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Step 1 > Reproductive > Flashcards

Reproductive Flashcards

1
Q

Sonic Hedgehog gene

A

Zone of polarizing activity at the base of limb buds
Anterior - posterior axis patterning, CNS development
Mutations –> holoprosencephaly

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2
Q

Wnt 7 gene

A

Apical ectodermal ridge at distal end of each limb

Dorsal-ventral axis patterning, limb development

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3
Q

FGF gene

A

Apical ectodermal ridge

Limb lengthening

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4
Q

Homeobox genes

A

segmental organization in cranial-caudal direction, transcription factor coding
Mutations –> appendages in wrong location
Isotretinoin –> increase hox gene expression

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5
Q

Within 1 week fetal development

A

hCG secretion begins around the time of implantation of blastocyst
Blastocyst sticks at day 6

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6
Q

Within 2 weeks of fetal development

A

Bilaminar disc (epiblast and hypoblast)

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7
Q

Within week 3 of fetal development

A

Gastrulation forms trilaminar embryonic disc
Cells from epiblast –> primitive streak –> endoderm, mesoderm, ectoderm
Notochord arises from midline mesoderm
overlying ectoderm –> neural plate

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8
Q

Weeks 3-8 of fetal development

A

Neural tube formed by neuroectoderm and closes by week 4
Organogenesis
Extremely susceptible to teratogens

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9
Q

Week 4 of fetal development

A

Heart begins to beat

Upper and lower limb buds begin to form

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10
Q

Week 6 of fetal development

A

fetal cardiac activity visible by transvaginal US

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11
Q

Week 8 of fetal development

A

fetal movements start

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12
Q

Week 10 of fetal development

A

Genitalia have male/female characteristics

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13
Q

Surface ectoderm

A

epidermis, adenohypophysis, lens of eye, epithelial lining of oral cavity, sensory organs of ear and olfactory epithelium, anal canal below pectinate line, parotid, sweat and mammary glands

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14
Q

Craniopharyngioma

A

benign Rathke puch tumor with cholesterol crystals, calcifications

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15
Q

Neural Tube

A

Brain, retina, spinal cord

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16
Q

Neural Crest

A

Melanocytes, odontoblasts, tracheal cartilage, Enterochromaffin cells, leptomeninges, PNS ganglia, adrenal medulla, schwann cells, spiral membrane, endocardial cushions, skull bones

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17
Q

Mesoderm

A

muscle, bone, connective tissue, serous lining of body cavities, spleen, CV structures, lymphatics, blood, upper vagina, kidneys, adrenal cortex, dermis, testes, ovaries, microglia

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18
Q

Notochord

A

nucleus pulposus of intervertebral disc

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19
Q

Endoderm

A

gut tube epithelium, urethra and lower vagina, luminal epithelial derivatives.

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20
Q

ACEi Teratogen

A

renal failure, oligohydramnios, hypocalvaria

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21
Q

Alkylating agents Teratogen

A

absence of digits, multiple anomalies

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22
Q

aminoglycosides Teratogen

A

ototox

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23
Q

antiepileptic drugs Teratogen

A

neural tube defects, cardiac defects, cleft palate, skeletal abnormalities

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24
Q

Diethylstilbestrol Teratogen

A

vaginal clear cell adenocarcinoma, congenital Mullerian anomalies

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25
Q

Fluoroquinolones Teratogen

A

cartilage damage

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26
Q

Folate antagonist Teratogen

A

Neural tube defects

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27
Q

Isotretinoin Teratogen

A

severe birth defects

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28
Q

Lithium Teratogen

A

ebstein anomaly

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29
Q

Methimazole Teratogen

A

aplasia cutis congenita (no skin)

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30
Q

Tetracyclines Teratogen

A

discolored teeth, inhibited bone growth

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31
Q

Thalidomide Teratogen

A

limb defects

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32
Q

Warfarin Teratogen

A

Bone and cartilage deformities, optic N atrophy, fetal cerebral hemorrhage

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33
Q

Alcohol Teratogen

A

Fetal alcohol syndrome
intellectual disability, microcephaly, facial abnormalities, limb dislocation, heart defects,
impaired migration of neuronal and glial cells

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34
Q

Cocaine Teratogen

A

low birth weight, preterm birth, IUGR, placental abruption

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35
Q

Smoking Teratogen

A

low birth weight, preterm labor, placental problems, IUGR, SIDS, ADHD

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36
Q

Iodine Teratogen

A

congenital goiter, or hypothyroidism

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37
Q

Maternal Diabetes

A

caudal regression syndrome, cardiac defects, neural tube defects, macrosomia, neonatal hypoglycemia, polycythemia

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38
Q

Methylmercury Teratogen

A

neurotox

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39
Q

Vitamin A excess Teratogen

A

high risk of spontaneous abortions and birth defects

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40
Q

X ray Teratogen

A

microcepahly, intellectual disability

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41
Q

Neonatal abstinence Syndrome

A

secondary to maternal substance use
uncoordinated sucking reflexes, irritability, high pitched crying, tremors, tachypnea, sneezing, diarrhea, seizures
T(x) opiate abuse: methadone, morphine, buprenorphine

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42
Q

Dizygotic twins

A

from 2 eggs that are separately fertilized by 2 sperm will have 2 separate amniotic sacs and 2 separate placentas

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43
Q

Monozygotic twins

A

from 1 fertilized egg that splits in early pregnancy
Cleavage 0-4 days –> separate placenta and amnion
Cleavage 4-8 days –> shared placenta
Cleavage 8-12 days –> shared amnion
Cleavage 13+ days –> shared body (conjoined)

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44
Q

Placenta

A

Primary site of nutrient and gas exchange between mother and fetus

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45
Q

Cytotrophoblast

A

inner layer of chorionic villi
makes cells
Fetal component of placenta

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46
Q

Synctiotrophoblast

A

Fetal Component of placenta

outer later of chorionic villi, synthesize and secrete hCG

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47
Q

Decidua Basalis

A

Maternal component of placenta

derived from endometrium. Maternal blood in lacunae

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48
Q

Umbilical cord

A

Artery and vein derived from allantois
2 umbilical arteries return deoxygenated blood from fetal internal iliac A to placenta
1 umbilical vein supplies oxygenated blood from placenta to fetus. Drains into IVE via liver or ductus venosus

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49
Q

Single umbilical artery

A

associated with congenital and chromosomal anomalies

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50
Q

Urachus

A

allantois forms from hindgut and extends into urogenital sinus.
Allantois –> urachus (duct between fetal bladder and umbilicus)
Failure to involute –> increase risk of infection and/or malignancy
obliterated urachus = umbilical L after birth

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51
Q

Patent Urachus

A

total failure of urachus to obliterate –> urine discharge from umbilicus

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52
Q

Urachal cyst

A

partial failure of urachus to obliterate, fluid filled cavity lined with uroepithelium between umbilicus and bladder.
Cyst can become infected and present as painful mass below umbilicus

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53
Q

Vesicourachal diverticulum

A

slight failure of urachus to obliterate –> outpouching bladder

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54
Q

Vitelline duct

A

7th week obliteration of vitelline duct (connect yolk sac to midgut lumen)

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55
Q

Vitelline Fistula

A

Vitelline duct fails to close –> meconium discharge from umbilicus

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56
Q

Meckel Diverticulum

A

Partial closure of vitelline duct, with patent portion attached to ileum
Asymptomatic, heterotopic gastric or pancreatic tissue –> melena, hematochezia, ab pain

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57
Q

1st Aortic arch

A

part of maxillary artery

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58
Q

2nd aortic arch

A

stapedial A and hyoid A

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59
Q

3rd Aortic arch

A

common carotid A and proximal Internal Carotid A

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60
Q

4th Aortic Arch

A

on left, aortic arch

on right, proximal part of right subclavian A

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61
Q

6th Aortic Arch

A

Proximal part of pulmonary A and ductus arteriosus (left)

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62
Q

Pharyngeal cleft derived from

A

ectoderm

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63
Q

Pharyngeal arches derived from

A

mesoderm and neural crest

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64
Q

Pharyngeal pouch derived from

A

endoderm

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65
Q

1st Pharyngeal cleft

A

external auditory meatus

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66
Q

2-4 pharyngeal cleft

A

temporary cervical sinuses. obliterated via proliferation of 2nd arch mesenchyme

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67
Q

Persistent cervical sinus

A

pharyngeal cleft cyst within lateral neck, anterior to SCM M

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68
Q

1st pharyngeal arch

A

Maxilla, zygomatic bone, mandible, Meckel cartilage, malleus, incus, sphenomandibular L
Muscles of mastication, mylohyoid, anterior belly of digastric, anterior tongue
CN V3

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69
Q

2nd Pharyngeal arch

A

Reichert cartilage, stapes, styloid, lesser horn of hyoid, stylohyoid L
Muscles of facial expression
CN VII

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70
Q

3rd Pharyngeal Arch

A

greater horn of hyoid
Stylopharyngeus
CN IX

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71
Q

4th and 6th pharyngeal arches

A

Arytenoids, cricoid, corniculate, cuneiform, thyroid
4th- pharyngeal constrictors, cricothyroid, levator veli palatini
Superior laryngeal Branch CNX
6th- intrinsic muscles of larynx except cricothyroid
Recurrent/inferior laryngeal branch CNX

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72
Q

Pierre Robin sequence

A

micrognathia, glossooptosis, cleft palate, airway obstruction

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73
Q

Treacher collins Syndrome

A

AD
Neural crest dysfunction
Craniofacial abnormalities, hearing loss, airway compromise

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74
Q

1st Pharyngeal pouch

A

middle ear cavity, eustachian tube, mastoid air cells

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75
Q

2nd pharyngeal pouch

A

epithelial lining of palatine tonsil

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76
Q

3rd pharyngeal pouch

A

dorsal wings –> inferior parathyroids

ventral wings –> thymus

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77
Q

4th pharyngeal pouch

A

dorsal wings –> superior parathyroids

ventral wings –> ultimopharyndeal body –> parafollicular cells of thyroid

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78
Q

Cleft lip

A

failure of fusion of maxillary and merged medial nasal processes

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79
Q

Cleft palate

A

failure of fusion of the two lateral palatine shelves or failure of fusion of lateral palatine shelf with the nasal septum and or primary palate

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80
Q

Female genital embryology

A

Default development. Mesonephric duct degenerates and paramesonephric duct develops

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81
Q

Male genital embryology

A

SRY gene on Y chromosome –> testes develop
Sertolli cells secrete Mullerian inhibitory factor –> suppresses development of paramesonephric duct
Leydig cells secrete androgens –> mesonephric ducts

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82
Q

Paramesonephric duct

A

Develops into female internal structures (fallopian tube, uterus, upper portion of vagina)

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83
Q

Mullerian agenesis

A

may present as primary amenorrhea in females with fuly developed secondary sexual characteristics

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84
Q

Mesonephric duct

A

develops into male internal structures (seminal vesicles, epididymis, ejaculatory duct, ductus deferens)
Female remnant = gartner duct

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85
Q

Absence of Sertoli cells or lack of MIF

A

develop both male and female internal genitalia and male external genitalia (streak gonads)

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86
Q

5a reductase deficiency

A

inability to convert testosterone into DHT –> male internal genitalia, ambiguous external genitalia until puberty

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87
Q

Septate uterus

A

incomplete resorption of septum
decreased fertility and early miscarriage
T(x) septoplasty

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88
Q

Bicornuate uterus

A

incomplete fusion of Mullerian ducts

increase risk of complicated pregnancy, early pregnancy loss, malpresentation, prematurity

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89
Q

Uterus didelphys

A

complete failure of fusion –> double uterus, cervix, vaginal
pregnancy possible

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90
Q

Genital tubercle

A

Male- glans penis and corpus cavernosum and spongiosum

Female- glans clitoris and vestibular bulbs

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91
Q

Urogenital sinus

A

Male- bulbourethral glands and prostate gland

Female- greater vestibular glands, urethral and paraurethral glands

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92
Q

Urogenital folds

A

Male- ventral shaft of penis

Female- labia minora

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93
Q

Labioscrotal swelling

A

Male- scrotum

Female- labia majora

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94
Q

Hypospadias

A

abnormal opening of the penile uretha on ventral surface of penis due to failure of urethral folds to fuse
Associated with inguinal hernia, cryptorchidism, chordee

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95
Q

Epispadias

A

Abnormal opening of the penile urethra on dorsal surface of penis due to faulty positioning of genital tubercle
Exstrophy of bladder is associated

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96
Q

Gubernaculum

A

Band of fibrous tissue
Male remnant- Anchors testes within scrotum
Female remnant- ovarian L and round L of uterus

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97
Q

Processus Vaginalis

A

Evagination of peritoneum
Male remnant- tunica vaginalis, persistent processus vaginalis –> hydrocele
Female remnant- obliterated

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98
Q

Gonadal Venous Drainage Right

A

Right ovary/testis –> right gonadal V –> IVC

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99
Q

Gonadal Venous Drainage Left

A

Left ovary/ testis –> left gonadal V –> left renal V –> IVC
Flow is less laminar on left so venous pressure is higher –> more likely varicocele

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100
Q

Gonadal Lymphatic Drainage Ovary/ Testis

A

para-aortic LN

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101
Q

Lymphatic drainage of body of uterus/cervix/superior bladder

A

External iliac nodes

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102
Q

Lymphatic drainage of prostate/cervix/corpus cavernosum/ proximal vagina

A

internal iliac nodes

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103
Q

Lymphatic drainage of distal vaginal/ vulva/ scrotum/ distal anus

A

superficial inguinal nodes

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104
Q

Lymphatic drainage of glans penis

A

deep inguinal nodes

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105
Q

Infundibulopelvic L

A

connects ovaries to lateral pelvic wall
contains ovarian vessels
At risk of injury during ligation of ovarian vessels

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106
Q

Cardinal L

A

connects cervix to side wall of pelvis
Contains uterine vessels
Ureter at risk of injury during ligations of uterine vessels in hysterectomy

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107
Q

Round L of uterus

A

Connects uterine horn to labia majora

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108
Q

Broad L

A

Connect uterus, fallopian tubes, and ovaries to pelvic side wall
Contains ovaries, fallopian tubes, round L of uterus
Comprises of mesosalpinx, mesometrium and mesovarium

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109
Q

Ovarian L

A

Connect medial pole of ovary to uterine horn
Derivative of gubernaculum
Latches to lateral uterus

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110
Q

Adenxal torsion

A

twisting of ovary and fallopian tube around infundibulopelvic L and ovarian L –> compression of ovarian vessels –> block lymphatics and venous outflow –> ovarian edema –> complete block of arterial inflow –> necrosis
Associated with ovarian masses
Acute pelvic pain, adnexal mass, nausea and vomiting

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111
Q

Sperm pathway for ejaculation

A 
Seminiferous tube
Epididymis
Vas deferens
Ejaculatory ducts
Urethra
Penis
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112
Q

Anterior Urethral injury

A

Spongy urethra via perineal straddle injury
Blood accumulates in scrotum
Blood at urethral meatus and scrotal hematoma

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113
Q

Posterior urethral injury

A

membranous urethra via pelvic fracture
urine leaks into retropubic space
blood at the urethral meatus and high riding prostate

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114
Q

Autonomic innervation of male sexual response

A

Erection- PNS (pelvic splanchnic, S2-S4)
NO –> increase cGMP –> vasodilate –> erection
NE –> increase Ca2+ –> smooth M contraction –> vasoconstriction –> no erection
Emission- SNS (hypogastric N T11-L2)
Expulsion- visceral and somatic nerves (pudendal N)

115
Q

Spermatogonia

A

maintain germ cell pool and produce primary spermatocytes
Line seminiferous tubules
Germ cells

116
Q

Sertoli cells

A

secrete inhibin B –> inhibit FSH
secrete androgen binding protein –> maintain testosterone
Produce MIF
Blood testis barrier
Nourish spermatozoa
High temp –> low sperm
Testosterone –>androsterone –> estrogen via aromatase

117
Q

Leydig Cells

A

Secrete testosterone in presence of LH
unaffected by temperature
Interstitium

118
Q

Spermatogenesis

A

Begins at puberty with spermatagonia
Full devlopment takes 2 months
Occurs in seminiferous tubules –> spermatids –> loss of cytoplasmic contents –> spermatozoa

119
Q

Tail mobility impaired sperm

A

ciliary dyskinesia or Kartagener syndrome

leads to infertility

120
Q

Tail mobility in CF

A

normal but absent vas deferens leads to infertility

121
Q

Estrogen source

A

ovary (17B estradiol), placental (estriol), adipose tissue (estrone)
Estradiol > estrone > estriol

122
Q

Estrogen Function

A

Develop genitalia and breast, female fat distribution
Growth of follicle, endometrial proliferation, increased myometrial excitability
Upregulate estrogen, LH, progesterone receptors
Inhibited by FSH and LH
stimulate prolactin secretion

123
Q

Progesterone

A

source: corpus luteum, placenta, adrenal cortex, testes
Prepare uterus for implantation of fertilized egg (luteal phase) - stimulate endometrial glandular secretions and spiral A development, produce thick mucus, prevent hyperplasia, increase body temp, decrease estrogen receptors, decrease LH and FSH
During pregnancy- maintains pregnancy, decrease myometrial excitability, decrease prolactin action
OVULATION

124
Q

Oogenesis

A

Primary oocyte begin meiosis I (fetal life) and complete meiosis I prior to ovulation- arrested in prophase 1 for years
Meiosis II arrested in metaphase II until fertilization (secondary oocyte)
Degenerate with not fertilized

125
Q

Ovulation

A

High estrogen, GnRH receptors on anterior pituitary –> LH surge –> ovulation
increase temperature due to progesterone

126
Q

Mittelschmerz

A

transient mid cycle ovulatory pain
associated with peritoneal irritation
Can mimic appendicitis

127
Q

Menstrual cycle

A

Follicular phase vary in length. Luteal phase =14 days, ovulation day + 14 days = menstruation
Follicular growth is fastest during 2nd week of follicular phase
estrogen stimulates endometrial proliferation
Progesterone maintains endometrium to support implantation
decrease progesterone –> decrease fertility

128
Q

Structural causes of abnormal uterine bleeding

A

Polyp
Adenomyosis
Leiomyoma
Malignany/hyperplasia

129
Q

Non structural causes of abnormal uterine bleeding

A 
Coagulopathy
Ovulatory
Endometrial
Iatrogenic
Not classified
130
Q

Most common place for fertilization

A

upper end of fallopian tubes

131
Q

Pregnancy

A

fertilization within 1 day of ovulation
Implant in uterus wall 6 days after fertilization- synctiotrophoblasts secrete hCG
high GFR –> low BUN, low glucosuria threshold
high CO –> high placental and uterus perfusion
Anemia
Hypercoagulability –> low blood loss
hyperventilation
increase lipolysis

132
Q

hCG

A

source: synctiotrophoblasts of placenta
maintain corpus luteum for 8-10 weeks (like LH)
After 8-10 weeks placenta makes its own estriol and progesterone
Identical a subunit as LH, FSH, TSH

133
Q

increase in hCG

A

multiple gestations, hytidaform moles

choriocarcinoma, down syndrome

134
Q

Decrease in hCG

A

ectopic/ failing pregnancy, edwards and patau syndrome

135
Q

Human placental lactogen

A

source: synctiotrophoblasts of placenta
stimulate insulin production
overall increase insulin resistance
gestational diabetes can occur if maternal pancreatic function cannot overcome the insulin resistance

136
Q

APGAR score

A

assessment of newborn vital signs after delivery
Appearance, Pulse, Grimace, Activity, Respiration
<7 –> further eval
if remains low –> increased risk the child will develop long term neuro damage

137
Q

Low birth weight

A

<2500g
caused by prematurity, intrauterine growth restriction
Associated with increased risk of SIDS and increase overall mortality

138
Q

Lactation

A

After delivery rapid decrease in progesterone disinhibits prolactin. Suckling required to maintain milk production and ejection
Prolactin- induce and maintain lactation and decrease reproductive function
Oxytocin- assists in milk letdown and uterine contraction

139
Q

Breast milk contains…

A

maternal IgA, macrophages, lymphocytes
Reduce infant infection and associated with low risk for child to develop asthma, allergies, DM, and obesity
Decreased maternal risk of breast and ovarian cancer
<6month infant

140
Q

Menopause

A

amenorrhea for 12 months
decrease estrogen production due to decline in number of ovarian follicles
Earlier in smokers
Preceded by 4-5 years of abnormal menstruation
HIGH FH, LH and GnRH
Hot flashes, atrophy of vagina, osteoporosis, CAD, sleep disturbance

141
Q

Testosterone

A 
testes
differentiation of epididymis, vas deferens, seminal vesicles
Growth spurt
Deep voice
close epiphyseal plates
libido
142
Q

DHT

A

testes
early- differentiation of penis, scrotum, prostate
Late- prostate growth, balding, sebaceous gland activity.

143
Q

Androgenic steroid abuse

A

abuse of anabolic steroids to increase fat free mass, muscle strength and performance
men with changes in behavior, ance, gynecomastia, high Hb and Hct, small testes
Women- virilization, acne, breast atrophy, male pattern baldness

144
Q

Tanner Stage 1

A

no sexual hair

Flat chest with raised nipple (female)

145
Q

Tanner Stage 2

A

Pubic hair appears
Testicular enlargement
Breast bud forms, mound forms

146
Q

Tanner Stage 3

A

Coarsening pubic hair
Penis size and length increase
Breast enlarges

147
Q

Tanner Stage 4

A

Coarse hair across pubis sparing thighs
penis width/ glas increase
breast enlarge, raised areola, mound on mound

148
Q

Tanner Stage 5

A

Coarse hair across pubis and medial thigh
penis and testis enlarge to adult size
Adult breast contour, areola flattens

149
Q

Precocious puberty

A

Secondary sexual characteristics before age 8 in girls and 9 in boys
High sex hormone exposure/ production –> increase linear growth, somatic and skeletal maturation

150
Q

Central Precocious Puberty

A

high GnRH secretion

idiopathic, CNS tumors

151
Q

Peripheral precocious Puberty

A

GnRH independent
high sex hormone production or exposure, congenital adrenal hyperplasia, estrogen secreting ovarian tumor, Leydig cell tumor, McCune Albright syndrome

152
Q

Klinefelter Syndrome

A

Male 47 XXY
testicular atrophy, eunuchoid body shape, tall, long extremities, gynecomastia, female hair distribution
Developmental delay
Infertility
Dysgenesis of seminiferous tubules –> low inhibin B –> high FSH
Abnormal Leydig cell function –> low testosterone –> high LH –> high estrogen

153
Q

Tuner Syndrome

A 
Female 45 XO
Short stature (SHOX gene), ovarian dysgenesis (streak ovary), shield chest, bicuspid aortic valve, coarctation of the aorta, lymphatic defects (webbed neck), horseshoe kidney
primary amenorrhea
Menopause before menarchy
low estrogen --> high LH and FSH
154
Q

Double Y males

A

47 XYY
Phenotypically normal
tall, normal fertility
associated with severe acne, learning disability, autism

155
Q

Ovotesticular disorder of Sex development

A

46 XX > 46 XY
both ovarian and testicular tissue present, ambiguous genitalia
hermaphroditism

156
Q

46 XX DSD

A

Ovaries present, external genitalia are virilized or ambiguous
Excessive inappropriate exposure to androgenic steroids in early gestation

157
Q

46 XY DSD

A

Testes present but external genitalia are female or ambiguous
via androgen insensitivity syndrome

158
Q

Placental Aromatase Deficiency

A

inability to synthesize estrogens from androgens.
Masculinization of female
high serum testosterone and androstenedione
Maternal virilization during pregnancy

159
Q

Androgen insensitivity Syndrome

A

Defect in androgen receptor resulting in normal appearing female
female external genitalia with scant axillary and pubic hair, rudimentary vagina, uterus and fallopian tubes absent
Normal functioning testes
high testosterone, estrogen and LH

160
Q

5a reductase deficiency

A

AR males
inability to convert testosterone to DHT
ambiguous genitalia until puberty
testosterone and estrogen normal, LH is normal or high, internal genitalia normal

161
Q

Kallmann Syndrome

A 
Failure to complete puberty
Hypogonadotropic hypogonadism
Defective migration of neurons and subsequent failure of olfactory bulbs to develop
low GnRH FHS LH testosterone
infertility
162
Q

Abruptio placentae

A

premature separation of placenta from uterine wall before delivery.
Risk factors- trauma, smoking, HTN, preeclampsia, cocaine abuse
abrupt, painful bleeding in third trimester, possible DIC, maternal shock, fetal distress

163
Q

Morbidly adherent placenta

A

defective decidual layer –> abnormal attachment and separation after delivery.
Risk factors- prior C section or uterine surgery
Detected US prior to delivery
complications: sheehans

164
Q

Placenta accreta

A

Morbidly adherent placenta
placenta attaches to myometrium without penetrating it
MOST COMMON

165
Q

Placenta increta

A

Morbidly adherent placenta

placenta penetrates into myometrium

166
Q

Placenta percreta

A

Morbidly adherent placenta

placenta penetrates through myometrium and into uterine serosa –> placental attachment to rectum or bladder

167
Q

Placenta previa

A

attachment of placenta over internal cervical os.
Risk: multiparity, prior C section
Associated with painless third trimester bleeding

168
Q

Vasa previa

A

fetal vessels run over cervical os –> vessel rupture, exsanguination, fetal death
Membrane rupture, painless vaginal bleeding, fetal brady
EMERGENCY C SECTION
Associated with velamentous umbilical cord insertion

169
Q

Pospartum Hemorrhage

A 
low tone of uterus
Trauma
Coagulopathy
Retained products of conception
T(x): uterine massage, oxytocin, surgical ligation of uterine or internal iliac A
170
Q

Ectopic pregnancy

A

implant of fertilized ovum in a site other than uterus (ampulla)
Suspect with history of amenorrhea, lower than expected hCG, sudden lower ab pain
confirm with US
Risk factors: prior ectopic preg, history of infertility, salpingitis, ruptured appendix, prior tubal surgery, smoking, advanced maternal age

171
Q

Polyhydramnios

A

too much amniotic fluid
idiopathic
Associated with fetal malformations (esophageal atresia, anencephaly), maternal DM, fetal anemia, multiple gestations

172
Q

Oligohydramnios

A

too little amniotic fluid
Associated with placental insufficiency, bilateral renal agenesis, posterior urethral valves.
Cause potter sequence

173
Q

Hydatidiform mole

A

Cystic swelling of chorionic villi and proliferation of chorionic epithelium
Presents with vaginal bleeding, emesis, uterine enlargement, pelvic pressure
Associated with hCG mediated sequelae- early pre-eclampsia, theca lutein cysts, hyperemesis gavidaram, hyperthyroidism

174
Q

Complete mole

A 
46 XX 46 XY
enucleated egg + single sperm
Hydropic villi, circumferential and diffuse trophoblastic proliferation
No fetal parts
(-) p57 protein
increase uterine size
HIGH hCG
honeycombed uterus
175
Q

Partial mole

A 
69 XXX, 69 XXY, 69 XYY
2 sperm + 1 egg
some vili are hydropic, focal trophoblastic proliferation
Yes fetal parts
(+) p57 protein
increased hCG
176
Q

Choriocarcinoma

A

rare
can develop during or after pregnancy in mom or baby
Malignancy of trophoblastic tissue
no choionic villi present, high frequency of bilateral theca lutein cysts
high hCG, SOB, hemoptysis
Hematogenous spread to lungs
T(x): MTX

177
Q

Gestational HTN

A

BP > 140/90 after 20th week
no pre-existing HTN
No proteinuria or end organ damage
T(x): Hydralazine, a methyldopa, labetolol, Nifedipine

178
Q

Pre ecalmpsia

A

New onset HTN with proteinuria or end organ damage after 20th week
Caused by abnormal placental spiral A –> endothelial dysfunction, vasoconstriction, ischemia
Increased incidence in patients with pre-existing HTN, DM, CKD, autoimmune disorders, >40years
Complications: placental abruption, coagulopathy, renal failure, pulmonary edema,
T(x): anti- HTN and IV Mg

179
Q

Eclampsia

A

preeclampsia + maternal seizures
Maternal death due to stroke, intracranial hemorrhage or ARDS
T(x): immediate delivery

180
Q

Gynecologic tumor

A

Endometrial > ovarian > cervical

Prognosis: cervical > endometrial > ovarian

181
Q

Bartholin cyst and abscess

A

Non neoplastic
via blockage of batholin gland duct –> accumulation of fluid
May lead to abscess
Reproductive age females

182
Q

Lichen sclerosus

A

Non neoplastic
thinning of epidermis with fibrosis/sclerosis of dermis
Presents with porcelain white plaques with red/violet border
Skin fragility with erosions can be observed
Most common in postmenopausal women
slight increase risk of SCC`

183
Q

Lichen simplex chronicus

A

Non neoplastic
Hyperplasia of vulvar squamous epithelium
leathery, thick skin with enhanced skin markings due to chronic rubbing or scratching

184
Q

Vulvar Carcinoma

A

Squamous epithelium linking vulva
leukoplakia
HPV 16 and 18
Risk: multiple partners, early coitarche

185
Q

Extramammary Paget Disease

A

Intraepithelial adenocarcinoma
CIS- low risk of underlying carcinoma
Pruritis, erythema, ulcers

186
Q

Imperforate Hymen

A

incomplete degeneration of central portion of hymen
Accumulation of vaginal mucus at birth –> self resolving bulge in introitus
untreated –> primary amenorrhea, cyclic ab pain, hematocolpos

187
Q

Vaginal SCC

A

secondary to cervical SCC

188
Q

Clear cell adenocarcinoma

A

women exposed to DES in utero

189
Q

Sarcoma botryoides

A

embryonal rhabdomyosarcoma variant
Affects girls <4 years
spindle shaped cells desmin +
clear grape like polypoid mass emerging from vagina

190
Q

Cervical dysplasia and CIS

A

disordered epithelial growth - basal layer of squamocolumnar junction and extends out
Associated with HPV 16 and 18
Koilocytes
asymptomatic or abnormal vaginal bleeding
Risk: multiple sexual partners, HPV, smoking, early coitarche, DES exposure, immunocompromise

191
Q

Cervical Invasive Carcinoma

A

SCC
pap smear can detect dysplasia
Lateral invasion can block ureters –> hydronephrosis –> renal failure

192
Q

Primary ovarian insufficiency

A

premature ovarian failure
Premature atresia of ovarian follicles in women of reproductive age.
Idiopathic associated with chromosomal abnormalities, autoimmunity
Need karyotype screening
patients present with signs of menopause after puberty but before age of 40
low estrogen, high LH and FSH

193
Q

Most common cause of anovolulation

A

pregnancy, polycystic ovarian syndrome, obesity, HPO axis abnormalities, premature ovarian failure, hyperprolactinemia, thyroid disease, eating disorder, competitive athletics, cushing, adrenal insufficiency, Turners

194
Q

Functional hypothalamic amenorrhea

A

Severe caloric restriction, high energy expenditure, stress –> functional disruption of pulsatile GnRH –> low LH and FSH, estrogen.
Low leptin and high cortisol
Associated with eating disorders and female athlete

195
Q

PCOS

A

Hyperinsulinemia/ insulin resistance alter hypothalamic hormonal feedback response –> high LH:FSH, high androgens
low fertility in women
Enlarged BILATERAL cystic ovaries
Amenorrhea, hirsutisn, acne
Associated with obesity, acanthosis nigricans
Increased risk of endometrial cancer
T(x): weight reduction, OCPs, clomiphene, spironolactone, finasteride, flutamide

196
Q

Primary dysmenorrhea

A

painful menses caused by uterine contraction to decrease blood loss –> ischemic pain
Mediated by prostaglandins
T(x): NSAIDs

197
Q

Follicular cyst

A

Distention of unruptured Grafian follicle
May be associated with hyperestrogenemia, endometrial hyperplasia
Most common in young women

198
Q

Theca lutein cyst

A

bilateral/multiple
Due to gonadotropin stimulation
Associated with choriocarcinoma and hydatidiform moles

199
Q

Ovarian Neoplasms

A

Adnexal mass in >55 years
Ab distention, bowel obstruction, pleural effusion
Risk increase with age, infertility, endometriosis, PCOS, genetic (BRCA1/2)
Risk decrease with previous pregnancy, Hx breastfeeding, OCPs, tubal ligation
Epithelial = (more serious) bilateral, lined with serous or mucinous epithelium.
CA125
Germ cell tumors –> somatic structure or extra embryonic
Sex cord tumors –> embryonal sex cord

200
Q

Serous cystadenoma

A

Epithelial
Benign
Most common

201
Q

Serous cystadenocarcinoma

A

Epithelium
Malignancy
Most common
Psammoma bodies

202
Q

Mucinous cystadenoma

A

Epithelial
Benign
Multiloculated, large
lined by mucous secreting epithelium

203
Q

Mucinous Cystadenocarcinoma

A 
Malignancy
Rare
Epithelial
Metastasize from appendiceal or GI
Pseudomyoma peritonei
204
Q

Brenner Tumor

A

Epithelial
Benign
solid, pale yellow tan tumor that is encapsulated
Coffee bean nuclei

205
Q

Dysgerminoma

A 
Germ cell tumor
Malignant
most common in adolescents
Sheets of uniform fried egg cells
increase hCG, LDH
206
Q

Mature cystic teratoma

A

Germ cell tumor
Benign
Most common in young females
cystic mass with elements of all 3 germ layers
May be painful secondary to ovarian enlargement/torsion

207
Q

Immature Teratoma

A 
Germ cell tumor
Malignant, aggressive
contains fetal tissue, neuroectoderm
<20 years
immature, embryonic like neural tissue
208
Q

Yolk sac tumor

A 
Malignant
Germ cell tumor
in ovaries and sacrococcygeal area in children
yellow, firable mass
Schiller Duval bodies
high AFP
209
Q

Thecoma

A

Benign
Sex cord stromal tumor
may produce estrogen
abnormal uterine bleeding in postemenopausal women

210
Q

Granulosa cell tumor

A 
Sex cord stromal tumor
Malignant
Women in 50s 
produce estrogen/ progesterone
postmenopausal bleeding, endometrial hyperplasia, sexual precocity, breast tenderness
Call Exner bodies
211
Q

Sertoli Leydig cell tumor

A

Sex cord stromal tumor
Benign
small grey to yellow broun mass
produce estrogen –> virilization

212
Q

Fibromas

A 
Sex cord stromal tumor
Benign
bundles of spindle shaped fibroblasts
Meigs syndrome (ovarian fibroma, ascites, pleural effusion)
pulling sensation in groin
213
Q

Adenomyosis

A

Extension of endometrial tissue into uterine myometrium
via hyperplasia of basal layer of endometrium
dysmenorrhea, AUB/HMB, enlarged, soft globular uterus
T(x): GnRH antagonists, hysterectomy, excision of an organized adenomyoma

214
Q

Asherman syndrome

A

Adhesions and/or fibrosis of the endometrium
low fertility, recurrent pregnancy loss, AUB, pelvic pain
Associated with dilation and curettage of intrauterine cavity

215
Q

Endometrial hyperplasia

A

abnormal enodmetrial gland proliferation stimulated by excess estrogen
High risk of endometrial carcinoma
Postmenopausal vaginal bleeding, high risk of anovulatory cycles, hormone replacement therapy, PCOS, granulosa cell tumors

216
Q

Endometriosis

A

Endometrium like glands/stroma outside endometrial cavity
May be due to retrograde flow, metaplastic transformation of multipotent cells, transportations of endometrial tissue via lymphatic system
Cyclic pelvic pain, bleeding, dysmenorrhea, dysparemia, dyschezia, infertility, normal sized uterus
T(x): NSAIDs, OCPs, progestin, GnRH agonists, danazol, laparoscopic removal.

217
Q

Endometritis

A

Inflammation associated with retained products of conception after delivery, miscarriage, abortion or with foreign body
Chronic = plasma cells on histo
T(x): gentamicin, clindamycin, ampicillin

218
Q

Endometrial Carcinoma

A

Irregular vaginal bleeding
Endmetrioid: unopposed estrogen exposure due to obesity, early menarche, late menopause, nulliparity. Abnormally arranged endometrial glands. loss of PTEN or mismatch repair proteins
Serous: associated with endometrial atrophy in postmenopausal women. Aggressive, Psammoma bodies. Formation of papillae and tufts

219
Q

Leiomyoma

A

multiple discrete tumors
high incidence in AA
benign smooth muscle tumor, malignant transformation is rare
Estrogen sensitive- tumor size increase in pregnancy and decrease with menopause
20-40
Asymptomatic, AUB or miscarriage
Severe bleeding –> Fe deficient anemia
Whorled pattern of smooth muscle bundles with borders

220
Q

Leiomyosarcoma

A

Malignant proliferation of smooth muscle arising from myometrium
Arises de novo
postmenopausal women
single lesion with area of necrosis

221
Q

Fibrocystic changes in Breast

A

Postmenopausal women 20-50 years
premenstrual breast pain or lumps, bilateral or mulifocal
Nonproliferatice lesions (simple cysts, papillary apocrine, stromal fibrosis)
risk of cancer not increased

222
Q

Sclerosing stroma

A

Fibrocystic changes in Breast
acini and stromal fibrosis associated with calcifications
slight increase risk for cancer

223
Q

Eptithelial Hyperplasia

A

Fibrocystic changes in Breast
cells in terminal ductal or lobular epithelium
increase risk of carcinoma with atypical cells

224
Q

Inflammatory Breast Disease

A

Fat necrosis: benign, usually painless, lump due to injury to breast tissue. Calcified oil cyst on mammography, necrotic fat and giant cells on biopsy
Lactational mastitis: during breast feeing, increased risk of bacterial infection through cracks in nipple (s. aureus)
T(x) Abx and continue breastfeeding

225
Q

Breast Fibroadenoma

A 
<35 
Benign
small well defined mobile mass
Fibrous tissue and glands
increased size and tenderness with high estrogen
226
Q

Breast intraductal papilloma

A

Benign
small fibroepithelial tumor within lactiferous ducts, beneath areola
nipple discharge

227
Q

Phyllodes Tumor Breast

A

Benign
large mass of connective tissue and cyst with leaf like lobulations
5th decade
May become malignant

228
Q

Gynecomastia

A

Breast enlargement in males due to high estrogen. Physiologic in newborn, pubertal and elderly
cirrhosis, hypogonadism and drugs also cause

229
Q

Breast cancer

A

Postmenopausal
palpable hard mass in upper outer quadrant
can be fixed to pectoral M, deep fascia, Cooper L and skin –> nipple retraction/ skin dimpling
HER2 overexpression
increase risk with age, Hx atypical hyperplasia, FMHx, white, BRCA1/2 mutation, high estrogen exposure, postmenopausal obesity, high total number of menstrual cycles, no breastfeeding, alcohol
Men: BRA 2 mutation, Klinefelter
Axillary LN metastasis is prognostic factor

230
Q

Ductal carcinoma in situ

A

Fills ductal lumen
Arise from ductal atypia
microcalcifications on mammography

231
Q

Comedocarcinoma

A

subtype of ductal CIS

Cells have high grade nuclei with extensive central necrosis and dystrophic calcifications.

232
Q

Paget Disease

A 
Extension of DCIS/ invasive breast cancer up the lactiferous ducts and into the contiguous skin of nipple--> eczematous patches over nipple and areolar skin
Paget cells (intraepithelial adenocarcinoma cells
233
Q

Lobular CIS

A

low E- cadherin expression
No mass or calcifications –> incidental biopsy finding
increased risk of cancer in either breast

234
Q

Invasive ductal carcinoma Breast

A

Firm, fibrous, rock hard mass with sharp margins and small glandular duct like cells in desmoplastic stroma

235
Q

Invasive lobular Carcinoma Breast

A

low E cadherin expression –> orderly row of cells and no duct formation
bilateral with multiple lesions in the same location

236
Q

Medullary Invasive Carcinoma Breast

A

large, anaplastic cells growing in sheets with associated lymphocytes and plasma cells
well circumscribed tumor

237
Q

Inflammatory invasive carcinoma breast

A

Dermal lymphatic space invasion –> breast pain with warm, swollen, erythematous skin around exaggerated hair follicles, peau d’orange
poor prognosis
lack palpable mass

238
Q

Peyronie Disease

A

Abnormal curvature of penis due to fibrous plaque within tunica albicans
Cause pain and anxiety
Surgical repair or treat with collagenase injections

239
Q

Ischemic priapism

A

painful sustained erection lasting >4 hours
Associated with SCD, meds
Treat immediately with corporal aspiration, intracavernosal phenylephrine, surgical decompression

240
Q

SCC of penis

A

Precursor in situ lesion: Bowen disease (leukoplakia), erythroplasia of Queyrate, Bowenoid papulosis
Associated with uncircumscribed males and HPV

241
Q

Cyptorchidism

A

Descent failure of one or both testes
impaired spermatogenesis, can have normal testosterone
associated with high risk of germ cell tumors
Prematurity increase risk
low inhibin B, high FSH and LH, low testosterone in bilateral
resolve spontaneously or orchiopexy before 2 years

242
Q

Testicular torsion

A

rotation of testicle around spermatic cord and vascular pedicle
12-18 years
occur after inciting event
acute, severe pain, high riding testis and absent cremasteric reflex
T(x): surgery within 6 hours, manual detorsion

243
Q

Varicocele

A

Dilated veins in pampiniform plexus due to high venous pressure
scrotal enlargement
left side more often due to increase resistance from L gonadal vein drainage into L renal V
can cause infertility due to high temp
Bag of worms
T(x): surgical ligation or embolization

244
Q

Extragonadal germ cell tumor

A

Arise midline
retroperitoneum, mediastinum, pineal and suprasellar regions (adults)
sacrococcydeal teratoma (children)

245
Q

Scrotal masses

A

benign scrotal lesion present as testicular masses that can be transilluminated

246
Q

Congenital hydrocele

A

incomplete obliteration of processus vaginalis

spontaneously resolve within 1 year

247
Q

Acquired hydrocele

A

Scrotal fluid collection usually secondary to infection, trauma, tumor

248
Q

Spermatocele

A

cyst due to dilated epididymal duct or rete testis

Paratesticular fluctuant nodule.

249
Q

Testicular tumors

A

Germ cell tumors (that produce sperm)
young men
increase risk with cryptorchidism, Klinefelter
Does NOT transilluminate
Sex Cord stromal tumors develop from embryonic sex cord. Benign

250
Q

Seminoma

A

Germ Cell Tumor
Malignant
painless, homogenous testicular enlargement.
Large cells in lobules with watery cytoplasm and fried egg appearance
high ALP
Radiosensitive
GREAT PROGNOSIS

251
Q

Teratoma Testicular

A

Germ cell tumor
may be malignant
Benign in children

252
Q

Testicular Embryonal Carcinoma

A 
Germ cell tumor
malignant
painful hemorrhagic mass with necrosis
high hCG, normal AFP
Worse prognosis than seminoma
253
Q

Yolk sac tumor Testicular

A 
Germ Cell Tumor
Malignant aggressive
yellpw, mucinous
Schiller Duval bodies
high AFP
<3 years
254
Q

Choriocarcinoma

A 
Germ cell tumor
Malignant
Disordered synctiotrophoblastic and cytotrophoblastic elements
Hematogenous spread to lungs and brain
high hCG
255
Q

Sertoli cell tumor

A

Benign

androblastoma from sex cord and stroma

256
Q

Leydig cell tumor

A

Benign
golden brown, contains Reinke crystals
produce androgens or estrogens –> gynecomastia in men, precocious puberty in boys

257
Q

Testicular lymphoma

A

malignant
older men
arises from metastatic lymphoma in testes

258
Q

Organisms that cause epididymitis and orchitis

A

C trachomatis, N gonorrhea (young men)
E coli and Pseudomonas (elderly, UTI, BPH)
Autoimmune

259
Q

Epididymitis

A

inflammation
localized pain and tenderness over posterior testis
Prehn sign +

260
Q

Orchitis

A

testicular pain and swelling

mumps orchitis increase infertility risk

261
Q

BPH

A

> 50
smooth elastic firm nodular enlargement of periurethral lobes –> compress urethra into vertical slit
increase frequency, nocturia, difficulty starting and stopping urine
May lead to distention and hypertrophy of bladder, hydronephrosis, UTI, high PSA
T(x): a1 antagonisms, 5a reductase inhibitors, PDE5 inhibitor

262
Q

Prostatitis

A

Dysuria, frequency, low back pain
Warm tender enlarged prostate
Acute bacterial: old men, E coli. young men, C trachomatis, N gonorrheae
Chronic- bacterial or nonbacterial,

263
Q

Prostatic adenocarcinoma

A

> 50
posterior lobe of prostate gland
high PSA
osteoblastic metastases in bone and high ALP in late stage
Metastasis to spine via Batson venous Plexus

264
Q

Goserelin, leuprolide

A 
GnRH analogs (pulsatile --> GnRH agonist, continuous --> GnRH antagonist)
Used in uterine fibroids, endometriosis, precocious puberty, prostate cancer, infertility. 
Adverse: hypogonadism, decreased libido, ED, nausea and vomiting
265
Q

Degarelix

A

GnRH antagonist
use for Prostate cancer
Adverse: Hot flashes, liver tox

266
Q

Estrogens

A

Ethinyl estradiol, DES, mestranol
Bind estrogen receptors
use in hypogonadism or ovarian failure, menstrual abnormalities, hormone replacement in postmen
Adverse: increase risk of endometrial cancer, bleeding in postmen. clear cell adenocarcinoma of vagina, increase risk thrombi
contra: ER + breast cancer, Hx DVT, tobacco >35 year old.

267
Q

Clomiphene

A

Antagonist of estrogen receptor in hypothalamus
Prevent normal feedback inhibition and increase LH and FSH –> ovulation
Used to treat infertility due to anovulation
Cause hot flashes, ovarian enlargement, multiple simultaneous pregnancies, visual disturbances

268
Q

Tamoxifen

A

Antagonist of estrogen at breast and agonist at bone and uterus
increase risk of thromboembolic event and endometrial cancer
used to treat and prevent recurrence of ER/PR + breast cancer

269
Q

Raloxifene

A

Antagonist of estrogen at breast, uterus and agonist at bone
increase risk of thromboembolic event
treat osteoporosis

270
Q

Aromatase inhibitors

A

Anastrozole, letrozole, exemestane
Inhibit peripheral conversion of androgens to estrogen
used in ER + breast cancer in postmen

271
Q

Hormone Replacement Therapy

A

Used for relief or prevention of menopausal symptoms, osteoporosis
Unopposed estrogen replacement therapy increase risk of endometrial cancer, progesterone is added. increased CV risk

272
Q

Progestins

A

Levonorgestrel, medroxyprogesterone, etonogestrel, norethindonre, megestrol
Bind progesterone receptor, decrease growth and increase vascularization of endometrium, thicken cervical mucus
Use for contraception , endometiral cancer, abnormal uterine bleeding, chronic anolvulation without estrogen

273
Q

Antiprogestins

A

Mifepristone, ulipristal
Competitive inhibitor
Used to terminate pregnancy, emergency contraceptive

274
Q

Combine contraception

A

Progestins and ethinyl estradiol
Estrogen and progestins inhibit Lh/FSH –> prevent estrogen surge –> no ovulation
Progestins –> thicken cervical mucus and inhibit endometrial proliferation –> limit sperm access and implantation of embryo
Adverse: menstrual bleeding, breast tenderness, VTE, hepatic adenoma
Contra: smokes > 35 years, CV disease, breast cancer, liver disease

275
Q

Copper intrauterine device

A

produce local inflammatory reaction toxic to sperm and ova, prevent fertilization and implantation, hormone free
used for long lasting reversible contraception, most effective emergency contraception
Adverse: heavy menses, dysmenorrhea, risk of PID with insertion

276
Q

Tocolytics

A

medication that relax the uterus
Terbutaline, nifedipine, indomethacin
used to decrease contraction frequency in preterm labor and allow time for administration of steroids

277
Q

Danazol

A

Synthetic androgen that acts as partial agonist at androgen receptor
used for endometriosis, hereditary angioedema
Adverse: weight gain, edema, acne, hirsutism, masculinization, low HDL, hepatotox, idiopathic intracranial HTN

278
Q

Testosterone, methyltestosterone

A

Agonist at androgen receptor
Treat hypogonadism and promote secondary sex characteristics, stimulate anabolism to promote recovery after burn
Adverse: masculinization, low intratesticular testosterone –> gonadal atrophy. Premature closure of epiphyseal plates. High LDL, low HDL

279
Q

Finasteride

A

Antiandrogen
5a reductase inhibitor
used for BPH and male pattern baldness
Adverse: gynecomastia and sexual dysfunction

280
Q

Flutamine, bicalutamide, apalutamide, enzalutamide

A

nonsteroidal competitive inhibitor at androgen receptor

used for prostate carcinoma

281
Q

Ketoconazole

A

Inhibit steroid synthesis

282
Q

Spironolactone

A

inhibit steroid binding

283
Q

Tamsulosin

A

a1 antagonist used to treat BPHby inhibiting smooth M contraction
Selective a1A/D receptors

284
Q

Minoxidil

A

Direct arteriolar vasodilator

used for Androgenetic alopecia , severe refractory HTN

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