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Flashcards in Reproductive Deck (565):
1

1st sign of puberty in males

increase in testicular size

2

1st sign of puberty in females

thelarche (onset of breast development)

3

Child orients to voice by...

4 months

4

Child orients to name and gestures by...

9 months

5

Rapprochement

Moving away from mom and coming back. By 2 years.

6

Language at 3 years

3-word sentences + 1,000 words + speech 75% intelligible

7

Counts to 10 by...

5 years

8

Prints letters by..

5 years

9

Oxytocin function

1) stimulates labor
2) uterine contractions
3) milk let-down
4) controls uterine hemorrhage

10

rectocele

Tear in the rectovaginal septum. Occurs in childbirth or hysterectomy.

11

Surfactant production begins...

Week 26, but mature levels not achieved until around week 35.

12

surfactant components

Complex mix of lecithings, the most important of which is dipalmitoylphosphatidylcholine.

13

What inhibits lactation before birth?

Progesterone (this is why retained placental tissue will inhibit lactation) AND estrogen. Both stimulate prolactin production, but block the action of prolactin on the breast.

14

If a woman can't lactate after childbirth think...

Sheehan's

15

What stimulates uterine contractions?

1) oxytocin, but only in third trimester and after cervix is dilated.
2) PGI2 stimulates uterine contractions prior.

16

Cystocele

Fibrous wall between bladder and vagina is torn by childbirth, allowing the bladder to herniate into the vagina. This causes a bulge of the anterior vaginal wall.

17

Rectocele

Tear in the rectovaginal septum. Rectal tissue bulges through tear and into vagina as hernia. Usually during childbirth or hysterectomy.

18

Autonomic innervation of the male sexual response

• /point and shoot erection, parasympathetic, ejaculation, sympathetic. Midget chef travelling out of his dick/emission (sperm moving from testes into prostatic urethra) = SNS, hypogastric. Beating off into a big bowl of pudding/ejaculation (sperm moving from prostatic urethra to outside) = visceral and somatic nerves, pudendal.
Location: Travis Krogman’s basement

19

When and why does body temperature increase occur?

Basal body temperature significantly increases shortly after ovulation, due to metabolic effects of progesterone produced by the corpus luteum. Progesterone acts at thermal regulatory center of hypothalamus. Basal body temperature remains high during the luteal phase of the menstrual cycle but falls precipitously a few days before the onset of menstruation.

20

Hysterosalpingogram + analyzing results.

1) injecting contrast medium into the uterus.
2) If the fallopian tubes are open, the contrast medium will fill the tubes and spill out into the abdominal cavity. Thus contrast in the abdominal cavity is normal. If they're blocked, then contrast medium will not spill out.

21

What determines development of Wolffian ducts?

Testosterone

22

How does LH increase testosterone synthesis?

Stimulating cholesterol desmolase.

23

What secretes GnRH?

Arcuate nuclei of hypothalamus.

24

Negative feedback of FSH secretion?

Inhibin

25

testosterone precursor

androstenedione

26

LH inhibition

- testosterone inhibits LH secretion by inhibiting release of GnRH
AND inhibiting release of LH

27

Growth of prostate regulated by...

DHT

28

Variation in FSH and LH levels over life span (male and female)

Childhood -- FSH greater than LH.
Puberty and reproductive years -- LH greater than FSH
Senescence -- FSH greater than LH.

29

Estrogen biosynthesis

Cholesterol --> pregnenolone --> androgens in theca cells. Androgens diffuses to granulose cells, where it is aromatized to estrogen.

30

Estrogen action in phase of menstrual cycle
1) follicular
2) midcycle
3) luteal

1) negative feedback on anterior pituitary
2) positive feedback on anterior pituitary
3) negative feedback on anterior pituitary

31

Estrogen and prolactin

Estrogen stimulates prolactin secretion but then blocks its action on the breast.

32

uterine threshold to contractile stimuli during pregnancy

Estrogen lowers the uterine threshold to contractile stimuli during pregnancy; progesterone raises the uterine threshold to contractile stimuli during pregnancy. Near term the estrogen/progesterone ratio increases, which makes the uterus more sensitive to contractile stimuli.

33

Follicular phase

1) primordial follicle develops to the graafian stage.
2) LH and FSH receptros are up-gregulated in theca and granulosa cells
3) Estradiol levels increase and cause proliferation of the uterus
4) FSH and LH are suppressed by effect of estradiol
5) progesterone is low.

34

ovulation in relationship to menses

always 2 weeks prior to menses, regardless of cycle length

35

estrogen levels in follicular and luteal phase

rise just prior to ovulation, then drop, then rise again during luteal phase.

36

cervical mucus during ovulation

Increases in quantity, becoming less viscous and more penetrable by sperm.

37

Luteal phase changes

1) corpus luteum develops
2) vasculatory and secretory activity of endometrium increases
3) rise in basal body temp

38

corpus luteum secretes...

estrogen + progesterone

39

Why does menses occur?

Abrupt withdrawal of estradiol and progesterone.

40

placenta secretes...

hCG

41

Pregnancy hormones

steadily rising estrogen + progesterone

42

progesterone synthesis during pregnancy

corpus luteum in 1st trimester, placenta in second and third

43

major placental estrogen

estriol

44

How is lactation maintained?

Suckling, which stimulates both oxytocin and prolactin secretion.

45

Why is ovulation suppressed during pregnancy?

Because prolactin
A) inhibits hypothalamic GnRH secretion
B) Inhibits the action of GnRH on the anterior pituitary and consequently inhibits LH and FSH secretion.
C) antagonizes the actions of LH and FSH on the ovaries.

46

Steroid hormones

glucocorticoids (cortisol) + estrogen/testosterone/progesterone + vitamin D + thyroid hormone + retinoic acid

47

Which step in hormone biosynthesis if inhibited blocks the production of all androgenic compounds but does not block the production of glucocorticoids?

17-hydroxypregnenolone --> dehydroepiandrosterone

48

Which step in steroid hormone synthesis is stimulated by ACTH?

cholesterol --> pregnenolone. This is the step catalyzed by cholesterol desmolase.

49

What is the source of estrogen during the second and third trimesters?

Maternal ovaries and the fetal adrenal gland. During the second and third trimesters, the fetal adrenal gland synthesis dehydroepiandosteroen-sulfate (DHEA-S) which is hydroxylated in the fetal liver and then transferred to the placenta, where it is aromatized to estrogen.

50

What is the source of estrogen during the first trimester?

corpus luteum

51

What stimulates oxytocin secretion?

dilation of the cervix.

52

PTU mechanism

Inhibits oxidation of iodide.

53

PTH renal receptors

Located on basolateral membranes, not luminal.

54

Site of action of PTH calcium reabsorption

Distal tubule

55

Insulin receptor

4 subunits + tyrosine kinase activity

56

Why do AIS patients lack a uterus and cervix?

Anti-mullerian hormone secretion

57

spermatozoa

motile sperm; mature sperm

58

spermatid

precursor to spermatozoa

59

When does spermatogenesis begin?

puberty

60

chromatid

one copy of a newly copied chromosome which is still joined to the other by a centromere.

61

spermatid: 1) ploidy 2) number of chromosomes

1N, 1C

62

spermatogonium: 1) ploidy 2) number of chromosomes

2N,2C

63

secondary spermatocyte: 1) ploidy 2) number of chromosomes

1N,2C

64

Primary spermatocyte: 1) ploidy 2) number of chromosomes

2N, 4C

65

primary spermatocyte DNA copy number

4C

66

spermiogenesis

final stage of spermatogenesis; maturation of spermatids into mature, motile spermatozoa.

67

Spermiation

Removal of unnecessary cytoplasm and organelles.

68

Where do sperm acquire motility?

Epididymis

69

Testosterone negative feedback point

inhibits GnRH

70

estrogen secreting cells of uterus

theca cells

71

other name for suspensory ligament

infundibulopelvic ligament

72

androstenedione site of synthesis

adrenal glands + gonads

73

Tanner staging

• Code: Tanner rower kid from Dartmouth: /**tanner stage is assigned independently to genitalia, pubic hair, and breast (e.g., a person can have Tanner stage 2 genitalia, Tanner stage 3 pubic hair). Tiny Tanner kid with hat on running around in hallway/1 = childhood (prepubertal). Closer left corner + hen nesting on his head + naked with blonde pubs + bra on/2 = pubic hair appears (pubarche) + breast buds form (thelarche). Far left corner + holding a hambone + dark thick pubic hair + dick hanging down to floor + huge double D’s/3 = pubic hair darkens and becomes curly + penis size/length increases + breasts enlarge. Far right corner + Tanner with long blond hair + super wide chode + nipples protruding from his chest + dark skin around his dick + /4 = penis width increases + darker scrotal skin + development of glans + raised areolae. Closer corner + hailing on tanner + dressed in suit + areolae sticks are gone/5 = adult + areolae are no longer raised.
• Location: Rowing room

74

Fertilization occurs on ___ day of ovulation

Day 1, otherwise degenerates.

75

menopause labs

High FSH

76

klinefelter's labs

High FSH, LH, and estrogen. Low T and inhibin.

77

androstenedione

converted to either testosterone or estrogen.

78

What converts androstenedione to testosterone?

17beta-hydroxysteroid dehydrogenase

79

hypogonadotropic hypogonadism

Kallman syndrome

80

HTN and proteinuria that develops in 8th week pregnancy

Molar pregnancy (preeclampsia only develops after 20th week)

81

Placenta accreta pathophys

Defective decidual layer leads to placenta attachment to myometrium

82

HIstology findings in ectopics

- decidualized endometrium only
- no chorionic villi or embryo

83

HPV tumorigenesis

E6 (HPV 16) inhibits p53; E7 (HPV 18) inhibits RB

84

Renal failure secondary to HPV infection pathophysiology

Cervical cancer >> lateral invasion to block ureters

85

Most common cause of endometritis

Retained products of conception

86

Endometrial hyperplasia conditions

1) PCOS
2) hormone replacement therapy
3) granulosa cell tumor

87

Most common gyn malignancy

Endometrial cancer

88

Most deadly gyn malignancy

ovarian cancer

89

Anovulation causes

1) prolactinoma
2) Cushing's
3) Thyroid disorders
4) adrenal insufficiency
5) HPO axis abnormalities
6) obesity
7) eating disorder

90

impotence

failure to sustain an erection during intercourse. analogous to amenorrhea.

91

PCOS pathophys?

increased estrogen production in fatty tissue suppresses FSH production GnRH increases in response and thus LH rises testosterone production increases in theca cells as a consequence elevated testosterone results in development of male sex characteristics.

92

Why are OCPs given in PCOS?

treat hirsutism and acne by suppressing pituitary LH secretion and subsequently decreasing ovarian androgen production

93

Treatment of choice for infertility in PCOS

weight loss

94

Drug to induce ovulation in PCOS/profertility

clomiphene

95

breast cancer RF's

She’s topless in the middle of a nativity scene + obese + black + tons of gerbil cycles stacked up behind her/risk factors = increased estrogen exposure + increased total number of menstrual cycles + older age at 1st live birth + obesity (increased estrogen exposure as adipose tissue converts androstenedione to estrone) + BRCA1 and BRCA2 gene mutations + African American ethnicity (increased risk for triple negative breast cancer).

96

multiparity is protective in what cancer?

endometrial

97

Most common cause of prostatitis

chronic abacterial prostatitis

98

Frequent low volume urine...

detrusor overactivity

99

PSA function

proteolytic enzyme that increases sperm motility and maintains semen in liquid state. Liquefies semen and allows sperm to swim freely.

100

Gonadal hormone affected less by cryptorchidism

Testosterone (leydig cells can survive, esp. with unilateral cryptorchidism)

101

Cryptorchidism RF for..

germ cell tumors

102

germ cell tumors

1) seminoma
2) Yolk sac
3) chorio
4) teratoma
5) embryonal carcinoma

103

vast majority of testicular cancer in men is...

germ cell tumor

104

90% of gonadal tumors in women are...

NON-germ cell tumors

105

spermatocele

dilated epididymal duct OR rate testis presenting as scrotal swelling (can be transilluminated)

106

Phimosis

Foreskin cannot be fully retracted. Usually due to small orifice of prepuce.

107

Balanoposthitis

Infection of glans and prepuce in uncircumscribed males due to smegma.

108

Molecules responsible for testicular descent

1) MIF (Transabdominal phase)
2) hCG/androgens (inguinoscrotal phase-spontaneous descent after birth)

109

Sex steroid affects on blood lipids

Testosterone increases LDL, decreases HDL.
Estrogen increases HDL, decreases LDL.

110

Treatment for hereditary angioedema

Danazol.

111

antidepressant to use for complicated depression with cardiac concerns

MAOIs

112

Spironolactone
1) MOA
20 mechanism

o Coded character: Spyro the dinosaur: he picks up desmond tutu covered in tacks and kills him + is attacking mike covered in tacks with thong/inhibits steroid BINDING, 17alpha-hydroxylase, 17,20 desmolase. Spyro has a bra on + is putting a baseball bat up his vagina/toxicity = gynecomastia + amenorrhea.
o Location: YHS auditorium, walkway between front and back seating areas

113

treatment for hirsutism

Ketonocazole/spironolactone

114

SERM that is an estrogen antagonist at uterus

Raloxifen

115

Exemestane

Aromatase inhibitor, like anastrazole

116

progesterone role in OCPs

Decrease proliferation of endometrium (less suitable for implantation) + thickening of cervical mucus + preventing shedding

117

CRH affects in pregnancy

1) stimulates laber
2) induces fetal cortisol secretion

118

Tamsulosin affects on peripheral vasculature

Selective for alpha1A,D receptors (found on prostate) vs. vascular alpha1B receptors. So it is a good drug for BPH.

119

PCOS clinical picture can be induced by which drug?

Danazol (androgen agonism leads to reduced LH secretion)

120

Other name for cardinal ligament

transcervical ligament

121

Ligament that is a derivative of the gubernaculum

Round ligament

122

squamous epithelia in vagina type

NONKERATINIZED stratified squamous

123

What neurotransmitter is antierectile?

NE

124

What regulates emission?

sympathetic NS

125

What nervous system controls ejaculation?

somatic and visceral

126

Source of energy for sperm

fructose

127

What is the acrosome in sperm derived from?

golgi apparatus

128

spermiogenesis

spermatid --> spermatozoa

129

what happens during spermiogenesis?

Extrusion of cytoplasm + gaining of acrosome and flagellum.

130

What 2 diseases are increased in offspring of older men?

Achondroplasia + Marfans

131

What do sertoli cells secrete?

1) inhibin
2) MIF
3) androgen-binding protein

132

leydig cell endocrine mechanism

paracrine

133

when does spermatogenesis begin?

puberty

134

How long does spermatogenesis take?

2 months

135

Site of spermiogenesis

epidydimis

136

Which hormone is responsible for early penile growth? late penile growth?

1) DHT
2) testosterone

137

testosterone and hematologic effect

Increases hematocrit

138

potency in decreasing order of estrogens

estradiol, estrone, estriol

139

estrogen form associated with fetal well-being

estriol

140

Holoprosencephaly

forebrain (prosencephalon) fails to develop into two hemispheres.

141

Sonic hedgehog

o Code: he’s riding a Polaris snowmobile/produced at base of limbs in zone of polarizing activity. Huge arrow sticking out of the wall above him from anterior to posterior/involved in patterning along anterior-posterior axis. Blue statue of brain with stem attached to his right (CNS code)/involved in CNS development. Cyclops for a head/mutation can cause holoprosencephaly.

142

Wnt-7

o Code: Whitney with a hook arm/Wnt-7. Sitting on top of a big ridge in the ground + club extremities/produced at apical ectodermal ridge (thickened ectoderm at distal end of each developing limb). She has big fish dorsal fins on/necessary for proper organization along dorsal-ventral axis.
Location: far left corner

143

FGF gene

o Code: Frank from Dartmouth/FGF. he’s on a ridge just like Whitney’s/produced at apical ectodermal ridge. He has super long limbs/stimulates mitosis of underlying mesoderm, providing for lengthening of limbs.
o Location: far right corner

144

Homeobox (Hox) genes

o Code: Ryder Hockman: huge arrow hanging down from ceiling/involved in segmental organization of embryo in a craniocaudal direction. /code for transcription factors. He has legs for arms and arms for legs/Hox mutations appendages in wrong locations.
Location: bouldering wall to right of entryway

145

Morula by...

day 4

146

blastocyst by...

Day 5

147

Implantation

Days 6-10

148

Week 1 of fetal development

o Code: Shark with top hat in entryway/week 1. Blastocyst stuck to left wall + placenta hanging from ceiling/hCG secretion begins around the time of implantation of blastocyst.

149

Week 2 of fetal development

o Code: Shark with ice cream sandwhich around his waist + in hen’s nest in front of entryway/bilaminar disc (epiblast, hypoblast). 2 weeks = 2 layers.

150

week 3 of fetal development

o Code: 3 layered disc around his waist + holding a hambone/trilaminar disc. /3 weeks = 3 layers. Chef next to him/gastrulation (cells of epiblast migrate through primitive streak to become the endoderm, mesoderm, and notochord). Fish skewered into a cord on the right + cave man streaked with poop to the right of it + giant neuron synapsing onto a plate + miso soup covered in skin on shelf above/primitive streak + notochord + mesoderm and its organization + neural plate begin to form. /primitive streak is a groove in the midline of the caudal half of the epiblast layer of the two layer embryo. /during gastrulation in the third week, cells of the epiblast migrate through the primitive streak to become the endoderm, mesoderm, and notochord.
o Location: Behind front desk.

151

gastrulation

cells of the epiblast migrate through the primitive streak to become the endoderm, mesoderm, and notochord.

152

When do fetal movements start?

Week 8. Gait at week 8.

153

Craniopharyngioma

o Code: Henry Nichols: Jesus standing on desk/rare, slow-growing, benign. He’s sitting on top of a saddle (suprasellar code)/typically located in the suprasellar region. /cystic with solid areas. He’s seating at the desk with his head covered in brown and yellow cysts + room flooded with yellow, viscuous fluid with yellow eggs floating in it and steak/cysts usually filled with a brownish-yellow, viscuous fluid resembling machine oil due to presence of protein and cholesterol crystals. Calcium balls hanging from the ceiling/calcification of cysts is highly characteristic. Massive almond dug into the right wall with Daniel Radcliffe/harry potter sitting on top/derived from remnants of Rathke’s pouch/anterior pituitary. Nests filled with wet carrots lining left wall + palisading fences surrounding carrots + Indians in the middle/on light microscopy, cysts are lined by cords/nests of stratified squamous epithelium with peripheral palisading and internal areas of lamellar “wet” keratin. Eyes on the side of his head/bitemporal hemianopsia. He has huge teeth/similar to tooth-like tissue because of origin from remnants of Rathke’s ouch.
o Location: Nate’s office

154

VACTERL syndrome

/half of neonates with tracheoesophageal fistula (TEF) have associated congenital malformations. /vertebral + anal + cardiac + tracheoesophageal fistula + renal + limb abnormalities.

155

Surface ectoderm derivatives

♣ Surface ectoderm
♣ Code: Will standing in front of bar: Daniel Radcliffe riding an almond on right/Rathke’s pouch (anterior pituitary). Eye hanging from bar and looking through lens + bar lined with corn/lens + cornea. His ears are cut off/inner ear sensory organs. Nose is bright red/olfactory epithelium. /nasal & oral epithelial linings. Roof covered in skin/epidermis. Skin is sweating + Will is salivating intensely + boobs squirting milk on roof/salivary, sweat & mammary glands. /surface ectoderm. Super long hair + really long nails + massive ears + bright white teeth/hair + nails + inner ear + external ear + enamel of teeth. Chipmunk face/parotid gland. 2 gay dudes banging on Will’s right/anal canal below pectinate line.
♣ Location: rooftop in front of bar

156

neural tube derivatives

♣ Code: huge tube with CNS statue in middle/neural tube. statue of a spinal cord + brain/brain & spinal cord. Almond on the right/posterior pituitary. Christmas tree to the right of it/pineal gland. Projector with white screen to the left of statue/retina. Optic fiber cables hanging all around top of neural tube/optic nerve. Floor covered with stars/astrocytes. Floaty tubes wrapped around neural tube/oligodendrocytes.
♣ Location: Rooftop right corner, closer to city

157

neural crest derivatives

♣ Code: wave crashing onto left side/neural crest. Gang of thugs to his left + gang tied around post and crying face on top of post/autonomic, sensory, and celiac ganglia + postganglionic sympathetic neurons. Dr. Schwann cleaning Will’s teeth/schwann cells. Apple pie on top of his head + spider on top eating the pie/pia and arachnoid mater. Red cushions all around him + aorticopulmonary septum spiraling up towards the sky behind the skull/aorticopulmonary septum & endocardial cushions. Arc d’triumph overhead made of bones and shark fins/branchial arches (bones and cartilage). Big statue of a skull behind Dr. Swan/skull bones. Massive mole on top of his head/melanocytes. Giraffe with head of medulla to the right of Dr. Schwann/adrenal medulla. Thighs attached to parachutes descending from the sky/thyroid parafollicular C cells. Dr. Schwann blasting dentin into the patients mouth/odontoblasts (dentin forming cell). Cartilaginous bone stuck into the patients trach/tracheal cartilage. 2 penguins at the foot of the bed/chromaffin cells. Fat opera singer on right (larynx code) with shark fin on her head/laryngeal cartilage.

158

Mesoderm derivatives

o Code: Sam Purcell: super jacked/Muscles (skeletal, cardiac & smooth). /connective tissue, bone & cartilage. Whole room lined with peritoneum and he’s inside of it/serosa linings (eg peritoneum). Floor covered in blood + heart hanging above him/cardiovascular system + blood + lymphatic system. Big filter in left far corner/spleen. Big giraffe behind him + 2 kidneys hanging on either side with ureters hanging down to the floor + he has huge swollen nuts/internal genitalia + kidney + ureters. /adrenal cortex.

159

endoderm derivatives

o Code: Sam Purcell: hippo at bar + huge stack of pancreas next to bar/GI tract + liver + pancreas. He has wings on/lungs. Mime at bar/thymus. Parachute on his back/parathyroids. Huge jacked thighs/thyroid follicular cells. Big ear attached to the middle of his head/middle ear. Bladder extrophy + pissing onto the floor/bladder + urethra.
o Location: bar on first floor

160

aplasia

absent organ despite presence of primordial tissue.

161

Hypoplasia

incomplete organ development; primordial tissue present

162

Disruption

Secondary breakdown of previously normal tissue or structure (eg, amniotic band syndrome).

163

Deformation

Extrinsic disruption; occurs after embryonic period.

164

Malfformat

Intrinsic disruption; occurs during embryonic period (weeks 3-8).

165

Sequence

Abnormalities resulting from a single primary embryologic event (eg. oligohydramnios --> Potter sequence).

166

ACE inhibitor teratogenic effect

Renal damage

167

antiepileptic teratogenic effects

NTDs + cardiac defects + cleft palate + skeletal abnormalities (eg, phalanx/nail hyoplasia, facial dysmorphism)

168

antiepileptics associated with teratogenic effects

valproate + carbamazepine + phenytoin + phenobarbital

169

Diethylstilbestrol teratogenic effects

Vaginal clear cell adenocarcinoma + congenital Mullerian anomalies

170

What drugs are folate antagonists?

1) trimethoprim
2) methotrexate
3) antiepileptics

171

methimazoel teratogenic effects

aplasia cutis congenita

172

tetracyclines teratogenic effects

discolored teeth + inhibited bone growth

173

term for limb defects with thalidomide

phocomelia, micromelia

174

Warfarin teratogenic effects

Bone deformities + fetal hemorrhage + abortion + ophthalmologic abnormalities

175

substance associated with sudden infant death syndrome

smoking

176

maternal diabetes teratogenic effects

caudal regression syndrome (anal atresia to sirenomelia) + congenital heart defects + NTDs + macrosomia

177

methylmercury teratogenic effects

neurotoxic

178

facial characteristics of fetal alcohol syndrome

Smooth philtrum + thin vermillion border (upper lip) + small palpebral fissures + small eye opening

179

Most severe presentation of fetal alcohol syndrome

Heart-lung fistulas + holoprosencephaly

180

dizygotic twin mechanism

2 eggs separately fertilized by 2 different sperm

181

urogenital sinus develops into..

prostate gland + bulbourethral glands (of cowper) in men. Greater vestibular glands (of bartholin) and urethral and paraurethral glands (of skene) in women.

182

Twinning

• Code: Marion and Johnny: left corner: both in separate eggs (chorion code) covered in hair hanging from ceiling/if cleavage is between 0-4 days dichorionic/diamnionic. /di/di can be either monozygotic or dizygotic twins. Dizygotic twins always have their own amnion and own placenta. Right corner: Cunkelman brothers are in same egg hanging from ceiling covered in ivy + but both in separate amnions/if cleavage is between 4-8 days monochorionic/diamniotic. One enlarged brother and one smaller brother at the feet/monochorionic placentas are monozygotic (identical twins) + are at highest risk of twin-twin transfusion syndrome (TTTS). Tin cans covering floor + Cunkelman brothers are 69ing in the same egg/cleavage between 8-12 days = monochorionic/monoamniotic. Right closer corner: Cunkelman brothers are stuck together + mouths full of dimes/after 13 days = monochorionic/monoamniotic conjoined twins. /Most dangerous type (umbilical cords can get twisted and cut off blood supply). /twin pregnancies increase risk of miscarriage + also causes hyperemesis (hyperemesis is caused by elevated betaHCG) + increased risk of aneuploidy.
• Location: AD basement

183

cytotrophoblast

Inner layer of chorionic villi

184

syncytiotrophoblast

Outer layer of chorionic villi; synthesizes and secretes hormones, eg, hCG (syncytiotrophoblast synthesizes hormones)

185

fetal components of placenta

cytotrophoblast + syncytiotrophoblast

186

How does syncytiotrophoblast evade immune attack from mom?

Lacks MHC-1 expression

187

Where does maternal blood exist in placenta?

Lacunae.

188

Umbilical arteries connect...

Fetal internal iliac arteries to placenta.

189

Fetal umbilical vein connections...

Drains into IVC via liver or via ductus venosus.

190

Wharton's jelly

Gelatinous substance within the umbilical cord.

191

umbilical arteries and vein origin

allantois

192

When is allantois formed?

3rd week

193

Urachus formation

Yolk sac forms the allantois, which extends into the urogenital sinus. Allantois becomes the urachus.

194

What is the urachus?

Duct between fetal bladder and umbilicus.

195

Patent urachus + presentation

Total failure of urachus to obliterate. Urine discharge from umbilicus.

196

Urachal cyst

partial failure of urachus to obliterate; fluid-filled cavity lined with uroepithelium, between umbilicus and bladder.

197

Urachal cyst sequela

Infection + adenocarcinoma

198

vesicourachal diverticulum

Slight failure of urachus to obliterate --> outpouching of bladder.

199

Function of vitelline duct

Connects yolk sac to midgut lumen.

200

When does vitelline duct usually obliterate?

7th week

201

Vitelline fistula etiology

Vitelline duct fails to close, leading to meconium discharge from umbilicus.

202

Meckel deverticulum etiology

Partial closure of vitelline duct, with patent portion attached to ileum.

203

What does maxillary artery branch from?

External carotid

204

Derivatives of 1st aortic arch?

Maxillary artery

205

Derivatives of 2nd aortic arch?

stapedial artery + hyoid artery

206

Derivatives of 3rd aortic arch?

Common carotid + proximal part of internal carotid

207

Derivatives of 4th aortic arch?

On left, aortic arch; on right, proximal part of right subclavian artery

208

Derivatives of 6th aortic arch?

Proximal part of pulmonary arteries and (ON LEFT ONLY) ductus arteriosus

209

Path of recurrent laryngeal nerve

Right recurrent loops around right subclavian artery; left recurrent lops around aortic arch distal to ductus arteriosus.

210

branchial arch derivatives

Clefts (aka GROOVES) = ectoderm
Arches = mesoderm (mmuscles, arteries) + neural crest (bones, cartilage)
Pouches = endoderm

211

External auditory meatus origin

1st branchial cleft

212

What do 2nd through 4th branchial clefts give rise to?

Temporary cervical sinuses, which are obliterated by proliferation of 2nd arch mesenchyme.

213

Branchial cleft cyst etiology

congenital epithelial cyst that arises on the ***lateral part of the neck due to failure of obliteration of the second branchial cleft (or failure of fusion of the second and third branchial arches) in embryonic development.

214

Pierre robin presentation

Micrognathia + glossoptosis + cleft palate + airway obstruction

215

1st arch nerve derivatives

V2 + V3

216

1st arch muscle derivatives

Muscles of mastication + mylohyoid + anterior belly of digastric + tensor tympani + tensor veli palatini

217

Muscles of mastication

Temporalis + masseter + lateral and medial pterygoids

218

1st arch cartilage derivatives

1) Maxillary process --> maxilla + zygoMatic bone
2) Mandibular process --> Meckel cartilage + mandible
3) Malleus and incus
4) sphenoMandibular ligament

219

2nd arch cartilage derivatives

(S's) Stapes + Styloid process + lesser horn of hyoid + stylohyoid ligament

220

2nd arch muscle derivatives

Muscles of facial expression -- Stapedius, Stylohyoid, platySma, posterior belly of digastric

221

3rd arch cartilage derivative

Greater horn of hyoid

222

3rd arch muscle derivative

Stylopharyngeus

223

3rd arch nerve derivative

CN IX

224

Caveat about arch 5

Makes no major developmental contributions

225

4th-6th arch cartilage derivative

Arytenoids + cricoid, corniculate + cuneiform + thyroid (ACCCT)

226

4th arch muscle derivatives

Most pharyngeal constrictors + cricothyroid + levator veli palatini

227

6th arch muscle derivatives

All intrinsic muscles of larynx except cricothyroid

228

What forms posterior 1/3 of tongue?

Arches 3 + 4

229

4th arch cranial nerve

CN X (superior laryngeal branch)

230

6th arch cranial nerve

CN X (recurrent laryngeal branch)

231

1st branchial pouch derivatives + caveat

1) middle ear cavity + eustachian tube + mastoid air cells.
2) endoderm-lined structures of ear.

232

2nd branchial pouch derivatives

Epithelial lining of palatine tonsil.

233

3rd branchial pouch derivatives

Dorsal wings --> inferior parathyroids.
Ventral wings --> thymus

234

3rd branchial pouch caveat

3rd-pouch structures end up below 4th pouch structures.

235

4th pouch derivatives

Dorsal wings --> superior parathyroids.
Ventral wings
--> ultimobranchial body
--> parafollicular (C) cells of thyroid.

236

Cleft lip etiology

Failure of fusion of maxillary + medial nasal processes (formation of primary palate)

237

cleft plate etiology

1) failure of fusion of 2 lateral palatine shelves
OR
2) Failure of fusion of lateral palatine shelves with nasal septum
AND/OR
3) failure of fusion of lateral palatine shelves with median palatine shelf

238

Female genital development

Mesonephric duct degenerates and paramesonephric duct develops.

239

What determines testes development?

TDF from SRY gene

240

MIF suppresses...

development of paramesonephric ducts.

241

What stimulates development of mesonephric duct?

Androgens from Leydig cells (Men have Mesonephric ducts)

242

mesoneprhic AKA...

Wolffian duct

243

What does paramesonephric (Mullerian) duct give rise to?

Fallopian tubes, uterus, upper portion of vagina.

244

What is the lower portion of the vagina derived from?

Urogenital sinus

245

What is the male remnant of the Mullerian duct?

Appendix testis

246

Disease name for mullerian agenesis

Mayer-Rokitansky-Kuster-Hauser syndrome

247

Mayer-Rokitansky-Kuster-Hauser syndrome presentation

Primary amenorrhea (due to a lack of uterine development) in females with fully developd secondary sexual characteristics (***functional ovaries).

248

What is the remnant of the mesonephric duct in females?

Gartner duct

249

What does the mesonephric (Wolffian) duct give rise to in men?

SEED -- Seminal vesicles, Epididymis, Ejaculatory duct, Ductus deferens.

250

What would happen if you lacked sertoli cells or MIF?

Develop both male and female internal genitalia and male external genitalia.

251

Bicornuate uterues etiology

Incomplete fusion of Mullerian ducts

252

Uterus didelphys

complete failure of fusion --> double uterus + double vagina + double cervix. *pregnancy possible.

253

genital tubercle gives rise to in men...

glans penis + corpus cavernosum and spongiosum

254

urogenital sinus gives rise to in men...

Bulbourethral glands (of Cowper) + prostate gland

255

urogenital folds gives rise to in men...

Ventral shaft of penis (penile urethra)

256

Labioscrotal swelling gives rise to in men...

scrotum

257

genital tubercle gives rise to in women...

glans clitoris + vestibular bulbs

258

urogenital sinus gives rise to in women...

Greater vestibular glands (of Bartholin) + Urethral and paraurethral glands (of Skene)

259

Urogenital folds give rise to in women...

Labia minora

260

Labioscrotal swelling gives rise to in women...

Labia majora

261

which spadias is more common?

hypospadias

262

hypospadias associations

inguinal hernia + cryptorchidism

263

hypospadias etiology

Failure of urethral folds to fuse

264

epispadias etiology

Faulty positioning of genital tubercle

265

epispadias associations

Exstrophy of the bladder

266

male remnant of gubernaculum

Anchors testes within scrotum.

267

female remnant of gubernaculum

Ovarian ligament + round ligament of uterus

268

Remnant of process vaginalis in men

Forms tunica vaginals

269

Female remnant of process vaginalis

obliterated

270

glans penis drainage

deep inguinal nodes

271

External iliac drainage

Body of uterus + cervix + superior bladder

272

What is at risk of injury during ligation of uterine vessels in hysterectomy?

Ureter

273

What does round ligament connect?

Uterine fundus to labia majora

274

Round ligament course

Travels through round inguinal canal; above the artery of Sampson.

275

Broad ligament connects

uterus, fallopian tubes, and ovaries to pelvic side wall

276

broad ligament contains...

ovaries, fallopian tubes, round ligaments of uterus

277

3 components of broad ligament

Mesosalpinx + mesometrium + mesovarium

278

Most common area for cervical cancer?

Squamocolumnar junction

279

glands in uterus in proliferative phase vs. secretory phase

Long tubular glands in proliferative phase; coiled glands in secretory phase.

280

Bulbourethral gland (Cowper) location in men

Sits below the prostate

281

What covers seminiferous tubules?

Tunica albuginea

282

area damaged with posterior urethra damage

membranous urethra

283

area damaged with anterior urethra damage

bulbar + penile urethra

284

anterior urethra damage sequela

Can cause urine to leak beneath deep fascia of Buck. If fascia is torn, urine escapes into superficial perineal space.

285

How do PDE-5 inhibitors work?

Inhibit cGMP breakdown.

286

Opposite mechanism as NO and erection

NE --> increased Ca concentration --> smooth muscle contraction --> vasoconstriction --> no boner.

287

What lines the seminiferious tubule?

Spermatogonium

288

What regulates spermatogenesis?

Sertoli cells

289

Aromatase in men?

Expressed in sertoli cells, which convert testosterone and androstenedione to estrogens.

290

What is the problem with varicocele?

Increases body temperature. Since sertoli cells are temp sensitive, this decreases sperm production + decreases inhibin B.
*testosterone production not affected by temperature.

291

spermatogonium pathway

spermatogonium --> spermatocyte --> spermatids --> spermatozoan.

292

What regulates female fat distribution?

estrogen

293

Estrogen regulatory actions

1) **upregulates estrogen + LH + progesterone receptors.
2) Feedback inhibition of FSH and LH

294

estrogen changes in pregnancy

50-fold increase in estradiol and estrone.
1000-fold increase in estriol

295

Desmolase function

cholesterol --> androgens

296

What stimulates desmolase?

LH

297

What positively stimulates aromatase?

FSH

298

What indicates ovulation?

Increased progesterone

299

Where is progesterone synthesized in men?

adrenal cortex + testes

300

Location of progesterone synthesis in women?

Corpus luteum + placenta + adrenal cortex

301

other impt functions of progesterone

1) uterine smooth muscle relaxation (preventing contractions)
2) decreased estrogen receptor expression

302

C =

# of chromatids

303

secondary oocyte: N,C

1N, 2C

304

ovum: N,C

1N, 1C

305

oogonium: N,C

2N, 2C

306

primary oocyte

2N, 4C

307

Ovulation mechanism

Increased estrogen leads to increased GnRH receptor expression on anterior pituitary. Estrogen surge stimulates LH release --> ovulation

308

Mittelschmerz associations + caveat

Peritoneal irritation (eg, follicular swelling/rupture, fallopian tube contraction).
*appendicitis.

309

When is follicular growth the fastest?

2nd week of follicular phase

310

oligomenorrhea

Greater than 35 day cycle

311

Polymenorrhea

Less than 21 day cycle

312

Metrorrhagia

Frequent or irregular menstruation

313

Menorrhagia defined as

Greater than 80 mL blood loss or greater than 7 days of mensss

314

menometrorrhagia

Heavy + irregular menstruation

315

When is it possible to get pregnant?

There are only 6 days during any cycle, regardless of length, when a woman can get pregnant -- the five days leading up to ovulation and the 24 hours after ovulation. This is because sperm can live for up to 5 days in a woman's body, and the ovum lives for only 12-24 hours.

316

Ductus venous

Shunts blood from umbilical vein directly into the IVC, bypassing the liver

317

Neuroectoderm

Includes both neural crest + neural tube

318

What secretes hCG in the placenta?

syncytiotrophoblasts

319

How do you calculate gestational age?

From date of last menstrual period.

320

How do you calculate embryonic age?

Calculated from date of conception (gestational age MINUS 2 weeks). (Woman had her period, roughly 2 weeks later ovulated and got pregnant, so you need to subtract the window period).

321

physiologic adaptations in pregnancy

1) Increased cardiac output (increased preload, decreased after load).
2) Increased HR
3) Increased placental and renal perfusion
4) Anemia (increased plasma, increased RBCs, leading to decreased viscosity)
5) hypercoagulable (in order to decrease blood loss at delivery)
6) Hyperventilation (in order to eliminate fetal CO2)

322

When dose hCG peak?

8-10 weeks. This is the period of time in which hCG maintains the corpus luteum (and thus progesterone synthesis)

323

When does corpus lute degenerate?

After 8-10 weeks. Placenta is capable of synthesizing its own estriol and progesterone by then.

324

Why can states of increased hCG cause hyperthyroidism?

Shared subunit of hCG and TSH.

325

What does pregnancy test detect?

Beta subunit of hCG (has to because this is the unique subunit).

326

Causes of increased hCG

1) Down syndrome
2) multiple gestations
3) hydatidorm moles
4) choriocarcinoma

327

Causes of decreased hCG

1) ectopics
2) Edwards
3) Patau

328

Apgar evaluated at

1 minute and 5 minutes

329

Grimace scoring on apgar

2 = cries and pulls away
1 = grimaces or weak cry
0 = no response

330

Respiration scoring on apgar

1) strong cry
2) slow, irregular, shallow gasps
3) no breathing

331

Low birth weight definition

Less than 2500 g

332

Low birth weight associations

increased risk of SIDS + increased risk of overall mortality.

333

Problems associated with low birth weight

1) impaired thermoregulation
2) immune disfunction
3) hypoglycemia
4) polycythemia
5) impaired neurocognitive/emotional development

334

Complications of low birth weight

1) infections
2) NRDS
3) necrotizing enterocolitis
4) intraventricular hemorrhage
5) persistent fetal circulation

335

What does breast milk contain?

IgA + macrophages + lymphocytes

336

What does breast milk reduce risk of?

Risk of asthma + allergies + DM + obesity.

337

what does breastfeeding reduce maternal risk for?

breast + ovarian cancer.

338

Menopause diagnosis

amenorrhea for 12 months.

339

why do women have decreased estrogen production with menopause?

Decline in follicles.

340

average age of menopause

51

341

Source of estrogens after menopause and complication

Peripheral conversion of androgens. Increased androgens can lead to hirsutism.

342

Hormonal changes of menopause

decreased estrogen + very increased FSH + increased LH + increased GnRH

343

premature ovarian failure

Signs of menopause before age 40

344

HAVOCS

Hot flashes + Atrophy of vagina + Osteoporosis + CAD + Sleep disturbances

345

Source of androstenedione

ADrenal

346

What is responsible for closing of epiphyseal plates in boys?

Estrogen converted from testosterone.

347

estrogen synthesis in males

by CYP 450 aromatase primarily in adipose tissue + testis

348

spermatogonium function

Undergo mitosis, continually replenishing supply of sperm

349

stage 1 tanner in girls

Flat-appearing chest with raised nipple + no sexual hair

350

Term for stage III breasts in girls

"breast mound"

351

Term for stage II breasts in girls

"breast bud"

352

glans development in tanner staging

Stage IV

353

Stage IV in girls breast term

"Mound on mound"

354

Caveat about pubic hair in Stage IV

*spares thighs

355

Caveat about pubic hair in Stage V

Covers medial thigh

356

Penis and testes growth in Stage V?

Enlarge to adult size

357

Cause of increased FSH in klinefelters?

Decreased inhibit B due to dysgenesis of seminiferous tubules.

358

Cause of increased estrogen in klinefelters?

decreased testosterone --> increased LH --> increased estrogen synthesis

359

Most common cause of primary amenorrhea?

Turner's

360

How could you get a Turner patient pregnant?

IVF + exogenous estradiol and progesterone

361

Other cause of Turner's?

Mitotic error leading to mosaicism

362

Double Y presentation

Normal fertility + severe acne + learning disability + ASD

363

Ovotesticular disorder of sex development

More common in girls.
Both ovarian and testicular tissue present (ovotestis); ambiguous genitalia.
Previously called true hermaphroditism.

364

AIS hormones

Increased LH + increased testosterone

365

46, XX DSD

Disorderment of Sexual Development. Ovaries present, but external genitalia virilized or ambiguous. Due to excessive and inappropriate exposure to androgenic steroids during early gestation (eg, CAH or exogenous androgens during pregnancy).

366

46, XY DSD

Testes present, but external genitalia female or ambiguous. Eg, AIS.

367

Placental aromatase deficiency presentation?

1) Can't synthesize estrogens from androgens, so XX virilization with increased testosterone and androstenedione.

368

Scenario: maternal virilization during pregnancy.

Placental aromatase deficiency. Fetal androgens aren't aromatized and can cross the placenta.

369

AIS labs

Increased testosterone + Increased estrogen + increased LH

370

5alpha-reductase inheritance

Inability to convert testosterone to DHT.

371

5alpha-reductase presentation

Ambiguous genitalia until puberty, when increased testosterone causes masculinization + increased growth of external genitalia.

372

5alpha-reductase labs

Normal testosterone/estrogen + normal or increased LH

373

Hydatidorm mole histo

Cystic swelling of villi + proliferation of chorionic epithelium (only trophoblast)

374

Preeclampsia before 20 weeks?

hydatidiform moles

375

partial mole etiology

2 sperm + 1 egg

376

hCG in complete mole vs. partial

Very high hCG in complete + only minor elevation in partial

377

Imaging buzzwords for complete mole

"Honeycombed"
"clusters of grapes"
"Snowstorm"

378

Risk of gestational trophoblastic neoplasia with complete mole

15-20%

379

Risk of gestational trophoblastic neoplasia with partial mole

less than 5%

380

Risk of choriocarcinoma wit complete mole

2%

381

Choriocarcinoma histology

1) Malignancy of trophoblastic tissue (cytotrophoblasts + syncytiotrophoblasts).
2) NO chorionic villi present.
3) Increased frequency of multiple/bialteral theca-lutein cysts.

382

Caveat about abrupt placenta

Can be concealed or apparent. Abrupt, painful bleeding.

383

RF's for placenta accreta

1) prior C-section
2) inflammation
3) placenta previa

384

Most common type of placenta accreta

placenta accreta

385

placenta accrete pathophys

placenta attaches to myometrium without penetrating it.

386

placenta increta pathophys

Placenta penetrates into myometrium

387

placenta percreta pathophys

Placenta penetrates through myometrium and into uterine serosa (invades entire uterine wall).

388

placenta percreta sequela

can result in placental attachment to rectum or bladder.

389

placenta accreta pathophys

Often detected on US prior to delivery. No separation of placenta after delivery leading to postpartum bleeding (can cause Sheehan's)

390

placenta previa RF's

1) multiparty
2) prior C-section

391

vasa previa

Fetal vessels run over, or in close proximity to cervical os.

392

vasa previa sequela

1) vessels can rupture
2) exsanguination
3) fetal death

393

vasa previa triad

Membrane rupture + painless vaginal bleeding + fetal bradycardia

394

fetal bradycardia

HR less than 110 beats/min

395

vasa previa management

Emergency C-section

396

vasa previa associations

Velamentous umbilical cord insertion

397

Velamentous umbilical cord insertion

Cord inserts in chorioamniotic membrane rather than placenta. Fetal vessels travels to placenta unprotected by Wharton jelly.

398

Causes of postpartum hemorrhaging

4 T's:
1) Tone (uterine atony)
2) Trauma
3) thrombin (coagulopathy)
4) tissue (retained products of conception)

399

Most common cause of postpartum hemorrhaging?

Uterine atony

400

Ectopic RF's

1) prior ectopic pregnancy
2) history of infertility
3) salpingitis (PID)
4) ruptured appendix
5) prior tubal surgery

401

Polyhydramnios other causes

1) fetal anemia
2) multiple gestations

402

oligohydramnios associations

1) placental insufficiency
2) bilateral renal genesis
3) posterior urethral valves

403

Gestational HTN

BP greater than 140/90 after 20th week of gestation. No pre-existing HTN. No proteinuria or end-organ damage

404

Gestational HTN treatment

Hydrazine, alpha-methyldopa, labetalol, nifedipine. Deliver at 37-39 weeks.

405

Causes of maternal death with eclampsia.

1) stroke
2) intracranial hemorrhage
3) ARDS

406

HELLP syndrome

- Hemolysis, Elevated Liver enzymes, Low platelets.
- Manifestation of severe eclampsia.

407

Gyn tumor epidemiology Incidence

endometrial, ovarian, cervical

408

Gyn tumor epidemiology mortality

ovarian, endometrial, cervical

409

Sarcoma botyroides is a..

variant of embryonal rhabdomyosarcoma

410

Sarcoma botyroides

vaginal tumor affecting girls under 4. Spindle shaped cells. design positive. Presents with clear, grape-like polypoid mass emerging from vagina.

411

Carcinoma in situ classification.

CIN 1, CIN 2, CIN 3 (severe dysplasia --> DCIS)

412

Classic presentation of DCIS

Postcoital vaginal bleeding

413

Number 1 risk factor for cervical DCIS

multiple sexual partners

414

Cervical cancer diagnosis

colposcopy + biopsy

415

Other name for PCOS

Stein-Leventhal syndrome

416

First aid explanation for PCOS pathophys

Hyperinsulinemia and/or insulin resistance alters hormonal feedback response --> Increased LH/FSH --> increased testosterone from theca internal cells --> decreased rate of follicular maturation --> enraptured follicles (cysts) + an ovulation.

417

Most common ovarian mass in young women?

Follicular cyst

418

What is a follicular cyst?

Distended and enraptured graafian follicle.

419

Follicular cyst associations

hyperestrogenism + endometrial hyperplasia

420

Theca-lutein cyst associations

choriocarcinoma + hydatidiform moles

421

What causes theca-lutein cysts?

gonadotropin stimulation

422

Majority malignant ovarian neoplasms are...

epithelial

423

Most common malignant tumor

serous cystuadenocarcinoma.

424

Other RFs for ovarian neoplasms

1) infertility
2) endometriosis
3) PCOS
4) BRCA mutations
5) Lynch syndrome

425

Protective factors for ovarian neoplasms

1) previous pregnancy
2) history of breastfeeding
3) OCPs
4) tubal ligation

426

Ovarian neoplasm presentation

adnexal mass + abdominal dissension + bowel obstruction + pleural effusion.

427

serous cyst adenoma histology

Lined with fallopian tube-like epithelium

428

Complex mass on ultrasound...

endometrioma

429

What is endometriosis?

ectopic endometrial tissue

430

what is an endometrioma?

endometriosis within ovary with cyst formation. This is endometriosis in the ovary.

431

What is a chocolate cyst?

endometrioma filled with dark, reddish-brown blood (in the ovary).

432

other name for mature cystic teratoma?

Dermoid cyst

433

Most common ovarian tumor in females 10-30 yo?

Mature cystic teratoma

434

struma ovarii

monodermal mature cystic teratoma presenting as hyperthyroidism

435

Presentation of mature cystic teratoma

Pain secondary to ovarian enlargement or torsion

436

Brenner tumor presentation

Looks like bladder. Solid tumor that is pale yellow-tan and appears encapsulated. "Coffee bean" nuclei.

437

fibromas

bundles of spindle-shaped fibroblasts

438

Miegs syndrome triad

ovarian fibroma + ascites + hydrothorax.

439

"pulling" sensation in groin...

Miens syndrome

440

theca + presentation

Basically a benign granulose cell tumor, may produce estrogen. Abnormal uterine bleeding in a postmenopausal woman.

441

Most common malignant stroll tumor...

Granulose cell tumor

442

Granulose cell tumor presentation in pre-adolescents

sexual precocity

443

Pseudomyxoma peritonei

Intraperitoneal accumulation of mutinous material from ovarian or appendiceal tumor.

444

Pseudomyxoma peritonei association

mutinous cystadenocarcinoma

445

Dysgerminoma histology + markers

1) sheets of uniform "fried egg" cells.
2) hCG + LDH

446

Tumor in sacrococcygeal area in young children...

Yolk sac tumor

447

What is an endometrial polyp?

well-circumscribed collection of endometrial tissue within uterine wall. May contain smooth muscle cells. Can extend into endometrial cavity.

448

Endometrial polyp presentation

Asymptomatic or painless abnormal uterine bleeding.

449

adenomyosis etiology

hyperplasia of basal layer of endometrium

450

Uterus presentation in adenomyosis

Uniformly enlarged, soft, globular uterus.

451

Most common tumor in females

Leiomyomas (uterine fibroids)

452

Which is a greater RF for endometrial carcinoma: nuclear type or complex architecture?

nuclear atypia

453

Most common gynecologic malignancy

Endometrial carcinoma

454

Peak incidence of endometrial carcinoma?

55-65 years old

455

endometritis causes

1) Retained products of conception
2) miscarriage
3) abortion
4) foreign body (IUD)

456

endometritis etiology

retained material in the uterus promotes infection by bacterial flora from vagina or intestinal tract.

457

endometritis treatment

gentamicin with clindamycin +/- ampicillin

458

Most common sites of endometriosis

Ovary (often bilateral) + pelvis + peritoneum.

459

Endometriosis etiology

1) retrograde flow
OR
2) metaplastic transformation of multipotent cells
OR
3) transportation of endometrial tissue via lymphatic system

460

dyschezia

pain with defecation

461

dyschezia in a woman think..

endometriosis

462

Uterus presentation in endometriosis

Normal-sized

463

Cyclic pelvic pain in a woman think...

endometriosis

464

endometriosis treatment options

1) NSAIDs
2) OCPs
3) progestins
4) GnRH agonists
5) danazol
6) laparoscopy

465

Breast conditions in the stroma

1) Fibroadenoma
2) phyllodes tumor

466

Terminal duct/lobular unit breast conditions

1) fibrocystic change
2) DCIS and LCIS
3) ductal carcinoma
4) lobular carcinoma

467

Lactiferous sinus and major duct breast conditions

1) intraductal papilloma
2) abscess/mastitis
3) Paget's disease

468

Most common benign breast disease in women under 35

fibroadenoma

469

Most common benign breast condition in women over 35

fibrocystic changes

470

Fibrocystic changes presentation

Woman over 35 with premenstrual breast pain or lumps; often bilateral and multifocal.

471

Most common cause of nipple discharge (serous or bloody)?

Intraductal papilloma

472

mammography finding fat necrosis

calcified oil cyst

473

When is gynecomastia physiologic?

Newborn, pubertal, and elderly males.

474

Most common site of malignant breast tumors

Terminal duct lobular unit

475

DCIS characteristics

1) Fills ductal lumen
2) Arises from ductal atypica

476

Mammography finding in DCIS

Microcalcifications

477

Paget cells

intraepithelial adenocarcinoma cells

478

Most common of all breast cancers

invasive ductal carcinoma

479

medullary carcinoma prognosis

Good

480

Inflammatory breast cancer prognosis

Poor (50% survival at 5 years)

481

Etiology of peyronie's

Abnormal curvature of penis due to fibrous plaque within tunica albuginea.

482

Penile fracture

Rupture of corpora cavernous due to forced bending.

483

priapism definition

erection lasting longer than 4 hours

484

priapism treatment options

1) corporal aspiration
2) intracavernosal phenylephrine
3) surgical decompression

485

bilateral vs unilateral lab findings in cryptorchidism

Testosterone is down in bilateral, normal in unilateral

486

Cryptorchidism commonly seen in...

Premies

487

"bag of worms" on palpation

varicocele

488

Varicocele -- transiluminate or no?

does NOT transilluminate.

489

varicocele treatment options

1) varicocelectomy
2) embolization

490

Most common locations of extragonadal germ cell tumors in adults

Retroperitoneum + mediastinum + pineal + suprasellar regions.

491

Most common cause of scrotal swelling in infants

congenital hydrocele

492

hematocele

bloody hydrocele

493

acquired hydrocele

scrotal fluid collection usually secondary to infection, trauma, or tumor.

494

paratesticular fluctuant nodule...

spermatocele. Paratesticular = intrascrotal mass without testicular origin

495

Things that don't transilluminate

1) varicocele
2) tumor

496

choriocarcinoma histology

Disordered syncytiotrophoblastic and cytotrophoblastic elements

497

choriocarcinoma mets

hematogenous mets to lungs + brain

498

potential presentation of choriocarcinoma

gynecomastia + hyperthyroidism pictures (due to shared alpha subunit

499

embryonal macroscopic description

hemorrhagic mass with necrosis

500

labs in embryonal carcinoma

1) Increased hCG + normal AFP when pure.
1) both increased when mixed.

501

Lydia cell tumor presentation

Gynecomastia in men, precocious puberty in boys

502

androblastoma

sertoli cell

503

caveat about testicular lymphoma

Arises from metastatic lymphoma to testes.

504

prostate in BPH description

smooth, elastic, firm nodular enlargement

505

Which lobes are involved in bPH

lateral and middle lobes (explains why urethra is compressed)

506

Other drug for BPH

tadalafil

507

tadalafil and caveat

PDE-5 inhibitor (sildenafil, vardenafil, tadalafil) but doesn't drop BP.

508

prostatitis prostate description

warm, tender, enlarged prostate.

509

Lobe most commonly involved in prostatic adenocarcinoma

Posterior lobe (peripheral zone)

510

other prostate cancer tumor

prostatic acid phosphatase (PAP) + ALP with osteoblastic bone mets.

511

infertility treatment

Leuprolide

512

What are the synthetic estrogens?

1) ethinyl estradiol
2) DES
3) mestranol

513

Treatment for men with androgen-dependent prostate cancer?

estrogen

514

estrogen contraindications?

1) ER positive breast cancer
2) history of DVTs

515

SERMs

1) clomiphene
2) tamoxifen
3) raloxifene

516

Clomiphene SE's

1) hot flashes
2) ovarian enlargement
3) multiple simultaneous pregnancies
4) visual disturbances

517

tamoxifen properties

Antagonist at breast; agonist at bone, uterus.

518

Treatment for ER/PR positive cancer?

Tamoxifen

519

Raloxifine properties

Antagonist at breast + antagonist at uterus + agonist at bone.

520

name some progestins

1) levonorgestrel
2) medroxyprogesterone
3) etonogestrel
4) norethindrone
5) megestrol

521

treatment for abnormal uterine bleeding?

progestins

522

Progestin challenge

Test used to evaluate a pt experiencing amenorrhea. If patient has sufficient estradiol, they will experience withdrawal bleeding after progestin is finished (this indicates she has estrogen which causing the lining of the uterus to build up which will cause bleeding), indicating the patient's amenorrhea is due to an ovulation. If no bleeding occurs after withdrawal, amenorrhea due to either a) low serum estradiol b) HPO dysfunction C) some others.

*Presence of withdrawal bleeding excludes anatomic defects and chronic anovulation without estrogen.

523

Asherman syndrome

adhesions or fibrosis of endometrium

524

ulipristal

antiprogestin

525

ulipristal use

emergency contraception

526

combined contraception mechanism

Estrogens and progestins inhibit LH/FSH and thus prevent estrogen surge and thus prevent LH surge and ovulation

527

combined contraception contraindications

1) smokers older than 35
2) cardiovascular disease
3) migraines (especially with aura)
4) breast cancer

528

Most effective emergency contraceptive?

copper IUD

529

ritodrine

like terbutaline, beta2 agonist used to relax the uterus and decrease contraction frequency.

530

danazol MOA

partial agonist at androgen receptors

531

tamsulosin MOA

inhibits smooth muscle contraction

532

Other use for PDE-5 inhibitors

pulmonary HTN

533

term for blue-tined vision (PDE-5 inhibitors)

cyanopia

534

dyspepsia

indigestion

535

dyspepsia associated with

PDE-5 inhibitors

536

anemia of pregnancy mechanism

Your body makes more blood in pregnancy but keeps the same amount of RBC's (eg increased plasma relative to RBCs)

537

Why does uterine atony cause bleeding?

Normally contraction of the uterus causes compression of blood vessels, inhibiting hemorrhaging during delivery

538

Anovulatory cycle etiology

normal bleeding is due to a decline in estrogen, with anovulatory cycles, there is no progesterone and bleeding is caused by unopposed estrogen (inability of estrogen to support a growing endometrium.

539

anovulatory cycle definition

absence of ovulation and a luteal phase.

540

Stress incontinence treatment

pelvic floor muscle strengthening (kegel) exercises + weight loss + pessaries (device inserted into the vagina to provide structural support).

541

When does rooting disappear by?

2-3 months

542

When does palmar grasp disappear by?

3 months

543

Galant reflex

stroking along one side of the spine while newborn is in ventral suspension (face down) causes lateral flexion of lower body toward stimulated side.

544

Chadwick's sign + timing

• Code: he has a vagina and it’s blue/bluish discoloration of the cervix, vagina, and labia resulting from increased blood flow. He’s pregnant + hash block to his right + ivy all around him/can be observed as early as 6 to 8 weeks after conception and its presence is an early sign of pregnancy.
• Location: Chad Lorenz from Yarmouth, far end of tennis court, right corner

545

Pica association

iron-deficiency anemia

546

rectal prolapse associations

associated with pregnancy + constipation + severe diarrhea + cystic fibrosis. Worm cartoon with a huge whip on left table/whipworm.

547

Imperforate anus

• Code: Nick fom NYA: green ball of gue hanging from ceiling overhead/manifests with inability to pass meconium. Green gue coming out of his dick/meconium may discharge from urethra or vagina if a fistula is present. Walls made of spades + huge yellow bag sticking out of ceiling from above + dead giraffe on floor in front of white board/commonly associated with urinary tract malformations (eg. Renal agenesis + hypospadias + epispadias + bladder extrophy).
• Location: upstairs in NYA

548

Primary amenorrhea in a patient with fully developed secondary sexual characteristics suggests..

Defect in genital tract like imperforate hymen or mullein duct anomaly.

549

imperforate hymen presentation

cyclic abdominal or pelvic pain + a hematocolpos that can manifest as a vaginal bulge and/or mass palpated anterior to the rectum + back pain + difficulties with defecation and urination.

550

Familial testotoxicosis
1) pathophys
2) treatment

Ron Jeremy. /mutation of LH receptor causes it to be constitutively activated. /autonomous leydig cell activity. /presentation = testes enlarged but not to the extent expected for degree of virilization. /autosomal dominance with only male penetrance. /treatment = androgen blocker OR ketoconazole.

551

Noonan syndrome

male version of Turner's

552

Neonatal abstinence syndrome (NAS)

o Code: bunch of people shooting up around the room/withdrawal from transplacental opiates due to maternal drug use. Super jacked baby (hypertonia code) + shitting on the ground + sweating profusely + black eyes (mydriasis code)/presentation = tachypnea + hypertonia + hyper-excitability + increased startle reflex + irritability + diarrhea + vomiting + ANS (sweating, sneezing, mydriasis). Jack from Dartmouth is cradling the baby/treatment = methadone or morphine. /stem may suggest it by mentioning hep C infection.
o Location: TV room

553

Why is maternal diabetes an RF for NRDS?

Insulin inhibits surfactant production

554

Cardiac complication of maternal diabetes

Transposition of the great arteries

555

Caudal regression syndrome

o Code: /associated with poorly controlled maternal diabetes. He has jellow legs + is pissing all over himself + has a tail + legs are fused together + on a stretcher + heart man in right corner + Joe holding stretcher up/presentation = sacral agenesis causing lower extremity flaccid paralysis + dorsiflexed contractures of the feet + urinary incontinence + anal atresia to sirenomelia + congenital heart defects + NTDs.
o Location: Harry Plumer’s dad’s house
o Sirenomalia = legs are fused together like a mermaid’s table

556

Bartholin's gland cyst

Barbara Neistadt: /relatively common. /presentation = tender, flocculent swelling below the skin of the posterolateral part of the labium majora. /obstruction of bartholin’s gland, typically a sequel to a previous infection. /cysts lined by either transitional epithelium or metaplastic squamous epithelium.

557

vestibular adenitis

• Code: Genevieve Adams: She’s inside of a vestibule + it’s lined with inflammation statues smoking blunts/chronic inflammation of the lesser vestibular glands. /vestibular glands lie just outside the hymenal ring. Ulcers covering her inside vagina + axe in her vagina/presentation = small + exquisitely painful ulcerations of the vestibular mucosa. /greater vestibular glands are Bartholin’s glands, minor are vestibular glands.
• Location: Table outside café in Ed2

558

Lichen sclerosus
1) presentation
2) histology

• Code: Anna Schreiber: /chronic inflammatory condition producing white plaques usually on or near genitals. She’s itching her vagina intensely ++ getting banged out and screaming in pain by her boyfriend/presentation = dyspareunia + dysuria + pruritis. Table lined with inflammation statues/histo = inflammatory infiltrate at dermal-epidermal junction + thinned epidermis. Squamous indian sitting on her right/RF for squamous cell carcinoma.
• Location: table outside of Ethai’s

559

presentation of ovarian cancers in young girls

precocious puberty

560

Peritoneal carcinomatosis

Omentum looks really f’d from transcoelomic spread of cancers in the abdominal cavity (ovarian carcinoma most common source but colon cancer can produce a similar picture).

561

Peritoneal effusion

1) Increased ammonia (produced by bacterial proliferation in the damaged intestine) without an increase in creatinine.
2) gram stain of peritoneal fluid will demonstrate presence of enteric flora.

562

Cloudy urine after sex...

retrograde ejaculation

563

Very little seminal fluid released from urethra

retrograde ejaculation

564

retrograde ejaculation associated with

complication of TURP due to damage of internal urethral sphincter.

565

Precocious puberty definition

Before age of 8 in girls, 9 in boys.