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Reproductive 1.1
UWORLD Female Reproductive Review
| Question | Answer |
|---|---|
| NT defects, orofacial clefts, microcephaly, and nail/digit hypoplasia, indicate teratogenic effects of what drug? | Phenytoin |
| What are the 3 main teratogenic effects of Lithium? | 1. Ebstein's anomaly 2. Nephrogenic DI 3. Hypothyroidism |
| What kind of defects are seen in a neonate, in which the mother used Valproate during pregnancy? | Neural Tube defects |
| The use of Isotretinoin during pregnancy may lead to a baby with: | Microcephaly, THYMIC APLASIA, small ears , and HYDROCEPHALUS |
| Patient born with limb and craniofacial abnormalities, NT defects, is to be suspected that the mother had ________________ during pregnancy. | MTX |
| What class of drug causes Renal agenesis? | ACE Inhibitor |
| 23 yo female patient comes to office with 20 wk gestation, to control her HTN, which type of drug is teratogenic to treat her condition, thus preventing abnormal kidneys? | Captopril |
| What are the teratogenic effects of Warfarin? | Nasal Hypoplasia and stipplied epiphysis |
| The use of ARBs during pregnancy may lead to: | Cardiac abnormalities in the neonate. |
| Sulfonamides cause ________________________________ when used by pregnant mother. | Kernicterus |
| 5 year old with small and stained teeth since birth. What is to be suspected? | Use of tetracyclines during pregnancy of the mother. |
| The _______________ gene codes is expressed in the ________ chromosome, and it encodes for __________________________. | SRY; Y; Testes- Determining Factor (TDF) |
| What is the ultimate factor that differentiates gonads into testes? | The Testes-Determining Factor (TDF) |
| Sertoli Cells: | 1. Cause regression of Mullerian Ducts 2. Suppress female INTERNAL organs (reproductive) |
| Leydig Cells: | 1. Produce Testosterone, |
| What is the role of Testosterone in development of male genitalia? | It causes the Wolffian ducts to become the male INTERNAL reproductive organs |
| What is the role of DHT ? | Enzyme required for male EXTERNAL genitalia (scrotum, penis), and prostate. |
| Testosterone aids to develop MALE ______________________ reproductive organs. | INTERNAL |
| DHT is responsible to the development of MALE _______________ genitalia, including the ___________, _____________, and _______________. | EXTERNAL; scrotum, penis and prostate |
| Which are the two most common bacterial organisms involved in PID? | C. trachomatis and N. gonorrhea |
| The recurrence of infections seen in PID lead to: | Scarring of Fallopian Tube, which lead to ectopic pregnancy and INFERTILITY. |
| What is the treatment for PID infection? | 3rd generation cephalosporin + Azithromycin or Doxycycline. |
| Recently pregnant woman, with fever, abdominal pain, uterine tenderness, and a foul-smelling vaginal discharge. Suspected Dx? | Septic Abortion from infected products of conception left inside uterine cavity. |
| What are the most common organisms causing Septic Abortion? | Staph aureus, gram (-) bacilli (E.coli) and Group B Strep. |
| What is a common complication of Septic Abortion? How is it clinically seen? | Asherman's Syndrome, characterized by amenorrhea and infertility. |
| PCOS, stands for: | PolyCystic Ovarian Syndrome |
| What are the 4 main characteristic seen in PCOS? | 1. Androgen Excess 2. Ovary Dysfunction 3. Insulin resistance 4. Obesity |
| Androgen excess in PCOS is manifested with: | Hirturism, ACNE, and Alopecia |
| In PCOS, a complication is Ovary dysfunction, which is seen with: | Menstrual irregularity, Polycystic Ovaries, and Enlarged Ovaries. |
| The Insulin Resistance produced in PCOS is clinically manifested in patient by developing: | Acanthosis nigricans, Endometrial hyperplasia due to increased levels of Estrogen. |
| How is PCOS treated? | 1. Weight loss 2. Combination oral contraceptives 3. Metformin |
| How do hormone-secreting contraceptives prevent pregnancy? | By the actions of Progestins. |
| How do progestins work? | - Inhibit ovulation. They decrease the FSH and LH synthesis in the anterior pituitary. |
| Which are systemic Progestins? | The pills, Patch, injection |
| What is the MoA of systemic Progestins? | Suppress GnRH and pituitary gonadotropin secretion, inhibiting ovulation. |
| Which are examples of Locally-Acting Progestins? | Progestin-only pills, IUD, and levonorgestrel. |
| How do locally-acting Progestins work? | By THICKENING the Cervical MUCUS, which impairs sperm penetration. |
| Thickening of cervical mucus by _____________, impairs the sperm to properly penetrate, thus preventing ovulation | IUD |
| IUD: | Intrauterine Device with locally acting Progestin. |
| What is the mode of action of Copper IUD? | creation of CYTOTOXIC inflammatory response in uterus, impairing sperm migration. |
| Hostile environment to the sperm, causing to to not be able to reach required site for penetration, is caused by the use of? | Copper IUD |
| How long can a Copper IUD work for? | Up to 12 years |
| What is the a common characteristic of an HSV-2 infection? | Painful Vesicular genital rash |
| HSV-2 affects which ganglia? | Sacral Dorsal Ganglia |
| The Sacral Dorsal ganglia is commonly infected by _____________- | HSV-2. |
| Varicella or ____________________, affects the ______________ _________ ganglia. | HSV-3; dorsal sensory |
| What are common manifestations of recurrent HSV-3 infection? | Shingles and, Post- herpetic neuralgia. |
| HSV-3 rash has a ______________________________ distribution. | Dermatomal |
| Woman of childbearing age presents with oligomenorrhea, hirsutism and polycystic ovaries. Suspected Dx? | PCOS |
| PCOS represents an increase risk in development of? | Endometrial Hyperplasia/Carcinoma |
| The disruption of intraovarian steroidogenesis seen in PCOS immediately lead to: | Anovulatory cycles |
| PCOS presents with chronic elevated levels of _________________ and decreased levels of ____________________________, which lead to the develpment of ____________________________ hyperplasia or carcinoma. | Estrogen; Progesterone; Endometrial |
| What are two common SERMS? | Tamoxifen and Raloxifene |
| SERM's mode of action? | 1. Competitive inhibitor of ESTROGEN binding 2. Mixed agonist/antagonist |
| What is the MC use for SERMS? | Breast Cancer |
| Raloxifene is commonly used in: | Postmenopausal women to treat osteoporosis. |
| Tamoxifene is commonly used in the treatment of: | Endometrial carcinoma due to its agonist estrogen effect |
| What are the side effects of SERMS? | Hot flashes and venous thromboembolism |
| What are two common 5-a-reductase inhibitors? | Finasteride and Dutasteride. |
| Finasteride blocks: | the conversion of Testosterone into DHT in the prostate |
| What is a common condition treated with finasteride? | BPH, as it decreases the volume and relieve the fixed component of bladder outlet obstruction. |
| How long does the effect of Finasteride may take to start seeing results? | 6-12 months |
| What are some side effects of 5a-reductase inhibitors? | Decreased libido and Erectile dysfunction. |
| What are other options of treatment of BPH, aside from 5a-reductase inhibitors? | 1. a-antagonists 2. Antimuscarinics |
| What is a common a-antagonist used in BPH? | Terazosin. It relaxes the smooth muscle of the bladder neck |
| What is a side effect of Terazosin? | Orthostatic Hypotension and dizziness. |
| What is another name used for Leylomas? | Fibroids |
| Woman complains of lower abdomen distention and a sensation of "pulling" down in the pelvic region. Dx? | Leiomyomas or Fibroids |
| What anatomical area do Fibroids commonly arise from? | Posterior subserosal surface of the uterus |
| The pressure created by ____________________ on the _______________ may lead to ____________________________. | Leylomas; Colon; Constipation. |
| Obstetrical Emergency | Postpartum Hemorrhage |
| During repair of a postpartum hemorrhage, the _________________ _________________ artery is ligated bilaterally, in order to decrease blood flow and control the hemorraghe, and by it saving patient's ________________ | Internal iliac artery: Fertility |
| Which gland secrets Prolactin? | Anterior Pituitary |
| What hormone promotes breast milk production? | Prolactin |
| What hormone inhibits the production of Prolactin? | Progesterone |
| What produces Progesterone during the 1st Trimester? | Corpus Luteum |
| After the 1st trimester, Progesterone is produced by? | Placenta |
| Once the child is born, there is a sudden ___________________ in ____________________, allowing for the production of breast milk. | Decrease in Progesterone |
| Proliferative phase: | Day 1-14 |
| Ovulation Day | Day 14 |
| Luteal Phase: | Day 15-28 |
| Progesterone levels are the highest during the _________________ phase. | Luteal |
| The LH surge occurs on day ___________- | 14 |
| Estrogen is the highest during? | Late proliferative phase, just prior to Ovulation day. |
| Involuntary loss of URINE with increased INTRAABDOMINAL pressure. | Stress Urinary Incontinence |
| Treatment for Stress Urinary incontinence | Kegel exercises |
| What muscles are targeted in doing the Kegel Exercises? | Levator ani muscles |
| What muscles are included or form the Levator ani muscles? | Iliococcygeus, Pubococcygeus, and Puborectalis. |
| Injury to any or all of the levator ani muscles lead to? | Urethral Hypermobility and pelvic organ Prolapse, which lead to Incomplete urethral closure --> stress incontinence |
| Digozyc twins? | 2 eggs and 2 sperms |
| Cystic Fibrosis is associated with ______________________ in males by the bilateral absence of _________________________________. | INFERTILITY; absence of vas deferens |
| Levels of FSH, LH and Testosterone are ____________________ in CF. | Normal |
| How is the diagnosis for Cystic Fibrosis made? | Elevated Cl -and Na+ in sweat and a history fo sinus infections. |
| Turner Syndrome | 45 XO |
| In Turner Syndrome, the ovaries are ________________________ and __________________, and these are known as ____________________ ________________. | Underdeveloped; Atrophic; Streak gonads. |
| Pregnant + DIC + hypotension + Hypoxia. Suspected Dx? | Amniotic fluid Embolism |
| Hos is an amniotic fluid embolism composed of? | Fetal Squamous cells, seen in mother's pulmonary vasculature. |
| In a Maternal serum Quadruple screening, the __________ levels are important to determine ___________________ ___________________. | AFP; accurate dating. |
| Increased levels of AFP in a maternal quadruple screen, indicate? | Open Neural Tube defects, Ventral Wall defects, and multiple gestations |
| What are some Open Neural Tube defects seen in increased AFP levels? | Anencephaly, open spina bifida |
| What are the Ventral Wall defects seen in fetuses with elevated AFP levels in maternal quadruple screen? | Omphalocele and Gastroschisis. |
| Decreased levels of AFP indicate? | Aneuploidies, such as Trisomies 18 and 21. |
| What are the 4 markers in a maternal serum quadruple screen? | AFP, Inhibin A, Estradiol, and b-hCG. |
| What is a Perineal Body? | Tissue between the urogenital and anal triangle. |
| Woman recently vaginally delivery, presents with Pelvic organ prolapse and dyspareunia. Suspect of? | Improper fix of the midline episiotomy. |
| Couple trying to conceive. Male Hx unremarkable. Female had Hx of PID poorly treated. What caused the wife's infertility? | The improper tx of PID, lead to scarring of the Fallopian Tubes leading to INFERTILITY. |
| What are some common complication of PID? | Tubo Ovarian abscesses, Infertility, Ectopic pregnancy, and Perihepatitis. |
| What protein is found in Gap Junctions? | Connexins |
| What is the main function of Gap junctions? | Intracellular communication |
| What are the two common proteins seen in Tight junctions? | Claudins and Occludins |
| Capherins are found in what type of junctions? | Adherens |
| What is the main function of Tight junctions? | Paracellular barrier |
| What are the cadherins found in Desmosomes? | Desmoglein and desmoplakin |
| Disease associated with dysfunction of Desmosomes? | Pemphigus Vulgaris |
| Condition associated with Hemidesmosomes? | Bullous pemphigus |
| Associated protein seen in Hemidesmosomes? | Integrins |
| What is the main function of Hemidesmosomes and Desmosomes? | Cellular Anchor |
| What drug works on the Leydig cell to decrease Testosterone synthesis? | Ketoconazole |
| An example of GnRH agonist | Leuprolide; works on anterior pituitary |
| Androgen-binding receptor drugs in androgen synthesis: | Flutamide, Cyproheptadine, and Spironolactone |
| What is PROGESTERONE responsible for, during the menstrual cycle? | Stimulating the Endometrium, to create a suitable environment for IMPLANTATION. |
| The decrease of _____________________, leads to endometrial cell to undergo __________________________, which leads to ______________ _________________. | Progesterone; Apoptosis; Menstrual bleeding |
| What is adenomyosis? | Hypertrophy of the Endometrium |
| Hyperplasia of the ovary? | Endometrial Cancer |
| Estrogen is made in the ________________________ cell with __________. | Granulosa cell; FSH. |
| Androgens in Estrogen synthesis is made in what cell? Which hormone is involved in its synthesis? | Theca cell; LH |
| ____________________________, used in patients with hyperprolactinemia, to treat infertility. | Bromocriptine |
| Infertility treatment for ovulatory failure? | Clomiphene |
| Abnormal presence of Endometrial tissue in areas outside the uterus. | Endometriosis |
| Chocolate cysts | Endometriosis |
| What are chocolate cysts seen in Endometriosis? | Old blood accumulated. |
| What is most commonly affected in Endometriosis? | The ovaries |
| Most common places affected by endometriosis | OVARY> Posterior cul-de sac > Broad ligaments > Uterosacral ligaments |
| What type of epithelium is found in the ovary? | Simple Cuboidal |
| The Fallopian Tubes are lined with what kind of epithelium? | Simple Columnar |
| The epithelium in the Fallopian tubes is ciliated, and damage to the cilia, causes? | Infertility |
| The uterus is lined with what kind of epithelium? | Simple Columnar |
| The cervix is divided into: | Ectocervix and Endocervix |
| The ectocervix is lined with what type of epithelium? | Stratified Squamous Non-keratinized |
| The endocervix is lined with what type of epithelium? | Simple Columnar |
| HPV tends to infect the ______________________, thus predisposing for cervical malignancy. | Endocervix |
| The vagina is lined with ______________________________________ epithelium. | Stratified Squamous Nonkeratinized. |
| Hallmark cells found in HPV infection. | Koilocytes. |
| What infectious agent causes cutaneous and genital warts? | HPV |
| What are Koilocytes? | pyknotic, superficial or immature squamous cells with a dense, irregular staining and Perinuclear Halo-like clearing. |
| What is a risk factor for HPV malignancy? | smoking |
| The oncogenesis of HPV is due to: | 1. E6 degrades p53 2. E7 degrades Rb |
| Misoprostol is an abortion medication. What is Misoprostol MOA? | Prostaglandin E1 agonist |
| 1. Progesterone antagonist 2. Glucocorticoid antagonist | Mifepristone |
| MTX is used as an abortion medication, as it MoA is? | Folic Acid antagonist |
| Prostaglandin _________ agonist. | E1.; Misoprostol |
| Multiple, different cell lines within the same body, defines what? | Mosaicism |
| The process of Mosaicism produces conditions such as: | Chromosomal nondisjunction, mutations during the 1st trimester. |
| What is the difference between Mosaicism and Somatic Mosaicism? | Somatic Mosaicism is a mix of mutated and normal cells, which develop a milder form of a disease. |
| What is Orchiopexy? | Surgical repair of undescended testicle. |
| What is the MC site an undescended testicle is lodged? | Inguinal canal |
| Where are the superficial and deep inguinal rings located? | External Abdominal Oblique Aponeurosis and Transversus Facia, respectively. |
| Prostate cancer metastasis commonly follows the? | Prostatic Venous Plexus |
| The Pampiniform plexus receives drainage from which organs: | Testes, Epididymitis, and Ductus deferens |
| To which structure dies Pampiniform Plexus drain into? | Testicular veins |
| Baby with head tilted to the side? | Congenital Torticollis |
| What is the most common cause of Congenital Torticollis? | Malposition of the head in the utero or birth trauma. |
| What are some associations of Congenital Torticollis? | Hip dysplasia, metatarsus adductus, and club foot. |
| What is the MC type of germ cell tumors? | Teratomas |
| Germ cell tumor, greater than 1 layer, hair, teeth, and skin? | Mature Teratoma |
| The ________________ in females, become the ________________, ____________, _______________, and _________________________. | Paramesonephric ducts; Fallopian Tubes, uterus, cervix, and upper vagina. |
| The disruption in the process of Paramesonephric ducts evolution to female reproductive organs, leads to: | Mullerian tract anomalies and Renal anomalies. |
| What is the result of failure of lateral fusion of Paramesonephric ducts? | Bicornuate Uterus |
| What is key characteristic of Bicornuate Uterus? | Indentation in the center of the Fundus. |
| Incomplete ____________________ ___________________ of Paramesonephric ducts leads to ____________________ uterus. | Lateral Fusion ; Bicornuate. |
| Mayer-Kallsnky-Kuster Syndrome | complete agenesis of the Paramesonephric ducts. |
| What are the characteristics of Mayer-Kullusky-Kuster Syndrome? | INFERTILITY due to Blind vaginal pouch and lack of Mullerian structures. |
| What type of GnRH administration or therapy is used to treat infertility? | PULSATILE GnRH |
| How is PULSATILE GnRH therapy increases chances to get pregnant? | Increased levels of FSH and LH leads to better ovulatory cycles |
| What conditions are treated with CONTINUOUS GnRH therapy? | Prostate cancer, Endometriosis, Precocious puberty, and postmenopausal breast cancer. |
| Under what therapy are FSH and LH level lower, PULSATILE or CONTINUOUS? | CONTINUOUS GnRH |
| Multiple cystic edematous hydrophilic villi as result of Trophoblast proliferation | Complete mole |
| A complete moles has elevated levels of? | b-hCG |
| Persistence elevation of b-hCG and negative pregnancy test, should raise suspicion of: | Choriocarcinoma |
Created by:
rakomi
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