Repro Flashcards

1
Q

Puberty

A

Before and after fertile years FSH > LH during fertile years LH is greater than FSH

  • Increase in LH signal steroid production and onset of puberty
  • In females breast buds occur before menarche
  • In males growth in size of testes is driven by seminferous tubule expansion and leydig growth
  • At puberty GNrH signals an increase in it’s own receptor number leading to increased pulsatile LH secretions
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2
Q

Sertoli Cells

A
  • Tight junctions
  • Secretions of fluid
  • Nitrients (ABP)
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3
Q

Leydig

A

-Interstitial cells and secrete testosterone

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4
Q

Sperm

A

Mitotic is spermatoagonia and meotic is to spermatidis (Haploid)

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5
Q

Semen

A
  • Seminal vesicles secretes: PG, fructose, citrate, and fibrinogen
  • Prostate: Alkaline fluid with Zn, citrate, Ca
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6
Q

Capacitation

A

Sperm gain motility in female tract through Ca influx

-Undergo acrosome reaction which allows for acrosome to fuse with PM

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7
Q

Testosterone

A
  • Leydig cells containn 17B hydroxysteroid hydrolase which converts weak androgens into testosetone
  • LH increases rate of desmolase conversion
  • Most stays locally to aid in spermatogenesis
  • Rest goes systemic
  • Testosterone is the major feedback and functioner
  • Required for development of itnernal male structures
  • DHT is external structures (5 alpha reductase def)
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8
Q

Follicular Development

A
  • In cortex granulosa cells begin to form around follicle
  • Then thecal cells begin to form outside of that and an antral follicle is formed
  • Thecal cells respond to LH and secrete estrogen while granulosa cells respond to FSH and secrete aromatase
  • Dominant follicle emerges and releases at ovulation. Completes first division. Arrested at metaphase 2
  • Completes metaphase 2 at fertilization
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9
Q

Implantation

A

Blastocyst implants onto cell wall and requires a high progesterone concentration
-Decidua envelopes and produces synctitiotrophobasts

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10
Q

Estogen

A
  • Secondary sex

- Stimlates endomertrial proliferation and contractions

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11
Q

Progesterone

A
  • halts proliferation and increases maturition and secretion

- Halts contractions

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12
Q

Placenta

A
  • Early pregnancy hormone levels are maintained by hCG and CL
  • 2nd and thrid trimester placenta secretes pregnenalone which goes to fetal adrenals and is converted to DHEAs then diffuses back to placenta where aromatase converts to estriol
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13
Q

Partrution

A

Uterine distension causes increase in contractions

  • Fetal HPA produces cortisol and increases the estrogen to progesterone ratio
  • Estrogen increases prostaglandins which cause uterine contraction
  • Cervical distension leads to oxytocin release
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14
Q

Labor

A
  • Early part is positioning
  • Second is delivery of baby
  • Third is delivery of placenta.
  • Oxytocin and strong contractoins prevent bleeding
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15
Q

Embryo

A

Sonic Hedgehog: AP patterning
WNT-7: Dorsal and ventral patterning
-FGF: Limb Lengthening
Hox: Segmentation and limb positioning

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16
Q

2 weeks

A

-Bilaminar

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17
Q

3 weeks

A

Trilaminar and primitive streak

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18
Q

3-8 weeks

A

-Embryonic period where organogenesis occurs. Fetus is susceptible to teratogens and neural tube defects

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19
Q

4 weeks

A

Heart

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20
Q

8 week

A

movement

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21
Q

10 weeks

A

genetalia

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22
Q

Endometrium

A
  • Proliferative stage driven by estrogen and cells increase in number and size but don’t secrete
  • Secretory: Progesterone. Glands become toruous and stroma becomes vacuolated with spiral arteries
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23
Q

Gastrulation

A

Epiblast (bilaminar disk) invagination and forms trilaminar disk

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24
Q

surface ectoderm

A
  • Forms all external structures, skin etc
  • Forms skin of oral cavity
  • Forms eye and lens
  • Forms AP (Craniopharyngoma)
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25
Q

Neuroectoderm

A

-CNS and neural structures. Retnia and optic nerve

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26
Q

Neural Crest

A
  • PNS and autonomics
  • C cells of thyrpid
  • Septation of heart
  • Melanocytes
  • Bones of skull including odontoblasts
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27
Q

Mesoderm

A
  • Muscle and connective tissue
  • Spleen
  • Peritoneal cavities (Spleen)
  • Blood vessels and heart
  • GU
  • VACTERL
  • Vertebral, Anal, Cardiac, TE, Renal, Limb
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28
Q

Endoderm

A
  • Internal strucutures
  • Gut
  • Branchial Pouches (PTH and Thymus)
  • Thyroid
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29
Q

Agnesis and Aplasia

A
  • Agenesis is that tissue was never present

- Aplasia is that tissue was present but never grew

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30
Q

Sacrococygeal Teratoma

A
  • Most common sacral mass in infants

- Remnant of caudal protion of primitive streak

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31
Q

Aminoglycosides

A

-CN 8 deafness

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32
Q

Tetracyclines

A

Teeth

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33
Q

Fluoroquinolones

A

Tendons and bones

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34
Q

ACEI/ARB

A

Renal agenesis leading to potters syndrome

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35
Q

Fetal Hydantoin (Carbemezepin/phenytoin)

A

-Microcephaly, facial anomalies, IUGR, Neural tube, cardiac, hypoplastic nails and distal digits

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36
Q

Lithium

A

-Ebstiens anomaly

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37
Q

Valproate

A

-Impairs folate metabolism leading to neural tube defects

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38
Q

DES

A

-Embyronal rhabdosarcoma

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39
Q

Retinol

A

-Cleft Palate and spontanous abortion

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40
Q

Warfarin

A

-Opthalmologic defects, bleeding, bone deformities, and aboriton. use heparin during pregnancy

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41
Q

FAS

A

-Microcephaly/holoprosencephaly, VSD and cardiac defects, mental retardation and facial defects, IUGR

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42
Q

Cocaine

A

-IUGR, premature placental rupture, baby addicted at birth

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43
Q

Smoking

A

IUGR, ADHD, preterm labor

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44
Q

Maternal Diabetes

A

Caudal regression syndrome, transposition of great vessels and neural tube defects

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45
Q

X rays

A

Retardation and microcephaly

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46
Q

Heroin

A

Tremors, irritability, yawning, rhinorrhea, etc

-Treat with opium

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47
Q

Twinning

A
  • Most are dizygotic and occur from fertilization of two differnt eggs. Will always be dichorionic (Placenta) diamniotic (Amniotic sac)
  • If monzygotic, split occurs of single fertilized egg early in development
  • 0-4 days (25%) dichorionic and diamniotic
  • 4-8 days (75%) monochorionic and diamniotic
  • later is mono/mono or conjoined and is very rare
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48
Q

Fetal Placental Tissue

A
  • Cytotrophoblasts are located at the inner layer and can divide
  • Synctitiotrophoblasts are located at the outer layer and secrete hCG and communicate with maternal placenta
  • Nutrient transfer occurs in lacunae
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49
Q

Umbilical Cord

A

2 arteires (off internal illiacs) deoxygenated blood

  • 1 Vein (through DV and to heart)
  • Also contains allantoic duct which communicates with yolk sac
50
Q

Allantois

A

-Early in gestation connects yolk sac to urogenital sinus, later replaced by urachal duct

51
Q

Urachal Duct

A
  • Connects urogenital sinus to yolk sac
  • Obliterated failure leads to persistance (Urine to flow through umbilicus
  • Vesicourachaldiverticula which can predispose to later adenocarcinoma of bladder
52
Q

Vittelline Duct

A
  • Connects midgut to yolk sac and allows for protrusion of gut contents during embyonic period
  • Normally oblierated by week7
  • Remnant leads to Vitteline fistula which causes meconium leakage at birth
  • Meckels diverticulum extends off terminal ileum, can have ectopic gastric glands that cause bleeding and ulceration (Periumbiliical pain)
53
Q

Aortic Arches

A

1st: Maxillary artery becomes superficial temporal and maxillary through spinosum. Supplies nasal and deeper oral structures
2nd: Stapedial and hyoid (only ossicle not done by 1 is stapes
3rd: Common carotid and first part of internal carotid
4th: Right brachiocephalic and left goes to arch of aorta
6th: Pulmonary arteries to DA
- R recurrent laryngeal around brachiocephalic/subclavian
- L recurrent laryngeal round arch of aorta and stuck on ligamentum arteriosum

54
Q

Branchial Aparatus

A

Arches are mesoderm
Clefts are ectoderm
Pouches are endoderm

55
Q

1st Cleft

A

External Auditory Meatus

  • rest of clefts dissapear as cervical sinus.
  • Persistent cervical sinus will present as lateral neck swelling
56
Q

1st Arch

A
  • Muscle of mastication, incus, malleus, mandible

- Treacher Collins is impaired migration of the first arch

57
Q

2nd arch

A
  • Stapedial artery and stapes. muscles of facial expression

- Hyoid cartilage

58
Q

3rd arch

A
  • Glossopharyngeal and stylopharyngous muscle
  • Contriubtes to posterior tongue
  • Fistual leads to communication between tonsils and lateral neck
59
Q

4th arch

A

Superior Laryngeal Nerve

  • Posterior pharynx and pharyngeal constrictors
  • Cricothyroid. Afferent limb of gag reflex (Elevates pharynx/palate)
  • Cricoid, thyroid, coriat etc cartillages
60
Q

6th arch

A
  • Recurrent laryngeal nerve (R around subclavian) L around aorta and stuck on ligamentum arteriosum
  • Muscles of larynx.
  • Posterior cricoarytenoid is only one that keeps folds open
61
Q

1st pouch

A

Endodermal strucures of ear

-Eustachian tube and middle ear, mastoid air cells

62
Q

2nd pouch

A

-Palatine tonsils

63
Q

3rd pouch

A
  • Inferior PTH (Dorsal wings)

- Thymus (Ventral wings)

64
Q

4th pouch

A

-Superior PTH

65
Q

DiGeorge

A

Abnormal development of 3rd and 4th pouches. Leads to no PTH and no Thymus

66
Q

MEN 2A

A
  • RET oncogene
  • Med C, Pheo, PTH
  • MEN2B is mucocutaneous neuromas
67
Q

Cleft Palate

A

Failed fushion of lateral palatine and nasal or medial palatines

68
Q

CLeft lip

A

Failed fusion of maxillary folds with medial nasal fold

69
Q

SRY

A

Contains TDF which is a transcription factor for MIF and testicle development

70
Q

Mullerian

A

Internal Femal Strucutures to proximal vagina

  • Deformation can lead to pirmary amenorrhea in the presence of normal hormonal status
  • Bicornate uterus occurs if there is incomplete fusion of mullerian ducts leads to miscarriages and UTI
71
Q

Male

A

Internal are encourgaed to grow by Test: Epidydymis, vas deferens, seminal vesicles ejaculatory ducts
-Scrotum, prostate and penis are encouraged to grow with DHT

72
Q

Analogs

A

Cowpers gland-corpora

  • Ventral shaft of penis is labia minora
  • Scrotum is majora
73
Q

Hypospadias

A

-improper fusion of labia minora

74
Q

epispadias

A
  • improper placement of the genitle tubercle

- Seen with bladder extrophy

75
Q

Descent

A

Gubernaculum through internal ring (Transversalis)

  • Internal oblique becomes the cremaster
  • External (Superfifical ring)
  • Periteoneal fold is the tunica vaginalis which is normally obliterated
76
Q

Lymph Drainage

A
  • Testis/OVaries to paraaortic
  • External strucutures to superficial inguinal
  • Uterus and upper vagina (Mullerian derivatives) obrotator, external illiac, hypogastric nodes
77
Q

Relaxin

A

Released during pregnancy to allow bones and joints to loosen and accomidate pregnancy

78
Q

Physiologic Changes in Pregnancy

A
  • Increased HR and CO with decreased peripheral resistance and BP
  • Increased GFR leads to physiologic glucosuria, filtered load is too high
  • Elevated blood volume and decreased osmolarity, there will also be a relative dilutional anemia and increase in fibrongogen (Clotting after birth)
  • Gastric emptying is slowed and respirations increase with a reduction in residual volume
79
Q

Orchitis

A

Can produce sterilty if bilateral and will involve destruction of the parenchyma of the testes leading to decreased T and inhibin with an increase in FSH and LH

80
Q

Epidydimitis

A

Most commonly bacterial, can be from spermatocele, but spermatocele is rarely symptomatic
-Prehns sign, where pain is reduced with testicular elevation will be present

81
Q

Seminoma

A

Most common tumor

  • Sub tunica albuginia with sheets of clear cells (Glycogen and lipids)
  • Good prognosis
  • Will be positive for PLAP and also hCG usually
  • There is an increased risk in patients with cryptorchidism
82
Q

Yolk Sac

A
  • Grossly appears yellowish
  • Microscopically will show glomeruloid schiller duval bodies and eosinophilic cells
  • Elevated AFP
  • Most commonly seen in young kids (5 years)
83
Q

Embryonal Carcinoma

A
  • Areas of hemorrhage and necrosis that may be painful
  • Commonly a mixed tumor with large amounts of anaplastic immautre large cells
  • Elevations in hCG and AFP are possible
84
Q

Chorciocarcinoma

A
  • Most common in younger patietns
  • WIll have elevated hCG
  • Generally a small primary with hematogenous metastasis
  • Elevated hCG levels may increase androgen production and lead to gynecomastia
85
Q

Teratoma

A
  • More commonly malignant in males and the more immature the more malignant
  • Mature has well formed layers of multiple tissues, commonly cartillage
  • Immature is less well differentiated
86
Q

Leydig

A
  • Secrete androgens and esterogens that often leads to gynecomastia
  • Reinke crystals are common
87
Q

Sertoli

A

-Hormonally silent tumor of chrods of sertoli cells

88
Q

Malignant Lymphoma

A

-More common testicular mass in older man. Highly malignant and poor prognosis

89
Q

Prostatitis

A

-If chronic will induce scarring and fibroblastic proliferation

90
Q

BPH

A
  • Nodular hyperplasis in the periurethral zone
  • Feels smooth on DRE
  • Caused by increased androgen sensitivity of prastate and androgen levels fall
  • DHT leads to increased cell survival and stromal proliferation (Hyperplasia) that leads to the urethral narrowing and clinical manifestations
  • Elevatinos in free PSA
  • Causes bladder hypertrophy and may cause diverticula
  • Tx with alpha blockers to relax sphincter (Tamsulosin/Prazosin)
  • Post Renal Azotemia which will present with initially normal values that decline and lead to azotemia
  • Increased risk for ascending infection as well
91
Q

Adenocarcinoma of Prostate

A
  • Occurs in the peripheral posterior zone and is palpated as a nodular mass with obliteration of central sulcus on DRE
  • Elevated levels of PSA (increased bound fraction) and PAP
  • Most commonly metastasizes to bone as sclerotic lesions with increased Alk Phos
  • Can metastasize to the para-aortic lymph nodes
  • Tx with androgen removal )Orchiectamy) Fluatmide, leuprolide
92
Q

Dysgerminoma

A

Most common ind turners

-PLAP sheets

93
Q

Sacrococcygeal teratoma

A

Most common tumor of sacrococcygeal region in kids

-Teratoma that is left over from primitive streak

94
Q

Choriocarcinoma

A

-Increase risk of Theca-Leutin cysts which occur due to increased gonadotopin secretion

95
Q

Mature Dermoid

A

-Formed of multiple layers, often see cysts and cartillage

96
Q

Immature dermoid

A
  • More commonly seen in youger patients

- Hemorrhage and necrosis with poorly defined cells

97
Q

Strumma Ovarii

A

-Monodermal tumor that can cause hyperthyroidism

98
Q

Granulosa Cell

A
  • Granulos cells that surroud in a follicular like pattern with eosiophilic cytoplasm
  • Express aromatase and secrete excess estrogen which may be associated with endometrial hyperplasia, infertitlit, and precocious puberty
99
Q

Epithelial Cell Tumors

A
  • CA-125 is good marker for progression of disease but is not specific enough to be used as screenin
  • Biggest risk factor is family history BRCA and Lynch Syndrome
  • Can commonly be bilateral, especially krukenberg
100
Q

Serous Adenoma

A
  • Uniloculated cyst with fallopian tube like epithelium

- Can become large and is benign (45%)

101
Q

Serous ADenocarcinoma

A
  • Uniloculated by lined by papillary disordered grwoth strucutre may lead to hemorrhage and necrosis
  • Psammoma bodies are often present
  • Malignant
102
Q

Mucinous

A
  • Multiloculated that appears like GI tissue
  • ADenoma is benign
  • Carcinoma may cause pseudomyxoma peritonei (Along with appendiceal tumor)
103
Q

Brenner Tumor

A

Made of transitional urothelium that has coffee bean shaped nuclei
-Benign

104
Q

Kruckenberg

A
  • Signet ring cell metastasis to ovaries from GI adeniocarcinoma
  • Almost always bilateral
105
Q

Fibroma

A
  • Fibroblasts arranged in spindle shapoed parallel arrangment
  • ASsociated with Pulmonary edema, Ascites
  • Called Meig’s sybndrome
106
Q

Fibrocystic Change

A

Most common in females that are premenopausal

  • Blue domed cysts occur due to dilation of ducts
  • Sclerosing adenosis is an increase in the number of acinini in a terminal lobule, may appear cancerous, but does not carry any risk
  • Fibrosis is just hyperplasia of stroma
  • Epithelial hyperplasia may occlude a duct and cause dialtion. Will always be lined by 2 epithelial layers when benign
  • If there is atypia associated with epthelial hyperplasia there is an increased risk for cancer
107
Q

Intraductal Papilloma

A
  • Papillary structures with psammoma bodies extend into the duct
  • There is often a double layer of epithelium and there will be perent basement membrane
  • Most common cause of bleeding, and is a benign tumor
108
Q

Phyllodes Tumor

A

Proliferation of teh stromal cells creating a large leaflike pattern

  • May transfrom into malognant rarely
  • Located deeper in the breast
  • Surgical removal must take wide margins because of reccurenc risk
  • Generally occurs late
109
Q

FIbroadenoma

A
  • Growth of stromal cells in a discrete movable hard mass

- Most commonly presents early in life and is hormone responsive

110
Q

Fat Necoris

A
  • Trauma leads to necrosis of fat and soponification by macrophages
  • May show calcified image, but is completely benign
111
Q

Mastitis

A

Most commonly caused by staph aureus and may be related to breast feeding

  • Treat with antibiotics
  • Be carfeul that it goes away and is not an inflammatory carcinoma
112
Q

Gynecomastia

A
  • Klienfeleters or other cause of elevated estrogen exposure
  • Drugs: Spironolactone, androgens, cimetidine, digitalis, alcohol, ketocolonazole. Inhibitors of Cyps that decrease androgens and increase estrogens
113
Q

Malignant Breast Cancer

A
  • Most important risk factor is family history and associated gentic diseases. BRCA
  • Other risk factors deal with increased lifetime estrogen exposure
  • Associated with estrogen and progesterone receptor positivity whih is importnt for treatment
  • Also EGFR ERBB2 which is blocked with traztuzumab
114
Q

DCIS

A

Most common form of breast cancer

  • Is in situ as long as basement membrane is still intact
  • Can be casseous necrosis and then is called comedocarcinoma
115
Q

LCIS

A
  • Arises in both lobules and is associated with elevated estrogen exposure
  • Carries an increased risk for both breasts, but in and of itself, only progresses 1/3 of the time
116
Q

Invasive ductal

A

Most common type, invasion through basement membrane

117
Q

Paget’s disease

A

DCIS that crawls through squamous epithelium around breast and produces erythema and pruritis

118
Q

Medullary

A

Asscoiated with early onset and BRCA

-Fleshy and cellular with lymphocytic infiltrate. Good Prognosis

119
Q

Inflammatory

A

Invasion of dermal lymphatics

  • Poor prognosis
  • Will have red and inflamed breast, differentiate from acute mastitis
120
Q

Invasive lobular

A

Contains single file cells that must lose E cadherin to become invasive
-Commonly bilateral