Repro/GU SM Lectures Flashcards
Ascending Infection
- leads to chorioamnionitis (mom) or funisitis (fetus)
- causes include GBS, enterococci, E.coli, ureaplasma, candida, herpes
Descending Infection
- leads to villitis
- causes include syphilis, tuberculosis, listeria, CMV, rubella, toxoplasmosis
Maternal Serum Markers in Fetal Down Syndrome
- increase in hCG and inhibin A
- decrease in alpha-fetoprotein and unconjugated estriol
Contraindications to Medical Abortions in First Trimester (mifepristone+misoprostol)
- ectopic pregnancy
- IUD
- corticosteroid use
- hemorrhagic disorders/poryphoria
- concurrent anticoagulant use
- chronic adrenal failure
- allergy
Non-Estrogen therapies for VMS
- SSRI’s (fluoxetine, escitalopram), do not use with tamoxifen
- SNRI’s (venlafaxine)
- clonidine
- gabapentin
GnRH analogues
- gonadorelin (GnRH synthetic)
- leuprolide (GnRH super-agonist)
- cetrorelix (GnRH receptor antagonist)
Gonadotropins
- follitropins alpha and beta
- lutropin alpha
- chorionogonadotropin alpha
Androgens
- testosterone propionate (slow releasing depot)
- methyltestosterone (orally effective synthetic preparation)
- stanozolol (orally effective synthetic preparation with slightly enhanced anabolic/androgenic ratio)
Androgen antagonists
- flutamide (receptor antagonist)
- finasteride and dutasteride (5-alpha reductase inhibitor)
- gossypol (damages seminiferous tubules and decreases sperm)
Estrogen
- estradiol benzoate (semisynthetic, long-acting)
- ethinyl estradiol (orally effective synthetic estrogen)
- conjugated equine estrogens (Premarin)
- diethylstilbesterol (non-steroidal, orally effective, long-acting, carcinogenic)
Progestin
- medroxyprogesterone (oral or depot)
- norethindrone, levonorgestrel (oral)
SERMS
- tamoxifen
- fulvestrant (absent initial stimulatory effect of estrogen)
Non-neoplastic ovarian cysts
- follicular cyst/cystic follicle
- corpus lutein cyst
- non neoplastic epithelial cyst (ie. ovarian surface epithelial cyst and ciliate tubal inclusion cyst)
Types of ovarian neoplasia
- surface epithelial tumors
- sex cord stromal tumors
- germ cell neoplasms
Common sites of “implants” by borderline subtype of serous epithelial ovarian tumor
omentum, pelvic sidewall, diaphragm, uterine serosal surface
Common primary tumors that metastasize to ovary
- endometrial carcinoma
- cervical SCC
- breast
- Krukenberg’s tumor (signet ring cell tumor from stomach)
- mucinous adenocarcinoma from appendix and colon
Tumor Markers
CA 125: ovarian epithelial tumor
CEA: mucinous ovarian tumor
HCG: embryonal carcinoma, choriocarcinoma
Inhibin: granulosa cell tumor
Lactase Dehydrogenase: dysgerminoma
Alpha fetal-protein: endodermal sinus tumor, embryonal carcinoma
Common sites of endometriosis
ovaries, uterine ligaments, rectovaginal septum, peritoneum, and appendix
Contents within the Deep Perineal Pouch
- deep transverse perineal muscle
- external urethral sphincter
- bulbourethral gland
Episiotomy (enlargement of the distal birth canal to facilitate difficult birth)
- Median cut (skin, vaginal wall, perineal body)
- Mediolateral cut (skin, vaginal wall, bulbospongiosus, superficial transverse perinei, UG diaphragm)
Mechanism of Erection
NO–> GC–> cGMP–> PKG–> increased uptake of Ca++ into intracellular stores and potassium efflux–> cell hyperpolarization
Contributing factors to Preterm Premature Rupture of Membranes
- alteration in cervical stromal composition
- induction of amniotic membrane matrix metalloproteinases
Gonadotropes
- acts via GPRCR and second messenger cAMP
- FSH–> sertoli cells–> spermatogenesis
- LH–> leydig cells–> steroidogenesis
Articulations of the innominate bone
- ilium articulates with sacrum
- ischium articulates with pubis and ilium
- pubis articulates with opposite pubis
Components of the pelvic brim
- pubic tubercles and crest
- pecten pubis
- arcuate line of ilium
- ala of sacrum
- sacral promontory
Pelvic Inflammatory Disease (progression of symptoms)
mucopurulent vaginal discharge–> midline abdominal pain and abnormal vaginal bleeding–> bilateral lower abdominal and pelvic pain with nausea and vomiting
Disseminated gonococcal disease
fever, joint pain, septic arthritis, tenosynovitis, rash
Treatment for STI’s
- ceftriaxone for N. gonorrhoeae
- azithromycin or doxycycline for chlamydia
- penicillin G for syphilis
- metronidazole for Trichomonas vaginalis and bacterial vaginosis
Tertiary Syphilis
- general paresis
- tabes dorsalis
- arygl robertson pupil
- aortitis
- gummas
Perinatal Infection (routes and bugs)
- Transvaginal (HIV, HSV, chlamydia, HBV)
- Transplacental (HIV, syphilis, HSV)
- Breast feeding (HIV, HBV)
Primary sex cords
seminiferous tubules in men, rete ovarii in women
Mesonephric duct
ductus deferens and epididymus in men, Gartner’s duct in women
Ureteric bud
ureter, pelvis, calyces, collecting tubules
UG sinus
urinary bladder, urethra, lower vagina, prostate and bulbourethral glands (male), urethral and paraurethral and greater vestibular glands (female)
Oocyte maturation
First meiotic division begins before birth and arrested in prophase–> at puberty first meiotic division is completed resulting in secondary oocyte and first polar body–> second meiotic division begins before ovulation and stops at metaphase–> second meiotic division is completed upon fertilization
Epithelium of Vagina
non-keratinized stratified squamous, pyknotic nuclei with “washed-out” appearance
SF1
- regulates HPG axis
- regulates genes including ACTH receptor, LH, AMH
SRY (testes-determining factor)
- induces sertoli cell differentiation
- migration of mesonephric cells into gonadal ridge
- male-specific vasculature
Sox9
- downstream of SRY
- expressed in sertoli cells
- regulates AMH and chondrogenesis (campomelic dysplasia)
Features of Turner Syndrome
Short stature, low hairline, shield-shaped thorax, widely spaced nipples, shortened metacarpals, small finger nails, brown spots (nevi), constriction of aorta, poor breast development, elbow deformity, streak gonads, lymphedema, horseshoe kidney, duplication of renal pelvis (aberrant bifurcation of calyces)
PCOS (consequence of low FSH levels)
the proportion of early growing (primary) follicles is significantly increased with a reciprocal decrease in the proportion of primordial follicles compared to normal ovaries
Most common causes of secondary amenorrhea (not including pregnancy, OCPs, and breast-feeding)
hypogonadotropic hypogonadism (secondary to weight loss), PCOS, premature ovarian failure, Asherman’s syndrome
Follicular Reserve
- Measured by AMH levels
- AMH is produced by pre and small antral follicles, whose number correlates with follicular reserve
Bacterial Pathogens implicated in UTI
- Outpatient: E.coli (80%), Staph. Saprophyticus (5%), proteus/klebsiella/enterococci (15%)
- Inpatient: E.coli (50%), proteus/klebsiella/enterococci (20%), pseudomonas/serratia/acinetobacter (30%)
Generations of Progestins
-1st generation (norethinedrone)
-2nd generation (levonorgesterel, norgestrel)
-3rd generation (etonogestrel)
Androgenic effects (2>1>3)
Core differences between low and high risk HPV
- Low risk HPV (mild dysplasia, condyloma, productive infection, transient lesions, clinically undetected, low risk HPV, surveillance or laser/cryo ablation)
- High risk HPV (CIN3, loss of coordination between viral expression and epithelial differentiation, persistent, pre-malignant, excisional procedure/hysterectomy)
Type 1 and Type 2 mutation patterns for ovarian epithelial tumor carcinogenesis
Type 1- KRAS/BRAF/PTEN, low grade serous or mucinous
Type 2- p53, BRCA 1/2, high grade serous
Postnatal diagnoses identified commonly secondary to antenatal hydronephrosis
Ureteropelvic junction obstruction, vesicoureteral reflux, ureterovesical junction obstruction, ureteroceles, posterior urethral valves
Etiologies of Ureteropelvic Junction Obstruction
- aperistaltic segment
- intrinsic narrowing
- ureteral polyps
- high insertion
- kinking secondary to periurethral fibrosis
- crossing vessel (lower pole renal artery)
Weigert-Meyer rule
- ureter associated with the lower pole of the kidney inserts more laterally and refluxes
- ureter associated with the upper pole of the kidney inserts more medially and obstructs
Renal Cell Carcinoma (sub-type, cell origin)
Clear cell (proximal tubules) papillary cell (proximal tubules) chromophobe (intercalated cell of CCD) oncocytoma (intercalated cell of CCD)
AD Heritable Syndromes for RCC (5%)
VHL- 3, renal cell carcinoma, retinal hemangioblastomas, pheochromocytomas, neuroendocrine tumors
Hereditary papillary RC- 7, papillary carcinoma
Hereditary leiyomyomatosis RCC- 1, papillary carcinoma, leiyomyomas, leiyosarcomas
Birt-Hogg-Dube- 17, oncocytomas, clear cell, chromophobe, cutaneous papules
