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
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
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
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
5
Q
Endoderm derivatives
- which layer
- forms
A
- internal layer
- gut tube epi, urethra, lower vagina, epi to lumen (lungs, gallbladder, liver, etc)
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
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
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
9
Q
Neonatal abstinence syndrome
- caused by
- sxs
A
- maternal opiate use - uncoordinated sucking, high pitched crying, tremors, tachypnea, sneezing, diarrhea, seizures
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
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
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
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
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
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
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
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)
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
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)
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
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
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
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
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
25
Gonadal drainage
- venous: left vs right; effects
- lymph: ovaries and testis, uterus, prostate/cervix/prox vag, distal vag/vulva/scrotum, glans penis
- 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
26
Female Uterine Ligaments
- infundibulopelvic: connects; contains; surgery; close to
- Cardinal: connects, contains
- Round: connects, derivative of
- Broad: connects, contains
- Ovarian: connects, derivative of
- 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
27
Adnexal Torsion
- what is it
- sequalae
- sxs
- 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
28
Female histo
- vulva
- vag
- ectocervix
- transformation zone
- endo cervix
- uterus
- fallopian tube
- ovary
- 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
29
Pathway of Sperm during ejaculation
- semineferous tubules, epididymus, vas defrens, ejaulatory duct, urethra, penis
30
Urethral injury
- anterior: part of urethra, mechanism, location of urine/blood accumulation, sxs
- posterior
- 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
31
Auto innervation of male sex response
- erection: which ANS, which nerve, pathway
- emission: which ANS, which nerve, pathway
- expulsion: which ANS, which nerve, pathway
- parasymp -\> pelvic splanchnic -\> NO -\> cGMP -\> SM relax -\> vasodilate
- Symp -\> hypogastric nerve -\> NE -\> increase Ca -\> smooth muscle contraction
- Symp -\> pudendal nerve
32
Semineferous tubules
- spermatogonia: what are they and their location
- sertoli cells: location, fxn
- leydig cells: location, fxn
- 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
33
Spermatogenesis
- pathway
- parts of sperm
-spermatogonium -\> primary spermatocyte -\> secondary spermatocyte -\> spermatid -\> spermatazoan - acrosome, head, neck, middle piece, tail
34
Estrogen
- source
- breast
- ovary
- uterus
- ovary, placenta, adipose - aids in development - growth of follicle - endometrial proliferation
35
Progesterone
- source
- luteal phase
- pregnancy
- 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
36
Oogenesis
- pathway
- when are polar bodies made
- oogonium -\> primary oocyte -\> secondary oocyte -\> ovum - when secondary oocyte and ovum are made
37
Ovulation
- starts w
- hypothalamus
- pituitary
- mittelschmerz
- increased estrogen
- GnRH
- LH surge -\> ovulation
- mid cycle ovulatory pain, associated with peritoneal irritation from follicular swelling and fallopian tube contraction
38
Phases of ovarian cycle
- pituitary: follicular phase, luteal phase
- ovary: follicular phase, luteal phase
- uterus: follicular, luteal phase
- 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
39
Abnormal Uterine bleeding
- characterized by
- structural (PALM)
- non-structural (COEIN)
- heavy menstrual bleeding or intermenstral bleeding
- Polyp, adenomyosis, leiomyoma, malignancy
- coagulopathy, ovulatory, endometrial, iatrogenic, not yet classified
40
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
- 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
41
HCG
- source
- function
- what takes over
- identical alpha subunit as
- increased
- decreased
- 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
42
Human placental lactogen
- other name
- source
- function
- chorionic somatomammotropin
- syncytiotrophoblast of placenta
- stimulates insulin production causing insulin resistance
43
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
- 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
44
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
- 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
45
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
- 3 yrs
- 4 yrs
- 4 yrs
- 5 yrs
- 3 yrs
- 4 yrs
- 4 yrs
- 4 yrs
46
Lactation
- how is it initiated?
- what is needed?
- prolactin function
- oxytocin function
- supplements for breastfed babies
- decrease risk of
- 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
47
Menopause
- Dx
- caused by
- avg onset
- preceded by
- source of estrogen after
- specific labs
- SXS, HAVOCS
- 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
Function of Testosterone
- fetal development
- puberty
- skeleton
- sex life
- conversion
- 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
Function of DHT
- early
- late
- differentiation of penis, scrotum, prostate - prostate growth, balding, sebaceous gland activity
50
Androgenic steroid abuse
- sxs in men
- patho in men
- sxs in women
- 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
Tanner stages
- I
- II
- III
- IV
- V
- 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
Precocious puberty
- what is it
- caused by
- sequalae
- central
- peripheral
- 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
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,
- 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
Diagnosing sex hormone disorder
- defective androgen receptor
- testosterone secreting tumor
- hypergonadotropic hypogonadism
- hypogonadotropic hypogonadism
- high testosterone and high LH
- high testosterone and low LH
- low testosterone and high LH
- low testosteron and low LH
55
Disorder of sex development
- 46, XX DSD: what is it, caused by
- 46 XY DSD: what is it, caused by
- 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
Placental aromatase deficiency
- what is it
- sxs
- what happens during pregnancy
- inability to synthesize estrogen from androgens
- masculinization of female with elevated testosterone
- maternal virilization
57
Androgen insensitivity syndrome
- what is it
- phenotypic
- genotypic
- what needs to be removed
- hormone levels
- 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
5 alpha reductase deficiency
- genetic
- what is it
- genotypically
- phenotypic
- puberty
- hormones
- 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
Kallman syndrome
- what is it
- causes
- sxs - hormones
- 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
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
- 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
Amniotic fluid abnormalities
- polyhydraminos
- oligohydraminos
- too much amniotic fluid, - too little amniotic fluid
62
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
- 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
Choriocarcinoma
- what is it
- histo
- sxs
- labs
- tx
- malignancy of trophoblastic tissue - no chorionic villi present - SOB, hemoptysis -\> spread to lungs - elevated HCG - methotrxate
64
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
- 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
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
- 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
Vulvar pathology neoplastic - vulvar carcinoma - extramammary paget dx
- 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
Vaginal tumors
- vaginal squamous cell carcinoma: secondary to
- clear cell adenocarcinoma:
- sarcoma botryoides: variant, epi, histo
- 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
Imperforate hymen
- what is it
- sequalae at birth
- saequale w/ puberty
- 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
Cervical Pathology
- dysplasia and carcinoma in situ
- invasive carcinoma
- disordered epi growth
- squamous cell carcinoma; pap smear detects cervical dysplasia before it progresses to invasive CA; lateral invasion can block ureters
70
Primary Ovarian Insuff
- other name
- what is it
- caused by, assocaited w/
- sxs
- hormones
- 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
Functional hypothalamic amenorrhea
- other name
- pathogenesis
- associated w.
- 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
PCOS
- what is it
- levels of hormones
- fetility
- US
- sxs
- tx
- 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
Ovarian cyst
- follicular: what is it; increases in
- theca lutein: what is it; associated w/
- distention of unruptured graffian follicle; hyper estrogen and endometrial hyperplasia
- due to gonadotropin stimulation, associated w. choriocarcinoma and hydatdiform mole
74
Ovarian neoplasm: Surface Epi tumors benign
- serous cyst adenoma: prevalence, histo,
- mucinous cystadenoma: gross, histo
- most common, fallopian tube epi, bilateral
- multi-oculated, large, lined by mucus secreting epi
75
Ovarian neoplasm: Germ cell tumors benign
- mature cystic teratoma: histo, sxs, hyperthyroid
- cystic mass containing elements from all 3 germ layers - pain secondary to enlargement or torsion - monodermal form w/ thyroid tissue
76
Ovarian neoplasm: Sex Chord tumors benign
- fibroma: histo
- sertoli leydig: gross, histo, sxs
- thecoma: produces?, sxs
- 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
Ovarian neoplasm: other benign
- brenner tumor: histo, gross
- bladder epi w/ solid coffee bean nuclei
- solid tumor that is pale yellow and tan and encapsulated
78
Ovarian neoplasm: Surface Epi tumors malignant
- serous cystadenocarcinoma
- mucinous cystadenocarcinoma
- psammoma bodies, bilateral, most common
- rare, malignant mucinous ovarian epi tumor; mets from other tumors; pseudomyxoma peritoni
79
Ovarian neoplasm: Sex Chord tumors malignant
- granulosa cell tumor: prevalence, epi, secretes, sxs, histo
- most common malignant stromal tumor - women in 50s - produes estrogen and progesterone - post menopausal bleeding, endometrial hyperplasia, breast tenderness - Call exner bodies
80
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
- 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
Ovarian neoplasm: other malignant - krukenberg tumor: where is it from, secretes, type of cell
- GI malignancy that mets to ovaries -\> mucin secreting signet cell adenocarcinoma
82
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
- 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
Benign Breast Dx: Fibrocystic changes
- sclerosing adenosis: what is it
- epithelial hyperplasia: cell type, increased risk w/
- acini and stromal fibrosis w/ calcification
- cells in terminal ductal or lobar epi, increased risk of carcinoma w/ atypical cells
84
Benign Breast Dx: Inflammaroty processes
- Fat necrosis: what is it, mammo results, biopsy, caused by
- Lactational Mastitis: when, pathogenesis, tx
- 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
Benign Breast Dx: Benign Tumors
- Fibroadenoma: epi, gross, estrogen
- Intraductal Papilloma: kind of tumor, location, sxs, prognosis
- Phyllodes tumor: what is it, prognosis
- 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
Gynecomastia - what is it
- breast enlargement in males because of increased estrogen
87
Breast CA
- epi
- sxs
- pathogenesis of dimpling
- pathogenesis of peu de orange
- common types
- 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
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
- 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
Breast CA invasive
- invasive ductal: gross, histo, tubular vs mucinous
- invasive lobular: histo, gross
- medullary: histo, mimics
- inflammatory: invasion of, sxs, prognosis
- 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
Penile pathology
- peyronie dx
- ischemic priapism
- squamous cell carcinoma
- 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
Cryptochordism - what is it - impaired - increased risk of
- failure of testicles to descend, - impaired spermatogenesis, - increased risk of germ cell tumors
92
Testicular torsion - what is it - when - cause
- 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
Varicocele - what is it - most common cause of - side at risk - sequalae - dx - tx
- 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
Scrotal masses - what are they - congenital hydrocele: epi, pathogenesis, tx - acquired hydrocele: what is it - spermatocele: what is it
- 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
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
- 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
Testicular non-germ cells
- leydig: gross, histo, produce -\> sxs, epi
- sertoli: what is it
- testicular lymphoma: caused by
- 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
Epididymitis - what is it - sxs - relief - progress
- inflammation of epidiymus - localized pain and tenderness over posterior testis - pain relief with scrotal elevation - can progress to involve testis
98
Orchitis - what is it - sxs - bugs and other causes
- inflammation of testis - present w/ testicular pain and swelling - C trach and N gonn, mumps, AI
99
BPH - what is it - prognosis - sxs - sequalae - labs - tx
- 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
Prostatitis - what is it - sxs - PE findings - causes
- 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
Prostatic adenocarcinoma - epi - location
- common in men older than 50 - from posterior lobe of prostate
102
Leuprolide - MOA - side effects
- 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
Estrogen - examples - MOA - indications - side effects
- 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
Selective estrogen receptor modulators - clomiphene: MOA, indication, side effect - tamoxifen: MOA/ location, indications, side effects - raloxifene: MOA, side effects, indications
- 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
Aromatase inhibitors - examples - MOA - indication
- anastrazole, letrozole - inhibit peripheral conversion of androgens to estrogen - ER+ breast CA in post menopausal women
106
Progestins
- examples
- MOA
- levonorgestrel, medroxyprogesterone, letonogestrel, norethindrone, megestr
- bind progesterone receptors, decrease growth and vascularization of endometrium and thickening cervical mucus
107
Anti-progestins
- examples
- MOA
- indication
-
108
Combined Contraceptive
- what is it
- forms
- MOA
- contraindications
- 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
Copper intrauterine device
- MOA
- effects
- produces local inflammatory reaction toxic to sperm and ova, preventing fertilization and implantation
- longer and heavier menses, risk of PID
110
Tocolytics
- MOA
- examples
- indications
- relax the uterus
- indomethacin, nifedipine, terbutaline
- decrease contraction frequency in preterm labor and allow for administration of steroid for fetal lung development
111
Danazol
- MOA
- indications
- side effects
- synthetic androgen that acts as partial agonist at androgen receptor
- endometriosis, hereditary angioedema
- weight gain, edema, acne, hirsutism, masculinization
112
Testosterone
- MOA
- indication
- adverse effects
- agonist at androgen recceptor
- hypogonadism -\> and promote development of secondary sex characteristics
- decrease intratesticular testosterone production by inhibiting release of LH -\> gonadal atrophy
113
Anti- androgens
- finasteride
- flutamide
- ketoconazole vs spironolactone
- 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
Tamsulosin
- MOA
- selective alpha 1 antagonist -\> inhibits smooth muscle contraction at prostate
115
PDE 5 inhibitors
- examples
- MOA
- indication
- side effects
- 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
Minoxidil
- MOA
- indication
- direct arteriolar vasodilator
- male pattern baldness
