Reproductive Flashcards
1
Q
Shh genes in develoment
A
AP axis and polarizing activity
2
Q
Wnt-7 in development
A
doral ventral paterning (from apical ectoderm)
3
Q
FGF in developmnet
A
mesoderm proliferation to lengthen limbs (from apical ectoderm)
4
Q
Hox in development
A
segmentation of embryo
5
Q
when does hCG secretion begin?
A
within 1 week of development as the blastocyst implants
6
Q
what week is gastrualtion?
A
3
7
Q
kidney origin
A
mesoderm
8
Q
parafollicular C cells of thyroid lineage?
A
neural crest
9
Q
sex organ origins
A
mesoderm
10
Q
adrenal chromaffin cells origin
A
neural crest
11
Q
nucleus pulposus of disc origin
A
notochord
12
Q
Mesodermal defects
A
VACTERL: Vertebral defects, Anal atresia, Cardiac defects, TracheoEsophageal fistula, Renal defects, Limb defects
13
Q
blood cell origin
A
mesoderm
14
Q
Agenesis vs Aplasia
A
Agenesis is due to lack of primordial tissue.
15
Q
When is the fetus most suseptible to teratogens?
A
week 3-8
16
Q
Teratogen: ACE inhib (1)
A
renal damage
17
Q
Teratogen: Alkylating agents (1)
A
absecnce of digits
18
Q
aorticopulmonary septum origin
A
neural crest
19
Q
melanocyte embryonic lineage
A
neural crest
20
Q
Teratogen: aminoglycoside (1)
A
CN 8 tox
21
Q
Teratogen: carbamazepine (4)
A
Also fetal hydratoin syndrome: neural tube defects, craniofacial defects, fingernail hypoplasia, growth restriction
22
Q
Teratogen: Diethylstibestol (2)
A
vaginal clear cell adenocarcinoma, mullerian anomalies
23
Q
Teratogen: Lithium (1)
A
Ebstein’s anomaly (atrialized right ventricle) (Dr. Epstien has no heart)
24
Q
Teratogen: Phenytoin (1…thing)
A
Fetal hydantoin syndrome: microcephaly, dysmorphic craniofacial features, hypoplasic nails, cardiac defects, growth retardation, retardation
25
Teratogen: Tetracyclines (1)
discolored teeth
26
Teratogen: Thalidomide (1)
FLIPPER LIMBS.
27
Teratogen: Valproate (1)
This inhibits folate uptake. Neural tube defects
28
Teratogen: Warfarin (4)
bone deformities, fetal hemorage, abortion, ophthalmoloigcal abnormalities
29
Leading cause of birth defects?
alcohol
30
Teratogen: cocaine (3)
fetal addiction, ab development, placenta abruptio
31
Teratogen: Smoking (4)
preterm labour, placental problems, ADHD, growth retardation
32
Teratogen: Iodine (1)
congential goiter aka hypothyroidism aka cretinism
33
Teratogen: Maternal diabetes (3)
caudal regression syndrome (anal atresia to sirenomelia LOOKS LIKE A MERMAID), congenital heart defects, neural tube defects
34
Teratogen: vitamin A excess (2)
spontaneous abortion and defects
35
Teratogen: X-rays (2)
microcephaly, mental retardation
36
Fetal alcohol syndrome
leading cause of congential defects: mental retardation, development retardation, microcephaly, holoprosencephaly, facial abnormalities, limb dislocations, heart/lung fistulas
37
What secretes hCG?
syncytiotrophoblast
38
umbilical vessels derive from?
allantois
39
umbilical vessels: number, connect, and oxygenation
two arteries which deliever deoxygenated blood from fetal internal iliac arteries.
one vein which brings oxygenated blood from placenta to IVC via ductus venosus
40
what is the urachal duct?
3rd week yolk sac becomes allantois becomes urachus which is a duct between yolk sac and bladder
41
patent urachus
urine discharge from umbiliicus
42
vesicourachal diverticulum
outpouching of bladder
43
vitelline duct function and destiny
7th week this duct which connects yolk sac to midgut lumen is obliterated
44
vitelline fistula
meconium discharge from umbilicus
45
meckel's diverticulum
part of vitelline duct persists to from true diverticulum of ileum. often has gastric mucosa
46
what does the aortic arches become?
arterial system only
47
1st aortic arch
part of maxilliary artery (branch of exernal carotid)
48
2nd aortic arch
Stapedial artery and hyoid artery (Second = Stapedial)
49
3rd aortic arch
3 = C. Common Carotid, and proximal part of interal Carotid artery
50
4th aortic arch
4 limbs (ie systemic). Left: aortic arch. Right: proximal part of right subclavian
51
6th aortic arch
proximal part of pulmonary arteries and ductus arteriosis (left)
52
Brachial cleft origin
ectoderm
53
brachial arch origin
mesoderm and neuro
54
brachial pouch origin
endoderm
55
1st brachial cleft
external auditory meatus
56
2nd - 4th clefts
temporary cervical sinuses. may persists as branchial clet cysts in lateral neck
57
1st branchial arch cartilage
M's: Meckel's cartilage, Mandible, Malleus, incus, sphenoMandibular lig
58
1st branchial arch muscles
M's: Muscles of Mastication (temporalis, masseter, lateral/medial pterygoid) Mylohyoid, anterior of digastric, tensor tympani, tensor veli palatini
59
Brachial Arch Nerves Mnemonic
Chew/V2-3 (1), Smile/7 (2), swallow stylishly/9-stylopharyngeus(3) or simply swallow/10 sup-lary (4) and speak/10-recurrent lar (6)
60
2nd arch cartilage
S's: Stapes, Styloid process, lesser horn of hyoid, Stylohyoid ligament
61
2nd arch muscles
S's: stapedius, stylohyoid, posterior belly of digastric. (facial expression muscles)
62
3rd arch cartilage
greater horn of hyoid
63
3rd arch muscles
styleopharyngeus
64
congential pharyngocutaneous fistula
fistula between tonsillar area and neck. persistance of 3rd branchial cleft and pouch
65
4-6th arch cartilage
thyroid, cricoid, arytenoids, corniculate, cuneifrom
66
4-6th arches muscles
pharyngeal and larynx muscles
67
what makes posterior 1/3 of tongue?
brachial arches 3 and 4
68
1st branchial pouch
middle ear/eustachian tube/mastoid air cells
69
2nd branchial pouch
tonsil epithelium
70
3rd branchial pouch
thymus and INFERIOR parathyroids
71
4th branchial pouch
superior parathyroids
72
DiGeorge syndrome
failure of 3/4 branchial pouches = no t cells and hypocalcemia
73
MEN 2A
mutation to RET in neuracrest. Pheos, parathyoid tumors (3/4 branchial pouchs), parafollicular cell tumor from NC
74
cleft lip vs cleft palate etiologies
lip: fusion of maxillary and medial nasal processes
palate: fusion of lateral/medial palatine process, nasal septum
75
which sex is default?
female
76
mesonephric duct "wolffian" vs paramesonephric duct "Mullerian"
male vs female GU structures
77
SRY gene
on Y chrom produces testies determining factor
78
Sertoli cells secrete _____ and leydig cells secrete ______ which cause
Mullerian inhibitory factor which blocks paramesonephric duct
Androgens which develop mesonephric ducts
79
Bicornuate uterus
incomplete fusion of paramesonephric ducts. heart shaped uterus
80
Hypospadia (what is, and cause)
opening of penis inferiorily.... due to failure of urethral folds to close
81
Epispadia (what is, cause, and association)
opening of penis above. faulty positioning of genital tubercle, bladder exstrophy (outside body)
82
descent of the testes: gubernaculum and process vaginalis
anchors testes within scrotum and forms tunica vaginals
83
descent of the ovaries: gubernaculum and process vaginalis
ovarian ligament + round ligament of uterus. obliterated
84
Venous drainage of gonads
left -> left gonadal vein -> left renal -> IVC
right -> right gonadal -> IVC
(just like adrenal veins)
85
which gonadal vein has higher pressure and risk
left cause of 90 degree entry point. varicocele more common
86
ovaries/testicular lymphatic drainage
para aortic nodes
87
outside of vagina and scrotum lymphatic drainage
superficial inguinal nodes
88
inside of vagina and utereus lymph nodes
obturator, external iliac and hypogastric nodes
89
Suspensitory ligament of ovary contains
Ovarian vessels
90
Cardinal ligament contains
Uterine vessels
91
Round ligament contains
Artery of Sampson
92
Broad ligament contains
Ovaries, Fallopian tubes and round ligament
93
Vagina and ectocervix histology
Stratified squamous
94
Endocervix histology
Simple columnar
95
Uterus histology
Simple columnar tubular glands
96
Fallopian tube histology
Simple columnar ciliated
97
Ovary histology
Simple cuboidal
98
Route Sperm takes
Seven up: seminiferous, epididymis, vas deferens, ejaculatory duct , (nothing), urethra, penis
99
Erection pathway
Parasympathetic via pelvic nerve. Increase NO then cGMP.
100
Emission (penis) pathway
Sympathetic via hypogastric nerve
101
Ejaculation pathway
Visceral and somatic nerves via pudendal nerve
102
Sildenafil and vardenafil
Inhibit cGMP breakdown so you won't have a limp dick
103
Sertoli cell function (6)
Inhibin which blocks FSH
Androgen binding protein to maintain high androgen
Tight junctions to create blood tested barrier
Nourish developing sperm
Antimullerian hormone
Temp sensitive
104
Sperm development
Spernatagonium-tight junction-> primary (diploid)-> seconday (haploid ) spermatocyte -> split into spermatid-> (lumen) spermatozoon
105
Ant pituitary on testies
LH- stims leydigs to make testosterone
| FSH- stims sertoli go make ABP and Inhibin
106
Hypothalamus released _______ to stim AP to stim testies
GnRH
107
what converts testosterone to DHT? what inhibits it
5alpha-reductase. Finasteride
108
what makes estrogen peripherally?
testosterone is converted to estrogen in adipose and leydig by aromatase
109
what does exogenous testosterone do?
inhibit hypothalamus so less LH less testosterone in testicle and tiny balls
110
estrone vs estradiol vs estriol potency
estradiol > estrone >estriol
111
estradiol source
ovary
112
estriol source
placenta
113
androstenedione source
adrenal (weak ass testosterone)
114
what indicates fetal well being?
1000X estriol
115
estrogen effects on prolatin
upregulates it but blocks effects at breast
116
estrogen effect on LH and FSH
feedback inhib
117
carrier of estrogen and special fact
SHBG upregulated by estrogen
118
what makes progestrone?
corpus luteum, placenta, adrenal cortex, testes
119
high progesterone means what?
ovulation
120
progestrone effects
maintain prego, decrease myometrial excitability, thick cervical mucus to block sperm, inhibit LH/FSH, decrease estrogen receptor
121
how is estrogen made in ovaries
pulsatile GnRH promotes LH and FSH. LH activates Desmolase in Theca cells to Cholestrol --> Androstenedione. transported to granulosa cell which under influence of FSH aromatase makes estrogen
122
tanner development stages
I: childhood II: public hair, breast buds III: public hair darkens, penis longer, breast larger IV: penis wider, darker scrotum, raised areolae, development of glans V: adult
123
Stable vs unstable period of menstrual cycle
Variant follicular stage + 14 day luteal phase
124
What stimulates endometrial growth?
Estrogen
125
Estrogen during menst cycle
Slowly rises to peak at ovulation to promote continuous endometrial growth. Then falls and peaks again with progesterone
126
Progesterone during men cycle
Rises after ovulation to maintain endometrium then falls off.
127
LH during men cycle
One sharp peak at ovulation
128
FSH during men cycle
Small FSH peaks preceded both estrogen peaks
129
Describe ovulation
Increased GnRH on ant pit causing estrogen surge. Causes LH surge causes ovulation. Then temp increases causing progesterone surge.
130
Mittelschmerz
Ovulation blood causes peritoneal inflammation mimicking appendicitis
131
When does the egg pause?
Prophase I till puberty. Metaphase II after ovulation
132
Fertilization timing and location and implant timing
Within a day of ovulation at upper end (ampulla) of Fallopian tube. Implants six days later
133
Lactation initiation and maintenance
After labor progesterone drops so lactation not inhibited. Need suckling to maintain to stim nerves and oxytocin and prolactin
134
hCG function
Maintain corpus luteum
135
Pathological hCG elevation (3)
Dysgerminoma, choriocarcinoma, hydatidiform mole
136
Menopause indicator
High FSH
137
What causes menopause?
Low estrogen due to decline in ovarian follicles
138
Klinefelter syndrome
XXY. Eunuch body type (the spider) but tall long, boobs. High FSH and estrogen in male.
139
Turner syndrome
XO. Short, streak ovary, shield chest, bicuspid aortic valve, webbing of neck due to lymph problems, horseshoe kidney, coarctation of aorta.
140
XYY male
Very tall, antisocial, acne
141
How do testosterone and LH react to each other?
T stims T recept which inhibits LH. LH stims T release.
142
what is a pseudohemaphrodite? male vs female
disagreement between internal and external genetalia. XY but looks like a female (but with testes) or XX but looks male
143
true hermaphrodite
both ovary and testies. 46 XX or 47 XXY
144
androgen insensitivity syndrome
XY female with rudimentary vagina. testes in labia
145
kallmann syndrome
defective migration of GnRH cells and olfaction bulb. anosmia, no secondary sexual characteristics, no GnRH
146
Honeycombed uterus or cluster of grapes
hydratidiform mole
147
hydratidiform mole precursor of
choriocarcinoma
148
abnormal vaginal bleeding and high beta-hCG
hydatidyl mole (cystic swelling of chorionic villi)
149
snow storm appearance
hydatidiform mole
150
treatment of hydatidiform mole treatment
treat like abortion: dialation, curettage, and methotrexate
151
complete hydatidyl mole: hCG, uterine size, cancer, fetal parts, components, karyotype
very high hCG, leads to choriocarcinoma, no fetal parts, 2 sperm + empty egg, 46 XX/XY (normal), uterine enlarged
152
partial hydatidyl mole: hCG, uterine size, cancer, fetal parts, components, karyotype
slightly high hCG, 69 XXX/XXY/XYY, normal uterus, rare cancer, yes fetal parts, 2 sperm + 1 egg
153
preeclampsia features
hypertension, proteinuria, edema
154
eclampsia features
preeclampsia + seizures
155
HELP syndrome
Hemolysis, Elevated Liver enzymes, Low Platelets seen in pregnancy and associated with preeclampsia
156
preeclampsia presentation
headache, blurred vision, ab pain, facial edema and limbs, altered mentation, hyperreflexia.
157
preeclampsia mortality risk
cerebral hemorrhage and ARDS
158
treatment for preeclampsia
deliever as soon as possible, MgSO4 (for seizures), and rest
159
abruptio placentae
detachment of placenta. associated with cocaine, smoking, and hypertension, and DIC. life threatening for both
160
painful bleeding in 3rd trimester
Abruptio placenta
161
massive bleeding after delievery
placenta accreta
162
painless bleeding during any trimester
placenta previa
163
placenta accreta
placenta stuck to myometrium due to failure of decidual layer (previous C section). massive bleeding after birth
164
placenta previa
placenta blocks cervical os. painless bleeding any trimester
165
retained placental tissue may cause
hemorrage or infxn
166
ectopic pregnancy common site
fallopian tubes
167
ectopic pregnancy clues
history of amenorrhea, low hCG, sudden ab pain like appendeciitis, no chorionic villia
168
ectopic pregnancy risk factrs
history of infertility, PID (Salpingitis), ruptured appendix, tubal surgery
169
cause of poly vs oligo hydramnios
poly can't swallow, oligo cant pee (or placental insufficency)
170
HPV 16 inhibits
p53 by E6
171
HPV 18 inhibits
RB by E7
172
cervical in situ carcinomas
CIN 1,2,3 (progressively worse)
173
risks for cervical cancer
multiple sexual partners, smoking, early sex, HIV
174
cervical koilocytes
squamous cell carcinoma of cervix
175
most common carcinoma of cervix and cause what?
SCC. can block ureters
176
endrometritis treatment
gentamycin + clindamycin with or without ampicillin
177
endrometriosis
ectopic endometral tissue (ovary or peritoneum). chocolate cysts
178
abnormal cyclical bleeding, painful intercourse, infertility, severe menstrual pain
endrometriosis
179
endometriosis treatment
oral contraceptives, NSAIDS, leuprolide, danazol
180
Endometriosis vs Adenomyosis?
endometriosis is ectopic extra uterine. adenomyosis is in myometrium so uterus is enlarged. requires hysterectomy
181
what causes endometrial hyperplasia? presentatoin?
excess estrogen, postmenopausal bleeding
182
prolonged use of estrogen without progestins?
endometrial carcinoma
183
most common gynocological malignancy
endometrial carcinoma
184
leiomyoma
fibroid. benign tumor of smooth muscle which swells with estrogen. doesn't progress. more common in blacks
185
leiomyosarcoma
highly agressive tumor of myometrium
186
gynecological tumor epidemiology
incidence: endomet > ovary > cervical (in US, cerv worldwide)
worse prognosis: ovarian > cervical > endometrial
187
causes of anovulation ranked: name first 4
pregnancy, polycystic ovarian syndrome, obesity, HPO axis problem, premature ovarian failure, hyperprolactinemia, thyroid disorder, eating disorder, cushings, adrenal insufficency
188
polycystic ovarian disease etiology
high LH leads to anovulation, low progesteron and theca cell androgen production (via high estrogen). associated with insulin resistance
189
bilateral ovarian cysts, hirsutism, amenorrhea, infertlity
polycystic ovarian disease
190
polycystic ovarian disease can lead to
endometrial cancer due to high estrogen
191
treatment of polycystic ovarian disease
weight loss, low dose OCP or medroxyprogestrone, spironolactone (hirutism antag), clomiphine (help infertility), metformim (if diabetic too)
192
most common ovarian mass in young women
follicular cyst (distended graafin follicule that is unruptured) due to high estrogen
193
cyst associated with high GnRH
theca-lutein cyst
194
most common ovarian germ cell tumor
teratoma
195
teratoma types
mature (dermoid cyst): most common; immature teratoma: agressive; struma ovarii: has thyroid tissue (hyper thyroid)
196
dysgerminoma
female version of seminoma. rare, sheets of uniform cells. turner sydrome. rare
197
choriocarcinoma
malignancy of trophoblastic tissue with no chorionic villi. high hCG. endometriosis assocaition. Met to lungs
198
yolk sac tumor
aggressive tumor of ovaries or testes. yellow, friable solid mass. high AFP. have Duval bodies which look like glomeruli.
199
Krukenberg tumor
GI malignancy that mets to ovaries. mucin-secerting signet cells in ovaries
200
serous cystadenoma vs adenocarcinoma
45% ovarian tumors each. fallopian tube-like lining. carcinoma has psammoma bodies. risks are BRCA1/2,HNPCC. frequently bilateral
201
mucinous cystadenoma/adenocarcinoma
mucus secreting tumors
202
CA-125
marker for ovarian cancer progression (not for screening)
203
Brenner tumor
Benign, unilateral, looks like bladder. pale-yellow-tan gross and encapsulated coffee bean on H&E
204
Meigs syndrome
triad of ovarian fibromas, ascites, and hydrothorax
205
Granulosa cell tumor
secretes estrogen, causes precocious puberty, endometrial hyperplasia.
206
Call-Exner bodies
small follicles filled with eosinophilic secretions found in granulosa cell tumors
207
vaginal squamal cell carcinoma
usually secondary to cervicall SCC
208
vaginal clear cell carcinoma
DES exposure in utero
209
vaginal sarcoma botryoides
girls under the age of 4. spindle-shapped tumors that are desmin positive
210
most common breast tumor
fibroadenoma (benign)
211
benign breast tumor: small, mobile, firm mass with sharp edges. increases in size with estrogen
fibroadenoma
212
benign breast tumor which is small and grows in the lactiferous ducts typically beneath areola. has bloodly discharge from nipple
intraductal papilloma
213
large bulky breast tumor with lots of connective tissue and cysts. "leaf like" projections
phyllodes tumor. some may become malignant
214
most important factor regarding the prognosis of malgnant breast cancer?
axillary lymph node mets
215
most common location of breast cancer
upper-outer quadarnt
216
Ductal carcinoma in situ
non-invasive tumor which fills ductal lumen (its just an early lesion, it will progress)
217
comedocarcinoma
DCIS with caseous necrosis
218
worst breast cancer
invasive ductal carcinoma
219
most common breast cancer
invasive ductal
220
breast cancer: firm, fibrous, "rock hard" mass with sharp margins and small, glandular duct-like cells
invasive ductal carcinoma
221
breast cancer with "stellate" morphology
invasive ductal
222
breast cancer with "indian file" orderly row of cells
invasive lobular
223
the bilateral breast cancer
invasive lobular
224
breast cancer that is fleshy, cellular, lymphocytic? prognosis?
medullary. good.
225
breast cancer with skin involvement. "orange peel" skin
Inflammatory breast cancer
226
Eczematous patches on nipple. Distinctive large cells with clear halo
Paget's disease of the breast.
| "I can see your halo! HALO! HALOOOOO!"
227
Fibrocystic disease
most common cause of breast lumps. change size but are safe. different types
228
infxn risk during breast feeding
acute mastitis. S. aureus
229
drugs which give guys bitch tits (gynecomastia)
Some Drugs Create Awkward Knockers: Spironolactone, Digitalis, Cimetdine, Alcohol, Ketoconazole
230
is BPH hypertrophy or hyperplasia?
hyperplasia (more cells)
231
how to diagnose prostate adenocarcinoma
high PSA or PAP followed by biopsies. osteoblastic mets in bone develop in late sage causing lower back pain (Alk Phos signifies this)
232
cryptorchidism
undecent of one or both testes. leydigs work fine but sertolis don't. impaired spermatogenisis
233
varicocele
enlargment of testicles (#1) due to venous blockage. "bag of worms" appearance
234
testicular tumor painless homogeneous enlargment, most common, large cells with watery cytoplasm, "Fried egg" appearance. high alk phos
seminoma, treat with radiation
235
yolk sac tumor in males
same as females. yellow egg. "duval bodies that look like glomerulii (high AFP)
236
male choriocarcinoma
high hCG which mets to the lungs. gynecomastia
237
male teratoma
malignant unlike female version
238
malignant painful male testicular tumor
embryonal carcinoma
