SM Flashcards
(290 cards)
1
Q
Provides nutrients to the sperm
A
Seminal vesicle
2
Q
Round ligament of the uterus is a fibrous cord that’s continuous with…
A
Ovarian ligament
3
Q
Space with the clitoris and openings of the vagina and urethra
A
Vestibule
4
Q
Paramesonephric duct persists as
A
Opening at the end of the uterine tubes
5
Q
Embryonic ureter
A
Mesonephric duct (Wolffian duct)
6
Q
Exstrophy of bladder/cloaca is caused by
A
Failure of mesoderm migration into cloacal membrane/ventral abdominal wall
7
Q
Gartner duct cysts
A
Abnormal persistence of mesonephrinc duct in females
8
Q
Double uterus/vagina
A
Results from failure of fusion of paramesonephric duct with each other or with the UG sinus
9
Q
Induces Sertoli cell differentiation and male-specific vasculature
A
SRY
10
Q
WNT4 mutation in 46 XX female
A
Mayer-Rokitansky-Kuster-Hauser syndrome
11
Q
Sox9 suppressed and WNT4 active for
A
Ovarian development
12
Q
Cells that make AMH
A
Sertoli cells
Works in paracrine fashion
13
Q
Persistent mullein duct syndrome
A
mutations in AMH in 46 XY male
14
Q
Placenta previa
A
Late implantation over cervical os
15
Q
Accreta
A
Implantation on myometrium
16
Q
Increta
A
Invasion into myometrium
17
Q
Percreta
A
Invasion through uterine serosa into adjacent structures
18
Q
3 stages of maternal response to infections of ascending infections in pregnancy
A
- Subchorionitis
- Chorioamnionitis
- Necrotizing amnionitis
19
Q
3 stages of fetal response to infection
A
- Phlebitis (vein)
- Arteritis (artery)
- Necrotizing funisitis (necrosis in Wharton’s jelly)
20
Q
Ascending infections of pregnancy
A
Mycoplasma Gardnerella Group B strep E. coli Enterococcus Candida HSV
21
Q
Hematogenous infection of pregnancy
A
Syphilis TB Listeria CMV, Rubella Toxoplasmosis
22
Q
Acute villitis
A
Listeria, E.coli, TB
23
Q
Chronic villitis
A
CMV, toxoplasmosis, syphilis
24
Q
Presentation of retroplacental hematoma/abruption
A
Painful bleeding
25
Virchow's triad
Stasis
Hyper-coagulability
Vascular damage
26
Consequence of FVM
Fetal neurologic damages (cerebral palsy)
27
Monochorionic twin placenta complications
```
Preterm labor
Twin twin transfusion
Twin reversed arterial perfusion
Cord entanglement
Congenital malformations
```
28
P57KIP2
Differentiates complete and partial moles because it's only expressed from maternal chromosomes
29
Choriocarcinoma metastasizes to where?
Lung, brain, liver
30
Passes through the lesser sciatic foramen
Pudenal nerve
31
Widest dimension of pelvis
Between arcuate lines of ilia
32
Narrowest dimension of pelvis
Between ischial spines
33
Fat filled space that allows for distention of rectum or vagina
Ischio-anal (rectal) fossa
34
Things that attach to the perineal body (central tendon of the perineum)
Pelvic diaphragm
Rectum
Urogenital diaphragm
35
Common sites for kidney stones
Renal pelvis
Common iliac vessels
Entrance to bladder
36
Adenomyosis
Presence of endometrial glandular tissue within myometrium.
| Present with menorrhagia and dysmenorrhea with a uniformly enlarged uterus
37
STI that's symptomatic in women
Chlamydia
38
Factors that increase risk of transmission of HIV
Hormonal effects
Nonoxynol - disrupts mucosal surface
Trauma
39
Microbicides
Tenofovir gel and barrier placement
40
HPV subtypes that cause genital warts
6, 11
41
HPV subtypes that cause cervical cancer
16, 18
42
Loose adherence of gonorrhea
Pili
43
Tight adherence of gonorrhea
Opa proteins
44
Charcot joint results from
Tabes dorsalis due to tertiary syphilis
45
Tx for syphilis
Penicillin
46
Remains unchanged during pregnancy
Gastric emptying time
47
Effect of pregnancy on hepatic labs
Increased D-dimer and Alk phos
| Decrease albumin
48
Change in immune cell types during pregnancy
Increase CD8 and granulocytes
| Decrease CD4 and monocytes
49
Fetal breathing movements begin when?
16-22 weeks
50
Stages of lung development
```
Pseudoglandular stage (5-16 weeks)
Canalicular stage (16-25 weeks)
Terminal sac/alveolar stage (25 weeks - 8 yrs of life)
```
51
Given to maintain PDA
Prostaglandins
52
Women who have delivered before have a ---- during delivery
Sharper acceleration curve
53
4th generation of progestins and analogue of spironolactone
Drospirenone
54
Hepatic changes from ethinyl estradiol exposure
Decrease albumin, LDL
| Increase goblins, coagulation proteins, angiotensinogen, sex hormone binding proteins, TG and HDL
55
Medical abortion agents
Mifepristone
| Misoprostol
56
Contraindications to medical abortions
```
Ectopic pregnancy
IUD
Corticosteroid
Hemorrhagic disease/porphyrias
Anticoagulants
Adrenal failure
Prostaglandin allergy
```
57
Osmotic dilators
Laminaria, lamicel, dilapan
58
Cycle fecundability
Single menstrual cycle results in pregnancy
59
Cycle fecundity
Single cycle results in live birth
60
Iatrogenic intrauterine adhesions
Asherman's syndrome
61
Causes of ovarian dysfunction
```
PCOS
Hypothalamic amenorrhea
Hyperprolactinemia
Thyroid disease
POI
```
62
When to check serum progesterone when assessing ovulation
day 21 of cycle
63
Good sperm volume
>1.5 ml
64
Good sperm concentration
>15 million/ml
65
Good sperm motility
>40%
66
Good sperm morphology
>4%
67
First line tx for ovulatory dysfunction in woman with PCOS
Letrozole
68
Most predictive for IVF success
Age and ovarian reserve
69
Connective tissue disease increases risk of what during pregnancy
Cervical insufficiency
70
Contraindications to cerclage in CI
```
Contractions/labor
PPROM
Infection
Fetal demise
Major fetal anomaly
```
71
Contraindications to expectant management
Labor
Significant vaginal bleeding
Infection
72
Maternal symptoms from preeclampsia
Headache
Visual changes
RUQ pain
73
Used to prevent eclampsia
MgSO4
74
Presentation of spontaneous abortion
Vaginal bleeding
Pelvic pain
Incidental finding on US
75
What should you absolutely screen women for that are going through menopause?
Depression!
76
FDA approved SSRI for VMS
Paroxetene
77
What menopausal symptoms don't resolve without treatment
Local vuvlovaginal symptoms
78
What layer is missing from the uterine tube?
Submucosa
79
Cervical glands
Branched and often with cysts
80
Estrogen effects on breast tissue
Elaboration of glands and ducts
81
Progesterone effects on breast tissue
Dilated ducts with milk
82
Placenta previa
No pain
| Fetal heart rate monitoring normal
83
Vasa previa
Active, heavy bright red bleeding compromising fetus
| Fetal heart rate monitoring abnormal
84
Causes nausea and vomiting of pregnancy
HCG
85
Causes GERD, constipation, decreased gallbladder motility of pregnancy
Progesterone
86
Etiology for anovulation
```
PCOS
Hypothalamic amenorrhea
Hyperprolactinemia
Thyroid disease
Premature ovarian failure
```
87
For women age 40-45 with irregular menstrual cycles, exclude
pregnancy, hyperprolactinemia and thyroid dysfunction
88
Estrogen only therapy leads to an increase risk of what?
Endometrial cancer`
89
Rapid plasma reagin
Test used for syphilis prior to to dark field microscopy
90
NE acting on ---- receptor contracts bladder neck
Alpha 1 receptors
91
NE acting on ---- receptor relaxes detrusor muscle
B3 receptor
92
ACh acting on --- receptor contracts detrusor muscle
M3 receptor
93
Stress incontinence
Lost of tone in UG diaphragm and increased intra-abdominal pressure
94
Highest control of micturition
Periaqueductal grey (PAG)
95
L Region of brainstem
Controls striated muscles to promote urinary continence
| AKA - Pontine Storage Center
96
M Region of brainstem
Controls smooth muscle to promote urination
| AKA - Pontine Micturition Center
97
Why does a UTI lead to urinary frequency?
Afferent sensory nerves are hyper sensitized which leads to a lower threshold for bladder contractions.
98
What nervous system is needed for defection but not urination.
Enteric nervous system
| Ex: Hirschsprung's disease -> megacolon
99
Example of conditions that can damage NANC nerve terminal and result in the absence of male erection in the presences of viagra
Diabetes
| CV disedase
100
Orgasm
Rhythmic contractions of perineal muscles
| Pudenal nerve activated globally
101
Neuropeptides of LSt (lumbar sphinothalamic) nerves
Galanin, CCK, enkephalin, NK-1R
102
Sexually dimorphic nuclei in the hypothalamus located in the medial prepotic area
Bigger in males
103
Lesion in SDN in males
Problems with sexual function and motivation
104
Lesion in SDN in females
Problems with mate selection
105
Inhibits sexual function
Ventral medullary regions of brainstem
106
Trisomy 21 maternal serum findings
Decreased AFP, uE3
| Increased hCG, inhibin A
107
Large nuchal translucency
Down's Syndrome
108
Measured for open neural tube defects
AFP and acetylcholinesterase
109
Confined placental mosaicism is associated with
IUGR
110
Growth and density of amniotic fluid cells is ideal at
16-18 weeks gestation
111
Maternal age increases risk for autosomal aneuploidies and sex chromosome aneuploidies except
45, X Turner's syndrome
| Polyploidies or micro deletions
112
Increase risk of translocation Down's syndrome if
Mom is carrying the robertsonian translocation
113
When is maternal serum screening less effective
Twin gestations
| Younger maternal age groups due to lower PPV
114
Carrier detection African American
Hemoglobinopathies, Hgb S, C
115
Carrier detection Mediterranean
Beta-thalassemia
116
Carrier detection SE Asian
Alpha-thalassemia
117
Carrier detection Caucasian
CF
118
Carrier detection Ashkenazi Jews
Tay-Sachs, CF, Canavan, Gaucher, familial dysautonomia
119
Omphalocele is common in
Trisomy 18 (Edward's syndrome)
120
Most common micro deletion syndrome
22q11.21 (DiGeorge)
| CHD (tetralogy of fallot), cleating, ID, immune disorders
121
Age of peak incidence of cervical cancer
45
122
Risk factors for cervical cancer
Multiple sexual partners
Early initiation of sexual activity
High parity
Smoking
123
Keratinization and intracellular bridges
| Pap test good at detecting
Squamous cell carcinoma (Cervical cancer)
124
Glandular and produces mucin
| Pap test not good at detecting
Adenocarcinoma (Cervical cancer)
125
High risk HPV
16 - most cervical cancers
| 18- associated with adenocarcinoma
126
Low risk HPV
6, 11
127
E6
Leads to the degradation of p53
128
E7
Leads to the lost RB-E2F and as a result an increase in P16 which pushes the cell into the cell cycle
129
Cause of Lichen sclerosis
Autoimmune or low estrogen
| See thinning and atrophy of the epithelium with stroll hyalinization (dense fibrosis)
130
What occasionally arises from lichen sclerosis?
Invasive squamous cell carcinoma
131
Lichen simplex chronicus
Squamous cell hyperplasia caused by chronic irritation (itching)
132
Differentiated pathway of vulvar squamous cell carcinoma
Associated with p53 mutation, lichen sclerosis and older women
133
Manifestation of underlying neoplasm of sweat glands or skin adnexae.
Sometimes represents internal malignancy (colon cancer, urothelila carcinoma)
Vulvar Paget's disease
134
3 M's (moulding, multi nucleation, margination) with pink nuclear inclusions (Cowdry A)
HSV 2
135
Inflammation is plasma cell rich and surrounds blood vessels
Syphilis
136
Smoking leads to a decrease of which hormone
Estrogen
137
Heterozygote mutation of MED12 on chromosome X
Leiomyoma
138
Most commonly mutated gene in endometroid cancer
PTEN
139
Treatment for breast cancer that actually increases risk for endometrial polyps
Tamoxifen
140
Menses is caused by a drop in
Progesterone
141
Plasma cells seen in chronic endometritis
Perinuclear clearing
| Eccentric nucleus with clockface chromatin
142
Fused cribiforming glands with a Swiss cheese appearance
Endometroid carcinoma
143
Cowden syndrome
Germline mutation in PTEN predisposing to endometrial carcinoma
144
JAZF1:JJAZ1 fusion
Endometrial stromal nodule/sarcoma
145
Infiltrative tumor nests (tongue-like projections) with small ovoid cells with little cytoplasm
Endometrial stromal sarcoma
146
Chemo agent used for carcinoma of the cervix
Cisplatin
147
Cigarette paper
Lichen sclerosis
148
Sites of metastasis for vulvar carcinoma
Lung, bone, brain, liver
149
May represent underlying colon or urothelial cancer
Paget's disease
150
Lateral boundary of perineum
Obturator internus muscle
151
Pelvic diaphragm converges on the
External anal sphincter
152
Superior fascia of UG diaphragm is located
Posterior and is deep
153
Inferior fascia/perineal membrane is located
Anterior and superficial
154
Both the pelvic diaphragm and UG diaphragm attach to
central tendon of the perineum
155
Pubovesicular ligament in females is similar to
Puboprostatic ligament in male
156
2 muscles within the UG diaphragm
External urethral sphincter
| Deep transverse perineal muscle
157
Pudendal nerve block anesthetizes
UG diaphragm and perineum
| No cervix
158
Sacral epidural anesthetizes
Cervix and upper vagina
| Misses body of uterus and fundus
159
Anesthesia of choice for childbirth
Lumbar epidural
160
Facilitates erection by impeding venous flow
Ischiocavernosus muscle
161
Expels the last drops of urine and contracts during ejaculation
Bulbospongiosus
162
In females, the ureters are extremely close to
uterine arteries
163
In males, the inferior gluteal artery is from
anterior division of internal iliac
164
In females, the inferior gluteal artery is from
posterior division of internal iliac
165
Artery that supplies the prostate gland
Inferior vesical artery
166
GnRH superagonist
Leuproloide
167
Synthetic GnRH
Gonadorelin
168
GnRH antagonist
Ganirelix, degarelix
169
Side effect of GnRH superagonists and antagonists
```
Nausea, headaches
Erectile dysfunction
Bone loss
Initial flare - bone pain, ureteral obstruction
Vaginal dryness, vaginal atrophy
```
170
Recombinant LH/hCG
Chorionogonadotropin
171
Recombinant FSH
Follitropin
172
Adverse effect of gondatropin administration in men
Gynecomastia
173
Depot testosterone
Testosterone propionate
174
Synthetic orally effective testosterone
Methyltestosterone
175
Anabolic testosterone
Stanozolol
176
Inhibits conversion of DHEA to testosterone by inhibiting 17-hydroxylase
Abiraterone
177
Inhibits 5a-reductase
Finasteride
| Dutasteride
178
Blocks androgen receptor
Enzalutamide
Docetaxel
Flutamide
Spironolactone
179
Synthetic 19-nortestosterone derivatives (progesterone)
Norethindrone, levonorgestrel
180
SERMs
Tamoxifen, Raloxifene
| Anti-breast cancer drugs
181
Aromatase inhibitors
Letrozole
| Anastrozole
182
Antiprogestin
Mifepristone
183
SARMs
Enzalutamide
| Bicalutamide
184
Inhibits proliferation of prostate cancer by targeting WDR5 complex
ERID 27
185
Targets NR4A to decrease fibroids
6-mercaptopurine
186
SERM that selectively antagonizes feedback inhibition at the pituitary and promote follicle maturation and induce ovulation
Clomiphene
187
Committed spermatogonium
Type 1 pale spermatogonium
188
Release of sperm into the lumen
Spermiation
| Interruption in this often causes male infertility
189
Morphological changes to sperm
Spermiogenesis
190
Epithelium of rete testis
Simple cuboidal
191
Has pseudo stratified columnar epithelium
Efferent ductules and seminal vesicle and prostate
192
Heat regulation in testis
Pampiniform plexus of veins
193
Indications for radiologic assessment
```
Penetrating trauma
Blunt + gross hematuria
Blunt + microhematuria and shock
Deceleration injuries
Pediatric injuries with hematuria
```
194
Bladder neck injury is most common in
Prepubescent boys
195
Best way to assess for testicular injury
Testicular ultrasound
196
Clinical presentation of scrotal trauma
Significant pain
| Firm scrotum, tender, ecchymosis
197
US finding suggesting testicular rupture
Heterogenous echo pattern within the testicular parenchyma with loss of contour
198
Most common cause of ureteral injury
iatrogenic
199
Most of the vagina should be suspended over
Levator ani
| If not -> prolapse
200
Obliterative procedure that involves closing the vaginal canal
Colpocleisis
201
What's more important for women's sexual functioning? Neurotransmitters or hormones?
Neurotransmitters
202
Excitatory neurotransmitters for libido in the limbic system
NE and dopamine
| NO, ACh, estrogen, androgens
203
Inhibitory neurotransmitters for libido in the pre-frontal cortex
serotonin and prolactin
204
When does testosterone surge in women?
Before ovulation when you should be wanting to have sex
205
SHBG is higher in
women
206
Conditions with low SHBG
PCOS, insulin resistance, anabolic steroids, hypothyroidism, obesity
207
Conditions with high SHBG
Anorexia, pregnancy, OCP, hyperthyroidism
208
What doesn't regulate libido
End organ
209
What regulates arousal
Central and hormonal regulation
| End organ physical capability
210
Most important for pain-free intercourse in women
End organ physical capability
211
Facilitator of arousal and orgasm
Oxytocin
212
Regulation of orgasm in women
Central and end organ mainly
213
Associated to hypoactive sexual desire disorder
Alcohol, OCP, SRRI**
214
CNS area that integrates libido
MPOA
215
CNS area that integrates thoughts and desire
Paraventricular nucleus
216
CNS area that inhibits libido and desire
PGN
217
Inhibits PDE2, 3, 4
Papaverine
218
Inhibits Ang 2, PGF, endothelin-1
Rhos kinase inhibitors
219
7-fold increase in risk of CV events in men < 40 presenting with
ED
220
Contraindications to PDE-5 inhibitors
Nitrates, Amyl Nitrate
221
Central scarring with very eosinophilic cells filled with mitochondria in the kidney
Renal Oncocytoma
222
Chicken wire appearance, small acini filled with glycogen and lipids
Clear cell RCC
223
Hematuria, flank mass, flank pain
Triad for papillary RCC
224
Prominent intercellular borders that appear plant like
| Pale cytoplasm rich in lysosomes
Chromophobe RCC
225
Cause of hemorrhagic cystitis
Cytotoxic agents such as cyclophosphamide
226
Malakoplakia
Chronic E.coli combined with phagocytic defect
| See calcifications in the cytoplasm of macrophages
227
Loss in a large segment of chromosome 9
Urothelial papillary carcinoma
228
FGFR3 mutation
Low grade urothelial carcinoma
229
P53 mutation
High grade urothelial carcinoma
230
Stimulates TH1 response to fight bladder cancer
BCG
231
Increases risk of upper tract urothelial cancer
Lynch 2 syndrome
232
Tumor markers for GCNIS and Seminoma
C-kit, Oct-4, PLAP
233
AFP and Glypican 3 positive and Schiller-Duval body
Yolk sac tumor
234
What cell type is lost in prostate cancer?
Basal cells
235
Stains for prostate basal cells
p63 + 34bE12
236
Gleason pattern 2
back to back glands
237
Gleason pattern 3
Donut infiltrating glands; no stroma
238
Gleason pattern 4
Fused glands
239
Gleason pattern 5
Solid sheet of cells
| Cribiform pattern with central necrosis
240
Prostatic ductal adenocarcinoma is equivalent to
Gleason pattern 4
241
Oat cell carcinoma
Small cell carcinoma
242
Prostate cancer's effect on bone
Induces bone formation
243
Hereditary PCa is what percentage of PCa?
15%
244
1/2 life of PSA
2-3 days
245
Common pattern of mets in PCa
Perineural invasion
246
New PCa marker
AMACR
247
Lymph nodes first affected by PCa
obturator hypogastric nodes
248
1st line tx for PCa mets
Androgen deprivation therapy
249
Sipuleucel-T
Immunotherapy for low disease burden PCa
250
Bone directed therapy for PCa mets
Denosumab and radium 223
251
Olaparib
PARP inhibitors
252
Mets for penile carcinoma
lung, liver, bone, brain
253
EGFR targeted therapy
Cetuximab, erlotinib, gefitinib
254
1/2 life of AFP
5-7 days
255
1/2 life of HCG
24 hrs
256
What's never elevated in pure seminomas?
HCG and AFP
257
Duplication of short arm chromosome 12 (D-cyclins)
Testicular cancer
258
Chemotherapy and radiation resistant
Teratoma
259
Lower PCa correlates with what and can lead to false negatives
Higher BMI
260
Reduced T:E linked to
PCa
261
Free PSA
Benign cancer
262
Complex PSA
Likely malignant cancer
263
Management for extra-peritoneal bladder ruptures
Insertion of Foley catheter
264
Trauma to anterior urethra requires
immediate repair
265
Normal testis size
> 4 cm x 2 cm
| > 20 cc
266
Drug that decreases libido
Spironolactone
267
Drug that reduces erectile function
Beta blockers and thiazides
268
Drug that reduces ejaculatory function
Alpha blockers, SSRIs
269
Dopamine agonists
Bromocriptine and carbergoline
270
Aromatase inhibitors
Anastrozole, Letrozole, Exemstane
271
P-pili
pyelonephritis
272
Type 1 pili
Cystitis
273
How do you treat a pregnant woman with a UTI?
beta-lactams
| TMP/SMX (except 3rd trimester)
274
Nonoxynol increases bacterial
adherence
275
Artery to vas deferens
Inferior vesicle artery
276
Artery to cremaster muscle
Inferior epigastric
277
Twist score
```
Testicular swelling
Hard testicle
Absent cremasteric reflex
Nausea or vomiting
High-riding testicle
```
278
Blue dot sight
Torsion of appendix testes (Mullerian duct remnant)
279
Failure of rupture of Chawall's membrane
Uretoceles
280
Blood supply to prostate
Inferior vesicular artery and internal pudendal artery
281
PSA 2 correlates with volume of prostate
40 ml
282
Prototype alpha 1a blocker for BPH
Tamsulosin
| SE (floppy iris syndrome)
283
Mirabegron
beta 3 agonist
284
Postobstructive diuresis
>200 ml/hr x 2 hrs
285
Lymph from the testes drain to the
Para-aortic nodes
286
Lymph from the scrotum drains to the
superficial inguinal nodes
287
Mild IPSS score for PCa
0-7
288
Moderate IPSS score for PCa
8-15
289
Severe IPSS score for PCa
>15
290
Lymph node drainage of bladder
deep pelvic nodes
