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Reproduction Flashcards

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1
Q

Agenesis

A

Absent organ due to absent primordial tissue

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2
Q

Aplasia

A

Absent organ despite presence of primordial tissue

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3
Q

Deformation

A

Extrinsic disruption
Occurs after embryonic period

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4
Q

Hypoplasia

A

Incomplete organ development
Primordial tissue present

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5
Q

Malformation

A

Intrinsic disruption
Occurs during embryonic period (3-8 weeks)

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6
Q

Teratogenic Effects of ACEI

A

Renal damage

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7
Q

Teratogenic Effects of Alkylating Agents

A

Absence of digits
Multiple abnormalities

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8
Q

Teratogenic Effects of Aminoglycosides

A

“A mean guy hit the baby in the ear”
CN VIII toxicity

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9
Q

Teratogenic Effects of Carbamazepine

A

Neural tube defects
Craniofacial defects
Fingernail hypoplasia
Developmental delay
IUGR (IntraUterine Growth Restriction )

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10
Q

Teratogenic Effects of Diethylstilbestrol (DES)

A

Vaginal clear cell carcinoma
Congenital Mullerian anomalies

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11
Q

Teratogenic Effects of Folate Antagonists

A

Neural Tube Defects

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12
Q

Teratogenic Effects of Li

A

Ebstein’s Anomaly (Atrialized RV)

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13
Q

Teratogenic Effects of Phenytoin

A

Fetal hydantoin syndrome: microcephaly, dysmorphic craniofacial features, hypoplastic nails and distal phalanges, cardiac defects, IUGR (IntraUterine Growth Restriction ), mental retardation

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14
Q

Teratogenic Effects of Tetracyclines

A

Discolored Teeth

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15
Q

Teratogenic Effects of Valproate

A

Inhibition of maternal folate absorption –> neural tube defects

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16
Q

Teratogenic Effects of Warfarin

A

“Do not wage Warfare on the baby, keep in Heppy with Heparin (does not cross the placenta)”
Bone deformities, fetal hemorrhage, abortion, ophthalmologic abnormalities

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17
Q

Teratogenic Effects of Thalidomide

A 
"Limb Defects with tha-LIMB-domide" 
Limb defects (flipper limbs)
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18
Q

Teratogenic Effects of EtOH

A

Leading cause of birth defects and mental retardation
Fetal Alcohol Syndrome

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19
Q

Teratogenic Effects of Cocaine

A

Abnormal fetal development and fetal addiction; Placenta abruption

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20
Q

Teratogenic Effects of Smoking (nicotine, CO)

A

Preterm labor, Placental problems, IUGR (IntraUterine Growth Restriction ), ADHD

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21
Q

Teratogenic Effects of Iodide (Lack or Excess)

A

Congenital Goiter or Hypothyroidism (cretinism)

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22
Q

Teratogenic Effects of Maternal Diabetes

A

Caudal regression syndrome (anal atresia to sirenomelia), Congenital Heart Defects (Transposition of the Great Vessels), Neural Tube Defects

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23
Q

Teratogenic Effects of Excess Vit A

A

Extremely high risk for spontaneous abortions and birth defects (cleft palate, cardiac abnormalities)

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24
Q

Teratogenic Effects of X Rays

A

Microcephaly, Mental Retardation

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25
Fetal Alcohol Syndrome
Mental Retardation, Pre and Post Natal Developmental Retardation, Microcephaly, Holoprosencephaly, Facial Abnormalities, Limb Dislocation, Heart and Lung Fistulas
26
Source of Estrogen
Ovary --\> 17β-estradiol Placenta --\> estriol Adipose tissue --\> estrone via aromatization
27
Potency of different kinds of estrogens
Estradiol \> Estrone \> Estiol
28
Estrogen Function Development In menstrual cycle Receptors Blood
Development of genitalia, breast, and female fat distribution Growth of follicle, endometrial proliferation, and ↑ myometrial excitability Feedback inhibition of LH and FSH and then LH surge Stimulation of prolactin secretion (but blocks it's action at the breast) Upregulates estrogen, LH, and progesterone receptors ↑ Transport proteins, SHBG, HDL, ↓LDL
29
How does pregnancy change estrogen levels
50x ↑ in estradiol and estrone 1000x ↑ in estiol (indicator of fetal well being
30
Mechanism of estrogen receptor
Expressed in cytoplasm When bound with ligand, translocates to the nucleus
31
Molecular cascade in Theca Cells
Pulsatile GnRH --\> LH --\> Desmolase D turns cholesterol in to androstenedione
32
Molecular cascade in Granulosa Cells
Pulsatile GnRH --\> FSH --\> Aromatase A turns androstenedione into estrogen
33
Source of Progesterone
Corpus Luteum, Placenta, Adrenal Cortex, Testes
34
Elevation of Progesterone indicates...
Ovulation
35
Function of Progesterone Menstural cycle Receptors Pregnancy
Stimulation of endometrial glandular secretions and spiral artery development Maintains endometrium to support implantation --/ LH and FSH ↓ myometrial excitability ↓ estrogen receptor expressivity Maintain pregnancy Production of thick cervical mucus (inhibits sperm entry into uterus) ↑ Body Temp Uterine smooth muscle relaxation (prevents contractions)
36
Tanner Stages of Sexual Development
I: Childhood II: Pubic hair appears (Pubarche), Breast bud forms (Thelarche) III: Pubic hair darkens and becomes curly. Penis size/length and breasts enlarge IV: Penis width ↑, Darker scrotal skin, Development of glans, raised areolae V: Adult. Areolae are no longer raised
37
Follicular Phase Estrogen FSH LH Progesterone
Estrogen: Stead rise FSH: Rises slightly then decreases slightly LH: Rises slightly then decreases slightly Progesterone: Low
38
Luteal Phase Estrogen FSH LH Progesterone
Estrogen: decreases, then spikes briefly before decreasing again FSH low LH low Progesterone: increases then decreases
39
Ovulation Estrogen FSH LH Progesterone GnRH Temp
Estrogen: just past peak FSH: low surge LH: high surge Progesterone: beginning to rise ↑ in GnRH receptors on ant pituitary ↑ Temp (due to progesterone)
40
Basic schematic of menstrual cycle
↑ estrogen --\> LH surge --\> Ovulation --\> Progesterone (from corpus luteum) --\> Progesterone levels fall --\> menstruation (apoptosis of endometrial cells)
41
Length of Follicular phase
Variable
42
Length of Luteal phase
Constant 14 days
43
When is follicular growth fastest?
2nd week of proliferative phase (follicular phase)
44
Oligomenorrhea
Cycle \> 35 days
45
Polymenorrhea
Cycle \< 21 days
46
Menometrorrhagia
Heavy, irregular menstruation at irregular intervals
47
Mittelschmerz
Blood from ruptured follicle or follicular enlargement causes peritoneal irritation that can mimic appendicitis
48
Primary Oocytes N C When do they enter and complete meiosis I
2N 4C Begin meiosis I during fetal life and complete meiosis I just prior to ovulation
49
When is meiosis II arrested? Until when?
"Arrested until egg MET sperm" Meiosis II arrested at Metaphase II until fertilization
50
If fertilization does not occur within 1 day what happens to secondary oocytes?
Degenerate
51
Oogenesis Names of cells with N and C
Oogonium (2N 2C) --\> Primary Oocyte (2N 4C) --\> Secondary Oocyte (1N 2C) --\> Ovum (1N 1C)
52
Where and When does fertilization most commonly occur?
Upper end of fallopian tube (ampulla) within 1 day of ovulation
53
When does implantation within the wall of the uterus occur?
Within 6 days after fertilization
54
What secretes hCG? When is hCG first detectable in blood and urine?
Trophoblast secretes hCG Detectable in blood 1 week after conception Detectable in urine 2 weeks after conception
55
Lactation When does it occur? What has changed chemically that allows it to happen? What is required to maintain lactation?
Occurs after labor because progesterone ↓ and this allows lactation to occur Suckling is required to maintain lactation: ↑ nerve stimulation --\> ↑ oxytocin and prolactin
56
Prolactin What does it do?
Induces and maintains lactation and ↓ reproductive function
57
Oxytocin What does it do?
Helps with milk letdown and involved with uterine contraction
58
hCG Source Function Uses
Syncytiotrophoblast of placenta Maintains corpus luteum (and thus progesterone) for 1st trimester by acting like LH Used to detect pregnancy
59
Why is hCG not needed in 2nd and 3rd trimesters?
Placenta synthesizes its own estriol and progesterone
60
Elevated hCG in pathological states
Hydatidiform moles, choriocarcinoma
61
Average age of menopause? What makes it earlier?
Average age at onset is 51 Earlier in smokers
62
What is happening hormonally in menopause?
↓ estrogen production becuse of ↓ # of follicles ↑↑FSH, ↑LH (no surge), ↑GnRH Ovaries continue to produce androgens under LH stimulation
63
What usually precedes menopause?
4-5 years of abnormal menstrual cycles
64
Source of estrogen after menopause?
Peripheral conversion of androgens
65
Best test to confirm menopause?
↑↑ FSH
66
What does Menopause produce?
"HHAVOC" Hirsutism, Hot flashes, Atrophy of the Vagina, Osteoporosis, Coronary artery disease
67
Menopause before age 40 indicates...
Premature ovarian failure
68
Menorrhagia
Heavy and/or prolonged menses
69
Average length of menses
3-5 days
70
Average blood loss during menses
35mL (10-80)
71
Metrorrhagia
Irregular menses
72
Dysmenorrhea
Painful menses
73
As women approach menopause, how does their cycle change
Follicular part becomes shorter. Failure of ovaries to produce follicles and estrogen --\> ↑↑ FSH and earlier LH/FSH surge
74
Perimenopause What is it? How long does it last?
Irregular/skipped menses and beginning of vasomotor symptoms Can last 5-10 years before menopause
75
Menopause definition
12 months of amenorrhea
76
Mechanisms of osteoporosis in menopause
Estrogen --/ bone resorption by osteoclasts
77
Leuprolide Mechanism Uses Toxicity
GnRH analog Pulsatile --\> Agonist Continuous --\> Antagonist (downregulation of GnRH receptors in pituitary --\> ↓ FSH/LH Pulsatile: treats infertility Continuous: Endometriosis, Prostate cancer (w/ Flutamide), Uterine fibroids, Precocious puberty Tox: Antiandrogen, Nausea, Vomiting
78
Testosterone, Methyltestosterone Mechanism Use Toxicity
Agonist for androgen receptors Treats: hypogonadism, Promotes development of secondary sex characteristics, Stimulation of anabolism to promote recovery after burn injury Tox: Masculinization in females, Reduces intratresticular testosterone in males by inhibiting release of LH which leads to gonadal atrophy, Premature closure of epiphyseal plate, ↑LDL, ↓HDL
79
Names of antiandrogens
Finasteride, Flutamide, Ketoconazole, Spironolactone
80
Finasteride Kind of drug MoA Uses Tox
Antiandrogen --/ 5α Reductase which turns T into DHT Treats BPH and hair loss Breast growth
81
Flutamide Kind of drug MoA Uses
Antiandrogen Nonsteroidal competitive inhibitor of androgens at the testosterone receptor Treats prostate carcinoma
82
Ketoconazole Kind of drug MoA Uses Toxicity
Antiandrogen Inhibits steroid synthesis (--/ 17,20 desmolase) Treats PCOS to prevent hirsutism Tox: gynecomastia and amenorrhea
83
Spironolactone Kind of drug MoA Uses Toxicity
Antiandrogen Inhibits steroid binding Treats PCOS to prevent hirsutism Tox: gynecomastia and amenorrhea
84
Estrogens Names MoA Use Tox Contraindication
Ethinly, Estradiol, DES, Mestranol Binds Estrogen receptors Treats Hypogonadism or Ovarian Failure, Menstrual abnormalities, HRT in postmenopausal women Used in men to treat androgen dependent prostate cancer Tox: ↑ risk of endometrial cancer, bleeding in postmenopausal women, clear cell carcinoma of the vagina/cervix in females exposed to DES in utero, ↑ risk of thrombi ER+ breast cancer, history of DVTs
85
Names of Selective Estrogen Receptor Modulators (SERMs)
Clomiphene, Tamoxifen, Raloxifene
86
Clomiphene Kind of Drug MoA Uses Toxicity
SERM Partial agonist at estrogen receptors in hypothalamus. Prevents normal feedback inhibition and ↑ LH and FSH from pituitary. Treats infertility and PCOS Tox: Hot flashes, ovarian enlargement, multiple simultaneous pregnancies, visual disturbances
87
Tamoxifen Kind of Drug MoA Uses
SERM Antagonist of estrogen receptors in breast tissue Treats and prevents recurrence of ER+ breast cancer
88
Raloxifene Kind of Drug MoA Uses
SERM Agonist of estrogen receptors in bone and reduces bone resorption Treats osteoporosis
89
Hormone Replacement Therapy Uses Toxicity
Used for the relief or prevention of menopausal symptoms (hot flashes, vaginal atrophy, etc) and osteoporosis (by ↑ estrogen --\> ↓ osteoclast activity) Unopposed use of estrogen --\> ↑ risk of endometrial cancer, so progesterone is added. Possible ↑ CV risk
90
Anastrozole/Exemestane MoA Uses
Aromatase inhibitor used to treat postmenopausal women with breast cancer
91
Progestins MoA Uses
Binds progesterone receptors. Reduces growth and ↑ vascularization of endometrium Used in oral contraceptives and treatment of endometrial cancer and abnormal uterine bleeding
92
Mifepristone (RU-486) MoA Co-administered with... Use Tox
Competitive inhibitor of progestins at progesterone receptor Termination of pregnancy. Administered w/ misoprostol (PGE) Tox: Heavy bleeding, GI effects (nausea, vomiting, anorexia), Abdominal pain
93
Oral Contraception What does it consist of? MoA Contraindications
Progestins + Estrogen E and P --/ LH/FSH which leads to prevention of estrogen surge. No estrogen surge --\> no LH surge. No LH surge --\> no ovulation Progestins cause thickening of the cervical mucus, thereby limiting access of sperm to uterus. Progestins --/ endometrial proliferation making it less suitable for implantation Contraindicated in smokers \>35 (CV events), Hx of Thromboembolism and stroke or Hx of estrogen dependent tumors
94
Terbutaline MoA Uses
β2 agonist that relaxes uterus Reduces premature uterine contractions
95
Tamsulosin MoA Uses Selectivity
α1 antagonist used to treat BPH by inhibiting smooth muscle contraction Selective for α1A and α1D (on prostate) vs α1B (vasculature)
96
Sildenafil, Vardenafil MoA Uses Tox Contraindications
--/ Phosphodiesterase 5 causing an ↑ in cGMP, smooth muscle relaxation in corpus cavernosum, ↑ blood flow, and penile erection Treats erectile dysfunction Tox: "Hot and sweaty, but then Headache , Heartburn, Hypotension" Headache, flushing, dyspnea, impaired blue-green color vision, Hypotension Risk of life threatening hypotension in nitrate users
97
Danazol MoA Uses Tox
Synthetic androgen that is a partial agonist at androgen receptor Endometriosis and hereditary angioedema Wt Gain, Edema, Acne, Hirsutism, Masculinization, ↓HDL, Hepatotoxicity
98
Endometriosis What is it? What tissue is affected? What does it cause? What causes it?
``` Non-neoplastic endometrial glands/stroma in abnormal locations In Ovary or on Peritoneum Cyclic bleeding (menstrual type) resulting in blood filled "chocolate cysts" Caused by retrograde menstrual flow ```
99
Endometriosis Clinical manifestation? Treatment
Dysmenorrhea, Menorrhagia, Dyspareunia, Infertility Uterus is normal size Treat with oral contraceptives, NSAIDs, Leuprolide, Danazol
100
Adenomyosis What is it? Clinical manifestation Treatment
Endometrium within myometrium Menorrhagia, Dysmenorrhea, Pelvic pain Enlarged uterus Hysterectomy
101
Cervical Dysplasia and Carcinoma In Situ Description Where does it begin and extend? Classification Histology
Disordered epithelial growth Begins at basal layer of squamo-columnar junction and extends outwards CIN1, CIN2, CIN3 (severe dysplasia or carcinoma in situ) depending on how high the basal cells extend Koilocytes: raisinoid nuclei with perinuclear halo
102
Cervical Dysplasia and Carcinoma In Situ Viral cause? Mechanism of viral cause? Prevention? Risk if untreated Risk factors
HPV16 and HPV18 (E6 --/ p53 andE7 --/ RB) Vaccine available May progress to invasive carcinoma if left untreated Multiple sexual partners, smoking , early intercourse, HIV
103
Cervical Invasive Carcinoma Most often what kind of carcinoma? Screen? Complications
Often squamous cell carcinoma Pap smear Lateral invasion can block ureter leading to renal failure
104
PCOS PathoPhys Gross Clinical manifestation Associated w/ Increased risk for
↑ frequency of pulsatile GnRA release --\> ↑LH + ↓FSH --\> anovulation --\> no progesterone Hyperandrogenism b/c of deranged steroid synthesis by Theca cells Bilaterally enlarged, cystic ovaries Amenorrhea, infertility, obesity, hirsutism Associated with insulin resistance Risk for endometrial cancer (↑ estrogen + no progesterone to oppose --\> ↑ aromatization of testosterone in fat)
105
PCOS treatment
Wt reduction Low does Oral Contraceptive or medroxyprogesterone (↓ LH and androgenesis) Spironolactone (acne and hirsutism) Clomiphene (infertility) Meformin (diabetes or metabolic syndrome)
106
Endometrial hyperplasia What is it? What causes it? Increased risk for... Presentation Risk factors
Abnormal endometrial gland proliferation Caused by excess estrogen stimulation ↑ risk for endometrial carcinoma Postmenopausal vaginal bleeding Anovulatory cycle, HRT, PCOS, Granulosa Cell Tumor
107
Endometrial Carcinoma Frequency Epidemiology Presentation Typically preceded by Risk factors Prognosis
Most common gynecologic malignancy Peak occurrence at 55-65 Vaginal bleeding Typically preceded by endometrial hyperplasia Prolonged use of estrogen w/o progesterone, obesity, diabetes, HTN, nulliparity, late menopause ↑ myometrial invasion --\> poor prognosis
108
Types of Myometrial tumors
Leiomyoma (fibroid) Leiomyosarcoma
109
Leiomyoma Type of tumor Frequency Gross Epidemiology What kind of tissue Malignant?
Myometrial tumor Most common of all tumors in females Multiple tumors with well-demarcated borders ↑ incidence in blacks. Peak at 20-40 Benign smooth muscle tumor Malignant transformation to Leiomyosarcoma is rare
110
Leiomyoma Hormone sensitive? Presentation Complications Histology
Estrogen sensitive: tumor size ↑ w/ pregnancy and ↓ w/ menopause May be asymptomatic, cause abnormal uterine bleeding, miscarriage Severe bleeding may lead to Iron Deficiency Anemia Whorled pattern of smooth muscle fibers
111
Leiomyosarcoma Kind of tumor Gross Where does it arise from? Epidemiology Prognosis
Myometrial tumors Bulky, irregular shaped tumor with areas of necrosis and hemorrhage. May protrude from cervix and bleed Typically arising de novo ↑ incidence in middle aged black women Highly aggressive w/ tendency to recur
112
Hydatidiform Moles What are they? Types Presentation Precursor of... Serum marker Gross Potential complication Treatment
Cystic swelling of chorionic villi and proliferation of chorionic epithelium (trophoblast) Complete vs Partial Presents with abnormal vaginal bleeding Most common precursor of choriocarcinoma ↑βhCG Honeycomb uterus or cluster of grapes appearance. Enlarged uterus Uterine rupture dilation and curettage and methotrexate
113
Complete Hydatidiform moles Appearance Fetus? Karyotype hCG Uterine size Conversion to choriocarcinoma Fetal parts Components Risk of complications
Snowstorm appearance with no fetus during 1st sonogram 46XX, 46XY ↑↑↑↑ hCG ↑ uterine size 2% choriocarcinoma No fetal parts 2 sperm (from same sperm that replicated) + empty egg 15-20% malignant trophoblastic disease
114
Partial Hydatidiform moles Karyotype hCG Uterine size Conversion to choriocarcinoma Fetal parts Components Risk of complications
69XXX, 69XXY, 69XYY ↑ hCG No change in uterine size Rare choriocarcinoma Has fetal parts 2 sperm + 1 egg Low risk of malignancy
115
Classical Preeclampsia presentation
Pregnant women with HTN, Proteinuria, and Edema
116
Classical Presentation of Eclampsia
Preeclampsia + Seizures
117
Preeclampsia Frequency When ↑ risk in... Caused by Associated w/ Mortality results from
7% of pregnant women from 20 weeks to 6 weeks postpartum ↑ risk in pts w/ HTN, Diabetes, Chronic Renal Disease, Autoimmune disorders Impaired vasodilation of spiral arteries --\> Placental ischemia --\> ↑ vascular tone Associated with HELLP syndrome Death from cerebral hemorrhage and ARDS
118
HELLP Syndrome
Hemolysis, Elevated Liver enzymes, Low Platelets
119
Clinical Manifestations of Preeclampsia Lab findings
Headache, Blurred vision, Abdominal pain, Edema of face and extremities, altered mentation, hyperreflexia Thrombocytopenia and Hyperuricemia
120
Treatment Preeclampsia
Delivery of fetus as soon as possible, Bed rest, monitoring, treat HTN IV MgSulfate to prevent seizures
121
Ovarian germ cell tumors most common in...
Adolescents
122
Dysgerminoma What kind of tumor? Malignant? Equivalent in male? Histology Associated w/ Markers
Ovarian germ cell tumor Malignant Equivalent to male seminoma but rarer (1% over 30%) Sheets of uniform cells Associated with Turners Syndrome hCG and LDH
123
Choriocarcinoma in females What kind of tumor? Frequency Malignant Who develops it? When does it develop? Source Histology What other pathologies is it related to? Metastases Serum markers
Ovarian germ cell tumor Rare but malignant Develops during or after pregnancy in mother or baby From trophoblastic tissue No chorionic villi and ↑ theca-lutein cysts On spectrum with moles as gestational trophoblastic neoplasms Early homogenous spread to lungs hCG
124
Yolk Sac (Endodermal Sinus) Tumor in women What kind of tumor? Malignant? Location What kind of pt? Gross Histology Marker
Ovarian germ cell tumor Aggressive malignancy in ovaries/testes and sacrococcygeal area of young children Yellow, friable, solid masses 50% of Schiller-Duval bodies (resemble glomeruli) AFP
125
Teratoma in women What kind of tumor Frequency Types of tissue? Types
Ovarian germ cell tumor 90% of ovarian germ cell tumors Contains cells from 2 or 3 germ layers Mature vs. Immature
126
Mature Teratoma in women Gross Frequency Malignant?
Dermoid Cyst Most common ovarian germ cell tumor Mostly benign
127
Immature Teratoma in women Malignant? Gross Presentation
Aggressively malignant Can have Struma Ovarii (functional thyroid tissue) Can present as hyperthyroidism
128
Serous Cystadenoma Kind of tumor Frequency Distribution Histology Malignant?
Ovarian non-germ cell tumor 45% of ovarian tumors Bilateral Lined with fallopian tube-like epithelium Benign
129
Marker for Ovarian cancer?
↑ CA-125 Good for monitoring progression but not screening
130
Serous cystadenocarcinoma Kind of tumor Frequency Distribution Histology Malignant? Genetic risk factors
Ovarian non-germ cell tumor 45% of ovarian tumors Bilateral Psammoma bodies Malignant BRCA1, BRCA2, HNPCC
131
Mucinous Cystadenoma Kind of tumor Malignant Histology
Ovarian non-germ cell tumor Benign Multilocular cyst lined by mucus secreting epithelium. Intestine-like tissue
132
Mucinous Cystadenocarcinoma Kind of tumor Malignant? Complication
Ovarian non-germ cell tumor Malignant Pseudomyxoma peritonei - intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor
133
Brenner Tumor Kind of tumor Malignant Distribution Gross Histology
Ovarian non-germ cell tumor Benign Unilateral Looks like Bladder. Solid tumor that is pale yellow-tan color and appears encapsulated Coffee bean nuclei on H&E
134
Fibromas Kind of tumor? Histology Complication Clinical Manifestation
Ovarian non-germ cell tumor Bundles of spindle shaped fibroblasts Meigs' Syndrome Pulling sensation in groin
135
Meigs Syndrome
Ovarian fibroma + ascites + hydrothorax
136
Granulosa Cell Tumor What kind of tumor Hormones Complications in kids vs adults Histology Presentation
Ovarian non-germ cell tumor Secretes estrogen Precocious puberty in children endometrial hyperplasia or carcinoma in adults Call-Exner bodies (small follicles filled with eosinophilic secretions) Abnormal uterine bleeding
137
Krukenberg Tumors Kind of tumor Source Histology
Ovarian non-germ cell tumor GI malignancy that metastasizes to ovaries Mucin secreting signet cell adenocarcinoma
138
Squamous Cell Carcinoma of the Vagina Usually secondary to...
SCC of cervix
139
Women at risk for Clear Cell Adenocarcinoma of the Vagina
DES exposure in utero
140
Sarcoma Botryoides (rhabdomyosarcoma variant) Kind of tumor Classic pt Histology
Vaginal Tumor Girls \<4 Spindle shaped, Desmin+ tumor cells
141
Dizygotic twins Frequency Egg # Amniotic sacs Placentas
80% of twins 2 eggs 2 separate amniotic sacs 2 separate placentas (chorions)
142
Monozygotic twins that split day 0-4 Stage Frequency Placenta Amniotic sacs Chorion
Morula 25% Fused or separate placenta Diamniotic Dichorionic
143
Monozygotic twins that split day 4-8 Stage Frequency Amniotic sacs Chorion
Blastocyst 75% Diamniotic Monochorionic
144
Monozygotic twins that split day 8-12 Frequency Amniotic sacs Chorion
Less than 1% Monoamniotic Monochorionic
145
Monozygotic twins that split after day 13
Monoamniotic Monochorionic Conjoined
146
Fetal Components of the placenta
Cytotrophoblast and Syncytiotrophoblast
147
Cytotrophoblast Where is it? What is it made from? Where is it from?
Inner layer of chorionic villi Cytotrophoblast made from Cells Fetal component
148
Syncytiotrophoblast Where is it? What does it secrete?
Outer layer of chorionic villi Secretes hCG
149
Maternal component of placenta Name Derived from?
Decidua Basalis Derived from endometrium
150
Where is maternal blood in the placenta?
In Lacunae
151
What makes up the Umbilical Cord?
2 Umbilical arteries and 1 Umbilical vein
152
Function of umbilical arteries Source?
Return deoxygenated blood from fetal internal iliac arteries to placenta
153
Function of umbilical vein? What does it drain into?
Supplies oxygenated blood from placenta to fetus Drains via ductus venosus into IVC
154
Single umbilical artery is associated with...
Congenital and Chromosomal Anomalies
155
What are the umbilical arteries and veins are derived from?
The Allantois
156
Urachal Duct What is it? Development? Failure to obliterate?
A duct between bladder and yolk sac 3rd week: Yolk sac forms allantois which extends into urogenital sinus. Allantois becomes urachus Patent Urachus: urine discharge from the umbilicus Vesicourachal diverticulum: outpouching of bladder
157
Meckel's diverticulum
Meckel's Diverticulum = outpouching of gut at ilium d/t vitalline duct remnant * Considered a true diverticulum (contains all layers of bowel incl muscular layer) * Can contain ectopic gastric tissue * Sx of melena, periumbilical pain, ulcerb (esp if gastric acid secreted) but often discovered incidentally * Dx via Technetium scan (taken up by parietal cells of gastric tissue) Rule of 2s: (mn) 1. 2% if population 2. M:F = 2:1 3. Within 2 feet of ileocecal valve 4. ~2" in size 5. Two --\> "true" diverticulum 6. two types of tissue 7. "T" for **two** and **technetium** scan
158
1st Aortic Arch forms
Maxillary artery (branch of external carotid)
159
2nd Aortic Arch forms
Stapedial artery and Hyoid artery
160
3rd Aortic Arch forms
Common Carotid artery and proximal part of Internal Carotid artery
161
4th Aortic Arch forms
L: Aortic arch R: Proximal part of Subclavian artery
162
6th Aortic Arch forms
Proximal part of pulmonary arteries and (on left only) ductus arteriosus
163
Branchial Apparatus AKA Composition with origin
Pharyngeal Apparatus "CAP" Clefts (grooves) from Ectoderm Arches from Mesoderm (muscles, arteries) and neural crest cells (bones, cartilage) Pouches from Endoderm
164
Branchial Clefts develop into
1st: External auditory meatus 2nd - 4th: form temporary cervical sinus which are obliterated by proliferation of 2nd arch mesenchyme
165
Persistent Cervical Sinus
Branchial cleft cyst within lateral neck
166
1st Branchial Arch Cartilage Muscles Nerves Pathology
Meckel's cartilage: Mandible, Malleus, incus, spheno-Mandibular ligament Muscles of Mastication (Temporalis, Masseter, Lat and Med Pterygoids), Mylohyoid, Anterior belly of the digastric, Tensor Tympani, Tensor Veli Palatini V2 and V3 Treacher Collins Syndrome --\> 1st arch crest fails to migrate --\> Mandibular hypoplasia and facial abnormalities
167
2nd Branchial Arch Cartilage Muscles Nerves
Reichert's Cartilage (Stapes, Styloid Process, Lesser horn of the Hyoid, Stylohyoid ligament) Muscles of facial expression, Stapedius, Stylohyoid, Posterior Belly of the Digastric CNVII
168
3rd Branchial Arch Cartilage Muscles Nerves Pathology
Greater horn of hyoid Stylopharyngeus CN IX ("swallow stylishly") Congenital Pharyngo-Cutaneous Fistula: Persistence of cleft and pouch --\> Fistula between tonsillar area, cleft in lateral neck
169
4th - 6th Branchial Arch Cartilage Muscles Nerves
Thyroid, Cricoid, Arytenoids, Corniculate, Cuneiform 4th: Most Pharyngeal Constrictors; Cricothyroid, Levator Veli Palatini 6th: All intrinsic muscles of larynx except cricothyroid CNX: 4th is superior laryngeal branch ("simply swallow"), 6th is recurrent laryngeal branch ("speak")
170
Branchial Arches Mnemonic
Chew, Smile, Swallow Stylishly, Simply Swallow, Speak
171
What forms posterior 1/3 of tongue
Branchia Arches 3 and 4
172
What does Branchia Arch 5 become?
5 makes no major developmental contributions
173
1st Branchial Pouch Develops into What does it contribute to?
Middle Ear Cavity, Eustachian Tube, Mastoid Air Cells Contributes to Endoderm-lined structures of ear
174
2nd Branchial Pouch develops into...
Epithelial lining of palatine tonsil
175
3rd Branchial pouch Develops into... Where does it end up
Dorsal wings develop into inferior parathyroids Ventral wing develops into Thymus Ends up below 4th
176
4th Branchial pouch develops into...
Dorsal wings develop into superior parathyroids
177
DiGeorge Syndrome What develops abnormally PathoPhys
Aberrant development of 3rd and 4th Branchial pouches T cell deficiency (Thymic aplasia) and Hypocalcemia (parathyroid doesn't develop)
178
Cleft Lip
Failure of fusion of maxillary and Medial Nasal Processes (formation of primary palate)
179
Cleft Palate
Failure of fusion of the lateral palatine processes, the nasal septum, and/or the median palatine process (formation of secondary palate)
180
Cleft Lip vs Cleft Palate
2 distinct etiologies but often occur together
181
Female genital development What kind of pathway? Ducts?
Default pathway Mesonephric duct degenerates and Paramesonephric duct develops
182
Phys of male genital development
SRY produces testes determining factor Sertoli cells secrete Mullerian Inhibitory Factor. Leydig cells secrete Testosterone that stimulate development of mesonephric ducts
183
Paramesonephric duct Name What does it develop into? Presentation of defect?
Mullerian Duct Fallopian tubes, uterus, upper vagina Primary amenorrhea with fully developed secondary sex characteristics
184
Mesonephric Duct Name What does it develop into?
Wolffian duct "SEED" Develops into Seminal vesicles, Epididymis, Ejaculatory duct, Ductus deferens
185
Bicornuate Uterus What is it? What can it lead to?
Incomplete fusion of Mullerian duct Can lead to urinary tract abnormalities and miscarriages
186
What does DHT do?
Promotes development of male external genitalia and prostate
187
What happens if there are no sertoli cells or no MIF?
Development of both male and female internal genitalia and male external genitalia
188
5αReductase Deficiency Chromosomes, Genitalia, Inheritance PathoPhys Presentation Hormonal findings
XY Internal genitalia normal AR Inability to convert T to DHT Ambiguous genitalia until puberty, when T causes masculinization and ↑ growth of external genitalia T and Estrogen levels are normal. LH normal or ↑
189
Genital Tubercle Male Female
Male: Glans, Corpus Cavernosum, Spongiosum Female: Glans Clitoris, Vestibular Bulbs
190
Urogenital Sinus Male Female
Bulbourethral glands, Prostate Greater vestibular glands of Bartholin and Urethral and Paraurethral glands of Skene
191
Urogenital folds Male Female
Ventral shaft of penis (penile urethra) Labia Minora
192
Labioscrotal swelling Male Female
Scrotum Labia Majora
193
Hypospadias What is it? What causes it? Frequency Why treat it?
"Hypo is Below" Abnormal opening of penile urethra on inferior (ventral) side of penis Due to failure of urethral folds to close More common than epispadias Fix to prevent UTIs
194
Epispadias What is it? What causes it? Association
"When you have Epispadias you hit your Eye when you pEE" Abnormal opening of penile urethra on superior (dorsal) side of penis Due to faulty positioning of genital tubercle Extrophy of the bladder
195
Gubernaculum What is it? Male remnant Female remnant
Band of Fibrous Tissue Anchors Testes within scrotum Ovarian ligament and Round ligament of the uterus
196
Processus Vaginalis What is it? Male remnant Female remnant
Evagination of peritoneum Forms tunica vaginalis Obliterated
197
Venous drainage of gonads?
L ovary/teste --\> L gonadal vein --\> L renal vein --\> IVC R ovary/teste --\> R gonadal vein --\> IVC
198
Lymphatic drainage of ovaries/testes
Para-Aortic Lymph Nodes
199
Lymphatic drainage of distal 1/3 of vagina, vulva, and scrotum
Superficial Inguinal Nodes
200
Lymphatic drainage of Proximal 2/3 of vagina and uterus?
Obturator, External Iliac and Hypogastric Nodes
201
On which side is Varicocele more common?
More common on Left because L venous pressure \> R venous pressure because L spermatic vein enters L renal vein at 90 degrees, so flow is less continuous on Left
202
Suspensory Ligament of the Ovaries Connects Structures contained
Ovaries to lateral pelvic wall Ovarian vessels
203
What can be damaged during oophorectomy?
Ureter is at risk during ligation of ovarian vessels in oophorectomy
204
Cardinal Ligament Connects Structures contained
Cervix to side wall of pelvis Uterine vessels
205
What can be damaged during hysterectomy?
Ureter at risk of injury during ligation of uterine vessels
206
Round Ligament of the Uterus Connects Structures contained Derivative from what? What does it travel through?
Uterine Fundus to Labia Majora Artery of Sampson Derivative of Gubernaculum Travels through round inguinal canal
207
Broad Ligament Connects Structures contained Components
Uterus, Fallopian Tubes, and Ovaries to Pelvic side wall Ovaries, Fallopian tubes, Round ligaments of the uterus Mesosalpinx, Mesometrium, Mesovarium
208
Ligament of the ovary Connects Structures contained Derivative from what?
"Latches ovary to Lateral uterus" Medial pole of ovary to lateral uterus None Derivative of gubernaculum
209
Vagina histology
Stratified Squamous Epithelium, Nonkeritinizing
210
Ectocervix histology
Stratified Squamous
211
Endocervix histology
Simple Columnar
212
Uterus Histology
Simple columnar, Pseudostratified tubular glands
213
Fallopian tube histology
Simple columnar, ciliated
214
Ovary histology
Simple cuboidal
215
Pathway of sperm
"SEVEN UP" Seminiferous tubules Epididymis Vas deferens Ejaculatory duct Nothing Urethra Penis
216
Erection System responsible? Nerve Pathway
Parasympathetic nervous system Pelvic nerve NO --\> ↑ cGMP --\> smooth muscle relaxation --\> vasodilation --\> proerectile
217
Nervous pathology of anti-erection
NE --\> ↑ [Ca] --\> smooth muscle contraction --\> vasoconstriction --\> antierectile
218
Nervous system responsible for emission Nerve?
Sympathetic nervous system Hypogastric nerve
219
Nerves responsible for Ejaculation
Visceral and Somatic Nerves Pudendal nerve
220
Spermatogonia Function What do they produce Location
Maintain germ pool Produce Primary Spermatocytes Line seminiferous tubules
221
Sertoli cells What do they secrete? Connections between cells? Function Effects of Temp? What changes temp?
Secretes inhibin (inhibits FSH), Androgen binding protein (maintains local levels of testosterone), AMH Tight junctions form blood-testis barrier --\> isolate gametes from autoimmune attack Support and nourish spermatozoa, Regulate spermatogenesis Temp sensitive: Varicocele or Cryptorchidism --\> ↑ Temp --\> ↓ sperm production and ↓ inhibin
222
Leydig Cells Secrete Effects of Temp? Location
Secrete Testosterone Unaffected by Temp Interstitium
223
Male Meiosis
Spermatogonium (2N2C) --\> Primary Spermatocytes (2N4C)--\> [Meiosis I] --\> Secondary Spermatocyte (1N2C) --\> [Meiosis II] --\> Spermatid (NC) --\> [Spermiogenesis] --\> Mature spermatozoon
224
Where are the tight junctions between Sertoli cells
Between Spermatogonium and Primary Spermatocytes
225
Time for full development of sperm?
2 months
226
Process of spermatogenesis
Loss of cytoplasmic contents and gain of acrosomal cap
227
Hormone pathways of Testes
Hypothalamus --\> GnRH --\> AP --\> FSH and LH FSH --\> Sertoli cells --\> ABP and Inhibin Inhibin --/ AP LH --\> Leydig cells --\> Testosterone --/ Hypothalamus and AP
228
Androgens Names w/ potency Source
DHT \> Testosterone \> Androstenedione T and D from testes, AnDrostenedione from ADrenal gland
229
Testosterone Functions
Differentiation of epididymis, vas deferens, seminal vesicles (internal genitalia except prostate) Growth spurt (penis, seminal vesicles, sperm, muscles, RBCs) Deepening of voice Closing of epiphyseal plates (via estrogen converted to testosterone) Libido
230
DHT functions Early Late
Differentiation of penis, scrotum and prostate Prostate growth, balding, sebaceous gland activity
231
What converts testosterone and androstenedione into estrogen
Aromatase in adipose tissue
232
Klinefelter's Syndrome Chromosomes Pathways Presentation Histo
XXY Dysgenesis of seminiferous tubule --\> ↓ inhibin --\> ↑ FSH Abnormal Leydig cell function --\> ↓ testosterone --\> ↑ LH --\> ↑ Estrogen Testicular atrophy, eunuchoid body shape, Tall, Long extremities, Gynecomastia, female hair distribution, Developmental delay Barr body
233
Turners Syndrome Chromosomes Pathways Presentation Gross anatomy Risk for? Histo
XO ↓ estrogen --\> ↑ LH and FSH Short, shield chest, amenorrhea, menopause before menarche Streak ovaries, bicuspid aortic valve, defective lymphatics --\> webbing of neck (cystic hygroma), lymphedema in feet and hands, Preductal coarctation of the aorta, horseshoe kidney Dysgerminoma No barr body
234
Double Y male Presentation Risks
Phenotypically normal, very tall, severe acne, normal fertility Antisocial behavior and autism spectrum disorder
235
Defective androgen receptor Testosterone LH
Testosterone ↑ LH ↑
236
Testosterone secreting tumor or exogenous steroids Testosterone LH
Testosterone ↑ LH ↓
237
Primary Hypogonadism Testosterone LH
Testosterone ↓ LH ↑
238
Hypogonadotropic Hypogonadism Testosterone LH
Testosterone ↓ LH ↓
239
Female pseudohermaphrodite Chromosomes Gonads External genitalia Cause
XX Ovaries Virilized or ambiguous genitalia Exposure to androgens during early gestation: congenital adrenal hyperplasia or exogenous administration
240
Male pseudohermaphrodite Chromosomes Gonads External genitalia Cause
XY Testes Female or ambiguous Androgen insensitivity syndrome is most common form
241
True Hermaphroditism Chromosomes Gonads Genitalia Frequency
XX or XXY Ovotestis Ambiguous genitalia Very rare
242
Androgen Insensitivity Syndrome PathoPhys External Genitalia Internal Genitalia What do they develop? Hormonal Findings?
Defective Androgen Receptor Normal appearing female with female external genitalia but with scant genital hair Rudimentary vagina. No Uterus or Fallopian tubes Testes in Labia Majora that must be surgically removed ↑ Testosterone, Estrogen, and LH
243
Kallmann Syndrome PathoPhys Presentation Findings
Defective migration of GnRH cells and formation of olfactory bulb Anosmia and lack of secondary sex characteristics ↓ GnRH, FSH, LH, T, and Sperm count
244
Abruptio Placentae What is it? Associated with what? ↑ risk with... Presentation Threat?
Premature detachment of placenta DIC Smoking, HTN, Cocaine Painful bleeding in 3rd trimester Life threatening for both fetus and mother
245
Placenta Accreta What is it? ↑ risk with... Presentation
Defective decidual layer allows placenta to attach to myometrium --\> No separation of placenta after birth Prior C section, Inflammation, Placenta previa Massive bleeding after delivery
246
Placenta previa What is it? ↑ risk with... Presentation
Attachment of placenta to lower uterine segment over internal cervical os Multiparity and prior C-section Painless bleeding in any trimester
247
Retained Placental Tissue leads to
Postpartum hemorrhage and ↑ risk of infection
248
Ectopic Pregnancy Most often location Presentation Dx Risk factors Often confused with... Histo
Fallopian tube Amenorrhea, lower than expected ↑ in hCG, sudden abdominal pain w/ or w/o bleeding US Infertility, PID, Rupture appendix, Tubal surgery Appendicitis Endometrial biopsy shows decidualized endometrium but no chorionic villi
249
Polyhydramnios Amount PathoPhys Associated with...
More than 1.5L Esophageal/Duodenal atresia --\> inability to swallow amniotic fluid Anencephaly
250
Oligohydramnios Amount PathoPhys What can it give rise to?
Less than .5L Placental insufficiency, bilateral renal agenesis, or posterior urethral valves (in males) leading to inability to excrete urine Potters Syndrome
251
Endometritis What is it? Treatment
Inflammation of the endometrium with retained products of conception following delivery (vaginal, C-section, miscarriage, abortion, foreign body) leads to bacterial infection from vaginal or intestinal flora Gentamycin + Clindamycin w/ or w/o Ampicillin
252
Gynecologic tumor epidemiology Incidence Prognosis
Endometrial \> Ovarian \> Cervical Ovarian \> Cervical \> Endometrial
253
Premature Ovarian Failure What is it? Presentation Findings
Premature atresia of ovarian follicles Menopause before age 40 ↓ estrogen, ↑ LH, ↑ FSH
254
Most common causes of anovulation
Pregnancy, PCOS, Obesity, HPO axis abnormalities, Premature Ovarian Failure, Hyperprolactinemia, Thyroid disorders, Eating disorders, Cushing's syndrome, Adrenal Insufficiency
255
Follicular Cyst What is it? Associated with? Frequency
Distention of unruptured graafian follicle Hyperestrinism and Endometrial Hyperplasia Most common ovarian mass in young women
256
Corpus Luteum Cyst What is it? Course
Hemorrhage into persistent corpus luteum Commonly regresses spontaneously
257
Theca Lutein Cyst # Cause? Associated with...
Bilateral and multiple Gonadotropin stimulation Choriocarcinoma and moles
258
Hemorrhagic Cyst What is it? Course
Blood vessel rupture into cyst wall. Cyst grows with ↑ blood retention Usually self resolves
259
Dermoid Cyst
Mature teratoma. Cystic growth with various tissues such as fat, hair, teeth, bone, cartilage
260
Endometrioid Cyst What is it? How does it vary Appearance with name
Endometriosis within ovary with cyst formation Varies with menstrual cycle When filled with dark, reddish brown blood it is called a chocolate cyst
261
Course of milk flow in breast
Lobules --\> Terminal duct --\> Major duct --\> Lactiferous sinus --\> Nipple
262
Fibroadenoma of the breast Characteristics Epidemiology Malignant? Hormones?
Small, Mobile, Firm Mass with sharp edges Most common tumor in those under 35 ↑ size and tenderness with ↑ estrogen Not a precursor to breast cancer
263
Intraductal Papilloma Size Location Presentation Malignant
Small tumor Lactiferous ducts, typically beneath areola Serous or bloody nipple discarge Benign with slight risk of carcinoma
264
Phyllodes Tumor Size Type of tissue Appearance Epidemiology Malignancy
Large and Bulky Connective tissue and Cysts Leaf-like projections Most common in 6th decade of life Some may become malignant
265
Malignant Breast Tumors When does it present Location Markers Prognostic factors Risk factors
Common postmenopause Terminal duct lobular unit in upper outer quadrant Estrogen/Progesterone receptors or c-erbB2 (HER2 an EGF receptor) Axillary lymph node involvement is important prognostic factor ↑ estrogen, total # of menstrual cycles, older age at 1st live birth, obesity, BRCA1, BRCA2 mutation
266
Ductal carcinoma in situ What kind of cancer? What does it look like Arise from Malignancy?
Noninvasive malignant breast tumor Fills ductal lumen Arises from ductal hyperplasia Early malignancy w/o basement membrane penetration
267
Comedocarcinoma What kind of cancer? Type Location Histo
Noninvasive malignant breast tumor Subtype of DCIS Ductal Caseous Necrosis
268
Invasive Ductal Breast Cancer What kind of cancer? Gross Histo Frequency Prognosis
Invasive malignant breast tumor Firm, fibrous, "rock hard" mass with sharp margins Small, glandular, duct-like cells with classic stellate morphology Most common (76%) Worst and most invasive
269
Invasive Lobular Breast Cancer What kind of cancer? Distribution Histo
Invasive malignant breast tumor Bilateral with multiple lesions in the same location Orderly row of cells (Indian File)
270
Medullary Breast Cancer What kind of cancer? Histo Prognosis
Invasive malignant breast tumor Fleshy, Cellular, Lymphocytic infiltrate Good prognosis
271
Inflammatory Breast Cancer What kind of cancer? PathoPhys Gross Prognosis
Invasive malignant breast tumor Dermal lymphatic invasion by breast carcinoma blocking lymphatic drainage Peau d'orange (breast skin resembles orange peel) 50% survival @ 5 years
272
Paget's Disease of Breast Gross Histo What does it suggest? Where else is it seen?
Eczematous patches on nipple Paget cells = large cells in epidermis with clear halo Suggets underlying DCIS Also seen on vulva
273
Fibrocystic Disease Epidemiology Presentation What does it indicate
Most common cause of breast lumps from 25 to menopause Premenstrual breast pain and multiple bilateral lesions. Fluctuations in size of mass Does not indicate risk of carcinoma
274
Fibrocystic Disease Subtypes
Fibrosis: hyperplasia of breast stroma Cystic: Fluid filled, blue dome. Ductal dilation Sclerosing adenosis: ↑ acini and intralobular fibrosis. Calcification. Often confused with cancer Epithelial hyperplasia: ↑ # of epithelial cell layers in terminal duct lobule. ↑ risk of carcinoma with atypical cells. Occurs in women over 30
275
Acute Mastitis What is it? When does it present What are they at risk for?
Breast abscess During breast feeding Risk of bacterial infection through cracks in nipple by S aureus
276
Fat Necrosis of the breast Dangerous? Presentation What causes it?
Benign Painless lump Injury (usually unreported)
277
What causes Gynecomastia?
Hyperestrogenism (Cirrhosis, Testicular tumor, Puberty, Old age) Klinefelter's Syndrome Drugs (Estrogen, Marijuana, Heroic, Psychoactive drugs, Spironolactone, Digitalis, Cimetidine, Alcohol, Ketoconazole) "Some Drugs Create Awkward Knockers"
278
Prostatitis Presentation Acute Cause Chronic Cause
Dysuria, Frequency, Urgency, Low back pain Acute: bacterial (E coli) Chronic: bacterial or abacterial (most common)
279
Benign Prostatic Hyperplasia Epidemiology PathoPhys Malignant
Men over 50 Nodular enlargement of periurethral (lateral and middle) lobes compresses urethra Not premalignant
280
Benign Prostatic Hyperplasia Presentation Complications Findings Treatment
Frequency, Nocturia, Dysuria, Difficulty starting and stopping stream Distention and Hypertrophy of the bladder, Hydronephrosis, UTIs ↑ PSA α1 antagonists (Terazosin, Tamsulosin), Finasteride
281
Prostatic Adenocarcinoma Epidemiology Location Diagnosis Tumor markers Metastasis?
Men over 50 Posterior lobe in peripheral zone ↑ PSA and subsequent biopsy Prostatic Acid Phosphatase and PSA Osteoblastic mets to bone present as lower back pain and ↑ AlkPhos
282
Cryptorchidism What is it? Consequences Associated with what? What increases risk for it? Labs
Undescended testis Impaired spermatogenesis (b/c of temp) but normal testosterone Risk of germ cell tumor Prematurity ↑ FSH, LH and ↓ inhibin (and testosterone if bilateral)
283
Varicocele PathoPhys Consequences Location Can lead to... Gross How is Diagnosis made? Treatment
Dilated veins in Pampiniform plexus b/c of ↑ venous pressure Most common cause of scrotal enlargement More common on Left Infertility Bag of Worms appearance Diagnosed by US Varicocelectomy, Embolization
284
Testicular Germ Cell Tumor Frequency Danger? Can present as... DDx
95% of all testicular tumors Most often malignant Can present as mixed germ cell tumor Testicular mass that does not transilluminate
285
Seminoma What kind of cancer? Malignant? Presentation Epidemiology Histo Labs Treatment Prognosis
Testicular Germ Cell Tumor Malignant Painless homogenous testicular enlargement Most common testicular tumor mostly affecting males 15-35 Large cells in lobules with watery cytoplasm and fried egg appearance Placental ALP Radiosensitive Late metastasis with excellent prognosis
286
Yolk Sac (endodermal sinus) tumor in males What kind of cancer? Gross Analog Histo Labs
Testicular Germ Cell Tumor Yellow, Mucinous Analogous to ovarian yolk sac tumor Schiller-Duval Bodies resemble primitive glomeruli ↑ AFP
287
Choriocarcinoma in males What kind of cancer? Danger? Labs What is it made of? Metastasis? Complications
Testicular Germ Cell Tumor Malignant Increased hCG Syncuytiotrophoblastic and Cytotrophoblastic elements Hematogenous mets to lungs Gynecomastia because of hCG
288
Teratoma in male What kind of cancer? Malignant? Labs
Testicular Germ Cell Tumor Unlike in females, malignant in adults Benign in children ↑ hCG +/or AFP in 50% of cases
289
Embryonal Carcinoma What kind of cancer? Danger? Presentation Prognosis Histo Pure? Labs
Testicular Germ Cell Tumor Malignant Painful Worse prognosis that seminoma Glandular/Papillary morphology Pure version is rare, most commonly mixed ↑ hCG and normal AFP (if pure). ↑ AFP when mixed
290
Testicular Non-Germ Cell Tumor Frequency Danger
5% of all testicular cancers Mostly benign
291
Leydig cell cancer What kind of cancer Histo What does it produce? Presentation Gross
Testicular non-Germ Cell Tumor Reinke Crystals Androgen producing Gynecomastia in men, precocious puberty in boys Golden Brown color
292
Sertoli cell Cancer What kind of cancer Description Origin
Testicular non-Germ Cell Tumor Androblastoma From sex cord stroma
293
Testicular Lymphoma What kind of cancer? Epidemiology Origin Course
Testicular non-Germ Cell Tumor Most common testicular caner in older men Arises from lymphoma metastases to testes Aggressive
294
Tunica Vaginalis Lesions What is it? Presentation Types w/ causes
Lesions in the serous covering of testis Present as testicular masses that can be transilluminated (vs testicular tumors) Hydrocele: ↑ fluid secondary to incomplete fusion of processus vaginalis Spermatocele: Dilated Epididymal Duct
295
Squamous Cell Carcinoma of the Penis Epidemiology Association
Asia, Africa, and South America HPV and lack of circumcision
296
Peyronie's Disease
Bent Penis due to acquired fibrous tissue formation
297
Priapism What is it? Causes
Painful sustained erection not associated with stimulation or desire Trauma, Sickle Cell Disease (RBCs trapped in vascular channel), Medication (anticoagulants, PDE5 inhibitors, antidepressants, α blockers, cocaine
298
danger weeks for teratogens
weeks 3-8 mn: 8 is symbol for infinity --\> what you do during pregancy has effects that last forever
299
T/F: During weeks 1 and 2 of development, a teratogen may cause the conceptus to die (all effect), but the conceptus may also live without any effects at all (none effect).
TRUE, this is called the all-or-none effect of teratogens? by contrast during weeks 3-8 this is not true and the effect is present in varyind degrees, and is less likely to kill the fetus alltogether
300
Which set of structures, in correct sequence, gives rise to an embryo?
inner cell mass --\> epiblast --\> embryo
301
omphalocele vs gastroschisis
1. **omphalocele** herniates through umbilical cord and is covered by peritoneum; good GI function; A/W other congenital conditions 2. **gastroschisis** herniates to the right of umbilical cord and is not covered by peritoneum; poor GI function d/t damaged bowels; NOT A/W other congenital conditions
302
omphalocele is A/w
* trisomy 21, 18 and 13 * Congenital heart defects * orofacial clefts * neural tube defects

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