVENLY distributed. Tubular, narrow, pseudo stratified glands. Second half (secretory phase, begins with ovulation). Glands become LARGER and COILED w/ large vacuoles. Edematous stroma with SPIRAL arteries.

22

Deformation vs. malformation vs disruption?

Deformation occurs due to extrinsic mechanical forces (e.g. Potter sequence). Disruption refers to secondary breakdown of previously normal tissue (amniotic band syndrome). Malformation is primary defect of cells (intrinsic developmental abnormality) (e.g. holoprosencephaly).

23

Koilocyte

Sign of infection with HPV. Immature squamous cell w/ dense, irregularly staining cytoplasm with PERINucLEAR clearing = halo. PYKNOTIC (apoptotic).

24

Parabasal cells

Round cells w/ HIGH N/C, basophilic cytoplasm. Dominate Pap smears of post-menopausal and postpartum women.

25

ABO disease

Must be IgG ab's (b/c only they cross placenta). Usually mothers make IgM uncless she is an O mom. Even so only 3% of O mom - X baby pregnancies have hemolytic disease of the newborn.

26

Achondroplasia

Constitutive activation (gain-of-function) of FGFR3. Sporadic mutation (adv. paternal age) in 85%, AD 15%. Homozygosity = death.

27

Urethral trauma

Posterior urethral injury is associated with pelvic trauma while anterior urethral injury is associated with straddle injuries. Inability to void w/ full bladder, high-riding boggy prostate, blood at urethral meatus. NO FOLEY.

28

What contains the ovarian nerves, arteries, veins, and lymphatics?

Suspensory ligament of the ovary

29

Treatment for hirsutism?

Spironolactone (blocks androgen receptors at hair follicles). Also flutamide (testosterone receptor antag) and finasteride (5-alpha-reductase inhibitor)

30

Vaginal adenosis?

Replacement of vaginal squamous epithelium with glandular columnar epithelium. Female children of women exposed to DES. Precursor to clear cell adenocarcinoma.

31

Ambiguous external genitalia in female infant and maternal virilization?

Aromatase deficiency. AR. High androgen and low estrogen. Aromatase converts Androstenedione to estrone and testosterone to estradiol.

32

Tamoxifen

SERM that used for tx of osteoporosis and breast cancer. But associated with increased incidence of endometrial cancer and thromboembolic disease

33

Raloxifene

Also a SERM. Agonist on bone, CV, and blood lipoproteins. Antagonist to BREAST and UTERUS. Decreases incidence of breast cancer and osteoporosis

34

Complete androgen insensitivity

Lack of androgen receptors in the body. 46,XY. Testosterone -> estradiol -> external female genitalia. Blind pouch vagina. Testes in the abdomen. Serum testosterone high, LH high, FSH normal.

35

Role of androgen binding protein (ABP)?

To ensure high lvls of testosterone in the seminiferous tubules to allow spermatogenesis to occur.

36

PCOS hormones

LH thought to be high. Causing theca-cells to make lots of androgens and estrogens, suppressing FSH.

37

Absolute contraindications to OCPs?

Prior hx of DVT/PE. Hx of estrogen-dependent rumor. Women > 35 who smoke heavily. HyperTG. Decompensated or active lier disease. Pregnancy.

38

Appendages in wrong locations?

Homeobox gnes

39

Gene involved in limb lengthening?

FGF gene. Produced at apical ectodermal ridge -> mitosis of underlying mesoderm

40

Gene mutation that can cause holoprosencephaly?

Sonic hedgehog gene

41

Dorsal-ventral axis vs. anterior-posterior axis organization genes?

Shh (BASE) for ant-post. Wnt-6 (apical ectodermal ridge) for dorsal-ventral.

42

Bilaminar vs. trilaminar timeline?

2 weeks vs. 3 weeks

43

Morula timeline?

Day 3

44

Implantation occurs when?

About 1 week after fertilization

45

When do the genitalia differentiate?

Week 10

46

When is fetal cardiac activity seen on US?

Week 6 (heart actually begins to beat at wk 4)

47

When do the limb buds form?

Week 4

48

Mesodermal defect acronym?

VACTERL - Vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal defects, limb defects (bone and muscle)

49

Thyroid embryo derivative?

Endoderm (follicular) and neural crest (parafollicular C cells)

50

Craniopharyngioma

Benign Rathke pouch (surface ectoderm) tumor with cholesterol crystals and calcifications

51

Deformation vs. malformation?

Deformation is extrinsic occurring after "embryonic period," whereas malformation is intrinsic (w 3-8)

52

Alkylating agent teratogenicity

Absence of digits, multiple anomalies

53

ACEi teratogenicity

Renal damage

54

Aminoglycosides teratogenicity

CN VIII tox

55

Carbamazepine teratogenicity

Neural tube, craniofacial, fingernail hypoplasia, dvpt delay, IUGR

56

DES teratogenicity

Vaginal clear cell adnocarcinoma, congenital Mulerian

57

Folate antagonists teratogenicity

Neural tube

58

Lithium teratogenicity

Ebstein anomaly (atrialized RV)

59

Methimazole teratogenicity

Aplasia cutis congenita (congenital absence of skin)

60

Phenytoin teratogenicity

Fetal hydantoin syndrome = microcephaly, dysmorphic craniofacial, hypoplastic neails, cardiac, IUGR, intellectual

61

Thalidomide teratogenicity

Limb defects - phocomelia

62

Valproate teratogenicity

Neural tube defects

63

Warfarin teratogenicity

Bone deformities, fetal emorrhage, abortion, optho

64

Cocaine teratogenicity

Abnormal fetal growth, fetal addiction, placental abruption

65

Smoking teratogenicity

LOW birth rate. Preterm labor. Placental problems.

66

Iodine teratogenicity

Congenital goiter or hypothyroidism

67

Maternal diabetes teratogenicity

Caudal regression syndrome: anal atresia to sirenomelia; congenital heart, neural tube

68

Vitamin A excess teratogenicity

Spontaneous abortions and birth defects (cleft palate, cardiac)

69

X-ray teratogenicity

Microcephaly, ID

70

Fetal alcohol syndrome

ID, developmental retardation, microcephaly, holoprosencephaly, facial abnormalities (smooth philtrum, thin upper lib, small palpebral fissures, hyper telorism), limb dislocation, heart defects

71

Cleavage at 0-4 days of monozygotic cell leads to

Fused OR separate placenta. But dichorionic diamniotic

72

Cleavage at 4-8 days of monozygotic cell

Monochorionic, diamniotic (most common)

73

Cleavage at 8-12 days of monozygotic cell

Monochorionic, monoamniotic

74

Cleavage >13 days of monozygotic cel

Likely mono-mono but CONJOINED twins

75

Cytotrophobloast vs. Syncytiotrophobloast

cyto = inner layer of chorionic villi. Syncytio = outer layer that secretes hCG

76

When does the vitelline duct obliterate?

Week 7

77

Aortic arch 1

Part of maxillary artery

78

Aortic arch 2

Stapedial artery

79

Aortic arch 3

Common carotid arteries and beginning of internal carotics

80

Aortic arch 4

Part of AA, part of right subclavian artery

81

Aortic arch 6

Proximal part of pulmonary arteries and the ductus arterosus

82

What do the branchial clefts do?

Branchial cleft 1 becomes external auditory meatus. Rest involute via temporary cervical sinus. If persist- > cyst in lateral neck

83

Branchial arch 1 nerve and abnormality

Nerve is V3. Treacher Collins syndrome -> mandibular hypoplasia and facial abnormalities

84

Branchial arch 2 nerve and abnormality

Nerve is VII. Abnormality is congenital pharyngocutaneous fistula = fistula between tonsillar area and lateral neck

85

Branchial arch 3 nerve

Nerve is IX.

86

Branchial arch 4-6 nerve

Nerve is X + recurrent X

87

Muscles of branchial arch 1

Muscles of mastication (temporalis, masseter, lateral and medial pterygoid, mylohyoid), ant. belly of digastric, tensor tympani, tensor veli palatini

88

Muscles of branchial arch 2

Facial expression, Stapedius, Stylohyoid, platysma, and post. belly of digastric

89

Muscles of branchial arch 3

Stylopharyngeus

90

Muscles of branchial arches 4,6

Pharyngeal, laryngeal

91

Cartilages of branchial arch 1

Meckel cartilage: Mandible, Malleus, incus, spheno-mandibular ligament

92

Cartilages of branchial arch 2

Stapes, sytloid process, lesser horn of hyoid, stylohyoid

93

Cartilage of branchial arch 3

Greater horn of the hyoid

94

Cartilages of 4,6th branchial arch

Thyroid, cricoid, arytenoids, croniculate, cuneiform

95

Branchial pouch 1

Middle ear, eustachian tube, mastoid air cells. ENDODERM

96

Branchial pouch 2

Epithelial lining of palatine tonsil

97

Branchial pouch 3

Dorsal - inferior parathyroid. Ventral - thymus.

98

Branchial pouch 4

Dorsal - superior parathyroids. Ventral - C-cells of thyroid gland.

99

Two mechanisms for cleft palate

Failure to fuse 2 lateral palatine processes. Fusion of one or more lateral palatine processes with the nasal septum and/or median palatine process

100

Cleft lip mech

Failure of fusion of maxillary and medial NASAL processes

101

Other names of Mullerian and Wolffian ducts?

Mullerian = parameonephric. Wolffian = mesonephric (renal)

102

Components of the Wolffian duct

SEED (Seminal vesicles, epididymis, ejaculatory duct, ductus deferens). NOT prostate.

103

What internal and external genitalia result in a XY has no MIF working?

Both male AND female internal genitalia. But male external genitalia (DHT going strong)

104

What internal and external genitalia results in a XY with 5alpha reductase deficiency?

Male internal genitalia but ambiguous external genitalia until puberty

105

Homolog of scrotum?

Labia majora

106

Homolog of Prostate gland?

Urethral and paraurethral glands of Skene

107

Homolog of Bartholin gland?

Bublourethral glands of Cowper

108

Homolog of Corpus cavernous and spongiosum?

Vestibular bulbs

109

Homolog of the labia minor?

Ventral shaft of penis

110

Hypospadia vs. epispadia

Ventral vs. dorsal. Failure to close fold vs. faulty positioning of genital tubercle.

111

Processus vaginalis

It is an evagination of the peritoneum that forms the tunica vaginalis in men and obliterates in women.

112

Gubernaculum?

The anchor that brings down the testes during its descent OR what becomes the ovarian ligament and round ligament of the uterus

113

What's weird about the venous drainage of the gonads?

The left side always goes from L gonadal vein into the L renal vein to IVC, whereas the R gonadal vein goes directly into the IVC.

114

Where are the uterine vessels located?

In the cardinal ligament. (Cervix to side wall of pelvis). Be careful of the ureters

115

Where are the ovarian vessels located?

Suspensory ligament of the ovaries. Be careful of the ureters.

116

Broad ligament contains what?

Ovaries, fallopian tubes, round ligament of the uterus

117

Round ligament connects what?

Uterine fundus to the labia major. (Round ligament pain)

118

Ovarian ligament connects what?

Medial pole of the ovary to the lateral uterus. Not in the broad ligament.

119

Histology of the female reproductive tract.

Stratified epithelium from vagina to transformation jone. Now simple columnar epithelium up into fallopian tubes. Ovaries have simple cuboidal epithelium on the outer surface.

120

Pathway of sperm?

Seminiferous tubules, Epididymis, Vas deferens, Ejaculatory ducts, (Nothing), Urethra, Penis. SEVEN UP.

121

Physiology of erection

PNS (pelvic). NO leads to increased cGMP -> SMC RELAX = blood filling. With sympathetic tone, NE -> increased Ca2+ which leads to SMC contraction and vasoconstriction = flaccid.

122

What nerves responsible for "shoot?"

SNS' hypogastric n. for emission. Pudendal nerve for ejaculation.

123

Theca cell role?

Desmolase converts cholesterol into androstenedione.

124

Granulosa cell role

Aromatase converts androstendeione from theca cells into estrogen.

125

Potency of estrogen-family hormones?

Estradiol (ovary) > estrone (peripheral) > estriol (placenta), which btw, is an indicator for fetal well being

126

What makes progesterone?

Corpus luteum, placenta, adrenal gland, testes

127

Function of progesterone

Endometrial glandular secretion, spinal artery development, maintain pregnancy, dec. myometrial excitability, thick cervical mucus to inhibit sperm entry, inhibits LH, FSH, uterine smooth muscle relaxation, dec. estrogen receptor expressivity, prevents endometrial hyperplasia

128

Tanner II vs. III vs IV

II is pubarche and telarche. III is darkening, curling, enlargement. But IV has darker scrotal skin, development of the glans, and raised areolae

129

Arrested development of oocytes where?

Meiosis is begun in fetal life but stops at Prophase 1 until selected for ovulation. As primary oocyte, finishes meiosis I and becomes secondary oocyte. It is arrested in METAphase II until fertilization. Must fertilize within ONE day.

130

Mittelschmerz

Transient mid-cycle ovulatory pain classicularlly associated with peritoneal irritation.

131

Exclusively breast fed infants require what vitamin supplementation?

Vitamin D

132

hCG role

Made by syncytiotrophoblast and acts like LH in 1st TM, which is required for the luteal cell to continue making progesterone (maintaining the pregnancy). In 2nd-3rd TM, corpus luteum degenerates.

133

hCG subunit for pregnancy test?

Beta subunit b/c alpha subunit is identical to LH, FSH, and TSH.

134

How to diagnosis menopause?

FSH increased (very specific)

135

Symptoms of menopause?

HAVOCS - Hot flashes, atrophy of the vagina, osteoporosis, coronary artery disease, sleep disturbances

136

How long does spermatogenesis take?

2 months

137

Spermatogonia vs. spertazooa?

Going to tbe a pserm. Zooa have acrosomal cap and loss of cytoplasm = zooming.

138

Potency of androgens?

DHT > tesosterone > androstenedione

139

Where do androgens get converted into estrogens in men?

Adipose and testis (Cytochrome P-450 aromatase)

140

Function of DHT?

Early on, in differentiation of male external genitalia plus prostate. Late - involved in prostate growth, balding, sebaceous gland activity

141

Function of testosterone

Differentiation of epididymis, vas, seminal vesicles. Growth spurt. Voice deepening. Closure of epiphyseal plates. Libido.

142

XYY Presentation

Pheno normal. Tall, acne, antisocial in 1-2%. Normal fertility.

143

Men: Testosterone down, LH down?

Hypogonadotropic hypogonadism

144

Men: Testosterone down, LH up?

Primary hypogonadism

145

Men: Testosterone up, LH down?

Exogenous testosterone (tumor, drugs)

146

Men: Testosterone up, LH up?

Androgen receptor defect

147

Most common etiology of a male pseudohermaphrodite?

Androgen insensitivity syndrome. Testes present but external genitalia are female/ambiguous.

148

Most common etiology of a female pseudohermaphrodite?

Congenital adrenal hyperpasia or exogenous androgens during pregnancy. Ovaries present but virilized/ambiguous external genitalia.

149

Aromatase deficiency

Can't make estrogens from androgens -> masculization of females (ambiguous genitalia) +/- maternal virilization during pregnancy because fetal androgens cross the placenta. Increased serum testosterone and androstenedione.

150

Androgen insensitivity syndrome

46 XY that is a normal appearing female with female external genitalia with rudimentary vagina. NO uterus or fallopian tubes. Testes (often found in labia majora). Increased testosterone, estrogen, and LH.

151

5alpha-reductase deficiency

AR and only limited in phenotype to males. Inability to convert testosterone -> DHT means ambiguous genitalia until puberty when increased testosterone -> masculinization and growth of external genitalia. NORMAL testosterone/estrogen. LH normal or increased. Internal genitalia are normal.

152

Kallmann syndrome

Hypogonadtropic hypogonadism 2/2 defect of GnRH migration. Decreased GnRH, decreased FSH, LH, testosterone, infertility. Anosmia.

153

Etiology of complete vs. partial mole?

Complete mole is completely paternal (which duplicates its genome) + enucleated egg. Partial mole = 2 sperm + egg.

154

Week cut-off for diagnosing gestational HTN?

Wk 20. HTN before week 20 suggests a molar pregnancy.

155

Treatment for gestational HTN?

alpha-methyldopa, labetalol, hydralazine, nefidipine; delivery at 39 weeks

156

Preeclampsia?

HTN > 20th week + proteinuria (>300 mg/24h). Severe features are Bp > 160/110, end-rgan damage. Caused by ABNL Spiral Arteries -> maternal endothelial dysf(x), vasoconstriction, and hyperreflexia

157

HELLP syndrome?

Hemolysis, elevated liver (enzymes), Low platelet count. Tx = immediate delivery

158

Tx differences between pre-eclampsia and eclampsia?

Both give antihypertensives, IV MgSO4. But immediately deliver in ecclampsia b/c of risk of maternal death 2/2 stroke w/ intracranial hemorrhage or ARDS

159

Increased incidence of PEC found with what conditions?

Pre-exisitng HTN, DM, chronic renal disease, or autoimmune disorders

160

Abnormal placental detachment types?

Placenta accreta attaches to myometrium w/o penetrating. Placenta increta penetrates into myometrium. Placenta percreta penetrates into uterine seroa ---> rectal or bladder attachment.

161

Presentation of placental abruption?

Abrupt, painful bleeding (concealed or apparent) in 3rd TM. Maternal DIC, shock, fetal distress.

162

Placenta previa

Attachment of placenta near the cervical os -> inc. risk of bleeding. RF's = multiparty, prior C-section

163

Presentation of ectopic pregnancy?

Sudden lower abdominal pain w/ or w/o vaginal bleeding. Amenorrhea. Lower-than-expected bCG rise. r/o appi. US diagnosis.

164

Pathophysiology of HPV virus -> cervical carcinoma?

HPV 16 and 18 produce two proteins: E6 and E7. E6 inhibits p53 while E7 inhibits RB. The virus, therefore, inhibits tumor suppressor genes

165

Endometritis inflammatory picture? What cells?

Plasma cells and lymphocytes.

166

Treatment of endometriosis?

NSAIDs, OCPs, progestins, GnRH agonists, surgery.

167

Adenomyosis

Extension of endometrial tissue into the myometrium. Presents with dysmenorrhea, menorrhagia. ENLARGED, soft uterus. Tx = hysterectomy.

168

RF's for endometrial hyperplasia?

Anovulatory cycles, HRT, PCOS, granulosa cell tumor.

169

Peak occurrence of leiomyomas?

Age 20-40

170

Most common causes of an ovulation?

Pregnancy, PCOS, obesity, HPO axis, premature ovarian failure, hyperprolactinemia, thyroid, eating

171

PCOS labs?

High androgens, High LH, low FSH. High androgens decrease SHBG -> increased FREE testosterone (active portion).

172

Mechanism for OCP treatment for PCOS?

Estrogens increase SHBG -> decreased free testosterone

173

Complications of PCOS?

Increased risk of endometrial cancer b/c of increased estrogens and absence of progesterone. (Therefore, tx with progesterones)

174

Most common ovarian mass in young women?

Follicular cyst

175

Cyst associated with choriocarcinoma and moles?

Theca-lutein cyst

176

"Chocolate cyst"

Endometriosis. Blood gives it the color.

177

Dermoid cyst

Mature teratoma with all sorts of tissue.

178

Corpus luteum cyst

2/2 hemorrhage into a persistent corpus luteum. Self-resolves.

179

Follicular cyst

Distention of unruptured graafian follicle. Often associated with hyperestrogenism and endometrial hyperplasia.

180

Most common ovarian neoplasm?

Serous cystadenoma - benign. Thin0walled. Fallopian-like epithelium.

181

Immature vs. mature teratoma?

Immature teratoma is malignant. More likely to contain thyroid tissue +/- embryonic-like neural tissue.

182

Psammomma bodied malignant ovarian neoplasm?

Serous cystadenocarcinoma

183

Granulosa cell tumor

Most common sex-cord tumor. Often produce estrogen/progesterone, so pt's present with abnormal uterine bleeding or sexual precocity. Call-Exner bodies.

184

Vaginal clear cell adenocarcinoma?

Women who had DES exposure in utero

185

Small, mobile firm breast mass that increases in size and tenderness right before menstruation?

Fibroadenoma - found in stroma

186

Serous or bloody nipple discharge?

Intraductal papilloma. Typically grows beneath areola (lactiferous sinus) and has a slight 1.5-2x risk of carcinoma.

187

Phyllodes tumor?

LARGE bulky mass of connective tissue (stroma). "Leaf-like" 6th decade

188

Non-invasive breast neoplasms?

DCIS (doesn't penetrate BM; in major duct), Comedocarcinoma (caseous necrosis; type of DCIS), Paget disease of breast (results from underlying DCIS extending up to lactiferous ducts).

189

Invasive ductal vs. invasive lobular breast cancer?

Ductal is worst, most invasive. Firm, "rock-hard" with sharp margins. Stellate infiltration. Invasive lobular is an ORDELRY row ("Indian file")

190

Acute mastitis?

An abscess. Staph aureus is most common. Tx = dicloxacillin + continued breast feeding

191

Drugs that can cause gynecomastia?

Spironolactone, marijuana, digitalis, estrogen, cimetidine, alcohol, heroin, dopamine D2 antagonists, ketoconazole

192

What lobes enlarge in BPH?

Lateral and middle

193

What lobes enlarge in prostatic adenocarcinoma?

Posterior lobe

194

Treatment of BPH?

alpha-1-antagonists (tamsulosin, terazosin). Finasteride (5-alpha reductase inhibitor)

195

Etiology of variocele?

Poor gonadal venous drainage. Usu. left b/c -> L renal vein.

196

Presentation of variocele?

Scrotal enlargement, bag of worms, dx w/ US. Decreases fertility b/c of increased temperature (Sertoli cell sensitive)

197

Non-tranilluminating testicular mass

Cancer

198

Seminoma

Painless homogenous testicular enlargement in 3rd decade. "Fried egg" on histo. Increased placental alkaline phosphate. Good prognosis. Tx = radiation (sensitive)

199

Most common testicular tumor of boys < 3 y/o

Yolk sac (endodermal sinus) tumor. "Schiller-Duval bodies'

200

GnRH analog?

Leuprolide

201

Clinical uses of leuprolide?

Pulsatile dosages used for infertility. Continuous uses used for uterine fibroids, precocious puberty, and prostate ca (with flutamide).

202

Names of estrogen drugs

Ethinyl estradiol, DES, mestranol

203

Clinical use of estrogens

Hypogonadism/ovarian failure, menstrual abnormalities, HRT, men with androgen-dependent prostate cancer

204

Clomiphene

Antagonist of estrogen receptors in hypothalamus preventing normal feedback inhibition -> increased LH and FSH. Used to treat infertility due to anovulation. SE's - hot flashes, ovarian enlargement, multiple simultaneous pregnancies, visual disturbances

205

Tamoxifen vs. raloxifene

Tamoxifen is antagonist on breast, agonist for uterus and bone. Raloxifene is agonist to bone, antagonist for uterus. Both associated with DVTs. Tamoxifen for breast cancer, raloxifene for osteoporosis.

206

Aromatase inhibitors?

Used for breast cancer. Anastrozole/exemestane

207

Mifepristone

Competetive inhibitor of progestins. Used with misoprostol (PGE1) for abortion.

208

Mechanisms of estrogen/progestin vs progestin-only OCPS?

Progestin only causes thickening of cervical mucus and inhibits endometrial proliferation. E/P's inhibit LH/FSH to prevent ovulation.

209

Terbutaline

A beta-2 agonist used as a tocolytic in labor.

210

Danazol

Partial agonist for androgen receptors. Used for endometriosis and hereditary angioedema.

211

Finasteride

5 alpha-reductase inhibitor. Used for BPH and male pattern baldness.

212

Flutamide

Competetive inhibitor of androgens at testosterone receptor used for prostate carcinoma.

213

17,20 desmolase inhibitors

Ketoconazole and spironolactone (also inhibits 17-alpha hydroxylase). Both used for PCOS to prevent hirsuitism. Side effects of gynecomastia and amenorrhea.

214

Side effects of PDE5 inhibitors?

HA, flushing, dyspepsia, color-vision. Hypotension if used with nitrates = life-threatening

215

Role of menotropin in fertility treatment?

Menotropin acts like FSH --> formation of dominant follicle. hCG is then used for LH surge to ovulate.

216

Primary energy source for sperm?

Fructose. Therefore relies on aldose reductase (glucose to sorbitol) and sorbitol dehydrogenase (sorbitol to fructose). High sorbitol dehydrognease activity.