Repro Flashcards
Pt presents with vaginal bleeding, a larger than expected uterus for gestational age, and high beta hCG. Karyotype reveals 46 XX. Dx?
Complete mole
Exclusively paternal DAN
Pt has thick white vaginal discharge daily (~1 tsp). pH = 4. Saline shows epithelial cells with scarce PMNs. Dx?
Normal
“Physiologic Leukorrhea”
What is at risk of injury during hysterectomy?
Ureter
Passes directly under the uterine artery
What complications are associated with bicornuate uterus?
Infertility Recurrent miscarriage Preterm labor Preterm delivery But pregnancies are often carried to term
What causes a bicornuate uterus?
Incomplete fusion of the paramesonephric ducts.
8 y/o presents with abdominal pain, prominent breast tissue, and started menses at 7.
Bx - fluid filled cavities with a “rosette”
Granulosa cell tumors
Sex cord-stromal cell tumors that secrete estrogen, and thus often present with signs and symptoms of hyperestrogenism causing precocious puberty in adolescents
Call-Exner bodies = fluid-filled cavities with a “rosette” appearance
23 y/o female presents with RUQ pain and PID is found on PE. Dx?
Fitz-Hugh-Curtis syndrome (Perihepatitis)
Seen in 25% of pts with PID.
On laproscopy - “violin-string” adhesions are present in the peritoneal cavity
32 y/o man presents with infertility. Small testes, gyneocomastia. Low testosterone and low LH. What would confirm the Dx?
Karyotyping
Klinefelter XXY, phenotypic male with testicular atrophy, gynecomastia, sparse body hair, infertility.
Elevated LH is secondary to testicular atrophy
Abn Leydig cell fxn -> decrease in testosterone -> no feedback at the AP -> increased LH
During a hysterectomy, severing of which structure would disrupt blood flow to the ipsilateral ovary?
Suspensory ligament
AKA infundibulopelvic ligaments
Contains ovarian a. and v.
Ovary receives collateral flow from the uterine a. that travel in the cardinal (transverse cervical) ligament at the base of the broad ligament
Premenopausal woman presents with multiple masses with dysmenorrhea. what is a commonly associated condition?
Enlargement of the mass with pregnancy Uterine fibroids (leiomyoma) = estrogen sensitive benign tumors of smooth muscle. Tx varies with severity. Severe = hysterectomy Can also try leuprolide, OCP, Progestins, or GnRH RH antagonist
What tx helps urinary flow in a BPH pt?
Tamsulosin
alpha 1 - antagonist
When a female is born, which phase of the cell cycle are her oocytes arrested in until ovulation?
Prophase I
After ovulation, the oocyte progresses through meiosis I and is arrested in?
Metaphase II until fertilization
Which syx would make a physician suspicious of postpartum depression in a new mom?
Feeling of worthlessness
Serious condition resembling major depressive disorder
What is postpartum blues?
Fatigue, anxiousness about the infant, weeping, irritability, emotional lability
If a pt begins HRT for meonpause what other conditions could be improved other than the typical menopause syx?
Decreased colorectal cancer and osteoporotic fx
Seldom use HRT (estro/progest) due to serious side effects (MI, stroke, DVT, and invasive breast cancer)
Hypospadias is due to a defect in?
Improper fusion of Urogenital folds
A woman is admitted for preeclampsia. She is given a drug that is used in expectant management of preeclampsia. 2 hours later labs show she has abnormally high levels of the drug. What syx would you expect?
hyporeflexia
Magnesium toxicity = loss of DTRs, SA and AV node blockade, drowsiness, respiratory depression, cardiac arrest
Magnesium sulfate is used to prevent seizures in preeclamptic women
What gene products cause cancer in HPV?
E6 - p53
E7 - Rb
Allows loss of control of the cell cycle despite DNA damage.
p53, Rb = tumor suppresors
hypophosphorylated Rb inhibits G1 to S progression
Pt presents with a adnexal mass during a routine pap smear.
Bx - nests of transitional cells with coffee bean-shaped nuclei among fibrous stroma
Dx?
Brenner tumors
Benign ovarian tumor that resembles bladder transitional epithelium.
Least common ovarian tumor.
In spermiogenesis, meiosis has been completed and cells are just undergoing their final morphologic changes and maturation. What’s the karyotype of these cells?
Spermatids = 23, 1N
23 chromosomes and haploid
Become secondary spermatocytes after meisosis 2 is completed
What golgi defect can occur in spermiogenesis?
globozoospermia (sperm with round heads)
Golgi is not transformed into the acrosome causing infertility. Correction of the transformation allows for spermiogenesis
What lab changes can be seen as a complication of preeclampsia
Increased D-dimers
HTN + edema + proteinuria
DIC is major complication as well as acute fatty liver, acute tubular necrosis, and HELLP syndrome
What is HELLP syndrome?
Hemolysis
Elevated Liver enzymes
Low Platelet count
If a pt is unable to get an erection during REM sleep, what is the problem and what is the treatment?
Pathological ED
Tx - sildenafil
Inhibits cGMP phosphodiesterase to increase cGMP -> smooth muscle relaxation in the corpus cavernosum
63 y/o female presents with weight gain x 2 months. on PE build up of mucinous fluid in the intra-abdominal cavity. Dx?
Pseudomyxoma peritonei
Filling of the intra-abdominal cavity upon rupture of a mucinous ovarian tumor (mucinous cystadenocarcinoma)
Which hormone causes the prenatal differentiation of the external genitalia in males?
Dihydrotestosterone
Made from testosterone by enzyme 5 alpha reductase.
3x more potent than testosterone
Prenatal - development of male external genitalia
Later in life - secondary sexual characteristics
Which type of tumor presents with vaginal bleeding and is estrogen-sensitive ovarian cells resembling endometrial tissue. Dx?
Endometrioid tumor
What increases the risk of cryptorchidism?
Prematurity
Cryptorchidism causes an increased risk of germ cell tumors and infertility
Risk of testicular cancer persists even if the cryptorchidism is surgically corrected
Ligation of the right cardinal (transverse cervical) ligament would compromise which vessel?
Right uterine a. and v.
A woman at 24 weeks gestation presents with vaginal bleeding. U/S shows a gestational sac and intrauterine fetal heartbeat. What is likely to be in her history?
Prior cesarean delivery
Placenta previa manifests as painless vaginal bleeding after 20 weeks gestation.
RFs = cesarean, increased number of pregnancies, twins, history of D&C for elective abortion
Male presents with a testicular mass that doesn’t tranilluminate, high alpha fetoprotein
On resection - large well demarcated mass, mucinous, and yellow. Dx and demographic?
Yolk sac tumor
Tumor of childhood
derived from malignant endodermal cells that secrete AF{
Syx - testicular swelling and pain
schiller-Duvall bodies - resemble glomeruli and are pathognomonic for sac tumors
male presents with a testicular mass that is large, well demacated, and gray/white in appearance. Histology - large cells in lobules with watery cytoplasm “fried egg” appearance. Dx and demographic
Seminomas
40-50 y/o
Never in infancy
What does the genital tubercle develop into?
Males - glans penis (DHT)
Female - clitoris
Describe the genetic components of the seminepherous tubule of the basal layer vs. the apical layer
2N (spermatogonia, supported by Sertoli cells) and N
20 y/o female presents with LLQ pain x 1 day. LMP was 2 weeks, B-hCG is negative. U/s reveals no masses or abnormalaties. Dx?
Mittelschmerz
Sudden onset abdominal pain in the middle of her menstrual cycle and all findings are inconsistent with pregnancy.
Amnio reveals Low AFP, unconjugated estriol, and B-hCG. Dx?
Trisomy 18
Edwards syndrome
Amnio reveals Low AFP, unconjugated estriol, but high B-hCG. Dx?
Trisomy 21
Also high inhibin A
Amnio reveals low B-hCG all other findings are WNL. Dx?
Trisomy 13
24 y/o Male pt has a nontender R testicle nodule and enlarged paraaortic lymph nodes. Dx?
Seminoma
Most common testicular cancer in 15-35 y/o
paraaortic lymphatic spread
