Reproductive Flashcards
Sertoli cells of male secrete blank during development?
Antimullerian hormone– causes atrophy of mullerian ducts
antimullerian hormone secreted by?
sertoli cells
Without testosterone, this structure fails to differentiate?
Wolffian ducts
Where is 5 alpha reductase located?
Prostate– converts testosterone into DHT
Where does GnRH come from?
Arcuate nuclei of hypothalamus
Sertoli cells secrete?
Inhibin– which is involved in negative feedback of FSH
Actions of dihydrotestoerone
differentiation of penis, scrotum, and prostate
Female external genitalia with no internal genital tract?
Androgen insensitivity XY–testosterone levels are elevated due to lack of negative feedback ( Testes are often found in the labia majora)
FSH and LH in prepubescent boy?
FSH>LH (after pubert LH>FSH)
Converts androgen to estradiol?
aromatase
FSH and LH levels during follicular phase?
LH and FSH are suppressed by neg feedback effect of estradiol on anterior pituitary– progesterone levels are low
End of follicular phase (FSH and LH)
Estradiol has a positive feedback effect on secretion of FSH and LH leading to the LH surge
Ovulation occurs as a result of?
Estrogen induced LH surge
What happens to estrogen after ovulatin?
Estrogen levels fall but rise again during luteal phase
What happens to cervical mucus during ovulaton?
More easily penetrable by sperm
Peak levels of HCG occur when?
9 weeks
How long does corpus luteum produce estradiol and progesterone for?
First semester– then progesterone is made by placenta and estrogens are made by the interplay of fetal adrenal gland and placenta
Major placental estrogen is called?
estriol
Describe the estrogen progesterone ratio that induced labor?
Estrogen:progesterone levels increases…. (no one knows this crap)
Describe prolactin production during pregnancy
Estrogen Stimulates prolactin production in pituitary but lactation does not occur because estrogen and progesterone block action of prolactin on the breast
What effects does prolactin have?
Inhibits GnRH and antagonizes the actions of LH and FSH on the ovaries
Where does adenohypophysis come from?
Surface ectoderm (Rathkes pouch)
Benign Rathkes pouch tumor with cholesterol crystals and calcification?
Craniopharyngiomas
Neuroectoderm derivatives?
CNS– brain, retina, optic nerve, spinal cord
Neural crest derivatives?
PNS and no neural structures nearby (melanocytes, chromaffin cells of adrenal, bones of skull, aorticopulmonary septum
Mesodermal defects?
VACTERL Vertebral defects Anal atresia Cardiac Tracheo esophageal fistula Renal defects Limb defects
What does the notochord do to the ectoderm?
Induces ectoderm to form neuroectoderm (neural plate).
Postnatal structure of notochord?
nucleus pulposus
Agenesis vs aplasia?
Absent organ due to absent primordial tissue vs absent organ despite PRESENCE of primordial tissue
Malformation vs deformation?
Malformation occurs during embryonic period (intrinsic disruption) vs deformation is extrinsic and occurs after embryonic period
Appendages in wrong locations occurs due to defect in?
Homeobox
Fetal atrealized right ventricle?
Lithium
Vaginal clear cell adenocarcinoma of fetus?
DES
Limb defects in neonate (flipper limbs)
Thalidomide ( Tha LIMB domide)
Inhibits maternal folate absorption?
Valproate
Drug that causes placental abruption?
Cocaine
Anal atresia in neonate dt?
maternal diabetes
High risk of spontaneous abortion and birth defects in excess?
Vit A
Inner layer of chorionic villi
cytotophoblast
Outer layer or chorionic villi
syncytiotrophoblast
Desidua basalis derived from?
Endometrium
Job of umbilical arteries?
Return deox blood from fetal INTERNAL Iliac arteries to placenta
Where are umbilical blood vessels derived from?
Allantois
Meconium discharge from umbilicus?
Vitelline fistula
Another name for mullerian duct?
Paramesonephric duct
Another name for Wolffian duct?
Mesonephric duct
Describe phenotype of XY with no sertoli cells or lack of MIF?
Male external genitalia and both internal genitalia
Lack of 5 alpha reductase?
Male internal and ambiguous external until puberty
Lymphatic drainage of ovaties and tests?
para aortic lymph nodes
Distal 1/3 of vagina/scrotum lymphatic drainage?
superficial inguinal nodes
Connects overies to lateral pelvic wall?
Suspensory ligament
Connects cervix to side wall of pelvis?
Cardinal ligament– contains uterine vessels
Connects uterine fundus to labia majora?
Round ligament of uterus– derivative of gubernaculum
Connects lots of vaginal crap to pelvic side wall?
Broad ligament
Female structure with ciliated simple columnar?
Fallopian tubes (cilia help move egg)
Female structure with stratified squamous epithelium?
Ectocervix and Vagina– strength from stress during pregnancy
Female structure with simple columnar epithelium?
Endocervix
Suspensor ligaments contain?
Ovarian vessels
This ligament contains uterine vessels?
Cardinal ligament– be careful during ligation of vessels in hysterectomy
Female structure with simple cuboidal?
Ovary– secretory
NO release stimulated by what nerve during erection?
Pelvic nerve
Nerve involved in ejaculation?
Pudendal nerve
Germ cells of sperm productoin?
Spermatogonium
Blood testes barrier formed by?
tight junctions of blood testis barrier– isolates gametes from autoimmune attack
Job of leydig cells?
produce testosterone– found in interstitium
ABP?
support spermatogenesis
Testosterone differentiates all internal genitalia except??
prostate is stimulated by DHT
Late effects of DHT?
Prostate, balding, sebaceous gland activity
what happens to testosterone in adipose tissue?
Converted to estrogen by aromatase
What type of estrogen is produced by a) ovary b) placenta
1) estradiol
2) Estriol
Where are estrogen receptors expressed?
Cytoplasm– when bound by ligand they translocate to nucleus
Stimulates spiral artery development?
Progesterone
Produces thick cervical mucus to inhibit sperm entry into uterus?
Progesterone
> 35 days cycle?
Oligomenorrhea
Metrorrhagia?
frequent but irregular menstruation
Menometrorrhagia?
Heavy, iregular menstruation at irregular intervals
Rise in estrogen has what effect on anterior pituitary during ovulation?
Increases GnRH receptors
Pain that mimics appendicitis
Mittelschmerz– blood from ruptured follicle causes periotoneal irritation
Primary oocytes are arrested in?
Prophase of Meiosis I before ovulation
Oocyte arrested in what stage until fertilization?
Metaphase II or meiosis II
Elevated in HCG in men may represent?
Testicular germ cell tumor
XY, external genitalia are ambiguous, testes present, looks like female?
Androgen insensitivity
Decrease in LH and increase in testosterone?
Exogenous testosterone or tumor
Increased LH and decreased Testosterone?
Primary hypogonadism
Dec LH and Test.
Hypogonadotropic hypogonadism (could be Kallmans)
Turner syndrome: Genotype? Clinical features? Hormones?
XO– short stature, ovarian dysgenesis (streak ovary); shield chest, bicuspid aortic valve, defects in lymphatics–>webbing of neck, lymphedema in feet and neck, PREDUCTAL coarctation of aorta, horseshoe kidney, dysgerminoma
Low estrogen leads to Increased LH and FSH
Pt presents with short stature, bicuspid aortic valve, and a wide neck– what does she have? What is the cause of the wide neck? Kidney problems?
Turners– impairment of lymphatics; can also see horseshoe kidney– PREDUCTAL COARCTATION
Ddx of primary amenorrhea?
Mullerian agenesis; Turners; imperforate hyman
Women presents with high LH and FSH; has never had a period. Her distal limbs have a bluish tintt?
Turners
Klinefelters is an example of what genetic process? Hormones?
Non-dysjunction– chromosomes do not separate
Dysgenesis of seminiferous tubules will lead to decreased inhibin and increased FSH?
Decreased testosterone will lead to increased LH and Inc estrogen
Very tall 16 yo boy presents to your office. His mother says he’s exhibiting antisocial behavior. You notice severe acne on his face?
Double Y males XYY (not all are antisocial)
Significant increase in testosterone and increase in LH– very low levels of DHT?
Androgen insensitivity
Defect in Kallmans?
Migration of GnRH and formation of olfactory bulb
Decreased GnRH, FSH, LH and testosterone, micropenis?
Kallmans (anosmia+secondary sexual characteristics)
Components of a complete hydatidiform mole?
2 sperm and empty egg
hCG in complete mole?
VERY high– high risk of malignant trophoblastic disease (20%)
Fetal parts in complete mole vs partial
complete=no fetal parts
partial= fetal part(ial)
Pathophys of hydatidiform mole?
Cystic swelling of chorionic villi and proliferation of chorionic epithelium- presents with abnormal vaginal bleeding
Most common precursor of choriocarcinoma?
Complete hydatidiform mole– High b hCG
honeycombed uterus?
hydatidiform mole
Treatment of hydatidiform mole?
Dilation and curettage and methotrexate
Preeclampsia?
HTN, proteinuria, and edema
HTN in pregnant woman before 20 weeks suggests?
Molar pregnancy
PP of Preeclampsia?
Placental ischemia due to impaired vasodilation of spiral arteries–>inc vascular tone– associated with HELLP
Pregnant pt presents with headache, blurred vision, and edema?
Preeclampsia– also see hyperreflexia
Painful bleeding in third trimester– associations?
Abruptio placentae– premature detachment– assoc with DIC (tissue factor from placenta into maternal circulation) ; increased with cocaine htn, and smoking
Implantation into the myometrium of placenta?
Placenta accreta (accreta means encased in i.e. encased in myometrium)
Painless bleeding during any trimester?
Placenta previa– Attachment of placenta to lower uterine segment
Potters syndrome?
Pot FEL– facial abnormalitites, extremities, limbs
PCOS hormones?
LH:FSH >3; high testosterone, and high estrogen from aromatization of tesosterone; low SHBG
The high LH prevents ovulation
Treatment of acne and hirsutism in pcos patients?
Spironolactone
Describe how LH causes decrease in FSH in PCOS?
Increased LH leads to increased androgens–>converted to estrogen in peripheral tissue–>estrogen has negative feedback on FSH
Most common ovarian mass in young women?
Follicular cyst
Ovarian cyst filled with fat, teeth, bone and cartilage?
Dermoid cyst
Chocolate cyst?
Endometrioid cyst
Dysgerminoma: tumor markers? Histology? Assoc?
Malignant Ovarian germ cell tumor
High hCG, and LDH
Sheets of uniform cells
Associated with Turners
Choriocarcinoma is a malignancy of? tumor marker?
Malignancy of trophoblastic tissues; chorionic villi NOT present; see a high hCG– early hematogenous spread to lungs
Ovarian germ cell cancer with early hematogenous spread to lungs?
Choriocarcinoma
Tumor marker AFP associated with?
Yolk sac tumors (endodermal sinus tumors)– yellow friable mass
Schiller Duval bodies?
Commonly seen in yolk sac (endodermal sinus tumor)– resemble glomeruli
Dermoid cyst and presents with hyperthyroidism
Struma ovarii– teratoma with functional thyroid tissue
HPV 16 is a blank gene product; HPV 18 is ?
E6 gene product that inhibits p53
18= e7 gene product that inhibits RB
Pt. presents with inflammation of endometrium. She had a miscarriage 30 days ago. Treatment?
Endometritis: gentamycin and clindamycin
Endometriosis: Histologicially?
endometrial glands/stroma in abnormal locations outside the uterus
Most common Gyn malignancy?
Endometrial carcinoma
Most common of all gyn tumors?
Leiomyoma (fibroids)
40 yo F; Whorled patter of smooth muscle, abnormal uterine bleeding
Leiomyoma– most common gyn tumor around the WHORLD– no its not! Just a mnemonic– cervical cancer is more common outside the US
Leiomyoma histology?
Whorled pattern
Leiomyosarcoma–where do they arise from?
De novo!– see necrosis and cellular atypia
Most common gyn cancer in US and world?
Endometrial in USA and Cervical in the world
Worst prognosis in terms of gyn cancers?
Ovarian is worse than cervical is worse than endometrial
Benign bilateral, overaian tumors;
Serous cystadenoma– lined with fallopian type epithelium
Malignant bilateral ovarian tumors? Histology?
Serous cystadenocarcinoma– psamomma bodies
Ovarian tumor with psammmoma bodies?
Serous cystadenocarcinoma
Ovarian tumor that presents with ascitis
Mucinous cystadenocarcinoma
Unilateral tumor of ovary. Pale yellow tan in color. Looks like bladder epithelium?
Brenners
Granulosa cell tumor secretes? Histology?
Estrogen–>precocious puberty in kids
Call exner bodies– small follicles with eosinophilic secretions
Also see abnormal uterine bleeding
Mucin secreting signet cell that metastasized to ovaries?
Krukenberg tumor
DES exposure in utero makes women susceptible to which type of cancer?
Clear Cell adenocarcinoma
Fibromas, ascitis and hydrothorax?
Meigs syndrome
Epinephrine is only produced by?
ADRENAL GLANDS
45 yo women with bloody nipple discharge?
intraductal papilloma
Major duct of breast?
Fibrocystic change and ductal carcinoma
Stroma of breast tissue?
Phyllodes tumor– leaf like projections
Leaf like projections– breast?
Phyllodes tumor
Breast cancer that is bilateral?
Lobular carcinoma
Serous tumors of ovary are bilateral
freebee
Mammography doesn’t pick up which cancers?
Lobular
35 yo woman small mobile firm mass. Marble like?
Fibroadenoma– increased size and tenderness with estrogen– not a precursor to breast cancer
Cleft=
Araches=
Pouches=
Ectoderm
Mesoderm
Endoderm
CAP coves outside from inside
Papillary carcinoma lacks?
Myoepithelial cells
