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Reproduction Flashcards

1
Q

Fibrocystic Breast Disease

A
  • Dense and lumpy breast

- Waxes and wanes with menstrual cycles

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2
Q

Intraductal Papilloma (of Breast)

A

Benign
MC cause of spontaneous nipple discharge BUT it is bloody or serosanguinous
- small tumor of lactiferous ducts usually beneath areola
- in premenopausal women

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3
Q

Endometritis

A

After giving birth is commonly from Bacteroides (leukocytosis and foul smelling discharge)

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4
Q

During erection, venous blood fills in:

A

Corpus cavernosa

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5
Q

_______ Passes through Inguinal Canal in Females

A

Round Ligament

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6
Q

Increased Risk of Leiomyoma in:

A

Black women

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7
Q

PCOS: LH and FSH

A

High LH/FSH ratio (LH very high and FSH is low)

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8
Q

Nerves and Vessels in ____________ of Ovary

A

Suspensory Ligament

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9
Q

______ decrease risk of Non-hereditary Ovarian Cancer

A

OCPs (fewer ovulatory cycles)

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10
Q

Pseudomyxoma Peritonei

A

(jelly belly): MC originates from ovary or appendix

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11
Q

VDRL/RPR & FTA-ABS

A

VDRL/RPR (screening) or FTA-ABS+(confirmatory): Syphilis (treponema)
- Can cause an aneurysm due to vasa vasorum obliteration

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12
Q

Tertiary Syphilis

A
  • Obliterative endarteritis of the vasa vasorum: Aortic aneurysm risk
  • Argyll Robertson pupils
  • Tabes dorsalis
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13
Q

Homeobox genes

A

DNA binding transcription factors

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14
Q

Lithium as teratogen

A

Ebstein anomaly (tricuspid valve abnormality w/ atrialized RV)

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15
Q

If newborn presents with opioid withdrawal symptoms:

A

(rhinorrhea, diarrhea, seizure, sneezing, tremor, etc.), give a tincture of opium

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16
Q

Rhabdomyosarcoma

A

Grape-like mass in vagina of child

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17
Q

Lymphogranuloma venerium

A
  • aw/ chlamydia
  • Necrotizing granulomatous inflammation of inguinal lymphatics
  • Initially painless then later very painful lymph nodes
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18
Q

Drugs causing Erectile Dysfunction

A

SSRIs and sympathetic blockers (clonidine, methyldopa, and B-blockers)

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19
Q

Aromatase Inhibitors

A

Exemastane and Anastrozole

- can be used in post-menopausal women for breast cancer

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20
Q

In PCOS Patients that Desire Fertility Use:

A

Clomiphene (SERM that is an antagonist at estrogen receptors preventing feedback inhibition)

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21
Q

Fibroadenoma (of Breast)

A

Benign, Small, mobile, firm mass (marble-like)
MC in young (under 35 yrs)
Cellular myxoid stroma around glandular/cystic spaces
- size and pain w/ estrogen

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22
Q

Nipple Retraction due to Invasive Breast Cancer

A

Infiltration of the suspensory Cooper’s ligament

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23
Q

Comedocarcinoma (Subtype of DCIS)

A

Solid sheets of pleomorphic high grade cells w/ central necrosis (does not extend beyond ductal basal membrane)

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24
Q

hPL (human placental lactogen)

A

Increases insulin resistance (stimulates proteolysis and lipolysis, inhibits gluconeogenesis)

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25
Endometrial tissue within the myometrium (enlarged soft uterus)
Adenomyosis
26
Biopsy of endometrium w/ an Ectopic Pregnancy
Decidual endometrium WITHOUT chorionic villi
27
Neuroectoderm Makes:
CNS, retina, optic nerve, neurohypophysis
28
Neural Crest makes:
PNS, melanocytes, parafollicular C cells, adrenal medulla chromaffin cells
29
Surface ectoderm makes:
epidermis, adenohypophysis (rathke's puch), below pectinate, ear, olfactory, glands
30
Extrinsic disruption
Deformation (after embryonic period) | eg. Potter
31
Intrinsic disruption
Malformation (during embryonic period)
32
Teratogen: Thalidomide
Flipper limb, limb defects
33
MC Type of Monozygotic Twin
Monochorionic (one placenta) Diamnionic (2 amniotic sacs) - Separate at 4-8 days before blastocyst stage (separating late is more likely to be conjoined)
34
Branchial Cleft = Branchial Arch = Branchial Pouch =
cleft is ectoderm (outermost) arch is mesoderm and neural crest pouch is endoderm (innermost)
35
Branchial Clefts
1st cleft --> external auditory meatus 2-4th clefts --> temporary cervical sinuses obliterated - remnants are branchial cleft cysts in lateral neck
36
Branchial Arch 1
M's (chew) Muscles of mastication, Mandible, Malleus V2, V3
37
Treacher Collins Syndrome
1st branchial arch failure | mandibular hypoplasia
38
Congenital Pharyngocutaneous Fistula
Persistent cleft and pouch (2nd arch) --> fistula between tonsillar area and neck
39
Branchial Arch 2
S's (smile) Stapedius, stylohyoid, stapes, styloid VII
40
Branchial Arch 3
(swallow stylishly) stylopharyngeus IX
41
Branchial Arch 4
(simply swallow) Pharyngeal constrictors, cricothyroid x (superior laryngeal branch)
42
Branchial Arch 6
(speak) all intrinsic muscles of larynx (except cricothyroid) X (recurrent laryngeal branch)
43
Branchial Pouch 1
Middle ear cavity, eustachian tube, mastoid air cells
44
Branchial Pouch 2
Tonsils (palatine)
45
Branchial Pouch 3
Inferior parathyroids + Thymus
46
Branchial Pouch 4
Superior parathyroids
47
Leydig (men) and Theca (women)
LH
48
Sertoli (men) and Granulosa (women)
FSH
49
SRY gene
Gene for MIF (mullerian inhibiting factor) Testes determining factor (testes development) only on Y chromosome
50
Testosterone in fetus
develops male internal structures
51
DHT in fetus
male external genitalia
52
Sertoli Cells
secrete FSH and MIF | production of sperm
53
Mesonephric Ducts
Wolffian Ducts --> male internal structures except prostate | seminal vesicles, epididymis, ejaculatory duct, and vas deferens
54
Paramesonephric Ducts
Mullerian ducts --> female internal structures (fallopian tubes, uterus, upper portion of vagina) Incomplete fusions of the paramesonephric ducts --> bicornate uterus
55
SRY gene but no Sertoli cells or no MIF
develop both male and female internal genitalia and male external genitalia (testosterone and DHT still present)
56
SRY gene but no 5a-reductase
male internal genitalia (testosterone still present) | ambiguous external genitalia until puberty (when testosterone causes 2ndary characteristics)
57
Male External Genitalia derived from
Genital Tubercle
58
Prostate Derived from
UG sinus
59
Innervation of Male Sexual Response
Erection: pelvic nerve Emission: hypogastric nerve Ejaculation: pudendal nerve
60
Gallstones in Pregnancy or w/ OCPs
Estrogen: cholesterol hypersecretion Progesterone: gallbladder hypomotility
61
Disinhibition of prolactin after delivery due to:
fall in progesterone | allows lactation
62
HcG to treat anovulation
Induces LH surge
63
Glands straight and wavy during:
Proliferative phase (day 1-14 before ovulation)
64
Glands coiled and sacculated and secreting glycogen rich mucus during:
Secretory Phase (after ovulation)
65
Until Ovulation: cells arrested in ____________
Prophase I
66
Until Fertilization: cells arrested in ____________
Metaphase II
67
Mittelschmerz
Transient mid-cycle ovulatory pain aw/ peritoneal irritation (may mimic appendicitis)
68
Oxytocin
Milk let down and uterine contractions
69
Very high FSH is specific for
Menopause (LH and GnRH high too, estrogen low)
70
Spermiogenesis
maturation of spermatid | low cytoplasmic contents and gain an acrosomal cap
71
Aromatase found in:
Testes and Adipose Tissue
72
Aromatase Deficiency:
Bones grow indefinitely | In females: it will cause ambiguous genitalia and also virilization of the mother (because it crosses)
73
Anosmia (can't smell) and infertile (decreased GnRH)
Kallmann Syndrome
74
Tx for Preeclampsia
IV Magnesium sulfate or benzo
75
Preeclampsia
Proteinuria, Edema, Hypertension
76
Eclampsia
Preeclampsia + seizures | - immediate delivery
77
HELLP
Hemolysis, Elevated Liver enzymes, Low Platelets | manifestation of preeclampsia but may not have hypertension
78
Placenta accreta
into the basal zone (attached to myometrium without penetrating it) MC type
79
Placenta increta
into the myometrium
80
Placenta percreta
into the serosa or organs (rectum or blood)
81
Polyhydramnios causes:
inability to swallow amniotic fluid (esophageal/duodenal atresia, anencephaly), maternal diabetes, etc
82
HPV: E6 and E7
E6 inhibits p53 | E7 inhibits Rb
83
Cervical dysplasia: histology
Koilocytes
84
Complication of lateral invasion of cervical cancer
blocking of ureters causing renal failure
85
Endometritis
Inflammation of endometrium (with plasma cell and lymphocytes) aw/ retained products of conception tx: gentamicin + clindamycin (with or without ampicillin)
86
Cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia, infertility, and NORMAL sized uterus
Endometriosis - outside of the endometrial cavity; may be distant - MC in ovary (chocolate cyst)
87
Multiple discrete estrogen-sensitive tumors that increase in size w/ pregnancy and decrease with menopause (Whorled pattern of smooth muscle)
Leiomyoma (MC tumor in females) - higher incidence in blacks - possibly present with iron-deficiency anemia due to bleeding
88
Incidence of gynecologic tumors
endometrial > ovarian > cervical cervical MC worldwide ovarian has worst prognosis
89
Hyperandrogenism (acne and hirsutism), hyperinsulinemia (due to resistance), infertility, very high LH:FSH in an Obese patient, also increased risk of endometrial adenocarcinoma
PCOS
90
PCOS Tx
OCPs or antiandrogens for hirsutism/acne Clomiphene for infertility Metformin for insulin insensitivity Cyclic progesterones to antagonize endometrial proliferation
91
MC ovarian mass in young women
Follicular cyst - distended, unruptured follicle - may be aw/ hyperestrogenism and endometrial hyperplasia
92
Theca-Lutein cyst
aw/ choriocarcinoma and moles
93
Dermoid Cyst (of Ovary) and (of Testes)
Mature cystic teratoma is benign (Malignant in Adult Males) Immature is malignant (has embryonic like neural tissues) - all 3 germ layers - MC in women 20-30 yrs old - may contain functional thyroid tissue --> hyperthyroidism [struma ovarii] - increased hCG and AFP in males
94
Ovarian Cancers
95% are epithelial (MC is serous cystadenocarcinoma) - can monitor progression with CA125 - risk decreased with anything that decreases the number of cycles and repair to ovarian surface (previous pregnancy, breastfeeding, OCPs, tubal ligation)
95
Serous Cystadenoma and Serous Cystadenocarcinoma (of Ovary)
``` MC ovarian neoplasm Adenoma: - Benign, thin wall, uni- or multi-locular - lined with fallopian-like epithelium - often bilateral Adenocarcinoma: - Malignant, usually bilateral - Psammoma bodies ```
96
Brenner Tumor (of Ovary)
Benign bladder like (pale yellow tan) encapsulated tumor in ovary - has coffee bean nuclei
97
Fibroma (of Ovary)
Benign bundles of spindle shaped fibroblasts in ovary | Miegs syndrome
98
Meigs Syndrome
Triad: Ovarian fibroma, ascites, and hydrothorax
99
Thecoma (of Ovary)
Benign May produce estrogen (like granulosa cell tumors) pw/ abnormal bleeding in a postmenopausal woman
100
Granulosa Cell Tumor
Malignant MC sex cord stromal tumor (MC in women in 50s) "Call-Exner bodies": resemble primordial follicles Produces Estrogen (possibly progesterone) --> endometrial hyperplasia and abnormal bleeding
101
Mucinous Cystadenoma and Mucinous Cystadenocarcinoma (of Ovary)
Adenoma: multiloculated, large, mucus secreting Adenocarcinoma: Pseudomyxoma peritonei (jelly belly)
102
Dysgerminoma (of Ovary)
``` Malignant MC in adolescents (equivalent to male seminoma) 30% of germ cell tumors Sheets of uniform "fried egg" cells HcG and LDH ```
103
Choriocarcinoma (of Ovary) and (of Testes)
Malignant trophoblastic tissue (During or after pregnancy) NO chorionic villi (synctiotropho and cytotropho tissue) Hematogenous spread to LUNGS - abnormal hCG, shortness of breath, and hemoptysis - aw/ theca-lutein cysts - Gynecomastia in males - Sx of Hyperthyroidism Very responsive to therapy
104
Yolk Sac tumor (of Ovary) and (of Testes)
Malignant (aggressive) - Yellow, friable, solid mass - "Schiller Duval Bodies": resemble glomerulus - High AFP - May be in sacrococcygeal area in young children - MC tumor of male infants
105
Squamous Cell Carcinoma of Vagina
Usually secondary to cervical SCC
106
Clear cell adenocarcinoma of Vagina
after exposure to DES
107
Sarcoma Botyroides (rhabdomyosarcoma)
Girls
108
Phyllodes Tumor (of Breast)
Benign, large mass of connective tissue and cysts "Leaf-like" MC in 60s; may become malignant
109
Triple Negative
More aggressive breast cancer (negative for ER, PR and Her2/Neu) MC in African Americans
110
DCIS (ductal carcinoma in situ)
Fills ductal lumen | Microcalcifications on mammography
111
Paget Disease (of Breast)
- Eczematous patches on Nipple - From underlying DCIS - cells are large w/ clear halo
112
Invasive Ductal (of Breast)
Malignant (worst, most invasive, MC) - firm (rock hard) mass w/ small glandular duct-like cells - classic "stellate" infiltration
113
Invasive Lobular (of Breast)
Malignant - "indian file" orderly row of cells - often bilateral and multiple lesions, may have signet rings
114
Medullary (Invasive cancer of Breast)
Malignant (w/ good prognosis) | -fleshy, lymphocytic infiltrate w/ plasma cells (large cells in sheets)
115
Inflammatory (Invasive cancer of Breast)
Malignant dermal lymphatic invasion (bad prognosis) "Peau d'orange": blocked lymphatic drainage Inflamed swollen breast w/out discrete mass (resembles acute mastitis)
116
Proliferative Breast Disease (4 types)
Fibrosis: hyperplasia of breast stroma Cystic: "blue dome" (fluid filled, ductal dilation) Sclerosing Adenosis: dense stroma w/ calcifications, acini, and fibrosis Epithelial Hyperplasia: increased epithelial cell layers in terminal duct
117
Acute Mastitis
Breast abscess during breast feeding (cracks in nipple) - MC s. aureus - Tx: dicloxacillin and continue feeding
118
Causes of Gynecomastia
Spironolactone (inhibits steroid binding), marijuana, digitalis, estrogen, cimetidine, alcohol, heroin, D2 antagonists, and ketoconazole (inhibits steroid synthesis)
119
Prostatitis
Acute: bacterial (e. coli usually) Chronic: Abacterial (MC)
120
Prostatic adenocarcinoma
MC in posterior lobe (peripheral zone) PAP and PSA are good markers Metastasis to bone, often lower back (high ALP) - small invasive glands w/ prominent nucleoli
121
Cryptorchidism
- undescended testes --> impaired spermatogenesis (due to increased temp) - can have normal testosterone level, might be lower if both are undescended (high FSH and LH, low inhibin) - increased risk w/ prematurity - increased risk of germ cell tumor
122
Tx for BPH
- alpha antagonists (prazosin, terazosin, tamsulosin) to relax smooth muscle [ work within a few days, double as HTN tx] - Finasteride (5-a-reductase inhibitor) to decrease size of prostate gland [takes 6-12 months]; can also treat male-pattern baldness
123
Varicocele
Dilated veins in the pampiniform plexus
124
Germ Cell Tumors (of Testicle)
95% of all testicular tumors; usually in young men Includes: seminoma, yolk sac, choriocarcinoma, teratoma, and embryonal [nongerm cell tumors are leydig, sertoli, and testicular lymphoma]
125
Seminoma (of testes)
Malignant; MC, often occurs in 30s - painless, homogenous testicular enlargement - "fried egg" large cells, watery cytoplasm - high ALP - Radiosensitive, excellent prognosis
126
Embryonal Carcinoma (of Testes)
Malignant, hemorrhagic mass w/ necrosis (painful, and worse prognosis than seminoma) MC "Glandular/papillary" morphology (pure is rare) Increased hCG, and normal AFP (high if mixed)
127
Leydig Cell Tumor (of Testes)
- Reinke crystals; golden brown tumor - usually androgen producing - gynecomastia, precocious puberty in boys (may also be in women, effects of high testosterone)
128
Sertoli Cell Tumor (of Testes)
- Androblastoma from sex cord stroma
129
Testicular Lymphoma
MC in older men (nor primary) usually from metastasis - aggressive - usually diffuse large B cell type
130
Squamous Cell Carcinoma of Penis: Precursor in situ lesions
aw/ HPV, MC in Asia, Africa, S. america Bowen: leukoplakia of penile shaft or scrotum Erythroplasia of Queyrat: erythroplakia on glans Bowenoid Papulosis: reddish papules, no increased risk
131
OCPs
Prevent estrogen surge and subsequent LH surge so no ovulation - Also thickens cervical mucus and inhibits endometrial proliferation - Don't use in smokers, or patients w/ history of stroke or thromboembolism, or w/ estrogen dependent tumors
132
Terbutaline
B2 agonist: relaxes uterus (decreases contraction during labor)
133
Danazol
Synthetic androgen partial agonist | - for endometriosis and hereditary angioedema
134
Stimulate anabolism to promote recovery after burn or injury w/:
testosterone or methyltestosterone
135
Flutamide
nonsteroidal competitive inhibitor of androgens | - for prostate cancer
136
Sildenafil, Vardenafil, Tadalafil (long acting)
Inhibit PDE5 causing increased cGMP and smooth muscle relaxation -> penile erection - headache, flushing, dyspepsia and impaired blue-green color vision - Do NOT take with nitrates --> life threatening hypotension
137
Alprostadil
Injected PG (prostaglandin) for erectile dysfunction
138
Bacterial Flora of Vagina
- Suppressed by broad-spectrum antibiotics, systemic steroids, immunosuppression - Gram + lactobacillus maintains pH 4-4.5 - facilitates Candida overgrowth
139
Tx for Candida Vaginitis
Fluconazole
140
Mullerian Aplasia (or MRKH Syndrome)
No upper vagina (vaginal agenesis w/ variable uterine development) - primary amenorrhea - normal ovaries that secrete estrogen so develop secondary sexual characteristics
141
High Beta-hCG and Inhibin A in Amniotic Fluid
Down's Syndrome
142
Vasectomy: Viable sperm in ejaculate for ______
3 months (at least 20 ejaculations)
143
Pelvic Fractures aw/:
injury to posterior urethra
144
Follicular Atresia
Apoptosis within primordial follicles if there is not sufficient FSH exposure
145
Fish to be avoided in pregnancy
Pregnant patients should avoid fish and seafood products that are high in mercury - shellfish and big salt-water fish should be avoided (tuna, swordfish, shark, king mackerel, tilefish, etc)
146
MC Cause of elevated AFP
Dating error | underestimation of age

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