Shit - Repro Flashcards
FAS mutations
limb dislocation, heart defects (PDA, VSD, ASD), Tetrallogy, heart-lung fistulas, holoprosencephaly.
syncitiotrophoblast role
Secrete bHCG which looks like LH, so corpus luteum is stimulated to keep making progesterone and not regress (sustains pregnancy). Eventually the placenta will take over progesterone (and estrogen) production role.
Syncytiotroph cell marker
NO MHC-I - prevents attack by maternal system
umbilical artery vs vein: carry, #, derived from, problems
Umbilical arteries (2) = deO2 from baby's internal iliac Umbilical vein (1) = O2 blood from placenta to baby liver/ductus venosus.
Derived from allantoid (form yolk sac)
1 artery (2-vessel cord) = congenital/chromosomal abnormalities
Urachus
from yolk sac from allantois
connects urogenital sinus to yolk sac
Fail to fust: fistula (bellybutton pee), cyst, vesicourachal diverticulum
vitelline duct
= omphalomesenteric duct
connects midgut to yolk sac
Fail to fuse = fistula (bellybutton poo), cyst, or meckel’s diverticulum
MEckel’s sequale
infection. heterotopic gastritis (choristoma) heterotopic pancreatic (choristoma)
Digeorge =
missing 3rd and 4th pouches
3 = thymus + inferior parathyroids
4 = C-cells + superior parathyroids
Parathyroids always from the dorsal wings; other = ventral
Cleft lip = failure of:
1’ palate
maxillary and medial NASAL processes
Cleft palate = failure of:
2’ palate
2 lateral PALATNE processes; or lateral PALATINE process with nasal SEPTUM or medial PALATINE process
congenital torticolis: s/s
neck, dip dysplasia, matatarsal adductus, talipes equinovarus
SRY
makes TDF –> grow testes
MIF
from sertoli cells, inhibit mullein (paramesonephric) duct system
Testosterone (embyo)
From leydig, makes internal male genetalia (except prostate)
Missing MIF or sertoli
Male from leydig side, but no regression of internal female genetalia
Missing 5-a-reductase
can’t turn testosterone to DHT, so internal male, external ambicuous until puberty, puberty = massive testosterone spike which promotes 2’ male sex characteristics
Uterus malformations: order of severity
septate, bicorunate, didelphys (double everything)
Mullerian agenesis (Maybe-Rokitansky-Kuster-Hauser)
Mullerian duct does not develop.
Ovaries and short blind vagina present.
1’ amenorrhea, no uterus/tubes
genital tubercle
glans (both), shaft, vestibular bulbs
Malposition = epispadias
urogenital sinus
Senke and bartholin
bulbourethral (cowpers) and prostate
urogenital folds
labia minora and ventral penis
Fait to fuse urethral fods = hypospadias
associations with hypospadias
cryptorchidism and inguinal hernia
associations with epispadias
bladder exstrophy
use of misoprostol (PGE1 analog) with mifepristone
sensitizes myometrium to mifepristone; also causes abdominal cramping/pain
gland penis and clitoris lymph drainage
deep inguinal
broad ligament
connects everything to pelvic SIDE wall
Nerves of boners
Erection = S2-S4 pelvic splanchnics (PSNS to hindgut) Emission = SNS hypogastrics Ejaculation = visceral and somatic nerves (pudendal)
Male cell affected by temperature
Stroll ONLY (so T fine)
enzymes in granulosa vs theca cells
granulosa = aromatase theca = desmolase
- after ovulation, granolas get LH-R; bring in cholesterol to make PROGESTINS
Estrogens from where?
Estradiol = ovary Estrone = fat Estriol = placenta *test of fetal well-being; placenta makes it from fetal adrenal DHEA to liver A/T
Estrogen levels in pregnancy
Estradiol and estrone increase 50x
Estriol increases 1000x
Hormone that increases body temperature
progesterone
Hormones on gonadotropins
Estrogen inhibits LH
Inhibin inhibits FSH
Progesterone inhibits both LH and FSH
Progesterone on estrogen
down regulated estrogen receptors (prevents unopposed estrogen and thus endometrial hyperplasia/CA)
Basic preeclampsia s/s
HTN, proteinuria, edema
Vaginal agenesis aka mullerian aplasia
mullein failure with short vagina and no or rudimentary uterus and tubes; no uterus = 1’ amenorrhea. Ovaries present, so full female 2’ sexual characteristics.
AIS
look female, but male internal structures. So internal testes, and minimal pubic/axillary hair because insensitive to androgens
Kartageners vs CF infertility
Kartgeners = immotile cilia CF = congenital absence of vas def
Turner via:
Loss of paternal X
Poli vs oligo - menorrhagia
oligo = few bleeds .: LONG cycle >35d poly = many bleeds .: SHORT cycle
stage of oocyte and chromosome contents
birth to ovulation = MIPI = 2N4C
ovulation to fertilization = MIIMII = 1N2C
post-fertilization = complete MII = 1N1C
Estrogen positive feedback mechanism
Estrogen induces GnRH receptors on the AP
Mittelschmerz
mid-cycle pain from peritoneal irritation (i.e. follicle swelling, tubal contraction); ddx = appendicitis
post-ovulatoin dates: fertilization (conception), implantation, bHCG detectoin
1d = fertilization (24h viable; sperm = 72) 6d = implant d7 = blood bHCG d14 = urine bHCG
What hormone(s) inhibit lactation during pregnancy
Progesterone AND estrogen
why don’t you get pregnant while breastfeeding?
prolactin inhibits GnRH release (only if baby feeds on demand)
what is in breast milk, and what diseases does it prevent
IgA, Macro, Lympho.
Baby: asthma, allergies, DM, obesity
Mom: breast and ovarian CA
where doe sP come from throughout pregnancy:
pre-conception = CL via LH
conception - week 8/10 = CL via syncitiotrophoblasts acting like LH; identical alpha units on LH, FSH, hCG, and TSH (.: preg test looks for beta subunit of hCG (b-hCG))
week 8/10- end = placenta (makes P and E)
high vs low hCG and what it means:
high = twins, h. mole, chorioCA, downs low = patau, edwards, failing/ectopic pregnancy
hPL job and outcome
inhibits maternal glucose uptake (give glucose to baby) and induces lipolysis (to feed mother with KB and FFA).
Increased by maternal hypoglycaemia, and can cause gestational DM
best marker of menopause
high FSH (no estrogen to feedback)
chromosome numbers in sperm development
gonium = 2N2C 1'cyte = 2N4C 2'cyte = 1N2C tid = 1N1C
late DHT effects
prostate growth, balding, sebaceous gland activity
where is aromatase found in males:
adipose and testes (sertoli)
Hormone levels in XXY
High LH and FSH
Low T and Inhibin (destruction and hyalinization of seminiferous tubules)
High E
Turners: what is missing, hormone levels
Missing: ovaries (streaky), period (via hormones), barr body
Hormones: low E, high LH and FSH
how to get XYY male + s/s
non-disfunction at dad M-II
s/s = tall, acne, LD, autism-spectrum
M-I vs M-II nonductionction; terminology
M-I = homologous chromosomes fail to separate = different M-II = sister chromatids fail to separate = identical
Maternal virilizatoin during pregnancy
fetus has aromatase deficiency; testosterone crosses the placenta
Kallmans genes and s/s
LOF of Kal-I, FGFR-1, GPR-54, GnRH-Rs
Anosmia, infertile, midline defects, long armspan, unlit. renal agenesis, syndactyly
complete mole:
XX or YY (empty egg + usually 1 sperm that then duplicates).
Dad controls placenta, so only see trophoblasts.
S/s = 1st trimester bleeding, very high hCG, enlarged uterus, hyperemesis, pre-eclampsia, hyperthyroidism, theca-lutein cysts, honeycomb/grapes/US snowstorm
partial mole =
69 so maternal also so both placental and fetal parts.
bleeding + abd pain
Gestational HTN =
> 140/90 after week 20; NO other s/s
Pre-eclampsia s/s + mechanism
Gestational HTN + proteinuria or end-organ dysfunction.
Via abnormal placental spiral arteries
pre-eclampsia drugs =
antiHTN (a-methyldopa, hydralazine, labetalol, nifedipine).
IV Mg-sulfate to prevent seizures (eclampsia)
HELLP: s/s + rx
pre-eclampsia + Hemolysis, Elevated Liver enz, Low Platelets. Can cause hepatic sub-capsular hematomas
Rx = delivery
Eclampsia s/s + rx
pre-exlampsia + seizures
Die from stroke, intracranial bleed, ARDS
Rx = IV Mg-sulfate + delivery
Painful vs painless 3rd trimester vaginal bleeding in pregnancy
painless = placenta previa painful = placenta abruptio
vasa previa: mechaism, s/s
usually via velamentous cord (into amino-chorio then to placenta rather than straight into placenta)
PainLESS bleeding, membrane rupture, fetal bradycardia (
Random cases of poly and oligohydramnios:
Poly = maternal DM, fetal anemia Oligo = placental insufficiency
Incidence of tumours vs mortality
Incidence (USA) = endometrial > ovarian > cervical
Mortality = ovarian > cervical > endometrial
Vagina tumours (3)
SqCC - 2’ from cervical from HPV
Clear cell AdenoCA - from adenosis from columnar remnants, via DES
Sarcoma botryoides -
E6 and E7
E6 - degrades p53
E7 - displaces TFs on Rb
Lichen sclerosis vs lichen simplex chronicus
Sclerosis = thin epi, fibrosed derm, parchment, risk SqCCA
simplex chronicus = leathery from itching
PCOS treatment
weight loss, spironolactone, ketoconazole, OCP, clomiphene citrate (blocks E-R @ hypo to increase LH and FSH to induce ovulation)
Follicular vs theca-lutein cyst associations
follicular = high estrogen, endometrial hyperplasia theca-lutein = chorio-CA and H mole
Random RF and preventative factor for ovarian tumours
RF = HNPCC (also for endometrial CA) Protective = tubal ligation
Benign ovarian neoplasms with buzzwords
Serous cystadenoma - columnar
Mucinous cystadenoma - multiloculated
Endometrioma - chocolate cyst
Dermoid - 3 layers; can be struma ovarii
Brenner - urothelium, coffee bean nuclei, encapsulated tumour
Fibroma -spindle; Meigs = fibroma, ascites, hydrothorax
Thecoma - estrogen
Malignant ovarian neoplasms with buzzwords
Immature teratoma - neuroectoderm
Granulosa - Estrogen/Progesterone; Call-exner bodies
Serous cystadenocarcinoma - psammoma bodies
Mucinous cystadenocarcinoma - pseudomyxomaperitonei (can also be from appendix)
Dysgerminoma - hCG and LDH
ChorioCA - hCG, early lung mets (SOB, hemoptysis)
Yolk sac - Schiller-Duvall (like glomeruli), AFP, ovaries/testies or sacrococcygeal
Krukenberg - mets, signet ring
Leiomyoma vs adenomyosis
Leio = irregularly enlarged; whorled Adeno = uniformly enlarged; SM hypertrophy and hyperplasia around hyperplaised endometrial basal layer
Asherman’s syndrome
2’ amenorhhea via stratum basale loss (i.e. D+C)
Intraductal papilloma: where, s/s
lactiferous duct .: serous/bloody nipple discharge (but benign)
FCC with sclerosing adenosis
calcifications
Lactation mastitis: bug and Rx
s. aureus; dicloxacillin
gynecomastic drugs:
Spironolactone, Digoxin, Cimetidine, Alcohol, Ketoconazole
Triple negative breast cancer
Black, more aggressive
Most important prognostic factor
axillary LN mets
Comedocarcinoma
Type of DCIS with central necrosis
rock hard breast mass with sharp margins, small glandular cells, stellate infiltration
invasive ductal CA. Most invasive, worst, MC
Indian file
Invasive stromal
Subtypes of invasive ductal:
Tubular
Mucinous
Inflammatory: peau d’orange, blocked dermal lymph drainage
Medullary: lymphocytic infiltrate
Peyronie
fibrous plaque in tunica albuguinea (surrounds cavernosae)
causes and rx of priapism
cause = sildenafil, trazodone rx = phenylepherine direct, manual, aspirate
SqCell penis:
Bowens = leukoplakia Queyrat = erythroplakia (cancer of gland) Bowenoid = CIS
Wxtragonadal germcell tumours: location in adults and kids
Adults = retroperitoneum, mediastinum, pineal gland, suprasellar
Kids = sacrococcygeal teratoma
LGV via
Chlamydia L1-L3
necrotizing granulomas
fluctuant scrotal cyst
spermatocele
Seminoma: who, marker
men in 30s (MC tumor).
ALP
Dysgerminoma = hCG and LDH]
yolk sac: who, marker, histo
boys
chorio in men s/s
gynecomastic and hyperthyroidism
teratoma in men
mature may malignant, hCG, AFP
embryonal CA
malignant, hemorhagic, necrosis, PAINFUL, usually mixed
Lydig cell tumours
reinke crystals, golden brown, androgens or estrogens
BPH lobes and zone
Lateral and middle LOBES
Periurethral ZONE
HyperPLASIA
Acute vs chronic prostatitis
Acute = bacterial (e. coli) chronic = bacterial or abacterial (MC)
Prostate Ca lobe and zone
Posterior LOBE
Peripheral ZONE
Prostate CA markers and grading
PPAP and PSA (increase total, decrease free fraction)
Grading via Gleason = architechture (not atypia)
Prostate CA bone mets =
Osteoblastic .: sclerotic lesions
