REPRODUCTIVE Flashcards
0
Q
Principal advances in the first 10 weeks of fetal development??(6)
A
Week 1 implantation Week 2 2 layers Bilaminar disc Week 3 3 layers trilaminar disk GASTRULATION Week 4. Heart beating 4 limbs Week 6 ✅ fetal cardiac activity Week 10 genitalia characteristics
1
Q
What are mesodermal defects VACTEREL?
A
Vertebral defects
Anal atresia
Cardiac defects
Tracheo-Esophageal fistula
Renal defects
Limb defects (bone and muscle)
2
Q
Seven most easy teratogenic agents
A
Amino glycosides CN VIII toxicity
Lithium Ebstein Anomaly
Methimazole Aplasia cutis congenital
Phenytoin Fetal hydantoin syndrome—cleft palate, cardiac defects, phalanx/fingernail hypoplasia
Thalidomide Limb defects 🐬
Valproate neural tube defects
Warfarin Bone , ophthalmologic defects
3
Q
What’s the effect of maternal diabetes in the fetal development? (3)
A
Caudal regression syndrome (anal atresia to sirenomelia)
congenital heart defects
neural tube defects
4
Q
Explain the type of monozygotic twins
A
13 days embryonic disc MONOCHORIONIC MONOAMNIOTIC SIAMESES
5
Q
What are the defects of urachus? (3)
A
Patent urachus
Urachal cyst
Vesicourachal diverticulum
6
Q
What are the defects of Viteline duct? (2)
A
Vitelline fistula
Meckel diverticulum
7
Q
What are aortic arch derivatives (5)?
A
1st arch is maximal art.
2nd Second = Stapedial and hyoid artery
3rd Common Carotid , internal Carotid
4th ➡️ aortic have arch ⬅️ right subclavian art.
6th pulmonary art. Ductus arteriosus
8
Q
Explain the first and second arch derivatives
A
1st Meckel cartilage: Mandible, Malleus, incus, spheno- Mandibular ligament,
Muscles of Mastication and anterior belly of digastric, rtensors
V2. V3 nerves
TREACHER COLLINS SD.
2st Reichert cartilage: Stapes, Styloid process, lesser horn of hyoid, Stylohyoid ligament
Muscles of fascial expression Stapedius, Stylohyoid, platySma, posterior belly of digastric
VII nerve Smile
PHARIGOCUTANEUS FISTULA
9
Q
Explain the third arch
A
3rd stylopharyngeus Msc–glossopharyngeal nerve
IX swallow
10
Q
Explain fourth and sixth arches
A
4th CN X simply swallow superior laryngeal nerve
pharyngeal constrictors; cricothyroid, levator veli palatini
6th CN X speak recurrent laryngeal nerve
Intrinsic laryngeal muscles
11
Q
Explain the four pouch derivatives
A
1 (ear)
2 (tonsils)
3 dorsal (bottom for inferior parathyroids)
3 ventral (to = thymus)
4 (top = superior parathyroids)
12
Q
Defects in MEN 2A
A
Adrenal medulla
Parathyroids
Para follicular cells
13
Q
What hormones are important for male embryologic development?
A
SRY gene —produces testis- determining factor testes development.
Sertoli cells secretes (MIF) ❎paramesonephric ducts.
Leydig cells secrete androgens ✅mesonephric ducts.
14
Q
What is the principal embryologic derivative for female internal organs?
A
Paramesonephric (Müllerian) duct
fallopian tubes, uterus, upper portion of vagina
Müllerian agenesis 1° amenorrhea
15
Q
What is the principal derivative embryologic male internal male organs?
A
Mesonephric (Wolffian) duct
Seminal vesicles, Epididymis, Ejaculatory duct, Ductus deferens
In females, remnant Gartner duct.
16
Q
What are the three uterine anomalies?
A
Septate uterus
Bicornuate uterus
Uterus didelphys
17
Q
Explain what last two products make urogenital folds and labioscrotal sweeping in male and female ?
A
Urogenital folds MALE penile urethra FEMELE Labia minora
Labosicrotal swelling MALE scrotum FEMELE Labia Majora
18
Q
Associations of hypospadias and epispadias
A
Hypospadias cryptorchidism inguinal hernia
Epispadia exstrophy of the bladder
19
Q
Where drains the left tonal vein?
A
Left renal vein ➡️ IVC
varicocele more common on the left
20
Q
What ligament is important to ligate in oophorectomy?
A
Infundibulopelvic ligament (suspensory ligament of the ovary) Contain ovarian ligaments
21
Q
What is the epithelium in outer surface of ovary?
A
Simple cuboidal epithelium
22
Q
Functions of Sertoli cells (6)
A
Secrete inhibin ❎FSH.
Secrete androgen-binding protein
Produce MIF
Tight junctions
Support and nourish developing spermatozoa
Temperature sensitive
23
Q
What estrogens are most potent?
A
Estradiol>estrone>estriol
24
Explain principal features of tanner stages (5)
I. Childhood (prepubertal)
II. Pubic hair appears (pubarche); breast buds form (thelarche)
III. Pubic hair darkens and becomes curly; penis size/length ; breasts enlarge
IV. Penis width , darker scrotal skin, development of glans; raised areolae
V. Adult; areolae are no longer raised
25
Definitions about menstruation (6)
Dysmenorrhea PAIN
Oligomenorrhea >35 days
Polymenorrhea 80mL >7days
Menometrorrhagia heavy irregular
26
Oocyte's Cycles (3)
Meiosis I is arrested in PROHASE I for years until Ovulation (1° oocytes).
Meiosis II is arrested in METAPHASE II until fertilization (2° oocytes)
27
Explain the Oocyte development phases (4)
Oogonium Diploid (2N, 2C)
⬇️
1° oocyte Diploid (2N, 4C)
⬇️
2° oocyte Haploid (1N, 2C)
⬇️
Ovum Haploid (1N, 1C)
28
Time to production of Beta hCG
First 10 weeks
| Acting like LH
29
Eat hCG is augmented and diminished ?(4.4)
hCG is ⬆️in multiple gestations, hydatidiform moles, choriocarcinomas, and Down syndrome
hCG is ⬇️ in ectopic/failing pregnancy, Edward syndrome, and Patau syndrome.
30
When is premature ovarian failure?
Menopause before age 40
31
How is the spermatogenesis?(5)
```
Spermatogonium Diploid(2N, 2C)
⬇️
1° spermatocyte Diploid (2N, 4C)
⬇️
2° spermatocyte Haploid (1N, 2C)
⬇️
Spermatid Haploid (1N, 1C)
⬇️
Mature spermatozoon Haploid(1N, 1C)
```
32
Potency of the three androgens
DHT>testosterone> androstenedione
33
How are FSH and LH in klinefelter and Turner syndrome?
⬆️ FSH
| ⬆️ LH
34
What's Female pseudo- hermaphrodite (XX) and Male pseudo- hermaphrodite (XY)
Female pseudo- hermaphrodite (XX) too much androgens
Male pseudo- hermaphrodite (XY) androgen insensitivity syndrome
35
What's Kallman syndrome ?
Defective migration of GnRH cells and formation of olfactory bulb; anosmia;
⬇️GnRH, FSH, LH, testosterone.
36
What signs are related whit hydatidiform mola? (3)
Hyperemesis gravidica
Hyperthyroidism
Preeclampsia
37
Kariotype and fetal parts in hydatidiform mole
Complete 46 XX , 46 XY
Empty egg+sperm
No parts
SNOWSTORM IN USG
Partial 69 XXX, 69 XXY, 69 XYY
Egg+ 2 sperms
✅Fetal PARTS
38
What HELLP means?(3)
Hemolysis,
| Elevated Liver enzymes
Low Platelets.
39
Defects in placental implantation deep (3) site (2)
ACRETA attaches myometrium whit out penetrating
INCRETA penetrates into myometrium
PERCRETA penetrates until serosa
PLACENTA PREVIA
Partial
Complete
40
What's the incidence of gynecologic tumors?
Endometrial>ovarian>cervical
41
Histologic features of sarcoma botryoides
Spindle-shaped cells
| Desmine ✅
42
What are the malignant VPH virus and its malignant products?
HPV16
HPV18
E6 (inhibit p53 suppressor gene)
E7( inhibit RB suppressor gene)
43
What are the sequence of polycystic ovarian syndrome?
Hyperinsulinemia and/or insulin resistance
alter hypothalamic hormonal feedback
⬆️LH:FSH,
⬆️androgens
⬇️rate of follicular maturation
⬆️ unruptured follicles (cysts) + anovulation.
44
Treatment for polycystic ovarian syndrome (5)
```
weight reduction
OCPs
clomiphene citrate
ketoconazole
spironolactone.
```
45
Principal feature of the seven benign ovarian tumors
Serous cystadenoma most common BILATERAL
Mucinous cystadenoma multiloculade large
Endometrioma chocolate cyst complex in USG
Mature cystic teratoma (dermoid cyst)thyroid tissue
Brenner tumor solid like BLADDER
Fibromas MEIGS SYNDROME ovarian fibroma, ascites, hydrothorax. “Pulling” sensation in groin.
Thecoma like Granulosum produce estrogen bleeding post menopause
46
Principal features of the eight malignant ovarian tumors
Immature teratoma THYROID TISSUE
Granulosa cell tumor abnormal uterine bleeding coffee bean nuclei
Serous cystadenocarcinoma MOST COMMON BILATERAL PSAMMOMA BODIES
Mucinous cystadenocarcinoma. Pseudomixoma peritoneal like apendice
Dysgerminoma adolescents fried egg cells hCG LDH
Choriocarcinoma. ⬆️frequency of bilateral/multiple theca-lutein cysts. ⬆️β-hCG,hemoptysis
Yolk sac (endodermal sinus) most common tumor male infants like gromerulo body ⬆️AFP
Krukenberg tumor primary GI tumor
47
What are the benign breast tumors ?
Fibroadenoma: 40yrs
48
What are the different proliferative breast diseases (4)?
Fibrosis
Cystic painful
Sclerosing adenosis
Epithelial hyperplasia
49
What drugs causes gynecomastia?(5)
```
Spironolactone
Digoxin
Cimetidine
Alcohol
Ketoconazole
```
50
What are the general characteristics of malignant breast tumors?(4)
Postmenopausal
Terminal duct lobular unit.
Overexpression of estrogen/progesterone receptors or c-erbB2 (HER-2, an EGF receptor)
Axillary lymph node = metastasis
51
What's the the single most important prognostic factor in breast malignant tumor?
Axilary lymph involvement
52
What makers give poor prognosis in breast tumors ?
triple negative (ER ⊝, PR ⊝, and Her2/Neu ⊝)
53
Noninvasive breast cancer (3)
Ductal carcinoma in situ (DCIS)
Comedocarcinoma: central necrosis
Paget disease: patches on nipple
54
What are invasive breast tumors?
Invasive ductal. Rock hard WORST
Invasive lobular INDIAN FILE ⬇️E-cadherin expression
Medullary. Lymphocytic infiltrate good prognosis
Inflammatory Peau d’orange 50%dead
55
What aré the precursor in situ lesions for squamous cell carcinoma?
Bowen disease
erythroplasia of Queyrat
Bowenoid papulosis
56
What are the most common extragonadal germ cell tumor?
Sacrococcygeal teratoma in young children
57
What a the principal features of tsticular germ cell tumors ? (5)
ALL ARE MALIGNANT
Seminoma:“fried egg” placental radio sensible ✅✅ PLAP
Yolk sac (endodermal sinus) tumor:Schiller duval bodies ⬆️AFP
58
Testicular non germ tumors (3)
Leyding reindeer crystals gynecomastia or rapid puberty GOLDEN
Sertoli
Testicular lymphoma 👴🏼
59
What are the causes of acute and chronic prostatitis?
Acute. E.coli
| Chronic abacterial
60
Where the prostatic adenocarcinoma ocurrs ?
Posterior lobe (peripheral zone)
61
What's leuprolide?
GnRH agonist
Infertility PULSATILE
prostate Ca CONTINUOS
62
What are selective estrogen receptor modulators?(3)
Clomiphene antogonist in hypothal amus ✅infertility
Tamoxifen❎ breast ✅ endometrium ✅bone
Raloxifene ❎ breast ❎ endometrium ✅ bone
63
Use of aromatase inhibitors (2)
Anastrazole
Exemestane
postmenopausal women with ER ⊕ breast cancer.
64
Use of mesiprestone
Inhibitor of pregesterone
| ABORTION
65
Contraindications for oral contraceptives (3)
smokers > 35 years old
history of thromboembolism and stroke
history of estrogen-dependent tumor.
66
Use of danazol
Agonist androgen receptor
Endometrosis
Hereditary angioedema
67
What are the principal features of antiandrogens (4)?
Finasteride 🚫5α-reductase
Flutamide. 🚫receptro CA prostate
Ketoconazole 🚫17,20-desmolase.
Spironolactone 🚫17α-hydroxylase, and 17,20-desmolase.
CAUSE GYNECOMASTIA AMENORRHEA
68
Type of alpha receptors found only in smooth muscle in prostate inhibited by tamsulosin?
α1A,D receptors
69
What's the most common cause of nipple pathologic discharge (blood)?
Intraductal papilloma whit proliferación of papillary cells
70
In what type of cancer is seen keratin pearls and intercellular bridges in epithelial cells ?
squamus cell cancer
71
What are the hallmarks of BENIGN mature cyst teratoma?
Sebaceous glands
| Keratinaceus debris
72
How can manifest the chronic herpes genitals?
Recurrent vesicles, ulcers, crusting
73
What type of cell is indicative of HPV infection?
KOILOCYTE!!!!!
74
Hat are the risk factors of epithelial ovarian cancer? (4)
Nuliparity
Endometriosis
BRCA-1 BRACA-2 LYNCH mutation
Postmenopausal
75
Hat are the protective factors of epithelial ovarian cancer? (3)
Oral contraceptives
Multi-parity breast feeding
Tubal ligation
76
Causes of uterin defects : bicornuate, didelphys, longitudinal uterin septum?
bicornuate incomplete lateral fusion
didelphys: complete lack of fusion
longitudinal uterin septum: failed involution
77
What is the function of testosterone in the genital fetal development ?
Stimulates mesonephric duct ( epididymis , vas defernets)
| DHT male external genitalia
78
What is the product of urogenital sinus in males and females (4,4)
👨🏻 bladder, urethra, prostate, bulbourethral glands
| 👩🏻 bladder , urethra, lower vagina, Bartholdi glands
79
Where lymphatic from glands of penis drains ?
Deep inguinal nodes which in turn drain into external iliac nodes
80
How is the innervation of penis to its erectile function?
Hypogastric nerve
⬇️
Inferior hypogastric plexus (fascia of prostate)
⬇️
lesser and greater cavernous nerves
⬇️
innervation corpora cavernous a and urethra
81
Consequence of pudendal nerve injury?
Fecal incontinence
Decrease penile sensation
External urethral paralysis
82
What are the layers of spermatic cord ? (3)
Internal spermatic fascia : form transversal is fascia
Cremasteric fascia: from internal oblique abdominal muscle
External spermatic fascia : from external oblique abdominal Msc
83
Where is the problem in the Peyrone disease?
Excess of collagen in TUNICA ALBUGINEA
84
Which muscle force blood into the clitoris when it is stimulated ?
Squiocavernosus
85
Which muscle is involved in posterior midline episiotomy?
Perineal body
86
Which artery is inside the round ligament ?
Sampson
87
Which process leads to menstruation after progesterone withdrawal?
APOPTOSIS!!!!
88
What's the gold standard for prolactinoma diagnosis ?
MRI of the brain
89
What the major inhibitor of prolactine secretion?
DOPAMINE
90
Muscles that have to be exercised in the keguel exercises?
LEVETOR ANI MUSCELS
Iliococcygeus
Pubococcygeus
Puborectalis
91
Which levels nerves are implied in urinary continence?(2)
L1-L2 Hypogastric plexus : bladder relaxation, internal sphincter contraction
S2-S4 pudendal nerve: external sphincter contraction
92
What is the tumor marker for nonseminomatous germ cells tumors?
What is the hormonal presentation?
hCG!!!!
PARANEOPLASIC HYPERTIROIDISM
because the hCG alpha subunits are very similar with TSH (FSH-LH)
93
Patients with polycyclic ovary syndrome are in risk for which type of cancer?
ENDOMETRIAL CARCINOMA !!!!
94
What type of cells are required to combat HPV infection?
T cells
95
What Histologic findings are related whit malignancy in fibrocystic disease of the breast? (2)
Atypical lobular hyperplasia
Atypical ductal hyperplasia
4-5 X risk
96
What's the serum marker for yolk sac tumor?
| And what is its pathognomonic Histologic finding ?
Alpha-fetoprotein
Schiller-Duval bodies
97
What is the drug analog of gonadotropin releasing hormone , used in prostate cancer?
LEUPROLIDE!!!!
98
What drug inhibits 5alpha reductase?
FINASTERIDE!!!!
99
Which drug blocks the androgen receptor used as anti cancerous ?
FLUTAMIDE!!!!!
Cyproterone acetate
Spironolactone
100
Mechanism of action of trastuzumab ?
Monoclonal antibody Antagonist at the ERB-B2 receptor
101
what is the mechanism of urge urinary incontinence?
increase intra abdominal pressure
102
difference among adenomyosis , leimyosis and endometrial hyperplasia?
ADENOMYOSIS uniformely enlarged
LEIOMYOSIS Irregularly enlarged
ENDOMETRIAL HYPERPLASIA No painful
103
important landmarks for pudendal nerve block (2)
ischial spines
| sacrospinous ligament
104
what arteries can be achived and accidentaly inyected in pudendal nerve block?
internal pudendal artery
| inferior gluteal artery
105
which nerves can be damaged after pelvic surgery? (3)
genitofemoral
iliohypogastric
obturador
106
which nerve can be damaged during log duration of lothotomy position?
lateral femoral cutaneuous
107
which ovaric tumor has coffee beans cells ?
ganulosa cells tumor
108
what elevated AFP means?
fetal neural defect
understimation of gestational age
twin
YOLK SAC TUMORS OVARIES AND TESTES
109
gestational choriocarcinoma is preceded by ....
ANY KIND OF PREGNANCY PHYSIOLOGIC OR PATHOLOGYC
110
what are the most common causative agents of orchitis in adolescents and older patients?
ADOLESCENTES Chlamidia trachomantis , Neisseria gonhorreae
| OLDER E. coli
111
cells which synthesize progesterone , testorone and estradiol ?
TECHA INTERNA progesterona and testosterone
| GRANULOSA estrogen
112
Which hormones activate and inhibit the prolactin secretion?
STIMULATION : TRH
INHIBITION : PROGESTERONE
113
When is the peak of B-hCG secretion?
9 week
114
Which artery have to be clamped bilaterally in order to control the bleeding in a uterine atony ?
Internal iliac ( hypogastric)
115
What is the most common agents in septic abortion?
STAPHYLOCOCCUS AUREUS!!!
gram-negative bacilli
Group B Streptococcus
116
Cause of cervicitis - pelvic inflammatory disease and vaginosis?
cervicitis-pelvic inflammatory disease N.GONORRHEAE , CHLAMYDIA
vaginosis. GARDNERELLA
117
Which genetic illnes is related whit ABSCENSE of vas deference bilaterally?
CYSTIC FIBROSIS
118
Where the gonadals veins drain?
Left gonadal ➡️ left renal vein
| Right gonadal ➡️ IVC
119
Association whit Mullerian Aplasia?
Renal agenesis
120
How patients whit Mullerian Aplasia are seen phenotipically?
Not upper vagina nor uterus
AMENORREA
Looks like women
121
Why patients with Turner syndrome are sterile?
ATROPHIC OVARIES !!!!
122
Explain de TWO arrested stages of the Oocyte formation..
Childhood until puberty MEIOSIS I ( prophase)
Puberty until fertilization MEIOSIS II (metaphase)
123
Causes of polyhydramnios?(2)
Impaired fetal swallowing
Increase fetal urination (⬆️CO= alloinmunization)
124
Why adolescents have irregular menstruations at the menarche?
ANOVULATORY CICLES!!!
Hypothalamic-pituitary-ovarian IMMATURE CICLES
125
What are the embryologic derivatives of hyoid bone? (2)
Lesser horn 2 ARCH
| Greater horn 3 ARCH
126
Big difference between fetal 21-hydroxylase and aromatase deficiencies?
🚫21-hydroxylase ➡️ fetus virilization
| 🚫aromatase ➡️ mother and fetus virilization
127
What is precocious puberty in Caucasian females ?
Development of secondary sexual characters at age less than 7 years old.
128
what receptors have to be analized in orther to predict breast tumor prognosis ?(3)
HER2
ER
PR
128
In congenital TORCH what are the principal fetal clinical effects ?
TOXOPLASMOSIS chorioretinitis, hydrocephalus, calcifications
OTHER
🔹VZV limb hypoplasia, cataracts , chorioretinitis.
🔹PARVOVIRUS ssDNA!!! hydrops fetalis
🔹SYPHILIS snuffles hepatomegaly skeletal anomalies
RUBELLA ssRNA!! Deafness, cataracts, blueberry muffin heart defect hepatosplenomegaly
CMV deafness chorioretinitis jaundice peri ventricular calcifications
HSV cutaneous vesicles lesions
129
Type of virus in TORCH
All are dsDNA least :
PARVOVIRUS ssDNA
RUBELLA ssRNA
130
what nerve can be injured in the labor by streching the labor canal
PUDENDAL NERVE!!!!!
pass near to schial spine
fecal , urinary incontinence , perineal pain
132
How is LH,FSH, inhibin and testosterone in cryptorchidism?
↔️TESTOSTERONE. ↔️LH
| ⬇️INHIBIN ⬆️FSH. ⬇️sperm
133
Hormone responsible by fusion of labial folds in male fetus?
Dihydrotestosterone
134
Where the glands drains?
Deep inguinal nodes
135
Why's hCG is used to ovulation?
Because the alpha subunit of hCG is similar to LH
136
Cause of disseminated intravascular coagulation in pregnant patients?
Placental damage
⬇️
Release tissue factor
137
Important cardiovascular consequence of amniotic fluid embolism?
CARDIOGENIC SHOCK
138
Important liver injury in pregnancy
Acute fatty liver of pregnancy
Nausea
Vomiting
Abdominal pain
⬆️ liver enzymes
139
Two principal infectious agents related with ectopic pregnancy?
Neisseria Gonorrhoeae
| Chlamydia Trachomatis
140
Management of PID?
Third generation cephalosporins (gonococcal coverage)
AND
Azithromycin or doxycycline (chlamydia coverage)
141
Principal phenotypic features in neonate with Down syndrome?(4)
Protruding tongue
Excessive skin at the nape of the neck
Upslanting palpebral fissures
Epicantal folds
142
What are the clinical features of amniotic fluid embolism?(4)
Carcinogenic shock
Hypo mic respiratory failure
Disseminated intravascular coagulation
Seizures or coma
143
What is the only indication of treatment of partner in vaginitis?
TRICHOMONIASIS
yellow-green malodorous
Ph>4.5
METRONIDAZOLE
144
Gene related with Hereditary Breast cancer?
Tumor suppressor genes
BRCA1 and BRCA2
145
What neoplastic lesion appears classically after mastectomy and Axillary lymph-node resection In breast cancer?
ANGIOSARCOMA
Stewart-Treves syndrome
146
How prostate cancer disseminate?
Hematogenously !!!!
Prostatic venous plexus
Vertebral venous plexus
