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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
Q

Placenta previa

A

placenta over cervical os
painless, no contractions
3rd trimester bleeding

26
Q

Placenta abruption

A

placenta separation due to hemorrhage into decidual basalis
bleeding (3rd trimester)
uterine tenderness, contractions

27
Q

Vasa previa

A

3rd trimester bleeding (from umbilical cord, due to trauma from baby head against cervical os)
can lead to fetal death

28
Q

Placental pathology

A

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
Q

Histology of fetal membranes

A

amnion, chorion, decidua

30
Q

Drugs for prevention of preterm labor

A

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
Q

Drugs for labor induction

A

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
Q

Drugs for postpartum hemorrhage

A

Oxytocin (maintains uterine contractions)

Ergonovine

33
Q

Most common mass lesions of breast by age

A

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
Q

Inflammatory conditions of breast

A

acute mastitis (breast abcess, during breast feeding, S aureus)
periductal mastitis
mammary duct ectasia
fat necrosis (benign painless lump from trauma)
other

35
Q

Non-proliferative breast changes (fibrocystic change)

A

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
Q

Complex sclerosing lesion of breast

A

40-60yo
usually non-palpable, detected on mammography
stellate or spiculated lesion with central core
Tx: excision

37
Q

(Intraductal) Papilloma of breast

A 
any age
usually central breast
nipple discharge is primary symptom
bloody discharge, subareolar mass
slight risk of carcinoma
38
Q

Risk of invasive carcinoma from benign lesions

A

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
Q

Fibroadenoma of breast

A

most common in young adults
solitary, well-circumscribed, moveable, painless
regress during menopause
NO risk of cancer

40
Q

Phyllodes tumor

A

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
Q

Ductal carcinoma in situ (DCIS)

A 
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
Q

Paget’s disease of the nipple

A

a form of DCIS extending to skin
ulcerated, eczematous skin
carcinoma cells in epidermis
usually high-grade or comedo type

43
Q

Lobar carcinoma in situ (LCIS)

A 
45-55yo
mostly multicentric and/or bilateral
rarely calcified, does not form mass or density
marker of risk for carcinoma
tamoxifen followup
44
Q

Invasive breast carcinoma

A

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
Q

Invasive ductal carcinoma

A

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
Q

Invasive lobular carcinoma

A

more often multicentric and bilateral
postmenopausal
orderly rows of cells, targetoid, signet ring
E-cadherin negative
hard tumor, irregular borders, no distinct margin

47
Q

Medullary carcinoma of breast

A 
younger ages, rare
BRCA1
better prognosis, rarely metastasize
Her2, ER/PR negative
oval circumscribed mass, soft, fleshy
syncytial growth pattern, lymphoplasmacytic infiltrate
48
Q

Tubular carcinoma

A 
40syo
multifocal sometimes
periphery of breast, excellent prognosis
some axillary metastasis
small, stellate
49
Q

Colloid (mucinous) carcinoma of breast

A 
postmenopausal
slow growing mass, good prognosis
some axillary metastasis
well-circumscribed, soft, pale blue
tumor cell and nests in pools of mucin
50
Q

Inflammatory carcinoma of breast

A 
clinical diagnosis
skin erythema, peau d'orange
differentiate from acute mastitis
thickening of skin, diffuse induration of parenchyma
bad prognosis
lymphatic emboli
51
Q

Male breast carcinoma

A

rare
BRCA2 assoc
palpable subareolar mass, nipple discharge common, axillary lymph involvement

52
Q

Gynecomastia

A

breasts in men
from hyperestrogen
klinefelter, cirrhosis, alcohol, anabolic steroids, testicular tumor, marijuana, drugs

53
Q

Criteria for high risk for familial breast cancer

A

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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