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1
Q

What causes a cleft palate?

A

Failure of fusion of the two lateral palatine processes or failure of fusion of lateral palatine processes with the nasal septum and/or median palatine process

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2
Q

What causes testes development?

A

SEY gene in Y chromosome produces testes determining factor

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3
Q

What secretes MIF?

A

Sertoli cells

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4
Q

Action of MIF

A

Suppresses development of paramesonephric ducts

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5
Q

What does the mesonephric duct become and what stimulates it to become this?

A

Seminal vesicles, epididymis, ejaculatory duct, ductus deferens. Stimulated by androgens from Leydig cells

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6
Q

Primary amenorrhea in a woman with fully developed secondary sexual characteristics

A

Mullerian agenesis

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7
Q

What causes development of the prostate?

A

DHT (so 5-alpha-reductase deficiency causes male internal genetalia, ambiguous external genetalia until puberty)

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8
Q

What does the genital tubercle become in men?

A

Glans penis and corpus cavernosum and spongiosum

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9
Q

What is the female homolog of the prostate gland?

A

Urethral and para urethral glands (of Skene)

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10
Q

What is the male homolog of the greater vestibular glands (of Bartholin)

A

Bulbourethral glands of Cowper

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11
Q

What is hypospadias associated with?

A

Inguinal hernia and cryptorchidism

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12
Q

Mehta causes epispadias?

A

Faulty positioning of genital tubercle

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13
Q

What do the urogenital folds become?

A

Ventral shaft of penis in men and labia minora in women

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14
Q

What causes a cleft lip?

A

Failure of fusion of the maxillary and medial nasal processes (formation of primary palate)

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15
Q

Lymph drainage of the proximal vagina/uterus

A

Obturator, external iliac, and hypogastric nodes

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16
Q

What is the other name for the suspensory ligament of the ovary?

A

Infundibulopelvic ligaments

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17
Q

What is the round ligament?

A

Connects the uterine funds to labia majora. Derivative of the gubernaculum. Travels through round inguinal canal; above artery of Sampson

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18
Q

Affects of temperature on Sertoli cells

A

Increased temperature causes decreased sperm production and decreased inhibin

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19
Q

Where are the Leydig cells?

A

In the interstitial between seminiferous tubules

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20
Q

What does androgen binding protein do and what secretes it?

A

Secreted by Sertoli cells, maintains local levels of testosterone (by binding and making it less lipophilic so it stays in the tubule)

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21
Q

What types of estrogen are made by the ovary, placenta, and adipose tissue and what is the potency?

A

Ovary: 17-beta-estradiol; placenta: estriol; adipose tissue: estrone via aromatization. Potency: Estradiol> estrone> estriol

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22
Q

Effect of SHBG on cholesterol

A

Increased transport proteins (SHBG) causes increased HDL and decreased LDL

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23
Q

Which cells in the female make androgens?

A

Theca interna cells

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24
Q

What enzyme is used to make androgens from cholesterol

A

Desmolase

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25
Which cells make estrogens from androgens
Grnaulosa cells
26
Where are estrogen receptors located?
Cytoplasm (translate to the nucleus when bound by estrogen)
27
Regulation of prolactin by estrogen and progesterone
Estrogen stimulates prolactin secretion, fall in progesterone after delivery disinhibits prolactin
28
When is follicular growth the fastest?
During the 2nd week of the proliferative phase
29
Where is meiosis I arrested and until when?
Arrested in prophase I for years until ovulation
30
Where is meiosis II arrested and until when?
Metaphase II until fertilization
31
What secretes hCG?
Syncytiotrophoblasts.
32
When is hCG detectable?
Detectable in blood 1 weeks after conception and on home test in urine two weeks after conception
33
Why do double Y males and people taking exogenous testosterone have acne?
Androgens stimulate follicular epidermal hyperproliferation and excessive sebum production
34
What do you see in aromatase deficiency?
Masculinization of female infants, increased serum testosterone and androstenedione. Can present with maternal virilization during pregnancy (fetal androgens cross the placenta)
35
Inheritance of aromatase deficiency
Autosomal recessive
36
Inheritance of complete androgen insensitivity syndrome
X-linked
37
Inheritance of 5-alpha-reductase deficiency
Autosomal recessive
38
What is Kallmann syndrome?
Hypogonadotropic hypogonadism. Defective migration of GnRH cells and formation of olfactory bulb, decreased synthesis of GnRH in the hypothalamus; anosmia. Most common mutation in KAL-1 gene or fibroblast growth factor-1, which code for proteins required in this migration
39
Which antihypertensives do you use for gestational HTN?
Alpha-methyldopa, labetalol, hydralazine, nifedipine
40
What may be the cause of preeclampsia?
Abnormal placental spiral arteries ->endothelial dysfunction, vasoconstriction, ischemia
41
What might cause maternal death in eclampsia?
Storke, intracranial hemorrhage, or ARDS
42
What does the blood smear show in HELLP syndrome?
Schistocytes
43
Complication of HELLP syndrome?
Can lead to hepatic sub capsular hematomas-> rupture -> severe hypotension
44
Histology of sarcoma botryoides
Spindle-shaped cells; desmin positive
45
How does HPV lead to cancer?
E6 gene product (inhibits p53 suppressor gene); E7 gene product (inhibits RB suppressor gene)
46
White atrophic macules with "cigarette paper" quality
Lichen sclerosis et atrophicus
47
What is a follicular cyst
Distention of unruptured graafian follicle. May be associated with hyperestrogenism, endometrial hyperplasia
48
What is a Thea-lutein cyst?
Due to gonadotropin stimulation. Associated with choriocarcinoma and hydatidiform moles
49
Most common malignant ovarian tumor
Serous cystadenocarcinoma
50
What is a Brenner tumor?
A benign ovarian neoplasm, looks like bladder. "Coffee bean" nuclei on H&E sain
51
What is Meigs syndrome?
Triad of ovarian fibroma (benign, bundles of spindle-shaped fibroblasts), ascites, hydrothorax
52
What is an immature teratoma?
Malignant (vs mature teratoma, which is benign). Made up of fetal tissue, neuroectoderm.
53
Which type of ovarian tumor produces estrogen?
Granolas cell tumor
54
Cells arranged haphazardly around collections of eosinophilic fluid
Call-Exner bodies in a granolas cell tumor
55
What is pseudomyxoma peritonei and which type of tumor causes it?
Intraperitoneal accumulation of mutinous material from ovarian or appendiceal tumor, caused by a mucinous cystadenocarcinoma
56
Ovarian tumor with sheets of "fried egg" cells
Dygerminoma
57
What do you see in choriocarcinoma?
Malignancy of trophoblastic tissue (cytotrophoblasts, syncytiotrophoblasts); NO chorionic villi present
58
Yellow, friable (hemorrhagic), solid mass in a child
Yolk sac (endodermal sinus) tumor
59
Tumor with things resembling glomeruli
Yolk sac tumor (glomeruli: Schiller-Duval bodies)
60
Whorled pattern of smooth muscle bundles with well-demarcated borders
Leiomyoma
61
Treatment for endometritis
Gentamicin + clindamycin with or without ampicillin
62
What are the two layers of epithelium lining lobules and ducts?
Luminal cells and myoepithelial cells
63
Histology of a phyllodes tumor
Large, bulky mass of connective tissue and cysts. "Leaf-life" projections
64
Green-brown nipple discharge
Mammillary duct ectasia. Characterized by ductal dilatation, inspissated breast secretions, and chronic granulomatous inflammation in the predicate and interstitial areas
65
Does apocrine metaplasia increase the risk for breast cancer?
NO
66
What is sclerosing adenosis?
Increased acini and interlobular fibrosis. Associated with calcifications.
67
Tx for lactational mastitis
Dicloxacillin
68
Most common pathogen for lactational mastitis
S. aureus
69
Which drugs can cause gynecomastia?
Spironolactone, digoxin, cimetidine, alcohol, ketoconazole
70
What are Paget cells?
Large cells in epidermis with clear halo
71
"Stellate" infiltration
Invasive ductal carcinoma
72
Breast cancer with orderly rows of cells
Invasive lobular, due to decreased E-cadherin expression
73
What is a penile fracture?
Rupture of corpora cavernous due to forced bending
74
Tx of priapism
Corporal aspiration, intracarvernosa phenylephrine, or surgical decompression
75
Precursor lesions for penile squamous cell carcinoma
Bowen disease: in penile shaft, presents as leukoplakia; Erythroplasia of Queyrat: cancer of glans, presents as erythroplakia; Bowenoid papulosis: carcinoma in situ of unclear malignant potential, presenting as reddish papules
76
What is penile SCC associated with
HPV, lack of circumcision
77
Where do you see extragonadal germ cell tumors?
In adults- most commonly in retroperitoneum, mediastinum, pineal, and suprasellar regions. In infants and young children, sacrococcygeal teratomas are most common
78
Do you biopsy testicular tumors?
NO because of risk of seeding the scrotum
79
Testicular tumor with large cells in lobules with watery cytoplasm, no hemorrhage or necrosis. Increased placental ALP
Seminoma, with "fried egg" appearance cells
80
Prognosis of seminoma
Excellent. Radiosensitive, late metastasis
81
Most common testicular tumor in boys
Yolk sac (endodermal sinus) tumor. Has Schiller- Duval bodies
82
What symptoms might you see of choriocarcinoma in males?
Gynecomastia, symptoms of hyperthyroidism. (Disordered syncytiotrophoblastic elements produces hCG, which is structurally similar to LH, FSH, and TSH)
83
In males are mature teratomas benign or malignant?
Malignant in adult males, but benign in children
84
Testicular tumor that is hemorrhagic and necrotic
Embyonal carcinoma. Often glandular/papillary morphology
85
Reinke crystals (eosinophilic cytoplasmic inclusion)
Seen in Leydig cell tumors. These tumors usually produce androgens->gynecomastia in men, precocious puberty in boys. Golden brown color
86
Treatment of BPH
alpha-1-antagonists (terazosin, tamsulosin) which cause relaxation of smooth muscle; 5-alpha-reductase inhibitors (e.g. finasteride); PDE-5 Inhibitors
87
Which part of the prostate does adenocarcinoma usually arise from?
Posterior lobe (peripheral zone)
88
What should you give before starting leuprolide for prostate cancer?
Flutamide for androgen receptor blockade
89
MOA of clomiphene
Antagonist at estrogen receptors in hypothalamus. Prevents normal feedback inhibition and increases release of LH and FSH from pituitary, which stimulates ovulation
90
What is anastrozole
An aromatase inhibitor
91
MOA of mifepristone
Competitive inhibitor of progestins at progesterone receptors
92
What are terbutaline, ritodrine?
Beta-2-agoists that relax the uterus; used to decrease contraction frequency in women during labor
93
MOA of danazol
Synthetic androgen that acts as a partial agonist at androgen receptos
94
Clinical use of danazol
Endometriosis, hereditary angioedema
95
How is ketoconazole an anti androgen?
Inhibits steroid synthesis (inhibits 17,20-desmolase)
96
MOA of minoxidil
Direct arteriolar vasodilator
97
Clinical use of minoxidil
Androgenetic alopecia; severe refractory hypertension

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