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1

What takes over the role of estrogen and progesterone secretion after the corpus luteum regresses around week 10?

Estrogen - fetal adrenal gland
Progesterone - placenta

2

Hormones involved in the pathogenesis of PCOS

High insulin -> high LH:FSH (>3) -> high androgens -> hirsutism and anovulation

3

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

4

Etiologies of polyhydramnios

GI tract obstruction
Anencephaly
High fetal cardiac output -> increased urination

5

Immunochemistry in complete vs. incomplete molar pregnancy

Complete = p57-negative
Incomplete = p57-positive

6

Mifepristone mechanism of action

Anti-progesterone drug that causes necrosis and sloughing of the decidual layer

7

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.

8

Regions of the male urethra

Posterior urethra: prostatic and membranous segments
Anterior urethra: bulbous and penile segments

9

Ligament that contains the ovarian artery, vein, lymphatics and nerve

Suspensory ligament of the ovary (i.e. tubuloinfundibular ligament)

10

Ligament that contains the uterine artery

Cardinal ligament (i.e. transverse cervical ligament)

11

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

12

Levator ani muscles

Ileococcygeus and pubococcygeus

13

Hormones that act on the ovary

LH -> theca interna -> progesterone and androgen synthesis
FSH -> granulosa cells -> aromatization of androgen to estradiol

14

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.

15

Vaginitis with normal pH

Candidiasis.
Trichomoniasis and bacterial vaginosis have higher pHs

16

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.

17

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

18

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.

19

Cancers associated with trisomy 21

AML-M7 and ALL as children

20

Hormone levels in Klinefelter syndrome

Hyalinization and fibrosis of seminiferous tubules -> non-functioning Sertoli cells -> increased FSH

Leydig cell dysfunction -> low testosterone -> increased LH

21

Gonadal arteries originate from...

Aorta, below renal arteries

22

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.

23

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

24

Nerve at high risk for injury during Pfannensteil incision C-section.

Iliohypogastric nerve innervates the suprapubic skin and lies near the site of incision

25

Loss of medial thigh sensation and ability to abduct after retroperitoneal lymph node dissection

Obturator nerve injury

26

Definition of primary amenorrhea

No menses or secondary sex characteristics by 13
No menses with secondary sex characteristics by 15

27

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.

28

Most common type of ovarian germ cell tumor

Mature teratoma

29

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

30

How can a translocation cause Down syndrome?

Translocation of both long arms of chromosome 21 to chromosome 14 with a single normal 21 chromosome results in three chromosome 21s.