Flashcards in Reproductive System - UWorld Deck (41)
What takes over the role of estrogen and progesterone secretion after the corpus luteum regresses around week 10?
Estrogen - fetal adrenal gland
Progesterone - placenta
Hormones involved in the pathogenesis of PCOS
High insulin -> high LH:FSH (>3) -> high androgens -> hirsutism and anovulation
What hormones result in involution of the paramesonephric (Mullerian) ducts, development of the mesonephric (Wolffian ducts) and male external genitalia?
MIH = paramesonephric duct involution
Testosterone = Wolffian duct formation (seminal vesicles, epididymus, ejaculatory duct and ductus deferens)
DHT = development of external genitalia
Etiologies of polyhydramnios
GI tract obstruction
High fetal cardiac output -> increased urination
Immunochemistry in complete vs. incomplete molar pregnancy
Complete = p57-negative
Incomplete = p57-positive
Mifepristone mechanism of action
Anti-progesterone drug that causes necrosis and sloughing of the decidual layer
Immigrant mom has joint pains and a rash on her neck that spread to her extremities while pregnant. Exam reveals posterior auricular and sub occipital lymphadenopathy. What conditions might the fetus have at birth?
She has rubella and likely did not receive the live-attenuated MMR vaccine prior to pregnancy. Congenital rubella syndrome consists of cataracts, cardiac defects (PDA) and sensorineural deafness.
Regions of the male urethra
Posterior urethra: prostatic and membranous segments
Anterior urethra: bulbous and penile segments
Ligament that contains the ovarian artery, vein, lymphatics and nerve
Suspensory ligament of the ovary (i.e. tubuloinfundibular ligament)
Ligament that contains the uterine artery
Cardinal ligament (i.e. transverse cervical ligament)
Degrees of vaginal tearing with birth
1st = through superficial skin + mucosa
2nd = through perineal body
3rd = through external/internal anal sphincter
4th = through rectal mucosa
Levator ani muscles
Ileococcygeus and pubococcygeus
Hormones that act on the ovary
LH -> theca interna -> progesterone and androgen synthesis
FSH -> granulosa cells -> aromatization of androgen to estradiol
Why does hCG work to induce ovulation
It has a similar alpha-subunit as LH, FSH and TSH. The similarity to LH induces follicle rupture from the ovary.
Vaginitis with normal pH
Trichomoniasis and bacterial vaginosis have higher pHs
Most common cause of Turner syndrome. Why do they have short stature?
Paternal non-disjunction of the X chromosome during meiosis II, resulting in 45XO phenotype in almost all cells. Patients will have short stature due to loss of SHOX gene, which promotes long bone growth.
Differentiating primary ciliary dyskinesia from cystic fibrosis
Primary ciliary dyskinesia may have situs inversus and immotile sperm due to defect in dyenin arm.
CF may have pancreatitis and absent vas deferens
Which syphilis tests can you use to track response to anti-treponemal therapy?
RPR and VDRL test for presence of cardiolipin, a byproduct of T. palladium infection. FTA-ABS tests for antibodies against treponemal antigens that remain positive for life.
Cancers associated with trisomy 21
AML-M7 and ALL as children
Hormone levels in Klinefelter syndrome
Hyalinization and fibrosis of seminiferous tubules -> non-functioning Sertoli cells -> increased FSH
Leydig cell dysfunction -> low testosterone -> increased LH
Gonadal arteries originate from...
Aorta, below renal arteries
Mayer-Rokitansky-Kuster-Hauser syndrome. Next think to check for when you make this diagnosis?
Blind vaginal pouch originates from urogenital sinus and absent uterus due to Mullerian (paramesonephric) agenesis. The next think you should do is a renal ultrasound because 50% of these patients may have a co-existing renal abnormality like renal agenesis.
Post-op patient with scrotal and medial thigh numbness after pelvic surgery
Injury to the genitofemoral nerve, most commonly due to retraction against the nerve as it lies on the psoas muscle
Nerve at high risk for injury during Pfannensteil incision C-section.
Iliohypogastric nerve innervates the suprapubic skin and lies near the site of incision
Loss of medial thigh sensation and ability to abduct after retroperitoneal lymph node dissection
Obturator nerve injury
Definition of primary amenorrhea
No menses or secondary sex characteristics by 13
No menses with secondary sex characteristics by 15
Mechanism for gestational hyperglycemia
Increasing levels of hPL secreted by the syncytiotrophoblasts results in increased insulin resistance, increased insulin release, increased maternal proteolysis and lipolysis. GDM occurs when the pancreas cannot secrete enough insulin to keep up with the increased blood glucose levels.
Most common type of ovarian germ cell tumor
Conditions associated with increased and decreased maternal serum AFP
Increased: multiple gestations, open neural tube defects and abdominal wall defects
Decreased: aneuploidy. Trisomy 21 will also have low E2, increased inhibin A and increased beta-hCG