Repro Flashcards
Pt had D&C, has not had menses since, what should be high on differential?
Asherman syndrome
- scraped off stratum basalis, leaving endometrium inadequate for implantation (too much scar tissue/adhesions)
deficiency in mineralocorticoids (aldosterone)
- hyponatremia, hyperkalemia, HYPOtension
- ambiguous genitalia d/t overproduction of androgens
21-b-hydroxylase deficiency (MCC CAH)
- hypotension activates RAAS
overproduction of mineralocorticoids with decreased levels of glucocorticoids and gonadal steroids
- HTN, hypokalemia
17-a-hydroxylase def
placenta adheres to surface of the myometrium, rather than decidua of uterus
placenta accreta
chorionic villi penetrate through the myometrium, to the uterine serosa or adjacent organs
placenta percreta
chorionic vili penetrate into myometrium
placenta increta
lutenized follicle cysts within the ovary
- woman presenting with unilateral or bilateral cystic adnexal masses with a history of recent pregnancy, known gestational trophoblastic disease, multiple gestations, ovarian hyperstimulation, or a pregnancy complicated by fetal hydrops
theca lutein cyst
- form as a result of overstimulation from high levels of hCG
- ovarian fibroma (proliferating spindle-shaped fibroblasts)
- ascites
- pleural effusion
Meigs syndrome
- removal of the fibroma results in elimination of ascites and pleural effusion
women in 30-40’s, pelvic pressure, pain, menorrhagia, and dysmenorrhea
- MC tumor in females
- appear as calcified lesions on xray
leiomyoma
- benign neoplasm of smooth muscle
- can cause spontaneous abortion and infertility
persistent scaling, eczematous eruption, or ulcerating lesion involving the nipple and areolar complex
- nipple may appear scaly or crusted, raw, vesicular, or ulcerated
Paget disease of breast
Paget disease of breast is a risk factor for what malignancy?
invasive ductal carcinoma
rapid onset and presents as red, warm, edematous skin that resembles inflammation
- thickening and dimpling of the skin that resembles an orange peel (peau d’orange)
inflammatory breast carcinoma
bloody nipple discharge without a palpable mass
intraductal papilloma
do aldosterone levels increase or decrease in pregnancy?
increase
does GFR increase or decrease in pregnancy?
increase
does systemic vascular resistance increase or decrease in pregnancy?
decrease
does tidal volume increase or decrease in pregnancy?
increase
does expiratory reserve volume increase or decrease in pregnancy?
decrease
does thyroid binding globulin increase or decrease in pregnancy?
increase
- bound T3/T4 increases
- free thyroxine (T4) remains the same
rare ovarian tumor containing ectopic thyroid tissue as the major cellular component
- nonspecific presenting symptoms that may include a pelvic mass, abdominal pain, ascites, abnormal vaginal bleeding, and hyperthyroidism
struma ovarii
what is the most common hormonal elevation seen in PCOS?
increase in LH (LH:FSH > 2)
- increase in LH occurs due to pituitary oversecretion and leads to both decreased synthesis of FSH as well as increased androgen production
what produces b-hCG?
syncytiotrophoblast of placenta
- also produces progesterone and human placental lactogen (aka human chorionic somatomammotropin) during pregnancy
what adverse effect can metoclopramide have on breast tissue?
it is an anti-dopaminergic -> stops inhibition of prolactin -> galactorrhea
male, 15-35 with a firm, nontender testicular mass that does not transilluminate
- precocious puberty, gynecomastia, impotence, or loss of libido
choriocarcinoma
solid, lobulated, yellow-tan tumor
- men of all ages, present with virilization and gynecomastia
- round nuclei, single prominent nucleoli, and abundant eosinophilic cytoplasm or abundant clear cytoplasm
- reinke crystals (rod-shaped intracytoplasmic crystal-like inclusions with rounded ends)
- inhibin alpha is tumor marker
leydig cell tumor
occur both in children and in middle-aged adults
- well-circumscribed and pale yellow to whitish gray in color
- uniform tall polyhedral cells that are arranged in nests, sheets, and cords resembling spermatic tubules
- perinuclear aggregates of intermediate filaments
- inhibin alpha is tumor marker
sertoli cell tumor
most common testicular neoplasm in infants and children
- painless and bulky testicular mass
- honeycomb pattern
- *schiller duval bodies (central vessel lined by fibrous tissue and surrounded by malignancy epithelial cells in a cystic space)
- a-fetoprotein is tumor marker
yolk sac tumor
cystic swelling of the chorionic villi and proliferation of trophoblastic tissue, without formation of any fetal tissue or amniotic fluid
- abdominal growth, hCG much higher than normal pregnancy ( >200,000)
complete mole
- partial mole will not have as high hCG
what is the dominant estrogen of late pregnancy?
estrone
- estradiol is dominant estrogen every other time
X-linked dominant, mutation causes methylation of FMR1 gene
- leads to CGG trinucleotide repeat
- mental retardation and autistic-like behaviors
fragile X
hyperphagia, early-onset obesity, hypogonadism, developmental delay, and hypotonia
- small hands and feet, almond shaped eyes
- paternal deletion on Xsome 15, mom’s copy is imprinted
Prader-Wili
lack of embryonic migration of the olfactory bulb cells to the hypothalamus
- lack of puberty development
- lack of secondary sex characteristics
- decreased GnRH, LH, and FSH
- decreased sense of smell
Kallman syndrome
- idiopathic hypogonadotropic hypogonadism that results from a deficiency of a gonadotropin-releasing hormone (GnRH) from the hypothalamus
pain caused by the abnormal implantation of endometrial glandular and stromal tissue within the myometrium
- uniformly enlarged and boggy uterus on physical examination, can be tender
adenomyosis
- more common in multiparous women, women over the age of 35, and those with a history of uterine surgeries such as cesarean section
pale, ovoid nucleus, large nucleolus, and a large amount of pale-staining cytoplasm
- what are they called and when would you see them?
halo cells
- Paget dz of breast
benign, small tumor that is found beneath the areola
- typically presents as bloody nipple discharge in woman less than 50
intraductal papilloma
multiple bilateral malignant breast lesions
- histo shows orderly row of cells, often described as “Indian files.”
invasive ductal carcinoma
bilateral ovarian metastases from a gastrointestinal tract adenocarcinoma
- invasive, mucin-filled, signet ring cancer cells
- associated with acanthosis nigricans and leser-trelat sign
Krukenberg tumor
what dopamine agonist is used to treat galactorrhea by inhibiting prolactin?
bromocriptine
- short stature, web necked, widely spaced nipples
- streak ovaries (ovarian dysgenesis)
- infertility d/t primary amenorrhea (low estrogen) -> high LH/FSH
- horseshoe kidney and bicuspid aorta
turner syndrome
male with gynecomastia, erectile dysfunction and decreased libido
- potential galactorrhea
prolactinoma
- pituitary adenoma that secretes excess prolactin, which decreases the secretion of GNrH and therefore, lowers LH and FSH
hyperandrogenism, irregular menstrual cycles
- increased LH and total testosterone, decreased FSH
- state of hyperinsulinemia and insulin resistance
PCOS
LH activates what enzyme in theca cells?
desmolase
- produces androstenedione
FSH activates what enzyme in granulosa cells?
aromatase
- produces estrogen
where is oxytocin produces?
hypothalamus
- released from posterior pituitary (same as ADH)
taking tamoxifen (SERM) after mastectomy increase your chance of what?
endometrial carcinoma
tx for endometriosis
- synthetic androgenic steroid that inhibits pituitary secretion of FSH and LH, inhibiting ovulation and ovarian estrogen release
danazol
MCC primary amenorrhea
- short stature, horseshoe kidney, coarctation of aorta, Madelung deformity of wrist, conductive hearing loss
Turner syndrome
what ligament is almost always involved in ovarian torsion?
infundibulopelvic (suspensory ligament of ovary)
what seizure med is known to cause fetal hydantoin syndrome?
- cleft lip, nail hypoplasia, growth and mental retardation, cardiac defects
phenytoin
- osteomalacia is a long term side effect for mother, NOT fetus
what mood stabilizer is known to cause Ebstein’s anomaly in pregnancy?
- large R atrium, small R ventricle
lithium
Estrogen promotes healthy bone turnover by inhibiting what?
osteoclasts
- after menopause, no more inhibition means too much osteoclast activity
when fetal blood vessels cross over internal os and are at risk of a tear?
- causes painful vaginal bleeding
vasa previa
gestational sac located in the lower uterine area instead of the typical fundal implantation, or close to or within a prior cesarean scar
- Loss of placental homogeneity appearing as venous lakes or placental lacunae
- Retroplacental myometrial thickness < 1 mm
- Disruption of the normally continuous white line between the bladder wall and uterine serosa interface
placenta accreta
progestin in OCP’s suppresses what?
LH release
estrogen in OCP’s suppresses what?
FSH release
genetic male, phenotypic female
- testes develop due to the presence of the SRY gene on the Y chromosome and are often found within the labia, inguinal canal, or intra-abdominally.
androgen insensitivity syndrome
what drug is a glucocorticoid and progesterone antagonist that competitively binds to the intracellular progesterone receptor to block the effects of progesterone
- it changes the uterine lining and causes detachment of the pregnancy, softening and opening of the cervix, and increasing uterine sensitivity to prostaglandin
mifepristone
synthetic prostaglandin E1 analog that has been shown to induce uterine contractions
- does not inhibit progestin
misoprostol
what does thyroid release hormone stimulate other than the thyroid?
prolactin release
what tanner stage?
- dark, coarse pubic hair that is sparse in distribution and enlargement of the breast, but with no separation of contour
stage 3
what tanner stage?
- pubic hair that is adult in quality (dark and coarse) but is limited to the pubic area, sparing the thighs
stage 4
what tanner stage?
- projection of the papilla above the areola and breast mound
stage 5 (sexually mature)
selective estrogen receptor modulator (SERM)
- inhibits negative feedback of estrogen in the hypothalamus on gonadotropin release
- increases release of LH and FSH from the anterior pituitary gland
- causes ovarian hyperstimulation -> multiple enlarged follicles are stimulated
clomiphene
- used to treat infertility in PCOS
GnRH analog, administered in continuous fashion to decrease LH and FSH production
leuprolide
antiandrogen used to decrease testosterone production
- inhibits 5-alpha reductase (thus inhibiting conversion of T -> DHT)
finasteride
semisynthetic ergot alkaloid and dopamine receptor agonist
- inhibits prolactin secretion
bromocriptine
persistent elevation of LH levels relative to FSH should immediately make you think of what?
PCOS
- estrogen must reach a certain concentration to trigger an LH surge -> ovulation
- in PCOS, estrogen levels do not reach the required concentrations -> anovulation
- excess androgens result in hirsutism, acne, and male pattern balding
what is the shortest antero-posterior diameter through which the fetal head must pass?
obstetric conjugate
- extends from the sacral promontory to the closest point on the convex posterior surface of the symphysis pubis
what is the widest distance between the iliopectineal lines?
transverse diameter
large, atypical adenocarcinoma cells with pale to clear cytoplasm (clear halos) that infiltrate though the epidermis as either single cells or clusters of cells
Paget’s disease of the breast
- look for older woman with nonhealing eczema on the nipple
Nodular proliferation of cells extending from the stratum basalis
basal cell carcinoma (skin)
Stromal overgrowth with compressed glandular structures
phyllodes tumor
- fibroepithelial neoplasm of stroma of the breast
what is the first line tx for prevention of maternal transmission of HIV?
zidovudine and lamivudine
- both NRTI’s that competitively inhibit reverse transcriptase (RNA-dependent DNA polymerase)
69 XXY or 69 XXX
- mildly elevated b-hCG
- can contian fetal parts (fetal heart tones can be heard early on)
partial mole
46 XX
- uterine size enlarged for gestational age
- significantly elevated beta-hCG (> 100,000 mIU/mL)
- absence of fetal parts upon ultrasound
complete mole
what is the earliest phenotypic change seen in puberty?
thelarche, aka breast development (average age 10)
- occurs in response to estradiol release from the ovaries
NOTE that adrenarche and gonardarche happen first (age 6-8), but no phenotypic changes can be seen, it is only hormonal
genetic males born with ambiguous genitalia
- may present with a clitoral-like phallus, bifid scrotum, pseudovaginal perineoscrotal hypospadias, and a rudimentary prostate
- internal genitalia are normal and luteinizing hormone (LH) may be normal or increased
- when child reaches puberty, testes descend and genitalia become more masculine in appearance
5-alpha reductase deficiency
most common testicular tumors in young adult males aged 15-35
- histo shows large cells in lobules with watery cytoplasm and a “fried egg” appearance
- Cryptorchidism is a known risk factor (for all testicular germ cell tumors)
- malignant, but metz slowly and respond well to radiation
seminoma
osteopathic treatment for dysmenorrhea?
sacral inhibition
- influences parasympathic activity to pelvic organs
chapmans point for ovaries?
on the pubic tubercle
chapmans point for uterus?
b/l sacral base, between L4/5 TP
what hormone
- causes the cervical mucus to become thick
- raises basal body temperature
- inhibits both LH and FSH secretion
progesterone
- highest during luteal phase
what hormone
- causes the cervical mucus to be thin and watery
- inhibits FSH secretion
- stimulates mitosis of the endometrium
estrogen
- highest during follicular phase
when is the follicular phase?
day 1-13
- menses, then proliferative phase
when is the luteal phase?
day 14-28
- aka secretory phase
what hormone is highest during menses, and then is the lowest of all 4 hormones the rest of the month?
FSH
should be suspected in any pregnant women who experiences vaginal bleeding after 20 weeks, especially when the bleeding is painless
- risk factors include a previous cesarean section, grand multiparity (usually > 5 deliveries), multiple gestation, increased maternal age, infertility treatment, previous surgery to the uterus, and smoking
placenta previa
high-riding testis with abnormal transverse lie and loss of the cremasteric reflex
- identified by Doppler ultrasound and immediate surgical evaluation
testicular torsion
- T10-11 sympathetics
Dopamine antagonists are the most common culprits of what?
- antipsychotic medications (FGA MC haloperidol and fluphenazine); SGA (risperidone and paliperidone); and prokinetic agents (metoclopramide).
galactorrhea
what does GnRH stimulate?
FSH, LH
OCP’s have a protective effect on what tissue?
endometrial and ovarian
- no change to breast tissue, evidence shows increased risk of cervical cancer?
leuprolide can be given continuously as a treatment for what?
uterine fibroids
- is a GnRH analog that works as an agonist when given in a pulsatile manner
- when given continuously, works as an antagonist
MOA of sildenafil?
inhibits phosphodiesterase-5 causing an increase in cGMP
- relaxes the smooth muscle of the vascular corpora cavernosa
lower back pain, vaginal bleeding, and ultrasound findings of a dark crescent-shaped region
placental abruption
what ligament does the artery of Sampson run through?
the round ligament
- connects the uterine fundus with the labia majora, running through the inguinal canal
In patients older than 35, what are the 3 MCC (bugs) of epididymitis?
Escherichia coli, Pseudomonas, and Proteus
In patients younger than 35, what are the 3 MCC of epididymitis?
Chlamydia trachomatis and Neisseria gonorrhoeae
what is the function of BRCA1?
homologous recombination
cellulitis of the periglandular tissue caused by nipple trauma from breastfeeding coupled with the introduction of bacteria from the infant’s pharynx into the nipple ducts
mastitis
- S. aureus is MCC
woman in 50-60’s, malignant ovarian tumor of epithelial origin
- ingrowths of papillary and glandular structures with stromal invasion
- psammoma bodies
- poorly differentiated, often described as solid sheets of cells
serous cystadenocarcinoma
malignant epithelial tumor
- multiple loculi lined with mucin-secreting epithelium and stromal invasion
- pseudomyxoma peritonei
mucinous adenocarcinoma
metastatic tumor, typically located from the stomach to the ovaries (usually bilateral)
- filled with mucin
- signet ring appearance
Krukenberg tumor
- Benign ovarian tumor
- Bilateral in 10%-25% of cases
- Typically filled with pale yellow or clear serous fluid
- Treatment is either unilateral salpingo-oophorectomy or ovarian cystectomy
serous cystadenoma
- Benign ovarian tumor
- Filled with mucin, often multiloculated
- Bilateral in less than 5% of cases
- Oftentimes very large tumors
mucinous cystadenoma
- Typically benign ovarian tumor
- Characterized by transitional (bladder) epithelium with stromal invasion
Brenner tumor
homogenous, thin, gray/white discharge that is smooth in texture and found to coat the vaginal walls
- pH > 4.5
- clue cells
- whiff test
BV -> gardnerella
- V common in pregnancy
- treat w/ oral metronidazole
green, frothy copious discharge
- cells may appear to have a corkscrew motility
trichimonas
- tx w/ oral metronidazole
male w/ bitemporal hemianopsia, gynecomastia, erectile dysfunction, infertility
pituitary adenoma (prolactinoma MC) - hypogonadotropic hypogonadism: prolactin inhibits GnRH -> decreased FSH/LH -> decreased testosterone
what hormone is responsible for testosterone production?
LH
what hormone is responsible for spermatogenesis?
FSH
folate antagonist that binds to the catalytic site of dihydrofolate reductase
- used to treat ectopic pregnancy
methotrexate
what is the first line agent for advanced ovarian cancer?
paclitaxel
- binds to beta subunit of tubulin, enhances microtubular stabilization
- formation of microtubule bundles that interfere with mitosis and cell division
genetic condition causing defective luteinizing hormone (LH) receptors on the Leydig cells
- ca present with hypospadius, micropenis, ambiguous genitalia, cryptorchidism, atrophic testes, bifid scrotum, and/or female external genitalia
- prostate, seminal vesicles, ductus deferens, and epididymis can be absent
Leydig cell hypoplasia
what hormone is responsible for the development of the mesonephric ducts?
- giving rise to the seminal vesicles, epididymis, ejaculatory duct, ductus deferens, and part of the prostate gland
LH
what hormone has structural homology with the TSH-FSH-LH hormone family through the alpha subunit?
hCG
- conditions that carry elevated hCG levels (i.e. testicular cancer) can produce symptoms of other hormones
- hyperthyroidism (through TSH) and gynecomastia (through LH)
male 46XY genotype, but external female phenotype
- no internal reproductive organs, meaning no uterus or uterine tubes, but instead have a “blind pouch” vagina
- undescended testes, palpable inguinal masses
- labs will reveal an increase in testosterone, estrogen, and LH
complete androgen insensitivity
male phenotype with testicular atrophy and female hair distribution
- dysgenesis of the seminiferous tubules -> increased FSH
- abnormal Leydig function -> decreased testosterone, increased LH, increased estrogen
Klinefelter syndrome (47XXY)
what SERM is used as treatment for osteoporosis?
raloxifene
- no increased risk of endometrial cancer (like tamoxifen)
teenage female with fully developed secondary sex characteristics (normal ovaries, NL breast development and pubic hair)
- short vagina, variable uterus -> won’t menstruate
vaginal agenesis aka Mayer-Rokitansky Kuster Hauser syndrome
46XY males who appear phenotypically female
- no pubic hair or secondary sex characteristics
- no uterus or ovaries
- cryptorchid testes
androgen insensitivity syndrome
primary amenorrhea, no secondary sex characteristics, olfactory sensory defect
Kallman syndrome
prominent forehead, long narrow face, large ears, prominent chin, macroorchidism
fragile X
- small gap on tip of long arm of X xsome (appears broken/fragile)
