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Flashcards in Everything Deck (58)
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What is the epithelial lining of the ovary?
Fallopian tubes?
Uterus?
Cervix?
Vagina?

Ovary - simple cuboidal
Fallopian tube - simple columnar
Uterus - simple columnar
Cervix - simple columnar (endocervix) and stratified squamous (exocervix)
Vagina - stratified squamous (nonkeratinized)

1

What is the triad of pre-eclampsia? What other conditions are associated?

Hypertension, proteinuria, and edema

Eclampsia is pre-eclampsia with seizures.

HELLP is pre-eclampsia with thrombotic microangiopathy involving the liver:
Hemolysis, Elevated Liver enzymes, Low Platelets (HELLP)

2

What causes pre-eclampsia?

Abnormality of maternal-fetal vascular interface in the placenta
Poor placental perfusion leads to release of inflammatory factors from hypoxic placenta = endothelial injury

3

What nerve is blocked by injecting anesthesia intravaginally in region of the ischial spine?

Pudendal nerve
derived from S2-S4 nerve roots
innervation to perineum and genitals

for complete perineal and genital anesthesia:
- genitofemoral nerve
- ilioinguinal nerve

4

Metastasis from a testicular cancer will spread to which lymph nodes?

Para-aortic (retroperitoneal) lymph nodes
Lymph drainage generally follows path of arterial supply -- testes originate within retroperitoneum and establish arterial supply from abdominal aorta, then descend through inguinal canals into scrotum

5

Where does lymph from the scrotum drain to?

Superficial inguinal lymph nodes

drain nearly all cutaneous structures inferior to the umbillicus, including external genitalia and the anus up to the pectinate line

6

Pt at 12wks gestation with high fasting levels of glucose and triglycerides. What hormone responsible?

human placental lactogen

- increases maternal insulin resistance (decreasing maternal glucose utilization and increasing blood glucose levels)
- increases maternal lipolysis and proteolysis (FFAs and ketones provide energy to mother, while glucose can go to fetus)

all serve to shunt carbohydrate metabolism (glucose and AAs) to the fetus, while FFAs, ketones, and glycerol provide energy for the mother

In hypoglycemia, hPL levels rise to maintain adequate fetal glucose supply.

7

What is the purpose of hPL?

serve to shunt carbohydrate metabolism (glucose and AAs) to the fetus, while FFAs, ketones, and glycerol provide energy for the mother

- increases maternal insulin resistance (decreasing maternal glucose utilization and increasing blood glucose levels)
- increases maternal lipolysis and proteolysis (FFAs and ketones provide energy to mother, while glucose can go to fetus)

8

Most common causes of pelvic inflammatory disease? Treatment? Presentation?

C. trachomatis and N. gonorrhoeae

3rd generation cephalosporin (ceftriaxone) used for N. gonorrhoeae
must ALWAYS include treatment for Chlamydia as well since Chlamydia often co-infects -- azithromycin or doxycycline (not sensitive to beta-lactams)

infection by either can often be asymptomatic
if symptomatic - purulent urethritis followed by ascension to the cervix and further spread to endometrium, tubes, peritoneum

9

Pt with infertility and history of purulent urethritis treated promptly with 3rd gen. cephalosporin -- reason?

tubule disease (PID) leading to infertility

treatment with ceftriaxone cleared up gonorrhea, but common co-infection with Chlamydia was not treated (not sensitive to beta-lactams) and asymptomatic infection led to Fallopian tube scarring and infertility

untreated urethritis, cervicitis, or PID leads to scarring of Fallopian tubes and infertility or ectopic pregnancy

10

Where are androgens converted to estrogen/estradiol? What enzyme is responsible for this conversion?

Granulosa cells

aromatase (converts androgens to estradiol under FSH stimulation)

11

What is the function of theca cells? What hormone regulates this process?

Theca cells convert cholesterol to androgens
(conversion catalyzed by desmolase enzyme)

LH stimulates theca cells (of the ovarian follicle) to produce androgens.

12

20yo male with gynecomastia, tall stature, small firm testicles? Lab findings?

Klinefelter's syndrome (XXY)

increased FSH levels
(dysgenesis of seminiferous tubules increases in decreased inhibin and increased FSH)

increased LH and estrogen
(abnormal Leydig cell function leads to decreased testosterone/loss of negative feedback)

13

On what day after ovulation and fertilization is beta-hCG detectable?

Day 8 - 11
one week after

14

What are Call-Exner bodies associated with?

Granulosa cell tumor (type of sex-cord stromal tumor)

15

What causes the LH surge? What hormone does the corpus luteum secrete?

progressive rise in estrogen as follicular phase advances

high levels of estrogen in the late follicular phase have a positive feedback effect on LH production --> LH surge

16

When does the secretory phase take place? What hormone predominates and what are the effects on the endometrium?

Secretory phase (day 15 - 28) from ovulation to the onset of menses

Progesterone predominates
- uterine glands coil and secrete glycogen-rich mucus
- endometrial stroma becomes edematous
- prominent spiral arteries extend to endometrial surface

17

Partial mole vs. complete mole:
- karyotype and origin?
- fetal tissue present?
- normal and/or hydropic villi?
- choriocarcinoma risk?

Partial mole:
- 69 chromosomes (XXX, XXY, XYY); normal ovum and 2 or duplicated sperm
- fetal tissue present
- both normal and hydropic villi
- minimal risk of malignancy

Complete mole:
- 46 chromosomes (XX, or very rarely XY); enucleated/empty egg and duplicated or 2 sperm
- NO fetal tissue
- mostly hydropic villi
- risk of choriocarcinoma

18

What serum marker is produced by malignant ovarian epithelial tumors?

CA-125

19

What is the most common type of ovarian malignancy?

majority arise from the surface epithelium of the ovary

20

Adenexal male in elderly female most likely?

ovarian malignancy

21

How many amnions and chorions for dizygotic twins?

ALWAYS 2 amnions and 2 chorions

22

How many chorions and amnions for monozygotic twins if separated:
- first 4 days
- 4-8 days
- 8-12 days
- 13+ days
Which is most common?

- first 4 days: 2 chorions, 2 amnions

- 4-8 days: 1 chorion, 2 amnions
(MOST COMMON)

- 8-12 days: 1 chorion, 1 amnion

- 13+ days: 1 chorion, 1 amnion (conjoined)

23

Two causes of amenorrhea with fully developed secondary sexual characteristics in a female? Hormone levels?

- imperforate hymen
- Müllerian duct abnormalities

normal levels of estrogen and gonadotropins (normal secondary sex traits)

24

What does nondisjunction in meiosis I lead to? Meiosis II?

Homologous chromosome separation in meiosis I:
failure leads to inheritance of BOTH of parent's homologous chromosomes (one chromatid from each of the two chromosomes in the parent)

Sister chromatid separation in meiosis II:
failure leads to inheritance of two identical sister chromatids from only ONE of the parent's homologous chromosomes

25

Null value looking at confidence interval for Relative Risk?
Null value looking at confidence interval for difference between two mean values?

Relative

26

Underdeveloped pt for 18yo, short, hirsutism, and small elongated ovaries? Genotype and mechanism?

Turner syndrome (XO)
due to mitotic error in early development

27

Congenital conditions associated with Turner syndrome?

- bicuspid aorta
- preductal coartation (femoral < brachial pulse, notched ribs)
- lymphatic defects lead to webbed neck and cystic hygroma
- horseshoe kidney

28

Endometrial glands in myometrium? Presentation?

Adenomyosis (endometriosis in the myometrium!)

uniformly enlarged uterus
menorrhagia or dysmenorrhea

29

What is the odds ratio? It is the main measure of association in what type of study design?

(For people that had disease, odds they had the exposure) / (For people that did not have disease, odds they had exposure)

Case control study