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Flashcards in Reproduction Deck (146):
1

Fibrocystic Breast Disease

- Dense and lumpy breast
- Waxes and wanes with menstrual cycles

2

Intraductal Papilloma (of Breast)

Benign
MC cause of spontaneous nipple discharge BUT it is bloody or serosanguinous
- small tumor of lactiferous ducts usually beneath areola
- in premenopausal women

3

Endometritis

After giving birth is commonly from Bacteroides (leukocytosis and foul smelling discharge)

4

During erection, venous blood fills in:

Corpus cavernosa

5

_______ Passes through Inguinal Canal in Females

Round Ligament

6

Increased Risk of Leiomyoma in:

Black women

7

PCOS: LH and FSH

High LH/FSH ratio (LH very high and FSH is low)

8

Nerves and Vessels in ____________ of Ovary

Suspensory Ligament

9

______ decrease risk of Non-hereditary Ovarian Cancer

OCPs (fewer ovulatory cycles)

10

Pseudomyxoma Peritonei

(jelly belly): MC originates from ovary or appendix

11

VDRL/RPR & FTA-ABS

VDRL/RPR (screening) or FTA-ABS+(confirmatory): Syphilis (treponema)
- Can cause an aneurysm due to vasa vasorum obliteration

12

Tertiary Syphilis

- Obliterative endarteritis of the vasa vasorum: Aortic aneurysm risk
- Argyll Robertson pupils
- Tabes dorsalis

13

Homeobox genes

DNA binding transcription factors

14

Lithium as teratogen

Ebstein anomaly (tricuspid valve abnormality w/ atrialized RV)

15

If newborn presents with opioid withdrawal symptoms:

(rhinorrhea, diarrhea, seizure, sneezing, tremor, etc.), give a tincture of opium

16

Rhabdomyosarcoma

Grape-like mass in vagina of child

17

Lymphogranuloma venerium

- aw/ chlamydia
- Necrotizing granulomatous inflammation of inguinal lymphatics
- Initially painless then later very painful lymph nodes

18

Drugs causing Erectile Dysfunction

SSRIs and sympathetic blockers (clonidine, methyldopa, and B-blockers)

19

Aromatase Inhibitors

Exemastane and Anastrozole
- can be used in post-menopausal women for breast cancer

20

In PCOS Patients that Desire Fertility Use:

Clomiphene (SERM that is an antagonist at estrogen receptors preventing feedback inhibition)

21

Fibroadenoma (of Breast)

Benign, Small, mobile, firm mass (marble-like)
MC in young (under 35 yrs)
Cellular myxoid stroma around glandular/cystic spaces
- size and pain w/ estrogen

22

Nipple Retraction due to Invasive Breast Cancer

Infiltration of the suspensory Cooper's ligament

23

Comedocarcinoma (Subtype of DCIS)

Solid sheets of pleomorphic high grade cells w/ central necrosis (does not extend beyond ductal basal membrane)

24

hPL (human placental lactogen)

Increases insulin resistance (stimulates proteolysis and lipolysis, inhibits gluconeogenesis)

25

Endometrial tissue within the myometrium (enlarged soft uterus)

Adenomyosis

26

Biopsy of endometrium w/ an Ectopic Pregnancy

Decidual endometrium WITHOUT chorionic villi

27

Neuroectoderm Makes:

CNS, retina, optic nerve, neurohypophysis

28

Neural Crest makes:

PNS, melanocytes, parafollicular C cells, adrenal medulla chromaffin cells

29

Surface ectoderm makes:

epidermis, adenohypophysis (rathke's puch), below pectinate, ear, olfactory, glands

30

Extrinsic disruption

Deformation (after embryonic period)
eg. Potter

31

Intrinsic disruption

Malformation (during embryonic period)

32

Teratogen: Thalidomide

Flipper limb, limb defects

33

MC Type of Monozygotic Twin

Monochorionic (one placenta)
Diamnionic (2 amniotic sacs)
- Separate at 4-8 days before blastocyst stage
(separating late is more likely to be conjoined)

34

Branchial Cleft =
Branchial Arch =
Branchial Pouch =

cleft is ectoderm (outermost)
arch is mesoderm and neural crest
pouch is endoderm (innermost)

35

Branchial Clefts

1st cleft --> external auditory meatus
2-4th clefts --> temporary cervical sinuses obliterated
- remnants are branchial cleft cysts in lateral neck

36

Branchial Arch 1

M's (chew)
Muscles of mastication, Mandible, Malleus
V2, V3

37

Treacher Collins Syndrome

1st branchial arch failure
mandibular hypoplasia

38

Congenital Pharyngocutaneous Fistula

Persistent cleft and pouch (2nd arch) --> fistula between tonsillar area and neck

39

Branchial Arch 2

S's (smile)
Stapedius, stylohyoid, stapes, styloid
VII

40

Branchial Arch 3

(swallow stylishly)
stylopharyngeus
IX

41

Branchial Arch 4

(simply swallow)
Pharyngeal constrictors, cricothyroid
x (superior laryngeal branch)

42

Branchial Arch 6

(speak)
all intrinsic muscles of larynx (except cricothyroid)
X (recurrent laryngeal branch)

43

Branchial Pouch 1

Middle ear cavity, eustachian tube, mastoid air cells

44

Branchial Pouch 2

Tonsils (palatine)

45

Branchial Pouch 3

Inferior parathyroids + Thymus

46

Branchial Pouch 4

Superior parathyroids

47

Leydig (men) and Theca (women)

LH

48

Sertoli (men) and Granulosa (women)

FSH

49

SRY gene

Gene for MIF (mullerian inhibiting factor)
Testes determining factor (testes development)
only on Y chromosome

50

Testosterone in fetus

develops male internal structures

51

DHT in fetus

male external genitalia

52

Sertoli Cells

secrete FSH and MIF
production of sperm

53

Mesonephric Ducts

Wolffian Ducts --> male internal structures except prostate
(seminal vesicles, epididymis, ejaculatory duct, and vas deferens)

54

Paramesonephric Ducts

Mullerian ducts --> female internal structures (fallopian tubes, uterus, upper portion of vagina)
Incomplete fusions of the paramesonephric ducts --> bicornate uterus

55

SRY gene but no Sertoli cells or no MIF

develop both male and female internal genitalia and male external genitalia
(testosterone and DHT still present)

56

SRY gene but no 5a-reductase

male internal genitalia (testosterone still present)
ambiguous external genitalia until puberty (when testosterone causes 2ndary characteristics)

57

Male External Genitalia derived from

Genital Tubercle

58

Prostate Derived from

UG sinus

59

Innervation of Male Sexual Response

Erection: pelvic nerve
Emission: hypogastric nerve
Ejaculation: pudendal nerve

60

Gallstones in Pregnancy or w/ OCPs

Estrogen: cholesterol hypersecretion
Progesterone: gallbladder hypomotility

61

Disinhibition of prolactin after delivery due to:

fall in progesterone
allows lactation

62

HcG to treat anovulation

Induces LH surge

63

Glands straight and wavy during:

Proliferative phase (day 1-14 before ovulation)

64

Glands coiled and sacculated and secreting glycogen rich mucus during:

Secretory Phase (after ovulation)

65

Until Ovulation: cells arrested in ____________

Prophase I

66

Until Fertilization: cells arrested in ____________

Metaphase II

67

Mittelschmerz

Transient mid-cycle ovulatory pain aw/ peritoneal irritation (may mimic appendicitis)

68

Oxytocin

Milk let down and uterine contractions

69

Very high FSH is specific for

Menopause (LH and GnRH high too, estrogen low)

70

Spermiogenesis

maturation of spermatid
low cytoplasmic contents and gain an acrosomal cap

71

Aromatase found in:

Testes and Adipose Tissue

72

Aromatase Deficiency:

Bones grow indefinitely
In females: it will cause ambiguous genitalia and also virilization of the mother (because it crosses)

73

Anosmia (can't smell) and infertile (decreased GnRH)

Kallmann Syndrome

74

Tx for Preeclampsia

IV Magnesium sulfate or benzo

75

Preeclampsia

Proteinuria, Edema, Hypertension

76

Eclampsia

Preeclampsia + seizures
- immediate delivery

77

HELLP

Hemolysis, Elevated Liver enzymes, Low Platelets
(manifestation of preeclampsia but may not have hypertension)

78

Placenta accreta

into the basal zone (attached to myometrium without penetrating it)
MC type

79

Placenta increta

into the myometrium

80

Placenta percreta

into the serosa or organs (rectum or blood)

81

Polyhydramnios causes:

inability to swallow amniotic fluid (esophageal/duodenal atresia, anencephaly), maternal diabetes, etc

82

HPV: E6 and E7

E6 inhibits p53
E7 inhibits Rb

83

Cervical dysplasia: histology

Koilocytes

84

Complication of lateral invasion of cervical cancer

blocking of ureters causing renal failure

85

Endometritis

Inflammation of endometrium (with plasma cell and lymphocytes) aw/ retained products of conception
tx: gentamicin + clindamycin (with or without ampicillin)

86

Cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia, infertility, and NORMAL sized uterus

Endometriosis
- outside of the endometrial cavity; may be distant
- MC in ovary (chocolate cyst)

87

Multiple discrete estrogen-sensitive tumors that increase in size w/ pregnancy and decrease with menopause
(Whorled pattern of smooth muscle)

Leiomyoma (MC tumor in females)
- higher incidence in blacks
- possibly present with iron-deficiency anemia due to bleeding

88

Incidence of gynecologic tumors

endometrial > ovarian > cervical
cervical MC worldwide
ovarian has worst prognosis

89

Hyperandrogenism (acne and hirsutism), hyperinsulinemia (due to resistance), infertility, very high LH:FSH in an Obese patient, also increased risk of endometrial adenocarcinoma

PCOS

90

PCOS Tx

OCPs or antiandrogens for hirsutism/acne
Clomiphene for infertility
Metformin for insulin insensitivity
Cyclic progesterones to antagonize endometrial proliferation

91

MC ovarian mass in young women

Follicular cyst
- distended, unruptured follicle
- may be aw/ hyperestrogenism and endometrial hyperplasia

92

Theca-Lutein cyst

aw/ choriocarcinoma and moles

93

Dermoid Cyst (of Ovary) and (of Testes)

Mature cystic teratoma is benign (Malignant in Adult Males)
Immature is malignant (has embryonic like neural tissues)
- all 3 germ layers
- MC in women 20-30 yrs old
- may contain functional thyroid tissue --> hyperthyroidism
[struma ovarii]
- increased hCG and AFP in males

94

Ovarian Cancers

95% are epithelial (MC is serous cystadenocarcinoma)
- can monitor progression with CA125
- risk decreased with anything that decreases the number of cycles and repair to ovarian surface (previous pregnancy, breastfeeding, OCPs, tubal ligation)

95

Serous Cystadenoma and Serous Cystadenocarcinoma (of Ovary)

MC ovarian neoplasm
Adenoma:
- Benign, thin wall, uni- or multi-locular
- lined with fallopian-like epithelium
- often bilateral
Adenocarcinoma:
- Malignant, usually bilateral
- Psammoma bodies

96

Brenner Tumor (of Ovary)

Benign bladder like (pale yellow tan) encapsulated tumor in ovary
- has coffee bean nuclei

97

Fibroma (of Ovary)

Benign bundles of spindle shaped fibroblasts in ovary
Miegs syndrome

98

Meigs Syndrome

Triad: Ovarian fibroma, ascites, and hydrothorax

99

Thecoma (of Ovary)

Benign
May produce estrogen (like granulosa cell tumors)
pw/ abnormal bleeding in a postmenopausal woman

100

Granulosa Cell Tumor

Malignant
MC sex cord stromal tumor (MC in women in 50s)
"Call-Exner bodies": resemble primordial follicles
Produces Estrogen (possibly progesterone) --> endometrial hyperplasia and abnormal bleeding

101

Mucinous Cystadenoma and Mucinous Cystadenocarcinoma (of Ovary)

Adenoma: multiloculated, large, mucus secreting
Adenocarcinoma: Pseudomyxoma peritonei (jelly belly)

102

Dysgerminoma (of Ovary)

Malignant
MC in adolescents (equivalent to male seminoma)
30% of germ cell tumors
Sheets of uniform "fried egg" cells
HcG and LDH

103

Choriocarcinoma (of Ovary) and (of Testes)

Malignant trophoblastic tissue (During or after pregnancy)
NO chorionic villi (synctiotropho and cytotropho tissue)
Hematogenous spread to LUNGS
- abnormal hCG, shortness of breath, and hemoptysis
- aw/ theca-lutein cysts
- Gynecomastia in males
- Sx of Hyperthyroidism
Very responsive to therapy

104

Yolk Sac tumor (of Ovary) and (of Testes)

Malignant (aggressive)
- Yellow, friable, solid mass
- "Schiller Duval Bodies": resemble glomerulus
- High AFP
- May be in sacrococcygeal area in young children
- MC tumor of male infants

105

Squamous Cell Carcinoma of Vagina

Usually secondary to cervical SCC

106

Clear cell adenocarcinoma of Vagina

after exposure to DES

107

Sarcoma Botyroides (rhabdomyosarcoma)

Girls

108

Phyllodes Tumor (of Breast)

Benign, large mass of connective tissue and cysts
"Leaf-like"
MC in 60s; may become malignant

109

Triple Negative

More aggressive breast cancer (negative for ER, PR and Her2/Neu)
MC in African Americans

110

DCIS (ductal carcinoma in situ)

Fills ductal lumen
Microcalcifications on mammography

111

Paget Disease (of Breast)

- Eczematous patches on Nipple
- From underlying DCIS
- cells are large w/ clear halo

112

Invasive Ductal (of Breast)

Malignant (worst, most invasive, MC)
- firm (rock hard) mass w/ small glandular duct-like cells
- classic "stellate" infiltration

113

Invasive Lobular (of Breast)

Malignant
- "indian file" orderly row of cells
- often bilateral and multiple lesions, may have signet rings

114

Medullary (Invasive cancer of Breast)

Malignant (w/ good prognosis)
-fleshy, lymphocytic infiltrate w/ plasma cells (large cells in sheets)

115

Inflammatory (Invasive cancer of Breast)

Malignant dermal lymphatic invasion (bad prognosis)
"Peau d'orange": blocked lymphatic drainage
Inflamed swollen breast w/out discrete mass (resembles acute mastitis)

116

Proliferative Breast Disease (4 types)

Fibrosis: hyperplasia of breast stroma
Cystic: "blue dome" (fluid filled, ductal dilation)
Sclerosing Adenosis: dense stroma w/ calcifications, acini, and fibrosis
Epithelial Hyperplasia: increased epithelial cell layers in terminal duct

117

Acute Mastitis

Breast abscess during breast feeding (cracks in nipple)
- MC s. aureus
- Tx: dicloxacillin and continue feeding

118

Causes of Gynecomastia

Spironolactone (inhibits steroid binding), marijuana, digitalis, estrogen, cimetidine, alcohol, heroin, D2 antagonists, and ketoconazole (inhibits steroid synthesis)

119

Prostatitis

Acute: bacterial (e. coli usually)
Chronic: Abacterial (MC)

120

Prostatic adenocarcinoma

MC in posterior lobe (peripheral zone)
PAP and PSA are good markers
Metastasis to bone, often lower back (high ALP)
- small invasive glands w/ prominent nucleoli

121

Cryptorchidism

- undescended testes --> impaired spermatogenesis (due to increased temp)
- can have normal testosterone level, might be lower if both are undescended (high FSH and LH, low inhibin)
- increased risk w/ prematurity
- increased risk of germ cell tumor

122

Tx for BPH

- alpha antagonists (prazosin, terazosin, tamsulosin) to relax smooth muscle [ work within a few days, double as HTN tx]
- Finasteride (5-a-reductase inhibitor) to decrease size of prostate gland [takes 6-12 months]; can also treat male-pattern baldness

123

Varicocele

Dilated veins in the pampiniform plexus

124

Germ Cell Tumors (of Testicle)

95% of all testicular tumors; usually in young men
Includes: seminoma, yolk sac, choriocarcinoma, teratoma, and embryonal
[nongerm cell tumors are leydig, sertoli, and testicular lymphoma]

125

Seminoma (of testes)

Malignant; MC, often occurs in 30s
- painless, homogenous testicular enlargement
- "fried egg" large cells, watery cytoplasm
- high ALP
- Radiosensitive, excellent prognosis

126

Embryonal Carcinoma (of Testes)

Malignant, hemorrhagic mass w/ necrosis
(painful, and worse prognosis than seminoma)
MC "Glandular/papillary" morphology (pure is rare)
Increased hCG, and normal AFP (high if mixed)

127

Leydig Cell Tumor (of Testes)

- Reinke crystals; golden brown tumor
- usually androgen producing
- gynecomastia, precocious puberty in boys
(may also be in women, effects of high testosterone)

128

Sertoli Cell Tumor (of Testes)

- Androblastoma from sex cord stroma

129

Testicular Lymphoma

MC in older men (nor primary) usually from metastasis
- aggressive
- usually diffuse large B cell type

130

Squamous Cell Carcinoma of Penis: Precursor in situ lesions

aw/ HPV, MC in Asia, Africa, S. america
Bowen: leukoplakia of penile shaft or scrotum
Erythroplasia of Queyrat: erythroplakia on glans
Bowenoid Papulosis: reddish papules, no increased risk

131

OCPs

Prevent estrogen surge and subsequent LH surge so no ovulation
- Also thickens cervical mucus and inhibits endometrial proliferation
- Don't use in smokers, or patients w/ history of stroke or thromboembolism, or w/ estrogen dependent tumors

132

Terbutaline

B2 agonist: relaxes uterus (decreases contraction during labor)

133

Danazol

Synthetic androgen partial agonist
- for endometriosis and hereditary angioedema

134

Stimulate anabolism to promote recovery after burn or injury w/:

testosterone or methyltestosterone

135

Flutamide

nonsteroidal competitive inhibitor of androgens
- for prostate cancer

136

Sildenafil, Vardenafil, Tadalafil (long acting)

Inhibit PDE5 causing increased cGMP and smooth muscle relaxation -> penile erection
- headache, flushing, dyspepsia and impaired blue-green color vision
- Do NOT take with nitrates --> life threatening hypotension

137

Alprostadil

Injected PG (prostaglandin) for erectile dysfunction

138

Bacterial Flora of Vagina

- Suppressed by broad-spectrum antibiotics, systemic steroids, immunosuppression
- Gram + lactobacillus maintains pH 4-4.5
- facilitates Candida overgrowth

139

Tx for Candida Vaginitis

Fluconazole

140

Mullerian Aplasia (or MRKH Syndrome)

No upper vagina (vaginal agenesis w/ variable uterine development)
- primary amenorrhea
- normal ovaries that secrete estrogen so develop secondary sexual characteristics

141

High Beta-hCG and Inhibin A in Amniotic Fluid

Down's Syndrome

142

Vasectomy: Viable sperm in ejaculate for ______

3 months (at least 20 ejaculations)

143

Pelvic Fractures aw/:

injury to posterior urethra

144

Follicular Atresia

Apoptosis within primordial follicles if there is not sufficient FSH exposure

145

Fish to be avoided in pregnancy

Pregnant patients should avoid fish and seafood products that are high in mercury
- shellfish and big salt-water fish should be avoided
(tuna, swordfish, shark, king mackerel, tilefish, etc)

146

MC Cause of elevated AFP

Dating error
(underestimation of age)