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Flashcards in Reproductive Deck (136):
1

most common causes of eugonadotropic amenorrhea

Mullerian duct anomalies or imperforate hymen

2

streak ovaries

turners syndrome

3

testicular feminization

aka androgen insensitivity
46XY appear phenotypically female, have a blind end vaginal pouch with no uterus
due to insensitive testosterone receptors

4

how can turners pts become pregnant

with donor oocyte, and they require hormonal supplementation during pregnancy to maintain uterine lining (estrogen and progesterone)

5

sonic hedgehog

patterning along anterior posterior axis, CNS mt holoprosencephaly

6

wnt 7

produced at apical ectodermal ridge necessary for dorsal ventral axis

7

FGF

lengthening of limbs

8

homebox (Hox) genes

segmental organization of embryo in craniofacial direction
-mt appendages in wrong locations

9

ectoderm:
surface
neuroectoderm
neural crest

surface ectoderm: epidermis, adenohypophysis (Rathke ppouch), lens of eye, epithelial lining of oral cavity, sensory organs of ear, olfactory epithelium, epidermis, anal canal below pectinate line, parotid, sweat and mamary glads
Neuroectoderm: CNS (brain, neurohypophysis, CNS neurons, oligodendrocytes, astrocytes, ependymal cells, pneal gland), retina, optic nerve, spinal cord
Neural crest: PNS, melanocytes, chromaffin cells of adrenal medulla, parafollicular C cells, cells of thyroid pia, arachnoid, bones of skull, oodontoblast, aorticopulmonary septum

10

mesoderm

defects=VACTERL
vertebral
anal atresia
cardiac defects
tracheoesophageal fistulas
Renal defects
limbs defects
also spleen, vagina, testes, ovaries, adrenal cortex, dermis

11

endoderm

Enternal layer
-gut tube epithelium, urethra, luminal epithelial derivatives-lungs, liver, bladder, pancreas, eustachain tube, thymus, parathyroid, thyroid follicular cells

12

teratogen: renal damage

ACEi

13

teratogen: absence of digits, + other anomalies

alkylating agents

14

teratogen: CN VIII toxicity

aminoglycosides

15

teratogen: facial dysmorphism, developmental delay, NTDs, phalanx/fingernail hypoplasia

carbamazepine

16

teratogen: vaginal clear cell adenocarcinoma, congenital mullerian anomalies

DES

17

teratogen: NTDs

folate antagonists

18

ebstein anomaly

lithium

19

teratogen: aplasia cutis congenita (congenital focus of epidermis with or without other skin layers)

methimazole

20

cleft palate, cardiac defects, phalanx/fingernail hypoplasia

phenytoin
-fetal hydantoin syndrome

21

discolored teeth, teratogen

tetracycline

22

teratogen: limb defects, phocomelia, micromelia, "flipper" limbs

thalidomide

23

NTDs

valproate-inhibits maternal folate absorption

24

bone defromities, fetal hemorrhage, abortion, opthalmologic abnormalities

warfarin

25

caudal regression syndrome

in babies with mother with diabetes
anal atresia to sirenomelia (mermaid syndrome)

26

microcephaly and intellectual disability

X ray exposure

27

hypertelorism, limb dislocation, heart-lung fistulas, holoprosencephaly, smooth philtrum

Fetal alcohol syndrome
failure of cell migration

28

which placental component lacks MHC 1 expression

syncytiotrophoblast-outer layer of chorionic villi
-secretes hCG (stimulates corpus luteum to secrete progesterone during the first trimester)

29

cytotrophoblast

inner layer of chorionic villi, makes cells

30

decidual basalis

maternal component of placents, derived from endometrium, maternal blood in lacunae

31

urachus

formed from the allantois during the 3rd week, duct between fetal bladder and yolk sac (bladder to umbilical cord)

32

vitelline duct

omphalomesenphric duct
connects midgut lumen to yolk sac (umbilicus)

33

meckel diverticulum

partial failure of vitelline duct closure (tur diverticulum)

34

1st aortic arch derivative

maxillary (branch of external carotid)

35

2nd aortic arch derivative

stapedial artery and hyoid artery

36

3rd aortic arch derivative

Carotids-common carotid and proxmial part of internal carotid

37

4th aortic arch derivative

on left-aortic arch
on right-proximal part of right subclavian artery

38

CAP

clefts=ectoderm
arches=mesoderm
pouches=endoderm

39

6th aortic arch derivative

proximal part of pulmonary arteries and ductus arteriosus

40

failure of closure of maxillary and medial nasal processed

cleft lip

41

failure of fusion of two lateral palatine processes OR failure of fusion of lateral palatine processes with nasal septum and/OR median palatine process

cleft palate

42

teacher collins syndrome

failure of first arch to migrate-mandibular hypoplasia ,facial abnormalities, FTT

43

congential pharyngocutaneous fistula

persistence of cleft and pouch--> fistula between tonsillar area and lateral neck

44

female genital development

(default) mesonephric duct degenerates and paramesonephric duct develops

45

male genital development

-SRY causes release of testis determining factor
which acts on Sertoli cells to produce mullerian (paramesonephric) inhibiting factor
-also acts on leydig cells to make testosterone and make mesonephric duct (SEED) seminal vesicles, epididymis, ejactulaory duct, ductus deferens

46

no sertoli cells or lack of MIF

get both female and male internal genitalia and male external genitalia

47

no 5 alpha reductase

testosterone is not converted to DHT and do not get external genitalia
-male internal genitalia ambiguous external genitali until puberty (increase in testosterone levels cause masculinization)

48

septate uterus

incomplete resorption of the septum
decreses fertility-septoplasty

49

bicornuate uterus

incomplete fusion of mullerian ducts
increases risk of complicated pregnancy

50

uterus didelphys

complete failure of fusion of mullerian ducts, double uterus, vaina, and cervia-pregnany possible

51

hypospadis

failure of urethral folds to fuse leaving an abnormal opening of penile urethra on ventral surface of penis
-associated with inguinal hernia and cryptorchidism

52

epispadis

abnormal opening of penile urethra on dorsal surface due to faulty positioning of gential tubercle
assocaited with exstrophy of the bladder

53

gubernaculum

anchors testes with scrotum
like female ovarian ligament and round ligament of uterus

54

processus vaginalis

forms tunica vaginalis in males and is obliterated in females

55

infundibulopelvic ligament

holds ovaries to lateral pelvic wall, contianes ovarian vessels
-LIGATE VESSELS during oophrectomy to avoid bleeding
ureters retroperitoneal and at risk of injury duing ligation of ovarian vessels

56

cardinal ligament

cervix to side wall of pelvis
-contains uterine vessels
gubernaculum derivative
continas sampson artery

57

boroad ligament

mesometrium, mesosalpinx, mesovarium-uterus, fallorian tubes and ovaries to pelvic side wall
contains ovaries, fallopian tubes, round ligament of uterus

58

ovarian ligament

medial pole of ovary to lateral uterus

59

vagina

stratified squamous epithelium
-contains glycogen

60

ectocervix

stratified squamous epithelium

61

transformation zone

squamocolumnar junction -most common area for cervial cancer

62

endocervix

simple columnar epithelium

63

uterus

simple pseudostratified columnar epithelium

64

fallopian tube

simple columnar epithelium

65

ovary

simple cuboidal epithelium

66

pathway of sperm during ejactulation

SEVEN UP
seminiferous tubules
epididymis
vas deferens
ejaculatory ducts
(nothing)
urethra
penis

67

blood at urethral meatus

urethral injury most likely at membranous portion from pelvic fracture
-bulbular urethra prone to blunt force

68

anterior urethral injury

straddle injury
urine leak beneath deep fascia (facia of Buck)

69

autonomic innervation of male sexual response

erection-parasympathetic via pelvic nerve (through No and cGMP)
emission-sympathetic via hypogastric
ejaculation-via pudendal

70

where are estrogen receptors found

cytpolasm, translocate to nucelues when bind estrogen

71

estrogen effects on cholesterol

increase HDL decrease LDL (convert cholesterol to androgens)

72

theca interna cells

make androgense

73

granulosa cells

convert androgens to estrogens
-estradiol in ovary, estriol in placenta

74

which phase of menstrual cycle can vary

follicular

75

primary oocytes are arrested in

prophase I until ovulation

76

secondary oocytes are arrested in

metaphase II until fertilization
-if fertilization does not occur within one day secondary oocyte degenrates

77

implantation occurs x days after fertiliztiaon

6, syncytiotrophoblasts secrete hCG which is detectable in blood 1 week after conception and on home test in urine 2 weeks after conception

78

exclusively breastfed babies require

vitamin D

79

bHCG shares same alpha subunit as

LH, FSH, TSH-beta unit is unique and is what is detected with urine pregnancy test

80

exogenous testosterone

dcreases amount of intratesticular testosterone leading to decreased testicular size and azoospermia

81

maternal virilization during pregnancy

aromatase deficiency in fetus
-causes increasing amount of androgens

82

treatment of pre-eclampsia

antihypertensives, IV mag to prevent seizures (alpha methyl dopa, labetolol, ydalizine, nifedipine)

83

HELLP

hemolysis elevated liver enzymes low platelets
-manifestation of severe pre-eclampsia
-smear shistocytes
-hepatic subcapsular hematomas-->rupture-->severe hypotension

84

placenta accreta

placenta attaches to myometrium without penetrating it

85

placenta increta

placenta penetrates into mymoetrium

86

placenta percreta

placenta penetrates though myometrium and into uterine serosa
-can result in placental attachment to rectum or bladder

87

placenta previa

attachment of placenta to lower uterine segment over internal cervial os
-painless thrid trimester bleeding

88

rf for placenta accreta/increta/percreta

prior c section, inflammation, placenta previa
found on US prior to delivery, placenta fails to detach after delivery

89

placental abruption

abrupt painful bleeding, premature separation of placenta from uterine wall
risk factors: smoking, hypertension, preeclampsia, cocaine use

90

vasa previa

fetal vessels run over or close to internal cervical os
-risk of vessel rupture, exanguination, death

91

membrane rupture, painless vaginal bleeding, fetal bradycardia (<110 beats/min)

vasa previa
associated with velamentous umbilical cord insertion: cord inserts into chorioamniotic membrane rather than placenta
-vessels travel to placenta unprotected by wharton jelly

92

risk factors for ectopic pregnancy

hx of infertility
PID (salpingitis)
ruptured appendix
prior tubal surgery

93

polyhydramnios associated wtih

>1.5-2L
duodenal atresia
anencephaly
maternal diabetes
fetal anemia
multiple gestation

94

oligohydramnios associated with

<0.5L
placental insufficiency
bilateral renal agenesis
posterior urethral valves
-cant excrete urine
can lead to Potter Sequence

95

sarcoma botryoides

vaginal tumor that affects girls <4
spindle shaped cells
desmin +
clear, grape-like, polypoid mass emerging from vagina

96

renal failure and koilocytes

invasive cervical carcinoma
-lateral invasion blocks ureters causing renal failure
-koilocyte-immaure squamous cells with dense, irregularly staining cytoplasm with perinuclear clearing forming a "halo"

97

skin warts

HPV 1, 4

98

genital warts

HPV 6, 11

99

intraepithelial cervical neoplasia

HPV 16, 18, 31, 33, 35 E6--> p53, E7--> Rb

100

follicular cyst

unruptured graafian follicle
-hyperestogenism, endometrail hyperplasia
most common ovarian mass in young women

101

theca-lutein cyst

due to gonadotropin stimulation, associated with choriocarcinoma and hydatidiform moles
-usually bilateral/multiple

102

solid ovarian tumor that is pale yellow-tan and appears encapsulated, coffee bean nuclei on HandE

Brenner tumor, benign ovarian neoplasm

103

bindles of spindle shaped fibroblasts

fibromas, benign ovarian neoplasm

104

call exner bodies

granulosa cell tumor
presents with abnml uterine bleeding, sexual precocity, breast tenderness
-estrogen and/or progesterone secreting

105

sheets of uniform fried egg cells, high hCG, LDH

dysgerminom, most common in adolescents

106

abnml hCG, shortness of breath, hemoptysis

choriocarcinoma
-rare, can develop after or during pregnancy in mother or baby, malignancy of trophoblastic tissue (cytotrophoblasts, synctiotrophoblasts)
-no chorionic villi
-hemotogenous spread to lungs, very responsive to chemo therapy

107

yellow, friable mass with schiller duval bodies , high afp

yolk sac (endodermal sinus) tumor
-aggressive, in ovaries or testes and sacrococcygeal area in young children
-afp tumor marker

108

mucin secreting signet cell adenocarcinoma

Krukenberg tumor

109

whorled pattern of smooth muscle bundles with well demarcated borders

leiomyoma (fibroid)
-irregularly enlarged uterus

110

dysmenorrhea, menorrhagia, uniformly soft enlarged globular uterus

adenomyosis
-extension of endometrial tissue (glandular) into myometrium (hypertrophy and hyperplasia)
-enlarged uterus

111

chocolate cysts, pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia

endometriosis
-infertility
-normal size uterus

112

inflammed endometrium

endometritis
-due to retained products of conception, IUD, foreign body

113

endometrial carcinoma risk factors

most common gynecologic malignancy
-p/w vaginal bleeding, age 55-65
-unopposed estrogen use
-obestiy
-diabetes
-hypertension
-nulliparity
-late menopause
-lynch syndrome

114

serous or bloody nipple discharge

intraductal papilloma

115

large, bulky breast mass of connective tissue and cysts

phyllodes tumor

116

drugs that cause gynecomastia

some drugs create awesome knockers
Spironolactone digoxin cimetidine alcohol ketaconazole

117

solid sheets of pleomorphic cells with central necrosis

comedocarcinoma (a subtype of DCIS)

118

eczematous patches on nipple

paget disease
-large cells in epidermis with clear halo

119

stellate infiltration

invasive ductal breast carcinoma
-firm fibrous, rock hard mass, with sharp margins and small glandular, duct like cells
worts and most invasinve

120

Indian file row of cells

invasive lobular
decreased E cadherin expression
-bitalera with multiple lesions in the same location

121

sheets of vesicular, plemorphic mitoctically active cells

medullary breast cancer

122

peau d orange breast

inflammatory breast tumor
-neoplastic cells, block lymphatic drainage, 50% survival at 5 years, often mistaken for mastitis or pagets

123

meds causing priaprism

sildenifil, trazodone
tx: corporal aspiration, intracavernosal phenylephrine or surgical decompression to prevent ischemia

124

penile leukoplakia

penile squamous cell carncinoma
-more common in asia, africa, south america

125

bowenoid papulosis

reddish penile papules,
carcinoma in situ
associated with HPV, lack of circumcision

126

penile
large cells in lobules with watery cytoplasm and fried egg appearance
increased ALP

seminoma
-malignant painless, homogenous testicular enlargement,

127

shiller duval bodeis high AFP in testicular mass

yolc sace (endodermal sinus) tumor

128

male with hemorrhagic stroke, gynecomastia, symptoms of hyperthyroidism

choriocarcinoma
-get hematogenous mets to lungs and brain
hCG can bing TSH receptors

129

treatment of BPH

alpha antagonists (terazosin, tamsulosin)
-smooth muscle relaxation
5alpha reductase inhibitors
-finasteride
PDE 5 inhibitors

130

where does prostatic adenocarcinoma most often arise q

posterior lobe of prostate gland
-increase total PSA with decreased fraction of free PSA

131

leuprolide

GnRH analog
agonist if pulsatile
antagoinst if continuous
used for infertility, prostate cacner, uterine fibroids, percocious puberty
toxicity: antiandrogen, nausea, vomiting

132

ethinyl estradiol
DES
mestranol

estrogen agonists
used for hypogonadism or ovarian failure, menstrual abnormlaities, hormone replacement therapy in post menopausal women, in men with androgen dependent prostate cancer
toxicity: increases risk of endometrial cancer, bleeding in postmenopausal women, clear cell adenocarcinoma of vagina in females exposd to DES in utero, increak risk of thrombi
contraindication +ER breast cancer

133

clomiphene

antagonist at estrogen hypothalamic receptor
increase LH/FSH causing ovulation

134

tamoxifen

estrogen antagonist at breast, agonist at bone/uterus, increase risk of thomboembolic events and endometrial cancer
used to treat ER/PR + breast cancer

135

raloxifene

antagonist at breast/uterus, agonist at bone, increase risk of thromboembolic events but no increased risk of endometrial cancer
used to treat osteoporosis

136

anastrozole/exemestane

aromatase inhibitors used in postmenopausal women with ER+ breast cancer