female repro Flashcards
lower 1/5 of vagina origin
urogenital sinus
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
failure of fusion of the 2 mullerian ducts
- double, uterus, double cervix, single vag
- double uterus, single cervix, single vag
- septate or arcuate uterus
imperforate hymen is due to?
failure of degeneration of the cells bw the junciton of the upper and lower vag
anti mullerian hormone
is secreted by
sertoli cells
what cells secrete androgens that stimulate development of mesonephric ducts
leydig cells
Q
newborn genetically male.
all external structures are male. you get an US eval and you identify fallopian tubes
what is the cause
inability of the embryonic testes to produce anti-mullerian hormone
(absence of sertoli cells which secrete anti-mullerian hormone
pt with hypospadias and small phalus
normal estrogen and testerone levels.
ambgous genitalia until puberty
5a reductase deficiency
(feminization of the penis)
the ureter is very close to the lateral fornix
a lower ureteric stone can be palpated
invasive cervical tumros compress on the ureter –>
hydronephrosis / ARF
during hysterectomy
clamping of what vessels may include the ureters –> anuria
uterine vessels in the (cardinal ligament)
pain from the euterus, cervix and adnexa
referred pain to
T10-L2
hematuria in a female pt at the base of the bladder is from?
vaginal artery
Q
ovulation occurs as a result of Estrogen induced LH surge
by what kind of feedback of the end of the follicular phasse
postive
the corpus luteum
is secreting what hormone/hormones
both!!!!
estrogen and progesterone (mostly progesterone
mild increase in temperature during ovulation is caused by what hormone?
progesterone
what is mittelschmerz
irritation of the peritoneum by fluid and/or blood from ruptured graafian follicle during ovulation
mimics appendicitis
low HCG is in favor of?
ectopic pregnancy
HPL
pt develops gestational diabetes
HPL has anti-insulin effect –> inc maternal blood glucose lvs –> inc nutrition to the fetus
insulin resistance of maternal tissue –> gestational diabetes
LH –> theca INTERNA cells to take
cholesterol –> andostenedione
what enzyme does this
desmolase
at this timing of splitting of the inner mass causing what type of twins?
2-3 days
DIchorionic
Diamniontic
at this timing of splitting of the inner mass causing what type of twins?
3-8 days
MONOchorionic
Diamniotic
at this timing of splitting of the inner mass causing what type of twins?
8-13 days
Mono chorionic
MONO amniotic
at this timing of splitting of the inner mass causing what type of twins?.
after 13 days
monochorionic
monoamniotic
CONJOINED
Q
effects of estrogen on lipids during pregnancy
____HDL and triglycerides
____ LDL and fat deposition
___ Na and water retention
inc HDL and triglycerides
dec LDL and fat deposition
inc salt (Na) and water retention
Q
what controls libido (sexual desire)
in females?
androgenic hormones (male)
not estrogen!!!
what is the cause of normal menstrual bleeding
progesterone withdraw
high yield!!!
mifepristone
can help induce abortion how
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
Q
what oral contraception can be given to mom immediately after delivery?
progestin (progesterone) only pill bc it cant be passed into the milk
intrauterine devices
can increase risk of what bacteria
actinomyces israelii
on the boards
intra uterine device prevent the implantation of the embryo at which stage and what day
on day 6
the Blatocyst stage attaches tothe endometrium (by eroding the endometrium w/ the syncytiotrophoblast
high yield.
almost all ovarian carcinomas seen in women with
BRCA1 or BRCA 2 mutationsare
serous carcinomas
high yield what is the moa of the drug used in PCOS to induce ovulation
CLOMIPHENE
estrogen antagonist that increases secretion of gonaotropins and stimulates ovulation
it may inc the incidence of pregnancy with multiple fetuses
sharp intermittent menstrual pain and spasms associated with ovulatory cyccles in the absence of pathologic findings
is this primary dysmenorrhea
true
bc no pathologic findings
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?
Prostaglanding F2a
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.
endometriosis
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?
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.
acute endometritis
is due to what microbes?
polymicrobial !!!!!!!
(grp B strept, ureaplasma urealyticum, peptostreptococcus)
chronic endometritis (lymphoplasmacytic)
associated with intrautertine device.
is associated with what microbe
(was on comsae)
actinomyces israeli
tx of acute endometritis
(fever, abnormal uterine bleeding, pelivc pain)
iv clindamycin + gentamicin
on boards
which vaginitis
present with normal pH of vagina
(3.8-4.5)
candida vulvovaginitis
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
posterior fornix
precurosor for squamous cell carincoma
always biopsy this lesion
on the vulva
leukoplakia.
- 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?
lichen sclerosus et atrophicus
can ask you if precancerious or not
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
C.
diastolic murmur in pregnancy is always pathologic
on test
premature labor.
management
first step is best rest and hydration
if no response start?
TOCOLYTIC DRUGS
- MgSO4, and terbutaline and nifedipine!!!!!
ON boards
elevated alpha-fetoprotein (AFP) levels may be due to?
underestimation of gestational age
pregnant women that has progressive AFP levels decreasing.
what does this indicate for the fetus
down syndrome
how to treat
threatened abortion
(vaginal bleeding, cramping, and closed cervix)
reassuramce, 24-48 hours bed rest. and
avoid coitus (sex)
what abortion
cramping and vaginal bleeding and bdilated cervix with protrusion of the product of conception
TX?
inevitable abortion
tx: evacuation of the contents
* send for chromsomal analysis
- the most common cause of abortion in the 1st trimester is chromosomal abnoramlities
what type of abortion
painless expulsiono of all the products of conception (fetus and placenta)
TX?
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
what type of abortion
no uterine growth and arrested fetal progression with fialure of expulsion of the product of conception
tx?
missed abortion
tx w/ D and C
know that DIC is a fatal complication of msised abortion
whats the cause of macrosomia
hyperinsulinemia
what causes large deposits of fetal fat?
high insulin levels in the fetus (NOT maternal insulin)
and
high maternal blood glucose.
if asymptomatic pt comes to your office for initial prenatal visit and found to have bacteriuria
what should your managment be
treat asymptomatic bacteriuria w?
ampicillin
cephalaxin
or
nitrofurantoin.
remember fluoroquinolone and sulfa are CI in pregnancy
34 yo women at 16 wks gestation has recurrent cystitis.
what is the most appropriate therap
treat recurrent cystitis w/
nitrofurantoin for the entire pregnancy
! Q on boards
pregnant pr nonpregnant pt with pyelonephritis
what should you do
admit to hospital and treat with IV antibiotics
