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Flashcards in Reproductive Deck (136)
1

Suspensory ligament of the ovaries

Contains ovarian vessels. Ovaries to lateral pelvic wall. Ureter at risk of injury during ligation of these vessels

2

Cardinal ligament

Contains uterine vessels. Ureter at risk of injury during ligation of these vessels in hysterectomy

3

Round ligament of the uterus

Nothing contained in this. Connects uterine fundus to labia majora

4

Broad ligament

Contains ovaries, fallopian tubes, and round ligaments of uterus. Mesosalpinx, mesometrium, and mesovarium are components of the broad ligament

5

Ligament of the ovary

Attaches ovary to lateral uterus

6

Histology of the ovary and fallopian tube respectively

Ovary - simple cuboidal, tube - simple columnar ciliated

7

Pathway of sperm

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

8

What nerves are responsible for erection, emission and ejactulation repsectively?

Erection - pelvic (parasympathetic), Emission - hypogastric (sympathetic), Ejaculation - pudendal (visceral and somatic)

9

What do sertoli cells and leydig cells respectively respond to and secrete?

Sertoli - respond to FSH, secrete inhibin. Leydig - respond to LH, secrete testosterone

10

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

11

What happens to inhibin levels at high temperatures?

They go down (sertoli cells are temp sensitive)

12

What happens to testosterone levels at high temperatures?

Nothing. Leydig cells are not temp sensitive like Sertoli cells are

13

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)

14

Potency of androgens

DHT more potent than Testosterone more potent than Androstenedione

15

Where is androstenedione made?

Adrenal glands

16

Potency of estrogens

Estradiol more potent than estrone more potent than estriol

17

What hormone is used as an indicator of fetal well being?

Estriol (increases 1000 fold in pregnancy)

18

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)

19

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

20

What happens to endometrial cells during menstruation?

Apoptosis

21

Mittelschmerz

Blood from a ruptured follicle causing peritoneal irritation that can mimic appendicitis

22

At what stage is the oocyte arrested until ovulation

Prophase of Meiosis I

23

At what stage is an oocyte arrested between ovulation and fertilization?

Metaphase of Meiosis II

24

Cells in oogenesis and the chromosome status of each

Oogonium (2N), Primary Oocyte (4N), Secondary Oocyte (2N), Ovum (N)

25

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

26

Test of choice to confirm menopause

FSH (will be greatly increased due to loss of negative feedback from declining estrogen levels)

27

Symptoms of menopause

HHAVOC. Hirsutism, Hot flashes, Atrophy of the Vagina, Osteoporosis, Coronary artery disease

28

Genetics and findings of Klinefelters

XXY. Testicular atrophy, tall, long extremities, gynecomastia, female hair distribution.

29

Lab findings in Klinefelters

FSH - low or normal, LH - elevated, Testosterone - usually elevated, Estrogens - normal or elevated

30

What will testicular biopsy show in Klinefelters?

Sparse, hyalinized seminiferous tubules

31

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

32

Lab findings in Turners

Decreased estrogen, Increased LH and FSH

33

Most common cause of primary amenorrhea

Turner syndrome

34

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

35

Most common cause of male pseudo-hermaphrodite (XY but ambiguous or female external genitalia)

Androgen insensitivity syndrome (testicular feminization)

36

Lab findings in androgen insensitivity syndrome

Increased testosterone, estrogen, and LH

37

5-alpha-reductase deficiency

AR (but only males can have it). Normal labs. Ambiguous genital until puberty (penis at 12). Otherwise normal

38

Kallman syndrome

Defective development of GnRH cells and olfactory placode. Anosmia, lack of secondary sexual characteristics. AD. Low GnRH, FSH, LH, Testosterone, and sperm count

39

Main features of preeclampsia

HTN, proteinuria, edema

40

Most common cause of death in preeclampsia

Cerebral hemorrhage or ARDS

41

Headache, blurred vision, abdominal pain, edema, altered mentation, hyperreflexia in pregnant woman

Preeclampsia

42

Treatment for eclampsia

Magnesium sulfate and diazepam

43

What increases risk of placental abruption?

Smoking, HTN, cocaine use

44

What increases risk of placenta accreta (failure of placental detachment after delivery)?

Prior c-section, inflammation, and placenta previa

45

What increases risk of placenta previa (attachment of placenta to lower uterine segment)?

Multiparity and prior c-section

46

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

47

Risk factors for ectopic pregnancy

History of infertility, salpingits (PID), ruptured appendix, prior tubal surgery

48

At what point does maternal age become a factor in infertility?

Age greater than or equal to 35

49

What is seen histologically in invasive SCC of the cervix?

Pyknotic nuclei, dense cytoplasm, and perinuclear clearing

50

Treatment for endometritis (inflammation due to retained products of conception, abortion, or foreign body)

Cefoxitin, ticarcillin-clavulanate, ampicillin-sulbactam

51

How do you distinguish between endometriosis and adenomyosis?

Ultrasound. Uterus is normal sized in endometriosis and is large in adenomyosis

52

Treatment for endometriosis

Danazol

53

Menorrhagia, dysmenorrhea, dyspareunia, pelvic pain.

May be endometriosis or adenomyosis. Do ultrasound to distinguish the to (uterine size)

54

Whorled pattern of smooth muscle bundles

Leimyoma (fibroid)

55

Lab findings in PCOS

Increased LH, Testosterone, and Estrogen. Decreased FSH

56

Treatment for PCOS

Weight loss, low-dose OCPs or medroxyprogesterone, spironolactone, clomiphene (if woman wants to get pregnant)

57

OCPs reduce the risk of which cancer and how?

Ovarian cancer by reducing total ovulations

58

Dermoid cyst

Mature teratoma (various types of tissue like hair, teeth, etc)

59

Struma ovarii

Teratoma containing functional thyroid tissue in the ovary. Can present as hyperthyroidism

60

Brenner tumor

Benign and unilateral ovarian tumor. Looks like bladder. Pale yellow-tan and appears encapsulated. Coffee bean nuclei on H and E

61

What type of tumor is responsible for pseudomyxoma peritonei?

Mucinous cystadenocarcinoma of the ovary. Appendiceal tumors can also do it

62

Meigs syndrome

Ovarian fibroma, ascites, hydrothorax. Pulling sensation in the groin

63

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

64

Call-Exner bodies

Small follicles filled with eosinophilic secretions associated with granulosa cell tumors

65

Vaginal carcinoma in girls under 4

Sarcoma botryoides (rhabdomyosarcoma variant). Spindle shaped tumor cells that are desmin positive

66

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

67

What is the most common breast tumor in women under 35?

Fibroadenoma

68

What breast tumor is increasingly tender at high estrogen times (pregnancy, menstruation, etc)

Fibroadenoma

69

Outcome of fibroadenoma

Not a precursor of breast cancer

70

List the benign breast tumors

Fibroadenoma (no progression), intraductal papilloma (may mean increased risk of cancer), phyllodes tumor (some may become malignant)

71

Where are intraductal papillomas typically found?

Beneath areola

72

Characteristics of breast fibroadenomas

Small, mobile, firm mass with sharp edges

73

Characteristics of phyllodes tumors

Large bulky mass of connective tissue and cysts with leaf like projections

74

Where do malignant breast tumors arise from?

Mammary duct epithelium or lobular glands

75

Risk factors for malignant breast cancer

Increased estrogen exposure (and all the things that cause this)

76

Ductal carcinoma in situ

Fills duct lumen, arises from ductal hyperplasia

77

Comedocarcinoma

Ductal malignancy with caseous central necrosis. Subtype of DCIS. If you see something with a center that looks very different, pick this one

78

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

79

Worst and most invasive breast cancer

Invasive ductal. Also the most common

80

Which breast cancer looks like an orderly row of cells?

Invasive lobular

81

Which breast cancer is often multiple and bilateral?

Invasive lobular

82

Appearance of medullary breast cancer

Fleshy, cellular, lymphocytic infiltrate. Good prognosis

83

Which breast cancer is associated with peau d orange?

Inflammatory. Neoplastic cells block lymphatic drainage

84

Appearance of Pagets disease of the breast

Eczematous patches on the nipple. Paget cells are large cells in epidermis with a clear halo

85

Premenstrual breast pain, multiple often bilateral lesions, fluctuation in size of mass.

Fibrocystic disease of the breast

86

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)

87

What is the most common pathogen in acute mastitis?

Staph aureus

88

Benign painless breast lump following trauma

Fat necrosis. 50 percent do not report trauma

89

Drugs that cause gynecomastia

Estrogen, marijuana, heroin, psychoactive drugs, spironolactone, digitalis, cimetidine, alcohol, ketoconazole

90

Where in the prostate do BPH and prostate cancer respectively tend to develop?

BPH - centrally (middle and anterior lobes), Cancer - posterior lobe

91

Lower back pain, increased alk phos, increased PSA and/or PAP

Suspect metastatic prostate adenocarcinoma. Will also present with urinary symptoms if very advanced

92

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

93

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

94

How can you tell a pure embryonal carcinoma apart from a mixed embryonal carcinoma

Mixed - increased AFP, pure - normal AFP

95

Histologic appearance of seminoma

Large cells in lobules with watery cytoplasm and fried egg appearance

96

Which testicular tumor resembles primitive glomeruli and what is its tumor marker?

Yolk sac tumor. AFP

97

Difference between mature teratoma in women and in men

In men it is most often malignant

98

Hydrocele is contained by what structure?

Tunica vaginalis

99

Leuprolide

GnRH analog (agonist when given pulsatile, antagonist when given continuously). Use for infertility, prostate cancer, fibroids

100

Exemestane

Aromatase inhibitor, used to treat ER-positive breast cancer

101

Finasteride

5a-reductase inhibitor. Use in BPH. Promotes hair growth but may cause gynecomastia

102

Flutamide

Competitive inhibitor at testosterone receptor. Use in prostate cancer

103

Ketoconazole

Inhibits steroid synthesis

104

Spironolactone (repro)

Inhibits steroid binding to receptor

105

List 3 pharmaceutically used estrogens

Ethinyl estradiol, DES, mestranol

106

Menotropin

Human menopausal gonadotropin. Acts like FSH to stimulate primary follicle. Use in infertility

107

What is given to induce ovulation in infertility treatment?

A large dose of hCG (simulates LH surge)

108

Clomiphene

SERM (agonist in hypothal). Stimulates ovulation, use to treat infertility in PCOS

109

Raloxifene

SERM. Agonist on bone, used to treat osteoporosis

110

Anastrozole and Exemestane

Aromatase inhibitors used in postmenopausal women with breast cancer

111

Mifepristone

Competitive inhibitor at progesterone receptor. Abortion.

112

Ritodrine and terbutaline

B2 agonists that relax the uterus and reduce premature contractions

113

Tamsulosin

Alpha-1 antagonist. Use in BPH. Selective targets receptors in prostate (alpha 1-a,d)

114

Sildenafil and vardenafil

PDE inhibitors. Use in erectile dysfunction

115

Danazol

Synthetic androgen. Use in endometriosis and hereditary angioedema

116

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

117

Most common cause of hirsutism

PCOS

118

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)

119

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)

120

Most common primary and secondary causes of dysmenorrhea

Primary - too much PGF (prostaglandin that increases contraction). Secondary - endometriosis

121

Most common cause of anovulatory bleeding

Sufficient estrogen stimulation without sufficient progesterone stimulation

122

Pain on defecation during period but no pain on defecation the rest of the time

Endometriosis to the pouch of douglas

123

GYN cancer ages

Cervical - 45, Endometrial - 55, Ovarian - 65

124

Most common cause of ovarian mass in a young woman

Follicular cyst. Not neoplastic. May cause peritonitis and suddent pain

125

Most common primary malignant ovarian tumor

Serous cystadenocarcinoma. PSAMMOMA BODIES

126

Causes of choriocarcinoma

15 percent from preexisting hydatidiform mole. 25 pct from spontaneous abortion, 25 pct from normal preggers

127

Where do choriocarcinomas tend to metastasize to?

Lungs

128

Most common cause of bloody nipple discharge of a woman under 50

Intraductal papilloma (benign)

129

Where do most breast cancers arise from

Major ducts

130

What tumors of the breast and ovary respectively are classically bilateral?

Breast - lobular carcinoma. Ovary - serous tumors

131

What type of breast cancers dont get picked up by mammography?

Lobular

132

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)

133

Ductal hyperplasia a precusor lesion for breast cancer. What are these hyperplastic cells sensitive to?

Estrogen

134

When cancers present as a palpable mass, is the mass typically painful or painless?

Painless. Painful masses are more characteristic of an inflammatory process

135

First step in the management of a palpable breast mass

Fine needle aspiration (same as for a nodule in thyroid)

136

Do women who are premenopausal or postmenopausal tend to ER PR positivity in their breast cancer?

Postmenopausal have more ER PR positivity. This is because presence of estrogen (in premenopausal women) leads to receptor downregulation