Reproductive Flashcards
most common causes of eugonadotropic amenorrhea
Mullerian duct anomalies or imperforate hymen
streak ovaries
turners syndrome
testicular feminization
aka androgen insensitivity
46XY appear phenotypically female, have a blind end vaginal pouch with no uterus
due to insensitive testosterone receptors
how can turners pts become pregnant
with donor oocyte, and they require hormonal supplementation during pregnancy to maintain uterine lining (estrogen and progesterone)
sonic hedgehog
patterning along anterior posterior axis, CNS mt holoprosencephaly
wnt 7
produced at apical ectodermal ridge necessary for dorsal ventral axis
FGF
lengthening of limbs
homebox (Hox) genes
segmental organization of embryo in craniofacial direction
-mt appendages in wrong locations
ectoderm:
surface
neuroectoderm
neural crest
surface ectoderm: epidermis, adenohypophysis (Rathke ppouch), lens of eye, epithelial lining of oral cavity, sensory organs of ear, olfactory epithelium, epidermis, anal canal below pectinate line, parotid, sweat and mamary glads
Neuroectoderm: CNS (brain, neurohypophysis, CNS neurons, oligodendrocytes, astrocytes, ependymal cells, pneal gland), retina, optic nerve, spinal cord
Neural crest: PNS, melanocytes, chromaffin cells of adrenal medulla, parafollicular C cells, cells of thyroid pia, arachnoid, bones of skull, oodontoblast, aorticopulmonary septum
mesoderm
defects=VACTERL vertebral anal atresia cardiac defects tracheoesophageal fistulas Renal defects limbs defects also spleen, vagina, testes, ovaries, adrenal cortex, dermis
endoderm
Enternal layer
-gut tube epithelium, urethra, luminal epithelial derivatives-lungs, liver, bladder, pancreas, eustachain tube, thymus, parathyroid, thyroid follicular cells
teratogen: renal damage
ACEi
teratogen: absence of digits, + other anomalies
alkylating agents
teratogen: CN VIII toxicity
aminoglycosides
teratogen: facial dysmorphism, developmental delay, NTDs, phalanx/fingernail hypoplasia
carbamazepine
teratogen: vaginal clear cell adenocarcinoma, congenital mullerian anomalies
DES
teratogen: NTDs
folate antagonists
ebstein anomaly
lithium
teratogen: aplasia cutis congenita (congenital focus of epidermis with or without other skin layers)
methimazole
cleft palate, cardiac defects, phalanx/fingernail hypoplasia
phenytoin
-fetal hydantoin syndrome
discolored teeth, teratogen
tetracycline
teratogen: limb defects, phocomelia, micromelia, “flipper” limbs
thalidomide
NTDs
valproate-inhibits maternal folate absorption
bone defromities, fetal hemorrhage, abortion, opthalmologic abnormalities
warfarin
caudal regression syndrome
in babies with mother with diabetes
anal atresia to sirenomelia (mermaid syndrome)
microcephaly and intellectual disability
X ray exposure
hypertelorism, limb dislocation, heart-lung fistulas, holoprosencephaly, smooth philtrum
Fetal alcohol syndrome
failure of cell migration
which placental component lacks MHC 1 expression
syncytiotrophoblast-outer layer of chorionic villi
-secretes hCG (stimulates corpus luteum to secrete progesterone during the first trimester)
cytotrophoblast
inner layer of chorionic villi, makes cells
decidual basalis
maternal component of placents, derived from endometrium, maternal blood in lacunae
urachus
formed from the allantois during the 3rd week, duct between fetal bladder and yolk sac (bladder to umbilical cord)
vitelline duct
omphalomesenphric duct
connects midgut lumen to yolk sac (umbilicus)
meckel diverticulum
partial failure of vitelline duct closure (tur diverticulum)
1st aortic arch derivative
maxillary (branch of external carotid)
2nd aortic arch derivative
stapedial artery and hyoid artery
3rd aortic arch derivative
Carotids-common carotid and proxmial part of internal carotid
4th aortic arch derivative
on left-aortic arch
on right-proximal part of right subclavian artery
CAP
clefts=ectoderm
arches=mesoderm
pouches=endoderm
6th aortic arch derivative
proximal part of pulmonary arteries and ductus arteriosus
failure of closure of maxillary and medial nasal processed
cleft lip
failure of fusion of two lateral palatine processes OR failure of fusion of lateral palatine processes with nasal septum and/OR median palatine process
cleft palate
teacher collins syndrome
failure of first arch to migrate-mandibular hypoplasia ,facial abnormalities, FTT
congential pharyngocutaneous fistula
persistence of cleft and pouch–> fistula between tonsillar area and lateral neck
female genital development
(default) mesonephric duct degenerates and paramesonephric duct develops
male genital development
-SRY causes release of testis determining factor
which acts on Sertoli cells to produce mullerian (paramesonephric) inhibiting factor
-also acts on leydig cells to make testosterone and make mesonephric duct (SEED) seminal vesicles, epididymis, ejactulaory duct, ductus deferens
no sertoli cells or lack of MIF
get both female and male internal genitalia and male external genitalia
no 5 alpha reductase
testosterone is not converted to DHT and do not get external genitalia
-male internal genitalia ambiguous external genitali until puberty (increase in testosterone levels cause masculinization)
septate uterus
incomplete resorption of the septum
decreses fertility-septoplasty
bicornuate uterus
incomplete fusion of mullerian ducts
increases risk of complicated pregnancy
uterus didelphys
complete failure of fusion of mullerian ducts, double uterus, vaina, and cervia-pregnany possible
hypospadis
failure of urethral folds to fuse leaving an abnormal opening of penile urethra on ventral surface of penis
-associated with inguinal hernia and cryptorchidism
epispadis
abnormal opening of penile urethra on dorsal surface due to faulty positioning of gential tubercle
assocaited with exstrophy of the bladder
gubernaculum
anchors testes with scrotum
like female ovarian ligament and round ligament of uterus
processus vaginalis
forms tunica vaginalis in males and is obliterated in females
infundibulopelvic ligament
holds ovaries to lateral pelvic wall, contianes ovarian vessels
-LIGATE VESSELS during oophrectomy to avoid bleeding
ureters retroperitoneal and at risk of injury duing ligation of ovarian vessels
cardinal ligament
cervix to side wall of pelvis
-contains uterine vessels
gubernaculum derivative
continas sampson artery
boroad ligament
mesometrium, mesosalpinx, mesovarium-uterus, fallorian tubes and ovaries to pelvic side wall
contains ovaries, fallopian tubes, round ligament of uterus
ovarian ligament
medial pole of ovary to lateral uterus
vagina
stratified squamous epithelium
-contains glycogen
ectocervix
stratified squamous epithelium
transformation zone
squamocolumnar junction -most common area for cervial cancer
endocervix
simple columnar epithelium
uterus
simple pseudostratified columnar epithelium
fallopian tube
simple columnar epithelium
ovary
simple cuboidal epithelium
pathway of sperm during ejactulation
SEVEN UP seminiferous tubules epididymis vas deferens ejaculatory ducts (nothing) urethra penis
blood at urethral meatus
urethral injury most likely at membranous portion from pelvic fracture
-bulbular urethra prone to blunt force
anterior urethral injury
straddle injury
urine leak beneath deep fascia (facia of Buck)
autonomic innervation of male sexual response
erection-parasympathetic via pelvic nerve (through No and cGMP)
emission-sympathetic via hypogastric
ejaculation-via pudendal
where are estrogen receptors found
cytpolasm, translocate to nucelues when bind estrogen
estrogen effects on cholesterol
increase HDL decrease LDL (convert cholesterol to androgens)
theca interna cells
make androgense
granulosa cells
convert androgens to estrogens
-estradiol in ovary, estriol in placenta
which phase of menstrual cycle can vary
follicular
primary oocytes are arrested in
prophase I until ovulation
secondary oocytes are arrested in
metaphase II until fertilization
-if fertilization does not occur within one day secondary oocyte degenrates
implantation occurs x days after fertiliztiaon
6, syncytiotrophoblasts secrete hCG which is detectable in blood 1 week after conception and on home test in urine 2 weeks after conception
exclusively breastfed babies require
vitamin D
bHCG shares same alpha subunit as
LH, FSH, TSH-beta unit is unique and is what is detected with urine pregnancy test
exogenous testosterone
dcreases amount of intratesticular testosterone leading to decreased testicular size and azoospermia
maternal virilization during pregnancy
aromatase deficiency in fetus
-causes increasing amount of androgens
treatment of pre-eclampsia
antihypertensives, IV mag to prevent seizures (alpha methyl dopa, labetolol, ydalizine, nifedipine)
HELLP
hemolysis elevated liver enzymes low platelets
- manifestation of severe pre-eclampsia
- smear shistocytes
- hepatic subcapsular hematomas–>rupture–>severe hypotension
placenta accreta
placenta attaches to myometrium without penetrating it
placenta increta
placenta penetrates into mymoetrium
placenta percreta
placenta penetrates though myometrium and into uterine serosa
-can result in placental attachment to rectum or bladder
placenta previa
attachment of placenta to lower uterine segment over internal cervial os
-painless thrid trimester bleeding
rf for placenta accreta/increta/percreta
prior c section, inflammation, placenta previa
found on US prior to delivery, placenta fails to detach after delivery
placental abruption
abrupt painful bleeding, premature separation of placenta from uterine wall
risk factors: smoking, hypertension, preeclampsia, cocaine use
vasa previa
fetal vessels run over or close to internal cervical os
-risk of vessel rupture, exanguination, death
membrane rupture, painless vaginal bleeding, fetal bradycardia (<110 beats/min)
vasa previa
associated with velamentous umbilical cord insertion: cord inserts into chorioamniotic membrane rather than placenta
-vessels travel to placenta unprotected by wharton jelly
risk factors for ectopic pregnancy
hx of infertility
PID (salpingitis)
ruptured appendix
prior tubal surgery
polyhydramnios associated wtih
>1.5-2L duodenal atresia anencephaly maternal diabetes fetal anemia multiple gestation
oligohydramnios associated with
<0.5L placental insufficiency bilateral renal agenesis posterior urethral valves -cant excrete urine can lead to Potter Sequence
sarcoma botryoides
vaginal tumor that affects girls <4
spindle shaped cells
desmin +
clear, grape-like, polypoid mass emerging from vagina
renal failure and koilocytes
invasive cervical carcinoma
- lateral invasion blocks ureters causing renal failure
- koilocyte-immaure squamous cells with dense, irregularly staining cytoplasm with perinuclear clearing forming a “halo”
skin warts
HPV 1, 4
genital warts
HPV 6, 11
intraepithelial cervical neoplasia
HPV 16, 18, 31, 33, 35 E6–> p53, E7–> Rb
follicular cyst
unruptured graafian follicle
-hyperestogenism, endometrail hyperplasia
most common ovarian mass in young women
theca-lutein cyst
due to gonadotropin stimulation, associated with choriocarcinoma and hydatidiform moles
-usually bilateral/multiple
solid ovarian tumor that is pale yellow-tan and appears encapsulated, coffee bean nuclei on HandE
Brenner tumor, benign ovarian neoplasm
bindles of spindle shaped fibroblasts
fibromas, benign ovarian neoplasm
call exner bodies
granulosa cell tumor
presents with abnml uterine bleeding, sexual precocity, breast tenderness
-estrogen and/or progesterone secreting
sheets of uniform fried egg cells, high hCG, LDH
dysgerminom, most common in adolescents
abnml hCG, shortness of breath, hemoptysis
choriocarcinoma
- rare, can develop after or during pregnancy in mother or baby, malignancy of trophoblastic tissue (cytotrophoblasts, synctiotrophoblasts)
- no chorionic villi
- hemotogenous spread to lungs, very responsive to chemo therapy
yellow, friable mass with schiller duval bodies , high afp
yolk sac (endodermal sinus) tumor
- aggressive, in ovaries or testes and sacrococcygeal area in young children
- afp tumor marker
mucin secreting signet cell adenocarcinoma
Krukenberg tumor
whorled pattern of smooth muscle bundles with well demarcated borders
leiomyoma (fibroid)
-irregularly enlarged uterus
dysmenorrhea, menorrhagia, uniformly soft enlarged globular uterus
adenomyosis
- extension of endometrial tissue (glandular) into myometrium (hypertrophy and hyperplasia)
- enlarged uterus
chocolate cysts, pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia
endometriosis
- infertility
- normal size uterus
inflammed endometrium
endometritis
-due to retained products of conception, IUD, foreign body
endometrial carcinoma risk factors
most common gynecologic malignancy
- p/w vaginal bleeding, age 55-65
- unopposed estrogen use
- obestiy
- diabetes
- hypertension
- nulliparity
- late menopause
- lynch syndrome
serous or bloody nipple discharge
intraductal papilloma
large, bulky breast mass of connective tissue and cysts
phyllodes tumor
drugs that cause gynecomastia
some drugs create awesome knockers
Spironolactone digoxin cimetidine alcohol ketaconazole
solid sheets of pleomorphic cells with central necrosis
comedocarcinoma (a subtype of DCIS)
eczematous patches on nipple
paget disease
-large cells in epidermis with clear halo
stellate infiltration
invasive ductal breast carcinoma
-firm fibrous, rock hard mass, with sharp margins and small glandular, duct like cells
worts and most invasinve
Indian file row of cells
invasive lobular
decreased E cadherin expression
-bitalera with multiple lesions in the same location
sheets of vesicular, plemorphic mitoctically active cells
medullary breast cancer
peau d orange breast
inflammatory breast tumor
-neoplastic cells, block lymphatic drainage, 50% survival at 5 years, often mistaken for mastitis or pagets
meds causing priaprism
sildenifil, trazodone
tx: corporal aspiration, intracavernosal phenylephrine or surgical decompression to prevent ischemia
penile leukoplakia
penile squamous cell carncinoma
-more common in asia, africa, south america
bowenoid papulosis
reddish penile papules,
carcinoma in situ
associated with HPV, lack of circumcision
penile
large cells in lobules with watery cytoplasm and fried egg appearance
increased ALP
seminoma
-malignant painless, homogenous testicular enlargement,
shiller duval bodeis high AFP in testicular mass
yolc sace (endodermal sinus) tumor
male with hemorrhagic stroke, gynecomastia, symptoms of hyperthyroidism
choriocarcinoma
-get hematogenous mets to lungs and brain
hCG can bing TSH receptors
treatment of BPH
alpha antagonists (terazosin, tamsulosin) -smooth muscle relaxation 5alpha reductase inhibitors -finasteride PDE 5 inhibitors
where does prostatic adenocarcinoma most often arise q
posterior lobe of prostate gland
-increase total PSA with decreased fraction of free PSA
leuprolide
GnRH analog agonist if pulsatile antagoinst if continuous used for infertility, prostate cacner, uterine fibroids, percocious puberty toxicity: antiandrogen, nausea, vomiting
ethinyl estradiol
DES
mestranol
estrogen agonists
used for hypogonadism or ovarian failure, menstrual abnormlaities, hormone replacement therapy in post menopausal women, in men with androgen dependent prostate cancer
toxicity: increases risk of endometrial cancer, bleeding in postmenopausal women, clear cell adenocarcinoma of vagina in females exposd to DES in utero, increak risk of thrombi
contraindication +ER breast cancer
clomiphene
antagonist at estrogen hypothalamic receptor
increase LH/FSH causing ovulation
tamoxifen
estrogen antagonist at breast, agonist at bone/uterus, increase risk of thomboembolic events and endometrial cancer
used to treat ER/PR + breast cancer
raloxifene
antagonist at breast/uterus, agonist at bone, increase risk of thromboembolic events but no increased risk of endometrial cancer
used to treat osteoporosis
anastrozole/exemestane
aromatase inhibitors used in postmenopausal women with ER+ breast cancer
