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45 Cards in this Set
- Front
- Back
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Complications of gametogenesis |
non-dysjunction - which causes aneuploidy (22 or 24 chromosomes instead of 23) |
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Progesterone maintains the uterine lining and inhibits the contraction of smooth muscle. List some side effects this may cause during pregnancy |
heartburn, constipation, ascending ureteric bacteria |
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sexual determination vs. sexual differentiation |
determination - genetic make up at birth (XY, XX) differentiation - events leading to gonadal sex (default is female) |
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what determines what the gonads will differentiate into? |
the presence of a Y chromosome |
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What investigations should you do for a couple that can't get pregnant? |
Ovulation - BBT, OPK, luteal Progesterone, day 3 FSH, TSH, prolactin Tubal - sono HSG, hysterosalpingogram, laparoscopy with dye Sperm analysis |
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Assisted Reproductive Technologies |
Ovulation Induction - good for anovulatory IUI - unexplained or low male fertility IVF - good for most issues Intracytoplasmic Sperm Injection - failed IVF Donor gametes |
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What are some reversible causes to male infertility |
smoking, BMI, heat, drugs, alcohol |
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What labwork would you do for male infertility? |
FSH/LH, testosterone, prolactin, semen analysis |
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What genetic studies would be helpful for male infertility? |
Karyotyping for Klinefelters, CF, or Y chromosome microdeletions |
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What is a rare pre-testicular cause of male infertility? Rx? |
Kallmann's Syndrome - hypogonadal hypogonadism and anosmia Rx- gonadotropins |
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List some anovulatory causes for infertility. Then list pelvic and uterine causes. |
PCOS hypothalmic suppression (athlete, anorexia) Thyroid def, high prolactin primary ovarian insufficiency age STI/PID, endometriosis, surgery, appendix, congenital, adhesions (Ashermann's), trauma |
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List criteria for late puberty in boys and girls |
Girls -no signs of puberty by 14, no period by 16, no period 2-3 years after breast dev Male - no testicular growth by 14, no growth spurt by 18 |
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Order of puberty for girls |
Boobs, pubes, then you grow and flow |
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Why does GnRH/FSH/LH stay low before female puberty? |
very sensistive to low dose estrogen (negative feedback) and CNS suppression |
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What hormone is responsible for therlarche? |
estrogen |
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What hormone is responsible for adrenarche (hair)? |
DHEA and androstenedione |
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What is Dx of precocious puberty in girls? What do you do about it? |
before 7 years old. investigate - hormone levels, serial bone age Rx- GnRH agonist until 10 or 11 |
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List causes of precocious puberty (true, psuedo) |
true- HPO axis problems, maybe tumor, etc. psuedo- cyst on ovaries, OCP |
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Spontaneous abortion Complete Incomplete Recurrent Inevitable Abortion Missed Abortion |
Spontaneous abortion -before 20wks Complete - all products expulsed Incomplete -not all products expulsed (increased risk of bleeding/infection) Recurrent -3+ before 20wks Inevitable Abortion - in the process Missed Abortion - |
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Signs Sx of abortion |
-bleeding, cramping, decreasing pregnancy Sx |
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If suspecting an abortion, what investations should you run? |
Hb hCG (qualitative and quantitative) Bloodgroup and cross match Rh status? Fetal US |
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What causes 60% of abortions? Other causes |
chromosomal abnormalities (most commonly, Turners) uncontrolled DM, thyroid, etc, antiphospholipid antibodies, physical issues with uterus |
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Rx for women who comes in with a spontaneous abortion? |
Stabilize, evaluate fetus via US if Rh-, WinRho Then either wait, medical mgt (misoprostol), or D&C |
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What if it is a septic spontaneous abortion? what is the protocol? |
IV Abx, get the infection under control before removing the tissue |
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What is the most dangerous location for an ectopic pregnancy? |
at the isthmus, most likely to rupture due to least amount of stretch |
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Sx of ectopic pregancy |
Pain > bleeding always think of ectopic if bleeding in first trimester |
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Dx of ectopic |
hCG - eratic, not doubling every 48 hrs -if hCG is over 1500, expect to see something on US US- absence in uterus |
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Rx for ectopic recurrent ectopic? |
+/- WinRho methotrexate or salpingostomy bilateral tubal ligation |
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What further investigations can you do for recurrent spontaneous abortion couples? |
karyotype - looking for translocations Hystertosalpingogram-look for fibroids TSH, prolactin, DM, thrombophilia screening cervical infection screening 75% will be normal |
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Abortion options |
methotrexate, misoprostol 1st tri: mifpristone or D+C 2nd tri: misoprostol or D+E |
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What structure is located in the false pelvis? |
nothing unless pregnant, then uterus |
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differences between female and male pelvis |
male - thick, heavy, long, heart shaped inlet, 50-60 degree subpubic angle female - oval inlet, large outlet, wide subpubic angle (80-85) |
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Muscles impacted by an epistiotomy |
perineal body, bulbospongiosum, superficial transverse perineal |
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What is responsible for the male scrotal appearance? |
dartos fascia |
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what muscle trauma would cause incontinence after childbirth |
external/internal sphinctors, levator ani |
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What ligament is the ovarian artery located in? What about the uterine artery? |
suspensory ligament lateral cervical ligament |
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What artery/vein couple does not come off/drain to the internal iliac artery/vein? |
ovarian artery comes directly off of the aorta and the right ovarian vein drains into the IVC while the left ovarian vein drains into the left renal vein |
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Why is an ectopic pregnancy at the isthmus so damn blood? |
it is where the uterine and ovarian arteries anastomose |
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Why can prostate cancer metasize so easily to the back? |
prostatic plexus and vertebral plexus are connected |
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There is an infective boil on the labia majora... where are the LN enlarged? |
superficial inguinal |
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What cells to LH and FSH stimulate? |
LH - theca interna --> make androgen FSH - granulosa cells ---> make estradiol |
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Sx of a prolapsed vagina |
incontinence, constipation |
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Rx for fibroids |
MRI guided US myomectomy ablation ulipristal |
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Dx criteria for PCOS |
abormal periods, clinical or biochemical signs of hyperandrogenism, polycystic ovaries (2/3) |
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PCOS is at higher risk of what type of cancers? |
endometrial hyperplasia or adenocarcinoma due to the unopposed estrogen |
