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Reproductive
FA complete review
| Question | Answer |
|---|---|
| Clomiphene stimulates the secretion of: | GnRH |
| In which structure does Clomiphene works on? | Hypothalamus |
| Stimulates the secretion of GnRH in the hypothalamus by blocking negative feedback? | Mechanism of action of Clomiphene |
| Which drug or medications work directly in the Ovary? (list) | 1. Oral contraceptives 2. Danazol |
| Inhibition on the ovary directly is done by: | Oral contraceptives and Danazol |
| What drugs inhibit P-450c17 (enzyme)? | Ketoconazole and Danazol |
| What is prevented to be synthesized by Ketoconazole and Danazol as thy ibnibitb P-450c14? | Androstenedione and Testosterone |
| Anastrozole inhibits which enzyme? | Aromatase |
| Which drug works by inhibiting Aromatase? | Anastrozole |
| Aromatase inhibitor | Anastrozole |
| What form of Estrogen is inhibited/stimulated by SERMs? | Estradiol |
| What is prevented by the action of SRRMS? | Gene expression in Estrogen-responsive cells |
| Which medications are known to inhibit specifically the synthesis of testosterone in men as it is secreted from the testes? | Ketoconazole and Spironolactone |
| Which diuretic is known to inhibit the production of testosterone? | Spironolactone |
| 5a-reductase inhibitor | Finasteride |
| What is prevented to form (convert) by the use of Finasteride? | Dihydrotestosterone |
| List of medication otha act by inhibiting the Androgen-receptor complex | 1. Flutamide 2. Cyproterone 3. Spironolactone |
| What is prevented by the inhibition of the Androgen-receptor complex? | Gene expression in Androgen-responsive cells |
| What medications (not list), can be used in order to prevent the gene expression in androgen-responsive cells? | Flutamide, cyproterone, and spironolactone |
| What is the mechanism of action of Leuprolide? | GnRH analog with agonist properties when used in pulsatile fashion; GnRH antagonist if used in continuous fashion |
| How does it have to be Leuprolide administered in order to have GnRH agonist properties? | Pulsatile fashion |
| Leuprolide has GnRH antagonistic properties when adminter in a _____________________ fashion. | Continuous fashion |
| What is the clinical use of Leuprolide? | Uterine fibroids, endometriosis, precocious puberty, prostate cancer, and infertility |
| What cancer is treated with Leuprolide? | Prostate cancer |
| What are common adverse effects of Leuprolide? | Hypogonadism, decreased libido, erectile dysfunction, nausea, and vomiting. |
| GnRH agonist/or antagonist depending on administration format? | Leuprolide |
| What are types of Estrogens? | Ethinyl estradiol, DES, and mestranol |
| MOA of Estrogens | Bind estrogen receptors |
| What are the clinical uses for estrogens? | 1. Hypogonadism or ovarian failure 2. Menstrual abnormalities 3. Hormone replacement therapy in postmenopausal women |
| What are associated adverse effects of Estrogen therapy? | 1. Increased risk of endometrial cancer 2. Bleeding in postmenopausal women 3. Clear cell adenocarcinoma of vaginia in females exposed to DES in utero 4. Increased risk of thrombi |
| What are some contraindications for estrogen usage? | - ER (+) breast cancer, - Hx of DVTs - Tobacco use in women > 35 years old. |
| What are possible cancer that can develop due to estrogen therapy? | Endometrial cancer and Clear cell adenocarcinoma of vagina |
| Which condition is associated with increased risk in postmenopausal women to develop endometrial cancer if treated with estrogen? | If the therapy is given without progesterone |
| In order to develop clear cell adenocarcinoma of vagina due to estrogen therapy, the woman has to be exposed to: | DES in utero |
| Degarelix is an _________________________ _____________________ . | GnRH antagonist |
| What are associated adverse effects of Degarelix? | Hot flashes and liver toxicity |
| What is the clinical use for Degarelix? | Prostate cancer |
| What kind of drugs are Goserelin and Leuprolide? | GnRH analogs |
| What are common Selective estrogen receptor modulators (SERMs)? | Clomiphene, Tamoxifen, Raloxifene |
| Antagonist at estrogen receptors in hypothalamus. | Clomiphene |
| Which SERM prevents normal feedback inhibition and increase the release of LH and FSH from pituitary, which stimulates ovulation? | Clomiphene |
| How does Clomiphene stimulate ovulation? | By preventing normal feedback inhibition of GnRH, thus increasing the release of LH and FSH. |
| Which type of infertility is treated with Clomiphene? | Infertility due to anovulation |
| What are associated side effects of Clomiphene therapy? | Hot flashes, ovarian enlargement, multiple simultaneous pregnancies, and visual disturbances. |
| Estrogen antagonist at breast; Estrogen agonist at bone, uterus. | Tamoxifen |
| What is a severe adverse effect of Tamoxifen? | Increased risk of thromboembolic events and endometrial cancer |
| What is the clinical use for Tamoxifen? | Treat and prevent recurrence of ER/PR (+) breast cancer. |
| Estrogen antagonist at breast and uterus, but agonist at bone. | Raloxifene |
| What activity increases the chances of thromboembolic events in people taking Raloxifene or Tamoxifen? | Smoking |
| What are the associated adverse effects seen with Raloxifene? | Increased risk of thromboembolic events, but NO increased risk of endometrial cancer |
| Which SERM is associated with increased risk of developing Endometrial cancer, Tamoxifen or Raloxifene? | Tamoxifen |
| What is the main or primary use for Raloxifene? | Osteoporosis |
| SERM used to treat osteoporosis | Raloxifene |
| List of common Aromatase inhibitors: | Anastrozole, Letrozole, and Exemestane |
| What is the mechanism of action of aromatase inhibitors? | Inhibit peripheral conversion of androgens to estrogen |
| What is the clinical use of Aromatase inhibitors? | ER (+) breast cancer in postmenopausal women |
| What are the main conditions treated with hormone replacement therapy? | Relief or prevention of menopausal symptoms, and osteoporosis |
| How does HRT treats/prevents postmenopausal osteoporosis? | Increased estrogen leads to a decrease in osteoclastic activity. |
| What are the associated risks of unopposed estrogen replacement therapy? | Increased risk o f endometrial cancer, - Possible cardiovascular risk |
| What are some common Progestins? | Levonorgestrel, medroxyprogesterone, etonogestrel, norethindrone, and megestrol |
| Levonorgestrel is a very common ________________. | Progestin |
| What is MOA of progestins? | Bind to progesterone receptors, decreasing growth and increase vascularization of endometrium, and thickening cervical mucus |
| What are the effects of progestins in the endometrium? | Increase growth and vascularization Thicken the cervical mucus |
| What are two common antiprogestins? | Mifepristone and Ulipristal |
| Mifepristone is an _____________________________. | Antiprogestin |
| MOA of antiprogestins | Competitive inhibitors of progestins at progesterone receptors |
| What is the clinical use for Mifepristone? | Termination of pregnancy |
| Mifepristone must be given with ___________________ to terminate a pregnancy. | Misoprostol |
| Ulipristal is used for: | Emergency contraception |
| What drugs if given together can case termination of pregnancy? | Mifepristone with misoprostol |
| Combined contraception is composed of: | Progestins and ethinyl estradiol |
| Ethinyl estradiol + Progestins = | Combined contraception |
| What are the possible presentations of combined contraception? | Pill, patch, and vaginal ring |
| How does combined therapy prevent pregnancy? | 1. Progestins and Estrogen inhibit LH/FSH and thus prevent estrogen surge 2. Progestins cause thickening of cervical mucus, thereby limiting access of sperm to uterus 3. Progestins inhibit endometrial proliferation --> less suitable for implantation |
| What does the inhibition of LH/FSH cause in combined contraception? | No estrogen surge --> No LH surge == NO ovulation |
| List of people with contraindicated combined therapy: | 1. Smokers > 35 years old 2. Patients with increased risk of CV disease 3. Migraine patients 4. Breast cancer patients 5. Liver disease patients |
| Which component of combined contraceptive causes a less suitable endometrium for explanation? | Progestins |
| What is the mechanism of action of the Copper intrauterine device? | Produces local inflammatory reaction toxic to sperm and ova, prevention fertilization and implantation; hormone free |
| How does a young woman with a Copper intrauterine device is wrong by saying, "this method has my hormones all over the place"? | The copper intrauterine device is hormone free |
| Apparatus used for contraception that provides a hostile and toxic environment for sperm and ova? | Copper intrauterine device |
| What is the most effective emergency contraception? | Copper intrauterine device |
| What are associated adverse effects of Copper intrauterine device as a contraceptive method? | -Havier or longer menses, dysmenorrhea. - Risk of PID with insertion |
| What are Tocolytics? | Medications that relax the uterus |
| What are some common Tocolytics? | Terbutaline, Nifedipine, and indomethacin |
| What is the purpose of using tocolytics? | Reduce contraction frequency in preterm labor and allow time for administration of steroids or allowance for transference to proper obstetrical care unit. |
| Terbutaline is a: | B2-agonists tocolytic |
| What is the purpose of administering steroids to preterm baby? | Promote fetal lung maturity |
| What is the mechanism of action of Danazol? | Synthetic androgen that act as partial agonist at androgen receptors. |
| What are the clinical uses for Danazol? | Endometriosis (MC), and Hereditary angioedema |
| Which common obstetric conditions is treated with Danazol? | Endometriosis |
| "Chocolate cyst" pathology is often treated with ___________. | Danazol |
| Synthetic androng that act as a partial agonist at androgen receptor | Mechanism of action of Danazol |
| Adverse effects of Danazol: | - Weight gain, edema, acne - Hirsutism, masculinization - Decreased HDL levels - Hepatotoxicity - Pseudotumor cerebri |
| Agonists at androgen receptor | Testosterone and Methyltestosterone |
| Organic androgen receptor agonist | Testosterone |
| Synthetic androgen receptor agonist | Danazol |
| What are the main uses of Testosterone (exogenous)? | 1. Treat hypogonadism and promote development of secondary sex characteristics 2. Stimulate anabolism to promote recovery after burn or injury |
| What is the lesser common used for testosterone? | Stimulate anabolism to promote recovery after burn or injury |
| What is the adverse effect of exogenous testosterone in females? | Masculinization |
| What is the adverse effect of exogenous testosterone in males? | Decrease intratesticular testosterone leading to inhibited release of LH which cause gonadal atrophy |
| Male gonadal atrophy is often seen as a adverse effect of exogenous __________________. | Testosterone |
| What is a male and female adverse effect of the use of testosterone? | Premature closure of epiphyseal plate, increase in LDL, and decrease in HDL. |
| List of common antiandrogenic medications? | 1. Finasteride 2. Flutamide 3. Ketoconazole 4. Spironolactone |
| Which is more potent, DHT or Testosterone? | DHT |
| Enzyme that converts testosterone into DHT? | 5-alpha-reductase |
| Testosterone ----X------------> DHT. What is X? | 5-alpha-reductase |
| What is an important and common 5a-reductase inhibitor? | Finasteride |
| What are the 2 uses for Finasteride? | 1. BPH 2. Male-pattern baldness |
| What associated adverse effects of Finasteride? | Gynecomastia and sexual dysfunction |
| MOA of Flutamide: | Nonsteroidal competitive inhibitor at androme receptors |
| Which medication is a non-steroidal competitive inhibitor at androgen receptors? | Flutamide |
| What is the clinical use for Flutamide? | Prostate carcinoma |
| What is the overall purpose of Ketoconazole? | Inhibits steroid synthesi |
| Which enzymes are inhibited by Ketoconazole? | - 17, 20 desmolase - 17-a-hydroxylase |
| Antiandrogen known to inibito 17-alpha-hydroxylase | Ketoconazole |
| What is the result of Ketoconazole inhibition of desmolase and 17a-hydroxylase? | Inhibit steroid synthesis |
| What is the main use for Ketoconazole? | Reduce androgenic symptoms of PCOS |
| Which are antiandrogens that can be used to reduce androgenic symptoms of PCOS? | Ketoconazole and Spironolactone |
| What are the associated adverse effects of Ketoconazole and Spironolactone? | Gynecomastia and amenorrhea |
| Spironolactone works by: | Inhibition of steroid binding, by inhibiting desmolase and 17-a hydroxylase. |
| What is the difference in MOA between Spironolactone and Ketoconazole? | Ketoconazole ---- inhibits steroid SYNTHESIS Spironolactone --- inhibits steroid BINDING |
| Which antiandrogen inhibits steroid synthesis, Ketoconazole or Spironolactone? | Ketoconazole |
| Which antiandrogen inhibits steroid binding, Ketoconazole or Spironolactone? | Spironolactone |
| alpha-1 antagonist used to treat BPH by inhibit smooth muscle contraction. | Tamsulosin |
| Which medication is seen as Selective for alpha-1A/D receptors on prostate vs vascular a-1B recetpros? | Tamsulosin |
| Which alpha receptors on prostate are selective by Tamsulosin | Alpha-1A/D |
| Tamsulosin MOA: | Alpha-1 antagonist used in BPH, that inhibits smooth muscle contraction |
| Which three medications are known to treat BPH? | Finasteride, Tamsulosin and Tadalafil |
| What are common Phosphodiesterase type 5 inhibitors? | Sildenafil, vardenafil, and tadalafil |
| PDE-5 inhibitors cause an _____________ in cGMP. | Increase |
| The increase in cGMP caused by sildenafil leads to: | Prolonged smooth muscle relaxation in response to nitric oxide |
| Which part of hte peins recieves more blood by the use of Viagra? | Corpus cavernosum of penis |
| While blood flow to corpus cavernosum of penis is increased, what other effect occurs with PDE-5 inhibitors? | Decrease poumomary vascular resistance |
| What is the clinical use for PDE-5 inhibitors? | 1. Erectile dysfunction 2. Pulmonary hypertension 3. BPH (Tadalafil only) |
| Which is the only PDE-5 inhibitor used to treat BPH? | Tadalafil |
| Adverse effects with PDE-5 inhibitors: | - Headache, flushing, dyspepsia, cyanopsia - Risks of life-threatening hypotension if taken with nitrates |
| Which are extremely contraindicated in a patient taking sildenafil? | Nitrates |
| What is the MOA of MInoxidil? | Direct arteriolar vasodilator |
| Clinical use for Minoxidil | 1. Androgenetic alopecia (pattern baldness) 2. Severe refractory hypertension |
| Why would a male try to hide the fact he is taking MInoxidil? | Its primary clinical use is for androgenetic alopecia |
| Which are drugs that treat male baldness? | Minoxidil and Finasteride |
| Disordered epithelial growth of the cervix. | Cervical dysplasia |
| What are the classifications of Cervical dysplasia? | CIN 1, CIN 2, and CIN 3 |
| Cervical carcinoma in situ is associated with HPV serotypes? | HPV-16 and HPV-18 |
| HPV-16 serotype produces which gene? | E6 gene |
| What is inhibited by E6 gene product of HPV-16? | TP53 |
| E7 gene product is known to inhibit | Rb |
| What cells are pathognomonic of HPV infection? | Koilocytes |
| Koilocytes are seen in what type of viral infection? | HPV |
| (+) for koilocytes. Dx? | HPV infection |
| What are known risk factors for HPV infection? | 1. Multiple sexual partners 2. HPV 3. Smoking 4. Early coitarche 5. DES exposure 6. Immunocompromised (HIV, transplant) |
| Cervical invasive carcinoma is most often of what type? | Squamous cell carcinoma |
| What is a possible complication of lateral invasion of Cervical Invasive carcinoma? | Hydronephrosis leading to renal failure |
| What is another way to refer to Primary Ovarian insufficiency? | Premature Ovarian failure |
| Premature atresia of ovarian follicles in women of reproductive age. Dx? | Primary ovarian insufficiency |
| What type of conditions are most associated with development of Primary ovarian insufficiency in women less than 30 y.o.? | Chromosomal abnormalities |
| A patient with signs of menopause after puberty but before the age of 40, with a diagnosed chromosomal abnormality. Dx? | Primary ovarian insufficiency |
| List of MCC of ANOVULATION: | 1. Pregnancy 2. PCOS 3. Obesity 4. HPO axis abnormalities/immaturity 5. Premature ovarian failure 6. Hyperprolactinemia 7. Thyroid disorders 8. Eating disorders 9. Competitive athletes 10. Cushing syndrome 11. Adrenal insufficiency, 12. Chromosomal abnormalities (Turner syndrome) |
| Another name of functional hypothalamic amenorrhea | Exercise-induced amenorrhea |
| What are some common causes/activities that cause functional hypothalamic amenorrhea? | Severe caloric restriction, increase energy expenditure, and/or stress. |
| What does the first affection of Functional hypothalamic amenorrhea? | Functional disruption of pulsatile GnRH secretion leading to decrease levels of LH, FSH, and estrogen. |
| "female athlete triad" is associate with what condition? | Functional hypothalamic amenorrhea |
| Pathogenesis of functional hypothalamic amenorrhea: | 1. Functional disruption of pulsatile GnRH secretion --> Decrease LH, FSH, estrogen. 2. Decrease in leptin due to decrease fat 3. Increase cortisol (stress, excessive exercise) |
| What is another name for Polycystic Ovarian syndrome (PCOS)? | Stein-Leventhal syndrome |
| What is the main disruption in PCOS that lead to hormonal changes? | Hyperinsulinemia and/or insulin resistance alter the hypothalamic hormonal feedback response |
| Are LH:FSH ratio increased or decreased in PCOS? | Increased |
| What is the result of the increased levels of LH:FSH and androgens in PCOS? | Unruptured follicles (cysts) + anovulation |
| What is a common cause of decreased fertility in women? | Polycystic ovarian syndrome |
| Enlarged, bilateral cystic ovaries; amenorrhea/oligomenorrhea, hirsutism, acne, and decreased fertility. Dx? | Polycystic ovarian syndrome |
| How is PCOS related to Endometrial cancer? | Increased risk of Endometrial cancer secondary to UNOPPOSED estrogen from repeated anovulatory cycles |
| What is the effect on estrogen due to recurrent anovulatory cycles in a PCOS patient? | Unopposed estrogen leads to its incrase and higher riks of endometrial cancer. |
| What are the non-medication life modifications used for treating PCOS? | 1. Weight reduction to decrease periphear estrone formation 2. OCPs |
| What is the medical (chemical) treatment for PCOS? | 1. Clomiphene, metformin to induce ovulation 2. Spironolactone 3. Ketoconazole (antiandrogenic) to treat hirsutism |
| Which antibiotic is usually used to treat hirsutism in PCOS patient? | Ketoconazole |
| Reason for Spironolactone use in PCOS treatment | Anti-androgenic; treating hirsutism |
| 1. Hyperglycemia 2. Hirsutism 3. Infertility | Common triad of symptoms seen in PCOS |
| What are the two main types of Ovarian cysts? | 1. Follicular cysts 2. Theca-lutein cysts |
| What is an Follicular ovarian cyst? | Distension of unruptured graafian follicle |
| Associations of Follicular ovarian cyst? | - Hyperestrogenism - Endometrial hyperplasia |
| What is the most common ovarian mass in young women? | Follicular ovarian cyst |
| Description of ovarian Theca-Lutein cyts? | Often bilateral and multiple |
| Ovarian Theca-Lutein cysts are due to: | Gonadotropin stimulation |
| What are common associations of Ovarian Theca-Lutein cysts? | Choriocarcinoma and Hydatidiform moles |
| List of common Endometrial pathologies: | 1. Polyp 2. Adenomyosis 3. Asherman syndrome 4. Leiomyoma (fibroid) 5. Endometrial hyperplasia 6. Endometrial carcinoma 7. Endometritis 8. Endometriosis |
| An endometrial polyp is: | Well-circumscribed collection of endometrial tissue within uterine wall. |
| What kind of cells are found in endometrial polyps? | Smooth muscle cells |
| An endometrial polyp can extend to the: | Endometrial cavity in the form of a polyp |
| An endometrial may be asymptomatic, or if symptomatic it presents with: | Painless abnormal uterine bleeding. |
| "Sac-like structure" of endometrial tissue within the uterine wall. Dx? | Endometrial polyp |
| What is adenomyosis? | Extension of endometrial tissue (glandular) into uterine myometrium |
| What is the most common cause fo Adenomyosis? | Hyperplasia of basal layer of endometrium. |
| What is the result (pathology) caused by the hyperplasia of the basal layer of endometrium? | Adenomyosis |
| What is the clinical presentation of Adenomyosis? | Dysmenorrhea, menorrhagia, uniformly enlarged, soft, globular uterus. |
| What is the treatment of Adenomyosis? | GnRH agonists, hysterectomy or excision of an organized adenomyoma. |
| What type of endometrial tissue is affected or extended in Adenomyosis? | Glandular endometrial tissue |
| Adhesions and /or fibrosi of the endometrium. Dx? | Asherman syndrome |
| Patient with Hx of recent dilation and curettage of intrauterine cavity, presents with abnormal uterine bleeding, pelvic pain, and Hx of infertility and recurrent pregnancy loss 2x? | Asherman syndrome |
| Leiomyoma = | Fibroid |
| Fibroid is also known as ___________________. | Leiomyoma |
| What is the most common tumor in females? | Leiomyoma |
| Description of a Leiomyoma: | 1. Benign smooth muscle tumor 2. Estrogen sensitive 3. Peak occurrence - women 20-40 years old |
| What ethnic population have higher levels of Leiomyoma recurrence? | African American women |
| What does an "Leiomyoma is Estrogen-sensitive" means? | Tumor size increase with pregnancy and decreases with menopause |
| Whorled pattern of smooth muscle cells bundles with well-demarcated borders. Which is the possible endometrial condition? | Leiomyoma |
| What is an hematologic adverse condition that may be a consequence of severe Leiomyomas? | Iron deficiency anemia |
| Medical procedures that are directed to check/treat the uterus may lead to development of? | Asherman syndrome |
| Abnormal endometrial gland proliferation usually caused by excess estrogen stimulation. Dx? | Endometrial dysplasia |
| What is the most characteristic symptom of Endometrial hyperplasia? | Postmenopausal vaginal bleeding |
| What are associated risk factor of Endometrial hyperplasia? | Anovulatory cycles, hormone replacement therapy, PCOS, and granulosa cell tumor |
| What is a higher risk factor for Endometrial hyperplasia, nuclear atypia or complex architecture? | Nuclear atypia |
| What is the MC gynecologic malignancy with peak at 55-65 years old? | Endometrial carcinoma |
| Postmenopausal vaginal bleeding. is a features of which malignancy? | Endometrial carcinoma |
| What is the most typical preceding condition of Endometrial carcinoma? | Endometrial hyperplasia |
| What are some associated risk factors that lead to development of Endometrial carcinoma? | 1. Prolonged use of estrogen without progestins, 2. Obesity 3. Diabetes 4. Hypertension 5. Nulliparity 6. Late menopause 7. Early menarche 8. Lynch syndrome |
| Which GI condition is often associated with Endometrial carcinoma? | Lynch syndrome |
| What is Endometritis? | Inflammation f endometrium associated with retained products of conception following delivery, miscarriage, abortion, or with foreign body (IUD). |
| How does retain material in uterus lead to Endometritis? | It promotes infection by bacterial flora from vaginal or intestinal tract |
| What a histological feature of chronic endometritis? | Presence of plasma cells on histology |
| Which condition is associated with (+) plasma cell on histology? | Chronic endometritis |
| What is the most common or usual treatment for Endometritis? | Gentamicin + clindamycin +/- ampicillin |
| Non-neoplastic endometrium-like glands/stroma outside endometrial cavity. Dx? | Endometriosis |
| Endometrial tissue outside of endometrium. Dx? | Endometriosis |
| What is the most common site for Endometriosis? | Ovary (frequency bilateral) |
| What are 3 common places for endometriosis to develop? | BIlateral ovaries, pelvis, and peritoneum |
| What is the description of endometriosis in the ovary? | Endometrioma |
| What is endometrioma? | Endometriosis in the ovary |
| Blood-filled "chocolate cysts" . Dx? | Ovarian endometriosis |
| What are some possible causes of Endometriosis? | 1. Retrograde blood flow 2. Metaplastic transformation of multipotent cells 3. Transportation of endometrial tissue via the lymphatic system |
| What are common clinical signs and symptoms of endometriosis? | Cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia, infertility. |
| How is the size of uterus with a women with Endometriosis? | Normal sized uterus |
| Treatment of Endometriosis? | -NSAIDs - Continuous OCPs - Progestins - GnRH agonists - Danazol - Laparoscopic removal |
| Danazol is used int the treatment of ____________________. | Endometriosis |
| What is a common features of Endometriosis to describe the cysts? | "Chocolate cysts" |
| What are the two subtypes of Fibrocystic changes of the breast? | 1. Sclerosing adenosis 2. Epithelial hyperplasia of the breast |
| What are the types of benign breast diseases (general)? | 1. Fibrocystic changes 2. Inflammatory processes 3. Benign tumors 4. Gynecomastia |
| Fibrocystic changes of the breast are most common what type of women? | Premenopausal women < 35 years old |
| Description of fibrocystic changes of the breast: | - Pre-menstrual pain or lumps - Often bilateral and multifocal |
| What are the cystic changes of the breast (definition)? | Non-proliferative lesions that include simple cysts, papillary aprocine change/metaplasia, and stromal fibrosis. |
| Sclerosing adenosis is a subtype of: | Fibrocystic changes of the breast |
| What is Sclerosing adenosis of the breast? | Acini and stromal fibrosis, associated with calcifications; minimal increase for cancer |
| Breast cells in terminal ductal or lobular epithelium with increased risk of carcinoma with atypical cells. Subtype of Fibrocystic breast changes. Dx? | Epithelial hyperplasia of breast |
| What are the two main benign breast inflammatory processes that cause disease? | 1 Fat necrosis 2 Lactational mastitis |
| How is Fat necrosis of the breast defined? | Benign, usually painless, lump due to injury to breast tissue |
| What is a typical finding of Fat necrosis on mammography? | Calcified oils cyst |
| What is Lactational mastitis? | Occurs during breastfeeding. Increased risk of bacterial infection through cracks in nipple |
| What i the most common pathogen that causes Lactational mastitis? | S. aureus |
| What are the benign tumors of the breast? | - Fibroadenoma - Intraductal papilloma - Phyllodes tumor |
| Fibroadenoma of the breast is a benign or malignant tumor? | Bening |
| Intraductal breast papilloma is a benign or malignant tumor? | Benign |
| What is the most common benign breast tumor in women under the age of 35? | Fibroadenoma |
| Description and features of Breast fibroadenoma? | - Small, defined, mobile mass, - Increases size and tenderness with increases levels of estrogen, such as in pregnancy an prior to menstruation |
| What type of benign tumor is usually seen with increased levels of tenderness and size few days prior to menstruation? | Breast fibroadenoma |
| Small fibroepithelial tumor within lactiferous ducts, typically beneath areola. Dx? | Intraductal papilloma of the breast |
| What is the most common cause of bloody or soeurs nipple discharge? | Intraductal papilloma of the breast |
| What is the Phyllodes tumor? | Large mass of connective tissue and cysts with "leaf-like" lobulations |
| Which benign breast tumor has changes of one day becoming malignant? | Phyllodes tumor |
| What decade of life is most commonly a Phyllodes tumor to develop? | 5th decade |
| "leaf-like" lobulations. Dx breast tumor? | Phyllodes tumor |
| Bloody nipple. MC benign breast tumor? | Intraductal papilloma of the breast |
| What is Gynecomastia? | Breast enlargement in males due to increased levels of estrogen compared with androgen activity. |
| What are some causes of Gynecomastia? | 1. Cirrhosis 2. Hypogonadism 3. Testicular tumors 4 . Drugs |
| What drugs/medications are known to cause gynecomastia? | Spironolactone, Hormones, Cimetidine, Finasteride, and Ketoconazole. |
| Abnormal breast growth in males. | Gynecomastia |
| What is an "embarrassing" condition in males, due to increased estrogen compared to androgen activity? | Gynecomastia |
| Which ducts have the presence of Intraductal adenoma growth? | Lactiferous ducts, beneath the areola. |
| What is Peyronie disease? | Abnormal curvature of penis due to fibrous plaque within tunica albugÃnea. |
| What is the distinction between Peyronie disease and Penis fracture? | Penis fracture is the ruprus of corpora cavernosa due to forced bening |
| Which type of conditions is likely due to practicing rough coitus? | Penile fracture |
| When is surgical repair of Peyronie disease recommended? | Once curvature stabilized |
| What are symptoms or associations of Peyronie disease? | Erectile dysfunction, pain, and anxiety. |
| Painful sustained erection lasting > 4 hours. Dx? | Ischemic priapism |
| What are common associative-causes of Priapism? | Sickle cell disease and medications (viagra) |
| Why is Sickle cell disease associated with development of Priapism? | Sickled RBCs block venous drainage of corpus cavernosum vascular channels |
| Treatment for ischemic priapism | Immediate corporal aspiration, intracavernosal phenylephrine, or surgical decompression to prevent ischemia |
| Intracavernosal phenylephrine is used for: | Treatment of priapism |
| Which parts of the world ar most affected by Squamous cell carcinoma of the penis? | Asia, Africa, and South America |
| What are the precursor in situ lesions for Squamous cell carcinoma of the penis? | 1. Bowen disease 2. Erythroplasia of Queyrat 3. Bowenoid papulosis |
| What penile pathology is associated with uncircumcised males and HPV? | Penile squamous cell carcinoma |
| Leukoplakia in the penis shaft. | Bowen disease |
| What is Bowen disease? | Precurus in situ lesion for Penile SCC that presents as leukoplakia in the shaft of penis |
| What is Erythroplasia of Queyrat? | Carcinoma in situ of the glans of the penis, that presents as erythroplakia. |
| What is Bowenoid papulosis? | Carcinoma in situ of unclear malignant potential, presented as reddish papules; precursor condition of Penile SCC. |
| Reddish papules in penis, which later gave rise to development Penile SCC? | Bowenoid papulosis |
| What is Cryptorchidism? | Undescended testis (one or both) |
| Medical term for undescended testis (one or both). | Cryptorchidism |
| Why does cryptorchidism cause impaired spermatogenesis? | Since sperm develop besta at temperatures < 37 degrees. |
| What type of tumors are most associated with Cryptorchidism? | Germ cell tumors |
| What is a common risk for Cryptorchidism? | Prematurity |
| How important hormonal levels affected in Cryptorchidism? | Decreased inhibin B, and increased LH and FSH. Testosterone Is normal in unilateral but decreased in bilateral cases of cryptorchidism |
| How does the levels of testosterone differ in bilateral cryptorchidism vs unilateral cryptorchidism? | Bilateral --> low testosterone leves Unilateral ---> normal levels |
| Rotation of testicle round the spermatic cord and vascular pedicle. Dx? | Testicular torsion |
| What is the definition of testicular torsion? | Rotation of testicle around the spermatic cord and vascular pedicle |
| In testicular torsion, the testicle is around which important stricture? | Spermatic cord |
| Testicle around the spermatic cord. Dx? | Testicular torsion |
| What is the clinical presentation of Testicular torsion? | Acute, severe pain, high-riding testis, and absent cremastic reflex |
| An absent cremasteric reflex in a 15 year old male, that present with sudden testicular pain. Dx? | Testicular torsion |
| Orchiopexy? | Surgical correction of Testicular torsion within the first 6 hours. |
| What is the treatment or procedure in Testicular torsion with a < 6 hours from event? | Orchiopexy |
| What is a varicocele? | Dilated veins in pampiniform plexus due to increased venous pressure |
| Dilated veins in pampiniform plexus due to increased venous pressure. Dx? | Varicocele |
| What plexus is associated or affected in Varicocele? | Pampiniform plexus |
| What is the most common cause of scrotal enlargement in adult males? | Varicocele |
| Which side is most common to develop a Varicocele, right or left? | Left side |
| Why is the left side of a male most prone to develop a varicocele? | Increase resistance to flow from left gonadal vein drainage into left renal vein |
| How is Varicocele diagnosed? | By standing clinical exam/Valsalva maneuver or US with Doppler |
| What is "felt" by doctor in inspecting a Varicocele? | "bag of worms" on palpation of testicule |
| Does a varicocele transilluminate? | No, it does not |
| "bag of worms" | Varicocele |
| What is the treatment for Varicocele? | Surgical ligation or embolization if associated with pain or infertility. |
| Benign scrotal lesions present as testicular masses that can be transilluminated. | Scrotal masses |
| Definition of scrotal masses. | Benign scrotal lesions present as a testicular masses that transilluminated. |
| Does scrotal masses or solid testicular tumors, transilluminate? | Scrotal masses |
| What are the most common forms of Scrotal masses? | 1. Congenital hydrocele 2. Acquired hydrocele 3. Spermatocele |
| Reason of congenital hydrocele development? | Incomplete obliteration of processus vaginalis |
| What is a very common cause of scrotal swelling in infants? | Congenital hydrocele |
| Failed obliteration of processus vaginalis leads to development of: | Congenial hydrocele |
| Which feature in development is failure that leads to Congenital Hydrocele? | Processus vaginalis |
| Scrotal fluid collection usually secondary to infection, trauma, or tumor. Dx? | Acquired hydrocele |
| Bloody acquired hydrocele | Hematocele |
| If the hydrocele is filled with blood, it is known as ______________. | Hematocele |
| What is a Spermatocele? | Cyst due to dilated epididymal duct or rete testis |
| Cyst formed by dilation of the epididymal duct or rete testis. Dx? | Spermatocele |
| Paratesticular fluctuant nodule. Dx? | Spermatocele |
| Common hyperplastic condition of the prostate in men over 50 years of age. | Benign prostatic hyperplasia |
| What are the characteristics of BPH? | Smooth, elastic, firm nodular enlargement of periurethral lobes, which compresses the urethra into a vertical slit. |
| What parts of the prostate gland are comprised in BPH? | Periurethral lobes (lateral and middle lobes) |
| If compresses the lateral and middle lobes of prostate, suspect conditions? | Benign prostatic hyperplasia |
| If the prostatic enlargement compressor arises from the posterior lobe, which is the suspected dx? | Prostatic adenocarcinoma |
| Is BPH premalignant? | No, it is not considered a premalignant condition |
| What are clinical symptoms or presenting conditions of BPH patients? | - Increased frequency of urination - Nocturia - Difficulty starting and stopping urine stream - Dysuria |
| What are possible complications of severe BPH? | Distension And hypertrophy of bladder, hydronephrosis, and UTIs. |
| What antigen is seen elevated in BPH? | Free PSA |
| What are the common drugs to treat BPH? | 1. Alpha-1 antagonists (tamsulosin) 2. 5a-reductase inhibitors (finasteride) 3. PDE-5 inhibitors (tadalafil) 4. Surgical resection /ablation |
| What is a common alpha-1 antagonist used in treating BPH? | Terazosin and Tamsulosin |
| What type of drugs are Terazosin and Tamsulosin? | Alpha-1 antagonists |
| What are the general characteristics of Prostatitis? | Dysuria, frequency, urgency, low back pain. Warm, tender, enlarged prostate |
| What are the two types of Prostatitis? | 1. Acute bacterial prostatitis 2. Chronic prostatitis |
| What is the most common pathogen that causes bacterial prostatitis in older men? | E. coli |
| Acute bacterial prostatitis in young men is most likely caused by: | C. trachomatis or N. gonorrhoeae infection. |
| What type of prostatitis may be bacterial or non-bacterial? | Chronic prostatitis |
| Common causes of chronic prostatitis: | - Secondary to previous infection - Nerve problems - Chemical irritation |
| What are the most common adnexal masses in women >> 55 years old? | Ovarian neoplasms |
| What are the 3 main origins of Ovarian neoplasms? | Surface epithelium, germ cells, and sex cord stromal tissue |
| What is the origin of the majority of malignant ovarian neoplasms? | Epithelial |
| What is the most common malignant ovarian tumor? | Serous cystadenocarcinoma |
| List of common predispositions or risk factor for ovarian cancer | 1. Advanced age 2. Infertility 3. Endometriosis 4. PCOS 5. Genetic predisposition 6. BRCA1 or BRCA2 mutation 7. Lynch syndrome 8. Strong family history |
| What are actions known to decrease risk of developing Ovarian cancer? | Previous pregnancy, history of breastfeeding, OCPs, tubal ligation. |
| What are clinical symptoms of ovarian neoplasms? | Adnexal mass, abdominal distension bowel obstruction, and pleural effusion |
| What marker is used to monitor therapy and relapse of an ovarian tumor? | CA125 |
| Is CA125 good for screening? | No, it is only used for therapy and relapse of Ovarian tumors |
| Maker of ovarian tumors | CA125 |
| What are the 3 types of BENIGN Ovarian surface epithelial tumors? | 1. Serous cystadenoma 2. Mucinous cystadenoma 3. Endometrioma |
| What is the most common ovarian neoplasm? | Serous cystadenoma |
| Description of Ovarian serous cystadenoma: | Lined with Fallopian tube-like epithelium; Often bilateral; Benign Surface epithelium origin |
| Which ovarian benign neoplasm is known to be lined with fallopian tube-like epithelium? | Serous cystadenoma |
| Multiloculated, large. Lined by mucus-secreting epithelium. Benign ovarian neoplasm | Mucinous cystadenoma |
| Endometriosis within ovary with cyst formation. Dx? | Endometrioma |
| What classic signs of Endometrioma? | Pelvic pain, dysmenorrhea, and dyspareunia. |
| What is the classic "cyst" seen with Endometrioma? | "Chocolate cyst" |
| Endometrioma filled with dark, reddish-brown blood. | "Chocolate cyst" |
| Which is the benign Ovarian germ cell tumor? | Mature cystic teratoma |
| What is another name for Mature cystic teratoma? | Dermoid cyst |
| Benign germ cell tumor of the ovary | Mature cystic teratoma |
| What is the most common ovarian benign tumor in females 10-30 years old? | Mature cystic teratoma |
| What does the cystic mass of a dermoid cyst consist of? | Elements of all 3 germ layers (teeth, hair, sebum) |
| Ovarian mass filled with teeth, hair, and sebum. Benign. Dx? | Mature cystic teratoma |
| What tumor is present with pain secondary to ovarian enlargement or torsion? | Mature cystic teratoma |
| Struma ovarii is associated with which ovarian tumor? | Mature cystic teratoma |
| What is struma ovarii? | Monodermal form of dermoid cyst with thyroid tissue, that uncommonly presents with hyperthyroidism. |
| Young woman presents with hyperthyroidism, but her Hypothalamic studies are normal, and only complain is pelvic pain prior menses. Dx? | Struma ovarii |
| What are the most common benign sex cord stromal tumors of the ovaries? | Fibroma and Thecoma |
| What is an ovarian fibroma? | Bundles of spindle-shaped fibroblasts |
| What syndrome is associated with Ovarian fibroma? | Meigs syndrome |
| What is Meigs syndrome? | Triad of ovarian fibroma, ascites, and hydrothorax |
| "Pulling" sensation in groin in young woman. | Ovarian fibroma |
| Ovarian fibroma + Hydrothorax + Ascites. Dx? | Meigs syndrome |
| What is the most common form to describe sensation produced by an Ovarian fibroma? | "Pulling" session in groin |
| What hormone is commonly produced by Thecoma? | Estrogen |
| How does a Thecoma is similar to a Granulosa cell tumor? | Both produce estrogen |
| What is the most common presentation of Thecoma (clinically)? | Abnormal uterine bleeding in a postmenopausal woman |
| What is a Brenner tumor? | Benign ovarian tumor, that is not classified as surface epithelium, sex cord, or germ cell tumor of the ovaries. |
| Resembles a bladder epithelium (transition cell tumor). | Brenner tumor |
| A Brenner tumor is an _______________ tumor. | Ovarian |
| Solid tumor that is pale yellow-tan and appears encapsulated. | Brenner tumor |
| What is the classical description staining of Brenner tumor nuclei? | "Coffee bean" nuclei in H&E stain. |
| List of Malignant surface epithelial tumors of the ovary: | 1. Serous cystadenocarcinoma 2. Mucinous cystadenocarcinoma |
| What is the MC ovarian malignant neoplasm? | Serous cystadenocarcinoma |
| What is an important histological finding of ovarian serous cystadenocarcinoma? | Psammoma bodies |
| What is an important complication of a ovarian mucinous cystadenocarcinoma? | Pseudomyxoma peritonei |
| What is Pseudomyxoma peritonei? | Intraperitoneal accumulation of mucinous material in Ovarian Mucinous cystadenocarcinoma |
| What are the 3 main malignant Germ cell tumor? | 1. Dysgerminoma 2. Immature teratoma 3. Yolk sac tumor |
| Ovarian dysgerminoma is most common among _______________. | Adolescents |
| Ovarian dysgerminoma is equivalent to which male tumor? | Seminoma |
| What is the approximate percentage of dysgerminoma in relation to germ cell tumors? | Accounts for 30% |
| What i the histological description of ovarian dysgerminoma? | Sheets of uniform "fried egg" cells |
| What are the tumor markers used in specifically with Ovarian dysgerminoma? | hCG and LDH |
| Aggressive, contains fetal tissue, neuroectoderm. Malignant ovarian germ cell tumor. Dx? | Immature teratoma |
| Mature Ovarian teratoma is ______________________. | Benign |
| Immature Ovarian teratoma is ______________________. | Malignant |
| Immature ovarian teratoma is likely to be diagnosed before _______ of age. | 20 |
| What is the most common representation of Immature ovarian teratoma? | Immature/embryonic-like neural tissue |
| Ovarian neoplasm that contains fetal components of neural tissue origin? | Immature teratoma |
| How else is the Yolk sac tumor of the ovary known as? | Ovarian endodermal sinus tumor |
| Ovarian endodermal sinus tumor = | Yolk sac tumor or the ovary |
| What is the most common tumor in male infants? | Yolk sac tumor |
| Aggressive, in ovaries or testes and sacrococcygeal area in young children. Dx? | Yolk sac tumor |
| Description and features of Yolk sac tumor of ovary or testes: | - Yellow, friable (hemorrhagic) , solid mass - 50% have Schiller-Duval bodies - AFP = tumor marker |
| What is the tumor marker for Yolk sac tumors? | AFP |
| What is the key histological feature of 50% of all Yolk sac tumors? | Schiller-Duval bodies |
| What does the Schiller-Duval bodes tend to resemble? | Glomeruli |
| What is the malignant sex cord tumor of the Ovary? | Granulosa cell tumor |
| Granulosa cell tumor is of what origin? | Sex cord stromal tumor |
| Granulosa cell tumor is malignant or benign ovarian tumor? | Malignant ovarian tumor |
| What is the most common ovarian malignant stromal tumor? | Granulosa cell tumor |
| What is produced by Granulosa cell tumors? | Estrogen and/or progesterone |
| What is the clinical presentation of Granulosa cell tumors? | - Postmenopausal bleeding - Sexual precocity (in pre-adolescent) - Breast tenderness |
| What is a common sign of possible granulosa cell tumor in a pre-adolescent woman? | Sexual precocity |
| Key histological finding of Granulosa cell tumors of the ovaries? | Call-Exner bodies |
| What are the Call-Exner bodies? | Granulosa cells arranged haphazardly around collections of eosinophilic fluid, resembling primordial follicles |
| What cells are arranged around eosinophilic fluid, and resemble primordial follicles? | Granulosa cells |
| (+) Call-Exner bodies. Dx? | Granulosa cell tumor |
| What type of ovarian neoplasm origin are Immature teratomas and Dysgerminomas? | Germ cell tumors |
| Malignant Sex cord stromal tumor of the ovary? | Granulosa cell tumor |
| GI malignancy that metastasizes to ovaires. Dx? | Krukenberg tumor |
| Mucin-secreting signet cell adenocarcinoma. | Krukenberg tumor |
| What is a Krukenberg tumor? | GI malignancy that goes to the ovaries, leading to development fo mucin-secreting signet cell adenocarcinoma |
| Which population of women are most likely to be affected b malignant breast tumors? | Postmenopausal |
| What is the most common location for malignant breast tumors to arise from? | Terminal duct lobular unit |
| Common characteristic (type) of malignant breast tumor | Amplification/overexpression of estrogen/progesterone receptors or c-erbB2 |
| Estrogen/Progesterone receptors or c-erbB2 = | HER-2, an EGF receptor |
| What are the triple negatives in malignant breast cancer? | ER (-) PR(-) Her2/Neu (-) |
| What is more aggressive breast tumor, a triple negative or a HER-2 (+) cancer? | Triple negative |
| What is the most important prognostic factor in early-stage malignant breast tumor? | Metastases to axillary lymph node |
| Which lymph node is associated with poor prognosis in breast cancer? | Axillary lymph node |
| Where is the most common location for malignant breast cancer? | Upper-outer quadrant |
| Common risk factors for malignant breast cancer: | 1. Increased estrogen exposure 2. Increased total number of menstrual cycles 3. Older age at 1st live birth 4. Obesity 5. BRCA1 or BRCA2 gene mutations 6. African American ethnicity |
| Which population is most likely to develop triple (-) breast cancer? | African American |
| What are the associated breast cancer gene mutations? | BRCA1 and BRCA2 |
| Which are the non-invasive malignant breast cancer tumors? | 1. Ductal carcinoma in situ of the breast 2. Comedocarcinoma 3. Paget disease of the breast 4. Lobular carcinoma in situ of the breast |
| Malignant breast cancer are divided into two featured categories: | Non-Invasive and, Invasive |
| Which breast cancer is seen with early microcalcifications on mammography? | Ductal carcinoma in situ of the breast |
| Breast ductal carcinoma in situ arises from: | Ductal atypia |
| DCIS of the breast | Fills ductal lumen |
| How is Early stage of DCIS of the breast seen? | Early malignancy without basement membrane penetration |
| Common subtype of DCIS of the breast | Comedocarcinoma |
| Ductal, central necrosis. Subtype of breast DCIS. Dx? | Comedocarcinoma |
| What is the cause of Paget disease of the breast? | Results from underlying DCIS or invasive breast cancer. |
| What are Paget cells? | Intraepithelial adenocarcinoma cells |
| What is the most important or key feature of Paget disease of the Breast? | Eczematous patches on nipple |
| What breast malignancy is presented with eczematous patches on nipple? | Paget disease of the Breast |
| Red rash on nipple. What is the most likely breast condition? | Paget disease of the Breast |
| What are the Invasive type of malignant breast tumors? | 1. Invasive ductal carcinoma 2. Invasive lobular carcinoma 3. Medullary carcinoma 4. Inflammatory breast cancer |
| Paget disease of the breast, is it invasive or non-invasive? | Non-invasive |
| DCIS is a non-invasive or invasive breast malignancy? | Non-invasive |
| Description of Invasive ductal carcinoma of the breast | Firm, fibrous, "rock-hard" mass with sharp margins and small, glandular, duct-like cells. |
| What ligaments are involved/affected in Invasive ductal carcinoma of the breast? | Suspensory ligaments |
| What causes the dimpling of skin seen in Invasive ductal carcinoma of the breast? | The deformation of the Suspensory ligaments by the tumor |
| What is the classic morphology seen in Invasive ductal carcinoma of the breast? | "stellate" infiltration |
| What is the most common type of malignant breast cancer? | Invasive ductal carcinoma of the breast |
| Which breast non-invasive carcinoma is seen with decreased E-cadherin expression? | Lobular carcinoma in situ of the breast |
| How is the risk of developing breast cancer differs from DCIS and LCIS? | LCIS increases cancer in either breast, while DCSI only on the same breast and quadrant. |
| Breast exam detects a firm, 'rock-hard" mass with well defined margins in the upper left outer quadrant. Most likely diagnosis? | Invasive ductal carcinoma of the breast |
| What kind of cells are found in Invasive Breast ductal carcinoma? | Duct-like cells in desmoplastic stroma |
| What is a shared feature of Invasive lobular breast carcinoma and Lobular carcinoma in situ of the breast? | Both have decreased E-cadherin expression |
| Which is the featured histological finding of Invasive lobular breast cancer? | Orderly row of cells ("single file") |
| Which invasive breast carcinoma lacks desmoplastic response? | Invasive lobular carcinoma of the breast |
| Medullary breast cancer: | Large, anaplastic cells growing in sheets with associated lymphocytes and plasma cells |
| Often bilateral with multiple lesions in the same location. What is the most likely breast cancer? | Invasive lobular carcinoma of the breast |
| Well-circumscribed breast tumor that can mimic a fibroadenoma. | Medullary breast cancer |
| What breast malignancy is associated with lymphocytes and plasma cells? | Medullary breast cancer |
| Anaplastic cells growing in sheets with WBCs and plasma cells. | Medullary breast cancer histological features |
| Which invasive breast cancer is seen with dermal lymphatic space invasion? | Inflammatory breast carcinoma |
| What are the clinical signs of Inflammatory breast cancer? | 1. Breast pain with warm 2. Swollen, erythematous skin around exaggerated hair follicles 3. Peau d' orange |
| Breast malignancy associated with "peau d' orange"? | Inflammatory breast carcinoma |
| Inflammatory breast cancer is often mistaken for: | Mastitis or Paget disease of the breast |
| What invasive breast malignancy, usually lacks a palpable mass upon physical exam or inspection? | Inflammatory breast carcinoma |
| What are the two types of Invasive breast carcinomas? | 1. Tubular subtype 2. Mucinous subtype |
| What is an invasive tubular breast cancer? | Well-differentiated tubules that lack myoepithelium |
| What is an Invasive Mucinous breast cancer featured with? | Abundant extracellular mucin and seen in older women |
| What are the main categories of testicular tumors? | Germ cell tumors and Non-germ cell tumors |
| List of Testicular Germ cell tumors | 1. Seminoma 2. Yolk sac tumor 3. Choriocarcinoma 4. Teratoma 5. Embryonal carcinoma |
| What type of testicular tumors account for nearly 95% of them? | Testicular germ cell tumors |
| What are two common conditions/risk factors for Testicular germ cell tumors? | 1. Cryptorchidism 2. Klinefelter syndrome |
| Do testicular germ cell tumors transilluminate? | No, they do not transilluminate |
| Why are testicular germ cell tumors not biopsy (usually)? | Risk of seeding scrotum |
| What is the most definite and common treatment for testicular germ cell tumors? | Radical orchiectomy |
| What is orchiectomy? | Surgical removal of one or both testicles. |
| What is the most common testicular tumor? | Seminoma |
| Seminoma is: | - Malignant - Painless - Homogenous testicular enlargement - Most common testicular tumor |
| Histology of a Seminoma (testicular tumor): | Large cells in lobules with watery cytoplasm and "fried egg" appearance |
| Which testicular tumor is seen with elevated placental ALP and is highly radiosensitive? | Seminoma |
| What is the female representation of a testicular seminoma (similar)? | Dysgerminoma |
| How is the prognosis in Seminoma? | Excellent |
| What is another name for testicular Yolk sac tumor? | Testicular endodermal sinus tumor |
| Yellow, mucinous; Aggressive malignancy of testes. (+) Schiller-Duval bodies. Dx? | Yolk sac tumor |
| What is a key serologic feature of testicular Yolk sac tumors? | Elevated AFP |
| What is the most common testicular tumor in children < 3 years old? | Yolk sac tumor |
| Description of a testicular Choriocarcinoma: | Malignant, increased hCG. Disordered syncytiotrophoblast and cytotrophoblast elements |
| Where does a testicular choriocarcinoma commonly metastasized to via blood? | Lungs and brain |
| What are some clinical symptoms associated with testicular Choriocarcinoma? | Gynecomastia and symptoms of Hyperthyroidism |
| Why does testicular choriocarcinoma is often seen with features fo hyperthyroidism? | Due to elevated levels of hCG, which shares the a-subunit with TSH. |
| What are the characteristic of testicular (male) teratoma? | Unlike females, mature teratoma in adult males is malignant and benign in children. |
| Which testicular tumor is malignant, in comparison to the same tumor but in females? | Mature teratoma |
| Testicular teratoma is benign in ___________________. | Children |
| Embryonal carcinoma characteristics: | Malignant Hemorrhagic mass with necrosis Painful |
| Which has a worse prognosis, seminoma or embryonal carcinoma? | Embryonal carcinoma |
| Which testicular germ cell tumor is painful? | Embryonal carcinoma |
| What is the common morphology of embryonal carcinoma of the testes? | Glandular/papillary |
| How is the most common presentation for an embryonal carcinoma? | Mixed with other tumors |
| Which is more likely to be seen, a "pure" embryonal carcinoma, or a mixed embryonal testicular carcinoma? | Mixed embryonal carcinoma |
| What are the associated levels of hCG and AFP in embryonal carcinoma? | Elevated hCG and normal AFP levels |
| When is a embryonal carcinoma seen with elevated AFP levels? | Mixed embryonal carcinoma |
| For what approximate percentage are testicular non-germ cell tumors accounted for? | 5% |
| Testicular non-germ cell tumors are mostly __________________. | Benign |
| Which are the 3 most common Testicular non-germ cell tumors? | 1. Leydig cell tumor 2. Sertoli cell tumor 3. Testicular lymphoma |
| What are key histological findings in Leydig cell tumors? | Reincke crystals |
| What are Reinke crystals? | Eosinophilic cytoplasmic inclusions |
| What type of testicular tumor is seen with Reinke crystals? | Leydig cell tumor |
| Golden-brown mass, (+) Reinke crystals on histology , Gynecomastia in male patient. Dx? | Leydig cell tumor |
| What is produced by Leydig cell tumor? | Androgens and estrogens which lead to gynecomastia in adults and precocious puberty in children. |
| Androblastoma from sex cord stroma. | Sertoli cell tumor |
| What is a Sertoli cell tumor? | Androblastoma from sex cord stroma |
| What is the most common testicular caner in older men? | Testicular lymphoma |
| How does testicular lymphoma most likely arises or develops? | From metastatic lymphoma to testes. Very aggressive |
| Prostatic adenocarcinoma is most common in men over _____ years old. | 50 |
| From which areas of the prostate, does prostatic adenocarcinoma, most commonly arises? | Posterior lobe (peripheral zone) of prostate gland |
| What is the most frequent way to diagnose Prostatic adenocarcinoma? | - Elevated PSA and, - Subsequent needle core biopsies. |
| What are the most useful prostate cancer tumor markers? | PAP and PSA |
| What is a common organ to which prostate cancer metastasizes to? | Bone |
| Which common male cancer is seen with Osteoblastic metastases in bone in its late stages? | Prostatic adenocarcinoma |
| How does Osteoblastic metastases from prostate cancer present clinically? | Lower back pin and increased serum ALP and PSA |
| Blood levels of a 62 year old male shoe elevated ALP and PSA. Suspected Dx? | Prostatic adenocarcinoma with Osteoblastic metastases to the bone. |
| What is the source(s) of Estrogen? | Ovary, placenta, and adipose tissue |
| Which type of estrogen is produced by the ovaries? | 17B-estradiol |
| What form of estrogen is produced by the placenta? | Estriol |
| Type of Estrogen produce by adipose tissue | Estrone via aromatization |
| What process is necessary for adipose tissue to produce estrogen in the form of estrone? | Aromatization |
| 17B-estradiol is produced by the _______________. | Ovaries |
| The from Estriol (of estrogen) is produced by the ______________. | Placenta |
| Which is the form of estrogen with the greatest potency? | Estradiol |
| Which source of estrogen produces the estrogen with the highest potency? | Ovaries as they produce estradiol |
| Estradiol > Estrone > estriol | Potency of estrogen from highest to lowest |
| List of functions of Estrogen: | 1. Development of genitalia and breast, female fat distribution 2. Growth of follicle, endometrial proliferation, and increased myometrial excitability 3. Upregulation of estrogen, LH, and progesterone receptors; Feedback inhibition of FSH and LH, then LH surge; stimulation of prolactin secretion 4. Increase transport proteins, SHBG; Increase HDL; decrease LDL |
| How is Estrogen related to structures and proliferations associated with viable pregnancy environment? | It promotes the growth of the follicle, Promotes endometrial proliferation Incrases myometrial excitability |
| Which receptors are upregulated by Estrogen? | Estrogen, LH, and progesterone receptor |
| Estrogen's feedback inhibition of FSH and LH causes ---> | LH surge |
| Effect of estrogen on prolactin | Stimulation of prolactin secretion |
| Increasing levels of estrogen have what effects on HDL and LDL? | Increases HDL and decreases LDL |
| What occurs to estradiol and estrone levels during pregnancy? | Increases a 50-fold |
| Which type of estrogen is used as an indicator of fetal well-being? | Estriol |
| How are estriol levels affected by pregnancy? | Increase in 1000-fold |
| Where in the cell are estrogen receptors located? | Cytoplasm |
| What are the common sources for progesterone? | Corpus luteum, placenta, adrenal cortex, and testes. |
| What are the functions of Progesterone? | 1. Stimulation of endometrial glandular secretion sand spiral artery development 2. Maintenance of pregnancy 3. Decrease myometrial excitability 4. Production of thick cervical mucus, which inhibits sperm entry into uterus 5. Increase body temperature 6. Inhibition of gonadotropins (LH, FSH) 7. Uterine smooth muscle relaxation 8. Decrease estrogen receptor expression 9. Prevents endometrial hyperplasia |
| The fall of progesterone after delivery causes: | Disinhibits prolactin lead to lactation |
| Lactation is due to: | Fall of progesterone after delivery causes disinhibition of prolactin |
| Increased levels o progesterone is indicative of? | Ovulation |
| Ovulation will be indicated by an increase in ______________ levels. | Progesterone |
| Progesterone is Pro----- | ProGESTATION |
| Prolactin is Pro ------ | Pro-LACTATION |
| Which hormones causes stimulation of endometrial glandular secretions and spiral artery development? | Progesterone |
| Which hormone maintains pregnancy? | Progesterone |
| The production of thick cervical mucus by progesterone is to: | Prevent sperm entry into the uterus |
| Which cholesterol derived hormone increases body temperature? | Progesterone |
| How does progesterone prevent contractions? | Uterine smooth muscle relaxation |
| Which hormone causes a decrease in estrogen receptor expression? | Progesterone |
| ________________ preventes endometrial hyperplasia. | Progesterone |
| Progesterone cause inhibition of _______________________. | Gonadotropins (LH and FSH) |
| Primary oocytes begin and complete formation during __________. | Meiosis I |
| At which phase are Primary Oocytes arrested? | Meiosis I Prophase I |
| Secondary oocytes are arrested in ------> | Meiosis II Metaphase II until fertilization |
| Meiosis I prophase I has | Primary oocytes |
| Meiosis II metaphase II has | Secondary oocytes |
| What needs to happen to a secondary oocyte in order to finish its maturation? | Fertilization |
| What is the N and C composition of a Primary Oocyte? | Diploid (2N, 4C) |
| What is the number of sister chromatids in a Primary Oocytes? | 46 sister chromatids |
| What needs to occur to a primary oocyte in order to advance from Meiosis I prophase I to become a secondary oocyte? | Ovulation |
| Number of sister chromatids in a secondary oocyte? | 23 |
| 1N, 2C describes the composition of what stage of oogenesis? | Secondary oocyte |
| Primary oocytes are _____________. | Diploid |
| Secondary oocytes and Ovum are ______________. | Haploid |
| How many polar bodies are seen in stage of a secondary oocyte? | 1 Polar body |
| Secondary oocyte is fertilized. It undergoes further maturation. What is the final number of polar bodies produced? | A total of 3 polar bodies |
| In respect to oogenesis, a 1N, 1C describes what stage? | Ovum |
| What is ploidy? | Number of complete sets of chromosomes in a cell |
| How many complete sets of chromosomes are in a diploid cell? | 2 |
| How many possible different autosomal alleles can be produced by a diploid organism? | 2 |
| What does the letter "N" in 2N, 4C mean? | Two homologous (diploid) unreplicated chromosomes |
| In connotation "2N, 4C", what does the 4C mean? | C= number of sister chromatids. Thus, 2 sets of homologous chromosomes with 2 sister chromatids each = 4C |
| Mnemonic for phases of Mitosis | I Party More At The Club |
| Ovulation is the---> | Rupture of follicle |
| Term used for rupture of follicle after LH surge | Ovulation |
| Path of Ovulation process | Increased Estrogen and GnRH receptors on anterior pituitary lead to LH surge (release) ----> ovulation |
| What is a common features of ovulation, that is progesterone induced? | Increase in temperature |
| What is Mittelschmerz? | Transient mid-cycle ovulatory pain |
| Mid-cycle ovulatory pain. Dx? | Mittelschmerz |
| Mittelschmerz is often confused with _________________. | Appendicitis |
| What causes peritoneal irritation, leading to Mittelschmerz? | Follicular swelling/rupture, fallopian tube contraction |
| How long is the Luteal phase in days? | 14 days |
| Ovulation day + 14 days = | Menstruation |
| Which menstrual cycle phase can vary in length? | Follicular phase |
| Which week of the menstrual cycle represents the fastest follicular growth? | 2nd week of follicular phase |
| What hormone is known to stimulate endometrial proliferation? | Estrogen |
| _______________ maintain endometrium to support implantation. | Progesterone |
| Which hormone is known to create environment suitable for implantation? | Progesterone |
| A decrease in progesterone leads to a decrease in ----> | Fertility |
| What hypothalamic hormone stimulates the anterior pituitary to secrete LH and FSH? | GnRH |
| Anterior pituitary hormones associated strongly with the menstrual cycle? | FSH and LH |
| The Menstrual cycle can be divided into two main sub-cycles, which are? | Ovarian cycle and the Uterine cycle |
| Which are the phases of the Ovarian cycle? | Follicular phase and Luteal phase |
| What are the phases of the Uterine cycle? | Menses, Proliferative, Secretory, and back to Menses |
| Initial menses and Proliferative phase of the uterine cycle, occurs at the same time as which ovarian phase? | Follicular phase |
| The Luteal phase is during which uterine cycle phase? | Secretory phase |
| How long would the Uterine Secretory phase is ? | 14 days approximately |
| At what point of the Uterine cycle are the Spiral arteries the longest/largest ? | Mid-secretory phase |
| Which Uterine phase has the smallest or less dense Spiral arteries along the endometrium? | Early proliferative phase |
| At what point of the menstrual cycle, approximately, is Estrogen at its highest level, with respect to the Ovarian/Uterine cycles? | Late Follicular phase of Late Proliferative Uterine phase |
| On what day of the menstrual cycle does ovulation occur? | 14th |
| What is produced (hormone) by the developing follicle in the early Follicular stage? | Estrogen |
| On what follicular phase are corpus luteum found or present? | Luteal phase |
| What is the last form of the follicle, after the Luteal phase? | Corpus albicans |
| Progesterone levels are at its highest during which point of the menstrual cycle? | Mid Luteal phase (or mid Uterine secretory phase) |
| What does AUB/HMB mean? | Abnormal Uterine Bleeding/Heavy Menstrual bleeding |
| AUB/IMB means? | Abnormal Uterine Bleeding/ IntraMenstrual Bleeding |
| What are the two categories of causes of Abnormal Uterine bleeding? | Structural and Non-structural |
| What are the Structural causes of abnormal uterine bleeding? | PALM: Polyp, Adenomyosis, Leiomyoma, or Malignancy/hyperplasia |
| What are the Non-structural causes of Abnormal uterine bleeding? | COEIN: Coagulopathy, Ovulatory, Endometrial, Iatrogenic, Not yet classified |
| What are terms to describe abnormal uterine bleeding, not longer recommended? | Menorrhagia, oligomenorrhea, or dysfunctional uterine bleeding |
| Where is the MC site for Fertilization? | Upper end of Fallopian tube (the ampulla) |
| Where is the ampulla in terms of fertilization location? | Upper end of the Fallopian tube |
| How long after ovulation does fertilization occurs? | Within 1 day |
| How many days afer fetiizaton does implantation occurs? | 6 days |
| Common site for implantation after fertilization | Within wall of the uterus |
| What hormone is secreted by Syncytiotrophoblasts and is detectable in blood after 1 week from conception? | hCG |
| hCG is detected in blood after ___________________. | A week since conception |
| How long after conception can hCG be detected in urine? | 2 weeks after conception |
| A home pregnancy test can be used as early as? | 2 weeks after conception |
| How is Gestational age calculated? | From date of last menstrual period |
| Calculated from date of last menstrual period | Gestational age |
| Calculated from date of conception | Embryonic age |
| Gestational age - 2 weeks = | Embryonic age |
| How is Cardiac output adapted in pregnancy? | Increased by increasing preload and decreased afterload, with increased HR |
| List of physiologic adaptations during pregnancy? | - Increase in cardiac output - Anemia - Hypercoagulability - Hyperventilation |
| During which weeks of pregnancy, does the hCG peaks? | 8-10 weeks |
| Which hormone secretion increases over the course of pregnancy? | Placental hormone |
| What is the reason that a pregnant woman experiences hyperventilation as an physiological adaptation? | Eliminate fetal CO2 |
| How is anemia created in a pregnant person? | Increase in plasma cells and decrease in RBCs |
| What is the main source of human chorionic gonadotropin? | Syncytiotrophoblast of placenta |
| What is the hCG function in relation to the 8 to 10 weeks of pregnancy? | Maintain corpus luteum by acting like LH |
| hCG has identical _____ subunit to LH, FSH, and TSH. | alpha-subunit |
| Which is the subunit that differentiates hCG from LH, FSH, and TSH? | beta-subunit |
| Which hormones shared identical alpha subunit with hCG? | LH, FSH, and TSH. |
| Reason a pregnant woman may develop hyperthyroidism? | Elevated levels of hCG, which may mimic TSH. |
| What does a pregnancy test detect ? | B-subunit of hCG |
| What are conditions that present with elevated hCG? | 1. Multiple gestations 2. Hydatidiform moles 3. Choriocarcinomas 4. Down syndrome |
| An decreasing level of hCG may indicate : | Ectopic/failing pregnancy, Edwards syndrome, and Patau syndrome |
| Which trisononimes are associated with low levels of human chorionic gonadotropin? | Edwards syndrome and Patau syndrome |
| Which common trisomy is associated with a high level of hCG? | Down syndrome |
| What is another name for Human Placental lactogen? | Chorionic somatomammotropin |
| Source of human placental lactogen | Syncytiotrophoblast of placenta |
| What is the main function of human placental lactogen? | Stimulates insulin production; overall increase insulin resistance |
| What is the consequence of maternal hypoglycemia? | Due to insulin resistance it leads to lipolysis, which preserves available glucose and amino acids for the fetus. |
| How is Gestational diabetes developed? | Occur if maternal pancreatic function cannot overcome that insulin resistance |
| Insulin resistance in pregnancy is related to which hormone? | Human placental lactogen |
| Two very important hormones produced by the Syncytiotrophoblast of placenta? | 1. human chorionic gonadotropin (hCG) 2. human placental lactogen |
| What is the APGAR score criteria based on? | A. appearance P. pulse G. grimace A. activity R. respiration |
| Assessment of newborn vital signs following delivery via a 10-point scale evaluated at 1 minute and 5 minutes. | APGAR score |
| Pink appearance has how many points in APGAR grading? | 2 |
| Pale or blue baby has a _____ score on appearance in APGAR scoring. | 0 |
| How many points are given to newborn with blue extremities only, in the appearance assessment in respect to APGAR score? | 1 |
| APGAR scores are from ____ to ___. | 0----2 |
| What is APGAR score requires further evaluation? | < 7 |
| What is the criteria in Grimace? | 2 points ---> Cries and pulls away 1 point ------> Grimaces or weak cry 0 point ----> No response to stimulation |
| In order to get a 2 point score in Pulse APGAR, the HR must be? | > 100 |
| Pulse APGAR score 0, it means? | No pulse |
| A HR of 89 bpm in newborn, will give how many APGAR points? | 1 point |
| What is a risk of low APGAR scores event after 5 minutes? | Long-term neurologic damage |
| No breathing gives how many APGAR score points? | 0 |
| What is the type of respiration description that will give 1 APGAR point? | Slow, irregular breathing |
| Newborn has arms and legs flexed. How many points are given in the APGAR scale? | 1 point |
| A child that does not regularly meet standard milestones is a candidate for? | Assessment for potential developmental delay |
| What age range is considered an infant? | 0-12 months |
| When is a human considered a toddler? | 12-36 months |
| Time range for Preschool age? | 3-5 years |
| What are the main 3 categories into milestones are divided? | Motor, Social, and Verbal/Cognitive |
| What are the primitive reflexes in an infant? | 1. Moro 2. Rooting 3. Palmar 4. Babinski |
| At what month is Moro reflex commonly disappeared? | 3 months |
| When is the approximate time in which the primitive rooting reflex disappear? | 4 months |
| Which primitive reflex is loss approximately at 6 months of age? | Palmar reflex |
| Which primitive reflex is lost/disappear at 3 months of age? | Moro reflex |
| Babinski sign is often present up to the _______ month of life. | 12 |
| When is the Babinski sign expected to disappear? | 12 month |
| If a baby has intact Rooting reflex, it means he or she was born how long ago? | Less than 4 months ago |
| What are milestones that test/evaluate posture? | 1. Lifts head up prone 2. Rolls and sits 3. Crawls 4. Stands 5. Walks |
| An infant is approximately how old to lift the head up prone? | 1 month |
| A baby is able to rolls and sits at what age? | 6 months |
| At point is an infant should start crawling? | 8 months |
| A baby that just started standing up, what is the approximate age? | 10 months |
| Normal age to start walking of an infant? | 12-18 months |
| Age of an infant passes a toys hand to hand? | 6 months |
| Pincer grasp is seen with: | 10 months |
| A baby starts pointing objects at what age? | 12 months |
| Social smile is seen at: | 2 months |
| Stranger anxiety is seen at: | 6 months |
| Separation anxiety is evident at what age? | 9 months |
| What is the approximate age in months in which a baby starts orientein to voice? | 4 months |
| Orients to voice | 4 months |
| Milestone. Oriented to name and gestures. Age? | 9 months |
| Milestone. Age of human in which there is object permanence? | 9 months |
| By what age, should parents may expect child to say "mama" and "dada"? | 10 months |
| What are motor milestones seen in a Toddler? | 1. Takes first steps - 12 mo 2. Climbs stairs - 18 mo 3. Cubes stacked 4. Cutlery - feeds self with fork and spoon by 20 mo 5. Kicks ball - 24 mo |
| What motor activity may be seen around 2 years old? | Kicks ball |
| What is the recreation part of a toddler milestones? | Parallel play by 24-36 months |
| At which stage of development of human, is rapprochement presented? | 24 month toddler |
| By what age does a human recognizes or realizes its own gender? | 36 months |
| How many words are usually known by a toddler? | 200 words by age 2 years |
| How old is a human that starts driving a tricycle? | 3 years old |
| By what age can a person stant copying lines or circles, and draws stick figures? | 4 years old |
| What can be expected, in motor milestones, by age 5? | Grooms self |
| Age by which a person begins having friends? | 4 years old |
| What age can a mother leave comfortably spends part of the day away from her? | 3 years old |
| A child telling a story with details may be expected how old to be? | 4 years old |
| A person with a vocabulary approximately 1000 -word extensive, is around what age? | 3 years old |
| How many grams define a low birth weight? | 2,500 grams |
| What are common causes of a low birth weight? | Prematurity and intrauterine growth restriction (IUGR) |
| What is a common event/action occuring after parturition and delivery of placenta? | Lactation due to rapid decrease in progesterone |
| Maintenance of lactation is due to: | Suckling, since increase nerve stimulation leads to increase oxytocin and prolactin secretion. |
| What is the function of Prolactin? | Induces and maintains lactation and decrease reproductive function |
| What are the functions of oxytocin? | 1. Assist in milk letdown 2. Promotes uterine contractions |
| Until what age is breast milk the ideal nutrition? | < 6 months of age |
| Breast milk contains: | Maternal immunoglobulins (mostly IgA), macrophages, and lymphocytes. |
| What conditions are less likely to occur to infant that is fed with Breast milk? | Decrease risk to develop asthma, allergies, diabetes mellitus, and obesity. |
| What is recommended to supplement children exclusively breast milk fed? | Vitamin D and Iron |
| What are the benefits to the mothers that breastfeed? | Decrease maternal risk of breast and ovarian cancer and facilities mother-child bonding. |
| How is menopause diagnosed? | Amenorrhea for 12 months |
| Decrease Estrogen production due to age-linked decline in number of ovarian follicles + amenorrhea for 12 months. Dx? | Menopause |
| What is the average age for menopause? | 51 years old |
| What activity tends to anticipate age onset for menopause? | Smoking |
| What occurs with the peripheral Estrogen (estrone) after menopause? | Converts into androgen, which elevated levels of androgen leading to hirsutism. |
| Which hormone is severely increased in menopause? | FSH |
| What are the hormonal changes in Menopause? | Decrease estrogen Mild increase in LH and GnRH Significant/Large increase in FSH |
| Which hormone is decreased in levels in menopause? | Estrogen |
| Does estrogen increase or decrease with menopause? | Decrease |
| What symptoms are seen with Menopause? | Hot flashes, Atrophy of the Vagina, Osteoporosis, Coronary artery disease, Sleep disturbances. |
| What is suggested by menopause before the age of 40? | Primary Ovarian insufficiency (premature ovarian failure) |
| Common androgens: | Testosterone, dihydrotestosterone (DHT), androstenedione |
| What form or type of androgen is the one with the highest potency? | DHT |
| Potency of androgens (highest low lowest)? | DHT > testosterone > andorstenedione |
| What are the sources of androgens? | - Testis --> DHT and testosterone - Adrenal - androstenedione |
| List of functions of testosterone: | 1. Differentiation of epididymis, vas deferens, seminal vesicles 2. Growth spur: penisn, seminal vesicles, sperm, muscle, RBCs 3. Deepening of voice 4. Closing of epiphyseal plates 5. Libido |
| What are the early DHT functions? | Differentiation of penis, scrotum, and prostate |
| What are the late DHT functions? | Prostate growth, balding, sebaceous gland activity |
| What enzyme converts testosterone to DHT? | 5a-reductase |
| What medication inhibits 5a-reductase? | Finasteride |
| Inhibition of 5a-reductase prevents: | Conversion of testosterone into DHT |
| How are androgens converted into estrogen in males? | By cytochrome P-450 aromatase in adipose tissue and penis primarily. |
| What is the key enzyme in the conversion of androgens to estrogen? | Aromatase |
| Aromatase is the key enzyme of: | Converting androgens into estrogen |
| Which "type" of testosterone is inhibited by Exogenous testosterone? | Intratesticular testosterone which leads to decrease testicular size and eventually azoospermia. |
| Testosterone helps differentiation of _______________ male genitalia. | Internal |
| What is the only internal male sexual organ not differentiated by Testosterone? | Prostate |
| When does spermatogenesis begins? | At puberty |
| How long does full development of spermatogonia take? | Two full months |
| In which structure does spermatogenesis occur? | Seminiferous tubules |
| Spermatogenesis produces ---> | Spermatids |
| What process does an spermatid needs to undergo , in order to fully mature into spermatozoon? | Spermiogenesis |
| What is the ploidy and number of chromatids (C) of an mature spermatozoon? | Haploid (1N, 1C) |
| The most apical part of the sperm's head is called the ___________. | Acrosome |
| What is the X and Y chromosomal status of a Secondary spermatocyte? | Either XX or YY. |
| In total, how main Haploid Spermatids are produced in spermatogenesis? | 4 |
| What is the composition of a sperm (spermatid) before undergoing spermiogenesis? | 23 single (sex-X or Y); Haploid 1N, 1C |
| What conditions are commonly seen by impair sperm motility? | Infertility such in Ciliary dyskinesia/Kartagener syndrome |
| How many Tanner stages are currently listed? | 5; Tanner stage I-V |
| What are the characteristics of Tanner stage I? | - No sexual hair - Flat-appearing chest with raised nipple |
| What Tanner stage is considered Pre-pubertal? | Tanner stage I |
| A 6 year old child is most likely in which Tanner stage, if healthy? | Tanner stage I |
| What are the features of Tanner stage II? | - Pubic hair appears (pubarche) - Testicular enlargement (male) - Breast bud forms (thelarche) [female] |
| What is Pubarche? | Initial appearance of pubic hair |
| What is thelarche? | Breast bud formation in females |
| Pubarche + Thelarche, are seen most commonly in which Tanner stage? | Tanner stage II |
| What years of age are usually covered or part of Tanner stage II? | ~8 - 11.5 |
| A human around ages of ~11.5-13 years old, is most commonly coursing which Tanner stage? | Tanner stage III |
| What approximate years of age are covered in Tanner stage III? | 11.5-13 years old |
| What are the features of Tanner stage III? | - Coarsening of pubic hair - Penis size/length (male) - Breast enlarges, mound forms (female) |
| In which Tanner stage, the females experience breast enlargement + formation of mound? | Tanner stage III |
| Coarse hair across pubis, sparing the thigh in male and female. This a characteristic of which Tanner stage? | Tanner stage IV |
| What are the approximate age (range) of a person in Tanner stage IV of sexual development? | ~13-15 years old |
| What are the male features of Tanner stage IV? | 1. Coarse hair across pubis, sparing the thigh 2. Penis width/glans increases |
| What is the breast (female) description of Tanner stage IV? | Breast enlarges, raised areola, and mound on mound |
| What Tanner stage covers people ~ > 15 years of age? | Tanner stage V |
| Features of pubic hair seen in Tanner stage V? | Coarse hair across pubis and medial thigh |
| Breast development of normal female in Tanner stage V? | Adult breast contour, areola flattens |
| By which Tanner stage of sexual development does the areola tends to flatten again? | Tanner stage V |
| Coarse hair across pubis, and including the medial thigh. Which Tanner stage is this part of? | Tanner stage V |
| What are the 3 criteria described by Tanner stage sexual development system? | 1. Genitalia 2. Pubic hair 3. Breast |
| Is it possible for a single person to have different Tanner stages? | Yes; Tanner stages are assigned independently to genitalia, pubic hair, and breast (female). |
| What is the most common cause of Aneuploidy? | Meiotic nondisjunction |
| List of sex chromosome disorders: | 1. Klinefelter syndrome 2. Turner syndrome 3. Double Y males 4. Ovotesticular disorder of sex development |
| What is the associated karyotype of Klinefelter syndrome? | 47, XXY |
| What are the clinical features of Klinefelter syndrome? | 1. Testicular atrophy 2. Eunuchoid body shape 3. Tall 4. Long extremities 5. Gynecomastia 6. Female hair distrubution |
| The presence of inactivated X chromosome (Barr body) in a male. Dx? | Klinefelter syndrome |
| What is a common cause of Hypogonadism? | Klinefelter syndrome |
| Which are the two structural abnormalities in Klinefelter syndrome, that produce hormonal changes? | 1. Dysgenesis of seminiferous tubules 2. Abnormal Leydig cell function |
| In Klinefelter syndrome, the dysgenesis of the seminiferous tubules has which consequences? | Decrease inhibin B secretion which leads to an elevated FSH. |
| What causes the elevated FSH in Klinefelter syndrome? | Low levels of inhibin B due to dysgenesis of seminiferous tubules |
| What are the results of abnormal Leydig function seen in Klinefelter syndrome? | Decrease testosterone leading to elevated LH which causes increase in Estrogen |
| Testosterone in Klinefelter syndrome is, low, normal, or elevated? | Low |
| FSH and LH in Klinefelter syndrome are ____________. | Elevated |
| Which sex hormone is elevated in a man with Klinefelter syndrome? | Estrogen |
| The elevation of FSH or LH causes elevated estrogen in Klinefelter syndrome? | LH |
| Which cell's abnormal function, in Klinefelter syndrome, is responsible for the low levels of testosterone? | Leydig cell |
| Low testosterone, mildly elevated FSH, LH, and estrogen. Dx? | Klinefelter syndrome |
| Associated karyotype of Turner syndrome | Female, 45, XO |
| 45XO. Dx? | Turner syndrome |
| List of clinical features seen in Turner syndrome: | 1. Short stature 2. Ovarian dysgenesis (streak ovary) 3. Shield chest 4. Bicuspid aortic valve 5. Coarctation of the aorta 4. Lymphatic defects 7, Horseshoe kidney |
| Another form to refer to the ovarian dysgenesis present in Turner syndrome? | Streak ovary |
| Coaratoin of aorta causing Femoral < brachial pulse. This features is commonly seen in ______________ syndrome. | Turner syndrome |
| What are the lymphatic defects seen with Turner syndrome? | Webbed neck or cystic hygroma; Lymphedema in feet, hands |
| Kidney defect or complication of Turner syndrome? | Horseshoe kidney |
| Horseshoe kidney is often seen with which sex chromosome disorder? | Turner syndrome |
| MCC of Primary amenorrhea | Turner syndrome |
| How many Barr bodies are associated with Turner syndrome? | Zero |
| Menopause before menarche. Dx? | Turner syndrome |
| Decreased levels of _______________ lead to increased LH and FSH in Turner syndrome. | Estrogen |
| Estrogen is ______________ in Turner syndrome. | Decreased |
| Estrogen is ________________ in Klinefelter syndrome. | Elevated |
| What is a rare cause of Turner syndrome? | Mitotic error --> Mosaicism (45XO, 46, XX) |
| 45, XO/46, XX. Dx? | Turner syndrome due to mosaicism caused by mitotic error. |
| Is pregnancy possible in Turner syndrome? | Yes, in some cases with IVF, exogenous estradiol-17B and progesterone therapy. |
| Karyotype of Double Y males | 47, XYY |
| What are some features of Double Y males? | 1. Very tall 2. Severe acne, 3. Learning disability (at times) 4. Autism spectrum disorders |
| 46, XX > 46, XY. Dx? | Ovotesticular disorder of sex development |
| Both ovarian and testicular tissue present (ovotestis); ambiguous genitalia | Ovotesticular disorder of sex development |
| What used to be the old name for Ovotesticular disorder of sex development? | True hermaphroditism |
| Which disorders of sex hormones have elevated levels of Testosterone? | 1. Defective androgen receptor 2. Testosterone-secreting tumor, exogenous steroids |
| Low testosterone + High LH. Dx? | Hypergonadotropic hypogonadism |
| Levels of testosterone and LH in hypogonadotropic hypogonadism. | Low testosterone and low LH |
| Defective androgen receptor has elevated levels of ___________ and __________. | Testosterone and LH |
| Overall definition of disorders of sex development | Disagreement between the phenotypic sex and the gonadal sex |
| Phenotypic sex is based on: | External genitalia, influence by hormonal levels |
| Sex hormone imbalance most likely will cause what type of sex abnormality-type? | Phenotypic |
| Gonadal sex: | Testes vs Ovaries; corresponds with Y chromosome |
| 46, XX DSD? | Ovaries present, but external genitalia are virilized or ambiguous |
| What is the MCC of 46, XX DSD? | Excessive and inappropriate exposure to androgens steroids during early gestation |
| 46, XY DSD? | Testes are present, but external genitalia are female or ambiguous |
| What is the most common form of 46, XY DSD? | Androgen-insensitivity syndrome |
| What is another term used for Androgen-insensitivity syndrome? | Testicular feminization |
| Male with testes, but female/ambiguous genitalia. Dx? | Androgen-insensitivity syndrome |
| What are common causes of FEMALE (XX) Hypergonadotropic hypogonadism? | Turner syndrome, Genetic mosaicism, pure gonadal dysgenesis |
| What type of conditions are classified as Hypogonadotropic hypogonadism? | CNS lesions, and Kallmann syndrome |
| Females with Hypergonadotropic hypogonadism are seen with ______________ but no breasts. | Uterus |
| Which condition in females is seen with no uterus but with breasts? | Utervaginal agenesis |
| No uterus but (+) breast in man. Dx? | Androgen insensitivity |
| Inability to synthesize estrogens from androgens. Dx? | Placental aromatase deficiency |
| What is the most common presentation of Placental aromatase deficiency? | Masculinization of female (46, XX DSD) infants, increase serum testosterone and androstenedione. |
| What is a symptom or features of a pregnant mother with child dx with placental aromatase deficiency? | Maternal virilization since fetal androgens can cross the placenta |
| Defect in androgen receptor resulting in normal-appearing female. Dx? | Androgen insensitivity syndrome |
| Are levels of testosterone, estrogen, and LH, elevated or decreased in Androgen insensitivity syndrome? | Elevated |
| A woman with diagnosed androgen insensitivity syndrome may have: | Normal functioning testes found in the labia majora |
| Inheritance mode of 5a-reductase insensitivity. | Autosomal recessive |
| Which condition is limited to genetic males (46, XY DSD)? | 5a-reductase deficiency |
| Which condition is seen to be controlled by puberty? | 5a-reductase deficiency |
| How are levels of testosterone, estrogen, and LH in 5a-reductase deficiency? | Normal |
| Failure to complete puberty; a form of hypogonadotropic hypogonadism. Dx? | Kallmann syndrome |
| What is the cause of Kallmann syndrome? | Defective migration of GnRH-releasing neurons and subsequent failure of GnRH-releasing olfactory bulbs to develop |
| What is a featured or key symptom of Kallmann syndrome? | Anosmia |
| Expected levels of androgens, and other sex hormones in Kallmann syndrome | Decreased levels of GnRH, FSH, LH, and testosterone |
| Why is the infertility in men with Kallmann syndrome? | Low sperm count |
| Infertility of women with Kallmann syndrome is due to: | Amenorrhea |
| Patient that cannot conceive and has anosmia. Dx? | Kallmann syndrome |
| Which of the Five senses is affected in Kallmann syndrome? | Smell |
| Which is a commonly suspected sex chromosome condition in cases the patient complains of not been able to smell food? | Kallmann syndrome |
| Which is the main hormone affected by decreased synthesis in Kallmann syndrome? | GnRH in the hypothalamus |
| Which cells are affected in Kallmann syndrome? | GnRH-releasing neurons |
| The defective GnRH-hypothalamic neurons in Kallmann syndrome lead to affection of? | GnRH-releasing olfactory bulbs to develop leading to decreased GnRH hypothalamic synthesis---> anosmia. |
| Anosmia is strongly associated with? | Kallmann syndrome |
| Cystic swelling of chorionic villi and proliferation of chorionic epithelium (only trophoblast). Dx? | Hydatidiform mole |
| What is a hydatidiform mole? | Cystic swelling of chorionic villi and proliferation of chorionic epithelium. |
| Which part of the chorionic epithelium is proliferated in a Hydatidiform mole? | Trophoblast |
| What is the classical clinical presentation (symptoms) of Hydatidiform mole? | 1. Vaginal bleeding 2. Uterine enlargement more than expected 3. Pelvic pressure/pain |
| What condition is often associated with hCG-mediated sequelae? | Hydatidiform mole |
| What is the hCG-mediated sequelae seen in Hydatidiform moles? | - Early preeclampsia (before 20 weeks), - Theca-lutein cysts - Hyperemesis gravidarum - Hyperthyroidism |
| Theca-lutein cysts is a complication seen with __________________ mole. | Hydatidiform mole |
| Early preeclampsia is defined as: | Before 20 weeks |
| What is hyperemesis gravidarum? | A pregnancy complication that is characterized by severe nausea, vomiting, weight loss, and possibly dehydration |
| What common endocrinological disorder is seen with a woman with a Hydatidiform mole? | Hyperthyroidism |
| What is the most common treatment for Hydatidiform moles? | 1. Dilation and curettage 2. Methotrexate |
| What anticancer drug is used in treating Hydatidiform moles? | Methotrexate |
| What are the two types of Hydatidiform moles? | Complete mole and Partial mole |
| What are the associated karyotype of Complete hydatidiform moles? | 46, XX; 46, XY |
| What are the components of Complete hydatidiform moles? | Most commonly enucleated egg + single sperm |
| Is there fetal parts in a complete hydatidiform mole? | No fetal parts |
| Which type of hydatidiform mole presents with increasing uterine size? | Complete mole |
| Which type of hydatidiform mole has severely increased levels of hCG? | Complete mole |
| What are the imaging features of a Complete Hydatidiform mole? | 1. "Honeycombed" uterus or "cluster of grapes" gross physical inspection, 2. "Snowstorm" on ultrasound |
| Which type of hydatidiform mole has higher risk of malignancy? | Complete mole |
| What are the associated karyotypes of a Partial hydatidiform mole? | 3; - 69, XXX, - 69, XXY, - 69, XYY |
| What are the components of a Partial Hydatidiform mole? | 2 sperm + 1 egg |
| 2 sperm and 1 egg often cause which type of hydatidiform mole? | Partial mole |
| Which type of Hydatidiform mole is seen with fetal parts? | Partial mole |
| Is a partial hydatidiform mole seen with fetal parts? | Yes; (+) for fetal parts |
| Which hydatidiform is seen with a minimal or slight increase in hCG level? | Partial mole |
| Which type of Hydatidiform mole is less associated with malignancy and choriocarcinoma development? | Partial mole |
| Rare trophoblastic malignancy, that may occur during or after pregnancy in mother or baby. Dx? | Choriocarcinoma |
| Which kinds of trophoblasts are included or proliferated in Choriocarcinoma? | Cytotrophoblast and syncytiotrophoblast |
| What are some associated characteristics of Choriocarcinoma? | - No chorionic villi present - Increased frequency of bilateral/multiple theca-lutein cysts |
| What are symptoms seen with Choriocarcinoma? | 1. abnormal increase in B-hCG 2. SOB 3. Hemoptysis |
| What malignancy is associated with "cannonball" metastases to the lungs? | Choriocarcinoma |
| Hematogenous spread of Choriocarcinoma to lungs, is often referred as: | "cannonball" metastases |
| What is Abruptio placentae? | Premature separation of placenta from uterine wall before delivery of infant. |
| What are some risk factor of Abruptio placentae? | Trauma, smoking, hypertension, preeclampsia, and cocaine abuse. |
| Clinical presentation of Abruptio placentae? | Abrupt, painful bleeding in third trimester. |
| Which pregnancy complication is seen as sudden and painful bleeding in the third trimester? | Abruptio placentae |
| What are possible complications of Abruptio placentae? | DIC, maternal shock, and fetal distress |
| Life threatening pregnancy complication for mother and fetus. | Abruptio placentae |
| What is Morbidly adherent placenta? | Defective decidual layer leading to abnormal attachment and separation after delivery. |
| What are risk factors leading to Morbidly adherent placenta? | 1. Prior C-section or uterine surgery involving myometrium, 2. Inflammation 3. Placenta previa 4. Advanced maternal age 5. Multiparity |
| What are the 3 main types of Morbidly adherent placenta? | 1. Placenta accreta 2. Placenta increta 3. Placenta percreta |
| What is the distinguishing factor among all 3 types of morbidly adherent placenta conditions? | The depth of penetration |
| Placenta accreta: | Placenta attaches to myometrium without penetrating it |
| What is the most common type of morbidly adherent placenta? | Placenta accreta |
| Placenta is seen attached to myometrium, but does not penetrate it. Dx? | Placenta accreta |
| What is placenta increta? | Placenta penetrates into myometrium |
| Which morbidly adherent placenta condition is seen with placenta penetrating the myometrium, but does not perforate it? | Placenta increta |
| What is the degree of depth seen in Placenta percreta? | Placenta penetrates and perforates the myometrium and into the uterine serosa |
| Which type of morbidly adherent placenta condition is seen with attachment and/or penetration into the Uterine serosa? | Placenta percreta |
| Which morbidly adherent placenta type is the one with the deepest penetration ? | Placenta percreta |
| If placenta attaches to myometrium but does not penetrate it. Dx? | Placenta accreta |
| Which morbidly adherent placenta is seen with invasion of the entire uterine wall? | Placenta percreta |
| What is a serious complication of Placenta percreta? | Placental attachment to rectum or bladder leading to hematuria |
| Which placenta-associated condition is possible seen with hematuria? | Placenta percreta |
| What type of pregnancy complication is seen with failed separation of placenta after delivery? | Morbidly adherent placenta |
| Possible cause of Sheehan syndrome | Morbidly adherent placenta |
| Attachment of placenta to lower uterine segment over internal cervical os. Dx? | Placenta previa |
| What is the definition of Placenta previa? | Attachment of the placenta to the lower uterine segment over internal cervical os. |
| Which type of placenta condition is associated with blockage of the internal cervical os? | Placenta previa |
| Associated with painless third trimester bleeding. | Placenta previa |
| Painful 3rd trimester bleeding. Dx? | Abruptio placentae |
| Painless 3rd trimester bleeding. Dx? | Placenta previa |
| Fetal vessels run over, or in close proximity to, cervical os. Dx? | Vasa previa |
| What are the possible consequences of Vasa previa? | Vessel rupture and exsanguination, and fetal death |
| What is the common clinical presentation triad seen with Vasa previa? | 1. Membrane rupture 2. Painless vaginal bleeding 3. Fetal tachycardia |
| Which two pregnancy conditions are often seen with painless vaginal bleeding? | Vasa previa and Placenta previa |
| What is considered fetal bradycardia? | < 110 bpm |
| What is the most common association to the development of Vasa previa? | Velamentous umbilical cord insertion |
| What is Velamentous umbilical cord insertion? | Cord insets in chorioamniotic membrane rather than placenta |
| Umbilical cord is inserted in chorioamniotic membrane and not in the placenta. | Velamentous umbilical cord insertion |
| What is the result of velamentous umbilical cord insertion in Vasa previa? | Fetal vessels travel to placenta unprotected by Wharton jelly |
| Unprotected fetal vessels traveling to placenta is often seen in: | Vasa previa due to velamentous umbilical cod insertion |
| What are the 4 MCC of Postpartum hemorrhage? | 1. Tone (uterine atony; MC) 2. Trauma 3. Thrombin (coagulopathy) 4. Tissue (retained products of conception) |
| What is the most common cause of postpartum hemorrhage? | Uterine atony |
| Implantation of fertilized ovum in a site other than the uterus, most often in ampulla of Fallopian tube. Dx? | Ectopic pregnancy |
| Where is the MC location for implantation in Ectopic pregnancy? | Ampulla of Fallopian tube |
| What are concerning factors that may lead to suspect Ectopic pregnancy? | - Hx of amenorrhea - Lower-than-expected rise in hCG based on dates - Sudden lower abdominal pain |
| What pregnancy complication is often mistaken for appendicitis? | Ectopic pregnancy |
| List of Ectopic pregnancy risk factors: | 1. Prior ectopic pregnancy 2. Hx of infertility 3. Salpingitis (PID) 4. Ruptured appendix 5. Prior tubal surgery 6. Smoking 7. Advanced maternal age |
| What are the two main amniotic fluid abnormality? | Polyhydramnios and Oligohydramnios |
| Too much amniotic fluid. | Polyhydramnios |
| What are the associated causes of Fetal polyhydramnios? | 1. Fetal malformations 2. Maternal diabetes 3. Fetal anemia 4. Multiple gestations |
| What are the common fetal malformations that cause Fetal polyhydramnios? | -Esophageal/duodenal atresia, and, - Anencephaly |
| How do fetal malformation lead to fetal Polyhydramnios? | Result in inability to swallow amniotic fluid |
| A diabetic mother places fetus in increased risk of which amniotic fluid condition? | Fetal polyhydramnios |
| Too little amniotic fluid | Oligohydramnios |
| What are the associated causes of Fetal Oligohydramnios? | Placental insufficiency, bilateral renal agenesis, posterior urethral valves (in males) and resultant inability to excrete urine. |
| Fetus cannot excrete urine. Dx? | Fetal oligohidramnios |
| What is a consequence of profound or severe fetal oligohydramnios? | Potter sequence |
| Potter sequence is a serious consequence of Polyhydramnios or Oligohydramnios? | Oligohydramnios |
| What is the definition of Gestational hypertension? | BP > 140/90 mm Hg after the 20th week of pregnancy |
| List of medications to treat gestational hypertension | Hydralazine a-methyldopa Labetalol Nifedipine |
| Preeclampsia is: | New-onset hypertension with either proteinuria or end-organ dysfunction after 20th week of gestation. |
| Hypertension + proteinuria in less than 20 weeks of gestation suggests: | Molar pregnancy |
| What is the cause of Preeclampsia? | Abnormal placental spiral arteries lead to endothelial dysfunction, vasoconstriction, and ischemia |
| What preexisting conditions increase risk of developing preeclampsia? | Hypertension, diabetes, CKD, autoimmune disorders such as Antiphospholipid antibody syndrome. |
| Complications of Preeclampsia? | - Placenta abruption - Coagulopathy - Renal failure - Pulmonary edema (PE) - Uteroplacental insufficiency - May lead to eclampsia and or HELLP syndrome |
| Preeclampsia + maternal seizures. Dx? | Eclampsia |
| Eclampsia may lead to maternal death due to: | Stroke, intracranial hemorrhage, or ARDS |
| What is the treatment for Eclampsia? | 1. IV Magnesium sulfate 2. Antihypertensives 3. Immediate delivery |
| What is the most characteristic (USMLE relevant) treatment option for Preeclampsia and Eclampsia? | IV magnesium sulfate |
| What are the components of HELLP syndrome? | Hemolysis Elevated Liver enzymes Low Platelets |
| What is a manifestation of severe Preeclampsia? | HELLP syndrome |
| What type of RBCs are seen in blood smear of HELLP syndrome? | Schistocytes |
| What are severe consequences of HELLP syndrome? | DIC and hepatic subcapsular hematomas leading to rupture and ultimately severe hypotension. |
| What is the treatment of HELLP syndrome? | Immediate delivery |
| What is the only definitive treatment for Preeclampsia? | Immediate delivery |
| What is the most common type of gynecologic tumor in the USA? | Endometrial |
| Which is the most common type of gynecologic tumor worldwide? | Cervical |
| Why is cervical cancer the most common gynecologic tumor worldwide? | Lack of screening or HPV vaccination |
| Which gynecologic tumor type has the worst prognosis? | Ovarian |
| Which type of gynecologic tumor has the best prognosis? | Cervical |
| Vulvar pathologies are divided into which two categories? | Non-neoplastic and Neoplastic vulvar pathologies |
| What are the Non-neoplastic vulvar pathologies? | 1. Bartholin cyst and abscess 2. Lichen sclerosus 3. Lichen simplex chronicus |
| What is the cause of Bartholin cysts or abscesses? | Blockage of Bartholin gland duct causing accumulation gland fluid |
| What type of infections are often associated with Bartholin cysts/abscess? | N. gonorrhoea infection |
| What is Lichen sclerosus? | Non-neoplastic vulvar pathology due to thinning of epidermis with fibrosis/sclerosis of dermis. |
| Porcelain-white plaques with a red or violet border in the vulva. Dx? | Lichen sclerosus |
| Which population of women are most at risk of developing Lichen sclerosus? | Postmenopausal women |
| Thinning of epidermis with fibrosis/sclerosis of dermis of the vulva. Dx? | Lichen sclerosus |
| Hyperplasia of vulvar squamous epithelium. Dx? | Lichen simplex chronicus |
| What is the presentation of Lichen simplex chronicus? | Leathery, thick vulvar skin with enhanced skin markings due to chronic rubbing or scratching. |
| What are the two main neoplastic vulvar pathologies? | 1. Vulvar carcinoma 2. Extramammary Paget disease |
| Carcinoma from squamous epithelial lining of vulva. Rare. Dx? | Vulvar carcinoma |
| Vulvar carcinoma presents along with ____________. | Leukoplakia |
| What is HPV-related vulvar carcinoma? | Associated with types HPV 16 and 18; Seen in persons with multiple partners and early coitarche. |
| What is a common cause of Non-HPV vulvar carcinoma? | Long-standing Lichen sclerosus |
| Intraepitelial vulvar adenocarcinoma. Dx? | Extramammary Paget disease |
| What are some symptoms of Extramammary Paget disease of the vulva? | Pruritus, erythema, crusting, and ulcers. |
| What are the most common vaginal tumors? | 1. Vaginal squamous cell carcinoma 2. Clear cell adenocarcinoma 3. Sarcoma botryoides |
| What is the MCC of Vaginal squamous cell carcinoma ? | Secondary to cervical SCC |
| Vaginal Clear Cell adenocarcinoma effects: | Women who had exposure to DES in utero |
| What exposure in utero leads to vaginal clear cell adenocarcinoma? | DES |
| What is Sarcoma botryoides? | Embryonal rhabdomyosarcoma varrian that affects girls < 4 years old |
| How si the presentation of Sarcoma botryoides? | Clear, grape-like, polypoid mass emerging from vagina |
| What vaginal tumor has spindle-shaped cells, (+) desmin and present in very young girls? | Sarcoma botryoides |
| What is the role/function of the placenta? | Primary site of nutrient and gas exchange between mother and fetus. |
| What are the fetal components of f the placenta? | Cytotrophoblast and Syncytiotrophoblast |
| What is the maternal component of the placenta? | Decidua basalis |
| What is the Cytotrophoblast? | Inner layer of chorionic villi |
| Which fetal component of the placenta makes cells? | Cytotrophoblast |
| Outer layer of chorionic villi | Syncytiotrophoblast |
| What is the role of Syncytiotrophoblast? | Synthesizes and secretes hormone |
| What is the main hormone produced by Syncytiotrophoblast? | hCG |
| What is hCG? | Hormone produced by Syncytiotrophoblast; structurally similar to LH |
| Secondary role of Syncytiotrophoblast? | Stimulates corpus luteum to secrete progesterone during first trimester. |
| Why is the syncytiotrophoblast not attacked by the maternal immune system? | Lacks MHC-I expression |
| A placental component derived from the Endometrium? | Decidua basalis |
| Maternal blood in lacunae | Decidua basalis |
| What are the components of the Umbilical cord? | Umbilical arteries (2) and Umbilical vein (1) |
| What is the role of the Umbilical arteries? | Return deoxygenated blood from fetal internal iliac arteries to placenta |
| Role of Umbilical vein? | Supplies oxygenated blood from placenta to fetus |
| What structure drains into IVC via liver or via ductus venosus? | Umbilical vein |
| Which structure in umbilical cord has deoxygenated oxygen in the blood? | Umbilical arteries |
| What is an associated pathology of the umbilical cord? | Single umbilical artery |
| The umbilical arteries and umbilical vein are derived from the _________________. | Allantois |
| What structures are derived from the Allantois? | Umbilical arteries and vein |
| What structure is produced at the 3rd week of gestation from the yolk sac? | Allantois |
| The allantois, extends into ___________________. | Urogenital sinus |
| What is the Urachus? | Duct between fetal bladder and umbilicus |
| Duct between the fetal bladder and umbilicus | Urachus |
| The allantois becomes the _________________. | Urachus |
| Failure of urachus to involute can lead to: | Anomalies that may increase risk of infection and/or malignancy if not treated |
| What is the Obliterated urachus? | Median umbilical ligament |
| What does the urachus become after birth? | Median umbilical ligament |
| What is the Patent urachus? | Total failure of urachus to obliterate --> urine discharge from umbilicus |
| What is key feature/symptom of Patent Urachus? | Urine discharge from umbilicus |
| Partial failure of urachus to obliterate. Dx? | Urachal cyst |
| What is the Urachal cyst? | Fluid-filled cavity lined with uroepithelium, between umbilicus and bladder |
| Painful mass below the umbilicus, which often is infected. Dx? | Urachal cyst |
| Slight failure of urachus to obliterate. Dx? | Vesicourachal diverticulum |
| What is the pathology of the outpouching of bladder? | Vesicourachal diverticulum |
| Associated pathologies of the Vitelline duct? | Vitelline fistula and Meckel diverticulum |
| At what week is the Vitelline duct obliterated? | 7th week |
| Another name of Vitelline duct? | Omphalomesenteric duct |
| What is structures are connected by the Vitelline duct? | Yolk sac to midgut lumen |
| Vitelline duct fails to close. Dx? | Vitelline fistula |
| What is the key symptom of Vitelline fistula? | Meconium discharge from umbilicus |
| Poop coming out from the bellybutton | Vitelline fistula |
| What is the cause of Meckel diverticulum? | Partial closure of vitelline duct |
| What condition is presented with a patent portion of vitelline duct attached to ileum (true diverticulum)? | Meckel diverticulum |
| What is found inside the Meckel diverticulum? | Heterotopic gastric and/or pancreatic tissue leading to melena, hematochezia, and abdominal pain. |
| Aortic arches derivatives develop into ---> | Arterial system |
| What are the precursors of the arterial system? | Aortic arches |
| The 1st Aortic arch gives rise to the --> | Maxillary artery |
| What branch of the external carotid is a derivative of the 1st aortic arch? | Maxillary artery |
| The maxillary artery is a derivative of which aortic arch? | 1st Aortic arch |
| What are the derivatives of the 2nd aortic arch? | Stapedial artery and hyoid artery |
| Stapedial and Hyoid arteries are derivatives of which aortic arch? | 2nd Aortic arch |
| Second Aortic arch gives rise to: | Stapedial artery and hyoid artery |
| What arteries are derivatives of the 3rd Aortic arch? | Common Carotid artery and the proximal part of internal Carotid artery |
| Common Carotid artery is a derivative of the _________ aortic arch. | 3rd Aortic arch |
| Which aortic arch gives rise to the proximal part of the Internal Carotid artery? | 3rd Aortic arch |
| Which part of the Internal Carotid artery is a derivative of the 3rd aortic arch? | Proximal part |
| What is the derivative, on the left, of the 4th aortic arch? | Aortic arch |
| Which aortic arch gives rise to the aortic arch? | 4th Aortic arch |
| What is the resultative derivative on the right of the 4th Aortic arch? | Proximal part of the Right Subclavian artery |
| Derivatives of the 4th aortic arch: | LEFT --> Aortic arch RIGHT ---> Proximal part of Right Subclavian artery |
| What are the derivatives of the 6th Aortic arch? | Proximal part of Pulmonary arteries and (left only) the Ductus arteriosus |
| Ductus arteriosus is a derivative of the _______ aortic arch. | 6th Aortic arch |
| Which is the bilateral derivative of the 6th aortic arch? | Proximal part of the Pulmonary arteries |
| On which side is the derivative of the 6th aortic arch derivative, Ductus arteriosus? | Left only |
| The Right recurrent Laryngeal nerve loops around the --- | Right Subclavian artery |
| Which structure is "looped" by the Left Recurrent Laryngeal nerve? | Aortic arch distal to ductus arteriosus |
| How is the Branchial apparatus composed? | Composed of branchial clefts, arches, and pouches |
| What is another name for the Branchial clefts? | Branchial grooves |
| A branchial groove is the same as a ____________________. | Branchial cleft |
| Branchial clefts are derived from _________________. | Ectoderm |
| Which part of the Branchial apparatus is derived from Ectoderm? | Branchial clefts |
| Which part of the Branchial apparatus is derived from the Mesoderm and Neural crest? | Branchial arches |
| Branchial arches are derived from : | Mesoderm and Neural crest |
| Mesoderm derived branchial arches give rise to: | Muscles and arteries |
| Neural crest derived branchial arches give rise toJ: | Bone and cartilage |
| Branchial pouches are derived from the _________________. | Endoderm |
| Which part of the Branchial apparatus is derived from the Endoderm? | Branchial pouches |
| Arrangement of the Branchial apparatus from outside to inside | CAP: Clefts --> Arches --> Pouches |
| The innermost part of the Branchial apparatus are the: | Branchial pouches |
| What does the 1st Branchial cleft derivatives into? | External auditory meatus |
| What is the Branchial cleft which derives into the external auditory meatus? | 1st Branchial cleft |
| Which branchial clefts develop into the temporary cervical sinuses? | 2nd through 4th Branchial clefts |
| What obliterates the temporary cervical sinuses? | Proliferation of 2nd arch mesenchyme |
| What is obliterated by the proliferation of the 2nd arch mesenchyme? | Temporary cervical sinuses |
| Failure to obliterate the temporary cervical sinuses lead into _____________. | Branchial cleft cyst |
| Location of Branchial cleft cyst | Lateral neck, anterior to sternocleidomastoid muscle |
| What is the MCC of Branchial cleft cyst? | Persistent cervical sinus |
| Is a branchial cleft cyst, lateral or midline, of the neck? | Lateral neck |
| What are the cartilage derivatives of the 1st Branchial arch? | 1. Maxillary process --> Maxilla, Zygomatic bone 2. Mandibular process --> Meckel cartilage --> Mandible, Malleus and Incus, Sphenomandibular ligament |
| Maxillary and Mandibular processes are cartilage/bone derivations of which branchial arch? | 1st Branchial arch |
| Muscles derived from the 1st Branchial arch: | 1. Muscles of Mastication 2. Mylohyoid muscle 3. Anterior belly of digastric 4. Tensor tympani 5. Anterior 2/3 of tongue 6. Tensor veli palatini |
| What are the muscles of mastication? | Temporalis, Masseter, Lateral and Medial Pterygoids |
| Muscles of mastication are derivatives of the ---> | 1st Branchial arch |
| Which ear muscle is a derivative of 1st branchial arch? | Tensor tympani |
| What branchial arch gives rise to the anterior 2/3 of the tongue? | 1st Branchial arch |
| Which nerve is derived of the 1st branchial arch? | CN V3 |
| Meckel cartilage is a derivative of the ____ branchial arch? | 1st Branchial arch |
| What are abnormalities associated with the 1st and 2nd Branchial arches? | 1. Pierre Robin sequence 2. Treacher Collins syndrome |
| Pierre Robin sequence is an abnormality or pathology of the ___________________ arches. | 1st and 2nd Branchial arches |
| What is Pierre Robin sequence features? | Micrognathia, glossoptosis, cleft palate, and airway obstruction |
| What is the cause of Treacher Collins syndrome? | Neural crest dysfunction |
| What are the main physical features of Treacher Collins syndrome? | Mandibular hypoplasia and facial abnormalities |
| Cartilage derived from the 2nd Branchial arch | Reichert cartilage |
| What is included as part of the Reichert cartilage? | Stapes, Styloid process, lesser horn of hyoid, and Stylohyoid ligament |
| Which bones are arised from the 2nd Branchial arch? | Staples, Styloid process, and lesser horn of Hyoid |
| Stapes is a derivative of the ___________________ arch. | 2nd Branchial arch |
| Muscle of facial expression are derived from which Branchial arch? | 2nd Branchial arch |
| List of muscles of 2nd Branchial arch: | 1. Muscles of facial expression 2. Stapedius 3. Stylohyoid 4. Platysma 5. Posterior belly of digastric |
| Posterior belly of digastric is derived from the ________________. | 2nd Branchial arch |
| Which nerve is a derivative of the 2nd Branchial arch? | CN VII |
| Which is the cartilage derivative of the 3rd Branchial arch? | Greater horn of Hyoid |
| Muscle derived from the 3rd Branchial arch | Stylopharyngeus |
| CN IX is a derivative of the ________ Branchial _________. | 3rd Branchial arch |
| Associated cartilage/bone derivatives of 4th-6th Branchial arches | Arytenoids Cricoid Corniculate Cuneiform Thyroid |
| 4th Branchial arch muscles: | - Most Pharyngeal constrictors - Cricothyroid - Levator veli palatini |
| The Cricothyroid is a derivative of which Branchial arch? | 4th Branchial arch |
| Which is the only intrinsic muscle of the larynx derived from the 4th Branchial arch? | Cricothyroid muscle |
| What muscles are derivatives of the 6th Branchial arch? | All intrinsic muscles of larynx except the Cricothyroid |
| Which CN innervate and is derived from both the 4th and 6th Branchial arches? | CN X |
| What part of CN X is derived from the 4th Branchial arch? | Superior Laryngeal branch |
| The Superior Laryngeal branch of CN X is derivation of which branchial arch? | 4th Branchial arch |
| The Recurrent and Inferior Laryngeal branches of CNX are derived from the: | 6th Branchial arch |
| Which parts of CN X are derived from the 6th Branchial arch? | Recurrent and Inferior Laryngeal branches |
| Which branchial arch(es) form the posterior 1/3 of the tongue? | 3 and 4 Branchial arches |
| Main derivatives of the 1st Branchial pouch | Middle ear cavity, Eustachian tube, and Mastoid air cells |
| What is an important contribution of the 1st branchial pouch? | Endoderm-lined structures of ear |
| What are the derivatives of the 2nd Branchial pouch? | Epithelial lining of palatine tonsil |
| What is the anatomical relation between 3rd-pouch and 4th-pouch structures? | 3rd-pouch structures end up BELOW 4th pouch structures |
| 2 main derivatives of the 3rd branchial pouch: | 1. Dorsal wings --> Inferior Parathyroids 2. Ventral wings --> Thymus |
| Which branchial pouch gives rise to the inferior parathyroids? | 3rd Branchial pouch |
| The thymus a derivative of the ______ branchial _____________. | 3rd Branchial pouch |
| What is the structure formed by the Ventral wings of the 3rd branchial pouch? | Thymus |
| Structure formed by the Dorsal wings of the 3rd branchial pouch | Inferior Parathyroids |
| Superior Parathyroids are a derivative of which branchial pouch? | 4th Branchial pouch |
| What are the structures formed by the Ventral wings of the 4th branchial pouch? | Ultimobranchial body --> Parafollicular (C) cells of thyroid |
| The parafollicular (C) cells of the thyroid are a derivative of the _____ Branchial ___________. | 4th Branchial pouch |
| MCC of DiGeorge syndrome | Chromosome 22q11 deletion |
| What pathology is due to aberrant development of 3rd and 4th pouches? | DiGeorge syndrome |
| What are the results of poor development of 3rd/4th branchial pouches, seen in DiGeorge syndrome? | - T-cell deficiency (Thymic aplasia) - Hypocalcemia (failure of parathyroid development) |
| What are the type of cardiac defects associated with DiGeorge syndrome? | Conotruncal abnormalities |
| DiGeorge syndrome is seen with ________________ (Ca2+ serum level). | Hypocalcemia |
| Hypo- or Hypercalcemia is seen in DiGeorge syndrome? | Hypocalcemia |
| What is the cause of Cleft lip? | Failure of fusion of the maxillary and merged medial nasal processes |
| The failure of the maxillary and medial nasal processes. Dx? | Cleft lip |
| Failure of fusion of the two lateral palatine shelves or failure of fusion of lateral palatine shelves with the nasal septum and/or median palatine shelf | Cleft palate |
| Defect in formation of secondary palate. Dx? | Cleft palate |
| Defect in formation of primary palate. Dx? | Cleft lip |
| What are the two causes of Cleft palate? | 1. Failure of fusion of the two lateral palatine shelves 2. Failure of fusion of lateral palatine shelves with the nasal septum and/or median palatine shelf |
| What is the default genital development? | Female |
| Mechanism of action of female genital development | Mesonephric duct degenerates and Paramesonephric duct develops. |
| Which gender is associated with SRY gene on Y chromosome? | Male |
| Which duct degenerates in female genital embryological development? | Mesonephric duct |
| Development of the Paramesonephric duct is seen in males or females genital development? | Female |
| What is produced by the SRY gene on the Y chromosome? | Testis-determining factor |
| What is secreted by Sertoli cells? | Mullerian inhibitory factor |
| What cells secrete Mullerian inhibitory factor? | Sertoli cells |
| What is MIF? | Mullerian inhibitory factor |
| What is the function of Mullerian inhibitory factor (MIF)? | Suppression of development of Paramesonephric ducts |
| What protein/hormone suppresses the development of Paramesonephric ducts in male genital development? | Mullerian inhibitory factor |
| What is secreted by Leydig cells? | Androgens |
| What is the role of androgens in male genitalia embryological development? | Stimulate development of mesonephric ducts |
| Substance that stimulates the development of Mesonephric ducts in males? | Androgens |
| Another name for the Paramesonephric duct? | Mullerian duct |
| Mullerian duct = | Paramesonephric duct |
| Develops into female internal structures- Fallopian tubes, uterus, upper portion of vagina. | Paramesonephric (Mullerian) duct |
| What is the male remnant of the Mullerian duct called? | Appendix testis |
| What is the appendix testis? | Remnant of male Paramesonephric (Mullerian) duct |
| Another name for Mullerian agenesis? | Mayer-Rokitansky-Kuster-Hauser syndrome |
| How is Mullerian agenesis clinically presented? | Primary amenorrhea in females with fully developed secondary sexual characteristics |
| Why is Mullerian agenesis presented with primary amenorrhea? | Due to a lack of uterine development |
| How are ovaries of a Mullerian agenesis patient? | Functional ovaries |
| Common name for the Mesonephric duct? | Wolffian duct |
| Develops into male internal structures, except the prostate. | Mesonephric (Wolffian) duct |
| What structures are developed by the Wolffian duct? | Seminal vesicles, Epididymis, Ejaculatory duct, Ductus deferens |
| What is the name of the female remnant of the Wolffian duct? | Gartner duct |
| SEED | Mnemonic used to recall the structures developed by the Wolffian duct. Seminal vesicles Epididymis Ejaculatory duct Ductus deferens |
| What is the result of either No Sertoli cells or lack of MIF? | Development of both female and male internal genitalia and male external genitalia. |
| What defect can be suspected in patient with both male and female internal genitalia, but only male external genitalia? | - Lack of Sertoli cells or, - Lack of MIF |
| What condition is presented by the inability to convert testosterone into DHT? | 5a-reductase deficiency |
| What are the sexual features presented in patient with 5a-reductase deficiency? | 1. Male internal genitalia 2. Ambiguous external genitalia until puberty |
| What happens during puberty to 5a-reductase deficiency patients? | Increase levels of testosterone lead to masculinization, of previous ambiguous external genitalia |
| Ambiguous external genitalia + Male internal genitalia; masculinization at 13 yo. Dx? | 5a-reductase deficiency |
| What is the role of Leydig cells in the testes, overly simplified? | Leads to male (internal and external) sexual differentiation |
| What is the overly simplified function of Sertoli cells in the testes? | Shut down female (internal) sexual diffentiation |
| What are the most common Uterine (Mullerian) anomalies? | 1. Septate uterus 2. Bicornuate uterus 3. Uterus didelphys |
| Incomplete resorption of septum of the uterus. Dx? | Septate uterus |
| What are symptoms of Septate uterus? | Decreased fertility and early miscarriage |
| Treatment for septate uterus | Septoplasty |
| What is the pathogenesis of Bicornuate uterus? | Incomplete fusion of Mullerian ducts |
| Complete failure of fusion of the uterus. Dx? | Uterus didelphys |
| What condition is presented with double uterus, cervix, and vagina? | Uterus didelphys |
| Is pregnancy posible in Uterus didelphys? | Yes |
| What androgen aids male development? | Dihydrotestosterone |
| What are the male structures derived from the Genital tubercle? | 1. Glans penis and, 2. Corpus cavernosum and spongiosum |
| Female derivatives of the genital tubercle? | 1. Glans clitoris 2. Vestibular bulbs |
| List of the undifferentiated genital structures: | 1. Genital tubercle 2. Urogenital sinus 3. Urogenital folds 4. Labioscrotal swelling |
| What is the male homolog of the Glans clitoris in females? | Glans penis |
| Female Vestibular bulbs = male __________________________. | Corpus cavernosum and spongiosum |
| What is the undifferentiated genitalia structure of the male Bulbourethral glands (of Cowper)? | Urogenital sinus |
| What are the male differentiated structures of the Urogenital sinus? | 1. Bulbourethral glands (of Cowper) 2. Prostate gland |
| Urogenital sinus + DHT ===> | Bulbourethral glands (of Cowper), and Prostate gland |
| Urogenital sinus + Estrogen ====> | Greater vestibular glands (of Bartholin) and Urethral and paraurethral glands (of Skene) |
| Glands of Bartholin and glands of Skene are _______________ derivatives from the _________________. | Female; Urogenital sinus |
| Which are the associated male genital glands coming from the Urogenital sinus? | Glands of Cowper |
| What is to become in men from the Urogenital folds as they are stimulated by DHT? | Ventral shaft of penis (penile urethra) |
| Ventral shaft of penis is a way to describe the __________________. | Penile urethra |
| What is the female homolog to the male penile urethra? | Labia minora |
| Labia minora is differentiated from the ---> | Urogenital folds |
| What is the pre-undifferentiated genital part of the Labia majora? | Labioscrotal swelling |
| Labioscrotal swelling becomes the _________________- in males. | Scrotum |
| What sex hormone is used to differentiate female genitalia? | Estrogen |
| What is Hypospadias? | Abnormal opening of the penile urethra on vental surface of penis due to failure of urethral fols to fuse |
| What is a rare male condition due to urethral folds fail to fuse during embryologic genital development? | Hypospadias |
| Which is most common, Epispadias or Hypospadias? | Hypospadias |
| What are common assocaiations of Hypospadias? | 1. Inguinal hernia 2. Cryptorchidism |
| Abnormal opeining of penile urethra on dorsal sufrace due to faulry positioning of genital tubercle. Dx? | Epispadias |
| Which penile abnormalite is due to a faulty positionning of hte genital tubercle? | Epispadias |
| What is a featured associateion of Epispadias? | Exstrophy of the bladder |
| What ar tehe tow most common congenital penile abnormaliteies? | Hyposapdias and Epispadias |
| Which surface of the penile urethra is affected in Hypospadias? | Ventral surface |
| Which surface of the penile urethra, ventral or dorsal, is affected in Epispadias? | Dorsal surface |
| What is the description of the Gubernaculum? | Band of fibrous tissue |
| What is the male remnant of the Gubernaculum? | Anchors testes with scrotum |
| What is the female remnant of the Gubernaculum? | Ovarian ligament + round ligament of the uterus |
| The Ovarian ligament and the Round Ligament of the Uterus are: | Female remnant of the Gubernaculum |
| Description of the Processus vaginalis | Evagination of peritoneum |
| What is the male remnant of the Processus vaginalis? | Tunica vaginalis |
| What happens to the Processus vaginalis in women? | It is obliterated |
| What is the path of LEFT Gonadal venous drainage? | Left ovary/testis --> Left gonadal vein --> Left renal vein --> IVC |
| Which vein is not "skipped" by the Right gonadal venous drainage, in comparison to the left side? | No Right renal vein |
| If the venous drainage does not include the renal vein, it represents which side? | Right side |
| If the venous drainage of the gonads includes the renal vein, it must indicate which side? | Left side |
| Which side has a longer gonadal venous drainage? | Left side |
| Which side is most common to develop a varicocele? | Left side |
| Why are varicoceles more common to occur in the Left side of the venous drainage? | Left venous pressure is greater than the right |
| Which vein enters the left renal vein at a 90 degree angle? | Left spermatic vein |
| Which renal vein, right or left, has a less laminar flow? | Left side |
| What is the lymphatic drainage of the ovaries/testis? | Para-aortic lymph nodes |
| What structures are known to drain lymph fluid into the Para-aortic lymph nodes? | Ovaries and testes |
| Where does lymph of the body of uterus and superior bladder drain into? | External iliac lymph nodes |
| What structures drain into the superficial inguinal nodes? | Distal vagina, vulva, scrotum, and distal anus |
| Which lymph nodes receive lymph drainage from the Prostate/cervix, corpus cavernosum, and proximal vagina? | Internal iliac nodes |
| Lymph of the glans penis drains into the _____________________ nodes. | Deep inguinal nodes |
| What is connected by the infundibulopelvic ligament? | Ovaries to lateral pelvic wall |
| What are the structures contained in the Infundibulopelvic ligament? | Ovarian vessels |
| What is another name for the Infundibulopelvic ligament? | Suspensory ligament of the ovary |
| Why are Ovarian vessels ligated during an Oophorectomy? | Avoid bleeding |
| In respect to the peritoneum and gonadal vessels where does the ureter course? | Retroperitoneally, close to gonadal vessels |
| What structures are at risk by ligation of ovarian vessels? | Ureters |
| What ligament contains the ovarian vessels? | Infundibulopelvic ligamet |
| What structures are contained by the Suspensory ligament of the ovary? | Ovarian vessels |
| Infundibulopelvic ligament = | Suspensory ligament of the ovary |
| Ovaries to lateral pelvic wall are connected by which ligament? | Infundibulopelvic ligament |
| What structures are connected by the Cardinal ligament? | Cervix to side wall of pelvis |
| What vessels are contained by the Cardinal ligament? | Uterine vessels |
| Infundibulopelvic ligament contains __________ vessels. Cardinal ligament contains the _______________ vessels. | ----- Ovarian vessels Uterine vessels |
| Which surgical procedure places the ureters in risk of injury by ligation of the uterine vessels? | Hysterectomy |
| Which vessels are ligated during a hysterectomy? | Uterine vessels |
| Which structures are at higher risk of injury during a Hysterectomy? | Ureters |
| What does the Round ligament of the uterus connect? | Uterine horn to labia majora |
| Uterine horn-----------------------------labia majora. Name of the connecting structure? | Round ligament of the uterus |
| Which ligament is a derivative of gubernaculum that has no association connecting ovaries? (Female) | Round ligament of the uterus |
| What canal is used by the Round ligament of the Uterus? | Round inguinal canal |
| Anatomical position of the Round Ligament of the Uterus with respect to the artery of Sampson? | Travels above the artery of Sampson |
| What structure is known tor travel above the artery of Sampson? | Round ligament of the uterus |
| What are the contained structures of the Broad ligament? | Ovaries, fallopian tubes, round ligaments of uterus |
| Which ligament contains the round ligament of the uterus? | Broad ligament |
| What is connected by the Broad ligament? | Uterus, fallopian tubes, and ovaries to pelvic side wall |
| [Uterus, Fallopian tubes, Ovaries]----------(Pelvic side wall). Represents? | Dotted line is the Broad ligament connects those structures together |
| Which ligament is known to contain the Round ligament of the uterus? | Broad ligament |
| Which ligament connects the Medial pole of ovary to uterine horn? | Ovarian ligament |
| What is the Broad ligament? | Fold of peritoneum that comprises the mesosalpinx, mesometrium, and mesovarium |
| A fold of the peritoneum that comprises the meso-salpinx, -metrium, and -ovarium. | Broad ligament |
| Ligament derivative of gubernaculum that connects the inside surface of the ovatire to the uterine horn | Ovarian ligament |
| Ovarian Ligament Latches to | Lateral uterus |
| Ovaries are contained by which ligament? | Broad ligament |
| Which structures associated with pregnancy are contained by the Broad ligament? | Ovaries and Fallopian tubes |
| It is safe to associate a Fallopian tube with which ligament? | Broad ligament |
| What is the pathway of sperm during ejaculation? | 1. Seminiferous tubules 2. Epididymis 3. Vas deferens 4. Ejaculatory duct 5. Urethra 6. Penis |
| What is mnemonic used to arrange properly the pathway that sperm travel during ejeaculation? | SEVEN UP |
| SEVEN UP: | Seminiferous tubules Epididymis Vas deferens Ejacularoty ducts N(nothing) Urethra Penis |
| Urethral injuries are almost exclusive of which gender? | Male |
| What is a classic sign that should raise suspicion of an urethral injury? | Blood is seen in urethral meatus |
| Which are the two main types of urethral injury? | Anterior and Posterior urethral injuries |
| What part of the urethra is injured in anterior urethral injury? | Bulbar (spongy) urethra |
| Injury to the Bulbal or Spongy urethra. Dx? | Anterior urethral injury |
| Which part of the urethra is injury in a posterior injury? | Membranous urethra |
| What is the mechanism of injury of an anterior urethral injury? | Perineal straddle injury |
| A pelvic fracture is the most common mechanism to cause which type of Urethral injury? | Posterior urethral injury |
| Where does urine leak in a posterior urethral injury? | Retropubic space |
| Leakage of urine into retropubic space. Dx? | Posterior urethral injury |
| Where (anatomical structure) is blood accumulated in an anterior urethral injury? | Scrotum |
| Which structure must torn in order for urine to leak into perineal space in a anterior urethral injury? | Buck fascia |
| What happens in an Anterior urethral injury if the Buck fascia is torn? | Urine escapes into perineal space |
| What are the common clinical symptoms of an Anterior urethral injury? | Blood at urethral meatus and Scrotal hematoma |
| Patient presents with a Scrotal hematoma. Most likely dx? | Anterior urethral injury |
| Blood at urethral meatus + high-riding prostate | Most common presentation of Posterior urethral injury |
| Vignette describes a person in VA and presenting a high-riding prostate.. Dx? | Posterior urethral injury due to pelvic fracture |
| Which part of the nervous system is in charge erection? | Parasympathetic nervous system |
| Which nerves are associated with penile erection? | Pelvic splanchnic nerves, S2-S4 |
| What action may be affected by damage to nerve roots S2-S4? | Erection |
| Is NO (nitric monoxide) anti-or proerectile? | Proerectile |
| What is the MOA of NO as proerectile? | NO --> Increases cGMP --> smooth muscle relaxation --> vasodilation ---> Pro-erection. |
| Which catecholamine is known to be antiereictile? | Norepinephrine |
| What is the direct effect of NE by which it causes smooth muscle contraction ? | Increases Ca2+ serum levels |
| Emission of male sexual response is performed by which part of the nervous system? | Sympathetic nervous system |
| What nerve is associated to cause emission in male sexual response? | Hypogastric nerve, T11-L2 |
| What part of male seuxal respones may be affected by damage or injury to nerve roots T12-L2? | Emission |
| Which nerve causes ejaculation of sperm? | Pudendal nerve |
| Injury to the Pudendal nerve may cause what effect on male sexual response? | Lack of ejaculation |
| No ejaculation is due to _____________ nerve damage. | Pudendal nerve |
| Visceral and Somatic nerves are involved in which part of the male sexual response? | Ejaculation |
| How doe PDE-5 inhibitors help erectile dysfunction? | Decrease the cGMP breakdown |
| Higher levels of cGMP would mean what to a male erection? | Better erection due to increased vasodilation |
| Most common PDE-5 inhibitor | Sildenafil |
| Function of Spermatogonia | Maintain germ cell pool and produce primary spermatocytes |
| What are the locations in which Spermatogonia is found? | - Line seminiferous tubules - Germ cells |
| List of functions of Sertoli cells | 1. Secrete inhibin B 2. Secrete Androgen-binding protein 3. Produce MIF 4. Tight junctios between adjacent Sertoli cells form the blood-testis barrier. 5. Support and nourish developing spermatozoa 6. Regulate spermatogenesis |
| How are Sertoli cells temperature sensitive? | Decrease sperm production and decreased inhibin B with increasing temperature |
| What is the function of inhibin B secreted by Sertoli cells? | Inhibit FSH |
| What Sertoli cell secretion inhibits FSH? | Inhibin B |
| What is the purpose of the Androgen-binding protein secreted by Sertoli cells? | Maintain local levels of testosterone |
| What protein is known to maintain local levels of testosterone? | Androgen-binding protein |
| Which cells secrete Inhibin B and Androgen-binding protein? | Sertoli cells |
| What is the purpose or function of the blood-testis barrier created by advent Sertoli cells' tight junctions? | Isolate gametes from autoimmune attack |
| What structure protects gametes from autoimmune attack and it is associated with Sertoli cells? | Blood-testis barrier |
| Which cells regulate spermatogenesis? | Sertoli cells |
| Which cells line the seminiferous tubules? | Sertoli cells |
| Non-germ cells of the male anatomy | Sertoli cells |
| Homolog of female granulosa cells | Sertoli cells |
| Which are the male "granulosa cells"? | Sertoli cells |
| Which cells secrete testosterone? | Leydig cells |
| What cells are found in the Seminiferous tubules? | Spermatogonia, Sertoli cells, and Leydig cells |
| What hormone is required by Leydig cells to produce testosterone? | LH |
| Is testosterone production affected by temperature? | No, it is not affected |
| Homolog of female theca interna cells | Leydig cells |
| Where in the seminiferous tubules are Leydig cells found? | Interstitium |
| Leydig cells are considered _________________ cells. | Endocrine cells |
| Leydig cells secrete/produce ______________________ in the presence of LH. | Testosterone |
| List of important genes of Reproductive embryogenesis: | 1. Sonic hedgehog gene 2. Wnt-7 gene 3. Fibroblast growth factor (FGF) gene 4. Homeobox (Hox) genes |
| Where is the Sonic hedgehog gene produced? | At base of limbs in zone of polarizing activity |
| What is the involvement or role of the Sonic hedgehog gene? | Patterning along anteroposterior axis and CNS development |
| What condition is associated by a mutation to the Sonic hedgehog gene? | Holoprosencephaly |
| What gene is probably mutated in patient with Holoprosencephaly? | Sonic hedgehog gene |
| Gene of reproductive embryogenesis found limbs with polarizing activity | Sonic hedgehog gene |
| Where is Wnt-7 gene produced? | Apical ectodermal ridge |
| What gene is produced or found in the thickened ectoderm at distal end of each developing limb? | Wnt-7 gene |
| What is the role or involvement of the Wnt-7 gene? | Proper organization along dorsal-ventral axis |
| What gene dictates proper organization along the dorsal-ventral axis? | Wnt-7 gene |
| Where is the Fibroblast growth factor (FGF) gene produced? | Apical ectodermal ridge |
| Which important embryological genes are produced at the apical ectodermal ridge? | Wnt-7 gene and FGF gene |
| Stimulates mitosis of underlying mesoderm, providing for lengthening of limbs. Gene? | Fibroblast Growth factor (FGF) gene |
| What is the function of the FGF gene? | Stimulate mitosis of underlying mesoderm, causing the lengthening of limbs. |
| Common used abbreviation of Homeobox gene? | Hox gene |
| What is the function or involvement of the Hox gene? | Segmental organization of embryo in a craniocaudal direction. |
| Code for transcription factors? | Homeobox genes |
| Hox mutations lead to: | Appendages in wrong locations |
| Neonates is seen with three arms at abnormal locations. Which is the probable gene mutated? | Homeobox genes |
| Hox mutation = | Wrong limb placement |
| On what day does fertilization occurs? | Day 0 |
| How many chromosomes (N) and Chromatids (C) are in a zygote on Day 1? | 2N (chromosomes) 4C (chromatids) |
| What is formed on Day 4 after Fertilization of the egg? | Morula |
| A day after the morula is formed, the ____________________ appears. | Blastocyst |
| Approximate day on which the Blastocyst is fully formed? | Day 5 |
| During which days after fertilization, does the implantation of the blastocyst into endometrium occurs? | Day 6-10 |
| What occurs on Day 6-10 after fertilization of egg? | Implantation |
| Into which tissue does the implantation occurs initially? | Endometrium |
| What is the inner lining of the uterus? | Endometrium |
| When does hCG secretion begins? (approximately) | Around the time of implantation of blastocyst |
| What occurs, in relation of hormone secretion, at time of implantation of the blastocyst? | Secretion of hCG |
| Approximate time when the Bilaminar disc appears? | Within week 2 |
| What ar the 2 layers found/produced in the bilaminar disc? | Epiblast and hypoblast |
| Around what week of embryogenesis is the trilaminar embryonic disc formed? | Within week 3 |
| How is the primitive streak formed? | Cells from epiblast invaginate |
| What type of tissue (embryological) are found in the primitive streak? | Endoderm, mesoderm, and ectoderm |
| What arises, around week 3 of embryogenesis, from the midline of the mesoderm? | Notochord |
| What happens to the overlying ectoderm of the primitive streak? | Becomes the neural plate |
| What forms the neural plate? | The overlying ectoderm of the primitive streak |
| Which weeks of embryogenesis make up the Embryonic period? | Weeks 3-8 |
| What actions/events take place during the Embryonic period? | 1. Neural tube formed by neuroectoderm and closes by week 4 2. Organogenesis |
| Which time/period is extremely susceptible to teratogens? | Weeks 3-8 |
| Neural tube is form by _____________________. | Neuroectoderm |
| At what week is the neural tube closed? | Week 4 |
| Events of Week 4 of embryogenesis: | 1. Heart begins to beat 2. Upper and lower limb buds begin to form |
| A newly beating heart in an embryo indicates how many weeks of pregnancy? | At least 4 weeks |
| Fetal cardiac activity visible by transvaginal ultrasound by week ____. | Week 6 |
| Approximate week of gestation at which fetal movements start? | Week 8 |
| What occurs at week 10 of embryogenesis? | Genitalia have male/female characteristics |
| What are the main divisions of Ectoderm? | 1. Surface ectoderm 2. Neural tube 3. Neural crest |
| The ectoderm is the _______________ _______________ layer. | External/ outer |
| Associated condition/tumor of the Surface ectoderm? | Craniopharyngioma |
| List of Surface ectoderm derivatives: | 1. Epidermis 2. Adenohypophysis (from Rathke's pouch) 3. Lens of eye 4. Epithelial linings of oral cavity, sensory organs of ear, and olfactory epithelium 5. Anal canal below the pectinate line 6. Parotid, sweat, mammary glands |
| Which part of the Pituitary gland is a surface ectoderm derivative? | Adenohypophysis |
| What part of the eye is of Surface ectoderm origin? | Lens of eye |
| What embryologic derivative makes up the lens of eye? | Surface ectoderm |
| Anterior pituitary gland is made from the ___________ __________. | Surface ectoderm |
| Surface ectoderm forms the epithelial lining of which structures: | Oral cavity, sensory organs of ear, and olfactory epithelium |
| Anal canal below the pectinate line is from which embryological tissue derivate? | Surface ectoderm |
| What are common glands originated from surface ectoderm? | Parotid, sweat, and mammary glands |
| Bening Rathke pouch tumor with cholesterol crystals, calcifications. Dx? | Craniopharyngioma |
| Why is a Craniopharyngioma associated as a Surface ectoderm malignancy? | It is a tumor of the Rathke pouch, which forms the adenohypophysis. |
| Above or below the pectinate line of the anal canal, is it made from Surface ectoderm? | Below |
| What are 3 main structures made from Neural tube? | 1. Brain, 2. Retina, and 3. Spinal cord |
| The neural tube gives rise to the brain, which is composed of: | Neurohypophysis, CNS neurons, Oligodendrocytes, Astrocytes, Ependymal cells, Pineal gland |
| Which gland is of Neural tube origin, and is part of the brain composition? | Pineal gland |
| What is the embryologic derivative to the Neurohypophysis? | Neural tube |
| Which Brain cells are of Neural tube origin? | CNS neurons, oligodendrocytes, astrocytes, and Ependymal cells |
| Which part of the eye is made of Neural tube? | Retina |
| Embryological derivatives of the Eye: Retina -----> Lens of Eye ----> | ------> Neural tube -------> Surface ectoderm |
| What can be a overly simplified way to remember structures made form the Neural crest? | PNS and non-neural structures nearby |
| List of Neural crest derivatives: | 1. Melanocytes 2. Myenteric (Auerbach) plexus 3. Odontoblasts 4. Endocardial cushions 5. Laryngeal cartilage 6. Parafollicular (C) cells of the thyroid 7. PNS 8. Adrenal medulla and all ganglia 9. Spiral membrane (aorticopulmonary septum) 10. Schwann cells, 11. Pia and arachnoid 12. Bones of skull |
| Embryologic derivative of Melanocytes? | Neural crest |
| What GI plexuses are of Neural crest origin? | Myenteric (Auerbach) plexuses |
| Auerbach plexus is an embryologic derivative of _______________. | Neural crest |
| Which skin related cells are a neural crest derivative? | Melanocytes |
| Odontoblasts and Melanocytes are derivatives of: | Neural crest |
| What is the embryological tissue of Endocardial cushions? | Neural crest |
| Cardiac structures of Neural crest origin: | 1. Endocardial cushions 2. Aorticopulmonary septum |
| Which organ's cartilage is of Neural crest origin? | Laryngeal cartilage |
| Which thyroid cells are derivatives of Neural crest? | Parafollicular (C) cells |
| The PNS is made from ____________ ___________. | Neural crest |
| What is conveyed in the PNS that has Neural crest origin? | Dorsal root ganglia, Cranial nerves, and autonomic ganglia |
| What is the origin embryological tissue of the Cranial nerve? | Neural crest |
| Autonomic ganglia is a derivative of: | Neural crest |
| Schwann cells are a drevivate fo ________ ___________. | Neural crest |
| What is the embryological tissue of the bones of skull? | Neural crest |
| Pia and arachnoid are derivatives of the ______________________. | Neural crest |
| List of Mesodermal derivatives: | 1. Muscle 2. Bone 3. Connective tissue 4. Serous lining 5. Spleen 6. Cardiovascular structures 7. Lymphatics 8. Blood 9. Wall of gut tube 10. Upper vagina 11. Kidneys 12. Adrenal medulla 13. Dermis 14. Testes and Ovaries |
| What is the only postnatal derivative of the Notochord? | Nucleus pulposus |
| What are the associated defects of Mesoderm? | Vertebral defects Anal atresia Cardiac defects Tracheo-Esophageal fistula Renal defects Limb defects |
| What common atresia is due to defective Mesoderm? | Anal atresia |
| What are the serous lining made from Mesoderm? | Peritoneum, Pericardium, and pleura |
| Muscle , bone, connective tissue and spleen are of __________________ origin. | Mesoderm |
| What part of the vagina is of Mesoderm derivation/ | Upper vagina |
| Blood and lymphatics are derivatives of? | Mesoderm |
| What is the embryological origin of the kidneys, adrenal cortedx, dermis and testes/ovaries? | Mesoderm |
| Dermis is of ___________________- derivation. | Mesoderm |
| Wall of gut tube is a derivative of __________________. | Mesoderm |
| Gut tube epithelium, included anal canal above the pectinate line, is of ____________________ origin. | Endoderm |
| Most of the urethra and lower vagina are derived of ____________. | Endoderm |
| What structures are derived from Urogenital sinus? | Lower vagina and urethra |
| What are the luminal epithelial derivatives? | Lungs, liver, gallbladder, pancreas, eustachian tube, thymus, parathyroid, and thyroid follicular cells |
| Thyroid follicular cells are ___________________ derivative. | Endoderm |
| What is the embryological tissue of luminal epithelial derivatives? | Endoderm |
| Thyroid follicular cells are of __________________ origin. | Endoderm |
| What is the definition of Agenesis? | Absent organ due to absent primordial tissue. |
| Absent organs due to absent primordial tissue. | Agenesis |
| Definition of Aplasia: | Absent organ despite presence of primordial tissue |
| Which error in morphogenesis depicts no organ, despite the presence of primordial tissue? | Aplasia |
| What is hypoplasia? | Incomplete organ development with primordial tissue present |
| Is primordial tissue present in hypoplasia? | Yes |
| Secondary breakdown of previously normal tissue or structure | Disruption |
| What is an example pathology of a error in Disruption? | Amniotic band syndrome |
| When do Deformation errors occur (gestation)? | After embryonic period |
| Which error in morphogenesis occurs during the Embryonic period? | Malformation |
| Intrinsic disruption is known as ________________. | Malformation |
| Extrinsic disruption is known as _________________. | Deformation |
| What is the definition of Sequence, as an error in morphogenesis? | Abnormalities result from single primary embryologic event |
| What is a common example of an error in sequence? | Oligohydramnios causing to Potter sequence |
| When are teratogens most dangerous to fetal development? | 3rd-8th weeks of pregnancy |
| Teratogenic susceptibility before week 3 produce --> | "all-or-none" effects |
| Teratogen affection to fetus after week 8 causes? | Growth and function deficits |
| Teratogenic effect of ACE inhibitors | Renal damage |
| Which type of medications can cause renal damage as a teratogenic effect? | ACE inhibitors |
| Teratogenic effect of alkylating agents? | 1. Absence of digits, 2. Multiple anomalies |
| The absence of digits as a teratogenic effect is due to: | Alkylating agents |
| Teratogen - Aminoglycosides cause: | Ototoxicity |
| Which type of antibiotics are associated with Ototoxicity caused by a teratogen? | Aminoglycosides |
| What are some important teratogenic defects caused by Antiepileptic drugs? | 1. NT defects 2. Cardiac defects 3. Cleft palate 4. Skeletal abnormalities (phalanx/nail hypoplasia, facial dysmorphism) |
| What are associated skeletal abnormalities due to teratogenic effects of antiepileptic drugs? | Phalanx/nail hypoplasia and Facial dysmorphism |
| List of most common teratogenic antiepileptics: | Valproate, carbamazepine, phenytoin, and phenobarbital |
| What is recommended as prevention of teratogenic effects due to antiepileptics? | High-dose folate supplementation |
| Teratogenic effects: Vaginal clear cell adenocarcinoma, and Congenital Mullerian anomalies. Associated medication? | Diethylstilbestrol |
| What are the associated teratogenic effects of Diethylstilbestrol? | 1. Vaginal clear cell adenocarcinoma 2. Congenital Mullerian anomalies |
| What are some common Folate antagonists? | Trimethoprim (TMP), Methotrexate (MTX), and anti-epileptic drugs |
| Main teratogenic effect of folate antagonist? | Neural tube defects |
| Teratogen - Isotretinoin causes? | Multiple severe birth defects |
| Ebstein anomaly is due to a which teratogen? | Lithium |
| What is Ebstein anomaly? | Apical displacement of tricuspid valve |
| Lithium intake during pregnancy is associated with development of: | Ebstein anomaly |
| Teratogen - Methimazole. | Aplasia cutis congenita |
| Aplasia cutis congenita is due to which teratogen? | Methimazole |
| What are the adverse teratogenic effects to Tetracyclines? | 1. Discolored teeth 2. Inhibited bone growth |
| Discolored teeth on baby may be due to: | Tetracycline use during pregnancy |
| What are the teratogenic effects produced by Thalidomide? | Limb defects (phocomelia, micromelia- "flipper" limbs |
| Which teratogen is associated with limb defects such as "flipper" limbs? | Thalidomide |
| Chronic anticoagulant considered a teratogen? | Warfarin |
| What are the teratogenic defects produced by Warfarin? | Bone deformities, fetal hemorrhage, abortion, ophthalmologic abnormalities |
| Which anticoagulant should be used on pregnant woman? | Heparin |
| Which are the most common substance abused that cause teratogenic effects? | Alcohol, Cocaine, and Smoking (nicotine, CO) |
| What are the teratogenic abnormalities or defects seen with Alcohol abuse? | 1. Birth defects and intellectual disability 2. Fetal alcohol syndrome |
| What vessel action is produced by consumption of cocaine? | Vasoconstriction |
| Presentation of teratogenic effects of Cocaine abuse? | Low birth weight, preterm birth, IUGR, and placenta abruption |
| What type of substance abuse is suspected by a preterm birth and placenta abruption? | Cocaine and Smoking |
| What is IUGR? | Intrauterine Growth Restriction; A condition in which a baby doesn't grow to normal weight during pregnancy. |
| IUGR is associated with ________________ abuse. | Cocaine |
| Teratogenic substance known to cause Vasoconstriction | Cocaine and Nicotine |
| What is possible reason to which Smoking and cocaine abuse share some teratogenic effects? | Both cause vasoconstriction |
| Associated teratogenic effects of smoking | 1. Low birth weight 2. Preterm labor 3. Placental problems 4. IUGR, SIDS, and ADHD |
| CO due to smoking causes? | Impaired O2 delivery --> teratogenic defects |
| Excess iodine during pregnancy is associated with: | Congenital goiter or hypothyroidism (cretinism) |
| Which maternal condition is associated with Caudal Regression syndrome? | Maternal diabetes |
| What is Caudal Regression syndrome? | Anal atresia to sirenomelia |
| Which congenital heart defects are associated with Maternal diabetes? | VSD, transposition of the Great vessels |
| List of teratogenic defects associated with Maternal diabetes: | 1. Caudal Regression syndrome 2. Congenital heart defects (VSD, TOGV) 3. NT defects 4. MacrosomÃa 5. Neonatal hypoglycemia 6. Polycythemia |
| Associated teratogen defect of Methylmercury | Neurotoxicity |
| Which are the highest/largest sources of methylmercury? | Swordfish, shark, tilefish, and king mackerel |
| What are the teratogen defects produced by Vitamin A excess? | 1. Extremely high risk for Spontaneous abortions and birth defects (cleft palate, cardiac). |
| What are the possible teratogenic abnormalities produced by X-rays? | Microcephaly and Intellectual disability |
| What is a common measure to reduce teratogenicity of X-ray exposure? | Lead shielding |
| What is the leading cause of intellectual disability in the U.S.? | Fetal alcohol syndrome |
| Associated abnormalities of Fetal alcohol syndrome | - Pre- and postnatal developmental retardation, microcephaly, facial abnormalities, limb dislocation, and heart defects |
| What are the facial abnormalities produced by Fetal alcohol syndrome? | Smooth philtrum, thin vermillion border (upper lip), small palpebral fissures |
| Most severe form of heart defects in Fetal alcohol syndrome | Heart-lung fistulas |
| What are the most severe complications of Fetal-alcohol syndrome? | Heart-lung fistulas and Holoprosencephaly |
| What mechanism is failed in Fetal alcohol syndrome? | Cell migration |
| What is Neonatal abstinence syndrome? | Complex disorder involving CNS, ANS, and GI systems; secondary to maternal opiate use/abuse |
| What kind of substance is abused in order to develop Neonatal Abstinence syndrome? | Opiate |
| Secondary to maternal opiate abuse/use. Dx? | Neonatal abstinence syndrome |
| What is the common clinical presentation of newborn with Neonatal abstinence syndrome? | - Uncoordinated sucking reflexes - Irritability - High-pitched crying - Tremors, tachypnea, sneezing, diarrhea, and, - Seizures |
| What is another term to refer to Dizygotic twins? | Fraternal |
| Dizygotic twins arise form? | 2 eggs that are separately fertilized by 2 different sperm. |
| What is the number of amniotic sacs and placenta(s) in dizygotic twins? | 2 separate amniotic sacs 2 separate placentas |
| What is the medical term for placenta? | Chorion |
| Another way to refer to monozygotic twins? | Identical twins |
| Monozygotic twins arise from? | 1 fertilized egg (1 egg + 1 sperm) that splits early in pregnancy |
| In monozygotic twins what determines the chorionicity and amnionicity? | The timing of cleavage |
| Twining; Cleavage 0-4 days --> | Separate chorion and amnion (2 & 2) |
| A shared chorion in twins is due to cleavage time? | Cleavage 4-8 days |
| Cleaved of monozygotic twins in Days 4-8 lead to: | Shared chorion |
| Shared amnion is seen if the cleavage is at__________________ days. | 8-12 |
| Twin cleavage 8-12 days lead to: | Shared amnion |
| What is the result of twin cleavage 13+ days? | Shared Body (conjoined) |
| When is cleavage of conjoined twins? | 13+ days |
| 2 eggs + 2 sperm = | Dizygotic twins |
| 1 egg + 1 sperm + early split in pregnancy = | Monozygotic twins |
| Twins that look just the same are | Monozygotic twins |
| Twin siblings that do not look exactly the same are known as: | Dizygotic twins |
| Chorion = | Placenta |
| What is chorionicity? | Number of placentas |
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rakomi
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