Repro Flashcards by Tom Pisano

Point in time when fetus is most at risk to teratogens? Why?

3-8 weeks dt organgenesis taking place

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What secretes MIF during male devo?

Sertoli cells

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Male devo process?

What cell types make what hormone? What do they do?

SRY gene of Y chromo produces TDF (testes devo factor)

From this comes:
Sertoli–>MIF–l Female devo
Leydig—>Androgens–>Male devo (testo=internal male, DHT=external male genitalia)

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Bicornate Uterus: how? Presentation?

Failure of fusion of the paramesonephric ducts. Repeated miscarages

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Most common cause of developing both male and female internal genitalia and male external

No sertoli cells thus get devo of both paramesonephric and mesonephric ducts

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5 alpha reductase def phenotype?

Cannot convert Test into DHT thus ambigus gentilia until puberty when you have enough of a surge to promote virulization

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Gubernaculum in females

Ovarian ligament and round ligament

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Broad ligament. Contains?

“Wing” between the Fallopian tube, ovaries and Uterus.

Contains Round ligament inside it

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Suspensatory Ligament (Infundibulopelvic ligament) of ovaries. Contains?

Connects ovaries to lateral pelvic wall.

Contains Ovarian vessels (need to be ligated before ophorectomy). Ureter courses retroperitoneally and risk for injury during ligation.

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Cardinal Ligament. Contains?

Connects cervix (C-ardnial C-ervix) to pelvic wall.
Contains Uterine Vessels (risk during hysterectomy)

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Round ligament. Contains?

Uterine fundus to labia majora (contination of Suspensatory ligament and female version of gubernaculum).
Contains nothing

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Ovarian ligament? Contains?

Medial Ovary to lateral uterus (derivative of gubernaculum)

Contains nothing.

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Pathway of Sperm during ejaculation?

SEVEN UP

Seminiferous tubules, Epididymis, Vas Deferens, Ejaculatory Ducts, (Nothing), Urethra, Penis

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Gene associated with high rates of endometrial cancer?

PTEN mutations

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Post menopausal bleeding?

Cancer until proven otherwise.

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Uterine Contraction?

Uterine Relaxation?

Contraction: PG and Oxytocin
Relaxation: B2

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Older woman with distended abdomen. Upon biopsy there is copious amount of gelatinous material.

Pseudomyxoma Peritonei (“JELLY BELLY”) from mucinous ovarian tumor thats seeded peritoneum.

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Leydig Cell tumor unique feature?

Reinke crystals

Testicular Tumor Markers:
Seminoma
Yolk Sac tumor
Choriocarcinoma
Embyronal carcinoma

Seminoma: Placental alkaline phosphatase/LDH
Yolk Sac tumor: Alpha feto protein
Choriocarcinoma: Beta-hCG
Embyronal carcinoma: Alpha feto AND beta hCG

Presentation of complete androgen insensitivity?

Tall, Large breasted, hairless, blind vaginal pouch, testis in labia—remove post puberty to prevent seminoma risk

OCP mechanism?

Continous levels of E2/P4 which prevent LH surge thus no ovulation

Where does the majority of a females:
DHEAS
Androsteindione
Testosterone 
DHT come from?

DHEAS/Androsteindione comes from adrenals. (AnDRo from ADrenals)
DHT/Testosterone comes from ovaries.

Increased estrogen exposure puts woman at risk for? Examples?

Breast cancer.
Anvulatory cycle (also at risk for endometrial), early menarche, late menopaus, obesity, increased breast tissue

Best marker of a healthy pregnancy towards end of preg?

E3 levels made by placenta. E2:E3 ratio remains 1:1 (competing for same estrogen receptor) until the end when E3 increases dramatically causing uterine contractions.

Cancer that can produce T3/T4?

Struma Ovarii (ovarian teratoma)

Oocytes arrested in what phase until preovulation? | Oocytes arrested in what phase postovulation until fertilized?

Prophase I: O-vulation prOphase | Metaphase II: until egg MET sperm.

Best test to Dx menopause?

FSH levels---they are the first to increase. (logically makes sense since this is a decline in follicles and hypo/pit are trying to stimulate them)

Male presents to you for infertility. He has is tall and has long arms. What do you suspect? What other things might he have? What test could you do? Hormone levels?

1) Hypogonadism due to Klinefelter's XXY. 2) Testicular Atrophy (small firm hard testis), Gynecomastia, Eunuchoid body habitus, female hair distribution. Possibly developmental delay 3) Look for barr body showing x chomo inactivation. 4) Issue at gonads thus increased FSH/LH. Decreased inhibin/test. Increased Estrogen.

Most common cause of Primary amenorrhia? Why? Accompanying presentation? How to assist with Preg?

1) Turners, XO. Dt ovarian dysgenesis (streak ovaries*******) 2) Short stature, webbed neck (posterior Cervical hygroma), Lymphatic defects in general. Shield chest, widely space nipples. Horsehoe kidney, Preductal Coarcatation, bicuspid aortic valve 3) Oocyte donation (cuz dysfunctional ovaries) and hormone replacement (E2, P4)

2 Tx for a female that comes in with too much B-hCG for her gestational age?

1) Dilation and curettage--risk for asherman's | 2) Methotrexate

Female presents with signs of appendicitis... | You do the right thing and do a quick pregnancy test, and you see low levels of BhCG, what do you think?

Atopic pregnancy, can mimic signs of appendicitis. There will be lower than normal pregnancy levels of BhCG

Condyloma Accuminata vs Lata?

Accuminata=HPV 6/11 | Lata=Syphilis (l's in lata and syphilis)

Where does cervical carcinoma invade? Causing?

Likes to invade locally. Will go and obstruct Ureters leading to hydronephrosis and renal failure

Landmark for pudendal nerve block?

Ischial Spine

Cryptorchism at risk for what?

GERM CELL TUMORS

3 Major risk factors for ED?

Diabetic, Atherosclerosis, and Coronary Heart Disease

Common side effect of Nitrates and PDE-5 inhibitors?

Headache, Flushing, HOTN (why you can't combine them.

Flutamide vs Finesteride?

Flutamide: Andro Receptor Antagonist ("Doug Flutie's a girl")-tx for Prostate Cancer Finesteride: 5-Alpha Reductase inhibitor; Tx for BPH, and allopecia

Fertilization most commonly occurs in?

The ampulla of uterine tubes (2nd part of tubes)

Urachal vs Vitelline ducts?

Urachal for U-rine | Vitelline connection to GI tube

Cavernous Nerves of penis do they come from (2 levels)? Damage likely during what surgery? Causing what?

Cavernous nerves of penis from prostatic nervous plexus which comes from Inferior hypogastric plexus. Damaged during prostatectomy/surgery (they are in the prostate fascial shell of the prostate) resulting in ED

OCP's can cause what liver disease? What else can cause it?

Hepatic Adenoma. Anabolic Steroids

Maternal Diabetes puts child at risk for?

Macrosomia (tractional type birthing issues=eg erb palsy), transposition of the great arteries, and Caudal Regression syndrome