15 Reproductive System

q123456's version from 2016-05-30 14:05


Question Answer
BRCA-1Breast and Ovarian tumor
Intersex1.Complete androgen insensitivity syndrome: Male pseudohermaphrodite
b)External genitalia are feminized
c)Nerther the male type internal nor the female type internal tracts develop
i.A 18 year old woman,, not yet menstruated, normal external genitalia, but the cervix is not seen
ii.A 14 year old girl, failure to menstruate, no breast development, no uterus, 46XY

2.5a-reductase deficiency: KA36-6/7
b)External genitalia are feminized
c)Male type internal tracts develop
use finasteride (5-a reductase inhibitor) during the pregnancy
3.11B-hydroxylase def:
c)serum potassium is 3.5 mEq/L.
d)Decreased aldosterone
e)increased androgen and 17OH progesterone

4.Klinefelter syndrome:
a)Small testes, small penis, gynecomastia, normal IQ
b)Infertility, gynecomastia, absence of spermatozoa, completely hyalinized seminiferous tubules


Question Answer
bilateral mastectomiesmechanical disruptin of the thoracic duct during the surgery>>>leakage of lymphatic fluid into the pleural cavity (high triglycerides and low cholesterol-chylous effusion)
paget disease of the breastan erythematous rash/ulcer lesion around the nipple KA25-34
ductal carcinoma
OvulationFSH stimulation>>>follicle growth/granulosa cells secret estradiol>>>GnRh pulses in hypothalamus>>>LH surge>>>Ovulation>>>corpus luteum>>>estrodiol and progesterone

LH surge: A process when your ovary releases an egg. LH from the pituitary gland suddenly increases and is released into your bloodstream, triggering your ovary to release an egg.

receives a short course of menotropins followed by a single injection of human chorionic gonadotropin (hCG). Menotropins: FSH, formtation of a dominant ovarian follicle, hCG: stimulate LH surge>>>induce ovualation

the first trimester of pregnancy: progesterone and estradiol are produced by the corpus luteum
the second and third trimesters of pregnancy: progesterone from placenta, estrogen from fetal adrenal gland
hCG frm embryonic syncytiotrophoblast during the first trimester: maintain the corpus luteum until the placenta can assume responsibility for estrogen and progesterone synthesis
polycystic ovarian disease
a hyperplastic luteinized theca interna >>>Elevated LH and androgen
Infertility and hirsutism

e.g. a 33 women: failure to conceive, acne and hair on the upper lip, periods are very light and irregular. elevated estrogen and androgen levels

high androgens and LH and low FSH

low FSH>>>Infertility
endometrial adenocarcinoma,
type 2 diabetes, atherosclerosis and coronary artery disease
High androgen>>>hirsutism,

1 large ovaries,
2 graywhite with innumerable cystic follicles
3 lined by granulosa cells (FSH stimulates granulosa cells to convert androgen to estrogen) with a hyperplastic luteinized theca interna (androgen).
4 absence of corpora lutea in the ovary (no progesterone)
Corpus luteumAfter ovulation, the empty follicle is stimulated by LH to become a new structure
The developing follicles secret only estradiol, the corpus luteum secretes both estradiol and progesterone
skin lesionssyphilis: condyloma lata

HPV: condyloma acuminatum

Chlamydia: lymphogramuloma venereum KA9-10
multiple enlarged, abscessed lymph nodes draining through the skin
painful palpable masses of the groin

haemophilus: chancroid (most common, genital ulcers, Africa/Asia. A cofactor in the transmission of HIV infection) young man has a PAINFUL ulcerative genital lesion

syphilis: chancre (hard and nontender)

Klebsiella: granuloma inguinale (PainLESS)
Endometrium-cyclic changesThe proliferative phases: while the ovary is in its follicular phase. Estradiol stimulate growth of the stratum functionale of the endometrium.
The secretory phase: when the ovary is in its luteal phase, progesterone stimulate uterine glands.
The menstrual phase: necrosis and sloughing of the the stratum functiale of the endometrium
turner syndromeOvaries consist of small amounts of connective tissue and no follicles
ovary tumorsmucinous cystadenoma of ovary
pseudomyxoma peritonei, mucus secreting cells(surface derived tumors)
McCune-Albright syndromecafé-au-lait skin pigmentation
early puberty
polyostotic fibrous dysplasia:replacement of bone with fibrous tissue-->fractures
LHKA31-25 Complete androgen resistance: high LH, "girl like", 46XY
in male: stimulates the release of testosterone from the leydig cells in the interstitium of the testicles
in female:
1) LH supports theca cells in the ovaries that provide androgens
2) an acute rise of LH ("LH surge") triggers ovulation and development of the corpus luteum.
FSHin male: stimulates the release of inhibin B from the sertoli cells in the seminiferous tubules of the testicles>>>
Selective impairent in sertoli cells function leads to decreased production of inhibin and increased FSH levels (Inhibin B has a negative feedback)

in female: FSH initiates follicular growth, specifically affecting granulosa cells>>>increases estrogen
menopause>>>estrogen drops>>>high FSH
androgens synthesized in ovarytheca interna
androgen is converted to estradiol in ovarygranulosa
high affinity for stratified squamous epithelium HPV
nonkeratinized stratified squamous epithelium in female genital structuresvagina and cervix
simple columnar endometrium
simple cuboidalovery

Section 2

Question Answer
an individual with a point mutation affecting the gene responsible for neurophysin synthesis is most likely to suffer from?diabetes insipidus
Neurophysin: a carrier proteins which transport vasopressin to the posterior pituitary from supraoptic nucleus of the hypothalamus.
centrial DI: Hypothalamic nuclei
human placental lactogen increasesecreted by the syncytiotrophoblast during pregnancy.
proteolysis and lipolysis and inhibits gluconeogenesis
Testicular malignancypainless testicular enlargement.
In postpubertal males, 95% of testicular tumors arise from germ cells, and all are malignant. neoplasms derived from Sertoli or Leydig cells (sex cord– stromal tumors) are uncommon and usually benign

Choriocarcinoma of testicular tumors: hCG. ***elevated hCG>>>Hyperthyroidism and increased T3/T4

York sac tumor of testicular tumors: AFP, newborn and infants, yellow-white homogeneous

placental alkaline phosphatase is elevated.
"fried egg"

incomplete descent of the testis from the abdomen to the scrotum
testes atrophy>>>testicular cancer, infertility
Aromatase deficiencyhigh androgen/low estrogen in female fetus>>>
1male type external genitalia,
2prmary amenorrhea,
3tall (estrogen is necessary for fusion of the epiphyses)
4mother virilization during pregnancy (facial hair growth/voice deepening)

5a-reductase deficency>>>Low DHT>>>a small phallus and hypospadias
17a hydroxylase deficiency>>>13 year old girl, 152/91, lack of 2rd sexual characteristics, a blind vigina, hypokalemia, low testosterone and estradiol, 46 xy
vasectomytransection of the vas deferens>>> still have viable sperm after 3 months and at least 20 ejaculations.

which of the following is most likely to occur during the first month following the vasectomy? viable sperm in the ejaculate
neoplasms of penissquamous epithelium, HPV infection, uncircumcised males
syphilisKA34-26 KA34-35

antibodies to specific treponemal antigens.

primary syphilis:Chancre (a painless hard ulcer on the penis)
secondary syphilis: generalized lymph node enlargement, palmar rash and condyloma latum
tertiary syphilis:
1) gummas: syphilitic orchitis: mimicking a testicular tumor with atypical histological features.e.g. a middle aged man with a long history of sexual activity SLOWLY develops testicular enlargement. interstitial inflammation with edema and prominent plasma cells infiltrate

Infantile syphilis:chronic rhinitis (snuffles) and mucocutaneous lesions similar to those seen in secondary syphilis in adults.
Late congenital syphilis: untreated congenital syphilis of more than 2 years’ duration.

Late congenital syphilis
a 9 year old girl is brought to the physician because of outward bowing of the anterior tibias, deafness and a flattened nose

teeth: notched central incisors,
interstitial keratitis with blindness: inflammation of the cornea
deafness from eighth cranial nerve injury.

The fluorescent treponemal antibody absorption (FTA-ABS) test is a diagnostic test for syphilis.

Treponemal antibody: remain positive indefinitely, even after successful treatment. These tests give strongly positive results in virtually all cases of secondary syphilis. They are not recommended as screening tests, however, because they remain positive after treatment and have a high false-positive test rate (approximately 2%) in the general population

NONtreponemal antibody test
1) the rapid plasma reagin (RPR): antibody to cardiolipin, an antigen that is present in both host tissues and the treponemal cell wall.

2) Venereal Disease Research Laboratory (VDRL) tests: antibody to cardiolipin: positive by 4 to 6 weeks of infection, may negative during the tertiary phase

Nontreponemal antibody test results often are negative during the early stages of disease, even in the presence of a primary chancre. Hence, during this period, direct visualization of the spirochetes by darkfield or immunofluorescence microscopy may be the only way to confirm the diagnosis.

argyll robertson pupils

bilateral small pupils that reduce in size on a near object (they “accommodate”), but do not constrict when exposed to bright light (they do not “react” to light).
degeneration of dorsal columns and dorsal roots

VASA VASORUM endarteritis and obliteration>>>inflammation, ischemia and weakening of the ADVENTITIA
Amniotic fluid (AF) embolismDIC
Amniotic fluid or fetal material during pregnancy enters the mother's bloodstream>>>enter the maternal pulmonary circulation>>>respiratory failure>>>R cardiac failure .
occur during delivery or immediately afterward.
EclampsiaHigh BP and proteinuria>>>seizure and placental ischemia>>>intrauterine growth retardation
e.g. a 38 year old primigravid woman at 34 weeks' gestation comes to the physician because of swelling of her hands and feet. Her BP is 158/100 mmHg. Urinalysis shows moderate proteinuria. Lab studies show elevated AST and ALT, and slightly decreased platelet. Which of the following is believed to be the initial event in the pathogenesis of the condition? placental ischemia (not DIC, eclampsia is not the cause of DIC in pregnant women)