bananas's version from 2015-07-14 18:31

Genital Embryology

Question Answer
Which system turns into female?Mullerian aka PARAmesonephric duct
What female structures are derived from Mullerian ducts?Fallopian tubes, Uterus, Upper vagina
- not ovaries
The lower vagina is derived from [?]Sinovaginal bulbs
Inhibition of the Paramesonephric ductsMullerian inhibitory factor (MIF)
MIF is secreted by [?]Sertoli cells
- Inhibin and Mullerian Inhibiting Factor
Testosterone is secreted by [?]Leydig cells
What does MIF do?Degeneration of Paramesonephric ducts
Which system turns into male?Mesonephric aka Wolffian
What male structures are derived from Mesonephric ducts?Seminal vesicles, Epididymis, Ejaculatory duct, Duct deferens [SEED]
What factors are necessary for the Wolffian duct to form?SRY (testes determining factor), DHT
What gene drives male development?SRY on the Y chromosome
SRY gene makes [?] for testicular developmentTestis determining factor
What enzyme is needed for male genitalia to develop?5-alpha-reductase: DHT
What keeps the mesonephric ducts alive?Testosterone
What blocks the urogenital sinus development?DHT blocks urogenital sinus from turning into lower vagina
Sertoli cells make [?]- MIF
- Inhibin (feedback to FSH)
- ABP (Androgen Binding Protein: maintains testosterone)
Leydig cells make [?]Testosterone
Blood-testes barrier is made ofSertoli cells
FSH stimulatesSertoli: make ABP and spermatogenesis
LH StimulatesLeydig cells: make testosterone!

Disorders of Differentiation

Question Answer
(46,xxy)Ovotesticular DSD aka true hermaphoriditism
(46,XY) Phenotypic femaleAndrogen insensitivity: defective receptor
Lumps in the labia are caused byAndrogen insensitivity. MIF stimulates testes.
Hormone levels in AISHigh testosterone, Low LH
(46,XY) masculinization at puberty5-alpha reductase deficiency: can't make DHT
Hormone levels with 5-alpha-reductase deficiencyRelatively normal
Fail to complete pubertyKallmann syndrome: Decreased synthesis of GnRH in the hypothalamus
Hormone levels in KallmannLow GnRH, Low LH, Low testosterone
Fully developed with amenorrhea and a short uterusMullerian agenesis. Due to lack of paramesonephric duct


Question Answer
Turner syndromeTina Turner X0.
Most common cause of primary amenorrhea?Turner syndrome. Lack normal ovaries and have streak gonads instead.
Turner syndrome presentationShort stature, webbed neck, low-set hairline, shield chest, underdeveloped secondary sex characteristics; edema dorusum of hands or feet in newborn*; streak gonads.
Pure gonadal dysgenesis46XY; phenotype female with uterus and fallopian tubes but streak gonads. Presents with primary amenorrhea.
Klinefelter syndromeCommon. 47 XXY. 1:850
Klinefelter syndrome genetic finding47 XXY with Barr body, inactivated x chromosome.
Klinefelter syndrome pathophysDysgenesis of seminiferous tubules (-> decrease inhibit and increase FSH) and or abnormal leydig cel function (-> decrease Testerone and increase LH and so increase estrogen).
Klinefelter syndrome clinicalTesticular atrophy, eunochoid body shape, tall, long extremities, gynecomastia, female hair distribution. Sometimes development delay.
Severe acne, learning disability, autism spectrum disorders associated with which DSDDouble Y Males. XYY.
Double Y Males XYY clinicalusually undiagnosed. Phenotypically normal. Random non disjunction event (paternal meiosis II); noninherited; normal fertility.


Question Answer
Glans penisGlans Clitoris
Corpus cavernosum/spongiosumVestibular bulbs
Bulbourethral glands (Cowper's)Greater vestilbular glands of Bartholin
Prostate glandUrethral and Para-urethral glands
Ventral shaft of penisLabia minora
ScrotumLabia majora
Infundibulopelvic ligament ovaries to lateral pelvic wall


Question Answer
cardinal ligament cervix to side wall of pelvis
round ligament of the uterus uterine fundus to labia majora
broad ligament uterus, fallopian tubes and ovaries to pelvic side wall
ovarian ligamentmedial pole of ovary to lateral uterus
ectocervixstratified squamous epithelium
transformation zonesquamocolumnar junction
endocervixsimple columnar epithelium, mucus-secreting

Innervation to the Dick

Question Answer
ErectionParasympathetics (Pelvic nerve Points): mediated by NO to relax and vasodilate the penis
How does sildafenil work?PDE-5 inhibitor: Inhibits PDE-5 from breaking down cGMP, mediator for NO
Erectile dysfunction is caused by damage to [?]Cavernous nerves (pelvic nerve) carrying PS fibers
EmissionSympathetic: Hypogastric nerve
EjaculationSympathetic: Pudendal nerve
MC damaged nerve during childbirth or bicycling?Pudendal nerve
What does the pudendal nerve do?Sensation and motor to:
1. Perineal muscles
2. External anal sphincter
3. External urethral sphincter
Main artery of the pelvis?Internal iliac
Main nerve of the pelvis?Pudendal!
Where does testicular cancer first metastasize?Para-aortic nodes
Lymphatic drainage of the testes or ovaries?Para-aortic nodes
Lymphatic drainage of the scrotum or vagina/vulva?Superficial inguinal nodes
Lymphatic drainage of the prostate or cervix/uterus?External and internal Iliac nodes


Question Answer
MC Congenital hernia?Indirect inguinal hernia: Failure of processus vaginalis to close
Path of an indirect inguinal hernia?Internal (deep) inguinal ring >> external (superficial) inguinal ring >> scrotum
Failure of processus vaginalis can result in [?]Indirect inguinal hernia and hydrocele
Which layers cover an indirect inguinal hernia?All 3 layers of spermatic fascia
Indirect hernias lie [?] to inferior epigastric arteryLateral
Direct hernias lie [?] to inferior epigastric arteryMedial
Acquired hernia?Direct inguinal hernia: usually heavy lifting
Path of direct inguinal hernia?Hesselbach's (inguinal) triangle >> Abdominal wall >> External Inguinal ring
Which layers cover direct inguinal hernia?External spermatic fascia only
Borders of hesselbach's triangle?Inguinal ligament
Inferior epigastric vessel
Lateral rectus abdominus
MC groin hernias in women?Femoral hernia [Fem-Fem]
Path of femoral hernia?Protrudes below inguinal ligament through Femoral canal
Hernia most susceptible to complications?Femoral
Incarcerationcontents of hernia get irreducibly trapped... obstructed flow
StrangulationNecrosis of herniated contents


Question Answer
MC incontinenceStress incontinence: weakened pelvic floor
After childbirthStress: Increased abdominal pressure against weak pelvic floor
Treatment of stress incontinanceLifestyle, Pessary, Surgery
Suddenly need to pee!Urge incontinence
Cause of urge incontinenceOveractive detrusor
Treatment of urge incontinence?Antimuscarinics:
- Oxybutynin
- Darifenacin
Continuous leakage of urineOverflow incontinence: overdistention of bladder
Treatment for overflow incontinencePessary, Surgery

Testicular cancer

Question Answer
Fried egg appearance Seminoma
MC testicular tumor Seminoma
MC Boys <3Yolk Sac (endodermal tumor)
Yellow, mucinous and aggressiveYolk Sac
Yolk sac
- Schiller Duvall bodies (primitive glomeruli)
PainfulEmbryonal Carcinoma: hemorrhagic mass
Glandular/papillary/Tubular morphologyEmbryonal Carcinoma
Teratoma in menMalignant! (but benign in kids)
Syncytiotrophoblast and cytotrophoblastsChoriocarcinoma
Hematogenous spreadChoriocarcinoma
Gynecomastia and hyperthyroidChoriocarcinoma
Older menTesticular lymphoma (metastatic, aggressive)
Leydig cell tumor: Reinke crystals
Gynecomastia in menLeydig cell tumors
High AFP- Yolk sac!
- Also teratomas
High HCG- Choriocarcinoma!
- Embryonal carcinoma
- Teratoma
High ALPSeminoma
Estrogen secretingSertoli cell
Testosterone secretingLeydig