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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
Q

Endometrial tissue within the myometrium (enlarged soft uterus)

A

Adenomyosis

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26
Q

Biopsy of endometrium w/ an Ectopic Pregnancy

A

Decidual endometrium WITHOUT chorionic villi

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27
Q

Neuroectoderm Makes:

A

CNS, retina, optic nerve, neurohypophysis

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28
Q

Neural Crest makes:

A

PNS, melanocytes, parafollicular C cells, adrenal medulla chromaffin cells

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29
Q

Surface ectoderm makes:

A

epidermis, adenohypophysis (rathke’s puch), below pectinate, ear, olfactory, glands

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30
Q

Extrinsic disruption

A

Deformation (after embryonic period)

eg. Potter

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31
Q

Intrinsic disruption

A

Malformation (during embryonic period)

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32
Q

Teratogen: Thalidomide

A

Flipper limb, limb defects

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33
Q

MC Type of Monozygotic Twin

A

Monochorionic (one placenta)
Diamnionic (2 amniotic sacs)
- Separate at 4-8 days before blastocyst stage
(separating late is more likely to be conjoined)

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34
Q

Branchial Cleft =
Branchial Arch =
Branchial Pouch =

A

cleft is ectoderm (outermost)
arch is mesoderm and neural crest
pouch is endoderm (innermost)

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35
Q

Branchial Clefts

A

1st cleft –> external auditory meatus
2-4th clefts –> temporary cervical sinuses obliterated
- remnants are branchial cleft cysts in lateral neck

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36
Q

Branchial Arch 1

A

M’s (chew)
Muscles of mastication, Mandible, Malleus
V2, V3

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37
Q

Treacher Collins Syndrome

A

1st branchial arch failure

mandibular hypoplasia

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38
Q

Congenital Pharyngocutaneous Fistula

A

Persistent cleft and pouch (2nd arch) –> fistula between tonsillar area and neck

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39
Q

Branchial Arch 2

A

S’s (smile)
Stapedius, stylohyoid, stapes, styloid
VII

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40
Q

Branchial Arch 3

A

(swallow stylishly)
stylopharyngeus
IX

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41
Q

Branchial Arch 4

A

(simply swallow)
Pharyngeal constrictors, cricothyroid
x (superior laryngeal branch)

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42
Q

Branchial Arch 6

A

(speak)
all intrinsic muscles of larynx (except cricothyroid)
X (recurrent laryngeal branch)

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43
Q

Branchial Pouch 1

A

Middle ear cavity, eustachian tube, mastoid air cells

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44
Q

Branchial Pouch 2

A

Tonsils (palatine)

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45
Q

Branchial Pouch 3

A

Inferior parathyroids + Thymus

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46
Q

Branchial Pouch 4

A

Superior parathyroids

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47
Q

Leydig (men) and Theca (women)

A

LH

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48
Q

Sertoli (men) and Granulosa (women)

A

FSH

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49
Q

SRY gene

A

Gene for MIF (mullerian inhibiting factor)
Testes determining factor (testes development)
only on Y chromosome

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50
Q

Testosterone in fetus

A

develops male internal structures

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51
Q

DHT in fetus

A

male external genitalia

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52
Q

Sertoli Cells

A

secrete FSH and MIF

production of sperm

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53
Q

Mesonephric Ducts

A

Wolffian Ducts –> male internal structures except prostate

seminal vesicles, epididymis, ejaculatory duct, and vas deferens

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54
Q

Paramesonephric Ducts

A

Mullerian ducts –> female internal structures (fallopian tubes, uterus, upper portion of vagina)
Incomplete fusions of the paramesonephric ducts –> bicornate uterus

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55
Q

SRY gene but no Sertoli cells or no MIF

A

develop both male and female internal genitalia and male external genitalia
(testosterone and DHT still present)

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56
Q

SRY gene but no 5a-reductase

A

male internal genitalia (testosterone still present)

ambiguous external genitalia until puberty (when testosterone causes 2ndary characteristics)

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57
Q

Male External Genitalia derived from

A

Genital Tubercle

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58
Q

Prostate Derived from

A

UG sinus

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59
Q

Innervation of Male Sexual Response

A

Erection: pelvic nerve
Emission: hypogastric nerve
Ejaculation: pudendal nerve

60
Q

Gallstones in Pregnancy or w/ OCPs

A

Estrogen: cholesterol hypersecretion
Progesterone: gallbladder hypomotility

61
Q

Disinhibition of prolactin after delivery due to:

A

fall in progesterone

allows lactation

62
Q

HcG to treat anovulation

A

Induces LH surge

63
Q

Glands straight and wavy during:

A

Proliferative phase (day 1-14 before ovulation)

64
Q

Glands coiled and sacculated and secreting glycogen rich mucus during:

A

Secretory Phase (after ovulation)

65
Q

Until Ovulation: cells arrested in ____________

A

Prophase I

66
Q

Until Fertilization: cells arrested in ____________

A

Metaphase II

67
Q

Mittelschmerz

A

Transient mid-cycle ovulatory pain aw/ peritoneal irritation (may mimic appendicitis)

68
Q

Oxytocin

A

Milk let down and uterine contractions

69
Q

Very high FSH is specific for

A

Menopause (LH and GnRH high too, estrogen low)

70
Q

Spermiogenesis

A

maturation of spermatid

low cytoplasmic contents and gain an acrosomal cap

71
Q

Aromatase found in:

A

Testes and Adipose Tissue

72
Q

Aromatase Deficiency:

A

Bones grow indefinitely

In females: it will cause ambiguous genitalia and also virilization of the mother (because it crosses)

73
Q

Anosmia (can’t smell) and infertile (decreased GnRH)

A

Kallmann Syndrome

74
Q

Tx for Preeclampsia

A

IV Magnesium sulfate or benzo

75
Q

Preeclampsia

A

Proteinuria, Edema, Hypertension

76
Q

Eclampsia

A

Preeclampsia + seizures

- immediate delivery

77
Q

HELLP

A

Hemolysis, Elevated Liver enzymes, Low Platelets

manifestation of preeclampsia but may not have hypertension

78
Q

Placenta accreta

A

into the basal zone (attached to myometrium without penetrating it)
MC type

79
Q

Placenta increta

A

into the myometrium

80
Q

Placenta percreta

A

into the serosa or organs (rectum or blood)

81
Q

Polyhydramnios causes:

A

inability to swallow amniotic fluid (esophageal/duodenal atresia, anencephaly), maternal diabetes, etc

82
Q

HPV: E6 and E7

A

E6 inhibits p53

E7 inhibits Rb

83
Q

Cervical dysplasia: histology

A

Koilocytes

84
Q

Complication of lateral invasion of cervical cancer

A

blocking of ureters causing renal failure

85
Q

Endometritis

A

Inflammation of endometrium (with plasma cell and lymphocytes) aw/ retained products of conception
tx: gentamicin + clindamycin (with or without ampicillin)

86
Q

Cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia, infertility, and NORMAL sized uterus

A

Endometriosis

  • outside of the endometrial cavity; may be distant
  • MC in ovary (chocolate cyst)
87
Q

Multiple discrete estrogen-sensitive tumors that increase in size w/ pregnancy and decrease with menopause
(Whorled pattern of smooth muscle)

A

Leiomyoma (MC tumor in females)

  • higher incidence in blacks
  • possibly present with iron-deficiency anemia due to bleeding
88
Q

Incidence of gynecologic tumors

A

endometrial > ovarian > cervical
cervical MC worldwide
ovarian has worst prognosis

89
Q

Hyperandrogenism (acne and hirsutism), hyperinsulinemia (due to resistance), infertility, very high LH:FSH in an Obese patient, also increased risk of endometrial adenocarcinoma

A

PCOS

90
Q

PCOS Tx

A

OCPs or antiandrogens for hirsutism/acne
Clomiphene for infertility
Metformin for insulin insensitivity
Cyclic progesterones to antagonize endometrial proliferation

91
Q

MC ovarian mass in young women

A

Follicular cyst

  • distended, unruptured follicle
  • may be aw/ hyperestrogenism and endometrial hyperplasia
92
Q

Theca-Lutein cyst

A

aw/ choriocarcinoma and moles

93
Q

Dermoid Cyst (of Ovary) and (of Testes)

A

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
Q

Ovarian Cancers

A

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
Q

Serous Cystadenoma and Serous Cystadenocarcinoma (of Ovary)

A 
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
Q

Brenner Tumor (of Ovary)

A

Benign bladder like (pale yellow tan) encapsulated tumor in ovary
- has coffee bean nuclei

97
Q

Fibroma (of Ovary)

A

Benign bundles of spindle shaped fibroblasts in ovary

Miegs syndrome

98
Q

Meigs Syndrome

A

Triad: Ovarian fibroma, ascites, and hydrothorax

99
Q

Thecoma (of Ovary)

A

Benign
May produce estrogen (like granulosa cell tumors)
pw/ abnormal bleeding in a postmenopausal woman

100
Q

Granulosa Cell Tumor

A

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
Q

Mucinous Cystadenoma and Mucinous Cystadenocarcinoma (of Ovary)

A

Adenoma: multiloculated, large, mucus secreting
Adenocarcinoma: Pseudomyxoma peritonei (jelly belly)

102
Q

Dysgerminoma (of Ovary)

A 
Malignant
MC in adolescents (equivalent to male seminoma)
30% of germ cell tumors
Sheets of uniform "fried egg" cells
HcG and LDH
103
Q

Choriocarcinoma (of Ovary) and (of Testes)

A

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
Q

Yolk Sac tumor (of Ovary) and (of Testes)

A

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
Q

Squamous Cell Carcinoma of Vagina

A

Usually secondary to cervical SCC

106
Q

Clear cell adenocarcinoma of Vagina

A

after exposure to DES

107
Q

Sarcoma Botyroides (rhabdomyosarcoma)

A

Girls

108
Q

Phyllodes Tumor (of Breast)

A

Benign, large mass of connective tissue and cysts
“Leaf-like”
MC in 60s; may become malignant

109
Q

Triple Negative

A

More aggressive breast cancer (negative for ER, PR and Her2/Neu)
MC in African Americans

110
Q

DCIS (ductal carcinoma in situ)

A

Fills ductal lumen

Microcalcifications on mammography

111
Q

Paget Disease (of Breast)

A
  • Eczematous patches on Nipple
  • From underlying DCIS
  • cells are large w/ clear halo
112
Q

Invasive Ductal (of Breast)

A

Malignant (worst, most invasive, MC)

  • firm (rock hard) mass w/ small glandular duct-like cells
  • classic “stellate” infiltration
113
Q

Invasive Lobular (of Breast)

A

Malignant

  • “indian file” orderly row of cells
  • often bilateral and multiple lesions, may have signet rings
114
Q

Medullary (Invasive cancer of Breast)

A

Malignant (w/ good prognosis)

-fleshy, lymphocytic infiltrate w/ plasma cells (large cells in sheets)

115
Q

Inflammatory (Invasive cancer of Breast)

A

Malignant dermal lymphatic invasion (bad prognosis)
“Peau d’orange”: blocked lymphatic drainage
Inflamed swollen breast w/out discrete mass (resembles acute mastitis)

116
Q

Proliferative Breast Disease (4 types)

A

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
Q

Acute Mastitis

A

Breast abscess during breast feeding (cracks in nipple)

  • MC s. aureus
  • Tx: dicloxacillin and continue feeding
118
Q

Causes of Gynecomastia

A

Spironolactone (inhibits steroid binding), marijuana, digitalis, estrogen, cimetidine, alcohol, heroin, D2 antagonists, and ketoconazole (inhibits steroid synthesis)

119
Q

Prostatitis

A

Acute: bacterial (e. coli usually)
Chronic: Abacterial (MC)

120
Q

Prostatic adenocarcinoma

A

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
Q

Cryptorchidism

A
  • 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
Q

Tx for BPH

A
  • 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
Q

Varicocele

A

Dilated veins in the pampiniform plexus

124
Q

Germ Cell Tumors (of Testicle)

A

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
Q

Seminoma (of testes)

A

Malignant; MC, often occurs in 30s

  • painless, homogenous testicular enlargement
  • “fried egg” large cells, watery cytoplasm
  • high ALP
  • Radiosensitive, excellent prognosis
126
Q

Embryonal Carcinoma (of Testes)

A

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
Q

Leydig Cell Tumor (of Testes)

A
  • Reinke crystals; golden brown tumor
  • usually androgen producing
  • gynecomastia, precocious puberty in boys
    (may also be in women, effects of high testosterone)
128
Q

Sertoli Cell Tumor (of Testes)

A
  • Androblastoma from sex cord stroma
129
Q

Testicular Lymphoma

A

MC in older men (nor primary) usually from metastasis

  • aggressive
  • usually diffuse large B cell type
130
Q

Squamous Cell Carcinoma of Penis: Precursor in situ lesions

A

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
Q

OCPs

A

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
Q

Terbutaline

A

B2 agonist: relaxes uterus (decreases contraction during labor)

133
Q

Danazol

A

Synthetic androgen partial agonist

- for endometriosis and hereditary angioedema

134
Q

Stimulate anabolism to promote recovery after burn or injury w/:

A

testosterone or methyltestosterone

135
Q

Flutamide

A

nonsteroidal competitive inhibitor of androgens

- for prostate cancer

136
Q

Sildenafil, Vardenafil, Tadalafil (long acting)

A

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
Q

Alprostadil

A

Injected PG (prostaglandin) for erectile dysfunction

138
Q

Bacterial Flora of Vagina

A
  • Suppressed by broad-spectrum antibiotics, systemic steroids, immunosuppression
  • Gram + lactobacillus maintains pH 4-4.5
  • facilitates Candida overgrowth
139
Q

Tx for Candida Vaginitis

A

Fluconazole

140
Q

Mullerian Aplasia (or MRKH Syndrome)

A

No upper vagina (vaginal agenesis w/ variable uterine development)

  • primary amenorrhea
  • normal ovaries that secrete estrogen so develop secondary sexual characteristics
141
Q

High Beta-hCG and Inhibin A in Amniotic Fluid

A

Down’s Syndrome

142
Q

Vasectomy: Viable sperm in ejaculate for ______

A

3 months (at least 20 ejaculations)

143
Q

Pelvic Fractures aw/:

A

injury to posterior urethra

144
Q

Follicular Atresia

A

Apoptosis within primordial follicles if there is not sufficient FSH exposure

145
Q

Fish to be avoided in pregnancy

A

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
Q

MC Cause of elevated AFP

A

Dating error

underestimation of age

Quick Notes for Step 1 (18 decks)

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