Reproduction Flashcards
1
Q
What do yo use for acne and hirsutism in PCOS?
A
OCP
2
Q
What are exemestane and anastrozole?
A
Aromatase inhibitors
3
Q
Diagnosis? Rupture of mucous producing tumor into peritoneal cavity
A
Pseudomyxoma peritoneii (jelly belly) MC from ovary or appendix
4
Q
What do sertoli cells do?
A
Spermatogensis, inhibin & MIF production, increase SHBG to maintain local levels of testosterone
5
Q
What do leydig cells do?
A
Testosterone production
6
Q
What is the best marker for menopause?
A
FSH
7
Q
How long are sperm viable for after vasectomy?
A
One month
8
Q
What do the paramesonephric ducts make?
A
Uterus, fallopian tube, cervix, and upper part of vagina
9
Q
Twins of different sexes are di or monozygotic?
A
Dizygotic and probably dichorionic and diamniontic
10
Q
How do you differentiate psychogenic from other causes of impotence?
A
Psychogenic is sudden and will persist while others are more intermittent and slowly become persistent. Also night time erections in psychogenic
11
Q
Diagnosis? Primary amenorrhea in developed girl
A
Imperforate hymen –> can get blood backed up in vagina (distension, back pain) aka hematocolpos
12
Q
What do you see clenched hands with overlapping fingers?
A
Edwards (Trisomy 18)
13
Q
What is congenital torticollis?
A
Head tilted to one side from trauma during birth or malposition in utero
14
Q
What is messed up in inflammatory carcinoma of the breast?
A
Obstruction of lymphatic ducts
15
Q
What are your hormone levels in klinefelters?
A
Increased FSH and LH (from lack of feedback inhibition since testosterone levels are low), high estrogen
16
Q
What do fertility enhancing drugs increase the risk for?
A
Ovarian cancer
17
Q
What is caudal regression syndrome?
A
Sacral agenesis due to maternal diabetes
18
Q
What congenital abnormality do you see with maternal diabetes?
A
Caudal regression syndrome?
19
Q
What do OCPs increase risk for?
A
Thrombotic events (MI, stroke)
20
Q
BPH is often present with what?
A
Prostate cancer
21
Q
What are Hox genes?
A
transcription regulators
22
Q
What pw/ dyspareunia, dyschezia, dysmenorrhea, infertility and normal sized uterus?
A
Endometriosis
23
Q
What causes skin retractions in breast cancer?
A
Invasion of suspensory cooper’s ligament
24
Q
What causes nipple dimpling in breast cancer?
A
Tumor invading central region of breast
25
Where does fluid accumulate in hydrocele?
Tunica vaginalis
26
How do OCPs prevent pregnancy?
Feedback inhibition to lower serum gonadotropins
Also prevent sperm penetration into uterus and impair embryo implantation
27
What happens in cyrptorchidism?
Semniferous tubules atrophy from temperature induced damage. Inhibin production and because sertoli cells damaged sperm count decreases. Leydig cells normal so secondary sex characteristics normal.
28
What is choriocarcinoma?
Can develop during or after pregnancy in baby or mom. Spreads hematogenously to lungs. Syntio and cytotrophoblast prolif with no chorionic villi. Inc bHCG. Increased frequency of theca-lutein cysts
Can cause gynecomastia in males
Hyperthyroidism (hcG resembles TSH)
29
What does hPL do?
Increases insulin resistance , stimulates proteolysis and lipolysis, inhibits gluconeogenesis. The increase glucose is for baby and protein/FA for mom. Too much can lead to diabetes. Maternal insulin resistance is due to increase hPL, placental GH, estrogen, progesterone, GC
30
When is an embryo most susceptible to teratogens?
Weeks 3-8
31
What do pia and arachnoid derive from?
Neural crest
32
What do retina, optic nerve derive from?
Neuroectoderm
33
What does the pineal derive from?
Neuroectoderm
34
Where does the lens of the eye derive from?
Surface ectoderm
35
Where do the olfactory epithelium and organs of ear derive from?
Surface ectoerm
36
Where does notochord derive from?
Mesodermal
37
What are VACTERL defects?
Mesodermal defects: vertebral, anal, cardiac, tracheoesophgeal fistula, renal, limb defects
38
What drug causes limb defects ("flipper limbs") in babies?
Thalidomide
39
What congenital defects does maternal diabetes cause?
Anencephaly, caudal regression syndrome, transposition of great arteries, sirenomelia (missing limb)
40
What is the MC monozygotic twin?
One placenta, two amnion (monochorionic, diamniotic), 4-8 days (after morula before blastocyst)
41
What secretes hCG?
Synctiotrophobllast (outer layer of chorionic villi)
42
What is the decidua basalis?
The endometrium during pregnancy. It is the maternal side of the placenta
43
What are the aortic arch derivatives?
```
1 - Maxillary
2- Stapedial, hyoid
3 - Common carotid, proximal part of internal carotid
4 - Aortic arch, right subclavian
6 - PDA, pulmonary arteries
```
44
What are the branchial cleft derivatives?
1 - external auditory meatus
| Rest obliterate
45
What does a persistent cervical sinus present as?
Branchial cleft cyst in lateral neck
46
What is the 1st branchial arch?
Mandible, malleus, mandibular ligament
Muscles of mastication, mylohyoid
CN V2 and V3
47
What is 2nd branchial arch?
Stapes, styloid, stylohyoid ligament
Stapes, stylohyoid, platysma
CN VII
48
What is 3rd branchial arch?
Stylopharyngeus
| CN IX
49
What is 4th-6th branchial arch?
4th- Superior laryngeal, cricothyroid, pharyngeal constrictors
6th - Recurrent laryngeal, laryngeal muscles
Thyroid and cricoid cartilage
50
What do you see mandibular hypoplasia and facial abnormalities with?
Treacher Collins Syndrome (1st arch neural crest fails to migrate)
51
What tissue are the branchial arches from?
Mesoderm (muscles, arteries) and neural crest (bone, cartilage)
52
What do you see a fistula between tonsillar area and lateral neck?
Congenital pharyngocutaneous fistula (2nd pharyngeal arch)
53
What is the 1st branchial pouch?
Ear (eustachian tube, middle ear, mastoid air cells etc)
54
What is the 2nd branchial pouch?
Tonsils
55
What is the 3rd branchial pouch?
Inferior parathyroid and thymus
56
What happens in cleft lip?
Maxillary and nasal prominences don't fuse
57
What happens in cleft palate?
Palatine processes don't fuse with each other or with nasal septum
58
What is bicornuate uterus?
Paremesonephric ducts don't fuse completely causing two uteruses and two vagina
59
What is the prostate derived from?
Urogenital sinus
60
What does the genital tubercle make?
Corpus cavernosum, glans penis (male)
| Vestibular bulbs, glans clitoris (female)
61
What is gubernaculum in the female?
Round ligament and ovarian ligament
62
What nerve is responsible for erection?
Pelvic nerve, pudendal nerve
63
What nerve is responsible for emission?
Hypogastric nerve
64
What nerve is responsible for ejaculation?
Pudendal nerve
65
What cells are temperature sensitive?
Sertoli cells (decreased inhibin and sperm production)
Remember leydig are not sensitive to temperature
66
Where is estriol?
Placenta. It is an indicator of fetal well being
67
Why are pregnant women more likely to get gallstones?
Estrogen induces cholesterol hypersecretion
| Progesterone causes GB hypomotility
68
What phase are you in if you see glands that secrete glycogen and spiral arteries in the endometrium?
Secretory
69
What is Mittelschmerz?
Midcycle ovulatory pain due to peritoneal irritation from follicular sweling/rupture, fallopian tube contraction). Mimcs appendicits
70
What is seen with menopause?
Hot flashes, sleep disturbances, osteporosis, vaginal atrophu, coronary artery diease
71
What is spermiogenesis?
Maturation of spermatid (loss of cytoplasmic contents, gain acrosomal cap) into spermatozoan
72
What is true hermaphroditism?
Ovotesticular with ambiguous genitalia. Both ovaries and testes
73
What do hormone levels look like for androgen insensitivity?
Increased testosterone, estrogen and LH (estrogen increases because LH trying to stimulate testosterone)
74
What is maternal death due to in eclampsia?
Stroke causing intracranial hemorrhage or ARDS
75
Diagnosis: hemolysis, increased AST and ALT, thrombocytopenia?
HELLP
76
What are placenta accreta, increta, percereta?
Accreta: attaches to myometrium
Increta: into myometrium
Percreta: through the myometrium into uterine serosa
77
What presents with pruritus, vaginal pain, dyspareunia, atrophic white papules/macule lesions?
Lichen Sclerosus
78
Which has increased risk for malignancy: lichen sclerosus or chornicus?
Sclerosus
79
What do you treat for an early ectopic pregnancy (
MTX
80
What does E6 do?
Inhibit p53
81
What does E7 do?
Inhibit Rb
82
What happens if SCC of cervix has lateral invasion?
Can block ureters and can cause renal failure
83
What presents with leukocytosis, foul discharge, and uterine tenderness?
Endometritis
84
What causes endometritis?
Retained products of conception, IUD, or previous PID that promotes infection (MC B. fragilis)
85
What presents with cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia, infertility and normal sized uterus?
Endometriosis
86
What presents with dysmenorrhea, menorrhagia and enlarged soft uterus?
Adenomyosis
87
What causes adenomyosis?
Hyperplasia of basalis layer
88
What are you at risk for if you have too much estrogen exposure without progesterone?
Endometrial hyperplasia and possibly carcinoma
89
Who is more likely to get leiomyoma?
BLACKS and 20-40yo
90
What is leiomyoma stimulated by?
Estrogen (increases with pregnancy and decreases with menopause)
91
What presents with enlarged uterus or uterine mass with severe bleeding?
Leiomyoma
92
What tumor has greatest incidence and worst prognosis?
Incidence: Endometrial
| Worst prognosis: Ovarian
93
What are the levels of hormones in PCOS?
REALLY increased LH
Increased FSH, testosterone, estrogen (from test. aromatization)
Increased insulin
Decreased progesterone
94
What happens with PCOS?
Insulin and testosterone decrease SHBG --> Inc free testosterone
LH increases due to pituitary/hypothalamus dysfunction
95
What is the treatment for PCOS?
Weight, hirsutism, acne: OCP, antiandorgen
Infertility: clomiphene citrate
Insulin resistance: metformin (dec insulin so dec testosterone and allows LH surge)
Endometrial protection: cyclic progesterone (antagonizes endometrial proliferation)
96
What is a follicular cyst?
Distention of unruptured follicle. Aw/ hyperestrogenism and endometrial hyperplasia. MC ovarian mass in young women
97
What is a theca lutein cyst?
Bialteral/multiple often. Due to gonadotropin stimulation. Aw/ choriocarcinoma and moles.
98
What is a dermoid cyst (aka mature cystic teratoma)?
Mature germ cell teratoma with fat, hair, teeth, bits of bone and cartilage. Can have thyroid tissue and cause hyperthyroid (struma ovarii)
Common in 20-30yo women
Malignant in males (inc hCG) not in females
99
What origin are majority of malignant ovarian neoplasms?
Epithelial
100
Which benign neoplasm is lined with fallopian like epithelium?
Serous cystadenoma
101
What is struma ovarii?
Functional thyroid tissue inside a germ cell tumor (cystic teratoma aka dermoid cyst)
102
Looks like bladder. What looks yellow-tan, encapsulated and had coffee bean nuclei on H & E?
Brenner tumor
103
What is Meigs syndrome?
Ovarian fibroma, ascites, and hydrothorax
104
What has bundles of spindle shaped fibroblasts?
Fibromas
105
What is a thecoma?
Benign. May produce estrogen. Presents as abnormal uterine bleeding in postmenopausal women.
106
What is an immature teratoma?
Aggressive, contains fetal tissue & neuroectoderm
107
What tumor produces estrogen/progesterone and pw/ abnormal uterine bleeding, sexual precocity, breast tenderness, and call-exner bodies?
Granulosa cell tumor
MC sex cord stromal tumor; ~50yo
Call Exner bodies resemble primordial follicles
108
What has sheets of fried egg cells, high hCG and LDH?
Dysgerminoma
MC In adolescents
Remember equivalent to seminoma
109
What is a yolk sac tumor?
In sacrococcyeal area in young children, aggressive
Yellow, friable solid mass
Schiller duvall bodies (resemble glomeruli)
Increased aFP
Common in boys
110
What is vaginal SCC?
Usually secondary to cervical SCC. Primary are rare
111
What has spindle shaped tumorcells that are desmin +?
```
Sarcoma botryoides (rhambdomyoscaroma variant)
Girls
```
112
What is a movable small painless firm mass in the breast?
Fibroadenoma (stromal tumor)
Not a precursor to breast cancer inc with estrogen
Compresses epithelium spaces
113
What presents with serous or bloody nipple discharge?
Intraductal papilloma
In lactiferous sinus. Increased risk for carcinoma
114
What is a large bulky mass with leaf like projects?
Phyllodes Tumor (stromal tumor)
May become malignant
115
What breast cancer is most aggressive?
Triple negative: ER, PR, Her2/Neu
Increased risk in african americans
116
What cas caseous ductal necrosis?
Comedocarcinoma
117
What often shows up early as microcalcifications on mammography?
DCIS
118
What presents with eczematous patches on nipples and large cells with clear halo on histology?
Paget's disease (those are paget cells)
From underlying DCIS
119
What is a rock hard mass with sharp margins and small glandular duct like cells? See stellate infiltration and desmoplastic stroma.
Invasive ductal
MC and worst
120
What has orderly row of cells?
Invasive lobular
Bilateral with multiple lesions in same location
121
What breast cancer is fleshy cellular with lymphocytic infiltrate?
Medullary
Good prognosis
122
What is inflammatory breast cancer?
Dermal lymphatic invasion. Peau d'orange from neoplastic cells blocking lymphatic drainage
123
What are the proliferative breast disease?
Fibrosis: hyperplasia
Cystic: fluid filled, blue dome
Sclerosis adenosis: inc acini and intralobular fibrosis, calcifications
Epithelial hyperplasia: inc epi cell layers in terminal duct lobule
124
How do you treat endometritis
Gentamicin + clindamycin
125
How do you treat mastitis?
Dicloxacillin
126
What causes gynecomastia?
Sprionolactone, marjiuana, digitalis, estrogen, cimetidine, alochol, heroin, dopamine antagonists, ketoconazole
127
What is prostatitis?
Acute: bacterial (E. coli)
Chronic: abacterial (MC)
Dysuria, frequency, low back pain, urgency
128
What were the things to remember with cryptorchdism?
Testosterone normal (leydig not temperature sensitive)
Decreased spermatogensis (sertoli temp sensitive)
Increased germ cell tumor risk
Prematurity increases risk
Inc FSH, LH; Dec inhibin
Testosterone dec in bilateral
129
What are the tumor markers for prostate adenocarcinoma
PAP and PSA
130
What is a seminoma?
Malignant, painless, hematogenous, fried egg appearance, large cells in lobules with watery cytoplasm
Increased ALP
Radiosensitive, late metastasis, great prognosis
131
What is embryonal carcinoma?
Malignant, hemorrhagic mass with necrosis, painful, glandular/papillary; WORST
Usually mixed w/ other tumor types
Inc hCG and normal AFP when pure , inc AFP if not pure
132
What is golden brown and has reinke crystals?
Leydig cell tumor
Androgen producing (gynecomastia, precocious puberty)
133
What is a sertoli cell tumor?
Androblastoma from sex cord stroma
134
What is a testicular lymphoma?
MC in older men; usually form metastates. Aggressive
135
What are SCC of penis?
Bowen: penile shaft, leukoplakia
Erythroplasia of Queyrat: glans, erythroplakia
Bowenoid papulosis: ressidh papules
Aw/ HPV
136
What is mifepristone?
Progesterone receptor antagonist
137
When are OCPs contraindicated?
Smokers > 35yo (inc CV events), history of thromboembolism or stroke, or estrogen dependent tumor
138
What is terbutaline?
Beta-2 agonist, relaxes uterus during labor
139
What is Danazol?
Partial androgen receptor agonist
Used for endometriosis, hereditary angioedema
140
What do you use for anabolism to promote recovery after burn or injury?
Testosterone
141
What do you treat male pattern baldness with?
Finasteride (DHT causes it)
142
What is flutamide?
Testosterone receptor inhibitor (blocks androgen binding)
143
What do you treat prostate carcinoma with?
Flutamide and Leuprolide
144
What do ketoconaozle and spironolactone do?
Keto: inhibits steroid synthesis
Spironolactone: inhibits steroid binding
145
Where does smooth muscle relaxation occur with PDE5 inhibitors?
Corpus cavernosum
146
Side effects of PDE5 inhibitors?
Flushing, headache, dyspepsia, blue green color vision problem
Life threatening hypotension in patients on nitrates
147
What causes candida vaginitis?
Antibiotics most commonly (suppress normal flora like lactobacillus)
Also OCP, steroid, diabetes, immunosuppresion
148
What increases in Down Syndrome?
hCG and inhibin
149
What is vaginal agenesis (MRKH syndrome or mullerian aplasia)
No upper vagina (short vagina) and variable uterine development. XX with normal ovaries and secondary sexual characteristics.
150
What are soft compressible masses that transilluminate? Found in the neck.
Cystic hygromas (associated with Turners)
151
What does mumps orchitis cause?
Leydig cell atrophy (decreased testosterone), seminiferous tubule atrophy, and infertility.
Treat with testosterone
152
Why do you see atretic follicles?
Lack of FSH exposure causes primordial follicles to undergo apoptosis
153
What is nandrolone?
A steroid (athletes take it)
