week one Flashcards
(133 cards)
1
Q
Describe the sperm pathway
A
Testes → epididymis → ductus deferens → ejaculatory ducts →prostatic ducts → prostatic urethra→ urethra → out
2
Q
How is the male pelvis different from the female pelvis?
A
It is more heart shaped and much smaller
3
Q
What are the seminiferous tubules responsible for?
A
Spermatogenesis
4
Q
What is the function of germ cells?
A
Differentiate to produce spermatocytes from onset of puberty
5
Q
What is the function of sertoli cells?
A
Larger cells that support, ature, and protects, sperm generation, secretes activin and inhibin
6
Q
What is the function of leydig cells?
A
Secrete testosterone
7
Q
Where are the germ cells, sertoli cells, leydig cells found?
A
Seminiferous tubules
8
Q
How many spermatids are produced during spermatogenesis?
A
4
9
Q
How many chromosomes does each sperm contain?
A
23
10
Q
How long does each sperm take to mature?
A
72 days
11
Q
Where do sperm mature?
A
Epididymis
12
Q
What is the structure of mature sperm?
A
Head: chromosomes
Midpiece: mitochondria and ATP
Tail: movement
13
Q
Where are mature sperm stored?
A
Tail of Epididymis
14
Q
Where is cancer most commonly found in the prostate?
A
Peripheral zone
15
Q
What does the bulbourethral gland secrete?
A
Pre-Seminal fluid
16
Q
What do the seminal vesicles secrete?
A
Viscous whitish-yellow fluid containing fructose and prostaglandins
17
Q
In males what does FSH stimulate?
A
Spermatogenesis
18
Q
In males what does LH stimulate?
A
Stimulates production of testosterone via leydig cells
19
Q
What does testosterone do?
A
Stimulates the development of male secondary sex characterits and spermatogensisi
20
Q
What layer of the endometrium is shed during menses?
A
Functional layer
21
Q
When is LH highest? When is FSH highest?
A
Both before ovulation, around day 11
22
Q
What hormone is highest during the follicular phase/during menses?
A
Estrogen
23
Q
What hormone is highest during the luteal phase/secretory phase?
A
Progesterone
24
Q
When is the endometrial lining the thickest?
A
During luteal phase, around day 28
25
When is the endometrial lining the thinnest?
Around day 7
26
When is basal body temperature lowest?
Around day 14
27
When is basal body temperature highest?
Day 16-26
Around ovulation
28
Ovarian cycle developmental steps
Primary follicle → theca → antrum → ovulation → corpus luteum forms → mature corpus luteum → corpus albicans
29
When is inhibin the highest?
Luteal phase, day 21, secretory phase
30
What is released from corpus luteum?
Progesterone, hCG
31
What is the impact of alcohol on a fetus?
Birth defects, fetal alcohol syndrome, and fetal alcohol effect
32
What teratogenic effect do androgens have?
Masculinization of external genitalia of a genotypically female fetus
33
What teratogenic effect do progestins have?
Hypospadias (urethral opening on underside of penis) in the male and heart defects
34
What teratogenic effect does diethylstilbestrol (DES) have?
Inc vaginal/cervical cancers in women
Inc in genital tract anomalies in males
35
What teratogenic effect do antibiotics have?
Tetracycline: crosses placenta and deposits in embryonic bones and teeth; causes mottling of teeth in third trimester and dec bone growth in long bones
Antituberculosis antibiotics may cause deafness
36
What teratogenic effect does vitamin A (and retinoic acid derivatives) have?
Abortion and birth defects; esp in 5-7th week gestation
37
What infections are teratogenic?
Toxoplasmosis
Other: HIV, Varicella-zoster, Syphilis, parvovirus, Epsine-Barr
Rubella
Cytomegalovirus
Herpes simplex
38
Radiation effect on pregnancy?
Developmental delays at 10-18 weeks
39
What are the parts of the male genital exam?
Inspection
Palpation (inguinal lymph, penis, scrotum and testes)
Inguinal hernia check
Prostate exam (maybe)
40
What does the horizontal chain of inguinal nodes drain?
Drains external genitalia (except testes), anal canal, gluteal area
41
What does the vertical chain of inguinal nodes drain?
Drains upper thigh
42
Explain what a direct hernia is
Tissue herniates behind external ring from the abdominal wall
43
Explain what a indirect hernia is
Tissue herniates through the inguinal canal
44
What lab tests are used when focusing on male reproductive concerns?
Testosterone
PSA
Urinalysis
Urine culture and sensitivity
GC/CT NAAT urine
Syphilis serum
HIV serum or finger stick
Hepatitis B, C serum
45
What imaging is used for male reproductive health concerns?
Ultrasound
Color doppler
Pelvic CT
Uroflowmetry
Tissue biopsy
46
At what age can an adolescent have confidentiality? At what age can they make a medical decision such as getting a vaccine without parent knowledge/consent?
Confidentiality: 10
Med decision: 15
47
What are the components of the Breast Cancer Risk Assessment Tool? At what age do you start?
Current age
Race
Age of menarche
Age of first live birth
Number of 1st degree relatives w breast cancer
Number of previous biopsies
Whether any breast biopsy has shown atypical hyperplasia
Women 35+
48
What is average blood loss during a period?
30 mL avg (13-80mL)
49
What are the 8 P’s to ask during sexual history?
Preferences (pronouns)
Partners (what type, how many)
Practices (oral, anal, vaginal, sex toys)
Protection from STIs
Prevention of pregnancy
Pleasure
Partner violence
50
When do you start screening for diabetes and lipids?
DM: 45, q3 years
Lipids: 20, q5 years
51
Components of the gynecological exam
CBE/Chest exam
External genital exam
Speculum exam
Bimanual exam
Rectal-vaginal exam (over 40 or with suspicion of endometriosis or CA)
52
Of the most common STDs, how many and which ones are curable?
4; syphilis, gonorrhea, chlamydia, trichomoniasis
53
Of the most common STDs, how many and which ones are NOT curable?
4; the viral infections; hep B, HSV, HPV, HIV
54
Recommended dx test for syphilis
Dark Field examination (DFA) of lesions; RPR or VDRL followed by FTA-ABS or TP-PA
55
Recommended dx test for trichomoniasis
Saline wet mount
Lipid based paps
NAAT
56
Recommended dx test for herpes
Viral culture or fluorescent antibody of ulcers
Glycoprotein G-based serum antibody tests
57
Recommended dx test for gonorrhea
Culture tests: (required for disseminated gonococcus testing):
Blood culture
Throat culture
Synovial fluid
Non-culture tests:
PCR/NAAT
DNA probe
Gram stain (dx in men, not women)
58
Recommended dx test for chlamydia
Polymerase chain rxn DNA probe or NAAT (same swab)
Swab endocervical, urethral. vaginal, pharyngeal, rectal, or dirty first morning void
59
For the dx of what pathologies is a vaginal wet mount “wet prep” indicated?
Vulvo-vaginal candidiasis
Bacterial vaginosis
Trichomonas vaginalis
60
What are normal vaginal flora?
Lactobacillus sp
Gardnerella vaginalis
Candida albicans
Corynebacterium sp (“diphtheroids”)
61
How is a wet prep prepared?
Sterile swab used to collect vaginal fluid
Swab in test tube with .5mL saline
Keep swab at body temp warm
Place drop of specimen mix on slide
Examine under high power 40x
62
Normal values for a wet prep
WBC: 0-5/high power field (hpf)
RBC: 0-2 to 0-5/hpf
Epithelial cells: 2-4+, depends on technique
Bacteria: 2+ described as moderate
Yeast: 0-5 cells/hpf
pH: 3.8-4.2
63
What is the most common cause of vaginitis in premenopausal women?
BV
64
What are the vaginal flora changes present with BV?
Decrease in lactobacilli
Increase in cocci, mycoplasma hominis, anaerobic G-rods, and peptostreptococcus
65
What are the criteria used to dx BV?
Amsel criteria:
-Homogenous, grayish-white discharge
-Vaginal pH > 4.5
-Positive whiff test
-Clue cells on wet mount
First 3 can overlap with trichomonas; clue cells are most reliable predictor of BV
66
What is a whiff test? What are possible results?
Drop of specimen mixed with 1 drop 10% KOH and wafted toward nose
“Fishy” odor can be the result of g. Vaginalis and trichomonas producing amines that volatilize on KOH addition
67
Wet prep KOH slide examination possible findings
Bacteria streaming off squamous epithelial cells (helps confirm BV)
Budding yeast/pseudohyphae that may have been obscured
68
Wet prep findings for candida vulvovaginitis
pH 4-4.5 (normal)
Yeast buds or spores or pseudohyphae
KOH prep destroys cellular elements to facilitate recognition of budding yeasts or hyphae
69
Signs and sx trichomonas vaginalis
Up to 50% asymp
Copious, greenish discharge
Strawberry cervix
70
Sequelae trichomonas vaginalis
Increased PID
Infertility
Post surgical infections
HIV transmission
Preterm birth
71
Wet prep key diagnostic points
Clue cells: epi cells with >75% bacteria; will NOT see abnormal number of WBCs
Positive whiff test: G vaginalis and trichomonas (trichomonas; must be actively motile in fresh samples for dx)
Candida albicans: single, budding, or pseudohyphae yeast forms seen
72
Differentiating features among vaginitis causes
BV:
-Thin, milky, “fishy” discharge
-pH > 4.5
-Pos whiff test
-Clue cells (20%+), no/few WBC
Candida:
-Thick, white, clumpy discharge
-pH < 4.5
-Neg whiff test
-Few WBCs
-Pseudohyphae or spores on KOH wet mount if non-albicans species
Trichomoniasis:
-Frothy, gray or yellow-green discharge
-pH > 4.5
-Possible pos whiff test
-Motile flagellated protozoa, many WBCs
73
Why can chlamydia not be cultured?
Because chlamydia are bacterial obligate intracellular organisms, they cannot be cultured on artificial media
74
What dx/RF would indicate gonorrhea testing?
Vaginal discharge
Pelvic pain
Urethritis or penile discharge
Proctitis
Pharyngitis
High risk for STIs
75
Gram stain can aid in the dx of what STD?
Gonorrhea in MALES; gram neg diplococci inside WBCs
76
What STD should be tested at the first prenatal visit and 3rd trimester for at risk pregnant women?
N. gonorrhoeae
77
What are some pathologies that can result in a false positive VDRL or RPR when testing for syphilis?
Malaria
Lepto
Leprosy
Mononucleosis
SLE, RA
78
What is the difference between VDRL/RPR and MHA/FTA when testing after syphilis treatment?
VDRL/RPR will revert to negative or decrease to very low titer
MHA/FTA remains positive for lifetime of pt
79
You should screen all patients positive for ___ for HIV
Syphilis; HIV-coinfection is common
HIV pts are at higher risk of neurosyphilis
80
Explain the difference between the various types of transmission for HSV
Horizontal: sexual contact, aerosal/fomite (rare)
Vertical: maternal/infant at birth
Autoinoculation: from one site to another
81
Classic sx of primary herpes
Systemic: fever, myalgia, malaise (can have meningitis, encephalitis, hepatitis)
Local: clusters of small, painful blisters that ulcerate and crust outside of mucus membranes
-Itching, dysuria, vaginal discharge, inguinal adenopathy, bleeding from cervix
82
What are the uses of CD4 T-lymphocyte counts in HIV?
Determining clinical prognosis
Assessing criteria for antiretroviral therapy
Monitoring therapy
Progressing to AIDS
83
What are the HIV testing options?
Enzyme immunoassays
Rapid tests
Western blot
Early diagnosis: P24 and Viral RNA
Initiation and monitoring treatment: CD4 and viral load
Lymphocyte immunophenotyping
84
What do 3rd gen HIV antibody tests look for? When can they detect? How long does it take to get results?
HIV antibodies
3 month after exposure
b/w a few days and a few weeks
85
What do 4th gen HIV antibody tests look for? When can they detect? How long does it take to get results?
HIV antibodies and p24 viral proteins
1 month after exposure
b/w a few days and a few weeks
86
What do HIV rapid tests look for? When can they detect? How long does it take to get results?
HIV antibodies
3 mon after exposure
w/in 20 min
Need to follow up with other test
87
What do HIV self-testing kits look for? When can they detect? How long does it take to get results?
HIV antibodies
3 mon after exposure
w/in 20 min
Need to follow up with other test
88
Hep B transmission
Susceptible individual exposed through blood or body fluids that contain HBV
Body fluids that do NOT confer risk: urine, vomit, feces, sweat
89
HBV RF
Increased number sex partners
MSM
Hx of other STIs
90
When would a suspected HPV wart need a biopsy?
Lesions are atypical
Dx is uncertain
Person is immunocompromised
Lesion does not respond to therapy
Lesions worsen during tx
91
At what age should females begin routine HPV screening?
30+
25-29: if pap comes back ASCUS or greater
92
Sexual assault evaluation components
Cultures for GC and CT from sites of penetration
Wet mount and culture for trichomonas
HIV, hep, and syphilis serology
93
In office tests/collections vs blood tests summary
In office:
Wet prep (active trich)
Off the pap (GC/CT)
Affirm or vaginitis PLUS panel (trich, GC/CT)
GC/CT (swab, urine)
Herpes PCR or culture
Blood tests:
HIV
Hep BsAg
Herpes antibody
Syphilis (screening: RPR or VDRL, diagnostic antibodies)
94
For what age groups and how often should you instruct male patients to perform self-testicular exams?
Age 15-35; monthly self exams
95
What area of the breast are most breast cancers found?
Upper outer (50%)
96
3 components of the pelvic exam, and what the physician is evaluating in each
External genital exam
-Inguinal lumph nodes
-Hair - distribution, lesions, folliculitis, lice
-Clitoral size
-Vulva and perineum - lesions, masses, swelling, erythematous changes, abnormal pigmentation
-Vestibule - abnormal pigmentation, discharges, inflammation, patency of introitus, retroceles, cystoceles; palpation of glands if indicated
Speculum exam
-Cervical changes, polyps, mucosal atrophy, tumors, cysts, masses, vaginal wall rugae, bleeding, discharge
-Collecting pH, preps, paps
Bimanual
-Cervical motion tenderness
-Uterine mobility
-Uterus position, shape, consistency, symmetry, mobility, tenderness
-Assessing pelvic floor strength
-Ovary size, shape, consistency, mobility, tenderness
97
When is a rectovaginal exam warranted?
Women > 40 or in any age with suspicion of endometriosis or cancer
98
What are the 3 columns of the shaft of the penis? Which contains the urethra?
Two lateral dorsal columns (corpora cavernosa)
One ventral column (corpus spongiosum) which contains the urethra
99
What are some possible findings during penis inspection and palpation?
Penile nodules, ulcers, scars, tenderness, bruising, retraction of foreskin, edema
Variation on location of urethral meatus (epispadias, hypospadias)
100
What are some possible findings during scrotum inspection and palpation?
Swelling (fluid-filled) or solid masses, herniations
Rashes, nodules, lesions
101
What are some possible findings during testes inspection and palpation?
Large, small, or undescended testes
Testicular swelling/mass, painful or painless
102
What are some possible findings during epididymis inspection and palpation?
Painless mass (spermatocele)
Painful swelling (epididymitis)
103
What are some possible findings during spermatic cord inspection and palpation?
Swelling: tender or nontender
104
What are some possible findings during inguinal lymph node examination?
Bilateral or unilateral lymphadenopathy, node scarring
105
What are some protective factors against breast cancer?
Exercise
Breastfeeding
Lower post-menopausal BMI
Oophorectomy
Aspirin
106
What are some major risk factors of breast cancer?
Age
Genetic predisposition
Estrogen exposure (menstruating years, hormonal medication/therapy)
Breast density
FH
Radiotherapy exposure
107
Explain the ACR categories for breast cancer (0-6)
0 - incomplete, additional imaging needed
1 - negative, routine (annual) (0%)
2 - benign - no follow up (0%)
3 - prob benign, follow up in 6 mo (0-2%)
4 - suspicion for malignancy
4a - low - 3-6 mo imaging for few years (2-10%)
4b - moderate - biopsy (10-50%)
4c - high sus - biopsy (50-95%)
5 - cancer, biopsy (95+%)
6 - known biopsy, proven cancer - excision
108
What is the proposed cause of cyclic breast pain?
Stimulation of ductal elements by estrogen
Stimulation of stroma by progesterone
Stimulation of ductal secretion by prolactin
109
Why might caffeine avoidance help with breast pain?
Increasing circulating catecholamines; women with fibrocystic dz may have increased sensitivity of adenylate cyclase system to catecholamines
110
Why might smoking cessation help with breast pain?
Smoking may increase breast pain by increasing epinephrine and via cAMP stimulation
111
What are recommendations for BSE and goals?
Not recommend
Earlier detection of breast abnormalities
112
When should you do a BSE if you are premenopausal?
Day 5-10 of cycle
113
When do you perform CBE?
Pt that present with a mass, dimpling, nipple d/c, or breast pain
114
What should you be looking for on the CBE visualization?
Erythema, dimpling, edema, ulceration, bulging, nipple inversion or d/c
115
What do you need to include in documenting nipple d/c?
Spontaneous or expressed w/ pressure
Quadrant
Number of ducts
Color od d/c
Unilateral or bilateral
Hemoccult +/-
116
At what age do you discontinue screening mammography?
Shared decision making with patient but 74 yo
117
What is mammography good at detecting?
Small cancer
118
What are the risks/challenges with mammography?
Radiation exposure, younger age, breast density, over-diagnosis, false positives, anxiety, and pain
119
What history is taken for menstrual history?
Age at menarche
Number of days of menses
Length and regularity of interval b/w cycles
LMP
Color and volume of flow
Symptoms with menses: cramps, loose stool, anovulation,
Hx heavy or intermenstrual bleeding, dysmenorrhea, postcoital bleeding,
120
What are the important parameters to remember regarding STI testing (age, etc)?
Chlamydia and gonorrhea annually for all sexually actie women < 24
All adolescent and adults through 65 years screen for HIV at least once in lifetime
High risk sexually acitive adults screening minimally annually fot CT, GC, and syphilis
Hepatitis C test those born 1845-1965 once in lifetime
121
List the percent risk for the following categories: average; moderate; high for developing breast cance
Average: <15%
Moderate: 15-20%
High: >20-25%
122
What is breast density, how does it affect risk of breast cancer and what increases the development of breast density?
Breast Density: high amount of lobular breast tissue
Effect on risk of breast cancer: inc risk; this is the tissue where breast cancer develops and it is harder to see breast cancer on imaging
What inc development of density:
Exogenous hormones; postmenopausal estrogen, progesterone hormone therapy
Varies during phases of cycle (inc in luteal)
Alcohol
123
Diagnostic Mammogram Indications
Women >30 with new breast complaint
Investigate a lesion
Screening
124
7 Characteristics to chart about any masses found:
Location
Size - mass, thickened areas, skin color changes
Shape
Consistency - soft, fibrous, hard
Texture - smooth, irregular
Mobility
Tenderness
125
Pathologic vs Physiologic Nipple d/c
Pathologic: unilateral, bloody, associated with mass or skin lesions
126
Workup for pt with non-cyclic/focal breast pain; ages >40, 30-39, <30
> 40: mammography and US
Pt 30-39: mammography +/- US
Pt <30, focused US
127
list some conventional mastalgia tx
physical support, OTC analgesics, manipulate hormone meds if applicable
progesterone, tamoxifen, danazol
128
list some naturopathic mastalgia tx
caffiene avoidance, smoking cessation, compression, alternating hot and cold, low fat high carb diet, EPO, vitex, chamomile extract, antiinflammatroy diet, seed cycling, iodine, castor oil and phytolocca oil topically, exercise
129
What are the strict contraindications to starting gender affirming hormone therapy?
Hx of hormone sensitive cancer, clotting disorders, venous thromboembolism, uncontrolled liver disease, uncontrolled CVD
130
What specific risks are associated with feminizing hormone therapy?
Increased risk of venous thromboembolism or prolactinoma due to estrogen use
Increased risk of hyperkalemia from spironolactone use
131
What specific risks are associated with masculinizing hormone therapy?
Increased risk of erythrocytosis or polycythemia due to testosterone use
132
What are the physical changes expected to occur with feminizing hormone therapy according to The Endocrine Society?
Redistribution of body fat
Decrease in muscle mass and strength
Softening of skin/decreased oiliness
Decreased sexual desire
Decreased spontaneous erections
Male sexual dysfunction
Breast growth
Decreased testicular volume
Decreased sperm production
Decreased terminal hair growth
Scalp hair
Voice changes
133
What are the physical changes expected to occur with masculinizing hormone therapy according to The Endocrine Society
Skin oiliness/acne
Facial/body hair growth
Scalp hair loss
Increased muscle mass/strength
Fat redistribution
Cessation of menses
Clitoral enlargement
Vaginal atrophy
Deepening of voice
