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BR-Reproductive
5/19/06
| Question | Answer |
|---|---|
| Gender determination | occurs after 7wks gestation; presence or absence of Y chrom (and SRY) determines which gonads drive differentiation |
| embryology - Day 0 | fertilization by sperm; initiates embryogenesis |
| embryology - within week 1 | implantation as BLASTOCYST |
| embryology - within week 2 | bilaminar disk |
| embryology - within week 3 | gastrulation; primitive streak, notochord, and neural plate begin to form |
| embryology - weeks 3-8 | neural tube formed; organogenesis; most suscetible to teratogens |
| embryology - week 4 | heart begins to beat; upper and lower limb buds form (thalidomide damage) |
| embryology - week 10 | genetalia have male/female characteristics |
| ectoderm categories | surface, neuroectoderm, neural crest cells |
| surface ectoderm | adenohypophysis, lens of eye, epithelial linings epidermis |
| neuroectoderm | neurohypophysis, CNS neurons, oligodendrocytes, astrocytes, pineal gland |
| neural crest cells | ANS, dorsal root ganglia, melanocytes, chromaffin cells of adrenal medulla, enterochromaffin cells, pia, celiac ganglion, schwann cells, odontoblasts, parafollicular (C) cells of thyroid, laryngeal cartilage |
| mesodermal derivatives | dura CT, muscle, bone, CV structures, lymphatics, blood, urogenital structrues, serous lining of body cavities (ex: peritoneum), spleen, adrenal cortex |
| endodermal derivatives | gut tube epithelium and derivatives (lungs, liver, pancreas, thymus, thyroid, parathyroid |
| notochord | induces ectoderm to form neuroectoderm (neural plate); its postnatal derivative is the nucleus pulposus of the intervertebral disk |
| rules of 2s for 2nd week of embryogenesis | 2 germ layers (bilaminar disk; epiblast & hypoblast); 2 cavities (amniotic, yolk sac); 2 components to placenta (cytotrophoblast, syncytiotrophoblast) |
| epiblast | precursur to ectoderm; invaginates to form primitive streak; cells from primitive streak give rise to intraembryonic mesoderm and endoderm |
| rule of 3s for 3rd week of embryogenesis | 3 germ layers (gastrula): ectoderm, mesoderm, endoderm |
| Teratogens: ACE inhibitor | renal damage |
| Teratogen: Cocaine | abnormal fetal development and fetal addiction |
| Teratogen: DES | vaginal clear cell adenocarcinoma |
| Teratogen: Iodide | congenital goiter or hypothyroidism |
| Teratogen: 13-cis-retinoic acid | extremely high risk for birth defects |
| Teratogen: thalidomide | limb defects ("flipper" limbs) |
| Teratogen: warfarin, xrays | multiple anomalies |
| Monozygotic twinning | 1 zygote splits evenly to form 2 amniotic sacs w/single common chorion and placenta |
| Dizygotic (fraternal) or monozygotic twins | Dizygotes develop individual placentas, chorions, and amnions; Monozygotes develop 2 placentas (separate or fused), chorions and amniotic sacs |
| Fetal erythropoiesis | Yolk sac (3-8wks), Liver (6-30wks), Spleen (9-28wks), Bone marrow (28wks onward); Fetal Hb = a2g2; Adult Hb a2b2; "Young Liver Synthesizes Blood" |
| Branchial clefts, arches, pouches (CAP) | derived from ectoderm, mesoderm, endoderm, respectively |
| Branchial arch 1 derivatives: "Ms" | Meckel's cartilage: mandible, malleus, incus, sphenoMandibular ligament; Muscles: Muscles of mastication (temporalis, Masseter, lateral/medial pterigoids; Mylohyoid, ant belly of digastric, tensor tympani, tensor veli palatini; CNV3 |
| Branchial arch 2 derivatives: "Ss" | Reichert's cartilage; Stapes, Styloid process, lesser horn of hyoid, Stylohyoid ligament; Muscles: facial expression, Stapedius, Stylohyoid, post belly of digastric; CNVII |
| Branchial arch 3 derivatives | "think of pharynx" (styloPHARYNGEOUS innervated by glossoPHARYNGEAL nerve) Cartilage: greater horn of hyoid; Muscles: stylopharyngeus; CNIX |
| Branchial arches 4-6 | Cartilage: thyroid, criocoid, arytenoids, corniculate, cuneiform; Muscles (4th): most parhyngeal constrictors, cricothyroid, levator veli palatini; (6th): all intrinsic mm of larynx except cricothyroid; CNX (4th), recrurent laryngeal branch of CNX (6th) |
| Branchial arch innervation: 1, 2, 3, 4, 6 | V2 and V3; VII; IX; X; X (recurrent laryngeal) |
| Branchial cleft 1 derivatives | external auditory meatus |
| Branchial cleft 2-4 derivatives | temporary cervical sinuses, which are obliterated by proliferation of 2nd arch mesenchyme; peristance = branchial cyst in neck |
| tongue development: 1st branchial arch | anterior 2/3; sensation via CNV3, taste via CNVII |
| Tongue development: 3rd and 4th branchial arches | posterior 1/3; sensation and taste via CNIX; extreme posteior via CNX |
| taste innervation | CNVII, IX, X |
| tongue pain sensation | CNV3, IX, X |
| tongue motor control | CNXII |
| Ear derivatives from 1st branchial arch | incus, malleus, tensor tympani (V3) |
| ear derivatives from 2nd branchial arch | stapes, stapedius (VII) |
| ear derivatives from 1st branchial cleft | external auditory meatus |
| ear derivatives from 1st pharyngeal membrane | eardrum, eustachian tube |
| 1st branchial pouch | middle ear, eustachian tubes, mastoid air cells; (endoderm-lined structures of ear) |
| 2nd branchial pouch | epithelial lining of palatine tonsil |
| 3rd branchial pouch | 3 structures: thymus (ventral wings), left and right inferior parathyroids (dorsal wings) |
| 4th branchial pouch | superior parathyroids |
| Aberrant development of 3rd and 4th branchial pouches | DiGeorge Syndrome; Tcell deficiency (thymic hypoplasia) and Hypocalcemia (parathyroid hypoplasia) |
| Persistance of thyroglossal duct | connection btw tongue and thyroid; "pyramidal lobe" of thyroid; originated from thyroid diverticulum in floor of primitive pharynx |
| most common site of ectopic thyroid tissue | tongue |
| foramen cecum | normal remnant of thyroglossal duct |
| cleft lip | failure of fusion of maxillary and medial nasal processes |
| cleft palate | failure of fusion of lateral palatine process, nasal septum, and/or median palatine process |
| Diaphragm is derived from: "Several Parts Build Diaphragm" | Septum transversum, Pleuroperitoneal folds, Body wall, Dorsal mesentery of esophagus; innervated by C3,4, 5 |
| Intramembranous Bone formation | spontaneous bone formation w/o preexisting cartilage |
| Endochondral Bone formation | ossification of cartilaginous molds; long bones; 1* and 2* ossification centers |
| Meckel's diverticulum | persistance of vitelline duct or yolk sac; a/w intussusception and volvulus, ectopic gastric and pancreatic tissue |
| Omphalomesenteric cyst | cystic dilation of vitelline duct |
| Pancreas | derived from foregut; ventral bud = head, uncinate process, main pancreatic duct; dorsal bud = body, tail, isthmus, accessory pancreatic duct |
| Spleen | arises from dorsal mesentery BUT is supplied by celiac artery of foregut |
| Mesonephric (wolffian) ducts; develops SEED | Seminal vesicles, Epididymis, Ejaculatory duct, Ductus deferens |
| Paramesonephric (mullerian) duct | develops into fallopian tubes, uterus, part of vagina |
| mullerian inhibiting peptide | secreted by testes to suppress development of mullerian/paramesonephric ducts |
| Genital tubercle | forms either glans penis (DHT) or glans clitoris (estrogen) |
| Urogenital sinus | forms corpus spongiosum, Cowper's bulbourethral glands, Prostate gland (DHT) or Vestibular bulbs, Bartholin vestibular glands, urethral/paraurethral skene's glands (estrogen) |
| Urogenital folds | forms ventral shaft of penis/penile urethra (DHT) or Labia minora (estrogen) |
| Labioscrotal swelling | forms scrotum (DHT) or Labia majora (estrogen |
| Bicornuate uterus | d/t incomplete fusion of paramesonephric ducts (mullerian); a/w urinary tract abnormalities and INFERTILITY |
| Hypospadias | more common; urethra opens on inferior (ventral) side of shaft d/t failure of urethral folds to close; fix to prevent UTIs |
| Epispadias | a/w exstrophy of bladder; urethra opens on superior (dorsal) side of shaft d/t faulty positioning of genital tubercle |
| Spermatogenesis | begins with spermatogonia (type A and B); full development takes 2 months; occurs in seminiferous tubules; type A forms both type A and B spermatogonia |
| Spermatogonium | diploid, 2N |
| 1* spermatocyte | diploid, 4N |
| 2* spermatocyte | haploid, 2N |
| Spermatid | haploid, N |
| Blood testis barrier | a tight junction (junctional complex) between sertoli cells |
| Derivation of sperm parts | Acrosome (golgi), Flagellum (centrioles), Neck (contains mitochondria); Food = Fructose |
| Meiosis and ovulation | 1* oocytes begin meiosis I during fetal life and complete meiosis I prior to ovulation |
| Meiosis I | arrested in prOphase for years until Ovulation |
| Meiosis II | arrested in METaphase until it has MET a sperm at fertilization |
| Polyhydraminos | >1.5-2L of amniotic fluid; a/w esophageal/duodenal atresia causing inability to swallow amniotic fluid; and with anencephaly |
| Oligohydraminos | <0.5L of amniotic fluid; a/w bilateral renal agenesis (Potter's syndrome) or posterior urethral valves (in males) and inability to excrete urine |
| Potter's syndrome | bilateral renal agenesis d/t oligohydraminos, limb and facial deformities, pulmonary hypoplasia; d/t malformation of ureteric bud; (can't Pee in utero) |
| Horseshoe kidney | INFERIOR poles of both kidneys fuse; they ascend from pelvis and get trapped under inferior mesenteric artery and remain in lower abdomen |
| Left ovary/testis venous drainage | flows to left gonadal vein --> left renal vein --> IVC |
| Right ovary/testis venous drainage | flows from right gonadal vein DIRECTLY to IVC |
| Suspensory ligament of ovaries | contains ovarian vessels |
| Transverse cervical (cardinal) ligament | contains uterine vessels |
| Round ligament of uterus | contains no important structures |
| Broad ligament of uterus | contains round ligaments of uterus and ovaries and the uterine tubules and vessels |
| Autonomic innervation of male ERECTION, EMISSION, and EJACULATION | mediated by Parasympathetics, Sympathetics and Visceral/Somatic nerves, respectively (Point and Shoot before it hits the target) |
| The course of the Ureters | they pass UNDER the UTERINE ARTERY and Ductus Deferens (retroperitoneal); "water (ureter) under the bridge (artery or ductus deferens)" |
| Primordial follicles | contain PRIMARY oocytes (XX genotype) and follicular (granulosa) cells that form the ovaries |
| Gubernaculum | assists in descent of ovaries toward perineum; it becomes the ovarian ligament and the round ligament of the uterus |
| Paramesonephric (mullerian) ducts | develop into uterine tubes and eventually the uterus |
| Breast development during fetal life | only the main lactiferous ducts form |
| Breast development during puberty | glands enlarge d/t increased estrogen, progestins, prolcactin, and growth hormone |
| Primary sex cords | contain primordial germ cells of XY genotype; Y chromosome contains testes-determining factor (TDF) which allows for male gonadal differentiation |
| Mullerian inhibiting hormone | secreted by Sertoli cells to inhibit Mullerian/paramesonephric duct development and associated female structures |
| Mesonephric (wolffian) ducts | are under influence of testosterone; form ductus deferens, seminal vesicles, ejaculatory ducts in male |
| Undescended testis (cryptorchidism) | usu descend w/in 1yr; if undescended, it causes sterility or testicular cancer; may be a/w with congenital inguinal hernia |
| Congenital inguinal hernia (indirect) | d/t communication btw TUNICA VAGINALIS (next to testis) and peritoneal cavity; a loop of intestine can become entrapped/obstructed; a/w cryptorchidism |
| True Hermaphroditism | both testicular and ovarian tissue present; external genitals are ambiguous; usu 46XX |
| Female psuedohermaphroditism | XX genotype w/VIRULIZATION of external genitals d/t EXCESS ANDROGEN EXPOSURE; a/w Congenital Adrenal Hyperplasia (21-hydroxylase deficiency; AR, low cortisol and high ACTH) |
| Male pseudohermaphroditism | XY; varying ambiguities in external genitals; LACK of MIF and TESTOSTERONE |
| Androgen Insensitivity Syndrome | testicular feminization; XY w/FEMALE PHENOTYPE; d/t defective androgen receptor; blind vagina, no female pubertal development |
| Double Uterus | d/t failure of fusion of PARAMESONEPHRIC DUCTS; may be divided internally by a thin septum or only at the superior part (bicornuate) |
| Kallmann's Syndrome | deficiency of GnRH = increased FSH and LH; no 2* sex traits; a/w HYPOPLASIA of OLFACTORY BULBS (anosmia) |
| Fetal Genetic abnormalities | greatly increases with maternal age >35; pts need additional counseling and genetic testing |
| Down's syndrome | Trisomy 21 (95%) or Robertsonial translocation of 14 and 21; MR (mcc in males), atrial septal defect; epicanthal folds, large tongue, simian crease, acute leukemia, Alzheimer's |
| Edward's syndrome | Trisomy 18; MR; "Rocker bottom feet;" second digit overlaps 3rd/4th; congenital heart dz, micrognathia (small jaw) |
| Patau's syndrome | Trisomy 13; MR, Microophthalmia, Polydactyly, Cleft lip/palate |
| Cri-du-chat syndrome | Deletion of 5p; cat-like cry; MR, microcephay, hypertelorism |
| Fragile X | second most common MR in males (behind Downs); MACRO-ORCHIDISM; long face, low-set large ears |
| Turner's syndrome | 45 XO; Monosomy of X chromosome; Absent Barr body; short stature, webbed neck; coarctation of aorta/bicuspid aortic valve; amenorrhea |
| Klinefelter's syndrome | 47, XXY; tall with long limbs; gynecomastia; hyalinization of seminiferous tubules & lack of spermatogenesis = sterility; One Barr Body |
| XYY syndrome | normal appearing male with AGGRESSIVE tendencies; may be over-represented in population of incarcerated males |
| XXX syndrome | usu asymptomatic; may be a/w Menstrual Irregularities and mild MR; 2 Barr Bodies |
| Prader-Willi syndrome | 15q12; Uniparental Disomy; maternal imprinting (no paternal contribution); Obesity, HYPERPHAGIA, HYPOGONADISM; short, MR |
| Angelmans Sydrome | 15q12 uniparental disomy; paternal imprinting (no maternal contribution); Ataxia, MR, INAPPROPRIATE LAUGHTER, "Happy Puppet" |
| Breast surgery for girls with precocious puberty | should be avoided b/c excision of a "lump" in premature thelarche will cause loss of entire breast |
| Menarche | final maturation of ovarian follicles; usu btw 11-14yo; follows thelarche by 2yrs |
| Precocious puberty | pubertal changes before 9yo in boys, 8yo in girls;can be CENTRAL (inc FSH, LH) or PERIPHERAL (d/t inc sex steroids) |
| True precocious puberty | early, but normal pubertal development; usu idiopathic; may cause emotional and social adjustment problems |
| Incomplete precocious puberty | premature development of a single pubertal characteristic (thelarche - breast buds, adrenarche - axillary hair, pubarche - pubic hair); self-limiting |
| LH | regulates conversion of cholesterol to pregnenolone (1st step in estrogen synthesis) in THECA CELLS |
| FSH | regulates the "final step" in estrogen synthesis in the GRANULOSA CELLS |
| Estrogen | secreted by ovary; induces 2* sex development; stimulates growth of endometrial spiral aa; thickens vaginal mucosa, induces breast DUCTAL development; stimulates bone growth (inc osteoblastic activity) |
| Progesterone | secreted by CORPUS LUTEUM; converts Proliferative endometrium to Secretory; induces endometrial proliferation; Inhibits uterine contractions; Increases viscosity of cervical mucus, body temp; induces breast GLANDULAR development |
| Menses | days 1-4 of menstrual cycle; without fertilization the endometrium is sloughed off |
| Follicular phase | days 5-14; after menses, FSH falls and ESTROGEN rises; by day 6-8, one recruited follicle is selected and the rest degenerate; Meiosis resumes (prophase I to metaphase II); formation of 1st polar body; uterine proliferation; LH surge |
| Ovulation | day 15; occurs AFTER LH surge; oocyte expelled into fallopian tube; cervical mucus is increased and thinned; body temperature raises 1*C |
| Luteal phase | days 15-28; corpus luteum makes progesterone and estrogen; rising estrogen inhibits FSH secretion; endometrial glands grow (secretory phase) creating spiral aa; endometrium is ready for potential implantation or menses |
| Fertilization | days 16-21; one sperm penetrates oocyte; oocyte completes meiosis II; spermatocyte and oocyte fuse to form zygote |
| Implantation | days 20-26 (1st week after fertilization); zygote embeds in endometrium; endometrial blood vessels infiltrate theca interna over 14 day period |
| Pregnancy | the corpus luteum persists under the influence of hCG secreted by rapidly developing placenta |
| Dysfunctional uterine bleeding | excessive bleeding during, or between, menstrual periods; mc gynocological prob in reproductive yrs d/t Leiomyoma, Anovulatory cycle, Organic lesions (tumor, polyp), Pregnancy complication, Endometrial hyperplasia, Corpus luteum cysts |
| Polycystic ovarian syndrome (Stein-Leventhal) | Triad: 2* amenorrhea, obesity, hirsutism; Increased LH and Testosterone; Stromal fibrosis ans small follicular cysts in ovaries |
| Endometriosis | non-neoplastic endometrial tissue outside of uterus; responds to hormonal cycle; usu bilateral in ovary; presents as pain and excessive bleeding during menstruation; large blood-filled sacs (chocolate cysts); may cause infertility |
| Menopause | dec ovarian fxn = low estrogen, high FSH; early signs = hot flashes, anxiety, mood swings, irritability; Late signs = vaginal dryness, Osteoporosis, dec HDL w/inc risk of coronary artery dz; atrophy of breast tissue |
| Normal pregnancy | always assume a childbearing aged woman could be pregnant; term is 40wks; signs = missed periods, fatigue, nausea, elevated b-hCG |
| Hormonal regulation of pregnancy | Fertilization (b-hCG from placenta maintains corpus luteum); First trimester (corpus luteum makes E & P); 2nd/3rd trimester (PLACENTA makes P; fetal adrenals/liver/placenta make E); Lactation (E & P fall which permits prolactin to stimulate breast milk) |
| Pudendal nerve block | can alleviate pain of childbirth; insert hand into vagina to locate ischial spine (landmark) and other hand inserts needle into skin lateral to vaginal opening |
| The narrowest diameter of birth canal | pelvic outlet between the ischial spines (interspinous distance) |
| Prenatal Amniocentesis | aspiration of amnion btw 10-14wks; AFP (neural tube defects), Spectrophotometry (hemolytic dz of newborn; Sex chromosomes (x-linked dzs); Cell culture (chromosomal abnormalities); Enzyme and DNA analysis |
| Prenatal Maternal Serum AFP | ELEVATED in neural tube defects; DECREASED in Downs Syndrome |
| Prenatal Chorionic Villi Sampling | done at 10wks; cells aspirated from villi and evaluated for genetic abnormalities |
| Prenatal Ultrasound | done at 12 weeks; measures fetal size, determines sex, diagnoses fetal malformations |
| Abruptio placentae | separation of placena from uterine wall prior to partuition; causes FETAL DEATH; may cause DIC in mom |
| Placenta accreta | invasive direct connection of uterus wall to placenta; d/t prior surgery or trauma; improper separation results in massive HEMORRHAGE |
| Placenta previa | placenta attaches to lower uterus and blocks cervical os; a/w BLEEDING |
| Ectopic pregnancy | Risks (PID; chronic salpingitis; previous surgery; endometriosis; previous ectopic pregnancy); Clinical (amenorrhea; pelvic pain, cervical tenderness; tissue mass (tubal); elevated b-hCG) |
| Preeclampsia | Triad: HTN, Albuminemia, Edema; mc in last trimester; can progress to eclampsia (seizures and DIC) |
| HELLP and Eclampsia | HTN, Elevated Liver enzymes, Low Platelets |
| Treatment for preeclampsia | Magnesium sulfate; but the only cure is with delivery of fetus |
| Hydatidiform Mole | placental villi that enlarge abnormally early in pregnancy; "Cluster of Grapes" with MARKED inc in b-hCG; Manifests w/vaginal Bleeding and INC UTERINE SIZE (>expeted for gestational stage); usu precede choriocarcinoma (malignant trophoblastic cells) |
| Complet hydatidiform mole | Diploid XX; NO EMBRYO; completely PATERNAL in origin |
| Partial hydatidiform mole | Triploid (XXX or XXY); EMBRYO present ("make up of 3 or more parts w/fetal parts") |
| Gestational Diabetes | insulin resistance occurs in normal pregnancy; mother may not be able to meet inc metabolic demands; 2 or more abnormal venous glucose values must be reached after 100g oral glucose (fasting >105, 1hr >190, 2hr >165, 3hr >145mg/dL) |
| High blood glucose in mother | leads to hypoglycemia in INFANT when born; macrosomia (enlarged body), inc risk of trauma, inc likelihood of c-section d/t large fetus |
| Infectious causes of birth defects: TORCH | Toxoplasmosis, other, Rubella, Cytomegalovirus, Herpes simplex |
| Wet Mount Gynecologic Diagnostic Test | vaginal epithelial scrapings placed on glass slide w/saline; Detects Trichomonas (pear-shaped w/sporadic movement) or Bacterial vaginosis (clue cells = epithelium w/rough edges) |
| Potassium hydroxide (KOH) gyno prep | addition of KOH to slide w/vaginal epithelium detects CANDIDIA (resistant to KOH, "budding cells w/short hyphae;" or BACTERIAL VAGINOSIS (KOH reacts w/bacterial amines = "Fishy odor") |
| Pap Smear - microbes detected | cells from cervix are scraped onto glass slide; Detects HPV (KOILOCYTES - large epithelial cells w/perinuclear clearing) or CMV (intranuclear inclusions w/halo around them "owl's eye"), or HSV (multinucleated giant cells) |
| Pap smear - Precancerous and Cancerous lesions | Precancerous cervical intraepithelial neoplasia (CIN 1, 2, 3); Cancerous INVASIVE SCC (mc) and Endometrial Adenocarcinoma |
| Chlamydia | mc STD; mostly b/c it is undetected when pt is co-infected with gonorrhea; Tx for gonorrhea should be supplemented w/chlamydia therapy for both pt and partner (azithromycin or doxycycline (C) + injection of ceftriaxone OR cirpo/foxin fluoroquinolone (G)) |
| 20-50% of pts with an STD | will be coinfected with another |
| Calmmatobacterium granulomatis | Granuloma inguinale; Bx shows DONOVAN BODIES |
| Chlamydia trachomatis | urethritis, acute PID from serotyps D-K; ulcerative lesions of genitalis w/ L1-L3 serotypes |
| PID | can be diagnosed via bimanual pelvic exam by doing "chandelier sign" for cervical motion; salpingitis can lead to infertility |
| Gardernella vaginalis | vulvovaginitis |
| Haemophilus ducreyi | Chancroid; PAINFUL ulcerative lesion on genitalia |
| HSV-2 | genital herpes; PAINFUL vesicles - lesions on genitals |
| HIV type 1 and 2 | can lead to AIDS |
| HPV types 6 and 11 | condyloma acuminatum of vulva |
| HPV types 16, 18, 31, 45 | genital or anal warts, SQUAMOUS CELL CARCINOMA of cervix, vagina, anus, penis |
| Neisseria gonorrheae | Urethritis; ACUTE PID; pharyngitis, MONOARTICULAR ARTHRITIS |
| Treponema pallidum | Syphilis; PAINLESS ulcerative lesions on genitalia; 1* - hard chancres; 2* - gray wartlike lesions (condyloma lata), 3* - neurologic symptoms like TABES DORSALIS, acending aortic aneurysm |
| Trichonomas vaginalis | Vulvovaginitis; male urethritis |
| Non STD infections of GU tract | Candida albicans (vulvovaginitis), Staphylococcus aureus (TSS), E. coli and Staph saprophyticus (UTIs) |
| Toxic Shock Syndrome | d/t S. aureus overgrowth on tampons; enterotoxin acts as a supertoxin causing excess activation of Thelper cells, resulting in increased cytokine production and septic shock |
| Serous Cystadenoma of ovary | cystic; benign; usu bilateral |
| Serous Cystadenocarcinoma | cystic; malignant; usu bilateral; most common ovarian neoplasm (50%) |
| Mucinous cystadenoma | mucin-filled cyst; benign ovarian tumor |
| Mucinous cystadenocarcinoma | mucin-filled ovarian cyst; malignant; PSEUDOMYXOMA PERITONEI (diffuse peritoneal metastasis secreting mucin) |
| Endometrioid tumor | resembles endometrium in ovary; malignant |
| Brenner tumor | resembles TRANSITIONAL epithelium in ovary; benign; rare |
| Clear cell tumor of ovary | abundant CLEAR CYTOPLASM; usu unilateral; rare |
| CA125 (cancer antigen 125) | elevated in over 80% of ovarian tumors |
| 75% of ovarian neoplasms | are epithelial in origin; usu seen in middle-aged to elderly women |
| Germ cell tumors | only 25% of ovarian neoplasms, BUT they are the most common ovarian tumors found in women <20yo |
| Ovarian Dysgerminoma | large cells w/clear cytoplasm; malignant; EQUIVALENT of seminoma; usu in KIDS |
| Ovarian Endodermal Sinus (Yolk sac tumor) | resembles yolk sac; Malignant; produces AFP |
| Ovarian Immature Teratoma | elements from multiple embryonic layers; poorly differentiated; resembles fetal or embryonic tissue; Malignant |
| Ovarian Mature Teratoma/Dermoid Cyst | Elements from multiple embryonic layers, including hair, bone, tooth, nerves; Duplication of maternal genetics; resembles adult tissue; MOST COMMON germ cell neoplasm (90%); BENIGN (malignant in males) |
| Ovarian Monodermal Teratoma | elements from one of teh embryonic germ layers; usu thyroid tissue (STRUMA OVARII); Benign, HYPERTHYROIDISM |
| Ovarian Choriocarcinoma | usu seen in combo w/other germ cell tumors; Malignant; produces b-hCG |
| Ovarian Granulosa-Theca tumor | lipid-laden cells; fibroblast proliferation; cuboidal cells in cords; eosinophilic follicles (Call-Exner Bodies); Benign; may secrete estrogen leading to precocious puberty or endometrial hyperplasia or carcinoma |
| Ovarian Thecoma-Fibroma | Fibroblast proliferation; Benign; rare; a/w ascites and hydrothorax = "MEIG'S SYNDROME" |
| Ovarian Sertoli-Leydig Cell Tumor | tubules containing testicular cells; produces testosterone and virulization |
| Ovarian Metastasis tumors | most commonly d/t GI, breast or ovarian cancer; KRUENBERG TUMOR = stomach cancer signet rings bilaterally in ovaries; only 5% of ovarian tumors |
| Cervical intraepithelial neoplacia | neoplastic changes beginning at SQUAMOCOLUMNAR junction |
| Squamous cell carcinoma of cervix | evolves from a progression of CIN; inc incidence a/w EARLY sexual activity and MULTIPLE sex partners |
| Leiomyoma of uterus | most common BENIGN tumor in women (versus mc malignancy = breast); usu multiple; size increases with estrogen from pregnancy and decreases with menopause |
| Leiomyosarcoma of uterus | uncommon; arises de novo; bulky necrotic/hemorrhagic; blacks; aggressive; recurs; may protrude from cervix/bleed |
| Endocervical carcinoma | MOST COMMMON MALIGNANCY of the female genital tract; a/w nulliparity i older women; EXOGENOUS ESTROGEN is a risk factor (as is diabetes, tamoxifen, HTN, obesity d/t adipose estrone); presents w/post-menopausal vaginal bleeding |
| Papillary hidradenoma of vulva/vagina | MOST COMMON benign tumor of vulva; presents as ulcerative bleeding nodule; originates from sweat glands; easily removed |
| Squamous cell carcinoma of vulva | OLDER women; preceded by vulvar dystrophy; a/w HPV 16, 18, 31, 33, 45 |
| Paget's disease of the vulva | histologically similar to dz of the breast, but not always a/w underlying adenocarcinoma unlike breast |
| Malignant melanoma of vulva/vagina | similar to condition in skin; 10% of malignant vulvar tumors |
| Squamous cell carcinoma of vagina | a rare site for primary cancer; usu an extension of cervical cancer |
| Clear cell adenocarcinoma of vulva/vagina | rare malignant tumor; a/w fetal exposure to DES |
| Sarcoma botryoides of vagina/vulva | a rhabdomyosarcoma; girls <5yo; "bunch of grapes" that protrude from vagina |
| Risk factors for breast cancer | >45yo, nulliparity, early menarche, late menopause, high fat diet, HER-2/neu oncogene activation, 1st degree relative w/+ Hx; Hx of breast cancer in contralateral breast |
| Breast cancer | MOST COMMON cancer in women, but 2ND cause of cancer death after lung cancer; mc location UPPER OUTER QUADRANT |
| Presence of estrogen and/or progesterone receptors on breast cancer | indicates a good prognosis d/t ability to employ hormonal (anti-estrogen) therapy |
| Acute mastitis | d/t entry of Staph aureus into nipple; causes abscesses; common in nursing moms and pts with eczema |
| Fibrocystic breast changes | MOST COMMON breast disorder; tender BILATERAL mass; "blue-domed" cysts; non-neoplastic; predisposition to cancer only w/evidence of cellular atypia |
| Fibroadenoma of breast | MOST COMMON breast tumor in women <25YO; painless benign rubbery mass |
| Intraductal papilloma of breast | benign tumor of lactiferous ducts; may have bloody or serous discharge |
| Phyllodes of breast | large mass, cysts, skin ulceration with malignant potential; may recur |
| Invasive ductal carcinoma of breast | MOST COMMON CARCINOMA; firm mass forms glands w/fibrous stroma; Malignant |
| Lobular carcinoma of breast | cancer cells fill ducts; BLOODY DISCHARGE, may be bilateral; "indian file" cells; malignant, may be progression of lobular carcinoma in situ |
| Paget's disease of the breast | superficial lesion of nipple or areola; paget cells (large w/marginal clearing) in epidermis; Malignant; indicative of UNDERLYING DUCTAL CARCINOMA |
| Medullary carcinoma of breast | soft, fleshy tumor w/LYMPHOCYTIC infiltrate; malignant |
| Gynecomastia in males can be d/t: | alcoholism, cimetidine, ketoconazole, spironolactone, digitalis |
| Male breast cancer | represents 1% of all breast cancer |
| Prostatic carcinoma | mc male cancer; enlarged, firm nodular prostate on DRE; elevated serum PSA and alk phos; bone metastasis (spine); effects on POSTERIOR lobe; 2nd most common cancer death in men (behind lung) |
| Benign prostatic hyperplasia | mc cause of male urinary obstruction; bladder distention or hypertrophy; UTIs; inc residual volume/frequency; nocturia, difficulty initiating stream; d/t age-related increase in testosterone and estrogen; common after 40yo; effects MIDDLE lobe |
| Digital rectal exam | checks anal tone (S2-S4 innervation); anterior to posterior structures = lower border of prostate, posterior aspect of prostate, bladder if distended |
| Hydrocele | serous fluid collects in tunica vaginalis; d/t patency btw peritoneal cavity and tunica vaginalis |
| Hematocele | blood collects in tunica vaginalis; usu d/t TRAUMA |
| Varicocele | engorgement of veins of spermatic cord; noticable when pt is standing; can cause infertility |
| Spermatocele | epididymal cyst containing sperm |
| Cryptorchidism | failure of 1 or both testes to descend; inc incidence of GERM CELL TESTICULAR CANCER (seminoma or embryonal carcinoma); failure to descend = atrophy and sterility |
| Testicular torsion | twisting of spermatic cord; if untreated, necrosis occurs |
| Orchitis | infxn & inflammation of testicle; may be viral or bacterial; can cause sterility if bilateral |
| Epididymitis | inflammation and infxn; usu N. gonorrhea, Chlamydia, E. coli or Mycobacterium tubercuolsis |
| Seminoma | MC germ cell tumor; lobules or nests; malignant; 35-40yo; similar to dysgerminoma of ovary; Radiosensitive and curable |
| Embryonal carcinoma of testis | germ cell; papillary convolutions; malignant; 20yo; more aggressive than seminomas |
| Yolk sac tumor (endodermal sinus) of testis | germ cell; anastomosing cords; malignant; inc AFP; presents with pain or metastasis; CHILDHOOD ~3yo |
| Teratoma of testis | 2+ embryonic layers w/cartilage, epithelium, liver, muscle tissue types; malignant; any age (more common in kids) |
| Mixed germ cell tumor of testis | most common testicular tumor; malignant; AGGRESSIVE; >1 neoplastic pattern |
| Leydig cell tumor (interstitial) of testis | testicular stroma w/ intracytoplasmic Reinke CRYSTALS; Benign; a/w PRECOCIOUS PUBERTY or gynecomastia d/t steroid, androgen, estrogen, ccsteroid production; similar to ovarian Sertoli-leydig tumor |
| Sertoli cell tumor (androblastoma) of testis | testicular stroma w/cord-like structures; benign; minor endocrine abnormalities; similar to ovarian Sertoli-leydig tumor |
| Choriocarcinoma of testis | Trophoblastic cells resembling placenal villi; malignant; HEMORRHAGIC; elevated b-hCG; early adulthood |
| Needlestick transmission of HIV | low risk; 0.3%; hepatitis C is more common |
| HIV infection pathology | infects CD4 Thelper cells via interaction with viral ptns gp120 and gp41 with eachother and the CD4 marker; it also infects MQs and monocytes (entry to CNS); viremia is a/w flu-like "acute retroviral syndrome" |
| 1st month of HIV infection | "window period" b/c p24 antigen is not yet detectable, but pt is contagious |
| Chronic HIV infection | immune response lowers viral load, but activ replication persists; no clinical sx for ~10yrs (latent period); CD4 count steadily declines until pt has wt loss, fever, night sweats, adenopathy |
| AIDS | <200 CD4 or opportunistic infxn (Pneumocystis pneumonia (80%); Kaposi's sarcoma; Bcell lymphoma (brain/BM); Toxoplasma gondii (brain abscess); CMV (retinitis); Cryptococcus (meningitis); MAI, TB, Candida (thrush, esophagitis), Cryptosporidium (diarrhea) |
| Diagnosis of HIV | ELISA for antibodies leads to a presumptive dx; must be confirmed by Western blot for Antibodies to gp41 or p24 viral proteins |
| Treatment of HIV | nucleoside analogues and protease inhibitors; combo HAART |
| Preeclampsia pathophysiology | placental ischemia triggers release of thromboplastic substances, increases renin synthesis and reduces prostaglandin E levels |
| Tremors, wt loss, heat intolerance, but low TSH levels (non-Grave's type hyperthyroid symptoms) and unilateral ovarian cystic mass | a/w monodermal teratomas that can develop mature thyroid tissue (struma ovarii) which produces excessive thyroid hormone |
Created by:
bscaryp