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Flashcards in Reproductive Deck (238):
1

Shh genes in develoment

AP axis and polarizing activity

2

Wnt-7 in development

doral ventral paterning (from apical ectoderm)

3

FGF in developmnet

mesoderm proliferation to lengthen limbs (from apical ectoderm)

4

Hox in development

segmentation of embryo

5

when does hCG secretion begin?

within 1 week of development as the blastocyst implants

6

what week is gastrualtion?

3

7

kidney origin

mesoderm

8

parafollicular C cells of thyroid lineage?

neural crest

9

sex organ origins

mesoderm

10

adrenal chromaffin cells origin

neural crest

11

nucleus pulposus of disc origin

notochord

12

Mesodermal defects

VACTERL: Vertebral defects, Anal atresia, Cardiac defects, TracheoEsophageal fistula, Renal defects, Limb defects

13

blood cell origin

mesoderm

14

Agenesis vs Aplasia

Agenesis is due to lack of primordial tissue.

15

When is the fetus most suseptible to teratogens?

week 3-8

16

Teratogen: ACE inhib (1)

renal damage

17

Teratogen: Alkylating agents (1)

absecnce of digits

18

aorticopulmonary septum origin

neural crest

19

melanocyte embryonic lineage

neural crest

20

Teratogen: aminoglycoside (1)

CN 8 tox

21

Teratogen: carbamazepine (4)

Also fetal hydratoin syndrome: neural tube defects, craniofacial defects, fingernail hypoplasia, growth restriction

22

Teratogen: Diethylstibestol (2)

vaginal clear cell adenocarcinoma, mullerian anomalies

23

Teratogen: Lithium (1)

Ebstein's anomaly (atrialized right ventricle) (Dr. Epstien has no heart)

24

Teratogen: Phenytoin (1...thing)

Fetal hydantoin syndrome: microcephaly, dysmorphic craniofacial features, hypoplasic nails, cardiac defects, growth retardation, retardation

25

Teratogen: Tetracyclines (1)

discolored teeth

26

Teratogen: Thalidomide (1)

FLIPPER LIMBS.

27

Teratogen: Valproate (1)

This inhibits folate uptake. Neural tube defects

28

Teratogen: Warfarin (4)

bone deformities, fetal hemorage, abortion, ophthalmoloigcal abnormalities

29

Leading cause of birth defects?

alcohol

30

Teratogen: cocaine (3)

fetal addiction, ab development, placenta abruptio

31

Teratogen: Smoking (4)

preterm labour, placental problems, ADHD, growth retardation

32

Teratogen: Iodine (1)

congential goiter aka hypothyroidism aka cretinism

33

Teratogen: Maternal diabetes (3)

caudal regression syndrome (anal atresia to sirenomelia LOOKS LIKE A MERMAID), congenital heart defects, neural tube defects

34

Teratogen: vitamin A excess (2)

spontaneous abortion and defects

35

Teratogen: X-rays (2)

microcephaly, mental retardation

36

Fetal alcohol syndrome

leading cause of congential defects: mental retardation, development retardation, microcephaly, holoprosencephaly, facial abnormalities, limb dislocations, heart/lung fistulas

37

What secretes hCG?

syncytiotrophoblast

38

umbilical vessels derive from?

allantois

39

umbilical vessels: number, connect, and oxygenation

two arteries which deliever deoxygenated blood from fetal internal iliac arteries.
one vein which brings oxygenated blood from placenta to IVC via ductus venosus

40

what is the urachal duct?

3rd week yolk sac becomes allantois becomes urachus which is a duct between yolk sac and bladder

41

patent urachus

urine discharge from umbiliicus

42

vesicourachal diverticulum

outpouching of bladder

43

vitelline duct function and destiny

7th week this duct which connects yolk sac to midgut lumen is obliterated

44

vitelline fistula

meconium discharge from umbilicus

45

meckel's diverticulum

part of vitelline duct persists to from true diverticulum of ileum. often has gastric mucosa

46

what does the aortic arches become?

arterial system only

47

1st aortic arch

part of maxilliary artery (branch of exernal carotid)

48

2nd aortic arch

Stapedial artery and hyoid artery (Second = Stapedial)

49

3rd aortic arch

3 = C. Common Carotid, and proximal part of interal Carotid artery

50

4th aortic arch

4 limbs (ie systemic). Left: aortic arch. Right: proximal part of right subclavian

51

6th aortic arch

proximal part of pulmonary arteries and ductus arteriosis (left)

52

Brachial cleft origin

ectoderm

53

brachial arch origin

mesoderm and neuro

54

brachial pouch origin

endoderm

55

1st brachial cleft

external auditory meatus

56

2nd - 4th clefts

temporary cervical sinuses. may persists as branchial clet cysts in lateral neck

57

1st branchial arch cartilage

M's: Meckel's cartilage, Mandible, Malleus, incus, sphenoMandibular lig

58

1st branchial arch muscles

M's: Muscles of Mastication (temporalis, masseter, lateral/medial pterygoid) Mylohyoid, anterior of digastric, tensor tympani, tensor veli palatini

59

Brachial Arch Nerves Mnemonic

Chew/V2-3 (1), Smile/7 (2), swallow stylishly/9-stylopharyngeus(3) or simply swallow/10 sup-lary (4) and speak/10-recurrent lar (6)

60

2nd arch cartilage

S's: Stapes, Styloid process, lesser horn of hyoid, Stylohyoid ligament

61

2nd arch muscles

S's: stapedius, stylohyoid, posterior belly of digastric. (facial expression muscles)

62

3rd arch cartilage

greater horn of hyoid

63

3rd arch muscles

styleopharyngeus

64

congential pharyngocutaneous fistula

fistula between tonsillar area and neck. persistance of 3rd branchial cleft and pouch

65

4-6th arch cartilage

thyroid, cricoid, arytenoids, corniculate, cuneifrom

66

4-6th arches muscles

pharyngeal and larynx muscles

67

what makes posterior 1/3 of tongue?

brachial arches 3 and 4

68

1st branchial pouch

middle ear/eustachian tube/mastoid air cells

69

2nd branchial pouch

tonsil epithelium

70

3rd branchial pouch

thymus and INFERIOR parathyroids

71

4th branchial pouch

superior parathyroids

72

DiGeorge syndrome

failure of 3/4 branchial pouches = no t cells and hypocalcemia

73

MEN 2A

mutation to RET in neuracrest. Pheos, parathyoid tumors (3/4 branchial pouchs), parafollicular cell tumor from NC

74

cleft lip vs cleft palate etiologies

lip: fusion of maxillary and medial nasal processes
palate: fusion of lateral/medial palatine process, nasal septum

75

which sex is default?

female

76

mesonephric duct "wolffian" vs paramesonephric duct "Mullerian"

male vs female GU structures

77

SRY gene

on Y chrom produces testies determining factor

78

Sertoli cells secrete _____ and leydig cells secrete ______ which cause

Mullerian inhibitory factor which blocks paramesonephric duct
Androgens which develop mesonephric ducts

79

Bicornuate uterus

incomplete fusion of paramesonephric ducts. heart shaped uterus

80

Hypospadia (what is, and cause)

opening of penis inferiorily.... due to failure of urethral folds to close

81

Epispadia (what is, cause, and association)

opening of penis above. faulty positioning of genital tubercle, bladder exstrophy (outside body)

82

descent of the testes: gubernaculum and process vaginalis

anchors testes within scrotum and forms tunica vaginals

83

descent of the ovaries: gubernaculum and process vaginalis

ovarian ligament + round ligament of uterus. obliterated

84

Venous drainage of gonads

left -> left gonadal vein -> left renal -> IVC
right -> right gonadal -> IVC
(just like adrenal veins)

85

which gonadal vein has higher pressure and risk

left cause of 90 degree entry point. varicocele more common

86

ovaries/testicular lymphatic drainage

para aortic nodes

87

outside of vagina and scrotum lymphatic drainage

superficial inguinal nodes

88

inside of vagina and utereus lymph nodes

obturator, external iliac and hypogastric nodes

89

Suspensitory ligament of ovary contains

Ovarian vessels

90

Cardinal ligament contains

Uterine vessels

91

Round ligament contains

Artery of Sampson

92

Broad ligament contains

Ovaries, Fallopian tubes and round ligament

93

Vagina and ectocervix histology

Stratified squamous

94

Endocervix histology

Simple columnar

95

Uterus histology

Simple columnar tubular glands

96

Fallopian tube histology

Simple columnar ciliated

97

Ovary histology

Simple cuboidal

98

Route Sperm takes

Seven up: seminiferous, epididymis, vas deferens, ejaculatory duct , (nothing), urethra, penis

99

Erection pathway

Parasympathetic via pelvic nerve. Increase NO then cGMP.

100

Emission (penis) pathway

Sympathetic via hypogastric nerve

101

Ejaculation pathway

Visceral and somatic nerves via pudendal nerve

102

Sildenafil and vardenafil

Inhibit cGMP breakdown so you won't have a limp dick

103

Sertoli cell function (6)

Inhibin which blocks FSH
Androgen binding protein to maintain high androgen
Tight junctions to create blood tested barrier
Nourish developing sperm
Antimullerian hormone
Temp sensitive

104

Sperm development

Spernatagonium-tight junction-> primary (diploid)-> seconday (haploid ) spermatocyte -> split into spermatid-> (lumen) spermatozoon

105

Ant pituitary on testies

LH- stims leydigs to make testosterone
FSH- stims sertoli go make ABP and Inhibin

106

Hypothalamus released _______ to stim AP to stim testies

GnRH

107

what converts testosterone to DHT? what inhibits it

5alpha-reductase. Finasteride

108

what makes estrogen peripherally?

testosterone is converted to estrogen in adipose and leydig by aromatase

109

what does exogenous testosterone do?

inhibit hypothalamus so less LH less testosterone in testicle and tiny balls

110

estrone vs estradiol vs estriol potency

estradiol > estrone >estriol

111

estradiol source

ovary

112

estriol source

placenta

113

androstenedione source

adrenal (weak ass testosterone)

114

what indicates fetal well being?

1000X estriol

115

estrogen effects on prolatin

upregulates it but blocks effects at breast

116

estrogen effect on LH and FSH

feedback inhib

117

carrier of estrogen and special fact

SHBG upregulated by estrogen

118

what makes progestrone?

corpus luteum, placenta, adrenal cortex, testes

119

high progesterone means what?

ovulation

120

progestrone effects

maintain prego, decrease myometrial excitability, thick cervical mucus to block sperm, inhibit LH/FSH, decrease estrogen receptor

121

how is estrogen made in ovaries

pulsatile GnRH promotes LH and FSH. LH activates Desmolase in Theca cells to Cholestrol --> Androstenedione. transported to granulosa cell which under influence of FSH aromatase makes estrogen

122

tanner development stages

I: childhood II: public hair, breast buds III: public hair darkens, penis longer, breast larger IV: penis wider, darker scrotum, raised areolae, development of glans V: adult

123

Stable vs unstable period of menstrual cycle

Variant follicular stage + 14 day luteal phase

124

What stimulates endometrial growth?

Estrogen

125

Estrogen during menst cycle

Slowly rises to peak at ovulation to promote continuous endometrial growth. Then falls and peaks again with progesterone

126

Progesterone during men cycle

Rises after ovulation to maintain endometrium then falls off.

127

LH during men cycle

One sharp peak at ovulation

128

FSH during men cycle

Small FSH peaks preceded both estrogen peaks

129

Describe ovulation

Increased GnRH on ant pit causing estrogen surge. Causes LH surge causes ovulation. Then temp increases causing progesterone surge.

130

Mittelschmerz

Ovulation blood causes peritoneal inflammation mimicking appendicitis

131

When does the egg pause?

Prophase I till puberty. Metaphase II after ovulation

132

Fertilization timing and location and implant timing

Within a day of ovulation at upper end (ampulla) of Fallopian tube. Implants six days later

133

Lactation initiation and maintenance

After labor progesterone drops so lactation not inhibited. Need suckling to maintain to stim nerves and oxytocin and prolactin

134

hCG function

Maintain corpus luteum

135

Pathological hCG elevation (3)

Dysgerminoma, choriocarcinoma, hydatidiform mole

136

Menopause indicator

High FSH

137

What causes menopause?

Low estrogen due to decline in ovarian follicles

138

Klinefelter syndrome

XXY. Eunuch body type (the spider) but tall long, boobs. High FSH and estrogen in male.

139

Turner syndrome

XO. Short, streak ovary, shield chest, bicuspid aortic valve, webbing of neck due to lymph problems, horseshoe kidney, coarctation of aorta.

140

XYY male

Very tall, antisocial, acne

141

How do testosterone and LH react to each other?

T stims T recept which inhibits LH. LH stims T release.

142

what is a pseudohemaphrodite? male vs female

disagreement between internal and external genetalia. XY but looks like a female (but with testes) or XX but looks male

143

true hermaphrodite

both ovary and testies. 46 XX or 47 XXY

144

androgen insensitivity syndrome

XY female with rudimentary vagina. testes in labia

145

kallmann syndrome

defective migration of GnRH cells and olfaction bulb. anosmia, no secondary sexual characteristics, no GnRH

146

Honeycombed uterus or cluster of grapes

hydratidiform mole

147

hydratidiform mole precursor of

choriocarcinoma

148

abnormal vaginal bleeding and high beta-hCG

hydatidyl mole (cystic swelling of chorionic villi)

149

snow storm appearance

hydatidiform mole

150

treatment of hydatidiform mole treatment

treat like abortion: dialation, curettage, and methotrexate

151

complete hydatidyl mole: hCG, uterine size, cancer, fetal parts, components, karyotype

very high hCG, leads to choriocarcinoma, no fetal parts, 2 sperm + empty egg, 46 XX/XY (normal), uterine enlarged

152

partial hydatidyl mole: hCG, uterine size, cancer, fetal parts, components, karyotype

slightly high hCG, 69 XXX/XXY/XYY, normal uterus, rare cancer, yes fetal parts, 2 sperm + 1 egg

153

preeclampsia features

hypertension, proteinuria, edema

154

eclampsia features

preeclampsia + seizures

155

HELP syndrome

Hemolysis, Elevated Liver enzymes, Low Platelets seen in pregnancy and associated with preeclampsia

156

preeclampsia presentation

headache, blurred vision, ab pain, facial edema and limbs, altered mentation, hyperreflexia.

157

preeclampsia mortality risk

cerebral hemorrhage and ARDS

158

treatment for preeclampsia

deliever as soon as possible, MgSO4 (for seizures), and rest

159

abruptio placentae

detachment of placenta. associated with cocaine, smoking, and hypertension, and DIC. life threatening for both

160

painful bleeding in 3rd trimester

Abruptio placenta

161

massive bleeding after delievery

placenta accreta

162

painless bleeding during any trimester

placenta previa

163

placenta accreta

placenta stuck to myometrium due to failure of decidual layer (previous C section). massive bleeding after birth

164

placenta previa

placenta blocks cervical os. painless bleeding any trimester

165

retained placental tissue may cause

hemorrage or infxn

166

ectopic pregnancy common site

fallopian tubes

167

ectopic pregnancy clues

history of amenorrhea, low hCG, sudden ab pain like appendeciitis, no chorionic villia

168

ectopic pregnancy risk factrs

history of infertility, PID (Salpingitis), ruptured appendix, tubal surgery

169

cause of poly vs oligo hydramnios

poly can't swallow, oligo cant pee (or placental insufficency)

170

HPV 16 inhibits

p53 by E6

171

HPV 18 inhibits

RB by E7

172

cervical in situ carcinomas

CIN 1,2,3 (progressively worse)

173

risks for cervical cancer

multiple sexual partners, smoking, early sex, HIV

174

cervical koilocytes

squamous cell carcinoma of cervix

175

most common carcinoma of cervix and cause what?

SCC. can block ureters

176

endrometritis treatment

gentamycin + clindamycin with or without ampicillin

177

endrometriosis

ectopic endometral tissue (ovary or peritoneum). chocolate cysts

178

abnormal cyclical bleeding, painful intercourse, infertility, severe menstrual pain

endrometriosis

179

endometriosis treatment

oral contraceptives, NSAIDS, leuprolide, danazol

180

Endometriosis vs Adenomyosis?

endometriosis is ectopic extra uterine. adenomyosis is in myometrium so uterus is enlarged. requires hysterectomy

181

what causes endometrial hyperplasia? presentatoin?

excess estrogen, postmenopausal bleeding

182

prolonged use of estrogen without progestins?

endometrial carcinoma

183

most common gynocological malignancy

endometrial carcinoma

184

leiomyoma

fibroid. benign tumor of smooth muscle which swells with estrogen. doesn't progress. more common in blacks

185

leiomyosarcoma

highly agressive tumor of myometrium

186

gynecological tumor epidemiology

incidence: endomet > ovary > cervical (in US, cerv worldwide)
worse prognosis: ovarian > cervical > endometrial

187

causes of anovulation ranked: name first 4

pregnancy, polycystic ovarian syndrome, obesity, HPO axis problem, premature ovarian failure, hyperprolactinemia, thyroid disorder, eating disorder, cushings, adrenal insufficency

188

polycystic ovarian disease etiology

high LH leads to anovulation, low progesteron and theca cell androgen production (via high estrogen). associated with insulin resistance

189

bilateral ovarian cysts, hirsutism, amenorrhea, infertlity

polycystic ovarian disease

190

polycystic ovarian disease can lead to

endometrial cancer due to high estrogen

191

treatment of polycystic ovarian disease

weight loss, low dose OCP or medroxyprogestrone, spironolactone (hirutism antag), clomiphine (help infertility), metformim (if diabetic too)

192

most common ovarian mass in young women

follicular cyst (distended graafin follicule that is unruptured) due to high estrogen

193

cyst associated with high GnRH

theca-lutein cyst

194

most common ovarian germ cell tumor

teratoma

195

teratoma types

mature (dermoid cyst): most common; immature teratoma: agressive; struma ovarii: has thyroid tissue (hyper thyroid)

196

dysgerminoma

female version of seminoma. rare, sheets of uniform cells. turner sydrome. rare

197

choriocarcinoma

malignancy of trophoblastic tissue with no chorionic villi. high hCG. endometriosis assocaition. Met to lungs

198

yolk sac tumor

aggressive tumor of ovaries or testes. yellow, friable solid mass. high AFP. have Duval bodies which look like glomeruli.

199

Krukenberg tumor

GI malignancy that mets to ovaries. mucin-secerting signet cells in ovaries

200

serous cystadenoma vs adenocarcinoma

45% ovarian tumors each. fallopian tube-like lining. carcinoma has psammoma bodies. risks are BRCA1/2,HNPCC. frequently bilateral

201

mucinous cystadenoma/adenocarcinoma

mucus secreting tumors

202

CA-125

marker for ovarian cancer progression (not for screening)

203

Brenner tumor

Benign, unilateral, looks like bladder. pale-yellow-tan gross and encapsulated coffee bean on H&E

204

Meigs syndrome

triad of ovarian fibromas, ascites, and hydrothorax

205

Granulosa cell tumor

secretes estrogen, causes precocious puberty, endometrial hyperplasia.

206

Call-Exner bodies

small follicles filled with eosinophilic secretions found in granulosa cell tumors

207

vaginal squamal cell carcinoma

usually secondary to cervicall SCC

208

vaginal clear cell carcinoma

DES exposure in utero

209

vaginal sarcoma botryoides

girls under the age of 4. spindle-shapped tumors that are desmin positive

210

most common breast tumor

fibroadenoma (benign)

211

benign breast tumor: small, mobile, firm mass with sharp edges. increases in size with estrogen

fibroadenoma

212

benign breast tumor which is small and grows in the lactiferous ducts typically beneath areola. has bloodly discharge from nipple

intraductal papilloma

213

large bulky breast tumor with lots of connective tissue and cysts. "leaf like" projections

phyllodes tumor. some may become malignant

214

most important factor regarding the prognosis of malgnant breast cancer?

axillary lymph node mets

215

most common location of breast cancer

upper-outer quadarnt

216

Ductal carcinoma in situ

non-invasive tumor which fills ductal lumen (its just an early lesion, it will progress)

217

comedocarcinoma

DCIS with caseous necrosis

218

worst breast cancer

invasive ductal carcinoma

219

most common breast cancer

invasive ductal

220

breast cancer: firm, fibrous, "rock hard" mass with sharp margins and small, glandular duct-like cells

invasive ductal carcinoma

221

breast cancer with "stellate" morphology

invasive ductal

222

breast cancer with "indian file" orderly row of cells

invasive lobular

223

the bilateral breast cancer

invasive lobular

224

breast cancer that is fleshy, cellular, lymphocytic? prognosis?

medullary. good.

225

breast cancer with skin involvement. "orange peel" skin

Inflammatory breast cancer

226

Eczematous patches on nipple. Distinctive large cells with clear halo

Paget's disease of the breast.
"I can see your halo! HALO! HALOOOOO!"

227

Fibrocystic disease

most common cause of breast lumps. change size but are safe. different types

228

infxn risk during breast feeding

acute mastitis. S. aureus

229

drugs which give guys bitch tits (gynecomastia)

Some Drugs Create Awkward Knockers: Spironolactone, Digitalis, Cimetdine, Alcohol, Ketoconazole

230

is BPH hypertrophy or hyperplasia?

hyperplasia (more cells)

231

how to diagnose prostate adenocarcinoma

high PSA or PAP followed by biopsies. osteoblastic mets in bone develop in late sage causing lower back pain (Alk Phos signifies this)

232

cryptorchidism

undecent of one or both testes. leydigs work fine but sertolis don't. impaired spermatogenisis

233

varicocele

enlargment of testicles (#1) due to venous blockage. "bag of worms" appearance

234

testicular tumor painless homogeneous enlargment, most common, large cells with watery cytoplasm, "Fried egg" appearance. high alk phos

seminoma, treat with radiation

235

yolk sac tumor in males

same as females. yellow egg. "duval bodies that look like glomerulii (high AFP)

236

male choriocarcinoma

high hCG which mets to the lungs. gynecomastia

237

male teratoma

malignant unlike female version

238

malignant painful male testicular tumor

embryonal carcinoma