Mock Exam Review Reproductive GU PDF

Mock Exam Review Reproductive GU Undral Munkhsaikhan MS, MD [email protected] Office: LMU Tower 324 Phone: (865) 370-2109 Urethritis Urethritis is the inflammation of the urethra. Causes: Gonococcal Non-gonococal urethritis: E coli, Chlamydia trachomatis, Mycoplasma genitalium, etc. Par...

Mock Exam Review Reproductive GU Undral Munkhsaikhan MS, MD [email protected] Office: LMU Tower 324 Phone: (865) 370-2109 Urethritis Urethritis is the inflammation of the urethra. Causes: Gonococcal Non-gonococal urethritis: E coli, Chlamydia trachomatis, Mycoplasma genitalium, etc. Part of Reiter syndrome (urethritis, conjunctivitis, arthritis) Associated with prostatitis, cystitis, and urethral cancer Lower urinary tract parts: ureters, urethra, and urinary bladder Infection of Urinary Bladder Risk Factors: Women 10x more likely than men to get UTIs Shorter urethra, closer to fecal flora Sexual activity Urinary catheterization Diabetes Pregnancy Male & Female Urinary System Infection of Urinary Bladder E. coli (75-95%) Cystitis Infection of bladder Lower urinary tract Pyelonephritis Infection of kidneys Upper urinary tract Most infections ascend Urethra  Cystitis  Pyelonephritis Infection of Urinary Bladder Symptoms Cystitis Dysuria (pain with urination) Frequency (going a lot) Urgency (always feel like you have to go) Suprapubic pain No systemic symptoms Usually normal plasma WBC count Hematuria Pyelonephritis Systemic symptoms (fever, chills) Flank pain Costovertebral angle tenderness (CVA) tenderness Hematuria WBC casts https://www.stepwards.com/?page_id=1736 Bladder Tumors >95% of bladder tumors are of epithelial origin Most common malignancy in the urinary system Risk factors: Smoking tobacco (increases risk 4X) Exposure to certain chemicals, such as those used in the dye, rubber, and leather industries. Chronic bladder inflammation or infections. Older age. Gender (men are more likely to develop bladder cancer than women). Family history of bladder cancer. Human papilloma virus Iatrogenic: radiation, cyclophosphamide, analgesics, etc Turner syndrome (45,XO or 45X) Genetically female Partially or completely missing an X chromosome Symptoms (without hormone treatment) Do not develop menstrual periods Do not develop breasts Infertility Congenital heart defect Short stature Edema of wrists and ankles in newborn Cystic hygroma in utero resulting in excess nuchal skin and “webbed” neck Klinefelter syndrome (47,XXY) Genetically male Aneuploid genetic condition Additional copy of the X chromosome The most common chromosomal disorders Symptoms: Testicular atrophy Infertility Gynecomastia (breast growth) Female distribution of hair Low testosterone Elevated FSH and LH High-pitched voice Klinefelter syndrome, diagnosed at age 19. Organ Testes (2) Scrotum Organs of the Male Reproductive System Function Produce sperm and testosterone (male sex hormone) Encloses and protects testes Epididymis (2) Portion of the seminal duct in which sperm mature and are stored Ductus deferens (2) Transport sperm during ejaculation upward inside the spermatic cord to the urethra Prostate gland Produces semen, the fluid that carries sperm; this fluid helps protect sperm from the vagina’s acidity during ejaculation Seminal vesicles Secrete the majority of the fluid (alkaline and rich in fructose) in semen (2 pair) Bulbourethral glands Secrete fluid that lubricates urethra and end of penis (Cowper’s gland) Ejaculatory ducts (2) Receive sperm and additives to produce seminal fluid; run through the prostate and open into the urethra Penis Male sexual organ that passes both urine and sperm Pathway of sperm during ejaculation Seminiferous tubules (Nothing) Urethra Epididymis Vas deferens Penis “SEVEN UP” Ejaculatory ducts First Aid 2021, p. 650 Organs of the Female Reproductive Systems Organ Function Ovaries Produces ova (female germ cells) and female sex hormones (estrogens and progesterone) Uterine tubes (fallopian tubes) Receive the ovum from the ovary and provide a site where fertilization of the ovum can take place. The tube serve as conduit along which the spermatoza travel to reach the ovum. Uterus Serves as a site for reception, retention, and nutrition of the fertlized ovum Vigina Not only is the female genital canal but also serves as the excretory duct for the menstrual flow and forms part of the birth canal Labia majora Form margins of pudendal cleft, enclose and protect the other external reproductive organs Labia minora Form margins of vestibule; protect openings of vigina and urethra Clitoris Provides feeling of pleasure during sitmulation Vestibular glands Secrete lubricating fluid into vestibule and viginal opening during coitus Mammary glands Produce and secrete milk for the nourishment of an infant Bartholin's glands They secrete mucus to lubricate the vagina and are homologous to bulbourethral glands in Pregnancy - Implantation Blastocyst implants in uterus about day 6-10 β-hCG secretion begins Pregnancy - Twins One pregnancy: two babies Dizygotic twins Two zygotes Two separate ova fertilized by two separate sperm Two siblings born from a single pregnancy “Fraternal twins” Monozygotic twins One zygote divides in two One ova fertilized by one sperm “Identical twins” Menstrual Cycle Phase I: Menses and the Follicular Phase Phase II: Ovulation (proliferative) Phase III: Luteal Phase (secretory) 1-13d 14-28d Ovulation is triggered by LH. FSH stimulates the growth and development of follicles in the ovaries, which contain oocytes (egg cells), and the growth and maturation of reproductive cells (oocytes and sperm). Estrogen levels cause the pituitary gland to release LH. Estrogen causes the endometrium to grow and thicken Progesterone promotes the thickening and maintenance of the uterine lining (endometrium) in preparation for the possible implantation of a fertilized egg. Breast Cancer Breast cancer is the most common cancer affecting women and is the second most important cause of death (after lung cancer) in women aged 35 to 54 years. This tumor is almost always an adenocarcinoma. Commonly in the left breast and outer upper quadrant. Widespread metastasis can occur by way of the lymphatic system and the bloodstream, through the other side breast, bone, liver, and brain. Predisposing Factors: Positive family history History of breast cancer in one breast Early menarche and late menopause Diet high in animal fat Proliferative fibrocystic disease with atypical epithelial hyperplasia Obesity First pregnancy after 30 years of age Factors Associated with Reduced Risk of Breast Cancer Asian, Hispanic, or Pacific Islander race Breastfeeding = protective Age < 20 at first pregnancy = protective Tamoxifen (estrogen inhibitor) Prior risk-reduction breast surgery History of oophorectomy Exercise/active lifestyle Low bone mineral density Ovarian tumors Epithelial tumors Serous cystadenoma Mucinous cystadenoma Brenner tumor Serous carcinoma Mucinous carcinoma Sex cord tumors Fibroma Thecoma Granulosa Cell Tumors Sertoli-Leydig Cell Tumor Ovarian Germ Cell Tumors Teratoma (Dermoid Cyst, Struma Ovarii, Immature Teratoma) Dysgerminoma Yolk Sac Tumor Choriocarcinoma Metastatic Cancer from non-ovarian primary Classification (WHO) of Ovarian Tumor Ovary is composed of three cell types. Tumor can arise from any of these cell types. 1. Surface epithelial tumor– adenomas/carcinomas Serous (common) Mucinous (common) Endometrioid Transitional Cell (Brenner) Other (e.g., Clear Cell Carcinoma) 2. Germ cell tumor - derived from oocytes 3. Sex cord tumor - derived from ovarian stroma First Aid, USMLE Ovarian Germ Cell Tumors Germ cell tumors (oocytes) Occur in young women Usually, 10 to 30 years old Many secrete AFP or β-hCG Tumors of germ cell derivatives Germ layers (Teratoma) Germ cells (Dysgerminoma) Yolk sack (Yolk sac tumors) Placental tissue (Choriocarcinoma) Mixed malignant germ cell tumor Teratoma Most common overall germ cell tumor Cells from all three germ layers Ectoderm (skin, hair follicles) Endoderm (lung, GI) Mesoderm (muscle, cartilage) Benign form (mature): Dermoid cyst Malignant form: Immature teratoma Rare mono dermal forms Men: Most Common Types of Cancer Prostate > Lung > Colon > Bladder > Melanoma Women: Breast > Lung > Colon > Uterine > Thyroid Most likely to metastasize to the jaws in men: Lung > Kidney > Liver > Prostate Metastasis of Cancers to the Jaw Most likely to metastasize to the jaws in women: Breast > Ovarian – Kidney > Colon Signs of jaw metastasis: Swelling, pain, & paresthesia Hypothalamic pituitary gonadal axis Hypothalamus -> GnRH-> LH & FSH ->Testis release testosterone in males / Ovary release estrogen in females-> Secondary sex characteristics & spermatogenesis in males/folliculogenesis for females. Sertoli cells Sertoli cells are activated by the follicle-stimulating hormone (FSH) secreted by the anterior pituitary. At puberty, FSH is essential for the initiation of spermatogenesis. Sertoli cells are elongated (tall columnar), non-dividing cells located in the seminiferous tubules of the testes. Function: Sertoli cells serve as nurse cells for spermatogenesis. They attach to germ cells and provide structural and biochemical support. Sertoli cells also transfer nutrients and other substances from the blood to the developing sperm. They form adheres-type junctions and gap junctions with all the development stages of sperm cells. Leydig cells Found adjacent to the seminiferous tubules in the testicle. LH primarily acts on the Leydig cells in the testes, stimulating them to produce and release testosterone. LH is secreted by the anterior pituitary gland in response to gonadotropin-releasing hormone (GnRH) released by the hypothalamus. When LH binds to receptors on Leydig cells, it stimulates them to produce and release testosterone. Pharyngeal Apparatus Embryonic structure Key for development of head and neck Three components 1. Pharyngeal arches (1st, 2nd, 3rd, 4-6th) 2. Pharyngeal clefts (1st, 2nd, 3rd, 4th) 3. Pharyngeal pouches (1st, 2nd, 3rd, 4th) 24-28 Day Old Embryo Arch Nerves Muscle 1st CN V (chew) Muscles of mastication (temporalis, masseter, pterygoids), anterior digastric, mylohyoid tensor tympani. 2nd 3rd 4th -6th Cartilage Vessel Maxillary process (Maxilla, Zygomatic bone). Mandibular process (Mandible, incus and malleus) Maxillary artery CN VII (smile) Stapedius, Auricular muscles, Stylohyoid, Posterior digastric, Muscles of facial expression. Reichert’s cartilage: Stapes (middle ear), Styloid process, Lesser horn of hyoid. Stapedial artery (Embryonic vessel) Hyoid artery (Embryonic vessel, Develops into a small branch of the internal carotid) CN IX (swallow) Stylopharyngeus Greater horn of hyoid Common carotid, Proximal internal carotid artery CN X (swallow and speak) 4th- Cricothyroid, Levator palatini, Pharyngeal constrictors. 6th- All intrinsic muscles of larynx except cricothyroid Both arches fuse to form larynx cartilage – Thyroid, Arytenoid, Cricoid, Corniculate, Cuneiform. 4th Arch (aortic arch, right subclavian artery) 6th Arch (pulmonary arch, left and right pulmonary artery, ductus arteriosus) Pouch Derivatives 1st Eustachian tube and middle ear cavity 2nd Lining of the palatine tonsils 3rd Dorsal – Inferior parathyroid glands Ventral – Thymus 4th Dorsal – Superior parathyroid glands Ventral – Ultimobranchial body (C cells) Cleft Lip and Palate Cleft lip: Most common craniofacial malformation Cleft lip and palate often occur together. 1 in 1,600 babies is born with cleft lip and palate in the United States. Cleft lip and palate result from tissues of the face not joining properly during development. Multifactorial etiology: Environmental Medication (antiseizure, methotrexate) Vitamin deficiency Obesity Genetic Cleft Lip The lip forms between the 4th to 7th weeks of pregnancy. 1 in 2,800 babies is born with cleft lip in the United States. Openings in a baby's upper lip Primary palate (front of palate) Due to failure of fusion of the intermaxillary segment (merged medial nasal processes) with the maxillary process (formation of 1° palate). A cleft lip may be detected with ultrasound around the 13th week of pregnancy. Need repair between 1 and 5 years of age. Cleft Palate The roof of the mouth (palate) is formed between the sixth and ninth weeks of pregnancy. 1 in 1,700 babies is born with cleft palate in the United States. Due to failure of fusion of the two lateral palatine shelves or failure of fusion of lateral palatine shelf with the nasal septum and/or 1° palate (formation of 2° palate). Openings in a baby's roof of the mouth (palate). Tongue During the 4th week of embryonic development, the tongue appears in the form of two lateral lingual swellings and one medial swelling, the so-called tuberculum impar. Anterior two-thirds: 1st and 2nd arches. Sensation: CN V (1st arch) Taste: CN VII (2nd arch) Posterior third: 3rd and 4th arches Sensory: CN IX (3rd arch) Some posterior taste CN X (4th arch)