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STEP 1 > Female Developmental > Flashcards

Female Developmental Flashcards

1
Q

In females, the ______ ducts fuse to form the fallopian tubes, uterus, cervix, and ____.

A

paramesonephric

upper vagina

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2
Q

Incomplete ______ fusion of the paramesonephric ducts results in a bicornuate uterus characterized by an indentation in the center of the fundus.

A

lateral fusion

*bicornate (V shaped uterus)

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3
Q

When a patient has difficulty conceiving or recurrent pregnancy loss, structural uterine anomalies can be screened by ______, which involves contrast injection through the cervix into the uterus with a concurrent pelvic x-ray.

A

hystero-salpingo-gram (HSG)

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4
Q

Patient’s HSG shows 2 unfused uterine horns with a central filling defect, which can represent a _____ uterus or a ______

A

bicornuate (V shaped uterus)|

longitudinal uterine septum (1 uterus completely split into 2 by a muscular septum)

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5
Q

2 separate uterus & cervix with an associated ovary

A

Didelphys uterus

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6
Q

caused by incomplete degeneration of the central portion of the fibrous tissue band connecting the walls of the vagina.

Adolescent patients typically present with primary amenorrhea, normal secondary sexual characteristics, and cyclic abdominal or pelvic pain due to accumulation of menstrual blood in the vagina and uterus aka ___

A

Imperforate hymen

hematocolpos

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7
Q 
Common manifestations of \_\_\_\_\_\_ include 
primary amenorrhea
short stature
high arched palate
widely spaced nipples
webbed neck
A

Turner syndrome (45,XO)

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8
Q

Primary amenorrhea occurs in Turner syndrome due to in utero degeneration of the _____ with replacement by fibrotic tissue.

A

ovarian follicles (gonadal dysgenesis)

*ovaries appear underdeveloped and atrophic (“streak gonads”)

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9
Q

____ manifests in the neonate with lymphedema, cystic hygromas (mass behind head), and or diminished femoral pulses (suggestive of ________)

A

Turner syndrome (45,XO)

coarctation of the aorta

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10
Q

Turner syndrome is characterized by a 45,X karyotype due to loss of ____

A

paternal chromosome X

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11
Q

Partial molar pregnancies have ___ or ____ karyotype as the result of fertilization of an ovum by ______

A

69,XXX
69,XXY
2 sperm

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12
Q

Partial moles typically contain:
fetal tissue
normal placental villi
intermixed with ____

A

hydropic villi

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13
Q

A complete mole has ____ and is composed entirely of

large, edematous, and disordered chorionic villi

appears grossly as ____ of vesicular structures.

A

no fetal structures

clusters of vesicular structures
“bunch of grapes”

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14
Q

Pelvic pain
vaginal bleeding
larger than expected uterus for gestational age
markedly β-hCG levels (trophoblastic hyperplasia)

A

Complete mole

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15
Q

Ultrasound demonstrates:
central heterogenous mass
multiple cystic areas

A

Complete mole

“Swiss cheese” or “snowstorm” pattern

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16
Q 
Risk factors for molar pregnancies include 
prior molar pregnancy 
prior miscarriage
\_\_\_\_\_\_\_
infertility.
A

extremes of maternal age

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17
Q

​​​​​​​​​​​​​​A complete mole most commonly results from the fertilization of an ovum that has _____ by one sperm (90% of cases).

A

no maternal chromosomes
(either due to absence or inactivation)

the haploid sperm replicates to form
(46 XX) purely paternal genome

*46,YY moles from duplication of 23Y sperm have not been observed, as a zygote without an X chromosome would not survive.

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18
Q 
​​​​​​​​​​​​​​A complete mole can also form from the fertilization of an ovum that has no maternal chromosomes 
by \_\_\_\_\_  (10% of cases).
A

two sperm

(46 XX, 46 XY) purely paternal genome

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19
Q

In vitro fertilization using a donated ovum is the most promising means of achieving pregnancy in a woman with

A

Turner syndrome

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20
Q

Turner syndrome is a genetically heterogeneous condition that is most commonly due to ____ during gametogenesis.

A

meiotic nondisjunction

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21
Q

The loss of all or part of the X chromosome in Turner syndrome results in a missing ___ gene, which normally promotes long bone growth.

A

SHOX

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22
Q

______ results in a mixture of normal and mutated somatic cells, often leading to a milder form of the disease.

these patients are missing the X chromosome in only some of their cells 45,X/46,XX

A

Somatic mosaicism

2 karyotypes evident on analysis

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23
Q

Pt with ____ have no upper vagina (short vaginal canal/ blind pouch) and variable uterine development. These patients are 46,XX females with normal ovaries and secondary sexual characteristics.

A

Müllerian aplasia (complete agenesis of paramesonephric ducts)

Mayer-Rokitansky-Küster-Hauser syndrome

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24
Q

The lower vagina originates from the _______ and

The upper vagina originates from the _______

A

urogenital sinus

Mullerian ducts (paramesonephric)

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25
Q

A transverse vaginal septum is an example of failed ______ of the paramesonephric ducts with the urogenital sinus.

This causes primary amenorrhea with cyclic pelvic pain from hematometra (menses retained in the uterus)

A

vertical fusion

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26
Q

A _______ is an example of failed vertical fusion of the paramesonephric ducts with the urogenital sinus.

A

transverse vaginal septum

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27
Q

left ovarian vein thrombosis can extend to the left renal vein. Right ovarian vein thrombosis can extend to the

A

IVC

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28
Q

Aromatase converts the androgens into estradiol.

It is located in what cell type?

A

Granulosa cells

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29
Q

What cells have the FSH receptor?

A

Granulosa cells/ Sertoli cells

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30
Q

What cells have the LH receptor?

A

Theca Cells/ Leydig cells

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31
Q

What cells produce progesterone and androgens in females?

A

Theca interna Cells

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32
Q

The absolute contraindications to the use of OCPs are:

Prior history of thromboembolic event or stroke
History of an estrogen-dependent tumor
Women over age 35 years who ___
Hypertriglyceridemia
Decompensated or active liver disease (would impair steroid metabolism)
Pregnancy

A

smoke heavily

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33
Q

Immediately prior to delivery, ___ stimulates upregulation of gap junctions between individual myometrial smooth muscle cells.

An increase in gap junction density at delivery heightens myometrial excitability.

Gap junctions consist of aggregated ____ proteins that allow passage of ions between myometrial cells.

A

estrogen

connexin

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34
Q

Ant- Post axis (limb bud) patterning
CNS development
*Holoprosencephaly

A

Sonic (SHH)

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35
Q

Dorsal-ventral axis

Apical Ridge

A

Wnt-7

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36
Q

Limb lengthening

Apical Ridge

A

Fibroblast Growth Factor (FGF)

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37
Q

Carnio-caudal axis

Segmental organization

A

HOX genes

38
Q

Arrested Oocyte phases:
At birth __
At Ovulation __

A

Prophase I

Metaphase I

39
Q

Extrinsic tissue disruption (ex: crowding = clubbed feet)

A

Deformation

40
Q

Intrinsic tissue disruption during embryonic period

A

Malformation

41
Q

No primordial tissue = no structure

A

Agenesis

42
Q

Primordial tissue, but no structure

A

Aplasia

43
Q

Primordial tissue, but incomplete structure

A

Hypoplasia

44
Q

Previously normal tissue is broken down

A

Disruption

45
Q

Both cystic hygromas (cystic posterior neck mass) and lymphedema occur due to abnormalities of lymphatic outflow in _____ syndrome

A

Turner syndrome

46
Q

The normal physiology of pregnancy involves chronic ___ caused by elevated progesterone levels stimulating an increase in central respiratory drive.

A

hyperventilation

47
Q

Give an opioid addicted baby morphine or

A

methadone

48
Q

detachment of the placenta from the uterus prior to fetal delivery, presents with painful vaginal bleeding; a tender, firm uterus; and fetal heart rate abnormalities. Risk factors include abdominal trauma, maternal hypertension, and tobacco or cocaine use

A

Abruptio placentae

49
Q

the fetal vessels traverse the internal cervical os and are unprotected/vulnerable to injury.
Patients typically have painless vaginal bleeding.

A

vasa previa

50
Q

placental implantation over the cervix, typically presents in the
third trimester with painless vaginal bleeding and no uterine tenderness.

A

Placenta previa

51
Q

full-thickness disruption of the uterine wall, is associated with severe lower abdominal pain, vaginal bleeding, and fetal heart rate tracing abnormalities (eg, bradycardia).
Typically occurs in patients with prior cesarean delivery has a uterus with palpable fetal parts

A

Uterine rupture

52
Q

High risk of DIC in this pregnancy complication

A

Abruptio placentae

53
Q

is associated with maternal HTN, abdominal trauma, use of tobacco or COCAINE (vasoconstrictors causing placental ischemia)

A

Abruptio placentae

54
Q

Prevent neonatal Intracranial hemorrhage with a Vitamin __ shot

A

K

55
Q

Pregnant women > 20 weeks gestation can experience compression of the ___ by the gravid uterus while in the supine position. This reduces venous return and cardiac output, which can result in hypotension and syncope.

A

inferior cava

56
Q

___-induced cholesterol hypersecretion and _____-induced gallbladder hypomotility are responsible for the increased incidence of cholelithiasis in women who are pregnant or using oral contraceptives.

A

Estrogen

progesterone

57
Q

A complete mole is composed of multiple cystic edematous hydropic villi as a result of trophoblast proliferation. Serial measurements of β-hCG should be performed following evacuation of a __ mole.

A

hydatidiform

58
Q

is new-onset hypertension at ≥20 weeks gestation plus proteinuria and/or signs of end-organ damage.

A

Preeclampsia

59
Q

Preeclampsia is caused by widespread maternal endothelial cell damage due to release of antiangiogenic factors from an ___ placenta.

A

ischemic

*The result is widespread capillary leakage (proteinuria, edema) and vasospasm (hypertension, end-organ hypoperfusion [eg, renal failure]).

60
Q

Pathology shows fetal tissue, focal trophoblastic hyperplasia, and some enlarged villi interspersed with normal villi.

A

partial mole (69XXX/Y)

61
Q

Fetal hyperinsulinemia persists for several days following birth and predisposes the infant to transient

A

hypoglycemia

62
Q

Uterine curettage would reveal decidual changes in the endometrium due to progesterone secretion but no embryonic or trophoblastic tissue (eg, no villi).

A

ectopic pregnancy

63
Q

Straight, short endometrial glands and compact stroma are found in the early ____ of the menstrual cycle.

A

proliferative phase

64
Q

A ___ anomaly is caused by extrinsic forces on a developing fetus.

A

deformation

65
Q

white pupils (cataracts), hearing loss, machine murmur (PDA)

A

congenital rubella

Live attenuated vaccine

66
Q

Pre-eclampsia causes proteinuria and decreased

A

VEGF

*endothelin and TXA2 are increased (vasoconstrictors)

67
Q

Pre-eclampsia can cause vision problems does to retinal artery

A

vasospasm

68
Q

occurs due to placental invasion into the myometrium through defects in the decidua basalis.

A

Placenta accreta spectrum

69
Q

Placenta accreta spectrum creates a morbidly adherent placenta that does not detach after fetal delivery, leading to

A

postpartum hemorrhage

*Manual placental extraction typically yields small placental fragments and increases bleeding.

70
Q

Common signs include hypoxia, hypotensive shock, and disseminated intravascular coagulation. Fetal squamous cells are seen in the pulmonary vasculature during histologic evaluation.

A

Amniotic fluid embolism

71
Q

Partial progesterone agonist (acts as progesterone antagonist during pregnancy)
Promotes placental separation & uterine contractions

A

Mifeprostone

72
Q

Prostaglandin E1 agonist

Stimulates uterine contractions

A

Misoprostol

73
Q

Ectopic pregnancy
Folic acid antagonist (inhibits dihydrofolate reductase)
Preferentially destroys proliferating fetal cells

A

Methotrexate

74
Q

Human placental lactogen increases maternal __ resistance

A

insulin

75
Q

Use of these antihypertensive drugs during pregnancy can result in fetal anuria, oligohydramnios, pulmonary hypoplasia, limb contractures, and calvarium/face bones defects.

A

ACE-I

ARBs

76
Q

Patients with a ruptured ___ have severe intraabdominal bleeding, which causes diffuse abdominal pain with rebound/guarding and hemodynamic instability.

A

ectopic pregnancy

77
Q

Pregnant women with severe ____ can develop HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) syndrome.

A

preeclampsia

78
Q

patients are also at risk for seizure, renal insufficiency, and disseminated intravascular coagulation due to widespread endothelial dysfunction.

A

preeclampsia

79
Q

Maternal ___ infection produces a low-grade fever, a maculopapular rash with cephalocaudal progression, and posterior auricular and suboccipital lymphadenopathy.

A

rubella

80
Q

Patients with preeclampsia are at risk for fetal growth restriction and oligohydramnios due to
abnormal placental ____ artery development,
which leads to
increased placental vascular resistance,
decreased uteroplacental perfusion
decreased umbilical vein oxygen delivery.

A

spiral artery

81
Q

a teratogenic medication that decreases maternal folate levels and increases the risk of fetal neural tube defects

A

Valproate

82
Q

It is associated with low levels of maternal serum α-fetoprotein and estriol and increased levels of β-hCG and inhibin A.

A

Down syndrome

83
Q

___ α-fetoprotein levels are seen in multiple gestation, open neural tube defects, and abdominal wall defects.

A

Elevated

84
Q

Renal effects of preeclampsia include oliguria with increased specific gravity, proteinuria, and serum ___ levels.

A

creatinine

85
Q

Drug associated with Ebstein’s anomaly, which is characterized by apical displacement of the tricuspid valve leaflets

A

Lithium

86
Q

Deficiency of this enzyme causes accumulation of androgens during pregnancy, resulting in ambiguous external genitalia in newborn girls and maternal gestational virilization.

A

Aromatase

87
Q

deficiency causes ambiguous genitalia in boys and increased production of mineralocorticoids (hypertension, hypokalemia).
Girls have phenotypically normal genitalia.

A

17 alpha hydroxylase

88
Q

Deficiency causes Increased androgen production causes ambiguous genitalia in girls

A

21 hydroxylase

89
Q

foul-smelling discharge after pregnancy termination.

A

Septic abortion

90
Q

Common offending pathogens of septic abortion include (2)

A

Staphylococcus aureus and E. Coli

*due to seeding of the uterine cavity during instrumentation.

STEP 1 (88 decks)

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