Reproductive Flashcards
Which lymph nodes does the scrotum drain to?
Superficial inguinal
Which lymph nodes do the testes/ovaries drain to?
Para-aortic
What medication can be given to prevent gynecomastia in men who are on androgen-deprivation therapy (ADT) for prostate cancer (e.g. orchiectomy, long-acting GnRH agonists, androgen receptor inhibitors).
Tamoxifen - inhibits the effects of estrogen on breast tissue.
How does adenomyosis present?
Usually in a middle-aged parous female. Symptoms include dysmenorrhea and heavy menstrual bleeding. Exam shows a uniformly enlarged uterus.
What kind of receptor is HER2?
HER2 is an oncogene which codes for a human epidermal growth factor receptor with tyrosine kinase activity in the intracellular domain. It is involved in epithelial growth, so carcinomas that overexpress HER2 demonstrate increased proliferation.
What hormone in pregnancy contributes to increased insulin resistance?
Human placental lactogen (hPL).
What are causes of polyhydramnios?
Defects associated with impaired swallowing: GI obstruction (e.g. duodenal, esophageal, or intestinal atresia) and anencephaly.
Increased fetal urination: high cardiac output due to anemia or twin-twin transfusion syndrome.
Maternal diabetes and multiple gestations can also cause more mild polyhydramnios.
What are the effects of fetal aromatase deficiency?
Maternal virilization (e.g. hirsutism) due to the transfer of excess androgens into maternal circulation. Affected newborn girls will have normal internal anatomy but will have ambiguous or male-type external genitalia. The fetus makes DHEA-S which in turn is converted through several steps into testosterone, estrone and estradiol in the placenta. Lack of aromatase in the placenta will cause excess testosterone production.
Why is the cause of skin retraction (i.e. dimpling) in the setting of invasive breast cancer?
Malignant infiltration of suspensory ligaments of the breast (e.g. Cooper ligament).
What are the most common pathogenic organisms to cause septic abortion (infection of retained products of conception)?
Gram-negative bacilli (e.g. E. coli), Staph aureus, and group B Strep
What is the first line treatment for PCOS in patients who desire to become pregnant?
Besides weight loss, medications that induce ovulation (e.g. clomiphene, letrozole). Clomiphene is a selective estrogen receptor modulator that prevents negative feedback inhibition of the hypothalamus and pituitary by circulating estrogen, resulting in FSH and LH production and ovulation. Letrozole is an aromatase inhbitor.
What is the preferred treatment besides weight loss for women with PCOS who do not desire to become pregnant?
Oral contraceptive pills. Spironolactone can also be used in women who do not respond to OC pills to treat acne and hirsutism.
What maternal factor has been linked to caudal regression syndrome?
Poorly controlled maternal diabetes. It is a rare defect in which infants are born without a sacrum and occasionally the lumbar spine. This results in flaccid paralysis of the legs, dorsiflexed contractures of the feet, and urinary incontinence. It can range in severity from isolated anal atresia to sirenomelia.
What is a developmental field defect?
When an initial embryonic disturbance leads to multiple malformations by disrupting the development of adjacent tissues and structures within a particular region (e.g. holoprosencephaly due to the failure of the cleavage of the prosencephalon into the telencephalon and diencephalon).
How is DIC from tissue factor vs amniotic fluid embolism released into maternal circulation differentiated from one another?
Blood pressure. Hypertension = tissue factor, hypotension and cardiogenic shock = amniotic fluid embolism.
The most common trigger for DIC in pregnancy is release of tissue factor from an injured placenta (e.g. placental abruption) into maternal circulation.
