Repro Flashcards
Presentation of kallman
Decreased GnRH
- amenorrhea
- No 2 sex characteristics
- no smell
presentation of androgen insensitivity
- Normal breast development (testosterone–>estriol)
- No pubic/axillary hair (estradiol/testosterone is the main driver)
- No wolffian/mullerian structures
Complete mole causes vaginal bleeding in:
The first trimester of pregnancy
theca lutein cysts
hydatidiform mole
Describe the differentiation of a male
SRY chromosome on Y chromosome–>Testes differentiating factor–>Development of testes–>sertoli and leydig cells
Sertoli cells synthesize MIF–>involution of paramesonephric ducts
Leydig cells make testosterone–>Wolffian duct–>epididymis and vas deferens–>DHT–>external genitalia
Causes of polyhydramnios
Decreased fetal swallowing (GI atresia)
Increased fetal urination (anemia, twin twin transfusion)
Causes of oligohydramnios
renal agenesis
posterior urethral valve
What is the problem with cryptorchidism?
Undescended testes atrophy, causing damage to sertoli cells. and infertility.
Low inhibitin, high FSH.
Normal LH and leydig cell function
Where does inhibitin/testosterone provide negative feedback?
Inhibin feeds back to pituitary
Testosterone feedsback to hypothalamus AND pituitary
Fusion of maxillary prominence with medial nasal prominence failure
cleft lip
Cleft palate
failure of palatine shelves to fuse with primary palate or each other
Ligation of uterine artery during hysterectomy can damage
The ureter
ovary epithelium
simple cuboidal
fallopian tube epithelium
simple columnar
uterus epithelium
simple columnar
cervix epithelium
simple columnar/stratified squamous
vagina epithelium
squamous
Which portion of the urethra in men is most likely to be injured
membranous segment.
Signs of urethral injury: blood at meatus, boggy prostate. Do NOT put in a foley catheter
Pudendal nerve innervates
pelvic floor
How do uterine fibroids present?
As menorrhagia
Ductus arteriosus is derived from:
The sixth aortic arch
Cause of pyelonephritis in a young healthy woman
vesicoureteral reflux causing retrograde urine. Normally if pt gets UTI, urine flow and bladder mucosa and urea prevent colonization
Imperforate anus
Problem with anorectal structures (surface ectoderm, below pectinate line)
–inability to pass meconium may come out vagina/urethra if fistulated
imperforate anus associated with
urogenital tract abnormalities most common (renal agenesis, bladder extrophy, spadias) -Vertebral defects -anal atresia cardiac/renal/limb anomalies tracheoesophageal fistula esophageal atresia
Urachus connects
bladder with yolk sac (vitteline duct)
Urachus derives from
allantois
The bladder derives form the
urogenital sinus
vesicourachal diverticulum
outputching of apex of the bladder. Caused by failure to close the urachus adjacent to the bladder
Failure to close the distal part of the urachus
urachal sinus. periumbilical tenderness and discharge from umbilicus
Failure of central portion of urachus to obliterate
urachal cyst, asymptomatic
estrogen secreting primary ovarian tumor
granulosa cell tumor
mucin secreting tumor
mucinous cystadenocarcinoma. Can cause pseudomyxoma peritonei, where peritoneum fills with mucin.
most common germ cell tumor
benign cystic teratoma (dermoid cyst)
Breast milk contains everything except
vitamin K and D
What vitamin deficiency are premie babies at risk for?
Right away, vitamin K. Vitamin D deficiency shows up at 6 months. newborns have hepatic immaturity and no GI tract necessary to synthesize vitamin K from gut flora. Also, they haven’t been eating their leafy green veggies. No teeth!
most common fraternal twin presentation
ALWAYS dichorionic, diamniotic but sometimes chorions can fuse
most common identical twin presentation
monochorionic, diamniotic
early separation of identical twins (0-4 days)
2 amnions, 2 chorions, 2 placentas
late separation of identical twins (8-12 days)
1 amnion, 1 chorion.
late separation of identical twins (13 days)
monochorionic conjoined twins
Testosterone inhibit
BOTH gnRH AND LH
inhibin inhibits
ONLY FSH
The right ovarian artery drains into the
inferior vena cava
The left drains into the left renal vein
Common complication of surgeries of the female reproductive tract
ligation of the ureter
vessels supplying the ovary travel through
The suspensory ligament
sonic hedgehog protein produced in
zone of polarizing activity (base of limbs)
sonic hedghog use:
anterior/posterior axis
mutation in sonic hedgehog
holoporsencephaly (failure of two hemispheres to separate)
wnt-7 gene produced in
apical ectodermal ridge (at the distal end of limbs)
wnt-7 use:
dorsal ventral organization
FGF gene produce in
apical ectodermal ridge
FGF fxn
mitosis of mesoderm to lengthen limbs
homeobox (hox) genes
cranio-caudal organization.
mutation in hox
appendages in wrong locations
when does hCG secretion begin
1 week
when does implantation happen
1 week
bilaminar disc formation (epiblast, hypoblast)
2 weeks
trilaminar disc
3 weeks
notochord, primitive streak, mesoderm, and neural plate form
3 weeks
embryonic period
3-8 weeks susceptible to teratogens
neural tube closed by
week 4
heart begins beating
week 4
limbs form
week 4
fetal movement, fetus appears
week 8
genitalia (can sex the fetus)
weeek 10
agenesis
absent organ from absent primordial tissue
aplasia
absent organ with primordial tissue present
deformation
extrinsic disruption after embryonic period
malformation
intrinsic disruption: occurs during embryonic period
teratogen: renal damage
ACE inhibitors
teratogen: absent digits, other anomalies
alkylating agents
teratogen: Neural tube defects, fingernail hypoplasia, and developmental delay with facial defects
carbamazepine
teratogen:vaginal clear cell adenocarcinoma and congenital mullerian anomalies
Diethylstilbestrol
teratogen:neural tube defects
folate antagonist
carbamazepine
valproate
teratogen: Ebstein’s anomaly (atrialized right ventricl)
lithium
teratogen: microcephaly, dysmorphic face, hypoplastic nails and distal phalances with cardiac defects
phenytoin (fetal hydantoin syndrome)
teratogen:flipper limbs
thalidomide
teratogen: bone deformities, hemorrhage, abortion
opthalmologic abnormalities
warfarin
teratogen:placental abruption
cocaine
teratogen: preterm labor and placental problems, ADHD
smoking
which drugs can cause intrauterine growth retardation?
carbamazepine
phenytoin
smoking
maternal diabetes can cause
anal atresia (caudal regression) congenital heart defects neural tube defects
Vitamin A causes
spontaneous abortions and birth defects
X rays cause
microcephaly and mental retardation
mental retardation, microcephaly, holoprosencephaly, face abnormalities, limb dislocation, and heart/lung fistulas
fetal alcohol syndrome
dizygotic twins always are
dichorionic
diamniotic
most monozygotic twins are
monochorionic
diamniotic
cleavage: dichorionic diamniotic monozygotic twins
0-4 days
cleavage: monochorionic diamniotic twins
4-8 days
cleavage: monochorionic monoamniotic twins
8-12 days
cleavage: monochorionic monoamniotic onjoined twins
> 13 days
fxn cytotrophoblast
cells of inner layer of chorionic villi
fxn syncytiotrophoblast
secretes hCG.
stimulates corpus luteum to make progesterone
umbilical arteries connect
fetal internal iliac arteries to placenta
umbilical arteries and veins derived from
allantois
umbilical vein connects
placenta to ductus venosus
contents of umbilical cord
2 arteries
1 vein
allantoic duct
wharton’s jelly
urachal duct
connects bladder and yolksac (umbilical cord)
urachal duct comes from
allantois
outpouching of bladder
vesicourachal diverticulum. failure of urachus to close
urine discharge from umbilicus
patent urachus
when does the allantois form
3 week
vitelline (omphalomesenteric duct)
connects yolk sac to gut lumen
discharge of meconium from umbilicus
vitelline fistula
meckel’s diverticulum: cause?
failure of vitelline duct to close
when does vitelline duct close
week 7
branchial cleft (grooves) vs arches vs pouches
cleft: ectoderm
arches: mesoderm and crest cells (bones, cartilage)
pouches: endoderm
1st branchial cleft
external auditory meatus
2nd-4th branchial clefts
temporary cervical sinuses
branchial left cyst in lateral neck caused by
persistent cervical sinus
pt with mandibular hypoplasia and facial abnormalities
failure of 1st arch neural crest cell migration (treacher collins)
persistence of fistula between tonsillar area and cleft in lateral neck caused by
3rd arch problem
=congenital pharyngocutaneous fistula
DiGeorge sx
No thymus
hypocalcemia (no parathyroids)
Men2A caused by mutation in
RET
RET codes
neural crest cells
parafollicular cells come from
neural crest cells
4th and 5th pharyngeal pouches
failure of fusion of maxillary and medial nasal processes
cleft lip
failure of fusion of lateral palatine processes, nasal septum, median palantine processes
cleft palate
paramesonephric duct
female system
mesonephric duct
male system
wolffian duct becomes
seminal vesicles
epididymis
ejaculatory duct
ductus deferens
paramesonephric duct becomes
fallopian tubes
uterus
upper portion of vagina
lower vagina from
urogenital sinus
fully developed 2ndary sex characteristics in a female indicates
functional ovaries
male development summary
- SRY=testes development–>simulate sertoli and leydig cells to form
- sertoli-MIF
- MIF inhibits paramesonephric ducts
- Leydig=androgen
- androgen simulates mesonephric duct
Both male and female internal genitalia, and male external genitalia
no MIF
male internal genitalia, ambigious external genitalia until puberty
5a reductase
hypospadias caused by
failure of urethral folds to close
epispadias caused by
faulty positioning of genital tubercle
epispadias associated with
extrophy of the bladder
gubernaculum in male
anchors testes in scrotum
gubernaculum in female
ovarian and round ligament of uterus
processus vaginalis forms
tunica vaginalis
more likely to get a hydrocele on the left or the right?
On the left–gonadal vein drains to left renal vein
ovaries/testes drain to what nodes
paraaortic lymph node
distal 1/3 or vagina/vulva drains to what nodes
superficial inguinal nodes
scrotum drains to
superficial inguinal nodes
proximal 2/3 of vagina drain what nodes
external iliac/hypogastric nodes
uterus drains to what nodes
external iliac/hypogastric nodes
suspensory ligament connects
ovaries to lateral pelvic wall
cardinal ligament connects
cervix to pelvis side wall
round ligament of the uterus connects
uterine fundus to labia majora
broad ligament connects
uterus, fallopian tubes, and ovaries to pelvic wall
ligament of the ovary connects
medial pole of ovary to lateral uterus
structures in suspensory ligament
ovarian vessels
structures in cardinal ligament
uterine vessels
structure in round ligament
artery of sampson
mesosalpinx
upper portion of broad ligament
mesometrium
lower portion of broad ligament
mesovarium
portion of broad ligament over the ovary
endocervix hsitology
simple columnar
uterus histology
simple columnar
fallopian histology
simple columnar
ovary histology
simple cuboidal
erection mediated by what nerve
pelvic.
emission (sperm into posterior urethra) nerve
hypogastric
ejaculation nerve
pudendal nerve
pathophys of erection
BONER:
1. NO–>cGMP–>smooth muscle relaxation–>vasodilation
BONER KILLER:
2. NE–>Increase in calcium in=vasoconstriction
nervous systems for erection, emission, ejaculation:
- Parasympathetic
- Sympathetic
- Somatic
sertoli cells secrete
- inhibitn
- androgen binding protein (increase local levels of testosterone)
- MIF
what forms the blood testes barrier?
sertoli cells
full development of sperm take how long
2 months
what does a spermatid do to become a spermatozoa?
loss of cytoplasmic contents
gain of acrosomal cap=mature spermatozoa
pirmary spermatocyte nuclear content
doubled chromosomes, 2N
secondary spermatocyte nuclear contents
double chromsomes, haploid
1N, 2C
spermatid nuclear contents
1N, 1C
haploid, one copy of everything
inhibin inhibits what?
ONLY anterior pituitary
Not hypothalamus
closure of epiphyseal plates
estrogen.
==In male, converted from testosterone by adipose tissue and leydig cells
DHT differentiates
penis, scrotum, prostate
Ovary produces what form of estrogen
17B-estradiol
placenta produces what form of estrogen
estriol
adipose estrogen
estrone
potency of different estrogens
estradiol>estrone>estriol
effect of estrogen on prolactin
Stimulates prolactin secretion but blocks prolactin action at the breast
estrogen receptors located where in the cell?
cystoplasm.
After binding, translocates to the nucleus
LH stimulates what enzyme
desmolase
–converts cholesterol to androstenedione
Effect of estrogen on transport proteins
increased SHBG
Increased HDL
decreased LDL
elevation in progesterone in a woman indicates
ovulation
effets of progesterone
decreases myometrial excitability increases body temperature inhibits FSH, LH relaxes uterine smooth muscle decreases estrogen receptors
Tanner stage: curly and dark pubic hair
III
Tanner stage: penis length and size increase
III
Tanner: Enlargement of breast beyond buds
III
Tanner: raised areolae
IV
which phase of your period is constant
luteal phase
normal cycle length
21-35 days
metrorrhagia
frequent but irregular menstruation
menometrorrhagia
heavy and irregular bleeding
what hormones peak at 14 days
FSH
LH
Estrogen
mittelschmerz
blood from ruptured follicle causes peritoneal irritation. looks like appendicitis
eggs are held in what state until ovulation
prophase I
eggs are held in what state until fertilization?
metaphase II
what hormones STEADILY increase throughout the pregnancy
prolactin
progesterone
estriol
after labor, what causes lactation?
removal of progesterone
elevated hCG in which pathological states?
hydatidiform moles and choriocarcinoma
menopause occurs earlier in what group?
smokers
best test to confirm meenopaus?
Increase in FSH
why do women become hirsuit after menopause?
increase in androgens (more LH) with peripheral conversion to estrone. (no negative feedback from estrogen)
menopause before age 40
think premature ovarian failure
hormonal levels in klinefelter’s
decreased inhibin
increased FSH
Increased LH
Increased estrogen
barr body
klinefelter’s
heart defects seen in turner’s
bicuspid aortic valve
preductal coractation
renal defect in turner’s
horseshoe
hormone levesl in turner’s
low estrogen
high FSH
high LH
very fall, sever, acne
antisocial behavior
normal fertility
XYY
high testosterone, high LH
defective androgen receptor
high testosterone, low LH
testosterone tumor or exogenous use
ovaries present, but external genitalia ambiguous
CAH
testes present, but external genitalia are ambiguous
androgen insensitivity
true hermaphroditism
Both ovary and testicular tissue present
normal appearing female with rudimentary vagina and no internal genitalia
- -testes in labia majora
- -very little hair
androgen insensitivity. remove testes to prevent malignancy!
labs in androgen insensitivity
high testosterone
high estrogen
high LH
labs in 5a reductase deficiency
testosterone and estrogen levels are hormal. LH is normal.
kallman syndrome cause
defective migration of GnRH
labs in kallman
low GnRH, FSH, LH
low testosteron and sperm count
most common precursor of a choriocarcinoma
hydatidiform mole
snowstorm appearance on US
complete mole
tx of mole
dilation and curettage and methotrexate
follow up after mole removal
monitor b-hCG
complete vs partial mole hcG
hcG much higher in complete mole
which mole more likely to convert to choriocarcinoma?
complete mole
risk of malignant trophoblastic disease higher in which mole?
complete mole
cause of pre-eclampsia
impaired vasodilation of spiral arteries
=increased vascular tone
sx of preeclampsia
hypertension, proteinuria and edema
sx of preeclampsia before 20 weeks
molar pregnancy
cause of death in preeclampsia
cerebral hemorrhage and ARDS
how to prevent seizures of eclampsia
IV magnesium sulfate
risk factors for abruptio placentae
Smoking, HTN, cocaine
cause: placenta accreta
defective decidual layer. placenta attaches to myometrium
risk factors for placenta accreta
C section
inflammation
placenta previa
risk factors: placenta previa
multiparity and prior C section
problems with retained placental tissue
postpartum hemorrhage
infection
hCG lower than expected on dates
ectopic
risk factors for ectopic pregnancy
- history of infertility
- salpingitis
- ruptured appendix
- prior tubal surgery
polyhydramnios assoc’d with
esophageal/duodenal atresia
anencephaly
oligohydramnios assoc’d with
bilateral renal agenesis
posterior urethral valves
placental insufficiency
potter’s syndrome
- pulmonary hypoplasia
- clubbed feet
- cranial abnormalities
- bilateral renal agenesis
HPV 16 gene product
E6. Inhibits p53
HPV 18 gene product
E7. Inhibits RB suppresor gene
sequelae of invasive carcinoma if growing laterally
block ureters=renal failure
endometritis
inflammation of endometrium from retained products of conception
tx for endometritis
gentamycin
clindamycin
endometriosis sx
menorrhagia, dysmenorrhea, pain with a normal sized nucleus
adenomyosis sx
menorrhagia, dysmenorrhea, pelvic pain with an enlarged uterus
tx: endometriosis
contraceptives, NSAIDS
leuprolide, danazol
endometrium within the myometrium
adenomyosis
tx of adenomyosis
hysterectomy
granulosa tumor will show
abnormal endometrial gland proliferation
–excess estrogen
risk factors of endometrial carcinoma
lots of estrogen
- obesity
- diabetes
- htn
- nulliparity
prognosis endometrial carcinoma
increased myometrial invasion=poorer prognosis
leiomyoma type of tumor
benign smooth muscle tumor
whorled pattern of smooth muscle bundles; tumor?
leimyoma
sx of leiomyoma
abnormal bleeding
miscarriage
bulky irregular tumor with necrosis and hmorrhage that may protrude from cervix and bleed. aggressive.
leimyosarcoma
leiomyoma and leiomyosarcoma have an increased incidence in
blacks
incidence by tumor type
endometrial>ovarian>cervical (US)
worst prognosis by tumor type
ovarian>cervical>endometrial
how does cushing’s cause anovulation?
high ACTH
–increased androgen production
labs in PCOS
high LH low FSH high testosterone high estrogen (peripheral. aromatization) NO progesterone
PCOS pts at increased risk for what cancer
endometrial cancer.
tx PCOS
weight loss medroxyprogesterone, OCPs
follicular cyst contents
unruptured graafian follicle
corpus luteum cyst
hemorrhage into corpus luteum
cause: theca lutein cyst
gnRH stimulation. usually multiple
theca/lutein cyst associated with
choriocarcinoma and moles
hemorrhagic cyst cause
blood vessel rupture into cyst
endometriod cyst
chocolate cyst. varies with menstrual cycle
elevated hCG and LDH. sheets of uniform cells
dysgerminoma
dysgerminoma associated with
Turner’s syndrome
choriocarcinoma biopsy shows
trophoblastic tissue with NO chorionic villi
schiller duval bodies
yolk sac tumor
choriocarcinoma assoc’d with
increased theca lutein cysts
choriocarcinoma spreads first to the
lungs
yellow friable solid mass= tumor?
yolk sac
where do yolk sac tumors present in adults? kids?
adults=ovaries and testes
kids=sacrococcygeal
immature vs mature teratoma (dermoid cyst)
immature is aggressive.
struma ovarii
teratoma that contains functional thyroid tissue
90 percent of ovarian non germ cell tumors are
serous cystadenoma or serous cystadenocarcinoma
histology: serous cystadenoma
fallopian tube epithelium
histology serous cystadenocarcinoma
psamomma bodies
multilocular cyst lined by mucus secreting epithelium. Intestine-like.
mucinsous cystadenoma
mucinous cystadenocarcinoma associated with
pseudomyxoma peritonei
pseudomyxoma peritonei
intraperitoneal accumulation of mucinous material from ovarian tumor
pulling sensation in groin with ovarian fibroma, ascites, and hydrothorax
fibromas
histology fibromas
spindle shaped fibroblasts
call exner bodies
small follicles with eosinophilic secretions. associated with granulosa cell tumor
estrogen secreting tumor
granulosa tumor
GI malignancy that metastasizes to ovaries
krukenberg
mucin secreting signet cell tumor in ovaries
krukenberg
girls under four with spindle shaped tumor cells that are desmin positive
sarcoma botryoides
Clear cell adenocarcinoma
women exposed to DES in utero
diseases of the nipple
Paget’s
abscess
diseases of the lactiferous sinus
intraductal papilloma
mastitis
diseases of the major duct
fibrocystic change
ductal cancer
diseases of the terminal duct
tubular carcinoma
diseases of the lobules
sclerosing adenosis
lobular carcinoma
diseases of the breast stroma
fibroadenoma
phyllodes tumor
small mobile firm mass with sharp edges in the breast
fibroadenoma
small tumor that grows in lactiferous ducts. Below areola
intraductal papilloma
large bulky mass of CT and cysts in breast.
phyllodes
“leaf like” projections in the breast
phyllodes
phyllodes age group
60’s
serous or bloody nipple discharge
intraductal papilloma
risk of carcinoma with fibroma, intraductal papilloma, and phyllodes?
fibroma=none
intraductal papilloma=1.5-2x risk
phyllodes can become malignantM
Most important prognostic factor with malignant breast tumors
axillary lymph node
ductal caseous necrosis
comedocarcinoma
rock hard mass with duct like cells
invasive ductal carcinoma
stellate morpholoby
invasive ductal carcinoma
indian file cells
invasive lobular carcinoma
histology of medullary invasive carcinoma
fleshy, cellular, lymphocytic infiltrate
peau d’orange skin with neoplastic cells blocking lymphatic ducts
inflammatory invasive breast cancer
eczematous patches on nipple
paget’s disease
which is the worst breast cancer to get
invasive ductal
Which breast cancer has a good prognosis
medullary
which breast cancer is usually bilateral with multiple lesions?
invasive lobular
large cells in epidermis with clear halo in breast biopsy
paget cells
Four types of fibrocystic disease
- fibrosis
- cystic
- sclerosing adenosis
- epithelial hyperplasia
most common cause of acute mastitis
S aureus colonizing during breast feeding
hyperplasia of the breast stroma—fibrocystic dz
fibrosis
fluid filled blue dome with ductal dilation–fibrocystic dz
cystic
increased acini and intralobular fibrosis with calcifications–fibrocystic dz
sclerosing adenosis. often confused with cancer
Increased number of epithelial cell layers in terminal duct lobule–fibrocystic dz
epithelial hyperplasia
which fibrocystic disease is associated with an increased risk of carcinoma?
epithelial hyperplasia
benign lump from injury to breast tissue
fat necrosis
drugs causing gynecomastia
spironolactone digitalis cimetidine alcohol ketoconazole
dysuria, frequency, urgency, and low back pain in a male
prostatitis
cause of acute prostatitis
bacterial
cause of chronic prostatitis
usually no bacteria
BPH = enlargement of…
lateral and middle lobes
sx of BPH
increased frequency of urination
difficulty starting and stopping pee
pain on urination
Treatment of BPH
terazosin, tamsulosin (a 1antagonist)
finasteride (5a reductase blocker)
prostate cancer arises from which area
posterior lobe, won’t cause sx like BPH
tumor markers for prostate cancer
- increased prostatic acid phosphatase
- increased total PSA
- decreased free PSA
how do you know if prostate cancer has metastasized to the bone?
serum alkaline phosphatase increase
cryptorchidism
undescended testes
cryptorchidism associated with increased risk of
increased risk of germ cell tumors
risk factor for cryptorchidism
prematurity
hormone levels in cryptorchidism
less inhibin, increased FSH and LH
- -testosterone decreased in bilateral cryptorchidism
- -testosterone normal in unilateral cryptorchidism
bag of worms
varicocele
tx of varicocele
surgery or embolization by radiologist
95 percent of testicular tumors are
germ cell tumors
homogeneous testicular enlargement. Watery cytoplasm and fried egg appearance: tumor?
seminoma
increase in PLAP
seminoma
seminoma age group
15-35
yellow, mucinous with schillar duval bodies: testicular tumor?
yolk sac
man with increased hCG
choriocarcinoma or teratoma or embryonal carcinoma
choriocarcinoma in a male metastsizes to
lungs
tumors producing gynecomastia
choriocarcinoma from hCG
mature teratoma in a adult male vs child prognosis
adult male=malignant
child=benign
teratoma labs
increased hCG and/or AFP
glandular/papillary morphology with increased hCG
embryonal carcinoma. Often a mixed tumor with increased AFP
Reinke crystals
leydig cell tumor
most common testicular cancer in older men
lymphoma
sertoli cell tumor
androblastoma from sex cord stroma
sx of leydig cell tumor
gynecomastia in men, precocious puberty in boys
hydrocele cause
incomplete fusion of processus vaginalis
cause spermatocele
dilated epididymal duct
bent penis from acquired fibrous tissue formation
peyronie’s disease
causes of priapism
trauma sickle cell disease medications PDE5 inhibitors antidepressants alpha blockers cocaine
