1 Reproductive Basics

Question 1

Produced by placental syncytiotrophoblast

Starts to appear by 10th week post fertilization, peaks at 9-10th week and plateaus by 20-22nd week

It has 2 subunits: alpha and beta

Answer 1

Human Chorionic Gonadotrophin

Question 2

3 functions of HCG

Answer 2

1. Maintains corpus luteum
2. Regulate steroid biosynthesis (placenta, fetal adrenal gland)
3. Testosterone source for male testes

Question 3

HCG subunit specific for PREGNANCY

Answer 3

Beta Subunit

Question 4

Pregnancy related hormone that is diabetogenic

Answer 4

HPL

parallels placental growth

Question 5

Sources of Progesterone during Pregnancy

Answer 5

Upto 6-7th week - corpus luteum

7-9th week CL + placenta

9th wk onwards - placenta only

Question 6

Early pregnancy fxn of progesterone

Answer 6

Endometrial secretory changes favorable for blastocyst implantation

Question 7

Late pregnancy fxn of progesterone

Answer 7

Immune tolerance and prevent myometrial contractions

Question 8

Estrogen moeities

Answer 8

• Estriol - non pregnant, reproductive years (follicle, granulosa, aromatase enzyme)
• •Estradiol - placenta (fetal adrenal DHEAS, sulfatase enzyme)
• ••Estrone - menopause (adipose)

Question 9

Cardiovascular Changes

Answer 9

Arterial BP
•systolic⬇️
•diastolic ⬇️⬇️

Venous Pressure
•central unchanged
•femoral ⬆️

Plasma volume ⬆️ by 50%

SVR - ⬇️ by 30%

Cardiac Output - ⬆️ by 50%

Murmurs (+) systolic ejection murmur at left SB

Slight Axis Deviation

Question 10

Hematologic Changes

Answer 10

⬆️ RBC mass, ⬆️ Plasma volume = Hemodilutional Anemia

WBC ⬆️

ESR ⬆️

Platelet “none”

Coag Fx - ⬆️⬆️ “hypercoaguble state”

Question 11

Pulmonary Changes

Answer 11

⬆️ TV, Minute Ventilation

Maintained VC

⬇️ Residual volume

Blood Gas - resp alkalosis

Question 12

In utero Shunts

Answer 12

Ductus Venosus (UV ⏩ IVC, RA)
•bypass liver sinusoids
Foramen Ovale (RA ⏩ LA)
•bypass pulmo circ
Ductus Arteriosus ( PA ⏩ Desc Aorta)

Question 13

Breast and Hormones

Answer 13

Estrogen
•from ovarian follicle
•duct, nipples, fat devt

Progesterone
•Corpus luteum
•Lobules and alveolar growth

Prolactin
•APG - milk production

Oxytocin
•PPG milk ejection

Question 14

Starts at conception ends with blastocyst implantation

Morula (intratubal phase) ⏩ Blastocyst (intrauterine)

Answer 14

1st week postconception

Question 15

Starts with implantation ends with devt of bilaminar germ disk

Development of syncytiotrophoblast

Answer 15

2nd week postconception

Question 16

Starts with 2-layer embryo ends with devt of trilaminar germ disk

Answer 16

3rd week postconception

Question 17

Earliest period of detecting serum B-HCG

Answer 17

2nd week (syncytiotrophoblast formation)

Question 18

Primordium of female internal reproductive system

In males ⏩ secretion of inhibitory factor to cause involution

Answer 18

Parasmesonephric (Mullerian) Duct

Question 19

Primordium of male internal reproductive system

Requires androgenic (testosterone) stimulation

Answer 19

Mesonephric (Wolffian) Ducts

Question 20

Devt of male external genitalia requires _____________ stimulation

Answer 20

DHT

Question 21

Period of greatest TERATOGENIC risks

Answer 21

3rd-8th week PC

Question 22

Teratogenic Agents

Answer 22

Ionizing Radiation - at 8-15th wk at least 20 rads

Chemo - 1st tri phenomenon

Tobacco - IUGR, preterm delivery, NO SYNDROME

Alcohol - FAS, midfacial hypoplasia, microcephaly, MR, IUGR

Cocaine - Abruptio, PD, IVH, IUGR

Marijuana - PD

Question 23

IUGR, MIDFACIAL HYPOPLASIA, LONg PHILTRUM, devt delay, short palpebral fissures, multiple joint anomalies, cardiac defects

Answer 23

Fetal Alcohol Syndrome

Question 24

T shaped uterus, vaginal adenosis, cervical hood, incompetent cervix, PD

Answer 24

Diethylstilbesterol DES syndrome

Question 25

IUGR, CF DYSMORPHISM, MR, MICROCEPHALY, nail hypoplasia, heart defects Neonatal ⬇️⬇️ Vit K dependent CF : II, VII, IX, X

Answer 25

Fetal Hydantoin (Dilantin) Syndrome

Question 26

Congenital Deafness, microtia, CNS defects, CHD

Answer 26

Isotretinoin

Question 27

Ebstein’s Anomaly (R heart defect)

Answer 27

Lithium

Question 28

VII nerve damage, hearing loss

Answer 28

Streptomycin

Question 29

Phocomelia, limb reduction defects, ear/nasal anomalies, pyloric/duodenal stenosis

Answer 29

Thalidomide

Question 30

Neural Tube Defects | Cleft lip, renal defects

Answer 30

Valproic Acid

Question 31

CHONDRODYSPLASIA (stippled epiphysis), microcephaly, MR, optic atrophy

Answer 31

Warfarin

Question 32

Most common aneuploidies in miscarriage

Answer 32

Trisomy 16 | Monosomy X

Question 33

``` Cystic hygromas Streak gonads 1 amenorrhea, infertility Short stature Neck webbing ```

Answer 33

``` Monosomy X (45 X) aka Turner’s Syndrome ```

Question 34

Tall stature, testicular atrophy , azospermia, gynecomastia

Answer 34

Klinefelter Syndrome (47, XXY)

Question 35

Short stature, MR, endocardial cushion defects (and/or) duodenal atresia

Answer 35

Trisomy 21

Question 36

Profound MR Rocker-bottom feet Clenched fists

Answer 36

Edward Syndrome (T18)

Question 37

IUGR, holosprosencephaly, cyclopia, severe cleft lip with palate fat

Answer 37

Patau Syndrome (T13)

Question 38

Transmission M=F, serial Delayed onset, variable c/e 50% of offsprings No carrier states

Answer 38

Autosomal Dominant

Question 39

AD : presence of carrier states

Answer 39

False

Question 40

Male=Females Skips generations Early, consistent c/e Carrier states

Answer 40

Autosomal Recessive

Question 41

AR genes Both parents HZ 1 parent HZ, HO Both parents, HO

Answer 41

50% aff 25% aff, 50% carrier, 25% N 100% aff

Question 42

HO females, Male carriers HO females, lethality in males

Answer 42

X-linked Dominant

Question 43

No male-male trans Exp only in males Female are carriers

Answer 43

X-linked Recessive

Question 44

Womem who are high risk for NTD should take _______ of Folic acid.

Answer 44

4mg (Absence of risk : 0.4mg)

Question 45

NTD, CHD, CL/P and pyloric stenosis are birth defects with _______ inheritance

Answer 45

Polygenic