USMLE (Fach) / Reproductive (Lektion)
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- Ectoderm Surface ectoderm:- Epidermis- Adenohypophysis (from Rathke pouch)- Lens of eye- Epithelial linings of oral cavity, sensory organs of ear, olfactory epithelium- Anal canal below the pectinate line- Parotid, ...
- Mesoderm - Muscle- Bone- Connective tissue, skin- Serous linings of body cavities (eg, peritoneum, pericardium, pleura)- Spleen (derived from foregut mesentery)- Cardiovascular structures- Lymphatics- Blood- Wall ...
- Endoderm - Gut tube epithelium (including anal canal above the pectinate line)- Most of urethra and lower vagina (derived from urogenital sinus)- Luminal epithelial derivatives (eg, lungs, liver, gallbladder, ...
- Potter sequence = atypical physical appearance of a fetus or neonate due to oligohydramnios experienced in the uterus - clubbed feet- pulmonary hypoplasia- cranial abnormalities
- Teratogens - Medications - ACE inhibitors → Renal damage- Alkylating agents → Absence of digits, multiple anomalies- Aminoglycosides → Ototoxicity- Antiepileptic drugs (valproate, phenytoin, carbamazepine, phenobarbital) ...
- Teratogens - Substance abuse Alcohol → Intellectual disability; fetal alcohol syndrome Cocaine → Low birth rate, preterm birth, IUGR, placental abruption Smoking (nicotine, CO) → Low birth weight (leading cause in developed ...
- Teratogens - Other Iodine (lack or excess) → Congenital goiter or hypothyroidism (cretinism) Maternal diabetes → Caudal regression syndrome (anal atresia to sirenomelia), congenital heart defects (eg, VSD, transposition ...
- Fetal alcohol syndrome Leading cause of intellectual disability in the US. - Pre- and postnatal developmental retardation- Microcephaly- Facial abnormalities (eg, smooth philtrum, thin vermillion border [upper lip], small ...
- Placenta Fetal component- Cytotrophoblast: Inner layer of chorionic villi, make cells.- Syncytiotrophoblast: Outer layer of chorionic villi; synthesizes and secretes hormones, eg, hCG (structurally similar to ...
- Urachus In the 3rd week the yolk sac forms the allantois, which extends into urogenital sinus.Allantois becomes the urachus, a duct between fetal bladder and umbilicus.Failure of urachus to involute can lead ...
- Vitelline duct 7th week – obliteration of vitelline duct (omphalomesenteric duct), which connects yolk sac to midgut lumen. Vitelline fistula: Vitelline duct fails to close → meconium discharge from umbilicus. Meckel ...
- DiGeorge syndrome Chromosome 21q11 deletion. - aberrant develoment of 3rd and 4th pouches --> T-cell deficiency (thymic aplasia) and hypocalcemia (failure of parathyroid development) - associated with cardiac defects (conotruncal ...
- Paramesonephric (Müllerian) duct Develops into female internal structures – fallopian tubes, uterus, upper portion of vagina (lower portion from urogenital sinus). - Male remnant is appendix testis. Müllerian agenesis (Mayer-Rokitansky-Küster-Hauser ...
- Müllerian agenesis (Mayer-Rokitansky-Küster-Hauser ... Congenital malformation characterized by the failure of the Müllerian duct (paramesonephric duct) to develop- 46, XX - 1° amenorrhoe - Absent or rudimentary uterus and upper vagina - Fully developed ...
- Mesonephric (Wollfian) duct Develops into male internal structures (except prostate) – Seminal vesicles, epididymis, ejactulatory duct, ductus deferens. - Female remnant is Gartner duct.
- SRY gene --> Testis-determining factor --> Testes 1. Sertoli cells --> Müllerian inhibitory factor --> degeneration of paramesonephric (Müllerian) duct (female internal genitalia) 2. Leydig cells --> Testosterone ...
- Congenital penile abnormalities Hypospadias: Abnormal opening of penile urethra on ventral surface of penis due to failure of urethral folds to fuse.- Hypospadias is more common than epispadias.- Associated with inguinal hernia and ...
- Female reproductive anatomy Infundibulopelvic ligament (suspensory ligament of the ovary):- Connects ovaries to lateral pelvic wall- Contains ovarian vessles- Ligate vessels during oophorectomy to avoid bleeding.- Ureters course ...
- Progesterone Source: Corpus luteum, placenta, adrenal cortex, testes Function:- Stimulation of endometrial glandular secretions and spiral artery development- Maintenance of pregnancy- ↓ myometrial excitability- ...
- Human chorionic gonadotropin (hCG) Source: Syncytiotrophoblast of placenta Maintains corpus luteum (and thus progesterone) for first 8-10 weeks of pregnancy by acting like LH (otherwise no luteal cell stimulation → abortion). After 10 ...
- Apgar score Assessment of newborn vital signs following delivery via a 10-point scale evaluated at 1 minute and 5 minutes. Appearance (pink, extremities blue, pale or blue)Pulse (>100, <100, no pulse)Grimace (cries ...
- Menopause Diagnosed by amenorrhea for 12 months.↓ estrogen production due to age-linked decline in number of ovarian follicles. Average age at onset is 51 years (earlier in smokers).- Menopause before age 40 ...
- Androgens Testosterone, dihydrotestosterone (DHT), androstenedione- Source: Testosterone and DHT – testis, androstenedione – adrenal- Potency: DHT > testosterone > androstenedione Testosterone:- Differentiation ...
- Klinefelter syndrome Male, 47 XXY.Dysgenesis of seminiferous tubules → ↓ inhibin B → ↑ FSH.Abnormal Leydig cell function → ↓ testosterone → ↑ LH → ↑ estrogen. - Testicular atrophy- Eunuchoid body ...
- Turner syndrome Female, 45 XO.↓ estrogen leads to ↑ LH, FSH.Menopause before menarche.Sometimes due to mitotic error → mosaicism (eg, 45,XO/46,XX). - Short stature (if untreated; preventable with GH therapy)- ...
- Androgen insensitivity syndrome (46,XY) X-linked defect in androgen receptor resulting in normal-appearing female (46,XY DSD). - Female external genitalia with scant axillary and pubic hair- Rudimentary vagina- Uterus and fallopian tubes ...
- 5α-reductase deficiency Autosomal recessive. Inability to convert testosterone to DHT. - Sex limited to genetic males (46,XY DSD) - Ambiguous genitalia until puberty, when ↑ testosterone causes masculinization/↑ growth ...
- Kallmann syndrome Failure to complete puberty, a form of hypogonadotropic hypogonadism. - Defective migration of GnRH-releasing neurons and subsequent failure of GnRH-releasing olfactory bulbs to develop → ↓ synthesis ...
- Hydatidiform mole Cystic swelling of chorionic villi and proliferation of chorionic epithelium (only trophoblast). Presents with vaginal bleeding, uterine enlargement more than expected, pelvic pressure/pain. Associated ...
- Placental abruption Premature separation (partial or complete) of placenta from the uterine wall before delivery of infant. Risk factors:- Trauma (eg, motor vehicle accident)- Smoking- Cocaine abuse- Hypertension, preeclampsia ...
- Morbidly adherent placenta Defective decidual layer → abnormal attachment and separation after delivery. Risk factors:- Prior C-section or uterine surgery involving myometrium- Inflammation- Placenta previa- Advanced maternal ...
- Placenta previa Attachment of placenta to lower uterine segment over (or <2 cm from) internal cervical os. Risk factors:- Multiparity- Prior C-section - Associated with painless third-trimester bleeding
- Ectopic pregnancy Implantation of fertilized ovum in a site other than the uterus, most often in ampulla of fallopian tube. Suspect with history of amenorrhea, lower-than-expected rise in hCG, sudden lower abdominal pain ...
- Vasa previa Fetal vessels run over, or in close proximity to, cervical os. - May result in vessel rupture, exsanguination, fetal death. Triad:1. Membrane rupture2. Painless vaginal bleeding3. Fetal bradycardia (<110 ...
- Postpartum hemorrhage Loss of >500 ml of blood within the first 24 hours after childbirth. Due to 4 T's:Tone (uterine atony, most common)Trauma (lacerations, incisions, uterine rupture)Thrombin (coagulopathy)Tissue (retained ...
- Amniotic fluid abnormalities Polyhydramnios: Too much amniotic fluid- Often idiopathic, but associated with fetal malformations (eg, esophageal/duodenal atresia, anencephaly; both result in instability to swallow amniotic fluid), ...
- Dysplasia and carcinoma in situ - begins at basal layer of squamocolumnar junction (transformation zone) - CIN 1-3 - associated with HPV 16 and 18, which produce the E6 (inhibits p53 suppressor gene) and E7 gene product (inhibits RB ...
- Common causes of anovulation - Pregnancy- Polycystic ovarian syndrome- Obesity- HPO axis abnormalities- Premature ovarian failure- Hyperprolactinemia- Thyroid disorders- Eating disorders- Competitive athletics- Cushing syndrome- ...
- Polycystic ovarian syndrome Also known asn Stein-Leventhal syndrome.Hyperinsulinemia and/or insulin resistance hypothesized to alter hypothalamic hormonal feedback response → ↑ LH:FSH, ↑ androgens (eg, testosterone) from ...
- Endometrial carcinoma Most common gynecologic malignancy, typically preceded by endometrial hyperplasia.- Peak occurrence at 55-65 years old. - Presents with vaginal bleeding. Risk factors:- Prolonged use of estrogen without ...
- Endometriosis Non-neoplastic endometrial-like glands/stroma outside of the endometrial cavity. - Most common sites are ovary (frequently bilateral), pelvis, peritoneum. In ovary, appears as endometrioma (blood-filled ...
- Gonadal drainage Venous drainage:- Left ovary/testis → left gonadal vein → left renal vein → IVC- Right ovary/testis → right gonadal vein → IVC Because the left spermatic vein enters the left renal vein at ...
- Oogenesis 1° oocytes begin meiosis I during fetal life and complete meiosis I just prior to ovulation. Meiosis I is arrested in prophase I until ovulation (1° oocytes, 2N4C). Meiosis II is arrested in metaphase ...
- Preeclampsia New-onset hypertension with either proteinuria or end-organ dysfunction after 20th week of gestation (<20th week suggests molar pregnancy). - Caused by abnormal placental spiral arteries → endothelial ...
- Eclampsia Preeclampsia + maternal seizures - Maternal death due to stroke, intracrancial hemorrhage, or ARDS. Treatment:- IV magnesium sulfate- Antihypertensives- Immediate delivery
- HELLP syndrome Hemolysis, Elevated Liver enzymes, Low Platelets A manifestation of severe preeclampsia. - Blood smear shows schistocytes.- Can lead to DIC and hepatic subcapsular hematomas → rupture → severe ...
- Gynecologic tumor epidemiology Incidence (US) – endometrial > ovarian > cervical- Cervical cancer is more common worldwide due to lack of screening or HPV vaccination. Prognosis: cervical (diagnosed <45 years old) > endometrial (middle-aged, ...
- Cervical pathology Dysplasia and carcinoma in situ- Begins at basal layer of squamocolumnar junction (transformation zone)- Classified as CIN 1-3- Associated with HPV-16 and -18, which produce E6 (inhibits p53) and E7 ...
- Primary ovarian insufficiency Also known as premature ovarian failure.Premature atresia of ovarian follicles in women of reproductive age. - Most often idiopathic; associated with chromosomal abnormalities (especially in females <30 ...
- Breast cancer therapy Positive for human epidermal growth factor 2/neu --> Trastuzumab Positive for estrogen receptor --> Tamoxifen