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1
Q

Gene produced at base of limbs (In ZPA) that is important for patterning along anterior posterior axis

A

Sonic hedgehog gene

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2
Q

Gene produced at apical ectodermal ridge necessary for proper organization along dorsal-ventral axis

A

Wnt-7 gene

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3
Q

Gene produced at apical ectodermal ridge that stimulates mitosis of underlying mesoderm and provides lengthening of limbs

A

FGF gene

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4
Q

Gene involved in organization of embryo in craniocaudal direction

A

Homeobox (HOX) genes

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5
Q

Mutation that results in appendages in wrong locations

A

Hox gene mutations

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6
Q

When does hCG secretion begin?

A

1 week after fertilization; around the time of implantation of blastocyst which is day 6

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7
Q

a. When is the embryo 2 layers?

b. When is the embryo 3 layers?

A

a. Within week 2 of development

b. Within week 3 (primitive streak, notochord, mesoderm neural plate begin to form)

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8
Q

When does neural tube close?

A

By week 4

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9
Q

What happens during week 4 of embryogenesis?

A

Heart begins to beat

Upper and lower limb buds begin to form

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10
Q

When is fetal cardiac activity visible by transvaginal ultrasound?

A

By week 6

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11
Q

When do genitalia have male or female characteristics during fetal development?

A

By week 10

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12
Q

Surface ectoderm derivatives

A 
Epidermis
Adenohypophysis
Lens of eye
Epithelial linings of oral cavity
Sensory organs of ear
Olfactory epithelium
Anal canal below the pectinate line
Parotid, sweat, mammary glands
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13
Q

Extrinsic disruption; occurs after embryonic period

A

Deformation

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14
Q

Secondary breakdown of previously normal tissue or structure. Example?

A

Disruption; amniotic band syndrome

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15
Q

Intrinsic disruption; occurs during embryonic period

A

Malformation

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16
Q

Abnormality resulting from a single primary embryologic event

A

Sequence (Potter sequence)

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17
Q

Causes of increased AFP

A

neural tube defect
multiple gestation
incorrect dating
abdominal wall defect

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18
Q

Fetal component of placenta

A

Cytotrophoblast - inner layer; makes cells

Synctiotrophoblast - outer layer of chorionic villi - secretes hCG

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19
Q

Why is the Synctiotrophoblast not attacked by the maternal immune system?

A

It lacks MHC-I expression

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20
Q

Maternal component of placenta

A

Decidua basalis; derived from endometrium; maternal blood in the lacunae

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21
Q

What is the urachus?

Anomalies associated with urachus?

A

In the 3rd week the yolk sac forms the allantois that extends into the urogenital sinus. The allantois becomes the urachus = a duct between fetal bladder and yolk sac

  • Patent urachus: total failure of urachus to obliterate –> urine discharge from umbilicus
  • Urachul cyst: partial failure of urachus to obliterate; fluid filled cavity lined with uroepithelium between umbilicus and bladder
  • Vesicourachal diverticulum: slight failure of urachus to obliterate –> outpouching of bladder
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22
Q

Complications of urachul cyst

A

Adenocarcinoma, infection

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23
Q

What is the vitelline duct?

Associated anomalies?

A

Vitelline duct connects the yolk sac to the midgut lumen

  • Vitelline fistula: if vitelline duct fails to close–> meconium discharge from umbilicus
  • Meckel diverticulum: partial closure of vitelline duct with patent portion attached to ileum –> causes melon, hematochezia, abdominal pain
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24
Q

Female homologs of:

a. Glans penis
b. corpus cavernosum and spongiosum
c. bulbourethral glands
d. prostate gland
e. ventral shaft of penis
f. scrotum

A

a. glans clitoris
b. vestibular bulbs
c. greater vestibular glands of Bartholin
d. urethral and paraurethral glands of Skene
e. labia minora
f. labia majora

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25
Failure of urethral folds to fuse
Hypospadias (abnormal opening on ventral surface)
26
Hypospadias associations
Cryptorchidism | Inguinal hernia
27
Epispadias associations
Exstrophy of bladder
28
Pathway of sperm ejaculation
``` Seminiferous tubules Epididymis Vas deferens Ejaculatory ducts (nothing) Urethra Penis ```
29
Cause of urine leaking beneath deep fascia of Buck
Anterior penile urethra injury
30
Source of: a. estradiol b. estriol c. estrone
a. ovary b. placenta c. adipose tissue
31
Functions of progesterone
``` Maintenance of pregnancy Decreased myometrial excitability Production of thick cervical mucus, which inhibits sperm entry into uterus Increased body temp Inhibition of gonadotropins Uterine smooth muscle relaxation Decreased estrogen receptor expression Prevents endometrial hyperplasia ```
32
Which phase of menstrual cycle varies in length? And which is set?
``` Follicular phase (proliferative) varies Secretory phase (luteal) is always 14 days ```
33
What layers are shed during menstruation?
Stratum compactum and stratum spongiosum
34
What hormones have the same alpha subunit?
hCG, LH, FSH, TSH
35
hCG levels in fetal anomalies
hCG increased in multiple gestations, hydatidiform moles, choriocarcinomas, down syndrome hCG decreased in ectopic/failing pregnancy, edward syndrome, patau syndrome
36
Source of estrogen after menopause
Peripheral conversion of androgens to estrone
37
Hormone to measure if you suspect menopause
FSH levels are drastically increased from loss of negative feedback due to decreased estrogen)
38
Where are androgens converted to estrogen and by which enzyme?
Adipose tissue and testis by P-450 aromatase
39
Hypogonadotropic hypogonadism
Kallmann syndrome --> from defective migration of GnRH cells and formation of olfactory bulb --> anosmia, decreased GnRH, FSH, LH, testosterone and infertility
40
Normal appearing female with rudimentary vagina; no uterus or fallopian tubes. (Structure felt in labia majora)
Androgen insensitivity syndrome (46 X, Y) | Breast development from testosterone converted to estradiol
41
Maternal virilization
Aromatase deficiency (fetal androgens cross placenta)
42
Masculinization of female infant with increased serum testosterone and androstenedione
Aromatase deficiency
43
Hydatidiform mole with increase of malignancy
Higher risk with complete mole (15-20%)
44
a. Karyotype of complete mole | b. Karyotype of partial mole
a. 46,XX or 46XY (enucleated egg + single sperm; sperm divides) b. 69 XXX, 69 XXY, 69 XYY (2 sperm + 1 egg)
45
Honeycombed uterus or clusters of grapes
Complete mole (46 XX or 46 XY)
46
preventing seizures in pre-eclampsia
IV magnesium sulfate
47
Decreased deep tendon reflexes Pulmonary edema Cardiac conduction defect AMS
IV Mg toxicity
48
Complication of HELLP syndrome
Hepatic subcapsular hematomas --> rupture --> severe hypotension
49
Pregnant woman with anemia, RUQ pain, jaundice, bruising
HELLP
50
Painless third trimester bleeding
Placenta previa
51
Vaginal tumor + for desmin
Sarcoma botryoides (rhabdomyosarcoma variant)
52
Clear, grape-like polypoid mass emerging from vagina
Sarcoma botryoides
53
Ovarian tumor with mucus secreting epithelium (like intestine)
Mucinous cystadenoma
54
What is a Dermoid cyst?
Mature cystic teratoma
55
Ovarian tumor that looks like bladder; coffee bean nuclei
Brenner tumor
56
Triad of ovarian fibroma, ascites and hydrothorax
Meigs syndrome
57
Tissue most common in immature teratoma
Neuroectoderm/ neural tissue
58
Call-Exner bodies
Granulosa cell tumor (resemble primordial follicles)
59
Psammoma bodies and ovarian tumor
Serous cystadenocarcinoma
60
Pseudomyxoma peritonei
Mucinous cystadenocarcinoma
61
Uniform fried egg cells | hCG and LDH
Dysgerminoma
62
Increased bhCG, shortness of breath, hemoptysis
Choriocarcinoma (hematogenous spread to lungs)
63
Yellow, friable mass Schiller-Duval bodies (resemble glomeruli) AFP tumor marker
Yolk sac (endodermal sinus) tumor
64
Mucin-secreting signet cell adenocarcinoma
Krukenberg tumor (GI malignancy that metastasizes to ovaries)
65
Whorled pattern of smooth muscle bundles with well-demarcated borders
Leiomyoma (fibroid)
66
Extension of endometrial tissue into uterine myometrium
Adenomyosis
67
Tender, boggy, enlarged uterus; dyspareunia
Adenomyosis
68
Cause of endometriosis
Retrograde flow Metaplastic transformation of multipotent cells Transportation of endometrial tissue via lymphatic system
69
Dyschezia
Pain with defecation
70
Danazol
Partial agonist at androgen receptors; used for endometriosis, hereditary angioedema (counteracts effects of estrogen)
71
Treatment for endometritis
Gentamicin + Clindamycin (with or without ampicillin)
72
Small, mobile firm mass with sharp edges in breast | Increases with estrogen
Fibroadenoma (most common in those
73
Small breast tumor that grows in lactiferous ducts (beneath areola) - benign
Intraductal papilloma
74
Benign tumor with serous or blood nipple discharge
Intraductal papilloma
75
Large, bulky mass of connective tissue and cysts (leaf like projections) - benign breast tumor
Phyllodes tumor (5th decade)
76
Inflammation of duct; green nipple discharge, in post menopausal women
Mamillary duct ectasia
77
Increased acini and interlobular fibrosis of breast | Calcifications
Sclerosing adenosis - benign (increased risk of developing cancer)
78
Ductal, central necrosis - noninvasive breast tumor
Comedocarcinoma
79
Drugs that cause Gynecomastia (Some Drugs Create Awesome Knockers)
``` Spironolactone Digoxin Cimetidine Alcohol Ketoconazole ```
80
Invasive breast tumor with reactive, desmoplastic stroma surrounding invasive glands
Invasive ductal cancer
81
Peau d'orange
Dermal lymphatic invasion by breast carcinoma (inflammatory)
82
Indian file orderly row of cells (due to decreased E-cadherin expression)
Invasive lobular breast cancer
83
Causes of Priapism
Trauma Sickle cell disease Medications (Sildenafil, Trazodone)
84
Leukoplakia on penile shaft
Bowen disease (squamous cell carcinoma)
85
Erythroplakia on penis
Etyrhoplasia of Queyrat (SCC); cancer of glans
86
Reddish papules on penis
Bowenoid papulosis (carcinoma in situ)
87
Cause of congenital hydrocele
Incomplete obliteration of processus vaginalis
88
Most common testicular tumor in boys
Yolk sac (endodermal sinus) tumor; Increased AFP, Schiller duval bodies (look like glomeruli)
89
Ovarian/testicular tumor with signs of hyperthyroidism
Choriocarcinoma; bhCG is structurally similar to LH, FSH, TSH
90
Painful testicular tumor
Embryonal carcinoma; most often mixed | Increased hCG and normal AFP levels (or increased if mixed)
91
Testicular tumor with Reinke crystals
Leydig cell tumor
92
What cells have fried egg appearance?
Koilocytes of HPV Oligodendrogliomas Seminomas/Dysgerminomas
93
Which parts of prostate does BPH affect?
Lateral and middle - the periurethral part
94
Osteoblastic metastases in bone
Prostatic adenocarcinoma metastases
95
Clomiphene mechanism
Antagonist at estrogen receptors in hypothalamus --> prevents normal feedback inhibition and increased release of LH/FSH
96
Raloxifene mechanism and S/E
Antagonist at breast, uterus; agonist at bone | Increased risk of thromboembolic events but no increased risk of endometrial cancer
97
Anastrazole/Exemestane
Aromatase inhibitors used in post menopausal women with ER + breast cancer (S/E = osteoporosis)
98
Mifepristone mechanism
Competitive inhibitor of progestins at progesterone receptors used for termination of pregnancy in combo with misoprostol (PGE1)
99
Terbutaline, Ritodrine
B2 agonists that relax the uterus | Used to decrease contraction frequency in women during labor
100
Finasteride mechanism and use
5 alpha reductase inhibitor; used for BPH and male pattern baldness (decreases conversion of testosterone to DHT)
101
Flutamide mechanism and use
Non-steroidal competitive inhibitor of androgen receptors | Used for prostate carcinoma
102
Ketoconazole mechanism
Inhibits steroids synthesis (inhibits 17,20 desmolase)
103
Minoxidil mechanism
Direct arteriolar vasodilator used for androgenetic alopecia and severe refractory hypertension
104
Blood nipple discharge differential
Intraductal papilloma - benign | Invasive papillary carcinoma - malignant

Step 1 AB (29 decks)

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