Step 1 - Repro 1

denniskwinn's version from 2015-04-25 16:16

Review of embryology and microbiology


Question Answer
Sexual Dysfunction DDx (3)Drugs (e.g. Antihypertensives, neuroepileptics, SSRIs, ethanol), Diseases (depression, diabetes), Psychological (performance anxiety) [causes of what?]
Female genital embryologydefault development -
1)Mesonephric duct degenerates
2)Paramesonephric duct develops
Mesonephric duct must be induced in order toStay, it will degenerate as default - leading to female development
Male genital embryology1)Induced by SRY gene on Y chromosome
2)Inhibition of mullerian (paramesonephric) formation secreted by sertoli cells. (AMH aka MIF)
3) Increased androgens (from Leydig cells) lead to development of mesonephric duct.
Mesonephric ductDevelops into male internal structures (except prostate) - akawolffian duct - seminal vesicles, epididymis, ejaculatory duct, and ductus deferens
Paramesonephric ductdevelops into fallopian tube, uterus and upper third of vagina - aka mullerian duct
Bicornuate uterusResults from incomplete fusion of paramesonephric ducts.
Associated w/urinary tract abnormalities and infertility (miscarriages in 2nd trimester)
Genital tubercle becomes1)W/DHT= glans penis, corpus cavernosum and spongiosum.
2) W/Estrogen = glans clitoris, vestibular bulbs
Urogenital sinus becomes1)W/DHT= bulbourethral glands (cowper) and prostate.
2) W/estrogen = Greater vestibular gland (bartholin) and skene glands
Urogenital folds become1)W/DHT = Ventral shaft of penis (penile urethra).
2)W/estrogen = Labia minora
Labioscrotal swelling becomes1)W/DHT = scrotum
2)W/ estrogen = Labia majora
HypospadiasAbnormal opening of penile urethra on inferior (ventral) side of penis due to failure of urethral folds to close. - more common than epispadias - needs fixed to prevent UTIs
EpispadiasAbnormal opening of penile urethra on superior (dorsal) side of penis due to faulty positioning of genital tubercle


Question Answer
Gonorrhea organismNeisseria gonorrhoeae [organism that causes what dz?]
Gonorrhea clinical featuresUrethritis, cervicitis, PID, prostatitis. epididymitis. arthritis. creamy purulent discharge [clinical features of?]
Syphilis organismTreponema pallidum
Primary syphilis clinical featuresPainless chancre
Secondary syphilis clinFever, lymphadenopathy, skin rashes, condylomata lata (warts)
Tertiary syphilis clingummas, tabes dorsalis, general paresis, aortitis, argyll robertsion pupil (bilateral small pupils that constrict when the patient focuses on a near object)
Chancroid organismHaemophilus ducreyi (you do cry) [organism that causes what?]
Chancroid clinpainful genital ulcers, inguinal adenopathy
Genital herpes organismHSV-2
Genital herpes clinpainful penile, vulvar or cervical ulcers - can cause systemic sx (fever, headache, myalgia)
Chlamydia organismChlamydia trachomatis (D-K)
Chlamydia clinUrethritis, cervicitis, conjunctivitis. Reiter's syndrome, PID
Lymphogranuloma venereum organismC. Trachomatis (L1-L3)
Lymphogranuloma venereum clinUlcers, lymphadenopathy, rectal strictures
Trichomoniasis organismTrichomonas vaginalis [causes?]
Trichomoniasis ClinVaginitis, strawberry-colored mucosa
AIDS clinOpportunistic infection, Kaposi’s sarcoma, lymphoma
Condylomata acuminata organismHPV 6, 11
Condylomata acuminata clinGenital warts, koliocytes [not the bug, but what's being described]
Hep B clinjaundice [clinical manifestation of what?]
Bacterial vaginosis organismGarderella vaginalis
Bacterial vaginosis clinNoninflammatory, malodorous discharge (fishy smell), positive whiff test, clue cells
PID top bugsNeisseria gonorrhoeae, C. Trachomatis
PID clinCervical motion tenderness, purulent cervical discharge, maybe salpingitis, endometritis, hydrosalpinx, tubo-ovarian abscess.

Endo Chapter


Question Answer
L gonad venous drainage_________ gonadal vein to L renal vein to IVC [drainage of what?]
R gonad venous drainage_ gonadal vein to IVC [drainage of what?]
Gonadal lymphatic dranagepara-aortic LN
Distal third vaginal lymphatic drainagesuperficial inguinal nodes [lymphatic drainage of what?]
Proximal two thirds of vagina - lymphatic drainage-Obturator, external iliac and hypogastric nodes [lymphatic drainage of what?]
Suspensory ligament of the ovaries connects _________, containing ___ovaries TO lateral pelvic wall, containing ovarian vessels [what connects]
Cardinal ligament connects ___ containing ___cervix TO side wall of pelvis, containing uterine vessels [what connects]
Round ligament of uterus connectsuterine fundus to labia majora [connection]
Broad ligament connectsUterus, fallopian tubes and ovaries TO pelvic side wall [what connects them?]
Broad ligament containsOvaries, fallopian tubes and round ligaments of uterus [contained in]
Ligament of ovary connectsOvary to uterus [connection]


Question Answer
Path of Sperm during ejaculation SEVEN UP -
1)Seminferous tubules
3)Vas deferens
4)Ejaculatory ducts
5) N= nothing
7) Penis
Autonomic innervation of erection(pelvic nerve)
- NO⇢⇡cGMP⇢smooth muscle relaxation⇢vasodilation⇢proerectile.
-NE⇢Ca⇢smooth muscle contraction⇢vasoconstriction⇢antierectile
Autonomic innervation sperm emission(hypogastric nerve) - SNS
Autonomic innervation ejaculation(pudendal nerve) - visceral somatic nerves
Effect of sildenafil and vardenafilInhibit cGMP breakdown [effect of what drugs]
Derivation of sperm acrosomeDerived from golgi apparatus [which sperm part]
Derivation of sperm flagellumFrom one of the centrioles
Spermatogonia (Germ cell) function/locationMaintain germ pool and produce primary spermatocytes / in seminferous tubules
Sertoli cells function/locationLine seminferous tubules -
1) secrete inhibin (inhibits FSH)
2)Secrete androgen-binding protein (ABP) to maintain levels of testosterone
3)Tight junction b/w cells from blood-testis barrier (prevent autoimmune attack)
4)Support and nourish developing spermatozoa, regulate spermatogenesis
5)produce AMH
Leydig cells function/locationSecrete testosterone - in the interstitium
Composition of semen1)60% from seminal vesicle (fructose, ascorbic acid, prostaglandins, phosphorylcholine, flavins)
2)20% prostate products (Zinc, citric acid, phospholipids, acid phosphatase, fibrinolysin). .


Question Answer
SpermatogenesisBegins at puberty w/spermatogonia - takes 2 months to fully develop
- occurs in seminferous tubules =produces spermatids that go through spermiogenesis.
SpermatogoniumDiploid (2N)=46 chromosomes= crosses blood-testis barrier = This is when replication(interphase) takes place
Primary spermatocyteDiploid (4N)= 46 sister chromatids- ready to splits into two cells and become secondary spermatocytes (which are haploid)
Secondary spermatocyteHaploid(2N) with sister chromatids -ready to split to spermatids that are haploid.
Spermatidshaploid w/ single sex chromosome
FSH to Sertoli cells leads toSperm production [caused by what acting on what?]
LH to Leydig cells lead totestosterone [production caused by what acting on what?]
Testosterone and DHT sourceTestis [source of what?]
Androstenedione sourceAdrenal [source of what?]
Testosterone function (5)1. Differentiation of epididymis, vas deferens, seminal vesicles.
2. Growth spurt (Penis, seminal vesicles, sperm, muscle, RBCs).
3. Deepening of voice
4. Closing of epiphyseal plates (via estrogen converted from testoterone)
5. Libido
DHT function1)Early life (differentiation of penis, scrotum, prostate) -
2)Late life (prostate growth, balding, sebaceous gland activity)
Testosterone to DHT by5 alpha reductase
Testosterone and androstenedione are converted to estrogen by _ in _aromatase , adipose tissue and sertoli cells
Exogenous testosterone lead toinhibition of HPG axis decreasing intratesticular testosterone decreasing testicle size leading to azoospermia
Estrogen sourceovary, placenta, blood - potency=estradiol>estrone>estriol
Estrogen function (4)1. Development of genitalia and breast, female fat distribution.
2. Growth of follicle, endometrial proliferation, increased myometrial excitability.
3. Upregulation of estrogen, LH, and progesterone receptors, feedback inhibition of FSH and LH, then LH surge; stimulation of prolactin secretion (but blocks its action and breast)
4. Increased transport of proteins, SHBG, ⇡HDL, ⇣LDL
Progesterone sourceCorpus luteum, placenta, Adrenal cortex, testes
Progesterone function (8)1. Stimulation of endometrial glandular secretions and spiral artery development
2. Maintenance of pregnancy
3. ⇣ myometrial excitability
4. Production of thick cervical mucus which inhibits sperm entry into the uterus
5. ⇡ body temperature
6. Inhibition of gonadotropids (LH,FSH)
7. Uterine smooth muscle relaxation (preventing contractions)
8. ⇣ estrogen receptor expressivity
Menstrual cycle overviewEstrogen surge leads to LH surge which leads to ovulation and then progesterone (from corpus luteum) keeps endometrium up then menstruation (via apoptosis of endometrial cells)
Stimulant of endometrial proliferationEstrogen [effect on endometrium]
Maintainer of endometriumProgesterone [effect on endometrium]
⇣ progesterone ⇢⇣ fertility [caused by decreased in which hormone]


Question Answer
Oligomenorrhea> 35 day cycle
Polymenorrhea< 21 day cycle
Metrorrhagiafrequent but irregular menstruation
Menometrorrhagiaheavy, irregular menstruation at irregular intervals
Ovulationcaused by LH surge - an increase in estrogen increases GnRH receptors on anterior pituitary - estrogen surge then stimulates LH release - and the temperature increases (progesterone induced)
Mittelschmerzblood from ruptured follicle causes peritoneal irritation that can mimic appendicitis
OogenesisPrimary oocytes begin meiosis 1 during fetal life and complete meoisis 1 just prior to ovulation [describes what process?]
Meiosis I arrested inprophase 1 for years until ovulation
Meiosis II arrested inMetaphase 2 until fertilization (Secondary oocytes) - and egg MET a sperm
Most common site of fertilizationupper end of fallopian tube (ampulla) - occurs within 1 day after ovulation
Implantation w/n wall of uterus occurs _________ days after fertilization6 [days after fertilization when this occurs]
Syncytiotrophoblasts secretebHCG (which is detectable in blood 1 week after conception and on home test in urine 2 weeks after conception) [secreted by what]
Lactation-After labor decrease in progesterone induces it.
-Suckling increases oxytocin and prolactin via increase nerve stimulation
ProlactinInduces and maintains lactation and decreases reproductive function
OxytocinAppears to help with milk letdown and may be involved with uterine contractions (function not yet entirely known)
hCG sourceSyncytiotrophoblast of placenta [source of what?]
hCG function (3)1. Maintains the corpus luteum (and thus progesterone) for the 1st trimester by acting like LH (otherwise no luteal cell stimulation and abortion results). In the 2nd and 3rd trimester, the placenta synthesizes its own estriol and pogesterone and the corpus luteum degenerates.
2. Used to detect pregnancy because it appears early in the urine
3. Elevated hCG in pathologic states (hydatidiform moles, choriocarcinoma, gestational trophoblastic tumors)
Menopause⇣ estrogen production due to age-linked decline in number of ovarian follicles. Average age of onset is 51 years (earlier in smokers). Usually preceded by 4-5 years of abnormal menstrual cycles source of estrogen after menopause becomes peripheral(estrone) conversion of androgens. ⇡ androgen cause hirsutism
Hormonal changes in menopause⇣estrogen, ⇡⇡ FSH, ⇡LH (no surge), ⇡GnRH, ⇡⇡FSH [hormonal changes when?]
Menopause sxHHAVOC: Hirsutism, Hot Flashes, Atrophy of the Vagina, Osteoperosis, Coronary artery Disease