Flashcards in Repro Deck (80):
Fetal development, what happens in:
Wk1, 2, 3, 3-8, 4, 8, 10
3=trilaminar disc, gastrulation
3-8=embryonic period, organogenesis
4=4 limbs, neural tube closes, heart beats
8=fetus moves, looks like baby
10=genitalia look M/F
What is gastrulation? How does it start?
process to form trilaminar embryonic disc w/in wk3
- epiblast invaginates to form the primitive streak
benign Rathke's pouch tumor w/ choles crystals, calcifications
Parotid, sweat and mammary glands are from where?
Adenohypophysis (ant pit) and lens of eye are from where?
Neuroectoderm makes what 4 things?
Brain, SC, retina and optic n. (CNS)
Neural crest makes what + 3 cell types?
PNS and melanocytes, chromaffin cells of ad med, C cells of thyroid
Schwann cells, pia and arachnoid, bones of skull, odontoblasts and aorticopulm septum are made from where?
Limb defects (bone and m.)
Notochord induces ectoderm to form neuroectoderm (neural plate) -> forms what in adult?
Nucleus pulposus of intervertebral disc
Endoderm forms what 9 strucs?
Gut tube epi + lungs, liver, GB, panc, eustachian tube, thymus, parathyroid, thyroid follicular cells
What are the umbilical art's in adults? What is the umbilical vein?
Medial umbilical ligaments
When does the yolk sac form the allantois?
What does the allantois become?
If this doesn't occur what happens?
It extends into UG sinus and becomes the urachus (duct btwn bladder and yolk sac)
- Patent urachus (urine out thr um) or vesicourachal diverticulum (outpouching of bladder)
What is the vitelline duct?
When does it obliterate?
Failure of it to close results in (2)?
Omphalo-mesenteric duct, which connects yolk sac to midgut lumen
Vitelline fistula (poo out thr umbilicus) or Meckel's diverticulum (parietal closure, patent part attached to ileum)
Aortic arches become:
1st, 2nd, 3rd, 4th, 6th?
1=MAXillary a. (1 is MAXimal)
2=Stapedial and hyoid a's (Second Stapedial)
3=Common Carotid and prox part of int Carotid (C is 3rd letter)
4=on L Ao arch, on R prox R subclavian a. (4 limbs, systemic a's)
6=prox pulm a's and on L ductus arteriosus (6 is pulm stuff)
Where do L and R recurrent laryngeal n's wrap around?
R loops around where R branciocephalic a becomes R CC and R SC
L loops around Ao arch, caught by ductus arteriosus
Where are brachial (pharyngeal) apparatuses derived from?
CAP (outside to inside)
Clefts = ectoderm
Arches = mesoderm
Pouches = endoderm
Branchial clefts are derived from?
- if this persists?
1=ext auditory meatus
2-4=temp cervical sinuses -> obliterated by 2nd arch mesenchyme
- persistent cervical cyst -> branchial cleft cyst in lat neck
1st branchial arch:
- cart? m's? n's?
- Meckel's cart: Mandible, Malleus, incus, spheno-Mandibular lig
- M's of Mastication, Mylohyoid, ant belly of digastric, tensor tympani/veli palatini
- V2/3 = chew!
Treacher Collins synd =
1st arch neural crest fails to migrate -> mandibular hypoplasia and facial abnl'ities
2nd branchial arch:
- cart? m's? n's?
-Reichert's cart: Stapes, Styloid process, lesser horn of hyoid, Stylohyoid lig
-M's of facial exp'n, Stapedius, Stylohyoid, post belly of digastric
-CNVII (facial exp'n) -> Smile!
3rd branchial arch:
- cart? m's? n's?
- Cart: greater horn of hyoid
- Stylopharyngeaus (innervated by...)
- CN IX=glossoPHARYNGEAL (swallow STYLishly)
Congenital pharyngocutaneous fistua =
persistence of cleft and pouch -> fistula btwn tonsillar area, cleft in lat neck
4th branchial arch: m and n?
3+4th arches together form?
- most pharyngeal constrictors, cricothyroid, levator veli palatini
- CN X (sup laryngeal branch for swallowing)
- post 1/3 of tongue
6th branchial arch: m and n?
- All m's of larynx (except cricothyroid)
- CN X (recurrent laryngeal branch for speaking)
CNs w/ both motor and sensory components?
Those which derive from branchial arches (except V2, sensory only):
V3 (1st), VII (2nd), IX (3rd), X (4+6th)
Branchial pouch derivatives (1-4)?
Ear, tonsils, bottom-to-top:
3=dorsal (bottom: inf parathyroids)
3=ventral (to: thymus)
4=(top: sup parathyroids)
- mutation in
- 3 manifestations
germline RET (neural crest cells)
- Pheo in ad medulla
- PT tumor (3/4th pharyngeal pouches)
- Parafollic cells (med thyroid ca) (from neural crest cells, 4/5th pouches)
Cleft lip/palate are due to?
Lip: maxillary and med nasal processes don't fuse
Palate: lat palantine, nasal septum and/or med palantine don't fuse
- stays due to ? from ?
- grows due to?
- MIF from Sertoli cells (bc of testis-determining factor)
- Testos from Leydig cells
- SEED: Seminal vesicles, Epididymis, Ejaculatory duct, Ductus deferens
What is the F equivalent of:
- glans penis
- corpus cavernosum and spongiosum
- bulbourethral gl's (of Cowper)
- ventral shaft of penis (penile urethra)
- glans clitoris
- vestibular bulbs
- greater vestibular bulbs (of Bartholin)
- urethral and paraurethral gl's (of Skene)
- labia minora
- labia majora
3 parts of the broad ligament around the uterus?
Mesometrium under the lig of the ovary
Mesosalpinx over the lig of the ovary
Mesoovarium coverin the ovary
What cell layer makes up:
- fallopian tube
- stratified sq epi, not keratinized
- stratified sq epi
- simple columnar epi
- simple columnar epi, pseudostratified tubular glands
- simple columnar epi, ciliated
- simple cuboidal epi
Pthwy of sperm during ejaculation?
Seminiferous tubules -> Epididymis -> Vas deferens (seminal vesicle, prostate) -> Ejac ducts -> (nothing) -> Urethra -> Penis
What n's are involved in erection, emission, and ejaculation?
- what level of SC?
Pelvic n. (parasymp) [S2-S4]
Hypogastric n. (symp NS)
Pudendal n. [T12-L1]
- secrete what 3 substances?
- tight jxns btwn cells form?
- purpose of cells?
- are sensitive to?
- inhibin B to inhibit FSH, ABP (androgen BP) to keep local testos level, MIF
- bl-testis barrier
- support/nourish developing spermatozoa
- T: high T -> decr'd sperm prod and less inhibin (varicocele, cryptorchidism)
- are they T sensitive?
Where does estrogen come from:
- most to least potent?
- adipose tissue via aromatization
- estradiol > estrone > estriol
FSH works on which cell? stim's what?
LH works on which cell? stim's what?
FSH on granulosa cell to make estrogen from androstenedione via aromatase
LH on theca cell to make androstenedione from choles via desmolase
- action on LH/FSH?
- actions on uterus?
- decr'd proges has what affect on fertility?
- elevation if it is indicative of?
- CL, placenta, ad cortex, testes
- inhib's them
- SmM relax (no contractions), decr'd estrogen R expressivity, decr'd myometrial excitation, stim'n of endometrial gl secretions and spiral art. development
- decr'd fertility bc endometrium isn't maintained to support implantation
breast bud forms in Tanner stage II (vs. pubarche when pubic hair appears)
bl from ruptured follicle or follicular enlargement causes peritoneal irritation that can mimic appendicitis
- Meiosis I is arrested at? as?
- Meiosis II is arrested at? as?
- if fertilized, becomes?
- prOphase I for yrs until Ovulation; (2n, 4c), 46 sister chromatids
- METaphase II until fertilization (2* oocytes) [An egg MET a sperm]; (1n, 2c), 23 sister chromatids
- haploid (1n, 1c)
hCG levels during preg are?
From CL until wk8, rising levels
Then placenta makes own estriol and proges, so levels decr, but come up again a little at wk30
- avg age? earlier in who?
- confirmatory test?
- hormonal changes are?
- sx of menopause?
- FSH (no neg fdbk from estrogen)
- decr'd estrogen, very incr'd FSH, incr'd LH (no surge), incr'd GnRH
- Menopause causes HHAVOC:
Hirsutism (incr'd androgens), Hot flashes, Atrophy of Vagina, Osteoporosis, CAD
How do you make estrone?
Androstenedione from ad cortex (although is also made in ovaries) is converte to estrone via aromatase in periph adipose cells
Where does estriol come from?
Estrogen of preg; end-product of estradiol metab'n; derives from fetal ad, placenta and mat liver
Where is DHEA from? What about DHEA-sulfate?
DHEA is 80% from ad cortex, rest from ovaries
DHEA-S is almost ALL from ad cortex
During preg, incr'd pl vol does what in kidneys?
- Why do you want an incr'd pl vol?
Incr's GFR, which incr's the clearance of urea and Cr so that their serum levels are at the lower limit of nl
- to incr the P needed to pump bl into mat lake in placenta
Do have a resp acidosis or alkalosis during preg? Why?
Alkalosis bc estrogen/proges stim the resp center -> decr'd PCO2 and incr'd PO2
During preg estrogen stim's incr'd production of what hormones?
T4 and cortisol, bc stim's syn of thyroid-binding globulin and transcortin -> incr'd BPs incr's the level of hormones, but the free fraction is still the same
- due to?
- incr'd risk of?
- fdbk loop perpetuating this?
- cysts come from?
- incr'd pit syn of LH and decr'd syn of FSH (LH:FSH ratio >2)
- hirsutism from incr'd LH stim'ing androgen syn
- endometrial ca from incr'd estrogen (from aromatization of androgens)
- incr'd estrogen -> pos fdbk on LH but neg fdbk on FSH -> more LH and less FSH
- supp'n of FSH -> follicle degen; fluid accum's -> subcortical cysts that enlarge the ovaries
- OCPs or medroxyprogesterone (decr's LH and androgenesis); spironolactone (for acne); clomiphene (for women who want to get preggers), metformin (for DM)
- incr'd bl loss
- incr'd flow and duration at irreg int's
- combo of meno- and metro-
- int's >35d
- int's <21d
1* dysmenorrhea sx due to?
2* dysmenorrhea usu due to?
PGF2a -> incr's uterine contractions
- triad of sx?
functioning gl's and stroma outside the uterus, usu in ovaries
- dysmenorrhea, dyspareunia (painful sex), infertility
Palpable ovaries in postmenopausal woman ddx?
Ovarian ca until proven otherwise
- Maternal surface?
- Fetal surface?
- cotyledons covered by decidua basalis
- amnion around fetus, covered by chorionic plate which is made of chorionic villi (lined by trophoblastic tissue: outside syncytiotrophoblast, inside cytotrophoblast)
HELLP synd =
- assoc'd w/?
- can proceed to?
Hemolysis, Elevated Liver nz's, Low Plt ct
Triad of preg labs for Down synd?
Low urine estriol and aFP
- due to?
- mortal from?
= HTN, proteinuria, edema
= preeclampsia + seizures
- placental ischemia from no vasodil of spiral art's -> incr'd vasc tone and HTN
- cerebral hemorrhage and ARDS
- delivery; IV Mg sulfate to prevent/trt seizures
Placenta accreta =
defective decidual layer allows placenta to attach to myometrium m. -> doesn't separate after birth -> hemorrhage, often needs hysterectomy
What do HPV 16 and 18 make to predispose one to ca?
HPV 16 - E6 = inhib's p53 suppressor gene
HPV 18 - E7 = inhib's Rb suppressor gene
TRF (thyroid releasing factor) stim's?
T4 and PRL
Drugs that can cause gynecomastia:
"Some Drugs Create Awkward Knockers"
Spironolactone (displaces E from SHBG and blocks androgen Rs)
Digoxin (has E activity)
Cimetidine (DHT R antag -> more E effects)
Alcohol (destroys liver -> more E bc not broken down)
Ketoconazole (displace E from SHBG)
Dizygotic twins in the womb are?
Monozygotic twins are usu?
Chorionic villi is made of?
Cytotrophobl on inner layer
Syncytiotrophobl on outer layer
- incr'd hCG and LDH
- incr'd hCG
- incr'd AFP
- dysgerminoma (assoc'd w/ Turner synd)
- choriocarcinoma (no chorionic villi!, goes to bl)
- yolk sac (endodermal sinus) tumor (Schiller-Duval bodies)
Struma ovarii =
ovarian teratoma w/ functional thyroid tissue
- psamomma bodies, malig, bilat
- lined w/ fallopian tube-like epi, benign
- looks like bladder, pale yellow tan, coffee bean nuc
- assoc'd w/ pseudomyxoma peritonei
- part of Meigs' synd
- serous cystadenocarcinoma
- serous cystadenoma
- Brenner tumor
- mucinous cystadenocarcinoma (jelly belly from tumor)
- ov fibroma (+ascites and hydrothorax)
- Call-Exner bodies
- mucin-secreting signet cell
- lined by mucus-secreting epi
- granuloma cell tumor (follicles w/ Eo'ic secretions)
- Krunkenberg tumor (GI met to ov's, adenoca)
- mucinous cystadenoca
Sarcoma botryoides =
- stain for?
rhabdomyosarcoma in vagina of yg girls
- desmin (+) bc stains m. cells
Vaginal tumor spreads which which LNs?
Lower 2/3 to inguinal LNs
Upper 1/3 to regional iliac nodes
- sm mobile firm mass w/ sharp edges
- sm tumor in under areola
- leaf-life projections, ct and cysts
- fibroadenoma (does NOT become ca)
- intraductal papilloma
- Phyllodes tumor
- ductal caseous necrosis
- stellate morpho, rock-hard
- row of cells, bilat, mult lesions
- Comedocarcinoma (type of DCIS)
- invasive ductal (worst, most common!)
- invasive lobular (no E-cadherin so can't make gl's)
- invades lymph, dimpled br skin
- lots of lymphs, BRCA1
- PAS+, keratin +, S100-
- Inflamm (neoplastic cells block lymph)
- medullary invasive ca
- Paget's dz (suggests DCIS)
- breast lumps, blue domed
- breast lumps, calcifications
- painless lump, calcifications
- cystic fibrocystic change
- sclerosing adenosis (fibrocystic change)
- fat necrosis
- incr'd FSH/LH, decr'd inhibin, T decr'd if bilat and nl if unilat
- incr'd PLAP, fried-egg appearance, malig
- incr'd AFP
- incr'd hCG
- incr'd hCG and/or AFP
- glandular/papillary, w/ bl/necrosis
- seminoma (most common! homogenous gray w/ no bl/necrosis)
- yolk sac (endodermal sinus) tumor (Schiller-Duval bodies), usu kids d hCG and/or AFP)
hCG can act on what 3 Rs?
TSH, FSH, and LH Rs