Reproductive - First Aid Flashcards Preview

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Flashcards in Reproductive - First Aid Deck (477):
1

Sonic hedgehog gene is produced at the...

base of the limbs in the zone of polarizing activity.

2

Sonic hedgehog gene is involved in..

patterning along the anterior posterior axis and CNS development.

3

Mutation of the sonic hedgehog gene can cause....

holoprosencephaly.

4

The Wnt-7 gene is produced at...

the apical ectodermal ridge (a thickened ectoderm at the distal end of each developing limb.

5

Wnt-7 gene is necessary for...

proper organization along the dorsal-ventral axis.

6

FGF gene is produced at the....

apical ectodermal ridge.

7

FGF gene stimulates....

mitotis of the underlying mesoderm providing for lengthening of limbs.

8

Homeobox (Hox) gene is involved in...

segmental organization of the embryo in a craniocaudlal direction.

9

Hox mutations lead to...

appendages in the wrong locations.

10

Day 0 of fetal development

fertilization by sperm, forming zygote, initiating embryogenesis

11

Fetal development within one week

hCG secretion begins around the time of implantation of the blastocyst

12

Fetal development within 2 weeks

bilaminar disc (epiblast, hypoblast) (2 weeks = 2 layers)

13

Fetal development within 3 weeks

trilaminar disc (3 wks = 3 layers) gastrulation primitive streak, notochord, mesoderm, neural plate begin to form

14

Fetal development during wks 3-8 (embryonic period)

neural tube formed by neuroectoderm and closes by wk 4; organogenesis **extremely susceptible to teratogens

15

Fetal development within within wk 4

heart begins to beat upper and lower limb buds (week 4 = 4 chambers, 4 limbs)

16

Fetal development within week 6

fetal cardiac activity is visible by transvaginal ultrasound

17

Fetal development within week 10

genitalia have male/female characteristics

18

Gastrulation is the process that...

forms the trilaminar embryonic disc. It establishes the ectoderm, mesoderm and endoderm germ layers.

19

Gastrulation starts with the....

epiblast invaginating to form the primitve streak.

20

Surface ectoderm derivatives (8)

-adenohypophysis -lens of eye -epithelial linings of oral -sensory organs of the ear -olfactory epithelium -epidermis -anal canal below pectinate line -parotid, sweat and mammary glands

21

A craniopharyngioma is...

a benign Rathke pouch tumor with cholesterol crystals and calcifications. (surface ectoderm derivative)

22

Neuroectoderm derivatives (3)

-brain (neurohypophysis, CNS neurons, oligodendrocytes, astrocytes, ependymal cells, pineal gland) -retina and optic nerve -spinal cord

23

Neural Crest derivatives (8)

-PNS (DRG, cranial nerves, celiac ganglion, Schwann cells, ANS) -melanocytes, -chromaffin cells of adrenal medulla -parafollicular cells of thyroid -pia and arachonid -bones of the skull -odontoblasts -aorticopulmonary septum

24

Mesoderm derivatives (15)

-muscle -bone -CT -serous linings -spleen -CV structures -lymphatics -blood -wall of gut tube -vagina -kidneys -adrenal cortex -dermis -testes -ovaries

25

Mesodermal defects =

VACTERL -Vertebral defects -Anal atresia -Cardiac defects -Tracheo-Esophageal fistula -Renal defects -Limb defects

26

Endoderm derivatives

-gut tube epithelium -most of urethra -luminal epithelial derivatives (lung, liver, gallbladder, pancreas, eustachian tube, thymus, parathyroid)

27

Agenesis

absent organ due to absent primordial tissue

28

Aplasia

absent organ despite presence of primordial tissue

29

Hypoplasia

incomplete organ development; primordial tissue present

30

Deformation

extrinsic disruption; occurs after the embryonic period

31

Disruption

secondary breakdown of a previously normal tissue (ex. amniotic band syndrome)

32

Malformation

intrinsic disruption; occurs during the embryonic period

33

Sequence

abnormalities result from a single primary embryological event

34

Before week 3, teratogens cause...

all-or-none effects.

35

After week 8, teratogens affect...

growth and function.

36

ACE Inhibitors cause...

renal damage.

37

Alkylating agents cause...

absence of digits

38

Aminoglycosides cause...

CN VIII toxicity

39

Carbamazepine causes...

neural tube defects*** craniofacial defects fingernail hypoplasia developmental delay IUGR

40

Diethylstilbestrol (DES) causes...

vaginal clear cell adenocarcinoma congenital Mullerian anomalies

41

Folate antagonists cause...

neural tube defects

42

Lithium causes...

ebstein anomaly (atrialized right ventricle)

43

Methimazole causes...

aplasia cutis congenita

44

Phenytoin causes...

Fetal hydantoin syndrome (microcephaly, dysmorphic craniofacial features, hypoplastic nails and distal phalanges, cardiac defects, IUGR and intellectual disability)

45

Tetracyclines cause...

discolored teeth

46

Thalidomide causes...

limb defects (phocomelia, micromelia)

47

Valproate causes...

inhibition of maternal folate absorption leading to neural tube defects

48

Warfarin causes...

bone deformities, fetal hemorrhage, abortion, and ophthalmologic abnormalities

49

Cocaine causes...

abnormal fetal growth and fetal addiction; placental abruption.

50

Smoking (nicotine, CO) causes...

low birth weight, preterm labor, placental problems, IUGR, and ADHD.

51

Iodine (lack or excess) causes...

congenital goiter or hypothyroidism (cretinism)

52

Maternal diabetes causes...

caudal regression syndrome (anal atreisa to sirenomelia), congenital heart defects and neural tube defects.

53

Excess vitamin A causes...

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

54

X-rays cause...

microcephaly and intellectual disability.

55

Congenital malformations (7) of Fetal Alcohol Syndrome include...

intellectual disability developmental retardation microcephaly holoprosencephaly facial abnormalities limb dislocation heart defects

56

Facial abnormalities of FAS include...

smooth philtrum, thin upper lip, small palpebral fissures and hypertelorism.

57

Dizygotic twins arise from...

2 eggs that are separately fertilized by 2 different sperm and will have 2 separate amniotic sacs and 2 separate placentas.

58

Monozygotic twins arise from...

1 fertilized egg that splits into 2 zygotes early in pregnancy.

59

The degree of separation between monozygotic twins depends on...

when the fertilized egg splits into 2 zygotes. the timing of this separation determines the number of chorions (placentas) and amnions.

60

Fetal components of the Placenta

-cytotrophoblast -syncytiotrophoblast

61

Maternal component of the placenta

decidua basalis

62

The cytotrophoblas is the...

inner layer of chorionic villi that makes cells.

63

The syncytiotrophoblast is the...

outer layer of chorionic villi that secretes hCG.

64

The decidua basalis is derived from the...

endometrium and has maternal blood in lacunae.

65

The umbilical arteries (2) return...

deoxygenated blood from the fetal internal iliac arteries to the placenta.

66

The umbilical vein (1) supplies...

oxygenated blood from the placenta to the fetus and drains into the IVC via the liver or via the ductus venosus.

67

The most oxygenated blood in the fetus is located in the...

umbilical vein.

68

A single umbilical artery is associated with..

congenital and chromosomal anomalies.

69

The umbilical arteries and veins are derived from...

allantois.

70

In the 3rd week, the yolk sac forms the...

allantois which extends into the urogenital sinus.

71

The allantois becomes the...

urachus, a duct between fetal bladder and yolk sac.

72

Failure of the urachus to obliterate results in (3):

1. patent urachus 2. urachal cyst (partial failure) 3. vesicourachal diverticulum

73

A patent urachus allows...

urine discharge from the umbilicus.

74

A urachal cyst is a...

fluid-filled cavity lined with uroepithelium, between the umbilicus and bladder.

75

A urachal cyst can lead to...

infection and adenocarcinoma.

76

A veicourachal diverticulum is...

outpouching of the bladder.

77

The vitelline duct is...

a connection from the yolk sac to the midgut lumen. It is obliterated in the 7th week.

78

Failure of the vitelline duct to close results in (2):

1. vitelline fistula 2. meckel diverticulum

79

Vitelline fistula causes...

meconium discharge from the umbilicus.

80

Meckel diverticulum has partial closure of the vitelline duct with the patent portion...

attached to the ileum (a true diverticulum).

81

A meckel diverticulum may contain...

ectopic gastric mucosa and/or pancreatic tissue leading to melena, periumbilical pain and ulcers.

82

The 1st aortic arch becomes...

part of the maxillary artery.

83

The 2nd aortic arch becomes...

the stapedial artery and hyoid artery.

84

The 3rd aortic arch becomes...

the common carotid artery and the proximal part of the internal carotid artery.

85

The 4th aortic arch becomes..

the aortic arch on the left and the right subclavian.

86

The 6th aortic arch becomes...

the proximal part of the pulmnoary arteries and the ductus arteriosus (on the left).

87

The branchial apparatus is composed of...

branchial clefts, arches and pouches.

88

The branchial clefts (grooves) are derived from...

ectoderm.

89

The branchial arches are derived from...

mesoderm (muslces, arteries) and neural crest (bone, cartilage).

90

The branchial pouches are derived from...

endoderm.

91

The 1st branchial cleft develops into the...

external auditory meatus.

92

the 2nd through 4th branchial clefts form...

temporay cervical sinuses which are obliterated by proliferation of 2nd arch mesenchyme.

93

A persistent cervical sinus leads to...

a branchial cleft syst within the lateral neck.

94

1st branchial arch cartilage derivatives

-meckel cartilage: mandible, malleus, incus, spheno-mandibular ligament

95

1st branchial arch muscle derivatives

-muscles of mastication (temporalis, masseter, lateral and medial pterygoids) -mylohyoid -anterior belly of digastric -tensor tympani -tensor veli palatini

96

1st branchial arch nerves

CN V2 and V3

97

Abnormality of the 1st branchial arch leads to...

Treacher Collins Syndrome (which is when the first arch neural crest fails to migrate leading to mandibular hypoplasia and facial abnormalities)

98

2nd branchial arch cartilage derivatives

Reichert cartilage (stapes, styloid process, lesser horn of the styoid and stylohyoid ligament)

99

2nd branchial arch muscle derivatives

Muscles of facial expression (stapedius, stylohyoid, platysma, belly of digastric)

100

2nd branchial arch nerve derivatives

CN VII (facial expression)

101

Abnormalities of the 2nd branchial arch leads to...

congenital pharyngocutaneous fistula (persistence of the cleft and pouch leads to a fistula between the tonsillar area and lateral neck)

102

3rd branchial arch cartilage derivatives

greater horn of hyoid

103

3rd branchial arch muscle derivatives

stylopharyngeus

104

3rd branchial arch nerve derivative

CN IX

105

4th-6th branchial arch cartilage derivatives

-thyroid -cricoid -arytenoids -corniculate -cuneiform

106

4th branchial arch nerve derivative

CN X (superior laryngeal branch)

107

6th branchial arch nerve derivative

CN X (recurrent laryngeal branch)

108

The 1st branchial pouch develops into...

the middle ear cavity, eustachian tube and mastoid air cells. (endoderm-lined ear structures)

109

The 2nd branchial pouch develops into...

epithelial lining of the palatine tonsil.

110

The 3rd branchial pouch develops into...

dorsal wings --> inferior parathyroids ventral wings --> thymus

111

The 4th branchial pouch develops into...

dorsal wings --> superior parathyroids

112

DiGeorge Syndrome is due to...

aberrant development of the 3rd and 4th branchial pouches which leads to T-cell deficiency (thymic hypoplasia) and hypocalcemia (failure of parathyroid devo).

113

MEN2A is due to a...

mutation of germline RET (neural crest cells).

114

Features of MEN2A (3)

-pheochromocytoma (adrenal medulla) -parathyroid tumor (3rd/4th pouches) -medullary thryoid cancer (4th/5th pouches)

115

Cleft lip is due to...

failure of fusion of the maxillary and medial nasal processes.

116

Cleft palate is due to..

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

117

Default emryological development is...

female. The mesonephric duct degenerates and the paramesonephric duct develops.

118

The SRY gene is located on the...

Y chromosome and produces testis-determining factor which causes the testes to develop.

119

Sertoli cells secrete...

mullerian inhibitory factor (MIF) that suppresses the development of the paramesonephric ducts.

120

Leydig cells secrete...

androgens taht stimulate the development of the mesonephric ducts.

121

The parapmesonephric (mullerian) ducts develop into...

female internal structures (fallopian tubes, uterus, uppe portion of the vagina).

122

The lower portion of the vagina is from the...

UG sinus.

123

Mullerian duct abnormalities result in...

anatomical defects that may present as primary amenorrhea with fully developed secondary sex characteristics.

124

The mesonephric (wolffian) ducts develop into...

male internal structures (except prostate) - seminal vesicles, epididymis, ejaculatory duct and ductus deferens.

125

A bicornate uterus results from...

incomplete fusion of the paramesonephric ducts. Can lead to recurrent miscarriages.

126

Complete failure of fusion of the paramesonephric ducts leads to...

double uterus and vagina.

127

No sertoli cells or a lack of MIF will lead to...

development of both male and female internal genitalia and male external genitalia.

128

5-alpha reductase deficiency leads to...

inability to convert testosterone into DHT; pts will have male internal genitalia and ambiguous external genitalia until puberty (when increased testosterone levels cause masculinization).

129

In the female, the genital tubercle becomes...

the glans clitoris and vestibular bulbs.

130

In the male, the genital tubercle becomes...

the glans penis and corpus cavernosum/spongiosum.

131

In the female, the urogenital sinus becomes...

the greater vestibular glands (Bartholin) and the urethral/paraurethral glands (Skene).

132

In the male, the urogenital sinus becomes...

the bulbourethral glands of Cowper and the prostate gland.

133

In the female, the urogenital folds become...

the labia minora.

134

In the male, the urogenital folds become...

the ventral shaft of the penis.

135

In the female, the labioscrotal swelling becomes the...

labia majora.

136

In the male, the labioscrotal swelling becomes the..

scrotum.

137

Hypospadias is an...

abnormal opening of the penile urethra on the inferior (ventral) side of the penis due to failure of the urethral folds to close.

138

Fix hypospadias to prevent..

UTIs.

139

Epispadias is...

an abnormal opening of the penile urethra on the superior (dorsal) side of the penis due to faulty positioning of the genital tubercle.

140

Epispadias is associated with...

exstrophy of the bladder.

141

The male remnant of the gubernaculum is...

anchoring the testes within the scrotum.

142

The female remnant of the gubernaculum is...

the ovarian ligament and the round ligament.

143

The male remnant of the processus vaginalis forms...

the tunica vaginalis.

144

The female remnant of the processus vaginalis is...

obliterated.

145

The left ovary/testis is drained via the...

left gonadal vein to the left renal vein to the IVC.

146

The right ovary/testis is drained via the..

right gonadal vein to the IVC.

147

Ovaries and testes lymph drain to the...

para-aortic LNs.

148

The distal vagina/vulva/uterus drain lymph to the...

superficial inguinal nodes.

149

The proximal vagina/uterus drains lymph to the...

obturator, external iliac and hypogastric nodes.

150

The left spermatic vein enters the left renal vein at a 90 degree angle leading to...

increased pressure compared to the right and more common varicoceles on the left.

151

The infundibulopelvic (suspensory) ligament connects...

the ovaries to the lateral pelvic wall.

152

The infundibulopelvic (suspensory) ligament contains...

the ovarian vessels. Need to be ligated during oophorectomy to avoid bleeding.

153

The ureter courses retroperitoneally close to...

the gonadal vessels and thus is at risk of injury during ligation of the ovarian vessels.

154

The cardinal ligament connects...

the cervix to the side wall of the pelvis.

155

The cardinal ligament contains...

the uterine vessels. The ureter is at risk during ligation of the uterine vessels in a hysterectomy.

156

The round ligament connects...

the uterine fundus to the labia majora.

157

The round ligament travels through...

the round inguinal canal above the artery of Sampson.

158

The broad ligament connects...

the uterus, fallopian tubes and ovaries to the pelvic side wall.

159

The broad ligament contains...

the ovaries, fallopian tubes and round ligaments.

160

The components of the broad ligament are the...

mesosalpinx, mesometrium and mesovarium.

161

The ovarian ligament connects the...

medial pole of the ovary to the lateral uterus.

162

Histology of the vagina

stratified squamous epithelium, nonkeratinized

163

Histology of the ectocervix

stratified squamous epithelium, nonkeratinized

164

Histology of the endocervix

simple columnar epithelium

165

Histology of the transformation zone

squamocolumnar juction (most common area for cervical cancer)

166

Histology of the uterus

simple columnar epithelium with long tubular glands

167

Histology of the fallopian tube

simple columnar epithelium, many ciliated cells, a few secretory (peg) cells

168

Histology of the ovary (outer surface)

simple cuboidal epithelium (germinal)

169

Female Sexual Response Cycle

1. phase of excitement (uterus elevates, vaginal lubrication) 2. plateau (expansion of inner vagina) 3. orgasm (contraction of uterus) 4. resolution

170

Female sexual response cycle is mediated by the..

autonomic nervous system.

171

Pathway of sperm during ejaculation

Semniferous tubules - epididymis - vas deferens - ejaclatory ducts - urethra - penis

172

Erection is innervated by the...

PNS (pelvic nerve). NO leads to increased cGMP causes smooth muscle relaxation, vasodilation and it becomes erect.

173

When the pelvic nerve secretes NE, this leads to..

an increase in calcium leading to smooth muscle contraction, vasoconstriction and this is antierectile.

174

Emission is innervated by...

the SNS (hypogastric nerve).

175

Ejaculation is innervated by...

visceral and somatic nerves (pudendal).

176

Spermatogonia (germ cells) maintain the...

germ pool and produce primary spermatocytes. They line the semniferous tubules.

177

Sertoli cells secrete...

inhibin (inhibits FSH) and androgen-binding protein (maintains local testosterone) and MIF.

178

Tight junctions between adjacent sertoli cells form..

the blood-testis barrier which isolates gametes from autoimmune attack.

179

Sertoli cells also support...

developing spermatozoa and regulate spermatogenesis.

180

Sertoli cells are sensitive to...

temperature. Increased temp leads to decreased sperm and increased inhibin.

181

The sertoli cells line...

seminiferous tubules.

182

The sertoli cells convert...

androstenedione to estrogen via aromatase.

183

Increased temperature of the testes is seen in both...

varicocele and cryptorchidism.

184

The Leydig cells secrete..

testosterone in the presence of LH. (unaffected by temp)

185

Estrogen sources

Ovary (17beta-estradiol) Placenta (estriol) Adipose tissue (estrone via aromatization)

186

Potency of the estrogens

estradiol > estrone > estriol

187

Estrogen is necessary for development of...

genitalia and breast and female fat distribution.

188

Estrogen is needed for growth of...

the follicle, endometrial proliferation and increased myometrial excitability.

189

Estrogen upregulates...

estrogen, LH and progesterone receptors.

190

Estrogen has feedback inhibition of...

FSH and LH, then an LH surge. It also stimulates prolactin secretion.

191

Estrogen increases...

transport proteins and SHBG; it increases HDL and decreases LDL

192

Estrogen during pregnancy:

50-fold increase in estradiol and estrone 1000-fold increase in estriol (indicator of fetal well-being)

193

Estrogen receptors are expressed in the...

cytoplasm and then translocate to the nucleus when bound.

194

In the theca cells, LH stimulates...

desmolase to convert cholesterol into androstenedione (which travels to the granulosa cells.

195

In the granulosa cells, FSH stimulates...

aromatase to convert androstenedione into estrogens.

196

Sources of progesterone

-corpus luteum -placenta -adrenal cortex -testes

197

Progesterone stimulates...

endometrial glandular secretions and spiral artery development.

198

Progesterone maintains...

pregnancy.

199

Progesterone decreases....

myometrial excitability (causes uterine smooth muscle relaxation) and estrogen receptor expressivity.

200

Progesterone produces...

thick cervical mucus, which inhibits early sperm entry into the uterus.

201

Progesterone increases...

temperature.

202

Progesterone inhibits...

LH and FSH.

203

Progesterone prevents...

endometrial hyperplasia.

204

The fall in progesterone after delivery acts to...

disinhibit prolactin which leads to prolactin.

205

Tanner Stages

I = childhood II = pubic hair appears (pubarche); breast buds (thelarche) III = pubic hair darkens, becomes curly; penis size/length increases; breasts enlarge IV = penis width increases; darker scrotal skin; development of glans; raised areolae V = adult; areolae no longer raised

206

The phase of the menstrual cycle that can vary in length is the...

follicular phase; luteal phase is usually a constant 14 days. Ovulation day + 14 days = menstruation

207

Decreased progesterone leads to...

decreased fertility.

208

Oligomenorrhea

> 35 day cycle

209

Polymenorrhea

210

Metrorrhagia

frequent but irregular bleeding (intermenstrual)

211

Menorrhagia

> 80 mL blood loss or > 7 days of menses (heavy menstrual bleeding)

212

Menometrorrhagia

heavy, irregular menstruation at irregular levels

213

Increased estrogen midcycle leads to...

the LH surge leads to ovulation leads to progesterone release from the corpus luteum. Then, progesterone levels fall (if no implantation) leading to menstruation via apoptosis of endometrial cells.

214

Primary oocytes begin...

meiosis I during fetal life and complete meiosis I just prior to ovulation.

215

Meiosis I is arrested in...

prophase I for years until ovulation (primary oocytes).

216

Meiosis II is arrested in...

metaphase II until fertilization (secondary oocytes).

217

If fertilizaiton does not occur within 1 day, then the...

secondary oocyte degenerates.

218

Ovulation is caused when...

increased estrogen and increased GnRH receptors on the anterior pituitary cause LH release leading to ovulation (rupture of the follicle).

219

Temperature during ovulation is...

increased from progesterone.

220

Mittelschmerz refers to...

transient mid-cycle ovulatory pain; classically associated with peritoneal irritation (follicular swelling, fallopian tube contraction). This can mimic appendicitis.

221

Fertilization most commonly occurs in the...

upper end of the fallopian tube (the ampulla). It occurs within one day of ovulation.

222

Implantation within the wall of the uterus occurs...

6 days after fertilization.

223

Syncytiotrophoblasts secrete...

hCG, which is detectable in the blood 1 week after conception and on the home urine test 2 wks after conception.

224

Suckling is required to maintain...

milk production since increased nerve stimulation increases oxytocin and prolactin.

225

Prolactin induces and maintains...

lactation and decreases reproductive fxn (decreases LH/FSH).

226

Oxytocin assists in...

milk letdown and promotes uterine contractions.

227

Breastmilk contains...

maternal Igs, macrophages and lymphocyts.

228

Breastmilk decreases risk for the child to develop....

asthma, allergies, DM and obesity (and infxns).

229

Exclusively breastfed infants require....

vitamin D supplementation.

230

Breastfeeding decreases maternal risk of...

breast and ovarian cancer.

231

hCG maintains...

the corpus luteum (and thus progesterone) for the 1st trimester by acting like LH to stimulate luteal cells.

232

In the 2nd and 3rd trimesters, the placenta synthesizes...

its own estriol and progesterone and the corpus luteum degenerates.

233

The alpha subunit of hCG is structurally....

identical to alpha subunits of LH, FSH, and TSH. The beta subunit is unique.

234

hCG is greatly increased in...

multiple gestations, hydatiform moles, and choriocarcinoma.

235

During menopause, there is decreased...

estrogen production due to age-linked decline in the number of ovarian follicles.

236

The source of estrogen after menopause becomes...

peripheral conversion of androgens. The increase in androgens leads to hirsutism.

237

Test for menopause with...

greatly increased FSH (due to loss of negative feedback on FSH due to decreased estrogen).

238

Hormonal changes during menopause (4)

1. decreased estrogen 2. increased FSH 3. increased LH 4. increased GnRH

239

Menopause causes:

HAVOCS -Hot flashes -Atrophy of the vagina -Osteoporosis -Coronary artery disease -Sleep disturbances

240

Spermatogenesis begins at...

puberty with spermatogonia. Full development takes 2 months. It occurs in the seminiferous tubules.

241

Spermatogenesis produces...

spermatids that undergo spermiogenesis (loss of cytoplasmic contnets, gain of acrosomal cap) to form mature spermatozoon.

242

Sources of Androgens

DHT and testosterone (testis) Androstenedione (adrenal)

243

Potency of the androgens

DHT > testosterone > androstenedione

244

Functions of Testosterone (5)

1. differentiation of epididymis, vas deferns, seminal vesicles 2. growth spurt 3. deepening voice 4. closing of epiphyseal plates (via estrogen conversion) 5. libido

245

Functions of DHT (2)

1. differentiation of penis, scrotum, prostate (early) 2. prostate growth, balding, sebaceous gland activity (late)

246

Testosterone is converted to DHT by...

5alpha-reductase.

247

In the male, androgens are converted to estrogen by...

cytochrome P450 aromatase (mainly in adipose tissue and testis).

248

Exogenous testosterone leads to inhibition of...

the hypothalamic-pituitary-gonadal axis leading to decreased intratesticular testosterone leading to decreased testicular size and azoospermia.

249

Klinefelter Syndrome Features (7)

-XXY (male) -testicular atrophy -eunuchoid body shape -tall -gynecomastia -female hair distribution -presence of inactivated X chromoxome (barr body)

250

In Klinefelter, the dysgenesis of the seminiferous tubules leads to...

decreased inhibin and increased FSH.

251

Turner Syndrome Features (8)

-XO (female) -short stature -ovarian dysgenesis (streak ovary) -shield chest -bicuspid aortic valve -preductal coarctation -lymphatic defects (webbed neck, cystic hygroma) -horseshoe kidney

252

Signs of preductal coarctation

femoral

253

Double Y males features (XYY) (5)

-phenotypically normal -very tall -severe acne -antisocial behavior -normal fertility

254

True hermaphroditism features

-46 XX or 47 XXY -both ovary and testicular tissue present -ambigous genitalia

255

Increased T, Increased LH

defective andgrogen receptor

256

Increased T, Decreased LH

testosterone secreting tumor or exogenous steroids

257

Decreased T, Increased LH

primary hypogonadism

258

Decreased T, Decreased LH

hypogonadotropic hypogonadism

259

Female Pseudohermaphrodite (XX)

-ovaries are present but external genitalia are virilized or ambiguous -due to excessive exposure to androgenic steroids during early gestation (CAH or exogenous)

260

Male Pseduohermaphrodite (XY)

-testes present but external genitalia are female or ambiguous

261

Aromatase Deficiency Features (3)

-inability to synthetize estrogens from androgens -masculinization of female infants and increased androgens -can present with maternal virilization during pregnancy

262

Androgen Insensitivity Features (5)

-defect in androgen receptor resulting in normal looking female -uterus and fallopian tubes absent -scant sexual hair -testes often in labia majora (remove to prevent malignancy) -increased T, E, and LH

263

5alpha-reductase deficiency features (6)

-autosomal recessive -inability to convert testosterone to DHT -ambiguous genitalia until puberty -testosterone/estrogen levels normal -LH is normal/increased -internal genitalia normal

264

Kallmann syndrome features

-failure to complete pubery -defective migration of GnRH cells and formation of olfactory bulb -decreased synthesis of GnRH -anosmia -decreased GnRH, FSH, LH, testosterone -infertility

265

A hydatidiform mole is a...

cystic swelling of chorionic villi and proliferation of chorionic epithelium (only trophoblast).

266

Treatment for hydatidiform moles

dilation and curettage and methotrexate (have to monitor beta-hCG after)

267

Karyotype of hydatidiform moles

Complete: 46 XX; 46 XY Partial: 69 XXX; 69 XXY; 69 XYY

268

Uterine size in hydatidiform moles

Complete: increased

269

Conversion to choriocarcinoma in hydatidiform moles

Complete: 2% Partial: rare

270

Fetal parts in hydatidiform moles

Complete: none Partial: Yes

271

Components of the hydatidiform moles

Complete: nucleated egg + single sperm (duplicates paternal DNA) Partial: 2 sperm + 1 egg

272

Symptoms of hydatidiform moles

Complete: vaginal bleeding, enlarged uterus, hyperemesis, pre-eclampsia, hyperthyroidism Partial: vaginal bleeding, abdominal pain

273

Imaging of hydatidiform moles

Compete: honeycombed uterus or "clusters of grapes" or "snowstorm" on U/S Partial: fetal parts

274

Gestational hypertension is defined as...

BP > 140/90 after the 20th week.

275

Treat gestational HTN with...

antihypertensives (alpha-methyldopa, labetalol, hydralazine, nifedipine) and deliver at 39 weeks.

276

Preeclampsia is defined as...

HTN, proteinuria (>300 mg/24 hr) after the 20th wk of gestation.

277

End-organ damage from severe preeclampsia results in...

HA, scotoma, oliguria, increased AST/ALT, and thrombocytopenia.

278

Preeclampsia is caused by...

abnormal placental spiral arteries and results in maternal endothelial dysfunction, vasoconstriction or hyperreflexia.

279

The incidence of preeclampsia is increased in pts with...

preexisting HTN, diabetes, chronic renal dz or autoimmune disorders.

280

Complications of preeclampsia (5)

1. placental abruption 2. coagulopathy 3. renal failure 4. uteroplacental insufficiency 5. eclampsia

281

Treatment of preeclampsia

-antihypertensives -deliver at 34 wks if severe -IV magnesium sulfate (to prevent seizure)

282

Eclampsia is...

preeclampsia + maternal seizures.

283

Maternal death in eclampsia is due to...

stroke leading to intracranial hemorrhage or ARDS.

284

Treatment of eclampsia is...

antihypertensives IV magnesium sulfate immediate delivery

285

HELLP Syndrome is...

Hemolysis, Elevated Liver enzymes, and Low Platelets (a manifestation of severe preeclampsia; deliver immediately)

286

Placental abruption is...

premature separation of the placenta from the uterine wall before delivery of the infant. Life threatening for both mother and fetus.

287

Risk factors for placental abruption include (5)...

trauma smoking HTN preeclampsia cocain abuse

288

Presentation of placental abruption

-abrupt, painful bleeding in 3rd trimester -possible DIC -maternal shock -fetal distress

289

Placental accreta, increta and percreta are due to...

defective decidual layers leading to abnormal attachment and separation after delivery.

290

Risk factors for placental accreta/increta/percreta include (3)...

prior C-section inflammation placenta previa

291

Placenta accreta

placenta attaches to the myometrium without penetrating it

292

Placenta increta

placenta penetrates into myometrium

293

Placenta percreta

placenta penetrates through the myometrium adn into the uterine serosa; can result in placental attachment to rectum or bladder

294

Presentation of Placenta accreta/increta/percreta

-no separation of placenta after delivery leading to massive bleeding

295

Placenta previa is...

attachment of the placenta to the lower uterine segment. It lies near, partially covers or completely covers the internal cervical os. (painless)

296

Risk factors for placenta previa (2)

multiparity prior C-section

297

Retained placental tissue may cause...

postpartum hemorrhage and increases risk of infection.

298

Ectopic pregnancy most often occurs in the...

ampulla of the fallopian tube.

299

Ectopic pregnancy should be suspected with a hx of...

amenorrhea, lower-than-expected rise in hCG and sudden lower abdominal pain. (+/- bleeding)

300

Ectopic pregnancy is confirmed with...

ultrasound.

301

Risk factors for ectopic pregnancy (4)

-hx of infertility -salpingitis -ruptured appendix -prior tubal surgery

302

Polyhdramnios (> 1.5-2 L) is associated with...

fetal malformations (inability to swallow amniotic fluid), maternal diabetes, and multiple gestations.

303

Oligohydramnios (

placental insufficiency, bilateral renal agenesis or posterior urethral valves (inability to excrete urine).

304

Profound Oligohydramnios can cause...

POTTER sequence.

305

Dysplasia/Carcinoma in situ is...

disordered epithelial growth that begins at the basal layer of squamocolumnar junction and extends outward.

306

Dysplasia/Carcinoma in situ is associated with....

HPV 16 and HPV 18 which both produce the E6 gene (inhibits p53) and E7 (inhibits Rb)

307

Dysplasia/Carcinoma in situ is typically...

asymptomatic or presents as abnormal vaginal bleeding. Can progress to invasive carcinoma (catch early with pap smear).

308

Risk factors for dysplasia/carcinoma in situ

-multiple sexual partners -smoking -early intercourse -HIV

309

Invasive carcinoma is often...

squamous cell carcinoma. Lateral invasion can block the ureters, causing renal failure.

310

Endometritis is...

inflammation of the endometrium (with plasma cells and lymphocytes).

311

Endometritis is associated with...

retained products of conception following delivery/miscarriage/abortion or foreign bodies such as an IUD.

312

Retained material in the uterus promotes...

infxn by bacterial flora from the vagina or intestinal tract.

313

Treatment for endometritis

gentamicin + clindamycin (+/- ampicillin)

314

Endometriosis is...

non-neoplastic endometrial glands/stroma outside of the endometrial cavity; most commonly in the ovaries, pelvis adn peritoneum; normal sized uterus.

315

In the ovary, endometriosis appears as...

an endometrioma (blood-filled "chocolate cyst").

316

Endometriosis can be due to...

retrograde flow, metaplastic transformation of multipotent cells or transportation of endometrial tissue via the lymphatic system.

317

Endometriosis is characterized by...

cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia and infertily.

318

Treatment for Endometriosis

NSAIDs OCPs progestins GnRH agonists surgery

319

Adenomyosis is...

extension of the endometrial tissue (glandular) into the uterine myometrium caused by hyperplasia of the basalis layer of the endometrium.

320

Adenomyosis is characterized by....

dysmenorrha, menorrhagia and an enlarged, soft, globular uterus.

321

Treatment for Adenomyosis

hysterectomy

322

Adenomyoma (polyp) is a...

well-circumscribed collection of endometrial tissue within the uterine wall. May contain smooth muscle cells.

323

Endometrial hyperplasia is...

abnormal endometrial gland proliferation caused by excess estrogen stimulation. Give an increased risk for endometrial carcinoma.

324

Endometrial hyperplasia manifests as...

postmenopausal vaginal bleeding.

325

Risk factors for endometrial hyperplasia include...

anovulatory cycles, hormone replacement therapy, polycystic ovarian syndrome, and granulosa cell tumor.

326

Endometrial carcinoma clinically presents with...

vaginal bleeding at ages 55-65.

327

Risk factors for endometrial carcinoma include...

prolonged use of estrogen w/o progestins obesity diabetes HTN nulliparity late menopause (often preceded by endometrial hyperplasia)

328

Leiomyoma (aka fibroid) often presents with...

multiple discrete tumors. Increased incidence in black females from 20-40 yrs old. It is a benign smooth muscle tumor.

329

Leiomyomas are sensitive to...

estrogen so the tumor size increases with pregnancy and decreases with menopause.

330

Leiomyoma manifestations include...

asymptomatic, abnormal uterine bleeding, miscarriage. Severe bleeding may cause iron deficiency anemia.

331

Leiomyomas do not progress to...

leiomyosarcoma.

332

Histology of Leiomyoma

whorled pattern of smooth muscle bundles with well-demarcated borders

333

Polycystic Ovarian Syncrome (PCOS) is...

hyperandrogenism due to deranged steroid synthesis by theca cells and hyperinsulinemia.

334

PCOS results in...

enlarged, bilateral cystic ovaries. It presents with amenorrhea, hirsutism, acne and infertility. Associated with obesity.

335

PCOS has an increased risk for...

endometrial cancer secondary to increased estrogens from aromatization of testosterone and absence of progesterone.

336

Treatment for PCOS

-weight reduction -OCPs -antiandrogens -clomiphene citrate -metformin -cyclic progesterones

337

Lab features of PCOS

-increased LH and FSH (ratio is LH:FSH, 3:1) -increased testosterone -increased estrogen -increased insulin

338

PCOS is the most common cause of....

infertility in women.

339

Follicular cyst is a...

distention of unruptured graafian follicle. May be associated with hyperestrogenism and endometrial hyperplasia.

340

Corpus luteum cyst is...

a hemorrhage into persitent corpus luteum.

341

Theca-lutein cyst

-often bilateral/multiple -due to gonadotropin stimulation -associated with choriocarcinoma and moles

342

Hemorrhagic cyst

-blood vessel rupture in cyst wall -cyst grows with increased blood retention

343

Dermoid cyst

-mature teratoma -cystic growths filled with various types of tissue such as fat, hair, teeth, etc.

344

Endometrioid cyst

-endometriosis within ovary with cyst formation -varies with menstural cycle -when filled with dark, reddish-brown blood, called a "chocolate cyst"

345

Risk of ovarian neoplasm is increased with...

age, infertility, endometriosis, PCOS, genetics (BRCA-1/2, HNPCC, fam hx).

346

Risk of ovarian neoplasm decreases with...

previous pregnancy, hx of breastfeeding, OCPs, tubal ligation.

347

Ovarian neoplasms presetn with...

adnexal mass, abdominal distention, bowel obstruction and pleural effusion.

348

Ovarian neoplasms can be monitored by measureing...

CA-125 levels (not for screening).

349

Serous cystadenoma features (3)

-thin-walled, uni or multi locular -lined with fallopian-like epithelium -often bilateral

350

Mucinous cystadenoma (2)

-multiloculated, large -lined by mucus-secreting epithelium

351

Endometrioma (3)

-mass arising from gorwth of ectopic endometrial tissue -complex mass on U/S -presents with pelvic pain, dysmenorrhea and dyspareunia

352

Mature cystic teratoma (dermoid cyst) (4)

-germ cell tumor (common in women 20-30) -contains elements form all 3 germ layers -presents with pain seoncdary to ovarian enlargement or torsion -can contain functional thyroid tissue and present as hyperthyroidism (struma ovarii)

353

Brenner tumor (2)

-solid tumor that is pale yellow-tan and appears encapsulated (looks like bladder) -coffee bean nuclei

354

Fibromas (3)

-bundles of spindle-shaped fibroblasts -Meigs syndrome -pulling sensation in groin

355

Meigs syndrome is a...

triad of fibroma, ascites and hydrothorax.

356

Thecoma (2)

-like granulosa cell tumors, may produce estrogen -usually present as abnormal uterine bleeding in a postmenopausal woman

357

Immature teratomas (3)

-aggressive -contains fetal (embryonic-like) tissue -neuroectoderm

358

Granulosa cell tumor (4)

-often produce estrogen and/or progesterone -present with abnormal uterine bleeding, xexual precocity, breast tenderness -usually in women in 50s -Call-Exner bodies (resemble primordial follicles)

359

Serous cystadenocarcinoma (2)

-frequently bilateral -psammoma bodies

360

Mucinous cystadenoma (2)

-pseudomyxoma pertonei (intraperitoneal accumulatio nof mucinous material from ovarian or appendiceal tumor)

361

Dysgerminoma (3)

-common in adolescents -sheets of uniform "fried egg" cells -tumor markers are hCG and LDH

362

Choriocarcinoma (7)

-develops during/after pregnancy in mother or baby -malignancy of trophoblastic tissue -no chorionic villi -increased frequency of theca-lutein cysts -presents with abnormal beta-hCG, SOB and hemoptysis -hematogenous spread to lungs -responds to chemo

363

Yolk sac (endodermal sinus) tumor (5)

-aggressive -in ovaries or testes and sacrococcygeal area in young children -yello, friable, solid mass -Schiller-Duval bodies (resemble glomeruli) -AFP tumor marker

364

Krukenberg tumor (2)

-GI malignancy that metastasizes to the ovaries -causes a mucin-secreting, signet cell adenocarcinoma

365

Vaginal Squamous Cell Carcinoma is usually...

secondary to cervical SCC.

366

Vaginal clear cell adenocarcionma affects...

women who had exposure to DES in utero.

367

Sarcoma botryoides affects...

girls

368

Fibroadenoma is a...

small, mobile firm mass with sharp edges most common in those younger than 35.

369

Fibroadenoma increases in size and tenderness with...

estrogen. It is not a precursor to cancer.

370

Intraductal papilloma is a...

small tumor that grows in the lactiferous ducts. Typically beneath the areola.

371

Intraductal papilloma presents with...

serous or bloody nipple discharge. Slight increased risk for carcinoma.

372

Phyllodes tumor is a...

large bulky mass of CT and cysts. "leaf-like" projections. (common in 6th decade)

373

Malignant breast tumors are commonly...

postmenopausal and arise from terminal duct lobular unit.

374

In malignant breast tumors, overexpression of...

estrogen/progesterone receptors or c-erbB2 is common.

375

Breast tumors are more aggressive if they are...

triple negative (ER -, PR -, Her2/Neu -).

376

The single most important prognostic factor for malignant breast cancer is...

axillary LN involvement indicating metastasis.

377

Most common location of malignant breast cancer

upper outer quadrant

378

Risk factors for malignant breast cancer (6)

1. increased estrogen 2. increased total number of menstrual cycles 3. older age at 1st live birth 4. obesity 5. BRCA1 and BRCA2 mutations 6. African Amerian ethnicity

379

Ductal carcinoma in situ fills...

the ductal lumena and arises from ductal atypia. Seen as microcalcifications.

380

Ductal carcinoma in situ is an early malignancy...

without basement membrane penetration.

381

Comedocarcinoma is a subtype of...

DCIS. It is ductal and has caseous necrosis.

382

Paget Disease results from...

underly DCIS.

383

Paget Disease presents with...

eczematous patches on the nipple. It has Paget cells (large cells in dermis with clear halo.

384

Invasive ductal carcinoma is a...

firm, fibrous, rock-hard mass with sharp margins and small, glandular, duct-like cells. Gross stellate infiltration.

385

Invasive lobular carcinoma is often...

bilateral with multiple lesions in the same location; orderly row of cells (indian file).

386

Medullary breast carcinoma is a...

fleshy, cellular lymphocytic infiltrate.

387

Inflammatory breast carcinoma is a...

dermal lymphatic invasion. Presents with peau d'orange.

388

Proliferative breast disease presents with...

premsentrual breast pain, bilateral, multiple lesions, and fluctuation in mass size.

389

Histologic types of Proliferative breast disease

1. Fibrosis 2. Cystic 3. Sclerosing adenosis 4. Epithelial hyperplasia

390

Fibrosis (proliferative brease disease)

hyperplasia of breast stroma

391

Cystic (proliferative breast disease)

fluid, billed, blue dome, ductal dilation

392

Sclerosing adenosis

increased acini and intralobular fibrosis; associated with calcifications; increased risk of cancer

393

Epithelial hyperplasia

increase in number of epithelial cell layers in terminal duct lobule; increased risk of carcinoma; occurs in women > 30

394

Acute mastitis is a...

breast abcess caused by cracks in the nipple from breast-feeding that leads to infxn from S. aureus

395

Acute mastitis should be treated with...

dicloxacillin and continued breast feeding.

396

Fat necrosis is a...

benign, usually painless lump that forms as a result of injury to breast tissue.

397

Fat necrosis findings

-calcifications on mammography -biopsy shows necrotic fat, giant cells

398

Gynecomastia results from...

hyperestrogenism (cirrhosis, testicular tumor, puberty, old age), Klinefelter syndrome and drugs.

399

Drugs that cause gynecomastia

-Spironolactone -marijuana -Digitalis -Estrogen -Cimetidine -Alcohol -Heroin -Dopaine D2 antagonists -Ketoconazole

400

Prostatitis usually presents with...

dysuria, frequency, urgency and low back pain.

401

Acute prostatitis is usually due to...

E. coli.

402

Benign prostatic hyperplasia (BPH) is characterized by...

smooth, elastic, firm nodular enlargement of the peiurethral lobes which compress the urethra into a vertical slit.

403

BPH often presesnts with...

increased frequency of urination, nocturia, difficulty stopping and starting stream, dysuria. Increased PSA

404

BPH may lead to...

distention/hypertrophy of the bladder, hydronephrosis, and UTIs.

405

Treatments for BPH

-alpha1 antagonists (terazosin, tamulosin which cause relaxation of smooth muscle) -finasteride

406

Prostatic adenocarcinoma arises most often from the...

posterior lobe (peripheral zone) of the prostate and is diagnosed by increased PSA and needle core biopsies.

407

Tumor markers of prostatic adenocarcinoma include...

PSA and PAP.

408

Prostatic adenocarcinoma may develop into...

osteoblastic metastases in the bone indicated by lower back pain and increased serum ALP.

409

Cryptorchidism is...

undescended testis, with impaired spermatiogenesis. Can have normal testosterone levels (Leydig cells unaffected by heat).

410

Cryptorchidism is associated with...

increased risk of germ cell tumors. Prematurity increases the risk.

411

Lab features of cryptorchidism

-decreased inhibin -increased FSH -increased LH -testosterone decreased in bilateral

412

Varicocele is...

dialted veins in the pampiniform plexus as a result of increased venous pressure. Most common cause of scrotal enlargment in adults.

413

Varicocele is most often on the...

left side because of increased resistance to flow from left gonadal vein drainage into the renal vein.

414

Varicocele appears as...

a "bag of worms" and is diagnosed by U/S w/ doppler.

415

Treatment for varicocele

varicocelectomy embolization

416

Risk factors for testicular germ cell tumors

-cryptorchidism -Klinefelter -young age

417

Seminoma features (5)

-painless, testicular enlargmeent -3rd decade -large cells in lobules with watery cytoplasm and a "fried egg" appearance -increased placental AFP -radiosensitive

418

Yolk sac tumor (testicular) (3)

-yellow, mucinous -schiller-duval bodies -common in boys

419

Choriocarcinoma (4)

-increased hCG -disordered syncytiotrophoblastic and cytotrophoblastic elements -hematogenous metastases to lungs and brain -may produce gynecomastia or hyperthyroid symptoms (hCG is an LH and TSH analog)

420

Teratoma (2)

-malignant in males (NOT in females) -increased hCG and/or AFP

421

Embryonal carcionma

-hemorrhagic mass with necrosis -painful -often glandular/papillary -increased hCG and normal AFP when pure

422

Leydig cell tumor (4)

-contains Reinke crystals -usually androgen producing -gynecomastia or precocious puberty -golden brown color

423

Sertoli cell tumor

-androblastoma from sex cord stroma

424

Testicular lymphoma

-arises from lymphoma metastases to testes

425

Tunica vaginals lesions are...

in the serous covering of the testis present as testicular masses that can be transilluminated.

426

Hydrocele

increaed fluid secondary to incomplete obliteration of processus vaginalis

427

Spermatocele

dialted epididymal duct

428

Penile SCC is most common in...

Asia, Africa and South America.

429

Precursor lesions to penile SCC

-Bowen disease -erythroplasia of Queyrat -bowenoid papulosis

430

Bowen Disease is in the...

penile shaft and presents as leukoplakia.

431

Erythroplasia of Queyrat is...

cancer of the glans that presents as erythroplakia.

432

Bowenoid papulosis presents as...

reddish papules.

433

Penile SCC is associated with...

HPV and a lack of circumcision.

434

Priapism is a...

painful, sustained erection.

435

Priapism is associated with...

trauma sickle cell disease (RBCs get trapped in vaculature) medications (anticoagulants, PDE-5 inhibitors, antidepressants, alpha-blockers and cocaine)

436

Leuprolide mechanism

-GnRH analog with agonist properties when used in a pulsatile fashion; antagonist properties when used continuously (downregulates GnRH receptor in the pituitary leading to decreased FSH/LH)

437

Clinical use of Leuprolide

infertility prostate cancer uterine fibroids precocious puberty

438

Clinical use of estrogens (ethinyl estradiol, DES, mestranol)

-hypogonadism or ovarian failure -mesntrual abnormalities -HRT in postmenopausal women -used in men with androgen dependent prostate cancer

439

Toxicity of estrogens

-increased risk of endometrial cancer -bleeding -clear cell adenocarcionma of vagina (DES) -increased risk of thrombi

440

Estrogens are contraindicated in...

ER + breast cancer and those with a hx of DVTs

441

Selective Estrogen Receptor Modulators (SERMs)

-Clomiphene -Tamoxifen -Raloxifene

442

Clomiphene is an...

antagonist at estrogen receptors in the hypothalamus that prevents normal feedback inhibition leading to increaed release of LH and FSH from the pituitary which stimulates ovulation.

443

CLompihene is used to treat...

infertility due to anovulation (PCOS).

444

Clomiphene may cause...

hot flashes, ovarian enlargement, multiple simultaneous pregnancies and visual disturbances.

445

Tamoxifen is an...

antagonist on breat tissue and agonist in bone and the uterus.

446

Tamoxifen is associated with...

endometrial cancer and thromboembolic events.

447

Tamoxifen is primarily used to treat and prevent recurrence of...

ER + breast cancer.

448

Raloxifene is an...

agonist on bone and antagonist at the uterus.

449

Raloxifene increases risk of...

thromboemblic events.

450

Raloxifene is used to treat...

osteoporosis bc it decreases resorption of bone.

451

HRT is used for...

relief of menopausal symptoms and osteoporosis.

452

Unopposed estrogen replacement therapy increases risk of...

endometrial cancer so progesterone is added.

453

Anastrozole/Exemestane are...

aromatase inhibitors used in postmenopausal women with breast cancer

454

Progestins MOA

bind progesterone receptors to decrease growth and increase vascularization of the endometrium

455

Progestins Use

used in oral contraceptives and in treatment of endometrial cancer and abnormal uterine bleeding

456

Mifepristone MOA

competitive inhibitor of progestins

457

Clinical use of mifepristone

termination of pregnancy (administered with misoprostol (PGE1))

458

In OCPs, estrogen and progestins inhibit...

LH/FSH and thus prevent the estrogen surge. No estrogen surge means no LH sruge means no ovulation.

459

In OCPs, progestins cause...

thickening of the cervical mucus (limiting access to sperm) and they inhibit endometrial proliferation making it less suitable for implantation.

460

Contraindications for OCPs

smokers > 35 hx of thromboembolism, stroke or estrogen-dependent tumors

461

Terbutaline is a...

beta2-agonist that relaxes the uterus; usted to decrease contraction frequency in women during labor.

462

Danazol MOA

synthetic androgen that acts as a partial agonist

463

Use of Danazol

endometriosis and angioedema

464

Toxicity of Danazol

-weight gain -edema -acne -hirsutism -masculinization -decreased HDL -hepatotoxicity

465

MOA of Testosterone and Methyltestosterone

agonist at androgen receptors

466

Use of Testosterone and Mehtyltestosterone

-hypogonadism -promotes development of secondary sex characteristics -stimulation of anabolism to promote recovery after burn or injury

467

Toxicity of testosterone

-masculinization -decrease intratesticular testosterone (gonadal atrophy due to decreased LH) -premature closure of epiphyseal plates -increased LDL, decreased HDL

468

Finasteride is a...

5alpha-reductase inhibitor that decreases the conversion of testosterone to DHT

469

Finasteride uses

-BPH -male pattern baldness

470

Flutamide is a...

nonsteroidal competitive inhibitor of androgens at teh testoterone receptor.

471

Flutamide is used in...

prostate carcinoma.

472

Ketoconazole inhibits...

steroid synthesis (inhibits 17,20-desmolase).

473

Spironolactone inhibits...

steroid binding, 17alpha-hydroxylase and 17,20-desmolase.

474

Ketoconazole and spironolactone are used in the treatment of...

PCOS to prevent hirsutism. Both have side effects of gynecomastia and amenorrhea.

475

Tamsulosin is an...

alpha1-antagonist used to treat BPH by inhibiting smooth muscle contraction. Selective for alpha1A,D receptor found on prostate.

476

Sildenafil and Vardenafil MOA

inhibit phosphodiesterase-5 causing increased cGMP, smooth muscle relaxation, increased blood flow and penile erection

477

Toxicity of Sildenafil and Vardenafil

-dyspepsia -impaired blue-green color vision -risk of life-threatening hypotension in pts taking nitrates (since they block teh breakdown of NO)