female repro Flashcards by conrad landers

lower 1/5 of vagina origin

urogenital sinus

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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

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imperforate hymen is due to?

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

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anti mullerian hormone

is secreted by

sertoli cells

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what cells secrete androgens that stimulate development of mesonephric ducts

leydig cells

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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

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pt with hypospadias and small phalus

normal estrogen and testerone levels.

ambgous genitalia until puberty

5a reductase deficiency

(feminization of the penis)

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the ureter is very close to the lateral fornix

a lower ureteric stone can be palpated

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invasive cervical tumros compress on the ureter –>

hydronephrosis / ARF

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during hysterectomy

clamping of what vessels may include the ureters –> anuria

uterine vessels in the (cardinal ligament)

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pain from the euterus, cervix and adnexa

referred pain to

T10-L2

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

vaginal artery

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ovulation occurs as a result of Estrogen induced LH surge

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

postive

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the corpus luteum

is secreting what hormone/hormones

both!!!!

estrogen and progesterone (mostly progesterone

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

progesterone

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what is mittelschmerz

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

mimics appendicitis

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low HCG is in favor of?

ectopic pregnancy

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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

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LH –> theca INTERNA cells to take

cholesterol –> andostenedione

what enzyme does this

desmolase

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

2-3 days

DIchorionic

Diamniontic

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

3-8 days

MONOchorionic

Diamniotic

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

8-13 days

Mono chorionic

MONO amniotic

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

after 13 days

monochorionic

monoamniotic

CONJOINED

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 mutations**are

**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** (lympho**plasmacytic**) 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**