Week 4 Flashcards
When does sex determination occur? Sex differentiation?
Fertilization
Embryonic period
Three groups of organs in the reproductive system?
Gonads: gametes produced
Reproductive ducts: gametes pass through
External genitalia: gamete delivery and reception
What class of hormones actively influences differentiation towards male? What factor leads to regression of female ducts?
androgens
mullerian inhibiting factor
What does the embryo contain during the indifferent period?
pair of undifferentiated gonads
two sets of ducts-mesonephric and paramesonephric
a set of elevations and folds around the cloacal membrane
What is the failure of testes to descend by birth?
How is congenital hydrocoele caused?
Cryptorchidism
Fluid leaking into tunic vaginalis during descent
What is the precursor to most of the prostate?
What is the precursor to the central zone (maybe)?
endoderm from prostatic urethra
mesoderm
Absence of what causes mesonephric ducts to atrophy?
Lack of what allows paramesonephric ducts to develop?
testosterone
MIF
What is an imperforate hymen?
hymen forms a complete septum across vagina, discovered when child begins to menstruate
What causes hypospadias?
What is associated with epispadias?
Incomplete fusion of urethral folds leads to ventral urethral opening
Urethra and penis open dorsally, associated with bladder exstrophy
What causes the development of male external genitalia in fetus?
presence of androgens
Sex chromosome disorders?
Klinefelters (XXY), Turner’s (XO), 46, XX or XY (Z gene), ovotesticular SDS (true hermaphrodite-mosaicism), gonadal dysgensis (can’t produce androgen)
Common cause for 46,XX DSD (female pseudohermaphrodite)?
Common cause for 46,XY DSD (male pseudohermaphrodite)?
What causes a micropenis?
Congenital adrenal hyperplasia (enhanced androgen exposure)
–21 hydroxylase deficiency
Androgen insensitivity syndrome
–most causes are actually idiopathic
Insufficient androgen production during androgen surge
PCOS presentation in clinic?
chronic anovulation
hyperandrogenism
Good evidence for menopause?
Fair evidence?
Poor evidence?
Vasomotor symptoms, vag dryness, sleep disturb, depressed mood
cognitive dys, urinary incontinence, sex dysfunction
body composition, joint aches and pains
What is the current indication for menopausal hormone therapy?
symptomatic women within a decade of their last period
“Chocolate cyst” is associated with what condition?
Endometriosis
What mutation is type 1 endometrial (endometroid) carcinoma associated with?
PTEN mutation
What mutation is associated with type II endometrial (serous) carcinoma?
p53 mutation
Most common benign tumor in females?
Leiomyomas
Stages of puberty?
First is the growth spurt.
Then breasts and pubic hair growth.
Menstruation is the last stage.
At what age should lack of secondary sex characteristics be evaluated?
At what age should lack of menstruation be evaluated?
14 years
16 years
Breast development is the result of ____?
Pubic hair growth is the result of ____?
Estrogen
Testosterone (to DHT)
An intact outflow duct is also important.
Test for precocious:
breast development
pubic/axillary hair
menstruation
Estrogen, FSH
Testosterone, LH
Estrogen, FSH, LH
Risk factor for tubal ectopic pregnancy
endometriosis
Tumors of the Fallopian tubes most associated with what gene?
BRCA
Most common mass of the ovary?
Functional cysts of the ovary
Most common ovarian neoplasm?
ovarian surface epithelial tumors
What cancer mestastizes to the ovary?
Breast cancer
What STI lesions are painful?
Which are painless?
Painful: herpes, chancroid, lymphogranuloma venereum
Not: syphilis, molluscum, genital wart
Unlike other DNA viruses, poxviruses (molluscum) replicate in?
What is present histologically in molluscum?
in the cytoplasm
large eosinophilic cytoplasmic inclusions
Most warts are caused by what strain of HPV?
Structurally, how is it different from molluscum and herpes virus?
6 and 11 (anything higher than 11 is a high risk strain) No envelope (has a capsid)
What STI bacteria do not gram stain?
Ureaplasma urealyticum Chlamydia trachomatis (cannot easily be seen)
Diagnostic of Gardnerella vaginalis?
Clue cells (epithelial cells with multiple pleomorphic bacteria in cytoplasm)
Risk factors for cervical neoplasia?
Early age at first intercourse
Multiple sex partners
Male partner with multiple previous sex partners
Persistent infection with high risk strain of HPV
How to recognize lower to high grade carcinoma in situ of cervix?
The nuclear to cytoplasm ratio increases.
What tumor suppressors do HPV E6 and E7 bind to promote DNA replication in more differentiated squamous cells?
p53 and Rb
Two strains of HPV that account for 70% of cases of CIN and cervical carcinoma?
HPV 16 and 18
Transition from quiescent to labor stage involves what hormonal transition?
Progesterone to estrogen dominance
How does oxytocin affect parturition?
Increases estrogen and prostaglandins
What do drugs that attempt to prevent preterm labor mostly try to do?
Preventing intracellular calcium influx
most common? maybe? Betamethasone before 34 weeks
Major cause of post partum hemorrhage?
Uterine atony
Maternal spiral arteries left open after delivery of the placenta
Most common benign breast disorder (due to repeated exposure to progesterone and estrogen during menstrual cycle)?
Fibroadenosis
cyst formation, slow growing masses of epithelium and CT
90% of breast cancers involve what? And are sensitive to what?
Duct epithelia
Estrogen levels
What unit of hCG provides specific activity?
What does it do?
Beta subunit
Prevents involution of the corpus luteum
Elevations of hCG above baseline levels is suspicious for?
multiple gestation, molar pregnancy
Which condition involved an open cervix?
Closed cervix?
Inevitable abortion
Threatened abortion
What is the discriminatory zone of hCG?
Levels above 1500-2000
Should be able to see normal pregnancy with transvaginal ultrasound
Complete versus partial molar pregancy
Partial: haploid ovum fertilized by two sperm or one sperm that duplicates
Complete: no fetal tissue or maternal DNA (hCG >100,000 or even 1,000,000)
What is snowstorm pattern on the ultrasound indicative of?
complete molar pregnancy
Drug used to treat ectopic pregnancy, hydatiform molar pregnancy, and choriocarcinoma
methotrexate
Most common second trimester infections?
TORCH
Toxoplasmosis, other=syphilis and parvovirus, rubella, cmv, herpes simplex
Classic triad of symptoms of toxoplasmosis in second trimester?
hydrocephalus, intracranial calcifications, chorioretinitis
Congenital CMV symptoms?
periventricular calcifications, intrauterine growth restriction, developmental delay, microcephaly, sensorineural hearing loss, retinitis, jaundice, hepatosplenomegaly, thrombocytopenia, hypotonia
Noninfectious second trimester complications
cervical insufficiency, fetal anomalies
Third trimester complications
PPROM, preterm labor, placental abnormalities, intrauterine fetal demise or growth restriction, macrosomia
What is placenta previa?
Placenta accreta?
Placenta abruption?
Placenta over internal cervical os, painless, implantation not secure
Placenta implantation extends into basal zone of endometrum
Hemorrhage into decidual basalis before birth, placental separation
What are the phases of sexual response?
excitement, plateau, orgasm and resolution
