Reproductive Flashcards
1
Q
Autosomal Trisomies
- Down
- Edwards
- Patau
A
- 21; quad screen: low AFP, low estriol, high BhCG, high inhibin A; nuchal rigidity
- 18; quad screen: low AFP, low estriol, low BhCG, low-normal inhibin A
- 13; cleft liP/Palate, holoProsencephaly, Polydactyly
2
Q
early fetal development
- week 1
- week 2
- week 3
- week 4
- week 6
- week 10
A
- week 1: implantation of blastocyst – hCG picked up on blood screen
- week 2: bilaminar disc (epiblast and hypoblast)
- week 3: trilaminar disc (gastrulation: ectoderm, mesoderm, endoderm)
- week 4: heart begins to beat, uppwer and low limb buds form (4 chambers to heart and 4 limbs)
- week 6: fetal cardiac activity visible by transvaginal US
- week 10: genitilia have male/female characteristics (perfect 10)
3
Q
aortic arch derivatives
A
- 1st arch: part of maxillary branch (branch of external carotid) – 1st arch is MAXimal
- 2nd arch: stapedial artery and hyoid artery (Second = Stapedial)
- 3rd arch: common carotid (C = 3rd letter in alphabet)
- 4th arch: aortic arch and part of R subclavian a (4th = 4 limbs –> systemic)
- 6th: pulmonary aa and ductus arteriosus (6th arch = pulmonary and pulmonary-to-systemic shunt)
4
Q
- branchial cleft derivatives
- branchial pouch derivatives
A
- cleft = ectoderm:
- 1st cleft –> external auditory meatus
- 2nd - 4th –> termporary cervical sinuses (become obliterated)
- pouch = endoderm
- 1st pouch –> middle ear, eustachian tubue, mastoid air cells
- 2nd pouch –> epi lining of palatine tonsils
- 3rd pouch –> inferior parathyroids and thymus
- 4th pouch –> superior parathyroids
- ** DiGeorge: absence of 3rd and 4th pouches
5
Q
branchial arch derivatives
A
- cartilage= Meckel, Mandible, Malleus; muscles = mm of Mastication, Mylohyoid; nerves = Maxillary and Mandibular division of CN V (“M” structures)
- cartilage: Stapes, Stylohyoid process, leSSer horn of hyoid, Stylohyoid ligament; muscles = mm of facial expression, Stapedius, Stylohyoid, platySma; nerves = CN Seven (“S” structures)
- muscles = stylopharyngeus; nerves = CN IX (“pharyngeal”)
- 4th-6th: cricoid and larynx structures + CN X (4th = superior laryngeal branch, 6th= recurrent laryngeal branch)
6
Q
Male and Female genital embryology
A
- Male: SRY gene on Y chromo produces TDF; sertoli cells secrete MIF that suppress –/ paramesonephric ducts; Leydig cells secrete androgen –> mesonephric ducts
- mesonephric ducts develop into male internal structures (except prostate)
- T –> DHT (via 5alpha reductase) induces development of male external genitalia and prostate
- Female: paramesonephric duct develops into fallopian tubues, uterus and upper portion of vagina (lower portion from urogenital sinus)
- failure of paramesonephric ducts to fuse = bicornate uterus
7
Q
Male genital homologs –> female counterpart
- glans penis
- corpus cavernosum + spongiosum
- Bulbourethral glands of Cowper
- Prostate gland
- Ventral shaft of penis (penile urethra)
- Scrotum
A
- glans clitoris (from genital tubercle)
- vestibular bulbs (from genital tubercle)
- Bartholin glands (from UG sinus – both B’s)
- urethral and paraurethral glands of Skene (from UG sinus – “PS”)
- labia minora (from UG folds)
- labia majora (from labioscrotal swelling)
8
Q
Female repro ligaments
- Suspensory ligament of ovaries
- Cardinal ligament
- Round ligament of uterus
- broad ligament
- ovarian ligament
A
- connects ovaries to pelvic wall – carries ovarian vessels
- connects cervix to pelvic wall – carries uterine vessels
- connects uterine fundus to labia majora – derivative of gubernaculum (travels through the round inguinal canal)
- connects uterus, fallopian tubes and ovaries to pelvic wall (mesosalpinx, mesometrium and mesovarium)
- connects medial pole of ovary to uterus – derivative of gubernaculum
9
Q
Estrogen
A
- ovary (estradiol); placenta (estriol); adipose tissue (estrone via aromatization)
- estradiol > estrone> estriol
- LH –> theca cell (cholesterol –> androstenedione via desmolase)
- FSH –> granulosa cell (andrestedione from theca cell converted to estradiol via aromatase)
- E upregulates E, LH and progesterone receptors
- E increases SHBG and HDL, lowers LDL
10
Q
- oligomenorrhea
- polymenorrhea
- metrorrhagia
- menorrhagia
- menometrorrhagia
A
- >35 day cycle
- < 21 day cycle
- breakthrough bleeding; frequent but irregular
- heavy menstrual bleeding (>80 mL)
- heavy, irregular menstruation
11
Q
oogenesis and spermatogenesis
A
- primary oocytes arrested in prOphase of meiosis I until ovulation (primary oocytes)
- occurs during fetal life
- secondary oocytes arrested metaphase of meosis II until fertilization (“an egg met a sperm”)
- spermatogenesis takes place in seminferous tubules at puberty
- Meiosis I: diploid –> haploid (failure = accumulation of primary spermatocytes)
- Meisosis II: haploid sister chromatid –> haploid sperm (failure = accumulation of secondary spermatocytes)
12
Q
Androgens
A
- testis: produce DHT and testosterone
- adrenals: AnDrostenedione (DHT > T> AD)
- T= differentation of internal genitalia except prostate); growth spurt; libido; deepening of voice
- T –> DHT via 5alpha reductase
- DHT = early- external genitalia and prostate; late = prostate growth, balding, sebaceous gland activity
- Androgens –> Estrogen by cytochrome p450 aromatase (adipose tissue and testes)
- exogenous T –> inhibition of HP axis –> decrease intratesticular T and decrease Testicular size –> azoospermia
13
Q
- Klinefelter
- Turner
A
- 47 XXY: testicular atrophy, gynecomastia, Barr body
- dysgenesis of seminiferous tubules –> decreased inhibin –> increased FSH
- abnormal Leydig cell fx –> low T –> hi LH –> estrogen (gynecomastia)
- 45 XO: most common cause of primary amenorrhea, no Barr body; bicuspid aortic valve and coarctation of aorta, cystic hygroma, webbed neck
14
Q
- female pseudohermaphrodite
- male pseudohermaphrodite
- 5alpha reductase deficiency
A
- XX: ovaries present but external genitalia virilized or ambiguous (due to excessive androgenic exposure during gestation or CAH)
- XY: testes present but external genitalia are female or ambigous
- androgen insensitivity syndrome: defect in DHT receptor resulting in normal-appearing female with blind vagina and testes in labia majora (increased T, E and LH)
- can’t convert T –> DHT: ambiguous genitalia until puberty; internal genitalia normal (T and E levels normal)
15
Q
- Leuprolide
- Clomiphene
- Tamoxifen
- Raloxifene
A
- GnRH analog – tx infertility (pulsatile), prostate cancer + uterine fibroids(continuous), precocious puberty (continuous)
- SERM: antag at ER in hypothalamus –> prevents (-) feedback on LH and FSH –> stimulate ovulation (tx infertility)
- SERM: antag on breast tissue, agonist on uterus + bone – tx ER+ BC but associated with endometrial cancer
- SERM: agonist on bone, antag on uterus – tx osteoporosis
