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RP (Male, Female, Lymphatic drainage, Embryo), Pregnancy by…

- - - - Tunica vaginalis
    - - P§: Defect gubernaculum or connect processes vaginalis
        
        Impaired spermatogenesis by Intolerance > 37° of Sertoli cell
        
        Lab: Hormonal T, but (-)Inhibin
        
        Consequence by Rick of germ cell tumor
    - - P§: Pass through Deep & Superfial Inguinal ring; inf. to epigastric artery due to failure closing processes vaginalis
        
        Infant present
    - - P§: pass through Inguinal triangle (Hesselbach) to Superficial ring; Medial to epigastric artery; Cover by External Spermatic fascia
        
        Present in Older man
    - - Getting above mass
        
        Positive in hernia
      - Transilumination
        
        Posirtive in Hydrocele
    - - Fluid retention due to failure of processes vaginalis fuse
    - - Genitofemoral branch
    - - P§: Pampiniform venous plexus dilate
        
        Left spermatic vein are common cause due to drainage to Left renal vein in high position
        
        Bag worm
        
        Consequence
        
        Infertility due to (+)Temp for sertoli cell
  - - - Leak beneath deep fascia or Superficial perineal space
      - Sexual action
        
        Erection by NO induce cGMP to Vd Parasym; Pelvic Splanchnic nerve
        
        Emission by Sym; Hypogastric nerve
        
        Ejaculation by Visceral; Peudenal nerve
    - - Associated
        
        Inguinal hernia
        
        Cryptorchidism
    - - GC
        
        Onset <5days
        
        Diplococci neg. Gram
        
        Tx: Ceftriaxone
      - NGC
        
        Onset more than week
        
        Non detect on gram stain
        
        Tx: Azithromycin or doxycycline
    - - by Chlamydria trachomatis sero L 1-3
      - SS
        
        Painless genital ulcer
        
        Recover
        
        Inguinal painful lymphadenopathy
  - - - Sertoli cell
        (temp labile)
        
        Spermatogenesis by T & Sertoli cell support
        
        Spermatogonium to Spermatid
        
        Spermiogenesis
        
        Spermatid to Spermatozoa: Golgi-Cap-Acrosomal-Mature phase
        
        Inhibin
        
        Androgen binding protein
        
        Tight junction of blood-Testis barrier from immun
        
        Estrogen
        convert from T
        
        Close epiphyseal plate
      - Spermatogonium, Spermatocyte, Spematid, Spermatozoa(mitochondria at middle piece)
    - - Testosterone
        
        Piuitary
        
        FSH
        
        LH
        
        Libido
        
        Deep voice
        
        RBCs
        
        Internal genitalia
        
        DHT
        by 5 alpha reductase
        of peripheral tissue
        
        Prostate
        
        Penis
        
        Sebaceous gland
        
        Balding
    - - P§: XXY (Barr body appear)
        
        Gonadal non function
        
        Sertoli cell non function
        
        (-)inhibin
        
        High FSH
        
        Leydig cell non function
        
        (-)T
        
        High LH
    - - Testicular germ cell tumor
        (younger than 30 yo)
        
        Seminoma
        
        Histo: Fired egg
        
        Lab: (+)placental ALP
        
        Yolk sac
        
        Histo: Schiller-duval body (flomerular like)
        
        Lab: (+)AFP
        
        Choriocarcinoma
        
        Lab: (+)hCG
        
        Risk factor
        
        Cryptorchidism
        
        Klinefelter syndrome
      - Testicular lymphoma (old man)
  - - - P§: Hyperplasia common of transitional zone
      - PE: Smooth, Firm nodule
      - SS: Difficultu star & stop stream, Dysuria
      - Lab: (+)PSA
      - Tx: Finasteride(5alpha reducatse), Tamsulosin(alpha 1 blocker)
    - - Common at Peripheral zone or Posterior lobe
      - Lab: (+)PSA
      - Prefer bone metastasis
        
        Lab: (+)PSA & (+)ALP
        
        Bone pain
  - - - Urethral injury
        
        Leak to retropubic space
- - - - 1° oocyte Prophase I
        
        Ovulation
        
        2° oocyte Metaphase II
    - - Follicular cell
        
        FSH
        
        Granulosa cell
        
        Estrogen by Aromatase converting Androgen
        
        Estrogen surge
        
        (+) Thrombocyte, Coagulation factor
        
        (+)HDL
        
        Inducing prolactin production, but inhibit action
        
        Theca interna cell
        
        Androgen
        
        Ovulation
        
        Corpus luteum
        
        Progesterone
        
        3 more items...
        
        W/O hCG
        
        1 more item...
        
        hCG
        
        1 more item...
    - - P§: XO
        
        Short
        
        Coarctation
        
        Webbed neck (lymphatic defect)
        
        Horseshoe kidney
        
        Ovarian agenesis
        
        No development
        Secondary sex characteristic
        
        Lab: low E, high FSH, LH
    - - P§: Age decline ovarian follicle
        
        Lab: high FSH
      - SS by low E
        
        Hot flash
        
        Atrophy vagina
        
        Osteoporosis
        
        Sleep disturbance
    - - P§: HyperInsulinemia (insulin resistance) -> alterate feedback
        -> High LH:FSH -> High androgen -> Unrupture Follicle -> No ovulation
        
        Enlarge & Bilateral cystic ovary
        
        Tx
        
        Clomiphene
        
        Amenorrhea/Oligomenorrhea
        
        Hirsutism
        
        Tx
        
        Spironolactone, Finasteride, Flutamide
        
        Associated
        
        Endometrial CA
        
        Obesity & Acanthosis nigricans
    - - Risk
        
        BRCA-1/-2 gene mut.
        
        Infertility
        
        55 year above
        
        Lynch syndrome
      - Lower risk
        
        Preg
        
        Breastfeeding history
        
        OCP
      - Classification
        
        Surface epithelium
        
        Tumor marker CA 125
        
        Serous cystadenoma
        
        Mucinous cystadenoma
        
        Serous cystadenoCA
        
        Germ cell
        
        Teratoma
        
        Some develop to Struma ovarii
        
        Dysgerminoma
        
        Histo: Fried egg cell
        
        Yolk sac/Endodermal sinus tumor
        
        Schiller-Duval body(glomeruli like)
        
        AFP
        
        Child
        
        Choriocarcinoma
        
        Sex cord
        
        Granulosa Theca cell tumor
        
        Krukenberg tumor
        
        Mucin-secreting signet cell CA from GI metastasis
  - - - Uterine prolapse
    - - in Follicular phase of ovary
        
        Estrogen
        
        Proliferation phase
      - in Luteum phase of ovary
        
        Progesterone
        
        Secretory phase(inhibit proliferate)
        
        & Decidual
        
        & Spiral artery
      - Hormone withdrawal
        
        Mense
        ;Apoptosis by loss growth hormone
      - Endometrial tumor
        
        Endometrial hyperplasia
        
        Risk factor
        
        Unopposed estrogen
        
        PCOS
        
        OCP drug
        
        Granulosa cell tumor
        
        Endometrioid CA (>55 yo.)
        
        Risk factor
        
        Obesity
        
        DM
        
        Nulliparity
        
        Late menopause
        
        Lynch syndrome
      - Endometriosis
        ;outside endometrial cavity
        
        Gross: Blood-filled “Chocolate cyst”, Burn powder
        
        SS
        
        Dyspareunia, Infertility, Cyclic pelvic pain
    - - Leiomyoma (Myoma uteri)
        
        Smooth muscle tumor (smooth bundle with well-demarcated border)
        
        SS
        
        Estrogen sensitive = increasing size in preg.
        
        AUB
        
        Miscarriage
      - Adenomyosis
        
        P§: Endometrial gland in myometrium
        
        SS
        
        Enlarge uterus, Menorrhagia
  - - - Fertilization
        
        Implant
        
        Cytotrophoblast
        
        Syncytiotrophoblast
        
        hCG
        
        alpha subunit
        
        TSH
      - Ectopic preg
        
        Cause: PID, Surgery
        
        SS
        
        Amenorrhea with absent uterus implant
        
        Low hCG
  - - - Pubic
      - Ischial spine
      - Sacrum
    - - Superficial
        
        Pudendal nerve
        (Labor block at Ischial spine)
      - Deep & Superficial pouch
        
        Perineal nerve
      - Glan of penis / Clitoris
        
        Dorsal nerve
      - Root nerve
        
        Parasym (P)
        
        Pelvic Splanchnic n.
        
        Sym. (H)
        
        Hypogastric n.
        
        Visceral & Somatic (P)
        
        Pudendal nerve
    - - UG diaphragm
        
        Median Episiotomy
        (Risk of cutting perineal body & Superficial transverse muscle)
        
        Stress incontinence
        
        P§: Pelvic diaphragm weakness; common cause by Parity; stimulate by Cough, Sneez, Laugh
      - Pelvic diaphragm
        (ischiorectal fossa)
        
        Levator anal
        
        Coccyneus
    - - SS
        
        Non indurated ulcer
        
        Irregular border & dirty base
        
        Painful
        
        Buboes/Lymphadenopathy
      - Lab
        
        Neg. gram school of fish
    - - Painful Multiple Vesicles
      - Tzank smear
        
        Multi-giant nucleated cell with ground glass / Cowday A
    - - Primary (chancre)
        
        Indurate Genital ulcer
        
        Painless clear base
      - Secondary (disseminate)
        
        Condyloma lata
        
        Papulosquamous rash typical palm & sole (nonpruritic)
        
        Patchy alopecia (moth eaten)
        
        Generalized lymphadenopathy
      - Latent
      - Tertiary (Granuloma)
        
        Gumma (skin)
        
        Aortic aneurysms (tree bark appearance)
        
        Neurosyphilis
        
        Tebes dorsalis
        
        Absent Pupil reflex with Accommodation reflex intact
      - Congenital
        by vertical transmission
        
        Snuffle
        
        Osteochondritis (Celery stalk like on X-ray)
        
        Skin rash
        
        Hutchinson's teeth
      - Dx
        
        Screening: VDRL, RPR
        
        Dx: TPHA, FTA-ABS
      - Tx: Benzathine pen. G
  - - - P§: Loss pH(>4.5) = Loss homeostasis of normal flora
        dominent bacteria is Gardnerella vaginalis
        
        SS
        
        Dysuria
        
        Fish odor
        
        Gray leukorrhea
        
        Lab
        
        Whiff test positive
        
        Clue cell
    - - Sexual transmitted infection
        
        SS
        
        Frothy
        
        Yellow-green discharge
        
        Vulvar irritate
        
        Strawberry Cervix
        
        Lab
        
        Wet smear for jerking movement
      - Tx: Metronidazole (with partner in Tv)
    - - Immunocompromised, DM, Pregnancy
        
        SS
        
        Pruritus
        
        Dysuria
        
        Vulvar irritate
        
        Curd/Milk -like plaque
        
        Lab
        
        Wet smear for Pseudohyphae with germ tube
  - - - Histo: Non-keratinized Stratified squamous epithelium
        
        Estrogen
        
        Homeostasis by pH of normal flora from Glycogen in pynotic cell (Lactobacillus )
    - - HPV infection
        
        HPV 6,11
        
        Condyloma accuminata
        
        HPV 16,18
        
        P§: E6 block P53 & E7 block RB gene
        
        CIN 1
        
        CIN 2
        
        CIN 3
        
        1 more item...
        
        Lab: Pap smear
        
        Histo: Koilocytic change in early to Dysplasia
        
        Risk
        
        Multiple sex, HIV, Young staring sex
    - - Histo: Simple columnar epithelium
        
        Cervical mucous
        
        Progesterone
        
        Thickening
        (prevent sperm)
        
        Estrogen
        
        Spinnbarkeit (NaCl mucus)
    - - GC
        
        N. gonorrhea
        
        Lab
        
        Diplo-cocci negative gram
        
        Tx: Ceftriaxone
      - Non-GC
        
        Chlamydia trachomatis(common), Mycoplasma
        
        Lab
        
        Non detect gram stain
        
        Tx: Azithromycin
      - SS
        
        (Yellow-green) Mucopurulent discharge
        
        Cervical motion tenderness
      - Complication
        
        PID
        
        Supra-pubic pain
        
        Adenexal tenderness
        
        Fever & Chill
        
        Complication
        
        Ectopic pregnancy
        
        Infertility
- - - - Persist Mesonephric duct (Wolffian) & Obliterate Paramesonephric duct
        
        Vas deferens
        
        Epididymis
        
        Seminal vesicles
    - - Develop Paramesonephric duct (Mullerian) & Disappear Mesonephric duct
        
        Fuse Müllerian duct
        
        Septum resorption
        
        Uterus
        
        Septa the uterus
        
        Bicornuate (incomplete fuse)
        
        Didelphys (infuse)
      - 21-hydroxylase
        
        Hypotension by (-)Aldosterone with HypoK+
        
        Virilization in XX
      - 11beta-hydroxylase
        
        DeoxyCorticosterone
        
        Hypertension with (-)Aldosterone
        
        Virilization
    - - P§: Failure to canalization
        
        Amenorrhea(Cryptomenorrhea) with monthly pain
  - - - Labioscrotal
        
        Scrotum
      - Urogenital Sinus
        
        Penis shaft
      - Prostate gland
      - 5alpha-reducatse def.
        
        DHT def. with Testosterone
        
        Ambioguous until puberty by Testosterone; quit change to Masculinization
        
        Lab: normal LH
    - - Labioscrotal
        
        Labia Major
      - Urogenital Sinus
        
        Labia Minor
  - - - Germ cell
        
        No TDF
        
        Ovary
        
        Prophase I of 1° oocyte
        
        TDF
        
        Testes
        
        Spermatogonium
      - Sexcord
        
        TDF
        
        Leydig cell
        
        Testosterone
        
        Sertoli cell
        
        MIF
        
        No TDF
        
        Follicular cell
- - - - Hyperemesis
      - N/V
- - - - Tx
        
        Hydralazine
        
        Methyl dopa
  - - - Tx
        
        Mg2+ Sulfate
- - - - Testicular atrophy
- - - - Hot flash
      - Endometrial hyperplasia
      - Thromboembolism in Smoker
- - - - Hot flash
      - Thromboembolism in Smoker
- - - - Ovulation
- - - - Staph. aureus
        
        Tx: Dicloxacillin
      - SS
        
        Breats tender
        
        Erythema, Warm, Purulent Nipple
    - - Axillary node/ Interpectoral node
      - Upper inner quadrant
        
        Parasternal node
    - - Fibroadenoma (<30yo)
        
        Estrogen sensitive (large when pregnancy)
      - Fibrocystic change
        (>25 yo)
        
        SS
        
        Prementrual pain
        
        Histo: Papillary, Appcrine, stromal fibrossis
    - - Serous/Bloody Nipple discharge
      - Histo: Fibrovascular core
    - - Histo: Leaf-like lobula
      - Rapid Large mass
    - - Risk factor
        
        Unopposed estrogen
        
        Obesity
        
        BRCA1,2
      - Classified expression
        
        HER-2/erbB2
        
        ER(+), PR(-)
        
        Triple negative
      - Most common upper outer quadrant
      - Ductal CA
        
        Histo: Lobular formation
      - Lobular CA
        
        Histo: Single file
      - SS
        
        Nipple retract by invade Cooper/Suspensory lig.
        
        Calcified on Mammogram
- - - - Azole
      - -navir