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Step 1 > Reproductive > Flashcards

Reproductive Flashcards

1
Q

CNS development

A

SONIC HEDGEHOG GENE

Mutation results in holoprosencephaly

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2
Q

Gene produced at apical ectodermal ridge

Organization along dorsal-ventral axis

A

WNT-7 GENE

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3
Q

Gene produced at apical ectodermal ridge

Stimulates underlying mesoderm (lengthening)

A

FGF GENE

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4
Q

Gene for segmental craniocaudal organization

Codes for transcription factors

A

HOMEOBOX GENES

Mutation results in appendages in wrong locations

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5
Q

Timing of hCG production and implantation of blastocyst

note: hcG levels peak at around 10 weeks . Are produced by a developing blastocyst and later the placental syncytiotrophoblast

A

WEEK 1

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6
Q

Timing of bilaminar disc - epiblast and hypoblast

A

WEEK 2

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7
Q

Timing of granulation and trilaminar disc:

Epiblast forms primitive streak (endoderm, mesoderm, ectoderm)
Midline mesoderm becomes notochord
Overlying ectoderm becomes neural plate

A

WEEK 3

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8
Q

Neuroectoderm forms neural tube
Organogenesis begins

Note - Very susceptible to teratogens (before all-or-none)

A

WEEK 3-8

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9
Q 
Timing of...
Heart begins to beat
TVUS detects heart
Fetal movement begins
Genitalia become M/F
A

4 weeks
6 weeks
8 weeks
10 weeks

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10
Q

Derivatives of surface ectoderm

A 
Adenohypophysis (Rathke pouch)
Epidermis
Salivary, sweat, and mammary glands
Anal canal below pectinate line
Oral cavity epithelium
Olfactory epithelium
Auditory sensory organs
Lens
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11
Q

Derivatives of neuroectoderm

A 
Brain
Spinal cord
Neurohypophysis
Pineal gland
Retina
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12
Q

Derivatives of neural crest

A 
PNS
Pia/Arachnoid
Cranial nerves
Skull bones
Odontoblasts
Melanocytes
Chromaffin cells (adrenal medulla)
Parafollicular (C) cells
Aorticopulmonary septum
Endocardial cushions
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13
Q

Derivatives of mesoderm

A 
Dermis
Muscle, bone, and connective tissue
CV structures, lymphatics, and blood
Serous linings
Spleen
Kidneys
Ureters
Adrenal cortex
Upper vagina
Testes and Ovaries
Notochord (nucleus pulposus)

Note - Defects result in VACTERL (vertebral, anal, cardiac, TE fistula, renal, limb) defects

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14
Q

Derivatives of endoderm

A 
Gut tube epithelium
Lungs
Thyroid
Thymus and Parathyroid
Eustachian tube
Stomach
Liver
Gallbladder
Pancreas
Bladder and Urethra
Lower vagina
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15
Q

Difference between agenesis and aplasia

A

Agenesis - Absent primordial tissue

Aplasia - Primordial tissue present

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16
Q

Difference between deformation and malformation

A

Deformation - Extrinsic disruption after embryonic period

Malformation - Intrinsic disruption during embryonic period (weeks 3-8)

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17
Q

Teratogenic effect of alkylating agents

A

Absence of digits

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18
Q

Teratogenic effect of Methimazole

A

Aplasia cutis congenita

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19
Q

Teratogenic effect of Tetracyclines

A

Discolored teeth

Inhibited bone growth

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20
Q

Teratogenic effect of Thalidomide

A

Limb defects

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21
Q

Teratogenic effect of Warfarin

A

Bone deformities
Fetal hemorrhage
Ophthalmologic abnormalities

Note - Use Heparin instead

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22
Q

Teratogenic effect of cocaine, smoking

Note - Mechanism is vasoconstriction

A

Low birth weight
Preterm birth
IUGR
Placental abruption

Note - Smoking also increases risk of SIDS

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23
Q

Teratogenic effects of maternal diabetes

A

Macrosomia
Caudal regression syndrome
Congenital heart defects
Neural tube defects

Note - Caudal regression syndrome presents with flaccid paralysis, limb contractures, anal atresia, and syringomyelia

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24
Q

Teratogenic effect of methylmercury - found in fish

A

Neurotoxicity

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25
Q

Teratogenic effect of X-rays

A

Microcephaly

Intellectual disability

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26
Q

Mechanism of fetal alcohol syndrome

A

Failure of cell migration

Note - Most severe form can present with heart-lung fistulas and holoprosencephaly

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27
Q 
Timing of cleavage for twins with...
Dichorionic diamniotic
Monochorionic diamniotic
Monochorionic monoamniotic
Conjoined
A

Before Morula (0-4 days)
Before Blastocyst (4-8 days)
Before embryonic disc (8-12 days)
> 13 days

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28
Q

Function of fetal placental component…
Cytotrophoblasts
Syncytiotrophoblasts

A

Inner layer - Produces cells
Outer layer - Produces hormones (e.g. b-hCG)

Note - Fetal component of placenta lacks MHCI to prevent attack by maternal immune system

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29
Q

Structure of maternal component of placenta

A

Decidua basalis contains maternal blood from endometrial vessels in lacunae around chorionic villi

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30
Q

Embryologic origin of umbilical arteries and umbilical vein

A

Allantois - Surrounding fluid is Wharton jelly

Note - Single artery associated with congenital and chromosomal abnormalities

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31
Q

Origin and function of urachus - 3rd week

A

Connects fetal bladder to umbilicus - derived from urogenital sinus (allantois)

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32
Q

Origin and function of vitelline duct (omphalomesenteric duct) - 7th week

A

Connects yolk sac to midgut lumen

Note - Failure to close forms vitelline fistula leading to meconium discharge from umbilicus

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33
Q

Location of looping of recurrent laryngeals

A

Right recurrent - Around right subclavian

Left recurrent - Distal to ductus arteriosus

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34
Q

Embryologic origin of branchial clefts, arches, and pouches

A

Cleft - Ectoderm
Arch - Mesoderm (muscle, arteries) and Neural crest (cartilage)
Pouch - Endoderm

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35
Q

1st branchial arch cartilage, muscle, and nerve

Note - Used for mastication

A

Cartilage:
Maxillary and Mandibular processes
Malleus and Incus

Muscle:
Muscles of mastication (masseter, temporalis, pterygoid)
Mylohyoid
Anterior belly of Digastric
Tensor tympani
Tensor veli palatini

Nerve:
CN V2 and V3

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36
Q

2nd branchial arch cartilage, muscle, and nerve

Note - Used for facial expression

A 
Cartilage:
Styloid
Stylohyoid ligament
Lesser horn of hyoid
Stapes
Muscle:
Muscles of facial expression
Stylohyoid
Platysma
Posterior belly of Digastric
Stapedius

Nerve:
CN VII

Note - Auditory volume modulation by Stapedius (CN VII)

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37
Q

3rd branchial arch cartilage, muscle, and nerve

Note - Used for swallowing

A

Cartilage:
Greater horn of hyoid

Muscle:
Stylopharyngeus

Nerve:
CN IX

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38
Q

4th-6th branchial arch, cartilage, muscle, and nerve

Note - Used for swallowing and speaking

A 
Cartilage:
Arytenoid
Cricoid
Corniculate
Cuneiform
Thyroid

Muscle:
Levator veli palatini
Pharyngeal constrictors
Intrinsic laryngeal muscles

Nerve:
4th - CN X superior laryngeal branch (swallow)
6th - CN X recurrent laryngeal branch (speak)

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39
Q

Micrognathia
Glossoptosis
Cleft palate
Airway obstruction

A

PIERRE ROBIN SEQUENCE

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40
Q

Mandibular hypoplasia

Facial abnormalities

A

TREACHER COLLINS SYNDROME

Neural crest dysfunction

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41
Q

Branchial pouch derivatives

A

1st - Middle ear, Eustachian tube, Mastoid air cells
2nd - Palatine tonsils
3rd - Inferior parathyroid, Thymus
4th - Superior parathyroid, Ultimobranchial body (parafollicular C cells)

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42
Q

Failure of the left or right maxillary process to fuse with the intermaxillary segment

Intermaxillary segment formed by fusion of medial nasal prominence - Failure to fuse is associated with severe midline defect

A

CLEFT LIP

Note - Cleft palate is failure of the secondary palate to fuse together, or to fuse with the primary palate

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43
Q

Mechanism of female genital development

A

Mesonephric duct degenerates
Paramesonephric (Mullerian) duct develops
Forms fallopian tubes, uterus, and upper vagina
In males remnant forms appendix testis

Note - Lower portion of vagina from urogenital sinus

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44
Q 
Primary amenorrhea (hypoplastic uterus)
Fully developed secondary characteristics (ovaries)

Note - Increased risk of unilateral renal agenesis

A

MULLERIAN AGENESIS (MAYER-ROKITANSKY-KUSTER-HAUSER SYNDROME)

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45
Q

Mechanism of male genital development

A

SRY on Y chromosome produces TDF
Testes develop
Sertoli cells secrete MiF
Leydig cells secrete Testosterone
Testosterone develops mesonephric (Wolffian) ducts
Forms seminal vesicles, Epididymis, Ejaculatory duct, Ductus deferens (not Prostate)
In females remnant forms Gartner’s duct

Note - External genitalia/Prostate (Genital tubercle, Urogenital sinus) require DHT (5a-reductase)

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46
Q

Development of both male and female internal genitalia, and male external genitalia

A

No Sertoli cells or lack of MiF

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47
Q

Double uterus, vagina, and cervix

A

Complete failure of Mullerian duct fusion

Note - Partial failure results in Bicornuate uterus

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48
Q 
Male and female derivatives of...
Genital tubercle
Urogenital sinus
Urogenital folds
Labioscrotal swelling
A

Glans penis/Corpus or Glans clitoris/Vestibular bulbs
Bulbourethral glands/Prostate or Bartholin/Skene glands
Penile urethra or Labia minora
Scortum or Labia

Note - Bartholin glands are Greater vestibular glands, and Skene’s glands are urethral/paraurethral glands

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49
Q

Mechanism of hypospadia

Note - Associated with inguinal hernias and cryptorchidism

A

Failure of urethral folds to fuse

-can cause increased UTI and sterility

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50
Q

Mechanism of epispadias

Note - Associated with bladder exstrophy

A

Faulty positioning of genital tubercle

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51
Q

Male and female derivatives of…
Gubernaculum - fibrous tissue
Processus vaginalis - invaginated peritoneum

A

Anchors testis to scrotum or ovarian/round ligaments

Tunica vaingalis or obliterated

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52
Q

Lymphatic drainage of…
Ovaries, Testes
Uterus, Cervix, Superior bladder
Prostate, Penis, Cervix, Proximal vagina, Inferior bladder
Vulva, Scrotum, Distal anus, Distal vagina
Glans penis

A 
Para-aortic (where testicular artery arises)
External iliac
Internal iliac
Superficial inguinal
Deep inguinal
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53
Q

Structures with in…
Infundibulopelvic (suspensory) ligament
Cardinal ligament (cervix)
Round ligament (fundus to labia majora)

A

Ovarian vessels/ovarian nerve plexus (ovarian torsion)
Uterine vessels
Sampson’s artery

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54
Q

Epithelial histology of fallopian tube and ovary

A

Fallopian - Simple columnar with cilia
Ovary - Simple cuboidal

Note - No cilia in uterus

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55
Q

Path of sperm during ejaculation

A 
Seminiferous tubules
Rete testis
Efferent ductules
Epididymis
Vas deferens
Ejaculatory duct
Urethra
Penis

Note - Seminal vesicle joins ejaculatory duct in prostate, and Cowper’s (bulbourethral) joins after prostate

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56
Q

Difference between presentation of posterior (membranous) and anterior (penile) urethral injury

A

Posterior - Pelvic fracture causing urine to leak into retropubic space between pubis and bladder

Anterior - Perineal straddle injury causing urine to leak beneath Buck’s fascia or through it into perineal space (scrotum, in front of pubis)

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57
Q

Innervation of erection, emission, and ejaculation

A

Erection - Pelvic nerve (parasympathetic)
Emission - Hypogastric (sympathetic)
Ejactulation - Pudendal (somatic)

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58
Q

Functions and regulation of Sertoli cells - line inside of seminiferous tubules

[ADD PIC FOR GNRH]

A

With FSH…
Regulate spermatogenesis
Support and nourish spermatozoa
Tight junctions form blood-testis barrier
Secrete androgen binding protein (maintain local levels)
Secrete Inhibin B to feedback inhibit FSH
Secrete MiF
Convert testosterone and androstenedione to estrogen

Note - Increased temperature decreases spermatogenesis (and inhibin production)

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59
Q

Function and regulation of Leydig cells - interstitium between seminiferous tubules

A

With LH…
Secretes testosterone

Note - Temperature independent

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60
Q

Relative potency of estrogens (greatest to least)

A

17b-Estradiol (ovary)
Estrone (adipose)
Estriol (placenta)

Note - Estradiol/Estrone increase 50x in pregnancy, while Estriol (fetal well being) increases 1000x

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61
Q

Metabolic effects of estrogen

A

Stimulates PRL
Stimulates SHBG
Stimulates HDL
Inhibits LDL

Note - Also inhibits Osteoclasts

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62
Q

Mechanism of estrogen production in granulosa cells

A

Pulsatile GnRH
LH activates Desmolase
Convert Cholesterol to Androgen
Androgen moves from Theca interna to Granulosa
Aromatase (under FSH) converts Androgen to Estrogen

Note - Ovary can also produce Androstenedione (P-450) which can be converted to Estrone

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63
Q

Timing of oogenesis

A 
Primary oocyte arrested in prophase I until ovulation
Secondary oocyte (haploid) arrested in metaphase II until fertilization
If fertilization does not occur within 1 day the oocyte degenerates
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64
Q

Mechanism of ovulation and menstruation

Note - Luteal phase is always 14 days after ovulation

[ADD MENSTRUATION PIC}

A

Follicular phase:
Developing follicle stimulates GnRH release
Estrogen leads to proliferation of endometrium (tubular glands)
Estrogen switches to positive feedback of LH and FSH
LH surge
Rupture of follicle and ovulation

Luteal phase:
Corpus luteum (theca-lutein) begins producing Progesterone (major) and Estrogen (minor) - Progesterone maintains endometrium (coiled glands)

Menstruation:
Corpus luteum regresses and endometrium sheds

Note - Increased temperature after ovulation is due to increase in Progesterone

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65
Q

Appendicitis-like pain associated with follicular swelling/rupture, or fallopian tube contraction

A

MITTELSCHMERZ

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66
Q

Definition of oligomenorrhea and polymenorrhea

A

Oligo - > 35 day cycle

Poly - < 21 day cycle

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67
Q

Menorrhagia (heavy) and Metrorrhagia (frequent, irregular)

A

Menometrorrhagia

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68
Q

Most frequent site of fertilization

A

Ampulla of fallopian tube

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69
Q

Placental hormone secretion during pregnancy

[add pregnancy]

A

b-hCG rises until 14 days then drops
17-OH progesterone rises in first trimester then declines
hPL rises throughout pregnancy in proportion ot fetal mass
CRH rises sharply around week 28

Note - b-hCG detected in serum at 1 week and on pregnancy tests at 2 weeks

Note - Decreased Estriol levels indicate placental abnormalities/FGR

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70
Q

Gestational age vs Embryonic age

A

Gestational - Last menstrual period

Embryonic - Gestational - 2

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71
Q 
Physiological adaptations during pregnancy...
CO
Preload (BV)
Afterload (SVR)
HR
RR
Plasma volume
RBC
Viscosity
Coagulability
A 
Increased
Increased
Decreased
Increased
Increased
Markedly increased
Increased
Decreased
Increased

Note - Increase in plasma volume is greater than increased in RBC leading to anemia

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72
Q

Function of b-hCG

A

Secreted by syncytiotrophoblasts to maintain corpus luteum and progesterone production - eventually placenta is able to make its own progesterone and estrogen and b-hCG decreases

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73
Q

Effects of Progesterone during pregnancy

note: hCG maintains the corpus luteum during the first trimester of pregnancy. A deficiency of hCG allows progesterone to drop and increasing the risk of miscarriage

A 
Decreased myometrial excitability
Production of thick cervical mucus
Inhibition of FSH, LH
Decreased Estrogen receptor expression
Fall after delivery disinhibits Prolactin

Note - Estrogen induces Prolactin

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74
Q 
APGAR 2, 1, 0 point criteria...
Appearance
Pulse
Grimace
Activity
Respiration

Note - < 7 requires evaluation

A 
Pink, Extremities blue, Pale or blue
>100, <100, No pulse
Cries/pulls away, Grimaces/weak cry, No response
Active, Flexion, None
Strong cry, Slow irregular, No breathing
75
Q 
Hormonal changes during menopause...
Estrogen
FSH
LH
GnRH

Note - Occurs earlier in smokers

A

Decreased
Markedly increased
Increased
Increased

Note - Estrogen source becomes peripheral conversion of androgens, and increased androgen leads to hirsutism

76
Q

Menopause before age 40

A

PREMATURE OVARIAN FAILURE (PRIMARY OVARIAN INSUFFICIENCY)

77
Q

Relative potency of Androgens (greatest to least)

A

DHT > Testosterone > Androstenedione (adrenals)

Note- most circulating testosterone is bound to albumin and sex-hormone binding globulin.

Note - DHT responsible for prostate growth, balding, and sebaceous gland activity

78
Q

Responsible for closing of epiphyseal plates

A

Conversion of Testosterone to Estrogen - in males occurs by Cytochrome P-450 aromatase in adipose tissue and testis

79
Q

Mechanism of steroid induced infertility

A

Inhibition of HPG axis
Decreased intratesticular testosterone
Decreased testicular size
Azoospermia

Note - Also increases LDL and decreases HDL

80
Q

Mechanism of spermatogenesis

[ADD PIC OF SPERMATOGENESIS]

A
  • Spermatogonia in seminiferous tubules in close association with basal lamina
  • cross blood-testis border
  • Complete replication to form primary spermatocyte
  • Meiosis I forms secondary spermatocytes (haploid)
  • Meiosis II forms spermatid
  • Spermiogenesis (loss of cytoplasm, gains acrosomal cap)
  • Fully mature spermatozoon
81
Q

Tanner Stage II

A

Pubarche
Testicular enlargement
Thelarche

82
Q

Tanner Stage III

A

Coarsening of pubic hair
Penis size and length
Breast enlarges, mound forms

83
Q

Tanner Stage IV

A

Coarse hair across pubis sparing thigh
Penis width/glans
Breast enlarges, raised areola, mound on mound

84
Q 
Primary hypogonadism/small penis
Hypergonadotropic hypogonadism
Tall with long extremities
Female hair distribution
Testicular atrophy/small firm testes
Gynecomastia

Presence of Barr body

A

KLINEFELTER 47 XXY

Dysgenesis of seminiferous tubules leads to…
Decreased inhibin B
Increased FSH

Abnormal Leydig cell function…
Decreased testosterone
Increases LH and Estrogen

85
Q 
Streak ovaries
Short stature
Shield chest
Bicuspid aortic valve
Coarctation
Webbed neck
Cystic hygroma
Lymphedema
Horseshoe kidney
hypothyroidism

No Barr body

A

TURNER SYNDROME 45 XO

Decreased estrogen
Increased FSH, LH

Note - Mosaicism may result in 45 XO, 46 XX

Note - Pregnancy may be possible with exogenous estrogen

86
Q

Both ovarian and testicular tissue present

Ambiguous genitalia

A

OVOTESTICULAR DISORDER OF DEVELOPMENT (TRUE HERMAPHRODITISM)

46 XX > 46 XY

87
Q 
Testosterone and LH in...
Defective androgen receptor
Testosterone secreting tumor or exogenous source
Primary hypogonadism
Hypogonadotropic hypogonadism
A

Increased, Increased
Increased, decreased
Decreased, Increased
Decreased, decreased

88
Q

Ovaries present
External genitalia ambiguous or virilized

Increased Testosterone
Increased Androstenedione

A

46 XX DSD (PLACENTAL AROMATASE DEFICIENCY)

Excessive exposure to androgens during gestation

89
Q

Female external genitalia
Testes present (labia majora) - usually in the abdominal or inguinal area
Rudimentary vagina
Uterus and fallopian tubes absent

Increased Testosterone
Increased Estrogen
Increased LH

A

46 XY DSD (ANDROGEN INSENSITIVITY)

androgen receptor defect

90
Q

Low sperm count or amenorrhea
Anosmia

Decreased GnRH
Decreased FSH
Decreased LH
Decreased Testosterone

A

KALLMANN SYNDROME

Hypogonadotropic hypogonadism - Defective migration of GnRH cells and formation of olfactory bulb

91
Q

Vaginal bleeding
Uterine enlargement more than expected
Pelvic pressure

b-hCG sequelae:
Early preeclampsia (< 20 wks)
Theca-lutein cysts
Hyperemesis gravidarum
Hyperthyroidism
A

HYDATIDIFORM MOLE (COMPLETE)

Cystic swelling of chorionic villi and proliferation of trophoblasts - May develop into Choriocarcinoma

Note - Partial moles are less symptomatic and present like miscarriages

92
Q 
Difference between complete and partial mole...
Karyotype
Components
Uterine size
hCG
Imaging
Risk of neoplasia
A 
Complete:
46XX; p-57-
Paternal DNA replicates in empty egg
Increased
Markedly increased
Snowstorm
Yes
Partial:
69XXX, 69XXY, 69XYY; p-57+
Two sperm fertilize a normal egg
Normal
Increased
Fetal parts
Rare

Note - Occasionally complete moles may also result from two sperm entering an empty egg (46XY)

93
Q 
Abnormal or elevated b-hCG
Shortness of breath
Hemoptysis
Hyperthyroidism
Hematogenous spread to lungs

Increased frequency of bilateral theca-lutein cysts

A

CHORIOCARCINOMA

Malignancy of cytotrophoblasts and syncytiotrophoblasts - No villi present

Note - May occur during or after pregnancy in mom or baby

94
Q

Risk factors for placental abruption - painful third trimester bleeding

A 
Trauma
Smoking
Hypertension
Preeclampsia
Cocaine
95
Q

Risk factors for placenta accreta/increta/percreta - postpartum bleeding

Note - Accreta is on myometrium, Increta is in myometrium, and Percreta is through myometrium into uterine serosa

A

Prior c-section
Inflammation
Placenta previa

96
Q

Risk factors for placenta previa - painless third trimester bleeding

A

Prior c-section

Multiparity

97
Q

Membrane rupture
Painless vaginal bleeding
Fetal bradycardia (< 110)

A

VASA PREVIA

Cord inserts into chorioamniotic membrane rather than the placenta (velamentous insertion) - fetal vessels travel to placenta unprotected by Wharton’s jelly

98
Q

Risk factors for…
Amenorrhea
Lower than expected b-hCG
Sudden lower abdominal pain

A

ECTOPIC PREGNANCY

results from delayed transit of the blastocyst into the uterine cavity

Prior ectopic pregnancy
Infertility or PID
Prior tubal surgery
Ruptured appendix

note: chlamydia commonly causes PID and ultimately scarring of the fallopian tubes via a type IV HSN rxn

99
Q

Causes of poly- and oligohydramnios

A 
Polyhydramnios:
GI atresias
Maternal diabetes
Fetal anemia
Multiple gestations

Oligohydramnios:
Placental insufficiency
Urogenital malformations

100
Q

Treatment of gestational (> 20 wks) hypertension - no end organ damage or preexisting HTN

(“Hypertensive Moms Love Nifedipine”)

Note - Before 20 wks indicates chronic HTN

A

Hydralazine
a-Methyldopa
Labetalol
Nifedipine

101
Q

Mechanism of preeclampsia - gestational HTN with proteinuria or end-organ damage

-HTN after 20 wks in previously normotensive women. if there is absence of proteinuria then it is just gestational HTN

A

Secondary to placental ischemia and hypoperfusion due to impaired remodeling of maternal spiral arteries

Abnormal placentation results in placental hypoxia - Placenta releases antiangiogenic factors which damage endothelium in mother

definitive treatment is termination of pregnancy via delivery

102
Q

Treatment of Eclampsia - preeclampsia with seizures leading to stroke, ICH, or ARDS

A

IV Mg/antihypertensives and immediate delivery

103
Q

Hemolysis
Transaminitis
Thrombocytopenia
Schistocytes on smear

A

HELLP SYNDROME

subset of severe preeclampsia

Can lead to hepatic subcapsular hematomas which rupture and cause hypotension - requires immediate delivery

104
Q

Incidence and mortality of gynecologic cancers (greatest to least)

A

Incidence - Endometrial > Ovarian > Cervical

Mortality - Ovarian > Endometrial > Cervical

105
Q

Toddler with…
Clear, grape-like mass from vagina
Spindle-shaped cells
Desmin+

A

SARCOMA BOTRYOIDES (EMBRYONAL RHABDOMYOSARCOMA VARIANT)

106
Q

Mechanism behind HPV 16/18 induced cervical cancer

Note - Most important risk factor is multiple sexual partners

[ADD PIC OF KOILO change}

A

Integration into host genome
E6 gene product degrades p53
E7 gene product binds RB releasing E2F

107
Q

Metabolic disorders resulting in anovulation

A 
Obesity or anorexia
Hyperprolactinemia
Thyroid disorders
Cushing syndrome
Adrenal insufficiency
108
Q

Mechanism of PCOS (Stein-Leventhal syndrome)

note: one or both ovaries are often significantly ENLARGED
note: treatment with spironolactone which blocks mineralocorticoid receptors, making it a potassium sparing diuretic. Spironolactone also has antiandrogen effects that can be used clinically to treat hirsutism in women

A

Hyperinsulinemia or insulin resistance alters hypothalamic hormonal feedback response

Increased LH/FSH increases androgens from theca interna

Decreased rate of follicular maturation leads to unruptured follicles (cysts) and anovulation

Note - Increased risk of endometrial cancer due to unopposed estrogen from anovulatory cycles

109
Q

Associations of follicular and theca-lutein cells

A

Follicular - Hyperestrogenism, Endometrial hyperplasia

Theca-lutein - Choriocarcinoma, Hydatidiform moles

110
Q

Used to monitor response of epithelial ovarian neoplasms to therapy

A

CA-125

i.e. cystadenocarcinomas which are derived from the surface epithelium of the ovaries

111
Q

Bilateral benign neoplasm lined with fallopian tube-like epithelium forming papillary fronds

  • May see Psammoma bodies
  • CA-125 marker +
A

SEROUS CYSTADENOMA

Most common ovarian neoplasm

112
Q

Multiloculated large benign neoplasm lined by mucus-secreting epithelium

A

MUCINOUS CYSTADENOMA

113
Q

Benign ovarian mass with thyroid follicles - may present with hyperthyroidism

Note - Often presents in women of childbearing age

A

MATURE CYSTIC TERATOMA (DERMOID CYST)

Immature teratoma often presents in older women and contains neuroectoderm - very malignant/aggressive

Note - May be malignant in adult males (not children or women)

114
Q

Grossly pale yellow-tan and encapsulated

Coffee bean nuclei on H/E stain

A

BRENNER TUMOR

Benign

115
Q 
Ovarian fibromas
Ascites
Hydrothorax
Pulling sensation in groin
Low back pain
A

MEIGS SYNDROME

116
Q

Postmenopausal bleeding
Precocious puberty
Breast tenderness
Increased inhibin

[ADD EXNER PIC]

Large, unilateral, yellow mass
Cuboidal cells in Rosettes (Call-Exner bodies)
Pink eosinophilic material surrounding coffee-bean nuclei

A

GRANULOSA CELL TUMOR

Associated with increased estrogen exposure (e.g. anovulation, nulliparity) - Decreased risk with pregnancies, breastfeeding, and birth control

Note - Yellow color due to lipid content in theca cells

Note- contrast to Sertoli-Leydig cell tumors that secrete male hormones

117
Q

Bilateral malignant ovarian neoplasm with Psammoma bodies

Note - Most common malignant ovarian neoplasm

A

SEROUS CYSTADENOCARCINOMA

118
Q

Intraperitoneal accumulation of mucinous material

A

PSEUDOMYXOMA PERITONEI

From ovarian mucinous cystadenocarcinoma or appendiceal tumor

119
Q

Teenage girl with sheets of “fried egg” cells
Elevated hCG
Elevated LDH

A

DYSGERMINOMA

Note - Not embryonic (teratoma) or extra-embryonic (yolk-sac, choriocarcinoma) tumor

120
Q

Toddler with…
Ovarian, testicular, or sacrococcygeal mass
Grossly yellow, friable (hemorrhagic) solid mass
Schiller-Duval bodies (endodermal sinuses that resemble primitive glomeruli)
Elevated AFP (AFP in schiller-duval bodies)

ADD PIC FOR SCHILLERDUVAL
note: AFP indicates yolk cell differentiation

A

YOLK SAC (ENDODERMAL SINUS) TUMOR or INFANTILE EMBRYONAL CARCINOMA

  • most common testicular cancer in young children
  • primitive cells, endodermal sinuses, cytoplasmic granules that stain immunologically for alpha-fetoprotein
121
Q

Mucin-secreting signet cell adenocarcinoma

usually b/l ovaries

[add krukenberg pic]

A

KRUKENBERG TUMOR

Metastasis from GI tract (usually stomach)

122
Q

Dysmenorrhea
Menorrhagia
Globular, soft uterus
nonfocal thickening of the myometrium

A

ADENOMYOSIS

Hyperplasia of basal layer of endometrium (glandular) into uterine myometrium (endometrial glands in the myometrium of the uterus)

Pain is caused by the glands breaking down and bleeding within the confines of the myometrium

Note - Uniformly enlarged uterus compared to fibroids (smooth muscle proliferation)

123
Q

Whorled pattern of smooth muscle bundles with well-demarcated borders

presents as heavy menstrual bleeding

biochemical vasoactive growth factors cause venous ectasia (dilation). large venules overwhelm normal hemostatic mechanisms (platelet aggregation, fibrin etc)

show immunoreactivity for smooth muscle acting

A

LEIOMYOMA (FIBROID)

uterine smooth muscle (myometrial) cells

submucosal/intracavitary fibroids have been associated with anemia

[ADD LEIOMYOMA PIC]

124
Q

Risk factors for endometrial hyperplasia/carcinoma

A 
HRT without Progestin
Nulliparity
Late menopause
PCOS
Obesity
Diabetes
Granulosa cell tumor
Lynch syndrome
125
Q

Treatment of endometritis - inflammatory infiltrate

A

Ampicillin + Gentamicin + Clindamycin

126
Q

Young woman with…
Small, well-defined, mobile mass
Increased size with estrogen
Slit ducts

A

FIBROADENOMA

Benign mass of breast stroma

127
Q

Premenopausal woman with…
Fluid-filled duct dilation, blue dome
Papillary apocrine change and metaplasia
Stromal fibrosis

A

FIBROCYSTIC CHANGE

Benign disease of terminal duct/lobular unit

Note - Increased acini or calcification with stromal fibrosis is sclerosing adenosis which slightly increases risk of cancer. It is characterized by fibrosis that distorts the glands and lobules into a whorled pattern and proliferation of small ducts

128
Q

Bloody or serous nipple discharge

Proliferating papillary cells with fibrovascular core

A

INTRADUCTAL PAPILLOMA

Benign tumor of lactiferous sinus - slight increased chance of cancer

THe presence of myoepithelial cells is key to the diagnosis of intraductal papilloma

[ADD PIC of MYOEPITHELIAL CELL]

129
Q

Pre or menopausal woman with…
Large mass of connective tissue
Leaf-like lobulation

A

PHYLLODES TUMOR

Benign tumor of stroma - may become malignant

130
Q

Calcified oil cyst on mammogram
Necrotic fat and giant cells on biopsy
Lipid laden (foamy) macrophages
Hemosiderin

A

FAT NECROSIS

131
Q

Drugs causing gynecomastia

“Some Hormones Create Knockers”

A

Spironolactone
Hormones
Cimetidine
Ketoconazole

132
Q

Filled ductal lumen with neoplastic cells
Nearby engorged blood vessels
Microcalcifications on mammography

A

DUCTAL CARCINOMA IN SITU

Note - If central necrosis of ductal proliferation then comedocarcinoma

133
Q

Intraepithelial adenocarcinoma

Lesions that are scaly, vesicular, or oozing start in nipple and spread to areola

+cytokeratin stain (epithelial cells) and mucin

A

PAGET DISEASE

underlying ductal adenocarcinoma (If mass then invasive and if no mass then in situ)

mucin containing cells (paget cells)

134
Q

Small, glandular nests/cords of duct-like cells surrounded by desmoplastic stromal response
Stellate infiltration on mammography

A

INVASIVE DUCTAL CARCINOMA

135
Q

Orderly row of cells (“Indian file”) in breast mass

Decreased E-cadherin expression

A

INVASIVE LOBULAR CARCINOMA

136
Q

Fleshy breast mass with lymphocytic infiltrate

sheet of tumor surrounded by abundant lymphoplasmacytic reaction

A

MEDULLARY CARCINOMA

Good prognosis

137
Q

Structure of the penis

A

Deep fascia contains…
Corpus spongiosum around urethra
Tunica albuginea
Deep dorsal vein, dorsal artery, and dorsal nerve

Tunica albuginea contains…
Corpus cavernosum around deep artery

Note - Fibrous plaque in tunica albuginea causes Peyronie’s disease

138
Q

SCC of penis presenting with…
Leukoplakia on shaft
Erythroplakia on glans
Reddish papules

Note - Associated with HPV

A 
Bowen disease (solitary white plaque)
Erythroplasia of Queyrat (single or multiple shiny red plaques)
Bowenoid papulosis (multiple red brown papules)
139
Q 
Levels in cryptorchidism
Inhibin B
FSH
LH
Testosterone
A

Decreased
Increased
Increased
Normal or Decreased if bilateral - Leydig temperature independent

140
Q

Scrotal mass increasing with standing

Does not transilluminate

A

VARICOCELE

aorta and superior mesenteric artery compress the left renal vein. The increased pressure in the left renal vein causes retrograde blood flow to testes and dilation of the pampiniform plexus –> “nutcracker effect”

also left gonadal vein is longer and more perpendicular

141
Q

Transilluminating swelling

A

HYDROCELE

The processus vaginalis is an evagination of the parietal peritoneum that descends through the inguinal canal

Incomplete obliteration of processus vaginalis results in spermatic cord hydrocele

142
Q

Paratesticular fluctuant nodule

A

SPERMATOCELE

Cyst in epididymis or rete testis

143
Q 
Teenage boy with...
Painless testicular enlargement
"Fried egg" cells
Increased ALP
PLAP + (placental alkaline phosphatase)
Nests or lobules of malignant cells surrounded by lymphocytic infiltrate
A

SEMINOMA

Radiosensitive - excellent prognosis

[ADD seminoma pic]

144
Q

Malignant hemorrhagic mass with necrosis
Painful
Glandular/papillary morphology
Elevated hCG

A

EMBRYONAL CARCINOMA

145
Q

Most common locations of extragonadal germ cell tumors

A

Retroperitoneum
Mediastinum
Pineal
Suprasellar

In infants and young children - sacrococcygeal teratomas

146
Q 
Golden brown mass
Reinke crystals - Eosinophilic cytoplasmic inclusion
Produce androgens or estrogen
Gynecomastia in men
Precocious puberty in boys
A

LEYDIG CELL TUMOR

Note - Sertoli-Leydig equivalent in women presents with masculinization

147
Q

Hyperplasia of lateral and middle prostate lobes

A

BPH

Smooth, elastic, firm nodular enlargement - not premalignant but may increase PSA

148
Q

Warm, tender, enlarged prostate

Low back pain

A

PROSTATITIS

Suspect acute bacterial prostatitis in a patient with exquisitely tender prostate gland

Acutely mostly e. coli
Chronically may be bacterial or abacterial

149
Q

Treatment of…
Hyperplasia of posterior prostate lobe
Elevated total PSA
Decreased free PSA

A

PROSTATIC ADENOCARCINOMA

Androgen receptor inhibitors - Flutamide, Bicalutamide
GnRH agonists - Leuprolide

Note - May also consider Estradiol/Mestranol

150
Q

Antiprogestins used for pregnancy termination and emergency contraception

A

Mifepristone - Termination
Ulipristal - Contraception

Note - Most effective emergency contraception is copper IUD
Note- in a patient with IUD infection think Actinomyces israelii

151
Q

Ductal epithelial hyperplasia with stromal fibrosis - No acinar cells

A

GYNECOMASTIA

-most common breast mass in men under 25 yo

Caused by…

Increased Estrogen (Tumors, Obesity, Cirrhosis, Hyperthyroidism, Androgen use)

Decreased Androgen (Hypogonadism, Hyperprolactinemia, Renal failure)

Drugs

152
Q

Mechanism of hyperandrogenism in PCOS

A

LH predominance leads to increased androgen production by Theca cells

Androgens are converted in the periphery to Estrogen also increasing the risk of endometrial hyperplasia

Note - Infertility treated with Clomiphene (estrogen receptor modulator) which decreases negative feedback of elevated Estrogen on the hypothalamus

153
Q

Ovarian mass producing thyroid hormone

A

Struma ovarii

  • Teratomas are the most common germ cell tumor of the ovary (originate from 3 germ layers) but struma ovarii is only one tissue type
  • Monodermal mature teratoma
  • Abundant mature thyroid tissue not under TSH control
  • Hyperthyroidism
154
Q

Most common etiologies (2) of septic abortion

A

S. aureus

E. coli

155
Q

Function of HPL

A

Increases maternal insulin resistance
Increased blood glucose, proteolysis, lipolysis
Glucose/Amino Acids shunted to fetus
Ketones provide energy for mother

Note - Also leads to compensatory increase in maternal insulin secretion which if inadequate leads to gestational diabetes

156
Q

Cause of DIC in postpartum hemorrhage

A

Released Tissue Factor (Thromboplastin)

Note - Rule out amniotic fluid embolism (cardiogenic shock)

157
Q 
Endometrial glands and stroma outside the uterus
Most commonly affects ovaries
Chocolate cyst (old blood and surrounded by thick fibrotic wall and surface adhesions)
A

Endometriosis

158
Q

What supplementation is not needed during pregnancy

toxicity can cause:
spontaneous abortions
fetal defects like microcephaly, cardiac, early epiphyseal closure, growth retardation

A

vitamin A

provitamin A from plant sources does not cause toxicity as it is metabolized into the active vitamin A in a highly regulated process

preformed vitamin causes toxicity due to efficient absorption and storage

TERATOGEN in first trimester when prganogenesis is occurring.

159
Q

First line medication in pregnancy for nausea and vomiting

A

B6

pyridoxine

160
Q 
Polymicrobial infection
after cesarean delivery
Malodorous locia (vaginal discharge etc) after delivery
uterine tenderness
leukocytosis

risk factors:

  • prolonged labor or rupture of membranes
  • cesarean delivery
A

postpartum endometritis

fever, leukocytosis, uterine tenderness, foul smelling vaginal discharge

161
Q

-Initiates transition from the proliferative phase of the endometrial cycle to the secretory phase

ADD PROGESTERONE PIC

A

Progesterone

  • proliferative phase is characterized by endometrial thickening and differentiation
  • secretory phase is characterized by a thick endometrium with long, coiled glands that are lined by a columnar epithelium with prominent cytoplasmic vacuoles adjacent to the gland lumen
162
Q

Mutations in the human epidermal growth factor 2 (HER-2) are a common cause of breast cancer. What is its gene products

A

Receptor tyrosine kinase

results in activation of Ras which induces activity of MAPKKK members like Raf. Raf continues phosphorylation cascade in the cell and induces cellular growth and proliferation

note: intrinsic tyrosine kinase activity or RTKs are the primary receptors for growth factors

163
Q

Spontaneous abortions are due to?

note: spread from circulation into the placenta causes an acute necrotizing villitis/chorionitis with presence of microabscesses (can be surrounded by histocytic proliferation)

A

LISTERIOSIS

Listeria monocytogenes from unpasteurized dairy foods and deli meats

164
Q

What is the most common cause of pelvic inflammatory disease and how do you stain it

A

Chlamydia trachomatis (D-K)

because it is an intracellular organism, it can only be visualized inside epithelial cells with iodine, giemsa, or fluorescent antibody strains

Lives inside epithelial cells and is an ATP scavenger and cannot synthesize its own ATP

165
Q

genotypic male with feminized genitalia and a normal male internal reproductive tract

virilization at puberty due to increased testosterone levels

can be due to finasteride exposure in utero (contraindicated)

A

5a-reductase deficiency

needed to make dihydrotestosterone which allows for differentiation of external genitalia

note: Wolffian duct becoming internal reproductive organs requires testosterone

166
Q

common causes of:

1) first trimester pregnancy loss
2) second and third trimester loss
3) third trimester loss

A

1) chromosomal abnormalities
2) chorioamnionitis due to ascending bacterial infections
3) abruptio placentae and placenta previa

167
Q

Male tumor types

A

ADD TUMOR PIC

168
Q

Uterine bleeding that occurs at irregular (intermenstrual) intervals is referred to as dysfunctional uterine bleeding

A

Usually due to anovulatory cycles

endometrium undergoes unopposed estrogenic stimulation

results in disorganized proliferative endometrium

Dx with the progestin challenge test which triggers menstruation

169
Q

Mullerian inhibiting substance or anti-Mullerian hormone is produced by

A

Sertoli cells in an XY fetus

it suppresses the differentiation of the paramesonephric(Mullerian) ducts an thereby prevents the formation of female internal reproductive organs

170
Q

[ADD PIC OF SEPTATEUTERUS]

A

complete or partial septate uterus

  • presence of a membrane that divides the uterine cavity
  • can cause a habitual abortion due to defective placental implantation
171
Q
  • gray white to yellow
  • cordlike structures resembling seminiferous tubules

[ADD TUMOR2}

A

SERTOLI CELL TUMOR

172
Q

Enter the inguinal canal by tearing through the posterior wall of the canal formed by the transversalis fascia. Passes through inguinal triangle

Note: All inguinal hernia pass through the superficial inguinal ring while only indirect inguinal hernias pass through the deep inguinal ring

A

DIRECT HERNIA

173
Q

Prostaglandin medication used to induce labor

A

dinoprostone

PGE2 induces cervical softening and effacement

174
Q

Cryptorchidism has an increased risk of

A

both the undescended testicle and the normal testicle are at increased risk of testicular cancer

175
Q

How does excessive exercise delay puberty?

Female athelete triad of intense exercise and dieting + amenorrhea + osteoporosis due to decreased estrogen

A

It suppresses hypothalamic secretion of GnRH

results in hypothalamic amenorrhea

low gonadotropins and estrogen

176
Q

Effect of growth hormone on insulin

A

reduce insulin sensitivity

during pregnancy the placenta produces a GH variant called placental growth hormone.

Causes gestational diabetes and hyperglycemia in the mother

177
Q

[add picture of inflammatory breast cancer]

A

Inflammatory breast cancer

  • marked swelling
  • erythema
  • warmth to skin
  • tumor invasion into dermal lymphatics
  • blockage causes lymphedema and “peau d’orange”
  • commonly mistaken for acute mastitis
178
Q

role of syncytiotrophoblasts and cytotrophoblasts in placental development

A

syncytiotrophoblasts invade the myometrium and develop an endothelial phenotype. Maternal spiral arteries are remodeled by invading fetal cytotrophoblasts to create a wide high capacitance low resistance vessel which facilitates delivery of oxygen and nutrients to the placental site

note: in pre eclampsia the invasion of cytotrophoblasts is incomplete and shallow. The spiral arteries fail to be invaded and remain small caliber vessels causing placental hypoperfusion

179
Q

Produces short germinating hyphae on germ tube test (inoculation of a sample into animal serum) or at body temp

A

candida albicans

note: risk factors include diabetes mellitus, systemic antibiotics, increased estrogen levels, decreased immunity

180
Q

Estrogens role in menstrual cycle

A

Estrogen levels are low at the beginning and rise slowly during the follicular phase

Estrogen suppresses FSH and LH through negative feedback inhibition

Estrogen reaches threshold and helf for atleast 2 days

Causes positive feedback and a surge in FSH and LH

Causes ovulation

181
Q

Most common inutero infection in the united states

  • petechial rash “blueberry muffin” baby
  • hepatosplenomegaly
  • periventricular brain calcification
  • jaundice
  • inflammation of the retina
  • sensorineural deafness
  • intracranial calcifications
  • microcephaly
  • heterophile negative mononucleosis
A

Congenital CMV infection

tx with ganciclovir

182
Q

Congenital torch infections

A

ADD TORCH

183
Q

Osteolytic lesions and osteoblastic lesions in metastasis to bone

A

breast metastasis can produce both osteolytic and osteoblastic lesions

lung, renal, and thyroid cancer generate osteolytic lesions

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