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133 Cards in this Set
- Front
- Back
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How do we determine a baby's due date?
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LMP - 3months + 7 days
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Pre-term baby is defined as...
Post-term baby is defined as... |
<35 weeks
>42 weeks |
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Small for gestational age (SGA) is defined as
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<2500 grams
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Symmetrical SGA may be cauased by...
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Symmetrical SGA is a 'baby' problem
1 - chromosomal abnormalities 2 - TORCH infections |
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Asymmetrical SGA may be caused by...
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Asymmetrical SGA is 'mom' problem
1 - poor blood supply (any cause) |
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Large for gestational age (LGA) is defined as...
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>4500 grams
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What are the causes of LGA?
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DM, monochorionic twins - twin/twin transfusion
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What happens to LGA baby 24 hrs after birth? 48 hrs after birth?
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24hrs - hypoglycemic (due to increased insulin production b/c of constant high glucose from mom in utero)
48hrs - hypocalcemia (immature parathyroids) |
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What are the stages of the menstrual cycle?
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Follicular/Proliferative (Days 1-10)- Estrogen (endometrium proliferates)
Ovulatory (Days 10- 14) - LH Luteal/Secretory - Progesterone (Days 14-28)(endometrium sloughs due to prog withdrawal) |
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How long can an an egg/sperm live in the fallopian tube?
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Egg- 3 days
Sperm 5 days |
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What changes do the breasts undergo during the menstrual cycle?
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Follicular phase - ductular growth
Luteal phase - glandular growth |
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What happens to breasts if overstimulated by progesterone during luteal phase?
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Glandular cysts may form
If continued overstimulation - fibrocystic disease may develop |
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In what order, and from where are the hormones released that control the menstrual cycle?
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Hypothalamus - GnRH
Pituitary - LH/FSH Theca interna of maturing egg - responds to LH and produces progesterone Progesterone stimulates nearby granulosa cells to make estrogen *Pineal gland resets system* Hypothalamus --> GnRH Pituitary --> LH and FSH (LH conc much higher than LH now) Theca cells respond to LH and egg released and progesterone produced Feedback inhibition begins and decreased prog results in sloughing of uterine lining |
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What effect does estrogen have on uterine decidua functionalis?
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proliferation during follicular phase
- if overstimulated, can cause dysfunctional uterine bleeding - if cont to overstimulate can cause adenomyosis - further overtimulation may cause endometriosis |
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What effect does estrogen have on uterine smooth muscle?
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stimulates growth of fibroids
- submucosal: presents with heavy bleeding - subserosal: presents with pelvic pain/pressure |
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What are the most common sites of endometriosis?
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ovary
uterosacral ligament pouch of Douglas |
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How is endometriosis diagnosed?
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laparoscopy
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How is endometriosis usually described on pathology?
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chocolate cysts or powder burns
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What is the effect of progesterone on the endometrium?
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increases spiral arteries, lipids, and glycogen in preparation of implantation of zygote
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What are two ways to prevent pregnancy "the morning after"?
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Mifeprostone (RU-486): blocks progesterone receptors resulting in dramatic drop in prog and sloughing of uterine lining
Plan B: give prog for 72 hours then withold |
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What drugs can be used to stimulate ovulation?
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Clomiphene: Inhibits GnRH feedback resulting in multiple ovulations per cycle
HCG: can use it to mimic LH to stimulate multiple ovulations/cycle since it shares an alpha-subunit with LH |
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How can any type of estrogen oversitmulation be treated?
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OCPs
GnRH analog (leuprolide) Danazole (side effect is masculinization) Surgery |
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How do birth control pills work?
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Ovulation is stimulated by LH surge. LH surge is feedback-inhibited by progesterone. Therefore, give progesterone in OCP to prevent ovulation.
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Which birth control methods are progesterone only?
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Depo-Provera
Nuva Ring Side effects: breakthrough bleeding (2/2 stim of growth of spiral arteries) |
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What can be used to prevent breakthrough bleeding from OCPs?
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Use combination pills with Estrogen/Progesterone. Estrogen will cause proliferation of endometrium beyond growth of spiral arteries and bleeding will stop
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What estrogen can be used to monitor fetal growth in the first trimester?
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Estriol
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Why must a fetus be delivered within 24 hours following IUFD?
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Because estriol decreases within the first 24hr following fetal demise. Mom's immune system will return to its normal state and attack the products of conception.
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When should hormone replacement therapy be given? How should it be given?
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ONLY if patient is symptomatic and feels she absolutely needs it.
If so, give lowest amount of E2 that will relieve sx - treat with this for 2 years - then start Tamoxifen |
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What is the first sign of puberty in females? Males?
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Females - Thelarche (breast buds)
Males - enlarged testicles |
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What is the fundal height at the following anatomic landmarks...
- pubic symphysis - umbilicus |
Pubic Symphysis - 12 cm
Umbilicus - 20 cm |
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What is the role of sertoli cells in the male reproductive system?
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1. produce inhibin
2. maintain the blood-testes barrier 3. Protect and nourish the sperm to maturity |
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What is the function of LH in males?
FSH in males? |
LH > testosterone > spermatogenesis
FSH >Sertoli cells > inhibin production |
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How long can an egg/sperm live in the fallopian tube?
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Egg - 3 days
Sperm - 5 days |
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What is the clinical definition of infertility?
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Inability to conceive after 1 year of unprotected intercourse (or 3 months if >35yo)
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What are the 3 main causes of infertility?
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Male - 50%
Female - 30% (Mcc is PID) Unknown - 20% |
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What are the causes of sexual dysfunction in...
Young men Older men The elderly |
Young - premature ejaculation
Old - Stress impotence Elderly - Vascular impotence |
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What are the signs/symptoms of a molar pregnancy?
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1. HTN in 1st trimester
2. Size of uterus inconsistent with dates 3. HCG increasing abnormally |
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All pregnancy tests calculate the presence of which hormone?
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B-HCG
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When is HCG first detectable in the blood? urine?
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Blood - 1 week after formation of zygote
Urine - 2 weeks after formation of zygote |
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What is the main function of HCG?
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Maintain corpus luteum so progesterone will continue to be secreted
Progesterone needed to maintain uterine lining. If progesterone production stops, lining sloughs and zygote is lost = miscarriage |
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What hormones are produced by the placenta?
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HCG
Estriol Progesterone HPL Inhibin Relaxin |
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HCG has the same alpha subunit as what other hormones?
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LH, FSH, and TSH
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Why are pregnant patients anemic?
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They aren't!!
Plasma volume increases 50%. RBC mass only increases 30% so it looks like patient is anemic, but she isn't |
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What is the function of Estrogen during pregnancy?
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Smooth muscle relaxation
Stimulates protein synthesis in the liver |
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What is the function of inhibin?
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Inhibits FSH - prevents another menstrual cycle from beginning.
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What is the function of HPL?
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Block's mom's insulin receptors --> insulin resistance --> gestational diabetes
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How does progesterone work as a birth control agent?
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Progesterone is physiologically secreted by the Theca interna cells in response to increased LH. Therefore, Progesterone feedback inhibits the further secretion of LH.
So externally-supplied progesterone will feedback inhibit LH resulting in lack of ovulation = birth control!! |
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What does the Seminal vesicle give to sperm?
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Food = fructose and clothes = semen
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What do the Bulbourethro/Cowper's glands secrete?
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Bicarbonate (neutralize acid in vagina)
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What does the prostate secrete?
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The prostate "HAZ" it
Hyaluronidase Acid Phosphatase Zinc |
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What is the capacitation reaction?
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Removal of semen by zinc
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What is the acrosomal reaction?
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Release of enzymes from head of sperm needed to break through the corona radiata
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What is the crystallization reaction?
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Formation of a wall around the egg once one sperm enters to prevent polyspermia
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Where does testosterone come from?
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Adrenal glands and testicles
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Where does DHT come from?
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Testicles after puberty
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What is a pseudohermaphrodite?
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A person with an external genitalia problem
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What is a true hermaphrodite?
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A person with an internal genitalia problem
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What is a female hermaphrodite?
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Doesn't exist - the default is female
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What is a female pseudohermaphrodite?
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XX with 21-hydroxylase deficiency resulting in high testosterone levels
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What is a male hermaphrodite?
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XY with MIF deficiency
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What is a male pseudohermaphrodite?
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XY with 17-OH deficiency resulting in low testosterone
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What is hirsutism?
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Hairy female
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What is virilization?
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Man-like female
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What is testicular feminization/androgen insensitivity syndrome?
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XY with DHT recepter dysfunction resulting in external genitalia = blind pouch vagina
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What is McCune-Albright syndrome?
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1. Precocious puberty
2. polyostotic fibrous dysplasia 3. pgmented skin macules |
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What stage of the menstrual cycle has the highest estrogen levels?
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Follicular - proliferative
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What stage of the menstrual cycle has the highest temperature?
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Ovulatory
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What stage of the menstrual cycle has the highest progesterone levels?
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Luteal stage - secretory
Progesteroneproduced by Theca interna cells of ruptured mature follicle |
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What form of estrogen is at it's highest in menopause? middle age? pregnancy?
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Menopause - E1: Estrone
Middle Age - E2: Estradiol Pregnancy - E3: Estriol |
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What dz states have increased estrogen?
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Pregnancy, Liver failure, p450 inhibition, obesity
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What is adenomyosis?
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Growth of endometrium into myometrium --> enlarged "boggy" uterus
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What does DES taken by mom cause in her daughter?
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adenomyosis
clearc cell CA of vagina repeat miscarriages |
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What is Kallman's Syndrome?
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No GnRH and anosmia (can't smell)
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What is Polycystic ovarian syndrome?
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Increased cysts eventually resulting in no ovulation --> no progesterone production
Pts can't inhibit LH --> obese, hairy, have acne Can lead to increased incidence of endometrial CA |
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What is Sheehan syndrome?
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Watershed infarct of pituitary due to increased hemorrhage during pregnancy
Leads to deficiency of cortisol, prolactin, and TSH |
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What is Asherman's syndrome?
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Uterine scarring following a D&C
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What is oligomenorrhea?
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Too few periods
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What is polymenorrhea?
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Too many periods
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What is the most common cause of post-coital vaginal bleeding? ...in pregnant women? ...in post-menopausal women?
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cervical cancer
pregnancy - placenta previa post-menopause - endometrial CA |
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What is chronic pelvic pain?
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endometriosis until proven otherwise
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What is dysfunctional uterine bleeding?
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Diagnosis of exclusion - usually due to anovulation
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What is Dysmenorrhea?
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Painful menses usually due to PGF2
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What is endometriosis?
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Caused by retrograde flow of endometrium to - ovary, uterosacral ligament, pouch of Douglas
Seen on pathology as powder burns or chocolate cysts Diagnosed by laparoscopy |
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What is Kleine regnung?
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Scant bleeding with ovulation
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What is menorrhagia?
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Heavy menstrual bleeding
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What is fibroids (leiomyoma)?
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uterine muscle tumors, benign
may present as pelvic fullness, asymmetric uterus on exam |
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What is metrorrhagia?
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bleeding or spotting between periods
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What is Mittleschmerz?
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Pain at ovulation
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What causes syphilis?
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Treponema Pallidum
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What is Herpes?
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ds DNA virus
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What is HPV?
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ds DNA virus
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What is Chlamydia?
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obligate intracellular parasite
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What causes Gonorrhea?
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gram negative diplococci
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What causes Chancroid?
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H. ducreyi
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What causes lymphogranuloma venereum?
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C. Trachomatis
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What causes lymphogranuloma inguinale?
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C. granulomatis
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What causes epididymitis?
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Chlamydia
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What is Mittleschmerz?
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Pain at ovulation
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What causes syphilis?
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Treponema Pallidum
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What is Herpes?
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ds DNA virus
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What is HPV?
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ds DNA virus
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What is Chlamydia?
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obligate intracellular parasite
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What causes Gonorrhea?
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gram negative diplococci
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What causes Chancroid?
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H. ducreyi
Gram neg rod School of fish |
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What causes lymphogranuloma venereum?
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C. Trachomatis
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What causes lymphogranuloma inguinale?
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C. granulomatis
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What causes epididymitis?
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Chlamydia
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What is Condyloma lata?
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Flat fleshy warts that ulcerate
indicative of secondary syphilis |
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What is condyloma accuminata?
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Verrucous "cauliflower" warts
koilocytes caused by HPV 6,11 |
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How does herpes present?
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primary: painful grouped vesicles on red base
secondary: painful solitary lesion |
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How does syphilis present?
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Primary: Painless chancre (1-6 wks)
Sexondary: Rash involving palms and soles, condyloma lata (6 wks) Tertiary: Neuro, cardio, bone sx (6 yrs) |
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How does chancroid present?
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Painful genital ulcer with necrotic center,
Gram neg rod, body of fish seen under microscope |
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How does lymphogranuloma venereum present?
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Painless ulcers
Abscessed nodes genital elephantiasis |
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How does granuloma inguinale present?
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spreading ulcer
Donovan bodies granulation test |
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How does chlamydia present?
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yellow pus from cervix
conjunctivitis PID |
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How does gonorrhea present?
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Palmar pustules
arthritis urethral discomfort |
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How does epididymitis present?
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unilateral scrotal pain decreased by support
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What causes non-bacterial infections in the fetus?
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TORCH infections - all symmetrical SGA
Toxoplasmosis Other - syphilis Rubella CMV HSV-2 |
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What are the clues for toxoplasmosis infection of baby?
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multiple ring-enhancing lesions on CT
cat urine parietal lobe |
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What are the clues for Syphilis infection of baby?
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Rhagade's (lip fissure)
saber shin legs (2/2 anterior bowing) Hutchinson's razor teeth Mulberry molars |
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What are the clues for Rubella infection of baby?
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Blueberry muffin rash
PDA cataracts hearing loss meningoencephalitis PNA |
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What are the clues for CMV infection of baby?
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spastic diplegia of legs
hepatosplenomegaly blindness central calcifications |
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What is Paget's disease of breast?
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Rash and ulcer around nipple, breast cancer
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What is lobular carcinoma?
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cells line up in single file
contralateral primary |
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What is comedocarcinoma?
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multiple focal areas of necrosis
"blackheads" |
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What is cystosarcoma phylloides?
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"Exploding mushroom"
firm rubbery moveable good prognosis |
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What is intraductal papilloma?
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nipple bleeding
most common breast CA |
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What is ductal carcinoma?
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Worst prognosis breast CA
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What is sarcoma boyroides?
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vaginal cancer
ball of grapes |
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What is a Sister Mary Joseph nodule?
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ovarian CA that spread to umbilicus
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What is Meig's syndrome?
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Pleural effusion
Ovarian fibroma Ascites |
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What are the side effects of estrogen?
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Weight gain
breast tenderness nausea headache |
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What are the side effects of progesterone?
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Acne
HTN depression |
