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680 Cards in this Set
- Front
- Back
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Where is the accessory storage site for sperm?
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Ampulla [near the seminal vesicles]
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Seminal vesicles produce two products...
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1. Nutrients [i.e. fructose]
2. Prostaglandins |
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What is the function of prostaglandins produced by the seminal vesicles?
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Stimulate oviduct and uterine contractions to aid in sperm transport.
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What are the two protective mechanisms that keep the testes at 1-2 degrees cooler than the body?
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1. Cremaster reflex
2. Countercurrent heat exchange with blood flow within pampiniform plexus |
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What two male reproductive structures secrete substances to neutralize the acidic pH of the vagina?
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1. Prostate [acid phosphatase]
2. Bulbourethral gland |
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Basic functional unit of the testis
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Seminiferous tubules
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Where does final maturation of sperm occur?
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Head of the epididymis
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What is the primary storage site of sperm?
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Tail of the epididymis
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Where does the sperm acquire motility?
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Epididymis and vas deferens
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What is the purpose of sperm coating glycoproteins produced by the epididymis?
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Protect sperm from immunologic attack [since they do not contain full genetic material, they are marked for attack unless protected]
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Nerves, blood vessels, and Leydig cells are located in the...
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Stroma of the testis
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______ : Inside seminiferous tubules :: ______ : outside seminiferous tubules
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Sertoli cells
Leydig cells |
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What are the three main functions of Sertoli cells?
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1. Support, protect, nutrition
2. Phagocytosis 3. Secretion |
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What four things do the Sertoli cells secrete?
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1. Inhibin
2. Androgen binding protein 3. Estrogen 4. Plasminogen activator |
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What is the function of Leydig cells?
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Secrete testosterone in response to LH
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What is the function of androgen binding protein?
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Keeps local levels of testosterone high.
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What divides the basal compartment from the adluminal component of the seminiferous tubules?
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Tight junctions [occluding junctions]
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Where are spermatogonia located?
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Outside of the tight junctions in basal component [all other sperm located in adluminal component]
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What is the function of the blood-testis barrier?
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Prevents immunological recognition of sperm as foreign body.
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What is the purpose of plasmin in sperm formation?
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Unzips tight junctions to let spermatogonia pass through.
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(T/F) Blood vessels supplying the sertoli cells are located within the basement membrane.
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False.
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1st meiosis reduces _______ while 2nd meiosis reduces _______.
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Chromosomes
Chromatids |
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Located in the adluminal compartment, and has 46 chromosomes.
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Primary spermatocyte
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Located in the adluminal compartment, and has 23 chromosomes and 46 chromatids.
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Secondary spermatocyte
Spermatid contains 23 chromatids. |
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Largest of all sperm cells...
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Primary spermatocyte
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How do you distinguish early and late spermatid?
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Late spermatid elongated head/tail
Early spermatid rounded |
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What is the function of Type A Spermatogonium?
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Regeneration of spermatogonium to renew pool.
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The entire spermatogenesis process takes ______ and repeats cyclically ever ______.
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64 days
2-3 weeks |
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Intracellular bridges keep _____ grouped to allow synchronous release.
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Spermatid
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Spermatogenesis requires...
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1. FSH
2. High local [T] |
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What is spermiogenesis?
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Maturation of spermatozoa
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What is spermiation?
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Release of sperm into lumen
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What two actions occur in the female body to the mature sperm?
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1. Capacitation - increases motility
2. Acrosome reaction - triggered by contact with egg |
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(T/F) Freshly ejaculated sperm can fertilize an egg.
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False - requires capacitation.
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List the following in order of flow of sperm:
Efferent ducts Tubuli recti Vas deferens Seminiferous tubules Ductus epididymis Rete testis |
Seminiferous tubules
Tubuli recti Rete testis Efferent ducts Ductus epididymis Vas deferens |
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How do you differentiate between ductus epididymis and efferent ducts?
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Ductus epididymis have a regular lumen while efferent ducts have irregular lumen.
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(T/F) Rete testis are surrounded by smooth muscle.
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False - efferent ducts.
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Rete testis have _____ epithelium while ductuli efferentes have _____ epithelium.
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Low cuboidal/squamous
Pseudostratified ciliated |
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What does the spermatic cord consist of?
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1. Vas deferens
2. Nerve 3. Artery |
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Which portion of the male reproductive system provides the majority of the seminal fluid?
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Seminal vesicles
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What is the main histological difference between seminal vesicles and vas deferens?
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More tortuous mucosal folds
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What two substances does the prostate add to the semen?
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1. Glycoproteins
2. Fibrinolytic enzymes |
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What is UNIQUE histologically about the prostate?
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Corpora amylacea - prostatic concretions [concentric rings due to glycoprotein component of glandular secretions]
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(T/F) Corpus spongiosum are paired in the penis.
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False - corpora cavernosa.
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Where are the helicene arteries located?
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Terminal arteries in the penis [tortuous when penis is flaccid]
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What are the Glands of Littre?
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Urethral glands that secrete mucus/mucoproteins for lubrication.
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How does an erection occur?
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CNS stimulation to release NO - dilates arteries - corpus cavernosum/spongiosum fill and compress veins to reduce blood flow out and penis becomes rigid.
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How does viagra work?
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Inhibits PDE5 so that cGMP action lasts longer and smooth muscle relaxation occurs longer.
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Name the two substances similar to inhibin produced by the Sertoli cells?
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Activin and follistatin
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Why do GnRH analogs have longer 1/2-lives?
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Substitution of glycine at the 6th AA location for a non-hydrolyzable AA [cannot be cleaved by endopeptidase]
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(T/F) GnRH can be measured in the periphery.
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False - peptide hormone, metabolized immediately.
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(T/F) Pulse amplitudes of GnRH and LH are highly variable.
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False - frequencies are variable [in women]
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____ and ____ pulses are synchronous.
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GnRH and LH
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(T/F) GnRH antagonists require a longer period of time to work.
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False - GnRH agonists.
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GnRH antagonist are ideally used in...
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prostate cancer [where a temporary increase in LH/FSH cannot be tolerated]
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What is responsible for the first phase of Ca++ increase in GnRH binding?
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PI pathway [PIP2 ---> IP3]
Sharp/transient |
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What is responsible for the second phase of Ca++ increase in GnRH binding?
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Influx of extracellular Ca+ via voltage-gated channels [VCCC]
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GnRH binds to a _______ receptor and its effects are regulated by changing _________.
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G-protein
number of receptors |
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LH stimulates steroidogenesis in two places...
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1. Phosphrylation of cholesterol esterase
2. Activation of Cyp11A1 |
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Delta 4 pathway [steroidogenesis] predominates in the ________ and Delta 5 predominates in ________.
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Ovaries
Testis |
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(T/F) Aromatase activity is much higher in women than in men.
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True.
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FSH acts on ______ and LH acts on ______ [male]
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Sertoli
Leydig |
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What is the 2-cell theory in relation to male sexual development?
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LH stimulates [T] production
[T] crosses over to Sertoli, aromatase activity converts to [E] |
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Why does the male body not produce a lot of estradiol?
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Because sertoli cells do not have a lot of aromatase.
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Active form of testosterone constitutes...
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2-3% circulating [T] + 30-40% bound to albumin
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Why is TeBG higher in women?
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Increased levels of TeBG with estradiol, and decreased by androgens.
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Why is DHT more potent than testosterone?
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Greater affinity for the receptor
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Adult castration leads to...
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decreased libido and decreased aggression [does not revert to pre-pubertal status]
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Prepubertal castration leads to...
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Tall, skinny, decreased libido, sexually infantile.
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Cryptorchidism is a failure of the testes to descend that can lead to....
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Deficient sperm production and damage to seminiferous tubules.
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Kallman's syndrome is the most common example of...
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Hypogonadotropic hypogonadism in males.
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Klinfelter's syndrome is the most common example of...
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Hypergonadotropic hypogonadism [end-organ failure] in males.
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(T/F) 90% of varicoceles are located on the right side.
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False - left side [drains into the renal vein]
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Most prostate cancers occur in what region of the prostate?
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Peripheral zone
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Most hyperplasias occur in what region of the prostate?
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Transitional zone
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What is the typical clinical presentation of acute bacterial prostatitis?
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Fever, chills, dysuria with tender prostate.
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Man presents with recurrent UTIs with suprapubic discomfort, what is your first suspicion?
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Chronic bacterial prostatits
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What is the best way to distinguish between chronic bacterial prostatitis and abacterial prostatits?
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Abacterial = no hx of recurrent UTIs
Urine culture will be negative, but leukocytosis present. |
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What is the most common cause of granulomatous prostatitis?
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BCG therapy for bladder cancer.
[other cause:fungal infxns in immunocompromised] |
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What is a possible explanation for why older men are more susceptible to BPH?
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Increased estrogen [relatively] increases sensitivity to DHT.
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Why do alpha-adrenergic antagonists work in therapy of BPH?
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Reduces prostatic muscle tone.
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Clinical features of BPH are caused by...
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1. Urethral compression
2. Urinary retention |
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(T/F) BPH shows a loss of basal cells histologically.
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False - this mainly occurs in carcinomas of the prostate.
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What is the main therapy for BPH?
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5-alpha reductase inhibitors
alpha-adrenergic blockers Surgery ONLY if unresponsive to medical therapy |
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(T/F) African Americans are at a higher risk for GCTs than Caucasians.
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False - Caucasian men are higher risk for GCTs. AAs are higher risk for prostate cancer.
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(T/F) Migrant populations to the U.S. do not show increased likelihood of prostate cancer.
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False - they do - environmental factors play a big role.
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Which gene is implicated in familiar prostate cancer?
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HPC1
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What are signs of advanced disease of prostate cancer?
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1. Dysuria/flow issues/frequency
2. Hematuria 3. Bone pain/unintended weight loss |
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What are the two components of screening for prostate cancer?
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DRE and PSA levels
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Name 8 conditions where PSA levels are elevated.
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1. Cancer
2. BPH 3. Prostatitis 4. Infarct 5. Extended exercise 6. Ejaculation 7. Massage 8. Instrumentation |
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If PSA is less than 10, greater than 4....risk of cancer is...
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25%
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If PSA is > 10 risk of cancer is...
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50%
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What is the physiologic role of PSA?
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Serine protease that helps liquefy seminal coagulum
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(T/F) A higher amount of free PSA [>25%] indicates a higher risk of cancer.
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False, indicates a lower risk.
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What are the four main things to be considered on microscopic assessment of prostate cancer?
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1. Grade
2. Perineural invasion 3. Lymphatic invasion 4. Capsular invasion |
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What is PIN?
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Precursor lesion for prostate cancer seen in 80% of cases [intraepithelial neoplasia]
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(T/F) Gleason grading ranges from 1-10.
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false, 2-10 [add up grading for two different dominant patterns observed]
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Prostate cancer is most likely to metastasize to...
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Bone.
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Stage B/Stage 2 prostate cancer is defined as...
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Cancer confined to the prostate
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(T/F) Cancer spreading to a distant lymph node is considered a metastases.
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True [but not if it's regional]
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What are the four mainstays of therapy for prostate cancer?
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1. No therapy if asymptomatic with advanced age/chronic illness
2. Surgery [consider complications] 3. Radiation 4. Medical treatment [hormonal] |
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What are the four main hormonal therapies for prostate cancer?
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1. Orchiectomy
2. Estrogen 3. GnRH analog 4. Androgen blockade [flutamide] |
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GCTs increase in incidence during which decades of life?
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15-34 y/o men
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What are three main factors that are suspected in pathogenesis of GCTs?
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1. Cryptorchidism
2. Testicular dysgenesis 3. Genetic factors [12 i ] |
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95% of testicular tumors are classified as ....
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Germ Cell Tumors
[other 5% is stromal] |
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Most common type of GCT
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Mixed type
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Most common type of pure GCT
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Seminoma
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What is the most common GCT for females?
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Teratomas
[GCTs are rare in women - 1%; 98% in men] |
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Histology of seminomas?
AFP levels in seminomas? |
Fried-egg appearance
Normal |
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What are the four markers you can use for embryonal carcinomas?
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1. placental alk phos +
2. AFP 3. hCG 4. CD30 + |
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Yolk sac tumors are a common testicular tumors in...
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infants to 3 y/o [rare in adults]
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Histology of yolk sac tumors?
AFP levels in yolk sac tumors? |
Schiller-Duval bodies + cords/sheets
AFP +, + alpha-antitrypsin |
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(T/F) Choriocarcinomas and teratomas are highly malignant in adults.
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True
Teratomas are benign in children |
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What defines a teratoma (histologically)?
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All 3 layers [from all 3 germ layers]
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What are the four possible constituents of mixed GCTs?
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1. Embryonal
2. Teratoma 3. Choriocarcinoma 4. Yolk sac tumor |
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(T/F) Non-seminomas are responsive to radiation therapy.
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False - seminomas are responsive [thus provide good prognosis]
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(T/F) The more elevated the AFP/hCG the poorer the prognosis for GCTs.
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True.
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What are two physiological effects of androgens?
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1. Stimulate renal EPO production
2. Decrease HDL |
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Name 5 medical uses of androgens?
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1. Anemia
2. Postmenopausal hormone replacement 3. Hormone replacement [men] 4. Oral contraceptives [progestin] 5. Angioedema [stanazol] |
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Name 11 complications of anabolic steroid use ...
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1. Hepatic dysfunction
2. Endocrine changes 3. Hirsutism 4. Alopecia 5. Major depression/mania 6. Aggressiveness 7. Increased libido 8. Hypertension 9. Infertility 10. Prostatic hypertrophy 11. Acne |
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What is the main complication in anabolic steroid use in children?
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Advanced bone maturation leading to short stature
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What are female-specific side effects of anabolic steroids?
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Menstrual irregularities
Masculinization Clitoromegaly |
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What are male-specific side effects of anabolic steroids?
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Gynecomastia, decreased size of testicles, oligospermia
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Why is androstenedione not successful to increase muscle mass?
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Pushes the body to form more estradiol [5-alpha reductase activity is most likely maxed out] - so you just get moobs.
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DHT is critical in _____ and lack of it can lead to ______.
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Fetal development
Ambiguous genitalia |
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Formation of DHT can be blocked by ...
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Finasteride [5-alpha reductase inhibitor]
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What medication can be used to medically castrate men?
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Leuprolide acetate
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What is the mechanism of action of leuprolide acetate?
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GnRH analog with continuous secretion it inhibits GnRH secretion.
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What are three diseases leuprolide acetate is used for?
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1. Prostate cancer
2. Endometriosis 3. Precocious puberty in kids |
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Finasteride is used for treatment of...
Mechanism of axn? |
BPH and alopecia
Inhibitor of 5-alpha reductase [type 2] |
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How does dutasteride and finasteride differ?
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Dutasteride blocks both type 1 and type 2 alpha reductase
Finasteride just does 1. |
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Which alpha reductase is responsible for 2/3 of the circulating DHT?
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Type 2.
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Flutamide, bicalutamide, and nilutamide are all used for....
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Treatment of prostate cancer
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How is spironolactone used in women [aside from htn]?
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Hirsutism and alopecia
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What is the mechanism of action of spironolactone?
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reduces 17alpha-hydroxylase activity lowering testosterone and androstenedione
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How is andrestendione converted to estradiol?
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Via estrone
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How is estradiol formed physiologically?
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Androstenedione to testosterone to estradiol via aromatase.
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Conversion of cholesterol to pregnelonone is a rate-limiting step mediated by...
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Cyp11A1
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The majority of follicles reside in the...
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Cortex of the ovary
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Where do major blood vessels enter the ovary?
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In the medulla
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Much like how the primary spermatogonia is exclusively found in the basal component; the primordial follicles are exclusively found ...
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In the cortex of the ovary
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What is the distinguishing feature between a primordial follicle and primary?
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Single layer of flattened granulosa cells in primordial
Cuboidal in primary |
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List the types of follicles in order of stages of development
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Primordial --> primary --> secondary
--> antral --> graafian follicle |
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In prenatal development the female sex cells migrate from the yolk sac endoderm to the genital ridge in the...
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4-5th month of gestation
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What is the difference between the mural and cumulus granulosa cells?
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Mural is adjacent to the basal lamina
Cumulus surrounds the oocyte |
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Which layer of the antral follicle contains the lymphatic and vascular support for the follicle?
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Theca cells
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The antrum is filled with fluid made by _____ _____ and contains what 3 components?
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Granulosa cells
Estrogen OMI [oocyte maturation inhibitor] Inhibin |
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What are two main histologic signs of atresia in the antral follicle?
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1. Granulosa cells become disorganized
2. Pyknotic nuclei [very dark] |
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(T/F) 99% of all follicles become atretic.
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True.
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(T/F) Oocyte maturation and follicle growth are synchronous.
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False - asynchronous.
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Primary oocyte has ___ chromosomes and ____ chromatids.
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46; 92
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Secondary oocyte has ___ chromosomes and ___ chromatids.
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23; 46
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Mature egg has ___ chromosomes and ___ chromatids.
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23 chromosomes; 23 chromatids
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Until a woman hits puberty, all her eggs are stuck in...
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Prophase of meiosis I
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What allows completion of meiosis I for the formation of secondary oocytes?
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LH surge
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What allows completion of meiosis II for the final production of the mature egg?
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Fertilization
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The minimum time for meiosis I in a female is ____, the maximum time for meiosis I is _____.
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12 yrs; 50 yrs
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(T/F) Prolactin helps with ovarian development and maturation.
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False -- no known ovarian function in humans.
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How does the pulsatility of GnRH change during the menstrual cycle?
|
1 pulse/h - early follicular
2 p/h - late follicular [d/t estrogen] 0.25 p/h - luteal phase [d/t progesterone] |
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What are the trends of GnRH secretion during the reproductive phase of a woman's life?
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Tonic - most of the time is spent in this region
Midcycle -- huge surge in GnRH |
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How does the brain initiate puberty?
|
Adipocytes make leptin
Leptin stimulates KISS gene Increase in kisspeptin Binds GPR54 to stimulate GnRH |
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(T/F) First couple of menstrual cycles are anovulatory.
|
True.
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List the following in order of the menstrual cycle:
-- ovulation -- luteal phase -- menses -- follicular phase |
Menses (1-5 days)
Follicular phase (1-14) Ovulation (14) Luteal phase (14-28) |
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The LH surge leads to three outcomes...
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1. Oocyte meiosis I
2. Ovulation 3. Corpus luteum formation |
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What is the critical moment that allows FSH to go from lower levels to a surge of LH?
|
Switch of [E] feedback from negative to positive with increasing levels [both [E] and inhibin]
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What mediates the subsequent decrease in FSH/LH post ovulation?
|
Progesterone and some estrogen from the corpus luteum provide negative feedback
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(T/F) The decrease in LH/FSH in the luteal phase causes the corpus luteum to regress.
|
False - cause unknown.
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Once a follicle contains an _____ it becomes GnRH dependent.
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Antrum
|
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How are follicles recruited to grow?
|
Inter-cycle surges [transient increase in FSH] -- day 28/day 1
|
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(T/F) Majority of follicle growth is not dependent on FSH.
|
True.
|
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The selection of a dominant follicle is based on its increased ability to utilize FSH which is determined by 3 factors...
|
Enhanced vascularity
Increased # FSH receptors Enhanced cAMP responsiveness |
|
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Why doesn't estradiol and inhibin feedback destroy the dominant follicle?
|
Selected follicle survives the declining FSH levels [ensures the destruction of other follicles]
|
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Providing exogenous FSH allows a higher likelihood of ovulation/pregnancy because...
|
Prevents "natural selection" of dominant follicle from occurring - thus 5-15 follicles can reach the ovulatory stage.
|
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What are the results of the LH surge?
|
1. Increased follicle size
2. Volume 3. Prostaglandins 4. tPA 5. Collagenase |
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|
Aside from the LH surge, what else stimulates plasmin/collagenase secretion?
|
Progesteron
|
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Ovulation is random and is mediated by ____ ____ ______ and typically occurs _________.
|
Smooth muscle contraction
12 hrs post LH peak |
|
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How does rescue of the corpus luteum occur?
|
Due to hCG release if fertile coitus has occurred.
|
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What four things does the corpus luteum secrete?
|
Progesterone
Relaxin Inhibin Estrogen |
|
|
What is the function of the corpus luteum?
|
Transform proliferative uterus into a secretory endometrium for implantation.
|
|
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What is the corpus albicans?
|
Follows the corpus hemorrhagicum - is the remaining scar tissue after luteolysis
Takes several cycles to completely get rid of |
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What are the two types of cells in the cortex?
|
1. Granulosa-lutein cells
2. Theca-lutein cells |
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What do granulosa-lutein cells produce?
|
Basal-level Progesterone
|
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What do theca-lutein cells produce?
|
Progesterone in response to LH pulses
|
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Proliferative phase = _______
Secretory phase = ______ |
Follicular phase
Luteal phase |
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|
A bicornuate uterus is described as...
|
Common vagina/cervix that becomes two uterus [Y-shaped]
|
|
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List the order of branching in uterine vasculature...
|
Uterine artery
Arcuate artery [within myometrium] Enters endomerium: Straight artery [radial] Helical artery [spiral] |
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|
Which part of the endometrium sloughs off every menstrual cycle?
|
The zona functionalis [basalis remains intact]
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Spiral [helical] arteries are located in the...
|
zona functionalis
|
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How can you identify the myometrium?
|
Interlacing bundle of smooth muscles!
|
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Associate the following endometrial thicknesses with the appropriate phase:
5-6 mm 0.5-1.0 mm 2-3 mm |
secretory
menstrual phase proliferative |
|
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Most menstrual flow originates from _____ system.
|
Venous sysytem [arteries remain coiled]
|
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Explain the mechanics behind blood pooling in menstruation
|
Blood escapes, pools and causes pressure necrosis of tissues/veins leading to sloughing of zona functionalis of endometrium.
|
|
|
How can you distinguish [histologically] between the proliferative and secretory phase?
|
The glands are straight, narrow producing thin watery mucus in proliferative
The glands are tortuous and sacculated in the secretory phase with thick, mucus secretions. |
|
|
What is the function of the tunica muscularis in the oviducts?
|
Helps move sperm towards the egg [stimulated by prostaglandins in sperm]
|
|
|
(T/F) The mucosa of the fallopian tubes are very tortuous and fill the lumen.
|
True.
|
|
|
What are the three layers of the vagina [histologic]?
|
Epithelium
Lamina propria Musculosa layer |
|
|
What type of epithelium characterizes the vagina?
|
Thick stratified, non-keratinized, squamous epithelium.
|
|
|
What hormone is responsible for the increase in body temperature post-ovulation?
|
Progesterone
|
|
|
What is responsible for the transient spike in progesterone before ovulation?
|
LH receptors from granulosa cells respond to increased LH surge to release progesterone.
[if you inhibit this, you can inhibit ovulation] |
|
|
What is ferning?
|
Mucus looks like a fern microscopically during ovulation and is very pliable.
|
|
|
Granulosa cells are ______ deficient.
|
Cyp17 deficient [thus cannot make estrogen precursors, relies on theca cells].
|
|
|
Fill in the blanks:
____ stimulates theca cells to make ________ which transfers to the _____ where it can be converted into _____ or _____ which is mediated by _____. |
LH
androstenedione granulosa cells estradiol or testosterone FSH |
|
|
(T/F) Estrogen and progesterone are like the yin and yang of sex hormones.
|
True -- estrogen makes thinner mucus and increases contractility [progesterone does opposite]
|
|
|
What is the source of the circulating estrogens in a post-menopausal woman?
|
High levels of FSH will cause production of androstenedione which can be converted into estrogen in the periphery [by adipocytes]
|
|
|
What is the most common cause of hypergonadotropic hypogonadism in females?
|
MENOPAUSE!!!
|
|
|
If a woman presents with abnormal uterine bleeding, before prescribing hormones - what do you rule out?
|
Structural causes [tumors/cancer/polyp/fibroids]
|
|
|
What is Menorrhagia?
|
Flow >=7 days or >80 mL
|
|
|
What is metrorrhagia?
|
Irregular bleeding between menses
|
|
|
What is menometrorrhagia?
|
Irregular, heavy bleeding
|
|
|
What is polymenorrhea?
|
Cycles <21 days apart
|
|
|
What is oligomenorrhea?
|
Cycles >35 days apart
|
|
|
Waht si amenorrhea?
|
Absence of menses for 6 months [or 3 cycles]
|
|
|
What is the distinction between primary and secondary amenorrhea?
|
Primary = never had your period
Secondary = you had them, now they've stopped |
|
|
What are two main options for ovulation induction for women having difficulty conceiving?
|
1. Clomiphene citrate [anti-estrogen to increase FSH]
2. Recombinant gonadotropin [increased exogenous FSH] |
|
|
What is a side effect of ovulatory induction that doctors must be aware of?
|
Increased number of follicles leads to increased estrogen which can lead to hypersecretion syndrome [rare]
|
|
|
What two synthetic estrogens are found in oral contraceptives?
|
Mestranol (prodrug of ethinyl estradiol)
Ethinyl estradiol |
|
|
How does estrogen prevent osteoporosis?
|
Decreasing the rate of resorption of bone by antagonizing parathyroid hormone?
|
|
|
What are the uses of synthetic estrogen?
|
Replacement therapy for primary hypogonadism
Postmenopausal therapy OCPs |
|
|
Estrogen replacement MUST be given with ______ for women who have not had _______
|
Progestin; hysterectomies
|
|
|
What are the three ways estrogen/progesterone can be given therapeutically?
|
Continuous estrogen ALWAYS.
Progesterone at the end Progesterone periodically Progesterone continuously |
|
|
Progestins used therapeutically ____ the activity of the estrogen component.
|
Reduce
|
|
|
Adverse effects of progestins are....
|
1. Increased blood pressure
2. Reduced HDL 3. Depression |
|
|
What are the 9 absolute contraindications of OCP use?
|
1. Pregnancy
2. Un-dxed abnormal genital bleeding 3. Hx of jaundice w/OCP 4. Thromboembolic disorders 5. CAD 6. Breast cancer 7. Endometrial cancer 8. Estrogen-dependent neoplasia 9. Hepatic adenomas/malignant |
|
|
What are the 14 benefits of OCP use?
Decreased risk of... |
1. Pregnancy
2. Ectopic pregnancy 3. Menstrual disorders 4. Breast disease 5. Ovarian cysts 6. Uterine fibroids 7. Ovarian cancer 8. Endometrial cancer 9. Endometriosis 10. PID 11. Rheumatoid arthirits 12. IDA 13. Duodenal ulcers 14. Acne |
|
|
What three OCPs are approved for the treatment of acne?
|
1. Ortho Tri-Cyclen
2. Estrostrep 3. YAZ |
|
|
What are the three main OCs used?
|
1. Ortho Tri-Cyclen
2. YAZ 3. Seasonale |
|
|
(T/F) Mestranol has only 67% of the activity of ethinyl estradiol (EE) .
|
True
Ortho-Novum 1/50 is not as strong a pill as 1/35 |
|
|
What does endometrial activity of a pill indicate?
|
Ability to stop breakthrough bleeding
[mediated by progestin] |
|
|
When should OC's be started?
|
Sunday after the end of the LMP
|
|
|
Weight gain is a side effect of an OCP - how do you differentiate the cause of this side effect?
|
Progesterone causes increased appetite
Estrogen leads to weight gain w/o increased appetite |
|
|
(T/F) Amenorrhea as a side effect of OCP use is highly concerning.
|
False - not a concern -- if the patient is uncomfortable then you can increase estrogen component.
[insufficient estrogen effect on endometrium] |
|
|
What is the most common cause of breakthrough bleeding in OCP use?
|
Skipping pills
|
|
|
Changes in corneal curvature can be due to...
|
Excess estrogen
|
|
|
The treatment for seizures as a s/e of the pill and insufficient vaginal lubrication are opposite....
|
1. seizures -- decrease estrogen
2. vaginal lub -- increased estrogen |
|
|
For nursing mothers, they should know that combination OC's...
|
Reduce the quality/quantity of breast milk [so she should breast feed immediately after taking her pills]
|
|
|
When should women begin OCPs after giving birth?
|
14 days post-partum [if combined]
3 days after if progestin only |
|
|
Give 4 medications that reduce the efficacy of OCs?
|
1. anticonvulsants
2. rifampin 3. antibiotics 4. St. John's Wort |
|
|
What are some side effects of Tamoxifen? (4)
|
1. Hot flushes
2. N/V 3. Increased risk of endometrial cancer 4. Liver damage |
|
|
Raloxifene is approved for...
|
1. Approved in post-menopausal prevention and rx of osteoporosis
2. Prevention of invasive breast cancer in women who have osteoporosis or who are at high risk of invasive breast cancer. |
|
|
Raloxifene has estrogen-like effects on bone/lipid metabolism...
|
Decreases LDL and total cholesterol
Not on the uterus or breast tissue |
|
|
What would the ideal SERM do?
|
Estrogen-like -- vagina, CNS, bone, liver
Anti-estrogen - breast/endometrium |
|
|
Danazol is used for the treatment...
|
Endometriosis
|
|
|
Aromatase inhibitors are used for the treatment...
|
Breast cancer in postmenopausal women
|
|
|
How do aromatase inhibitors work?
|
Blocks estrogen production from tissues other than the ovaries
|
|
|
(T/F) Danazol is a pregnancy category X drug.
|
True -- suppresses FSH/LH surge thus can have androgenic effect on female fetus and ambiguous genitalia.
|
|
|
Give 3 examples of aromatase inhibitor drugs.
|
1. Anastrazole
2. Exemestane 3. Letrozole |
|
|
Development of the mammary gland is mediated by...
|
Maternal prolactin and placental estrogen and progesterone
|
|
|
Development of breast tissue occurs along .... [embryonically]
|
Milk lines [thus altered regression can lead to supernumerary nipples]
|
|
|
What is the functional unit of the breast lobule
|
TDLU [terminal duct lobular units]
|
|
|
List the division of breast tissue from nipple to TDLUs...
|
Nipple --> lactiferous duct/sinus --> segmental duct --> subsegmental duct --> TDLUs
|
|
|
The vast majority of breast carcinomas arise....
|
in TDLUs - not ducts
|
|
|
What are the 3 components of the acini located within each TDLU?
|
1. Cuboidal epithelial cells
2. Myoepithelium 3. Basal almina |
|
|
Where are most breast carcinomas located?
What is this correlated with? |
Upper outer quadrant [50%]
Amount of glandular tissue |
|
|
Why are mamograms easier to read for postmenopausal women?
|
Dense active breast tissue has been replaced with fat [which appears dark] - thus easier to see calcifications/lumps.
|
|
|
Fibroadenomas arise from ....
|
Intralobular stroma
|
|
|
Fibroadenomas typically arise in women in their ______ and is associated with _____.
|
20-40s
Hyperestrogenism |
|
|
How do fibroadenomas appear microscopically?
|
Delicate proliferation of intralobular stromal cells
|
|
|
What is the gross appearance of fibroadenomas?
|
Well demarcated, grayish white, clefts evident
|
|
|
Phyllodes tumors behave like _____ tumors and tend to occur in women in their _____; they have ____ risk of malignancy.
|
Fibroepithelial tumors
40s-60s 10% are malignant |
|
|
How do phyllodes tumors typically appear microscopically?
|
Increased number of stromal cells
Mitotic figures common Dilated clefs from cystic development |
|
|
Fibrocystic changes are changes that occur with menstruation cycles and is associated with ______ and occurs in women between ______.
|
Excess estrogen
25-45 y/o |
|
|
(T/F) Fibrocystic changes leads to an increased risk of breast cancer.
|
False [no increased risk]
|
|
|
What are the five histologic distinctions of fibrocystic changes?
|
1. Dilated ducts
2. Adenosis 3. Fibrosis 4. Apocrine metaplasia 5. Hyperplasia |
|
|
What is the distinction between adenosis and hyperplasia?
|
Hyperplasia does not maintain the 2 cell layers while adenosis does.
Adenosis = increased # of acini in each lobule |
|
|
(T/F) Fibroadenoma and fibrocystic changes indicate no increased risk of cancer.
|
True
|
|
|
(T/F) Mild hyperplasia is indicative of increased risk of cancer.
|
If no atypia - this is false
Moderate/severe hyperplasia is increased risk. |
|
|
What are the 4 microscopic features of hyperplasia?
|
1. monomorphic
2. hyperchromatic 3. ovoid nuclei 4. punched out spaces |
|
|
List the 8 risk factors for breast cancer...
|
1. Gender
2. Age 3. Genetics 4. Family hx 5. Personal hx 6. Hx of radiation 7. Prolonged estrogen stimulation 8. Race |
|
|
What is the lifetime risk for a woman to get breast cancer?
|
1 in 8
|
|
|
What is the risk for women older than 50 yrs of age to get breast cancer?
|
75%
|
|
|
What percentage of breast cancers are hereditary? And familial?
|
5-10% hereditary
15-20% familial 80% sporadic |
|
|
Give 4 examples of prolonged estrogen stimulation..
|
1. Nulliparity
2. 1st child after 30 y/o 3. Early menarche 4. Late menopause |
|
|
What are 4 preventable risk factors (breast cancer)?
|
1. Alcohol
2. Smoking 3. Obesity and diet 4. Lack of exercise |
|
|
Majority of Carcinoma-in situs are discovered via...
|
Mammogram
|
|
|
Histology of High grade DCIS
|
Central necrosis
Dystrophic calcification/fibrosis |
|
|
Histology of low grade DCIS
|
Microcalcifications
No necrosis Monomorphic neoplastic cells |
|
|
How does LCIS typically present?
|
Clinically silent, incidental finding for other biopsies [cannot be seen on mammogram]
|
|
|
Histology of paget's?
|
Large neoplastic cells with clear cytoplasm
|
|
|
How does Paget's present, clinically?
|
Erythematous, moist, eczematous lesion of the nipple [epidermal]
|
|
|
Most breast cancers are what type?
|
Infiltrating ductal carcinoma - NOS
|
|
|
Which breast cancer has the poorest prognosis?
|
Inflammatory carcinoma
|
|
|
Which two breast carcinomas have the best prognosis?
|
Mucinous
Tubular |
|
|
Histology of infiltrating ductal carcinoma - NOS?
|
Cords, nests, tubules
Desmoplastic response - infiltration of tumor cells with surrounding fibrosis |
|
|
What is the clinical appearance of inflammatory carcinoma of the breast?
|
Peau d' Orange
|
|
|
Histology of lobular carcinoma
|
String of pearls
|
|
|
Histology of tubular carcinoma
|
Angulated glands
[single layer of low grade malignant cells in a dense collagenized stroma] |
|
|
Histology of mucinous carcinoma
|
Extracellular mucin/soft gelatenous mass
|
|
|
Histology of medullary carcinoma
|
Syncytium-like sheets
T-cell lymphocytes |
|
|
Both mucinous and medullary carcinoma are associated with...
|
Hypermethylation of BRCA1
|
|
|
What is the most significant prognostic factor for breast cancer?
|
Nodal status
|
|
|
ER(+) tumors tend to metastasize to ______ while lobular carcinomas metastasize to the _______.
|
Bone
GI/ovaries |
|
|
T2 lesion for breast cancer is defined as...
|
2-5 cm
|
|
|
N1 for breast cancer is defined as....
|
Involvement of 1-3 positive lymph nodes
|
|
|
Which receptor status is most responsive to hormonal therapy?
|
ER+ / PR+
|
|
|
How is Her2/neu expression tested?
|
Immunohistochemical staining
or FISH [preferred] |
|
|
If a breast cancer is positive for Her2-neu - what do you prefer to treat with?
|
Trastuzumab
|
|
|
What is the mechanism of action of trastuzumab?
|
Blocks receptor dimerization/cell signaling also induces ADCC by NK cells
|
|
|
Triple negative breast cancer predominate in...
|
Women younger than 50
Pre-menopausal African |
|
|
Triple negative breast cancer is typically what type of cancers [histologically]?
|
IDC-NOS and medullary
|
|
|
Triple negative breast cancers overlap with...
|
BRCA1
Basal-like cancers |
|
|
What is the rx for triple-negative breast cancer?
|
Chemotherapy [not hormonal therapy]
|
|
|
What are the five subtypes for genotypic diagnosis?
|
Luminal subtype A/B
Her2/Neu + Basal subtype Normal breast-like |
|
|
Which genetic subtype of breast cancers have the best overall survival?
|
Luminal subtype A
|
|
|
Removal of breast tissue and pectoralis major is called a ....
|
Radical mastectomy
|
|
|
Removal of entire breast while maintaining muscular structures...
|
Simple mastectomy
|
|
|
(T/F) Anastrozole can only be used in post-menopausal women.
|
True
|
|
|
Most common type of breast cancer based on genetic profiling in all women?
|
Luminal type A
|
|
|
Most common breast cancer in premenopausal African American women based on genetic profiling?
|
Basal type
|
|
|
What must be true before you can do a genomic analysis for breast cancer?
|
Stage 1-2 of cancer, node negative
ER+ |
|
|
What two medications inhibit Cyp2D6 activity? Why is this medically important?
|
Tamoxifen function requires Cyp2D6
Fluoxteine [prozac] Paroxetine [paxil] |
|
|
What are the 6 features that indicate an increased likelihood of BRCA mutations?
|
1. Multiple cases of early onset breast cancer
2. Ovarian cancer (with family history of breast or ovarian cancer) 3. Breast and ovarian cancer in the same woman 4. Bilateral breast cancer 5. Ashkenazi Jewish heritage 6. Male breast cancer |
|
|
BRCA-1 Associated cancers
|
Breast cancer [mainly female]
Second primary breast Ovarian cancer Prostate [men only] |
|
|
BRCA-2 Associated cancers
|
Breast cancer [male also]
Ovarian cancer [<< risk than BRCA-1] Prostate [men] Pancreatic Melanoma |
|
|
80% of BRCA1 breast tumors are...
|
Basal subtype [triple negative]
|
|
|
Ovarian cancers in BRCA1/BRCA2 is predominantly what type?
|
papillary serous adenocarcinoma
|
|
|
(T/F) Breast and ovarian cancer prognosis is worse in hereditary types versus sporadic.
|
False - equivalent for breast, but ovarian CA prognosis is BETTER in hereditary.
|
|
|
Name 4 other genetic conditions associated with increased breast cancer risk
|
Li Fraumeni
Cowden Peutz Jeghers Ataxia telangiectasia |
|
|
Li Fraumeni
|
TP53
|
|
|
Cowden
|
PTEN
|
|
|
Peutz Jegher
|
STK11
|
|
|
ATaxia telangiectasia
|
ATM
|
|
|
Li Fraumeni - 4 Bs...
|
Breast
Brain Bone Blood |
|
|
What is the clinical presentation of Cowden's?
|
Hamartomas – skin
thyroid (multinodular), breast (fibrocystic), colon (ganglioneuromas), uterus (fibroids), macrocephaly |
|
|
Most male breast cancers are...
|
Invasive ductal carcinomas and hormone-receptor positive
|
|
|
What is the drawback to the gail model?
|
Does not help assess hereditary cancer risk
|
|
|
What four things does the Gail model include?
|
1. Age
2. Reproductive hx 3. Benign breast disease hx 4. Mother/sister breast cancer hx |
|
|
What is the only factor in the Claus model considered for breast cancer risk assessment
|
Family history of breast cancer
|
|
|
What is BRCApro?
|
Software that calculates probability of a person carrying a mutation - so you can know WHO to test.
|
|
|
What two ethnic populations are at higher risk for BRCA mutations?
|
Ashkenazi Jew
Icelandic person |
|
|
If a person has a negative BRCA1/2 mutation with a known BRCA1/2 mutation in the family - what does that mean?
|
They have a sporadic cancer risk - but no familial risk!!
|
|
|
What are the four primary preventions of breast cancer for BRCA1/2 positive patients?
|
1. Mastectomy
2 Pre-menopausal oophrectomy 3. Tamoxifen [chemoprevention] 4. Lifestyle changes [breastfeeding (BRCA1) /smaller family (BRCA2)/exercise] |
|
|
What are the 3 secondary prevention of breast cancer?
|
1. Early detection of tumors when surgery alone would be feasible
2. Early clinical surveillance (begin at age 25) 3. Breast MRI instead of mammography |
|
|
The urogenital sinus in females becomes the...
|
Lower vagina
|
|
|
The caudal fused portion of the Mullerian ducts becomes the...
|
Uterus/cervix/upper 2/3 of the vagina
|
|
|
The cranial unfused portion of the Mullerian ducts becomes the...
|
Fallopian ducts
|
|
|
The Mullerian ducts begin to form at ______ gestation
The _______ ducts regress. |
6th week
Wolffian [mesonephric] |
|
|
What is the histology of the ectocervix?
|
Non-kertinizing squamous epithelium [same as the vagina]
|
|
|
(T/F) The squamocolumnar junction is where the columnar epithelium is replaced by squamous and is a non-dynamic location in a woman's cervix.
|
False - the definition is true; however, the location of the junction changes with hormonal changes.
|
|
|
Nabothian cysts are...
And is a sign of... |
Cysts that appear on the surface of the cervix due to blockage of glands
chronic inflammation |
|
|
What is acanthosis?
[NOT a. nigrans, just acanthosis] |
Thickening of the mucous epithelium in the cervix - sign of chronic inflammation.
appears grossly as a white plaque [leukoplakia] |
|
|
How can you differentiate between acute and chronic inflammation?
|
Acute - PMNs + edema
Chronic - lymphocytes |
|
|
How do oral antibiotics increase the likelihood of vaginal infections?
|
Can deplete lactobacillus [normal vaginal flora] - which inhibits the drop in vaginal pH that is protective.
|
|
|
What is the substrate within the cervix that allows bacteria to grow?
|
Glycogen from shedding epithelium.
|
|
|
Microscopy of a genital lesion of a woman shows ground glass nuclei in grape clusters -- diagnosis ....
|
Herpes simplex
|
|
|
Woman presents with purulent exudate your diagnosis is...
|
Gonorrhea
|
|
|
Pap smear shows lymphoid germinal centers and plasma cells with an other asymptomatic patient -- what is your diagnosis?
|
Chlamydia
|
|
|
Which two strains are oncogenic in HPV?
Which two strains cause condyloma acuminatum? |
16/18 = oncogenic risk
6/11 = condyloma acuminatum All 4 are covered in HPV vaccine. |
|
|
What are the 9 risk factors for cervical neoplasia?
|
1. young at first intercourse
2. multiple sexual partners 3. high parity 4. OCP use 5. HLA subtypes 6. Repeated infections of HPV 16/18 7. A male partner w/multiple sexual partners 8. nicotine use 9. Immunosuppression |
|
|
What is the pathophysiology [mechanism of infection] for HPV?
|
Infections immature basal cells [can replicate within mature, but do not infect them] -- re-initiates DNA synthesis inducing dysplasia at areas of broken epithelia in cervix or squamocolumnar junction.
|
|
|
(T/F) HPV can only infect epithelial cells.
|
False - can infect glandular and neuroendocrine cervical cells.
|
|
|
What is cervical intraepithelial neoplasia?
|
Neoplastic cells that are confined to the mucosal lining of the cervix [contained within the epithelia]
|
|
|
How is CIN detected?
|
Screening = pap smear
Based on dysplasia - may choose to do f/u biopsy [pap smear = screening, NOT diagnostic] |
|
|
High grade SIL with CIN is associated with...what is the recommended follow-up?
|
Moderate and severe dysplasia
Biopsy/resection [cryotherapy or loop electrical excision] |
|
|
(T/F) Raised lesions in the cervix are more malignant than flat condyloma.
|
False - flat are more malignant/high-risk.
|
|
|
Associate the following with their degree of dysplasia:
Full epithelial thickness involved Lower 1/3 of epithelia has increased N/C ratio Lower 2/3 of epithelia has increased N/C ratio |
Severe
Low-grade Moderate |
|
|
Majority of cervical dysplasias occur in the....
|
Transformation zone
|
|
|
The majority of cervical neoplasms are...
|
Squamous cell carcinoma
|
|
|
What do patients typically die of if they have cervical squamous cell cancer?
|
Renal failure due to involvement of ureters [causes hydronephrosis]
|
|
|
Carcinoma confined to the cervix= Stage ___
Carcinoma confined to the prostate = Stage ______ Carcinoma confined to the endometrium = Stage ______ |
Stage I
Stage II Stage IA |
|
|
What is pelvic exenteration?
|
Removal of pelvis/rectum/bladder in severe end-stage squamous cell carcinoma of the cervix.
|
|
|
While 80% of cervical neoplasms are squamous, 15% are _____ which can be preceded _______.
|
Adenocarcinomas
Adenocarcinoma in-situ Clinically similar to squamous cell cancers. |
|
|
Adenosquamous cell carcinomas arise from...
|
Reserve endocervical basal cells
|
|
|
(T/F) Women with a history of HPV infections cannot be vaccinated for HPV.
|
False - they can be vaccinated and should be.
|
|
|
What is the age range for the HPV vaccine?
|
As early as 9 y/o, recommend starting at 11/12
Upper limit = 26 years old |
|
|
How often should pap smears be done?
|
Every year until the age of 30 where if you have completely normal can spread it out every 2-3 yrs.
|
|
|
When should pap smears be started?
|
Age 21 or 3 yrs within first sexual contact.
|
|
|
Who should NOT be vaccinated for HPV?
|
Pregnant women, women intending to be pregnant, women allergic to yeast.
|
|
|
What is the difference between the early epithelia and late epithelia in the secretory phase of the endometrium?
|
Edematous/vacuolated [early]
Cuboidal/increased eosinophilia [late] |
|
|
When are anovulatory cycles physiologically normal/common?
|
Onset of menarche
Perimenopausal |
|
|
What does the endometrium appear like with a woman on OCP use?
|
Discordance between stroma and glands
Glands = inactive Stroma = resembles decidua of pregnancy |
|
|
What does the endometrium appear like with a woman on OCP use?
|
Discordance between stroma and glands
Glands = inactive Stroma = resembles decidua of pregnancy |
|
|
What is the most common cause of abnormal uterine bleeding in post-menopausal women?
|
Endometrial atrophy
|
|
|
What is the most common cause of abnormal uterine bleeding in post-menopausal women?
|
Endometrial atrophy
|
|
|
What is the VERY FIRST thing you want to check for in a pre-menopausal woman presenting with abnormal uterine bleeding?
|
Rule out pregnancy.
|
|
|
What is the VERY FIRST thing you want to check for in a pre-menopausal woman presenting with abnormal uterine bleeding?
|
Rule out pregnancy.
|
|
|
While acute endometritis is rare - what is a common etiology of this problem?
|
Result of bacterial infection following delivery/miscarriage.
|
|
|
While acute endometritis is rare - what is a common etiology of this problem?
|
Result of bacterial infection following delivery/miscarriage.
|
|
|
What is the treatment of acute endometritis?
|
Curettage and antibiotics.
|
|
|
What is the treatment of acute endometritis?
|
Curettage and antibiotics.
|
|
|
What are four causes of chronic endometritis?
|
1. PID
2. IUD 3. Retained post-partum products 4. TB [rare] |
|
|
What are four causes of chronic endometritis?
|
1. PID
2. IUD 3. Retained post-partum products 4. TB [rare] |
|
|
What is the histologic indication of chronic endometritis?
What is the treatment? |
Plasma cell infiltrate
Antibiotics [Chlamydia is usually organism of insult] |
|
|
What is the histologic indication of chronic endometritis?
What is the treatment? |
Plasma cell infiltrate
Antibiotics [Chlamydia is usually organism of insult] |
|
|
What is adenomyosis?
|
Growth of glands into the myometrium [gives uterus a globoid appearance]
|
|
|
What is adenomyosis?
|
Growth of glands into the myometrium [gives uterus a globoid appearance]
|
|
|
Treatment of breast cancer with ______ leads to increased incidence of _______ which may develop into _________.
|
Tamoxifen
Endometrial polyps Adenocarcinomas [d/t estrogenic effect on uterus] |
|
|
Treatment of breast cancer with ______ leads to increased incidence of _______ which may develop into _________.
|
Tamoxifen
Endometrial polyps Adenocarcinomas [d/t estrogenic effect on uterus] |
|
|
What is the etiology of endometrial hyperplasia?
And thus what is the recommended treatment? |
Prolonged estrogen therapy
Progestin [high dose or cyclic] OR hysterectomy |
|
|
What is a common genetic alteration associated with endometrial hyperplasia?
|
PTEN
|
|
|
What is a common genetic alteration associated with serous endometrial carcinoma?
|
p53
|
|
|
(T/F) Type II endometrial carcinoma has a better prognosis because it is not related to elevated estrogen levels.
|
False - it isn't related to estrogen BUT has a worse prognosis.
|
|
|
Complex atypical hyperplasia is associated with what type of risk for endometrial carcinoma?
|
25-50%
|
|
|
How do you differentiate between complex and simple endometrial hyperplasia?
|
Glands are simple/tubular in simple hyperplasia
In complex hyperplasia - they are more branched |
|
|
What are the four risk factors for endometrial carcinoma?
|
1. Infertility
2. Diabetes mellitus 3. Obesity 4. Hypertension |
|
|
The most common invasive carcinoma of the female reproductive tract is...
|
Endometrial cancer
|
|
|
Type I endocarcinomas are the most common type of endometrial cancers and histologically typically shows...
|
Endometrioid types
|
|
|
While a variety of types of cells can develop in endometrail cancer [based on tissue of origin] what are the three main histologic indications of endometrial cancer?
|
1. Confluent glands
2. Excessive intrapapillary growth 3. Desmoplastic response |
|
|
(T/F) Endometrial cancers are common in women < 40 years of age.
|
False - most common in post-menopausal women.
|
|
|
What defines a malignant mixed mullerian tumor?
|
Both eptihelial and mesenchymal components in histology
VERY AGGRESSIVE. |
|
|
What is the most common uterine tumor?
|
Leiomyoma [uterine fibroid]
|
|
|
What do uterine fibroids typically show on histology?
|
Spindled cells with oval nucleus [resembles normal myometrium but more numerous]
|
|
|
Uterine carcinomas tend to spread _______ while leiomyosarcomas tend to spread _______.
|
Lymphatic
Hematogenous |
|
|
What is the difference between an ovarian cyst and a follicle?
|
Follicle is < 2 cm
Cyst is > 2 cm |
|
|
What is PCOS (Stein-Leventhal syndrome)?
|
Bilateral cysts on the ovaries
|
|
|
What is the histology of the ovarian cysts in PCOS?
|
Thickened cortex and hyperthecosis [too many theca cells = root of the problems]
|
|
|
Define And Defend (Including Scripture Proofs) The "Inerrancy" Of Scripture.
|
The Bible, in all that it teaches, is free from error. Where it speaks to history it is true, but it doesn't speak to everything. The inerrancy of scripture flows out of its inspiration; God-inspired writings contain no errors.
|
|
|
What is endometriosis? Where does it commonly manifest?
|
Growth of endometrial glands/stroma outside of the uterus
[metaplastic/metastatic are two theories] Ovaries |
|
|
What are the typical clinical symptoms of a woman with endometriosis?
|
Infertility, cyclic pain with menstruation [even on OCP use], hematochezia, pelvic pain, hematuria
|
|
|
"Chocolate cysts"
|
Endometriosis
[chocolate = denatured blood] |
|
|
(T/F) Majority of ovarian tumors are malignant.
|
False [80% are benign]
Older women are more likely to have malignant ovarian tumors. |
|
|
Endometrial cancers are more infiltrative but ovarian cancers tend to ______ more patients.
|
kill
|
|
|
What is the typical clinical presentation of a young woman with an ovarian tumor?
|
Bloating/inability to lose weight despite diet and exercise --> d/t ascites/edema and peritoneal involvement
|
|
|
(T/F) Nulliparity is a risk factor for ovarian cancer.
|
True.
|
|
|
What are the most common extra-mullerian cancers to metastasize to the ovaries?
|
Colon
Breast Krukenberg stomach tumor [bilateral] |
|
|
What are the most common cancers to metastasize to the ovaries?
|
Mullerian duct cancers
|
|
|
What are the four types of ovarian cancers?
|
Surface epithelium
Germinal epithelium Ovarian stroma Metastases |
|
|
What are the 3 major epithelial subtypes of surface epithelium ovarian tumors?
|
1. Endometrioid [resembles uterus]
2. Serous [resembles ovaries] 3. Mucinous [resembles cervix] |
|
|
(T/F) The more solid a cyst appears the more likely it is to be malignant.
|
True [benign ovarian tumors are typically very cystic]
|
|
|
What are surface epithelial inclusion cysts?
|
Preliminary lesions to the surface-epithelium stromal tumor.
|
|
|
Most common histology seen in:
Ovarian cancer Endometrial cancer Cervical cancer |
Serous
Endometrioid Squamous |
|
|
Psammoma bodies can be seen in what type of cancer?
|
Serous adenocarcinoma [typically older women]
|
|
|
What is a dermoid?
|
Ovarian germ cell tumor with mature components [hair/sebaceous material]
|
|
|
How does an immature teratoma differ from a mature teratome?
|
Significant solid component, immature/fetal appearing tissue [the more immature = worse prognosis]
|
|
|
How is a mature vs. an immature teratoma treated?
|
Mature = resection
Immature = chemotherapy |
|
|
What is struma ovarii?
|
Growth of monodermal tissue in the ovary that produces thyroid tissue.
|
|
|
Semina:male::_______:female
|
Dysgerminoma [VERY rare in female]
|
|
|
Endometrial hyperplasia + ovarian tumor makes you think the tumor is what type?
|
Sex cord tumor [feminizing -- with secretion of estrogen from granulosa cells]
|
|
|
Cell-exner bodies
|
Seen in adult variant of sex cord ovarian tumor
Gland like with central lumen with pink secretions |
|
|
Juvenile subtype of ovarian sex cord tumors tend to recur ever ....
|
3 yrs
adult variant has a better prognosis [10-20 yrs recurrence] |
|
|
Histologically, ovarian fibromas resemble...
|
Leiomyomas of the uterus
[spindled cells] |
|
|
What is Meig's syndrome?
|
Ovarian fibroma on the right side that causes a hydrothorax
|
|
|
What is the Basal Nevus syndrome?
|
Inherited, autosomal dominant syndrome
Ovarian fibroma + multiple basal carcinomas of the skin |
|
|
If you see bilateral tumors in the ovary [or feel two adnexal masses] and r/o PCOS - what should you be thinking?
|
Serous adenocarcinoma [if older woman]
Krukenberg tumor met. [if younger] |
|
|
What are the two phases of sperm transport?
|
Rapid phase [immediately to the oviduct in 20 minutes]
Delayed phase [several hours later] - sperm was stored in cervical crypts |
|
|
Functional lifespan of:
Oocyte Sperm |
~24 hrs
1-2 days |
|
|
Sperm detect ____ on the zona pellucida and attach which then stimulates the _____ reaction which causes a breakdown of the ZP, the ____ ____ then occurs to prevent _________ and finally _____ occurs.
|
ZP3 receptors; acrosomal
zona reaction; polyspermia syngamy |
|
|
What is the difference between ICSI and IVF?
|
ICSI [intra-cytoplasmic sperm injection] is utilized if the sperm cannot fertilize the egg in the petri dish [IVF].
|
|
|
At what stage is the embryo when implantation occurs?
|
7-8 days post ovulation --> blastocyst
|
|
|
Where does fertilization occur?
|
Distal end of the oviduct [it travels towards the uterus in the next couple of days]
|
|
|
What is hatching?
|
Embryo escapes from the zona pellucida [required for implantation]
|
|
|
What are the three components of the decidual reaction? And what triggers it?
|
1. Dilation of blood vessels
2. Increased capillary permeability 3. Proliferation of glandular/epithelial cells Response to attaching blastocyst [mediated by progesterone] |
|
|
What are the three functions of trophoblasts?
|
1. Nutrition
2. Makes hCG 3. Becomes placenta [fetal portion] |
|
|
The "inner cell mass" of a blastocyst or the embryoblast has three functions...
|
1. Becomes embryo
2. Gives rise to amnion 3. Source of stem cells |
|
|
(T/F) Maternal/fetal blood mixes and that is how nutrition is relayed.
|
False - chorionic villi SIT in maternal blood and diffusion occurs.
|
|
|
(T/F) The blood-placental barrier is static throughout pregnancy.
|
False - dynamic. The substances allowed to pass through change.
[steroids can get in] |
|
|
The maternal component of the placenta is called the _________; the fetal component of the placenta is called the _______.
|
Decidua basalis
Chorionic plate |
|
|
The chorionic villi is composed of two types of cells...
|
1. Syncytiotrophoblasts
2. Cytotrophoblasts |
|
|
What is the function of cytotrophoblasts?
|
GnRH production
|
|
|
What is the function of syncytiotrophoblasts [5 secretory hormones]
|
Estrogen
Progesterone hcG hPL [human placental lactogen] relaxin |
|
|
What are Hofbauer cells?
|
Resident macrophages in the chorionic villi
|
|
|
If you see identical twins - what do you know about their fertilization/placenta?
|
Only one egg fertilized [they both HAVE to be the same gender] and shared the same placenta
[unless division occurs in morula stage] |
|
|
If you see fraternal twins - what do you know about their fertilization/placenta?
|
Two eggs fertilized - two separate placenta.
|
|
|
Cleavage at morula stage...
|
Dichorionic/diamniotic
|
|
|
Cleavage blastocyst stage...
|
Monochorionic/diamniotic
|
|
|
Cleavage of implanted blastocyst...
|
Monochorionic/monoamniotic
|
|
|
Cleavage of formed embryonic disc...
|
Conjoined twins
|
|
|
What is the twin-twin transfusion syndrome?
|
Monochorionic/diamniotic -- one baby takes more nutrition the other baby produces less amniotic fluid/reduced blood vessels.
|
|
|
hCG function in pregnancy
|
maintains corpus luteum and progesterone secretion
|
|
|
progesterone function in pregnancy
|
1. maintains decidua
2. promotes glandular secretions 3. prevents maternal immune attack on fetal antigens 4. reduces contractions |
|
|
estrogen function in pregnancy
|
proliferation of endometrium
|
|
|
prolactin function in pregnancy
|
development of mammary glands [surges up as soon as baby is born [b/c placenta removed, thus no estrogen/progesterone to inhibit prolactin]]
|
|
|
hPL [human placental lactogen] function in pregnancy
|
shifts energy utilization from glucose to fat
|
|
|
relaxin function in pregnancy
|
loosens pelvic bones and ligaments
|
|
|
The placenta cannot make _______ and _______.
The fetus cannot make _______. The mother mainly provides _____. |
androgens nor cholesterol
progesterone cholesterol |
|
|
What can be tested to check the integrity of the maternal/placental/fetal unit?
|
Estriol
|
|
|
Hormone produced in large quantities unique to pregnancy [aside from hCG]
|
Estriol
|
|
|
Hormone derived from the peripheral conversion of androgens [female]
|
Estrone
|
|
|
Most abundant/potent estrogen in the female body
|
Estradiol
|
|
|
What is the mechanism of action of gestational diabetes?
|
hPL/prolactin/GH antagonize insulin
insulin resistance increases maternal glucose increases fetal glucose increases stimulates fetal insulin production increased growth *[fetal insulin not important for glucose homeostasis, mainly maternal] |
|
|
What are the 5 hormones required for parturition?
|
Progesterone
Estrogen Relaxin Prostaglandins Oxytocin |
|
|
Which prostaglandins are implicated in parturition?
|
PG-E2, PGF-a2
|
|
|
(T/F) Drop in progesterone level initiates parturition.
|
False - ratio of E/P or increased estrogen causes increased oxytocin receptors and PG production.
[NOT JUST PROGESTERONE] |
|
|
What is the role of estrogen in parturition?
|
Maintains progesterone receptors
|
|
|
What are Braxton-hicks contractions?
|
Contracts before labor begins [prepares uterus] -- NOT true labor.
|
|
|
When is basal prolactin the highest in a mother?
|
Right after gestation
Surges afterwards are due to suckling reflex |
|
|
Continued lactogenesis relies on...
|
Milk formation and REMOVAL required for lactogenesis to continue
|
|
|
What is colostrum?
|
Initial milk formed after parturition [provides passive immunity]
|
|
|
Milk ejection is mediated by...
|
Oxytocin [stimulates myoepithelial cells]
|
|
|
The magnitude of prolactin response is dependent on...
[suckling reflex] |
1. Length of suckling
2. Intensity of suckling |
|
|
How is oxytocin stimulated to release to help milk "let down"?
|
Neural sensory receptors pick up on suckling sensation -- stimulate posterior pituitary to synthesize more oxytocin to release.
|
|
|
Why is breastfeeding a natural birth control?
|
Suckling reflex inhibits GnRH which then reduces FSH/LH levels [no ovulation]
|
|
|
How is prolactin secretion increased during breastfeeding?
|
Suckling reflex inhibits dopamine and increases prolactin releasing factor.
|
|
|
What are the three main epidemiologic reasons for the decrease in trend of abortions?
|
1. Better long-term contraceptives
2. Emergency contraception approval 3. Decreased teen pregnancy rates |
|
|
(T/F) Majority of abortions are completed during the 2nd trimester.
|
False - 1st trimester
|
|
|
What are the abortion options in the first trimester?
|
Dilitation and curettage
Medical abortion |
|
|
What is the process of dilitation and curettage?
|
1. Mifepristone/misoprostol/laminaria are used to dilate the pelvis
2. Curettage 3. F/u antibiotics |
|
|
What is the process of a medical abortion?
|
Administer mifepristone [RU486]
Home administration of misoprostol Office f/u |
|
|
(T/F) Medical abortions carry a lower risk compared to surgical options.
|
False - medical abortions have a higher risk [N/V and bleeding] and also has a lower success rate.
|
|
|
What is the range of gestational age allowed for second trimester abortions?
|
14-24 weeks
|
|
|
What are the abortion options in the 2nd trimester?
|
1. Dilitation and evacuation
2. Induction of labor |
|
|
Up to 20 weeks, which is the better option for 2nd trimester abortion?
|
D&E is safer choice
between 20-24 weeks both labor induction and D&E are equal options |
|
|
What is the most common complication of 2nd trimester abortion associated with labor induction?
|
Retention of placenta
|
|
|
What side effects are important to counsel women in when discussing IUDs?
|
Copper increases bleeding
Levonorgestrel reduces bleeding [these are common reasons for stopping IUD contraception] |
|
|
What are the contraindications to IUD use? [5]
|
1. Abnormal uterus structure
2. Bleeding disorders [copper IUD] 3. Wilson's disease [copper IUD] 4. Non-monogamous 5. Pelvic infxn or recent STD |
|
|
What are the three contraindications for a vasectomy?
|
1. Abnormal scrotum
2. Varicocele 3. Infection |
|
|
What four things increase the likelihood of complications from a tubal ligation?
|
1. Obesity
2. Past abdominal surgery 3. Diabetes 4. General anesthesia |
|
|
(T/F) Transcervical sterilizations are irreversible procedures.
|
True
|
|
|
How is early/late failure defined in vasectomies?
|
Early failure -- first 4 months with persistent sperm
Late failure - reappearance of sperm |
|
|
What are the three complications of vasectomies?
|
1. Painful sperm granuloma [self-limiting]
2. Infection 3. Epididymitis |
|
|
(T/F) Prostate and testicular cancer rates are higher in vasectomized populations.
|
False.
|
|
|
(T/F) Reversal of tubal ligations can restore ability to get pregnant with no additional risks.
|
False - increased risk of ectopic pregnancies.
|
|
|
(T/F) Tubal ligation has no change in risk for ovarian and breast cancer.
|
False - reduces risk of ovarian cancer, no change in breast.
|
|
|
List the options for progesterone-only contraceptives
|
Depo-provera
Implanon [implantable] Progestin-only pills |
|
|
What are the four bad side effects of depo-provera use?
|
1. Headaches
2. Weight gain 3. Reversible bone loss 4. Delay in conception [~9 months] |
|
|
What are the two main benefits of DepoProvera use?
|
1. Can be used in lactation
2. Reduces endometrial cancer risk |
|
|
What is the main side effect of progestin-only use contraception?
|
Irregular bleeding
|
|
|
What is the hormone in progestin-only pills?
|
Norethindrone
|
|
|
When prescribing progestin-only pills - what is important to counsel the patient on?
|
Take it at the SAME time
If you miss your window by >3 hrs [use a backup] |
|
|
When counseling a patient on use of the vaginal ring - what is important to emphasize?
|
If removed for >3 hrs then you need a back-up
|
|
|
How are vaginal rings used?
|
3 weeks in the body - 1 week out[menstruate]
|
|
|
(T/F) Progestin-only pills are as effective as combined OCPs.
|
False - less effective.
|
|
|
What is a major advantage of using the patch as a contraceptive method?
|
Does not have increased risk of DVT [but still contains both estrogen/progestin]
|
|
|
What is the estimated efficacy of barrier method contraception?
|
>10% in use failure rate
[moderately effective 81-90%] |
|
|
What is the efficacy for Plan B?
|
75% of expected pregnancies prevented
window of opportunity - within 120 hrs [sooner the better] PURE progesterone [levonorgestrel] |
|
|
When do the gonads fully develop?
|
20 weeks
|
|
|
Mullerian ducts
Wolffian ducts |
female; paramesonephric duct
male; mesonephric duct |
|
|
The Wolffian ducts become...
|
Prostate
Epididymis Vas deferens |
|
|
Urogenital sinus becomes...
|
Prostate
Vagina [lower 1/3] |
|
|
Genital tubercle becomes...
|
Glans penis
Clitoris |
|
|
Genital swelling becomes...
|
Scrotum
Labia majora |
|
|
Urethral genital folds...
|
Labia minora
Body of penis |
|
|
When do the gonads begin to sexually differentiate?
|
At ~ 5 weeks
|
|
|
Which cells secrete anti-mullerian hormone [or mullerian inhibiting factor]?
|
Sertoli cells
|
|
|
What on the Y chromosome allows the differentiation of male gonads?
|
SRY [sex determining region of Y] produces TDF [testis determining factor] which initiates differentiation of primary sex cords.
|
|
|
Why does 5-alpha reductase deficiency not lead to lack of gonadal development if DHT is not formed?
|
DHT is critical for EXTERNAL genitalia
testosterone drives gonadal development [stimulates Wolffian duct systems] |
|
|
(T/F) Estradiol is critical for Mullerian duct formation and external genitalia.
|
False - absence of DHT is more important.
|
|
|
When is the external genitalia distinguishable in a developing fetus?
|
~12 weeks.
|
|
|
What is the pathophysiology of CAH?
|
P450 - c21 and c11 deficiency leads to deficient cortisol production
Increased ACTH production -- thus promotes adrenal androgen production leads to virilism |
|
|
What drug leads to masculinization of the female fetus?
What drug leads to the feminization of the male fetus? [thus you don't prescribe it to pregger ladies] |
Anabolic steroids
Finasteride |
|
|
What is true hermaphrodism?
|
Contains both types of gonads.
|
|
|
Normal appearing woman with a blind-pouch vagina, what are you thinking...
|
Androgen Insensitivity Syndrome
|
|
|
How does CAH differ in presentation between men and women?
|
Men - early puberty/normal
Women - normal internal structures but ambiguous genitalia [both caused by excess adrenal androgens] |
|
|
What are the two major stages of fetal development?
|
Embryo [1st 8 weeks]
Fetus [8 wks to term] |
|
|
At what point is the baby least susceptible to teratogens?
Most susceptible? |
after 13 weeks
first 8 weeks [during organogenesis] |
|
|
What is the order of hematopoiesis in a developing fetus?
|
Mesoblastic period [yolk sac]
-- 0-8 wks Hepatic period [liver] -- 8-30 wks Myeloid period [bone marrow] -- 30 wks to term |
|
|
What two organs receive the most blood supply from fetal cardiac output?
|
Placenta
Brain |
|
|
Describe the changes in HbF:HbA ratio in a fetus.
|
shifts from 100% to 70% between 26-40 weeks
so baby is born with 30% HbA |
|
|
What is the difference between HbF and HbA?
|
HbF has higher affinity for O2 and lower affinity for 2,3-DPG
[2 alpha chains, 2 gamma chains] |
|
|
What are the two most common congenital malformations?
|
1. Congenital heart disease
2. Neural tube defects |
|
|
When does TG synthesis begin in the fetus?
|
4 weeks [thyroid gland is first gland to develop]
|
|
|
When does iodine trapping in the fetal thyroid begin?
|
8-10 weeks
|
|
|
While TSH/T3/T4 synthesis is detected at ____ weeks, fetal thyroid function is low until _______ weeks.
|
12 weeks
20 weeks |
|
|
(T/F) TSH cannot cross the placenta.
|
True - mother supplies thyroid hormone directly to baby.
|
|
|
What is important [aside from family history/medical history] to acquire from a pregnant woman?
|
Exposure to teratogens -- EtOH, nicotine, teratogens, folate deficiency.
|
|
|
What are the three components of pregnancy screenings?
|
1. Determining AMA
2. 1st trimester screening [11-14 wks] 3. 2nd trimester screenings [15-20 wks] |
|
|
If a woman does not want any invasive screening measures - what would you still conduct as a screening process?
|
11 wk and 17 wk ultrasound of baby [assess for Downs]
|
|
|
What are you checking for in the 1st trimester maternal serum screen?
|
Elevated beta-hCG
Decreased PAPP-A |
|
|
Serum abnormalities in NTD?
|
Elevated AFP
|
|
|
Serum abnormalities in Trisomy 21?
|
Decreased AFP, uE3
Increased hCG, inhibin A |
|
|
Serum abnormalities in Trisomey 18?
|
Decreased AFP, uE3, hCG
|
|
|
When is the earliest you can conduct a CVS? and what are the risks?
|
10-12 weeks [1st trimester]
1/100 risk of miscarriage |
|
|
When is the earliest you can conduct an amniocentesis? and what are the risks?
|
15 wks earliest [2nd trimester]
1/200-300 risk of miscarriage |
|
|
What is the most common reason for a false positive on a maternal serum check?
|
Wrong gestation age.
|
|
|
List the following in order of frequency:
Patau's Downs Edward's NTD Turner's |
Downs
NTD Turner's Edward's Patau's |
|
|
Most common genetic abnormality in miscarriages
|
Turner's syndrome
|
|
|
Most common aneuploid condition
|
Trisomy 21 [Downs]
|
|
|
Single, transverse palrmar crease
Low-set ears Short long bones Congenital heart defect Distinct facial features |
Downs
|
|
|
Congenital heart defect
GU abnormalities Craniofacial abnormalities Renal disease "rocker bottom" feet |
Patau
|
|
|
Congenital heart defect
"rocker bottom" feet Prominent occiput Clenched fists Low-set ears |
Edward's
|
|
|
(T/F) Majority of children with Edward's syndrome that survive the first year of life are female.
|
True.
|
|
|
What is the recurrence risk for a multifactorial inheritance like NTD?
|
3-5% risk of recurrence
|
|
|
What is the carrier rate for Cystic Fibrosis among Caucasian/Ashkenazi Jew populations?
|
1/25
|
|
|
Name the etiology of increased cardiac output in pregnant women?
|
Increased stroke volume [early]
Increased heart beat [later] |
|
|
When is blood pressure lowest in a pregnant woman?
|
When she is lying on her left side [pressure away from vena cava return]
|
|
|
(T/F) It is normal for a pregnant woman to have upper and lower body edema.
|
False - just lower. upper = pathological
|
|
|
What are the 4 EKG changes that are benign in a pregnant woman?
|
1. 15 degree LAD
2. ST depression 3. unifocal PVC's 4. Supraventricular tachycardias |
|
|
What heart sounds are normal to hear in a pregnant woman?
|
S3 gallop + systolic ejection murmur
|
|
|
What causes the elevation in BP during labor?
|
Each contraction sends increased amounts of blood away from the uterus to the body [blood loss reduces this increase in blood pressure]
|
|
|
(T/F) Plasma volume increases are greater with multiple gestation and macrosomic infants.
|
True.
|
|
|
(T/F) The iron demand of a pregnant woman is mainly for increased fetal demands.
|
False - for increased RBC production in maternal [mother's demands!!!]
|
|
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Why does physiologic anemia occur in pregnant women?
|
Increase in plasma volume is greater than increase in RBC production [relative]
|
|
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(T/F) The fetus will become anemic before the mother does.
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False - iron [ferrous state] is actively transported to the fetus - so mother will be anemic first.
|
|
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What is the best indicator for anemia in a pregnant woman?
|
Total serum ferritin should stay WNL
[TIBC increase d/t estrogen] |
|
|
Name 3 conditions that increase the folate requirements of a pregnant woman [moreso than normal]?
|
1. Multiple gestation
2. Taking phenytoin 3. Hemoglobinopathies |
|
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(T/F) Both Vitamin B12 and Fe are passively transported across the placenta.
|
False - actively.
|
|
|
List the 4 hematologic profile changes in a pregnant woman? [if a CBC was done]
|
1. Increased WBCs
2. Decreased platelets 3. Increased ESR 4. Increased ability to neutralize heparin [so more would be required than usual] |
|
|
List the change that occurs to the following during pregnancy:
Vital capacity Tidal volume Residual volume |
Unchanged
Increased Decreased [mechanical compression from fetus] |
|
|
What is labor?
|
Contractions of increasing intensity and frequency that lead to effacement/dilatation of cervix
|
|
|
What are the 5 indications of true labor? [to distinguish from false labor]
|
Increasing intensity
Increasing frequency Associated with back AND ab pain Not relieved by sedation Progressive dilatation |
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First stage of labor
|
Uterine contractions leading to dilatation and effacement
|
|
|
Second stage of labor
|
From effacement to birth of baby
|
|
|
Third stage of labor
|
Birth of baby to delivery of placenta
|
|
|
List the 7 cardinal movements of birth in order...
|
1. Engagement
2. Descent 3. Flexion 4. Internal Rotation 5. Extension 6. External rotation 7. Expulsion |
|
|
What are the two diameters typically considered on the fetal head...
|
Biparietal diameter [transverse plane]
Suboccipitobregmental [diameter when head is flexed] |
|
|
Which pelvis shape are most women? most men?
|
Gynecoid
Android |
|
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Why do African American women often deliver their babies face up?
|
Anthropoid pelvis -- more anterior room - babies come out face up [least resistance].
|
|
|
What is the major disadvantage of the midline episiotomy?
|
Extension through anal sphincter possible leading to exposure of rectal contents --> increased infection.
|
|
|
How is uterine hemostasis achieved?
|
Oxytocin leads to intense vasoconstriction produced by the myometrium which helps decrease blood loss.
|
|
|
What are the two external signs that the placenta has separated from the uterus?
|
1. Gush of blood
2. Umbilical cord protrudes farther out of the vagina |
|
|
How can hypotonic uterine contractions be treated?
|
Intervals are regular but not strong enough - administer pitocin [oxytocin]
|
|
|
How can hypertonic uterine contractions be treated?
|
Too strong and do not lead to coordinated effacements -- give a sedative [demerol].
|
|
|
What is the difference between the latent and active phase of the first stage of labor?
|
Latent -- effacement/dilatation is occurring but contractions may be irregular
Active -- progressive cervical dilation [clinically apparent] |
|
|
What are two advantages of completing an amniotomy?
|
1. Helps shorten length of labor
2. Can observe for meconium [assess fetal status] |
|
|
Name the structure that is sequentially perforated in the following lacerations:
First-degree Second degree Third Fourth |
Mucosa/fascia
Muscles Anal sphincter Rectal mucosa |
|
|
(T/F) Hemorrhage is the most common cause of death during pregnancy.
|
True.
|
|
|
49% of maternal deaths rise from..
|
1. Hemorrhage
2. Hypertension 3. Infection |
|
|
What is the main distinction between abruptio placenta and placenta previa?
|
Abruptio = painful vaginal bleeding/tenderness
Placenta previa = painless vaginal bleeding |
|
|
What is placenta accreta?
|
When the placenta implants deep into the myometrium [and thus cannot separate properly]
|
|
|
What are four possible etiologies of placenta previa?
|
1. Multiparity
2. Advancing age 3. Large placenta 4. Defective vascularization of decidua |
|
|
What is your first diagnostic approach to vaginal bleeding in a pregnant woman?
|
Ultrasound and determine source of bleeding
NO PELVIC EXAM |
|
|
What is HELLP syndrome?
|
Hemolytic anemia
Elevated liver enzymes Lowered platelets Variant of pre-eclampsia |
|
|
What is the difference between pre-eclampsia + eclampsia?
|
Eclampsia = pre-eclampsia + convulsions
|
|
|
What are the 7 risk factors for PIH?
|
1. Nulliparity
2. Family hx 3. Vascular disease 4. Obesity 5. Multi-fetal gestation 6. Previous pregnancy pre-eclampsia 7. Previous complicated pregnancy |
|
|
What distinguishes mild pre-eclampsia from severe pre-eclampsia?
|
BP surpasses 160/110
Microalbuminuria --> severe proteinuria Onset of maternal symptoms Elevated liver enzymes |
|
|
What are four post-abortal complications of pregnancy?
|
1. Retained placenta
2. Uterine perforation 3. Cervical laceration 4. Vaginal laceration |
|
|
What are the main causes of spontaneous abortion [loss before 20 wks gestation]?
|
1. Maternal - inflammation or uterine abnormality
2. Fetal - genetic/acquired abnormality, implantation abnormality |
|
|
What is the most important predisposing condition to ectopic pregnancy?
|
PID with chronic salpingitis
|
|
|
Most common location of ectopic pregnancy
|
Fallopian tubes
|
|
|
What are three complications discussed with multi-gestation
|
1. Twin-twin transfusion syndrome
2. Babies entangled [monochorionic/monoamniotic] 3. Fetus papyraceous |
|
|
Hematogenous spread of infection to placenta - what are the typical organisms?
|
Toxoplasma
Rubella Cytomegalovirus Herpes |
|
|
What is funisitis?
|
Inflammation/infection of umbilical cord
|
|
|
What is the only definitive treatment of eclampsia?
|
Delivery of the baby
|
|
|
Pathophysiology of partial mole
|
2 sperm implant an egg to create triploid
Or sperm duplicates and implants egg |
|
|
Pathophysiology of a complete mole
|
sperm duplicates and implants EMPTY egg to create diploid
two sperm implant empty egg |
|
|
(T/F) Partial moles are more likely to become choriocarcinomas.
|
False - complete moles.
|
|
|
What is pathologically [microscope/gross] different between complete and partial mole?
|
Complete = grape clusters + large uterus + edematous villi
Partial = small uterus + edematous/fibrotic villi |
|
|
(T/F) Gestational choriocarcinoma has a poor prognosis.
|
False - 100% remission with chemotherapy
|
|
|
Patients with gestational choriocarcinoma typically present with what history?
|
F/u lung/CNS metastases after pregnancy/abortion with vaginal bleeding
|
|
|
What is Placental Site Trophoblastic tumor?
|
Polyploid tumor localized to the uterine myometrium that is composed of intermediate trophoblasts.
|
|
|
Polydactyly is an example of a....
|
malformation
|
|
|
Smoking as a teratogen is an example of a....
|
disruption
|
|
|
Hepatomegaly inducing fetal deformities due to mechanical forces...
|
deformation
|
|
|
Potter's is an example of a...
|
sequence
|
|
|
Chromosomal abnormalities are an example of a....
|
syndrome
|
|
|
What are the four things a Downs child has an increased risk/co-morbidity for...
|
1. Endocardial cushion defects
2. ALL 3. Alzheimer's/dementia 4. Abnormal immune response |
|
|
(T/F) Amnion rupture sequence is the most common cause of intrauterine fetal demise and has a high recurrence risk.
|
False - most common cause but is not likely to recur.
|
|
|
Cervical cystic hygroma - what should you think of...
|
Turner's syndrome
|
|
|
How do you distinguish between an omphalocele and a gastrochisis?
|
Gastrochisis = paraumbilical
Omphalocele = through umbilicus |
|
|
What are the 3 major causes of non-immune hydrops fatalis?
|
1. Fetal anemia
2. Chromosomal abnormalities 3. Cardiovascular defects |
|
|
What is the major immune-related cause of hydrops fatalis?
|
ABO incompatibility
|
|
|
What is pterygia?
|
Soft tissue growth over the iris
|
|
|
What is the most serious problem associated with hydrops fatalis?
|
Kernicterus -- unconjugated bilirubin in the brain.
|
|
|
What is the most common cause of death in infants?
|
Congenital malformations/deformations/chromosomal abnormalities
|
|
|
What is the cut-off for "pre-term"?
|
<38 weeks
|
|
|
What are the 4 major risk factors for pre-term births?
|
1. Premature pre-term amniotic rupture
2. Multiple gestations 3. Structural abnormalities 4. Intrauterine infections |
|
|
What are the 3 most common risk factors for PPROM?
|
1. Maternal smoking
2. Prior hx of pre-term 3. Vaginal bleeding during pregnancy |
|
|
How can you distinguish between fetal and placental factors affecting growth of fetus?
|
1. Fetal - symmetric
2. Placental - asymmetric [normal head, small body] |
|
|
Which factor is most common in producing SGA infants?
|
Maternal factors [toxins, malnutrition, toxemia]
|
|
|
What is the most common injury to LGA births?
|
Clavicular fracture
|
|
|
What is the most common 'concerning' injury in a birth?
|
Intracranial hemorrhage
|
|
|
What is caput succedaneum?
|
Cone head from deformation through birth canal - regresses.
|
|
|
What are the top three birth defects in the US?
|
1. Downs
2. Cleft lip 3. Cleft palate |
|
|
Early onset of sepsis in a neonate...what do you think the etiology is...
|
E. Coli or GBS
|
|
|
Sepsis in an infant between 7 days and 3 months...what do you think the etiology is...
|
Listeria or Candida
|
|
|
Describe the mechanism of RDS
|
pre-term --> low surfactant --> lungs don't get O2 --> hypoxia --> acidosis --> reduces surfactant more [cycle repeats]
|
|
|
RDS in the newborn is strongly associated with what 3 factors?
|
1. Male
2. Maternal diabetes 3. C-section |
|
|
What are the 3 associated complications of RDS?
|
1. Necrotizing enterocolitis
2. PDA 3. Intraventricular hemorrhage |
|
|
(T/F) 90% of SIDS occur in the first 6 months of life.
|
True, although the definition extends for all infancy.
|
|
|
CF, Galactosemia, and PKU are inherited...
|
autosomal recessive
|
|
|
CF patients typically die from...
|
Obstructive pulmonary disease w/infection [Staph or Pseudomonas]
|
|
|
What is the abnormality in cystic fibrosis?
|
CFTR gene on chromosome 7
defective chloride channel protein |
|
|
(T/F) Galactosemia cannot be prevented, and progresses to death.
|
False - diet for at least first 2 years of life prevents progression.
|
|
|
Most common benign tumor of infancy...
|
Hemangioma
|
|
|
What are the 6 types of birth trauma injuries possible?
|
1. Clavicular fracture
2. Facial nerve injury 3. Brachial plexus injury 4. Lacerations 5. Intracranial injury 6. Humeral fracture |
|
|
What is your differential diagnosis for "Small Round Blue" cell tumors in children
|
1. Neuroblastoma
2. Medulloblastoma 3. Rhabdomyosarcoma 4. Ewing's 5. Burkitt's lymphoma 6. Wilms 7. Retinoblastoma |
|
|
Genetic marker in neuroblastoma
|
N-myc amplification [1, 17, or 11]
|
|
|
Genetic marker in embryonal rhabdomyosarcoma
|
t(2, 13)
|
|
|
Genetic marker in Burkitt's
|
t(8;14)
|
|
|
Genetic marker in Ewing's sarcoma/PNET
|
t(11;22)
|
|
|
Genetic marker in Wilms
|
11p13 deletion/mutation
|
|
|
Clinical presentation of neuroblastoma
|
Infant with fever, weight loss, large abdominal mass and calcifications on x-ray
|
|
|
Clinical presentation of Wilms
|
Renal mass [abdominal] or in the context of other disorders -- WAGR, Denys-Drasch, and Beckwith-Weidemann
|
|
|
Most common extracranial solid malignancy of childhood
|
Neuroblastoma
|
|
|
Most common primary renal tumor in childhood
|
Nephroblastoma [Wilms]
|
|
|
(T/F) Adrenal gland location of neuroblastomas are better prognosis.
|
False - worse.
|
|
|
(T/F) Diagnosis at <18 months and lack of N-myc amplification with DNA hyperdiploid/tetraploid are good prognostic indicators for neuroblastoma.
|
True.
[opposite is unfavorable] |
|
|
Which of the following has the highest likelihood of exhibiting Wilms tumor?
WAGR Denys-Drash Beckwith-Wiedemann |
Denys-Drash
[also has gonadal dysgenesis!] |
|
|
Prognosis in Wilms is typically good unless what is present?
|
Anaplastic cells indicate poor response to chemotherapy
|
|
|
What is the precursor lesion to Wilms?
|
Nephroblastomatosis -- multicentric or diffuse nephrogenic elements.
|
|
|
RPR/VRDL are examples of...
|
non-treponemal antigen tests
|
|
|
(T/F) Treponemal antibody tests usually positive for life.
|
True.
|
|
|
Treatment for syphilis
|
Penicillin
|
|
|
Reiter's syndrome consists of...
|
Eye lesions
Genital lesions Joint disease |
|
|
What does "HAIR AN" stand for in regards to PCOS?
|
Hirsutism
Anovulation Insulin resistance Acanthosis nigricans |
|
|
PCOS is defined as the presence of two of the following three..
|
1. Polycystic ovaries
2. Hyperandrogenism 3. Oligo- or anovulation |
|
|
Give five causes of functional hypothalamic amenorrhea [reduced FSH]
|
1. Exercise
2. Stress 3. Diet 4. Malnutrition 5. Psychologic eating disorders |
|
|
What are the symptoms/signs of Mayer-Rokitansky?
|
cyclic abdominal pain with cycles
"blind pouch" vagina puberty has occurred |
|
|
(T/F) The H-P-O axis is dysfunctional in Mayer-Rokitansky syndrome.
|
False - it is fully functional
Simply lacks the structures - but the hormones are there! [have ovaries, just no fallopian tubes/uterus/cervix/vagina] |
|
|
In AIS what is a critical procedure to complete to reduce likelihood of cancer?
|
Remove testes and provide hormone therapy to prevent osteoporosis.
|
|
|
How can you distinguish Mayer-Rokitansky [Mullerian agenesis] from AIS?
|
Both have blind pouch vagina and female phenotype
Mullerian agenesis however will have "cyclic abdominal pain" and are able to have biological children with a surrogate due to presence of ovaries AIS is XY karyotype |
