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Step 1, 1.3.12

Reproductive II

QuestionAnswer
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