Flashcards in Reproductive Deck (136)
Suspensory ligament of the ovaries
Contains ovarian vessels. Ovaries to lateral pelvic wall. Ureter at risk of injury during ligation of these vessels
Contains uterine vessels. Ureter at risk of injury during ligation of these vessels in hysterectomy
Round ligament of the uterus
Nothing contained in this. Connects uterine fundus to labia majora
Contains ovaries, fallopian tubes, and round ligaments of uterus. Mesosalpinx, mesometrium, and mesovarium are components of the broad ligament
Ligament of the ovary
Attaches ovary to lateral uterus
Histology of the ovary and fallopian tube respectively
Ovary - simple cuboidal, tube - simple columnar ciliated
Pathway of sperm
SEVEN UP. Seminiferous tubules, Epididymis, Vas deferens, Ejaculatory ducts, (nothing), Urethra, Penis
What nerves are responsible for erection, emission and ejactulation repsectively?
Erection - pelvic (parasympathetic), Emission - hypogastric (sympathetic), Ejaculation - pudendal (visceral and somatic)
What do sertoli cells and leydig cells respectively respond to and secrete?
Sertoli - respond to FSH, secrete inhibin. Leydig - respond to LH, secrete testosterone
Besides secreting inhibin, what are 4 other functions of sertoli cells
1) Secrete androgen binding protein, 2) Produce anti-mullerian hormone, 3) Isolate gametes with tight junctions, 4) Support and regulate spermatogenesis
What happens to inhibin levels at high temperatures?
They go down (sertoli cells are temp sensitive)
What happens to testosterone levels at high temperatures?
Nothing. Leydig cells are not temp sensitive like Sertoli cells are
Give cells in spermatogenesis in order and indicate chromosome status at each step
Spermatogonium (2N), Primary spermatocyte (4N), Secondary spermatocyte (2N), Spermatid (N), Spermatozoon (N)
Potency of androgens
DHT more potent than Testosterone more potent than Androstenedione
Where is androstenedione made?
Potency of estrogens
Estradiol more potent than estrone more potent than estriol
What hormone is used as an indicator of fetal well being?
Estriol (increases 1000 fold in pregnancy)
What is the primary product of the granulosa cell and the theca cell respectively and to which hormone does each respond?
Theca - responds to LH and makes androstenedione, Granulosa - responds to FSH and makes estrogen (from androstenedione)
In which menstrual phase will you see straight glands in the endometrium and in which phase will you see tortuous glands?
Proliferative phase - straight glands and arteries, Secretory phase - tortuous glands and arteries
What happens to endometrial cells during menstruation?
Blood from a ruptured follicle causing peritoneal irritation that can mimic appendicitis
At what stage is the oocyte arrested until ovulation
Prophase of Meiosis I
At what stage is an oocyte arrested between ovulation and fertilization?
Metaphase of Meiosis II
Cells in oogenesis and the chromosome status of each
Oogonium (2N), Primary Oocyte (4N), Secondary Oocyte (2N), Ovum (N)
Prolactin, progesterone, and estriol more or less increase linearly during pregnancy. What hormone does not follow this pattern and what pattern does it follow?
hCG. Peaks early (10 weeks) and declines significantly after that
Test of choice to confirm menopause
FSH (will be greatly increased due to loss of negative feedback from declining estrogen levels)
Symptoms of menopause
HHAVOC. Hirsutism, Hot flashes, Atrophy of the Vagina, Osteoporosis, Coronary artery disease
Genetics and findings of Klinefelters
XXY. Testicular atrophy, tall, long extremities, gynecomastia, female hair distribution.
Lab findings in Klinefelters
FSH - low or normal, LH - elevated, Testosterone - usually elevated, Estrogens - normal or elevated
What will testicular biopsy show in Klinefelters?
Sparse, hyalinized seminiferous tubules
Genetics and findings in Turners
XO. Short, streak ovary, shield chest, bicuspid aortic valve, webbing of neck (cystic hygroma), lypmhedema in feet and hands, coarctation, horshoe kidney, dysgerminoma
Lab findings in Turners
Decreased estrogen, Increased LH and FSH
Most common cause of primary amenorrhea
Most common cause of female pseudo-hermaphrodite (XX with virilized external genitalia)
CAH, Exogenous androgens during pregnancy, or other cause of exposure to androgens during gestation
Most common cause of male pseudo-hermaphrodite (XY but ambiguous or female external genitalia)
Androgen insensitivity syndrome (testicular feminization)
Lab findings in androgen insensitivity syndrome
Increased testosterone, estrogen, and LH
AR (but only males can have it). Normal labs. Ambiguous genital until puberty (penis at 12). Otherwise normal
Defective development of GnRH cells and olfactory placode. Anosmia, lack of secondary sexual characteristics. AD. Low GnRH, FSH, LH, Testosterone, and sperm count
Main features of preeclampsia
HTN, proteinuria, edema
Most common cause of death in preeclampsia
Cerebral hemorrhage or ARDS
Headache, blurred vision, abdominal pain, edema, altered mentation, hyperreflexia in pregnant woman
Treatment for eclampsia
Magnesium sulfate and diazepam
What increases risk of placental abruption?
Smoking, HTN, cocaine use
What increases risk of placenta accreta (failure of placental detachment after delivery)?
Prior c-section, inflammation, and placenta previa
What increases risk of placenta previa (attachment of placenta to lower uterine segment)?
Multiparity and prior c-section
What is the main difference in presentation of placenta previa and placental abruption?
Placenta previa creates bleeding in ANY trimester, placental abruption only occurs in the third trimester
Risk factors for ectopic pregnancy
History of infertility, salpingits (PID), ruptured appendix, prior tubal surgery
At what point does maternal age become a factor in infertility?
Age greater than or equal to 35
What is seen histologically in invasive SCC of the cervix?
Pyknotic nuclei, dense cytoplasm, and perinuclear clearing
Treatment for endometritis (inflammation due to retained products of conception, abortion, or foreign body)
Cefoxitin, ticarcillin-clavulanate, ampicillin-sulbactam
How do you distinguish between endometriosis and adenomyosis?
Ultrasound. Uterus is normal sized in endometriosis and is large in adenomyosis
Treatment for endometriosis
Menorrhagia, dysmenorrhea, dyspareunia, pelvic pain.
May be endometriosis or adenomyosis. Do ultrasound to distinguish the to (uterine size)
Whorled pattern of smooth muscle bundles
Lab findings in PCOS
Increased LH, Testosterone, and Estrogen. Decreased FSH
Treatment for PCOS
Weight loss, low-dose OCPs or medroxyprogesterone, spironolactone, clomiphene (if woman wants to get pregnant)
OCPs reduce the risk of which cancer and how?
Ovarian cancer by reducing total ovulations
Mature teratoma (various types of tissue like hair, teeth, etc)
Teratoma containing functional thyroid tissue in the ovary. Can present as hyperthyroidism
Benign and unilateral ovarian tumor. Looks like bladder. Pale yellow-tan and appears encapsulated. Coffee bean nuclei on H and E
What type of tumor is responsible for pseudomyxoma peritonei?
Mucinous cystadenocarcinoma of the ovary. Appendiceal tumors can also do it
Ovarian fibroma, ascites, hydrothorax. Pulling sensation in the groin
What does a granulosa cell tumor secrete and what are two functional consequences of this?
Estrogen. Can present with precocious puberty, also can cause endometrial hyperplasia or carcinoma
Small follicles filled with eosinophilic secretions associated with granulosa cell tumors
Vaginal carcinoma in girls under 4
Sarcoma botryoides (rhabdomyosarcoma variant). Spindle shaped tumor cells that are desmin positive
Give the pathology associated with each of the following parts of the breast: nipple, lactiferous sinus, major duct, terminal duct, lobule, and stroma
Nipple - Pagets, abcess. Lactiferous sinus - intraductal papilloma, abscess, mastitis. Major duct - fibrocystic change, ductal cancer. Terminal duct - tubular carcinoma. Lobule - lobular carcinoma, sclerosing adenosis. Stroma - fibroadenoma, phyllodes tumor
What is the most common breast tumor in women under 35?
What breast tumor is increasingly tender at high estrogen times (pregnancy, menstruation, etc)
Outcome of fibroadenoma
Not a precursor of breast cancer
List the benign breast tumors
Fibroadenoma (no progression), intraductal papilloma (may mean increased risk of cancer), phyllodes tumor (some may become malignant)
Where are intraductal papillomas typically found?
Characteristics of breast fibroadenomas
Small, mobile, firm mass with sharp edges
Characteristics of phyllodes tumors
Large bulky mass of connective tissue and cysts with leaf like projections
Where do malignant breast tumors arise from?
Mammary duct epithelium or lobular glands
Risk factors for malignant breast cancer
Increased estrogen exposure (and all the things that cause this)
Ductal carcinoma in situ
Fills duct lumen, arises from ductal hyperplasia
Ductal malignancy with caseous central necrosis. Subtype of DCIS. If you see something with a center that looks very different, pick this one
What is the appearance of invasive ductal breast cancer and what is this appearance due to?
Firm, fibrous, rock hard mass with sharp margins and small glandular duct like cells. Stellate morphology. This is due to suspensory ligament infiltration
Worst and most invasive breast cancer
Invasive ductal. Also the most common
Which breast cancer looks like an orderly row of cells?
Which breast cancer is often multiple and bilateral?
Appearance of medullary breast cancer
Fleshy, cellular, lymphocytic infiltrate. Good prognosis
Which breast cancer is associated with peau d orange?
Inflammatory. Neoplastic cells block lymphatic drainage
Appearance of Pagets disease of the breast
Eczematous patches on the nipple. Paget cells are large cells in epidermis with a clear halo
Premenstrual breast pain, multiple often bilateral lesions, fluctuation in size of mass.
Fibrocystic disease of the breast
Histologic types of fibrocystic disease of the breast
Fibrosis, cystic, sclerosing adenosis (increased acini and intralobular fibrosis with calcifications), epithelial hyperplasia (inc risk of carcinoma if atypical)
What is the most common pathogen in acute mastitis?
Benign painless breast lump following trauma
Fat necrosis. 50 percent do not report trauma
Drugs that cause gynecomastia
Estrogen, marijuana, heroin, psychoactive drugs, spironolactone, digitalis, cimetidine, alcohol, ketoconazole
Where in the prostate do BPH and prostate cancer respectively tend to develop?
BPH - centrally (middle and anterior lobes), Cancer - posterior lobe
Lower back pain, increased alk phos, increased PSA and/or PAP
Suspect metastatic prostate adenocarcinoma. Will also present with urinary symptoms if very advanced
Why might a left varicocele accompany nephrotic syndrome?
Loss of antithrombin 3 in urine leads to thrombus in left renal vein, increases pressure in left scrotum
What remote symptom can you get in choriocarcinoma and teratoma and why?
Hyperthyroidism. hCG is similar to TSH and may stimulate T3 and T4 production
How can you tell a pure embryonal carcinoma apart from a mixed embryonal carcinoma
Mixed - increased AFP, pure - normal AFP
Histologic appearance of seminoma
Large cells in lobules with watery cytoplasm and fried egg appearance
Which testicular tumor resembles primitive glomeruli and what is its tumor marker?
Yolk sac tumor. AFP
Difference between mature teratoma in women and in men
In men it is most often malignant
Hydrocele is contained by what structure?
GnRH analog (agonist when given pulsatile, antagonist when given continuously). Use for infertility, prostate cancer, fibroids
Aromatase inhibitor, used to treat ER-positive breast cancer
5a-reductase inhibitor. Use in BPH. Promotes hair growth but may cause gynecomastia
Competitive inhibitor at testosterone receptor. Use in prostate cancer
Inhibits steroid synthesis
Inhibits steroid binding to receptor
List 3 pharmaceutically used estrogens
Ethinyl estradiol, DES, mestranol
Human menopausal gonadotropin. Acts like FSH to stimulate primary follicle. Use in infertility
What is given to induce ovulation in infertility treatment?
A large dose of hCG (simulates LH surge)
SERM (agonist in hypothal). Stimulates ovulation, use to treat infertility in PCOS
SERM. Agonist on bone, used to treat osteoporosis
Anastrozole and Exemestane
Aromatase inhibitors used in postmenopausal women with breast cancer
Competitive inhibitor at progesterone receptor. Abortion.
Ritodrine and terbutaline
B2 agonists that relax the uterus and reduce premature contractions
Alpha-1 antagonist. Use in BPH. Selective targets receptors in prostate (alpha 1-a,d)
Sildenafil and vardenafil
PDE inhibitors. Use in erectile dysfunction
Synthetic androgen. Use in endometriosis and hereditary angioedema
Where are the two main androgens in women made?
Testosterone - ovary, DHEA sulfate - adrenals. So if you have virilization, check those two levels and it will tell you which organ is the problem
Most common cause of hirsutism
Levels of androgens and estrogens in PCOS and effects on FSH and LH
Both high. Excess production of androgens and aromatization to estrogens. High estrogen levels suppress FSH and increase LH (which causes theca cells to make more testosterone, repeating cycle)
What breaks the cycle of PCOS and how?
OCPs. They suppress LH (which is inciting testosterone production, which gets aromatized to estrogens, which leads to high LH levels)
Most common primary and secondary causes of dysmenorrhea
Primary - too much PGF (prostaglandin that increases contraction). Secondary - endometriosis
Most common cause of anovulatory bleeding
Sufficient estrogen stimulation without sufficient progesterone stimulation
Pain on defecation during period but no pain on defecation the rest of the time
Endometriosis to the pouch of douglas
GYN cancer ages
Cervical - 45, Endometrial - 55, Ovarian - 65
Most common cause of ovarian mass in a young woman
Follicular cyst. Not neoplastic. May cause peritonitis and suddent pain
Most common primary malignant ovarian tumor
Serous cystadenocarcinoma. PSAMMOMA BODIES
Causes of choriocarcinoma
15 percent from preexisting hydatidiform mole. 25 pct from spontaneous abortion, 25 pct from normal preggers
Where do choriocarcinomas tend to metastasize to?
Most common cause of bloody nipple discharge of a woman under 50
Intraductal papilloma (benign)
Where do most breast cancers arise from
What tumors of the breast and ovary respectively are classically bilateral?
Breast - lobular carcinoma. Ovary - serous tumors
What type of breast cancers dont get picked up by mammography?
Most common cause of mass in breast of a woman over 50
Infiltrating ductal carcinoma (mammography not sensitive to pick it up when it is simply intraductal)
Ductal hyperplasia a precusor lesion for breast cancer. What are these hyperplastic cells sensitive to?
When cancers present as a palpable mass, is the mass typically painful or painless?
Painless. Painful masses are more characteristic of an inflammatory process
First step in the management of a palpable breast mass
Fine needle aspiration (same as for a nodule in thyroid)