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Step 1, 1.3.12
Reproductive II
| Question | Answer |
|---|---|
| What are the general characterisitcs of fibrocystic disease? | most common cause of breast lumps. see post menstral breast pain and multiple lesions. usually doesnt incr risk of carcinoma |
| What are the 4 histologic types of fibrocystic disease? | 1. fibrosis 2. cystic 3. sclerosing adenosis 4. epithelial hyperplasia |
| What is seen in fibrosis of fibrocystic breast disease? | hyperplasia of breast stroma |
| What is seen in cystic type of fibrocystic breast disease? | fluid filled, blue dome. ductal dilation |
| What is seen in sclerosing adenosis of fibrocystic breast disease? | incr acini and intralobular fibrosis. associated with calcifications |
| What is seen in epithelial hyperplasia of fibrocystic breast disease? | incr in number of epithelial cell layers in terminal duct lobule. incr risk of carcinoma with atypical cells. occurs in women > 30 years of age |
| What is acute mastitis? What is the most common etiology? | breast abscess during breast feeding. incr risk of bacterial infection thru cracks of nipple. S. aureus most common. |
| What is fat necrosis of the breast? | benign painless lump. forms as result of injury to bresst tissue. upt to 50% might not report trauma |
| What is gynecomastia? | results from hyperestrogenism (cirrhosis, testicular tumor, puberty, old age), Klinefelter's syndrome, or drugs |
| What is a mnemonic for the drugs which can cause gynecomastia? | Some Drugs Create Awesome Knockers (estrogen, marajuna, heroin, psychoactive drugs. Spironolactone, Digitalis, Cimetidine, Alcohol, Ketoconazole) |
| What are the sx of prostatitis? | dysuria, frequency, urgency, low back pain |
| What are the most common causes of acute vs chronic prostatitis? | acute: bacteria (E.coli); chronic: bacterial or abacterial |
| When does benign prostatic hyperplasia (BPH) happen and what might be the cause? | common in men >50. hyperplasia NOT hypertrophy of prostate gland. may be related to age related incr in estridiol w/ posible sesitization of the prostate to growth promoting effects of DHT. |
| What characterizes the pathophys of benign prostatic hyperplasia (BPH)? | characterized by nodular enlargement of the periurethral (lateral and middle) lobes which compresses the urethra into a vertical slit |
| How might benign prostatic hyperplasia (BPH) present? | incr urinary frequency, nocturia, difficulty starting and stopping, dysuria. |
| What can benign prostatic hyperplasia (BPH) lead to? | distention and hypertrophy of bladder, hydronephrosis, UTIs. |
| What is an Ag detector for benign prostatic hyperplasia (BPH) ? | incr free prostate specific Ag (PSA) |
| What is the Tx for benign prostatic hyperplasia (BPH) ? | alpha 1 antagonists (terazocin, tamsulosin, causes relaxation of SMM, finasteride |
| When does prostatic adenocarcinoma arise and from what? | men > 50 y/oi from posterior lobe of prostate gland and is dx by digital rectal exam (hard nodule) and prostate biopsy. |
| What are 2 useful tumor markers for prostatic adenocarcionoma? What levels are seen? | prostatic acid phosphatase (PAP), and prostate specific antigen (PSA). incr total PSA with decr fraction of free PSA |
| What metastasis might be seen with prostatic adenocarcinoma? How can you tell? | osteoblastic metastases as indicated by lower back pain and incr serum alkalinephosphatase and PSA |
| What is cryptoorchidism? | undescended testes, imparied spermatogenesis (due to temp) |
| What hormone levels are seen in cryptoorchidism? What is it a predisosing factor for? | normal testoterone, decr inhibin, incr FSH, normal LH. crytoorchidism is a RF for incr risk of germ cell tumors |
| What is the major RF for cryptoorchidism? | prematurity |
| What is a varicocele? What can it cause? | dilated veins in pampiniform plexus due to incr venous P. most common cause of scrotal engorgement |
| What side is a scrotal varicocele more often seen? Why? | more common on left side due to incr resistance to flow from left spermatic vein drainage into left renal vein. |
| What maight be a consequence of a scrotal varicocele? | infertility due to incr temp. |
| What is the appreance and how is the dx of scrotal varicocele made? | "bag of worms" made by US |
| What is the tx for scrotal varicocele? | varciolectomy, embolization by intervenitonal radiology |
| What are the general characteristics of testicular germ cell tumors? | most often malignant. can present as mized. DDX for a testicular mass that does not transluminate = cancer |
| What is seen in a seminoma testicular germ tumor? | malignant. painless. homogenous testicular enlargement. most common. most males 15-35. |
| What is the physical and histiological appearance of a seminoma testicular germ cell tumor? | large cells in lobules with with watery cytoplasm and fried egg appearance. |
| What is the radiosenstivity and prognosis of a seminoma testicular germ cell tumor? | radiosensitive . late metastasis with excellent prognosis |
| What is seen in embryonal carcinoma testicular germ cell tumor? | malignant, painful, worse prognosis than seminoma. |
| What is the the morphology of a embryonal carcinoma? | often glandular/paillary. rarely pure, mostly mixed. |
| What hormone levels might be seen in a pure emryonal carcinoma? | incr hCG and normal AFP when pure. (incr AFP when mixed) |
| What is seen and what is the morphology of a yolk sac (endodermal sinus) testicular germ cell tumor? | yellow, mucnous appearance. analogous to ovarian yolk sac tumor. See Schiller-Duval bodies resembling primitive glomeruli. incr AFP |
| What hormone levels and what is the morphology of choriocarcinoma testicular germ cell tumor? where does it metastasize to? | incr hCG. malignant. disordered syncytiotrophoblastic and cytotrophoblastic material. hematogenous metastases to liungs |
| What physiologic changes can a choriocarcinoma testicular germ cell tumor cause? How? | gynecomastic since it has incr hCG and hCG is an LH analog |
| What hormone levels are seen and what is the malignancy of a male teratoma? | unlike female, very often malignant. incr hCG and or AFP |
| What are the general characterisitcs of testicular non germ cell tumors? What are the 3 major types? | 5% mostly benign. Leydig cell, Sertoli cell, testicular lymphoma |
| What is the morphology and what might be caused by a Leydig cell tumor? | contains Reinke crystals, usually androgen producing, gynecomastia in men, precoscious puberty in boys. golden brown in coloe |
| What is the origin of a Sertoli cell tumor? | androblastoma from sex cord stroma |
| Who gets testicular lymphoma? Where does it come from? | most common testicular cancer in older men. not a primary cancer. arises from lymphoma metastases to testes |
| What are tunica vaginalis lesions? how do they present? | lesions in the serous covering of the testis. present as testicular masses that can be transluminatewd. |
| What are the 2 types of tunica vaginalis lesions? What is the mech of each? | 1. hydrocele (incr fluid secondary to incomplete fusion of the processus vaginalis) 2. Spermatocele - dilated epidymal duct |
| Who gets Squamous cell carcinoma of the penis? What is it associated with? | more common in Asia, africa, south america. commonly associated w/ HPV and lack of circumcision |
| What is Peyronie's disease? | ben penis due to acquired fibrous tissue formation |
| What is priapsim and what might cuase it? | psinful sustained erection not associated with desire. associated with trauma, SCA (trapped RBC), meds ( anticoagulants, PDE5 inhibitors, antiodepressants, alpha blockers, cocaine) |
| What are some positive and negative controls on the anterior pituitary? | +=clomiphene. neg=oral contraceptives, danazol (ant pit controls release of FSH and LH) |
| What might be a negative control on p450c17 release of androstenedione from ovary? | ketoconazole, danazol |
| What drug might be an inhibitor of aromatase? | anastrozole |
| What drug is a negative control on estradiol conversion to estrogen? | fulvestrant |
| What drugs might decr release of testosterone from the testis? | ketoconazole, spironolactone |
| What drug is an inhibitor of 5 alpha reductase (decr DHT)? | finasteride |
| What drugs inhibit the androgen receptor complex? | flutamide, cyproterone, spironolactone |
| What is the mech of leuprolide? | GnRH analog with agonist properties when used pulsaltile. antagonist if used continuously (down regulates GnRH receptor in pituitary)= decr FSH,LH |
| What is the clinical use of leuprolide? | infertility (pulsatile), prostate cancer (continous with flutamide), uterine fibrosis |
| What are the major SE of leuprolide? | antiandrogen, n/v |
| What is the mech of testosterone (methyltestosterone)? | agonist at androgen receptor |
| What is the clinical use of testosterone (methyltestosterone)? | treats hypogonadism and promotes development of secondary sex characterisics. stim. anabolism to promote recovery after burn or injury, treats ER positive breast cancer ( exemestane) |
| What are the major SE of testosterone (methyltestosterone) | masculinization in females. reduces intratesticular testosterone in males by inhibiting release of LH (via negative feedback)-->gonal atrophy. premature closing of epyphyseal plates. incr LDL, decr HDL |
| What is the mech of finasteride? | 5 alpha reductase inhibitor (decr DHT conversion) |
| What is the clinical use of finasteride? | BPH, promotes hair growth, used to tx baldness. To prevent bladness give a drug fro b reast growth |
| What is the mech and use of flutamide? | nonsteroidal competitive inhibitor of androgens at the testosterone receptor. used in prostate cancewr |
| What is the mech of ketoconazole? | inhibits steroid synthesis via inhibitng desmolase |
| What is the mech of spironolactone? | prevents steroid bindings |
| What are ketoconazole and spironolactone used for? | tx of polycystic ovarian syndrome to prevent hirsuitism. |
| What are the major SE of spironolactone and ketoconazole? | gynecomastia and amenorrhea |
| What is the class of ethinyl estradiol, DES, mestranol? | estrogens |
| What is the mech of ethinyl estradiol, DES, mestranol? | bind estrogen receptors |
| What is the clinical use of ethinyl estradiol, DES, mestranol? | hypogonadism or ovarian failure, menstrual abnormalities, HRT in postmenopausal women; use in men with androgen dependent prostate cancer |
| What are the majro SE of ethinyl estradiol, DES, mestranol? | incr risk of endometrial cancer, bleeding in post menopausal women, clear cell adenocarciona of vagina in females with DES exposure in utero, incr risk of thrombi, |
| What are the major CONTRAI for ethinyl estradiol, DES, mestranol? | ER positive breast cancer, DVT Hx |
| What is the class of clomiphene, tamoxifen, raloxifene? | selective estrogen receptor modulators (SERMs) |
| What is the mech of clomiphene? | partial agonist at estrogen receptors in hypothalamus. prevents normal feedback inhibitionand incr LH, FSH release= stimulates ovulation |
| what is the clinical use of clomiphene? | tx infertility and PCOS |
| What are the major SE of clomiphene? | hot flashes, ovarian enlargement, multiple simultaneous pregnancies, visual disturbances |
| What is the mech of tamoxifen, When is it used? | estrogen antagonist on breast tissue. used to tx and prevent recurrence of ER positive breast cancer |
| What is the mech of raloxifene? when is it used? | agonist on bone; reduces resorbtion of bone. used to tx osteoporosis |
| What is the clinical use of Hormone replacement therapy? | used for relief or prevention of menopausal sx (hot flashes, vaginal atrophy) and osteoporosis(incr estrogen=decr osteoclast activity) |
| What are the SE of hormone replacement therapy? | if unopposed: incr risk of endometrial cancer, so progesterone is added. possible CV risk |
| What is the mech and use of anastrozole/exmestane? | aromatase inhibitors used in post menopausal women with breast cancer |
| What is the mech of progestins? | bind progesterone receptors, reduce growth and incr vascularization of the endometrium |
| What is the clinical use of progestins? | oral contraceptives and tx of endometrial canmcer and abnormal uterine bleeding |
| What is the mech of Mifepristone (RU-486)? | competitive inhibitor of progestins at progesterone receptors |
| What is the clinical use of Mifepristone (RU-486)? | killing kids. admistered with misoprostol (PGE1) |
| What are the major SE of Mifepristone (RU-486)? | heavy bleeding, n/v, annorexia, abdominal pain |
| What is the mech of oral contraceptives (synthetic progestins, estrogen)? | inhibits LH/FSH which prevents estrogen surge. no estrogen surge=no LH surge=no ovulation. progestins thicken cervical mucus and reduce sperm penetration. also inhibit endometrial proliferation making the endometrium less suitable for implantation |
| What are the major CONTRA I for oral contraceptives? | smokers >35 y/o (incr CV events), pt with thromboembolic hx, or hx of estrogen dependent tumor |
| What is the mech/use of ritodrine/terbutaline? | Beta 2 agonists that relax the uterus; reduce premature uterine contractions |
| What is the mech and use of tamsulosin? | alpha 1 antagonist used to tx BPH by inhibiting SMM, selective for alpha 1 A,D receptors on prostate vs vascular alpha 1 B receptors |
| What is the mech of sildenafil, varedenafil? | inhibit cGMP phosphodiesterase, incr cGMP=SMM relaxation in corpus cavernosum, incr blood flow and eerection |
| What is the clinical use of sildenafil, varednafil? | tx of erectile dysfunction |
| What is the major SE of sildenafil, varedenafil? | HA, flushing, dyspepsia, impaired blue green color vision, risk of life threatening hypoTN in pt taking nitrates. "Hot and Sweaty" then HA, heartburn, hypotension |
| What is the mech of danazol? | synthetic androgen that acts as a partial agonist at androgen receptors |
| What is the clinical use of danazol? | endometrosis and hereditary angiodema |
| What are the major SE of danazol? | weight gain, edema, acne, hirsutism, masculinization, decr HDL levels |
Created by:
tjs2123
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