Female and Male GU/Repro Flashcards
(52 cards)
1
Q
epithelia of ovary
A
- simple
- cuboidal
- (aka germinal)
- rapidly proliferate to repair ovulatory surface defects
2
Q
epithelia of fallopian tube
A
- simple
- columnar
- ciliated cells transport egg/embryo
- damage can cause infertility, hydrosalpinx, ectopic pregnancy
3
Q
epithelia of uterus
A
- simple
- columnar
- (aka endometrium)
- stratum FUNCTIONALIS sloughs off d/r menstruation
- prolonged estrogen exposure prevents shedding, resulting in hyperplasia/malignancy
4
Q
epithelia of cervix
A
- ECTO-cervix:
- stratified
- squamous
- NON-keratinized
- ENDO-cervix:
- simple
- columnar
- cervical glans secrete mucus:
- thin and watery during ovulation
- mucus plug during pregnancy
- HPV infection predisposed to cervical malignancy
5
Q
epithelia of vagina
A
- stratified
- squamous
- NON-keratinized
- maintains acidic environment to prevent infection
6
Q
Endometriosis
A
- imp c/o chronic pain an dinfertility
- d/t endometrial cells implanted on various pelvic organs (mc:)
- ovary
- posterior cul-de-sac
- broad ligaments
- uterosacral ligaments
- histoL
- hemosiderin deposits
- endometrial glands or stroma outside the uterus
7
Q
Granulosa cell tumor of the ovary
A
- Clinical features:
- large unilat adnexal mass
- INC estrogen
- can present w/ endometrial hyperplasia
- precocious puberty
- INC inhibin
- Histo:
- Call-Exner bodies
- cuboidal granulosa cells
- rosette pattern
- coffee bean nuclei
- ylw theca cells with lipid
- Call-Exner bodies
8
Q
AFP (alpha-fetoprotein)
A
- normally produced by fetal liver and yolk sac
- tumor marker in pts with:
- hepatocellular ca
- NON-seminomatous testicular ca
- ovarian ca
9
Q
beta-hCG
A
- confirm pregnancy
- screen for:
- gestational trophoblastic dz
- germ cell tumors
10
Q
CA-125 (cancer antigen)
A
- elevated in epithelial carcinomas of the ovary
- serous
- endometriod
- clear cell
- stromal tumors do NOT release significant amounts of CA-125
11
Q
Sertoli-Leydif tumors
A
- type of ovarian sex cord tumor
- produces testosterone
- affected pts CP: evidence of HYPER-androgenism:
- hirsutism
- clitoromegaly
- deepening voice
12
Q
Struma ovarii
A
- germ cell tumor of the ovary
- can cause hyperthyroidism by secreting THYROXINE
- histopath: mature thyroid tissue
13
Q
septic abortion
A
- RF: pregnancy ermination with retaine dproducts of conception
- micro:
- gram neg bacilli
- S. aureus and E coli d/t seeding of the uterine cavity d/r instrumentation
- CP:
- fevers, chils, lower abdo pain, bloody or purulent vaginal discahrge
- boggy and tender uterus with dilated cervix
- pelvic US:
- retained products of conception
- INC vascularity
- echogenic material in the cavity
- thick endometrial stripe
14
Q
GnRH
A
pulsatile
15
Q
FSH…FGS
A
- FSH:
- granulosa (FEMALE)
- have aromatase
- location of androgen to estrogen
- sertoli (MALE)
- makes Inhibin B
- granulosa (FEMALE)
16
Q
LH…LTL
A
- Theca (interna) {FEMALE}
- cholesterol to androgens (and progesterone)
- Leydig {MALE}
- Testosterone
- neg feedback on LH and GnRH
- Testosterone
17
Q
FP vs. LS
A
- follicular/Proliferative
- first few days: menses
- primary, secondary, vesicular (surge of estradiol)
- LH and FSH surge at DAY 14
- —-crossover—-
- luteal/secretory
- corpus luteum-secretes progesterone
- regression
- corpus albicans
- making home for embryonic implantation (matures lining)
- spiral arterial coil
18
Q
ovary–E–LH
A
- FSH stimulates ovary (in menopause INC FSH)
- ovary stimulates estrogen release
- estrogen stimulates LH surge (similar to hCG)
- dominant follicle will RUPTURE
19
Q
progesterone withdrawal
A
- INC prostaglandins=vasocontriction of spiral arteries
- INC metalloproteases
- APOPTOSIS
- degeneration of functionalis later
- menstrual flow
20
Q
prolactin and menses
A
anovulation (lactational amenorrhea)
21
Q
functional hypothalamic amenorrhea
A
- secondary amen w.:
- low body weight
- frequent strenuous exercise
- lanugo (fine hair..inadequte calorie intake)
- seen in competitive atheltes, dancers, models
- reduced circulating leptin d/t diminished adipose tissue stores
- inhibits pulsatile GnRH form hypothalamus=DEC pit LH and FSH secretion=low circulating estrogen levels andddd amen
22
Q
what are three different types of contraceptive methods?
A
- systemic progestins
- locally-acting progestins
- copper IUD
23
Q
systemic progestins-contraceptives
A
- combined hormonal contraceptive:
- pill, transdermal patch, vaginal ring
- progestin implant/injection
- primary MOA: suppresses GnRH and pituitary gonadotropin secretion=inhibits ovulation
- b/c LH spike is required to stimulate ovulation
24
Q
locally acting progestins–Contraceptives
A
- progestin-only (Norethindrone) pill or Levonorgestrel IUD
- primary MOA: thickens cervical mucus and impairs sperm penetration
25
copper IUD--Contraceptives
* primary MOA: creates chronic cytotoxic inflammatory response in uterus impairing sperm migration
26
roles of progesterone and estrogen in hormonal contraceptives
* progestin-synthetic equivalent to progesterone
* responsible for pregnancy prevention in all hormonal contraceptives
* estrogen-included to improve the bleeding profile
27
what are the three mechanisms of Down syndrome
* meiotic NONdisjunction (95%)
* path: extra copy of c21 in every cell-recurrence based on maternal age
* unbalance translocation:
* all/pt of extra c21 ATTACHED to another chromosome
* HIGH recurrence risk if balances translocation is present in one parent
* Mosaicism
* SOME (nottt all) cells have extra c21 copy
* nondisjunction event in early embryonic life
28
SERMS
* tamoxifen and Raloxifene
* MOA: competitive inhibitor of estrogen binding
* mixed agonist/ANT-agonist
* indications:
* prevent breast ca in high-risk pts
* t: adjuvant tx of breast ca
* R: post-men osteoporosis
* SE:
* hot flashes
* venous thromboembolism
* endometrial hyperplasia and carcinoma (T only)
29
Tamoxifen and the L
* T has a favorable effect on serum lipids, with a DEC in total and LDL cholesterol
* no significant change in HDL
* serum TG may INC in some pts
30
amniotic fluid embolism (AFE)-Clinical features
* cardiogenic shock
* hypoxemic respiratory failure
* DIC
* tissue factor (thromboplastin) released from amniotic fluid
* triggers DIC
* seizures or coma
31
What is AFE (amniotic fluid embolism)
* rare complication d/r pregnancy or shortly after delivery
* PP:
* amniotic fluid with arachidonic acid metabolites enters maternal circulation through sites of uterine trauma or cervical lacerations
* get anaphylactoid rxn
* amniotic fluid causes occlusions and vasospasm of the maternal pulmonary circulaion=
* LV failure
* DEC CO
* severe V/Q mismatch
* hypoxia and hypotensive shock lead to cardiopulmonary arrest
32
AFE (amniotic fluid embolism) autopsy
* fetal squamous cells and mucin in the maternal pulmonary arteries
33
maternal serum alpha-fetoprotein screening (MSAFP)
* INC MSAFP:
* open NTD (anencephaly, open spina bifida)
* ventral wall defects (omphalocele, gastroschisis)
* multiple gestation
* DEC MSAFP
* aneuploidies (trisomy 18 & 21)
34
DS and unbalanced Robertsonian translocation
* entire long arm of one chromosome 21 is translocated to the long arm of an acocentric chromosome (chromosome 14)
* indivs have 46 chromosome, BUT one chrom14 is comprised of the long arms of both c14 and 21
* 46, XX, t(14;21)
* affected parent is asymptomatic
35
DS quadruple screen
* LOW MSAFP
* LOW unconjugated estriol
* HIGH beta-hCG
* HIGH Inhibin A (secreted from placenta with hCG)
36
perineal body
* tendinous ctr point of the perineum
* sepratates urogenital and anal triangles
* the following structures are anchored to it:
* bulbospongiosus muscle
* external anal sphincter muscle
* superficial and deep transverse perineal muscles
* fibers form the external urethral sphincter, levator ani, and muscular coat of the rectum
37
(midline) episiotomies
* espisiotomies are used to enlarge the vaginal outlet to facilitate delivery and reduce the risk of severe perineal laceration
* midline epi
* vertical incision from posterior vaginal opening to perineal body
* transects the vaginal lining and the submucosal tissue but NOT:
* *the external anal sphincter*
* *the rectal mucosa*
* improper repair of a midline epi--\>pelvic organ prolapse of dyspareunia
38
What happens when the clitoris is stimulated
ischiocavernosus muscle forces blood into the clitoris
39
levator ani muscle
* part of anal triangle
* supports pelvic floor
* can be strengthened by Kegel exercises
* often stretched, pushed aside, torn by fetal crowning and delivery
40
imperforate hymen
* **obstructive lesion** caused by *incomplete degeneration* of the ctl portion of the *fibrous tissue band* connecting the walls of the vagina
* CP:
* primary amenorrhea
* **nml secondary sex characteristics**
* cycliv abdominal or pelvic pain d/t accumulation of menstrual blood in vagina and uterus (**hematocolpos**)
* pressure from collection of blood=*back pain and difficulties with defecation*
* examination:
* vaginal bulge and/or mass palpated anterior to the rectum
41
Kallman syndrome
* d/t impaired synthesis of gonadotropin-releasing hormone by hypothalamus
* CP:
* primary amenorrhea
* absent secondary sexual characteristics
* olfactory sensory defect
42
urethral injury
* FOley catheter is contraindicated, can owrsen injury
* perform retrograde urethrogram to assess urethral integrity
43
dysmorphic features of DS
* epicanthal folds
* upslanting palpebral fissures
* protruding tongue
* excessive skin at the nape of the neck
* borth weight and length below avg
* hypotonia and a weak startle (Moro) reflex
44
pudendal nerve block for perineal laceration repair
* PN is derived from S2-S4 nerve roots
* sensory: perinum and motor: urethral and anal sphincters
* landmarks:
* ischial spines and sacrospinus ligament
* ischial spines=bony protrusions located posterolateral to the vaginal sidewall
* sacrospinus ligament=firm band that runs medially and posteriorly from the ischial spine to the sacrum
45
lateral femoral cutaneous
* L2-L3
* sensory to anterior and lateral thigh
46
inferior gluteal
* L5-S2
* motor to gluteus maximus
47
genitofemorl
* L1-L2
* sensory to scrotum/labia majora, medial thigh
48
obturator
* L3-L4
* sensory to medial thigh and motor to adduction
49
iliohypogastric
T12-L1 and sensory to suprapubic
50
congenital torticollis epi + PP
* develops 2-4 wks of age
* mc d/t: birth trauma (breech delivery) --or-- malposition of the head in utero (d/t fetal macrosomia or oligohydramnios)
* result: SCM injury and fibrosis
51
congenital torticollis CP and PE
* CP:additional musculoskeletal anomalies:
* hip dysplasia
* metatarsus adductus (adduction of the forefoot)
* talipes quinovarus (clubfoot)
* clinical diagnosis:
* PE: head tilted toward the affected side
* chin pointed away form contracture
* soft-tissue mass may be palpable in inferior 1/3 of affected SCM
* sever casesL plagiocephaly and facial asymmetry
* Tx: resolve with conservative therapy and stretching exercises
52
Metronidazole disulfiram-like reaction
* Metro treats trichomonas vaginitis and bacterial vaginosis
* avoid alcohol!!! or.... will get disulfiram-like reaction
* inhibits *acetaldehyde dehydrogenase* and causes **acetaldehyde accumulation**
* systemic adverse effects: HA, abdo cramps, nausea, flushing
