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STEP > Gynecology > Flashcards

Gynecology Flashcards

1
Q

Which medications can be used for pregnancy termination?

A
  1. Methotrexate
  2. Misoprostol
  3. Mifepristone
    Mifepristone and Misoprostol together increase pregnancy termination success during first trimester.
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2
Q

What is the mechanism of action of Mifepristone?

A
  • Progesterone antagonist that binds the progesterone receptors with greater affinity than natural hormone.
  • Results in apoptosis and necrosis of the uterine decidua preventing further development of first trimester pregnancy.
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3
Q

What is the mechanism of action of Misoprostol?

A
  • Prostaglandin E1 analog

- Causes cervical softening and uterine contractions leading to expulsion of the pregnancy

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4
Q

What is the action of progesterone in pregnancy?

A

It is secreted by the corpus luteum during the second half of the menstrual cycle to develop the endometrium for implantation.
It is then produced by the placenta for maintenance of pregnancy.

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5
Q

Why does a long term decrease in progesterone lead to a higher risk of endometrial carcinoma?

A

Because progesterone has inhibitory effects on the endometrium, it counters estrogen-driven proliferation, thereby a decrease in progesterone leads to risk of endometrial hyperplasia and adenocarcinoma.

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6
Q

Polycystic ovarian syndrome diagnosis

A

Two of the following:

  1. Hyperandrogenism
  2. Irregular periods
  3. Polycystic ovaries on ultrasound
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7
Q

What does PCOS result from?

A

Increased activity of:
17alpha-hydroxylase
17, 20 lyase
3beta-hydroxysteroid dehydrogenase

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8
Q

Patient with anemia, thrombocytopenia, neutropenia, reticulocytopenia, normal cell lines on peripheral smear and no splenomegaly, most likely diagnosis?

A

Aplastic anemia

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9
Q

Most common causes of aplastic anemia?

A
  1. Viruses (Parvovirus B19, Epstein-Barr)
  2. Autoimmune
  3. Drugs (carbamazepine, chloramphenicol, sulfonamides)
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10
Q

What does bone marrow biopsy show in aplastic anemia?

A

Hypocellular marrow composed mainly of fat and stromal cells

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11
Q

Name a few causes of pancytopenia without splenomegaly?

A

Severe B12 and folic acid deficiency
Acute leukemia’s
Myelodysplastic syndrome
Aplastic anemia

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12
Q

Which diseases would result in a bone marrow biopsy with hypercellular marrow with increased blasts?

A
  • Myelofibrosis
  • Chronic Myelogenous Leukemia
  • Myelodysplastic syndrome
    AML
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13
Q

What do you see in myelofibrosis?

A 
Anemia
Bone marrow fibrosis
Extra medullary hematopoiesis
Leukoerythroblastosis and tear drop cells in peripheral smear
Hepatosplenomegaly
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14
Q

Who is at increased risk for Endometriosis? Who is not

A 
Increased risk:
- Nulliparity
- Early menarche
- Prolonged menses
Decreased risk
- Multiparity
- Extended lactation 
- Late menarchy
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15
Q

What is endometriosis?

A
  • Presence of endometrial tissue outside the uterus
  • Bleeding and shedding of extrauterine endometrium leads to formation of blood collections
  • Blood collections eventually undergo hemolysis and inflammation leading to adhesions distorting organ function and structure
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16
Q

What are the adverse effects of endometriosis?

A
  • Adhesions in the fallopian tubes may interfere with ovulation and tube function.
  • Adhesions in the uterosacral ligaments may result in fixed retroverted uterus
  • Infiltration in the cul-de-sac may cause painful intercourse and tenderness with palpation of the posterior vaginal fornix.
  • Dysmenorrhea (painful menses) results with shedding of the ectopic tissue.
17
Q

Mechanism of action of Selective Estrogen Receptor Modulators?

A
  • Competitive inhibitors of estrogen receptor binding and block ER+ cell growth in breast tissue
  • Have a mixed agonist/antagonist action
18
Q

What are the adverse effects of Selective Estrogen Receptor Modulators?

A
  • Hot flushes
  • Venous thromboembolism
  • Endometrial hyperplasia and carcinoma (tamoxifen only)
  • Increased risk of stroke
  • Osteopenia and eventual increased risk of Osteoporosis
  • Increased triglycerides
19
Q

What are Selective Estrogen Receptor Modulators indicated for?

A
  • Prevention of breast cancer in high risk patients
  • Tamoxifen is adjuvant treatment of breast cancer in premenopausal women, also for fibroadenomas and cystic changes.
  • Raloxifene is for postmenopausal osteoporosis
20
Q

What molecular changes occur right before labor in myometrium?

A
  • Estrogen stimulates upregulation of gap junctions between myometrial smooth muscle cells
  • Increase in gap junction density at delivery heightens myometrial excitability
  • Gap junctions consist of aggregated connexin-43 proteins that allow passage of ions between myometrial cells.
  • Estrogen also increases expression of uterotonic oxytocin receptors which mediate calcium transport through ligand activated calcium channels.
  • Combination of gap junctions and uterotonic receptors results in coordinated synchronous labor contractions
21
Q

What are the 4 stages of the follicular phase of the menses cycle?

A
  1. Begins with primary follicle
  2. Turns into secondary follicle
  3. Becomes vesicular follicle
  4. Then ends when ovulation starts
22
Q

What hormones predominate in the follicular phase?

A
  • FSH stimulates cycle
  • Then estrogen rises and peaks
  • Leads to LH peak which leads to ovulation
23
Q

What are the 4 stages of the luteal phase?

A
  1. Starts with ovulation
  2. Progresses to corpus luteum
  3. Regression if it is not fertalized
  4. Corpus albicans is final stage
24
Q

What hormones predominate in the luteal phase?

A
  • Progesterone predominates most of the phase
  • Estrogen remains constant
  • LH and FSH are minimal
25
Q

Where are FSH and LH released from?

A
  • The anterior pituitary
26
Q

What is the action of FSH?

A
  • Stimulates the ovary to recruit 1 primary follicle

- Stimulates granulosa cells inside the follicle to produce estrogen and leading to rise in serum estrogen

27
Q

What is the action of LH?

A
  • Causes rupture of the follicle

- Leads to extrusion of the secondary oocyte (ovulation)

28
Q

When are FSH, LH and Estrogen levels the highest?

A
  • Right before ovulation

STEP (28 decks)

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