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Reproductive 2


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drainage of left ovary/testis?
left gonadal vein - left renal ven - IVC
drainage of right ovary/testis?
right gonadal ven - IVC
what does the suspensory ligament of the ovaries contain?
ovarian vessels
what does the transverse cervical/cardinal ligament contain?
uterine vessels
what does the round ligament of the uterus contain?
no important structures
what does the broad ligament of the uterus contain?
round ligaments of uterus and ovaries and uterine tubules and vessels
what is the acrosome derived from?
what is the flagellum (tail) of sperm derived from?
one of the centrioles
what is the sperm food supply?
what does spermatogenesis begin with?
spermatogonia (type A and B)
where does spermatogenesis occur?
seminiferous tubules
what does type A spermatogonia form?
both type A and type B
what forms the blood-testis barrier?
junctional complex (tight junction) between Sertoli cells
what stimulates testosterone release from Leydig cells?
FSH stimulates sertoli cells to produce what?
androgen binding protein & inhibin (inhibits FSH)
what converts testosterone and androstenedione to estrogen in adipose tissue?
list the forms of estrogen in order of potency
estradiol > estrone > estriol
what enzyme converts cholesterol to androstenedione in the theca cell? what stimulates it?
desmolase; LH
what converts androstenedione to estrogen in the granulosa cell? what stimulates it?
aromatase; FSH
what is elevation of progesterone indicative of?
what does unopposed estrogen therapy increase the risk of? what can be added to decrease this risk?
endometrial cancer; progesterone decreases the risk
this hormone is responsible for stimulation of endometrial glandular secretions and spiral artery development
what does progesterone do to myometrial excitability?
decreases it
what influence does progesterone have on uterine smooth muscle?
relaxes it
when is follicular growth the fastest?
during 2nd week of proliferative phase
what stimulates endometrial proliferation?
what maintains the endometrium to support implantation?
when does the estrogen surge occur?
day before ovulation - stimulates LH, inhibits FSH
what effect does progesterone have on temperature?
increases it
what is the role of OCPs?
prevent estrogen surge, LH surge so ovulation does not occur
what maintains the corpus luteum for the 1st trimester?
when does hCG appear in urine after fertilization?
8 days
what is the average age of onset of menopause?
51 - earlier in smokers
what happens to estrogen levels after menopause?
what happens to levels of FSH, LH, GnRH at menopause?
increase (FSH increases the most; no LH surge)
what does a bicornuate uterus result from?
incomplete fusion of the paramesonephric ducts; associated with UT abnormalities and infertility
what does hypospadias result from?
failure of urethral folds to close - opening on inferior/ ventral side
what does epispadias result from?
faulty positioning of genital tubercle - on superior/dorsal side
what is hypospadias associated with?
UTIs - more common than epispadias
what is epispadias associated with?
exstrophy of the bladder
what stage is an oocyte in prior to ovulation?
prOphase of meiosis I
what stage is a follicle in until fertilization?
METaphase of meiosis II
what is Mittelschmerz
blood from ruptured follicle causes peritoneal irritation - can mimic appendcitis
ovaries present, but external genitalia are virilized or ambiguous - due to exposure to androgenic steroids during early gestation
female pseudohermaphrodite (XX)
testes present, but external genitalia are female or ambiguous
male pseudohermaphrodite
what is the phenotype in androgen insensitivity syndrome (46, XY)?
female - female external genitalia with rudimentary vagina, uterus and uterine tubes generally absent; develops testes
in androgen insensitivity, what levels of testosterone, estrogen, LH are seen?
all high
cryptorchidism is associated with an increased risk for what?
germ cell tumors, especially seminoma and embryonal carcinoma
what happens in 5-alpha reductase deficiency?
unable to convert T-DHT; ambiguous genitalia until puberty, when increased testosterone causes masculinization of genitalia
what levels of testosterone, estrogen, and LH are associated with 5-alpha reductase deficiency?
normal; LH normal or increased
in what location is nodular enlargement seen in BPH?
periuretheral (lateral and middle) lobes
from where does prostatic adenocarcinoma most often arise?
posterior lobe (peripheral zone)
what is the genotype of a complete hyatidiform mole? what is the origin?
46, XX- completely paternal in origin
what is HELLP syndrome?
Hemolysis, Elevated LFTs, Low Platelets
what is the treatment for eclampsia?
IV magnesium sulfate and diazepam
increased risk of abruptio placentae with what?
smoking, hypertension, cocaine use
painful uterine bleeding usually during 3rd trimester
abruptio placentae - premature separatino of placenta (may be associated with DIC)
defective decidual layer allows placenta to attach directly to myometrium
plaenta accreta
what stimulates theca cells to secrete androstenedione and testosterone?
what stimulates aromatase activity in granulosa cells?
where is the deep inguinal ring?
about 1/2 inch above the midpoint of the inguinal ligament
how do indirect inguinal hernias enter the inguinal canal?
through the deep inguinal ring
in many cases of Paget disease of the breast, what else is present?
underlying adenocarcinoma
lump in breast with prominent multinucleated giant cell reaction?
fat necrosis
three types of ovarian tumors that can produce large amounts of steroid hormones?
sertoli-leydig cell tumors, fibroma-thecomas, granulosa cell tumors
what is the most likely condition predisposing to breast abscess/mastitis?
breast feeding
what predisposes to placenta accreta?
prior C-section or inflammation; may have massive hemorrhage after delivery
placenta previa?
attachment of placenta to lower uterine segement; may occlude cervical os
painless bleeding in any trimester
placenta previa
what is polyhydraminos (>1.5-2L) associated with?
esophageal/duodenal atresia; anencephaly
what is oligohydraminos (<0.5L) associated with?
bilateral renal agenesis or posteror urethral valves (in males)
cervical dysplasia - HPV
what types of HPV are associated with CIN?
16, 18
how does HPV cause CIN?
HPV viral proteins E6 & E7 bind and inactivate gene products of p53 & Rb
endometrial hyperplasia puts one at an increased risk for what?
endometrial CA
abnormal endometrial gland proliferation usually caused by excess estrogen stimulation
endometrial hyperplasia
what is the most common gynecological malignancy?
endometrial carcinoma
what is the peak age for endometrial carcinoma? how does it typically present?
55-65; vaginal bleeding
risk factors for endometrial cancer?
prolonged estrogen use, obesity, diabetes, and hypertension
leiomyomas are sensitive to what?
estrogen - increased sized with pregnancy and decreased with menopause
amenorrhea, infertility, obesity, hirsutism
polycystic ovarian syndrome
increased LH production leads to anovulation, hyperandrogensim due to deranged steroid synthesis
treatment for polycystic ovarian syndrome?
weight loss, OCPs, gonadotropin analogs, or surgery

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