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BOARDS! > Female and Male GU/Repro > Flashcards

Female and Male GU/Repro Flashcards

1
Q

epithelia of ovary

A
  • simple
  • cuboidal
  • (aka germinal)
  • rapidly proliferate to repair ovulatory surface defects
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2
Q

epithelia of fallopian tube

A
  • simple
  • columnar
  • ciliated cells transport egg/embryo
  • damage can cause infertility, hydrosalpinx, ectopic pregnancy
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3
Q

epithelia of uterus

A
  • simple
  • columnar
  • (aka endometrium)
  • stratum FUNCTIONALIS sloughs off d/r menstruation
  • prolonged estrogen exposure prevents shedding, resulting in hyperplasia/malignancy
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4
Q

epithelia of cervix

A
  • ECTO-cervix:
    • stratified
    • squamous
    • NON-keratinized
  • ENDO-cervix:
    • simple
    • columnar
  • cervical glans secrete mucus:
    • thin and watery during ovulation
    • mucus plug during pregnancy
  • HPV infection predisposed to cervical malignancy
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5
Q

epithelia of vagina

A
  • stratified
  • squamous
  • NON-keratinized
  • maintains acidic environment to prevent infection
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6
Q

Endometriosis

A
  • imp c/o chronic pain an dinfertility
  • d/t endometrial cells implanted on various pelvic organs (mc:)
    • ovary
    • posterior cul-de-sac
    • broad ligaments
    • uterosacral ligaments
  • histoL
    • hemosiderin deposits
    • endometrial glands or stroma outside the uterus
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7
Q

Granulosa cell tumor of the ovary

A
  • Clinical features:
    • large unilat adnexal mass
    • INC estrogen
      • can present w/ endometrial hyperplasia
      • precocious puberty
    • INC inhibin
  • Histo:
    • Call-Exner bodies
      • cuboidal granulosa cells
      • rosette pattern
      • coffee bean nuclei
    • ylw theca cells with lipid
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8
Q

AFP (alpha-fetoprotein)

A
  • normally produced by fetal liver and yolk sac
  • tumor marker in pts with:
    • hepatocellular ca
    • NON-seminomatous testicular ca
    • ovarian ca
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9
Q

beta-hCG

A
  • confirm pregnancy
  • screen for:
    • gestational trophoblastic dz
    • germ cell tumors
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10
Q

CA-125 (cancer antigen)

A
  • elevated in epithelial carcinomas of the ovary
    • serous
    • endometriod
    • clear cell
  • stromal tumors do NOT release significant amounts of CA-125
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11
Q

Sertoli-Leydif tumors

A
  • type of ovarian sex cord tumor
  • produces testosterone
  • affected pts CP: evidence of HYPER-androgenism:
    • hirsutism
    • clitoromegaly
    • deepening voice
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12
Q

Struma ovarii

A
  • germ cell tumor of the ovary
  • can cause hyperthyroidism by secreting THYROXINE
  • histopath: mature thyroid tissue
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13
Q

septic abortion

A
  • RF: pregnancy ermination with retaine dproducts of conception
  • micro:
    • gram neg bacilli
    • S. aureus and E coli d/t seeding of the uterine cavity d/r instrumentation
  • CP:
    • fevers, chils, lower abdo pain, bloody or purulent vaginal discahrge
    • boggy and tender uterus with dilated cervix
  • pelvic US:
    • retained products of conception
    • INC vascularity
    • echogenic material in the cavity
    • thick endometrial stripe
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14
Q

GnRH

A

pulsatile

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15
Q

FSH…FGS

A
  • FSH:
    • granulosa (FEMALE)
      • have aromatase
      • location of androgen to estrogen
    • sertoli (MALE)
      • makes Inhibin B
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16
Q

LH…LTL

A
  • Theca (interna) {FEMALE}
    • cholesterol to androgens (and progesterone)
  • Leydig {MALE}
    • Testosterone
      • neg feedback on LH and GnRH
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17
Q

FP vs. LS

A
  • follicular/Proliferative
    • first few days: menses
    • primary, secondary, vesicular (surge of estradiol)
  • LH and FSH surge at DAY 14
  • —-crossover—-
  • luteal/secretory
    • corpus luteum-secretes progesterone
    • regression
    • corpus albicans
    • making home for embryonic implantation (matures lining)
    • spiral arterial coil
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18
Q

ovary–E–LH

A
  • FSH stimulates ovary (in menopause INC FSH)
  • ovary stimulates estrogen release
  • estrogen stimulates LH surge (similar to hCG)
    • dominant follicle will RUPTURE
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19
Q

progesterone withdrawal

A
  • INC prostaglandins=vasocontriction of spiral arteries
  • INC metalloproteases
    • APOPTOSIS
    • degeneration of functionalis later
    • menstrual flow
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20
Q

prolactin and menses

A

anovulation (lactational amenorrhea)

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21
Q

functional hypothalamic amenorrhea

A
  • secondary amen w.:
    • low body weight
    • frequent strenuous exercise
    • lanugo (fine hair..inadequte calorie intake)
  • seen in competitive atheltes, dancers, models
  • reduced circulating leptin d/t diminished adipose tissue stores
    • inhibits pulsatile GnRH form hypothalamus=DEC pit LH and FSH secretion=low circulating estrogen levels andddd amen
22
Q

what are three different types of contraceptive methods?

A
  • systemic progestins
  • locally-acting progestins
  • copper IUD
23
Q

systemic progestins-contraceptives

A
  • combined hormonal contraceptive:
    • pill, transdermal patch, vaginal ring
  • progestin implant/injection
  • primary MOA: suppresses GnRH and pituitary gonadotropin secretion=inhibits ovulation
    • b/c LH spike is required to stimulate ovulation
24
Q

locally acting progestins–Contraceptives

A
  • progestin-only (Norethindrone) pill or Levonorgestrel IUD
  • primary MOA: thickens cervical mucus and impairs sperm penetration
25
Q

copper IUD–Contraceptives

A
  • primary MOA: creates chronic cytotoxic inflammatory response in uterus impairing sperm migration
26
Q

roles of progesterone and estrogen in hormonal contraceptives

A
  • progestin-synthetic equivalent to progesterone
    • responsible for pregnancy prevention in all hormonal contraceptives
  • estrogen-included to improve the bleeding profile
27
Q

what are the three mechanisms of Down syndrome

A
  • meiotic NONdisjunction (95%)
    • path: extra copy of c21 in every cell-recurrence based on maternal age
  • unbalance translocation:
    • all/pt of extra c21 ATTACHED to another chromosome
    • HIGH recurrence risk if balances translocation is present in one parent
  • Mosaicism
    • SOME (nottt all) cells have extra c21 copy
    • nondisjunction event in early embryonic life
28
Q

SERMS

A
  • tamoxifen and Raloxifene
  • MOA: competitive inhibitor of estrogen binding
    • mixed agonist/ANT-agonist
  • indications:
    • prevent breast ca in high-risk pts
    • t: adjuvant tx of breast ca
    • R: post-men osteoporosis
  • SE:
    • hot flashes
    • venous thromboembolism
    • endometrial hyperplasia and carcinoma (T only)
29
Q

Tamoxifen and the L

A
  • T has a favorable effect on serum lipids, with a DEC in total and LDL cholesterol
  • no significant change in HDL
  • serum TG may INC in some pts
30
Q

amniotic fluid embolism (AFE)-Clinical features

A
  • cardiogenic shock
  • hypoxemic respiratory failure
  • DIC
    • tissue factor (thromboplastin) released from amniotic fluid
    • triggers DIC
  • seizures or coma
31
Q

What is AFE (amniotic fluid embolism)

A
  • rare complication d/r pregnancy or shortly after delivery
  • PP:
    • amniotic fluid with arachidonic acid metabolites enters maternal circulation through sites of uterine trauma or cervical lacerations
    • get anaphylactoid rxn
    • amniotic fluid causes occlusions and vasospasm of the maternal pulmonary circulaion=
      • LV failure
      • DEC CO
      • severe V/Q mismatch
    • hypoxia and hypotensive shock lead to cardiopulmonary arrest
32
Q

AFE (amniotic fluid embolism) autopsy

A
  • fetal squamous cells and mucin in the maternal pulmonary arteries
33
Q

maternal serum alpha-fetoprotein screening (MSAFP)

A
  • INC MSAFP:
    • open NTD (anencephaly, open spina bifida)
    • ventral wall defects (omphalocele, gastroschisis)
    • multiple gestation
  • DEC MSAFP
    • aneuploidies (trisomy 18 & 21)
34
Q

DS and unbalanced Robertsonian translocation

A
  • entire long arm of one chromosome 21 is translocated to the long arm of an acocentric chromosome (chromosome 14)
  • indivs have 46 chromosome, BUT one chrom14 is comprised of the long arms of both c14 and 21
  • 46, XX, t(14;21)
  • affected parent is asymptomatic
35
Q

DS quadruple screen

A
  • LOW MSAFP
  • LOW unconjugated estriol
  • HIGH beta-hCG
  • HIGH Inhibin A (secreted from placenta with hCG)
36
Q

perineal body

A
  • tendinous ctr point of the perineum
  • sepratates urogenital and anal triangles
  • the following structures are anchored to it:
    • bulbospongiosus muscle
    • external anal sphincter muscle
    • superficial and deep transverse perineal muscles
    • fibers form the external urethral sphincter, levator ani, and muscular coat of the rectum
37
Q

(midline) episiotomies

A
  • espisiotomies are used to enlarge the vaginal outlet to facilitate delivery and reduce the risk of severe perineal laceration
  • midline epi
    • vertical incision from posterior vaginal opening to perineal body
    • transects the vaginal lining and the submucosal tissue but NOT:
      • the external anal sphincter
      • the rectal mucosa
  • improper repair of a midline epi–>pelvic organ prolapse of dyspareunia
38
Q

What happens when the clitoris is stimulated

A

ischiocavernosus muscle forces blood into the clitoris

39
Q

levator ani muscle

A
  • part of anal triangle
  • supports pelvic floor
  • can be strengthened by Kegel exercises
  • often stretched, pushed aside, torn by fetal crowning and delivery
40
Q

imperforate hymen

A
  • obstructive lesion caused by incomplete degeneration of the ctl portion of the fibrous tissue band connecting the walls of the vagina
  • CP:
    • primary amenorrhea
    • nml secondary sex characteristics
    • cycliv abdominal or pelvic pain d/t accumulation of menstrual blood in vagina and uterus (hematocolpos)
    • pressure from collection of blood=back pain and difficulties with defecation
  • examination:
    • vaginal bulge and/or mass palpated anterior to the rectum
41
Q

Kallman syndrome

A
  • d/t impaired synthesis of gonadotropin-releasing hormone by hypothalamus
  • CP:
    • primary amenorrhea
    • absent secondary sexual characteristics
    • olfactory sensory defect
42
Q

urethral injury

A
  • FOley catheter is contraindicated, can owrsen injury
  • perform retrograde urethrogram to assess urethral integrity
43
Q

dysmorphic features of DS

A
  • epicanthal folds
  • upslanting palpebral fissures
  • protruding tongue
  • excessive skin at the nape of the neck
  • borth weight and length below avg
  • hypotonia and a weak startle (Moro) reflex
44
Q

pudendal nerve block for perineal laceration repair

A
  • PN is derived from S2-S4 nerve roots
  • sensory: perinum and motor: urethral and anal sphincters
  • landmarks:
    • ischial spines and sacrospinus ligament
      • ischial spines=bony protrusions located posterolateral to the vaginal sidewall
      • sacrospinus ligament=firm band that runs medially and posteriorly from the ischial spine to the sacrum
45
Q

lateral femoral cutaneous

A
  • L2-L3
  • sensory to anterior and lateral thigh
46
Q

inferior gluteal

A
  • L5-S2
  • motor to gluteus maximus
47
Q

genitofemorl

A
  • L1-L2
  • sensory to scrotum/labia majora, medial thigh
48
Q

obturator

A
  • L3-L4
  • sensory to medial thigh and motor to adduction
49
Q

iliohypogastric

A

T12-L1 and sensory to suprapubic

50
Q

congenital torticollis epi + PP

A
  • develops 2-4 wks of age
  • mc d/t: birth trauma (breech delivery) –or– malposition of the head in utero (d/t fetal macrosomia or oligohydramnios)
    • result: SCM injury and fibrosis
51
Q

congenital torticollis CP and PE

A
  • CP:additional musculoskeletal anomalies:
    • hip dysplasia
    • metatarsus adductus (adduction of the forefoot)
    • talipes quinovarus (clubfoot)
  • clinical diagnosis:
    • PE: head tilted toward the affected side
      • chin pointed away form contracture
    • soft-tissue mass may be palpable in inferior 1/3 of affected SCM
    • sever casesL plagiocephaly and facial asymmetry
  • Tx: resolve with conservative therapy and stretching exercises
52
Q

Metronidazole disulfiram-like reaction

A
  • Metro treats trichomonas vaginitis and bacterial vaginosis
  • avoid alcohol!!! or…. will get disulfiram-like reaction
    • inhibits acetaldehyde dehydrogenase and causes acetaldehyde accumulation
    • systemic adverse effects: HA, abdo cramps, nausea, flushing

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