02b: Repro Flashcards
1
Q
Mutation in sonic hedgehog gene:
A
Holoprosencephaly (failure of L and R hemispheres to separate)
Gene is involved in anteroposterior axis patterning and CNS development
2
Q
Hox gene mutations:
A
Appendages in wrong locations; abnormal skeletal malformations
3
Q
Hox genes code for:
A
Transcription factors (involved in segmental organization of embryo)
4
Q
Gastrulation occurs at week:
A
3
3 weeks = 3 layered embryonic disc
5
Q
Which weeks of early fetal development is embryo most susceptible to teratogens?
A
3-8 (embryonic period)
6
Q
Fetal development: heart begins to beat at which week?
A
4 (limb buds appear too)
4 weeks = 4 limbs and 4 heart chambers
7
Q
Fetal development: when do you expect fetal movement to start?
A
Week 8 (“Gait at week 8”)
8
Q
Fetal development: when can sex of baby be apparent?
A
Week 10 (“Tenitalia”)
9
Q
Parotid, sweat, mammary glands arise from (ecto/meso/endo)-derm.
A
Ectoderm
10
Q
Retina arises from neural (tube/crest).
A
Tube (all CNS)
11
Q
List key structures that arise from neural crest
A
“MOTEL PASS” - think PNS
- Melanocytes
- Odontoblasts
- Thyroid cartilage
- Enterochromaffin cells
- Laryngeal cartilage
- Parafollicular cells of thyroid
- Adrenal medulla/Auerbach plexus
- Septum (aorticopulmonary septum)
- Schwann cells
12
Q
Testes and ovaries derived from (ecto/meso/endo)-derm.
A
Mesoderm
13
Q
The notochord function is (X). Does it have any post-natal derivatives?
A
X = induce ectoderm to form neuroectoderm (neural plate)
Only nucleus pulposus of intervertebral disc
14
Q
Baby born with ototoxicity. You ask mom about what exposure?
A
Aminoglycosides
15
Q
In utero DES exposure puts fetus at risk for:
A
Congenial mullerian anomalies and vaginal clear cell adenocarcinoma
16
Q
T/F: Vaping is ok during pregnancy.
A
False - teratoginicity of smoking is due to nicotine (causes vasoconstriction) which is present in vape smoke
17
Q
Swordfish, and certain fish types, should be avoided during pregnancy due to (X) levels, which can cause (Y).
A
X = methylmercury Y = neurotoxicity
18
Q
Pregnant surgeon wears lead shield during surgery to prevent (X) exposure, which can cause (Y) in baby.
A
X = X-ray Y = microcephaly, intellectual disability
19
Q
Mechanism of abnormalities in fetal alcohol syndrome are due to abnormal (X) process.
A
X = cell migration
20
Q
It’s bhCG’s structural similarity to (X) that allows it to prompt corpus luteum to secrete (Y) during first trimester.
A
X = LH Y = progesterone
21
Q
(Cyto/syncytio)-trophoblast layer is in direct contact with maternal circulation. Why doesn’t mom’s immune system attack?
A
Syncytiotrophoblasts;
Cells lack MHC-1 expression
22
Q
T/F: Umbilical arteries are oxygen poor
A
True - return deox blood from fetal internal iliac aa to placenta
23
Q
T/F: There are two umbilical aa and two umbilical vv.
A
False - one umbilical v
24
Q
Yolk sac forms allantois in Week 3. Allantois becomes (X), a duct between:
A
X = urachus
Fetal bladder and umbilicus
25
Baby has urine coming out of belly button. What's the pathogenesis?
Patent urachus
26
Least severe result of incomplete obliteration of urachus:
Vesicourachal diverticulum (outpouching of bladder)
27
Baby has poopy coming out of belly button. What's the pathogenesis?
Vitelline fistula (duct fails to close)
28
Meckel diverticulum: what is duct attached to?
Ileum and umbilicus
29
Aortic arch I derivative:
Maxillary a (1st arch is MAXimal)
30
Aortic arch 2 derivative:
Stapedial and hyoid aa (Second is Stapedial)
31
Aortic arch 3 derivative:
Common carotids and proximal part of internal carotid (C = 3rd letter of alphabet)
32
Aortic arch 4 derivative:
Aortic arch (L) and prox subclavian (R)
4th arch for the 4 limbs (systemic blood supply)
33
Aortic arch 5 derivative:
Nada
34
Aortic arch 6 derivative:
Proximal pulm aa; and ductus arteriosus (on L)
35
L recurrent laryngeal nerve loops around (X) vessel and R loops around (Y) vessel.
```
X = aortic arch (distal to ductus arteriosus)
Y = R subclavian a
```
36
List the components of the branchial apparatus, from outside to inside. State which embryonic tissue layer each is derived from)
CAP
1. Clefts (ectoderm)
2. Arches (mesoderm and neural crest)
3. Pouches (endoderm)
37
CN associated with first branchial arch
Trigeminal V2, V3
| Children first "chew" then "smile" then "swallow stylishly" or "simply swallow" and then "speak"
38
CN associated with second branchial arch
CN VII
| Children first "chew" then "smile" then "swallow stylishly" or "simply swallow" and then "speak"
39
CN associated with third branchial arch
CN IX ("stylo"-pharyngeus innervated by glossopharyngeal n)
| Children first "chew" then "smile" then "swallow stylishly" or "simply swallow" and then "speak"
40
CN associated with fourth branchial arch
CN X (superior laryngeal branch)
| Children first "chew" then "smile" then "swallow stylishly" or "simply swallow" and then "speak"
41
CN associated with fifth branchial arch
Nada (regresses)
42
CN associated with sixth branchial arch
CN X (recurrent laryngeal branch; all intrinsic muscles of larynx except cricothyroid)
(Children first "chew" then "smile" then "swallow stylishly" or "simply swallow" and then "speak")
43
First branchial pouch derivatives
"Ear, tonsils, bottom-to-top"
Middle ear cavity, eustachian tube, mastoid air cells
44
Second branchial pouch derivatives
"Ear, tonsils, bottom-to-top"
Lining of palatine tonsil
45
Third branchial pouch derivatives
"Ear, tonsils, bottom-to-top"
Third pouch gives rise to three structures
1. Bottom parathyroids (from dorsal wings) (2)
2. Thymus (ventral wings) (1)
46
Fourth branchial pouch derivatives
"Ear, tonsils, bottom-to-top"
Superior parathyroids
47
DiGeorge Syndrome: (X) chromosomal abnormality with abnormal development of (Y)
```
X = 22q11 deletion
Y = 3rd and 4th branchial pouches
```
48
Main symptoms of DiGeorge syndrome
1. T-cell deficiency (thymic aplasia)
| 2. Hypocalcemia (failed parathyroid development)
49
Cleft lip due to failure of fusion of:
Maxillary and medial nasal processes (formation of primary palate)
50
Cleft palate due to failure of fusion of:
1. Two lateral palatine shelves OR
2. Lateral palatine shelves with nasal septum OR
3. Lateal palatine shelves with median palatine shelf
Secondary palate formation abnormal
51
Male remnant of paramesonephric duct
Appendix testis
52
F remnant of mesonephric duct
Gartner duct
53
Patient is 46, XY with functional Leydig cells but non-functional Sertoli cells. What internal/external sex structures would you expect?
Internal: M and F (no sertoli cells, no MIH so female internal genitalia sticks around)
External: M (testosterone/androgens present)
54
Complete failure of fusion of paramesonephric ducts (double uterus, cervix, vag):
Uterus Didelphys
55
Glans penis equivalent in F
"Glans" Clitoris
56
Bulbourethral glands in (M/F) equal (X) glands in (M/F).
M (aka Cowper glands)
X = Bartholin
F
57
Corporus cavernosum and spongiosum in M are (X) in F
X = vestibular bulbs
58
Prostate gland in M is (X) in F
X = Urethral and paraurethral glands (of Skene)
59
Hypospadias is due to failure of which process?
Fusion of urethral folds
60
Epispadias is condition in which (X) and results due to abnormality in which process?
X = abnormal opening of penile urethra on dorsal surface of penis
Faulty positioning of genital tubercle
61
Gubernaculum is composed of (X) tissue and has which function in the male?
X = fibrous
| Anchors testes within scrotum
62
Gubernaculum remnant in female
Ovarian and round ligaments of uterus
63
Tunica vaginalis equivalent in female
There isn't one... the processus vaginalis is obliterated in F
64
Ovaries lymph drainage
Para-aortic lymph nodes (like testes)
65
Body of uterus drains to which lymph nodes?
External iliac
66
Cervix drains to which lymph nodes?
External and internal iliac
67
Superior bladder drains to which lymph nodes?
External iliac
68
Prostate drains to which lymph nodes?
Internal iliac
69
Distal vagina/vulva drain into which lymph nodes?
Superficial inguinal
70
Scrotum drains into which lymph nodes?
Superficial inguinal
71
Glans penis drains into which lymph nodes?
Deep inguinal
72
Distal anus drains into which lymph nodes?
Superficial inguinal
73
Infundibulopelvic, aka (X), ligament connects which two structures?
X = suspensory ligament of ovary
Ovary to lateral pelvic wall
74
Oopherectomy: (X) ligament must be ligated to avoid bleeding
X = suspensory ligament (contains ovarian vessels)
75
Uterine vessels are housed in which ligament?
Cardinal ligament (attaches cervix to side wall of pelvis)
76
Hysterectomy: (X) ligament must be ligated to avoid bleeding
X = cardinal (containing uterine vessels)
77
Ovarian ligament attaches which structures?
Ovary (medial side) to lateral side of uterus
Note: contains no structures and is derivative of gubernaculum
78
Vagina epithelium type
SSNKE
79
Ectocervix epithelium type
SSNKE
80
Endocervix epithelium type
Columnar
81
Uterus epithelium type
Simple columnar (with glands)
82
Fallopian tube epithelium type
Simple columnar, ciliated
83
Ovary (outer surface) epithelium type
Simple cuboidal (germinal epithelium)
84
Seminiferous tubules: (X) cells secrete androgen-binding protein. (Y) cells nourish developing spermatozoa.
X = Y = sertoli
85
T/F: Testosterone production is temperature-sensitive.
False - unaffected by temp (but sperm production declines with high temps)
86
Blood-testis barrier formed by:
Sertoli cells (adjacent cells have tight junctions)
87
(X) cells in testes convert androgens/testosterone to estrogen.
X = sertoli (via aromatase)
88
Female homolog to Leydig cells.
Theca interna cells (and granulosa cells are homolog to sertoli cells)
89
T/F: Leydig and Sertoli cells line seminiferous tubules.
False - Sertoli cells and spermatogonia line seminiferous tubules; leydig cells located in interstitium
90
Pregnancy: the indicator for fetal well-being is a 1000-fold (increase/decrease) in which hormone?
Increase
Estriol (placental estrogen)
Note: other estrogens (estradiol, estrone) also rise, but only by 50-fold
91
At menses, when (oocyte/oogonium/ovum) completes meiosis I, it separates the genetic info (evenly/unevenly).
Primary oocyte
| Evenly BUT cytoplasm not split equally (large cell is secondary oocyte and smaller cell becomes polar body)
92
T/F: Secondary oocyte is haploid.
True - 1N, 2C (chromatids)
93
(Estrogen/LH) surge stimulates (Estrogen/LH) release and thus ovulation.
Estrogen
| LH
94
How early after conception is at-home urine test able to detect positive pregnancy? What (exactly) being detected in these tests?
2 weeks (beta-hCG detectable after about 1 week in blood)
beta (specific) subunit of beta-hCG
95
Gestational age calculated from (X). Embryonic age calculated from (Y).
```
X = last menstrual period
Y = conception date (gestational age minus 2 weeks)
```
96
RBC count increases during pregnancy. So why is female typically anemic?
Higher increase in plasma
97
PCOS patient presents with complaints of infertility. For fertility treatment, you start a short course of (X) to assist in dominant ovarian follicle formation. Then, you introduce a single injection of (Y) to mimic LH surge.
```
X = menotropins (mimic FSH)
Y = beta-hCG
```
98
Apgar score determined by which features? And score under (X) requires further evaluation.
APGAR = Appearance, Pulse, Grimace, Activity, Respiration (each gets 0, 1, or 2 pts)
X = 7
99
T/F: Testosterone responsible for differentiation of all male internal genitalia.
False - all except prostate (DHT)
100
T/F: Testosterone responsible for male growth spurt.
True
101
T/F: DHT responsible for penis differentiation and deepening of voice.
False - deepening of voice via testosterone
102
T/F: Estrogen responsible for epiphyseal plate closing in men.
True - via action of P450 aromatase conversion of testosterone (in adipose and testes)
103
Finasteride MOA
Inhibits 5a-reductase (reduce DHT)
"Fina for Five-a"
104
"Spermiogenesis" refers to process in which (X) becomes (Y). Which steps entail this process?
```
X = spermatids
Y = spermatozoon (mature sperm; "zoons zoom toward the egg")
```
1. Loss of cytoplasmic contents
2. Gain acrosomal cap
105
Congenital heart defects commonly seen in Turner's
1. Coarction
| 2. Bicuspid aortic valve
106
T/F: XYY fetus will die in utero.
False - typically normal males that may be very tall, have severe acne/learning disability/autism
107
Patient presents few days post-partum with elevated beta-hCG, dyspnea, and hemoptysis. What's at the top of your differential?
Choriocarcinoma
108
Choriocarcinoma: malignancy of (X) cells with (Y)-appearing chorionic villi and hematogenous spread to (Z)
```
X = trophoblasts (cyto/syncytio-trophoblasts)
Y = NO chorionic villi
Z = lungs (cannonball metastases)
```
109
Presence of p57 indicates that hydatidiform mole is (complete/partial)
Partial (p57 from maternal genome, which is absent in complete mole)
110
34 yo G2P1 present to the ER claiming her water broke and is now having vaginal bleeding. She denies pain, but appears distressed. Fetal heart rate is 105 bpm. Likely diagnosis and next step?
Vasa previa (fetal vessels run in close proximity to cervical os and may rupture)
Emergent C-section
111
Vasa previa typically associated with abnormal placement/insertion of (X).
X = umbilical cord ("velamentous insertion"; inserts into chorioamniotic membrane instead of placenta and vessels not protected by Wharton jelly)
112
Most common cause of post-partum hemorrhage
Uterine atony (uterus fails to contract and compress blood vessels)
113
Most common infectious agent(s) in septic abortion.
S. aureus and G- bacilli
114
Rx for gestational hypertension (pregnancy-induced)
"Hypertensive Moms Love Nifedipine"
1. Hydralazine
2. alpha-Methyldopa
3. Labetalol
4. Nifedipine
115
Risk factors for pre-eclampsia
1. PHx/FHx
2. Nulliparity
3. Obesity
4. Chronic HT, diabetes, or renal disease
116
Pt presenting with signs of pre-eclampsia at under 20 weeks gestation indicates:
molar pregnancy
117
The key instigator in the pathogenesis of pre-eclampsia is:
Abnormal placental spiral arteries (placental hypoxia/ischemia)
118
Pre-eclampsia treatment and management.
1. IV Mg-sulfate (to prevent seizures)
2. Anti-HT
3. Delivery of baby is definitive treatment
119
Pre-eclampsia can lead to either eclampsia and/or (X) syndrome, which is a manifestation of severe pre-eclampsia.
X = HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets)
120
Rx for HELLP syndrome is (X) and for eclampsia is (Y)
X = Y = immediate delivery
121
24 yo G1P0 at 30 weeks gestation presents to the clinic complaining of dizziness, sweating, and nausea when lying down. Sitting and standing or laying down on her (R/L) improves symptoms. What's the likely diagnosis and etiology?
L
Supine hypotension syndrome
Gravid uterus (usually over 20 weeks pregnant) compresses and obstructs IVC (decreasing preload)
