1
Q
Name the 9 organs that form the male reproductive system
A
scrotum testes epididymis vas deferens prostate seminal vesicles cowper's glands urethra penis
2
Q
Describe the anatomy of the scrotum
A
a sac composed of skin, fascia, and smooth muscle (dartos muscle).
Supports the testes with optimum temperature to produce spermatoza
3
Q
Where does the production of sperm take place??
A
Testicles are divided into lobules which then contain sminiferous tubules which are coiled. It is here that soernatigebesis takes place. Sertoli cells in the epithelial lining, support the spermatoza.
4
Q
What do intersitial cells of leydig produce?
A
androgen, particularly testosterone.
5
Q
There are several ducts that carry sperm from the seminiferous tubules to the exterior of the body. Name them (4)
A
- epididymis- a coiled tube that runs along the posterior side of the testis,
- Vas deferens0 con;t of epi, within spermatic cord- which also contains blood, vessels, nerves, and cremaster muscle
- ejaculatory ducts- formed by saccular dilation at the end of the vas deferens and the duct of seminal vesivles.
- urethra- tubes that extends from the bladder to the glans penis.
6
Q
The urethra is composed of 3 parts. Name them-
A
- prostatic urethra (receives secretions from prostate gland)
- cavernous urethra (surrounded by erectile tissue)
- membranous urethra (surrounded by the external urethral sphincter.
7
Q
The male reproductive system also includes accessory glands that produce fluids that serve to keep sperm viable and carry them from the body. This mixed fluid is called sperm. Name the 3 accessory ducts
A
- seminal vesicles- small sacs behind bladder. secrete an aljaline substance that nourish and protect sperm
- prostate gland- the size and shape of the chestnut. Secretes alkaline substance that increases sperm motility and ability to survive acidic environments.
- cowper’s (bulbourethral) glands- Size of a pea. Produce alkaline mucous-containing secretion that lubricates, protects
8
Q
The penis is composed of 3 parts. Name them
A
- root-
- body- formed by 3 cylindrical masses of erectile tissue.
- Glans penis- the highly innervated tup of the penis
9
Q
How is an errection formed?
A
Arterioles dilate when stimulated, allowing more blood to flow into the veins that can drain away, producing an errection. This is an Autonomic nervous system response.
10
Q
Which two hormonal systems control the male reproductive system
A
testicular hormones - testosterone, and androstenedione and dihydrotestosterone
pituitary/hypothalamic hormones
11
Q
Following puberty, testosterone is responsible for male secondary sexual characteristics…. name them (5)
A
- growth and development of male genitalia
- male pattern hair distribution
- enlargement of the larynx and lengthening of vocal crds,
- increased sweat and sebaceous gland activity
5;. increaser muscle and bone mass, metabolic activity and RBC mass, and increase O2 capacity
12
Q
What is GnRH (Gonadotropin releasing hormone)
A
Its produced by the hypothalamus to stimulate the production of pituitary hormones. Hormones secreted by the pituitary, control androgen production and tesitcular funtion.
13
Q
What is FSH (follicle stimulating hormones)
A
produced by pituitary gland and acts on receptors in the seminiferous tubulews to produce spermatoza.
14
Q
What is LH (luteinizing hormone) - AKA- interstitial cell stimulating hormone
A
it affects the receptors in the interstitial cells of Leydig to produce and secrete testosterone. Increased lev els of testosterone act to inhibit the secretion of GnRH and decrease production of FSG and LH.
15
Q
What are the 7 organs that form the female reproductive system?
A
- ovaries
- fallopian tubes
- uterus
- cervis
- vagina
- external genitalia or vulva
- breast
16
Q
After puberty, one oocyte is releases from the follicular cells to form primordial follicles. What hormones control its release?
A
puituitary gonadotropic hormones (GnRH, FSH and LH). The empty follicle undergoes changes to become the corpus Luteum (yellow body). The lutein cells of the corpus luteum produce estrogen and progesterone.
17
Q
Where foes fertilization of the ova usually take place?
A
fallopian tube
18
Q
describe the uterus
A
hollow, muscular organ. I lies in the pelvis between the rectum and urinary bladder. It is composed of 3 layers
- perimetrium (serosa)
- myometrium (smooth muscle)
- endometrium
19
Q
The endometrium is composed of epithelial cells and glands, and there are 3 distinct parts. Name them
A
- fundus- round portion,
- body- thick-walled central portion
- cervix- constricted neck that protrudes into the vagina.
20
Q
describe the breast
A
milk-producing glands located on front of chest. They are composed of 15-20 irregularly shaped lobes of glandular tissue, that produce milk when cued by specific hormones after pregnancy.
21
Q
What are the 5 principale female hormones?
A
Hypothalamic GnRH, pituitary FSH and LH, as well as estrogen and progesterone secreted by the ovaries.
22
Q
What does estrogen do to the body?
A
causes growth of reproductive organs, regulates fat deposition, lipid and calcium metabolism, hypothalamic temperature, vasomotor activity, and the production of vaginal secretions.
23
Q
Define menopause
A
one year of amenorrhea (no mentration) in midlife due to the final phase in the maturation of the female reproductive system. Can also be caused by removing ovaries or chemically with medication that interferes with the action of estrogen.
- sxs include: hot flashes, insomnia, night sweats, depression, emotional irritability.
- Tx’ed with HRT-
24
Q
What is BPH?
when does it occur
what is happening when it occurs?
A
- benign prostate hypertrophy
- males >45 yo,
- glandylar tissue thickens d/t stimulation by testosterone, producing nonmalignant hyperplasia- exrtra mass pushes on bladder and urethra causing sxs of discomfort and severe complications.
25
How is BPH treated?
- mild sxs = waiting
-non-invasive Rx that black the action of testosterone. (proscar and avodart, cardura, uroxatreal, flomax)
- minimaly invasive: TUMT, TUIP, TUNA, ILC
and VLAP
- invasive: TURP- for severe sxs.
26
Which two medications reduce PSA by 50%?
>> Finasteride and dutasteride. (proscar and avodart)
27
What is a typically screening test used to evaluate condition of the prostate?
PSA serum levels.
Note it is a prostate-tissue specific agent but not a prostate-cancer specific agent. Using a lower threhold to define and abnormal PSA is helpful, suchs as DRE test, to increase the value of the +ve.
28
Does the predictive value of a normal PSA change?
Yes, it increases as people age.
29
In the serum, PSA circulates in two forms, what are they?
1. free PSA
2. PSA bound to other proteins.
The ration between the two has been used to increase the likelihood of findings cancer when considering a biopsy.
30
What is protatits
Inflammation of the prostate. It can be acute or chronic., bacterial/nonbacteroial, inflammatory or non-inflammatory.
31
What is the tx options for pathogen-associated prostatitis-
1. antimicrobial drugs / abx > anti-inflammatory agents > surgery
2.
32
How is a prostate abscess dx?
Ultrasound
33
What is prostatodynia?
a condition that mimics prostatitis but without evidence of infection or inflammation.
- called chronic nonbacterial prostatitis, or chornic nonbacterial prostatis or chronic pelvic pain synfrom
- tx'ed with sxs relief.
34
An underlying caused of prostatitis is prostate stones. What is this? how is it dx?
detected via ultrasounds. its causes a blockage of the glandular ducts which builds up the prostatic secretions. These fluids then dry up and calcify
This can harbour pathogens,
difficult to remove, prostatic massage can help break the stones up,
35
Define Testicular cancer
- highly treatable, with orchiectomy and for advances stages radiation/chemo + therapeutic approaches
- occurs in young men
- sxs, heavy feeling in area of testies
- dx with ultrasound, CT and chest xrays. Blood work is done before surgery
- divided into two kinds
36
What are the two histologic types of testicular cancer?
1. seminoma - sensitive to radiation, 90% cure rates
| 2. non seminoma, - lower cure rate and depends on stage
37
What are examples of nonseminoma tumors?
1. embryonal carcinoma
2. teratoma,
3. yolk sac carcinoma
4. choriocarcinoma
38
How is testicular cancer classified?
TNM classification
39
What is Epididymitis and Orchitis?
infections of the testes and supporting structures.
- bacterial, such as UTI and STD, virusus
- tx'ed with and anti-inflammatories.
40
What is testicular atrophy, and what causes it?
failure of the testes to thrive and thus shrink or wither- cant produce sperm/testosterone
caused by abuse of anabolic steroids, trauma, infection
41
What is cryptorchism?
the failure of one or both testes to descend into the scrotum from the body. If not corrected, it can present a high risk of cancer in adult hood.
42
What is hydrocele?
a maass in the scrotum resulting from excessive accumulation of fluid.
ie from overproducting lymph secondary to inflammation of obstruction. possibly congential.
-tx'ed with survery, aspiration, injuection of sclerotic drugs
43
What is spermatocele (cyst)
a mass or cystic structure, typically found at the top of the testis.
- dx by ultrasound, and tx'ed with surgery or aspiration
44
What is vericocele?
swelling in the scortum caused by varicose veins.
dx by exam and ultrasound
can cause infertility, tx'ed by surgical lifation of veins.
45
What is Erectile Dysfunction?
the inability to initiate or maintain an erection.
- increases in prevalance with age
- causes: hormonal, psychological, vascular, or neurological impairements.
- cause is endothelial dysfunction associate with diabetes, HTN, atherosclerosis, MS, nerve damage
46
How do you tx ED?
silenafil citrate- Viagra. Causes increased relaxation of the muscle tissue in arterial walls, which improves the blood flow. (all arteries are affected)
>> note that this Rx does not produce erections- sexual excitation must also be present
47
What is Fibrocystic disease?
A general term that encompases a variety of conditions of the breast that involve lumpiness, cysts, or inflammation. Fibrocystic disease can be accompanied by mastalgia.
- caused by hormonal changes that cause swelling.
- tx'ed with anti-inflammatories, or estrogen inhibiting Rx. Aspiration if needed.
- dxed with exam, mammogram, ultrasound
48
What are fibroadenomas?
benign tumors
dx with ultrasound,
tx with excision or cryoablation
49
What are examples of benign tumors ? which can only be dx'ed with a biopsy? ***
1. fat necrosis
2. fibroadenomas
3. sclerosing adenosis ***
50
What is Ductal papilloma?
A benign tumor derived from epithelial cells lining the milk ducts
- sxs: bleeding,
- dx: by a galactogram (ductogram)
- tx: surgical removal
* can sometimes become malignant: papillocarcinoma
51
What is Pagets disease of the breast?
- form of ductal carcinoma in situ,
- sxs: crusting scaling erosion of the nipple, milky discharge or blody.
- benign, but can become malignant.
52
What is endometriosis?
occurance of endometrial tissue outside of the uterine cavity.
- bleeding frm the tissue outside of the uterus causes local inflammation, formation of scar tissue, and/or cystic structures (endometriomas) that contain blood, fluid and menstrual debris
- can have underlying genetic component, can rise d/t surgery complication, or retrograde menstration
- Sxs: infertility, painful menstruation, dyspareunia (pain sex),
- dx by visualization of the lesion at time of surgery or by biopsy via laparoscopy
- tx: drugs that affect the female hormone cycle/induce menopause-like state, surgery to remove uterus/ovaries, laser abalation
53
NAme the 8 kinds of various abnomal uterine bleeding
1. amenorrhea- absence of menstrual periods
2. dysmenorrhea- painful menstrual periods
3. oligomenorrhea- infequent menstrual period
4. polymenorrhea- cyles <21 days
5. menorrhagia- abN long mentrual periods,
6. metrorrhagia- bleeding between regular periods
7. postmenpausal bleeding
8. dysfunctional uterine bleeding- hormonal abnomalities
54
How is abnormal bleeding dxed?
- age and ovulatory status- leads to investigations based on R/O method. This can involve
1. physical examination,
2. evaluation for pregnancy
3. evaluation of ovarian, thyroid and coagulation factors
4. pap smear
5. u/s CT
55
What are some disorders associated with abN uterine bleeding?
- adenomyosis: benign endometrial invasion of the myometrium,
- leiomyoma (fibroids)
- malignancy
56
What are some causes of post-menopausal bleeding?
1. atrophic vaginitis
2. atrophic endometrium
3. endometrial polyps
4. endomertial hyperplasia ( >4mm endometrial thickness is bad)
57
When is Dysfunctional uterine bleeding seen? (DUB)
adolescents,
| - refers to bleeding associated with hormonal imbalance. - oe estrogen, endometrial hyperplasia, PCOS
58
How is abN uterine bleeding tx'ed?
hormonal tx
dilation and curettage of endocervix and uterine cavity,
induction of ovulation with clomiphene
hysterectomy
59
What is Polycystic Ovarian Syndrome?
PCOS-
features: ^ androgens, ovulatory dysfunction, abN menstrual cycles, obesity, abN facial hair, and common infertility
causes: primary hyperandrogegism, adrenal hyperplasia, hypothalamic-pituitary dysfunction, ^ insulin resistance.
dx: hormonal testing/ u/s
Tx: underlying cause if possible, metformin, contraceptives
60
What is pelvic inflammatory disease (PID)"?
acute infection of female genital tract caused by # of pathogens. Can include fallopian tubes, and uterine lining with the possibility of spreading to other tissues and organs. PID can lead to peritonitis.
sxs: inflammation, pain, fever, dischage, abN uterine bleeding.
dx: exam with tenderness, abN discomfort, ^ WBC of secretions and ^ CRP
tx: abx and surgery to drain abscesses if needed
61
Define Uterine Fibroids (leiomyomas)
benign tumors of smooth muscle tissue in the uterine wall and adjoining structures.
- can grow and cause pain/bleeding/reproductive dysfunction.
- genetic predisposition, response to injury, present of growth factors,
- dx: physical exam and/or u/s
tx- estrogen blocking drugs, surgery, hysterectomy, localized destruction of the fibroid by myolysis, artery embolization
** Needs to be followed- can develop to malignancy
62
Family history has a role in the development of gynecologic tumors. Which two syndromes are genetically linked to an increased risk of developing genitourinary disorders?
1. Hereditary nonpolyposis colorectal cancer (HNPCC)
| 2. breast and ovarian cancer syndrome (linked to BRCA1 and BRCA 2 genetic mutations.
63
Differentiate between the two types of endometrial cancers
1. type 1- ^ levels of estrogen, most common, low grade with ^ progesterone receptors
2. type 2- not associated to ^ level of estrogen, and tend to metastasize readily, papillary serous or clear cell hystologies. high-gade with low profesterone receptor levels.
64
How is endometrial cancers diagnosed and txed?
incidental discovery for those who are Asxs- pap test, travasvaginal ultrasonography, endometrial biopsy, hysterscopy with dilation and curettage or sonohysterography is indicated
Surgery, followed by radiation or chemo, if indication.
65
Who are more at risk for developing Type 1 endometrial cancers? (6)
1. unopposed estrogen tx
2. used tamoxifen
3. morbidly obese
4. diabetic + HTN
5. hx of ovulatory dysfunction
6. genetic predisposition
66
Who are more at risk for developing Type 2 endometrial cancers? (6)
older, >70 yo,
67
Is ovary cancer congenital/familial?
yes 5-10% are familial, with highest risk amound those with 2+ first-degree affected.
68
How is ovary cancer typically dx'ed and tx'ed
CA 125, hCG, LDH and trasvaginal ultrasonography
surgery, pelvic washing, sampling of lymph nodes.
radiation and chemo recommended for advanced stages
69
What are some good prognostic factors for ovarian cancer?
1. young age
2. good response to tx
3. lower-stage well-differentiated histology
4. cell type, other than mucinous and clear cell
5. smaller disease volume before surgery
6. absence of ascites before tx
70
What is the most frequent histological type of cervical cancer?
squamous cell followed by adenocarcinoma.
71
Squamous cell carcinoma of the cervix is associated with what infection?
HPV
72
What is the purpose of a pap exam?
screening efforts for HPV and other abN disease.
they can detect CIN or cervical dysplasia early and enables tx of the cervical cancer early
73
What are some sxs of cervical cancer?
How is it dxed?
How is it txed?
1. vaginal discharge, abN bleeding, Pelvic pain
2. dx by pap and biopsy
3. tx by surgery (hystrectomy) , or conization
74
What is Cancer of the Vulva?
| ie. Vulvar intraepithelial neoplasia (VIN)
associated with HPV infection
- females with hx of SCC or vaginal cancer are at higher risk
- most are squamous cell tumors
- sxs open lesion and itching.
Tx with local excision, or laser ablation or total vulvectomy with lymph node disection
75
Most vaginal cancers are what type of carcinomas?
squamous cell carcinoma.
76
Exposure to Diethylstillbestrol (DES) before birth is associated to what?
develpment of clear cell adenocarcinoma of the vagina, Vaginal sarcoma, and sarcoma betryoides.
77
What are the sxs of vagina cancer
what is the dx
what is the tx
1. bleeding, fistulas, dyspareunia
2. pelvic exam, pap test, biopsy
3. radiation therapy, radical surgery
78
What are the leading causes of maternal deaths in pregnancy complications
1, MVA
2. thromboembolic disease
3. aneathesia complications
4. hemorrhage
5. infection
6. HTN
79
What are some blood test results that are altered during pregnancy?
1. increase RBC, blood mass
2. IDA,
2. ^ cholesterol
4. increase Alk. phos
5. Decreased Albumin
6. decreased BUN
7. decrease Ca
8. decreased immune system reactivity
9. increase coagulability
10. increased insulin released but decreased insulin sensitivity
80
What is pre-eclampsia
is a sundrome that arises suddenly, if untx'ed can lead to eclampsia.
- sxs: HTN, proteinuria, edma
- txed with observation.
81
What is Eclampsia
pregnancy complication which can be fetal
sxs include: HTN, proteinuria, edma and seizures and coma,
once baby is delivered, recovery is usually rapid
82
What is Hyperemesis gravidarum (HG)
excessive nausea and vomiting during the first trimester of pregnany.
- develops sxs of dehydration, acidosis, and abN weight loss
- can cause liver damage
- tx;ed with rehydration, electrolutes and vitamins, a bland diet is recommended.
83
What is HELLP Syndrome
- similar to pre-eclampsia and eclampsia. Its defined by hemolysis, elevated liver enzymes, low platelet
84
What is Cholestasis of pregnancy?
elevated hormones on bile transport
intence itching, develops - associated with jaundice and dark urine.
tx'ed with cholestyramine and vit K
85
What is acute fatty liver of pregnancy
rare disorder
- sxs of nausea, vomiting, abdo discomfort and jaundice, LFTs are elevated
- biopsy shows small fat droplets
- mortality is high
- tx'ed with termination of the pregnancy
86
What is peripartum cardiomyopathy
heart dilated, increased risk of congestive heart failure, arrhythmia and pulmonary emboli
dx late/after pregnancy
sxs of dypnea, fatigue, ankle edema, nocturia and palpitations
sometimes heart will return to normal, if not heart transplant is required
87
What is Ectopic Pregnancy?
- occurs when the zygote implants itself outside the uterine cavity.
- ^ mortality d/t tissue rupture
- risks include inflammatory disease, hx of abortion, previous ectopic pregnancy
- sxs of adbo pain, and syncope.
- dx'ed with u/s laparoscopy
- tx'ed with surgery removal
88
What are Gestational Trophoblastic Tumors ( GTTs)
rare and highly curable tumor that arise from the products of conception in the uterus
sxs: bleeding, enlarging uterus, passage of grape-like molar tissue
dx with ultrasound, serum levels of beta-hCG
89
What is the most common form of GTT?
hydatidiform mole (molar pregnancy) a genetic disorder of pregnancy in which only placental tissue is present.
90
What is the less common form of GTT?
invasice mole, which is a locally invasive by rarely metastatic lesion.
91
Define HPV, sxs and tx.
1. HPV- several types, >> cause genital warts
- ^^ risk with multiple partners
2. tx'ed with electrocauterization, laser, cruotherapy, excision. Typocal tx and caustic agens are also used but not always effective.
92
What causes Gonorrhea?
What are the sxs
what are the complications?
What are the tx options
1. bacterium Neisseria gonorrhoeae or (GC)
2. burning, itching, and discharge.
3. urethrits/epididymitis in M
salpingitis and PID in F
4. abx
93
What causers syphilis?
what are the sxs?
how is it tx'ed?
1. caused byspirochete teponema pallidum. It infiltrates lumphocytes
2. painless ulcer called a chancre- if not tx'ed will heal in 4-8 weeks. Then a rash develops 6-12 weeks after, sxs of enlarged spleen/liver, fever, headache, anemia, jaundice and albuminuria. if untx'ed can lead to endarteritis obliterans. and body wide masses, ulcerations and necrosis.
3. penicillin, abx, unless contraindicated. F/U is required,
94
What causes Herpes?
What are the sxs?
how is it dxed?
What is the tx?
1. Herpes simplex virus (HSV)- two serotypes: tyep 1, HSV-1 and HSV-2.
2. aSXS or painful ulcerated lesions, fever, enlarged lymph nodes. Sxs occur without breaks
3. Assays of blood, cell culture oe PCR for HSV DNA.
4. topical and oral medication
95
What are HSV-1 sxs
cold sores, fever blisters,
96
What are HSV-2 sxs?
sores and lesions in genital region, although cross contamination with HSV-1 does occur
97
What causes chlamydia?
What are the sxs?
how is it dxed?
what is the tx?
1. bacterium Chlamydia Tranchomatis
2. urethritis, epididymitis, infertility and reiter syndrome in M. Sxs include cervicitis, PID, infertility or ectopic pregnancy in F.
3. test for gram stain
4. abX
98
What causes Chancroid?
What are the sxs?
what are the complications if untx'ed?
how is it tx'ed?
1. bacillys haemophilus,
2. painful, irregular shaped ulcers,
3. lymphadenopathy, lymph node abscesses, severe tissue destruction
4. abx
ALU 201
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