March 25 - Repro Flashcards
Endometrium in phases of menstrual cycle
Proliferative phase
- estrogen driven
- straight short endometrial glands with compact stroma
- gland:stroma ratio less than 1
Secretory/luteal phase
- progesterone driven
- decidualization, preparing uterus for implantation
- dilated, coiled glands with increased gland to stroma ratio
- vascularized edematous stroma
Congenital rubella syndrome
- microcephaly and mental retardation
- cataracts, deafness (cataracts present as white pupils)
- PDA, pulmonic stenosis
MMR vaccine
All three components are live attenuated
Hep A vaccine
killed virus
Rabies vaccine
killed virus
Porstatic plexus
Lies within the fascia surrounding the prostate. Originates from the inferior hypogastric plexus. Includes cavernous nerves which innervate the corpora cavernosa of the penis and urethra and parasympathetics resonsible for erection. Damage during prostatectomy can cause erectile dysfunction.
Epithelia of female genital tract
Ovary: simple cuboidal
Fallopian tube, uterus, and endocervix: simple columnar
Ectocervix and vagina: Stratified squamous, non-keratinizing
Endometriosis: pathology, etioloty, symptoms, treatment
Pathology: Endometrial cells implanted on various pelvic organs. Hemosiderin deposits, powder burn lesions (purple-brown spots)
Etiology: Two hypotheses: retrograde menstruation and metaplasia
Symptoms: pelvic pain, infertility, dysmenorrhea, dyspareunia
Treatment: NSAIDs, GnRH agonist, hysterectomy
Uretrhal injury due to trauma: presentation, and most common location
Inability to void, blood at urethral meatus, high riding boggy prostate due to hematoma formation behind th gland. Pelvic trauma most commonly causes damage to the bulbomembranous junction of the urethra where it curves.
Lymphatic drainage of male repro organs
Testis: para-aortic nodes
Glans penis: deep inguinal nodes
Scrotum: superficial inguinal nodes
Communicating hydrocele
Collection of peritoneal fluid in the tunica vaginalis. Due to failure of the connection between tunica vaginalis and peritoneum to obliterate. Common in newborns. Presents as painless scrotal swelling that transilluminates
Risk factors for testicular cancer
Klinefelter’s syndrome. History of cryptorchidism
Male urethra portions
- Prostatic urethra: widest portion, where other ducts dump in
- Membranous urethra: passes through perineal membrane and surrounded by perineal muscles. Narrowest part
- Penile urethra: longest part
Urethral rupture above vs below urogenital diaphragm
Urogenital diaphragm is the junction between the membranous and penile urethra.
Rupture below: urine goes to scrotum and perineum
Rupture above: urine goes to retropubic spaces
Cause of bicornuate uterus
Partial failure of fusion of Mullerian ducts
Uterine hypoplasia or agenesis
Caused by failure of the paramesonephric ducts to form; commonly associated with urinary tract anomalies
Unicornuate uterus
Failure of one of the paramesonephric ducts to form
Didelphus uterus
Both ducts develop but fail to fuse. Can have separate or shared cervix/vagina
Bicornuate uterus
Failed fusion at the top of the uterus; single cervix. Most common uterine anomaly
Septate uterus
Normal external shape (doesn’t have two horns) but have two separate cavities inside
Arcuate uterus
Small midline indentiation; failure of septum to completely dissolve
DES uterus
Due to exposure to DES in utero. T shaped uterine cavity
Ligaments of ovary: suspensory, cardinal/transferse cervical, round
Suspensory: house ovarian artery and vein
Cardinal/transferse cervical: house uterine arteries. Form base of broad ligament
Round ligament: no structures
Embryologic structures that give rise to external genitalia
Genital tubercle: glans penis/clitoris
Urogenital folds: ventral shaft of penis/labia minora
Labioscrotal folds: scrotum/labia majora
beta-hCG structure
shared subunit with TSH, LH, and FSH
Organogenesis
Occurs during weeks 3-8. When exposure to teratogens is the most concerning
Testicular seminoma
Large cells with clear cytplasm and central nuclei. Homogenous mass without hemorrhage or necrosis. Good prognosis
Embryonal germ cell testicular tumor
Hemorrhagic and necrotic. Can form glands. Aggressive. May differentiate when give chemo
Yolk sac testicular tumor
Seen in young kids. Schiller Duval bodies (glomeruloid like structure). Elevated AFP.
Choriocarcinoma testicular tumor
Makes beta hCG. Synctiotrophoblasts and cytotrophoblasts but no villi. Spreads early via blood.
Twinning - timing
Day 3 or earlier: di/di
Day 4-8: mono/di
Day 8+: mono/mono
Epispadius vs hypospadius
Epispadius: urethral opening on dorsal penis. Caused by abnormal development of genital tubercle
Hypospadius: urethral opening on ventral penis. Caused by abnormal development of urogenital folds
Development of prostate
Exception in that it doesn’t develop from Wolffian duct, develops from urogenital sinus along with prostatic urethra in response to testosterone
Complete vs partial mole: uterine size, beta hCG, and immunohistochemistry
Complete: enlarged uterus inconsistent with dating, extremely high beta hCG, p57 negative
Partial mole: normal uterus, normal to high beta hCG, p57 positivw
Cell cell connections during labor
Just prior to labor, estrogen stimluates upregulaton of gap unctions while increases myometrial excitability
Krukenberg tumor
Primary gastric cancer metastasized to ovary. Pathology is signet ring cells producing mucin
Uterine fibroids: pathology, locations, presentation
Pathology: Benign, monocloncal tumors of uterine smooth muscle. Express estrogen receptors and are estrogen responsive (can enlarge with increased estrogen and cna regress with menopause or leuprolide)
Locations: Subserosal most common, intramural (in uterine wall), or submucosal (below endometrium)
Presentation: pelvic pressure, menorrhagia, metrorrhagia, constipation if in the posterior uterus, obstructive urinary symptoms if displaces uterius upward
High vs low grade CIN
HIgh grade: invades beyond lower 1/3 of cervical epithelium (to epithelial surface); associated with HPV 16 or 18 and often progress to cancer
Low grade: cells not invaded past lower 1/3, associated with HPV 6 and 11; usually regress
Ureter injury during hysterectomy
Very common due to close proximity of ureter and uterine artery. Injury with suture causes flank pain due to urine obstruction. Transection causes urine leak and flank pain. Voiding can be normal as injur y is unilateral
Congenital torticollis
Presents at 2-4 weeks. Caused by birth trauma or malposition of the head in utero. Damage to SCM muscel results in fibrosis and contraction. HEad is tilted toward affected side
Infundibulopelvic ligament
Another name for suspensory ligament of the ovary. Houses ovarian vessels and ovarian nerve plexus
Distinguishing causes of vaginal bleeding during pregnancy
Abruptio placentae: painful vaginal bleeding in 3rd trimester, prior to labor. May see initiation of contraction. Risk factors include HTN, smoking, cocaine
Uterine rupture: painful vaginal bleeding during labor, seen during vaginal delivery in women wtih prior C section
Placenta previa: placentation that covers cervical os; painless bright red vaginal bleeding
PCOS diagnosis
Based on
- clinical symptoms: hirsutism, insulin resistance, infertility, anovulatory bleeding, enlarged cystic ovaries
- LH/FSH 3:1 (normal is 1.5:1)
Paget disease of nipple: histology
large cells with clear halos
Phenytoin side effect
horizontal nystagmus on vertical gaze
