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Step 1 > Reproductive > Flashcards

Reproductive Flashcards

1
Q

most common causes of eugonadotropic amenorrhea

A

Mullerian duct anomalies or imperforate hymen

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2
Q

streak ovaries

A

turners syndrome

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3
Q

testicular feminization

A

aka androgen insensitivity
46XY appear phenotypically female, have a blind end vaginal pouch with no uterus
due to insensitive testosterone receptors

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4
Q

how can turners pts become pregnant

A

with donor oocyte, and they require hormonal supplementation during pregnancy to maintain uterine lining (estrogen and progesterone)

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5
Q

sonic hedgehog

A

patterning along anterior posterior axis, CNS mt holoprosencephaly

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6
Q

wnt 7

A

produced at apical ectodermal ridge necessary for dorsal ventral axis

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7
Q

FGF

A

lengthening of limbs

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8
Q

homebox (Hox) genes

A

segmental organization of embryo in craniofacial direction

-mt appendages in wrong locations

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9
Q

ectoderm:
surface
neuroectoderm
neural crest

A

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

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10
Q

mesoderm

A 
defects=VACTERL 
vertebral 
anal atresia 
cardiac defects 
tracheoesophageal fistulas 
Renal defects
limbs defects 
also spleen, vagina, testes, ovaries, adrenal cortex, dermis
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11
Q

endoderm

A

Enternal layer
-gut tube epithelium, urethra, luminal epithelial derivatives-lungs, liver, bladder, pancreas, eustachain tube, thymus, parathyroid, thyroid follicular cells

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12
Q

teratogen: renal damage

A

ACEi

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13
Q

teratogen: absence of digits, + other anomalies

A

alkylating agents

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14
Q

teratogen: CN VIII toxicity

A

aminoglycosides

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15
Q

teratogen: facial dysmorphism, developmental delay, NTDs, phalanx/fingernail hypoplasia

A

carbamazepine

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16
Q

teratogen: vaginal clear cell adenocarcinoma, congenital mullerian anomalies

A

DES

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17
Q

teratogen: NTDs

A

folate antagonists

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18
Q

ebstein anomaly

A

lithium

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19
Q

teratogen: aplasia cutis congenita (congenital focus of epidermis with or without other skin layers)

A

methimazole

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20
Q

cleft palate, cardiac defects, phalanx/fingernail hypoplasia

A

phenytoin

-fetal hydantoin syndrome

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21
Q

discolored teeth, teratogen

A

tetracycline

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22
Q

teratogen: limb defects, phocomelia, micromelia, “flipper” limbs

A

thalidomide

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23
Q

NTDs

A

valproate-inhibits maternal folate absorption

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24
Q

bone defromities, fetal hemorrhage, abortion, opthalmologic abnormalities

A

warfarin

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25
Q

caudal regression syndrome

A

in babies with mother with diabetes

anal atresia to sirenomelia (mermaid syndrome)

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26
Q

microcephaly and intellectual disability

A

X ray exposure

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27
Q

hypertelorism, limb dislocation, heart-lung fistulas, holoprosencephaly, smooth philtrum

A

Fetal alcohol syndrome

failure of cell migration

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28
Q

which placental component lacks MHC 1 expression

A

syncytiotrophoblast-outer layer of chorionic villi

-secretes hCG (stimulates corpus luteum to secrete progesterone during the first trimester)

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29
Q

cytotrophoblast

A

inner layer of chorionic villi, makes cells

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30
Q

decidual basalis

A

maternal component of placents, derived from endometrium, maternal blood in lacunae

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31
Q

urachus

A

formed from the allantois during the 3rd week, duct between fetal bladder and yolk sac (bladder to umbilical cord)

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32
Q

vitelline duct

A

omphalomesenphric duct

connects midgut lumen to yolk sac (umbilicus)

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33
Q

meckel diverticulum

A

partial failure of vitelline duct closure (tur diverticulum)

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34
Q

1st aortic arch derivative

A

maxillary (branch of external carotid)

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35
Q

2nd aortic arch derivative

A

stapedial artery and hyoid artery

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36
Q

3rd aortic arch derivative

A

Carotids-common carotid and proxmial part of internal carotid

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37
Q

4th aortic arch derivative

A

on left-aortic arch

on right-proximal part of right subclavian artery

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38
Q

CAP

A

clefts=ectoderm
arches=mesoderm
pouches=endoderm

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39
Q

6th aortic arch derivative

A

proximal part of pulmonary arteries and ductus arteriosus

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40
Q

failure of closure of maxillary and medial nasal processed

A

cleft lip

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41
Q

failure of fusion of two lateral palatine processes OR failure of fusion of lateral palatine processes with nasal septum and/OR median palatine process

A

cleft palate

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42
Q

teacher collins syndrome

A

failure of first arch to migrate-mandibular hypoplasia ,facial abnormalities, FTT

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43
Q

congential pharyngocutaneous fistula

A

persistence of cleft and pouch–> fistula between tonsillar area and lateral neck

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44
Q

female genital development

A

(default) mesonephric duct degenerates and paramesonephric duct develops

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45
Q

male genital development

A

-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

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46
Q

no sertoli cells or lack of MIF

A

get both female and male internal genitalia and male external genitalia

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47
Q

no 5 alpha reductase

A

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)

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48
Q

septate uterus

A

incomplete resorption of the septum

decreses fertility-septoplasty

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49
Q

bicornuate uterus

A

incomplete fusion of mullerian ducts

increases risk of complicated pregnancy

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50
Q

uterus didelphys

A

complete failure of fusion of mullerian ducts, double uterus, vaina, and cervia-pregnany possible

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51
Q

hypospadis

A

failure of urethral folds to fuse leaving an abnormal opening of penile urethra on ventral surface of penis
-associated with inguinal hernia and cryptorchidism

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52
Q

epispadis

A

abnormal opening of penile urethra on dorsal surface due to faulty positioning of gential tubercle
assocaited with exstrophy of the bladder

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53
Q

gubernaculum

A

anchors testes with scrotum

like female ovarian ligament and round ligament of uterus

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54
Q

processus vaginalis

A

forms tunica vaginalis in males and is obliterated in females

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55
Q

infundibulopelvic ligament

A

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

56
Q

cardinal ligament

A

cervix to side wall of pelvis
-contains uterine vessels
gubernaculum derivative
continas sampson artery

57
Q

boroad ligament

A

mesometrium, mesosalpinx, mesovarium-uterus, fallorian tubes and ovaries to pelvic side wall
contains ovaries, fallopian tubes, round ligament of uterus

58
Q

ovarian ligament

A

medial pole of ovary to lateral uterus

59
Q

vagina

A

stratified squamous epithelium

-contains glycogen

60
Q

ectocervix

A

stratified squamous epithelium

61
Q

transformation zone

A

squamocolumnar junction -most common area for cervial cancer

62
Q

endocervix

A

simple columnar epithelium

63
Q

uterus

A

simple pseudostratified columnar epithelium

64
Q

fallopian tube

A

simple columnar epithelium

65
Q

ovary

A

simple cuboidal epithelium

66
Q

pathway of sperm during ejactulation

A 
SEVEN UP 
seminiferous tubules 
epididymis 
vas deferens
ejaculatory ducts 
(nothing)
urethra 
penis
67
Q

blood at urethral meatus

A

urethral injury most likely at membranous portion from pelvic fracture
-bulbular urethra prone to blunt force

68
Q

anterior urethral injury

A

straddle injury

urine leak beneath deep fascia (facia of Buck)

69
Q

autonomic innervation of male sexual response

A

erection-parasympathetic via pelvic nerve (through No and cGMP)
emission-sympathetic via hypogastric
ejaculation-via pudendal

70
Q

where are estrogen receptors found

A

cytpolasm, translocate to nucelues when bind estrogen

71
Q

estrogen effects on cholesterol

A

increase HDL decrease LDL (convert cholesterol to androgens)

72
Q

theca interna cells

A

make androgense

73
Q

granulosa cells

A

convert androgens to estrogens

-estradiol in ovary, estriol in placenta

74
Q

which phase of menstrual cycle can vary

A

follicular

75
Q

primary oocytes are arrested in

A

prophase I until ovulation

76
Q

secondary oocytes are arrested in

A

metaphase II until fertilization

-if fertilization does not occur within one day secondary oocyte degenrates

77
Q

implantation occurs x days after fertiliztiaon

A

6, syncytiotrophoblasts secrete hCG which is detectable in blood 1 week after conception and on home test in urine 2 weeks after conception

78
Q

exclusively breastfed babies require

A

vitamin D

79
Q

bHCG shares same alpha subunit as

A

LH, FSH, TSH-beta unit is unique and is what is detected with urine pregnancy test

80
Q

exogenous testosterone

A

dcreases amount of intratesticular testosterone leading to decreased testicular size and azoospermia

81
Q

maternal virilization during pregnancy

A

aromatase deficiency in fetus

-causes increasing amount of androgens

82
Q

treatment of pre-eclampsia

A

antihypertensives, IV mag to prevent seizures (alpha methyl dopa, labetolol, ydalizine, nifedipine)

83
Q

HELLP

A

hemolysis elevated liver enzymes low platelets

  • manifestation of severe pre-eclampsia
  • smear shistocytes
  • hepatic subcapsular hematomas–>rupture–>severe hypotension
84
Q

placenta accreta

A

placenta attaches to myometrium without penetrating it

85
Q

placenta increta

A

placenta penetrates into mymoetrium

86
Q

placenta percreta

A

placenta penetrates though myometrium and into uterine serosa
-can result in placental attachment to rectum or bladder

87
Q

placenta previa

A

attachment of placenta to lower uterine segment over internal cervial os
-painless thrid trimester bleeding

88
Q

rf for placenta accreta/increta/percreta

A

prior c section, inflammation, placenta previa

found on US prior to delivery, placenta fails to detach after delivery

89
Q

placental abruption

A

abrupt painful bleeding, premature separation of placenta from uterine wall
risk factors: smoking, hypertension, preeclampsia, cocaine use

90
Q

vasa previa

A

fetal vessels run over or close to internal cervical os

-risk of vessel rupture, exanguination, death

91
Q

membrane rupture, painless vaginal bleeding, fetal bradycardia (<110 beats/min)

A

vasa previa
associated with velamentous umbilical cord insertion: cord inserts into chorioamniotic membrane rather than placenta
-vessels travel to placenta unprotected by wharton jelly

92
Q

risk factors for ectopic pregnancy

A

hx of infertility
PID (salpingitis)
ruptured appendix
prior tubal surgery

93
Q

polyhydramnios associated wtih

A 
>1.5-2L 
duodenal atresia
anencephaly 
maternal diabetes
fetal anemia 
multiple gestation
94
Q

oligohydramnios associated with

A 
<0.5L
placental insufficiency 
bilateral renal agenesis 
posterior urethral valves 
-cant excrete urine 
can lead to Potter Sequence
95
Q

sarcoma botryoides

A

vaginal tumor that affects girls <4
spindle shaped cells
desmin +
clear, grape-like, polypoid mass emerging from vagina

96
Q

renal failure and koilocytes

A

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”
97
Q

skin warts

A

HPV 1, 4

98
Q

genital warts

A

HPV 6, 11

99
Q

intraepithelial cervical neoplasia

A

HPV 16, 18, 31, 33, 35 E6–> p53, E7–> Rb

100
Q

follicular cyst

A

unruptured graafian follicle
-hyperestogenism, endometrail hyperplasia
most common ovarian mass in young women

101
Q

theca-lutein cyst

A

due to gonadotropin stimulation, associated with choriocarcinoma and hydatidiform moles
-usually bilateral/multiple

102
Q

solid ovarian tumor that is pale yellow-tan and appears encapsulated, coffee bean nuclei on HandE

A

Brenner tumor, benign ovarian neoplasm

103
Q

bindles of spindle shaped fibroblasts

A

fibromas, benign ovarian neoplasm

104
Q

call exner bodies

A

granulosa cell tumor
presents with abnml uterine bleeding, sexual precocity, breast tenderness
-estrogen and/or progesterone secreting

105
Q

sheets of uniform fried egg cells, high hCG, LDH

A

dysgerminom, most common in adolescents

106
Q

abnml hCG, shortness of breath, hemoptysis

A

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
107
Q

yellow, friable mass with schiller duval bodies , high afp

A

yolk sac (endodermal sinus) tumor

  • aggressive, in ovaries or testes and sacrococcygeal area in young children
  • afp tumor marker
108
Q

mucin secreting signet cell adenocarcinoma

A

Krukenberg tumor

109
Q

whorled pattern of smooth muscle bundles with well demarcated borders

A

leiomyoma (fibroid)

-irregularly enlarged uterus

110
Q

dysmenorrhea, menorrhagia, uniformly soft enlarged globular uterus

A

adenomyosis

  • extension of endometrial tissue (glandular) into myometrium (hypertrophy and hyperplasia)
  • enlarged uterus
111
Q

chocolate cysts, pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia

A

endometriosis

  • infertility
  • normal size uterus
112
Q

inflammed endometrium

A

endometritis

-due to retained products of conception, IUD, foreign body

113
Q

endometrial carcinoma risk factors

A

most common gynecologic malignancy

  • p/w vaginal bleeding, age 55-65
  • unopposed estrogen use
  • obestiy
  • diabetes
  • hypertension
  • nulliparity
  • late menopause
  • lynch syndrome
114
Q

serous or bloody nipple discharge

A

intraductal papilloma

115
Q

large, bulky breast mass of connective tissue and cysts

A

phyllodes tumor

116
Q

drugs that cause gynecomastia

A

some drugs create awesome knockers

Spironolactone digoxin cimetidine alcohol ketaconazole

117
Q

solid sheets of pleomorphic cells with central necrosis

A

comedocarcinoma (a subtype of DCIS)

118
Q

eczematous patches on nipple

A

paget disease

-large cells in epidermis with clear halo

119
Q

stellate infiltration

A

invasive ductal breast carcinoma
-firm fibrous, rock hard mass, with sharp margins and small glandular, duct like cells
worts and most invasinve

120
Q

Indian file row of cells

A

invasive lobular
decreased E cadherin expression
-bitalera with multiple lesions in the same location

121
Q

sheets of vesicular, plemorphic mitoctically active cells

A

medullary breast cancer

122
Q

peau d orange breast

A

inflammatory breast tumor

-neoplastic cells, block lymphatic drainage, 50% survival at 5 years, often mistaken for mastitis or pagets

123
Q

meds causing priaprism

A

sildenifil, trazodone

tx: corporal aspiration, intracavernosal phenylephrine or surgical decompression to prevent ischemia

124
Q

penile leukoplakia

A

penile squamous cell carncinoma

-more common in asia, africa, south america

125
Q

bowenoid papulosis

A

reddish penile papules,
carcinoma in situ
associated with HPV, lack of circumcision

126
Q

penile
large cells in lobules with watery cytoplasm and fried egg appearance
increased ALP

A

seminoma

-malignant painless, homogenous testicular enlargement,

127
Q

shiller duval bodeis high AFP in testicular mass

A

yolc sace (endodermal sinus) tumor

128
Q

male with hemorrhagic stroke, gynecomastia, symptoms of hyperthyroidism

A

choriocarcinoma
-get hematogenous mets to lungs and brain
hCG can bing TSH receptors

129
Q

treatment of BPH

A 
alpha antagonists (terazosin, tamsulosin) 
-smooth muscle relaxation 
5alpha reductase inhibitors 
-finasteride 
PDE 5 inhibitors
130
Q

where does prostatic adenocarcinoma most often arise q

A

posterior lobe of prostate gland

-increase total PSA with decreased fraction of free PSA

131
Q

leuprolide

A 
GnRH analog 
agonist if pulsatile 
antagoinst if continuous 
used for infertility, prostate cacner, uterine fibroids, percocious puberty 
toxicity: antiandrogen, nausea, vomiting
132
Q

ethinyl estradiol
DES
mestranol

A

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

133
Q

clomiphene

A

antagonist at estrogen hypothalamic receptor

increase LH/FSH causing ovulation

134
Q

tamoxifen

A

estrogen antagonist at breast, agonist at bone/uterus, increase risk of thomboembolic events and endometrial cancer
used to treat ER/PR + breast cancer

135
Q

raloxifene

A

antagonist at breast/uterus, agonist at bone, increase risk of thromboembolic events but no increased risk of endometrial cancer
used to treat osteoporosis

136
Q

anastrozole/exemestane

A

aromatase inhibitors used in postmenopausal women with ER+ breast cancer

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