Reproductive Flashcards
(136 cards)
1
Q
most common causes of eugonadotropic amenorrhea
A
Mullerian duct anomalies or imperforate hymen
2
Q
streak ovaries
A
turners syndrome
3
Q
testicular feminization
A
aka androgen insensitivity
46XY appear phenotypically female, have a blind end vaginal pouch with no uterus
due to insensitive testosterone receptors
4
Q
how can turners pts become pregnant
A
with donor oocyte, and they require hormonal supplementation during pregnancy to maintain uterine lining (estrogen and progesterone)
5
Q
sonic hedgehog
A
patterning along anterior posterior axis, CNS mt holoprosencephaly
6
Q
wnt 7
A
produced at apical ectodermal ridge necessary for dorsal ventral axis
7
Q
FGF
A
lengthening of limbs
8
Q
homebox (Hox) genes
A
segmental organization of embryo in craniofacial direction
-mt appendages in wrong locations
9
Q
ectoderm:
surface
neuroectoderm
neural crest
A
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
Q
mesoderm
A
defects=VACTERL vertebral anal atresia cardiac defects tracheoesophageal fistulas Renal defects limbs defects also spleen, vagina, testes, ovaries, adrenal cortex, dermis
11
Q
endoderm
A
Enternal layer
-gut tube epithelium, urethra, luminal epithelial derivatives-lungs, liver, bladder, pancreas, eustachain tube, thymus, parathyroid, thyroid follicular cells
12
Q
teratogen: renal damage
A
ACEi
13
Q
teratogen: absence of digits, + other anomalies
A
alkylating agents
14
Q
teratogen: CN VIII toxicity
A
aminoglycosides
15
Q
teratogen: facial dysmorphism, developmental delay, NTDs, phalanx/fingernail hypoplasia
A
carbamazepine
16
Q
teratogen: vaginal clear cell adenocarcinoma, congenital mullerian anomalies
A
DES
17
Q
teratogen: NTDs
A
folate antagonists
18
Q
ebstein anomaly
A
lithium
19
Q
teratogen: aplasia cutis congenita (congenital focus of epidermis with or without other skin layers)
A
methimazole
20
Q
cleft palate, cardiac defects, phalanx/fingernail hypoplasia
A
phenytoin
-fetal hydantoin syndrome
21
Q
discolored teeth, teratogen
A
tetracycline
22
Q
teratogen: limb defects, phocomelia, micromelia, “flipper” limbs
A
thalidomide
23
Q
NTDs
A
valproate-inhibits maternal folate absorption
24
Q
bone defromities, fetal hemorrhage, abortion, opthalmologic abnormalities
A
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
