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STEP > Reproductive > Flashcards

Reproductive Flashcards

1
Q

1st sign of puberty in males

A

increase in testicular size

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2
Q

1st sign of puberty in females

A

thelarche (onset of breast development)

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3
Q

Child orients to voice by…

A

4 months

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4
Q

Child orients to name and gestures by…

A

9 months

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5
Q

Rapprochement

A

Moving away from mom and coming back. By 2 years.

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6
Q

Language at 3 years

A

3-word sentences + 1,000 words + speech 75% intelligible

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7
Q

Counts to 10 by…

A

5 years

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8
Q

Prints letters by..

A

5 years

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9
Q

Oxytocin function

A

1) stimulates labor
2) uterine contractions
3) milk let-down
4) controls uterine hemorrhage

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10
Q

rectocele

A

Tear in the rectovaginal septum. Occurs in childbirth or hysterectomy.

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11
Q

Surfactant production begins…

A

Week 26, but mature levels not achieved until around week 35.

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12
Q

surfactant components

A

Complex mix of lecithings, the most important of which is dipalmitoylphosphatidylcholine.

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13
Q

What inhibits lactation before birth?

A

Progesterone (this is why retained placental tissue will inhibit lactation) AND estrogen. Both stimulate prolactin production, but block the action of prolactin on the breast.

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14
Q

If a woman can’t lactate after childbirth think…

A

Sheehan’s

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15
Q

What stimulates uterine contractions?

A

1) oxytocin, but only in third trimester and after cervix is dilated.
2) PGI2 stimulates uterine contractions prior.

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16
Q

Cystocele

A

Fibrous wall between bladder and vagina is torn by childbirth, allowing the bladder to herniate into the vagina. This causes a bulge of the anterior vaginal wall.

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17
Q

Rectocele

A

Tear in the rectovaginal septum. Rectal tissue bulges through tear and into vagina as hernia. Usually during childbirth or hysterectomy.

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18
Q

Autonomic innervation of the male sexual response

A

• /point and shoot erection, parasympathetic, ejaculation, sympathetic. Midget chef travelling out of his dick/emission (sperm moving from testes into prostatic urethra) = SNS, hypogastric. Beating off into a big bowl of pudding/ejaculation (sperm moving from prostatic urethra to outside) = visceral and somatic nerves, pudendal.
Location: Travis Krogman’s basement

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19
Q

When and why does body temperature increase occur?

A

Basal body temperature significantly increases shortly after ovulation, due to metabolic effects of progesterone produced by the corpus luteum. Progesterone acts at thermal regulatory center of hypothalamus. Basal body temperature remains high during the luteal phase of the menstrual cycle but falls precipitously a few days before the onset of menstruation.

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20
Q

Hysterosalpingogram + analyzing results.

A

1) injecting contrast medium into the uterus.
2) If the fallopian tubes are open, the contrast medium will fill the tubes and spill out into the abdominal cavity. Thus contrast in the abdominal cavity is normal. If they’re blocked, then contrast medium will not spill out.

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21
Q

What determines development of Wolffian ducts?

A

Testosterone

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22
Q

How does LH increase testosterone synthesis?

A

Stimulating cholesterol desmolase.

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23
Q

What secretes GnRH?

A

Arcuate nuclei of hypothalamus.

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24
Q

Negative feedback of FSH secretion?

A

Inhibin

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25
Q

testosterone precursor

A

androstenedione

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26
Q

LH inhibition

A
  • testosterone inhibits LH secretion by inhibiting release of GnRH
    AND inhibiting release of LH
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27
Q

Growth of prostate regulated by…

A

DHT

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28
Q

Variation in FSH and LH levels over life span (male and female)

A

Childhood – FSH greater than LH.
Puberty and reproductive years – LH greater than FSH
Senescence – FSH greater than LH.

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29
Q

Estrogen biosynthesis

A

Cholesterol –> pregnenolone –> androgens in theca cells. Androgens diffuses to granulose cells, where it is aromatized to estrogen.

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30
Q

Estrogen action in phase of menstrual cycle

1) follicular
2) midcycle
3) luteal

A

1) negative feedback on anterior pituitary
2) positive feedback on anterior pituitary
3) negative feedback on anterior pituitary

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31
Q

Estrogen and prolactin

A

Estrogen stimulates prolactin secretion but then blocks its action on the breast.

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32
Q

uterine threshold to contractile stimuli during pregnancy

A

Estrogen lowers the uterine threshold to contractile stimuli during pregnancy; progesterone raises the uterine threshold to contractile stimuli during pregnancy. Near term the estrogen/progesterone ratio increases, which makes the uterus more sensitive to contractile stimuli.

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33
Q

Follicular phase

A

1) primordial follicle develops to the graafian stage.
2) LH and FSH receptros are up-gregulated in theca and granulosa cells
3) Estradiol levels increase and cause proliferation of the uterus
4) FSH and LH are suppressed by effect of estradiol
5) progesterone is low.

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34
Q

ovulation in relationship to menses

A

always 2 weeks prior to menses, regardless of cycle length

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35
Q

estrogen levels in follicular and luteal phase

A

rise just prior to ovulation, then drop, then rise again during luteal phase.

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36
Q

cervical mucus during ovulation

A

Increases in quantity, becoming less viscous and more penetrable by sperm.

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37
Q

Luteal phase changes

A

1) corpus luteum develops
2) vasculatory and secretory activity of endometrium increases
3) rise in basal body temp

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38
Q

corpus luteum secretes…

A

estrogen + progesterone

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39
Q

Why does menses occur?

A

Abrupt withdrawal of estradiol and progesterone.

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40
Q

placenta secretes…

A

hCG

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41
Q

Pregnancy hormones

A

steadily rising estrogen + progesterone

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42
Q

progesterone synthesis during pregnancy

A

corpus luteum in 1st trimester, placenta in second and third

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43
Q

major placental estrogen

A

estriol

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44
Q

How is lactation maintained?

A

Suckling, which stimulates both oxytocin and prolactin secretion.

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45
Q

Why is ovulation suppressed during pregnancy?

A

Because prolactin
A) inhibits hypothalamic GnRH secretion
B) Inhibits the action of GnRH on the anterior pituitary and consequently inhibits LH and FSH secretion.
C) antagonizes the actions of LH and FSH on the ovaries.

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46
Q

Steroid hormones

A

glucocorticoids (cortisol) + estrogen/testosterone/progesterone + vitamin D + thyroid hormone + retinoic acid

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47
Q

Which step in hormone biosynthesis if inhibited blocks the production of all androgenic compounds but does not block the production of glucocorticoids?

A

17-hydroxypregnenolone –> dehydroepiandrosterone

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48
Q

Which step in steroid hormone synthesis is stimulated by ACTH?

A

cholesterol –> pregnenolone. This is the step catalyzed by cholesterol desmolase.

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49
Q

What is the source of estrogen during the second and third trimesters?

A

Maternal ovaries and the fetal adrenal gland. During the second and third trimesters, the fetal adrenal gland synthesis dehydroepiandosteroen-sulfate (DHEA-S) which is hydroxylated in the fetal liver and then transferred to the placenta, where it is aromatized to estrogen.

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50
Q

What is the source of estrogen during the first trimester?

A

corpus luteum

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51
Q

What stimulates oxytocin secretion?

A

dilation of the cervix.

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52
Q

PTU mechanism

A

Inhibits oxidation of iodide.

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53
Q

PTH renal receptors

A

Located on basolateral membranes, not luminal.

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54
Q

Site of action of PTH calcium reabsorption

A

Distal tubule

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55
Q

Insulin receptor

A

4 subunits + tyrosine kinase activity

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56
Q

Why do AIS patients lack a uterus and cervix?

A

Anti-mullerian hormone secretion

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57
Q

spermatozoa

A

motile sperm; mature sperm

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58
Q

spermatid

A

precursor to spermatozoa

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59
Q

When does spermatogenesis begin?

A

puberty

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60
Q

chromatid

A

one copy of a newly copied chromosome which is still joined to the other by a centromere.

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61
Q

spermatid: 1) ploidy 2) number of chromosomes

A

1N, 1C

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62
Q

spermatogonium: 1) ploidy 2) number of chromosomes

A

2N,2C

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63
Q

secondary spermatocyte: 1) ploidy 2) number of chromosomes

A

1N,2C

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64
Q

Primary spermatocyte: 1) ploidy 2) number of chromosomes

A

2N, 4C

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65
Q

primary spermatocyte DNA copy number

A

4C

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66
Q

spermiogenesis

A

final stage of spermatogenesis; maturation of spermatids into mature, motile spermatozoa.

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67
Q

Spermiation

A

Removal of unnecessary cytoplasm and organelles.

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68
Q

Where do sperm acquire motility?

A

Epididymis

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69
Q

Testosterone negative feedback point

A

inhibits GnRH

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70
Q

estrogen secreting cells of uterus

A

theca cells

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71
Q

other name for suspensory ligament

A

infundibulopelvic ligament

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72
Q

androstenedione site of synthesis

A

adrenal glands + gonads

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73
Q

Tanner staging

A
  • Code: Tanner rower kid from Dartmouth: /**tanner stage is assigned independently to genitalia, pubic hair, and breast (e.g., a person can have Tanner stage 2 genitalia, Tanner stage 3 pubic hair). Tiny Tanner kid with hat on running around in hallway/1 = childhood (prepubertal). Closer left corner + hen nesting on his head + naked with blonde pubs + bra on/2 = pubic hair appears (pubarche) + breast buds form (thelarche). Far left corner + holding a hambone + dark thick pubic hair + dick hanging down to floor + huge double D’s/3 = pubic hair darkens and becomes curly + penis size/length increases + breasts enlarge. Far right corner + Tanner with long blond hair + super wide chode + nipples protruding from his chest + dark skin around his dick + /4 = penis width increases + darker scrotal skin + development of glans + raised areolae. Closer corner + hailing on tanner + dressed in suit + areolae sticks are gone/5 = adult + areolae are no longer raised.
  • Location: Rowing room
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74
Q

Fertilization occurs on ___ day of ovulation

A

Day 1, otherwise degenerates.

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75
Q

menopause labs

A

High FSH

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76
Q

klinefelter’s labs

A

High FSH, LH, and estrogen. Low T and inhibin.

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77
Q

androstenedione

A

converted to either testosterone or estrogen.

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78
Q

What converts androstenedione to testosterone?

A

17beta-hydroxysteroid dehydrogenase

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79
Q

hypogonadotropic hypogonadism

A

Kallman syndrome

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80
Q

HTN and proteinuria that develops in 8th week pregnancy

A

Molar pregnancy (preeclampsia only develops after 20th week)

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81
Q

Placenta accreta pathophys

A

Defective decidual layer leads to placenta attachment to myometrium

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82
Q

HIstology findings in ectopics

A
  • decidualized endometrium only

- no chorionic villi or embryo

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83
Q

HPV tumorigenesis

A

E6 (HPV 16) inhibits p53; E7 (HPV 18) inhibits RB

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84
Q

Renal failure secondary to HPV infection pathophysiology

A

Cervical cancer&raquo_space; lateral invasion to block ureters

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85
Q

Most common cause of endometritis

A

Retained products of conception

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86
Q

Endometrial hyperplasia conditions

A

1) PCOS
2) hormone replacement therapy
3) granulosa cell tumor

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87
Q

Most common gyn malignancy

A

Endometrial cancer

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88
Q

Most deadly gyn malignancy

A

ovarian cancer

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89
Q

Anovulation causes

A

1) prolactinoma
2) Cushing’s
3) Thyroid disorders
4) adrenal insufficiency
5) HPO axis abnormalities
6) obesity
7) eating disorder

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90
Q

impotence

A

failure to sustain an erection during intercourse. analogous to amenorrhea.

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91
Q

PCOS pathophys?

A

increased estrogen production in fatty tissue suppresses FSH production GnRH increases in response and thus LH rises testosterone production increases in theca cells as a consequence elevated testosterone results in development of male sex characteristics.

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92
Q

Why are OCPs given in PCOS?

A

treat hirsutism and acne by suppressing pituitary LH secretion and subsequently decreasing ovarian androgen production

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93
Q

Treatment of choice for infertility in PCOS

A

weight loss

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94
Q

Drug to induce ovulation in PCOS/profertility

A

clomiphene

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95
Q

breast cancer RF’s

A

She’s topless in the middle of a nativity scene + obese + black + tons of gerbil cycles stacked up behind her/risk factors = increased estrogen exposure + increased total number of menstrual cycles + older age at 1st live birth + obesity (increased estrogen exposure as adipose tissue converts androstenedione to estrone) + BRCA1 and BRCA2 gene mutations + African American ethnicity (increased risk for triple negative breast cancer).

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96
Q

multiparity is protective in what cancer?

A

endometrial

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97
Q

Most common cause of prostatitis

A

chronic abacterial prostatitis

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98
Q

Frequent low volume urine…

A

detrusor overactivity

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99
Q

PSA function

A

proteolytic enzyme that increases sperm motility and maintains semen in liquid state. Liquefies semen and allows sperm to swim freely.

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100
Q

Gonadal hormone affected less by cryptorchidism

A

Testosterone (leydig cells can survive, esp. with unilateral cryptorchidism)

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101
Q

Cryptorchidism RF for..

A

germ cell tumors

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102
Q

germ cell tumors

A

1) seminoma
2) Yolk sac
3) chorio
4) teratoma
5) embryonal carcinoma

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103
Q

vast majority of testicular cancer in men is…

A

germ cell tumor

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104
Q

90% of gonadal tumors in women are…

A

NON-germ cell tumors

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105
Q

spermatocele

A

dilated epididymal duct OR rate testis presenting as scrotal swelling (can be transilluminated)

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106
Q

Phimosis

A

Foreskin cannot be fully retracted. Usually due to small orifice of prepuce.

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107
Q

Balanoposthitis

A

Infection of glans and prepuce in uncircumscribed males due to smegma.

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108
Q

Molecules responsible for testicular descent

A

1) MIF (Transabdominal phase)

2) hCG/androgens (inguinoscrotal phase-spontaneous descent after birth)

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109
Q

Sex steroid affects on blood lipids

A

Testosterone increases LDL, decreases HDL.

Estrogen increases HDL, decreases LDL.

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110
Q

Treatment for hereditary angioedema

A

Danazol.

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111
Q

antidepressant to use for complicated depression with cardiac concerns

A

MAOIs

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112
Q

Spironolactone
1) MOA
20 mechanism

A

o Coded character: Spyro the dinosaur: he picks up desmond tutu covered in tacks and kills him + is attacking mike covered in tacks with thong/inhibits steroid BINDING, 17alpha-hydroxylase, 17,20 desmolase. Spyro has a bra on + is putting a baseball bat up his vagina/toxicity = gynecomastia + amenorrhea.
o Location: YHS auditorium, walkway between front and back seating areas

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113
Q

treatment for hirsutism

A

Ketonocazole/spironolactone

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114
Q

SERM that is an estrogen antagonist at uterus

A

Raloxifen

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115
Q

Exemestane

A

Aromatase inhibitor, like anastrazole

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116
Q

progesterone role in OCPs

A

Decrease proliferation of endometrium (less suitable for implantation) + thickening of cervical mucus + preventing shedding

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117
Q

CRH affects in pregnancy

A

1) stimulates laber

2) induces fetal cortisol secretion

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118
Q

Tamsulosin affects on peripheral vasculature

A

Selective for alpha1A,D receptors (found on prostate) vs. vascular alpha1B receptors. So it is a good drug for BPH.

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119
Q

PCOS clinical picture can be induced by which drug?

A

Danazol (androgen agonism leads to reduced LH secretion)

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120
Q

Other name for cardinal ligament

A

transcervical ligament

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121
Q

Ligament that is a derivative of the gubernaculum

A

Round ligament

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122
Q

squamous epithelia in vagina type

A

NONKERATINIZED stratified squamous

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123
Q

What neurotransmitter is antierectile?

A

NE

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124
Q

What regulates emission?

A

sympathetic NS

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125
Q

What nervous system controls ejaculation?

A

somatic and visceral

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126
Q

Source of energy for sperm

A

fructose

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127
Q

What is the acrosome in sperm derived from?

A

golgi apparatus

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128
Q

spermiogenesis

A

spermatid –> spermatozoa

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129
Q

what happens during spermiogenesis?

A

Extrusion of cytoplasm + gaining of acrosome and flagellum.

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130
Q

What 2 diseases are increased in offspring of older men?

A

Achondroplasia + Marfans

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131
Q

What do sertoli cells secrete?

A

1) inhibin
2) MIF
3) androgen-binding protein

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132
Q

leydig cell endocrine mechanism

A

paracrine

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133
Q

when does spermatogenesis begin?

A

puberty

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134
Q

How long does spermatogenesis take?

A

2 months

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135
Q

Site of spermiogenesis

A

epidydimis

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136
Q

Which hormone is responsible for early penile growth? late penile growth?

A

1) DHT

2) testosterone

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137
Q

testosterone and hematologic effect

A

Increases hematocrit

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138
Q

potency in decreasing order of estrogens

A

estradiol, estrone, estriol

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139
Q

estrogen form associated with fetal well-being

A

estriol

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140
Q

Holoprosencephaly

A

forebrain (prosencephalon) fails to develop into two hemispheres.

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141
Q

Sonic hedgehog

A

o Code: he’s riding a Polaris snowmobile/produced at base of limbs in zone of polarizing activity. Huge arrow sticking out of the wall above him from anterior to posterior/involved in patterning along anterior-posterior axis. Blue statue of brain with stem attached to his right (CNS code)/involved in CNS development. Cyclops for a head/mutation can cause holoprosencephaly.

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142
Q

Wnt-7

A

o Code: Whitney with a hook arm/Wnt-7. Sitting on top of a big ridge in the ground + club extremities/produced at apical ectodermal ridge (thickened ectoderm at distal end of each developing limb). She has big fish dorsal fins on/necessary for proper organization along dorsal-ventral axis.
Location: far left corner

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143
Q

FGF gene

A

o Code: Frank from Dartmouth/FGF. he’s on a ridge just like Whitney’s/produced at apical ectodermal ridge. He has super long limbs/stimulates mitosis of underlying mesoderm, providing for lengthening of limbs.
o Location: far right corner

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144
Q

Homeobox (Hox) genes

A

o Code: Ryder Hockman: huge arrow hanging down from ceiling/involved in segmental organization of embryo in a craniocaudal direction. /code for transcription factors. He has legs for arms and arms for legs/Hox mutations appendages in wrong locations.
Location: bouldering wall to right of entryway

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145
Q

Morula by…

A

day 4

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146
Q

blastocyst by…

A

Day 5

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147
Q

Implantation

A

Days 6-10

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148
Q

Week 1 of fetal development

A

o Code: Shark with top hat in entryway/week 1. Blastocyst stuck to left wall + placenta hanging from ceiling/hCG secretion begins around the time of implantation of blastocyst.

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149
Q

Week 2 of fetal development

A

o Code: Shark with ice cream sandwhich around his waist + in hen’s nest in front of entryway/bilaminar disc (epiblast, hypoblast). 2 weeks = 2 layers.

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150
Q

week 3 of fetal development

A

o Code: 3 layered disc around his waist + holding a hambone/trilaminar disc. /3 weeks = 3 layers. Chef next to him/gastrulation (cells of epiblast migrate through primitive streak to become the endoderm, mesoderm, and notochord). Fish skewered into a cord on the right + cave man streaked with poop to the right of it + giant neuron synapsing onto a plate + miso soup covered in skin on shelf above/primitive streak + notochord + mesoderm and its organization + neural plate begin to form. /primitive streak is a groove in the midline of the caudal half of the epiblast layer of the two layer embryo. /during gastrulation in the third week, cells of the epiblast migrate through the primitive streak to become the endoderm, mesoderm, and notochord.
o Location: Behind front desk.

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151
Q

gastrulation

A

cells of the epiblast migrate through the primitive streak to become the endoderm, mesoderm, and notochord.

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152
Q

When do fetal movements start?

A

Week 8. Gait at week 8.

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153
Q

Craniopharyngioma

A

o Code: Henry Nichols: Jesus standing on desk/rare, slow-growing, benign. He’s sitting on top of a saddle (suprasellar code)/typically located in the suprasellar region. /cystic with solid areas. He’s seating at the desk with his head covered in brown and yellow cysts + room flooded with yellow, viscuous fluid with yellow eggs floating in it and steak/cysts usually filled with a brownish-yellow, viscuous fluid resembling machine oil due to presence of protein and cholesterol crystals. Calcium balls hanging from the ceiling/calcification of cysts is highly characteristic. Massive almond dug into the right wall with Daniel Radcliffe/harry potter sitting on top/derived from remnants of Rathke’s pouch/anterior pituitary. Nests filled with wet carrots lining left wall + palisading fences surrounding carrots + Indians in the middle/on light microscopy, cysts are lined by cords/nests of stratified squamous epithelium with peripheral palisading and internal areas of lamellar “wet” keratin. Eyes on the side of his head/bitemporal hemianopsia. He has huge teeth/similar to tooth-like tissue because of origin from remnants of Rathke’s ouch.
o Location: Nate’s office

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154
Q

VACTERL syndrome

A

/half of neonates with tracheoesophageal fistula (TEF) have associated congenital malformations. /vertebral + anal + cardiac + tracheoesophageal fistula + renal + limb abnormalities.

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155
Q

Surface ectoderm derivatives

A

♣ Surface ectoderm
♣ Code: Will standing in front of bar: Daniel Radcliffe riding an almond on right/Rathke’s pouch (anterior pituitary). Eye hanging from bar and looking through lens + bar lined with corn/lens + cornea. His ears are cut off/inner ear sensory organs. Nose is bright red/olfactory epithelium. /nasal & oral epithelial linings. Roof covered in skin/epidermis. Skin is sweating + Will is salivating intensely + boobs squirting milk on roof/salivary, sweat & mammary glands. /surface ectoderm. Super long hair + really long nails + massive ears + bright white teeth/hair + nails + inner ear + external ear + enamel of teeth. Chipmunk face/parotid gland. 2 gay dudes banging on Will’s right/anal canal below pectinate line.
♣ Location: rooftop in front of bar

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156
Q

neural tube derivatives

A

♣ Code: huge tube with CNS statue in middle/neural tube. statue of a spinal cord + brain/brain & spinal cord. Almond on the right/posterior pituitary. Christmas tree to the right of it/pineal gland. Projector with white screen to the left of statue/retina. Optic fiber cables hanging all around top of neural tube/optic nerve. Floor covered with stars/astrocytes. Floaty tubes wrapped around neural tube/oligodendrocytes.
♣ Location: Rooftop right corner, closer to city

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157
Q

neural crest derivatives

A

♣ Code: wave crashing onto left side/neural crest. Gang of thugs to his left + gang tied around post and crying face on top of post/autonomic, sensory, and celiac ganglia + postganglionic sympathetic neurons. Dr. Schwann cleaning Will’s teeth/schwann cells. Apple pie on top of his head + spider on top eating the pie/pia and arachnoid mater. Red cushions all around him + aorticopulmonary septum spiraling up towards the sky behind the skull/aorticopulmonary septum & endocardial cushions. Arc d’triumph overhead made of bones and shark fins/branchial arches (bones and cartilage). Big statue of a skull behind Dr. Swan/skull bones. Massive mole on top of his head/melanocytes. Giraffe with head of medulla to the right of Dr. Schwann/adrenal medulla. Thighs attached to parachutes descending from the sky/thyroid parafollicular C cells. Dr. Schwann blasting dentin into the patients mouth/odontoblasts (dentin forming cell). Cartilaginous bone stuck into the patients trach/tracheal cartilage. 2 penguins at the foot of the bed/chromaffin cells. Fat opera singer on right (larynx code) with shark fin on her head/laryngeal cartilage.

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158
Q

Mesoderm derivatives

A

o Code: Sam Purcell: super jacked/Muscles (skeletal, cardiac & smooth). /connective tissue, bone & cartilage. Whole room lined with peritoneum and he’s inside of it/serosa linings (eg peritoneum). Floor covered in blood + heart hanging above him/cardiovascular system + blood + lymphatic system. Big filter in left far corner/spleen. Big giraffe behind him + 2 kidneys hanging on either side with ureters hanging down to the floor + he has huge swollen nuts/internal genitalia + kidney + ureters. /adrenal cortex.

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159
Q

endoderm derivatives

A

o Code: Sam Purcell: hippo at bar + huge stack of pancreas next to bar/GI tract + liver + pancreas. He has wings on/lungs. Mime at bar/thymus. Parachute on his back/parathyroids. Huge jacked thighs/thyroid follicular cells. Big ear attached to the middle of his head/middle ear. Bladder extrophy + pissing onto the floor/bladder + urethra.
o Location: bar on first floor

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160
Q

aplasia

A

absent organ despite presence of primordial tissue.

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161
Q

Hypoplasia

A

incomplete organ development; primordial tissue present

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162
Q

Disruption

A

Secondary breakdown of previously normal tissue or structure (eg, amniotic band syndrome).

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163
Q

Deformation

A

Extrinsic disruption; occurs after embryonic period.

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164
Q

Malfformat

A

Intrinsic disruption; occurs during embryonic period (weeks 3-8).

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165
Q

Sequence

A

Abnormalities resulting from a single primary embryologic event (eg. oligohydramnios –> Potter sequence).

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166
Q

ACE inhibitor teratogenic effect

A

Renal damage

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167
Q

antiepileptic teratogenic effects

A

NTDs + cardiac defects + cleft palate + skeletal abnormalities (eg, phalanx/nail hyoplasia, facial dysmorphism)

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168
Q

antiepileptics associated with teratogenic effects

A

valproate + carbamazepine + phenytoin + phenobarbital

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169
Q

Diethylstilbestrol teratogenic effects

A

Vaginal clear cell adenocarcinoma + congenital Mullerian anomalies

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170
Q

What drugs are folate antagonists?

A

1) trimethoprim
2) methotrexate
3) antiepileptics

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171
Q

methimazoel teratogenic effects

A

aplasia cutis congenita

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172
Q

tetracyclines teratogenic effects

A

discolored teeth + inhibited bone growth

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173
Q

term for limb defects with thalidomide

A

phocomelia, micromelia

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174
Q

Warfarin teratogenic effects

A

Bone deformities + fetal hemorrhage + abortion + ophthalmologic abnormalities

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175
Q

substance associated with sudden infant death syndrome

A

smoking

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176
Q

maternal diabetes teratogenic effects

A

caudal regression syndrome (anal atresia to sirenomelia) + congenital heart defects + NTDs + macrosomia

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177
Q

methylmercury teratogenic effects

A

neurotoxic

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178
Q

facial characteristics of fetal alcohol syndrome

A

Smooth philtrum + thin vermillion border (upper lip) + small palpebral fissures + small eye opening

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179
Q

Most severe presentation of fetal alcohol syndrome

A

Heart-lung fistulas + holoprosencephaly

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180
Q

dizygotic twin mechanism

A

2 eggs separately fertilized by 2 different sperm

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181
Q

urogenital sinus develops into..

A

prostate gland + bulbourethral glands (of cowper) in men. Greater vestibular glands (of bartholin) and urethral and paraurethral glands (of skene) in women.

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182
Q

Twinning

A
  • Code: Marion and Johnny: left corner: both in separate eggs (chorion code) covered in hair hanging from ceiling/if cleavage is between 0-4 days dichorionic/diamnionic. /di/di can be either monozygotic or dizygotic twins. Dizygotic twins always have their own amnion and own placenta. Right corner: Cunkelman brothers are in same egg hanging from ceiling covered in ivy + but both in separate amnions/if cleavage is between 4-8 days monochorionic/diamniotic. One enlarged brother and one smaller brother at the feet/monochorionic placentas are monozygotic (identical twins) + are at highest risk of twin-twin transfusion syndrome (TTTS). Tin cans covering floor + Cunkelman brothers are 69ing in the same egg/cleavage between 8-12 days = monochorionic/monoamniotic. Right closer corner: Cunkelman brothers are stuck together + mouths full of dimes/after 13 days = monochorionic/monoamniotic conjoined twins. /Most dangerous type (umbilical cords can get twisted and cut off blood supply). /twin pregnancies increase risk of miscarriage + also causes hyperemesis (hyperemesis is caused by elevated betaHCG) + increased risk of aneuploidy.
  • Location: AD basement
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183
Q

cytotrophoblast

A

Inner layer of chorionic villi

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184
Q

syncytiotrophoblast

A

Outer layer of chorionic villi; synthesizes and secretes hormones, eg, hCG (syncytiotrophoblast synthesizes hormones)

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185
Q

fetal components of placenta

A

cytotrophoblast + syncytiotrophoblast

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186
Q

How does syncytiotrophoblast evade immune attack from mom?

A

Lacks MHC-1 expression

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187
Q

Where does maternal blood exist in placenta?

A

Lacunae.

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188
Q

Umbilical arteries connect…

A

Fetal internal iliac arteries to placenta.

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189
Q

Fetal umbilical vein connections…

A

Drains into IVC via liver or via ductus venosus.

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190
Q

Wharton’s jelly

A

Gelatinous substance within the umbilical cord.

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191
Q

umbilical arteries and vein origin

A

allantois

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192
Q

When is allantois formed?

A

3rd week

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193
Q

Urachus formation

A

Yolk sac forms the allantois, which extends into the urogenital sinus. Allantois becomes the urachus.

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194
Q

What is the urachus?

A

Duct between fetal bladder and umbilicus.

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195
Q

Patent urachus + presentation

A

Total failure of urachus to obliterate. Urine discharge from umbilicus.

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196
Q

Urachal cyst

A

partial failure of urachus to obliterate; fluid-filled cavity lined with uroepithelium, between umbilicus and bladder.

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197
Q

Urachal cyst sequela

A

Infection + adenocarcinoma

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198
Q

vesicourachal diverticulum

A

Slight failure of urachus to obliterate –> outpouching of bladder.

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199
Q

Function of vitelline duct

A

Connects yolk sac to midgut lumen.

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200
Q

When does vitelline duct usually obliterate?

A

7th week

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201
Q

Vitelline fistula etiology

A

Vitelline duct fails to close, leading to meconium discharge from umbilicus.

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202
Q

Meckel deverticulum etiology

A

Partial closure of vitelline duct, with patent portion attached to ileum.

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203
Q

What does maxillary artery branch from?

A

External carotid

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204
Q

Derivatives of 1st aortic arch?

A

Maxillary artery

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205
Q

Derivatives of 2nd aortic arch?

A

stapedial artery + hyoid artery

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206
Q

Derivatives of 3rd aortic arch?

A

Common carotid + proximal part of internal carotid

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207
Q

Derivatives of 4th aortic arch?

A

On left, aortic arch; on right, proximal part of right subclavian artery

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208
Q

Derivatives of 6th aortic arch?

A

Proximal part of pulmonary arteries and (ON LEFT ONLY) ductus arteriosus

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209
Q

Path of recurrent laryngeal nerve

A

Right recurrent loops around right subclavian artery; left recurrent lops around aortic arch distal to ductus arteriosus.

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210
Q

branchial arch derivatives

A

Clefts (aka GROOVES) = ectoderm
Arches = mesoderm (mmuscles, arteries) + neural crest (bones, cartilage)
Pouches = endoderm

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211
Q

External auditory meatus origin

A

1st branchial cleft

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5
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212
Q

What do 2nd through 4th branchial clefts give rise to?

A

Temporary cervical sinuses, which are obliterated by proliferation of 2nd arch mesenchyme.

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213
Q

Branchial cleft cyst etiology

A

congenital epithelial cyst that arises on the ***lateral part of the neck due to failure of obliteration of the second branchial cleft (or failure of fusion of the second and third branchial arches) in embryonic development.

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214
Q

Pierre robin presentation

A

Micrognathia + glossoptosis + cleft palate + airway obstruction

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215
Q

1st arch nerve derivatives

A

V2 + V3

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216
Q

1st arch muscle derivatives

A

Muscles of mastication + mylohyoid + anterior belly of digastric + tensor tympani + tensor veli palatini

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217
Q

Muscles of mastication

A

Temporalis + masseter + lateral and medial pterygoids

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218
Q

1st arch cartilage derivatives

A

1) Maxillary process –> maxilla + zygoMatic bone
2) Mandibular process –> Meckel cartilage + mandible
3) Malleus and incus
4) sphenoMandibular ligament

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219
Q

2nd arch cartilage derivatives

A

(S’s) Stapes + Styloid process + lesser horn of hyoid + stylohyoid ligament

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220
Q

2nd arch muscle derivatives

A

Muscles of facial expression – Stapedius, Stylohyoid, platySma, posterior belly of digastric

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221
Q

3rd arch cartilage derivative

A

Greater horn of hyoid

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222
Q

3rd arch muscle derivative

A

Stylopharyngeus

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223
Q

3rd arch nerve derivative

A

CN IX

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224
Q

Caveat about arch 5

A

Makes no major developmental contributions

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225
Q

4th-6th arch cartilage derivative

A

Arytenoids + cricoid, corniculate + cuneiform + thyroid (ACCCT)

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226
Q

4th arch muscle derivatives

A

Most pharyngeal constrictors + cricothyroid + levator veli palatini

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227
Q

6th arch muscle derivatives

A

All intrinsic muscles of larynx except cricothyroid

228
Q

What forms posterior 1/3 of tongue?

A

Arches 3 + 4

229
Q

4th arch cranial nerve

A

CN X (superior laryngeal branch)

230
Q

6th arch cranial nerve

A

CN X (recurrent laryngeal branch)

231
Q

1st branchial pouch derivatives + caveat

A

1) middle ear cavity + eustachian tube + mastoid air cells.

2) endoderm-lined structures of ear.

232
Q

2nd branchial pouch derivatives

A

Epithelial lining of palatine tonsil.

233
Q

3rd branchial pouch derivatives

A

Dorsal wings –> inferior parathyroids.

Ventral wings –> thymus

234
Q

3rd branchial pouch caveat

A

3rd-pouch structures end up below 4th pouch structures.

235
Q

4th pouch derivatives

A

Dorsal wings –> superior parathyroids.
Ventral wings
–> ultimobranchial body
–> parafollicular (C) cells of thyroid.

236
Q

Cleft lip etiology

A

Failure of fusion of maxillary + medial nasal processes (formation of primary palate)

237
Q

cleft plate etiology

A

1) failure of fusion of 2 lateral palatine shelves
OR
2) Failure of fusion of lateral palatine shelves with nasal septum
AND/OR
3) failure of fusion of lateral palatine shelves with median palatine shelf

238
Q

Female genital development

A

Mesonephric duct degenerates and paramesonephric duct develops.

239
Q

What determines testes development?

A

TDF from SRY gene

240
Q

MIF suppresses…

A

development of paramesonephric ducts.

241
Q

What stimulates development of mesonephric duct?

A

Androgens from Leydig cells (Men have Mesonephric ducts)

242
Q

mesoneprhic AKA…

A

Wolffian duct

243
Q

What does paramesonephric (Mullerian) duct give rise to?

A

Fallopian tubes, uterus, upper portion of vagina.

244
Q

What is the lower portion of the vagina derived from?

A

Urogenital sinus

245
Q

What is the male remnant of the Mullerian duct?

A

Appendix testis

246
Q

Disease name for mullerian agenesis

A

Mayer-Rokitansky-Kuster-Hauser syndrome

247
Q

Mayer-Rokitansky-Kuster-Hauser syndrome presentation

A

Primary amenorrhea (due to a lack of uterine development) in females with fully developd secondary sexual characteristics (***functional ovaries).

248
Q

What is the remnant of the mesonephric duct in females?

A

Gartner duct

249
Q

What does the mesonephric (Wolffian) duct give rise to in men?

A

SEED – Seminal vesicles, Epididymis, Ejaculatory duct, Ductus deferens.

250
Q

What would happen if you lacked sertoli cells or MIF?

A

Develop both male and female internal genitalia and male external genitalia.

251
Q

Bicornuate uterues etiology

A

Incomplete fusion of Mullerian ducts

252
Q

Uterus didelphys

A

complete failure of fusion –> double uterus + double vagina + double cervix. *pregnancy possible.

253
Q

genital tubercle gives rise to in men…

A

glans penis + corpus cavernosum and spongiosum

254
Q

urogenital sinus gives rise to in men…

A

Bulbourethral glands (of Cowper) + prostate gland

255
Q

urogenital folds gives rise to in men…

A

Ventral shaft of penis (penile urethra)

256
Q

Labioscrotal swelling gives rise to in men…

A

scrotum

257
Q

genital tubercle gives rise to in women…

A

glans clitoris + vestibular bulbs

258
Q

urogenital sinus gives rise to in women…

A

Greater vestibular glands (of Bartholin) + Urethral and paraurethral glands (of Skene)

259
Q

Urogenital folds give rise to in women…

A

Labia minora

260
Q

Labioscrotal swelling gives rise to in women…

A

Labia majora

261
Q

which spadias is more common?

A

hypospadias

262
Q

hypospadias associations

A

inguinal hernia + cryptorchidism

263
Q

hypospadias etiology

A

Failure of urethral folds to fuse

264
Q

epispadias etiology

A

Faulty positioning of genital tubercle

265
Q

epispadias associations

A

Exstrophy of the bladder

266
Q

male remnant of gubernaculum

A

Anchors testes within scrotum.

267
Q

female remnant of gubernaculum

A

Ovarian ligament + round ligament of uterus

268
Q

Remnant of process vaginalis in men

A

Forms tunica vaginals

269
Q

Female remnant of process vaginalis

A

obliterated

270
Q

glans penis drainage

A

deep inguinal nodes

271
Q

External iliac drainage

A

Body of uterus + cervix + superior bladder

272
Q

What is at risk of injury during ligation of uterine vessels in hysterectomy?

A

Ureter

273
Q

What does round ligament connect?

A

Uterine fundus to labia majora

274
Q

Round ligament course

A

Travels through round inguinal canal; above the artery of Sampson.

275
Q

Broad ligament connects

A

uterus, fallopian tubes, and ovaries to pelvic side wall

276
Q

broad ligament contains…

A

ovaries, fallopian tubes, round ligaments of uterus

277
Q

3 components of broad ligament

A

Mesosalpinx + mesometrium + mesovarium

278
Q

Most common area for cervical cancer?

A

Squamocolumnar junction

279
Q

glands in uterus in proliferative phase vs. secretory phase

A

Long tubular glands in proliferative phase; coiled glands in secretory phase.

280
Q

Bulbourethral gland (Cowper) location in men

A

Sits below the prostate

281
Q

What covers seminiferous tubules?

A

Tunica albuginea

282
Q

area damaged with posterior urethra damage

A

membranous urethra

283
Q

area damaged with anterior urethra damage

A

bulbar + penile urethra

284
Q

anterior urethra damage sequela

A

Can cause urine to leak beneath deep fascia of Buck. If fascia is torn, urine escapes into superficial perineal space.

285
Q

How do PDE-5 inhibitors work?

A

Inhibit cGMP breakdown.

286
Q

Opposite mechanism as NO and erection

A

NE –> increased Ca concentration –> smooth muscle contraction –> vasoconstriction –> no boner.

287
Q

What lines the seminiferious tubule?

A

Spermatogonium

288
Q

What regulates spermatogenesis?

A

Sertoli cells

289
Q

Aromatase in men?

A

Expressed in sertoli cells, which convert testosterone and androstenedione to estrogens.

290
Q

What is the problem with varicocele?

A

Increases body temperature. Since sertoli cells are temp sensitive, this decreases sperm production + decreases inhibin B.
*testosterone production not affected by temperature.

291
Q

spermatogonium pathway

A

spermatogonium –> spermatocyte –> spermatids –> spermatozoan.

292
Q

What regulates female fat distribution?

A

estrogen

293
Q

Estrogen regulatory actions

A

1) **upregulates estrogen + LH + progesterone receptors.

2) Feedback inhibition of FSH and LH

294
Q

estrogen changes in pregnancy

A

50-fold increase in estradiol and estrone.

1000-fold increase in estriol

295
Q

Desmolase function

A

cholesterol –> androgens

296
Q

What stimulates desmolase?

A

LH

297
Q

What positively stimulates aromatase?

A

FSH

298
Q

What indicates ovulation?

A

Increased progesterone

299
Q

Where is progesterone synthesized in men?

A

adrenal cortex + testes

300
Q

Location of progesterone synthesis in women?

A

Corpus luteum + placenta + adrenal cortex

301
Q

other impt functions of progesterone

A

1) uterine smooth muscle relaxation (preventing contractions)
2) decreased estrogen receptor expression

302
Q

C =

A

of chromatids

303
Q

secondary oocyte: N,C

A

1N, 2C

304
Q

ovum: N,C

A

1N, 1C

305
Q

oogonium: N,C

A

2N, 2C

306
Q

primary oocyte

A

2N, 4C

307
Q

Ovulation mechanism

A

Increased estrogen leads to increased GnRH receptor expression on anterior pituitary. Estrogen surge stimulates LH release –> ovulation

308
Q

Mittelschmerz associations + caveat

A 
Peritoneal irritation (eg, follicular swelling/rupture, fallopian tube contraction).
*appendicitis.
309
Q

When is follicular growth the fastest?

A

2nd week of follicular phase

310
Q

oligomenorrhea

A

Greater than 35 day cycle

311
Q

Polymenorrhea

A

Less than 21 day cycle

312
Q

Metrorrhagia

A

Frequent or irregular menstruation

313
Q

Menorrhagia defined as

A

Greater than 80 mL blood loss or greater than 7 days of mensss

314
Q

menometrorrhagia

A

Heavy + irregular menstruation

315
Q

When is it possible to get pregnant?

A

There are only 6 days during any cycle, regardless of length, when a woman can get pregnant – the five days leading up to ovulation and the 24 hours after ovulation. This is because sperm can live for up to 5 days in a woman’s body, and the ovum lives for only 12-24 hours.

316
Q

Ductus venous

A

Shunts blood from umbilical vein directly into the IVC, bypassing the liver

317
Q

Neuroectoderm

A

Includes both neural crest + neural tube

318
Q

What secretes hCG in the placenta?

A

syncytiotrophoblasts

319
Q

How do you calculate gestational age?

A

From date of last menstrual period.

320
Q

How do you calculate embryonic age?

A

Calculated from date of conception (gestational age MINUS 2 weeks). (Woman had her period, roughly 2 weeks later ovulated and got pregnant, so you need to subtract the window period).

321
Q

physiologic adaptations in pregnancy

A

1) Increased cardiac output (increased preload, decreased after load).
2) Increased HR
3) Increased placental and renal perfusion
4) Anemia (increased plasma, increased RBCs, leading to decreased viscosity)
5) hypercoagulable (in order to decrease blood loss at delivery)
6) Hyperventilation (in order to eliminate fetal CO2)

322
Q

When dose hCG peak?

A

8-10 weeks. This is the period of time in which hCG maintains the corpus luteum (and thus progesterone synthesis)

323
Q

When does corpus lute degenerate?

A

After 8-10 weeks. Placenta is capable of synthesizing its own estriol and progesterone by then.

324
Q

Why can states of increased hCG cause hyperthyroidism?

A

Shared subunit of hCG and TSH.

325
Q

What does pregnancy test detect?

A

Beta subunit of hCG (has to because this is the unique subunit).

326
Q

Causes of increased hCG

A

1) Down syndrome
2) multiple gestations
3) hydatidorm moles
4) choriocarcinoma

327
Q

Causes of decreased hCG

A

1) ectopics
2) Edwards
3) Patau

328
Q

Apgar evaluated at

A

1 minute and 5 minutes

329
Q

Grimace scoring on apgar

A 
2 = cries and pulls away
1 = grimaces or weak cry
0 = no response
330
Q

Respiration scoring on apgar

A

1) strong cry
2) slow, irregular, shallow gasps
3) no breathing

331
Q

Low birth weight definition

A

Less than 2500 g

332
Q

Low birth weight associations

A

increased risk of SIDS + increased risk of overall mortality.

333
Q

Problems associated with low birth weight

A

1) impaired thermoregulation
2) immune disfunction
3) hypoglycemia
4) polycythemia
5) impaired neurocognitive/emotional development

334
Q

Complications of low birth weight

A

1) infections
2) NRDS
3) necrotizing enterocolitis
4) intraventricular hemorrhage
5) persistent fetal circulation

335
Q

What does breast milk contain?

A

IgA + macrophages + lymphocytes

336
Q

What does breast milk reduce risk of?

A

Risk of asthma + allergies + DM + obesity.

337
Q

what does breastfeeding reduce maternal risk for?

A

breast + ovarian cancer.

338
Q

Menopause diagnosis

A

amenorrhea for 12 months.

339
Q

why do women have decreased estrogen production with menopause?

A

Decline in follicles.

340
Q

average age of menopause

A

51

341
Q

Source of estrogens after menopause and complication

A

Peripheral conversion of androgens. Increased androgens can lead to hirsutism.

342
Q

Hormonal changes of menopause

A

decreased estrogen + very increased FSH + increased LH + increased GnRH

343
Q

premature ovarian failure

A

Signs of menopause before age 40

344
Q

HAVOCS

A

Hot flashes + Atrophy of vagina + Osteoporosis + CAD + Sleep disturbances

345
Q

Source of androstenedione

A

ADrenal

346
Q

What is responsible for closing of epiphyseal plates in boys?

A

Estrogen converted from testosterone.

347
Q

estrogen synthesis in males

A

by CYP 450 aromatase primarily in adipose tissue + testis

348
Q

spermatogonium function

A

Undergo mitosis, continually replenishing supply of sperm

349
Q

stage 1 tanner in girls

A

Flat-appearing chest with raised nipple + no sexual hair

350
Q

Term for stage III breasts in girls

A

“breast mound”

351
Q

Term for stage II breasts in girls

A

“breast bud”

352
Q

glans development in tanner staging

A

Stage IV

353
Q

Stage IV in girls breast term

A

“Mound on mound”

354
Q

Caveat about pubic hair in Stage IV

A

*spares thighs

355
Q

Caveat about pubic hair in Stage V

A

Covers medial thigh

356
Q

Penis and testes growth in Stage V?

A

Enlarge to adult size

357
Q

Cause of increased FSH in klinefelters?

A

Decreased inhibit B due to dysgenesis of seminiferous tubules.

358
Q

Cause of increased estrogen in klinefelters?

A

decreased testosterone –> increased LH –> increased estrogen synthesis

359
Q

Most common cause of primary amenorrhea?

A

Turner’s

360
Q

How could you get a Turner patient pregnant?

A

IVF + exogenous estradiol and progesterone

361
Q

Other cause of Turner’s?

A

Mitotic error leading to mosaicism

362
Q

Double Y presentation

A

Normal fertility + severe acne + learning disability + ASD

363
Q

Ovotesticular disorder of sex development

A

More common in girls.
Both ovarian and testicular tissue present (ovotestis); ambiguous genitalia.
Previously called true hermaphroditism.

364
Q

AIS hormones

A

Increased LH + increased testosterone

365
Q

46, XX DSD

A

Disorderment of Sexual Development. Ovaries present, but external genitalia virilized or ambiguous. Due to excessive and inappropriate exposure to androgenic steroids during early gestation (eg, CAH or exogenous androgens during pregnancy).

366
Q

46, XY DSD

A

Testes present, but external genitalia female or ambiguous. Eg, AIS.

367
Q

Placental aromatase deficiency presentation?

A

1) Can’t synthesize estrogens from androgens, so XX virilization with increased testosterone and androstenedione.

368
Q

Scenario: maternal virilization during pregnancy.

A

Placental aromatase deficiency. Fetal androgens aren’t aromatized and can cross the placenta.

369
Q

AIS labs

A

Increased testosterone + Increased estrogen + increased LH

370
Q

5alpha-reductase inheritance

A

Inability to convert testosterone to DHT.

371
Q

5alpha-reductase presentation

A

Ambiguous genitalia until puberty, when increased testosterone causes masculinization + increased growth of external genitalia.

372
Q

5alpha-reductase labs

A

Normal testosterone/estrogen + normal or increased LH

373
Q

Hydatidorm mole histo

A

Cystic swelling of villi + proliferation of chorionic epithelium (only trophoblast)

374
Q

Preeclampsia before 20 weeks?

A

hydatidiform moles

375
Q

partial mole etiology

A

2 sperm + 1 egg

376
Q

hCG in complete mole vs. partial

A

Very high hCG in complete + only minor elevation in partial

377
Q

Imaging buzzwords for complete mole

A

“Honeycombed”
“clusters of grapes”
“Snowstorm”

378
Q

Risk of gestational trophoblastic neoplasia with complete mole

A

15-20%

379
Q

Risk of gestational trophoblastic neoplasia with partial mole

A

less than 5%

380
Q

Risk of choriocarcinoma wit complete mole

A

2%

381
Q

Choriocarcinoma histology

A

1) Malignancy of trophoblastic tissue (cytotrophoblasts + syncytiotrophoblasts).
2) NO chorionic villi present.
3) Increased frequency of multiple/bialteral theca-lutein cysts.

382
Q

Caveat about abrupt placenta

A

Can be concealed or apparent. Abrupt, painful bleeding.

383
Q

RF’s for placenta accreta

A

1) prior C-section
2) inflammation
3) placenta previa

384
Q

Most common type of placenta accreta

A

placenta accreta

385
Q

placenta accrete pathophys

A

placenta attaches to myometrium without penetrating it.

386
Q

placenta increta pathophys

A

Placenta penetrates into myometrium

387
Q

placenta percreta pathophys

A

Placenta penetrates through myometrium and into uterine serosa (invades entire uterine wall).

388
Q

placenta percreta sequela

A

can result in placental attachment to rectum or bladder.

389
Q

placenta accreta pathophys

A

Often detected on US prior to delivery. No separation of placenta after delivery leading to postpartum bleeding (can cause Sheehan’s)

390
Q

placenta previa RF’s

A

1) multiparty

2) prior C-section

391
Q

vasa previa

A

Fetal vessels run over, or in close proximity to cervical os.

392
Q

vasa previa sequela

A

1) vessels can rupture
2) exsanguination
3) fetal death

393
Q

vasa previa triad

A

Membrane rupture + painless vaginal bleeding + fetal bradycardia

394
Q

fetal bradycardia

A

HR less than 110 beats/min

395
Q

vasa previa management

A

Emergency C-section

396
Q

vasa previa associations

A

Velamentous umbilical cord insertion

397
Q

Velamentous umbilical cord insertion

A

Cord inserts in chorioamniotic membrane rather than placenta. Fetal vessels travels to placenta unprotected by Wharton jelly.

398
Q

Causes of postpartum hemorrhaging

A

4 T’s:

1) Tone (uterine atony)
2) Trauma
3) thrombin (coagulopathy)
4) tissue (retained products of conception)

399
Q

Most common cause of postpartum hemorrhaging?

A

Uterine atony

400
Q

Ectopic RF’s

A

1) prior ectopic pregnancy
2) history of infertility
3) salpingitis (PID)
4) ruptured appendix
5) prior tubal surgery

401
Q

Polyhydramnios other causes

A

1) fetal anemia

2) multiple gestations

402
Q

oligohydramnios associations

A

1) placental insufficiency
2) bilateral renal genesis
3) posterior urethral valves

403
Q

Gestational HTN

A

BP greater than 140/90 after 20th week of gestation. No pre-existing HTN. No proteinuria or end-organ damage

404
Q

Gestational HTN treatment

A

Hydrazine, alpha-methyldopa, labetalol, nifedipine. Deliver at 37-39 weeks.

405
Q

Causes of maternal death with eclampsia.

A

1) stroke
2) intracranial hemorrhage
3) ARDS

406
Q

HELLP syndrome

A
  • Hemolysis, Elevated Liver enzymes, Low platelets.

- Manifestation of severe eclampsia.

407
Q

Gyn tumor epidemiology Incidence

A

endometrial, ovarian, cervical

408
Q

Gyn tumor epidemiology mortality

A

ovarian, endometrial, cervical

409
Q

Sarcoma botyroides is a..

A

variant of embryonal rhabdomyosarcoma

410
Q

Sarcoma botyroides

A

vaginal tumor affecting girls under 4. Spindle shaped cells. design positive. Presents with clear, grape-like polypoid mass emerging from vagina.

411
Q

Carcinoma in situ classification.

A

CIN 1, CIN 2, CIN 3 (severe dysplasia –> DCIS)

412
Q

Classic presentation of DCIS

A

Postcoital vaginal bleeding

413
Q

Number 1 risk factor for cervical DCIS

A

multiple sexual partners

414
Q

Cervical cancer diagnosis

A

colposcopy + biopsy

415
Q

Other name for PCOS

A

Stein-Leventhal syndrome

416
Q

First aid explanation for PCOS pathophys

A

Hyperinsulinemia and/or insulin resistance alters hormonal feedback response –> Increased LH/FSH –> increased testosterone from theca internal cells –> decreased rate of follicular maturation –> enraptured follicles (cysts) + an ovulation.

417
Q

Most common ovarian mass in young women?

A

Follicular cyst

418
Q

What is a follicular cyst?

A

Distended and enraptured graafian follicle.

419
Q

Follicular cyst associations

A

hyperestrogenism + endometrial hyperplasia

420
Q

Theca-lutein cyst associations

A

choriocarcinoma + hydatidiform moles

421
Q

What causes theca-lutein cysts?

A

gonadotropin stimulation

422
Q

Majority malignant ovarian neoplasms are…

A

epithelial

423
Q

Most common malignant tumor

A

serous cystuadenocarcinoma.

424
Q

Other RFs for ovarian neoplasms

A

1) infertility
2) endometriosis
3) PCOS
4) BRCA mutations
5) Lynch syndrome

425
Q

Protective factors for ovarian neoplasms

A

1) previous pregnancy
2) history of breastfeeding
3) OCPs
4) tubal ligation

426
Q

Ovarian neoplasm presentation

A

adnexal mass + abdominal dissension + bowel obstruction + pleural effusion.

427
Q

serous cyst adenoma histology

A

Lined with fallopian tube-like epithelium

428
Q

Complex mass on ultrasound…

A

endometrioma

429
Q

What is endometriosis?

A

ectopic endometrial tissue

430
Q

what is an endometrioma?

A

endometriosis within ovary with cyst formation. This is endometriosis in the ovary.

431
Q

What is a chocolate cyst?

A

endometrioma filled with dark, reddish-brown blood (in the ovary).

432
Q

other name for mature cystic teratoma?

A

Dermoid cyst

433
Q

Most common ovarian tumor in females 10-30 yo?

A

Mature cystic teratoma

434
Q

struma ovarii

A

monodermal mature cystic teratoma presenting as hyperthyroidism

435
Q

Presentation of mature cystic teratoma

A

Pain secondary to ovarian enlargement or torsion

436
Q

Brenner tumor presentation

A

Looks like bladder. Solid tumor that is pale yellow-tan and appears encapsulated. “Coffee bean” nuclei.

437
Q

fibromas

A

bundles of spindle-shaped fibroblasts

438
Q

Miegs syndrome triad

A

ovarian fibroma + ascites + hydrothorax.

439
Q

“pulling” sensation in groin…

A

Miens syndrome

440
Q

theca + presentation

A

Basically a benign granulose cell tumor, may produce estrogen. Abnormal uterine bleeding in a postmenopausal woman.

441
Q

Most common malignant stroll tumor…

A

Granulose cell tumor

442
Q

Granulose cell tumor presentation in pre-adolescents

A

sexual precocity

443
Q

Pseudomyxoma peritonei

A

Intraperitoneal accumulation of mutinous material from ovarian or appendiceal tumor.

444
Q

Pseudomyxoma peritonei association

A

mutinous cystadenocarcinoma

445
Q

Dysgerminoma histology + markers

A

1) sheets of uniform “fried egg” cells.

2) hCG + LDH

446
Q

Tumor in sacrococcygeal area in young children…

A

Yolk sac tumor

447
Q

What is an endometrial polyp?

A

well-circumscribed collection of endometrial tissue within uterine wall. May contain smooth muscle cells. Can extend into endometrial cavity.

448
Q

Endometrial polyp presentation

A

Asymptomatic or painless abnormal uterine bleeding.

449
Q

adenomyosis etiology

A

hyperplasia of basal layer of endometrium

450
Q

Uterus presentation in adenomyosis

A

Uniformly enlarged, soft, globular uterus.

451
Q

Most common tumor in females

A

Leiomyomas (uterine fibroids)

452
Q

Which is a greater RF for endometrial carcinoma: nuclear type or complex architecture?

A

nuclear atypia

453
Q

Most common gynecologic malignancy

A

Endometrial carcinoma

454
Q

Peak incidence of endometrial carcinoma?

A

55-65 years old

455
Q

endometritis causes

A

1) Retained products of conception
2) miscarriage
3) abortion
4) foreign body (IUD)

456
Q

endometritis etiology

A

retained material in the uterus promotes infection by bacterial flora from vagina or intestinal tract.

457
Q

endometritis treatment

A

gentamicin with clindamycin +/- ampicillin

458
Q

Most common sites of endometriosis

A

Ovary (often bilateral) + pelvis + peritoneum.

459
Q

Endometriosis etiology

A

1) retrograde flow
OR
2) metaplastic transformation of multipotent cells
OR
3) transportation of endometrial tissue via lymphatic system

460
Q

dyschezia

A

pain with defecation

461
Q

dyschezia in a woman think..

A

endometriosis

462
Q

Uterus presentation in endometriosis

A

Normal-sized

463
Q

Cyclic pelvic pain in a woman think…

A

endometriosis

464
Q

endometriosis treatment options

A

1) NSAIDs
2) OCPs
3) progestins
4) GnRH agonists
5) danazol
6) laparoscopy

465
Q

Breast conditions in the stroma

A

1) Fibroadenoma

2) phyllodes tumor

466
Q

Terminal duct/lobular unit breast conditions

A

1) fibrocystic change
2) DCIS and LCIS
3) ductal carcinoma
4) lobular carcinoma

467
Q

Lactiferous sinus and major duct breast conditions

A

1) intraductal papilloma
2) abscess/mastitis
3) Paget’s disease

468
Q

Most common benign breast disease in women under 35

A

fibroadenoma

469
Q

Most common benign breast condition in women over 35

A

fibrocystic changes

470
Q

Fibrocystic changes presentation

A

Woman over 35 with premenstrual breast pain or lumps; often bilateral and multifocal.

471
Q

Most common cause of nipple discharge (serous or bloody)?

A

Intraductal papilloma

472
Q

mammography finding fat necrosis

A

calcified oil cyst

473
Q

When is gynecomastia physiologic?

A

Newborn, pubertal, and elderly males.

474
Q

Most common site of malignant breast tumors

A

Terminal duct lobular unit

475
Q

DCIS characteristics

A

1) Fills ductal lumen

2) Arises from ductal atypica

476
Q

Mammography finding in DCIS

A

Microcalcifications

477
Q

Paget cells

A

intraepithelial adenocarcinoma cells

478
Q

Most common of all breast cancers

A

invasive ductal carcinoma

479
Q

medullary carcinoma prognosis

A

Good

480
Q

Inflammatory breast cancer prognosis

A

Poor (50% survival at 5 years)

481
Q

Etiology of peyronie’s

A

Abnormal curvature of penis due to fibrous plaque within tunica albuginea.

482
Q

Penile fracture

A

Rupture of corpora cavernous due to forced bending.

483
Q

priapism definition

A

erection lasting longer than 4 hours

484
Q

priapism treatment options

A

1) corporal aspiration
2) intracavernosal phenylephrine
3) surgical decompression

485
Q

bilateral vs unilateral lab findings in cryptorchidism

A

Testosterone is down in bilateral, normal in unilateral

486
Q

Cryptorchidism commonly seen in…

A

Premies

487
Q

“bag of worms” on palpation

A

varicocele

488
Q

Varicocele – transiluminate or no?

A

does NOT transilluminate.

489
Q

varicocele treatment options

A

1) varicocelectomy

2) embolization

490
Q

Most common locations of extragonadal germ cell tumors in adults

A

Retroperitoneum + mediastinum + pineal + suprasellar regions.

491
Q

Most common cause of scrotal swelling in infants

A

congenital hydrocele

492
Q

hematocele

A

bloody hydrocele

493
Q

acquired hydrocele

A

scrotal fluid collection usually secondary to infection, trauma, or tumor.

494
Q

paratesticular fluctuant nodule…

A

spermatocele. Paratesticular = intrascrotal mass without testicular origin

495
Q

Things that don’t transilluminate

A

1) varicocele

2) tumor

496
Q

choriocarcinoma histology

A

Disordered syncytiotrophoblastic and cytotrophoblastic elements

497
Q

choriocarcinoma mets

A

hematogenous mets to lungs + brain

498
Q

potential presentation of choriocarcinoma

A

gynecomastia + hyperthyroidism pictures (due to shared alpha subunit

499
Q

embryonal macroscopic description

A

hemorrhagic mass with necrosis

500
Q

labs in embryonal carcinoma

A

1) Increased hCG + normal AFP when pure.

1) both increased when mixed.

501
Q

Lydia cell tumor presentation

A

Gynecomastia in men, precocious puberty in boys

502
Q

androblastoma

A

sertoli cell

503
Q

caveat about testicular lymphoma

A

Arises from metastatic lymphoma to testes.

504
Q

prostate in BPH description

A

smooth, elastic, firm nodular enlargement

505
Q

Which lobes are involved in bPH

A

lateral and middle lobes (explains why urethra is compressed)

506
Q

Other drug for BPH

A

tadalafil

507
Q

tadalafil and caveat

A

PDE-5 inhibitor (sildenafil, vardenafil, tadalafil) but doesn’t drop BP.

508
Q

prostatitis prostate description

A

warm, tender, enlarged prostate.

509
Q

Lobe most commonly involved in prostatic adenocarcinoma

A

Posterior lobe (peripheral zone)

510
Q

other prostate cancer tumor

A

prostatic acid phosphatase (PAP) + ALP with osteoblastic bone mets.

511
Q

infertility treatment

A

Leuprolide

512
Q

What are the synthetic estrogens?

A

1) ethinyl estradiol
2) DES
3) mestranol

513
Q

Treatment for men with androgen-dependent prostate cancer?

A

estrogen

514
Q

estrogen contraindications?

A

1) ER positive breast cancer

2) history of DVTs

515
Q

SERMs

A

1) clomiphene
2) tamoxifen
3) raloxifene

516
Q

Clomiphene SE’s

A

1) hot flashes
2) ovarian enlargement
3) multiple simultaneous pregnancies
4) visual disturbances

517
Q

tamoxifen properties

A

Antagonist at breast; agonist at bone, uterus.

518
Q

Treatment for ER/PR positive cancer?

A

Tamoxifen

519
Q

Raloxifine properties

A

Antagonist at breast + antagonist at uterus + agonist at bone.

520
Q

name some progestins

A

1) levonorgestrel
2) medroxyprogesterone
3) etonogestrel
4) norethindrone
5) megestrol

521
Q

treatment for abnormal uterine bleeding?

A

progestins

522
Q

Progestin challenge

A

Test used to evaluate a pt experiencing amenorrhea. If patient has sufficient estradiol, they will experience withdrawal bleeding after progestin is finished (this indicates she has estrogen which causing the lining of the uterus to build up which will cause bleeding), indicating the patient’s amenorrhea is due to an ovulation. If no bleeding occurs after withdrawal, amenorrhea due to either a) low serum estradiol b) HPO dysfunction C) some others.

*Presence of withdrawal bleeding excludes anatomic defects and chronic anovulation without estrogen.

523
Q

Asherman syndrome

A

adhesions or fibrosis of endometrium

524
Q

ulipristal

A

antiprogestin

525
Q

ulipristal use

A

emergency contraception

526
Q

combined contraception mechanism

A

Estrogens and progestins inhibit LH/FSH and thus prevent estrogen surge and thus prevent LH surge and ovulation

527
Q

combined contraception contraindications

A

1) smokers older than 35
2) cardiovascular disease
3) migraines (especially with aura)
4) breast cancer

528
Q

Most effective emergency contraceptive?

A

copper IUD

529
Q

ritodrine

A

like terbutaline, beta2 agonist used to relax the uterus and decrease contraction frequency.

530
Q

danazol MOA

A

partial agonist at androgen receptors

531
Q

tamsulosin MOA

A

inhibits smooth muscle contraction

532
Q

Other use for PDE-5 inhibitors

A

pulmonary HTN

533
Q

term for blue-tined vision (PDE-5 inhibitors)

A

cyanopia

534
Q

dyspepsia

A

indigestion

535
Q

dyspepsia associated with

A

PDE-5 inhibitors

536
Q

anemia of pregnancy mechanism

A

Your body makes more blood in pregnancy but keeps the same amount of RBC’s (eg increased plasma relative to RBCs)

537
Q

Why does uterine atony cause bleeding?

A

Normally contraction of the uterus causes compression of blood vessels, inhibiting hemorrhaging during delivery

538
Q

Anovulatory cycle etiology

A

normal bleeding is due to a decline in estrogen, with anovulatory cycles, there is no progesterone and bleeding is caused by unopposed estrogen (inability of estrogen to support a growing endometrium.

539
Q

anovulatory cycle definition

A

absence of ovulation and a luteal phase.

540
Q

Stress incontinence treatment

A

pelvic floor muscle strengthening (kegel) exercises + weight loss + pessaries (device inserted into the vagina to provide structural support).

541
Q

When does rooting disappear by?

A

2-3 months

542
Q

When does palmar grasp disappear by?

A

3 months

543
Q

Galant reflex

A

stroking along one side of the spine while newborn is in ventral suspension (face down) causes lateral flexion of lower body toward stimulated side.

544
Q

Chadwick’s sign + timing

A
  • Code: he has a vagina and it’s blue/bluish discoloration of the cervix, vagina, and labia resulting from increased blood flow. He’s pregnant + hash block to his right + ivy all around him/can be observed as early as 6 to 8 weeks after conception and its presence is an early sign of pregnancy.
  • Location: Chad Lorenz from Yarmouth, far end of tennis court, right corner
545
Q

Pica association

A

iron-deficiency anemia

546
Q

rectal prolapse associations

A

associated with pregnancy + constipation + severe diarrhea + cystic fibrosis. Worm cartoon with a huge whip on left table/whipworm.

547
Q

Imperforate anus

A
  • Code: Nick fom NYA: green ball of gue hanging from ceiling overhead/manifests with inability to pass meconium. Green gue coming out of his dick/meconium may discharge from urethra or vagina if a fistula is present. Walls made of spades + huge yellow bag sticking out of ceiling from above + dead giraffe on floor in front of white board/commonly associated with urinary tract malformations (eg. Renal agenesis + hypospadias + epispadias + bladder extrophy).
  • Location: upstairs in NYA
548
Q

Primary amenorrhea in a patient with fully developed secondary sexual characteristics suggests..

A

Defect in genital tract like imperforate hymen or mullein duct anomaly.

549
Q

imperforate hymen presentation

A

cyclic abdominal or pelvic pain + a hematocolpos that can manifest as a vaginal bulge and/or mass palpated anterior to the rectum + back pain + difficulties with defecation and urination.

550
Q

Familial testotoxicosis

1) pathophys
2) treatment

A

Ron Jeremy. /mutation of LH receptor causes it to be constitutively activated. /autonomous leydig cell activity. /presentation = testes enlarged but not to the extent expected for degree of virilization. /autosomal dominance with only male penetrance. /treatment = androgen blocker OR ketoconazole.

551
Q

Noonan syndrome

A

male version of Turner’s

552
Q

Neonatal abstinence syndrome (NAS)

A

o Code: bunch of people shooting up around the room/withdrawal from transplacental opiates due to maternal drug use. Super jacked baby (hypertonia code) + shitting on the ground + sweating profusely + black eyes (mydriasis code)/presentation = tachypnea + hypertonia + hyper-excitability + increased startle reflex + irritability + diarrhea + vomiting + ANS (sweating, sneezing, mydriasis). Jack from Dartmouth is cradling the baby/treatment = methadone or morphine. /stem may suggest it by mentioning hep C infection.
o Location: TV room

553
Q

Why is maternal diabetes an RF for NRDS?

A

Insulin inhibits surfactant production

554
Q

Cardiac complication of maternal diabetes

A

Transposition of the great arteries

555
Q

Caudal regression syndrome

A

o Code: /associated with poorly controlled maternal diabetes. He has jellow legs + is pissing all over himself + has a tail + legs are fused together + on a stretcher + heart man in right corner + Joe holding stretcher up/presentation = sacral agenesis causing lower extremity flaccid paralysis + dorsiflexed contractures of the feet + urinary incontinence + anal atresia to sirenomelia + congenital heart defects + NTDs.
o Location: Harry Plumer’s dad’s house
o Sirenomalia = legs are fused together like a mermaid’s table

556
Q

Bartholin’s gland cyst

A

Barbara Neistadt: /relatively common. /presentation = tender, flocculent swelling below the skin of the posterolateral part of the labium majora. /obstruction of bartholin’s gland, typically a sequel to a previous infection. /cysts lined by either transitional epithelium or metaplastic squamous epithelium.

557
Q

vestibular adenitis

A
  • Code: Genevieve Adams: She’s inside of a vestibule + it’s lined with inflammation statues smoking blunts/chronic inflammation of the lesser vestibular glands. /vestibular glands lie just outside the hymenal ring. Ulcers covering her inside vagina + axe in her vagina/presentation = small + exquisitely painful ulcerations of the vestibular mucosa. /greater vestibular glands are Bartholin’s glands, minor are vestibular glands.
  • Location: Table outside café in Ed2
558
Q

Lichen sclerosus

1) presentation
2) histology

A
  • Code: Anna Schreiber: /chronic inflammatory condition producing white plaques usually on or near genitals. She’s itching her vagina intensely ++ getting banged out and screaming in pain by her boyfriend/presentation = dyspareunia + dysuria + pruritis. Table lined with inflammation statues/histo = inflammatory infiltrate at dermal-epidermal junction + thinned epidermis. Squamous indian sitting on her right/RF for squamous cell carcinoma.
  • Location: table outside of Ethai’s
559
Q

presentation of ovarian cancers in young girls

A

precocious puberty

560
Q

Peritoneal carcinomatosis

A

Omentum looks really f’d from transcoelomic spread of cancers in the abdominal cavity (ovarian carcinoma most common source but colon cancer can produce a similar picture).

561
Q

Peritoneal effusion

A

1) Increased ammonia (produced by bacterial proliferation in the damaged intestine) without an increase in creatinine.
2) gram stain of peritoneal fluid will demonstrate presence of enteric flora.

562
Q

Cloudy urine after sex…

A

retrograde ejaculation

563
Q

Very little seminal fluid released from urethra

A

retrograde ejaculation

564
Q

retrograde ejaculation associated with

A

complication of TURP due to damage of internal urethral sphincter.

565
Q

Precocious puberty definition

A

Before age of 8 in girls, 9 in boys.

STEP (85 decks)

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