Reproductive Flashcards
patter of hormones during gestation
- 17-OH protgesterone/hCG
- progesterone/hPL
- cortisol
- rises during 1st tri and then falls (17-OH declines after destruction of corpus lutem, and hCG declines after placenta no longer needs corpus lutem)
- increase steadily throughout pregancy (P-maintain uterine lining and hPL increases with fetal mass)
- increases steadily starting around wk 28-initiates labor and fetal lung maturation
pts risk of breast cancer is increased with sclerosing adenosis with ductal hyperplasisa and not apocrine metaplasia because
apocrine metaplasia is benign, common, non-proliferative change and associated with increased breast cancer risk, Sclerosisng adenosis is a type of proliferative fibrocystic dz, if hyperplastic is can lead to invasive breast cancer.
pt taking drug that increases gonadotropins, decreases estradiol and endometrial proliferation blocks aromatase and not estrogen receptors because
blocking estrogen receptors would decrease endometrial proliferation. however the lack of negative feedback of estrogen on hypo would lead to increased levels of gonadotropins and estradiol. blocking aromatase would result in decreased estradiol despite increased levels of gonadotropins
what cells express LH receptors during early follicular phase? and which express LH receptors during late follicular development?
theca cell and granulosa cell
P450scc
side chain cleavage enzyme. first step in ovarian steriodogenesis, converts cholesterol to pregnenolone.
drug used to treat herpes blocks viral DNA polymerase and not viral release from cell because
viral release from cell are the action so of neuraminidase inhibitors (-ivir=influenza), whereas drugs that inhibit viral DNA polymerase (-ovir i.e. Acyclovir) are used to treat herpes
describe glands, stroma, and mitotic figures in the different stages of endometrium development
- early proliferative 4-7 days-glands-straight and short, compact stroma, little mitotic activity
- mid proliferative phase 6-10 days-glands are longer, little stromal edema, numerous mitotic figures
- later proliferative 11-14, wavy glands, subnuclear vacuoles, prominent mitotic activity,
- secretory phase- stromal edema
asynchronous secretory endometrium
secretory epithelium has mismatch of staging between stroma and glands.
proliferative endometrium wit stromal breakdown
cause of bleeding in anovulation
bone metastases type:
breast, prostate, colon, kidney, lung, thyroid,
- both blastic and lytic
- blastic
- doesn’t metastasize to bone
- the rest produce lytic lesions
a young girl with virilization, HTN, hypoK, hyper 17-OH progetersone, and hypoALD has a defect in 11-beta-hydroxylase and not 17-alpha hydroxylase because
all CAH mutations lower CTH and would cause low blood pressure. the only reason for HTN is b/c of elevated 11-deoxycorticosterone (11-DOC) seen in 11-beta-hydroxylase. 17-alpha mutation would cause lack of secondary chacteristics in females and pseudo-hermaphroditism in males
PLAP and CD17 are markers for
seminoma cell membrane
drug with PE2 and oxytocic activity used to induce cervical softening during labor is dinoprostone not misoprostol because
misoprostol has PE1 not PE2. both can be used to ripen cervix
mechanism of cephalasporins
like penicillins, inhibit cell wall synthasis by blocking transpeptidaton enzymes. not as susceptible to beta lactams (aka penicillinases.)
young female athlete with irregular menstruation needs a progestin challenge and not clomiphene because
progestin challenge will confirm anovulation. anovulation can be treated with C (blocks estrogen mediated negative feedback on hypothlamus)
a pt with 46 chromosomes, a barr body, and ambiguous genitalia has excess production of androgens and not mutation of androgen receptor gene becuase
this pt is a female (a Barr body is only found in females). thus the ambiguous genitalia is due to over production of androgens. AID (androgen insensitivity syndrome) results in male (46XY) with external female features.
ground glass nuclei, cowdry type A bodies, and multinucleated giant cells dz and treatment
HSV-acyclovir
ampB +fluconazole treats
cryptococcus neoformans
hypospadias
congenitital displacement of urethral opening onto ventral surface (underside) of penis. can lead to UTIs or infertility
phimosis
foreskin cannot be retracted over shaft of penis
preeclampia symptoms before 20wks gestation is most likely, after 6 months
hydatidiform mole
twin gestation or anencephaly(causes polyhydramnios)
16 year boy with painless lump in left breast and no fluid discharge, most likely has gynecomastia and not intraductal papilloma because
gynecomastia is common in youth and can occur in one or both breast. intraductal papilloma is rare in men and would present with blood nipple discharge
major of testosterone is bound to
sex-steriod binding globulin and vry little is bound to albumin
Cal-Exner bodies
granulosa cell tumors, uniform cuboidal cells resembling structures reminiscent of ovarian follicle
bicornate uterus
abnormal Y shaped uterine cavity- can cause spontaneous abortions in 2nd trimester
testicular arteries originate from. penis is supplied by
aorta, internal pudenal artery (from internal iliac artery)
location of hernias
all are lateral to lateral wall of rectus muscle
direct-within inguinal triangle, medial to i. epigastric art and vein, superior to inguinal canal.
indirect-lateral to epigastrics, through both deep and superficial inguinal rings (surrounded by all 3 layers of fascia)
femoral-through superficial inguinal ring, posterior to inguinal ligament
initial event of preeclampsia
placental ischemia-trigger release of thromboplastic substances, increases renin synthesis and reduces prostaglandin E levels.
epithelial hyperplasia and not ca2+ deposits is associated with an increased risk for breast cancer because
calcium deposits are seen in malignant and benign lesions and used mostly for diagnostic purposes. where as proliferative changes such as hyperplasia can lead to carcinoma
activin vs inulin
activate FSH vs inhibit FSH, produced in testes.
pt with mental retardation, X chromosomal breakage, and macro-orchidism may also have cardiac abnormalties and not renal because
pt has fragile X syndrome- Xtra large testis, ears, and jaw. also associated with mitral valve prolapse and autism. x linked defect affects methylation of FMR1 gene.
bleeding in placenta previa vs placenta abrupton
previa is painless and abruption is painful bleeding
hematosalpinx def and causes
bleeding into fallppian tubes-ectopic preg or transverse vaginal septum (obstruction of blood flow)
test results for Downs
Edwards and Patau syndromes
downs-increased nuchal transluency, decreased Papp-a and increased free beta-hCG
edwards- low PAPP and low beta-hCG
patau-low free beta-hcg, low papp-a, increased nuchal translucency
most important factor for pathogenesis in N gonorrhae is pili and not IgA protease because
although N. gonorrhae produces IgA protease to allow for mucosal colonization pili are what allow it to adhere to membrane, inhibit phagocytosis, and undergo antigenic variation
violin string adhesions of peritoneum to liver
fitz-hugh-curtis syndrome-infection of gillson’s capsule (liver capsule) due to severe PID
processus vaginalis becomes
tunica vaginalis, partial closure results in hydrocele in children
increased number of columnar cells with preservation of BM
moderately differentiated cells with striated pattern
endometrial hyperplasia
rhabdomyomasw
hyperplasia to invasive adenocarcinoma
simple hyperplasia-dilated and irregular glands rare risk
complex hyperplasia w/o atypia- irregular glands and mitotic figures 5% risk
complex hyperplasia with atypia- glands, mitotic cells, and nuclear atypia. 25% risk
male pt with ambigous genetial, lipid laden adrenals, and decreased levels of all steroids (C21, C17, and C18), with no response to ACTH or hCG has Steroidogenic acute regulatory protein (StAR) defiecncy and not 21-alpha hydroxylase def. because
21-alpha hydroxylase wouldn’t lead to a decrease in all steroid production in fact it would increase androgen production. StAR is needed to transport cholesterol from outer to inner mintochondral, adrenal, and gonadal membranes. manifest at young age-congenital lipoid adrenal hyperplasia
man with thickened, whitish plaque with slightly ulcerated, crusted surface. biposy shows dysplatic epithelial cells, mitoses, disorder epithelium and intact BM has SCC in situ and not condyloma acuminatum because
lesion is Bowen Disease- vs condyloma which is usually a papillary lesion.
other types of SCC in situs lesions are BBQ
bowen, bowenoid(mutiple reddish brown pauplar lesions), and queyrat (shnny red papules)
white skin plaques on or near genitals with inflammatory infiltrate at dermal-epidermal junction and thinned epidermis
lichen sclerosis
reduced inhibin levels in young woman
premature menopause
whorled pattern with well demarcated borders
leiomyoma (fibroid)
pregancy mother presenting with symptoms of DM has increased hGH and not decreased hGH because
human growth hormone is released by placenta and acts like growth hormone, stimulating insulin-like growth factor (IGF-1) to increase glucose and amino acids for baby, also hGH has anti-insulin effects and can cause DM
cell cycle phase before ovulation
diplotene stage of prophase 1 of 1st meiotic division
posterior fornix is in contact with
retrouterine space-pouch of Douglas
middle layer of urogentital diaphragm, containing sphincter urethrae muscle
below and lateral to pelvic diaphrage
between bladder and rectum in males
spce in female pelvis between bladder and uterus
deep perineal pouch, ischioanal space,rectovesical space, vesicoutrine space
multi giant nulceated cells originate from, rxn in breast is
histocytes, fat necrosis
RB suppression is associated with
CIN, retinoblastoma, osteosarcoma, colon, and lun
structure drainage:
- superficial inguinal nodes
- testes
- deep inguinal nodes and part of uterus
- bladder, internal genital glands, parts of uterus and cervix
- buttocks, loever limbs, anterior abdomin wall, perineum
- deep inguinal nodes
- para-aorta
- external iliac nodes
- internal iliac nodss
- superficial ingunial nodes
palpate the what in order to perform a pudendal nerve block
ischial spine-connects greater and lesser sciatic foramens
male pt with normal internal genital and femized external genetials has 5alpha reductase deficency and not complete androgen resistance because
complete androgen resistance results in no internal genitals. 5alphaR is needed to convert T to DHT which is needed for 2ndary virilization
quetion 33.34
answers
