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First aid > Repro > Flashcards

Repro Flashcards

1
Q

Sonic hedgehog gene

A

Zone of polarizing activity at base of limb bud
AP axis pattern, CNS deve3lopment

Mutations–> holoprosencephaly

Wnt 7 gene - apical ectodermal ridge– makes dorssal ventral limbs

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2
Q

Fibroblast growth factor-

A

apical ectodermal ridge, limb lengthening of mesoderm

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3
Q

Homeobox gene

A

segmental organizatoin in cranial caudal direction, transcription factor coding

mutation lead to appendages in wrong locations

Isotretinoid–> Hox gene expression

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4
Q

Neural crest cells

A

from ectoderm MOTEL PASSES

PNS and non neural structures near by

Melanocytes
Odontoblasts
Tracheal catrilage
Enterochromaffin cells 
Leptomeninges (arachnoid and pia)
PNS ganglia
Adrenal medulla 
Schwann cells
Spiral membrane 
Endocardial cussions
Skull
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5
Q

Mesoderm

A

Middle/ meat layer
Mesodermal defects- Vacterl
Vertebral defects, Anal Atresia, Cardiac defects, TE fistula, Renal defects, Limb defects

Spleen, lymphatics blood, wall of gut tube, upper vagina, kidney, adrenal cortex dermis testes, ovaries

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6
Q

Endoderm

A

Gut tube epithelium, urethra and lower vagina, luminal epithelium, lungs liver gallbladder, pancreas, eustachian tube, thymus, PTH thyroid follicular cells

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7
Q

Twinning

A

Dizygotic (2 eggs separately fertilized by 2 different sperm , 2 separate amniotic sacs, 2 separate placentas)

Mono (1 egg, and 1 sperm that splits in early pregnancy- the timing of cleavage determines

cleave 0-4 days separate everything
4-8 days- shared Chorion, 8-12 days shared amnion- Cleavage after 13 days- shared body

rule of 4

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8
Q

Placenta

A

1’ site of nutrient and gas exchange between mom and fetus

Fetal component: Cytotrophoblast (inner layer of chorionic villi) makes the cells. Syncytiotrophoblast- outer layer of chorionic villi- synthesizes and secretes hormones (hCG (structurally like LH, stimulates corpus luteum to secrete progesterone during first trimester)- lacks MHC 1 expression–> decreased chance of attack by mom immune system

Maternal component- decidua basalis- derived from endometrium , maternal blood in lacunae

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9
Q

umbilical cord

A 
2 arteries (that carry deoxy blood to mom heart)
1 umbilical vein (away from mom carries oxy blood to baby)

Artery or vein terminology refers to baby

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10
Q

Urachus

A

allantois forms from hindgut and extends into urogenital sinus
Allantois becomes the urachus a duct between fetal bladder and umbilicus, failure of urachus to involute can lead to anomalies that may increase risk of infection and/or malignancy (adenocarcinoma )

Obliterated urachus is represented by the median umbilical ligament after birth, which is covered by median umbilical fold of the peritoneum

Patent urachus- total failure of urachus to obliterate–> urine discharge from umbilicus

Urachal cyst- partial failure, cyst can become infected and present as painful mass below umbilicus

vesicourachal diverticulum- slight failure of urachus to obliterate–> outpuching of bladder

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11
Q

Vitelline duct

A

7th week- obliteration of vitelline duct omphalomesenteric duct, which connects yolk sac to midgut lumen

Vitelline fistula- vitelline duct fails to close–> meconium discharge from umbilicus

Meckel diverticulum (partial closure of vitelline duct)- may be asymtomatic, may patent portion attached to ileum may have heterotopic gastric and or pancreatic tissue–> melena, hematochezia, abdominal pain

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12
Q

Aortic arch derivatives

A

develop into arterial system
1st- part of maxillary artery (branch of external carotid) maximal

2nd- Stapedial artery and hyoid artery, Stapedial

3rd- Common carotid artery and proximal part of internal carootid artery (c 3rd letter of alphabet)

4th- on left, aortic arch, on right proximal part of right subclabian, 4th limbs

6th- pulmonary

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13
Q

Pharyngeal apparatus

A

composed of pharyngeal clefts, arches, pouches
Pharyngeal Clefts- derived from eCtoderm- and grooves
Pharyngeal Arches- derived from mesoderm (muscle arteries) and nueral crest (bones, cartilage)- mesoderm and neural crest
Pharyngeal Pouches- derived from endoderm

CAP (Clefts, Arches, Puches)

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14
Q

Pharyngeal cleft derivatives

A

1st cleft develops into external auditory meatus
2nd through 4- temporary cervical sinuses, obliterate
Persistent cervical sinus–> pharyngeal cleft cyst within lateral neck ANTERIOR to Sternocleidomastoid muscle (doesnt move with swallowing vs thyroglossal duct cyst)

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15
Q

pharyngeal arch derivatives

1st pharyngeal arch

A

Maxillary process–> maxilla, zygoMatic bone,
Mandibular process- Mechel cartilage–> mandible

Malleus and incus sphenoMandibular ligament

Muscles of Mastication– temporalis, Masseter, lateral and Medial pterygoids, Mylohyoid, anterior belly of digastric, tensor tympani, anterior 2/3 of tongue, tenso veli palatini

CN v3 chew

Pierre Robin sequence- micrognathia, glossoptosis, cleft palate, airway obstruction

Treacher Collin syndrome- AD neural crest dysfunction–> craniofacial abnormalities (zygomatic bone and mandidibular hypolasia) hearing loss, airway compromise

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16
Q

2nd pharyngeal arch

A

Reichert cartilage: Stapes, Stylid process, LeSSESr horn of hyoid Stylohoid ligament

Muscles of faciall expression, Stapediud, Stylohoid, platysma, posterior belly of digastric

CN7 - Facial expression SMILE

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17
Q

3rd pharyngeal arch

A

Greater horn of hyoid

Stylopharyngeus (glossopharyngeal nerve)

CN9 (swallow stylishy

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18
Q

4th and 6th

A

ACCCT
Artenoids, Cricoid, corniculate, cuneform, thyroid *used to sing)

CN x simply swallow and speak

19
Q

Pharyngeal pouch pneumonic

A 
EAR, Tonsils, bottom to top
1, Ear
2. tonsils
3. Dorsal (bottom for inferior parathyroids)
4. ventral (to= thymys
5. top superior parathyroids)
20
Q

Cleft lip and ceft palate

A

Distint multifactorial etiologies, but often occur togerthe

Cleft lip- due to failure of fusion of maxillary and merged medial nasal processes (formation of 1’ palate)

Cleft palate- due to failure of fusion of the 2 lateral palatine shelves or failure of fusion of lateral palatine shelf woth nsasal septum and or 1’ palat formation

21
Q

Genital embryology male vs female

A

Females- default development, mesonephric duct degenerates and paramesonephric duct develops

Males- SRY Gene on Y chromosome– produces testis determining factor–> testes development . Sertoli cells secrete Mullerian inhibitory factor (antimullerian hormone) that suppresees the development of paramesonephric ducts, Leydig cells secrete androgens that stimulate development of mesonephric ducts

22
Q

Paramesonephric (Mullerian ducts)

A

Develops into female internal structures– fallopian tubes, uterus, upper portion of vagina (the lower portion is from the urogenital sinus) Male remnant is appendix testis

Mullerian agenesis- may present as 1’ amenorrhea (due to a lack of uterine due to lack of uterine development 2’ sexual characteristics (functional ovaries)

23
Q

Mesonephric (wolffian ducts)

A

Develops into male internal structures (except prostate)- Seminal vesicles, Epididymus, Ejaculatory duct, ductus deferens (SEED) Female remnant is gartner duct

24
Q

sexual differentiation

A

XY- has SRY gene–> testes (Leydig cells + Sertoli cells)
Leydig cells Make testosterone–> activates mesonephric duct (wolffian duct)–> internal male genitals

Leydig cells also contain 5a reductase–> External male genitals and prostate
Sertoli cells produce inhibitory mullerian duct

XX has no SRY–> ovaries–> estradiol–> external female genitals ( Clitoris, Labia, Distal vagina)

Lack of MIF–> internal female genitals (fallopian tubes, Uterus, Proximal vagina

25
Q

Sexual differentiation issues

A

Absence of sertoli cells or lack of Mullerian inhibitory factor–> develop both male and internal female internal genitalia and male external genitals

5areductatse def–> no DHT –> male internal genitals with ambiguous external genitals until puberty

Leydig Leads to male (internal and external sex differentiation)
Sertoli Shuts down female (internal sexual differentiation)

26
Q

Uterine (mullerian duct) anomalies

A

Septate uterus- common anomaly , incomplete resorption of septum–> decreased fertility and early misscarriage, cut out the septum

Bicrnuate uterus- incomplete fusion of mullerian ducts–> increased risk of complicated pregnancy, early pregnancy, malpresentation prematurity

Uterus didelphys- commplete failure of fusion double uterus, cervix and vagina– pregnancy possible

27
Q

Gonadal venous drainage

A

Left ovary/ testes–> left gonadal vein–> left renal vin –> IVC

28
Q

Gonadal lymph drainage

A

Ovaries/testes–paraaortic lymph nodes

Body of uterus/ cervix/ superior part of bladder–> external iliac nodes

prostate/cervix/corpus cavernosum/proximal vagina–> internal iliac nodes

Distal vagina/ vagina/ scrotum/ distal anus–> superficial inguinal nodes

Glans of penis–> deep inguinal nodes

29
Q

Ligaments of female reproductive anatomy

A

Infundibulopelvic (suspensory ligament) Connects ovaries to lateral pelvic walls contains the ovarian vessels, ligate them during oophorectomy to avoid bleeding , Ureter courses retroperotneally at risk of injury

Cardinal/transverse cervical ligaments- connects cervix to side wall of pelvis, contains uterine vessels, ureter at risk of injury during ligation in hysterctomy

Round ligament of the uterus- connects uterine horn to labia majora. Derivative of gubernaculum, travels through round ligament of inguinal canal above the artery of Sampson

Broad ligament- connects uterus, fallopian tubes, and ovaries to the pelvic side wall. contains Ovaries, fallopian tubes, round ligaments of uterus, fold of peritoneum that comprimises the mesosalpinx, mesometrium, and mesovarium

Ovarian ligament- medial pole of ovary to uterine horn, derivative of gubernaculum, ovarian ligament latches to lateral uterus

30
Q

urethral injury

A

Occurs almost exclusively in men
Blood at urethra
dont catheterize them

Anterior urethral injury- bulbar, spongy urethra. due to perneal straddle injury, blood accumulates in scrotum, if buck fascia breaks, urine escapes into perineal space, blood will accumulate at urethral meatus and scrotal hematoma

Posterior urethral injury- membranous urethra injured, due to pelvic fracture, urine leaks into retropubic space. Blood at urethra meatus and high riding prostate

31
Q

Autonomic innervation of male sexual response

A

Erection- Parasympathetic nervous system (pelvic splanchnic nerves, S2-S4). NO–> increased cGMP–> smooth muscle relaxation–> Vasodilation-> proerectile
NE-> increased Ca–> smooth muscle contaction–> vasoconstriction –> antierectile
Emission–> sympathetic nervous system (hypogastric nerve, T11-L2)
Expulsion- visceral and Somatic nervers (pudendal nerve)

Point, Squeeze, and shoot

S234 keep the penis off the floor

PDE5 inhibitor (sildenafil–> decreased cGMP breakdown)

32
Q

Spermatogonia

A

Line the seminiferous tubules, Germ cells

Maintain germ cell pool and produce 1’ spermatocytes

33
Q

Sertoli cells

A

Secrete inhibin B–> inhibit FSH
Secrete androgen-binding protein –> maintain local levels of testosterone
Produce MIF. Tight junctions between adjacent sertoli cells form blood-testis barrier–> isolate gametes from autoimmune attack

Support and nourish developing spermatozoa, Regulated spermatogenesis
Temp sensitive–> decrease sperm production and decreased inhibin B with increase temperature

Line seminiferous tubulues, Non germ cells, Convert testosterone and androstenedione to estrogen via aromatase, Sertoli cells are inSide Seminfourus tubules, Support Sperm Synthesis, and inhibit FSH, homolog of female granulosa cells

increased tem seen in varicocele, cryptorchidism

34
Q

Leydig cells

A

Secrete testosterone in the presence of LH, testosteron production unaffected by temperature

Interstitial cells, endocrine cells, Homolog of female theca interna cells- Leydies dig testosterone

35
Q

Spermatogenesis

A

begins at puberty with spermatogonia, Full development takes 2 months, Occurs in seminiferous tubules

Produces spermatids that undergo spermiogenesis (loss of cytoplasmic contents, gain of acrosomal cap) to form mature spermatozoa

Gonium is going to be a sperm, Zoon is Zooming to the egg

Tail mobility impaited in ciliary dyskinesia/kartagner syndrome–> infertility Tail mobility normal in CF, just no vas degerens)

36
Q

estrogen

A

Ovaries make them (17 B estradiol), placenta (estriol), adipose tissue (estrone via aromatization)

Potency (estradiol> Estrone> estriol)
Develops the genitals and breast, female fat distribution
Growth of follicle, endometrial proliferation, increased myometrial excitability

Upregulation of estrogen, LH, and progesterone receptors, feedback inhibition of FSH and LH surge stimulates prolactin secretion

increased transport proteins, SHBG, increases HDL, decreased LDL

Pregnanct- 50 fold increase estradiol and strone, 1000 fold increase in estriol (indicator of fetal well being

Estrogen receptors expressed in cytoplasm , translocate to nucleus when bond to estrogen

37
Q

Progesterone

A

comes from corpus luteum, placenta, adrenal cortex and testes

During luteal phase, preps uterus for implantation of fertilized egg

Stimulation of endometrial glandular secretion and spiral artery development

Production of thick cervical mucus–> inhibits sperm entry
Prevents endometerial hyperplasia, increased body temp, decreased estrogen receptor expression, decreased gonadotropid LH FSH secretion

During pregnancy maintain of pregnancy, decreased myometrial excitability–> decreased contraction frequency and intensity, decreased prolactin action on breast

Fall in progesterone after delivery disinhibits prolactin–> milk let down increased progesterone is indicative of ovulation

38
Q

OOgenesis

A

1’ oocytes begin meiosis 1 during fetal life and complete meiosis 1 just before ovulation

Meiosis 1 is arrested in prOphase 1 for years until Ovulation

Meiosis 2 is arrested in metaphase 2 until fertilization when egg METs sperm,

39
Q

Ovulation

A

increased estrogen, increased gNrh receptors on aterior pituitary

Estrogen surge then stimulates LH release –> ovulation rupture of follicle

Increased temperature (progesterone induced)

Mittelschmerz– transient mid cycle ovulatory pain (Middle hurts) follicular swelling

40
Q

Menstrual cycle

A

Follicular phase can vary in length, luteal phase is always 14 days (the corpus luteum can only survive 2 weeks without hCG, and the endometrium can only reach a certain length) Follicular growth is fastes during 2nd week of the follicular phase

Estrogen stimulates endometrial proliferation, estrogen maintains endometrium to support implantation

decreased progesterone –> dcrease fertility

41
Q

Abnormal uterine bleeding

A

Characterized as either heavy menstrual bleeding or intermenstrual bleed

PALM COEIN
Structural causes (palm)- Polyp, Adenomyosis, Leiomyoma, malignancy/hyperplasia

Nonstructural causes (COEIN) - coagulopathy, ovulatory, Endometrial, Iatrogenic, no idea

42
Q

Pregnancy

A

Fertilization most commonly occurs in upper end of fallopian tube (the ampula) in one day of ovuation before progesterone creates a mucus plug

Syncytiotrophoblasts secrete hCG which is detectable in blood 1 week after conception

Gestational age- calculated from date of last menstrual period

increased GFR, decreased BUM and creatinine, decrease glucosuria threshold
increased CO, anemia (relatice), hypercoagulability (evolution to prevent blood loss at delivery)
hyperventilation (eliminate fetal CO2
increase lipolysis and fat utilization

43
Q

HPL

A

syncytiotrophoblast of placenta
stimulates insulin production, overall increase insulin resistance
Gestational diabetes can occur if maternal pancreatic function

First aid (12 decks)

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