Reproductive Flashcards
role of human placental lactogen during pregnacy-produced, similar to, metabolism effects (3)
secreted from syncytiotrophoblast
-similar to prolactin and growth hormone
increases insulin resistance (more glucose for baby), stimulate proteolysis and lipolysis (mother uses this as fuel=more glucose for baby), and inhibits gluconeogensis (more glucose for baby).
what pregnany hormones can cause maternal insulin resistance?
human placental lactogen (hPL), placental growth hormone, estrogens, progesterone, and glucocorticoids
nutrients not found in breast milk
vitamin D-give supplements
and vit K-injection at birth to prevent hemorrhagic diseaese
primary oocytes are in which stage before ovulation? after ovulation?
before- prophase of meiosis I
after- metaphase of meiosis II
which hormone stimulates the production of androgens? which cells respond to this?
LH, theca interna cells of ovarian follicle
LH, Leydig cells secrete testosterone regardless of temperature
androgens are converted to estradiol where? name enzyme? which hormone controls this?
granulosa cells with the enzyme aromatase FSH
theca externa cells
serve as connective tissue support structure for follicle
which hormones prevent lactogenesis during pregnancy? (2) what do they promote?
estrogen progesterone. inhibit role of prolactin and after birth their levels decrease and prolactin can have it’s effect.
breast growth
role of hCG in pregancy- levels fall when?
maintain corpus luteum until placenta can make estrogen and progesterone. levels fall by mid-pregnancy
role of LH during pregnancy
none- levels are low due to feedback inhibtion of anterior pituitary gland
pts with fetal mutations remember taking acetominaphen during preg and pt with baby w/o mutations do not remember taking actominaphen=this type of bias
recall bias
difference between primary amenorrhea causes by imperforate hymen, hyperprolactinemia, Kallmann syndrome, Turner syndrome, pregnancy
- fully developed secondary characteristics, cyclic abdominal pain, hematocolpos (vagina filled with menstrual blood-mass palpated anterior to rectum)
- an also present with oligomenorrhea in addition to abnormal hormone levels (i.e galactorrhea, hypoestrogenemia)
- absent secondary characteristics, an olfactory sensory defect
- short stature, webbed neck, shielded chest, fibrotic ovaries absent sexual characteristics
- increased hCG levels
does endometriosis cause amenorrhea?
no is causes dysmenorrhea, and dsyspareunia
nevi vs accessory nipples vs keloids
- both raised and hyperpigmented
- nevi and keloids do not influenced by menstrual cycle changes
- keloids are a result of trauma to skin.
define anti-Rh (D) immunoglobin (RhoGAM)-consist of, used for. given when (2)?
consists of IgG anti-Rh(D) antibodies. give to Rh-negative mothers at 28 wks and immediately postpartum. blocks maternal immune response to fetal Rh (D) antigens
epithelium in ovary, fallopian tube, uterus, cervix, vagina
- simple cuboidal
- simple columnar
- simple (pseudostratified) columnar
- simple columnar (endocervix); stratified squamous (ectocervix)
- stratified squamous (non-keratinized)
name organ associated with these epithelial features
-aka germinal epithelium, transitions to peritoneum at broad ligament of uterus
ovary
name organ associated with ciliated cells help transport egg/embryo; peg cells (secrete nutrients)
fallopian tube
name organ associated with tubular glands, a functional and basal layer, cyclic changes
uterus
name organ associated with cervical glands, cyclic changes allowing for less viscous mucus at time of ovulation
cervix
name organ associated with presence of glycogen
vagina
name associated epithelial tumors of
ovary, fallopian tube uterus, cervix, vagina
- serous,mucinous, endometrioid, clear cell, brenner (urothelial)
- rare
- endometrial CA
- condyloma acuminatun, squamous cell CA, adenocarcinoma
- squamous cell CA
when is beta-hCG production occur? detectable in maternal serum?
- after blastocyst successfully implants, usually 6 days after ovulation.
- 8-11 days
after fertilization
- 3-4 days
- 5-6days
- > 6 days
- enters uterus as 2-8 cells embryo or multi-celled morula
- morula becomes blastocsyst and is free floating
- implantation occurs
Downs due to nondisjunction in meiosis I vs meiosis II
failure of homologus pairs to separate (child has 3 different versions of chromosome 21)
failure of sister chromatids to separate (child has 2 different version of chromosome 21 which double the amount of one of them)
amino/chorion number in -dizygotic twins monozygotic 0-4 days monozygotic at 4-8 days monozygotic at 8-12 days and monozygotic after 13 days
- always dichorionic/diamniotic
- dichorionic/diamnionic
- monochorionic/diamniotic (after morula)
- mono/mono (after blastocyst)
- mono/mono conjoinedd twins (after formed embryonic disk)
histological appearance of endometrial stroma in days. main hormone present
1-14
mid cycle
15-28
- proliferative phase. compact non-edematous stroma, gland:stroma ratio less than 1, glands are straight and narrow with small lumens, controlled by estrogren
- between proliferative and secretory phase. ovulation, coiled glands with occasional cytoplasmic vacuoles. LH surge
- mid-secretory phase. gland:stroma ratio is 1:1, stromal edema, dilated and coiled glands with wide lumens controlled by progesterone
Klinefelter’s syndrome has what lab values? what determines degree of feminization?
- increased FSH, due to gonadal failure
- elevated estradiol
- estrogen:testosterone ration determines extend of feminization
PCOS is aka
Stein-Leventhal Syndrome
PCOS presents how?
obesity, hyperandrogenism, oligomenorrhea, infertility, and enlarged ovaries with multiple cysts
intraductal papilloma discharge vs prolactinoma discharge
- bloody or serosanginous (no problems with ovulation)
- milky discharge (also look for amenorrhea)
what is a common cause of menstrual cycle variability in a female several years after menarche and a few years before menopause?
annovulation
- can have heavy periods with spotting in between
- no progesterone rise b/c no LH surge, leads to unopposed estrogen mediated endometrium proliferation
which ovarian tumors secrete estrogen? how does this present in a patient? cancer risk?
granulosa cell and theca tumors.
hyperestrogenemic state causes endometrial hyperplasia and abnormal bleeding
-predisposed to endometrial adenocarcinoma
rubella in mother and in neonate?
- low grade fever, maculopapular rash with cephalocaudal progression, and posterior auricular and suboccipital lympadenopathy, polyarthritis and polyarthralgia are possible sequelae
- congenital rubella is associated with senorineural deafness, cataracts and PDA
Huctingson’s incisors and mulberry molars
congenital syphillus
age at which conception is considered advanced
35
unilateral erythema carcinoma and scale crust around nipple
Paget’s disease
solid sheets of vescular, pleomorphic mitoticaly active cells with significant lymphoplasmacytic infiltration around and within the tumor
medullary carcinoma
central acinar compression and distortion (by surrounding) fibrotic tissue and peripheral ductal dilation
sclerosing adenosis
leaflike and similar to fibroadenomas-cancer risk?
Phyllodes tumor (cancer risk) -no risk with fibroadenomas
pleomorphic solid sheets, high grade cells with central necrosis
comedocarcinoma
name 4 parts of normal menstrual cycle and hormones involved
- menstrual, follicular, ovulatory, and luteal
- after menstration estrogen promotes proliferation of endometrium
- FSH stimulates estrogen production and one dominant follicile to form in one of the ovaries
- as follicular phase continues a progresses increasing levels of estrogen has a positive feedback on LH production
- LH surge causes rupture of dominant follicle leading to ovulation
- progesterone increases after LH surge to maintain endometrium (peak in mid-luteal phase)
how is pudendal nerve block preformed? type of anesthesia. for complete perineal and genital anesthesia?
injecting anesthetics intravaginally in the region of the ischial spine
- majority of perineum
- additional blockade of genitofermoral and ilioingiunal nerves
what drains to superficial inguinal lymph nodes?
-cutaneous structures inferior to umbilicus, external genitalia and anus up to pectinate line
deep inguinal nodes
glans penis and ciltioris
external iliac nodes
drain superficial and deep inguinal nodes and deep lymphatics of abdominal wall below umbilicus
inferior mesenteric nodes
drain structures supplied by IMA. descending and sigmoid colon as well as upper part of rectum
-efferents drain to para-aortic nodes
lymph from testes drains where? lymph from scrotum
para aortic nodes
superficial inguinal lymph nodes
pts with PCOS and infertility are treated how? mech of action
- clomiphene citrate
- estrogen receptor modulator
- decreased negative feedback inhibition on hypothalalmus from increased estrogen and allowing for increased gonadotrophin production
name genetic cause of Turner’s syndrome? give 3 examples? which is most common?
mitotic error in early development
- complete monosomy (45,X,O), mosaicism (45XO/46XX) or partial deletion of one X chromosome (46 XX)
- mc cause is monosomy
T or F smoking is a risk factor for CIN?
false, strongest risk factor is HPV infection (early first intercourse and multiple sex partners)
endometrial glandular tissue within myometrium
adenomyosis
benign pseduoencapsulated tumor of monoclonal uterine smooth muscle. swirled spindles
leiomyoma
mc type of endometrial carcinoma? mc presentation?
adenocarcinoma
abnormal uterine bleeding in a postmenopausal woman
normal endometrial tissue (stomal and glands) in abnormal locations
endometriosis
- cervicitis with purulent white discharge
- gray discharge with fishy order made worse with KOH
- vaginal puritis, white curd like discharge and labial erthema
- yellow green foamy, foul-smelling discharge, motile trophozoties with flagellae
- vagianal dryness, serosanginous, watery discharge and dsypareunia
- N. gonorrhoeae or c. trachomatis
- bacterial vaginosis (BV) i.e gardenerella vaginalis
- candida albicans
- trichomonas
- atrophic vaginitis, seen in postmenopausal or hypoestrogenemic women
triad of pre-elampsia
-HTN, edema, and proteinuria
HELLP syndrome
hemolytic anemia, elevated liver enzymes and low platelets
