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female repro Flashcards

1
Q

lower 1/5 of vagina origin

A

urogenital sinus

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2
Q

young 21 yo women seen for dyspareunia and dysmenorrhea. pelvic exam reveals a double vagina and a double cervix. the transvaginal US indicated the clinial findings.

what is the defect that she has during embryogenesis

A

failure of fusion of the 2 mullerian ducts

  • double, uterus, double cervix, single vag
  • double uterus, single cervix, single vag
  • septate or arcuate uterus
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3
Q

imperforate hymen is due to?

A

failure of degeneration of the cells bw the junciton of the upper and lower vag

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4
Q

anti mullerian hormone

is secreted by

A

sertoli cells

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5
Q

what cells secrete androgens that stimulate development of mesonephric ducts

A

leydig cells

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6
Q

Q

newborn genetically male.

all external structures are male. you get an US eval and you identify fallopian tubes

what is the cause

A

inability of the embryonic testes to produce anti-mullerian hormone

(absence of sertoli cells which secrete anti-mullerian hormone

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7
Q

pt with hypospadias and small phalus

normal estrogen and testerone levels.

ambgous genitalia until puberty

A

5a reductase deficiency

(feminization of the penis)

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8
Q

the ureter is very close to the lateral fornix

a lower ureteric stone can be palpated

A
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9
Q

invasive cervical tumros compress on the ureter –>

A

hydronephrosis / ARF

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10
Q

during hysterectomy

clamping of what vessels may include the ureters –> anuria

A

uterine vessels in the (cardinal ligament)

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11
Q

pain from the euterus, cervix and adnexa

referred pain to

A

T10-L2

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12
Q

hematuria in a female pt at the base of the bladder is from?

A

vaginal artery

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13
Q

Q

ovulation occurs as a result of Estrogen induced LH surge

by what kind of feedback of the end of the follicular phasse

A

postive

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14
Q

the corpus luteum

is secreting what hormone/hormones

A

both!!!!

estrogen and progesterone (mostly progesterone

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15
Q

mild increase in temperature during ovulation is caused by what hormone?

A

progesterone

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16
Q

what is mittelschmerz

A

irritation of the peritoneum by fluid and/or blood from ruptured graafian follicle during ovulation

mimics appendicitis

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17
Q

low HCG is in favor of?

A

ectopic pregnancy

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18
Q

HPL

pt develops gestational diabetes

A

HPL has anti-insulin effect –> inc maternal blood glucose lvs –> inc nutrition to the fetus

insulin resistance of maternal tissue –> gestational diabetes

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19
Q

LH –> theca INTERNA cells to take

cholesterol –> andostenedione

what enzyme does this

A

desmolase

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20
Q

at this timing of splitting of the inner mass causing what type of twins?

2-3 days

A

DIchorionic

Diamniontic

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21
Q

at this timing of splitting of the inner mass causing what type of twins?

3-8 days

A

MONOchorionic

Diamniotic

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22
Q

at this timing of splitting of the inner mass causing what type of twins?

8-13 days

A

Mono chorionic

MONO amniotic

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23
Q

at this timing of splitting of the inner mass causing what type of twins?.

after 13 days

A

monochorionic

monoamniotic

CONJOINED

24
Q

Q

effects of estrogen on lipids during pregnancy

____HDL and triglycerides

____ LDL and fat deposition

___ Na and water retention

A

inc HDL and triglycerides

dec LDL and fat deposition

inc salt (Na) and water retention

25
Q

Q

what controls libido (sexual desire)

in females?

A

androgenic hormones (male)

not estrogen!!!

26
Q

what is the cause of normal menstrual bleeding

A

progesterone withdraw

27
Q

high yield!!!

mifepristone

can help induce abortion how

A

progesterone antagonist

with an affinity for the progesterone 5 times that of neutral progesterone.

blocks the binding of progesterone to its receptor on the endometrium

28
Q

Q

what oral contraception can be given to mom immediately after delivery?

A

progestin (progesterone) only pill bc it cant be passed into the milk

29
Q

intrauterine devices

can increase risk of what bacteria

A

actinomyces israelii

30
Q

on the boards

intra uterine device prevent the implantation of the embryo at which stage and what day

A

on day 6

the Blatocyst stage attaches tothe endometrium (by eroding the endometrium w/ the syncytiotrophoblast

31
Q

high yield.

almost all ovarian carcinomas seen in women with

BRCA1 or BRCA 2 mutationsare

A

serous carcinomas

32
Q

high yield what is the moa of the drug used in PCOS to induce ovulation

A

CLOMIPHENE

estrogen antagonist that increases secretion of gonaotropins and stimulates ovulation

it may inc the incidence of pregnancy with multiple fetuses

33
Q

sharp intermittent menstrual pain and spasms associated with ovulatory cyccles in the absence of pathologic findings

is this primary dysmenorrhea

A

true

bc no pathologic findings

34
Q

on boards

primary dysmenorrhea

(sharp intermittent menstrual pain and spasms associated with ovulatory cycles in absence of pathologic findings)

there is uterine vasoconstriction, anoxia, and sustained contractions mediated by?

A

Prostaglanding F2a

35
Q

chronic pain

  • lower back pain
  • pelvic and abdominal pain

dyspareunia (painful sex)

infertility - due to fallopian tube obstruction

dysuria and painful defecation (dyschezia)

menorrhagia (heavy menstrual bleeding)

spotting.

A

endometriosis

36
Q

Q on boards

pt with endometriosis pain that is in middle lower abdomen unresponsive to meds.

what can you do?

**what nerve is cut**

this helps with pain only where?

A

presacral neurectomy

(superior hypogastric plexus) b

carries the sensory nerves from the uterus and cervix

but NOT the ovaries and fallopian tubes.

helps with pain from the uterus and cervix but NOT the lateral sides of the pelvis.

37
Q

acute endometritis

is due to what microbes?

A

polymicrobial !!!!!!!

(grp B strept, ureaplasma urealyticum, peptostreptococcus)

38
Q

chronic endometritis (lymphoplasmacytic)

associated with intrautertine device.

is associated with what microbe

(was on comsae)

A

actinomyces israeli

39
Q

tx of acute endometritis

(fever, abnormal uterine bleeding, pelivc pain)

A

iv clindamycin + gentamicin

40
Q

on boards

which vaginitis

present with normal pH of vagina

(3.8-4.5)

A

candida vulvovaginitis

41
Q

Question on boards

for any vaginal discharge - the best site for specimen collection for culture or examination is?

A. uterine cavity

B urethra

C endocervical canal

D rectum

E posterior fornix

A

posterior fornix

42
Q

precurosor for squamous cell carincoma

always biopsy this lesion

on the vulva

A

leukoplakia.

43
Q
  • white patches and scarring –> atrophy of the vulva
  • thinning of epidermis and fibrosis of the dermis

NO inc risk for squamous carcinoma

whats the diagnosis?

A

lichen sclerosus et atrophicus

can ask you if precancerious or not

44
Q

all of the following are physiological maternal changes during pregnancy except?

A. CO may increase by 40% and inc heart rate 12-18bpm

B. mild decrease of both systolic and diastolic BP

C. Diastolic murmur during pregnancy is always normal

D. hypercoagulable state is common during pregnancy

E. increased blood volume –> dec HCT

A

C.

diastolic murmur in pregnancy is always pathologic

45
Q

on test

premature labor.

management

first step is best rest and hydration

if no response start?

A

TOCOLYTIC DRUGS

  • MgSO4, and terbutaline and nifedipine!!!!!
46
Q

ON boards

elevated alpha-fetoprotein (AFP) levels may be due to?

A

underestimation of gestational age

47
Q

pregnant women that has progressive AFP levels decreasing.

what does this indicate for the fetus

A

down syndrome

48
Q

how to treat

threatened abortion

(vaginal bleeding, cramping, and closed cervix)

A

reassuramce, 24-48 hours bed rest. and

avoid coitus (sex)

49
Q

what abortion

cramping and vaginal bleeding and bdilated cervix with protrusion of the product of conception

TX?

A

inevitable abortion

tx: evacuation of the contents

* send for chromsomal analysis

  • the most common cause of abortion in the 1st trimester is chromosomal abnoramlities
50
Q

what type of abortion

painless expulsiono of all the products of conception (fetus and placenta)

TX?

A

complete aborption

check the product of conception and send it to pathology

monitor the HCG level and make sure that it is back to 0

if not it means inncomplete abortion and needs D and C

51
Q

what type of abortion

no uterine growth and arrested fetal progression with fialure of expulsion of the product of conception

tx?

A

missed abortion

tx w/ D and C

know that DIC is a fatal complication of msised abortion

52
Q

whats the cause of macrosomia

A

hyperinsulinemia

53
Q

what causes large deposits of fetal fat?

A

high insulin levels in the fetus (NOT maternal insulin)

and

high maternal blood glucose.

54
Q

if asymptomatic pt comes to your office for initial prenatal visit and found to have bacteriuria

what should your managment be

A

treat asymptomatic bacteriuria w?

ampicillin

cephalaxin

or

nitrofurantoin.

remember fluoroquinolone and sulfa are CI in pregnancy

55
Q

34 yo women at 16 wks gestation has recurrent cystitis.

what is the most appropriate therap

A

treat recurrent cystitis w/​

nitrofurantoin for the entire pregnancy

56
Q

! Q on boards

pregnant pr nonpregnant pt with pyelonephritis

what should you do

A

admit to hospital and treat with IV antibiotics

board review (20 decks)

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