Reproductive + Urogenital Flashcards
Functional Hypothalamic Amenorrhea
what is it? causes? complications?
a SECONDARY amenorrhea due to LOW LEPTIN via low adipose tissue
causes: excess weight loss, exercise, chronic illness and eating disorders
decr. leptin > decr. pulsatile GnRH secretion > decr. FSH/LH > low estrogen
also causes OSTEOPOROSIS
Granulosa Cell Tumor
type, histo (2 special features)
macro - color, size, location
sex cord stromal tumor
cuboidal cells in sheets/cords with COFFEE-BEAN nuclei and CALL-EXNER BODIES (follicle/rosette-like) with pink center
high lipid content = YELLOW/firm macro
mostly unilateral + large in post-menopausal women (but can cause precocious puberty in young pt)
Small underdeveloped ovaries primarily composed of CT with no follicles.
What is this, what disease is it assoc. with + what are the other features?
“Streak ovaries” ofTurner Syndrome
45, X- lack of paternal X causes loss of ovarian follicles by age 2 > high FSH and LH
withamenorrheaandinfertility
short stature, shield chest, webbed neck, low posterior hairline
lymphedema,bicuspid aortic valve(25%) oraortic coarctation(5%)
Newborn girl with posterior neck mass, bilateral nonpitting edema of hands and feet, diminished femoral pulse.
Neck US > cystic spaces separated by CT
What is the mass, why is it there, what causes the condition + explain other findings?
Turner syndrome
45, X due to loss of paternal X
cystic hygromaon neck due to abnormal lymph flow
edema common to Turner’s, diminished femoral pulse due toaorctic coarcation(2nd commonest CV abn in Turner’s after bicuspid aortic valve)
14 yr old with soft, hyperpigmented non-tender bump below rt breast; has always been there, but got bigger at puberty; becomes tender just before menses
what is it?
accessory nippleAKApolythelia / supernumerary nipple
failed involution ofmammary ridge; histo same as normal nipple; may swell / be tender during menses, pregnancy or lactation
Spina bifida - type of inheritance?
Multifactorial
- many genesplay role in neurulation; folic acid deficiency is major factor
- common in first-degree relatives of those affected
1 cause of pathological
physiological vs. patho nipple discharge
1 =intraductal papilloma- usually no mass or skin change, bloody/serosanguinous dischargeunilaterally due to proliferation of papillary cells in duct/cyst wall withfibrovascularcore (twisting of stalk > bleed), with foci of atypia orductal carcinoma in situ
physio = bilateral, nonbloody / milky without masses or skin changes
patho = bloody or serosanguinous w/ or w/o mass or skin change
Differential dx of abnormal menstrual bleeding
3 diagnoses + their features
Fibroids - heavy menses; constipation, polyuria, pelvic pain/heaviness; ENLARGED uterus
Adenomyosis - dysmenorrhea, pelvic pain; heavy menses; “bulky, globular + tender uterus” (endometrial tissue in myometrium)
Endometrial cancer/hyperplasia - history of obesity, nulliparity, chronic anovulation; irregular, intermenstrual or postmenopausal bleed; NONTENDER uterus
Endometriosis
risk factors? protective factors?
Risk - nulliparity, early menarche or prolonged menses
Protective - multiparity, extended lactation, late menarche
less frequent menstrual cycles > less opportunity for endometrium to disseminate out of uterus
Endometriosis
s/s? (uterine position, menstrual changes)
locations + associated complications?
responds to menstrual hormonal changes > bleeding + shedding > collections of blood in ectopic loci > hemolysis can cause inflammation + adhesions
Infertility - adhesions interfere with ovulation + Fallopia
Fixed, RETROVERTED uterus - adhesions on uterosacral ligament
PAINFUL SEX - infiltration of Douglas pouch; tender palpation of posterior vaginal fornix
DYSMENORRHEA - shedding of ectopic tissues
Estrogen deficiency
causes? vaginal changes? sx?
premature ovarian failure or menopause
glycogen-deficient epithelium; flattened labial folds + vaginal rugae > DYSPAREUNIA + menstrual irregularity
Congenital Torticollis
causes? associated issues?
Causes include…
BIRTH TRAUMA - breech delivery, etc.
IN UTERO MALPOSITION - fetal macrosomia or oligohydramnios
(cervical spine deformities)
cause SCM injury + fibrosis
May also have…
hip dysplasia
metatarsus adductus - forefoot adduction
clubfoot - “talipes equinovarus”
Congenital Torticollis
presentation? dx?
develops by 2-4 WEEKS of age
HEAD TILT TOWARDS affected side, with CHIN POINTED AWAY
Soft tissue mass palpable in inferior 1/3 of SCM
Plagiocephaly - “flat head syndrome” skull malformation sometimes seen
Facial asymmetry - sometimes
Maternal hypertension during gestation
can cause what?
asymmetric intrauterine growth restriction
normal/near-normal head size with REDUCED ABDOMINAL CIRCUMFERENCE
Hypertension in pregnancy
Chronic htn vs. gestational htn?
Chronic - greater than/equal to 140/90 PRIOR TO CONCEPTION or 20 WEEKS
Gestational - new-onset high BP AFTER 20 WEEKS (with no proteinuria or end-organ damage)
Pre-eclampsia vs. eclampsia
Pre-eclampsia - new-onset high BP AFTER 20 WEEKS plus PROTEINURIA or END-ORGAN DAMAGE
Eclampsia - pre-clampsia plus new-onset GRAND MAL SEIZURE
Pre-eclampsia
risks + pathophys
nulliparity, personal/fam history, obesity + chronic htn
abnormal placental vasculature > placental hypoxia + ischemia > ANTIANGIOGENIC FACTORS into maternal circ > endothelial injury with permeability increase and PROTEINURIA
end-organ damage includes HA, visual changes, and abdominal pain from liver damage
HELLP syndrome
acronym?
cause?
Hemolysis
Elevated Liver enzymes
Low Platelets
manifestation of severe pre-eclampsia
Adenomyosis
what? in whom?
endometrial glandular tissue in the myometrium
common in MIDDLE-AGED PAROUS women
Adenomyosis
s/s? definitive dx?
heavy menstruation
dysmenorrhea
UNIFORMLY ENLARGED uterus
definitive dx is by HYSTERECTOMY BIOPSY bc normal endometrial biopsy doesn’t reach myometrium
Endometrial polyps
what? how? s/s?
benign projections of uterine lining
hyperplastic growth of endometrial glands + stroma
abnormal bleeding
NO uterine enlargement
Endometrial hyperplasia
what? s/s?
greater increase in gland proliferation as compared to stroma (polyps are both glands + stroma)
irregular menstrual bleeding that is NOT painful
Uterine Leiomyoma
what? s/s?
proliferation of myometrial SM
heavy menstrual bleeding
uterus is IRREGULARLY ENLARGED
Urachal abnormalities (3)
urachus is a remnant of the allantois
- Patent urachus - all the way open
- Urachal sinus - adjacent to umbilicus
- Urachal cyst - midway btwn bladder + umbilicus
Straw-colored discharge at umbilicus, worsened by crying, straining or lying prone
local skin irritation + erythema
Patent Urachus
Periumbilical tenderness
Purulent umbilical discharge
Urachal sinus
periumbilical sinus is prone to persistent and recurrent infections
Menopause
hormonal changes
FSH increases, due to…
- resistant ovarian follicles
- lack of inhibin
low estrogen also > less feedback inhibition on GnRH and pituitary (ESTRONE, not estradiol, produced outside ovary becomes major estrogen)
progesterone decreases as well
Sertoli-Leydig cell ovarian tumor
presentation? who? histo?
SEX CORD-STROMAL tumor in YOUNG WOMEN with adnexal mass, amenorrhea and VIRILIZATION
hollow/solid tubes lined by round Sertoli cells w/ fibrous stroma
what is VACTERL association?
syndrome of birth defects with at least 3 of:
vertebral anomalies anal atresia cardiac defects tracheoesophageal fistula renal defects limb defects
Maternal Serum AFP Screening
Increased in?
Decreased in?
Increased:
Open NT Defects (anencephaly, open spina bifida)
Ventral Wall Defects (omphalocele, gastroschisis)
Multiple Gestation
Decreased:
Aneuploidy (trisomy 18, 21 etc.)
AFP
Where is it made? How/when does it change? Clinical consequence of this?
Fetal liver, GI tract and yolk sac (early gestation)
Increases with gestational age
Correct gestation aging is important in determining what normal AFP levels should be. In mothers with previously irregular menses this can be hard, and may require ultrasound.
dizygotic twins
how do they form? how many chorions/amnions? how many placentas?
2 oocytes + 2 sperm > twins’ sex may differ
2 amnions + 2 chorions (dichorionic, diamniotic)
chorions may fuse if close > 1 or 2 placentas
monozygotic twins
most common time it starts? most common amniotic/chorionic situation?
usually occurs at END OF 1st WEEK > 2 embryos, each with their own amnion, but a SINGLE CHORION and COMMON PLACENTA
monochorionic, diamniotic
monozygotic twins
early separation > what chorionic/amniotic situation
separation at days 0-4
similar to dizygotic twins > 2 chorions, 2 amnions and 2 placentae +/- placental fusion
monozygotic twins
late separation > what chorionic/amniotic situation
separation at 8-12 days
1 amniotic sac + 1 chorion > high fetal fatality rate via umbilical cord entanglement
what is the cause of conjoined twins?
monozygotic twins separating LATER THAN 13 DAYS after fertilization
monoamniotic, monochorionic
most common site of ectopic pregnancy? imaging?
risk factors?
FALLOPIAN AMPULLA, will appear as an ADNEXAL MASS on US
Any tubal pathology, such as…
Previous infection
Surgery - eg, TUBAL LIGATION (pregnancy rare after ligation, but 1/3 are ectopic if they implant!)
ectopic pregnancy
Treatment
Dx including endometrial histo
Tx - surgical removal and hemostatic maintenance
Dilation + curettage of uterus - can stop bleeding and determine ectopia vs. normal preg
Histo - “decidualized endometrium” with DILATED, COILED GLANDS and VASCULAR EDEMATOUS STROMA (normal changes for the “luteal” phase of cycle via progesterone)
Urethral injury in men
most common site?
Membranous part
less supported/protected than prostatic or penile parts
pelvic fracture often injures it
Mechanism for formation of a COMPLETE MOLE?
most common mech, less common mech
most common - fertilization of an “empty” ovum with NO MATERNAL CHROMOSOMES by a single 23, X sperm > duplicates its chroms. to form 46, XX complete mole
(46, YY have not been observed b/c they just die)
less common - fertilization of empty ovum with 2 DIFFERENT SPERM > can be 46, XX or 46, XY
Mechanism of formation of PARTIAL MOLE?
an egg WITH ITS CHROMOSOMES (23, X) is fertilized by TWO SPERM resulting in 3 possibilities…
69, XXX
69, XXY
69, XYY
Risk factors for molar pregnancy (4)
Advanced maternal age
Prior molar pregnancy
Prior miscarriage
Infertility
Complete molar pregnancy
gross morpho? ultrasound? histo?
NO FETAL STRUCTURES, with large edematous disorded “bunch of grapes” chorionic villi
US shows “swiss cheese” or “snowstorm” - a central heterogenous mass with MULTIPLE CYSTIC areas
histo - trophoblastic hyperplasia
Complete molar pregnancy
s/s? labs?
pelvic pain + vaginal bleeding
uterus larger than expected for gestational age
HIGH beta-hCG!!! (via trophoblastic hyperplasia)
two drugs used in tx of infertility
for 2 phases of menstrual cycle
MENOTROPIN (human menopausal gonadotropin) - mimics FSH to form dominant follicle
hCG - mimics LH > surge causes ovulation
(alpha subunit of hCG is similar to LH)
Gestational choriocarcinoma
from what cells? when? s/s?
malignant TROPHOBLAST tumor
preceded by NORMAL PREGNANCY usually, but can be after molar, ectopic or aborted preg
vaginal bleeding, uterine enlargement and VERY HIGH BETA-hCG!!
Gestational choriocarcinoma
spread? macro? histo?
1 site is LUNGS
hematogenous spread after uterine wall invasion
bulky mass in uterus that is SOFT, YELLOW-WHITE and with NECROSIS + HEMORRHAGE
may or may not have fetal tissue
histo - proliferation of mononuclear CYTOTROPHOBLASTS and multinuclear SYNCYTIOTROPHOBLASTS with NO VILLI
what is the difference in chorionic villi in a PARTIAL vs. COMPLETE vs. INVASIVE mole?
partial - FOCALLY enlarged + hydropic villi
complete - DIFFUSELY enlarged + hydropic
invasive - same as complete, but TROPHOBLASTS INVADE MYOMETRIUM (thus is malignant)
Aromatase deficiency
inheritance? fetal effect? maternal effect?
AR inheritance
high androgens, low estrogens in fetus
maternal virilization - later in preg
fetus has NORMAL INTERNAL but AMBIGUOUS EXTERNAL genitalia
later, primary amenorrhea, OSTEOPOROSIS with TALL STATURE (late epi plate closure)
Nicotine use during pregnancy
what baby effects?
what pregnancy effects?
increased prematurity / low birth weight risk
placenta previa + abruption risk
Phenytoin during pregnancy
what anomalies can result? 3 things
cardiac defects
cleft lip/palate
hypoplastic nails
Congenital Rubella Syndrome
basic triad… i think Sketchy has much more, so make another card on that
hearing loss
cataracts
cardiac defects
Indirect Inguinal Hernia
cause? presentation? in whom?
failed obliteration of processus vaginalis (as in hydrocele)
indirect inguinal hernia (and hydrocele) can present as an asymptomatic scrotal mass that INCREASES WITH VALSALVA
seen in children (as they are a developmental abnormality and not acquired)
