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USMLE World Missed Questions > Reproductive Systems > Flashcards

Flashcards in Reproductive Systems Deck (61):

Where does lymph from the scrotum drain? From the testes?

Scrotum- superficial inguinal notes; testes- para aortic.


What type of genes are BRCA-1 and BRCA-2?

DNA repair genes; they are in particularly involved in repair of dsDNA breaks.


How are the uterine tubes, uterus, cervix, and superior 1/3 of the vagina formed in normal fetal development?

Fusion of the paramesonephric ducts.


What occurs due to failure of the paramesonephric ducts to fuse?

Utereus didelphys, the most extreme example of non-fusion where two separate vaginas, cervices, and uterine horns develop. A bicornate uterus may also form (less severe).


What is a bicornate uterus?

A partially separate uterus attached to a single cervix and vagina


How is a bicornate uterus formed?

Failure of fusion of the paramesonephric ducts.


In males, what may occur due to incomplete fusion of the urethral folds?



Name two findings seen with patients with endometriosis.

Nodularity of the uterosacral ligaments and fixed retroversion of the uterus.


How are fibroadenomas characterized histologically?

By a cellular, often myxoid stroma that encircles the epithelium-lined glandular and cystic spaces. Epithelium can be compressed by the surrounding stroma.


What is the weakest part of the posterior urethra?

The membranous part.


How may trauma to the pelvis cause injury to the urethra?

Fracture often results in disruption of the posterior urethra at the bulbomembranous junction.


In what instances are posterior vs anterior urethral injuries most common?

Posterior- pelvic fractures; anterior- straddle injuries.


Under what stimulation are androgens produced in the ovarian follicle?

Via stimulation by LH of the theca interna cells


How are androgens produced by the ovarian follicule converted to estradiol?

By aromatase within granulosa cells which convert to estradiol under FSH stimulation.


What is the function of theca externa cells?

Connective tissue support for the structure of the follicle.


What is another name for the mullerian ducts?

Paramesonephric ducts.


What may occur as a result of abnormal transformation of mullerian ducts in a female?

Hypoplasia or agenesis of the vagina and uterus, duplication of the vagina, cervix, and uterus, unicornuate, bicornuate, and septate uterus.


What is the term used to describe a case where menses are absent in the context of normally functioning ovaries and a normally functioning anterior pituitary gland?

Eugonadotropic amenorrhea.


What are the two most common causes of primary eugonadotropic amenorrhea?

Imperforate hymen or Mullerian duct anomalies.


In a female born with ambiguous genitalia, no utereus, and with gonadal cells containing a Y chromosome, lack of what fetal substances was present?

Mullerian Inhibiting Factor


What are the three steps of reproductive system differentiation?

Gonadal development; genital duct development; external genitalia development.


In males, what is the role of testosterone and DHT in genitalia development?

Testosterone mediates internal development; DHT mediates development of external genitalia.


Exogenous administration of what factors contributes to apoptosis of endometrial cells?

Antiprogestin abortifacient or withdrawal of progesterone.


Name the five subtypes of ductal carcinoma in-situ (DCIS).

comedocarcinoma, solid, cribiform, papillary, and micropapillary.


How is comedocarcinoma identified histologically?

Solid sheets of pleomorphic, high-grade cells with central necrosis. Often accompanied by chronic inflammation and concentric fibrosis.


When does the secretory phase of the menstrual cycle occur?

From day 15 through day 28.


Describe the stroma and during the secretory phase.

Progresterone released by corpus luteum causes uterine glands to coil and secrete glycogen rich mucus; endometrial stroma becomes edematous and is completely traversed by tortuous spiral arteries that extend from teh deeper layers to the uterine lumen.


What causes hypospadius?

Incomplete fusion of urethral (urogenital) folds


What causes epispadius?

Faulty positioning of the genital tubercle in the fifth week of gestation.


Describe the symptoms of a Haemophilus ducreyi infection.

Ulcerative, chancroid STI. Within a few days of innoculation, a tender, red papule appears on the external genitals that eventually erodes to become a painful ulcer. Regional lymph nodes may swell and become chronic ulcers.


What symptoms are characteristic of a Klebsiella inguinale infection?

Granuloma inguinale first manifests as a painless papule on the genitalia that ulcerates. Lymphadenopathy is uncommon and intracytoplasmic Donovan bodies are diagnostic. If untreated, scarring and strictures can lead to lymphatic obstruction and elephantitis.


What is Lymphogranuloma venerum (LGV) and what causes it?

Caused by Chlamydia trach. L1-L3, it is characterized by painless ulcers with later progression to painful inguinal lymphadenopathy and ulceration. It is characterized histologically by chlamydial inclusion bodies in cellular cytoplasm.


Describe the appearance of a koliocyte.

Immature squamous cell with dense, irregularly staining cytoplasm and perinuclear clearing resulting in a halo


Where are parabasal cells found?

They predominate pap smears from post-menopausal and post-partum women.


What is the indication and mechanism of action of mifepristone?

Abortifacient used for therapeutic abortions for up until 49 days after conception. It is a progesterone antagonist with a very high affinity for the progesterone receptor. It also has anti-progestin effects that release endogenous prostaglandins and sensitize the myometrium (side effects of this include abdominal cramps, nausea, vaginal bleeding).


What is the role of progesterone in pregnancy?

Necessary for implantation and maintanence of pregnancy


What structure delivers the nerves and vessels that supply the ovary?

Suspensory ligament of the ovary.


Name three possible triggers of candida vaginitis.

Changes in vaginal pH, damage to vaginal microflora, epithelial injury. These can be triggered by antibiotic use, contraceptives, corticosteroid therapy, uncontrolled DM, and immunosuppression.


How is choriocarcinoma characterized histologically?

By abnormal proliferation of both cytotrophoblasts and syncytiotrophoblasts. No villi are present.


What is the primary mechanism of action of combination OCPs?

Suppression of synthesis of FSH and LH in the anterior pituitary which leads to inhibition of ovulation. They also cause thickening of cervical mucous and cause production of progestin which prevents growth of the endometrium making it unsuitable for implantation.


What is adenomyosis?

The presence of endometrial glandular tissue within the myometrium.


What findings are present to make a diagnosis of adenomyosis?

A uniformly enlarged uterus with normal appearing endometrial tissue within the myometrium.


What results from a lack of sertoli cells in a male embryo?

Paramesonephric ducts will develop into female internal genitalia. Fetus will have male external genitalia and both male and female internal genitalia.


Where is inhibin secreted from?

Sertoli cells.


In cryptorchidism, what cells are typically not impaired?

Leydig cells; secondary sexual characteristics and performance are normal.


What type of tumors are Granulosa-theca cell tumors and in who do they normally arise?

Sex-cord stromal tumors; arise most commonly in postmenopausal women. They are derived from ovarian stroma. They secrete estrogen.


What type of epithelium lines the ovary?

Simple cuboidal


What type of epithelium lines the fallopian tube?

Simple columnar


What type of epithelium lines the uterus?

Simple, pseudostratified columnar


What type of epithelium lines the cervix?

Simple columnar (endocervix), stratified squamous (ectocervix)


What type of epithelium lines the vagina?

Stratified squamous non-keratinized.


In a patient with ectopic pregnancy, uterine biopsy or cutterage would reveal what types of endometrial changes?

Pregnancy related changes- decidualization of stroma without embryonic tissue or chorionic villi. i.e. gestational changes in the endometrium without chorionic villi.


What characterizes granulosa cell tumors histopathologically?

Call-Exner bodies (small follicle like structures filled with eosinophilic secretions).


How do granulosa cell tumors most commonly present?

With hyperestrogenemia causing endometrial hyperplasia and abnormal uterine bleeding.


How are patients with PCOS treated pharmaceutically?

With OCPs (or clomiphene in women wishing to become pregnant).


What is the mechanism of action of clomiphene?

It is a SERM that prevents negative feedback inhibition on the hypothalamus by circulating estrogen which results in increased gonadotropin production and ovulation.


What are the greatest risk factors for HPV infection?

Age at first intercourse, multiple sexual partners, prostitution.


Abdominal discomfort and adenexal mass in an elderly female indicate what type of cancer?

Ovarian cancer.


Where do most ovarian malignancies originate?

From the ovary's surface epithelium.


What is produced by malignant ovarian epithelial tumors that can be used as a serum marker?



In what malignancies is serum a-fetoprotein elevated?

HCC and nonseminomatous testicular germ cell tumors (i.e. yolk sac tumors).