Reproductive Flashcards
(284 cards)
1
Q
Sonic Hedgehog gene
A
Zone of polarizing activity at the base of limb buds
Anterior - posterior axis patterning, CNS development
Mutations –> holoprosencephaly
2
Q
Wnt 7 gene
A
Apical ectodermal ridge at distal end of each limb
Dorsal-ventral axis patterning, limb development
3
Q
FGF gene
A
Apical ectodermal ridge
Limb lengthening
4
Q
Homeobox genes
A
segmental organization in cranial-caudal direction, transcription factor coding
Mutations –> appendages in wrong location
Isotretinoin –> increase hox gene expression
5
Q
Within 1 week fetal development
A
hCG secretion begins around the time of implantation of blastocyst
Blastocyst sticks at day 6
6
Q
Within 2 weeks of fetal development
A
Bilaminar disc (epiblast and hypoblast)
7
Q
Within week 3 of fetal development
A
Gastrulation forms trilaminar embryonic disc
Cells from epiblast –> primitive streak –> endoderm, mesoderm, ectoderm
Notochord arises from midline mesoderm
overlying ectoderm –> neural plate
8
Q
Weeks 3-8 of fetal development
A
Neural tube formed by neuroectoderm and closes by week 4
Organogenesis
Extremely susceptible to teratogens
9
Q
Week 4 of fetal development
A
Heart begins to beat
Upper and lower limb buds begin to form
10
Q
Week 6 of fetal development
A
fetal cardiac activity visible by transvaginal US
11
Q
Week 8 of fetal development
A
fetal movements start
12
Q
Week 10 of fetal development
A
Genitalia have male/female characteristics
13
Q
Surface ectoderm
A
epidermis, adenohypophysis, lens of eye, epithelial lining of oral cavity, sensory organs of ear and olfactory epithelium, anal canal below pectinate line, parotid, sweat and mammary glands
14
Q
Craniopharyngioma
A
benign Rathke puch tumor with cholesterol crystals, calcifications
15
Q
Neural Tube
A
Brain, retina, spinal cord
16
Q
Neural Crest
A
Melanocytes, odontoblasts, tracheal cartilage, Enterochromaffin cells, leptomeninges, PNS ganglia, adrenal medulla, schwann cells, spiral membrane, endocardial cushions, skull bones
17
Q
Mesoderm
A
muscle, bone, connective tissue, serous lining of body cavities, spleen, CV structures, lymphatics, blood, upper vagina, kidneys, adrenal cortex, dermis, testes, ovaries, microglia
18
Q
Notochord
A
nucleus pulposus of intervertebral disc
19
Q
Endoderm
A
gut tube epithelium, urethra and lower vagina, luminal epithelial derivatives.
20
Q
ACEi Teratogen
A
renal failure, oligohydramnios, hypocalvaria
21
Q
Alkylating agents Teratogen
A
absence of digits, multiple anomalies
22
Q
aminoglycosides Teratogen
A
ototox
23
Q
antiepileptic drugs Teratogen
A
neural tube defects, cardiac defects, cleft palate, skeletal abnormalities
24
Q
Diethylstilbestrol Teratogen
A
vaginal clear cell adenocarcinoma, congenital Mullerian anomalies
25
Fluoroquinolones Teratogen
cartilage damage
26
Folate antagonist Teratogen
Neural tube defects
27
Isotretinoin Teratogen
severe birth defects
28
Lithium Teratogen
ebstein anomaly
29
Methimazole Teratogen
aplasia cutis congenita (no skin)
30
Tetracyclines Teratogen
discolored teeth, inhibited bone growth
31
Thalidomide Teratogen
limb defects
32
Warfarin Teratogen
Bone and cartilage deformities, optic N atrophy, fetal cerebral hemorrhage
33
Alcohol Teratogen
Fetal alcohol syndrome
intellectual disability, microcephaly, facial abnormalities, limb dislocation, heart defects,
impaired migration of neuronal and glial cells
34
Cocaine Teratogen
low birth weight, preterm birth, IUGR, placental abruption
35
Smoking Teratogen
low birth weight, preterm labor, placental problems, IUGR, SIDS, ADHD
36
Iodine Teratogen
congenital goiter, or hypothyroidism
37
Maternal Diabetes
caudal regression syndrome, cardiac defects, neural tube defects, macrosomia, neonatal hypoglycemia, polycythemia
38
Methylmercury Teratogen
neurotox
39
Vitamin A excess Teratogen
high risk of spontaneous abortions and birth defects
40
X ray Teratogen
microcepahly, intellectual disability
41
Neonatal abstinence Syndrome
secondary to maternal substance use
uncoordinated sucking reflexes, irritability, high pitched crying, tremors, tachypnea, sneezing, diarrhea, seizures
T(x) opiate abuse: methadone, morphine, buprenorphine
42
Dizygotic twins
from 2 eggs that are separately fertilized by 2 sperm will have 2 separate amniotic sacs and 2 separate placentas
43
Monozygotic twins
from 1 fertilized egg that splits in early pregnancy
Cleavage 0-4 days --> separate placenta and amnion
Cleavage 4-8 days --> shared placenta
Cleavage 8-12 days --> shared amnion
Cleavage 13+ days --> shared body (conjoined)
44
Placenta
Primary site of nutrient and gas exchange between mother and fetus
45
Cytotrophoblast
inner layer of chorionic villi
makes cells
Fetal component of placenta
46
Synctiotrophoblast
Fetal Component of placenta
| outer later of chorionic villi, synthesize and secrete hCG
47
Decidua Basalis
Maternal component of placenta
| derived from endometrium. Maternal blood in lacunae
48
Umbilical cord
Artery and vein derived from allantois
2 umbilical arteries return deoxygenated blood from fetal internal iliac A to placenta
1 umbilical vein supplies oxygenated blood from placenta to fetus. Drains into IVE via liver or ductus venosus
49
Single umbilical artery
associated with congenital and chromosomal anomalies
50
Urachus
allantois forms from hindgut and extends into urogenital sinus.
Allantois --> urachus (duct between fetal bladder and umbilicus)
Failure to involute --> increase risk of infection and/or malignancy
obliterated urachus = umbilical L after birth
51
Patent Urachus
total failure of urachus to obliterate --> urine discharge from umbilicus
52
Urachal cyst
partial failure of urachus to obliterate, fluid filled cavity lined with uroepithelium between umbilicus and bladder.
Cyst can become infected and present as painful mass below umbilicus
53
Vesicourachal diverticulum
slight failure of urachus to obliterate --> outpouching bladder
54
Vitelline duct
7th week obliteration of vitelline duct (connect yolk sac to midgut lumen)
55
Vitelline Fistula
Vitelline duct fails to close --> meconium discharge from umbilicus
56
Meckel Diverticulum
Partial closure of vitelline duct, with patent portion attached to ileum
Asymptomatic, heterotopic gastric or pancreatic tissue --> melena, hematochezia, ab pain
57
1st Aortic arch
part of maxillary artery
58
2nd aortic arch
stapedial A and hyoid A
59
3rd Aortic arch
common carotid A and proximal Internal Carotid A
60
4th Aortic Arch
on left, aortic arch
| on right, proximal part of right subclavian A
61
6th Aortic Arch
Proximal part of pulmonary A and ductus arteriosus (left)
62
Pharyngeal cleft derived from
ectoderm
63
Pharyngeal arches derived from
mesoderm and neural crest
64
Pharyngeal pouch derived from
endoderm
65
1st Pharyngeal cleft
external auditory meatus
66
2-4 pharyngeal cleft
temporary cervical sinuses. obliterated via proliferation of 2nd arch mesenchyme
67
Persistent cervical sinus
pharyngeal cleft cyst within lateral neck, anterior to SCM M
68
1st pharyngeal arch
Maxilla, zygomatic bone, mandible, Meckel cartilage, malleus, incus, sphenomandibular L
Muscles of mastication, mylohyoid, anterior belly of digastric, anterior tongue
CN V3
69
2nd Pharyngeal arch
Reichert cartilage, stapes, styloid, lesser horn of hyoid, stylohyoid L
Muscles of facial expression
CN VII
70
3rd Pharyngeal Arch
greater horn of hyoid
Stylopharyngeus
CN IX
71
4th and 6th pharyngeal arches
Arytenoids, cricoid, corniculate, cuneiform, thyroid
4th- pharyngeal constrictors, cricothyroid, levator veli palatini
Superior laryngeal Branch CNX
6th- intrinsic muscles of larynx except cricothyroid
Recurrent/inferior laryngeal branch CNX
72
Pierre Robin sequence
micrognathia, glossooptosis, cleft palate, airway obstruction
73
Treacher collins Syndrome
AD
Neural crest dysfunction
Craniofacial abnormalities, hearing loss, airway compromise
74
1st Pharyngeal pouch
middle ear cavity, eustachian tube, mastoid air cells
75
2nd pharyngeal pouch
epithelial lining of palatine tonsil
76
3rd pharyngeal pouch
dorsal wings --> inferior parathyroids
| ventral wings --> thymus
77
4th pharyngeal pouch
dorsal wings --> superior parathyroids
| ventral wings --> ultimopharyndeal body --> parafollicular cells of thyroid
78
Cleft lip
failure of fusion of maxillary and merged medial nasal processes
79
Cleft palate
failure of fusion of the two lateral palatine shelves or failure of fusion of lateral palatine shelf with the nasal septum and or primary palate
80
Female genital embryology
Default development. Mesonephric duct degenerates and paramesonephric duct develops
81
Male genital embryology
SRY gene on Y chromosome --> testes develop
Sertolli cells secrete Mullerian inhibitory factor --> suppresses development of paramesonephric duct
Leydig cells secrete androgens --> mesonephric ducts
82
Paramesonephric duct
Develops into female internal structures (fallopian tube, uterus, upper portion of vagina)
83
Mullerian agenesis
may present as primary amenorrhea in females with fuly developed secondary sexual characteristics
84
Mesonephric duct
develops into male internal structures (seminal vesicles, epididymis, ejaculatory duct, ductus deferens)
Female remnant = gartner duct
85
Absence of Sertoli cells or lack of MIF
develop both male and female internal genitalia and male external genitalia (streak gonads)
86
5a reductase deficiency
inability to convert testosterone into DHT --> male internal genitalia, ambiguous external genitalia until puberty
87
Septate uterus
incomplete resorption of septum
decreased fertility and early miscarriage
T(x) septoplasty
88
Bicornuate uterus
incomplete fusion of Mullerian ducts
| increase risk of complicated pregnancy, early pregnancy loss, malpresentation, prematurity
89
Uterus didelphys
complete failure of fusion --> double uterus, cervix, vaginal
pregnancy possible
90
Genital tubercle
Male- glans penis and corpus cavernosum and spongiosum
| Female- glans clitoris and vestibular bulbs
91
Urogenital sinus
Male- bulbourethral glands and prostate gland
| Female- greater vestibular glands, urethral and paraurethral glands
92
Urogenital folds
Male- ventral shaft of penis
| Female- labia minora
93
Labioscrotal swelling
Male- scrotum
| Female- labia majora
94
Hypospadias
abnormal opening of the penile uretha on ventral surface of penis due to failure of urethral folds to fuse
Associated with inguinal hernia, cryptorchidism, chordee
95
Epispadias
Abnormal opening of the penile urethra on dorsal surface of penis due to faulty positioning of genital tubercle
Exstrophy of bladder is associated
96
Gubernaculum
Band of fibrous tissue
Male remnant- Anchors testes within scrotum
Female remnant- ovarian L and round L of uterus
97
Processus Vaginalis
Evagination of peritoneum
Male remnant- tunica vaginalis, persistent processus vaginalis --> hydrocele
Female remnant- obliterated
98
Gonadal Venous Drainage Right
Right ovary/testis --> right gonadal V --> IVC
99
Gonadal Venous Drainage Left
Left ovary/ testis --> left gonadal V --> left renal V --> IVC
Flow is less laminar on left so venous pressure is higher --> more likely varicocele
100
Gonadal Lymphatic Drainage Ovary/ Testis
para-aortic LN
101
Lymphatic drainage of body of uterus/cervix/superior bladder
External iliac nodes
102
Lymphatic drainage of prostate/cervix/corpus cavernosum/ proximal vagina
internal iliac nodes
103
Lymphatic drainage of distal vaginal/ vulva/ scrotum/ distal anus
superficial inguinal nodes
104
Lymphatic drainage of glans penis
deep inguinal nodes
105
Infundibulopelvic L
connects ovaries to lateral pelvic wall
contains ovarian vessels
At risk of injury during ligation of ovarian vessels
106
Cardinal L
connects cervix to side wall of pelvis
Contains uterine vessels
Ureter at risk of injury during ligations of uterine vessels in hysterectomy
107
Round L of uterus
Connects uterine horn to labia majora
108
Broad L
Connect uterus, fallopian tubes, and ovaries to pelvic side wall
Contains ovaries, fallopian tubes, round L of uterus
Comprises of mesosalpinx, mesometrium and mesovarium
109
Ovarian L
Connect medial pole of ovary to uterine horn
Derivative of gubernaculum
Latches to lateral uterus
110
Adenxal torsion
twisting of ovary and fallopian tube around infundibulopelvic L and ovarian L --> compression of ovarian vessels --> block lymphatics and venous outflow --> ovarian edema --> complete block of arterial inflow --> necrosis
Associated with ovarian masses
Acute pelvic pain, adnexal mass, nausea and vomiting
111
Sperm pathway for ejaculation
```
Seminiferous tube
Epididymis
Vas deferens
Ejaculatory ducts
Urethra
Penis
```
112
Anterior Urethral injury
Spongy urethra via perineal straddle injury
Blood accumulates in scrotum
Blood at urethral meatus and scrotal hematoma
113
Posterior urethral injury
membranous urethra via pelvic fracture
urine leaks into retropubic space
blood at the urethral meatus and high riding prostate
114
Autonomic innervation of male sexual response
Erection- PNS (pelvic splanchnic, S2-S4)
NO --> increase cGMP --> vasodilate --> erection
NE --> increase Ca2+ --> smooth M contraction --> vasoconstriction --> no erection
Emission- SNS (hypogastric N T11-L2)
Expulsion- visceral and somatic nerves (pudendal N)
115
Spermatogonia
maintain germ cell pool and produce primary spermatocytes
Line seminiferous tubules
Germ cells
116
Sertoli cells
secrete inhibin B --> inhibit FSH
secrete androgen binding protein --> maintain testosterone
Produce MIF
Blood testis barrier
Nourish spermatozoa
High temp --> low sperm
Testosterone -->androsterone --> estrogen via aromatase
117
Leydig Cells
Secrete testosterone in presence of LH
unaffected by temperature
Interstitium
118
Spermatogenesis
Begins at puberty with spermatagonia
Full devlopment takes 2 months
Occurs in seminiferous tubules --> spermatids --> loss of cytoplasmic contents --> spermatozoa
119
Tail mobility impaired sperm
ciliary dyskinesia or Kartagener syndrome
| leads to infertility
120
Tail mobility in CF
normal but absent vas deferens leads to infertility
121
Estrogen source
ovary (17B estradiol), placental (estriol), adipose tissue (estrone)
Estradiol > estrone > estriol
122
Estrogen Function
Develop genitalia and breast, female fat distribution
Growth of follicle, endometrial proliferation, increased myometrial excitability
Upregulate estrogen, LH, progesterone receptors
Inhibited by FSH and LH
stimulate prolactin secretion
123
Progesterone
source: corpus luteum, placenta, adrenal cortex, testes
Prepare uterus for implantation of fertilized egg (luteal phase) - stimulate endometrial glandular secretions and spiral A development, produce thick mucus, prevent hyperplasia, increase body temp, decrease estrogen receptors, decrease LH and FSH
During pregnancy- maintains pregnancy, decrease myometrial excitability, decrease prolactin action
OVULATION
124
Oogenesis
Primary oocyte begin meiosis I (fetal life) and complete meiosis I prior to ovulation- arrested in prophase 1 for years
Meiosis II arrested in metaphase II until fertilization (secondary oocyte)
Degenerate with not fertilized
125
Ovulation
High estrogen, GnRH receptors on anterior pituitary --> LH surge --> ovulation
increase temperature due to progesterone
126
Mittelschmerz
transient mid cycle ovulatory pain
associated with peritoneal irritation
Can mimic appendicitis
127
Menstrual cycle
Follicular phase vary in length. Luteal phase =14 days, ovulation day + 14 days = menstruation
Follicular growth is fastest during 2nd week of follicular phase
estrogen stimulates endometrial proliferation
Progesterone maintains endometrium to support implantation
decrease progesterone --> decrease fertility
128
Structural causes of abnormal uterine bleeding
Polyp
Adenomyosis
Leiomyoma
Malignany/hyperplasia
129
Non structural causes of abnormal uterine bleeding
```
Coagulopathy
Ovulatory
Endometrial
Iatrogenic
Not classified
```
130
Most common place for fertilization
upper end of fallopian tubes
131
Pregnancy
fertilization within 1 day of ovulation
Implant in uterus wall 6 days after fertilization- synctiotrophoblasts secrete hCG
high GFR --> low BUN, low glucosuria threshold
high CO --> high placental and uterus perfusion
Anemia
Hypercoagulability --> low blood loss
hyperventilation
increase lipolysis
132
hCG
source: synctiotrophoblasts of placenta
maintain corpus luteum for 8-10 weeks (like LH)
After 8-10 weeks placenta makes its own estriol and progesterone
Identical a subunit as LH, FSH, TSH
133
increase in hCG
multiple gestations, hytidaform moles
| choriocarcinoma, down syndrome
134
Decrease in hCG
ectopic/ failing pregnancy, edwards and patau syndrome
135
Human placental lactogen
source: synctiotrophoblasts of placenta
stimulate insulin production
overall increase insulin resistance
gestational diabetes can occur if maternal pancreatic function cannot overcome the insulin resistance
136
APGAR score
assessment of newborn vital signs after delivery
Appearance, Pulse, Grimace, Activity, Respiration
<7 --> further eval
if remains low --> increased risk the child will develop long term neuro damage
137
Low birth weight
<2500g
caused by prematurity, intrauterine growth restriction
Associated with increased risk of SIDS and increase overall mortality
138
Lactation
After delivery rapid decrease in progesterone disinhibits prolactin. Suckling required to maintain milk production and ejection
Prolactin- induce and maintain lactation and decrease reproductive function
Oxytocin- assists in milk letdown and uterine contraction
139
Breast milk contains...
maternal IgA, macrophages, lymphocytes
Reduce infant infection and associated with low risk for child to develop asthma, allergies, DM, and obesity
Decreased maternal risk of breast and ovarian cancer
<6month infant
140
Menopause
amenorrhea for 12 months
decrease estrogen production due to decline in number of ovarian follicles
Earlier in smokers
Preceded by 4-5 years of abnormal menstruation
HIGH FH, LH and GnRH
Hot flashes, atrophy of vagina, osteoporosis, CAD, sleep disturbance
141
Testosterone
```
testes
differentiation of epididymis, vas deferens, seminal vesicles
Growth spurt
Deep voice
close epiphyseal plates
libido
```
142
DHT
testes
early- differentiation of penis, scrotum, prostate
Late- prostate growth, balding, sebaceous gland activity.
143
Androgenic steroid abuse
abuse of anabolic steroids to increase fat free mass, muscle strength and performance
men with changes in behavior, ance, gynecomastia, high Hb and Hct, small testes
Women- virilization, acne, breast atrophy, male pattern baldness
144
Tanner Stage 1
no sexual hair
| Flat chest with raised nipple (female)
145
Tanner Stage 2
Pubic hair appears
Testicular enlargement
Breast bud forms, mound forms
146
Tanner Stage 3
Coarsening pubic hair
Penis size and length increase
Breast enlarges
147
Tanner Stage 4
Coarse hair across pubis sparing thighs
penis width/ glas increase
breast enlarge, raised areola, mound on mound
148
Tanner Stage 5
Coarse hair across pubis and medial thigh
penis and testis enlarge to adult size
Adult breast contour, areola flattens
149
Precocious puberty
Secondary sexual characteristics before age 8 in girls and 9 in boys
High sex hormone exposure/ production --> increase linear growth, somatic and skeletal maturation
150
Central Precocious Puberty
high GnRH secretion
| idiopathic, CNS tumors
151
Peripheral precocious Puberty
GnRH independent
high sex hormone production or exposure, congenital adrenal hyperplasia, estrogen secreting ovarian tumor, Leydig cell tumor, McCune Albright syndrome
152
Klinefelter Syndrome
Male 47 XXY
testicular atrophy, eunuchoid body shape, tall, long extremities, gynecomastia, female hair distribution
Developmental delay
Infertility
Dysgenesis of seminiferous tubules --> low inhibin B --> high FSH
Abnormal Leydig cell function --> low testosterone --> high LH --> high estrogen
153
Tuner Syndrome
```
Female 45 XO
Short stature (SHOX gene), ovarian dysgenesis (streak ovary), shield chest, bicuspid aortic valve, coarctation of the aorta, lymphatic defects (webbed neck), horseshoe kidney
primary amenorrhea
Menopause before menarchy
low estrogen --> high LH and FSH
```
154
Double Y males
47 XYY
Phenotypically normal
tall, normal fertility
associated with severe acne, learning disability, autism
155
Ovotesticular disorder of Sex development
46 XX > 46 XY
both ovarian and testicular tissue present, ambiguous genitalia
hermaphroditism
156
46 XX DSD
Ovaries present, external genitalia are virilized or ambiguous
Excessive inappropriate exposure to androgenic steroids in early gestation
157
46 XY DSD
Testes present but external genitalia are female or ambiguous
via androgen insensitivity syndrome
158
Placental Aromatase Deficiency
inability to synthesize estrogens from androgens.
Masculinization of female
high serum testosterone and androstenedione
Maternal virilization during pregnancy
159
Androgen insensitivity Syndrome
Defect in androgen receptor resulting in normal appearing female
female external genitalia with scant axillary and pubic hair, rudimentary vagina, uterus and fallopian tubes absent
Normal functioning testes
high testosterone, estrogen and LH
160
5a reductase deficiency
AR males
inability to convert testosterone to DHT
ambiguous genitalia until puberty
testosterone and estrogen normal, LH is normal or high, internal genitalia normal
161
Kallmann Syndrome
```
Failure to complete puberty
Hypogonadotropic hypogonadism
Defective migration of neurons and subsequent failure of olfactory bulbs to develop
low GnRH FHS LH testosterone
infertility
```
162
Abruptio placentae
premature separation of placenta from uterine wall before delivery.
Risk factors- trauma, smoking, HTN, preeclampsia, cocaine abuse
abrupt, painful bleeding in third trimester, possible DIC, maternal shock, fetal distress
163
Morbidly adherent placenta
defective decidual layer --> abnormal attachment and separation after delivery.
Risk factors- prior C section or uterine surgery
Detected US prior to delivery
complications: sheehans
164
Placenta accreta
Morbidly adherent placenta
placenta attaches to myometrium without penetrating it
MOST COMMON
165
Placenta increta
Morbidly adherent placenta
| placenta penetrates into myometrium
166
Placenta percreta
Morbidly adherent placenta
| placenta penetrates through myometrium and into uterine serosa --> placental attachment to rectum or bladder
167
Placenta previa
attachment of placenta over internal cervical os.
Risk: multiparity, prior C section
Associated with painless third trimester bleeding
168
Vasa previa
fetal vessels run over cervical os --> vessel rupture, exsanguination, fetal death
Membrane rupture, painless vaginal bleeding, fetal brady
EMERGENCY C SECTION
Associated with velamentous umbilical cord insertion
169
Pospartum Hemorrhage
```
low tone of uterus
Trauma
Coagulopathy
Retained products of conception
T(x): uterine massage, oxytocin, surgical ligation of uterine or internal iliac A
```
170
Ectopic pregnancy
implant of fertilized ovum in a site other than uterus (ampulla)
Suspect with history of amenorrhea, lower than expected hCG, sudden lower ab pain
confirm with US
Risk factors: prior ectopic preg, history of infertility, salpingitis, ruptured appendix, prior tubal surgery, smoking, advanced maternal age
171
Polyhydramnios
too much amniotic fluid
idiopathic
Associated with fetal malformations (esophageal atresia, anencephaly), maternal DM, fetal anemia, multiple gestations
172
Oligohydramnios
too little amniotic fluid
Associated with placental insufficiency, bilateral renal agenesis, posterior urethral valves.
Cause potter sequence
173
Hydatidiform mole
Cystic swelling of chorionic villi and proliferation of chorionic epithelium
Presents with vaginal bleeding, emesis, uterine enlargement, pelvic pressure
Associated with hCG mediated sequelae- early pre-eclampsia, theca lutein cysts, hyperemesis gavidaram, hyperthyroidism
174
Complete mole
```
46 XX 46 XY
enucleated egg + single sperm
Hydropic villi, circumferential and diffuse trophoblastic proliferation
No fetal parts
(-) p57 protein
increase uterine size
HIGH hCG
honeycombed uterus
```
175
Partial mole
```
69 XXX, 69 XXY, 69 XYY
2 sperm + 1 egg
some vili are hydropic, focal trophoblastic proliferation
Yes fetal parts
(+) p57 protein
increased hCG
```
176
Choriocarcinoma
rare
can develop during or after pregnancy in mom or baby
Malignancy of trophoblastic tissue
no choionic villi present, high frequency of bilateral theca lutein cysts
high hCG, SOB, hemoptysis
Hematogenous spread to lungs
T(x): MTX
177
Gestational HTN
BP > 140/90 after 20th week
no pre-existing HTN
No proteinuria or end organ damage
T(x): Hydralazine, a methyldopa, labetolol, Nifedipine
178
Pre ecalmpsia
New onset HTN with proteinuria or end organ damage after 20th week
Caused by abnormal placental spiral A --> endothelial dysfunction, vasoconstriction, ischemia
Increased incidence in patients with pre-existing HTN, DM, CKD, autoimmune disorders, >40years
Complications: placental abruption, coagulopathy, renal failure, pulmonary edema,
T(x): anti- HTN and IV Mg
179
Eclampsia
preeclampsia + maternal seizures
Maternal death due to stroke, intracranial hemorrhage or ARDS
T(x): immediate delivery
180
Gynecologic tumor
Endometrial > ovarian > cervical
| Prognosis: cervical > endometrial > ovarian
181
Bartholin cyst and abscess
Non neoplastic
via blockage of batholin gland duct --> accumulation of fluid
May lead to abscess
Reproductive age females
182
Lichen sclerosus
Non neoplastic
thinning of epidermis with fibrosis/sclerosis of dermis
Presents with porcelain white plaques with red/violet border
Skin fragility with erosions can be observed
Most common in postmenopausal women
slight increase risk of SCC`
183
Lichen simplex chronicus
Non neoplastic
Hyperplasia of vulvar squamous epithelium
leathery, thick skin with enhanced skin markings due to chronic rubbing or scratching
184
Vulvar Carcinoma
Squamous epithelium linking vulva
leukoplakia
HPV 16 and 18
Risk: multiple partners, early coitarche
185
Extramammary Paget Disease
Intraepithelial adenocarcinoma
CIS- low risk of underlying carcinoma
Pruritis, erythema, ulcers
186
Imperforate Hymen
incomplete degeneration of central portion of hymen
Accumulation of vaginal mucus at birth --> self resolving bulge in introitus
untreated --> primary amenorrhea, cyclic ab pain, hematocolpos
187
Vaginal SCC
secondary to cervical SCC
188
Clear cell adenocarcinoma
women exposed to DES in utero
189
Sarcoma botryoides
embryonal rhabdomyosarcoma variant
Affects girls <4 years
spindle shaped cells desmin +
clear grape like polypoid mass emerging from vagina
190
Cervical dysplasia and CIS
disordered epithelial growth - basal layer of squamocolumnar junction and extends out
Associated with HPV 16 and 18
Koilocytes
asymptomatic or abnormal vaginal bleeding
Risk: multiple sexual partners, HPV, smoking, early coitarche, DES exposure, immunocompromise
191
Cervical Invasive Carcinoma
SCC
pap smear can detect dysplasia
Lateral invasion can block ureters --> hydronephrosis --> renal failure
192
Primary ovarian insufficiency
premature ovarian failure
Premature atresia of ovarian follicles in women of reproductive age.
Idiopathic associated with chromosomal abnormalities, autoimmunity
Need karyotype screening
patients present with signs of menopause after puberty but before age of 40
low estrogen, high LH and FSH
193
Most common cause of anovolulation
pregnancy, polycystic ovarian syndrome, obesity, HPO axis abnormalities, premature ovarian failure, hyperprolactinemia, thyroid disease, eating disorder, competitive athletics, cushing, adrenal insufficiency, Turners
194
Functional hypothalamic amenorrhea
Severe caloric restriction, high energy expenditure, stress --> functional disruption of pulsatile GnRH --> low LH and FSH, estrogen.
Low leptin and high cortisol
Associated with eating disorders and female athlete
195
PCOS
Hyperinsulinemia/ insulin resistance alter hypothalamic hormonal feedback response --> high LH:FSH, high androgens
low fertility in women
Enlarged BILATERAL cystic ovaries
Amenorrhea, hirsutisn, acne
Associated with obesity, acanthosis nigricans
Increased risk of endometrial cancer
T(x): weight reduction, OCPs, clomiphene, spironolactone, finasteride, flutamide
196
Primary dysmenorrhea
painful menses caused by uterine contraction to decrease blood loss --> ischemic pain
Mediated by prostaglandins
T(x): NSAIDs
197
Follicular cyst
Distention of unruptured Grafian follicle
May be associated with hyperestrogenemia, endometrial hyperplasia
Most common in young women
198
Theca lutein cyst
bilateral/multiple
Due to gonadotropin stimulation
Associated with choriocarcinoma and hydatidiform moles
199
Ovarian Neoplasms
Adnexal mass in >55 years
Ab distention, bowel obstruction, pleural effusion
Risk increase with age, infertility, endometriosis, PCOS, genetic (BRCA1/2)
Risk decrease with previous pregnancy, Hx breastfeeding, OCPs, tubal ligation
Epithelial = (more serious) bilateral, lined with serous or mucinous epithelium.
CA125
Germ cell tumors --> somatic structure or extra embryonic
Sex cord tumors --> embryonal sex cord
200
Serous cystadenoma
Epithelial
Benign
Most common
201
Serous cystadenocarcinoma
Epithelium
Malignancy
Most common
Psammoma bodies
202
Mucinous cystadenoma
Epithelial
Benign
Multiloculated, large
lined by mucous secreting epithelium
203
Mucinous Cystadenocarcinoma
```
Malignancy
Rare
Epithelial
Metastasize from appendiceal or GI
Pseudomyoma peritonei
```
204
Brenner Tumor
Epithelial
Benign
solid, pale yellow tan tumor that is encapsulated
Coffee bean nuclei
205
Dysgerminoma
```
Germ cell tumor
Malignant
most common in adolescents
Sheets of uniform fried egg cells
increase hCG, LDH
```
206
Mature cystic teratoma
Germ cell tumor
Benign
Most common in young females
cystic mass with elements of all 3 germ layers
May be painful secondary to ovarian enlargement/torsion
207
Immature Teratoma
```
Germ cell tumor
Malignant, aggressive
contains fetal tissue, neuroectoderm
<20 years
immature, embryonic like neural tissue
```
208
Yolk sac tumor
```
Malignant
Germ cell tumor
in ovaries and sacrococcygeal area in children
yellow, firable mass
Schiller Duval bodies
high AFP
```
209
Thecoma
Benign
Sex cord stromal tumor
may produce estrogen
abnormal uterine bleeding in postemenopausal women
210
Granulosa cell tumor
```
Sex cord stromal tumor
Malignant
Women in 50s
produce estrogen/ progesterone
postmenopausal bleeding, endometrial hyperplasia, sexual precocity, breast tenderness
Call Exner bodies
```
211
Sertoli Leydig cell tumor
Sex cord stromal tumor
Benign
small grey to yellow broun mass
produce estrogen --> virilization
212
Fibromas
```
Sex cord stromal tumor
Benign
bundles of spindle shaped fibroblasts
Meigs syndrome (ovarian fibroma, ascites, pleural effusion)
pulling sensation in groin
```
213
Adenomyosis
Extension of endometrial tissue into uterine myometrium
via hyperplasia of basal layer of endometrium
dysmenorrhea, AUB/HMB, enlarged, soft globular uterus
T(x): GnRH antagonists, hysterectomy, excision of an organized adenomyoma
214
Asherman syndrome
Adhesions and/or fibrosis of the endometrium
low fertility, recurrent pregnancy loss, AUB, pelvic pain
Associated with dilation and curettage of intrauterine cavity
215
Endometrial hyperplasia
abnormal enodmetrial gland proliferation stimulated by excess estrogen
High risk of endometrial carcinoma
Postmenopausal vaginal bleeding, high risk of anovulatory cycles, hormone replacement therapy, PCOS, granulosa cell tumors
216
Endometriosis
Endometrium like glands/stroma outside endometrial cavity
May be due to retrograde flow, metaplastic transformation of multipotent cells, transportations of endometrial tissue via lymphatic system
Cyclic pelvic pain, bleeding, dysmenorrhea, dysparemia, dyschezia, infertility, normal sized uterus
T(x): NSAIDs, OCPs, progestin, GnRH agonists, danazol, laparoscopic removal.
217
Endometritis
Inflammation associated with retained products of conception after delivery, miscarriage, abortion or with foreign body
Chronic = plasma cells on histo
T(x): gentamicin, clindamycin, ampicillin
218
Endometrial Carcinoma
Irregular vaginal bleeding
Endmetrioid: unopposed estrogen exposure due to obesity, early menarche, late menopause, nulliparity. Abnormally arranged endometrial glands. loss of PTEN or mismatch repair proteins
Serous: associated with endometrial atrophy in postmenopausal women. Aggressive, Psammoma bodies. Formation of papillae and tufts
219
Leiomyoma
multiple discrete tumors
high incidence in AA
benign smooth muscle tumor, malignant transformation is rare
Estrogen sensitive- tumor size increase in pregnancy and decrease with menopause
20-40
Asymptomatic, AUB or miscarriage
Severe bleeding --> Fe deficient anemia
Whorled pattern of smooth muscle bundles with borders
220
Leiomyosarcoma
Malignant proliferation of smooth muscle arising from myometrium
Arises de novo
postmenopausal women
single lesion with area of necrosis
221
Fibrocystic changes in Breast
Postmenopausal women 20-50 years
premenstrual breast pain or lumps, bilateral or mulifocal
Nonproliferatice lesions (simple cysts, papillary apocrine, stromal fibrosis)
risk of cancer not increased
222
Sclerosing stroma
Fibrocystic changes in Breast
acini and stromal fibrosis associated with calcifications
slight increase risk for cancer
223
Eptithelial Hyperplasia
Fibrocystic changes in Breast
cells in terminal ductal or lobular epithelium
increase risk of carcinoma with atypical cells
224
Inflammatory Breast Disease
Fat necrosis: benign, usually painless, lump due to injury to breast tissue. Calcified oil cyst on mammography, necrotic fat and giant cells on biopsy
Lactational mastitis: during breast feeing, increased risk of bacterial infection through cracks in nipple (s. aureus)
T(x) Abx and continue breastfeeding
225
Breast Fibroadenoma
```
<35
Benign
small well defined mobile mass
Fibrous tissue and glands
increased size and tenderness with high estrogen
```
226
Breast intraductal papilloma
Benign
small fibroepithelial tumor within lactiferous ducts, beneath areola
nipple discharge
227
Phyllodes Tumor Breast
Benign
large mass of connective tissue and cyst with leaf like lobulations
5th decade
May become malignant
228
Gynecomastia
Breast enlargement in males due to high estrogen. Physiologic in newborn, pubertal and elderly
cirrhosis, hypogonadism and drugs also cause
229
Breast cancer
Postmenopausal
palpable hard mass in upper outer quadrant
can be fixed to pectoral M, deep fascia, Cooper L and skin --> nipple retraction/ skin dimpling
HER2 overexpression
increase risk with age, Hx atypical hyperplasia, FMHx, white, BRCA1/2 mutation, high estrogen exposure, postmenopausal obesity, high total number of menstrual cycles, no breastfeeding, alcohol
Men: BRA 2 mutation, Klinefelter
Axillary LN metastasis is prognostic factor
230
Ductal carcinoma in situ
Fills ductal lumen
Arise from ductal atypia
microcalcifications on mammography
231
Comedocarcinoma
subtype of ductal CIS
| Cells have high grade nuclei with extensive central necrosis and dystrophic calcifications.
232
Paget Disease
```
Extension of DCIS/ invasive breast cancer up the lactiferous ducts and into the contiguous skin of nipple--> eczematous patches over nipple and areolar skin
Paget cells (intraepithelial adenocarcinoma cells
```
233
Lobular CIS
low E- cadherin expression
No mass or calcifications --> incidental biopsy finding
increased risk of cancer in either breast
234
Invasive ductal carcinoma Breast
Firm, fibrous, rock hard mass with sharp margins and small glandular duct like cells in desmoplastic stroma
235
Invasive lobular Carcinoma Breast
low E cadherin expression --> orderly row of cells and no duct formation
bilateral with multiple lesions in the same location
236
Medullary Invasive Carcinoma Breast
large, anaplastic cells growing in sheets with associated lymphocytes and plasma cells
well circumscribed tumor
237
Inflammatory invasive carcinoma breast
Dermal lymphatic space invasion --> breast pain with warm, swollen, erythematous skin around exaggerated hair follicles, peau d'orange
poor prognosis
lack palpable mass
238
Peyronie Disease
Abnormal curvature of penis due to fibrous plaque within tunica albicans
Cause pain and anxiety
Surgical repair or treat with collagenase injections
239
Ischemic priapism
painful sustained erection lasting >4 hours
Associated with SCD, meds
Treat immediately with corporal aspiration, intracavernosal phenylephrine, surgical decompression
240
SCC of penis
Precursor in situ lesion: Bowen disease (leukoplakia), erythroplasia of Queyrate, Bowenoid papulosis
Associated with uncircumscribed males and HPV
241
Cyptorchidism
Descent failure of one or both testes
impaired spermatogenesis, can have normal testosterone
associated with high risk of germ cell tumors
Prematurity increase risk
low inhibin B, high FSH and LH, low testosterone in bilateral
resolve spontaneously or orchiopexy before 2 years
242
Testicular torsion
rotation of testicle around spermatic cord and vascular pedicle
12-18 years
occur after inciting event
acute, severe pain, high riding testis and absent cremasteric reflex
T(x): surgery within 6 hours, manual detorsion
243
Varicocele
Dilated veins in pampiniform plexus due to high venous pressure
scrotal enlargement
left side more often due to increase resistance from L gonadal vein drainage into L renal V
can cause infertility due to high temp
Bag of worms
T(x): surgical ligation or embolization
244
Extragonadal germ cell tumor
Arise midline
retroperitoneum, mediastinum, pineal and suprasellar regions (adults)
sacrococcydeal teratoma (children)
245
Scrotal masses
benign scrotal lesion present as testicular masses that can be transilluminated
246
Congenital hydrocele
incomplete obliteration of processus vaginalis
| spontaneously resolve within 1 year
247
Acquired hydrocele
Scrotal fluid collection usually secondary to infection, trauma, tumor
248
Spermatocele
cyst due to dilated epididymal duct or rete testis
| Paratesticular fluctuant nodule.
249
Testicular tumors
Germ cell tumors (that produce sperm)
young men
increase risk with cryptorchidism, Klinefelter
Does NOT transilluminate
Sex Cord stromal tumors develop from embryonic sex cord. Benign
250
Seminoma
Germ Cell Tumor
Malignant
painless, homogenous testicular enlargement.
Large cells in lobules with watery cytoplasm and fried egg appearance
high ALP
Radiosensitive
GREAT PROGNOSIS
251
Teratoma Testicular
Germ cell tumor
may be malignant
Benign in children
252
Testicular Embryonal Carcinoma
```
Germ cell tumor
malignant
painful hemorrhagic mass with necrosis
high hCG, normal AFP
Worse prognosis than seminoma
```
253
Yolk sac tumor Testicular
```
Germ Cell Tumor
Malignant aggressive
yellpw, mucinous
Schiller Duval bodies
high AFP
<3 years
```
254
Choriocarcinoma
```
Germ cell tumor
Malignant
Disordered synctiotrophoblastic and cytotrophoblastic elements
Hematogenous spread to lungs and brain
high hCG
```
255
Sertoli cell tumor
Benign
| androblastoma from sex cord and stroma
256
Leydig cell tumor
Benign
golden brown, contains Reinke crystals
produce androgens or estrogens --> gynecomastia in men, precocious puberty in boys
257
Testicular lymphoma
malignant
older men
arises from metastatic lymphoma in testes
258
Organisms that cause epididymitis and orchitis
C trachomatis, N gonorrhea (young men)
E coli and Pseudomonas (elderly, UTI, BPH)
Autoimmune
259
Epididymitis
inflammation
localized pain and tenderness over posterior testis
Prehn sign +
260
Orchitis
testicular pain and swelling
| mumps orchitis increase infertility risk
261
BPH
>50
smooth elastic firm nodular enlargement of periurethral lobes --> compress urethra into vertical slit
increase frequency, nocturia, difficulty starting and stopping urine
May lead to distention and hypertrophy of bladder, hydronephrosis, UTI, high PSA
T(x): a1 antagonisms, 5a reductase inhibitors, PDE5 inhibitor
262
Prostatitis
Dysuria, frequency, low back pain
Warm tender enlarged prostate
Acute bacterial: old men, E coli. young men, C trachomatis, N gonorrheae
Chronic- bacterial or nonbacterial,
263
Prostatic adenocarcinoma
>50
posterior lobe of prostate gland
high PSA
osteoblastic metastases in bone and high ALP in late stage
Metastasis to spine via Batson venous Plexus
264
Goserelin, leuprolide
```
GnRH analogs (pulsatile --> GnRH agonist, continuous --> GnRH antagonist)
Used in uterine fibroids, endometriosis, precocious puberty, prostate cancer, infertility.
Adverse: hypogonadism, decreased libido, ED, nausea and vomiting
```
265
Degarelix
GnRH antagonist
use for Prostate cancer
Adverse: Hot flashes, liver tox
266
Estrogens
Ethinyl estradiol, DES, mestranol
Bind estrogen receptors
use in hypogonadism or ovarian failure, menstrual abnormalities, hormone replacement in postmen
Adverse: increase risk of endometrial cancer, bleeding in postmen. clear cell adenocarcinoma of vagina, increase risk thrombi
contra: ER + breast cancer, Hx DVT, tobacco >35 year old.
267
Clomiphene
Antagonist of estrogen receptor in hypothalamus
Prevent normal feedback inhibition and increase LH and FSH --> ovulation
Used to treat infertility due to anovulation
Cause hot flashes, ovarian enlargement, multiple simultaneous pregnancies, visual disturbances
268
Tamoxifen
Antagonist of estrogen at breast and agonist at bone and uterus
increase risk of thromboembolic event and endometrial cancer
used to treat and prevent recurrence of ER/PR + breast cancer
269
Raloxifene
Antagonist of estrogen at breast, uterus and agonist at bone
increase risk of thromboembolic event
treat osteoporosis
270
Aromatase inhibitors
Anastrozole, letrozole, exemestane
Inhibit peripheral conversion of androgens to estrogen
used in ER + breast cancer in postmen
271
Hormone Replacement Therapy
Used for relief or prevention of menopausal symptoms, osteoporosis
Unopposed estrogen replacement therapy increase risk of endometrial cancer, progesterone is added. increased CV risk
272
Progestins
Levonorgestrel, medroxyprogesterone, etonogestrel, norethindonre, megestrol
Bind progesterone receptor, decrease growth and increase vascularization of endometrium, thicken cervical mucus
Use for contraception , endometiral cancer, abnormal uterine bleeding, chronic anolvulation without estrogen
273
Antiprogestins
Mifepristone, ulipristal
Competitive inhibitor
Used to terminate pregnancy, emergency contraceptive
274
Combine contraception
Progestins and ethinyl estradiol
Estrogen and progestins inhibit Lh/FSH --> prevent estrogen surge --> no ovulation
Progestins --> thicken cervical mucus and inhibit endometrial proliferation --> limit sperm access and implantation of embryo
Adverse: menstrual bleeding, breast tenderness, VTE, hepatic adenoma
Contra: smokes > 35 years, CV disease, breast cancer, liver disease
275
Copper intrauterine device
produce local inflammatory reaction toxic to sperm and ova, prevent fertilization and implantation, hormone free
used for long lasting reversible contraception, most effective emergency contraception
Adverse: heavy menses, dysmenorrhea, risk of PID with insertion
276
Tocolytics
medication that relax the uterus
Terbutaline, nifedipine, indomethacin
used to decrease contraction frequency in preterm labor and allow time for administration of steroids
277
Danazol
Synthetic androgen that acts as partial agonist at androgen receptor
used for endometriosis, hereditary angioedema
Adverse: weight gain, edema, acne, hirsutism, masculinization, low HDL, hepatotox, idiopathic intracranial HTN
278
Testosterone, methyltestosterone
Agonist at androgen receptor
Treat hypogonadism and promote secondary sex characteristics, stimulate anabolism to promote recovery after burn
Adverse: masculinization, low intratesticular testosterone --> gonadal atrophy. Premature closure of epiphyseal plates. High LDL, low HDL
279
Finasteride
Antiandrogen
5a reductase inhibitor
used for BPH and male pattern baldness
Adverse: gynecomastia and sexual dysfunction
280
Flutamine, bicalutamide, apalutamide, enzalutamide
nonsteroidal competitive inhibitor at androgen receptor
| used for prostate carcinoma
281
Ketoconazole
Inhibit steroid synthesis
282
Spironolactone
inhibit steroid binding
283
Tamsulosin
a1 antagonist used to treat BPHby inhibiting smooth M contraction
Selective a1A/D receptors
284
Minoxidil
Direct arteriolar vasodilator
| used for Androgenetic alopecia , severe refractory HTN
