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Step1 > Reproductive > Flashcards

Reproductive Flashcards

1
Q

Venous drainage in reproductive anatomy

A

Left gonadal vein takes the Longest way

Left ovary/testis –> left gonadal vein –> left renal vein –> IVC

right ovary/testis –> right gonadal vein –> IVC

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2
Q

Why are varicoceles more common on the left side?

A

because the left spermatic vein enters the left renal vein at a 90 degree angle .

flow is less laminar on left than on right –> left venous pressure >right venous pressure

results in varicocele more common on left

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3
Q

lymphatic drainage: ovaries/testes

A

para-aortic lymph nodes

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4
Q

lymphatic drainage: body of uterus/superior bladder

A

external iliac nodes

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5
Q

lymphatic drainage: prostate/cervix/corpus cavernosum/proximal vagina

A

internal iliac nodes

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6
Q

lymphatic drainage: distal vagina/vulva/scrotum/distal anus

A

superficial inguinal nodes

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7
Q

lymphatic drainage: glands penis

A

deep inguinal nodes

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8
Q

This ligament connects the ovaries to the lateral pelvic wall. Which ligament is it and what structures does it contain

A

Infundibulopelvic ligament or suspensory ligament

contains ovarian vessels

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9
Q

What do you want to ligate during an oophorectomy

A

suspensory ligament or infundibulopelvic ligament because it has the ovarian vessels

avoid bleeding

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10
Q

Ureter courses ______ close to the gonadal vessels. It is at risk of injury during ligation of _____ and _____ vessels

A

retroperitoneally

ovarian
and uterine vessels

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11
Q

This ligament connects the cervix to side wall of pelvis. What ligament? what does it contain?

A

cardinal ligament

contains the uterine vessels

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12
Q

This ligament connects the uterine horn to labia majora

A

round ligament of the uterus

derivative of gubernaculum

travels through round inguinal canal above the artery of sampson

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13
Q

This ligament connects the uterus, fallopian tubes, and ovaries to pelvic side walls

A

Broad ligament

contains the ovaries, fallopian tubes, round ligaments of uterus

Mesosalpinx - tube portion
Mesometrium - uterus
Mesovarium - ovaries

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14
Q

What ligament connects the medial pole of ovary to uterine horn

A

ovarian ligament

derivative of gubernaculum

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15
Q

What is the most common area for cervical cancer

A

transformation zone that is squamocolumnar junction

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16
Q

The vagina and endocervix are (histology)

A

stratified squamous epithelium , non keratinized

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17
Q

Endocervix,uterus, and fallopian tubes are (histology)

A

simple columnar epithelium

uterus is SCE with long tubular glands in proliferative phase and coiled glands in secretory phase

fallopian tube is ciliated

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18
Q

Ovary, outer surface is (histology)

A

simple cuboidal epithelium (germinal epithelium covering surface of ovary)

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19
Q

Pathway of sperm

A 
Seminiferous tubules
Epididymis
Vas deferens
Ejaculatory duct (after seminal vesicle and ampulla join)
Urethra
Penis
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20
Q

Patient has blood at the urethral meatus and a scrotal hematoma

A

Anterior urethral injury at the bulbar (spongy) urethra

blood is accumulating in scrotum and if bucks fascia is also torn then it escapes into perineal sapce

due to perineal straddle injury

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21
Q

Patient has blood at urethral meatus and a high riding prostate

A

Posterior urethral injury at the membranous urethra

urine leaks into retropubic space

due to pelvic fracture

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22
Q

Erection is due to ______ nervous system

A

parasympathetic NS

pelvic splanchnic nerves (S2-S4)

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23
Q

NO effect on erection

A

proerectile

it increases cGMP which causes smooth muscle relaxation –> vasodilation –> proerectile

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24
Q

PDE5 inhibitors like sildenafil effect on erection

A

decrease cGMP breakdown therefore proerectile

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25
Q

Norepinephrine effect on erection

A

increases calcium which causes smooth muscle contraction and vasoconstriction –> antierectile

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26
Q

Emission (release of semen from reproductive glands and contraction of reproductive duct) is controlled by the _____ system

A

sympathetic nervous system

hypogastric nerve T11-L2

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27
Q

Ejaculation (release from urethra) is controlled by _____ nerves

A

visceral and somatic nerves

pudendal nerves

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28
Q

Cells in the seminiferous tubules

A

Spermatogonia
Sertoli cells
Leydig cells

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29
Q

Spermatogonia

A

cells in seminiferous tubules that maintain germ cell pool and produce primary spermatocytes

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30
Q

Sertoli cells

A

cells in seminiferous tubules

  • Stimulated by FSH
  • Secrete inhibin B which feedback inhibits FSH
  • Secrete androgen binding protein to maintain local levels of testosterone
  • Support and nourish developing spermatozoa
  • Regulate spermatogenesis
  • Temperature sensitive
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31
Q

How do sertoli cells protect gametes from autoimmune attack

A

tight junctions between adjacent sertoli cells form the blood testis barrier

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32
Q

How does temperature impact sertoli cells

A

causes decreased sperm production and decreased inhibin B (important for feedback inhibiting FSH)

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33
Q

What enzyme converts testosterone and androstenedione to estrogen in the sertoli cells

A

aromatase

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34
Q

sertoli cells are the homolog of female ___

A

granulosa cells

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35
Q

Leydig cells

A

secrete testosterone in the presence of LH

unaffected by temperature

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36
Q

leydig cells are the homolog of female

A

theca interna cells

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37
Q

Source of estrogen

A

ovary (17beta-estradiol)
placenta (estriol)
adipose (estrone via aromatization)

estradiol>estrone> estriol

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38
Q

Estrogen functions to upregulate

A

estrogen, LH, and progesterone receptors

feedback inhibition of FSH and LH, then LH surge

Stimulates prolactin secretion

increases transport proteins like sex hormone binding globulin

Increases HDL and decreases LDL

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39
Q

estrogen levels during pregnancy

A

50 fold increase in estradiol and estrone

1000 fold increase in estriol which is an indicator of fetal wellbeing

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40
Q

pathway for converting cholesterol to estrogen

A

1) LH binds LHR on theca cells and causes cAMP + of desmolase
2) desmolase converts cholesterol to androstenedione
3) androstenedione enters granulosa cells
4) FSH binds FSHR on granulosa cells and causes cAMP + of aromatase
5) aromatase converts androstenedione to estrone
6) estrone estradiol
7) Estradiol –> estrogen which leaves the franulosa cells

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41
Q

Source of progesterone

A

corpus luteum, placenta, adrenal cortex, testes

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42
Q

Function of progesterone

A
  • Stimulation of endometrial glandular secretions and spiral artery development
  • Maintains pregnancy
  • Reduces myometrial excitability
  • Thick cervical mucus to prevent sperm entry
  • Increase body temperature
  • Inhibition of gonadotropins (LH and FSH)
  • Uterine smooth muscle relaxation (preventing contractions)
  • Decrease estrogen receptor expression
  • Prevent endometrial hyperplasia
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43
Q

Progesterone is _____

A

PROGESTation

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44
Q

Fall in progesterone after delivery disinhibits ____ and allows for lactation

A

prolactin

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45
Q

primary oocytes are arrested in _____ until ovulation

A

prophase I

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46
Q

secondary oocytes are arrested in _____ until fertilization

A

metaphase II

“an egg met a sperm”

degenerates if egg does not meet sperm in 1 day

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47
Q

product of complete oogenesis

A

1 ovum

3 polar bodies

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48
Q

hormone changes during ovulation

A

increase estrogen
increase GnRH receptors on anterior pituitary

estrogen surge causes LH release –> ovulation (rupture of follicle)

increase in temperature is due to progesterone

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49
Q

Mittelschmerz

A

transient mid cycle ovulatory pain

peritoneal irritation

can mimic appendicitis

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50
Q

phases of menstrual cycle

A

Follicular phase (Varies in length)
Ovulation
Luteal phase

ovulation + 14 days= menstruation

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51
Q

Follicular growth is fastest during ____ week of the _____ phase because ____ stimulates endometrial proliferation. _________ maintains the endometrium to support implantation during the _____ phase.

A

2nd week of the follicular phase because estrogen stimulates endometrial proliferation

Progesterone maintains the endometrium to support implantation during the luteal phase of the ovarian cycle

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52
Q

effect of low progesterone on fertility?

A

decreases fertility

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53
Q

menstrual cycle: ___ and ___ release from the ____ pituitary stimulates the developing follicle to release ______. This is around the time of _____

A

LH and FSH

anterior pituitary

estrogen

menses in uterine cycle (early follicular phase in ovary)

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54
Q

menstrual cycle: As estrogen levels increase we get a ______ surge and also ___ increase. This causes ____

A

LH surge and FSH increase

ovulation ( at the end of proliferative phase of the uterine cycle )

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55
Q

menstrual cycle: as LH and FSH decrease during the ___ phase, so does ________ and ______. But then the ______ produces _____ and _____. This is the ____ phase of the uterine cycle

A

luteal phase (ovarian cycle)

so does the estrogen and progesterone levels

corpus luteum produces estrogen and progesterone (important for endometrial proliferation and maintaining implantation)

This is the secretory phase of the uterine cycle (luteal phase of ovarian cycle)

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56
Q

ovarian cycle

A

follicular phase

Luteal phase

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57
Q

Uterine cycle

A

menses –> proliferative –> ovulation –> secretory –> menses

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58
Q

corpus luteum degrades into the

A

corpus albicans

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59
Q

Abnormal uterine bleeding due to structural causes

A

PALM

polyp
adenomyosis
leiomyoma
malignancy/hyperplasia

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60
Q

abnormal uterine bleeding due to non structural causes

A

COEIN

coagulopathy
ovulatory
endometrial
iatrogenic
not yet classified
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61
Q

Where does fertilization most commonly occur

A

ampulla (upper end of fallopian tube)

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62
Q

_________ secretes hCG

A

syncytiotrophoblasts

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63
Q

hCG peaks at ________ then decreases. All other placental hormones increase in secretion till end of pregnancy

A

8-10 weeks

detectable in urine at 2 weeks
in blood at 1 week

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64
Q

gestational age

A

date of last menstrual period

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65
Q

embryonic age

A

gestational age - 2 weeks

date of cenception

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66
Q

physiological adaptations during pregnancy

A

increased CO
increased HR
Anemia due to higher increase in plasma compared to RBC

hypercoagulability to decrease blood loss during pregnancy

hyperventilation to eliminate fetal CO2

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67
Q

hCG functions to maintain _____ for first 8-10 weeks of pregnancy by acting like _____. After 8-10 weeks, placenta synthesizes its own estriol and progesterone and the ______ degenerates

A

corpus luteum and thus prgesterone

acts like LH (identical alpha subunit to LH, FSH, and TSH)

corpus luteum degerates

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68
Q

Why can an increase in hCG cause hyperthyroidism

A

because hCG has a similar alpha subunit as TSH

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69
Q

____ subunit of hCG is unique and thus is used for pregnancy tests

A

beta

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70
Q

Other causes of high hCG

A

multiple gestations
hydatidiform moles
choriocarcinomas
down syndrome

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71
Q

Causes of decrease in hCG

A

ectopic/failing pregnancy
edwards
patau syndrome

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72
Q

Human placental lactogen/ chorionic somatomammotropin

A

secreted by syncytiotrophoblasts of the placenta

stimulates insulin production and overall increase insulin resistance. This causes maternal hypoglycemia –> lipolysis. This preserves available glucose and AA for fetus

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73
Q

gestational diabetes

A

occurs when maternal pancreatic function cannot overcome the insulin resistance

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74
Q

APGAR score

A 
Appearance 
Pulse
Grimace
Activity
Respiration

Score each 2-0 for a 10 point scale evaluated at 1 minute and 5 minutes

<7 score requires further evaluation

low score after later time points there is a risk the child will develop long term neurologic damage

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75
Q

Appearance scoring for APGAR

A

2 if pink
1 if extremities blue
0 if pale or blue

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76
Q

Pulse scoring for APGAR

A

2 if >100 bpm
1 <100 bpm
0 no pulse

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77
Q

Grimace scoring for APGAR

A

2 if cries and pulls away
1 if grimaces or weak cry
0 if no response to stimulation

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78
Q

Activity scoring for APGAR

A

2 if active movement
1 if arms and legs flexed
0 if no movement

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79
Q

Respiration scoring fo APGAR

A

2 if strong cry
1 if slow, irregular
0 no breathing

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80
Q

Motor milestones for 0-12 months : primitive reflexes (moro, rooting, palmar, babinski)

A

Moro reflex disappears by 3 months
Rooting reflex disappears by 4 months
Palmar reflex disappears by 6 months
Babinski reflex disappears by 12 months

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81
Q

Motor milestones for 0-12 months: posture and picks

A 
lifts head up prone by 1 month
rolls, sits, and passes toys hand to hand by 6 months
crawls by 8 months
stands and has pincer grasp by 10 months
Points to objects by 10 months
walks by 12-18 months
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82
Q

Social milestones for 0-12 months

A

social smile by 2 months
stranger anxiety by 6 months
separation anxiety by 9 months

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83
Q

Verbal/cognitive milestones for 0-12 months

A

orients to voice by 4 months
orients to name and gesture by 9 months
object permanence by 9 months
says mama and dada by 10 months

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84
Q

Motor milestones for 12-36 months (toddler)

A 
Takes first steps by 12 months
Climbs stairs by 18 months
Cubes stacked number = age x 3
Feeds self by fork and spoon by 20 months
Kicks ball by 24 months
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85
Q

Social milestones for 12-36 months (toddler)

A

Parallel play by 24-26 months
Moves away from and returns to mother by 24 months
Core gender identity formed by 36 months

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86
Q

verbal/cognitive milestones by 12-36 months (toddler)

A

200 words by age 2 (2 zeros)

2 word sentences

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87
Q

Motor milestones for 3-5 yrs (preschool)

A

Tricycle by 3 years
Copies line or circle, stick figures by 4 years
Hops on one foot by 4 years
Uses buttons or zippers, grooms self by 5 years

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88
Q

social milestones for 3-5 yrs (preschool)

A

Comfortably spends part of day away from mother by 3 years

Cooperative play and has imaginary friends by 4 years

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89
Q

verbal/cognitive milestones by 3-5 yrs (preschool)

A

1000 words by age 3 (3 zeros)
Complete sentences and prepositions by 4 years
Can tell detailed stories by 4 years

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90
Q

Low birth weight

A

defined as <2500 g

increased risk of SIDS and increased overall mortality

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91
Q

Rapid decrease in _______ disinhibits and initiates lactation

A

progesterone

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92
Q

Suckinling causes increased nerve stimulation and increase in _____ and _____

A

oxytocin and prolactin

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93
Q

prolactin

A

induces and maintains lactation and decreases reproductive function

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94
Q

oxytocin

A

assists in milk let down and promotes uterine contractions

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95
Q

breast feading decreases risk for child to develop

A

asthma, allergies, diabetes mellitus, and obesity

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96
Q

what do you need to supplement in children who are exclusively breast fed

A

vitamin D and iron supplementation

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97
Q

what benefit does breast feeding have for a mother

A

decreases risk of breast and ovarian cancer

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98
Q

Where do you get estrogen after menopause

A

peripheral conversion of androgens

increasing androgens causes hirsutism

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99
Q

hormonal changes in menopause:

A 
drop in estrogen
drastic increase in FSH
increase in LH
no LH surge
increase GnRH
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100
Q

Androstenedione is from the

A

adrenal glands

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101
Q

androgen potency

A

DHT>testosterone>androstenedione

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102
Q

Testosterone is converted to DHT by

A

5alpha reductase

103
Q

In men androgens are converted to estrogen by

A

cytochrome P450 aromatase

adipose tissue and testis

104
Q

Giving exogenous testosterone causes azoospermia. Why?

A

exogenous testosterone causes inhibition of hypothalamic-pituitary-gonadal axis

this decreases intratesticular testosterone

this decreases testicular size

causing azoospermia

105
Q

Testosterone function

A
  • Differentiation of epididymis, vas deferens, seminal vesicles (internal genitalia except prostate)
  • Growth spurt: penis, seminal vesicles, sperm, muscle, RBCs
  • Deepening of voice
  • Closing of epiphyseal plates (via estrogen converted from testosterone)
  • Libido
106
Q

DHT

A

early: differentiation of penis, scrotum, prostate
late: prostate growth, balding, sebaceous gland activity

107
Q

Spermatids undergo spermiogenesis which involves

A

losing cytoplasmic contents and gaining a acrosomal cap to form mature spermatozoon

“spermatogonium is going to be a sperm”
“spermatozoon is zoomng to the egg”

108
Q

Impaired tail mobility in mature spermatozoon can lead to infertility. This is linked to what syndrome

A

Kartagener syndrome or ciliary dyskinesia

109
Q

Tanner stages

A

stage the genitalia, pubic hair, and breast separately

110
Q

Tanner stage 1 (genitalia, pubic hair, and breast)

A
  • no sexual hair
  • flat appearing chest with raised nipple

“prepubertal”

111
Q

Tanner stage 2 (genitalia, pubic hair, and breast)

A
  • pubarche
  • testicular enlargement in boys
  • Therache/breast bud formation in girls

8-11.5 years

112
Q

Tanner stage 3 ((genitalia, pubic hair, and breast)

A
  • coarsening of pubic hair
  • penile size/length increases in boys
  • breast enlarges and mound forms in girls
113
Q

Tanner stage 4 (genitalia, pubic hair, and breast)

A
  • coarse pubic hair across pubis but sparing thigh
  • penis width/glans increases in boys
  • breast enlarges, raised areola, mound on mound in girls

13-15 yo

114
Q

Tanner stage 5 ((genitalia, pubic hair, and breast))

A
  • coarse hair across pubis and medial thigh
  • penis and testis enlarge to adult size in men
  • adult breast contour, areola flattens in women

> 15 yo

115
Q

Patient is a male thathas testicular atrophy, a eunuchoid body shape, is tall, has long extremities, gynecomastia, and female hair distribution.

A

Klinefelter syndrome

Male ,47,XXY (inactivated X chromosome or Barr body)

116
Q

Patients with klinefelter syndrome have dysgenesis of seminiferous tubules which results in decreased _____ and thus increased _____

A

decreased inhibin B

Increased FSH

117
Q

Patients with klinefelter syndrome have abnormal leydig cell function which causes a decrease in ______ which causes an increase in LH and then increase in estrogen

A

testosterone

118
Q

Common problems associated with turners syndrome

A

Shield chest
Bicuspid aortic valve
Coarctation (femoral pulse < brachial pulse)
Lymphatic defects causing the webbed neck or cystic hygroma
Lymphedema in feet and hands
Horseshoe kidney
Amenorrhea

119
Q

Turner syndrome estrogen, LH, and FSH levels

A

Female, 45, XO

Low estrogen levels result in increased LH and FSH. This is because estrogen and progesterone together are important for producing negative feedback at hypothalamus. Without this negative feedback, the GnRH increases and ultimately so does LH and FSH

120
Q

These patients are phenotypically normal males that are very tall. They have normal fertility and may have severe acne, learning disability, or autism

A

Double Y males

47,XYY

121
Q

Ovotesticular disorder of sex development

A

46,XX > 46, XY

Both ovarian and testicular tissue present (ovotestis)

Ambiguous genitalia

used to be called true hermaphorditism

122
Q

Patient has high testosterone and high LH

A

Defective androgen receptor

123
Q

Patient has high testosterone and low LH

A

Testosterone secreting tumor

Exogenous steroids

124
Q

Patient has low testosterone and high LH. Give example of syndrome

A

Hypergonadotropic hypogonadism (primary)

ex) turners syndrome

125
Q

Patient has low testosterone and low LH. Give example of syndrome

A

hypogonadotropic hypogonadism (secondary)

ex) kallman syndrome

126
Q

Patient has ovaries but their external genitalia are virilized or ambiguous

A

46,XX disorder of sexual development

can be due to congenital adrenal hyperplasia or exogenous administration of androgens during pregnancy

127
Q

Patient has test present but external genitalia are female or ambigious

A

46,XY disorder of sexual development

most common form is androgen insensitivity syndrome resulting in testicular feminization

128
Q

phenotypic sex

A

external genitalia

influenced by hormone levels

129
Q

Gonadal sex

A

internal genitalia (ovaries vs testes)

influenced by y chromosome

130
Q

If patient has a uterus but no breasts

A

hypergonadotropic hypogonadism
or
hypergonadotropic hypogonadism

131
Q

If patient has no uterus but has breasts

A

uterovaginal agenesis in genotypic female

or

androgen insensitivity in genotypic male

132
Q

if patient has no uterus or breasts

A

male genotype with insufficient production of testosterone

133
Q

placental aromatase deficiency

A

inability to synthesize estrogens from androgens. Results in an increase in testosterone and androstenedione

results in masculinization of female (46, XX DSD) infants –> ambiguous genitalia

can present with mother being virilized during pregnancy due to fetal androgens crossing the placenta

134
Q

female external genitalia with rudimentary vagina
no uterus or fallopian tubes
Normal functioning testes that are found in labia majora

A

androgen insensitivity syndrome - defect in androgen receptor resulting in normal appearing female (46,XY DSD)

high testosterone, estrogen, LH

135
Q

Patient presented with ambiguous genitalia until puberty. Then the rise in testosterone causes masculinization and growth of external genitalia

A

5α-Reductase deficiency

autosomal recessive

genetic males (46,XY DSD)

unable to convert testosterone to DHT

Testosterone and estrogen levels are normal
LH can be normal or high
Internal genitalia normal

136
Q

This patient failed to complete puberty due to defective migration of GnRH releasing neurons and subsequent failure of GnRH releasing olfactory bulbs to develop. There is a decrease in synthesis of GnRH in the hypothalamus

A

kallman syndrome

hypogondotropic hypogonadism

hyposmia/anosmia, low GnRH, FSH, LH and testosterone

infertility (low sperm in males and amenorrhea in females)

137
Q

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

A

hydatidiform mole

presents with vaginal bleeding, uterine enlargement more than expected, pelvic pressure/pain, early preeclampsia, theca-lutein cysts, hyperemesis gravidarum, hyperthyroidism

hCG mediated sequelae

138
Q

Complete hydatidiform mole

A

karyotype: 46,XX or 46,XY

most commonly enucleated egg + single sperm

no fetal parts present
uterine size increased
very high increase in hCG
"honeycombed"uterus or "cluster of gapes"
"snowstorm" on ultrasound

complete has a greater risk of malignancy (15-20%)

139
Q

Partial hydatiform mole

A

karyotype: 69,XXX; 69, XXY; 69 XYY

due to 2 sperm + 1 egg

there are some fetal parts present
normal uterine size
increase in hCG
Imaging shows fetal parts

140
Q

Malignancy of trophoblastic tissue (cytotrophoblasts, syncytiotrophoblasts)

A

choriocarcinoma

  • No chorionic villi present
  • Increase frequency of bilateral/multiple theca-lutein cysts
  • Abnormal increase in beta hCG (pregnancy)
  • Shortness of breath
  • Hemoptysis
  • Hematogenous spread to lungs causing “cannonball” metastases
141
Q

Abruptio placentae

A

premature separation (partial or complete) of placenta from uterine wall before delivery of infant

patient presents with abrupt painful bleeding in third trimester.The bleeding can be concealed or apparent.

complications: DIC, maternal shock, fetal distress, life threatening for mother and baby

142
Q

Morbidly adherent placenta

A

Defective decidual layer resulting in abnormal attachment and separation after delivery.

often detected on ultrasound prior to delivery. No separation of placenta after delivery results in postpartum bleeding and possible sheehan syndrome

Sheehan’s syndrome, also known as postpartum pituitary gland necrosis, is hypopituitarism (decreased functioning of the pituitary gland), caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth

143
Q

Three types of morbidly adherent placenta

A

1) placenta accreta
2) placenta increta
3) placenta percreta

144
Q

Placenta accreta

A

most common type of morbidly adherent placenta

placenta attaches to myometrium without penetrating it

thing accreta or “attaches”

145
Q

Placenta increta

A

type of morbidly adherent placenta

placenta penetrates into the myometrium

think increta “into”

146
Q

Placenta percreta

A

placenta penetrates/perforates through myometrium and into uterine serosa (invades the uterine wall)

placental attachment to rectum or bladder can cause hematuria

think percreta “ perforates”

147
Q

Placenta previa

A

attachment of placenta to lower uterine segment over (or <2 cm from) internal cervical os

painless third trimester bleeding

a “preview” of the placenta is visible through cervix

partial - only part of placenta over internal cervical os
complete- all of internal cervical os is covered by placenta

148
Q

Vasa previa

A

fetal vessels run over or in close proximity to cervical os

may result in vessel rupture, exsanguination, fetal death.

associated with velamentous umbilical cord insertion (Cord inserts in chorioamniotic membrane rather than placenta) and thus fetal vessels travel to placenta unprotected by wharton jelly

149
Q

patient presents with membrane rupture, painless vaginal bleeding and fetal bradycardia (<110 beats/min). What is the next step?

A

patient has vasa previa

emergency C section

150
Q

4 Ts of postpartum hemorrhage

A

Tone (uterine atony is most common cause)
Trauma
Thrombin
Tissue (retained products of conception)

151
Q

Ectopic pregnancies commonly occur at?

A

ampulla of the fallopian tube

152
Q

hCG seen with ectopic pregnancy

A

lower than expected rise in hCG based on dates

can often be msitake with appendicitis

153
Q

polyhydramnios

A

too much amiotic fluid

due to inability to swallow amniotic fluid (esophageal/duodenal atresia, anencephaly),
maternal diabetes, fetal anemia, multiple gestations

154
Q

Oligohydramnios

A

too little amniotic fluid

associated with placental insufficiency, bilateral renal agenesis, posterior urethral valves (in males) and resultant inability to excrete urine

can cause potter sequence

155
Q

potter sequence

A

Potter sequence is the atypical physical appearance of a baby due to oligohydramnios experienced when in the uterus. It includes clubbed feet, pulmonary hypoplasia and cranial anomalies related to the oligohydramnios.

156
Q

Gestational hypertension

A

BP > 140/90 after 20th week of gestation

no preexisting hypertension

no proteinuria

no end organ damage

treat: antihypertensives (hydralazine, α-methyldopa, labetalol, nifedipine)

157
Q

preeclampsia

A

new-onset hypertension with either proteinuria or end organ dysfunction after 20th week of gestation ( <20 wks suggests a molar pregnancy)

caused by abnormal placental spiral arteries –> endometrial dysfunction, vasoconstriction, ischemia

treat: antihypertensives, IV magnesium sulfate (to prevent seizure), definitive is delivery of fetus

158
Q

eclampsia

A

preeclampsia + maternal seizures

maternal death due to stroke, intracranial hemorrhage, or ARDS

treat: IV magnesium sulfate, antihypertensives, immediate delivery

159
Q

HELLP syndrome

A

Hemolysis
Elevated Liver enzymes
Low Platelet

due to severe preeclampsia

treat with immediate delivery

can lead to DIC and hepatic subcapsular hematomas –> rupture –> severe hypotension

160
Q

incidence of gyn tumors

A

in us: endometrial > ovarian > cervical
worldwide: cervical is more common

prognosis? Cervical> endometrial > ovarian

161
Q

bartholin cyst and abscess is related to what kind of infection

A

N gonorrhoeae

162
Q

Lichen sclerosus

A

thinning of epidermis with fibrosis/sclerosis of dermis

postmenopausal women

benign but slightly increased risk of SCC

163
Q

Lichen simplex chronicus

A

hyperplasia of vulvar squamous epithelium

benign

no risk of SCC

presents with leathery, thick vulvar skin with enhanced skin markings due to chronic rubbing or scratching

164
Q

HPV related vulvar carcinoma

A

HPV types 16 and 18

165
Q

Non HPV related vulvar carcinoma

A

related to long standing lichen sclerosus in females >70 yo

166
Q

Vaginal SCC is usually secondary to

A

cervical SCC

167
Q

What type of vaginal tumor are women at risk for after exposure to DES in utero

A

clear cell adenocarcinoma

168
Q

patient is a 3 yo girl with clear, grape like, polypoid mass emerging from vagina

A

sarcoma botryoides

spindle shaped cells
Desmin +
embryonal rhabdomyosarcoma variant

169
Q

Dysplasia and carcinoma in situ

A

begins at basal layer of squamocolumnar jnction (transformation zone) and extends outward

classified as CIN1,CIN2,CIN3 (severe, irreversible dysplasia or carcinoma in situ) depending on extent of dysplasia

HPV 16 and 18

170
Q

how does HPV 16 and 18 cause dysplasia

A

both produce the E6 gene product that inhibits p53 and the E7 gene product that inhibits pRb

171
Q

______ are pathognomonic of HPV infection

A

koilocytes

172
Q

primary ovarian insufficiency

A

signs of menopause after puberty but before age 40

decrease estrogen, increase LH and FSH

173
Q

Polycystic ovarian syndrome or Stein-leventhal syndrome

A
  • enlarged bilateral cystic ovaries
  • hyperinsulinemia and or insulin resistance hypothesized to alter hypothalamic hormonal feedback response that causes increase in LH:FSH
  • increase in androgens from theca interna cells
  • decreases rate of follicular maturation –> unruptured follicles (cysts) + anovulation. Repeated anovulatory cycles results in an increased risk of endometrial cancer secondary to unopposed estrogen
174
Q

Most common ovarian mass in young women

A

follicular cyst due to distention of unruptured graafian follicle

175
Q

Theca-lutein cysts

A

bilateral and multiple

due to gonadotropin stimulation

associated with choriocarcinoma and hydatidiform moles

176
Q

Most common adnexal mass in women >55 yo

A

ovarian neoplasms

risk decreases with previous pregnancy

177
Q

Majority of malignant ovarian neoplasms are

A

epithelial (serous cystadenocarcinoma is most common)

178
Q

What marker is helpful in monitoring response to therapy for ovarian neoplasms

A

CA 125

179
Q

Surface epithelial tumors - ovarian neoplasms

A

Benign

1) serous cystadenoma - bilateral, fallopian tube like epithelium
2) Mucinous cystadenoma -lined by mucus secreting epithelium
3) endometrioma - endometriosis within ovary with cyst formation

180
Q

Chocolate cyst is related to what kind of tumor

A

endometrioma filled with dark, reddish brown blood

endometriosis within ovary with cyst formation

181
Q

Germ cell tumors - ovarian neoplasms

A

Mature cystic teratoma (dermoid cyst)

Benign

most common ovarian tumor in females 10-30 yo

cystic mass with elements of all 3 germ layers

monodermal form with thyroid tissue (struma ovarii) uncommonly presents with hyperthyroidism

182
Q

Sex cord stromal tumors - ovarian neoplasms

A

Benign

1) Fibroma - bundles of spindle shaped fibroblasts causing Meigs syndrome.
2) Thecoma - granulosa cell tumors that may produce estrogen

183
Q

Patient presents with pulling sensation in groin. Also has the triad of ovarian fibroma, ascites, hydrothorax

A

Meigs syndrome

184
Q

Patient presents with abnormal uterine bleeding and is postmenopausal. What ovarian tumor are you worried about

A

thecoma - a sex cord stromal tumor

benign

185
Q

Brenner tumor

A

resembles bladder epithelium (transitional cell tumor)

pale yellow tan and appears encapsulated

coffee bean nuclei on H&E stain

usually benign

186
Q

Most common malignant ovarian neoplasm

A

surface epithelium tumor : serous cystadenocarcinoma

bilateral

psammoma bodies

187
Q

Surface epithelium ovarian tumors that are malignant

A

1) serous cystadenocarcinoma

2) mucinous cystadenocarcinoma

188
Q

What is a complication associated with mucinous cystadenocarcinoma

A

pseudomyxoma peritonei- intraperitoneal accumulation of mucinous material

189
Q

Germ cell ovarian tumors that are malignant

A

1) dysgerminoma
2) Immature teratoma
3) tolk sac tumor

190
Q

dysgerminoma

A

most common in adolescents

equivalent to male seminoma

sheets of uniform “fried egg” cells

hCG and LDH= tumor markers

191
Q

Immature teratoma

A

aggressive, contains fetal tissue, neuroectoderm

dx before 20 yo

192
Q

Yolk sac tumor

A

ovarian endodermal sinus tumor

aggressive

in ovaries or testes and sacrococcygeal area in young children

yellow, friable (hemorrhagic), solid mass

50% have schiller duval bodies that resemble glomeruli

AFP=tumor marker

193
Q

most common germ cell tumor in male infants

A

yolk sac tumor

194
Q

most common malignant sex cord stromal tumor

A

granulosa cell tumor

women in 50s

often produces estrogen and progesterone and causes postmenopausal bleeding, sexual precocity (in preadolescents) , breast tenderness

Call-exner bodies - granulosa cells arranged haphazardly around collections of eosinophilic fluid, resembling primordial follicles

195
Q

krukenberg tumor

A

Gi malignancy that metastasizes to ovaries –> mucin secreting signet cell adenocarcinoma

commonly presents as bilateral ovarian masses

196
Q

Patient presents with dysmenorrhea, menorrhagia, uniformly enlarges soft globular uterus

A

adenomyosis

extension of endometrial tissue (glandular) into uterine myometrium

caused by hyperplasia of basal layer of endometrium

197
Q

Patient presents with decreased fertility, recurrent pregnancy loss, abnormal uterine bleeding, pelvic pain

A

Asherman syndrome

adhesions and or fibrosis of endometrium

198
Q

Most common tumor in females

A

Leiomyoma (fibroid)

199
Q

Leiomyoma (fibroid)

A

multiple discrete smooth mm tumors

estorgen sensitive therefore tumor size increases with pregnancy and decreases with menopause

20-40 yo

severe bleeding may lead to iron deficiency anemia

whorled pattern of smooth mm bundles with well demarcated borders on histology

200
Q

Most common gynecologic malignancy

A

endometrial carcinoma

55-65 yo

preceded by endometrial hyperplasia

risk factors: prolonged use of estrogen without progestins, nulliparity, late menopause, early menarche, lynch syndrome etc

201
Q

chronic endometritis characterized by presence of ____ on histology

A

plasma cells

tx with gentamicin + clindamycin +/- ampicillin

202
Q

Fibrocystic breast changes

A

common in women < 35 yo

premenstrual breast pain or lumps

1) sclerosing adenosis - acini and stromal fibrosis associated with calcifications
2) epithelial hyperplasia - cells in terminal ductal or lobular epithelium. Increased risk of carcinoma with atypical cells

203
Q

Fat necrosis in breast

A

Inflammatory process

benign usually painless lump due to injury to breast tissue

mammography: calcified oil cyst
Biopsy: necrotic fat and giant cells

204
Q

Lactational mastitis

A

occurs during breastfeeding and increases risk of bacterial infection through cracks in nipple

treat with antibiotics and continue breast feeding

inflammatory process

205
Q

most common pathogen in lactational mastiitis

A

S. aureus is most common pathogen

206
Q

FIbroadenoma in breast

A

women < 35 yo

benign - no increased risk of cancer

small, well defines, mobile mass

increase size and tenderness with increased estrogen

207
Q

Intraductal papilloma

A

benign - small fibroepithelial tumor within lactiferous ducts typically beneath areola

most common cause of nipple discharge (serous or bloody)

slight increased risk of cancer

208
Q

Phyllodes tumor

A

benign

large mass of connective tissue and cysts with leaf like lobuations

most common in 5th decade

some may be malignant

209
Q

drugs that commonly cause gynecomastia

A

spironolactone
cimetidine
finasteride
ketoconazole

210
Q

Malignant breast tumors

A

postmenopausal common

usually arise from terminal duct lobular unit

axillary lymph node involvement indicating metastasis is the most important prognostic factor in early stage disease

most often located in upper outer quadrant of breast

211
Q

genetics behind malignant breast tumors

A

amplification/overexpression of estrogen/progesterone receptors or c-erbB2 (HER-2 an EGF receptor) is common

triple negative (ER -, PR - , Her2/Neu - ) are more aggressive

212
Q

Ductal carcinoma in situ

A

fills ductal lumen

Arises from ductal atypia. often seen early as microcalcifications on mammography

early malignancy without basement membrane penetration

213
Q

Comedocarcinoma

A

ductal, central necrosis

subtype of ductal carcinoma in situ

214
Q

Paget disease results from

A

results from underlying ductal carcinoma in situ or invasive breast cancer

215
Q

Patient notices a firm, fibrous, rock hard mass with sharp margins and small glandular duct like cells in her breast. What tumor is she most likely to have?

A

Invasive ductal carcinoma - most common and is 75% of breast cancers

tumor can deform suspensory ligament and cause dimpling of skin

classic morphology of stellate infiltration

216
Q

invasive lobular carcinoma of breast

A

orderly row of cells “single file” due to decreased E-cadherin

invasive

often bilateral with multiple lesions in the same location

217
Q

medullary carcinoma of breast

A

invasive

fleshy cellular lymphocytic infilrate

good prognosis

218
Q

inflammatory breast cancer

A

dermal lymphatic invasion of breast carcinoma

poor prognosis

219
Q

Patient has a peau d’ orange sign , what kind of breast cancer does this indicate

A

inflammatory breast cancer due to dermal lymphatic invasion by breast carcinoma

skin texture change due to edema leading to tightening of coopers suspensory ligament

neoplastic cells block lymphatic drainage

220
Q

Patient presents with abnormal curvature of penis due to fibrous plaque within the tunica albuginea

A

peyronie disease

221
Q

Penile fracture is due to rupture of ______ due to forced bending

A

corpora cavernosa

222
Q

Painful sustained erection lasting >4 hours

A

ischemic priapism

due to meds and sickle cell disease (block venous drainage)

223
Q

SCC in the penis is due to many precursor in situ lesions

A

Bowen disease - leukoplakia
Erythroplasia of Queyrat - erythroplakia
Bowenoid papulosis - present as red papules

224
Q

Sperm develops best at what temperature

A

37 celcius

225
Q

why do patients with cryptorchidism have normal testosterone levels

A

because leydig cells are unaffected by the rise in temperature

only low if bilateral

226
Q

what labs do you see in a patient with cryptorchidism

A

low inhibin B

high FSH and LH

227
Q

testicular torsion involves the rotation of testicle around _____ and _____. Commonly present with an absent ____ reflex

A

spermatic cord and vascular pedicle

cremasteric reflex

228
Q

Surgical procedure used to treat testicular torsion

A

Orchiopexy - move testicle into scrotum and permanently fix it there

do it to other testicle too because it is susceptible

229
Q

Varicocele is due to dilated veins in the ________ plexus due to increased venous pressure

A

pampiniform plexus

230
Q

Varicocele is diagnosed by

A

standing clinical exam / valsalva maneuver
doppler
does not transilluminate

231
Q

Extragonadal germ cell tumors

A

arise in midline locations

in adults most commonly in retroperitoneum, mediastinum, pineal, and suprasellar regions

232
Q

congenital hydrocele (scrotum) is due to

A

incomplete obliteration of processus vaginalis

spontaneously resolve by 1 yo

233
Q

spermatocele

A

cyst due to dilated epididymal duct or rete testis

paratesticular fluctuant nodule

234
Q

95% of all testicular tumors are ______ cell tumors

A

germ cell tumors

young men

risk factors: cryptorchidism and klinefelter syndrome

do not transilluminate

235
Q

How do you test/treat testicular germ cell tumors

A

do not biopsy because it can seed

removed via radical orchiectomy

236
Q

seminoma

A

most common testicular tumor

malignant germ cell tumor of testicle

painless, homogenous testicular enlargement

large cells in lobules with watery cytoplasm and fried egg appearance

increase placental ALP

similar to dysgerminoma in females. late metastasis. excellent prognosis

237
Q

yolk sac tumor or testicular endodermal sinus tumor

A

Testicular germ cell tumor

yellow mucinous aggressive malignancy of testes

analogous to ovarian yolk sac tumor

schiller duval bodies resemble primitive flomeruli

increased AFP is highly characteristic

238
Q

most common testicular tumor in boys <3 yo

A

yolk sac tumor or testicular endodermal sinus tumor

239
Q

Choriocarcinoma

A

malignant

increased hCG

disorder syncytiotrophoblastic and cytotrophoblastic elements

hematogenous metastases to lungs and brain

may produce gynecomastia, hyperthyroidism due to alpha subunit of hCG being similar to TSH

240
Q

Mature teratoma in males vs children

A

may be malignant but benign in children

testicular germ cell tumor

241
Q

Embryonal carcinoma

A

testicular germ cell tumor

malignant hemorrhagic mass with necrosis

painful, worse prognosis than seminoma

often glandular/papillary morphology and usually mixed tumor types

increased AFP if mixed
normal AFP if pure

242
Q

Testicular non germ cell tumors are mostly _____

A

benign

243
Q

Leydig cell tumor

A

testicular non germ cell tumor

golden brown color that contains Reinke crystals (eosinophilic cytoplasmic inclusions)

produces androgens or estrogens –> gynecomastia in men and precocious puberty in boys

244
Q

sertoli cell tumor

A

testicular non germ cell tumor

androblastoma from sex cord stroma

245
Q

testicular lymphoma

A

testicular non germ cell tumor

most common testicular cancer in older men

arises from metastatic lymphoma to testes

aggressive

246
Q

benign prostatic hyperplasia involves enlargement of waht lobes of the prostate

A

periurethral lobes

increased PSA

247
Q

treatment for benign prostatic hyperplasia

A

alpha1-antagonists to relax urethra smoothmm
5alpha reductase inhiitors
PDE5 inhibitors
surgical resection

248
Q

prostatitis

A 
dysuria
frequency
urgency
low back pain
warm, tender, enlarged prostate
249
Q

acute bacterial prostatitis in older men (pathogen)

A

E. Coli

250
Q

acute bacterial prostatitis in younger men (pathogen)

A

C trachomatis

N gonorrhoeae

251
Q

Chronic prostatitis

A

either bacterial or nonbacterial

252
Q

prostatic adenocarcinoma

A

men > 50 yo

posterior lobe more common (peripheral zone)

diagnosed with increased PSA and subsequent needle core biopsy

osteoblastic metastases in bone may develop in late stages as indicated by lower back pain and icnreased serum ALP and PSA

253
Q

Useful markers in prostatic adenocarcinoma

A

prostatic acid phosphatase (PAP)
and PSA

increase in total PSA
decrease fraction of free PSA

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