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Reproductive Flashcards

1
Q

Genes for embryology

  • sonic hedgehog: fxn; mutation
  • Wnt-7: location, fxn
  • Fibroblast growth factor: location, fxn
  • Homeobox genes: fxn; mutation
A
  • produced at base of limbs, CNS development; holoproencephaly - produced at apical ectodermal ridge, needed for proper organization along dorsal ventral axis - produced at apical ectodermal ridge -> stimulates mitosis of underlying mesoderm for lengthening of limbs - involved in segmental organization of embryo in cranio-caudal direction and code for transcription factors; appendages in wrong location
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2
Q

Early fetal development

  • early: what happens at day 1, 2-3, 4, 5, 6-10
  • wk 1: secreted
  • wk 2: layers
  • wk 3: layers, and specific things that occur at each
  • wk 3- 8: formation and closure of, other genesis
  • wk 4: activity start in, and what begins to form
  • wk 6: US
  • wk 8: whats new
  • wk 10: whats new
A
  • fertilization -> 1: zygote formed -> 2-3: 2/4 cells, moving down fallopian tube, 4: morula (16), 5: blastocyst, 6-10: implantation
  • hCG secretion begins once implanted
  • bilaminar disk created
  • trilaminar disk created (endo, meso, ecto); cells from epiblast invaginate and form primitive streak; notochord arises from meso; ecto become neural plate
  • neural tube formed by neuroectoderm and closed by wk4; organogenesis
  • heart beats, upper and lower limb buds begin
  • cardiac activity visible by transvaginal US
  • fetal movement starts
  • genitalia have male/female characteristics
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3
Q

Ectoderm derivatives

  • which layer
  • surface: skin, eye, mouth, ear/nose, glands
  • neural tube
  • neural crest: skin, mouth, lungs, brain, nerves, adrenal, heart, head
A
  • external
  • epidermis, lens, epi lining of oral cavity, sensory organs of ears and olfactory, parotid/mammary/sweat
  • brain, retina, SC
  • melanocyte, odontoblast, tracheal lining, leptomeninges, PNS ganglia, adrenal medulla, schwann cells, spiral membrane, endocardial cushions, bones of sull
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4
Q

Mesoderm derivatives

  • main fxn: middle tissue
  • other stuff: 3
  • notochord: fxn, derivative
A
  • muscle, bone, connective tissue, dermis, blood, linings of cavities
  • kidney, adrenal cortex, spleen, testis/ovaries
  • induces neuroextodermal diff of ectoderm; nuc pulposis
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5
Q

Endoderm derivatives

  • which layer
  • forms
A
  • internal layer
  • gut tube epi, urethra, lower vagina, epi to lumen (lungs, gallbladder, liver, etc)
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6
Q

Types of erros in morphogenesis

  • agenesis
  • aplasia
  • hypoplasia
  • disruption
  • deformation
  • malformation
  • sequence
A
  • absent organ w/o primordial tissue
  • absent organ w/ primordial tissue
  • incomplete organ development
  • secondary breakdown of previously normal tissue
  • problem arises after embryonic development -> usually due to outside problems (mult gest -> crowding -> foot prblm)
  • problem occurs during embryonic period
  • abnormalities bc of single embryo event -> oligohydraminos causing potters
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7
Q

Teratogens

  • ACE inhibitors
  • Aminoglycoside
  • Lithium
  • Tetracycline
  • Warfarin
  • EtOH
  • Cocaine
  • Smoking
  • Maternal DM
A
  • renal failure, oligohydraminos, hypocalciuria
  • oto tox
  • ebstein anomaly
  • disoclored teeth, inhibited bone growth
  • bone deformities, fetal hemmorrhage
  • fetal EtOH syndrome
  • low birth weight, preterm birth
  • low birth weight, preterm birth, ADHD, SIDS
  • heart defects, neural tube defects, macrosomia
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8
Q

Fetal EtOH syndrome

  • what does it cause
  • facial abnormalities
  • heart
  • brain
A
  • leading cause of intellectual disability
  • smooth philtrum, thin vermillion, small palpebral fissure
  • heart lung fistula
  • holoprosencephaly: forebrain does not split into two hemis
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9
Q

Neonatal abstinence syndrome

  • caused by
  • sxs
A
  • maternal opiate use - uncoordinated sucking, high pitched crying, tremors, tachypnea, sneezing, diarrhea, seizures
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10
Q

Twins

  • dizygotic
  • monozygotic
  • cleave 0-4
  • cleave 4-8
  • cleave 8-12
  • cleave 13+
A
  • come from 2 separate eggs fertilized by 2 separate sperm -> 2 separate amniotic sacs and placentas
  • come from 1 egg and 1 sperm that splits
  • separate chorion and amnion
  • separate amnion, same chorion
  • same amnion and chorion
  • conjoined
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11
Q

Placenta

  • cytotrophoblast: layer, fxn
  • syncytiotrophoblast: layer, fxn
  • decidua basalis: layer, derived from, contains
A
  • inner layer of fetal component, makes cells outer layer
  • outer layer of fetal component, synthesizes hormone (bHCG)
  • maternal component of placenta, dervied from endometrium, contains maternal blood in the lacunae
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12
Q

Umbilical Chord

  • arteries: how many, what do they carry,
  • veins: how many, what do they carry, where does it flow
  • vessels dervied from
  • wharton jelly
A
  • 2, unoxy blood from fetal iliac art to placenta
  • 1, oxy blood -> into IVC through liver or ductus venosus
  • allantois - surrounds the vessels within the chord, protecting and stabilizing them
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13
Q

Urachus

  • derived from
  • previously
  • fxn
  • becomes the
  • patent
  • urachal cyst: what is it, complication
  • vesicourachal diverticulum
A
  • yolk sac
  • the allantois
  • duct between fetal bladder and umbilicus
  • median umbilical ligament
  • failure or urachus to obliterate and urine is dischared from umbilicus
  • partial failure to obliterate -> fluid filled cavity lined with uro-epi between umbilicus and bladder; can become infected
  • slight failure to obliterate -> outpouching of bladder
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14
Q

Vitelline duct

  • what is it
  • obliterates
  • vitelline fistula: what is it, what does it cause
  • meckel diverticulum what is it, what does it cause
A
  • connects yolk sac to midgut lumen
  • 7th wk gestation
  • vitelline duct fails to close -> meconium discharge from umbilicus
  • partial close of the duct w/ patent portion attached to ileum causing true diverticulum
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15
Q

Aortic arch derivatives

  • 1st
  • 2nd
  • 3rd
  • 4th
  • 6th
A
  • maxillay
  • stapedial and hyoid a
  • common and internal carotid
  • left: aortic ach, right: subclavian
  • pulm art and ductus arteriosus
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16
Q

Pharyngeal apparatus

  • consists of: number and parts
  • cleft 1, 2-4
A
  • 6 cleft (ecto), arch (meso), pouch (endo)
  • external auditory meatus, temporary cervical sinuses -> later obliterated
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17
Q

Pharyngeal arch derivatives

  • 1st: cartilage, muscles, nerves
  • 2nd: cartilage, muscles, nerves
  • 3rd: cartilage, muscles
  • 4th-6th: cartilage, muscles, nerves
A
  • maxilla and zygomatic bone, mandible, malleus, incus; muscles of mastication, V3 to chew
  • stapes, styloid; muscle of facial expression; CN VII
  • hyoid, stylopharyngeus, glossopharyngeal
  • arytenoid, cricoid, thyroid; most pharyngeal constrictors, cricothyroid, intrinsic muscles of larynx; CN X (superior laryngeal and recurrent/inferior laryngeal branch)
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18
Q

Pharyngeal pouch derivatives

  • 1
  • 2
  • 3
  • 4
A
  • middle ear, eustachian tube
  • epi lining of palantine tonsil
  • inferior parathyroid and thymus
  • superior parathyroid, parafollicular cells of thyroid
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19
Q

Genital Embryology

  • female: induced by, duct
  • male: induced by, suppresses
  • paramesonephric duct: other name, develops into, mayer-rokitansky-kuster-hauser syndrome
  • mesonephric dut: other name, develops into
A
  • default development; degenerates allowing for developemtn of paramesonephric duct
  • SRY gene on Y chrom -> testes develop, development of paramesonephric duct by sertoli cells producing mullerian inhib factor and leydig cells secreting androgens that stimulate development of mesonephric duct
  • mullerian duct -> fallopian tubes, uterus and upper portions of vagina, mallerian duct agenesis cauing primary amenorrhea bc uterus does not form but pt has secondary sexual characteristics because ovaries normally developed
  • wolfian duct -> seminal vesical, epididymus, ejact duct, ductus deferens (SEED)
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20
Q

Sexual differentiation

  • ovaries: lead to development of
  • testis
  • internal vs external testis
A
  • induced bc of lack of SRY -> will form clitoris, labia and distal vagina while paramesonephric duct will form fallopian, uterus and prox vag
  • need sry
  • leydig cells must be able to produce testosterone and convert to DHT, testosterone will activate mesonephric duct to form internal genitalia strx but penis and scortum depend on DHT
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21
Q

Uterine anomalies

  • septate: what is it, causes, tx
  • bicornate: what is it, causes
  • didelphys: what is it, causes, pregnancy
A
  • incomplete resorption of septum, decreased fertility and early miscarriage, septoplasty
  • incomplete fusion of mallerian ducts, increased risk complicated pregnancy and loss
  • complete failure of fusion -> double uterus, cervix vagina; pregnancy is possible
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22
Q

male/femal genital homologs

  • genital tubercle
  • urogenital sinus
  • urogenital folds
  • labioscrotal swelling
A
  • glans penis or clitoris
  • cowper and prostate glands or bartholin and skene glands
  • ventral side of penis or labia minora
  • testicles or labia majora
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23
Q

Congenital penile abnormalities

  • hypospadius: what is it, caused by
  • epispadius: what is it, caused by
A
  • abnormal opening of penile urethra on ventral surface of penis, failure of urethral folds to fuse
  • abnormal opening of penile urethra on dorsal surface of penis, faulty position of genital tubercle
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24
Q

Descent of testes and ovaries

  • gubernaculum: what is it, male remnant, female remnant
  • processus vaginalis: what is it, male remnant, female remnant
A
  • band of fibrous tissue, anchors testis in scrotum, forms ovarian and round ligaments
  • evagination of peritoneum, tunica vaginalis, obliterated
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25
Q

Gonadal drainage

  • venous: left vs right; effects
  • lymph: ovaries and testis, uterus, prostate/cervix/prox vag, distal vag/vulva/scrotum, glans penis
A
  • left will drain into left renal v while right goes straight into IVC, emphalocele more common on left bc increased pressure
  • para-aortic LN, external iliac LN, internal iliac LN, superficial inguinal LN, deep inguinal LN
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26
Q

Female Uterine Ligaments

  • infundibulopelvic: connects; contains; surgery; close to
  • Cardinal: connects, contains
  • Round: connects, derivative of
  • Broad: connects, contains
  • Ovarian: connects, derivative of
A
  • ovaries to lateral pelvic wall; ovarian vessels; must be ligated during oophrectomy to avoid bleeding; ureter is retroperitoneal and is very close to gonadal vessels
  • cervix to side wall of pelvis; uterine vessels
  • uterine horn to labia majora, derivative of gubernaculum
  • uterus, fallopian tubes, and ovaries to pelvic side walls; ovaries, fallopian tubes, round ligament
  • medial pole of ovary to uterine horn; derivative of gubernaculum
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27
Q

Adnexal Torsion

  • what is it
  • sequalae
  • sxs
A
  • twisting of ovary and fallopian tubes around infundibulopelvic and ovarian ligaments
  • compression of ovarian vessels, blocking venous and lymph outflow but continued arterial supply -> ovarian edema, but if arterial supply is cut off then infarction and necrosis
  • acute pelvic pain, adnexal mass, and nausea/vommitting
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28
Q

Female histo

  • vulva
  • vag
  • ectocervix
  • transformation zone
  • endo cervix
  • uterus
  • fallopian tube
  • ovary
A
  • strat squamous
  • strat squamous, non-keratinized
  • strat squamous, non-keratinized
  • squamocolumnar junction
  • simple columnar
  • simple columnar w/ long tubular glands in prolif phase and coiled glands in secretory
  • simple columnar, ciliated
  • simple cuboidal
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29
Q

Pathway of Sperm during ejaculation

A
  • semineferous tubules, epididymus, vas defrens, ejaulatory duct, urethra, penis
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30
Q

Urethral injury

  • anterior: part of urethra, mechanism, location of urine/blood accumulation, sxs
  • posterior
A
  • spongy; straddle injury; blood into scrotum and urine into bucks fascia; blood at urethral meatus and scrotal hematoma
  • membranous urethra; pelvic fracture; urine into retropubic space; blood at urethral meatus and prostate pushed up
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31
Q

Auto innervation of male sex response

  • erection: which ANS, which nerve, pathway
  • emission: which ANS, which nerve, pathway
  • expulsion: which ANS, which nerve, pathway
A
  • parasymp -> pelvic splanchnic -> NO -> cGMP -> SM relax -> vasodilate
  • Symp -> hypogastric nerve -> NE -> increase Ca -> smooth muscle contraction
  • Symp -> pudendal nerve
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32
Q

Semineferous tubules

  • spermatogonia: what are they and their location
  • sertoli cells: location, fxn
  • leydig cells: location, fxn
A
  • germ cells that are in middle of semineferous tubule waiting to mature
  • at periphery of seminerferous tubules -> secrete androgen binding protein to maintain high enough testosterone levels for sperm to mature and inhibin B to inhibit FSH; and their tight junctions form blood testis barrier
  • in the intersitium of the semineferous tubules, secrete testosterin in presence of LH
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33
Q

Spermatogenesis

  • pathway
  • parts of sperm
A

-spermatogonium -> primary spermatocyte -> secondary spermatocyte -> spermatid -> spermatazoan - acrosome, head, neck, middle piece, tail

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34
Q

Estrogen

  • source
  • breast
  • ovary
  • uterus
A
  • ovary, placenta, adipose - aids in development - growth of follicle - endometrial proliferation
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35
Q

Progesterone

  • source
  • luteal phase
  • pregnancy
A
  • corpus luteum, placenta, adrenal cortex, testes
  • prepares uterus for implantation by increasing endometrial glandular secretions and spiral a development;

. - maintains pregnancy by inhibiting myometrium contraction

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36
Q

Oogenesis

  • pathway
  • when are polar bodies made
A
  • oogonium -> primary oocyte -> secondary oocyte -> ovum - when secondary oocyte and ovum are made
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37
Q

Ovulation

  • starts w
  • hypothalamus
  • pituitary
  • mittelschmerz
A
  • increased estrogen
  • GnRH
  • LH surge -> ovulation
  • mid cycle ovulatory pain, associated with peritoneal irritation from follicular swelling and fallopian tube contraction
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38
Q

Phases of ovarian cycle

  • pituitary: follicular phase, luteal phase
  • ovary: follicular phase, luteal phase
  • uterus: follicular, luteal phase
A
  • FSH slowly rises as estrogen rises, the drops quickly when estrogen starts to rise very quickly cauing LH to surge, estrogen peaks then causing LH to peak -> ovulation; LH and FSH drop and towards the end of luteal phase FSH starts to rise to get ready for new follicular phase
  • follicle starts to mature, at ovulation the egg is pushed out of the ovary, and in luteal phase the ovary becomes corpus luteum
  • start of follicular phase is menses then goes into proliferative phase, ovulation occurs, uterus is secretory
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39
Q

Abnormal Uterine bleeding

  • characterized by
  • structural (PALM)
  • non-structural (COEIN)
A
  • heavy menstrual bleeding or intermenstral bleeding
  • Polyp, adenomyosis, leiomyoma, malignancy
  • coagulopathy, ovulatory, endometrial, iatrogenic, not yet classified
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40
Q

Pregnancy

  • where does fertilization occur
  • when does fertilization occur
  • when does implantation occur
  • when is HCG detectable: blood vs urine
  • how is gestational age calculated
  • how is embryonic age calculated
  • physiological adaptations: heart, blood, lungs, fat
A
  • the ampulla of the fallopian tube
  • within 1 day of ovulation
  • 6 days after fertilization
  • 1 week after conception and in urine 2 weeks after conception
  • date from last menstrual period
  • date from day of conception -> gestational minus 2 wks
  • increase cardiac output, HR, anemia, hypercoagulability, hyperventilation, increase in lipolysis
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41
Q

HCG

  • source
  • function
  • what takes over
  • identical alpha subunit as
  • increased
  • decreased
A
  • syncytiotrophoblast of placenta - maintain corpus luteum for first 8-10 wks keeping progesterone high - estriol and progesterone secreted by placenta - LH, FSH, TSH - multiple gestations, hydatdiform mole, Downs - etopic, edwards, patau
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42
Q

Human placental lactogen

  • other name
  • source
  • function
A
  • chorionic somatomammotropin
  • syncytiotrophoblast of placenta
  • stimulates insulin production causing insulin resistance
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43
Q

Infant and child development 0-12 months

  • moro gone
  • rooting gone
  • palmar gone
  • babinski gone
  • lifts head up
  • rolls and sits
  • stands
  • walks
  • social smile
  • stranger anxiety
  • separation anxiety
  • orients to noise
  • orients to name
  • object permanence
  • oratory
A
  • 3 mo
  • 4 mo
  • 6 mo
  • 12 mo
  • 1 mo
  • 6 mo
  • 10 mo
  • 12-18 mo
  • 2 mo
  • 6 mo
  • 9 mo
  • 4 mo
  • 9 mo
  • 9 mo
  • 10 mo
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44
Q

Infant and child development 12-36 months

  • cruises
  • climbs stairs
  • cubes stacked
  • feeds self
  • kicks ball
  • parallel play
  • reapproachment
  • realization
  • 50 words and 2 word sentences
  • 200+ words
A
  • 12 mo
  • 18 mo
  • age*3
  • 20 mo
  • 24 mo
  • 24-26 mo
  • moves away from and returns to mother 24 mo
  • core gender is realized 36 mo
  • 2 yrs
  • 3 yrs
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45
Q

Infant and child development 3-5 yrs

  • tricycle
  • stick figure
  • hops on one foot
  • grooms self and can use buttons
  • can be away from mom for most of day
  • cooperative play/ imaginary friends
  • 1000 words, uses complete sentences and perpositions
  • can tell detailed stories
A
  • 3 yrs
  • 4 yrs
  • 4 yrs
  • 5 yrs
  • 3 yrs
  • 4 yrs
  • 4 yrs
  • 4 yrs
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46
Q

Lactation

  • how is it initiated?
  • what is needed?
  • prolactin function
  • oxytocin function
  • supplements for breastfed babies
  • decrease risk of
A
  • rapid decrease in progestore allows for increase in prolactin
  • suckling -> maintains milk production and ejection by increasing levels of oxytocin and prolactin
  • induces and maintains lactation and decreases reproductive function
  • assits in milk let down and promotes uterine contraction
  • vit D and Fe
  • breast and ovarian CA
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47
Q

Menopause

  • Dx
  • caused by
  • avg onset
  • preceded by
  • source of estrogen after
  • specific labs
  • SXS, HAVOCS
A
  • Amenorrhea for 12 months
  • decrease in estrogen level bc of decrease in number of ovarian follicles
  • 51
  • 4 to 5 yrs of abnormal menstrual cycles
  • adipose tissue
  • very high FSH
  • hot flashes, atrophy of vag, osteoporosis, CAD, sleep disturbances
48
Q

Function of Testosterone

  • fetal development
  • puberty
  • skeleton
  • sex life
  • conversion
A
  • differentiation of epidydimus, vas deferens and seminal vesicles
  • growth of penis, seminal vesicles, increase in sperm count and muscles, deepening of voice
  • closure of epiphyseal plates
  • increase in libido
  • To DHT via 5 alpha reductase or estrogen by aromatase
49
Q

Function of DHT

  • early
  • late
A
  • differentiation of penis, scrotum, prostate - prostate growth, balding, sebaceous gland activity
50
Q

Androgenic steroid abuse

  • sxs in men
  • patho in men
  • sxs in women
A
  • changes in behavior, increase in acnes, gynecomastia, small testes
  • exogenous testosterone -> decrease amnt testosterone produced by leydig cells -> decrease sperm count -> decrease testicle size
  • virilization
51
Q

Tanner stages

  • I
  • II
  • III
  • IV
  • V
A
  • both: no sexual hair, F: flat chest w/ raise nipple
  • b: pubic hair, M: testes enlarge, F: breast bud forms
  • b: coarse pubic hair, M: length of penis increases, F: breast enlarges and mound forms
  • b: coarse hair up to pubis, m: penis width increases, f: raised areola, mound on mound
  • b: hair to medial thigh, M: penis and testes enlarge to adult size, F: adult breast contour w/ flat areola
52
Q

Precocious puberty

  • what is it
  • caused by
  • sequalae
  • central
  • peripheral
A
  • appearance of secondary sex characteristics before age 8 in girls and age 9 in boys
  • increase in sex hormone exposure or production
  • increase in height causing premature closing of epiphyseal plate -> short stature
  • early activation of GnRH; idipathic or brain tumor
  • GnRH independent, increase in hormones because of adrenal hyperplasia, estrogen secreting ovarian tumor, leydig tumor, or McCune albright syndrome
53
Q

Sex chrom disorder

  • Turners: genetics, causes, sxs, heart problem, kidney problem, most common cause of, hormone levels
  • Klinefelters: genetics, body; mind; cause; hormone levels and pathogenesis
  • Double Y male: what is it, phenotype, sxs
  • Ovotesticular disorder: what is it,
A
  • 45 XO; short, ovarian dysgenesis, shield chest, bicuspid aortic valve, coarctation, horeshoe kidney, short 4th metatarsal, most common cause of primary amenorrhea, low estrogen and high FSH/LH,
  • 47, XXY; testicular atrophy; tall ,long extremities, gynecomastia; developmental delay; cause of hypogonadism in infertility work up; dysgenesis of seminefeous tubules w/ decreased inhibin B causing high FSH; abnormal leydig cell function decreases testosterone high LH and estrogen
  • XYY, phenotypically normal but very tall, normal fertility; severe, learning disability, autism
  • Both ovaries and testes present, ambigous genitalia
54
Q

Diagnosing sex hormone disorder

  • defective androgen receptor
  • testosterone secreting tumor
  • hypergonadotropic hypogonadism
  • hypogonadotropic hypogonadism
A
  • high testosterone and high LH
  • high testosterone and low LH
  • low testosterone and high LH
  • low testosteron and low LH
55
Q

Disorder of sex development

  • 46, XX DSD: what is it, caused by
  • 46 XY DSD: what is it, caused by
A
  • ovaries present but external genitalia virilized or ambiguous; excessive androgen exposure in utero
  • testes present but external genitalia are female or ambiguous; caused by androgen insensitivity
56
Q

Placental aromatase deficiency

  • what is it
  • sxs
  • what happens during pregnancy
A
  • inability to synthesize estrogen from androgens
  • masculinization of female with elevated testosterone
  • maternal virilization
57
Q

Androgen insensitivity syndrome

  • what is it
  • phenotypic
  • genotypic
  • what needs to be removed
  • hormone levels
A
  • defect in androgen receptor, causing a phenotypic female (female external genitalia, w/ rudimentary vagina) in genotypic male (uterus and fallopian tubes not present, instead there are testis in the labia majora
  • testes have to be removed to prevent CA -

high testosterone, estrogen, LH

58
Q

5 alpha reductase deficiency
- genetic

  • what is it
  • genotypically
  • phenotypic
  • puberty
  • hormones
A
  • autosomal recessive
  • inability to convert testosterone to DHT
  • internal genitalia are normal (testes)
  • external genitalia do not form fetally
  • increase in testosterone causes masculinization and increased growth of external genitalia
  • testosterone and estrogen normal
59
Q

Kallman syndrome

  • what is it
  • causes
  • sxs - hormones
A
  • defective migration of GnRH releasing neurons and failure of olfactory bulbs to develop
  • decrease synthesis of GnRH in hypothalamus
  • hyposmia/anosmia
  • decreased GnRH, FSH, LH, testosterone
60
Q

Pregnancy complications

  • Abruptio placentae: what is it, risks, sxs
  • Morbidly adherent placenta: what is it; risks; types; dx; sequlae
  • Placenta previa: what is it; risks; sxs
  • Vasa previa: what is it; sequlae; sxs; tx; associated w/
  • Postpartum hemorrhage: causes, 4Ts
  • Ectopic pregnancy: what is it; sxs
A
  • premature separation of placenta from uterine wall before delivery of infant; trauma, smoking, HTN, cocaine; abrupt, painful bleeding, possible DIC - defective decidual layer -> abnormal attachment and separation after delivery; prior c section or uterine surgery, mulitparity; accreta- attaches to myometrium but does not penetrate, increta- penetrates myometrium, percreta - through myometrium and into serosa; on US prior to delivery; no separation of placenta after delivery - attachment of placenta to lower uterine segment close to the internal cervical os; multi-parity, prior c section; painless third trimester bleeding - fetal vessels run over or in close proximity to cervical os; vessel rupture, exsanguination, fetal death; membrane rupture, painless vaginal bleeding, fetal bradycardia; emergency c section; velamentous umbilical cord insertion - tone (uterine atony) , trauma (lacerations, uterine rupture), thrombin (coagulopathy), tissue (reatined products of conception) - implantation of fertilized ovum in site other than uterus; amenorrhea, low HCG, lower abdominal pain
61
Q

Amniotic fluid abnormalities

  • polyhydraminos
  • oligohydraminos
A
  • too much amniotic fluid, - too little amniotic fluid
62
Q

Hydatidiform mole

  • what is it
  • sxs
  • tx
  • complete: components, histo, fetal parts, uterine size, hcg, imaging, risk of invasive mole and choriocarcinoma
  • partial: components, histo, fetal parts, uterine size, hcg, imaging, risk of invasive mole and choriocarcinoma
A
  • cystic swelling of chorionic villi and proliferation of chorionic epi
  • vaginal bleeding, uterine enlargement, pelvic pressure/pain
  • D and C and methotrexate; monitor HCG
  • egg w/o nuc and normal sperm meet, sperm DNA duplicates; hydropic villi, circumferential and diffuse trophoblastic proliferation; no fetal parts; uterine size increased; HCG increased; honeycombed uterus or clusters of grapes w/ snowstrom on US; 20% risk of invasive mole and 2% choriocarcinoma - 2 sperm and 1 egg; some hydropic villi; positive for fetal parts; uterine size is normal; hcg is minimally elevated; fetal parts seen on imaging; low risk of invasive mole and choriocarcinoma
63
Q

Choriocarcinoma

  • what is it
  • histo
  • sxs
  • labs
  • tx
A
  • malignancy of trophoblastic tissue - no chorionic villi present - SOB, hemoptysis -> spread to lungs - elevated HCG - methotrxate
64
Q

HTN in pregnancy

  • gestational HTN: what is it
  • preeclampsia: what is it; pathogenesis; risks; sequlae
  • ecclampsia: what is it; tx
  • HELLP syndrome: what is it; caused by; sequlae; tx
A
  • BP > 140/90 after 20 wks of gestation w/o proteinuria or end organ damage
  • BP > 140/90 after 20 wks of gestation w/ proteinuria or end organ damage; abnormal placental spiral arteries w/ endothelial dysfunction vasoconstriction and ischemia; pre-existing HTN, DM, CKD, AI disorder; placental abruption, coagulopathy, renal failure, pulm edema
  • preeclampsia + maternal seizures; IV mg sulfate, antihypertensives
  • hemolysis, elevated liver enzymes, low plateles; caused by preeclampsia; DIC and hepatic subscapular hematomas -> rupture -> severe hyotension; delivery
65
Q

Vulvar pathology Non- neoplastic

  • Bartholin cyst and abcess: what is it, leads to, epi, bug
  • lichen sclerosus: histo; gross; epi; increase risk
  • lichen simplex chronicus: histo; gross; risk
A
  • blockage of bartholin gland duct causing accumulation of gland fluid; can lead to abcess secondary to obstruction; reproductive age females; N gon
  • thinning of epi w/ fibrosis/sclerosis of dermis; porcelain-white plaque w/ red/violet border; postmenopausal women; benign but increase risk for SCC
  • hyperplasia of vulvar squamous epi; leathery/thick vulvar skin w/ enhanced skin marking bc of chronic rubbing or scratching; no risk SCC
66
Q

Vulvar pathology neoplastic - vulvar carcinoma - extramammary paget dx

A
  • carcinoma from squamous epi lining of vulva; rare; high risk HPV or long standing lichen sclerosus - intraepi adenocarcinoma; low risk of underlying carcinoma; pruritis, erythema, crusting, ulcers
67
Q

Vaginal tumors

  • vaginal squamous cell carcinoma: secondary to
  • clear cell adenocarcinoma:
  • sarcoma botryoides: variant, epi, histo
A
  • secondary to cervical SCC
  • affects women who had exposure to DES in utero
  • embryo rhabdomyosarcoma variant; girls younger than 4 yrs; spindle shaped cells w/ desmin and clear, grape-like, polyploid mass emerging from vagina
68
Q

Imperforate hymen

  • what is it
  • sequalae at birth
  • saequale w/ puberty
A
  • failure of hymen central epi to degenerate after birth - accumulation of vaginal mucus at birth that causes a bulge in introitus - primary amenorrhea, cyclic abdominal pain, hematocolpos (accumulation menstrual blood in vag)
69
Q

Cervical Pathology

  • dysplasia and carcinoma in situ
  • invasive carcinoma
A
  • disordered epi growth
  • squamous cell carcinoma; pap smear detects cervical dysplasia before it progresses to invasive CA; lateral invasion can block ureters
70
Q

Primary Ovarian Insuff

  • other name
  • what is it
  • caused by, assocaited w/
  • sxs
  • hormones
A
  • premature ovarian failure - premature atresia of ovarian follicles in women of reproductive age - idiopathic, but associated w/ chromosomal abnormalities - signs of menopause before 40 - decreased estrogen, increased LH/FSH
71
Q

Functional hypothalamic amenorrhea

  • other name
  • pathogenesis
  • associated w.
A
  • exercise induced amenorrhea
  • severe caloric restriction (decreased leptin) or stress disrupt pulsatile GnRH secretion which decreases LH, FSH, and estrogen
  • eating disorders and female athletes
72
Q

PCOS

  • what is it
  • levels of hormones
  • fetility
  • US
  • sxs
  • tx
A
  • hyperinsulinemia cause insulin resistance -> high LH:FSH
  • increased androgens and decreased estrogen
  • decreased rate of follicular maturation -> no ovulation
  • enlarged, bilateral cytic ovaries
  • amenorrhea, hursutism, acne
  • cycle reg, weight reduction, OCP, spironolactone or finasteride
73
Q

Ovarian cyst

  • follicular: what is it; increases in
  • theca lutein: what is it; associated w/
A
  • distention of unruptured graffian follicle; hyper estrogen and endometrial hyperplasia
  • due to gonadotropin stimulation, associated w. choriocarcinoma and hydatdiform mole
74
Q

Ovarian neoplasm: Surface Epi tumors benign

  • serous cyst adenoma: prevalence, histo,
  • mucinous cystadenoma: gross, histo
A
  • most common, fallopian tube epi, bilateral
  • multi-oculated, large, lined by mucus secreting epi
75
Q

Ovarian neoplasm: Germ cell tumors benign

  • mature cystic teratoma: histo, sxs, hyperthyroid
A
  • cystic mass containing elements from all 3 germ layers - pain secondary to enlargement or torsion - monodermal form w/ thyroid tissue
76
Q

Ovarian neoplasm: Sex Chord tumors benign

  • fibroma: histo
  • sertoli leydig: gross, histo, sxs
  • thecoma: produces?, sxs
A
  • spindle shaped fibroblasts
  • small, grey to yellow-brown mass, resembles testicle w/ tubules and cords lined by pink sertoli cells; produce androgens -> virilzation
  • produce estrogen, present as abnormal uterine bleeding
77
Q

Ovarian neoplasm: other benign

  • brenner tumor: histo, gross
A
  • bladder epi w/ solid coffee bean nuclei
  • solid tumor that is pale yellow and tan and encapsulated
78
Q

Ovarian neoplasm: Surface Epi tumors malignant

  • serous cystadenocarcinoma
  • mucinous cystadenocarcinoma
A
  • psammoma bodies, bilateral, most common
  • rare, malignant mucinous ovarian epi tumor; mets from other tumors; pseudomyxoma peritoni
79
Q

Ovarian neoplasm: Sex Chord tumors malignant

  • granulosa cell tumor: prevalence, epi, secretes, sxs, histo
A
  • most common malignant stromal tumor - women in 50s - produes estrogen and progesterone - post menopausal bleeding, endometrial hyperplasia, breast tenderness - Call exner bodies
80
Q

Ovarian neoplasm: Germ cell tumors malignant

  • dysgerminoma: epi, similar to, histo, labs
  • immature teratoma: prognosis, type of tissue, epi
  • yolk sac tumor: kind of tumor, prognosis, gross, histo
A
  • most common in adolescents, equivalent to male seminoma but rarer; fried egg cells, increased HCG and LDH
  • aggressive, contains fetal tissue/ neuroectoderm, before age 20,
  • ovarian ednodermal sinus tumor, aggressive, yellow/friable/solid mass, schiller duval bodies
81
Q

Ovarian neoplasm: other malignant - krukenberg tumor: where is it from, secretes, type of cell

A
  • GI malignancy that mets to ovaries -> mucin secreting signet cell adenocarcinoma
82
Q

Uterine conditions

  • polyp: what is it, type of cells, sxs
  • adenomyosis: what is it; caused by; sxs; tx
  • asherman syndrome: what is it; sequalae; risks
  • leiomyoma: prevalence, cell type, transformation, sensitive to; pattern/histo
  • endometrial hyperplasia: what is it, caused by, increases risk of, sxs
  • endometrial carcinoma: sxs, endometriod type (caused by, epi, risk factors, histo, genetic), serous (caused by, prognosis, histo)
  • endometritis: what is it, bugs from, histo, tx
  • endometriosis: what is it, where is it found, histo on ovary; sxs; TX
A
  • polyp: well circumscribed collection of endometrial tissue within the uterine wall; SM cells; asymptomatic or painless abnormal uterine bleeding
  • adenomyosis: extension of endometrial tissue into uterine myometrium; hyperplasia of basal lay of endometrium; dysmenorrhea w/ uniformly enlarged soft golbular uterus; GnRH agonist, hysterectomy
  • asherman: adhesion or fibrosis of endometrium; decreased fertility, recurrent pregnancy loss, pelvic pain; associated with D and Cs
  • leiomyoma: most common benign tumor in females; smooth muscle tumors; can undergo malignant transformation to leomyoma sarcoma; estrogen sensitive and increases in size with pregnancy; 20-40 yrs old; whorled pattern of smooth muscle w/ well demarcated borders.
  • hyperplasia: abnormal endometrial gland proliferation bc of increased estrogen production, increased risk endometrial cancer; postmenopausal vaginal bleeding
  • irregular bleeding; endometriod- unopposed estrogen exposure and endometrial hyperplasia, perimenipausal women, obesity/DM/HTN, abnormally arranged endo glands, loss of PTEN; serous- endometrial atrophy in postmenopausal women, aggressive, formation of papillae and tufts
  • inflammation of endometrium bc of retained products of conception after delivery; bacteria from vagina or intestesinal tract, plasma cells, gentamicin/clindamycin +/- ampicillin
  • endometrial like glands outside endometrial cavity; ovary/ pelvis/ peritoneum; blood filled chocolat cysts; pelvic pain/ bleeding/ dysmenorrhea/ dysparunia; NSAID/ continuous OCP/ GnRH agonist/ laprascopic removal
83
Q

Benign Breast Dx: Fibrocystic changes

  • sclerosing adenosis: what is it
  • epithelial hyperplasia: cell type, increased risk w/
A
  • acini and stromal fibrosis w/ calcification
  • cells in terminal ductal or lobar epi, increased risk of carcinoma w/ atypical cells
84
Q

Benign Breast Dx: Inflammaroty processes

  • Fat necrosis: what is it, mammo results, biopsy, caused by
  • Lactational Mastitis: when, pathogenesis, tx
A
  • benign, painless lump due to injury of breast tissue; looks like calcified oil cyst on mammo; necrotic fat w/ giant cells on biopsy; not everyone has trauma
  • occurs during breastfeeding, increased risk of bacterial infection through cracks in nipple, treat w/ antibiotic and continue breast feeding
85
Q

Benign Breast Dx: Benign Tumors

  • Fibroadenoma: epi, gross, estrogen
  • Intraductal Papilloma: kind of tumor, location, sxs, prognosis
  • Phyllodes tumor: what is it, prognosis
A
  • most common in women younger than 35; small, well defined, mobile mass; increased size and tenderness with increase in estrogen
  • small fibroepithelial tumor in lactiferous duct, beneath areola; nipple discharge, slight increased risk of CA
  • large mass of CT with leaflike lobules; some can become malignant
86
Q

Gynecomastia - what is it

A
  • breast enlargement in males because of increased estrogen
87
Q

Breast CA

  • epi
  • sxs
  • pathogenesis of dimpling
  • pathogenesis of peu de orange
  • common types
A
  • post menopausal women
  • palpable hard mass in uper outer quadrant
  • fixed to pec/ deep fascia/ cooper ligament/ overlying skin
  • dermal lymph invasion -> lymphedema -> thickened skin around exaggerated hair follicles
  • PR+, ER+, HER2+, neg for all 3 is very aggressive
88
Q

Breast CA non-invasie

  • Ductal carcinoma in situ: fills, caused by, mammogram, histo, sxs, comedocarcinoma
  • Paget dx: what is it, sxs
  • Lobular carcinoma in situ: sxs, how is it found
A
  • fills ductal lumen, from ductal atypia, mico-calcifications, does not penetrate basement membrane, does not produce a mass; comedo- subtype w/ cells that have high grade nuclei and extensive central necrosis
  • extension of underlying DCIS up lactiferous ducts and into contiguous skin of nipple; eczematous patches over nipple and areolar skin
  • does not produce mass or calcification -> usually incidental biopsy finding
89
Q

Breast CA invasive

  • invasive ductal: gross, histo, tubular vs mucinous
  • invasive lobular: histo, gross
  • medullary: histo, mimics
  • inflammatory: invasion of, sxs, prognosis
A
  • firm, fibrous, rock hard mass w/ sharp margins and small, glandular, duct-like cells in desmoplastic stroma; tubular- well diff tubules that lack myoepithelium vs mucinous abundant extracellular mucin
  • low e cadherin expression w/ orderly row of cells and no duct formation; lacks desmoplastic response, bilateral w/ mult lesions in same location
  • large anaplastic cells gorwing in sheets w/ associated lymphocytes and plasma cells, well circumscribed tumor can mimic fibroadenoma
  • invasion of dermal lymph spaces -> painful breast w/ warm, swollen, erythematous skin, peu’ de orange; poor prognosis
90
Q

Penile pathology

  • peyronie dx
  • ischemic priapism
  • squamous cell carcinoma
A
  • abnormal curvature of penis, fibrous plaque in tunica albuginea, ED, pain and anxiety, surgical repair or tx w/ collagenase - painful sustained erection lasting greater than 4 hrs, sickle cell dx, corporal aspiration, intracavernosal phenylepi or surgical decompression - in situ lesions are precursor, bowens in penile shaft, Queyrat glans
91
Q

Cryptochordism - what is it - impaired - increased risk of

A
  • failure of testicles to descend, - impaired spermatogenesis, - increased risk of germ cell tumors
92
Q

Testicular torsion - what is it - when - cause

A
  • rotation of testicle around spermatic cord and vascular pedicle - males 12-18 yrs old - trauma or spontaneous - acute, severe pain with absent cremasteric reflex
93
Q

Varicocele - what is it - most common cause of - side at risk - sequalae - dx - tx

A
  • dilated v in pampiniform plexus bc of increase in venous pressure - most common cause of scrotal enlargement - left side bc increase resistance to flow in gonadal v bc it drains into left renal v - infertility bc increase in temp - on US w/ doppler and does not transilluminate - surgical ligation or embolization
94
Q

Scrotal masses - what are they - congenital hydrocele: epi, pathogenesis, tx - acquired hydrocele: what is it - spermatocele: what is it

A
  • benign scrotal lesions - transilluminated - infants, incomplete obliteration of processus vaginalis, spontaneously resolve by 1 yr old - scrotal fluid collection secondary to infection, trauma, tumor - cyst due to dilated epidydimal duct or rete testes
95
Q

Testicular germ cell tumors

  • seminoma: what is it, prevalence, epi, histo, biomarkers, prognosis
  • yolk sac tumor: gross, prognosis, analagous to, histo, biomarkers, epi
  • choriocarcinoma: biomarkers -> causes , what is it, mets
  • teratoma: what is it
  • embryonal carcinoma: gross, prognosis, types, biomarkers
A
  • malignant, painless, homogenous testicular enlargement; most common testicular tumor does not occur in infancy; large cells in lobules w/ watery cytoplasm and fried egg appearance; increase ALP; late mets, good prognosis - yellow, mucinous; aggressive malignancy of testes; analagous to yolk sac tumor in females; schiller duval bodies; AFP high; common in boys under 3 yrs - malignant; high HCG; disordered syncytiotrophoblast and cytotrophoblast; blood mets to lung and brain, produce gynecomastia - mature teratoma is malignant - malignant hemorrhagic mass with necrosis, painful; worse prognosis; pure or mixed; high hcg and normal AFP when pure
96
Q

Testicular non-germ cells

  • leydig: gross, histo, produce -> sxs, epi
  • sertoli: what is it
  • testicular lymphoma: caused by
A
  • golden brown, contain reinke crystals, produce androgens or estrogens -> gynecomastia in men and precocious puberty in males
  • androblastoma from sex cord stroma
  • from metastatic lymphoma to testes
97
Q

Epididymitis - what is it - sxs - relief - progress

A
  • inflammation of epidiymus - localized pain and tenderness over posterior testis - pain relief with scrotal elevation - can progress to involve testis
98
Q

Orchitis - what is it - sxs - bugs and other causes

A
  • inflammation of testis - present w/ testicular pain and swelling - C trach and N gonn, mumps, AI
99
Q

BPH - what is it - prognosis - sxs - sequalae - labs - tx

A
  • smooth, elastic firm nodular enlargement of periurethral lobes, compress urethra - not pre-malignant - increased frequency of urination, diff starting and stopping urination, - distention and hypertrophy of bladeder, hydronephrosis, UTI’s - high PSA - alpha 1 antagonists, 5 alpha reductase inhibitors, PDE5 inhibitors
100
Q

Prostatitis - what is it - sxs - PE findings - causes

A
  • inflammation of prostate - dysuria, frequency, urgency, low back pain - warm, tender, enlarged prostate - E coli in older and c trach and n gonn in younger
101
Q

Prostatic adenocarcinoma - epi - location

A
  • common in men older than 50 - from posterior lobe of prostate
102
Q

Leuprolide - MOA - side effects

A
  • GnRH analog w/ agonist properties when used in pulsatile fashion and antagonist properties when used continuously (down reg GnRH receptor in pit to decrease LH and FSH) - Hypogonadism, decreased libido, ED, n/v
103
Q

Estrogen - examples - MOA - indications - side effects

A
  • ethinyl estradiol, DES, mestranol - bind estrogen receptors - hypogonadism/ ovarian failure, hormone replacement in postmenopausal women - risk of endometrial CA, post menopausal bleeding, clear cell adenocarcinoma of vagina (when exposed in utero), risk of thrombi
104
Q

Selective estrogen receptor modulators - clomiphene: MOA, indication, side effect - tamoxifen: MOA/ location, indications, side effects - raloxifene: MOA, side effects, indications

A
  • antagonist at estrogen receptor in hypothalamus, prevents normal feedback inhibition nd increases release of LH and FSH -> stimulate ovulation; treat infertility; hot flashes, ovarian enlargement, multiple pregnancies, visual disturbances - antagonist at breast, agonist at bone and uterus; increase risk of thromboembolic event and endometrial CA; treat and prevent recurrence of ER+ breast CA - antagonist at breast and agonist at bone; increased risk of thromboembolic event; osteoporosis
105
Q

Aromatase inhibitors - examples - MOA - indication

A
  • anastrazole, letrozole - inhibit peripheral conversion of androgens to estrogen - ER+ breast CA in post menopausal women
106
Q

Progestins

  • examples
  • MOA
A
  • levonorgestrel, medroxyprogesterone, letonogestrel, norethindrone, megestr
  • bind progesterone receptors, decrease growth and vascularization of endometrium and thickening cervical mucus
107
Q

Anti-progestins

  • examples
  • MOA
  • indication
A

-

108
Q

Combined Contraceptive

  • what is it
  • forms
  • MOA
  • contraindications
A
  • progestin and ethinyl estradiol
  • pill, patch, vaginal ring
  • estrogen and progestins will inhibit FSH and LH -> no LH surge -> no ovulation
  • smokers and over 35, migraines w/ aura, breast CA, liver dx
109
Q

Copper intrauterine device

  • MOA
  • effects
A
  • produces local inflammatory reaction toxic to sperm and ova, preventing fertilization and implantation
  • longer and heavier menses, risk of PID
110
Q

Tocolytics

  • MOA
  • examples
  • indications
A
  • relax the uterus
  • indomethacin, nifedipine, terbutaline
  • decrease contraction frequency in preterm labor and allow for administration of steroid for fetal lung development
111
Q

Danazol

  • MOA
  • indications
  • side effects
A
  • synthetic androgen that acts as partial agonist at androgen receptor
  • endometriosis, hereditary angioedema
  • weight gain, edema, acne, hirsutism, masculinization
112
Q

Testosterone

  • MOA
  • indication
  • adverse effects
A
  • agonist at androgen recceptor
  • hypogonadism -> and promote development of secondary sex characteristics
  • decrease intratesticular testosterone production by inhibiting release of LH -> gonadal atrophy
113
Q

Anti- androgens

  • finasteride
  • flutamide
  • ketoconazole vs spironolactone
A
  • 5 alpha reductase inhibitor; BPH and male pattern baldness; gynecomastia
  • non steroid androgen receptor inhibitor; prostate CA
  • inhibit steroid synthesis (17,20 desmolase/ 17 alpha hydroxylase); vs inhibit steroid binding; PCOS
114
Q

Tamsulosin

  • MOA
A
  • selective alpha 1 antagonist -> inhibits smooth muscle contraction at prostate
115
Q

PDE 5 inhibitors

  • examples
  • MOA
  • indication
  • side effects
A
  • sildenafil, tadalafil, vardenafil
  • inhibit PDE5 -> increase cGMP -> prolonged smooth muscle relaxation in response to NO -> increase blood flow to corpus cavernosum of penis; decreases pulm vascular resistance
  • ED, pulm HTN
  • headache, cyanopia, flushing, life threatening hypotension in pt taking nitrate
116
Q

Minoxidil

  • MOA
  • indication
A
  • direct arteriolar vasodilator
  • male pattern baldness

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