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Endocrine / Reproduction > Week 3 - Part 1 > Flashcards

Week 3 - Part 1 Flashcards

1
Q

Neural tube defects

A

most common birth defects
1:1000 in US
tube closure is at 4 weeks gestation
anencephaly, open/closed spina bifida, encephalocele
Tx: folic acid supplement during first 4 weeks

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2
Q

Causes of congenital anomalies

A

alcohol, ionizing radiation, isotretinoin, teratogens, uncontrolled diabetes, etc
Infections: CMV, Parvo B19, varicella, toxoplasmosis, herpes simplex, treponema pallidum (syphilis), rubella

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3
Q

Early pregnancy

A

ovulation is 14d before menses
dominan follicle transforms into corpus luteum (esrogen to progesterone)
fertilization is 24-48hrs after ovulation, tranforms into morula then blastocyst
Implantation is 6-7d after fertilization, syncytiotrophoblasts invade myometrium

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4
Q

First trimester bleeding

A

not necessarily abnormal

  • implantation bleeding (really early)
  • subchorionic hemorrhage
  • incomplete abortion (cervix open)
  • ectopic pregnancy
  • hestational trophoblastic neoplasia
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5
Q

Diagnosis of pregnancy

A

urine pregnancy test= B-hCG
hCG shares a subunit with LH, FSH, TSH
hCG doubles every 48hrs in normal preg, peaks at 10 weeks

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6
Q

Molar pregnancy

A

multi-cystic mass in uterus
Complete: 46xx/xy all paternal DNA, no fetus, super high hCG, risk of choriocarcinoma, theca lutein cysts, complications
Partial: triploid 69xxy, fetus present, less risk of other stuff
Tx: methotrexate (DHFR inhibitor)

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7
Q

Normal (adaptive) Changes during pregnancy

A

Blood: decreased systemic vascular resistance, widened pulse pressure, increased cardiac output, increased HR, increased blood volume (more than RBC mass) ((aort-caval compression- supine hypotension, use left lateral tilt), systolic murmurs,, everything gets even more ramped up during labor and pushing
Respiratory: increased tidal vol, unchanged resp rate, decreased total lung capacity, hyperventilation (dec pCO2, compensatory dec HCO3)
Hematologic: glucocorticoid mediated leukocytosis, pro-thrombotic state, venous stasis
Endocrine: insulin resistance, increased thyroid, increased cortisol
GI: slowed motility, GERD, nausea (bc hCG), biliary stasis, elevated alk phos

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8
Q

Stages of labor

A

1: longest, latent= contractions with slow cervical dilation,, active= fast cervical dilation (change around 4cm)
2: complete dilation until delivery
3: after fetus before placenta (30min)

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9
Q

Labor contractions

A

quiescent state= progesterone, low # of gap junctions
upregulation of CAP+ uterine stretch= estrogen phenotype= labor
stim by oxytocin (PLC) and prostaglandins
action potential- intracellular Ca- calmodulin- myosin- contraction

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10
Q

Uterine contraction relaxants

A

relaxin, NO, Mg, PTHrp, B2-agonists, oxytocin-antagonist, Ca-channel-blockers, prostaglandin-inhibitors

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11
Q

Labor trigger theory

A

increases in ACTH or CRH- promotes myometrial contractility

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12
Q

Gestational diabetes

A

onset of abn glucose tolerance during preg
test all women 24-48weeks
risks: obesity, fam hx, AA
high glucose supply to baby leads to hyperinsulinemia, which can result in hypoglycemia after birth
also macrosomia, polyhydramnios
dx: glucola screen + fasting glucose

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13
Q

Hypertensive disorders of pregnancy

A

gestational HTN= new onset HTN
Preeclampsia= severe HTN + proteinuria or end organ damage (eclampsia=seizures)
HELLP= severe HTN + hemolysis, elevated liver tests, low platelets
Fetal sequelae= small birth weight, oligohydramnios, preterm, metabolic/CV disorders

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14
Q

Preeclampsia

A

pathophys: sFlt1, sEng, defective trophoblast differentiation, Ang antibodies, incomplete spiral artery remodeling – placental hypoperfusion
also fetal growth restriction and oligohydramnios
Management: close monitoring, delivery is only sure, MgSO4 for seizure prophylaxis, betamethasone for fetal lung maturation

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15
Q

gestational hyperthyroid

A

transient, due to excess hCG
hyperemesis gravidarum= nausea, vomiting due to excess hCG
-also can get Hashimoto’s or Graves, or iodine def,

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16
Q

Mortality rations and things

A

maternal mortality rate= # maternal deaths / # reproductive age women *100000
maternal mortality ratio (MMR)= # maternal deaths / # live births * 100000
Most common cause of maternal death= hemorrhage, HTN disorder, sepsis
fetal mortality rate (FMR)= # fetal deaths / number of live + stillbirths *1000
neonatal mortality rate (NMR)= # neonatal deaths / # live births * 1000
perinatal mortality rate (PMR)= # fetal + neonatal deaths / # live + stillbirths *1000
stillbirth(fetal death)= 20w-birth
neonatal= birth-28d
perinatal= 20w-28d

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17
Q

Indications for genetic testing

A

advanced maternal age over 35 or 33 for twins
fathers over 40-45
hx of pregnancy loss

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18
Q

1st trimester screening

A

risk assessment for ts21,13,18
11w-13w
all pregnant pts
uses ultrasound (nuchal translucency and nasal bone) and serum analysis (b-hCG and PAPP-A)

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19
Q

Non-invasive prenatal screening (NIPS) via cell-free fetal DNA

A

the new thing on the block
risk assessment for high risk maternal pop
available 10w– (1st trimester)
uses serum analysis of DNA

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20
Q

2nd semester screening

A

maternal serum quad test
risk assessment for DS, ts18, neural tube defects
avail 15w-20w
for all preg pts
uses serum analysis: AFP, hCG, uE3(estriol), DIA

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21
Q

Prenatal diagnostic testing

A

FISH, karyotype, (microarray)
chorionic villus sampling (CVS): for all preg, increases risk of loss by 1%
amniocentesis: for all preg, increases preg loss rate
cordocentesis/PUBS: umbilical blood sampling: used for follow-up diagnosis only

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22
Q

1st semester fetal death

A

most common: chromosomal abn, aneuploidies (ts16)
also other genetic things
uterine abns (septum, polyps, etc)
infection (CMV, rubella, toxoplasma)

23
Q

2nd semester fetal death

A 
cervical insufficiency (painless cervical dilation
premature rupture of membranes, infection (flu)
24
Q

3rd trimester fetal death

A 
premature rupture of membranes
preterm labor
placental abruption
umbilical cord compression
infection
intrauterine growth restriction
placental dysfunction
HTN disorders
25
Placenta previa
placenta over cervical os painless, no contractions 3rd trimester bleeding
26
Placenta abruption
placenta separation due to hemorrhage into decidual basalis bleeding (3rd trimester) uterine tenderness, contractions
27
Vasa previa
3rd trimester bleeding (from umbilical cord, due to trauma from baby head against cervical os) can lead to fetal death
28
Placental pathology
cord entanglement Funisitis= inflammation of the cord (fetal response) Meconium staining= maternal leukocytes take up meconium Chorioamnionitis Oligohydranios= squamous metaplasia fetal/maternal vasculopathy distal villous hypoplasia malignancy (rare): choriocarcinoma, hydatidiform moles, neuroblastoma(fetal)
29
Histology of fetal membranes
amnion, chorion, decidua
30
Drugs for prevention of preterm labor
progesterone tocolytics: inhibit uterine contractions - Nifedipine (Ca-channel blocker) - MgSO4 (Ca-influx antagonist)- can't use for long bc low Ca levels - Indomethacin (COX inhibitor)- can induce ductus arteriosis closure
31
Drugs for labor induction
Dinoprostone (PGE2): promotes ripening and dilatation of cervix (side= uterine hyperstim) Misoprostol (PGE1): same Oxytocin: drug of choice (sides= uterine hyperstim and tetany)- short half-life
32
Drugs for postpartum hemorrhage
Oxytocin (maintains uterine contractions) | Ergonovine
33
Most common mass lesions of breast by age
15-25: fibroadenoma 25-35: fibroadenoma (cyst or cancer possible) 35-50: fibrocystic changes, cancer, cyst over 50: cancer until otherwise Pregnant: lactating adenoma, cyst, mastitis, cancer
34
Inflammatory conditions of breast
acute mastitis (breast abcess, during breast feeding, S aureus) periductal mastitis mammary duct ectasia fat necrosis (benign painless lump from trauma) other
35
Non-proliferative breast changes (fibrocystic change)
30-50yo, common lumpy breast, mass, calcifications, nipple discharge pain, tenderness may occur in premenstrual phase Includes: cysts, fibrosis, mild adenosis, mild ductal hyperplasia, apocrine metaplasia
36
Complex sclerosing lesion of breast
40-60yo usually non-palpable, detected on mammography stellate or spiculated lesion with central core Tx: excision
37
(Intraductal) Papilloma of breast
``` any age usually central breast nipple discharge is primary symptom bloody discharge, subareolar mass slight risk of carcinoma ```
38
Risk of invasive carcinoma from benign lesions
None: adenosis, fibroadenoma, fibrosis, hyperplasia w/o atypia, cysts, apocrine metaplasia Small: complex fibroadenoma, sclerosing adenosis, solitary papilloma Moderate: atypical ductal/lobular hyperplasia Significant: DCIS(ipsilateral), LCIS(both)
39
Fibroadenoma of breast
most common in young adults solitary, well-circumscribed, moveable, painless regress during menopause NO risk of cancer
40
Phyllodes tumor
fibroepithelial tumor of breast benign or malignant 50-60yo increased in latin women discrete palpable breast mass, non-encapsulated rapid growth leaf-like or epithelium lined clefts, cysts, inc cellularity
41
Ductal carcinoma in situ (DCIS)
``` 50-60yo some can be bilateral or multicentric some have palpable mass fills ductal lumen comedo(caseous necrosis) or non-comedo Tx: surgery, radiation, hormonal some low grade and most high grade progress to invasive ```
42
Paget's disease of the nipple
a form of DCIS extending to skin ulcerated, eczematous skin carcinoma cells in epidermis usually high-grade or comedo type
43
Lobar carcinoma in situ (LCIS)
``` 45-55yo mostly multicentric and/or bilateral rarely calcified, does not form mass or density marker of risk for carcinoma tamoxifen followup ```
44
Invasive breast carcinoma
palpable mass, dimpling of skin, retraction of nipple, calcifications most in upper outer quadrant ductal, lobular, or medullary Molecular subtypes: Luminal A,B, HER2, Basal-like
45
Invasive ductal carcinoma
majority of carcinomas well to poorly differentiated, worst stellate morphology, firm fibrous, glandular cells usually assoc with DCIS most express ER/PR, some express Her2/Neu
46
Invasive lobular carcinoma
more often multicentric and bilateral postmenopausal orderly rows of cells, targetoid, signet ring E-cadherin negative hard tumor, irregular borders, no distinct margin
47
Medullary carcinoma of breast
``` younger ages, rare BRCA1 better prognosis, rarely metastasize Her2, ER/PR negative oval circumscribed mass, soft, fleshy syncytial growth pattern, lymphoplasmacytic infiltrate ```
48
Tubular carcinoma
``` 40syo multifocal sometimes periphery of breast, excellent prognosis some axillary metastasis small, stellate ```
49
Colloid (mucinous) carcinoma of breast
``` postmenopausal slow growing mass, good prognosis some axillary metastasis well-circumscribed, soft, pale blue tumor cell and nests in pools of mucin ```
50
Inflammatory carcinoma of breast
``` clinical diagnosis skin erythema, peau d'orange differentiate from acute mastitis thickening of skin, diffuse induration of parenchyma bad prognosis lymphatic emboli ```
51
Male breast carcinoma
rare BRCA2 assoc palpable subareolar mass, nipple discharge common, axillary lymph involvement
52
Gynecomastia
breasts in men from hyperestrogen klinefelter, cirrhosis, alcohol, anabolic steroids, testicular tumor, marijuana, drugs
53
Criteria for high risk for familial breast cancer
3-2-1 3 fam members w breast ca any age 2 fam members with one less than 50yo 1 fam member with ovarian ca

Endocrine / Reproduction (7 decks)

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