3/16 Repro Flashcards
Bicornuate uterus
-due to what?
incomplete fusion of paramesonephric ducts
Germ cell tumor & inc. T4 & T3.
-whats the connection?
Germ cell tumor releases bHCG which has same alpha-subunit as TSH (and LH & FSH).
-This acts like TSH and causes thyroid to produce more thyroxine!
*bHCG shares significant sequence homology in the beta-subunit w/TSH as well.
Superficial inguinal nodes
-drain what region?
- all cutaneous lymph from umbilicus to the feet including external genitalia & anus (until pectinate line).
- excludes posterior calf which drains to popliteal l.nodes.
main mode of action of OCPs?
suppress synth of FSH and LH.
- leads to inhibition of ovulation (no LH spike).
- also cause thickening of cervical mucus, but this is not the main mode of action.
Which HPV causes warts?
6 & 11
Which HPV can cause cervical carcinoma?
16, 18, 31, 33
citrate
-effect w/renal stones?
-high citrate is good, binds calcium and prevents it from precipitating.
direct inguinal hernia
-cause?
weakness of transversalis fascia.
Sonic hedgehog gene
- patterning along which axis?
- involved in development of what?
- mutation can lead to what?
- anterior-posterior axis.
- Involved in CNS development
- mutation can cause holoprosencephaly.
Wnt-7 gene
-Necessary for proper organization along which axis?
dorsal-ventral axis.
FGF gene
-function?
-Stimulates mitosis of underlying mesoderm, providing for lengthening of limbs.
Homeobox (Hox) genes
- involved in organization of embryo in which direction?
- mutations lead to what?
- craniocaudal direction
- Hox mutations appendages in wrong locations.
Bilaminar disc
-which week?
2 weeks = 2 layers
When is fetus most susceptible to teratogens?
Weeks 3-8, the “embryonic period”.
-this is when organogenesis occurs.
Upper & lower limb buds begin to form
-which week?
4 weeks = 4 limbs
Heart begins to beat
-which week?
week 4
-4 chambers in your heart
Fetal cardiac activity visible by transvaginal ultrasound.
-which week?
week 6
Genitalia have male/female characteristics.
-which week?
week 10
gastrulation
- what is it?
- what starts it off?
- Process that forms the trilaminar embryonic disc.
- Establishes the ectoderm, mesoderm, and endoderm germ layers.
-Starts with the epiblast invaginating to form the primitive streak.
First 2 layers of the inner cell mass?
-which contributes to the embryo?
epiblast & hypoblast
-epiblast becomes the embryo
What is the epiblasts new cavity?
amniotic cavity
-it will eventually surround the entire embryo.
which sect of the mesoderm forms the parietal body cavity?
somatic/parietal lateral plate mesoderm
*Amniotic cavity follows it around & now surround the entire embryo. It disconnects from the somatic lateral plate mesoderm.
which sect of the mesoderm forms the gut tube/CT/smooth muscle of gut tube?
visceral/splanchnic lateral plate mesoderm
Neural crest origin
- which marker?
- name some structures
S-100 (+)
- melanoma
- schwannoma
- langerhan cell histiocytosis
Notochord
-adult derivative?
Nucleus pulposus of intervertebral disc.
Deformation vs malformation
Deformation = extrinsic disruption; occurs after the embryonic period.
Malformation = intrinsic disruption; occurs during the embryonic period (weeks 3–8).
Absence of digits
-which teratogen?
alkylating agent
fingernail hypoplasia
-which teratogen?
Carbamazepine, phenytoin.
Aplasia cutis congenita
-which teratogen?
Methimazole
Fetal hydantoin syndrome
- which teratogen?
- what is it?
-phenytoin
-microcephaly, dysmorphic craniofacial features, hypoplastic nails and distal phalanges, cardiac defects,
IUGR, intellectual disability
Caudal regression syndrome (anal atresia to
sirenomelia)
-which teratogen?
glucose
-Maternal diabetes
Smooth philtrum, thin upper lip
-which congenital problem?
fetal alcohol syndrome
hypertelorism
Abnormally increased distance between two organs or bodily parts, usually referring to an increased distance between the orbits (eyes)–orbital hypertelorism.
What is a chorion?
placenta
Dizygotic twins
- how many chorions?
- how many amniotic sacs?
- 2 separate chorions
- 2 separate amniotic sacs
Monozygotic twins
-When do you get 2 chorions (placentas)?
If they split before day 4.
-after day 4, you always get just 1 chorion (placenta).
Monozygotic twins
-when does the fertilized egg split into 2 zygotes?
75% of the time, day 4-8.
25% before day 4.
<1% after day 8.
Monozygotic twins
-at what point will they share an amniotic cavity?
If they split after 8 days, which is <1%.
-so 99% of the time, you will have 2 amniotic cavities.
Conjoined twins
- when do they split?
- how many chorions?
- how many amniotic sacs?
> 13 days.
-monoamniotic, monochorionic.
Most common twinning:
- when is the split?
- how many chorions?
- how many amniotic sacs?
75% of the time, day 4-8
- Monochorionic
- Diamniotic
Inner layer of chorionic villi.
Cytotrophoblast
-Cytotrophoblast cells = mitotically active & serve as the stem cells for formation of the syncytiotrophoblast. The syncytiotrophoblast is mitotically inactive.
Outer layer of chorionic villi
Syncytiotrophoblast
Syncytiotrophoblast or Cytotrophoblast
-which makes bHCG?
Syncytiotrophoblast
Umbilical vessels
- 2 of which?
- mnemonic?
2 umbilical arteries
*arteries = longer word = there are more of them.
Umbilical arts
-stem from which fetal arteries?
internal iliac arts.
Umbilical arteries and veins are derived from:
Allantois
urachus
- derivative of what?
- function in utero?
- allantois becomes the urachus.
- Duct connecting fetal bladder to yolk sac and allows bladder to drain waste into the yolk sac.
Urachal cyst
-can predispose to what cancer?
-adenocarcinoma at dome of the bladder.
obliterated urachus becomes what?
-median umbilical ligament.
Obliteration of vitelline duct
-which week?
7th week
Branchial clefts—derived from:
ectoderm
Branchial arches—derived from:
mesoderm and neural crest
Branchial pouches—derived from:
endoderm
DiGeorge syndrome
-branchial cleft, pouch, or arch problem?
-3rd & 4th POUCHES.
Which part of LN is not well developed in di Georges?
-mnemonic?
- l. node paracortex.
- paracortex = T cell country.
*Mr. T Pities the fool. T cells in Paracortex.
Cleft lip—failure of fusion of the:
- maxillary and medial nasal processes (formation of 1°
palate) .
Cleft palate—failure of fusion of the:
-two lateral palatine processes
or
-failure of fusion of lateral palatine processes with the nasal septum and/or median palatine process.
Cleft palate
-how can it present?
-makes it difficult for baby to make proper suction for feeding, resulting in choking/coughing.
Most common breast mass in a younger woman?
fibroadenoma
Bicornuate uterus
-Sxs:
-recurrent miscarriages.
Clomiphene
-location of action?
-blocks estrogen receptors in hypothalamus.
Most common testicular tumor?
Seminoma 40%
Short palpebral fissues
-teratogen?
fetal alcohol syndrome
Upper portion of vagina + female internal structures made from what?
paramesonephric duct (mullerian duct)
Bottom 1/3 of vagina made from what?
urogenital sinus
Müllerian duct abnormalities result in:
-anatomical defects that may present as 1° amenorrhea in females with fully developed 2° sexual characteristics (indicator of functional ovaries).
Mesonephric (Wolffian) duct
- develops into what structures?
- mnemonic?
SEED
- Seminal vesicles
- Epididymis
- Ejaculatory duct
- Ductus deferens
No Sertoli cells or lack of Müllerian inhibitory
factor:
- develop both male and female internal genitalia and male external genitalia.
- not stopping female + you’re still making male bc leydig cells still making testosterone.
- DHT will cause external male.
5α-reductase deficiency:
-male internal genitalia, ambiguous external genitalia until
puberty (when testosterone levels cause inc. and cause masculinization)
“penis at 12” phenomenon
- a “girl” may getting an enlarged clit aroud puberty age.
- what disease can this be?
5α-reductase deficiency
hypospadias
- cause?
- more or less common than epispadias?
- failure of urethral folds to close.
- more common than epispadias.
epispadias
- cause?
- associated condition?
- faulty positioning of genital tubercle.
- Exstrophy of the bladder is associated with Epispadias.
Gubernaculum
-male remnant?
Anchors testes within scrotum.
Gubernaculum
-female remnant?
Ovarian ligament + round ligament of uterus.
Infundibulopelvic ligament (suspensory ligament of the ovaries) -contains what?
Ovarian vessels.
What is at risk of injury during ligation of ovarian vessels.
- when do you ligate these vessels?
- ovarian vessels contained in which ligament?
ureter
- oophorectomy
- infundibulopelvic lig. (suspensory lig of ovary).
Cardinal ligament
- contains what?
- ligated when? whats at risk of being damaged?
uterine vessels
-ligated during hysterectomy, watch out for ureter.
Round ligament of the uterus
-contains what?
- contain no major structures.
- round like 0 as in 0 structures
Ovarian ligament
-contains what?
- contain no major structures.
- O like 0 as in 0 important structures
Ovary, outer surface
-epithelial type?
-Simple cuboidal epithelium (germinal epithelium covering surface of ovary).
Sperm acquire motility in epididymis which is lined by:
-Pseudostratified columnar epi w/sterocilia.
Which n. contains para fibers for male sexual response?
-which pathway is activated?
pelvic nerve
-NO => inc. cGMP => smooth muscle relaxation => vasodilation = erection.
How does erection go away?
Norepinephrine => inc. [Ca2+] => smooth muscle contraction => vasoconstriction => antierectile.
Male sexual response: Emission
-which nerve?
Sympathetic nervous system
-hypogastric nerve.
Male sexual response: Ejaculation
-which nerve?
visceral and somatic nerves
-pudendal nerve.
What forms blood-testes barrier?
Whats its purpose?
Tight junctions between adjacent Sertoli cells form blood-testis barrier => isolate gametes from autoimmune attack.
Sertoli cells
- temp sensitive?
- if so, what changes?
- yes
- dec. sperm prod & dec. inhibin prod w/high temps.
Leydig cells
- temp sensitive?
- if so, what changes?
no
Leydig or Sertoli
-which one has aromatase?
Both
Sertoli cells need testosterone to help make sperm. If you take exogenous testosterone, will your sperm count increase?
-if you take exogenous testosterone, your sperm
count can be decreased b/c you need high LOCAL
testosterone concentration for sperm production.
Testosterone has neg. feedback on what?
GnRH & LH
*so indirectly also FSH
Inhibin (via sertoli cell) has neg. feedback on what?
FSH
Which estrogen made in:
Ovary:
placenta:
adipose tissue:
- ovary = 17β-estradiol
- placenta = estriol
- adipose tissue = estrone via aromatization
Estrogen
-inc or dec transport protein synth?
Inc
Estrogen
- effect on HDL?
- effect on LDL?
- inc HDL
- dec LDL
Potency of the estrogens? Estrone, estriol, estradiol.
-which one can be normal in a post-menopausal woman?
estradiol > estrone > estriol
-estrone may be normal in post-menopausal woman.
Where are estrogen receptors?
Estrogen receptors expressed in the cytoplasm; translocate to the nucleus when bound by ligand.
Fall in what hormone after delivery disinhibits prolactin lactation?
Fall in progesterone after delivery disinhibits PRL lactation.
Myometrial excitability
- which hormone increases it?
- which hormone decreases it?
- estrogen increases
- progesterone decreases
*pro-gestation: you dont want myometrium contracting during gestation, that would abort the baby.
Which hormone inc. female’s body temp?
progesterone
*pro-gestation, you got a bun in the oven, the temperature will be increased.
menstruation
-example of what kind of cell death?
apoptosis
Most common meds causing impotence?
SSRIs & sympathetic blockers
Fetal hydronephrosis
-where is the obstruction most commonly?
Uretopelvic junction
-last part of the ureter to canalize is where it meets the renal pelvis.
Where is the uretopelvic junction?
where ureter meets the renal pelvis.
-aka the start of the ureter.
adenomyosis
-whats uterus going to look like?
uniformly enlarged
*i wouldn’t guess that it would be uniformly enlarged.
3 Sxs of pre-eclampsia?
-when does it usually happen?
HTN, proteinuria, edema.
-after 20th week of gestation.
When are peak progesterone levels seen?
mid-luteal phase
Luteal phase aka:
secretory phase
Why dont beta-lactams work against chlamydia?
bc it has no peptidoglycan cell wall
Fever, rash, oliguria 1-3 wks after you give a medication:
- whats the disease?
- which cells are classically seen?
drug-induced acute interstitial nephritis
-eosinophils
Syphillis
-what are the warts called?
condyloma lata
Follicular growth is fastest during ____ week of
proliferative phase.
2nd
Metrorrhagia
-define:
-intermenstrual bleeding: frequent but irregular menstruation.
Menorrhagia
-define:
-heavy menstrual bleeding: > 80 mL blood loss or > 7 days of menses.
Menometrorrhagia:
-define:
heavy, irregular
menstruation at irregular intervals.
Progesterone effect on LH
Progesterone inhibits LH.
- basis for OCPs containing progesterone.
- estrogen (unless very high level) also inhibits LH and FSH.
What phase are primary oocytes arrested in until ovulation?
prophase 1
What phase does the secndary oocyte progress to but stop at unless its fertilized?
metaphase 2
What phase does the oocyte have to reach before ovulation can occur?
metaphase 2
*has to be in metaphase when the sperm meets it.
How many chromatids do primary oocytes (prophase 1 arrest) have?
-46 chromatids: S phase has happened but mitosis has not finished.
secondary oocyte (meta2 arrest)
- ploidy?
- chromatids?
1N, 2C
-homologous chroms separate after meiosis 1 so you get haploid cells.
How long after fertilization is implantation?
6 days
How soon is bHCG present in blood & urine, and which cells are secreting it?
Syncytiotrophoblasts secrete hCG, which is detectable in blood 1 week after conception and on home test in urine
2 weeks after conception.
