Reproductive System - UWorld Flashcards
What takes over the role of estrogen and progesterone secretion after the corpus luteum regresses around week 10?
Estrogen - fetal adrenal gland
Progesterone - placenta
Hormones involved in the pathogenesis of PCOS
High insulin -> high LH:FSH (>3) -> high androgens -> hirsutism and anovulation
What hormones result in involution of the paramesonephric (Mullerian) ducts, development of the mesonephric (Wolffian ducts) and male external genitalia?
MIH = paramesonephric duct involution Testosterone = Wolffian duct formation (seminal vesicles, epididymus, ejaculatory duct and ductus deferens) DHT = development of external genitalia
Etiologies of polyhydramnios
GI tract obstruction
Anencephaly
High fetal cardiac output -> increased urination
Immunochemistry in complete vs. incomplete molar pregnancy
Complete = p57-negative Incomplete = p57-positive
Mifepristone mechanism of action
Anti-progesterone drug that causes necrosis and sloughing of the decidual layer
Immigrant mom has joint pains and a rash on her neck that spread to her extremities while pregnant. Exam reveals posterior auricular and sub occipital lymphadenopathy. What conditions might the fetus have at birth?
She has rubella and likely did not receive the live-attenuated MMR vaccine prior to pregnancy. Congenital rubella syndrome consists of cataracts, cardiac defects (PDA) and sensorineural deafness.
Regions of the male urethra
Posterior urethra: prostatic and membranous segments
Anterior urethra: bulbous and penile segments
Ligament that contains the ovarian artery, vein, lymphatics and nerve
Suspensory ligament of the ovary (i.e. tubuloinfundibular ligament)
Ligament that contains the uterine artery
Cardinal ligament (i.e. transverse cervical ligament)
Degrees of vaginal tearing with birth
1st = through superficial skin + mucosa 2nd = through perineal body 3rd = through external/internal anal sphincter 4th = through rectal mucosa
Levator ani muscles
Ileococcygeus and pubococcygeus
Hormones that act on the ovary
LH -> theca interna -> progesterone and androgen synthesis
FSH -> granulosa cells -> aromatization of androgen to estradiol
Why does hCG work to induce ovulation
It has a similar alpha-subunit as LH, FSH and TSH. The similarity to LH induces follicle rupture from the ovary.
Vaginitis with normal pH
Candidiasis.
Trichomoniasis and bacterial vaginosis have higher pHs
Most common cause of Turner syndrome. Why do they have short stature?
Paternal non-disjunction of the X chromosome during meiosis II, resulting in 45XO phenotype in almost all cells. Patients will have short stature due to loss of SHOX gene, which promotes long bone growth.
Differentiating primary ciliary dyskinesia from cystic fibrosis
Primary ciliary dyskinesia may have situs inversus and immotile sperm due to defect in dyenin arm.
CF may have pancreatitis and absent vas deferens
Which syphilis tests can you use to track response to anti-treponemal therapy?
RPR and VDRL test for presence of cardiolipin, a byproduct of T. palladium infection. FTA-ABS tests for antibodies against treponemal antigens that remain positive for life.
Cancers associated with trisomy 21
AML-M7 and ALL as children
Hormone levels in Klinefelter syndrome
Hyalinization and fibrosis of seminiferous tubules -> non-functioning Sertoli cells -> increased FSH
Leydig cell dysfunction -> low testosterone -> increased LH
Gonadal arteries originate from…
Aorta, below renal arteries
Mayer-Rokitansky-Kuster-Hauser syndrome. Next think to check for when you make this diagnosis?
Blind vaginal pouch originates from urogenital sinus and absent uterus due to Mullerian (paramesonephric) agenesis. The next think you should do is a renal ultrasound because 50% of these patients may have a co-existing renal abnormality like renal agenesis.
Post-op patient with scrotal and medial thigh numbness after pelvic surgery
Injury to the genitofemoral nerve, most commonly due to retraction against the nerve as it lies on the psoas muscle
Nerve at high risk for injury during Pfannensteil incision C-section.
Iliohypogastric nerve innervates the suprapubic skin and lies near the site of incision
Loss of medial thigh sensation and ability to abduct after retroperitoneal lymph node dissection
Obturator nerve injury
Definition of primary amenorrhea
No menses or secondary sex characteristics by 13
No menses with secondary sex characteristics by 15
Mechanism for gestational hyperglycemia
Increasing levels of hPL secreted by the syncytiotrophoblasts results in increased insulin resistance, increased insulin release, increased maternal proteolysis and lipolysis. GDM occurs when the pancreas cannot secrete enough insulin to keep up with the increased blood glucose levels.
Most common type of ovarian germ cell tumor
Mature teratoma
Conditions associated with increased and decreased maternal serum AFP
Increased: multiple gestations, open neural tube defects and abdominal wall defects
Decreased: aneuploidy. Trisomy 21 will also have low E2, increased inhibin A and increased beta-hCG
How can a translocation cause Down syndrome?
Translocation of both long arms of chromosome 21 to chromosome 14 with a single normal 21 chromosome results in three chromosome 21s.
Common presentation of a gonadotrophic pituitary adenoma
Mass effect, the alpha-subunit of FSH and LH are typically inactive
Most common cause of an elevated AFP
Dating error
How does the date of separation determine the placenta and amnion status in monozygotic twinning
Days 0-4 = di, di
Days 4-8 = monochorionic diamniotic
Days 8-12 = monochorionic, mono amniotic
> 13 days = conjoined
Painful genital ulcer with:
A) Gray-yellow exudate, organisms clumped in long parallel strands like a school of fish
B) Multinucleate giant cells and intracytoplasmic inclusions
Painless genital ulcer with:
C) Extensive and progressive lesions with deeply staining gram-negative intracytoplasmic inclusions cysts and granulation tissue
D) Clean erythematous base with thin, delicate, corkscrew organisms on dark field microscopy
E) Small, shallow rapidly healing ulcers with intracytoplasmic inclusion bodies in epithelial cells and leukocytes
A) Chancroid B) Genital herpes C) K. inguinale (donoviasis) D) Syphilis E) Lymphogranuloma venereum
Antibiotic that can cause a disulfiram-like reaction when taken with alcohol
Metronidazole
Why might a patient with a germ cell tumor present with paraneoplastic hyperthyroidism?
beta-hCG has the same alpha subunit as TSH, LH and FSH and can bind to TSH receptors and cause symptoms of hyperthyroidism
Genes that predispose patients to pheochromocytoma
VHL, RET1 and NF1
Treatment of Graves’ ophthalmopathy
High dose steroids to reduce Th1-mediated fibroblast stimulation
Lymph node drainage from the testes? Glans and posterior superficial calves? Scrotum?
Testes = para-aortic
Glans and posterior calf = deep inguinal
Scrotum = superficial inguinal
Why preserve the prostatic shell in a patient undergoing prostatectomy?
The inferior hypogastric plexus gives off the prostatic parasympathetic nerve plexus in the prostatic fascia. The greater and lesser cavernous nerves exit the prostatic fascia to innervate the corpora cavernosa and are the nerves involved in erection.
Invasive mole vs. gestational choriocarcinoma
Invasive mole has diffusely hyper plastic trophoblasts invading the myometrium as chorionic villi
Choriocarcinoma has anaplastic and necrotic trophoblasts invading blood vessels and no chorionic villi
