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Step 1 > Reproductive > Flashcards

Reproductive Flashcards

1
Q

Sonic hedgehog gene

A
  • Produced at base of limbs in zone of polarizing activity - - Involved in patterning along anteroposterior axis and CNS development
  • Mutation can cause holoprosencephaly
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2
Q

Wnt-7 gene

A
  • Produced at apical ectodermal ridge (thickened ectoderm at distal end of each developing limb)
  • Necessary for proper organization along dorsal-ventral axis
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3
Q

FGF gene

A
  • Produced at apical ectodermal ridge

- Stimulates mitosis of underlying mesoderm, providing for lengthening of limbs

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4
Q

Homeobox (Hox) genes

A
  • Involved in segmental organization of embryo in a craniocaudal direction
  • Code for transcription factors
  • Hox mutations → appendages in wrong locations
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5
Q

Within week 1

A
  • hCG secretion begins around the time of implantation of blastocyst
  • Blastocyst sticks at day 6
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6
Q

Within week 2

A
  • Bilaminar disc (epiblast, hypoblast)

- 2 weeks = 2 layers

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7
Q

Weeks 3-8

A
  • Gastrulation forms trilaminar embryonic disc
  • Cells from epiblast invaginate → primitive streak → endoderm, mesoderm, ectoderm
  • Notochord arises from the midline mesoderm
  • Overlying the ectoderm becomes neural plate
  • 3 weeks = 3 layers
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8
Q

Week 4

A
  • Heart begins to beat
  • Upper and lower limb
  • 4 weeks = 4 limbs and 4 heart chambers
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9
Q

Week 6

A

Fetal cardiac activity visible by transvaginal ultrasound

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10
Q

Week 8

A
  • Fetal movements start

- “Gait at week 8”

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11
Q

Week 10

A

Genitalia have male/female characteristics

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12
Q

Surface ectoderm

A
  • Epidermis
  • Adenohypophysis (from Rathke pouch)
  • Lens of eye
  • Epithelial linings of oral cavity, sensory organs of ear, and olfactory epithelium
  • Epidermis
  • Anal canal below the pectinate line
  • Parotid, sweat and mammary glands
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13
Q

Neuroectoderm

A
  • Brain (neurohypophysis, CNS neurons, oligodendrocytes, astrocytes, ependdymal cells, pineal gland)
  • Retina
  • Spinal cord

“Neuroectoderm - think CNS”

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14
Q

Neural crest

A
  • PNS (dorsal root ganglia, cranial nerves, autonomic ganglia, Scwann cells)
  • Melanocytes
  • Chromaffin cells of adrenal medulla
  • Parafollicular (C) cells of thyroid
  • Pia and arachnoid
  • Bone of skull
  • Odontoblasts
  • Aorticopulmonary septum
  • Endocardial cushions
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15
Q

Mesoderm

A
  • Muscle
  • Bone
  • Connective tissue
  • Serous linings of body cavities (eg peritoneum)
  • Spleen (derived from foregut mesentery)
  • Cardiovascular structures
  • Lymphatics
  • Blood
  • Wall of gut tube
  • Upper vagina
  • Kidneys
  • Adrenal cortex
  • Dermis
  • Testes
  • Ovaries
  • Notochord induces ectoderm to form neuroectoderm (neural plate), its only postnatal derivative is the nucleus pulposus of the intervertebral disc

Mesodermal defects = VACTERL

  • Vertebral defects
  • Anal atresia
  • Cardiac defects
  • Tracheo-Esophageal fistula
  • Renal defects
  • Limb defects (bone and muscle)
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16
Q

Endoderm

A
  • Gut tube epithelium (including anal canal above the pectinate line)
  • Most of the urethra and lower vagina (derived from urogenital sinus)
  • Luminal epithelial derivatives (eg lungs, liver, gallbladder, pancreas, eustachian tube, thymus, parathyroid, thyroid follicular cells)
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17
Q

Deformation vs malformation

A

DEFORMATION: extrinsic disruption; occurs after embryonic period

MALFORMATION: intrinsic disruption; occurs during embryonic period (weeks 3-8)

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18
Q

ACE inhibitors

A

Renal damage

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19
Q

Alkylating agents

A

Absence of digits, multiple anomalies

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20
Q

Aminoglycosides

A

Ototoxicity

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21
Q

Antiepileptic drugs

A
  • Neural tube defects
  • Cardiac defects
  • Cleft palate
  • Skeletal abnormalities (eg phalanx/nail hypoplasia, facial dysmorphism)
  • High dose folate supplementation recommended.
  • Most commonly valproate, carbamazepine, phenytoin, phenobarbital
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22
Q

Diethylstibestrol

A
  • Vaginal clear cell adenocarcinoma

- Congenital Mullerian anomalies

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23
Q

Folate antagonists

A
  • Neural tube defects

- Includes trimethroprim, methotrexate, antiepileptic drugs

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24
Q

Isotretinoin

A
  • Multiple severe birth defects

- Contraception mandatory

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25
Q

Lithium

A

Ebstein anomaly (apical displacement of tricuspid valve)

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26
Q

Methimazole

A

Aplasia cutis congenita

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27
Q

Tetracyclines

A

Discolored teeth, inhibited bone growth

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28
Q

Thalidomide

A

Limb defects (phocomelia, micromelia - “flipper” limbs)

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29
Q

Warfarin

A
  • Bone deformities
  • Fetal hemorrhage
  • Abortion
  • Ophthalmologic abnormalities
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30
Q

Alcohol

A
  • Common cause of birth defects and intellectual diability

- Fetal alcohol syndrome

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31
Q

Cocaine

A
  • Low birth weight
  • Preterm birth
  • IUGR
  • Placental abruption
  • Cocaine → vasoconstriction
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32
Q

Smoking (nicotine, CO)

A
  • Low birth weight (leading cause in developed countries)
  • Preterm labor
  • Placental problems
  • IUGR
  • SIDS
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33
Q

Iodine (lack or excess)

A

Congenital goiter or hypothyroidism (cretinism)

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34
Q

Maternal diabetes

A
  • Caudal regression syndrome (anal atresia to sirenomelia)
  • Congenital heart defects
  • Neural tube defects
  • Macrosomia
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35
Q

Methylmercury

A
  • Neurotoxicity

- Highest in swordfish, shark, tilefish and king mackerel

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36
Q

Vitamin A excess

A

Extremely high risk for spontaneous abortions and birth defects (cleft palate, cardia)

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37
Q

X-rays

A

Microcephaly, intellectual disability. Minimized by lead shielding.

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38
Q

Fetal alcohol syndrome

A
  • Leading cause of intellectual disability in the US
  • Newborns of alcohol-consuming mothers have ↑ incidence of congenital abnormalities
  • Pre and postnatal developmental retardation
  • Microcephaly
  • Facial abnormalities (eg smooth philtrum, thin vermillion border [upper lip], small palpebral fissures)
  • Limb dislocation
  • Heart defects
  • Heart-lung fistulas and holoprosencephaly in most severe forms
  • MECHANSIM IS FAILURE OF CELL MIGRATION
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39
Q

Dizygotic twins

A

Arise from 2 eggs that are separately fertilized by 2 different sperm (always 2 zygotes) and will have 2 separate amniotic sacs and 2 separate placentas (chorions)

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40
Q

Monozygotic twins

A
  • Arise from 1 fertilized egg (1 egg + 1 sperm) that splits in early pregnancy
  • The timing of cleavage determines chorionicity (number of chorions) and amnionicity (aumber of amnions)
  • Cleavage at 0-4 days → dichorionic, diamniotic (25%)
  • Cleavage at 4-8 days → monochorionic, diamniotic (75%)
  • Cleavage at 8-12 days → monochorionic, monoamniotic (rare)
  • Cleavage after 13 days → monochorionic, monoamniotic (conjoined - rare)
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41
Q

Cytotrophoblast

A
  • Inner layer chorionic vili

- Makes cells

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42
Q

Syncytiotrophoblast

A
  • Outer layer chorionic villi
  • Synthesizes and secretes hormones (eg hCG - structurally similar to LH; stimulates corpus luteum to secrete progesterone during first trimester)
  • Lacks MHC-I expression → ↓ chance of attack by maternal immune system
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43
Q

Decidua basalis

A
  • Derived from endometrium

- Maternal blood in lacunae

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44
Q

Single umbilical artery (2-vessel cord)

A

Associated with congenital and chromosomal anomalies

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45
Q

Umbilical arteries and vein are derived from

A

Allantois

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46
Q

Urachus

A
  • In the 3rd week the yolk sac forms the allantois, which extends into urogenital sinus
  • Allantois becomes the urachus, a duct between the fetal bladder and umbilicus
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47
Q

Patent urachus

A

Total failure of urachus to obliterate → urine discharge from umbilicus

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48
Q

Urachal cyst

A
  • Partial failure of urachus to obliterate
  • Fluid-filled cavity lined with uroepithelium, between the umbilicus and bladder
  • Can lead to infection, adenocarcinoma
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49
Q

Vesicourachal diverticulum

A

Slight failure of urachus to obliterate → outpouching of bladder

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50
Q

Vitelline duct

A

7th week - obliteration of vitelline duct (omphalo-mesenteric duct), which connects yolk sac to midgut lumen

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51
Q

Vitelline fistula

A

Vitelline duct fails to close → meconium discharge from umbilicus

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52
Q

Meckel diverticulum

A
  • Partial closure of vitelline duct, with patent portion attached to ileum (true diverticulum)
  • May have heterotropic gastric and/or pancreatic tissue → melena, hematochezia, abdominal pain
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53
Q

1st aortic arch

A

Part of maxillary artery.

“1st arch is maximal”

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54
Q

2nd aortic arch

A

Stapedial artery and hyoid artery.

“Second = Stapedial”

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55
Q

3rd aortic arch

A

Common carotid and proximal part of internal carotid artery.

“C is the 3rd letter of the alphabet”

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56
Q

4th aortic arch

A
  • On left, aortic arch
  • On right, proximal part of right subclavian artery

“4th arch (4 limbs) = systemic”

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57
Q

6th aortic arch

A

Proximal part of pulmonary arteries and (on left only) ductus arteriosus.

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58
Q

Right recurrent laryngeal nerve loops around

A

Right subclavian artery

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59
Q

Left recurrent laryngeal nerve loops around

A

Aortic arch distal to ductus arteriosus

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60
Q

1st branchial cleft

A

External auditory meatus

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61
Q

2nd-4th branchial clefts

A
  • Temporary cervical sinuses, which are obliterated by proliferation of 2nd arch mesenchyme
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62
Q

Persistent cervical sinus

A
  • From 2nd-4th branchial clefts
  • Within lateral neck, anterior to sternocleidomastoid muscle
  • IMMOBILE during swallowing
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63
Q

1st branchial arch cartilage

A
  • Maxillary process → maxilla, zygoMatic arch

- Mandibular process → Meckel cartilage → Mandible, Malleus, and incus, sphenoMandibular ligamen

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64
Q

1st branchial arch muscles

A
  • Muscles of Mastication (temporalis, Masseter, lateral and Medial pterygoid)
  • Mylohyoid
  • Anterior belly of digastric
  • Tensor tympani
  • Tensor veli palatini
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65
Q

1st branchial arch nerves

A
  • CN V2 and V3

- Chew

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66
Q

2nd branchial arch cartilage

A

Reichert cartilage: Stapes, Styloid profess, lesser horn of the hyoid, Stylohyoid ligament

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67
Q

2nd branchial arch muscles

A
  • Muscles of facial expression
  • Stapedius
  • Stylohyoid
  • PlatySma
  • Posterior belly of the digastric
68
Q

2nd branchial arch nerves

A
  • CN VII (facial expression)

- Smile

69
Q

3rd branchial arch cartilage

A

Greater horn of the hyoid

70
Q

3rd branchial arch muscles

A

Stylopharyngeus (think of stylopharyngeus innervated by glossopharyngeal nerve)

71
Q

3rd branchial arch nerves

A
  • CN IX

- Stylopharyngeus → swallow stylishly

72
Q

4th-6th branchial arch cartilages

A
  • Arytenoids
  • Cricoid
  • Corniculate
  • Cuneiform
  • Thyroid

“Used to sing and ACCCT”

73
Q

4th-6th branchial arch muscles

A
  • 4th arch: most pharyngeal constrictors, cricothyroid, levator veli palatini
  • 6th arch: all intrinsic muscles of larynx except cricothyroid
74
Q

4th-6th branchial arch nerves

A
  • 4th arch: CN X (superior laryngeal branch) [simply swallow]
  • 6th arch: CN X (recurrent laryngeal branch) [speak]
75
Q

Pierre Robin sequence

A
  • 1st and 2nd branchial arch defect
  • Micrognathia
  • Glossoptosis
  • Cleft palate
  • Airway obstruction
76
Q

Treacher Collins syndrome

A
  • 1st and 2nd branchial arch defect

- Neural crest dysfunction → mandibular hypoplasia, facial abnormalities

77
Q

1st branchial pouch

A
  • Middle ear cavity, eustachian tube, mastoid air cells

- Contributes to endoderm-lined structures of ear

78
Q

2nd branchial pouch

A

Epithelial lining of palatine tonsil

79
Q

3rd branchial pouch

A
  • Dorsal wings → inferior parathyroid glands
  • Ventral wings → thymus
  • 3rd pouch structures end up below 4th pouch structures
80
Q

4th branchial pouch

A
  • Dorsal wings → superior parathyroid glands

- Ventral wings → ultimobranchial body → parafollicular C cells of thyroid

81
Q

DiGeorge syndrome

A
  • Chromosome 22q11 deletion
  • Aberrant development of 3rd and 4th pouches → T cell deficiency (thymic aplasia) and hypocalcemia (failure of parathyroid development)
  • Associated with cardiac defects (conotruncal anomalies)
82
Q

Cleft lip

A

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

83
Q

Cleft palate

A

Failure of fusion of the 2 lateral palatine shelves or failure of fusion of lateral palatine shelves with the nasal septum and/or median palatine shelf (formation of secondary palate)

84
Q

Female genital embryology

A
  • Default development

- Mesonephric duct degenerates and paramesonephric duct develops

85
Q

Male genital embryology

A
  • SRY gene on Y chromosome - produce testis-determining factor → testes development
  • Sertoli cells secrete Mullerian inhibitory factor (MIF) that suppresses development of paramesonephric ducts
  • Leydig cells secrete androgens that stimulate development of mesonephric ducts
86
Q

Paramesonephric (Mullerian) duct

A
  • Develops into female internal structures - fallopian tubes, uterus, upper portion of vagina (lower portion from urogenital sinus)
  • Male remnant is appendix testis
87
Q

Mesonephric (Wolffian) duct

A
  • Develops into male internal structures (except prostate) - Seminal vesicles, Epididymis, Ejaculatory duct, Ductus deferens (SEED)
  • In females, remnant of mesonephric duct → Gartner duct
88
Q

Mullerian agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome)

A

May present as primary amenorrhea (due to a lack of uterine development) in females with fully developed secondary sexual characteristics (functional ovaries)

89
Q

Septate uterus

A
  • Commonly anomaly vs normal uterus
  • Incomplete resorption of septum
  • ↓ fertility
  • Treat with septoplasty
90
Q

Bicornuate uterus

A
  • Incomplete fusion of Mullerian ducts

- ↑ risk of complicated pregnancy

91
Q

Uterus didelphys

A
  • Complete failure of fusion → double uterus, vagina, cervix

- Pregnancy possible

92
Q

Genital tubercle

A
  • DHT → glans tubercle, corpus cavernosum, spongiosum

- ESTROGEN → glans clitoris, vestibular bulbs

93
Q

Urogenitalsinus

A
  • DHT → bulbourethral glands (of cowper), prostate gland

- ESTROGEN → greater vestibular glands (of Bartholin), urethral and paraurethral glands (of Skene)

94
Q

Urogenital folds

A
  • DHT → ventral shaft of penis (penile urethra)

- ESTROGEN → labia minora

95
Q

Labioscrotal swelling

A
  • DHT → scrotum

- ESTROGEN → labia majora

96
Q

Hypospadias

A
  • Abnormal opening of penile urethra on ventral surface of penis due to failure of urethral folds to fuse
  • Associated with inguinal hernia and cryptorchidism
97
Q

Epispadias

A
  • Abnormal opening of penile urethra on dorsal surface of penis due to faulty positioning of genital tubercle
  • Associated with exostrophy
98
Q

Gubernaculum (band of fibrous tissue)

A
  • MALE REMNANT: anchors testes within scrotum

- FEMALE REMNANT: ovarian ligament + round ligament of the uterus

99
Q

Processus vaginalis (evagination of peritoneum)

A
  • MALE REMNANT: forms tunica vaginalis

- FEMALE REMNANT: obliterated

100
Q

Gonadal venous drainage

A

Left ovary/testis → left gonadal vein → left renal vein → IVC

Right ovary/testis → right gonadal vein → IVC

101
Q

Gonadal lymphatic drainage

A

Ovaries/testes → para-aortic lymph noes

Body of uterus/ cervix/ superior bladder → external iliac nodes

Prostate/ cervix/ corpus cavernosum/ proximal vagina → internal iliac nodes

Distal vagina/ vulva/ scrotum/ distal anus → superficial inguinal nodes

Glans penis → deep inguinal nodes

102
Q

Infundibular ligament

A
  • Suspensory ligament of the ovary
  • Connects ovaries to lateral pelvic wall
  • Contains ovarian vessels
  • Ligate vessels during oophorectomy to avoid bleeding
  • Ureters course retroperitoneally, close to gonadal vessels → at risk of injury during ligation of ovarian vessels
103
Q

Cardinal ligament

A
  • Connects cervix to side of wall of pelvis
  • Contains uterine vessels
  • Ureter at risk of injury during ligation of uterine vessels in hysterectomy
104
Q

Round ligament of the uterus

A
  • Connects uterine fundus to labia majora
  • Derivative of gubernaculum
  • Travels through round inguinal canal above the artery of Sampson
105
Q

Broad ligament

A
  • Connects uterus, fallopian tubes, and ovaries to pelvic wall
  • Contains ovaries, fallopian tubes, round ligament of the uterus
  • It is a fold of peritoneum that comprises the MESOSALPINX, MESOMETRIUM, and MESOVARIUM
106
Q

Ovarian ligament

A
  • Connects medial pole of ovary to lateral uterus

- Derivative of gubernaculum

107
Q

Compare histology of the uterus during proliferative and secretory phase

A
  • Simple columnar epithelium
  • PROLIFERATIVE: with long tubular glands
  • SECRETORY: with coiled glands
108
Q

Urethral injury from pelvic fracture

A

Damage to posterior urethra - membranous urethra, specifically. Injury can cause urine to lead into retropubic space.

109
Q

Urethral injury from perineal straddle injury

A

Damage to anterior urethra - bulbar and penile urethra. Injury can cause urine to leak beneath deep fascia of Buck. If fascia is torn, urine escapes into superficial perineal space.

110
Q

How does progesterone influence the myometrium

A

↓ myometrium excitability

111
Q

How does progesterone influence body temperature

A

↑ body temperature

112
Q

Length of luteal phase

A

14 days

113
Q

When does menstruation occur

A

Ovulation + 14 days = menstruation

114
Q

When is follicular growth fastest

A

During the 2nd week of the follicular phase

115
Q

When does implantation occur

A

Implantation within the wall of the uterus occurs 6 days after fertilization.

116
Q

When does hCG begin to be secreted

A

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

117
Q

Gestational age

A

Calculated from date of last menstrual period

118
Q

Embryonic age

A

Calculated from date of conception (gestational age minus 2 weeks)

119
Q

Physiologic adaptations in pregnancy

A
  • ↑ CO (↑ preload, ↓ afterload, ↑ HR → ↑ placental and renal perfusion)
  • Anemia (↑↑ plasma, ↑ RBCs → ↓ viscosity)
  • Hypercoaguability (to ↓ blood loss at delivery)
  • Hyperventilation (eliminate fetal CO2)
120
Q

When does hCG peak

A

8-10 weeks

121
Q

Function of hCG

A
  • Maintains corpus luteum (and thus progesterone) for first 8-10 weeks of pregnancy by acting like LH (otherwise no luteal cell stimulation → abortion)
  • After 8-10 weeks, placenta synthesizes its own estriol and progesterone and corpus luteum degenerates
  • Has identical α subunit as LH, FSH, TSH (states of ↑ hCG can cause hyperthyroidism)
  • β subunit is unique (pregnancy tests for this)
  • ↑ in multiple gestations, hydatiform moles, choriocarcinomas, and Down syndrome
  • ↓ in ectopic/failing pregnancy, Edward syndrome, and Patau syndrome
122
Q

What does APGAR stand for

A

Appearance, Pulse, Grimace, Activity, and Respiration

123
Q

Low birth weight is associated with

A
  • ↑ risk of SIDS
  • Impaired thermoregulation and immune function
  • Hypoglycemia
  • Polycythemia
  • Impaired neurocognitive/ emotional development
124
Q

What coordinates closing of the epiphyseal plates

A

Estrogen converted from testosterone

125
Q

Effects of exogenous testosterone

A

Inhibition of hypothalamic-pituitary-gonadal axis → ↓ intratesticular testosterone → ↓ testicular size → azoospermia

126
Q

Klinefelter syndrome labs

A
  • (47, XXY)
  • Dysgenesis of seminiferous tubules → ↓ inhibin B → ↑ FSH
  • Abnormal Leydig cell function → ↓ testosterone → ↑ LH → ↑ estrogen
127
Q

Turner syndrome labs

A
  • (46, XO)

- ↓ estrogen → ↑ LH, ↑ FSH

128
Q

Double Y males

A
  • XYY
  • Phenotypically normal (usually undiagnosed), very tall
  • Normal fertility
  • May be associated with severe acne, learning disability, autism and spectrum disorders
129
Q

Ovotesticular disorder of sex development

A
  • 46, XX > 46, XY
  • Both ovarian and testicular tissue present (ovotestis)
  • Ambiguous genitalia
  • Previously called true hermaphrodtism
130
Q

Defective androgen receptor labs

A

↑ testosterone, ↑ LH

131
Q

Testosterone-secreting tumor, exogenous steroids labs

A

↑ testosterone, ↓ LH

132
Q

Primary hypogonadism labs

A

↓ testosterone, ↑ LH

133
Q

Hypogonadotropic hypogonadism

A

↓ testosterone, ↓ LH

134
Q

Placental aromatase deficiency

A
  • Inability to synthesize estrogens from androgens
  • Masculinization of female (46, XX) infants (ambiguous genitalia), ↑ testosterone and androstenedione
  • Can present with maternal virilization during pregnancy (fetal androgens can cross the placenta)
135
Q

Androgen insensitivity syndrome

A
  • 46, XY
  • Defect in androgen receptor resulting in normal-appearing female
  • Female external genitalia with scant sexual hair, rudimentary vagina
  • Uterus and fallopian tubes absent
  • Patients develop normal functioning testes (often found in labia majora; surgically removed to prevent malignancy)
  • ↑ testosterone, estrogen, LH
136
Q

5α-reductase deficiency

A
  • AR
  • Sex limited to genetic males (46, XY)
  • Inability to convert testosterone to DHT
  • Ambiguous genitalia until puberty, when ↑ testosterone causes masculinization/ ↑ growth of external genitalia
  • Testostrone/estrogen levels are normal
  • LH is normal or ↑
  • Internal genitalia are normal
137
Q

Kallmann syndrome

A
  • Failure to complete puberty
  • A form of hypogonadotropic hypogonadism
  • Defective migration of GnRH cells and formation of olfactory bulb
  • ↓ GnRH synthesis in the hypothalamus
  • ANOSMIA
  • ↓ GnRH, FSH, LH, testosterone
  • Infertility (low sperm count in males, amenorrhea in females)
138
Q

Placental abruption (abruptio placentae)

A
  • Premature separation (partial or complete) of placenta from uterine wall before delivery of infant
  • RISK FACTORS: trauma, smoking, hypertension, preeclampsia, cocaine abuse
  • PRSENTATION: abrupt, painful bleeding (concealed or apparent) in 3rd trimester; possible DIC, maternal shock, fetal distress
  • Life threatening for mother and fetus
139
Q

Placenta accreta/ increta/ percreta

A
  • Defective decidual layer → abnormal attachment and separation after delivery
  • RISK FACTORS: prior C-section, inflammation, placenta previa
  • 3 types distinguishable by depth of penetration
  • PRESENTATION: often detected on ultrasound prior to delivery
  • No separation of placenta after delivery → postpartum bleeding (can cause Sheehan syndrome)
140
Q

Placenta accreta

A

Placenta attaches to myometrium without penetrating it, most common type

141
Q

Placenta increta

A

Placenta penetrates into myometrium

142
Q

Placenta percreta

A

Placenta penetrates (“perforates”) through myometrium and into uterine serosa (invades entire uterine wall); can result in placental attachment to rectum or bladder

143
Q

Placenta previa

A
  • Attachment of placenta to lower uterine segment over (or
144
Q

Vasa previa

A
  • Fetal vessels run over, or in close proximity to, cervical os
  • May result in vessel rupture, exsanguination, fetal death
  • TRIAD: MEMBRANE RUPTURE, PAINLESS VAGINAL BLEEDING, FETAL BRADYCARDIA (
145
Q

Postpartum hemorrhage

A
  • Due to 4 Ts
  • Tone (uterine atony, most common)
  • Trauma (lacerations, incisions, uterine rupture)
  • Thrombin (coagulopathy)
  • Tissue (retained products of conception)
146
Q

Cause of preeclampsia

A

Caused by abnormal placental spiral arteries → endothelial dysfunction, vasoconstriction, ischemia

147
Q

When does preeclampsia present

A

New-onset hypertension with either proteinuria or end-organ dysfunction after 20th week of gestation (

148
Q

Complications of preeclampsia

A
  • Placental abruption
  • Coagulopathy
  • Renal failure
  • Uteroplacental insufficiency
  • Ecclampsia
149
Q

Gestational hypertension

A
  • Pregnancy induced hypertension
  • Presents after 20th week
  • NO PROTEINURIA OR END-ORGAN DAMAGE
150
Q

HELLP syndrome can lead to

A

Hepatic subcapsular hematomas → rupture → severe hypotension

151
Q

Compare follicular and theca-lutein cysts

A
  • FOLLICULAR CYST: distention of unruptured graafian follicle; may be associated with hyperestrogenism, endometrial hyperplasia; most common ovarian mass in young women
  • THECA-LUTEIN CYST: often bilateral/multiple; due to gonadotropin stimulation; associated with choriocarcinoma and hydatiform moles
152
Q

Which ovarian neoplasm is associated with pseudomyxoma peritonei

A

Mucinous cystadenocarcinoma. It is an intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor.

153
Q

What type of teratoma contains neuroectoderm

A

Immature teratomas. Malignant, aggressive. Typically represented by immature/embryonic like neural tissue. Usually post-menopausal (mature cystic teratomas/dermoid cysts generally present in women 10-30)

154
Q

Lynch syndrome is a risk factor for what endometrial condition

A

Endometrial carcinoma

155
Q

Fibrocystic changes

A
  • Most common in premenopausal women > 35 years
  • Presents with premenstual breast pain or lumps; often bilateral and multifocal
  • Nonproliferative lesions include simple cysts (fluid-filled duct dilation, blue dome), papillary apocrine change/metaplasia, stromal fibrosis
  • Risk of cancer is usually not increased
156
Q

Comedocarcinoma

A
  • Ductal, central necrosis

- Subtype of DCIS

157
Q

Peyronie disease

A
  • Abnormal curvature of penis due to fibrous plaques within tunica albuginea
  • Associated with erectile dysfuction
  • Can cause pain, anxiety
  • Consider surgical repair once curvature stabilizes
  • Distinct from PENILE FRACTURE (rupture of corpora cavernosum due to forced bending)
158
Q

Dilation of which veins causes varicocele

A

Pampiniform plexus

159
Q

Extragonadal germ cell tumors

A
  • Arise in midline locations
  • In adults, most commonly in retroperitoneum, mediastinum, pineal and suprasellar regions
  • In infants and young children, sacrococcygeal teratomas are more common
160
Q

Congenital hydrocele

A

Common cause of scrotal swellings in infants, due to incomplete obliteration of processus vaginalis

161
Q

Acquired hydrocele

A
  • Scrotal fluid collection usually secondary to infectin, trauma or tumor
  • If bloody → hematocele
162
Q

Spermatocele

A
  • Cyst due to dilated epididymal duct or rete testis

- Paratesticular fluctuant nodule

163
Q

Leydig cell tumor

A
  • Golden brown color
  • Contains Reinke crystals (eosinophilic cytoplasmic inclusions)
  • Produce androgens or estrogens → gynecomastia in men, precocious puberty in boys
164
Q

Sertoli cell tumor

A

Androblastoma from sex cord stroma

165
Q

Testicular lymphoma

A
  • Most common testicular cancer in older men
  • Not a primary cancer
  • Arises from metastatic lymphoma to testes
  • Aggressive
166
Q

Is BPH hyperplasia or hypertrophy

A

Smooth, elastic firm nodular enlargement (hyperplasia not hypertrophy) of periurethral (lateral and middle lobes) which compress the urethra into a vertical slit. NOT premalignant.

167
Q

Prostatitis

A
  • Dysuria, frequency, urgency, low back pain
  • Warm, tender, enlarged prostate
  • ACUTE: bacterial
  • CHRONIC: bacterial or abacterial

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