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FA complete review

Clomiphene stimulates the secretion of: GnRH
In which structure does Clomiphene works on? Hypothalamus
Stimulates the secretion of GnRH in the hypothalamus by blocking negative feedback? Mechanism of action of Clomiphene
Which drug or medications work directly in the Ovary? (list) 1. Oral contraceptives 2. Danazol
Inhibition on the ovary directly is done by: Oral contraceptives and Danazol
What drugs inhibit P-450c17 (enzyme)? Ketoconazole and Danazol
What is prevented to be synthesized by Ketoconazole and Danazol as thy ibnibitb P-450c14? Androstenedione and Testosterone
Anastrozole inhibits which enzyme? Aromatase
Which drug works by inhibiting Aromatase? Anastrozole
Aromatase inhibitor Anastrozole
What form of Estrogen is inhibited/stimulated by SERMs? Estradiol
What is prevented by the action of SRRMS? Gene expression in Estrogen-responsive cells
Which medications are known to inhibit specifically the synthesis of testosterone in men as it is secreted from the testes? Ketoconazole and Spironolactone
Which diuretic is known to inhibit the production of testosterone? Spironolactone
5a-reductase inhibitor Finasteride
What is prevented to form (convert) by the use of Finasteride? Dihydrotestosterone
List of medication otha act by inhibiting the Androgen-receptor complex 1. Flutamide 2. Cyproterone 3. Spironolactone
What is prevented by the inhibition of the Androgen-receptor complex? Gene expression in Androgen-responsive cells
What medications (not list), can be used in order to prevent the gene expression in androgen-responsive cells? Flutamide, cyproterone, and spironolactone
What is the mechanism of action of Leuprolide? GnRH analog with agonist properties when used in pulsatile fashion; GnRH antagonist if used in continuous fashion
How does it have to be Leuprolide administered in order to have GnRH agonist properties? Pulsatile fashion
Leuprolide has GnRH antagonistic properties when adminter in a _____________________ fashion. Continuous fashion
What is the clinical use of Leuprolide? Uterine fibroids, endometriosis, precocious puberty, prostate cancer, and infertility
What cancer is treated with Leuprolide? Prostate cancer
What are common adverse effects of Leuprolide? Hypogonadism, decreased libido, erectile dysfunction, nausea, and vomiting.
GnRH agonist/or antagonist depending on administration format? Leuprolide
What are types of Estrogens? Ethinyl estradiol, DES, and mestranol
MOA of Estrogens Bind estrogen receptors
What are the clinical uses for estrogens? 1. Hypogonadism or ovarian failure 2. Menstrual abnormalities 3. Hormone replacement therapy in postmenopausal women
What are associated adverse effects of Estrogen therapy? 1. Increased risk of endometrial cancer 2. Bleeding in postmenopausal women 3. Clear cell adenocarcinoma of vaginia in females exposed to DES in utero 4. Increased risk of thrombi
What are some contraindications for estrogen usage? - ER (+) breast cancer, - Hx of DVTs - Tobacco use in women > 35 years old.
What are possible cancer that can develop due to estrogen therapy? Endometrial cancer and Clear cell adenocarcinoma of vagina
Which condition is associated with increased risk in postmenopausal women to develop endometrial cancer if treated with estrogen? If the therapy is given without progesterone
In order to develop clear cell adenocarcinoma of vagina due to estrogen therapy, the woman has to be exposed to: DES in utero
Degarelix is an _________________________ _____________________ . GnRH antagonist
What are associated adverse effects of Degarelix? Hot flashes and liver toxicity
What is the clinical use for Degarelix? Prostate cancer
What kind of drugs are Goserelin and Leuprolide? GnRH analogs
What are common Selective estrogen receptor modulators (SERMs)? Clomiphene, Tamoxifen, Raloxifene
Antagonist at estrogen receptors in hypothalamus. Clomiphene
Which SERM prevents normal feedback inhibition and increase the release of LH and FSH from pituitary, which stimulates ovulation? Clomiphene
How does Clomiphene stimulate ovulation? By preventing normal feedback inhibition of GnRH, thus increasing the release of LH and FSH.
Which type of infertility is treated with Clomiphene? Infertility due to anovulation
What are associated side effects of Clomiphene therapy? Hot flashes, ovarian enlargement, multiple simultaneous pregnancies, and visual disturbances.
Estrogen antagonist at breast; Estrogen agonist at bone, uterus. Tamoxifen
What is a severe adverse effect of Tamoxifen? Increased risk of thromboembolic events and endometrial cancer
What is the clinical use for Tamoxifen? Treat and prevent recurrence of ER/PR (+) breast cancer.
Estrogen antagonist at breast and uterus, but agonist at bone. Raloxifene
What activity increases the chances of thromboembolic events in people taking Raloxifene or Tamoxifen? Smoking
What are the associated adverse effects seen with Raloxifene? Increased risk of thromboembolic events, but NO increased risk of endometrial cancer
Which SERM is associated with increased risk of developing Endometrial cancer, Tamoxifen or Raloxifene? Tamoxifen
What is the main or primary use for Raloxifene? Osteoporosis
SERM used to treat osteoporosis Raloxifene
List of common Aromatase inhibitors: Anastrozole, Letrozole, and Exemestane
What is the mechanism of action of aromatase inhibitors? Inhibit peripheral conversion of androgens to estrogen
What is the clinical use of Aromatase inhibitors? ER (+) breast cancer in postmenopausal women
What are the main conditions treated with hormone replacement therapy? Relief or prevention of menopausal symptoms, and osteoporosis
How does HRT treats/prevents postmenopausal osteoporosis? Increased estrogen leads to a decrease in osteoclastic activity.
What are the associated risks of unopposed estrogen replacement therapy? Increased risk o f endometrial cancer, - Possible cardiovascular risk
What are some common Progestins? Levonorgestrel, medroxyprogesterone, etonogestrel, norethindrone, and megestrol
Levonorgestrel is a very common ________________. Progestin
What is MOA of progestins? Bind to progesterone receptors, decreasing growth and increase vascularization of endometrium, and thickening cervical mucus
What are the effects of progestins in the endometrium? Increase growth and vascularization Thicken the cervical mucus
What are two common antiprogestins? Mifepristone and Ulipristal
Mifepristone is an _____________________________. Antiprogestin
MOA of antiprogestins Competitive inhibitors of progestins at progesterone receptors
What is the clinical use for Mifepristone? Termination of pregnancy
Mifepristone must be given with ___________________ to terminate a pregnancy. Misoprostol
Ulipristal is used for: Emergency contraception
What drugs if given together can case termination of pregnancy? Mifepristone with misoprostol
Combined contraception is composed of: Progestins and ethinyl estradiol
Ethinyl estradiol + Progestins = Combined contraception
What are the possible presentations of combined contraception? Pill, patch, and vaginal ring
How does combined therapy prevent pregnancy? 1. Progestins and Estrogen inhibit LH/FSH and thus prevent estrogen surge 2. Progestins cause thickening of cervical mucus, thereby limiting access of sperm to uterus 3. Progestins inhibit endometrial proliferation --> less suitable for implantation
What does the inhibition of LH/FSH cause in combined contraception? No estrogen surge --> No LH surge == NO ovulation
List of people with contraindicated combined therapy: 1. Smokers > 35 years old 2. Patients with increased risk of CV disease 3. Migraine patients 4. Breast cancer patients 5. Liver disease patients
Which component of combined contraceptive causes a less suitable endometrium for explanation? Progestins
What is the mechanism of action of the Copper intrauterine device? Produces local inflammatory reaction toxic to sperm and ova, prevention fertilization and implantation; hormone free
How does a young woman with a Copper intrauterine device is wrong by saying, "this method has my hormones all over the place"? The copper intrauterine device is hormone free
Apparatus used for contraception that provides a hostile and toxic environment for sperm and ova? Copper intrauterine device
What is the most effective emergency contraception? Copper intrauterine device
What are associated adverse effects of Copper intrauterine device as a contraceptive method? -Havier or longer menses, dysmenorrhea. - Risk of PID with insertion
What are Tocolytics? Medications that relax the uterus
What are some common Tocolytics? Terbutaline, Nifedipine, and indomethacin
What is the purpose of using tocolytics? Reduce contraction frequency in preterm labor and allow time for administration of steroids or allowance for transference to proper obstetrical care unit.
Terbutaline is a: B2-agonists tocolytic
What is the purpose of administering steroids to preterm baby? Promote fetal lung maturity
What is the mechanism of action of Danazol? Synthetic androgen that act as partial agonist at androgen receptors.
What are the clinical uses for Danazol? Endometriosis (MC), and Hereditary angioedema
Which common obstetric conditions is treated with Danazol? Endometriosis
"Chocolate cyst" pathology is often treated with ___________. Danazol
Synthetic androng that act as a partial agonist at androgen receptor Mechanism of action of Danazol
Adverse effects of Danazol: - Weight gain, edema, acne - Hirsutism, masculinization - Decreased HDL levels - Hepatotoxicity - Pseudotumor cerebri
Agonists at androgen receptor Testosterone and Methyltestosterone
Organic androgen receptor agonist Testosterone
Synthetic androgen receptor agonist Danazol
What are the main uses of Testosterone (exogenous)? 1. Treat hypogonadism and promote development of secondary sex characteristics 2. Stimulate anabolism to promote recovery after burn or injury
What is the lesser common used for testosterone? Stimulate anabolism to promote recovery after burn or injury
What is the adverse effect of exogenous testosterone in females? Masculinization
What is the adverse effect of exogenous testosterone in males? Decrease intratesticular testosterone leading to inhibited release of LH which cause gonadal atrophy
Male gonadal atrophy is often seen as a adverse effect of exogenous __________________. Testosterone
What is a male and female adverse effect of the use of testosterone? Premature closure of epiphyseal plate, increase in LDL, and decrease in HDL.
List of common antiandrogenic medications? 1. Finasteride 2. Flutamide 3. Ketoconazole 4. Spironolactone
Which is more potent, DHT or Testosterone? DHT
Enzyme that converts testosterone into DHT? 5-alpha-reductase
Testosterone ----X------------> DHT. What is X? 5-alpha-reductase
What is an important and common 5a-reductase inhibitor? Finasteride
What are the 2 uses for Finasteride? 1. BPH 2. Male-pattern baldness
What associated adverse effects of Finasteride? Gynecomastia and sexual dysfunction
MOA of Flutamide: Nonsteroidal competitive inhibitor at androme receptors
Which medication is a non-steroidal competitive inhibitor at androgen receptors? Flutamide
What is the clinical use for Flutamide? Prostate carcinoma
What is the overall purpose of Ketoconazole? Inhibits steroid synthesi
Which enzymes are inhibited by Ketoconazole? - 17, 20 desmolase - 17-a-hydroxylase
Antiandrogen known to inibito 17-alpha-hydroxylase Ketoconazole
What is the result of Ketoconazole inhibition of desmolase and 17a-hydroxylase? Inhibit steroid synthesis
What is the main use for Ketoconazole? Reduce androgenic symptoms of PCOS
Which are antiandrogens that can be used to reduce androgenic symptoms of PCOS? Ketoconazole and Spironolactone
What are the associated adverse effects of Ketoconazole and Spironolactone? Gynecomastia and amenorrhea
Spironolactone works by: Inhibition of steroid binding, by inhibiting desmolase and 17-a hydroxylase.
What is the difference in MOA between Spironolactone and Ketoconazole? Ketoconazole ---- inhibits steroid SYNTHESIS Spironolactone --- inhibits steroid BINDING
Which antiandrogen inhibits steroid synthesis, Ketoconazole or Spironolactone? Ketoconazole
Which antiandrogen inhibits steroid binding, Ketoconazole or Spironolactone? Spironolactone
alpha-1 antagonist used to treat BPH by inhibit smooth muscle contraction. Tamsulosin
Which medication is seen as Selective for alpha-1A/D receptors on prostate vs vascular a-1B recetpros? Tamsulosin
Which alpha receptors on prostate are selective by Tamsulosin Alpha-1A/D
Tamsulosin MOA: Alpha-1 antagonist used in BPH, that inhibits smooth muscle contraction
Which three medications are known to treat BPH? Finasteride, Tamsulosin and Tadalafil
What are common Phosphodiesterase type 5 inhibitors? Sildenafil, vardenafil, and tadalafil
PDE-5 inhibitors cause an _____________ in cGMP. Increase
The increase in cGMP caused by sildenafil leads to: Prolonged smooth muscle relaxation in response to nitric oxide
Which part of hte peins recieves more blood by the use of Viagra? Corpus cavernosum of penis
While blood flow to corpus cavernosum of penis is increased, what other effect occurs with PDE-5 inhibitors? Decrease poumomary vascular resistance
What is the clinical use for PDE-5 inhibitors? 1. Erectile dysfunction 2. Pulmonary hypertension 3. BPH (Tadalafil only)
Which is the only PDE-5 inhibitor used to treat BPH? Tadalafil
Adverse effects with PDE-5 inhibitors: - Headache, flushing, dyspepsia, cyanopsia - Risks of life-threatening hypotension if taken with nitrates
Which are extremely contraindicated in a patient taking sildenafil? Nitrates
What is the MOA of MInoxidil? Direct arteriolar vasodilator
Clinical use for Minoxidil 1. Androgenetic alopecia (pattern baldness) 2. Severe refractory hypertension
Why would a male try to hide the fact he is taking MInoxidil? Its primary clinical use is for androgenetic alopecia
Which are drugs that treat male baldness? Minoxidil and Finasteride
Disordered epithelial growth of the cervix. Cervical dysplasia
What are the classifications of Cervical dysplasia? CIN 1, CIN 2, and CIN 3
Cervical carcinoma in situ is associated with HPV serotypes? HPV-16 and HPV-18
HPV-16 serotype produces which gene? E6 gene
What is inhibited by E6 gene product of HPV-16? TP53
E7 gene product is known to inhibit Rb
What cells are pathognomonic of HPV infection? Koilocytes
Koilocytes are seen in what type of viral infection? HPV
(+) for koilocytes. Dx? HPV infection
What are known risk factors for HPV infection? 1. Multiple sexual partners 2. HPV 3. Smoking 4. Early coitarche 5. DES exposure 6. Immunocompromised (HIV, transplant)
Cervical invasive carcinoma is most often of what type? Squamous cell carcinoma
What is a possible complication of lateral invasion of Cervical Invasive carcinoma? Hydronephrosis leading to renal failure
What is another way to refer to Primary Ovarian insufficiency? Premature Ovarian failure
Premature atresia of ovarian follicles in women of reproductive age. Dx? Primary ovarian insufficiency
What type of conditions are most associated with development of Primary ovarian insufficiency in women less than 30 y.o.? Chromosomal abnormalities
A patient with signs of menopause after puberty but before the age of 40, with a diagnosed chromosomal abnormality. Dx? Primary ovarian insufficiency
List of MCC of ANOVULATION: 1. Pregnancy 2. PCOS 3. Obesity 4. HPO axis abnormalities/immaturity 5. Premature ovarian failure 6. Hyperprolactinemia 7. Thyroid disorders 8. Eating disorders 9. Competitive athletes 10. Cushing syndrome 11. Adrenal insufficiency, 12. Chromosomal abnormalities (Turner syndrome)
Another name of functional hypothalamic amenorrhea Exercise-induced amenorrhea
What are some common causes/activities that cause functional hypothalamic amenorrhea? Severe caloric restriction, increase energy expenditure, and/or stress.
What does the first affection of Functional hypothalamic amenorrhea? Functional disruption of pulsatile GnRH secretion leading to decrease levels of LH, FSH, and estrogen.
"female athlete triad" is associate with what condition? Functional hypothalamic amenorrhea
Pathogenesis of functional hypothalamic amenorrhea: 1. Functional disruption of pulsatile GnRH secretion --> Decrease LH, FSH, estrogen. 2. Decrease in leptin due to decrease fat 3. Increase cortisol (stress, excessive exercise)
What is another name for Polycystic Ovarian syndrome (PCOS)? Stein-Leventhal syndrome
What is the main disruption in PCOS that lead to hormonal changes? Hyperinsulinemia and/or insulin resistance alter the hypothalamic hormonal feedback response
Are LH:FSH ratio increased or decreased in PCOS? Increased
What is the result of the increased levels of LH:FSH and androgens in PCOS? Unruptured follicles (cysts) + anovulation
What is a common cause of decreased fertility in women? Polycystic ovarian syndrome
Enlarged, bilateral cystic ovaries; amenorrhea/oligomenorrhea, hirsutism, acne, and decreased fertility. Dx? Polycystic ovarian syndrome
How is PCOS related to Endometrial cancer? Increased risk of Endometrial cancer secondary to UNOPPOSED estrogen from repeated anovulatory cycles
What is the effect on estrogen due to recurrent anovulatory cycles in a PCOS patient? Unopposed estrogen leads to its incrase and higher riks of endometrial cancer.
What are the non-medication life modifications used for treating PCOS? 1. Weight reduction to decrease periphear estrone formation 2. OCPs
What is the medical (chemical) treatment for PCOS? 1. Clomiphene, metformin to induce ovulation 2. Spironolactone 3. Ketoconazole (antiandrogenic) to treat hirsutism
Which antibiotic is usually used to treat hirsutism in PCOS patient? Ketoconazole
Reason for Spironolactone use in PCOS treatment Anti-androgenic; treating hirsutism
1. Hyperglycemia 2. Hirsutism 3. Infertility Common triad of symptoms seen in PCOS
What are the two main types of Ovarian cysts? 1. Follicular cysts 2. Theca-lutein cysts
What is an Follicular ovarian cyst? Distension of unruptured graafian follicle
Associations of Follicular ovarian cyst? - Hyperestrogenism - Endometrial hyperplasia
What is the most common ovarian mass in young women? Follicular ovarian cyst
Description of ovarian Theca-Lutein cyts? Often bilateral and multiple
Ovarian Theca-Lutein cysts are due to: Gonadotropin stimulation
What are common associations of Ovarian Theca-Lutein cysts? Choriocarcinoma and Hydatidiform moles
List of common Endometrial pathologies: 1. Polyp 2. Adenomyosis 3. Asherman syndrome 4. Leiomyoma (fibroid) 5. Endometrial hyperplasia 6. Endometrial carcinoma 7. Endometritis 8. Endometriosis
An endometrial polyp is: Well-circumscribed collection of endometrial tissue within uterine wall.
What kind of cells are found in endometrial polyps? Smooth muscle cells
An endometrial polyp can extend to the: Endometrial cavity in the form of a polyp
An endometrial may be asymptomatic, or if symptomatic it presents with: Painless abnormal uterine bleeding.
"Sac-like structure" of endometrial tissue within the uterine wall. Dx? Endometrial polyp
What is adenomyosis? Extension of endometrial tissue (glandular) into uterine myometrium
What is the most common cause fo Adenomyosis? Hyperplasia of basal layer of endometrium.
What is the result (pathology) caused by the hyperplasia of the basal layer of endometrium? Adenomyosis
What is the clinical presentation of Adenomyosis? Dysmenorrhea, menorrhagia, uniformly enlarged, soft, globular uterus.
What is the treatment of Adenomyosis? GnRH agonists, hysterectomy or excision of an organized adenomyoma.
What type of endometrial tissue is affected or extended in Adenomyosis? Glandular endometrial tissue
Adhesions and /or fibrosi of the endometrium. Dx? Asherman syndrome
Patient with Hx of recent dilation and curettage of intrauterine cavity, presents with abnormal uterine bleeding, pelvic pain, and Hx of infertility and recurrent pregnancy loss 2x? Asherman syndrome
Leiomyoma = Fibroid
Fibroid is also known as ___________________. Leiomyoma
What is the most common tumor in females? Leiomyoma
Description of a Leiomyoma: 1. Benign smooth muscle tumor 2. Estrogen sensitive 3. Peak occurrence - women 20-40 years old
What ethnic population have higher levels of Leiomyoma recurrence? African American women
What does an "Leiomyoma is Estrogen-sensitive" means? Tumor size increase with pregnancy and decreases with menopause
Whorled pattern of smooth muscle cells bundles with well-demarcated borders. Which is the possible endometrial condition? Leiomyoma
What is an hematologic adverse condition that may be a consequence of severe Leiomyomas? Iron deficiency anemia
Medical procedures that are directed to check/treat the uterus may lead to development of? Asherman syndrome
Abnormal endometrial gland proliferation usually caused by excess estrogen stimulation. Dx? Endometrial dysplasia
What is the most characteristic symptom of Endometrial hyperplasia? Postmenopausal vaginal bleeding
What are associated risk factor of Endometrial hyperplasia? Anovulatory cycles, hormone replacement therapy, PCOS, and granulosa cell tumor
What is a higher risk factor for Endometrial hyperplasia, nuclear atypia or complex architecture? Nuclear atypia
What is the MC gynecologic malignancy with peak at 55-65 years old? Endometrial carcinoma
Postmenopausal vaginal bleeding. is a features of which malignancy? Endometrial carcinoma
What is the most typical preceding condition of Endometrial carcinoma? Endometrial hyperplasia
What are some associated risk factors that lead to development of Endometrial carcinoma? 1. Prolonged use of estrogen without progestins, 2. Obesity 3. Diabetes 4. Hypertension 5. Nulliparity 6. Late menopause 7. Early menarche 8. Lynch syndrome
Which GI condition is often associated with Endometrial carcinoma? Lynch syndrome
What is Endometritis? Inflammation f endometrium associated with retained products of conception following delivery, miscarriage, abortion, or with foreign body (IUD).
How does retain material in uterus lead to Endometritis? It promotes infection by bacterial flora from vaginal or intestinal tract
What a histological feature of chronic endometritis? Presence of plasma cells on histology
Which condition is associated with (+) plasma cell on histology? Chronic endometritis
What is the most common or usual treatment for Endometritis? Gentamicin + clindamycin +/- ampicillin
Non-neoplastic endometrium-like glands/stroma outside endometrial cavity. Dx? Endometriosis
Endometrial tissue outside of endometrium. Dx? Endometriosis
What is the most common site for Endometriosis? Ovary (frequency bilateral)
What are 3 common places for endometriosis to develop? BIlateral ovaries, pelvis, and peritoneum
What is the description of endometriosis in the ovary? Endometrioma
What is endometrioma? Endometriosis in the ovary
Blood-filled "chocolate cysts" . Dx? Ovarian endometriosis
What are some possible causes of Endometriosis? 1. Retrograde blood flow 2. Metaplastic transformation of multipotent cells 3. Transportation of endometrial tissue via the lymphatic system
What are common clinical signs and symptoms of endometriosis? Cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia, infertility.
How is the size of uterus with a women with Endometriosis? Normal sized uterus
Treatment of Endometriosis? -NSAIDs - Continuous OCPs - Progestins - GnRH agonists - Danazol - Laparoscopic removal
Danazol is used int the treatment of ____________________. Endometriosis
What is a common features of Endometriosis to describe the cysts? "Chocolate cysts"
What are the two subtypes of Fibrocystic changes of the breast? 1. Sclerosing adenosis 2. Epithelial hyperplasia of the breast
What are the types of benign breast diseases (general)? 1. Fibrocystic changes 2. Inflammatory processes 3. Benign tumors 4. Gynecomastia
Fibrocystic changes of the breast are most common what type of women? Premenopausal women < 35 years old
Description of fibrocystic changes of the breast: - Pre-menstrual pain or lumps - Often bilateral and multifocal
What are the cystic changes of the breast (definition)? Non-proliferative lesions that include simple cysts, papillary aprocine change/metaplasia, and stromal fibrosis.
Sclerosing adenosis is a subtype of: Fibrocystic changes of the breast
What is Sclerosing adenosis of the breast? Acini and stromal fibrosis, associated with calcifications; minimal increase for cancer
Breast cells in terminal ductal or lobular epithelium with increased risk of carcinoma with atypical cells. Subtype of Fibrocystic breast changes. Dx? Epithelial hyperplasia of breast
What are the two main benign breast inflammatory processes that cause disease? 1 Fat necrosis 2 Lactational mastitis
How is Fat necrosis of the breast defined? Benign, usually painless, lump due to injury to breast tissue
What is a typical finding of Fat necrosis on mammography? Calcified oils cyst
What is Lactational mastitis? Occurs during breastfeeding. Increased risk of bacterial infection through cracks in nipple
What i the most common pathogen that causes Lactational mastitis? S. aureus
What are the benign tumors of the breast? - Fibroadenoma - Intraductal papilloma - Phyllodes tumor
Fibroadenoma of the breast is a benign or malignant tumor? Bening
Intraductal breast papilloma is a benign or malignant tumor? Benign
What is the most common benign breast tumor in women under the age of 35? Fibroadenoma
Description and features of Breast fibroadenoma? - Small, defined, mobile mass, - Increases size and tenderness with increases levels of estrogen, such as in pregnancy an prior to menstruation
What type of benign tumor is usually seen with increased levels of tenderness and size few days prior to menstruation? Breast fibroadenoma
Small fibroepithelial tumor within lactiferous ducts, typically beneath areola. Dx? Intraductal papilloma of the breast
What is the most common cause of bloody or soeurs nipple discharge? Intraductal papilloma of the breast
What is the Phyllodes tumor? Large mass of connective tissue and cysts with "leaf-like" lobulations
Which benign breast tumor has changes of one day becoming malignant? Phyllodes tumor
What decade of life is most commonly a Phyllodes tumor to develop? 5th decade
"leaf-like" lobulations. Dx breast tumor? Phyllodes tumor
Bloody nipple. MC benign breast tumor? Intraductal papilloma of the breast
What is Gynecomastia? Breast enlargement in males due to increased levels of estrogen compared with androgen activity.
What are some causes of Gynecomastia? 1. Cirrhosis 2. Hypogonadism 3. Testicular tumors 4 . Drugs
What drugs/medications are known to cause gynecomastia? Spironolactone, Hormones, Cimetidine, Finasteride, and Ketoconazole.
Abnormal breast growth in males. Gynecomastia
What is an "embarrassing" condition in males, due to increased estrogen compared to androgen activity? Gynecomastia
Which ducts have the presence of Intraductal adenoma growth? Lactiferous ducts, beneath the areola.
What is Peyronie disease? Abnormal curvature of penis due to fibrous plaque within tunica albugĂ­nea.
What is the distinction between Peyronie disease and Penis fracture? Penis fracture is the ruprus of corpora cavernosa due to forced bening
Which type of conditions is likely due to practicing rough coitus? Penile fracture
When is surgical repair of Peyronie disease recommended? Once curvature stabilized
What are symptoms or associations of Peyronie disease? Erectile dysfunction, pain, and anxiety.
Painful sustained erection lasting > 4 hours. Dx? Ischemic priapism
What are common associative-causes of Priapism? Sickle cell disease and medications (viagra)
Why is Sickle cell disease associated with development of Priapism? Sickled RBCs block venous drainage of corpus cavernosum vascular channels
Treatment for ischemic priapism Immediate corporal aspiration, intracavernosal phenylephrine, or surgical decompression to prevent ischemia
Intracavernosal phenylephrine is used for: Treatment of priapism
Which parts of the world ar most affected by Squamous cell carcinoma of the penis? Asia, Africa, and South America
What are the precursor in situ lesions for Squamous cell carcinoma of the penis? 1. Bowen disease 2. Erythroplasia of Queyrat 3. Bowenoid papulosis
What penile pathology is associated with uncircumcised males and HPV? Penile squamous cell carcinoma
Leukoplakia in the penis shaft. Bowen disease
What is Bowen disease? Precurus in situ lesion for Penile SCC that presents as leukoplakia in the shaft of penis
What is Erythroplasia of Queyrat? Carcinoma in situ of the glans of the penis, that presents as erythroplakia.
What is Bowenoid papulosis? Carcinoma in situ of unclear malignant potential, presented as reddish papules; precursor condition of Penile SCC.
Reddish papules in penis, which later gave rise to development Penile SCC? Bowenoid papulosis
What is Cryptorchidism? Undescended testis (one or both)
Medical term for undescended testis (one or both). Cryptorchidism
Why does cryptorchidism cause impaired spermatogenesis? Since sperm develop besta at temperatures < 37 degrees.
What type of tumors are most associated with Cryptorchidism? Germ cell tumors
What is a common risk for Cryptorchidism? Prematurity
How important hormonal levels affected in Cryptorchidism? Decreased inhibin B, and increased LH and FSH. Testosterone Is normal in unilateral but decreased in bilateral cases of cryptorchidism
How does the levels of testosterone differ in bilateral cryptorchidism vs unilateral cryptorchidism? Bilateral --> low testosterone leves Unilateral ---> normal levels
Rotation of testicle round the spermatic cord and vascular pedicle. Dx? Testicular torsion
What is the definition of testicular torsion? Rotation of testicle around the spermatic cord and vascular pedicle
In testicular torsion, the testicle is around which important stricture? Spermatic cord
Testicle around the spermatic cord. Dx? Testicular torsion
What is the clinical presentation of Testicular torsion? Acute, severe pain, high-riding testis, and absent cremastic reflex
An absent cremasteric reflex in a 15 year old male, that present with sudden testicular pain. Dx? Testicular torsion
Orchiopexy? Surgical correction of Testicular torsion within the first 6 hours.
What is the treatment or procedure in Testicular torsion with a < 6 hours from event? Orchiopexy
What is a varicocele? Dilated veins in pampiniform plexus due to increased venous pressure
Dilated veins in pampiniform plexus due to increased venous pressure. Dx? Varicocele
What plexus is associated or affected in Varicocele? Pampiniform plexus
What is the most common cause of scrotal enlargement in adult males? Varicocele
Which side is most common to develop a Varicocele, right or left? Left side
Why is the left side of a male most prone to develop a varicocele? Increase resistance to flow from left gonadal vein drainage into left renal vein
How is Varicocele diagnosed? By standing clinical exam/Valsalva maneuver or US with Doppler
What is "felt" by doctor in inspecting a Varicocele? "bag of worms" on palpation of testicule
Does a varicocele transilluminate? No, it does not
"bag of worms" Varicocele
What is the treatment for Varicocele? Surgical ligation or embolization if associated with pain or infertility.
Benign scrotal lesions present as testicular masses that can be transilluminated. Scrotal masses
Definition of scrotal masses. Benign scrotal lesions present as a testicular masses that transilluminated.
Does scrotal masses or solid testicular tumors, transilluminate? Scrotal masses
What are the most common forms of Scrotal masses? 1. Congenital hydrocele 2. Acquired hydrocele 3. Spermatocele
Reason of congenital hydrocele development? Incomplete obliteration of processus vaginalis
What is a very common cause of scrotal swelling in infants? Congenital hydrocele
Failed obliteration of processus vaginalis leads to development of: Congenial hydrocele
Which feature in development is failure that leads to Congenital Hydrocele? Processus vaginalis
Scrotal fluid collection usually secondary to infection, trauma, or tumor. Dx? Acquired hydrocele
Bloody acquired hydrocele Hematocele
If the hydrocele is filled with blood, it is known as ______________. Hematocele
What is a Spermatocele? Cyst due to dilated epididymal duct or rete testis
Cyst formed by dilation of the epididymal duct or rete testis. Dx? Spermatocele
Paratesticular fluctuant nodule. Dx? Spermatocele
Common hyperplastic condition of the prostate in men over 50 years of age. Benign prostatic hyperplasia
What are the characteristics of BPH? Smooth, elastic, firm nodular enlargement of periurethral lobes, which compresses the urethra into a vertical slit.
What parts of the prostate gland are comprised in BPH? Periurethral lobes (lateral and middle lobes)
If compresses the lateral and middle lobes of prostate, suspect conditions? Benign prostatic hyperplasia
If the prostatic enlargement compressor arises from the posterior lobe, which is the suspected dx? Prostatic adenocarcinoma
Is BPH premalignant? No, it is not considered a premalignant condition
What are clinical symptoms or presenting conditions of BPH patients? - Increased frequency of urination - Nocturia - Difficulty starting and stopping urine stream - Dysuria
What are possible complications of severe BPH? Distension And hypertrophy of bladder, hydronephrosis, and UTIs.
What antigen is seen elevated in BPH? Free PSA
What are the common drugs to treat BPH? 1. Alpha-1 antagonists (tamsulosin) 2. 5a-reductase inhibitors (finasteride) 3. PDE-5 inhibitors (tadalafil) 4. Surgical resection /ablation
What is a common alpha-1 antagonist used in treating BPH? Terazosin and Tamsulosin
What type of drugs are Terazosin and Tamsulosin? Alpha-1 antagonists
What are the general characteristics of Prostatitis? Dysuria, frequency, urgency, low back pain. Warm, tender, enlarged prostate
What are the two types of Prostatitis? 1. Acute bacterial prostatitis 2. Chronic prostatitis
What is the most common pathogen that causes bacterial prostatitis in older men? E. coli
Acute bacterial prostatitis in young men is most likely caused by: C. trachomatis or N. gonorrhoeae infection.
What type of prostatitis may be bacterial or non-bacterial? Chronic prostatitis
Common causes of chronic prostatitis: - Secondary to previous infection - Nerve problems - Chemical irritation
What are the most common adnexal masses in women >> 55 years old? Ovarian neoplasms
What are the 3 main origins of Ovarian neoplasms? Surface epithelium, germ cells, and sex cord stromal tissue
What is the origin of the majority of malignant ovarian neoplasms? Epithelial
What is the most common malignant ovarian tumor? Serous cystadenocarcinoma
List of common predispositions or risk factor for ovarian cancer 1. Advanced age 2. Infertility 3. Endometriosis 4. PCOS 5. Genetic predisposition 6. BRCA1 or BRCA2 mutation 7. Lynch syndrome 8. Strong family history
What are actions known to decrease risk of developing Ovarian cancer? Previous pregnancy, history of breastfeeding, OCPs, tubal ligation.
What are clinical symptoms of ovarian neoplasms? Adnexal mass, abdominal distension bowel obstruction, and pleural effusion
What marker is used to monitor therapy and relapse of an ovarian tumor? CA125
Is CA125 good for screening? No, it is only used for therapy and relapse of Ovarian tumors
Maker of ovarian tumors CA125
What are the 3 types of BENIGN Ovarian surface epithelial tumors? 1. Serous cystadenoma 2. Mucinous cystadenoma 3. Endometrioma
What is the most common ovarian neoplasm? Serous cystadenoma
Description of Ovarian serous cystadenoma: Lined with Fallopian tube-like epithelium; Often bilateral; Benign Surface epithelium origin
Which ovarian benign neoplasm is known to be lined with fallopian tube-like epithelium? Serous cystadenoma
Multiloculated, large. Lined by mucus-secreting epithelium. Benign ovarian neoplasm Mucinous cystadenoma
Endometriosis within ovary with cyst formation. Dx? Endometrioma
What classic signs of Endometrioma? Pelvic pain, dysmenorrhea, and dyspareunia.
What is the classic "cyst" seen with Endometrioma? "Chocolate cyst"
Endometrioma filled with dark, reddish-brown blood. "Chocolate cyst"
Which is the benign Ovarian germ cell tumor? Mature cystic teratoma
What is another name for Mature cystic teratoma? Dermoid cyst
Benign germ cell tumor of the ovary Mature cystic teratoma
What is the most common ovarian benign tumor in females 10-30 years old? Mature cystic teratoma
What does the cystic mass of a dermoid cyst consist of? Elements of all 3 germ layers (teeth, hair, sebum)
Ovarian mass filled with teeth, hair, and sebum. Benign. Dx? Mature cystic teratoma
What tumor is present with pain secondary to ovarian enlargement or torsion? Mature cystic teratoma
Struma ovarii is associated with which ovarian tumor? Mature cystic teratoma
What is struma ovarii? Monodermal form of dermoid cyst with thyroid tissue, that uncommonly presents with hyperthyroidism.
Young woman presents with hyperthyroidism, but her Hypothalamic studies are normal, and only complain is pelvic pain prior menses. Dx? Struma ovarii
What are the most common benign sex cord stromal tumors of the ovaries? Fibroma and Thecoma
What is an ovarian fibroma? Bundles of spindle-shaped fibroblasts
What syndrome is associated with Ovarian fibroma? Meigs syndrome
What is Meigs syndrome? Triad of ovarian fibroma, ascites, and hydrothorax
"Pulling" sensation in groin in young woman. Ovarian fibroma
Ovarian fibroma + Hydrothorax + Ascites. Dx? Meigs syndrome
What is the most common form to describe sensation produced by an Ovarian fibroma? "Pulling" session in groin
What hormone is commonly produced by Thecoma? Estrogen
How does a Thecoma is similar to a Granulosa cell tumor? Both produce estrogen
What is the most common presentation of Thecoma (clinically)? Abnormal uterine bleeding in a postmenopausal woman
What is a Brenner tumor? Benign ovarian tumor, that is not classified as surface epithelium, sex cord, or germ cell tumor of the ovaries.
Resembles a bladder epithelium (transition cell tumor). Brenner tumor
A Brenner tumor is an _______________ tumor. Ovarian
Solid tumor that is pale yellow-tan and appears encapsulated. Brenner tumor
What is the classical description staining of Brenner tumor nuclei? "Coffee bean" nuclei in H&E stain.
List of Malignant surface epithelial tumors of the ovary: 1. Serous cystadenocarcinoma 2. Mucinous cystadenocarcinoma
What is the MC ovarian malignant neoplasm? Serous cystadenocarcinoma
What is an important histological finding of ovarian serous cystadenocarcinoma? Psammoma bodies
What is an important complication of a ovarian mucinous cystadenocarcinoma? Pseudomyxoma peritonei
What is Pseudomyxoma peritonei? Intraperitoneal accumulation of mucinous material in Ovarian Mucinous cystadenocarcinoma
What are the 3 main malignant Germ cell tumor? 1. Dysgerminoma 2. Immature teratoma 3. Yolk sac tumor
Ovarian dysgerminoma is most common among _______________. Adolescents
Ovarian dysgerminoma is equivalent to which male tumor? Seminoma
What is the approximate percentage of dysgerminoma in relation to germ cell tumors? Accounts for 30%
What i the histological description of ovarian dysgerminoma? Sheets of uniform "fried egg" cells
What are the tumor markers used in specifically with Ovarian dysgerminoma? hCG and LDH
Aggressive, contains fetal tissue, neuroectoderm. Malignant ovarian germ cell tumor. Dx? Immature teratoma
Mature Ovarian teratoma is ______________________. Benign
Immature Ovarian teratoma is ______________________. Malignant
Immature ovarian teratoma is likely to be diagnosed before _______ of age. 20
What is the most common representation of Immature ovarian teratoma? Immature/embryonic-like neural tissue
Ovarian neoplasm that contains fetal components of neural tissue origin? Immature teratoma
How else is the Yolk sac tumor of the ovary known as? Ovarian endodermal sinus tumor
Ovarian endodermal sinus tumor = Yolk sac tumor or the ovary
What is the most common tumor in male infants? Yolk sac tumor
Aggressive, in ovaries or testes and sacrococcygeal area in young children. Dx? Yolk sac tumor
Description and features of Yolk sac tumor of ovary or testes: - Yellow, friable (hemorrhagic) , solid mass - 50% have Schiller-Duval bodies - AFP = tumor marker
What is the tumor marker for Yolk sac tumors? AFP
What is the key histological feature of 50% of all Yolk sac tumors? Schiller-Duval bodies
What does the Schiller-Duval bodes tend to resemble? Glomeruli
What is the malignant sex cord tumor of the Ovary? Granulosa cell tumor
Granulosa cell tumor is of what origin? Sex cord stromal tumor
Granulosa cell tumor is malignant or benign ovarian tumor? Malignant ovarian tumor
What is the most common ovarian malignant stromal tumor? Granulosa cell tumor
What is produced by Granulosa cell tumors? Estrogen and/or progesterone
What is the clinical presentation of Granulosa cell tumors? - Postmenopausal bleeding - Sexual precocity (in pre-adolescent) - Breast tenderness
What is a common sign of possible granulosa cell tumor in a pre-adolescent woman? Sexual precocity
Key histological finding of Granulosa cell tumors of the ovaries? Call-Exner bodies
What are the Call-Exner bodies? Granulosa cells arranged haphazardly around collections of eosinophilic fluid, resembling primordial follicles
What cells are arranged around eosinophilic fluid, and resemble primordial follicles? Granulosa cells
(+) Call-Exner bodies. Dx? Granulosa cell tumor
What type of ovarian neoplasm origin are Immature teratomas and Dysgerminomas? Germ cell tumors
Malignant Sex cord stromal tumor of the ovary? Granulosa cell tumor
GI malignancy that metastasizes to ovaires. Dx? Krukenberg tumor
Mucin-secreting signet cell adenocarcinoma. Krukenberg tumor
What is a Krukenberg tumor? GI malignancy that goes to the ovaries, leading to development fo mucin-secreting signet cell adenocarcinoma
Which population of women are most likely to be affected b malignant breast tumors? Postmenopausal
What is the most common location for malignant breast tumors to arise from? Terminal duct lobular unit
Common characteristic (type) of malignant breast tumor Amplification/overexpression of estrogen/progesterone receptors or c-erbB2
Estrogen/Progesterone receptors or c-erbB2 = HER-2, an EGF receptor
What are the triple negatives in malignant breast cancer? ER (-) PR(-) Her2/Neu (-)
What is more aggressive breast tumor, a triple negative or a HER-2 (+) cancer? Triple negative
What is the most important prognostic factor in early-stage malignant breast tumor? Metastases to axillary lymph node
Which lymph node is associated with poor prognosis in breast cancer? Axillary lymph node
Where is the most common location for malignant breast cancer? Upper-outer quadrant
Common risk factors for malignant breast cancer: 1. Increased estrogen exposure 2. Increased total number of menstrual cycles 3. Older age at 1st live birth 4. Obesity 5. BRCA1 or BRCA2 gene mutations 6. African American ethnicity
Which population is most likely to develop triple (-) breast cancer? African American
What are the associated breast cancer gene mutations? BRCA1 and BRCA2
Which are the non-invasive malignant breast cancer tumors? 1. Ductal carcinoma in situ of the breast 2. Comedocarcinoma 3. Paget disease of the breast 4. Lobular carcinoma in situ of the breast
Malignant breast cancer are divided into two featured categories: Non-Invasive and, Invasive
Which breast cancer is seen with early microcalcifications on mammography? Ductal carcinoma in situ of the breast
Breast ductal carcinoma in situ arises from: Ductal atypia
DCIS of the breast Fills ductal lumen
How is Early stage of DCIS of the breast seen? Early malignancy without basement membrane penetration
Common subtype of DCIS of the breast Comedocarcinoma
Ductal, central necrosis. Subtype of breast DCIS. Dx? Comedocarcinoma
What is the cause of Paget disease of the breast? Results from underlying DCIS or invasive breast cancer.
What are Paget cells? Intraepithelial adenocarcinoma cells
What is the most important or key feature of Paget disease of the Breast? Eczematous patches on nipple
What breast malignancy is presented with eczematous patches on nipple? Paget disease of the Breast
Red rash on nipple. What is the most likely breast condition? Paget disease of the Breast
What are the Invasive type of malignant breast tumors? 1. Invasive ductal carcinoma 2. Invasive lobular carcinoma 3. Medullary carcinoma 4. Inflammatory breast cancer
Paget disease of the breast, is it invasive or non-invasive? Non-invasive
DCIS is a non-invasive or invasive breast malignancy? Non-invasive
Description of Invasive ductal carcinoma of the breast Firm, fibrous, "rock-hard" mass with sharp margins and small, glandular, duct-like cells.
What ligaments are involved/affected in Invasive ductal carcinoma of the breast? Suspensory ligaments
What causes the dimpling of skin seen in Invasive ductal carcinoma of the breast? The deformation of the Suspensory ligaments by the tumor
What is the classic morphology seen in Invasive ductal carcinoma of the breast? "stellate" infiltration
What is the most common type of malignant breast cancer? Invasive ductal carcinoma of the breast
Which breast non-invasive carcinoma is seen with decreased E-cadherin expression? Lobular carcinoma in situ of the breast
How is the risk of developing breast cancer differs from DCIS and LCIS? LCIS increases cancer in either breast, while DCSI only on the same breast and quadrant.
Breast exam detects a firm, 'rock-hard" mass with well defined margins in the upper left outer quadrant. Most likely diagnosis? Invasive ductal carcinoma of the breast
What kind of cells are found in Invasive Breast ductal carcinoma? Duct-like cells in desmoplastic stroma
What is a shared feature of Invasive lobular breast carcinoma and Lobular carcinoma in situ of the breast? Both have decreased E-cadherin expression
Which is the featured histological finding of Invasive lobular breast cancer? Orderly row of cells ("single file")
Which invasive breast carcinoma lacks desmoplastic response? Invasive lobular carcinoma of the breast
Medullary breast cancer: Large, anaplastic cells growing in sheets with associated lymphocytes and plasma cells
Often bilateral with multiple lesions in the same location. What is the most likely breast cancer? Invasive lobular carcinoma of the breast
Well-circumscribed breast tumor that can mimic a fibroadenoma. Medullary breast cancer
What breast malignancy is associated with lymphocytes and plasma cells? Medullary breast cancer
Anaplastic cells growing in sheets with WBCs and plasma cells. Medullary breast cancer histological features
Which invasive breast cancer is seen with dermal lymphatic space invasion? Inflammatory breast carcinoma
What are the clinical signs of Inflammatory breast cancer? 1. Breast pain with warm 2. Swollen, erythematous skin around exaggerated hair follicles 3. Peau d' orange
Breast malignancy associated with "peau d' orange"? Inflammatory breast carcinoma
Inflammatory breast cancer is often mistaken for: Mastitis or Paget disease of the breast
What invasive breast malignancy, usually lacks a palpable mass upon physical exam or inspection? Inflammatory breast carcinoma
What are the two types of Invasive breast carcinomas? 1. Tubular subtype 2. Mucinous subtype
What is an invasive tubular breast cancer? Well-differentiated tubules that lack myoepithelium
What is an Invasive Mucinous breast cancer featured with? Abundant extracellular mucin and seen in older women
What are the main categories of testicular tumors? Germ cell tumors and Non-germ cell tumors
List of Testicular Germ cell tumors 1. Seminoma 2. Yolk sac tumor 3. Choriocarcinoma 4. Teratoma 5. Embryonal carcinoma
What type of testicular tumors account for nearly 95% of them? Testicular germ cell tumors
What are two common conditions/risk factors for Testicular germ cell tumors? 1. Cryptorchidism 2. Klinefelter syndrome
Do testicular germ cell tumors transilluminate? No, they do not transilluminate
Why are testicular germ cell tumors not biopsy (usually)? Risk of seeding scrotum
What is the most definite and common treatment for testicular germ cell tumors? Radical orchiectomy
What is orchiectomy? Surgical removal of one or both testicles.
What is the most common testicular tumor? Seminoma
Seminoma is: - Malignant - Painless - Homogenous testicular enlargement - Most common testicular tumor
Histology of a Seminoma (testicular tumor): Large cells in lobules with watery cytoplasm and "fried egg" appearance
Which testicular tumor is seen with elevated placental ALP and is highly radiosensitive? Seminoma
What is the female representation of a testicular seminoma (similar)? Dysgerminoma
How is the prognosis in Seminoma? Excellent
What is another name for testicular Yolk sac tumor? Testicular endodermal sinus tumor
Yellow, mucinous; Aggressive malignancy of testes. (+) Schiller-Duval bodies. Dx? Yolk sac tumor
What is a key serologic feature of testicular Yolk sac tumors? Elevated AFP
What is the most common testicular tumor in children < 3 years old? Yolk sac tumor
Description of a testicular Choriocarcinoma: Malignant, increased hCG. Disordered syncytiotrophoblast and cytotrophoblast elements
Where does a testicular choriocarcinoma commonly metastasized to via blood? Lungs and brain
What are some clinical symptoms associated with testicular Choriocarcinoma? Gynecomastia and symptoms of Hyperthyroidism
Why does testicular choriocarcinoma is often seen with features fo hyperthyroidism? Due to elevated levels of hCG, which shares the a-subunit with TSH.
What are the characteristic of testicular (male) teratoma? Unlike females, mature teratoma in adult males is malignant and benign in children.
Which testicular tumor is malignant, in comparison to the same tumor but in females? Mature teratoma
Testicular teratoma is benign in ___________________. Children
Embryonal carcinoma characteristics: Malignant Hemorrhagic mass with necrosis Painful
Which has a worse prognosis, seminoma or embryonal carcinoma? Embryonal carcinoma
Which testicular germ cell tumor is painful? Embryonal carcinoma
What is the common morphology of embryonal carcinoma of the testes? Glandular/papillary
How is the most common presentation for an embryonal carcinoma? Mixed with other tumors
Which is more likely to be seen, a "pure" embryonal carcinoma, or a mixed embryonal testicular carcinoma? Mixed embryonal carcinoma
What are the associated levels of hCG and AFP in embryonal carcinoma? Elevated hCG and normal AFP levels
When is a embryonal carcinoma seen with elevated AFP levels? Mixed embryonal carcinoma
For what approximate percentage are testicular non-germ cell tumors accounted for? 5%
Testicular non-germ cell tumors are mostly __________________. Benign
Which are the 3 most common Testicular non-germ cell tumors? 1. Leydig cell tumor 2. Sertoli cell tumor 3. Testicular lymphoma
What are key histological findings in Leydig cell tumors? Reincke crystals
What are Reinke crystals? Eosinophilic cytoplasmic inclusions
What type of testicular tumor is seen with Reinke crystals? Leydig cell tumor
Golden-brown mass, (+) Reinke crystals on histology , Gynecomastia in male patient. Dx? Leydig cell tumor
What is produced by Leydig cell tumor? Androgens and estrogens which lead to gynecomastia in adults and precocious puberty in children.
Androblastoma from sex cord stroma. Sertoli cell tumor
What is a Sertoli cell tumor? Androblastoma from sex cord stroma
What is the most common testicular caner in older men? Testicular lymphoma
How does testicular lymphoma most likely arises or develops? From metastatic lymphoma to testes. Very aggressive
Prostatic adenocarcinoma is most common in men over _____ years old. 50
From which areas of the prostate, does prostatic adenocarcinoma, most commonly arises? Posterior lobe (peripheral zone) of prostate gland
What is the most frequent way to diagnose Prostatic adenocarcinoma? - Elevated PSA and, - Subsequent needle core biopsies.
What are the most useful prostate cancer tumor markers? PAP and PSA
What is a common organ to which prostate cancer metastasizes to? Bone
Which common male cancer is seen with Osteoblastic metastases in bone in its late stages? Prostatic adenocarcinoma
How does Osteoblastic metastases from prostate cancer present clinically? Lower back pin and increased serum ALP and PSA
Blood levels of a 62 year old male shoe elevated ALP and PSA. Suspected Dx? Prostatic adenocarcinoma with Osteoblastic metastases to the bone.
What is the source(s) of Estrogen? Ovary, placenta, and adipose tissue
Which type of estrogen is produced by the ovaries? 17B-estradiol
What form of estrogen is produced by the placenta? Estriol
Type of Estrogen produce by adipose tissue Estrone via aromatization
What process is necessary for adipose tissue to produce estrogen in the form of estrone? Aromatization
17B-estradiol is produced by the _______________. Ovaries
The from Estriol (of estrogen) is produced by the ______________. Placenta
Which is the form of estrogen with the greatest potency? Estradiol
Which source of estrogen produces the estrogen with the highest potency? Ovaries as they produce estradiol
Estradiol > Estrone > estriol Potency of estrogen from highest to lowest
List of functions of Estrogen: 1. Development of genitalia and breast, female fat distribution 2. Growth of follicle, endometrial proliferation, and increased myometrial excitability 3. Upregulation of estrogen, LH, and progesterone receptors; Feedback inhibition of FSH and LH, then LH surge; stimulation of prolactin secretion 4. Increase transport proteins, SHBG; Increase HDL; decrease LDL
How is Estrogen related to structures and proliferations associated with viable pregnancy environment? It promotes the growth of the follicle, Promotes endometrial proliferation Incrases myometrial excitability
Which receptors are upregulated by Estrogen? Estrogen, LH, and progesterone receptor
Estrogen's feedback inhibition of FSH and LH causes ---> LH surge
Effect of estrogen on prolactin Stimulation of prolactin secretion
Increasing levels of estrogen have what effects on HDL and LDL? Increases HDL and decreases LDL
What occurs to estradiol and estrone levels during pregnancy? Increases a 50-fold
Which type of estrogen is used as an indicator of fetal well-being? Estriol
How are estriol levels affected by pregnancy? Increase in 1000-fold
Where in the cell are estrogen receptors located? Cytoplasm
What are the common sources for progesterone? Corpus luteum, placenta, adrenal cortex, and testes.
What are the functions of Progesterone? 1. Stimulation of endometrial glandular secretion sand spiral artery development 2. Maintenance of pregnancy 3. Decrease myometrial excitability 4. Production of thick cervical mucus, which inhibits sperm entry into uterus 5. Increase body temperature 6. Inhibition of gonadotropins (LH, FSH) 7. Uterine smooth muscle relaxation 8. Decrease estrogen receptor expression 9. Prevents endometrial hyperplasia
The fall of progesterone after delivery causes: Disinhibits prolactin lead to lactation
Lactation is due to: Fall of progesterone after delivery causes disinhibition of prolactin
Increased levels o progesterone is indicative of? Ovulation
Ovulation will be indicated by an increase in ______________ levels. Progesterone
Progesterone is Pro----- ProGESTATION
Prolactin is Pro ------ Pro-LACTATION
Which hormones causes stimulation of endometrial glandular secretions and spiral artery development? Progesterone
Which hormone maintains pregnancy? Progesterone
The production of thick cervical mucus by progesterone is to: Prevent sperm entry into the uterus
Which cholesterol derived hormone increases body temperature? Progesterone
How does progesterone prevent contractions? Uterine smooth muscle relaxation
Which hormone causes a decrease in estrogen receptor expression? Progesterone
________________ preventes endometrial hyperplasia. Progesterone
Progesterone cause inhibition of _______________________. Gonadotropins (LH and FSH)
Primary oocytes begin and complete formation during __________. Meiosis I
At which phase are Primary Oocytes arrested? Meiosis I Prophase I
Secondary oocytes are arrested in ------> Meiosis II Metaphase II until fertilization
Meiosis I prophase I has Primary oocytes
Meiosis II metaphase II has Secondary oocytes
What needs to happen to a secondary oocyte in order to finish its maturation? Fertilization
What is the N and C composition of a Primary Oocyte? Diploid (2N, 4C)
What is the number of sister chromatids in a Primary Oocytes? 46 sister chromatids
What needs to occur to a primary oocyte in order to advance from Meiosis I prophase I to become a secondary oocyte? Ovulation
Number of sister chromatids in a secondary oocyte? 23
1N, 2C describes the composition of what stage of oogenesis? Secondary oocyte
Primary oocytes are _____________. Diploid
Secondary oocytes and Ovum are ______________. Haploid
How many polar bodies are seen in stage of a secondary oocyte? 1 Polar body
Secondary oocyte is fertilized. It undergoes further maturation. What is the final number of polar bodies produced? A total of 3 polar bodies
In respect to oogenesis, a 1N, 1C describes what stage? Ovum
What is ploidy? Number of complete sets of chromosomes in a cell
How many complete sets of chromosomes are in a diploid cell? 2
How many possible different autosomal alleles can be produced by a diploid organism? 2
What does the letter "N" in 2N, 4C mean? Two homologous (diploid) unreplicated chromosomes
In connotation "2N, 4C", what does the 4C mean? C= number of sister chromatids. Thus, 2 sets of homologous chromosomes with 2 sister chromatids each = 4C
Mnemonic for phases of Mitosis I Party More At The Club
Ovulation is the---> Rupture of follicle
Term used for rupture of follicle after LH surge Ovulation
Path of Ovulation process Increased Estrogen and GnRH receptors on anterior pituitary lead to LH surge (release) ----> ovulation
What is a common features of ovulation, that is progesterone induced? Increase in temperature
What is Mittelschmerz? Transient mid-cycle ovulatory pain
Mid-cycle ovulatory pain. Dx? Mittelschmerz
Mittelschmerz is often confused with _________________. Appendicitis
What causes peritoneal irritation, leading to Mittelschmerz? Follicular swelling/rupture, fallopian tube contraction
How long is the Luteal phase in days? 14 days
Ovulation day + 14 days = Menstruation
Which menstrual cycle phase can vary in length? Follicular phase
Which week of the menstrual cycle represents the fastest follicular growth? 2nd week of follicular phase
What hormone is known to stimulate endometrial proliferation? Estrogen
_______________ maintain endometrium to support implantation. Progesterone
Which hormone is known to create environment suitable for implantation? Progesterone
A decrease in progesterone leads to a decrease in ----> Fertility
What hypothalamic hormone stimulates the anterior pituitary to secrete LH and FSH? GnRH
Anterior pituitary hormones associated strongly with the menstrual cycle? FSH and LH
The Menstrual cycle can be divided into two main sub-cycles, which are? Ovarian cycle and the Uterine cycle
Which are the phases of the Ovarian cycle? Follicular phase and Luteal phase
What are the phases of the Uterine cycle? Menses, Proliferative, Secretory, and back to Menses
Initial menses and Proliferative phase of the uterine cycle, occurs at the same time as which ovarian phase? Follicular phase
The Luteal phase is during which uterine cycle phase? Secretory phase
How long would the Uterine Secretory phase is ? 14 days approximately
At what point of the Uterine cycle are the Spiral arteries the longest/largest ? Mid-secretory phase
Which Uterine phase has the smallest or less dense Spiral arteries along the endometrium? Early proliferative phase
At what point of the menstrual cycle, approximately, is Estrogen at its highest level, with respect to the Ovarian/Uterine cycles? Late Follicular phase of Late Proliferative Uterine phase
On what day of the menstrual cycle does ovulation occur? 14th
What is produced (hormone) by the developing follicle in the early Follicular stage? Estrogen
On what follicular phase are corpus luteum found or present? Luteal phase
What is the last form of the follicle, after the Luteal phase? Corpus albicans
Progesterone levels are at its highest during which point of the menstrual cycle? Mid Luteal phase (or mid Uterine secretory phase)
What does AUB/HMB mean? Abnormal Uterine Bleeding/Heavy Menstrual bleeding
AUB/IMB means? Abnormal Uterine Bleeding/ IntraMenstrual Bleeding
What are the two categories of causes of Abnormal Uterine bleeding? Structural and Non-structural
What are the Structural causes of abnormal uterine bleeding? PALM: Polyp, Adenomyosis, Leiomyoma, or Malignancy/hyperplasia
What are the Non-structural causes of Abnormal uterine bleeding? COEIN: Coagulopathy, Ovulatory, Endometrial, Iatrogenic, Not yet classified
What are terms to describe abnormal uterine bleeding, not longer recommended? Menorrhagia, oligomenorrhea, or dysfunctional uterine bleeding
Where is the MC site for Fertilization? Upper end of Fallopian tube (the ampulla)
Where is the ampulla in terms of fertilization location? Upper end of the Fallopian tube
How long after ovulation does fertilization occurs? Within 1 day
How many days afer fetiizaton does implantation occurs? 6 days
Common site for implantation after fertilization Within wall of the uterus
What hormone is secreted by Syncytiotrophoblasts and is detectable in blood after 1 week from conception? hCG
hCG is detected in blood after ___________________. A week since conception
How long after conception can hCG be detected in urine? 2 weeks after conception
A home pregnancy test can be used as early as? 2 weeks after conception
How is Gestational age calculated? From date of last menstrual period
Calculated from date of last menstrual period Gestational age
Calculated from date of conception Embryonic age
Gestational age - 2 weeks = Embryonic age
How is Cardiac output adapted in pregnancy? Increased by increasing preload and decreased afterload, with increased HR
List of physiologic adaptations during pregnancy? - Increase in cardiac output - Anemia - Hypercoagulability - Hyperventilation
During which weeks of pregnancy, does the hCG peaks? 8-10 weeks
Which hormone secretion increases over the course of pregnancy? Placental hormone
What is the reason that a pregnant woman experiences hyperventilation as an physiological adaptation? Eliminate fetal CO2
How is anemia created in a pregnant person? Increase in plasma cells and decrease in RBCs
What is the main source of human chorionic gonadotropin? Syncytiotrophoblast of placenta
What is the hCG function in relation to the 8 to 10 weeks of pregnancy? Maintain corpus luteum by acting like LH
hCG has identical _____ subunit to LH, FSH, and TSH. alpha-subunit
Which is the subunit that differentiates hCG from LH, FSH, and TSH? beta-subunit
Which hormones shared identical alpha subunit with hCG? LH, FSH, and TSH.
Reason a pregnant woman may develop hyperthyroidism? Elevated levels of hCG, which may mimic TSH.
What does a pregnancy test detect ? B-subunit of hCG
What are conditions that present with elevated hCG? 1. Multiple gestations 2. Hydatidiform moles 3. Choriocarcinomas 4. Down syndrome
An decreasing level of hCG may indicate : Ectopic/failing pregnancy, Edwards syndrome, and Patau syndrome
Which trisononimes are associated with low levels of human chorionic gonadotropin? Edwards syndrome and Patau syndrome
Which common trisomy is associated with a high level of hCG? Down syndrome
What is another name for Human Placental lactogen? Chorionic somatomammotropin
Source of human placental lactogen Syncytiotrophoblast of placenta
What is the main function of human placental lactogen? Stimulates insulin production; overall increase insulin resistance
What is the consequence of maternal hypoglycemia? Due to insulin resistance it leads to lipolysis, which preserves available glucose and amino acids for the fetus.
How is Gestational diabetes developed? Occur if maternal pancreatic function cannot overcome that insulin resistance
Insulin resistance in pregnancy is related to which hormone? Human placental lactogen
Two very important hormones produced by the Syncytiotrophoblast of placenta? 1. human chorionic gonadotropin (hCG) 2. human placental lactogen
What is the APGAR score criteria based on? A. appearance P. pulse G. grimace A. activity R. respiration
Assessment of newborn vital signs following delivery via a 10-point scale evaluated at 1 minute and 5 minutes. APGAR score
Pink appearance has how many points in APGAR grading? 2
Pale or blue baby has a _____ score on appearance in APGAR scoring. 0
How many points are given to newborn with blue extremities only, in the appearance assessment in respect to APGAR score? 1
APGAR scores are from ____ to ___. 0----2
What is APGAR score requires further evaluation? < 7
What is the criteria in Grimace? 2 points ---> Cries and pulls away 1 point ------> Grimaces or weak cry 0 point ----> No response to stimulation
In order to get a 2 point score in Pulse APGAR, the HR must be? > 100
Pulse APGAR score 0, it means? No pulse
A HR of 89 bpm in newborn, will give how many APGAR points? 1 point
What is a risk of low APGAR scores event after 5 minutes? Long-term neurologic damage
No breathing gives how many APGAR score points? 0
What is the type of respiration description that will give 1 APGAR point? Slow, irregular breathing
Newborn has arms and legs flexed. How many points are given in the APGAR scale? 1 point
A child that does not regularly meet standard milestones is a candidate for? Assessment for potential developmental delay
What age range is considered an infant? 0-12 months
When is a human considered a toddler? 12-36 months
Time range for Preschool age? 3-5 years
What are the main 3 categories into milestones are divided? Motor, Social, and Verbal/Cognitive
What are the primitive reflexes in an infant? 1. Moro 2. Rooting 3. Palmar 4. Babinski
At what month is Moro reflex commonly disappeared? 3 months
When is the approximate time in which the primitive rooting reflex disappear? 4 months
Which primitive reflex is loss approximately at 6 months of age? Palmar reflex
Which primitive reflex is lost/disappear at 3 months of age? Moro reflex
Babinski sign is often present up to the _______ month of life. 12
When is the Babinski sign expected to disappear? 12 month
If a baby has intact Rooting reflex, it means he or she was born how long ago? Less than 4 months ago
What are milestones that test/evaluate posture? 1. Lifts head up prone 2. Rolls and sits 3. Crawls 4. Stands 5. Walks
An infant is approximately how old to lift the head up prone? 1 month
A baby is able to rolls and sits at what age? 6 months
At point is an infant should start crawling? 8 months
A baby that just started standing up, what is the approximate age? 10 months
Normal age to start walking of an infant? 12-18 months
Age of an infant passes a toys hand to hand? 6 months
Pincer grasp is seen with: 10 months
A baby starts pointing objects at what age? 12 months
Social smile is seen at: 2 months
Stranger anxiety is seen at: 6 months
Separation anxiety is evident at what age? 9 months
What is the approximate age in months in which a baby starts orientein to voice? 4 months
Orients to voice 4 months
Milestone. Oriented to name and gestures. Age? 9 months
Milestone. Age of human in which there is object permanence? 9 months
By what age, should parents may expect child to say "mama" and "dada"? 10 months
What are motor milestones seen in a Toddler? 1. Takes first steps - 12 mo 2. Climbs stairs - 18 mo 3. Cubes stacked 4. Cutlery - feeds self with fork and spoon by 20 mo 5. Kicks ball - 24 mo
What motor activity may be seen around 2 years old? Kicks ball
What is the recreation part of a toddler milestones? Parallel play by 24-36 months
At which stage of development of human, is rapprochement presented? 24 month toddler
By what age does a human recognizes or realizes its own gender? 36 months
How many words are usually known by a toddler? 200 words by age 2 years
How old is a human that starts driving a tricycle? 3 years old
By what age can a person stant copying lines or circles, and draws stick figures? 4 years old
What can be expected, in motor milestones, by age 5? Grooms self
Age by which a person begins having friends? 4 years old
What age can a mother leave comfortably spends part of the day away from her? 3 years old
A child telling a story with details may be expected how old to be? 4 years old
A person with a vocabulary approximately 1000 -word extensive, is around what age? 3 years old
How many grams define a low birth weight? 2,500 grams
What are common causes of a low birth weight? Prematurity and intrauterine growth restriction (IUGR)
What is a common event/action occuring after parturition and delivery of placenta? Lactation due to rapid decrease in progesterone
Maintenance of lactation is due to: Suckling, since increase nerve stimulation leads to increase oxytocin and prolactin secretion.
What is the function of Prolactin? Induces and maintains lactation and decrease reproductive function
What are the functions of oxytocin? 1. Assist in milk letdown 2. Promotes uterine contractions
Until what age is breast milk the ideal nutrition? < 6 months of age
Breast milk contains: Maternal immunoglobulins (mostly IgA), macrophages, and lymphocytes.
What conditions are less likely to occur to infant that is fed with Breast milk? Decrease risk to develop asthma, allergies, diabetes mellitus, and obesity.
What is recommended to supplement children exclusively breast milk fed? Vitamin D and Iron
What are the benefits to the mothers that breastfeed? Decrease maternal risk of breast and ovarian cancer and facilities mother-child bonding.
How is menopause diagnosed? Amenorrhea for 12 months
Decrease Estrogen production due to age-linked decline in number of ovarian follicles + amenorrhea for 12 months. Dx? Menopause
What is the average age for menopause? 51 years old
What activity tends to anticipate age onset for menopause? Smoking
What occurs with the peripheral Estrogen (estrone) after menopause? Converts into androgen, which elevated levels of androgen leading to hirsutism.
Which hormone is severely increased in menopause? FSH
What are the hormonal changes in Menopause? Decrease estrogen Mild increase in LH and GnRH Significant/Large increase in FSH
Which hormone is decreased in levels in menopause? Estrogen
Does estrogen increase or decrease with menopause? Decrease
What symptoms are seen with Menopause? Hot flashes, Atrophy of the Vagina, Osteoporosis, Coronary artery disease, Sleep disturbances.
What is suggested by menopause before the age of 40? Primary Ovarian insufficiency (premature ovarian failure)
Common androgens: Testosterone, dihydrotestosterone (DHT), androstenedione
What form or type of androgen is the one with the highest potency? DHT
Potency of androgens (highest low lowest)? DHT > testosterone > andorstenedione
What are the sources of androgens? - Testis --> DHT and testosterone - Adrenal - androstenedione
List of functions of testosterone: 1. Differentiation of epididymis, vas deferens, seminal vesicles 2. Growth spur: penisn, seminal vesicles, sperm, muscle, RBCs 3. Deepening of voice 4. Closing of epiphyseal plates 5. Libido
What are the early DHT functions? Differentiation of penis, scrotum, and prostate
What are the late DHT functions? Prostate growth, balding, sebaceous gland activity
What enzyme converts testosterone to DHT? 5a-reductase
What medication inhibits 5a-reductase? Finasteride
Inhibition of 5a-reductase prevents: Conversion of testosterone into DHT
How are androgens converted into estrogen in males? By cytochrome P-450 aromatase in adipose tissue and penis primarily.
What is the key enzyme in the conversion of androgens to estrogen? Aromatase
Aromatase is the key enzyme of: Converting androgens into estrogen
Which "type" of testosterone is inhibited by Exogenous testosterone? Intratesticular testosterone which leads to decrease testicular size and eventually azoospermia.
Testosterone helps differentiation of _______________ male genitalia. Internal
What is the only internal male sexual organ not differentiated by Testosterone? Prostate
When does spermatogenesis begins? At puberty
How long does full development of spermatogonia take? Two full months
In which structure does spermatogenesis occur? Seminiferous tubules
Spermatogenesis produces ---> Spermatids
What process does an spermatid needs to undergo , in order to fully mature into spermatozoon? Spermiogenesis
What is the ploidy and number of chromatids (C) of an mature spermatozoon? Haploid (1N, 1C)
The most apical part of the sperm's head is called the ___________. Acrosome
What is the X and Y chromosomal status of a Secondary spermatocyte? Either XX or YY.
In total, how main Haploid Spermatids are produced in spermatogenesis? 4
What is the composition of a sperm (spermatid) before undergoing spermiogenesis? 23 single (sex-X or Y); Haploid 1N, 1C
What conditions are commonly seen by impair sperm motility? Infertility such in Ciliary dyskinesia/Kartagener syndrome
How many Tanner stages are currently listed? 5; Tanner stage I-V
What are the characteristics of Tanner stage I? - No sexual hair - Flat-appearing chest with raised nipple
What Tanner stage is considered Pre-pubertal? Tanner stage I
A 6 year old child is most likely in which Tanner stage, if healthy? Tanner stage I
What are the features of Tanner stage II? - Pubic hair appears (pubarche) - Testicular enlargement (male) - Breast bud forms (thelarche) [female]
What is Pubarche? Initial appearance of pubic hair
What is thelarche? Breast bud formation in females
Pubarche + Thelarche, are seen most commonly in which Tanner stage? Tanner stage II
What years of age are usually covered or part of Tanner stage II? ~8 - 11.5
A human around ages of ~11.5-13 years old, is most commonly coursing which Tanner stage? Tanner stage III
What approximate years of age are covered in Tanner stage III? 11.5-13 years old
What are the features of Tanner stage III? - Coarsening of pubic hair - Penis size/length (male) - Breast enlarges, mound forms (female)
In which Tanner stage, the females experience breast enlargement + formation of mound? Tanner stage III
Coarse hair across pubis, sparing the thigh in male and female. This a characteristic of which Tanner stage? Tanner stage IV
What are the approximate age (range) of a person in Tanner stage IV of sexual development? ~13-15 years old
What are the male features of Tanner stage IV? 1. Coarse hair across pubis, sparing the thigh 2. Penis width/glans increases
What is the breast (female) description of Tanner stage IV? Breast enlarges, raised areola, and mound on mound
What Tanner stage covers people ~ > 15 years of age? Tanner stage V
Features of pubic hair seen in Tanner stage V? Coarse hair across pubis and medial thigh
Breast development of normal female in Tanner stage V? Adult breast contour, areola flattens
By which Tanner stage of sexual development does the areola tends to flatten again? Tanner stage V
Coarse hair across pubis, and including the medial thigh. Which Tanner stage is this part of? Tanner stage V
What are the 3 criteria described by Tanner stage sexual development system? 1. Genitalia 2. Pubic hair 3. Breast
Is it possible for a single person to have different Tanner stages? Yes; Tanner stages are assigned independently to genitalia, pubic hair, and breast (female).
What is the most common cause of Aneuploidy? Meiotic nondisjunction
List of sex chromosome disorders: 1. Klinefelter syndrome 2. Turner syndrome 3. Double Y males 4. Ovotesticular disorder of sex development
What is the associated karyotype of Klinefelter syndrome? 47, XXY
What are the clinical features of Klinefelter syndrome? 1. Testicular atrophy 2. Eunuchoid body shape 3. Tall 4. Long extremities 5. Gynecomastia 6. Female hair distrubution
The presence of inactivated X chromosome (Barr body) in a male. Dx? Klinefelter syndrome
What is a common cause of Hypogonadism? Klinefelter syndrome
Which are the two structural abnormalities in Klinefelter syndrome, that produce hormonal changes? 1. Dysgenesis of seminiferous tubules 2. Abnormal Leydig cell function
In Klinefelter syndrome, the dysgenesis of the seminiferous tubules has which consequences? Decrease inhibin B secretion which leads to an elevated FSH.
What causes the elevated FSH in Klinefelter syndrome? Low levels of inhibin B due to dysgenesis of seminiferous tubules
What are the results of abnormal Leydig function seen in Klinefelter syndrome? Decrease testosterone leading to elevated LH which causes increase in Estrogen
Testosterone in Klinefelter syndrome is, low, normal, or elevated? Low
FSH and LH in Klinefelter syndrome are ____________. Elevated
Which sex hormone is elevated in a man with Klinefelter syndrome? Estrogen
The elevation of FSH or LH causes elevated estrogen in Klinefelter syndrome? LH
Which cell's abnormal function, in Klinefelter syndrome, is responsible for the low levels of testosterone? Leydig cell
Low testosterone, mildly elevated FSH, LH, and estrogen. Dx? Klinefelter syndrome
Associated karyotype of Turner syndrome Female, 45, XO
45XO. Dx? Turner syndrome
List of clinical features seen in Turner syndrome: 1. Short stature 2. Ovarian dysgenesis (streak ovary) 3. Shield chest 4. Bicuspid aortic valve 5. Coarctation of the aorta 4. Lymphatic defects 7, Horseshoe kidney
Another form to refer to the ovarian dysgenesis present in Turner syndrome? Streak ovary
Coaratoin of aorta causing Femoral < brachial pulse. This features is commonly seen in ______________ syndrome. Turner syndrome
What are the lymphatic defects seen with Turner syndrome? Webbed neck or cystic hygroma; Lymphedema in feet, hands
Kidney defect or complication of Turner syndrome? Horseshoe kidney
Horseshoe kidney is often seen with which sex chromosome disorder? Turner syndrome
MCC of Primary amenorrhea Turner syndrome
How many Barr bodies are associated with Turner syndrome? Zero
Menopause before menarche. Dx? Turner syndrome
Decreased levels of _______________ lead to increased LH and FSH in Turner syndrome. Estrogen
Estrogen is ______________ in Turner syndrome. Decreased
Estrogen is ________________ in Klinefelter syndrome. Elevated
What is a rare cause of Turner syndrome? Mitotic error --> Mosaicism (45XO, 46, XX)
45, XO/46, XX. Dx? Turner syndrome due to mosaicism caused by mitotic error.
Is pregnancy possible in Turner syndrome? Yes, in some cases with IVF, exogenous estradiol-17B and progesterone therapy.
Karyotype of Double Y males 47, XYY
What are some features of Double Y males? 1. Very tall 2. Severe acne, 3. Learning disability (at times) 4. Autism spectrum disorders
46, XX > 46, XY. Dx? Ovotesticular disorder of sex development
Both ovarian and testicular tissue present (ovotestis); ambiguous genitalia Ovotesticular disorder of sex development
What used to be the old name for Ovotesticular disorder of sex development? True hermaphroditism
Which disorders of sex hormones have elevated levels of Testosterone? 1. Defective androgen receptor 2. Testosterone-secreting tumor, exogenous steroids
Low testosterone + High LH. Dx? Hypergonadotropic hypogonadism
Levels of testosterone and LH in hypogonadotropic hypogonadism. Low testosterone and low LH
Defective androgen receptor has elevated levels of ___________ and __________. Testosterone and LH
Overall definition of disorders of sex development Disagreement between the phenotypic sex and the gonadal sex
Phenotypic sex is based on: External genitalia, influence by hormonal levels
Sex hormone imbalance most likely will cause what type of sex abnormality-type? Phenotypic
Gonadal sex: Testes vs Ovaries; corresponds with Y chromosome
46, XX DSD? Ovaries present, but external genitalia are virilized or ambiguous
What is the MCC of 46, XX DSD? Excessive and inappropriate exposure to androgens steroids during early gestation
46, XY DSD? Testes are present, but external genitalia are female or ambiguous
What is the most common form of 46, XY DSD? Androgen-insensitivity syndrome
What is another term used for Androgen-insensitivity syndrome? Testicular feminization
Male with testes, but female/ambiguous genitalia. Dx? Androgen-insensitivity syndrome
What are common causes of FEMALE (XX) Hypergonadotropic hypogonadism? Turner syndrome, Genetic mosaicism, pure gonadal dysgenesis
What type of conditions are classified as Hypogonadotropic hypogonadism? CNS lesions, and Kallmann syndrome
Females with Hypergonadotropic hypogonadism are seen with ______________ but no breasts. Uterus
Which condition in females is seen with no uterus but with breasts? Utervaginal agenesis
No uterus but (+) breast in man. Dx? Androgen insensitivity
Inability to synthesize estrogens from androgens. Dx? Placental aromatase deficiency
What is the most common presentation of Placental aromatase deficiency? Masculinization of female (46, XX DSD) infants, increase serum testosterone and androstenedione.
What is a symptom or features of a pregnant mother with child dx with placental aromatase deficiency? Maternal virilization since fetal androgens can cross the placenta
Defect in androgen receptor resulting in normal-appearing female. Dx? Androgen insensitivity syndrome
Are levels of testosterone, estrogen, and LH, elevated or decreased in Androgen insensitivity syndrome? Elevated
A woman with diagnosed androgen insensitivity syndrome may have: Normal functioning testes found in the labia majora
Inheritance mode of 5a-reductase insensitivity. Autosomal recessive
Which condition is limited to genetic males (46, XY DSD)? 5a-reductase deficiency
Which condition is seen to be controlled by puberty? 5a-reductase deficiency
How are levels of testosterone, estrogen, and LH in 5a-reductase deficiency? Normal
Failure to complete puberty; a form of hypogonadotropic hypogonadism. Dx? Kallmann syndrome
What is the cause of Kallmann syndrome? Defective migration of GnRH-releasing neurons and subsequent failure of GnRH-releasing olfactory bulbs to develop
What is a featured or key symptom of Kallmann syndrome? Anosmia
Expected levels of androgens, and other sex hormones in Kallmann syndrome Decreased levels of GnRH, FSH, LH, and testosterone
Why is the infertility in men with Kallmann syndrome? Low sperm count
Infertility of women with Kallmann syndrome is due to: Amenorrhea
Patient that cannot conceive and has anosmia. Dx? Kallmann syndrome
Which of the Five senses is affected in Kallmann syndrome? Smell
Which is a commonly suspected sex chromosome condition in cases the patient complains of not been able to smell food? Kallmann syndrome
Which is the main hormone affected by decreased synthesis in Kallmann syndrome? GnRH in the hypothalamus
Which cells are affected in Kallmann syndrome? GnRH-releasing neurons
The defective GnRH-hypothalamic neurons in Kallmann syndrome lead to affection of? GnRH-releasing olfactory bulbs to develop leading to decreased GnRH hypothalamic synthesis---> anosmia.
Anosmia is strongly associated with? Kallmann syndrome
Cystic swelling of chorionic villi and proliferation of chorionic epithelium (only trophoblast). Dx? Hydatidiform mole
What is a hydatidiform mole? Cystic swelling of chorionic villi and proliferation of chorionic epithelium.
Which part of the chorionic epithelium is proliferated in a Hydatidiform mole? Trophoblast
What is the classical clinical presentation (symptoms) of Hydatidiform mole? 1. Vaginal bleeding 2. Uterine enlargement more than expected 3. Pelvic pressure/pain
What condition is often associated with hCG-mediated sequelae? Hydatidiform mole
What is the hCG-mediated sequelae seen in Hydatidiform moles? - Early preeclampsia (before 20 weeks), - Theca-lutein cysts - Hyperemesis gravidarum - Hyperthyroidism
Theca-lutein cysts is a complication seen with __________________ mole. Hydatidiform mole
Early preeclampsia is defined as: Before 20 weeks
What is hyperemesis gravidarum? A pregnancy complication that is characterized by severe nausea, vomiting, weight loss, and possibly dehydration
What common endocrinological disorder is seen with a woman with a Hydatidiform mole? Hyperthyroidism
What is the most common treatment for Hydatidiform moles? 1. Dilation and curettage 2. Methotrexate
What anticancer drug is used in treating Hydatidiform moles? Methotrexate
What are the two types of Hydatidiform moles? Complete mole and Partial mole
What are the associated karyotype of Complete hydatidiform moles? 46, XX; 46, XY
What are the components of Complete hydatidiform moles? Most commonly enucleated egg + single sperm
Is there fetal parts in a complete hydatidiform mole? No fetal parts
Which type of hydatidiform mole presents with increasing uterine size? Complete mole
Which type of hydatidiform mole has severely increased levels of hCG? Complete mole
What are the imaging features of a Complete Hydatidiform mole? 1. "Honeycombed" uterus or "cluster of grapes" gross physical inspection, 2. "Snowstorm" on ultrasound
Which type of hydatidiform mole has higher risk of malignancy? Complete mole
What are the associated karyotypes of a Partial hydatidiform mole? 3; - 69, XXX, - 69, XXY, - 69, XYY
What are the components of a Partial Hydatidiform mole? 2 sperm + 1 egg
2 sperm and 1 egg often cause which type of hydatidiform mole? Partial mole
Which type of Hydatidiform mole is seen with fetal parts? Partial mole
Is a partial hydatidiform mole seen with fetal parts? Yes; (+) for fetal parts
Which hydatidiform is seen with a minimal or slight increase in hCG level? Partial mole
Which type of Hydatidiform mole is less associated with malignancy and choriocarcinoma development? Partial mole
Rare trophoblastic malignancy, that may occur during or after pregnancy in mother or baby. Dx? Choriocarcinoma
Which kinds of trophoblasts are included or proliferated in Choriocarcinoma? Cytotrophoblast and syncytiotrophoblast
What are some associated characteristics of Choriocarcinoma? - No chorionic villi present - Increased frequency of bilateral/multiple theca-lutein cysts
What are symptoms seen with Choriocarcinoma? 1. abnormal increase in B-hCG 2. SOB 3. Hemoptysis
What malignancy is associated with "cannonball" metastases to the lungs? Choriocarcinoma
Hematogenous spread of Choriocarcinoma to lungs, is often referred as: "cannonball" metastases
What is Abruptio placentae? Premature separation of placenta from uterine wall before delivery of infant.
What are some risk factor of Abruptio placentae? Trauma, smoking, hypertension, preeclampsia, and cocaine abuse.
Clinical presentation of Abruptio placentae? Abrupt, painful bleeding in third trimester.
Which pregnancy complication is seen as sudden and painful bleeding in the third trimester? Abruptio placentae
What are possible complications of Abruptio placentae? DIC, maternal shock, and fetal distress
Life threatening pregnancy complication for mother and fetus. Abruptio placentae
What is Morbidly adherent placenta? Defective decidual layer leading to abnormal attachment and separation after delivery.
What are risk factors leading to Morbidly adherent placenta? 1. Prior C-section or uterine surgery involving myometrium, 2. Inflammation 3. Placenta previa 4. Advanced maternal age 5. Multiparity
What are the 3 main types of Morbidly adherent placenta? 1. Placenta accreta 2. Placenta increta 3. Placenta percreta
What is the distinguishing factor among all 3 types of morbidly adherent placenta conditions? The depth of penetration
Placenta accreta: Placenta attaches to myometrium without penetrating it
What is the most common type of morbidly adherent placenta? Placenta accreta
Placenta is seen attached to myometrium, but does not penetrate it. Dx? Placenta accreta
What is placenta increta? Placenta penetrates into myometrium
Which morbidly adherent placenta condition is seen with placenta penetrating the myometrium, but does not perforate it? Placenta increta
What is the degree of depth seen in Placenta percreta? Placenta penetrates and perforates the myometrium and into the uterine serosa
Which type of morbidly adherent placenta condition is seen with attachment and/or penetration into the Uterine serosa? Placenta percreta
Which morbidly adherent placenta type is the one with the deepest penetration ? Placenta percreta
If placenta attaches to myometrium but does not penetrate it. Dx? Placenta accreta
Which morbidly adherent placenta is seen with invasion of the entire uterine wall? Placenta percreta
What is a serious complication of Placenta percreta? Placental attachment to rectum or bladder leading to hematuria
Which placenta-associated condition is possible seen with hematuria? Placenta percreta
What type of pregnancy complication is seen with failed separation of placenta after delivery? Morbidly adherent placenta
Possible cause of Sheehan syndrome Morbidly adherent placenta
Attachment of placenta to lower uterine segment over internal cervical os. Dx? Placenta previa
What is the definition of Placenta previa? Attachment of the placenta to the lower uterine segment over internal cervical os.
Which type of placenta condition is associated with blockage of the internal cervical os? Placenta previa
Associated with painless third trimester bleeding. Placenta previa
Painful 3rd trimester bleeding. Dx? Abruptio placentae
Painless 3rd trimester bleeding. Dx? Placenta previa
Fetal vessels run over, or in close proximity to, cervical os. Dx? Vasa previa
What are the possible consequences of Vasa previa? Vessel rupture and exsanguination, and fetal death
What is the common clinical presentation triad seen with Vasa previa? 1. Membrane rupture 2. Painless vaginal bleeding 3. Fetal tachycardia
Which two pregnancy conditions are often seen with painless vaginal bleeding? Vasa previa and Placenta previa
What is considered fetal bradycardia? < 110 bpm
What is the most common association to the development of Vasa previa? Velamentous umbilical cord insertion
What is Velamentous umbilical cord insertion? Cord insets in chorioamniotic membrane rather than placenta
Umbilical cord is inserted in chorioamniotic membrane and not in the placenta. Velamentous umbilical cord insertion
What is the result of velamentous umbilical cord insertion in Vasa previa? Fetal vessels travel to placenta unprotected by Wharton jelly
Unprotected fetal vessels traveling to placenta is often seen in: Vasa previa due to velamentous umbilical cod insertion
What are the 4 MCC of Postpartum hemorrhage? 1. Tone (uterine atony; MC) 2. Trauma 3. Thrombin (coagulopathy) 4. Tissue (retained products of conception)
What is the most common cause of postpartum hemorrhage? Uterine atony
Implantation of fertilized ovum in a site other than the uterus, most often in ampulla of Fallopian tube. Dx? Ectopic pregnancy
Where is the MC location for implantation in Ectopic pregnancy? Ampulla of Fallopian tube
What are concerning factors that may lead to suspect Ectopic pregnancy? - Hx of amenorrhea - Lower-than-expected rise in hCG based on dates - Sudden lower abdominal pain
What pregnancy complication is often mistaken for appendicitis? Ectopic pregnancy
List of Ectopic pregnancy risk factors: 1. Prior ectopic pregnancy 2. Hx of infertility 3. Salpingitis (PID) 4. Ruptured appendix 5. Prior tubal surgery 6. Smoking 7. Advanced maternal age
What are the two main amniotic fluid abnormality? Polyhydramnios and Oligohydramnios
Too much amniotic fluid. Polyhydramnios
What are the associated causes of Fetal polyhydramnios? 1. Fetal malformations 2. Maternal diabetes 3. Fetal anemia 4. Multiple gestations
What are the common fetal malformations that cause Fetal polyhydramnios? -Esophageal/duodenal atresia, and, - Anencephaly
How do fetal malformation lead to fetal Polyhydramnios? Result in inability to swallow amniotic fluid
A diabetic mother places fetus in increased risk of which amniotic fluid condition? Fetal polyhydramnios
Too little amniotic fluid Oligohydramnios
What are the associated causes of Fetal Oligohydramnios? Placental insufficiency, bilateral renal agenesis, posterior urethral valves (in males) and resultant inability to excrete urine.
Fetus cannot excrete urine. Dx? Fetal oligohidramnios
What is a consequence of profound or severe fetal oligohydramnios? Potter sequence
Potter sequence is a serious consequence of Polyhydramnios or Oligohydramnios? Oligohydramnios
What is the definition of Gestational hypertension? BP > 140/90 mm Hg after the 20th week of pregnancy
List of medications to treat gestational hypertension Hydralazine a-methyldopa Labetalol Nifedipine
Preeclampsia is: New-onset hypertension with either proteinuria or end-organ dysfunction after 20th week of gestation.
Hypertension + proteinuria in less than 20 weeks of gestation suggests: Molar pregnancy
What is the cause of Preeclampsia? Abnormal placental spiral arteries lead to endothelial dysfunction, vasoconstriction, and ischemia
What preexisting conditions increase risk of developing preeclampsia? Hypertension, diabetes, CKD, autoimmune disorders such as Antiphospholipid antibody syndrome.
Complications of Preeclampsia? - Placenta abruption - Coagulopathy - Renal failure - Pulmonary edema (PE) - Uteroplacental insufficiency - May lead to eclampsia and or HELLP syndrome
Preeclampsia + maternal seizures. Dx? Eclampsia
Eclampsia may lead to maternal death due to: Stroke, intracranial hemorrhage, or ARDS
What is the treatment for Eclampsia? 1. IV Magnesium sulfate 2. Antihypertensives 3. Immediate delivery
What is the most characteristic (USMLE relevant) treatment option for Preeclampsia and Eclampsia? IV magnesium sulfate
What are the components of HELLP syndrome? Hemolysis Elevated Liver enzymes Low Platelets
What is a manifestation of severe Preeclampsia? HELLP syndrome
What type of RBCs are seen in blood smear of HELLP syndrome? Schistocytes
What are severe consequences of HELLP syndrome? DIC and hepatic subcapsular hematomas leading to rupture and ultimately severe hypotension.
What is the treatment of HELLP syndrome? Immediate delivery
What is the only definitive treatment for Preeclampsia? Immediate delivery
What is the most common type of gynecologic tumor in the USA? Endometrial
Which is the most common type of gynecologic tumor worldwide? Cervical
Why is cervical cancer the most common gynecologic tumor worldwide? Lack of screening or HPV vaccination
Which gynecologic tumor type has the worst prognosis? Ovarian
Which type of gynecologic tumor has the best prognosis? Cervical
Vulvar pathologies are divided into which two categories? Non-neoplastic and Neoplastic vulvar pathologies
What are the Non-neoplastic vulvar pathologies? 1. Bartholin cyst and abscess 2. Lichen sclerosus 3. Lichen simplex chronicus
What is the cause of Bartholin cysts or abscesses? Blockage of Bartholin gland duct causing accumulation gland fluid
What type of infections are often associated with Bartholin cysts/abscess? N. gonorrhoea infection
What is Lichen sclerosus? Non-neoplastic vulvar pathology due to thinning of epidermis with fibrosis/sclerosis of dermis.
Porcelain-white plaques with a red or violet border in the vulva. Dx? Lichen sclerosus
Which population of women are most at risk of developing Lichen sclerosus? Postmenopausal women
Thinning of epidermis with fibrosis/sclerosis of dermis of the vulva. Dx? Lichen sclerosus
Hyperplasia of vulvar squamous epithelium. Dx? Lichen simplex chronicus
What is the presentation of Lichen simplex chronicus? Leathery, thick vulvar skin with enhanced skin markings due to chronic rubbing or scratching.
What are the two main neoplastic vulvar pathologies? 1. Vulvar carcinoma 2. Extramammary Paget disease
Carcinoma from squamous epithelial lining of vulva. Rare. Dx? Vulvar carcinoma
Vulvar carcinoma presents along with ____________. Leukoplakia
What is HPV-related vulvar carcinoma? Associated with types HPV 16 and 18; Seen in persons with multiple partners and early coitarche.
What is a common cause of Non-HPV vulvar carcinoma? Long-standing Lichen sclerosus
Intraepitelial vulvar adenocarcinoma. Dx? Extramammary Paget disease
What are some symptoms of Extramammary Paget disease of the vulva? Pruritus, erythema, crusting, and ulcers.
What are the most common vaginal tumors? 1. Vaginal squamous cell carcinoma 2. Clear cell adenocarcinoma 3. Sarcoma botryoides
What is the MCC of Vaginal squamous cell carcinoma ? Secondary to cervical SCC
Vaginal Clear Cell adenocarcinoma effects: Women who had exposure to DES in utero
What exposure in utero leads to vaginal clear cell adenocarcinoma? DES
What is Sarcoma botryoides? Embryonal rhabdomyosarcoma varrian that affects girls < 4 years old
How si the presentation of Sarcoma botryoides? Clear, grape-like, polypoid mass emerging from vagina
What vaginal tumor has spindle-shaped cells, (+) desmin and present in very young girls? Sarcoma botryoides
What is the role/function of the placenta? Primary site of nutrient and gas exchange between mother and fetus.
What are the fetal components of f the placenta? Cytotrophoblast and Syncytiotrophoblast
What is the maternal component of the placenta? Decidua basalis
What is the Cytotrophoblast? Inner layer of chorionic villi
Which fetal component of the placenta makes cells? Cytotrophoblast
Outer layer of chorionic villi Syncytiotrophoblast
What is the role of Syncytiotrophoblast? Synthesizes and secretes hormone
What is the main hormone produced by Syncytiotrophoblast? hCG
What is hCG? Hormone produced by Syncytiotrophoblast; structurally similar to LH
Secondary role of Syncytiotrophoblast? Stimulates corpus luteum to secrete progesterone during first trimester.
Why is the syncytiotrophoblast not attacked by the maternal immune system? Lacks MHC-I expression
A placental component derived from the Endometrium? Decidua basalis
Maternal blood in lacunae Decidua basalis
What are the components of the Umbilical cord? Umbilical arteries (2) and Umbilical vein (1)
What is the role of the Umbilical arteries? Return deoxygenated blood from fetal internal iliac arteries to placenta
Role of Umbilical vein? Supplies oxygenated blood from placenta to fetus
What structure drains into IVC via liver or via ductus venosus? Umbilical vein
Which structure in umbilical cord has deoxygenated oxygen in the blood? Umbilical arteries
What is an associated pathology of the umbilical cord? Single umbilical artery
The umbilical arteries and umbilical vein are derived from the _________________. Allantois
What structures are derived from the Allantois? Umbilical arteries and vein
What structure is produced at the 3rd week of gestation from the yolk sac? Allantois
The allantois, extends into ___________________. Urogenital sinus
What is the Urachus? Duct between fetal bladder and umbilicus
Duct between the fetal bladder and umbilicus Urachus
The allantois becomes the _________________. Urachus
Failure of urachus to involute can lead to: Anomalies that may increase risk of infection and/or malignancy if not treated
What is the Obliterated urachus? Median umbilical ligament
What does the urachus become after birth? Median umbilical ligament
What is the Patent urachus? Total failure of urachus to obliterate --> urine discharge from umbilicus
What is key feature/symptom of Patent Urachus? Urine discharge from umbilicus
Partial failure of urachus to obliterate. Dx? Urachal cyst
What is the Urachal cyst? Fluid-filled cavity lined with uroepithelium, between umbilicus and bladder
Painful mass below the umbilicus, which often is infected. Dx? Urachal cyst
Slight failure of urachus to obliterate. Dx? Vesicourachal diverticulum
What is the pathology of the outpouching of bladder? Vesicourachal diverticulum
Associated pathologies of the Vitelline duct? Vitelline fistula and Meckel diverticulum
At what week is the Vitelline duct obliterated? 7th week
Another name of Vitelline duct? Omphalomesenteric duct
What is structures are connected by the Vitelline duct? Yolk sac to midgut lumen
Vitelline duct fails to close. Dx? Vitelline fistula
What is the key symptom of Vitelline fistula? Meconium discharge from umbilicus
Poop coming out from the bellybutton Vitelline fistula
What is the cause of Meckel diverticulum? Partial closure of vitelline duct
What condition is presented with a patent portion of vitelline duct attached to ileum (true diverticulum)? Meckel diverticulum
What is found inside the Meckel diverticulum? Heterotopic gastric and/or pancreatic tissue leading to melena, hematochezia, and abdominal pain.
Aortic arches derivatives develop into ---> Arterial system
What are the precursors of the arterial system? Aortic arches
The 1st Aortic arch gives rise to the --> Maxillary artery
What branch of the external carotid is a derivative of the 1st aortic arch? Maxillary artery
The maxillary artery is a derivative of which aortic arch? 1st Aortic arch
What are the derivatives of the 2nd aortic arch? Stapedial artery and hyoid artery
Stapedial and Hyoid arteries are derivatives of which aortic arch? 2nd Aortic arch
Second Aortic arch gives rise to: Stapedial artery and hyoid artery
What arteries are derivatives of the 3rd Aortic arch? Common Carotid artery and the proximal part of internal Carotid artery
Common Carotid artery is a derivative of the _________ aortic arch. 3rd Aortic arch
Which aortic arch gives rise to the proximal part of the Internal Carotid artery? 3rd Aortic arch
Which part of the Internal Carotid artery is a derivative of the 3rd aortic arch? Proximal part
What is the derivative, on the left, of the 4th aortic arch? Aortic arch
Which aortic arch gives rise to the aortic arch? 4th Aortic arch
What is the resultative derivative on the right of the 4th Aortic arch? Proximal part of the Right Subclavian artery
Derivatives of the 4th aortic arch: LEFT --> Aortic arch RIGHT ---> Proximal part of Right Subclavian artery
What are the derivatives of the 6th Aortic arch? Proximal part of Pulmonary arteries and (left only) the Ductus arteriosus
Ductus arteriosus is a derivative of the _______ aortic arch. 6th Aortic arch
Which is the bilateral derivative of the 6th aortic arch? Proximal part of the Pulmonary arteries
On which side is the derivative of the 6th aortic arch derivative, Ductus arteriosus? Left only
The Right recurrent Laryngeal nerve loops around the --- Right Subclavian artery
Which structure is "looped" by the Left Recurrent Laryngeal nerve? Aortic arch distal to ductus arteriosus
How is the Branchial apparatus composed? Composed of branchial clefts, arches, and pouches
What is another name for the Branchial clefts? Branchial grooves
A branchial groove is the same as a ____________________. Branchial cleft
Branchial clefts are derived from _________________. Ectoderm
Which part of the Branchial apparatus is derived from Ectoderm? Branchial clefts
Which part of the Branchial apparatus is derived from the Mesoderm and Neural crest? Branchial arches
Branchial arches are derived from : Mesoderm and Neural crest
Mesoderm derived branchial arches give rise to: Muscles and arteries
Neural crest derived branchial arches give rise toJ: Bone and cartilage
Branchial pouches are derived from the _________________. Endoderm
Which part of the Branchial apparatus is derived from the Endoderm? Branchial pouches
Arrangement of the Branchial apparatus from outside to inside CAP: Clefts --> Arches --> Pouches
The innermost part of the Branchial apparatus are the: Branchial pouches
What does the 1st Branchial cleft derivatives into? External auditory meatus
What is the Branchial cleft which derives into the external auditory meatus? 1st Branchial cleft
Which branchial clefts develop into the temporary cervical sinuses? 2nd through 4th Branchial clefts
What obliterates the temporary cervical sinuses? Proliferation of 2nd arch mesenchyme
What is obliterated by the proliferation of the 2nd arch mesenchyme? Temporary cervical sinuses
Failure to obliterate the temporary cervical sinuses lead into _____________. Branchial cleft cyst
Location of Branchial cleft cyst Lateral neck, anterior to sternocleidomastoid muscle
What is the MCC of Branchial cleft cyst? Persistent cervical sinus
Is a branchial cleft cyst, lateral or midline, of the neck? Lateral neck
What are the cartilage derivatives of the 1st Branchial arch? 1. Maxillary process --> Maxilla, Zygomatic bone 2. Mandibular process --> Meckel cartilage --> Mandible, Malleus and Incus, Sphenomandibular ligament
Maxillary and Mandibular processes are cartilage/bone derivations of which branchial arch? 1st Branchial arch
Muscles derived from the 1st Branchial arch: 1. Muscles of Mastication 2. Mylohyoid muscle 3. Anterior belly of digastric 4. Tensor tympani 5. Anterior 2/3 of tongue 6. Tensor veli palatini
What are the muscles of mastication? Temporalis, Masseter, Lateral and Medial Pterygoids
Muscles of mastication are derivatives of the ---> 1st Branchial arch
Which ear muscle is a derivative of 1st branchial arch? Tensor tympani
What branchial arch gives rise to the anterior 2/3 of the tongue? 1st Branchial arch
Which nerve is derived of the 1st branchial arch? CN V3
Meckel cartilage is a derivative of the ____ branchial arch? 1st Branchial arch
What are abnormalities associated with the 1st and 2nd Branchial arches? 1. Pierre Robin sequence 2. Treacher Collins syndrome
Pierre Robin sequence is an abnormality or pathology of the ___________________ arches. 1st and 2nd Branchial arches
What is Pierre Robin sequence features? Micrognathia, glossoptosis, cleft palate, and airway obstruction
What is the cause of Treacher Collins syndrome? Neural crest dysfunction
What are the main physical features of Treacher Collins syndrome? Mandibular hypoplasia and facial abnormalities
Cartilage derived from the 2nd Branchial arch Reichert cartilage
What is included as part of the Reichert cartilage? Stapes, Styloid process, lesser horn of hyoid, and Stylohyoid ligament
Which bones are arised from the 2nd Branchial arch? Staples, Styloid process, and lesser horn of Hyoid
Stapes is a derivative of the ___________________ arch. 2nd Branchial arch
Muscle of facial expression are derived from which Branchial arch? 2nd Branchial arch
List of muscles of 2nd Branchial arch: 1. Muscles of facial expression 2. Stapedius 3. Stylohyoid 4. Platysma 5. Posterior belly of digastric
Posterior belly of digastric is derived from the ________________. 2nd Branchial arch
Which nerve is a derivative of the 2nd Branchial arch? CN VII
Which is the cartilage derivative of the 3rd Branchial arch? Greater horn of Hyoid
Muscle derived from the 3rd Branchial arch Stylopharyngeus
CN IX is a derivative of the ________ Branchial _________. 3rd Branchial arch
Associated cartilage/bone derivatives of 4th-6th Branchial arches Arytenoids Cricoid Corniculate Cuneiform Thyroid
4th Branchial arch muscles: - Most Pharyngeal constrictors - Cricothyroid - Levator veli palatini
The Cricothyroid is a derivative of which Branchial arch? 4th Branchial arch
Which is the only intrinsic muscle of the larynx derived from the 4th Branchial arch? Cricothyroid muscle
What muscles are derivatives of the 6th Branchial arch? All intrinsic muscles of larynx except the Cricothyroid
Which CN innervate and is derived from both the 4th and 6th Branchial arches? CN X
What part of CN X is derived from the 4th Branchial arch? Superior Laryngeal branch
The Superior Laryngeal branch of CN X is derivation of which branchial arch? 4th Branchial arch
The Recurrent and Inferior Laryngeal branches of CNX are derived from the: 6th Branchial arch
Which parts of CN X are derived from the 6th Branchial arch? Recurrent and Inferior Laryngeal branches
Which branchial arch(es) form the posterior 1/3 of the tongue? 3 and 4 Branchial arches
Main derivatives of the 1st Branchial pouch Middle ear cavity, Eustachian tube, and Mastoid air cells
What is an important contribution of the 1st branchial pouch? Endoderm-lined structures of ear
What are the derivatives of the 2nd Branchial pouch? Epithelial lining of palatine tonsil
What is the anatomical relation between 3rd-pouch and 4th-pouch structures? 3rd-pouch structures end up BELOW 4th pouch structures
2 main derivatives of the 3rd branchial pouch: 1. Dorsal wings --> Inferior Parathyroids 2. Ventral wings --> Thymus
Which branchial pouch gives rise to the inferior parathyroids? 3rd Branchial pouch
The thymus a derivative of the ______ branchial _____________. 3rd Branchial pouch
What is the structure formed by the Ventral wings of the 3rd branchial pouch? Thymus
Structure formed by the Dorsal wings of the 3rd branchial pouch Inferior Parathyroids
Superior Parathyroids are a derivative of which branchial pouch? 4th Branchial pouch
What are the structures formed by the Ventral wings of the 4th branchial pouch? Ultimobranchial body --> Parafollicular (C) cells of thyroid
The parafollicular (C) cells of the thyroid are a derivative of the _____ Branchial ___________. 4th Branchial pouch
MCC of DiGeorge syndrome Chromosome 22q11 deletion
What pathology is due to aberrant development of 3rd and 4th pouches? DiGeorge syndrome
What are the results of poor development of 3rd/4th branchial pouches, seen in DiGeorge syndrome? - T-cell deficiency (Thymic aplasia) - Hypocalcemia (failure of parathyroid development)
What are the type of cardiac defects associated with DiGeorge syndrome? Conotruncal abnormalities
DiGeorge syndrome is seen with ________________ (Ca2+ serum level). Hypocalcemia
Hypo- or Hypercalcemia is seen in DiGeorge syndrome? Hypocalcemia
What is the cause of Cleft lip? Failure of fusion of the maxillary and merged medial nasal processes
The failure of the maxillary and medial nasal processes. Dx? Cleft lip
Failure of fusion of the two lateral palatine shelves or failure of fusion of lateral palatine shelves with the nasal septum and/or median palatine shelf Cleft palate
Defect in formation of secondary palate. Dx? Cleft palate
Defect in formation of primary palate. Dx? Cleft lip
What are the two causes of Cleft palate? 1. Failure of fusion of the two lateral palatine shelves 2. Failure of fusion of lateral palatine shelves with the nasal septum and/or median palatine shelf
What is the default genital development? Female
Mechanism of action of female genital development Mesonephric duct degenerates and Paramesonephric duct develops.
Which gender is associated with SRY gene on Y chromosome? Male
Which duct degenerates in female genital embryological development? Mesonephric duct
Development of the Paramesonephric duct is seen in males or females genital development? Female
What is produced by the SRY gene on the Y chromosome? Testis-determining factor
What is secreted by Sertoli cells? Mullerian inhibitory factor
What cells secrete Mullerian inhibitory factor? Sertoli cells
What is MIF? Mullerian inhibitory factor
What is the function of Mullerian inhibitory factor (MIF)? Suppression of development of Paramesonephric ducts
What protein/hormone suppresses the development of Paramesonephric ducts in male genital development? Mullerian inhibitory factor
What is secreted by Leydig cells? Androgens
What is the role of androgens in male genitalia embryological development? Stimulate development of mesonephric ducts
Substance that stimulates the development of Mesonephric ducts in males? Androgens
Another name for the Paramesonephric duct? Mullerian duct
Mullerian duct = Paramesonephric duct
Develops into female internal structures- Fallopian tubes, uterus, upper portion of vagina. Paramesonephric (Mullerian) duct
What is the male remnant of the Mullerian duct called? Appendix testis
What is the appendix testis? Remnant of male Paramesonephric (Mullerian) duct
Another name for Mullerian agenesis? Mayer-Rokitansky-Kuster-Hauser syndrome
How is Mullerian agenesis clinically presented? Primary amenorrhea in females with fully developed secondary sexual characteristics
Why is Mullerian agenesis presented with primary amenorrhea? Due to a lack of uterine development
How are ovaries of a Mullerian agenesis patient? Functional ovaries
Common name for the Mesonephric duct? Wolffian duct
Develops into male internal structures, except the prostate. Mesonephric (Wolffian) duct
What structures are developed by the Wolffian duct? Seminal vesicles, Epididymis, Ejaculatory duct, Ductus deferens
What is the name of the female remnant of the Wolffian duct? Gartner duct
SEED Mnemonic used to recall the structures developed by the Wolffian duct. Seminal vesicles Epididymis Ejaculatory duct Ductus deferens
What is the result of either No Sertoli cells or lack of MIF? Development of both female and male internal genitalia and male external genitalia.
What defect can be suspected in patient with both male and female internal genitalia, but only male external genitalia? - Lack of Sertoli cells or, - Lack of MIF
What condition is presented by the inability to convert testosterone into DHT? 5a-reductase deficiency
What are the sexual features presented in patient with 5a-reductase deficiency? 1. Male internal genitalia 2. Ambiguous external genitalia until puberty
What happens during puberty to 5a-reductase deficiency patients? Increase levels of testosterone lead to masculinization, of previous ambiguous external genitalia
Ambiguous external genitalia + Male internal genitalia; masculinization at 13 yo. Dx? 5a-reductase deficiency
What is the role of Leydig cells in the testes, overly simplified? Leads to male (internal and external) sexual differentiation
What is the overly simplified function of Sertoli cells in the testes? Shut down female (internal) sexual diffentiation
What are the most common Uterine (Mullerian) anomalies? 1. Septate uterus 2. Bicornuate uterus 3. Uterus didelphys
Incomplete resorption of septum of the uterus. Dx? Septate uterus
What are symptoms of Septate uterus? Decreased fertility and early miscarriage
Treatment for septate uterus Septoplasty
What is the pathogenesis of Bicornuate uterus? Incomplete fusion of Mullerian ducts
Complete failure of fusion of the uterus. Dx? Uterus didelphys
What condition is presented with double uterus, cervix, and vagina? Uterus didelphys
Is pregnancy posible in Uterus didelphys? Yes
What androgen aids male development? Dihydrotestosterone
What are the male structures derived from the Genital tubercle? 1. Glans penis and, 2. Corpus cavernosum and spongiosum
Female derivatives of the genital tubercle? 1. Glans clitoris 2. Vestibular bulbs
List of the undifferentiated genital structures: 1. Genital tubercle 2. Urogenital sinus 3. Urogenital folds 4. Labioscrotal swelling
What is the male homolog of the Glans clitoris in females? Glans penis
Female Vestibular bulbs = male __________________________. Corpus cavernosum and spongiosum
What is the undifferentiated genitalia structure of the male Bulbourethral glands (of Cowper)? Urogenital sinus
What are the male differentiated structures of the Urogenital sinus? 1. Bulbourethral glands (of Cowper) 2. Prostate gland
Urogenital sinus + DHT ===> Bulbourethral glands (of Cowper), and Prostate gland
Urogenital sinus + Estrogen ====> Greater vestibular glands (of Bartholin) and Urethral and paraurethral glands (of Skene)
Glands of Bartholin and glands of Skene are _______________ derivatives from the _________________. Female; Urogenital sinus
Which are the associated male genital glands coming from the Urogenital sinus? Glands of Cowper
What is to become in men from the Urogenital folds as they are stimulated by DHT? Ventral shaft of penis (penile urethra)
Ventral shaft of penis is a way to describe the __________________. Penile urethra
What is the female homolog to the male penile urethra? Labia minora
Labia minora is differentiated from the ---> Urogenital folds
What is the pre-undifferentiated genital part of the Labia majora? Labioscrotal swelling
Labioscrotal swelling becomes the _________________- in males. Scrotum
What sex hormone is used to differentiate female genitalia? Estrogen
What is Hypospadias? Abnormal opening of the penile urethra on vental surface of penis due to failure of urethral fols to fuse
What is a rare male condition due to urethral folds fail to fuse during embryologic genital development? Hypospadias
Which is most common, Epispadias or Hypospadias? Hypospadias
What are common assocaiations of Hypospadias? 1. Inguinal hernia 2. Cryptorchidism
Abnormal opeining of penile urethra on dorsal sufrace due to faulry positioning of genital tubercle. Dx? Epispadias
Which penile abnormalite is due to a faulty positionning of hte genital tubercle? Epispadias
What is a featured associateion of Epispadias? Exstrophy of the bladder
What ar tehe tow most common congenital penile abnormaliteies? Hyposapdias and Epispadias
Which surface of the penile urethra is affected in Hypospadias? Ventral surface
Which surface of the penile urethra, ventral or dorsal, is affected in Epispadias? Dorsal surface
What is the description of the Gubernaculum? Band of fibrous tissue
What is the male remnant of the Gubernaculum? Anchors testes with scrotum
What is the female remnant of the Gubernaculum? Ovarian ligament + round ligament of the uterus
The Ovarian ligament and the Round Ligament of the Uterus are: Female remnant of the Gubernaculum
Description of the Processus vaginalis Evagination of peritoneum
What is the male remnant of the Processus vaginalis? Tunica vaginalis
What happens to the Processus vaginalis in women? It is obliterated
What is the path of LEFT Gonadal venous drainage? Left ovary/testis --> Left gonadal vein --> Left renal vein --> IVC
Which vein is not "skipped" by the Right gonadal venous drainage, in comparison to the left side? No Right renal vein
If the venous drainage does not include the renal vein, it represents which side? Right side
If the venous drainage of the gonads includes the renal vein, it must indicate which side? Left side
Which side has a longer gonadal venous drainage? Left side
Which side is most common to develop a varicocele? Left side
Why are varicoceles more common to occur in the Left side of the venous drainage? Left venous pressure is greater than the right
Which vein enters the left renal vein at a 90 degree angle? Left spermatic vein
Which renal vein, right or left, has a less laminar flow? Left side
What is the lymphatic drainage of the ovaries/testis? Para-aortic lymph nodes
What structures are known to drain lymph fluid into the Para-aortic lymph nodes? Ovaries and testes
Where does lymph of the body of uterus and superior bladder drain into? External iliac lymph nodes
What structures drain into the superficial inguinal nodes? Distal vagina, vulva, scrotum, and distal anus
Which lymph nodes receive lymph drainage from the Prostate/cervix, corpus cavernosum, and proximal vagina? Internal iliac nodes
Lymph of the glans penis drains into the _____________________ nodes. Deep inguinal nodes
What is connected by the infundibulopelvic ligament? Ovaries to lateral pelvic wall
What are the structures contained in the Infundibulopelvic ligament? Ovarian vessels
What is another name for the Infundibulopelvic ligament? Suspensory ligament of the ovary
Why are Ovarian vessels ligated during an Oophorectomy? Avoid bleeding
In respect to the peritoneum and gonadal vessels where does the ureter course? Retroperitoneally, close to gonadal vessels
What structures are at risk by ligation of ovarian vessels? Ureters
What ligament contains the ovarian vessels? Infundibulopelvic ligamet
What structures are contained by the Suspensory ligament of the ovary? Ovarian vessels
Infundibulopelvic ligament = Suspensory ligament of the ovary
Ovaries to lateral pelvic wall are connected by which ligament? Infundibulopelvic ligament
What structures are connected by the Cardinal ligament? Cervix to side wall of pelvis
What vessels are contained by the Cardinal ligament? Uterine vessels
Infundibulopelvic ligament contains __________ vessels. Cardinal ligament contains the _______________ vessels. ----- Ovarian vessels Uterine vessels
Which surgical procedure places the ureters in risk of injury by ligation of the uterine vessels? Hysterectomy
Which vessels are ligated during a hysterectomy? Uterine vessels
Which structures are at higher risk of injury during a Hysterectomy? Ureters
What does the Round ligament of the uterus connect? Uterine horn to labia majora
Uterine horn-----------------------------labia majora. Name of the connecting structure? Round ligament of the uterus
Which ligament is a derivative of gubernaculum that has no association connecting ovaries? (Female) Round ligament of the uterus
What canal is used by the Round ligament of the Uterus? Round inguinal canal
Anatomical position of the Round Ligament of the Uterus with respect to the artery of Sampson? Travels above the artery of Sampson
What structure is known tor travel above the artery of Sampson? Round ligament of the uterus
What are the contained structures of the Broad ligament? Ovaries, fallopian tubes, round ligaments of uterus
Which ligament contains the round ligament of the uterus? Broad ligament
What is connected by the Broad ligament? Uterus, fallopian tubes, and ovaries to pelvic side wall
[Uterus, Fallopian tubes, Ovaries]----------(Pelvic side wall). Represents? Dotted line is the Broad ligament connects those structures together
Which ligament is known to contain the Round ligament of the uterus? Broad ligament
Which ligament connects the Medial pole of ovary to uterine horn? Ovarian ligament
What is the Broad ligament? Fold of peritoneum that comprises the mesosalpinx, mesometrium, and mesovarium
A fold of the peritoneum that comprises the meso-salpinx, -metrium, and -ovarium. Broad ligament
Ligament derivative of gubernaculum that connects the inside surface of the ovatire to the uterine horn Ovarian ligament
Ovarian Ligament Latches to Lateral uterus
Ovaries are contained by which ligament? Broad ligament
Which structures associated with pregnancy are contained by the Broad ligament? Ovaries and Fallopian tubes
It is safe to associate a Fallopian tube with which ligament? Broad ligament
What is the pathway of sperm during ejaculation? 1. Seminiferous tubules 2. Epididymis 3. Vas deferens 4. Ejaculatory duct 5. Urethra 6. Penis
What is mnemonic used to arrange properly the pathway that sperm travel during ejeaculation? SEVEN UP
SEVEN UP: Seminiferous tubules Epididymis Vas deferens Ejacularoty ducts N(nothing) Urethra Penis
Urethral injuries are almost exclusive of which gender? Male
What is a classic sign that should raise suspicion of an urethral injury? Blood is seen in urethral meatus
Which are the two main types of urethral injury? Anterior and Posterior urethral injuries
What part of the urethra is injured in anterior urethral injury? Bulbar (spongy) urethra
Injury to the Bulbal or Spongy urethra. Dx? Anterior urethral injury
Which part of the urethra is injury in a posterior injury? Membranous urethra
What is the mechanism of injury of an anterior urethral injury? Perineal straddle injury
A pelvic fracture is the most common mechanism to cause which type of Urethral injury? Posterior urethral injury
Where does urine leak in a posterior urethral injury? Retropubic space
Leakage of urine into retropubic space. Dx? Posterior urethral injury
Where (anatomical structure) is blood accumulated in an anterior urethral injury? Scrotum
Which structure must torn in order for urine to leak into perineal space in a anterior urethral injury? Buck fascia
What happens in an Anterior urethral injury if the Buck fascia is torn? Urine escapes into perineal space
What are the common clinical symptoms of an Anterior urethral injury? Blood at urethral meatus and Scrotal hematoma
Patient presents with a Scrotal hematoma. Most likely dx? Anterior urethral injury
Blood at urethral meatus + high-riding prostate Most common presentation of Posterior urethral injury
Vignette describes a person in VA and presenting a high-riding prostate.. Dx? Posterior urethral injury due to pelvic fracture
Which part of the nervous system is in charge erection? Parasympathetic nervous system
Which nerves are associated with penile erection? Pelvic splanchnic nerves, S2-S4
What action may be affected by damage to nerve roots S2-S4? Erection
Is NO (nitric monoxide) anti-or proerectile? Proerectile
What is the MOA of NO as proerectile? NO --> Increases cGMP --> smooth muscle relaxation --> vasodilation ---> Pro-erection.
Which catecholamine is known to be antiereictile? Norepinephrine
What is the direct effect of NE by which it causes smooth muscle contraction ? Increases Ca2+ serum levels
Emission of male sexual response is performed by which part of the nervous system? Sympathetic nervous system
What nerve is associated to cause emission in male sexual response? Hypogastric nerve, T11-L2
What part of male seuxal respones may be affected by damage or injury to nerve roots T12-L2? Emission
Which nerve causes ejaculation of sperm? Pudendal nerve
Injury to the Pudendal nerve may cause what effect on male sexual response? Lack of ejaculation
No ejaculation is due to _____________ nerve damage. Pudendal nerve
Visceral and Somatic nerves are involved in which part of the male sexual response? Ejaculation
How doe PDE-5 inhibitors help erectile dysfunction? Decrease the cGMP breakdown
Higher levels of cGMP would mean what to a male erection? Better erection due to increased vasodilation
Most common PDE-5 inhibitor Sildenafil
Function of Spermatogonia Maintain germ cell pool and produce primary spermatocytes
What are the locations in which Spermatogonia is found? - Line seminiferous tubules - Germ cells
List of functions of Sertoli cells 1. Secrete inhibin B 2. Secrete Androgen-binding protein 3. Produce MIF 4. Tight junctios between adjacent Sertoli cells form the blood-testis barrier. 5. Support and nourish developing spermatozoa 6. Regulate spermatogenesis
How are Sertoli cells temperature sensitive? Decrease sperm production and decreased inhibin B with increasing temperature
What is the function of inhibin B secreted by Sertoli cells? Inhibit FSH
What Sertoli cell secretion inhibits FSH? Inhibin B
What is the purpose of the Androgen-binding protein secreted by Sertoli cells? Maintain local levels of testosterone
What protein is known to maintain local levels of testosterone? Androgen-binding protein
Which cells secrete Inhibin B and Androgen-binding protein? Sertoli cells
What is the purpose or function of the blood-testis barrier created by advent Sertoli cells' tight junctions? Isolate gametes from autoimmune attack
What structure protects gametes from autoimmune attack and it is associated with Sertoli cells? Blood-testis barrier
Which cells regulate spermatogenesis? Sertoli cells
Which cells line the seminiferous tubules? Sertoli cells
Non-germ cells of the male anatomy Sertoli cells
Homolog of female granulosa cells Sertoli cells
Which are the male "granulosa cells"? Sertoli cells
Which cells secrete testosterone? Leydig cells
What cells are found in the Seminiferous tubules? Spermatogonia, Sertoli cells, and Leydig cells
What hormone is required by Leydig cells to produce testosterone? LH
Is testosterone production affected by temperature? No, it is not affected
Homolog of female theca interna cells Leydig cells
Where in the seminiferous tubules are Leydig cells found? Interstitium
Leydig cells are considered _________________ cells. Endocrine cells
Leydig cells secrete/produce ______________________ in the presence of LH. Testosterone
List of important genes of Reproductive embryogenesis: 1. Sonic hedgehog gene 2. Wnt-7 gene 3. Fibroblast growth factor (FGF) gene 4. Homeobox (Hox) genes
Where is the Sonic hedgehog gene produced? At base of limbs in zone of polarizing activity
What is the involvement or role of the Sonic hedgehog gene? Patterning along anteroposterior axis and CNS development
What condition is associated by a mutation to the Sonic hedgehog gene? Holoprosencephaly
What gene is probably mutated in patient with Holoprosencephaly? Sonic hedgehog gene
Gene of reproductive embryogenesis found limbs with polarizing activity Sonic hedgehog gene
Where is Wnt-7 gene produced? Apical ectodermal ridge
What gene is produced or found in the thickened ectoderm at distal end of each developing limb? Wnt-7 gene
What is the role or involvement of the Wnt-7 gene? Proper organization along dorsal-ventral axis
What gene dictates proper organization along the dorsal-ventral axis? Wnt-7 gene
Where is the Fibroblast growth factor (FGF) gene produced? Apical ectodermal ridge
Which important embryological genes are produced at the apical ectodermal ridge? Wnt-7 gene and FGF gene
Stimulates mitosis of underlying mesoderm, providing for lengthening of limbs. Gene? Fibroblast Growth factor (FGF) gene
What is the function of the FGF gene? Stimulate mitosis of underlying mesoderm, causing the lengthening of limbs.
Common used abbreviation of Homeobox gene? Hox gene
What is the function or involvement of the Hox gene? Segmental organization of embryo in a craniocaudal direction.
Code for transcription factors? Homeobox genes
Hox mutations lead to: Appendages in wrong locations
Neonates is seen with three arms at abnormal locations. Which is the probable gene mutated? Homeobox genes
Hox mutation = Wrong limb placement
On what day does fertilization occurs? Day 0
How many chromosomes (N) and Chromatids (C) are in a zygote on Day 1? 2N (chromosomes) 4C (chromatids)
What is formed on Day 4 after Fertilization of the egg? Morula
A day after the morula is formed, the ____________________ appears. Blastocyst
Approximate day on which the Blastocyst is fully formed? Day 5
During which days after fertilization, does the implantation of the blastocyst into endometrium occurs? Day 6-10
What occurs on Day 6-10 after fertilization of egg? Implantation
Into which tissue does the implantation occurs initially? Endometrium
What is the inner lining of the uterus? Endometrium
When does hCG secretion begins? (approximately) Around the time of implantation of blastocyst
What occurs, in relation of hormone secretion, at time of implantation of the blastocyst? Secretion of hCG
Approximate time when the Bilaminar disc appears? Within week 2
What ar the 2 layers found/produced in the bilaminar disc? Epiblast and hypoblast
Around what week of embryogenesis is the trilaminar embryonic disc formed? Within week 3
How is the primitive streak formed? Cells from epiblast invaginate
What type of tissue (embryological) are found in the primitive streak? Endoderm, mesoderm, and ectoderm
What arises, around week 3 of embryogenesis, from the midline of the mesoderm? Notochord
What happens to the overlying ectoderm of the primitive streak? Becomes the neural plate
What forms the neural plate? The overlying ectoderm of the primitive streak
Which weeks of embryogenesis make up the Embryonic period? Weeks 3-8
What actions/events take place during the Embryonic period? 1. Neural tube formed by neuroectoderm and closes by week 4 2. Organogenesis
Which time/period is extremely susceptible to teratogens? Weeks 3-8
Neural tube is form by _____________________. Neuroectoderm
At what week is the neural tube closed? Week 4
Events of Week 4 of embryogenesis: 1. Heart begins to beat 2. Upper and lower limb buds begin to form
A newly beating heart in an embryo indicates how many weeks of pregnancy? At least 4 weeks
Fetal cardiac activity visible by transvaginal ultrasound by week ____. Week 6
Approximate week of gestation at which fetal movements start? Week 8
What occurs at week 10 of embryogenesis? Genitalia have male/female characteristics
What are the main divisions of Ectoderm? 1. Surface ectoderm 2. Neural tube 3. Neural crest
The ectoderm is the _______________ _______________ layer. External/ outer
Associated condition/tumor of the Surface ectoderm? Craniopharyngioma
List of Surface ectoderm derivatives: 1. Epidermis 2. Adenohypophysis (from Rathke's pouch) 3. Lens of eye 4. Epithelial linings of oral cavity, sensory organs of ear, and olfactory epithelium 5. Anal canal below the pectinate line 6. Parotid, sweat, mammary glands
Which part of the Pituitary gland is a surface ectoderm derivative? Adenohypophysis
What part of the eye is of Surface ectoderm origin? Lens of eye
What embryologic derivative makes up the lens of eye? Surface ectoderm
Anterior pituitary gland is made from the ___________ __________. Surface ectoderm
Surface ectoderm forms the epithelial lining of which structures: Oral cavity, sensory organs of ear, and olfactory epithelium
Anal canal below the pectinate line is from which embryological tissue derivate? Surface ectoderm
What are common glands originated from surface ectoderm? Parotid, sweat, and mammary glands
Bening Rathke pouch tumor with cholesterol crystals, calcifications. Dx? Craniopharyngioma
Why is a Craniopharyngioma associated as a Surface ectoderm malignancy? It is a tumor of the Rathke pouch, which forms the adenohypophysis.
Above or below the pectinate line of the anal canal, is it made from Surface ectoderm? Below
What are 3 main structures made from Neural tube? 1. Brain, 2. Retina, and 3. Spinal cord
The neural tube gives rise to the brain, which is composed of: Neurohypophysis, CNS neurons, Oligodendrocytes, Astrocytes, Ependymal cells, Pineal gland
Which gland is of Neural tube origin, and is part of the brain composition? Pineal gland
What is the embryologic derivative to the Neurohypophysis? Neural tube
Which Brain cells are of Neural tube origin? CNS neurons, oligodendrocytes, astrocytes, and Ependymal cells
Which part of the eye is made of Neural tube? Retina
Embryological derivatives of the Eye: Retina -----> Lens of Eye ----> ------> Neural tube -------> Surface ectoderm
What can be a overly simplified way to remember structures made form the Neural crest? PNS and non-neural structures nearby
List of Neural crest derivatives: 1. Melanocytes 2. Myenteric (Auerbach) plexus 3. Odontoblasts 4. Endocardial cushions 5. Laryngeal cartilage 6. Parafollicular (C) cells of the thyroid 7. PNS 8. Adrenal medulla and all ganglia 9. Spiral membrane (aorticopulmonary septum) 10. Schwann cells, 11. Pia and arachnoid 12. Bones of skull
Embryologic derivative of Melanocytes? Neural crest
What GI plexuses are of Neural crest origin? Myenteric (Auerbach) plexuses
Auerbach plexus is an embryologic derivative of _______________. Neural crest
Which skin related cells are a neural crest derivative? Melanocytes
Odontoblasts and Melanocytes are derivatives of: Neural crest
What is the embryological tissue of Endocardial cushions? Neural crest
Cardiac structures of Neural crest origin: 1. Endocardial cushions 2. Aorticopulmonary septum
Which organ's cartilage is of Neural crest origin? Laryngeal cartilage
Which thyroid cells are derivatives of Neural crest? Parafollicular (C) cells
The PNS is made from ____________ ___________. Neural crest
What is conveyed in the PNS that has Neural crest origin? Dorsal root ganglia, Cranial nerves, and autonomic ganglia
What is the origin embryological tissue of the Cranial nerve? Neural crest
Autonomic ganglia is a derivative of: Neural crest
Schwann cells are a drevivate fo ________ ___________. Neural crest
What is the embryological tissue of the bones of skull? Neural crest
Pia and arachnoid are derivatives of the ______________________. Neural crest
List of Mesodermal derivatives: 1. Muscle 2. Bone 3. Connective tissue 4. Serous lining 5. Spleen 6. Cardiovascular structures 7. Lymphatics 8. Blood 9. Wall of gut tube 10. Upper vagina 11. Kidneys 12. Adrenal medulla 13. Dermis 14. Testes and Ovaries
What is the only postnatal derivative of the Notochord? Nucleus pulposus
What are the associated defects of Mesoderm? Vertebral defects Anal atresia Cardiac defects Tracheo-Esophageal fistula Renal defects Limb defects
What common atresia is due to defective Mesoderm? Anal atresia
What are the serous lining made from Mesoderm? Peritoneum, Pericardium, and pleura
Muscle , bone, connective tissue and spleen are of __________________ origin. Mesoderm
What part of the vagina is of Mesoderm derivation/ Upper vagina
Blood and lymphatics are derivatives of? Mesoderm
What is the embryological origin of the kidneys, adrenal cortedx, dermis and testes/ovaries? Mesoderm
Dermis is of ___________________- derivation. Mesoderm
Wall of gut tube is a derivative of __________________. Mesoderm
Gut tube epithelium, included anal canal above the pectinate line, is of ____________________ origin. Endoderm
Most of the urethra and lower vagina are derived of ____________. Endoderm
What structures are derived from Urogenital sinus? Lower vagina and urethra
What are the luminal epithelial derivatives? Lungs, liver, gallbladder, pancreas, eustachian tube, thymus, parathyroid, and thyroid follicular cells
Thyroid follicular cells are ___________________ derivative. Endoderm
What is the embryological tissue of luminal epithelial derivatives? Endoderm
Thyroid follicular cells are of __________________ origin. Endoderm
What is the definition of Agenesis? Absent organ due to absent primordial tissue.
Absent organs due to absent primordial tissue. Agenesis
Definition of Aplasia: Absent organ despite presence of primordial tissue
Which error in morphogenesis depicts no organ, despite the presence of primordial tissue? Aplasia
What is hypoplasia? Incomplete organ development with primordial tissue present
Is primordial tissue present in hypoplasia? Yes
Secondary breakdown of previously normal tissue or structure Disruption
What is an example pathology of a error in Disruption? Amniotic band syndrome
When do Deformation errors occur (gestation)? After embryonic period
Which error in morphogenesis occurs during the Embryonic period? Malformation
Intrinsic disruption is known as ________________. Malformation
Extrinsic disruption is known as _________________. Deformation
What is the definition of Sequence, as an error in morphogenesis? Abnormalities result from single primary embryologic event
What is a common example of an error in sequence? Oligohydramnios causing to Potter sequence
When are teratogens most dangerous to fetal development? 3rd-8th weeks of pregnancy
Teratogenic susceptibility before week 3 produce --> "all-or-none" effects
Teratogen affection to fetus after week 8 causes? Growth and function deficits
Teratogenic effect of ACE inhibitors Renal damage
Which type of medications can cause renal damage as a teratogenic effect? ACE inhibitors
Teratogenic effect of alkylating agents? 1. Absence of digits, 2. Multiple anomalies
The absence of digits as a teratogenic effect is due to: Alkylating agents
Teratogen - Aminoglycosides cause: Ototoxicity
Which type of antibiotics are associated with Ototoxicity caused by a teratogen? Aminoglycosides
What are some important teratogenic defects caused by Antiepileptic drugs? 1. NT defects 2. Cardiac defects 3. Cleft palate 4. Skeletal abnormalities (phalanx/nail hypoplasia, facial dysmorphism)
What are associated skeletal abnormalities due to teratogenic effects of antiepileptic drugs? Phalanx/nail hypoplasia and Facial dysmorphism
List of most common teratogenic antiepileptics: Valproate, carbamazepine, phenytoin, and phenobarbital
What is recommended as prevention of teratogenic effects due to antiepileptics? High-dose folate supplementation
Teratogenic effects: Vaginal clear cell adenocarcinoma, and Congenital Mullerian anomalies. Associated medication? Diethylstilbestrol
What are the associated teratogenic effects of Diethylstilbestrol? 1. Vaginal clear cell adenocarcinoma 2. Congenital Mullerian anomalies
What are some common Folate antagonists? Trimethoprim (TMP), Methotrexate (MTX), and anti-epileptic drugs
Main teratogenic effect of folate antagonist? Neural tube defects
Teratogen - Isotretinoin causes? Multiple severe birth defects
Ebstein anomaly is due to a which teratogen? Lithium
What is Ebstein anomaly? Apical displacement of tricuspid valve
Lithium intake during pregnancy is associated with development of: Ebstein anomaly
Teratogen - Methimazole. Aplasia cutis congenita
Aplasia cutis congenita is due to which teratogen? Methimazole
What are the adverse teratogenic effects to Tetracyclines? 1. Discolored teeth 2. Inhibited bone growth
Discolored teeth on baby may be due to: Tetracycline use during pregnancy
What are the teratogenic effects produced by Thalidomide? Limb defects (phocomelia, micromelia- "flipper" limbs
Which teratogen is associated with limb defects such as "flipper" limbs? Thalidomide
Chronic anticoagulant considered a teratogen? Warfarin
What are the teratogenic defects produced by Warfarin? Bone deformities, fetal hemorrhage, abortion, ophthalmologic abnormalities
Which anticoagulant should be used on pregnant woman? Heparin
Which are the most common substance abused that cause teratogenic effects? Alcohol, Cocaine, and Smoking (nicotine, CO)
What are the teratogenic abnormalities or defects seen with Alcohol abuse? 1. Birth defects and intellectual disability 2. Fetal alcohol syndrome
What vessel action is produced by consumption of cocaine? Vasoconstriction
Presentation of teratogenic effects of Cocaine abuse? Low birth weight, preterm birth, IUGR, and placenta abruption
What type of substance abuse is suspected by a preterm birth and placenta abruption? Cocaine and Smoking
What is IUGR? Intrauterine Growth Restriction; A condition in which a baby doesn't grow to normal weight during pregnancy.
IUGR is associated with ________________ abuse. Cocaine
Teratogenic substance known to cause Vasoconstriction Cocaine and Nicotine
What is possible reason to which Smoking and cocaine abuse share some teratogenic effects? Both cause vasoconstriction
Associated teratogenic effects of smoking 1. Low birth weight 2. Preterm labor 3. Placental problems 4. IUGR, SIDS, and ADHD
CO due to smoking causes? Impaired O2 delivery --> teratogenic defects
Excess iodine during pregnancy is associated with: Congenital goiter or hypothyroidism (cretinism)
Which maternal condition is associated with Caudal Regression syndrome? Maternal diabetes
What is Caudal Regression syndrome? Anal atresia to sirenomelia
Which congenital heart defects are associated with Maternal diabetes? VSD, transposition of the Great vessels
List of teratogenic defects associated with Maternal diabetes: 1. Caudal Regression syndrome 2. Congenital heart defects (VSD, TOGV) 3. NT defects 4. MacrosomĂ­a 5. Neonatal hypoglycemia 6. Polycythemia
Associated teratogen defect of Methylmercury Neurotoxicity
Which are the highest/largest sources of methylmercury? Swordfish, shark, tilefish, and king mackerel
What are the teratogen defects produced by Vitamin A excess? 1. Extremely high risk for Spontaneous abortions and birth defects (cleft palate, cardiac).
What are the possible teratogenic abnormalities produced by X-rays? Microcephaly and Intellectual disability
What is a common measure to reduce teratogenicity of X-ray exposure? Lead shielding
What is the leading cause of intellectual disability in the U.S.? Fetal alcohol syndrome
Associated abnormalities of Fetal alcohol syndrome - Pre- and postnatal developmental retardation, microcephaly, facial abnormalities, limb dislocation, and heart defects
What are the facial abnormalities produced by Fetal alcohol syndrome? Smooth philtrum, thin vermillion border (upper lip), small palpebral fissures
Most severe form of heart defects in Fetal alcohol syndrome Heart-lung fistulas
What are the most severe complications of Fetal-alcohol syndrome? Heart-lung fistulas and Holoprosencephaly
What mechanism is failed in Fetal alcohol syndrome? Cell migration
What is Neonatal abstinence syndrome? Complex disorder involving CNS, ANS, and GI systems; secondary to maternal opiate use/abuse
What kind of substance is abused in order to develop Neonatal Abstinence syndrome? Opiate
Secondary to maternal opiate abuse/use. Dx? Neonatal abstinence syndrome
What is the common clinical presentation of newborn with Neonatal abstinence syndrome? - Uncoordinated sucking reflexes - Irritability - High-pitched crying - Tremors, tachypnea, sneezing, diarrhea, and, - Seizures
What is another term to refer to Dizygotic twins? Fraternal
Dizygotic twins arise form? 2 eggs that are separately fertilized by 2 different sperm.
What is the number of amniotic sacs and placenta(s) in dizygotic twins? 2 separate amniotic sacs 2 separate placentas
What is the medical term for placenta? Chorion
Another way to refer to monozygotic twins? Identical twins
Monozygotic twins arise from? 1 fertilized egg (1 egg + 1 sperm) that splits early in pregnancy
In monozygotic twins what determines the chorionicity and amnionicity? The timing of cleavage
Twining; Cleavage 0-4 days --> Separate chorion and amnion (2 & 2)
A shared chorion in twins is due to cleavage time? Cleavage 4-8 days
Cleaved of monozygotic twins in Days 4-8 lead to: Shared chorion
Shared amnion is seen if the cleavage is at__________________ days. 8-12
Twin cleavage 8-12 days lead to: Shared amnion
What is the result of twin cleavage 13+ days? Shared Body (conjoined)
When is cleavage of conjoined twins? 13+ days
2 eggs + 2 sperm = Dizygotic twins
1 egg + 1 sperm + early split in pregnancy = Monozygotic twins
Twins that look just the same are Monozygotic twins
Twin siblings that do not look exactly the same are known as: Dizygotic twins
Chorion = Placenta
What is chorionicity? Number of placentas
Created by: rakomi
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