15 Reproductive Systemrename
q123456's version from 2016-05-30 14:05
|BRCA-1||Breast and Ovarian tumor|
|Intersex||1.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
c)serum potassium is 3.5 mEq/L.
e)increased androgen and 17OH progesterone
a)Small testes, small penis, gynecomastia, normal IQ
b)Infertility, gynecomastia, absence of spermatozoa, completely hyalinized seminiferous tubules
|bilateral mastectomies||mechanical 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 breast||an erythematous rash/ulcer lesion around the nipple KA25-34|
|Ovulation||FSH 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
type 2 diabetes, atherosclerosis and coronary artery disease
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 luteum||After 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 lesions||syphilis: 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 changes||The 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 syndrome||Ovaries consist of small amounts of connective tissue and no follicles|
|ovary tumors||mucinous cystadenoma of ovary |
pseudomyxoma peritonei, mucus secreting cells(surface derived tumors)
|McCune-Albright syndrome||café-au-lait skin pigmentation|
polyostotic fibrous dysplasia:replacement of bone with fibrous tissue-->fractures
|LH||KA31-25 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
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.
|FSH||in 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 ovary||theca interna|
|androgen is converted to estradiol in ovary||granulosa|
|high affinity for stratified squamous epithelium||HPV|
|nonkeratinized stratified squamous epithelium in female genital structures||vagina and cervix|
|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 increase||secreted by the syncytiotrophoblast during pregnancy.|
proteolysis and lipolysis and inhibits gluconeogenesis
|Testicular malignancy||painless 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.
incomplete descent of the testis from the abdomen to the scrotum
testes atrophy>>>testicular cancer, infertility
|Aromatase deficiency||high androgen/low estrogen in female fetus>>>|
1male type external genitalia,
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
|vasectomy||transection 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 penis||squamous epithelium, HPV infection, uncircumcised males|
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
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) embolism||DIC|
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.
|Eclampsia||High 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)