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Reproductive 1.1

UWORLD Female Reproductive Review

QuestionAnswer
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