Reproductive Flashcards
1
Q
Sonic Hedgehog gene?
A
Produced at the base of the limbs
Involved in patterning (anteriorposterior)
Mutation will cause holoprosencphalu
2
Q
Wnt-7 gene?
A
Produced at ectodermal ridge
Necessary for proper organization along dorsal/ventral axis
3
Q
FGF gene?
A
Provides lengthening of the limbs
4
Q
Homeobox genes?
A
Hox mutations lead to appendages
5
Q
Milestones in fetal developpment?
A
Week 1: blastocyte sticks at day 6
week 2: 2 layers
Week 3: three layers (cells from epiblast invginate—> primitive streak—> endoderm, mesoderm, ectoderm
Notochord arises from midline mesoderm
week 3-8: embryonic period (neuroectoderm and closes by week 4)
Organogenesis
Week 4: Heart begins to beat (has 4 limbs and 4 heart chambers)
week 6: Fetal cardiac activity is visible
week 8: fetal movements start
week 10: genitila have male and female characteristics
6
Q
Parts formed by surface ectoderm?
A
lens of the eyes epithelial linings of the oral cavity sensory organs of the ear olfactory epithelium epidermis Sweat Mammary glands
7
Q
Formed by neuroectoderm?
A
Brain CNS neurons Autonomic ganglia Melanocytes Chromaffin cells of adrenal medulla aortopulmonary septum endocardial cushions
8
Q
Formed by mesoderm?
A
Muscle Bone Linings Vagina Kidneys adrenal cortex Dermis Testes Ovaries
Mesoderm defects Vertebra defects Anal atresia Cardiac defects Tracheo-esophageal fistula Renal defects Limb defects
9
Q
what does endoderm form?
A
Gut tube epithilium (including anal canal above the pectinate line)
Urethra Lower vagina lungs liver gallbladder pancreas eustachian tube thymus parathryroud
10
Q
What is agenesis?
A
Absent organ due to absent premordial tissue
11
Q
Aplasia?
A
Absent organ even in the presence of primordial tissue
12
Q
Hypoplasia?
A
Incomplete organ developpement (premordial tissue present)
13
Q
Disruption?
A
Secondary breakdown of of normal tissue or disruption
14
Q
Deformation?
A
extrinsic disruption (occurs during embryonic period 3-8)
15
Q
Malformation?
A
Intrinsic disruption (during embryonic period 3-8 days)
16
Q
Sequence?
A
Abnormalities result from single 1 embryologic event
17
Q
When are babies most suscpetible to teratogens?
A
From the 3rd to the 8th week
(organogenesis
Before week 3 (all or none effect) and after the 8th week (growth and function are affected)
18
Q
List common medications that are teratogens ( and the effect)
A
ACE : renal damage
Alkylating agent: absence of digits
Aminoglycosydes: ototoxicity
Anti-epileptice: neural tube, cardiac, cleft palate, skeletal abnormalities, phalanx/nail hypoplasia, facial dysmorphism
Diethylstilbestrol: vaginal clear cell adenocarcinoma
Congenital mullerin anomalies
Folate antagonists: neural tube defects
Isotretinoin: multiple birth defects
Lithium: Ebstein anomaly
Methimazole: aplasia cutis congenita
Tetracyclines: discolored teeth
Talidomaide: limb defect, phocomelia, micromelia, flipper limbs
Warfarin: bone deformities, fetal hemorrhage, abortion, oprthalmologic abnormalities
19
Q
effects of alcohol?
A
Itellectual disability
Fetal alchol syndrome
20
Q
Effects of cocaine?
A
Low birth weight
Preterm birth
IUGR
placental abruption
21
Q
Effects of smoking?
A
Low birth weight Preterm labor SIDS IUGR placental problems
Nicotine causes vasoconstrcition (CO impairs O2 delivery)
22
Q
Lack or excess Iodine?
A
Congenital goiter or hypothyroidism
23
Q
Maternal diabetes?
A
Caudal regression syndrome
Congenital heart defects
24
Q
Methyl mercury?
A
Neurotoxicity (swordfish, shark, tilefish, lin
25
Vitamin A excess
High risk for spontaneous abortions
| And birth defects
26
X-rays?
Microcephaly
Intellectual disability
Minimized by lead shielding
27
Symptoms of fetal alcohol syndrome?
```
Mental retardation
Microcephaly
Facial abnormalities
Smooth philtrum
Thin vermillion brder
Small palpebral fissures
Limb dislocaton
Heart defects
Heart-lung fistulas
Holoprosencephaly
```
28
Dizygotic twins?
Faternal twins
2 eggs that are seperately fertilized by 2 different sperm
2 seperate amniotic sacs
2 zygots
29
Monozygotic twins?
1 fertilized egg (1 egg and 1 sperm) that splits early in pregnenacy
The timing of clevage determines the chorionicity and amnionicty
30
what is the most common type of monzygotic twins development?
Monochorionic (diamniotic) 75%
31
What are the fetal components of the placenta?
Cytotrophblast: inner layer of chorionic villi
Cytotophhoblast makes cells
Synctiotrophoblast: outer layer of chorionic villi
Synthesizes and secretes hormones hCG (structurally similar to LH) stimulates corpis luteum to secrete progesterone during first trimester
32
what are the maternal components of the placenta?
```
Decidua basalis (derived from the endometriym)
Maternl blood in lacuna
```
33
How does the fetal exchange work?
Fetal circulation (CO 2 and H20, urea, waste products and hormones are out of the cell
```
Maternal circulation
Sends O2
H2O electrotlytes
Nutrients
Hormones
IgG
Drugs
Virus.
```
34
How does the umbilical cord work?
Two umbilical arteries return deoxygenated blood from fetal internal iliac arteries to the placenta
Ombilical vein supplies oxygenated blood from placenta to fetus
Drains into the IVC via ductus venosus
35
What is urachus?
Yolk sac forms in the allantois (extends into the urogenital sinus)
Allantois becomes urachus a duct between the fetal bladder and the umbilicus
36
What is a patent urachus?
Failure of the urachus to obliterate and urine is discharged from the umbilicus
37
what is a urachel cyst?
Partial failure of the urachus to obliterate
Fluid filled cavity lined with uroepithilium (between the umbbilicus and bladder)
Can lead to infection
Can lead to adenocarcinoma
38
Characteristics of vesicourachel diverticulum?
Slight failure of the urachus to obliterate (outpouching of the bladder)
39
What is the vitelline duct?
Obliteration of the vitelline duct (connecys the yolk sac to the midgut lumen)
40
What is a vitelline fistula?
Vitelline duct fails to close with meconium discharge from the umbilicus
41
What is Meckel diverticulum?
Partial closure of the vitelline duct
Patent portion attached to the ileum (true diverticulum)
May have gastric or pancreatic tissue
Can result in melena, hematochezia, abdominal pain
42
what are the aortic arch derivatives?
1st: maxillary artery, branch of the external carotid
2nd: stapedial artery and hyoid artery
3rd: Common carotid artery and proximal part of the internal carotid
4th: proximal part of right subclavian artery
6th: Proximal part of pulmonary arteries and ductus
43
what is Di Geororge's syndrome?
Chromosome 22q11 deletion
Thymic aplasia
Hypocalcemia
Cardiac defects
44
Cleft lip and cleft lip palare
Cleft lip: failure of fusion of the maxillary and medial nasal processes
Cleft palate: failure of fusion of the two lateral palentine shelves
Both usually occur together
45
what is the mullerian duct?
Develops into female internal structures
Fallopian tubes, uterus, upper portion of the vagina
Male remnant is appendix testes
46
what is the mesonephric (wolfmann duct)
```
Develops into the internal structures of the male
Seminal vesicls
Epididymis
Ejaculatory duct
Ductus deferens
In females, remnant mesonephric duct
```
47
what does the SRY gene on Y chromosome do?
Produces testis determining factor (and testes developpement)
48
what do sertoli cells secrete?
Mullerian inhibitary factor (MIF)
| suppresses developpement of parameonephric ducts
49
What do Leydig cells do?
Secrete androgens that stimulate the developpement of paramesonephric ducts
50
What happens if have no sertoli cells or lack Mullerian inhibitaory factor?
Will develop male and female internal genitilia
| BUT male external genitilia
51
What if have 5 reductase deficiency?
Inability to convert testosterone into DHT
Male internal genitilia
Ambigous external genitilia until hits puberty, and then the increase in testosterone will cause masculinization
52
Characteristics of septate uterus?
Common anomly vs normal
Incomplete resorption of the septum
Decrease in fertility
Treat with septoplasty
53
Bicornate uterus?
Incomplete fusion of theMullerian ducts
| Increase risk of complicated pregnaney
54
Uterus didelphys?
Complete failure of fusion
Double uterus, vagina and cervix
Pregnancy is possible
55
What is hypospadias?
Abnoraml opening of penile urethra on ventral surface of the penis due to failure of the urethral folds to fuse
Hypospadias is more common then epispadias
Associated with inguinal hernia
56
what is epispadias?
Abnormal opening of the penile urethra on the dorsal surface of the penis
Due to faulty positioning of the tubercle
Extrophy of the bladder is asscoated with epispadias
(Goes up the pee)
57
what parts of the body anchor the testes?
Gubernaculum (band of fibrous tissue)
58
What does the processus vaginalis do?
forms turnica vaginalis
59
what is the female remnant of the guernaculum ?
rian ligament with round ligament of uterus
60
How does the venous drainage of the left ovary/testes?
Left gonadal vein to the left renal vein to the IVC
| right ovary/testes to the right gonadal vein to the IVC
61
How does lymphatic drainage occur?
Ovaries and testes drain to para aortic lymph nodes
Body of the uterus/cervix/superior bladder to the external iliac nodes
Prostate/cervox/corpus cavernosum/proximal vagina drains into the internal iliax nodes
Glans penis : drains in deep inguinal nodes
62
What does the infundibulopelvic ligament do?
Connects overies to the lateral pelvic wall
They are ligated during oophprectomy to avoid bleeding
Ureter courses retroperitoneally close to the gonad vessels
At risk during ligation of the ovarian vessels
63
What does the cardinal ligament do?
Cervix to the side wall of the pelvis
Contains uterine vessels
Ureter at risk during ligation of the uterine vessels in hysterectomy
64
What does round ligament of the uterus do?
Uterine fundus to the labia majora
Can be an issue in derivative of gubernaculum
Travels through round inguinal canal
Above the artery of Sampson
65
What does broad ligament do?
Connects the uterus, fallopian tubes and ovaries to the pelvic wall
66
what does Ovarian ligament do?
Median pole of the ovary to lateral uterus
67
Type of cell in the vagina?
stratefied squamous epithelium , non keratin
68
Type of cell in ectocervix?
Stratefied squamous epithelium, non keratin
69
Transformation zone?
squamocolumnar junction (most commone area for cervical cancer)
70
Uterus?
Columnar epithilium with long tubular glands in proliferative phase
71
Fallopian tubes>
Simple columnar epithilium (ciliated)
72
Ovary (outer surface)
Cuboidal epithelium
73
What is the pathway of semen ejaculation?
```
Seminiferous tubules
epipidymis
Vas deferens
ejaculatory ducts
Ureathra
Penis
```
74
Characteristics of urethral injury?
```
Suspect if there is blood seen on the urethral meatus
Prosterior urethra (membraneous urethra prone to injury from pelvic injury
Can cause urine to leak into the retropubic space
```
Anterior urethra at risk of damage due to perineal saddle injury
Can cause the urine to leak beneath the fascia of Bcuk
If fascia is torn, urine escapes into superficial perineal space
75
what is autonomic innervation of male sexual response?
Erection is parasympathetic nervous system
| NO -----> cGMP---->Smooth muscle relaxation----> vasodilation ---> proerectile
76
What is the anti-erectile response?
Norephineprine---> to Ca ----> smooth muscle constriction ----> anti-erectile
77
what is responsible for emission of the semen?
Sympathetic nervous system (hypogasrtic nerve)
78
What is responsible for the ejaculation of semen?
Visceral and somatic nerves
| Pudendal nerve
79
How does sildenafil work?
PDE-5 inhibitors decrease cGMP breakdown
80
Function of speratogonia (germ cells)
Maintain germ pool and produce 1 spermatocytes
| Line semingerous tubules
81
Function of sertoli cells (non-germ cells)
Secrete inhibitn B -inhibit FSH
Secrete androgen-binding protein (maintain local levels of testosterone)
Produce MIF
Tight junctions between sertoli cells form barrier and protect against autoimmune attack
Supports and noursihes developping spermatozoa
Temperature sensative: decrease sperm production and inhibin B with increase in temperature
Hormone functions: Lines seminiferous tubules
Convert testosterone and androstenedione to estrogen via aromatase
82
Functions of Leydig cells?
```
Secrete testosterone in the presence of LH
These cells (unlike sertoli cells) are unafected by the temperature
```
Found in the interstitium
Homolog of female theca interna cells
83
Source of estrogen?
| Potency of types of estrogen?
Estradiol > estrone > estriol
Produced by the ovary, placenta, adipose tisse
84
What is the function of estrogen?
Developpement of genitilia and breast
Female fat distribution
Growth of follicle, endometrial proliferation, increase of myometrial excitability
85
Levels of estrogen in pregnancy?
50 fold increase in estradiol and estrone
| 1000 fold in estriol (indicator of fetal well being)
86
what causes upregulation of estrogen?
Upregulation of estrogen, LH, and progesterone receptors
Estrogen causes feedback inhibition of FH and FSH
87
What does LH surge cause?
Stimulation of prolactin secretion
88
What is the source of progesterone?
Corpus luteum, placenta, adrenal cortex, testes
89
What happens to progesterone after delivery?
Decrease in progesterone which disihnits prolactin and causes lactation
An increase in progesterone is indicative of ovulation
90
what are the functions of progesterone?
Stimulation of endometrial glandular secretions and spiral artery developpement
Maintains pregnancy
Decrease in myometrial excitability
Production of thick cervical mucis which inhibits sperm entry into uterus
Increases body temperature
Inhibition of gonadotropins (LH and FSH)
Uterine smooth muscle relaxation (prevent contractions)
Decrease estrogen receptor expression
Prevents endometrial hyperplasia
91
The steps of oogenesis?
1 (primary) oocytes begin meiosis during fetal life and complete it just prior to ovulation
Meiosis 1 stops for years in prophase until ovulation
Meiosis 2: arrested in metaphase until fetlizatio (where they become 2 oocytes)
If fertilization doesnt occur within 1 day, the 2 secondary oocyte degnerates
92
How do hormones cause ovulation?
Increase in estrogen
Increase i GnRH receptos on the anterior pituary
Estrogen surge stimulates LH release
Leads to ovulation (rupture of the follicle)
Increase in temperature (due to progesterone)
93
What is mittelschemerz ?
```
Transient mid cycle ovulation pain
Due to peritoneal irritation
Due to follicular swelling/rupture
Fallopian tube contraction
Can mimic appendicitis
```
94
Roughly describe the mentrual cycle?
Follicular phase can vary in length
Luteal phase is 14 days
Ovulation + 14 days = mentruation
95
When is follicular growth the fastest?
During the second week of the follicular phase
96
Role of estrogen in menstrual cycle?
Stimulates endometrial proliferation
97
Role of progesterone in the menstrual cycle?
Progesterone maintains the endometrium to support implantation
Decrease in progesterone leads to decrease in fertility
98
What is dysmenorrhea?
Pain with menses, often associated with endometriosis
99
What is oligomenorrhea?
> 35 days in a cycle
100
What is metorrhagia?
Frequent or irregular menstruation
101
What is menorrhagia?
Heavy mentrual bleeding (more 80 ml, or blood loss that is more then 7 days of menses)
102
What is menometrorrhagia?
Heavy, irregular menstruation
103
Where does fertilization occur?
In upper end of the Fallopian Tube (the ampulla)
| Occurs within 1 day of ovulation
104
When does implantation occur?
Wall of the uterus within 6 days of fertilization
105
When does HCG surge occur?
Detectable 1 week after conception
| At home urine test 2 weeks after conception
106
What is the gestational age?
From date of the last menstrual period
107
What is embryonic age?
Calculated from the date of conception (gestational age minus 2 weeks)
108
Physiologic adaptations in pregnancy?
Increase cardiac output
Increase preload, and decrease afterload
Increase HR (increase plasma, increase RBC, decrease viscosity)
Hypercoagulability (decrease blood loss at delivery)
Hyperventilation (eliminate fetal CO2)
109
What is the source of HCG?
| Function of HCG?
Placenta
Function:
Maintains corpus luteum for 8-10 weeks of pregnancy acting like LH
After 8 weeks, placenta synthesizes it's own estriol and progesterone as the corpus luteum degenerates
Used to detect pregnancy in the urine
110
What happens to HCG in pathological states?
HCG increased in multiple gestation
Hydatiform moles
Choriocarcinomas
Down's syndrome
B-HcG decreases in ectopic or failing pregnancy
Edward syndrome
Patau sundrome
111
What is the Apgar score?
Appearance (2 pink, 1 extremities blue, 0 pale or blue)
Pulse (2 > 100 npm, < 100 bmp 1, no pulse 0)
Grimace (Cries and pulls away 2, weak cry 1, no response 0)
Activity (2, active movement, 1 arms and legs flexed, 0 no movement)
Respiration (strong cry 2, slow and irregular 1, no breathing 0)
112
what is low birthweight?
| Causes?
Defined as less then 2500 grams
Caused by prematurity or IUGR
Associated with increase rsik of SIDS and with mortality
113
Problems associated with low birthweight?
```
Imparied thermoregulation
Compormised immune function
Hypoglycemia
Polycythemia
Impaired neuorcognitive/emotional developpement
```
114
What are complications of low birth weight?
```
Infections
Respiratory distress
Necrotizing enterocolitis
Intraventricular hemmorrhage
Persistent fetal circulation
```
115
How do hormones begin lactation?
After labor have decrease in progesterone and estrogen dishinbits lacations
Suckling causes nerve stimulation with release of oxytocin and prolactin
116
what does prolactin do?
Induces and maintains lactation and decreases reproductive function
117
What does oxytocin do?
assists in milk being let down
| Promotes uterine contractions
118
Why is breast milk best for the baby?
```
Ideal for infants < 6 months
Contains maternal immunoglobulins
Passive immunity mostly IgA
Breast milk reduces infections
Decreases change of asthma, allergies, DM, and Obesity
```
If have exclusively breastfed infant, will require vitamin D supplementation
119
What are the benefits of breastfeeding?
Decrease maternal risk of breast and ovaria cancer
| Facilitates mother and child bonding
120
What is menopause?
| Hormone response?
Amenorrhea for 12 months
Decrease in estrogen due to age linked decline i umber of ovarian follicles
Average onset is 51 years old (earlier if smojer)
Usually have 4-5 years of abnormal mesntrual cycle
Source of estrogen (estrone) after menopuase becomes peripheral conversion of androgens
FSH increases for menopase (due to negative feedback of FSH due to decrease om estrogen)
121
What are symptoms of menopause?
```
Hot flashes
Atrophy of the Vagina
Osteoporosis
CAD
Sleep disturbances
Menopause before 40 suggests primary ovarian insufficency
```
122
What are the different types of androgens?
Testosterone
Dihydrotrestosterone
Androstenedione
123
what is the source of androgens?
DHT and testosterone
| Androstenedione (adrenal)
124
what are the relative potency of testosterone?
DHT > testosterone > androstenedione
125
What is the function of testosterone?
Differention of epididymyus
Vas deferens
Seminal vesicles
Growth spurt (penis and seminal vesicales) sperm, muscles, RBC
Voice is deeper
Closing of epiphyseal plates (via estrogen that is converted to testosterone)
Libido
126
What is the function of DHT?
Differentiation of penis, scrotum and prostate
Late: prostate growth
Balding
Sebaceous gland activity
127
How is testosterone converted to DHT?
5 alpha reductase (this is inhibited by finasteride)
Androgens converted to estrogen by cytochrome p450 (in males) in adipose tissue and testis
Aromatase is key in conversion of androgens to estrogen
128
What happens after exogenous testosterone is given?
Inhibition of the hypothalamus-pituaitry-gonadal axis
Decrease intratesticular testosterone
Decrease in testicular size
Azzospermia
129
When does spermatogenesis occur?
Begins at puberty with spermatogonia
Full developpemt takes 2 months
Occurs in the seminferous tubules
Produces spermatids that undergo speriogenesis (loss of cytoplasmic contents, gain of acrosomal cap) to form mature spermatozoon.
130
What are the Tanner stages of developement?
Stage 1:No sexual hair (flat appearing chest with raised hair)
Stage 2: Pubic hair appears at the pubarche
Testicular enlargement
Breast bud forms (thelarche)
Stage 3:
Coasing of pubic hair
Penis size increases in size (length)
Breast enlarge and mound forms
Stage 4:
Coarse hair accross the pubis
Sparing thigh (penis size increases in width and glans increase)
Breast enlarge with raised areola
Stage 5:
Coarse hair accross the pubis and the medial thigh
Penis and testes enlarge to adult size
Adult breast contou, areola flattens
131
Characteristics of Klinefelter syndrome?
```
47, XXY
Testicyle atrophy
Enuchoid body shape
Tall and long extremeties
Gynecomastia
Female hair distribution
Presence of inactivated X chromosome
Common cause of hypogonadism seen in infertility
```
```
Dysgenesis of the seminferous tubules
Decrease inhibit B
Increase of FSH
Abnormal Leydig cell function
Decrease in testosterone
Increase LH
Increase in estrogen
```
132
Characteristics of Turner's syndrome?
```
Short stature (if untreated)
Ovarian dysgenesis
Sheilf chest
Bicuspid aortic valve
conarctation (femoral < brachial pulse)
Lymphatic defects (webbed neck or cystic hygroma, lyphedema in feet and hands, horseshoe kidney
```
Most common cause of amenorrhea
Menopause before menarche
Decrease in estrogen leads to increase in LH and FSH
Sometimes due to mitotic error (mosaicism)
45 XO, XO
Pregnancy is possible (IVF) exogenous estradiol 17B and progesterone
133
What are double Y males?
XYY
```
Phenotypically normal
Normal fertility
Severe acne
Learning disability
Autism spectrum disorders
```
134
Ovotesticular disorder of sex developpement?
46 XX > 46 XY
Both ovarian and testicular tissue present (ovotestis)
Ambiguous genitilia
Previously called true hemaphrodisme
135
Testosterone is high, LH is high, disorder?
Defective androgen receptor
136
Testosterone is high, LH is low?
Testosterone secreting tumor or exogenous steroids
137
Testosterone is low, and LH is high?
Primary hypogonadism
138
Testosterone low, and LH low?
Hypogonadotropic hypogonadism
139
Disease with 46 XX, DSD
Ovaries present
External genitilia are virulized or ambiguous
Due to excessive and inapprpriate exposure to androgenic steroids during early gestation
140
Disease with 46 XY, DSD?
Testes are present
external genitlia are female or ambiguous
Most common form is androgen insensitivty syndrome
141
Placenta aromatase deficiency?
Inability to synthesize estrogen from androgens
Musculinization of female (46 XX)
Infants with ambigious genitilia
Increase in serum testosterone and androstenedione
Can present with maternal virilization during pregnancy (the fetal androgens cross the placenta)
142
Androgen insensitivity syndrome? (46 XY)
Defect in androgen receptor leading to normal appearing female
Female external genitlia, scant sexual hair
Rudimentary vagina
Uterus and fallopian tubes absent
Patients develop normal functioning testes
Often found in the labia majora (removed to prevent Cancer)
Increase in testosterone, estrogen, and LH
143
5 alpha reductase deficiency?
```
Autosomal recessive
Sex linked to genetic males (46 XY)
Inability to convert testosterone to DHT
Ambiguous genitilia until puberty
When testosterone causes masculinization and increase in growth of genitilia
```
Testoterone/estrogen levels are normal
Internal genitilia are normal
144
Kallmann syndrome?
```
Failure to complete puberty
A form of hypogonadotropic hypogonadism
Defective migration of GnRH cells
Formation of olfactory bulb
Decrease in synthesis of GnRh in the hypothalamus
Anosmia
Decrease in GnRH, FSH, LH, testosterone
Infertility (low sperm count in males, and amenorrhea in females).
```
145
General characteristics of hydatidform mole?
Cystic swelling of chorionic villi and proliferation of chorionic epithelim
Presents with vaginal bleeding, uterine enlargement and pelvic pressure/ pain
```
Associated with hCG mediated sequelae
early preclampsia (before 20 weeks)
Theca lutein cysts
Hyperemesis gravidarum
hyperthyroidism
```
Treatement: dilatation and curettage
with methotrexate
Monitor with B HCG
146
Charactersitics of the complete mole?
Karyotype: 46 XX or 46 XY
Componets: enucleated egg and single sperm
Duplicated paternal DNA
No fetal parts
Uterine size is increased
HCG is very increased
Imaging: Honeycombed uterus with clusters of grapes or snowstorm on the US
Risk of malignancy is 15-20%
Risk of choriocarcinoma is 2%
147
Characteristics of partial mole?
```
Karyotype: 69 XXX or 69XXY, 69 XYY
Components: 2 sperm and 1 egg
Fetal parts: yes
No change in uterine size
HCG mildly increased
Risk of malignancy is less then 5%
Risk of choriocarcinoma: RARE
```
148
What is choriocarcinoma?
Rare
Develops during or after pregnancy in mother or the baby
Malignancy of the trophoblastic tissue
No chorionic villi present
Increase frequency of bilateral multiple theca-lutein cysts
Presents with abnormal increase in B-Hcg
Shortness of breath, hemoptysis
Can have hematogenous spread to the lungs.
149
Placenta abruption?
Premature seperation of the placenta from the uterine wall before delivery
```
Risk factors:
Trauma
Smoking
HT
Preeclampia
Cocaine abuse
```
```
Presentation:
Abrupt, painful bleeding in third trimester
Possible DIC
maternal shock
Fetal distress
```
Life threatening for the mother and fetus
150
Placenta accreta/increta/percreta?
Defective decidual layer (abnormal attachement and seperation)
Risk factors:
Previous C section
Inflammation
Placenta Previa
151
Placenta accreta?
placenta attaches to the myometrium without penetrating it. This is the most common type
152
Placenta increta?
Placenta penetrates into the myometrium
153
Placenta percreta?
Placenta perforates through the myometrium and into the uterine serosa
The placenta can attach to the rectum or the bladder
Presentation: often by ultrasound
No seperaton of placenta after the delivery
Can cause post partum bleeding with Sheehan syndrome
154
Placenta previa?
Attachement of placenta to lower uterine segment over internal os (or less then 2 cm away)
Risk factors:
multiparity
prior C-section
Associated with painless third semester bleeding
155
Vas previa?
```
Fetal vessels run near the cervical os
Can result in rupture and extrangination
Painless vaginal bleeding
Fetal bradycardia (< 110 per minute)
Emergency C-section
```
Associated with velamentous unmbilcial cord (insertion of chord in choroamniotic membrane rather then placenta) so unprotected by Wharton Jelly.
156
What are causes of postpartum hemorrhage?
Tone (uterine atony)
Trauma (lacerations, incisions, uterine rupture)
Thrombin (coagulopathy)
Tissue (retained products of conception)
157
Characteristics of ectopic pregnancy?
Most often in ampulla of fallopian tubes
| Shows 10 mm embryo in oviduct at 7 weeks of gestation
158
When to suspect history of amenorreha?
Lower then expected HCG (based on dates)
Sudden lower abdominal pain
Confirmed with US
Often clinically mistaken for appendicitis
159
What are risk factors for ectopic pregnancy?
```
Prior ectopic
History of infertility
Salpingitis
Ruptured appendix
Prior tubal surgery
```
160
Two types of amniotic fluid abnormalities?
```
Polyhyraminos: too much amniotic fluid
Associated with fetal malformations
Maternal diabetes
Fetal anemia
multiple gestations
```
Can result in esophageal/duodenal atresia
Anencephaly
Both result in inability to swallow animotic fluid
Oligohydraminos: too little amniotic fluid
Assocayed with placental insufficnecy
bilateral renal agenesis
Posterior urethral valves
Inability to excrete urine
Profound oligohydraminos can cause Potter sequence.
161
What are the types of HTN in pregnancy?
Gestational HTN
Preeclampsia
Eclampsia
HELLP syndrome
162
Gestational HTN?
BP > 140/90 after 20th week of gestation
No preexisting HTN
No proteinuria
No end organ damage
Treatment: hydralazine, methyldopa, labetalol, Nifedipine
Deliver at 37-39 weeks
163
Preeclampsia?
New onset HTN
Has protinuria
End organ dysfunction after 20th week of gestation
May proceed to preeclampsia (which is siezures)
HELLP syndrome
Caused by abnormal placental spiral arteries that cause endothelial dysfunction and vasoconstriction
```
Risk factors include:
HTN
DM
Chronic renal disease
Autoimmune
```
164
What are complications of preeclampsia?
```
Placental abruption
Coagulopathy
Renal failure
uteroplacental insufficiency
Eclampsia
```
165
Characteristics of Ecclampsia?
| Treatement?
Need to have preeclampisa AND maternal seizures
Can have death due to stroke, intracranial hemorrage or ARDS
Treatment: IV Magnesium sulfate
Antihypertensives
Immediate delivery
166
Characteristics of the HELPP syndrome?
```
Hemolysis
Elevated liver enzymes
Low platelets
Blood smear will show schistocytes
Can lead to hepatic subcapsular hematomas (rupture and severe hypotension)
```
167
What are characteristics of gynecological tumors?
Incidence of tumors in the US
endometrial > ovarian> cervical
(Cervical cancer is more common in the other parts of the world due to lack of screening and lack of HPV vaccination)
168
What are the type of vaginal tumors?
Usually secondary to squamous cell carcinoma, because primary vaginal carcinoma is rare
Clear cell adenocarcinoma: Affects women who have exposure to DES in utero
```
Sarcoma botryoides (embyronal rhabdomyosacoma variant) Affects girls less the 4 years old. Spindle shaped cells.
Presents as clear, grape-like polypoid mass emerging from the vagina
```
169
What are the characteristics of cervical pathology?
Dyplasia and carcinoma in situ: disordered epithelial growth, usually begins ar the basal layer of squamocoloumnar junction (transformation zone)
Associated with HPV 16 or HPV 18
May progress to invasive carcinom if left untreated
Typically is assymptomatic
Risk factors include: multiple sexual partners
170
Characteristics of invasive carcinoma in-situ?
Usually squamous cell carcinoma in situ
Pap smear can catch cervical dysplasia before it progresses
Diagnosis is with colposcopy and biospy
Lateral invasion can block the ureters
171
What is premature ovarian failure?
Premature atresia of ovarian folliciles in women of reproductive age
Patients present with signs of menopause before the age of 40
Have decrease in estrogen, increase in LH and increase in FSH
172
What are most common cause of anovulation?
```
Pregnancy
Polycystic ovarian syndrome
Obesity
HPO axis abnormality
Premature ovarian failure
Hyperprolactinemia
thyroid disorder
Eating disorder
Competitive athletics
Cushing syndrome
Adrenal insufficiency
```
173
Charcteristics of polycystic ovarian syndrome?
Hyperinsulinemia
Insulin resistence
Will alter the hypothalamic hormonal feedback response (increase in LH: FSH) from internal theca cells
Decrease the rate of follicular maturation
Unrupturedfollicles (cysts) + anovulution
Common cause of subfertility in women
```
Enlarged bilateral cystic ovaries
Presentes with amenorrhea/oligomenorrhea
hirutism
acne
decrease in fertility
obesity
Increased risk of endometrial cancer due to unopposed estrogen from repeated anovulatory cycle
```
```
Treatment:
Weight reduction
Oral contraceptive pills
Clomiphene citrate
Ketaconazole
Spironolactone
```
174
Types of Ovarian cysts and characteristics?
Follicular cyst: distention of unruptured graafian follicle
Associated with hyperestogenism
Endometrial hyperplasia
Most common ovarian mass in young women
Theca-lutein cyst: bilateral/multiple
Due to gonadotropin stimulation
Associated with choriocarcinoma and hydatidiform moles
Ovarian neoplams: most common adrenxal mass in women > 55 years old
Can be benign or malignant
Arise from surface epithelium, germ cells, or sex cord tissue
```
Majority of malignant tumors are epithelial
Risk increased with ade
infertility
endometriosis
PCOS
BRACA 1 and BRACA 2
Lynch syndrome
Family history
```
Risk will decrease with previous pregnancy, history of breastfeeding, oral contraception, tubal ligation
Presents with adnexal mass
Abdominal distention
Bowel obstruction
Pleural effusion
Monitor relapse and therapy by measuring CA 125 levels (not good for screening)
175
Serous cystadenoma?
Most common ovarian neoplams (lined with fallopian tube like epithelium, often bilateral
176
Mucinous cystadenoma?
Multiloculated, large, lined by mucos-secreting epithelium
177
Endomerioma?
Endometriosis (ectopic endometrial tissue) within the ovary with cyst formation
Presents with pelvic pain
Dysmenorrhea
Dyspareunia
Symptoms may vary with menstrual cycle
Chocolate cyst endometrioma filled with dark, reddish brown blood
Complex mass on ultrasound
178
Mature, cystic teratoma (dermoid cyst)
Germ cell tumor
Most common in females 10-30 years old
Cystic mass containing elements from all 3 germ layers (teeth, hair, sebum)
Can present secondary to ovarian torsion or enlargement
A monodermal form with thyroid tissue (stuma ovarii) can sometimes present as hypothyroid
179
Brenner tumor?
Looks like a bladder
Solid tumor that is pale yellow-tan and appears encapsulated
Coffee bean nuclei on H & E stain
180
Fibromas?
Bundles of spindle shaped fibroblasts
Meigs syndrome: triad of ovarian fibromas, ascites, hydrothorax
Pulling sensation in the groin
181
Thecoma?
Simular to granulosa cell tumor
May produce estrogen
Usually presents as abnormal uterine bleeding in a post menopausal women
182
Granulosa cell tumor?
Most common malignant stromal tumor
Predominantly women in the 50's
Often produces estrogen and progesterone
Presents with postmenopausal bleeding, sexual precocity (in pre-adolescents)
Breast tenderness
Histology shows Call-Exner bodies
Granulosa cells arrange haphazardly around collection of eosinophilc fluid (resembles primordial follicles)
183
Serous cystadenocarcinoma?
Most common malignamnt ovarian neoplasm (frequenlt bilateral) Psammona bodirs
184
Mucinos cystadenocarcinoma>
Pseudomyxoma perionei0intraperitoneal accumulation of mucinous material from ovaian appendiceal tumor
185
Immature teratoma?
```
Aggressive.
Contains fetal tissue
Neuroectoderma
Commonly diagnosed after menopaise
Typically represented by immature/embryonic like neural tissue
```
186
Dysgerminoma?
```
Most common in adolescents
Equivalent to male semnoma but rarer
1% of all ovarian tumors
30% of germ cell tumors
Sheets of uniform *fried egg cells*
HCG, LDH (tumor markers)
```
187
Yolk sac (endodermal sinus) tumor?
Aggressive in ovaries or testes and sacrococygea area in young children
Most common umore in male infants
Yellow
Friable
Solid mass
50% have Schiller-Duval bodies (resemble glomeuli)
AFP = tumor markers
188
What is Krukenberg tumor?
GI malignancy that has metastasize to the ovaries
| Mucin-secreting signet cell adenocarcinoma
189
Endometiral polyp?
Collection of endometrial tissue within uterine wall
May contain smooth muscle cells
Can extend into the endometrial cavity in the form of polyp
May be assymptomatic or present with painless abdominal uterine bleeding
190
Adenomyosis?
Extension of endometiral tissue (glandular( into the uterine myometrium
Caused by hyperplasia of basal layer of endometrium
Presents with dysmenorrhea, menorrhagia
Uniformly enlarged, soft, flobular uterus
Treatment with GnRh agonists, hysterectomy
191
Leiomyoma (Fibroid)
Most common tumor in females
Presents with multiple, discrete tumors
Increase incidence in African American
Benign smooth muscle tumor
Malignant transformation to leiomyosarcoma is rare
Estrogen sensitive (tumor size increases with pregnancy and decreases with menopause)
Peak occurrence is 20-40 years old
May be asymptomatic, cause abnormal uterine bleeding or result in miscarriage
Severe bleeding may lead to iron deficinecy anemia
Whorled pattern of smooth muscle bundles with well demarcated borders
192
Endometrial hyperplasia?
Abdnormal endometrial gland proliferation
Caused by excess estrogen stimulation
Increase risk for endometrial carcinoma
Nuclear atypia is greater risk factor then complex architecture
Presents as postmenopausal vaginal bleeding
Risk factors include anovuloatroy cyctes
Hormone replacement therapy
Polycystic ovarian syndrome
Granulosa cell tumor
193
Endometrial carcinoma?
```
Most common gynecological malignancy
Peak occurence at 55-65 years old
Presents with vaginal bleeding
Preceeded by endometrial hyperplasia
Risk factors include prolonged use of estrogen withour progestins, obesity, diabetes, HTN, nulliparity, late menopause, Lynch syndrome
```
194
Endometritis?
Inflammation of the endometrium
Associated with retained products of conception after delivery, miscarriage, abortion, or foreign body (IUD)
Retained material in the uterus promotes infection by bacterial flora from vagina or intestinal tract
Treatment: gentamicin and clindamycin
+/- ampicillin
195
Endometriosis?
Non-neoplastic endometrial glands/stome outside of the endometrial cavity
Can be found anywhere
The most common sites are the ovary (frequently bilateral, pelvis, peritoneum)
In ovary appears as endometroma (blood filled-chcholate cyst)
Can have metastatic transformation of multipotent cells
Endometirosis occurs because the cells are transported via lymphatic system
Characterised by cyclic pelvic pain, bleeding,dysmenorreha, dyspareeunia, dychezia *pain with defecation), infertility and normal sized uterus
Treatment: NSAIDS, OCPS, progestins, GnRH agonists, danazol, laproscopic removal
196
what are parts of the breast pathology?
(from the nipple into the breast)
Nipple then lactiferous sinus----> major duct--->terminal lobular duct ----->stoma)
The terminal duct (lobular unit), is where you get fibrocystic change, DCIS, LCIS, Ductal carcinoma, lobular carcinoma
197
Fiboradenoma?
Common in women under 35 years old
Small, well defined mobile mass
Increase in size and tenderness with estrogen (pregnancy or prior to mensturation)
Risk of cancer is not increased
198
Fibrocystic changes?
Extensio of endometrial tissue (glandular) into uterine myometrium
Hyperplasia of the basal layer
Presentes with dysmenorrhea, menorrhagia
Uniformly enlarged, soft, globular uterus
Treatment with GnRH agonisr, hysterectomy
199
Sclerosing adenosis?
Increase in acinii
Increase in stromal fiboris
Associated with calcifications
Slight 1.5 to 2X risk for cancer
200
Intraductal papilloma?
Small papillary tumor with lactiferous ducts
Typically right below the areola
Common cause of nipple discharge
Increase of 1.5-2X the risk of cancer
201
epithilial hyperplasia?
Increase cells in terminal duct or lobular epitheliem
| Increase risk of carcinoma with atypical cells
202
Phyllodes tumor?
large mass of connective tissue with cysts and leaf-lke lobulations
Most common in the 5th decade
Some may become malignant
203
Fat necrosis of the breast?
Benign
Usually painless lump due to injury to the beast tissue
Calcified oil cyst on the mammography
Necrotic fat and giant cells on biposy
Up to 50% of patients may not report the trauma
204
Lactational mastitis?
Occurs during breast feeding
Increased risk of infection through cracks in the nipple
Staph aureus is the most common pathogen
Treat with antibiotics and continue breast feeding
205
Gynecomastia?
Breast enlargement in males due to increase estrogen compared with androgen activity
Physiologic in newborns, pubertal, and elderly males
May presist after puberty
Other causes incloude cirrhosis, hypogonadism (Klinefleter syndrome)
Testicular tumors and drugs
Include: spironolactone, hormones, cimentidine, ketaconazole
206
Characteristics of malignant tumors?
Usually post menopause
From terminal duct lobular unit
Overexpression of estrogen/progesterone receptor or c-erbB2, Her02 an ECF receptor
Commonly triple negative ER-, PR- Her2/Neu-
More aggressive
Axillary node involvement usually means metastasis (important prognostic factor in early stage disease)
Most often uppper quadrant of the breast
207
what are risk factors for malignant breast tumors?
Increase estrogen exposure
Increase in total number of mentrual cycle
Older age at first live birth
Increase estrogen exposure in the adipose tissue
BRCA 1 and BRCA 2 gene mutations
African American ancestry (increase risk of triple negative breast cancer)
208
Ductal carcinoma in situ?
fills ductal lumen
Arises from ductal atypia
Often seen as cacifications on the x-ray
209
Comedocarcinoma?
Ductal central necrosis
| Subtype of DCIS
210
Paget disease?
Results from underlying DCIS or ivasive breast cancer
Ecsematous patches on the nipple
Paget cells = intraepithiliak adenocarcinoma
211
Invasive ductal carcinoma?
Firm, fibrous, and rock hard mass with small, glandular duct like cells
Will see stellate infiltration
212
Invasive lobular carcinoma?
Orderly row of cells (indian file)
Due to E-cadherin expression
Often bilateral with multile lesions in the same location
213
Medullary carcinoma?
Fleshy cellular, lymphocytic infiltrate
| Good prognosis
214
Inflammatory breast cancer?
Dermal lymphatic invasion by breast carcinoma
Peau d'orhange (breast cancer resembles orange peel)
Neoplastic cells block lympathic drainage
Poor prognosis: 50% survival at 5 years
Often mistaken for mastitis of Paget's disease
215
Peyronie disease?
Abnormal curvature of the penis due to fibrous plaque within the tunica albuginea
Associated with erectile dysfunction
Can cause pain, anxiety
surgical repair once curvature stabilizes
Distinct from penile fracture
216
Ischemic priapism?
```
Painful erection lasting more then 4 hours
Associated with sickle cell disease
Medications (sildenafil)
Trazadone
Treat with corperal aspiration
intracavernosal pheyephrine
Surgical decompression
```
217
Squamous cell carcinoma of the penis?
Most common in Asia, Africa, South America
There are usually precursor lesions such as Bowen disease (in penile shaft, presents as leukoplakia), erythroplasia of Querat (cancer of glans, presents as erythroplakia)
Bowenoid papulosis (carcinoma in situ of unclear malignant potential presenting as reddish papules
Associated with HPV and lack of circumcision
218
Cryto-orchidism?
Undescended Testis (one or both)
Impaired spermatogenesis
Sperm develope at < 37 degrees
Can have normal testosterone levels (Leydig cells are unaffected by temperature)
Associated with increase in germ cell tumors
Prematurity is a risk of crytopochidims
Decrease in inhibin B
Increase in FSH
Increase in LH
Testosteron is decreased in cryptoorchidimsm
Normal in unilateral
219
Varicocele?
Dilated veins in pampiniform plexus due to increase in venous pressure
Most common cause of scotal enlargement within males
Most often on the left side because increase in resistance of the gonadal vein draining into the left renal vein
Diagnosed by clinical exam (distention on inspection and bag of worms)
Distention on inspection (bag of worms) or on ultrasound
Treatment: vriocelectomy or embolzation
220
Scrotal mass?
Benign scrotal leisions
Present as testicular masses
Can be translluminated (vs solid testicular tumors)
221
Congenital hydrocele?
Common cause of scrotal swelling within infants due to incomplete oblieration of processus vaginalis
222
Acquired hydrocele?
Scrotal fluid collection secondary to infection
Trauma
Tumore
If bloody hematocele
223
Spermatocele?
Cyst due to dilated epipidiymal ducte or rete testes
| Will have paratesticular fluctuant nodule
224
Seminoma?
Malignant, painless, homogenous testicular enlargement
Most common testicular tumor
Does not occur in infacny
large cells with watery cytoplasm and fried egg appearence
increase placantal ALP
Radiosensitive
Late mets, excellent prognosis
225
Yolk sac (endodermal sinus tumor)
```
Yellow, mucinous
Aggressive malignance of the testes
Analogous to Ovarian yolk sac tumor
AFP is highly characteristic
Most common testicular tumor in boys is < 3 years old
```
226
Choriocarcinoma?
Malignant
Increase in BHCG
Disordered synctiotrophoblasts and cytotrophoblastic elements
Hematogenous mets to the lungs and the brain
May produce gynecomastia, symptoms of hypothyroidism
227
Teratoma?
Unlike females, mature teratoma in adult males may be malignant
Usually benign in children
228
Embyonal carcinoma?
Malignant, hemoragic mass with necrosis, painful
Worst prognosis than seminoma
Often glandular/papillary morphology
Pure embyonal carcinoma is rare
Most commonly mixed with other tumor types
229
Leydig cell?
Goldne brown color
Contains Rinke crystals (esinophilc cytoplasmic inclusions)
Produce androgen/estrogen and cause gynecomastic in men
Precococious puberty in boys
230
Sertoli cells?
Androblastoma from sex cord stroma
231
Testicular lymphoma?
Most common testicular cancer in older men
| Arises from mestastic lymphoma to testes, it is aggressive
232
Benign protatic hyperplasia?
Common in men > 50 years old
Characterized by smooth, elastic, firm nodule enlargement (hyperplasia and firm nodular enlargement)
Lobes can compress the periurethral (lateral and middle lobes)
These compress the urethra into a vertical slit
Can often present with increase in frequency of urination, nocturia, difficulty in starting and stopping urine stream or dysuria
May lead to distention or hypertrophy of the bladder
Hydronephorsis
UTI
Increase in free prostate specific antigen
Treatment (terzosin, tamsulosin)
Relaxation of smooth muscle
Tadalafil
233
Prostatitis?
```
Dysuria
Frequency
Urgency
Low back pain
Warm, tender, enlaged prostate
```
Acute: bacterial, chronic bacterial or abacterial
234
Prostatic adenocarcinoma?
Common in men > 50 years old
Arises within the posterior lobe of prostate gland
Usually diagnosed by increase in PSA and subsequenct needle core biopsies
Prostatic acid phophatease (PAP) and PSA are useful markers
LOOK at total PSA with decrease in fraction of free PSA
Osteoblastic mets in bone may develop in the late stages as indicated by lower back pain, and increase in serum ALP and PSA
235
The path of reproductive hormones (control)?
Hypothalums-----> GnRH----->anterior pituitary----> LH/FSH (ovary)----->androstenedione and testsoterone----->aromatase converts to estriol--->estrone---->estradiol
Men:
Hypothalaum---->GnrH-----> anterior pituitaty---->LH (testes)---->testosterone---->dihydrotestosterone---->androgen receptor complex-----> gene expression in androgen responsive cells
236
What is leuprolide used for?
GnRh analog with agonist properties when used in pulsatile fashion
When used in continuous fashion can be used to downregulate GnRh receptors in pituitary (decreased FSH/LH)
```
Clinical uses:
Uterine fibroids
Endometriosis
Precocious puberty
Prostate Cancer
Infertility
```
237
When to use estrogens?
Bind estrogen receptors
Clinical uses:
Hypogonadism or ovarian failure
Menstrual abnormalities
Hormone replacement therapy in postmenopausal women
Used in men with androgen-dependent prostate cancer
Adverse effects: Increase risk of endometrial cancer
Bleeding in postmenopausal women
Clear cell adenocarcinoma in vagina of women exposed to DES in utero
Increase risk of thrombi
Contraindications to estrogen therapy
estrogen receptor postive cancer
History of DVT
238
What are selective estrogen receptor modulators?
Clomiphene: Antagonist estrogen receptors in hypothalamus
Prevents normal feedback inhibition and release of LH and FSH from pituitary which stimulates ovulation
Causes hot flashes, ovarian enlargement
Multiple simultaneous pregnancies
Visual disturbances
239
Use of Tamoxifen?
Antagonis at estrogen receptors in the hypothalamus
Prevents normal feeback inhibition (increase release of LH and FSH from pituitay) which stimulates ovulation
Used to treat infertility due to anovaultion (PCOS)
May cause hot flashes, ovarian enlargement, multiple simultaneous pregnencies and endometrial cacer
Used to treat ER/PR + breast Cancer
240
Use of Raloxifene?
Antagonist at breast, uterus, agonist at bone
Increases risk of thromboembolic events BUT no increase in the risk of endometrial cancer
Used to primarily treat ostroporosis
241
Use of aromatase inhibitors?
Names: anastrozole, letrozole, exemestane
Mechanism: inhibit peripheral conversion of androgens to estrogen
Clinical use: ER+ breast cancer in postmenopausal women
242
Hormone replacement therapy?
Use for prevention of menopausal symptoms (hot flashes, vaginal atrophy)
Will cause osteoporosis due to increase in estrogen and decrease in osteoclast activity
Unopposed estrogen replacement therapy will increase the risk of endometrial cancer, so progesterone is added
Possible increase risk of cardiovascular
243
Use of Progestins?
Levonogestrel, medoxyprogesterone, etonogestrel, norethindrone and many otheres
Mechanism: binds progesterone receptors, decreases growth, increase vascularisation of endometrium, and will thicken the cervical mucos
Clinical use: contraception (pill, intrauterine device, implant, depot injection)
Effects: abnormal uterine bleeding and endometrial bleeding
244
What is the progestin challenge?
Asherman syndrome
| Chronic anovulation without estrogen
245
Anti-progestins?
Mifepristone, ulipristal
Mechanism: competitive inhibitors of progestins at progesterone receptors
Clinical use: termination of pregnancy (misoprostol) and emergency contraception (ulipristal)
246
Use of combined contraception?
Progestins and ethinyl estradiol include the pill, patch and vaginal ring
Estrogen and progestins inhibit LH/FSH and prevent estrogen surge
No estrogen surge---> no LH surge---> no ovulation
Progestins: cause thickening of the mucus, limiting access of sperm to the uterus
Progestins inhibit endometrial proliferation, and it is less suitable to implantation of an embryo
247
What are contraindications to combined contraception?
Smokers more then 35 years old
| Patients with cardiovascular disease (include history of DVT, CAD, stroke, migraine) and breast CA
248
How does the IUD work?
Produces local inflammatory reaction to toxic sperm and ova preventing fertilizaion and implantation (hormone free)
Clincial: long term reversible contraception
Most effective emergency contraceptopn
Adverse effects: loger menses, dysmenorrhea, risk of PID with insertion
249
Use of terbutaline, ritodrine?
B2 agonsit that relaxes the uterus
| Used to decrease contraction frequency in women during labor
250
Danazol use?
Mechanism: synthetic androgen that acts as agonist at individual androgen receptors
Clinical use:endometrioisis, hereditary angioedema
```
Adverse effects:
weight gain
edema
Acne
Hirutisme
Masculinization
Decrease HDL levels
Heptatotoxicity
```
251
Uses of testosterone, methytestosterone?
Agonist at androgen receptors
Clincial: treat hypogonadism and promote development of secondary characteristics
```
When give to females:
Masculinization
Decrease in intratesticular testosterone in males
Stimulates anabolism
Gonadla atrphy
Premature closure of epiphysiseal plates
Increase in LDL and decrease in HDL
```
252
Uses, and examples of antiandrogens??
Testosterone (5 alpha reductase) to DHT (more potent)
Finasteride: 5 alpha reductase inhibitos (decrease conversion of testosterone to DHT)
Used for BPH and male pattern baldness
253
Use of ketocanazole (form antiandrogen)
Inhibits steroid synthesis (inhibits 17, 20 desmolase)
254
Use of spironolactone?
Inhibits steroid binding (17 alpha hydroxylase and 17, 20 desmolase)
Used for polycystic ovarian syndrome to reduce androgenic symptoms
Both have side effects of gynecomastia and amenorrhea
255
Use of tamsulosin?
Alpha agonist used to treat BPH by inhibiting smooth muscle contraction
Selective for alpha 1A, D receptors (found in the prostate)
256
Use of phosphodiesterase type 5 inhibitors?
Sildenafil, vardenafil, tadlafil
Mechanism: inhibits PDE05 and increases cGMP and causes prolonged smooth muscle relaxation in response to NO
Increase flow in corpus cavernosum of the penis
Decrease in pulmonary vascular reistance
Clinical use: erectile dysfunction, pulmonary hypertension and BP (tadafil only)
Adverse effects: headache, flushing, dyspepsia, cyanopia (blue tinted vision) risk of life-threatening hypotension if taking nitrates
257
Use of minoxidil?
Direct arteriolar vasodilator
| Clinical use: androgenetic alopecia, and severe refractory hypertension
