Repro Flashcards
Gene produced at base of limbs (In ZPA) that is important for patterning along anterior posterior axis
Sonic hedgehog gene
Gene produced at apical ectodermal ridge necessary for proper organization along dorsal-ventral axis
Wnt-7 gene
Gene produced at apical ectodermal ridge that stimulates mitosis of underlying mesoderm and provides lengthening of limbs
FGF gene
Gene involved in organization of embryo in craniocaudal direction
Homeobox (HOX) genes
Mutation that results in appendages in wrong locations
Hox gene mutations
When does hCG secretion begin?
1 week after fertilization; around the time of implantation of blastocyst which is day 6
a. When is the embryo 2 layers?
b. When is the embryo 3 layers?
a. Within week 2 of development
b. Within week 3 (primitive streak, notochord, mesoderm neural plate begin to form)
When does neural tube close?
By week 4
What happens during week 4 of embryogenesis?
Heart begins to beat
Upper and lower limb buds begin to form
When is fetal cardiac activity visible by transvaginal ultrasound?
By week 6
When do genitalia have male or female characteristics during fetal development?
By week 10
Surface ectoderm derivatives
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
Extrinsic disruption; occurs after embryonic period
Deformation
Secondary breakdown of previously normal tissue or structure. Example?
Disruption; amniotic band syndrome
Intrinsic disruption; occurs during embryonic period
Malformation
Abnormality resulting from a single primary embryologic event
Sequence (Potter sequence)
Causes of increased AFP
neural tube defect
multiple gestation
incorrect dating
abdominal wall defect
Fetal component of placenta
Cytotrophoblast - inner layer; makes cells
Synctiotrophoblast - outer layer of chorionic villi - secretes hCG
Why is the Synctiotrophoblast not attacked by the maternal immune system?
It lacks MHC-I expression
Maternal component of placenta
Decidua basalis; derived from endometrium; maternal blood in the lacunae
What is the urachus?
Anomalies associated with urachus?
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
Complications of urachul cyst
Adenocarcinoma, infection
What is the vitelline duct?
Associated anomalies?
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
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. glans clitoris
b. vestibular bulbs
c. greater vestibular glands of Bartholin
d. urethral and paraurethral glands of Skene
e. labia minora
f. labia majora
Failure of urethral folds to fuse
Hypospadias (abnormal opening on ventral surface)
Hypospadias associations
Cryptorchidism
Inguinal hernia
Epispadias associations
Exstrophy of bladder
Pathway of sperm ejaculation
Seminiferous tubules Epididymis Vas deferens Ejaculatory ducts (nothing) Urethra Penis
Cause of urine leaking beneath deep fascia of Buck
Anterior penile urethra injury
Source of:
a. estradiol
b. estriol
c. estrone
a. ovary
b. placenta
c. adipose tissue
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
Which phase of menstrual cycle varies in length? And which is set?
Follicular phase (proliferative) varies Secretory phase (luteal) is always 14 days
What layers are shed during menstruation?
Stratum compactum and stratum spongiosum
What hormones have the same alpha subunit?
hCG, LH, FSH, TSH
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
Source of estrogen after menopause
Peripheral conversion of androgens to estrone
Hormone to measure if you suspect menopause
FSH levels are drastically increased from loss of negative feedback due to decreased estrogen)
Where are androgens converted to estrogen and by which enzyme?
Adipose tissue and testis by P-450 aromatase
Hypogonadotropic hypogonadism
Kallmann syndrome –> from defective migration of GnRH cells and formation of olfactory bulb –> anosmia, decreased GnRH, FSH, LH, testosterone and infertility
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
Maternal virilization
Aromatase deficiency (fetal androgens cross placenta)
Masculinization of female infant with increased serum testosterone and androstenedione
Aromatase deficiency
Hydatidiform mole with increase of malignancy
Higher risk with complete mole (15-20%)
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)
Honeycombed uterus or clusters of grapes
Complete mole (46 XX or 46 XY)
preventing seizures in pre-eclampsia
IV magnesium sulfate
Decreased deep tendon reflexes
Pulmonary edema
Cardiac conduction defect
AMS
IV Mg toxicity
Complication of HELLP syndrome
Hepatic subcapsular hematomas –> rupture –> severe hypotension
Pregnant woman with anemia, RUQ pain, jaundice, bruising
HELLP
Painless third trimester bleeding
Placenta previa
Vaginal tumor + for desmin
Sarcoma botryoides (rhabdomyosarcoma variant)
Clear, grape-like polypoid mass emerging from vagina
Sarcoma botryoides
Ovarian tumor with mucus secreting epithelium (like intestine)
Mucinous cystadenoma
What is a Dermoid cyst?
Mature cystic teratoma
Ovarian tumor that looks like bladder; coffee bean nuclei
Brenner tumor
Triad of ovarian fibroma, ascites and hydrothorax
Meigs syndrome
Tissue most common in immature teratoma
Neuroectoderm/ neural tissue
Call-Exner bodies
Granulosa cell tumor (resemble primordial follicles)
Psammoma bodies and ovarian tumor
Serous cystadenocarcinoma
Pseudomyxoma peritonei
Mucinous cystadenocarcinoma
Uniform fried egg cells
hCG and LDH
Dysgerminoma
Increased bhCG, shortness of breath, hemoptysis
Choriocarcinoma (hematogenous spread to lungs)
Yellow, friable mass
Schiller-Duval bodies (resemble glomeruli)
AFP tumor marker
Yolk sac (endodermal sinus) tumor
Mucin-secreting signet cell adenocarcinoma
Krukenberg tumor (GI malignancy that metastasizes to ovaries)
Whorled pattern of smooth muscle bundles with well-demarcated borders
Leiomyoma (fibroid)
Extension of endometrial tissue into uterine myometrium
Adenomyosis
Tender, boggy, enlarged uterus; dyspareunia
Adenomyosis
Cause of endometriosis
Retrograde flow
Metaplastic transformation of multipotent cells
Transportation of endometrial tissue via lymphatic system
Dyschezia
Pain with defecation
Danazol
Partial agonist at androgen receptors; used for endometriosis, hereditary angioedema (counteracts effects of estrogen)
Treatment for endometritis
Gentamicin + Clindamycin (with or without ampicillin)
Small, mobile firm mass with sharp edges in breast
Increases with estrogen
Fibroadenoma (most common in those
Small breast tumor that grows in lactiferous ducts (beneath areola) - benign
Intraductal papilloma
Benign tumor with serous or blood nipple discharge
Intraductal papilloma
Large, bulky mass of connective tissue and cysts (leaf like projections) - benign breast tumor
Phyllodes tumor (5th decade)
Inflammation of duct; green nipple discharge, in post menopausal women
Mamillary duct ectasia
Increased acini and interlobular fibrosis of breast
Calcifications
Sclerosing adenosis - benign (increased risk of developing cancer)
Ductal, central necrosis - noninvasive breast tumor
Comedocarcinoma
Drugs that cause Gynecomastia (Some Drugs Create Awesome Knockers)
Spironolactone Digoxin Cimetidine Alcohol Ketoconazole
Invasive breast tumor with reactive, desmoplastic stroma surrounding invasive glands
Invasive ductal cancer
Peau d’orange
Dermal lymphatic invasion by breast carcinoma (inflammatory)
Indian file orderly row of cells (due to decreased E-cadherin expression)
Invasive lobular breast cancer
Causes of Priapism
Trauma
Sickle cell disease
Medications (Sildenafil, Trazodone)
Leukoplakia on penile shaft
Bowen disease (squamous cell carcinoma)
Erythroplakia on penis
Etyrhoplasia of Queyrat (SCC); cancer of glans
Reddish papules on penis
Bowenoid papulosis (carcinoma in situ)
Cause of congenital hydrocele
Incomplete obliteration of processus vaginalis
Most common testicular tumor in boys
Yolk sac (endodermal sinus) tumor; Increased AFP, Schiller duval bodies (look like glomeruli)
Ovarian/testicular tumor with signs of hyperthyroidism
Choriocarcinoma; bhCG is structurally similar to LH, FSH, TSH
Painful testicular tumor
Embryonal carcinoma; most often mixed
Increased hCG and normal AFP levels (or increased if mixed)
Testicular tumor with Reinke crystals
Leydig cell tumor
What cells have fried egg appearance?
Koilocytes of HPV
Oligodendrogliomas
Seminomas/Dysgerminomas
Which parts of prostate does BPH affect?
Lateral and middle - the periurethral part
Osteoblastic metastases in bone
Prostatic adenocarcinoma metastases
Clomiphene mechanism
Antagonist at estrogen receptors in hypothalamus –> prevents normal feedback inhibition and increased release of LH/FSH
Raloxifene mechanism and S/E
Antagonist at breast, uterus; agonist at bone
Increased risk of thromboembolic events but no increased risk of endometrial cancer
Anastrazole/Exemestane
Aromatase inhibitors used in post menopausal women with ER + breast cancer (S/E = osteoporosis)
Mifepristone mechanism
Competitive inhibitor of progestins at progesterone receptors used for termination of pregnancy in combo with misoprostol (PGE1)
Terbutaline, Ritodrine
B2 agonists that relax the uterus
Used to decrease contraction frequency in women during labor
Finasteride mechanism and use
5 alpha reductase inhibitor; used for BPH and male pattern baldness (decreases conversion of testosterone to DHT)
Flutamide mechanism and use
Non-steroidal competitive inhibitor of androgen receptors
Used for prostate carcinoma
Ketoconazole mechanism
Inhibits steroids synthesis (inhibits 17,20 desmolase)
Minoxidil mechanism
Direct arteriolar vasodilator used for androgenetic alopecia and severe refractory hypertension
Blood nipple discharge differential
Intraductal papilloma - benign
Invasive papillary carcinoma - malignant
